卡氮介脂质体后续给药法治疗肺癌脑转移瘤的临床研究

目的探讨卡氮介(BCNU)和卡氮介脂质体(BL)治疗肺癌脑转移的疗效及毒性反应,评价后续给药法在疗效、毒性反应的作用。方法将60例经病理检查证实及脑CT确诊的肺癌脑转移患者随机分为BL组(30例)和BCNU组(30例)。BL组:后续法应用BL治疗,BCNU组:采用常规给药治疗。结果BL组脑转移患者生存期优于BCNU组(P<0.05),两组治疗方法对脑转移患者的有效率差异无统计学意义(P>0.05),血液毒性反应发生率BL组低于BCNU组,生存质量BL组高于BCNU组(P<0.05)。结论BL后续给药法在患者生存期、生存质量、毒性反应发生率均优于常规法BCNU的治疗。     

卡氮介脂质体后续给药法治疗肺癌脑转移瘤的临床研究

目的研究在肺癌脑转移瘤治疗中卡氮介脂质后续给药法的治疗效果。方法选择了2010年1月—2012年1月来该院治疗肺癌脑转移的60例患者作为研究对象,随机分为BL组和BUCN组,BUCN组患者进行常规给药治疗,BL组患者应用后续法BL治疗。结果 BL组患者的生存时间显著高于BCNU组患者,有明显的差异统计学意义。两组患者治疗效果比较,无显著差异性。BL组抑制骨髓毒性显著低于BCNU组,P<0.01。结论在毒性发生率、生存时间以及生活质量等指标方面,BL后续给药法显著优于常规的BCNU治疗方法,尤其是对于中晚期肺癌脑转移比较严重的患者,能有效提高和改善患者生活质量,进一步延长患者生存时间,治疗效果值得肯定。     

卡介菌多糖核酸联合中药治疗扁平疣临床观察

目的观察卡介茵多糖核酸联合中药治疗扁平疣的疗效。方法采用单独卡介菌多糖核酸、单独中药及卡介菌多糖核酸联合中药三种方法治疗扁平疣120例，观察2个月，以皮损消退面积评价疗效。结果治疗2个月后，三组患者总有效率分别为55％、50％、80％。卡介菌多糖核酸组与中药组比较疗效相当（P〉0．05），而卡介菌多糖核酸联合中药组与前两者比较则取得了更好的疗效（P〈0．05）。结论卡介菌多糖核酸联合中药治疗扁平疣疗效好、不良反应少，值得推广。     

依巴斯汀联合卡介菌多糖核酸治疗慢性荨麻疹的临床疗效及安全性

目的探讨依巴斯汀联合卡介菌多糖核酸治疗慢性荨麻疹的临床疗效,观察其临床应用的安全性。方法将本院近年来收治的96例确诊的慢性荨麻疹患者分为单纯依巴斯汀治疗组（对照组）和依巴斯汀联合卡介菌多糖核酸治疗组（观察组）,每组各48例,观察两组患者的临床疗效。结果观察组和对照组患者治疗总有效率分别为87．5％、70．8％,组间比较差异有统计学意义（P〈0．05）。观察组患者治疗后的症状评分为（1．9±0．6）分,优于对照组患者的（2．8-±0．8）分,差异有统计学意义（P〈0．05）。两组患者治疗期间均未发生严重不良反应。结论采用依巴斯汀联合卡介菌多糖核酸治疗慢性荨麻疹临床疗效可靠,且不良反应发生率较低,患者耐受性好,应在临床大力推广使用。     

拓扑替康联合卡铂与足叶乙苷联合卡铂比较一线治疗小细胞肺癌临床研究

目的比较拓扑替康联合卡铂（TC）与足叶乙苷联合卡铂（CE）一线治疗小细胞肺癌的疗效及不良反应。方法初治小细胞肺癌患者69例，TC组（34例）：应用拓扑替康1mg／m2，静脉滴注，第1—5天，卡铂300mg／m2，静脉滴注，第1天。CE组（35例）：应用足叶乙苷100mg／d，静脉滴注，第1—5天，卡铂300mg／m2，静脉滴注，第1天。两种方案均以21d为1个周期。2个周期后评价疗效及不良反应。结果TC组有效率为76．5％，CE组有效率为71．4％，两组比较差异无统计学意义，P〉0．05；TC组无进展生存期为4．1个月，CE组无进展生存期为2．6个月，两组比较差异有统计学意义，P〈0．05；两组不良反应发生率比较差异均无统计学意义，P〉0．05。结论与足叶乙苷联合卡铂方案相比，拓扑替康联合卡铂方案疗效相似，不良反应相近，且无进展生存期延长，是小细胞肺癌一线治疗的安全有效方案。     

卡培他滨联合方案治疗老年晚期结直肠癌的临床研究

目的评价卡培他滨联合方案治疗老年晚期结直肠癌的疗效与不良反应。方法77例老年晚期结直肠癌患者随机分组，卡培他滨联合组（36例）接受奥沙利铂（L—OHP）加卡培他滨方案化疗，OLF组（41例）接受L-OHP加氟尿嘧啶／亚叶酸钙（FU／CF）方案化疗，观察对比其疗效与不良反应。结果卡培他滨联合组的有效率为41．67％，肿瘤控制率（临床受益率）为77．78％，中位肿瘤进展时间为7．9个月。OLF组的有效率为39．02％，肿瘤控制率为75．61％，中位肿瘤进展时间为7．2个月。两组有效率比较差异无统计学意义（P〉0．05）。不良反应：两组均无严重的化疗相关不良反应，两组患者骨髓抑制、消化道反应、脱发、皮疹、肝肾功能损害、神经毒性的发生率比较差异均无统计学意义（P均〉0．05），卡培他滨联合组手足综合征的发生率较OLF组明显升高（P〈0．05）。结论对老年晚期结直肠癌患者，卡培他滨联合方案与OLF方案疗效相仿，不良反应均可耐受，卡培他滨口服给药缩短了住院时间，提高了老年患者的生活质量，卡培他滨联合方案不失为一种老年晚期结直肠癌患者一线治疗方案的较佳选择。     

论卡培他滨联合洛铂治疗转移性乳腺癌78例临床观察

目的探讨卡培他滨联合洛铂治疗转移性乳腺癌的临床疗效。方法对我科2009年12月-2012年12月收治的转移性乳腺癌妇女156例进行回顾分析,随机分为观察组采用卡培他滨联合洛铂治疗,对照组采用卡培他滨单一治疗。结果观察组在有效率和疾病控制率中明显优于对照组,差异有统计学意义（P〈0．05）。两组在皮肤色素沉着、骨髓抑制、消化道反应中无明显差异（P〉．05）,在WBC减少、手足综合征等比较中,观察组明显优于对照组（P〈0．05）。患者毒副反应均为为Ⅰ、Ⅱ度。随访6-18个月,观察组中位生存期为（14．8±2．1）个月,1年生存率为88．4％（69/78）;对照组中位生存期为（13．5±2．1）个月,1年生存率为82,1％（64／78）。结论卡培他滨联合洛铂治疗可有效提高转移性乳腺癌的总体治疗水平,具有比单药治疗更好的应用前景,值得应用。     

卡介菌多糖核酸与化疗药物联合治疗肺癌的实验研究

目的 探讨卡介菌多糖核酸（BCG－PSN）与化疗药物联合治疗肺癌的机理。方法 小鼠130只,分为A、B、C三组,分别测定单纯口服或腹腔内注射BCG－PSN后小鼠的巨噬细胞吞噬功能、淋巴细胞转化刺激指数及溶血素试验;单以下注射环磷酰胺（Cy）和BCG－PSN与Cy联合用药后小鼠的自然杀伤（NK）细胞活性、巨噬细胞吞噬功能、白细胞介素－2（IL－2）活性和淋巴细胞转化率4项抗肿瘤免疫指标。结果 单纯了或腹腔内注射BCG－PSN组巨噬细胞吞噬功能和溶血素反应增强（P＜0．01）;淋巴细胞转化率无变化;单纯皮下注射环磷酰胺组上述4项抗肿瘤免疫指标明显减退;BCG－PSN与Cy联合用药组4项抗肿瘤免疫指标与单用Cy组相比明显增强（P＜0．01）。结论 卡介菌多糖核酸能恢复被化疗药物减退的抗肿瘤免疫功能,增强化疗药物的抗肿瘤作用。为该药与化疗药物联合应用于肺癌的治疗提供了理论依据。     

艾迪注射液联合TC方案治疗晚期非小细胞肺癌的疗效观察

目的观察艾迪注射液联合TC方案治疗晚期非小细胞肺癌的疗效、不良反应及其对生活质量的影响。方法将78例经病理组织学或细胞学检查确诊的非小细胞肺癌患者分为两组：对照组39例，采用Tc方案治疗，紫杉醇135mg／m2、d1，卡铂300mg／m2、d1；治疗组在此治疗方案的基础上联用艾迪注射液50ml，连用8—10d。21d为1个周期，连用2个周期评价疗效。结果治疗组有效率为59．0％，对照组为51．3％，两组比较差异无统计学意义（P〉0．05），治疗组Karnofsky评分提高率高于对照组（P〈0．05）。白细胞下降发生率治疗组和对照组分别为64．1％和82．1％，恶心呕吐发生率两组分别为41．0％和76．9％（P〈0．05）。结论艾迪注射液联合TC方案治疗晚期非小细胞肺癌，可降低化疗对患者免疫功能的影响及不良反应发生率，改善患者的生活质量。     

力比泰与多西他赛联合卡铂治疗晚期非小细胞肺癌的临床观察

目的对比观察力比泰与多西他赛（docetaxel）联合卡铂（carboplatin）治疗晚期非小细胞肺癌的临床疗效及毒副反应。方法晚期非小细胞肺癌患者共27例,分为两组。治疗组12例,首次力比泰给药前7d开始lYl服叶酸600Ixg,1次／d,连服至末次力比泰给药后21d停药;维生素B12 1000μg／次,首次力比泰给药前7d内肌肉注射1次,以后每3个周期肌注1次;力比泰500μg／m。,10min以上静脉滴注,第1天、21天为一周期。对照组15例,多西他赛用量75mg／m^2,静脉滴注,第1天,同时配伍卡铂AUC5mg,静脉滴注,第1天、21—28天为1个疗程。每例患者至少接受2个疗程的治疗。结果治疗组与对照组总有效率差异无统计学意义（P〉0．05）。对照组血液学及非血液学毒性较治疗组明显,治疗组病人生活质量高于对照组。结论力比泰与多西他赛联合卡铂对晚期非小细胞癌治疗疗效相似,但力比泰组毒性反应相对较轻,临床使用安全。     

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.     

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.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.