深静脉高营养（TPN）预防食管癌切除术后吻合口瘘的临床研究

本研究收集食管癌行食管癌切除胃代食管术病例２６５例，分为未用深静脉高营养组（ＮＴＰＮ）和深静脉高营养组（ＴＰＮ）。分别对各组临床资料进行比较分析，结果显示：ＴＰＮ组葡萄糖供给量（８．３７±２．１２ｇ／ｋｇ／２４小时）显著高于ＮＴＰＮ组（２．７７±０．７１ｇ／ｋｇ／２４小时）（Ｐ＜０．０１），（０．３０±０．１４ｇ／ｋｇ／小时）Ｐ＜０．０５。吻合口瘘发生率ＴＰＮ组（２．１％）则显著低于ＮＴＰＮ组（１５．２％）Ｐ＜０．００１。结果提示ＴＰＮ组可明显降低吻合口瘘发生率。作者于ＴＰＮ促进吻合的愈合，预防吻合口瘘发生的有关机理进行了讨论。     

What is the HACCP (hazard analysis critical control point) approach and how can it be applied to enteral tube feeding?

The HACCP (hazard analysis critical control point) concept is now widely applied in the food industry and provides a structured and critical approach to the identification and control of hazards that may affect food safety. It has shifted the emphasis for control from retrospective end-product testing to the effective control of raw materials and key processing operations.
This paper discusses how the HACCP approach can be applied to enteral feeding. This involves each unit assembling a multidisciplinary team of personnel involved in enteral feeding. This team will then carry out a detailed analysis of the process from selection of ingredients and feeding systems through to consumption of the feed by the patient by constructing a flow chart that relates specifically to each unit. They can then identify and assess the hazards associated with the handling of the product at each stage in the process. This will enable them to identify the points where control over an identified hazard can be achieved (critical control points, CCP) such as quality of ingredients, design of administration systems, preparation and distribution of the feeds and the procedures involved in the assembly and manipulation of the systems. Control and monitoring procedures can then be specified and implemented at relevant stages in the process. The major strengths of the HACCP procedure are that it entails a team effort from key personnel involved in the full range of activities associated with the product and each detailed analysis is specific to each unit's practices and resources and can be continually reviewed and modified in response to changing circumstances.     

Diethylnitrosamine-induced metastasizing hepatocellular carcinomas in New Zealand white rabbits

Summary The aim of this study was to produce large liver tumors reliably, and to diagnose the tumors during development. Therefore, New Zealand white rabbits were treated withN-nitrosodiethylamine orally three times per week by gavage and were examined by clinical-chemical assay at regular intervals during the average treatment period of 14 months. The total cumulative dose was 1200 mgN-nitrosodiethylamine over 14 months. After a short treatment period the initial dose of 3 mg/kg had to be reduced to 1.5 mg/kg. In all 11 treated animals (100%) liver tumors were seen at the end of the study. Four control animals did not show any neoplastic changes. Clinical parameters investigated were for an assessment of liver function, total protein, urea, creatinine, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, albumin and neuraminic acid as well as some serum electrolytes. The in vivo diagnosis of liver tumors based on changes in these parameters proved to be relatively unreliable. The liver enzyme tests and urea concentration only yielded significant changes when the liver tumors were very large. Changes in neuraminic acid levels were the most reliable indicator for the presence of a liver tumor in this animal model. In the 11 treated animals, serum values of this marker increased towards the end of the study'by an average of 300 mg/dl. The induced tumors were mainly hepatocellular carcinomas. Only in 1 animal was a hepatocellular adenoma found. Further primary tumors diagnosed were six adenomas in the kidneys and two uterus adenomas, as well as nasal cavity tumors (two papillomas, one carcinoma, one adenoma and one adenocarcinoma). In 70% of the treated rabbits the hepatocellular carcinomas had metastasized to the lungs.     

全肠外营养对老年晚期消化系统恶性肿瘤病人生存期的影响

目的:评估全肠外营养(TPN)对老年晚期消化系统恶性肿瘤病人生存期的影响。方法:回顾性分析121例老年晚期消化系统恶性肿瘤病人TPN治疗后的生存期。结果:TPN治疗后,患者生存期不同程度延长,为9～126天,平均68.1天,多数在两月左右。结论:TPN可延长老年晚期消化系统恶性肿瘤病人的生存期。     

A comparison of the effects of a macrobiotic diet and a western diet on drug metabolism and plasma lipids in man

Summary We have compared the effects of two dietary regimens with different macronutrient compositions — a macrobiotic diet and a Western diet — on drug metabolism and plasma lipids in seven healthy volunteers.The macrobiotic diet, high in carbohydrate, low in protein and fat, and devoid of animal food sources, was eaten for a ten day control period, as was the Western diet, high in calories, fat, and protein, as well as animal food sources. We determined the influences of these diets on the clearance of orally administered antipyrine, oxazepam, and methadone, as well as on plasma lipids.There was a statistically significant change in antipyrine clearance as well as in plasma LDL-cholesterol and HDL-cholesterol after the dietary periods. This suggests that the influence of dietary changes may have some effect on the clearance of therapeutic drugs. However, this is not universal and is probably important when the drug is highly dependent on the mixed-function oxidase system.     

静息能量消耗测定在慢性肝病中的应用

慢性肝病患者的静息能量消耗应采用开放式间接测热法测得,合理的能量代谢调整有助于肝功能改善并防止并发症发生,测定静息能量消耗可为慢性肝病患者营养支持治疗个体化提供依据。     

医学生营养知识与膳食状况调查

①目的了解医学生营养知识的掌握情况及对教育传播方式的需求意见，以加强营养知识教育，改善大学生的健康素质。②方法对762名在校大学生进行问卷调查。③结果医学院在校生对营养知识及常识掌握深度和广度都不够，但渴求得到营养知识的欲望比较高，对营养知识的重要性认识正确。有73．6％的学生认为营养知识对生活很重要。87．2％的学生愿意接受营养知识的教育，对营养知识教育的传播方式也表现出特有的需求意向。大学生的膳食结构不够合理，奶类、薯类、鱼虾禽类、豆制品摄入不足。④结论应加强医学生营养知识教育，使医学生做到科学合理的安排膳食，改善饮食行为，促进身体健康。     

Familial and socioeconomic influences on children''s well-being: An examination of preschool children in Kenya

As patterns of family formation change, it is important to know how children's lives are affected by their parents' marital and socioeconomic circumstances. Using data from the 1993 Kenya Demographic and Health Survey, this study shows that children of never married and formerly married mothers have significantly higher probabilities of polio dropout and acute undernutrition than those of monogamously married mothers. The number of male household members of working age greatly enhances the chances of full immunization and the nutritional status of children whose mothers were previously married. For children of never married mothers, the benefits of residing with males of working age are largely a function of ethnicity. The results also show that, although children are not disadvantaged nutritionally when their fathers have more than one wife, polygyny is associated with a higher probability of polio dropout and lower probability of full immunization than monogamy. Higher socioeconomic status is associated with a greater probability of full immunization and a lower probability of malnutrition but socioeconomic factors do not explain the effects of mothers' marital status. The findings underscore the complex realities of family interaction and the importance of the broader social context in accounting for variations in child welfare across diverse marital situations.     

Intravenous feeding with medium chain triglycerides. Effect on blood gases and the complement system in critically ill patients

Critically ill patients are usually in a catabolic state and may require total parenteral nutrition; this often includes lipid emulsions. Any adverse effects of constituents on pulmonary function, white cell function or the haemocoagulation system could have disastrous consequences in such patients. We have investigated the effects of a new intravenous lipid preparation containing medium chain triglycerides, which, in severely ill malnourished patients are theoretically a preferable energy source to conventional drug chain triglycerides. In a pilot study 17 critically ill patients whose lungs were artificially ventilated were given this lipid emulsion; no adverse effects were observed. Arterial oxygen and carbon dioxide tensions, ratio of inspired oxygen fractional concentration to arterial oxygen tension, platelet and white cell counts all remained constant and the complement system was not activated.     

针刺导管空肠造口术肠内营养在胰十二指肠切除术病人中的应用

目的探讨针刺导管空肠造口术(NCJ)肠内营养(EN)在胰十二指肠切除术病人中的应用效果。方法32例病人,16例术后肠外营养(PN)(对照组),16例术后行导管空肠造口术(NCJ)肠内营养(EN)治疗(实验组)。结果术后实验组的胃肠动力比对照组的恢复早(P<0.05)。治疗前两组病人血蛋白指标(白蛋白、前白蛋白、转铁蛋白)无明显差异。治疗后两组均升高,而实验组血蛋白指标的水平明显高于对照组(P<0.05),二者差异显著。结论导管空肠造口术(NCJ)肠内营养(EN)应用于胰十二指肠切除术病人中比肠外营养(PN)具有更多的优点。