福建省非典型埃尔托霍乱弧菌的遗传多样性研究

目的探索福建省非典型埃尔托霍乱弧菌(aEVC)的进化变迁规律,了解aEVC的变异株种类、基因特征,并分析不同类别变异株对霍乱流行趋势的影响。方法运用单基因片段分析技术,选择1962-2005年代表性O1群埃尔托霍乱菌株49株,对ctxB基因扩增产物进行序列测定和比对分析,确定ctxB基因型;同时对毒力因子tcpA和rstR基因分别进行古典型(Cl)和埃尔托型(El)特异的PCR扩增,确定其基因型别。结合ctxB、tcpA、rstR3种基因不同型别的组合形式,确定福建省aEVC菌株的多样性。结果1986年前菌株ctxB基因以埃尔托型B3型为主占92.00%(23/25),而1994年后菌株以古典型B1型为主占95.83%(23/24)。根据ctxB、rstR、tcpA3种基因不同型别的组合形式,1986年前菌株88.00%(22/25)表现为埃尔托型基因特征B3、El、El,1994年后菌株100.00%(24/24)表现为杂合型(Hybrid)变异株基因特征B1、El和(或)Cl、El。结论福建省霍乱菌株存在aEVC进化事件。ctxB、rstR、tcpA基因表现为B1、El和(或)Cl、El的杂合型变异株是福建省aEVC的主要特征型别,此类菌株于1994年后全面取代原来流行的埃尔托霍乱弧菌。不同血清型的aEVC变异株对菌株流行能力的影响不同,稻叶型埃尔托型菌株比杂合型流行时间要长,而小川型杂合型菌株比埃尔托型流行时间要持久。     

非O1/非O139群霍乱弧菌感染病例分离株分子流行病学分析

目的 分析安徽省马鞍山市连续2个月内监测到的6例具有霍乱疑似症状、感染非O1/非O139群霍乱弧菌的病例,判断疫情的聚集性.方法 对病例分离株进行生化和血清型别鉴定以及溶血试验,药敏试验检测抗生素耐药谱,应用荧光PCR和常规PCR进行霍乱弧菌特异基因、毒力及其相关基因的检测,包括ompW、ctx 、tcpA、toxR、hlyA 、zot、ace、rstR和gⅢCTX,应用脉冲场凝胶电泳(PFGE)分析其分子型别.结果 生化鉴定和血清学试验鉴别腹泻病例6株菌株为非O1/非O139霍乱弧菌,均产生β溶血;14种药物中有12种属于全部敏感;荧光PCR检测霍乱弧菌特异性基因ompW均为阳性,ctx、tcpA 、zot、ace、rstR和gⅢCTX基因均为阴性,toxR 、hlyA基因有5株菌扩增阳性,1株菌(1001434446)为阴性;PFGE显示6株菌带型均不相同,但有2株非常相似,分离株与霍乱弧菌产毒株相似性很低.结论 6例感染非产毒的非O1/非O139群霍乱弧菌病例发病虽相对集中,但属于散发病例,在局部地区频繁出现,提示其公共卫生意义不可忽视.     

广东省2009－2013 年霍乱弧菌病原学特征分析

目的 分析广东省2009－2013 年霍乱病例及环境来源O1/O139 群霍乱弧菌病原学特征。方法 选取2009－2013 年广东省霍乱病例来源、环境（水体和海水产品）来源的O1/O139群霍乱弧菌。采用血清分型、抗菌药物敏感性试验、毒力基因PCR 检测和脉冲场凝胶电泳（PFGE）分子分型方法 , 研究不同来源的霍乱弧菌血清型、抗菌药物敏感性、毒力基因携带以及分子分型方面的异同。结果 2009－2013 年广东省共分离得到各类来源O1/O139 群霍乱弧菌190株（病例16 株, 外环境174 株）。病例来源菌株分为O1 群稻叶型（3 株）、小川型（7 株）和O139 群（6株）3 种菌型;其中10 株ctxA 基因阳性, 2 株小川型菌株携带不完整CTXΦ噬菌体;5 株菌对11 种抗菌药物完全敏感, 3 株对4 种抗菌药物表现出耐受。外环境来源菌株中53 株稻叶型, 22 株小川型和2 株O139 群菌株携带不完整CTXΦ噬菌体;2 株O139 菌株检出ctxA 基因阳性;25 株对≥4 种抗菌药物耐受, 其中有2 株同时对11 种抗菌药物中的7 种耐受, 以水产品中的稻叶型菌株为主（13株）。PFGE分子分型结果显示, 菌株经NotⅠ酶切后的PFGE型别表现出明显的多样性。稻叶型和O139 群病例菌株的带型聚集在同一个聚类中, 小川型病例菌株带型分散在不同的聚类中, 病例来源菌株与环境来源菌株的带型差别较大。结论 广东省O1/O139 群霍乱弧菌毒力基因和遗传特征复杂多样, 菌株多重耐药形势严峻, 需要加强菌株型别变异及耐药监测。     

O1群霍乱弧菌新变异株的研究进展

O1群霍乱弧菌(Vibrio cholerae)是霍乱的病原体[1]。根据其"O"抗原的不同可分为200多个血清群[2]。根据其表型差异,O1群霍乱弧菌又可分为古典型(Classical biotype V.cholerae,CVC)和El Tor型(El Tor biotype V.cholerae,EVC)2个生物型。古典型与El Tor型不仅在表型和基因特性上不     

江苏省1999—2005年霍乱弧菌的脉冲场凝胶电泳分析

目的了解江苏省1999-2005年间分离的霍乱弧菌核酸特征,及O139群与O1群霍乱弧菌在基因组水平上的关联。方法 NotⅠ酶切霍乱弧菌基因组,脉冲场凝胶电泳(PFGE)得到指纹图谱,并进行比较分析。结果 PFGE指纹图谱将全部136株霍乱弧菌分为6类,PFGE-A型由1株临床来源El Tor、120株临床来源和9株环境来源的O139组成,PFGE-B型由1株临床来源的El Tor组成,PFGE-C型由1株临床来源的El Tor和1株临床来源的O139组成,PFGE-D型由1株环境来源的El Tor组成,PFGE-E型由1株环境来源的O139组成,PFGE-F型由1株临床来源的O139组成。结论PFGE指纹图谱提示O139起源于不同克隆的El Tor霍乱弧菌,为了解O139的进化路线和流行规律提供了有效证据。作为高分辨率的基因分型工具,PFGE可用于追踪霍乱弧菌的暴发流行传染源,并在其分子流行病学研究中发挥重要作用。     

上海市1962-2011年霍乱弧菌表型特征及分子分型研究

目的 分析1962-2011年上海市霍乱弧菌的表型及分子分型特征.方法 采用WHO推荐的改良K-B纸片法,对222株霍乱弧菌进行11种抗菌药物(头孢曲松、强力霉素、诺氟沙星、环丙沙星、复方新诺明、丁胺卡那霉素、四环素、氯霉素、萘啶酸、氨苄西林、庆大霉素)敏感试验.以PCR检测霍乱毒素基因(ctxA)、小带联结毒素基因(zot)、辅助霍乱肠毒素基因(ace)、溶血素基因(hlyA)、毒素协调菌毛基因(tcpA)、外膜蛋白基因(ompU)和调控蛋白基因(toxR).采用脉冲场凝胶电泳(PFGE)方法对菌株进行分子分型,用BioNumerics软件分析电泳图谱.结果 222株霍乱弧菌经药物敏感试验分析显示,1962-1996年的菌株对多种药物敏感,2005-2011年的菌株对多种药物耐药.O139群耐药率明显高于O1群,O139群产毒株的耐药率比非产毒株高.毒力基因分析显示,1962-1996年霍乱患者来源菌株多为O1群产毒株,2005-2011年患者来源菌株多为O139群产毒株,水体来源菌株未检出ctxA基因,O1群水产来源菌株以hlyA⁺ toxR⁺ ompU⁺为主,占25.6％(11/43),O139群水产来源菌株以hlyA⁺ toxR⁺ompU⁺ctxA ⁺ace ⁺zot⁺ tcpA⁺为主,占76.1％(16/21).PFGE分析将222株菌分为121个PFGE型,O139群分为3个聚类,O1群分为5个聚类.结论 上海市霍乱弧菌随着时间推移表型及分子特征均发生了很大变化,耐药情况加重.     

非霍乱弧菌在不同食品中的生存和生长

非霍乱弧菌在生化学性状上与霍乱弧菌两种生物型(古典生物型和El Tor生物型)有关,但与O 1抗血清不凝集。这种弧菌引起腹泻疾病的报告在亚洲和其他地方不断增加,并发现在水和海味食品中广泛存在。作者从腹泻病人中分离到三株非霍乱弧菌:1株不发酵蔗糖、血清群O 32(Heiberg V);1株发酵蔗糖、血清群O 24(HeibergⅡ);另1株亦发酵蔗糖、血清群O 37(HeibergⅠ),用此三菌株进行了在不同PH和温度条件下,在各种食品中的生长情况的研究。不同温度下的生长情况:置10 g样品(米     

广东省2014年食源性副溶血弧菌病原学特征分析

目的 了解2014年广东省食源性副溶血弧菌分离株的血清型别、抗生素敏感性、毒力基因携带情况以及分子分型特征。方法 对60株副溶血弧菌分离株进行血清分型、抗生素敏感性试验及检测耐热直接溶血素基因(tdh)和耐热相关溶血素基因(trh),并进行脉冲场凝胶电泳(PFGE)和多位点序列(MLST)分型。结果 60株分离株可分为13个血清型,主要型别为O3:K6、O4:K8、O1:K36和O4:KUT;对氨苄西林、磺胺复合物和头孢噻吩的耐药率分别为100.0%、43.3%和28.3%,有56.7%(34/60)的菌株对2类及以上抗生素同时耐药,2株菌对3类抗生素同时耐受。毒力基因PCR检测发现,有63.3%(38/60)的分离株为tdh⁺trh^-菌株,仅1株为tdh⁺trh+菌株。分子分型显示,经NotⅠ酶消化后,60株副溶血弧菌可产生48个PFGE谱型,可分为3个聚类(Cluster A、B和C)。其中Cluster B的菌株主要分离自食源性疾病监测中心散发病例,血清型以O3:K6为主,PFGE谱型的相似度在62.6%～100.0%;Cluster C主要是由4株O4:K8型菌株组成,谱型相似度为56.7%～62.5%。60株菌MLST分型可分为26个ST型,其中33株菌为ST-3型,主要是O3:K6和O1:K36菌株;4株O4:K8菌株聚集成另一个不同于ST-3型的相对优势的菌群。结论 2014年广东省副溶血弧菌菌型多样性可能是疾病高发的原因之一,O4:K8型菌株的分子特征与其他优势血清型别明显不同,应高度警惕该型菌株引起暴发的可能。     

上海市浦东新区食源性小肠结肠炎耶尔森菌耐药及分子流行病学特征

目的 了解上海市浦东新区食源性小肠结肠炎耶尔森菌耐药及分子流行病学特征。方法 2012-2016年主动、定点采集上海市浦东新区4类流通生鲜食品,使用冷增菌方法分离小肠结肠炎耶尔森菌,并分析菌株生物型、血清型、毒力基因型、耐药性和PFGE分子型别。结果 共采集食品3 900份（禽类590份、畜类1 074份、水产品1 488份、蔬菜748份）,其中111份（2.8%）检出小肠结肠炎耶尔森菌。禽类制品（5.3%,31/590）和畜类制品（4.5%,48/1 074）的检出率高于水产品（1.6%,24/1 488）和蔬菜制品（1.1%,8/748）。分离株以生物1A型（95.5%）和O：8血清型（42.3%）为主,且分离数与年总分离数呈正相关。所有菌株均缺失4种（ail、ystA、yadA和virF）产毒株标记的毒力基因,76株（68.5%）ystB基因阳性（其中35株属于1A/O：8/ystB）。分离株对氨苄西林（74.8%）和阿莫西林/克拉维酸（70.3%）的耐药率最高,对头孢西丁不敏感率超过50.0%;未发现三代头孢菌素或氟喹诺酮类抗菌药物耐药株,38.7%（43/111）的菌株为多重耐药。O：8和O：5血清型菌株分别存在44和18种PFGE分子型别。结论 上海市浦东新区食源性小肠结肠炎耶尔森菌暴露风险以禽类制品和畜类制品为主,优势菌型为1A/O：8/ystB,虽无典型产毒株特征但仍有潜在致病力。菌株耐药率处于较低水平但存在多重耐药株,PFGE分子型别提示菌株呈高度遗传多样性。     

珠江河口水体O1群和O139群霍乱弧菌监测

目的 分析珠江河口水体O1群和O139群霍乱弧菌菌型特征,探讨环境水体监测的方法和疫情监测中的作用.方法 2006年3月至2007年2月,在珠江河口选择24个水样采集点,每月采集一次,进行O1群和O139群霍乱弧菌的分离培养,并利用实时PCR监测样品增菌液中的O1群和O139群霍乱弧菌.采样同时测定气温、水温等气象资料.用脉冲场凝胶电泳(PFGE)对分离菌株进行分型分析.结果 监测期间共采样862份,霍乱弧菌分离阳性率7.77%,实时PCR阳性率为26.33%.按月的水样检测阳性率与水温变化趋势相似;城区监测点阳性率高于其他区域,在一家海产品批发市场排水口下游检测到产毒O139群菌株;菌株的菌型构成中,分离菌株主要为非产毒株;O1群E1 Tor小川和稻叶型以及O139群菌株的分离无季节变化趋势;PFGE分析75株分离株被分为49种带型,相似性为57.4%～100%,表现出明显的多样性.结论 霍乱弧菌在珠江河口水体中广泛存在,并呈现多样性.水体监测提供产毒菌株的指示,可作为环境危险评价的指标,且能在霍乱弧菌的监测和霍乱疫情预警中发挥作用.     

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.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.