成人社区获得性肺炎患者分离的肺炎支原体对大环内酯类药物耐药性和机制研究

目的了解本地区成人社区获得性肺炎(CAP)患者分离的肺炎支原体(MP)对大环内酯类药物耐药性和机制。方法收集273例CAP患者呼吸道样本进行MP分离培养,测定MP对3种大环内酯类药物的最低抑菌浓度(MICs),巢式PCR扩增MP临床菌株23SrRNA基因片段并测序,分析23SrRNA基因2063和/或2064 A→G点突变与大环内酯类药物耐药相关性。结果 273例样本,MP阳性45例,阳性率为16. 5%,不同性别MP感染阳性率差异无统计学意义(P0. 05)。18株MP对3种大环内酯类药物均敏感,目的基因均无突变发生,26株至少对一种大环内酯类药物耐药。18株对3种大环内酯类抗生素均敏感和1株只对红霉素耐药(MIC=1μg/ml)的菌株均无突变发生。1株对3种大环内酯类药物均耐药的菌株存在A2064G突变,其余25株至少对2种大环内酯类抗生素耐药株均发生A2063G突变。结论肺炎支原体对大环内酯类药物耐药严重,耐药机制是23S rRNA基因2063和/或2064 A→G点突变。     

肺炎支原体耐大环内酯类抗菌药物分子机制的初步研究

目的 了解肺炎支原体(MP)耐大环内酯类抗菌药物情况及主要的耐药机制.方法 从32例因MP引起呼吸道感染的患儿取咽拭子,采用改良Hayflick培养基分离培养;运用药物敏感试验筛选耐大环内酯类抗菌药物的耐药株;聚合酶链反应(PCR)扩增结合序列测定分析耐药分子机制.结果 32份标本培养成功19份;药敏结果显示19株MP临床分离株中有15株耐药,占78.9%,而且一旦对其中1种药物耐药,对其他大环内酯类抗菌药物也均呈耐药性;敏感株和标准株FH的测序结果完全相同,15株耐药株23S rRNAV区均出现了A2063G的点突变,其中有2株为敏感株和耐药株共生.结论 MP对大环内酯类抗菌药物耐药现状严重,其主要的耐药机制为23S rRNAV区产生点突变.     

吉林地区儿童肺炎支原体耐药状况检测分析

目的了解吉林地区支原体肺炎患儿耐大环内酯类抗菌药物状况及探讨可能存在的耐药机制。方法收集来本院就诊的1 272例0岁~15岁急性呼吸道感染患儿的咽拭子标本。进行支原体快速培养与药敏试验;抽取耐红霉素的支原体培养液100例提取DNA,进行16S rRNA基因PCR扩增;抽取16S rRNA基因PCR扩增阳性标本30例进行23S rRNA基因PCR扩增、琼脂糖凝胶电泳、回收目的片段测序,测序结果与Gen Bank已登录的肺炎支原体标准株(M129)23S rRNA基因进行比对。观察其有无耐药基因位点的突变。结果吉林地区呼吸道感染的患儿肺炎支原体快速鉴定培养阳性率为35.30%;肺炎支原体耐药率最高的是红霉素(61.1%);耐药肺炎支原体19株的分子机制均为23S rRNA结构域V区2063位点A-G的突变。结论首次证明吉林地区耐药肺炎支原体的分子机制为23S rRNA结构域V区2063位点AG的突变。     

肺炎支原体大环内酯类药物耐药机制研究

目的了解本地区儿童肺炎支原体(MP)的感染及大环内酯类耐药基因(23S rRNA)突变与耐药的相关性。方法收集614例肺炎患儿呼吸道样本,实时荧光定量PCR(RT-PCR)检测MP感染及23S rRNA基因2063和/或2064 A→G点突变情况,对MP阳性样本进行药敏试验,分析23S rRNA基因2063和/或2064 A→G点突变与大环内酯类药物耐药相关性。结果 614例样本,MP阳性77例,阳性率为12.5%,其中59例23S rRNA存在2063和/或2064A→G点突变,突变发生率为76.6%。所有突变株对对5种大环内酯类药物均不敏感,所有未突变株5种大环内酯类药物均敏感。结论肺炎支原体对大环内酯类药物耐药严重,耐药机制是23S rRNA基因2063和/或2064 A→G点突变,RT-PCR检测MP感染及23S rRNA基因点突变能为肺炎患儿临床MP感染的诊断和治疗提供一定的参考依据。     

小儿肺炎支原体感染耐药情况回顾分析

目的 了解2015-2016年北京地区儿童肺炎支原体(MP)耐药情况及耐药机制分析。方法 采集2015-2016年首都医科大学附属北京朝阳医院儿科收治的,具有发热、咳嗽或咽痛等呼吸道感染症状之一的,门诊和住院的89例患儿的呼吸道咽拭子标本,进行MP 培养与药敏试验,采用巢式PCR扩增法鉴定MP 耐药位点。结果 53例MP阳性,感染率为59%,18株为敏感株,耐药率66%,32株存在23S rRNA 结构域Ⅴ区A2063G 点突变。3株2063、2064位点均有突变。结论 北京地区肺炎支原体感染率高,对大环内酯类抗生素耐药率上升趋势,耐药机制主要为23S rRNA 结构域Ⅴ区点突变。     

生殖支原体耐药现状及机制

生殖支原体对四环素类、大环内酯类、氟喹诺酮类药物均已出现耐药,且耐药率逐年增加,甚至出现了多重耐药的现象。大环内酯类药物的耐药主要由23S rRNA单碱基突变所致,氟喹诺酮类耐药与 parC、 gyrA、 gyrB、 parE突变相关,四环素类药物的耐药机制尚不明确。生殖支原体耐...     

肺炎链球菌对大环内酯类抗菌药物耐药机制的研究

目的 调查烟台地区肺炎链球菌对抗菌药物的敏感性,研究烟台地区肺炎链球菌对大环内酯类抗菌药物耐药机制.方法 收集社区和临床分离的肺炎链球菌.根据美国临床实验室标准化研究所/美国临床实验室标准化委员会(CLSI/NCCLs)的推荐,用K-B法、Etest法检测肺炎链球菌对青霉素等11种抗菌药物的耐药性及对大环内酯类抗菌药物的耐药表型;用聚合酶链反应(PCR)扩增耐药基因ermB和mefE基因.结果 42株肺炎链球菌中25株对青霉素低度耐药(65.0%),无对青霉素高度耐药株;肺炎链球菌对大环内酯类和克林霉索表现出极高的耐药率,对红霉素和克林霉素耐药率为98.0 %和93.0%;42株肺炎链球菌中40株检测到ermB基因、1株检测剑mefE基因,其中9株菌同时检测到ermB和mefE基因.结论 烟台地区对青霉素不敏感肺炎链球菌检出率高;对红霉素和克林霉素近乎全部耐药,ermB基因介导的靶位改变是烟台地区肺炎链球菌对大环内酯类抗菌药物的主要耐药机制.     

社区获得性支原体肺炎的临床研究

目的探讨肺炎支原体急性感染致社区获得性肺部感染成年患者的临床特征及其耐药性。方法选取医院2014年1月-2016年7月收治的502例社区获得性肺部感染(CAP)成年患者为研究对象,根据是否感染肺炎支原体(MP)分为MP感染组和非MP感染组,对两组患者的临床资料及影像学特点进行比较分析。结果 502例CAP患者中共检出MP感染患者170例(MP感染组),MP感染率为33.86%;MP感染组和非MP感染组患者在白细胞计数(WBC)、淋巴细胞比例(LY%)、中性粒细胞比例(NEUT%)、血红蛋白浓度(HB)等指标无明显差异;MP感染组感染部位位于左中下肺叶的患者明显多于非MP感染组患者,差异有统计学意义(P<0.05);MP感染组对抗菌药物的敏感性以四环素类最高,其次为喹诺酮类,大环内酯类最低,其中以强力霉素(92.35%)敏感性最佳。结论 MP感染所致CAP成年患者在临床上多具有纵隔淋巴结肿大的影像学特征,由于该类患者对于不同抗菌药物存在不同程度的耐药性,因此建议临床治疗考虑首选四环素类抗菌药物进行治疗。     

社区获得性支原体肺炎的临床研究北大核心CSCD

目的探讨肺炎支原体急性感染致社区获得性肺部感染成年患者的临床特征及其耐药性。方法选取医院2014年1月-2016年7月收治的502例社区获得性肺部感染(CAP)成年患者为研究对象,根据是否感染肺炎支原体(MP)分为MP感染组和非MP感染组,对两组患者的临床资料及影像学特点进行比较分析。结果 502例CAP患者中共检出MP感染患者170例(MP感染组),MP感染率为33.86%;MP感染组和非MP感染组患者在白细胞计数(WBC)、淋巴细胞比例(LY%)、中性粒细胞比例(NEUT%)、血红蛋白浓度(HB)等指标无明显差异;MP感染组感染部位位于左中下肺叶的患者明显多于非MP感染组患者,差异有统计学意义(P<0.05);MP感染组对抗菌药物的敏感性以四环素类最高,其次为喹诺酮类,大环内酯类最低,其中以强力霉素(92.35%)敏感性最佳。结论 MP感染所致CAP成年患者在临床上多具有纵隔淋巴结肿大的影像学特征,由于该类患者对于不同抗菌药物存在不同程度的耐药性,因此建议临床治疗考虑首选四环素类抗菌药物进行治疗。     

儿童肺炎链球菌对大环内酯类抗生素的耐药性及相关基因研究

目的:研究介导肺炎链球菌临床分离株耐大环内酯类药物的相关基因。方法:选自儿童感染的32株耐红霉素肺炎链球菌,以PCR检测大环内酯类耐药基因ermB、mefA、mefE。结果:32株肺炎链球菌耐药基因ermB占93.7%,mefE占6.3%,未检出mefA。结论:ermB编码23SrRNA甲基化酶致靶位改变是肺炎链球菌对大环内酯类抗生素耐药的主要机制,大环内酯类抗生素已不是治疗肺炎链球菌的有效药物。     

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.