酸牛奶用于婴儿生理性腹泻的效果观察

生理性腹泻多见于 6个月的母乳喂养婴儿 ,生后不久即出现腹泻 ,添加辅食后大便逐渐转为正常[1] 。其发生可能与母乳成分存在个体差异及婴儿消化功能不完善有关 ,具体原因尚待进一步探讨。但由于婴儿胰淀粉酶活性较低 ,故不宜过早地 ( 3个月以前 )喂淀粉类食物。新生儿及婴儿胰脂肪酶和胰蛋白酶的活性都较低 ,故对脂肪和蛋白质的消化和吸收能力不够完善。所以 1个月～ 4个月婴儿只能添加菜汤、水果汁等 ,5个月～ 6个月可添加米汤、米糊、蛋黄、菜泥等。酸牛奶具有易消化、易吸收的特点。且较鸡蛋黄口感好 ,小儿易于接受 ,便于喂养。现就其用…     

The financial losses from the migration of nurses from Malawi

Background  

The migration of health professionals trained in Africa to developed nations has compromised health systems in the African region. The financial losses from the investment in training due to the migration from the developing nations are hardly known.     

Lactic acidosis: from sour milk to septic shock

Lactic acidosis is frequently encountered in the intensive care unit. It occurs when there is an imbalance between production and clearance of lactate. Although lactic acidosis is often associated with a high anion gap and is generally defined as a lactate level >5 mmol/L and a serum pH <7.35, the presence of hypoalbuminemia may mask the anion gap and concomitant alkalosis may raise the pH. The causes of lactic acidosis are traditionally divided into impaired tissue oxygenation (Type A) and disorders in which tissue oxygenation is maintained (Type B). Lactate level is often used as a prognostic indicator and may be predictive of a favorable outcome if it normalizes within 48 hours. The routine measurement of serum lactate, however, should not determine therapeutic interventions. Unfortunately, treatment options remain limited and should be aimed at discontinuation of any offending drugs, treatment of the underlying pathology, and maintenance of organ perfusion. The mainstay of therapy of lactic acidosis remains prevention.     

鼻饲母乳在新生儿缺氧缺血性脑病治疗中的应用

目的 :探讨鼻饲母乳治疗新生儿缺氧缺血性脑病 (HIE)的价值。方法 :随机将轻、中度HIE新生儿 85例分为A、B两组。两组在相同常规综合治疗的同时 ,A组鼻饲母乳 ,B组经口喂养 ,治疗 5d后比较两组的总蛋白、血浆白蛋白、尿素氧、胆红素与血糖水平 ,以及平均住院日及住院期间并发症发生的情况。结果 :A组患儿血胆红素水平、血糖、住院期间败血症的发生率低于B组。结论 :鼻饲母乳对HIE新生儿予以营养支持能取得满意疗效     

How to feed patients with sepsis

Sepsis is associated with profound catabolism and hypermetabolism that complicate provision of nutritional support. These metabolic changes are caused by inflammatory mediators involved in the septic process and cannot be reversed by nutritional means. High protein isocaloric nutritional regimens are recommended if possible, in association with aggressive measures to control the sepsis. However, nutritional therapy and its complications may also affect the incidence and course of sepsis. Hyperglycemia and conventional intravenous fat emulsions have been shown to increase susceptibility to infection. Enteral nutrition is associated with fewer infectious complications than parenteral nutrition, at least in severely injured patients. Recently nutritional formulations have been introduced that contain novel substrates that enhance various aspects of immunity. Several studies have suggested that this immunonutrition reduces infection risk in the critically ill, and preliminary findings suggest it may even have an effect on survival in sepsis.     

Persistency of high proinflammatory cytokine levels from colostrum to mature milk in preeclampsia

OBJECTIVES: Recent evidence suggests a role of an excessive maternal inflammatory response in the pathogenesis of preeclampsia. Whether this imbalance can be transferred from mother to breast milk remains to be established. DESIGN AND METHODS: 15 preeclamptic and 15 healthy pregnant women were recruited in this study. Colostrum and milk samples were collected postpartum in the first 48 h and at 30 days, respectively. Samples were analyzed for interleukin (IL)-1beta, IL-6, IL-8, tumor necrosis factor (TNF)-alpha and soluble IL-2R (sIL-2R) levels with chemiluminescence enzyme immunometric assays. RESULTS: Colostrum cytokine levels corrected for gestational age and type of delivery were not significantly different in the two groups. Cytokine levels significantly decreased in mature milk versus colostrum in the control group (P < 0.05), but did not significantly decrease in the preeclampsia group (P > 0.05), except for TNF-alpha (P < 0.05). Mature milk IL-8 and TNF-alpha levels were higher in the preeclampsia group versus controls (P < 0.05). CONCLUSION: Results of this study show that proinflammatory cytokines in breast milk exhibit biological variation at different periods of human lactation. In preeclampsia, high cytokine levels persist at least for 30 days. These results suggest that preeclampsia may affect milk cytokine balance and offer an immunological signal for the host defense in high-risk neonates.     

活化的巨噬细胞对肝癌细胞系细胞迁移的影响

目的：探讨肿瘤相关巨噬细胞对肝癌细胞系细胞转移与侵袭力的影响。方法：巨噬细胞加入佛波酯进行刺激培养,体外模拟肿瘤相关巨噬细胞的体内环境,然后把其上清加入肝癌细胞系的transwell小室中去,观察其对肝癌细胞迁移的影响。结果：活化的巨噬细胞上清可对肝癌细胞系的迁移产生明显影响。结论：肿瘤相关巨噬细胞可能参与了肝癌细胞的体内转移过程。     

Spontaneous migration of bullet from arm to forearm and its ultrasound guided removal

Spontaneous migration of a retained bullet is rare. We are presenting here a case of a 24-year-old male with spontaneous migration of bullet from arm to forearm. At the time of initial injury, bullet was left inside the arm as it was deep and patient had no complaints. Three months after injury, he started complaining of pain over forearm and tingling sensations in the forearm and hand over median nerve distribution. Radiographs showed bullet in the proximal forearm. The bullet was than precisely localized and removed under ultrasound guidance. This case report emphasizes the fact that spontaneous migration of bullet in extremities may occur and have the potential to cause neurovascular damage. Removal under ultrasound guidance is a viable option in such locations.     

Human milk banking to 1985

This paper provides a literature review of the use of donor human milk by hospitals in Australia and elsewhere from the postwar period through to the early 1980s, and establishes the context for a small study of practices which happened in that period. The latter study will be reported elsewhere. The purpose of this paper is to provide a resource for future comparison when the history of the new hospital milk banks of the 21st century is written. Relevant literature in English and two articles in French were accessed.     

How to feed patients with renal dysfunction

Renal dysfunction is common in critically ill patients and its presence has, in the past, posed serious challenges to nutritional support. Such challenges were due to the increased azotemia induced by protein or amino acid administration, the fluid overload caused by the administration of nutrients, and the difficulties associated with the control of these complications by means of conventional dialytic techniques.The development and increasing application of continuous renal replacement therapy has removed such concerns, because control of azotemia and fluid balance can be predictably and reliably achieved in all patients. Accordingly, the presence of renal failure should in no way influence the amount or type of nutritional support administered to a critically ill patient. We recommend that approximately 30-35 kCal/kg/d be administered enterally and begun within the first few hours of admission to the intensive care unit, and that protein intake be kept in the 1.5-2 g/kg/d range.Accumulating evidence also suggest that immune-enhancing enteral preparations decrease the duration of hospital stay, the number of infections, and perhaps mortality. Such preparations should be used in these patients. Finally, adequate vitamin and trace element supplementation is recommended to counterbalance the decrease in antioxidants and the loss of some vitamins during continuous renal replacement therapy. Available evidence suggests that if these steps are applied as part of a protocol-based approach to the nutritional support of patients with renal failure, morbidity and perhaps mortality can be significantly decreased.