Effectiveness of mass screening for breast cancer in Japan

BACKGROUND: Breast cancer screening has been conducted in Japan mainly by physical examination, the standard method for breast cancer screening according to the Law of Health Services for the Elderly. The purpose of this study was to evaluate the effectiveness of mass screening for breast cancer in Japan. METHODS: We calculated the average coverage-rates for breast cancer screening per year from 1986 to 1995 for women aged 30-69 years for all of the 3255 municipalities in Japan, selecting "high coverage-rate" municipalities with average coverage-rates of 20%, 30%, 40% or more. Two municipalities were selected as "controls" for each high coverage-rate municipality, and were matched for population, National Health Insurance rate, and the age-adjusted death rate from cancer of the female breast in the period 1986-90. We compared the change in the age-adjusted death rate from 1986-90 to 1991-95 of the high coverage-rate municipalities and the comparable controls. RESULTS: The percent reduction in the age-adjusted death rate from cancer of the breast in the high coverage-rate municipalities was statistically significantly greater than those in the controls. CONCLUSIONS: The results suggest that mass screening for female breast cancer, mainly by physical examination, contributed to the reduction of mortality from breast cancer.     

Eficacia,seguridad y satisfacción de los procedimientos de sedoanalgesia en las urgencias españolas

Objectives

To offer analgesia and sedation should be a priority in paediatric emergency departments. The aim of this study was to determine the effectiveness and safety of the sedation-analgesia procedure, as well as the satisfaction of the doctors, patients and parents.

Norplant皮下埋植剂使用七年效果

对Norplant皮下埋植剂继续使用7年以上的效果作了多中心研究。3600余妇女使用满6年,2400余妇女使用满7年。第6、第7年的年妊娠率均为0.4/100妇女年。妊娠率随体重增加而增加(P<0.05),随年龄的增长而降低,第6、7年合并计算任何年龄组或体重组其年妊娠平均未超过1/100妇女年。     

A Case-Control Study of the Effectiveness of Cervical Cancer Screening in Osaka, Japan

In the small town of Nose in Osaka, Japan, a population-based screening program for cervical cancer by Papanicolaou smear has been conducted since 1965. In order to evaluate the effectiveness of screening in terms of the reduction of the mortality and the incidence of invasive cervical cancer, two types of case-control studies were carried out. In the first study, the case series consisted of all women who died of cervical cancer under 80 years of age at the time of diagnosis in 1965-1987 (N = 15). For each case, 10 controls were chosen from living residents, matched by year of birth. It showed that the odds ratio (OR) of dying of cervical cancer for screened versus non-screened women was 0.22 (95%CI = 0.03-1.95). In the second study, the case series consisted of all women who were diagnosed as having invasive cancer under 80 years of age at the time of diagnosis in the same period (N = 28). For each case, 10 controls were chosen from living residents without invasive cancer, matched by year of birth and according to whether or not they were screened at the year of the diagnosis of the matched case. It showed that the OR of getting invasive cancer for screened versus non-screened women was 0,41 (95%CI = 0.13-1.29). From these results, it was estimated that 78% of cervical cancer mortality and 59% of invasive cervical cancer incidence among non-screened women could be prevented by cervical cancer screening.     

复方蜂毒注射液对大鼠实验性肝纤维化的治疗作用

为了研制防治肝纤维化的有效药物，用蜂毒及联合苦参碱的复方制剂，对大鼠实验性肝纤维化进行了治疗观察。结果显示，治疗组肝脏中羟脯氨酸、Ⅰ型胶原明显低于模型组并有显著性差异（P＜0．01）；血清中Ⅰ型胶原也明显低于模型组（P＜0．01）；肝脏重量低于模型组2g左右；肝组织病理切片观察到治疗组肝纤维化发生率明显低于模型组。实验结果表明，复方蜂毒对大鼠实验性肝纤维化有治疗作用。     

非M3型急性白血病患者中MUC1基因和MDR1基因表达及其与临床疗效的关系

背景与目的:MUC1基因在胃癌、卵巢癌、多发性骨髓瘤、恶性淋巴瘤等肿瘤中有表达,在急性白血病患者中有较高的表达。但MUC1基因和多药耐药基因(MDR1)相互关系以及两者的表达与急性白血病治疗效果的关系尚有待探讨。本研究拟探讨MUC1基因与MDR1基因表达及其与非M3型急性白血病患者治疗效果的关系。方法:应用逆转录鄄聚合酶链反应(RT鄄PCR)法检测34例初治非M3型急性白血病患者MUC1和MDR1的表达,并观察两种基因表达及其与临床疗效的关系。结果:34例初治非M3型急性白血病患者中MUC1基因阳性率为50%,MDR1基因阳性率为29.4%。MUC1基因阳性患者的MDR1阳性率为52.9%,明显高于MUC1阴性者的5.9%(P=0.003)。MUC1基因阴性者完全缓解(CR)率达94.1%,阳性患者CR率52.9%,两组有显著性差异(P<0.05);MDR1基因阴性者CR率为91.7%,明显高于阳性患者的50.0%(P<0.05)。MUC1基因和MDR1基因均阳性者CR率为55.6%,MUC1基因和MDR1基因均阴性者16例,全部获得CR。结论:非M3型急性白血病MUC1基因阳性者MDR1基因表达率较高,MUC1基因及MDR1基因均为阴性者治疗缓解率高。提示联合检测MUC1基因和MDR1基因对判断初治非M3型急性白血病的疗效有良好的预测作用,可作为临床判断疗效的一项有意义的指标。     

Effectiveness of Bacillus Calmette Guerin (BCG) vaccination in the prevention of leprosy: a population-based case-control study in Yavatmal District, India

OBJECTIVE: To estimate the effectiveness of Bacillus Calmette Guerin (BCG) vaccination in the prevention of leprosy. Study design. Population-based case-control study. METHODS: The study was carried out in Yavatmal District, Maharashtra, India. It included 364 cases of leprosy (diagnosed by the World Health Organization's criteria), born since 1962, that were detected during a leprosy survey conducted by the Government of Maharashtra in 2,175,514 people. Each case was pair-matched with one neighbourhood control for age, sex and socio-economic status. Exclusion criteria for controls included past or current history of tuberculosis or leprosy. BCG vaccination status was assessed by examination for the presence of a BCG scar, immunization records if available and information from subjects/parents of children. Subjects who were uncertain about BCG vaccination were not included. RESULTS: A significant protective association between BCG and leprosy was observed [odds ratio=0.46, 95% confidence intervals (CI) 0.34-0.61]. Overall vaccine effectiveness (VE) was 54% (95% CI 39-66). BCG effectiveness against multibacillary, paucibacillary and single skin lesion leprosy was 68% (95% CI 26-86), 57% (95% CI 29-74) and 48% (95% CI 22-65), respectively. Analysis of linear trend revealed a significant linear association between the protective effect of BCG and the type of leprosy. The BCG vaccine was more effective in those aged < or =20 years compared with those aged >20 years (VE 61%, 95% CI), among females compared with males (VE 60%, 95% CI), in lower socio-economic strata compared with upper and middle strata (VE 57%, 95% CI), and in subjects who had a BCG scar size < or =5 mm compared with those with a BCG scar size >5 mm (VE 61%, 95% CI). However, these differences were not statistically significant, as reflected by the overlapping 95% CIs. The overall prevented fraction was 35% (95% CI 22-46). CONCLUSION: The current study identified a beneficial role of BCG vaccination in the prevention of leprosy in the study population.     

Levetiracetam for people with mental retardation and refractory epilepsy

Levetiracetam (LEV) is a novel antiepileptic drug (AED) with efficacy against a wide range of seizures types. The aim of this observational study was to assess its effectiveness in patients with mental retardation and refractory epilepsy. Sixty-four patients were started on adjunctive LEV after a 3-month baseline. LEV was initially dosed at 250 mg daily and increased by 250 mg every 2 weeks thereafter according to clinical response. Caregivers rated the patient's sleep, appetite, alertness, and behavior as poor (1), reasonable (2), or good (3) at each clinic visit. Patients were reviewed until one of four endpoints was reached: seizure freedom for at least 6 months, > or = 50% reduction in seizure frequency (responder) over a 6-month period, <50% reduction in seizure frequency (marginal effect) over a 6-month period, or LEV withdrawal due to lack of efficacy, adverse effects, or both. Twenty-four (38%) patients became seizure-free, 10 of whom were controlled on LEV 250 mg twice daily. An additional 18 (28%) patients were classified as responders, and 8 (12%) reported only marginal benefit from adjunctive LEV. Fourteen (22%) patients discontinued LEV (6 worsening seizures, 1 lack of efficacy, 7 adverse effects). Caregivers rated combined sleep, appetite, alertness, and behavior scores as "improved" at the end of follow-up (P<0.001). LEV improved seizure control in the majority of patients with mental retardation and may also have enhanced their quality of life.     

腔静脉滤器对妇产科病人肺栓塞的预防价值

目的:研究永久和临时腔静脉滤器运用于妇产科病人对肺栓塞的预防效果、并发症。方法:33例病人安放VTF(Vena Tech-LGM filter,VTF)永久滤器23支;安放FRF02临时滤器(Filter RF02,FRF02)11支(其中1例,安放永久和临时滤器各1只)。永久滤器随访期(3~57)月,平均22月,临时滤器平均置入4.9天。随访有无发生或再发肺栓塞,复查腹部平片,做滤器处彩超和CT检查。结果:复查病例6.7%(1/15)的VTF发生移位,6.7%(1/15)的VTF内有血栓。安放永久滤器病例,1例再发肺栓塞。安放临时滤器病例,发生穿刺部位血肿1例,取出滤器上附有血栓3例,未发生肺栓塞。结论:对于合并静脉血栓性疾病的妇产科病人,使用永久和临时滤器,安全性高,对肺栓塞有良好的预防作用。