多发性骨髓瘤患者化疗后医院感染病原菌分布及危险因素分析

目的 探讨多发性骨髓瘤(MM)患者化疗后医院感染病原菌种类及其危险因素,以降低感染率。方法 回顾性分析2010年3月-2013年3月80例多发性骨髓瘤患者临床资料,分析感染部位、感染病原菌种类以及化疗后感染影响因素。结果 80例患者中有21例化疗后发生感染,感染率为26.25%;其中感染部位主要是消化系统占42.85%,其次呼吸道、泌尿系统,分别占23.81%、19.05%;共分离出病原菌23株,其中革兰阳性菌5株占21.73%,革兰阴性菌16株占69.57%,革兰阳性菌中以金黄色葡萄球菌为主占13.03%,革兰阴性菌中以大肠埃希菌为主占26.09%;多因素分析显示,BMI高(β=3.085,OR=21.854)、Dukes分期高(β=3.189,OR=24.247)、合并有糖尿病(β=2.671,OR=25.221)是MM患者化疗后感染的影响因素。结论 多发性骨髓瘤患者化疗后容易导致各种病原菌感染,临床上需要加强患者的风险评估,对于合并有糖尿病、临床症状严重以及肥胖的患者应采取有效的预防和控制感染手段。     

多发性骨髓瘤患者存活期的危险因素分析

目的分析影响多发性骨髓瘤患者存活期的危险因素。方法回顾性分析我院2014年12月-2017年12月间收治的153例MM患者的临床资料,排除随访丢失者后,共纳入140例MM患者,根据生存期分为预后不良组(生存时间≤1年,n=42)与预后良好组(生存时间1年,n=98),分析两组性别、发病年龄、ISS分期、费用自付占比等一般资料以及血红蛋白、血小板、血清白蛋白、血肌酐、血β2微球蛋白(β2-MG)、血清钙、kappa轻链及骨病分级等实验室检查指标,分析影响MM患者生存期的独立危险因素。结果单因素分析显示,组间性别无差异(P0.05),发病年龄、ISS分期、费用自付占比、血红蛋白、血小板、血清白蛋白、血清肌酐、血β2-MG、血清钙、血清kappa轻链及骨病分级间均存在明显差异(P0.05);多因素Logistic回归分析显示,发病年龄≥60岁、血清肌酐≥353.6μmol/L、血β2-MG≥3.5 mg/L以及kappa轻链≥19.4 mg/L均是影响MM患者生存期的独立危险因素。结论 MM患者临床表现复杂,生存期差异明显,而年纪越大、血清肌酐、血β2-MG及kappa轻链水平越高,生存期越短。     

多发性骨髓瘤老年患者化疗后感染因素分析与对预后的影响

目的探讨初治多发性骨髓瘤(MM)老年患者化疗后感染的临床特点、易感因素及对预后的影响,以降低感染率。方法对2000年2月-2013年3月85例初治老年MM患者化疗后感染的临床资料进行回顾性分析,所有数据采用SPSS 13.0软件进行统计分析。结果患者化疗后感染45例,感染率为52.9%;64.4%的感染发生于第一个疗程后,PD方案与传统化疗方案相比感染率差异无统计学意义;感染部位以呼吸道感染最多见;36例患者检出病原菌52株,其中革兰阴性杆菌占44.2%、革兰阳性球菌占19.2%、真菌占36.6%;肾功能不全、低白蛋白血症、粒细胞减少、ECOG评分≥3分为感染的易感因素。结论老年多发性骨髓瘤患者是化疗后感染的高危人群,感染后生存期短、早期病死率高,化疗期间需加强免疫保护。     

肝硬化腹水合并自发性细菌性腹膜炎的病原学及危险因素分析

目的探讨肝硬化腹水合并自发性细菌性腹膜炎(SBP)的病原学特点及危险因素。方法回顾性分析医院2012年1月-2015年6月收治124例肝硬化腹水并发SBP患者的临床资料,对患者的临床表现、实验室病原学检查结果,同时对所有患者的临床病理因素采用Logistic回归分析,分析其发病的危险因素。结果患者主要表现包括发热、腹胀、腹痛;124例患者中共有81例细菌培养结果为阳性,阳性率为65.32%,共检出病原菌88株,其中革兰阳性55株占62.50%,革兰阴性菌31株占35.23%,真菌2株占2.27%;对患者的性别、年龄、临床表现、是否合并有消化道出血、血常规WBC水平、腹水常规WBC水平、白蛋白水平进行统计分析,经单因素分析,血清白蛋白、腹水WBC、腹水白蛋白以及伴有消化道出血与SBP发生具有密切的关系(P<0.05);经过Logistic多因素回归分析结果显示,消化道出血和腹水蛋白是肝硬化腹水患者并发SBP的独立危险因素(P<0.05)。结论肝硬化腹水合并自发性细菌性腹膜炎患者主要为革兰阳性菌感染导致,其中表皮葡萄球菌感染较为多见,患者腹水蛋白≤10g/L和消化道出血是发病的独立危险因素。     

糖尿病合并多发性骨髓瘤患者化疗后感染的病原菌分布及其影响因素

目的 探讨糖尿病合并多发性骨髓瘤患者化疗后感染的病原菌分布及影响因素。方法 选取2020年4月至2022年5月本院收治的糖尿病合并多发性骨髓瘤患者68例。收集患者的人口学特征、体质量指数、住院时间、疾病完全缓解情况、治疗过程中是否有侵入性操作、白蛋白水平、空腹血糖、Durie-Salmon分期;记录患者化疗后感染情况、感染部位、病原菌种类,分析影响因素。结果 68例糖尿病合并多发性骨髓瘤患者中有19例(27.94%)化疗后发生感染,共培养并分离出病原菌20株;其中革兰氏阴性菌14株(70.00%),革兰氏阳性菌6株(30.00%)。体质量指数≥24 kg/m²、住院时间≥30 d、未疾病完全缓解、白蛋白<30 g/L、空腹血糖≥7.0 mmol/L的糖尿病合并多发性骨髓瘤患者化疗后感染率明显高于体质量指数<24 kg/m²、住院时间<30 d、疾病完全缓解、白蛋白≥30 g/L、空腹血糖<7.0 mmol/L的患者,差异均有统计学意义(均P<0.01);随着Durie-Salmon分期的增加糖尿病合并多发性骨髓瘤...     

乳腺癌患者术后切口感染的病原菌特征及其危险因素分析

目的 分析乳腺癌患者术后切口感染的病原菌特征及其危险因素。方法 采用方便抽样法抽取2018年6月至2022年10月兰州市某医院收治进行改良根治术后乳腺癌患者作为研究对象进行切口感染情况的跟踪随访,收集其基本情况、疾病情况及相关检测指标,采用描述性分析方法对感染情况及病原菌特征进行分析,并采用单、多因素分析方法对切口感染影响因素进行分析。结果 本研究共纳入改良根治术后乳腺癌患者2 100例,术后切口感染患者42例,感染率为2.00%,共检出55株病原菌,革兰阴性菌、革兰阳性菌占比分别为63.64%、34.55%。多因素Logistic回归分析结果显示,糖尿病(OR=3.550)、ASA评分较高(OR=3.740)、引流时间≥10 d(OR=3.248)、联合放疗或化疗(OR=4.129)、术前白蛋白水平<35 g/L(OR=2.667)、术前血红蛋白水平<70 g/L(OR=3.248)、术前白细胞计数<4×10⁹个/L(OR=3.435)均为乳腺癌患者术后切口感染的危险因素。结论 乳腺癌患者术后切口感染的主要病原菌为革兰阴性菌,且其危险因素众多,...     

全髋关节置换术后患者感染的影响因素分析

目的分析全髋关节置换术(THA)后患者感染的影响因素,提出针对性的干预措施。方法回顾性分析2013年2月-2015年2月在医院接受THA手术的420例患者临床资料,分析术后感染的发生率以及危险因素;采用SPSS19.0软件对数据进行统计分析。结果 420例THA手术患者中共有24例患者术后发生感染,感染率为5.7%;共分离出病原菌28株,其中革兰阳性菌12株占42.9%,革兰阴性菌16株占57.1%;单因素分析显示,年龄60岁、手术时间180min、长期应用激素、并发糖尿病、髋关节手术史、血清白蛋白≤35g/L等因素的差异有统计学意义(P0.05),上述因素为THA术后患者感染发生的危险因素,进一步对上述因素进行多因素logistic回归分析显示,年龄、手术时间、长期应用激素、并发糖尿病、髋关节手术史、血清白蛋白≤35g/L是THA手术后患者发生感染的独立危险因素。结论 THA术后感染病原菌以革兰阴性菌为主,感染的发生与多种因素密切相关,应针对感染的危险因素进行干预,以降低患者的术后感染率。     

多发性骨髓瘤肾损害23例临床特征及相关因素分析

目的 探讨多发性骨髓瘤肾损害的临床特征及相关因素.方法 回顾性分析23例多发性骨髓瘤肾损害患者的临床资料和实验室检查.结果 全组病例均有不同程度的贫血,20例(86.96%)有不同程度的蛋白尿,平均24 h尿蛋白定量(2.64±3.96)g.8例(34.78%)有镜下血尿,3例(13.04%)表现为肾病综合征.慢性肾功能不全14例(60.87%),急性肾功能不全3例(13.04%).血尿酸升高16例(69.57%).骨骼疼痛16例(69.57%),X线检查有改变12例(52.17%),血钙升高9例(39.13%).初诊误诊14例(60.87%).而与其他因素如年龄、血清白蛋白、血清球蛋白、骨髓瘤细胞、血尿酸、继发感染无关(P＞0.05).结论 多发性骨髓瘤临床表现复杂,伴有蛋白尿和(或)肾功能不全、贫血、骨骼疼痛等,高钙血症与高尿酸血症是多发性骨髓瘤肾损害的常见原因,可加重肾脏的损害,应尽早行骨髓穿刺检查.     

67例多发性骨髓瘤患者尿蛋白分析

目的:检测多发性骨髓瘤( MM)患者尿蛋白及其肾功能相关指标,以探讨尿蛋白是否能作为肾脏早期损伤最灵敏的 诊断指标.方法:对 67例 MM患者在诊断时进行尿蛋白测定,然后分别测定尿蛋白阳性结果、阴性结果两组患者的 血清免疫球蛋白、肌肝、尿素、白蛋白、血钙.结果:肾功能不良的 MM患者,用血清指标(肌肝、尿素)评估只有 19例 (28.3% ),而用尿蛋白评估是 46例 (68.7% ).大多数 IgG型(占总体 IgG69.7%)和所有的轻链型 MM患者中尿蛋白 阳性.在尿蛋白阳性和尿蛋白阴性患者的生化结果对比分析中,发现血清肌肝 (P<0.01),尿素 (P<0.001)、β 2-微 球蛋白 (P<0.05).白蛋白 (P<0.05)在两类 MM患者之间有显著差异,没有发现血清钙有显著差异( P>0.05).结 论:尿蛋白比其他生化指标能更好地识别早期阶段的肾损伤,是 MM患者肾损伤灵敏的诊断指标.     

恶性肿瘤患者医院败血症危险因素的病例对照研究

目的 探讨恶性肿瘤患者医院败血症的危险因素.方法 对恶性肿瘤医院败血症患者采用1:2配比的病例对照研究方法,采用单因素及多因素Cox回归分析.结果 多因素Cox回归分析显示,糖尿病史(OR=6.864)、原发感染灶(OR=20.189)、中心静脉置管(OR=28.664)、激素使用(OR=8.355)、中性粒细胞＜0.5 g/L(OR=12.090)、血白蛋白＜35 g/L(OR=3.758),均是恶性肿瘤患者医院败血症发生的危险因素.结论 应针对各种危险因素采取有效的预防措施,减少恶性肿瘤患者医院败血症的发生.     

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 human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

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.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

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.     

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.