含特殊营养物质的肠内营养对消化道肿瘤术后机体免疫及炎症反应的影响

评价含谷氨酰胺、精氨酸、ω- 3多不饱和脂肪酸等特殊营养物质的免疫增强型肠内营养制剂对肿瘤病人手术后代谢、炎性反应及免疫功能的影响。将 48例消化道恶性肿瘤手术病人 ,随机分为常规肠内营养组和特殊肠内营养组。手术后第一天开始等热量、等氮量肠内营养支持一周。于术前、手术后第一天清晨和研究结束时分别检测多核白细胞的趋向性、吞噬功能 ,及其在吞噬过程中氧化代谢情况 ,巨噬细胞一氧化氮自由基 (NO)产生量 ,血清细胞因子 IL- 1、IL- 2、IL- 6及TNF- α浓度 ,外周血淋巴细胞总数、T细胞亚群 (CD3、CD4、CD8)及 NK细胞数及…     

消化道肿瘤手术后早期应用免疫增强型肠内营养的作用

目的：评价免疫增强型肠内营养制剂对肿瘤病人手术创伤后代谢，炎症反应，免疫功能及预后的影响。方法：88例消化道恶性肿瘤手术病人随机分为常规肠内营养组（对照组）和免疫增强型肠内营养组（研究组）。手术后第1天开始等热量，等氮肠内营养支持1周。于术前，术后第1，4天和研究结束时分别检测免疫，炎症反应及营养指标。结果 ：研究结束时，研究组多数免疫指标均明显高于对照组（P＜0．01）；而血IL－6，TNF－α）浓度及CRP水平则明显低于对照组（P＜0．05）。研究期间两组白蛋白，每天及氮平衡无显著差异，术后第8天，研究组血浆前白蛋白，转铁蛋白浓度明显高于对照组。研究组术后4天以后的感染性并发症发生率明显低于对照组，平均住院时间也明显低于对照组。结论：免疫增强型肠内营养制剂可减轻肿瘤病人手术创伤后的应激和炎症反应程度，增强机体免疫功能，改善预后。     

免疫增强型肠内营养对消化道恶性肿瘤病人术后免疫功能和炎症反应的影响

目的观察术后免疫增强型肠内营养对消化道恶性肿瘤病人术后免疫功能及炎症反应的影响。方法消化道恶性肿瘤病人42例,随机分为研究组、对照组,各21例。于术后1~8d,研究组使用含谷氨酰胺、精氨酸、ω-3多不饱和脂肪酸的免疫增强型肠内营养制剂,对照组使用常规的制剂能全力。观察术前1d、术后1d和术后9d:①免疫球蛋白(IgG、IgM、IgA)、T淋巴细胞亚群(CD4、CD8、CD4/CD8);②血清中细胞因子白介素(IL-6)、肿瘤坏死因子(TNF-α)。结果研究组IgA、CD4水平及CD4/CD8显著高于对照组(p<0·05)。炎症反应指标,研究组IL-6、TNF-α显著低于对照组(p<0·05)。结论免疫增强型肠内营养可减轻消化道恶性肿瘤病人术后的机体炎症反应,改善免疫功能。     

精氨酸等强化肠内营养对颅脑外伤患者营养及免疫功能的影响

目的 探讨精氨酸、谷氨酰胺强化肠内营养对重度颅脑外伤病人的营养支持效果及对免疫功能的影响。方法 47例重度颅脑外伤病人随机分为氨基酸强化组和常规对照组，术后48h内开始管饲肠内营养，精氨酸、谷氨酰胺强化组和对照组等氮等热量营养支持，观测肠内营养前、第7d和第10d各患者的营养指标和免疫指标。结果精氨酸、谷氨酰胺强化组和对照组病人总蛋白、白蛋白、三角肌皮褶厚度、身高体重指数等差异无显著性，观察组内脏蛋白浓度高于对照组；观察组病人IgA、IgG、IgM、C3、C4、CD3、CD4、CD4/CD8上升较对照组明显（P〈0.05）。结论 精氨酸、谷氨酰胺强化肠内营养剂的营养支持效果良好，可增强机体免疫功能，促进机体康复。     

消化道肿瘤-T-术后早期肠内营养疗效研究

目的评价消化道肿瘤手术后早期肠内营养的安全性,比较手术后短期应用要素制剂爱伦多的肠内营养与标准肠外营养支持的疗效。 方法62例消化道恶性肿瘤手术患者,随机分为对照组、肠外营养组和肠内营养组。手术后第一天开始等热卡、等氮量的肠外或肠内营养支持一周。检测体重、机体测量指标、血浆各内脏蛋白浓度及氮平衡等营养指标,外周血T细胞亚群、NK细胞和NK细胞活性等免疫指标及血清氨基酸谱。 结果三组病人术后体重下降分别为4．26±1．03ks、2．04±0．65ke和2．12±o．72kg,对照组与肠外营养组、肠内营养组之间差异有显著性(P<0．05),后两组之间无差异。术后各内脏蛋白浓度均低于术前,对照组降低最明显,与肠外或肠内营养组之间差异有显著性(P<0．05),而后两组之间无差异。三组病人平均氮平衡为—8．6±3．12g／d,—4．22±2．02g／d及—3．88±2．35g／d,对照组与肠外或肠内营养组之间差异有显著性(P<0．05),而后两组之间无差异。手术后各组病人外周血T细胞亚群、NK细胞和NK细胞活性均不同程度下降,但三组之间差异无显著性意义。三组病人血清谷氨酰胺水平明显下降,术后1周对照组和肠外营养组血清谷氨酰胺水平仍处于低水平,而肠内营养组却有一定程度恢复。 结论消化道肿瘤手术后早期肠内营养支持是安全、有效的方法,短期肠内营养和肠外营养支持的临床效果基本相同。     

胃肠癌术后肠外营养支持加精氨酸强化对机体免疫功能的影响

目的：观察胃肠癌术后肠外营养支持加精氨酸强化对机体免疫功能的影响。方法：选择胃肠癌行根治术后病人40例，随机分为试验组和对照组。试验组采用精氨酸强化肠外营养支持，对照组应用常规的肠外营养支持。分别在术前、术后第1天及第8天检测IgG、IgA、IgM、T细胞亚群、NK细胞活性和IL－2的改变。结果：胃肠癌病人术前均有不同程度的免疫功能低下，术后第1天IgG,IgA,IgM,CD4^ ,CD4^ ,CD4^ /CD8^ ，NK细胞活性IL－2均较术前显著下降，术后第8天试验组上述指标迅速恢复，并超过术前水平，与对照组相比差异显著（P＜0．01）。结论：精氨酸强化肠外营养对胃肠癌病人后免疫功能具有明显的增强作用。     

肠外或肠内营养对消化道肿瘤患者术后免疫功能的影响

目的：比较肠内营养与肠外营养对消化道肿瘤患术后免疫功能的影响。方法：将40例消化道肿瘤患随机分为肠内营养（EN）组肠外营养（PN）组，每组20例，试验周期为7天。术后第2天开始予等热量、等氮量营养支持1周。检测术前和术后第8天患外周血淋巴细胞计数、林巴细胞亚群CD3、CD4、CD8、CD25（IL－2受体）和NK细胞等细胞免疫指标，以及IgG、IgM、IgA、补体C3、C4、CH50和CRP等体液免疫指标。结果：两组患均无严重感染性并发症发生。两组总淋巴细胞计数在术前与术后第8天均无显性变化。EN组CD3、CD4、CRP和IgM水平明显升高，PN组NK细胞水平明显下降，而IgA水平明显升高。结论：术后肠内营养安全且可行。肠内营养可改善T辅助细胞功能，并维持NK细胞的正常水平；而肠外营养可抑制机能的细胞免疫功能。外科 营养对于体液免疫影响不大。     

精氨酸强化肠外营养对外科危重病人免疫功能影响的研究

目的观察精氨酸强化肠外营养对术后外科危重病人免疫功能的影响。方法选择危重病人30例，随机分为实验组采用精氨酸强化肠外营养和对照组应用常规的肠外营养。营养支持前后分别检验T细胞亚群(CD3^ 、CD4^ 、CO8^ )，NK细胞活性，IL-2受体浓度。结果营养支持后9天实验组CD4^ 、CO4^ ／CO8^ 、NK细胞活性、IL-2受体浓度较营养支持前明显升高，统计学差异显，而对照组所有指标改善无明显统计学意义。结论精氨酸强化肠外营养可以改善外科危重病人的免疫功能。     

术后病人应用水解蛋白为氮源的肠内营养与标准肠外营养的对比研究

为评估以水解蛋白为氮源的、含中链脂肪及纤维素的平衡型肠内营养对中国人群的代谢效应，我们进行了以标准的肠外营养作为对照的前瞻性临床研究。２２例手术后病人，用随机表分为肠内营养组（研究组）及肠外营养组（对照组）。于手术后５～１０ｄ给病人以传统的标准肠外营...     

脂肪乳剂对食管癌术后应激反应和免疫功能的影响

目的：探讨脂肪乳剂对食管癌术后应激反应和免疫功能的影响。方法：采用前瞻性随机对照设计，将３３例食管癌切除术病人随机分为两组，A组（15例）为对照组，接受不含脂肪乳剂的肠外营养，B组（18例）接受含有脂肪乳剂的肠外营养。两组病人的一般临床情况、营养热量分布一致。分别于术前、术后不同时段测定血清中皮质醇、IL－6和IL－10、T细胞亚群、NK细胞活性、免疫球蛋白和血清蛋白浓度。结果：术后第1、3天两组病人血清皮质醇和IL－6水平均显著升高（P＜0．01），且B组显著高于A组。术后两组CD3^ 、DC4^ 、CD4^ /CD8^ 均显著降低（P＜0．01）。术后10天B组CD4^ /CD8^ 比值显著低于A组（P＜0．05）。术后3天CD4^ /CD8^ 比值与血清皮质醇呈显著正相关，亦与术后第1天IL－6水平呈显著正相关。然而，术后血清IgA、IgM、IgG水平无显著变化，两组间亦无显著差异。结论：含大剂量亚油酸的脂肪乳剂能提高机体的应激反应及应激诱导的免疫抑制。     

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.