重组人血管内皮抑制素注射液联合放化疗治疗局部晚期头颈部鳞癌的疗效及安全性

目的:分析重组人血管内皮抑制素注射液联合放化疗治疗局部晚期头颈部鳞癌的疗效及安全性。方法:选取2013年2月-2016年2月收治的局部晚期头颈部鳞癌患者100例,根据随机数字表法分为观察组和对照组,各50例。对照组单纯给予放化疗治疗,观察组在对照组基础上联合重组人血管内皮抑制素注射液治疗,两组均以21 d为一个治疗周期。比较两组近期疗效、无进展生存期(PFS)、总生存时间(OS)、不良反应发生及生活质量评分。结果:观察组疾病控制率为80.00%,高于对照组的78.00%,但比较差异无统计学意义(P0.05);观察组PFS为(18.89±5.89)个月,长于对照组的(14.78±2.56)个月(t=4.525,P=0.000);观察组OS为(26.89±5.78)个月,长于对照组的(20.22±0.18)个月(t=8.156,P=0.000);两组患者白细胞降低、血小板降低、贫血、恶心、呕吐、腹泻、放射性皮炎、放射性黏膜炎发生率比较,差异均无统计学意义(P0.05);治疗后,两组生活质量各维度评分均高于治疗前(P0.05),且观察组均高于对照组(P0.05)。结论:局部晚期头颈部鳞癌应用重组人血管内皮抑制素注射液联合放化疗治疗的效果显著,安全性高,在临床上值得推广。     

非区域淋巴结转移与胸段局部晚期食管鳞癌同步放化疗预后的关系

目的探究非区域淋巴结转移与胸段局部晚期食管鳞癌根治性同步放化疗预后的关系。方法回顾性分析2013年1月至2018年12月湖州市中心医院接受根治性同步放化疗的139例胸段食管癌患者的病历及随访资料,其中有非区域淋巴结转移患者33例为观察组,无非区域淋巴结转移患者106例为对照组,采用倾向性评分匹配法1∶1匹配,分析比较两组患者同步放化疗后的总缓解率、无进展生存期（PFS）及总生存期（OS）。结果观察组总缓解率为57.5%;对照组总缓解率为76.4%（P＜0.05）;倾向性评分匹配前,观察组和对照组中位PFS分别为7.3个月和13.0个月,中位OS分别为12.1个月和19.6个月。观察组PFS和OS均短于对照组（均P＜0.05）。匹配后,观察组和对照组中位PFS分别为7.3个月和12.4个月,中位OS分别为12.1个月和19.8个月,观察组PFS和OS仍短于对照组（均P＜0.05）。非区域淋巴结转移、cTNM是影响PFS和OS的独立危险因素。结论非区域淋巴结转移是影响接受根治性同步放化疗胸段局部晚期食管鳞癌患者预后的重要因素。     

胰腺癌非手术患者治疗模式与预后——单中心230例回顾性研究

背景 胰腺癌非手术患者的主要治疗手段仍是以放化疗为主的综合治疗,但其最佳治疗模式及疗效尚不明确。目的 分析接受基于放疗的综合治疗的胰腺癌非手术患者临床病理特征、治疗模式及预后。方法 分析2016年1月-2020年12月解放军总医院第一医学中心放疗科收治的230例接受基于放疗的综合治疗的胰腺癌非手术患者(医学上不能手术切除或不适合手术)。Kaplan-Meier法计算中位总生存期(median overall survival,mOS)和中位无进展生存期(median progressionfree survival,mPFS)。Cox风险比例模型分析影响患者生存的独立预后因素。结果 230例患者中,男140例,女90例,中位年龄64(33～88)岁。全组患者中位随访时间19.9个月(95%CI:18.2～27.7个月),m OS和m PFS分别为17.1个月和10.3个月,1年、2年、3年、4年和5年OS分别为68.1%、30.0%、16.0%、4.9%和2.5%。局限期(Ⅰ/Ⅱ期)、局部晚期(Ⅲ期)和转移性(Ⅳ期)胰腺癌患者mOS分别为21.1个月、17.0个月和14.1个月,mPF...     

尼妥珠单抗联合吉西他滨一线治疗晚期胰腺癌的疗效观察

背景 尼妥珠单抗是以表皮生长因子受体(epidermal growth factor receptor,EGFR)为靶点的靶向药物,在国外的临床研究中取得良好的效果,但国内大规模的临床试验数据相对较少.目的 探讨尼妥珠单抗联合吉西他滨(gemcitabine,GEM)一线治疗晚期胰腺癌的疗效和安全性.方法 通过解放军总医院大数据平台,检索2012年1月-2019年6月在解放军总医院第一医学中心治疗的晚期胰腺癌患者的临床资料,根据不同治疗方案,通过倾向性匹配,共纳入122例晚期胰腺癌患者,联合组61例采用尼妥珠单抗+GEM,单药组61例采用GEM单药化疗.比较两组患者的一般资料、不良反应发生率、无进展生存期(progression free survival,PFS)和总生存期(overall survival,OS).结果 联合组PFS优于单药组(4.5个月vs 3.1个月,P<0.001);联合组OS也高于单药组(7.4个月vs 6.4个月,P<0.001).多因素分析显示,GEM联合尼妥珠单抗一线治疗晚期胰腺癌可延长晚期胰腺癌患者的生存期(P<0.001).两组间与治疗相关的不良事件发生率无统计学差异(P>0.05).结论 与GEM单药相比,尼妥珠单抗联合GEM一线治疗晚期胰腺癌可增加患者的生存获益,且未增加不良反应,对于晚期胰腺癌患者来说是一个可供选择的一线治疗方案.     

健脾解毒通络方联合替加氟维持治疗晚期胃癌

目的:通过观察健脾解毒通络方联合替加氟维持治疗的晚期胃癌患者,分析该方案对晚期胃癌患者无进展生存时间(Progress Free Survival,PFS)、总体生存率(overall survival,OS)的影响并研究与晚期胃癌预后相关的临床因素。方法:搜集30例晚期胃癌患者,并对接受该方案维持治疗后的PFS、OS进行统计分析并研究影响预后的相关因素。结果:30例患者中位PFS是(15. 000±4. 674)个月;中位OS是(27. 000±5. 439)个月; 1年生存率约78. 94%; 2年生存率约36. 84%; 3年生存率约10. 52%,5年生存率约10%;手术治疗对能明显延长PFS但对OS无明显差异;淋巴结转移能明显减少PFS、OS;脏器转移情况是决定PFS、OS长短的相关因素。结论:健脾解毒通络方联合替加氟维持治疗可以提高晚期胃癌患者近期疗效,改善生存质量,延长无疾病进展时间,总生存期也有延长趋势,且不良反应低,耐受性好。     

薏苡仁甘油三酯在吉西他滨三维适形同步放化疗治疗局部晚期胰腺癌中免疫调节功能观察

目的:探讨薏苡仁甘油三酯注射液在三维适形放疗同步吉西他滨化疗治疗局部晚期胰腺癌中的免疫调节功能及对生存的影响?方法:56例局部晚期的胰腺癌随机分为治疗组和对照组?对照组:吉西他滨同步三维适形放疗;治疗组:薏苡仁甘油三酯注射液(100 ml/d)联合吉西他滨同步三维适形放疗,连用21?28 d为1个周期,共使用2个疗程,分别测定治疗前后CD3?CD4?CD8?CD4/CD8的值?结果:治疗组CD4+?CD4+/CD8+?NK细胞治疗后比治疗前显著提高(P < 0.05),治疗组中位生存期17.2个月,对照组12.4个月(P < 0.05);结论:薏苡仁甘油三酯注射液能提高接受三维适形放疗同步吉西他滨化疗的局部晚期胰腺癌患者的免疫能力,提高患者中位生存期?     

尼妥珠单抗联合紫杉醇脂质体、顺铂同步放化疗治疗晚期食管癌的效果

目的观察尼妥珠单抗联合紫杉醇脂质体、顺铂同步放化疗治疗晚期食管癌的疗效和安全性。方法选取2014年2月至2017年4月郑州大学第一附属医院收治的78例晚期食管鳞癌患者,根据治疗方案分为观察组和对照组,各39例。对照组接受紫杉醇脂质体、顺铂方案化疗联合放疗,每3周为1个疗程,观察组在对照组基础上每周接受1次尼妥珠单抗治疗,观察两组的治疗效果和不良反应。结果观察组和对照组的客观缓解率(ORR)分别为51.28%和20.51%,中位生存期(mOS)分别为24.7、17.0个月,中位无进展生存期(mPFS)分别为17.2、9.1个月,差异有统计学意义(均P<0.05)。观察组的不良反应发生情况与对照组比较,差异无统计学意义(P>0.05)。结论晚期食管癌患者行尼妥珠单抗联合紫杉醇脂质体和顺铂同步放化疗治疗有一定效果,可延长患者的PFS和OS,不良反应可耐受,值得在临床中推广应用。     

重组人内皮抑制素联合同步放化疗对局部晚期非小细胞肺癌的疗效及安全性分析

目的探讨重组人内皮抑制素联合同步放化疗（化疗方案为长春瑞滨联合卡铂）治疗局部晚期非小细胞肺癌（NSCLC）的疗效及安全性。方法122例局部晚期NSCLC患者分别接受同步放化疗（单纯治疗组）76例,重组人内皮抑制素联合同步放化疗（联合治疗组）46例;比较两组患者无进展生存期（PFS）、总生存期（OS）及不良反应发生率。结果单纯治疗组疾病客观反应率（ORR）为86.8%,疾病缓解率（DCR）为92.1%;联合治疗组ORR为80.4%,DCR为91.3%;两组患者ORR及DCR比较,差异均无统计学意义（均P＞0.05）。联合治疗组中位PFS及OS（14.5、21.5个月）均明显高于单纯治疗组（9.3、15.0个月）,差异均有统计学意义（均P＜0.05）。病理类型亚组分析显示,肺腺癌患者联合治疗组中位PFS高于单纯治疗组（P＜0.05）,中位OS比较差异无统计学意义（P＞0.05）;肺鳞癌患者两组中位PFS及OS比较,差异均无统计学意义（均P＞0.05）。两组患者恶心呕吐、放射性肺炎发生率比较,差异均有统计学意义（均P＜0.05）;骨髓抑制、放射性食管炎发生率比较,差异均无统计学意义（均P＞0.05）。两组患者3级以上不良反应有骨髓抑制、放射性肺炎。结论重组人内皮抑制素联合同步放化疗能有效改善局部晚期NSCLC患者的生存情况,且未增加严重的不良反应。     

康莱特注射液联合阿帕替尼治疗晚期胃癌的临床研究

目的:研究康莱特注射液联合阿帕替尼治疗晚期胃癌的效果.方法:90例晚期胃癌患者分为两组,每组45例.对照组采用阿帕替尼化疗,试验组在此基础上联合康莱特注射液治疗.比较两组临床疗效、无进展生存期(PFS)、1年生存期(OS)、客观缓解率(ORR)、毒副反应发生率及生活质量改善情况.结果:化疗后比较,两组ORR比较差异无统计学意义(P>0.05);试验组血清白细胞介素2(IL-2)、干扰素-γ(INF-γ)和肿瘤坏死因子-α(TNF-α)水平均低于对照组(P<0.05);试验组0～Ⅳ级贫血、肝功能异常的毒副反应发生率低于对照组,试验组生活质量改善率高于对照组(P<0.05).随访1年后,试验组PFS、OS均高于对照组(P<0.05).试验组1年生存率略高于对照组,但差异无统计学意义(P>0.05).结论:康莱特注射液联合阿帕替尼治疗晚期胃癌患者,可改善血清炎症因子水平、减少毒副反应,提高生活质量.     

康莱特加同步放化疗治疗局部晚期非小细胞肺癌临床研究

目的：观察康莱特注射液（KLT）联合同步放化疗对局部晚期非小细胞肺癌的治疗效果。方法：48例局部晚期非小细胞肺癌患者,随机分为两组,综合组：25例,采用盖诺＋顺铂方案同步放化疗,放疗予常规分割,2Gy/f,总量56～60Gy,同时加用康莱特注射液200ml/d静脉滴入,21天为1个疗程,共2个疗程。对照组：23例,采用盖诺＋顺铂方案同步放化疗。2疗程后评价疗效,通过KPS评分、体重变化观察生存质量改善情况。结果：两组完全缓解率分别为20.0%和13%（P〉0.05）;有效率分别为80.0%和69.5%（P〉0.05）;综合组3级以上骨髓抑制发生率为40.0%,而对照组为69.6%（P〈0.05）;综合组3级以上消化道不良反应发生率为8.0%,对照组为34.8%（P〈0.05）;综合组无3级以上放射性肺炎发生,而对照组为4.4%（P〉0.05）;综合组3级以上放射性食管炎发生率16.0%,对照组为43.5%（P〈0.05）;综合组治疗前后KPS评分及体重评分明显高于对照组（P〈0.05）。结论：康莱特联合同步放化疗可以减轻放化疗引起的胃肠道反应,减少3级以上骨髓抑制和3级以上放射性食管炎的发生,使患者的生存质量得到改善,但从疗效分析,NP方案同步放化疗是否联合使用康莱特,无统计学差异。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.