慢性阻塞性肺疾病患者继发肺部真菌感染的临床分析

目的探讨慢性阻塞性肺疾病(COPD)患者继发肺部真菌感染的临床特点。方法回顾性分析2008年1月到2010年12月安徽医科大学第一附属医院收治的COPD继发肺部真菌感染患者病例,并对其耐药情况进行比较。结果本组199例COPD患者检出白色念珠菌137例(68.84%),光滑念珠菌32例(16.08%),热带念珠菌17例(8.54%),克柔念珠菌9例(4.52%),毛霉菌3例(1.51%),清酒假丝酵母菌1例(0.50%);白色念珠菌检出率有下降趋势,热带念珠菌有上升趋势;196例真菌对伏立康唑、氟康唑、两性霉素B、伊曲康唑、氟胞嘧啶的耐药率分别为3.6%、5.1%、1.0%、8.7%和0;2008年至2010年白色念珠菌和光滑念珠菌耐药率变化差异无统计学意义。结论 COPD患者继发肺部真菌感染病原菌仍以白色念珠菌为主,其次为光滑念珠菌和热带念珠菌;白色念珠菌和光滑念珠菌耐药率无明显改变。     

临床酵母样真菌的感染特点及耐药性研究

目的了解临床酵母样真菌的感染类型、分布以及耐药情况,为临床诊断治疗提供合理的用药依据.方法采用常规方法进行真菌培养,用科玛嘉显色培养基联合法国生物梅里埃API 20C AUX鉴定条进行鉴定,药敏试验采用微量稀释法.结果864株酵母样真菌中,白色念珠菌619株（71.6%）,其次为热带念珠菌116株（13.4%）和克柔念珠菌47株（5.4%）,非白色念珠菌感染的比例逐年上升（21.5%）.其中,呼吸道标本酵母样真菌检出率最高,达79.7%,其次是消化道为8.8%,泌尿道为4.7%.科室分布依次为干部科、呼吸科、急诊内科、血液科等;白色念珠菌对两性霉素B、5-氟胞嘧啶高度敏感,达90%以上,对氟康唑和伊曲康唑的敏感性有所降低.结论酵母样真菌的检出率与患者基础疾病密切相关;对氟康唑等药物的敏感性有下降的趋势,未发现对4种药物同时耐药的菌株,提示在治疗中,药敏监测是非常必要的.     

院内150例真菌感染及其耐药性分析

目的研究院内真菌感染的特点及耐药状况。方法对临床标本分离的真菌,用TAB Expression鉴定仪鉴定,E—test抗真菌药敏试纸条进行药敏试验。结果150株真菌共有14个种,以白色念珠菌为主．占45．3％。各种真菌对6种抗真菌药物均有不同程度的耐药。结论院内真菌感染呈上升趋势,并且产生一定的耐药株。     

四年间酵母样真菌感染的病原菌分布与耐药特征分析

目的了解临床酵母样真菌感染的流行特点及其耐药性,指导临床合理运用抗真菌药物。方法运用WHONET软件对中南大学湘雅三医院4年间临床分离出的酵母样真菌与其耐药进行回顾性分析。结果4年间临床酵母样真菌感染率由2002年的9.0%升至2005年的13.8%,白色念珠菌仍是引起临床感染的主要真菌,但其构成比由2002年的69.7%降至2005年的49.1%,而近平滑念珠菌的构成比4年间增加了9.5%,成为临床酵母样真菌感染的第二位病原菌。4年间临床酵母样真菌对唑类药物的耐药率增加了9.6%~16.8%。结论临床酵母样真菌引起的感染逐年增加,种类增多,对唑类药物的耐药情况日趋严重,应加强对临床真菌感染与耐药性情况的监测,以指导临床合理使用抗生素。     

下呼吸道真菌感染的临床特点及耐药性分析

目的探讨住院患者下呼吸道真菌感染的临床特点,对其耐药性进行分析,以指导临床合理用药。方法回顾性调查2008年1月至2009年12月间安徽医科大学第一附属医院发生下呼吸道真菌感染的病例,并进行统计学分析。结果 374例下呼吸道真菌感染患者检出白色念珠菌253例(67.6%),光滑念珠菌74例(19.8%),热带念珠菌28例(7.5%),克柔念珠菌10例(2.7%),其他假丝酵母菌3例(0.8%),毛霉菌4例(1.1%),烟曲霉菌2例(0.5%)。本组资料药敏结果显示各种真菌对多种抗真菌药物敏感率较高,其中两性霉素B、伏立康唑和氟康唑的敏感率较高,而伊曲康唑的耐药率最高,达到12.2%。结论下呼吸道真菌感染仍以白色念珠菌感染为主,光滑念珠菌和热带念珠菌其次,3种念珠菌占总分离真菌的94.9%,5种抗真菌药物的耐药率以伊曲康唑最高,社区获得性感染患者预后明显优于医院感染患者。     

外阴阴道念珠菌病的病原检测及体外药敏试验

目的了解STD门诊患者外阴阴道念珠菌病的菌种分布及对常用抗真菌药物的敏感状况,为临床治疗提供参考。方法取STD门诊疑似念珠菌感染患者的阴道分泌物标本,用沙氏琼脂培养基分离纯化菌株,然后用ATB ID 32C酵母菌鉴定系统和ATB Fungus3药敏系统进行菌种鉴定与药物敏感试验。结果950份标本中检出306株念珠菌,占32.21%,其中白色念珠菌226株,阳性率为73.86%;光滑念珠菌37株,阳性率为12.09%;热带念珠菌24株,阳性率为7.84%;近平滑念珠菌13株,占4.25%。药敏结果显示：念珠菌对5-氟胞嘧啶（5-FC）;两性霉素B（AMB）,伏立康唑（VRC）耐药率〈6%;近平滑念珠菌对5种抗真菌药物均敏感;白色念珠菌对氟康唑（FCZ）、伊曲康唑（ICZ）耐药率依次：9.29%、11.06%,光滑念珠菌药耐药率依次为37.84%,67.57%,热带念珠菌药耐药率依次为8.33%、12.5%。结论STD门诊患者阴道念珠菌检出率明显高于普通妇科门诊患者,检出菌种仍以白色念珠菌为主,但光滑念珠菌和热带念珠菌生殖道感染有明显上升趋势;念珠菌对两性霉素B、5-氟胞嘧啶敏感性较高,对唑类药物有耐药菌株。因此,念珠菌鉴定和药敏监测是非常必要的,临床医生应根据药敏结果合理使用抗真菌药物。     

院内深部真菌感染92例临床分析

目的探讨院内深部真菌感染的临床表现、感染相关因素及诊断治疗措施.方法对1993年1月至2002年12月间经微生物检查证实的92例院内深部真菌感染的病例临床资料进行回顾性分析.结果在92例患者中,肺部疾病26例,糖尿病19例,血液病及肿瘤19例,外科手术后13例,消化系统疾病6例,慢性肾脏病6例,风湿性疾病3例.主要感染真菌为白色念珠菌和酵母菌.感染相关因素:长时间应用广谱抗生素病人65例,应用糖皮质激素22例,应用免疫抑制剂18例,应用气管切开或气管内插管以及中心静脉留置导管17例,进行血液净化治疗的9例.治疗痊愈59例(64.1%),好转10例(10.9%),死亡23例(25%).结论白色念珠菌是院内深部真菌感染的主要致病菌株,有逐年增加趋势,病死率高.与长时间应用广谱抗生素及免疫抑制剂等有相关性.     

北京朝阳医院深部真菌感染的临床分析和药敏试验

目的对院内临床深部真菌感染的标本进行分离鉴定和药敏试验,为临床感染性疾病提供病原学诊断和合理使用抗真菌药物的依据。方法采用念珠菌显色培养基进行鉴定。对真菌(丝状菌)用棉蓝染色直接镜检和培养相结合的方法进行鉴定。采用纸片扩散法进行药敏试验。结果450株真菌标本中,念珠菌396株,占88.0%;真菌(丝状菌)54株,占12.0%。分离菌株对药物的敏感性分别为氟康唑90.15%,两性霉素B97.98%,伊曲康唑91.67%,氟胞嘧啶89.1%。结论院内真菌感染以念珠菌最为多见,特别是白念珠菌和热带念珠菌。     

肿瘤患者深部真菌感染的菌株分布及耐药性分析

探讨肿瘤患者深部真菌医院感染的病原菌分布特点及耐药现状。回顾性分析2008年1月至2009年12月哈尔滨医科大学第一临床医学院住院肿瘤患者送检标本分离出的173株真菌的分布及耐药情况。肿瘤患者深部真菌医院感染以下呼吸道感染为主,占76.3%,真菌种类主要是白假丝酵母菌(74.6%);真菌药敏试验结果表明,深部真菌对两性霉素B和5-氟胞嘧啶耐药率均5%;对伊曲康唑及伏立康唑的耐药率为0~6.5%;对氟康唑耐药率有上升趋势,为2.5%~25.0%。临床分离的真菌主要集中在呼吸道标本,以白假丝酵母菌为主,对抗真菌药物普遍敏感,应积极治疗,合理利用抗真菌药物,改善患者预后,减少耐药菌株的产生。     

念珠菌分离鉴定及耐药性分析

目的 了解念珠菌在临床标本中的分布情况及常用抗真菌药物的敏感性,为临床使用抗真菌药提供依据.方法 对2003年至2005年各种临床标本中分离的244株念珠菌进行鉴定,用真菌药敏卡做念珠菌对8种抗真菌药物的药敏试验,结合临床资料综合分析.结果 痰液标本念珠菌检出率最高达60.7%,其次是分泌物为19.3%.共分离白色念珠菌142株,占58.2%,热带念珠菌54株,占22.1%,敏感性较高的药物是5-FC、NYS、AMB,灰黄霉素耐药率最高,达到70%以上.结论 肿瘤,免疫功能低下,病情严重,意识障碍,长期卧床的患者念珠菌感染以白色念珠菌为主,长期使用抗生素是患者真菌感染的主要原因,真菌药敏试验可为临床治疗提供依据.     

Survival after Locoregional Recurrence or Second Primary Breast Cancer: Impact of the Disease-Free Interval

The association between the disease-free interval (DFI) and survival after a locoregional recurrence (LRR) or second primary (SP) breast cancer remains uncertain. The objective of this study is to clarify this association to obtain more information on expected prognosis. Women first diagnosed with early breast cancer between 2003–2006 were selected from the Netherlands Cancer Registry. LRRs and SP tumours within five years of first diagnosis were examined. The five-year period was subsequently divided into three equal intervals. Prognostic significance of the DFI on survival after a LRR or SP tumour was determined using Kaplan-Meier estimates and multivariable Cox regression analysis. Follow-up was complete until January 1, 2014. A total of 37,278 women was included in the analysis. LRRs or SP tumours were diagnosed in 890 (2,4%) and 897 (2,4%) respectively. Longer DFI was strongly and independently related to an improved survival after a LRR (long versus short: HR 0.65, 95% CI 0.48–0.88; medium versus short HR 0.81, 95% CI 0.65–1.01). Other factors related to improved survival after LRR were younger age (<70 years) and surgical removal of the recurrence. No significant association was found between DFI and survival after SP tumours. This is the first study to explore the association between the DFI and survival after recurrence in a nationwide population-based cancer registry. The DFI before a LRR is an independent prognostic factor for survival, with a longer DFI predicting better prognosis.     

Decreasing seroprevalence of Helicobacter pylori infection during 1993-2003 in Guangzhou, southern China

BACKGROUND: Prevalence of Helicobacter pylori infection is inversely associated with socioeconomic conditions. The aim of the study was to evaluate changes in the seroprevalence of H. pylori infection during 1993-2003 in Guangzhou, a representative city of southern China with quick improvement in socioeconomy. METHODS: From March to August 2003, sera were collected from 1471 healthy persons (760 male and 711 female subjects, aged 3-92 years) undergoing annual routine health examination in Guangzhou. H. pylori infection was checked by enzyme-linked immunosorbent assay (ELISA). RESULTS: In 2003, the overall prevalence rate of H. pylori infection was 47% with no gender difference (p > .05). Children aged 1-5 years had the prevalence rate of 19.4%. The prevalence rate then increased steadily with annual infection rate of approximately 1% after this age, reaching a plateau of approximately 55% after the age of 50 years. The peak seroprevalence rate was 63.2% at 40-50 years. Comparing the prevalence rate of H. pylori infection in 2003 with data obtained in 1993, statistically significant decrease of H. pylori infection rate ranged from 11.4 to 18.0% in different age groups was found. The overall age-standardized H. pylori seroprevalence rate was 62.5% in 1993 and 49.3% in 2003. The seroprevalence of H. pylori was found to be significantly decreased over a time span of 10 years (p < .001). CONCLUSIONS: Our data suggest that the seroprevalence of H. pylori infection has significantly decreased during the 10-year period in Guangzhou. This change may be attributable to the improvement in socioeconomic conditions in this city.     

Low prevalence of transmitted drug resistance in patients newly diagnosed with HIV-1 infection in Sweden 2003-2010

Transmitted drug resistance (TDR) is a clinical and epidemiological problem because it may contribute to failure of antiretroviral treatment. The prevalence of TDR varies geographically, and its prevalence in Sweden during the last decade has not been reported. Plasma samples from 1,463 patients newly diagnosed with HIV-1 infection between 2003 and 2010, representing 44% of all patients diagnosed in Sweden during this period, were analyzed using the WHO 2009 list of mutations for surveillance of TDR. Maximum likelihood phylogenetic analyses were used to determine genetic subtype and to investigate the relatedness of the sequences. Eighty-two patients showed evidence of TDR, representing a prevalence of 5.6% (95% CI: 4.5%-6.9%) without any significant time trends or differences between patients infected in Sweden or abroad. Multivariable logistic regression showed that TDR was positively associated with men who have sex with men (MSM) and subtype B infection and negatively associated with CD4 cell counts. Among patients with TDR, 54 (68%) had single resistance mutations, whereas five patients had multi-drug resistant HIV-1. Phylogenetic analyses identified nine significantly supported clusters involving 29 of the patients with TDR, including 23 of 42 (55%) of the patients with TDR acquired in Sweden. One cluster contained 18 viruses with a M41L resistance mutation, which had spread among MSM in Stockholm over a period of at least 16 years (1994-2010). Another cluster, which contained the five multidrug resistant viruses, also involved MSM from Stockholm. The prevalence of TDR in Sweden 2003-2010 was lower than in many other European countries. TDR was concentrated among MSM, where clustering of TDR strains was observed, which highlights the need for continued and improved measures for targeted interventions.     

Shifting seroepidemiology of hepatitis A in Japan, 1973-2003

BACKGROUND: Hepatitis A infection is caused by hepatitis A virus (HAV) contracted through fecal-oral transmission. Life-long immunity is conferred after infection. Improved sanitary conditions have generally resulted in a significant decline in the incidence of hepatitis A. However, a low incidence of infection results in increased HAV susceptibility. The present study investigates the prevalence of anti-HAV antibody and clarifies the current HAV status and HAV susceptibility in Japan at 2003. METHODS: A total of 2,430 serum specimens collected during 2003 from Japanese individuals ranging in age from 0-92 years, were tested for anti-HAV antibody using an inhibition enzyme linked immunosorbent assay. All specimens were obtained from the WHO and the National Serum Reference Bank/National Institute of Infectious Diseases, Tokyo, Japan. RESULTS: The overall seroprevalence was 12.2%. Anti-HAV antibodies were rarely detected in individuals between 0-44 years of age. Starting from the age of 45-49 years, seropositivity gradually increased through age 65 years and above. Seroprevalence was not affected by gender, and geographic distribution did not affect age-specific seroprevalence until the age of 60 years. CONCLUSIONS: HAV susceptibility in Japan is increasing annually. Particularly, the prevalence of anti-HAV antibody in individuals older than 50 years in 2003 was 50.3%, which is significantly lower than that of corresponding studies in 1994 (74.3%), 1984 (96.9%) and 1973 (96.9%). The growing susceptible population of advanced age results in more frequent HAV infection among them. The surveillance of anti-HAV antibody prevalence is useful for implementing preventive measures and for controlling the spread of HAV.     

Total reactive antioxidant potential and DNA fragmentation index as fertility sperm parameters

There is a growing evidence that oxidative stress play a major role in the etiology of defective sperm function including impaired morphology, motility, metabolism and fertility. The aim of the present study was to examine: 1/ total reactive antioxidant potential (TRAP) in seminal plasma; 2/ sperm DNA fragmentation index (DFI), 3/ sperm morphology and motility and 4/ cellular membrane integrity (hypoosmotic swelling test: HOS test) in patients attending in vitro fertilization/intracytoplasmatic sperm injection ( IVF/ICSI) program. According to the DFI value, the men were divided into: group 1 with DFI ≤15% (n=38) and group 2 with DFI ≥15% (n=37). Significant differences between the two groups were found in TRAP, sperm motility, morphology and concentration as well as HOS test scores. In group 1, DFI was negatively correlated with sperm motility and HOS test scores (p<0.05). The sperm morphology was positively correlated with sperm motility and HOS test scores in both groups. There was no correlation between TRAP and sperm chromatin fragmentation. Our results suggest that seminal plasma TRAP level may be a DFI independent parameter of sperm fertility.     

Diurnal variation in sperm DNA fragmentation: analysis of 11,382 semen samples from two populations and in vivo animal experiments

ABSTRACT

Circadian rhythms have been found in some reproductive functions phenotypes but remain unclear for sperm DNA fragmentation index (DFI). The present study aims to investigate the diurnal variation of DFI in mice model and men sperm. Adult male mice were sacrificed for sperm DFI with Sperm Chromatin Structure Assay (SCSA) in 24 hours at 6 evenly distributed time points. A cosinor pattern of DFI was observed with a nadir at zeitgeber time 10 AM. In a community population with 630 semen samples collected between 8 AM and 20 PM, the temporal variation of DFI also fit a cosinor pattern with a ? 343° acrophase and a nadir at 11 AM (P = .031). In a reproductive-medical-center dataset of 10752 semen samples collected between 7 AM and 11 AM, the decreasing trend of DFI was also confirmed. For the males with multiple samples, intra-individual comparison between different timepoints was performed, and each consecutive hour after 7 AM was also associated with 2.5 (95% CI: ?1.0, 5.9)% lower DFI by SCSA or 4.9 (1.9, 7.8)% lower DFI by SCD. Our study reveals a daily diurnal variance in sperm DFI which may suggest a practical approach to get more qualified sperms for natural or assisted reproduction.

Abbreviations: BMI, Body mass index; DFI, DNA fragmentation index; MARHCS, Male Reproductive Health in the Chongqing College Students; RMC, Reproductive Medical Center; SCD, Sperm Chromatin Dispersion; SCSA, Sperm Chromatin Structure Assay.     

Effects of urbanization on stream benthic invertebrate communities in Central Amazon

Urbanization and its physical and chemical effects on aquatic environments influence invertebrate communities negatively. Yet, it is not clear how urbanization affects inter-annual variation of invertebrate assemblages in streams. We 1) evaluated urbanization effects on the ecological conditions (biotic and abiotic) of streams in Manaus and 2) analyzed invertebrate community variation over time (between 2003 and 2010). Data on abiotic variables and invertebrates from 2003 were obtained from a previous study. In 2010 we sampled abiotic variables and invertebrate communities in the same low-order urban streams sampled in 2003 (n = 40). We recorded high values of total nitrogen, total phosphorous, deforestation, total impervious area (TIA), water temperature, pH, and electrical conductivity in the most urbanized streams, as compared to the least-impacted ones. In contrast, the least-impacted streams had high dissolved oxygen concentrations. Water quality was poorer in 2010 than in 2003: oxygen concentration was lower and total nitrogen, total phosphorous, deforestation, and TIA significantly higher in 2010. We recorded higher inter-annual variation of abiotic variables in the most-impacted streams as compared to the least-impacted streams. EPT (%, Ephemeroptera, Plecoptera, and Trichoptera) and richness metrics decreased with urbanization. On the other hand, % OP (percent of Oligochaeta and Psychodidae) increased with urbanization. Observed and EPT richness and% OP increased between 2003 and 2010. On the other hand, rarefied richness decreased between years. Increases of observed and EPT richness between 2003 and 2010 were related to low inter-annual variability in streams conditions; however, differences of% OP and rarefied richness were not related to inter-annual variability in environmental conditions. The degree of urbanization did not explain the magnitude of the within-stream difference of invertebrate communities between 2003 and 2010. The increased effects of urbanization represented by the abiotic variables sampled and the reduction of invertebrate richness and increased dominance of tolerant taxa indicate that public policy is not enough to protect or mitigate human impacts on the urban water systems under study.     

Sperm chromatin structural integrity in normospermic boars is not related to semen storage and fertility after routine AI

Standard semen parameters are limited in their capacity to distinguish subfertile boars and to assess storage influences on liquid preserved boar semen. The evaluation of sperm chromatin structural integrity could have potential as a diagnostic tool in AI practice. This study assessed whether the determination of sperm DNA integrity adds a useful diagnostic tool for selection of boar ejaculates in routine AI procedure and assessment of storage effects in diluted semen. Special emphasis was laid on the standard spermatological characterization of semen samples in parallel with the determination of the DNA fragmentation index (DFI) through the sperm chromatin structure assay (SCSA). Six hundred ninety two (692) ejaculates from 79 Piétrain boars in an AI center were analyzed for motility, morphology and DFI over a period of 24 weeks. 95.5% of the semen samples had a DFI < 5% with low distribution of variation for DFI due to boar and ejaculate (< 5%). 61.3% of ejaculates with DFI > 5% showed values below thresholds for sperm motility or morphology. Based on field data from 13,239 inseminations, fertility of boars with temporarily elevated DFI was not impaired (P > 0.05). 24 randomly selected diluted semen samples did not show a significant increase of DFI during 168 h storage (P > 0.05). In a further experiment, 42 diluted semen samples from 14 normospermic boars were assessed for motility, membrane integrity (PI, FITC-PNA) and SCSA parameters. Three single ejaculates showed an increase of DFI at 120 and 168 h storage time. This was accompanied by a pronounced loss of both motility and membrane integrity. In conclusion, the evaluation of sperm chromatin structural integrity by the SCSA has only limited value for identifying sperm deficiencies in normospermic fresh or stored boar semen. Temporarily elevated DFIs seem not to be indicative of subfertility in normospermic boars.     

2006～2010年泌尿生殖道炎症患者支原体感染率检测与耐药性分析

目的 了解杭州市萧山区2006～ 2010年泌尿生殖道炎症患者支原体感染及耐药情况.方法 对4 023例泌尿生殖道炎症患者用支原体鉴定及药敏试剂盒进行支原体培养及药敏试验.结果 支原体总检出率为48.1％,女性检出率51.2％明显高于男性41.8％ (P ＜0.05).支原体培养阳性患者中Uu单独感染1701例(88.0％),Mh单独感染57例(2.9％),Uu+ Mh混合感染176例(9.1％),Uu单独感染明显高于Mh单独感染和Uu+ Mh混合感染(P＜0.05).5年间支原体阳性检出率从2006年的39.4％到2010年的58.1％逐年增高,感染模式观察期内无明显变化.支原体对交沙霉素、原始霉素和强力霉素均敏感(敏感率≥91.4％),对四环素、红霉素、氧氟沙星和环丙沙星的耐药率高,均大于50％.比较2006年至2010年各种支原体对9种药物的耐药率,除四环素外耐药率呈不同程度上升,四环素耐药率2007年和2008年较高,后逐年下降,2010年为53.5％.混合感染总体耐药率比Uu或Mh单独感染耐药率高.结论 泌尿生殖道炎症患者支原体感染Uu比较常见,且女性检出率显著高于男性.临床分离支原体大多具有多重耐药性,临床治疗需根据药敏结果加以选择.     

2003-2008年我国实验猴BV抗体检测结果及抗体水平变化规律的分析

目的对近年来我国实验猴BV（猴疱疹病毒Ⅰ型）抗体检测结果进行比较分析,以了解我国实验猴BV感染情况及其抗体水平变化规律,为我国实验猴质量控制及标准化提供依据。方法根据国标中ELISA方法 ,对2003～2008年我国11个单位送检的2个品种猴血清进行BV抗体检测,并对检测结果进行统计分析。结果检测的4612份猴血清中,有1843份BV抗体呈阳性,阳性率为39.96%;6年中检测猴群BV抗体阳性率基本在30%～50%。幼年（≤2岁）、青年（2.1～4.0岁）、成年（4.1～6.5岁）、老年（≥6.5岁）4个不同年龄段猴BV感染率分别为26.28%、31.53%、53.74%、87.27%。不同年龄感染率差异显著（P〈0.01）。雌猴BV感染率（35.91%）高于雄猴（34.93%）,但两者差异不显著（P〉0.05）。结论不同年龄猴BV感染率不同,随着年龄的增长BV感染率升高。