三甲基氯化锡中毒4例调查分析

近年来,甲基锡化合物替代铅盐类稳定剂在塑料行业中得到了广泛的应用。由于工艺控制技术难度较高,甲基锡稳定剂在合成过程中,往往含有多种杂质。三甲基氯化锡是甲基锡稳定剂的主要杂质之一,也是引起职业中毒的主要原因。其毒性高,常温下可挥发,主要通过呼吸道、消化道进入体内,主要作用于中枢神经系统,靶器官是边缘系统和小脑,并可引起低血钾。此外,肝功能也可出现一定损伤。值得注意的是,有机锡中毒往往具有1—5d的潜伏期,早期可仅为轻度类神经症状或兴奋表现,症状无特异性,容易误诊为精神病。2008年11月20日我们受理了4例三甲基氯化锡中毒患者的职业病诊断申请,现报告如下。     

一起再生锡回收致三甲基氯化锡中毒5例临床分析

回顾分析一起再生锡回收而导致三甲基氯化锡中毒5例患者的临床资料,其中2例出现中毒性脑病,经过积极治疗病情均好转。5例患者的血锡、尿锡水平与血钾具有相关性。本文病例提示再生锡回收行业需警惕三甲基氯化锡中毒。     

三甲基氯化锡中毒患者健康状况的追踪调查

目的调查6年前发生的三甲基氯化锡中毒患者目前的健康状况。方法整群抽取居住在同一村庄的原三甲基氯化锡中毒患者29人和对照26人作为本次研究的对象。进行问卷调查和神经内科检查,测定与贫血、肝功能、甲状腺功能相关的血液生化指标和性激素水平,并测定头发中锡的含量。结果原三甲基氯化锡中毒患者残留的自觉症状主要为记忆力减退、反应速度慢、头痛、眩晕以及乏力等,原患者中膝腱反射、跟腱反射减弱人数多于对照组。血液生化检测项目以及发锡的含量在患者与对照之间差异无显著性。结论6年前的三甲基氯化锡中毒患者仍残留有对神经系统的影响,但目前血液生化指标和发锡含量未见到与当年中毒的相互关系。     

2例职业性急性三甲基氯化锡中毒误诊分析

目的研究避免职业性急性三甲基氯化锡(TMT)中毒误诊的主要方法。方法对2例职业性急性TMT中毒病例临床资料进行综合分析。结果2例病例以行为异常、情感障碍等精神症状及低钾血症为特征性表现。首诊医师缺乏TMT中毒知识是误诊主要原因。结论有机锡塑料稳定剂作业工人出现神经系统损害、低钾血症应警惕急性TMT中毒。     

急性三甲基锡中毒225例临床分析

急性三甲基锡中毒的临床表现特殊,主要以行为异常、情感障碍等精神症状为主,并发低血钾。本文对225例三甲基锡中毒病例进行了临床分析,并对并发严重低血钾的治疗进行了探讨。     

急性三甲基锡中毒临床特点分析

在无毒或低毒类有机锡热稳定剂中,常含有三甲基锡(TMT).TMT化合物为神经毒物,病变主要在边缘系统和小脑,引起神经细胞变性、坏死;近年发现TMT中毒者低钾血症发生率较高.本文根据收集到的236例病人资料,就急性三甲基锡中毒的临床特点进行分析总结.     

急性有机锡中毒5例报道并文献复习

对某化工厂一起事故的5名急性有机锡中毒患者的临床资料进行回顾分析,有机锡中毒以脑病为主要临床特征,表现为中枢抑制或兴奋症状,可伴有精神障碍、小脑性共济障碍和癫痫发作。低血钾、心律失常伴轻中度肝脏损害是常见的辅助检查异常。早期明确诊断,采取综合措施,预后良好。 更多还原     

急性三甲基氯化锡中毒45例

三甲基氯化锡是一种性能优越的聚氯乙烯热稳定剂,目前在工业生产中应用广泛,可通过呼吸道和完整的皮肤吸收进入体内,如不注意防护容易引起中毒.国内外关于其中毒的临床报道不多.我们从2000年6月～2004年6月共收治了45例急性三甲基氯化锡中毒患者,现分析报道如下.     

某塑料厂一起三甲基氯化锡中毒事故调查分析

目的 调查某塑料厂两名农民工发生中毒的原因。方法 综合分析农民工中毒经过、有关临床资料和现场劳动卫生学调查结果。结果 农民工在受雇生产粒料时加班加点，每天工作长达14小时，车间无系统通风排毒设施，工人无防毒口罩；生产粒料的稳定剂和两名农民工尿中锡含量分别为6．02(mg／kg)和0．076、0．084(mg／L)；两农民工经过2—3日的潜伏期后，相继出现了类似三烷基锡中毒的临床症状，并且都有低血钾及低血钾的临床表现。结论 两名农民工被诊断为“轻度三甲基氯化锡中毒”；建议加大《中华人民共和国职业病防治法》在私营企业中的宣传力度，不能忽视对短期务工者的上岗前职业卫生知识教育。     

亚急性三甲基氯化锡中毒22例临床分析

三甲基氯化锡(trimethyltin chloride, TMT)毒性高,严重中毒可致死亡.国外1978年起共报道三甲基锡中毒事故6起,其中明确为TMT中毒仅1起,中毒22人[1-3].国内最近4年才报道TMT中毒[4-7],中毒人数却远较国外多.职业性中毒于1998年在广东省首次发现,生活性中毒则发生在江西省,如1998年江西龙南、定南等县连续发生被TMT污染的猪油中毒事件,中毒达1 000余人.为进一步探讨亚急性TMT中毒的临床特点、诊断及治疗,特对我院22例住院患者的临床资料进行了回顾性分析,现将结果报告如下.     

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 human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

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.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.