脊柱转移性肿瘤外科治疗生存质量分析

【目的】对脊柱转移性肿瘤患者手术前后的生存质量指标进行评估，评价外科治疗的价值。【方法】23例患者，男性12例，女性11例，平均年龄60岁。对接受手术治疗的23例脊柱转移性肿瘤患者手术前后的疼痛程度、食欲、睡眠、不良情绪、体力状况以及神经脊髓功能等指标进行前瞻性观察、比较和综合评价。【结果】颈椎转移瘤3例，胸椎转移瘤12例，腰椎转移瘤8例。除1例术后出现肺功能衰竭死亡，其余患者无其他严重围手术期并发症。患者术后2周、1个月、3个月的疼痛程度、食欲、睡眠质量、不良情绪、神经功能等均较术前明显改善，以疼痛改善最为显著，体力状况也于术后1个月、3个月较术前改善。术后患者平均生存期8．7个月，术后1年存活率为27％。【结论】外科治疗能显著改善脊柱转移性肿瘤患者的生存质量。对于能够耐受手术、估计生存期超过3个月的脊柱转移性肿瘤患者，转移瘤椎体切除重建的外科干预是值得推荐的治疗手段。     

脊柱转移性肿瘤的手术切除与脊柱稳定性重建

目的：观察脊柱转移性肿瘤的手术切除和脊柱稳定性重建的外科疗效。方法：对29例脊柱转移性肿瘤患者进行脊椎肿瘤切除减压．单纯植骨或钛网、人工椎体植骨加椎弓根钉棒或钢板螺钉内固定．一期重建脊柱稳定性，术后根据病理结果均给予化疗、放疗和激素等综合治疗。观察术后局部疼痛缓解，脊髓神经功能恢复及脊柱椎节的稳定性情况。结果：随访6个月～62个月，平均26个月。所有病人术后局部疼痛缓解．脊髓神经功能无加重损伤，其中12例患者脊髓神经功能得到不同程度恢复。术后影像学检查提示：脊柱内固定物在位．椎体序列恢复良好，椎间高度恢复。结论：脊柱转移性肿瘤的手术切除和脊柱稳定性重建的外科疗效肯定，适应征具备者应积极手术治疗。     

椎体成形术结合后路短节段椎弓根固定治疗16例胸、腰椎转移性肿瘤

目的探讨后路短节段椎弓根钉棒系统结合瘤椎内骨水泥填充,治疗胸、腰椎转移性肿瘤的临床疗效。方法对2007年7月至2011年3月山东省济宁市第一人民医院脊柱外科收治的伴神经症状的16例胸、腰椎转移性肿瘤患者,施行后路椎管减压、瘤椎骨水泥填充、联合短节段椎弓根钉棒固定治疗。观察术后患者疼痛缓解、神经功能恢复情况及生存时间。结果围术期无死亡,切口均I期愈合,未发生感染或裂开。术后生存期均超过3个月,平均8.6个月(4.5～14.0个月)。术后患者疼痛程度、神经功能均有改善。结论椎体成形术结合后路短节段椎弓根固定治疗胸、腰椎转移性肿瘤安全、创伤小,能有效缓解患者疼痛,重建并维持脊柱稳定性,提高患者生存质量。     

Tomita评分系统在脊柱转移瘤中的应用及评价

目的：探讨Tomita预后评分法对脊柱转移瘤的临床应用价值。方法：对49例脊柱转移瘤应用Tomita预后评分法进行评估,根据评分结果选择治疗方法。结果：有43例获得随访,随访4～27个月,1例4个月后发现内固定物松动,1例术后10d死亡。手术组疼痛缓解平均2．6分。脊髓及神经根损害术后均改善。结论：原发肿瘤性质及重要脏器转移情况影响患者预后。Tomita预后评分法可有效判断预后,指导制定治疗方案。对于单发、生存期较长的脊柱转移瘤采取积极手术治疗,可取得较满意的疗效。     

脊柱转移性肿瘤患者手术护理干预

目的:探讨脊柱转移性肿瘤患者手术护理干预措施及效果。方法:选取我院2009年1月~2010年12月进行手术治疗的26例脊柱转移性肿瘤患者为观察对象,分析围手术期间的护理实施过程与效果,指导临床对脊柱转移性肿瘤疾病的手术护理实践。结果:26例脊柱转移性肿瘤患者经手术治疗与综合护理,患者术后安返病房,20例疼痛完全缓解,5例部分缓解,1例无明显缓解,术后发生1例切口感染,1例单侧下肢温热感,术后3个月随访观察中神经功能均没有恶化,存活23例,存活率达88.46%。结论:脊柱转移性肿瘤患者手术复杂,难度较大,进行综合全面的护理干预措施可以保障手术完整性和成功性,显著改善手术患者的预后,减轻症状,提高生存质量。     

脊柱恶性肿瘤的综合治疗策略临床分析

目的 探讨脊柱恶性肿瘤综合治疗策略的临床意义及预后.方法 2003年1月～2008年12月收治脊柱原发恶性肿瘤及原发病灶隐匿的转移瘤患者25例,对其临床特点、术前穿刺取病理活检、术前半程放疗、手术方式、术后放化疗等综合治疗策略及预后进行分析.观察随访手术时间、术中出血量、局部疼痛和脊髓功能的恢复情况,以及肿瘤的复发、植骨融合、脊柱稳定性情况.结果 25例患者均顺利完成手术,手术时间120～300min,术中出血500～3200ml,平均1500ml.术后随访6个月～5年,所有患者近期疗效满意,局部疼痛及神经系统症状均有不同程度的缓解或改善.末次随访存活病例植骨融合良好,无内固定松动、移位、断裂及脊柱失稳情况,无局部复发.术后6个月、1、2、3、4年的生存率分别为100%,96.00%,84.00%,76.00%,68.20%.结论 对于脊柱原发恶性肿瘤及原发病灶隐匿的转移瘤进行合理有效、及时的综合治疗,能够稳定和重建脊柱,减轻或缓解疼痛,维持或改善神经功能,从而改善患者的生活质量,延长生存期.     

手术/非手术治疗对脊柱转移性肿瘤患者长期心理状况的影响及疼痛控制效果

目的对比研究手术/非手术治疗对脊柱转移性肿瘤患者长期心理状况的影响及疼痛控制效果。方法采用Zung焦虑自评量表、Zung抑郁自评量表和数字疼痛分级法对脊柱转移性肿瘤确诊患者(手术组和非手术组)分别于确诊时及术后(确诊后)第1、3、6、9个月进行了5次焦虑、抑郁和疼痛测评,对比分析手术治疗及非手术治疗效果。结果 216例符合条件的脊柱转移性肿瘤患者入选本研究,其中接受脊柱肿瘤手术患者101例,未接受手术患者115例。两组确诊时焦虑、抑郁状态和疼痛程度的差异无统计学意义。从术后(确诊后)3个月开始到术后9个月,两组患者焦虑、抑郁状态均有所缓解,手术组患者焦虑、抑郁评分均低于非手术组,差异具有统计学意义(P=0.000)。手术组患者疼痛评分在9个月内降至(1.2±0.9)分,非手术组评分降至(6.4±2.0)分,手术组患者术后4次疼痛程度评分低于非手术组(P=0.000)。结论手术治疗缓解脊柱转移性肿瘤患者焦虑、抑郁状态及控制疼痛效果均优于非手术治疗。     

脊柱转移瘤的外科治疗

目的探讨脊柱转移瘤的外科治疗价值。方法选择３１例严重疼痛或／和合并神经功能障碍的脊柱转移瘤患者,以不同的手术方法治疗。结果除４例仍在随访中,所有病例存活３月～７年,平均存活１７．６月,治疗期间无任何并发症的发生,疼痛症状及神经功能亦有不同程度的恢复。结论脊柱转移瘤应谨慎选择外科治疗,当患者合并严重的疼痛或／和神经功能受损害经非手术治疗无效时,应考虑手术治疗减压、内固定,手术可改善患者的症状和神经功能,提高患者的生活质量。     

股骨干转移瘤手术治疗

骨组织是癌症转移的好发器官，仅次于肺脏和肝脏；在转移性骨肿瘤中，股骨发病率仅次于脊柱和骨盆。骨转移所引起的疼痛、活动障碍及病理性骨折严重影响患者的生活质量，给患者带来极大痛苦。股骨是人体最重要的承重骨，当股骨发生转移性肿瘤时，更易发生病理性骨折。随着转移瘤保肢手术的开展，给予此类患者手术固定治疗，日益被患者及其家属接受。我院自2001年2月-2008年4月治疗股骨干转移瘤12例，对于提高患者生活质量、延长生存期取得比较满意的效果。     

射频消融术治疗脊柱转移肿瘤患者的疗效观察及分析

目的:探讨射频消融术(RFA)治疗脊柱转移肿瘤患者的临床疗效。方法:选择脊柱转移肿瘤患者102例,均采取射频消融术进行治疗,记录比较患者治疗前及治疗后7 d、3个月、6个月及1年后VAS、JOA及Oswestry评分,并对患者术后疼痛缓解情况进行分级评价。结果:术后7 d、3个月、6个月及1年后VAS、JOA及Oswestry脊柱转移肿瘤患者的评分与术前相比均有所改善,差异均有统计学意义(P<0.05);患者术后疼痛缓解程度分级均在80%以上,且各时间点疼痛缓解优良率比较,差异无统计学意义(P>0.05)。结论:射频消融术治疗脊柱转移瘤患者具有良好的止痛效果。     

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.