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.     

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.     

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。     

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.     

胃癌病人脉管内癌栓与临床病理因素及预后的关系

目的分析胃癌病人脉管内癌栓与淋巴结转移等病理特征的关系及其对疾病预后影响。方法回顾性分析375例胃癌病人术后临床及病理资料,其中脉管内癌栓阳性者54例,阴性者321例,分析脉管内癌栓与疾病分期、淋巴结转移等的关系,并比较同期癌栓阳性组与阴性组病人3年及5年生存率的差异。结果不同UICC分期、肿瘤浸润深度、组织分化程度、淋巴结转移程度胃癌病人脉管内癌栓的发生率比较,差异皆有显著意义（χ^2=7.355-20.066,P〈0.05）。脉管内癌栓阴性病人Ⅰb＋Ⅱ期、Ⅲ期的3年、5年生存率高于同期阳性组,差异有统计学意义（χ^2=3.950-5.632,P〈0.05）。结论脉管内癌栓是胃癌病人重要的预后因素,应予以高度重视。     

92例宫颈癌患者预后影响因素的分析研究

目的分析宫颈癌患者的预后影响因素。方法选择2004年3月～2009年12月在邯郸市中心医院妇科治疗的宫颈癌患者92例,组间生存率的比较采用Log-rank检验,采用Cox比例风险模型进行多因素分析,探讨宫颈癌的预后影响因素。结果 Log-rank检验显示,临床分期、淋巴结转移、宫旁浸润或脉管瘤栓、环氧合酶-2（COX-2）阳性、人乳头瘤病毒16-E6蛋白（HPV16-E6）阳性与预后有关（P〈0.05）,而年龄、病理类型、宫颈肌层浸润深度与预后无关（P〉0.05）。Cox比例风险模型结果显示,临床分期、淋巴结转移、宫旁浸润或脉管瘤栓、COX-2阳性、HPV16-E6阳性与宫颈癌预后显著相关（P〈0.05）;而肿瘤分化程度、病灶直径与宫颈癌预后无关（P〉0.05）。结论淋巴结转移、宫旁浸润或脉管瘤栓、COX-2、HPV16-E6为宫颈癌的独立预后因素。     

胃癌肝转移危险因素的相关性分析

目的分析胃癌肝转移和无肝转移患者的临床病理因素,确立临床病理因素与胃癌肝转移的关系。方法回顾性分析2002～2008年收治的胃癌发生肝转移和非肝转移的患者各78例的临床病理资料,对胃癌肝转移的可能危险因素采用Logistic回归模型进行单因素和多因素分析。结果单因素分析结果显示胃癌的临床病理分期、大体类型、分化程度、浸润深度、脉管浸润、肿瘤直径和淋巴结转移与胃癌肝转移有关,通过Logistic回归模型多因素分析显示大体类型(P=0.003,OR=6.198)和脉管浸润(P=0.026,OR=2.571)是胃癌肝转移最重要的影响因素。结论胃癌发生肝转移可能与肿瘤的大体类型、脉管浸润、分化程度、肿瘤直径、淋巴结转移、浸润深度和临床病理分期有关。     

脉管癌栓阳性与阴性的结直肠癌患者预后差异比较

目的 比较结直肠癌手术切除标本中的脉管癌栓阳性患者与阴性患者预后差异。 方法 回顾性分析2005～2010年温州医科大学附属台州医院胃肠外科手术治疗的结直肠癌患者临床病理资料,用单因素分析探讨脉管癌栓和临床病理资料的关系。对可能影响患者生存的因素进行单因素和Cox多因素模型分析,分析可能影响结直肠癌预后的因素。Kaplan-Meie生存分析阳性脉管癌栓和结直肠癌患者生存预后关系。 结果 单因素方差分析发现:癌栓的发生率与肿瘤分化程度(P=0.01),淋巴结转移(P＜0.001),TNM分期(P＜0.001)关系密切,癌栓的发生同样和结直肠癌患者的生存率(P＜0.001)有密切关系。Cox多危险因素回归分析发现:癌栓(P=0.001),淋巴结转移(P=0.025),TNM分期(P＜0.001)可以作为结直肠癌患者的独立预后危险因素;从Kaplan-Meie生存分析中发现:脉管癌栓阴性的患者的生存率明显高于存在脉管癌栓阳性的患者(P＜0.001)。 结论 脉管癌栓与淋巴结的转移关系密切,脉管癌栓阳性明显影响患者的生存预后,并且脉管癌栓可以作为结直肠癌患者的独立预后因素;因此我们认为针对此类高危患者,临床上应采取更积极更具有针对性的治疗来提高患者的生存质量和延长患者的生存时间。      

早期胃癌淋巴结转移的相关危险因素分析及治疗策略

目的探讨早期胃癌淋巴结转移的相关危险因素,为进一步制定最佳治疗方案提供理论依据。方法回顾性分析2015年1月至2018年12月宁波医疗中心李惠利医院收治的414例早期胃癌患者,按浸润深度分为两组：T1a（肿瘤侵犯固有层或黏膜肌层）组186例患者及T1b（肿瘤侵犯黏膜下层）组228例患者,对早期胃癌患者的性别、年龄、肿瘤部位、肿瘤病理类型、分化程度、肿瘤直径、是否合并溃疡、是否发生脉管侵犯及神经侵犯与淋巴结转移的相关性进行单因素及多因素logistic回归分析。结果T1a组患者单因素结果分析显示患者性别、是否为印戒细胞癌、分化程度、肿瘤直径、是否发生脉管侵犯均与淋巴结转移相关（均P＜0.05）;而患者的年龄、肿瘤部位、是否合并溃疡均与淋巴结转移无相关（均P＞0.05）。T1b组患者单因素分析结果显示肿瘤部位、是否为印戒细胞癌、分化程度、是否发生脉管侵犯均与淋巴结转移相关（均P＜0.05）;而患者的性别、年龄、肿瘤直径、是否合并溃疡、是否发生神经侵犯均与淋巴结转移无相关（均P＞0.05）。多因素logistic回归分析结果显示肿瘤部位上部、未发生脉管侵犯为淋巴结转移的保护因素,分化程度为淋巴结转移的危险因素,即肿瘤部位（胃窦、幽门）、分化程度（低分化）、脉管侵犯（是）为淋巴结转移的独立危险因素（均P＜0.05）。结论肿瘤部位、分化程度及是否发生脉管侵犯与早期胃癌的淋巴结转移密切相关,术前准确评估患者病理指标,对于早期胃癌治疗方案的选择有指导意义。     

T1a～T1b期胃癌患者发生脉管浸润的风险因素及预后分析

目的 分析影响T1a~T1b期胃癌患者发生脉管浸润的风险因素及预后生存情况,为胃癌患者的临床治疗提供参考。 方法 选取2013年3月-2015年6月在杭州师范大学附属医院诊断且符合纳入标准的80例T1a~T1b期胃癌患者为研究对象,按脉管是否浸润将其分为脉管浸润组(24例)和脉管未浸润组(56例)。比较2组患者的临床病理特征;采用Cox多因素分析影响T1a~T1b期胃癌患者发生脉管浸润的风险因素;比较2组患者的3年累积生存率。 结果 脉管浸润组患者淋巴结转移率明显高于脉管未浸润组(P<0.05)、肿瘤大体分型中溃疡型所占比例明显高于脉管未浸润组(P<0.05)、肿瘤分化程度中低分化所占比例明显高于脉管未浸润组(P<0.05)、肿瘤浸润深度中T1b期所占比例明显高于脉管未浸润组(P<0.05);2组患者的癌结节、肿瘤直径比较差异无统计学意义(P>0.05)。Cox多因素分析结果显示,淋巴结转移与肿瘤浸润深度是胃癌患者脉管浸润的独立风险因素(P<0.05)。脉管浸润组患者的3年累积生存率明显低于脉管未浸润组(P<0.05)。 结论 淋巴结转移、肿瘤浸润深度是T1a~T1b期胃癌患者发生脉管浸润的独立风险因素,发生脉管浸润的T1a~T1b期胃癌患者的预后情况不佳。      

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.