复发性上皮性卵巢癌41例临床分析

目的:探讨复发性上皮性卵巢癌的综合治疗方法、再次肿瘤细胞减灭术的临床价值及影响再次肿瘤细胞减灭术治疗效果的因素。方法:回顾性分析41例复发性上皮性卵巢癌的临床资料。结果;复发后行再次肿瘤细胞减灭术联合术后化疗的患者和单纯化疗的患者比较复发后生存时间明显延长(P<0.05);复发后进行再次肿瘤细胞减灭术联合术后化疗的22例患者中初次治疗后的临床缓解时间(DFI)≤12个月的患者复发后中位生存时间较DFI>12个月的患者明显缩短(P<0.01);再次肿瘤细胞减灭术基本切净或残余灶≤2cm的患者和残余灶>2cm的患者比较,复发后中位生存时间明显延长(P<0.05);再次术后化疗疗程数>3次的患者和≤3次的患者比较,复发后中位生存时间明显延长(P<0.01)。结论:在严格选取手术适应症的前提下,再次肿瘤细胞减灭术辅以术后规律、足疗程的化疗可以延长复发患者的生存时间。     

脑转移瘤的外科治疗

目的　研究影响脑转移瘤手术治疗预后的因素。方法　回顾性分析 35例脑转移瘤外科治疗的临床资料。根据治疗方法将其分成 6组 ,统计分析各组治疗结果。结果　 1年生存率为 4 8.6 % ,2年生存率为 14 .3% ,5年生存率为 2 .9%。手术加放疗组平均生存时间为 (14 .6± 1.8)个月 ,显著高于单纯手术组的 (8.3± 1.9)个月 (P <0 .0 5 )。手术加化疗组平均生存时间为 (13.0± 3.5 )个月 ,与单纯手术组无显著差异 (P >0 .0 5 )。结论　脑转移瘤经外科治疗后预后仍差。手术后结合放疗优于单纯手术 ,而手术后化疗不能有效地延长脑转移瘤患者的生存时间。     

241例直肠癌临床分析

目的　初步探讨直肠癌预后的因素。　方法　通过回顾分析我院 1985年 1月～ 1997年 12月收治的 2 41例直肠癌的 5年生存率 ,并研究其影响因素。　结果　总 5年生存率为 43 2 % ,Dukes’A、B、C、D期的 5年生存率分别为71 4%、63 .2 %、3 2 2 %、0 ,肿瘤距肛门≥ 7cm的 5年生存率为 5 2 % ,<7cm的生存率为 3 8.5 % ,两组差异显著 (P <0 0 5 ) ;不同病理类型的 5年生存率有显著差异 (P <0 0 5 ) ;单纯手术、手术加放疗、手术加化疗、手术加放化疗组的 5年生存率分别为 41 1% ,3 8 9% ,5 0 % ,44 4% ,术后放、化疗与单纯手术 5年生存率比较差异无统计意义 (P >0 0 5 ) ,B期组术后 5年局部复发率和转移年分别为 2 3 2 %、3 2 6% ,C期组则分别为 2 8.9% ,44 4% ,术后放疗与单纯手术比较可能降低局部复发率 ,而C期术后放化疗与单纯手术比较能降低远处转移率 (3 2 %比 5 7.5 % ) ,两者差异显著 (P <0 0 5 )。　结论　临床分期、肿瘤距肛门距离、病理类型是影响直肠癌 5年生存率的重要因素 ,术后放化疗能降低C期远处转移率 ,术后放疗可能减少局部复发率     

阑尾类癌32例诊治分析

目的　探讨阑尾类癌的临床及生物学特性、诊断和手术治疗经验。方法　回顾性分析自 1978～ 1998年收治的 3 2例阑尾类癌患者临床资料。结果　本组 3 2例患者中 2 6例 ( 81 2 5 %)的症状和体征提示为阑尾炎。 6例患者 ( 18 75 %)为偶然发现。肿瘤直径 <1 0cm 2 5例 ,1 0～ 2 0cm 4例 ,>2 0cm 3例。 2 9例局限于阑尾壁内 ,2例侵犯兰尾系膜 ,1例伴局部淋巴结转移。 3例肿瘤直径 >2 0cm侵犯阑尾系膜及局部淋巴结转移 ,再次行右半结肠切除术 ,2例行盲肠切除术 ,2 7例行阑尾切除术。 2 8例患者获得随访 ,均无复发和远处转移。结论　阑尾类癌少见 ,多表现为阑尾炎的症状。阑尾根部类癌行盲肠切除术 ,<1 0cm的阑尾类癌仅作单纯阑尾切除术即可 ,1 0～ 2 0cm的阑尾类癌可行阑尾及其系膜切除术 ,>2 0cm的阑尾类癌应行右半结肠切除术     

下咽癌120例临床疗效的回顾性分析

目的探讨下咽癌单纯手术、术后放疗和术后放疗 化疗的临床疗效。方法回顾性分析1979年2月~2002年10月收治的下咽癌120例。单纯手术组(简称S组)30例,术后放疗组(简称S R组)60例,术后放疗和化疗组(简称S R C组)30例。随访中位时间42.7个月。结果根据Kaplan-Meier方法统计S组、S R组、S R C组3、5年生存率分别为34.9%、30.4%,47.5%、42.9%,56.1%、47.3%。S组3、5年生存率和S R组及S R C组3、5年生存率存在显著性差异(χ2=8.87,P=0.003,χ2=4.74,P=0.029,χ2=11.47,P=0.009,χ2=13.22,P=0.001),S R组和S R C组3年生存率存在显著性差异(χ2=3.42,P=0.047),S R组和S R C组5年生存率差异无显著性(χ2=2.60,P=0.279)。结论术后放疗明显提高了下咽癌3、5年生存率,应该成为下咽癌首选的治疗方法。合并化疗的综合治疗未能明显提高下咽癌5年生存率。     

32例I期上皮性卵巢癌诊治的回顾性分析

目的　探讨I期上皮性卵巢癌的规范化诊断与治疗。方法　对 14 6例上皮性卵巢癌进行回顾性分析 ,全部手术标本均经病理检查证实。结果　 1980年 1月～ 2 0 0 2年 6月 ,共收治上皮性卵巢癌 14 6例 ,其中I期癌 3 2例 ,占 2 1 92 % ,平均发病年龄45 3 2岁。初诊症状以自行触及肿物、腹胀、腹痛及压迫症状为前 4位就诊原因。除 3例未在本院手术外 ,其余都在本院手术和化疗。治疗结果 3 2例I期癌中失访者 4例 ,3例死于其它疾病 ,5例复发 ,3例死亡 ,5年生存率 92 87% ,10年生存率 83 90 %。结论　早期与晚期卵巢癌的预后有明显的差别 ,如果对卵巢癌能作出早期诊断及规范化治疗 ,可提高生存率。     

PBX3在卵巢癌中的表达及其与临床病理参数和预后的关系

目的探讨配对盒基因3 (PBX3)在卵巢癌中的表达及其与临床病理参数和预后的关系。方法选取2010年1月-2015年12月在该院妇科行手术治疗并病理证实的卵巢癌患者134例,同时取距卵巢癌组织5 cm以上的正常卵巢组织为癌旁组。采用酶联免疫吸附法及免疫组化法测定卵巢癌组织及正常卵巢组织中PBX3蛋白的表达水平,分析其与临床病理参数和预后的关系。结果卵巢癌组PBX3蛋白表达水平高于癌旁组(P0. 05);卵巢癌组PBX3阳性率高于癌旁组(χ2=20. 210,P0. 01); PBX3蛋白表达与年龄相关性不明显(P0. 05),与肿瘤最大径、病理学分级、TMN分期、浸润深度、淋巴血管间隙浸润、淋巴结转移、复发相关性明显,且肿瘤最大径≥5 cm、病理学分期越高、TMN分期越高、浸润深度越深、有淋巴血管间隙浸润、有淋巴结转移、有复发,PBX3蛋白阳性表达率越高(均P0. 05); PBX3阴性组3年生存率及生存期均明显高于PBX3阳性组(P0. 01)。结论 PBX3在卵巢癌的发生发展过程中起促进作用; PBX3蛋白在卵巢癌组织中表达量增加,PBX3蛋白低表达的卵巢癌患者能获得较好的预后。     

再次减灭术对复发卵巢癌患者的影响因素分析

目的探讨采用外科手术方法对复发性卵巢癌减灭治疗的临床效果及意义。方法选择内江市第二人民医院2002-2005年复发性卵巢癌患者34例,均采取手术方法对复发肿瘤及转移病灶进行减灭治疗,评价患者手术情况、生存率以及影响患者生存时间的相关因素。结果 34例患者均手术成功,术后临床症状均获得改善,再次手术后1、3、5年生存率分别为62.3%、38.2%、20.6%,平均生存时间为35.5个月,多因素分析显示,初次手术肿瘤分期及再次手术切除范围是患者再次手术后生存的独立影响因素。结论再次肿瘤减灭术治疗复发卵巢癌能够取得较好的临床效果,提高了患者的生存时间。     

复发性上皮性卵巢癌紫素或环磷酰胺配伍铂类治疗疗效及费用

目的比较复发性上皮性卵巢癌患者应用紫素加铂类(TP组)与环磷酰胺加铂类(PC组)方案化疗的疗效及费用。方法我院1998年1月至2003年1月收治的符合入选标准的复发性上皮性卵巢癌患者39例,其中TP方案化疗24例,PC方案化疗15例。对2组在总生存率、中位生存时间、药物反应率、不良反应、住院费用等方面进行回顾性分析。结果TP组复发后中位生存时间为28．64月,PC组中位生存时间为17．29月,2组比较,差异有统计学意义(P＜0．05);TP组及PC组复发患者化疗后有效反应持续时间中位数分别为25．02月和1．40月,2组比较,差异有统计学意义(P＜0．05);2组消化系统不良反应比较,Z=—0．422(P＜0．05),2组血液系统均无Ⅳ度不良反应发生;TP组医疗费用为62934元,PC组为22 497元,2组比较,差异有统计学意义(P＜0．05),TP组每生存1年,平均住院费用为64 641元,PC组每生存1年,平均住院费用为21 318元。结论紫素加铂类作为复发性卵巢癌的首选化疗方案,患者化疗后有效率、复发后生存时间及有效反应持续时间等方面优于环磷酰胺加铂类组,而化疗费用亦高于PC组。     

卵巢组织中蛋白激酶CK2β表达与卵巢癌病理特征的关系

目的 研究卵巢癌组织蛋白激酶CK2β表达与卵巢病理特征的关系。方法 回顾性分析台州恩泽医疗中心(集团)恩泽医院2014年2月—2017年2月98例卵巢癌患者临床资料,取卵巢癌组织与癌旁组织病理活检标本,行免疫组化检测。记录蛋白激酶CK2β表达情况,比较不同蛋白激酶CK2β表达水平患者临床病理特点(FIGO肿瘤分期、分化程度、化疗敏感性、组织分型、肿瘤直径)。随访记录98例患者3年无进展生存率和总生存率。采用Cox风险模型分析影响卵巢癌患者3年无进展生存率和总生存率的独立因素。结果 98例患者癌组织与癌旁组织蛋白激酶CK2β表达情况差异有统计学意义(P<0.05)。癌组织阳性表达率为84.69%,显著高于癌旁组织的21.43%,差异有统计学意义(P<0.05)。卵巢癌癌组织CK2β阴性、CK2β低表达及CK2β高表达3组患者FIGO、化疗敏感性及分化程度差异有统计学意义(P<0.05),其中CK2β高表达组肿瘤分期显著高于低表达组和阴性组,化疗敏感性差于其他两组,分化程度低于其他两组(P<0.05)。3组患者年龄、体质指数(BMI)、组织分型及肿瘤直径差异均无统计...     

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 occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.