脑利钠肽检测对心力衰竭患者院内死亡的预测价值

目的 研究血浆脑利钠肽(BNP)检测对心力衰竭患者院内死亡风险的预测价值.方法 76例心力衰竭患者分别在入院时(BNP1)和治疗5 d后(BNP2)检测血浆BNP水平,并定义bnp=BNP2-BNP1.记录院内死亡事件,并进行统计分析.结果 住院期间院内死亡7例,性别、年龄、NYHA分级、原发病与院内死亡风险之间无相关性.血浆BNP依次为BNP1(1495.6±1218.4)ng/L、BNP2(1088.5±1214.9)ng/L、bnp(407.0±1062.8)ng/L,均与院内死亡风险呈正相关(相关系数分别为0.381、0.669、0.399),ROC曲线下面积依次为0.784、0.933、0.812,P值和95%可信区间依次为0.006(0.645～0.922)、0.000(0.862～1.003)、0.003(0.650～0.973).BNP1、BNP2和bnp的cut-off值分别取2245.0 ng/L、938.5 ng/L和-1.0 ng/L时,灵敏度分别为55.6%、89.6%和100.0%,特异度分别为74.6%、77.8%和86.6%.结论 血浆BNP水平可作为院内死亡风险的预测指标.     

神经生长因子早期干预对新生儿缺氧缺血性脑病血清IL-6、IL-18影响的研究

目的探讨新生儿缺氧缺血性脑病（HIE）外周血清白细胞介素（IL）-6、IL-18的动态变化及神经生长因子对新生儿HIE的干预治疗作用以及有关分子机制。方法分为对照组、常规组、干预组。在1、3及7d采用酶联免疫吸附测定（ELISA）方法检查血清IL-6、IL-18的水平。结果（1）IL-6水平：对照组、常规组、干预组1d依次为（80．2±8．6）、（40．1±7.2）、（48．2±7．3）ng／L；3d依次为（81．6±8．8）、（52．2±7．6）、（61．2±7．8）ng／L；7d依次为（83．2±8．9）、（75．2±8．2）、（82．1±8．7）ng／L。（2）IL-18水平：对照组、常规组、干预组1d依次为（210．2±32．3）、（940．2±36．6）、（842．1±35．5）ng／L；3d依次为（294．2±33．2）、（1287．6±39．8）、（701．2±34．7）ng／L；7d依次为（116．1±30．5）、（937．2±36．2）、（352．7±33．8）ng／L。结论缺氧缺血后，HIE患儿外周血IL-6水平减低，IL-18水平升高，神经生长因子能平衡IL-6、IL-18的水平，调节免疫功能，保护神经细胞。     

银杏叶提取物对急性脑梗死病人血浆氧化修饰低密度脂蛋白水平影响的研究

目的观察银杏叶提取物注射液对脑梗死病人血浆氧化修饰低密度脂蛋白（OX-LDL）、超氧化物歧化酶（SOD）、丙二醛（MDA）水平的影响。方法60例急性脑梗死病人分为两组：试验组30例，静脉滴注银杏叶提取物注射液20ml／次，qd，连续14d；对照组30例，每日静脉滴注香丹注射液20ml，连续14d。于治疗前和治疗后14d分别检测血浆0X—LDL、SOD、MDA的水平变化。结果试验组病人治疗前血浆0X—LDL、SOD、MDA水平分别为（0．70±0.19）mg／L、（81．0±8．0）kU／L、（6．6±1．3）μmol／L，治疗后分别为（0．52±0．26）mg／L、（106．0±6．0）kU／L、（4．2±1．2）μmol／L，治疗前后有非常显著差异（P〈0．01）；对照组治疗前后血浆OX-LDL、SOD、MDA水平变化不明显（P〉0．05）。治疗期间两组病人均未出现明显不良反应。结论银杏叶提取物注射液具有清除自由基、降低血浆OX-LDL水平的作用。     

血清雌三醇、孕酮联合测定监测硝酸甘油静脉注射治疗先兆早产的临床研究

目的观察硝酸甘油静脉注射治疗先兆早产的临床效果。测定雌三醇（E3）、孕酮（P）的变化，探讨其作用机理。方法102例先兆早产患者随机分为硫酸镁加硫酸舒喘灵常规治疗组55例，和静脉注射硝酸甘油组47例。两组孕妇治疗前后分别抽取外周静脉血，采用放射免疫分析法测定血清中E3，电化学发光法测定血清中P水平。观察两组孕妇用药前后复查E3、P的变化及治疗效果，以及分娩启动先兆早产与E3、P的关系。结果①硝酸甘油组：先兆早产孕妇在24h内宫缩消失，有效率91．48％。延长至37w分娩的孕妇为93．69％。治疗后宫缩消失时间（20．19±10．64）h。硫酸镁加硫酸舒喘灵组：先兆早产孕妇在72h内宫缩消失，有效率89．09％。延长至37w分娩的孕妇为83％。治疗后宫缩完全消失时间（58.95±25.28）h。硝酸甘油组延长先兆早产孕妇孕期效果明显优于硫酸镁组（P〈0.01）。②硝酸甘油组孕妇血浆中E3水平由治疗前的（76．72±44．86）ng／L，显著下降至治疗后的（67．14±35．47）ng／L。两组比较，差异有显著性（P〈0．05）。硫酸镬组孕妇血浆中E3水平治疗前（77．67±36.17）ng/L，治疗后上升为（87．66±35．58）ng/L。差异无显著性（P〉0．05）。③硝酸甘油组孕妇血浆中P水平治疗前（106．23±40．17）ng／L，明显上升至治疗后的（115．66±41．33）ng／L。硫酸镁组孕妇血浆中P水平治疗前（107．78±38．25）ng／L，治疗后显著上升为（120.8±39．27）n∥L，差异有极显著性（P〈0．01）。结论先兆早产与E3水平的增高，孕酮水平的降低有关。硝酸甘油静脉注射后，孕妇血中E3水平降低，孕酮水平增高。达到治疗先兆早产的目的。硝酸甘油静脉注射是一种安全有效的抗早产药物。     

动态检测血清C反应蛋白预测脑梗死复发的临床研究

目的 探讨血清C反应蛋白（CRP）水平预测动脉粥样硬化性脑梗死（ATCI）复发的临床价值。方法 采用免疫透射比浊法测定86例ATCI患者发病后72h内、第1个月、第6个月的CRP浓度，分别记为CRP1、CRP2、CRP3。追踪随访12个月后将其中19例复发脑梗死患者作为复发组，并将67例未复发患者中随机抽出30例作对照组，对照分析两组间CRP水平。结果 ATCI复发患者3个时期的CRP浓度分别为（21，25±5．08）mg／L，（16．53±3，12）mg／L．（16．07±3．78）mg／L；未复发患者3个时期CRP浓度分别为（11，94±3．04）mg／L，（8，64±2．13）mg／L，（8，78±2．0）mg／L。两者间均有显著性差异（P〈0．01）。结论 血清动态检测C反应蛋白可作为脑梗死复发的预测指标。     

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。     

白细胞介素-13对成年人支气管哮喘的影响

目的通过检测白细胞介素（IL）-13浓度及其变化，探讨它在成人支气管哮喘（哮喘）发病机制中的意义，同时检测IL-10、肿瘤坏死因子（TNF）-α浓度，探讨它们与IL-13的相互关系。方法以31例哮喘患者（哮喘组）及9例健康者（对照组）作为研究对象。采集诱导痰及外周血标本，制作成涂片进行细胞学分析；用酶联免疫吸附法测定IL-13、TNF-α及IL-10浓度。结果哮喘组血清IL-13浓度高于对照组[分别为（89．88±36．75）ng／L和（27．03±12．19）ng／L，P〈0．01]，诱导痰中浓度也高于对照组[分别为（69．14±24．48）ng／L和（18．74±8．87）ng／L，P〈0．01]，且血清中的浓度高于诱导痰中的浓度（P〈0．05）；激素使用患者诱导痰中浓度比非激素使用患者低（P〈0．05），诱导痰中IL-13浓度与嗜酸粒细胞百分比呈显著正相关（r=0．54，P〈0．05）。哮喘组诱导痰中TNF-α及IL-10浓度均较对照组高[TNF-α分别为（66．32±18．74）ng／L和（5．36±6．86）ng／L，P〈0．01；IL-10分别为（118．08±55．17）ng／L和（5．66±8．03）ng／L，P〈0．05]。哮喘组中，发作期诱导痰中IL-10浓度高于稳定期浓度（P〈0．05）。轻度哮喘患者诱导痰中TNF-α浓度与重度哮喘患者比较差异有统计学意义（P〈0．05）。结论IL-13是与哮喘发病病理过程相关的细胞因子，与嗜酸粒细胞的活动关系密切，参与哮喘气道炎性反应及气道高反应性的发生，哮喘患者在激素治疗后其浓度降低。     

血浆同型半胱氨酸与急性脑梗死关系的临床研究

目的探讨血浆同型半胱氨酸（Hcy）与急性脑梗死的关系及其临床意义。方法86例急性脑梗死患者（急性脑梗死组）和同期66例体检正常的健康者（对照组）采用荧光偏振免疫分析法测定血浆Hcy，采用化学发光法测定叶酸和维生素B12，并将结果进行比较。结果急性脑梗死组血浆Hcy为（20．08±8．72）μmol／L，对照组为（12．50±2．20）μmol／L，两组比较差异有统计学意义（P〈0．01）；急性脑梗死组血浆叶酸为（4．98±5．01）μg／L，对照组为（7．68±2．02）μg／L，两组比较差异有统计学意义（P〈0．01）；急性脑梗死组血浆维生素B12为（227．39±127．89）pmol／L，对照组为（311．64±152．15）pmol／L，两组比较差异有统计学意义（P〈0．01）。结论急性脑梗死患者血浆Hcy是升高的，而血浆叶酸和维生素B12呈下降趋势，Hcy是急性脑梗死的独立危险因素。     

原发性高血压病患者踝-臂指数与C反应蛋白及纤维蛋白原相关性的探讨

目的 踝-臂指数（ankle-brachialindex，ABI）是一种非创伤性探测下肢动脉系统有无狭窄、动脉硬化、无症状缺血的方法。本研究通过应用ABI判断高血压下肢无症状缺血的发生率，及其与炎症的关系。方法 连续6个月在我院心内科住院病人中选择患者200例，其中高血压组150例，正常血压组50例，所有患者均接受下肢超声多普勒听诊仪检查，ABI小于1．0作为判断高血压下肢无症状缺血的指标。结果 150例高血压患者中有56例ABI小于1．0，占高血压患者组37．3％；正常血压组有4例ABI小于1．0，占8，0％，两组ABI值分别为0．87±0．07，1．38±0．08（P〈0．01）；高血压组中ABI〈1，0与ABI〉1．0的血浆C-反应蛋白（CRP）水平分别为3992±1264（ug／L），3212±1963（μg／L）（P〈0．01）；纤维蛋白原（FIB）水平分别为3．8±0．1g／L，3，2±0．5g／L（P〈0．05）。结论 高血压组中ABI小于0．1的患者提示有下肢无症状缺血存在，ABI小于1．0的患者血浆CRP、FIB水平升高；ABI下降，CRP、FIB水平增高与下肢无症状缺血的发生显著相关。提示炎症参与了下肢无症状缺血的发生，ABI可作为高血压患者下肢动脉粥样硬化发生的早期指标。     

进口和国产地氯雷他定的人体药代动力学及相对生物利用度的研究

目的研究进口和国产地氯雷他定的人体药代动力学及相对生物利用度。方法选择8名男性健康志愿者，采用反相高效液相色谱法，以紫外309nm为检测波长，测定了单剂量（5mg）口服进口和国产地氯雷他定在人体内的血药浓度。结果地氯雷他定的体内动态过程呈一级吸收的二房室开放模型，进口片和国产片的Cmax分别为（316.71±39.66）和（314．80±31.79）ng／ml，tmax分别为（0.72±0．09）和（0．72±0.09）h，t1／2β分别为（10．71±3．06）和（9.95±2.41）h，AUC0-∞分别为（2728．52±356．06）和（2753.01±360．33）ngh／ml。结论选择Cmax和AUC0～∞进行三因素方差分析与双单侧t检验，结果表明进口片和国产片两种制剂具有生物等效性。     

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.     

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.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.