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.     

肠内免疫营养在恶性梗阻性黄疸病人术后的临床应用

目的:观察肠内免疫营养对恶性梗阻性黄疸病人术后的临床应用效果.方法:该研究是前瞻、随机、单盲和对照的临床研究.将40例接受手术治疗的恶性梗阻性黄疸病人,随机分为标准肠内营养组和肠内免疫营养组,每组20例.两组病人年龄、性别、手术方式等方面均有可比性.术中空肠造口,术后按125.52 kJ/(kg·d)给予等热量的肠内营养支持,连续应用10天以上.标准肠内营养组给予标准肠内营养剂,肠内免疫营养组给予肠内免疫营养剂(Supportan).分别于手术前2天,术后第4和第14天检测血清清蛋白、前清蛋白、谷丙转氨酶、谷草转氨酶、外周血T淋巴细胞亚群和血清IL-6水平.结果:①术后第14天时,肠内免疫营养组血清清蛋白水平明显高于标准肠内营养组(P＜0.05).②术后第14天时,谷丙转氨酶、谷草转氨酶两组间无显著性差异.③术后第4天时肠内免疫营养组CD4/CD8比值明显高于标准肠内营养组(P＜0.01).与术前2天相比,术后第14天时肠内免疫营养组的CD4/CD8比值明显升高(P＜0.05),而在标准肠内营养组则无显著性差异.④术后第14天时,肠内免疫营养组血清IL-6水平明显低于标准肠内营养组(P＜0.05).结论:恶性梗阻性黄疸病人手术后应用肠内免疫营养能改善病人的营养状况,增强机体对肿瘤的免疫功能,调理急性炎症反应,改善预后.     

免疫肠内营养在高龄胃癌病人术后免疫调节作用的观察

目的:观察免疫肠内营养对高龄胃癌病人术后恢复、免疫功能、营养状况的影响。方法:将68例高龄胃癌病人(70岁)手术后随机分为免疫肠内+肠外营养(EN+PN)组和肠外营养(PN)组。于术前1 d、术后第1和第7天检测相关的营养和免疫血清指标,观察术后恢复情况,并比较和分析。结果:两组病人术后第1天血清总蛋白(TP)、清蛋白(ALB)、前清蛋白(PA)、Ig G、Ig A水平以及CD3、CD4、CD4/CD8较术前1 d有显著下降。术后7天EN+PN组血清TP、ALB、PA、Ig G、Ig A以及CD3、CD4、CD4/CD8与PN组比有显著性差异(P0.01)。术后EN+PN组和PN组发生术后并发症无显著性差异。结论:早期使用肠内免疫营养制剂,可改善高龄胃癌病人手术后的免疫功能和营养状态。     

肠内免疫营养对胃癌手术病人免疫功能和急性炎性反应的调理作用

目的 :观察胃癌病人围手术期使用肿瘤特异性肠内免疫营养物 Supportan对病人的营养、免疫和急性炎性反应的调理作用。　方法 :本研究是一个前瞻、随机、单盲、对照的临床研究。30例营养不良择期手术的胃癌病人 ,随机分为两组 :1、免疫营养组 (Supportan,n=15 ) ,2、标准营养组 (能全素 Nutrison,n=15 )。两组使用等热量肠内营养 ,12 5 k J(30 kcal) / (kg· d)。术前置鼻胃管 ,使用 7天。术中均行空肠造口 ,术后 12小时开始空肠输注肠内营养 ,连续 7天。术前第 8、1天 ;术后第 1、8天抽取静脉血 ,检测血清白蛋白、前白蛋白、转铁蛋白、T淋巴细胞亚群、血清免疫球蛋白、血清 IL - 6、CRP、PGE2 浓度。　结果 :两组病人术后均有急性炎性反应的发生和免疫功能的降低。但免疫营养组比标准营养组的术后第 1、8天的 CD4/ CD8比值、血清 Ig G水平有显著增加 ;血清 IL- 6、CRP、PGE2 有显著下降 ;术后第 8天血清前白蛋白浓度有显著增加。　结论 :胃癌合并营养不良的病人围手术期使用肠内免疫营养物 Supportan可以改善手术后免疫功能的低下 ,缓解急性相炎性反应和增加内脏蛋白的合成。     

术后早期肠内免疫营养在老年胃癌中的应用

目的 探讨术后早期肠内免疫营养对老年胃癌患者营养状况及免疫功能的影响.方法 将86例60岁以上老年胃癌患者分为对照组43例,瑞能组43例,对照组给予静脉营养,瑞能组在静脉营养的基础上,术后24 h后开始实施肠内营养,经空肠营养管输注肠内营养制剂Supportan(瑞能),量由500 ml/d逐渐增至1500 ml/d,分别于术前1 d及术后第8天抽取外周血,测定营养及免疫指标.结果 术后瑞能组的血浆前白蛋白较对照组恢复快(P<0.05),瑞能组的CD3、CD4细胞数、CD4/CD8比值及NK细胞数高于对照组(P<0.05).结论 术后早期肠内免疫营养可改善老年胃癌患者的营养状况,增强机体的免疫功能.     

全胃切除病人术后免疫增强型肠内营养的作用

目的:研究全胃切除病人术后早期免疫增强型肠内营养支持对机体免疫功能的影响.方法:选择进展期胃癌根治性全胃切除病人52例,随机分为免疫增强型肠内营养组(试验组)和常规肠内营养组(EN组).两组病人均从术后第1天起自营养管给予等热量、等氮量的肠内营养制剂.试验组使用免疫增强型肠内营养制剂Stresson,EN组使用常规的肠内营养制剂能全力,共7d.于术前及术后第1、8天分别抽取外周血,测定IgG、IgA、IgM及 T淋巴细胞亚群(CD3、CD4、CD8、CD4/CD8比值).结果:术后第1天,两组病人的各项免疫指标均有所下降,而术后第8天两组的IgG、IgM、IgA、CD3、CD4和CD4/CD8均明显回升,并高于术前水平,两组比较差异有显著性意义(P＜0.05).结论:胃癌根治性全胃切除病人术后早期免疫增强型肠内营养支持,可有效地改善病人的免疫功能.     

肠内普通营养与肠内免疫营养对胃癌患者术后营养支持效果比较分析

目的 比较肠内普通营养与肠内免疫营养对胃癌患者术后营养支持效果.方法 选择2008年1月～2011年12月期间某院外科住院需要行手术治疗的30例胃癌患者作为研究对象,按照单盲数字表格法随机分组分为肠内普通营养组(TEN组)及肠内免疫营养组(EIN组)各15例,术后TEN组给与肠内普通营养,EIN给与肠内免疫营养,检测术后d1、d9患者营养指标及免疫指标变化.结果 (1)术后d1血清总蛋白、白蛋白、前白蛋白及转铁蛋白浓度在TEN与EIN组间比较差异无统计学意义(P＞0.05),术后d9血清总蛋白、前白蛋白浓度在TEN与EIN组间比较差异有统计学意义(P＜0.05),白蛋白及转铁蛋白组间比较差异无统计学意义(P＞0.05). (2)术后d 1 IgG、IgA、IgM、CD3、CD4、CD8在TEN与EIN组间比较差异无统计学意义(P＞0.05),术后d9IgG、IgA、IgM、CD3、CD4在TEN与EIN组间比较差异有统计学意义(P＜0.05),CD8组间比较差异无统计学意义(P＞0.05).结论 肠内免疫营养较肠内普通营养对机体免疫功能上调能力更强,特定的免疫增强剂有效的保护和改善了患者免疫功能.     

围手术期联合应用四君子汤和大黄的早期肠内营养对胃癌术后近期免疫功能的影响

目的评价在围手术期应用中药大黄的基础上,术后早期联合应用四君子汤和肠内营养对胃癌患者免疫功能的影响。方法将40例胃癌手术患者随机分为常规肠内营养组(对照组)和大黄、四君子汤干预肠内营养组(研究组)。研究组术前1天、术后18、36小时,经鼻饲管给予中药大黄,对照组给予相同剂量的生理盐水;两组患者均于术后第36小时开始给予等热量、等氮肠内营养支持至术后第10天,研究组在予以肠内营养的同时,经鼻肠管予以四君子汤治疗,并持续应用至术后第10天,对照组经鼻肠管予以相同剂量的生理盐水。两组分别于术前1天,术后第1、10天检测外周血T淋巴细胞亚群(CD3、CD4、CD8及CD4/CD8),免疫球蛋白(IgA、IgG、IgM)浓度。结果研究组术后10天CD3、CD4、CD4/CD8及IgG水平均显著高于对照组(P<0.05)。结论同手术后单独应用肠内营养相比,围手术期联合应用中药的肠内营养具有显著的细胞免疫增强作用,可有效纠正胃癌患者术后细胞免疫抑制状态。     

术后早期肠内免疫营养在老年胃癌中的应用

目的 探讨术后早期肠内免疫营养对老年胃癌患者营养状况及免疫功能的影响.方法 将86例60岁以上老年胃癌患者分为对照组43例,瑞能组43例,对照组给予静脉营养,瑞能组在静脉营养的基础上,术后24 h后开始实施肠内营养,经空肠营养管输注肠内营养制剂Supportan（瑞能）,量由500 ml/d逐渐增至1500 ml/d,分别于术前1 d及术后第8天抽取外周血,测定营养及免疫指标.结果 术后瑞能组的血浆前白蛋白较对照组恢复快（P〈0.05）,瑞能组的CD3、CD4细胞数、CD4/CD8比值及NK细胞数高于对照组（P〈0.05）.结论 术后早期肠内免疫营养可改善老年胃癌患者的营养状况,增强机体的免疫功能.     

肠内免疫营养对老年食管癌病人术后免疫水平的影响

目的:研究肠内免疫营养(EIN)制剂对老年食管癌病人术后免疫水平的影响。方法:选取老年食管癌病人92例,随机分为两组,试验组给予EIN,对照组给予普通肠内营养(EN)。两组病人术后均给予同等的热量和氮量,于术前1 d、术后第1和第8天分别检测相关的营养和免疫指标,包括血清总蛋白(TP)、前清蛋白(PA)、清蛋白(ALB)、转铁蛋白(TF)、Ig G、Ig A、Ig M、CD3、CD4、CD4/CD8、NK细胞,并对各项指标进行比较和分析。结果:两组病人术前各项免疫和营养指标均无显著性差异(P0.05)。术后第1天,各组血清蛋白指标和免疫指标均明显低于术前1 d。术后第8天,两组病人血清蛋白水平较术后第1天明显上升,但组间差异无统计学意义(P0.05),试验组免疫指标Ig G、CD3、CD4、CD4/CD8、NK细胞明显高于对照组,差异有显著性统计学意义(P0.05)。试验组病人的住院时间缩短,感染并发症的发生率降低。结论:老年食管癌术后应用EIN制剂可提高病人的免疫功能,降低术后感染并发症的发生率,缩短住院时间。     

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.