伏立康唑+卡泊芬净联合治疗血液病患者侵袭性肺部曲霉菌属感染

目的了解应用伏立康唑+卡泊芬净联合治疗侵袭性肺部曲霉菌属感染的疗效及安全性。方法诊断侵袭性肺部曲霉菌属感染的患者,给予伏立康唑+卡泊芬净联合治疗7~10 d,然后根据疗效决定序贯口服伏立康唑治疗还是换用其他药物。结果 7例临床诊断和1例拟诊为侵袭性肺部曲霉菌属感染的患者,经联合抗曲霉菌属治疗后7例有效,1例无效;8例患者均能耐受伏立康唑+卡泊芬净联合用药。结论卡泊芬净+伏立康唑联合治疗恶性血液病患者侵袭性肺部曲霉菌属感染,是安全有效的治疗选择。     

伏立康唑与两性霉素B治疗急性淋巴细胞白血病真菌感染的临床疗效分析

目的探讨分析伏立康唑与两性霉素B治疗急性淋巴细胞白血病真菌感染的临床疗效及安全性。方法回顾性分析2008年2月-2013年5月收治的急性淋巴细胞白血病合并侵袭性真菌感染的患者94例,将其随机分为伏立康唑组及两性霉素B组,每组各47例,伏立康唑组给予伏立康唑配合一般支持治疗;两性霉素B组给予两性霉素B配合一般支持治疗;比较两组治疗效果及不良反应发生率。结果真菌感染患者治疗后总有效率伏立康唑组为72.34%,两性霉素B组为53.19%;不良反应发生率两性霉素B组为44.68%,伏立康唑组为21.28%,伏立康唑组消化道反应、肝功能损害和肾功能损害发生率明显低于两性霉素B组,差异均有统计学意义(P<0.05)。结论伏立康唑治疗急性淋巴细胞白血病合并侵袭性真菌感染总有效率较高,并且不良反应发生率较低。     

伏立康唑在恶性血液病患者真菌感染中的应用

目的 调查恶性血液病患者真菌感染后使用伏立康唑治疗的情况,同时与相似患者使用脂质体两性霉素B的情况进行对照,并进行文献复习.方法 50例患者使用伏立康唑治疗,57例患者使用两性霉素B治疗,根据患者临床表现及CT变化判断疗效.结果 伏立康唑组患者有效40例,大多数患者耐受良好;两性霉素B组有效37例,患者耐受较差,甚至无法继续治疗.结论 伏立康唑可替代两性霉素B有效用于恶性血液病患者真菌感染的治疗.     

恶性血液病合并侵袭性真菌感染92例临床特点及疗效分析

目的 探讨恶性血液病合并侵袭性真菌感染的临床特点及不同抗真菌药物的治疗效果.方法 对2010年9月至2013年5月收治的92例恶性血液病合并侵袭性真菌感染患者的临床资料进行回顾性分析.按治疗方法不同分成伏立康唑组（31例）、两性霉素B组（31例）和氟康唑组（30例）,对三组患者的致病因素和临床疗效进行分析,并与同期住院治疗的92例无侵袭性真菌感染的恶性血液病患者进行侵袭性真菌感染的易感因素分析.结果 恶性血液病合并侵袭性真菌感染的感染部位主要为单纯肺部72.83％（67/92）和胃肠道15.22％（14/92）.伏立康唑组、两性霉素B组和氟康唑组总有效率分别为83.87％（26/31）、87.10％（27/31）和66.67％（20/30）,伏立康唑组和两性霉素B组治疗效果明显优于氟康唑组,差异有统计学意义（P＜0.05）.相关分析结果显示广谱抗生素使用超过7 d（x^2=18.342,P=0.000）、持续粒细胞缺乏5d以上（x2^=17.452,P=0.000）、治疗期间使用糖皮质激素（x^2=16.537,P=0.000）、住院时间超过20 d（x^2=10.324,P=0.001）是导致恶性血液病合并侵袭性真菌感染的危险因素.结论 对存在合并侵袭性真菌感染危险因素的恶性血液病患者应早期进行经验性抗真菌治疗,伏立康唑是恶性血液病合并侵袭性真菌感染的较好选择.     

两种治疗方法对肺结核合并侵袭性肺曲霉菌病的疗效观察

目的 评估两种治疗方法对肺结核合并侵袭性肺曲霉菌病的疗效.方法 将41例肺结核合并侵袭性肺曲霉菌病的患者随机分成两组,其中A组24例,应用两性霉素B脂质体与伊曲康唑序贯治疗:首先应用两性霉素B脂质体注射液静脉滴注,1次/d,疗程2周,后改用伊曲康唑胶囊口服,每次0.2 g,2次/d,疗程10周;B组17例,先应用两性霉素B脂质体注射液静脉滴注,用法同A组,后改用伏立康唑片口服,0.2 g/次,2次/d,疗程10周;两组总疗程均为12周;分别对两组的疗效进行统计分析.结果 B组治疗有效率为64.7％,A组治疗有效率为33.3％,两组间差异有统计学意义(P＜0.05).结论 应用两性霉素B脂质体与伏立康唑序贯治疗肺结核合并侵袭性肺曲霉菌病的疗效较好.     

两性霉素B与伏立康唑治疗急性淋巴细胞白血病患者侵袭性真菌感染的临床分析

目的探讨急性淋巴细胞白血病患者侵袭性真菌感染应用两性霉素B与伏立康唑治疗的临床效果比较,以达治疗的安全性。方法选取2010年4月-2013年5月接受诊治的急性淋巴细胞白血病发生侵袭性真菌感染患者54例,按照随机数字表法将其分为治疗组与对照组,每组各27例;对照组患者给予两性霉素B治疗,治疗组给予伏立康唑治疗;两组患者均在用药两周后评价疗效及不良反应发生率。结果治疗总有效率治疗组为81.48%,显著高于对照组的51.85%,差异有统计学意义(P<0.05);治疗组患者低钾血症发生率为3.70%,明显低于对照组的70.37%,差异有统计学意义(P<0.05);治疗组患者生存质量较对照组明显改善。结论应用伏立康唑治疗急性淋巴细胞白血病合并侵袭性真菌感染效果明显优于两性霉素B,且不良反应较轻,患者生存质量较好,具有重要临床价值。     

伏立康唑与两性霉素B治疗急性淋巴细胞白血病合并侵入性真菌感染的对照研究

目的 比较伏立康唑与两性霉素B治疗急性淋巴细胞白血病合并侵入性真菌感染的疗效及安全性.方法 回顾性分析60例次急性淋巴细胞白血病合并侵入性真菌感染患者,治疗组给予伏立康唑注射液4 mg/kg静脉滴注,1次/12 h,对照组给予两性霉素B,从小剂量开始缓慢加大剂量至1 mg/kg静脉滴注,1次/d,两组均于治疗后2周评价疗效及不良反应发生率.结果 治疗有效率治疗组为76.67％、对照组为46.67％,对照组不良反应消化道损害、肾功能损害、低钾血症和静脉炎发生率显著高于治疗组,对照组总不良反应发生率为73.33％,高于治疗组的26.67％,差异有统计学意义(P＜0.05).结论 伏立康唑治疗急性淋巴细胞白血病合并侵入性真菌感染安全性好、疗效确切.     

肝移植术后真菌感染的诊治

目的探讨肝移植术后真菌感染的诊断和治疗。方法 217例肝移植患者术后怀疑真菌感染时,行体液或导管真菌培养,结合影像学、活组织检查及诊断性治疗结果综合判断,一旦诊断确定,即给予氟康唑治疗,无效者改用伏立康唑和两性霉素B,同时调整免疫抑制治疗方案。结果 217例患者中,术后并发真菌感染22例次,例次感染率为10.1%,感染发生在术后4～34 d;假丝酵母菌属感染占63.6%,曲霉菌属感染占31.8%;氟康唑治疗有效者占63.6%,伏立康唑治疗有效者占22.7%,两性霉素B治疗有效者占4.5%,2例各种抗真菌药物治疗均无效,治疗总有效率为90.9%。结论肝移植术后真菌感染的发生率较高,应依据影像学、病原学、活组织检查综合判断真菌感染,及时选用氟康唑、伏立康唑及两性霉素B治疗。     

伏立康唑治疗血液病患者侵袭性真菌感染疗效分析

目的探讨血液病患者侵袭性真菌感染临床特征及伏立康唑治疗临床效果与安全性,为临床诊治提供参考。方法选择2012年12月-2015年1月78例血液病合并侵袭性真菌感染患者,观察患者临床特征并行病原学分析,按照治疗方案分为对照组与观察组,对照组36例患者使用两性霉素B脂质体治疗,观察组42例患者使用伏立康唑治疗,对比两组患者治疗有效率、感染控制时间、用药时间及并发症发生率。结果 25例确诊患者送检标本分离出真菌25株,其中曲霉菌属8株、白色假丝酵母菌6株、克柔假丝酵母菌3株、近平滑假丝酵母菌4株、热带假丝酵母菌及光滑假丝酵母菌各2株;观察组患者治疗痊愈15例、显效13例,治疗有效率83.33%,明显高于对照组的69.44%,对比差异有统计学意义(P<0.05);观察组感染控制时间及用药时间分别为(2.63±1.45)(6.17±1.33)d,明显短于对照组,对比差异有统计学意义(P<0.05)。结论伏立康唑治疗血液病患者侵袭性真菌感染疗效确切,安全性高,值得临床推广应用。     

初治急性白血病患者化疗期间并发真菌感染的临床分析及防治对策

目的 探讨初治急性白血病患者诱导化疗期间并发真菌感染的原因及防治措施,为有效预防与控制医院真菌感染提供依据.方法 回顾性调查2010年1月-2012年2月住院的88例初治急性白血病患者诱导化疗期间并发真菌感染资料,对初治急性白血病患者真菌感染率、感染部位、病原学监测、真菌感染易感因素、抗真菌药物使用等进行统计分析.结果 88例急性白血病患者初治诱导化疗过程中发生真菌感染50例,感染率为56.8％,应用抗细菌药物治疗感染的同时加用抗真菌药物治疗30例,占34.1％;30例真菌感染患者中,拟诊患者24例,占80.0％,临床诊断6例患者,占20.0％,无确诊病例;常见的感染部位为肺部28例,占93.3％;老年患者、中性粒细胞缺乏时间＞5 d,广谱抗菌药物使用时间＞7 d等均是真菌感染发生的重要诱因;共送检20份痰标本,5例患者痰培养阳性,菌种分别为白色假丝酵母菌及曲霉菌属各2株,近平滑假丝酵母菌1株,痰培养阳性率为25.0％;抗真菌药物使用伏立康唑16例,单用卡泊芬净1例,单用两性霉素B、卡泊芬净联合两性霉素B各2例、伏立康唑联合两性霉素B7例,3种药物联用2例,经积极抗感染治疗,26例患者好转后出院,但仍有4例患者因呼吸衰竭死亡.结论 初治急性白血病患者由于存在各种易感因素,诱导化疗期间极易发生感染,其中合并真菌感染发生率高,感染好发部位为呼吸道,一旦发生真菌感染,则病死率明显增加,病原学培养阳性率极低,需多次行血培养及痰培养以提高诊断率,应及早进行预防性治疗或早期经验性抗真菌治疗.     

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.     

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.     

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.