Efficacy of selected hand hygiene agents used to remove Bacillus atrophaeus (a surrogate of Bacillus anthracis) from contaminated hands

Context  The intentional use of Bacillus anthracis transmitted via the US mail in October-November 2001 resulted in 22 people developing inhalation or cutaneous anthrax. Glove use with handwashing prior to and after contact with potential contaminated environmental surfaces and cutaneous lesions has been recommended. However, only limited data are available on the susceptibility of B anthracis to antiseptics. Objective  To evaluate the efficacy of several hand antiseptics (interventions) and soap and water (control) against Bacillus atrophaeus, a surrogate of B anthracis. Design, Setting, and Participants  Challenge study conducted among healthy adult volunteers, using the Standard Test Method for Evaluation of the Effectiveness of Health Care Professional Handwash Formulations (American Society for Testing and Materials E 1174-94) to determine the efficacy of various hand hygiene products at wash times of 10, 30, and 60 seconds. Volunteers were excluded if they had eczema, psoriasis, or other chronic skin conditions; nonintact skin; or allergies to any study agent. Study agents were a waterless rub containing 61% ethyl alcohol, a 2% chlorhexidine gluconate preparation, and an antibacterial microfiber towel that releases hypochlorite. A nonantimicrobial soap was used as a control. Main Outcome Measure  Reduction of B atrophaeus spores (log₁₀ CFU/mL) on contaminated hands. Results  Washes of 10, 30, and 60 seconds with either soap and water or 2% chlorhexidine gluconate eliminated 1.5 to 2.0 log₁₀ CFUs/mL of B atrophaeus spores at wash 3. Mean reductions (95% confidence intervals) with 10-, 30-, and 60-second washes with soap and water were 2.4 (2.2-2.5), 2.3 (2.2-2.4), and 2.1 (1.9-2.4) log₁₀ CFUs/mL, respectively; and with 2% chlorhexidine gluconate, 2.1 (2.0-2.3), 1.8 (1.5-2.0), and 1.7 (1.5-1.9) log₁₀ CFUs/mL, respectively. Handwashing with chlorine-containing towels was increasingly effective as the wipe time increased; reductions at 10, 30, and 60 seconds were 1.3 (1.1-1.5), 1.6 (1.2-2.0), and 2.2 (2.1-2.2) log₁₀ CFUs/mL, respectively. A waterless rub containing 61% ethyl alcohol was ineffective in eliminating B atrophaeus spores at all times tested (0 [-0.1 to 0.1], -0.2 [-0.3 to -0.1], and 0 [-0.2 to 0.2] log₁₀ CFUs/mL). Conclusions  In this evaluation of hand hygiene agents, handwashing with soap and water, 2% chlorhexidine gluconate, or chlorine-containing towels reduced the amount of B atrophaeus spore contamination, whereas use of a waterless rub containing ethyl alcohol was not effective in removing spores.      

炭疽芽孢DNA适配子结构与长度对亲和力的影响

目的 研究炭疽芽孢适配子结构与长度变化对其与芽孢之间亲和力的影响。方法 人工合成f77-1适配子序列，并构建在其7条突变体序列，将这些寡核苷酸序列分别与炭疽芽孢结合，利用TMB显色系统判断读取吸光度A值，确定各序列与芽孢间亲和力大小；同时通过核酸序列分析软件包模拟各序列的二级结构，推断适配子的结构与亲和力之间的关系。结果 适配子f77-1与突变体中的f77-3与芽孢亲和力较好，约是突变体中f77-4亲和力的11倍，二级结构显示：f77-1,f77-3都具有茎环或发卡结构，且3'端都有连续3个G。结论 适配子5'端的茎环结构和发卡结构是这些寡核苷酸序列与芽孢结合的结构基础，3'端的连续3个G可能对提高亲和力起着重要的作用。     

One-year health assessment of adult survivors of Bacillus anthracis infection

Context  Little is known about potential long-term health effects of bioterrorism-related Bacillus anthracis infection. Objective  To describe the relationship between anthrax infection and persistent somatic symptoms among adults surviving bioterrorism-related anthrax disease approximately 1 year after illness onset in 2001. Design, Setting, and Participants  Cross-sectional study of 15 of 16 adult survivors from September through December 2002 using a clinical interview, a medical review-of-system questionnaire, 2 standardized self-administered questionnaires, and a review of available medical records. Main Outcome Measures  Health complaints summarized by the body system affected and by symptom categories; psychological distress measured by the Revised 90-Item Symptom Checklist; and health-related quality-of-life indices by the Medical Outcomes Study 36-Item Short-Form Health Survey (version 2). Results  The anthrax survivors reported symptoms affecting multiple body systems, significantly greater overall psychological distress (P<.001), and significantly reduced health-related quality-of-life indices compared with US referent populations. Eight survivors (53%) had not returned to work since their infection. Comparing disease manifestations, inhalational survivors reported significantly lower overall physical health than cutaneous survivors (mean scores, 30 vs 41; P = .02). Available medical records could not explain the persisting health complaints. Conclusion  The anthrax survivors continued to report significant health problems and poor life adjustment 1 year after onset of bioterrorism–related anthrax disease.      

炭疽杆菌保护性抗原基因芯片探针的制备

目的快速制备炭疽杆菌保护性抗原基因芯片探针。方法根据PubMed上公布的炭疽杆菌保护性抗原的DNA序列设计引物,扩增保护性抗原基因。利用酶切、AT克隆方法快速分析筛选出保护性抗原基因片段的重组子,从而制备成芯片探针。DNA自动分析仪对克隆片段进行序列测定,生物信息学软件对其基因序列进行分析。结果根据炭疽杆菌保护性抗原设计的引物,可以扩增出长2 205 bp的保护性抗原基因,经酶切、AT克隆方法筛选出约7个长度不一的片段,对其片段进行序列测定并进行Blast序列比对得知这些片段均属于炭疽杆菌保护性抗原基因。结论利用PCR扩增产物并结合酶切、AT克隆方法可以快速、简便地制备基因芯片探针。     

炭疽杆菌保护性抗原基因芯片探针的制备

目的 快速制备炭疽杆菌保护性抗原基因芯片探针。方法 根据PubMed上公布的炭疽杆菌保护性抗原的DNA序列设计引物，扩增保护性抗原基因。利用酶切、AT克隆方法快速分析筛选出保护性抗原基因片段的重组子，从而制备成芯片探针。DNA自动分析仪对克隆片段进行序列测定，生物信息学软件对其基因序列进行分析。结果根据炭疽杆菌保护性抗原设计的引物，可以扩增出长2205bp的保护性抗原基因，经酶切、AT克隆方法筛选出约7个长度不一的片段，对其片段进行序列测定并进行Blast序列比对得知这些片段均属于炭疽杆菌保护性抗原基因。结论 利用PCR扩增产物并结合酶切、AT克隆方法可以快速、简便地制备基因芯片探针。     

Secondary and tertiary palliative care in US hospitals

Charles F. von Gunten, MD,PhD

JAMA. 2002;287:875-881.

Palliative care services provide secondary and tertiary levels of palliative care, the interdisciplinary care of patients in which the goal is comfort and quality of life. Primary palliative care refers to the basic skills and competencies required of all physicians and other health care professionals. Secondary palliative care refers to the specialist clinicians and organizations that provide consultation and specialty care. Tertiary palliative care refers to the academic medical centers where specialist knowledge for the most complex cases is practiced, researched, and taught. The case of Reverend J, a man with advanced cancer admitted to an acute palliative care unit in a teaching hospital, illustrates the use of secondary and tertiary clinical palliative care services in hospitals and health care systems.

     

抗炭疽PA15单克隆抗体的制备及免疫学检测方法的建立

目的:制备抗炭疽保护性抗原15(protective antigen,PA15)单克隆抗体,初步建立双抗体夹心ELISA检测炭疽感染者血清中的保护性抗原?方法:以纯化的PA63蛋白为免疫原免疫小鼠,利用杂交瘤技术制备单克隆抗体,SDS-PAGE电泳检测抗体纯度,间接ELISA?Western blot?免疫沉淀(IP)和蛋白质谱分析单抗特异性,并建立双抗体夹心ELISA检测方法?结果:制备了2株抗PA15单克隆抗体,命名为3D7和8E9?SDS-PAGE电泳可见抗体的重链和轻链,间接ELISA?Western blot发现单抗3D7和8E9可与PA15?PA63特异性结合,IP和蛋白质谱分析发现单抗3D7可与PA83特异性结合,双抗体夹心ELISA方法检测炭疽感染血清中保护性抗原的最低检出浓度为16 ng/ml?结论:成功制备了抗PA15单克隆抗体,并建立了双抗体夹心ELISA方法检测炭疽感染血清中的保护性抗原?     

圆弧青霉提取物对枯草杆菌芽胞DNA重组效应

从河南食管癌高发区林县粮食中分离出24株圆弧青霉,采用Raulin-Thom液体培养基培养,经三氯甲烷萃取后得棕黄色粉末状提取物。用枯草杆菌芽胞DNA重组试验检测其重组效应。结果表明:不加(S-9)活化系统16株提取物为阳性(64%),加S-9后24株皆为阴性,提示提取物中含有直接诱变物。     

Deposition in the respiratory tract of cattle of spores of Bacillus subtilis var niger by inhalation and by nasal instillation

Spores of Bacillus subtilis var niger were deposited in the lungs, tracheae and nasal cavities of four calves by aerosol inhalation and in three calves by intranasal instillation. From each calf 20 specimens of lung tissue, each weighing one gm, three of trachea and three of nasal mucosa were examined for spore content. The average numbers of spores per gm of lung tissue from animals exposed to aerosols were 3.05 and 4.84, 2.35 and 2.02 x 10(4). Lungs from animals exposed intranasally contained only 747, 62 and 1424 spores per gm of tissue respectively. Animals exposed intranasally had a hundred to a thousand fold more spores on nasal mucosa than animals exposed by aerosol and the latter had a thousand fold more spores on tracheal mucosa than calves exposed intranasally. Aerosol inhalation exposed the lung and trachea more densely and uniformly than did intranasal instillation.     

枯草杆菌二联活菌肠溶胶囊、马来酸曲美布汀联合盐酸氟西汀治疗肠易激综合征疗效观察

目的:观察枯草杆菌二联活菌肠溶胶囊、马来酸曲美布汀联合盐酸氟西汀治疗肠易激综合征的疗效及不良反应。方法:102例肠易激综合征患者随机分成四组,A组26例,用美常安加马来酸曲美布汀加盐酸氟西汀治疗;B组26例用美常安治疗;C组25例,用马来酸曲美布汀治疗;D组25例,用美常安加马来酸曲美布汀。4周后对四组进行疗效比较。结果:A组总有效率为88.5%,B组总有效率为65.4%,C组总有效率为68.0%,D组总有效率为76.0%;A组与B组、C组、D组比较,总有效率差异有统计学意义(P<0.05),B组与C组相比,总有效率差异无统计学意义。D组与B组及C组比较,总有效率差异有显著性(P<0.05);四组患者均未发现明显的不良反应。结论:美常安、马来酸曲美布汀联合盐酸氟西汀治疗肠易激综合征疗效确切,无明显不良反应。     

全氟化碳联合沐舒坦雾化吸入对兔急性肺损伤的影响

目的 观察雾化吸入全氟化碳(perfluorocarbon,PFC)及盐酸氨溴素(商品名沐舒坦)对兔急性肺损伤肺组织病理改变、气体交换、TNF-α mRNA及抗氧化方面的影响.方法 用油酸制备兔急性肺损伤(acute lung injury,ALI)模型后,将动物随机分为4组:常规机械通气(A)组、全氟化碳(B)组、沐舒坦(C)组,联合治疗(D)组.分别在ALI前、ALI及ALI后1、2、3、4 h共6个时点观察动脉血气指标的变化,实验结束后取6个不同部位的肺组织做病理切片,取2个不同部位的肺组织做TNF-α mRNA原位杂交,肺组织匀浆检测丙二醛(MDA).结果 D组PaO2及肺静态顺应性(static lung compliance,CLst)高于A组,与B组比较无差异(P＞0.05);D组病理改变轻于A组,原位杂交提示D组TNF-α mRNA原位表达低于A组和B组,自身比较结果显示:背侧肺叶TNF-α mRNA表达高于腹侧肺叶(P＞0.05).D组肺组织匀浆MDA低于A组和B组(P＜0.05).结论 PFC联合沐舒坦雾化吸入能明显改善实验兔ALI肺氧合能力,升高PaO2,改善肺静态顺应性,减少肺组织中的TNF-α mRNA表达及自由基的损害.