O139群霍乱弧菌的核糖体基因分型及其与药物抗性相关性研究

目的了解杭州市及浙江省部分地区O139群霍乱弧菌分离株的核糖体基因分型特征及其与抗生素抗性关系。方法对1994～2004年杭州市分离的105株及2000年浙江省部分地区分离的5株O139群菌株，PCR法检测ctxA和tcpA基因，纸片扩散法测定抗生素抗性，应用核糖体基因分型技术进行分子分型；并与1997～2001年分离的20株O1群霍乱弧菌流行株代表菌株的分子分型结果进行比较。结果杭州市105株O139群菌株中，95株ctxA阳性菌株分为8个型（Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ、Ⅶ和Ⅷ型），其中Ⅱ型菌株为2000年后的优势克隆群（占73．7％，70／95），并于2004年引起一起较大规模的爆发；10株ctxA阴性菌株被分为3个型（α、β和У型）。2000年浙江绍兴市4株axA阳性O139群分离株属Ⅱ型，浙江湖州市1株axA阴性分离株属У型。20株O1群流行代表菌株被分为5个型（A、B、C、D和E型），其中A型和B型分别与O139群中的Ⅵ型和Ⅶ型的带谱相同。ctxA阳性和axA阴性O139群菌株间的耐药谱显著不同。67株Ⅱ型O139群菌株中共有28种耐药谱，最少的仅对2种抗生素同时耐药，最多对11种抗生素同时耐药；分别有对11种和10种抗生素耐药的菌株在2002～2004年间成为优势菌（81．5％，22／27）。结论1994～2004年间多种核糖体基因型O139群霍乱弧菌在杭州同时或替换流行，多重耐药的核糖体基因型Ⅱ型O139群菌株于2002～2004年间成了杭州优势流行菌株。     

杭州市O139群霍乱弧菌耐药变迁及毒力基因携带

目的 研究杭州市1994～2003年分离的O139群霍乱弧菌耐药性变迁以及携带ctxA、tcpA毒力基因的情况。方法 运用K—B法和PCR，检测90株O139群霍乱弧菌对抗生索的敏感性以及是否携带ctxA、tcpA毒力基因。结果 90株O139群霍乱弧菌中无丁胺卡那耐药的菌株，13株对诺氟沙星和环丙沙星耐药；对氨苄青霉索、复方新诺明分别有5年和6年的耐药率为100％；2002、2003年耐药谱增加到7种。87．87％的O139群霍乱弧菌同时携带ctxA、tepA毒力基因。结论10年来分离自杭州的O139群霍乱弧菌的耐药情况日益严重；O139群霍乱弧菌是否携带ctxA、tcpA毒力基因在对抗生素敏感性方面差异有统计学意义。     

下城区健康人群粪便中检出O1和O139群霍乱弧菌毒力株和无毒力株

目的：对下城区饮食、服务行业人员粪便标本进行霍乱弧菌监测。方法：2007年1月-2007年9月采集25052名饮食、服务行业从业人员健康体检者粪便标本,分别接种于碱性蛋白胨水增菌后分离4号琼脂。通过培养特性、菌落形态、革兰染色、动力和生化试验等检查,对所分离的疑似霍乱弧菌菌株进行初步鉴定,采用霍乱弧菌O1群及O139群单克隆抗体的玻片凝集试验、噬菌体生物分型、霍乱弧菌ctxA和tcpA基因PCR检测进一步鉴定各霍乱菌株。结果：上述标本中检出O1血清群和O139血清群霍乱弧菌各1株。1株O1血清群霍乱弧菌噬菌体生物分型为1 L,属埃尔托生物型非流行菌株,霍乱弧菌ctxA和tcpA毒力基因PCR检测结果为ctxA阴性,tcpA阳性,判定为有毒力的非流行菌株。另1株O139血清群霍乱弧菌ctxA和tcpA基因PCR检测结果均为阴性,为无毒力非流行菌株。结论：尽管所检出的2株霍乱弧菌均为非流行菌株,但因携带者从事职业的特殊性,仍应引起高度重视。     

O139群霍乱弧菌16S rRNA基因分型分析

[目的]研究北京市O139群霍乱弧菌的分子生物学特征。[方法]对北京市1998～2000年的30株O139群霍乱弧菌进行PCR霍乱肠毒素（CT）基因检测,以16SrRNA为探针对菌株DNA进行Southern杂交后对图谱进行核糖体基因（RT）分型分析。[结果]对30株霍乱弧菌RT图谱进行分析,共存在5种16SrRNA核糖体基因型,其中CT阳性的O139群霍乱弧菌为RT1型,CT阴性的O139群霍乱弧菌为RT2-RT5型。[结论]北京市不同年份的O139群霍乱弧菌CT阳性菌株核糖体基因型较为单一,CT阴性菌株基因型具有明显的多样性。提示北京市O139群霍乱弧菌CT阳性菌株和CT阴性菌株遗传发生上相距较远。     

2009年杭州市01群霍乱弧菌的分子特征及耐药性

目的 研究2009年杭州市O1群霍乱弧菌分离株的分子特征及菌株耐药情况。方法 选取2009年分离自杭州市7个区县的30株O1群霍乱弧菌分离株,用PCR检测其肠毒素A基因（ctxA）和毒素共调菌毛A基因（tcpA）,以脉冲场凝胶电泳（pulsed-field gel electrophoresis,PFGE）进行分子分型并作相似度分析,用改良K-B纸片法检测菌株的耐药谱。结果 30株O1群霍乱弧菌分离株中,ctxA -并tcpA+基因型菌株有24株,占80.00％;ctxA -并tcpA -基因型菌株有4株,占13.33％;ctxA+并tcpA+基因型菌株有2株,占6.67％。27株菌（3株因降解未分型）分为11种PFGE型别(P1～P11);23株ctxA -并tcpA+基因型菌株（1株因降解未分型）分为P1～P7等7种型别,相似度≥91.4％,其中P1型占56.52％ (13/23)。7株从同一起暴发事件中分离的ctxA -并tcpA+菌株的PFGE型别分别为P1（6株）和P2（1株）,相似度为97.6％。24株ctxA -并tcpA+菌株对氨苄西林、妥布霉素和阿米卡星的耐药率分别为20.83％( 5/24)、4.17％ (1/24)和4.17％ (1/24)。结论2009年杭州市O1群霍乱弧菌流行株的基因型是ctxA -并tcpA+型;ctxA -并tcpA+型O1群霍乱弧菌菌株的耐药情况尚不严重。     

2010年湖南省霍乱弧菌病原学特征及溯源分析

目的分析2010年湖南省霍乱弧菌分离株的病原学特征,比较霍乱疫情分离株与常规监测分离株之间的克隆相关性,追溯传染源。方法对疫情与监测分离到的42株霍乱弧菌进行常规生物分型和PCR检测毒力基因,对23株代表株进行药敏试验,对18株代表株通过脉冲场凝胶电泳(PFGE)获得电泳图谱,利用BioNumerics软件对图谱进行聚类分析,探讨菌株间的相关性。结果 2010年从湖南省霍乱疫情中分离10株霍乱弧菌均为O139群,ctxA阳性率100%。常规监测分离霍乱弧菌32株,其中O1群15株,全部为ctxA阴性株;O139群17株,ctxA阳性率94.11%。23株霍乱弧菌耐药结果显示强力霉素、复方新诺明的耐药率分别为47.83%、56.52%,发现1株对诺氟沙星、环丙沙星耐药。PFGE方法显示有5种脉冲场凝胶电泳图谱,相似率在82%~100%之间,甲鱼中分离的O139群霍乱弧菌与霍乱疫情分离菌株之间高度同源。结论湖南省霍乱弧菌存在紧密相关的流行克隆群;被O139群霍乱弧菌污染的甲鱼很可能是湖南省霍乱疫情发生的主要传染来源,海、水产品的监测是霍乱防控的重点;要密切关注对诺氟沙星、环丙沙星的耐药变化。     

广东省O1/O139群霍乱弧菌耐药监测分析

目的分析广东省霍乱病例及环境来源O1/O139群霍乱弧菌对抗生素的敏感性,为霍乱防控提供依据。方法选取2006-2008年广东省O1/O139群霍乱病例分离株38株,环境株145株,以毒素基因ctxAB的PCR检测区分产毒株与非产毒株;采用WHO推荐的改良Kirby-Bauer纸片法,分析霍乱弧菌对11种抗生素在体外的药物敏感性。结果183株O1/O139群霍乱弧菌中,ctxAB阳性44株,ctxAB阴性139株。分离自病例的菌株和ctxAB阳性菌株中,小川型菌株只对四环素、萘啶酸和复方新诺明有一定耐药;稻叶型菌株对萘啶酸和复方新诺明100%耐药,而O139群菌株对四环素、萘啶酸和复方新诺明等多种抗生素有一定耐药;分离自环境的菌株和ctxAB阴性菌株中,小川型和稻叶型菌株对四环素、萘啶酸和复方新诺明等多种抗生素有一定耐药,而O139群则仅对萘啶酸、复方新诺明和氨苄西林有一定耐药;分离自病例的菌株和ctxAB阳性菌株以耐多药为主,耐多药率分别为78.9%和75.0%,高于分离自环境的菌株和ctxAB阴性菌株的31.7%和30.9%(P0.01)。结论广东省O1/O139群霍乱弧菌中分离自病例的菌株和ctxAB阳性菌株耐多药率较高,应予以密切关注。     

珠江河口水体霍乱弧菌监测及菌株毒力基因分布特征

目的 了解珠江河口水体中O1群和O139群霍乱弧菌的分布状况,分析菌株的分子特征和毒力基因特征.方法 对2009年1月至2010年12月从珠江河口水体中分离的59株O1群和10株O139群霍乱弧菌,采用聚合酶链反应(PCR)方法体外检测ctxA、tcpA、ace、zot、tcpl,hlyA、toxR和ompU等毒力相关基因,并进行毒力相关基因分型分析,对限制性内切酶Not Ⅰ消化后的基因组DNA进行脉冲场凝胶电泳(PFGE)分析,采用BioNumerics软件分析图谱,得到菌株带型相似性的聚类分析树状图.结果 2009-2010年共采集1 152份水体标本,分离得到O1/O139群霍乱弧菌69株,其中O1群埃尔托霍乱弧菌59株(小川型18株,稻叶型41株),O139群霍乱弧菌10株.PCR检测69株菌ctxA全部阴性,hlyA和toxR全部阳性,基因分型可分成9个型.稻叶型菌株中,34.15％(14/41)为hlyA+ toxR+ ompU+ ace+ zot+ tcpⅠ+型;小川型菌株中,66.67％(12/18)为hlyA+toxR+型;O139群菌株中,70％(7/10)为hlyA+ toxR+型.PFGE分型发现,O139群菌株PFGE相似度为69.9％～ 95.5％;O1群菌株相似度为72.8％～ 100.0％,可分成3个聚类.结论 在霍乱流行间歇期,该地区外环境水体中O1群和O139群霍乱弧菌非产毒株广泛存在,基因型别多样.     

江西省2006-2008年人间霍乱弧菌致病力及药敏检测

目的掌握江西省人群中霍乱弧菌菌型变迁、毒力基因、耐药情况,为霍乱防治提供科学依据。方法采用血清学分型法对人群分离的霍乱弧菌进行分型,同时以主要毒力基因ctx为引物对分离的霍乱弧菌进行PCR扩增,并采用改良K-B纸片法对部分菌株进行10种抗生素的药物敏感试验。结果 2006-2008年期间,共从人群中分离到霍乱菌株139株(O139群136株,O1群小川型3株),其中从患者中分离到O139群41株、O1群小川型1株;从密切接触者中分离到O139群95株、O1群小川型2株。毒力实验结果显示O139群中除1株外,其余的均扩增出与阳性对照一致的毒力基因(ctx)条带,而O1群小川型均未扩增出毒力基因(ctx)条带,与阴性对照一致。药敏结果显示:O139群和O1群小川型霍乱弧菌均对利福平、丁胺卡那、氟哌酸、环丙沙星、头孢噻肟100%敏感,耐药性在90%以上的药物是四环素、强力霉素。结论江西省2006-2008年间人群中分离到的霍乱弧菌中,O139群与O1群小川型并存,O139群为优势菌;O139群菌株绝大多数为产毒株,小川型均为非产毒株。药敏结果供霍乱治疗和必要时的预防药物选择提供依据。     

2009-2012年江西省外环境霍乱弧菌致病力及药敏检测

目的掌握江西省外环境中霍乱弧菌菌型分布、毒力基因、耐药现状,为霍乱防治提供科学依据。方法采用血清学分型法对外环境中分离的霍乱弧菌进行分型,同时以主要毒力基因ctx为引物对检索的霍乱弧菌进行PCR扩增,并应用K-B纸片法对部分菌株进行10种抗生素的药物敏感试验。结果 2009-2012年期间,共从外环境中分离到霍乱菌株156株。毒力实验结果显示37株O139群中15株扩增出与阳性对照一致的毒力基因(ctx)条带,而119株O1群除2株小川型外,其余均未扩增出毒力基因(ctx)条带,与阴性对照一致。药敏结果显示:O139群和O1群对丁胺卡那霉素、诺氟沙星、环丙沙星、头孢噻肟90%以上敏感。结论江西省2009-2012年间外环境中分离到的霍乱弧菌中,O139群与O1群并存,O1群为优势菌;水产品中O139群菌株绝大多数为产毒株,而O1群菌株绝大多数为非产毒株。应重点加强水产品的霍乱监测。药敏结果供霍乱治疗和必要时的预防药物选择提供依据。     

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.