贝伐单抗联合CapeOx用于转移性结直肠癌转换化疗的临床研究

目的 探讨贝伐单抗联合CapeOx方案用于转移性结直肠癌转换化疗的疗效及安全性.方法 63例潜在可切除性转移性结直肠癌采用随机数字表法随机分为研究组(n=31)和对照组(n=32),研究组接受贝伐单抗联合CapeOx(奥沙利铂联合卡培他滨)方案化疗,对照组接受单纯CapeOx方案化疗,每6周进行疗效评价,符合条件的行手术切除.结果 研究组和对照组的R0切除率分别为45％和19％,RR率分别为61％和34％,研究组的R0切除率及总缓解率高于对照组,差异有统计学意义(P＜0.05).两组的常见Ⅲ/Ⅳ度不良事件包括中性粒细胞减少、腹泻等,差异无统计学意义(P＞0.05).结论 贝伐单抗联合CapeOx方案化疗可以提高潜在可切除性转移性结直肠癌的切除率及有效率,副反应无明显增加,可用于转移性结直肠癌的转换化疗.     

贝伐珠单抗联合化疗方案对转移性结直肠癌疗效及EGFR表达的影响

目的探讨贝伐珠单抗联合化疗方案对转移性结直肠癌疗效及表皮生长因子受体(EGFR)的影响。方法选取2016年6月至2018年6月本院收治的转移性结直肠癌患者120例,随机分为研究组和对照组,每组60例。对照组使用经典FOLFOX方案进行化疗,研究组在此基础上联合贝伐珠单抗治疗,两组均治疗4个周期。比较治疗前后两组患者的疗效和EGFR水平。结果治疗4个周期后,研究组总有效率为53.33%,明显高于对照组的33.33%,差异有统计学意义(P0.05);治疗4个周期后,两组患者EGFR水平[(4.81±1.53)mg/L]均明显低于治疗前[(18.05±2.72)mg/L],且研究组患者EGFR水平明显低于对照组[(6.24±1.29)mg/L],差异均有统计学意义(均P0.05)。两组患者治疗期间白细胞减少、血小板减少、蛋白尿、消化道不良反应、肝功能异常、周围神经毒性发生率比较差异均无统计学意义(均P0.05)。结论贝伐珠单抗可有效提升转移性结直肠癌患者FOLFOX化疗方案的治疗效果,安全性较佳。     

西妥昔单抗联合FOLFIRI化疗方案治疗晚期结肠癌疗效分析

目的分析对晚期结肠癌予以西妥昔单抗联合FOLFIRI化疗方案的治疗效果。方法选取本院在2013年3月—2016年3月所收治的晚期结肠癌患者48例,以治疗方法的不同进行分组,24例予以FOLFIRI化疗患者作为对照组,24例予以西妥昔单抗联合FOLFIRI化疗患者作为观察组,对比两组患者的治疗效果。结果观察组的疗效与对照组比较,差异具有统计学意义(P0.05);对比两组不良反应,差异无统计学意义(P0.05)。结论予以西妥昔单抗联合FOLFIRI化疗治疗晚期结肠癌患者效果显著。     

贝伐单抗在结直肠癌靶向治疗中的临床应用价值探讨

目的:探讨贝伐单抗在结直肠癌靶向治疗中的临床应用价值。方法:选择我院40例2015年2月-2016年2月结直肠癌患者。随机分组,常规化疗方案组采取常规化疗方案治疗,贝伐单抗靶向治疗组则采取常规化疗方案+贝伐单抗治疗。比较两组疾病疗效;平均生存期;治疗前后患者生存质量水平、卡氏评分水平;不良反应发生率。结果:贝伐单抗靶向治疗组疾病疗效、平均生存期、生存质量水平、卡氏评分水平相比较常规化疗方案组更好,P0.05。贝伐单抗靶向治疗组和常规化疗方案组不良反应发生率相似,P0.05。结论:常规化疗方案+贝伐单抗治疗结直肠癌效果好。     

FOLFIRI方案二线治疗晚期结直肠癌的临床观察

目的:研究和探讨FOLFIRI方案二线治疗晚期结直肠癌的效果,为日后临床治疗提供参考价值。方法:选择2009年12月到2013年12月来我院进行晚期结直肠癌治疗的患者,其中58例患者一线FOLFOX4化疗失败,改用FOLFIRI方案进行二线挽救治疗,观察和分析临床治疗效果。结果:58例患者出现呕吐、恶心38例,占65.52%;腹泻等胃肠道疾病21例,占36.21%;口腔炎16例,占27.59%;血小板数降低13例,占22.41%;脱发9例,占15.52%;贫血7例,占12.07%;肝肾功能衰竭5例,占8.62%。其中,晚期结直肠癌完全缓解8例,病情稳定14例,无效36例,临床治疗有效率为37.93%。结论:使用FOLFIRI方案对晚期结直肠癌进行二线化疗治疗,临床疗效可观,且临床不良反应可以得到控制,具有推广价值。     

卡培他滨加奥沙利铂治疗晚期结直肠癌的临床疗效分析

目的 探讨卡培他滨加奥沙利铂(XELOX)治疗晚期结直肠癌的疗效与安全性.方法 回顾性分析2002年6月至2008年6月收治的28例具有完整临床资料的晚期结直肠癌患者接受XELOX方案治疗的情况,卡培他滨1000 mg/m~2,口服,2次/d,第1～14天,奥沙利铂130 mg/m~2,静脉滴注,2～6 h,第1天,21 d为1个周期,所有患者均完成至少2个周期化疗.结果 28例患者共进行152个周期化疗,中位数4个周期(2～10个周期),部分缓解12例,稳定11例,进展5例,有效率42.9%.中位疾病进展时间6.4个月(2～24个月),中位生存时间10个月(4~33个月),中位随访时间13个月(2～35个月),1年生存率为60.7%(17/28),2年生存率为17.9%(5/28).主要不良反应是骨髓抑制、神经系统毒性、手足综合征、消化道反应、肝功能异常等,无明显肾毒性和心脏毒性,未发生因化疗产生严重不良反应而终止治疗者,无化疗相关性死亡病例.结论 XELOX方案治疗晚期结直肠癌疗效确切,安全可靠,操作简便,值得临床深入研究及推广应用.     

FOLFIRI化疗方案及其与西妥昔单抗联用治疗晚期结肠癌分析

目的比较西妥昔单抗（爱必妥）联合FOLFIRI化疗方案治疗晚期结肠癌与单纯FOLFIRI化疗方案治疗晚期结肠癌的疗效。方法将我院2008年1月至2009年12月58例采用西妥昔单抗联合FOLFIRI化疗治疗的结肠癌患者作为观察组,将我院2006年1月至2007年12月只使用了FOLFIRI化疗方法治疗的49例结肠癌患者作为对照组。比较两组患者的治疗后生存状况。结果观察组的病情缓解率和治疗后生存质量都好于对照组,毒副作用两组患者反应都不明显。结论FOLFIRI方案联合西妥昔单抗治疗晚期结肠癌,比单独的FOLFIRI化疗方案取得了更好的治疗效果,可明显缓解患者病情,提高患者生存率和生活质量,毒副反应也较轻,处于患者可耐受范围之内。     

老年直肠癌晚期患者行XELOX联合贝伐单抗治疗后腹腔镜辅助根治术的临床疗效

目的探讨老年直肠癌晚期患者行XELOX和贝伐单抗治疗后腹腔镜辅助根治术的临床疗效。方法回顾性研究老年患者66例,手术方式均为腹腔镜辅助根治直肠癌切除术。随机将患者分为治疗组(33例)和对照组(33例)。治疗组在术前行XELOX和贝伐单抗(bevacizumab,Bev)治疗(Bev 7.5 mg/kg+XELOX方案),而对照组在术前行常规化疗XELOX方案。比较两组术中术后基本情况、术后不良反应和并发症、术后复发率、术后生存期以及术后生存质量。结果两组患者术中术后基本情况比较差异不显著,因此术后不同化疗方案治疗疗效具有可比性。两组患者术后出现并发症的差异不显著,但术后不良反应中,治疗组患者的便秘以及出血不良发生率明显高于对照组。两组患者术后1年复发率无显著性差异,但治疗组的2年、3年和5年复发率均显著低于对照组。治疗组患者术后2年、3年和5年生存期均高于对照组,且有显著性差异。结论在老年直肠癌患者中行XELOX联合贝伐单抗治疗后腹腔镜辅助根治术,能有效控制肿瘤复发,增加老年患者的2年无病生存期,提高老年患者生存质量,对老年直肠癌患者具有重要临床意义。     

CPT-11或草酸铂联合5-氟脲嘧啶/亚叶酸钙治疗晚期结直肠癌的临床研究

目的比较CPT-11联合5-氟脲嘧啶/亚叶酸钙(FOLFIRI方案)和草酸铂联合5-氟脲嘧啶/亚叶酸钙(FOLFOX4方案)对晚期结直肠癌患者的疗效和安全性。方法经细胞学或病理学证实、并有客观病灶的晚期大肠癌患者随机分为两组,24例应用FOLFIRI方案治疗,23例应用FOLFOX4方案治疗。以上两种方案均2周重复,每4周为一完整周期,每个受试者均接受两个及以上周期的治疗。对两组近期疗效和不良反应进行对比观察。结果FOLFIRI组22例可评价疗效,有效率为40.9%;FOLFOX4组23例可评价疗效,有效率为47.8%;两组之间比较无统计学意义(p>0.05)。中位疾病进展时间:FOLFIRI组7.2个月,FOL-FOX4组8.9个月(p>0.05),FOLFIRI组的腹泻发生率(45.8%)比FOLFOX4组(17.4%)明显(p<0.05),FOLFOX4组的神经毒性发生率(52.2%)明显高于FOLFIRI组(8.3%)(p<0.01),其它副作用包括白细胞减少、贫血、血小板减少、肝功能损害、恶心呕吐、静脉炎等,两组的不良反应均以Ⅰ、Ⅱ度为主,两组之间差异无统计学意义。结论对于晚期结直肠癌,FOLFOX4和FOLFIRI方案获得相似的近期疗效,两种方案均有较好的耐受性。     

替吉奥联合伊立替康治疗晚期结直肠癌的临床疗效观察

目的：探讨替吉奥联合伊立替康在结直肠癌化疗中的疗效及安全性。方法：将64例结直肠癌患者随机分为两组,研究组31例,使用替吉奥联合伊立替康,对照组33例,采用FOLFIRI方案。结果：入组病例均可进行疗效评价。研究组完全缓解率（CR）12．9％,部分缓解率（PR）51．6％,有效率（RR）64．5％,对照组完全缓解率（CR）6．1％,部分缓解率（PR）39．4％,有效率（RR）45．5％。研究组有效率高于对照组,但差异无统计学意义（P〉0．05）。不良反应：两组白细胞减少、腹泻、恶心呕吐、肝功能异常方面差异有统计学意义（P〈0．05）,而在贫血、血小板减少、肾功能异常、口腔炎、周围神经损伤、手足综合征方面,两组比较差异无统计学意义（P〉0．05）.研究组及对照组中位无进展期为6．6个月、4．3个月,两组比较差异有统计学意义（P〈0．05）。结论：替吉奥联合伊立替康治疗结直肠癌疗效肯定,不良反应少,耐受性好。     

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.     

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.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.