黄芪匀浆膳对重型颅脑损伤患者免疫功能和营养代谢的影响

目的研究黄芪匀浆膳对重型颅脑损伤患者免疫功能及营养代谢的影响。方法将75例患者依不同营养措施综合考虑各非处理因素分为黄芪匀浆膳组、匀浆膳组和肠内营养多聚合剂组,每组25例。黄芪匀浆膳组尽早(48～72小时)给予改良匀浆膳加黄芪水煎液(相当于生药60g)治疗,匀浆膳组仅给予改良匀浆膳治疗,肠内营养多聚合剂组给予肠内营养多聚合剂治疗,早期肠内营养不足部分由肠外营养补充,共20天。各组肠内营养支持前后均采血测定IgA、IgG、IgM,T细胞亚群(CD4、CD8、CD4/CD8),同时监测空腹血糖、白蛋白、转铁蛋白、血红蛋白、氮平衡等营养代谢指标。结果黄芪匀浆膳组营养支持后IgG、CD4(%)、CD4/CD8升高,与匀浆膳组和肠内营养多聚合剂组比较,差异具有显著性(P<0.01);黄芪匀浆膳组和匀浆膳组营养支持后空腹血糖降低,与肠内营养多聚合剂组比较,差异具有显著性(P<0.01,P<0.05),黄芪匀浆膳组与匀浆膳组比较,差异亦有显著性(P<0.05);黄芪匀浆膳组营养支持后,负氮平衡转为正氮平衡,转铁蛋白与白蛋白升高,与匀浆膳组和肠内营养多聚合剂组比较,差异具有显著性(P<0.05,P<0.01)。结论黄芪匀浆膳可显著改善重型颅脑损伤患者免疫功能、血糖及蛋白质营养代谢。     

黄芪肠内营养对2型糖尿病合并缺血性卒中病人免疫功能影响

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体液免疫(IgA、IgG、IgM)和细胞免疫(T细胞亚群)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.治疗组给予黄芪水煎液(相当于生药60 g)加改良匀浆膳;对照组给予能全力,共30 d.两组肠内营养支持前后均测定IgA、IgG、IgM和T细胞亚群,同时监测空腹血糖、血浆清蛋白、转铁蛋白和血红蛋白等营养指标.结果:①治疗组肠内营养支持后,IgG、IgM、CD4和CD4/CD8比值均升高,与对照组比较,差异有显著性意义(P＜0.05,P＜0.01);②治疗组肠内营养支持后空腹血糖降低,与对照组比较,差异有显著性意义(P＜0.01).③两组病人经营养支持后,转铁蛋白升高(P＜0.05).结论:黄芪肠内营养可明显改善2型糖尿病合并缺血性卒中病人免疫功能及空腹血糖.     

早期肠内营养在重型颅脑损伤病人中的合理应用

目的:探求早期肠内营养对重型颅脑损伤病人血糖、蛋白质代谢和并发症的影响.方法:将40例重型颅脑损伤病人随机分成两组,即试验组于术后48～72 h给予改良匀浆膳治疗,对照组给予能全力治疗,不足部分由肠外营养补充.在营养支持第1、15和30天分别检测两组病人的血糖、血清清蛋白、转铁蛋白、血红蛋白、氮平衡和并发症.结果:血糖、蛋白质代谢在两组得到明显改善(P＜0.01,P＜0.05),试验组与对照组相比,血糖和氮平衡改善更为明显(P＜0.05).结论:对重型颅脑损伤病人早期实施肠内营养是一项重要措施,改良匀浆膳与能全力相比有降低血糖和促进氮平衡的作用.     

低糖类肠内营养制剂对高血糖危重症病人的影响

目的:评价低糖类肠内营养制剂对高血糖危重症病人的影响.方法:将52例病人随机分成研究组和对照组,分别给予相同热量和氮量的肠内营养支持.研究组用康全达,对照组用能全力.观察治疗前后血糖、血浆清蛋白、血红蛋白、血脂、二氧化碳分压和氧分压的变化.结果:研究组病人空腹血糖水平变化小,无需加用胰岛素;对照组病人空腹血糖明显升高,需加用胰岛素治疗.研究组治疗后与对照组比较,血气分析指标变化差异有显著性意义(P＜0.05).两组病人肠内营养支持后的清蛋白和血红蛋白水平明显升高,而血脂变化差异无显著性意义.结论:低糖类肠内营养制剂对控制危重症病人的高血糖、改善呼吸功能和营养状况有一定的作用.     

新型糖尿病肠内营养制剂改善急性重症缺血性脑卒中病人的血糖和胰岛素抵抗状态

目的:研究急性重症缺血性脑卒中病人的胰岛素抵抗状态,并探讨可能改善病人血糖和胰岛素抵抗状态的肠内营养(EN)制剂. 方法:采用随机对照前瞻性研究,对脑卒中量表评分(NIHSS)≥10分并伴有吞咽困难的急性缺血性脑卒中病人62例,随机分为新型糖尿病EN治疗组(A组)和传统糖尿病EN治疗组(B组).观察两组病人的胰岛素抵抗状态,并比较使用不同EN制剂病人治疗第7天的营养状况和胰岛素抵抗水平. 结果:①治疗第7天,两组急性重症脑卒中病人的营养状况均无明显变化,其中A组病人的血脂明显改善;②治疗第7天,A组EN支持12 h后血糖和日血糖最大波动幅度均显著低于B组(P＜0.05).A组治疗后胰岛素抵抗指数(HOMA-IR)、空腹血糖、营养支持后8和12 h血糖、日血糖最大波动幅度均较治疗前有显著改善(P＜0.05). 结论:新型糖尿病型EN制剂不仅对急性缺血性脑卒中病人提供足够的能量支持,而且能改善病人胰岛素抵抗状态,协助控制血糖.     

高血糖危重病病人的肠内营养应用

目的:观察用不同肠内营养配方对高血糖危重病病人营养支持后血糖、血脂等的影响. 方法:分别用安素、能全力、益力佳对45例病人行相同热量的肠内营养,监测空腹血糖、血常规、血清钾、钠、氯、肝肾功能、前清蛋白及转铁蛋白,留24 h尿,测尿素氮、肌酐浓度. 结果:鼻饲安素和能全力病人空腹血糖明显升高,需加用胰岛素治疗,而益力佳组空腹血糖波动小,无需加用胰岛素(P<0.05).三组病人肠内营养前后的血清三酰甘油和胆固醇均无明显变化. 结论:危重病病人应该早期进行肠内营养,并根据病人的不同情况选用不同的肠内营养剂.     

脑梗死昏迷病人的早期肠内营养

０　引　　言　　脑梗死昏迷病人的早期肠内营养治疗,对纠正病人的负氮平衡,防止体重过分丢失,促进病人康复具有重大意义。但若早期肠内营养不当,病人亦可出现腹胀、腹泻、呕吐等并发症。本文在２０例病人初步随机对比了混合奶、匀浆、要素膳和匀浆＋要素膳的肠内营养支持效果和不良反应。１　临床资料１．１　观察对象和方法　本组共２０例,均为临床确诊的脑梗死昏迷病人,其中男１６例,女４例,年龄为４２～７５岁。肠内营养开始时间为脑梗死发生后１周内。将观察对象按不同的鼻饲营养液分为四组,每组５例。第一组为混合奶组,第二…     

短肽型肠内营养制剂适用于老年脑卒中病人的营养支持

目的:评价短肽型肠内营养(EN)制剂对老年脑卒中病人营养支持治疗的疗效. 方法:将60例出现吞咽障碍需营养支持治疗的老年脑卒中病人,随机分为试验组(n =30,入院48 h内鼻饲给予短肽型EN制剂)和对照组(n=30,入院48 h内鼻饲给予匀浆膳).观察两组病人营养支持前后营养指标和不良反应的发生情况.结果:经过30 d的营养支持,试验组病人较对照组能更好地维持前清蛋白、清蛋白和血红蛋白水平;对照组病人前清蛋白、清蛋白和血红蛋白水平比入院时有显著降低(P＜0.01).试验组病人不良反应(腹胀、腹泻、呕吐、胃潴留、误吸和吸入性肺炎)的发生率(36.67％)显著低于对照组(56.67％),差异有显著性统计学意义(P＜0.05). 结论:短肽型EN制剂对老年脑卒中病人营养支持治疗的疗效和安全性均优于匀浆膳.     

回生淀粉匀浆膳对2型糖尿病管饲病人血糖的影响

目的:探讨回生米饭作匀浆膳主食对2型糖尿病管饲病人餐后血糖应答的影响。方法:采用人群自身对照研究方法,将22例病情和血糖基本稳定的2型糖尿病管饲病人随机分为两组,即普通米饭匀浆膳组和回生米饭匀浆膳组。普通米饭匀浆膳组病人试验前3 d给予普通米饭匀浆膳,后3 d给予回生米饭匀浆膳;回生米饭匀浆膳组则食用顺序相反。每组各11例。普通米饭匀浆膳用新鲜蒸米饭作主食,回生米饭匀浆膳用冷藏蒸米饭作主食,其他食物成分相同,两种匀浆膳总热量相等。于试验第3天和第6天观察病人空腹和餐后30、60、120和180 min血糖和胰岛素的变化,持续观察病人的胃肠道反应。结果:与普通米饭匀浆膳比较,管饲回生米饭匀浆膳后,病人餐后60和120 min血糖值均显著降低(P<0.01),餐后30 min胰岛素水平显著降低(P<0.05);餐后血糖应答曲线和胰岛素释放曲线均低于管饲普通米饭匀浆膳后,且波动平稳。试验期间未发生消化道不良反应。结论:回生淀粉匀浆膳作主食具有吸收缓慢而持久的特点,可维持餐后血糖稳定,病人耐受性良好。     

肝源性糖尿病病人营养干预效果的观察

目的:观察营养干预对肝源性糖尿病病人血糖和肝功能的影响.方法:将57例病人随机分为观察组(n=29)和对照组(n=28).两组给予相同的保肝药物,观察组采取严格的饮食治疗措施,对照组使用胰岛素控制血糖.结果:观察组经营养干预后,空腹血糖、餐后2h血糖和糖化血红蛋白,均较干预前明显下降(P＜0.05).对照组治疗后空腹血糖和餐后2h血糖,较干预前明显下降(P＜0.05).两组病人治疗后肝功能指标和血糖较治疗前均有显著改善,但两组间差异无显著性意义(P＞0.05).结论:合理的营养治疗对控制肝源性糖尿病病人的病情效果较好.     

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 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.     

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.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

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.