医院感染中大肠埃希菌耐药质粒的同源性分析

目的了解不同医院不同科室大肠埃希菌耐药质粒流行状况，分析菌株间的同源性，为控制院内感染流行提供依据。方法采用药敏分析、质粒消除实验、质粒图谱及限制性内切酶图谱等技术对医院感染大肠埃希菌耐药质粒进行同源性分析。结果从2家省级医院不同科室196份标本中分离到E．coli25株，分离率为12．8％。检出菌对抗生素的耐药率为76．0％，有28．0％的菌株仅耐1种药，对3种及3种以上抗生素耐药的有32．0％。在25株分离菌中19株检出质粒，检出率为76．0％。所有菌株均有24．8kb质粒，提示该质粒是医院致病性大肠埃希菌的流行质粒。对13株携带质粒的耐药大肠埃希菌进行质粒消除，除1株菌的耐药性始终未变化外，其余12株的耐药性有不同程度地改变，其中7株耐药性全部消失，5株仅有部分改变。大小相同的耐药质粒经EcoRI酶切后发现同一科室菌株的耐药质粒有相同的DNA片段，不同科室菌株间也有相似的酶切图谱。结论医院病房存在流行耐药质粒，不同科室有不同的质粒流行。各科室菌株间有一定的同源性。     

医院感染中金黄色葡萄球菌耐药质粒的同源性分析

目的了解不同医院不同科室金黄色葡萄球菌（SAU）耐药质粒流行状况,分析菌株间的同源性,为控制医院感染流行提供依据。方法采用药敏分析、质粒消除实验、质粒图谱及限制性内切酶图谱等技术对医院感染SAU耐药质粒进行同源性分析。结果从两所省级医院不同科室196份标本中分离到SAU15株,分离率为7.7%;检出菌对所用抗菌药物的耐药率为86.7%,有13.3%的菌株仅耐1种药,对≥3种抗菌药物耐药的有46.7%;在15株分离菌中12株检出质粒,检出率为80.0%;所有菌株均有38kb的大质粒,提示该质粒是医院SAU的流行质粒;对11株携带质粒的耐药SAU进行质粒消除,除2株菌的耐药性始终未变化外,其余9株的耐药性有不同程度地改变,其中3株耐药性全部消失,其余菌株的耐药性仅有部分改变;大小相同的耐药质粒经EcoRⅠ酶切后发现同一科室菌株的耐药质粒有相同的DNA片段,不同科室菌株间也有相似的酶切图谱。结论医院病房存在流行耐药质粒,不同科室有不同的质粒流行,各科室菌株间有一定的同源性。     

医院金黄色葡萄球菌耐药及质粒同源性分析

目的 了解医院环境金黄色葡萄球菌耐药性及质粒同源性,为制定预防外源性医院感染措施提供依据.方法 抽取2所省级医院5个科室进行消毒前随机采样,进行细菌培养分离鉴定,并对金黄色葡萄球菌进行药敏实验,质粒消除、质粒图谱及限制性内切酶图谱分析.结果 196份样本中,分离到金黄色葡萄球菌15株.占7.7%;其中空气检出率最高,为19.1%.金黄色葡萄球菌的青霉素耐药率为60.0%,3种或以上耐药46.7%;有12株(80.0%)检出质粒,11株含质粒的耐药金葡菌进行质粒消除后,有9株耐药性变化,2株未变化.耐药质粒分子量1.06～39.93kb.3株含有共同耐药谱的乙医院烧伤科金葡菌有相似质粒.不同医院也有相似质粒谱.用EcoRI酶切4株金葡菌质粒后,质粒片段增多,分子量变化,含有5种相同大小的质粒.结论 金葡菌的高危传播途径是空气且耐药性高,不同医院和不同科室的金葡菌有同源耐药质粒.     

中国1993～2000年分离淋球菌的流行病学和细菌学特征

目的：研究中国1993-2000年分离的淋球菌对青霉素、四环素、环丙沙星、大观霉素和头孢曲松的敏感性及其营养分型和携带质粒情况，为制订淋病治疗方案和防治对策的参考依据。方法：用琼脂稀释法测定菌株对抗菌药物的敏感性，用改良Catline法和碱裂解法测定菌株的营养分型和携带耐药质粒的情况。结果：8年来共检测了4976株淋球菌对抗生素的敏感性，发现对青霉素耐药率为71.60％，产青霉素酶淋球菌（PPNG）菌株占15.54；对四环素的耐药菌株占93.02％，由质粒介导的高度耐四环素淋球菌（TRNG）菌株占10.48％；环丙沙星的耐药菌株占53.30％；对大观霉素和头孢曲松的耐药菌株分别占0.36％和0.46％。1995年和1996年南京地区菌株的营养分型原型（proto）占46.4％和47.53％，脯氨酸（pro^-）型占48.4％和50.22％。对40株淋球菌作了质粒分型：30株非PPNG菌株中，2株（15％）不含任何质粒；28株含有4.2kb、4.9kb、5.4kb和39.5kb质粒；10株PPNG株和非PPNG株所含有的5.4kb质粒虽分子量相近，但酶切点不尽相同。结论：1993-2000年分离的淋球菌对青霉素、四环素和环丙沙星耐药率较高，对大观霉素和头孢曲松仍较敏感。南京地区1995-1996年流行的淋球菌的营养分型我大变化。含5.4kb质粒的PPNG和非PPNG菌株所含核苷酸的排列顺序可能有所不同。     

医务人员鼻腔携带表皮葡萄球菌β-内酰胺酶测定与质粒分型研究

目的了解医务人员鼻腔携带表皮葡萄球菌耐药情况及是否存在其流行株。方法对我院医务人员鼻腔表葡菌携带调查。结果发现其携带率为６１．９５％，儿科、神经外科工作人员携带率分别为８８．８９％、８９．４７％，经质粒及质粒限制性内切酶分析证实：极大部分工作人员鼻腔携带菌质粒图谱各异，而小儿科、神经外科有少数菌株质粒酶切图谱相同，说明可能存在交叉感染。结论本组菌株β－内酰胺酶阳性率为８５．９３％，ＭＲＳＥ检出率为７５．００％，此与医务人员长期接触β－内酰胺类抗生素有关；本组菌株粘质阳性率为２３．４３％，说明医务人员携带以正常菌为多，侵袭菌株少     

下呼吸道医院感染阴沟肠杆菌耐药性及分子生物学特性研究

目的 掌握下呼吸道医院感染阴沟肠杆菌耐药谱及分子流行病学特征。方法 耐药谱选用改良K－B法和MIC、Alkalin lysis小量快速提取质粒,经琼脂糖电泳获得细菌质粒DNA图谱,用限制性核酸内切酶Hind Ⅲ、EcoRⅠ、BglⅠ、BamHⅠ分别酶切细菌染色体DNA,凝胶电泳及拍照等。结果 呼吸病区10名下呼吸道感染患者和环境的分离菌株均耐CB、AP、CZ、FT,对AP、CZ的最小抑菌浓度均＞128μg/ml,而烧伤患者分离菌耐10种抗生素;感染患者菌质粒DN图谱显示2.3、2.7、3.5MD3条质粒带,不同于其他菌;4种限制笥核酸内切酶分别酶切染色体DNA,在同种酶切图谱中,感染患者和环境分离菌的酶切带相同,而烧伤患者菌不同。结论 3种分型技术联合应用,证明此次下呼吸道感染流行EC属同一克隆菌;传播途径主要为消毒不彻底的氧气设施;此方法准确、可靠、特异必强,为控制和预防下呼吸道医院感染、追踪传染源、切断传播途径提供遗传学信息,对临床医生选用敏感有效抗生素起指导作用。     

医务人员鼻腔携带表皮葡萄球菌β—内酰胺酶测定与质粒分 …

目的 了解医务人员鼻腔携带表皮葡萄球菌耐药情况及是否存在其流行株。方法 对我院医务人员鼻腔表葡菌携带调查。结果 发现其携带率为６１．９５％，儿科、神经外科工作人员携带率分别为８８．８９％、８９．４７％，经质粒及质粒限制性内切酶分析证实：极大部分工作人员鼻腔携带菌质粒图谱各异，而小儿科、神经外科有少数菌株质粒酶切图谱相同，说明可能存在交叉感染。结论 本组菌株β－内酰胺酶阳性率为８５．９３％，ＭＲＳＥ     

儿童乳牙龋中变形链球菌临床分离株葡糖基转移酶催化活性区cat基因的遗传多态性

目的:探讨变形链球菌葡糖基转移酶催化活性区cat基因的遗传多态性与不同龋敏感儿童龋病发生的关系。方法:随机选取60名3～5岁的高龋、中龋及无龋儿童,取牙面菌斑样本接种于MS培养基上,每人随机挑取1～5株临床分离株,提取细菌染色体DNA,经PCR扩增cat基因片段,分别采用限制性内切酶HinfⅠ、MboⅠ、TaqⅠ进行限制性片段长度多态性分析,对不同龋敏感者口腔变形链球菌临床分离株进行基因分型。结果:不同龋敏感儿童变形链球菌临床分离株经限制性内切酶HinfⅠ酶切后,限制性片段长度多态性分析酶谱出现了差异,且各组差异经卡方分析有统计学意义。MboⅠ、TaqⅠ限制性内切酶酶切后,限制性片段长度多态性分析酶谱没有差异。结论:不同龋敏感儿童变形链球菌葡糖基转移酶催化活性区cat基因型不同,并可能在一定程度上与变形链球菌利用葡糖基转移酶合成胞外多糖的能力相关。     

烧伤病房革兰氏阴性杆菌质粒传播的分子生物学研究

应用耐药谱、质粒、限制性核酸内切酶的分析,以及质粒消除试验研究烧伤病房的革兰氏阴性杆菌携带R质粒。结果发现,82株革兰氏阴性杆菌74株携带有14.8、13.7,13.4md的质粒占90.24％,其中有44株(59％)还携带有12.2,8.1md质粒。而且细菌携带的R质粒带越多,耐药谱越广。通过质粒消除试验发现细菌的耐药基因多数位于质粒上。用限制性内切酶HindⅢ消化前三条质粒出现相同的六条酶切片段,提示这三条质粒出现了传染病暴发。     

耐碳青酶烯类肠杆菌科细菌的耐药机制研究

目的研究ICU收集的耐碳青酶烯类肺炎克雷伯菌、大肠埃希菌、褪色沙雷菌分子流行病学特征及耐药机制。方法用脉冲场凝胶电泳(PFGE)和肠杆菌科基因间重复一致性序列-PCR(ERIC-PCR)分析耐药株的分子流行病学特征,采用特异性PCR和序列分析、接合试验、质粒提取和转化试验、质粒消除试验、外膜蛋白分析技术来分析介导碳青酶烯类耐药的分子机制。结果 12株肺炎克雷伯菌分属2个流行克隆型、13株大肠埃希菌属于5个流行克隆型、3株褪色沙雷菌属于2个流行克隆型;药物敏感试验显示,分离株对亚胺培南和美罗培南的MIC分别为16～128μg/ml和8～256μg/ml;所有菌株均扩增出介导碳青酶烯类耐药的KPC-2基因;3株褪色沙雷菌接合试验获得成功,部分菌株进行质粒提取、质粒分子杂交、质粒转化和质粒消除试验显示,KPC-2定位于约为56kb的质粒上;外膜蛋白比较分析显示部分耐药菌株发生外膜蛋白改变。结论医院ICU分离出耐碳青酶烯类肺炎克雷伯菌、大肠埃希菌和褪色沙雷菌;产KPC-2是介导对碳青酶烯类药物耐药的主要原因;部分菌株外膜蛋白改变可能参与耐药;垂直传播以及通过质粒的水平传播可能是耐药株在ICU流行的主要方式。     

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.     

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.     

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.     

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.     

The risk of heat exhaustion at a deep underground metalliferous mine in relation to surface temperatures

The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.