胰头癌根治术中区域性淋巴结清扫的应用价值探讨

目的　研究胰头癌手术中行区域性淋巴结清扫的疗效情况。方法　将符合入选标准的胰头癌患者 4 6例 ,随机分成两组 ,改良胰十二指肠切除术加区域性淋巴结清扫 2 2例为观察组 ,经典胰十二指肠切除手术 2 4例为对照组 ,对两组术后病理检查结果、生存病例、病死率等方面进行比较分析。结果　两组病例在癌肿直径大小、病理组织学分型方面无明显差异 ,P >0 .0 5 ;观察组清除转移的淋巴结数目明显高于对照组 ,P <0 .0 1;术后经随访 2～ 6 6个月 ,观察组死亡 7例 ,对照组死亡 17例 ,观察组死亡例数显著低于对照组 (P <0 .0 1) ,观察组 5年生存病例高于对照组。结论　胰头癌根治术中应用区域性淋巴结清扫可使淋巴结广泛得到清除 ,延长存活的时间 ,提高胰头癌患者的术后生存率     

乳腺癌浸润相关因素分析及其在保乳手术中的应用

目的探讨乳腺癌保乳手术距肿瘤边缘最佳的切除范围及肿瘤浸润相关因素。方法对100例乳腺癌患者行肿瘤切除的标本分别距肿瘤边缘0.5、1.0、1.5、2.0cm处进行病理学检查,并对乳腺癌浸润与肿瘤大小、年龄、腋窝淋巴结及肿瘤分期等临床相关性进行分析。结果100例标本中,分别于0.5、1.0、1.5、2.0cm处发现癌细胞浸润36、26、15、0例,肿瘤浸润距离与肿瘤大小呈正相关,与年龄呈负相关,与肿瘤分期(Ⅰ、Ⅱ期)无明显相关性。0.5cm浸润距离的腋窝淋巴结阳性率较高,大于1.0cm的浸润距离与腋窝淋巴结状态无相关性。结论乳腺癌行保乳手术的切除范围至少应为距离肉眼可见肿瘤边缘2.0cm的癌旁组织。     

乳腺癌浸润相关因素分析及其在保乳手术中的应用

目的 探讨乳腺癌保乳手术距肿瘤边缘最佳的切除范围及肿瘤浸润相关因素。方法 对100例乳腺癌患者行肿瘤切除的标本分别距肿瘤边缘0．5、1．0、1．5、2．0cm处进行病理学检查，并对乳腺癌浸润与肿瘤大小、年龄、腋窝淋巴结及肿瘤分期等临床相关性进行分析。结果 100例标本中，分别于0．5、1．0、1．5、2．0cm处发现癌细胞浸润36、26、15、0例，肿瘤浸润距离与肿瘤大小呈正相关，与年龄呈负相关，与肿瘤分期（I、Ⅱ期）无明显相关性。0．5cm浸润距离的腋窝淋巴结阳性率较高，大于1．0cm的浸润距离与腋窝淋巴结状态无相关性。结论 乳腺癌行保乳手术的切除范围至少应为距离肉眼可见肿瘤边缘2．0cm的癌旁组织织。     

前哨淋巴结阳性乳腺癌患者非前哨淋巴结转移的影响因素分析

目的探讨腋窝前哨淋巴结(SLN)阳性的乳腺癌患者非前哨淋巴结(nSLN)转移情况与其临床病理特征之间的关系。方法回顾性分析2011年1月-2018年2月吉林大学第二医院乳腺外科64例临床分期为T1-2N0M0期、SLN阳性并行腋窝淋巴结清扫术(ALND)的乳腺癌病人资料,其中28例患者nSLN有转移、36例患者nSLN无转移。应用卡方检验、秩和检验以及多因素Logistic回归分析等统计学方法分析nSLN转移与其临床病理特征的关系。结果在SLN阳性的乳腺癌病人中,56%(36/64)腋窝淋巴结转移仅限于SLN。单因素分析结果显示,nSLN转移与阳性SLN数目、原发肿瘤直径以及神经/脉管等淋巴结外浸润情况有关(Z=-1.991,P=0.047;Z=-2.145,P=0.031;χ^2=5.630,P=0.018);与病理类型、组织学分级、激素受体状态、是否多个病灶、人表皮生长因子受体2(HER-2)以及Ki67表达状况无关。多因素分析显示,原发肿瘤直径、神经/脉管等淋巴结外浸润以及阳性SLN数目均为nSLN转移的独立影响因素(OR=2.700,P=0.006;OR=2.759,P=0.008;OR=1.934,P=0.009)。结论肿瘤直径较大、有神经/脉管等淋巴结外浸润以及阳性SLN数目较多的SLN阳性乳腺癌患者更容易发生nSLN转移。     

原发性早期乳腺癌保乳手术后五年原位复发特点分析

目的 总结原发性早期乳腺癌保乳手术后5年原位复发的特点.方法 2000年5月至2005年5月保乳手术治疗原发性早期乳腺癌47例,行象限切除加腋窝淋巴结清扫39例,单纯肿块局部广泛切除术无腋窝淋巴结清扫8例,其中术后行全乳切线加瘤床放疗40例.结果 随访5～10(7.0±1.5)年,原位复发3例,占6.4%(3/47),均为非浸润性癌.术后行全乳切线加瘤床放疗者原位复发率(2.5%,1/40)低于未行全乳放疗者(28.6%,2/7)(P=0.035),行象限切除加腋窝淋巴结清扫者原位复发率(2.6%,1/39)低于行单纯肿块局部广泛切除术无腋窝淋巴结清扫者(25.0%,2/8)(P=0.029).结论 原发性早期乳腺癌保乳手术后放疗及象限切除加腋窝淋巴结清扫是必要的,可降低5年原位复发率.     

保留肋间臂神经在乳腺癌腋窝淋巴结清扫术中的应用

目的探讨乳腺癌腋窝淋巴结清扫术中保留肋间臂神经(intercostobrachial nerve,ICBN)临床意义。方法回顾性分析123例I、Ⅱ、Ⅲa期乳腺癌患者,分为2组:实验组64例,行乳腺癌腋窝淋巴结清扫术时保留ICBN;对照组59例,术中切除ICBN。结果术对患侧腋窝及上臂内侧感觉功能进行观察,实验组中正常58例(90.63%),感觉异常6例(9.37%);对照组中正常10例(16.95%),感觉异常49例(83.05%),2组比较,差异有统计学意义(P<0.01)。随访2～4年,均未见肿瘤局部复发或转移。结论 I、Ⅱ及Ⅲa期乳腺癌腋窝淋巴结清扫术保留ICBN可明显减少术后患侧腋窝、上臂内侧感觉异常,从而提高生活质量,且不会明显增加复发风险。     

乳腺癌改良根治术中胸肌间淋巴结转移的临床特征及相关因素分析

目的 分析乳腺癌患者胸肌间淋巴结的检出率、转移率及其影响因素,探讨胸肌间淋巴结清扫的意义和指征.方法 回顾性分析148例接受乳腺癌改良根治术并且胸肌间淋巴结单独送病理检查患者的临床资料,记录胸肌间淋巴结的检出率和转移情况,分析胸肌间淋巴结转移与肿瘤大小、腋窝淋巴结、临床分期、新辅助化疗、激素受体、人表皮生长因子受体2(Her-2)表达以及乳腺癌分子亚型的关系.结果 胸肌间淋巴结检出率、胸肌间淋巴结总体转移率、腋窝淋巴结阳性者胸肌间淋巴结转移率分别为13.5％(20/148),4.7％(7/148)和10.9％(7/64).不同腋窝淋巴结转移、肿瘤TNM分期患者胸肌间淋巴结转移率比较差异有统计学意义(P＜ 0.05),但与激素受体状况、Her-2表达以及乳腺癌分子亚型之间未见相关(P＞0.05);新辅助化疗并未降低肿瘤局部偏晚患者的胸肌间淋巴结转移率;胸肌间淋巴结转移者表现为肿瘤较大、腋窝淋巴结转移多、TNM分期较晚.结论 胸肌间淋巴结转移多见于肿瘤直径较大、腋窝淋巴结转移多、TNM分期较晚、局部晚期以及适合新辅助化疗的乳腺癌患者,这些指征可能意味着需要常规进行胸肌间淋巴结的手术清扫和单独送检.     

腔镜下乳腺癌腋窝淋巴结清扫术15例临床分析

目的 探讨腔镜技术用于乳腺癌腋窝淋巴结清扫术的可行性.方法 15例乳腺癌患者行腔镜下腋窝淋巴结清扫术,记录淋巴结清扫数目,了解清扫效果;腔镜手术结束后,行常规乳腺癌改良根治术,验证腔镜手术清扫效果.结果 15例腔镜手术时间46～138 min,平均74 min,前期手术时间较长,后期手术技术熟练后时间明显缩短.腔镜下每例取出淋巴结11～26个,平均13.6个,其中6例发现1～5个转移淋巴结;后行常规清扫手术每例取出淋巴结0～6个,平均2.6个,未发现转移淋巴结.腔镜下腋窝淋巴结清扫术中出血很少,未出现手术并发症.结论 借助腔镜器械,通过腋窝处微小隐蔽切口能比较顺利地完成乳腺癌腋窝淋巴结微创清扫,手术效果确切.     

保乳手术加放疗治疗早期乳腺癌的初步研究

目的 研究保留乳房手术加放疗治疗早期乳腺癌的可行性和推广这种术式的可能性。方法1999-11～2001-10，对临床Ⅰ，Ⅱ期乳腺癌病人，实施了保乳手术。术前检查明确有无手术指征，按自愿选择的原则采用保乳手术。原发灶做局部广泛切除，术后常规行根治性放疗。于放疗前和放疗后分别评价保乳手术的美容效果。结果共实施保乳手术18例，占同期乳腺癌手术病人的10．2％。肿瘤直径0．3～3．0cm，术后病理分期0期4例，I期12例，Ⅱ期2例。象限切除 腋窝淋巴结清扫(axilary lymph node dissection，ALND)7例，区段切除 腋窝淋巴结清扫8例，单纯区段切除3例。18例病人中，有1例放疗后美容效果不理想。全部病例随访来发现复发和转移。结论乳腺癌保乳手术美容效果良好，放疗对乳房外形无明显影响，保乳手术加放疗，可显著提高乳腺癌患者生活质量。     

颈淋巴结阴性甲状腺微小癌术前中央区淋巴结转移相关因素分析

目的 探讨颈淋巴结阴性(cN0)甲状腺微小癌术前中央区淋巴结转移的相关因素.方法 收集49例确诊为cNo甲状腺微小癌并行中央区淋巴结清扫患者的临床资料,分析年龄、性别、肿瘤直径、肿瘤是否侵犯甲状腺包膜、组织学类型等因素与术前中央区淋巴结转移的关系.结果 49例患者中,11例发现术前中央区淋巴结转移,转移率为22.4％(11/49).单因素分析结果显示,仅肿瘤直径与术前中央区淋巴结转移有关(P=0.012),而患者年龄、性别、肿瘤位于单侧或双侧、原发病灶数、肿瘤是否侵犯甲状腺包膜、是否合并其他甲状腺良性疾病以及组织学类型对术前中央区淋巴结转移的影响差异均无统计学意义(P＞0.05).进一步分别取肿瘤直径5、6、7及8 mm为截断值进行分层分析,结果发现肿瘤直径≥5 mm者术前中央区淋巴结转移率为38.5％(10/26),＜5 mm者术前中央区淋巴结转移率为4.3％(1/2),差异有统计学意义(P=0.006).而以6、7或8 mm为截断值进行分层分析时,组间术前中央区淋巴结转移率比较差异无统计学意义(P＞0.05).结论 cN0甲状腺微小癌具有一定的术前中央区淋巴结转移率,肿瘤直径≥5 mm的cNo甲状腺微小癌术前中央区淋巴结转移率较高,应行中央区淋巴结清扫.     

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.     

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.     

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 risk of heat exhaustion at a deep underground metalliferous mine in relation to surface temperatures

The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.