33例肝占位性病变MRI误诊的分析

我院１９８８年以来４０００余例腹部ＭＲＩ中，发现肝占位性病变误诊３３例。所用机型为美国Ｄｉｓｏｎｉｃｓ公司０．５Ｔ超导ＭＲＩ，自旋回波序列（ＳＥ序列）、常规Ｔ１加权（Ｔ１ＷＩ）、质子加权（ＰＤＷＩ）、Ｔ２加权（Ｔ２ＷＩ），覆盖全肝。其中，ＰＨＣ误诊为ＭＨＣ５例、ＭＨＣ误诊为ＰＨＣ６例、ＰＨＣ误为ＨＨＥ５例、ＭＨＣ误诊为ＨＨＥ２例、ＨＨＥ误诊为ＰＨＣ６例、肝硬化结节误诊为ＰＨＣ２例、炎性假瘤误诊为ＰＨＣ３例、肝结核误诊为ＰＨＣ１例、ＨＣＹ误诊为ＨＨＥ３例。本文从病变的影像学特征和扫描技术方面详细探讨了误诊的原因和鉴别诊断要点。     

原发性肝癌伴胆道癌栓的诊治

目的 探讨原发性肝癌伴胆道癌栓的临床特点、病理改变、诊治方法和改善预后的途径。方法 分析16例病例的一般资料、临床表现、影像学和病理检查。结果 无术后死亡，原发病灶未切除，仅做T管引流2例，术后生存时间为2．5～4．5个月，14例原发病灶切除者，术后生存1～4．5年。结论 原发性肝癌伴胆道癌栓患者，积极手术治疗和综合治疗是提高生活质量和改善预后的有效方法。     

原发性肝癌超声检出率及临床分析

目的探讨原发性肝癌检出率及危险因素。方法应用B超、彩色多普勒血流显像（CDFI）及三维彩色血管能量成像（3D－CPA）检查10,383例肝脏。结果正常组肝癌检出率为0．14％,脂肪肝组检出率为0．84％,慢性肝炎及HBV感染组检出率为10．56％,肝硬化组检出率为36．61％。与正常组比较,肝癌发生危险度在肝硬化组最高（RR＝261．5,95CI＝140．45～47914）,依次为慢性肝炎、HBV感染组（RR＝75．43,95％CI＝40．21～137．53）及脂肪肝组（RR＝6．00,95％CI＝3．22～1836）。结论慢性肝炎、HBV感染、肝硬化中原发性肝癌发生危险度高;脂肪肝和慢性肝炎、HBV感染及肝硬化一样同属原发性肝癌的高危人群。     

AFP、AFU、GPDA对原发性肝癌的联合检测

对４７ 例原发性肝癌病人,３５ 例肝良性病病人,５１ 例正常对照进行了血清甲胎蛋白（ Ａ Ｆ Ｐ） 、α－ Ｌ 岩藻糖苷酶（ Ａ Ｆ Ｕ） 、甘氨酰脯氨酸二肽氨基肽酶（ Ｇ Ｐ Ｄ Ａ） 的检测。结果显示单独检测 Ａ Ｆ Ｐ 阳性检出率最高,其次为 Ａ Ｆ Ｕ, Ｇ Ｐ Ｄ Ａ 最低;联合检测可明显提高阳性检出率,但特异性降低。对三者分别进行相关性分析,结果说明三者无相关性;肝癌病人３ 种指标在有无肝外转移间无统计学差异。     

HBV 感染、家族肝癌史与 ABO 血型在低发区原发性肝癌的关系

本文研究了高、低发区５１０例ＰＨＣＨＢＶ感染、家族肝癌史及与ＡＢＯ血型的关系，结果表明：１肝癌低发区与高发区一样，合并ＨＢＶ感染的ＰＨＣ患者达８０．７４％，远多于无ＨＢＶ感染者；男性多于女性；有家族肝癌史的ＰＨＣ患者占４０．００％，且合并ＨＢＶ感染的ＰＨＣ有家族肝癌史者显著多于ＨＢＶ阴性组（Ｐ＜０．０５）；２低发区ＰＨＣ中，有家族肝癌史的Ａ型血者显著多于相应对照组（Ｐ＜０．０５）。提示我国肝癌低发区ＰＨＣ发生的最重要外因亦为ＨＢＶ感染，遗传易感性则是其内因；而有ＨＢＶ感染或有家族肝癌史者是ＰＨＣ的高危人群，且后者中的Ａ型血者更为易患，对这一人群需加强监测，警惕ＰＨＣ的发生。     

保尔佳对原发性肝癌患者sIL-2R、IL-6、TNFα的影响及促进肝癌细胞凋亡的初步研究

对２０例原发性肝癌患者（大剂量组１０例、小剂量组１０例）临床应用保尔佳１周，用ＥＬＩＳＡ法检测治疗组用药前后外周血及用药后门静脉血的ｓＩＬ－２Ｒ，ＩＬ－６，ＴＮＦα的水平变化及用末端转移酶标记法（ＴＵＮＥＬ法）检测治疗组肝癌细胞的凋亡情况，与未治疗组、正常对照组相比。结果表明，治疗组外周血ｓＩＬ－２Ｒ水平明显下降（大剂量组Ｐ＜０．０１、小剂量组Ｐ＜０．０５），ＩＬ－６水平明显上升（大剂量组Ｐ＜０．０１、小剂量组Ｐ＜０．０５），ＴＮＦα水平有所下降（大剂量组Ｐ＜０．０５、小剂量组Ｐ＞０．０５），治疗组门静脉血与外周血ｓＩＬ－２Ｒ、ＩＬ－６、ＴＮＦα两者间无明显差异（Ｐ＞０．０５）。ＴＵＮＥＬ法检测显示保尔佳能促进肝癌细胞的凋亡（Ｐ＜０．０１，大、小剂量组间Ｐ＞０．０５）。且保尔佳对肝癌患者的血常规、肝功能等无不良影响。保尔佳是一种具有增强机体免疫功能、促进肿瘤细胞凋亡且无明显毒副作用的新型抗癌药物。     

TAK1 mediates the collagen-II-dependent induction of the COX-2 gene and PGE2 release in primary human chondrocytes

We investigated the role of transforming growth factor-beta activated kinase 1 (TAK1) in collagen II signaling in primary human chondrocytes (PHCs). We asked whether TAK1 acts as a modulator of collagen II signaling with respect to collagen-II-dependent induction of cyclooxigenase-2 (COX-2) in PHCs and release of PGE2 from PHCs. Therefore, PHCs were incubated with collagen II, and cells were then analyzed by RT-PCR for the expression of COX-2. ELISA was used to quantify PGE2 release. To examine the influence of TAK1 on these events, TAK1 gene silencing was performed by RNAi in PHCs prior to collagen II treatment. Results indicated that COX-2 gene expression and PGE2 release are specific outcomes of collagen II signaling and that both depend on TAK1 mediation. These findings are promising in that therapeutic inhibition of TAK1 might be used to reduce pain and relieve inflammatory symptoms that are common in osteoarthritis.     

Predicting healthcare expenditure by multimorbidity groups

Objectives

This article has two main purposes. Firstly, to model the integrated healthcare expenditure for the entire population of a health district in Spain, according to multimorbidity, using Clinical Risk Groups (CRG). Secondly, to show how the predictive model is applied to the allocation of health budgets.

WHO's Service Availability and Readiness Assessment of primary health care services of commune health centers in a rural district of Northern Vietnam

The objective of this study was to assess the availability and readiness of the primary health care (PHC) services of commune health centers (CHCs) in Quoc Oai, a rural district of Northern Vietnam based on the World Health Organization's Service Availability and Readiness Assessment (SARA) tool. The study was done in 2 steps. First, the heads of the 21 CHCs of Quoc Oai district were interviewed using SARA, a quantitative survey, and the responses were then validated by direct observations of each facility. The results showed that although the average number of health staffs in each CHC met the national standards (at least 5 staffs per CHC), its allocation within each CHC was not properly met because some CHCs had only 2 health staffs. Several health equipment and facilities were not fully available in many CHCs, and although the majority of the PHC services were available at the CHCs, their readiness remained limited. Several significant correlates between the availability of health care workers and the availability of the facilities and the PHC services were observed, suggesting that they depend upon and affect one another in the health system. Using the SARA‐based inventory, the study helps health managers and policy makers to prioritize efforts and allocate resources more appropriately. To be effective, attention should be given to how to make facilities, services, and human resources for health ready for PHC activities—more investment and support from the system (from higher to lower level) and the government.     

高尔基体蛋白73、AFP、VEGF在原发性肝癌组织中的表达及临床意义

目的分析评价高尔基体蛋白73（GP73）、AFP、VEGF在原发性肝癌、癌旁组织以及正常肝脏组织中的表达及临床意义。方法取原发性肝癌组织、癌旁组织及正常肝组织,分别检测GP73、AFP、VEGF的含量。结果肝癌组织中GP73、VEGF和AFP表达最强,其次为癌旁组织,正常组织中表达最弱,三者比较,差异有统计学意义（P〈0.01）。肝癌组织中,GP73和VEGF的表达均显著高于AFP（P〈0.01）。经Pearson相关分析显示GP73和VEGF在肝癌组织中的表达水平具有相关性（r=0.271,P〈0.01）。结论 GP73、VEGF和AFP在肝癌组织中呈高表达,联合检测三者有助于原发性肝癌的诊断。