抗生素和免疫抑制剂的个体化用药对肝移植受体术后感染的影响

目的评价采用抗生素和免疫抑制剂的个体化治疗方案对肝移植受体术后感染的影响。方法回顾性分析采用抗生素和免疫抑制剂的个体化用药对31例肝移植受体术后的感染发生率、病原菌谱以及病死率的影响。结果住院期间发生感染15例次，常见病原菌为阴沟肠杆菌、铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、表皮葡萄球菌等，根据药敏试验，主要以泰能、他格适或特治星进行治疗。通过控制免疫抑制剂的血药浓度，术后感染率（48．4％）显著低于2003年之前移植病例的感染率（86．7％），P〈0．05。细菌和真菌感染率明显减少（P〈0．05），巨细胞病毒（CMV）感染率差异无统计学意义（P〉0．05）。结论抗生素和免疫抑制剂的个体化应用，可以明显减少肝移植受体术后发生感染和其他并发症的风险。     

肝移植受体医院感染危险因素研究

目的研究肝移植受体医院感染的流行病学特征,探讨其危险因素,采取有效干预措施。方法利用医院信息网络,前瞻性目标监测2007-2008年肝移植术后病例,应用病例对照研究方法,分析肝移植后发生医院感染的危险因素。结果 2007、2008年医院感染率分别为32.58%、19.90%;2008年医院感染率明显低于2007年,差异有统计学意义(P<0.01);2007年排在前5位的感染分别为肺部感染(44.18%)、上呼吸道感染(18.60%)、胆道感染(13.95%)、腹腔感染(9.30%)及Ⅱ类切口感染(4.65%),2008年分别为肺部感染(51.28%)、腹腔感染(15.40%)、上呼吸道感染(10.26%)、胆道感染(7.69%)及Ⅱ类切口感染(7.69%);多因素logistic回归分析结果显示,肝移植术后发生医院感染的主要因素为尿管插管、术前用药和气管切开。结论利用前瞻性目标监测肝移植受体医院感染的发生,可采取有针对性的干预措施,达到预防在先的目的,从而避免肝移植术后医院感染的发生。     

35例肝移植患者下呼吸道细菌感染分析

目的 调查肝移植受体在重症监护室(ICU)期间下呼吸道感染细菌分布及耐药情况，找出降低肺部感染方法。方法 回顾性分析35例肝移植受体下呼吸道分离出的277株病原菌及药敏结果。结果 革兰阴性(G^-)菌占66．79％，革兰阳性(G^ )菌占21．66％，真菌占11．55％，主要致病菌依次为阴沟肠杆菌、金黄色葡萄球菌和铜绿假单胞菌，对绝大多数抗生素耐药。结论 合理、适当选用抗生素以及统一、整体管理对降低肝移植受体术后感染非常重要。     

口腔颌面肿瘤术后感染的原因分析与预防

目的探讨口腔颌面肿瘤术后感染的病原菌种类及防治措施。方法对口腔颌面肿瘤术后引起感染的原因、病原菌种类及耐药性进行调查分析。结果口腔颌面肿瘤术后感染率为12.60%(81/643);感染的发生与年龄、侵入性操作、制动和误吸等有关;创口和下呼吸道是感染发生的主要部位;感染病原菌以葡萄球菌为主(占46.88%),其次为链球菌(占11.72%)、大肠杆菌(11.72%)和铜绿假单胞菌(10.94%),真菌的感染率为6.25%;耐苯唑西林葡萄球菌检出率为66.3%,耐苯唑西林葡萄球菌对七种常用抗菌素耐药率均在50%以上;革兰阴性杆菌对4种及4种以上的抗生素的耐药率超过40%,其对大多数常用抗菌素均显示较高的耐药率(>55%),与非耐药株有统计学差异。结论口腔颌面肿瘤术后感染以革兰阳性菌感染为主,但革兰阴性菌仍是重要的致病菌;抗生素耐药率逐渐升高,且具有高耐药与多重耐药的特点。预防性应用抗生素可明显减少术后感染的可能性,治疗时建立有效的引流是必不可少的方法,细致而熟练的护理也是避免术后感染发生的重要措施。     

肝移植术后医院感染流行特征分析

目的分析肝移植术后患者医院感染的流行特征,为制定医院感染预防策略提供依据。方法调查214例肝移植住院患者病历资料和实验室结果,采用描述性流行病学方法对肝移植受体感染情况进行分析。结果 214例接受肝移植的患者中,有90例发生医院感染,感染率为42.06%,平均感染例次1.77次;男性感染率显著高于女性(2χ=7.666,P<0.05);感染集中分布于术后3周内,占所有感染76.73%;感染好发部位为下呼吸道、腹腔、手术部位,分别占感染的37.10%、29.56%、13.84%;主要病原菌为革兰阳性球菌,占51.67%,最常见的致病菌是屎肠球菌、MRSA、凝固酶阴性葡萄球菌,分别占所有病原菌的17.22%、14.44%、10.56%。结论肝移植患者是医院感染的高危人群,术后感染率高,应加强肝移植患者围手术期感染监测并制定综合有效医院感染预防控制措施。     

剖宫产术后感染病原菌及影响因素

目的 分析剖宫产术后产妇感染病原菌分布及其影响因素。方法 回顾性收集2020年1月-2022年12月广州中医药大学第一附属医院及益阳市妇幼保健院收治的2 048例剖宫产产妇临床资料,根据术后是否发生感染分为感染组102例和非感染组1 946例,统计剖宫产产妇术后感染现状及感染部位、病原菌种类分布,多因素Logistic回归分析剖宫产产妇术后感染的影响因素,比较两组术前及术后72 h炎症、应激指标水平。结果 剖宫产产妇术后感染率为4.98%,其中切口感染占比47.06%、泌尿系统感染占比24.51%、呼吸系统感染占比18.63%、生殖系统感染占比8.82%、腹腔感染占比9.80%;共分离出133株病原菌,主要感染病原菌种类为大肠埃希菌、铜绿假单胞菌、肠球菌、表皮葡萄球菌;体质量指数(BMI)、胎膜早破、羊水污染、合并妊娠期糖尿病、麻醉时间≥1 h、术中出血量均为剖宫产产妇术后感染的独立危险因素(P<0.05),术前预防性使用抗生素为剖宫产产妇术后感染的保护因素(P<0.05);两组术后72 h血清白细胞介素(IL)-6、IL-10、去甲肾上腺素(NE)、皮质醇(COR)水平较...     

肝移植患者术后耐碳青霉烯类革兰阴性菌感染的影响因素分析

目的分析肝移植患者术后医院感染的流行病学特征及耐碳青霉烯类革兰阴性菌(CR-GNB)感染的影响因素,为术后感染防控提出科学依据。方法回顾性分析2017年1月-2018年6月四川大学华西医院肝移植手术患者188例的临床资料。采用1∶4配对病例对照研究,选取术后CR-GNB感染患者为病例组,共16例,未发生术后感染患者为对照组,共55例(其中9例为1∶3配对)。分析患者性别、年龄、抗菌药物使用情况、基础疾病等临床资料,归纳肝移植患者术后感染CR-GNB的影响因素。结果 188例肝移植患者,术后感染35例,感染率为18.62%。感染CR-GNB病原菌主要为耐碳青霉烯类的鲍氏不动杆菌(CRAB)和耐碳青霉烯类的肺炎克雷伯菌(CRKP),感染CR-GNB的患者不良预后率为62.50%,高于非感染患者9.15%(P<0.001)。抗菌药物联用与气管插管天数是肝移植术后患者感染CR-GNB的影响因素(P<0.05)。气管插管时间为肝移植术后患者感染CRAB的影响因素(P=0.040),但与CRKP感染无相关性。结论肝移植的感染率较高,其中CR-GNB感染将导致患者预后较差,临床应针对不同的感染影响因素采取合理的控制措施,以降低术后感染率。     

口腔颌面外科术后感染的临床分析

目的探讨口腔颌面外科术后感染影响因素及病原菌分布,以期为临床防治提供相关依据。方法回顾性分析2008年2月-2013年1月行口腔颌面外科术患者的临床资料,对其发生术后感染情况及其影响因素和病原菌分布进行分析。结果 262例行口腔颌面外科术患者术后感染58例感染率为22.1%;主要以良、恶性肿瘤术后感染为主,感染率分别占9.9%和8.4%;共分离出病原菌64株,其中革兰阳性菌42株占65.6%,以葡萄球菌属为主,革兰阴性菌17株占26.6%,以铜绿假单胞菌为主,真菌5株占7.8%;年龄、侵入性操作及误吸是口腔颌面外科术后感染的危险因素(P<0.05),而性别和体质量指数对其影响不明显。结论口腔颌面外科术后感染率较高,病原菌以革兰阳性菌为主,减少侵入性操作和误吸、针对不同患者采用个性化护理是减少术后感染发生的重要措施。     

肝移植术后不同时期胆道感染的病原菌分布及耐药性的研究

目的了解肝移植术后不同时期胆道感染病原菌的种类及其对常用抗菌药物的耐药率,以指导临床。方法对2003年4月-2009年12月肝移植术后35例不同时期出现胆道感染的患者培养出的69株细菌及其药敏试验结果进行统计学分析。结果标本的阳性检出率为72.5%,病原菌以大肠埃希菌、铜绿假单胞菌、粪肠球菌和牛链球菌多见,且术后不同时期的病原菌谱有显著不同,差异有统计学意义(χ2=4.483,P<0.05),术后早期以革兰阴性杆菌为主(72.2%),而在晚期常见革兰阳性球菌(53.8%);革兰阴性杆菌对亚胺培南(12.9%)、阿米卡星(32.3%)和头孢吡肟(32.3%)的耐药率较低,革兰阳性球菌对万古霉素(7.7%)和哌拉西林/他唑巴坦(34.6%)的耐药率较低。结论肝移植术后胆道感染的病原菌谱区别于与普通患者,其中大部分为多药耐药菌,治疗时应根据药敏试验选择合适抗菌药物。     

麻醉时间对剖宫产术后感染发生率及应激指标影响

目的:探讨麻醉时间对剖宫产术后感染发生率及应激指标的影响。方法:回顾性分析2016年1月30日—2019年4月30日本院剖宫产1200例临床资料,观察术后感染发生情况及术后感染特点、病原菌分布情况,并分析麻醉时间对术后感染影响及不同麻醉时间患者手术前后应激指标(去甲肾上腺素、皮质醇和血糖)变化。结果:术后感染70例(5.8%),切口感染为主(44.3%),其次为泌尿系统感染(22.9%),革兰阳性杆菌占55.6%,以金黄色葡萄球菌为主;革兰阳性杆菌占44.4%,以大肠埃希菌为主。术中出血≥200ml、术中输血、麻醉时间≥1h、术前未使用抗生素、侵入性检查≥5次及胎膜早破的产妇术后感染率增加(P<0.05)。多因素分析显示,术中出血≥200ml、麻醉时间≥1h、侵入性检查≥5次是剖宫产术后感染的危险因素,术前预防性使用抗生素是剖宫产术后感染保护因素(均P<0.05)。术后麻醉时间≥1h组去甲肾上腺素、皮质醇和血糖均高于麻醉时间<1h组(P<0.05)。结论:剖宫产术麻醉时间≥1h可增加术后应激水平及感染发生率,缩短麻醉时间及术前预防性使用抗菌药物是降低感染发生的有效措施。     

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.