HACCP的历史、原则和要求

阐述HACCP的发展历史,使用原则和具体操作要求,为制定HACCP制度提供指南。     

The value of objective measurements to select patients who are malnourished

Several studies have attempted to define nutritional parameters that can be used to select malnourished hospitalised patients for nutritional support. A combination of objective nutritional parameters was evaluated in a group of 50 patients selected for total parenteral nutrition on clinical grounds only and compared with a control group. This control group consisted of 38 patients who were admitted for elective minor surgical procedures such as varicectomy and hernia repair. On a subset of 18 objective nutritional measurements, discriminant analysis was performed. In the evaluation it was shown that a combination of albumin (ALB), prealbumin (PALB), total lymphocyte count (TLC) and the percentage of ideal weight (PIW) was the most useful combination of nutritional tests in discriminating a chosen malnourished (M) group and a control group who were declared not malnourished (NM). With this combination the patients were correctly classified in 93% with a sensitivity of 93% and a specificity of 94%.     

医用多参数监护仪的基本原是及使用

本文系统描述了多参数监护仪的定义，组成部分，工作原理，实施方法，及其使用当中的安全标准和领导高精尖领域的最新进展。     

Release of norethisterone from a bioabsorbable implant in female bonnet monkeys (Macaca radiata)

Bioabsorbable implants prepared by fusion of 85% norethisterone (NET) and 15% cholesterol were inserted subdermally in four cycling bonnet monkeys (Macaca radiata). No skin reaction or inflammation was observed at the site of implantation. Plasma concentration of norethisterone (NET) measured by radioimmunoassay were monitored for 14 to 16 months at monthly intervals. In the first month weekly samples were analysed. NET was released into circulation within 24 hours after insertion of the implant. In all the monkeys, except one, a sharp rise in NET (1.9 to 20 ng/ml) occurred immediately after insertion. Levels then remained between 1.7 and 0.6 ng/ml for about 4 months. Thereafter they remained steady up to about 9 months in two monkeys and gradually declined to about 0.4 ng/ml in the remaining two. In all except one, there was a sudden burst of NET release between the 10th and 11th month. The hormone almost cleared out of circulation by the 14th to 16th month. Initial menstrual cycles after pellet insertion were disturbed, leading to spotting and irregular bleeding. Regular cycles appeared from 5 to 8 months after the insertion of the implant. These cycles were ovulatory, as determined by the progesterone levels.     

Serum prolactin concentrations related to copper or inert intrauterine devices (IUDs) in women

A report that serum prolactin concentrations were almost doubled by the use of copper IUDs led us to study the effect of both copper and inert IUDs. We studied 105 normal women in whom all other prolactinergic factors had been excluded; 25 of them were using copper IUDs, 25 were using inert IUDs and there were 55 controls. No differences were found in the mean prolactin levels between these groups (4.3, 4.5 and 4.3 microgram/l, respectively). We conclude that copper and inert IUDs do not affect prolactin secretion.     

Cryopreservation of viable Giardia intestinalis trophozoites

A technique is described for the cryopreservation of Giardia intestinalis trophozoites. The most satisfactory results were obtained when organisms were preserved with either 7·5 or 10% dimethyl sulphoxide (Me₂SO) and cooled using a liquid nitrogen controlled freezer. Under these conditions more than 70% of organisms were motile after thawing. Lower recovery rates were obtained using glycerol as the cryopreservant or when samples were placed directly into a ?70 °C refrigerator to cool. Cultures were successfully re-established from material cooled under controlled conditions using either 7·5% Me₂SO or glycerol as the cryopreservant. However, the former had an initial generation time of 12·0 hours compared to 24·5 hours for the latter.     

Skin bacteria and Op Site chest dressings

Growth of skin bacteria on the infraclavicular region was studied in two series of male volunteers. In the first, Op Site, a polyurethane adhesive film dressing, was compared with an occlusive polyvinyl chloride (PVC) dressing, on povidone iodine (PVI) prepared skin in 10 volunteers. Bacteria were sampled, using perspex cylinders and buffered Triton X-100 detergent, at 2, 4, 7 and 14 days, cultured aerobically and anaerobically, and colonies counted at 24 and 48 h respectively. Colony counts under Op Site were less than for undressed (control) skin and under PVC, at all days sampled, the difference being statistically significant at 2 and 14 days for controls and 4 days for PVC. In the second, four regimens of skin preparation, with Op Site dressings were compared in 12 volunteers, skin being sampled 4, 7 and 14 days. Chlorhexidine (CHD) and PVI were compared with and without defatting. Defatting significantly reduced colony counts at 4 and 7 days, whereas no differences were demonstrated between CHD and PVI. The combination of defatting and CHD resulted in colony counts consistently less than 10(3) organisms at 4 and 7 days. Op Site does not potentiate the growth of skin bacteria and is preferable to an occlusive PVC adhesive dressing. Op Site may be left intact on the chest for up to 7 days, colony counts remaining within acceptable limits.     

The effect of environmental temperature on resting metabolic rate and respiratory quotient following elective surgery

Twenty male patients undergoing routine elective abdominal surgery of moderate severity nursed at either 20 or 28 degrees C had indirect calorimetry carried out on a control day pre-operatively and for the first four post-operative days. The mean resting metabolic rate over the four post-operative days was significantly elevated by 9% above control value. This increase was maximal on post-operative day 1 (13%). Respiratory quotient fell over four days of the post-operative period indicating that a greater proportion of energy was being derived from body fat stores. Nursing at different environmental temperatures did not affect these responses.     

Orchidectomy in a rural African population

From 1971 to 1977 in Zaria, Nigeria, orchidectomy was performed on 341 men, mostly in the third to sixth decades of life. The testis itself was diseased only in 21% of cases. Torsion of the spermatic cord with testicular infarction occurred in 11% and cancer was present in less than 2%. Orchidectomy was performed therapeutically in 5% of the patients. The major causes for testicular resection were complicated and large inguinal herniae and hydroceles. These two conditions are a source of socio-economic hardship and considerable morbidity in a farming population. It would thus be worth while to include facilities for surgery of small herniae and hydroceles in plans for rural health care.     

A field trial of a single intramuscular injection of long-acting chloramphenicol in the treatment of meningococcal meningitis

During an epidemic of meningococcal meningitis 86 patients with symptoms and signs of meningitis were treated with a single intramuscular injection of a long-acting oily preparation of chloramphenicol (Tifomycine). Treatment was given by auxiliary medical staff who worked in four separate village dispensaries under the supervision of the local medical officer. The clinical response to treatment was satisfactory; 79 of 86 patients (92%) recovered fully with few residual disabilities. There were five deaths (5.8%) but a definite diagnosis of meningococcal meningitis was established in only one of these patients. Treatment was changed because of a poor clinical response in two further patients. Diagnosis was eventually proved in 45 patients (52%). The response to treatment of patients in this group was similar to that observed in the remaining 41 patients. The results of this preliminary study show that a single dose injection of a long-acting chloramphenicol is of value in the management of epidemics of meningococcal meningitis in rural areas because patients can be treated locally and early in their village dispensaries, thereby minimizing the need to transport them to urban hospitals which are often distant and congested.     

Frequency of blood group antigens in Nigerian children with falciparum malaria.

The frequencies of the following blood group antigens: A, B, O, M, N, S, s, U, Fya, FyB, Lea, Jsa and K have been determined in Nigerian children with severe falciparum malaria. The frequency distribution of M, N, S, s, U, Fya and Fyb were not significantly different in children with life-threatening falciparum malaria and controls. The frequencies of A, B, O, Lea, Jsa and K found in the children with severe malaria were similar to those previously reported for healthy adults in this population. The Duffy blood group antigens Fya and Fyb were virtually absent from both infected and control children. This finding is in variance with a Fya frequency of 23% reported by Worlledge et al. (1974) for healthy adults in this population.     

The sensitivity of Plasmodium falciparum to chloroquine and amodiaquine in Ibadan, Nigeria

An extended in vivo test of the sensitivity of Plasmodium falciparum to antimalarial drugs in Nigerian children showed no evidence of resistance to chloroquine and amodiaquine. However, the results of a small number of in vitro tests suggest a decreased sensitivity of the parasite to chloroquine when compared with the results of earlier studies in the same locality.     

Clinical and immunological responses with Pr- beta-hCG-TT vaccine

Six different batches of Pr-beta-hCG-TT vaccine have been evaluated in 23 women for the antibody response. The anti-sera formed against these conjugates were capable of reacting immunologically with the whole hCG in radioimmunoassays and also neutralized the biological activity of hCG in radioreceptor assays. The antibody titres attained peak levels 4-6 months after the first injection. The peak titres could not be sustained and most of the subjects showed a spiky pattern. One subject was considered as non-respective, two others had fairly low titres. Amongst the conjugates tested, batch 108 with SPLPS (sodium pthalate denatured with lipo-polysaccharides from S. entritides) seemed more promising, but the addition of the adjuvant was found to be pyrogenic and unlikely to be accepted clinically.