医院侵袭性真菌感染的菌种分类及临床分布

目的了解医院内侵袭性真菌感染的流行病学特点,为减少真菌感染提供实验依据。方法回顾性分析2006-2009年住院患者真菌培养阳性的菌种分类、标本种类、疾病种类、科室分布等。结果 4年间共检出侵袭性真菌1 945株,总的检出率为17.0%,2006-2009年真菌的检出率分别为14.6%、15.7%、16.8%和21.2%。真菌种类以念珠菌属为主,占92.4%,以白色念珠菌居多,占60.5%;丝状菌占7.6%。检出的1 945株真菌主要分离自痰、尿和大便标本。真菌感染患者主要来自呼吸科、心血管内科、传染科、神经内科和ICU等科室。结论侵袭性真菌的检出率逐年升高,白色念珠菌仍是医院内侵袭性真菌感染的主要病原菌,非白色念珠菌和毛霉菌属引起的感染不断增加。     

188株真菌医院内感染的调查

目的　了解崇州市医院 1997年 1月～ 2 0 0 0年 12月院内真菌感染及其药物敏感情况。　方法　采用回顾性调查确诊为医院内感染菌株 ,按真菌培养分离方法进行鉴定。　结果　 1997～ 2 0 0 0年发生院内真菌感染菌株数为 188株 ,感染构成比由 1997年的 2 9.8%降至 2 0 0 0年的 2 1.3 % ,引起院内感染的 188株真菌共分为 6个种 ,主要是白色念珠菌、热带念珠菌 ,其中白色念珠菌感染率最高占 88.8%。标本来源中 ,痰标本真菌检出率最高为 112株 ,占 5 9.6%。被检出的真菌中 ,对制霉菌素敏感菌株最高为 187株 ,对咪康唑耐药 3株 ,对两性霉素耐药 1株 ,对酮康唑耐药 4株。院内真菌感染发生与患者的原发病、大量免疫抑制剂和激素应用、抗生素反复长期使用等有密切关系。　结论　肺部念珠菌病最常见 ,有严重基础疾病及长期使用抗生素者发病率较高 ,治疗原发疾病 ,临床上应早诊断、早治疗 ,合理使用抗生素和抗真菌剂 ,以减少多重耐药和降低院内真菌感染率     

重症监护病房（ICU）患者肺部真菌感染的临床特点及相关危险因素

目的：探讨重症监护病房（ICU）患者肺部真菌感染的临床特点及相关危险因素分析。方法：对在我院接受治疗的921例重症监护病房ICU患者（其中42例感染）资料进行分析,分析患者感染率、感染疾病和部位分布,并采取有效的护理对策对其进行预防。结果：本次调研中,42例出现感染,感染率为4．56％;对患者感染部位进行病原菌分离（共分离出83株）,患者主要以呼吸道、肺部感染为主,共有59株病原菌,占71．1％;83株病原菌中白色念珠菌最多（65株,占78．3％）。结论：重症监护病房（ICU）患者肺部真菌感染率较高,其感染因素有：年龄、住院时间、休克、基础病变等,患者病变主要病菌为白色念珠菌等。     

医院真菌感染的临床调查与耐药性分析

目的　了解医院内真菌感染的临床特点、危险因素及真菌对药物的敏感情况。方法　采用回顾性调查 ,对 1 999～ 2 0 0 1年住院病例中的真菌感染病例进行统计分析。结果　 3年间发生医院真菌感染 1 0 3例 ,感染构成比由 1 999年的 8.4 7%上升到 2 0 0 1年的 1 8.6 8% ,3年之间差异有显著性意义 (χ2 =1 0 .99,P <0 .0 1 )。引起医院感染的真菌有 7个种 ,其中以白色念珠菌为主 ,占 5 8.2 5 % ;热带念珠菌次之 ,占 2 9.1 3%。医院真菌感染的部位以呼吸道最高 ,占全部医院真菌感染的 2 6 .2 1 % ,其次为泌尿道 ,占 2 0 .39%。被检出的医院内感染真菌抗药模式为 :对 5 氟胞嘧啶、两性霉素B、制霉菌素敏感 ,而对咪康唑、益康唑、酮康唑耐药。医院真菌感染的发生与基础疾病 ,长期使用广谱抗菌药物 ,大量使用免疫抑制剂 ,以及各种侵入性诊疗技术和年龄老龄化等因素密切相关。结论　医院真菌感染有逐年上升趋势 ,已成为医院感染致死的主要因素之一 ;同时医院感染真菌的耐药性也逐渐增多 ,对唑类抗真菌药物已明显耐药     

医院内深部真菌感染的前瞻性调查

目的　了解目标人群医院内真菌感染的危险因素、发病率和疾病谱。方法　对 1997年 10月～ 1999年 12月间在我院部分病房住院治疗的患者的医院内真菌感染进行前瞻性调查、分析 ,对分离到的其中 5 6株白色念珠菌进行药敏试验。结果　医院感染和医院内真菌感染的发病率分别为 12 .3%和 2 .5 7% ,医院内真菌感染的主要部位分别是口腔 ( 39.5 1% )、下呼吸道 ( 34.5 7% )和尿路 ( 17.2 8% ) ,主要的真菌为念珠菌 ( 90 .6 2 % ) ;医院内真菌感染的发生与免疫抑制剂治疗、多种广谱抗生素的使用 ( >3种 )、气管切开或插管、昏迷 ( >3d)、年龄≥ 6 5岁、留置导尿、恶性肿瘤性疾病等有关 ;白色念珠菌对两性霉素 B、氟康唑、氟胞嘧啶和伊曲康唑的敏感性分别为 10 0 %、94 .6 %、92 .86 %和 5 7.1%。结论　接受免疫抑制剂和多种广谱抗生素治疗、昏迷、体内留置导管的患者易发生医院内真菌感染 ;白色念珠菌仍是医院内真菌感染的主要病原 ;药敏试验表明 ,白色念珠菌对两性霉素 B、氟康唑、5 - FC高度敏感 ,而对伊曲康唑的敏感性较差     

ICU患者肺部真菌感染的临床分布及耐药性

目的了解ICU患者真菌肺部感染的菌种分布,为临床治疗真菌肺部感染提供依据。方法回顾性分析某医院ICU病房2008年8月-2010年8月间患者真菌引起肺部感染的真菌构成、真菌耐药特征与临床治疗转归。结果 852例ICU患者中,87例患者发生了真菌性肺部感染,共检出9类91株真菌,白色念珠菌是引起ICU患者肺部感染最主要的真菌。91株真菌对咪康唑、益康唑、酮康唑、氟康唑、5-氟胞嘧啶、两性霉素B、制菌霉素的耐药率分别为26.37%、23.08%、16.48%、26.37%、18.68%、5.49%、9.89%。87例肺部真菌感染患者中有19例患者死亡。结论真菌引起的肺部感染具有较高的耐药性,临床危害大,是ICU患者死亡的重要因素之一,应引起临床的高度重视。     

呼吸内科病房院内肺部真菌感染的临床分析

目的研究呼吸内科病房院内肺部真菌感染的可能性诱发因素、真菌类型、基础疾病及治疗效果。方法回顾性分析2010年10月-2012年10月在我院内科治疗时发生院内肺部真菌感染的60例患者的临床资料。结果呼吸内科病房院内肺部真菌感染由机体、真菌与环境综合作用生成,其中,基础疾病继发感染是引起肺部真菌感染的主要原因;主要可能性诱因是长期使用抗生素（56．7％）、各种激素（81．7％）、侵人性操作（53．3％）;白色念珠菌是主要病原菌（73．3％）。随着年龄的增长,呼吸内科病房院内肺部真菌感染的几率提升,60岁以上患者占76．5％。经过综合治疗与抗真菌药物治疗,治疗总有效数为56,总有效率为93．3％。结论呼吸内科病房院内肺部真菌感染无临床特异性,在治疗中要充分利用综合性治疗与高校抗真菌药物治疗,早发现、早诊断,并进行及时预防与治疗,可有效减少院内肺部真菌感染的发生率。     

ICU中心静脉置管血流真菌感染的相关因素分析

目的探讨重症监护病房(ICU)中心静脉置管相关性血流真菌感染(CVC-RBFI)的临床特点及影响预后的因素。方法选择2010年1月-2012年12月ICU中发生导管相关性真菌血流感染的63例患者为研究对象,运用多因素logistic回归分析CVC-RBFI临床特点和主要生化指标与预后的关系,数据使用SPSS18.0软件进行统计分析。结果 ICU CVC-RBFI患者基础疾病前4位分别为肿瘤、神经系统疾病、肺部疾病、腹部疾病,分别占34.9%、19.0%、14.3%、14.3%;诱发因素主要有广谱抗菌药物使用>5d、静脉营养≥10d、中心静脉导管留置>5d等,其分别占96.8%、95.2%、93.7%;共检出真菌63株,其中白色假丝酵母菌26株占41.27%,非白色假丝酵母菌占58.73%,多因素logistic回归分析显示,合并细菌菌血症、APACH EⅡ评分>18分是CVCRBFI死亡的独立危险因素。结论 ICU CVC-RBFI病原菌以白色假丝酵母菌为主,病死率高,加强对上述危险因素及真菌药敏监测、及早撤除医源性侵入因素,可以改善CVC-RBFI患者的预后。     

某医院不同住院患者医院内真菌感染的流行病学调查

目的:了解我院不同病区住院病人的获得性真菌感染的发病情况、流行病学分布和相关因素。方法:收集医院内2008年-2009年内1、内2、外1、外2和ICU5科,336例真菌感染的病例,进行菌种分布和病区来源等流行病学分析和调查。结果:336份样品中,内1、内2、外1、外2和ICU分别为224例、73例、2例、9例和28例。共分离到白色念珠菌、热带念珠菌、光滑念珠菌、克柔念珠菌、近平滑念珠菌和烟曲霉共6种真菌。结论:内科病区的真菌获得性感染率要高于外科病区,ICU病区位居第二。白色念珠菌是分离到的主要病原真菌,烟曲霉的侵入性真菌感染病例全部在ICU病区。合并基础疾病免疫力低的患者以及机械性通气和创伤性治疗的患者是院内真菌感染的高危人群。     

医院内真菌感染的分布及药物敏感性分析

目的了解医院内真菌感染分布及药物敏感情况,为预防真菌感染、合理使用抗真菌药物提供依据。方法常规培养分离出真菌,然后接种在科玛嘉显示培养基进行显色,并用法国生物梅里埃公司生产的API20CAUX酵母菌鉴定到种,利用ATB FUNGUS3真菌药敏板条进行MIC法药敏试验。结果湖南省肿瘤医院2008年6月-2011年6月期间,真菌感染来源的主要病区依次是胸部内科(35.2%)、重症监护病房(29.0%)、老干内科(17.4%);真菌感染的标本主要来自痰(69.6%),其次,尿液占9.2%,大便和分泌物各占7.4%、6.8%;在500株真菌中,白色假丝酵母菌占54.6%,其次是热带假丝酵母菌25.8%、近平滑假丝酵母菌9.2%、克柔假丝酵母菌8.2%;500株真菌中,23.08%白色念珠菌(63/273),30.0%非白念(68/227)对5-氟胞嘧啶不敏感;30.8%非白念(70/227)对氟康唑不敏感,其中87.8%克柔念珠(36/41)对氟康唑耐药;17.2%非白念(39/227)对伊曲康唑不敏感;8.4%非白念(19/227)对伏立康唑不敏感;8.8%非白念(20/227)对两性霉素B不敏感。所有白色念珠菌对氟康唑、伊曲康唑、伏立康唑、两性霉素B均敏感。结论临床感染的真菌仍以白色念珠菌为主,非白色念珠菌的感染有上升趋势,药敏结果显示非白念对5-氟胞嘧啶、氟康唑、伊曲康唑产生了较强的耐药性;因此,常规开展真菌药敏试验,进行耐药性监测,可以为预防真菌感染、合理使用抗真菌药物提供依据。     

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.