多重耐药铜绿假单胞菌耐药基因及亲缘性分析

目的 了解解放军第98医院临床分离的多重耐药铜绿假单胞菌（MRPA）中抗菌药物相关耐药基因存在状况及菌株亲缘性.方法 在2003年9月-2004年10月间从临床分离30株MRPA,采用PCR及序列分析的方法分析24种基因blaTEM、blaSHV、blaOXA-10群、blaPER、blaVEB、blaIMP、blaVIM、blaGES、blaCARB、blaDHA、blaMIR、aac（3）-Ⅰ、aac（3）-Ⅱ、aac（3）-Ⅲ、aac（3）-Ⅳ、aac（6＇）-Ⅰ、aac（6＇）-Ⅱ、ant（3＂）-Ⅰ、ant（2＂）-Ⅰ、aph（3＇）-Ⅵ、oprD、qacE△1-sul1、catB、cml1,采用Average法进行耐药基因聚类分析以确定菌株亲缘性.结果 30株MRPA中blaTEM、blaOXA-10群、blaCARB、aac（3）-Ⅱ、aac（6＇）-Ⅰ、aac（6＇）-Ⅱ、ant（3＂）-Ⅰ、ant（2＂）-Ⅰ、qacE△1-sul1和cml1基因的阳性率分别为66.7%、3.3%、3.3%、76.7%、3.3%、33.3%、53.3%、26.7%、83.3%和3.3%,blaOXA-10群基因经序列分析确认为blaOXA-10型ESBLs,27株（90.0%）发生oprD基因缺失突变;其他基因均阴性;根据耐药基因聚类分析该30株MRPA可分4群,为医院感染所致.结论 临床分离的MRPA中至少存在10种耐药基因,oprD基因缺失突变率很高,MRPA可导致克隆传播医院感染,并存在暴发性流行.     

烧伤患者铜绿假单胞菌感染株的消毒剂-磺胺耐药基因、Ⅰ类整合酶基因研究

目的铜绿假单胞菌(PAE)感染株的消毒剂-磺胺耐药相关基因qacE△1-sul1和Ⅰ类整合酶基因(intⅠ1)存在状况。方法对分离自天津第四医院烧伤住院患者创面20株PAE菌的qacE△1-sul1i、ntⅠ1基因进行检测。结果20株PAE菌qacE△1-sul1i、ntⅠ1基因均阳性。结论PAE菌全部携带消毒剂-磺胺耐药基因、Ⅰ类整合酶基因。     

慢性重型肝炎患者痰泛耐药木糖氧化产碱菌木糖氧化亚种39种耐药基因的研究

目的 研究慢性重型肝炎患者痰泛耐药木糖氧化产碱菌木糖氧化亚种(AXXxx)39种耐药基因.方法 应用API鉴定条/PSE5.0药敏条和NMIC/ID-109鉴定/药敏板鉴定和细菌药敏试验,用PCR法检测分离于慢性重型肝炎患者合格痰标本1株泛耐药AXXxx临床分离株16S rRNA、29种β-内酰胺酶基因(bla)、6种氨基糖苷类修饰酶基因(AMEs)、1种消毒剂/磺胺耐药基因(qacE△1-sul1)、3种整合子基因(int Ⅰ1、2、3)等39种耐药基因,经测序和同源性分析证实并分析其分布情况.结果 该菌经16S rRNA测序和同源性分析,证实为AXXxx;经测序和同源性分析证实7种耐药基因阳性[两种bla基因(blaTEM-116、blaCARB-8)、3种AMEs基因aac(6′)-Ⅱ、aae(3)-Ⅱ、ant(3″)-Ⅰ、qacE△1-sul1和Ⅰ类整合子基因(int Ⅰ1)];其他27种bla基因、3种AMEs基因(aac (6′)-Ⅰ b、aac(3)-Ⅰ、ant(2″)-Ⅰ]和2种整合子基因(intⅠ 2、intⅠ 3)均为阴性.结论 该株泛耐菌耐药机制为多重机制,主要与7种耐药相关基因[blaTEM-116、blaCARB-8、aac(6′)-Ⅱ、aac(3)-Ⅱ、ant(3″)-Ⅰ、qacE△1-sul1和Ⅰ类整合子]有关.     

泛耐药鲍氏不动杆菌39种耐药相关基因的研究

目的 研究痰泛耐药鲍氏不动杆菌(PRBAB) 39种耐药相关基因.方法 应用法国生物梅里埃公司的API鉴定条/PSE5.0药敏条和美国BD公司的Phoenix NMIC/ID-109鉴定/药敏板进行细菌鉴定和药敏试验,应用PCR法检测1株分离于合格痰标本PRBAB临床分离株29种β-内酰胺酶相关基因(bla)、6种氨基糖苷类修饰酶基因(AMEs)、消毒剂/磺胺耐药基因(qacE△1-sul1)、3种整合子基因(intⅠ 1、2、3)等39种耐药相关基因,分析其分布情况.结果 该菌7种耐药相关基因阳性:bla基因(bla TEM、blaADC),AMEs基因[aac(6')-Ⅰb、aac(3)-Ⅰ、ant(3")-Ⅰ、qacE△1-sul1和Ⅰ类整合子基因(intⅠ1)];其他32种基因AMEs基因[aac(6')-Ⅱ、aac(3)-Ⅱ)、ant(2")-Ⅰ)等]均阴性.结论 泛耐药ABA耐药机制为多重机制,主要与7种耐药相关基因(bla TEM、blaADC、aac(6')-Ⅰb、aac(3)-Ⅰ、ant(3")-Ⅰ、qacE△1-sul1和Ⅰ类整合子)有关.     

耐亚胺培南铜绿假单胞菌亲缘性分析

目的了解耐亚胺培南铜绿假单胞菌菌株的亲缘性。方法聚合酶链反应（PCR）法对耐亚胺培南铜绿假单胞菌进行β-内酰胺酶基因、氨基糖苷类修饰酶（AMEs）基因、消毒剂耐药基因（qacE△1-sul1）、膜微孔蛋白基因（oprD2）及整合酶基因（intⅠ1）的检测,并以耐药基因为分子标记作聚类分析。结果β-内酰胺类耐药相关基因TEM、CARB、DHA、IMP阳性率分别为5.9%、32.4%、14.7%、17.6%,而SHV、OXA-10、PER、VEB、GES、VIM、GIM、SPM均为阴性;oprD2缺失率为2.9%;aac（6′）-Ⅰ、aac（6′）-Ⅱ和ant（2″）-Ⅰ阳性率分别为21.2%、33.3%、48.5%;qacE△1-sull基因为41.2%;IntⅠ1阳性率为3.0%,试验菌株存在克隆传播和近缘关系现象。结论耐亚胺培南铜绿假单胞菌可导致克隆传播,遗传标志物聚类分析方法可快速了解试验菌株间的亲缘关系。     

22株多药耐药铜绿假单胞菌菌株亲缘性分析及耐药机制研究

目的 研究22株多药耐药铜绿假单胞菌(PAE)菌株的亲缘性.方法 采用聚合酶链反应(PCR)法检测22株多药耐药铜绿假单胞菌的β-内酰胺类耐药基因、氨基糖苷类修饰酶(AMEs)基因、喹诺酮类耐药基因、耐消毒剂基因(qacE△1-sul1)和整合酶基因,并以耐药基因为分子标志作聚类分析.结果 22株菌中aac(6')-Ⅰ b、blaCARB、gyrA、oprD2、ant(2')-Ⅰ和qacE△1-sul1基因的阳性率为100%,aac(3)-Ⅰ、aac(6')-Ⅱ、blaGES、blaGIM、blaOXA-10群、blaPER、blaSPM、blaSHV和blaDHA基因均阴性,blalMP-Ⅰ、blaTEM、blaVEB、aac(3)-Ⅱ、ant(3')-Ⅰ、int Ⅰ 1和blaVIM基因的阳性率分别为95.5%、77.3%、13.6%、4.5%、4.5%、4.5%和4.5%;经样本聚类分析显示存在严重的克隆传播.结论 22株铜绿假单胞菌β-内酰胺类、氨基糖苷类抗菌药物耐药与产β-内酰胺酶和氨基糖苷类修饰酶密切相关.医院感染铜绿假单胞菌可导致克隆传播医院感染,并引起暴发性流行.     

鲍氏不动杆菌耐药基因和整合子、转座子遗传标记及菌株亲缘性研究

目的了解鲍氏不动杆菌(ABA)耐药基因和整合子、Tn21/Tn501转座子存在状况及菌株亲缘性。方法对分离自临床27株ABA进行耐药基因、整合子、转座子检测,检测结果作聚类分析。结果27株中blaTEM、blaOXA-23群、blaADC、aac(3)-Ⅰ、aac(6′)-Ⅰ、ant(3″)-Ⅰ、qacE△1-sulⅠ、intⅠ1阳性率分别为81.5%、44.4%、85.2%、85.2%、66.7%、81.5%、85.2%、85.2%,其余基因均阴性,聚类分析显示存在克隆传播现象。结论ABA可导致克隆传播医院感染,并存在暴发性流行。     

泛耐药肺炎克雷伯菌的耐药基因研究

目的 了解1株对临床常用18种抗菌药物(包括亚胺培南、美罗培南)均耐药的肺炎克雷伯菌(KPN)所携带的耐药基因状况.方法 对该株KPN进行了9类耐药基因的PCR法检测,包括β-内酰胺酶基因blaTEM、blaSHV、blaLEN、blaOKP、blaCTX-M-1、2、9群、blaOXA-1、2、10群、blaCARB、blaPER、blaVEB、blaGES、金属β-内酰胺酶基因blaIMP、blaVIM、blaKPC,AmpC酶基因blaDHA、blaACT/MIR、blaCMY/MOX、blaCMY/LAT,氨基糖苷修饰酶基因aac(3)-Ⅰ、aac(3)-Ⅱ、aac(6')-Ⅰ b、aac(6')-Ⅱ、ant(2")-Ⅰ、ant(3")-Ⅰ,喹诺酮类耐药基因qnrA、TMP耐药基因dfrA1、dfrA17,消毒剂磺胺耐药基因qacE△1-sul1,整合子遗传标记基因intⅠ1、intⅠ2、intⅠ3,转座子遗传标记基因tnpA、merA,共计36种.结果 KPN共检出7种耐药基因,分别为β-内酰胺酶基因blaTEM,blaSHV,金属β-内酰胺酶基因blaKPC-2,氨基糖苷修饰酶基因aac(3)-Ⅱ,ant(3")-Ⅰ,消毒剂磺胺耐药基因qacE△1-sull,整合子遗传标记基因intⅠ1.结论 在该株泛耐药KPN中发现了少见的blaKPC-2金属β-内酰胺酶基因,该菌对18种抗菌药物的耐药可能与其同时携带有多种耐药基因有关,临床应对此类菌株引起重视.     

铜绿假单胞菌连续分离株耐药性与遗传学特征研究

目的了解铜绿假单胞菌（PAE）连续分离株耐药性与遗传学特征。方法采用PCR检测86株PAE连续分离株耐药基因和整合子、转座子。结果86株中oprD2基因缺失47株（55.0%）、β-内酰胺酶基因blaCARB阳性26株（30.2%）、blaVIM阳性12株（14.0%）、blaDHA阳性3株（3.5%）、blaTEM阳性1株（1.1%）;氨基糖苷类修饰酶基因ant（2″）-Ⅰ阳性24株（27.9%）、aac（6′）-Ⅱ阳性21株（24.4%）、aac（6′）-Ⅰb阳性13株（15.1%）、ant（3″）-Ⅰ阳性4株（4.7%）,存在克隆传播现象。结论绍兴连续分离的PAEβ-内酰胺酶、氨基糖苷类修饰酶基因携带率高。PAE可导致克隆传播医院感染,并存在暴发性流行。     

烧伤科同期存在铜绿假单胞菌两种流行株传播

目的了解烧伤科分离铜绿假单胞菌(PAE)的同期流行情况。方法对2006年1月-2007年12月烧伤科分离的32株PAE采用PCR及序列分析的方法,分析44种耐药基因,Average法进行耐药基因聚类分析以确定菌株亲缘性。结果 32株PAE中,基因阳性率分别为TEM 100.0%、OXA-10 28.1%、VEB 25.0%、IMP25.0%、VIM 9.4%、oprD缺失100.0%、aac(6′)-Ⅰb 9.4%、aac(6′)-Ⅱ3.1%、ant(3″)-Ⅰ28.1%、ant(2″)-Ⅰ25.0%、rmtB1 3.1%、qacE△1-sul1 50.0%、tnp513 9.4%、tnpA 6.2%、merA 34.4%和intⅠ1 40.6%,其他基因均阴性;根据耐药基因聚类分析32株PAE分为2群,为烧伤科该时期存在的主要流行株。结论烧伤科分离的32株PAE,检测到16种耐药基因,主要有2种流行株传播,可导致克隆传播医院感染,存在暴发流行的趋势。     

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.     

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.     

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.     

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.