人hMPV最新研究进展

人偏肺病毒(hMPV)是近年来发现的一种呼吸道病毒,病毒从症状与呼吸道合胞病毒(hRSV)感染相似的患儿的鼻咽部分泌物中分离出来,常见于儿科患者,成人和免疫力低下的个体也可以受到感染。hMPV感染可引起儿童严重的细支气管炎和肺炎,其症状与呼吸道合胞病毒感染难以区分。有关呼吸道病毒的研究众多,对于引起急性呼吸道感染的一些常见病原体,已经有了一定的认识和了解。然而,关于hMPV的研究却始终难以深入,特别是对它的分子发病机制及对其不同治疗方式的有效性评估还知之甚少。本文就h MPV的分子病毒学、流行病学、临床特征、实验室检查及治疗和控制策略做一概述,旨在为实验室和临床提供参考。     

广州地区儿童急性呼吸道感染患者中偏肺病毒的感染调查

目的 了解广州地区14岁以下急性呼吸道患儿人类偏肺病毒(humanmetapneumovirus,hMPV)的感染情况,分析广州地区儿童感染hMPV的流行病学特征及临床特征,为hMPV的预防和治疗提供一些依据.方法 2006年9月至2008年8月,在广州某医院的儿科门诊及住院部的急性呼吸道患儿中采集521份鼻咽拭子标本,提取总核酸,用逆转录聚合酶链反应(RT-PER)扩增hMPV的核蛋白(N)基因的213个核苷酸片段,对16份强阳性的扩增产物进行测序和序列分析,同时对采集病例的流行病学资料进行统计分析.结果 521份标本用RT-PCR方法检测后,共有39份标本为N基因阳性,检出率为7.49%,hMPV发病高峰期在10月和4月份,对N基因进行序列测序与分析,结果与北京株BJ1897N基因的同源性高达99%,与泰国AY550156株N基因的同源性高达97%,基因型别以B型为主.结论 广州地区的儿童急性呼吸道感染中hMPV感染是原因之一,且以6岁以下的儿童感染为主,但不同性别的感染率差异无统计学意义,感染hMPV的临床症状主要表现为:高热、咳嗽、头痛、咽痛、卡他症状、肺部影像学改变等,其中大部分患者表现有高热和咳嗽,且有41.03%的hMPV患者合并感染其他呼吸道病毒.     

长沙地区急性下呼吸道感染儿童呼吸道合胞病毒、偏肺病毒临床特征及流行状况分析

目的了解长沙地区急性下呼吸道感染（ALRTI）儿童呼吸道合胞病毒（RSV）及人偏肺病毒（hMPV）的流行病学特点和临床特征。方法收集2007年9月-2008年8月湖南省人民医院儿科医学中心1 165例ALRTI住院儿童鼻咽抽吸物样本,进行RSV及hMPV基因检测。对RSV和hMPV感染患儿流行病学特点、临床表现及实验室检查结果等进行比较。结果 1 165例样本检出RSV阳性标本315例,检出率为27.04%,1岁以下患儿占64.1%;hMPV阳性76例,检出率为6.52%,1岁以下患儿占63.15%;RSV感染全年均有发生,第一年11月到次年2月份为检出高峰,hMPV的检出高峰在3-4月;RSV感染病例气促的发生率高于hMPV感染病例（P〈0.05）,发热、喘息、呕吐、腹泻的发生率两种病毒间差异无统计学意义（P〉0.05）;RSV、hMPV感染病例白细胞、C-反应蛋白、转氨酶及心肌酶等实验室指标变化比较差异无统计学意义（P〉0.05）;影像学检查同以散在肺部实变或间质病变为主,鲜有累及大片肺叶及胸膜。14例患儿同时存在RSV及hMPV感染,混合感染率1.20%（14/1 165）。RSV及hMPV协同感染患儿发绀几率较单一RSV感染患儿高（P〈0.05）,白细胞升高几率大于单一感染者（P〈0.05）,而喘息、气促、呕吐、腹泻发生率及C-反应蛋白、转氨酶、心肌酶等实验室检测指标变化与单一RSV或hMPV感染比较差异无统计学意义（P〉0.05）;单一hMPV感染患儿的发热率高于单一RSV感染或两者协同感染患儿（P〈0.05）。单一感染和协同感染病例间病程、住院天数及预后比较差异无统计学意义（P〉0.05）。结论 RSV及hMPV均是引起长沙地区婴幼儿下呼吸道感染的重要病原,流行季节相近,具有相似的临床特征及影像改变,临床上难以鉴别。RSV感染较hMPV感染患儿更易发生气促,而hMPV感染则相对更易出现发热症状。混合hMPV感染可能有加重RSV感染患儿呼吸道症状的趋势。     

2009年至2010年湖南地区儿童呼吸道人偏肺病毒及其他病毒感染的检测结果报告

目的 了解人类偏肺病毒(hMPV)在湖南地区小儿呼吸感染系统感染中的感染情况,分析其流行病学特点.方法 选取2009年2月至2010年5月湖南省儿童医院1355例呼吸道感染住院患儿,采用直接免疫荧光法(DFA)进行hMPV检测,并结合其他7种常见呼吸道病毒感染的情况对其流行特征进行分析和探讨.结果 1355份标本共检测出hMPV阳性标本226份,检出率为16.7%;检测出其他病毒阳性标本289份,检出率为21.3%:检测出混合感染的阳性标本54份,检测出率为4.0%两性儿童、不同年龄段、不同季节hMPV检出情况P＞0.05,统计学差异无意义;感染hMPV患儿确诊肺炎捡出率为58.8%,P＜0.05,统计学差异有意义;不同年龄段、不同季节其他病毒检出情况P＜0.05,统计学差异有意义;不同年龄段混合感染检出情况P＞0.05,统计学差异无意义;不同季节混合感染检出情况P＜0.05.统计学差异有意义.结论 2009年至2010年度儿童感染hMPV的可能性与性别,年龄和季节均无关;感染hMPV患儿临床诊断结果主要是肺炎;其他病毒感染儿童有一定的年龄针对性和季节流行性;混合感染多发于秋季,春季比较少见.     

徐州市急性呼吸道感染儿童中人偏肺病毒感染状况研究

目的 了解徐州市因急性呼吸道感染而就诊的儿童中hMPV感染情况,并简要描述病毒感染后引起的临床症状.方法 采集咽拭子,提取RNA,用设计的引物进行一步法RT-PCR,扩增产物用琼脂糖凝胶电泳检测.结果 83份咽拭子标本,21份标本为hMPV的RNA阳性标本,感染率25.30%.阳性患者中80.95%表现为高热(≥38.5℃)、咳嗽,28.57%缺氧,61.90%患者被诊断为支气管炎.结论 徐州地区儿童中的急性呼吸道感染与hMPV感染有关;咳嗽、发热是hMPV感染后的主要临床症状.     

北京地区2004-2006年婴幼儿急性呼吸道感染中人偏肺病毒感染的研究

目的了解北京地区急性呼吸道感染婴幼儿中人偏肺病毒（hMPV）的感染情况。方法采集2004年7月至2006年6月首都儿科研究所附属儿童医院门诊和住院呼吸道感染患儿的咽拭子和鼻咽洗液临床标本3330份，进行细胞培养和间接免疫荧光检测病毒；同时提取标本中病毒RNA后经逆转录聚合酶链反应扩增位于hMPVM基因的片段，经琼脂糖凝胶电泳检测扩增片段。结果从3330份临床标本中检测到110份hMPV阳性标本，阳性率3．3％。hMPV感染的患儿男女比例为1．5：1，其中〈1岁年龄组患儿占46．4％（51／110），1～岁年龄组患儿占11．8％（13／110），2～5岁年龄组患儿占33．6％（37／110），〉5岁年龄组患儿占8．2％（9／110）。hMPV感染患儿的临床症状以肺炎占的比例最大，为44．5％（49／110）；其次是诊断为上呼吸道感染（22．7％，25／110）；诊断为毛细支气管炎的占10．9％（12／110），其中诊断支气管炎占7．3％（8／110）。2004年7月至2005年6月期间几乎每个月份（除2005年5月和6月）都检出hMPV感染的阳性标本，未出现明显的流行高峰。而2005年7月至2006年6月期间hMPV出现了较为明显的流行，于2006年4月为最高峰，阳性检出率为17．1％。110例hMPV感染的临床标本中有6份标本存在与其他呼吸道病毒的合并感染。hMPV和同期的人呼吸道合胞病毒的感染高峰没有重叠。结论hMPV是北京地区婴幼儿急性呼吸道感染（尤其是下呼吸道感染）的重要病毒病原之一，其感染对2岁以下婴幼儿威胁更大。     

嘉兴地区住院婴幼儿感染人偏肺病毒的研究

目的了解人偏肺病毒(hMPV)和合胞病毒(RSV)在嘉兴地区的流行情况及感染的人群分布。方法收集医院2008年12月-2009年12月因急性呼吸道感染入院治疗的患儿共计3359例,用实时定量PCR和直接免疫荧光(DFA)法对样本进行检测。结果 3359例样本中hMPV阳性63例,RSV阳性494例,在整个季节中hMPV的阳性率为1.88%,RSV为14.7%;流行季节hMPV最高感染率为6.14%,RSV为41.15%;感染的人群中6月龄婴幼儿的患病率最高,其hMPV的感染率为2.71%,RSV为24.69%。结论 hMPV和RSV在嘉兴地区按一定的时段流行,并且易感6月龄的婴幼儿。     

粤东地区小儿呼吸道感染病原中首次检出人类偏肺病毒

目的分析人类偏肺病毒(hMPV)在粤东地区的感染情况及所致疾病的临床特点。方法(1)应用TemPCR技术对120例呼吸道感染患儿的鼻咽分泌物扩增多种病原体,并应用多重荧光微球技术检测hMPV等病毒核酸;(2)分析hMPV感染患儿的临床资料。结果120份标本中hMPV阳性6份(5%),占常见病毒阳性者的24%,占100例其他常见呼吸道病毒检测阴性患儿的6%。6株hMPV特异性核酸扩增片段核酸测序结果与GenBank中人类偏肺病毒AF371337(NL00-1)株的基因同源性>95%。6例hMPV阳性患儿中,临床表现为毛细支气管炎4例、喘息型肺炎1例、上呼吸道感染1例。结论hMPV是粤东地区小儿呼吸道感染的重要病毒性病原体之一,其感染主要引起小儿喘息性疾病。     

上海地区人偏肺病毒致儿童急性下呼吸道感染的分子流行病学研究

目的 建立可靠的TaqMan-MGB实时荧光RT-PCR方法 ,检测临床样本中人偏肺病毒(hMPV)N基因,以了解2006年10月至2008年2月期间上海地区hMPV致儿童急性下呼吸道感染(ALRTI)的临床与分子流行病学特点.方法 为了明确hMPV在儿童ALRTI中的地位,用直接免疫荧光方法 检测呼吸道合胞病毒(RSV),腺病毒,A、B型流感病毒,1、2和3型副流感病毒7种儿童常见呼吸道病毒抗原,结合肺炎支原体、沙眼衣原体荧光定量PCR检测结果 及细菌学培养结果 进行分析.结果 2006年10月至2008年2月上海地区ALRTI儿童鼻咽分泌物中hMPV的检出率为3.86%(24/622),2006-2007年冬季和2007-2008年冬季检出率分别为6.60%(14/212)和1.11%(2/180);hMPV致儿童ALRTI以＜5岁儿童多见.该期间上海地区hMPV仅见A2亚型株流行.呼吸道病毒是上海地区儿童ALRTI主要病原,在儿童ALRTI中hMPV感染可能仅次于RSV,是常见的呼吸道病毒.结论 hMPV是上海地区儿童ALRTI的重要病原体.     

免疫荧光法研究桐乡地区婴幼儿呼吸道偏肺病毒感染

目的研究桐乡地区婴幼儿急性呼吸道感染患者中偏肺病毒(hMPV)感染及临床意义。方法采用免疫荧光法,对2008年8月-2009年7月收集的431例急性呼吸道感染婴幼儿的呼吸道分泌物标本进行hMPV抗原检测;同时检测呼吸道合胞病毒(RSV)等其他常见呼吸道病毒的感染情况。结果 431份标本中检测到hMPV阳性68例,阳性率为15.78%;68例中临床诊断为肺炎者38例,占55.88%。结论 hMPV为桐乡地区婴幼儿急性呼吸道感染的重要病原体,冬季高发,春秋两季发病率也较高;hMPV感染易发展为肺炎等较重病症,在临床上应引起高度重视。     

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.