重组人生长激素与不同负荷营养支持对腹部大手术后病人代谢的影响

目的:观察不同营养负荷下重组人生长激素(rhGH)对腹部大手术后病人机体代谢所产生的影响.方法:将32例病人随机分为三组:即A组(低热量组)11例,用83.68 kJ/(kg·d)营养支持;B组(低热量加rhGH组)10例,术后第1～7天用83.68 kJ/(kg·d)﹢rhGH 4 U/d营养支持;C组(高热量加rhGH组)11例,术后第1～7天用125.52 kJ/(kg·d)﹢rhGH 4 U/d营养支持.术后观察病人尿氮排出量的变化、血清清蛋白和前清蛋白水平.结果:术后第8天B组和C组血清前清蛋白明显高于A组(P＜0.05),其中C组明显高于B组(P＜0.05).术后第1～8天各组尿氮排出量均大于术前.术后第4天开始,B组和C组尿氮排出量减少,与A组比差异有显著性意义.术后第8天C组尿氮排出较B组下降更明显.结论:在腹部大手术后应用rhGH的条件下,适度地增加营养负荷,可以达到较好的效果.     

添加谷氨酰胺双肽的低热量肠外营养在高龄腹部手术病人的临床应用

目的 :探讨添加谷氨酰胺 (Gln)双肽的低热量肠外营养 (PN)在高龄腹部手术病人中的应用价值。　方法 :4 0例病人随机分成研究组和对照组 ,各 2 0例。所有病人术后第 1～ 6天接受等热量 83.6kJ/ (kg·d)、等氮 0 .16 g/(kg·d)的PN支持 ,研究组病人另增加 0 .3g/ (kg·d)的Gln双肽。术前及术后第 1、7天检测血清白蛋白、前白蛋白、IgG、IgA和IgM ,并进行淋巴细胞计数 (LCC)。计算术后第 1、4、7天氮平衡。　 结果 :两组病人术后血清白蛋白和前白蛋白值均较术前下降 ,对照组下降明显 (P <0 .0 5 ) ;术后LCC均较术前升高 ,尤以研究组升高显著 (P <0 .0 1)。累积氮平衡研究组明显高于对照组 (P <0 .0 5 )。未观察到不良反应或并发症。　结论 :添加Gln双肽的低热量肠外营养在高龄腹部手术病人中使用安全 ,具有改善氮平衡、减轻术后血清蛋白水平下降和促进淋巴细胞计数恢复的作用     

低热量肠外营养联合生长激素在胃肠道肿瘤病人术后应用的临床研究

目的:探讨重组人生长激素(rhGH)对胃肠道肿瘤病人术后蛋白质代谢的影响.方法:将39例胃肠道肿瘤病人随机、双盲分为两组:低热量肠外营养支持 安慰剂为对照组(n=20);低热量肠外营养支持 rhGH为治疗组(n=19).观察病人术后血清胰岛素样生长因子(IGF-1)和蛋白质代谢的变化情况.结果:IGF-1、前清蛋白、转铁蛋白、纤维连接蛋白术后3 d均有明显下降,治疗后都有不同程度的恢复.治疗组术后10 d IGF-1、前清蛋白、转铁蛋白、纤维连接蛋白明显高于对照组(P＜0.05);治疗组正氮平衡也比对照组恢复得早(P＜0.05).结论:低热量肠外营养支持联合rhGH能促进胃肠道肿瘤病人的蛋白质合成,明显改善病人术后的营养状况.     

肠内与肠外营养在老年食管癌病人围手术期应用的比较

目的:客观评估围手术期肠内营养(EN)与肠外营养(PN)支持对老年食管癌病人术后转归的影响。方法:采用单中心前瞻性随机对照临床研究设计,将老年食管癌病人随机分为EN组(研究组,26例)和全肠外营养组(TPN)(对照组,27例)。研究组病人于术前5 d开始,除正常饮食外,再加口服EN液(康全甘)500 ml/d,术后24 h开始输注EN液;对照组病人术后常规使用TPN。并于术前5 d、手术当天、术后24 h和术后1周分别检测两组病人肝功能、三酰甘油和空腹血糖,记录术后30 d内并发症发生率及种类、住院天数、术后重症监护室留观天数,医疗费用和病死率。结果:研究组病人术后第1天清蛋白和前清蛋白水平显著高于对照组。对照组病人术后第7天转氨酶、三酰甘油和空腹血糖显著升高。对照组病人Ⅲa级以上严重并发症发生率显著增高。研究组病人住院天数、重症监护室留观时间和医疗费用均显著低于对照组。结论:老年食管癌病人围手术期应用EN支持可改善糖脂代谢,降低术后严重并发症率,减少医疗费用。     

围手术期谷氨酰胺强化全肠外营养对胃肠道肿瘤病人营养状况的影响

目的:研究围手术期谷氨酰胺强化的全肠外营养(TPN)对接受术前化疗的胃肠道肿瘤病人营养状况的影响. 方法:将60例胃肠道肿瘤病人随机分为TPN组、谷氨酰胺强化TPN (Gln-TPN)组和对照组,每组20例病人.对照组给予常规术前准备和术后治疗,TPN组和Gln-TPN组分别给予术前5 d和术后5 d营养支持.两组给予等氮0.20 g/(kg·d)和等热量104.6 kJ/(kg·d),同时接受为期5 d的术前化疗.Gln-TPN组中25%～35%的氮源由谷氨酰胺双肽提供,其余的氮源及TPN组的氮源由乐凡命提供.检测术前、术后病人的体重、肱三头肌皮皱厚度、上臂肌围、血浆清蛋白、前清蛋白、转铁蛋白、血浆和肌肉中谷氨酰胺浓度、氮平衡等营养指标.结果:研究期间三组病人无严重并发症发生.三组病人术后体重、肱三头肌皮皱厚度、上臂肌围,血浆前清蛋白、转铁蛋白浓度、氮平衡,均较术前明显下降,术后三组间比较差异无显著性意义.对照组体重丢失最为严重,术后第6 d Gln-TPN组肌肉中及血浆谷氨酰胺浓度明显高于其他两组.结论:谷氨酰胺强化的TPN可提高血浆和肌肉中谷氨酰胺浓度,减少肌肉分解、脂肪消耗,促进机体蛋白质的合成,有益于减轻手术和化疗造成的高分解状态.     

谷氨酰胺强化的低氮低热量肠外营养对结直肠癌合慢性阻塞性肺疾病病人的影响

目的:评价丙氨酰谷氨酰胺注射液(LALG)强化的低氮低热量肠外营养(PN)支持对合并慢性阻塞性肺疾病(COPD)的结直肠癌病人术后营养、免疫状况和肺功能的影响. 方法:将48例符合研究标准的结直肠癌病人随机分为研究组和对照组,每组24例.所有病人均于术后使用非蛋白质热量83.7 kJ/(kg·d),氮为0.17h/(kg·d)的PN支持,研究组病人再加入LALG 0.5g/(kg·d).比较两组病人术后的营养指标、免疫功能、肺功能和肺部感染率. 结果:术后第7天两组病人均转为氮平衡,营养和免疫功能指标均明显增高,但研究组增高更明显.研究组病人肺功能改善明显优于对照组,肺部感染率明显低于对照组. 结论:加入LALG的低氮低热量PN可改善合并COPD的结直肠癌病人术后的营养状况,提高病人的免疫功能和肺功能,减少肺部感染的发生率.     

谷氨酰胺和精氨酸对围手术期结直肠肿瘤病人免疫功能和营养状况的影响

目的:探讨谷氨酰胺(Gln)和精氨酸(Arg)对围手术期结直肠肿瘤病人免疫功能和营养状况的影响.方法:将62例结直肠肿瘤病人随机分为对照组和研究组,每组31例.对照组病人行肠外营养(PN),研究组行PN加Gln和Arg,观察结直肠肿瘤病人术前3d、术后第2和第7天免疫反应和营养状态的变化.结果:术后第7天,研究组病人血清免疫球蛋白A水平、CD4/CD8比值和体重指数(BMI)明显高于对照组和术前3d,而血液C-反应蛋白和肿瘤坏死因子-α水平明显低于对照组和术前3d.血清总蛋白、清蛋白、前清蛋白、白细胞介素-2(IL-2)、CD4、CD8、IgG、IgM水平变化无显著性差异.结论:Gln和Arg可提高围手术期结直肠肿瘤病人机体免疫应答,减轻炎性反应,调节肿瘤病人的代谢异常.     

丙氨酰-谷氨酰胺双肽对腹部术后病人肠道通透性和应激反应的影响

目的:观察给予丙氨酰-谷氨酰胺(Aln-Gln)双肽对腹部术后病人早期肠道通透性和应激反应的影响. 方法:将20例腹部手术病人分为研究组和对照组,每组各10例.从术后第1天开始,研究组病人静脉给予Aln-Gln双肽0.5 g/(kg·d),共4 d;对照组病人给予同等容量的等渗盐水.于手术前、后分别检测尿乳果糖/甘露醇(L/M)比值和血浆Gln浓度、二胺氧化酶(DAO)、皮质醇和IL-6等. 结果:对照组术后第5天血浆Gln浓度较术前下降16%;研究组较术前升高17%,明显高于对照组(P<0.05).研究组术后第5天血浆DAO和尿L/M比值均较术前明显降低,并显著低于对照组,皮质醇和IL-6的恢复明显优于对照组. 结论:静脉给予Aln-Gln双肽能改善腹部术后病人的肠黏膜屏障功能,减轻术后早期应激反应,有利于术后的快速康复.     

早期肠内营养对胃胰腺肿瘤术后免疫和营养状况的影响

目的:比较早期肠内营养(EEN)与肠外营养(PN)对胃、胰腺肿瘤术后免疫和营养状况的影响.方法:胃、胰腺肿瘤病人96例,分为EEN组52例、PN组24例和对照组(常规补液)20例.术后24 h开始给予肠内或肠外营养,检测术前和术后第9 d营养以及免疫指标,观察术后严重并发症及肠功能的恢复.结果:EEN组和PN组术后体重、前清蛋白、清蛋白、IgG、IgM及IgA均显著高于对照组(P＜0.05),而EEN组和PN组之间差异无显著性意义;EEN组和PN组术后CD3 、CD4 、CD4 /CD8 均显著高于对照组(P＜0.01),并且EEN组术后CD4 、CD4 /CD8 亦显著高于PN组(P＜0.05).结论:EEN可明显改善胃、胰腺肿瘤术后近期的营养和免疫状况,在术后细胞免疫和肠功能恢复方面明显优于肠外营养.     

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.     

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.