扶正养阴方辅助高强度聚焦超声治疗兔肝VX2肿瘤的实验研究

目的探讨扶正养阴方联用高强度聚焦超声（HIFU）治疗兔肝VX2肿瘤的治疗效果。方法30只兔肝VX2肿瘤模型随机分为HIFU组（HIFU照射）、联用组（HIFU照射＋扶正养阴方）和对照组（不予任何治疗），每组10只，治疗后监测肿瘤体积、丙氨酸氨基转移酶（ALT），脏器转移及组织病理学改变等。结果HIFU组与联用组的肿瘤体积较对照组缩小，差异有统计学意义（P〈0．05），但HIFU组与联用组差异无统计学意义。治疗后28d，联用组和HIFU组的ALT低于对照组（P〈0．05）且联用组降低更明显（P〈0．01）。联用组未发生肺转移，HIFU组有2只发生肺转移，对照组全部发生肺转移。超声和病理检查均提示HIFU治疗后肿瘤组织变性坏死。结论扶正养阴方联用HIFU能有效地抑制兔肝VX2肿瘤的生长，可为HIFU联用中药治疗肝癌的临床研究提供实验依据。     

乳腺癌高强度聚焦超声消融后残留肿瘤增殖能力的变化

目的探讨兔乳腺种植瘤经高强度聚焦超声（HIFU）消融后残留肿瘤增殖能力的变化。方法兔鳞癌细胞株VX2肿瘤组织块接种于新西兰兔乳腺,建立兔乳腺种植瘤模型,2周后行HIFU治疗,通过控制探针侧温度,造成肿瘤残留。56只兔子随机分为对照组（n=16）和HIFU组（n=40）,经电子显微镜和琥珀酸脱氢酶（SDH）组织化学染色检查确认消融效果和残留肿瘤组织消融后不同时间点检测增殖细胞核抗原（PCNA）的表达情况,同时观察动物生存时间和肿瘤脏器转移的情况。结果HIFU组消融后,残留肿瘤的PCNA表达呈一过性降低,21d后恢复至消融前水平。HIFU组的生存时间明显长于对照组,而肺部及腹腔脏器出现转移的时间明显晚于对照组（P〈0．05）。结论即使HIFU未能一次完全消融肿瘤,在短时间内也能有效抑制残留肿瘤的生长和转移,延长机体的生存时间。     

超声造影在高强度聚焦超声治疗子宫肌瘤中的应用

目的探讨超声造影在高强度聚焦超声（HIFU）治疗子宫肌瘤中的应用价值。方法选择经临床、超声检查诊断为子宫肌瘤,不愿接受手术治疗的已生育患者30例,在二维超声定位及实时监控下应用HIFU进行治疗。于HIFU治疗前1周、治疗2次、1、3及6个月后采用常规二维超声、彩色多普勒超声及超声造影观察肌瘤大小、内部回声、血流变化及超声造影图像改变。结果 HIFU治疗后3个月及6个月,30个子宫肌瘤体积逐渐缩小,所有瘤体内部回声增强、彩色血流均消失。超声造影显示26个腺肌瘤内造影剂持续无灌注,4个瘤体内部呈网格状及星点状少许灌注。结论超声造影是HIFU治疗子宫肌瘤疗效评价的有效方法。     

扶正养阴方联用高强度聚焦超声对VX2兔体液免疫功能的影响

目的:观察扶正养阴方与高强度聚焦超声(HIFU)联用对肝移植性鳞癌(VX2)兔体液免疫功能的影响。方法:30只VX2兔于肿瘤移植后2周随机分为联用组10只、HIFU组10只、对照组10只,分别接受HIFU+扶正养阴方治疗,HIFU照射和假照射治疗,治疗后观察1个月,检测各组体液免疫球蛋白变化。结果:治疗后第1天对照组免疫球蛋白无明显变化,联用组与HIFU组下降显著,治疗后第7,14,28天对照组免疫球蛋白呈下降趋势,联用组与HIFU组免疫球蛋白不同程度升高。结论:HIFU可提高荷瘤兔的体液免疫,联用扶正养阴方可促进肿瘤负荷机体免疫功能的早期恢复并改善机体免疫力,减少免疫功能紊乱引起的不良反应。     

乳腺癌高强度聚焦超声消融后残留肿瘤增殖能力的变化

目的 探讨兔乳腺种植瘤经高强度聚焦超声(HIFU)消融后残留肿瘤增殖能力的变化.方法 兔鳞癌细胞株VX＿2肿瘤组织块接种于新西兰兔乳腺,建立兔乳腺种植瘤模型,2周后行HIFU治疗,通过控制探针侧温度,造成肿瘤残留.56只兔子随机分为对照组(n=16)和HIFU组(n=40),经电子显微镜和琥珀酸脱氢酶(SDH)组织化学染色检查确认消融效果和残留肿瘤组织消融后不同时间点检测增殖细胞核抗原(PCNA)的表达情况,同时观察动物生存时间和肿瘤脏器转移的情况.结果 HIFU组消融后,残留肿瘤的PCNA表达呈-过性降低,21 d后恢复至消融前水平.HIFU组的生存时间明显长于对照组,而肺部及腹腔脏器出现转移的时间明显晚于对照组(P<0.05).结论 即使HIFU未能一次完全消融肿瘤,在短时间内也能有效抑制残留肿瘤的生长和转移,延长机体的生存时间.     

高强度聚焦超声治疗非手术胰腺癌近期疗效评价及生存分析

目的 探讨高强度聚焦超声（high intensity focused ultrasound, HIFU）治疗非手术胰腺癌近期疗效及生存情况。方法 筛选符合入组条件的非手术胰腺癌患者30例（3例患者共接受2次HIFU治疗，共计33例次），记录患者HIFU治疗前1周和治疗后1个月肿瘤标志物CA19-9和靶病灶影像学变化，对患者进行生存随访。结果 HIFU治疗后，靶病灶最大直径为（4.8±1.54）cm，与治疗前最大直径（4.67±1.50）cm相比，差异无统计学意义（P=0.328）；胰腺超声造影检查提示靶病灶区血供减少，CT增强检查示靶病灶区内密度降低，MRI增强检查示T1WI信号增加，T2WI信号降低；57.7%患者血清CA19-9降低。30例患者中位生存期10.4个月（95%CI： 7.93～12.8），6、12个月生存率分别为66.7%和20%。结论 HIFU治疗能够有效抑制肿瘤生长，减轻肿瘤负荷，延长胰腺癌患者的生存期，且不良反应少，是非手术胰腺癌患者的治疗方法之一。     

高强度聚焦超声治疗兔移植性乳腺肿瘤的安全性评价

目的 :评价高强度聚焦超声 (HighIntensityFocusedUltrasound ,HIFU)治疗兔乳腺移植性肿瘤的安全性。方法 :4 0只兔乳腺移植性肿瘤于肿瘤移植后 11天随机分为治疗组 2 0只 ,手术组 10只 ,对照组 10只。治疗组接受HIFU覆盖治疗 ,手术组接受常规手术切除局部肿瘤 ,对照组接受假照治疗。采集辐照前后声像图进行对比性观察 ,于HIFU辐照后即刻切取肿瘤作肉眼观察 ,观察肿瘤的转移情况。HIFU辐照前后查肝功、生化及肾功 ,观察其变化。结果 :HIFU辐照前肿瘤声像图呈低回声团块 ,辐照后肿瘤声像图呈明显强回声。HIFU辐照前肿瘤切面呈粉红色 ,辐照后肿瘤呈白色凝固性损伤灶 ;治疗组和手术组的肿瘤转移率分别为 2 0 %和 30 % ,无显著性差异 (P >0 .0 5 ) ,均明显低于对照组 (10 0 % ,P <0 .0 5 )。HIFU辐照后治疗组动物的肝功、血生化及肾功与辐照前相比 ,以及手术组和对照组比较 ,差异无显著性 (P >0 .0 5 )。结论 :在B超实时监控下 ,HIFU准确有效地杀灭乳腺肿瘤 ,不增加肿瘤转移的危险性 ,对动物的肝功、血生化及肾功无影响。因此 ,HIFU治疗系统治疗是安全的。     

高强度聚焦超声治疗兔乳腺移植瘤的病理变化

目的:观察兔乳腺移植瘤经高强度聚焦超声(High intensity focused ultrasound,HIFU)治疗后的病理变化.方法:42只实验兔随机分成HIFU组(n=35)、对照组(n=7),HIFU组在B超监控下接受HIFU治疗,辐照后采集标本行病理检查.结果:HIFU辐照后靶区呈灰白色;即刻HE染色显示肿瘤细胞形态、排列与对照组无明显变化;电镜显示细胞膜、核膜断裂,细胞器破坏,胞质内出现无膜结构大小不等的空泡;琥珀酸脱氢酶(Succinate dehydrogenase,SDH)、增殖细胞核抗原(Proliferating cell nuclear antigen,PCNA)阴性表达,提示肿瘤细胞已死亡;随着时间的延长坏死肿瘤组织逐渐液化吸收,纤维化.结论:HIFU能有效地灭活肿瘤细胞,为HIFU开展治疗乳腺癌的临床应用提供参考价值.     

阴式彩色多普勒对高强度聚焦超声治疗子宫肌瘤随访观察

目的：运用阴式彩色多普勒（CDFI）观察高强度聚焦超声（HIFU）治疗子宫肌瘤的疗效。方法：78例临床确诊的子宫肌瘤患者行HIFU治疗后,应用阴式彩色多普勒超声在术后1、3、6和12个月进行随访观察,比较治疗前后瘤体大小、回声、血流动力学的变化。结果：78例子宫肌瘤HIFU治疗后1～12个月CD—FI复查,治疗后1个月肌瘤出现缩小,治疗后3个月瘤体明显缩小,与治疗前相比有显著差异。结论：HIFU治疗子宫肌瘤明确有效,阴式彩色多普勒超声可用于HIFU疗效的观察     

高强度聚焦超声联合中药扶正消瘤方治疗子宫肌瘤的研究

目的 评价高强度聚焦超声(HIFU)联合中药扶正消瘤方治疗子宫肌瘤的临床疗效.方法 110例子宫肌瘤患者191个病灶采取HIFU联合中药扶正消瘤方治疗3个月,通过经阴道彩超观察比较治疗前后子宫肌瘤回声、体积及血流灌注的改变情况,进行统计学相关分析.结果 子宫肌瘤患者经HIFU联合中药扶正消瘤方治疗前后,肌瘤内部回声发生明显变化,靶区内出现不均质高回声增强区域,术后3个月还可出现液化坏死或钙化高回声;治疗后肌瘤体积明显变小,肌瘤周边滋养血管的搏动指数(PI)、阻力指数(RI)明显增加,Adler半定量血流分级显示血流灌注明显减少,差异有统计学意义(P＜0.05).结论 HIFU联合中药扶正消瘤方治疗子宫肌瘤可导致肿瘤大小和血流参数发生明显变化,经阴道彩超可以无创性动态评价其疗效.     

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.     

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.     

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.