Oral cancer incidence and mortality in China, 2011
肝细胞癌(HCC)靶向治疗的研究进展
肝细胞癌(HCC)靶向治疗的研究进展许智婷【摘要】肝细胞癌(hepatocellular carcinoma,HCC)是最常见的恶性肿瘤之一,具有起病隐匿、进展快、复发早和预后差的临床特点,临床发现时大多已属晚期.随着对HCC分子信号通路研究的不断深入,靶向治疗在治疗晚期HCC方面已表现出明显优势,多靶点的酪氨酸激酶抑制剂索拉菲尼已在临床上广泛应用.本文归纳了HCC 治疗的分子靶点、靶向治疗药物的作用机制、临床疗效、毒性作用和不良反应以及联合治疗方面的进展,并探讨目前研究中存在的机遇和挑战,以期为临床用药和进一步研究提供参考.【期刊名称】《复旦学报（医学版）》【年(卷),期】2019(046)002【总页数】5页(P276-280)【关键词】肝细胞癌(HCC);靶向治疗;酪氨酸激酶抑制剂;分子靶点;索拉非尼【作者】许智婷【作者单位】复旦大学附属中山医院超声科上海200032;上海市影像医学研究所上海200032【正文语种】中文【中图分类】R735.7肝细胞癌(hepatocellular carcinoma,HCC)是肝癌最常见的原发形式,也是仅次于肺癌和胃癌的全球第三大致死癌症类型。
全世界每年因HCC死亡人数超过74.5万,中国占55%[1]。
常用的肝癌治疗方案包括肝切除、肝移植、射频消融、经动脉化疗栓塞和放射性栓塞术,但大多数肝癌患者在晚期才被诊断,BCLC C期患者大多已丧失手术机会。
靶向治疗是在细胞分子水平上,针对致癌位点来设计相应的药物,药物进入体内会特异性地与致癌位点结合并发生作用,使肿瘤细胞死亡。
酪氨酸激酶抑制剂索拉非尼(sorafenib)是目前唯一被美国FDA批准的HCC靶向治疗药物[2]。
在HCC的发生过程中,有几种分子相关的信号通路可以被激活,这些通路参与细胞分化(如Wnt)、增殖(如EGF、IGF、HGF/C-MET、RAF/MEK/ERK)、存活(如Akt /m-TOR)、血管生成(如VEGF、PDGF、FGF),有助于肿瘤生长和转移[3],为HCC 的靶向治疗提供了潜在的分子靶标。
肝细胞癌血清标志物的研究进展_沈鹏
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叙事医学对晚期癌症患者抑郁情绪及死亡认知态度的影响
叙事医学对晚期癌症患者抑郁情绪及死亡认知态度的影响摘要：目的研究叙事医学对晚期癌症患者抑郁情绪及死亡认知态度的影响，探索晚期肿瘤患者多元化服务的安宁疗护措施。
方法收集2019年01月-2021年01月住院晚期癌症患者52例，按照患者（或家属）首诊意愿，接受叙事医学为研究组32例和不接受叙事医学为对照组20例。
对照组采用常规临终照护，包括口腔及会阴护理、缓解疼痛、进食困难及呼吸困难管理、心理支持；研究组在此基础上加用叙事医学干预，通过叙事能力进行医患沟通。
比较两组患者抑郁情绪及死亡认知态度。
结果干预1周后，研究组抑郁情绪GDS-15为6.72±2.11，对照组8.15±1.94；研究组死亡恐惧和死亡逃避发生9例占28.13%、中性接受、趋近接受和逃离接受共23例占71.87%；对照组死亡恐惧和死亡逃避发生12例占60.00%、中性接受、趋近接受和逃离接受共8例占40.00%，差异有统计学意义(P<0.05)。
结论叙事医学能有效降低晚期肿瘤患者的抑郁情绪，帮助他们减轻对死亡的恐惧，正确认识死亡，以保持晚期癌症患者的舒适和尊严。
关键词：叙事医学；晚期癌症；抑郁情绪；死亡认知态度The influence of narrative medicine on depression and death perception in patients with advanced cancerPeng aijun,Xu yinpin.Department of Geriatrics,Zhongren Senior Care Hospital,JinshanDistrict,Shanghai 201501,China*Corresponding author:Xu yinpin,Email:****************[ABSTRACT]Objective:Study the influence of narrative medicine on depression and death cognitive attitudes in patients with advanced cancer,and explore the peaceful treatment measures for a variety of services for advancedcancer patients.Methods:Collect 52 patients with advanced cancer who were hospitalized from January 2019 to January 2021.According to the willingness ofthe patient(or family member) to first see,32 cases of narrative medicine were accepted as research group and 20 cases were not accepted as control group.The control group used routine terminal care,including oral and perineal care,pain relief,eating difficulties and respiratory difficulties management,psychological support.On this basis,the research team used narrative medical intervention to communicate with doctors and patients through narrative pare the depression and death cognitive attitudes of the two groups ofpatients.Results:One week after the intervention,depression GDS-15 in the study group was 6.72±2.11,and the control group was 8.15±1.94;in the study group, death fear and death escape occurred in the study group accounted for 28.13%,anda total of 23 cases were neutral acceptance,convergence and escape acceptances accounted for 71.87 percent;12 deaths fear and death escapes in the controlgroup accounted for 61.0%,and 8 cases were neutral acceptance, convergence and escape acceptance,accounting for a total of 40.00%.The difference wasstatistically significant(P<0.05).Conclusion:Narrative medicine can effectively reduce the depression of patients with advanced cancer,help them reduce theirfear of death,and correctlyrecognize death in order to maintain the comfort and dignity of patients with advanced cancer.[KEYWORDS]Narrative medicine;advanced cancer;depression;cognitiveattitude to death2001年美国学者哥伦比亚大学医学院的临床医学教授丽塔.夏蓉(Rita Charon)［1］首次提出叙事医学概念，采用叙事沟通对患者的故事进行认知、吸收、诠释并为之感动，与患者建立相互信任的关系，旨在为临终患者提供更好的照护。
进展期胃癌新辅助化疗DOS方案疗效评估
进展期胃癌新辅助化疗DOS方案疗效评估发表时间：2017-08-25T15:18:02.313Z 来源：《航空军医》2017年第12期作者：杨晓琳殷先利郭戈杨罗英刘淮李蓉蓉向芳[导读] DOS方案用于局部进展期胃癌能提高R0切除率及病理缓解率，且不明显增加不良反应和手术并发症。
（湖南省肿瘤医院湖南长沙 410013）摘要：目的评价DOS方案（多西他赛联合奥沙利铂及替吉奥）在Ⅲ期进展期胃癌新辅助化疗的有效性及安全性。
方法89例局部进展期的胃癌患者术前随机分成研究组及对照组，研究组44例采用DOS方案新辅助化疗3周期，对照组45例采用SOX（奥沙利铂联合替吉奥）方案新辅助化疗3周期；评估疗效后进行胃癌根治术，术后继续化疗3周期。
观察患者的R0切除率，病理缓解率，3年复发转移率及生存率以及手术相关并发症和化疗的相关不良反应。
结果研究组RO切除率为95.45%（42/44），对照组为82.22%（37/45），研究组要高于对照组，两组有统计学差异（P＜0.05）；研究组病理缓解率（PCR+nPCR）高于对照组，研究组为59.09%（26/44），对照组为37.7%（17/45），两组差异有统计学意义；研究组3年复发转移率为34.09%（15/44），对照组为53.33%（24/45），对照组的复发转移率高于研究组，但两组差异未达到统计学意义（P＞0.05）；研究组1年、2年、3年生存率为分别为95.45%（42/44），86.36%（38/44），70.45%（31/44），对照组为91.11%（41/45），71.11%（32/45），62.22%（28/45），两组生存曲线无统计学差异（P＞0.05）；两组的手术相关并发症及化疗相关不良反应发生率无统计学差异（P＞0.05）。
结论DOS方案用于局部进展期胃癌能提高R0切除率及病理缓解率，且不明显增加不良反应和手术并发症。
关键词：胃癌是最常见的恶性肿瘤之一，在全世界范围内其发病率排名第五，肿瘤相关性死亡排名第三，亚洲尤其是东亚为高发区，胃癌发生率明显高于世界平均水平［1-2］。
2011年云南省肿瘤登记地区恶性肿瘤的发病与死亡_文洪梅
医药前沿杂志2011年云南省肿瘤登记地区恶性肿瘤的发病与死亡文洪梅1，成会荣1，王建宁2，林蕾3，刘晓丽4，秦明芳1（1.云南省疾病预防控制中心，云南昆明650022；2.个旧肿瘤防治工作领导办公室，云南个旧661000；3.红塔区疾病预防控制中心，云南红塔653100；4.腾冲县疾病预防控制中心，云南腾冲679100）摘要：［目的］评估云南省2011年恶性肿瘤发病与死亡情况。
［方法］按照国家癌症中心制定的审核方法和评价标准对云南省6个肿瘤登记处上报的2011年肿瘤登记数据进行整理和评估，共3个登记处的数据符合标准作为汇总数据，按地区、性别、年龄别、肿瘤别发病率和死亡率分层，然后结合2011年全省人口数据，估计全省恶性肿瘤合计和主要肿瘤的发病、死亡情况。
中国2000年全国人口普查的人口结构和Segi’s世界人口结构作为标准计算年龄标准化率。
［结果］2011年纳入分析的3个登记处覆盖人口共1477507人，占全省2011年人口数的3.21%。
病理诊断比例（MV%）为73.85%，只有死亡证明书比例（DCO%）为1.19%，死亡发病比（M/I）为0.61。
据估计，2011年新发恶性肿瘤病例约71247例，死亡病例43041例。
全省恶性肿瘤发病率为155.59/10万（男性157.48/10万，女性152.32/10万），中标率为177.53/10万，世标率为140.39/10万，累积率为16.33%。
红塔区发病率为201.60/10万，中标发病率为187.80/10万；个旧市发病率为195.32/10万，中标发病率为167.98/10万；腾冲县发病率为161.80/10万，中标发病率为176.19/10万。
全省恶性肿瘤死亡率为93.62/10万（男性111.22/10万，女性74.68/10万），中标死亡率为107.22/10万，世标死亡率为84.71/10万，累积死亡率（0~74岁）为10.12%；红塔区死亡率为122.98/10万，中标死亡率为112.37/10万；个旧市死亡率为114.70/10万，中标死亡率为96.21/10万；腾冲县死亡率为100.42/10万，中标死亡率为109.21/10万。
口腔颌面部恶性肿瘤术后患者心理痛苦及相关因素分析
・88・JournalofNursingScience Mar2021Vol.36No.6口腔颌面部恶性肿瘤术后患者心理痛苦及相关因素分析郭宏梅1,王伟平2,徐春燕1,贺敏敏1,郑甜甜1,帅婷&Psychological distress and associated factors in patients receiving surgical management for oral and maxillofacial malignancy Guo Hongmei#Wang Weiping#Xu Chunyan#He Minmin#Zheng Tiantian#Shuai Ting摘要：目的探索口腔颌面部恶性肿瘤术后患者心理痛苦状况并分析其相关因素，为开展有效心理支持干预提供参考°方法采用心理痛苦温度计及其相关问题列表、自尊量表、知觉压力量表对399例口腔颌面部恶性肿瘤术后患者进行调查°结果口腔颌面部恶性肿瘤术后患者心理痛苦得分为（3.34土2.81）分，显著心理痛苦水平检出率为43.6%"患者心理痛苦水平与自尊水平呈负相关，与知觉压力水平呈正相关（均P<0.01）Logistic回归分析结果表明，人均月收入、无时间精力做家务、经济问题、恐惧、悲伤、担忧、睡眠问题、便秘、口腔疼痛、疼痛等是口腔颌面部恶性肿瘤患者术后心理痛苦的影响因素（P<0.05,P< 0.01）结论口腔颌面部恶性肿瘤患者术后心理痛苦检出率较高，影响因素较多，医护人员应予以重视并给予有效措施减轻其心理痛苦水平"关键词：口腔颌面部肿瘤；心理痛苦；自尊；知觉压力；疼痛；恐惧；睡眠问题中图分类号：R473.78文献标识码:B DOI：10.3870/j.issn.1001-4152.2021.06.088据2018年国际癌症研究所最新数据显示，口腔颌面部恶性肿瘤的年新发病例和年死亡病例分别为50万和25万，对人类健康的危害性仅次于甲状腺癌而居头颈部肿瘤的第2位（1）。
肠造口病人健康促进行为的研究进展
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All Rights Reserved.据报道,2020年结直肠癌全球发病人数约193.2万例,死亡病例约93.5万例,其发病率和死亡率分别居恶性肿瘤的第3位和第2位[1]㊂外科手术是根治结直肠癌的主要手段,超过半数的结直肠癌病人需行腹会阴联合直肠癌根治术,虽然术后病人生存率高,但其腹壁将永久携带造口[2]㊂研究显示,在行造口术后部分病人原有的健康行为水平降低,目前我国肠造口病人的健康行为水平不容乐观,应引起临床工作者的重视[3]㊂因此,对肠造口病人健康促进行为的相关研究进行综述,以期帮助临床工作者提高肠造口病人健康促进行为水平提供参考依据㊂1健康促进行为的内涵健康促进(h e a l t h p r o m o t i o n,H P)的概念暂未统一,目前大众比较认可的是‘渥太华宪章“中对健康促进的定义:健康促进是个体能够提高健康决定因素的控制力度,以维护和增进健康的过程[4]㊂健康促进行为(h e a l t h-p r o m o t i n g b e h a v i o u r s,H P B s)是指以健康促进为导向,个体开展更加积极且有益健康的生活行为方式,从而产生正面的健康结局[5]㊂2肠造口病人健康行为评估工具肠造口病人健康行为主要是运用专门的测评工具评估,常用的评估量表分为普适性量表和特异性量表㊂常见的普适性测评工具有健康促进生活方式量表(H P L P)㊁健康促进生活方式量表Ⅱ(H P L P-Ⅱ)㊁健康促进策略量表(S U P P H)㊁健康行为量表(H P L)以及健康习惯量表(HH S),均具有良好的信效度,并已在多个领域应用[4,6-7]㊂普适性量表对肠造口病人健康促进行为的评价缺乏一定的特异性,因此韩雪娜等[8-9]基于行为意向的理论㊁自我决定理论以及健康促进行为的相关研究编制了肠造口病人专用的健康促进行为评估工具,包括肠造口健康促进行为意向问卷㊁肠造口病人健康促进行为动机问卷㊂量表的C r o n b a c h'sα系数为0.802~0.921,编制过程具备一定的科学性,信效度良好㊂但都只选取1所医院的病人进行测试,也未进行验证性因子分析㊂未来研究中需要在不同地区不同级别的医院进一步验证问卷的信效度,从而提高问卷的科学性和可靠性㊂3肠造口病人健康促进行为相关影响因素3.1非疾病因素3.1.1年龄万珊珊[10]对202例肠造口病人健康行为分析结果显示,>60岁病人的健康行为优于其他年龄段病人,与向薇等[11]研究结果具有一定相似性㊂原因可能是因为老年病人对特殊且陌生的造口需要一定的时间接受,加上自我形象和身体功能严重受损,导致健康行为水平较低㊂而刘华玲等[12]的研究显示,中青年病人的健康行为较老年病人差,可能原因是中青年病人事业繁重,无暇顾及身体,因此健康行为评分低㊂目前,关于年龄是否影响肠造口病人健康行为的研究还需进一步探讨,临床工作者应要根据病人不同年龄段的接受能力㊁生活方式来针对性地进行护理干预,以提高其生活质量㊂3.1.2性别研究显示,性别是炎症性肠病病人健康促进生活方式的主要影响因素之一(P<0.05),女性病人较男性病人健康促进生活得分更高,可能是由于女性对疾病敏锐性较高,会主动汲取健康知识,且遵医行为较好,因此健康行为水平更高[13]㊂3.1.3文化程度文化程度是病人健康促进行为的预测影响因子之一㊂韩雪娜等[14]指出,健康促进行为与教育水平呈正相关,分析可能的原因是文化程度高的病人知晓健康促进行为对自身疾病康复的重要性,能通过书籍㊁视频等积极学习健康知识,掌握一定的造口护理的技巧㊂3.1.4家庭月收入贾莉莉[15]研究结果表明,肠造口病人家庭收入与其健康促进行为呈正相关,对于家庭月收入高的病人来说,其健康促进行为水平较家庭月收入低的病人好,与武洋等[16]研究结果一致㊂目前,仍有较多造口附属产品无法纳入医保,长期的治疗及造口护理用品费用,致使许多家庭尤其是农村病人承受着较大的经济负担㊂3.1.5自我效能自我效能指个体对于自己能够采取某种健康行为的信念㊁判断和主观感受[17]㊂鲍玉新等[18]分析了115例肠造口病人自我效能与感知控制的相关性,其结果表明,自我效能较差,其排便控制较差,性生活满意度也较低㊂因此,提高病人的自我效能感,对病人的生活质量有积极作用㊂3.1.6自我感受负担陈旭[19]的研究显示,肠造口病人的自我感受负担与健康相关行为呈负相关㊂原因可能是肠造口病人原有的肛门排泄口移至腹部,导致病人自我形象改变,增加病人的自我感受负担[20]㊂3.2疾病相关因素3.2.1术后时间研究显示,造口术后时间是结直肠癌肠造口病人健康行为的重要预测因子㊂造口术后时间越长,肠造㊃8392㊃C H I N E S EE V I D E N C E-B A S E D N U R S I N G A u g u s t,2023V o l.9N o.16Copyright©博看网. All Rights Reserved.口病人的健康行为水平也越高[15]㊂分析原因可能是造口术后初期饮食㊁体力等都未恢复,从而影响到健康促进行为的实施㊂而随着行造口术时间的推移,病人逐步掌握造口的知识和技能,自我护理能力随之提高,能更好地应对生活中因疾病带来的一系列问题,健康促进行为也随之提高,与宋琴芬等[21]研究结果一致㊂3.2.2造口并发症据报道,结直肠癌病人术后造口并发症发生率高达60%以上[22]㊂据研究表明,造口并发症与健康行为呈负性相关关系,并发症越多,病人健康行为越差[11]㊂3.3社会支持研究表明,社会支持水平与健康促进行为是正向关系,即社会支持水平越高,健康行为水平越高[23]㊂临床工作者除了主动向病人提供医疗㊁心理支持外,在病人疾病稳定情况下可鼓励其主动为病友等提供支持,避免长时间处于被动接受支持的状态㊂3.4家庭因素郑红丽[24]的研究指出,家庭功能越好,健康促进行为水平越高,与俞婷婷等[25]的研究结果一致㊂研究表明,造口病人家庭关怀度越高,其造口的适应能力越强㊂原因可能是肠造口病人可以得到更多来自家庭成员给予的信息和情感支持,安全感较高,有助于缓解病人因造口产生的负性情绪,促进疾病康复[26]㊂因此,在关注肠造口病人的同时,也应增加对肠造口家庭的关注,调动家庭成员对病人造口护理㊁饮食㊁运动等方面的监督作用㊂4基于健康促进行为相关理论的护理干预在肠造口病人中的应用4.1健康信念模型(H B M)20世纪末R o s e n s t o c k提出H B M[27]㊂目前,基于H B M的健康教育已被广泛应用在慢性病㊁癌症㊁产科等领域[28-30]㊂刘春红等[31]的研究认为,随着健康信念提高,病人就越容易采取积极的健康相关行动,从而产生更好的自我管理行为㊂董亚娟[32]基于H B M的自我护理模式,有效增强了肠造口病人社交效能与生活质量㊂胡莹等[33]对120例肠造口病人基于健康信念模式展开健康知识教育㊁自护技能培训和随访教育,6个月后发现病人的造口并发症发生率有效降低,生活质量得到提高㊂因此,帮助病人建立恢复疾病健康的信念,可以改善不良的健康相关行为㊂4.2保护动机理论(P MT)1975年由R o g e r s提出P MT[34]㊂P MT是从动机因素探讨健康行为,通过认知调节的评估解释来行为改变[35]㊂P MT是H B M的延伸和扩展㊂与H B M相比,P MT中加入了自我效能,更科学合理地解释了行为改变的内在机制㊂周凌芸等[36]基于P MT理论的综合护理干预,增强病人对疾病的易感性认知,通过危机意识教育㊁个性化指导等,最终提高病人的生活质量㊂4.3跨理论模型(T T M)20世纪70年代P r o c h a s k a等提出T T M[35],包含了4部分内容,分别是变化的阶段和程序㊁自我效能和决策平衡㊂韩梅梅等[37]基于T T M的动机访谈,从入院第1天到出院3个月分别以正确认知㊁增强信心㊁提高效能㊁自我护理㊁自我接纳5个主题,进行动机访谈教育,使得病人自愿或积极地去获取相关的知识和技能,进而改变其行为,结果发现病人的自尊水平得到提高,并减少并发症的发生㊂5小结与展望肠造口病人的健康促进行为直接影响其健康结局,提高健康促进行为的护理干预是目前亟待解决的问题㊂国内有关肠造口病人健康促进行为的研究多处于小样本㊁单中心阶段,日后,应积极探寻肠造口病人健康促进行为的有利因素,并加强大样本㊁多中心的关于提高肠造口健康促进行为的干预性研究㊂并且,应充分利用造口门诊进行干预后疗效追踪,充分发挥医院-社区-家庭三级联动的大优势和特点[38],构建系统化的肠造口病人健康促进行为干预模式和体系,切实促进病人的健康行为,提高病人的生存质量㊂参考文献:[1] S U N G H,F E R L A YJ,S I E G E LRL,e t a l.G l o b a l c a n c e r s t a t i s t i c s2020:G L O B O C A N e s t i m a t e s o f i n c i d e n c e a n d m o r t a l i t yw o r l d w i d e f o r36c a n c e r s i n185c o u n t r i e s[J].C A:aC a n c e r J o u r n a lf o rC l i n i c i a n s,2021,71(3):209-249.[2]张倩,杨永萍,王吉华.以适应性领导理论为基础的干预在直肠癌永久性肠造口患者中的应用[J].中华现代护理杂志,2021,27(8): 1087-1091.[3]万珊珊,杨长永,卫莉.新辅助化疗直肠癌造口患者健康行为现状及影响因素分析[J].中国实用护理杂志,2019,35(1):60-64. 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[17] A HMA DS HA R O N I SK,MO H DR A Z IM N,A B D U LR A S H I DNF,e t a l.S e l f-e f f i c a c y o f f o o t c a r eb e h a v i o u ro f e l d e r l yp a t i e n t sw i t hd i a b e t e s[J].M a l a y s i a nF a m i l y P h y s i c i a n,2017,12(2):2-8.[18]鲍玉新,邵丽萍.结直肠癌造口患者感知控制与自我护理效能分析[J].解放军护理杂志,2018,35(13):25-28.[19]陈旭.永久性肠造口病人自我感受负担及健康相关行为与生活质量的关系研究[J].全科护理,2021,19(6):823-826. [20]范艺禧,彭亚,李倩儿,等.肠造口病人自我形象研究进展[J].护理研究,2022,36(19):3459-3462.[21]宋琴芬,尹光啸,刘春娥,等.直肠癌永久性造口患者体力活动现状及影响因素研究[J].护理学杂志,2021,36(1):14-18. [22] B U R C H J.C o m p l i c a t i o n s o f s t o m a s:t h e i r a e t i o l o g y a n dm a n a g e m e n t[J].B r i t i s h J o u r n a l o fC o mm u n i t y N u r s i n g,2017,22(8):380-383.[23]朱晖,李聪,李亚飞,等.社会支持在慢性心力衰竭患者自我效能感与健康促进行为的中介作用[J].齐鲁护理杂志,2020,26(19): 38-41.[24]郑红丽.高龄经产妇孕期健康促进行为与家庭功能㊁心理一致感的关系研究[J].护理管理杂志,2020,20(1):1-6. [25]俞婷婷,赵若华,许碧香,等.糖尿病患者家庭功能与健康行为的相关性研究[J].中国全科医学,2018,21(19):2308-2312.[26]孙春燕,王晓峥.家庭关怀对结直肠癌永久性肠造口患者生活质量及并发症的影响[J].中国肿瘤临床与康复,2017,24(11): 1383-1386.[27] R O S T A M I-M O E Z M,R A B I E E-Y E G A N E H M,S H O K O U H I M,e t a l.E a r t h q u a k e p r e p a r e d n e s so fh o u s e h o l d sa n d i t s p r e d i c t o r sb a s e do nh e a l t hb e l i e fm o d e l[J].B M C P u b l ic H e a l t h,2020,20(1):646.[28] D A N I E L S K J,P H A R A O H H.D e v e l o p i n g ac h i l d r e n'sh e a l t hr i s kb e h a v i o u r p r e v e n t i o n p r o g r a mt a r g e t i n gg r a d e4-7l e a r n e r si n t h e w e s t e r nc a p e,S o u t h A f r i c a:as t u d y p r o t o c o l[J].B M CP u b l i cH e a l t h,2021,21(1):1021.[29] L A UJ,L I M T Z,J I A N L I N WO N G G,e ta l.T h eh e a l t hb e l i e fm o d e l a n d c o l o r e c t a l c a n c e r s c r e e n i n g i n t h e g e n e r a l p o p u l a t i o n:a s y s t e m a t i cr e v i e w[J].P r e v e n t i v e M e d i c i n e R e p o r t s,2020,20: 101223.[30] K H O R AMA B A D IM,D O L A T I A N M,H A J I A NS,e t a l.E f f e c t so f e d u c a t i o nb a s e do nh e a l t hb e l i e fm o d e l o nd i e t a r y b e h a v i o r s o fI r a n i a n p r e g n a n tw o m e n[J].G l o b a l J o u r n a lo f H e a l t hS c i e n c e,2015,8(2):230-239.[31]刘春红,赵惠芬,胡蓉芳.2型糖尿病患者自我管理行为与健康信念及家庭功能的相关性[J].解放军医学杂志,2018,43(11):989-990.[32]董亚娟.基于H B M及O r e m自护理论的护理在M i l e s术肠造口患者康复中的应用研究[D].衡阳:南华大学,2020. [33]胡莹,李响,张茜,等.健康信念模式健康教育对直肠癌肠造口患者自护能力及生活质量的影响[J].癌症进展,2018,16(13): 1684-1687.[34] L I N H X,C H E N M J,Y U N Q P,e ta l.T o b a c c od e p e n d e n c ea f f e c t s d e t e r m i n a n t sr e l a t e dt o q u i t t i n g i n t e n t i o na n db e h a v i o u r[J].S c i e n t i f i cR e p o r t s,2021,11(1):20202.[35] MO P K H,F O N G V W I,S O N G B,e ta l.A s s o c i a t i o n o fp e r c e i v e d t h r e a t,n e g a t i v e e m o t i o n s,a n d s e l f-e f f i c a c y w i t hm e n t a lh e a l t ha n d p e r s o n a l p r o t e c t i v eb e h a v i o r a m o n g C h i n e s e p r e g n a n tw o m e nd u r i n g t h e C O V I D-19p a n d e m i c:c r o s s-s e c t i o n a ls u r v e y s t u d y[J].J o u r n a lo f M e d i c a lI n t e r n e tR e s e a r c h,2021,23(4): e24053.[36]周凌芸,鲁凤娟.保护动机理论在直肠癌造口术患者护理中的应用[J].护理实践与研究,2020,17(10):62-65.[37]韩梅梅,范苗苗,李小峰.基于跨理论模型的动机性访谈对直肠癌结肠造口患者自我护理能力及自尊水平的影响[J].安徽医学, 2021,42(11):1306-1309.[38]陶嘉怡,韦桂源,陈志英,等.肠造口病人三元联动护理平台的研究进展[J].循证护理,2022,8(20):2756-2758.(收稿日期:2022-12-18;修回日期:2023-08-06)(本文编辑孙玉梅)㊃0492㊃C H I N E S EE V I D E N C E-B A S E D N U R S I N G A u g u s t,2023V o l.9N o.16Copyright©博看网. 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Plin2在肺癌中的表达及临床意义
2040Chin J Lab Diagn,December»2020,Vol 24,No. 12文章编号：1007 — 4287(2020)12 — 2040 — 02Plin2在肺癌中的表达及临床意义王晶莹ia，刘洋2,刘启迪ib*(1.吉林大学中日联谊医院a.检验科；b.呼吸内科，吉林长春130033;2.吉林大学第二临床医院放射线科)全球每年的新增肺癌数量高达180万，其中一 半以上死于该病[1]。
流行病学对肺癌的15年生存 率调查结果显示，不同地区不同疾病进展阶段的患者的生存率从4%到17%不等[2]。
而较为常规的治 疗手段是手术切除[3]，此外，肺癌的5年生存率也基 于不同的病理分区，呈现出较大的差异[4]。
因此发 现可以用于早期诊断的肿瘤标志物对于改善患者的 预后是十分有意义的。
紫苏脂素2(Pl i n2)是一种与细胞内脂滴（LDs)代谢有关的蛋白质。
然而，对其表达的调控会影响多种代谢和年龄相关疾病的严重程度，如脂肪肝、胰 岛素抵抗和2型糖尿病（T2D)、心血管疾病、动脉粥 样硬化、肌萎缩和癌症[5’6]，研究显示该蛋白可能在这些病理状态中起作用。
本研究目的在于寻找肺癌 的差异表达蛋白，探索其作为肿瘤标志物的意义。
1材料与方法1.1研究对象收集手术中切取的新鲜肿瘤组织、正常组织，置于无菌容器内，P B S冲洗，液氮速冻。
1.2方法通过生物信息数据库T C G A检索，初 步确认P l i n2的表达情况，免疫印迹进一步观察其在肺癌组织及癌旁组织中的差异表达情况.免疫组 化染色，探讨P l i n2的表达意义。
1.3主要试剂 N，N’_亚甲双丙烯酰胺，蛋白定量 试剂盒，甘氨酸，无水乙醇，蛋白抽提试剂盒，丙烯酰 胺，D A B试剂盒，Tris-base,二甲苯。
1.4统计学处理数据采用卡方检验，用SPSS12.0 软件分析，P<〇. 05定义为有统计学意义。
2结果2. 1TCGA数据库检索差异表达基因Plin2通过在线检索T C G A数据库，搜索肺癌中的差 异表达基因，发现P l i n2基因在肺癌组织中的转录水平显著低于癌旁组织。
葡糖胺对慢性腰痛与退行性腰椎骨关节炎所致疼痛相关残讲解
JAMA Vol. 304 No. 1, July 7, 2010Original Contributions 论著Effect of Glucosamine on Pain-Related Disability in Patients With Chronic Low Back Pain and Degenerative Lumbar Osteoarthritis: A Randomized Controlled Trial 葡糖胺对慢性腰痛与退行性腰椎骨关节炎所致疼痛相关残疾的作用研究：一项随机对照试验Survival Differences Following Lung Transplantation Among US Transplant Centers 于不同移植中心行肺移植后的存活率差异调查Tight Blood Pressure Control and Cardiovascular Outcomes Among Hypertensive Patients With Diabetes and Coronary Artery Disease对糖尿病及冠心病患者实施强化血压控制与其负性心血管事件结局的关系研究Primary Communication 简报发表Telomere Length and Risk of Incident Cancer and Cancer Mortality端粒长度与癌症发生风险及死亡率的关系研究The Rational Clinical Examination 合理临床检查Can This Patient Read and Understand Written Health Information?识别低文化患者的简易办法：一项系统回顾分析Commentaries 评论Restoring Health to Health Reform将健康归还医改Cardiopulmonary Resuscitation: Celebration and Challenges心肺复苏：庆贺与挑战Meaningful Use of Health Information Technology Is Managing Information健康信息技术的应用意义在意管理信息Aging Adults With Intellectual Disabilities智能障碍的老龄化人群带来医疗挑战Original Contributions 论著Effect of Glucosamine on Pain-Related Disability in Patients With Chronic Low Back Pain and Degenerative Lumbar Osteoarthritis: A Randomized Controlled Trial 葡糖胺对慢性腰痛与退行性腰椎骨关节炎所致疼痛相关残疾的作用研究：一项随机对照试验AbstractContext Chronic low back pain (LBP) with degenerative lumbar osteoarthritis (OA) is widespread in the adult population. Although glucosamine is increasingly used by patientswith chronic LBP, little is known about its effect in this setting.Objective To investigate the effect of glucosamine in patients with chronic LBP and degenerative lumbar OA.Design, Setting, and Participants A double-blind, randomized, placebo-controlled trial conducted at Oslo University Hospital Outpatient Clinic, Oslo, Norway, with 250 patients older than 25 years of age with chronic LBP (>6 months) and degenerative lumbar OA. Interventions Daily intake of 1500 mg of oral glucosamine (n = 125) or placebo (n = 125) for 6 months, with assessment of effect after the 6-month intervention period and at 1 year (6 months postintervention).Main Outcome Measures The primary outcome was pain-related disability measured with the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes were numerical scores from pain-rating scales of patients at rest and during activity, and the quality-of-life EuroQol-5 Dimensions (EQ-5D) instrument. Data collection occurred during the intervention period at baseline, 6 weeks, 3 and 6 months, and again 6 months following the intervention at 1 year. Group differences were analyzed using linear mixed models analysis.Results At baseline, mean RMDQ scores were 9.2 (95% confidence interval [CI], 8.4-10.0) for glucosamine and 9.7 (95% CI, 8.9-10.5) for the placebo group (P = .37). At 6 months, the mean RMDQ score was the same for the glucosamine and placebo groups (5.0; 95% CI, 4.2-5.8). At 1 year, the mean RMDQ scores were 4.8 (95% CI, 3.9-5.6) for glucosamine and 5.5 (95% CI, 4.7-6.4) for the placebo group. No statistically significant difference in change between groups was found when assessed after the 6-month intervention period and at 1 year: RMDQ (P = .72), LBP at rest (P = .91), LBP during activity (P = .97), and quality-of-life EQ-5D (P = .20). Mild adverse events were reported in 40 patients in the glucosamine group and 46 in the placebo group (P = .48). Conclusions Among patients with chronic LBP and degenerative lumbar OA, 6-month treatment with oral glucosamine compared with placebo did not result in reduced pain-related disability after the 6-month intervention and after 1-year follow-up.Trial Registration Identifier: NCT00404079Survival Differences Following Lung Transplantation Among US Transplant Centers 于不同移植中心行肺移植后的存活率差异调查AbstractContext Although case loads vary substantially among US lung transplant centers, the impact of center effects on patient outcomes following lung transplantation is unknown. Objective To assess variability in long-term survival following lung transplantation among US lung transplant centers.Design, Setting, and Patients Analysis of data from the United Network for OrganSharing registry for 15 642 adult patients undergoing lung transplantation between 1987 and 2009 in 61 US transplantation centers still active in 2008.Main Outcome Measures Mixed-effect Cox models were fitted to assess survival following lung transplantation at individual centers.Results In 2008, 19 centers (31.1%) performed between 1 and 10 lung transplantations;18 centers (29.5%), from 11 to 25 transplantations; 20 centers (32.8%), from 26 to 50 transplantations; and 4 centers (6.6%), more than 50 transplantations. One-month, 1-year, 3-year, and 5-year survival rates among all 61 centers were 93.4% (95% confidence interval [CI], 93.0% to 93.8%), 79.7% (95% CI, 79.1% to 80.4%), 63.0% (95% CI, 62.2% to 63.8%), and 49.5% (95% CI, 48.6% to 50.5%), respectively. Characteristics of donors, recipients, and surgical techniques varied substantially among centers. After adjustment for these factors, marked variability remained among centers, with hazard ratios for death ranging from 0.70 (95% CI, 0.59 to 0.82) to 1.71 (95% CI, 1.36 to 2.14) for low- vs high-risk centers, for 5-year survival rates of 30.0% to 61.1%. Higher lung transplantation volumes were associated with improved long-term survival and accounted for 15% of among-center variability; however, variability in center performance remained significant after controlling for procedural volume (P < .001).Conclusions Center-specific variation in survival following lung transplantation was only partly associated with procedural volume. However, other statistically significant sources of variability remain to be identified.Tight Blood Pressure Control and Cardiovascular Outcomes Among Hypertensive Patients With Diabetes and Coronary Artery Disease对糖尿病及冠心病患者实施强化血压控制与其负性心血管事件结局的关系研究AbstractContext Hypertension guidelines advocate treating systolic blood pressure (BP) to less than 130 mm Hg for patients with diabetes mellitus; however, data are lacking for the growing population who also have coronary artery disease (CAD).Objective To determine the association of systolic BP control achieved and adverse cardiovascular outcomes in a cohort of patients with diabetes and CAD.Design, Setting, and Patients Observational subgroup analysis of 6400 of the 22 576 participants in the International Verapamil SR-Trandolapril Study (INVEST). For this analysis, participants were at least 50 years old and had diabetes and CAD. Participants were recruited between September 1997 and December 2000 from 862 sites in 14 countries and were followed up through March 2003 with an extended follow-up through August 2008 through the National Death Index for US participants.Intervention Patients received first-line treatment of either a calcium antagonist or β-blocker followed by angiotensin-converting enzyme inhibitor, a diuretic, or both toachieve systolic BP of less than 130 and diastolic BP of less than 85 mm Hg. Patients were categorized as having tight control if they could maintain their systolic BP at less than 130 mm Hg; usual control if it ranged from 130 mm Hg to less than 140 mm Hg; and uncontrolled if it was 140 mm Hg or higher.Main Outcome Measures Adverse cardiovascular outcomes, including the primary outcomes which was the first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke.Results During 16 893 patient-years of follow-up, 286 patients (12.7%) who maintained tight control, 249 (12.6%) who had usual control, and 431 (19.8%) who had uncontrolled systolic BP experienced a primary outcome event. Patients in the usual-control group had a cardiovascular event rate of 12.6% vs a 19.8% event rate for those in the uncontrolled group (adjusted hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.25-1.71; P < .001). However, little difference existed between those with usual control and those with tight control. Their respective event rates were 12.6% vs 12.7% (adjusted HR, 1.11; 95% CI, 0.93-1.32; P = .24). The all-cause mortality rate was 11.0% in the tight-control group vs 10.2% in the usual-control group (adjusted HR, 1.20; 95% CI, 0.99-1.45; P = .06); however, when extended follow-up was included, risk of all-cause mortality was 22.8% in the tight control vs 21.8% in the usual control group (adjusted HR, 1.15; 95% CI, 1.01-1.32; P = .04).Conclusion Tight control of systolic BP among patients with diabetes and CAD was not associated with improved cardiovascular outcomes compared with usual control.Trial Registration Identifier: NCT00133692Primary Communication 简报发表Telomere Length and Risk of Incident Cancer and Cancer Mortality端粒长度与癌症发生风险及死亡率的关系研究AbstractContext Telomeres are essential to preserve the integrity of the genome. Critically short telomeres lead to replicative cell senescence and chromosomal instability and may thereby increase cancer risk.Objective To determine the association between baseline telomere length and incident cancer and cancer mortality.Design, Setting, and Participants Leukocyte telomere length was measured by quantitative polymerase chain reaction in 787 participants free of cancer at baseline in 1995 from the prospective, population-based Bruneck Study in Italy.Main Outcome Measures Incident cancer and cancer mortality over a follow-up period of 10 years (1995-2005 with a follow-up rate of 100%).Results A total of 92 of 787 participants (11.7%) developed cancer (incidence rate, 13.3 per 1000 person-years). Short telomere length at baseline was associated with incident cancer independently of standard cancer risk factors (multivariable hazard ratio [HR] per 1-SD decrease in loge-transformed telomere length, 1.60; 95% confidence interval [CI], 1.30-1.98; P < .001). Compared with participants in the longest telomere length group, the multivariable HR for incident cancer was 2.15 (95% CI, 1.12-4.14) in the middle length group and 3.11 (95% CI, 1.65-5.84) in the shortest length group (P < .001). Incidence rates were 5.1 (95% CI, 2.9-8.7) per 1000 person-years in the longest telomere length group, 14.2 (95% CI, 10.0-20.1) per 1000 person-years in the middle length group, and 22.5 (95% CI, 16.9-29.9) per 1000 person-years in the shortest length group. The association equally applied to men and women and emerged as robust under a variety of circumstances. Furthermore, short telomere length was associated with cancer mortality (multivariable HR per 1-SD decrease in loge-transformed telomere length, 2.13; 95% CI, 1.58-2.86; P < .001) and individual cancer subtypes with a high fatality rate.Conclusion In this study population, there was a statistically significant inverse relationship between telomere length and both cancer incidence and mortality.The Rational Clinical Examination 合理临床检查Can This Patient Read and Understand Written Health Information?识别低文化患者的简易办法：一项系统回顾分析AbstractContext Patients with limited literacy are at higher risk for poor health outcomes; however, physicians' perceptions are inaccurate for identifying these patients.Objective To systematically review the accuracy of brief instruments for identifying patients with limited literacy.Data Sources Search of the English-language literature from 1969 through February 2010 using PubMed, Psychinfo, and bibliographies of selected manuscripts for articles on health literacy, numeracy, reading ability, and reading skill.Study Selection Prospective studies including adult patients 18 years or older that evaluated a brief instrument for identifying limited literacy in a health care setting compared with an accepted literacy reference standard.Data Extraction Studies were evaluated independently by 2 reviewers who each abstracted information and assigned an overall quality rating. Disagreements were adjudicated by a third reviewer.Data Synthesis Ten studies using 6 different instruments met inclusion criteria. Among multi-item measures, the Newest Vital Sign (English) performed moderately well for identifying limited literacy based on 3 studies. Among the single-item questions, asking about a patient's use of a surrogate reader, confidence filling out medical forms, andself-rated reading ability performed moderately well in identifying patients with inadequate or marginal literacy. Asking a patient, “How confident are you in filling out medical forms by yourself?” is associated with a summary likelihood ratio (LR) for limited literacy of 5.0 (95% confidence interval [CI], 3.8-6.4) for an answer of “a little confident” or “not at all confident”; a summary LR of 2.2 (95% CI, 1.5-3.3) for “somewhat confident”; and a summary LR of 0.44 (95% CI, 0.24-0.82) for “quite a bit” or “extremely confident.” Conclusion Several single-item questions, including use of a surrogate reader and confidence with medical forms, were moderately effective for quickly identifying patients with limited literacy.Commentaries 评论Restoring Health to Health Reform将健康归还医改Cardiopulmonary Resuscitation: Celebration and Challenges心肺复苏：庆贺与挑战Meaningful Use of Health Information Technology Is Managing Information健康信息技术的应用意义在意管理信息Aging Adults With Intellectual Disabilities智能障碍的老龄化人群带来医疗挑战。
(完整word版)医学标书范文3
河南省科技攻关计划项目
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姓名: JiangDongbao 项目名称： FGFR4表达对结直肠癌细胞株生物学行为的
影响及作用机制的研究
单位：郑州大学
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211009103_2020_年全球肝癌和胆囊癌发病死亡分析
2020年全球肝癌和胆囊癌发病死亡分析单天昊1，安澜1，徐梦圆1，曾红梅1*，蔡建强2*（1. 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院肿瘤登记办公室，北京 100021；2. 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院肝胆外科，北京 100021）摘要目的：依据GLOBOCAN 2020数据比较2020年全球和中国肝癌和胆囊癌发病死亡负担，为癌症防控提供参考。
方法：依据国际癌症研究机构发布的2020年全球各国肝癌和胆囊癌发病死亡数据，比较其在不同地区、不同性别及年龄别间的差异。
结果：2020年全球新发肝癌病例905 677例，因肝癌死亡病例830 180例，标化发病率和标化死亡率分别为9.5/10万和8.7/10万；2020年全球新发胆囊癌病例115 949例，因胆囊癌死亡病例84 695例，标化发病率和标化死亡率分别为1.2/10万和0.84/10万。
2020年全球肝癌标化发病率前5位的国家为蒙古、埃及、老挝、柬埔寨和越南；全球胆囊癌标化发病率前5位的国家为玻利维亚、智利、孟加拉国、尼泊尔和韩国。
2020年中国新发肝癌病例410 038例，标化发病率为18.2/10万，标化发病率居全球第8位；因肝癌死亡病例391 152例，标化死亡率为17.2/10万。
2020年中国新发胆囊癌病例28 923例，标化发病率为1.2/10万，标化发病率居全球第39位；因胆囊癌死亡病例23 297例，标化死亡率为0.97/10万。
结论：肝癌和胆囊癌发病死亡负担在不同国家和人群间存在差异，应根据不同人群的发病死亡特点制订相应防控策略。
关键词：肝癌；胆囊癌；发病率；死亡率；全球Global liver cancer and gallbladder cancer incidence and mortality in 2020Shan Tianhao 1, An Lan 1, Xu Mengyuan 1, Zeng Hongmei 1*, Cai Jianqiang 2*(1. Office of National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; 2. Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/CancerHospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China)AbstractObjective: According to the data of GLOBOCAN 2020, we compared the global and Chinese incidence and mortality of liver cancer and gallbladder cancer in 2020, to provide a scientific basis for cancer prevention and control.Method: According to the incidence and mortality data of liver cancer and gallbladder cancer released by the International Agency for Research on Cancer in 2020, the differences among different regions, genders and ages were compared.Result: In 2020, there were 905 677 new cases and 830 180 deaths of liver cancer globally, with age-standardized incidence and mortality rates of 9.5/100 000 and 8.7/100 000, respectively. For gallbladder cancer, the numbers of new cases and deaths were 115 949 and 84 695, respectively, with the age-standardized incidence and mortality of 1.2/100 000 and 0.84/100 000, respectively. The top five countries with highest incidence of liver cancer were Mongolia, Egypt, Laos, Cambodia and Vietnam. The top five countries with highest incidence of gallbladder cancer were Bolivia, Chile, Bangladesh, Nepal and Korea. In 2020, there were 410 038 new cases of liver cancer in China, with a standardized incidence rate of 18.2/100 000, ranking 8th among all countries. There were 391 152 new cases of death from liver cancer in China, with an age-standardized mortality rate of 17.2/100 000. For gallbladder cancer, there were 28 923 new cases ofincidence in China, with an age-standardized incidence rate of 1.2/100 000, ranking 39th among all countries. There were单天昊国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院肿瘤登记办公室*通信作者：肝癌和胆囊癌是肝胆系统最常见的2种恶性肿瘤，这2种癌症都具有侵袭性强、生存率低、防治难度巨大的特点。
2015 -2020 年皖北地区口腔癌发病与死亡
[收稿日期]2022-02-11 [修回日期]2022-11-25[基金项目]安徽高校协同创新项目(GXXT⁃2020⁃021)[作者单位]1.蚌埠医学院第一附属医院口腔颌面外科,安徽蚌埠233004;2.中国科学技术大学附属第一医院口腔颌面外科,安徽合肥230001;3.安徽医科大学第一附属医院口腔颌面外科,安徽合肥230001;4.安徽省阜阳市人民医院口腔科,236004;5.上海交通大学医学院附属第九人民医院口腔颌面头颈肿瘤外科,上海200011;6.江苏省徐州市中心医院口腔颌面外科,221000[作者简介]李建成(1965-),男,主任医师,教授.[文章编号]1000⁃2200(2022)12⁃1693⁃05㊃公共卫生㊃2015-2020年皖北地区口腔癌发病与死亡分析李建成1,陈传俊2,薛浩伟3,陈旭兵4,阮 敏5,孟 箭6[摘要]目的:分析2015-2020年皖北地区口腔癌发病与死亡情况㊂方法:收集2015-2020年皖北地区口腔癌新发病例㊁死亡病例,计算口腔癌的发病率㊁死亡率㊁0~74岁累积率㊁35~64岁截缩率等指标,标准化率采用2010年全国人口普查标准人口构成和Segi′s 标准人口构成作为标准㊂结果:2015-2020年皖北地区共收集新发口腔癌病例2602例,口腔癌死亡病例867例㊂口腔癌发病率㊁中国标准化发病率㊁世界标准化发病率㊁0~74岁累积发病率㊁35~64岁截缩发病率分别为9.37/10万㊁9.65/10万㊁7.66/10万㊁0.94%㊁12.13/10万㊂其中城市居民口腔癌发病率为6.21/10万,中国标准化发病率为6.06/10万,农村居民口腔癌发病率12.42/10万,中国标准化发病率13.76/10万,农村居民口腔癌发病高于城市;男性口腔癌发病率11.52/10万,中国标准化发病率为11.82/10万,女性口腔癌发病率为7.19/10万,中国标准化发病率为7.43/10万,男性口腔癌发病率高于女性㊂2015-2020年皖北地区口腔癌死亡率为3.12/10万,中国标准化死亡率为3.20/10万,世界标准化死亡率2.54/10万,0~74岁累积死亡率为0.32%,截缩死亡率为3.81/10万㊂2015-2020年皖北地区OC 总发病率6年间呈上升趋势,总死亡率相对较为稳定,OC 发病率和死亡率均随着年龄升高而呈波动性上升趋势㊂结论:口腔癌是威胁皖北地区居民身心健康的恶性肿瘤之一,积极开展口腔健康宣教,加强发病因素预防,可有效降低口腔癌发病率,也是皖北地区口腔癌防控的重要措施㊂[关键词]口腔癌;发病率;死亡率[中图法分类号]R 739.8 [文献标志码]A DOI :10.13898/ki.issn.1000⁃2200.2022.12.017Incidence and mortality of oral cancer in the northern area of Anhui Province in 2015-2020LI Jian⁃cheng 1,CHEN Chuan⁃jun 2,XUE Hao⁃wei 3,CHEN Xu⁃bing 4,RUAN Min 5,MENG Jian 6(1.Department of Oral and Maxillofacial Surgery ,The First Affiliated Hospital of Bengbu Medical College ,Bengbu Anhui 233004;2.Department of Oral and Maxillofacial Surgery ,The First Affiliated Hospital of University of Science and Technology of China ,Hefei Anhui 230001;3.Department of Oral and Maxillofacial Surgery ,The First Affiliated Hospital of Anhui Medical University ,Hefei Anhui 230001;4.Department of Stomatology ,Fuyang People′s Hospital ,Fuyang Anhui 236004;5.Department of Oromaxillofacial Head and Neck Oncology ,Shanghai Ninth People′s Hospital ,Shanghai Jiao Tong University School of Medicine ,Shanghai 200011;6.Department of Oral and Maxillofacial Surgery ,Xuzhou Central Hospital ,Xuzhou Jiangsu 221000,China )[Abstract ]Objective :To analyze the incidence and mortality of oral cancer in the northern area of Anhui Province in 2015-2020.Methods :The new cases and deaths of oral cancer in the northern area of Anhui Province from 2015to 2020were collected,and the incidence,mortality,cumulative rate(0-74years old),truncation rate (35-64years old)and other indicators of oral cancer were calculated.The Chinese population census in 2010and Segi′s world population were used for standardized rate.Results :A total of 2602new oral cancer cases and 867oral cancer deaths were collected in the northern area of Anhui Province from 2015to 2020.The incidence of oral cancer,the age⁃standardized rate of incidence by Chinese standard population (ASRIC)and by world standardpopulation (ASRIW),cumulative rate (0-74years old),truncation rate(35-64years old)were 9.37/105,9.65/105,7.66/105,0.94%,and 12.13/105,respectively.The incidence and ASRIC of oral cancer in urban areas were 6.21/105and 6.06/105,the incidence and ASRIC of oral cancer in rural residents were 12.42/105and 13.76/105,and the incidence of oral cancer in rural residents was higher than that in urban areas.The incidence and ASRIC of oral cancer in male were 11.52/105and 11.82/105,theincidence and ASRIC of oral cancer in female was 7.19/105and 7.43/105,and the incidence of oral cancer in male was higher thanthat in female.The mortality of oral cancer,the age⁃standardized rate of incidence by ASRMC and by ASRMW,cumulative rate(0-74years old),truncation rate(35-64years old)were 3.12/105,3.20/105,2.54/105,0.32%,3.81/105,respectively.From 2015to 2020,the totalincidence rate of oral cancer in northern area of Anhui Province had an increased trend in 6years,and the total mortality rate was relatively stable.The incidence rate andmortality of oral cancer fluctuated with age.Conclusions :Oral cancer is one of the malignant tumors threatening the health of northern area of Anhui Province.Oral health education can be actively carried out and preventive measures can be strengthened as the focus of oral cancer prevention and control in northern area of Anhui Province.[Key words]oral cancer;incidence;mortality 口腔癌(oral cancer,OC)是头颈部最常见的恶性肿瘤之一[1-2]㊂因种族㊁生活习惯㊁经济发展状况㊁医疗水平等因素的影响,世界各地OC发病率的差别较大,资料[3-4]显示,在一些高发地区如印度㊁亚美尼亚等,每年OC新发病例数可占恶性肿瘤的40%,其中新发男性病例可占男性恶性肿瘤的25%,全球OC发病率呈上升趋势㊂而欧美国家经济发展水平较高地区的OC发病率较低[5-6]㊂OC 目前被WHO列为危害人类健康最常见的恶性肿瘤之一,其发生发展会导致病人语言㊁咀嚼㊁呼吸㊁吞咽等功能的丧失及面部外形的改变㊂全球每年OC死亡人数约占总癌症死亡总人数的2%[7],其5年生存率报道在30%~60%[8-9]㊂我国OC发病率和死亡率虽低于世界高发地区,但仍高于欧美发达国家,且存在着明显地区差异,由北往南发病率呈直线上升趋势,特别是华南及台湾地区明显高于其他各地[10-11]㊂资料[12-14]显示,OC发病率呈上升趋势且趋向年轻化㊁老龄化二级发展㊂口腔癌也是危害皖北地区人民健康的恶性肿瘤之一,本研究通过皖北地区(6个地级市)OC流行病学调查,分析OC发病和死亡原因,以期为OC防治提供参考㊂1 资料与方法1.1 一般资料 选取安徽皖北地区6个地级市所管辖18个县(市)㊁17个行政区医保农保登记中心和皖北地区设置肿瘤登记点登记的发生于2015-2020年期间新发OC病人,另有较少部分来源于相关医院或社区的补充㊂死亡数据通过电话㊁跟踪随访及死亡鉴测专业机构数据统计,并通过核对㊁查实,剔除重复及医疗机构调查补充获得OC病人的死亡数据㊂新发和死亡病理检查资料主要来源于皖北地区三级以上公立医院㊁省内权威三甲医院和省外国内知名医疗机构㊂所获得数据总符合率> 98.76%,符合流行病学调查要求㊂2015-2020年皖北地区人口数据资料来源于2020年全国人口第7次普查㊂2020年皖北地区调查人口数为26821785人,2015年人口总数27390900人㊂1.2 方法 本文采用疾病相关健康问题的国际统计分类中ICD⁃10/C00~C14,对新发口腔癌病例采用C00~C06㊁C14,排除C07~C13大涎腺㊁口咽㊁鼻咽㊁下咽等部位恶性肿瘤㊂按照ICD⁃10编码中C00~C06要求,对来自于皖北地区农保㊁医保登记中心和肿瘤登记点新发口腔癌病例进行登记㊁核查,对符合要求者进行录用,并对录用的病人行详细的资料登记,建立Excel OC病人数据库;其次通过相关医疗机构调查添加遗漏者,对病人进行病历资料回顾,核对病理资料,重新完善数据库;通过各种方式掌握病人及家属的联系方式,了解目前病人生存或死亡状况,对于失访者通过公安机关与当地政府联系;采用Excel软件对皖北地区口腔癌流行病学行统计学分析㊂1.3 统计学方法 通过Excel整理皖北地区2015 -2020年OC发病及死亡数据,按照地区(城市㊁农村)㊁性别(男㊁女)及年龄(0~㊁5~㊁10~㊁ ㊁85~岁)完成分层㊂以我国2010年第6次人口普查数据作为标准人口,计算中国年龄标准化发病(死亡)率(age⁃standardized rate of incidence/mortality by Chinese standard population,ASRIC/ASRMC),以1985年Segi′s世界标准人口为标准计算世界年龄标准化发病(死亡)率(age⁃standardized rate of incidence/mortality by world standard population, ASRIW/ASRMW)㊂采用SAS㊁CanReg4软件行数据分析,应用IARC crg Tools进行数据检查和估算,使用Joinpoint Software4.5分析2015-2020年OC发病率和死亡率的时间趋势㊂2 结果2.1 皖北地区2015-2020年OC发病情况 皖北地区2015-2020年OC总体发病率㊁ASRIC㊁ASRIW㊁累积发病率(0~74岁)㊁截缩率(35~ 64岁)分别为9.37/10万㊁9.65/10万㊁7.66/10万㊁0.94%㊁12.13/10万,其中农村高于城市,男性高于女性(见表1)㊂2.2 不同年龄段OC发病情况 0~24岁OC发病率相对最低,发病率在1/10万以下,城乡㊁男女无明显差别;25~34岁总体发病率已接近2/10万,主要表现为农村发病率较城市增高,35~44岁总体发病率以上到3/10万~4/10万之间,仍表现为农村发病率较高,但以上年龄段均为OC发病率极低值期㊂45岁以后OC发病率波动性上升,本组发病年龄高峰期为65~79岁,极值为75~79岁年龄段,同时45岁以后各年龄组农村发病率均高于城市(见表2)㊂表1 2015-2020年安徽省皖北地区OC发病率项目新发病例人口发病率/(1/10万) ASRIC/(1/10万)ASRIW/ (1/10万)0~74岁累积发病率/%35~64岁截缩发病率/(1/10万) 城市84713633171 6.21 6.06 5.30.667.39农村17551412799312.4213.7610.66 1.2719.01男性16131400703711.5211.829.6 1.1715.38女性989137541277.197.43 5.770.78.89合计2602277611649.379.657.660.9412.13 表2 2015-2020年安徽省皖北地区各年龄段群OC发病率(1/10万)年龄/岁合计男性女性城市农村0~0.230.160.320.320.20 5~0.110.200.000.160.09 10~0.390.400.370.140.55 15~0.130.080.180.090.16 20~0.720.640.790.08 1.51 25~ 1.92 1.84 1.99 1.35 2.65 30~ 1.80 2.990.630.70 3.46 35~ 3.52 4.90 2.15 2.53 4.89 40~ 4.04 5.48 2.69 2.83 5.47 45~8.8812.33 5.56 4.5414.66 50~28.2334.5521.7216.1954.23 55~17.0720.0114.199.0825.13 60~24.0830.9117.0220.8726.41 65~41.4345.6636.9533.7547.24 70~54.8274.3634.6038.7066.90 75~47.0757.7937.3828.5959.09 80~35.9248.3526.5535.4836.16 85+44.2467.4931.9543.3644.66合计9.3711.527.19 6.2112.42 2.3 不同年份OC发病情况 2015-2020年皖北地区OC总发病率和男性㊁女性及农村OC发病率均呈上升趋势,城市OC发病率则有下降趋势;ASRIC 在2015-2019年无论城市㊁农村㊁男性㊁女性及总体均呈上升趋势,而2020年各项均较2019年降低(见表3)㊂2.4 OC癌死亡情况 2015-2020年皖北地区总体死亡率㊁ASRMC㊁ASRMW㊁0~74岁累积死亡率㊁35~64岁死亡截缩率分别为3.12/10万㊁3.20/10万㊁2.54/10万㊁0.32%㊁3.81/10万,且上述5种死亡率均为男性高于女性,农村高于城市(见表4)㊂表3 2015-2020年安徽省皖北地区OC发病趋势(1/10万)项目2015201620172018201920202015-2020发病率 男性 1.93 1.75 1.79 2.01 2.03 2.02 1.92 女性0.89 1.11 1.18 1.15 1.42 1.45 1.19 城市 1.300.85 1.180.97 1.050.89 1.04 农村 1.51 1.92 1.76 2.16 2.39 2.92 2.07 合计 1.42 1.43 1.49 1.58 1.72 1.74 1.56 ASRIC 男性 1.91 1.77 1.85 2.11 2.09 2.09 1.97 女性0.91 1.13 1.21 1.22 1.52 1.43 1.24 城市 1.150.77 1.110.95 1.07 1.01 1.01 农村 1.74 2.16 2.02 2.55 2.63 2.66 2.29 合计 1.42 1.45 1.54 1.67 1.80 1.76 1.61表4 2015-2020年安徽省皖北地区OC死亡率项目新发病例人口死亡率/(1/10万)ASRMC/(1/10万)ASRMW/(1/10万)0~74岁累积死亡率/% 35~64岁截缩死亡率/(1/10万) 城市27513633171 2.02 1.96 1.760.22 2.14农村59214127993 4.19 4.63 3.550.43 6.28男性55314007037 3.95 4.06 3.310.40 5.19女性31413754127 2.28 2.33 1.780.22 2.49合计86727761164 3.12 3.20 2.540.32 3.812.5 不同年龄段人群OC死亡情况 OC总体死亡最高年龄段为70~79岁,其次为80岁以上及60~ 69岁,59岁以下人群死亡率均相对较低,城乡差别不大(见表5)㊂2.6 不同年份OC死亡率 皖北地区2015-2020年OC总死亡率相对较为稳定㊂2016-2017年总体死亡率较高,其中男性2015-2018年死亡率较高,女性较为恒定;2015-2020年中国标准化总死亡率㊁男女和城乡死亡率每年数值均较稳定(见表6)㊂3 讨论 WHO国际癌症研究机构(IARC)在‘2018全球癌症报告“中指出,2018年新增OC病人占新增总癌症2.50%,死于OC病人占癌症总死亡人数3.20%;而我国癌症统计学分析OC新增病例占总体新发现癌症的1.12%,OC死亡占癌症的0.87%[15],中国OC发病㊁死亡构成比明显低于国际水平㊂同时中国肿瘤登记年报中还表现出中国OC发病率特点,即南方发病率大于北方发病率,由南向北为递减趋势;农村人口发病率大于城市人口发病率;沿海地区大于内陆[16-18]㊂ 表5 2015-2020年安徽省皖北地区各年龄组人群OC死亡率(1/10万)年龄/岁合计男性女性城市农村0~0.190.330.000.320.135~0.000.000.000.000.0010~0.000.000.000.000.0015~0.090.000.180.190.0020~0.340.550.160.000.7625~0.120.000.220.210.0030~0.63 1.280.000.700.5335~ 1.04 1.400.600.60 1.6740~0.95 1.220.850.54 1.4545~ 2.93 4.82 1.30 1.24 5.1850~9.7512.937.24 5.2119.5655~ 4.43 5.26 3.22 2.46 6.4160~8.2111.41 4.58 6.709.3165~13.9113.8213.1712.6914.8470~20.6827.8511.5313.8925.7775~19.8124.8815.5711.0725.5080~10.6912.4313.018.2512.0585+13.1321.098.9213.4612.97合计 3.12 3.95 2.28 2.02 4.19表6 2015-2020年安徽省皖北地区OC死亡趋势(1/10万)项目2015201620172018201920202015-2020死亡率 合计0.470.660.620.510.380.480.52 男性0.710.820.730.690.440.570.66 女性0.240.490.520.320.320.400.38 城市0.390.400.480.290.230.260.34 农村0.550.870.750.710.530.800.70 ASRMC 合计0.500.650.640.530.380.510.53 男性0.710.830.750.720.440.610.68 女性0.270.480.520.330.330.400.39 城市0.350.350.450.280.220.310.33 农村0.660.990.870.840.740.450.77 安徽皖北地区位于沿淮地带并与河南㊁江苏㊁山东㊁湖北相邻,人口总数26821785人(2020年人口统计),2015-2020年皖北地区共发生OC病人约2602例,6年的总发病率9.37/10万,平均每年中标率1.61/10万,均低于2010年以来全国及各省有肿瘤登记地区相继报道的OC发病中标率[19-20],但与近年来普查报道[2,15]较为一致㊂其流行病学特征:(1)OC发病率总体呈上升趋势,在2015-2018年以每年2.64%的速度显著增长,在2019-2020年保持稳定;女性和农村地区发病率分别增加了62.67%㊁93.46%,男性在这一时期较为稳定;皖北地区城镇化率由2015年的44.55%上升至2020年的58.33%,城市发病率下降了31.33%,呈下降趋势,其中城市女性下降明显,下降了40.95%㊂(2) OC死亡率总体呈下降趋势,在2015-2016年死亡率增加了38.49%,在2017-2019年以每年22.27%的速度显著下降,2020年保持稳定;本资料中男女发病性别比从2015年的2.23下降到2020年的1.44,男性虽然每年死亡率均较女性高,但女性死亡率升高速度高于男性,男性和城市地区死亡率下降明显,下降率分别为19.82%㊁31.96%,其中城市女性死亡率下降约49.82%,然而女性和农村死亡率呈上升趋势,上升率分别为69.27%㊁45.72%㊂(3)从发病年龄分布来看,2015-2020年40岁以前发病率较低,发病高峰年龄稳定在为65~ 80岁,较国内统计资料40~60岁高峰大,患病年龄逐渐增长的趋势,其主要原因可能与整体人均平均年龄的延长有关;其中男性发病高峰年龄为50~ 85岁,女性发病高峰年龄为65~85岁,女性发病高峰年龄较男性高,城市地区发病年龄高峰为60~85岁,农村地区发病年龄高峰为50~85岁,城市发病年龄高峰较农村低㊂此外,本统计数据显示OC病人男1613例,女989例,男女构成比为1.63,而在城镇病人男女构成比1.93,农村病人男女构成比1.57,均低于OC发病率较高地区男女构成比㊂报道资料显示,OC发病率较高的国家和地区,OC病人男女构成比相对较高,如印度为3.27[21],我国台湾㊁湖南分别为10.5[22]㊁3.2[23];而OC发病率较低国家男女构成相对较低,如美国为1.42㊁日本1.45[25]㊂年龄方面,本组数据显示OC发病率较高年龄段为45~79岁,占OC总病人数的91.00%,而高峰年龄段为50~ 74岁,占总发病人数的63.45%,与BHURGRI等[26]报道相一致㊂本组OC发病部位中以舌癌发病率最高,为23.33%,其次为下颌骨牙龈癌18.17%㊁颊癌14.97%㊁上颌骨牙龈癌13.86%㊁口底癌11.50%㊁上下唇黏膜癌11.44%㊁硬腭癌6.73%㊂病理表现以鳞状细胞癌最多,占84.58%,其次为腺癌9.02%,主要为腺样囊性癌㊁黏表细胞癌及肌上皮癌等,来源于间叶组织肿瘤占6.40%,主要为肉瘤㊁恶性黑色素瘤㊂[参考文献][1] PERES MA,MACPHERSON LMD,WEYANT RJ,et al.Oraldiseases:a global public health challenge[J].Lancet,2019,394(10194):249.[2] MIRANDA⁃FILHO A,BRAY F.Global patterns and trends incancers of the lip,tongue and mouth[J].Oral Oncol,2020,102:104551.[3] ABHINAV RP,WILLIAMS J,LIVINGSTON P,et al.Burden ofdiabetes and oral cancer in India[J].J Diabetes Complications,2020,34(11):107670.[4] BHATTACHARJEE T,KERKETA M,BABU NA.Differences oforal cancer 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2012年中国恶性肿瘤发病和死亡分析_陈万青
2012年中国恶性肿瘤发病和死亡分析陈万青，郑荣寿，张思维，曾红梅，左婷婷，贾漫漫，夏昌发，邹小农，赫捷（全国肿瘤防治研究办公室，全国肿瘤登记中心，国家癌症中心，北京100021）摘要：［目的］对2015年全国肿瘤登记中心收集的全国各登记处上报的2012年恶性肿瘤登记资料进行分析，估计我国恶性肿瘤的发病与死亡。
［方法］全国肿瘤登记中心共收到261个登记处上报的2012年肿瘤登记数据，通过审核和评估，共193个肿瘤登记处的数据符合入选标准。
将入选的登记处按地区（城乡）、性别以及年龄别、肿瘤别发病率和死亡率分层，结合2012年全国人口数据，估计全国恶性肿瘤合计和主要肿瘤的发病、死亡情况。
标化率采用2000年全国人口普查人口和Segi’s标准人口结构为标准。
［结果］全国193个登记处共覆盖登记人口198060406人（其中城市100450109人，农村97610297人），报告的恶性肿瘤新病例556163例，死亡病例345483例。
病理诊断比例为69.13%，只有死亡证明书比例为2.38%，死亡发病比为0.62。
据估计，全国2012年新发恶性肿瘤病例约358.6万例，死亡病例218.7万例。
全国恶性肿瘤发病率为264.85/10万（男性289.30/10万，女性239.15/10万），中国人口标化率(中标率)为191.89/10万，世界人口标化率(世标率)为187.83/10万，累积率（0～74岁）为21.82%。
城市地区发病率为277.17/10万，中标发病率为195.56/10万，农村地区发病率为251.20/10万，中标发病率为187.10/10万。
全部地区恶性肿瘤死亡率为161.49/10万（男性198.99/10万，女性122.06/10万），中标死亡率为112.34/10万，世标死亡率为111.25/10万，累积死亡率（0~74岁）为12.61%。
城市地区死亡率为159.00/10万，中标死亡率107.23/10万。
替诺福韦酯联合鳖甲煎丸对乙型肝炎肝硬化的疗效
替诺福韦酯联合鳖甲煎丸对乙型肝炎肝硬化的疗效马燕妮, 陈勇军, 庄银安（湛江中心人民医院感染性疾病科，广东湛江 524000）摘要：目的研究替诺福韦酯联合鳖甲煎丸对乙型肝炎肝硬化的疗效。
方法选取2015年1月至2018年1月湛江中心人民医院收治的186例乙型肝炎肝硬化患者进行前瞻性研究，采用随机抽签法平均分成试验组和对照组，每组93例。
对照组予以替诺福韦酯（300 mg/d）治疗，试验组在对照组的基础上加用鳖甲煎丸（口服，3 g/次，3次/d）治疗，均连续治疗12个月。
比较两组治疗前后天门冬氨酸氨基转移酶（aspartate aminotransferase，AST）、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、血清白蛋白（albumin，ALB）、总胆红素（total bilirubin，TBil）、透明质酸（hyaluronic acid，HA）、层粘连蛋白（laminin，LN）、Ⅳ型胶原（type Ⅳ collagen，Ⅳ-C）、Ⅲ型前胶原（type Ⅲprocollagen，PCⅢ）、血清C反应蛋白（C-reactive protein，CRP）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）、白细胞介素-1β（interleukin-1β，IL-1β）、肝癌发病率及病死率的差异。
结果治疗12个月后，试验组AST [（65.17 ± 12.39）U/L vs（97.05 ± 18.63）U/L]、ALT [（70.31 ± 11.38）U/L vs （106.83 ± 14.38）U/L]、TBil [（27.30 ± 4.21）μmol/L vs（48.16 ± 6.08）μmol/L]、HA [（102.75 ± 15.44）mg/L vs（152.46 ± 17.08）mg/L]、LN [（100.88 ± 16.32）μg/ml vs（153.72 ± 17.07）μg/ml]、Ⅳ-C [（95.32 ± 11.74）μg/L vs（122.59 ± 13.18）μg/L]、PCⅢ [（100.14 ± 12.56）μg/L vs（152.98 ± 15.41）μg/L]、CRP [（3.28 ± 1.56）mg/L vs（5.11 ± 2.04）mg/L]、TNF-α [（22.17 ± 8.01）μg/L vs（31.95 ± 8.23）μg/L]及IL-1β [（6.57 ± 1.47）ng/L vs（10.18 ± 3.01）ng/L]均显著低于对照组（P均＜ 0.05），而ALB [（38.92 ± 4.37）g/L vs（33.65 ± 3.84）g/L]水平显著高于对照组（t = 8.726，P＜ 0.001）。
(高中英语写作)高一吸烟的英语作文
高一吸烟的英语作文吸烟对人的健康是有害的，它会引起肺癌，在刚刚过去的几年中;许多人因此而丧命，还可能引发其他的疾病。
下面是我给大家带来高一吸烟的英语作文，欢迎大家阅读参考，我们一起来看看吧!高一吸烟的英语作文1Tobacco smoke contains at least three kinds of dangerous chemicals to the human body: the tar, nicotine and carbon monoxide, tar is made up of several kinds of material blending material, will condense into a viscous material in the lungs. Nicotine is a drug can make people addiction, absorbed by the lungs, mainly affect the nervous system. Carbon monoxide would reduce the ability of red blood cells carry oxygen around the body.A 15 to 20 cigarettes a day, the susceptibility to lung cancer, cancer of the mouth or throat cancer death risk, than the people do not smoke 14 times; The probability of its susceptibility to esophageal cancer death than non-smokers 4 times of the National Peoples Congress; Died in the big 2 times the risk of bladder cancer; The risk of dying from heart disease also want 2 times larger. Smoking is the leading cause of chronic bronchitis and emphysema, and chronic lung disease itself, also increasethe risk of get pneumonia and heart disease, and smoking also increases the risk of high blood pressure.Data have shown that long-term smokers lung cancer incidence of 10 ~ 20 times higher than non-smokers, 6-10 times the incidence of laryngeal cancer, coronary heart disease (CHD) 2 to 3 times the incidence of a disease. A three-fold higher incidence of circulatory system, 2-8 times higher incidence of chronic bronchitis. Someone on a survey of 1000 households, found that smoking families children under the age of 16 of respiratory disease than non-smoking family. Children under the age of five, in not smoking families, 33. 5% had respiratory symptoms, and cigarette smoking was 44 families. 5% had respiratory symptoms. Smoking has special dangerous to women, women smoking if you are using oral contraceptives, can increase the heart attack the venous thrombosis of lower limbs and opportunities; Prone to premature fetus in pregnant women who smoke and underweight babies immune function is reduced, easy to get sick; According to statistics, pregnant women passive smoking of infant birth defects rate significantly increased.Smoking harm harm, should consciously not good hygienic habit of smoking.烟草的烟雾中至少含有三种对人体有危险的化学物质：焦油，尼古丁和一氧化碳，焦油是由好几种物质混合成的物质，在肺中会浓缩成一种粘性物质。
口服化疗肿瘤患者药物素养研究进展
口服化疗肿瘤患者药物素养研究进展黄婷婷福建医科大学附属福州市第一医院胃肠外科，福建福州 350000[摘要] 肿瘤患者的发病率和病死率居高不下，口服化疗药物已发展为肿瘤患者的主要治疗手段之一，但其药物依从性差及药物不良反应却是肿瘤患者要面临的重要问题，而良好的药物素养则是确保用药安全及化疗疗效的关键。
本文将从药物素养的定义和口服化疗肿瘤患者药物素养的现状、评估方法、影响因素及干预措施等方面进行综述，提出口服化疗肿瘤患者药物素养未来研究的方向，以期为提高口服化疗肿瘤患者的药物素养水平、保证化疗疗效提供参考依据。
[关键词] 口服化疗；肿瘤患者；药物素养；服药依从性[中图分类号] R473.73 [文献标识码] A [文章编号] 2095-0616（2024）05-0058-05DOI:10.20116/j.issn2095-0616.2024.05.13Research progress on drug literacy of tumor patients administrated with oral chemotherapy drugsHUANG TingtingDepartment of Gastrointestinal Surgery, Fuzhou No.1 Hospital Affiliated with Fujian Medical University, Fujian, Fuzhou 350000, China[Abstract] The incidence rate and mortality of tumor patients remain high, and oral chemotherapy drugs have become one of the main treatment methods for tumor patients. However, their poor drug compliance and adverse drug reactions are important problems faced by tumor patients, and good drug literacy is the key to ensure medication safety and guarantee chemotherapy efficacy. This article will review the definition of drug literacy, and the current status, assessment methods, influencing factors, and intervention measures of drug literacy in tumor patients undergoing oral chemotherapy, and propose future research directions for drug literacy in oral tumor patients administrated with oral chemotherapy drugs, to provide reference basis for improving the drug literacy level of tumor patients administrated with oral chemotherapy drugs and guaranteeing chemotherapy efficacy. [Key words] Oral chemotherapy drugs; Tumor patients; Drug literacy; Medication compliance癌症是影响人类健康的世界性公共卫生问题。
口腔肉瘤样癌1例
237欢迎关注本刊公众号·个案报道·《中国癌症杂志》2020年第30卷第3期 CHINA ONCOLOGY 2020 Vol.30 No.3基金项目：广东省自然科学基金（2016A030313312）。
通信作者：毕卓菲 E-mail: sumsjessie@1 临床资料 患者，女性，50岁，于2017年10月9日因“发现右下牙龈肿物1月余”就诊于中山大学孙逸仙纪念医院口腔科。
患者在2017年9月拔牙后出现右侧下牙龈肿物，且逐渐增大，在进食后肿物会因为摩擦而出血。
患者否认既往射线接触史、手术外伤史，否认患其他疾病，否认吸烟、酗酒、咀嚼槟榔病史。
查体发现右下牙龈可见约5 cm×3 cm 的红色肿块，触之疼痛。
颈部淋巴结未触及明显肿大。
MRI 显示，右下牙龈肿块大小为46 mm×45 mm×36 mm ，与右下颌骨分界不清，与周围软组织和舌界限清晰，同时可见双侧多个小的颌下淋巴结（图1）。
影像学的初步诊断为牙龈恶性病变。
其他检查包括胸部X 线和腹部超声结果均正常。
患者接受了根治性肿瘤切除术和区域淋巴结清扫术。
标本的组织病理学检查结果提示癌细胞表现为许多小而不规则的梭形细胞混合少量鳞癌细胞，癌细胞侵犯骨骼，淋巴结阳性（1/8），无淋巴脉管癌栓。
免疫组织化学分析显示，肿瘤细胞的P63、P40、vimentin 和Cam5.2表达呈阳性，细胞角蛋白（cytokeratin ，CK ）5/6和34βE12呈弱阳性表达，肌动蛋白、结蛋白、S-100、CD34和上皮膜抗原（epithelial membrane antigen ，EMA ）表达呈阴性（图2）。
根据病理学检查结果明确诊断为右下牙龈肉瘤样癌（T 4N 1M 0 ⅣA 期）。
因肿瘤侵犯骨骼、淋巴结阳性，患者术后接受了4个周期由奈达铂（100 mg/m 2）和紫杉醇 （135 mg/m 2）组成的辅助性化疗，同时接受调强放疗（intensity-modulated radiation therapy ，IMRT ）。
吸烟的危害（Thedangersofsmoking）
吸烟的危害（The dangers of smoking）Harmful substances in smokeIt is a well-known fact that smoking is harmful to health.. Different cigarettes are released with different chemicals, but major chemicals such as tar and carbon monoxide are different. When cigarettes are ignited, substances that are harmful to the body are divided into six broad categories:(1) aldehydes, nitrides, olefins, these substances have a stimulating effect on the respiratory tract.(2) nicotine can stimulate sympathetic nerve and cause blood vessel intima damage.(3) amines, cyanides and heavy metals are toxic substances.(4) arsenic, cadmium, methyl hydrazine, aminophenol, and other radioactive substances. These substances have carcinogenic effects.(5) phenolic compounds and formaldehyde, etc. these substances have the function of accelerating carcinogenesis.(6) carbon monoxide can reduce red blood cells and send oxygen to the whole body.CarcinogenesisSmoking has been recognized as carcinogenic. Epidemiological studies have shown that smoking is one of the most importantpathogenic factors of lung cancer, especially squamous cell carcinoma and small cell undifferentiated carcinoma. Smokers are 13 times more likely to develop lung cancer than non-smokers, and if they smoke more than 35 cigarettes a day, the risk is 45 times higher than non-smokers. The lung cancer mortality rate of smokers is 10~13 times higher than non-smokers. About 85% of deaths from lung cancer are caused by smoking. Smokers who are exposed to chemical carcinogens such as asbestos, nickel, uranium and arsenic at the same time have a higher risk of developing lung cancer. Polycyclic aromatic hydrocarbons in tobacco smoke, the polycyclic aromatic hydrocarbon hydroxylase metabolism after having cytotoxic and induced mutation in the smokers than non-smokers for high concentration hydroxylase. Smoking reduces the activity of natural killer cells, thereby weakening the body's ability to monitor, kill, and remove tumor cells, further explaining that smoking is a high risk factor for many cancers. The incidence of laryngeal cancer in smokers is ten times higher than non-smokers. The incidence of bladder cancer was increased by 3 times, which may be related to smoke in the beta naphthylamine. In addition, smoking and lip cancer, tongue cancer, oral cancer, esophageal cancer, gastric cancer, colon cancer, pancreatic cancer, kidney cancer and cervical cancer have a certain relationship. Clinical studies and animal experiments show that carcinogens in smoke can also affect the fetus through the placenta, resulting in a significant increase in the incidence of cancer in their offspring.Two 、 influence on heart and cerebral blood vesselMany studies have concluded that smoking is a major risk factor for many heart and cerebrovascular diseases. The incidence ofcoronary heart disease, hypertension, cerebrovascular disease and peripheral vascular disease in smokers has increased significantly. Statistics show that 75% of patients with coronary heart disease and hypertension have a history of smoking. The incidence of coronary heart disease in smokers are 3.5 times higher than non-smokers, coronary heart disease mortality rate higher than 6 times, the incidence of myocardial infarction rate higher than 2 to 6 times, the pathological anatomy also found that coronary atherosclerotic lesions in the former than in the latter extensive and serious. The incidence of coronary heart disease increased by 9~12 times in three subjects with high blood pressure, high cholesterol and smoking. 30% to 40% of deaths from cardiovascular diseases are caused by smoking, and the increase in mortality is directly proportional to the amount of cigarette smoking. Nicotine and carbon monoxide in smoke are recognized as major harmful factors in coronary atherosclerosis, but the exact mechanism is not fully understood. Most scholars believe that the changes of blood lipid, platelet function and abnormal blood rheology play an important role. High density lipoprotein cholesterol (HDL-C) stimulates the formation of prostacyclin (PGI2) in vascular endothelial cells, and PGI2 is the most potent vasodilator and substance that inhibits platelet aggregation. Smoking can damage the vascular endothelial cells, and caused a decrease in serum HDL-C, cholesterol, PGI2 levels decreased, resulting in the peripheral vascular and coronary artery contraction, wall thickening, luminal stenosis and blood flow and cause myocardial ischemia. Nicotine can also promote platelet aggregation. The carbon monoxide in the smoke combines with hemoglobin to form carbon monoxide hemoglobin, which affects the oxygen carrying capacity of the red blood cells,causing hypoxia and causing coronary artery spasm. Due to tissue hypoxia, resulting in compensatory polycythemia, increased blood viscosity. In addition, smoking can increase the level of plasma fibrinogen, coagulation system dysfunction; smoking can also affect four arachidonic acid metabolism, reduce production of PGI2, so that the relative increase in thromboxane A2, vasoconstriction, platelet aggregation increased. All of these may promote the occurrence and development of coronary heart disease. Because of myocardial hypoxia, myocardial stress increased, ventricularfibrillation threshold decreased, so smokers with coronary heart disease were more prone to arrhythmia, sudden death risk increased.Smokers are 2 to 3.5 times more likely to develop strokes than non-smokers, according to the report. The risk of stroke increases nearly 20 times if both smoking and hypertension are present.In addition, smokers are susceptible to occlusive arteriosclerosis and occlusive thrombotic arteritis. Smoking can cause chronic obstructive pulmonary disease (COPD), which eventually leads to pulmonary heart disease.Three, the impact on the respiratory tractSmoking is one of the major causes of chronic bronchitis, emphysema, and chronic airway obstruction. The experimental study showed that long-term smoking caused the damage of cilia and shortened the cilia of bronchial mucosa, and affected the removal of cilia. In addition, submucosal gland hyperplasia andhypertrophy, mucus secretion increases, the composition has changed, easy to block the bronchioles. In dog experiments, exposure to large amounts of soot can cause emphysema. China Medical University Institute of respiratory disease, the study found that smokers of lower respiratory tract macrophages (AM) and neutrophil elastase (PMN) and compared with nonsmokers increased significantly, and the mechanism may be due to smoke and harmful gas stimulation, lower respiratory tract mononuclear macrophage system is activated, the activation of AM in addition to the release of elastase outside at the same time, the release of PMN chemokines, PMN from the mobile to the pulmonary capillary. The activation of AM release of macrophage growth factor, attract fibroblasts; and the PMN release of toxic oxygen free radicals and elastase, collagenase, protease, elastic protein, multi role in lung mucin, basement membrane and collagen fibers, which lead to the destruction of alveolar wall and interstitial fibrosis interval. According to the report, in 1986, nearly 13 million people suffered from COPD in the United States, and more than 90 thousand people died in 1991. Smoking was the main cause. Smokers with chronic bronchitis than non-smokers 2 times to 4 times, and the amount and duration of smoking and smoking is proportional, patients often have chronic cough, sputum and dyspnea activities. Pulmonary function test showed respiratory obstruction, decreased lung compliance, ventilatory function and diffusion function, and decreased arterial partial pressure of oxygen. Even younger asymptomatic smokers have mild pulmonary hypofunction. COPD may cause spontaneous pneumothorax. Smokers often suffer from chronic pharyngitis and vocal cord inflammation.Four, the influence on the digestive tractSmoking can cause gastric acid secretion increase, generally increased by 91.5% than non-smokers, and can inhibit the secretion of sodium bicarbonate in the pancreas, resulting in an increase of duodenal acid load, causing ulcers. Nicotine in tobacco can reduce the tension of the pyloric sphincter and make it easy to flow back, thus weakening the defense factors of the gastric and duodenal mucosa, promoting the occurrence of chronic inflammation and ulceration, and delaying the healing of the original ulcer. In addition, smoking reduces the tension of the lower esophageal sphincter and is prone to reflux esophagitis.Five, othersSmoking is more harmful to women than men. Smoking women can cause menstrual disorders, pregnancy difficulties, ectopic pregnancy, low estrogen, osteoporosis and premature menopause. Smoking in pregnant women can cause spontaneous abortion, fetal growth retardation and low birth weight. Others, such as premature birth, stillbirth, abruption of placenta, placenta previa and so on, may be related to smoking. Smoking during pregnancy can increase the mortality before and after birth and the incidence of congenital heart disease. These hazards are due to smoke harmful substances such as carbon monoxide into the fetal blood, forming carboxyhemoglobin, nicotine and also cause hypoxia; vasoconstriction, reduced fetal blood supply and nutrition supply, thus affecting the normal fetal growth and development. 90% of women with lung cancer, 75% of COPD and 25% of coronary heart disease are related to smoking. The rateof women dying from breast cancer is 25% higher than that of non-smoking women. Nicotine has been shown to reduce the secretion of sex hormones and kill sperm, reducing sperm count, abnormal morphology and vitality, resulting in fewer chances of conception. Smoking can also cause testicular dysfunction, male sexual dysfunction and sexual dysfunction, leading to male infertility. Cigarette smoking can cause tobacco amblyopia, and smoking in the elderly can cause macular degeneration. This may be due to increased atherosclerosis and platelet aggregation, resulting in partial hypoxia. Recently, a study in the United States found that smoking in loud noise can cause permanent hearing loss and even deafness.Six 、 passive smokingRefers to people who live and work around smokers, unconsciously inhale smoke, dust particles, and various toxic substances. Passive smokers inhaled concentration of harmful substances is not lower than smokers, smokers spit out the cold smoke, 1 times more than hot smoke smoke tar inhaled by smokers in 2 times, 4 times more carbon monoxide than BAP. The study found that women who smoked regularly in the workplace had higher rates of coronary heart disease than did workplaces with or without passive smokers. According to an international sampling survey, 50% of smokers with cancer are passive smokers.A large number of epidemiological investigations show that the prevalence of lung cancer in husbands who smoke cigarettes is 1.6 to 3.4 times higher than that of husbands who do not smoke. Passive smoking in pregnant women can affect the normal growth and development of the fetus.Some scholars have analyzed more than 5000 pregnant women, found that when the husband smoked more than 10 cigarettes a day, the fetus's prenatal mortality increased by 65%; the more smoking, the higher the mortality rate. Smoking families have more respiratory diseases than non-smokers.。