69例经食道心房调搏进行心脏负荷试验的临床评价

本文采用经食道心房调搏进行心脏负荷试验,对冠心病心绞痛、可疑冠心病、健康人三组69人进行临床研究。结果表明,该试验对冠心病心绞痛诊断的敏感性与双倍二级梯运动试验相同,皆为(11/14)78.5％。(指冠心病组)。     

食管调搏超声心动图与食管调搏心电图负荷试验诊断冠心病的对比观察

本文采用食管调搏超声心动图和食管调搏心电图负荷试验,对24例冠心病、11例临床”健康人“进行了自身对比观察,其结果显示:两种方法对诊断冠心病的敏感性、特异性分别为83.3%、81.8%和37.5%、72.7%前者明显优于后者(P<0.005)。认为此法为一种可靠、易行的诊断冠心病的无创新方法。     

食道心房调搏心负荷试验

1967年,Sowton介绍了心房调搏心负荷试验用于冠心病诊断,但这种侵入性方法,未能象运动试验那样普及应用。我院自1981年起开始应用经食道的心房调搏方法,并用心房调搏心负荷试验检查了56例高龄老年人,现将这种方法的具体使用及诊断价值做一介绍。     

运动试验中ST/HR指数对冠心病诊断的应用价值

目的 探讨ST/HR指数对冠心病诊断的准确性;研究ST/HR指数对三支病变诊断的应用价值.方法 172例患者接受次极量平板运动试验和冠状动脉造影检查,观察各例患者运动中心率相关的ST/HR指数的变化及STD观察值与阳性判断标准比较.结果 STD诊断方法 对冠心病诊断的敏感性、特异性为60%、77%;ST/HR指数对冠心病诊断的敏感性、特异性分别为g9%、50%.STD诊断方法 对三支病变的敏感性仅有31%,随着病变程度的加重,ST/HR指数的计算值逐渐增加,ST/HR指数≥3.3 μv/(次·min),在三支病变诊断中的敏感性、特异性分别为78%、74%.两者在敏感性上差异有统计学意义.结论 ST/HR指数与传统运动试验诊断标准相比,对冠心病的诊断具有相似的准确性;对三支痛变有较高的定量预测价值.     

运动心电图与电子束CT联合评价对冠心病的诊断价值

目的　探讨运动心电图 (EET)与电子束 (EBCT)检测的冠状动脉钙化 (CAC)联合评价对冠心病的诊断价值。方法　经选择性冠状动脉造影并于同期行EBCT和EET检查的患者 13 5例 ,记算冠状动脉钙化积分 (CS) ,结合CS和EET评价对冠心病的诊断价值。结果　CS阈值预测冠心病的敏感性、特异性、阳性预测值和阴性预测值分别为 77%、81%、74%和 83 % ;EET阳性预测冠心病的敏感性、特异性、阳性预测值和阴性预测值分别为 73 %、76%、68%和 80 % ;CS阈值和EET综合评价 ,平行试验的敏感性和阴性预测值分别达 93 %和 92 % ,系列试验的特异性和阳性预测值分别达 96%和 91% ,均显著高于单项试验的相应指标 ( P <0 0 5和0 0 1)。结论　电子束CT冠状动脉钙化检测与运动心电图联合评价能显著提高冠心病的诊断价值。     

食管调搏负荷超声心动图在诊断冠心病中的应用

冠心病（CHD）的无创伤性诊断一直是心血管领域探讨的热点课题,节段性室壁运动异常（RVWMA）是超声心动图（UCG）诊断CHD的特异性指标,有文献表明这种异常先于心电异常。为探讨食管调搏负荷超声心动图试验（TEAPL-UCG）在诊断冠心病中的价值,作者对60例临床疑诊CHD患者,进行了负荷UCG（TEAPL-UCG）检查,并与静息状态下的超声心动图（rest-UCG）和食管调搏负荷心电图（TEAPL-ECG）试验进行了比较,结果报告如下。     

运动平板试验在冠心病诊断中的临床应用价值

目的评价运动平板试验在冠心病诊断中的临床应用价值。方法选择700例可疑冠心病患者分别行运动平板试验及冠状动脉造影,将两检查结果进行比较。结果运动平板试验对冠心病诊断的敏感性为89.2%,特异性为58.7%,阳性预测率为65.2%,阴性预测率为86.3%,准确度为72.9%。结论运动平板试验是一种安全、无创、价廉、可靠的诊断方法。     

药物负荷脉冲多普勒组织成像早期诊断冠心病

目的联合使用脉冲组织多普勒成像（PW—TDI）和潘生丁负荷试验对左室局部纵向心肌的舒缩功能进行定量分析,为早期诊断冠心病提供可靠依据。方法选择冠心病患者77例,设正常对照组25例,均经冠状动脉造影证实。应用PW—TDI分别测量两组静息状态及潘生丁负荷状态下左室各壁基底段和中段Vs、Ve、Va及RIVRT。结果单纯应用脉冲多普勒组织成像,冠心病组Vs、Ve、e／a较对照组减低,R／VRT较对照组延长且有显著性差异（P〈0．05）,诊断冠心病敏感性79．3％、特异性71．6％。潘生丁负荷状态下,两组对应数据差异均明显增大（P〈0．01）,诊断冠心病敏感性81．8％、特异性87．1％。结论PW—DTI结合潘生丁负荷实验对冠心病的早期诊断有值得肯定的应用价值。     

无创心脏血流动力监测联合被动抬腿试验对容量反应性的预测价值

目的评价无创心脏血流动力监测联合被动抬腿试验(PLR)预测ICU危重病患者容量反应性的价值。方法选择36例需容量复苏的危重病患者,根据对容量负荷试验的反应(以容量负荷试验后△CVP≤2 mm Hg者为有反应)将患者分为有反应组和无反应组,评价无创心脏血流动力监测联合PLR预测容量反应性的价值。结果 PLR与容量负荷试验后两组SV均增加,反应组SV增加幅度明显大于无反应组(P0. 05);无创心脏血流动力监测联合PLR预测容量反应性的敏感性为50. 0%(95%CI 29. 1～70. 9%),特异性为88. 2%(95%CI 63. 6～98. 5%),无创心脏血流动力监测联合容量负荷预测容量反应性的敏感性为79. 2%〔95%CI(57. 8～92. 9)%〕,特异性为82. 4%〔95%CI(56. 6～96. 2)%〕;两者ROC曲线下面积(AUC)比较差异无统计学意义(P0. 05)。结论无创心脏血流动力监测联合PLR预测容量反应的价值不优于无创心脏血流动力监测联合容量负荷试验。     

冷加压超声心动图试验对老年冠心病的诊断意义

本文报道20例老年冠心病及10例健康老年人(对照组),在采用一种静态心脏负荷试验即CPT过程中,观察UCG变化,计算出PCWP、LVEDP、SV、EF等项左室功能指标。结果老年冠心病组CPT后PCWP、LVEDP升高,EF斜率变慢;SV、EF降低;而对照组各项指标呈相反改变,两组间各指标差恢显著增大。以健康老年指标又±1.645SD为冠心病诊断标准,LVEDP敏感性95%,特异性100%,准确性90%;EF敏感性85%,特异性100%,准确性90%。左室舒张功能指标较收缩功能指标敏感性更高。认为CPT—UCG试验作为冠心病诊断的辅助方法,具有一定实用价值。     

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.     

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.