Ⅳ期直肠癌的外科治疗及预后分析

目的:探讨Ⅳ期直肠癌患者原发病灶切除的价值和适应证.方法:回顾性分析2005年1月至2010年12月在外科治疗的118例Ⅳ期直肠癌患者的临床资料,将118例分为二组,手术切除原发病灶组(105例)和仅行造瘘术组(13例).采用Kaplan-Meier法进行生存分析,Log-rank检验进行统计学比较,应用Cox比例风险模型进行多因素分析.结果:118例中105例行直肠原发病灶切除,同期行转移瘤切除16例;13例行造瘘术.手术切除原发病灶组总的5年生存率为8.5%.其中同期行转移瘤切除者5年生存率31.2%,行辅助化疗者5年生存率20%.手术切除原发病灶组与造瘘组中位生存期分别为15个月、13个月(x2=0.736.P=0.778).手术切除原发病灶组中转移灶切除和转移灶未切除中位生存期分别为20个月、14个月(x2=5.382,P=0.020).手术切除原发病灶加术后全身化疗为主者中位生存期为21个月,多因素分析显示原发肿瘤分化程度、肝转移瘤最大径和全身化疗是影响直肠原发肿瘤切除预后的最主要因素,结论:对于Ⅳ期直肠癌能同时切除原发及转移病灶的患者,外科手术治疗可延长生存时间.     

减瘤手术对不可治愈的结直肠癌患者生存时间的影响

目的 研究除手术切除外未经任何其他治疗的不可治愈的结直肠癌患者,行原发肿瘤切除对患者生存时间的影响.方法 收集143例除手术切除外未经任何其他治疗的不可治愈的结直肠癌患者的临床资料,其中91例予姑息性切除(减瘤手术组),52例未切除(非手术组).比较原发肿瘤切除对患者生存时间的影响.结果 减瘤手术组中位生存时间(10个月)明显长于非手术组(3个月),P＜0.01;只有远处转移不合并有癌性腹水和种植转移者手术切除原发肿瘤患者中位生存时间(10个月)明显长于非手术切除患者(3个月),P＜0.01.术后并发症两组比较差异无统计学意义(P＞0.05).结论 原发结直肠癌患者减瘤手术在技术上是可行的,不会造成癌扩散,能够提高患者的生存质量和延长患者的生存时间.     

鼻咽癌颈部可疑阳性淋巴结60Gy放疗剂量的疗效观察

目的 观察鼻咽癌患者颈部可疑阳性淋巴结(最大横断面短径≥0.5 cm但＜1 cm、包膜完整、无中央坏死)放疗剂量为60 Gy时淋巴结的消退情况、有无局部复发,以及患者的不良反应及预后.方法 回顾性分析2006年1月至2007年12月我院46例含有颈部可疑阳性淋巴结的鼻咽癌患者,颈部可疑阳性淋巴结予以60 Gy的放疗剂量,以MRI检查为标准,评价疗效.结果 放疗剂量达60 Gy时颈部淋巴结转移灶CR 42例,有效率达91.3％,放疗前后淋巴结消退有意义(P＜0.05),治疗结束时所有患者60 Gy照射区域均出现Ⅰ级放射性皮炎.5年总生存率80.4％ (37/46),5年无瘤生存率76.1％ (35/46),5年颈部淋巴结局部控制率95.7％ (44/46),5年远处转移率13.0％ (6/46);5年无颈部纤维化患者.结论 60 Gy的放疗剂量是鼻咽癌颈部可疑阳性淋巴结转移很好的控制剂量,且不良反应较轻,患者可耐受.     

手术前血清胃蛋白酶原水平对胃癌预后的预测价值

目的 探讨胃癌患者术前胃蛋白酶原水平与临床病理指标的关系以及对术后生存预后的预测价值.方法 入组的151例胃癌患者在手术前1周做胃蛋白酶原水平的检测,随后随访,收集患者的临床病理指标以及生存时间等.结果 血清胃蛋白酶原检测结果显示,151例患者中,90例(59.6％)患者胃蛋白酶原阳性,61例(40.4％)患者胃蛋白酶原阴性.胃蛋白酶原阴性和胃癌患者的淋巴结转移、远处转移以及高临床分期具有显著的相关性,差异均有统计学意义(P＜0.01).生存分析结果表明,胃蛋白酶原检测阴性的患者5年总生存率(60.7％)及5年无复发生存率(56.7％)均明显低于阳性者(分别为80.5％、77.8％),差异均有统计学意义(P＜0.01).胃蛋白酶原阴性是胃癌不良预后的独立预测因素.结论 血清胃蛋白酶原检测有可能做为预测胃癌预后的指标.     

软腭癌放射治疗的预后因素分析

目的 :探讨影响软腭癌放射治疗的预后因素。方法 :1990年 1月至 1999年 7月我科收治的软腭癌患者 90例 ,男性 63例 ,女性 2 7例。鳞癌 48例 ,低分化癌 2 2例 ,未分化癌 12例 ,腺癌 8例。采用直线加速器外照射 ,照射剂量 60～ 70GY/6～ 7W。用Kaplan -Meier法计算生存率和局部控制率 ,Logrank法做差异检验 ,Cox回归法统计影响局部控制率 (LC)和总生存率 (OS)的预后因素。结果 :中位随访时间 5 7个月 (5个月～ 114个月 )。 5年总生存率分别为 44 4%。 5年局部控制率为 44 3 % 19例在随访过程中出现局部复发 (10例为原发部位复发 ,8例为颈部淋巴结复发 ,1例因失访复发部位不详 ) ,16例出现远处转移。结论 :T N分期 ,病理类型 ,疗终时肿瘤有无残存是影响软腭癌放射治疗疗效的主要因素。     

肝癌患者外周血甲胎蛋白mRNA表达与术后生存和转移的相关性研究

目的 探讨肝癌患者外周血甲胎蛋白(AFP)mRNA的表达与术后生存和转移的关系.方法 收集2005年1月至2006年12月经过根治性手术切除的肝癌患者66例.提取外周血细胞总RNA,巢式PCR检测AFP mRNA的表达.术后随访60个月.结果 肝癌患者外周血AFPmRNA表达率为40.91％(27/66).肝癌患者外周血AFP mRNA的表达与有无微血管入侵和转移密切相关(P＜ 0.05或＜0.01),而与患者的性别、年龄、有无HBV感染、有无肝硬化、AFP浓度、肿瘤大小及数量、Edmondson分级无相关性(P＞0.05).AFP mRNA阳性肝癌患者术后1、2、≥3年的生存率分别是66.7％(18/27)、38.9％(7/18)、28.6％(2/7),AFP mRNA阴性肝癌患者分别为84.6％(33/39)、60.6％(20/33)、45.0％(9/20),两者比较差异有统计学意义(P＜0.01).结论 肝癌患者外周血AFPmRNA的检测可以提示肿瘤早期的微小转移,可以用来作为术后复发的预测指标.     

探讨宫颈癌术后盆腔淋巴结转移对复发及预后的影响

目的:探讨宫颈癌术后盆腔淋巴结转移对复发及预后的影响。方法:回顾性分析137例在我院接受宫颈癌手术患者的临床资料,根据盆腔淋巴结转移情况将患者分为3组,即无淋巴结转移组(对照组,n=42),1枚淋巴结转移组(A组,n=51),≥2枚淋巴结转移组(B组,n=44),术后对患者进行5年的随访,观察复发及生存情况。结果:术后随访结果表明A、B两组患者术后复发率及远处转移率均高于对照组患者(p0.05),B组患者术后复发率及远处转移率均高于A组患者(P0.05)。对照组患者3年生存率和5年生存率均高于A、B两组患者(P0.05),A组患者的3年生存率和5年生存率高于B两组患者(P0.05)。结论:宫颈癌术后盆腔淋巴结转移与复发及生存率有密切关系,淋巴结转移个数越多术后复发风险较高,且生存率较低。     

影响骨肉瘤患者预后的多因素分析

目的 探讨影响骨肉瘤患者预后的因素.方法 回顾性分析32例骨肉瘤患者的临床资料,对患者性别、年龄、病程、血清碱性磷酸酶(AKP)水平、肿瘤大小、肿瘤生长部位、Enneking外科分期、手术方式及远处转移9个因素进行统计学分析.结果 32例患者均获得随访,随访时间6～ 52(40.28±5.58)个月;随访期间死亡12例,3年生存率为62.5％(20/32).单因素分析结果显示肿瘤生长部位、Enneking外科分期、手术方式及远处转移与患者预后明显相关(P＜0.05).多因素分析结果显示Enneking外科分期、手术方式及远处转移是影响患者预后的独立危险因素(OR值分别为2.420、0.318、2.166,P值分别为0.008、0.006、0004).结论 Enneking外科分期、手术方式及远处转移是影响骨肉瘤患者预后的独立危险因素,早期诊断及充分切除肿瘤可改善患者预后.     

进展期胃癌患者术后复发相关因素分析

目的 分析进展期胃癌患者行根治性手术后复发转移的相关因素.方法 回顾性分析1997年1月至2001年6月收治的428例进展期胃癌并行根治性手术患者的临床资料.采用Kaplan-Meier生存率分析法统计患者术后生存率,采用Log-rank检验单因素分析和COX比例风险模型多因素分析方法分析进展期胃癌患者根治术后复发相关因素.结果 复发率为35.90％( 154/428),5年生存率为45.4％.经Log-rank检验单因素分析结果表明:年龄、肿瘤大小、Borrmann分型、浸润深度、淋巴转移范围和分化程度与胃癌根治术后复发有显著相关性(P＜ 0.05).COX回归模型多因素分析结果显示:肿瘤大小、浸润深度和淋巴转移范围是影响胃癌术后复发的独立因素(P＜0.05).结论 患者的年龄、肿瘤大小、Borrmann分型、pTN分期以及肿瘤分化程度是胃癌根治术后预后的重要影响因素;肿瘤大小、浸润深度和淋巴转移范围是影响胃癌根治术后预后的独立因素.     

233例乳腺癌的治疗及预后分析

目的探讨影响乳腺癌疗效和预后的各种因素。方法回顾性分析233例乳腺癌患者的临床资料，观察生存率。并进行单因索及多因素回归分析。结果全组病例1，2，3，5，8年生存率分别为95．71％、82．83％、61．37％、37．34％、6．90％。单因素分析显示腋窝淋巴结转移数、原发肿瘤大小与生存成负相关（P〈0．001）；TNM晚期及复发患者中位生存时间明显缩短（P〈0．0001）；术后辅助化疗方案、病理类型、综合治疗方式与生存相关具有统计学意义。COX比例风险模型分析显示治疗方式、术后辅助性化疗方案和复发具有独立预后意义（P〈0．05）。结论乳腺癌患者的远期生存及复发与原发肿瘤大小、腋窝淋巴结转移状态、病理类型、术后辅助性化疗方案及个体化综合治疗方式密切相关。     

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.     

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.     

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.     

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.     

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.