肠内营养支持对肿瘤病人手术前后营养状况的影响

目的　探讨肿瘤病人手术前后补充营养素对营养状况的影响。方法　将 10 8例择期手术的肿瘤病人随机分为两组 ,治疗组 5 6例 ,对照组 5 2例。治疗组在术前 3～ 5d及术后 2～ 3d起 ,采用基本膳食 +均衡营养素 2 0 0g/d+蛋白粉 2 0 g ,口服或管饲 ;对照组术前术后均采用基本膳食。结果　治疗组手术前后体质量无差异 (P >0 .0 5 ) ;对照组术后体质量与术前比较有统计学意义 (P <0 .0 5 )。上臂围 (MAC)、肱三头肌皮褶厚度 (TSF)、上臂肌围(AMC) ,两组病人分别与术前比较均无统计学意义 (P >0 .0 5 )。治疗组术后Hb与术前比较有统计学意义 (P <0 .0 5 ) ,血清白蛋白手术前后差异无统计学意义 (P >0 .0 5 ) ;对照组术后Hb与术前比较无统计学意义 (P >0 .0 5 ) ,血清白蛋白与术前比较有统计学意义 (P <0 .0 5 )。治疗组术后负氮平衡得到纠正 ,而对照组仍处于负氮平衡状态。结论　择期手术肿瘤病人手术前后早期合理地供给充足热能和蛋白质等营养素 ,满足病人由于手术创伤使机体处于高分解代谢的营养需求。术后病人体质量稳定 ,没有营养不良发生 ,减少了术后并发症 ,对术后病人的伤口愈合有良好的促进作用     

糖尿病人剖胸术后血糖水平与切口感染的关系

目的：探讨糖尿病人剖胸术后血糖水平与切口感染的关系及其合理的控制标准。方法：以胸外科择期手术病人为研究对象，将65例并存糖尿病病人（糖尿病组）与随机抽取的232例同期手术非糖尿病病人（对照组），按照相应手术后血糖水平对比分析，数据资料以卡方处理。结果：糖尿病组与对照组总的切口的感染率分别为16．92％和5．17％，统计学处理有极显著差异性（P＜0．01）。组内比较：糖尿病组随术后血糖水平的增高，切口感染率增加（P＜0．05）；对照组术后血糖水平变化与切口感染无关（P＞0．05）。组间比较：术后血糖≤9.9mmol/L，两组切口感染率无差异性（P＞0．05）；10．0－14．9mmol/L区间内两组切口感染率比较有统计学意义（P＜0．05）。结论：（1）在降低切口感染率方面，糖尿病人血糖控制较非糖尿病人更具有切实的临床意义；（2）术后血糖水平以9．9mmol/L为上限标准，在符合临床实际的同时，能有效地控制切口感染率。     

添加谷氨酰胺双肽的低热量肠外营养在高龄腹部手术病人的临床应用

目的 :探讨添加谷氨酰胺 (Gln)双肽的低热量肠外营养 (PN)在高龄腹部手术病人中的应用价值。　方法 :4 0例病人随机分成研究组和对照组 ,各 2 0例。所有病人术后第 1～ 6天接受等热量 83.6kJ/ (kg·d)、等氮 0 .16 g/(kg·d)的PN支持 ,研究组病人另增加 0 .3g/ (kg·d)的Gln双肽。术前及术后第 1、7天检测血清白蛋白、前白蛋白、IgG、IgA和IgM ,并进行淋巴细胞计数 (LCC)。计算术后第 1、4、7天氮平衡。　 结果 :两组病人术后血清白蛋白和前白蛋白值均较术前下降 ,对照组下降明显 (P <0 .0 5 ) ;术后LCC均较术前升高 ,尤以研究组升高显著 (P <0 .0 1)。累积氮平衡研究组明显高于对照组 (P <0 .0 5 )。未观察到不良反应或并发症。　结论 :添加Gln双肽的低热量肠外营养在高龄腹部手术病人中使用安全 ,具有改善氮平衡、减轻术后血清蛋白水平下降和促进淋巴细胞计数恢复的作用     

术后短期全肠外营养临床疗效对比研究

探讨营养状况尚可、接受中等手术病人术后短期 TPN的实际临床价值。采用前瞻性对比研究的方法 ,将 6 0例术前无营养不良、接受中等腹部手术、术后 10天内可开始进食的病人分为营养组和对照组 ,营养组术后予 TPN治疗 ,对照组术后常规治疗 ,观察两组病人手术前后体重、血浆白蛋白、外周血淋巴细胞总数、术后胃肠功能恢复时间和并发症发生率。结果两组病人手术前后的体重、血浆白蛋白、外周血淋巴细胞总数均无差异 (P>0 .0 5 ) ;而营养组和对照组肛门排气时间分别是 (5 6 .5± 9.6 )和 (45 .5± 7.5 ) h,两组比较差异显著 (t=5 ,P<0 .0 1) …     

腹膜转运特性对持续不卧床腹膜透析患者营养状态的影响

目的　评价腹膜转运特性与持续不卧床腹膜透析 (CAPD)患者营养状况之间的关系。方法　我们观察了 3 9例CAPD病人 ,采用腹膜平衡试验将患者分为 3组 :高转运 +高平均转运组 (H +HA) ,低平均转运组 (LA) ,低转运组 (L)。测定 3组CAPD患者在腹透前后的营养指标 :标准化蛋白氮呈现率 (nPNA)与血清白蛋白值 (ALB) ,同时观察透析充分性指标 :每周肌酐清除率 (Ccr/W)与每周尿素清除指数 (KT/V .W)。并对 3组间的差异性进行统计学分析。结果　H +HA组患者在腹透后其nPNA、血清白蛋白值均明显低于另两组〔nPNA (g/kg.d) :0 84± 0 13和 1 0 7± 0 3 1、 1 0 4± 0 15 ,P值均 <0 0 5 ;ALB (g/L) :3 2 83±2 41和 3 6 2 2± 4 0 1、 3 5 2 3± 1 5 8,P值均 <0 0 5〕。H +HA组患者每周肌酐清除率显著高于另两组〔Ccr/W(L) :77 91± 2 8 3 2和 5 5 66± 8 41、 5 4 3 7± 8 68,P <0 0 5〕 ,但 3组病人在每周尿素清除指数上并没有明显的差异 (P >0 0 5 )。结论　腹膜转运性高的患者尽管透析更充分一些 ,但其营养状况要更差 ,腹膜转运特性可能是影响CAPD患者营养状态的重要因素。     

食管癌术后早期肠内营养预防肺部感染的临床研究

目的研究食管癌术后早期肠内营养对预防肺部感染所起的作用.方法把食管贲门癌剖胸切除术患者随机分为治疗组(EN)和对照组(PN).EN组(n=50)采用术后第1～5天经鼻肠营养管滴饲能全力500～1 000ml/d,PN组(n=45)术后仅予静脉营养支持;两组病例均在术后第1天和第5天查血淋巴细胞计数、白蛋白、转铁蛋白、前白蛋白,观察这5 d内有否肺部感染.结果EN组术后无肺部感染病例,PN组4例;EN组术后第1天和第5天的白蛋白和淋巴细胞计数前后对比升高明显(P＜0.01),而PN组稍有升高(P＞0.05);两组患者的转铁蛋白和前白蛋白前后对比轻微升高(P＞0.05).结论食管癌术后早期肠内营养有预防肺部感染作用.     

人血白蛋白对术前无低蛋白血症结直肠癌患者预后的影响

目的探讨围术期应用白蛋白对术前无低蛋白血症结直肠癌患者术后并发症和营养状况的影响。方法选择2017年1月—2018年1月医院收治的100例直结肠癌限期手术患者,采用随机数字法将其分为对照组和观察组,各50例。对照组围术期采用常规营养支持,观察组围术期在对照组的基础上加用静脉输注人血白蛋白。比较两组患者的术后并发症发生率和患者术前、术后7 d的营养状况。结果术后,两组患者低蛋白血症、吻合口瘘、肠梗阻和切口水肿的发生率相比较,差异无统计学意义(P> 0. 05),而观察组的切口感染和总并发症的发生率均高于对照组(P <0. 05);术后7 d,观察组的体质量高于对照组(P <0. 05),而白蛋白、铁蛋白和转铁蛋白两组相比无差异(P> 0. 05)。结论无低蛋白血症的结直肠癌患者在围术期使用白蛋白会增加并发症的发生,且对患者的营养状况并无改善,故不推荐对无低蛋白血症的结直肠癌患者常规使用人血白蛋白。     

重组人生长激素与肠外营养支持在腹部外科危重病人的应用

目的 :探讨重组人生长激素 (rhGH)与肠外营养支持 (PN)在腹部外科危重病人治疗中的作用。　方法 :随机选择有严重创伤、感染并伴有低白蛋白血症 (<30g/L)的腹部外科危重病人 4 0例 ,2 0例为对照组 (PN) ,2 0例为实验组 (rhGH PN) ,观察治疗前后病人氮平衡及血浆蛋白的变化。　结果 :对照组和实验组治疗干预后 ,负氮平衡均逐渐减少 ,与对照组相比 ,实验组负氮平衡减少更为明显 (P <0 .0 5 ) ,治疗后第 5天达到正氮平衡。治疗前两组病人血清蛋白指标无明显差异 ,治疗后均升高 ,而实验组血清蛋白水平明显高于对照组 (P <0 .0 5 ) ,二者差异显著。　结论 :rhGH与PN联合应用可明显纠正负氮平衡 ,促进蛋白质合成 ,因而必将成为危重病人营养支持的理想方法。     

剖胸术后切口感染经济损失病例对照分析

目的：从卫生经济学的角度探讨控制剖胸术后切口感染的重要性。方法：以胸外科择期手术患者为研究对象，通过病例对照分析，对35对（感染组和对照组）病例的医疗费用和住院天数进行回顾性调查，计量资料以t检验处理。结果：感染组的住院总费用和住院天数均明显高于对照组（P＜0．01）；住院费用分类统计：感染组的处置费和床位费明显高于对照组（P＜0．01），营养支持费用两组比较有统计学意义（P＜0．05），抗生素费用和检验特征费两组的比较差异无显著性（P＞0．05）。结论：剖胸术后切口感染是不能忽视的医院感染组成部分，其造成的经济损失是巨大的；根据胸外科的特点，控制切口感染对降低经济损失、减轻患者痛苦、提高生存质量均有切实的意义。     

深静脉导管引流在治疗结核性渗出性胸膜炎中的应用

目的　探讨应用深静脉导管胸腔内置管引流治疗结核性渗出性胸膜炎中的疗效。　方法　在全身规则抗结核治疗下 ,治疗组 3 2例结核性胸腔积液患者 ,采用深静脉导管胸腔内置管引流 ,对照组 3 3例采用常规每周 2～ 3次胸腔穿刺抽液治疗。观察两组患者的胸液引流量、胸液消失时间、胸膜增厚情况以及体温变化。　结果　 (1)胸液引流量 :治疗组中位数为 1615ml ,对照组中位数为 95 0ml ,两组比较有显著差异 (P <0 .0 5 )。 (2 )胸液消失时间 :治疗组平均(3 .88± 1.42 )d ,对照组 (18.2 3± 13 .76)d ,两组比较有非常显著差异 (P <0 .0 1)。 (3 )胸膜增厚发生率 :治疗组 2例(6.2 5 % ) ,对照组 6例 (2 4.2 % ) ,两组比较有非常显著差异 (P <0 .0 1)。 (4 )平均退热时间 :治疗组平均 (3 .5± 1.3 )d ,对照组 (3 .8± 1.1)d ,两组比较无统计学意义。　结论　胸腔内留置深静脉导管引流治疗结核性渗出性胸膜炎的方法方便 ,操作简单 ,创伤小 ,引流胸液充分 ,疗效满意 ,有较好的临床应用前景。     

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.     

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.     

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.     

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.