Cancer in the Gambia: 1988-97

We describe the incidence of cancer in The Gambia over a 10-year period using data collected through the Gambian National Cancer Registry. Major problems involved with cancer registration in a developing country, specifically in Africa are discussed. The data accumulated show a low overall rate of cancer incidence compared to more developed parts of the world. The overall age standardized incidence rates (ASR) were 61.0 and 55.7 per 100 000 for males and females, respectively. In males, liver cancer was most frequent, comprising 58% of cases (ASR 35.7) followed by non-Hodgkin lymphoma, 5.4% (ASR 2.4), lung 4.0%, (ASR 2.8) and prostate 3.3% (ASR 2.5) cancers. The most frequent cancers in females were cervix uteri 34.0% (ASR 18.9), liver 19.4% (ASR 11.2), breast 9.2% (ASR 5.5) and ovary 3.2% (ASR 1.6). The data indicate that cancers of the liver and cervix are the most prevalent cancers, and are likely to be due to infectious agents. It is hoped that immunization of children under 1 year against hepatitis B will drastically reduce the incidence of liver cancer in The Gambia.     

How complete and accurate are cancer registrations notified by the National Health Service Central Register for England and Wales?

STUDY OBJECTIVE: To assess the completeness and accuracy of notification of cancers by the National Health Service Central Register (NHSCR) for England and Wales. DESIGN: Comparison of 720 cancer registrations ascertained from NHSCR up to May 1999 with those ascertained for the same cohort from six other sources and a pathology review of the NHSCR cancer registrations. PARTICIPANTS: People born in Cumbria, north west England, 1950-89, and diagnosed with cancer throughout the UK, 1971-1989. MAIN RESULTS: Cancer diagnoses notified by NHSCR differed substantially from those determined by this pathology review for 47 of the 688 notified cases reviewed (7%; 95% CI 5%, 9%). Over one third of these discrepancies were attributable to failures in data capture or coding by the cancer registration system and almost half to changes in diagnosis; 26 of the 47 discrepant cases were reclassified as non-malignant and 21 as malignancies but with a substantially different diagnosis. The 694 confirmed malignancies represented 94% (95%CI 92%, 95%) of the 740 cancers ascertained from all sources. CONCLUSIONS: It is estimated that the cancer registration system missed at least 10% (95%CI 6%, 15%) of all incident cases of malignant disease. Without additional ascertainment from multiple sources and diagnostic review, it would be incautious to use NHSCR cancer registrations as the sole basis of an epidemiological study.     

改善门诊流程 促进医患和谐

改善门诊流程就是以病人为中心，在现有就诊流程的基础上，充分利用信息技术手段，对门诊的作业流程进行重新思考和重新设计，以求得医院门诊在成本、质量、服务和速度等方面获得进一步的改善，从而减缓医护人员与病人之间可能出现的矛盾。从几个方面探讨了改善门诊流程的途径和方法，经多家医院实施和验证，在医护人员工作效率、病人满意度、医院效益等指标上都有了显著提高，和谐的医患关系得到加强。     

高度散光患者虹膜定位波前引导的LASIK与常规LASIK手术疗效的比较

目的:比较高度散光患者虹膜定位波前引导的LASIK(IR-LASIK)手术与常规LASIK手术的临床效果。方法:≥2.0DC的高度散光患者分别使用VISXS4-IR准分子激光机进行IR-LASIK手术(204例338眼)和常规LASIK手术(180例335眼),对术后裸眼视力和残留散光度数进行比较,IR手术组检查了眼球旋转的角度。结果:IR-LASIK手术组术后2d裸眼视力(≥1.0者89.1%)明显优于常规LASIK手术组(≥1.0者83.6%,P<0.05),术后残留散光度数也明显小于常规LASIK手术组(0.56DCvs1.15DC,P<0.01)。IR-LASIK手术组波前像差检查的散光度数和轴位均与显然验光结果有一定的差别,所有患眼手术时均发生了眼球旋转。这可能是IR手术后疗效较好的重要原因。结论:IR-LASIK手术能够明显改善高度散光患者术后裸眼视力,减轻术后的散光残留。     

Completeness in an African cancer registry

Objective: A high level of completeness of case-finding is essential if data from cancer registries are to be useful for comparative studies. A large case series, collected independently of the cancer registry case-finding mechanisms, as part of a study of the influence of HIV infection on cancer risk, was used to evaluate the completeness of the registry in Kampala, Uganda, for the years 1994–1996. Results: For adults aged 15 or more, the completeness of registration of diagnosed cancer cases was 89.6% (95% CI 87.0–91.7) overall. It varied with age (better ascertainment of younger cases, aged under 30) and cancer site (with Kaposi sarcoma cases significantly better identified), and cases with a histology report were more likely to be registered than those without (though the difference was not significant). Completeness declined with time, as in most registries, which continue to identify late cases some time after the initial diagnosis. Conclusion: This is the first objective measurement of completeness of cancer registration in Africa, and it gives reassurance that published incidence rates are reasonably accurate (provided that there is not an insistence on the very latest results).     

Risk of developing ovarian cancer among women with ovarian endometrioma: a cohort study in Shizuoka, Japan

Although some studies have indicated that endometriosis may increase the risk of developing ovarian cancer, there are no data from epidemiologic studies in Japan. We prospectively analyzed all cases of ovarian endometrioma enrolled in the prefecture-wide Shizuoka Cohort Study on Endometriosis and Ovarian Cancer Programme, which was initiated in 1985. To evaluate the risk of ovarian cancer by time periods subsequent to ovarian endometrioma diagnosis, a cohort of 6,398 women with a clinically documented ovarian endometrioma in Shizuoka between 1985 and 1995 was identified from the Shizuoka Cancer Registry (SCR), with follow-up through 2002. Ovarian cancer incidence among cohort members was ascertained by linkage to the SCR using a unique person-identification number. Standardized incidence ratios (SIR) and their 95% confidence intervals (CI) were computed by a use of prefecture-wide rates of ovarian cancer, adjusted for age and calendar year. During follow-up of up to 17 years of the ovarian endometrioma cohort, 46 incident ovarian cancers were identified, yielding that the ovarian cancer risk was elevated significantly among patients with ovarian endometrioma (SIR = 8.95, 95% CI = 4.12-15.3). The SIR did not increase with increasing follow-up duration. The risk increased with increasing age at ovarian endometrioma diagnosis, with a SIR equal to 13.2 (95% CI = 6.90-20.9) in women above 50 years of age. Our findings for the first time support the hypothesis that ovarian endometrioma increases the subsequent risk of developing ovarian cancer in Shizuoka, Japan.     

网络环境下人体器官的三维重建及变形仿真

背景：利用何种模型何种算法对不同器官组织进行变形仿真，既可保证逼真性又可兼顾实时性，目前的设计都是在单机系统上实现。 目的：为了实现基于网络的人体器官的变形仿真及交互，设计以人体器官肾脏为例，利用CT图像，在VRML平台上实现器官模型的三维重建。 方法：利用质点弹簧模型建立肾脏的物理模型，实现变形计算。最后通过VRML外部编程接口EAI和Java-Applet进行通信，实现器官模型在任意位置、任意外力作用下的变形模拟。 结果与结论：在CT图像的基础上实现了人体器官肾脏的三维重建，并利用质点弹簧模型实现了人体器官肾脏的变形模拟。借助于JAVA和VRML的结合，实现了网络环境下肾脏的变形仿真，用户只需在网页界面中输入作用力的大小和作用位置点的序列，即可得到肾脏变形情况的场景。研究虽仅以简单的拉伸和挤压变形为例，其他变形亦可通过类似的方法实现。实验为人体器官的变形和虚拟手术系统的网络交互功能的实现提供了一种思路。     

Automatic segmentation of cardiac MRI cines validated for long axis views

Segmentation of cardiac magnetic resonance imaging is considered an important application in clinical practice. An automatic algorithm is proposed for segmentation of both endocardial and epicardial boundaries, in long-axis views. The data consisted of 126 patients, yielding 1008 traces. Estimated clinical parameters were highly correlated to gold standard measurements. The error between the automatic tracing and the gold standard was not significantly different than the error between two manual observers. In conclusion, a tool for segmenting the myocardial boundaries in the long-axis views is proposed, which works well, as demonstrated by the validation performed using a clinical dataset.     

基于组织连续切片后三维重建技术的研究进展

]三维重建技术对于人体内部微观结构的展现细致详尽,为基础科学和临床科研提供了全面的解剖资料。本文综述了组织包埋、切片、染色及计算机辅助人体组织连续切片后进行的组织结构三维重建,展现了组织连续切片三维重建技术中各步骤不同方法的优势与不足,为相关研究提供借鉴。