宫颈癌发病年龄与临床预后因素的关系探讨

【目的】探讨宫颈癌发病年龄与临床预后因素的关系。【方法】回顾分析南方医院 1997年 1月至2 0 0 2年 12月收治的 93例宫颈癌 ,根据患者年龄分为年轻组 (≤ 35岁 )和中老年组 (>35岁 ) ,对其临床分期、病理组织学、细胞分化等临床资料进行对比分析。【结果】两组患者在临床分期、组织学上比较有统计学差异 ;≤ 35岁组 :≤Ⅱa期占 82 .6 1% ,≥Ⅱb期占 17.39% ,鳞癌占 86 .6 7% ,腺癌占 13.39% ;而 >35岁组 :≤Ⅱa期占 5 1.4 3% ,≥Ⅱb期占 4 8.73% ,鳞癌占 82 .98% ,腺癌占 17.0 2 %。从细胞分化程度分析 ,≤ 35岁组和 >35岁组比较差异无显著性。而 >35岁组宫颈癌患者具有临床期别较高、腺癌较多的不良预后因素。【结论】年轻宫颈癌患者预后较好。     

年轻宫颈癌患者临床特征及预后Meta分析

目的探讨年龄≤35岁年轻宫颈癌患者发病的临床病理特点。方法检索Pubmed、Ovid-medline全文数据库、CNKI、维普数据库、万方数据库等并收集有关年龄≤35岁年轻宫颈癌患者与>35岁的中老年宫颈癌患者的病例对照研究文献,按预定标准进行筛选,对纳入研究进行质量评价,并提取相应指标完成Meta分析。结果根据本研究的纳入与排除标准,最终纳入文献16篇,其中英文文献3篇,中文文献13篇,共包括13 714例宫颈癌患者(年轻宫颈癌患者2 582例,中老年宫颈癌患者11 132例)。Meta分析表明:年轻宫颈癌患者临床分期为早期(0^ⅡA)发生率、病理组织学分型为宫颈非鳞癌(腺癌为主)发生率、组织学分级为低分化(G3)、盆腔淋巴结转移阳性发生率显著高于中老年宫颈癌患者。癌灶直径大于4 cm、宫颈基层浸润深度≥1/2、脉管浸润的差异无统计学意义。结论 35岁以下年轻宫颈癌患者临床分期以早期癌为主,病理组织学分型为低分化非鳞癌,但生存率较中老年组低。应加强宫颈癌防治知识的宣传和筛查的推广,做到早诊断、早治疗。     

年轻早期宫颈癌病理特征及临床分析

目的分析年轻妇女宫颈癌的临床病理特征和治疗特点。方法对2006年1月～2010年6月收治的48例年轻早期宫颈癌患者的临床资料进行回顾性分析,以同期收治的35岁以上早期宫颈癌患者60例作为对照组,分析比较两组患者的临床表现、病理特征和淋巴结转移情况及治疗特点。结果研究组临床表现以接触性出血为主(P<0.05),中低分化比例较对照组有统计学差异(P<0.05),临床分期、病理学类型及淋巴结转移与对照组差异无统计学意义(P>0.05)。结论宫颈癌有年轻化趋势,接触性出血为年轻妇女宫颈癌的危险信号。临床分期、病理学类型及淋巴结转移均与年龄无关。     

56例年轻宫颈癌临床特点及合理治疗分析

目的分析年轻妇女宫颈癌(35岁以下年轻妇女宫颈癌)的发病趋势、临床病理特点、治疗措施及预后。方法对56例年轻宫颈癌患者的临床资料、病理学诊断结果进行回顾性分析。结果 2005年6月至2010年5月重庆现代女子医院的年轻宫颈癌例数与同期宫颈癌总数之比逐年上升(P<0.01)。年轻宫颈癌中宫颈腺癌及其他非鳞癌总的构成比明显高于同期中老年宫颈癌中非鳞癌所占比例,二者差异有统计学意义(P<0.01)。结论年轻宫颈癌发病率呈上升趋势,年轻宫颈癌的病理类型亦发生了明显变化,故应更好地对年轻宫颈癌患者进行预后估计,并采取相应的综合治疗措施,以改善患者的预后。     

年轻妇女宫颈癌的临床分析

目的探讨山西医科大学第二医院收治的宫颈癌患者中,年轻宫颈癌的发病趋势及临床特点,为临床诊治及预防提供依据。方法回顾性分析2002年1月至2013年12月收治的≤35岁的宫颈癌患者73例为观察组,963例中老年宫颈癌患者为对照组,统计年轻宫颈癌的发病趋势,比较两组患者的临床特征。结果年轻宫颈癌的发病率呈逐渐上升的趋势;年轻宫颈癌患者在首发症状同对照组相比,差异有统计学意义(P<0.05);两组在临床病理分型无统计学差异(P>0.05);年轻宫颈癌患者早期癌比例及盆腔淋巴结转移率高,同对照组相比差异有统计学意义(P<0.05)。结论重视年轻宫颈癌的发病,做好健康教育宣传及宫颈癌筛查工作,做到早发现、早诊断、早治疗,提升宫颈癌患者的生存率及生活质量。     

35岁以下宫颈癌患者的临床及病理特点分析

目的探讨35岁以下宫颈癌患者的临床及病理特点。方法回顾性分析52例年龄小于35岁的年轻宫颈癌患者的临床资料(观察组),按照1∶1比例选择同期年龄大于36岁的中老年宫颈癌患者作为对照组,比较两组患者在性行为、首发症状、宫颈体征、国际妇产科联盟(FIGO)分期、病理类型、生存期等方面的差异,同时进行统计学分析。结果与对照组比较,观察组首次性行为年龄小、性伴侣数多;首发症状以接触性阴道出血为主;宫颈糜烂多;0-Ⅱa期宫颈癌的比率高;非鳞癌比率高;预后差(P<0.05)。结论年轻宫颈癌患者具有自身临床及病理特点,预后较差,应做好青少年早期性教育,普及宫颈癌的防治知识,提高普查活检诊断技术,强调临床综合性治疗,以提高宫颈癌患者的生存率,减少肿瘤向局部和远处转移。     

年轻宫颈癌患者临床特征分析

宫颈癌是危害妇女健康的主要恶性肿瘤之一,近年来年轻妇女宫颈癌发病率有升高的趋势。本文回顾性分析宫颈癌患者的临床资料,探讨年轻宫颈癌的特点。1对象和方法1.1对象2002-01/2003-06在我院妇科住院手术的宫颈癌患者220例,术后均由病理证实,年龄21~68(41.5±4.5)岁。≤35岁的40例宫颈癌患者作为观察组,同期>35岁的180例宫颈癌患者作为对照组,1.2方法回顾性分析220例患者的临床资料,比较两组患者在临床症状、宫颈形态、临床分期、病理类型及组织学分级、治疗方案和预后等方面上的差异。临床分期按国际妇产科联盟(F IGO)1988年分期法,病理类型及分级按WHO原则。1.3统计学处理采用SPSS 12.0统计软件包进行处理,计量资料以均值±标准差(x-±s)表示,应用采用方差分析及t检验,计数资料应用2χ检验,P<0.05为差异有统计学意义。2结果2.1临床表现观察组初次性行为年龄平均(19.5±2.5)岁,低于对照组的(23.4±3.5)岁(t=7.45,P<0.05);观察组性伴侣数1.5±0.4,多于对照组的1.1±0.2(t=2.34,P<0.05);观察组首发症状接触性阴道出血者3...     

年轻宫颈癌患者预后不良的分子病理因素分析

目的探讨35岁以下女性宫颈癌的分子病理特征，揭示其预后不良的分子因素，为提高疗效提供有意义的治疗靶点。方法对64例35岁以下宫颈癌患者（研究组）的病理资料进行回顾性分析，随机选取同期治疗的90例35岁以上宫颈癌患者（对照组）的病理资料做为对照进行比较，运用免疫组化、图像分析的方法同步测定、分析2组之间survivin、P27的蛋白表达差异。结果研究组5年生存率为65．6％，对照组为84．4％，差异有统计学意义（P〈0．05）。Survivin的表达量研究组较对照组明显升高（P〈0、05）；P27在2组之问的表达量无统计学意义（P〉0．05）。结论年轻妇女宫颈癌预后差，其分子病理分析提示与Burvivin的表达有关，以此为靶点通过生物治疗有望改善年轻宫颈癌患者的预后。     

年轻宫颈癌患者预后因素分析

目的探讨年龄≤35岁的年轻宫颈癌患者临床病理特点、预后及其影响因素。方法回顾性分析67例年龄≤35岁宫颈癌患者的临床资料。结果单因素分析结果显示,产次、瘤体直径、病理类型、肌层浸润程度、淋巴结转移、临床病理分期、治疗方式为影响预后的因素;Cox回归分析结果显示,瘤体直径≥4cm、淋巴结转移、临床病理分期、治疗方式为影响预后的独立危险因素。结论新疆地区宫颈癌年轻化趋势明显,且预后较差。     

年轻与中老年子宫颈癌患者的临床与病理特征比较

目的:比较年轻子宫颈癌患者与中老年子宫颈癌患者的临床和病理特征。方法:回顾分析301例子宫颈癌患者的临床资料。比较年轻组(年龄≤35岁)和中老年组(年龄>35岁)患者的临床及病理特征。结果:301例子宫颈癌患者平均发病年龄为(45.07±0.52)岁,发病高峰年龄为35～46岁(54.2%);年轻组43例(14.3%),中老年组258例(85.7%)。所有患者中,多孕(G≥3次)170例(56.5%);多产(P≥2次)102例(33.9%)。临床表现以接触性出血及不规则阴道出血为主,中老年组无症状体检发现的比例较年轻组高(26.0%比20.9%)。年轻组腺癌构成比(16.3%)高于中老年组腺癌构成比(6.7%)(P<0.05)。年轻组以Ia期占44.2%,中老年组占25.6%(P<0.05)。在病理特征方面,年轻组发生淋巴转移的比例以及脉管浸润、宫旁浸润和间质浸润的深度均低于中老年组。结论:年轻子宫颈癌患者较中老年子宫颈癌患者肿瘤的临床分期早,腺癌发生率高。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.