雾化吸入重组人干扰素-γ治疗复治耐多药肺结核的临床研究

目的探讨重组人干扰素-γ雾化吸入治疗复治耐多药肺结核的疗效。方法选择复治痰涂片抗酸染色阳性或痰菌培养阳性、耐多药肺结核患者64例,随机分为:治疗组32例,雾化吸入干扰素-γ100万U,隔日1次,疗程为8周;对照组32例,雾化吸入异烟肼0．1g+丁胺卡那霉素0．2 g,每日1次,疗程为8周。两组患者给予抗结核方案为HRZE(S)／6HRE,或根据药敏结果调整用药。4周、8周末检查痰涂片、痰菌培养、血沉和胸部CT各1次。结果治疗组和对照组,4周末:痰涂片转阴分别为11例、8例(x2=0．03,P=0．80);痰菌培养转阴分别为9例、5例(x2=0．64,P= 0．50);血沉恢复正常分别为26例、19例(x2=0．14,P=0．70);病灶吸收好转分别为13例、9例(x2 =0．11,P=0．70)。8周末:痰涂片转阴分别为20例、13例(x2=0．49,P=0．50);痰菌培养转阴分别为23例、10例(x2=5．01,P=0．02);血沉恢复正常分别为30例、23例(x2=0．02,P=0．90);病灶吸收好转分别为25例、12例(x2=4．40,P=0．05)。结论重组人干扰素-γ作为一种免疫调节剂,雾化吸入治疗耐多药肺结核疗效明显,可以在临床中推广应用。     

γ-干扰素联合微卡对初治肺结核患者的早期疗效及免疫机制探讨

目的探讨γ-干扰素联合微卡辅助抗结核治疗的疗效及免疫机制。方法160例肺结核患者随机分为四组：基础用药组、γ-干扰素组、微卡组及联合组，每组40例。基础用药：所有病例均采用标准短程化疗（2HRETM4HR），各干预组均给予相应的药物，观察各组2个月末痰菌阴转和病灶吸收情况，治疗前和2个月末用APAAP法检测患者外周血T细胞亚群CD4＋、CD8＋比例，同时用ELISA法检测患者外周血IFN-1和IL-4含量。结果与基础用药组比较，γ-干扰素组、微卡组、联合组痰菌阴转率明显升高（P〈0．05）；与γ-干扰素组、微卡组比较，联合组痰菌阴转率差异无统计学意义（P〉0．05）；与基础用药组比较，γ-干扰素组、微卡组、联合组病灶吸收显效率增加（P〈0．05）；与γ-干扰素组、微卡组比较，联合组病灶吸收显效率更明显（P〈0．05）。γ-干扰素组、微卡组、联合组外周血T细胞亚群CD4＋比例和IFN-γ含量变化值均显著高于基础用药组（P〈0．05）；与γ-干扰素组、微卡组比较，联合组变化值增高更显著（P〈0．05）。γ-干扰素组、微卡组、联合组外周血T细胞亚群CD8＋比例和IL4含量变化值显著低于基础用药组（P〈0．05）；与γ-干扰素组、微卡组比较，联合组变化值降低更显著（P〈0．05）。结论γ-干扰素和微卡能改善肺结核患者的细胞免疫功能。有助于痰菌转阴。促进病灶吸收，增强化疗疗效，是较好的结核病免疫治疗制剂，且两者联用具有协同作用。     

影响肺结核痰菌涂片阳性检出率的有关因素调查报告

目的：调查肺结核病人痰液标本性状对痰涂片检查阳性率的影响因素,为提高痰检质量提供参考依据。方法：采用世界卫生组织（WHO）所推荐的标准Ziehl—Neelsen法。结果：干酪样痰336例,查痰菌阳性182例,阳性率为54．2％;血痰148例,查痰菌阳性47例,阳性率为31．8％;黏液痰3154例,查痰菌阳性889例,阳性率为28．2％;唾液1308例,查痰菌阳性30例,阳性率为2．3％;不同性状痰液的涂阳检出率有显著性差异（x^2=759．7,P〈0．005）。结论：痰涂片镜检是发现结核病传染源最主要的手段,痰涂片的质量是提高结核病检出率的关键。     

湖南省慈利县2002-2006年肺结核病人中HIV感染哨点监测结果

目的监测慈利县活动性肺结核病人艾滋病毒（HIV）感染流行趋势，为制定艾滋病预防控制规划提供依据，为预防效果的评价提供准确信息。方法采用酶联免疫吸附试验（ELISA）对哨监测点的活动性肺结核病人进行HIV初筛，初筛阳性者采用蛋白印迹（WB）实验确认。结果2100例肺结核病人中，HIV感染者9例，占0．43％。男性组感染率0．44％，女性组感染率0．41％，差异无统计学意义（x^2=0．0004，P〉0．05）。感染者年龄在25—67岁，痰结核菌涂片阳性和阴性的肺结核HIV感染率分别为0．16％和0．82％，差异有统计学意义（x^2=5．19，P〈0．05）。结论应重点加强肺结核病人的HIV哨点监测，同时对这些高危人群采取干预措施，控制HIV的传播。     

3种方法检测肺结核患者痰标本结果分析

目的比较3种检测方法对肺结核患者痰菌检出率,探索噬菌体生物扩增法提高肺结核病患者结核菌阳性检出率的可行性。方法对同1例肺结核患者的痰标本,采用直接厚涂片法、结核分枝杆菌培养法和噬菌体生物扩增法检测结核分枝杆菌。结果在150例肺结核患者痰标本中,直接厚涂片法检出菌阳26例（检出率为17．3％）,痰结核分枝杆菌培养阳性33例（检出率为22．0％）,噬菌体生物扩增法阳性85例（检出率为56．7％）,噬菌体扩增法阳性检出率高于直接厚涂片法和分枝杆菌培养法（χ^2=51．8,38．8,P〈0．01）。结论噬菌体生物扩增法可提高肺结核病例的痰菌检出率。     

γ-干扰素加全身化疗治疗多耐药肺结核的临床观察

目的：观察全身化疗基础上加γ-干扰素雾化吸人治疗多耐药肺结核的临床疗效。方法：选取32例患者,分为观察组和对照组,对两组患者均给予全身化疗,观察组在化疗同时,雾化吸入γ-干扰素,观察疗效。结果：在治疗6个月和治疗结束,观察组的痰细菌学检查阴转率（分别为75％和100％）均高于对照组,差异有统计学意义（P〈0．05）;治疗结束时,观察组病灶吸收率（93．75％）显著高于对照组（62．50％）,差异有统计学意义（P〈0．05）;观察组空洞缩小率（93．75％）高于对照组（68．75％）,差异无统计学意义（P〉0．05）,观察组症状改善率（68．75％）高于对照组（31．25％）,差异有统计学意义（P〈0．05）。结论：γ-干扰素联合全身化疗治疗多耐药肺结核效果强于单纯全身化疗。     

血小板计数在结核病患者诊治中的意义

目的探讨血小板计数变化在结核病患者诊治中的规律。方法对200例住院结核病患者血小板计数结果作为研究对象、200例非结核病肺部疾病患者血小板计数结果作为研究对照组进行分析；对30例肺结核排菌患者血小板计数结果作为研究对象。结果200例结核病患者中血小板增多者占32．5％，均数为266．4×10^9/L；200例非结核病肺部疾病患者血小板增多者占3．0％，均数为190．3×10^9/L，两者结果比较有统计学差异，P〈0．01。对30例肺结核排菌患者血小板计数量与肺结核排菌量（痰涂片查抗酸菌）、血沉、C反应蛋白的关系，血小板计数随着排菌量（痰涂片查抗酸菌）、血沉、C反应蛋白的增加而增加，个别病人痰涂片查抗酸菌大量排菌时，血小板计数PLT〉700×10。／L以上。结论肺结核患者血小板计数比其他非结核病肺部疾病患者血小板计数结果明显偏高，血小板计数增高与结核病严重程度呈着正相关，因重症肺结核病人的血沉明显加快，C反应蛋白也增高，当重症结核病人的病情得到控制趋于稳定时血小板计数也降到正常范围之内，因此，血小板计数增高在结核病的鉴别诊断及治疗监测当中有一定指导意义。     

2002—2007年益阳市痰液涂片阳性与肺结核检出结果

目的了解2002—2007年益阳市疾病预防控制中心门诊痰液涂片阳性与肺结核患者的检出率，以加强对结核病的防治。方法回顾性分析门诊患者痰液涂片检查结果。痰液涂片采用不需加热的Acid Fast Stain（cold Stain）石碳酸复红染色法。结果2002—2007年各年度痰涂片阳性率分别为16．90％、18．27％、20．83％、21．57％、21.88％、22．03％（P〈0．01）（r=0．985，Y=0．256X-143．285）；后3年痰液涂片阳性率为21．83％，明显高于前3年的阳性率18．83％，两者差异有统计学意义（P〈0．01）。结论益阳市肺结核患病率有上升趋势，应加大预防控制措施的力度。     

奈替米星和司帕沙星联合治疗耐多药肺结核近期疗效分析

目的探讨奈替米星联合司帕沙星治疗耐多药肺结核的近期疗效。方法选择2010年7月至2011年7月我院住院治疗的耐多药肺结核患者356例，随机分为治疗组和对照组2组，各178例，其中治疗组以奈替束星联合司帕沙星治疗为主：对照蛆以氧氛沙星和丁胺卡那霉素治疗为主，治疗3个月后，比较2组患者的近期疗效。结果治疗组强化期及继续期结束后，痰菌阴转率分别为73．0％．91.0％，明显优于对照组的（49．4％和69．1％），P〈0．05，具有统计学意义；2组患者治疗结束后，治疗组总有效率为93．3％，显著高于对照组总有效率84．3％，P〈0．05，具有统计学意义。结论奈替米星联合司帕沙星治疗耐多药肺结核具有安全性高，疗效明确，痰菌转阴速度快，不良反应少的特点，值得临床推广应用。     

住院患者下呼吸道感染病原菌临床调查与分析

目的调查某院住院患者下呼吸道感染病原菌变化情况，为临床治疗提供依据。方法回顾性分析1998年1月-2003年12月住院患者下呼吸道感染痰培养结果。结果共调查患者10970例，痰标本送检率为58．52％，痰培养阳性率为36．54％，共检出病原菌2346株。各年份病原菌检出均以革兰阴性菌为主。平均占64．75％，其中肺炎克雷伯菌居第1位，但检出率逐年下降，构成比差异有显著性（x^2=26．53，P〈0．05）；铜绿假单胞菌占第2位，各年份构成比差异无显著性（x^2=6.608，P〉0.05）；大肠埃希菌居第3位，各年份构成比差异有显著性（x^2=38．48，P〈0．05）。革兰阳性菌占21．87％，以金黄色葡萄球菌为主，其各年份构成比差异有显著性（x^2=21．08，P〈0．05）。真菌占10．95％。结论下呼吸道感染病原菌菌谱是不断变化的，呼吸道感染性病原菌诊断是临床选用有效抗菌药物的重要依据，临床医师应高度重视。     

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.     

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.     

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.     

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.     

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.