肾移植术后早期感染类型分析

目的 总结肾移植术后早期感染的类型、原因及死亡率,以提高其生存率.方法 对1102例肾移植术后发生感染的298例住院患者临床资料进行回顾性分析,总结感染类型、病原体、预后等.结果 肾移植术后早期感染率为27.04％,其中肺部269例,泌尿系统15例,消化道9例,切口3例,颅内及全身各1例;应用抗胸腺细胞球蛋白(ATG)后感染率达59.35％;病原体以革兰阴性菌为主占64.77％,革兰阳性菌占19.80％,真菌占6.71％,卡氏肺孢子虫占4.03％,病毒占3.02％;感染率中男女无差异,男性发生感染后死亡及切除移植肾比例较高.结论 肾移植术后早期感染患者有一定的规律,应合理应用免疫抑制剂,加强肺部感染的早期诊断和全身支持治疗,尤其是男性患者.     

肾移植患者术后肺部感染的临床特征分析

目的探讨肾移植术后患者肺部感染的临床特点和治疗方法。方法回顾性分析2010年10月-2015年12月医院收治的肾移植术后合并肺部感染患者130例的临床资料,分析患者肺部感染的临床特点及治疗方法。结果研究期间共诊治肾移植术后患者肺部感染130例次。肺部感染发生时间多发生于术后6个月76.92%(100/130);主要临床症状为发热83.85%(109/130)、咳嗽55.38%(72/130)、咳痰46.15%(60/130)和呼吸困难37.69%(49/130)。影像学表现主要为斑片状密度增高影40.00%(52/130)。在130例次感染中,有65例患者检测病原体阳性,病原体以混合感染为主占46.15%(30/65)。结论肾移植术后肺部感染多发于术后半年后,患者多因发热、咳嗽、呼吸困难就诊,混合感染多见,针对病原菌应用抗菌药物及对症支持治疗是治疗成功的关键。     

肾移植患者感染死亡的临床及病理学分析

目的为防止肾移植患者并发感染提供参考。方法分析２０年来２４例同种异体肾移植患者的尸检材料及临床资料。结果感染的发生率为６６．７％，由感染致死的占５０％。感染的病原菌除细菌、真菌外，还有结核菌、病毒、放线菌。各种不同病原体所引起的病变有不同特征和临床表现。结论感染是导致肾移植患者死亡的主要原因，一些措施（如：加强肾移植术前、术后管理）可有效地预防感染的发生     

肾移植术后肺部感染临床分析

目的探讨肾移植术后肺部感染的临床特点及治疗方法。方法对47例肾移植术后肺部感染患者的临床资料进行回顾性分析。结果47例患者中,肺部感染发生于移植术后<6个月者36例(76.60%),6~12个月8例(17.02%),>12个月3例(6.38%);其中有10例出现急性呼吸窘迫综合征(ARDS),5例病死。细菌感染15例,真菌感染5例,巨细胞病毒感染4例,结核感染2例,混合感染21例。结论肾移植术后肺部感染多发生于术后1年内,病原体呈多样性,早期发现病原体、合理治疗、及时调整免疫治疗方案是治疗成功的关键。     

肾移植术后肺部感染的病原体分析与诊治

目的 探讨肾移植术后肺部感染的病原体诊断,提高患者生存率.方法 回顾性地分析2003年8月-2008年8月43例肾移植术后肺部感染患者临床资料.结果 肾移植术后肺部感染的病原体主要有真菌(44.2%)、病毒(30.2%)、结核分枝杆菌(9.3%)和其他细菌(9.3%);出现时间一般在术后<6个月;曲霉菌属及卡氏肺囊虫性肺炎病死率高,分别为28.6%和16.7%.结论 早期诊断及经验性治疗尤为重要,发病早期无特殊急重情况不建议联合治疗.     

心血管病住院患者肺部感染的原因分析

目的 分析心血管病患者住院期间并发肺部感染原因,提出防治对策,以期为降低心血管病住院患者医院感染的发生提供参考依据.方法 对432例心血管病患者临床资料进行回顾性分析,分析患者肺部感染发生情况.结果 432例患者住院期间发生肺部感染者64例,感染率为14.81％;患者高龄、合并有多种基础疾病、抗菌药物应用种类较多、抗菌药物应用时间较长、有侵入性操作、住院时间较长等是引起心血管病住院患者肺部感染发生的主要危险因素(P＜0.01);64例肺部感染患者痰培养共检出病原菌68株,其中革兰阳性菌45株占66.18％,革兰阴性菌21株占30.88％,真菌2株占2.94％,革兰阴性菌主要为肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌,分别占25.00％、17.65％、11.76％,革兰阳性菌主要为金黄色葡萄球菌、表皮葡萄球菌、溶血性链球菌,分别占11.76％、7.35％、4.41％,真菌主要为白色假丝酵母菌,占2.94％.结论 心血管病住院患者并发肺部感染的原因主要与高龄、合并有多种基础疾病、抗菌药物应用种类较多、抗菌药物应用时间较长、有侵入性操作、住院时间较长等原因有关,感染病原菌主要为革兰阴性菌,应针对以上高危因素进行干预,以降低医院感染发生率.     

上消化道穿孔患者术后肺部感染的临床分析

目的探讨上消化道穿孔患者术后肺部感染的临床分析及干预对策,以期提高临床治疗水平。方法回顾性分析2010年1月-2013年1月65例上消化道穿孔手术患者,对其中的12例肺部感染患者临床表现、病原菌和危险因素等采用SPSS16.0进行分析。结果上消化道穿孔患者术后肺部感染临床表现以发热、咳嗽、咳痰、胸闷、气短等肺部感染为主,实验室以白细胞和C-反应蛋白升高为主;病原菌以革兰阴性菌中以铜绿假单胞菌和肺炎克雷伯菌为主,占52.6%;其中年龄>65岁、术后未镇痛、全麻、有肺部慢性基础疾病、胃肠减压时间>48h、术前存在休克是上消化道穿孔术后肺部感染危险因素(P<0.05);经过综合治疗后治愈率为90.77%。结论上消化道穿孔术后肺部感染临床表现明显,早期干预可提高预后。     

肾移植术后肺部感染的临床探讨

目的：探讨肾移植术后肺部感染的防治。方法：对1123例肾移植术后并发肺部感染的110例患者的临床资料进行回顾性分析。结果：101例肺部感染临床治愈，11例ARDS中抢救成功2例，死亡9例。病原菌分布：细菌感染69例（63％），巨细胞病毒（CMV）感染20例（18％），真菌感染16例（15％），结核菌感染8例（7％），病原菌不明9例（8％）。结论：细菌是肾移植术后肺部感染的主要致病菌；早期作出病原学诊断是治疗肾移植术后肺部感染的关键。     

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。     

肾移植后严重肺部感染的诊治难点和对策

感染是肾移植的重要并发症和死亡原因。Rubin[1] 统计报道肾移植术后 1年约有 70 %的患者至少发生 1次不同程度和类型的感染。肾移植术后严重肺部感染病情重 ,发展快 ,病死率高 ,Jha等[2 ] 报道救治成功率为 5 9%。本文就肾移植术后严重肺部感染的诊治难点及对策综述如下。1　诊断中的难点[3～ 6]1.1　病原体检测困难　国外文献[3 ] 认为 :肾移植术后严重肺部感染常见病原体为巨细胞病毒、曲霉菌、卡氏肺囊虫、结核杆菌、诺卡菌等。国内任吉忠等[4]报道 :肾移植术后严重肺部感染以细菌为主要致病菌 ,双重及混合感染占有相当比例。细菌有肺…     

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.