BACKGROUND & AIMS: :The vitamin B12 status of 20 subjects who were on home parenteral nutrition after surgical or functional small bowel resection and were given 1000 micrograms cyanocobalamin every 3 mo was studied by comparing their plasma vitamin B12, homocysteine (HS), and methylmalonic acid (MMA) concentrations. The plasma vitamin B12 concentration (median 145 pmol/L, 95% confidence interval: 123-217) was subnormal in four cases and borderline in four others. In the "4low B12" group, the concentrations of the markers of vitamin B12 deficiency were in the normal range; HS 10.7 mumol/L (8.0-12.3); and MMA, 0.15 mumol/L (0.09-0.19). References values were HS, 10.0 mumol/L (9.4-12.6); and MMA, 0.16 mumol/L (0.10-0.19). Thus, there were no metabolic signs of vitamin B12 deficiency in these subjects on parenteral nutrition, despite the fact that their plasma vitamin B12 levels were low. Analysis of individual data showed that the four patients with low circulating B12 had markers of intracellular vitamin B12 deficiency in the normal range.

背景与目标： ：通过比较血浆中维生素B12，高半胱氨酸（HS）和甲基丙二酸（MMA）的研究，研究了20名接受手术或功能性小肠切除术后家庭肠胃外营养并每3个月接受1000微克氰钴胺的受试者的维生素B12状况浓度。血浆维生素B12浓度（中位数145 pmol / L，95％置信区间：123-217）在4例中低于正常，在其他4例中处于临界水平。在“ 4low B12”组中，维生素B12缺乏症标志物的浓度在正常范围内。 HS 10.7摩尔/升（8.0-12.3）;和MMA，0.15摩尔/升（0.09-0.19）。参考值为HS，10.0 mumol / L（9.4-12.6）；和MMA，0.16摩尔/升（0.10-0.19）。因此，尽管血浆维生素B12水平较低，但这些受试者在肠外营养方面没有维生素B12缺乏症的代谢迹象。对个人数据的分析表明，四名低循环B12患者的细胞内维生素B12缺乏症标志物在正常范围内。

BACKGROUND & AIMS: :Few well-constructed studies have systematically evaluated medical investigation protocols for children with autistic spectrum disorders. This is in large part due to the heterogeneous nature of the population and changing diagnostic frameworks. This review outlines the studies that have directed investigation strategies to date, and discusses how these might be applied in the clinical situation. The importance of listing the conditions that may be present on the basis of the specific clinical presentation, and using a thorough history and examination to generate a pre-test probability of the target disorders is emphasized if tests are to be useful in directing therapy or broader management approaches.

背景与目标： ：很少有结构完善的研究能够系统地评估自闭症谱系障碍儿童的医学研究方案。这在很大程度上是由于人群的异质性和不断变化的诊断框架。这篇综述概述了迄今为止指导研究策略的研究，并讨论了如何将这些策略应用于临床。如果测试对指导治疗或更广泛有用，则强调列出根据具体临床表现可能出现的疾病，并使用详尽的病史和检查以产生目标疾病的预测试概率的重要性。管理方法。

BACKGROUND & AIMS: Although nutrition is an important part of medical care, nutrition education is not provided in most training programs for physicians in the United States, resulting in limited nutrition knowledge among physicians and limited nutritional care of patients. A nutrition education program was provided by a physician nutrition specialist in a family practice residency program. For 6 mo, the nutrition specialist provided the family physicians with recommendations for nutritional care for their patients. The effects of the education program on residents' and faculty physicians' nutrition knowledge and nutritional patient care, patients' perceptions of the importance of nutrition, and physicians' dietary patterns were determined by pre- and post-intervention nutrition exams for physicians and patients, patient questionnaires about attitudes toward nutrition, chart reviews, and physicians' diet records. The nutrition education program resulted in an increase in physicians' nutrition knowledge scores (P < 0.01) and an increase in the frequency with which physicians discussed nutrition and recommended diets for their patients (P < 0.05). This suggests that nutrition education by a physician nutrition specialist within a family practice residency program can be effective in increasing nutritional care provided to patients.

背景与目标： 尽管营养是医疗保健的重要组成部分，但在美国大多数医师的培训计划中并未提供营养教育，这导致医师之间的营养知识有限，患者的营养保健也有限。营养保健教育计划是由医师营养专家在家庭执业驻留计划中提供的。营养专家在6个月内为家庭医生提供了有关为其患者提供营养护理​​的建议。通过干预前和干预后对医师和患者的营养检查来确定教育计划对住院医师和教职医师的营养知识和患者营养的影响，患者对营养重要性的看法以及医师的饮食方式的影响，有关营养态度的患者问卷调查表，图表评论以及医生的饮食记录。营养教育计划导致医师的营养知识得分增加（P <0.01），医师讨论营养和为患者推荐饮食的频率增加（P <0.05）。这表明在家庭执业住院医师计划中，由医生营养专家进行的营养教育可以有效地增加提供给患者的营养保健服务。

BACKGROUND & AIMS: :In the last few years, our knowledge of genetically determined causes of short stature has greatly increased by reports of challenging patients, who offered the opportunity to study genes that play a role in growth. Since the first paper that showed the etiology of Laron syndrome [Godowski PJ, et al: Proc Natl Acad Sci USA 1989;86:8083-8087], many mutations in the growth hormone (GH) receptor have been identified. Recently, new mutations or deletions have been found in several components of the GH-insulin-like growth factor-I (IGF-I) axis: a homozygous mutation of the GH1 gene, resulting in a bio-inactive GH; mutations in the STAT5b gene, which plays a major role in the GH signal transduction; a homozygous missense mutation in the IGF-I gene; heterozygous mutations in the IGF-I receptor gene and a homozygous deletion of the acid-labile subunit gene. In this mini review, we describe the clinical and biochemical features of these genetic defects. Genetic analysis has become essential in the diagnostic workup of a patient with short stature. However, regarding the time consuming nature of molecular analysis, it is important to carefully select the patient for specific genetic evaluation. To help in this selection process, we developed flowcharts, based on the recently described patients, that can be used as guidelines in the diagnostic process of patients with severe short stature of unknown origin.

背景与目标： ：在过去的几年中，由于对挑战性患者的报道，我们对遗传决定的矮小身高原因的了解大大增加了，这些患者为研究在生长中起作用的基因提供了机会。自从第一篇显示Laron综合征病因的论文以来[Godowski PJ等人：Proc Natl Acad Sci USA 1989; 86：8083-8087]，已经确定了生长激素（GH）受体的许多突变。最近，在GH-胰岛素样生长因子-I（IGF-I）轴的几个组成部分中发现了新的突变或缺失：GH1基因的纯合突变，导致了生物失活的GH； STAT5b基因的突变，在GH信号转导中起主要作用； IGF-I基因的纯合错义突变； IGF-1受体基因中的杂合突变和对酸不稳定的亚基基因的纯合缺失。在这个小型综述中，我们描述了这些遗传缺陷的临床和生化特征。遗传分析已成为身材矮小的患者的诊断检查中必不可少的。但是，考虑到分子分析的耗时性质，重要的是要仔细选择患者进行特定的基因评估。为了帮助选择过程，我们根据最近描述的患者制定了流程图，可以将其用作诊断患有严重身材矮小，来源不明的患者的诊断过程中的指导原则。

BACKGROUND & AIMS: BACKGROUND:The Nutrition Embedded Evaluation Programme Impact Evaluation (NEEP-IE) study is a cluster randomised controlled trial designed to evaluate the impact of a childcare centre-based integrated nutritional and agricultural intervention on the diets, nutrition and development of young children in Malawi. The intervention includes activities to improve nutritious food production and training/behaviour-change communication to improve food intake, care and hygiene practices. This paper presents the rationale and study design for this randomised control trial. METHODS:Sixty community-based childcare centres (CBCCs) in rural communities around Zomba district, Malawi, were randomised to either (1) a control group where children were attending CBCCs supported by Save the Children's Early Childhood Health and Development (ECD) programme, or (2) an intervention group where nutritional and agricultural support activities were provided alongside the routine provision of the Save the Children's ECD programme. Primary outcomes at child level include dietary intake (measured through 24-h recall), whilst secondary outcomes include child development (Malawi Development Assessment Tool (MDAT)) and nutritional status (anthropometric measurements). At household level, primary outcomes include smallholder farmer production output and crop-mix (recall of last production season). Intermediate outcomes along theorised agricultural and nutritional pathways were measured. During this trial, we will follow a mixed-methods approach and undertake child-, household-, CBCC- and market-level surveys and assessments as well as in-depth interviews and focus group discussions with project stakeholders. DISCUSSION:Assessing the simultaneous impact of preschool meals on diets, nutrition, child development and agriculture is a complex undertaking. This study is the first to explicitly examine, from a food systems perspective, the impact of a preschool meals programme on dietary choices, alongside outcomes in the nutritional, child development and agricultural domains. The findings of this evaluation will provide evidence to support policymakers in the scale-up of national programmes. TRIAL REGISTRATION:ISRCTN registry, ID: ISRCTN96497560 . Registered on 21 September 2016.

背景与目标： 背景：营养嵌入式评估计划影响评估（NEEP-IE）研究是一项集群随机对照试验，旨在评估基于托儿所的营养和农业综合干预对马拉维幼儿饮食，营养和发育的影响。干预措施包括改善营养食品生产的活动和培训/行为改变交流，以改善食物摄入，护理和卫生习惯。本文介绍了这项随机对照试验的原理和研究设计。
方法：将马拉维Zomba地区周边农村社区的60个社区托儿中心（CBCC）随机分为（1）对照组，在该组中，儿童参加了由Save the Children's Early Childhood Health and Development（ECD）计划支持的CBCC，或（2）一个干预小组，在该小组的日常服务之外，还提供了营养和农业支持活动。儿童一级的主要结局包括饮食摄入量（通过24小时召回来衡量），而次级一级的结局包括儿童发育（马拉维发育评估工具（MDAT））和营养状况（人体测量）。在家庭一级，主要成果包括小农户的农产品产量和作物结构（回顾上个生产季节）。测量了理论上的农业和营养途径的中间结果。在此试验期间，我们将采用混合方法，并进行儿童，家庭，CBCC和市场级别的调查和评估，以及与项目利益相关者的深入访谈和焦点小组讨论。
讨论：评估学龄前膳食对饮食，营养，儿童发育和农业的同时影响是一项复杂的工作。这项研究是第一个从食品系统的角度明确检查学龄前儿童饮食计划对饮食选择以及营养，儿童发育和农业领域的成果的影响的研究。评估的结果将为支持决策者扩大国家计划提供证据。
试用注册：ISRCTN注册，ID：ISRCTN96497560。 2016年9月21日注册。

BACKGROUND & AIMS: BACKGROUND:Diabetes mellitus (DM) is associated with hyperglycemia, inflammatory disorders and abnormal lipid profiles, currently the extracts from leaves of cynara scolymus has been discovered to treat metabolic disorders and has been stated by multitudinous scientists according to a good source of polyphenols compounds. The present study aimed to evaluate the protective effect of the ethanol leaves extract of C. scolymus in alloxan induced stress oxidant, hepatic-kidney dysfunction and histological changes in liver, kidney and pancreas of different experimental groups of rats. METHODS:We determinate the antioxidant activity by ABTS .+ and antioxidant total capacity (TAC) of all extracts of C. scolymus leaves, the inhibition of α-amylase activity in vitro was also investigated. Forty male Wistar rats were induced to diabetes with a single dose intraperitoneal injection (i.p.) of alloxan (150 mg/kg body weight (b.w.)). Diabetic rats were orally and daily administrated of ethanol extract from C. scolymus at two doses (200-400 mg/kg, b.w) or (12 mg/kg, b.w) with anti-diabetic reference drug, Acarbose for one month. Ethanol extract of C. scolymus effect was confirmed by biochemical analysis, antioxidant activity and histological study. RESULTS:The results indicated that the ethanol extract from leaves of C. scolymus showed the highest antioxidant activity by ABTS .+ (499.43g± 39.72 Trolox/g dry extract) and (128.75 ± 8.45 mg VC /g dry extract) for TAC and endowed the powerful inhibition in vitro of α-amylase activity with IC50=72,22 ug/uL. In vivo, the results showed that ethanol extract from the leaves of C. scolymus (200-400 mg/kg) decreased significantly (p < 0.001) the α-amylase levels in serum of diabetic rats, respectively associated with significant reduction (p < 0.001) in blood glucose rate of 42,84% and 37,91% compared to diabetic groups after 28 days of treatment, a significant lowered of plasma total cholesterol (T-Ch) by 18,11% and triglyceride (TG) by 60,47%, significantly and low-density lipoproteins (LDL-C) by 37,77%, compared to diabetic rats, moreover, the administration of ethanol extract appears to exert anti-oxidative activity demonstrated by the increase of CAT, SOD and GSH activities in liver, kidney and pancreas of diabetic rats. This positive effect of the ethanol extract from C. scolymus was confirmed by histological study. CONCLUSION:These observed strongly suggest that ethanol extract from the leaves of C. scolymus has anti-hyperglycemic properties, at least partly mediated by antioxidant and hypolipidemic effects.

背景与目标： 背景：糖尿病（DM）与高血糖，炎性疾病和异常脂质状况相关，目前已发现粘虫c叶片的提取物可治疗代谢紊乱，许多科学家已根据多酚化合物的良好来源进行了陈述。本研究旨在评价鳞球菌乙醇叶提取物对四氧嘧啶诱导的应激氧化剂，肝肾功能障碍以及不同实验组大鼠肝，肾和胰腺组织学变化的保护作用。
方法：我们通过ABTS测定抗氧化活性。鼠尾草叶片的所有提取物的抗氧化剂和总抗氧化剂（TAC），还研究了其对α-淀粉酶活性的体外抑制作用。通过单剂量腹膜内注射（i.p.）四氧嘧啶（150 mg / kg体重（b.w.））将40只雄性Wistar大鼠诱发为糖尿病。糖尿病大鼠口服和每天服用两种剂量（200-400 mg / kg，b.w）或（12 mg / kg，b.w）的鼠尾草乙醇提取物和抗糖尿病参考药物阿卡波糖（acarbose）。通过生化分析，抗氧化活性和组织学研究证实了粘液梭状芽胞杆菌的乙醇提取物作用。
结果：结果表明，ABTS从粘枝sco叶片中提取的乙醇具有最高的抗氧化活性。 （499.43g±39.72 Trolox / g干提取物）和（128.75±8.45 mg VC / g干提取物）用于TAC，并在体外有效抑制α-淀粉酶活性，IC50 = 72.22 ug / uL。在体内，结果显示，从粘液梭菌的叶子中提取乙醇（200-400 mg / kg）显着降低（p <0.001）糖尿病大鼠血清中的α-淀粉酶水平，分别与显着降低有关（p <0.001）。在治疗28天后，与糖尿病组相比，血糖比率分别为0.001、42.84％和37.91％，血浆总胆固醇（T-Ch）显着降低了18.11％，甘油三酸酯（TG）显着降低了60与糖尿病大鼠相比，低密度脂蛋白（LDL-C）降低了47.7％，低密度脂蛋白（LDL-C）降低了37.77％，此外，乙醇提取物的给药似乎表现出抗氧化活性，这是由于CAT，SOD和GSH的增加所证明的在糖尿病大鼠肝，肾和胰腺中的活性。组织学研究证实了粘液梭菌乙醇提取物的这种积极作用。
结论：这些观察结果强烈表明，从粘液梭菌的叶子中提取乙醇具有抗降血糖作用，至少部分是由抗氧化剂和降血脂作用介导的。

BACKGROUND & AIMS: :The revisions proposed for the DSM-5 would greatly alter how personality pathology is conceptualized, assessed, and diagnosed. One aspect of the proposed changes, elimination of four current personality disorders, has raised considerable controversy. The present study attempts to inform this debate by exploring clinicians' views of the structure of Personality Disorders using the current diagnostic system, the DSM-IV. An exploratory factor analysis was conducted on the DSM-IV Personality Disorder criteria using clinician ratings for 280 patients. The factor analysis revealed eight clear and meaningful factors. The eight factors contained all six personality disorders proposed for retention in DSM-5 but also contained clear representations of two disorders (Paranoid and Schizoid) identified for removal from the system. These conditions appear to have clinical utility and their removal may have unintended negative consequences in clinical practice. Dependent and Avoidant criteria also merged to form a new construct with interesting clinical implications. These findings provide new insights into the complex typologies clinicians employ when applying the DSM-IV system to personality disordered patients. Lastly we argue that successful refinement of clinically significant constructs, like diagnostic systems, requires a balanced appraisal of evidence for clinical utility as well as external and internal validity.

背景与目标： ：针对DSM-5提出的修订将极大地改变人格病理学的概念化，评估和诊断方式。所提议的改变的一方面，消除了当前的四种人格障碍，引起了相当大的争议。本研究试图通过使用当前的诊断系统DSM-IV探索临床医生对人格障碍结构的看法来为这场辩论提供信息。使用临床医师评估的280名患者，对DSM-IV人格障碍标准进行了探索性因素分析。因素分析揭示了八个明确而有意义的因素。八个因素既包含提议保留在DSM-5中的所有六个人格障碍，也包含明确识别出的两个人格障碍（Paranoid和Schizoid），可以从系统中移除。这些情况似乎具有临床用途，将其清除可能会在临床实践中产生意想不到的负面影响。受抚养者和回避者的标准也合并在一起，形成了一种具有有趣临床意义的新结构。这些发现为临床医生在将DSM-IV系统应用于人格障碍患者时采用的复杂类型提供了新的见解。最后，我们认为要成功地完善具有临床意义的结构（如诊断系统），需要对临床实用性以及内部和外部有效性的证据进行均衡的评估。

BACKGROUND & AIMS: :To better explore the clinical heterogeneity of bipolar mood states, we developed a dimensional scale for assessing all mood episodes (depressive, hypomanic, manic, mixed states) using the same tool. The Multidimensional Assessment of Thymic States (MATHYS) (Henry et al., 2008) provides two scores, a total score measuring a level of activation and a sub-score of emotional reactivity. The aim of this study was to establish the appropriate cut-off in total activation versus inhibition and in the emotional reactivity sub-score in bipolar disorders. Patients (n=187) during an acute episode and controls (n=89) filled in the MATHYS. Receiver Operating Characteristic (ROC) curves were obtained to estimate the sensitivity and specificity of the global score and the emotional reactivity sub-score of the MATHYS, in order to differentiate patients from controls. ROC curves showed very satisfactory sensitivity and specificity levels both for the total score and the sub-score of emotional reactivity, thus providing an appropriate cut-off. Concerning the total score between 0 and 200, patients with a score lower than 91 had significant global inhibition and those with a score higher than 109 had significant global activation. Regarding the emotional reactivity sub-score between 0 and 40, patients with a score lower than 16 had significant emotional hyporeactivity and those with a score higher than 24 had significant emotional hyperreactivity. Our results provide cut-offs for the MATHYS to identify patients in an acute phase.

背景与目标： ：为了更好地探索双相情感状态的临床异质性，我们开发了一种用于使用同一工具评估所有情绪事件（抑郁，躁狂，躁狂，混合状态）的量表。胸腺状态的多维评估（MATHYS）（Henry等，2008）提供了两个评分，一个总评分用于衡量激活水平，另一个是情感反应分数。这项研究的目的是确定双相情感障碍的总激活与抑制以及情绪反应性亚评分的适当分界。急性发作期间的患者（n = 187）和对照组（n = 89）填写了MATHYS。获得接收者操作特征（ROC）曲线以估计MATHYS总体评分和情绪反应性子评分的敏感性和特异性，以区分患者与对照组。 ROC曲线在总分和情绪反应的亚评分中均显示出非常令人满意的敏感性和特异性水平，因此提供了适当的临界值。关于总分在0到200之间，得分低于91的患者具有显着的总体抑制作用，得分高于109的患者具有显着的全局抑制作用。对于0至40之间的情绪反应性子评分，得分低于16的患者有明显的情绪低反应性，而分数高于24的患者则有明显的情绪高反应性。我们的结果为MATHYS识别急性期患者提供了界限。

BACKGROUND & AIMS: :Activating KIR-HLA-C ligand complexes and HLA-G∗14bp insertion/deletion (+/-) polymorphism were associated to Autism Spectrum Disorders (ASD) and were suggested to correlate with inflammation during fetal development. We evaluated whether HLA-G∗14bp(+/-) and KIR-HLA-C complexes are associated with cognitive and behavioral scores and EEG profile in 119 ASD children (58 from Sardinia, 61 from Peninsular Italy). KIR2DS1-C2; KIR2DS2-C1; KIR2DL1-C2; KIR2DL2-C1; KIR2DL3-C1 and HLA-G∗14bp(+/-) were molecularly genotyped by Single Specific Primer PCR and gel electrophoresis. Univariate linear model analysis adjusted for age, gender and provenience showed statistically higher scores of Childhood Autism Rating Scale (CARS) and Autistic Core Behavior in KIR2DS1-C2+/HLA-G∗14bp+ASD children (43.7±1.5, p=0.03; 3.3±0.1, p=0.03, respectively). These results suggested a synergistic polygenic association of KIR2DS1-HLAC2+/HLA-G∗14bp+ pattern with behavioral impairment in ASD children.

背景与目标： ：激活的KIR-HLA-C配体复合物和HLA-G * 14bp插入/缺失（/-）多态性与自闭症谱系障碍（ASD）相关，并被认为与胎儿发育过程中的炎症相关。我们评估了119名ASD儿童（58名来自撒丁岛，61名来自意大利半岛）的HLA-G * 14bp（/-）和KIR-HLA-C复合物是否与认知和行为评分以及脑电图谱相关。 KIR2DS1-C2; KIR2DS2-C1; KIR2DL1-C2; KIR2DL2-C1;通过单特异性引物PCR和凝胶电泳对KIR2DL3-C1和HLA-G * 14bp（/-）进行分子基因分型。根据年龄，性别和出身水平进行的单变量线性模型分析显示，在KIR2DS1-C2 / HLA-G * 14bp ASD儿童中，儿童自闭症评分量表（CARS）和自闭症核心行为在统计学上较高（43.7±1.5，p = 0.03; 3.3±分别为0.1，p = 0.03）。这些结果表明，KIR2DS1-HLAC2 / HLA-G * 14bp模式与ASD儿童的行为障碍存在协同的多基因关联。

BACKGROUND & AIMS: INTRODUCTION:The most severe complication of parenteral nutrition (PTN) is catheter-related infection (CRI). OBJECTIVES:To study the incidence rate and factors associated to CRI. MATERIAL AND METHODS:271 patients followed at the Nutrition Unit for 6 months. The composition of the PTN was calculated according to the metabolic demands. 20.3% received a lipid solution enriched with omega-3 fatty acids (SMOF Fresenius Kabi®) and 79.7% with olive oil (Clinoleic Baxter®). RESULTS:The rate of CRI was 25 per 1,000 days of PTN (55 patients: 61.7±17.8 years, 60.3% males, 29.3±10.6 days of hospital stay and 10.4% mortality). Coagulase-negative Staphylococcus was the most frequently isolated microorganism. There were no differences by age, gender, mortality, or composition of the PTN between patients with or without infection. The patients treated with omega-3 received more calories with the PTN, at the expense of higher intake of glucose and lipids. However, the rate of infection was similar, although there was a not significant trend towards a lower infection rate when using the omega-3 composition (14.5% vs. 23.1%, respectively, p = 0.112). The duration of the nutritional support was higher in patients with CRI (13.0 ± 9.7 vs. 9.3 ± 8.1, p = 0.038). Total mortality (16.9%) was independent of the presence or absence of CRI (10.4% vs. 18.7%, p = 0.090) or of the use of omega-3 lipids or olive oil in the PTN (10.9% vs. 18.5%, p = 0.125). CONCLUSION:Patients submitted to PTN have a high rate of CRI. The presence of infection is related to the duration of the PTN, being independent of the age, gender, and composition of the solution. The use of omega-3 lipid solutions may be beneficial although further studies are needed to confirm this.

背景与目标： 简介：肠胃外营养（PTN）的最严重并发症是导管相关感染（CRI）。
目的：研究CRI的发生率及相关因素。
材料与方法：271例患者在营养科接受了6个月的随访。根据代谢需要计算PTN的组成。 20.3％的人接受了富含omega-3脂肪酸（SMOF FreseniusKabi®）的脂质溶液，而79.7％的接受了橄榄油（ClinoleicBaxter®）的脂质溶液。
结果：PTN的CRI率为25/1000天（55例患者：61.7±17.8岁，男性为60.3％，住院时间为29.3±10.6天，死亡率为10.4％）。凝固酶阴性葡萄球菌是最常分离的微生物。在有或没有感染的患者之间，PTN的年龄，性别，死亡率或组成没有差异。用omega-3治疗的患者接受PTN吸收的卡路里更多，但要以增加葡萄糖和脂质的摄入为代价。但是，感染率相似，尽管使用omega-3组合物时感染率降低的趋势并不明显（分别为14.5％和23.1％，p = 0.112）。 CRI患者的营养支持持续时间更长（13.0±9.7与9.3±8.1，p = 0.038）。总死亡率（16.9％）与是否存在CRI（10.4％对18.7％，p = 0.090）或PTN中是否使用omega-3脂质或橄榄油无关（10.9％对18.5％， p = 0.125）。
结论：提交PTN的患者的CRI率很高。感染的存在与PTN的持续时间有关，而与溶液的年龄，性别和组成无关。尽管需要进一步的研究来证实这一点，但使用omega-3脂质溶液可能是有益的。

BACKGROUND & AIMS: :The need to find effective treatments for patients with Anorexia or Bulimia nervosa has led to the professionals who care for them to develop new forms of treatment that take into account the variables that cause resistance to change. Patients in this study (2006-2009) have the following characteristics: 340 patients who have 7 or more years of evolution and/or have tried numerous previous treatments without having succeeded in starting and / or maintaining the desired changes, that allowed them to recover steadily. As the proposed treatment, the patient-treatment team is based on the principles of the training model. It considers the patient holistically, it informs and provides him with resources to increase its commitment to change. Teaches the patient to take care physically and mentally as a way to regain their health and leave the disorder in a stable way. Includes family members as essential support in the recovery of their closest. Therapists require extensive experience in the treatment of ED, flexibility, ability to integrate with other team members even if they use different theoretical models, skills for group sessions, ability to handle negative emotions and frustration tolerance. Finally, the model presented below has been implemented, recovered patients whose stay in the disorder exceeded 15 years of development and led to permanent occupational disability.

背景与目标： 由于需要为患有厌食症或神经性贪食症的患者找到有效的治疗方法，因此引起了专业人士的关注，他们开发出了新的治疗形式，并考虑到了引起抗药性变化的因素。本研究（2006-2009年）的患者具有以下特征：340位患者经历了7年或更长时间的进化和/或尝试过多种先前的治疗而未成功开始和/或维持所需的改变，从而使他们得以康复稳步。作为建议的治疗方法，患者治疗团队基于培训模型的原则。它从整体上考虑患者，为患者提供信息并为其提供资源，以增加其对变化的承诺。教给病人身心上的照顾，以恢复健康并稳定地摆脱疾病。包括家庭成员，以帮助他们恢复最亲密的关系。治疗师需要在ED的治疗方面具有丰富的经验，灵活性，与其他团队成员融为一体的能力，即使他们使用不同的理论模型，小组会议的技能，应对负面情绪的能力和挫败感的容忍度。最终，实施了以下模型，恢复了在该疾病中停留超过15年并导致永久性职业残疾的患者。

BACKGROUND & AIMS: INTRODUCTION:Significant malnutrition exists in a high percentage of patients with head and neck cancer. Malnutrition is associated with defects in immune function that may impair the host response to malignancy. Malnutrition and immunosupression make patients highly susceptible to postoperative infections and complications. OBJECTIVES:Some studies of patients receiving immuno-nutrition in the perioperative period in head and neck cancer have shown beneficial effects on clinical outcome and inmune status. The authors carried out a systematic review of randomised control trials to determine whether perioperative immunonutrition has a role in the treatment of head and neck cancer. METHODS:14 trials of polymeric nutritional supplementation with immunonutrition were identified. Two studies compared two types of immunonutrition. RESULTS:A reduction in the length of postoperative hospital stay was seen in some trials, but the reason for this reduction is not clear. Some studides showed statistical differences with less complications in arginine-enhanced group and also showed a significant decrease of fistula complications in patients treated with a high arginine dose enhanced formula, if compared with a medium dose of arginine. CONCLUSION:[corrected] Those planning future studies face challenges. A suitable powered clinical trial is required before firm recommendations can be made on the use of immunonutrition in head and neck cancer patients postoperatively.

背景与目标： 简介：大量的营养不良存在于头颈癌患者中。营养不良与免疫功能缺陷有关，可能损害宿主对恶性肿瘤的反应。营养不良和免疫抑制使患者对术后感染和并发症高度敏感。
目的：一些对头颈部癌患者围手术期接受免疫营养治疗的患者的研究表明，其对临床结局和免疫状况具有有益作用。作者对随机对照试验进行了系统评价，以确定围手术期免疫营养是否在头颈癌的治疗中起作用。
方法：鉴定了14项免疫营养性高分子营养补充试验。两项研究比较了两种类型的免疫营养。
结果：在某些试验中，术后住院时间减少了，但是减少的原因尚不清楚。与中等剂量的精氨酸相比，精氨酸增强组的某些研究结果显示统计学差异且并发症较少，并且用高精氨酸剂量增强配方治疗的患者的瘘管并发症也显着减少。
结论：[已纠正]那些计划未来研究的人面临挑战。在对头颈癌患者术后使用免疫营养提出确切建议之前，需要进行适当的临床试验。

BACKGROUND & AIMS: OBJECTIVE:Breast-feeding is associated with maternal health, such as electrolyte metabolism, lipid profile and body component change. The aim of this study was to evaluate the relationship between duration of breast-feeding and obesity in postmenopausal women. METHODS:We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012, a cross-sectional study in a Korean population. A total of 6621 postmenopausal women were analyzed. RESULTS:Body mass index and waist circumference were greater in women who had breast-fed for 6 months or more than in those who had not (BMI: 23.7±0.1 vs 24.5±0.1, P<0.0001; WC: 80.6±0.4 vs 82.8±0.3, P<0.001). This association persisted after adjustment for confounding factors (BMI: odds ratio[OR]1.54, 95% confidence interval[CI] 1.19-2.0; WC: OR1.67, 95% CI 1.29-2.17). The duration of breast-feeding tended to increase with increasing BMI and WC (P for trend, 0.001 for each). The proportions of women with greater BMI and WC increased with increasing duration of breast-feeding (27.3% in ≤6 months vs 41.2% in >18months, P<0.0001). CONCLUSION:The results of this study suggest that prolonged breast-feeding may be associated with greater BMI and WC among postmenopausal women.

背景与目标： 目的：母乳喂养与孕妇健康有关，例如电解质代谢，脂质分布和身体成分变化。这项研究的目的是评估绝经后妇女的母乳喂养时间与肥胖之间的关系。
方法：我们分析了2010-2012年韩国国民健康与营养检查调查（KNHANES）的数据，这是一项针对韩国人群的横断面研究。总共对6621名绝经后妇女进行了分析。
结果：母乳喂养6个月或更长时间的妇女的身体质量指数和腰围比没有母乳的妇女更大（BMI：23.7±0.1 vs 24.5±0.1，P <0.0001; WC：80.6±0.4 vs 82.8 ±0.3，P <0.001）。调整混杂因素（BMI：比值比[OR] 1.54，95％置信区间[CI] 1.19-2.0； WC：OR1.67，95％CI 1.29-2.17）后，这种关联仍然存在。母乳喂养的时间倾向于随着BMI和WC的增加而增加（趋势P，每种0.001）。 BMI和WC较高的女性比例随着母乳喂养时间的增加而增加（≤6个月为27.3％，而> 18个月为41.2％，P <0.0001）。
结论：这项研究的结果表明，延长母乳喂养可能与绝经后妇女的BMI和WC升高有关。

BACKGROUND & AIMS: BACKGROUND:The majority of patients with depressive disorders are treated by general practitioners (GPs) and are prescribed antidepressant medication. Patients prefer psychological treatments but they are under-used, mainly due to time constraints and limited accessibility. A promising approach to deliver psychological treatment is blended care, i.e. guided online treatment. However, the cost-effectiveness of blended care formatted as an online psychological treatment supported by the patients' own GP or general practice mental health worker (MHW) in routine primary care is unknown. We aim to demonstrate non-inferiority of blended care compared with usual care in patients with depressive symptoms or a depressive disorder in general practice. Additionally, we will explore the real-time course over the day of emotions and affect, and events within individuals during treatment. METHODS:This is a pragmatic non-inferiority trial including 300 patients with depressive symptoms, recruited by collaborating GPs and MHWs. After inclusion, participants are randomized to either blended care or usual care in routine general practice. Blended care consists of the 'Act and Feel' treatment: an eight-week web-based program based on behavioral activation with integrated monitoring of depressive symptomatology and automatized feedback. GPs or their MHWs coach the participants through regular face-to-face or telephonic consultations with at least three sessions. Depressive symptomatology, health status, functional impairment, treatment satisfaction, daily activities and resource use are assessed during a follow-up period of 12 months. During treatment, real-time fluctuations in emotions and affect, and daily events will be rated using ecological momentary assessment. The primary outcome is the reduction of depressive symptoms from baseline to three months follow-up. We will conduct intention-to-treat analyses and supplementary per-protocol analyses. DISCUSSION:This trial will show whether blended care might be an appropriate treatment strategy for patients with depressive symptoms and depressive disorder in general practice. TRIAL REGISTRATION:Netherlands Trial Register: NTR4757; 25 August 2014. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4757 . (Archived by WebCite® at http://www.webcitation.org/6mnXNMGef ).

背景与目标： 背景：大多数抑郁症患者均由全科医生（GPs）进行治疗，并开了抗抑郁药。患者偏爱心理治疗，但由于时间紧迫且可及性有限，因此未得到充分利用。提供心理治疗的一种有前途的方法是混合护理，即指导性在线治疗。但是，由患者自己的全科医生或全科医生精神保健工作者（MHW）支持的在线初级心理保健形式的混合保健在常规初级保健中的成本效益尚不清楚。我们的目标是证明在一般情况下，患有抑郁症症状或抑郁症患者的混合护理与常规护理相比不劣于常规护理。此外，我们将探讨情绪，情感和治疗过程中个体内部事件的全天实时过程。
方法：这是一项务实的非自卑性试验，包括GP和MHW的协作招募的300例抑郁症患者。纳入后，将参与者随机分为常规常规护理中的混合护理或常规护理。混合护理由“行为与感觉”治疗组成：这是一个基于行为激活的八周基于网络的计划，具有对抑郁症状和自动反馈的集成监控。 GP或他们的MHW通过至少三节的定期面对面或电话咨询来指导参与者。在12个月的随访期内评估抑郁症状，健康状况，功能障碍，治疗满意度，日常活动和资源使用情况。在治疗过程中，情绪和情感的实时波动以及日常事件将使用生态瞬时评估进行评估。主要结果是抑郁症状从基线减少到三个月的随访。我们将进行意向性治疗分析和补充的按方案分析。
讨论：该试验将表明在一般实践中，混合护理是否可能是抑郁症和抑郁症患者的合适治疗策略。
试用注册：荷兰试用注册：NTR4757； 2014年8月25日。http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4757。 （由WebCite®存档，网址为http://www.webcitation.org/6mnXNMGef）。

BACKGROUND & AIMS: :The present investigation describes the effect on the isolated rat ileum of methanolic extracts derived from Conyza filaginoides (D. C.) Hieron (Asteraceae), Croton fragilis HBK. (Euphorbiaceae), Dodonaea viscosa Jacq. (Sapindaceae), Gymnosperma glutinosum (Spreng) Less. (Asteraceae), Parthenium tomentosum DC. var. stramonium (Greene) Rollins (Asteraceae), Potentilla thurberi A. Gray (Rosaceae), Pterogonum atrorubens (Englem.) H. Gross (Polygonaceae), Zornia venosa Mohlenbr. (Fabaceae) and Datura lanosa Barclay ex Bye (Solanaceae). In all the cases the extracts inhibited, in a concentration-dependent manner, the spontaneous contraction of the intestinal smooth muscle. The most active extract was that of D. viscosa. These findings tend to support the ethnomedical use of the selected species as spasmolytic agents in Mexican traditional medicine. Additionally, the potential antimicrobial activity of the extracts against pathogenic enterobacteria was investigated. Seven of the nine plants evaluated displayed antibacterial effects.

背景与目标： ：本研究描述了从Conyza filaginoides（D. C.）Hieron（Asteraceae），脆弱的巴豆HBK提取的甲醇提取物对离体大鼠回肠的作用。 （大戟科），Dodonaea viscosa Jacq。 （无患子科），裸子植物（Gymnosperma glutinosum）（Spreng）少。 （菊科），Parthenium tomentosum DC。变种amo（Greene）罗林斯（菊科），委陵菜A. Gray（蔷薇科），翼龙（Pterogonum atrorubens）（英）H. Gross（Po科），百日草（Zornia venosa）Mohlenbr （Fabaceae）和Datura lanosa Barclay ex Bye（Solanaceae）。在所有情况下，提取物均以浓度依赖性方式抑制肠平滑肌的自发收缩。活性最高的提取物是粘枝梭状芽胞杆菌。这些发现倾向于支持在种族学上将所选物种用作墨西哥传统医学中的解痉剂。此外，研究了提取物对病原性肠杆菌的潜在抗菌活性。被评估的九种植物中有七种显示出抗菌作用。