TP和MVP方案治疗非小细胞肺癌72例临床分析

目的评价MVP（MMC＋VDS＋PDD）与TP（Paelilaxel＋PDD）2种化疗方案治疗中晚非小细胞肺癌的疗效。方法72例中晚期非小细胞肺癌患者分为2组，MVP组37例，MMC（丝裂霉索）6—8mg／m^2，静脉推注，d1；Vindesine（长春地辛）2｀3mg／m^2，静脉滴注。d1，d8；PDD70～80mg／m^2，静脉滴注，d1。TP组35例，Paclitaxel（紫杉醇）170～180mg／m^2，静脉滴注。d1；PDD70—80mg／m^2。静脉滴注，d1。每3—4周为1周期，连用2～3周期。结果MVP及TP组有效率分别为27．0％与42．9％。主要不良反应MVP组为骨髓抑制及恶心、呕吐；TP组为骨髓抑制、恶心呕吐及脱发。结论MVP及TP化疗方案在治疗中晚期非小细胞肺癌的有效率统计学上无显著差异，毒性可耐受。     

紫杉醇联合氟尿嘧啶和顺铂方案治疗晚期胃癌

目的 观察紫杉醇联合氟尿嘧啶及顺铂（PFC）方案治疗1晚期胃癌的临床疗效和毒副反应。方法 晚期胃癌患者20例，给予紫杉醇（PTX）65mg／m^2，静滴4h，第1，8天给药；氟尿嘧啶（5-FU）500mg／m^2，静滴6h，第1～5天；顺铂（CDDP）20mg／m^2，静滴，第1～5天，21d为1周期，至少2个周期后评价疗效和毒副反应。结果 全组20例均可评价疗效，获得CR2例，PR10例，SD5例，PD3例，近期客观有效率60．0％，中位TTP为7．5个月。主要毒副反应为骨髓抑制、恶心呕吐和脱发。结论 PFC方案治疗晚期胃癌疗效较高，毒副反应轻，多数患者耐受良好，值得临床推广运用。     

紫杉醇、氟尿嘧啶、顺铂联合治疗晚期胃癌26例

目的观察紫杉醇、氟尿嘧啶及顺铂（PFC）方案治疗晚期胃癌的临床疗效和毒副作用。方法晚期胃癌患者26例,给予紫杉醇（PTX）65mg／m^2,静滴4小时,第1、8天给药;氟尿嘧啶（5-FU）600mg／m^2,静滴6小时,第1～5天;顺铂（CDDP）20mg／m^2,静滴,第1～5天,21天为1周期,至少2个周期后评价疗效和毒副作用。结果全组26例均可评价疗效,获得PR11例,SD11例,PD4例,近期客观有效率42．31％,中位TTP为7．5个月。主要毒副作用为骨髓抑制、恶心、呕吐和脱发。结论PFC方案治疗晚期胃癌疗效较高,毒副作用轻,多数患者耐受良好,值得临床推广运用。     

NF方案与PF方案治疗中晚期食管癌的临床观察

目的主要观察奈达铂（NDP）＋氟尿嘧啶（5-Fu）方案及顺铂（DDP）＋氟尿嘧啶（5-Fu）方案治疗中晚期食管癌的近期疗效和毒副作用。方法追踪观察：我院观察2005年3月至2006年2月46例患者分为AB组。A组NF：NDP／5-Fu60—100mg／m^2，静滴，第1天。5-Fu：500—750mg／m^2，静滴，第1—5天。每28天为1周期，2—3周期为1疗程。B组PF：DDP／5-Fu方案：DDP60—100mg／m^2，静滴，第1天。5-FuS00—750mg／m^2，静滴，第1—5天。每28天为1周期，2—3周期为1疗程。结果以化疗后复查食管照影肿瘤缩小程度，作为评价标准，可评价疗效46例，NDP／5-Fu方案治疗23例，有效率为50．9％（14，23）；DDP／5-Fu方案治疗23例，有效率为48．0％（13，23），两组有效率无统计学差异（P〉0．05）。胃肠道反应、骨髓抑制等毒副反应A组较B组明显为轻（P〉0．05）。结论奈达铂是治疗食管癌的有效药物，联合氟尿嘧啶与DDP／5-Fu方案疗效接近，但胃肠道反应、骨髓抑制A组较B组轻。     

健择或并卡铂治疗老年中晚期非小细胞肺癌效果比较

①目的比较健择或并卡铂治疗老年中晚期非小细胞肺癌（NSCLC）临床疗效与不良反应。②方法将54例老年中晚期非小细胞肺癌病人随机分为两组。单药组32例,采用健择1000mg／m^2静脉点滴,第1、8天;联合化疗组22例,采用健择1000mg／m^2静脉点滴,第1、8天,加卡铂300mg／m^2静脉点滴,第2天。完成2个周期以上治疗的病人按WHO标准进行临床疗效及不良反应评估。③结果单药组有效率为25.0％（8／32）,联合化疗组为54．5％（12／22）,两组比较差异有显著性（χ^2=4．88,P〈0．05）;联合化疗组不良反应率较单药组高（χ^2=23．182～32．616,P〈0．01）,主要毒性反应为骨髓抑制。④结论单药健择不良反应轻,能有效提高老年病人生存质量及用药安全性。     

紫杉醇联合顺铂治疗晚期胃癌临床观察

目的：评价紫杉醇联合顺铂治疗晚期胃癌的有效性和安全性。方法：采用紫杉醇175mg／m^2静滴3小时,第1天,顺铂20mg/m^2静滴,第1～5天。21天为1个周期,连用2个周期后评价疗效。结果：29例中,完全缓解4例（13．8％）,部分缓解11例（37．9％）,稳定10例（34．5％）,进展4例（13．8％）。总有效率1．7％。不良反应主要为恶心呕吐,腹泻、脱发等。结论：紫杉醇联合顺铂治疗晚期胃癌疗效较高,安全性好。     

PFC方案治疗48例进展期胃癌的临床疗效观察

目的：评价以紫杉醇(paclitaxel)为主的、联合5-氟脲嘧啶(5-Fu)及顾铂(CDDP)的治疗方案(简称PFC方案)对进展期胃癌进行近期疗效与不良反应的观察。方法：病理确诊的进展期胃癌患者48例，采用紫杉醇35～50mg／m^2静滴3h，第1、8、15天；5-FU750mg／m^2持续静滴，第1～5天；CDDP20mg／m^2，静滴，第1～5天。每4周为1周期，至少2周期评价疗效。结果：全组患者均可评价疗效。其中完全缓解(CR)4例(8．3％)，部分缓解(PR)24例(50．O％)，稳定(SD)15例(31．3％)，进展(PD)5例(10．4％)；全组总有效率(ORR)为58．3％；其中低剂量组(紫杉醇35mg／m^2)有效率40％(8／20)，无CR病例。高剂量组(紫杉醇50mg／m^2)有效率71．4％(20／28)，CR4例，二者差异有显著性(P=0．04)；初治组有效率61.5％(16／26)，复治组有效率54．5％(12／22)，二者差异无显著性。主要的毒副反应为骨髓抑制、恶心／呕吐和脱发。结论：PFC是治疗进展期胃癌活性较高的方案，毒副反应轻，如患者全身情况允许，可选用高剂量组方案。     

国产吉西他滨联合卡铂治疗复发性乳腺癌的临床研究

目的观察国产吉西他滨联合卡铂治疗复发性乳腺癌的疗效和毒性。方法吉西他滨1200mg／m2，用生理盐水稀释后静脉滴注30min，第1天，第8天；卡铂350mg/m^2，加入5％葡萄糖500ml中静脉滴注2h，第2天；21d为1个周期。结果40例人选患者中，完全缓解1例（2．5％），部分缓解16例（40．0％），稳定15例（37．5％），进展8例（20．0％），总有效率为42．5％；中位疾病进展时间4．8个月（1～15个月）；1年生存率47．5％。最常见的毒副反应为恶心、呕吐．骨髓抑制和皮疹。结论吉西他滨联合卡铂治疗复发性乳腺癌，有效率较高，毒副反应可耐受，值得在临床推广使用。     

香菇多糖联合吉西他滨与顺铂治疗非小细胞肺癌效果

目的探讨应用香菇多糖联合吉西他滨与顺铂治疗晚期非小细胞肺癌（NSCLC）的效果。方法对98例经病理或细胞学检查证实的晚期NSCLC的初治病人给予联合化疗,随机分为香菇多糖、吉西他滨和顺铂（GPL）组与吉西他滨和顺铂（GP）组。GP组吉西他滨1000mg／m^2静脉注射,第1、8天,顺铂25mg／m^2加入生理盐水250mL中静滴,第1～3天;21d为1个周期,每例治疗不超过6个周期。GPL组在GP组治疗的基础上,将香菇多糖1mg加入50g／L的葡萄糖注射液250mL中静滴,每周2次,连用8周,并比较两组疗效。结果两组有效率、1年生存率、中位生存期比较差异无显著性。最常见的毒副作用为恶心呕吐,GPL和GP组的Ⅲ＋Ⅳ度反应发生率分别为4．08％和55．10％,两组比较差异有显著性（χ^2=30．620,P〈0．05）;其余毒副作用轻微,可耐受。结论香菇多糖联合吉西他滨与顺铂治疗晚期NSCLC与单纯化疗相比疗效相似,而毒副作用轻,安全可行,值得临床推广应用。     

奥沙利铂联合亚叶酸钙和5氟尿嘧啶治疗晚期胃癌的疗效观察

目的 观察奥沙利铂联合亚叶酸钙和5氟尿嘧啶治疗晚期胃癌的疗效和毒副反应。方法 奥沙利铂100mg／m^2，静脉滴注2h，第1天；亚叶酸钙200mg／m^2，静滴2h，第1～5天；5氟尿嘧啶500mg／m^2，静滴4h第1～5天。21d为1周期，行3周期治疗后判定疗效。结果 入组病例27例，完全缓解（CR）2例，部分缓解（PR）9例，病情稳定（SD）12例，病情进展（PD）4例，总有效率（0RR）40．7％（11／27），中位总生存期10个月。不良反应为骨髓抑制、恶心、呕吐、腹泻、外周感觉神经毒性、黏膜炎、静脉炎等。以骨髓抑制、感觉性神经毒性为主，其中白细胞减少占59．3％，血小板减少占29．6％，外周感觉神经异常70．4％。毒副反应Ⅰ度和Ⅱ度较多，Ⅲ度以上较少，无化疗相关死亡。结论奥沙利铂联合亚叶酸钙和5-氟尿嘧啶治疗晚期胃癌疗效肯定，毒副反应能耐爱，值得进一步试用。     

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.     

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.