针灸后局部结核感染的实验室检测报告

目的：检测某中医诊所受诊者局部感染病原菌,为探索事件致病原因提供科学依据。方法：采集病人局部感染脓液和痰液标本,进行涂片、分离培养、药敏试验、结核分枝杆菌鉴定等检测。结果：检测46例病人的脓液标本78份,其中48份标本检出人结核分枝杆菌,涉及病例32人,受检病例阳性率为69.57%（32/46）,脓液标本检出率为61.54%（48/78）。检测11例患者痰液标本,9例结核分枝杆菌阳性,阳性率为81.82%（9/11）。9例痰液阳性标本与48份脓液阳性标本结核分枝杆菌鉴定,为同源人结核分枝杆菌。结论：该中医诊所在诊疗过程中陆续引发受诊者针灸部位局部感染,其病原菌为人结核分枝杆菌。为现场流行病学分析致病原因和受感染患者的医疗救治提供了科学依据。     

重型颅脑外伤患者肺部医院感染的危险因素与控制对策

目的 探讨重型颅脑外伤患者肺部医院感染的危险因素,为肺部医院感染的预防与控制提供有效依据.方法 选择医院2011年1-12月收治的135例重型颅脑外伤患者并发肺部医院感染的危险因素分析,并寻找控制对策.结果 135例重型颅脑外伤患者发生肺部感染49例,感染率为36.3％;49例患者送检痰标本154份,经细菌学检验共分离病原菌124株,引起重型颅脑外伤患者肺部医院感染的病原菌为革兰阴性菌、革兰阳性菌、真菌,分别占66.94％、14.52％、18.54％;发生肺部感染危险因素为年龄、激素及抗菌药物应用、呼吸机应用、住院时间、昏迷、气管切开等.结论 加强对危险因素的控制,可有效降低重型颅脑外伤患者肺部医院感染率.     

肾移植患者肺部浸润的病原学分析及支气管镜应用价值

目的 研究肾移植患者肺部浸润的病原学特点及支气管镜检查诊断性应用价值,为临床诊断与治疗提供依据.方法 2006年11月-2011年9月88例肾移植患者因肺部浸润共进行90次支气管镜检查,包括支气管肺泡盥洗和防污染毛刷.结果 55例通过支气管镜获得了明确的病原学诊断,其中单独卡氏肺孢子虫感染23例占41.82％,单独巨细胞病毒感染11例占20.00％,单独细菌感染3例占5.45％,单独结核分枝杆菌感染2例占3.64％;混合感染共16例占29.09％;大多数机会性感染发生在第2阶段,少部分发生在第3阶段.结论 支气管镜检查对评估肾移植患者的肺部浸润是一种极为有效的方法,特别对第2、3阶段的机会性感染的诊断具有极高的价值.     

一起结核杆菌引起医院感染的调查报告

目的调查某诊所发生的一起结核杆菌医院感染事件,分析其流行特点和发生原因,为加强医院感染管理提供依据。方法对某医院结核杆菌感染事件开展现场调查,描述流行状况,采用病例对照研究分析流行病学病因,采集感染灶脓液标本检测结核杆菌。结果采集46例患者78份感染局部病灶脓液标本进行结核杆菌检测,其中32例感染者的48份标本结核杆菌阳性。59例病例及其124处感染部位均有过针灸治疗。病例对照研究结果显示,针灸治疗经历次数差异有统计学意义(P0.05);感染发生与针灸频次有关联(P0.05);药物醋酸曲安奈德使用差异有统计学意义(P0.05)。结论本事件是一起医疗过程引起的结核杆菌群体性感染事件,针灸治疗和药物醋酸曲安奈德使用是可能的危险因素。加强医疗过程消毒和规范用药,避免交叉感染,是防制此类医源性感染事件发生的重要措施。     

肝硬化合并医院感染的危险因素分析

目的 探讨肝硬化患者合并医院感染的相关危险因素.方法 选择2008年6月—2011年9月医院收治的肝硬化合并医院感染患者613例,所有入选病例经明确诊断后详细收集和记录患者的性别、年龄、既往病史、并发症等相关危险因素,并充分结合实验室及其特殊检查进行回顾性分析.结果 613例肝硬化患者中,92例发生医院感染,感染率为15.01％年龄大、白蛋白低、住院时间长、有侵入性操作、有并发症、有合并症、预防性应用抗菌药物为医院感染的危险因素,其中年龄＞40岁患者感染率为19.75％,白蛋白＜3.0 g/dl患者感染率为19.71％,住院时间≥20 d患者感染率为21.43％,有侵入性操作感染率为18.23％,有并发症、合并症患者感染率为18.05％、25.23％,预防性应用抗菌药物患者感染率为19.61％.结论 只有充分重视引起肝硬化患者合并医院感染的危险因素,并据此积极采取多角度、全方位的防治措施,才能尽可能的将肝硬化合并医院感染的比率控制在最低范围.     

高龄胃癌术后肺部感染调查分析与对策

目的 降低高龄胃癌手术后患者并发肺部感染的发生率.方法 对2007年10月-2011年10月108例高龄胃癌手术患者中发生肺部感染的原因进行回顾性分析.结果 108例高龄胃癌手术患者术后发生肺部感染15例,感染率为13.89％;卧床时间≥4d、切口疼痛≥48 h、留置胃管≥3d、术前吸烟及患慢性支气管炎是高龄患者胃癌手术后发生肺部感染的危险因素(P＜0.05),其感染率分别为16.67％、16.25％、15.67％、17.86％及18.42％.结论 做好术前指导、控制患者吸烟、控制感染、有效减轻切口疼痛等可以有效降低高龄胃癌手术肺部感染的发生率.     

EICU患者肺部感染因素调查分析

目的 探讨急诊重症监护病房(EICU)患者肺部感染发生的相关影响因素,为临床治疗肺部感染提供依据.方法 选取医院2009年12月-2012年9月EICU收治的293例患者为研究对象,针对患者肺部感染的相关因素进行统计分析和研究.结果 293例EICU患者中发生肺部感染44例,感染率为15.02％;年龄＜30岁,感染率为8.33％;年龄＞60岁,感染率高达20.73％,随着患者年龄的不断升高,肺部感染的发病率呈现升高趋势;感染病原菌种类中革兰阴性杆菌占70.44％、革兰阳性球菌占14.47％、真菌占15.09％.结论 EICU患者肺部感染发生率随着患者年龄的升高呈现上升趋势,临床实践的过程中应加强患者病原菌监测,同时采用有针对性的预防肺部感染的临床手段和措施.     

T细胞斑点试验对活动性结核与非结核分枝杆菌感染的鉴别诊断价值北大核心CSCD

目的结核分枝杆菌(MTB)与非结核分枝杆菌(NTM)感染的鉴别较困难,本研究拟评估T细胞斑点试验(T-SPOT.TB)在活动性MTB与NTM感染的鉴别诊断价值。方法选取医院2013年1月-2017年2月各类标本分枝杆菌培养阳性并确诊为活动性感染患者176例,查找患者同期T细胞斑点试验结果,分别计算其对MTB与NTM感染的诊断灵敏度与特异度。结果活动性结核分枝杆菌感染114例,84例接受T-SPOT.TB试验,81例阳性,阳性率96.4%;非结核分枝杆菌感染62例,46例接受T-SPOT.TB试验,9例阳性,阳性率19.6%;T-SPOT.TB鉴别诊断灵敏度与特异度分别为96.4%、80.4%;肺部感染病例中,71例肺结核患者接受T-SPOT.TB试验,70例阳性,阳性率98.6%;40例非结核分枝杆菌肺病患者中,T-SPOT.TB阳性6例,阳性率15.0%,肺部感染患者中T-SPOT.TB灵敏度与特异度分别为98.6%、85.0%。结论 T细胞斑点试验对于MTB与NTM感染的灵敏度、特异度高,具有优良的临床鉴别诊断价值。     

T细胞斑点试验对活动性结核与非结核分枝杆菌感染的鉴别诊断价值

目的结核分枝杆菌(MTB)与非结核分枝杆菌(NTM)感染的鉴别较困难,本研究拟评估T细胞斑点试验(T-SPOT.TB)在活动性MTB与NTM感染的鉴别诊断价值。方法选取医院2013年1月-2017年2月各类标本分枝杆菌培养阳性并确诊为活动性感染患者176例,查找患者同期T细胞斑点试验结果,分别计算其对MTB与NTM感染的诊断灵敏度与特异度。结果活动性结核分枝杆菌感染114例,84例接受T-SPOT.TB试验,81例阳性,阳性率96.4%;非结核分枝杆菌感染62例,46例接受T-SPOT.TB试验,9例阳性,阳性率19.6%;T-SPOT.TB鉴别诊断灵敏度与特异度分别为96.4%、80.4%;肺部感染病例中,71例肺结核患者接受T-SPOT.TB试验,70例阳性,阳性率98.6%;40例非结核分枝杆菌肺病患者中,T-SPOT.TB阳性6例,阳性率15.0%,肺部感染患者中T-SPOT.TB灵敏度与特异度分别为98.6%、85.0%。结论 T细胞斑点试验对于MTB与NTM感染的灵敏度、特异度高,具有优良的临床鉴别诊断价值。     

NICU患者并发肺部感染的危险因素分析

目的 分析神经内科重症监护病房(NICU)患者医院肺部感染的危险因素,为医院肺部感染的管理及预防提供理论依据.方法 回顾性分析医院NICU2009年9月-2012年9月66例住院患者临床资料,统计分析患者医院肺部感染的危险因素.结果 66例NICU住院患者中共有28例发生医院肺部感染,感染率为42.4％;脑梗死、脑出血、蛛网膜下腔出血、重症肌无力和癫痫持续状态患者的医院肺部感染率分别为43.4％、42.8％、40.0％、42.8％和40.0％,统计分析显示各组之间差异无统计学意义;年龄＞65岁、住院时间＞2周、有意识障碍及侵入性操作感染率分别为52.8％、52.4％、55.0％、59.1％.结论 NICU患者医院肺部感染发生率高,年龄、住院时间、有无意识障碍和侵入性医疗操作是其医院肺部感染的高危因素.     

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.