血液病患者医院感染的临床资料与病原菌回顾性调查分析

目的 探讨血液病患者医院感染好发部位、病原菌和危险因素,制定预防控制医院感染的干预措施.方法 对426例血液病医院感染患者的病历资料进行回顾性调查分析.结果 血液病患者医院感染的好发部位以呼吸道感染发病率最高占61.9％、其次是口腔感染占9.7％、其余依次为泌尿道感染占7.5％、消化道感染占6.0％、皮肤黏膜感染占6.0％、血液感染占5.2％、其他部位感染占3.7％;医院感染的危险因素是患者年龄、住院天数、白细胞减少、接受放化疗、免疫抑制剂、激素的应用等;医院感染病原菌均为多药耐药菌.结论 应制定有效的干预对策,预防与控制血液病患者医院感染.     

大气污染对健康影响的疾病负担研究进展

大气污染对健康的影响已受到越来越多的关注,如何定量描述大气污染所造成的健康影响成为环境与健康领域的研究热点和难点,近年来已有学者采用疾病负担指标评价大气污染对健康的影响:全球疾病负担(GBD)2010研究中,归因于颗粒物污染造成的伤残调整寿命年(DALY)约为7 600万,归因于O3造成的DALY约为245万;欧洲国家每百万人因O3污染损失约30~140 DALY;2004—2008年期间,北京市PM10、PM2.5、NO2和SO2日均浓度每增加1个四分位间距,死亡寿命损失年(YLL)分别为15.8,15.8,15.1和16.2。采用疾病负担评价大气污染危害可为政府制定环境政策和健康干预措施提供更直接的依据。该文综述了大气主要污染物对健康影响疾病负担的研究进展。     

Measurement of airborne fibers: a review

Current fiber measurement techniques arose primarily due to health concerns over asbestos exposure. Fiber toxicity appears to be primarily a function of fiber concentration, dimensions and durability in the lungs. There are two basic approaches to fiber measurement. Fibers can be collected on filters and counted or analyzed by light or electron microscopy; alternatively, fibers can be detected directly using a combination of fiber alignment and light scattering techniques. All of these measurement approaches work best when the fibers are simple rod-shaped particles. However, most fibers can exist as curved rods, complex bundles of fibrils, and agglomerates of fibers and compact particles. These non-ideal shapes contribute to measurement bias and variability.     

胸膜腔曲霉菌属感染文献复习

目的分析胸膜腔曲霉菌病患者的基础疾病、临床表现、危险因素,探讨胸膜腔曲霉菌病治疗的有效方法,提高对胸膜腔曲霉菌病的认识。方法回顾性分析1例采用全身应用抗曲霉菌属药物联合胸膜腔冲洗及局部保留用药成功救治的胸膜腔曲霉菌病患者的诊治过程及随访资料,评价其疗效和不良反应,并通过万方数据库及PubMed检索国内外中英文文献,对检出的9例类似病例进行文献复习。结果该患者胸膜腔曲霉菌病治愈,无不良反应或重大并发症,随访两年病情稳定;分析该病例及文献报道的9例病例发现,10例胸膜腔曲霉菌属感染均为继发性,均患有基础疾病,2例为肺曲霉菌病术后、8例应用了糖皮质激素和(或)广谱抗菌药物、9例伴有支气管胸膜瘘、9例为男性患者;10例胸膜腔曲霉菌病患者治疗方法中3例采用手术加术后抗曲霉菌属药物治疗,3例采用≥2种药物联合治疗,2例应用了单一抗曲霉菌属药物治疗,2例应用了单一抗曲霉菌属药物及胸腔冲洗保留药物治疗。结论抗曲霉菌属药物全身应用联合胸膜腔局部冲洗用药是胸膜腔曲霉菌病的有效治疗方法,重视基础疾病的规范治疗和积极支持疗法有助于疾病恢复。     

Exposures to respirable, airborne Penicillium from a contaminated ventilation system: clinical, environmental and epidemiological aspects

Symptoms compatible with hypersensitivity pneumonitis (HP) in two of fourteen employees in a clerical office prompted an investigation of their work environment. Forced-air heater-cooler units which had not been properly maintained were implicated when they were found to be grossly contaminated with predominantly Penicillium molds. Air-sampling for viable, respirable-size particulates in the affected office and an unaffected office in the same building demonstrated a 50- to 80-fold excess in the number of colony-forming-units per cubic meter of air in the affected office. Persistent alveolitis was documented by repeated bronchoalveolar lavage, gallium scan, and other studies in one affected worker whose peripheral lymphocytes underwent blast transformation in response to Penicillium antigens obtained by air-sampling in the work environment. The other affected worker had asthma, presumably exacerbated by exposures to a variety of inhaled environmental irritants and antigens. Despite a documented reduction of airborne fungi to background exposure levels after clean-up of the forced-air units, the worker with persistent alveolitis has had occasional recurrences of symptoms consistent with HP. Further research is needed to establish health guidelines for control of occupational and non-occupational exposures to respirable fungal organisms which may contaminate cooling, heating and humidifying systems in these settings. A multidisciplinary method of approach to such research is described.     

Occupational exposure to hazardous airborne pollutants: effects of air mixing and source location

The presence of airborne pollutants in indoor environments has been associated with occupants' discomfort and/or adverse health effects. This study investigates occupational exposure in relation to indoor air mixing and source location relative to a human body. Experimental and computational methods were used to provide information about the pollutant distribution in the vicinity of the human body for different levels of room air mixing. Study results show that the often used assumption of uniform pollutant distribution in an occupied space is not always appropriate for estimation of inhalation exposure. Results also indicate that an occupant may experience very high acute exposure to airborne pollutants when little air mixing exists in a space and the pollutant source is in the vicinity of the occupant. The buoyancy-driven flow induced by the convective heat transfer from an occupant's body can transport pollutants in the occupant's vicinity to the breathing zone. Specific study results reveal that a source located in the occupant's front chest region makes a relatively large contribution to the breathing zone concentration compared with the other sources in the vicinity of the human body. With the source position in this region, exposure can be nine times greater than that calculated with the uniform mixing assumption. The buoyancy-driven convective plume around a body seems to have a significant influence on pollutant transport and human exposure, especially in the absence of room air mixing.     

Nosocomial diarrhea: a review of pathophysiology, etiology, and treatment strategies

Diarrhea is a frequent complication among hospitalized patients. Nosocomial diarrhea is generally diagnosed as increased frequency and decreased consistency of stools developing after 72 hours of hospitalization. The causes of nosocomial diarrhea may be infectious or noninfectious. Noninfectious etiologies occur most commonly, and are often adverse effects of medications or enteral nutrition therapies. Infectious etiologies are most concerning and include Clostridium difficile and norovirus. Patients with nosocomial diarrhea should be placed in isolation with contact precautions in place until the presence of C difficile infection is determined. Irrespective of etiology, diarrhea can cause serious complications in hospitalized patients, including malnutrition, hemodynamic instability, metabolic acidosis, and potentially fatal pseudomembranous colitis. This article reviews nosocomial diarrhea, including its pathophysiology, infectious and noninfectious causes, and treatment strategies based on identified cause.     

Infectious disease consultations in a Japanese tertiary care teaching hospital: a retrospective review of 508 cases

Objective

Limited epidemiological data are available at tertiary care teaching hospitals in Japan. We reviewed infectious disease (ID) consultations in a tertiary acute care teaching hospital in Japan.

Methods

This is a retrospective review of the ID consultations from October 2016 to December 2017. The demographic data, such as requesting department, consultation wards, and final diagnosis, were analyzed.

Results

There were 508 ID consultations during the 15-month study period. Among the 508 consultations, 201 cases (39.6%) were requested from the internal medicine department and 307 cases (60.4%) were requested from departments other than internal medicine. The most frequent requesting departments were Surgery (n?=?102, 20.1%), Pulmonary Medicine (n?=?41, 8.1%), and Plastic Surgery (n?=?35, 6.7%). The most common diagnoses were intra-abdominal (n?=?81, 16.0%), respiratory (n?=?62, 12.2%), and skin and soft tissue infections (n?=?59, 11.6%). ID consultations for disease diagnosis and management were more frequent in the internal medicine group than in the non-internal medicine group (37 cases, 20.8% vs. 40 cases, 13.7%, p?=?0.046), and the number of requests for consultations for noninfectious diseases at the time of final diagnosis was higher in the internal medicine group than in the non-internal medicine group (21 cases, 11.8% vs. 16 cases, 5.5%, p?=?0.0153).

Conclusion

Some physicians prefer ID specialists to identify and solve various medical problems. Internists had a greater tendency to request consultations for diagnostic problems, and noninfectious disease specialists have more requests for consultation at the point of final diagnosis. The role of ID specialists is expanding, from individual patient management to antibiotic stewardship, antibiotic prophylaxis, and development of and adherence to antibiotic protocol implementation based on the hospital’s microbial susceptibility and infection control. Although the number of specialists is limited in Japan, ID services now play an important role for achieving a good outcome in patient management.

     

Nosocomial postneurosurgical Acinetobacter baumannii meningitis: a retrospective study of six cases admitted to Hamad General Hospital, Qatar

This article reports six cases of nosocomial Acinetobacter baumannii meningitis in patients who had undergone neurosurgical procedures with placing of external ventricular drains. The mean time between surgery and onset of infection was 27 days [standard deviation (SD) 14] Multi-drug resistance was observed in three cases (50%) and carbapenem resistance was noted in two cases (33%). All patients had received empirical antibiotics and these were appropriate in five cases (83%). The mean duration of antimicrobial treatment was 12.5 (SD 2.4) days. Two of the six patients (33%) died in hospital.     

Precipitating antibodies and positive skin tests in workers exposed to airborne antigens from a contaminated humidification system

Summary Precipitating antibodies and positive skin tests to antigens from a contaminated humidification system in a synthetic carpet yarn plant were tested in a group of exposed (n =66) and non-exposed (n = 45) workers. The first investigation was carried out in 1979 shortly before hygienic actions to reduce exposure had been taken. In 1981 and 1985 they were repeated. The significant difference between the positive skin reactions and of positive serology (4 or more lines), observed in 1979 between the exposed and non-exposed population, was not found in 1981 and 1985. In 1979 the differences were the most pronounced in the non-smoking individuals. However, even in that category the significant difference disappeared in 1981 and 1985. A positive skin test in 1979 did not increase the chance of having a positive skin test during repeat investigations. In serology this was only the case when the positive criterion was lowered to three or more lines. This study demonstrates that, in the absence of a quantitative analysis of airborne antigens, skin tests and serology may be helpful in obtaining an estimation of antigenic contamination of the air and subsequent sensitization on a group level. However, these tests are less appropriate when used in an individual health surveillance program at this type of nonspecific antigen exposure.     

Precipitating antibodies and positive skin tests in workers exposed to airborne antigens from a contaminated humidification system

Precipitating antibodies and positive skin tests to antigens from a contaminated humidification system in a synthetic carpet yarn plant were tested in a group of exposed (n = 66) and non-exposed (n = 45) workers. The first investigation was carried out in 1979 shortly before hygienic actions to reduce exposure had been taken. In 1981 and 1985 they were repeated. The significant difference between the positive skin reactions and of positive serology (4 or more lines), observed in 1979 between the exposed and non-exposed population, was not found in 1981 and 1985. In 1979 the differences were the most pronounced in the non-smoking individuals. However, even in that category the significant difference disappeared in 1981 and 1985. A positive skin test in 1979 did not increase the chance of having a positive skin test during repeat investigations. In serology this was only the case when the positive criterion was lowered to three or more lines. This study demonstrates that, in the absence of a quantitative analysis of airborne antigens, skin tests and serology may be helpful in obtaining an estimation of antigenic contamination of the air and subsequent sensitization on a group level. However, these tests are less appropriate when used in an individual health surveillance program at this type of nonspecific antigen exposure.     

2007-2009年ICU医院感染调查与分析

目的了解ICU内医院获得性感染的流行病学规律、病原菌、医院感染类型和分布,探讨其易感因素指导临床防治,合理使用抗菌药物,降低细菌耐药性的产生。方法对ICU 2007年1月-2009年12月7738例住院患者进行回顾性调查,有427例患者符合医院获得性感染的标准。结果医院获得性感染的平均感染率为5.52%,呼吸道感染位居首位,占72.13%;常见病原菌有鲍氏不动杆菌、金黄色葡萄球菌、铜绿假单胞菌和肺炎克雷伯菌,革兰阴性菌居首位,革兰阳性菌有上升趋势。结论 ICU内医院感染的患病率仍居高不下,ICU医院感染部位仍以呼吸道为主,应加强空气传播的防护建立相应的监控制度,掌握病原菌变化规律,更有效地预防和治疗ICU内获得性感染。     

Clinical significance of extra-pulmonary involvement of invasive aspergillosis: a retrospective autopsy-based study of 107 patients

Disseminated aspergillus infection has a poor prognosis, but few reports have been published on extra-pulmonary involvement in aspergillosis. We reviewed 107 autopsy records of patients with invasive aspergillosis. Fifty-five patients had extra-pulmonary aspergillosis. Organs involved included heart, kidney, central nervous system, gastrointestinal tract, spleen, liver, thyroid gland and pancreas. Extra-pulmonary aspergillosis produces different manifestations according to involved organs. Risk factors associated with dissemination included cytotoxic chemotherapy within a month of death (P=0.0087). Lack of response to empiric or preemptive treatment of amphotericin B predicted IA dissemination (P=0.0328). To improve prognosis of IA, it is important to recognize clinical features of extra-pulmonary aspergillosis and to institute the aggressive anti-fungal treatment.     

Nosocomial transmission of HIV in Africa: what tribute is paid to contaminated blood transfusions and medical injections?

We reviewed the published data on the possible impact of medical injections and blood transfusions on the spread of human immunodeficiency virus (HIV) in Africa. We also compared these results to our experience in Rwanda, central Africa. The importance of medical injections in the epidemic of HIV infection seems to differ from one area to another. The excess of injections experienced by HIV seropositive subjects in Zaire could be secondary to the parenteral treatment of early HIV-related illness or to the treatment of sexually transmitted diseases, rather than being the cause of HIV infection, as suggested by Rwandese studies. In contrast, blood transfusions have been shown to represent an important source of nosocomial HIV infection in many African countries. Effective and relatively inexpensive measures to diminish the iatrogenic spread of HIV infection in developing countries are summarized.     

Endothelial dysfunction in obesity and insulin resistance: a road to diabetes and heart disease

Obesity, insulin resistance, and endothelial dysfunction closely coexist throughout the natural history of type 2 diabetes. They all can be identified not only in people with type 2 diabetes, but also in various groups at risk for the disease, such as individuals with impaired glucose tolerance, family history of type 2 diabetes, hypertension, dyslipidemia, prior gestational diabetes, or polycystic ovary syndrome. Whereas their evident association cannot fully establish a cause-effect relationship, fascinating mechanisms that bring them closer together than ever before are rapidly emerging. Central or abdominal obesity leads to insulin resistance and endothelial dysfunction through fat-derived metabolic products, hormones, and cytokines. Insulin resistance leads to endothelial dysfunction through the frequent association with traditional cardiovascular risk factors and through some more direct novel mechanisms. Some specific and shared insulin signaling abnormalities in muscle, fat, and endothelial cells, as well as some new genetic and nontraditional factors, may contribute to this interesting association. Some recent clinical studies demonstrate that nonpharmacological and pharmacological strategies targeting obesity and/or insulin resistance ameliorate endothelial function and low-grade inflammation. All these findings have added a new dimension to the association of obesity, insulin resistance, and endothelial dysfunction that may become a key target in the prevention of type 2 diabetes and cardiovascular disease.     

Interactive effects of antioxidant genes and air pollution on respiratory function and airway disease: a HuGE review

Susceptibility to the respiratory effects of air pollution varies between individuals. Although some evidence suggests higher susceptibility for subjects carrying variants of antioxidant genes, findings from gene-pollution interaction studies conflict in terms of the presence and direction of interactions. The authors conducted a systematic review on antioxidant gene-pollution interactions which included 15 studies, with 12 supporting the presence of interactions. For the glutathione S-transferase M1 gene (GSTM1) (n=10 studies), only 1 study found interaction with the null genotype alone, although 5 observed interactions when GSTM1 was evaluated jointly with other genes (mainly NAD(P)H dehydrogenase [quinone] 1 (NQO1)). All studies on the glutathione S-transferase P1 (GSTP1) Ile105Val polymorphism (n=11) provided some evidence of interaction, but findings conflicted in terms of risk allele. Results were negative for glutathione S-transferase T1 (GSTT1) (n=3) and positive for heme oxygenase 1 (HMOX-1) (n=2). Meta-analysis could not be performed because there were insufficient data available for any specific gene-pollutant-outcome combination. Overall the evidence supports the presence of gene-pollution interactions, although which pollutant interacts with which gene is unclear. However, issues regarding multiple testing, selective reporting, and publication bias raise the possibility of false-positive findings. Larger studies with greater accuracy of pollution assessment and improved quality of conduct and reporting are required.     

孕期环境空气污染物暴露和先天性心脏病关系的Meta分析

目的 探讨孕期空气污染物暴露与先天性心脏病（先心病）发生的关系,为先心病的一级预防提供循证医学证据。方法 收集国内外发表的有关孕期空气污染物暴露与先心病有关的流行病学研究文章,对连续性增长和高浓度对比低浓度的污染物与先心病亚型的关系效应值分别进行合并。使用Stata 12.0软件对文献进行Meta分析。结果 共纳入20篇英文文献。Meta分析结果显示,CO暴露增加法洛四联症的发生风险（高浓度对比低浓度OR=1.22,95%CI：1.03~1.44））;NO₂暴露增加主动脉缩窄的发生风险（浓度每升高10 mm³/m³ OR=1.01,95%CI：1.01~1.20）;O₃暴露增加房间隔缺损的发生风险（浓度每升高10 mm³/m³ OR=1.14,95%CI：1.03~1.26）;PM₁₀暴露增加房间隔缺损的发生风险（浓度每升高10 μg/m³ OR=1.10,95%CI：1.03~1.19）。此外,还发现CO暴露和房间隔缺损的发生,PM₁₀暴露和室间隔缺损的发生存在负相关。结论 孕期暴露于空气污染物CO、O₃、NO₂、PM₁₀可能会增加先心病的发生风险。