从HBV感染发展致肝癌的模式

原发性肝癌 (ＰＨＣ)的病因和发病机制至今尚未确定 ,目前一致认为乙肝病毒持续感染是ＰＨＣ发生的重要因素。本研究通过 118例ＨＢｓＡｇ阳性ＰＨＣ患者的临床、癌旁组织病理资料 ,分析探讨了从ＨＢＶ感染演变成肝癌的模式。1　材料和方法　　研究对象为ＨＢｓＡｇ阳性ＰＨＣ住院患者 118例 ,全部经病理证实 ,男 10 6例 ,女 12例 ,年龄 8～ 6 8岁 ,其中 8～ 39岁 11例 ,4 0～ 4 9岁 34例 ,5 0～ 5 9岁 4 2例 ,≥ 6 0岁 31例。男女之比为 8.8:1。ＨＢｓＡｇ的检测采用酶联免疫法测定 ,病理标本于手术切除癌肿或剖腹探查时取材于癌旁组织 ,经…     

医院工作人员HBsAg阳性分布状况分析

为了解医院工作人员乙肝病毒感染状况 ,以制定和采取相应的防治措施 ,1998年笔者对本院 6 75名工作人员进行了ＨＢｓＡｇ携带状况调查 ,现报告如下。1　对象与方法1 1　调查对象　本院工作人员 6 75名 ,年龄 :19～ 5 5岁 ,平均 46 3岁 ,其中男 2 83名 ,女 392名 ;医务人员 5 0 5名 ,后勤职工 46名 ,机关干部 2 4名。1 2　调查方法　血样标本为静脉血 2ｍｌ,分离血清备用 ,采用酶链免疫吸附法检测 (ＥＬＩＳＡ)ＨＢｓＡｇ。2　结果在 6 75名中ＨＢｓＡｇ阳性者 34例 (5 0 % ) ;ＨＢｓＡｂ阳性者 2 79例 (4 1 33 % )。2 1　ＨＢｓＡｇ感染…     

低浓度HBsAg人群血清乙肝病毒标志测定意义

乙型肝炎病毒表面抗原 (ＨＢｓＡｇ)测定是诊断乙型肝炎病毒 (ＨＢＶ)感染的重要依据之一 ,不同人群血清ＨＢｓＡｇ浓度可相差成千上万倍 ,关于低浓度ＨＢｓＡｇ血清ＨＢＶ标志测定研究不多。我们对低浓度ＨＢｓＡｇ人群血清进行了乙肝病毒表面抗体 (抗 -ＨＢｓ)、乙肝病毒核心抗体 (抗ＨＢｃ)、乙肝病毒ｅ抗原及其抗体 (ＨＢｅＡｇ、抗 -ＨＢｅ)测定 ,并探讨其临床意义。1　材料和方法1 1　标本　收集患者或健康体检者低浓度ＨＢｓＡｇ血清。1 2　仪器　奥地利ＣｌｉｎｉＢｉｏ 12 8Ｃ酶标仪 ,美国Ｍｕｌｔｉｗａｓｈ洗板机 ,德国ｅｐｐｅ…     

低水平乙肝病毒表面抗原的结果分析

乙型肝炎表面抗原 (ＨＢｓＡｇ)是诊断乙肝病毒感染的指标之一。其结果准确与否 ,对目前社会上参军、升学、提干、招工表 1　低水平ＨＢｓＡｇ乙肝标志物检测结果 8种抗 ＨＢｓ抗 ＨＢｃ抗 ＨＢｅＡｇ 抗 ＨＢｅ ＨＢｇＡｇ吸光模式值 (Ａ)0 .0 9～ 0 .10 5 0 .10 6～ 0 .2 0 .2 1～ 0 .4ｎ-+-+613 7 2 6++-+2 0 2 4++--0 10 1-++-10 2 3--+-110 2-+--0 2 2 4---+10 0 1----17 19等有着直接影响 ,并广泛引起人们注意。特别是一些低水平的血清ＨＢｓＡｇ,由于多种因素的影响 ,容易造成时阴时阳的结果。据有关资料统计显示[1 ] ,低水平的…     

检测聚合清蛋白受体对乙肝的诊断价值

为了解聚合清蛋白受体 (ＰＨＳＡ Ｒ )对乙肝的诊断价值 ,19961998年 ,我们检测了乙肝患者的ＰＨＳＡ Ｒ、ＨＢＶＤＮＡ、ＨＢｅＡｇ、抗 ＨＢｅ ,发现慢性重度乙肝 (ＣＨＢⅢ )的ＰＨＳＡ Ｒ阳性率较高 ,是乙肝病毒传染性和乙肝病毒复制的诊断依据 ,具有一定诊断价值。1　对象和方法1 1　对象　被检者 686例 ,男 5 81例 ,女 10 5例 ;年龄18～ 63岁 ,平均 3 2 6岁。诊断均符合 1995年 (北京 )第 5届全国传染病寄生虫病学术会议修改的《病毒性肝炎防治方案》的标准 ,其中急性乙肝 (ＡＨＢ) 3 8例 ,慢性轻度乙肝 (ＣＨＢⅠ ) 188例 ,慢性中…     

输血和缝针刺伤传播乙型肝炎病毒的感染特点比较

我们以输血和缝针刺伤传播乙型肝炎病毒(ＨＢＶ )分别作为大量输血和微量血液接种传播方式的代表 ,采用套式聚合酶链反应 (ｎ ＰＣＲ)极量稀释法确定ＨＢＶ感染剂量 ,并以此作为评价ＨＢｓＡｇ阳性血液传染强度的基础 ,对两种传播方式ＨＢＶ感染特点进行比较。1　对象和方法1 1　对象　ＨＢｓＡｇ阳性 15 6例 ,男 10 2例 ,女 5 4例 ;年龄 6～ 82岁 ,平均 4 1 0岁。对ＨＢＶ血清学和分子生物学标志进行检测分析。1 2　方法　 (1)标本采集 :于入院次日晨空腹抽静脉血 3ｍｌ,分离血清置 4 0℃冰冻保存 ,血清收集结束后 ,在相同条件下由专人进…     

健康查体乙肝病毒5项血清标志物的体会

我所于 1 999年 1 1月～ 1 2月对某部机关部分人员进行了乙肝病毒 (ＨＢＶ) 5项血清标志物ＨＢｓＡｇ、抗 -ＨＢｓ、ＨＢｅＡｇ、抗 -ＨＢｅ和抗 -ＨＢｃ的检测。此次查体较易引起大家困惑的是抗 -ＨＢｃ阳性率高的问题以及与其他医院检验结果的可比性问题 ,对此有必要加以阐释 ,以供商讨。1　材料和方法1 1　对象　某部机关干部战士、离退休老干部共 96 9人 ,年龄 1 8～ 71岁。1 2　仪器　ＳｔａｔＦａｘ 2 1 0 0型酶标仪 ,ＳｔａｘＦａｘ 2 6 0 0型洗板机 (美国产 )。1 3　试剂　上海科华公司ＥＩＡ试剂盒 ,批号 991 0 1 6。1 4　…     

乙型肝炎病毒感染者血清前S1抗原检测的临床应用

乙型肝炎病毒ＨＢＶ是一种嗜肝细胞病毒 ,(ＨＢｓＡｇ)基因组分别编码Ｓ、前Ｓ1、前Ｓ2、三种蛋白 ,从而组成ＨＢｓＡｇ的主要蛋白。前Ｓ1主要存在于完整的Ｄｅｎｅ颗粒的表面 ,其在病毒的感染、装配、复制中具有十分重要的作用。本文旨在探讨此项指示对乙型肝炎病毒感染者检测、治疗和预后分析的临床应用价值。1　资料与方法1.1　一般资料 :采集 2 35例乙型肝患者血清 ,经乙肝试剂盒酶联免疫方法测定。其结果分成ＨＢｓＡｇ +ＨＢｅＡｇ +ＨＢｃＡｂ +组 (第 1组 ) ,ＨＢｓＡｇ +ＨＢｅＡｂ +ＨＢｃＡｂ +组 (第 2组 ) ,ＨＢｓＡｇ+ＨＢｃ…     

乙型肝炎病毒检测方法的比较

一般认为，在血清或血浆中乙肝病毒表面抗原（ＨＢｓＡｇ）的存在，就表明已感染乙肝病毒，但ＨＢｓＡｇ的出现并不能提供病毒在体内复制活动的信息。以往认为，在慢性乙型肝炎患者中，ＨＢｅＡｇ的存在与否被认为直接反映了乙肝病毒在体内的活动能力。随着基因诊断技术...     

苦参碱联合抗乙肝核糖核酸治疗乙型肝炎的疗效

目前 ,在我国人群中慢性乙肝病毒 (ＨＢＶ)感染者已逾千万 ,因此 ,多年以来 ,慢性乙肝 (ＣＨＢ)的抗病毒治疗一直是人们关注的重点。我们通过对苦参碱联用抗乙肝核糖核酸治疗ＣＨＢ的疗效观察 ,探讨联合用药的抗病毒效果以及疗效判定因素。1　资料与方法1.1　病例来源　 68例治疗组和 40例对照组均选自 1997年 1月 2 0 0 0年 10月间收治的ＣＨＢ患者。所有病例均符合 1995 (北京 )全国传染病与寄生虫病学术会议修订的诊断标准。其中ＨＢｅＡｇ阳性 88例 ,抗 -ＨＢｅ阳性 2 0例。治疗甲组 44例 ,(包括ＨＢｅＡｇ阳性 3 6例、抗 -ＨＢｅ阳性 8…     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。