加速康复外科在结直肠癌手术中的效果评价及影响因素分析

目的:评估结直肠手术应用加速康复外科(ERAS)的临床效果,分析影响ERAS实施效果的相关因素。方法:回顾性分析了张家港澳洋医院2015年1月到2017年2月收治的167例因结直肠癌行结直肠切除的病人的临床资料。其中,2015年1月到2016年3月,共89例病人采用传统的围手术期处理方案,设为传统方案组。从2016年4月到2017年2月,共78例病人采用ERAS围手术期处理方案,设为ERAS组。对两组病人基线资料,围手术期情况以及术后结局进行比较分析。结果:ERAS组和传统方案组相比,两组的基线数据如年龄、性别、BMI、肿瘤部位、肿瘤组织学分级及分期之间没有显著性差异(P0.05)。术中情况比较,ERAS组更多的采用腹腔镜的手术方式,术中需要输血的病人比例低于传统方案组(P0.05)。术后结局比较,ERAS组在术后排气时间、术后住院时间以及术后ICU住院时间均低于传统方案组,且术后I级并发症以及II级并发症的发生率降低,差异具有统计学意义。单因素及多因素分析的结果表明,腹腔镜的手术方式是保证ERAS实施效果的独立保护性因素(OR:0.33,95%CI=0.22~0.47,P=0.005),而术前CRP水平则是影响ERAS实施效果的独立危险因素(OR:3.97,95%CI=3.26~4.35,P=0.016)。结论:本研究再次证实在结直肠外科中,ERAS方案的实施可以缩短病人术后排气时间、术后住院时间以及术后ICU住院时间。同时,ERAS可以降低术后I-II级并发症的发生。并且对于结直肠手术病人,腹腔镜的应用以及术前病人CRP水平关系到ERAS的实施效果。     

术前肠内免疫营养对结肠癌病人免疫功能的影响

目的:探讨术前应用肠内免疫营养支持对结肠癌病人免疫功能的影响. 方法:将40例结肠癌病人随机分为两组,每组20例.试验组术前给予瑞能肠内免疫营养支持7 d,对照组术前常规饮食准备.观察术前和术后免疫指标以及术后感染性并发症的发生率及住院时间. 结果:术后两组病人各项免疫指标水平均有不同程度下降,但试验组手术前后各项指标无显著性差异;而对照组术后第3天的外周血淋巴细胞总数、CD4 /CD8 和术后第7 天的淋巴细胞总数、CD3 、CD4 、CD4 /CD8 、血清IgG、IgM水平均较入院时显著降低(P＜0.05);试验组术后第7天淋巴细胞总数、CD3 、CD4 、CD4 /CD8 和血清IgG、IgM水平明显高于对照组(P＜0.05);试验组术后感染性并发症的发生率显著低于对照组(P＜0.05);两组住院时间无显著性差异(P＞0.05). 结论:术前使用肠内免疫营养制剂,能明显改善结肠癌病人的免疫状况,减少术后感染性并发症的发生.     

应激性高血糖对胃癌术后肠内营养实施的影响及护理策略

目的:观察应激性高血糖(SHG)对胃癌术后营养治疗实施的影响,并总结相关护理策略。方法:回顾性分析2017年1月至2019年12月在我院接受胃癌根治术的病人,病人术后均接受早期肠内营养(EN)治疗,以是否发生SHG将病人分为SHG组(32例)和非SHG组(63例)。收集术前一般资料,术后胃肠道功能恢复时效,EN不耐受症状,术前及术后血糖不稳定指数(GLI),以及术后C-反应蛋白(CRP)。结果:SHG组病人术后恢复经口进食时间(t=3.311;P=0.001)和术后住院日(t=3.031;P=0.003)均显著长于非SHG组。SHG组病人术后EN不耐受症状的发生率显著高于非SHG组(χ~2=8.273, P=0.004)。SHG组病人术前GLI(t=7.561;P 0.01)及术后GLI(t=6.977,P 0.01)均显著高于非SHG组病人;术前GLI预测术后SHG发生的敏感性为84.38%,特异性为82.54%。SHG组病人术后第3天CRP显著高于非SHG组病人[(45.9±11.3) vs (26.7±9.8) mg/L, t=8.567, P 0.01],且SHG组病人术后GLI与CRP呈现显著正相关(r=0.656, P 0.01)。结论:术后并发SHG影响胃癌术后康复及EN顺利实施,而术前GLI对胃癌术后SHG的发生具有一定预测价值。     

克罗恩病的围手术期营养支持

目的:探讨围手术期营养支持对克罗恩病(CD)手术治疗的应用价值和经验。方法:回顾性分析因CD相关并发症而进行手术的150例次病人,对病人的营养指标、CD病变活动度指标、病变部位、手术原因、手术方式、术前及术后营养支持应用情况、手术相关并发症等进行相关统计。结果:有130例病人入院时即存在营养不良(86.67%),表现为体质指数(BMI)<18.5或近3个月体质量下降10%以上。围手术期营养支持后病人术前和出院时Hb、ALB、PA、TF和淋巴细胞计数等较入院时均显著改善,但BMI增加不明显。53例病人出院后继续行家庭EN,3个月后平均BMI显著增加(19.24vs17.64,P<0.001)。136例手术获得成功,14例发生手术相关并发症,其中2例死亡。2例危重病人采取损伤控制性手术原则联合营养支持救治成功。出院时,病人病变活动度(CDAI)评分、C-反应蛋白(CRP)水平、红细胞沉降率(ESR)均较入院时显著下降。结论:围手术期营养支持对改善CD病人的预后具有积极的意义。对于危重CD病人采用损伤控制性手术,能取得较好的治疗效果。     

妇科手术后发生医院感染的相关因素分析

目的：探讨妇科手术后发生医院感染的相关因素及其对策。方法选择2008年1月至2012年12月在孝感市中心医院妇科接受妇科手术治疗的2549例患者中,术后发生医院感染的53例患者的临床病历资料为研究对象。采用回顾性分析方法对其临床病历资料进行分析,详细记录患者年龄及术前身体状况、手术时间、手术方式、手术室洁净度、术前准备情况、抗菌药物应用情况、留置尿管时间等,以探讨妇科手术后发生医院感染的相关因素（本研究遵循的程序符合孝感市中心医院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象的知情同意）。结果本组接受妇科手术治疗后发生医院感染的发生率为2.08%（53/2549）。对与因妇科手术发生医院感染的可能相关因素进行非条件多因素logistic回归分析结果显示,妇科手术术后发生医院感染的相关因素为①患者年龄[OR=1.153,95%CI （1.081~1.231）;P=0.000];②术前准备情况[OR=4.782,95%CI（1.516~15.088）;P=0.008];③手术方式[OR=12.735,95%CI（1.549~104.708）;P=0.018];④手术室洁净度[OR=6.352,95%CI （2.207~18.292）;P=0.001];⑤手术时间[OR=5.347,95%CI（1.423~18.423）;P=0.004];⑥留置尿管时间[OR=5.991,95%CI（1.687~21.547）;P=0.003];⑦术前应用抗菌药物[OR=5.292,95%CI （1.122~24.958）;P=0.035]。结论妇科手术后发生医院感染与多因素有关,应加强对医院感染的管理,重视术前、术中、术后各环节以降低妇科手术后的医院感染率。     

食管癌病人围手术期营养状况对其术后恢复的影响

目的:研究食管癌病人围手术期营养状况及术前营养支持对其术后恢复的影响,为临床诊治提供参考.方法:回顾性分析2019年1月份到12月份在厦门大学附属中山医院胸外科手术的102例食管癌围手术期病人,通过营养风险筛查2002(NRS 2002)工具评估营养风险的发生率.分析术前营养支持对不同营养风险病人术后NRS 2002评分、白蛋白、血红蛋白、BMI指数、手术并发症、住院天数的影响.结果:食管癌围手术期有营养风险病人为63例(61.8％),无营养风险病人为39例(38.2％).有营养风险的食管癌病患,术后并发症的发生率及住院时间明显高于无营养风险病人(P＜0.05);有营养风险的病人在术前行营养支持治疗后,术后NRS 2002评分、BMI指数、白蛋白、血红蛋白均显著优于无营养支持病人,术后并发症发生率及住院时间显著低于未行营养支持病人(P＜0.05).Logistic回归分析显示:NRS 2002评分≥3分、术前未进行营养支持治疗及合并基础疾病为食管癌病人术后并发症的独立危险因素.结论:营养风险在食管癌病人中发生率较高,术前进行营养风险筛查,并对存在营养风险的病人积极给予营养支持治疗,可以显著改善术后营养状况并减少病人术后并发症的发生.     

不同手术时间对BP患者的临床效果及对炎症因子、T淋巴细胞的作用对比分析

目的对比分析不同手术时间对胆源性胰腺炎(BP)患者的临床效果及对炎症因子、T淋巴细胞的作用。方法选取2013年1月-2018年7月来我院就诊的BP患者65例为研究对象,采用前瞻性随机临床对照研究方法,按随机数字表法分为A组(发病3d内行手术的患者,n=31)与B组(发病7周左右病情稳定再行手术的患者,n=34)。比较两组的手术临床指标,术前、术后3d两组的炎症因子和T淋巴细胞水平,以及并发症情况。结果两组的术后住院时间、术后平均引流量和中转开腹数比较差异无统计学意义(P0.05),A组的手术时间明显多于B组(P0.05),A组的术中出血量明显低于B组(P0.05);术后3d,两组的C-反应蛋白(CRP)和白介素(IL)-6水平比较差异无统计学意义(P0.05),但两组的CRP和IL-6水平明显高于术前(P0.05);术前和术后3d,两组的CD3~+、CD4~+、CD8~+和CD4~+/CD8~+水平比较差异无统计学意义(P0.05);两组切口感染发生率比较差异无统计学意义(P0.05)。结论与发病7周左右病情稳定再行手术相比,早期手术对BP患者术后的炎症因子、T淋巴细胞水平,以及并发症发生情况均具有相同的影响,且两种时间手术的整体临床效果也同样理想。     

结直肠癌患病饮食相关危险因素病例对照研究

目的探讨结直肠癌发生的主要危险因素,为制定结直肠癌的防治措施提供科学依据。方法采用以医院为基础的1:1配对病例对照研究方法,选择2013年1月~2014年12月间入包头市肿瘤医院经病理切片确诊的结直肠癌病人作为病例。对研究对象进行问卷调查。采用配对四格χ~2检验和条件logistic回归对资料进行单因素及多因素分析,计算比值比(OR值)及OR值的95%可信区间(95%CI)。结果单因素分析结果表明:新鲜蔬菜水果(χ~2=28.372,P=0.000)、红肉(χ~2=6.429,P=0.001)、腌渍类食物(χ~2=13.885,P0.01)、油炸食品摄入频率(χ~2=20.645,P=0.000)及食用油种类(χ~2=15.284,P=0.000)、口味咸淡(χ~2=6.195,P=0.013)与结直肠癌发病有关。多因素条件logistic回归分析结果显示:红肉摄入频率≥8次/周(OR=2.854,95%CI:1.269~6.419)、新鲜蔬菜水果摄入频率≤7次/周(OR=4.663,95%CI:2.049~10.661)、经常摄入腌渍类食物(OR=8.338,95%CI:1.237~56.215)和油炸食品(OR=2.869,95%CI:1.364~6.034)及食用油以动物油(OR=6.378,95%CI:2.716~14.981)为主是结直肠癌发病的危险因素。结论红肉摄入频率高(≥8次/周)、新鲜蔬菜水果摄入频率低(≤7次/周)、经常摄入腌渍类食物和油炸食品及食用油以动物油为主是结直肠癌发病的危险因素。     

谷氨酰胺强化的肠外营养对食管癌病人术后机体应激反应及免疫功能的影响

目的:评价谷氨酰胺(Gln)强化的肠外营养(PN)支持对食管癌根治术后病人应激反应及免疫功能的影响. 方法:选取食管癌根治术后的病人72例,随机双盲分为试验组(Gln强化组)和对照组(单纯PN组),每组36例.术后分别给予两组病人等氮和等热量营养支持7d,试验组病人术后24 h内于PN液中添加Gln为0.35 g/(kg·d).比较两组病人手术前后免疫和炎性指标变化. 结果:两组病人术前C3、C4和C反应蛋白(CRP)均高于正常值,IgA、IgG、IgM均低于正常值,CD3、CD4、CD4/CD8均低于正常值,CD8高于正常值.术后第1天,两组病人C3、C4和CRP均进一步升高,IgA、IgG、IgM均较术前有所下降,CD3、CD4、CD4/CD8均较术前下降.术后第7天,试验组病人CRP显著低于对照组(P＜0.05),而IgA、IgG显著高于对照组(P＜0.05),CD4亦显著高于对照组(P＜0.05). 结论:添加Gln强化的PN支持能有效地改善食管癌病人术后的免疫功能和减轻应激反应.     

L-精氨酸对围手术期胃癌病人炎性反应和免疫功能的影响

目的:研究L-精氨酸(L-Arg)对围手术期胃癌病人炎性反应和免疫功能的影响. 方法:将围手术期胃癌病人随机分为研究组和对照组,研究组(n=33)行营养支持加L-Arg治疗,L-Arg 0.4g/(kg·d)通过静脉给予;对照组(n=30)行营养支持治疗加等量的等渗盐水.能量供给为125.4 kJ/(kg·d),氮量为0.2g/(kg·d),治疗10d.观察胃癌病人术前3d、术后第3和第7天血清C-反应蛋白(CRP)、白细胞介素-2(IL-2)、IL-6、IL-10、肿瘤坏死因子-α(TNF-α)、T淋巴细胞亚群CD4+、CD8+水平和CD4 +/CD8+比值的变化. 结果:术后第7天,研究组病人血IL-2、TNF-α水平和CD4+/CD8+比值均明显高于对照组和术前3d,而血液CRP和IL-10水平明显低于对照组和术前3d.术后第7天,CRP水平明显低于术后第3天. 结论:L-Arg可影响胃癌病人的炎性反应水平,下调具有促进肿瘤生长能力的炎性因子水平,上调胃癌病人细胞免疫应答.     

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.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

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.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

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.