高通量血液滤过治疗时机对老年脓毒性休克患者的影响

目的分析老年脓毒性休克患者分别在6小时早期复苏内、6小时早期复苏后实施高通量血液滤过(High Volume Hemofiltration,HVHF)治疗过程中的生命体征和血管活性药物用量的变化,评价HVHF治疗时机对老年脓毒性休克患者的影响。方法选择老年脓毒性休克患者21例,根据HVHF治疗时机分为两组。A组(8例):在6小时内给予早期复苏治疗,同时联用HVHF。B组(13例):在6小时内给予早期复苏治疗,于6小时后再联用HVHF治疗。比较两组患者0、24、48、72 h的APACHE-Ⅱ评分、SOFA评分、血管活性药物用量。结果 A组患者在HVHF治疗24、48、72 h的APACHE-Ⅱ评分、SOFA评分及血管活性药物用量明显优于B组患者,结果有显著性差异(p<0.05)。结论早期HVHF治疗可以降低老年脓毒性休克患者APACHE-Ⅱ及SOFA评分,减少血管活性药物用量。     

血液滤过开始时间对脓毒症预后的影响

目的:探讨连续性血液净化(CBP)开始时间对脓毒血症患者预后的影响.方法对2009.5-2010.12于本院ICU住院的50例脓毒症患者,根据诊断脓毒症后进行血液滤过的时间分为早期血液滤过组(诊断脓毒症48小时内),和晚期血液滤过组(诊断脓毒症后大于48小时).进行不同时段的CBP治疗,观察及统计其对血流动力学、氧合功能、生化指标、住ICU时问及预后的影响.结果:A,B组在治疗前APACHE-Ⅱ评分、SOFA评分、死亡危险性R(%)无显著统计学意义,但从CBP开始治疗10天后APACHE-Ⅱ评分、SOFA评分、死亡危险性R(%)均有明显下降,且A组下降更多,与B组比较存在显著差异(P<0.05);在出ICU时,虽然APACHE-Ⅱ评分无统计学意义,但SOFA评分、死亡危险性R(%)A组比B组均有明显下降(P<0.05);A组较B组人住ICU时间短,亦有显著差异(P<0.05).随着治疗时间的延长,两组患者血白细胞、血肌酐、尿素氮、血浆肿瘤坏死因子(TNF)、白细胞介素-1(IL-1)、IL-6和内毒素(LPS)浓度均有降低,但A组降低更明显(P<0.05).CBP对脓毒血症有明显的治疗作用,且早期(48小时内)介入,可以提高脓毒血症患者的救治率,改善预后.     

老年消化道肿瘤病人术后经三腔胃肠管早期肠内营养的应用价值

目的:探讨三腔胃肠管在老年消化道恶性肿瘤病人手术后EEN的应用价值. 方法: 选取28例老年消化道恶性肿瘤病人,术后给予EEN,分为单腔普通营养管(胃肠减压管 鼻肠管)组和经鼻置三腔胃肠管组.术后48 h开始给予以瑞能为主的EN,对比置管成功率、病人出现呕吐、腹泻等不耐受情况的比例、达到预期营养目标的比例、感染发生率等,并在第8天复查肝、肾功能,评价三腔胃肠管在老年消化道恶性肿瘤病人术后的应用价值.结果: 三腔胃肠管在胃肠减压的同时,还可进行EN,降低了并发症的发生率;采用瑞能进行EEN未发现严重不良反应. 结论: 老年消化道恶性肿瘤病人术后采用三腔胃肠管进行的EEN安全可行.     

重症急性胰腺炎病人不同时机早期肠内营养治疗效果研究

目的:探讨重症急性胰腺炎(SAP)病人早期肠内营养(EN)治疗的效果。方法:选择180例SAP病人随机分为三组,早期肠内营养(EEN)组于患病后第3天通过鼻空肠管给予EN、肠内营养(EN)组于患病后第6天通过鼻空肠管给予EN和肠外营养(PN)组,每组60例。并分别测定各组病人在患病后相同时间点的相关生化和营养指标,评估其疗效。结果:EN组病人营养指标、反映病情严重度指标恢复正常均快于PN组。EEN组较EN效果更好。结论:SAP病人早期EN治疗效果肯定,宜尽早给予EN。     

降钙素原、C-反应蛋白、中性粒细胞与淋巴细胞比值在评估急性胰腺炎严重程度和预后中的临床价值

目的 探讨降钙素原(PCT)、C-反应蛋白(CRP)、中性粒细胞与淋巴细胞比值(NLR)在评估急性胰腺炎严重程度和预后中的临床价值。方法 选择2020年11月—2021年12月在本院收治的121例急性胰腺炎患者作为研究对象,按疾病严重程度分为轻症组(MAP,n=52例)、中症组(MSAP,n=51例)和重症组(SAP,n=18例),另选取同期体检的50例健康体检者设为对照组。检测各组患者的PCT、CRP及NLR水平,将其与APACHE-Ⅱ评分和住院天数进行相关性分析,同时采用受试者工作曲线(ROC曲线)分析PCT、CRP及NLR水平在急性胰腺炎患者预后中的临床意义。结果 SAP组血清PCT、CRP、NLR水平及住院天数、APACHE-Ⅱ评分均高于MSAP组、MAP组,差异有统计学意义(P<0.05);MSAP组血清PCT、CRP水平均高于MAP组,差异有统计学意义(P<0.05);Pearson相关性分析结果显示,血清PCT、CRP水平与APACHE-Ⅱ评分成显著性正相关,NLR与APACHE-Ⅱ评分无相关性(P=0.194);ROC曲线分析显示,三者联合检测时其预测预后不...     

早期肠内营养治疗对脓毒症病人机械通气脱机的临床观察

目的:评价早期肠内营养(EN)方式对脓毒症病人机械通气治疗脱机的影响. 方法:将64例确诊为脓毒症病人行机械通气者随机分为24h内EN治疗(A组,n=32)和72 h后EN治疗(B组,n=32).在常规综合治疗的基础上,A组24于h内给予EN和肠外营养(PN)治疗;B组于72 h内给予TPN治疗,72 h后加用EN,两组病人接受等氮、等热量营养支持.比较两组不同时机加用EN支持1周后的营养状况、临床有效率、脱机成功率以及28 d病死率等. 结果:两组病人营养支持及综合治疗后有效率无显著性差异(P＞0.05),但血清清蛋白、前清蛋白和总蛋白、淋巴细胞计数水平有所升高,其中A组明显高于B组(P＜0.05).同时,两组病人治疗后氧合指数、呼吸浅快指数、口腔闭合压、肺动态顺应性均明显好于治疗前(P＜0.05),组间氧合指数和病死率无统计学差异(P＞0.05).而A组呼吸浅快指数、口腔闭合压、肺动态顺应性与B组比较有显著性差异(P＜0.05),A组脱机成功率明显高于B组(P＜0.05). 结论:EEN支持可提高脓毒症病人的营养状态,有利于肠功能恢复,缩短病人机械通气时间,提高脱机成功率.     

早期肠内营养对脑卒中病人营养状态和预后的影响

目的:评估EEN对脑卒中病人营养状态和预后的影响. 方法:将48例脑卒中病人随机分为EEN组和延迟EN(DEN)组.EEN组于患病72 h内开始给予EN支持;DEN组患病72 h后、6 d内开始给予EN支持.入院第l和第14天检测两组病人的营养指标和NIHSS评分,第14天观察感染性并发症,第30 天对住院病人和已出院的病人进行Rankin修订量表评分. 结果:入院时,两组的营养指标和NIHSS评分均无显著性差异.入院后14d.EEN组血清ALB和PA显著高于DEN组(P<0.05);两组病人N1HSS评分较入院时均有改善,EEN组优于DEN组;EEN组病人的感染发生率明显少于DEN组(P<0.05).人院第30天,EEN组病人的Rankin修订量表优于DEN组(P<0.05). 结论:对伴有进食障碍的脑卒中病人,EEN支持能稳定营养状态,减少感染性并发症,促进神经功能恢复,提高生活质量,改善预后.     

早期肠内营养添加谷氨酰胺对重症急性胰腺炎炎症反应和免疫功能的影响

目的: 观察EEN中添加Gln对重症急性胰腺炎(SAP)炎症反应和免疫功能的影响. 方法: 将60例病人随机分为三组,常规EN组在入院第7～10天行EN;EEN组在第2～4天行EN;Gln强化组在EEN液中添加Gln 0.6 g/(kg·d).进行APACHEⅡ评分,并检测病人入院时、入院后第2、5、7、10、14和30天的CRP、IL-6、Gln浓度和单核细胞表面人白细胞抗原(HLA-DR);记录EN前后病人每天的膀胱压和肠鸣音.当膀胱压﹥25 cmH2O、肠鸣音消失时,停用EN. 结果: ①常规EN组、EEN组和Gln组病人各完成临床观察17例、16例和16例.常规EN组病人EN开始时间晚于EEN组和Gln组(P<0.05),但在耐受性、达全量时间、持续时间、EN支持途径和并发症等比较中,三组病人无显著性差异(P>0.05).②在病程早期,常规EN组病人APACHEⅡ评分、CRP、IL-6均高于EEN组和Gln组,HLA-DR和Gln浓度较低(P<0.05),Gln组IL-6较EEN组更低,而HLA-DR和Gln浓度更高(P<0.05);③未完成临床观察者EN前的APACHEⅡ评分、多器官功能障碍综合征(MODS)发生率、膀胱压均明显高于完成临床观察者(P<0.05). 结论:SAP病人早期在EN液中添加Gln,对升高血Gln浓度、降低早期炎症反应、改善免疫功能的作用更加明显.     

三腔胃肠管在胰十二指肠切除术后早期肠内营养中的应用

目的:探讨胰十二指肠切除术后经三腔胃肠管行早期肠内营养的应用价值。方法:选取58例行胰十二指肠切除术的病人,分为三腔胃肠管组和普通胃管组,术后24 h开始给予EN。对比两组病人的置管成功率、出现呕吐、腹泻等不耐受情况的比例和感染发生率等,并在第8天复查肝、肾功能,评价三腔胃肠管在胰十二指肠切除术后病人中的应用价值。结果:采用三腔胃肠管进行空肠EN的同时进行胃内减压,显著地降低了并发症的发生率。结论:胰十二指肠切除术后病人采用三腔胃肠管行EN安全可靠,耐受性好,能减少术后并发症。     

肠内营养与肠外营养支持在重症胰腺炎合并局部并发症患者中的应用效果及对Hb、ALB、CRP、APACHEⅡ评分的影响

目的探讨肠内营养(EN)和肠外营养(PN)在重症胰腺炎合并局部并发症患者中的应用效果及对血红蛋白(Hb)、白蛋白(ALB)、C反应蛋白(CRP)、急性生理与慢性健康(APACHEⅡ)评分的影响。方法选取2016年4月-2017年11月我院收治的重症胰腺炎合并局部并发症患者95例,根据患者营养方式分为A组(53例)和B组(42例)。两组患者均给予基础对症治疗,A组给予EN治疗,B组给予PN治疗。比较两组患者干预前、干预14 d后Hb、ALB、CRP、APACHEⅡ评分,统计两组营养干预相关并发症发生率,随访3个月比较两组患者死亡率及存活患者假性囊肿、胰周积液吸收时间。结果干预14 d,两组Hb、ALB、CRP、APACHEⅡ评分较干预前均下降(P0.05),且B组Hb、ALB低于A组(P0.05),CRP、APACHEⅡ评分高于A组(P0.05)。A组营养干预相关并发症发生率(13.21%)与B组(11.90%)比较无统计学差异(P0.05)。A组死亡率为1.89%,明显低于B组的14.29%(P0.05); A组假性囊肿、胰周积液吸收时间均短于B组(P0.05)。结论 EN在重症胰腺炎合并局部并发症患者中的应用效果优于PN,能更有效地维持患者Hb、ALB水平,改善患者预后,促进患者局部假性囊肿、胰周积液病灶吸收。     

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.     

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.     

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.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

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.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.