2005-2009年六安市结核病控制项目效果评析

目的：分析六安市2005~2009年结核病控制项目效果及原因。方法：收集2005~2009年六安市实施结核病控制资料。结果：2005~2009年,全市共接诊可疑肺结核病人50969例,发现活动性肺结核病人22920例,其中涂阳16184例;活动性肺结核登记率由82.15/10万降低到54.66/10万,涂阳登记率由54.13/10万降低到42.81/10万;初治涂阳治愈率由85.02%上升到92.11%,初治涂阴疗程完成率由87.17%上升到93.78%;总体到位率由76.54%上升到94.97%。结论：六安市全面实施结核病控制项目效果显著,实现了高治愈率的规划目标,项目实行的各项技术政策是成功的,促进了六安市结核病控制工作的可持续发展。

Deprescribing antihypertensive treatment in nursing home patients and the effect on blood pressure

Background It is debatable whether treating multimorbid nursing home patients with antihypertensive drugs produces beneficial effects. Most cardiovascular guidelines promote treatment; few have advice on how to deprescribe when treatment may no longer be necessary. We investigated the effect of medication review on antihypertensive drug use and the association between cognition, blood pressure, and prescribing. Methods From August 2014 to December 2015, 765 patients from 72 units （clusters） in 32 Norwegian nursing homes were included in a 4-month, multicentre, cluster-randomized, controlled trial, with 9-month follow-up. Patients ≥ 65 years old with antihypertensive treatment （n = 295, 39%） were randomized to systematic medication review where the physician received support from peers （collegial mentoring） or were given care as usual （control condition）. Outcome measures were the number of antihypertensive drugs, systolic blood pressure, and pulse. We used hospitalizations and deaths as criteria to assess harm. Results At baseline, each patient used 9.2 ± 3.5 regular drugs, and 1.6 ± 0.7 antihypertensives. Mean blood pressure was 128/71 mmHg and 9% had a systolic pressure ≥ 160 mmHg. Between baseline and month four, antihypertensives were deprescribed to a significantly higher extent in the intervention group （n = 43, 32%） compared to control （n = 11, 10%）; Incidence Rate Ratio = 0.8, 95% CI = 0.7？0.9. In the intervention group, there was an immediate increase in systolic blood pressure when antihypertensives were reduced, from baseline 128 ± 19.5 mmHg to 143 ± 25.5 mmHg at month four. However, at month nine, the blood pressure had reverted to baseline values （mean 134 mmHg）. Deprescription did not affect pulse and systolic pressure. The number of hospitalizations was higher in control patients at month four （P = 0.031） and nine （P = 0.041）. Conclusion A systematic medication review supported by collegial mentoring significantly decreased the use of antihypertensive drugs in nursing home patients without an effect on the systolic blood pressure over time.

Regulatory T cells in viral hepatitis

The pathogenesis and outcome of viral infections are significantly influenced by the host immune response. The immune system is able to eliminate many viruses in the acute phase of infection. However, some viruses, like hepatitis C virus (HCV) and hepatitis B virus (HBV), can evade the host immune responses and establish a persistent infection. HCV and HBV persistence is caused by various mechanisms, like subversion of innate immune responses by viral factors, the emergence of T cell escape mutations, or T cell dysfunction and suppression. Recently, it has become evident that regulatory T cells may contribute to the pathogenesis and outcome of viral infections by suppressing antiviral immune responses. Indeed, the control of HCV and HBV specific immune responses mediated by regulatory T cells may be one mechanism that favors viral persistence, but it may also prevent the host from overwhelming T cell activity and liver damage. This review will focus on the role of regulatory T cells in viral hepatitis.

Progress of heat-hazard treatment in deep mines

Based on the urgency of thermal hazard control in deep coal mines,we studied the status of deep thermal damage and cooling technology both at home and abroad,summarized the causes of deep thermal hazard,analysed and compared the control technologies for deep thermal hazards.The results show that the causes of deep thermal damage can be attributed to three aspects,i.e.,climate,geological and mining factors,of which the geological factors are deemed the major reasons for thermal hazards.As well,we compared a number of cooling technologies of domestic and overseas provenance,such as central air conditioning cooling technology,ice cooling technology and water cooling technology,with one other cooling technology,i.e.,the HEMS cooling technology,which has a large and important effect with its unique＂pure air＂cooling technology,realizes the utilizing of heat resources from underground to the ground.This technology makes use of heat obtained underground;thus the technology can promote low-carbon environmental economic development in coal mines,in order to achieve low- carbon coal production in China.

HIV/AIDS in Asia:The Shape of Epidemics and Their Molecular Epidemiology

The Asia-Pacific region is a home to 60% of the population in the world and to approximately one quarter of people with HIV/AIDS. Close to a million of people has been infected and a half million people died of AIDS annually in Asia,becoming the second largest epicenter of global AIDS epidemic. Molecular epidemiology has been useful tool to track a course of HIV spread. In-depth knowledge from the studies on molecular epidemiology elucidates the dynamics of HIV spread and the interrelationship of epidemics in the different regions in Asia.

Whole process control and precision therapy in lung cancer

Lung cancer is one of the most common malignant tumors in the world. Non-small cell lung cancer （NSCLC） accounts for approximately 80% of lung cancer cases, and approximately 75% of patients are diagnosed in the middle and late stages. The treatment methods mainly include surgery, chemotherapy, radiotherapy, molecular targeted therapy, traditional Chinese medicine therapy, and immune therapy. We summarize the current status of lung cancer-related treatment options and targets.

T-Helper I Cell/T-Helper 2 Cell Balance with Anti Inflammatory Therapy in Partly Controlled Asthmatic Children

The authors aimed to assess Thl （T-helper cell 1）/Th2 （T-helper cell 2） balance, through evaluation of serum IFN-γ （interferon gamma） and IL-4 （interleukin 4）, during asthma exacerbation and study the effect of anti inflammatory therapy. A randomized prospective case-control study was designed. The sludy included 30 asthmatic patients, aging 8-14 years. All were diagnosed as partly controlled asthmatics. Twenty, age and sex matched, healthy children were included in the study as control group All participants were subjected to medical history, clinical examination, pulmonary function testing, eosinophilic blood counting, estimation of serum interleukine-4 and interferon gamma. Patients were treated for 6 weeks with 2 different anti inflammatory drugs. All methods were then repeated for follow up. IL-4 serum level was significantly higher in subjects with partly controlled asthma than in control subjects （P = 0.01）, and then in asthmatic patients after therapy （P = 0.0000）, while IFN-）, serum level was significantly lower in subjects with partly controlled asthma than in control subjects （P = 0.01）, and than in asthmatic patients after therapy （P = 0.0000）. Interferon gamma showed a significant negative correlation with IL-4 among the healthy control group （r = -0.559, P = 0.010）. Both LTA （leukotriene antagonist） and ICS （inhaled corticosteroids） therapy lead to significant improvement, but there were no statistically significant differences （P 〉 0.05） between them as regard the pulmonary functions and the laboratory evaluating parameters. Both serum levels of IL-4 and IFN-γ, could be used as a reliable inflammatory biomarker for the evaluation and follow up of asthmatic patients.

AIDS Research and Its Role in China's AIDS Prevention and Control Policies

By the end of 2005,the estimated number of HIV infected people in China was 650,000. The seriousness of the epidemic calls for effective control measures to tackle the problems in order to avoid the tragedy in Africa from happening in China. "Prevention First" is the cornerstone of the country's health policy. On 2003 World AIDS Day,Premier Jiabao Wen announced a new national AIDS control policy,"Four Frees and One Care". This policy clearly shows that the Chinese government has once again taken full responsibility to solve public health problems and has profound impact far beyond the AIDS field. In early 2006,the central government put scientific and technology innovation as a national priority and set the target to build an innovative China by year 2020. Since then,the government has been increasing investment in science and technology with major emphasis on both infectious diseases control and new drug research and development. For the first time,development of 100 new drugs and control of major infectious diseases (AIDS,HBV,TB and other emerging infectious diseases) have been selected as national key scientific projects. China's best minds in related fields will be pooled to work together in order to remove the technical barriers blocking efficient control of the major infectious disease in China. Knowledge on molecular epidemiology,immunology,pathogenesis,HAART,as well as HIVDR strains will certainly provide urgently needed scientific information for China's AIDS control program. Only evidence-based strategy from good research will provide long-term effective control of AIDS.

Importance of Monitoring of Emotional Stress and Physiological Functions of Humans during the Night Sleep

The diagnosis of disease and prescription of therapy are mainly realized through the control of physiological functions in humans during wakefulness. However, little attention is paid to evaluate the functional state of a patient in sleep. The efficiency of prescribed medicines is also determined in wakefulness. The effects of these drugs during sleep are usually out-of-sight of a physician. Human psychoemotional state during wakefulness is closely related to sleep. Various serious disturbances in physiological functions appear during the night sleep. They include cardiovascular disorders （hypertensive crisis, myocardial infarction, arrhythmias, stroke, etc.）, which may cause sudden death. A large body of evidence shows that stress is followed by sleep disorders. They serve as a factor, which contributes to the development of stress. It should be noted that sleep is the major anti-stress factor. The vicious circle is formed, which can be revealed by a complex control of human physiological functions during wakefulness and sleep. We developed a new methodology and constructed an information-and-equipment device for monitoring of vital physiological functions of humans during sleep in a real everyday life. This approach holds much promise for the diagnosis of disease and evaluation of therapeutic efficacy.

Survey on physicians' opinions of post-mastectomy radiotherapy for breast cancer in Guangdong province

Objective:The aim of our study was to comprehensively access current status of radiotherapy physicians' opinions in post-mastectomy radiotherapy(PMRT) for breast cancer in Guangdong province.Methods:From June 2007 to June 2008,questionnaires on the clinical value,sequencing with chemotherapy and endocrine therapy,indications and irradiated targets for PMRT were sent to physicians of all radiotherapy departments registering at Radiotherapy Professional Committee of Guangdong Anti-cancer Association.Results:There were 126 physicians joining this investigation.Proportions of physicians who accepted the views that PMRT could merely improve local control or can improve both local control and overall survival were 100% and 25.2%.The most common sequences of PMRT and chemotherapy or endocrine therapy were "sandwich" and sequential modes,performed 46.9% and 59.5% respectively.The median interval of surgery and PMRT was 8 weeks.Proportions of physicians who accepted T3-4 diseases,or four or more axillary lymph nodes metastasis,or T1-2 with 1-3 positive lymph nodes,or T1-2N0 with primary tumor located in the center or inner quadrant as the indications of PMRT were 97.6%,100%,46.8%,13.5%,respectively.Proportions of physicians who accepted chest wall,supraclavicular region,internal mammary chain or axilla as irradiated targets were 86.5%,100%,49.2% and 38.9% respectively.Conclusion:For Radiotherapy physicians of Guangdong Province,there is still lacking of consensus in the opinions of whether PMRT can improve survival,and optimal sequencing with chemotherapy or endocrine therapy,and how to make decision for patients with T1-2 with 1-3 positive lymph nodes,and rational irradiated targets,which requires advanced professional training for physicians and further prospective clinical trial evidences to guide clinical practice.

Evaluation of the Curative Effect of External Beam Radiotherapy and Brachytherapy for Tongue Carcinoma

OBJECTIVE To evaluate the curative effect of external beam radiothera-py (EBRT) and brachytherapy (BT) for tongue carcinoma. METHODS From 1991 to 2003, 35 patients received EBRT and BT in our department. We analyzed their curative and side effects retrospectively. RESULTS Local control was 80%. The 3-year overall (OS) and disease specific survival (DSS) rates were 75% and 79%. One patient developed metastases. Three patients (9%) developed different late complications. CONCLUSIONS Local regional control, survival, and complications in patients with tongue carcinoma treated by EBRT and BT have been satis-factory.

Challenges and Opportunities:the Expanded Government-led HIV/AIDS Programs in China

HIV/AIDS has posed an increasingly serious issue in China. In recent years,Chinese government has taken further intensified efforts to combat HIV/AIDS with high-level political commitment,supportive policy development,increased financial allocation,large-scale of government-led initiatives,expanded international cooperation and great involvement of non-governmental organizations. Meanwhile gaps and challenges coexist impacting the implementation and the results of national HIV/AIDS programs. Thus,further government efforts are needed to improve and tailor the actions to meet the requirement of HIV/AIDS control in China.

Successful treatment of intracardiac air embolism using intracardiac catheter aspiration

Intracardic air embolism is uncommon, however it is a serious condition which frequently leads to catastrophic complications during or after invasive procedures resulting in significant morbidity and mortality. For a successful re- suscitation of patients with intracardiac air embolism, hy- perbaric oxygen therapy is critical.~~2~ Still, due to a hyper- baric chamber＇s unavailability at many hospitals and con- cerns about patient movement resulting in further embolism during transport, such treatment method is gradually dimin- ishing.

Adjuvant postoperative radiochemotherapy for patients with gastric carcinoma:a single institution experience

Objective： The suboptimal outcome after surgery alone for gastric cancer indicated the necessity of adjuvant treatment for potentially resectable carcinoma of the stomach. In 2001, postoperative adjuvant radiochemotherapy started to be implemented in the NCI, Cairo, Egypt. However, the fear of the acute complication hindered its use as a standard treatment with some staff didn＇t follow the SWAG＇s adjuvant protocol. The aim of this report is to verify this issue. Methods： In the period from 1999 to 2009, 320 out of 581 patients with gastric carcinoma, underdid potentially curative surgery. Adjuvant postoperative radiochemotherapy for stage ≥ IIA started since 2001. Radiation （45 Gy, 1.8 Gy/f） was targeted to the tumor bed, anastomosis site, duodenal stump, remnant stomach and regional lymph node together with 4-5 cycles chemotherapy （SWOG protocol）. Survival analysis was performed and comparison between survival curves was done to analysis different prognostic factors. Results： The patients＇ age ranged from 17 to 86 years [mean （54 ± 12.5） years]. About 1/3 of the patients had a diffuse lesion. Adenocarcinoma was the most common pathology （60.4%）. High grade pathology constituted 59.1% of the cases. About one fifth of the patients had metastatic disease at presentation. Only 351 （75%） of the patients had potentially curative gastrectomy. The median number of lymph node （LN） dissected was 12 （ranged from 0-45） with a median number of the positive LN of 3.5 （ranged from 0-40）. Postoperative mortality was 12%. The median follow up period was 21.9 months （ranged from 3-129.4 months）. For the 257 patients who had curative surgery, 164 （62.8%） patients were alive at the end of follow up. During follow up period, 30 patients had Ioco-regional relapse, and 26 patients had metastasis, and 39 patients had both pattern of failure. The overall survival （OS）, Ioco-regionar control （LRC）, and metastasis free survival （MFS） rates, at median follow up period of 22 months, were 61.2%, 66.7% and 71%, respectively. At 3 and 5 years the corresponding values were： OS （42% and 28%）, LRC （64% and 50.4%） and MFS （56.3% and 49%）, respectively. Only stage and degree of nodal involvement had an adverse effect on all survival rates. Proximal lesion had poor OS rates. As regard LR control rate, mucinous cell type, and high grade had a bad effect. Although patients with less than D1 dissection had low OS and LRC rate, it didn＇t reach significant level. There was a significant improved 5-year OS rate for concurrent chemoradiotherapy （CCRTh, 55%） versus no or single adjuvant modality （27%）, P = 0.035. A subgroup analysis according to CTH regimen showed a trend for all survival rates with ECF compared to bolus 5FU/LV. However, none was statistically significant. Conclusion： In operable gastric carcinoma, postoperative concomitant radiochemotherapy with 5FU and LV is feasible with acceptable toxicity with a significant increase of Iocoregional control. A well designed phase III clinical trial - with ECF regimen and conformal radiotherapy - is worth to start to increase local control and decrease toxicity.

Quantitative Changes in Protein and Cholesterol in Haemolymph of the Red Palm Weevil Rhynchophorus ferrugineus after Treatment Leucokininll

We estimated quantitative changes to the content of protein and cholesterol in the Haemolymph of adult Red Palm Weevil after being fed on sugar cane treatment with different concentrations of LeucokininlI. In males, 0.05% has recorded significant increase in total protein, then 0.25% concentration compeer control, while the maximum high of females 4.846 mg at 0.05% compeer control. The effect of leucokininlI on content of haemolymph cholesterol has shown result that 0.05% concentration and have a clear impact on cholesterol concentration for both sexes with an average reduction of 37.989 mg in males compeer with 120.123 for control, and 57.263 in females compeer with 96.087 mg for control.

Higher radiation dose with a shorter treatment duration improves outcome for locally advanced carcinoma of anal canal

AIM： To assess whether radiation dose and duration of treatment influence local control and survival of patients with locally advanced anal cancer treated with definitive chemoradiation. METHODS： Twenty-eight consecutive patients who were treated with definitive radiation therapy for bulky anal cancers （〉 5 cm in size） were reviewed. Nineteen patients had T3 lesions, 8 patients had T4 lesions, and 15 patients had lymph node involvement. The median tumor size was 7.5 cm. All but one patient received concurrent chemoradiation. The median radiation dose was 54 Gy. The median duration of treatment was 58 d. RESULTS： With a median follow-up of 2.5 years in all patients and 7.8 years in living patients, the 2-year local recurrence-free probability was 570 and overall survival rate was 67%. Neither radiation dose nor duration of treatment alone was predictive of either time to local failure or overall survival. However, longer treatment breaks can potentially mask an advantage over higher radiation doses. Therefore, we examined those patients who received ≥ 54 Gy within 60 d, comparing them to the rest of the patients. Of patients who received ≥54 Gy within 60 d, local progression-free probability was 890 versus 420 for the rest of the group （P = 0.01）. CONCLUSION： Local failure is a significant problem in locally advanced carcinomas of-the anal canal. Higher radiation doses with limited treatment breaks may offer an increase in local control and survival.

Surgery for Crohn's disease in the era of biologicals:A reduced need or delayed verdict?

Crohn's disease(CD) is a chronic inflammatory bowel disease that can affect the entire gastrointestinal tract.Ultimately,up to 70% of all patients will need surgery,despite optimized medical therapy.Moreover,about half of the patients will need redo-surgery because of disease recurrence.The introduction of anti-tumor necrosis factor(TNF) drugs(Infliximab in 1998) revolutionized the treatment of CD.Different randomized trials assessed the efficacy of anti-TNF treatment not only to induce,but also to maintain,steroid-free remission.Furthermore,these agents can rapidly lead to mucosal healing.This aspect is important,as it is a major predictor for long-term disease control.Subgroup analyses of responding patients seemed to suggest a reduction in the need for surgery at median-term follow up(1-3 years).However if one looks at population surveys,one does not observe any decline in the need for surgery since the introduction of Infliximab in 1998.The short follow-up term and the exclusion of patients with imminent surgical need in the randomized trials could bias the results.Only 60% of patients respond to induction of anti-TNF therapy,moreover,some patients will actually develop resistance to biologicals.Many patients are diagnosed when stenosing disease has already occurred,obviating the need for biological therapy.In a further attempt to change the actual course of the disease,top down strategies have been progressively implemented.Whether this will indeed obviate surgery for a substantial group of patients remains unclear.For the time being,surgery will still play a pivotal role in the treatment of CD.

Control the invasive growth of gastrointestinal epithelial tumor

Invasive growth of epithelial tumor is a very complex process. Therefore,clarifying the molecular mechanisms of the invasive growth of tumor cells will help us find new targets for cancer therapy,and suppress tumor growth and development more effectively.

Continued application of Endostar combined with chemotherapy in advanced hemangioendothelioma of bone

By one case of hemangioendothelioma of bone accompanying pulmonary metastasis was treated with rh-endostatin injection (Endostar) combined with chemotherapy. The patient got partial response (PR) for 3 years after the application of Endostar maintenance therapy and Endostar combined with taxane-based chemotherapy. During the period of using Endostar as monotherapy, the patient got long-term disease control and good quality of life. There was no drug related adverse event during the therapy of Endostar. Suggested continued using of Endostar combined with chemotherapy could achieve an convinced therapeutic effect. Then using Endostar as maintenance treatment after patient got the optimal efficacy was feasible and profitable. This treatment strategy of long-term administration of Endostar was worthy of further observation, to explore the feasibility for long-term administration of combined with chemotherapy in the treatment of hemangioendothelioma of bone accompanying pulmonary metastasis.