肝脏移植术后肺部感染的防治

目的 探讨肝脏移植术后肺部感染的防治措施.方法 回顾性分析78例肝移植术后发生肺部感染的临床资料.结果 肺部感染的发病率为48.8%;首次发生肺部感染的时间为术后(9.56±5.53)d;78例中右侧肺炎44例,左侧肺炎14例,双侧肺炎20例;手术时间长、术后机械通气时间、腹腔出血、术中输液量、肾功异常等为肺部感染的高危因素;78例患者中68例(87.2%)好转,10例(12.8%)死亡.结论 肝移植后肺部感染病死率较高,细菌、真菌是主要的病原体;缩短手术时间、减少腹腔出血、控制液体入量、术后尽快拔除气管插管、保护肾功、提高病原检测技术等是防治肝移植术后肺部感染的关键.     

肝移植患者术后肺部感染阿萨希丝孢酵母菌的临床与药物敏感性分析

目的探讨肝移植患者术后肺部感染阿萨希丝孢酵母菌的临床表现及药物敏感性,提高临床有效治疗和前期预防意识。方法回顾性分析2014年9月-2015年4月中山大学岭南医院4例肝移植术后感染阿萨希丝孢酵母菌患者的临床资料,对送检标本做病原菌培养、鉴定及药敏试验,综合分析肝移植术后阿萨希丝孢酵母菌感染的临床特点,数据采用SPSS 17.0软件进行统计分析。结果肝移植术后阿萨希丝孢酵母菌肺部感染临床表现主要为呼吸系统感染的症状;肝脏移植、激素、免疫抑制剂、广谱抗菌药物、静脉置管、使用呼吸机等是肝移植术后阿萨希丝孢酵母菌肺部感染的高危因素,该菌对氟康唑、伏立康唑等多种抗真菌药物敏感,患者感染预后较差均死亡。结论肝移植术后相关治疗容易导致阿萨希丝孢酵母菌肺部感染,该菌感染预后差但对多种抗真菌药物敏感,及早发现及目标用药是控制肝移植术后该菌侵袭性严重感染的关键。     

肝移植术后肺部感染的临床分析

目的分析肝移植术后肺部感染的高危因素,探讨其防治措施。方法回顾性分析46例成人肝移植病例资料,分为肺部感染组和未发生肺部感染组,分析患者感染的多种危险因素。结果肝移植术后肺部感染的发生率为43.5%,病死率60.0%,感染与术中输液量、术后机械通气时间、血肌酐、白蛋白、腹腔出血、胸腔积液等因素有关,肺部感染组与未发生肺部感染组中的差异有统计学意义(P<0.05)。结论肝移植术后肺部感染病死率较高,肝移植术中尽量控制液体输入量、术后尽快拔除气管插管、预防肾功能不全、加强营养、及时处理大量胸腔积液和腹腔出血是预防肺部感染的重要因素。     

医院感染病原体的构成及耐药谱研究

目的 探讨医院感染病原体的构成及耐药情况。方法 对我院4年间出院的31422人进行调查，确诊患医院感染者1783例，对造成医院感染的主要病原体进行药敏试验测定。结果 医院感染发病率5．67％，发生医院感染的主要部位是呼吸道，占46．4％，其次为手术伤口18．58％和泌尿道16．3％；引起医院感染的病原体以G^-菌为主，占58．22％，G^ 菌为27．85％，真菌为13．93％。结论 控制医院感染的主要部位是呼吸道，耐药菌株不断增加，以G^-杆菌为主；合理使用抗生素是控制耐药菌株出现的关键措施。     

35例肝移植患者下呼吸道细菌感染分析

目的 调查肝移植受体在重症监护室(ICU)期间下呼吸道感染细菌分布及耐药情况，找出降低肺部感染方法。方法 回顾性分析35例肝移植受体下呼吸道分离出的277株病原菌及药敏结果。结果 革兰阴性(G^-)菌占66．79％，革兰阳性(G^ )菌占21．66％，真菌占11．55％，主要致病菌依次为阴沟肠杆菌、金黄色葡萄球菌和铜绿假单胞菌，对绝大多数抗生素耐药。结论 合理、适当选用抗生素以及统一、整体管理对降低肝移植受体术后感染非常重要。     

42例肝移植术后医院感染的调查

目的了解我院肝移植术后医院感染的发病特点及其危险因素,探讨防治措施。方法回顾性调查我院2002年8月~2004年12月间42例肝移植患者术后医院感染发生情况,并进行统计分析。结果42例肝移植患者中有24例术后发生医院感染,感染率为57.14%。好发部位为肺部、血液及腹腔、胆道,其中75.44%发生在术后的前两周内。结论肝移植患者术后医院感染率较高,术后的前两周是感染的高危时段。易感因素患者基础病所致的免疫功能缺损、各种侵入性操作及大量免疫抑制剂和广谱药物的使用。     

心脏大血管术后肺部感染病原学及危险因素

目的探讨心脏大血管术后患者肺部感染的病原学及危险因素。方法选取2017年10月-2020年3月海南医学院第一附属医院收治的心脏大血管手术患者247例的资料进行回顾性分析。分析患者的手术类型及相应的肺部感染情况。统计并分析肺部感染患者的病原学及药敏试验结果。筛选心脏大血管术后患者肺部感染的影响因素。结果 247例患者术后共有32例发生肺部感染,感染率为12.96%。不同手术分类的感染率比较差异具有统计学意义(χ~2=22.834,P0.001),其中主动脉置换手术后发生肺部感染的比例最高。肺部感染患者痰液标本中共分离出58株病原体,革兰阴性菌34株,占58.62%,革兰阳性菌19株,占32.76%,真菌5株,占8.62%。最常见的病原体为洋葱伯克霍尔德菌,共12株,占20.69%。Logistic多因素回归分析显示,年龄较大、手术类型为主动脉置换、手术耗时较长、住院时间较长、呼吸机使用时间较长,均为心脏大血管术后患者肺部感染的影响因素(P0.05)。结论心脏大血管手术后患者出现肺部感染的风险较高,感染的病原体以革兰阴性菌为主。心脏大血管手术后患者出现肺部感染的影响因素较多,应在工作中采取针对性的预防措施。     

肝移植术后医院感染流行病学分析

目的探讨肝移植术后医院感染发生状况及其病原菌分布,为控制肝移植术后医院感染的发生提供有针对性的预防措施。方法采用回顾性调查方法对某院2004年9月—2005年9月期间肝移植术后病例中发生医院感染的病例进行流行病学分析。结果147例肝移植病人中,发生医院感染38例(54例次),感染率为25.9%(例次感染率为36.7%);医院感染部位以肺部感染最高,为21例次(38.9%),其次是切口感染18例次(33.3%);病原学检验以细菌感染(76.2%)占首位。结论肺部感染、切口感染是肝移植术后较常见的感染部位,细菌是肝移植术后最常见的病原体,其次为真菌。     

食管贲门癌患者术后肺部感染的临床分析

目的探讨食管贲门癌患者术后肺部感染的相关危险因素及诊治对策,以提高医疗服务质量。方法回顾性分析医院2012年1月-2013年1月146例手术治疗食管贲门癌患者资料,对感染高危因素进行分析,采用SPSS13.0软件进行统计处理。结果 146例患者中27例发生术后肺部感染,感染率为18.49%;手术时间、病程、年龄、合并基础疾病、手术切口长度、营养状况、预防性使用抗菌药物、吸烟、未采用术后自控镇痛等与肺部感染密切相关(P<0.05);共培养出病原菌27株,革兰阴性菌19株占70.37%,以铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌和鲍氏不动杆菌为主,革兰阳性菌8株占29.63%,以金黄色葡萄球菌、表皮葡萄球菌为主;革兰阴性菌对氨苄西林、左氧氟沙星高度耐药,革兰阳性菌对万古霉素、亚胺培南敏感性较高。结论术前综合评价,掌握手术指征,发现肺部潜在疾患,合理的手术方案、娴熟的手术操作技术可降低肺部创伤,术后针对感染高危因素进行干预是降低患者肺部感染率与控制感染的有效措施。     

胸外科机器人手术患者术后肺部感染病原菌及其危险因素

目的 探讨机器人胸外科手术患者术后肺部感染病原菌及其危险因素。方法 回顾性分析2020年8月-2022年6月于解放军总医院第一医学中心行达芬奇机器人手术的患者124例的临床资料，分析术后肺部感染病原菌，并归纳术后肺部感染的危险因素。结果 经达芬奇机器人手术治疗的124例患者，术后发生肺部感染19例，感染率为15.32%;共培养分离病原菌33株，其中革兰阴性菌有25株占75.76%,革兰阳性菌8株占24.24%;主要致病菌中，铜绿假单胞菌对哌拉西林/他唑巴坦、亚胺培南以及头孢哌酮/舒巴坦的耐药率>40%,肺炎克雷伯菌对阿米卡星、头孢他啶以及左氧氟沙星耐药率较高(37.50%);手术方式是达芬奇机器人胸外科手术后肺部感染的危险因素(P=0.018)。结论 对胸外科机器人手术患者，手术方式是影响患者肺部感染的重要因素，早期识别致病菌和耐药谱，对降低肺部感染率有重要意义。     

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.