人感染H7N9禽流感1例报告

目的调查1例人感染H7N9禽流感病例,总结疫情防控工作经验。方法对病例和密切接触者进行个案调查与分析,采用实时荧光定量PCR检测病例咽拭子H7N9禽流感病毒核酸作确诊。结果患者以发热为首发症状,继而出现咳嗽、咳痰和左下肺炎,伴有高血压、糖尿病等基础性疾病,实时荧光定量PCR检测病例咽拭子H7N9禽流感病毒核酸阳性。经达菲等抗病毒治疗,康复出院。患者发病前7 d内曾去过农贸市场。密切接触者50人,均未出现流感样症状,血清H7N9禽流感HI抗体均为阴性。结论该病例以发热肺炎为主要临床特征,感染来源未明,不能排除农贸市场禽类区暴露的可能,未发现人传人情况。     

从1例人禽流感（H5N1）病例发病确诊过程的启示

目的通过分析北京市首例人禽流感（H5N1）病例的发病确诊过程,探讨人禽流感病例早发现、早报告、早诊断的关键点。方法对该病例的流行病学、临床和实验室资料进行分析。结果患者2008年12月24日发病,先后就诊过3家医院,期间出现重症肺炎且病情逐渐加重。2009年1月4日专家会诊时发现患者发病前有禽类接触史。当晚诊断为“不明原因肺炎”上报。1月5日7：20患者死亡。患者的下呼吸道吸取物H5N1病毒核酸检测阳性,咽拭子检测为阴性。1月6日患者确诊为人禽流感（H5N1）病例。对患者多种标本进行病毒分离,仅从肺穿刺标本中分离出H5N1病毒。结论不明原因肺炎病例监测发现人禽流感病例的灵敏度受到医院诊断报告意识的影响;禽类接触史的及时掌握有助于早期发现人禽流感病例;禽流感病毒检测应尽量采集患者的下呼吸道标本。     

新生儿肺炎支原体肺炎26例临床分析

目的:了解新生儿肺炎支原体肺炎的发病特点,提高其诊断与治疗水平。方法:采用前瞻性研究方法对周口市妇幼保健院救治的26例新生儿肺炎支原体肺炎病例进行临床分析。结果:新生儿肺炎支原体肺炎的患儿起病急,以气促、口吐白沫为主症,所有的患儿均有肺部体征,并易出现呼吸困难、肺外并发症。结论:新生儿肺炎支原体肺炎病情重,肺外症状多见,治疗以红霉素、阿奇霉素联用,早期吸氧、使用糖皮质激素有助于病情缓解。     

肝脏移植术后卡氏肺孢子虫肺炎的诊治

目的探讨肝移植术后合并卡氏肺孢子虫肺炎的诊治. 方法总结对肝移植术后并发卡氏肺孢子虫肺炎的成功诊治经验. 结果 63例原位肝移植病例中,1例于肝移植术后94d发生卡氏肺孢子虫肺炎,临床症状为发热、呼吸困难,影像学显示双肺弥漫性间质浸润改变,血气分析提示Ⅰ型呼吸衰竭;临床诊断"卡氏肺孢子虫肺炎",给予激素和超大剂量的复方新诺明后治愈出院. 结论卡氏肺孢子虫肺炎是肝移植术后少见、严重的机会性感染,应及时诊治;常规小剂量复方新诺明预防性治疗可以有效预防肝移植术后卡氏肺孢子虫肺炎的发生.     

流行性感冒诊断与治疗指南(2011年版)

流行性感冒(以下简称流感)是人类面临的主要公共健康问题之一。流感的流行病学最显著特点为:突然暴发,迅速扩散,造成不同程度的流行,具有季节性,发病率高但病死率低(除人感染高致病性禽流感)。季节性流感一般可引起伴有发热的急性呼吸系统疾病,起病急剧,虽然大多为自限性,但是在重症感染或引起并发症时则需要住院治疗;重症病例的高危人群主要为老年人、年幼儿童、孕产妇或有慢性基础疾病者;少数重症病例可因呼吸或多脏器衰竭而死亡。人感染高致病性禽流感(以下简称人禽流感)病死率高达60%以上。疫苗接种是防控流感的主要方法。早期使用抗流感病毒药物治疗可以缓解流感症状、缩短病程,降低并发症发生率、缩短排毒时间并且可能降低病死率;在流行期间,预防性使用可能降低患病率。在经历了2009年全球甲型H1N1流感疫情后,为进一步加强流感临床防治并做好相应准备工作,我国仍然急需一部反映流感最新进展、可指导实际临床工作的诊疗指南。因此,卫生部组织了我国流感防治研究领域的病原学、流行病学、实验室诊断、临床、中医、疾病预防控制等方面专家,在总结我国既往流感诊疗方案和临床经验的基础上,参考国内外最新研究成果,制定了适合我国临床使用的《流行性感冒诊断与治疗指南(2011年版)》。《指南》主要涵盖了流感病原学和流行病学、临床表现、诊断与鉴别诊断、治疗和预防等最新的综合性信息,以指导提高我国流感的诊断防治水平,减轻流感对人类健康和社会造成的危害。     

1例人感染高致病性禽流感（H5N1）死亡的调查

目的探讨2006年2月4日湖南省邵阳市中心医院报告的1例不明原因肺炎死亡病因。方法访谈病例发病前后相关知情人,了解病例活动情况以及所在地家禽死亡情况,查阅临床病志,对密切接触者进行医学观察,采集病例的鼻咽分泌物、气管吸取物、肺穿刺物、唾液,应用逆转录-聚合酶链反应(RT-PCR)和实时荧光定量PCR法(Real-timePCR)检测A/H5N1亚型特异的核酸片段。结果病例发病前6d有宰杀鸡鸭史,对103例密切接触者经7d的医学观察,没有发热和异常情况,病例主要表现为双肺渗出性病变伴白细胞计数显著下降迅速进展为呼吸循环哀竭,病例气管分泌物、肺穿刺液H5N1禽流感病毒核酸均为阳性,咽拭子、唾液检测阴性。结论该病例是一起“禽-人”感染禽流感病毒致死的病例,正常家禽有可能携带H5N1禽流感病毒,应引起高度重视。     

小儿肺炎支原体肺炎156例临床特征分析

目的：探讨小儿肺炎支原体肺炎的临床特征，为临床诊治总结经验。方法收集我院收治的156例小儿支原体肺炎病例，对其临床表现、查体、辅助检查、治疗与转归等情况进行总结分析。结果小儿肺炎支原体肺炎主要发病季节为冬春季，部分患儿可合并细菌感染，大部分患儿有集体生活史。主要临床表现为发热、咳嗽、气促和喘憋；部分患儿可出现恶心、呕吐、食欲不振、精神萎靡、肌肉酸痛及皮疹等。查体阳性体征主要为肺部啰音，少数患儿可有皮疹、脾大、肾区叩痛等肺外阳性体征。辅助检查以胸部X线检查和外周血支原体抗体阳性为主，部分患儿可有血常规、尿常规、血沉、心肌酶、肝功能等变化。入院后主要予以大环内酯类抗生素治疗，合并细菌感染者加用敏感抗生素；全部患儿接受治疗后均康复出院，住院时间14~21 d，平均17.4 d。结论小儿肺炎支原体肺炎是儿科的常见病和多发病，往往具有病情隐匿、临床表现不典型及病程较长的特点，临床医师在收治此类病例时，应该在进行充分辅助检查的基础上，给予系统治疗。     

3例人感染H7N9禽流感重症病例临床特征分析

目的分析人感染H7N9禽流感重症病例临床特征,为临床诊断和治疗提供依据。方法回顾性分析绍兴市中心医院收治的3例人感染H7N9禽流感重症病例的临床特征,并采集患者呼吸道分泌物,进行禽流感病毒核酸检测。结果 3例病例以发热、咳嗽或消化道症状起病,主要表现为咳嗽、咯痰等呼吸道症状或有呕吐、腹泻等消化道症状;均有发热,最高体温40.0℃,用非甾体抗炎镇痛药后体温短暂下降,但数小时后体温回升,持续高热8~10 d,热程第5~9 d内进展为呼吸困难合并急性呼吸窘迫综合征(ARDS)。实验室检测显示,白细胞计数正常或稍降低,淋巴细胞下降明显;乳酸脱氢酶、天门冬氨酸氨基转移酶、超敏C反应蛋白、D-二聚体随疾病进展进行性升高;H7N9禽流感病毒核酸PCR均呈阳性。发病初,3例病例肺部听诊均未现明显阳性体征,胸部影像学表现为片状高密度影,内见空气支气管征,单侧肺或双侧肺感染起病,48 h内迅速发展为双侧肺感染并伴胸腔积液,均为肺部实变。流行病学调查显示1例有明确的活禽接触史。最终治愈1例,死亡2例。结论人感染H7N9禽流感病例临床特征不典型,肺部病变进展快,死亡率高,在冬春季应高度重视不明原因肺炎。     

广东省农村首例人禽流感H5N1病例的流行病学分析

目的 确定人感染高致病性禽流感疫情,查明感染来源,以采取相应措施控制疫情.方法 采用现场流行病学调查和实验室检测相结合的方法 对广东省海丰县1 例不明原因肺炎病例进行诊断和分析.结果 该患者女性,44岁,于2008年2月16日开始发病,病初表现为流感样症状,持续发热,1周内胸片出现两肺大片浸润阴影,病情进展迅速,抗生素治疗无效,全身多器官功能衰竭,于2月25日死亡.患者痰液标本禽流感病毒(H5N1)核酸阳性,病毒分离阳性,基因序列分析显示,分离的H5N1病毒 [A/Guangdong/1/ 2008(H5N1)]仍为禽源性特征.患者居住广东省海丰县海城镇某村,发病前后未离开过居住地,未接触过类似病人.海丰县是候鸟迁徙栖息地,2004年曾发生禽流感疫情.患者发病前1周曾接触与进食自养的病死鸡.病家附近见有水鸟(麻雀和白鹭)活动.经医学观察8 d,所有密切接触者(包括患者的丈夫共91人)均未出现类似症状.参照卫生部<人感染高致病性禽流感应急预案>,采取一系列控制措施后,疫情没有扩散.结论 该病例确诊为广东省农村首例人感染高致病性禽流感病例,感染来源可能是禽流感病毒(H5N1)从病死禽直接传给人,但未发现人传人的现象.今后应继续加强不明原因肺炎监测,加强人感染高致病性禽流感的应急贮备、培训和健康教育.     

婴幼儿肺炎支原体感染临床分析

目的:探讨婴幼儿肺炎支原体感染的临床特征、诊断及治疗。方法:回顾性分析经临床及病原学检查确诊的肺炎支原体感染45例住院婴幼儿。结果:婴幼儿支原体肺炎多以下呼吸道感染为主,肺外并发症以消化系统、循环系统为主,其他如神经、皮肤、泌尿系统亦多受累,临床症状和病原学检查可对其确诊。治疗首选阿奇霉素、红霉素,亦应注意综合治疗及肾上腺皮质激素的使用。结论:婴幼儿肺炎支原体肺炎临床表现多种多样、病情重、并发症多,病原学对婴幼儿肺炎支原体感染诊断有重要意义。对以呼吸道外症状为主要表现的病例要注意早发现、早诊断,及时给予足量阿奇霉素、红霉素治疗,预后较好。     

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.     

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.     

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.     

The risk of heat exhaustion at a deep underground metalliferous mine in relation to surface temperatures

The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.     

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.