目的对三亚市2022年7月15日发生一起食源性暴发事件进行同源性分析,为临床治疗和防控提供科学依据,探讨脉冲场凝胶电泳(Pulsed-field gel electrophoresis,PFGE)技术和基质辅助激光解析电离飞行时间质谱(matrix-assisted laser desorpti...目的对三亚市2022年7月15日发生一起食源性暴发事件进行同源性分析,为临床治疗和防控提供科学依据,探讨脉冲场凝胶电泳(Pulsed-field gel electrophoresis,PFGE)技术和基质辅助激光解析电离飞行时间质谱(matrix-assisted laser desorption/ionization time-of-flight mass spectrometry,MALDI-TOF MS)技术在沙门菌同源分析中的应用可行性。方法通过传统的细菌检验方法、PFGE和MALDI-TOF MS技术与临床症状、流行病特征相结合,准确对食物中毒事件溯源分析。结果本起事件中出现发热、恶心、呕吐等中毒症状共14例,均有在同一餐厅就餐经历,发病过程和临床表现相似,其中1例为该餐厅制蛋炒饭厨师。经病原学培养鉴定显示为猪霍乱沙门菌和鼠伤寒沙门菌共同引起,其中采集患者14例,检出猪霍乱沙门菌5例,鼠伤寒沙门氏菌3例,阳性率为57.14%(8/14)。环境样本检出1份,食品样本2份。PFGE图谱结果显示9种PFGE型,7株菌株同源性为95.0%,4株菌株同源性为94.0%。结论此次食物中毒原因是食用被猪霍乱沙门菌的蛋炒饭和含鼠伤寒沙门菌污染的猪肉肠。今后应加强食品污染和有害因素风险监测,从食品供应源头保证食品安全,严防食源性感染事件发生。同时规范相关人员健康体检,多渠道宣教食源性疾病危害和预防知识也至关重要。展开更多
AIM: To prospectively assess the impact of time of endoscopy and endoscopist's experience on the outcome of non-variceal acute upper gastrointestinal (GI) bleeding patients in a large teaching hospital.METHODS: Al...AIM: To prospectively assess the impact of time of endoscopy and endoscopist's experience on the outcome of non-variceal acute upper gastrointestinal (GI) bleeding patients in a large teaching hospital.METHODS: All patients admitted for non-variceal acute upper GI bleeding for over a 2-year period were potentially eligible for this study. They were managed by a team of seven endoscopists on 24-h call whose experience was categorized into two levels (high and low) according to the number of endoscopic hemostatic procedures undertaken before the study. Endoscopic treatment was standardized according to Forrest classification of lesions as well as the subsequent medical therapy. Time of endoscopy was subdivided into two time periods: routine (8 a.m.-5 p.m.) and on-call (5 p.m.-8 a.m.). For each category of experience and time periods rebleeding rate, transfusion requirement, need for surgery, length of hospital stay and mortality we compared. Multivariate analysis was used to discriminate the impact of different variables on the outcomes that were considered.RESULTS: Study population consisted of 272 patients (mean age 67.3 years) with endoscopic stigmata of hemorrhage. The patients were equally distributed among the endoscopists, whereas only 19% of procedures were done out of working hours. Rockall score and Forrest classification at admission did not differ between time periods and degree of experience.Univariate analysis showed that higher endoscopist's experience was associated with significant reduction in rebleeding rate (14% vs 37%), transfusion requirements (1.8±0.6 vs 3.0±1.7 units) as well as surgery (4% vs 10%), but not associated with the length of hospital stay nor mortality. By contrast, outcomes did not significantly differ between the two time periods of endoscopy.On multivariate analysis, endoscopist's experience was independently associated with rebleeding rate and transfusion requirements. Odds ratios for low experienced endoscopist were 4.47 for rebleeding and 6.90 for need of transfusion after the endoscopy.CONCLUSION: Endoscopist's experience is an important independent prognostic factor for non-variceal acute upper GI bleeding. Urgent endoscopy should be undertaken preferentially by a skilled endoscopist as less expert staff tends to underestimate some risk lesions with a negative influence on hemostasis.展开更多
文摘目的对三亚市2022年7月15日发生一起食源性暴发事件进行同源性分析,为临床治疗和防控提供科学依据,探讨脉冲场凝胶电泳(Pulsed-field gel electrophoresis,PFGE)技术和基质辅助激光解析电离飞行时间质谱(matrix-assisted laser desorption/ionization time-of-flight mass spectrometry,MALDI-TOF MS)技术在沙门菌同源分析中的应用可行性。方法通过传统的细菌检验方法、PFGE和MALDI-TOF MS技术与临床症状、流行病特征相结合,准确对食物中毒事件溯源分析。结果本起事件中出现发热、恶心、呕吐等中毒症状共14例,均有在同一餐厅就餐经历,发病过程和临床表现相似,其中1例为该餐厅制蛋炒饭厨师。经病原学培养鉴定显示为猪霍乱沙门菌和鼠伤寒沙门菌共同引起,其中采集患者14例,检出猪霍乱沙门菌5例,鼠伤寒沙门氏菌3例,阳性率为57.14%(8/14)。环境样本检出1份,食品样本2份。PFGE图谱结果显示9种PFGE型,7株菌株同源性为95.0%,4株菌株同源性为94.0%。结论此次食物中毒原因是食用被猪霍乱沙门菌的蛋炒饭和含鼠伤寒沙门菌污染的猪肉肠。今后应加强食品污染和有害因素风险监测,从食品供应源头保证食品安全,严防食源性感染事件发生。同时规范相关人员健康体检,多渠道宣教食源性疾病危害和预防知识也至关重要。
文摘AIM: To prospectively assess the impact of time of endoscopy and endoscopist's experience on the outcome of non-variceal acute upper gastrointestinal (GI) bleeding patients in a large teaching hospital.METHODS: All patients admitted for non-variceal acute upper GI bleeding for over a 2-year period were potentially eligible for this study. They were managed by a team of seven endoscopists on 24-h call whose experience was categorized into two levels (high and low) according to the number of endoscopic hemostatic procedures undertaken before the study. Endoscopic treatment was standardized according to Forrest classification of lesions as well as the subsequent medical therapy. Time of endoscopy was subdivided into two time periods: routine (8 a.m.-5 p.m.) and on-call (5 p.m.-8 a.m.). For each category of experience and time periods rebleeding rate, transfusion requirement, need for surgery, length of hospital stay and mortality we compared. Multivariate analysis was used to discriminate the impact of different variables on the outcomes that were considered.RESULTS: Study population consisted of 272 patients (mean age 67.3 years) with endoscopic stigmata of hemorrhage. The patients were equally distributed among the endoscopists, whereas only 19% of procedures were done out of working hours. Rockall score and Forrest classification at admission did not differ between time periods and degree of experience.Univariate analysis showed that higher endoscopist's experience was associated with significant reduction in rebleeding rate (14% vs 37%), transfusion requirements (1.8±0.6 vs 3.0±1.7 units) as well as surgery (4% vs 10%), but not associated with the length of hospital stay nor mortality. By contrast, outcomes did not significantly differ between the two time periods of endoscopy.On multivariate analysis, endoscopist's experience was independently associated with rebleeding rate and transfusion requirements. Odds ratios for low experienced endoscopist were 4.47 for rebleeding and 6.90 for need of transfusion after the endoscopy.CONCLUSION: Endoscopist's experience is an important independent prognostic factor for non-variceal acute upper GI bleeding. Urgent endoscopy should be undertaken preferentially by a skilled endoscopist as less expert staff tends to underestimate some risk lesions with a negative influence on hemostasis.
