卵巢癌术后化疗联合醋酸甲羟孕酮抑制盆腔病理血管生成的研究

目的探讨卵巢癌术后化疗联合醋酸甲羟孕酮（MPA）抑制盆腔病理血管生成作用及其对预后的评价。方法实验组53例,Ⅰ/Ⅱ期30例（56.6%）,Ⅲ/Ⅳ期23例（43.4%）。化疗方案：2001年以前采用PAC（顺铂＋表阿霉素＋环磷酰胺）或PC（顺铂＋环磷酰胺）;2001年及以后为PT方案（紫杉醇＋卡铂）静脉化疗6个疗程;第7个疗程行髂内动脉化疗栓塞,同时数字减影观察盆腔病理血管。术后1年时,再增加1次髂内动脉化疗栓塞造影。术后进食开始服用MPA250mg/d×12个月。每次化疗前测定CA125。对照组37例,Ⅰ/Ⅱ期20例（54.1%）,Ⅲ/Ⅳ期17例（45.9%）,除不用MPA外,卵巢癌手术后化疗方案及检查方法与实验组相同。随访两组3年、5年生存率。结果①CA125水平实验组在第7疗程结束后和术后1年时,Ⅰ/Ⅱ期和Ⅲ/Ⅳ期与对照组比较下降明显,差异有显著性（P〈0.05,P〈0.05;P〈0.05,P〈0.01）。②实验组髂内动脉分支血管走形迂曲、紊乱及火焰状病理血管者明显少于对照组,差异有显著性（P〈0.05）;第7疗程后盆腔病理血管改变与血CA125水平呈明显正相关（r=0.95,P〈0.001）,即盆腔造影有病理血管者,血CA125升高。③Ⅰ/Ⅱ期3年和5年生存率实验组分别为88.33%、41.23%。对照组分别为79.59%、34.31%,两组比较实验组高于对照组,差异有显著性（P〈0.01,P〈0.05）;Ⅲ/Ⅳ期3年和5年生存率实验组分别为17.52%,1.34%。对照组分别为12.49%、0,两组比较实验组高于对照组,差异有显著性（P〈0.05,P〈0.01）。结论MPA对卵巢癌盆腔病理血管生成有明显抑制作用;MPA联合化疗可延长卵巢癌患者的生存时间;髂内动脉造影显示盆腔病理血管,可作为评价治疗效果及预后的指标;连续服用12个月MPA是安全的。     

经髂内动脉选择性介入治疗膀胱癌

目的 探讨膀胱癌数字减影血管造影表现及血管内介入治疗效果。方法 ９６例膀胱癌均行两次髂内动脉灌注化疗，并于治疗前后行髂内动脉造影及Ｂ超、膀胱镜检查。结果 多血管型５４例（５６．２％），少血管型４２型（４３．８％），治疗后，完全缓解２０例，部分缓解５５例，无效２１例，总有效率为７８．１％。结论 数字减影血管造影及介入治疗是膀胱癌有效诊断和非手术治疗的一种方法。     

盆腔肿瘤供血及介入治疗选择

目的：探讨盆腔肿瘤供血特点对介入治疗选择的意义。材料和方法;分析58例盆腔肿瘤(男12例,女46例)年龄23岁～63岁,分别作双侧选择性髂内动脉造影,观察盆腔肿瘤的供血,行供血动脉选择性插管灌注栓塞治疗．化疗药物为阿霉素类、卡铂、5-Fu、MMC,栓塞剂主要为明胶海绵颗粒。结果：58例盆腔肿瘤中,54例为髂内动脉前干分支血管主要供血,仅少数病例是髂外动脉参与供血．并对52例妇科盆腔肿瘤及4例骶(尾)部肿瘤行肿瘤主要供血血管选择性灌注栓塞治疗,介入治疗术后所有病例均有全身情况改善,症状减轻,20例宫颈癌得以二期手术切除,4例子宫大出血得以控制;4例骶(尾)部肿瘤先行肿瘤供血动脉栓塞,栓后手术切除清楚,出血量减少。结论：盆腔血管解剖和肿瘤血管特点,是介入治疗选择基础,可作为盆腔肿瘤急诊止血症状,手术前后的辅助治疗或不能手术患者的姑息治疗不可缺少的手段．     

经髂内动脉选择性介入治疗膀胱癌

目的探讨膀胱癌数字减影血管造影表现及血管内介入治疗效果。方法96例膀胱癌均行两次髂内动脉灌注化疗，并于治疗前后行髂内动脉造影及B超、膀胱镜检查。结果多血管型54例(56．2％)，少血管型42例(43．8％)。治疗后，完全缓解20例，部分缓解55例，无效21例，总有效率为78．1％。结论数字减影血管造影及介入治疗是膀胱癌有效诊断和非手术治疗的一种方法。     

子宫动脉造影解剖及其血管内栓塞治疗的研究

探讨子宫动脉造影解剖及其血管内栓塞治疗的临床疗效。方法：采用Seldinger技术，行双侧髂内-子宫动脉造影，了解子宫动脉解剖以及子宫肌瘤的血供状况，超选择插入子宫肌瘤供血动脉内并行栓塞治疗。结果：60例患者子宫动脉均由同侧髂内动脉发出，60%子宫动脉起源于髂内动脉前干，对侧斜位显示子宫动脉开口及行程为最佳投照体位。子宫肌瘤由双侧子宫动脉供血并均显示丰富，呈双侧优势型35例，占58.3%；双侧子宫动脉均参与供血，但一侧供血较对侧明显丰富，供血量超过子宫肌瘤瘤体的1/2,呈单侧优势型21例，占35%；仅有一侧子宫动脉参与供血，呈单侧供血型4例, 占6.7%。术后患者原有的症状消失。B超复查显示，术后3个月肌瘤平均缩小40%，6个月平均缩小55%，12个月平均缩小60%。结论：子宫动脉栓塞治疗子宫肌瘤安全有效；了解子宫动脉解剖及子宫肌瘤的血管构筑，可提高技术成功率     

靶血管介入灌注治疗晚期卵巢癌的临床观察

目的：观察靶血管介入治疗晚期卵巢癌临床疗效。方法：在DAS的监测下Seldeinger氏法靶动脉造影，并将导管直达供应肿瘤或肿瘤转移灶的动脉血管。然后用碘乳剂栓塞介入靶动脉，同时用明胶海绵栓塞。靶动脉介入灌注晚期卵巢癌37例。对照组为同期仅用静脉化疗的晚期卵巢癌21例。结果：靶血管介入组治疗37例，完全缓解（CR）7例，部分缓解（PR）16例，CR＋PR23例，占65．71％；稳定6例，进展4例。对照组组25例，完全缓解（CR）2例，部分缓解（PR）5例，CR＋PR7例，占28．00％；稳定11例，进展7例。尤其在肿瘤转移灶的治疗上比传统的治疗方法有着明显的差别P＜0．05。结论：靶血管介入灌注治疗晚期卵巢癌具有较好疗效，特别是对转移性癌灶的效果更优于传统的方法。     

经导管治疗下肢动脉闭塞性疾病疗效与方法分析

目的：探讨经导管血管内溶拴治疗下肢动脉闭塞性疾病的疗效、价值和方法。方法：10例患者均选择经股动脉穿刺插管，1例患者因左侧髂总动脉起始部闭塞．改行右锁骨下动脉插管，采用微量泵注入尿激酶50万～200万U。结果：髂总动脉血栓1倒，髂外动脉1例，股浅动脉和腘动脉各3例，胫前动脉2例。结论：经导管血管内溶栓治疗，疗效可靠，方便快捷，是治疗动脉闭塞性疾病的可行方法。     

盆腔动脉造影解剖学研究及其临床意义

目的:探讨盆腔动脉造影解剖及其最佳投照体位,指导超选择盆腔血管插管,提高介入治疗的成功率。方法:收集正常成人腹主动脉及髂总动脉造影资料51例,测量其双侧髂总动脉间的夹角、双侧髂内动脉开口的高度和髂总动脉长度;观察髂内动脉及其分支正位、对侧斜位、同侧斜位造影片上显示程度;分析髂内动脉及分支的血管造影表现及其造影解剖类型。结果:①正常成年男性双侧髂总动脉夹角均数为57.22°±8.39°,正常成年女性双侧髂总动脉夹角均数为66.41°±7.99°,女性髂总动脉夹角大于男性(P<0.01);右侧髂内动脉开口高于左侧,左侧髂总动脉长于右侧;②对侧斜位是显示髂内动脉及分支的最佳体位;③本组正常成人髂内动脉造影可分为四种解剖类型。结论:对盆腔血管介入治疗的患者,应根据其性别及其髂内动脉血管造影解剖类型、髂总动脉的主干长度,选择最佳投照体位,实行个体化介入手术操作和治疗。     

晚期卵巢癌细胞减灭术后髂内动脉灌注化疗86例临床观察

目的研究晚期卵巢癌细胞减灭术后应用导管介入髂内动脉灌注化疗的治疗。方法经手术及病理证实为晚期卵巢癌患者86例,未能彻底切除,细胞减灭术后实施单侧股动脉灌入化疗。结果86例患者腹胀、腹水均消失。B超检查12例肿块完全消失;75例肿块缩小,其中PR29例,MR46例。结论导管介入选择性髂内动脉灌注化疗可增加肿瘤局部血内抗癌药物浓度,明显缓解卵巢癌症状,使肿块缩小,是治疗晚期卵巢癌的有效方法。     

髂内动脉灌注大剂量化疗药物治疗盆腔恶性肿瘤的分析

目的：该文对盆腔恶性肿瘤动脉灌注大剂量化疗药物进行了分析和研究。方法：搜集盆腔各种恶性肿瘤18例，以顺铂、表阿霉素及丝裂霉素大剂量联合动脉灌注化疗为主，分析了选择插管方式、动脉灌注化疗临床意义与价值。结果：所有病例均成功实施了髂内动脉大剂量联合灌注化疗治疗，肿瘤完全缓解9例，部分缓解6例，无变化3例，总有效率为83.5％。结论：髂内动脉灌注大剂量抗癌药物，可使局部肿瘤组织内有长时间恒定较高的药物浓度，延长了药物对肿瘤组织的接触时间，才能达到杀灭肿瘤细胞的作用，经过治疗后肿瘤坏死、缩小或消失，还可以为手术切除创造有利条件，最终达到提高患者生存期的目的。     

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…