873例次天津市儿童肿瘤住院患者医保支付费用分析

摘 要：［目的］ 对住院儿童肿瘤患者进行医保支付费用的分析,为医院加强控费管理和儿童大病患者医保政策的优化提供依据。［方法］ 以天津市肿瘤医院儿童肿瘤科2014至2018年诊断为恶性肿瘤的873例次住院医保患者为研究对象,利用SPSS 19.0统计软件,分析患者基本情况、病种构成、诊治特点与住院费用、医保支付费用的关系。［结果］ 873例次儿童肿瘤患者男童多于女童。恶性淋巴瘤、肾母细胞瘤、横纹肌肉瘤为前3位诊治病种,占51.77%。手术治疗和内科治疗为主要治疗方式。平均住院日、次均发生费用和次均医保支付费用均呈下降趋势。住院费用构成中药品费所占比例最高,在30%以上。医保报销后患者个人负担仍较大。［结论］ 儿童肿瘤治疗周期较长,关键有效治疗手段的医保支付比例偏低,致使总体医保费用支持不足,患者家庭负担较重。提高儿童肿瘤患者治疗的医保支付比例、扩大儿童恶性肿瘤支付项目的限定范围或引入商业保险作为补充是将来发展的主要方向。     

Alterations in glycoproteins and lipids in azaserine-induced acinar cell carcinoma of rat pancreas

Glycoproteins and lipids of rat pancreatic acinar cell carcinomas maintained in nude mice and in cell culture, were analyzed. The tumor contained significantly elevated levels of glycoproteins when compared with their normal counterparts. SDS-PAGE of tumor glycoproteins revealed that there were increased amounts of small molecular weight glycoproteins and the tumor also contained a 51,000 dalton glycoprotein which was not detected in the pancreas, liver or the sera of the control animals. The tumor in nude mice and cancer cells in culture had decreased lecithins and triglycerides, and increased amounts of free fatty acids, and both free and esterified cholesterols. The results indicate that altered glycoprotein and lipid compositions represent some of the characteristic features of the acinar cell carcinoma.     

Childhood leukemia in a rural county: Does “unusual” incidence signify clustering?

Several physicians in Shasta County, California reported having diagnosed an unusually large number of children with leukemia during 1967. We attempted to determine if the incidence was significant or if any meaningful aggregation of patients in time or place had occurred. From 1962 to 1975 the incidence of leukemia in Shasta County and in a comparison county (Placer) were only slightly higher than expected. No significant differences between observed and expected numbers of patients were observed in communities in both counties. However, the diagnosis of seven patients in 1967 and eight of the total of 17 patients in one 11 month period in Shasta County was highly unusual.     

Survival Impact of Time to Initiation of Adjuvant Radiation for Merkel Cell Carcinoma: An Analysis of the National Cancer Database

PurposeThis study aimed to determine the impact of time to initiation (TTI) of adjuvant radiation therapy (RT) on overall survival (OS) for patients with stage I or II Merkel cell carcinoma (MCC).Methods and materialsThe National Cancer Database was queried for patients with MCC of the head and neck, trunk, or extremities diagnosed between 2006 and 2014. Patients who did not undergo resection or receive adjuvant RT within 180 days of surgery were excluded. TTI was defined as the time from resection to first RT fraction. Linear regression was used to define factors associated with TTI. Recursive partitioning analysis modeling was performed to determine an optimal threshold for TTI. Cox proportional hazards modeling was performed to define covariates associated with OS.ResultsA total of 2293 patients were included in this study. The median TTI for the cohort was 62 days (interquartile range, 43-86 days). TTI was not associated with OS for the overall cohort by multivariable Cox modeling (P = .19). Age, treatment facility type, lymph node examination, anatomic subsite, and surgical margin were associated with TTI (P < .05). Age, sex, insurance status, Charlson-Deyo comorbidity score, lymph node examination status, tumor size, and surgical margin were associated with OS (all P < .05).ConclusionsIncreased TTI of adjuvant RT was not associated with OS for patients with early stage MCC in this analysis of the National Cancer Database. The median TTI of 62 days from resection to adjuvant RT initiation for our study cohort contextualizes TTI on a national level and may offer reassurance for patients with prolonged postoperative wound healing or intercurrent illness delaying immediate RT initiation. Despite the lack of a clear detriment to survival with increased TTI up to 180 days from surgery, unnecessary delays in initiating adjuvant therapy should continue to be minimized while ensuring optimal recovery from resection.     

Terminal transferase levels in chronic myelogenous leukemia in blast crisis and in remission

Terminal deoxynucleotidyl transferase (TdT) has been cited as a possible biological marker for acute lymphoblastic leukemia (ALL) and the blast phase of chronic myeloid leukemia (CML). In the present study high levels of TdT, comparable to levels present in normal thymus, were observed in circulating leukocytes of a CML patient in blast crisis. Sequential studies revealed disappearance of TdT from circulating leukocytes after remission was induced with vincristine and prednisone therapy. Blood TdT returned to moderately elevated levels in the absence of detectable circulating blasts, 5 months before the reappearance of blast crisis. During blast crisis the malignant cells were devoid of myeloid features on light and electron microscopy and were peroxidase negative and periodic acid-Schiff (PAS) positive. These studies demonstrate that elevated TdT levels may occur with or without detectable morphologic evidence of circulating blast cells. The presence of complement receptors on agranular blasts during the blast phase of chronic myeloid leukemia is a new finding.     

Expanded Tγ cell populations with the morphology of large granular lymphocytes — I. Immunological,clinical and morphological characterization

Lymphocytes from two patients with Tγ cell proliferations displaying the morphology of large granular lymphocytes (LGL) were characterized in terms of cell marker phenotyping and immunologic functions. In both patients, the lymphocytes were positive for E-R, HuTLA, OKT5, OKT8, OKT11, OKM1, VEP13, Leu1, Leu2a, Lyt2 and Lyt3 and were negative for Tμ, Tar, SIg, BA1, BA2, E_M-R, C₃d-R, C₃b-R, OKT6, OKT9, Leu3a, OKIa1 and TdT. In addition, investigations for T411, T811 and M522 in patient 1 yielded positive results. There were differences in the phenotype of the two patients with regard to the reactions with OKT3, OKT10 and VEP10. While, in patient 1, OKT3 was very pronounced and OKT10 and VEP10 were completely negative, OKT10 and VEP10 were very pronounced in patient 2, whereas OKT3 was positive only in a very small percentage of cells. Though the lymphocytes in both patients were potent effectors of NK and K functions (patient 2 more strongly than patient 1 and a noticeably reduced mitogen response was shown to PHA, Con A and zinc, patient 1 showed a distinct suppression of allogenic and autologous B cell response to transformation into ISC, coinciding with the clinical observation of a hypogammaglobulinemia; neither B cell suppression nor dysgammaglobulinemia was seen in patient 2. The results are discussed with regard to other comparable Tγ proliferations reported in the literature.     

乳腺癌术后皮瓣坏死的相关因素及其预防

我院１９８４年１月至１９９３年１２月对４０６例乳腺癌患者施行了手术治疗，术后发生皮瓣坏死共１３６例，占３３．５％。皮瓣坏死的发生与多种因素有关。本文就其发生的相关因素进行分析，认为采取适当的预防措施可减少皮瓣坏死的发生率，早期及时处理，采用有效方法可缩短伤面愈合时间。     

CLINICOPATHOLOGICAL AND SURGICAL STUDY OF VERRUCOUS CARCINOMA OF PENIS

ＣＬＩＮＩＣＯＰＡＴＨＯＬＯＧＩＣＡＬＡＮＤＳＵＲＧＩＣＡＬＳＴＵＤＹＯＦＶＥＲＲＵＣＯＵＳＣＡＲＣＩＮＯＭＡＯＦＰＥＮＩＳＷａｎｇＸｕｚｈｏｕ；ＺｈａｎｇＺｉｘｕａｎ；ＧａｏＺｈｏｎｇｙｕ；ＬｉａｎｓＳｉｔａｉ；ＴｉａｎＪｉｘｉ王绪洲，张紫萱，高促...     

Effect of high dose diethylstilbestrol and ICRF-159 on the growth and metastases of the R3327 MAT-LyLu prostate-derived tumor

The R3327 MAT-LyLu, a lymphotrophic, metastatic prostate-derived rat tumor was treated with high dose diethylstilbestrol or the chemotherapeutic agent ICRF-159. Both drugs inhibited the growth of the primary tumor and the development of metastases.     

Action Levels on Dose and Anatomic Variation for Adaptive Radiation Therapy Using Daily Offline Plan Evaluation: Preliminary Results

Purpose

This study aimed to develop action levels for replanning to accommodate dosimetric variations resulting from anatomic changes during the course of treatments, using daily cone beam computed tomography (CBCT).

Evaluation of the Perth experience in treating with ionizing radiations and VHF (434 megahertz) radiations

Holt and Nelson's experience in 52 patients with head and neck cancer treated with 434 MHz microwave hyperthermia and ionizing irradiation in Perth, Western Australia was reviewed during the author's visit there in the spring of 1978. The 2 year disease-free survival of 47% for patients with advanced disease (T3, T4 or N2, N3) is promising. This is especially encouraging since these results were obtained with lower than conventional doses of irradiation and normal tissue tolerance was excellent. Phase 1/11 studies in this country appear warranted.     

Inhibition of proliferation of cultured cells by polyamine and cysteine interaction

Both L-cysteine and spermidine oxidation inhibited the proliferation of cultured cells when these reagents were added in low concentrations. Higher concentrations (above 1 mM) of cysteine were not cytotoxic. Furthermore, high concentrations of L-cysteine partially protected against spermidine oxidation toxicity. D-cysteine on its own behaved exactly the same as an equimolar concentration of L-cysteine, but instead of protecting against the effects of spermidine oxidation, the inhibition was enhanced. A possible mechanism for the interaction is discussed.     

Volatilization of mutagens from beef during cooking

The process of cooking beef substances which are mutagenic in the Ames Salmonella/microsome bioassay [1,2]. In this study, the formation and disposition of basic mutagens produced by cooking beef at different temperatures were examined. Mutagenic activity increased exponentially with cooking temperature between 137 degrees C and 252 degrees C. However, the amount of mutagenic activity remaining in the meat was only 1--7% of that which was volatilized into the air. The ingested dose of mutagens may therefore be significantly influenced by factors which restrict the dissipation of mutagens from the container, as well as by cooking temperature. Inhalation of airborne mutagens from cooking, as an alternative route of exposure, should be investigated when considered in light of some epidemiological data showing an excess of lung and bladder cancer among cooks and kitchen workers.     

The importance of short term exposure of C3H 10T12 cells to polycyclic hydrocarbons: Evidence for hydrocarbon-mediated anticarcinogenic activity

Since it has been shown that transformation frequencies (TF) of cultured mammalian cells exposed to polycyclic aromatic hydrocarbons (PAH) reach a maximum with increasing PAH concentration and then decline, we have examined TF in C3H $\text{10T}\text{1}\text{2}$ CL8 ($\text{10T}\text{1}\text{2}$) cells as a function of an additional parameter of treatment, length of exposure. A 15-min exposure to either benzo[a]pyrene (BP) or 3-methylcholanthrene (3-MC), at concentrations ranging from 0.3 to 10 μg/ml, was sufficient to induce transformation suggesting that, in $\text{10T}\text{1}\text{2}$ cells, non-induced enzymes of the cytochrome P-450 system are involved in the metabolic activation of PAH. At lower BP concentrations (0.3–1.25 μg/ml), TF generally increased with exposure time; at higher BP concentrations (2.5–10 μg/ml) maximal TF were achieved with 3 h of exposure. For 3-MC, maximal TF occurred at 0.5–1 h with a concentration of 10 μg/ml and at 1–6 h with lower concentrations. Moreover, low TF were obtained after 12-h and 24-h exposures to 10 μg/ml BP or 3-MC. These results show that TF depend on both the length of exposure and concentration of PAH. Since both BP and 3-MC are extensively metabolized to polyoxygenated derivatives and conjugates, we suggest that certain metabolites may be anticarcinogenic or antipromoting agents. The identities of such metabolites are yet to be determined.     

The hematopoietic protective effect of bacterial endotoxin prior to nitrogen mustard in the mouse and dog

Bacterial endotoxin was given to mice 24 h before nitrogen mustard (HN2). Total nucleated cells and peroxidase positive cells/humerus were significantly higher during the recovery phase in endotoxin-treated mice compared to controls given HN2 alone. Endotoxin was also given prior to HN2 in dogs, and a suggestive hematopoietic protective effect was found.     

Forestomach squamous papillomas in the rat: effect of dietary zinc deficiency on induction

Administration of N-nitrosodimethylamine (NDMA) to zinc deficient rats intragastrically twice weekly for 8 weeks resulted in the development of forestomach tumors in 63% of treated animals. The tumors were frequently found at the junction between the fore and glandular stomach and were multiple. Smaller numbers of tumors were also present in the more proximal parts of the forestomach. All tumors were squamous papillomas. Similar tumors were not observed in zinc sufficient pair-fed rats given NDMA. These findings showed that NDMA, a non-esophageal and non-forestomach carcinogen in the rat, was tumorigenic in the presence of zinc deficiency.     

Transient structural change in hepatic DNA of rats chronically exposed to dimethylnitrosamine

Structural analysis by chromatography on benzoylated-DEAE-cellulose (BD-cellulose) has been made of hepatic DNA from rats treated for up to 21 weeks with dimethylnitrosamine (DMN). The carcinogen (1 mg/kg body wt) was administered on a daily basis by intraperitoneal injection. By comparison with preparations from saline-treated controls, the proportion of DNA retained by benzoylated-DEAE-cellulose in the presence of 1.0 M NaCl was increased by administration of the carcinogen. Variation in the result, dependent upon the time after the final dose, suggested a complex relationship between structural damage to DNA and duration of treatment. Structural damage was confirmed by S1 nuclease digestion. The observations imply that in the course of chronic administration, increasing time is required to complete DNA repair processes operative in rat liver.