耐碳青酶烯类铜绿假单胞菌相关耐药基因及I型整合酶基因研究

目的研究耐碳青酶烯类铜绿假单胞菌的相关耐药基因及Ⅰ型整合酶基因。方法采用聚合酶链反应（PCR）法对铜绿假单胞菌碳青酶烯类耐药相关的金属β-内酰胺酶IMP、VIM、SPM、GIM基因和外膜蛋白oprD2基因及Ⅰ型整合酶基因等6种主要耐药基因进行检测与分析。结果51株耐亚胺培南和美罗培南铜绿假单胞菌SPM、GIM金属酶基因检测均阴性,16株IMP和5株VIM型金属酶基因阳性,14株耐亚胺培南铜绿假单胞菌oprD2基因阳性,其余37株铜绿假单胞菌oprD2基因阴性,7株产金属酶并同时伴有膜孔蛋白oprD2基因缺失,49株Ⅰ型整合酶基因intⅠ1阳性。结论膜孔蛋白oprD2基因缺失是铜绿假单胞菌对碳青酶烯类抗菌药物耐药的主要原因,其次是产生金属酶,Ⅰ型整合酶基因广泛存在于铜绿假单胞菌中,提示要加强对耐药基因在病原菌种属间传播和扩散的监测工作。     

儿科铜绿假单胞菌的OprD基因突变及表达对碳青霉烯类抗生素耐药的作用

目的:探讨我院儿科病区分离的碳青霉烯类耐药铜绿假单胞菌(CRPA)流行情况及OprD基因突变及表达在碳青霉烯类耐药中的作用。方法:儿科分离的30株碳青霉烯类耐药的铜绿假单胞菌,随机扩增DNA多态性(RAPD)进行同源性分析;PCR法检测KPC、IMP、VIM、SPM等产酶基因和OprD基因并双向测序及比对;FQ-RT-PCR测定OprD基因的mRNA相对表达量;SDS-PAGE电泳分析OprD外膜蛋白缺失情况。结果:儿科病区30株CRPA中,检出IMP基因阳性菌株1株,接合试验阴性。oprD基因缺失4株(4/30),突变率100%(9/9),碱基突变主要集中在1010 bp~1136 bp和1212 bp~1355 bp区域。CRPA菌株的oprD基因相对表达量与非耐药组差异有显著性(t=6.145,P<0.05),oprD基因突变位点与其表达量之间无相关性。结论:oprD基因发生广泛突变及表达量降低或缺失是本院儿科CRPA菌株对碳青霉烯类抗生素耐药的主要原因之一。     

β-内酰胺酶基因与铜绿假单胞菌耐碳青霉烯类药物的关系研究

目的探讨β-内酰胺酶基因与铜绿假单胞菌耐碳青霉烯类药物的关系,为临床合理使用抗菌药物提供依据。方法对临床分离的690株铜绿假单胞菌进行回顾性分析;并选取52株耐碳青霉烯类抗生素的铜绿假单胞菌,利用PCR法检测其中8种主要β-内酰胺酶编码基因的分布情况。结果 690株铜绿假单胞菌中,临床分布以痰标本为主,占56.52%(390/690),其次为伤口分泌物,占11.88%(82/690);病区分布以ICU检出率最高,占16.23%(112/690),其次为神经外科和呼吸内科,分别占13.91%(96/690)和10.58%(73/690);在检测的15种抗生素中,耐药率超过50%的达9种(60%),耐药率最高为氨苄西林/舒巴坦(98.00%),其次为复方新诺明(93.00%)和替卡西林(92.00%),耐药率最低为多粘菌素E(6.00%);β-内酰胺酶基因的PCR结果显示,IMP阳性25份,VIM阳性17份,IMP和VIM均阳性7份,OXA阳性3份,其它β-内酰胺酶耐药基因(SPM,TEM,PER,GES,SHV)均阴性。结论临床分离铜绿假单胞菌主要来自呼吸道标本,科室分布以ICU、神经外科和呼吸科为主,其耐药情况非常严重;本地区铜绿假单胞对碳青霉烯类抗生素耐药可能主要与β-内酰胺酶基因IMP和VIM相关。     

绍兴地区铜绿假单胞菌亚胺培南耐药机制研究

目的探讨绍兴地区耐亚胺培南铜绿假单胞菌的耐药机制.方法对5株亚胺培南耐药的铜绿假单胞菌和4株亚胺培南敏感的铜绿假单胞菌进行IMP、VIM和oprD2基因等3种基因检测和测序.结果 5株亚胺培南耐药的铜绿假单胞菌均检出VIM基因,经比对分析为VIM-2型;无IMP基因检出,oprD2基因均无缺失.结论绍兴地区耐亚胺培南的铜绿假单胞菌由VIM-2型基因引起.     

碳青霉烯耐药铜绿假单胞菌感染的分子流行病学及治疗

铜绿假单胞菌是院内感染常见致病菌。碳青霉烯耐药铜绿假单胞菌(CRPA)明显增加死亡风险, 需高度重视。CRPA耐药机制包括外排系统过表达、膜通透性下降、产碳青霉烯酶与生物膜等, 碳青霉烯酶以B类金属-β内酰胺酶中的VIM和IMP为主。ST235是最高危克隆, 在我国及世界范围内广泛分布。预防CRPA感染是关键, 治疗可选择多黏菌素、头孢他啶/阿维巴坦等药物, 期望针对不同耐药机制的新型抗菌药物能早日惠及患者。     

基层医院铜绿假单胞菌耐药性分析及耐药基因检测

目的分析二级医院临床分离铜绿假单胞菌抗菌药物敏感性和金属酶、β-内酰胺酶流行情况,指导临床用药。方法回顾性分析2013年2月-2015年10月医院临床分离的非重复铜绿假单胞菌318株,所有菌株均用K-B法进行药敏试验;收集30株耐亚胺培南铜绿假单胞菌,采用聚合酶链反应(PCR)检测4种碳青霉烯酶耐药基因IMP、VIM、OXA-10、OXA-23。结果铜绿假单胞菌对阿米卡星耐药率最低,对头孢哌酮/舒巴坦、环丙沙星、哌拉西林/他唑巴坦、头孢他啶、亚胺培南耐药率依次为27.9%,30.9%,33.0%,34.2%,35.7%,对哌拉西林、美洛西林耐药率较高,耐药率分别为42.0%、54.6%。经基因检测发现VIM型阳性株24株,OXA-10阳性株1株,未扩增出IMP、OXA-23阳性株。结论基层医院铜绿假单胞菌耐药率也很高,以产金属β-内酰胺酶为主,OXA酶检出率较低,基因型为OXA-10。     

耐亚胺培南铜绿假单胞菌耐药特征及其耐药机制的初步研究

目的分析临床分离的耐亚胺培南铜绿假单胞菌对常用抗菌药物的耐药特征及对亚胺培南的耐药机制。方法采用BD Phoenix 100 全自动微生物分析仪进行细菌鉴定,纸片扩散法（K B法）进行药敏试验;聚合酶链反应(PCR)检测碳青霉烯酶相关基因(IMP、VIM、OXA、GES)及外膜蛋白基因oprD2。结果耐亚胺培南铜绿假单胞菌对阿米卡星耐药率最低,为8.33%;对庆大霉素、妥布霉素的耐药率＜20%;第三四代头孢菌素、氨曲南、美罗培南、复方磺胺甲口恶唑、米诺环素等抗菌药物抗菌活性差, 耐药率＞60%,对氨苄西林/ 舒巴坦全部耐药。检测到1株OXA 17阳性菌,阳性率2.78%;oprD2缺失率为38.89%;未检测到其余耐药基因。结论耐亚胺培南铜绿假单胞菌除对氨基糖苷类抗生素耐药率较低外, 对其他常用抗菌药物耐药严重;膜蛋白OprD2缺失与碳青霉烯酶产生等机制导致铜绿假单胞菌对亚胺培南耐药。     

耐亚胺培南铜绿假单胞菌金属β-内酰胺酶基因研究

目的 对耐亚胺培南铜绿假单胞菌进行相关耐药基因研究.方法 采用聚合酶链反应(PCR)法对耐亚胺培南铜绿假单胞菌相关的金属β-内酰胺酶IMP、VIM、SPM、GIM基因进行检测与分析.结果 62株耐亚胺培南铜绿假单胞菌中16株IMP和5株VIM型金属酶基因阳性,SPM和GIM型金属酶基因全部为阴性.结论 铜绿假单胞菌产金属β-内酰胺酶是泰安地区该菌对亚胺堵南耐药的重要机制.     

β-内酰胺酶基因与铜绿假单胞菌耐碳青霉烯类药物的关系研究

目的探讨β-内酰胺酶基因与铜绿假单胞菌耐碳青霉烯类药物的关系,为临床合理使用抗菌药物提供依据。方法对临床分离的690株铜绿假单胞菌进行回顾性分析;并选取52株耐碳青霉烯类抗生素的铜绿假单胞菌,利用PCR法检测其中8种主要β-内酰胺酶编码基因的分布情况。结果690株铜绿假单胞菌中,临床分布以痰标本为主,占56.52%（390/690）,其次为伤口分泌物,占11.88%（82/690）;病区分布以ICU检出率最高,占16.23%（112/690）,其次为神经外科和呼吸内科,分别占13.91%（96/690）和10.58%（73/690）;在检测的15种抗生素中,耐药率超过50%的达9种（60%）,耐药率最高为氨苄西林/舒巴坦（98.00%）,其次为复方新诺明（93.00%）和替卡西林（92.00%）,耐药率最低为多粘菌素E（6.00%）;β-内酰胺酶基因的PCR结果显示,IMP阳性25份,VIM阳性17份,IMP 和 VIM均阳性7份,OXA阳性3份,其它β-内酰胺酶耐药基因（SPM,TEM,PER,GES,SHV）均阴性。结论临床分离铜绿假单胞菌主要来自呼吸道标本,科室分布以ICU、神经外科和呼吸科为主,其耐药情况非常严重;本地区铜绿假单胞对碳青霉烯类抗生素耐药可能主要与β-内酰胺酶基因IMP和VIM相关。     

耐亚胺培南铜绿假单胞菌耐药特征和碳青霉烯酶基因分析

目的研究耐亚胺培南铜绿假单胞菌对常用抗菌药物耐药性及其产碳青霉烯酶的基因特征。方法对耐亚胺培南铜绿假单胞菌的耐药性进行回顾性分析;Carba NP法进行碳青霉烯酶表型确证;PCR进行基因型检测。结果 640株耐亚胺培南铜绿假单胞菌对氨曲南耐药率最高,为58.8%;对3种氨基糖苷类耐药率最低,为19.2%~20.6%;对其他6种抗菌药物耐药率为40.0%~51.1%。检出72株耐亚胺培南铜绿假单胞菌产碳青霉烯酶,阳性率为11.3%。基因型检测3株为KPC-2型,占4.2%,26株为IMP型,占36.1%,43株为VIM型,占59.7%。结论耐亚胺培南铜绿假单胞菌对氨基糖苷类敏感性较好,但对其他抗菌药物耐药性严重;碳青霉烯酶主要以金属β-内酰胺酶为主。     

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.     

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.     

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.