69例IgA肾病的临床病理分析

目的 研究IgA肾病临床和病理之间的相互关系,并用于指导治疗.方法 对2005年7月～2006年6月进行肾活检的69例IgA肾病患者的临床及病理资料进行分析.结果 IgA肾病临床表现多样,以蛋白尿伴血尿最多见,占53.6%,病理类型以Ⅱ、Ⅲ型多见.同时随着病理类型的加重,高血压、肾功能不全发生率亦增高.结论 IgA肾病病理和临床之间有一定的内在联系,应将临床和病理结合起来制订治疗方案和判断预后.     

69例IgA肾病的临床病理分析

目的研究IgA肾病临床和病理之间的相互关系，并用于指导治疗。方法对2005年7月～2006年6月进行肾活检的69例IgA肾病患者的临床及病理资料进行分析。结果IgA肾病临床表现多样，以蛋白尿伴血尿最多见，占53．6％，病理类型以Ⅱ、Ⅲ型多见。同时随着病理类型的加重，高血压、肾功能不全发生率亦增高。结论IgA肾病病理和临床之间有一定的内在联系，应将临床和病理结合起来制订治疗方案和判断预后。     

老年肾病综合征120例临床和病理特点

目的探讨、分析老年肾病综合征（NS）的临床与肾病理特点。方法回顾性分析2008年1月~2010年12月某院〉60岁120例老年NS患者的临床表现和肾活检病理诊断类型及其之间的关系。结果男性75例,女性45例,平均年龄（69.9±5.1）岁。120例NS患者中合并肾炎综合征有56例（46.7%）,合并的其他主要疾病有高血压（50例）、慢性肾病（34例）、2型糖尿病（23例）、冠心病（19例）、急性肾损伤（10例）。肾活检病理诊断中膜性肾病62例（51.7%）;其余分别为局灶节段性肾小球硬化症11例、系膜增殖性肾炎9例、IgA肾病8例、微小病变7例、糖尿病肾病5例、糖尿病肾病合并膜性肾病2例、淀粉样变肾病3例、紫癜性肾炎3例、肾小球轻微病变2例、ANCA相关性肾炎2例、多发性骨髓瘤肾损害、慢性间质性肾炎、狼疮性肾炎各1例。结论老年人发生NS临床表现与年轻患者显著不同,老年NS的病理改变仍以膜性肾病为主,存在多种继发因素。     

46例不典型膜性肾病的病理研究

目的:阐明病理表现为不典型膜性肾病的病例的不同临床与病理特点.方法:回顾性分析经肾活检确诊的不典型膜性肾病患者46例,对其临床资料、病理特征进行统计分析.结果:①本研究中病理表现为不典型膜性肾病占有率为乙肝相关性肾炎26%、狼疮性肾炎19.5%、病因不明的不典型膜性肾病54.3%.②46例肾病患者临床表现为肾病综合征的达28例,且本研究的病例在血尿、高血压的发病情况中三者间无统计学意义.而血清补体C3、C4的降低在狼疮性肾炎患者中明显.结论:不典型性膜性肾病的病因复杂,临床表现相似,但有各自临床与病理特点,尚需很多方面的研究以指导治疗.     

IgA肾病单纯性血尿患者肾脏病理分级与临床的关系

目的分析Ig A肾病单纯性血尿患者牛津病理分级与血尿及肾功能的关系,为Ig A肾病单纯性血尿患者的治疗提供理论依据。方法横断面分析我院84例经肾活检确诊为原发性Ig A肾病单纯性血尿患者的病理及临床资料。结果 84例Ig A肾病单纯性血尿患者中仅有4例发现时双肾肾小球滤过率<60ml/min。病理表现发生肾小球球性硬化的占60.71%,35例(41.67%)出现肾小球节段硬化;发生肾小球全球和(或)节段硬化的病例数占64.28%。肾小球球性和/或节段硬化比例主要集中在30%以内。根据Ig A肾病牛津分级标准,M1、S1、E1、T1和T2及C1的发生率分别为69%、41.7%、10.7%、27.3%及25%。血尿严重程度与毛细血管内细胞增多有关(P<0.05),与肾功能损伤无明显关系。小管萎缩及间质纤维化的程度与病程长短明显相关(P=0.02),且其严重程度直接影响肾功能水平(P<0.01)。结论 Ig A肾病单纯性血尿患者临床损伤轻微,但肾脏病理损伤不一定轻,小管萎缩/间质纤维化程度与肾功能损伤明显相关。     

112例特发性膜性肾病的临床与病理分析

目的探讨成年人特发性膜性肾病的临床特点与病理特征。方法回顾2007年1月²013年6月于广州市第一人民医院住院并经肾穿刺确诊的特发性膜性肾病患者112例,比较不同年龄段患者的临床资料及病理特点。结果我院特发性膜性肾病患者平均年龄(46.01±14.66)岁,其中男52例(占46%)、女60例(占54%)。主要临床表现为肾病综合征(约84.8%)及浮肿(约86.6%),病理分期Ⅰ期、Ⅱ期为占67.8%。随着年龄的增长,血压、血尿酸、总胆固醇及低密度脂蛋白均明显增高,eGFR明显下降。青年组肾小管间质炎症细胞浸润及小动脉透明变性发生率显著低于老年组(p<0.05)。结论不同年龄特发性膜性肾病患者临床与病理表现有一定差异,临床治疗上应各有侧重。     

268例原发性肾小球疾病的临床病理分析

为了解原发性肾小球疾病的病理类型。对268例原发性肾小球疾病进性肾活检，分析其性别、年龄、病理类型与临床表现。结果表明，原发性肾小球疾病以青壮年男性为多见，病理类型以IgA肾病和系膜增生性肾小球肾炎最多，分别占32．8％、24．6％。临床表现以肾病综合征和慢性肾小球肾炎为主。     

51例肾病综合征临床病理分析

目的探讨肾病综合征临床与病理分型的临床意义。方法对51例肾病综合征患者均行肾活检病理学检查。结果51例肾病综合征中,原发性肾病综合征42例,占82.35%。微小病变居首位,其次为膜性肾病和系膜增生性肾炎;9例继发性肾病综合征患者中乙肝相关性肾病占首位。结论肾病综合征患者进行肾活检十分必要,对治疗和预后判断方面具有指导意义。     

类风湿性关节炎肾损害的组织病理改变--附4例报告及文献复习

目的探讨类风湿性关节炎(RA)肾损害的组织病理学改变特点. 方法总结4例RA肾损害的临床病理资料,并结合文献进行分析.结果 4例均呈蛋白尿伴血尿,其中3例肾功能不全,组织病理为IgA肾病2例、节段系膜增生性肾炎及局灶节段性肾小球硬化各1例,文献报道临床表现以蛋白尿、血尿为主,可呈肾病综合征或伴肾功能不全,病理类型以系膜增生性肾炎(包括IgA肾病)、膜性肾病和肾淀粉样变性多见.结论类风湿性关节炎的组织病理学改变以系膜增生性肾炎最常见,临床表现多样化.     

2型糖尿病早期糖尿病性肾病21例临床特点分析

目的：分析2型糖尿病早期糖尿病性肾病的临床特点。方法：选取21例2型糖尿病早期糖尿病性肾病患者,通过记录患者的年龄,性别,糖尿病病程,发现肾脏疾病的病程,血压,眼底;乙型肝炎病毒学检查,尿常规,尿蛋白定量,血糖,血肌酐,尿素氮,肾脏B超等以及电镜检查,分析其临床特点。结果：所有患者中19例合并高血压,10（47.6%）例呈糖尿病视网膜病改变,21例均有白蛋白尿或微量白蛋白尿,蛋白尿是DKD最常见的临床表现之一,应用24小时尿液收集标本行尿微量白蛋白定量的测定是最敏感的指标。3例患者表现间歇性微量白蛋白尿,而肾脏活检上已表现为糖尿病结节样硬化的病理改变。故临床合并有糖尿病视网膜病变、高血压及微量白蛋白尿三联症对指导临床治疗及判断预后起着极其重要的作用。甚至应及早进行肾活检,通过肾活检病理检查可将DKD和糖尿病伴发的原发性肾小球疾病区分开来。本组病例中可以得出临床表现为肾病综合症伴随肾功能不全（71.4%）的患者,预后最差,5例患者1～3年进入血液透析治疗阶段。表现为非肾病者14例,有6例（42.9%）伴随肾功能不全,这说明在临床上并不是所有的DKD都有低蛋白血症类似肾病综合症表现,部分患者临床表现少量蛋白尿但已伴有明显的肾功能不全,此类患者起病隐匿,对ACEI或AT1RA治疗疗效不佳,肾功能衰竭很快进入终末期,预后不良。结论：糖尿病患者,定期检查24小时尿蛋白定量,若伴有微量白蛋白尿或有间断白蛋白尿,并部分伴随高血压伴或不伴糖尿病性视网膜病变者应积极予以行肾脏病理检查,早期明确病理诊断,及早予以大剂量ACEI或AT1RA治疗,若临床表现为大量蛋白尿,则已是糖尿病性肾病Ⅳ期,预后不良。     

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.     

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.     

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.     

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.     

The risk of heat exhaustion at a deep underground metalliferous mine in relation to surface temperatures

The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.