肠内营养联合生长激素对烫伤大鼠免疫功能和炎症反应的影响

目的:研究肠内营养及联合重组人生长激素对烫伤大鼠免疫功能和炎症反应的影响. 方法:致64只SD大鼠30%TBSA三度烫伤,随机分为肠内营养联合生长激素(ENGH)组及肠内营养(EN)组,另取8只大鼠作为伤前对照组,两组给予等热量肠内营养液.ENGH组于伤后12 h腹部皮下注射重组人生长激素1 U/kg,以后每24 h注射1次;EN组于相同时间注射等体积的等渗盐水.分别于伤前、伤后第1、4、7、10天抽取静脉血,检测血清免疫球蛋白和蛋白质浓度、T淋巴细胞亚群、血清内毒素、IL-6、TNF-α浓度. 结果:烧伤后两组CD3 、CD8 、CD4 /CD8 均显著降低,ENGH组在伤后第7、10天CD3 、CD4 、CD8 、CD4 /CD8 值与EN组相比,差异有显著性意义(P<0.05,P<0.01).烧伤后两组血清IgG、IgM、IgA的水平较对照组明显降低,但ENGH组轻度降低,在伤后第10天与EN组相比,差异有显著性意义(P<0.05);血清总蛋白、清蛋白和转铁蛋白浓度较EN组升高.ENGH组和EN组血清内毒素、IL-6、TNF-α的水平较对照组显著升高(P<0.01),ENGH组血清内毒素、IL-6、TNF-α的水平在伤后较EN组明显降低(P<0.05,P<0.01). 结论:早期肠内营养联合生长激素可促进蛋白质合成,改善烧伤后免疫功能的低下,降低内毒素的移位,减轻烧伤后炎症反应.     

肠内免疫营养预防大鼠术后腹腔粘连的实验研究

目的探讨肠内免疫营养对大鼠术后腹腔炎症反应及腹腔粘连程度的影响。方法32只雄性SD大鼠随机分为肠内免疫营养（EIN）组和肠内营养（EN）组。喂食5d后行腹壁和盲肠浆膜的缺损术制成大鼠腹腔粘连模型。分别于术后1、4、7、10d取腹腔灌洗液测定IL-6、TNF-α含量；术后10d处死动物，观察腹腔粘连状况并送病理检查。结果术后EIN组和EN组腹腔灌洗液IL-6和TNF-α的水平较对照组显著升高（P〈0.01）。EIN组腹腔灌洗液IL-6和TNF-α水平在术后4、7、10d较EN组明显降低（P〈0.05）。EIN组和EN组粘连分级差异有统计学意义（P〈0.01）。光镜下EIN组炎症反应轻微，纤维增生不明显。结论EIN可以减轻大鼠术后腹腔炎症反应，并能有效地降低腹腔粘连的发生。     

肠内营养对食管癌术后应激反应和肠道屏障功能的影响

目的:探讨EN对食管癌病人术后应激反应和肠道屏障功能的影响. 方法:将54例食管癌切除术病人随机分成PN组(n=28例)和EN组(n=26例).分别检测手术前后不同时段的血清细胞因子、T细胞亚群、NK细胞活性、蛋白质和内毒素水平等. 结果:血清ALB、PA和FT等营养指标术后均显著降低,但两组间差异无显著性意义.术后第1和第3天,两组病人血清IL-6水平较术前均显著升高(P<0.01),EN组显著低于PN组.血清IL-10与IL-6变化相似.术后两组CD3+、CD4+、CD4+/CD8+均显著降低(P<0.01),术后第10天EN组显著高于PN组(P<0.05).术后第10天EN组NK细胞活性明显超过PN组.EN组血清内毒素水平术后显著低于PN组(P<0.05). 结论:EN支持对食管癌术后病人能减少血清内毒素、抑制过度炎症反应和维持机体免疫功能.     

肠内免疫微生态营养对重症急性胰腺炎全身炎性反应及预后的影响

目的 探讨肠内免疫微生态营养对重症急性胰腺炎(SAP)全身炎性反应及预后的影响.方法 57例SAP患者在人院48 h内采用随机数字表法被随机分为肠外营养组(PN组)28例和肠内免疫微生态营养组(EIN组)29例,分别进行相应的营养支持7d.入院时及营养后1、3、5、7 d分别检测外周血内毒素、TNF-α、IL-1β、IL-6、IL-10及单核细胞NF-κB活性,并统计两组治疗结果.结果 入院时EIN组内毒素、TNF-α、IL-1β、IL-6、IL-10及单核细胞NF-κB活性与PN组比较差异无统计学意义;营养后7 d,EIN组内毒素、TNF-α、IL-1β、IL-6、IL-10及单核细胞NF-κB活性分别为(2.70±O.13)ng/L、(30.13 4±8.12)ng,L、(20.17±8.04)ng,L、(36.43±8.24)ng,L、(86.45 ±14.54)ng/L、(70.4±3.2)%,均较PN组的(3.25±0.32)ndL、(313.42±144.35)ng/L、(155.29±32.78)ng/L、(324.15±31.47)ng/L、(472.72±48.55)ng/L、(88.4±5.3)%明显下降(P<0.05或<0.01).结论 早期肠内免疫微生态营养能有效减轻内毒素血症,减低NF-κB活性及细胞因子浓度,维持促抗炎反应平衡,改善患者病情及预后.     

肠内免疫微生态营养对全胃切除患者术后免疫功能及治疗效果的影响

目的探讨肠内免疫微生态营养对全胃切除患者免疫功能及临床预后的影响。方法47例全胃切除患者随机分为肠内营养组（EN组）和肠内免疫微生态营养组（EIN组）。比较两组肠内营养支持后1、3、7d外周血T细胞亚群CD4＋、CD8＋及免疫球蛋白IgA、IgG、IgM的变化,并统计临床治疗效果。结果营养支持后,两组3d及7d后EIN纽与EN组比较CD4＋T细胞及CD4＋／CD8＋比值有显著统计学差异;治疗第7d,EIN组免疫球蛋白Iga、IgG、IgM水平明显高于EN组;治疗结束后,EIN组与EN组术后肛门排气恢复时间、并发症发生率有统计学差畀。结论全胃切除患者应用肠内免疫微生态营养可改善免疫功能,减少感染、手术及死亡的发生率,是一种安全、有效的营养支持方式。     

肠内免疫微生态营养对实验性坏死性胰腺炎猪的肝损害的影响

目的观察肠内免疫微生态营养(EIN)对实验性坏死性胰腺炎猪的肝损害的影响.方法20头普通江淮猪胰管注射5％牛磺胆酸钠1 ml/kg制备急性坏死性胰腺炎(ANP)模型,造模后24 h有2头死亡,18头猪按随机数字分组法分为全肠外营养组(TPN)、肠内要素营养组(EEN)和肠内免疫微生态营养组( EIN),分别进行相应的营养8d.于造模前,造模后24h,营养支持第1、2、4、8天检测外周血内毒素、谷草转氨酶(AST)、谷丙转氨酶(ALT)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6).营养支持8d后剖腹测定腹水量、肝脏丙二醛(MDA)含量及超氧化物歧化酶(SOD)活力、肝组织TNF-α mRNA和IL-6 mRNA的表达以及肝脏病理学改变,进行病理评分.结果造模后24 h EIN组外周血内毒素、AST、ALT、TNF-α、IL-6均较造模前明显增高(P均＜0.01),但与其他两组的差异无统计学意义.营养支持8d后,EIN组上述5项指标均明显低于TPN组和EEN组(P均＜0.05).营养8d后,EIN组的腹水量、肝脏MDA含量、TNF-α mRNA表达、IL-6 mRNA表达及肝脏病理学评分均明显低于TPN组和EEN组,而肝脏SOD活力则明显高于TPN组和EEN组(P均＜0.05).结论早期给予EIN能从多方面保护ANP引起的肝损害.     

围手术期肠内营养支持对食管癌患者术后免疫功能的影响

目的 研究围手术期肠内营养支持对食管癌患者术后免疫功能的影响.方法将80例食管癌患者随机分为肠内营养（EN）组与肠外营养（PN）组,以不同方式营养支持至术后第7天.所有患者均于术前、术后第1、8天测量IgG、IgM、IgA、CD4、CD8、CD4/CD8、C-反应蛋白（CRP）和α-抗胰蛋白酶.结果术后第1天,PN组免疫球蛋白均下降（P〈0.05）,EN组IgA下降（P〈0.05）;术后第8天两组免疫球蛋白均较术后第1天升高（P〈0.05）;EN组术后第8天免疫球蛋白均明显高于PN组（P〈0.01）;两组术后第1天的CD4淋巴细胞较术前下降（P〈0.05）,EN组术后第1天CD8明显升高（P〈0.01）,EN组术后第8天的CD4、CD4/CD8均高于PN组（P〈0.01）,CD8低于PN组（P〈0.05）;术后第1天CRP、α-抗胰蛋白酶较术前均显著升高（P〈0.01）,术后第8天较术后第1天均显著下降（P〈0.01）;术后第8天EN组患者CRP、α-抗胰蛋白酶均显著低于PN组（P〈0.01）.结论围手术期对食管癌患者进行肠内营养支持,能提高患者免疫能力,降低术后全身炎性反应,有利于术后恢复,值得推广.     

肠内营养对长期禁食危重症病人炎性反应和细胞免疫的影响

目的:前瞻性观察长期禁食的危重症病人对恢复肠内营养(EN)初期免疫炎性反应的影响. 方法:将28例禁食14 d以上的危重症病人,分别于实施EN前和EN后第1、第3和第7天检测外周血中内毒素、白细胞(WBC)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL-1、IL-6、IL-4、IL-10)、T淋巴细胞亚群(CD3、CD4、CD4/CD8)和抗组织相容性抗原-DR(HLA-DR)水平. 结果:①内毒素、WBC、CRP、TNF-α、IL-6水平在EN实施第1、3天后均较EN前显著提高;IL-1在EN实施第1天显著提高;IL-4和IL-10较EN实施前无明显改变.②CD4和CD4/CD8在EN第7天较EN前显著提高. 结论:长期禁食的危重症病人在恢复EN初期全身炎症反应增强,持续EN可减轻增强的炎性反应,并改善病人的细胞免疫功能.     

肠内营养支持对慢性阻塞性肺疾病机械通气患者免疫功能的影响

目的探讨慢性阻塞性肺疾病并发呼吸衰竭患者机械通气时早期肠内营养支持治疗对患者免疫功能的影响。方法采取随机、对照试验方法,27例患者随机分为肠内营养治疗组(EN组)和对照组,治疗7天。观察治疗前后血清白蛋白,免疫球蛋白IgA、IgG、IgM,血液淋巴细胞总数(TLC)及T细胞亚群等的变化。结果EN组血淋巴细胞总数、血清白蛋白、IgA、IgG浓度、CD3(%)、CD4(%)及CD4/CD8较治疗前显著升高(P<0.05,P<0.01)。治疗后两组比较,EN组血淋巴细胞总数、血清白蛋白、IgA、IgG浓度、CD3(%)、CD4(%)及CD4/CD8显著高于对照组(P<0.05,P<0.001)。结论对于慢性阻塞性肺疾病机械通气患者,及时合理的肠内营养支持治疗有助于改善机体的免疫功能,提高综合治疗的疗效。     

胃癌术后早期肠内免疫营养的作用

目的:研究肠内免疫营养对胃癌手术后病人营养、免疫及炎症反应的影响. 方法:将96例胃癌病人随机分为肠内免疫营养组(研究组)和常规肠内营养组(对照组),分别于术后第2～8天给予等氮、等热量的肠内营养支持.于手术前1天、术后第1天和第9天分别检测总蛋白、清蛋白、前清蛋白、转铁蛋白、IgG、IgM、IgA、CD4、CD8、CD4/CD8、IL-1α、IL-2、IL-6、IL-10、TNF-α等项目,用药期间留24 h尿、粪测定氮,计算氮平衡. 结果:研究结束时研究组前清蛋白、IgA、CD4、CD4/CD8均显著高于对照组,IL-6、TNF-α显著低于对照组. 结论:肠内免疫营养可减轻胃癌病人手术创伤后机体炎症反应,改善免疫功能.     

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.