河南省2000-2007年志贺菌多中心研究

志贺菌属分为AB、CD 4个群,即痢疾志贺菌(S.dysenteriae)、福氏志规菌(S.flexneri)、鲍氏志贺菌(S.boydii)、宋内志贺菌(S.sonnei)以及50多个血清型(包括亚型).现将河南省各监测点2000-2007年志贺菌菌型、药敏和毒力基因检测结果报道如下.     

小儿急性细菌性痢疾发病影响因素及病原菌分布和耐药性特征

目的分析小儿急性细菌性痢疾发病影响因素及病原菌分布、耐药性特征,为相关防治工作提供参考依据。方法选取2018年1月-2020年1月收治的175例急性细菌性痢疾患儿为病例组,健康体检儿童175例为对照组。分析小儿急性细菌性痢疾发病的影响因素。对患儿粪便标本进行细菌培养,采用Kirby-Bauer纸片扩散法进行药敏试验。结果手卫生、饮水习惯、餐具、可疑进食史是小儿急性细菌性痢疾发病的影响因素。175例急性细菌性痢疾患儿粪便标本中,检测出121例阳性,粪便阳性率为69.1%,共分离出病原菌121株,以福氏志贺菌为主,占73.6%。志贺菌对头孢他啶、头孢吡肟、左氧氟沙星耐药率较低,对氨苄西林、复方新诺明、诺氟沙星耐药率较高。结论小儿急性细菌性痢疾发病受手卫生、饮水习惯、餐具、可疑进食史等因素影响,感染病原菌以福氏志贺菌为主,应根据药敏试验结果选择治疗药物,同时加强防范措施,做好小儿急性细菌性痢疾的防治工作。     

152株儿童腹泻志贺菌菌型分布及耐药性分析

目的:了解儿童腹泻志贺菌菌型分布及耐药性情况,为临床合理用药提供指导。方法:收集2008~2012年唐山市妇幼保健院细菌性腹泻患儿粪便标本中分离出的志贺菌共152株,以纸片扩散法测定抗菌药物的敏感性。结果:152株志贺菌中以B群福氏志贺菌占优势,D群宋内志贺菌次之。药敏显示,志贺菌属对氨苄西林的耐药率达100.0%,对阿莫西林/克拉维酸、氨苄西林/舒巴坦高达82.2%、81.6%,对头孢噻肟、头孢曲松、头孢哌酮的耐药率分别为73.7%、76.3%、77%,而对头孢他啶、氨曲南耐的耐药率为30.3%、40.1%;亚胺培南、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦的耐药率低,D群耐药率很低。结论:志贺氏菌其耐药性有所增加,提示临床合理用药。     

腹水分离菌株及耐药性分析

目的 了解我院患者腹水样本中病原菌种类及其对抗生素的耐药情况,为临床合理应用抗生素和经验用药提供参考.方法 对我院2008年1-12月临床送检的腹水样本中分离培养的病原菌分布情况和耐药性进行回顾性分析.结果 在1653份腹水样本中共分离到病原菌151株,阳性检出率为9.13%,其中革兰阴性菌占66.23%,革兰阳性菌占25.17%,真菌占8.61%.分离到的病原菌中前4名依次为大肠埃希菌(53.64%)、表皮葡萄球菌(10.60%)、丝状真菌(7.95%)、藤黄微球菌(6.62%).革兰阴性菌以大肠埃希菌为主,其对氨苄西林、哌拉西林、氨苄西林/舒巴坦、庆大霉素的耐药率分别为78.26%、55.56%、46.67%、39.62%,对阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦耐药率较低.革兰阳性菌以表皮葡萄球菌为主,其对氨曲南和哌拉西林耐药率为100%,对万古霉素、氨苄两林、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢唑林等无耐药.真菌以丝状真菌为主,感染率较高(7.95%).结论 腹水样本中病原菌呈明显多样化.大肠埃希菌是我院腹水感染的主要致病菌,对阿米卡星,哌拉西林/他唑巴坦,头孢哌酮/舒巴坦较敏感.表皮葡萄球菌对氨曲南100%耐药,对万古霉素、氨苄西林、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢唑林等敏感.     

2006～2007年通州区志贺菌检测与耐药性分析

目的:了解通州区志贺菌菌型及对抗生素的耐药性,为细菌性痢疾的防治提供科学依据。方法:从60份腹泻病人粪便中检出志贺菌20株,采用国家标准检测方法进行生化鉴定、血清学分型和药物敏感试验。结果:阳性率33.33%,分别属于福氏志贺菌(B群)、宋氏志贺菌(D群)两个群6个血清型,其中以B群为主,14株占70.00%,D群次之,6株占30.00%。志贺菌对抗生素萘啶酸(NAL)、四环素(TET)、利福平(RFA)、复方新诺明(SMZ)、氨苄西林(AMP)高度耐药,耐药率均达90.00%以上,对氧氟沙星(OFX)高度敏感,敏感率达100.00%。结论:通州区志贺菌感染的优势菌型为福氏F4 c型为主,占35.00%,其次为宋内1相,占30.00%。应该合理使用抗生素,减少耐药现象。     

2006年-2014年杭州市儿童细菌性痢疾的菌谱分布及耐药性变迁

目的调查2006年1月-2014年12月杭州市细菌性痢疾的菌谱分布和耐药特点,为临床治疗及流行病学分析提供依据。方法对杭州市儿童医院2006年-2014年粪便标本中分离的211株志贺菌进行血清分型,并以K-B琼脂法进行药敏实验和耐药性统计分析。结果 211株志贺菌中福氏志贺菌(B群)139株,宋内志贺菌(D群)66株,鲍氏志贺菌(C群)6株,福氏志贺菌与宋内志贺菌的比值为2.11∶1,未检出痢疾志贺菌。福氏志贺菌耐药率普遍比宋内志贺菌耐药率高。结论细菌性痢疾病原体主要是福氏志贺菌,其次为宋内志贺菌。福氏志贺菌耐药率多高于宋内志贺菌,多重耐药率较高。临床治疗应以药敏为依据选用抗菌药物,可首选哌拉西林/他唑巴坦,其次选头孢他啶、头孢吡肟、头孢哌酮/舒巴坦经验治疗。     

腹泻患儿151株志贺菌分布特征与耐药性分析

摘要:目的　探讨少儿腹泻患儿的志贺菌菌群分布特征与耐药特征,为临床防治提供依据。方法　选用志贺菌与沙门菌琼脂培养基进行培养,对于可疑的菌株经VITEK-32细菌鉴定仪与血清凝集鉴定到群,采用K-B的方法分析抗生素的耐药性。结果　151株志贺菌中主要为宋内志贺菌（85株,占56.3%）和福氏志贺菌（64株,占42.4%）,且感染患儿主要集中在0～10岁年龄段,占总感染率的72.2%（109/151）。药敏结果显示,福氏志贺菌和宋内志贺菌对氨苄西林、氨苄西林/舒巴坦、哌拉西林和复方磺胺甲噁唑的耐药率较高,均大于50%,对三代头孢及四代头孢的耐药率均在35%以下;福氏志贺菌对环丙沙星和左氧氟沙星的耐药率分别为29.6%和21.8%,未发现宋内志贺菌对环丙沙星和左氧氟沙星耐药,且两者对哌拉西林/三唑巴坦和亚胺培南全部敏感。31株多重耐药菌经纸片确认试验均为超光谱β-内酰酯酶（ESBLs）阳性菌株,但未发现头孢菌素酶（AmpC）酶阳性者。结论　腹泻患儿以感染宋内志贺菌与福氏志贺菌的婴幼儿为主,两种志贺菌对抗生素的药敏性差别比较大。     

大连市53株志贺菌的菌群分布及药敏试验分析

目的了解大连市细菌性痢疾的病原菌志贺氏菌型分布及其药物敏感状况,为细菌性痢疾临床治疗和预防控制提供依据。方法按《全国细菌性痢疾监测方案》提供的方法进行病原菌分离鉴定和药敏试验。结果经生化与血清学复核鉴定为志贺菌53株,其中宋内志贺菌37株,福氏志贺菌15株,鲍氏志贺菌1株,分别占分离菌株的69．81％、28．30％和1．89％。药敏试验显示53株志贺菌敏感药物为头孢噻吩、环丙沙星、头孢噻肟和阿莫西林,耐药的有利福平、氨苄西林、四环素、复方新诺明和庆大霉素,且有50株菌出现了≥3种的多重耐药现象。结论大连市引起细菌性痢疾的痢疾杆菌以宋内氏志贺菌为主,其次为福氏志贺菌;并对目前常用的抗生素表现一定的耐药性,应当引起重视。药物头孢噻吩、环丙沙星、头孢噻肟和阿莫西林可作为目前临床治疗痢疾的常用药物。     

一起福氏志贺菌X变种暴发流行的病原学鉴定

目的:对一起暴发流行细菌性痢疾的病原菌进行分离鉴定,为细菌性痢疾临床治疗和预防控制提供依据。方法:按《全国细菌性痢疾监测方案》提供的方法进行病原菌分离鉴定和药敏试验。结果:采集的15份标本中,4份粪便和1张洗碗布标本检出福氏志贺茵X变种。5株福氏志贺茵X变种对氨苄西林、阿莫西林、庆大霉素、四环素、萘啶酸、复方新诺明均耐药,对环丙沙星、诺氟沙星、头孢噻吩、头孢噻肟、利福平均敏感。结论:本次疫情为一起由福氏志贺菌X变种引起的食源性细菌性痢疾暴发流行。     

绍兴市区志贺菌感染的流行病学及耐药状况调查

[目的]了解绍兴市区志贺菌感染的分布特点及耐药状况,为细菌性痢疾的防治和临床合理用药提供依据。[方法]粪便常规培养,鉴定致病菌,用Kirby-Bauer法检测病原菌的耐药性。[结果]在1 760份腹泻患者粪便标本中,检出志贺菌63株,以福氏志贺菌为主。其对氨苄青霉素耐药率最高,复方新诺明和哌拉西林次之,对第3代头孢菌素和喹诺酮类药物也有一定的耐药性;对痢特灵最敏感。[结论]福氏志贺菌是本地区细菌性痢疾的主要病原菌,对目前常用的抗菌药物已表现出一定的耐药性,应引起高度重视。     

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.     

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.     

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.