通过多元回归分析确定甲状腺癌的诊断程序

为制定甲状腺癌术前、术中诊断的严格程序，减少其误诊误治。选择２７项观察指标，采用Ｓｔａｔａ统计学软件，对所有指标进行Ｌｏｇｉｓｔｉｃ逐步多元回归分析。单因素分析显示，１９项指标在甲状腺良恶疾病的表现中，有显著性差异（Ｐ〈０．０５）；多因素分析表明，结果表明：①术中明确诊断是正常重要的阶段。若发现肿块质地硬、与周围组织粘连、肿瘤数目多于一个，以及肿块是混合性或实质性，应考虑恶性可能：②术前仔细体检及     

甲状腺肿瘤137例临床分析

经手术和病理诊断的甲状腺良、恶性肿瘤１３７例中，男２２例，女１１５例，男：女为１：５．２．年龄１０～７５岁，平均年龄４２．５岁。术前诊断甲状腺腺瘤１２３例，甲状腺癌８例，甲状腺囊肿６例。１３７例全部采取手术治疗，其中甲状腺腺瘤摘除术１０９例，甲状腺大部分切除术１０例，甲状腺部分切除术８例，甲状腺腺叶切除术２例，甲状腺癌根治术８例。术后病理诊断：甲状腺腺瘤１１２例（８１．７５％），甲状腺癌２５例（１８．２５％）。提示甲状腺肿瘤术前明确诊断，术中行甲状腺、周围组织及淋巴结的探查，对怀疑有恶变趋向者行冰冻切片检查，可进一步明确肿瘤性质，对其采取一次性根治性手术有重要意义。     

甲状腺滤泡性良恶性病变细胞核形态定量分析

采用图像分析技术对２０例滤泡性甲状腺癌，１０例滤泡性甲状腺瘤及１０例结节性甲状腺肿标本进行了细胞核形态定量分析，结果表明甲状腺滤泡癌细胞核面积、直径及周长均大于甲状腺良性病变细胞核的相应参数值（Ｐ＜０．０５），但圆度改变不显著（Ｐ＞０．０５）。提示甲状腺良恶性病变细胞核大小改变存在着显著差异，作为辅助指标在滤泡性甲状腺良恶性病变的鉴别诊断中有着重要意义。     

^99mTc—MIBI显像对甲状腺癌术后复发、颈淋巴结转移的定性诊断价值

为探讨^99m锝－甲氧基异丁基异腈（^99mTc-MIBI)显像对颈部肿块的鉴别诊断价值,对对照组17例,甲状腺癌术后组23例,甲状腺腺瘤组21例,甲状腺癌未手术组3例,不明原发灶的颈部恶性肿瘤组2例,行^99mTc-MIBI显像,共检测肿块64个,53个与病理对照。结果显示：观察法诊断良、恶性肿块的灵敏度为90．3％,特异度为78．8％,正确指数0．70;甲状腺癌术后组12个良性肿块无假阳性,仅3个小于0．5cm淋巴结转移灶未检出,甲状腺瘤7个肿块假阳性。RI值法灵敏度58．1％,特异度54．5％,正确指数0．13。研究表明：观察法优于RI值法：^99mTc-MIBI显像对颈部肿瘤具有一定的定性诊断价值,尤其是对明确的甲状腺癌术后病例,甲状腺内复发肿块或颈部肿大的淋巴结^99mTcO4^-显像未显示,而^99mTc-MIBI显像阳性者应高度警惕恶性病变。     

血清肿瘤特异性生长因子检测对甲状腺癌的诊断价值

目曲：探讨肿瘤特异性生长因子（tumor specific growth factor,TSGF）在甲状腺癌诊断中的应用价值。方法：以甲状腺癌患者为肿瘤组,以甲状腺良性肿瘤患者作为对照组,测定甲状腺癌患者血清中肿瘤特异性生长因子含量。结果：甲状腺癌患者血清中的肿瘤特异性生长因子含量明显高于甲状腺良性肿瘤患者（P〈0．05）。结论：血清肿瘤特异性生长因子检测是鉴别甲状腺良恶性肿瘤的可靠指标,对甲状腺癌的诊断有一定的临床价值。     

甲状腺良恶性结节临床鉴别方法分析

目的：探讨甲关腺结节的临床特征及术前辅助检查对判断结节良恶性的作用。方法：对1369例甲状腺良性结节和97例甲状腺癌的结节之临床特征进行相关性分析,并统计分析甲状腺核素扫描和甲状腺B超结果。结果：甲状腺结节患者之年龄,性别与甲状腺癌无明显关系（P＝0．3702）;甲状腺结节数目与甲状腺癌亦无明显关系（P＝0．2138）;甲状腺结节直径则与甲状腺癌有密切关系,结节大者恶性可能性大（P＝0．01356）;甲状腺结节质地也与甲状腺癌有关,结节质地坚硬者恶性可能大,甲状腺核素扫描发现之“冷结节”与甲状腺癌无明显关系（P＝0．1813）;甲状腺B超检查结果对提高甲状腺癌检出率无帮助。结论：除应积极提高细针刺刺（FNA）的细胞诊断学和穿刺术水平外,仍应重视甲状腺结节患者的临床资料。对于年龄较轻,甲状腺结节直径大于1cm且质地较硬的患者,不论其结节数目多少均宜尽早手术,对于直径小于1cm的患者,提倡B超检查随访,必要时B超引导下细针穿刺活检以排除甲状腺微小癌。     

甲状腺癌患者血清中SIL—2R测定的临床意义

测定５９例甲状腺良、恶生疾病患者血清中可溶性白介素人受体（ＳＩＬ－２Ｒ）。结果显示：甲朱癌患者血清中ＳＩＬ－２Ｒ明显高于良性疾病组及对照组（Ｐ〈０．０１）。良性腺瘤及结节性甲状腺肿与对照组间无明显差异（Ｐ〉０．０５）。甲状腺癌术后５～１０天血清中ＳＩＬ－２Ｒ较术前增高,可能与术前血清中ＳＩＬ－２Ｒ高水平及干扰机体免疫有关。术后约２０天基本降至正常。甲状腺癌血清中ＳＩＬ－２Ｒ升高与甲状腺 的病理类型     

甲状腺结节的鉴别诊断

甲状腺结节分单发性与多发性,甲状腺单结节经检查发现为癌肿者明显高于甲状腺多结节,区别结节的良、恶性有重要意义。 一、常见病因 主要包括：（１）甲状腺腺瘤;（２）结节性甲状腺肿;（３）甲状腺囊肿;（４）甲状腺炎：亚急性甲状腺炎、慢性淋巴细胞性甲状腺炎：（５）甲状腺癌：乳头状癌、滤泡细胞癌、未分化癌和髓样癌等;（６）甲状腺转移癌。 二、诊断方法 病史对甲状腺结节的鉴别诊断起着重要作用。询问病史时要注意甲状腺结节癌变的易患因素。体检应注意甲状腺结节的大小、质地、单结节或多结节、有无压痛、能否活动、与周围组…     

核仁组织区嗜银颗粒对乳腺及甲状腺病变诊断价值的研究

目的 探讨核仁组成区嗜银颗粒（ＡｇＮＯＲ）的计数和异形颗粒分析对区别良恶性病变的诊断意义。方法 采用针吸细胞技术对乳腺及甲状腺病变穿刺标本进行ＡｇＮＯＲ定量和形态分析。结果 ４３例不同类型乳腺癌,ＡｇＮＯＲ平均值４．４０（Ｐ〈０．０１）,１２例乳腺上皮良性增生,平均值２．９０,４５例不同类型甲状腺癌,ＡｇＮＯＲ平均值３．５０（Ｐ〈０．０１）,１０例甲状腺上皮良性增生,平均值１．７７,良、恶性肿瘤细胞ＡｇＮＯＲ颗粒的体积和形态有明显差别。结论 核仁组成嗜银颗粒（ＡｇＮＯＲ）的计数对于区别乳腺和甲状腺良、恶性病变具有一定诊断价值,同时对平均值,大中颗粒百分比和异形颗粒百分比等三项参数进行综合分析,将会大大提高其诊断和临别诊断价值。     

甲状腺肿瘤ras—p21及EBV LMP—1的表达及意义

目的：研究ras癌基因及EBV感染在甲状癌中的意义。方法：应用SABC免疫组化法对88例甲状腺肿瘤（乳头状癌34例,滤泡性癌17例,髓样癌5例,未分化癌8例,腺瘤24例）进行研究,观察ras癌基因蛋白产物p21及EBVLMP－1的表达情况。结果：甲状腺癌p21的表达与甲状腺肿瘤良恶性有关,甲状腺癌p21阳性率（６２．５％）明显高于甲状腺腺瘤（３３．３％）（Ｐ＜０．０５）。甲状腺癌p21组织学分型无关。ＬＭＰ－２在甲状腺癌中的表达率为１５．６％,癌周组织无表达。结论：ras癌基因突变为甲状腺癌发生中的早期事件,p21检测可作为甲状腺泡性肿良恶性鉴别的辅助指标,提示ＥＢＶ感染与甲状腺癌的发生有关。     

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.