惠州市62例新型冠状病毒肺炎确诊病例的流行病学特征分析

目的 分析惠州市新型冠状病毒肺炎（COVID-19）确诊病例的流行病学特征,为疫情防控提供科学依据。方法 采用回顾性研究方法,收集2020年1月19日至5月31日惠州市中心人民医院收治的62例COVID-19确诊患者资料,分析其流行病学特征、新冠病毒核酸检测结果和住院相关情况。结果 惠州市确诊病例发病集中在2020年1月20日至2月18日,惠东县29例、惠城区17例、惠阳区11例、博罗县5例。轻型22例、普通型37例和重型3例,无危重型病例。男女比例为1∶1,发病年龄为1~85岁,中位数为46（36,60）岁。有明确湖北旅居史55例（88.71%）,无明确接触史3例（4.84%）。未出现本地病例,主要以湖北省输入性病例（55例）为主,并且多为家族聚集性病例（45例）。经两两比较,重型病例住院天数长于轻型和普通型病例（P<0.05）;不同临床分型病例的发病年龄和核酸首次转阴所需天数的差异无统计学意义（P>0.05）。9例（14.52%）病例在出院6~15 d内出现复阳现象,复阳病例第2次入院核酸转阴间隔时间较首次入院核酸转阴间隔时间短（P<0.05）。结论 惠州市COVID-19以湖北省输入性和家庭聚集性为主,主要分布在惠东县。病例以轻型和普通型为主,住院天数与病情严重程度相关。     

株洲地区80例新型冠状病毒肺炎患者临床特征分析

 

目的 分析新型冠状病毒肺炎（COVID-19）患者的临床和流行病学特征,以进一步提高对该病的认识。方法 对2020年1月20日-2月27日株洲市80例确诊为COVID-19住院患者的临床资料进行回顾性分析,包括流行病学情况、临床特征、治疗及转归情况,比较轻型和普通型组、重型和危重型组患者的临床特点。结果 80例 确诊患者中,湖北疫区来源22例（27.5%）,非湖北疫区来源58例（72.5%）,其中有明确接触传染源者45例（56.3%）,无明确接触史者13例（16.3%）。聚集性疫情共17起,涉及病例55例,湖北输入性聚集疫情4起,病例9例,其中家庭聚集3起;本地聚集性疫情13起,病例46例,家庭聚集10起,社交聚集2起,朋友聚餐1起。80例患者中位年龄为47.5岁;男女比例为1 ∶1;22例患者（27.5%）合并基础疾病,居前3位的基础疾病依次为高血压病、糖尿病、冠心病;轻型病例8例（10.0%）,普通型55例（68.8%）,重型11例（13.8%）,危重型6例（7.5%）。主要临床症状为发热、咳嗽咳痰、乏力、头痛、肌肉酸痛、腹泻。与轻型和普通型组患者相比,重型和危重型组患者年龄更大,糖尿病、高血压病比例更高,发生呼吸困难、呼吸频率>24次/分比例高,差异均有统计学意义（均P<0.05）。白细胞数正常或减低者78例（97.5%）,淋巴细胞计数<1.0×10⁹/L者20例（25.0%）;重型和危重型组患者的淋巴细胞计数、淋巴细胞百分比、血红蛋白、清蛋白均低于轻型和普通型组患者（均P<0.05）,多项血液指标比较差异有统计学意义。9例（11.3%）患者无肺炎表现,15例（18.8%）患者肺部单侧受累,56例（70.0%）患者肺部双侧受累,17例（100.0%）重型、危重型患者均为双肺受累。结论 新型冠状病毒感染呈家族聚集性发病,年龄大、合并基础疾病在重症和危重症患者中所占比例较高,大多数重型患者淋巴细胞计数显著减少,可作为临床预警指标。

     

2022年上海市某区定点医院151例新型冠状病毒肺炎病例临床特征分析

目的分析2022年上海市151例本土新型冠状病毒肺炎（简称“新冠肺炎”）患者的临床特征。方法回顾2022年4月13日至5月10日上海市某区级定点医院收治的151例新冠肺炎患者临床资料,分析其临床特征、实验室检查、肺部影像学特征以及治疗转归情况。结果151例患者年龄3~97岁,中位年龄72岁,以社区、家庭聚集性病例为主;临床分型以轻型（95例,62.9%）和普通型（47例,31.1%）为主;重型/危重型患者（9例,6.0%）大多数为高龄、合并多种基础疾病;未接种新冠疫苗比例高达66.9%,重型/危重型患者未接种者比例更高。最常见的首发症状是咳痰（71例,47.0%）、发热（51例,33.8%）和干咳（30例,19.9%）;轻型、普通型患者白细胞、中性粒细胞计数大多为正常或下降,重型/危重型上升显著（P<0.001）;重型/危重型患者D?二聚体、肌酐、肌红蛋白、肌钙蛋白升高以及淋巴细胞下降均较其他类型常见（P<0.05）;重型/危重型和普通型患者使用抗生素、抗病毒药物、胸腺法新和肝素的比例显著高于轻型（P<0.05）。治愈出院患者（138例,91.4%）中,治疗后核酸转阴中位天数为12 d,轻型患者转阴天数显著短于普通型与重型/危重型（P<0.01）;4例（2.6%）死亡病例均>80岁、未接种疫苗、合并多种基础疾病,最终死于原发疾病。结论该区定点医院收治的新冠肺炎患者以聚集性病例为主,未接种新冠疫苗比例高,大多数患者为轻型,但高龄、合并基础疾病多、未接种疫苗均是发展为重型的高危因素。尽早病情评估,制订综合性治疗方案或是改善预后的关键。     

新型冠状病毒肺炎 无症状感染者的临床与免疫学特征分析

[摘要]　目的　探讨新型冠状病毒肺炎（coronavirus disease 2019, COVID-19）无症状感染者的临床和免疫学特征。方法　选取2020年1月22日—6月22日石家庄市第五医院收治的59例COVID-19患者作为研究对象,分析不同疾病分期患者的临床资料。利用流式细胞术检测患者外周血T淋巴细胞亚群计数,Procarta Plex多细胞因子检测系统检测外周血25种细胞因子和9种趋化因子水平。结果　59例COVID-19患者中,无症状感染组28例（47.5%）、轻型组6例（10.2%）、普通型组19例（32.2%）,重型/危重型组6例（10.2%）。无症状感染组中位年龄为23.0（19.3,34.8）岁,显著低于普通型组的35.0（24.0,52.0）岁和重型/危重型组的64.5（52.0,68.3）岁（P均＜0.05）。无症状感染组患者较少患有基础疾病,均无症状、体征和胸部CT变化,其外周血CD3+ T细胞、CD4+ T细胞、CD8+ T细胞计数均显著高于重型/危重型组（P均＜0.05）,同时CD4+ T细胞计数显著高于普通型组（P＜0.05）。14例无症状感染组患者治疗前与治疗后CD3+ T细胞、CD4+ T细胞和CD8+ T细胞计数比较,差异均无统计学意义（P均＞0.05）。14例无症状感染组患者治疗前后CD4+ T细胞计数的变化幅度均显著低于普通型组、重型/危重型组（P均＜0.05）。无症状感染组外周血可检测到11种细胞因子和趋化因子,其中IL-7水平显著高于对照组, IP-10水平均显著低于普通型组、重型/危重型组,差异均具有统计学意义（P均＜0.05）。结论　COVID-19无症状感染者以青年为主,但未发现与性别因素相关。随着COVID-19病情进展,普通型、重型/危重型患者外周血T细胞亚群计数降低,而细胞因子和趋化因子水平升高,但上述指标在无症状感染者中未见显著改变。     

影响Omicron变异株感染轻型和普通型COVID-19患儿核酸转阴时间缩短因素分析

目的 探讨Omicron变异株感染轻型与普通型新型冠状病毒疾病(COVID-19)患儿的临床特征及影响其核酸检测结果转为阴性(以下简称为“核酸转阴”)时间缩短因素。方法 选取2022年4月7日至5月20日上海交通大学医学院附属仁济医院南院区“亲子病房”集中收治的150例Omicron变异株感染轻型和普通型COVID-19患儿为研究对象。采用回顾性分析方法,根据这150例患儿的核酸转阴中位时间为13 d,将其分别纳入快转阴组(n=84,核酸转阴时间<13 d)和慢转阴组(n=66,核酸转阴时间≥13 d)。对2组患儿年龄、性别、轻型与普通型COVID-19患儿构成比、疫苗接种率、COVID-19相关临床表现及COVID-19发病48 h内系统炎症指数(SII)、中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)、血小板与淋巴细胞比值(PLR)等,进行成组t检验、Mann-Whitney U检验或χ²检验。采用多因素非条件logistic回归分析方法,分析影响Omicron变异株感染轻型与普通型COVID-19患儿核酸转阴时间缩短的因素。2组患...     

咽拭子新型冠状病毒核酸检测的临床价值

 目的 了解某院新型冠状病毒肺炎（COVID-19）患者的临床资料及咽拭子检查结果,评价咽拭子新型冠状病毒（SARS-CoV-2）核酸检测的临床价值,为临床诊断COVID-19提供参考。方法 回顾性收集中南大学湘雅医院2020年1月23日—2月18日经SARS-CoV-2核酸检测确诊COVID-19患者病历资料,分析患者临床资料、病毒核酸检测的取样次数、取样方法、标本类型、检测手段等信息。结果 28例确诊患者平均年龄（43.78±14.46）岁,男女比例为2.5∶1,46.42%的患者有武汉/湖北旅居史,14.29%的患者与确诊COVID-19患者有密切接触史。患者临床表现以发热（78.57%）、咳嗽（53.57%）为主,实验室检查可见白细胞计数正常（71.43%）,淋巴细胞计数下降（53.57%）,肺部CT呈多发磨玻璃影（92.59%）及斑片影（70.37%）。28例确诊病例中,发病至确诊的中位时间为5.5 d。首次采集标本SARS-CoV-2检测阳性者18例（64.29%）,首次可疑阳性1例;首次阴性（包括可疑阳性）,第二次采集阳性者5例（17.86%）;前两次采集阴性,第三次采集阳性者2例（7.14%）;经四次检测阳性者1例（3.57%）;经五次检测后阳性者2例（7.14%）。鼻/口咽拭子采样26例（92.86%）,诱导排痰2例（7.14%）,经鼻咽拭子、咽拭子、痰标本RT-PCR确诊27例（96.43%）,痰标本NGS测序确诊1例（3.57%）。结论 COVID-19临床常表现有发热及干咳,但无特异性,仍需依赖SARS-CoV-2核酸检测才能确诊。咽拭子作为发热门诊首选的SARS-CoV-2核酸采集方式具有简便易行的优势,但检测结果呈阴性并不能排除SARS-CoV-2感染。     

广州市新型冠状病毒肺炎疫情流行特征分析

目的 对广州市新型冠状病毒肺炎（COVID-19）疫情的流行特征进行分析,为指导疫情防控提供科学依据。 方法 对广州市COVID-19确诊病例及无症状感染者进行流行病学调查,采用描述流行病学方法描述流行特征及病例临床特征,分析感染来源及与疾病严重程度相关因素。 结果 截至2020年3月11日,广州市共报告361例新型冠状病毒感染者,其中确诊病例347例（占96.1%）,无症状感染者14例。病例以外地输入为主,占73.2%,其中80.3%为湖北省输入（204/254）。63.7%的病例与聚集性疫情关联,且以家庭聚集为主（占85.1%）。最常见症状为发热（占78.1%）,其次为干咳（占45.9%）。93.9%的病例表现为轻型或普通型,仅1例死亡。男性、高龄、职业为离退人员、自述有心脑血管疾病史和发病前14 d内有医疗机构就诊史等因素与重症型病例有关（P<0.05或P<0.01）。 结论 广州市COVID-19疫情以湖北省输入为主,部分地区出现本地感染,家庭聚集性疫情多发,但尚未发生社区传播,提示在以输入病例为主的地区采取加强主动排查、严格隔离确诊病例和密切接触者等措施,可有效控制本地传播。     

德尔塔毒株新冠病毒肺炎患者临床分型影响因素分析

目的：探讨Delta毒株新冠病毒肺炎（COVID-19）患者不同临床分型的影响因素,为更好地防控疫情传播和病情恶化提供理论依据。方法：基于2021年9—12月期间确诊的云南省德宏州本土感染Delta毒株COVID-19患者141例,应用单因素和多因素logistics回归模型分析轻型/普通型感染的影响因素。结果：本研究共纳入141例本土Delta毒株COVID-19患者,男性45例（31.91%）,女性96例（68.09%）。多因素logistic回归分析显示,调整潜在的混杂因素后,年龄≥30岁的人群感染Delta毒株COVID-19出现轻型/普通型临床症状的危险性增加（OR=2.30,95%CI:1.14～4.67）,且年龄每增加1岁,出现轻型/普通型临床症状的危险性就增加2%(OR=1.02,95%CI:1.00～1.04)。这一现象在女性人群中更加显著,而在男性人群中差异无统计学意义。结论：年龄较大的Delta毒株COVID-19女性患者发生轻型/普通型临床症状的危险性增加。     

多次核酸阴性后确诊COVID-19病例临床特征

目的分析新型冠状病毒鼻咽拭子核酸检测多次阴性后确诊为新型冠状病毒肺炎(COVID-19)患者临床特征。方法筛选2020年2月5日-2月25日武汉大学人民医院隔离病房住院患者,选取73例多次新型冠状病毒鼻咽拭子核酸检测阴性,疑似或者临床诊断为COVID-19的患者作为研究对象,将其分为三组(排除COVID-19组、核酸阴性组和核酸阳性组),收集其临床资料,分析临床症状、实验室检查、新型冠状病毒核酸检测、胸部CT影像学。结果与排除COVID-19组比较,核酸阴性组发病到住院时间较长(P=0.002),淋巴细胞计数较低(P=0.047),更容易出现乏力(P0.05)。与核酸阳性组比较,核酸阴性组重型及危重型患者较多(P=0.012),更容易出现乏力(P0.05)。白细胞总数排除COVID-19组较核酸阴性组、核酸阳性组明显升高(P0.05)。4例患者痰液核酸检测阳性,1例患者同时出现粪便及痰液核酸检测阳性。临床诊断为COVID-19患者新型冠状病毒抗体检测呈阳性,排除COVID-19患者新型冠状病毒抗体检测呈阴性。临床诊断为COVID-19的58例患者影像学均呈典型COVID-19影像学改变。结论 COVID-19诊断一定要结合流行病学资料、临床特点、实验室和影像学检查及病程发展、治疗反应等综合评估。     

COVID-19患者淋巴细胞数及Th/Tc值预测病情进展研究

 目的 探讨新型冠状病毒肺炎（COVID-19）患者病情进展与外周血淋巴细胞数（TLC）、CD4⁺T（Th）与CD8⁺T（Tc）比值变化情况,以及TLC和Th/Tc值作为新冠肺炎病情进展监测指标的可行性。方法 收集2020年1月28日—2月10日某院确诊的12例COVID-19患者的实验室检测资料,根据临床症状分为重型/危重型组、轻型/普通型组两组,采用流式细胞仪检测两组患者外周血TLC,比较不同病情患者TLC、Th/Tc值。结果 COVID-19患者TLC占比低于正常值范围,重型/危重型组较轻型/普通型组更低;COVID-19患者Th细胞占比、Th/Tc值高于正常范围,重型/危重型组比轻型/普通型组患者更高。流式检测结果显示,两组患者T淋巴细胞、Th细胞、Tc细胞绝对值均降低,轻型/普通型组、重型/危重型组T淋巴细胞［（913±275）μL VS（526±228）μL］、Th细胞［（530±99）μL VS（351±41）μL］、Tc细胞［（255±84）μL VS（128±70）μL］绝对值比较,差异均有统计学意义（均P<0.05）。结论 通过TLC、Th/Tc的值判断COVID-19患者免疫状态,预测炎症水平,可为监测COVID-19患者疾病进展和确定抗"炎症因子风暴"治疗时机提供依据。     

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.     

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.