营养支持治疗在慢性肝功能衰竭病中效果观察

目的探究营养支持治疗在慢性肝衰竭上在治疗上的效果。方法对住入我院的40例慢性肝衰竭患者的营养状况进行综合的分析评价,对这些患者进行治疗时,以现代的内科综合治疗为主,再辅助以相对专业的营养支持治疗,结合患者自身情况选用肠内或肠外或者是两者相结合的方法进行具体的治疗。以生化指标的具体变化以及营养状况作为对比条件,对患者的情况进行治疗前后的比较,进而来判断其临床疗效到底如何。结果在未进行治疗的时候,40例患者中有38例都存在着营养不良的状况,但是这些患者营养不良的程度各自之间都有所差别,经过一段时间的治疗,其营养不良的现象均有所好转,只是好转的程度各有差异。结论在进行对慢性肝病患者的治疗时,要结合患者自身的不同差异,根据患者具体的病情以及病情的发展情况,采取适合于患者的营养支持方案,如果患者能够很好地再配合内科医生进行综合地治疗,就一定会取得相当好的疗效。     

Leishmania donovani: Dynamics of L. donovani evasion of innate immune cell attack due to malnutrition in visceral leishmaniasis

ObjectiveMalnutrition may be significant in the modulation of immune responses in visceral leishmaniasis (VL). Data on the relationship between malnutrition and innate immune response in VL are limited. The aim of this study was to examine the effect of malnutrition on the profile of innate immune functions of polymorphonuclear neutrophil granulocytes (PMNs) and monocytes through comparison of well-nourished and malnourished Indian patients with VL.MethodsForty individuals were enrolled comprising 20 active and untreated cases of VL and 20 non-VL individuals from the endemic region of Bihar, India. The patients with VL were segregated into two groups of 10 well-nourished and 10 malnourished participants. Patients' blood samples were directed against a crude Leishmania donovani extract (soluble leishmanial antigen) and phorbol 12-myristate-13-acetate plus ionomycin. The transendothelial cell adherence migration abilities of the PMNs and monocytes directed against these antigens were determined in whole-blood assays by flow cytometry. The chemokine (interleukin [IL]-8, macrophage inflammatory protein [MIP]-1 α) and cytokine support (tumor necrosis factor -α, interferon [IFN]-γ, IL-10), which could be significant in transendothelial cell migration, and efficacies of antileishmanial phagocytic function and reactive oxygen species (ROS) generation were also determined.ResultsSevere hindrance in the adherence of innate immune cells to the endothelial wall due to Leishmania parasites, as revealed by decreased shedding of l-selectin (CD62 L) and down-regulation of CD11 b expression on the surface of the PMNs and monocytes, occurred in malnourished VL patients. The production of MIP-1 α and IL-8 in response to L. donovani antigen was reduced in malnourished patients. In contrast, malnutrition in VL patients significantly reduced the IFN-γ and TNF-α produced by these immune cells, whereas the levels of IL-10 were significantly elevated. Malnourished VL patients were observed with severely dysfunctional PMNs and monocytes in terms of ROS activity that could not be recovered by stimulation with L. donovani antigen.ConclusionsMalnutrition linked to VL can be a decisive factor in the dynamics of L. donovani evasion of innate immune cell function in VL patients.     

Prise en charge nutritionnelle d’une patiente après allogreffe de cellules souches hématopoïétiques

Patients undergoing allogeneic stem cell transplantation (ASCT) after myeloablative conditioning (MAC) have a high incidence of malnutrition that is known to increase the risk of mortality. The case of this patient hospitalized in 2007 illustrates the standard of care developed by the nutritional support team (UTNC) of Lille University Hospital since the 2000s in such patients.     

营养干预对维持性血液透析患者营养不良的影响

目的　分析营养干预对维持性血液透析(MHD)患者营养不良发生率的影响。方法　选取本院MHD患者196例，应用随机数字表随机分为研究组和对照组，每组98例，研究组进行营养干预6个月，对照组自主饮食，观察并对比两组6个月后的营养不良发生率。结果　干预组和对照组基线情况一致，无论是年龄、生化指标还是营养不良发生率差异均无统计学意义(均P＞0.05)。6个月后，尽管研究组营养不良率［35.7%（35/98）］较基线水平［33.7%(33/98)］略有增加，但是差异无统计学意义（P=0.764）；而对照组自主饮食6个月后营养不良率［59.2%(58/98)］显著增加，与基线相比差异有统计学意义（P=0.000）； 营养干预6个月后研究组营养不良发生率较对照组下降，差异有统计学意义（P=0.000）。结论　对MHD患者进行营养干预6个月，可以明显降低营养不良的发生率，改善预后，但长期疗效有待于进一步研究。     

Environmental risk factors in outpatient recovery from malnutrition

Studies evaluating Nutrition Rehabilitation Centres indicate that they hold several advantages over alternative methods of care for malnourished children. Nonetheless, an important minority of outpatient cases attending such centres does not make adequate progress, and this has been attributed to shortcomings in their home environment.

A survey in Uganda showed that different features of the home environment affected progress for urban and rural outpatients. The findings also suggest that for both groups the child's home situation can indeed be used to explain his progress, with eight variables explaining around 70 percent of the variance in recovery scores. These variables describe the size of the child's family, the level of food resources available, and the amount of help his mother can martial in caring for him.

Information on these predictors of recovery could be recorded in the case notes on the child's first attendance at the clinic, thereby providing an initial estimate of the risk that he will not respond adequately to the outpatient treatment, requiring, instead, more intensive care.