新生儿缺氧缺血性脑病脑血流动力学变化及价值

目的:探讨新生儿缺氧缺血性脑病(HIE)的脑血流动力学变化及血流频谱特点,并探讨其临床意义。方法:对52例HIE患儿进行经颅多普勒超声(TCD)检测,包括大脑中动脉(MCA),大脑前动脉(ACA),大脑后动脉(PCA)的血流速度,频谱形态,搏动指数(PI),阻力指数(RI),异常声频的检测,以健康新生儿15例为正常对照组。结果:①脑血流轻度组舒张末期流速(Vd)、收缩峰流速(Vs)局部降低,中、重度组Vd广泛降低,Vs局部降低,重度组尤为显著(P<0.05);②PI、RI轻度组与对照组差异无统计学意义,中度组局部增高,重度组双侧大脑动脉PI、RI普遍增高(P<0.05)。结论:运用脉冲多普勒超声检测脑血流动力学变化,可用于HIE的早期诊断,病情判断和预后评估,对指导治疗具有重要意义。     

经颅多普勒超声在足月新生儿缺氧缺血性脑病诊断和严重程度评估中的价值

目的探讨经颅多普勒超声在足月新生儿缺氧缺血性脑病(HIE)诊断和严重程度评估中的价值。方法纳入2021年3月—2022年3月杭州市第九人民医院收治的HIE足月新生儿172例,根据HIE分度标准分成轻度组(49例)、中度组(65例)、重度组(58例),选取同期于产科分娩的健康足月新生儿40例作为对照组。所有新生儿均行经颅多普勒超声检查,检测大脑中动脉(MCA)的收缩期峰值血液流速(Vs)、舒张期血液流速(Vd)、平均血液流速(Vm)、阻力指数(RI),利用新生儿神经行为评分(NBNA)评估患儿神经行为。绘制受试者工作特征(ROC)曲线,分析超声指标对HIE患儿的评估价值。结果轻度组的Vs、Vd、Vm分别为(36.05±1.10)cm/s、(9.16±0.27)cm/s、(26.45±2.81)cm/s,中度组的Vs、Vd、Vm分别为(33.68±1.67)cm/s、(7.25±0.43)cm/s、(23.16±1.86)cm/s,重度组的Vs、Vd、Vm分别为(30.75±2.16)cm/s、(5.42±0.91)cm/s、(19.35±1.20)cm/s,3组的Vs、Vd、Vm均低于对照组的(42.71±3.65)cm/s、(13.48±2.69)cm/s、(31.76±3.65)cm/s,且中度组、重度组低于轻度组(均P<0.05)。轻度组、中度组、重度组的RI分别为(0.70±0.09)、(0.79±0.06)、(0.88±0.10),高于对照组的(0.63±0.07),且中度组、重度组高于轻度组(均P<0.05)。轻度组、中度组、重度组的NBNA评分分别为(31.45±1.98)分、(28.65±1.67)分、(24.67±2.16)分,低于对照组的(38.13±1.52)分,且中度组、重度组低于轻度组(均P<0.05)。HIE患儿的Vs、Vd、Vm与NBNA评分均呈正相关(r=0.736,0.755,0.589,均P<0.05),RI与NBNA评分呈负相关(r=-0.658,P<0.05)。Vs、Vd、Vm、RI单独与联合诊断HIE的ROC曲线下面积(AUC)分别为0.718、0.766、0.790、0.814、0.904。Vs、Vd、Vm、RI单独与联合鉴别轻度、中重度HIE的AUC分别为0.752、0.772、0.776、0.799、0.874。超声评估与临床确诊结果高度一致(Kappa值=0.695)。结论经颅多普勒超声能反映HIE患儿的脑血流动力学变化,对HIE诊断及严重程度评估有较高的价值。     

新生儿窒息脑血流动态检测及预后评估

目的:探讨新生儿窒息时脑血流的改变与脑损伤的关系,并通过检测脑血流对预后做出初步评估。方法:应用彩色多普勒超声诊断仪对窒息新生儿100例在生后5天内连续检测其大脑中动脉及大脑前动脉的收缩期峰值流速(Vs)、舒张末期速度(Vd)、平均速度(Vm)、搏动指数(PI)及阻力指数(RI),并与对照组30例进行比较。对13例合并HIE的患儿进行1~2年随访,并进行DQ测定。结果:①生后24h内轻度窒息组脑血流低于对照组,P<0.05;重度窒息组Vs、Vd、Vm均低于对照组,P均<0.01,轻度窒息组与重度窒息组比较VsP<0.05,VdP<0.01,VmP<0.05。②生后24h内轻度窒息组和重度窒息组PI均升高,但经统计学处理P>0.05;RI明显升高,P<0.01。③频谱特征:第1天重度窒息组收缩期峰值较小,部分舒张末期血流信号接近不显示,呈现仅有收缩峰而无舒张期的单峰型特点,直至第5天接近正常双峰型。④对13例HIE儿进行随访,DQ异常4例。结论:脑血流量减少是引起窒息后脑损伤的主要原因;脑血流恢复较慢者可能会影响疾病的预后。     

30例急性有机磷农药中毒患者经颅多普勒超声检查分析

目的 探讨急性有机磷农药中毒(AOPP)轻、中、重度患者脑血流灌注变化的规律.方法 回顾分析30例AOPP患者双侧大脑中动脉(MCA)血流频谱形态和血流动力学参数.结果 12例轻度AOPP患者中9例收缩期峰值流速(Vp)、舒张末期流速(Vd)、平均流速(Vm)增高,患者搏动指数(PI)、阻力指数(RI)基本正常;12例中度AOPP患者Vp、Vm、Vd均中度下降,PI、RI均升高;6例重度AOPP患者Vm、Vd明显下降,PI、RI明显升高;大部分患者频谱形态出现异常.结论 经颅多普勒超声检查能够对AOPP患者提供丰富的脑血流动力学资料,为患者的病情评估、预后和科研提供可靠的依据,具有重要的临床和科研意义.     

新生儿HIE脑血流阻力与平均速度对照研究

目的：观察足月新生儿短期内（3－15d)日龄与脑血流阻力与平均速度的关系以及轻－中度HIE－3d后脑血流指标是否正常，3－10d新生儿脑血流情况。方法：彩色多谱勒超声仪测定大脑前、中、后动脉血流阻力与平均速度。结果：（1）正常足月儿和轻中度HIE患者3－15d内脑血流分别存在A－RI和Vmean的改变,两者随日龄增加而增高（均P＜0．05）；（2）轻中度HIE 3d后脑血流指标与正常组差异无明显性；（3）生理性黄疸新生儿RM－RI高于正常组（P＝0．03），RM－Vmean则呈相反变化（但P＞0．05），结论：使用彩色多谱勒超声对新生儿脑血流动力学进行监测时，应注意A－RI和RM－Vmean与日龄的相关性，轻中度HIE 3d后脑血流应恢复正常，否则应追踪观察，尤其注意RM－Vmean是恢复正常，新生儿生理性黄疸存在局部脑血流阻力增高及血流量下降，对黄疸程度重，特别是考虑病理性者应及时退黄处理。     

经颅多普勒分析20例急性一氧化碳中毒脑血流灌注改变规律

为探讨急性一氧化碳轻、中、重度中毒患者脑血流灌注改变规律,回顾分析各患者双侧大脑中动脉流频谱形态和血流动力学参数。结果 13例轻度CO中毒中9例Vm、Vd增高,大部分PI下降;5例中度中毒Vm、Vd轻度下降,PI、RI大部分升高;2例重度中毒Vm、Vd明显降,PI、RI升高;大部分患者频谱形态出现异常。利用经多普勒TCD对CO中毒患者的检测,可为患者的治疗、康复提供可靠依据,具有重要的临床意义。     

经颅多普勒监测重型脑外伤病人的颅内压

目的 研究经颅多普勒（TCD）在重型脑外伤病人颅内压（ICP）监测中的应用价值。方法 对18例重型脑外伤病人，应用TCD检测大脑中动脉（MCA）的收缩峰流速（Vs）、舒张期速度（Vd）、平均血流速度（Vm）、血管搏动指数（PI）、阻力指数（RI）。同时记录ICP及格拉斯哥预后评分（GOS）。结果 随着ICP升高，PI、RI增大，Vd减慢，与对照组比较差异有统计学意义（P〈0．01），PI〉1．5的病人预后不良（P〈0．05）。结论 TCD可以无创监测脑外伤病人ICP的升高，对临床治疗和预后评价有重要指导意义。     

原发性高血压早期肾损害肾内血流动力学改变和内皮素-1及肾上腺髓质素的相关性分析

目的探讨原发性高血压并肾功能损害患者早期双侧肾内动脉血流动力学改变与内皮素-1（ET-1）、肾上腺髓质素（ADM）的相关性。方法将90例轻、中度原发性高血压患者,根据血α1-微球蛋白,血、尿β2-微球蛋白水平分为肾损害早期高血压组45例和无肾损害高血压组45例。采用双抗体夹心ELISA法对各组对象血浆ADM、ET-1水平进行测定,并同时用彩色超声多谱勒技术监测双侧叶段动脉（SRA）？叶间动脉（IRA）的收缩期峰速度（Vs）、舒张期末血流速度（Vd）、平均血流速度（Vm）、血流峰速加速时间（AT）、脉冲指数（PI）、阻力指数（RI）等血流参数。结果⑴肾损害早期高血压组与无肾损害高血压组比较,血浆ET-1、ADM水平明显增高（P〈0.001）;SRA、IRA的Vs、Vd、Vm显著降低（P〈0.05）,AT明显延长（P〈0.01）,PI和RI明显增高（P〈0.05）。⑵直线相关分析,ADM、ET-1与Vs、Vd、Vm负相关（P〈0.001）,与PI、RI、AT正相关（P〈0.001）。ADM、ET-1、与Vs、Vd、AT、RI存在回归关系。结论原发性高血压并肾功能损害患者早期肾内动脉血流动力学及血浆内皮素-1、肾上腺髓质素水平发生明显变化,内皮素-1、肾上腺髓质素可能在原发性高血压肾损害早期发挥重要作用。     

新生儿缺氧缺血性脑病血镁检测及临床意义

目的：探讨新生儿缺氧缺血性脑病（HIE）血镁变化及临床意义。方法：测定入院24h内的52例HIE患儿血镁值,并与25例正常新生儿对照。结果：52例HIE患儿中有41例血镁值降低,其中轻度组与对照组比较差异无显著性（P〉0．05）;中度组与对照组及轻度组比较,重度组与中度组比较差异有显著性（均P〈0．05）：重度组与对照组及轻度组比较差异有非常显著性（均P〈0．01）。结论：HIE患儿血镁含量多低于正常,临床分度越重,血镁下降越明显。     

28例急性CO中毒的经颅多普勒超声分析

为探讨急性一氧化碳(CO)轻、中、重度中毒患者脑血流灌注改变规律,回顾分析各患者双侧大脑中动脉血流频谱形态和血流动力学参数。结果13例轻度CO中毒中10例Vm、Vd增高,大部分PI下降;9例中度中毒Vm、Vd均轻度下降,PI、R I大部分升高;6例重度中毒Vm、Vd明显下降,PI、R I升高;大部分患者频谱形态出现异常。利用经颅多普勒(TCD)对CO中毒患者的检测,可为患者的治疗、康复提供可靠依据,具有重要的临床意义。 更多还原     

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.     

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.     

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.