肠球菌属耐药基因检测

目的了解临床分离的肠球菌属抗菌药物耐药基因存在状况。方法采用聚合酶链反应(PCR)检测7种耐药相关基因。结果 20株粪肠球菌中,tetM基因阳性为40.0%,ermB基因为60.0%,aac(6′)/aph(2′)为75.0%,ant(6)-Ⅰ为50.0%,TEM为5.0%,aph(3′)-Ⅲ为50.0%;20株屎肠球菌tetM基因阳性为40.0%,ermB为65.0%,aac(6′)/aph(2′)为90.0%,ant(6)-Ⅰ为70.0%,TEM为25.0%,aph(3′)-Ⅲ为70.0%。结论临床分离的肠球菌属耐药相关基因携带率高,肠球菌属对多种抗菌药物耐药率高,注意消毒隔离。     

多药耐药鲍氏不动杆菌中氨基糖苷类修饰酶基因的分析研究

目的调查多药耐药鲍氏不动杆菌(MDRAB)中氨基糖苷类修饰酶基因和16SrRNA甲基化酶基因的存在情况。方法收集张家港市第一医院2008年3-11月住院患者标本中分离的多药耐药鲍氏不动杆菌共20株,采用聚合酶链反应(PCR)的方法分析9种氨基糖苷类修饰酶基因和2种16SrRNA甲基化酶基因。结果 20株多耐药鲍氏不动杆菌检出5种氨基糖苷类修饰酶基因:aac(3)-Ⅰ、aac(3)-Ⅱ、aac(6′)-Ⅰb、ant(3″)-Ⅰ、aph(3′-)Ⅰ,其余氨基糖苷类修饰酶基因和16SrRNA甲基化酶基因均未检出。结论多药耐药鲍氏不动杆菌氨基糖苷类耐药主要与产氨基糖苷类修饰酶相关,其中aac(3)-Ⅰ、aac(6′)-Ⅰb、ant(3″)-Ⅰ、aph(3′)-Ⅰ4种基因已在MDRAB中流行。     

多药耐药铜绿假单胞菌16S rRNA甲基化酶及氨基糖苷类修饰酶基因研究

目的探讨多药耐药铜绿假单胞菌(MDRPA)氨基糖苷类耐药机制。方法应用PCR检测18种16SrRNA甲基化酶和氨基糖苷类修饰酶基因。结果 20株MDRPA检出aac(3)-Ⅱ、aac(6′)-Ⅰb、aac(6′)-Ⅱ、aph(3′)-Ⅱb等4种氨基糖苷类修饰酶基因,阳性率分别为60.0%、30.0%、60.0%、35.0%,共有12株检出氨基糖苷类修饰酶基因。结论该组MDRPA氨基糖苷类耐药机制与产氨基糖苷类修饰酶相关。     

大肠埃希菌中同时发现携带aac(6′)-Ⅰb及aac(6′)-Ⅰb-Cr氨基糖苷类修饰酶基因

目的了解大肠埃希菌(ECO)氨基糖苷类药物获得性耐药基因流行状况。方法收集2009年10月-2010年3月临床分离的MDR-ECO 20株,PCR法检测14种氨基糖苷类修饰酶基因[aac(3)-Ⅰ、aac(3)-Ⅱ、aac(3)-Ⅲ、aac(3)-Ⅳ、aac(6′)-Ⅰb、aac(6′)-Ⅱ、ant(2″)-Ⅰ、ant(3″)-Ⅰ、aadA4/5、aadA6/16、ant(4′)-Ⅰ、aph(3′)-Ⅰ、aph(3′)-Ⅱa、aph(3′)-Ⅱb]和6种16S rRNA甲基化酶基因(armA、rmtA、rmtB、rmtC、rmtD、npmA),部分PCR阳性产物进行测序,并经BLASTn比对确认。结果 14种氨基糖苷类修饰酶基因共检出aac(3)-Ⅱ、aac(6′)-Ⅰb、ant(3″)-Ⅰ、aadA5、aph(3′)-Ⅰ5种,阳性率分别为25.0%、25.0%、5.0%、65.0%和55.0%;其余9种氨基糖苷类修饰酶基因和6种16S rRNA甲基化酶基因均未检出;5株aac(6′)-Ⅰb PCR阳性产物均进行了测序,经BLASTn比对确认1株为aac(6′)-Ⅰb型,其余4株均为aac(6′)-Ⅰb-cr型。结论该组MDR-ECO氨基糖苷类药物获得性耐药与氨基糖苷类修饰酶基因密切相关,而与甲基化酶基因无关系。     

耐甲氧西林凝固酶阴性葡萄球菌产酶耐药基因分子流行病学研究

目的了解耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)产酶耐药基因流行病学状况. 方法我们对55株MRCNS菌进行了TEM-1基因(编码青霉素酶)、aph(3＇)-Ⅲ和aac(6＇)/aph(2＂)基因(编码氨基糖苷类修饰酶)、erm基因(编码红霉素甲基化酶)检测. 结果 55株MRCNS菌TEM-1、aph(3＇)-Ⅲ和aac(6＇)/aph(2＂)、erm基因阳性株分别为54、43、16、45株,阳性率分别为98.2%、78.2%、29.1%、81.8%;其中同时检出TEM-1基因、aph(3＇)-Ⅲ或aac(6＇)/aph(2＂)基因、erm基因39株(70.9%). 结论 70.9% MRCNS菌已同时携带青霉素酶、氨基糖苷类修饰酶和红霉素甲基化酶基因.     

肺炎克雷伯菌老年患者分离株氨基糖苷类药物耐药相关基因研究

目的了解肺炎克雷伯菌老年患者分离株16S rRNA甲基化酶、氨基糖苷类修饰酶基因的存在状况。方法自2006年1~10月住院患者标本中分离并筛选出20株多药耐药肺炎克雷伯菌,微量肉汤稀释法检测20种抗菌药物的敏感性;PCR法检测16S rRNA甲基化酶、氨基糖苷类修饰酶基因。结果20株多药耐药肺炎克雷伯菌16S rRNA甲基化酶(rmtA、rmtB、rmtC、rmtD、armA和npmA)基因均为阴性;氨基糖苷类修饰酶aac(3)-Ⅱ基因阳性15株、aac(6′)-Ⅰb基因阳性1株、ant(3″)-Ⅰ基因阳性16株、aph(3′)-Ⅰ基因阳性3株、ant(2″)-Ⅰ基因阳性1株。结论研究结果显示,肺炎克雷伯菌老年患者分离株对氨基糖苷类药物耐药的主要原因是aac(3)-Ⅱ、aac(6′)-Ⅰb、ant(3″)-Ⅰ、aph(3′)-Ⅰ和ant(2″)-Ⅰ5种氨基糖苷类修饰酶基因的存在;从肺炎克雷伯菌中检出aac(6′)-Ⅰb-Cr型和aph(3′)-Ⅰ均为国内首次。     

泛耐药鲍氏不动杆菌氨基糖苷类耐药相关基因研究

目的 了解泛耐药鲍氏不动杆菌(PDRAB) 16S rRNA甲基化酶、氨基糖苷类修饰酶基因及其耐药机制.方法 选择2009年1月-2010年3月ICU住院患者痰液标本,分离到20株PDRAB,采用纸片扩散法检测20种抗菌药物的敏感性;PCR法检测15种16S rRNA甲基化酶、氨基糖苷类修饰酶基因.结果 20株PDRAB 16S rRNA甲基化酶基因rmtA、rmtB、rmtC、rmtD和npmA均阴性;氨基糖苷类修饰酶aac(3)-Ⅰ基因阳性15株、aac (6′)-Ib基因阳性18株、ant(3″)-Ⅰ基因阳性19株、aph(3′)-Ⅰ基因阳性13株,armA基因阳性20株.结论 PDRAB对氨基糖苷类药物耐药的主要原因是携带aac(3)-Ⅱ、aac(6′)-Ib、ant(3″)-Ⅰ、aph(3′)-Ⅰ和ant(2″)-Ⅰ等5种氨基糖苷类修饰酶基因.     

多药耐药铜绿假单胞菌氨基糖苷类耐药相关基因研究

目的研究临床分离的多药耐药铜绿假单胞菌(MDR-PEA)常见氨基糖苷类修饰酶及甲基化酶基因的存在状况。方法收集2009年2月-2010年4月从医院住院患者分离出来的MDR-PAE20株,采用聚合酶链反应(PCR)及序列分析的方法分析对6种甲基化酶及8种氨基糖苷类修饰酶基因进行检测及测序。结果 20株MDR-PAE中,甲基化酶基因rmtB阳性率为15.0%;氨基糖苷类修饰酶基因aac(3)-Ⅱ、aac(6′)-Ⅰb、aac(6′)-Ⅱ、ant(3″)-Ⅰ、ant(2″)-Ⅰ的阳性率分别为40.0%、10.0%、20.0%、15.0%、10.0%,未检出aac(3)-Ⅰ、ant(4′)-Ⅰ及aph(3′)-Ⅱb。结论产氨基糖苷类修饰酶是MDR-PAE对氨基糖苷类药物耐药的主要机制,非产氨基糖苷类修饰酶MDR-PAE株对氨基糖苷类药物耐药可能与其他机制有关。     

多药耐药鲍氏不动杆菌氨基糖苷类药物耐药遗传学背景研究

目的了解临床分离的多药耐药鲍氏不动杆菌(MDR-ABA)氨基糖苷类药物耐药遗传学背景。方法从2009年4-8月中山大学附属第三医院住院患者中分离20株MDR-ABA,用K-B法测定鲍氏不动杆菌对10种抗菌药物的敏感性,采用PCR及序列分析的方法分析氨基糖苷类修饰酶基因。结果 20株MDR-ABA检出aac(3)-Ⅰ、aac(6′)-Ⅰb、ant(3′)-Ⅰ、aph(3′)-Ⅰ4种基因阳性,6种16S rRNA甲基化酶基因未检出。结论临床分离的MDR-ABA中氨基糖苷类修饰酶基因阳性率较高,MDR-ABA氨基糖苷类抗菌药物耐药主要与氨基糖苷类修饰酶基因有关;通过可移动遗传元件介导是细菌获得氨基糖苷类修饰酶基因的主要因素。     

多药耐药鲍氏不动杆菌氨基糖苷类耐药相关基因研究

目的 检测分析鲍氏不动杆菌的耐药性、全面了解多药耐药鲍氏不动杆菌氨基糖苷类耐药机制.方法 药敏试验为K-B法、基因检测采用PCR法对20株多药耐药鲍氏不动杆菌(MDRAB)进行了7种氨基糖苷类修饰酶和2种16S rRNA甲基化酶基因检测.结果 20株鲍氏不动杆菌耐药率除亚胺培南外,对其余药物的耐药率均＞95.0％,共有aac(3)-Ⅰ、aac(6′)-Ⅰ b、ant(3″)-Ⅰ、aph(3′)-Ⅰ 4种氨基糖苷类修饰酶基因阳性,阳性率分别为75.0％、90.0％、95.0％、65.0％,并检出armA 16S rRNA甲基化酶基因,阳性率为55.5％.结论 该组MDRAB多种氨基糖苷类药物耐药与同时存在产氨基糖苷类修饰酶、产16S rRNA甲基化酶有关.     

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.