2012年江苏省食源性致病菌耐药监测分析

目的了解江苏地区食源性致病菌对常用抗菌药物的耐药性,为食源性致病菌风险评估和指导临床合理用药提供依据。方法应用Etest方法对分离出的金黄色葡萄球菌、副溶血性弧菌及沙门菌进行药物敏感性测定。结果金黄色葡萄球菌对红霉素的耐药率最高(33.3%),其次为复方磺胺甲恶唑(15.9%)、四环素(11.1%),多重耐药率为3.2%;副溶血性弧菌对四环素和复方磺胺甲恶唑耐药率分别为2.1%、3.2%;沙门菌对萘啶酸的耐药率为50.0%。结论及时掌握细菌耐药状态,对合理使用抗生素有重要指导作用。     

2015年镇江市食源性致病菌耐药监测分析

目的了解镇江市食源性致病菌对常用抗生素的耐药情况。方法采用微量肉汤稀释法,对镇江市2015年度食源性疾病常规监测中分离的沙门菌、副溶血性弧菌以及志贺菌进行药敏鉴定。结果 2015年采集食品样123份、病例粪便标本798份,共分离58株阳性菌株。药敏实验前,分离菌株复核均为阳性,实验结果表明分离株多重耐药率为31.0%,其中分离的21株沙门菌、8株志贺菌多重耐药率分别为57.1%、75.0%,耐≥6种抗生素的菌株分别占19.0%、62.5%;沙门菌对氨苄西林(61.9%)、四环素(52.4%)和萘啶酸(52.4%)耐药率较高;志贺菌对氨苄西林、氨苄西林/舒巴坦、萘啶酸和复方磺胺甲恶唑耐药率较高(均达75.0%);29株副溶血性弧菌仅1株对氨苄西林耐药(3.4%),8株对氨苄西林呈中介(27.6%),其余对所选抗生素均敏感(70.0%)。结论 2015年镇江市食源性致病菌耐药情况较为严重。应进一步加强监测,及时了解致病菌耐药情况,指导本地区合理使用抗菌药。     

水产动物源副溶血性弧菌耐药性研究

目的 掌握辽宁省水产动物源副溶血性弧菌的耐药情况,探讨耐药基因型与表型间的关联性,进一步揭示耐药机制,为科学防控副溶血性弧菌食物中毒提供理论依据。方法 应用肉汤稀释法对168株水产动物源副溶血性弧菌进行耐药谱研究,测定菌株对14种常见抗生素的最小抑菌浓度和其中4种抗生素的最小杀菌浓度。应用实时荧光定量PCR方法对菌株进行7种常见耐药基因及I类整合子inT1基因的检测。结果 168株辽宁省水产动物源副溶血性弧菌对14种常见抗生素的耐药率分别为青霉素G 98.21%、磺胺甲噁唑70.24%和氨苄西林67.85%。菌株对恩诺沙星的敏感率最高,为97.62%,且出现不同耐药程度的多重耐药株,AMP/PG/SMX和PG/SMX为优势耐药菌谱。菌株主要耐药基因型有blaCARB(29.55%)、blaCARB-Sul II(15.26%)、blaCARB-blaTEM(15.26%)。耐药基因与耐药表型的符合率不高。结论 水产动物源副溶血性弧菌对磺胺甲噁唑和β-内酰胺类抗生素耐药率较高,对恩诺沙星的敏感率最高,恩诺沙星的杀菌和抑菌效果显著,提示可将恩诺沙星用于预防和治疗副溶血性弧菌病的首选药。水产...     

泰州市市售食品食源性致病菌谱及耐药状况分析

目的:了解泰州市市售食品中常见食源性致病菌的污染状况和对抗生素的耐药情况。方法:采集市售的各类食品样品,按照国家规定的标准检验方法进行食源性致病菌的分离培养、生化及血清学鉴定和药敏试验,并依据CLSI(美国临床实验室标准委员会)规定判断结果。结果:533份各类食品样共检出沙门菌33株,检出率为6.59%;单核细胞增生李斯特菌50株,检出率为11.63%;副溶血性弧菌17株,检出率为28.30%;金黄色葡萄球菌27株,检出率为18.12%。未检出大肠杆菌O157:H7、阪崎杆菌和空肠弯曲菌。沙门菌、副溶血性弧菌、金黄色葡萄球菌对抗生素普遍耐药,单核细胞增生李斯特菌对抗生素的耐药性相对较低,但对氨苄西林、萘啶酸、四环素有一定的耐药性。结论:泰州市市售食品存在食源性致病菌的污染,主要污染的食源性致病菌为单核细胞增生李斯特菌、沙门菌、金黄色葡萄球菌和副溶血性弧菌。污染食品的食源性致病菌对抗生素普遍存在耐药。     

2010年江苏省食源性致病菌耐药监测分析

目的:了解沙门菌和金黄色葡萄球菌对临床上常用抗菌药物的耐药性,为微生物风险评估提供依据.方法:应用微量肉汤稀释法,对分离出的沙门菌和金黄色葡萄球菌进行耐药性测定.结果:沙门菌对四环素的耐药率最高,达27.03％,对四环素、氯霉素、磺胺嘧啶耐药率均超过10％;金黄色葡萄球菌对青霉素的耐药率最高,达61.54％,对万古霉素...     

湖南省即食食品中食源性致病菌污染状况及耐药性研究

目的 了解湖南地区即食食品中食源性致病菌的污染状况和耐药性,为预防和控制食源性疾病提供科学依据. 方法 从湖南地区的农贸市场、超市和餐饮单位采集即食食品(凉拌菜和熟肉制品),依据GB 4789-2010和GB/T 4789-2008方法,对样品进行沙门菌等4种食源性致病菌检测,分离菌株使用微量肉汤稀释法进行药敏试验. 结果 991份样品共检出食源性致病菌92株,检出率为9.28％,其中检出金黄色葡萄球菌68株,检出率为6.86％,检出沙门菌和单增李斯特菌各12株,检出率为1.21％,未检出大肠埃希菌O157.药敏结果显示金黄色葡萄球菌和沙门菌均具有一定的耐药性,其中金黄色葡萄球菌对苯唑西林的耐药率高达61.76％,而且多重耐药明显. 结论 湖南地区即食食品存在一定的食源性致病菌污染,应加大卫生监督力度,防止食源性疾病的暴发流行;同时应控制动物饲料中抗生素的添加使用,加强抗生素的管理和耐药性监测.     

食源性沙门菌和致泻性大肠杆菌的耐药性分析

目的为食源性疾病的预防及临床合理使用抗菌药物提供科学依据。方法根据CLSI推荐的微量肉汤稀释法进行药敏检验,定量测定致病菌的最低抑菌浓度(MIC)。结果受试的27株食源性沙门菌全部对头孢西丁敏感,对萘啶酸、四环素、甲氧苄啶/磺胺甲噁唑、氯霉素、庆大霉素、环丙沙星、头孢噻肟的耐药率分别为59.3%、56.6%、33.3%、29.6%、25.9%、7.4%、3.7%。12株食源性致泻性大肠杆菌全部对头孢噻肟敏感,对庆大霉素、环丙沙星、头孢西丁、氯霉素、四环素、甲氧苄啶/磺胺甲硝唑的耐药率分别为66.7%、58.3%、58.3%、58.3%、25.0%、25.0%、16.7%。沙门菌和致泻性大肠杆菌耐药株均存在多重耐药现象及多种耐药谱。结论食源性沙门菌和致泻性大肠杆菌的耐药情况严重,应加大对食源性致病菌耐药性的监测,加强对抗菌药物的监管,以减少耐药株的产生。     

肉汤稀释法MIC药敏试剂盒对沙门菌检测结果分析

目的检测来源于食源性疾病的病人粪便标本中分离的沙门菌耐药情况,掌握我国食源性致病菌的耐药趋势和耐药谱,为指导抗生素在人类临床和动物饲养中的合理应用,控制耐药菌株的传播提供重要的参考性数据。方法根据CLSI推荐的微量肉汤稀释法进行药敏检验,定量测定致病菌的最低抑菌浓度（minimal inhibitory concentration,MIC）。结果 66株沙门菌对萘啶酸（NAL）、四环素（TET）、头孢噻肟（CTX）、氯霉素（CHL）、甲氧苄啶/磺胺甲噁唑（TMP/SMZ）、头孢西丁（CFX）、环丙沙星（CIP）、庆大霉素（GEN）均有不同程度的耐药。耐药率分别是：42.4%、39.4%、22.7%、12.1%、7.6%、6.0%、4.5%、4.5%,MIC值在4~608μg/ml之间。13株多重耐药,其中2株5重耐药,抗药谱不一致;6株4重耐药,其中4株抗药谱一致;2株3重耐药,株抗药谱一致;5株2重耐药,其中2株抗药谱一致。结论来源于吉林省各医院食源性疾病监测点的病人粪便标本中分离到的沙门菌存在多种抗生素的耐药。应高度重视和加强食源性疾病中沙门菌的耐药性监测,以保证食品安全和人类健康。     

宁波地区腹泻病人中食源性致病菌检测与分析

目的:了解宁波地区感染性腹泻病人中致病菌构成和耐药性,为防控腹泻病提供依据.方法:致病菌检测采用直接分离与增菌分离相结合的方法;细菌鉴定采用生化筛检和API等,鉴定到种、群;致病菌血清分型采用血清凝集法;药敏试验采用K-B法,耐药基因检测采用PCR法.结果:9 256份标本检出8类16种3 473株病原菌,检出率为37.52％,以副溶血性弧菌最多,沙门菌次之,气单胞菌第三,且副溶血性弧菌的检出率明显高于其它病原菌,差异有统计学意义(P＜0.01);血清分型发现副溶血性弧菌的O∶3群、沙门菌的甲型副伤寒、志贺菌的福氏志贺菌、致病性大肠杆菌O:119为各病原菌的优势菌,检出了福氏1C等志贺菌新亚型;药敏试验显示致病菌对大多数抗生素敏感,但有45株为多重耐药菌,其中气单胞菌23株、志贺菌8株、致泻性大肠杆菌8株、金黄色葡萄球菌3株、变形杆菌2株、沙门菌1株,占总菌数的2.45％,检出了bla-TEM、sull和aacc等3种耐药基因.结论:宁波地区腹泻食源性致病菌构成复杂,副溶血性弧菌是最主要的流行病原菌;检出福氏C型志贺菌提示其血清型可能或正在转换,需加强对志贺菌变迁的监测,以预防疾病的暴发;致病性不强的气单胞菌和类志贺邻单胞菌检出率较高,应引起关注;病原菌对多种抗生素敏感,可用于预防和治疗.有2.45％的病原菌为ESBL,涉及多个菌属,说明耐药菌产生的复杂性,采取合理用药是关键,以减少耐药菌的传播和扩散.     

淮安市灌肠类熟肉制品生产环节致病菌检测及病原学分析

目的了解淮安市灌肠类肉制品各生产环节致病菌污染状况及病原学特征。方法根据国家食品安全微生物检测标准检测金黄色葡萄球菌、沙门菌和单核细胞增生李斯特菌,使用脉冲场凝胶电泳(PFGE)对致病菌进行分子分型,同时对其进行药敏分析。结果 105份样品中,致病菌总体污染率为17.14%,主要致病菌为金黄色葡萄球菌和沙门菌。原辅料、中间产品和环境污染率分别为31.82%、29.03%和4.76%。经PFGE分型,沙门菌菌株的基因型比较相近,同源性高,而金黄色葡萄球菌分离株型别分散。经药敏分析,沙门菌对氨苄西林和萘啶酸的耐药菌株最多,而对头孢他啶和头孢西丁不耐药;金黄色葡萄球菌对磺胺甲恶唑的耐药菌株最多,而对头孢噻圬和庆大霉素不耐药。结论金黄色葡萄球菌、沙门菌是灌肠类熟肉制品生产环节的主要污染菌群,原辅料是主要污染来源。分离出的致病菌大多具有多重耐药性。     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。     

西林瓶装注射用水的装量检查分析

为了检查西林瓶装注射用水的实际分装量是否符合2005年版《药典》三部要求,按照2005年版《药典》三部中“生物制品分装和冻干规程”,分装规格为0．8ml的西林瓶装注射用水10000瓶,随机在分装过程的前、中、后阶段共抽取100瓶,轧盖、目检。分别用1ml标定注射器及1ml普通无菌注射器抽取每瓶注射用水的实际体积,以t检验法对实际抽取量与标示量的差值进行统计学分析,结果显示其与2005年版《药典》三部要求分装附加量为0．1ml相比有显著性差异（P〈0．001）。