2011-2013年龙岩市手足口病流行病学 及病原学特征分析

摘要:目的　分析2011-2013年龙岩市手足口病（HFMD）流行病学和病原学特征。方法　运用描述流行病学方法对龙岩市2011-2013年HFMD资料进行分析。选取部分经实时荧光RT-PCR法检测,其他肠道病毒（Enterovirus,EV）阳性咽拭标本,用人横纹肌肉瘤（RD）细胞进行病毒分离,用RT-PCR法进行检测、序列测定和同源性分析,对分离到的病毒进行分析鉴定。结果　2011-2013年龙岩市HFMD发病率均处于较高水平。发病高峰出现在5-7月,男性多于女性。＜5岁儿童病例占报告总病例的93.6%,散居儿童占75.4%。104份其他EV阳性标本病毒分离培养物,经RT-PCR法检测EV阳性88份（84.6%）,其中29份肠道病毒71型（EV71）阳性,4份EV71和柯萨奇病毒A16型（CVA16）同时阳性,3份柯萨奇病毒B5型（CVB5）阳性,2份柯萨奇病毒A10型（CVA10）阳性,50份EV阳性培养物仍未能分型。分离到的EV71型属于C4a基因亚型。CVA16型属于B1b基因型。结论　龙岩市HFMD 疫情处于高流行态势,＜5岁散居儿童是主要发病人群,病原仍以EV71和CVA16为主,同时发现了CVB5和CVA10病毒。     

2008-2010年湖南省哨点医院手足口病病原学检测结果及基因特征分析

目的针对2008-2010年湖南省哨点医院手足口病实验室检测结果及其基因特征进行分析,为湖南省手足口病的综合防治提供参考资料。方法收集湖南省哨点医院2008-2010年手足口病病例送检的咽拭子、粪便等标本,用RD、Hep-2细胞对标本进行病毒分离,应用RT-PCR及Real ti me-PCR技术检测原始样本和分离阳性毒株中的肠道病毒71型（EV71）、柯萨奇病毒A组16型（CVA16）、非EV71和CVA16的其它肠道病毒（EV）,将分离到的EV71采用RT-PCR方法进行VP1编码区基因扩增,并对扩增产物进行序列测定和分析。结果 2008-2010年湖南省哨点医院HFMD患者2 448例的各类标本中检测到EV71病毒阳性1 228份,CVA16病毒阳性169份,EV71和CVA16病毒核酸同时阳性12份,非EV71和CVA16的其它肠道病毒（以下简称为EV）阳性518份,病原谱构成以EV71型为主,其构成比为63.73%（1 228/1 927）,其次EV占26.88%（518/1 927）、CVA16占8.77%（169/1 927）、EV71＋CVA16混合感染占0.62%。三种不同型别肠道病毒在每月中均有报告,EV71为优势病原体,4-7月达到峰值,其次为EV型,CVA16型每月维持在低水平的感染。HFMD病例人群男性高于女性（1.95：1）,1~3岁儿童是重症病例数及死亡病例数最多年龄段;湖南省14个地市（州）HFMD的病原谱均以EV71型为主。对845份阳性标本进行病毒分离,共获得肠道病毒211株,其中EV71型131株,CVA16病毒19株,非EV71和CVA16的其它EV型49株,混合感染12株。13株EV71 VP1编码区全长序列之间核苷酸同源性为97.35%~100%,氨基酸同源性为98.2%~100%,基因型为C4a亚型。结论 EV71型是2008-2010年湖南省手足口病流行的主要病原,也是引起手足口重症病例和死亡病例的主要毒株类型,属于C4a亚型。     

四川省2007～2008年急性弛缓性麻痹病例病原谱特征分析

目的描述四川省2007～2008年急性弛缓性麻痹(Acute Flaccid Paralysis,AFP)病例监测中,分离到的部分非脊髓灰质炎肠道病毒(Nonpolio Enterovirus,NPEV)的型别特征,探讨AFP病例可能的病原谱。方法对四川省2007～2008年AFP病例中分离到的14株NPEV进行基因测序定型。结果测序结果经比较分析,确定肠道病毒(Enterovirus,EV)A组的柯萨奇病毒A组4、5、10型(Coxsackievirus Group A Type4、5、10,CVA4、CVA5、CVA10)和EV71型(Type71,EV71)各1株;EVB组的埃柯病毒(Enteric Cytopathogenic Human Orphan Virus,ECHO;引起细胞病变的人肠道孤儿病毒)6型(ECHO6)和30型(ECHO30)各3株,ECHO251株,CVA91株,CVB3和CVB5各1株。结论四川省2007～2008年AFP病例的病原谱可能包括多型别的NPEV。     

盐城市肠道病毒71型和柯萨奇病毒A组16型分子流行病学特征分析

目的分析盐城市手足口病(hand foot and mouth disease,HFMD)病原学及分子流行病学特征,了解盐城市近年来HFMD病原学构成和肠道病毒71型(Enterovirus 71,EV71)、柯萨奇病毒A组16型(Coxsackievirus A16,CA16)毒株流行概况。方法收集HFMD样本,对阳性标本进行病毒培养和分离,提取病毒RNA,利用逆转录-聚合链酶反应、序列测定和基因进化树构建、同源性分析等方法,对阳性扩增产物进行基因型鉴定。结果盐城市HFMD病原学构成以EV71和CA16循环交替流行为主,其他肠道病毒占较大比例。基因进化树图结果显示:EV71毒株均为C4a亚型,CA16毒株为B1a和B1b亚型交替流行,其中以B1b亚型为流行优势株。同源性分析结果显示:EV71和CA16各亚型之间核苷酸和氨基酸同源性较高,亚型之间亲缘性较近,相对于原始株已发生较大变异。结论盐城市EV71和CA16毒株流行优势株遗传性较稳定,基因亚型与国内外研究结果相一致。     

四川省急性弛缓性麻痹病例中肠道病毒71型的基因特征分析

目的了解2006-2014年四川省急性弛缓性麻痹(Acute Flaccid Paralysis,AFP)病例中肠道病毒71型(Enterovirus 71,EV71)的基因特征。方法对四川省2006-2014年AFP病例中分离到的10株EV71进行全VP1区逆转录-聚合酶链(RT-PCR)反应扩增和核苷酸序列测定,进行序列比对和构建进化树。结果从3 216份AFP粪便标本中,分离出10株EV71病毒。经测序鉴定10株EV71均为C4基因亚型中的C4a进化分支。来源病例的临床诊断分别为:肠道病毒感染3例,格林巴利综合征4例,肌炎3例。10株EV71之间核苷酸同源性为93.6%~98.5%,氨基酸同源性为97.9%~100.0%。结论 2006-2014年四川地区AFP病例中分离到的EV71为C4基因亚型中的C4a进化分支。     

2018年济南市14株柯萨奇病毒A组6型VP1基因特征分析

目的 分析济南市导致手足口病(hand, foot and mouth disease, HFMD)的柯萨奇病毒A组6型(Coxsackievirus A6, CVA6)分离株VP1基因特征及氨基酸变异。方法 2018年济南市HFMD常规监测病例样本经实时荧光RT-PCR检测,随机选择部分CVA6核酸阳性样本进行细胞分离鉴定,扩增阳性分离株VP1基因序列并进行同源性比较、氨基酸变异及系统进化分析。结果 2018年共检测652份样本,其中CVA6核酸阳性率为47.85%（312/652）,远高于人肠道病毒A组71型（human enterovirus A 71, EV71）（7.06%, 46/652）和柯萨奇病毒A组16型(Coxsackievirus A16, CVA16)（8.44%,55/652 ）,为济南市HFMD最主要病原体。通过细胞分离成功获得14株CVA6病毒,经VP1基因系统进化分析显示,济南市CVA6分离株均为基因D5亚型,VP1基因核苷酸及氨基酸序列同源性分别为94.2%~100%和98.0%~100%,与2017年广东株（GenBank 登录号MG385796、MG385815）、广西株（GenBank 登录号MH018512）、云南株（GenBank 登录号LC413143）及2014年江西株（GenBank 登录号KY913482）等亲缘关系较近。VP1蛋白主要存在V174I等位点变异,与国内流行的D5亚型基本一致。结论 2018年CVA6病毒为导致济南HFMD的主要病原,与广东、广西、云南和江西等省分离株亲缘关系较近,属于我国目前流行的基因D5亚型。     

福州市手足口病病原构成及肠道病毒71型VP1基因特征分析

目的探讨福州地区手足口病(HFMD)病原谱构成及肠道病毒71型(EV71)的基因特征。方法采集临床诊断为手足口病患者的咽拭子或肛拭子标本1 235例,通过real-time PCR法确定所有标本的肠道病毒型别。获取EV71型分离株,并对VP1基因片段进行测序,利用DNAStar和Mega 5.1软件进行核苷酸、氨基酸同源性分析并构建系统发生树。结果共检测出932份肠道病毒阳性标本,其中EV71、柯萨奇A16型(Cox A16)和其他肠道病毒的阳性率分别为34.5%(426/1 235)、9.8%(121/1 235)、31.2%(385/1 235)。40株EV71型分离株的VP1基因核苷酸同源性为91.0%~100.0%,氨基酸同源性为95.0%~100.0%。40株病毒基因在系统发生树上与C4基因亚型最为相近,属于C4a基因亚型。结论 EV71是引起福州地区手足口病流行的主要病原体,EV71型病毒株均属于C4a基因亚型,与同期中国大陆EV71参考株基因型相似。     

长沙市2010年手足口病EV71型VP1区基因序列分析

目的了解2010年长沙市手足口病（hand-foot-mouth disease,HFMD）重症和普通病例肠道病毒71型（human Enterovirus 71,EV71）VP1区基因特征。方法收集12例HFMD重症和普通病例的咽拭子或肛拭子标本进行VP1区基因RT-PCR扩增和核苷酸序列测定,测序结果利用sequin软件提交至GenBank,Lasergene和Mega5软件对测序结果进行氨基酸比对分析和构建进化树。结果 12株EV71 VP1区基因序列在进化树上与C基因型中的C4a亚型代表株属同一分支,在核苷酸同源性分析中,12株EV71与C4a亚型代表株（3254-TAI-98）的同源性达到92.6%-93.3%,高于与A、B、C1、C2、C3、CVA16型或亚型代表株的同源性（分别为79.9%-80.7%、83.1%-84.0%、87.9%-88.7%、89.1%-89.8%8、7.8%-88.2%和57.3%-58.4%）;12株EV71病毒VP1之间的核苷酸有高度的同源性：同源性为98.1%-100.0%,高于与C4亚型代表株的同源性（92.6%-93.3%和91.8%-92.7%）。2010年分离自长沙的重症和普通病例与2008年分离自北京、深圳和阜阳的EV71病毒VP1基因序列之间的氨基酸变异位点少。结论 2010年长沙市流行的EV71型病毒属于C基因型中的C4亚型;12例HFMD重症和普通病例的EV71 VP1区基因序列差异较小;不同时间、不同地区和不同病例来源的EV71 VP1区氨基酸变异位点无关联。     

2015-2016年贵州省手足口病非EV71、非CVA16肠道病毒型别鉴定和分析

目的 探讨2015-2016年贵州省手足口病非EV71(Enterovirus 71,EV 71)、非CVA16(Coxsackievirus A16,CVA16)肠道病毒株的病原构成及优势型别。方法 共收集2015-2016年贵州省儿童手足口病疑似患者肛拭子350例标本,应用实时荧光定量PCR法筛选出非EV71、非CVA16型肠道病毒,采用 RT-PCR法扩增病毒VP1区序列,PCR阳性扩增产物进行测序,对测得序列进行型别鉴定并与国内外各型代表株进行核苷酸同源性分析,构建系统进化树。结果 从收集到的手足口病疑似患者肛拭子标本中,共分离到21株其他肠道病毒,分别为:CVA5、CVA7、CVA9、CVB3(Coxsackievirus B3,CVB3)、 CVB4 、E11(Echovirus11,ECHO11)、 E17各1株,CVA10 、CVB1各2株,CVB5、E7各5株。通过系统发育树揭示,分离到的同型别毒株之间具有同源性,而非同型别的毒株与国内外各代表株之间具有同源性。结论 贵州省引起手足口病的非EV71、非CVA16型肠道病毒型别分布较广,包括CVB组,CVA组和ECHO病毒,其中CVB5、E7为非EV71、非CVA16型肠道病毒主要病原体。     

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 occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.     

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.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

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.     

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.