First, heart failure
Heart failure refers to a series of symptoms and signs such as disorder of hemodynamics and neurohumoral activities, fatigue dyspnea, decreased exercise endurance, venous congestion and limb edema. This is because when the cardiovascular disease develops to a certain extent, the myocardial systolic and/or diastolic dysfunction decreases, resulting in a decrease in cardiac output. Now it's called heart failure.
clinical picture
The clinical features of congestive heart failure are insufficient cardiac output, reduced tissue blood perfusion and congestion of pulmonary circulation or systemic venous system.
Symptoms of acute left heart failure: 1. Dyspnea: fatigue dyspnea, high pillow position, paroxysmal dyspnea at night, cardiogenic asthma.
2. Cough, expectoration and hemoptysis
3. Symptoms of low cardiac output include fatigue, dizziness, palpitation, renal insufficiency and oliguria.
Signs: heart enlargement, heart murmur, diastolic galloping rhythm, alternating pulse, etc.
Symptoms of right heart failure: nausea, vomiting, abdominal distension and other gastrointestinal congestion.
Signs: The carotid artery is full and dilated, the liver is large, and there is gravitational edema.
Complete heart failure
Differential diagnosis: cardiogenic asthma and bronchial asthma
Emergency treatment: posture, sitting position, drooping of both lower limbs, localized congestion of cuff of sphygmomanometer of both upper limbs, prevention of cardiovascular reflux and oxygen inhalation.
Drugs: diuretic furosemide 20 mg+5% g.s 20 ml iu slow push.
Furosemide 20 mg+5% g.s 100 ml iu slowly.
Oral diuretic
Angiotensin converting enzyme inhibitor
digoxin
Beta receptor blocker
Aldosterone antagonist
Short for ARBITRAGEUR
Vasodilator nerve
Positive inotropic drugs
cardiogenic shock
It is an extreme manifestation of heart pump failure. In addition to the signs of heart failure, the decrease of blood pressure and serious insufficiency of blood supply to important organs and tissues lead to systemic microcirculation dysfunction and structural damage to important organs, which is called pathophysiological syndrome. Cardiogenic shock is often an important manifestation of acute myocardial infarction, or it may be a serious arrhythmia, which is the terminal manifestation of various heart diseases, so its severity and mortality are much higher than that of general heart failure.
Clinical manifestations: 1. Abnormal consciousness; 2. Fast pulse, exceeding 100 beats/min, thin or untouchable; 3. The limbs are wet and cold; 4. Systolic blood pressure is 30%; 6. Pulse pressure difference
Mild, moderate and severe shock, very severe shock
Treatment, general treatment
Absolute bed rest, oxygen inhalation and establishment of venous access.
Drugs: maintain blood pressure and transfer under supervision.
hypertensive crisis
Hypertension crisis includes hypertension emergency and hypertension sub-emergency.
Hypertensive emergencies are characterized by a severe increase in blood pressure (BP >: 180/ 120mmHg) accompanied by progressive target organ dysfunction. Hypertension emergency requires immediate antihypertensive treatment to prevent further damage to target organs. Hypertensive emergencies include hypertensive encephalopathy, intracranial hemorrhage, acute myocardial infarction, acute left heart failure with pulmonary edema, unstable angina pectoris and aortic dissection aneurysm.
Hypertension emergency refers to the serious increase of hypertension without target organ damage.
Management of hypertensive crisis;
Hypertension emergency: such patients should enter the intensive care unit, continuously monitor their blood pressure and apply appropriate antihypertensive drugs as soon as possible.
The goal of blood pressure reduction is intravenous infusion of antihypertensive drugs, and the average arterial blood pressure drops rapidly at 1 hour, but not more than 25%, and the blood pressure drops to about160/100-10mmhg in the next 2-6 hours. Excessive lowering of blood pressure can cause kidney, brain or coronary artery ischemia. If this blood pressure level can be tolerated and the clinical situation is stable, gradually reduce the blood pressure in the next 24 ~ 48 hours to make it reach the normal level. The following situations should be excluded: acute ischemic stroke-there is no clear clinical trial evidence to require immediate antihypertensive treatment; Aortic dissection should quickly reduce SBP to about 100mmHg (if tolerable).
Some hypertensive emergency patients may benefit from oral short-acting antihypertensive drugs, such as captopril, labetalol and clonine.
Commonly used antihypertensive drugs in emergency include sodium nitroprusside (intravenous injection), nicardipine, urapidil, diazoxide, hydrabendazine, labetalol, esmolol, phentolamine and so on.
Hypertension emergency
hypertensive encephalopathy
An acute or subacute consequence of severe hypertension, characterized by headache, dullness, insanity or coma, with or without convulsions.
Hypertensive encephalopathy is a typical hypertensive crisis and a potential reversible encephalopathy, brain edema.
Rapidly changing neurological abnormalities, including temporary cortical blindness, hemiparalysis and unilateral sensory loss.
Blood pressure is very high, usually diastolic pressure >; 140mmHg, grade 3 or 4 retinopathy often occurs, and cerebrospinal fluid pressure often increases.
Hypertensive crisis: Due to tension, fatigue, cold, melanoma attack, sudden cessation of taking antihypertensive drugs and other incentives, blood pressure rises sharply, arterioles have a strong spasm, which affects the blood supply of important organs and produces critical symptoms. Hypertension can occur in both early and late stages, and blood vessels with arteriosclerosis changes are particularly prone to spasm. During the crisis, symptoms such as palpitation, dry mouth, excessive sweating, pale or red skin, irritability, tremor, and ischemic symptoms of affected organs caused by spastic arteries (vertebrobasilar artery, internal carotid artery, retinal artery, coronary artery, etc.) occur. ) happens.
Please refer to the relevant chapters of neurology for acute cerebrovascular disease and lacunar state.
Gradually reduce blood pressure to near normal range within 4-6 hours.
Sodium nitroprusside 0.25- 10ug/kg min IV (the maximum dose is only10min), immediately1-2min.
Nicardipine hydrochloride 5- 15 mg/h intravenous injection of 5- 10 min 1-4h.
Nitroglycerin 5-100 ug/min iv+2-5min 3-5min.
Esmolol hydrochloride 250-500 ug/kg min 1 min, and then 50-100/kg min for 4 minutes.
This order can be repeated.
Phentolamine 5-15mg intravenous injection1-2min 3-10min.
Severe arrhythmia
Frequent premature beats are characterized by rhythmic paroxysmal supraventricular tachycardia and paroxysmal ventricular tachycardia.
Flutter height variable atrioventricular block in patients with torsade de pointes and atrial fibrillation.
Q-T interval prolongation syndrome
In principle, after using sedatives, such as diazepam 10mg vo or iv, transfer to hospital for treatment.
coronary heart disease
Coronary atherosclerotic heart disease refers to the heart disease that coronary atherosclerosis and/or dynamic pathological changes lead to stenosis or obstruction of vascular lumen, which leads to imbalance between oxygen supply and oxygen demand in myocardium and leads to myocardial ischemia and hypoxia. It is also called ischemic heart disease for short.
Symptoms and signs of angina pectoris
The discomfort of angina pectoris is often not pain but irritability. There is a feeling of squeezing behind the sternum, radiating to the left shoulder and the inside of the left arm, which may involve fingers. It can also radiate to the left submandibular region, showing toothache and gum pain, and some of them go to the stomatology department for medical treatment, and can also radiate to the back throat and the inside of the right arm. It is often not angina pectoris that can accurately point to the apex of the heart and describe pain like sharp short-term needle stimulation.
There are no signs when angina pectoris attacks, but there are often phenomena such as accelerated heart rate, elevated blood pressure and distant heart sounds. Even the abnormality of the second heart sound and the appearance of the fourth heart sound are uncommon and difficult to determine.
Typical angina pectoris is induced by physical activity or emotional excitement, which often lasts for several minutes and then relieves after rest.
Nocturnal angina pectoris should be paid more attention to, which is the equivalent symptom of paroxysmal dyspnea at night. Recumbent angina pectoris often increases blood pressure and heart rate. Generally speaking, the characteristics of patients with angina pectoris are fixed. Once it changes, it is called unstable angina pectoris, which should be highly valued by medical staff and relatives.
The basis of diagnosis is the chief complaint of chest discomfort, which appears after exertion and relieves after rest. The diagnosis can be made by sublingual nitroglycerin test, which is characterized by relieving discomfort within 1.5 minutes to 3 minutes.
Careful collection of medical history and differential diagnosis often do not lead to misdiagnosis. Such as gastrointestinal diseases, dyspnea and painless ischemia.
Treatment is mainly to prevent or alleviate ischemia and minimize symptoms.
There are three commonly used drugs, which can effectively relieve symptoms when used alone or in combination, namely nitrates, B receptor blockers and calcium antagonists. Nitroglycerin 0.3-0.6 mg is taken sublingually, which usually relieves in 1.5-3 minutes. /kloc-Don't use 3 diapers for 0/5 minutes. Is considered invalid. Isosorbide mononitrate is the active metabolite of dinitrate. Usage: Take 20mg orally twice a day. Isosorbide nitrate 10 mg three times a day. B-blockers block the sympathetic nerve stimulation of the heart, reduce the heart rate and systolic blood pressure, reduce myocardial oxygen consumption and improve exercise tolerance. Calcium blockers and vasodilators can be used to treat angina pectoris with hypertension and relieve coronary artery spasm. Secondly, the use of aspirin depends on the situation.
After nearly five years' research, it is found that the proportion of China Han people who take nitroglycerin is as high as 25%. This suggests that clinicians should consider the genetic factors of patients in the process of using nitroglycerin. Nitroglycerin plays an anti-angina effect mainly by reducing myocardial oxygen consumption. It is found that "mitochondrial acetaldehyde dehydrogenase 2" in human body is the key to the formation of nitric oxide, an effective metabolite of nitroglycerin. However, if the patient's gene carries the gene mutation of "Lys-504", the biotransformation process of nitroglycerin in the body will be blocked, and it is difficult for the drug to play its role effectively. Dr Jin Wei also warned patients with coronary heart disease and angina pectoris not to regard nitroglycerin tablets as a "life-saving straw". The correct use method is limited to 3 tablets for 3 times, that is, take 1 tablet every 3 minutes when it is ineffective. If the pain is still not relieved after taking 3 times 15 minutes, you should go to the hospital as soon as possible, and don't delay the treatment opportunity.
When taking nitroglycerin, you should sit still or squat down against the wall. This is because nitroglycerin can dilate systemic veins and increase systemic venous capacity. When the patient stands upright, due to gravity, a large amount of blood accumulates in the lower limbs, resulting in insufficient relative blood volume, decreased blood pressure, dizziness and even fainting. Although postural hypotension will not occur when medicine is taken in supine position, the cardiac load will be aggravated and the drug effect will be weakened due to the increase of cardiac blood volume.
Acute coronary syndrome
As an emergency of coronary heart disease, ACS covers a series of clinical pathophysiological states from unstable angina pectoris (UA), acute non-ST-segment elevation myocardial infarction (NSTEMI) to ST-segment elevation acute myocardial infarction (STEMI), and is one of the most common causes of disability and even death of coronary heart disease.
Vulnerable plaque-inflammatory reaction-instability of plaque fibrous cap and plaque rupture-occlusive thrombosis
Chest pain or chest discomfort is the main manifestation.
Regardless of ECG and ST segment elevation, 80-90% patients with new localized ST segment elevation are diagnostic indicators of acute myocardial infarction.
Biochemical marker
Radionuclide imaging
Two-dimensional echocardiography
Intravascular ultrasound
Danger stratification
Chest discomfort or chest pain —————→ Non-cardiogenic factors
Early ECG evaluation ↓
Acute coronary syndrome
↓————————————————↓
ST segment elevation without ST segment elevation
↓ ↓ ↓
Unstable angina pectoris myocardial infarction myocardial infarction
↓ ↓ ↓
Unstable angina pectoris non-Q wave myocardial infarction Q wave myocardial infarction
treat cordially
Severe arrhythmia
Frequent premature beats are characterized by rhythmic paroxysmal supraventricular tachycardia and paroxysmal ventricular tachycardia.
Atrial flutter and highly variable atrioventricular block in patients with torsade de pointes and atrial fibrillation
Q-T interval prolongation syndrome
In principle, after using sedatives, such as diazepam 10mg vo or iv, transfer to hospital for treatment.
Second, hepatitis B health education
Hepatitis B is an intestinal infection caused by hepatitis B virus (HBV).
(A) the content of health education
1, hepatitis B epidemiology
Source of infection: The source of infection of hepatitis B includes acute and chronic patients and virus carriers.
Transmission route: Injection is the main transmission route of hepatitis B, including blood transfusion and blood products, group inoculation, drug injection and acupuncture. Non-injection routes include close contact in life, mother-to-child transmission, surgery and blood contact.
2. Self-care of patients with hepatitis B
Rest: Patients with acute hepatitis should stay in bed in the early stage until their symptoms and liver function are obviously improved, and then start to get up and do appropriate physical activities.
Diet: Eat more protein properly, avoid a diet with too high calories, and the food should be digestible, light and diversified.
Daily behavior: don't smoke, don't drink, and control your sex life. Married women should not be pregnant during their illness.
Psychological adjustment: avoid excessive tension and fatigue, and feel comfortable.
Medical behavior: follow the doctor's advice and go to the hospital for reexamination regularly.
(b) Health education strategy and implementation
1, health education for target population
(1) Health education for patients: make them understand the importance of drug therapy and non-drug therapy; Early diagnosis and early treatment; Provide good community health care services to promote functional and psychological rehabilitation; Strengthen follow-up and management.
(2) Health education for high-risk groups: For the families of hepatitis B patients and virus carriers, women of childbearing age should strengthen relevant knowledge propaganda, improve their self-care ability, and make them take protective measures.
(3) National health education: popularize relevant knowledge through publicity columns, pamphlets, symposiums, consultation and audio-visual education, and consciously adopt healthy behaviors and lifestyles. Strengthen health education in primary and secondary schools and kindergartens, so that they can establish correct health concepts, develop good health habits, take the initiative to vaccinate against hepatitis B, and be good family health educators and supervisors.
2, health prescription in the community health service should take advantage of the opportunity of diagnosis and treatment, health examination, issued a targeted health prescription.
Third, the health education of diabetes
(A) the risk behavior of diabetes
1. Obese people who don't control their weight are more likely to develop diabetes than ordinary people.
2. Lack of regular moderate-intensity aerobic endurance exercise can accelerate the degradation of blood sugar, thus reducing blood sugar concentration and preventing obesity and losing weight.
3. Bad medical behavior is mainly manifested in not adhering to all kinds of non-drug treatment and medication in strict accordance with the doctor's advice.
(B) Health education countermeasures
1, filtering
(1) Patients diagnosed with diabetes.
(2) The high-risk population generally has one of the following risk factors, all of which can be included in the high-risk population and should be the focus of screening: ① Family history of diabetes; ② Obese people (BMI ≥ 25); ③ Past history of abnormal glucose metabolism during pregnancy and macrosomia (baby's birth weight ≥ 4 kg); ④ Hypertension, hyperlipidemia or premature coronary heart disease; ⑤ The diet structure changes greatly, and there are people with overnutrition; ⑥ Those with little physical activity or sudden decrease in exercise.
2. Diabetes health education
(1) Health education content
1) Dietary principles for diabetic patients
① Cultivate good eating habits: quantify each meal regularly; The daily available total calories are allocated according to the principle that carbohydrates account for 50%-60%, protein accounts for 65,438+05% and fat accounts for 25%.
② Balanced nutrition: The recipe for each meal should include four basic foods (grains, fruits and vegetables, meat and milk, and calcium) as far as possible. Eat more foods rich in fiber, with breakfast accounting for 65,438+0/5, lunch and dinner accounting for 2/5 respectively.
3 avoid eating sweets, reduce greasy food and avoid eating animal fat; Minimize eating out.
2) Exercise and reasonable diet are the two foundations for controlling diabetes. Moderate exercise can reduce blood sugar and weight, promote blood circulation, enhance resistance and reduce complications. Exercise must be regular and persistent, pay attention to proper rest, and wear good clothes, shoes and socks. If you exercise regularly, you must tell the doctor to make appropriate adjustments in medicine or diet. Exercise intensity should be controlled at 60%-70% of the maximum safe exercise heart rate, and the maximum safe exercise heart rate =220- age.
3) Personal hygiene is easily infected by high blood sugar, and the most common is skin infection; Therefore, we must pay attention to personal hygiene, especially foot hygiene. Diabetic patients are prone to periodontal disease. In order to keep teeth healthy, we should do the following: gargle or brush your teeth twice a day after meals, and the method should be correct; Check your teeth regularly. If you have tooth decay or periodontal disease, you should treat it in time.
4) unwell colds, colds, bacterial infections, injuries, and depression can all cause blood sugar to rise and fall. It must be noted that the dosage cannot be reduced at will. When you lose appetite, you should be careful in your diet, stick to eating and eat digestible food. If you vomit, you must see a doctor.
5) Female diabetic patients are prone to complications such as toxemia, infection and dystocia during pregnancy or childbirth, which has a great impact on mother and baby. Therefore, pregnancy, childbirth and postpartum must be properly taken care of by medical staff. Once a female patient is pregnant, she should be examined as soon as possible. It is best to get pregnant when diabetes is under control and the doctor allows it. When patients don't want to give birth again, they should be sterilized as soon as possible.
6) The medication instruction for patients must strictly follow the doctor's advice, and the dosage cannot be adjusted at will. Patients who need insulin injections should learn to inject themselves or by relatives. When suffering from other diseases and pregnancy, it is necessary to increase the injection dose under the guidance of a doctor. Patients injected with insulin are more prone to hypoglycemia, so they should eat more starchy foods and carry a small amount of sugar with them for emergencies.
7) First aid card Make a small first aid card for the patient to facilitate first aid. The first aid card should include: name, age, telephone number, address and weight. Doctors recommend daily food intake, medication (name and dosage) and other diseases. Emergency contact information (name, telephone number, address).
(2) Health education for the target population
1) Education for diabetic patients and their families: In addition to professional doctors, patients should become self-care and self-care doctors, and their families should be supervised. Community doctors should strengthen follow-up and management.
2) Health education for high-risk groups: correct bad behavior habits through health education and gradually develop a healthy lifestyle; Take effective supervision and control to reduce the risk of avoidable diseases.
3) Health education for the general population: it is mainly to publicize the dangers, severity and prevention of diabetes, highlight the risk factors of diabetes, and emphasize early detection, early treatment and how to prevent diabetes. Effective measures should be taken and followed up to prevent people with impaired glucose tolerance from turning into diabetes.
4) Education of community medical personnel: Doctors are the key to mass education and patient education, and provide early diagnosis and treatment for diabetic patients, and provide them with reasonable treatment and answer difficult questions. Nurses can specifically guide patients how to monitor themselves, correctly monitor and record blood sugar and urine sugar, and use drugs correctly. Health prescription is an effective way of health education for patients, which should be vigorously promoted.
5) Health management In the community health service center, it is necessary to establish and improve the health files of diabetics, high-risk groups and the whole community, and carry out health management by classification.
Fourthly, health education of tumor diseases.
(A) to eliminate or avoid pathogenic factors
1, for some industries that produce carcinogens, it is necessary to improve the technological process or carry out harmless treatment to strengthen it.
Industrial monitoring, regular physical examination of workers, strengthen safety and health publicity and education.
2. Prevent and eliminate environmental pollution: including air, soil, crops, water, food, occupation, etc.
To eliminate waste gas, waste water and waste residue, we should conscientiously implement the policy of "overall planning, rational layout, comprehensive utilization, turning harm into benefit, relying on the masses, making joint efforts, protecting the environment and benefiting the people".
3. block the synthesis of carcinogens: vitamin c can block the synthesis of nitrosamines with strong carcinogenicity.
Carotene has a good effect on preventing cancer of digestive tract and respiratory tract.
(b) the role of preventing certain environmental carcinogens
1, excessive ultraviolet radiation will cause cancer, so we should pay attention to avoid excessive direct sunlight on the skin.
2. Mold pollution of grain. Liver cancer and esophageal cancer in China are all related to aflatoxin. Therefore, the most fundamental measure is to prevent grain mildew.
3. Some foods are improperly processed, such as poor smoking and excessive frying, which will produce carcinogens; Some food additives (colorants, preservatives, foaming agents) can cause animal tumors, so those proved to be carcinogenic are inedible and should be banned. At the same time, it is also of positive significance to prevent the pollution of drinking water, and to drink drinking water (such as bleaching powder) after disinfection.
(3) Protecting and improving the environment
1. Do a good job in the patriotic health campaign: do a good job in the work of "two pipes" (pipe manure) and "five reforms" (changing wells to toilets, barns to stoves to the environment). It also plays a great role in preventing tumors.
2, do a good job in the comprehensive utilization and proper disposal of industrial "three wastes".
(D) enhance self-care ability
Various carcinogenic factors in the external environment can only cause tumors through the action of the body, so personal hygiene, physical strength, mental state and immune function are closely related to the occurrence and development of tumors.
1, pay attention to hygiene, enhance physical fitness and improve the body's disease resistance.
(1) Restrain alcohol and tobacco: Tobacco tar can cause lung cancer, and some alcoholic beverages contain carcinogenic nitrosamines, which can cause esophageal cancer and gastric cancer.
(2) Oral hygiene: inadequate oral hygiene, dental caries, residual roots, improper dentures, etc. It has inflammatory and mechanical stimulation effects on oral mucosa and is easy to cause tumors.
(3) Persisting in physical exercise and enhancing the body's disease resistance are of positive significance for preventing tumors.
(4) Pay attention to the hygiene of sexual organs. Early marriage, prolificacy, not breastfeeding and phimosis are closely related to the incidence of cervical cancer, breast cancer and penile cancer.
2. Early detection, early diagnosis and early treatment. Early detection and timely treatment of tumor is an important link to reduce tumor mortality. It is necessary to combine publicity with general survey to find early cancer patients in the population in time. According to the characteristics of tumors in China, ten early warning signals are put forward: ① There are palpable or unnecessary masses in breast, skin, tongue or other parts of the body. ② The wart (tumor) or nevus changes obviously, such as color deepening, rapid increase, itching, depilation, exudation, ulceration and bleeding. ③ Persistent abnormal digestion. ④ Choking sensation, pain, discomfort behind sternum, foreign body in esophagus or upper pain when swallowing food. ⑤ Tinnitus, hearing loss, nasal congestion and nosebleeds, bloody nasopharyngeal secretions, headaches and neck masses caused by aspiration and cough. ⑥ Abnormal bleeding during menstruation, irregular vaginal bleeding outside menstruation or after menopause, and contact bleeding. ⑦ Persistent hoarseness, dry cough and blood in sputum. (8) Unexplained bloody stool or mucus, alternating diarrhea and constipation, and unexplained hematuria. Pet-name ruby incurable wound ulcer. Attending long-term unexplained weight loss.
Through health education, the masses found one of the above signals and immediately sought medical treatment.
Attachment: diet cancer prevention method 14
The World Cancer Research Foundation (WCRF) has devoted itself to the basic, clinical and anti-cancer research of cancer for many years, summarized the research results in the field of cancer all over the world, and put forward 14 cancer prevention suggestions with extensive scientific basis from the aspects of diet and health.
1, arrange your diet reasonably. Plant foods, such as vegetables, fruits, cereals and beans, should account for more than 2/3 in the daily diet.
2. Control your weight to avoid being too light or too heavy. Weight gain in adulthood should not exceed 5 kg. Body mass index less than 20, underweight, body mass index 20-30, slightly overweight, body mass index greater than 30, seriously overweight.
3. Insist on physical exercise. If there is little or only light activity at work, there should be a brisk walk around 1 hour/day. Sweating and strenuous exercise at least 1 hour/week.
4. Eat more fruits and vegetables. You should eat 400-800 grams of fruits and vegetables every day. Green leafy vegetables, carrots, potatoes and citrus fruits have the strongest anti-cancer effects. Eat more than 5 kinds of fruits and vegetables every day and stick to it all the year round, so as to have the effect of continuous cancer prevention.
5. Eat 600-800g of various cereals, beans and plant roots every day. The less processed food, the better. Eat less refined sugar.
6. Do not advocate drinking. Even if you want to drink, men should drink more than two cups a day, and women should not drink more than one cup a day.
7. Eating red meat (i.e. cattle, sheep and pork) should not exceed 90g every day. It's better to eat fish and poultry than red meat. 8. Eat less high-fat food, especially animal fat. Select the appropriate vegetable oil and control the dosage.
9. Eat less salt. Eat less salted food, and the daily consumption of salt should be below 6 grams.
10, don't eat food stored at room temperature for too long, which may be contaminated by mycotoxin.
1 1. Preserve perishable food by cold storage or other suitable methods.
12. It is safe that the level of additives, pollutants and residues in food is lower than the national limit, but improper use may affect health.
13, do not eat burnt food, barbecue fish or bacon directly on the fire, and occasionally eat bacon.
14. For people who basically follow the above suggestions, it is generally unnecessary to take nutritional supplements, which may not be helpful to reduce the risk of cancer.