458株铜绿假单胞菌感染及耐药性分析

目的对本院分离的铜绿假单胞菌（PA）的感染及耐药性分析，为临床治疗提供依据。方法用Walkaway40型全自动细菌鉴定仪鉴定458株PA进行来源监测及其耐药试验并进行统计学分析。结果458株PA来源痰及咽拭子（70．3％），伤口分泌物（10．3％）；分离到PA的科室以重症监护病房（ICU）为主，占60．7％；药敏结果显示，PA对β-内酰胺类、磺胺类、氨基糖苷类、喹诺酮类、四环素类抗生素均有很高的耐药性，耐药率均〉50％，而碳青酶烯类、β-内酰胺类及含酶抑制剂复合药耐药率较低，最低为亚胺培南10．9％，其次是头孢哌酮／舒巴坦12．7％，哌拉西林／三唑巴坦14．8％。结论PAI临床分离株多来自ICU病房的痰及咽拭子和伤口分泌物标本，且耐药情况严重，多重耐药性明显，临床应合理使用抗生素，以减少耐药菌株在医院内的传播。     

儿科重症监护病房呼吸机相关性肺炎病原菌分布与耐药性分析

目的了解医院儿科重症监护病房（PICU）呼吸机相关性肺炎（VAP）病原菌分布及耐药性变化，并分析原因及对策，指导VAP的早期经验性抗菌药物应用。方法符合VAP诊断标准的82例在PICU呼吸机治疗的患儿，收集其痰细菌培养阳性结果，进行统计分析。结果2005年1月-2006年12月PICU符合条件的痰标本共分离病原菌187株，其中革兰阴性菌占76．5％（143株），鲍氏不动杆菌33株、大肠埃希菌30株、铜绿假单胞菌28株，其对β-内酰胺类抗菌药物有较高的耐药性；革兰阳性菌占24．5％（44株），表皮葡萄球菌（11株）、金黄色葡萄球菌（9株）除对万古霉素仍敏感外，对头孢菌素以及氨基糖苷类抗菌药物的耐药率很高。结论PICU患儿VAP深部痰培养仍以革兰阴性菌为主，其耐药性较强，特别是产ESBLs的菌株对β-内酰胺类抗菌药物；革兰阳性菌以葡萄球菌属为主，但粪肠球菌的耐药性比较严重。     

ICU与普通病房铜绿假单胞菌感染分布及耐药性分析

目的 对比重症临护病房(ICU)与普通病房铜绿假单胞菌(PAE)感染分布特征和耐药性,以指导临床合理用药.方法 采用法国生物梅里埃公司VITEK-32、VITEK-2 Compact全自动微生物测试仪鉴定PAE,药敏试验用K-B纸片法;抗菌药物耐药率的显著性比较用x2检验.结果 分离341株PAE主要来自痰液占62.5％;科室分布ICU最多占51.3％;秋季感染率最高为34.0％,ICU与普通病房感染PAE月份分布差异不大;ICU分离菌株对亚胺培南耐药率为27.4％、普通病房为5.4％,差异有统计学意义(P＜0.05),对阿米卡星、头孢吡肟、庆大霉素、左氧氟沙星、头孢他啶、妥布霉素、哌拉西林/他唑巴坦耐药率高于普通病房,差异有统计学意义(P＜0.05);ICU中PAE多药耐药(MDR)占53.2％、泛耐药(PDR)占18.8％;普通病房MDR占14.5％、PDR占3.6％,差异有统计学意义(P＜0.05).结论 PAE分离最主要来自痰标本,应加强病房环境的消毒,有利于降低铜绿假单胞菌感染;ICU铜绿假单胞菌耐药率显著高于普通病房;MDR和PDR分离率很高,ICU MDR＞50.0％,耐药性严重.     

2003-2007年铜绿假单胞菌感染分布及耐药性变迁

目的分析铜绿假单胞菌对多种抗菌药物耐药性的动态变迁以及感染病例科室分布,为临床合理治疗提供可靠依据。方法 2003-2007年,从临床标本中分离703株铜绿假单胞菌(PAE),用K-B扩散法进行药敏试验,根据美国NCCLS制定的标准判读结果。结果 2006年和2007年的PAE分离率上升为第1位;703株PAE主要从痰及咽拭子标本中检出占78.9%;ICU的检出率最高,占41.0%;药敏结果显示头孢他啶、头孢曲松、头孢哌酮、头孢吡肟、阿米卡星抗菌活性最强,而头孢唑林、氨苄西林、阿莫西林、氯霉素、磺胺甲噁唑/甲氧苄啶和亚胺培南的耐药率>70.0%。结论 PAE感染对抗菌药物耐药率有逐年增高趋势,各科室的感染情况有明显的差别,且多表现为多药耐药,通过对PAE的分布及耐药性进行监测,为临床科学合理地使用抗菌药物,并进行有效地控制PAE感染,具有十分重要的意义。     

1999-2010年医院铜绿假单胞菌感染的耐药趋势及临床分布特点

目的了解医院铜绿假单胞菌(PAE)的耐药性变迁和临床分布特点,为合理应用抗菌药物和预防控制医院感染提供依据。方法回顾性分析1999年1月-2010年12月临床标本中分离的3475株PAE资料;用Who-net 5.4软件分析PAE的耐药率变迁。结果 PAE、多药耐药PAE(MDRPA)和泛耐药PAE(PDRPA)分离率及对临床常用的15种抗菌药物耐药率总体呈上升趋势;PAE感染主要发生在ICU(15.7%)和外科病房(15.5%);痰标本所占比例最高(71.0%);高龄患者检出率高,占50.1%。结论 PAE的耐药形势严峻,2003-2008年MDRPA和PDRPA的检出率不断增加,2009年以后呈下降趋势;ICU及老年患者居多的科室是预防控制的重点科室。     

铜绿假单胞茵医院感染的临床分布及耐药性分析

目的了解医院感染铜绿假单胞菌（PAE）分布特点及耐药性,为临床治疗铜绿假单胞菌（PAE）引起的感染提供可靠依据。方法回顾分析2011年1月-2013年6月医院各临床标本分离的PAE的分布及对常见药物的耐药性。结果期间共分离PAE164株,其中痰及下呼吸道标本分离出122株,占74．4％;其次为创面分泌物18株,占11％。PAE对头孢呋辛、头孢曲松、头孢噻肟有较高的耐药率,均〉88％;耐药率较低的为哌拉西林／他唑巴坦、阿米卡星、亚胺培南、头孢他啶,均〈15％。结论PAE是医院感染的常见致病菌之一,易产生多重耐药性,应加强对PAE耐药性的动态监测,治疗PAE引起的感染应根据体外药敏试验结果合理选用抗菌药物。     

铜绿假单胞菌临床分离与耐药性监测

目的 了解我院住院病人铜绿假单胞菌耐药性与耐药趋势。方法 分析我院2003年1月至2005年12月住院病人所分离的该菌，并监测抗菌药物的耐药性变化。结果 3年间分离出37株铜绿假单胞菌，该菌在临床各病区的分布情况：重症监护室（ICU）32．4％（12／37）、感染科（呼吸科）18．9％（7／37）、骨科16．2％（6／37）、普外科16．2％（6／37）、内-科（神经、消化、血液、肿瘤、综合）10．8％（4／37）、其他科5．4％（2／37）。其中痰标本51．4％（19／37）、咽拭子21．6％（8／37）、分泌物16．2％（6／37）、血液5．4％（2／37）、其他5．4％（2／37）。该菌对抗菌药物活性较好的是庆大霉素、氧氟沙星、阿米卡星、哌拉西林／他唑巴坦，耐药率分别为2．7％、16．2％、32．4％、32．4％。耐药率较高的是头孢他啶、头孢噻肟、哌拉西林，分别为56．8％、51．4％、51．4％。结论我院住院病人该菌监测结果显示对喹诺酮类、氨基糖甙类、β-内酰胺酶抑制剂复合药物保持较好的的敏感性，β-内酰胺酶类头孢抗生素耐药性呈升高的趋势，需加强对铜绿假单胞菌耐药率的连续监测。     

金黄色葡萄球菌的分布与耐药性调查

目的了解金黄色葡萄球菌（SAU）的分布与耐药现状,为临床医师合理使用抗菌药物提供科学依据。方法对我院2010年1月-2012年12月临床分离的SAU进行回顾性分析,药敏试验采用K—B琼脂扩散法和E—test法,以美国临床和实验室标准协会（CLSI）的标准执行。结果分离的229株SAU在痰或咽拭子标本中所占比例最高,为41．5％;SAU广泛分布于临床各科室,分离率最高的科室为ICU,占31．0％,其次是脑外科和儿科;117株为耐甲氧西林金黄色葡萄球菌（MRSA）,占SAU的51．1％。MRSA对多种抗菌药物普遍耐药,对青毒素、苯唑西林、头孢西丁耐药率高达100．0％;甲氧西林敏感金黄色葡萄球菌（MSSA）对多数药物耐药率均小于50．0％,未分离到对万古霉素、利奈唑胺耐药的菌株。结论MRSA在分离的SAU中所占比例较高,且对多种抗菌药物普遍耐药。加强细菌耐药性的监测与控制,是预防医院感染的有效措施。     

两种常见非发酵菌的临床分布及耐药性分析

目的 分析铜绿假单胞菌(PAE)和鲍氏不动杆菌(ABA)的临床分布特点及耐药性,为临床合理应用抗菌药物提供依据.方法 回顾性分析医院2008年10月-2011年9月分离的904株铜绿假单胞菌、751株鲍氏不动杆菌的感染特征和耐药性.结果 PAE和ABA临床标本主要来源于痰液,分别占78.5％和80.8％,检出率以重症监护病房(ICU)最高,分别为30.6％和46.2％;PAE对阿米卡星耐药率为3.9％,妥布霉素为5.5％,哌拉西林/他唑巴坦为9.0％,庆大霉素为9.8％,环丙沙星为20.9％,亚胺培南为21.8％;ABA对阿米卡星的耐药率较低为4.7％,其余均＞40.0％.结论 两种常见非发酵菌对抗菌药物的耐药率存在差异,临床医师应根据药敏结果选择敏感的抗菌药物进行治疗,同时,应加强ICU的消毒隔离措施.     

2008-2010年ICU铜绿假单胞菌耐药性分析

目的 了解ICU铜绿假单胞菌(PAE)的耐药性,为指导临床用药及控制感染提供依据.方法 回顾性调查2008年1月-2010年12月ICU PAE感染的临床情况,对571株PAE的药敏试验结果进行统计分析.结果 3年分离的571株PAE主要来自呼吸道标本,占75.7％;测定的多数抗菌药物耐药率呈逐年上升趋势,2010年有9种抗菌药物的耐药率＞40.0％,2010年亚胺培南和美罗培南的耐药率分别较2009年降低8.0％和1.2％.结论 PAE的耐药性已十分严重,应定期监测ICU PAE耐药情况,为临床合理用药提供参考,同时加强对抗菌药物合理使用的管理.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.     

The Life Events Inventory: re-scaling based on an occupational sample.

The objective of this study was to compare the validity of the original weightings used by the Life Events Inventory (LEI) with those obtained from a contemporary occupational sample. Fifty male and 62 female manufacturing employees (age range 16-55 years) assigned scores to each item on a slightly modified version of the LEI scale. The current sample consistently assigned higher weights to events/items than did the original sample, but there was high agreement in terms of item ranking. Some distinct age and gender differences in scoring were apparent, and are discussed further. It was concluded that when separate weightings are employed for age and gender groups, the LEI remains a useful tool for quantifying background levels of stress in both workplace stress audits and epidemiological studies where statistical control for non-occupational sources of stress is required.     

Maxillofacial injuries related to work accidents: a new concept of a hospital-based full electronic occupational trauma surveillance system

The objective of this study was to investigate the occurrence of occupational maxillofacial injuries using a newly installed relational database. Twenty-six injuries were identified out of 28,624 patients admitted to the emergency unit during a 12 month period. Falls from height or being struck by moving objects were common causes of these injuries. Two-thirds of those identified were construction workers. This paper demonstrates the power of modern databases to identify specific occurrences that may provide the basis for prevention in the future.     

Rôles physiologiques des endocannabinoïdes dans le contrôle de l’homéostasie énergétique

Endocannabinoids are endogenous lipids which modulate the release of neurotransmitters and activate different signaling pathways, through the binding to cannabinoïd receptors, CB1 and CB2. Endocannabinoids are involved in the control of a variety of behavioural and neuroendocrine functions, including feeding behaviour. In the central nervous system, they essentially modulate the expression of orexigen or anorexigen neuropeptides thus resulting in the stimulation of food intake. Their peripheral targets are mainly the liver and the white adipose tissue where they stimulate lipogenesis, through the modulation of several enzymes and proteins expressions. Cannabinoïd receptor agonists are nowadays prescribed to improve appetite of people suffering from cancer or AIDS. In the same way, CB1 antagonist, such as Rimonabant, could provide efficient treatment of obesity.     

Stress in police officers: a study of the origins,prevalence and severity of stress-related symptoms within a county police force

BACKGROUND: High levels of stress-related illness are causing concern across industry. Against a background of impending legislative moves to try to improve this situation, there is a need to identify key work-related stressors. Police work tends to be regarded as inherently stressful because of the personal risk of exposure to confrontation and violence and the day-to-day involvement in a variety of traumatic incidents. As a result, high levels of stress-related symptoms might be expected in this population. OBJECTIVE: To examine the sources of stress-related symptoms within police officers and measure the prevalence of significant associated mental ill-health. METHOD: A cross-sectional questionnaire survey of a population of 1206 police officers was performed to assess levels of strain associated with a series of potential home and work related stressors. Participants were then split into low and high scoring groups on the basis of a General Health Questionnaire (GHQ) threshold score in order to identify those stressors most associated with mental ill-health effects. RESULTS: Occupational stressors ranking most highly within the population were not specific to policing, but to organizational issues such as the demands of work impinging upon home life, lack of consultation and communication, lack of control over workload, inadequate support and excess workload in general. The high scoring group constituted 41% of the population and differed significantly from those with low scores in perception of all stressors, ranking both personal and occupational stressors more highly, and from personality constraints appeared significantly more 'stress-prone'. A significant association between gender and mental ill-health was found, with females more likely to score more highly on the GHQ than males. CONCLUSION: This study confirms previous findings of organizational culture and workload as the key issues in officer stress. Given that the degree of symptomatology appears to be worsening, management action is required. Further research is indicated within the police population into a possible increased susceptibility in female officers.