尿毒症患者血管内皮功能测定和精氨酸的影响

目的检测尿毒症患者血管舒张功能,评价L-精氨酸对血管内皮功能的影响。方法应用高分辨率超声诊断仪,检测9例尿毒症患者静息状态下,肱动脉反应性充血及含服硝酸甘油后的内径变化等指标,并予L-精氨酸后再次检测相同指标。结果反应性充血前后患者肱动脉血管内径分别为(4．26±0．54)mm和(4．43±0．58)mm,P>0．05,含服硝酸甘油后为(4．73± 0．43)mm,P<0．05。应用L-精氨酸后,反应性充血前后患者肱动脉血管内径分别为(4．37± 0．77)mm和(4．44±0．74)mm,P>0．05;含服硝酸甘油后为(4．82±0．60)mm,P<0．05。与应用前相比,应用L-精氨酸后患者血管内皮依赖性舒张功能的差异无统计学意义。结论尿毒症患者血管内皮依赖性舒张功能受损;L-精氨酸未改变尿毒症患者血管内皮依赖性舒张功能。     

高血压性心脏病患者血管内皮功能的超声研究

目的研究高血压性心脏病患者的血管内皮功能。方法高血压性心脏病组30例、高血压组32例及正常对照组21例,应用高分辨率彩色超声诊断仪,在基础状态、反应性充血及含服硝酸甘油后测定肱动脉血管内径、反应性充血后、含服硝酸甘油后的血管内径变化率;肱动脉基础血流量、反应性充血后、含服硝酸甘油后的血流量及其变化率以评定肱动脉血流介导的血管舒张功能。结果①与正常对照组相比,高血压性心脏病组和高血压组的内皮依赖性舒张功能和非内皮依赖性舒张功能均明显降低（P〈0.05）;②同高血压组相比,高血压性心脏病组患者的内皮依赖性舒张功能和非内皮依赖性舒张功能进一步降低（P〈0.05）;③高血压性心脏病组患者内皮依赖性舒张功能与患者的血压、血脂（主要是甘油三脂和低密度脂蛋白胆固醇）以及病程呈负相关。结论①高血压性心脏病组患者比高血压组患者血管内皮功能损害更明显,提示血管内皮功能损害可能是高血压性心脏病发生、发展的机制之一。②高血压性心脏病患者的血管内皮依赖性舒张功能与患者的血压、血脂和病程呈负相关。③作为一种无创性检测血管内皮功能的方法,血管彩色超声检查具有简单方便、重复性好、准确度高等优点。     

老年肺炎患者肱动脉血管舒张功能变化的研究

目的探讨老年肺炎患者血管内皮舒张功能的变化以及该变化在肺炎发生发展中的作用。方法选择32例老年肺炎患者(肺炎组)和22例老年非肺炎者(对照组),采用高分辨血管外超声法检测肱动脉介导的内皮依赖性血管舒张功能(FMD)和硝酸甘油介导的内皮非依赖性血管舒张功能(NMD)。分别比较肺炎患者发病时、感染控制后及与对照组FMD和NMD的差异。结果肺炎组发病时FMD较对照组显著降低[(2.21±0.16)%vs(2.80±0.21)%,P0.01],肺炎控制后较肺炎发病时FMD升高[(2.68±0.19)%vs(2.21±0.16)%,P0.05],较对照组无统计学差异(P0.05)。肺炎发病时NMD较对照组明显增加[(25.6±2.12)%vs(17.8±1.32)%,P0.01],控制后NMD较发病时明显下降[(18.4±1.96)%vs(25.6±2.12)%,P0.01﹚],较对照组无统计学差异(P0.05)。结论老年肺炎患者FMD受损,随着感染的控制,舒张功能有改善,受损的血管内皮有所修复。     

海洛因对人体血管内皮舒张功能影响的临床研究

目的研究静脉注射和非静脉注射吸食海洛因患者肱动脉血管内皮舒张功能的改变,探讨海洛因对人体神经一内分泌一免疫功能的影响及其相互之间的关系。方法超声检查34例静脉注射海洛因患者、30例非静脉注射海洛因患者和30例正常人对照组,肱动脉内皮依赖性（EDD）及非内皮依赖性（EID）舒张功能,并进行对比分析。结果三组肱动脉内径基础值无统计学意义（P〉0．05）;静脉注射海洛因患者肱动脉内皮依赖性和非内皮依赖性舒张功能,EDD／EID与对照组比较有显著差异（P〈0．01）;非静脉注射海洛因患者肱动脉内皮依赖性和非内皮依赖性舒张功能,EDD／EID与对照组比较有差异（P〈0．05）。结论静脉注射和非静脉注射海洛因患者肱动脉内皮依赖性和非内皮依赖性舒张功能明显受损。肱动脉血管内皮舒张功能检查为吸食海洛因患者神经一内分泌一免疫功能损伤提供依据,还可以作为监测和评估病情的指标。     

冠心病患者外周血管内皮功能的临床研究

目的　采用彩色多普勒超声测定外周血管肱动脉内皮依赖性舒张反应,评价冠心病(coronaryarterydisese ,CAD)患者的血管内皮功能。方法　对6 0例CAD患者和2 0例正常人,进行肱动脉气囊加压前后的血管内径、血流速度变化和血浆一氧化氮(NO)浓度检测。结果　①CAD组肱动脉加压前后血管直径和血流速度变化百分比明显小于正常组P <0 .0 5 ;CAD组NO浓度明显低于正常组[(31.97±9.0 2 )uml/l,比(5 7.6 7±10 .80 )uml/l],P <0 .0 1;②CAD组肱动脉加压前后血管直径变化百分比与血浆NO浓度呈明显正相关(r =0 .83,P <0 .0 1)。结论　CAD患者的血管内皮功能下降。     

阿托伐他汀对冠心病患者内皮舒张功能影响的研究

目的　超声检测内皮依赖性及非依赖性舒张功能 ,研究冠心病 (CHD)患者内皮功能的变化及其临床意义。研究 3羟基 -3甲基戊二酰辅酶A(HMG -CoA)还原酶抑制剂———阿托伐他汀在改善内皮功能方面的作用。方法　 12 0例患者应用高频超声检测肱动脉血流介导的及硝酸甘油 (GTN)引起的舒张反应 ,并观察阿托伐他汀治疗 10～ 12周后内皮舒张功能的变化。结果　总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL -C)水平及高血压、糖尿病发病率在冠心病组中明显高于对照组。冠心病组的肱动脉基础内径略大于对照组 ,但无统计学意义 (P >0 0 5 )。冠心病组由血流介导的以及GTN引起的肱动脉舒张反应 ,均明显低于对照组 (P<0 0 1)。经阿托伐他汀治疗后 ,冠心病患者的内皮舒张功能有明显改善 ( P <0 0 1)。结论　在冠心病患者和有危险因素的人群中开展血管内皮功能检查 ,可为早期发现、预防和治疗冠心病提供依据 ,可作为监测和评估病情变化的指标。阿托伐他汀具有改善内皮功能的作用。     

糖尿病并发冠心病超声检测颈动脉粥样硬化及内皮功能临床分析

目的 探讨糖尿病并发冠心病患者的动脉粥样硬化及内皮功能变化.方法 采用二维超声测定颈动脉内中膜厚度和硬化斑块指数衡量动脉粥样硬化程度,测定肱动脉内径代表血管内皮舒张功能.患病组36例,对照组40例.结果 患病组,IMT、动脉粥样硬化斑块检出率、硬化斑块指数(Plaque index,PI)明显大于对照组(P＜0.05).患病组与对照组相比,肱动脉内皮依赖性血管舒张功能明显受损(P＜0.01),内皮非依赖性舒张功能则无明显变化(P》0.05).结论 糖尿病并发冠心病患者存在严重颈动脉粥样硬化及内皮依赖性血管舒张功能明显受损.     

非酒精性脂肪性肝病患者调脂治疗对血管内皮功能的影响

目的了解非酒精性脂肪性肝病(NAFLD)患者经非诺贝特调脂治疗后对胰岛素抵抗和内皮依赖性血管舒张功能的影响。方法测定30例男性NAFLD患者(NAFLD组)和30例正常男性(对照组)的身高、体重、腰围、臀围和空腹血糖(FBG)、空腹胰岛素(FINS)、血脂水平,测定血流介导的血管舒张功能,评价胰岛素抵抗指数(HOMA-IR)。对NAFLD患者用非诺贝特调脂治疗3个月后,动态观察指标变化。结果NAFLD组体重指数(BMI)、FBG、FINS、HOMA-IR和血脂高于对照组,肱动脉舒张功能低于对照组(P<0.01)。NAFLD组用非诺贝特3个月后血甘油三酯(TG)、FBG、HOMA-IR、FINS有明显下降,血流介导的肱动脉舒张功能明显改善、流速增加,与治疗前比较,差异有统计学意义。结论NAFLD患者内皮依赖性血管舒张功能明显受损,存在更明显的高胰岛素血症和胰岛素抵抗,调脂治疗除能改善脂代谢紊乱、纠正糖代谢异常和提高胰岛素的敏感性外,还能改善血流介导的内皮依赖性血管舒张功能。     

心衰患者尿酸对血管内皮功能的影响及别嘌呤醇的干预

目的探讨心力衰竭(心衰)患者尿酸(UA)升高对血管内皮功能的影响及别嘌呤醇干预对尿酸升高的慢性心衰内皮依赖性血管舒张功能的影响。方法将30例心衰患者随机分为别嘌呤醇组和对照组,对照组15例,用常规药物治疗2周;别嘌呤醇组15例,在常规药物治疗基础上加用别嘌呤醇。采用高分辨超声技术检测血流介导和硝酸甘油介导的肱动脉舒张功能,并测定治疗前后血浆UA和内皮素(ET-1)。结果(1)用药前,二者比较UA水平及ET-1水平,差异无统计学意义(P>0.05);用药后,别嘌呤醇组UA水平及ET-1水平和对照组比较均降低,差异有统计学意义(P<0.05)。各组用药后UA水平及ET-1水平均明显降低(P<0.01)。(2)别嘌呤醇组和对照组肱动脉内径基础值无明显差异(P>0.05),反应性充血引起肱动脉内径变化别嘌呤醇组明显增加(P<0.01)。含服硝酸甘油后两组肱动脉内径均明显扩张,但两组肱动脉内径变化无明显差异(P>0.05)。结论心衰患者经药物干预后,UA水平降低,ET-1水平随之下降,尤以别嘌呤醇组降低明显。别嘌呤醇治疗后UA水平明显降低,内皮依赖性血管舒张功能明显改善,别嘌呤醇是慢性心衰的一种便宜而有效的辅助药物。     

高频超声对甲状腺功能减低患者血管内皮依赖性舒张功能的诊断价值

目的：了解高频超声在检测甲状腺功能减低患者血管内皮依赖性舒张功能中的价值。方法：用高频超声对82例甲状腺功能减低患者（甲减组）及90例无高血压病、糖尿病及心脑血管疾病的志愿者（对照组）检查血管内皮依赖性舒张功能,测定两组患者肱动脉内皮依赖性舒张功能并进行对照分析。结果：甲状腺功能减低患者反应性充血诱发的肱动脉内径百分变化率明显低于对照组（P〈0.01）。结论：甲状腺功能减低患者存在内皮依赖性舒张功能障碍,高频超声对评价血管内皮依赖性舒张功能有重要价值。     

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.     

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.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

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.     

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.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.