血浆置换治疗乙型病毒性肝炎所致的慢加急性肝衰竭的因素分析

目的探讨乙型肝炎病毒引起的慢性肝衰竭血浆置换治疗疗效的影响因素。方法选择2013年1月-2013年12月符合条件的慢加急性肝衰竭患者239例进行血浆置换,根据患者出院时转归分为有效和无效,对可能影响疗效的因素(年龄、病程、治疗前总胆红素、凝血酶原活动度、肝性脑病、肝肾综合征、治疗时应用的血浆种类)进行Logistic回归分析。结果多因素Logistic回归分析显示,年龄46.68岁、病程7 d、凝血酶原活动度31.66%、合并肝肾综合征、合并2级以上肝性脑病是PE治疗肝衰竭无效的危险因素(P0.05)。相对危险度依次为:5.924、6.816、11.427、50.352和3.489。结论对于乙型肝炎病毒引起的慢加急性肝衰竭患者建议及早进行血浆置换,常规合理地应用抗病毒药物治疗原发病,预防肝肾综合征和肝性脑病的发生,可提高PE治疗的有效率。     

影响重型肝炎预后的危险因素分析

目的探讨影响重型肝炎预后的危险因素,为重型肝炎的临床治疗提供理论性依据。方法采用Logistic回归模型对106例重型肝炎患者的14项临床指标进行统计学研究。结果年龄、腹水、肝性脑病、白细胞升高、总胆红素升高、总胆固醇降低、血氨升高、肌酐升高、凝血酶原活动度降低是影响重型肝炎患者预后的重要因素。其中血氨升高、肌酐升高、凝血酶原活动度降低以及合并肝性脑病或腹水是影响重型肝炎预后的独立危险因素。结论积极护肝,加强预防和控制各种并发症,维持内环境的稳定,是改善重型肝炎患者预后,提高其存活率的关键。     

HBV相关慢加亚急性肝衰竭患者预后因素分析

目的探讨乙肝病毒相关慢加亚急性肝衰竭(HBV-SACLF)患者预后的影响因素。方法收集365例HBV-SACLF临床资料,分为存活组(266例)和死亡组(99例),比较其主要并发症(原发性腹膜炎、肺部感染、真菌感染、上消化道出血、肝肾综合征、肝性脑病)发生率及基线时临床检测指标;用单因素和多因素logistic回归分析,筛选影响患者预后的独立危险因素。结果 365例HBV-SACLF平均(41.2±13.0)岁,随访期病死率27.1%(99/365);死亡组的年龄、并发症发生率及基线中性粒细胞百分比、总胆红素、肌酐和凝血酶原国际比值高于存活组;而血红蛋白、血小板计数、白蛋白、谷氨酰转肽酶、胆碱酯酶、胆固醇、血钠、凝血酶原活动度指标低于存活组;多因素logistic回归分析结果:肝性脑病、凝血酶原活动度低、血小板低和年龄大者,是影响患者预后的独立危险因素。结论影响HBV-SACLF患者预后因素复杂多样,早期评估预后对降低患者病死率有重要意义。     

肝硬化并发肝性脑病的危险因素及预后分析

目的分析肝硬化患者并发肝性脑病的相关危险因素及预后。方法选取我院2013年1月至2015年12月收治的83例单纯肝硬化患者作为对照组,选取同期76例肝硬化并发肝性脑病患者作为研究组,收集可能导致肝性脑病的临床资料,分析肝硬化患者并发肝性脑病的危险因素及预后。结果研究组的血氨(AM)、血糖、谷丙转氨酶(ALT)、血清总胆红素(TBIL)、血尿素氮(BUN)、血肌酐(SCr)和凝血酶原时间(PT)水平均高于对照组(P<0.05)。研究组的感染、上消化道出血和腹水发生率均高于照组(P<0.05),而血钠(Na+)和血清白蛋白(ALB)水平均低于照组(P<0.05)。研究组预后良好率为63.16%,低于对照组的83.13%(P<0.05)。结论针对肝性脑病发生的危险因素对患者进行提前干预,可预防肝性脑病,改善预后。     

重型病毒性肝炎患者的病死概率监测与临床应用初探

重型肝炎的治疗转归主要取决于患者就诊时病情的发展阶段。采用Logistic回归方法,对201例患者的临床及实验室资料进行历史前瞻性分析,筛选出凝血酶原活动度(Pa)、白球蛋白比值(A/G)、血清胆红素(SB)、肌酐(Cr)、肝性脑病(B)、感染(I)及消化道出血(H)等7个对预后影响最大的变量,组成多元线性回归方程,用来提供患者的病死概率值,借以划分病期,为改进临床科研分组方法、制订治疗方案提供依据。     

慢性乙型肝炎重叠甲、戊型肝炎对肝功能及其预后的影响

目的了解慢性乙型肝炎患者重叠感染甲型或戊型肝炎对其肝功能及病情转归的影响。方法收集慢性乙型肝炎重叠甲型肝炎（慢乙肝+甲肝组）患者45例、慢性乙型肝炎重叠戊型肝炎（慢乙肝+戊肝组）患者47例和单纯慢性乙型肝炎（慢乙肝组）患者60例进行对比分析。应用酶联免疫吸附试验(ELISA)检测乙型肝炎病毒（HBV）标志物及抗HAV IgM、抗HEV IgM,荧光定量聚合酶链反应 (FQ PCR) 法检测HBV载量,同时检测肝功能和凝血酶原时间。结果慢乙肝+戊肝组患者的总胆红素、转氨酶增高,清蛋白下降,总胆红素、转氨酶恢复正常时间和凝血酶原时间延长,重型肝炎发病率及病死率均显著高于慢乙肝+甲肝组和慢乙肝组(P<0.05)。慢乙肝+甲肝组患者的总胆红素、转氨酶增高,总胆红素、转氨酶恢复正常时间较慢乙肝组显著延长(P<0.05),但两组的清蛋白下降、凝血酶原时间延长、重型肝炎发病率及病死率差异无统计学意义(P>0.05)。结论甲型肝炎重叠感染对慢性乙型肝炎的转氨酶、胆红素有一定影响;戊型肝炎重叠感染对慢性乙型肝炎的肝功能及其预后均有严重的影响。     

肝移植术中血浆输注对肝功能及凝血功能的影响

目的 对患者术前及术后24 h内临床指标进行对比,分析肝移植手术中血浆输注对患者肝功能、凝血功能以及预后的影响。方法 回顾性分析2018年1月—2021年6月本院同种异体肝移植术患者150例,根据术中是否输注血浆分为输血浆组与非输血浆组,比较2组间临床指标的变化。结果 术中输血浆组患者血小板（PLT）指标低于非输血浆组;凝血酶原时间（PT）、国际标准化比值（INR）、凝血酶时间（TT）、终末期肝病模型（MELD）评分、ICU住院天数、住院天数等指标均高于非输血浆组,差异均有统计学意义（P<0.05）。采用ROC曲线预测术中输注血浆,凝血酶原时间（PT）的曲线下面积最高（0.644）。经多因素Logistic回归分析,患者术前凝血酶原时间（PT）是术中血浆输注的独立危险因素。结论 术中输血浆组的患者凝血功能、肝功能指标较差,终末期肝病患者术前调整肝功能和凝血功能是防止术中大量出血、增强手术后预后的方式之一。     

中间型人工肝支持系统治疗慢性重型肝炎106例临床研究

目的评价中间型人工肝支持系统——血浆置换治疗慢性重型肝炎的临床疗效和安全性及血浆置换首次效应与预后关系。方法对106例慢性重型肝炎患者进行血浆置换治疗,观察第一次置换前后患者临床症状变化,比较治疗前后血红蛋白,谷丙转氨酶,白蛋白,球蛋白,总胆红素,凝血酶原变化。结果血浆置换后,患者的临床症状均有不同程度缓解,有效率达70.7%,最终存活率45.3%。谷丙转氨酶,总胆红素,白蛋白,球蛋白,凝血酶原时间和血红蛋白置换前后差异均有显著性(P<0.05或P<0.01)。好转组与恶化组首次置换后总胆红素下降幅度,PT缩短程度亦有显著性差异(P<0.05或P<0.01)。结论中间型人工肝支持系统———血浆置换对慢性重型肝炎患者临床症状,肝功能均有改善,首次置换效果佳者,预后好,生存率提高。     

妊娠急性脂肪肝7例临床分析

目的 探讨急性脂肪肝患者的早期临床表现及治疗措施和母儿结局的关系.方法 回顾性分析山西医科大学第二医院12年内7例妊娠急性脂肪肝的临床资料.结果 多数患者在孕晚期表现为厌食、恶心、呕吐、上腹部不适和黄疸,实验室检查表现为转氨酶升高、血清胆红素水平升高、低蛋白血症、低纤维蛋白血症、凝血酶原时间延长、部分凝血酶原时间延长.孕妇的并发症主要为腹水、低血糖、肾功能不全、凝血功能障碍、子痫前期、产后出血和肝性脑病.母儿死亡率为28%.结论 妊娠急性脂肪肝的早期诊断和治疗可明显改善预后结局,其重点是及时终止妊娠和大剂量新鲜血浆的输注.     

重型肝炎应用新鲜冰冻血浆的临床观察

目的 观察重型肝炎患者使用新鲜冰冻血浆的疗效.方法 114例重型肝炎患者随机分为血浆组(64例)和对照组(50例),均治疗15天和30天,分别观察白蛋白(A)、凝血酶原活动度(PTA)、血氨和TbiL,还观察两组死亡率及其死亡原因.结果 两组在治疗15天后,血浆组在改善低蛋白血症、降低胆红素、升高凝血酶原活动度方面较不使用血浆组有疗效,但30天后对比无显著性差异.血浆组血氨下降不显著.血浆组总体死亡率较低,其死亡原因主要为肝性脑病和肝肾综合征.结论 使用新鲜冰冻血浆在治疗重型肝炎有一定的支持作用,可有效降低重型肝炎患者的死亡率,但长期使用新鲜冰冻血浆,可能会使血氨和毒素增加,疗效降低,不宜作常规或长期应用.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.