营养不良老年人非药物干预临床实践指南

老年人是营养不良的高发人群,营养不良与众多不良临床结局密切相关,严重影响老年人的身体健康和生活质量,给家庭和社会造成沉重负担。因此,采取有效措施改善老年人的营养不良至关重要,非药物干预是改善营养状况的重要措施。然而,国内尚无专门针对营养不良老年人的非药物干预临床实践指南,因此,中国老年护理联盟、国家老年医学中心和国家老年疾病临床医学研究中心的营养专家,通过对老年人营养不良最新的国内外文献的全面检索与分析,采用推荐意见评估、制订及评价(GRADE)分级体系制订了本指南,针对营养不良老年人非药物干预提出9条推荐意见,以期能够改善老年人营养不良状况,提高生活质量。本指南侧重于可经口进食的营养不良老年人,聚焦于肠内营养,肠外营养不在本指南讨论范围内。     

The persistence of interleukin-6 is regulated by a blood buffer system derived from dendritic cells

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原发性肝癌患者抑郁症状与不成熟防御机制的关系

目的：了解原发性肝癌（PLC）患者的抑郁症状和不成熟防御机制（IDM）的水平，探讨PLC患者的抑郁症状与IDM的关系。方法：采用流调用抑郁自评量表（CES－D）和防御式方式问卷（DSQ）对PLC患者和健康组各100例进行调查。结果：1）PLC患者中49％可能或肯定有抑郁症状，其中23％肯定有抑郁症状，其发生率高于健康组；2）PLC组的CES－D总分高于健康组；3）PLC组比健康组采用较多分裂和潜意显现机制，采用较少抱怨机制；4）肯定有抑郁症状者比无抑郁症状者采用较多IDM；5）两组CES－D总分与IDM均分呈显著正相关，Pearson r为0.473-0.776，其中PLC组为0．473。结论：抑郁症状是PLC患者常见的负性情绪，医护人员应引起重视，并指导患者采用成熟的防御机制代替不成熟防御机制，预防并减轻患者的抑郁症状，以提高患者的生活质量。     

Interactions between taste receptors in the frog tongue

Summary Receptors sensitive to stimulation with dilute CaCl₂ solutions and located in different fungiform papillae of the frog tongue are cross-connected via branches of the glossopharyngeal nerve fibers to form chemical sensory units comprising on average about 3 papillae; often one or more papillae were found to be common to different units.The receptor response observed when single papillae were individually stimulated increased, when the strength of the stimulus was raised, at a much lower rate than that obtained by stimulating the whole tongue surface. This proves that the antidromic impulses travelling in the cross-connections linking different papillae result in an evident depression of the receptor response to CaCl₂.The possible functional significance of mutual interaction between the receptors in the frog tongue is discussed.This study was supported by grants from the Consiglio Nazionale delle Ricerche (Impresa di Elettrofisiologia) of Rome, Italy.     

Large-scale variation among human and great ape genomes determined by array comparative genomic hybridization

Large-scale genomic rearrangements are a major force of evolutionary change and the ascertainment of such events between the human and great ape genomes is fundamental to a complete understanding of the genetic history and evolution of our species. Here, we present the results of an evolutionary analysis utilizing array comparative genomic hybridization (array CGH), measuring copy-number gains and losses among these species. Using an array of 2460 human bacterial artificial chromosomes (BACs) (12% of the genome), we identified a total of 63 sites of putative DNA copy-number variation between humans and the great apes (chimpanzee, bonobo, gorilla, and orangutan). Detailed molecular characterization of a subset of these sites confirmed rearrangements ranging from 40 to at least 175 kb in size. Surprisingly, the majority of variant sites differentiating great ape and human genomes were found within interstitial euchromatin. These data suggest that such large-scale events are not restricted solely to subtelomeric or pericentromeric regions, but also occur within genic regions. In addition, 5/9 of the verified variant sites localized to areas of intrachromosomal segmental duplication within the human genome. On the basis of the frequency of duplication in humans, this represents a 14-fold positional bias. In contrast to previous cytogenetic and comparative mapping studies, these results indicate extensive local repatterning of hominoid chromosomes in euchromatic regions through a duplication-driven mechanism of genome evolution.     

Discordant immunologic and virologic responses to highly active antiretroviral therapy are associated with increased mortality and poor adherence to therapy

OBJECTIVE: To examine the independent association of discordant virologic and immunologic responses to highly active antiretroviral therapy (HAART) with mortality. METHODS: A population-based study of 1527 treatment-naive individuals initiating HAART used Cox proportional hazards modeling to determine the independent association of treatment response at 3 to 9 months with nonaccidental mortality. Logistic regression was used to examine associations with discordant responses. RESULTS: Viral load (VL)/CD4 discordant responses were seen in 235 (15.4%) of subjects, and VL/CD4 responses were seen in 179 (11.7%) of subjects. In adjusted Cox regression models, discordant responses were found to be independently associated with an increased risk of mortality (VL/CD4: relative hazard [RH] = 1.87, 95% confidence interval [CI]: 1.15 to 3.04; VL/CD4: RH = 2.47, 95% CI: 1.54 to 3.95). VL/CD4 discordance was found to be associated with increasing age, baseline HIV RNA load <100,000 copies/mL, baseline CD4 counts <50 cells/muL, the use of lamivudine (3TC)/zidovudine (ZDV), and poor adherence to therapy. VL/CD4 discordance was associated with younger age; injection drug use; baseline HIV RNA load >100,000 copies/mL; the use of 3TC/ZDV, didanosine (ddI)/3TC, or ddI/stavudine; and poor adherence to therapy. CONCLUSION: Discordant responses are independently associated with an increased risk of mortality and are, in turn, associated with poor adherence to therapy.     

Seasonal exacerbation of eosinophilic esophagitis histologic activity in adults and children implicates role of aeroallergens

Background

Disease activity may correlate with environmental aeroallergen exposure in eosinophilic esophagitis. The association between seasons and flares of eosinophilic esophagitis (EoE) histologic activity has not been extensively studied.

SEM of the proximal tubule of the adult rabbit kidney

The present study utilizes the scanning electron microscope (SEM) to reveal the surface morphology of proximal tubular cells and the parietal cells of Bowman's capsule of the adult rabbit nephron. To facilitate the examination of the basal surface of these cells, proximal tubules were dissected free and treated with collagenase to remove the basememt membrane. Other blocks of tissue were cryofractured to expose the lateral cell surfaces of the proximal tubules. Our investigation has shown that the lateral and basal surfaces of both the convoluted and straight segments of the proximal tubule have numerous processes. However, the arrangement and degree of branching is distinctly different in the two segments. The convoluted segment has large lateral ridges which form at the base of the microvilli and fan out to divide into lateral-basal processes. Many of the lateral-basal processes reach the basement membrane intact, interdigitating with complementary processes from adjacent cells. However, some of the lateral-basal processes branch into short, knobby projections (basal villi) which may also reach the basement membrane. Patches of basal villi are interspersed between broad regions of interdigitating lateralbasal processes. Therefore, in the convoluted segment, the lateral-basal processes form the major part of the basal cell surface. In tubular cells of the pars recta, unlike convoluted tubular cells, the majority of the ridges remain unbranched and pass directly to the basal surface where they divide into elaborate basal villi. Thus the basal surface of the pars recta cells is highly complex, appearing leaf-like, being a composite of numerous basal villi with a few lateral ridges. The basal surface of some parietal cells of Bowman's capsule have parallel ridges, which results in patches of striations.