肠内营养和肠外营养对重型颅脑损伤患者胃液pH值的影响

目的探讨实施早期肠内营养和肠外营养对重型颅脑损伤患者胃液pH值的影响。方法我院2007年1月至2009年5月间收治的168例重型颅脑损伤患者（格拉斯哥昏迷评分≤8分）随机分为早期肠内营养组（EEN组,n=84）和肠外营养组（PN组,n=84）,其中EEN组患者鼻腔内插入14F硅胶胃管进行早期肠内营养,PN组患者给予全静脉营养。分别于人院即刻和人院后第3、5、7天监测患者胃液pH值及消化道出血情况。结果两组患者人院即刻胃液pH值均明显低于正常值,ENN组患者人院后第3、5、7天胃液pH值均明显高于PN组（P〈0．001）。两组患者入院即刻消化道出血发生率差异无统计学意义（P〉0．05）,EEN组患者入院后第3、5、7天消化道出血发生率均明显低于PN组（P〈0．05）。结论重型颅脑损伤患者胃酸呈高分泌状态,给予早期肠内营养支持可升高胃液pH值,可能对降低上消化道出血发生率起一定作用。监测胃液pH值对应激性溃疡出血的发生具有预警作用。     

营养支持对重型颅脑损伤病人营养指标和肺部感染的影响

目的:探讨肠内营养(EN)与肠外营养(PN)支持对重型颅脑损伤病人营养指标和肺部感染的影响。方法:将62例重型颅脑损伤病人分为PN组(n=30)和EN组(n=32)。比较两组病人在营养支持后第1和第2周的营养指标及肺部感染的发生率。结果:EN组病人的血清清蛋白和前清蛋白较PN组有明显改善,而PN组病人的谷丙转氨酶较EN组有明显升高。EN组病人肺部感染发生率明显低于PN组。结论:EN支持可改善重型颅脑损伤病人的营养指标,减少肺部感染的发生率,有利于病人康复。     

代谢监测下早期营养支持对重型颅脑损伤病人预后的影响

目的:比较在能量代谢测定系统(简称:代谢车)监测指导下,早期采用不同营养方式及能量组合治疗重型颅脑损伤病人的临床疗效以及并发症的发生率。方法:将符合研究标准的重型颅脑损伤病人共184例随机分为肠内营养组(EN,n=61)、肠外营养组(PN,n=62)和混合营养组(PN+EN,n=61)。采用代谢车每天清晨测定病人静息能量消耗值(REE,kcal/d)连续2周,根据REE提供适宜的能量供给病人。监测病人第1、7和第14天的血清清蛋白(ALB),血红蛋白(Hb),前清蛋白(PA)和氮平衡(NB)的变化以及伤后1个月时GOS评分;同时观察病人在营养治疗期间肺炎、呕吐、误吸和消化道出血等并发症的发生率。结果:PN+EN组病人ALB、Hb、PA和NB变化、早期肺炎与入住ICU时间等指标均优于EN组或PN组,差异有显著性统计学意义(P0.05)。PN组病人消化道出血、呕吐、误吸的发生率最高,与其他两组比有显著性差异(P0.05);2周后病人病死率比较,PN组发生率最高,且与其他两组比较有显著性统计学差异(P0.05)。结论:伤后早期采用代谢车测定重型颅脑损伤病人的静息能量消耗,指导营养供给的模式更为科学准确。采用PN+EN混合营养供给模式更适合重型颅脑损伤病人早期营养支持。     

电针刺激天枢穴对重型颅脑损伤病人肠内营养并发症的防治作用

目的:探讨电针刺激天枢穴对重型颅脑损伤病人肠内营养(EN)并发症的防治作用. 方法:将117例重型颅脑损伤行EN治疗的病人随机分为试验组(56例)和对照组(61例).试验组病人在EN的同时给予电针刺激穴位;对照组只给予EN治疗.观察两组病人发生误吸、反流、吸入性肺炎、腹泻、消化道出血等并发症的情况,并每天测定病人胃黏膜的二氧化碳分压(PgCO2)和pH值(pHi)以及胃潴留量和喂养量. 结果:试验组病人电针刺激穴位后以上并发症的发生率明显低于对照组.试验组病人经电针刺激穴位后胃黏膜PgC02明显降低,胃黏膜pHi明显升高,胃潴留量明显减少,喂养量明显增加,两组间比较差异均有显著性统计学意义(P＜0.05). 结论:应用电针刺激天枢穴位治疗,能明显降低重型颅脑损伤病人EN治疗的并发症.     

重型颅脑外伤后早期肠内营养预防肺部感染的临床研究

目的:观察早期肠内营养(EEN)支持对重型颅脑外伤病人肺部感染的预防疗效。方法:选择青壮年重型颅脑外伤60例,随机分为EEN组和对照组。EEN组在伤后或术后12～24 h内给予EN,对照组在伤后或术后24 h～5 d给予EN,利用双糖试验法测定两组病人的肠黏膜屏障功能,观察病人肺部感染发生时间等临床指标。结果:EEN组病人伤后第7天乳果糖/甘露醇比值明显低于对照组,病人平均体温、肺部感染发生率也低于对照组,按照ADL评分法,EEN组病人的恢复期日常行为能力明显好于对照组。结论:EEN可改善重型颅脑外伤病人的肠黏膜屏障功能,减少肺部感染的发生率,有利于病人的康复。     

早期营养支持对重型颅脑损伤的临床意义

目的 :评价不同营养方法对重型颅脑损伤早期营养支持的临床意义。　方法 :140例重型颅脑损伤者随机分成 5组 ,每组 2 8例。A组早期同时给予 EN和 PN ;B组给予早期 PN,1周后逐渐过渡至 EN ;C组单纯 PN ,PN时间超过 2周 ;D组早期给予单纯 EN;E组用传统的延迟性 EN。进行有关临床观察及统计学分析。　结果 :重型颅脑损伤者伤后早期能从不同营养途径获得营养成分。 A、B组 2周时血糖及各项营养指标均优于 D、E组 (P<0 .0 5 )与 C组基本相同 (P>0 .0 5 ) ,早、晚期并发症发生率低于其他 3组 ,预后优于其他 3组。 A、B两组间比较 ,A组消化道出血发生率低于 B组 ,费用更节约。　结论 :重型颅脑损伤后早期联合进行 EN、PN是临床较合理的营养支持方法 ,对预后有重要的价值。     

老年结直肠癌病人围手术期肠内营养应用及其疗效分析

目的:探讨老年结直肠癌病人围手术期肠内营养(EN)的可行性及疗效.方法:回顾分析90例老年结直肠癌病人围手术期营养支持临床资料.EN组46例病人,术前给予EN支持,术后给予早期肠内营养(EEN).肠外营养(PN)组44例,术前给予常规流质饮食,术后第1天开始给予PN支持.结果:EN组病人术后第8天前清蛋白和转铁蛋白水平...     

重型脑损伤患者早期肠内加肠外营养效果观察

目的探讨肠内加肠外营养支持在重型颅脑损伤患者中的合理应用。方法140例重型颅脑损伤患者随机分成5组,每组28例,A组早期同时给予肠内营养(EN)和肠外营养(PN);B组给予早期PN,一周后逐渐过渡到到EN;C组单给PN,PN时间超过2周;D组早期给予单纯EN;E组用传统延迟性EN。进行有关临床观察及统计学分析。结果重型颅脑损伤者伤后早期能从不同营养途经获得营养成分,A组2周时血糖及各项营养指标均优于B组(P<0.05)且A组早、晚期并发症发生率60.7%、35.7%均低于B组85.7%、57.1%,预后亦优于B组,A、B两组间比较,A组消化道出血发生率低于B组14.3%,费用更节约。结论重型颅脑损伤后早期联合进行EN、PN是临床较合理的营养支持方法,对预后有重要的价值。     

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。     

早期肠内营养在食管癌行食管-胃颈部器械吻合术后的应用

目的: 探讨食管癌根治术病人行胃-食管消化道吻合器颈部吻合术后EEN的效果. 方法: 对340例食管癌病人采用食管次全切除,吻合器行胃-食管颈部吻合.将病人分为吻合器吻合 EN组、手工吻合 EN组和手工吻合 PN组.术后第1天开始分别给予营养支持1周,观察病人的肠道恢复时间、术后住院时间;围手术期营养指标、免疫指标、术后并发症. 结果: 两EN组的肠道恢复时间、术后住院时间较PN组明显缩短(P＜0.01);围手术期营养指标和免疫功能指标也明显高于PN组;两EN组术后并发症明显低于PN组.器械吻合 EN组在吻合口瘘和吻合口狭窄方面低于手工吻合 EN. 结论: 食管癌根治术病人行胃-食管吻合器颈部吻合术后EEN安全可行,能明显改善病人的营养状况,加速病人的康复,减少手术并发症.     

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.