不同来源产志贺毒素大肠埃希菌分布特征

目的探讨不同标本中产志贺样毒素大肠埃希菌（STEC）的分布特征。方法采集动物粪便、肉类食品和排污口污泥样品，常规分离大肠埃希菌，血清学分型，PCR鉴定产志贺样毒素（stx1，stx2）菌株。结果293份标本中鉴定出8株STEC，1株为产志贺毒素O157：H7型，2株为不产志贺毒素O157：H7型，5株为产志贺毒素非O157：H7型。结论STEC存在于不同来源的标本中，菌株表型与毒力因子存在一定差异。     

网状分枝扩增方法检测志贺毒素2基因

目的 建立一种快速、灵敏检测志贺样毒素2(STX2)的方法。方法 用网状分枝扩增技术(RAM)和PCR检测合成的志贺样毒素2基因和临床分离的菌株，确定该方法的灵敏度和特异性。结果 RAM最少能检测10个志贺样毒素2的DNA分子，与PCR具有同样灵敏度。用PCR和RAM检测临床标本和食品中分离的33株大肠埃希菌，其中26株stx2基因为阳性，2种方法检测结果一致。结论 RAM与PCR方法相同的灵敏度和特异性，但操作简便，并且是在等温条件下扩增核酸，成本较低，适合检测食品和临床标本中大肠埃希菌志贺样毒素2。     

大肠埃希菌O157∶H7携带stx2::IS1203v基因研究

目的了解中国部分地区大肠埃希菌O157：H7菌株携带志贺毒素基因变异状况。方法采用聚合酶链反应扩增志贺毒素基因，使用核苷酸序列测定判断是否存在志贺毒素的新变种，用HeLa细胞毒性实验研究其细胞毒性的变化。结果1992—2002年中国部分地区分离到的289株产志贺毒素的大肠埃希菌O157：H7中有3株菌携带的志贺毒素2（stx2）基因有1．3kb的插入序列（IS）插入，且这段IS和IS1203变种（IS1203 variant，IS1203v）有100％的核苷酸序列同源性。IS1203v插入到3株大肠埃希菌O157：H7 stx2基因的位置及开放性读码框（ORF）方向有所不同。除此之外，3株菌原有的stx2基因序列完全一致且为Stx2原型毒素。和Stx2原型毒素相比，这3株携带stx2：：IS1203v基因的菌株对HeLa细胞的毒性明显降低。结论分离到IS1203v插入stx2基因的大肠埃希菌O157：H7菌株；IS1203v的插入可导致对HeLa细胞的细胞毒性降低。     

2000～2005年海盐县肠出血性O157:H7大肠埃希菌监测

目的：了解海盐县肠出血性O157：H7大肠埃希菌的分布及流行情况。方法：采取肠道门诊病人肛拭样和动物宿主粪便，采用免疫磁珠分离和大肠杆菌O157特异性单克隆抗体胶体金快速诊断技术以及特定培养基分离鉴定技术检测O157：H7大肠埃希菌。结果：从1例腹泻患者的大便中检了了1株O157：H7大肠埃希菌，不产生类志贺毒素；从动物粪便中检出7株O157大肠埃希菌。结论：海盐地区人群中感染率较低，且为非产毒株；猪、鸡是我地区O157：H7大肠埃希菌的主要贮存宿主动物。     

2007年浙江省衢州地区动物中产志贺毒素大肠埃希菌O157:H7感染状况

目的:了解2007年浙江省衢州地区产志贺毒素大肠埃希菌O157:H7在动物中的分布情况及其耐药性、PFGE分型及毒力基因携带状况。方法:按全国O157:H7监测方案于5~10月份肠道传染病高发季节,在衢州地区采集各种动物粪便/肛拭,用免疫磁珠富集后进行O157:H7分离培养、鉴定,可疑菌株以PCR法检测O、H抗原及志贺样毒素(SLT1和SLT2)、粘附抹平因子(eaeA)及溶血素(hly)4种毒力基因。用脉冲场凝胶电泳(pulse field gel electrophoresis,PFGE)方法进行同源性分析,同时选择14种抗生素进行药敏试验,分析分离所得菌株的耐药状况。结果:共监测动物粪便标本300份,分离得产志贺毒素大肠埃希菌O157:H7菌株16株,分离率为5.33%。16株O157:H7菌株,毒力基因Hly、eaeA、SLT2均阳性,SLT1均阴性。脉冲场凝胶电泳分型显示,16株O157:H7菌株可分2个PFGE基因型,型间差异较小。耐药性分析显示这些菌株对红霉素、利福平的耐药率最高,达100.0%,对其他受试抗生素均敏感。结论:该地区动物中产志贺毒素大肠埃希菌O157:H7带菌率较高,所分离菌株主要携带SLT2基因,因此推测该地区存在发生产志贺毒素大肠埃希菌O157:H7感染暴发或流行的潜在危险,需增加对动物源性O157:H7的监测力度。     

进口冷冻肉制品O157：H7大肠埃希菌调查分析

目的：对进口冷冻肉制品O157：H7大肠埃杀菌进行检测。方法：用Binax试剂进行筛选。结果：从174份进口冷冻肉制品中检出4株O157：H7大肠埃希菌,分离率为2．3％,结论：该分离株发酵山梨醇,不具溶血素和志贺样毒素基因,但仍具毒力,41℃增菌培养能抑制杂菌,可提高检出率。     

食品中肠出血性大肠埃希菌O157:H7的PCR检测

目的建立快速准确检测食品中肠出血性大肠埃希菌O157：H7的方法。方法采用多重聚合酶链式反应技术（MPCR）特异性扩增肠出血性大肠埃希菌O157：H7的STX、rfbE、fliC基因。结果分别在228，378，709bp处扩增出3个目的基因片段，且只有肠出血性大肠埃希菌O157：H7获得扩增，其他菌种扩增均呈阴性。结论PCR方法比传统细菌检测方法更特异、快速、灵敏和简便，为食品中肠出血性大肠埃希菌O157：H7的快速检测提供了新的手段。     

多重PCR方法快速检测E.coli O157毒力及rfbEO157基因

[目的]探索一种快速、特异的检测大肠埃希菌O157的多重PCR(multiplex PCR)方法。[方法]选用针对大肠埃希菌O157志贺样毒素1、2(stx1、stx2)基因、溶血素(hlyA)基因、粘附抹平因子(eae)基因和O157特异性基因(rfbEO157)的5对引物，在同一扩增体系中进行PCR，检测9株不同来源的O157和其他大肠埃希菌21株。[结果]通过优化多重PCR反应条件和循环参数，5对特异性引物只扩增相应的基因片段，检测结果与应用常规PCR获得的结果一致。[结论]该多重PCR方法能够在一次扩增中同时反应待测菌株是否为大肠埃希菌O157及其携带毒力基因的情况，可为大肠埃希菌O157的诊断及流行病学调查提供一种简便、经济、快速的检测手段。     

大肠埃希菌O157血清型分离株的脉冲场凝胶电泳分型

目的了解杭州地区分离的产志贺毒素和不产志贺毒素大肠埃希菌O157菌株的分子流行病学特征。方法对杭州地区于1997～2005年间自散发腹泻患者和动物中分离的10株大肠埃希菌O157血清型菌株,PCR检测毒力基因stx1、stx2、eae和ehxA,eae阳性者进行eae基因分型;按标准化的脉冲场凝胶电泳法(pulsefieldgelelectrophoresis,PFGE)进行分子分型,并与国内其他省份分离的产志贺毒素大肠埃希菌(Shigatoxin_producingEscherichiacoli,STEC)O157∶H7菌株进行比较。结果杭州分离菌株HZ1_11携带毒力基因stx2、γ型eae和ehxA,为浙江省检获的首株STECO157∶H7;3株杭州O157∶NM分离菌株(2_1、26_1和SR05株)仅携带β型eae基因;其他6株杭州O157∶H?分离菌株中,均未检出毒力基因。PFGE揭示,在杭州人源O157菌株中,STECO157∶H7HZ1_11株与近年江苏和安徽分离STECO157∶H7菌株密切近缘,且其图谱与江苏菌株几乎完全相同;3株eae阳性的O157∶NM分离菌株聚类成与STECO157∶H7菌株较远的一簇,杭州1株stx阴性的O157∶H?(1_68株)则处于另一独立的一簇。5株杭州O157∶H?动物分离菌株与其他人源菌株图谱差异极大。结论浙江省首株STECO157∶H7可能是源自近年在江苏流行的STECO157∶H7菌株。β型eae阳性的大肠埃希菌O157∶NM菌株可能具有引起散发腹泻的能力。     

产志贺样毒素大肠埃希菌Ⅰ类整合子的鉴定和分析

目的阐明各种来源的产志贺样毒素大肠埃希菌(Shiga toxin-producing E. coli,STEC)中I类耐药整合子的分布、特征、所含基因盒的状况以及所表达的耐药信息.方法常规分离出大肠埃希菌、血清学分型,PCR法鉴定产stx1-2毒素性菌株;纸片扩散法对17种抗菌药物进行耐药性监测和分析;PCR法鉴定I类整合子阳性株;PCR产物测序并对结果进行分析.结果各种标本中共鉴定出46株产志贺样毒素大肠埃希菌,其中23株为O157:H7;全部STEC对复方新诺明耐药,对链霉素耐药率为28.3%,氨苄西林为30.4%,而且有5株对至少＞4种抗菌药物多重耐药,耐药谱为复方新诺明-链霉素-氨苄西林-庆大霉素;46株分离株中有11株(23.9%)鉴定出I类整合子,PCR产物测序得知9株携带aadA1基因盒,2株携带aadA2基因盒,均来自氨基糖苷类抗菌药物耐药菌株(39.3%),传递对氨基糖苷类抗菌药物的耐药性.结论I类整合子存在于各种来源的产志贺样毒素大肠埃希菌中,并携带相应的基因盒,决定着对氨基糖苷类抗菌药物的耐药性.     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.