TACE和微波固化消融联合治疗肝细胞癌疗效观察

目的 探讨肝动脉栓塞化疗(TACE)和微波固化消融联合治疗肝细胞癌(HCC)的疗效.方法 研究组:TACE和超声引导下经皮经肝穿刺微波消融(PMCT)联合治疗HCC 46例;对照组:TACE治疗HCC 40例.结果 (1)研究组与对照组的1、2、3年生存率分别是65%、30%、15%和30%、10%、0,2组之间比较差异有统计学意义(P<0.05).(2)2组的局部复发率和并发症发生率分别是20%、85%和25%、70%,2组之间比较差异无统计学意义(P>0.05).结论 TACE和微波固化消融联合治疗可望成为HCC的治疗途径之一.     

超声引导下经皮穿刺微波消融治疗子宫肌瘤20例

目的 探讨超声引导下微波消融(MWA)治疗子宫肌瘤的有效性和安全性.方法 使用微波治疗仪对20例单发子宫肌瘤患者进行治疗,比较治疗前后患者的超声图像和临床症状的变化,将疗效分为治愈、显效、有效和无效.结果 治疗前肌瘤体积(69.3±7.3)cm3,治疗后1、6个月随访,术后肌瘤体积分别为(36.8±8.2)cm3和(17.2±5.6)cm3,与术前比较,差异均有统计学意义;肌瘤体积缩小率分别为(46.9±11.4) %和(75.2±23.3)%;治愈、显效、有效者分别占75.0 %(15/20)、20.0 %(4/20)、5.0 %(1/20),总有效率为100 %.结论 MWA治疗子宫肌瘤疗效确切,具有创伤小、操作简单、痛苦小、时间短、并发症少等优点,是一种值得推广的介入治疗方法.     

原位射频消融术与手术治疗小肝癌的临床疗效对比研究

目的：评价经皮原位射频消融与手术切除治疗小肝癌的疗效。方法收集我院2010年3月至2014年6月之间419例肝功能损伤处于ChildA级的小肝癌(单个肿瘤、直径≤5.0cm)患者。其中经原位射频消融治疗287例，手术切除治疗132例。经对比分析显示手术切除组1、3、5年存活率分别为90.31%、64.88%、37.85%，射频消融组存活率分别为92.75%、72.87%、46.58%，组间差异无统计学意义（P=0.7025）；分层分析显示，对于直径≤3.0cm肿瘤，手术切除组1、3、5年存活率分别为87.91%、72.10%、61.21%，射频消融组1、3、5年存活率分别为97.32%、48.25%、37.29%，两组之间差异无统计学意义(P=0.7589)；对于直径3.0～5.0cm肿瘤，手术切除组1、3、5年存活率分别为89.28%、73.25%、42.56%，射频消融组1、3、5年存活率分别为83.56%、49.35%、23.14%，两组之间差异无统计学意义(P=0.1256)。结论对于肝功能处于ChildA级小肝癌病人，射频消融与手术切除治疗效果相近，可在某些情况下可替代手术切除。     

经皮射频联合无水酒精注射治疗第一肝门区肝癌

目的探讨对于位于第一肝门区的小肝癌行B超引导经皮肝穿刺射频消融(PRFA)联合瘤内无水酒精注射(EI)治疗的可行性、疗效和应注意的问题。方法选择肿瘤位于第一肝门区、直径≤5 cm、病理或临床证实为原发性或继发性肝癌的26例患者进行PRFA EI治疗。治疗前甲胎蛋白(AFP)阳性者治疗后定期复查AFP。治疗后1个月复查MR I、彩超或CT确定肿瘤是否完全坏死,以后每3个月定期复查。计算肿瘤原位复发率和累积生存率。结果AFP转阴率约为76.9%(10/13),MR I或CT显示第一肝门区肿瘤完全凝固坏死率为84.6%(22/26)。0.5、1年肿瘤原位复发率分别为23.1%(6/26)、26.9%(7/26),1、2、3年累积生存率分别为92.3%(24/26)、82.3%(14/17)、75.0%(9/12),无胆管狭窄发生。结论第一肝门区小肝癌并非PRFA治疗的禁忌证,只要治疗时穿刺点选择恰当、穿刺路径合理、超声监测下电极展开确切、热凝范围控制恰当,对于第一肝门区小肝癌PRFA EI治疗是一种行之有效的治疗方法。     

动脉栓塞化疗联合冷消融治疗大肝癌生存3年以上随访观察

目的探讨动脉栓塞化疗(TACE)联合冷消融使大肝癌患者长期存活的可行性。方法收集TACE联合冷消融治疗后(316例)生存3年以上的大肝癌患者132例,肝内肿瘤直径全部大于5.0cm。患者首先接受TACE治疗,2～3周后,采用氩氦冷冻系统冷消融治疗。密切随访观察患者病情变化,记录患者的生存时间。结果本组患者治疗后临床症状好转、甲胎蛋白下降、肿块缩小。随访3.1～5.2年,患者平均生存(46.4±11.3)个月。术后3、4、5年的生存率分别为41.8%、32.6%和28.2%。结论TACE联合冷消融对直径大于5.0cm的晚期肝癌具有良好效果,术后严格随访,及时处理肝癌复发与转移病灶,是使大肝癌患者获得长期生存的有效途径。     

射频消融术对肝脏肿瘤患者临床疗效及肝内感染的影响因素分析

目的探讨射频消融术对肝脏肿瘤患者的临床疗效以及肝内感染因素分析,以防止感染的发生。方法选取2013年1月-2014年12月肝脏肿瘤患者66例,在彩超引导下全麻进行射频消融治疗,调查患者术后一周内感染率,统计患者术后各类型肿瘤完全消融情况,随访两年记录患者肿瘤局部复发以及生存率。结果病灶直径4cm患者肿瘤完全消融率显著高于病灶直径4cm患者,病灶位置为非靠近大血管的肿瘤完全消融率显著高于病灶靠近大血管者,病灶直径4cm者肿瘤局部复发率显著低于病灶直径4cm以上者,病灶位置为非靠近大血管的肿瘤局部复发率显著低于病灶靠近大血管者,差异均有统计学意义(P0.05);治疗后发生术后感染2例,以上因素可能与感染相关;患者一年生存率为95.5%、两年生存率为80.3%。结论射频消融术对肝脏肿瘤患者进行治疗,完全消融率高且两年局部复发率较低,患者术后感染例数较少,两年生存率较高,该治疗手段疗效显著,值得临床推广及应用。     

肿块消融术与外科手术治疗早期肝癌效果的比较

目的回顾性分析评价CT引导下经皮射频消融术和外科切除术治疗早期肝癌的临床疗效。方法本研究收取了88例早期肝癌患者,实施经CT引导下射频消融术和外科切除术治疗,其中,射频消融术治疗组患者45例,肿瘤大小1.2～3.8cm,平均2.1cm,其余43例患者实施外科切除术治疗,肿瘤大小3.2～4.8cm,平均4.1cm。术后1个月行增强CT检测,以评价射频消融和外科切除术的治疗效果。结果主要并发症的发生于外科手术切除组(22/43例)显著多于射频消融术组(10/45例)。1、3、5年总体生存率,射频消融术组分别为97.5%、88.7%和72.1%,外科手术切除组分别为88.5%、70.2%、60.1%。相对应的无复发生存率,射频消融术组分别为66.4%、52.2%、47.8%,外科手术切除组为77.6%、58.1%、52.1%。结论 CT引导下经皮射频消融术治疗肿瘤创伤小、并发症少、近期疗效明显,是一种有效的微创手术,CT引导下经皮射频消融术的疗效和安全性优于外科手术切除。     

宫内膜癌80例临床分析

[目的]观察子宫内膜癌治疗效果和治疗方法对复发的影响。[方法]选择我院2006年1月~2010年1月子宫内膜癌患者80例,根据采取的治疗措施异同,分为单纯手术治疗(单纯手术者)和手术治疗为基础的综合治疗(综合治疗组)。其中单纯手术治疗患者共25例,手术为基础的综合治疗共55例。[结果]①单纯手术组患者1年、3年和5年生存率分别为72.0%、48.0%、24.0%;综合治疗组1年、3年和5年生存率分别为90.9%、67.2%、40.0%。综合治疗组1年、3年和5年生存率分别与单纯手术组比较,差异有统计学意义(P﹤0.05)。②单纯手术组局部复发率和远处复发率分别为52.0%和36.0%,综合治疗组局部复发率和远处复发率分别为18.2%和20.0%,两组局部复发率和远处复发率比较,差异有统计学意义(P﹤0.05)。[结论]子宫内膜癌不同治疗方法影响着患者的1年、3年和5年生存率及复发,以手术为基础的综合治疗能够提高患者生存率和降低患者局部复发及远处复发,优于单纯手术治疗。     

经皮射频消融联合无水酒精注射治疗结直肠癌肝转移疗效观察

目的评价经皮射频消融(PRFA)联合无水酒精注射(PEI)治疗结直肠癌肝转移的疗效。方法B超引导下PRFA联合PEI治疗结直肠癌肝转移37例61个病灶,肿瘤直径1.5~7.8 cm。应用RF2000射频仪和10电极LeVeen针。病灶>2.5 cm者予分层多点叠合射频消融。对1~2 cm的小肿瘤选择Ch iba针注射无水酒精,而对>3 cm者应用Quadra-Fuse多位穿刺注射针。随访观察病灶影像形态表现、血清癌胚抗原(CEA)变化、病人病情缓解率与生存时间。结果PRFA PEI经过均顺利,并发症2例(5.4%),腹壁穿刺针道转移和电极片灼伤皮肤各1例,无相关死亡。随访率97.3%(36/37),随访期17~65月,缓解率(CR PR)为94.4%。患者1、2、3年生存率分别为97.2%、75.0%和52.8%。结论PRFA联合PEI是治疗结直肠癌肝转移的有效微创局部治疗方案。     

不同方式治疗晚期子宫内膜癌62例临床分析

目的:探讨不同方式治疗晚期子宫内膜癌的价值。方法:Ⅲ、Ⅳ期子宫内膜癌患者62例,按治疗方式分为4组:单纯手术组7例,手术+放疗组17例,手术+化疗+放疗组29例,放疗+化疗组9例。比较各组的5年生存率、局部及远处复发率。结果:62例总的5年生存率为30.6%(19/62)。单纯手术组、手术+放疗组、手术+放疗+化疗组、放疗+化疗组的5年生存率分别为14.3%(1/7)、29.4%(5/17)、41.4%(12/29)和11.1%(1/9);局部复发率分别为57.1%(4/7)、17.6%(3/17)、17.2%(5/29)和44.4%(4/9);远处复发率分别为28.6%(2/7)、29.4%(5/17)、17.2%(5/29)和33.3%(3/9)。手术+放疗+化疗组5年生存率最高,但与单纯手术组及化疗+放疗组之间差异尚无显著意义(P>0.05);手术辅助放疗能降低局部复发率(P<0.05),辅助化疗降低远处复发率的差异无显著意义(P>0.05)。结论:晚期子宫内膜癌强调综合治疗,手术辅助放疗效果肯定,辅助化疗可能有效。     

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.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

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.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

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.     

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.