谷氨酰胺对多器官功能障碍综合征病人营养代谢及肠道屏障的影响

目的:评价谷氨酰胺(Gln)对多器官功能障碍综合征(MODS)病人营养状态及肠道黏膜通透性的影响.方法:将20例MODS病人随机分为对照组和Gln组,比较两组病人血清清蛋白、转铁蛋白、血糖、氮平衡以及尿乳果糖/甘露醇比值(L/M)的变化,并观察病人肝、肾功能及不良反应.结果:Gln组治疗后清蛋白、前清蛋白和转铁蛋白均较治疗前明显升高,与对照组相比差异有显著性意义(P＜0.05);Gln组负氮平衡于第4天、对照组于第8天转化为正氮平衡,两组比较差异有显著性意义(P＜0.05);Gln组尿L/M降低,与对照组相比差异有显著性意义(P＜0.05);病人肝、肾功能和血糖等均无变化.结论:Gln可促进MODS病人蛋白质合成,改善负氮平衡,降低肠黏膜通透性,无不良反应发生.     

强化支链氨基酸和谷氨酰胺的肠内营养支持对肝硬化病人的治疗作用

目的:探讨强化支链氨基酸(BCAA)和谷氨酰胺(Gln)的肠内营养(EN)支持对肝硬化病人营养状况、肝功能和凝血功能的影响. 方法:选择存在营养不良风险的肝硬化病人87例,随机分为对照组(n=44)和治疗组(n=43).治疗组病人给予口服BCAA粉50 g/d和Gln 15g/d;对照组给予等热量等氮的复方氨基酸颗粒.分别测定两组病人在营养治疗前、营养治疗第4周末和第9周末的营养指标(血清总蛋白、前清蛋白、清蛋白和转铁蛋白)、肝功能指标(丙氨酸氨基转移酶、门冬氨酸氨基转移酶、总胆红素、直接胆红素)和凝血指标(凝血酶原时间测定和凝血酶原活动度).分析比较两组病人治疗前后各项指标的变化. 结果:治疗组病人的营养指标和肝功能指标在治疗第4周末和第9周末较治疗前和较对照组均有明显改善(P＜0.05).而凝血指标的改善仅在治疗第9周末时有显著性差异(P＜0.05). 结论:强化BCAA和Gln的EN支持可增加肝硬化病人的蛋白质合成,改善其营养状况,有益于肝功能的恢复,进而防止肝性脑病的发生.     

早期肠内营养对脑卒中吞咽障碍患者氮平衡、免疫功能及预后的影响探究

目的探讨早期肠内营养对脑卒中并发吞咽障碍患者氮平衡、免疫功能及预后的影响。方法选择湖南省某医院神经内科2015年2月-2016年2月收治的脑卒中并发吞咽障碍患者72例作为研究对象,按照随机数字表法分为观察组和对照组,每组36例。观察组患者在常规治疗的基础上,于入院48h内通过鼻肠管给予营养液进行肠内营养支持;对照组患者在常规治疗的基础上,给予常规半流质饮食。比较2组患者治疗1周、2周、3周及4周时的氮平衡情况,比较2组患者治疗前、治疗10d时的血清免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)等免疫功能指标水平以及血红蛋白(Hb)、前清蛋白(PA)、白蛋白(ALB)等营养指标水平。此外,比较2组患者治疗前、治疗10d时的美国国立卫生院神经功能缺损评分(NIHSS)、格拉斯哥昏迷评分(GCS)及急性生理学及慢性健康状况评分系统(APACHEⅡ)评分。同时观察记录治疗10d内2组患者并发症的发生情况。结果 2组患者均处于负氮平衡状态,随着治疗的进行,2组患者的负氮平衡状态均有显著改善,且观察组患者在治疗1周、2周、3周及4周时的氮平衡状态均优于对照组(P0.05)。治疗10d时,观察组患者的IgG,IgA及IgM水平均高于对照组(P0.05);观察组患者Hb,PA及ALB水平均高于对照组(P0.05);观察组患者的NIHSS及APACHEⅡ评分均低于对照组(P0.05),而观察组患者的GCS评分显著高于对照组(P0.05)。此外,观察组患者误吸、肺部感染、腹泻腹胀的发生率均低于对照组(P0.05)。结论早期肠内营养支持能够有效改善脑卒中并发吞咽障碍患者的营养状态和免疫功能,纠正机体负氮平衡,恢复神经功能,同时减少并发症的发生,对改善患者预后具有积极意义。     

慢性阻塞性肺病加重期患者早期肠内营养支持研究

目的探讨慢性阻塞性肺病(COPD)加重期患者早期肠内营养支持的治疗效果。方法将58例COPD加重期患者分为早期肠内营养组33例和肠外营养组25例,分别于治疗前、治疗第5d及治疗第10d检测各项生化指标,并观察两组并发症情况,计算死亡率。结果早期肠内营养与肠外营养组治疗后各营养指标均有所下降,早期肠内营养组的蛋白类指标降幅低于肠外营养组(P<0.05)。早期肠内营养组感染性并发症发生率(27.27%)低于肠外营养组(56.00%),非感染性并发症发生率(69.70%)高于肠外营养组(40.00%),差别均有统计学意义(P<0.05)。早期肠内营养与肠外营养组死亡率差别无统计学意义(P>0.05)。结论COPD加重期患者进行早期肠内营养支持可有效控制患者营养状况的恶化,纠正或减轻患者的负氮平衡,对于减少感染性并发症具有重要意义。     

黄芪肠内营养对2型糖尿病合并缺血性卒中病人营养代谢的影响

目的:研究黄芪肠内营养对2型糖尿病合并缺血性卒中病人营养代谢的影响. 方法:将64例病人随机分为治疗组和对照组,每组32例.治疗组为黄芪水煎液(相当于生药60 g)加改良匀浆膳,对照组为改良匀浆膳,两组给予105 kJ/(kg·d)的营养支持,等氮、等热量供给,共30 d.两组肠内营养支持前后分别检测空腹血糖及餐后2 h血糖、血清胰岛素、血脂、清蛋白、转铁蛋白、血红蛋白、氮平衡等营养代谢指标. 结果:治疗组肠内营养支持后胰岛素抵抗改善,空腹及餐后血糖降低,与对照组比较差异有显著性意义(P＜0.05,P＜0.01).治疗组经营养支持后,负氮平衡转为正氮平衡,血清清蛋白升高,与对照组比较差异有显著性意义(P＜0.05). 结论:黄芪肠内营养支持可明显改善2型糖尿病合并缺血性卒中病人胰岛素抵抗、血糖及蛋白质营养代谢.     

重症患者肠内营养及生长激素治疗的疗效观察

目的 探讨早期肠内营养(EN)和生长激素(GH)对危重病患者救治的效果.方法 70例危重患者随机分为EN组和EN+GH组.两组营养支持均等热量、等氮量.分别于营养支持前后检测血生化、营养状态指标及肠道黏膜通透性.营养支持治疗10 d后测定两组的免疫学指标与T细胞亚群.营养支持期间每天测定氮平衡,并计算累计氮平衡.结果 EN+GH组体重、白蛋白、转铁蛋白水平的改善优于EN组,但差异无显著性(P＞0.05),而EN+GH组前白蛋白、纤维连接蛋白显著高于EN组(P＜0.05).EN+GH组IgA水平显著低于EN组,而CD4、NK水平显著高于EN组(P＜0.05).EN+GH组肠道通透性显著低于EN组(P＜0.05).EN+GH组累计氮平衡为正氮平衡,而EN组为负氮平衡,二者之间差异具有显著性(P＜0.05).结论 早期EN支持能迅速改善危重患者营养状态,减少并发症,适量应用GH能增强免疫功能,降低致残率和死亡率.     

添加谷氨酰胺双肽的低热量肠外营养在高龄腹部手术病人的临床应用

目的 :探讨添加谷氨酰胺 (Gln)双肽的低热量肠外营养 (PN)在高龄腹部手术病人中的应用价值。　方法 :4 0例病人随机分成研究组和对照组 ,各 2 0例。所有病人术后第 1～ 6天接受等热量 83.6kJ/ (kg·d)、等氮 0 .16 g/(kg·d)的PN支持 ,研究组病人另增加 0 .3g/ (kg·d)的Gln双肽。术前及术后第 1、7天检测血清白蛋白、前白蛋白、IgG、IgA和IgM ,并进行淋巴细胞计数 (LCC)。计算术后第 1、4、7天氮平衡。　 结果 :两组病人术后血清白蛋白和前白蛋白值均较术前下降 ,对照组下降明显 (P <0 .0 5 ) ;术后LCC均较术前升高 ,尤以研究组升高显著 (P <0 .0 1)。累积氮平衡研究组明显高于对照组 (P <0 .0 5 )。未观察到不良反应或并发症。　结论 :添加Gln双肽的低热量肠外营养在高龄腹部手术病人中使用安全 ,具有改善氮平衡、减轻术后血清蛋白水平下降和促进淋巴细胞计数恢复的作用     

低剂量谷氨酰胺对老年脓毒症患者氧化应激保护作用的随机对照研究

目的观察老年脓毒症危重期患者使用免疫营养添加物谷氨酰胺(Gln),对其营养状况和氧化应激损伤的影响。方法采用前瞻、随机、对照临床研究。28例老年脓毒症危重患者随机分为Gln强化营养组(n=14)和常规营养组(n=14),两组使用等热能肠内营养105kJ/(kg·d)。Gln组另给予Gln粉剂口服4g/d,连续7d,于第1、8天检测血清白蛋白(ALB)、前白蛋白(PAB)、脂质过氧化物(LPO)和谷胱甘肽(GSH)水平,并比较急性生理与慢性健康评分(APACHEⅡ)。结果Gln组第8天的血清PAB、GSH水平比常规组显著增高,差异有显著性(P<0.05),而血清LPO水平及APACHEⅡ评分均较常规组明显下降,两组差异有显著性(P<0.05)。结论老年脓毒症患者在危重期应用Gln强化的肠内营养可增进机体抗氧化应激的能力。     

进展期胃癌术后早期肠内-肠外营养联合应用与肠外营养的临床比较

目的探讨进展期胃癌术后早期肠内营养和肠外营养联合应用的可行性、安全性和临床效果。方法62例进展期胃癌患者术后第一天随机分为(1)肠外营养(PN)组;(2)肠内和肠外联合营养(EN-PN)组;(3)对照组。观察在治疗过程中3组患者并发症的发生率、术后肠功能恢复时间、平均住院天数及营养评定的各项指标,进行对比分析。结果对照组并发症发生率明显高于EN-PN组和PN组(P<0.05)。对照组术后胃肠功能恢复时间及平均住院天数较EN-PN组和PN组明显延长(P<0.05),而EN-PN组与其余两组比较显著缩短(P<0.05)。EN-PN组和PN组术后血清白蛋白、前白蛋白和转铁蛋白在营养支持后均明显升高(P<0.05),体重下降缓慢,负氮平衡均得到有效纠正。结论进展期胃癌术后早期肠内营养及肠外营养联合应用安全、可行,在改善机体营养状况方面与全肠外营养相似,并有促进和维护胃肠道功能的作用,同时费用较低。     

免疫肠内营养支持对急性脑梗死诱发SIRS的调理作用

目的观察免疫肠内营养(EN)支持对急性脑梗死诱发全身炎症反应综合征(SIRS)患者细胞免疫功能和急性炎症反应的调理作用。方法选择急性脑梗死诱发SIRS病例64例,随机分为免疫EN治疗组和标准EN对照组各32例。在明确诊断后开始鼻饲,研究时间共10d。观察两组患者EN前后血清蛋白、免疫指标的变化及急性生理和慢性健康状况(APACHEⅢ)评分。结果研究结束时,治疗组的前白蛋白和转铁蛋白显著高于对照组(P<0.05),淋巴细胞总数、CD3、CD4、CD4/CD8及自然杀伤细胞活性显著高于对照组(P<0.05),白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及C-反应蛋白(CRP)显著低于对照组(P<0.01)。同时,治疗组的APACHEⅢ评分较对照组下降显著(P<0.05)。结论免疫EN支持可以改善急性脑梗死诱发SIRS患者的细胞免疫功能和急性炎症反应,有利于控制病情。     

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.     

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.     

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.     

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.