选择性深低温断血流对心肺等重要器官的影响

目的研究猴脑缺血后行选择性深低温顺行脑灌注对脑、心肺等全身主要器官的影响。方法成年健康恒河猴8只,动物随机分为二组:选择性深低温组(双侧颈总动脉脉夹闭后低温灌流,n=5),常温组(双侧颈总动脉夹闭,n=3)。常温下临时夹闭双侧颈总动脉10min后,选择性深低温组经右颈内动脉灌流2℃林格氏液,右颈内静脉回流,降低脑温至18℃,维持60min后,开放夹闭的颈总动脉及颈内静脉,猴缓慢复苏。于缺血前、后连续监测脑电生理活动,手术中持续监测中心体温、脉搏、呼吸、血压及尿量,术后每天行中枢神经系统功能检查,取脑及心肺等重要脏器行光镜检查。常温组用相同方法灌流37℃林格氏液。结果在8只恒河猴中,选择性深低温组5只猴术中、术后血压、脉搏变化相对稳定,断血流70min后意识恢复并长期生存,术后脑电生理活动恢复到术前水平,术后中枢神经系统功能检查正常,心肺、脑等重要器官组织观察正常;常温组3只猴在灌流60min后未恢复意识,灌流结束1d内死亡,心肺、脑等重要器官可见不同程度异常。结论严重脑缺血后行选择性深低温顺行脑灌注60min是安全可靠的,无严重心肺并发症发生,不会遗留有不可逆性脑缺血损害。     

牛磺酸对沙鼠脑缺血—再灌注损伤的脑保护作用实验研究

探讨牛磺酸对脑缺血再灌注损伤的作用。方法 建立沙土鼠脑缺血－再灌注模型进行实验。设立实验组Ｇ３，实验组Ｇ２及对照组Ｇ１。处死动物后，即时分别检测各组血浆内皮素，脑组织脂质过氧化物，脑组织湿／干重比值，脑组织学光镜检查等。结果 四项检测方法从不同方面证实牛磺酸对脑缺血再灌注损伤有抗自由基，稳定细胞膜，降低内皮素，保护脑等抗脑缺血再灌注损伤的脑保护作用，与未用牛磺酸组有显著差别。     

深低温停循环顺灌脑保护在主动脉手术中的应用

目的探讨深低温停循环在主动脉手术中应用的安全时限及更优脑保护方案。方法选择2009年1月～2012年1月深低温停循环(Deep Hypothermic Circulatory Arrest,DHCA)应用于主动脉手术12例,全身麻醉,PH稳态体外循环管理,降温至鼻咽温16℃停止循环,手术操作完毕后,恢复循环,复温至鼻咽温37℃脱离体外循环。8例经股动脉灌注,4例经右腋动脉灌注,经腔房管回流,心脏停跳液灌注经左右冠状动脉开口选择性灌注。结果术中最低鼻咽温14.3～17.3℃(15.9±2.7℃),体外循环时间223～412 min(296.9±54.3 min),主动脉阻断时间102～231 min(174.2±39.3 min)。深低温停循环下选择性脑灌注时间37～153 min(73.2±42.2 min)。1例患者术中主动脉夹层急性破裂死亡,1例患者因渗血延迟关胸于72 h后关胸,未发生中枢神经系统并发症、肾功不全、截瘫等。结论深低温停循环技术是大血管及复杂紫绀型先心病手术的重要生命支持技术,采用PH稳态进行体外循环管理可行,4例经右腋动脉行顺行选择性脑灌注(Antegrade Selective Cerebral Perfusion,ASCP)取得良好效果,余7例停循环时间短未行脑选择性灌注并无脑部并发症,证明DHCA仍是脑保护的基本技术。     

单、双侧侧脑室引流治疗脑室系统出血的疗效对比

目的 探讨两种不同侧侧脑室引流方法治疗脑室系统出血的疗效.方法 85例脑室系统出血患者中,采用单侧侧脑室引流+脑室内尿激酶纤溶治疗+腰椎穿刺放脑脊液置换术39例(单侧侧脑室引流组),采用双侧侧脑室引流+脑室内尿激酶纤溶治疗+终池持续引流术46例(双侧侧脑室引流组).结果 单侧侧脑室引流组治愈率为15.38%(6/39),有效率为56.41%(22/39),病死率为23.08%(9/39);双侧侧脑室引流组治愈率为30.43%(14/46),有效率为78.26%(36/46),病死率为8.70%(4/46).两组疗效比较差异有统计学意义(P＜0.05).单侧侧脑室引流组脑室系统内积血清除时间为(8.9±3.4)d,双侧侧脑室引流组脑室系统内积血清除时间为(6.3±2.1)d,两组比较差异有统计学意义(P＜0.05).结论 双侧侧脑室引流+脑室内尿激酶纤溶治疗+终池持续引流术治疗脑室系统出血操作简便,疗效好.     

PARP-1抑制剂PJ34对大鼠局灶脑缺血再灌注损伤的影响

[目的]探讨PARP-1抑制剂PJ34干预治疗对大鼠局灶脑缺血/再灌注损伤的影响. [方法]用线栓法建立局灶脑缺血/再灌注模型(Ⅰ组),分别经左侧侧脑室注射PJ34(Ⅱ组)、生理盐水(Ⅲ组)和假手术组(Ⅵ组);通过Klenow标记及TUNEL染色技术检测鼠脑中单、双链DNA断裂,分别用原位杂交及免疫组化技术检测鼠脑中PARP-1蛋白的表达,同时测定脑组织及血浆中TNF-α、IL-6及IL-8含量变化和细胞凋亡情况. [结果]与Ⅰ组比较,Ⅲ组鼠脑缺血侧DNA单、双链断裂,PARP-1的表达均无明显差异,Ⅱ组缺血侧脑中Klenow及TUNEL阳性细胞数均明显减少,PARP-1的表达明显减少,TNF-α、IL-6及IL-8含量和凋亡减少.[结论]PARP-1抑制剂PJ34对脑缺血/再灌注损伤具有保护作用.     

异丙酚对大鼠局灶性脑缺血/再灌注损伤的保护作用

目的探讨异丙酚对大鼠脑缺血／再灌注损伤的保护作用。方法采用改良longa法制备大鼠脑缺血／再灌注模型．随机分为假手术组、对照组、异丙酚组，观察异丙酚对脑缺血／再灌注损伤的保护作用并研究其机制。结果异丙酚明显抑制脑缺血／再灌注后血炎性细胞因子（TNF—α、IL-1β.IL-6、IL-8）升高的程度，改善光镜下脑组织结构的损害，明显升高脑组织超氧化物歧化酶（SOD）的活性，减少丙二醛（MDA）的生成。结论异丙酚抑制脑缺血佴灌注时炎性细胞因子的合成和释放，抑制脂质过氧化物MDA的积聚，提高氧化酶SOD的活性，减轻脑组织皮层的损害，减少海马CA1区神经元的死亡，具有脑保护作用。     

侧脑室穿刺联合第三脑室穿刺引流治疗重度脑室出血

目的观察侧脑室穿刺联合第三脑室穿刺引流、脑脊液置换治疗重度脑室出血的疗效。方法回顾22例重度脑室出血患者经侧脑室穿刺联合第三脑室穿刺持续外引流、侧脑室及第三脑室分别进行脑脊液/生理盐水等量置换治疗的效果。结果 22例患者治愈6例,占27.3%;有效9例,占40.9%;植物生存状态4例,占18.2%;死亡3例,占13.6%。结论重度脑室出血尽早行侧脑室联合第三脑室穿刺外引流、脑脊液置换,能有效降低颅内压,尽快清除脑室内积血,改善脑脊液循环,预防脑积水的发生。     

脑缺血再灌注Na～＋-K～＋-ATPase损伤作用的实验性治疗初探

目的：探讨尼莫地平和东莨菪碱治疗脑缺血再灌注损伤的作用机理。方法：夹闭双侧颈总动脉和椎动脉复制脑完全性缺血模型。60只家兔均分成六组,假手术组、脑缺血组、脑缺血再灌注组、脑低温治疗组、东莨菪碱治疗组、尼莫地平治疗组。采集脑和血液标本测量Na＋-K＋-ATPase、超氧化物歧化酶（SOD）、丙二醛（MDA）活性。结果：缺血再灌注组脑组织SOD和Na＋-K＋-ATPase活性降低、MDA含量升高;相反,治疗组SOD和Na＋-K＋-ATPase活性升高,MDA含量降低。结论：东莨菪碱和尼莫地平具有保护缺血再灌注组脑组织Na＋-K＋-ATPase活性的作用,其机理可能与它们抑制自由基介导的脂质过氧化,减少脂质过氧化物的生成有关。     

镁离子在缺血性脑损伤中作用的分析

目的 研究脑缺血动物脑内镁离子（Mg^2 )的变化,确定脑缺血与Mg^2 浓度有关。方法 用^31P磁共振光谱对前脑缺血大鼠脑内Mg^2 浓度进行动态观察;在缺血20min灌注MgCl2。结果 大鼠体内自然浓度Mg^2 不足以保护缺血性脑损伤,24h内人为提高大鼠脑组织Mg^2＋可以有效地减少缺血引起的脑损伤。临床试验也证实,用MgSO4治疗脑缺血患者死亡率及致残率均低于安慰组。结论 适度补充Mg^2 对缺血性脑损伤患者有保护作用,是治疗急性卒中的一种可行性方案。     

依达拉奉对大鼠脑缺血再灌注损伤水通道蛋白4的影响

目的探讨依达拉奉注射液对大鼠缺血再灌注损伤后脑组织水通道蛋白4(aquaporin 4,AQP4)含量的影响。方法 2013年1月—2014年6月,线栓法制备大鼠局灶性脑缺血再灌注模型,分为对照组、模型组、治疗组,缺血30 min再灌注120 min,观察依达拉奉对脑缺血再灌注引起的神经功能缺损症状,干/湿重法测量脑组织含水量,TTC法观察脑梗死体积变化,应用酶联免疫检测技术观察大鼠脑内AQP4含量的变化。计量资料比较采用t检验,P0.05为差异有统计学意义。结果对照组未出现神经症状改变及脑梗死。治疗后,治疗组神经症状评分、脑梗死体积与模型组比较,差异有统计学意义(P0.05)。模型组动物脑组织含水量[(82.06±0.81)%]较对照组[(77.20±1.02)%]显著升高(P0.05);治疗组动物脑组织含水量[(79.25±0.90)%]较模型组均显著降低(P0.05)。对照组动物脑组织AQP4含量[(0.65±0.06)ng/ml]均显著低于模型组[(1.75±0.25)ng/ml](P0.05),治疗组动物脑组织AQP4含量[(1.11±0.19)ng/ml]均显著低于模型组(P0.05)。结论依达拉奉对大鼠脑缺血有保护作用,能减轻脑水肿,其机制可能与降低缺血后AQP4表达有关。     

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.