绒癌八例治疗失败原因分析及对策

１９７５年２月～１９９７年４月，在我院收治的绒癌病人中，有８例因入院前后治疗失误而死亡，现对其治疗失败原因进行分析，并提出对策。１临床资料１．１职业与年龄工人１例，农民７例；年龄２３～４５岁，平均２９．５岁。１．２末次妊娠性质及至发病时间葡萄胎３例，...     

鼻咽癌首程治疗后远处转移病例的预后因素分析

目的：探讨影响鼻咽癌远处转移病例预后的因素。方法：回顾性分析94例鼻咽癌远处转移病例的临床资料。结果：全组的1、3及5年累积生存率分别为37．5％、11．7％及3．3％。单因素和多因素分析均显示无远处转移间歇期（MFI：metastasis free interval）＞12个月、无肝脏转移、转移灶的放疗剂量≥40Gy、转移后化疗周期数≥4、转移后治疗疗效达CR的患者预后较好。另外,多因素分析显示病程（首次起病至首程治疗开始的间期）较长的患者预后较好。结论：MFI、转移部位、病程、转移后的放疗或化疗及疗效是鼻咽癌远处转移病例的独立预后因素。     

影响病毒性脑炎预后的相关因素分析（附154例报告）

病毒性脑炎是小儿常见的颅内感染性疾病．治疗上主要采取综合疗法。其预后差异较大，受多种因素影响，我院1990-1997年间共收治154例，报告如下。     

中晚期肝癌的化疗栓塞治疗（附60例病例）

中晚期肝癌的化疗栓塞治疗（附６０例病例）李葆青①邹英华②李松年肝癌的治疗，早期以外科手术切除为首选。但大多数患者被发现时均已为中晚期肝癌，早已失去了手术切除的机会。近年来，中晚期肝癌的化疗栓塞（ＴＡＣＥ）治疗渐为普及。现对笔者在北京医科大学附属一院影...     

单纯细支气管肺泡癌42例生存率及预后因素探讨

目的探讨影响单纯型细支气管肺泡癌（BAC）患者的预后因素。方法根据2004年BAC最新定义,在156例BAC中选取符合标准的单纯型BAC42例进行回顾性分析,按首次就诊时有无临床症状、TNM分期、影像学分型以及细胞生物学指标Ki67、p53进行分组配对,先用χ2检验最后用Cox模型分析处理各组数据。结果42例患者中位生存时间50个月,其1、2、3、5年总生存率分别为100%、95%、84%、62%;按TNM分期,Ⅰ＋Ⅱ期和Ⅲ＋Ⅳ期患者的1、2、3、5年生存率分别为100%、95%、92%、86%和100%、90%、74%、53%（P〈0.05）。首诊时患者有无症状、影像学分型以及细胞p53表达也与生存预后相关。Cox多因素分析提示首诊时有无症状和TNM分期是独立的预后影响因子。结论影响单纯BAC5年生存率的主要因素有患者首诊时有无临床症状及TNM分期,总体生存率较高。     

非霍奇金淋巴瘤染色体异常与临床疗效及预后关系的探讨

非霍奇金淋巴瘤染色体异常与临床疗效及预后关系的探讨张清媛，贾素文，崔淑珍，李永学，孙玉柱，张灵生，韩传贵我们制备了３３例非霍奇金淋巴瘤（ＮＨＬ）患者的瘤组织染色体标本，初步探讨了ＮＨＬ染色体异常与疗效及预后的关系。材料和方法１病例：１９８９年９月～１...     

舌根癌治疗的探讨：附56例病例报告

我院自１９７５年至１９８８年共收治舌根癌５６例。治疗后１、３、５年生存率分别为６２．５％，２８．６％、１６．１％，治疗手段分为单纯放疗（３４例），化疗加放疗（１６例），手术加放疗（６例）．各组的３年生在率分别为２６．５％、３７．５％，１６．７％。根据本文治疗结果，作者建议采用化疗加放疗的综合治疗。     

影响绒毛膜癌预后因素的分析与防治

目的 :探讨绒毛膜癌 (绒癌 )影响预后的高危因素 ,并提出防治措施。方法 :对 64例绒癌患者的临床资料进行回顾性分析 :5 8例接受正规化治疗 ,必要时辅以超选择性动脉插管灌注化疗或手术 ,分析临床疗效及毒副反应 ,并比较影响疗效的高危因素。结果 :5 8例患者中 ,5 2例有效 ,6例耐药 ,总有效率 89.7% ( 5 2 / 5 8)。有效组与耐药组的年龄比较 ,差异有高度显著性 (P <0 .0 1) ,两组血HCG比较 ,差异有显著性 (P <0 .0 5 ) ,两组间比较子宫大小及子宫动脉RI值 ,差异无显著性 (P >0 .0 5 )。Ⅰ、Ⅱ期总有效率 94 .6%。Ⅲ期由原来单用静脉化疗的 78.9%升至89.5 %。白细胞水平在 1、2、3组方案中分别为 ( 2 .0 4± 0 .5 3 )× 10 9/L、( 2 .76± 0 .2 6)× 10 9/L、( 1.5 2± 0 .2 8)× 10 9/L。结论 :患者年龄、血HCG与耐药性的产生有关。高危及耐药性绒癌可用EMA/CO化疗 ,且联合超选择性动脉插管灌注化疗及手术 ,能进一步改善治疗效果。治疗中注意观察白细胞水平 ,避免严重的骨髓抑制。     

Psychological Risk Factors of Functional Impairment After COVID-19 Deaths

ContextPeople bereaved from COVID-19 report higher levels of grief than people bereaved from natural causes. The full impact of this onslaught of grief will not be known for some time. Ensuring high-quality bereavement care in the context of COVID-19 presents unprecedented challenges to end-of-life care.ObjectivesWe aimed to determine how psychological symptoms explain functional impairment.MethodsA sample of people bereaved through COVID-19 (N = 307) in the United States completed demographic questions and self-report measures of neuroticism; symptoms of depression, generalized anxiety, posttraumatic stress, separation distress, and dysfunctional grief; and functional impairment due to a COVID-19 loss.ResultsMost participants’ scores were in the clinical ranges for generalized anxiety, depression, dysfunctional grief, and functional impairment. Functional impairment scores were not associated with age, gender, and time since loss but were associated with being diagnosed with COVID-19, having received professional help with the loss, and a close relationship to the deceased. A logistic regression model showed that, after controlling for covariates, the odds of functional impairment significantly increased by 27% for higher scores in separation distress, 25% for higher scores in dysfunctional grief, and 13% for higher scores in posttraumatic stress.ConclusionPeople bereaved because of COVID-19 are at risk of functional impairment, especially if they have symptoms of separation distress, dysfunctional grief, and/or posttraumatic stress. Attention to identifying and treating functional impairment may be important in facilitating grieving persons’ full participation in social and economic life during and after the pandemic.     

292例早产危险因素及预后影响因素分析

回顾性分析292例早产的危险因素以及胎龄、分娩方式对早产儿预后的影响。结果胎膜早破、妊娠期高血压疾病(重度子痫前期)、前置胎盘、双胎、疤痕子宫是导致早产的主要危险因素;胎龄越小、早产儿体重越低,早产儿发病率及死亡率越高(P均<0.05);分娩方式与早产儿预后无关(P>0.05)。     

Psychologic Factors and Risk of Mortality After Spinal Cord Injury

Krause JS, Carter R, Zhai Y, Reed K. Psychologic factors and risk of mortality after spinal cord injury.

Objective

To identify the association of 2 distinct psychologic constructs, personality and purpose in life (PIL), with risk of early mortality among persons with spinal cord injury (SCI).

Design

Prospective cohort study with health data collected in late 1997 and early 1998 and mortality status ascertained in December 2005.

Setting

A large rehabilitation hospital in the southeastern United States.

Participants

Adults (N=1386) with traumatic SCI, at least 1 year postinjury.

Interventions

Not applicable.

Main Outcome Measures

We first evaluated the significance of a single psychologic predictor (a total of 6 scales) while controlling for biographic and injury predictors using Cox proportional hazards modeling and subsequently built a comprehensive model based on an optimal group of psychologic variables.

Results

There were a total of 224 (16.2%) observed deaths in the full sample. The total number of deaths was reduced to 164 in the final statistical model (of 1128 participants) because of missing data. All 6 psychologic factors were statistically significant in the model that was adjusted for biographic and injury factors, whereas only 3 psychologic factors were retained in the final comprehensive model, including 2 personality scales (Impulsive Sensation Seeking, Neuroticism-Anxiety) and the PIL scale. The final comprehensive model only modestly improved the overall prediction of survival compared with the model with only biographic and injury variables, because the pseudo-R² increased from 0.121 to 0.129, and the concordance increased from 0.730 to 0.747.

Conclusions

The results affirm the importance of psychologic factors in relation to survival after SCI.     

肝癌碘油化疗性栓塞术——疗效及影响因素分析

肝动脉碘油化疗性栓塞术(下称LP-TAE术)是目前治疗中晚期原发性肝癌最有效的姑息疗法之一。本文对52例原发性肝癌经LP-TAE术治疗后的42例随访资料作了较全面、系统的疗效评估及疗效影响因素分析。结果显示术后中位生存期11.5个月,半年、1年和2年生存率分别为70％、56.8％和42.5％;影响疗效的主要因素为肿瘤大小、肿瘤有无包膜、门脉主干有无癌栓及施行LP-TAE术的次数。     

外阴阴道念珠菌病危险因素研究

目的调查外阴阴道念珠菌病的患病情况及分布特征,并探讨女性外阴阴道念珠菌病的危险因素。方法通过病例对照研究,比较住房工作环境、疾病史及生活卫生习惯等多种因素与外阴阴道念珠菌病的关系。结果外阴阴道念珠菌病好发于夏秋季,好发时间是月经来潮前。工作强度大、近期有流产史、常穿紧身裤、非经期常使用卫生护垫、药液清洗外阴不当等是发病的危险因素;而太阳常晒内裤等是保护因素。结论外阴阴道念珠菌病的发生与社会环境、生理心理、生活习惯等多方面因素有关,医务人员要加强防治该病的指导力度。     

低体重新生儿的危险因素和预后分析

目的:探讨出生低体重儿的原因和防治措施.方法:对1989年1月至2009年12月我科出生的545例低体重儿(出生时体重低于2500克)的发生和死因进行回顾性分析.结果:低体重儿母亲妊娠期并发症如流感、中重度贫血和妊娠高血压综合征等明显增高;低体重儿死亡率为15.72%,显著高于正常出生体重儿(P<0.01);其主要死因是新生儿肺炎、致死性畸形、败血症和颅内出血等.结论:母亲孕期并发症是低体重儿主要原因,积极治疗和护理孕期母亲疾患和低体重儿是减少低体重儿和降低其死亡率的关键.