社区腹泻患者感染致泻大肠埃希菌分布与耐药性分析

目的了解社区腹泻患者感染致泻大肠埃希菌(Diarrheagenic E.coli,DEC)的常见类型及耐药性,为制定有效治疗措施提供参考依据。方法收集医院2013年7-11月442例门诊腹泻患者粪便标本,采用针对肠致病性大肠埃希菌(EPEC)、非典型EPEC(ATEC)、肠产毒素性大肠埃希菌(ETEC)、肠凝聚性大肠埃希菌(EAEC)、肠侵袭性大肠埃希菌(EIEC)、产志贺毒素大肠埃希菌(STEC)6种类型DEC共11对致病基因(escV、bfpB、stx1、stx2、elt、estIa、estIb、invE、astA、aggR、pic)的特异性引物对分离得到的大肠埃希菌进行多重PCR测定;应用微量稀释法检测DEC对常用抗菌药物的敏感性。结果 442例门诊腹泻患者中130例分离到DEC,占29.4%,其中10例同时分离到两种致病菌,6例分离到同一种致病菌包括两种基因型;共分离到147株DEC,包括EAEC100株占68.0%、ETEC7株占4.8%、ATEC9株占6.1%、EIEC和STEC各1株,未分型29株占19.7%。结论社区DEC以EAEC最为常见,且出现ATEC感染;DEC对常用抗菌药物的耐药性因致病性不同而异,临床治疗需考虑DEC类型并加强耐药性监测。     

浙江省腹泻患者致泻性大肠埃希菌血清型分布及其鉴定效率的评价

目的 了解浙江省致泻性大肠埃希菌（DEC）血清型分布并探讨其血清学鉴定分类方法的鉴定效率。方法 对2009年7月至2013年6月浙江省腹泻症候群病原谱监测网络菌株库中的696株DEC菌株（通过毒力基因鉴定）开展血清学凝集试验,比较毒力基因和血清学鉴定分类的结果。结果 696株DEC中288株（41.4%）能明确O抗原型别,分属于35种O血清群。171株（24.6%）H血清凝集,分属于21种H型。肠集聚性大肠埃希菌（EAEC）、产肠毒素性大肠埃希菌（ETEC）、肠致病性大肠埃希菌（EPEC）和肠出血性大肠埃希菌（EHEC）凝集率分别为31.9%（130/408）、70.6%（127/180）、31.5%（29/92）和14.3%（2/14）,分属于30、18和15种O血清群,1株EHEC为O157∶H7。EAEC和EPEC血清群相对较多样化,而ETEC则相对集中,不同类型DEC可具有同一血清群/型。根据血清学结果可分类的75株DEC中,42株毒力基因和血清学分类结果一致,33株不一致。结论 浙江省DEC血清群/型种类多样,单纯采用血清学筛查可造成极大的漏检或误分,建议采用毒力基因鉴定分类。     

产毒性和致病性大肠埃希菌中小肠结肠炎耶尔森菌强毒力岛分布的研究

目的：了解小肠结肠炎耶尔森菌强毒力岛在产毒性（ETEC）和致病性大肠埃希菌（EPEC）中的分布。方法：用聚合酶链反应扩增和原位杂交方法。结果：在检测的93株ETEC和10株EPEC的毒力岛的检出率分别为32.25%(32/93)和30.00%(3/10),1株肠聚集性大肠埃希菌（EAggEC)也检出了毒力岛,而且这些阳性菌株中的岛大部分连接到天门冬氨酸tRNA（asntRNA)位点。结论：ETEC、EPEC以及EAggEC是致病性较强的病原菌,而小肠结肠炎耶尔森菌强毒力岛在ETEC和EPEC中具有阳性率较高的分布,对于进一步研究大肠埃希菌毒力变化和毒力的调控以及细菌毒力的进化具有重要意义。     

2015-2016年江阴市致泻性大肠埃希菌监测及其毒力基因分析

目的了解2015-2016年江阴市致泻性大肠埃希菌[肠致病性大肠埃希菌(EPEC)、肠产毒性大肠埃希菌(ETEC)、肠侵袭性大肠埃希菌(EIEC)、肠出血性大肠埃希菌(EHEC)、肠聚集性大肠埃希菌(EAEC)]的感染、分布及其毒力基因的携带情况。方法对2015-2016年哨点医院提供的感染性腹泻样本进行实时荧光定量PCR检测,确定其致病型别及其携带的毒力基因。结果 359份腹泻标本中,检出致泻性大肠埃希菌31份,检出率8.64%,其中EAEC 15份,检出率4.18%,EPEC 13份,检出率3.62%,ETEC 3份,检出率0.84%,未检出EIEC及EHEC。15株EAEC中,携带astA基因8株,携带aggR+pic基因6株,携带astA+aggR+pic基因1株。13株EPEC均携带eae基因,3株ETEC均携带estI基因。致泻性大肠埃希菌主要集中在夏秋季节高发,2015年主要以EPEC为主,2016年主要以EAEC为主。结论江阴市致泻性大肠埃希菌主要以EAEC和EPEC两个型别为主,携带的毒力基因呈多态性,显示其致病力和侵袭力具有多样性和复杂性,应加强监测。     

大肠埃希菌中强毒力岛的irp1、irp3、irp4基因检测

目的检测大肠埃希菌中耶尔森菌强毒力岛的irp1、irp3、irp4基因.方法采用PCR与菌落原位斑点杂交技术,检测1990～1992年分离于我国五大军区腹泻病人的106株大肠埃希菌的irp1、irp3、irp4基因,其中肠产毒型大肠埃希菌（Enterotoxigenic E.coli,ETEC）94株、肠侵袭型大肠埃希菌（Enteroinvasive E. coli,EIEC）1株、肠致病型大肠埃希菌（Enteropathic E. coli,EPEC）10株及肠凝集型大肠埃希菌（Enteropathic aggregative E. coli,EAEC）1株.结果irp1、irp3和irp4阳性检出率分别为12.3%（13/106）、86.8%（92/106）和61.3%（65/106）,差异有显著性（X2=122.27,P＜0.05）.94株ETEC中,10株irp1阳性（阳性率10.6%）,81株irp3阳性（阳性率86.2%）,55株irp4阳性（阳性率58.5%）;10株EPEC中,1株irp1阳性,9株irp3阳性,8株irp4阳性;1株EIEC和1株EAEC,irp1、irp3和irp4基因均为阳性.结论大肠埃希菌中携有耶尔森菌强毒力岛的irp1、irp3、irp4基因,这3个基因在小肠结肠炎耶尔森菌（Y.enterocolitica）和大肠埃希菌（E.coli）之间存在水平性转移.     

佛山市十类食品致泻大肠埃希氏菌污染状况与分析

致泻大肠埃希氏菌(diarrheogenic Escherichiacoli,DEC)是重要的食物中毒及腹泻病原.目前国际上把DEC分为五大类:肠致病性大肠埃希氏菌(EPEC),产肠毒素大肠埃希氏菌(ETEC),肠侵袭性大肠埃希氏菌(EIEC),出血性大肠埃希氏菌(EHEC),和肠集聚性大肠埃希氏菌(EAggEC).     

多重实时PCR检测沙门菌、志贺菌和致泻性大肠埃希菌

目的 建立多重实时荧光PCR检测沙门菌侵袭蛋白A基因（invA）、肠产毒性大肠埃希菌（ETEC）不耐热肠毒素基因（elt）、志贺菌和肠侵袭性大肠埃希菌侵袭力基因（ipaH）的方法。方法 优化多重实时荧光PCR的反应条件,检测系列10倍稀释的阳性菌DNA提取物。90份腹泻患者粪便样品经缓冲蛋白胨水（buffered peptone water,BP）增菌6h后进行多重实时荧光PCR检测,并对阳性标本进行菌株分离和鉴定。结果 多重实时PCR方法最低可以检测到10CFU／μl的福氏2aF301株、10。CFU／μl的鼠伤寒沙门菌和ETEC44815株。检测腹泻患者粪便样品,elt基因阳性率为14．4％（13／90）,ipaH基因阳性率为5．6％（5／90）;并从阳性样品中分离到3株elt基因阳性大肠埃希菌和4株ipaH基因阳性大肠埃希菌。整个检测过程可在10h内完成,其中包括BP增菌6h。结论 建立了同时检测invA、elt、ipaH毒力基因的多重实时荧光PCR方法,具有高度的特异性,可用于沙门菌、肠产毒性大肠埃希菌、志贺菌和肠侵袭性大肠埃希菌菌株的毒力基因鉴定及临床腹泻粪便标本的快速筛检。     

腹泻症候群致泻性大肠埃希氏菌血清型及毒力基因检测

目的：通过对腹泻症候群中致泻大肠埃希菌的血清型和多重PCR检测,了解本地区致泻大肠埃希菌的血清群、型分布规律,所携带毒力基因及相互之间的相关性,为腹泻症候群中致泻大肠埃希菌的检测、鉴定提供科学依据,以提高阳性株的检出率。方法：对本地区2012-2013年腹泻症候群监测医院门诊未使用过抗生素腹泻患者的稀便、水样便、黏脓便或脓血便标本通过増菌、各种选择性培养基筛选出病原菌,后经生化试验、多重PCR试验和血清型分型试验进行鉴定。结果：本次检测共检出65株血清凝集致泻大肠埃希菌,分属EPEC、EIEC、ETEC,以EPEC为主,占83.08%,共8个血清型,其中血清型O55：H59、O128：H67占58.47%;共检出4种相关毒力基因,其中escV 49株（75.38%）。未分血清型菌株27株,检出相关毒力基因共5种,分属EPEC、EIEC、ETEC、EAEC,其中escV 15株（55.56%）。结论：本地区腹泻症候群中血清学阳性致泻大肠埃希菌以EPEC为主,常见血清型为O55：H59、O128：H67,毒力基因为escV、escV＋bfpB、invE、elt。未分血清型致泻大肠埃希菌毒力基因为escV、escV＋bfpB、invE、elt、astA,与已分型菌株携带基因基本一致。腹泻患者的大肠埃希菌检测中,在传统的细菌分离培养、生化试验、血清学鉴定的基础上,有必要进行大肠埃希菌的毒力基因检测,以提高阳性检出率,避免漏检,提高致泻性大肠埃希菌的诊断。     

泰州市腹泻病人中致泻大肠埃希氏菌感染状况及 病原学特征分析

摘要:目的　了解泰州市腹泻病人中致泻大肠埃希氏菌感染状况、毒力基因、分子分型以及耐药性情况,为致泻大肠埃希氏菌防治提供依据。方法　对2013年泰州市215份腹泻病人粪便标本进行多重PCR鉴定和分离培养,并对分离的致泻大肠埃希氏菌菌株进行生化鉴定、脉冲场凝胶电泳（Pulsed Field Gel Electrophoresis,PFGE）分子分型以及药敏试验。结果　215份腹泻病人粪便标本共检测出致泻大肠埃希氏菌30株,其中EPEC 20株（占9.30%）,EAEC 5株（占2.33%）,ETEC 5株（占2.33%）;PFGE结果表明,30株致泻大肠埃希氏菌PFGE带型种类多,各亲缘关系较近,但无100%的同源菌,同时PFGE分析结果表明在同一个粪便中有2种不同致泻大肠埃希氏菌感染情况存在;药敏试验表明,30株致泻大肠埃希氏菌对阿莫西林、四环素耐药性最高,3耐以及以上占63.33%。结论　泰州市腹泻病人中致泻大肠埃希氏菌感染普遍存在,并以EPEC、EAEC、ETEC感染为主,菌株的耐药性较强,耐药谱广;基因型呈多态分布,且具有流行相关性。     

2019—2022年上海市奉贤区哨点医院致泻性大肠埃希菌的耐药性和同源性

【目的】开展上海市奉贤区的致泻性大肠埃希菌（DEC）耐药性和同源性分析,为临床合理用药和风险监测预警提供依据。【方法】收集2019—2022年上海市奉贤区腹泻病检测中分离到的DEC,采用微量肉汤稀释法进行21种抗生素药物敏感试验,采用脉冲场凝胶电泳（PFGE）进行聚类分型。【结果】腹泻病例DEC检出率为18.99%(131/690)、肠聚集性大肠埃希菌（EAEC）占64.89%(85/131)、肠产毒性大肠埃希菌（ETEC）占22.14%(29/131)、肠致病性大肠埃希菌（EPEC）占12.21%(16/131)、肠出血性大肠埃希菌（EHEC）占0.76%(1/131),未检出肠侵袭性大肠杆菌（EIEC）。DEC检出具有明显夏季高发的季节性特点。DEC多重耐药率为66.41%,共有65种耐药谱,耐药率最高的5种抗生素是氨苄西林（60.31%）、萘啶酸（51.91%）、头孢唑林（50.38%）、四环素（44.27%）、复方新诺明（35.11%）,2019—2022年DEC对左氧氟沙星的耐药率明显升高。85株EAEC聚类分析相似度为58.4%～100.0%,得到69种带型;29株ETEC...     

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.     

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.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

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.