直肠癌伴脉管癌栓危险因素分析及临床意义

目的 探讨直肠癌发生脉管癌栓的危险因素及脉管癌栓对实施直肠癌根治术患者的预后影响.方法 分析2012年1月至2016年12月该院普外科接受直肠癌根治术的118例直肠癌患者临床、病理及随访资料.患者分为观察组和对照组,采用单、多因素分析发生脉管癌栓的危险因素及脉管癌栓对直肠癌根治术患者的预后影响.结果 单因素分析发现,两组年龄、肿瘤病理组织学类型、肿瘤浸润深度、肿瘤大体类型、淋巴结转移等方面比较差异有统计学意义(P＜0.05).多因素Logistic回归分析发现,淋巴结转移、肿瘤病理组织学类型、肿瘤浸润深度是直肠癌发生脉管癌栓的独立危险因素(P＜0.05).两组1、3、5年累积总体生存率及累积无瘤生存率比较差异均有统计学意义(P＜0.05).结论 淋巴结转移、肿瘤病理组织学类型、肿瘤浸润深度是直肠癌发生脉管癌栓的独立危险因素,脉管癌栓影响直肠癌根治术患者的预后.     

幽门螺杆菌感染对原发性胃癌患者肝脏转移及其生存状况的影响

目的探讨幽门螺杆菌(Hp)感染对原发性胃癌患者肝脏转移及其生存状况的影响。方法选取2012年2月～2013年2月收治的136例原发性胃癌患者为研究对象,其中包括58例存在同时性肝脏转移病灶(转移组),78例患者未发现肝脏转移病灶(非转移组)。制定统一调查表,统计患者临床资料,包括性别、年龄、体重指数(BMI)、肝炎史、肿瘤直径、肿瘤部位、肿瘤分期、病理分化程度、组织学分型、淋巴结转移、浸润深度、脉管浸润、Borrmann分型、血清癌胚抗原(CEA)、甲胎蛋白(AFP)和Hp感染。结果转移组和非转移组的肿瘤直径、肿瘤分期、浸润深度、脉管浸润、淋巴结转移、Borrmann分型、CEA、AFP和Hp感染比较差异有统计学意义(P<0.05或0.01)。Logistic回归分析结果显示,肿瘤直径、肿瘤分期、脉管浸润、CEA、AFP和Hp感染是胃癌患者发生肝脏转移的独立危险因素(P<0.05或0.01)。49例原发性胃癌肝脏转移患者中,Hp感染患者和无Hp感染患者平均生存期时间分别为(14.5±5.2)个月和(28.5±6.2)个月,两组比较差异有统计学意义(P<0.05)。结论肿瘤直径、肿瘤分期、脉管浸润、CEA、AFP和Hp感染与原发性胃癌患者发生肝脏转移密切相关,且Hp感染者预后更差。     

直径≤2 cm胃癌的淋巴结转移与临床病理特征的关系

目的:探讨肿瘤直径≤2 cm胃癌的淋巴结转移状况及其临床病理特征,为制定合理治疗方案提供依据.方法:对手术证实的453例肿瘤直径(最大径)≤2 cm的胃癌的临床病理资料进行回顾性分析,对患者年龄、性别、肿瘤组织学类型、形态学类型、大小、部位、浸润深度、脉管内癌栓等临床病理特征与淋巴结转移的关系进行单因素与多因素分析.结果:453例直径≤2 cm的胃癌中早期胃癌255例、进展期胃癌198例;淋巴结转移率分别为11.8%和46.0%(P=0.000 1);3.5%的早期胃癌与7.6%的进展期胃癌可见脉管内癌栓(P=0.034 1).影响肿瘤直径≤2 cm的胃癌淋巴结转移的主要因素有肿瘤组织学类型、大小、浸润深度与脉管内癌栓等,Logistic回归分析显示肿瘤组织学类型、浸润深度与脉管内癌栓是肿瘤直径≤2 cm的胃癌淋巴结转移的独立危险因素.分层分析显示肿瘤大小、浸润深度与脉管内癌栓是直径≤2 cm的早期胃癌淋巴结转移的危险因素;而肿瘤组织学类型与浸润深度则是直径≤2 cm的进展期胃癌淋巴结转移的危险因素.结论:肿瘤直径≤2 cm的胃癌的淋巴结转移与肿瘤组织学类型、浸润深度及脉管内癌栓等因素有关.临床上应参考上述临床病理因素判断淋巴结转移风险,确定肿瘤直径≤2 cm的胃癌手术方案.     

影响进展期胃癌根治术预后的多因素分析

目的探讨影响进展期胃癌根治术预后的相关危险因素,为临床防治提供参考。方法回顾性分析作者医院2003-07/2007-07月期间收治的152例患者行胃癌根治术的临床资料,对所有患者进行跟踪随访。生存率采用Kaplan-Meier分析法,率的比较采用χ2检验,对有统计意义的单因素进行多因素非条件的logistic回归分析。结果单因素分析结果显示,有无淋巴结转移,TNM分期,肿瘤大小、分化程度、浸润深度、淋巴结清扫范围、术后并发症及大体分型与进展期胃癌根治术的预后相关（P〈0.05）。多因素非条件的logistic回归分析显示,有无淋巴结转移,TNM分期、分化程度、浸润深度和淋巴结清扫范围是影响胃癌根治术后预后的相对独立危险因素（P〈0.05）。结论有无淋巴结转移,TNM分期、分化程度、浸润深度和淋巴结清扫范围是影响胃癌根治术后预后的相对独立危险因素。     

影响胃癌术后患者预后的相关因素分析

目的 探讨影响胃癌患者预后的相关因素.方法 回顾性分析108例行胃癌根治性手术患者的临床和病理资料,采用Kaplan-Meier法和Cox比例风险回归进行分析.结果 单因素分析显示,肿瘤大小、组织学类型、联合脏器切除、肿瘤浸润度、淋巴结转移数、脉管内是否有癌栓、术后有无化疗和TNM分期与预后显著相关,P<0.05.多因素分析显示,肿瘤浸润度、淋巴结转移数量、脉管内癌栓是影响患者预后的独立因素,P<0.05.淋巴结转移数≤15枚者和>15枚者的5年生存率分别为54.2%和27.8%,P=0.005.脉管内无癌栓者和有癌栓者的5年生存率分别为54.5%和31.0%,P=0.023.肿瘤浸润深度＜1/2者和≥1/2者的5年生存率分别为52.1%和32.4%,P=0.044.结论 肿瘤浸润度、淋巴结转移度、脉管内癌栓可以作为评估胃癌患者预后的独立指标.     

120例行根治性手术的胃癌患者预后的多因素分析

目的：探讨影响行根治性手术的胃癌患者预后的多因素分析。方法回顾性分析120例胃癌术后的患者临床资料,以性别、年龄、肿瘤病理组织分型、是否术后辅助化疗、肿瘤大小、肿瘤浸润深度、是否有癌栓、TMN临床分期、淋巴结清扫个数、术前血CEA是否升高为指标,采用单因素和多因素Cox回归法分析胃癌的预后影响因素。结果单因素分析表明,肿瘤大小、癌栓、肿瘤浸润深度、TMN临床分期、术后辅助化疗、术前血CEA升高、淋巴结清扫个数为胃癌预后的影响因素。进一步多因素回归分析表明,术后辅助化疗、术前血CEA升高、淋巴结清扫个数、TNM分期是胃癌的独立预后因素。结论经COX模型分析,术后辅助化疗、术前血CEA升高、淋巴结清扫个数、TNM分期为影响胃癌的独立预后因素。     

影响胃癌患者预后多因素相关性分析

目的:通过分析胃癌患者的临床特征、肿瘤的病理特征及治疗情况,研究影响肿瘤预后的相关因素。方法:收集西安医学院附属医院自2005年1月至2011年1月收治并行手术治疗的胃癌患者为研究对象。结果:术前血红蛋白、肿瘤部位、肿瘤大小、Bormann分型、组织分化类型、浸润深度、淋巴结转移度、pTNM分期、术中清除淋巴结数是影响胃癌预后的相关因素(P<0.05)。而年龄、性别、手术方式、是否化疗对胃癌预后的影响没有统计学意义(P>0.05)。Bormann分型,浸润深度及淋巴结转移度是对胃癌预后的独立风险因素。而术前血红蛋白、术中清除淋巴结数、肿瘤部位、肿瘤大小在单因素分析中与胃癌预后有关,但在最终的多变量模型中未能显示其有统计学意义。结论:术前血红蛋白、肿瘤部位、肿瘤大小、Bormann分型、组织分化类型、浸润深度、淋巴结转移度、pTNM分期、术中清除淋巴结数是影响胃癌预后的相关因素。组织分化类型,Bormann分型,浸润深度及淋巴结转移度是对胃癌预后的独立风险因素。     

227例早期胃癌的临床病理特征及预后分析

目的 分析早期胃癌的临床病理特征与预后之间的关系.方法 回顾性分析1994年1月至2004年12月实施D2根治术且资料完整的227例早期胃癌患者的临床资料,采用Kaplan-Meier法进行生存分析,Log rank检验进行统计学比较,Cox比例风险模型进行多因素分析.结果 227例患者的5年生存率为90.3％.单因素分析显示,肿瘤浸润深度、脉管瘤栓和区域淋巴结转移与患者术后生存率有关;而性别、年龄、肿瘤大小、肿瘤位置、大体类型、分化程度与术后生存率无关.多因素分析显示,区域淋巴结转移是影响预后的独立危险因素.结论 早期胃癌伴有区域淋巴结转移的患者预后差,行根治性手术后应接受综合治疗并严格随访.     

C—erbB-2和nm-23—H1在胃癌组织中的表达及临床意义

目的 本文探讨C-erbB-2 和 nm-23-H1在胃癌组织中的表达及其与病理分型,临床分期,淋巴结转移,肿瘤浸润深度,组织学分级的关系. 方法 采用免疫组化S-P法测定76例胃癌组织石蜡切片中C-erbB-2 和 nm-23-H1蛋白的表达. 结果 C-erbB-2在胃癌组织中的表达与肿瘤浸润深度,组织学分级,淋巴结转移,TNM分期呈正相关,P<0.05,与病理分型无关.nm-23-H1 与淋巴结转移,肿瘤浸润深度,TNM分期呈负相关,P<0.05,与病理分型,组织学分级无关.C-erbB-2 和 nm-23-H1 呈负相关. 结论 C-erbB-2 和 nm-23-H1可以作为判断胃癌生物学行为和预后的一个重要的客观标记物.     

1 126例结肠癌患者的临床病理特征及预后分析

目的 探讨结肠癌患者临床病理特征及其与预后的关系.方法 选择性别、年龄、血型、围手术期输血量、病程、肿瘤部位、肿瘤最大径、肿瘤大体类型、病理分级、组织学类型,转移淋巴结数目、肠壁浸润深度、远处转移、Dukes分期等14项临床病理指标,用单因素和多因素分析的方法研究其对1 126例结肠癌患者预后的影响.结果 单因素分析显示年龄、围手术期输血量、病程、肿瘤部位、肿瘤最大径、肿瘤大体类型、病理分级、组织学类型、转移淋巴结数目、肠壁浸润深度、远处转移、Dukes分期为影响预后的因素,COX回归模型分析显示,仅病理分级、组织学类型、远处转移、Dukes分期为结肠癌患者预后的独立影响因素.结论 病理分级、组织学类型、远处转移、Dukes分期为结肠癌患者预后的独立影响因素.     

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.