气相色谱-质谱联用法测定饮用水中邻苯二甲酸酯类物质

[目的]建立一种测定饮用水中邻苯二甲酸酯的气相色谱质谱方法。[方法]饮用水中邻苯二甲酸酯被二氯甲烷萃取，萃取液浓缩后进行气相色谱-质谱分析，以选择离子监测方式分析，定量则以同位素内标法测定。[结果]邻苯二甲酸二甲酯、邻苯二甲酸二乙酯、邻苯二甲酸二丁酯、邻苯二甲酸二（2-乙基己基）酯、邻苯二甲酸二正辛酯的线性范围分别为50-400μg／L、50～400μg／L、50-400μg／L、200～1600μg／L、200～1600μg／L，相关系数均在0．99以上，低、高2种浓度加标回收率均在78．2％～92．5％之间，相对标准偏差均小于10％，5种邻苯二甲酸酯的最低检出浓度分别为0．1μg／L、0．1μg／L、0．1μg／L、0．3μg／L、0．3μg／L。对20份饮用水进行了测定，20份水样均检出了邻苯二甲酸二丁酯，其中11份水样检出了邻苯二甲酸二（2-乙基己基）酯。[结论]方法适合于饮用水中邻苯二甲酸酯的测定。     

肝炎后肝硬化与酒精性肝硬化患者临床特征的比较及防治

目的在肝硬化患者中,肝炎后肝硬化、酒精性肝硬化属于两种最为常见的肝硬化类型。本文将基于二者的一系列临床特征展开相应的探讨,以期为后续治疗提供理论基础。方法以30例肝炎后肝硬化患者（A组）以及30例酒精性肝硬化患者（B组）为研究对象,对其临床特征展开全面而综合的比较分析。结果①男性患者居多,A组为60％,B组为86．67％,P〈0.05;在年龄方面,A组（58．7±7．5）岁,B组（52．8±5．4）岁,P〈0．05;在病程方面,A组为（6．9±3．6）年,B组为（6．0±2．8）年,P〉0．05。②在肝掌、蜘蛛痣、男性乳房发育、肝大的发生率方面,A组分别为26．67％、26．67％、0％、6．67％,B组分别为73．33％、80％、13．33％、46．67％,P〈0．05;在脾大、黄疸、腹水的发生率方面,A组分别为、60％、13．33％、80％,B组分别为53．33％、13．33％、80％,P〉0．05。③在肝肾综合征、原发性肝癌的发生率方面,A组分别为13．33％、26．67％,B组分别为6．67％、13．33％,P〈0．05;在上消化道出血、肝性脑病的发生率方面,A组分别为33．33％、20％,B组分别为40％、26．67％,P〉0．05。④在GGT、AST／ALT、ALP方面,A组分别为（63．9±10．3）U／L、（1．02±0．23）、（119．7±25．4）U／L,B组分别为（139．5±48．0）U／L、（1．99±20．54）、（215．8±46．6）U／L,P〈0．05;在A／G、TBIL方面,A组分别为（0．82±0．11）、（47．4±25．7）μmol／L,B组分别为（0．87±0．23）、（49．5±27．4）0,mol／L,P〈0．05。结论结合A组和B组患者各自的临床特征,予以目的明确的防治措施,能够获得较为理想的防治效果。     

单剂吗啡鞘内注入于小儿术后镇痛的应用

目的：探讨单剂吗啡鞘内注入行小儿术后镇痛的可行性及安全性。方法：选择3～7岁腰麻患儿60例，随机等分成A、B、C 3组，腰麻药中含吗啡为A组0μg／kg，B组2μg／kg，C组4μg／kg。记录术后12h内患儿、其家属、病房护士疼痛评分，观察不良反应发生情况。结果：术后12h疼痛评分，A组明显高于B组（P〈0．05）和C组（P〈0．01）。B组与C组比较差异无统计学意义（P〉0．05），C组不良反应较A、B组多。结论：小儿单次小剂量吗啡鞘内注入行术后镇痛是安全有效的，2μg／kg能较好地满足镇痛要求。     

慈溪市高中寄宿学生维生素营养状况评价

目的了解慈溪市高中寄宿生维生素营养状况，并针对出现的问题提出改进措施。方法采用5d称重法和调查问卷法，对慈溪市2所寄宿制高中1990名学生进行膳食营养调查，随机抽73名学生测定尿中维生素B1、维生素B2、维生素C、肌酐质量浓度，并进行维生素营养评价。结果学生的能量、蛋白质、维生素B1，维生素C摄入量均超过推荐摄入量的80％，能够满足机体需要；维生素B2摄入量不足，只占到RNIs的64．3％；73名学生尿维生素B1、维生素B2、维生素C、肌酐的平均质量浓度分别为48.0μg／L，8.9μg／L，12.4mg／L和0.29g／L，维生素B1、维生素B2、维生素C不足率分别为6．9％，83.6％和4．1％。结论为保证高中寄宿生的维生素营养，应改善膳食结构，加强营养教育，采取营养干预措施。     

高血糖对老年急性心肌梗死患者临床和预后的影响

目的观察血糖升高对老年急性心肌梗死（AMI）患者临床和预后的影响。方法选取老年AMI患者223例,根据人院第一次随机血糖分为3组,A组〈7．8mmol／L．B组7．8～11．0mmol／L,C组≥11．0mmol／L。A组为血糖正常组,B、C组为血糖升高组。结果入院随机血糖高的患者,平均年龄较大,A组与B组、C组年龄相比[（68．8±7．5）岁比（71．6±7．3）岁、（74．3±7．1）岁,P〈0．05]。C组与A组相比血甘油三酯[（1．57±0．83）mmol／L比（1．31±0．63）mmol／L,P〈0．05],尿酸[（360．2±172．3）μmol／L比（273±8613）μmol／L,P〈0．05],肌酐[（125．2±90．5）μmol／L比（85．7±23．6）μmol／L,P〈0．05]浓度较高。与A组比较,B、C组复合壁心肌梗死多见（38．9％比59．7％、66．7％,P〈0．05）。C组与A组相比左室射血分数（43．5±6．37）％比（58．5±8．36）％,P〈0．05）较低。与A组比较,B、C组患者溶栓再通率低（54．8％比40．6％、28．6％,P〈0．05）,冠脉造影提示支血管病变多见（51．6％比73．7％、69．2％,P〈0．05）;C组比A组并发心力衰竭多见（35．4％比15．9％,P〈0．05）,住院病死率（20．8％比4．5％,P〈0．05）增加。结论老年AMI患者入院随机血糖升高,提示病情重、梗死面积大、并发症多、预后差及病死率高。     

上海市948名中小学生贫血现况及其相关因素

目的 了解上海市中小学生的贫血患病率及其影响因素，为防制中小学生贫血提供依据。方法 选取6～17岁中小学生共948人，采用氰化高铁法测定其血红蛋白，并按照WHO推荐的贫血诊断标准对其进行贫血筛查。同时，选取100名贫血学生与正常学生进行1：1配对，空腹静脉采血后测定其血清铁、总铁结合力、运铁蛋白饱和度，叶酸、维生素B12、血铜及血铅含量，对结果进行统计分析。结果 中小学生贫血患病率为21．6％，其中郊区为24．3％，市区为17．2％。贫血组与对照组运铁蛋白饱和度分别为19．5％和35．9％，血清铁分别为13．9μmol／L和23．5μmol／L，总铁结合力分别为76．3μmol／L和66．5μmol／L，维生素B12分别为380．7pmol／L和348．2pmol／L，叶酸分别为16．5nmol／L和15．8nmol／L，血铅分别为123．2μg／L和99．5μg／L，血铜974．8μg／L和1001．1μg／L。结论 上海市中小学生目前的贫血患病率较高，铁缺乏是贫血的主要原因，且铅过载可能对上海中小学生贫血的发生有一定的影响。     

药物治疗输卵管妊娠三种不同方法的临床观察

目的观察甲氨蝶呤、甲氨蝶呤联合米非司酮和中药治疗输卵管妊娠的疗效及孕酮水平变化。方法将97例输卵管妊娠患者按治疗方法不同为3组,A组33例MTX（50mg／m^2）单次肌内注射,同时服中药7d,B组34例MTX（50mg／m^2）单次肌内注射,C组30例MTX（50mg／m^2）单次肌内注射,24h后口服米非司酮200mg,1次／d,共3次。3组均定期监测血β-hCG及孕酮水平,B超监测包块缩小情况。分析3组疗效。结果A、B、c组治愈率分别为78．8％,67．6％,80％,差异均无统计学意义（P〉0．05）。B组中血孕酮〈31．71nmol／L和血孕酮≥31．71nmol／L的治愈率差异有统计学意义。包块缩小时间,A组优于B、c组,差异有统计学意义（P〈0．05）。结论对血β—hCG〈2000U／L的输卵管妊娠单用MTX（50mg／m^2）单次肌肉注射疗程简单、效果好、副反应少;对孕酮≥31．7nm／1的输卵管妊娠应选用MTX、米非司酮联合用药,使β-hCG在更快的时间内降至正常水平,而MTX配合中药联合治疗．使包块的吸收更快。     

肝硬化患者血栓调节蛋白、抗凝及纤溶系统的变化与Child-Pugh分级的关系

目的探讨肝硬化患者血栓调节蛋白（TM）、抗凝及纤溶系统指标的变化及其与Child-Pugh分级的关系。方法肝硬化患者77例，按Child-Pugh分级进行分组：A级组12例，B级组32例，C级组33例；对照组20例。均检测TM、抗凝血酶-Ⅲ（AT-Ⅲ）、蛋白-C（PC）、蛋白-S（PS）、D-二聚体、组织纤溶酶原激活物（t-PA）和纤溶酶原激活物抑制剂-1（PAI-1）。结果在对照组、A级组、B级组、C级组中，TM随病情加重而升高，分别为（4．24±0．81）μg／L、（4．36±2．56）μg／L、（6．66±3．30）μg／L、（6．79±3．69）μg／L；AT-Ⅲ随病情加重而逐渐降低，分别为（102．35±8．12）％、（105．46±8．71）％、（102．09±8．39）％、（94．32±9．85）％；PC和PS随病情加重而有逐渐减低的趋势；D-二聚体随病情加重而逐渐增高，分别为（0．27±0．13）mg／L、（0．42±0．26）mg／L、（0．79±0．35）mg／L、（0．93±0．43）mg／L；t-PA和PAI-1随肝功能恶化而变化的现象不明显。结论肝硬化患者的TM、抗凝和纤溶系统指标存在明显的异常且和Child-Pugh分级相关。检测以上指标有助于对肝功能损害程度及预后的判断。     

胰岛素强化治疗对不同病程的2型糖尿病胰岛功能的影响

目的 观察不同病程的2型糖尿病患者胰岛素强化治疗2周后胰岛功能的变化。方法 将74例确诊的2型糖尿病患者按病程分成三组：A组25例，病程＜5年；B组25例，病程5～10年；C组24例，病程＞ 10年。对三组患者均采用胰岛素泵连续皮下输注，对比治疗前后血糖、C肽水平。结果 治疗后三组患者血糖均显著下降(P＜0.01)，胰岛功能变化不一:A组治疗前空腹C肽(2.30±1.08)μg/L、餐后2h C肽(9.09±5.41)μg/L，治疗后分别为(2.76±0.83)、( 10.95±4.80)μg/L，空腹C肽、餐后2h C肽均有明显改善(P＜0.01)；B组治疗前空腹C肽(2.26±0.96)μg/L、餐后2h C肽(8.31±4.25) μg/L，治疗后分别为(2.46±0.93)、(8.55±3.49)μg/L，空腹C肽有明显改善(P＜0.01)，餐后2h C肽无明显改善(P＞0.05)；C组治疗前空腹C肽(2.18±0.78)μg/L、餐后2h C肽(8.16±2.69)μg/L，治疗后分别为(2.29±0.71)、(8.20±2.47)μg/L，空腹C肽、餐后2h C肽均无明显改善(P＞0.05)。结论 不论病程长短，2型糖尿病患者经胰岛素泵强化治疗均可明显降低血糖；病程≤10年的患者胰岛功能可不同程度地得到改善，其中病程＜5年的患者收益最多，病程越长，收益越少；病程＞ 10年的患者胰岛功能没有得到改善，已发生不可逆的衰退。     

激素替代冻融胚胎移植第 6 天血清孕酮与临床结局的关系

目的：探讨在激素替代冻融胚胎移植（FET）周期中,移植第6天血清孕酮与FET临床结局的关系。方法：回顾性分析行激素替代FET261个周期的临床资料。依据移植第6天血清孕酮水平分组,A组（孕酮〈20μg／L）,B组（20μg／L≤孕酮〈30μg／L）,C组（孕酮≥30μg／L）,比较各组临床特征、妊娠率及流产率的差异。同时根据FETT床结局分为D组：宫内活胎组,E组：妊娠结局不良组,F组：未妊娠组,比较各组移植第6天血清雌激素、孕激素水平的差异。结果：C组妊娠率（50％）明显高于B组妊娠率（28．5％）,B组妊娠率高于A组妊娠率（11．1％）,差异有统计学意义（P〈O．05）;A组流产率（60％）高于C组（18％）,差异有统计学意义（P〈0．05）;移植第6天血清孕酮水平D组和E组高于F组,差异有统计学意义（P〈O．05）。结论：在激素替代FET周期中移植第6天血清孕酮水平对FET临床结局有一定的预测性,血清孕酮值越高妊娠结局越好,且流产率更低。     

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.     

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.     

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.     

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.