中国原发性肝癌肝动脉化疗栓塞术和射频消融联合治疗与单独治疗的有效性和安全性比较

目的比较原发性肝癌肝动脉化疗栓塞术(TACE)和射频消融(RFA)联合治疗与两者单独治疗的有效性和安全性。方法通过Pub Med、中国生物医学文献数据库和中国知网数据库的检索与文献筛选,纳入符合要求的临床随机对照试验的原始文献。采用荟萃(Meta)分析,比较联合治疗与单独治疗的有效性和安全性。结果最终纳入31篇随机对照试验(2 675例患者)的分析显示,联合组的原发性肝癌治疗总有效率及1年、2年和3年生存率显著高于TACE单独治疗(合并OR值为3.26~4.62),也显著高于RFA单独治疗(合并OR值为1.68~3.11)。TACE与RFA联合治疗原发性肝癌的不良反应和并发症发生率与两者单独治疗的差异无统计学意义。结论原发性肝癌TACE和RFA联合治疗效果较好,但TACE与RFA联合治疗原发性肝癌的安全性仍需进一步研究。     

肝癌TACE与RFA治疗前后ICG R15及肝功能变化

目的通过测定原发性肝癌(HCC),肝动脉化疗栓塞术(TACE)与射频消融(RFA)治疗前后吲哚氰绿(ICG R15)及肝血清学指标,比较两种治疗方法对肝功能的损害。方法选取北华大学附属医院收治的HCC患者64例,分为TACE组(32例),RFA组(32例)。两组患者于术前及术后1周测定吲哚氰绿试验15min滞留率(indocyanine green retention rate at 15 min,ICG R15)和肝血清学指标。根据术前及术后上述指标的改变,评估并比较两组治疗方法对肝功能损害的程度。结果两种治疗方法均对肝功能造成损害,两组治疗后ICG R15均值都高于治疗前(P0.05),TACE组治疗前后ICG R15均值的差值明显高于RFA组(P0.05)。TACE组TB,ALT,γ-GT治疗前后的差值高于RFA组(P0.05)。结论两种治疗方法对肝功能均造成一定损害,与TACE比较,RFA对肝功能的损害轻。     

血管性与非血管性介入联合治疗原发性肝癌的疗效观察

[目的]探讨肝动脉化学拴塞(TACE)联合经皮射频消融(RFA)和经皮无水酒精注射(PEI)治疗原发性肝癌的治疗效果和应用价值.[方法]对原发性肝癌患者经TACE后疗效不满意的38例患者行联合RFA和PEI周期性治疗,评价肿瘤坏死率,患者生存率.[结果]肿瘤完全坏死29例,坏死率80.6%±5.1%,生存率6个月100%±0.0%,9个月96.5%±2.2%,12个月82.7%±4.3%,18个月65.5%±3.4%,无严重并发症出现.[结论]TACE联合RFA、PEI序贯治疗肝癌可提高肿瘤完全坏死率并延长患者生存期,并发症少.     

大分割三维适形放疗联合经导管动脉化疗栓塞治疗不能手术原发性肝癌临床研究

目的 探讨大分割三维适形放疗(3DCRT)联合经导管动脉化疗栓塞(TACE)治疗不能手术原发性肝癌的临床疗效.方法 102例不能手术切除的中晚期原发性肝癌患者按随机数字表法分为两组,对照组49例,采用TACE治疗,观察组53例,采用大分割3DCRT联合TACE治疗,定期检查,判断两组患者近期疗效,调查患者1、2、3年生存率、不良反应以及治疗后血清甲胎蛋白(AFP)的表达情况.结果 观察组患者完全缓解率、进展率、总有效率分别为17.0％ (9/53)、11.3％(6/53)、73.6％ (39/53),对照组分别为2.0％(1/49)、28.6％(14/49)、51.0％( 25/49),两组比较差异有统计学意义(P＜0.05).两组不良反应比较差异无统计学意义(P＞0.05).对照组1、2、3年的生存率分别为51.0％(25/49)、28.6％( 14/49)、14.3％ (7/49),中位生存期为15个月；观察组分别为71.7％(38/53)、52.8％( 28/53)、39.6％( 21/53)、20个月.观察组2、3年生存率明显高于对照组,差异有统计学意义(P＜ 0.05或＜0.01).观察组血清AFP阳性患者治疗前后无明显变化率为9.8％(4/41),与对照组的31.6％( 12/38)比较差异有统计学意义(P＜0.05).结论 大分割3DCRT联合TACE治疗不能手术原发性肝癌的临床疗效好,值得在临床中推广.     

肝动脉化疗栓塞联合超声引导下射频消融及经皮肝穿刺瘤内无水酒精注射治疗乏血供大肝癌的疗效分析

目的探讨肝动脉化疗栓塞(TACE)联合超声引导下射频消融(RFA)及经皮肝穿刺瘤内无水酒精注射(PEI)治疗乏血供大肝癌的临床疗效。方法选取2012年3月至2014年9月在我院行介入治疗的48例乏血供大肝癌患者,其中26例行TACE联合RFA、PEI(联合组),22例行TACE(对照组)。分析比较两组的临床疗效和生存率。结果术后联合组的治疗有效率和血清AFP下降率分别为84.62%和80.77%,均明显高于对照组的59.09%和50.00%(P<0.05)。联合组术后6、12、18、24个月的生存率分别为100.0%、92.3%、80.8%、65.4%,均明显高于对照组的77.3%、63.6%、45.5%、36.4%(P<0.05)。结论与单独行TACE比较,TACE联合RFA、PEI治疗乏血供大肝癌的疗效显著,可有效提高患者的生存率。     

经皮肝穿射频消融联合介入治疗小肝癌与传统的手术切除治疗对照研究

目的比较肝动脉化疗碘油栓塞术(TACE)与射频消融术(RFA)联合介入治疗原发性小肝与传统手术治疗小肝癌的临床效果,为临床制定治疗方法提供依据。方法回顾性分析2007年2月～2009年2月我院采用TACE联合RFA治疗的66例小肝癌患者的临床资料,并以同期采用手术切除治疗的66例患者为对照组,比较两组患者12、24、36个月临床复发率和生存率,手术并发症发生率。结果观察组12、24、36个月临床复发率分别为3.03%、7.58%、12.12%,对照组分别为3.03%、9.09%、13.64%,其中24、36个月复发率两组间比较差异具有统计学意义(P<0.05)。观察组12、24、36个月生存率分别为100.00%、98.48%、93.94%,对照组分别为100.00%、96.97%、92.42%,其中24个月、36个月生存率两组间比较差异具有统计学意义(P<0.05)。治疗期间观察组并发症发生率为3.03%,对照组并发症发生率为10.61%,组间比较差异具有统计学意义(P<0.05)。结论 TACE联合RFA治疗小肝癌疗效确切,并发症发生率低,值得临床推广。     

TACE联合射频消融对初发性及复发性肝癌的疗效及对预后影响因素研究

目的探究经肝动脉化疗栓塞术(TACE)联合射频消融(RFA)治疗初发性及复发性肝癌的疗效及预后影响因素。方法抽取2012年6月-2014年10月我院收治的78例肝癌患者,将初发性肝癌患者作为对照组,复发性肝癌患者作为研究组,各39例。两组均采用TACE+RFA治疗,术后随访2年。统计两组临床疗效、不同随访时间(第6、12、24个月)生存率,对比治疗前后Child-Pugh评分变化情况,并分析预后影响因素。结果研究组治疗有效率(82.05%)与对照组(87.18%)对比,差异无统计学意义(P0.05)。治疗前两组Child-Pugh评分对比差异无统计学意义(P0.05);治疗后两组Child-Pugh评分均较治疗前有所降低,且组间对比差异无统计学意义(P0.05)。研究组术后第6、12、24个月生存率(92.31%、79.49%、61.54%)与对照组(92.31%、76.92%、66.67%)对比差异无统计学意义(P0.05)。合并门静脉侧支循环、Child-Pugh分级、AFP及总胆红素均为肝癌患者预后影响因素。结论联合采用TACE与射频消融治疗初发性及复发性肝癌均可取得显著疗效,改善患者肝功能,提高生存率,且合并门静脉侧支循环、Child-Pugh分级、AFP及总胆红素均为肝癌患者预后影响因素。     

肝动脉栓塞化疗治疗中晚期原发性肝癌20例

目的:探讨经肝动脉栓塞(TACE)化疗治疗中晚期原发性肝癌的治疗效果。方法:对20例中晚期肝癌患者进行TACE化疗术,药物是卡铂500mg,丝裂霉素10mg,5-氟尿嘧啶1.25g,超声乳化油10～30ml。伴有肿块破裂或肝硬化时同时用明胶海绵颗粒做肝动脉栓塞或部分脾栓塞术。而同时期仅予保守治疗20例患者为对照组。结果:治疗组全部病例均取得较好的治疗效果,肿瘤有不同程度缩小,生活质量有所改善,生存时间半年生存16例(生存率80%),1年生存11例(生存率55%),2年生存3例(生存率15%),而对照组半年生存7例(生存率35%),1年生存3例(生存率15%),均明显低于治疗组(P<0.01)。结论:采用TACE化疗术治疗中晚期肝癌疗效较好。     

灌注栓塞治疗30例原发性肝癌的疗效评价

[目的]探讨灌注栓塞治疗原发性肝癌的临床疗效。[方法]60例原发性肝癌患者,分成观察组和对照组。对照组采用肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗;观察组采用门静脉持续灌注化疗(portal vein infusion chemotherapy,PVC)配合TACE治疗。[结果]观察组总有效率为56.67%优于对照组总有效率30.00%,差异有统计学意义(P﹤0.05)。观察组1年生存率为66.67%高于对照组40.00%,差异有统计学意义(P﹤0.05)。[结论PVC配合TACE治疗原发性肝癌疗效佳,具有重要临床价值。     

TACE联合射频消融对中期肝癌患者血清GP73、AFP、AFP-L3的影响

目的观察经肝动脉化疗栓塞术(TACE)联合射频消融(RFA)治疗中期肝癌(HCC)近期疗效及对血清高尔基体糖蛋白-73(GP73)、甲胎蛋白(AFP)、甲胎蛋白异质体-3(AFP-L3)水平的影响。方法以本院收治的300例中期HCC患者,非随机临床同期对照研究及患者自愿原则分为对照组(TACE治疗,n=150)、实验组(TACE联合RFA,n=150),评估两组近期疗效,观察治疗前、治疗后血清GP73、AFP、AFP-L3、超氧化物歧化酶(SOD)、丙二醛(MDA)水平,随访两组治疗后1年、2年复发率及总生存率,比较两组安全性。结果实验组近期有效率明显高于对照组(P<0.05);治疗后两组GP73、AFP、AFP-L3水平较治疗前明显降低,且实验组明显低于对照组(P<0.05),治疗后两组SOD、MDA较治疗前明显升高(P<0.05),但治疗后两组比较差异无统计学意义(P>0.05);实验组治疗后2年复发率明显低于对照组(P<0.05),两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论与单一TACE治疗比较,TACE联合RFA可明显提高中期HCC患者近期疗效、降低复发率,可有效杀死肿瘤细胞从而使AFP、AFP-L3及GP73水平明显下降,此外联合治疗不会增加机体氧化应激反应,安全性好。     

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.     

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.     

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.     

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.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.