肿瘤病症辨治心悟

正肿瘤是机体在各种致癌因素作用下,局部组织的某一个细胞在基因水平上失去对其生长的正常调控,导致其克隆性异常增生而形成的异常病变。一般将肿瘤分为良性和恶性两大类。恶性肿瘤即临床俗称的"癌病",本篇多指此病。肿瘤是一种多发、常见、易变、难治、难愈、预后不良的疑难重病,是全身性疾病的局部表现,任何单一手段的局部治疗,均难以彻底治愈。对于肿瘤患者,不但要尽可能治其病,更要尽可能提高患者生存质量、延长生存期。中医     

用Cox’s回归模型分析老年人舌鳞癌生存率

目的：探讨老年人舌鳞癌预后的影响因素。方法：收集经病理证实的６３例老年人舌鳞癌,对影响其生存率的众因素进行回归分析。结果：影响其预后的因素依次为①肿瘤的局部控制;②治疗方法;③颈部淋巴结的预防性根治术;④肿瘤大小;⑤年龄。结论：肿瘤的局部控制是影响其预后的关键;其次是颈部淋巴结的根治术;另外综合治疗明显优于单一治疗。建议尽可能选择综合治疗,特别要强调肿瘤的局部控制和预防性颈部淋巴结清扫术。     

射频消融术治疗肝脏肿瘤的临床观察

局部射频消融治疗作为一种微创手术,已经成为继手术切除、介入治疗后的第3大肝脏肿瘤治疗手段,由于其疗效确切,在小肝癌的治疗方面,射频消融疗效与手术切除相近,因此被认为是小肝癌的根治性治疗手段之一.射频消融术可经皮、经腹腔镜手术和经开腹手术三种.局部消融治疗的特点包括:直接作用于肿瘤,具有高效快速的优势;治疗范围局限于肿瘤及其周围组织,对机体影响小,可以多次治疗.现将2009年-2010年收治的32例经皮经肝、腹腔镜下、开腹直视下射频消融术治疗肝脏肿瘤,报告如下.     

恶性肿瘤患者能量代谢及相关机制的研究进展

能量代谢是指三大营养物质在体内代谢过程中伴随的能量产生和利用过程.肿瘤本身的作用、机体对肿瘤的反应以及抗肿瘤治疗使肿瘤患者的代谢具有特殊性.通常认为,初诊肿瘤患者的静息能量消耗增加,且与C反应蛋白和一些炎症细胞因子的释放相关;经有效治疗后,静息能量消耗则不同程度下降.肿瘤的分期及分化程度对机体代谢也有影响,但不同的研究结果存在矛盾.文章就肿瘤患者的能量代谢特点及相关影响因素进行综述.     

中西医结合治疗原发性支气管炎肺癌的近况

原发性支气管肺癌(以下简称肺癌),是指原发于支气管粘膜和肺泡的癌肿,是最常见的恶性肿瘤,其发病率与死亡率逐年上升,在我国有些大城市肺癌死亡率已跃居各种恶性肿瘤的首位.通过多年的临床实践,我国学者多数对中西医结合治疗肿瘤有了比较明确共识:(1)在患者初次就诊时由于邪盛,首要任务是应用中西医的各种方法包括手术、放射性、化学药物尽可能地打击和消灭肿瘤,但在这时要注意保护机体的正气;(2)待肿瘤负荷大大减低以后,将治疗重点转为最大限度地促进骨髓和免疫功能的恢复,即重建正气的阶段;(3)经过一个阶段的免疫和骨髓功能的重建,在必要时还可再转入以打击肿瘤为主的第三阶段即巩固治疗,尽可能地扫除潜在或残存细胞;(4)以后再转入长期的扶正治疗.这样的治疗模式已在很多常见的肿瘤中证明不但能改善患者的免疫功能和一般状况,而且可一定程度上提高治愈率,因而受到国内外学术界的瞩目[1].综观我国近年来中西医结合治疗肺癌的一些情况,即充分地体现了这一治疗模式,取得了较好的疗效.现将我国近年来运用中医药各种疗法配合手术、放化疗等治疗肺癌的临床与实验研究情况综述如下.     

PICC用于术后化疗的护理体会

肿瘤患者术后进行化学疗法是临床治疗的重要手段,但长期的化疗易导致静脉损伤,患者难以耐受化疗药物引起的静脉炎及药物外渗引起的局部皮肤损伤等而中断治疗,延误治疗的最佳时机,给患者造成机体和经济上的损害.     

中医药治疗肿瘤的现状与展望

中医药是我国肿瘤综合治疗的一个重要组成部分,也是我国特有的抗癌治疗模式。有资料表明,在我国有2／3以上的恶性肿瘤患者在接受现代医学治疗的同时应用中医药治疗。中医治疗肿瘤的特点是坚持整体观念,以人为本,把人看作一个整体,以证候为靶点,通过四诊进行精确的辨证,然后处方用药,调整患者的阴阳、寒热、虚实,达到新的阴阳平衡,所以它更多的是改变肿瘤的生存环境,使机体内环境向不利于肿瘤发展的方向发展,从而增强患者整体的免疫功能和抗癌能力,但其杀灭癌细胞作用较弱;而西医治疗肿瘤多以手术、放疗、化疗为主,长于杀灭局部癌细胞,但同时对正常的机体组织也有一定的损伤;如将中西医之长有机结合起来,优势互补,将是最理想的选择。     

铜绿假单胞菌注射液辅助治疗恶性肿瘤的应用进展

铜绿假单胞菌注射液的基础研究和临床应用均表明其具有较强免疫原性,不仅调整机体体液免疫,使机体产生不同菌属的高效价广谱抗体;同时也可全面调整机体细胞免疫,增强机体抗感染能力.配合手术后的放化疗治疗,可以降低术后感染的并发症及肿瘤复发率、增强放化疗效果,提高肿瘤患者的生存质量,在多种恶性肿瘤的临床治疗中被证实使用有效,且安全可靠,无明显毒副作用.现将铜绿假单胞菌注射液辅助治疗恶性肿瘤的现状做一综述.     

新辅助化疗结合放疗与单纯放疗治疗局部晚期宫颈癌的临床比较

目的 分析和研究新辅助化疗结合放疗与单纯放疗治疗局部晚期宫颈癌的临床比较.方法 选取局部晚期宫颈癌患者78例,将其按奇、偶数字表法随机分为观察组与对照组,每组39例.对照组患者术前采用单纯放疗方法 治疗;观察组患者术前采用新辅助化疗结合放疗方法 治疗,将2组患者疗效进行对比.结果 2组患者治疗前肿瘤直径差异无统计学意义;观察组患者治疗后肿瘤直径低于对照组(P<0.05).观察组患者治疗期间不良反应发生率低于对照组(P<0.05).结论 将新辅助化疗结合放疗应用于局部晚期宫颈癌患者术前治疗,能够达到有效缩小肿瘤体积的作用,并且患者在治疗期间不良反应发生率低,对提高手术切除率及延长患者生存时间均具有重要作用.     

中医药对肿瘤病人心身疾病及生存质量的影响

目前．对恶性肿瘤的治疗，特别是如何改善患者心身疾病，提高生存质量、延长患者生存期，仍是肿瘤界的一大难题。中西医结合方法。把对肿瘤的局部治疗与对机体的全面关注紧密结合起来，包括建立生理、心理和社会的防御系统，从而明显提高了疗效。减轻了肿瘤病人的心身问题，改善了生存质量和延长了生存期。中医药通过调节机体内环境，增强机体的全面防御能力．尤其在改善生存质量方面发挥了不可替代的重要作用，从而减少了肿瘤病人的心身问题，延长了患者的生存期。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.