疑诊蠊缨滴虫肺部感染1例报告及文献复习

目的提高蠊缨滴虫肺部感染的诊断及致病机制认识水平。方法通过肺泡灌洗液镜检及1个肺蠊缨滴虫感染病例分析,结合文献报道对病例进行总结。结果肺蠊缨滴虫感染多发生在南方地区,临床症状差异较大,可表现为发热、咳嗽、咳痰和气促;影像学表现各异,多依靠肺泡灌洗液光学显微镜及电镜检查确诊;甲硝唑治疗有效。结论临床上对不明原因的咳嗽、咳痰和发热病人,在治疗效果不佳、且以常见病难以解释时,要注意有蠊缨滴虫肺部感染的可能。     

福建省首例肺部蠊缨滴虫感染病例及虫体形态观察

目的 介绍福建省首例蠊缨滴虫（Lophomonias blattarum）感染病例。方法 对支气管肺泡灌洗液镜检。结果 患者“感冒”月余,首诊对症治疗无效;后到福建省某医院治疗,CT检查见双肺弥漫性病变、双肺门及纵膈多发肿大淋巴结、双侧胸膜肥厚粘连,对支气管肺泡灌洗液（BALF）镜检,见大量可活动虫体,送省CDC寄生虫病防治科鉴定,经直接涂片和瑞氏染色观察,诊断为蠊缨滴虫,并对蠊缨滴虫的形态进行描述。结论 对某些“感冒”治疗无效者应考虑蠊缨滴虫感染。     

蠊缨滴虫肺部感染4例分析

蠊缨滴虫（Lophomomas blattarum）是一种动物源性寄生原虫,由其引起人体感染的案例之前偶有报道[1],近年来呈上升趋势,但其流行规律、传播途径、致病机制目前尚不明确。宁波市医疗中心李惠利医院在不足半年时间内,发现4例蠊缨滴虫引起的肺部感染,现结合文献,对案例进行讨论。     

肺曲霉菌感染病例分析

目的探讨支气管肺泡灌洗液半乳甘露聚糖(Galactomannan,GM)试验对临床肺部曲霉菌感染患者的诊断价值。方法对2017年西安交通大学第一附属医院收治的肺部曲霉菌感染的一例重症患者的临床资料、影像学及病原学资料、诊断和治疗过程及药物浓度监测结果进行分析总结。结果患者病情危重,以慢性阻塞性肺疾病急性加重期,肺部感染,Ⅱ型呼吸衰竭为主要诊断。给予抗细菌及真菌等治疗效果不佳,治疗过程中多次血GM试验阴性,G试验阴性,痰培养及血培养均阴性。但患者体温、白细胞升高,治疗中给予纤维支气管镜检查,并留取支气管肺泡灌洗液培养及GM试验,结果提示GM试验3.87,支气管肺泡灌洗液培养提示烟曲霉生长。患者诊断明确,根据药敏结果结合患者脏器功能选择伏立康唑抗真菌治疗,并监测药物浓度指导抗真菌药物调整,患者好转出院。结论对于血清GM试验阴性的重症肺部感染患者,常规抗感染治疗效果不佳时,应尽早行支气管肺泡灌洗液GM试验及培养。支气管肺泡灌洗液GM试验比血清GM试验更有利于肺部曲霉菌感染的早期诊断。     

1例蠊蠳滴虫致肺部感染的诊断与治疗分析

<正>蠊缨滴虫病原体属于原生动物门、鞭毛虫纲、超鞭毛虫目、缨滴虫亚目、缨滴虫科、缨滴虫属的单细胞原虫,是一种寄生于白蚁、蟑螂(包括森林树木中的蟑螂)肠道的单细胞原虫。蠊缨滴虫病(lophomoniasis blattarum)是新发现的一种人体寄生虫病,20世纪末我国陆续有从人呼吸道检出蠊缨滴虫的报道,近年来该类病例报明显增多。蠊缨滴虫所致呼吸道感染可能是一种新发的、人们尚未完全认识的机会性感染寄生     

纤维支气管镜在机械通气合并肺部感染中的应用

目的总结纤维支气管镜检查和支气管肺泡灌洗对机械通气合并肺部感染患者的临床疗效.方法对58例因各种原因呼吸衰竭行机械通气合并肺部感染患者应用纤维支气管镜检查气道、负压吸除气道分泌物、取痰细菌培养、支气管肺泡灌洗等治疗.结果纤维支气管镜检查并活检发现腺癌1例;发现气管狭窄2例;明确了出血部位2例;痰培养阳性50例.58例经纤维支气管镜治疗,治疗后PaO2、PaCO2、SaO2明显好转,与治疗前比较差异有统计学意义(P＜0.05),机械通气时间明显缩短.结论纤维支气管镜检查和支气管肺泡灌洗在机械通气合并肺部感染中的应用是安全、有效的治疗方法.     

鹦鹉热衣原体肺炎病例报道1例

本文报道1例重症鹦鹉热衣原体肺炎病例,患者有明确的病禽接触史,临床表现为干咳、发热、呼吸衰竭,胸部CT表现为右肺下叶实变影,左肺少量渗出磨玻璃影。采用宏基因组学检测方法在支气管肺泡灌洗液（BALF）中检出鹦鹉热衣原体,经硝基咪唑类、碳青霉烯类等抗菌药物治疗后好转出院。     

HIV阳性病例中肺部感染的病原体

在HIV血清阳性病例中肺部感染是发病和死亡的重要原因。仅靠普通痰液检查诊断肺部感染,特别是诊断卡氏肺囊虫肺炎(PCP),有一定困难。作者用纤维支气管镜(FB)作支气管肺泡灌洗(BAL)及活检,将获得的灌洗液及病理标本进行多种微生物学检查。研究对象符合下列标准:(1)ELISA和Western印迹试验证实有HIV感染,(2)有肺部感染症状,(3)胸部X线或CT检查异常。受试者共90例,76例为     

惠普尔养障体重症肺炎1例报告

惠普尔养障体是一种革兰阳性杆菌,属于苛养菌,临床常难以确诊。惠普尔氏病是由惠普尔养障体引起的一种慢性多系统感染性疾病,常见的靶器官是胃肠道、关节,肺部罕见受累。本文报告患者临床表现为发热、咳嗽、呼吸困难,双肺CT提示弥漫性磨玻璃影,支气管镜肺泡灌洗液宏基因测序提示为惠普尔养障体、热带念珠菌混合感染,给予美罗培南、复方磺胺甲口恶唑、氟康唑治疗好转。本文就该例惠普尔养障体肺炎病例进行报告及文献复习,旨在提高临床对惠普尔养障体感染的认识,做到早诊断、早治疗。     

重症肺部感染应用纤支镜支气管肺泡灌洗并局部抗生素治疗的临床观察

目的：分析研究重症肺部感染患者通过纤支镜支气管肺泡灌洗并局部抗生素治疗的方法以及治疗效果,为临床提供依据。方法：选取2014年2月~2015年2月重症肺部感染患者资料66例实施回顾性分析,将66例患者随机分为两组,对照组患者通过常规治疗方式,观察组患者在对照组基础之上联合纤支镜支气管肺泡灌洗术实施治疗,记录两组患者48小时之后的血气分析情况以及痰培养阳性率,比较观察组和对照组患者咳嗽、发热以及咳痰症状消失时间等。结果：两组患者治疗48小时之后与治疗之前比较血氧分压以及氧合指数全部得到改善,观察组改善程度显著高于对照组（P〈0.05）,差异有统计学意义;观察组患者咳嗽、发热以及咳痰症状消失时间、住ICU时间和脱机时间显著低于对照组（P〈0.05）,差异有统计学意义。结论：针对重症肺部感染患者通过纤支镜支气管肺泡灌洗并局部抗生素治疗效果显著,可以有效改善患者的症状,降低肺部感染程度,减少住院时间,应该在临床中大力推广使用。     

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.     

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.     

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.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

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.     

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.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.