原发性肝癌患者肝动脉化疗栓塞术后肝区疼痛的临床意义

目的探讨肝动脉化疗栓塞术（TACE）后肝区疼痛与近期疗效的关系。方法１１８例原发性肝癌患者按照TACE术后肝区疼痛程度分为两组，A组无明显肝区疼痛，B组有明显肝区疼痛，比较两组病灶在首次介入治疗后的反应，分析TACE后肝区疼痛的相关因素。结果首次介入术后４～６周行CT检查，按RECIST标准评价疗效，A、B两组CR、PR、SD、PD分别为０、１．４５％、８８．４１％、１０．１４％和０、１４．２９％、８１．６３％、４．０８％，有效率OR（CR＋PR）比较差异有统计学意义（P＝０．００８７）。分析术后疼痛原因可能与术前病灶血供、包膜、肝硬化和术后病灶碘油充填类型有关，其中碘油沉积分型与疼痛分级呈负相关（r＝－０．５３９，P＜０．０１）。结论介入术后肝区疼痛多提示患者肿瘤栓塞效果好、预后好。充分认识TACE后肝区疼痛与疗效相关性具有重要临床意义。     

TACE联合瘤体注射热碘油治疗大肝癌

【摘要】 目的 探讨经肝动脉化疗栓塞术 （TACE） 联合经皮肝穿刺注射热碘油治疗大肝癌的临床疗效。方法 86例原发性肝癌随机分为2组，43例患者采用TACE术后并经皮肝穿刺注射热碘油治疗作为治疗组；另外43例患者TACE治疗作为对照组。结果 治疗组有效率为68%，对照组有效率为53%，两组间差异有统计学意义（P < 0.05）。两组术后肿瘤大小变化差异有统计学意义（P < 0.05）；术后随访6、12、18、24个月生存例数和生存率分别为:43例（100%），36例（84%），23例（53%），14例（33%）；对照组分别为:40例（94%），30例（70%），16例（37%）和9例（21%）。但两组术后肝功能损害比较差异无统计学意义。结论 经皮肝穿刺注射热碘油联合TACE治疗原发性肝癌的效果明显优于常规TACE治疗。

     

细胞因子诱导杀伤细胞灌注治疗原发性肝癌临床应用

目的探讨肝动脉细胞因子诱导杀伤细胞（CIK细胞）灌注＋超液化碘油栓塞治疗原发性肝癌的疗效。方法采用超选择段性肝动脉灌注CIK细胞＋超液化碘油栓塞治疗原发性肝癌及经皮肝穿刺瘤体内多点注射CIK细胞共３８例（研究组）；将同期采用常规剂量经肝动脉段性化疗栓塞（C-TACE）联合经皮肝瘤体内注入无水乙醇８０例（双介入组）；单纯经皮肝动脉常规剂量C-TACE１３４例（单纯组）相比较。结果研究组、双介入组和单纯组近期显效率分别为７６．３％、４１．３％和１４．９％，研究组的AFP降至正常及明显下降率则显著高于双介入组和单纯组，３组血清AFP变化差异有统计学意义（P＜０．０１）。结论采用超选择段性肝动脉灌注CIK细胞＋超液化碘油栓塞综合治疗原发性肝癌，可以提高患者的免疫功能、生存质量，延长带瘤生存期。     

肝右叶前、后段原发性肝癌动脉化疗栓塞术后近期疗效比较

目的分析位于肝右叶前、后段原发性肝癌（HCC）患者在TACE治疗后病灶近期疗效的差异及意义。方法回顾性分析我院２００８年３月－２００９年１月首次行肝动脉化疗栓塞术（TACE）治疗２８３例HCC患者,将其中按影像学检查符合筛选标准５８例（８３个病灶）分两组。A组:共２３例,病灶位于肝右叶前段（Ⅴ、Ⅷ段）;B组:共３５例,病灶位于肝右后段（Ⅵ、Ⅶ段）。分析经TACE治疗前１周内及治疗后１、３个月复查的CT、MRI 资料,按照RECIST标准比较两组病灶近期疗效的差异。结果治疗１个月后A、B两组的CR、PR、SD、PD分别为０、４．３％、８７．０％、８．７％和０、２２．９％、６８．６％、８．６％,有效率OR（CR＋PR）比较差异无统计学意义（P＝０．０７３）;３个月后两组的CR、PR、SD、PD分别为０、８．７％、７３．９％、１７．４％和０、３４．３％、６２．９％、２．９％,OR比较差异有统计学意义（P＝０．０３１）;两组病灶大小随时间变化,后段组比前段组缩小明显（F＝７．８７３,P＜０．０５）。结论肝右叶后段HCC经TACE治疗后短期疗效优于前段,对于不同位置病灶的综合治疗有重要指导价值。     

CT 灌注成像在肝癌 TACE 术后疗效评价中的应用价值

目的探讨双源CT灌注成像（CTPI）在HCC TACE术后疗效评价中的价值。方法对２４例HCC患者于TACE术前１～３d、术后６～８d和３０～４０d分别行双源CT灌注扫描,经肝脏CT灌注软件得到肝动脉灌注量（HAP）、门静脉灌注量（PVP）、肝动脉灌注指数（HPI）等彩色灌注图,在图像上分别测定相应的灌注参数值,观察TACE治疗前后肿瘤组织的血流灌注变化及肿瘤的大小改变,评价TACE治疗肿瘤的疗效。结果TACE术前９例肿瘤呈均匀高灌注,１５例呈不均匀高灌注。术后８例瘤灶内碘油沉积密实,１６例碘油沉积不均。灌注图像显示碘油沉积区域无血流灌注,碘油稀疏及缺乏区域仍有血流灌注。所有患者术前、术后６～８d及肿瘤残留患者复发前后的肿瘤组织HAP、HPI差异均有统计学意义（P＜０．０５）,而PVP则差异无统计学意义（P＞０．０５）。术前、术后６～８d肿瘤最大径以及肿瘤残留患者复发前后肿瘤最大径均无明显变化（P＞０．０５）。TACE术后,１６例残瘤组织及正常肝组织HAP、PVP、HPI差异均有统计学意义（P＜０．０１）。结论CT灌注成像能直观和定量地反映肝癌TACE前后的血流动力学变化,有助于TACE疗效的评价。     

中晚期原发性肝癌合并症的介入治疗研究

目的探讨中晚期原发性肝癌合并症的综合介入治疗方法。方法将经病理、影像学诊断及AFP值证实的原发性肝癌符合筛选条件的患者共６２例,按住院号数的单、双数随机分成两组:对照组（单纯TACE组）３２例,综合治疗组（TACE＋合并症处理组）３０例。综合治疗组行TACE术时对肝动静脉瘘、门静脉癌栓及下腔静脉病变等并发症给予综合处理。结果TACE组治疗３２例患者,１、２和３年生存率分别为６８％、５０％和１９％,中位生存期１．５年;综合治疗组３０例患者１、２和３年生存率分别为８７％、７５％和４８％,中位生存期２．０年。综合治疗组的生存率及生存期均显著高于对照组（P＜０．０５）。与对照组相比综合治疗组疗效与死亡风险率差异有统计学意义（P＜０．０５）。结论原发性肝癌合并症的控制可增加TACE的疗效,显著提高原发性肝癌患者生存率,延长生存期。     

经肝动脉化疗栓塞对高危因素肝癌的疗效观察

目的探讨经肝动脉化疗栓塞（TACE）对高危因素肝癌的治疗效果。方法回顾性分析２００１年１月至２００５年１２月２６６例肝癌患者接受５３６次介入治疗，患有门静脉癌栓或血胆红素升高（＞３４μmol／L）者为高危组，余患者为低危组。高危组７４例（２７．８％），低危组１９２例。高危组采用更加超选择性栓塞、较少的栓塞剂用量和较少的手术次数（为１．４和２．３P＜０．０５），比较两组患者的术后并发症发生率、生存期。结果全部并发症的发生率为３．５％，两组并发症的发生率差异无统计学意义（分别为２．５和７．６％，P＝０．０７）熏高危组１、３年生存率分别为４５％和１６％，低危组１、３年生存率分别为６３％和１８％，低危组生存期长于高危组，但两组间差异无统计学意义（P＝０．０８）。结论高危因素肝癌患者TACE术后并发症发生率未显著增加。采用适当的技术，TACE对高危因素肝癌患者是安全的。     

CT定位仪在CT引导经皮肺部肿块穿刺活检的对照研究

目的探讨CT穿刺角度定位仪（CT定位仪）在CT引导经皮肺部肿块穿刺活检（percutaneous puncture biopsy，PPB）的应用价值。方法根据电脑数字表随机分配原则对１２６例肺部肿块患者进行分组，研究组使用CT定位仪，对照组不使用该仪器，两者均进行CT引导下PPB检查，比较两组一次穿刺成功率，穿刺诊断的正确率，穿刺次数和并发症发生率。结果研究组借助CT定位仪独有导向针的指向作用，大大提高了一次穿刺的成功率，两组一次穿刺的成功率分别为９５％和８２％（P＝０．０２３），在肿块直径≤２cm患者尤其明显（P＝０．０２６）；提高了穿刺诊断的正确率:两组分别是９５．２％和８４．１％（P＝０．０４）；两组气胸发生率分别为４．８％和１５．８％，两组间差异有统计学意义（P＝０．０４０４）。结论使用CT定位仪行经皮肺肿块穿刺活检术，尤其在病灶小且远离胸壁时，可以准确把握穿刺方向，提高穿刺的准确度，减少手术盲目性及危险性，从而提高穿刺成功率，减少气胸发生。同时，CT定位仪具有使用简便，适用于各种螺旋与非螺旋CT机等优点，具有良好的临床应用前景。     

同轴微导管肝动脉化疗栓塞联合射频消融治疗原发性肝癌

目的探讨经肝动脉微导管化疗栓塞（TACE）联合射频消融（RFA）术治疗原发性肝癌（HCC）的疗效。方法回顾分析１０００例HCC的DSA表现与术前多层螺旋CT（MSCT）检查结果。其中１７９例病灶局限于１个肝段,采用微导管超选择插管栓塞。术后４周复查动态增强CT和（或）MR,对４０例病灶碘油聚集不良者,进行RFA,术后１个月复查。结果DSA发现直径３cm以上肿块６７０例,３cm以下病灶２０２例,子灶４００例,动静脉瘘、动门脉瘘４８２例,异常血供４３０例,门脉癌栓３６２例。局限于１个肝段的病灶,微导管栓塞后４周,肿瘤局部控制率为７７．６％;控制不良者行RFA后１个月,肿瘤局部控制率为９７．５％。结论DSA对于发现３cm以下小病灶（含子灶雪、肿瘤血供、动静脉瘘、动门脉瘘具有绝对的优势,对HCC的术前评价具有不可替代性的作用。RFA是HCC的有效的治疗方法,是TACE疗效不佳者的理想选择     

缺氧诱导因子 -１α 在兔 VX２ 肝癌模型 TACE 术后的表达及其临床意义

目的探讨缺氧诱导因子-１α（HIF-１α）在兔VX２肝癌模型TACE术后的表达及其与肿瘤血管生成的相关性。方法２４只荷VX２瘤兔随机分为３组，每组８只。对照组:经肝动脉注入生理盐水２ml；TAE组:单纯碘油（UFLP）０．５～０．８ml栓塞，TACE组:碘油抗癌药混悬液（UFLP＋THP）栓塞，UFLP０．５～０．８ml，THP２mg。于术后２周应用免疫组化法分别检测肿瘤组织中HIF-１α、血管内皮生长因子（VEGF）的表达，用CD３４单克隆抗体标记肿瘤血管内皮细胞，计数肿瘤组织中的微血管密度（MVD）。结果TAE组和TACE组HIF-１α、VEGF表达与MVD值均明显高于对照组，差异有统计学意义（P＜０．０５），HIF-１α与VEGF的表达及MVD的变化呈正相关（r S ＝０．５３７，P＜０．０１；r S ＝０．４２３，P＜０．０５）。结论TACE能明显上调HIF-１α的表达，HIF-１α通过调控其下级基因VEGF的表达而促进肿瘤血管的生成，影响肝癌的预后。     

火电厂节能工作浅析

本文探讨了火电厂节能基本程序和工作方法,分析节能工作要从基础工作、技术创新、设备整治、燃烧管理等方面入手的论述.     

浅析磨合期汽车的使用

如何合理使用磨合期的汽车，使其摩擦机件的磨损量能够平稳、均匀地磨合而不至于过度磨损，对汽车实际使用寿命有着重要的意义。从机器磨合期的特点和磨损机理出发，对汽车磨合期如何正确使用进行了有实际意义的探讨。     

Geothermal energy in agriculture in Yugoslavia

SFR Yugoslavia has natural hot water springs practically all over its territory, indicating the presence of geothermal reservoirs underground. There is no final estimate of how much energy can be expected from this new resource, except for figures based on the results of studies and investigations.The first use of geothermal energy in Yugoslavia in numerous spas dates back to the 19th century. Some remarkable examples of central heating are known, but the most widespread use is in agriculture (in greenhouse heating, farm heating and drying of agricultural products).     

Energy conservation measures in an institutional building in sub-tropical climate in Australia

In this study, various energy conservation measures (ECMs) on heating, ventilating and air conditioning (HVAC) and lighting systems for a four-storied institutional building in sub-tropical (hot and humid climate) Queensland, Australia are evaluated using the simulation software called DesignBuilder (DB). Base case scenario of energy consumption profiles of existing systems are analysed and simulated first then, the simulated results are verified by on-site measured data. Three categories of ECMs, namely major investment ECMs (variable air volume (VAV) systems against constant air volume (CAV); and low coefficient of performance (COP) chillers against high COP chillers); minor investment ECMs (photo electric dimming control system against general lighting, and double glazed low emittance windows against single-glazed windows) and zero investment ECMs (reset heating and cooling set point temperatures) are evaluated. It is found that the building considered in this study can save up to 41.87% energy without compromising occupancies thermal comfort by implementing the above mentioned ECMs into the existing system.     

Uncertainties in decarbonising heat in the UK

Heating is arguably one of the most difficult sectors to decarbonise in the UK's energy system. Meeting the 80% greenhouse gas emission reduction target by 2050 is likely to require that heat related emissions of CO₂ from buildings are near zero by 2050, and there is a 70% reduction in emissions from industry (from 1990 levels). Though it is clear that the use of the natural gas network will reduce over time, recent modelling suggests a limited residual role for gas by 2050 to help meet peaks in heat demand. High levels of uncertainty about the way in which heat will be decarbonised present a number of challenges to policy makers. This paper will explore the risks and uncertainties associated with the transition to a low carbon heat system in the UK as outlined by the 4th carbon budget review. The potential impact of key uncertainties on the levelised costs of heat technologies and the development of energy networks are explored using a sensitivity analysis approach. Policy changes required to decarbonise the heat sector are also examined.     

Solar drying in sludge management in Turkey

Two main wastewater treatment plants in Bursa city in Turkey will start to operate and produce at least 27,000 tons of dry solids per year by the end of 2006. The purpose of this study was to investigate an economical solution to the sludge management problem that Bursa city would encounter. The general trend in Turkey is mechanical dewatering to obtain a dry solid (DS) content of 20%, and liming the mechanically dewatered sludge to reach the legal landfilling requirement, 35% DS content. This study recommends limited liming & solar drying as an alternative to only-liming the mechanically dewatered sludge. Open and covered solar sludge drying plants were constructed in pilot scale for experimental purposes. Dry solids and climatic conditions were constantly measured. Faecal coliform reduction was also monitored. The specially designed covered solar drying plant proved to be more efficient than the open plant in terms of drying and faecal coliform reduction. It was found that, if the limited liming & solar drying method was applied after mechanical dewatering instead of only-liming method, the total amount of the sludge to be disposed would be reduced by approximately 40%. This would lead to a reduction in the transportation, handling, and landfilling costs. The covered drying system would amortize itself in 4 years.     

Viscous heating in liquid flows in micro-channels

Many experimental works on forced convection through micro-channels evidenced that when the hydraulic diameter is less than 1 mm, conventional theory can no longer be considered as suitable to predict the pressure drop and convective heat transfer coefficients. This conclusion seemed valid for both gas and liquid flows. Sometimes the authors justified this claim by invoking “new” micro-effects. On the contrary, in this paper the explanation of the experimental results obtained for micro-channels in terms of friction factors will be researched inside the conventional theory (Navier-Stokes equations). In particular, this paper will focus on the role of viscous heating in fluids flowing through micro-channels. A criterion will be presented to draw the limit of significance for viscous dissipation effects in micro-channel flows. The role of the cross-sectional geometry on viscous dissipation will be highlighted and the minimum Reynolds number for which viscous dissipation effects can no longer be neglected will be calculated as a function of the hydraulic diameter and of the micro-channel geometry for different fluids. It will be demonstrated how viscous effects can explain some experimental results on the Poiseuille numbers in micro-channels, which recently appeared in the open literature.     

Energy consumption in rural transportation in India

Energy consumption in rural transportation has been computed, taking into account the energy embodied in vehicles or bullocks, as well as the fuels or feeds and food (of operators). Bullock cart transport consumes over four times more energy than vehicles. However, animal transport will continue to be preferred because of its availability.     

Electoral cycles in electricity losses in India

A third of electricity in India is lost each year, where losses refer to power that is supplied but not billed. Utilizing data from the power corporation of Uttar Pradesh, India's most populous state, we study the politics of electricity losses. Examining annual data over four decades, we document that UP's electricity losses tend to increase in periods immediately prior to state assembly elections. Drawing upon geographically disaggregated data for the period 2000–09, we observe higher line losses just prior to the 2002 and 2007 state elections. Our analysis shows that the incumbent party was more likely to retain the assembly seat as line losses in the locality increased. We interpret these results as corroboration that political parties deliberately redirect electricity to flat rate and unbilled users in a context of chronically inadequate supply. Political factors appear to affect line losses in ways that technical and economic factors alone cannot explain.