Nutrition and Health for Older Persons in Rural America: A Managed Care Model

Health care services and resources for older persons living in rural areas may be highly variable, and integrated service-delivery models are often lacking. This article presents a managed-care model of nutrition risk screening and intervention for older persons in rural areas. Nutrition risk screening was implemented by the Geisinger Health Care System, Danville, Pa, to target all eligible enrollees in a regional Medicare risk program. A single remote clinic site participating in the managed health care system was chosen for further study of a linked screening and case-management effort for undernourished persons. Screening and intervention at the clinic site selected for this study were guided by centralized expertise and resources. Individualized evaluation and intervention plans were developed with the aid of a dietitian and implemented by the clinic case manager. Of the 417 subjects who completed screening at the remote site, 68 met the risk criteria for undernutrition and were selected for case management. Many of the targeted persons received interventions that included evaluations by a physician or physician extender (eg, physician assistant, nurse practitioner) at the clinic and consultations with nutrition, mental health, or social services professionals. Twenty-six of the subjects who took part in the intervention completed a follow-up screening 6 months later. Ten of those persons no longer exhibited risk criteria. This demonstrates the feasibility of a linked screening and case management program for nutrition risk in the managed-care setting. J Am Diet Assoc. 1997; 97: 885-888.     

SOD-like Activity of Copper Salicylate Complex in Tween Micel-lar Systems

合成了水杨酸铜络合物并分析了其组成，提纯了Ｔｗｅｅｎ－２０，－４０，－６０，－８０，并测定了它们在ｐＨ７．４的磷酸缓冲液中的ＣＭＣ。用Ｃｙｔ．ｃ还原法分别测定了水杨酸铜络合物在不同介质中的ＳＯＤ样活性。详细研究了表面活性剂与水杨酸铜络合物协同清除Ｏ－２的作用。观察到在胶束体系中水杨酸铜络合物的ＳＯＤ样活性明显高于缓冲液体系无表面活性剂时的ＳＯＤ样活性，表面活性剂本身也具有清除Ｏ－２的功能。抗红细胞膜脂质过氧化实验也得到类似结果。这可用胶束催化解释。水杨酸铜－Ｔｗｅｅｎ体系可能是一种潜在的抗炎药物。     

尿路复合性恶性肿瘤（附21例报告）

报告２１例尿路复合性恶性肿瘤，位于肾盂２例，膀胱１９例。主要临床表现为血尿，绝大多数病人伴有尿路刺激症状。低分化的移行细胞癌（ＴＣＣ）与继发性复合肿瘤有密切关系。２１例中１例为ＴＣＣ复合肉瘤，１１例为ＴＣＣ复合鳞癌，７例为ＴＣＣ复合腺癌，２例为腺癌复合鳞癌。本组２例肾盂肿瘤分别行肾输尿管全长加膀胱袖口状切除术和肾部分切除术，术后存活６个月和１年；膀胱肿瘤１４例行膀胱部分切除术，已生存３年４例，１年２例，未满１年２例，３例１～２年内死亡，失访３例；２例根治性膀胱全切术已生存５年和３年以上；３例行ＴＵＲＢｔ，已生存３年１例，１５年１例，未满１年１例。对尿路复合性恶性肿瘤的组织学、临床和病理特征进行了讨论。     

TGF—β1对膀胱移行细胞癌细胞粘附性的调节

为了解ＴＧＦβ１对肿瘤粘附性的调节，采用Ｎｏｒｔｈｅｒｎ杂交分析测定了两个膀胱癌细胞系ＴＧＦβ１及ＦＮｍＲＮＡ的表达，并用体外测定方法检测了ＴＧＦβ１对两细胞系粘附性质的调节。结果表明：ＴＧＦβ１仅可使低表达ＦＮ的２５３Ｊ细胞的粘附性增强，而这种增强与ＦＮ表达的增加成正比；同样浓度的ＴＧＦβ１对高表达ＦＮ的６４７Ｖ细胞的粘附性无明显影响。提示肿瘤细胞粘附能力的可变性是其具有转移能力的原因之一。     

我院耐甲氧西林金黄色葡萄球菌的耐药性及肠毒素分析

收集了我院１９９４年１０月至１９９５年４月金黄色葡萄球菌１００株，应用药敏试验筛选ＭＲＳＡ，并检测其对１２种抗生素的耐药性，计算ＭＩＣ５０和ＭＩＣ９０，应用乳胶凝集试验法，测定其肠毒素产生率。结果我院总的ＭＲＳＡ阳性率为６０％，烧伤科的ＭＲＳＡ的阳性率为６７．４％，内科６２．５％，骨科４４．５％，ＭＲＳＡ耐药性低于５０％的有万古霉素（３．３％）去甲万古霉素（５％），丁胺卡那霉素（２１．５％）３种，     

风心病并发脑栓塞病人的瓣膜替换术

报告６４例风心病并发脑栓塞病人的瓣膜替换术。术前心功能Ｉ级１０例、ＩＩ级３８例、ＩＶ级１６例。伴房颤者５４例。脑栓塞史半年以上者４４例，６个月以内２０例，其中２个月以内者１４例。３４例有程度不同的脑栓塞后遗症。行二尖瓣替换术４７例、双瓣膜替换术１７例，同期行三尖瓣环环缩或成形术４３例。术中证实有左房血栓２５例（３９％）。手术死亡率６．２５％。术后并发颅内出血和栓塞各１例。结果表明风心病并发脑栓塞病人的手术效果良好。作者指出，脑栓塞２个月以上者应尽早手术，２个月以内者则应根据脑栓塞程度、恢复情况及有无左房血栓，选择手术时机。并介绍了围术期的处理经验。     

温缺血时间与同种心脏瓣膜细胞活性的关系

以１０具脑外伤死亡的健康男性的心脏的６０个同种主动脉、肺动脉瓣叶分为６组进行实验。经不同的温缺血时间灭菌并经过３个月的液氮深低温保存后，通过流式细胞计数测定细胞活性，同时行组织块贴壁培养及电镜观察。结果表明：温缺血时间在１２小时以内，细胞活性为９３．４９±２．３５％，较对照组无明显下降。灭菌２４小时，细胞活性为８９．８２±３．５２％，较对照组明显下降，Ｐ＜０．０１，并且可见形态上改变；冷冻后细胞活性进一步下降，但下降幅度减低，冻存３年后活细胞仍占８０％。结论为：温缺血时间对细胞活性有影响，时间延长与活性的下降成正相关。因此温缺血时间应控制在１２小时以内。