儿童马尔尼菲青霉病分析

目的了解儿童马尔尼菲青霉病的临床表现及实验室诊断特点。方法对3例马尔尼菲青霉病患儿的临床资料和实验室检查进行分析。结果马尔尼菲青霉菌常首先在血液或骨髓中检出。真菌检查可见明显特征：涂片镜下可见细胞内外有腊肠样菌体，部分有横隔；真菌培养表现为双相菌，25℃为真菌相，底部产生特征性红色素，35℃为酵母相，无色素，有酵母样菌体。结论儿童马尔尼菲青霉菌感染主要因免疫功能不完善引起，容易误诊和漏诊，预后凶险，应加强认识，早期诊断、及时治疗有利于取得良好的预后。     

艾滋病合并马尔尼菲青霉菌感染的实验室检测

目的 明确从AIDS患者血液、骨髓中检出的病原体为马尔尼菲青霉菌.方法 取患者血液、骨髓于血培养瓶中置Bacter/Alert 3D血培养仪中培养,待血培养仪报阳性即作革兰染色,并转种至马铃薯斜面培养基于27℃和37℃孵育,观察真菌生长情况及菌落形态,并作乳酸棉兰染色于显微镜下观察菌体特征.结果 该菌为一双相真菌,27℃见菌丝相,呈淡黄色绒毛样,并产生酒红色色素,镜下可见典型的帚状枝及孢子链;37℃见酵母相,不产生特征性色素,镜下见酵母样细胞.结论 从体内分离出马尔尼菲青霉菌,即可诊断为马尔青霉菌病,也可排除组织胞浆菌感染.     

儿童马尔尼菲青霉病分析

目的 了解儿童马尔尼菲青霉病的临床表现及实验室诊断特点.方法 对3例马尔尼菲青霉病患儿的临床资料和实验室检查进行分析.结果 马尔尼菲青霉菌常首先在血液或骨髓中检出.真菌检查可见明显特征:涂片镜下可见细胞内外有腊肠样菌体,部分有横隔;真菌培养表现为双相菌,25℃为真菌相,底部产生特征性红色素,35℃为酵母相,无色素,有酵母样菌体.结论 儿童马尔尼菲青霉菌感染主要因免疫功能不完善引起,容易误诊和漏诊,预后凶险,应加强认识,早期诊断、及时治疗有利于取得良好的预后.     

艾滋病合并播散性双相型真菌感染的真菌培养及鉴别

〔目的〕提高对艾滋病合并播散性荚膜组织胞浆菌病、马尔尼菲青霉菌病的实验诊断水平。〔方法〕取患者血液置于Bact alert12 0血培养仪配套培养瓶培养 ,然后转种哥伦比亚血平板、沙保劳琼脂平板 ,观察荚膜组织胞浆菌、马尔尼菲青霉菌分别于 2 5℃及 3 7℃孵育时的菌落特征、镜下形态特点。〔结果〕荚膜组织胞浆菌及马尔尼菲青霉菌均为双相型真菌 ,2 5℃培养为霉菌相。荚膜组织胞浆菌 ,无色素 ,生长缓慢 ,7-10d后可见白色绒毛样或棉花团样菌落 ,镜下可见特征性的齿轮状或棘状大分生孢子 ;3 7℃培养时为酵母相 ,镜下可见圆形、卵圆形 2 -4 μm的芽生孢子。马尔尼菲青霉菌 2 5℃培养 3 -4d为白色绒毛样菌落 ,菌落周围出现水溶性的葡萄酒样红色色素 ,镜下可见特征性的帚状枝 ;3 7℃孵育时为白色酵母样菌落 ,无色素 ,镜下可见圆形、卵圆形及特征性腊肠样孢子。〔结论〕艾滋病患者对荚膜组织胞浆菌、马尔尼菲青霉菌易感 ,易至播散性感染 ,从患者体内检出荚膜组织胞浆菌、马尔尼菲青霉菌是诊断荚膜组织胞浆菌病、马尔尼菲青霉菌病的金标准。     

马尔尼菲青霉菌病的研究进展

马尔尼菲青霉菌(penicillium marneffei,PM)是青霉菌属中唯一温度依赖型双相真菌,也是迄今所发现的惟一能使人体致病的青霉菌,它既能以菌丝相在24~28℃自然环境中生长,还能在35~37℃环境下以酵母相在人体内生长繁殖[1].人体内部由于受到马尔尼菲青霉菌侵入不能被巨噬细胞清除则形成马尔尼菲青霉病(penicilliosis marneffei,PSM),此病是引起免疫缺陷或免疫功能低下人群的一种机会感染致病性真菌病,目前全球多达十几个国家和地区均发现PM感染患者,在我国则以南部地区多见.     

艾滋病合并马尔尼菲青霉菌病17例临床分析

目的探讨艾滋病合并马尔尼菲青霉菌病的临床及实验室特征。方法回顾性分析2006年3月～2012年1月某院收治的明确诊断为艾滋病合并马尔尼菲青霉菌病17例临床特征及实验室资料。结果艾滋病合并马尔尼菲青霉菌病的临床主要表现为发热17例(100%),咳嗽12例(70.6%),贫血13例(76.5%),消瘦11例(64.7%),皮疹10例(58.8%);16例(94.1%)患者外周血CD4+T淋巴细胞﹤50cells/μl;所有病例血液中培养出马尔尼菲青霉菌;在沙保罗琼脂培养基中马尔尼菲青霉菌呈酵母相(37℃)或菌丝相(25℃);使用氟康唑、伏立康唑或两性霉素B治疗,8例治愈,2例好转,2例自动出院,5例死亡,以两性霉素B疗效最好,氟康唑疗效差。结论艾滋病合并马尔尼菲青霉菌病的临床表现复杂多样,当HIV阳性患者出现发热、咳嗽、贫血、消瘦、皮疹,CD4+T淋巴细胞﹤50cells/μl,应高度怀疑马尔尼菲青霉菌病;确诊马尔尼菲青霉菌感染依赖病原学检查;治疗上建议首选两性霉素B。     

儿童马尔尼菲青霉菌感染的鉴定方法研究

目的设计马尔尼菲青霉菌（PM）种特异性引物,采用荧光定量PCR的方法,并结合传统的形态学检查,以达到可以在临床实验室进行快速诊断的目的。方法取患儿血液、骨髓进行真菌双相培养,观察真菌生长情况及菌落形态,显微镜下观察菌体特征,并将培养物涂片进行一系列染色。针对PM5．8SrRNA设计特异性PCR引物,采用核酸荧光染料SYBRGreenI进行实时荧光定量PCR检测。结果PM为双相性真菌,于25℃为青霉相,于37℃为酵母相,并均有典型的菌落形态特征。染色可见菌体根据染色方法不同、形态不同呈现不同特征。荧光定量PCR方法的特异性较好,与该菌属内的其他细菌间无交叉反应。结论PM的特征性菌落形态对该菌有诊断价值,对该菌进行某些简单的染色可作为快速诊断与鉴别该菌的主要辅助手段,而实时荧光定量PCR方法在检测PM中的应用可以大大缩短临床的诊断时间,提高临床诊断的准确度和效率。     

艾滋病合并马尔尼菲青霉病临床分析

目的 探讨艾滋病合并马尔尼菲青霉病的流行病学、临床表现、确诊方法.方法 对2007年1月-2010年12月医院及传染病院收治的27例艾滋病合并马尔尼菲青霉病患者的临床资料进行了回顾性分析.结果 27例患者血液及骨髓经培养后长出酵母样菌,确诊为马尔尼青霉菌,以发热(100.00％)、咳嗽(77.78％)、皮疹(51.85％)、淋巴结肿大(44.44％)、贫血(85.19％)、白细胞降低(100.00％)为主要表现;经治疗病情好转22例,占81.48％,死亡3例,死亡率11.11％,5例于治疗后3个月后死亡.结论 AIDS患者出现发热、消瘦、贫血、皮疹、淋巴结肿大等情况时应及时进行马尼尔菲青霉病的相关检查,及早诊断与治疗对改善预后有重要意义.     

临床护理路径在艾滋病合并马尔尼菲青霉病治疗中的应用

马尔尼菲青霉病(PSM)是由马尔尼菲青霉菌(PM)引起的深部真菌病有严重消耗性疾病或免疫功能低下者易于感染此病。包括严重基础疾病、应用免疫抑制剂和艾滋病(AIDS)患者,如不及时治疗,可造成全身各系统受损。现将     

艾滋病患者合并马尔尼菲青霉菌感染1例

马尔尼菲青霉菌(Penicillium marneffei,PM)是青霉菌中唯一的一种温度双相型真菌,感染所引起的深部真菌病称马尔尼菲青霉病(PM病).自1997年首例人感染该菌以来,艾滋病(AIDS)患者合并感染PM较少见.我院收治了1名艾滋病患者,从3次血培养、1次骨髓培养、1次皮肤丘疹培养中均分离出PM,现报道如下.     

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.