急性混合细胞白血病实验室特征与临床相关性研究

目的探讨急性混合细胞白血病(HAL)的实验室特征及其与诊断分型和临床治疗的相关性.方法对27例HAL住院患者的临床及实验资料进行回顾性分析.结果HAL患者临床上易合并肝、脾、淋巴结肿大及各种浸润症状.外周白细胞数高,易合并重度贫血.免疫表型中双系列较双表型多见.诱导缓解治疗缓解率为25.0%.以兼顾急性淋巴细胞白血病(ALL)和急性非淋巴细胞白血病(AML)方案及针对ALL的方案缓解率高.形态学表现为髓系白血病,合并重度贫血者以及有细胞遗传学异常者化疗缓解率低;而免疫表型、外周血白细胞数、血小板是否正常、是否合并浸润症状对化疗有效率无影响.化疗后易合并肺部细菌和霉菌混合感染,预后差.结论HAL病情凶险,临床有一定特点,但诊断应进行以免疫表型为主的MICM分型.形态学表现为髓系白血病,合并重度贫血者以及有细胞遗传学异常者诱导缓解治疗效果不佳.治疗应首选兼顾ALL和AML的方案或针对ALL的方案.     

VDCP方案诱导治疗成人急性淋巴细胞白血病的临床观察及其评价

在急性淋巴细胞白血病(ALL)初次诱导化疗中,采用较强烈化疗方案可提高缓解率已得到国内外公认。全国第二届白血病治疗会议北方组推荐VDCP方案为诱导治疗ALL首选方案。我院于1989年12月至1991年4月收治的14例ALL,采用了上述方案做为诱导缓解方案,完全缓解后再按会议制定的方案进行6个疗程的巩固强化治疗,结果报导如下。材料与方法一、1989年12月至1991年4月住院的ALL共计17例,未完成一个疗程者3例,可供统计分析的14例。其中初治病例12例,复治病例2例,男     

伊达比星在初治急性淋巴细胞白血病高危组患儿联合化疗中的使用和疗效观察

目的：观察长春新碱（VCR）和左旋门冬酰胺酶（L-asp）联合伊达比星（IDA）的VILD方案在治疗初治急性淋巴细胞白血病高危组患儿（HR-ALL）的效果。方法：回顾分析2005年2月-2013年4月在本院接受化疗的初治急性淋巴细胞白血病高危组患儿,33例使用VILD方案强化化疗,15例使用长春新碱和左旋门冬酰胺酶联合表柔比星（Epi）的VDLD方案强化化疗,比较两组的无事件生存期（EFS）和5年无事件生存率。结果：VILD方案治疗组和VDLD方案治疗组的EFS分别为（80.98±5.36）个月和（52.06±9.10）个月,5年无事件生存率为（83.3±7.0）%和（52.5±13.1）%（P=0.029）。结论：VILD方案治疗急性淋巴细胞白血病高危组患儿疗效优于VDLD方案。     

小儿急性淋巴细胞白血病长期存活61例分析

目的 对61例存活5年以上的小儿急性淋巴细胞白血病(ALL)患儿进行分析,探讨影响其长期存活的因素.方法 对这61例ALL患儿通过骨髓形态分型、免疫分型、染色体核型分析(MIC)、临床分型和微量残留病(MRD)检测,以及通过不同时期3组化疗方案及4种髓外白血病防治方法比较,了解其对疗效及预后的影响.结果 61例5年以上存活ALL患儿与176例5年以下存活患儿比较,二者染色体差异有显著意义(P=0.007),临床分型、骨髓形态分型及免疫分型比较差异无显著意义(P＞0.05).61例5年以上存活的ALL患儿中,不同时期3组治疗方案无病存活率比较,VCP(长春新碱、环磷酰胺、强的松)组与VDLP(长春新碱、柔红霉素、L-门冬酰胺酶、强的松)组间差异有显著意义(P=0.010).采用60Co头颅照射为主的治疗方案,3例发生中枢神经系统白血病(CNSL),采用大剂量氨甲碟呤(HDMTX)防治组,无CNSL发生,5例发生睾丸白血病(TL)的患儿均系60Co头颅照射组,HDMTX组无TL发生(P=0.000).61例5年以上存活ALL患儿中,25例已存活10年以上,现仍然存活,另36例存活5至10年者中,有5例死于骨髓复发,这两者骨髓复发的差异无显著意义(χ2=3.78,P=0.072).纳入本研究的所有ALL患儿中,26例MRD检测呈阳性,其中14例化疗停止时已转为阴性,13例仍长期存活;12例停止化疗后MRD呈弱阳性者,其中7例长期存活.结论 系统规范化疗,是ALL患儿长期存活的关键,骨髓复发、髓外白血病是影响存活的重要因素.MRD转阴,可以作为患儿停止化疗的重要参考指标.     

小儿“非高危型”急性淋巴细胞白血病降低强度的规范化治疗

目的 了解“非高危型”急性淋巴细胞性白血病(AL)患儿降低治疗强度的可行性.方法 选取2007年1月至2012年2月期间应用改良Dutch ALLⅥ方案治疗35例“非高危型”ALL患儿为治疗组,选取同期应用改良IC-2002-AL方案治疗的“标危组”ALL患儿112例为对照组,比较两组患儿的诱导缓解率、3年无事件生存率、感染病死率、复发率指标和病人的住院治疗费用.结果 35例治疗组患儿诱导缓解率100％;3年无事件生存率85.71％;感染病死率2.86％;复发率11.43％;无失访病例;总治疗失败率14.29％;每位患儿平均住院次数8.60±2.40次;平均每次住院费用4 486.78±2 358.42元.112例对照组患儿诱导缓解率100％,3年无事件生存率60.71％;感染病死率7.14％;复发率7.14％;失访率25.00％;总治疗失败率39.29％;每位患儿平均住院次数9.80±3.90次;平均每次住院费用6 137.93±3 597.23元.两组患儿复发率差异无统计学差异(x2=0.65,P ＞0.05);3年无事件生存率,感染病死率和总治疗失败率差异均有统计学意义(x2值分别为7.50、4.22、5.78,均P＜0.05);两组患儿平均每次治疗费用差异无统计学意义(t=1.83,P＞0.05);平均住院次数差异有统计学意义(t=2.09,P＜0.05).结论 改良Dutch ALLⅥ方案治疗“非高危型”急性淋巴细胞白血病初步结果安全可行,疗效满意,费用低廉.     

吡柔比星为主联合化疗用于急性白血病治疗疗效观察

目的：探讨以吡柔比星为主联合化疗在治疗急性白血病过程中的临床疗效.方法：选取在我院接诊的100例初治急性白血病患者为疗效观察对象,治疗组,50例初治急性白血病患者,其中30例急性非淋巴细胞白血病（ANLL）患者接受予TA 方案化疗,即吡柔比星联合阿糖胞苷,20例急性淋巴细胞白血病（ALL）接受VTLP方案化疗,即吡柔比星联合长春新碱、左旋门冬酰胺酶、强的松;对照组,50例初治急性白血病患者,其中28例ANLL患者接受DA 方案化疗,22例ALL患者接受VDLP方案化疗,两种治疗方案均将柔红霉素代替吡柔比星.对两组患者进行3个疗程的治疗,比较两组患者的临床疗效.结果：治疗组完全缓解率高于对照组,组间比较差异具有统计学意义（P〈0.05）.结论：在急性白血病临床治疗过程中,以吡柔比星为主联合化疗是急性白血病的有效治疗方案.     

小儿急性白血病的诊断治疗进展

急性白血病是严重影响儿童生命的恶性肿瘤性疾病 ,近 2 0年来 ,儿童急性白血病的治疗取得了飞速的发展 ,现报告如下。1　小儿急性白血病治疗观念进展治疗目标是彻底治愈 ,从而达到长期无病生存 ,并越来越注重患儿的生活质量。系统、长期、多药联合的化疗治疗方案已得到公认。儿童急性白血病 ,特别是急性淋巴细胞性白血病 (ＡＬＬ)已被公认是恶性肿瘤中治愈率最高的疾病之一 ,单纯化疗可使儿童标危型ＡＬＬ 5年无病生存率达 75 %以上 ,高危型ＡＬＬ和急性非淋巴细胞性白血病 (ＡＮＬＬ) 5年无病生存率达 4 0 %以上。早期的连续强烈化疗是儿童…     

43例1~7岁小儿ALL临床疗效分析

目的:探讨小儿急性淋巴细胞白血病(ALL)的治疗效果。方法:应用全国小儿ALL诊疗建议(第二次修订草案)治疗43例1~7岁小儿ALL。结果:43例患儿总CR率97.7%,无事故生存(EFS)率:1年为(97.67±2.30)%,2~4年为(95.29±3.25)%,5年以上为(73.53±8.47)%。结论:应用全国小儿ALL诊疗建议(第二次修订草案)治疗1~7岁小儿ALL效果比较好,毒副作用较轻,患儿能够耐受,1~7岁ALL患儿有更多的治愈机会,此方案比较适合我国国情。     

FAT方案治疗复发、难治性急性白血病疗效观察

目的观察FAT方案治疗复发难治性急性白血病的疗效.方法氟达拉宾 (Fludarabine)25 mg/(m2·d)加入生理盐水250 ml中静脉滴注,于化疗第1～5天用;吡柔比星(THP)20 mg/(m2·d)加入5%葡萄糖500 ml中静脉滴注,于化疗第1～2天用;阿糖胞苷(Ara-C)150 mg/(m2·d)于化疗第1～7天静脉滴注.FAT方案总疗程7 d.结果 25例复发难治性急性白血病的患者中,完全缓解(CR)15例,CR率为60%;部分缓解(PR)6例,PR率为24%;未缓解(NR)4例,NR率为16%;总有效率为84%.结论 FAT方案为治疗复发、难治性急性白血病的有效方案.     

急性淋巴细胞性白血病骨髓单个核细胞CD11a的表达及临床意义

目的探讨淋巴细胞功能相关抗原-1(LFA-1)的α链CD11 a在急性淋巴细胞性白血病(ALL)的表达情况及其临床意义。方法采用免疫酶标ABC法检测20例初治ALL患者和8例正常对照骨髓单个核细胞CD11 a的表达。结果CD11 a在ALL患者骨髓单个核细胞的表达率(35.23±13.57)%明显低于对照组(87.13±5.38)%(P<0.05),治疗后完全缓解组的表达率(44.64±10.15)%显著高于未缓解组(23.72±6.13)%(P<0.05)。结论ALL患者骨髓单个核细胞的CD11 a表达异常,对ALL的预后判断有一定意义。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

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.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

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.