洛铂联合三氧化二砷TACE治疗老年原发性肝癌的临床疗效观察

【摘要】 目的 探讨洛铂联合三氧化二砷（As2O3）TACE治疗老年原发性肝癌的疗效及安全性。方法将95例肝功能为Child- Pugh A或B级的中晚期及不愿外科手术治疗的早期原发性肝癌老年患者按照不同用药方案分为观察组（n=48）和对照组（n=47），两组均行 TACE介入治疗，观察组使用洛铂（40 mg/m2）联合As2O3（10 mg/m2），对照组使用As2O3（10 mg/m2），每间隔6 周行1 次TACE。评价两组介入治疗的客观有效率（RR）、疾病控制率（DCR）、中位无进展生存期（mPFS）及不良反应发生率。结果 观察组和对照组的RR 分别为50.0%、48.9%（P＞0.05）；DCR 分别为85.4%、80.9%，差异无统计学意义（P＞0.05），mPFS分别为9.0个月、6.0个月，差异有显著统计学意义（P＜0.001），两组的不良反应主要为恶心呕吐、发热及转氨酶升高等，差异均无统计学意义（P＞0.05）。结论 洛铂联合As2O3治疗老年原发性肝癌可延长患者的mPFS，不良反应可耐受，可以是治疗老年原发性肝癌的较好方案，但要将其作为常规用药方案，尚有待大样本随机对照研究进一步证实。
     

TACE联合RFA及自体细胞因子诱导的杀伤细胞肝动脉灌注治疗原发性肝癌的临床研究

【摘要】 目的 观察TACE联合RFA和自体细胞因子诱导的杀伤细胞（CIK）肝动脉灌注治疗临床分期Ⅰ期原发性肝癌的临床疗效。方法 对2009年1月至2010年5月确诊的80例行综合介入治疗的肝癌患者进行随访研究，根据是否联合CIK治疗，分为TACE联合RFA及自体CIK细胞治疗组38例（研究组），TACE联合RFA治疗组42例（对照组）。比较两组术后的生活质量（QOL）、免疫功能指标变化、无进展生存期（PFS）及生存率观察指标。结果 ①QOL评分:研究组术后QOL改善明显高于对照组（P<0.05）；②免疫功能:研究组和对照组免疫功能指标治疗前后对比差异有统计学意义（P<0.05），两组相比，组间差异也有统计学意义（P<0.05）；③PFS和生存率:研究组和对照组的中位PFS分别为48个月和40.1个月； 1、2、3、5年生存率分别为100%、89.5%、71.1%、55.3%和95.2%、88.1%、64.3%、28.6%，研究组的中位PFS和生存率高于对照组。结论 TACE联合RFA及自体CIK细胞肝动脉灌注治疗临床分期Ⅰ期的原发性肝癌能提高患者生活质量、改善患者免疫功能、延长患者的中位PFS和总生存率。

     

微球联合碘油栓塞治疗肝癌的初步经验

目的研究采用微球联合碘油作为栓塞剂治疗肝癌的安全性及疗效。方法对肝癌患者行经动脉化疗栓塞（TACE）治疗时除使用化疗药物外，选用直径３００～５００μm的微球１～２ml及碘油１０～２０ml作为栓塞剂。分别观察患者术前、术后肝功能、血清甲胎蛋白（AFP）水平、肿瘤的改变情况及栓塞相关并发症。结果３６例原发性肝癌患者入选本组研究。TACE术后患者黄疸指数、丙氨酸转氨酶和碱性磷酸酶均有不同程度升高，血清白蛋白、AFP水平明显降低；肿瘤不同程度坏死、缩小明显（P＜０．０５）。结论在肝癌介入治疗中，使用微球联合碘油作为栓塞剂，疗效明显；但可造成一定程度的肝功能损害，应注意栓塞剂的用量及肝功能保护。     

原发性肝癌患者介入治疗期间的NK活性变化

随机选择60例在本院接受介入治疗的原发性肝癌患者分为三组:Ⅰ组(20例)采用本院常规的介入治疗方案,Ⅱ组(20例)采用常规介入治疗的同时,分别在术后2小时和48小时,静脉滴注硫代硫酸钠4g,共计8g。Ⅲ组(20例)在Ⅰ组的相同条件下于术后1周开始肌注干扰素100万单位,每周二次二个月以上。结果表明:原发性肝癌患者的 NK 活性明显低于正常健康人群,经介入治疗后,NK 活性显示为逐渐下降;在术后加用硫代硫酸钠能够有效的保持 NK 活性,较长期地低剂量干扰索可以在一定程度上提高患者的 NK 活性。     

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。

     

积极心理干预对肝癌患者介入治疗创伤后成长及乐观倾向的影响

【摘要】 目的 探讨适合原发性肝癌介入治疗患者的积极心理干预方案,并验证其对患者创伤后成长及乐观倾向的作用。方法 将126例患者随机分成对照组和研究组。对照组（63例）予以常规心理护理,研究组（63例）在对照组基础上接受以积极心理学理论为基础的护理干预, 心理干预周期为4周,每周1次,每次20～30 min。结果 干预4周后研究组的创伤后成长及乐观倾向两方面均优于对照组,差异有统计学意义（P<0.01）。结论 实施积极心理干预能够提高肝癌介入治疗患者积极情绪,促进其心身功能康复。

     

亚砷酸-碘油乳剂介入治疗原发性肝癌疗效分析

目的 探讨亚砷酸-碘油乳剂介入治疗原发性肝癌的近期疗效与对肝功能的影响.方法 选择52例肝动脉化疗栓塞患者随机分为治疗组27例和对照组25例,治疗组选用亚砷酸-碘油乳剂作为化疗栓塞方案,对照组选用丝裂霉素、表阿霉素、顺铂、碘油作为化疗栓塞方案,分别观察两组介入治疗后临床症状及肝功能6项指标.结果 与对照组相比,治疗组临床症状改善更显著,对肝功能的损害亦较轻.结论 亚砷酸-碘油乳剂是介入治疗原发性肝癌的一种安全有效的化疗栓塞剂.     

不同的栓塞材料经肝动脉栓塞治疗肝癌破裂出血的疗效对比分析

【摘要】 目的 探讨不同的栓塞材料治疗肝癌破裂出血的疗效对比。方法 回顾分析近 3 年收治的 57例,经导管肝动脉不同的栓塞材料栓塞治疗原发性肝癌破裂出血患者的临床资料,其中使用明胶海绵 19例,使用Embosphere微球 21例,使用明胶海绵+Embosphere微球17例,评价各组术后肝功能变化以及即时止血和再次出血率。结果 明胶海绵组、微球组、明胶海绵+微球组之间术后肝功能指标差异无统计学意义（P>0.05）;明胶海绵组栓塞术后1周内复发出血高于微球组、明胶海绵+微球组（P<0.05）。结论 利用明胶海绵加Embosphere微球或者单独使用Embosphere微球经导管动脉栓塞术治疗肝癌破裂出血疗效确切,值得在临床上推广应用。
     

国产CalliSpheres载药微球治疗原发性肝癌12例

【摘要】 目的 观察国产CalliSpheres载药微球治疗原发性肝癌的安全性及临床疗效。方法 对12例应用国产CalliSpheres载药微球治疗的原发性肝癌患者，回顾性分析术前及随访的临床资料、实验室检查和影像学检查资料。结果 12例患者首次化疗栓塞技术成功率为100%，中位随访时间为 7.5个月（6~9个月），术后1周患者AST和ALT较术前升高，差异有统计学意义（P<0.05），但其均值均未超过正常值上限（40 U/L）；肝功能Child- Pugh分级、血肌酐、血红蛋白含量、白细胞及血小板计数与术前差异无统计学意义（P>0.05）。术后3、6个月的疾病缓解率（CR+PR）分别为75.0%、66.7%，疾病控制率（CR+PR+SD）分别为91.7%和83.3%。其中10例AFP≥200 μg/L患者，术后AFP水平明显下降。术后3个月CalliSpheres载药微球联合碘化油序贯栓塞组的完全缓解率、疾病缓解率及疾病控制率大于单纯CalliSpheres载药微球栓塞组，但差异无统计学意义（P>0.05）。术后不良反应主要以腹痛及发热为主，随访期间出现胸腔积液2例，肝脓肿1例，肺转移1例。结论 国产CalliSpheres载药微球对原发性肝癌的治疗安全可行，其近期临床疗效较好，远期疗效及与碘化油联合应用的疗效需多中心、大样本的进一步研究。

     

原发性大肝癌患者TACE后S－腺苷蛋氨酸的护肝作用

目的探讨S－腺苷蛋氨酸对原发性大肝癌患者经肝动脉介入化疗栓塞（TACE）后急性肝功能损害的保护作用。方法回顾性分析自２００３年５月－２００７年１０月我院收治的５１例肝肿瘤患者进行术后护肝治疗,治疗组在TACE后静脉滴注S－腺苷蛋氨酸１０００mg ／d;对照组TACE后静脉滴注甘利欣３０ml／d（含甘草酸二铵盐１５０mg ）治疗。两组均在TACE术前第１天,术后第２、４、８天抽血查肝功能。结果肝功能各指标在TACE前后均发生明显变化,术后第２天ALT、AST、TBIL及DBIL均较术前不同程度的升高（P＜０．０５）,术后第４天起各指标开始逐渐下降。治疗组总TACE前TBIL、DBIL、ALT和AST与术后第８天比较差异无统计学意义（P＞０．０５）。对照组ALT、AST及TBIL、DBIL在TACE术后第８天有显著升高（P＜０．０５）。总蛋白（TP）及白蛋白（A）TACE前与术后第８天比较无显著性差异（P＞０．０５）。治疗组中１５例（６０％）患者汉密顿抑郁量表总分出现下降。结论S－腺苷蛋氨酸对肝癌患者TACE治疗后有保护肝功能作用,近期保护急性肝损害疗效满意。S－腺苷蛋氨酸还具有一定的抗抑郁作用,可增加TACE的疗效,提高患者的生活质量。     

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.     

Nonequilibrium in the transport of heat and reactants in combustion in porous media

Combustion in inert, catalytic and combustible porous media occurs under the influence of a large range of geometric length scales, thermophysical and thermochemical properties, and flow, heat and mass transfer conditions. As a result, a large range of phenomenological length and time scales control the extent of departure from local thermal and chemical nonequilibrium. The use of intraphase and interphase nonequilibria have allowed for the design of new combustion processes and systems, such as, catalytic reactors and converters, porous radiant burners, direct energy and gas conversion devices and systems, chemical sensors, and material synthesis processes. Improvement of current and design of yet newer and more innovative systems requires further investigations into the gas-phase and surface chemistry, solid-state and condensed-phase physics, transport in disordered structures, and mathematical and numerical methods. Here we summarize the processes leading to thermal and chemical nonequilibrium, their role in the combustion in porous media, their innovative uses and effects on applications, the current modeling of these processes and the modeling techniques that may allow for further improvements and developments.     

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.     

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.     

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.     

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.