超声造影在胰腺癌可切除性评估中的价值

目的 利用超声造影检查了解胰腺癌侵犯周围血管的情况,探讨术前超声造影对胰腺肿瘤可切除性的评估价值。方法 收集45例术前超声造影检查资料完整且经术后病理学检查证实为胰腺癌患者的临床资料。回顾并记录术前超声造影检查显示的胰周大血管受侵犯情况、根据分型标准对肿块可切除性（根治性或姑息性手术）的评价结果以及最终手术方式选择情况,分析术前超声造影评估胰腺癌肿块可切除性的阳性和阴性预测值以及敏感性和特异性。结果 术前超声造影检查显示,45例患者共67条胰周大血管受侵,其中腹腔动脉、肠系膜上动脉、肠系膜上静脉、肝总动脉的受侵率分别为31.1%、22.7%、22.2%和22.2%。术前超声造影评估可切除肿块20例,实际切除（根治性手术）17例,阳性预测值85.0%;评估不可切除肿块25例,实际未切除（姑息性手术）20例,阴性预测值80.0%（20/25）;判断肿瘤可切除性的敏感性和特异性分别为77.3%和86.9%。结论 超声造影可较为准确地反映胰周大血管受侵犯情况,对于胰腺癌术前可切除性评估具有一定的参考价值。     

螺旋CT双期增强扫描在胰腺癌诊断中的应用

目的研究螺旋CT胰腺期、门脉期双期增强扫描在胰腺癌诊断和胰腺周围血管侵犯及正确评估手术切除可行性的价值。方法对22例行螺旋CT双期增强扫描胰腺癌CT征象,以及胰腺周围血管的受侵情况进行分析,并与手术结果比较。结果延时35 s进行胰腺期扫描能清晰显示胰腺及胰周血管改变,22例胰腺癌均表现为较明显的低密度灶,其中胰周血管中断4例,包绕4例,部分包绕2例,术前认为可以切除13例,术中切除11例。结论螺旋CT胰腺期增强扫描能清晰地显示胰腺癌,并有利于胰腺癌周围血管侵犯和可切除性的评估。     

多层螺旋CT双期扫描对胰腺癌的诊断价值及术前评估

目的LCT表现,评价多层螺旋CT双期扫描的诊断价值及手术可切除性的评估。方法顾分析25例胰腺癌的多层螺旋CT双期扫描图像资料,分析肿瘤的部位、大小、强化特征和胰周血管是否受侵等,并与手术结果对照。结果胰腺癌灶在胰腺期较实质期强化程度低,病灶与正常胰腺组织间密度差别大,病变显示清晰;与手术结果对比,多层螺旋CT双期扫描对胰周动脉受侵评价的准确度为88%,对胰周静脉受侵评价的准确度为80%。结论螺旋CT双期扫描可清晰显示胰腺肿瘤的部位、范围、强化特征和胰周血管,对胰腺癌的诊断有重要价值,有助于术前治疗方案的选择和可切除性的评估。     

超声造影在胰腺癌可切除性评估中的价值

目的 利用超声造影检查了解胰腺癌侵犯周围血管的情况,探讨术前超声造影对胰腺肿瘤可切除性的评估价值.方法 收集45例术前超声造影检查资料完整且经术后病理学检查证实为胰腺癌患者的临床资料.回顾并记录术前超声造影检查显示的胰周大血管受侵犯情况、根据分型标准对肿块可切除性（根治性或姑息性手术）的评价结果以及最终手术方式选择情况,分析术前超声造影评估胰腺癌肿块可切除性的阳性和阴性预测值以及敏感性和特异性.结果 术前超声造影检查显示,45例患者共67条胰周大血管受侵,其中腹腔动脉、肠系膜上动脉、肠系膜上静脉、肝总动脉的受侵率分别为31.1%、22.7%、22.2%和22.2%.术前超声造影评估可切除肿块20例,实际切除（根治性手术）17例,阳性预测值85.0%;评估不可切除肿块25例,实际未切除（姑息性手术）20例,阴性预测值80.0%（20/25）;判断肿瘤可切除性的敏感性和特异性分别为77.3%和86.9%.结论 超声造影可较为准确地     

64排螺旋CT诊断胰腺癌及胰周血管的价值

目的 探讨64排螺旋CT对胰腺癌的诊断及胰周血管侵犯的判断的价值.方法 21例经手术或病理证实的胰腺癌患者病灶各期强化特点及血管受侵的情况,并与手术记录对照.结果 21例胰腺癌均表现为胰腺肿块,平扫为等密度或等低混合密度病灶,增强后呈相对不均匀强化,境界模糊,以胰腺实质期显示最明显,17例CT发现血管受侵犯病例中,15例与手术探查相符.4例CT未发现血管受侵犯病例中,2例手术证实有血管受侵.结论 64排螺旋CT可以清晰显示胰腺癌肿块,在三期增强造影中,可评估胰腺血管是否受侵犯,是目前一种理想的检查方法 .     

多排螺旋CT三期增强扫描诊断胰腺导管腺癌血管侵袭的价值

目的探讨多排螺旋CT(MDCT)三期增强扫描诊断胰腺导管腺癌侵袭胰腺周围血管的价值。方法回顾性分析82例胰腺导管腺癌的MDCT三期增强及后处理图像资料和临床资料,分析胰腺癌胰周动脉和静脉入侵的MDCT征象,并与手术病理诊断结果相对照,获得MDCT判定不可切除肿瘤的阳性预测值。结果 492例胰周大血管有157例受到肿瘤侵袭,其中动脉受侵64例,静脉受侵93例。有39%的受侵静脉(36/93)被肿瘤包绕大于1/2血管周长,而有97%(60/64)的受侵动脉被肿瘤包绕大于1/2血管周长甚至被肿瘤包埋(χ2=12.85,p0.05)。有67%(62/93)的受侵静脉有血管狭窄或闭塞,而受侵动脉只有35%(26/64)(χ2=9.62,p0.05)。有70%(65/93)的受侵静脉管壁呈不规则状,受侵动脉管壁不规则只有42%(13/64)(χ2=10.78,p0.05)。MDCT判定可切除肿瘤为21例,不可切除肿瘤为61例,不可切除性的阳性预测值为98%。结论 MDCT三期动态增强扫描可较好的对胰腺导管腺癌侵袭胰腺周围大血管进行诊断,并能较准确的评估肿瘤是否可以切除。     

16层螺旋CT多期增强扫描对胰腺癌侵犯胰周血管的评估

目的 研究16层螺旋CT多期增强扫描评估胰腺癌侵犯胰周血管的价值.方法 对20例胰腺癌患者进行16层螺旋CT多期增强扫描和三维血管重建,结合源图像比较正常胰腺组织与肿瘤组织在各项增强中的强化程度,评价胰腺癌对胰周血管的侵犯情况,与术中所见对照.结果 16层螺旋CT多期增强扫描能清晰地显示胰腺癌的各种表现及胰周血管,以动脉晚期显示最佳,20例发现80支胰周血管受侵犯,表现为血管被肿瘤包绕或受压移位,管腔狭窄或闭塞,管壁浸润,CT评估肿瘤可切除准确度75%,不可切除准确度90%.结论 16层螺旋CT多期增强扫描在诊断胰腺癌、术前分期以及肿瘤可切除性的评估中具有很高的应用价值.     

64排胰周血管CTA在胰腺癌诊断价值的分析

目的 探讨64排螺旋CT对胰腺癌的诊断及胰周血管侵犯的判断的价值。方法 21例经手术或病理证实的胰腺癌患者病灶各期强化特点及血管受侵的情况,并与手术记录对照。结果 21例胰腺癌均表现为胰腺肿块,平扫为等密度或等低混合密度病灶,增强后呈相对不均匀强化,境界模糊,以胰腺实质期显示最明显,17例CT发现血管受侵犯病例中,15例与手术探查相符。4例CT未发现血管受侵犯病例中,2例手术证实有血管受侵。结论 64排螺旋CT可以清晰显示胰腺癌肿块,在三期增强造影中,可评估胰腺血管是否受侵犯,是目前一种理想的检查方法。     

MDCT三期增强扫描在胰腺癌诊断及临床中的应用价值

目的评价MDCT三期增强扫描在胰腺癌诊断及临床中的应用价值。方法回顾性分析26例经病理证实的胰腺癌患者的MDCT资料并进行分析。结果26例胰腺癌病例中,位于胰头者18例,胰体者5例,胰尾者3例。肿块直径3～6cm22例、1～3cm4例;动脉期扫描有不均匀轻度强化,伴有胰管和胆管扩张、胆总管阻塞24例、合并胰腺囊肿2例、肿瘤侵及血管15例、胰周脂肪受侵20例、腹膜后淋巴结转移16例。结论MDCT三期增强扫描在胰腺癌诊断及临床分期中有重要应用价值。     

多层螺旋CT胰周血管成像对胰腺癌可切除性评估的应用

目的探讨多层螺旋CT胰周血管成像对胰腺癌可切除性评估的应用情况。方法分析重庆市合川区人民医院2010年2月~2014年3月收治的60例胰腺癌患者临床资料,均采用螺旋CT扫描与手术对照。观察胰腺血管侵犯Loyer分型、胰腺周围主要动脉和静脉受侵犯分级情况。结果螺旋CT评估胰腺血管侵犯Loyer分型可切除血管206支,不可切除血管74支;螺旋CT评估胰腺周围主要动脉受侵犯分级可切除动脉157支,不可切除11支;螺旋CT评估胰腺周围主要静脉受侵犯分级可切除静脉69支,不可切除43支;螺旋CT评估Loyer分型可切除准确率为71.0%(199/280),血管受侵犯分级可切除准确率为77.8%(218/280)。结论多层螺旋CT在胰腺癌血管侵犯的可切除性评估中起着重要的补充作用,在胰腺癌血管侵犯多层螺旋CT评估中对动、静脉评判标准要有所区别,才能提高评估的准确性。     

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…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…