血清降钙素原联合C反应蛋白对儿童川崎病并发冠状动脉损害的预测价值

目的探讨儿童川崎病急性期血清降钙素原(PCT)水平联合血清C反应蛋白(CRP)水平,对并发冠状动脉损害(CAL)的预测价值。 方法选取2015年11月1日至2016年12月31日,于重庆医科大学附属儿童医院确诊为川崎病后,接受规范化治疗,并且符合本研究纳入、排除标准的217例川崎病患儿为研究对象。采用回顾性分析方法,收集所有患儿的性别、年龄等一般临床资料,血清PCT、CRP水平检测结果,以及川崎病发病后30 d内的超声心动图检查结果。根据217例患儿川崎病急性期是否并发CAL,将其分别纳入CAL组(n＝72)和非CAL组(n＝145)。采用Mann-Whitney U检验,比较2组患儿的血清PCT、CRP水平。采用χ²检验,比较2组患儿的血清PCT、CRP阳性率。采用二元logistic回归分析方法,构建血清PCT与CRP水平预测川崎病患儿并发CAL的联合预测因子L。绘制联合预测因子L及血清PCT、CRP水平预测川崎病患儿并发CAL的受试者工作特征(ROC)曲线,计算ROC曲线下面积(ROC-AUC),根据约登指数最大原则,确定联合预测因子L及血清PCR与CRP水平预测川崎病患儿并发CAL的最佳临界值,同时计算预测川崎病患儿并发CAL的敏感度、特异度。2组患儿性别构成比、年龄等一般临床资料比较,差异均无统计学意义(P>0.05)。 结果①CAL组与非CAL组患儿血清PCT水平中位数分别为1.16 μg/L与0.04 μg/L,血清CRP水平中位数分别为25.0 mg/L与16.4 mg/L,2组患儿血清PCT、CRP水平比较,差异均有统计学意义(Z＝－2.454,P＝0.046;Z＝－6.412,P<0.001)。2组患儿血清PCT、CRP阳性率分别比较,差异均无统计学意义(χ²＝1.222,P＝0.269;χ²＝0.665,P＝0.415)。②以川崎病患儿是否并发CAL作为二分类结局变量,血清CRP、PCT水平作为自变量,建立二元logistic回归方程的结果显示,血清CRP、PCT水平升高,均为川崎病患儿并发CAL的独立危险因素(OR＝1.077,95%CI：1.027～1.190,P<0.001;OR＝1.046,95%CI：1.015～1.078,P＝0.003)。构建的联测预测因子L的表达式为：L＝x₁＋0.608x₂,其中x₁、x₂分别是指血清CRP、PCT水平。③ROC曲线分析结果显示,联合预测因子L及血清PCT、CRP水平,对预测川崎病患儿并发CAL的ROC-AUC分别为0.773(95%CI：0.700～0.845,P<0.001),0.560(95%CI：0.475～0.645,P＝0.148)和0.767(95%CI：0.695～0.839,P<0.001)。根据约登指数最大原则,联合预测因子L及血清PCT、CRP水平,预测川崎病患儿并发CAL的最佳临界值分别为23.068、2.32 μg/L和22.0 mg/L,此时其预测川崎病患儿并发CAL的敏感度分别为68.1%、30.6%、68.1%,特异度分别为83.4%、86.9%、80.7%。 结论监测儿童川崎病急性期血清PCT、CRP水平及其联合预测因子L值(L＝x₁＋0.608x₂,其中x₁、x₂分别是指血清CRP、PCT水平),对儿童川崎病急性期并发CAL具有预测价值。     

川崎病患儿并发冠状动脉病变相关危险因素与治疗分析

目的分析川崎病患儿并发冠状动脉病变(CAL)相关危险因素与治疗情况。方法回顾性分析2016年5月-2018年5月该院治疗的159例川崎病患儿的临床资料,将合并CAL的54例患儿设为CAL组,未合并CAL的105例患儿设为NCAL组,分析两组患儿临床资料,统计两组患儿年龄、性别、发热持续时间、临床诊断情况、血红蛋白(Hb)、白细胞计数(WBC)、C-反应蛋白(CRP)、血小板计数(PLT)、红细胞沉降率(ESR)等检测结果。结果 CAL组年龄≤2岁患儿占比、男性患儿占比均高于NCAL组(P0. 05);与NCAL组相比,CAL组Hb水平相对较低,CRP50 mg/L患儿占比相对较高(P0. 05);患儿性别为男性、CRP50 mg/L、Hb水平降低为诱发CAL高危因素(P0. 05); 159例川崎病患儿确诊后均实施了丙种球蛋白、阿司匹林治疗,且针对血小板升高、伴有冠脉损伤者则加以维生素E、双嘧达莫等治疗,经积极对症治疗后小儿病情已获显著改善。结论川崎病患儿并发CAL相关危险因素主要有男性患儿、Hb水平降低、CRP50mg/L,早期诊断并实施科学有效治疗有助于促进患儿病情转归、减少冠脉损伤。     

静脉注射丙种球蛋白治疗不完全川崎病血清sFas水平变化

目的 观察血清sFas水平在静脉注射丙种球蛋白(IVIG)治疗不完全川崎病(IKD)前后的变化,探讨sFas在IKD中的发病机制和IVIG治疗的作用机制.方法 选取IKD患儿38例,另选同期本院外科住院的斜疝术前患儿(9例)及门诊健康体检儿童(11例)共20例为对照组.IKD患儿予IVIG联合阿司匹林(ASP)治疗,分别于治疗前、治疗后3、14 d取血备检,采用双抗夹心酶联免疫吸附试验(ELISA)检测血清sFas的水平.同时检测血浆纤维蛋白原(PT-D)、D二聚体(D-D)和C反应蛋白(CRP)含量.结果 IKD患儿治疗前血sFas、PT-D、D-D、CRP水平明显高于对照组[(0.55±0.14) ng/L vs(0.24±0.04) ng/L,(552.3±147.2)mg/dl vs(277.3±82.5)mg/dl,(649.0±201.6) μg/L vs (315.4±91.8) μg/L,(72.2±28.7)mg/L vs (7.2±2.9) mg/L;t'=12.41,9.11,8.64,13.82;P＜0.05];治疗后3d,IKD患儿血sFas水平明显下降,分别与治疗前及对照组比较差异有统计学意义[(0.43±0.09) ng/L vs(0.55 ±0.14)ng/L、(0.24±0.04) ng/L,F=47.624,P＜0.05];治疗后14 d,IKD患儿血sFas水平与对照组比较差异统计学无意义[(0.24±0.05) ng/L vs(0.24±0.04) ng/L,t=0.596,P＞0.05].结论 IVIG治疗前血sFas水平异常增高,提示细胞凋亡功能紊乱参与了IKD的发病机制,IVIG的治疗作用可能参与细胞凋亡过程.     

不完全型川崎病的临床分析

目的 分析不完全型川崎病(IKD)的临床特点.方法 回顾性分析46例川崎病(1(I))患者的临床资料,对14例IKD患者(IKD组)与32例典型KD(CKD)患者(CKD组)的主要临床表现、辅助检查结果、冠状动脉病变(CAL)发生率和静脉免疫球蛋白(IVIG)无反应型KD的发生率进行比较.结果IKD组与CKD组年龄和性别构成比较差异无统计学意义(P>0.05).IKD组发热时间为(11.43±9.12)d,CKD组为(7.12±2.83)d,两组比较差异有统计学意义(P<0.05).IKD组结膜充血发生率为57.14%(8/14),颈部淋巴结肿大发生率为28.57%(4/14),手足硬肿发生率为35.71%(5/14).口腔黏膜病变的发生率为42.86%(6/14),低于CKD组的93.75%(30/32)、59.38%(19/32)、78.12%(25/32)和75.00%(24/32),差异均有统计学意义(P<0.01或<0.05).两组辅助检查结果和CAL的发生率比较差异无统计学意义(P>0.05).IKD组MG无反应型KD的发生率为40.00%(4/10),高于CKD组的6.45%(2/31),差异有统计学意义(P<0.05).结论 尽管IKD临床症状隐匿,结膜充血、手足硬肿和口腔黏膜病变的发生率较低,但辅助检查结果与发生CAL的风险与CKD类似.此外,IKD对WIG治疗不敏感,应引起临床医生的重视.     

抗中性粒细胞抗体在不完全川崎病早期诊断中的价值

目的探讨抗中性粒细胞抗体(Anti-Neutrophil Cytoplasmic Antiboby,ANCA)对不完川崎病(Incomplete Kawasaki Disease,IKD)的诊断价值。方法检测20例IKD患儿急性期和恢复期的ANCA,并检测急性期外周血象、C-反应蛋白(CRP)、血沉(ESR)及心脏彩超等。同期住院25例呼吸道感染患儿作为对照组。结果不完全川崎病组急性期血清ANCA阳性率明显高于对照组及恢复期,并显著高于并发冠脉病变的阳性率,ANCA阳性组急性期CRP值显著高于ANCA阴性组,而ESR、WBC、PLT无统计学差异(p>0.05)。结论检测ANCA有助于IKD患儿的早期诊断。     

血液灌流辅助治疗儿童过敏性紫癜的临床价值

目的探讨血液灌流辅助治疗儿童过敏性紫癜(HSP)的临床价值及治疗指征。 方法选择2013年4月至2015年4月,于成都市妇女儿童中心医院住院治疗的239例HSP患儿为研究对象。根据患儿疾病严重程度和是否采用血液灌流治疗,将其分为4组：轻症观察组(n＝76,为轻症HSP患儿,采用常规治疗＋血液灌流),轻症对照组(n＝84,为轻症HSP患儿,采用常规治疗),重症观察组(n＝47,为重症HSP患儿,采用常规治疗＋血液灌流)及重症对照组(n＝32,为重症HSP患儿,采用常规治疗)。常规治疗包括抗炎、抗过敏、抗凝及对症处理,血液灌流为辅助治疗。回顾性分析239例HSP患儿病例资料,对2组轻症或2组重症HSP患儿急性期治疗后临床症状改善情况等近期疗效指标,以及1年内皮疹复发率及肾脏损害发生率2项远期疗效指标,采用t检验或χ²检验就行统计学比较。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》,并与患儿家属签订知情同意书。 结果①重症观察组HSP患儿腹痛及血便消失时间、关节肿痛消失时间及皮肤紫癜减轻时间[(4.8±0.6) d、(3.0±0.7) d、(3.4±0.8) d],均短于重症对照组[(5.8±0.5) d、(4.2±0.8) d、(4.5±0.7) d],并且差异均有统计学意义(t＝15.499、7.060、6.040,P<0.001);对2组重症HSP患儿随访1年的皮疹复发率及肾脏损害发生率比较,差异均无统计学意义(P>0.05)。2组轻症HSP患儿上述5项指标比较,差异均无统计学意义(P>0.05)。②重症观察组HSP患儿治疗第7天时,尿微量白蛋白、转铁蛋白、α1微球蛋白、β2微球蛋白,血清白细胞介素(IL)-1及肿瘤坏死因子(TNF)-α水平[(20.6±15.0) mg/L、(6.6±0.6) mg/L、(8.0±1.0) mg/L、(0.32±0.23) mg/L、(6.9±1.6) mg/L、(9.6±2.9) mg/L],均低于重症对照组[(38.4±10.4) mg/L、(9.0±1.0) mg/L、(10.2±1.7) mg/L、(3.50±1.40) mg/L、(8.3±1.7) mg/L、(12.9±2.8) mg/L],并且差异均有统计学意义(t＝5.804、13.191、6.686、15.286、3.823、5.004,P<0.001)。2组轻症HSP患儿治疗第7天时上述6项指标比较,差异均无统计学意义(P>0.05)。 结论血液灌流辅助治疗可缓解重症HSP患儿临床症状、减轻急性肾损伤,但是对轻症或重症HSP患儿皮疹复发及肾脏损伤,尚未发现有预防作用。建议血液灌流仅用于重症HSP患儿的辅助治疗。     

早产儿高胆红素血症与肾损伤的关系研究

目的探讨早产儿高胆红素血症与肾损伤的关系。 方法选择2015年3～9月,在宜宾市第一人民医院新生儿科住院治疗的20例早产儿高胆红素血症患儿(黄疸组)及15例无高胆红素血症早产儿(对照组)为研究对象,并根据早产儿入院时血清总胆红素(TSB)浓度,将黄疸组进一步分为轻度黄疸亚组(n＝9)和重度黄疸亚组(n＝11)。采集受试者静脉血及尿液检测TSB浓度、血清胱抑素C、尿微量白蛋白(mAlb)、尿α₁-微球蛋白(MG)及尿β₂-MG含量。统计学比较黄疸组与对照组间TSB浓度、血清胱抑素C及上述3项尿微量蛋白含量差异,黄疸组不同类型肾损伤早产儿胎龄、出生体重、TSB浓度、日龄、病程及生后首次出现黄疸时间差异,以及黄疸组患儿各临床观察指标间相关性。本研究遵循的程序符合宜宾市第一人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象监护人知情同意,并与监护人签署临床研究知情同意书。黄疸组与对照组患儿性别构成比、胎龄、出生体重及日龄比较,差异均无统计学意义(P>0.05)。 结果①轻度和重度黄疸亚组的尿mAlb[(13.3±7.8) mg/L、(15.1±11.9) mg/L],尿α₁-MG[(21.2±12.9) mg/L、(15.6±11.5) mg/L]及尿β₂-MG[(5.6±3.7) mg/L、(5.3±3.8) mg/L]含量均分别较对照组高[(6.8±2.3) mg/L、(8.0±2.5) mg/L、(1.3±1.0)mg/L],且差异有统计学意义(P<0.05);但轻度与重度黄疸亚组的上述3项尿微量蛋白指标比较,差异则无统计学意义(P>0.05)。轻度、重度黄疸亚组及对照组之间血清胱抑素C含量比较,差异均无统计学意义(P>0.05)。②单纯肾小管损伤、混合型肾损伤及无肾损伤患儿的胎龄、出生体重和TSB浓度比较,差异均无统计学意义(P>0.05)。单纯肾小管损伤患儿的日龄、病程和生后首次出现黄疸时间[(4.1±3.1) d、(1.3±0.8) d、(2.9±2.3) d]均分别较无肾损伤患儿[(14.6±8.2) d、(6.2±3.8) d、(8.4±4.9) d]小、短和早,混合型肾损伤患儿的生后首次出现黄疸时间[(3.8±2.2) d]较无肾损伤患儿早,单纯肾小管损伤患儿的日龄和病程较混合型肾损伤患儿[(9.8±6.6) d、(6.0±5.5) d]小和短,上述差异均有统计学意义(P<0.05)。③黄疸组患儿尿mAlb和尿α₁-MG之间(r＝0.822),尿mAlb和尿β₂-MG之间(r＝0.769),以及尿α₁-MG和尿β₂-MG之间(r＝0.660)均呈直线正相关关系(P<0.001)。尿α₁-MG及尿β₂-MG与生后首次出现黄疸时间均呈直线负相关关系(r＝－0.534、－0.508,P<0.05)。 结论早产儿高胆红素血症可导致肾损伤,日龄、病程和生后首次出现黄疸时间可能与肾损伤类型相关。3项尿微量蛋白联合检测,可作为早产儿高胆红素血症性肾损伤的早期诊断指标。     

大剂量丙种球蛋白治疗小儿川崎病的效果观察

目的探究大剂量丙种球蛋白在小儿川崎病治疗中的应用效果。方法选择2014年12月—2017年1月收治的川崎病患儿90例,根据随机数字表法分为两组,每组45例。给予对照组常规剂量的丙种球蛋白治疗,观察组予以大剂量丙种球蛋白治疗,比较两组临床疗效。计量资料比较采用t检验,计数资料比较采用χ~2检验,P0.05为差异有统计学意义。结果观察组手足肿胀消失时间、淋巴结消肿时间、结黏膜充血消失时间及退烧时间[(2.64±1.12)、(2.56±0.76)、(2.34±1.12)、(3.04±1.24)d]均短于对照组[(3.98±1.42)、(4.36±1.03)、(3.42±1.34)、(4.67±1.68)d],差异具有统计学意义(均P0.05);两组治疗后IgG、CRP及ESR指标均有明显的改善,且观察组IgG、CRP及ESR指标[(14.26±0.72)g/L、(15.26±4.61)mg/L、(29.56±11.34)mm/h]优于对照组[(11.78±0.71)g/L、(23.64±7.32)mg/L、(42.67±12.51)mm/h],差异具有统计学意义(均P0.05)。结论在小儿川崎病治疗中使用大剂量丙种球蛋白可有效提高治疗效果,改善患儿各项免疫细胞指标,缩短临床症状体征消退时间。     

丙戊酸钠联合左乙拉西坦治疗儿童癫痫的疗效及其对血清S-100β与高迁移率族蛋白-1的影响

目的探讨丙戊酸钠联合左乙拉西坦治疗儿童癫痫(children epilepsy)的疗效，以及对患儿血清S-100β与高迁移率族蛋白(HMGB)-1的影响。 方法选择2016年7月至2018年10月，在内蒙古包钢医院诊断为儿童癫痫的160例患儿为研究对象。采用随机数字表法，将其随机分为研究组(n＝80)与对照组(n＝80)，对其癫痫发作分别采取丙戊酸钠联合左乙拉西坦治疗与仅用丙戊酸钠的治疗策略。治疗16周后，评价2组患儿癫痫发作治疗有效率及改善脑电图痫样放电治疗有效率，并采用χ²检验进行统计学比较。治疗前、后，对2组患儿炎症相关指标进行检测，包括血清肿瘤坏死因子(TNF)-α，高敏C反应蛋白(hs-CRP)，同型半胱氨酸(Hcy)水平及血细胞比容(HCT)与红细胞沉降率(ESR)，以及血清S-100β与HMGB-1水平。对上述指标治疗前、后组内比较，采用配对t检验；组间比较，采用成组t检验。2组患儿治疗过程中不良反应率比较，采用χ²检验。本研究遵循的程序符合内蒙古包钢医院伦理委员会要求，并获得批准(审批文号：BG201606073)，与所有受试儿监护人签署临床研究知情同意书。2组患儿性别构成比、年龄、病程、治疗前癫痫每年发作次数、治疗前脑电图痫样放电发生率及癫痫发作类型构成比等一般临床资料比较，差异均无统计学意义(P>0.05)。 结果①治疗后，研究组患儿癫痫发作的治疗有效率、改善脑电图痫样放电治疗有效率分别为92.5%(74/80)与85.0%(68/80)，显著优于对照组的68.8%(55/80)与58.8%(47/80)，并且差异均有统计学意义(χ²＝14.444、13.635，P<0.001)。②治疗后，研究组患儿的血清TNF-α、hs-CRP、Hcy水平及HCT与ESR分别为(53.1±14.0)pg/mL、(5.0±2.5)mg/L、(12.5±3.1)μmol/L、(38.1±5.1)%与(3.0±0.5)mm/h，显著低于其治疗前的(107.9±17.8)pg/mL、(10.1±2.5)mg/L、(42.2±5.8)μmol/L、(45.3±4.5)%与(5.2±0.6)mm/h，并且差异均有统计学意义(t＝21.644、12.902、40.393、9.468、25.194，P<0.001)；对照组患儿的血清TNF-α、hs-CRP、Hcy水平及HCT与ESR分别为(60.6±17.8)pg/mL、(8.2±2.2)mg/L、(15.2±3.1)μmol/L、(40.2±3.4)%与(4.5±0.6)mm/h，显著低于其治疗前的(112.4±14.3)pg/mL、(9.3±3.8)mg/L、(41.1±2.8)μmol/L、(44.6±5.5)%与(5.4±0.8)mm/h，并且差异均有统计学意义(t＝20.292、2.241、55.456、3.320、8.050，P<0.05)。治疗后组间比较，研究组患儿的上述指标均显著低于对照组，并且差异均有统计学意义(t＝2.962、8.595、5.508、3.064、17.178，P<0.05)。③治疗后，研究组患儿的血清S-100β与HMGB-1水平分别为(0.65±0.38)μg/L与(5.3±2.4)μg/L，显著低于治疗前的(0.91±0.32)μg/L与(8.1±2.0)μg/L，并且差异均有统计学意义(t＝4.681、8.020，P<0.001)；对照组患儿的血清S-100β与HMGB-1水平分别为(0.78±0.27)μg/L与(6.4±2.2)μg/L，显著低于治疗前的(0.88±0.25)μg/L与(7.9±1.7)μg/L，并且差异均有统计学意义(t＝2.431、P＝0.016，t＝4.826、P<0.001)。治疗后，研究组患儿的上述指标，均显著低于对照组，并且差异均有统计学意义(t＝2.495、P＝0.014，t＝2.840、P＝0.005)。④2组患儿治疗过程中恶心呕吐、纳差、头晕、嗜睡及肝、肾功能损伤等不良反应率比较，差异无统计学意义(P>0.05)。 结论丙戊酸钠联合左乙拉西坦治疗癫痫患儿的疗效，显著优于仅用丙戊酸钠者，而且患儿血清S-100β及HMGB-1降低更显著，导致的不良反应率更低，具有一定临床应用价值。     

川崎病合并肝功能异常患儿临床分析

目的 探讨川崎病合并肝功能异常患儿的临床资料及预后相关因素。方法 收集杭州市儿童医院2020年9月—2022年2月收治的147例川崎病患儿的临床资料，依据肝功能是否损害分为肝功能异常组和肝功能正常组。比较两组患儿性别、年龄、住院时间、入院后血清白蛋白、总胆红素(TB)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、总胆汁酸、白细胞计数(WBC)、血红蛋白(Hb)、血小板(PLT)、超敏C-反应蛋白(CRP)、白细胞介素-6(IL-6)、降钙素原(PCT)、红细胞沉降率(ESR)、静注丙种球蛋白(IVIG)无应答发生率、不完全川崎病及冠状动脉病变(CAL)发生情况有无差异。结果 147例川崎病患儿中肝功能正常组104例，肝功能异常组43例，肝功能异常发生率为29.25%。肝功能异常组炎症相关指标WBC、CRP、PCT及IL-6水平显著高于肝功能正常组，差异均有统计学意义(均P<0.05)。肝功能正常组与肝功能异常组CAL及不完全川崎病发生情况比较，差异无统计学意义(P>0.05)。肝功能异常组IVIG无应答发生率为23.26%(10/43),显著高于肝功能正常组的8.65%(...     

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.     

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.     

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.     

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.     

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.