食管癌术后早期肠内营养支持40例效果观察

目的:探讨食管癌患者术后早期肠内营养实施方法和效果。方法:将80例食管癌手术患者随机分为早期肠内营养(EN)组和肠外营养(PN)组各40例,术后分别给予早期肠内营养和肠外营养支持,比较两组术后并发症发生情况、肠鸣音恢复时间、排气、排便时间、住院天数及术前、术后7 d营养指标状况等。结果:EN组肺部炎症和静脉炎发生率均低于PN组、腹泻发生率高于PN组(P<0.05);EN组术后各项指标恢复时间均短于PN组,术后7 d营养指标状况优于PN组(P<0.05)。结论:食管癌术后早期行肠内营养安全有效,可以提高机体营养状态,降低感染等并发症的发生率,促进机体快速康复,缩短住院时间。     

颅脑外伤患者术后早期肠内营养支持耐受性及影响因素分析

目的:探讨颅脑外伤患者术后早期肠内营养(EN)支持的耐受性及其影响因素。方法:对73例颅脑外伤患者在术后均给予早期EN支持,观察患者EN耐受性情况,分析其影响因素。结果:本组30例患者结束早期EN支持过程中发生腹胀或腹泻等胃肠道反应,认为存在EN不耐受;患者性别、年龄、营养液起始用量、过渡至目标用量时间等对EN不耐受发生率均无明显影响(P0.05)。结论:大部分颅脑外伤患者术后能够耐受早期EN支持,而发生不耐受症状的患者经过对症治疗症状基本能够得到缓解。     

食管癌与贲门癌患者术后早期应用肠内营养的效果及护理

目的 探讨食管癌、贲门癌患者术后早期应用肠内营养（EN）支持的效果及护理体会.方法 90例食管癌术后患者随机分为两组,术后早期肠内营养（EN）组60例和对照组（常规禁食、补液）30例.EN组为术后次日起应用肠内营养.观察两组术后胃肠功能恢复指标：肛门排气与排便时间;胃潴留、腹胀、腹泻、呕吐、反流、误吸、吸入性肺炎、鼻黏膜损伤发生率;监测术前及术后第7天营养指标：体重、白蛋白（ALB）、前白蛋白（PAB）、转铁蛋白和外周血淋巴细胞计数（TLC）.结果 EN组术后排气与排便时间较对照组明显提前（P＜0.05）;胃潴留、腹胀较对照组少（P＜0.05）.EN组前白蛋白（PAB）、转铁蛋白和外周血淋巴细胞计数（TLC）明显升高（P＜0.05）;术后体重减轻较对照组少.结论 术后早期肠内营养支持安全、有效,精心的护理是确保早期肠内营养支持的关键因素.     

食管癌根治术后经十二指肠营养管行营养支持55例临床护理

目的:探讨食管癌根治术后经十二指肠营养管行早期肠内营养支持的临床护理方法.方法:为55例食管癌根治术患者术中留置十二指肠营养管,术后第2天开始经营养管注入肠内营养液.结果:本组患者能够耐受营养管.除1例患者术后5 d不慎自行拔管外,其余患者留置12～15 d,遵医嘱拔管.2例发生腹胀,2例发生腹泻,相应护理后症状消失或缓解,未影响营养支持继续进行.结论:食管癌根治术后经十二指肠营养管行早期肠内营养支持可满足患者术后的营养需要,减轻其经济负担,降低其并发症发生率,缩短其住院时间,促进其康复.     

Ⅱ、Ⅲ期食管癌术后早期肠内营养的临床应用分析

目的探讨食管癌术后早期肠内营养的可行性和临床应用价值。方法 220例Ⅱ、Ⅲ期食管癌患者术后分别给予肠外(PN)和早期肠内营养(EN)支持。分组对比患者术后恢复情况、营养支持费用、血液检测指标、并发症情况和出院后首次复诊的营养状况。结果 EN组较PN组患者肠鸣音恢复、肛门排气时间明显缩短,体重、人血白蛋白测量值术后第14 d和出院后首次复诊EN组明显高于PN组(P<0.05);EN组营养支持费用明显减少(P<0.05);术后第8 d、14 d外周血淋巴细胞计数EN组明显高于PN组(P<0.05);而2组术后吻合瘘、肺部感染、心律失常并发症发生率差异不明显。结论Ⅱ、Ⅲ期食管癌患者术后早期肠内营养安全可行,可以改善机体营养状况,促进患者的康复。对吻合口瘘等并发症的预防作用不明显,但可以明显缩短吻合瘘发生后的住院时间和降低治疗费用。     

胃癌术后早期行肠内营养支持的意义及护理

目的：探讨胃癌术后早期行肠内营养的意义及其护理方法。方法将本院2014年3月至2015年7月收治的128例胃癌手术患者,随机分为对照组及研究组,每组64例。对照组给予胃癌术后行完全肠外营养( TPN),待肠功能恢复后过渡为肠内营养( EN),不足部分由肠外营养( PN)补充。研究组在术后早期即行EN,并于术后营养过程中予以合理的护理辅助。比较两组患者术后10 d营养指标、免疫指标、术后排气时间、住院时间及感染、腹胀、腹痛、腹泻、吻合口瘘等并发症的发生率。结果术后10 d,两组患者体重、前白蛋白水平等营养指标的差异均无统计学意义(P>0.05)；研究组血浆白蛋白指标明显高于对照组(P<0.05)； CD4、 CD4/CD8等免疫指标明显高于对照组(均 P<0.05)；肛门排气时间明显快于对照组( P<0.05)；感染、吻合口瘘、腹胀、腹痛、腹泻等并发症的发生率明显低于对照组( P<0.05)；住院时间明显短于对照组( P<0.05)。结论胃癌术后早期行肠内营养支持,同时采取合理的护理方法,有助于提高患者营养及免疫功能,缩短肛门排气时间,降低术后感染、吻合口瘘、腹胀、腹痛、腹泻等并发症的发生率,缩短平均住院日,降低医疗费用,在术后患者快速康复中具有重要意义。     

外科危重病人早期肠内营养的监护与研究

目的　探讨早期肠内营养 (EN)在外科危重病人中的合理应用 ,分析肠内营养胃肠道并发症相关因素及监护方法。方法　对 48例外科危重病人实施EN ,根据病情分单纯消化道手术组 (31例 )与重症组 (17例 )。观察 2组肠道喂养量、输注速度、EN天数、血清蛋白及肠道耐受情况 ,进行对照研究。结果　单纯手术组对术后早期EN耐受较好。重症组EN天数、腹泻、腹胀的发生率高于手术组 ;腹泻发生与ALB水平呈负相关 ,与APACHE -Ⅱ、输注速度呈正相关。结论　加强外科危重病人EN过程监护及正确选择EN途径及输注方式十分重要 ,消化道大手术后尽早过渡到EN是安全可行的。重症组EN胃肠道相关并发症的发生率明显增高 ,多以PN +EN形式实现其营养支持。     

食管癌根治术后经十二指肠营养管行营养支持55例临床护理

目的：探讨食管癌根治术后经十二指肠营养管行早期肠内营养支持的临床护理方法。方法：为55例食管癌根治术患者术中留置十二指肠营养管,术后第2天开始经营养管注入肠内营养液。结果：本组患者能够耐受营养管。除1例患者术后5 d不慎自行拔管外,其余患者留置12-15 d,遵医嘱拔管。2例发生腹胀,2例发生腹泻,相应护理后症状消失或缓解,未影响营养支持继续进行。结论：食管癌根治术后经十二指肠营养管行早期肠内营养支持可满足患者术后的营养需要,减轻其经济负担,降低其并发症发生率,缩短其住院时间,促进其康复。     

食管癌切除术后早期肠内营养与肠外营养的观察对比

为探讨食管癌切除术后患者早期营养途径,对早期肠内营养(EN)与肠外营养(PN)进行比较分析,以选择合适的营养途径.结果食管癌切除术后早期EN组和PN组在术后1周内营养指标较术前均有明显改善(P＜0.05),但EN组恢复肛门排气时间短于PN组(P＜0.05),EN组恢复排便时间较PN组提前(P＜0.01).认为对于一般状况及经济条件较好的食管癌术后患者可采取PN的方式进行早期营养;对EN患者可采取必要的护理干预及方法改进,进一步减轻患者的不适感.     

术后早期肠内与肠外营养对食管癌患者应激反应、营养状况及恢复的影响

目的探讨术后早期肠内营养(EN)与肠外营养(PN)对食管癌患者应激反应、营养状况及恢复的影响。方法选取84例食管癌手术患者随机分为EN组(42例,EN)和PN组(42例,PN)。比较两组患者术前、术后7 d的应激指标、营养指标及术后恢复情况。结果术后7 d,PN组血清促肾上腺皮质激素(ACTH)、皮质醇(Cor)水平均高于术前及EN组(P<0.05);两组血清转铁蛋白(TRF)、白蛋白(ALB)水平均升高,且EN组高于PN组(P<0.05)。EN组的术后首次排气时间及住院时间均短于PN组(P<0.05)。结论食管癌患者术后予以早期EN较PN更利于减轻患者的应激反应、改善营养状况并可促进患者的恢复。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."