小于胎龄儿生后早期血浆游离卡尼汀与血糖、血脂的关系

目的:了解小于胎龄儿生后早期血浆游离卡尼汀(CT)与血糖、血脂及主要体格测量指标的关系。方法:64例小于胎龄儿作为研究对象,30例足月适于胎龄儿作为对照组。所有研究对象生后早期未喂养前采集静脉血,并测量身长、体重、头围、腹围。采用高效液相色谱法(HPLC)测定血浆卡尼汀浓度,全自动生化分析仪常规检测血糖、血脂、白蛋白。应用SPSS 13.0软件进行统计学分析。结果:早产小于胎龄儿组(A组)血浆卡尼汀浓度为(38.67±12.75)μmol/L,足月小于胎龄儿组(B组)为(45.31±16.47)μmol/L,足月适于胎龄儿组(C组)为(54.17±18.35)μmol/L,3组比较差异有统计学意义(F=7.82,P<0.05),与另2组比较,早产小于胎龄儿组卡尼汀浓度更低。匀称型SGA血浆卡尼汀浓度比非匀称型SGA组低,差异有统计学意义(t=2.95,P<0.01)。小于胎龄儿血浆卡尼汀与HDL-C(r=0.46,P<0.05)、与ApoB(r=0.42,P<0.05)、G lu(r=0.52,P<0.05)、体重(r=0.51,P<0.05)、腹围(r=0.47,P<0.05)呈正相关,与TG(r=-0.44,P<0.05)、LDL-C(r=-0.57,P<0.05)呈负相关。结论:小于胎龄儿生后早期血浆游离卡尼汀浓度下降,早产小于胎龄儿更明显。小于胎龄儿生后早期血浆游离卡尼汀水平与血糖及血脂水平有关,与出生体重及腹围有关,小于胎龄儿生后早期卡尼汀的降低与葡萄糖及脂肪代谢紊乱有关。监测小于胎龄儿血浆游离卡尼汀浓度及适量补充卡尼汀对于防治生后早期代谢紊乱可能有益。     

表皮生长因子、抗心磷脂抗体与胎儿生长发育的关系

【目的】测定母血、脐血表皮生长因子(epidermal growthfactor,EGF)与脐血抗心磷脂抗体(anticardiolip-in antibodies,ACA)水平与胎儿生长发育的关系。【方法】收集小于胎龄儿(small for gestational age,SGA)组(18例)、适于胎龄儿(appropriate for gestational age,AGA)组(20例)、大于胎龄儿(large for gestational age,LGA)组(17例)的脐血5ml及其母产后第2d肘静脉血2ml,酶联免疫法测EGF、ACA-IgG和ACA-Ig M。【结果】①SGA组脐血EGF含量显著高于AGA组、LGA组(P<0.05),胎儿出生体重与胎儿自身EGF水平呈现明显负相关(r=-0.573,P<0.001),胎儿出生身长与胎儿自身EGF水平呈现负相关(r=-0.343,P<0.05);②SGA组母血EGF含量明显低于AGA组、LGA组,胎儿出生体重与母亲血EGF水平呈现正相关(r=0.391,P<0.05),胎儿出生身长与母亲血EGF水平无相关(r=0.264,P>0.05);③母血与脐血EGF水平差异无显著性(P>0.05);④新生儿ACA-IgG阳性与宫内生长迟缓(intrauterine growth retardation,I UGR)、胎膜早破、宫内窘迫的发生有关。【结论】胎儿体重与母血和胎儿EGF水平变化有关,胎儿身长与胎儿EGF水平变化有关,证实EGF对胎儿的调节作用;脐血ACA-IgG与I UGR的发生有关。     

小于胎龄儿早期血脂及脂蛋白代谢特点

目的 了解小于胎龄儿(small for gestational age neonates,SGA)早期血脂及脂蛋白代谢特点。方法 选择无严重并发症新生SGA 47例为研究对象,以45例足月适于胎龄儿(adequate for gestational age,AGA)作为对照组。于出生后12 h内静脉采血,测定血浆总胆固醇(total cholesterol,TC)、甘油三脂(triglyceride,TG),低密度脂蛋白胆固醇(low-density lipoprotein cholesterols,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterols,HDL-C)、载脂蛋白(apolipoproteins,apo)A1及apo-B水平,计算LDL-C/HDL-C及apo-B/apo-A1比值;并进一步将SGA根据是否足月、宫内发育迟缓程度(出生体重位于同胎龄平均体重P₃以下为SGA1组,P₃~P₁₀之间为SGA2组)及性别进行分组,比较上述指标的水平。结果 与对照组比较, SGA患儿具有高的TC(2.41±0.61 vs 2.11±0.78,P<0.05)、LDL-C(0.90±0.44 vs 0.71±0.42,P<0.05)和apo-B(0.40±0.22 vs 0.29±0.15,P<0.01)浓度,及高的LDL-C/HDL-C(1.31±1.29 vs 0.82±0.46,P<0.05)、apo-B/apo-A1(0.60±0.35 vs 0.40±0.19,P<0.01)比值;SGA1组比SGA2组具有低的TC、HDL-C及apoA1水平,而具有高的apo-B/apo-A1比值(P<0.01或<0.05);早产SGA患儿比足月SGA患儿具有低的TG水平(P<0.05);性别对SGA血脂及脂蛋白水平没有影响。结论 不良的宫内环境使SGA早期可出现脂质代谢异常,宫内发育迟缓越严重脂质代谢异常越明显,SGA远期可能更易出现心血管疾病;早产SGA血浆TG水平低于足月SGA,可能与新生儿成熟度相关。     

母血脐血胰岛素、糖脂水平测定及其意义

【目的】　测定小于胎龄儿 (SGA)、适于胎龄儿 (AGA)、大于胎龄儿 (LGA)母血脐血胰岛素 (INS)、糖脂水平并分析其相关因素 ,探讨不同宫内环境下胎儿INS、糖脂水平变化及意义。　【方法】　均选取无明显产科并发症的剖宫产母亲及其新生儿 ,其中SGA 2 0例 ,AGA 2 7例 ,LGA 2 1例。采用ELISA法测定INS ,葡萄糖氧化酶法测定血糖 (Glu) ,大型生化仪测定甘油三脂 (TG)和胆固醇 (CHOL)。　【结果】　①LGA组母血脐血INS水平明显高于SGA组和AGA组 (P <0 .0 5 ) ,SGA组与AGA组母血脐血之间INS水平差异无统计学意义 (P >0 .0 5 ) ;LGA组母血TG水平明显高于SGA、AGA组 (P <0 .0 5 )。SGA组脐血TG水平明显高于AGA和LGA(P <0 .0 5 ) ,三组母血脐血血糖、CHOL差别无统计学意义 (P >0 .0 5 )。②母血与脐血INS、TG、CHOL、血糖水平之间无相关性 ;母血INS水平与胎儿的体格发育指标无相关性。③SGA组母亲孕前体块指数 (BMI)明显低于AGA组及LGA组 (P <0 .0 5 ) ,后两者之间差别无统计学意义。LGA组母亲孕期体重增加明显高于SGA组及AGA组 (P <0 .0 5 )。母亲孕前BMI、孕期体重增加、身高与胎儿出生体重呈正相关。。　【结论】　不同的宫内环境引起胎儿内分泌及代谢的改变 ,SGA儿的TG水平明显升高及LGA儿的高胰岛素血症可能     

胰岛素、胰岛素样生长因子-1、生长激素释放多肽在胎儿宫内发育迟缓的意义

【目的】本文主要探讨胰岛素(insulin,INS)、胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)、生长激素释放多肽(ghrelin)在胎儿宫内发育迟缓中的作用。【方法】将新生儿分两组:①适于胎龄儿组39例;②宫内发育迟缓儿组24例。均在出生时采集脐血,测血糖,用ELISA法测定血清IGF-1和Ghrelin。用化学发光法测定胰岛素。同时测量新生儿体重,身长,头围,并计算体质指数、胎龄和葡萄糖/胰岛素比值(G/I),进行组间比较,并统计分析血清胰岛素与人体测量指标、IGF-1、Ghrelin的相关性。【结果】适于胎龄儿组与宫内发育迟缓儿组血糖、G/I、INS、IGF-1、Ghrelin差异有显著性(P值均<0.05);胰岛素与体重、身长、体质指数、头围、IGF-1呈显著正相关(P<0.05),与Ghrelin呈显著负相关(r=-0.382,P<0.01)。【结论】胰岛素在胎儿生长发育中的起重要作用,并与IGF-1和Ghrelin共同参与胎儿宫内发育迟缓的调节。     

糖耐量减退患者血脂的改变与胰岛素抵抗的关系

目的:探讨糖耐量减退(IGT)患者血脂成分的改变及其与胰岛素抵抗(IR)程度的关系.方法:收集28例正常糖耐量(NGT)者和新诊断的55例IGT患者的临床资料,分别测定血脂谱.利用稳态模型胰岛素抵抗指数(HOMA-IR)量化IR程度.结果:IGT患者血清甘油三酯(TG)与低密度脂蛋白-胆固醇(LDL-C)水平显著高于NGT组(P<0.05及P<0.01),高密度脂蛋白-胆固醇(HDL-C)值明显低于NGT组(P<0.001).IGT患者HOMA-IR显著高于NGT组(P<0.01).HOMA-IR与TG水平呈正相关(r=0.32,P<0.01),与LDL-C呈正相关(r=0.26,P<0.05).HOMA-IR与HDL-C负相关(r=-0.27,P<0.05).结论:新诊断的IGT患者已经存在血脂代谢异常,且与IR密切相关.     

早期血浆蛋白质量对新生儿营养评价

【目的】 通过对新生儿血浆蛋白测定结果分析,探讨生后早期血浆蛋白质量对新生儿营养状况评估价值。 【方法】 选取120例新生儿为研究对象,分以下四组:早产小于胎龄儿组(small for gestational age, SGA)30例,早产适于胎龄儿(appropriate for gestational age, AGA)组30例,足月小于胎龄儿组30例,足月适于胎龄儿组30例。所有研究对象生后24 h 内静脉采血测定血浆蛋白进行比较分析。 【结果】 1)SGA组血浆前白蛋白质量(serum protein mass/prealbumin, SPM/PA)显著低于AGA组;2)早产儿AGA组白蛋白(albumin, ALB)低于足月儿AGA组;3)早产儿组前白蛋白(prealbumin, PA)及SPM/PA均低于足月儿组。上述差异均有统计学意义(P<0.05)。 【结论】 1)新生儿早期SPM/PA是评价新生儿营养状况的重要指标;2)SPM/PA还可作为评定胎龄,区分适于胎龄儿和小于胎龄儿的有效指标。     

不同出生胎龄的2～7岁小于胎龄儿生长激素释放多肽、胰岛素样生长因子-1、胰岛素水平及其与生长发育的关系

目的探讨生长激素释放多肽(Ghrelin)、胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)、胰岛素在小于胎龄儿(SGA)生长发育中的作用。方法分别检测2～7岁早产SGA、足月SGA血Ghrelin、IGF-1、IGFBP-3、胰岛素、血糖的水平,并与相应的早产AGA、足月AGA进行比较,并做相关性分析。结果 Ghrelin在早产SGA组高于足月SGA(P<0.05),与早产AGA无明显差异,早产AGA高于足月AGA(P<0.05),足月SGA高于足月AGA(P<0.01)。IGF-1和IGFBP-3水平在早产SGA组低于足月SGA(P<0.05),早产AGA组明显低于足月AGA组(P<0.0001)。胰岛素水平在足月SGA组最高。胰岛素抵抗指数(IRI)在各组间比较与胰岛素结果一致。早产SGA组与足月SGA组中Ghrelin与各项指标的相关分析显示:Ghrelin与体重标准差计分(SDS)、IGF-1、IGFBP-3、胰岛素及IRI呈负相关,早产SGA组分别为(r=-0.683,P<0.002;r=-0.749,P<0.001;r=-0.828,P<0.001;r=-0.694,P<0.005;r=-0.822,P<0.001),足月SGA组分别为(r=-0.792,P<0.001;r=-0.707,P<0.002;r=-0.615,P<0.01;r=-0.648,P<0.005;r=-0.679,P<0.005)。结论 Ghrelin参与了早产儿和SGA儿生后的生长发育过程,但与追赶生长程度的关系不大。Ghrelin作为胰岛素的反调节因子,以负反馈的形式调节能量代谢。     

脂肪因子Chemerin在非酒精性脂肪肝中的临床意义

目的探讨非酒精性脂肪肝(non-alcoholic fatty liver disease,NAFLD)患者血清chemerin水平的变化及临床意义。方法选择2010年5月—2011年6月NAFLD患者46例,轻度24例B组,中重度22例C组,正常对照组26例A组,分别检测各组空腹血糖(FBS)、胰岛素(FINS)、血脂、chemerin水平及体质指标。甘油三酯、空腹胰岛素、HOMA-IR、chemerin均经对数(lg10)转换使之正态化后再分析。采用方差分析、相关分析、偏相关分析以及多元线性回归分析,P<0.05为差异有统计学意义。结果三组中的收缩压、舒张压均无明显差异(均P>0.05)。NAFLD组(B+C组)WC、WHR、BMI、FBS、FINS、HOMA-IR、TG、TC、LDL-C、Chemerin水平均显著高于正常对照组(均P<0.05);HDL-C水平显著低于正常对照组(P<0.05);而中重度NAFLD组(C组)BMI、FINS、TG、HOMA-IR、Chemerin水平均显著高于轻度NAFLD组(均P<0.05)。应用Pearson相关性分析显示,血清Chemerin水平与BMI(r=0.482)、WHR(r=0.421)、TG(r=0.390)、HOMA-IR(r=0.329)、FINS(r=0.301)、TC(r=0.287)LDL-C(r=0.253)正相关,与HDL-C(r=-0.316)负相关(P<0.05)。以是否患NAFLD为应变量,以WC、WHR、BMI、FBS、FINS、HOMA-IR、TG、TC、LDL-C、Chemerin为自变量,进行逐步回归分析。结果显示TG、Chemerin、进入方程,Y=31.533+1.372*TG+0.864*Chemerin。结论 NAFLD患者中血清Chemerin水平增加,在NAFLD的发生发展中具有重要的意义。     

早期喂养对小于胎龄儿胰岛素敏感性的影响

目的 分析小于胎龄儿婴儿期胰岛素敏感性的变化及早期不同喂养方式对其胰岛素敏感性的影响,为临床上对小于胎龄儿(SGA)早期营养干预提供了依据和线索。方法 收集2011年6月-2014年6月在北京大学第三医院产科出生的小于胎龄儿为SGA组,正常对照(NC)组为同期同一家医院出生的健康适于胎龄儿(AGA)。两组新生儿进入本院儿童保健中心随访,进行常规体格测量,以及空腹血浆血糖(FPG)和空腹血清胰岛素(FINS)水平的测定,根据公式计算胰岛素抵抗指数(IRI)。根据生后4个月内的喂养方式不同,分为母乳喂养组、人工喂养组和混合喂养组,然后根据SGA组的IRI是否高于NC组的中位数将SGA又分为对胰岛素不敏感和对胰岛素敏感两组。结果 SGA组在1岁内生长发育速度快于NC组,但在1岁时仍未能追赶上NC组。在1岁时,SGA组婴儿的IRI值显著高于NC组(t=3.715,P<0.05)。生后早期母乳喂养较人工喂养和混合喂养的SGA胰岛素敏感性更高(χ²=7.02,P<0.05)。结论 SGA在婴儿期生长发育速度快于正常体重儿,但未能追赶上正常体重儿。SGA在婴儿期末已经表现出胰岛素敏感性的差异。生后早期喂养方式不同对SGA的胰岛素敏感性可能有一定的影响。     

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.     

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.     

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.     

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.