医院感染肺炎克雷伯菌耐药性及氨基糖苷类修饰酶、β-内酰胺酶基因研究

目的明确广州地区引起医院感染的肺炎克雷伯菌耐药性及氨基糖苷类修饰酶、β-内酰胺酶基因存在状况. 方法采用MicroScan微生物鉴定系统NC-21试验板微量肉汤法,测定20株医院感染分离的肺炎克雷伯菌对20种抗菌药物的敏感性,采用聚合酶链反应技术分析9种氨基糖苷类修饰酶基因和2种β-内酰胺酶基因. 结果该20株菌呈现多重耐药,除对亚胺培南敏感率高达95%外,对氨基糖苷类抗菌药物的耐药率在75.0%～90.0%之间,其他药物耐药率为55%～100%;18株（90.0%）检出氨基糖苷类修饰酶基因,ant（3″）-Ⅰ、 aac（6′）-Ⅰ、aac（3）-Ⅱ、aac（3）-Ⅰ、aac（6′）-Ⅱ和aph（3′）-Ⅵ基因阳性率分别为80.0%、70.0%、65.0%、35.0%、25.0%和5.0%,aac（3）-Ⅲ、aac（3）-Ⅳ和ant（2″）-Ⅰ基因均阴性;20株菌均检出β-内酰胺酶编码基因,其中TEM基因阳性率85.0%,DHA基因阳性率80.0%. 结论广州地区临床分离的肺炎克雷伯菌多重耐药严重,氨基糖苷类修饰酶基因和β-内酰胺酶编码基因携带率很高,存在DHA型质粒AmpC酶基因.     

ICU分离铜绿假单胞菌耐药特征及菌株聚类分析研究

目的了解自重症监护病房(ICU)患者分离到的铜绿假单胞菌(PAE)中β-内酰胺类药物耐药相关基因、氨基糖苷类修饰酶基因存在状况和菌株的亲缘性。方法对21株PAE,采用PCR检测β-内酰胺类药物耐药相关基因(TEM、SHV、OXA-10群、PER、VEB、GES、CARB、IMP、VIM、SPM、GIM、DHA、FOX、MOX和oprD2),氨基糖苷类修饰酶基因(aac(3)-Ⅱ、aac(6′)-Ⅰ、aac(6′)-Ⅱ、ant(3″)-Ⅰ、ant(2″)-Ⅰ和aac(3)-Ⅰ)。结果21株PAEβ-内酰胺类药物耐药相关基因中TEM阳性21株(100.0%)、SHV阳性2株(9.5%)、GES阳性1株(4.8%)、CARB阳性2株(9.5%)、VIM阳性4株(19.0%),oprD2基因缺失14株(66.7%),其余基因均阴性;氨基糖苷类修饰酶基因中aac(3)-Ⅱ阳性4株(19.0%)、aac(6′)-Ⅰ阳性5株(23.8%)、aac(6′)-Ⅱ阳性2株(9.5%)、ant(3″)-Ⅰ阳性1株(4.8%)和ant(2″)-Ⅰ阳性4株(19.0%),aac(3)-Ⅰ为阴性。结论ICU患者分离到的铜绿假单胞菌携带多种β-内酰胺酶和氨基糖苷类修饰酶基因,聚类分析显示存在克隆传播医院感染。     

产ESBLs肺炎克雷伯菌氨基糖苷类修饰酶基因研究

目的了解产ESBLs肺炎克雷伯菌中氨基糖苷类修饰酶基因存在状况。方法对35株肺炎克雷伯菌,采用聚合酶链反应（PCR）检测aac（3）-Ⅰ、aac（3）-Ⅱ、aac（6′）-Ⅰ、aac（6′）-Ⅱ、ant（3″）-Ⅰ、ant（2″）-Ⅰ等6种氨基糖苷类修饰酶基因。结果35株肺炎克雷伯菌中,共有26株检出氨基糖苷类修饰酶基因（74.3%）。结论产ESBLs肺炎克雷伯菌氨基糖苷类修饰酶基因携带率高。     

铜绿假单胞菌在重症监护病房分离株氨基糖苷类修饰酶基因研究

目的 了解分离自重症监护病房（ICU）患者的铜绿假单胞菌中氨基糖苷类修饰酶基因存在状况。方法 对21株铜绿假单胞菌（PAE），采用聚合酶链反应（PCR）检测aac（3）-Ⅰ、aac（3）-Ⅱ、aac（6＇）-Ⅰ、aac（6＇）-Ⅱ、ant（3＂）-Ⅰ、ant（2＂）-Ⅰ等6种氨基糖苷类修饰酶基因。结果 本组21株PAE菌中aac（3）-Ⅱ阳性4株（19．0％）、aac（6’）-Ⅰ阳性5株（23．8％）、aac（6＇）-Ⅱ阳性2株（9．5％）、ant（3＂）-Ⅰ阳性1株（4．8％）和ant（2＂）-Ⅰ阳性4株（19．0％），aac（3）-Ⅰ为阴性，共有9株检出氨基糖苷类修饰酶基因（42．8％）。结论 分离自ICU患者的铜绿假单胞菌氨基糖苷类修饰酶基因携带率高。     

20株多药耐药鲍氏不动杆菌氨基糖苷类修饰酶基因研究

目的了解多药耐药鲍氏不动杆菌（MDR-ABA）氨基糖苷类修饰酶基因存在情况。方法采用PCR对20株MDR—ABA进行了aac（6’）-Ⅰad、aac（6’）-Ⅰb、aac（3）-Ⅰ、ant（3″）-Ⅰ等4种氨基糖苷类修饰酶基因检测研究。结果20株MDR～ABA中aac（3）-Ⅰ阳性12株（60％）、aac（6’）-Ⅰb阳性15株（75％）、ant（3″）-Ⅰ阳性18株（90％），aac（6’）一I ad基因阴性；本组20株MDR—ABA中未发现AAC新亚型aac（6’）-Ⅰad基因。结论20株MDR—ABA中均检出氨基糖苷类修饰酶基因；基因型与氨基糖苷类耐药表型相符，可导致克隆传播医院感染，对鲍氏不动杆菌进行aac（6’）-Ⅰad基因研究为国内首次。     

鲍氏不动杆菌β-内酰胺酶、氨基糖苷类修饰酶、氯己定、磺胺耐药基因研究

目的了解20株鲍氏不动杆菌(ABA)β-内酰胺酶、氨基糖苷类修饰酶编码基因、氯己定、磺胺耐药基因存在状况。方法对20株ABA进行了9种β-内酰胺酶基因、3种氨基糖苷类修饰酶基因和氯己定、磺胺耐药基因检测,以耐药基因为分子标记作检测结果的样本聚类进行菌株亲缘性分析。结果20株ABA中blaTEM阳性13株(65%)、blaADC阳性12株(60%)、blaSHV阳性1株(5%),其他β-内酰胺酶基因均阴性;20株ABA中氨基糖苷类修饰酶基因aac(3)-Ⅰ阳性12株(60%)、aac(6′)-Ⅰ阳性13株(65%)、ant(3″)-Ⅰ阳性14株(70%);14株检出qacE△1-sul1基因(70%),以耐药基因为分子标记作检测结果的样本聚类分析显示,其中9株为克隆传播。结论该20株菌β-内酰胺类、氨基糖苷类抗菌药物耐药与产β-内酰胺酶和氨基糖苷类修饰酶密切相关,并存在克隆传播。     

鲍氏不动杆菌β-内酰胺酶和氨基糖苷类修饰酶基因研究

目的了解临床分离的鲍氏不动杆菌中β-内酰胺酶、氨基糖苷类修饰酶编码基因存在状况。方法自临床分离39株鲍氏不动杆菌,采用聚合酶链反应(PCR)检测耐药基因(TEM、SHV、PER、VEB、GES、CARB、CTX-M-1群、OXA-23群、OXA-24群、IMP、VIM、DHA、aac(3)-Ⅰ、aac(3)-Ⅱ、aac(6′)-Ⅰ、aac(6′)-Ⅱ、ant(3″)-Ⅰ、ant(2″)-Ⅰ)。结果39株中TEM阳性13株(33.3%)、OXA-23群阳性20株(51.3%)、aac(3)-Ⅰ阳性25株(64.1%)、aac(6′)-Ⅰ阳性25株(64.1%)、ant(3″)-Ⅰ阳性29株(74.4%),其余基因均阴性。结论在绍兴临床分离的鲍氏不动杆菌β-内酰胺酶、氨基糖苷类修饰酶编码基因携带率高。     

鲍曼不动杆菌16SrRNA甲基化酶基因和氨基糖苷类修饰酶基因检测及作用研究

目的了解医院分离的多重耐药的鲍曼不动杆菌（ABA）氨基糖苷类药物各种耐药相关基因存在状况,探讨ABA多药耐药机制。方法收集20株分离自2010年1-12月岳阳市二人民医院患者临床分离的ABA,采用纸片扩散法测定16种抗菌药物的敏感性,采用PCR法检测armA、rmtA、rmtBr、mtC、rmtD、npmAa、ac（3）-Ⅰa、ac（3）-Ⅱ、aac（6′）-Ⅱ、aac（6′）-Ⅰba、ac（6′）-Ⅰa、ant（3＂）-Ⅰ、ant（2＂）-Ⅰ等16SrRNA甲基化酶与氨基糖苷类修饰酶基因。结果 1株检出16SrRNA甲基化酶基因（armA）,15株检出氨基糖苷类修饰酶基因[其中aac（3）-Ⅰ为80%、ant（2＂）-Ⅰ为80%、aac（3）-Ⅱ为40%、aac（6′）-Ⅰb为15%]。结论鲍曼不动杆菌的多重耐药与氨基糖苷类修饰酶基因和16-SrRNA甲基化酶基因相关。鲍曼不动杆菌存在新的氨基糖苷类药物耐药机制。     

神经内科重症监护病房铜绿假单胞菌氨基糖苷类修饰酶基因研究

目的 了解分离自神经内科重症监护病房患者的铜绿假单胞菌(PAE)氨基糖苷类修饰酶基因存在状况.方法 对36株铜绿假单胞菌,采用ATB微生物鉴定仅鉴定细菌,用PCR法检测aac(3)-Ⅰ、aac(3)-Ⅱ、aac(3)-Ⅲ、aac(3)-Ⅳ、aac(6')-Ⅰ、aac(6')-Ⅱ、aph(3')-Ⅵ、ant(3″)-Ⅰ和ant(2″)-Ⅰ等9种氨基糖苷类修饰酶基因.结果 36株PAE中aac(6')-Ⅱ阳性19株52.8%、aac(3)-Ⅱ阳性17株47.2%、aac(6')-Ⅰ阳性4株11.1%和aph(3')-Ⅵ阳性1株2.8%,而其他基因均阴性,共有28株(77.8%)检出氨基糖苷类修饰酶基因.结论 神经内科重症监护病房铜绿假单胞菌氨基糖苷类修饰酶基因携带率很高.     

两所医院铜绿假单胞菌连续分离株16S rRNA甲基化酶、氨基糖苷类修饰酶基因研究

目的 了解江浙地区两所医院铜绿假单胞菌(PAE)连续分离株的耐药性和16S rRNA甲基化酶、氨基糖苷类修饰酶基因存在情况.方法 K-B法检测PAE连续分离株的耐药性,PCR方法检测5种16SrRNA甲基化酶(rmtA、rmtB,rmtC,rmtD、armA)和6种氨基糖苷类修饰酶基因(aac(3)-Ⅰ、aac(3)-Ⅱ,aac(6')-Ⅰ b、aac(6')-Ⅱ,ant(3")-Ⅰ、ant(2")-Ⅰ).结果 两所医院PAE对头孢哌酮/舒巴坦、亚胺培南、美罗培南与阿米卡星药物敏感性A院为74.2%、80.0%、82.9%、68.5%,B院为90.0%、50.0%、50.0%、95.0%;β-内酰胺类药物、环丙沙星、复方新诺明耐药率极高,两所医院PAE均未检出16S rRNA甲基化酶.结论 不同医院PAE氨基糖苷类修饰酶基因检出率可不同.     

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.     

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.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

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.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

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.