大鼠急性一氧化碳中毒后血液流变学动态变化的特点

目的 探讨急性一氧化碳(CO)中毒后大鼠血液流变学及凝血功能变化的特点及其在急性CO中毒迟发性脑病(DNS)中的作用.方法 采用腹腔注射CO法制备急性CO中毒大鼠模型;采用Pulsinelli-Brierley方法制备全脑缺血再灌注大鼠模型,根据神经病理学检查和Morris水迷宫行为学试验鉴定大鼠是否发生DNS,并进一步观察出现脑病大鼠的血液流变学变化特征.结果 全脑缺血再灌注模型大鼠在再灌注后很快出现血细胞比容、血浆黏度及全血黏度明显增加血液流变学异常和血液凝固性增强等凝血功能障碍;急性CO中毒DNS模型大鼠早期可见红细胞变形指数降低(36.717±1.818),且全血黏度、血细胞比容(29.65±0.61)亦均降低的血液流变学改变,同时凝血功能明显下降,此间未见明显的循环功能障碍.在末次染毒1 d后上述指标开始向全脑缺血再灌注模型表现转变,7～14 d后达到高峰,但不及缺血再灌注组变化剧烈.结论 急性CO中毒后可诱发微循环障碍,且具有与其他原因所致循环障碍不同的特点,此变化可能是CO中毒后发生DNS的重要病理学基础.     

急性一氧化碳中毒家兔脑血流变学和凝血功能的变化

目的 探讨急性一氧化碳(CO)中毒家兔脑血流变学和凝血功能的变化及其在迟发性脑病(DEACMP)中的可能作用.方法 腹腔注射CO制备急性中毒模型,使血HbCO浓度达50%以上持续30～36 h,动态检测初次染毒后30 min、6 h及末次染毒后10 min、6 h、12 h、18 h、24 h、3 d、7 d、14 d颈静脉血的全血粘度(200s-、100s-、50s-、3s-)、血浆粘度、血浆纤维蛋白原(Fib)、血浆钙离子浓度([Ca2+])、部分活化凝血酶原时间(APTT)、活化部分凝血酶时间(PT)的变化,并进行全血细胞分析.结果 家兔末次染毒后10 min,不同切变率下全血粘度即有显著降低,24 h后则逐渐升高,14 d时仍高于正常;末次染毒后10 min至14 d血浆纤维蛋白原及血浆粘度亦均高于对照组;部分活化凝血酶原时间、活化部分凝血酶时间于末次染毒后10 min明显延长,3 d后方大致恢复正常;血浆[Ca2+]于末次染毒后10 min明显下降,24 h后恢复正常;红细胞(RBC)计数和红细胞压积(Hct)于末次染毒后18 h升高,14 d仍高于对照组.结论 急性CO中毒早期,脑循环即出现血液浓缩和凝血功能异常,表现为RBC和Hct升高,血[Ca2+]下降、凝血时间延长等;3 d后凝血功能虽见恢复,但血液浓缩未见改善,RBC、Hct、全血粘度和血浆粘度持续升高,这些脑循环障碍的高危因素可能是急性CO中毒迟发性脑病发病的重要病理生理学基础.     

中老年白内障患者凝血功能与血液流变学变化分析

目的探讨中老年白内障患者体内凝血功能、血液流变学指标水平变化及临床意义。方法选取60例中老年白内障患者(观察组)及60例健康体检者(对照组),比较2组人员凝血功能(TT、Fib、PT、APTT)及血液流变学(红细胞压积、血浆黏度、全血低切黏度、全血高切黏度)水平变化。结果观察组TT、PT水平与对照组比较差异无统计学意义(P0.05)。观察组Fib水平高于对照组,APTT水平低于对照组,差异均有统计学意义(P0.05)。观察组患者全血高切黏度水平与对照组比较差异无统计学意义(P0.05)。观察组红细胞压积、血浆黏度及全血低切黏度水平均高于对照组,差异有统计学意义(P0.05)。结论中老年性白内障患者多伴有凝血功能与血液流变学的改变,因此加强对上述指标的检测将会为该疾病的诊断与治疗提供依据。     

妊娠晚期孕妇凝血四项指标检测的临床意义

妊娠是妇女的一段特殊生理期,在孕晚期孕妇多项血液指标都会有不同程度的变化,特别是孕妇的凝血状态。凝血四项检测包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fib)。     

血栓、止血试验在肿瘤疾病中的应用

目的:探讨止血凝血试验用于恶性肿瘤疾病的临床意义。方法:应用法国STA COMPACT止血凝血分析仪检测330例恶性肿瘤和14例良性肿瘤患者血浆4项指标(凝血酶原时间PT、活化部分凝血酶原时间APTT、纤维蛋白原Fib、凝血酶时间TT)。结果:与正常人对照组比较,PT、APTT、Fib三项指标有明显差异的肿瘤是鼻咽癌、卵巢癌、肠癌、肺癌、肝癌、食管癌,二项指标有差异的是恶性淋巴瘤、乳腺癌、胃癌、宫颈癌、宫肌瘤、头颈部恶性肿瘤,而四项指标完全没有差异的是子宫体癌。值得注意的是凝血酶时间TT在330例恶性肿瘤、14例良性肿瘤中都与正常对照组没有差异。结论:PT、APTT、Fib可作为恶性肿瘤凝血像的检测指标。     

肺癌患者凝血功能4项指标变化及临床意义

目的了解肺癌患者组4项凝血指标的变化并探讨其临床意义。方法利用美国产ACL-3000全自动血凝分析仪测定231例肺癌患者和147例健康体检者的血浆凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fib)含量,同时计数血小板(PLT)。结果231例肺癌患者中40例(17.3%)血小板升高,8例(3.5%)PT延长,42例(18.18%)APTT延长,Fib升高128例(55.41%),不同病理分型患者的凝血功能指标差异无显著性。结论4项凝血指标中PLT、Fib在肺癌患者中均有不同程度的增高,肺癌患者存在凝血功能紊乱。     

围生期足月儿、早产儿不同程度黄疸对凝血四项水平影响

【目的】探讨围生期足月儿、早产儿不同程度黄疸对凝血四项水平影响,为临床早期干预异常的凝血象提供依据。【方法】采398例围生儿黄疸血浆,测凝血酶原时间PT(prothrombin time)、活化部分凝血活酶时间APTT(activated partial thromboplastin time)、凝血酶时间TT(thrombin time)、纤维蛋白原Fib(fibrinogen)。【结果】胆红素越高,APTT、PT、TT延长,Fib含量降低,早产与足月儿各对应组比较,其APTT、PT、TT均明显延长,Fib含量低。新生儿黄疸越明显,出血倾向发生率越高(P0.01)。【结论】对新生儿高胆红素血症凝血功能监测是必需的,尤其中重度黄疸,给以注射维生素K1等早期干预异常凝血象。     

不明原因复发性流产患者凝血功能、血液流变学状况及低分子肝素治疗效果

目的：探讨不明原因复发性流产(URSA)患者凝血功能、血液流变学状况及低分子肝素(LMWH)治疗效果。方法：选择2019年1月-2020年6月本院收治的URSA患者96例,随机数字表法分为两组各48例,对照组给予常规保胎治疗、观察组加用LMWH治疗,检测两组妊娠前(基线期)、妊娠6、8周时凝血功能指标[D-二聚体(D-D)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶活血酶时间(APTT)、纤维蛋白原(FIB)]、血液流变学参数[高切与低切全血表观黏度、全血还原黏度、血浆黏度],并与48例健康孕妇(健康组)、比较。结果：基线期、妊娠6周及8周时,URSA患者的D-D、FIB、高切与低切全血表观黏度、全血还原黏度、血浆黏度均高于健康组,PT、TT、APTT均低于健康组(均P<0.05)。妊娠6周、8周,健康组的D-D、全血表观黏度、全血还原黏度、血浆黏度较基线期升高,D-D、FIB降低,PT、TT、APTT、全血表观黏度、全血还原黏度、血浆黏度升高,且观察组的D-D、FIB、全血表观黏度、全血还原黏度、血浆黏度均低于对照组,PT、TT、APTT均高于对照组(均P<...     

脑纹状体多巴胺系统在急性CO中毒后的变化研究

目的观察急性一氧化碳(CO)中毒后纹状体多巴胺(DA)及其代谢产物含量的动态变化,探讨单胺氧化酶B(MAO-B)及DA系统变化在急性CO中毒迟发性脑病(delayed neruopsychologic sequelae,DNS)发病中的意义。方法采用腹腔注射CO法制备急性CO中毒大鼠模型,利用阿朴吗啡诱导旋转实验鉴定DNS模型,分析不同模型脑组织纹状体DA系统、MAO-B活性变化。结果急性CO中毒后纹状体MAO-B活性即明显降低,仅为对照组水平的43%;同时用清醒动物脑微透析实验观察纹状体DA及其代谢产物浓度变化发现,CO中毒后1 h DA浓度即增加,其代谢产物则明显降低,提示急性CO中毒早期DA代谢显著降低;中毒14 d后DNS模型大鼠纹状体MAO-B活性显著增加,为对照组活性的1.7倍,DA浓度则显著降低,仅为对照组的29%,代谢产物浓度明显增加,提示出现运动功能障碍的DNS模型脑纹状体MAO-B活性显著升高,DA代谢明显增加。结论急性CO中毒DNS大鼠脑纹状体MAO-B活性可异常升高,加速DA代谢,影响DA神经系统保持锥体及锥体外系运动协调功能,同时生成的大量DA代谢产物具有毒性作用,可进一步加重脑循环...     

高危产妇剖宫产术后早期预防性应用依诺肝素钠对凝血功能及静脉血栓形成的影响

目的:探讨高危产妇剖宫产术后早期预防性应用依诺肝素钠对凝血功能指标及静脉血栓形成的影响。方法:将112例接受剖宫产的高危产妇随机分为对照组与观察组各56例,对照组术后给予常规预防,观察组术后1d开始预防性使用依诺肝素钠。对比两组静脉血栓发生情况,分别于术前及术后6d测定凝血功能指标活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板计数(PLT)及血液流变学指标血浆黏度(PV)、全血高切黏度(HBV)、全血低切黏度(LBV)、红细胞变形指数(EDI),检测下肢静脉血流速度。结果:观察组下肢静脉血栓发生率(1.8%)低于对照组的(12.5%)(P0.05)。术后6d,两组的APTT、TT、PLT均无明显变化(P0.05),但观察组D-D、FIB、PV、HBV、LBV低于对照组,EDI高于对照组(P0.05),两组股深静脉、腘静脉与胫后静脉的血流速度均显著升高且观察组高于对照组(P0.05)。结论:高危产妇剖宫产术后早期预防性应用依诺肝素钠可改善血液流变学参数及下肢静脉血流速度,降低静脉血栓形成率,但不影响凝血功能。     

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.     

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.     

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.