手臂振动病是长期使用振动工具引起的以末梢循环障碍为主的全身性疾病，可引起手臂骨关节-肌肉的损伤，被认为是最具致残性的疾病之一，典型表现为振动性白指。职业性手臂振动病发病机制尚未阐明，目前无特效治疗药物，确诊患者应及时调离手传振动作业岗位，根据病情需要进行扩张血管、营养神经、物理和运动疗法等综合治疗。本文对3例手臂振动病患者的临床资料进行分析，以提高政府、企业和员工的重视。

目的 探讨丙烯腈(acrylonitrile,AN)对大鼠学习记忆能力、海马细胞增殖、神经相关蛋白的影响.方法 将40只成年雄性SD大鼠按体重随机分为4组,每组10只,分别为对照(0 mg/kg)组及5、10、20 mg/kg AN染毒组,均灌胃染毒4周.染毒后以Morris水迷宫和避暗实验进行神经行为测试.测试后腹腔注射5-溴-2-脱氧尿嘧啶核苷(5-bromo-2-deoxyuridine,BrdU)标记海马组织中的神经增殖细胞,并在激光共聚焦显微镜下观察.以Western blot法检测海马组织中神经生长相关蛋白神经营养素-3(neurotrophin3,NT-3)、神经营养素-4(neurotrophin 4,NT-4)和Toll样受体4(toll-like receptor 4,TLR4)的表达情况.结果 对照组大鼠发育正常、行动迅速,5、10 mg/kg AN染毒组大鼠行为基本正常,20 mg/kg AN染毒组大鼠活动明显减少、反应迟钝.4组大鼠在染毒过程中的体重变化无明显差异(P>0.05).各染毒组大鼠的水迷宫实验潜伏期长于对照组,避暗实验潜伏期短于对照组,差异有统计学意义(P<0.05或P<0.01).10、20 mg/kg AN染毒组大鼠的海马细胞增殖率均低于对照组,差异有统计学意义(P<0.01).10、20 mg/kgAN染毒组大鼠海马组织中的NT-3、TLR4蛋白表达均低于对照组,差异有统计学意义(P<0.05或P<0.01),NT-4在各组中的表达无明显差异(P>0.05).结论 AN对大鼠学习记忆能力有明显影响,其机制可能是通过降低海马组织中TLR4和NT-3的表达来抑制神经细胞增殖,引起学习记忆功能障碍.

通过对一起职业性急性加氢裂化催化剂中毒事故中的5位患者的临床表现、实验室检查结果和职业卫生学调查资料进行综合分析,探讨中毒途径、可能毒物和中毒原因.结果显示,该次事故是由加氢裂化催化剂暴露引起的以肝脏损害为主的中毒,中毒途径可能是皮肤,毒物可能是美国Criterion公司最新生产的加氢裂化催化剂DN-3552,致毒成分可能是五氧化二磷(P2 O5),事发的直接原因是更换催化剂过程中产生的大量粉尘透过汗湿的皮肤侵入人体导致中毒,但粉尘产生过多的原因尚不明确.提示,加氢裂化催化剂可致中毒性肝损伤,在启用新型催化剂时应严格按规范操作,作业过程中出现明显异常时应及时查找原因防止发生事故.

Objective:To explore the dynamic variation of serum neuron‐specific enolase (NSE) and its clinical significance in patients with acute organophosphate poisoning .Methods:Ninety patients with acute organophosphate poisoning were enrolled into case group ,and other 90 healthy subjects were enrolled as control group .Venous blood samples of 3 .0 mL were collected from the all 180 subjects at admission .Apart from the 8 patients died on day 1 ,the other 172 subjects underwent collection of 3 .0 mL venous blood samples on day 2 ,day 3 ,day 5 ,day 7 .Serum NSE concentration was measured by enzyme‐linked immu‐nosorbent assay ,while cholinesterase(ChE) was determined by photoelectric colorimetry .Results:Eight patients in case group died on admission day ,of whom the average concentration of NSE and ChE were (131 .72 ± 10 .84) ng/mL ,(199 ± 228) U/L , respectively .Concentration of NSE of the rest 82 patients on day 1 ,day 2 ,day 3 were (54 .56 ± 5 .46) ng/mL ,(36 .18 ± 5 .27) ng/mL ,(20 .56 ± 4 .64) ng/mL ,respectively ,and concentration of the control group on the corresponding time points were (9 .72 ± 3 .92) ng/mL ,(9 .48 ± 3 .66 )ng/mL ,(9 .86 ± 3 .62)ng/mL ,respectively .Statistically significant differences were de‐tected between two groups(P< 0 .01) .Average concentration of ChE of the rest 82 patients on day 1 ,day 2 ,day 3 were (1628 .60 ± 112) U/L、(2113 .59 ± 324) U/L、(2474 .75 ± 711) U/L ,respectively ,and those in the control group on the corre‐sponding time points were (5982 ± 215) U/L ,(5651 ± 136) U/L ,(5783 ± 764)U/L ,respectively .Statistically significant differences were detected between two groups(P<0 .01) .The concentrations of NSE were in significantly negative correlation with that of ChE in mild ,middle and severe poisoning patients on day 1 ,day 2 ,day 3 ,and in positive correlation with the poi‐soning severity .The correlation coefficients rs>0 .05 ,P<0 .05 .Conclusions:Serum NSE may be used as an reference indica‐tor in the diagnosis and treatment of acute organophosphate poisoning .

Objective To investigate the characteristics and influential factors of occupational contact dermatitis(OCD)in cyanides exposed workers and to provide criteria for diagnosis and prevention.Methods 429 cyanides exposed workers from a petrochemical factory were investigated with questionnaire and medical surveillance involving occupational history,protective measures,incidence rate and treatment situation.A cross-sectional survey with stratified cluster and random sampling were performed.Results The prevalence of OCD in the cyanides exposed workers was 30.8% significantly higher than that of unexposed workers(χ2=6.46,P0.05).Dermatitis mainly located on the bare part of the body or on direct contact parts.The causation mainly was due to in contact with two different cyanide compounds or mixture of several cyanides.The incidence of workers working in an environment of high cyanide concentration,or with a long contact duration and manual operation showed the highest rate of OCD.July to September was the season of frequent occurrence for OCD.Results of single factor analysis showed that age,job category and wearing or not the protective gloves correlated with OCD,the difference was significant(P0.05).The unconditional logistic regression analysis showed that gloves wearing were the protective factor to the incidence of OCD.Conclusions Lowering the environment temperature,taking the effective protective measures and strengthening workers'awareness could effectively reduce the incidence of OCD.

目的分析7例聚氨酯漆所致职业性皮肤病的临床特征。方法采用描述性方法对该组病例的一般资料、临床表现、治疗、劳动卫生学调查进行分析总结。结果聚氨酯漆中的游离异氰酸酯可能是本起职业性皮肤病事故的原因,本组病例表现为鲜红色斑丘疹及多型红斑,经糖皮质激素为主的综合治疗症状全部消退,其中1例史蒂文斯-约翰逊综合征经大剂量甲强龙治疗后病情逐渐好转。结论异氰酸酯可能导致职业性药疹样皮炎,必要时需应用大剂量糖皮质激素治疗。

Objective:To evaluate the efficacy of azithromycin in the treatment of chronic Chlamydia pneumoniae infection of the chronic obstructive pulmonary disease(COPD) patients.Methods: It was a prospective randomized,placeboo controlled clinical trial.There were sixty five stable-staged COPD patients enrolled and assigned into two groups.Thirty five cases of the study group were given azithromycin 500 mg once daily by oral administration,and thirty cases of the control group were received the oral placebo of starch pill,one course of treatment was that took the medicine for 5 days,and then stopped oral administration for 23 days(named one course of treament),which course were repeated 3 times.Before and after the intervention,both were recorded symptom scores,pulmonary function of FEV1/FVC(%),plasma levels of high sensitivity C-reactive protein(Hs-CRP),Cpn-IgG and Cpn-IgA.Results: There were 65 patients who fulfilled the study tests;35 patients of the treated group got improved clinical scores,(2.60±0.50 vs.1.70±0.28,P<0.05);FEV1/FVC(%) also increased,[(57±9)% vs.(60±7)%,P<0.05];plasma levels of Hs-CRP [(4.54±0.65)mg·L-1(3.80±0.5)mg·L-1 ];Cpn-IgG Positive 23 cases before treatment,13 cases after treatment,P<0.05;Cpn-IgA positive 19 cases before treatment,12 cases after treatment,P<0.05.Conclusions: Azhithromycin used for treating the chronic Chlamydia pneumonia infection of the COPD patients is able to relieve the clinical symptom and improve the lung function,decrease the plasma levels of Hs-CRP,Cpn-IgG and Cpn-IgA.