门诊克罗恩病患者家庭肠内营养支持的实施与效果

目的　指导门诊克罗恩病患者进行家庭肠内营养支持,随访观察效果。方法　选择2014年4月至2015年6月在南京军区南京总医院临床营养中心门诊就诊的克罗恩病活动期患者26例,给予家庭肠内营养联合药物治疗,比较患者治疗前后营养状况、克罗恩病活动度、生活质量的变化。结果　家庭肠内营养支持后,患者体质量指数由（177±21）kg/m2增至（198±20）kg/m2（P＜0001）,淋巴细胞比例由（0216±0066）增至（0305±0106）（P=0007）,白蛋白由（403±59）g/L增     

肠内联合肠外营养支持用于老年晚期消化道恶性肿瘤化疗患者的观察

目的 探讨肠内联合肠外营养支持对老年晚期消化道恶性肿瘤化疗的影响。方法 将2006年至2011年本院肿瘤内科收治的79例老年晚期消化道恶性肿瘤患者采用随机数字表法分为两组,治疗组（n=42）采用营养支持联合化疗,对照组（n=37）采用单纯化疗,入院后行营养风险筛查,2个化疗周期后比较营养状态、Karnofsky功能状态评分、毒性反应、院内感染率的变化。结果 两个周期化疗后,治疗组的体重指数 ［（19.00±3.31）kg/m2比（18.24±1.98）kg/m2,P=0.04］、白蛋白［（33.90±1.50） g/L比（29.90±2.38）g/L,P=0.02］、前白蛋白［（28.19±1.50)g/L比（25.51±8.38）g/L,P=0.01］、血红蛋白［（107.0±6.90)g/L 比（104.20±9.70）g/L,P=0.02］、淋巴细胞［（2.99±0.55)×109/L比（2.63±0.20）×109/L,P=0.03］均显著升高。化疗不良反应方面,治疗组骨髓抑制发生率明显低于对照组（28.57%比83.78%,P=0.00）;治疗组中有营养风险者的骨髓抑制发生率为31.03%,显著低于对照组的95.45%（P=0.00）,其他毒性反应差异无统计学意义。治疗组两次化疗后的院内感染发生率均显著低于对照组（0比10.81%,P=0.03;2.38% 比27.03%,P=0.02）。结论 老年晚期消化道恶性肿瘤患者化疗期间联合应用肠内加肠外营养支持有利于机体营养状况及体能的改善,减轻毒性反应,是院内感染发生的保护性因素。营养支持符合化疗患者的需求,具有安全、有效、合理的特点。     

重度烧伤患者早期肠内营养支持的经济学评价

目的研究重度烧伤患者早期肠内营养支持的疗效及费用。方法采用随机临床分组试验,将41例烧伤面积超过30%的患者分为肠内营养组(enteral nutrition,EN,n=21)和肠外营养支持为主的常规治疗组(conventionaltherapy,CONT,n=20)。治疗7天后观察两组内脏蛋白水平和预后炎症营养指数(prognostic inflammatory and nutritionalindex,PINI)等的变化及不良反应。结果治疗7天后EN组的前白蛋白水平显著高于CONT组[(115.8±31.0)mg/Lvs.(69.4±17.3)mg/L,P<0.01];PINI显著低于CONT组(162.9±89.4vs.343±149,P<0.01);EN组治疗7天的费用比CONT组节约382.06元(P=0.00)。结论早期肠内营养支持改善营养状况的疗效优于常规治疗,且费用低,具有良好的成本效果比。     

重症SARS患者的临床营养支持及血糖水平和胰岛素用量与结局的关系

目的观察重症SARS患者接受临床营养支持前后部分与营养有关指标的变化,并分析血糖水平/胰岛素用量与结局的关系。方法以我所英东重症医学监护中心收治的21例临床诊断重症SARS患者为研究对象,转入ICU后均给予呼吸支持及临床营养支持。经肠内营养接受的热量约4184kJ/d(1000kcal/d),蛋白质约38g/d;经肠外营养接受的热量约3347.2kJ/d(800kcal/d)。监测给予患者肠内、肠外营养支持前后的血糖、血清白蛋白、血淋巴细胞总数及谷丙转氨酶等指标的变化。所有患者均接受甲基强的松龙约200mg/d。为将血糖保持在4.44～7.78mmol/L(80～140mg/dl)的较低水平,应用静脉泵入胰岛素,记录血糖及胰岛素用量,再分析其与结局的关系。结果在发病(11.0±2.8)d后转入ICU的21例患者中,16例(76.2%)伴有营养不良。经过平均12d肠内与肠外营养支持后,患者血清白蛋白显著升高犤(28.5±2.2)g/Lvs(37.0±4.1)g/L犦(P=0.0001);血淋巴细胞总数升高犤(0.74±0.47)×109/Lvs(1.22±0.73)×109/L犦(P=0.02);血谷丙转氨酶升高的病例有所下降,但差异不显著(81.0%vs57.1%,P=0.18);生存组血糖降至较低水平犤(9.5±2.3)mmol/Lvs(6.3±1.8)mmol/L犦(P=0.0002);死亡组血糖也有下降犤(13.0±3.3)mmol/Lvs(9.5±1.3)mmol/L犦(P=0.04);生存组血糖水平低于     

结肠癌术后不同营养支持方式的对比研究

目的探讨结肠癌术后早期肠内营养支持对患者营养状况的改善及并发症发生率的影响。方法2002年1～12月收治的51例行结肠癌根治性手术的患者随机分组,即早期肠内营养支持(EN组)、胃肠外营养(PN组)及常规补液组。营养支持共5～7d,分别测定其术前及术后营养相关指标,并观察其并发症发生率。结果术后10d测定肠内营养支持组白蛋白为(35.2±5.8)g/L,前白蛋白(280.3±52.2)mg/L熏体重(59.9±5.0)kg熏均较常规补液组白蛋白穴31.6±4.2雪g/L,前白蛋白穴231.6±55.8雪mg/L,体重穴56.5±5.3雪kg明显升高穴P<0.05雪,与PN组眼白蛋白穴35.8±5.5雪g/L,前白蛋白穴289.3±49.2雪mg/L,体重穴60.2±4.7雪kg演差异无显著性,排气时间比PN组及对照组均缩短穴P<0.05雪,感染性并发症发生率较对照组及PN组明显降低穴P<0.05雪。结论术后早期肠内营养可改善结肠癌术后营养状况,降低感染性并发症发生率。     

术后早期肠内营养对胃肠肿瘤患者体液免疫的影响

目的探讨术后早期肠内营养对胃肠肿瘤患者体液免疫的影响。方法将2003年6～12月本科收治的30例胃肠道肿瘤患者均分为肠内营养(EN)和肠外营养(PN)两组。EN组术后24小时内经鼻空肠管输注肠内营养液,PN组经外周静脉输注营养液,两组热卡、氮量相同。于术前(营养支持前)、术后第7天(营养支持后)检测体液免疫指标IgA、IgG、IgM、C3、C4和CH50。结果EN组体液免疫指标较营养支持前差异无显著性(P>0.05)。PN组IgA、IgG、IgM差异无显著性;但C3、C4、CH50营养支持前分别为(1.091±0.227)、(0.221±0.051)和(40.950±11.400)g/L,营养支持后分别为(0.782±0.233)、(0.162±0.058)和(32.440±9.355)g/L,支持后较支持前明显降低,差异具有显著性(P=0.002,0.009,0.049)。结论胃肠肿瘤术后早期肠内营养对改善机体体液免疫有一定作用。     

重度烧伤病人早期肠内营养支持的研究

目的:研究重度烧伤病人早期应用肠内营养支持的疗效及安全性。方法:41例烧伤面积超过30%的病人随机分为肠内营养组(TEN,n=21)和肠外营养支持为主的常规治疗组(CONT,n=20)。给与相当氮量和能量,7d后观察两组内脏蛋白、肿瘤坏死因子-α和预后炎症营养指数(prognosticinflammatoryandnutritionalindex,PINI)等的变化及不良反应。结果:TEN组前白蛋白水平(mg/L)从99.9±25.1上升至115.8±31.0,CONT组从96.0±31.8显著下降至69.4±17.3(P<0.01)。TEN组C-反应蛋白与TNF-α水平显著低于CONT组,CONT组的PINI值比TEN组显著升高;两组不良反应发生情况相当。结论:早期肠内营养支持改善重度烧伤病人营养状况的疗效优于常规治疗,安全可行。     

早期肠内营养支持对卒中后吞咽功能障碍患者营养状况及结局的影响

目的 评价肠内营养支持对卒中后吞咽功能障碍患者的营养状况及临床结局的影响.方法 选取2013年8月至2014年7月在郑州大学第五附属医院住院的急性卒中合并吞咽功能障碍的患者148例,于入院48内采用抽签法随机分入肠内营养组(n =75,早期肠内营养支持)和对照组(n =73,常规饮食).比较入院第1天和第21天两组患者的营养状况(肱三头肌皮褶厚度,血清总蛋白、白蛋白及血红蛋白水平)、肺部感染发生率、病死率及神经功能恢复情况.结果 入院第1天,肠内营养组的肱三头肌皮褶厚度,血清总蛋白、白蛋白、血红蛋白水平与对照组差异无统计学意义[(15.4±4.1)mm比(15.1±3.7) mm,t=1.36,P=0.392; (75.7±2.6) g/L比(76.6±3.1) g/L,t=1.12,P=0.254; (39.2±1.8) g/L比(38.7±2.1) g/L,t=1.24,P=0.200; (137.4±14.5) g/L比(135.1 ±15.3) g/L,t=1.01,P=0.461];入院第21天,肠内营养组这4项营养状况指标均显著高于对照组[(13.5±3.9)mm比(11.2±4.6) mm,t=2.08,P=0.019;(63.3±4.1) g/L比(57.1±4.7) g/L,t=4.01,P=0.001; (35.7±1.6) g/L比(34.1±2.0)g/L,t=2.31,P=0.022;(125.7±17.9) g/L比(120.3±16.7)g/L,t=2.39,P=0.027].肠内营养组肺部感染发生率、病死率及美国国立卫生研究院卒中量表评分均显著低于对照组(41.3％比63.2％,x2=9.69,P=0.002; 15.3％比21.2％,x2 =3.27,P=0.01; 11.1±4.1比14.7±3.9,t=2.98,P=0.007).结论 早期肠内营养支持可改善卒中合并吞咽功能障碍患者的营养状况及临床结局,可能还有助于改善患者的神经功能.     

恶性肿瘤患者术后应用肠内营养支持的体会

目的探讨恶性肿瘤患者术后运用肠内营养支持的方法及疗效。方法选取2013年10月至2014年12月经我院营养科会诊并实施肠内营养支持的恶性肿瘤术后患者38例进行回顾性分析,对患者肠内营养支持前与肠内营养支持10天后的血红蛋白(HGB)、总蛋白(TP)及白蛋白(ALB)等指标进行对比分析;并根据营养支持途径分为单纯肠内营养支持组与肠内联合肠外营养支持组,对两组患者营养支持前后上述指标的差值进行比较分析。结果 38例恶性肿瘤术后患者经营养支持治疗后各项指标均较治疗前有所增高,差异有显著统计学意义(P0.05),单纯肠内营养支持组(EN组)与肠内联合肠外营养支持组(EN+PN组)比较在治疗前无统计学差异(P0.05),治疗后差异有显著统计学意义(P0.05)。结论对恶性肿瘤术后患者运用肠内营养支持有助于改善其营养状况;对无法达到足量肠内营养支持的患者,联合使用肠外营养既可保护肠道功能又能供给充足能量,更利于改善患者的营养状况。     

肠内外营养支持治疗在ICU机械通气患者应用价值研究

目的:探讨ICU机械通气患者采取肠内外营养支持治疗的临床价值。方法:研究对象取2017年5月11日至2018年3月22日64例ICU机械通气患者,动态随机化分组,对照组及观察组各32例。对照组实施肠外营养,观察组予以肠内营养。观察两组营养状况、不良事件发生情况。结果:观察组干预后血红蛋白、血清白蛋白为(11.80±1.16)g/L、(42.03±3.88)g/L,高于对照组数据,P0.05;两组不良事件发生概率无显著差异,P0.05。结论:在ICU机械通气患者营养支持中,肠内营养支持应用效果更佳,可显著改善患者营养状况。     

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.