骨与关节结核患者病原菌分布与耐药性分析

目的研究骨与关节结核病患者病原菌分布及耐药性,为临床诊治骨与关节结核提供参考。方法以2012年1月-2014年1月于医院就诊的72例骨与关节结核患者为研究对象,运用BACTEC MGI 960系统进行菌种鉴定、药敏试验和分枝杆菌属培养,对菌种的分布、耐药及分枝杆菌属阳性率进行分析。结果培养4周时分枝杆菌属培养阳性25株阳性率为34.72%,培养至8周时升高至42株占58.33%,两者差异有统计学意义(P<0.05);分枝杆菌属中分离出结核分枝杆菌25株占59.52%、牛分枝杆菌占11株26.19%、非结核分枝杆菌6株占14.29%;进行42株分枝杆菌属进行药敏试验,出现耐药菌株17株耐药率40.48%,其中牛分枝杆菌5株、结核分枝杆菌6株、非结核分枝杆菌6株。结论延长培养时间可增加阳性培养率,骨与关节结核病原菌主要为结核分枝杆菌,其次为非结核分枝杆菌和牛分枝杆菌,且有较高的耐药率。     

矽肺患者结核分枝杆菌临床分离培养与抗结核药物敏感检测

目的分析矽肺患者结核分枝杆菌临床检验结果,并对分离菌株进行药敏检测。方法以2011年10月至2013年10月临床诊断为矽肺合并肺结核的127例患者(矽肺结核组)和53例无合并肺结核矽肺患者(矽肺组)为研究对象,收集患者的痰标本,分别进行结核分枝杆菌痰涂片检查和BACTEC-MGIT 960培养,并对培养阳性的结核分枝杆菌菌株作一线抗结核药物的药敏分析。结果矽肺结核组患者痰涂片检查和BACTEC-MGIT 960培养的阳性率均高于矽肺组(47.2%vs 0.0%,67.7%vs 5.7%,P<0.01);矽肺结核组患者BACTEC-MGIT 960培养的阳性率高于同组患者的痰涂片检查阳性率(67.7%vs 47.2%,P<0.01)。180例患者痰标本经BACTEC-MGIT 960培养检出结核分枝杆菌阳性者共89株,该89株分离株均对一线抗结核药物耐药,总耐药率为100.0%,耐多药率为28.0%。耐药顺序从高到低依次为异烟肼、链霉素、乙胺丁醇和利福平。结论矽肺患者标本中分离出的结核分枝杆菌对抗结核药物呈现较高的耐药率,对矽肺患者定期进行结核分枝杆菌感染的检查是防治耐药结核分枝杆菌菌株传播的有效措施。     

2008-2010年结核分枝杆菌的耐药性分析

目的了解2008-2010年结核患者分离出的结核分枝杆菌对常用抗结核药物的耐药性变迁。方法采用罗氏培养系统进行结核分枝杆菌培养,药敏试验采用绝对浓度法,回顾性分析天津市海河医院分离的455株痰结核分枝杆菌的耐药性。结果 455株结核分枝杆菌对链霉素、左氧氟沙星、利福平、乙胺丁醇、异烟肼、阿米卡星、对氨基水杨酸的总耐药率分别为29.2%、24.6%、23.1%、18.2%、18.5%、13.4%、9.2%。结论结核分枝杆菌的耐药率仍然较高,规范、足量、联合用药,是减缓耐药率的主要途径。     

复治涂阳肺结核患者分枝杆菌属培养及药敏结果分析

目的 了解衢州地区痰涂阳性肺结核患者对常用抗结核药物的耐药性,为临床用药提供依据.方法 衢州地区的痰涂阳性复治肺结核142例患者送检的痰液进行分枝杆菌属培养和药敏试验,分析抗结核药物的耐药性.结果 85例获得菌种鉴定和有药物敏感试验结果者中结核分枝杆菌复合群82例,非结核分枝杆菌3例,82例结核分枝杆菌复合群中耐药47例,总耐药率57.32％.结核分枝杆菌对抗结核药物的耐药率依次为异烟肼45.12％、利福平39.02％、链霉素34.15％、氧氟沙星34.15％、乙胺丁醇12.20％、卡那霉素7.32％.结论 衢州地区复治涂阳肺结核患者耐药性严重,应开展分枝杆菌属培养和药敏试验,并根据药敏结果组成治疗方案.     

周口市596株结核分枝杆菌耐荮陸分析

目的了解周口市结核分枝杆菌的耐药情况。方法收集2015年1月至2016年1月周口市所辖各县疾控中心结核分枝杆菌培养阳性的菌株以及期间周口市第五人民医院住院患者标本,采用BD-960结核分枝杆菌快速培养系统和比例法进行细菌鉴定及药敏试验。结果596株结核分枝杆菌中,耐多药(MDR)菌株4株(7.40%),任何耐药抗结核一线药物中耐药性依次为链霉素(21.50%),异烟肼(19.50%),利福平(13.60%),乙胺丁醇(6.70%),二线药物耐药性最高为左氧氟沙星(7.20%),最低为卡那霉素(2.70%)。结论二线药物左氧氟沙星耐药呈上升趋势,需引起临床重视;卡那霉素耐药性最低,推荐复治和耐药患者使用;耐多药高于全国水平,需加强监管。     

原发性肺癌患者结核分枝杆菌L-型感染与耐药性分析

目的探讨原发性肺癌患者结核分枝杆菌L-型感染及耐药性,为临床治疗提供依据。方法选取2012年5月-2015年8月医院224例原发性肺癌患者肺组织标本,采用原位分子杂交技术对组织标本结核分枝杆菌L-型感染进行检测,并对其进行药敏试验统计耐药率。结果 224例肺癌患者术后有87例组织标本检测结果呈阳性,阳性率为38.84%;对其致病组织进行病原菌分离,共分离出结核分枝杆菌L-型117株;其对一线和二线抗结核药物的耐药率分别为52.99%和47.01%;对耐多药(MDR)和广泛耐药(XDR)结核分枝杆菌L-型的耐药性进行统计显示,MDR结核分枝杆菌L-型的耐药率为35.04%,显著高于XDR结核分枝杆菌L-型的耐药率16.24%,比较差异有统计学意义(P0.05)。结论临床结核分枝杆菌L-型耐药性较高,分析其耐药性对结核分枝杆菌L-型感染治疗有一定的指导意义。     

BACTEC MGIT 960系统在分枝杆菌属菌种初步鉴定及药敏中的应用

目的评价BACTEC MGIT 960系统在分枝杆菌属菌种鉴定及药敏中的应用价值。方法显微镜观察BACTEC MGIT 960系统分离的162株分枝杆菌在液体培养基中的形态,传统生化和核酸检测法同时鉴定分枝杆菌属菌种,分析细菌形态与菌种之间的关系;应用BACTEC MGIT 960系统对分离的141株结核分枝杆菌进行药敏试验。结果 162株分枝杆菌属在MGIT液体培养基中呈索条状、分枝状、点粒状和分散状4种形态;呈索条状132株分枝杆菌属均为结核分枝杆菌,呈点粒状10株和分散状6株分枝杆菌属均为非结核分枝杆菌;对链霉素、异烟肼、利福平和乙胺丁醇的耐药率分别为9.9%、14.2%、9.2%和6.4%,总耐药率18.4%,同时耐利福平和异烟肼的为8.5%;药敏平均检测时间为9.3 d。结论 BACTEC MGIT 960系统可快速将分枝杆菌属初步鉴定为结核分枝杆菌和非结核分枝杆菌,能快速准确获得临床一线抗结核药物的药敏结果。     

引起结核病分枝杆菌类型及其耐药性探讨

目的：对109株分枝杆菌进行分型和药敏试验的观察，了解引起结核病分枝杆菌主要类型及其耐药现状，为结核病的诊治提供准确的病原学和合理用药依据。方法：采用BACIECTB460仪器和BBIMGIT^TM分枝杆菌生长检测管进行分枝杆菌培养和药敏试验。结果：培养出109株分枝杆菌有四种类型，即人型分枝杆菌99株(90．8％)、牛型分枝杆菌3株(2．7％)、偶发分枝杆菌3株(2．7％)、龟分枝杆菌4株(3．6％)。结核分枝杆菌对异烟肼(INH)、乙胺丁醇(EMB)、利福平(RFP)、链霉素(Sm)的耐药率分别为54．9％、50．0％、41．2％、50．0％。结论：目前人型结核分枝杆菌仍然是引起结核病的主要病原菌，有少数患者可感染非结核分枝杆菌，这些分枝杆菌多数对异烟肼、链霉素产生较强的耐药性，结核分枝杆菌耐药性强于非结核分枝杆菌。提示临床和实验室须加强分枝杆菌的培养和耐药性监测，及时制订结核病的诊治、预防、控制等措施。     

679株结核分枝杆菌药敏结果分析

目的:了解衢州地区结核分枝杆菌耐药情况,指导临床医生合理选择抗结核药物和制定个性化的治疗方案。方法:采用比例法对694株痰培养阳性菌株进行一线抗结核药物异烟肼(INH)、利福平(REF)、链霉素(SM)、乙胺丁醇(EMB)和二线药物卡那霉素(KM)、氧氟沙星(OFX)的耐药性检测,利用鉴别培养基对分枝杆菌进行初步菌种鉴定。结果:679株结核分枝杆菌药敏的总耐药率21%,耐多药率5.2%,六种抗结核药物的耐药情况分别是异烟肼12.67%,链霉素10.46%、氧氟沙星7.95%、利福平6.19%、乙胺丁醇2.36%、卡那霉素2.06%.复治病人的总耐药率、耐多药率和单药耐药率明显高于初治病人。结论:应加强肺结核初治病人的规范化治疗,加大对复治结核病人的治疗和管理,预防耐药病人尤其是耐多药病人的产生和传播。     

分格平板分枝杆菌药敏培养基在结核分枝杆菌药敏检测中的应用

目的 评价分格平板分枝杆菌药敏培养基,在结核分枝杆菌药敏检测中的应用.方法 收集临床分离的结核分枝杆菌51株,药敏方法分别采用分格平板分枝杆菌药敏培养基比例法和罗氏培养基比例法(试管比例法).结果 试管比例法:51株结核分枝杆菌的耐药率对异烟肼为68.6％、利福平为51.0％、乙胺丁醇为49.0％、链霉素为52.9％;与试管比例法相比较,分格平板琼脂比例法药敏结果2株对异烟肼耐药、1株利福平耐药和2株乙胺丁醇耐药菌株与其不符,其余结果一致;4种一线抗结核药物的药敏结果符合率分别为异烟肼94.3％、利福平96.3％、乙胺丁醇92.0％、链霉素100.0％;51株分离的临床结核分枝杆菌中泛耐药24株,多药耐药7株,而对4种药物全敏感12株,敏感率仅为23.9％.结论 分格平板琼脂比例法操作简便,结果符合率高,容易观察,能广泛应用各级临床结核实验室.     

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.