青年人胃癌的临床和生物学特点

目的：探讨青年人胃癌的临床和生物学特点。方法：分析了48例年龄≤35岁的胃癌患者的临床病理资料，分子生物学指标的表达情况及预访结果，并与162例中老年胃癌患者进行比较。结果：与中老年组相比，（1）青年人胃癌组肿瘤细胞分化程度低，以浸润型生长为主，淋巴管和静脉侵犯率高（均P＜0．05），肿瘤组织PCNA，CD44V6和MMP－9表达均显著高于中老年胃癌组（均P＜0．05）。（2）青年人胃癌组术前血清白蛋白水平高于中老年胃癌组，术前合并症发生率低于中老年组（均P＜0．05），两组术后并发症发生率的差别无显著性意义（P＞0．05），青年人胃癌组术后5年生存率为54．94％，中老年胃癌组术后5年生存率为48．26％，两者的差别无显著性意义（P＞0．05），结论：青年人胃癌具有更为恶性的生物学特性，青年人胃癌具有术前合并症少，营养状况较好的临床特点，青年人胃癌患者的术后生存率与中老年胃癌患者无明显差别。     

青年胃癌患者临床病理特点及预后因素分析

目的探讨青年胃癌临床特点及病理特征,分析其预后影响因素。方法回顾性分析河南科技大学第四附属医院2007年1月～2009年1月收治的428例行胃癌手术治疗患者的临床及病理资料,分析青年胃癌患者的临床病理特征及预后相关因素。结果与中老年胃癌患者相比,青年组胃癌侵犯全胃及并发腹膜转移所占比例较高（P〈0．05）,肿瘤分化程度更低,浸润程度更深（P〈0．05）,术后5年生存率较低,但差异无统计学意义（P〉0．05）。单因素及多因素分析表明,腹膜转移、TNM分期及手术方式是患者预后的独立危险因素。结论青年胃癌患者比中老年胃癌患者肿瘤分化更差,手术方式、腹膜转移及临床TNM分期是影响青年患者预后的独立危险因素。     

40岁以下青年人直肠癌临床病理特征及预后

目的探讨〈40岁青年人直肠癌的临床病理特征及预后。方法将1995年1月～2001年12月收治并有完整手术资料的568例直肠癌病人分为两组：〈40岁（青年组，109例），≥40岁组（中老年组，459例），对这两组病例，临床病理及随访资料进行回顾性分析比较。结果两组的家族史、误诊率、组织类型、分化程度、分期、淋巴结转移及侵袭深度等有明显差异（P〈0．05），而在部位、大体类型上无明显差异（P〉0.05）。两组5a生存率分别为34％、66％，有明显差异（P〈0．0001）。结论青年人直肠癌在临床病理特征及预后上与中老年人有着明显不同的特征，要提高对青年直肠癌的认识，做到早发现、早诊断、早治疗。     

青年人与老年人胃癌的临床特点分析

目的 总结分析青年人与老年人胃癌的不同临床特点，探讨其治疗方法。方法 对我院1990年1月～12月住院手术治疗，经病理检查确诊的59例青年人胃癌与356例老年人胃癌进行回顾性分析，比较两组的临床特点。结果 青年组女性所占比例明显高于老年组女性，发病性别比例具有统计学差异（P〈0．01）；肿瘤部位，青年组多位于胃窦部，占66．10％，老年组虽然以胃窦部为主，但贲门部比例较青年组高，占39．16％，两组发病部位分布具有统计学差异（P〈0．01）；青年组病理组织类型分化差，以低分化腺癌为主，占49．15％。老年组以中分化腺癌为主，占49．16％，发病病理组织类型分布具有统计学差异（P〈0.01）；青年组胃癌手术方式与老年组相近（P〉0．05）；青年组与老年组预后均较差，两组无统计学差异（P〉0．05）。结论 青年人与老年人胃癌具有不同的临床特点，整体病期均较晚，预后均差。因此，早期发现、早期诊断是提高疗效的关键。     

青年胃癌患者临床病理特点及长期生存率

目的 探讨青年胃癌患者临床病理特点及长期预后.方法 回顾性分析1996年1月至2006年12月因胃癌于我院行手术治疗的197例临床病理及随访资料。197例胃癌患者中,年龄≤40岁的患者有15例（青年组）,年龄＞40岁的患者有182例（中老年组）.结果 青年组患者女性比例较中老年组为高,差异有统计学意义（P＜0.05）。与中老年胃癌患者相比,青年胃癌患者表现为病情较为恶化,具体体现在浸润较深（pT4者较中老年比例为高）、分化较差、弥漫型多见（按芬兰Lauren分型）,差异有统计学意义（P＜0.05）.根治性手术后,青年组3年生存率、5年生存率类似,差异无统计学意义（P＞0.05）。姑息性手术后,青年组和中老年组1年生存率、3年生存率相当,差异无统计学意义（P＞0.05）。结论 与中老年胃癌患者相比,青年胃癌患者以女性为多,病情较为恶化,但长期生存率类似。     

青年组胃癌19例临床分析

作者分析了1988年-2005年间216例胃癌病例的组织学分化程度及随访结果，将其中年龄≤35周岁的青年组胃癌19例与年龄〉35周岁的197例中老年组胃癌比较，分析结果：1.青年组胃癌男、女比例为1：1.4，而中老年组男、女比例为2.6：1；2.青年组胃癌组织学分比较差者占84.2%，高于中老年组的71.6%；3.青年组胃癌TNM分期偏晚，Ⅲ、Ⅳ期者占78.9%，高于中老年组的72.6%。作者认为：青年组与中老年组在手术切除率与术后5年生存率方面无明显差异，多数青年患者确诊较晚，争取早期发现是改善预后的关键。     

青年胃癌患者的预后分析

目的探讨青年（≤40岁）胃癌患者的临床特征及预后。方法分析2000年12月至2008年12月本院手术治疗的780例胃癌患者的资料,比较青年胃癌患者与老年（≥70岁）胃癌患者临床病理特征及预后。结果780例胃癌患者中,青年患者76例,占917％。老年患者90例,占11．5％。与老年胃癌患者比较,青年胃癌患者无报警症状比例升高（23．7％vs11．1％,P=O031）;早期胃癌比例升高（26．3％vs8,9％,P=0．003）。青年胃癌患者和老年胃癌患者的5年生存率无明显区别（36．1％vs29．1％,P=0．560）。进一步分析表明,早期胃癌患者中,青年组预后要优于老年组,中位生存期分别为943个月和63．3个月（P=0．023）;进展期胃癌患者中,青年组不如老年组,中位生存期分别为30,9月和41．3个月（P=0．042）。结论与老年胃癌比较,青年胃癌具有“报警症状”少、早期胃癌比例高的特点;青年胃癌预后并不差于老年胃癌,年轻是预后的保护性因素。     

500例胃癌临床病理特征及外科治疗效果分析

目的：探讨该院近20年来胃癌临床病理特征及外科治疗效果的变迁。方法回顾性分析该院1990年1月至2009年12月行胃癌手术切除的500例患者的临床病理资料,分为前阶段组（1990～1999年）和近阶段组（2000～2009年）,比较两组患者的临床病理特征及生存差异。结果全组患者5年生存率为48．0％,其中行根治性切除患者5年生存率为53．0％。前阶段组与近阶段组患者肿瘤大小、病理类型、T分期、N分期和淋巴结清扫数目的差异有统计学意义（P＜0．05）。前阶段组和近阶段组患者5年生存率分别为40．2％和50．9％,其中根治性切除患者5年生存率分别为45．8％和58．2％,差异均有统计学意义（ P＜0．05）。多因素预后分析证实,时间段是胃癌患者的独立预后因素（H R＝0．793,95％ C I：0．672～0．881）。结论近20年来,胃癌的外科治疗效果较前得到了显著提高,对影响胃癌预后的高危因素要提高警惕。     

老年人胃癌的临床分析

目的探讨老年胃癌患者的临床表现、手术及预后特点。方法将我院干部病房收治的209例胃癌患者分为老年组（≥65岁）与非老年组（〈65岁）,对比两组的临床资料。结果老年组胃癌占63．2％,无症状者明显多于非老年组（23．5％比16．9％,P〈0．05）。老年组伴随病多于非老年组（81．8％比64．9％,P〈0．05）。两组手术切除率（90．9％比97．4%、根治性切除率为（73．5％比89．6%）、围手术期并发症率（14．4％比7．8％）、围手术期死亡率（3．0％比0％）有明显差异（P〈0．05）,5年生存率差异无统计学意义（59．7％比61．1％,P〉0．05）。多因素分析TNM分期和手术根治度是独立的预后影响因素（P〈0．05）。结论老年胃癌中无症状患者多见,伴随病多见,手术风险较非老年组大;老年胃癌预后与非老年患者无明显差别,其预后与TNM分期和手术根治度有关。     

以健脾为基础的复方辨证治疗对老年胃癌患者生存期的影响

背景：胃癌是最常见的恶性肿瘤之一,中医药已广泛用于胃癌的临床治疗,但尚未见到较大样本临床对照研究对其疗效进行评价。目的：通过对220例老年胃癌预后的分析,研究以健脾为基础的中药复方辨证治疗对老年胃癌预后的影响。设计、场所、受试者和干预措施：采用前瞻性同期病例对照研究方法,将65岁及以上老年胃癌病例（来自上海龙华医院肿瘤一科、瑞金医院消化外科和仁济医院普外科）分为接受中药复方辨证治疗的中药组和未接受中药治疗的非中药组。主要结局指标：依据临床病理分期,是否接受根治性手术和化疗进行分层。运用单因素及Cox多因素回归分析方法分析两组病例的临床病理因素及手术、化疗以及中药治疗对预后的影响。结果：共有220例病例纳入研究。中药组89例,非中药组131例。总体220例病例的Cox多因素回归分析表明,影响老年胃癌患者生存的独立的预后因素分别是临床病理分期、手术方式、化疗和中药治疗（P〈0．01）。服用中药的相对危险度为0．322,95％可信区间在0．212～0．489。中药组中位总生存期为41．129个月,1、3、5年生存率分别为85．2％、55．6％、45．7％;非中药组中位总生存期为17．195个月。1、3、5年生存率分别为63．9％、26．9％、21．9％。对未手术或术后复发转移的晚期胃癌分层研究,Cox多因素回归分析示,中药治疗和化疗是影响老年晚期胃癌患者总生存期独立的保护性因素（P〈0．01）,服用中药的相对危险度为0．421,95％可信区间在0．255～0．693;晚期中药组（36例）中位总生存期为17．819个月,晚期非中药组（60例）中位生存期为8．548个月。对临床病理分期为Ib—IV（T4N1-3M0、T1—3N3M0）接受根治性手术（R0）且接受3个及以上周期术后辅助化疗病例的分层研究结果显示,术后中药组和术后非中药组的无病生存期和总生存期均未达到中位数,故未作Cox多因素回归分析;术后中药组（33例）1、3、5年无病生存率分别为97．0％、59．9％、50．4％,1、3、5年生存率分别为100．0％、74．1％、61．49／6;术后非中药组（69例）1、3、5年无病生存率分别为82．6％、51．1％、51．1％,1、3、5年生存率分别为86．9％、55．6％、55．6％。结论：以健脾为基础的中药复方辨证治疗可改善老年胃癌的总体预后,是老年晚期胃癌预后的有效保护性因子,对老年根治性胃癌术后无病生存期和总生存期的影响需要继续随访评价。     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.