慢性阻塞性肺疾病急性加重期患者病毒感染分析及对气道炎症的影响

目的探讨慢性阻塞性肺疾病(COPD)急性加重期患者的病毒感染情况及对气道炎症的影响。方法选择2015年3月-2016年3月医院收治的COPD患者130例为研究对象,分为急性加重期组80例和稳定期组50例。所有患者入院第1天清晨空腹采集静脉血,间接免疫荧光法检测血中呼吸道合胞病毒(RSV)、腺病毒(ADV)、副流感病毒(PIV)、甲型流感病毒(FLU-A)、乙型流感病毒(FLU-B)、单纯疱疹病毒(HSV)、巨细胞病毒(CMV)的免疫球蛋白M(IgM)、免疫球蛋白G(IgG)抗体。比较各组病毒感染总阳性率、IgM及IgG抗体检测的阳性率。根据IgM抗体检测结果将急性加重期组分为:IgM阳性患者28例和IgM阴性患者(52例)。酶联免疫吸附实验(ELISA)法检测两组患者诱导痰液中白细胞介素-8(IL-8)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)、白细胞介素-10(IL-10)水平。结果急性加重期组病毒感染总阳性率、IgM检测阳性率、IgG检测阳性率分别为87.5%、35.0%、85.0%,均高于稳定期组的72.0%、14.0%、66.0%(P0.05);急性加重期组RSV、HSV的IgM、IgG抗体检测阳性例数均高于稳定期组;IgM阳性患者痰液中IL-8、IL-6、TNF-α水平均高于IgM阴性患者,IL-2、IL-10水平均低于IgM阴性患者(P0.05)。结论病毒感染与COPD急性加重关系密切,并可以导致气道炎症情况加重。     

维生素D对稳定期慢性阻塞性肺疾病患者肺泡灌洗液中白介素因子、肿瘤坏死因子-α的影响

目的研究慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)稳定期患者服用不同剂量的维生素D对患者肺泡灌洗液白细胞介素6、8、17(IL-6、IL-8、IL-17)、肿瘤坏死因子-α(TNF-α)的影响及其对肺功能的影响。方法选取COPD稳定期患者100例(COPD组),分为A、B两组,每组50例,同期门诊体检无异常的中老年健康体检者50例为对照(对照组)。以酶联免疫吸附法(ELISA)检测治疗前后肺泡灌洗液IL-6、IL-8、IL-17、TNF-α水平,肺功能的变化。使用SPSS 18.0软件,采用χ~2检验和t检验进行数据处理。结果治疗前,试验组肺泡灌洗液中IL-6、IL-8、IL-17、TNF-α高于对照组,差异有统计学意义(P0.01)。试验组A和试验组B,治疗后肺泡灌洗液中IL-6、IL-8、IL-17、TNF-α明显低于治疗前,差异有统计学意义(P0.01),对照组治疗前后IL-6、IL-8、IL-17、TNF-α差异无统计学意义(P0.05)。同时,试验组A与试验组B比较,治疗后肺泡灌洗液中IL-6、IL-8、IL-17、TNF-α差异无统计学意义(P0.05)。试验组A和试验组B治疗前后第1秒用力呼气空积(FEV1)、用力肺活量(FVC)、FVC相比,差异有统计学意义(P0.05),对照组治疗前后肺功能FEV1/FVC、FVC差异无统计学意义(P0.05)。结论 COPD稳定期患者的气道仍然存在慢性炎症,维生素D能通过降低稳定期COPD患者气道中的炎症因子IL-6、IL-8、IL-17和TNF-α等起到抗炎作用,从而延缓COPD患者的肺功能下降。     

慢阻肺合并肺结核患者血清细胞因子水平变化及意义

目的探讨慢性阻塞性肺疾病(COPD)合并肺结核(TB)患者血清细胞因子水平变化及其在临床上的意义。方法选取2013年8月-2015年8月到我院呼吸内科及结核科住院治疗的COPD合并TB患者60例(A组),TB患者50例(B组),COPD患者52例(C组),和同期入院检查的40例正常健康人群(D组)作为研究对象,并用双抗体夹心ELISA方法测定,且比较各组主要细胞因子白介素(IL-6)、干扰素(IFN-γ)、肿瘤坏死因子(TNF-α)的表达水平,并分析其水平变化的临床意义。结果A、B、C组的吸烟比例均明显高于D组,且A组和C组的吸烟比例高于B组,A组和C组的FEV1%均明显低于B组和D组,差异具有统计学意义(P0.05)。A、B、C组的IFN-γ、IL-6、TNF-α水平均明显高于D组,且A、B组IFN-γ、IL-6、TNF-α水平明显高于C组,A组IFN-γ、IL-6、TNF-α水平高于B组,差异具有统计学意义(P0.05)。结论COPD合并TB患者血清中的IFN-γ、IL-6、TNF-α等细胞因子均明显偏高,其在COPD合并TB疾病的病变过程中有重要的意义,且可为提前预防COPD合并TB的发生及治疗提供理论依据。     

血清IL-6、IL-8、C反应蛋白、TNF-α在COPD急性加重期患者中的表达及意义

目的 探讨血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、C反应蛋白、肿瘤坏死因子-α(TNF-α)在慢性阻塞性肺疾病(COPD)急性加重期患者中的表达及意义.方法 选取2018年1月至12月本院收治的COPD急性加重期患者189例,分为呼吸衰竭组51例和非呼吸衰竭组138例,收集同期COPD缓解期患者39...     

COPD患者血清白细胞介素-8、可溶性细胞间黏附分子-1和可溶性E-选择素的测定及临床意义

目的探讨白细胞介素-8(IL-8)、可溶性细胞间黏附分子-1(sICAM-1)和可溶性E-选择素(sE-selectin)在慢性阻塞性肺疾病(COPD)气道炎症中的作用.方法采用双抗体夹心酶联免疫吸附试验(ELISA)检测COPD急性加重期、缓解期及健康者各20例血清中IL-8、sICAM-1及sE-selectin的含量.结果COPD急性加重期及缓解期患者血清IL-8、sICAM-1、sE-selectin水平明显高于健康对照组,COPD急性加重期又明显高于缓解期,差异有统计学意义(P＜0.05或P＜0.01);健康对照组中吸烟者血清IL-8、sICAM-1水平明显高于不吸烟者,差异有统计学意义(P＜0.05).结论IL-8、ICAM-1及E-selectin在COPD气道炎症中均起着重要作用.     

肺结核患者治疗中免疫球蛋白E及血清细胞因子检测的临床意义

目的探讨抗肺结核治疗检测免疫球蛋白E(IgE)和血清细胞因子白细胞介素(IL)-6、IL-8、IL-10、肿瘤坏死因子-α(TNF-α)水平变化,在肺结核治疗中的价值,以寻找更直观反应病情变化的指标。方法选择医院2014年1月-2015年1月肺结核患者79例,随肺结核治疗情况分为A、B组,A组34例为初次患病进展期肺结核分枝杆菌感染患者,B组45例为经治疗后复发患者,两组患者均给予短程抗结核治疗,观察入院时、治疗3个月不同痰检结果,TNF-α、IL-6、IL-8、IL-10、IgE指标变化及治疗效果。结果 A组患者入院时IL-6、IL-8、IL-10指标水平均低于B组,差异有统计学意义(P0.05),两组患者TNF-α、IgE组间对比,差异无统计学意义;经3个月治疗,A组痰检阴性18例、阳性13例、强阳性3例,B组阴性15例、阳性20例、强阳性10例;A组阳性、强阳性患者IL-6、IL-8与同组阴性患者同指标对比,差异无统计学意义,IL-10、TNF-α及IgE与同组阴性患者同指标对比,差异有统计学意义(P0.05),TNF-α、IgE与B组同指标同痰检结果对比,差异有统计学意义(P0.05);A组患者治疗总有效率为94.12%,B组患者为77.78%,两组总有效率对比,差异有统计学意义(P0.05)。结论肺结核患者TNF-α、IgE水平对临床指导治疗及肺结核感染程度均具有重要价值。     

IL-4及IL-8检测在慢性阻塞性肺疾病中的意义

目的探讨白介素-4(IL-4)及白介素-8(IL-8)在慢性阻塞性肺疾病(COPD)发病机制中的作用。方法搜集28例COPD急性加重期患者,25例COPD缓解期患者和30例健康者的静脉血,离心后取血清,采用酶联免疫法(ELISA)测定其中IL-4及IL-8水平,同时对COPD患者常规测定动脉血PO2、PCO 2以及一秒钟用力呼气容积占预计值百分比(FEV1%),并把它与IL-4及IL-8进行相关性比较。结果COPD急性加重期患者血清IL-4及IL-8水平明显高于缓解期及健康对照组,缓解期明显高于对照组,差异有显著性(P<0.05),COPD急性加重期血中IL-4及IL-8含量与PO 2、FEV1%呈负相关,与PCO 2呈正相关。结论IL-4及IL-8参与了COPD气道炎症反应,IL-4及IL-8检测对慢性阻塞性肺疾病诊断和预后判断具有积极作用。     

COPD患者急性发作期血清CRP、TNF-α、IL-8水平变化及临床意义

目的 探讨慢性阻塞性肺病（COPD）急性发作期血清中超敏C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白介素-8（IL-8）变化和临床意义.方法 采用免疫比浊法和ELISA法测量46例急性发作期COPD患者及30健康对照血清中CRP、TNF-α、IL-8水平,同时测量FEVI%,比较2组CRP、TNF-α、IL-8水平及FEV1%变化.结果 COPD急性发作期患者血清CRP、TNF-α、IL-8水平显著高于健康对照组（P〈0.01）.COPD急性加重期患者血清CRP、TNF-α、IL-8水平与FEV1%均呈负相关（r=-0.57,-0.72,-0.65,P〈0.01）.结论 COPD急性发作期患者血清CRP、TNF-α、IL-8水平高低与FEV1%密切相关,其可作为COPD急性发作期的指标,对临床诊治及预后具有指导意义.     

吸烟对男性肺功能及气道炎症的影响

目的 探讨痰液中白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、中性粒细胞与吸烟者气道炎症的相关性,以及IL-8、TNF-α、中性粒细胞与吸烟的相关性.方法 收集30例男性吸烟者(吸烟组)和30例男性非吸烟者(非吸烟组)的痰液,对痰液进行痰细胞分类及计数,并用酶联免疫吸附法(ELISA)测定痰上清液中IL-8、TNF-α的浓度.结果 吸烟组痰液中IL-8水平、中性粒细胞百分比明显高于非吸烟组,差异均有统计学意义(分别为P＜0.05,P＜0.01);吸烟组痰液中TNF-α水平与不吸烟组比较,差异无统计学意义(P＞0.05).吸烟组中,吸烟指数＞400支·年者与吸烟指数≤400支·年者比较,痰上清液中IL-8水平差异无统计学意义(P＞0.05).吸烟组痰液中IL-8水平与中性粒细胞百分比呈正相关性(r=544).结论 IL-8和中性粒细胞共同参与了吸烟者气道炎症反应,吸烟是导致气道炎症的一种重要因素.     

吸入乙酰半胱氨酸治疗COPD的疗效及对痰液粘稠度、气道阻力的影响

目的观察吸入乙酰半胱氨酸对慢性阻塞性肺疾病(COPD)的疗效及对痰液粘稠度、气道阻力的影响。方法利用随机抽签法将我院76例COPD分为两组,各38例。对照组采取COPD常规治疗方法,研究组在其基础上雾化吸入乙酰半胱氨酸,比较两组治疗前后痰液粘稠度、气道阻力、血清炎症因子[白介素13(IL-13)、巨噬细胞炎症蛋白-1α(MIP-1α)、肿瘤坏死因子α(TNF-α)]、肺功能、不良反应及疗效。结果研究组治疗总有效率为94.74%,明显高于对照组的76.32%(P0.05);治疗2周后,研究组痰液粘稠度明显优于对照组(P0.05),IL-13、MIP-1α、TNF-α水平、R5、Z5、FRES、RV/TLC均明显低于对照组(P0.05),FEV1明显高于对照组(P0.05);两组不良反应总发生率比较无显著差异(P0.05)。结论吸入乙酰半胱酸治疗COPD,可有效降低痰液粘稠度与气道阻力,减轻机体炎症反应,疗效良好,且不会加重不良反应。     

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 occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.