含橄榄油的新型脂肪乳剂对危重症病人免疫功能和炎性反应的影响

目的:通过对危重症病人分别应用含有橄榄油的新型脂肪乳与传统的中/长链脂肪乳,比较两种脂肪乳剂对病人免疫功能和炎性反应的影响. 方法:将50例入住ICU行肠外营养(PN)支持7d以上的危重症病人(APACHEⅡ评分＞12分),按前瞻、随机、对照原则分为研究组和对照组,两组病人按等氮、等热量进行全胃肠外营养(TPN)支持.于TPN前1d和TPN后第7天检测血清蛋白质、免疫和炎症指标. 结果:①TPN后两组病人的血清前清蛋白、视黄醇结合蛋白、转铁蛋白明显增加,与TPN前比有显著性差异(P＜0.05).②TPN后两组病人的C-反应蛋白下降,血总淋巴细胞计数、T淋巴细胞亚群中的T辅助性淋巴细胞(CD4)、T辅助性淋巴细胞/抑制性淋巴细胞(CD4/CD8)比值升高,研究组与对照组比有显著性差异(P＜0.05). 结论:含橄榄油的新型脂肪乳剂能提高危重症病人的免疫功能和降低炎性反应.     

鱼油脂肪乳对重症脑卒中病人免疫功能的影响

目的:探讨鱼油脂肪乳对重症脑卒中病人康复过程中免疫功能的影响。方法:将86例符合入组条件的重症脑卒中病人随机分为观察组(添加鱼油脂肪乳治疗,n=46)和对照组(常规营养治疗,n=40),其他治疗两组无差异。通过检测两组治疗前和治疗后2周免疫球蛋白(Ig G、Ig A、Ig M)、血总淋巴细胞计数(TLC)和T细胞亚群(CD3+、CD3+CD4+、CD3+CD8+、CD4+/CD8+)水平,并对两种治疗方法的结果进行比较。结果:治疗前两组病人各指标无显著性差异。2周后,观察组病人Ig G、Ig A、Ig M和TLC高于对照组,其中Ig G、Ig M和TLC明显升高(P0.05)。T细胞亚群水平中CD3+、CD3+CD4+、CD4+/CD8+水平明显高于对照组(P0.05),而抑制T细胞(CD3+CD8+)的计数无明显变化(P0.05)。结论:鱼油脂肪乳在重症脑卒中病人的康复过程中起着调节和改善免疫功能的作用。     

围手术期谷氨酰胺强化全肠外营养对胃肠道肿瘤病人免疫功能的影响

目的:研究围手术期谷氨酰胺强化的全肠外营养(TPN)对接受术前化疗的胃肠道肿瘤病人免疫功能的影响.方法:将60例胃肠道肿瘤病人随机分为TPN组、谷氨酰胺强化TPN(Gln-TPN)组和对照组,每组20例病人.对照组给予常规术前准备和术后治疗,TPN组和Gln-TPN组分别给予术前5 d和术后5 d营养支持,两组给予等氮0.20g/(kg·d)和等热量104.6 kJ/(kg·d),同时接受为期5 d的术前化疗.Gln-TPN组中25%～35%的氮源由谷氨酰胺双肽提供,其余的氮源及TPN组的氮源由乐凡命提供.检测术前、术后病人的外周血淋巴细胞总数、T淋巴细胞亚群(CD3 、CD4 、CD8 )及NK细胞数量等免疫指标及前列腺素E2、C反应蛋白(CRP)浓度等炎性反应指标.结果:研究期间三组病人无严重并发症发生.三组病人术后CD3 细胞和CD8 细胞百分比均较术前明显下降,术后水平三组间比较差异无显著性意义.Gln-TPN组CD4 和NK细胞数量及CD4 /CD8 明显高于其他两组,术后Gln-TPN组淋巴细胞总数高于TPN组,而前列腺素E2和C反应蛋白浓度则低于TPN组.结论:谷氨酰胺强化的TPN可降低血浆中前列腺素E2和CRP浓度,促进淋巴细胞增生,调节机体的炎性反应,增强机体的细胞免疫功能.     

鱼油脂肪乳对重症颅脑外伤病人炎性反应的影响

目的:探讨鱼油脂肪乳对重症颅脑外伤病人炎性反应的影响.方法:选择颅脑外伤病人44例,随机分为常规胃肠外营养组(TPN组)和鱼油脂肪乳治疗组(鱼油组),每组各22例.两组病人均接受等氮、等热最的TPN.病人所需热量为83.68 kJ(20 kcal)/(kg·d),氮为0.2 g/(kg·d).鱼油组病人用鱼油脂肪乳,共...     

富含n-3多不饱和脂肪酸的肠外营养对脓毒症大鼠T淋巴细胞亚群和炎性因子的影响

目的:探讨富含n-3多不饱和脂肪酸(PUFA)的肠外营养(PN)对脓毒症大鼠外周血T淋巴细胞亚群和血清炎性因子的影响。方法:将36只大鼠随机分为四组,颈静脉置管术2 d后行盲肠结扎穿孔术或假手术,1对照组:给予自由饮食;2NS组:给予等渗盐水输注+自由饮食;3SO组:给予富含豆油的标准肠外营养(PN)液;4FO组:给予富含PUFA的PN液。脓毒症5 d后,检测IL-6、IL-10和T细胞亚群等。结果:脓毒症5 d后,FO组大鼠外周血CD3+、CD4+、CD4+/CD8+与NS组和SO组比有所升高,但较对照组大鼠下降;与NS组大鼠比,FO组血清IL-6、IL-10、外周血Tregs比例有所下降。结论:应用富含n-3 PUFA的PN可降低脓毒症大鼠血清炎性因子和调控外周血T淋巴细胞亚群。     

顽固性功能性便秘病人免疫功能的变化

目的:探讨顽固性功能性便秘病人免疫功能的变化。方法:选取入住我院的顽固性功能性便秘病人60例(便秘组)和入院行痔疮和低位肛瘘病人60例(对照组)。入院后第1天,抽血检测免疫球蛋白(Ig A、Ig G和Ig M)、C反应蛋白(CRP)、促炎因子(TNF-α、IL-6)、T淋巴细胞亚群(CD3+、CD4+CD3+、CD8+CD3+、CD4+/CD8+和HLA-DR)水平。结果:便秘组病人Ig G和Ig M、TNF-α和IL-6的浓度明显高于对照组,CD3+和CD8+CD3+表达明显低于对照组,CD4+/CD8+表达明显高于对照组。结论:顽固性功能性便秘病人出现明显的免疫功能紊乱和免疫炎症反应状态。     

鱼油脂肪乳对食管癌病人术后免疫功能的影响

目的:探讨鱼油脂肪乳对食管癌病人术后免疫功能的影响. 方法:将77例食管癌病人随机分为观察组(治疗中添加鱼油脂肪乳,n =41)和对照组(常规治疗,n=36),其他治疗两组相同.两组病人于术前1d、术后第1和第7天检测血清免疫球蛋白IgG、IgA、IgM、总淋巴细胞计数(TLC)和T细胞亚群水平(CD3+、CD3+CD4+、CD4+/CD8+),并对两组的结果数据进行比较. 结果:术前1d,两组病人各指标均无显著性差异.术后第1天,两组病人各指标均较术前明显降低;术后第7天,观察组病人IgG、IgA、IgM和TLC较对照组明显升高(P＜0.05).T细胞亚群中CD3+、CD3+CD4+、CD4+/CD8+水平明显高于对照组(P＜0.05),而抑制T细胞CD3+CD8+则无显著性差异(P＞0.05). 结论:鱼油脂肪乳可有效提高食管癌病人术后的免疫功能.     

低氮低热量肠外营养对胃癌术后病人免疫功能的影响

目的:探讨低氮低热量肠外营养对胃癌术后病人免疫功能的影响.方法:将87例胃癌病人双盲、随机分为全胃肠外营养组(TPN,44例)和低氮低热量肠外营养组(HHPN,43例).病人于手术前1 d、术后第1和第8天分别检测外周血淋巴细胞计数(TLC)、免疫球蛋白(IgG、IgM、IgA)、T淋巴细胞亚群(CD4、CD8、CD4...     

谷氨酰胺强化肠外营养在外科危重患者中的作用

目的:探讨全胃肠外营养(TPN)加丙胺酰-谷氨酰胺注射液对外科危重症患者营养及免疫功能的影响。方法:将94例外科重症需要TPN的患者随机分为治疗组和对照组,均给予8dTPN治疗,其中治疗组患者每天加用丙胺酰-谷氨酰胺注射液0.4g/kg。检测患者TPN前、TPN后2d及8d的营养及免疫指标并进行分析。结果:治疗组、对照组与TPN前比较,TPN后2d血清ALB、PAB、TRF水平、PNI均有不同程度恢复,CD4的百分比、CD4/CD8比值、IgG、IgA、IgM有不同程度下降,治疗组优于对照组,在TPN后8d两组比较差异有统计学意义(t=2.235,t=2.167;P<0.05);而CD8的百分比与上述相反(t=2.178,P<0.01)。结论:外科危重症患者在TPN治疗基础上加用丙胺酰-谷氨酰胺注射液能有效改善机体营养和免疫状况,从而促进预后。     

鱼油脂肪乳治疗脑外伤后SIRS的临床研究

目的:观察鱼油脂肪乳治疗脑外伤后全身炎症反应综合征(SIRS)的临床疗效,并探讨其可能机制。方法:将148例脑外伤后并发SIRS病人随机分为治疗组和对照组,每组74例。两组除给予常规临床处理外,治疗组给予20%脂肪乳250 ml+鱼油脂肪乳10 g静脉滴注;对照组给予20%脂肪乳250 ml,1次/d,共10 d。观察两组病人治疗前后急性生理学和慢性健康状况评分(APACHEⅡ)、多器官功能障碍综合征(MODS)发生率和病死率,并测定治疗前后血C-反应蛋白(CRP)水平。结果:治疗后两组病人APACHEⅡ评分明显降低。两组MODS发生率和病死率均有显著差异(P0.05)。鱼油脂肪乳治疗组病人CRP浓度明显低于对照组(P0.01)。结论:鱼油脂肪乳治疗脑外伤后SIRS的临床疗效显著,对稳定病人早期生命体征和降低脑外伤病死率的作用较好。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.