短肽型肠内营养制剂对肠黏膜炎大鼠营养状况的影响

目的:探讨短肽型肠内营养制剂(PBEN)对肠黏膜炎大鼠营养状况的影响. 方法:利用甲氨喋呤(MTX)建立大鼠肠黏膜炎模型.60只大鼠随机分为6组,即基础饲料(BF)组,短肽型肠内营养制剂(PBEN)组,整蛋白型肠内营养制剂(IPEN)组,MTX+ BF组,MTX+ PBEN组和MTX+ IPEN组.于第0天和第6天,给予MTX+BF组、MTX+ PBEN组和MTX+ IPEN组腹腔注射10 mg/kg MTX造成大鼠肠道持续损伤.从第1天开始,BF组和MTX+ BF组饲喂BF;PBEN组和MTX+ PBEN组饲喂PBEN;IPEN组和MTX+ IPEN组饲喂IPEN.每组大鼠每天按159.0 kJ(38 kcal)/100 g给予膳食.每天记录各组大鼠的体重和进食量.于第11天处死大鼠,检测血浆中D-乳酸、二胺氧化酶(DAO)和血清总蛋白(TP)、清蛋白(ALB)、前清蛋白(PA)、转铁蛋白(TF)和视黄醇结合蛋白(RBP)水平. 结果:大鼠进食BF或PBEN、IPEN后各指标间无显著性差异(P＞0.05).MTX造模导致大鼠肠黏膜严重损伤,MTX+ BF组各项指标与BF组比有显著性差异(P＜0.05).MTX+ PBEN组大鼠体重下降程度低于MTX+BF组和MTX +IPEN组(P＜0.05).第11天时,MTX+ PBEN组大鼠血浆D-乳酸和DAO水平均低于MTX+ BF组和MTX+ IPEN组,且血清TP、ALB、PA、TF和RBP水平均高于MTX+ BF组和MTX+ IPEN组(P＜0.05).结论:PBEN可有效地改善肠黏膜炎大鼠的营养状况.     

肝癌合并肝硬化患者术后不同剂型肠内营养的临床效果

目的 比较氨基酸型和整蛋白型肠内营养制剂用于肝癌合并肝硬化患者术后营养治疗的临床效果。方法　肝癌合并肝硬化术后患者207例,等热量等氮肠内联合肠外营养连续至少5 d,按肠内营养剂型分为氨基酸型制剂组（氨基酸为氮源,104例）和整蛋白型制剂组（整蛋白为氮源,103例）。观察肠道通气时间、术后住院时间、腹泻发生率、术后并发症发生率等临床结果,以及电解质、肝功能相关生化指标。结果　2组患者术前及术中资料差异无统计学意义（P>0.05）;氨基酸型制剂组较整蛋白型制剂组腹泻发生率高（23.08%比8.74%,P=0.005）,肠道通气时间早［（55.87±10.12）h 比（68.27±9.07）h,P=0.000）］;两组患者腹胀发生率（10.58%比13.59,P=0.506）、术后住院时间［（10.30±3.50）d 比（10.12±4.26） d,P=0.738］、并发症发生率（43.27%比33.98%,P=0.170）及术后7 d钾［（4.02±0.50） mmol/L比（3.98±0.55） mmol/L,P=0.644］、钠［（136.29±3.55）mmol/L比（136.23±2.74）mmol/L,P=0.913］、丙氨酸氨基转移酶［（90.22±64.29）U/L比（96.01±59.74）U/L,P=0.556］、天门冬氨酸氨基转移酶［（36.01±19.68）U/L比（39.00±18.88）U/L,P=0.329］、总胆红素［（15.39±8.64）μmol/L 比（15.43±8.33）μmol/L,P=0.978］差异均无统计学意义（P>0.05）;氨基酸型制剂组较整蛋白型制剂组白蛋白水平高［（32.87±3.54） g/L 比（31.37±3.50） g/L, P=0.008］、前白蛋白水平高［（11.41±4.32)mg/dl比（9.84±3.64）mg/dl,P=0.014］,但凝血酶原时间活动度水平低［（66.94±7.24） s比（70.63±8.49）s,P=0.017）］。结论　两种制剂均有利于肝癌合并肝硬化患者术后肝功能恢复,氨基酸型制剂更有助于肠功能恢复和蛋白质合成,整蛋白型制剂肠道耐受性较好并促进凝血功能恢复。     

经鼻空肠管行肠内营养对肝功能的影响

目的　观察经鼻空肠管行肠内营养后患者肝功能的变化。方法　选取2011年9月至2014年8月郑州人民医院重症医学科需经鼻饲管行肠内营养的住院患者74例,采用随机数字表法分为鼻空肠管组（n=36）与鼻胃管组（n=38）,分别留置鼻空肠管与鼻胃管,启动早期肠内营养。观察两组患者开始肠内营养后第7、14天的肝功能各项指标。结果　鼻空肠管组31例患者（86.11%）出现至少1项肝功能异常,鼻胃管组23例（60.53%）出现至少1项肝功能异常,差异有统计学意义（χ2=6.136,P=0.013)。鼻胃管组与鼻空肠管组患者谷丙转氨酶（ALT）、谷草转氨酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（γ-GGT）及白蛋白（ALB）在第7天的差异无统计学意义［（39.1±8.6）U/L比（42.3±8.9）U/L,t=-1.475,P=0.145;（36.2±6.8）U/L比（38.0±7.1）U/L,t=-1.237,P=0.220;（61.8±11.5）U/L比（63.1±13.2）U/L,t=-0.696,P=0.489;（47.3±8.2）U/L比（50.5±7.5）U/L,t=-1.640,P=0.106;（35.2±6.7）g/L比（36.2±7.4）g/L,t=-0.610,P=0.543］;第14天鼻空肠管组ALP、γ-GGT及ALB水平显著高于鼻胃管组［（201.2±15.2）U/L比（116.5±13.6）U/L,t=-25.380,P=0.000;（109.4±7.2）U/L比（49.2±6.5）U/L,t=-37.665,P=0.000;（37.2±7.1）g/L比（30.1±6.5）g/L,t=-4.490,P=0.000］。鼻胃管组与鼻空肠管组第7、14天的总胆红素［（4.6±0.9）μmol/L比（4.8±1.0）μmol/L,t=-0.905,P=0.368;（4.8±1.2）μmol/L比（5.2±1.1）μmol/L,t=-1.492,P=0.140］、间接胆红素［（6.1±0.8）μmol/L比（6.3±0.9）μmol/L,t=-1.012,P=0.315;（6.9±0.9）μmol/L比（7.3±1.0）μmol/L,t=-1.811,P=0.074］、直接胆红素［（4.0±0.6）μmol/L比（3.9±0.5）μmol/L,t=0.777,P=0.440;（5.1±0.8）μmol/L比（5.4±0.9）μmol/L,t=-1.517,P=0.134］差异均无统计学意义。鼻空肠管组肺部感染发生率显著低于鼻胃管组（30.56%比55.26%,χ2=4.598,P=0.032）。结论　与经鼻胃管行肠内营养比较,经鼻空肠管行肠内营养可能更易导致肝功能异常。     

个性化营养支持对高龄顽固性心力衰竭患者近期结局的影响

目的观察和比较单纯肠内营养（EN）、单纯肠外营养（PN）、肠内肠外联合营养（EN+PN） 3种营养支持方式对高龄顽固性心力衰竭患者近期结局的影响及其安全性。方法 选取2004年1月至2012年9月在北京军区总医院263临床部住院的247例高龄顽固性心力衰竭患者,采用随机数字表法分为EN+PN组（n=87）、EN组（n=76）、PN组（n=84）。随机分组后根据患者耐受情况,EN组2例转入EN+PN组,PN组3例转入EN+PN组。于营养支持前和营养支持7 d后检测血清学指标和心脏超声血液动力学指标,根据全身症状计算营养支持后好转率,记录不良事件发生情况进行安全性评价。结果 研究过程中共8例患者退出,其中EN组4例,PN组1例,EN+PN组3例。与营养支持前比较,各组营养支持7 d后血清前白蛋白［EN组,（0.17±0.01）g/L比（0.11±0.02）g/L;PN组,（0.19±0.01）g/L比（0.09±0.02）g/L;EN+PN组,（0.24±0.04）g/L比（0.10±0.02）g/L］、白蛋白［EN组,（34.14±1.00）g/L比（31.25±1.02）g/L;PN组,（33.89±1.20）g/L比（30.99±1.07）g/L;EN+PN组,（36.66±1.36）g/L比（31.00±1.01）g/L］、转铁蛋白［EN组,（1.99±0.39）g/L比（1.86±0.36）g/L;PN组,（2.01±0.41）g/L比（1.89±0.34）g/L;EN+PN组,（2.58±0.47）g/L比（1.92±0.33）g/L］均显著升高(P均=0.008);EN+PN组的前白蛋白（P=0.007、0.008）、白蛋白（P=0.041、0.040）、转铁蛋白（P=0.007、0.008）均显著高于EN组和PN组。PN组营养支持后血糖显著升高［（8.06±2.35）mmol/L比（5.81±2.21）mmol/L,P=0.009］,其余两组营养支持前后差异无统计学意义。与营养支持前比较,3组营养支持7 d后每搏输出量（SV)［EN组,（60.91±7.26）ml比（45.09±6.42）ml;PN组,（61.01±7.29）ml比（45.19±6.39）ml;EN+PN组,（65.42±7.43）ml比（46.11±6.41）ml;P均=0.008］、左心室射血分数（LVEF）［EN组,（45.78±0.09）%比（34.61±0.09）%;PN组,（45.11±0.11）%比（34.55±0.08）%;EN+PN组,（49.79±0.11）%比（34.42±0.09）%;P均=0.008］、左心室舒张末期内径（LVEdd）［EN组,（60.22±2.42）mm比（63.20±2.19）mm,P=0.008;PN组,（60.28±2.44）mm比（62.98±2.11）mm,P=0.044;EN+PN组,（57.43±2.40）mm比（63.09±2.08）mm,P=0.008］、左心室收缩末期内径（LVEsd）［EN组,（54.08±6.06）mm比（56.15±6.03）mm,P=0.044;PN组,（54.42±6.10）mm比（56.31±6.11）mm,P=0.044;EN+PN组,（51.48±5.27）mm比（56.32±6.13）mm,P=0.008］均明显改善;EN+PN组的SV（P=0.003、0.004）和LVEF（P均=0.004）均显著大于EN组和PN组,LVEdd（P=0.004、0.005）和LVEsd（P=0.004、0.005）均显著小于EN组和PN组。EN组、PN组、EN+PN组的好转率分别为75.71%（53/70）、75.00%（60/80）、83.15%（74/89),异常状况评分与营养支持前比较均显著改善（P均=0.000）;EN+PN组的好转率显著高于EN组和PN组（P均=0.005）,PN组与EN组的好转率差异无统计学意义（P=0.059）。PN组的恶化率为15.00%,明显高于EN组（12.85%,P=0.048）和EN+PN组（6.74%,P=0.045）。营养支持期间EN+PN组不良事件发生率显著低于EN组［22.47%（20/89）比37.14%（26/70）,P=0.005］,与PN组比较差异无统计学意义［35.00%（28/80）,P=0.057］。结论 对于高龄顽固性心力衰竭患者, EN+PN可提高血清前白蛋白、白蛋白、转铁蛋白水平,缓解临床症状,改善血液动力学,且不良事件发生率较低,是优于单纯EN或PN的营养支持方式。     

全胃切除术后恢复十二指肠路径P型和功能性空肠间置代胃消化道重建术对患者远期营养状况的影响

目的比较全胃切除术后P型空肠间置代胃和功能性空肠间置代胃（FJI)两种恢复食物经十二指肠路径的消化道重建方式对患者远期营养状况和生活质量的影响。方法 2003年1月至2011年6月,50例胃癌患者在东华医院行全胃切除术,其中27例行P型空肠间置代胃消化道重建术,23例行FJI消化道重建术。术后第1天至第7天予以全肠外营养支持。观察患者围术期并发症情况。术后6个月和12个月分别监测两组患者体重、血清总蛋白、血清白蛋白、血红蛋白和反流性食管炎发生情况,计算营养评定指数（NAI）。结果 50例患者均未发生严重手术并发症,无围术期及化疗相关死亡。术后6个月P型组和FJI组的体重减轻量［（3.67±0.91)kg比(3.44±0.52)kg,P=0.28］、血清总蛋白［（52.62±1.67)g/L比(53.22±1.24)g/L,,P=0.16］、血清白蛋白［（31.26±1.29)g/L比(30.70±2.41)g/L,P=0.32］、血红蛋白［（118.01±5.96)g/L比(117.83±6.72)g/L,P=0.92］、NAI(P=0.39)和反流性食管炎发生率（11.1%比13.0%,P=1.00）差异无统计学意义。术后12个月两组的体重减轻量［（2.71±0.45)kg比(2.74±0.42)kg,P=0.77］、血清总蛋白［（53.93±1.66)g/L比(53.34±1.84)g/L,P=0.24］、血清白蛋白［（32.60±1.42)g/L比(30.76±2.10)g/L,P=0.23］、血红蛋白［（124.18±6.56)g/L比(119.99±6.13)g/L,P=0.16］、NAI(P=0.43)和反流性食管炎发生率（7.4%比8.7%,P=1.00）差异无统计学意义。结论 全胃切除术后P型和FJI这两种消化道重建方式对患者术后远期营养状况和生活质量的影响无差异。     

肠内联合肠外营养支持用于老年晚期消化道恶性肿瘤化疗患者的观察

目的 探讨肠内联合肠外营养支持对老年晚期消化道恶性肿瘤化疗的影响。方法 将2006年至2011年本院肿瘤内科收治的79例老年晚期消化道恶性肿瘤患者采用随机数字表法分为两组,治疗组（n=42）采用营养支持联合化疗,对照组（n=37）采用单纯化疗,入院后行营养风险筛查,2个化疗周期后比较营养状态、Karnofsky功能状态评分、毒性反应、院内感染率的变化。结果 两个周期化疗后,治疗组的体重指数 ［（19.00±3.31）kg/m2比（18.24±1.98）kg/m2,P=0.04］、白蛋白［（33.90±1.50） g/L比（29.90±2.38）g/L,P=0.02］、前白蛋白［（28.19±1.50)g/L比（25.51±8.38）g/L,P=0.01］、血红蛋白［（107.0±6.90)g/L 比（104.20±9.70）g/L,P=0.02］、淋巴细胞［（2.99±0.55)×109/L比（2.63±0.20）×109/L,P=0.03］均显著升高。化疗不良反应方面,治疗组骨髓抑制发生率明显低于对照组（28.57%比83.78%,P=0.00）;治疗组中有营养风险者的骨髓抑制发生率为31.03%,显著低于对照组的95.45%（P=0.00）,其他毒性反应差异无统计学意义。治疗组两次化疗后的院内感染发生率均显著低于对照组（0比10.81%,P=0.03;2.38% 比27.03%,P=0.02）。结论 老年晚期消化道恶性肿瘤患者化疗期间联合应用肠内加肠外营养支持有利于机体营养状况及体能的改善,减轻毒性反应,是院内感染发生的保护性因素。营养支持符合化疗患者的需求,具有安全、有效、合理的特点。     

哺乳期过度营养对大鼠血压及血管内皮舒张功能的影响

目的　观察出生后过度营养及高脂饮食对大鼠血压的影响，探讨哺乳期及早期持续过度营养导致高血压发生发展的病理生理机制。方法　应用小窝鼠模型，SD大鼠雄仔出生3 d后按随机数字表法分为哺乳期正常营养组（10只/窝）和哺乳期过度营养组（3只/窝）。3周断乳后，再分别按随机数字表法完全随机分组给予标准饲料和高脂饲料至16周；共分为4组：正常营养组、哺乳期过度营养组、断乳后过度营养组、持续过度营养组。每周监测体质量，于3、16周测定大鼠内脏脂肪质量、收缩压及心率。取大鼠胸主动脉行血管内皮舒张功能测定。HE染色观察血管组织形态，硝酸还原法检测血管组织中一氧化氮，实时定量-PCR测定血管内皮型一氧化氮合酶（eNOS）mRNA表达，Western blot法检测其总蛋白及磷酸化蛋白表达水平。结果　出生后3周哺乳期过度营养组大鼠体质量［（77.80±0.57）g 比 （62.80±0.85）g，t=14.576, P＜0.01］、脂肪质量［腹膜后：（8.19±0.49） mg/g 比 (4.92±0.31)mg/g, t=5.629, P＜0.01; 生殖周：(3.50±0.29)mg/g比(2.08±0.13)mg/g, t=4.552,P＜0.01］显著高于正常营养组大鼠;血管组织中磷酸化-eNOS的蛋白表达明显下降并持续到16周（F=15.215, P＜0.01）；断乳后高脂喂养增加哺乳期过度营养组大鼠体质量、脂肪质量。至16周时，持续过度营养组出现高血压［（149±1.94） mmHg（1 mmHg=0.133 kPa），F=22.834, P＜0.01］、血管内皮舒张功能受损（F=7.648， P＜0.05）及磷酸化-eNOS的蛋白表达下降（F=15.215, P＜0.01），而断乳后过度营养组仅出现血压改变。结论　哺乳期过度营养断乳后高脂饮食可导致高血压，血管组织磷酸化eNOS表达的持续下降可能是哺乳期过度营养诱导成年期血管内皮舒张功能紊乱发生的重要分子机制。     

ω-3多不饱和脂肪酸对大鼠肠道缺血/再灌注损伤时Toll样受体4和高迁移族蛋白-1的影响

目的 研究大鼠肠道缺血/再灌注损伤时远隔组织Toll样受体4（TLR4）与内源性配体高迁移族蛋白-1（HMGB1）的表达及ω-3多不饱和脂肪酸（ω-3 PUFA)的干预作用。方法 SD雄性大鼠48只, 体重（281.50±22.68）g,胃造口后随机分为3组：正常饮食组、肠内营养组、肠内营养加ω-3 PUFA组（ω-3 PUFA组）。根据肠道缺血/再灌注时是否进行肠淋巴引流,每组又分为亚组：引流组和不引流组(共6组,n=8)。所有大鼠用无创血管夹夹闭肠系膜上动脉60 min后复灌120 min;3个引流亚组在缺血/再灌注同时行淋巴引流术180 min。结果 ω-3 PUFA引流组与肠内营养引流组淋巴液中白细胞介素-6均较正常饮食引流组低［ω-3 PUFA引流组、肠内营养引流组、正常饮食引流组：（85.35±23.93）、（97.58±40.34）、（154.57±69.30)ng/L,P=0.021］;ω-3 PUFA引流组血清HMGB1显著低于其他5组［ω-3 PUFA不引流组、肠内营养不引流组、正常饮食不引流组、ω-3 PUFA引流组、肠内营养引流组、正常饮食引流组：（2.95±1.17）、（3.86±0.99）、（4.45±1.73）、（1.71±1.41）、（2.11±0.56）、（3.13±0.79）μg/L, P=0.000］,ω-3 PUFA不引流组与肠内营养不引流组HMGB1均低于正常饮食不引流组(P均＜0.05)。ω-3 PUFA组的血清内毒素显著低于正常饮食不引流组和肠内营养不引流组 ［ω-3 PUFA不引流组、ω-3 PUFA引流组、肠内营养不引流组、正常饮食不引流组 ：（0.020±0.004）、 （0.018±0.006）、（0.028±0.006）、（0.028±0.005）EU/ml, P=0.014］,ω-3 PUFA引流组和ω-3 PUFA不引流组肿瘤坏死因子-α显著低于肠内营养不引流组、正常饮食不引流和正常饮食引流组［ ω-3 PUFA引流组、ω-3 PUFA不引流组、肠内营养不引流组、正常饮食不引流组、正常饮食引流组：（12.03±6.57）、(14.32±6.11)、（23.27±15.60）、（27.42±10.37）、（26.87±5.30）ng/L,P=0.013］。 所有不引流组空肠和回肠黏膜肿胀、萎缩、糜烂,甚至出现断裂。ω-3 PUFA组空、回肠HMGB1黄染以及损伤情况都轻于另外两组。3个淋巴液引流组空肠、回肠和肝脏的TLR4 mRNA表达均低于非引流组［空肠：ω-3 PUFA不引流组、肠内营养不引流组、 正常饮食不引流组、ω-3 PUFA引流组、肠内营养引流组、正常饮食引流组： 2.32± 0.62、3.08±1.29、3.50±2.44、1.62±0.79、1.67±1.11、1.94±0.81, P=0.025; 回肠：ω-3 PUFA不引流组、肠内营养不引流组、正常饮食不引流组、ω-3 PUFA引流组、肠内营养引流组、正常饮食引流组： 2.67±1.08、5.22±3.96、 6.95±4.92、1.70±0.68、1.80±0.29、3.68±1.47, P=0.012;肝脏：ω-3 PUFA不引流组、肠内营养不引流组、正常饮食不引流组、 ω-3 PUFA引流组、肠内营养引流组、正常饮食引流组： 5.67±1.94、7.50±3.89、7.18±4.55、1.70±0.86、3.90±1.95、4.12±2.11, P=0.001］,与肠道、肝脏和肺脏的HMGB1表达减少和核因子-κB活性降低相一致（P＝0.000）。结论 肠道缺血再灌注时淋巴管引流和(或) ω-3 PUFA干预能够减少HMGB1和炎症因子的产生,抑制HMGB1和TLR4 mRNA的表达,从而减轻远隔组织的损伤。     

外科胰腺肿瘤患者营养不足和营养风险发生率的前瞻性调查研究

目的　调查外科胰腺肿瘤患者营养不足和营养风险发生率。方法　对2014年1月至2015年12月,因各种胰腺肿瘤入住北京医院普外科,接受手术治疗的121例住院患者,根据肿瘤性质分为胰腺癌组和其他胰腺肿瘤组,主要应用营养风险筛查2002方法,前瞻性比较不同胰腺肿瘤患者的营养不足和营养风险发生率以及物理测量、体成分和外周血蛋白质水平等,记录临床结局。结果　121例符合入选标准的胰腺肿瘤患者进入本研究,胰腺癌组90例和其他胰腺肿瘤组31例,平均年龄（61.9±13.6）岁;平均体质量指数（23.20±2.95）kg/m2;上臂围（28.8±3.5）cm;肌肉组织量（44.6±7.4）kg;脂肪组织量（16.8±7.6）kg;两组在人体测量和体成分等方面差异无统计学意义（均P＞0.05）;胰腺癌组空腹血糖［（6.45±2.47）mmol/L］显著高于对照组［（4.95±0.79）mmol/L］（P＜0.001）,白蛋白［（39.0±4.7）g/L比(42.3±2.9)g/L,P＜0.001］,总蛋白［（62.8±6.2）g/L比(66.3±2.9)g/L,P＜0.001］和前白蛋白［（136.1±85.4）mg/L比(197.8±112.6),P=0.011］均显著低于对照组;营养不足发生率为4.1%,营养风险发生率78.5%;其中胰腺癌组营养风险发生率显著高于其他胰腺肿瘤组（91.1%比38.7%,χ2=36.525,P＜0.001）。结论　外科胰腺癌患者营养风险发生率较高,蛋白水平低和糖代谢异常,可导致住院时间延长。     

深度水解蛋白配方粉喂养早产儿相关营养状况分析

目的　探讨以深度水解蛋白配方粉作为开奶喂养的早产儿相关营养状况。方法　收集2013年1月至2014年12月上海儿童医学中心新生儿重症监护室首次以深度水解蛋白配方粉开奶喂养的早产儿共157例,记录相关诊断、出生情况、营养摄入、生长发育等。根据有无喂养不耐受（不耐受组和耐受组）和出生体质量（＜1 500 g、1 500~2 500 g和≥2 500 g组）进行分组,分析生长发育情况及其相关因素。结果　共60例（38.2%）早产儿发生喂养不耐受。出生体质量和胎龄越小,发生喂养不耐受越多,其中＜1 500 g组喂养不耐受为71.1%。与耐受组比较,喂养不耐受组出生体质量［（1 620±440）g比（1 980±421）g,P=0.000］、胎龄［（31.3±2.6）周比（33.0±2.1）周,P=0.000］、出生头围［（28.9±2.2）cm比（30.4±1.9）cm,P=0.000］和出生身长［（41.1±3.9）cm比（43.2±3.4）cm,P=0.000］明显减小,转奶时间［（26.4±17.6)d比（7.9±5.3)d,P=0.000］和达到足量喂养时间［（21.5±10.0)d比（13.8±6.2)d,P=0.000］明显延长。同时,开奶时间［＜1 500 g组（6.1±5.1)d,1 500~2 500 g组（3.8±2.5)d,≥2 500 g组（3.3±1.2)d,P=0.002］、转奶时间［＜1 500 g组（28.7±18.3)d,1 500~2 500 g组（9.7±8.1)d,≥2 500 g组（7.0±3.8)d,P=0.000］和达到足量喂养时间［＜1 500 g组（24.0±10.4)d,1 500~2 500 g组（14.3±6.0)d,≥2 500 g组（11.4±3.5)d,P=0.000］出生体质量越小组越晚。不耐受组和＜1 500 g组有更多患儿接受肠外营养支持（93.3%;97.8%）,且肠外营养提供热量［＜1 500 g组（325.9±59.4）kJ/（kg·d）,1 500~2 500 g组（281.2±64.8）kJ/（kg·d）,≥2 500 g组（269.9±43.9）kJ/（kg·d）,P=0.001］和持续时间［＜1 500 g组（27.1±14.5)d,1 500~2 500 g组（13.0±7.0)d,≥2 500 g组（8.7±3.4)d,P=0.000］更多。生长发育方面不耐受组头围增长较快［不耐受组（0.7±0.6） cm/周,耐受组（0.6±0.5） cm/周,P=0.045］。＜1 500 g 组体质量增长［（21.8±9.5） g/d］和头围增长［（0.8±0.4） cm/周］均明显高于其他出生体质量组［体质量增长：1 500~2 500 g组（14.2±7.6）g/d,≥2 500 g组（4.9±11.9）g/d,P=0.000;头围增长：1 500~2 500 g组（0.5±0.4）cm/周,≥2 500 g组（0.6±0.8）cm/周,P=0.005］。对是否有喂养不耐受作变量控制后,偏相关分析显示住院期间体质量增长与胎龄（r=-0.666,P=0.035）、出生体质量（r=-0.700,P=0.024）、头围（r=-0.846,P=0.002）以及恢复至出生体质量天数（r=-0.697,P=0.025）呈负相关,与头围增长（r=0.672,P=0.033）呈正相关,而与出生身长、开奶、转奶时间和达到足量喂养时间、肠外营养热量和持续天数,以及住院天数和一些并发症有无无相关性。结论　深度水解蛋白配方粉喂养的早产儿发生喂养不耐受的能获得类似于喂养耐受组早产儿的生长发育,与肠外营养的应用有关。胎龄越小、出生体质量头围越低的早产儿更适于采用深度水解蛋白配方奶作为开奶喂养。     

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.     

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.     

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.     

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.