抗真菌药物单独与联合应用对烟曲霉菌的体外抗菌活性研究

目的了解常用抗丝状真菌药物对烟曲霉菌的体外抗菌活性,指导临床对侵袭性曲霉病的合理用药。方法药敏试验方法采用美国临床实验室标准化研究所(CLSI)制定的用于产丝孢状真菌的体外药敏方案(M38-A),按规定的标准进行。结果4种抗丝状真菌药物卡泊芬净(CBF)、伏立康唑(VRC)、两性霉素B(AMB)、伊曲康唑(ICZ)对32株烟曲霉菌的MIC90分别为2.0mg/L、8.0mg/L、4.0mg/L、4.0mg/L,联合药物AMB VRC、AMB ICZ、VRC ICZ的部分抑菌浓度(FIC)指数<1,分别为50.0%、43.75%、18.75%。结论烟曲霉菌对AMB和ICZ的耐药性不断升高。对于预防和治疗烟曲霉菌的轻、中度感染,VRC和ICZ可作为经验用药或初始治疗的首选药物;对中、重度的烟曲霉菌感染,应首选卡泊芬净治疗,并根据患者个体和病情发展情况合理调整抗真菌药物。     

多重耐药铜绿假单胞菌体外联合药敏研究

目的评价头孢哌酮/舒巴坦与左氧氟沙星(组1)、多黏菌素B与利福平(组2)联合应用,对43株多重耐药铜绿假单胞菌的体外抗菌效应。方法采用琼脂稀释法测定抗菌药物单独应用和最佳组合效应时的MIC值,计算部分抑菌浓度(FIC)指数,判定联合抑菌效应。结果头孢哌酮/舒巴坦与左氧氟沙星、多黏菌素B与利福平联合应用后对铜绿假单胞菌的MIC均有显著降低(P<0.01),根据FIC指数分布,表现协同作用的分别为65.1%和93.0%;相加作用的分别为32.6%和7.0%;无关作用的分别为2.3%和0;无拮抗作用。结论头孢哌酮/舒巴坦与左氧氟沙星、多黏菌素B与利福平联合应用,对多重耐药铜绿假单胞菌的体外抗菌作用以协同和相加为主,特别是多黏菌素B与利福平联合应用显示了良好的协同作用。     

两性霉素B联合阿奇霉素及其他抗真菌药对烟曲霉体外抗菌活性研究

目的探讨两性霉素B(AMB)联合阿奇霉素(AZI)及其他常用抗真菌药对临床分离的30株烟曲霉体外抗菌活性,以指导临床治疗侵袭性曲霉病合理用药。方法药敏试验采用美国临床实验室标准化研究所(CLSI)制定的M38 A方案。结果抗真菌药体外抗菌活性依次为伏立康唑(VRC)0.29μg/mL,卡泊芬净(CBF)0.45μg/mL,伊曲康唑(ICZ)0.52μg/mL,AMB 0.55μg/mL。烟曲霉对特比萘芬(TBF)、5-氟胞嘧啶(5 FC)、氟康唑(FCZ)、AZI均显示耐药。联合用药有协同作用的为:AMB+ICZ(96.67%)、AMB+VRC(90.00%)、AMB+CBF(83.33%)、AMB+5-FC(50.00%)。结论单独用药时,AMB、ICZ、VRC、CBF有很强的抗烟曲霉作用,烟曲霉对FCZ耐药,AZI无对抗烟曲霉作用;联合用药时,AMB与ICZ、VRC、CBF、5 FC有协同抗菌作用。对于侵袭性曲霉病,可选择AMB联合用药。     

两性霉素B联合阿奇霉素及其他抗真菌药对烟曲霉体外抗菌活性研究 FREE

目的探讨两性霉素B（AMB）联合阿奇霉素（AZI）及其他常用抗真菌药对临床分离的30株烟曲霉体外抗菌活性,以指导临床治疗侵袭性曲霉病合理用药。方法药敏试验采用美国临床实验室标准化研究所（CLSI）制定的M38 A方案。结果抗真菌药体外抗菌活性依次为伏立康唑（VRC）0.29 μg/mL,卡泊芬净(CBF)0.45 μg/mL,伊曲康唑（ICZ）0.52 μg/mL,AMB 0.55 μg/mL。烟曲霉对特比萘芬（TBF）、5 氟胞嘧啶（5 FC）、氟康唑（FCZ）、AZI均显示耐药。联合用药有协同作用的为：AMB＋ICZ（96.67%）、AMB+VRC（90.00%）、AMB+CBF（83.33%）、AMB+5 FC(50.00%)。结论单独用药时,AMB、ICZ、VRC、CBF有很强的抗烟曲霉作用,烟曲霉对FCZ耐药,AZI无对抗烟曲霉作用;联合用药时,AMB与ICZ、VRC、CBF、5 FC有协同抗菌作用。对于侵袭性曲霉病,可选择AMB联合用药。     

阿奇霉素与头孢他啶联合的体外抗菌活性研究

目的探讨阿奇霉素与头孢他啶联合的体外抗菌活性研究。方法采用棋盘法设计,微量肉汤稀释法测定不同浓度组合的抗菌药物对33株临床分离的铜绿假单胞菌的最低抑菌浓度（MIC）,并计算最低抑菌浓度（FIC）指数,判定联合效应。结果头孢他啶与阿奇霉素联合以相加作用为主,少数为协同作用。相加作用22株为66．7％,协同作用10株为30．3％,无关作用1株为3％,拮抗0株。结论二者的联合可为临床治疗严重铜绿假单胞菌感染提供参考。     

绿原酸联合两性霉素B对烟曲霉菌生物膜干预作用的体外研究

目的探讨绿原酸(CRA)对早期(24h)、成熟期(48h)烟曲霉菌生物膜(BF)的破坏及其联合两性霉素B(AMB)的杀菌作用,为临床烟曲霉菌BF相关性感染的治疗提供参考依据。方法构建体外烟曲霉菌24、48h BF模型,分空白组、CRA组、AMB组、CRA+AMB组;两倍稀释法测定药物的最低抑菌浓度(MIC)和最小杀菌浓度(MFC);结晶紫法定量BF;扫描电镜(SEM)观察BF的形态。结果受试菌株经培养24、48h后可形成稳定BF,各组药物作用48h后BF定量显示,早期和成熟期BF空白组和单独AMB组相比差异均无统计学意义,而早期的CRA组较空白组和AMB组的BF减少(P<0.05),与CRA组相比,CRA+AMB组BF则进一步减少(P<0.05);成熟期的CRA+AMB组与空白组、单独AMB组或CRA组比较,BF也明显减少(P<0.05);SEM观察早期和成熟期BF,CRA组均较空白组和AMB组胞外基质明显减少,CRA+AMB组胞外基质和菌丝均显著减少。结论绿原酸可以破坏早期和成熟期生物膜,与AMB联合可以增强AMB对生物膜的渗透性,与AMB具有协同杀菌效果。     

磷霉素联合4种抗菌药物对泛耐药鲍氏不动杆菌体外活性研究

目的探讨磷霉素(FOS)与4种临床常用抗菌药物联合应用,以增强临床分离泛耐药鲍氏不动杆菌(XDRAB)体外抗菌活性。方法收集临床分离的XDRAB 50株,采用微量肉汤法和棋盘法测定FOS与左氧氟沙星、美罗培南、阿米卡星及头孢哌酮/舒巴坦4种常用抗菌药物联合使用的最低抑菌浓度(MIC),计算其部分抑菌浓度指数(FIC);用扫描电镜对比观察药物单用和联用时细菌形态变化。结果 4种抗菌药物与FOS联合使用在体外对XDRAB抗菌活性较单用增强,FOS联用美罗培南FIC值显示协同与相加作用分别占32%和46%;FOS联用左氧氟沙星(LVX)占58%和26%;FOS联用头孢哌酮/舒巴坦(CFS)占32%和54%;FOS联用阿米卡星(AMK)则占44%和38%;FIC值显示FOS与4种抗菌药物联合使用,协同与相加作用约占80%;扫描电镜观察到1/4MIC浓度的FOS单用时,细菌肿胀变形,而与其他4种抗菌药物1/4MIC联用时,细菌变形坏死。结论联合使用FOS能增强左氧氟沙星、美罗培南、阿米卡星及头孢哌酮/舒巴坦4种抗菌药物对XDRAB的抗菌活性。     

甲硝唑与不同抗菌药物联合对艰难梭菌体外抗菌活性对比研究

目的不同种类抗菌药物会以不同的作用机制对艰难梭菌(难辨梭状芽孢杆菌,clostridium difficile,CD)起效,因此联合用药在临床上比较常见。探讨甲硝唑与卡达唑胺、非达霉素、万古霉素分别联用对临床分离的CD的体外抗菌活性,为临床联合用药提供实验依据。方法将甲硝唑与卡达唑胺、非达霉素、万古霉素在体外单独以及分别联用作用于32株CD菌株,采用琼脂二倍稀释法,测定最低抑菌浓度(minimum inhibitory concentration,MIC)、计算部分抑菌浓度指数(fractional inhibitory concentration,FIC),绘制杀菌曲线。评价甲硝唑与其他3种抗菌药物分别联合应用的体外抗菌活性。结果万古霉素与甲硝唑联合后18.8%为相加作用,无拮抗作用,MIC值无明显改变;卡达唑胺联合甲硝唑后89.1%为协同作用,卡达唑胺的MIC50、MIC90值分别下降为单用时的60.0%和50.0%;非达霉素联合甲硝唑后90.6%为协同作用,非达霉素的MIC50、MIC90值分别下降为单用时的50.0%和12.8%。结论卡达唑胺、非达霉素分别与甲硝唑在体外联合均具有协同抗菌作用,能降低对CD的MIC,而万古霉素联合甲硝唑MIC无明显改变。     

磷霉素联合常规抗菌药物对耐万古霉素肠球菌的体外抗菌活性影响

目的探讨磷霉素联合常规抗菌药物对耐万古霉素肠球菌(VRE)的体外抗菌活性影响,为耐万古霉素肠球菌患者治疗提供可靠的参考依据。方法采集2013年1月-2014年12月医院患者痰标本中分离出的50株VRE,将磷霉素与常规抗菌药物(利奈唑胺、阿莫西林、达托霉素)作用于菌株,并测定其最低抑菌浓度(MIC),分析药物对VRE的体外抗菌活性影响。结果磷霉素与常规3种抗菌药物联合使用,对VRE的MIC,明显低于单用药物的MIC,其抗菌活性明显增加;磷霉素+利奈唑胺联用以相加作用为主占70.0%,磷霉素+达托霉素联用以协同作用为主占60.0%,磷霉素+阿莫西林联用以协同、相加作用为主,各占40.0%。结论应用磷霉素联合利奈唑胺、阿莫西林、达托霉素等抗菌药物,均具有较好的抗菌效果,提高了对VRE的体外抗菌活性。     

不同浓度乙二胺四乙酸对产ESBLs多重耐药肺炎克雷伯菌的体外抗菌活性的影响

目的 探讨不同浓度乙二胺四乙酸(EDTA)对产超广谱β-内酰胺酶(ESBLs)多重耐药肺炎克雷伯菌的体外抗菌活性的影响。方法 收集2020—2021年临床分离的478株肺炎克雷伯菌菌株，对产ESBLs多重耐药株使用哌拉西林/舒巴坦、阿米卡星、环丙沙星、美罗培南等敏感抗菌药物进行单一或联合低、中、高浓度EDTA处理，采用微量肉汤稀释棋盘法评估体外抗菌活性，应用结晶紫生物膜试验评估生物膜抑制效果。结果 分离肺炎克雷伯菌中产ESBLs菌株167株(占34.93%),标本主要为痰液(占48.08%),采集自ICU占23.72%;多重耐药率为93.41%,对哌拉西林/舒巴坦、阿米卡星、环丙沙星、美罗培南敏感。与抗生素单药作用相比，联合低、中、高浓度EDTA进行处理后，最小抑菌浓度(MIC)均降低，提示联合EDTA后抗生素药物体外抗菌活性均有所增强；分级抑制浓度指数(FICI指数)为0～1,表明EDTA与受试抗菌药物间为协同作用或相加作用；随EDTA浓度增加，协同作用增加。生物膜抑制效果测定，受试抗菌药物单一使用吸光度(OD)值均低于菌液组(t值为13.61～35.09,P值均<0.05);...     

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.     

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.     

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.