安徽省基本药物改革前后新农合住院病人流向与医疗费用比较

目的：比较分析安徽省基本药物改革前后新农合住院病人流向和医疗费用变化情况。资料与方法：抽取安徽3个县新农合数据,并对3个县卫生行政部门和6个乡镇卫生院的关键知情者进行访谈。结果：基本药物制度改革以后,样本地区参合人员总住院数量下降了13.80%,其中乡镇卫生院下降了55.07%,县级医院和县级以上医院分别上升了12.17%和20.81%;总的次均住院费用和次均住院自付费用分别增长了29.32%和32.07%,住院总费用增长了11.48%。结论：基本药物制度改革以后,新农合病人在乡镇卫生院住院大幅减少,县级及以上医院住院增长明显;乡镇卫生院次均住院费用得到控制,但由于县级以上医院次均住院费用和住院人数增长,导致住院总费用上涨、参合病人的实际补偿水平下降。     

Body composition and metabolic changes associated with massive intestinal resection in mice

Background

The specific changes in body composition and metabolism during the adaptation response to massive intestinal loss are presently unclear. The present study was designed to determine alterations in these parameters using an established mouse model.

Methods

Male C57/Bl6 mice underwent either 50% small bowel resection (SBR) or transection with reanastomosis (Sham) operation. Oxygen consumption per unit time, carbon dioxide production per unit time, respiratory quotient, and energy expenditure were measured by indirect calorimetry along with body composition determination by nuclear magnetic resonance at postoperative days 1, 3, 7, 14, 21, and 28.

Results

The mice that underwent SBR had lower rates of metabolism as measured by decreased energy expenditure, carbon dioxide production per unit time and oxygen consumption per unit time when compared with the Sham group throughout the study period. During adaptation, SBR mice had restoration of body fat at two weeks after the operation while the lean mass and body weight remained lower throughout.

Conclusion

Without supplemental parenteral nutrition, the adaptation response to massive SBR is characterized by reduced energy metabolism and an inappropriate replenishment of fat stores over lean mass. Futures studies will be needed to determine the metabolic effects of various growth factors designed to enhance structural features of adaptation.     

Growth hormone and changes in energy balance in growth hormone deficient adults

Background  Adults with growth hormone deficiency (AGHD) have an adverse body composition with an increased prevalence of obesity. It is not known whether growth hormone replacement (GHR) results in alterations in energy intake (EI) and/or energy expenditure (EE). The aim of the study was to investigate the effects of GHR on EI and EE.
Materials and methods  Nineteen hypopituitary adults (14 males, 5 females, mean age 46·2 years) with severe GHD (peak GH response to glucagon ≤ 9 mU L⁻¹) were studied. All patients self-injected recombinant human GH starting with 0·3 mg s.c. daily. The following were measured before and following 6 months of stable maintenance of GHR: food intake during a test meal, appetite ratings, resting EE (indirect calorimetry) and voluntary physical activity (accelerometry).
Results  GHR nearly doubled voluntary physical activity (mean activity units 3319 vs. 1881, P  = 0·007) and improved quality of life score (mean score 9·1 vs. 16·5, P  < 0·0001). Subjects reported higher fasting hunger ratings (mean 64·8 vs. 49·6, P  = 0·02) but ad libitum energy intake remained unchanged. Eating behavioural traits were favourably altered with lower disinhibition (mean 6·0 vs. 7·2, P  = 0·02) and lower susceptibility to hunger ratings (4·6 vs. 6·8, P  = 0·001) after GHR. Additionally, GHR did not result in significant changes in resting EE, body weight and body mass index.
Conclusions  GHR in AGHD significantly improves voluntary physical activity and quality of life. Following GHR, subjects experience greater 'state' (physiological) hunger, reductions in eating disinhibition and hunger susceptibility, but no effects on calorie intake or macronutrient choice were detected.     

Resting energy expenditure in manic episode

Objective:  We aimed to assess the resting energy expenditure in bipolar I disorder, manic episode patients.
Method:  Forty-two bipolar I disorder, manic episode patients that were treated in the inpatient psychiatry clinic of Trakya University Hospital and had met the necessary study criteria were included along with 27 controls. DSM-IV criteria and the Bech-Rafaelsen Mania Rating Scale were used to evaluate patients' diagnosis and severity of the manic episodes. The indirect calorimetry device was used to measure resting energy expenditure values.
Results:  Resting energy expenditure values of manic patients were found to be higher than those of the controls. Controls showed significant correlations between body mass index and resting energy expenditure, but manic patients did not exhibit similar correlations. There was also no relation between Bech-Rafaelsen Mania Rating Scale scores and resting energy expenditure values in manic patients.
Conclusions:  We found significantly increased resting energy expenditure values in bipolar I disorder, manic episode patients. These findings suggest a possible clinical use of resting energy expenditure for evaluation of bipolar I disorder manic episode and also suggest resting energy expenditure as a possible biological marker.     

恶性肿瘤患者能量代谢及相关机制的研究进展

能量代谢是指三大营养物质在体内代谢过程中伴随的能量产生和利用过程.肿瘤本身的作用、机体对肿瘤的反应以及抗肿瘤治疗使肿瘤患者的代谢具有特殊性.通常认为,初诊肿瘤患者的静息能量消耗增加,且与C反应蛋白和一些炎症细胞因子的释放相关;经有效治疗后,静息能量消耗则不同程度下降.肿瘤的分期及分化程度对机体代谢也有影响,但不同的研究结果存在矛盾.文章就肿瘤患者的能量代谢特点及相关影响因素进行综述.     

与社区共同进行慢性病管理工作的体会

治疗慢性疾病尤其是合并两种以上不同脏器和功能障碍的老年慢性病患者,需要一个长期相对稳定和连续诊疗的过程。通过在朝阳区六里屯社区卫生服务中心将近一年的每周查房和专家门诊的经历,以及对一些患者多年的随访和治疗体会,我深切感受和体会到建立并不断完善三级医院和社区卫生服务中心所有慢性病的防治网络迫在眉睫,如慢性心力衰竭、慢性阻塞性肺疾病、脑血管病的康复治疗、肿瘤患者化疗间歇期或晚期患者的维持治疗等。     

Relative changes in resting energy expenditure during weight loss: a systematic review

A more comprehensive understanding of the effects of weight loss on the changes in resting energy expenditure (EE) is relevant. A MEDLINE search was performed to identify studies with information relevant to this systematic review. From this search, the mean rate of resting EE decrease relative to weight loss was calculated from 90 available publications. A decrease of resting EE relative to weight loss of ?15.4 ± 8.7 kcal kg^?1 was observed from 2996 subjects. No sex differences were noted in the overall resting EE decrease relative to weight loss. However, a significant sex differences was seen with pharmacological interventions, which seemed to depress the resting EE relative to weight loss to a greater extent in men than in women (P < 0.05). A greater drop in resting EE relative to weight loss was observed for short interventions (more than 2 but less than 6 weeks) when compared with long interventions (<6 weeks) (–27.7 ± 6.7 vs. ?12.8 ± 7.1 kcal kg^?1) (P < 0.001). Men and women have a similar decrease in resting EE relative to weight loss except in the case of pharmacological interventions. Short interventions also produced greater resting EE losses relative to weight loss.     

Adipose tissue hormones and the regulation of food intake

Over the past decade, adipose tissue has been shown to produce numerous factors that act as hormones. Many of these act on the brain to regulate energy balance via dual effects on food intake and energy expenditure. These include well-characterised hormones such as leptin, oestrogen and glucocorticoids and novel factors such as adiponectin and resistin. This review provides a perspective on the role of these factors as lipostats.     

Metabolic Abnormalities,Dietary Risk Factors and Nutritional Management in Amyotrophic Lateral Sclerosis

Amyotrophic Lateral Sclerosis (ALS) is a devastating progressive neurodegenerative disease that affects motor neurons, leading to a relentless paralysis of skeletal muscles and eventual respiratory failure. Although a small percentage of patients may have a longer survival time (up to 10 years), in most cases, the median survival time is from 20 to 48 months. The pathogenesis and risk factors for ALS are still unclear: among the various aspects taken into consideration, metabolic abnormalities and nutritional factors have been the focus of recent interests. Although there are no consistent findings regarding prior type-2 diabetes, hypercholesterolemia and ALS incidence, abnormalities in lipid and glucose metabolism may be linked to disease progression, leading to a relatively longer survival (probably as a result of counteract malnutrition and cachexia in the advanced stages of the disease). Among potential dietary risk factors, a higher risk of ALS has been associated with an increased intake of glutamate, while the consumption of antioxidant and anti-inflammatory compounds, such as vitamin E, n-3 polyunsaturated fatty acids, and carotenoids, has been related to lower incidence. Poor nutritional status and weight loss in ALS resulting from poor oral intake, progressive muscle atrophy, and the potential hypermetabolic state have been associated with rapid disease progression. It seems important to routinely perform a nutritional assessment of ALS patients at the earliest referral: weight maintenance (if adequate) or gain (if underweight) is suggested from the scientific literature; evidence of improved diet quality (in terms of nutrients and limits for pro-inflammatory dietary factors) and glucose and lipid control is yet to be confirmed, but it is advised. Further research is warranted to better understand the role of nutrition and the underlying metabolic abnormalities in ALS, and their contribution to the pathogenic mechanisms leading to ALS initiation and progression.     

The effect of olfactory stimulation on energy expenditure in growing preterm infants

Aim: To test the hypothesis that olfactory stimulation in growing healthy preterm infants leads to an increase in resting energy expenditure (REE). Design: A prospective, randomized clinical trial with crossover was conducted in 20 healthy, appropriate weights for gestational age, gavage‐fed preterm infants. Infants were studied while asleep and cared for in a skin servo‐controlled convective incubator. Using a pipette, 15 drops of saturated solution of vanillin (Aldrich, Fallavier, France) were dripped to a cloth diaper that was placed on the opposite side of the incubator. REE was measured by indirect calorimetry (DeltaTrac II, Helsinki, Finland) exactly 1 h after feeding. Each infant was studied twice by randomization: after a period of 20 min of vanillin odour or after 20 min without vanillin odour. Results: We found no statistically significant difference in REE of preterm infants when exposed to vanillin odour (74.5 ± 10.1 kcal/kg/day) in comparison with their REE when not exposed to vanillin odour (79.0 ± 11.3 kcal/kg/day). Conclusions: Vanillin odour does not significantly influence REE in metabolically and thermally stable preterm infants.