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。     

肠道缺血再灌注损伤对血浆游离氨基酸水平的影响

目的研究肠道缺血再灌注损伤时肠道黏膜损伤和血浆游离氨基酸的变化。方法24只健康雄性SD大鼠随机分为3组（每组8只）：空白组、假手术组和肠道缺血再灌注（I/R）组。测定所有大鼠空肠和回肠黏膜的厚度和绒毛高度,进行下腔静脉取血,血浆沉淀蛋白质后测定游离氨基酸水平。结果I/R组与空白组和假手术组比较,空、回肠的黏膜厚度和绒毛高度明显下降［空肠黏膜厚度：(401.50±117.79)、(529.22±54.73)、(499.54±64.48)μm,F=31.869,P=0.000;空肠绒毛高度：(271.37±84.29)、(365.26±46.98)、(349.67±56.11)μm,F=30.472,P=0.000;回肠黏膜厚度：(254.20±43.56)、(324.70±30.56)、(298.26±58.46)μm,F=30.442,P=0.000;回肠绒毛高度：(169.37±37.25)、(221.62±37.26)、(193.25±38.39)μm,F=24.145,P=0.000］,假手术组和I/R组的血浆总游离氨基酸(F=5.075,P=0.016)、8种必需氨基酸(F=11.216,P=0.000)、谷氨酰胺(F=4.326,P=0.027)和支链氨基酸（BCAA）(F=10.662,P=0.001)较空白组降低,差异均有统计学意义（P均<0.05）,且I/R组的必需氨基酸和支链氨基酸水平明显低于假手术组（P均<0.05）。芳香族氨基酸在3组中的含量差异无统计学意义(F=0.578,P=0.570)。假手术组和I/R组的支链氨基酸/芳香族氨基酸比值显著低于空白组［(2.4±0.6)、(1.9±0.4)、(3.1±0.7),F=5.215,P=0.014］,I/R组低于假手术组,但差异无统计学意义（P>0.05）。假手术组和I/R组磷酸乙醇胺(F=5.897,P=0.009)、牛磺酸(F=10.702,P=0.001)、瓜氨酸(F=6.360,P=0.007)、胱氨酸(F=15.344,P=0.000)和磷酸丝氨酸(F=4.878,P=0.018)水平较空白组均有所降低,且I/R组的牛磺酸和胱氨酸与假手术组相比明显减少（P均<0.05）。I/R组血浆鸟氨酸(F=4.961,P=0.017)、精氨酸(F=13.940,P=0.000)浓度低于空白组和假手术组,差异均有统计学意义（P均<0.05）。I/R和假手术组色氨酸(F=5.429,P=0.031)和谷氨酸(F=15.241,P=0.000)浓度较空白组增高,且I/R组谷氨酸浓度明显高于假手术组（P<0.05）。结论大鼠肠道缺血再灌注损伤引起肠道黏膜损伤和血浆游离氨基酸变化,肠道屏障损伤可能与谷氨酰胺浓度下降、蛋白分解增加相关。     

多囊卵巢综合征患者血清Irisin和25（OH）维生素D3及其他代谢指标的相关性

目的　通过检测多囊卵巢综合征（PCOS）患者体内Irisin的水平并分析其与25（OH）维生素D3及其他代谢指标的相关性,进一步探讨Irisin在PCOS中的作用,为PCOS的诊断及治疗提供新的方向。方法　收集2015年4月至2016年1月在山西医科大学附属第一医院生殖不孕不育中心门诊就诊的PCOS患者67例,同时选择72例在体检中心进行体检的育龄期妇女作为对照组。测量两组人群的身高、体质量、腹围、腰围、臀围、血压,计算体质量指数（BMI）和腰臀比（WHR）。检测所有个体血清中Irisin、25（OH）维生素D3、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）、空腹胰岛素（FINS）、卵泡刺激素（FSH）、黄体生成素（LH）、睾酮（TES）等生化指标,计算胰岛素抵抗指数（HOMA-IR）。结果PCOS患者体质量［（66.074±12.952）kg比（57.671±8.806）kg,P=0.000］、BMI［（25.340±4.149）kg/m2比（22.201±3.585）kg/m2,P=0.003］、腰围［（88.829±12.212）cm比（80.550±10.343）cm,P=0.007］、臀围［（100.805±8.614）cm比（92.007±9.325）cm,P=0.000］、WHR（1.279±0.082比0.857±0.071,P=0.000）、舒张压［（78.548±8.936）mmHg比（73.071±10.614）mmHg,P=0.036］、TG［（2.263±1.142）mmol/L比（1.330±1.329）mmol/L,P=0.019］、FPG［（5.128±0.392）mmol/L比（4.809±0.394）mmol/L,P=0.008］、FINS［（13.319±8.122）mU/L比（4.921±2.028）mU/L,P=0.000］、LH［（8.153±2.271）IU/L比（3.811±2.607）IU/L,P=0.000］、TES［（63.068±25.704）ng/dl比（34.811±11.827）ng/dl,P=0.000］、HOMA-IR（2.245±0.853比1.021±0.153,P=0.000）增加,血清Irisin水平［（831.542±98.484）ng/ml比（612.345±86.308）ng/ml,P=0.006］明显升高,HDL-C［（1.278±0.345）mmol/L比（2.493±0.262）mmol/L,P=0.011］、25(OH)维生素D3水平［（17.181±5.078）nmol/L比（20.823±5.305）nmol/L,P=0.009］显著降低;PCOS患者Irisin与体质量（r=0.396,P=0.028）、BMI（r=0.712,P=0.000）、腰围（r=0.462,P=0.021）、臀围（r=0.478,P=0.006）、WHR（r=0.686,P=0.002）、TG（r=0.397,P=0.036）、HOMA-IR（r=0.467,P=0.019）呈正相关,与25(OH)维生素D3（r=－0.654,P=0.004）呈负相关;多重回归分析在PCOS患者中以Irisin为因变量,其他体测及生化指标为自变量,发现血清Irisin水平与BMI（β=0.822,P＜0.001）、TG（β=0.076,P=0.035）、25(OH)维生素D3（β=－0.242,P=0.027）有线性回归关系。结论PCOS患者血清Irisin水平显著升高,且与25（OH）维生素D3、BMI、HOMA-IR、TG存在相关性。Irisin为PCOS的诊断及治疗提供新的思路。     

Betatrophin与1型和2型糖尿病患者胰岛β细胞功能及其他代谢指标的相关性

目的　观察Betatrophin在1型和2型糖尿病患者体内的变化,分析Betatrophin水平与各代谢相关指标的相关性。方法　收集1型糖尿病患者30例、2型糖尿病患者44例和健康人群（对照组）80例。测量人体指标,检测相关代谢的血生化指标,采用酶联免疫吸附试验检测Betatrophin水平。采用单因素方差分析比较多组之间的差异,直线相关分析研究Betatrophin与体测及生化指标的相关性。采用多元线性回归分析Betatrophin的影响因素。结果　1型糖尿病患者Betatrophin 水平［（3.57±0.48）ng/ml比（2.26±0.54）ng/ml,P＜0.05］、空腹血糖［(12.3±2.4)mmol/L比（4.8±2.6）mmol/L,P＜0.05］、餐后2 h血糖［(23.1±3.2)mmol/L比（7.2±3.1）mmol/L,P＜0.05］、糖化血红蛋白（HbA1c）［(9.9±3.5)%比（5.3±2.4）%,P＜0.05］较对照组明显升高,空腹C肽［（0.12±0.08）ng/ml比（0.47±0.16）ng/ml,P＜0.05)］、餐后2 h C肽水平［（0.14±0.09）ng/ml比（1.06±0.49）ng/ml,P＜0.05］及HOMA-β指数（26.20±12.70比 82.93±48.12,P＜0.05）下降。Betatrophin水平与年龄（r=0.417, P＜0.05)、HbA1c（r=0.475, P＜0.05)、空腹血糖（r=0.386, P＜0.05)、餐后2 h血糖（r=0.367, P＜0.05)、HOMA-β（r=－0.400, P＜0.05）相关。其主要影响因素为HOMA-β、空腹血糖、年龄和 HbA1c。2型糖尿病患者和对照组相比,具有较高的Betatrophin水平［（4.87±0.65）ng/ml比（2.26±0.54）ng/ml, P＜0.05］、三酰甘油［（2.20±1.60）mmol/L比（1.36±0.76）mmol/L, P＜0.05］、空腹血糖［(8.9±2.8)mmol/L比（4.8±2.6）mmol/L,P＜0.05］、餐后2 h血糖［(17.7±4.2)mmol/L比（7.2±3.1）mmol/L,P＜0.05］、空腹胰岛素［（15.30±8.60）μU/ml比（5.02±2.34）μU/ml,P＜0.05］、空腹C肽［（1.93±1.60）ng/ml比（0.47±0.16）ng/ml, P＜0.05］、餐后2 h C肽［（5.20±2.70）ng/ml比（1.06±0.49）ng/ml, P＜0.05］、HbA1c［（7.9±2.2）%比（5.3±2.4）%, P＜0.05］、HOMA-IR指数（4.70±2.30比 1.59±0.94,P＜0.05）以及较低的HOMA-β指数（57.50±22.30比 82.93±48.12,P＜0.05）。Betatrophin与年龄（r=0.442, P＜0.05)、空腹血糖（r=0.362, P＜0.05)、空腹胰岛素（r=0.312, P＜0.05)、HbA1c（r=0.486, P＜0.05)、三酰甘油（r= 0.270, P＜0.05）、低密度脂蛋白胆固醇（r= 0.294, P＜0.05）、HOMA-IR（r=0.436, P＜0.05）呈正相关,与高密度脂蛋白胆固醇（r=－0.257, P＜0.05）、HOMA-β（r=-0.365, P＜0.05）呈负相关。2型糖尿病患者Betatrophin主要影响因素为 BMI、 HOMA-IR、HOMA-β、空腹血糖和年龄。且其Betatrophin浓度高于1型糖尿病患者［（4.87±0.65）ng/ml比（3.57±0.48）ng/ml,P＜0.05］。 结论　Betatrophin与糖尿病患者糖代谢及β细胞功能相关,且与2型糖尿病患者脂代谢紊乱关系密切,推测Betatrophin可能参与了糖尿病的发生。     

全谷物豆类复合主食对肥胖者肠道微生态及代谢指标的影响

目的　探讨全谷物豆类复合主食在改善肥胖者人体测量学和代谢指标以及肠道微生态方面的临床效果。方法　选择单纯性肥胖者87例,按随机数字表法分为全谷物豆类复合主食组(试验组,n=44)与细粮主食组(对照组,n=43)。基线和干预3个月后,分别检测并比较两组受试者的体重（BW）、体重指数（BMI）、腰围（WC）、臀围（HC）、腰臀比（WHR）、空腹血糖（FPG）、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)的变化,以及肠道双歧杆菌、乳酸杆菌、产气荚膜梭菌、肠杆菌、肠球菌和拟杆菌菌落计数。结果　试验组与对照组分别有6例与4例被剔除。饮食干预后3个月,试验组与对照组BW［(69.45±7.07)kg比(72.42±5.79)kg,P=0.000］、BMI［(26.08±1.48)kg/m2比(27.27±0.81)kg/m2,P=0.000］、WC［(82.48±9.30)cm比(86.96±4.93)cm,P=0.000］、HC［(90.08±6.57)cm比(92.42±6.67)cm,P=0.000］、WHR(0.92±0.11比0.95±0.10,P=0.003)比较差异均有统计学意义;试验组FPG、TC、LDL-C水平均显著低于对照组［(4.92±0.75)mmol/L比(5.41±1.21)mmol/L,P=0.037;(3.85±1.13)mmol/L比(4.38±1.26)mmol/L,P=0.046;(3.55±1.04)mmol/L比(4.16±1.40)mmol/L,P=0.033］,试验组HDL-C水平显著高于对照组［(1.13±0.37)mmol/L比(0.92±0.26)mmol/L,P=0.004］;试验组与对照组肠道双歧杆菌［(7.94±0.58)lg CFU/g比(6.95±0.38)lg CFU/g,P=0.000］、乳酸杆菌［(7.67±0.46)lg CFU/g比(6.96±0.57)lg CFU/g,P=0.000］、拟杆菌［(5.53±0.44)lg CFU/g比(4.80±0.23)lg CFU/g,P=0.000］菌落总数比较差异均有统计学意义,试验组产气荚膜梭菌［(4.40±0.49)lg CFU/g比(5.11±0.63)lg CFU/g,P=0.000］显著低于对照组。结论　全谷物豆类复合主食可改善肥胖者人体测量学指标、部分脂质代谢指标和肠道菌群结构。其机制可能与通过促进肠道固有有益菌存活和增殖,从而改善肥胖者糖脂代谢有关。     

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。     

学龄期儿童有氧能力与人体成分的关系

目的　调查上海市学龄期儿童有氧运动能力现状,探讨人体成分与有氧运动能力之间的关系。方法　以上海市杨浦区一所小学63名儿童为研究对象,分析人体成分（生物电阻抗法）和有氧运动能力（固定功率运动试验,间接测定法）,测定体脂比例（FAT%）、去脂体质量(FFM)、肥胖度、最大氧摄取量（VO2max）、最大氧脉搏等指标,分析各项指标之间的关系,比较超重肥胖儿童与非超重肥胖儿童各项指标的差异。结果　除1名未进行人体成分测试者外,余62名受试儿童中,超重肥胖组男生与非超重肥胖组相比,VO2max绝对值更高而VO2max相对值更低［（1 038.50±157.93）ml/min比（923.90±82.03）ml/min, F=4.812, P=0.005;（23.62±4.22）ml/(kg·min)比（27.75±2.41）ml/(kg·min),F=5.633,P=0.002］,差异有统计学意义;超重肥胖组的最大氧脉搏有升高趋势,但差异无统计学意义（P＞0.05）。女生中,与非超重肥胖组相比,超重肥胖组的VO2max绝对值有升高趋势［（966.70±131.22）ml/min比（892.55±108.71）ml/min］,但无统计学意义（P＞0.05）;超重肥胖组的VO2max相对值低于非超重肥胖组［（23.84±4.30）ml/(kg·min)比(28.09±4.52）ml/(kg·min)］,差异有统计学意义（P＜0.05）;最大氧脉搏高于非超重肥胖组 ,但差异无统计学意义。控制年龄因素后,VO2max相对值与体质量指数（BMI）、肥胖度、FAT%、脂肪量（FM）、FFM、脂肪含量指数（FMI）、去脂体质量（FFMI）均呈显著负相关（男：r=-0.675,P＜0.000 1;r=-0.634,P＜0.000 1;r=-0.667,P＜0.000 1;r=-0.726,P＜0.000 1;r=-0.594,P＜0.000 1;r=-0.686,P＜0.000 ; r=-0.456,P=0.010。女：r=-0.651,P＜0.000 1;r=-0.552,P=0.002; r=-0.527,P=0.003; r=-0.633,P＜0.000 1; r=-0.520,P=0.004;r=-0.579,P=0.001;r=-0.597,P=0.001）。男生中,最大氧脉搏与BMI、FFM、FFMI均显著正相关(r=0.358,P=0.048;r=0.543,P=0.002;r=0.554,P=0.001);女生中,最大氧脉搏与FFM、FFMI呈正相关(r=0.378,P=0.043;r=0.449,P=0.014)。结论　学龄期儿童的有氧运动能力与人体成分有关。肥胖程度越高,有氧运动能力越差。最大氧脉搏与去脂体质量有一定相关性。     

食欲素水平与慢性阻塞性肺疾病发生营养不足的相关性

目的 探讨血浆食欲素水平变化对慢性阻塞性肺疾病（COPD）发生营养不足的影响。方法 检测40例稳定期COPD患者（分为COPD伴营养不足组20例、COPD不伴营养不足组20例）及20例健康体检者的血浆食欲素、瘦素、肿瘤坏死因子-α及与营养状况相关的人体重指数。食欲素、瘦素和肿瘤坏死因子-α采用酶联免疫吸附法测定。分析食欲素与瘦素、肿瘤坏死因子-α及人体重指数之间的相关性。结果 COPD伴营养不足组血浆食欲素浓度为（0.11±0.01）μg/L,显著低于COPD不伴营养不足组（0.16±0.02）μg/L（P=0.000）和健康对照组（0.15±0.02）μg/L（P=0.002）。40例稳定期COPD患者血浆食欲素水平（0.14±0.03）μg/L与瘦素水平（16.05±3.56）ng/L、肿瘤坏死因子-α水平（9.18±2.70）ng/L存在负相关（r值分别为-0.295、-0.477,P值分别为0.049、0.002）,与体重指数（20.88±4.20）kg/m2呈正相关（r=0.641,P=0.000）。结论 食欲素水平的变化与营养状况密切相关,但其具体机制尚需进一步研究。     

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。     

血清铁蛋白与肥胖儿童非酒精性脂肪性肝病的关系

目的　探讨血清铁蛋白（SF）与肥胖儿童非酒精性脂肪性肝病的关系。方法　以6～14岁肥胖儿童为研究对象，入选儿童均了解肥胖持续时间，进行体格检查（身高、体质量、腰围、臀围）、生物电阻抗法（体脂含量）、血清学指标（肝氨基转移酶、血脂代谢、空腹血糖、胰岛素、SF）以及肝脏超声检查。按稳态评估模型（HOMA）计算胰岛素抵抗（IR）指数。根据肝脏超声及肝氨基转移酶将所有研究对象分为单纯性肥胖（SOC）组、肥胖儿童伴非酒精性单纯性脂肪肝（NAFL）组和肥胖儿童伴非酒精性脂肪性肝炎（NASH）组。结果　共纳入肥胖儿童86例，年龄（10.4±1.9）岁，其中SOC组26例、肥胖儿童伴NAFL组28例、肥胖儿童伴NASH组32例。肥胖儿童伴NASH组腰围-标准差分值（Z分值）、腰臀比、HOMA-IR指数、SF均明显高于肥胖儿童伴NAFL组［2.3±0.3比2.1±0.3，P=0.020；1.0±0.0比0.9±0.1，P=0.014；4.0±1.7比2.9±1.8，P=0.006；（104.1±49.6）μg/L比（68.4±22.7）μg/L，P=0.004］和SOC组［2.3±0.3比1.9±0.3，P=0.000；1.0±0.0比0.9±0.1，P=0.012；4.0±1.7比2.5±1.6，P=0.001；（104.1±49.6）μg/L比（59.2±28.9）μg/L，P=0.001］，体质量指数-Z分值差异无统计学意义(2.8±0.5比2.7±0.6，P=0.524；2.8±0.5比2.7±0.6，P=0.662)；肥胖儿童伴NAFL组和SOC组各项指标比较差异均无统计学意义［2.1±0.3比1.9±0.3，P=0.260；0.9±0.1比0.9±0.1，P=0.952；2.9±1.8比2.5±1.6，P=0.283；(68.4±22.7)μg/L比（59.2±28.9）μg/L，P=0.161］。控制年龄、体质量指数、腰围、腰臀比、三酰甘油、HOMA-IR指数影响，SF仍与肥胖儿童非酒精性脂肪肝病变程度呈正相关（r=0.335，P=0.002）。结论　血清铁蛋白可能是肥胖儿童NASH发生的独立危险因素。     

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.     

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.