目的:了解多学科协作(multidisciplinary team,MDT)模式下直肠癌术后肺转移治疗决策现状和结局,为加强医疗质量管理、完善MDT模式提供依据。方法:回顾性收集2007年7月至2015年2月北京大学肿瘤医院680例接受术前新辅助治疗联合根治术的...目的:了解多学科协作(multidisciplinary team,MDT)模式下直肠癌术后肺转移治疗决策现状和结局,为加强医疗质量管理、完善MDT模式提供依据。方法:回顾性收集2007年7月至2015年2月北京大学肿瘤医院680例接受术前新辅助治疗联合根治术的直肠癌患者临床资料,调查术后发生肺转移的患者在MDT模式下的治疗决策、执行情况和生存结局。结果:研究纳入85例术后肺转移患者,68例采用MDT模式治疗,其中28例建议行局部根治,40例建议行姑息治疗;决策总执行率为89.7%(61/68),未执行者均选择进一步保守治疗。局部根治的患者在直肠原发灶术后首次发生复发/转移后的3年复发/转移后生存率(survival after recurrence,SAR)高于姑息治疗患者(84.8%vs.37.6%,P<0.001)。结论:在MDT模式运行良好的情况下,直肠癌根治术后肺转移的治疗决策执行率较高,部分患者在该模式下有机会获得根治且预后良好;引入“患者参与”和“社会支持”将有助于构建全新MDT模式和提高医疗质量管理水平。展开更多
The corrosion behavior of environmental barrier coatings(EBCs)directly affects the service life and stability of ceramic matrix composite(CMC)structural parts in the aero-engines.The silicon carbide(SiC)whisker toughe...The corrosion behavior of environmental barrier coatings(EBCs)directly affects the service life and stability of ceramic matrix composite(CMC)structural parts in the aero-engines.The silicon carbide(SiC)whisker toughening phase and c-AlPO_(4) bonding phase are firstly used to improve the service life of novel tri-layer Yb_(2)Si_(2)O_(7)/mullite/SiC EBCs in the burner rig test.The formation of penetrating cracks in Yb_(2)Si_(2)O_(7)/mullite/SiC coating caused the failure of coating at 1673 K.The SiC whiskers in mullite middle coating significantly inhibited the formation of penetrating cracks in Yb_(2)Si_(2)O_(7)/mullite/SiC coating,and efficiently prevented the oxidation of carbon fiber reinforced silicon carbide(C_(f)/SiC)samples for 360-min thermal cycles(24 times)with a weight loss of 6.19×10^(−3) g·cm^(−2).Although c-AlPO_(4) particles further improved the service life of SiC_(w)-mullite(SM)coating,the overflow of PO_(x) gas aggravated the formation and expansion of cracks in the Yb_(2)Si_(2)O_(7) outer coating,and caused the service life of overall Yb_(2)Si_(2)O_(7)/c-AlPO_(4)-SiC_(w)-mullite(ASM)/SiC coating to be slightly lower than that of Yb_(2)Si_(2)O_(7)/SM/SiC coating.This study guides the design of modified tri-layer EBCs with long service life in high-temperature and high-speed gas environment.展开更多
文摘目的:了解多学科协作(multidisciplinary team,MDT)模式下直肠癌术后肺转移治疗决策现状和结局,为加强医疗质量管理、完善MDT模式提供依据。方法:回顾性收集2007年7月至2015年2月北京大学肿瘤医院680例接受术前新辅助治疗联合根治术的直肠癌患者临床资料,调查术后发生肺转移的患者在MDT模式下的治疗决策、执行情况和生存结局。结果:研究纳入85例术后肺转移患者,68例采用MDT模式治疗,其中28例建议行局部根治,40例建议行姑息治疗;决策总执行率为89.7%(61/68),未执行者均选择进一步保守治疗。局部根治的患者在直肠原发灶术后首次发生复发/转移后的3年复发/转移后生存率(survival after recurrence,SAR)高于姑息治疗患者(84.8%vs.37.6%,P<0.001)。结论:在MDT模式运行良好的情况下,直肠癌根治术后肺转移的治疗决策执行率较高,部分患者在该模式下有机会获得根治且预后良好;引入“患者参与”和“社会支持”将有助于构建全新MDT模式和提高医疗质量管理水平。
基金funded by the National Key R&D Program of China(Grant Nos.2021YFB3703800 and 2021YFB3703802)National Natural Science Foundation of China(Grant No.52102122)+1 种基金National Key Laboratory of Science and Technology on High-strength Structural Materials,Central South University(Grant No.SYSJJ2021LWS01)China Postdoctoral Science Foundation(Grant No.2022M711540).
文摘The corrosion behavior of environmental barrier coatings(EBCs)directly affects the service life and stability of ceramic matrix composite(CMC)structural parts in the aero-engines.The silicon carbide(SiC)whisker toughening phase and c-AlPO_(4) bonding phase are firstly used to improve the service life of novel tri-layer Yb_(2)Si_(2)O_(7)/mullite/SiC EBCs in the burner rig test.The formation of penetrating cracks in Yb_(2)Si_(2)O_(7)/mullite/SiC coating caused the failure of coating at 1673 K.The SiC whiskers in mullite middle coating significantly inhibited the formation of penetrating cracks in Yb_(2)Si_(2)O_(7)/mullite/SiC coating,and efficiently prevented the oxidation of carbon fiber reinforced silicon carbide(C_(f)/SiC)samples for 360-min thermal cycles(24 times)with a weight loss of 6.19×10^(−3) g·cm^(−2).Although c-AlPO_(4) particles further improved the service life of SiC_(w)-mullite(SM)coating,the overflow of PO_(x) gas aggravated the formation and expansion of cracks in the Yb_(2)Si_(2)O_(7) outer coating,and caused the service life of overall Yb_(2)Si_(2)O_(7)/c-AlPO_(4)-SiC_(w)-mullite(ASM)/SiC coating to be slightly lower than that of Yb_(2)Si_(2)O_(7)/SM/SiC coating.This study guides the design of modified tri-layer EBCs with long service life in high-temperature and high-speed gas environment.
