子宫内膜癌预后相关因素分析

目的　探讨影响子宫内膜癌的预后因素。方法　从 1981年 1月至 2 0 0 2年 12月 ,北京大学第一医院妇产科共收治子宫内膜癌患者 32 3例 ,回顾分析所有患者的临床、病理资料 ,采用单因素及多因素分析方法 ,分析影响子宫内膜癌患者预后的因素。结果　单因素分析表明 ,手术病理期别、病理分级、组织类型、肌层浸润、宫颈浸润、腹腔洗液细胞学情况、附件浸润、盆腔淋巴结转移、手术切除子宫范围、盆腔淋巴结切除、术后辅助治疗是影响子宫内膜癌预后的相关因素。多因素回归分析表明 ,手术病理期别、病理分化、肌层浸润 ,淋巴结转移 ,手术切除子宫范围是影响子宫内膜癌预后的独立因素。结论　子宫内膜癌的预后与高危因素有关 ,根据病人的具体情况 ,选择合理的个体化治疗方案 ,才能提高患者预后。     

子宫内膜癌临床及预后因素分析

目的搜集我院15年间收治的子宫内膜癌患者的临床、病理及随访资料,分析子宫内膜癌临床病理特点及预后相关因素。方法对我院1991~2005年间,收治住院有完整资料的150例子宫内膜癌患者的临床、病理资料进行回顾性分析并进行随访。结果(1)患者年龄为30~80岁,平均年龄55.1岁±8.6岁;≤45岁者20例(13.3%),平均年龄37.2岁±6.0岁。其中,2000~2005年18例(17.0%)与1991~1999年2例(4.5%)资料相比,患者年龄有年轻化趋势(P<0.05)。临床表现以绝经后阴道流血最多,其次为绝经前月经量增多或不规则阴道流血分别占69.2%、30.8%。(2)绝经前患者确诊时间迟于绝经后患者(P<0.01);年龄与确诊时间有显著性相关(rs=0.290,P<0.05)。(3)术前B超检查在癌浸润深度上诊断符合率:无肌层浸润为40.9%、肌层浸润≤1/2为42.0%,与术后病理检查相比有统计学意义(P<0.05);肌层浸润>1/2为84.0%,两者相比无统计学意义(P>0.05)。(4)生存分析:①年龄、绝经与否5年生存率无显著性差异;②病理类型、肌层浸润、组织学分级、手术-病理分期预后,有统计学意义(P<0.05)。(5)上述单因素分析结果有意义的预后因素,经Cox比例风险回归分析显示:病理类型、手术-病理分期、肌层浸润深度和组织学分级,是影响患者预后的独立危险因素。结论(1)子宫内膜癌发病呈逐年上升趋势,发病年龄有年轻化趋势。绝经前妇女一旦出现月经紊乱及其相关临床表现时,应首先排除子宫内膜癌。(2)较年轻的患者出现症状后到确诊的时间亦较长。(3)经多因素分析,病理类型、手术-病理分期、肌层浸润深度及组织学分级是子宫内膜癌的独立预后因素;年龄、绝经与否无显著的独立预后意义。(4)手术-病理I、II、III期5年生存率,分别为88.5%、72.9%、48.6%,IV期3年生存率为33.3%,5年生存率为0%。(5)B超检查对判断癌浸润深度(肌层受浸>1/2时)有一定价值。     

Ⅱ型子宫内膜癌预后因素的COX回归分析

目的分析Ⅱ型子宫内膜癌患者的生存情况,探讨其预后影响因素。方法回顾性收集75例Ⅱ型子宫内膜癌患者的临床资料及随访结局,对组织学分级、病灶大小、深肌层浸润、子宫外转移、淋巴结转移、FIGO分期、治疗方式等因素进行单因素Kaplan-Meier和多因素COX回归模型分析。结果 75例Ⅱ型子宫内膜癌患者中位随访时间37.9个月,生存时间为6～144个月,1、3、5a累计生存率分别为90.6%、66.7%、49.9%。单因素Kaplan-Meier分析结果表明:组织学分级、病灶大小、深肌层浸润、子宫外转移、淋巴结转移、FIGO分期、治疗方式的生存率,差异有统计学意义(P<0.05)。Cox风险比例回归模型进行多因素分析结果显示:组织学分级、深肌层浸润、FIGO分期、治疗方式是影响Ⅱ型1子宫内膜癌患者预后的独立危险因素。结论组织学分级、深肌层浸润、FIGO分期可影响Ⅱ型子宫内膜癌患者的生存情况,虽手术作为主要的治疗手段,术后补充治疗亦有望改善Ⅱ型子宫内膜癌患者的预后。     

112例子宫内膜癌预后相关因素分析

目的:通过分析子宫内膜癌临床病理资料,探讨影响子宫内膜癌预后的因素。方法:回顾性分析112例子宫内膜癌患者的临床病理资料,采用Cox比例风险回归模型研究与预后相关因素。结果:初始治疗为手术治疗的子宫内膜癌患者112例,总生存率为87.1%。单因素分析显示,是否绝经、组织学类型与子宫内膜癌的局部复发有关,而肌层浸润深度、宫颈侵犯与否及是否绝经和总体存活有关。Cox多变量回归分析显示,细胞学分级、组织学类型与子宫内膜癌的复发有关,宫颈是否侵犯与总体存活有关。结论:子宫内膜癌预后良好,应系统评估患者预后因素,实行个体化的治疗方案。     

75例子宫内膜癌治疗及预后相关因素分析

目的 探讨子宫内膜癌的治疗及预后相关因素.方法 回顾性分析我院1995-2000年收治的75例子宫内膜癌患者的临床病理资料并电话随访.结果 75例患者、平均年龄56.1岁;组织学分级在绝经前后有统计学差异(P<0.05);手术病理分期愈晚,预后愈差;深肌层浸润者,组织学分级差、淋巴结转移率高;手术为主与放疗为主治疗相比差异不明显(P0.05);孕激素对改善预后有一定的价值.结论 子宫内膜癌有年轻化趋势;手术病理分期、肌层浸润深度、组织学分级、淋巴结转移情况及孕激素的应用都是影响预后的相关因素.     

子宫内膜癌Ⅱ期术后联合放疗的临床疗效观察

目的 探讨子宫内膜癌Ⅱ期手术后辅助放射治疗的疗效及其预后因素.方法 对湖南省肿瘤医院妇瘤科2003年1月～2007年6月收治的96例子宫内膜癌Ⅱ期患者进行回顾性研究.全部患者术后辅助直线加速器盆腔野体外照射,其中24例加阴道施源器腔内后装治疗.按患者年龄、肌层浸润、宫旁脉管癌栓、病理类型、病理级别5个观察指标分析与疾病预后的关系.结果 患者5年生存率82.3％.肌层浸润、病理类型、宫旁脉管癌栓与疾病预后显著相关(P＜0.05),年龄和病理级别与预后无明显相关(P＞0.05).结论 子宫内膜癌Ⅱ期手术后辅助放射治疗的疗效肯定,肌层浸润、病理类型、宫旁脉管癌栓是影响子宫内膜癌Ⅱ期生存率的预后因素.     

Ⅱ期子宫内膜癌预后因素分析

目的：分析Ⅱ期子宫内膜癌患者的预后因素，探讨提高Ⅱ期子宫内膜癌5年生存率的治疗方式。方法：通过对164例Ⅱ期子宫内膜癌患者的治疗随访，对影响预后的相关因素进行统计分析。结果：总5年生存率为74．4％。病理类型，细胞分化程度，肌层浸润深度，盆腔淋巴结转移，手术方式均为影响预后的主要因素。结论：明确术前诊刮价值，实行手术病理分期，规范子宫广泛切除加盆腔淋巴清扫术，对高危因素患者给予术前术后放疗，是提高Ⅱ期子宫内膜癌5年生存率的关键。     

浅析子宫内膜癌的临床病理特点及预后分析

目的探讨子宫内膜癌的病理学特征与临床及预后的关系。方法对110例子宫内膜癌患者的临床病理特点和5年随访结果进行回顾性分析。结果年龄分布主要以50～60岁年龄段居多,主要症状为无痛性阴道流血,组织学分级主要为高分化腺癌,占59.1%;组织学类型主要为子宫内膜样腺癌者,占76.4%;肌层浸润主要为浸润深度〈1/2者,占62.7%;子宫内膜样腺癌中ER,PR均阳性者87例,占88.8%。结论子宫内膜癌的预后与其组织病理学分型和分级,手术-病理分期,肌层浸润深度及受体是否表达密切相关。     

子宫内膜癌治疗及预后相关因素75例临床分析

目的：探讨子宫内膜癌（endometrialcarcinoma,EC）的治疗及预后相关因素。方法：回顾性分析我院2007～2012年收治的75例子宫内膜癌患者的临床病理资料,并全部电话随访。结果：75例患者5年生存率69．3％;临床表现子宫异常出血27例、异常阴道排液15例、疼痛19例及其他症状14例;绝经前病例为39．4％,已占相当比例,有年轻化趋势;临床病理分期晚,则预后差;癌灶侵润的深度与淋巴结转移及病理组织学分级密切相关,癌灶浸润至深肌层,或扩散到宫颈管,或癌组织分化不良时,易发生盆腔及腹主动脉旁淋巴结转移、病理组织学分级也差;手术为主、放疗、化疗为辅助治疗的综合治疗预后好、并发症少;孕激素对改善预后有一定的价值。结论：以手术为主的综合治疗是目前治疗子宫内膜癌的首选治疗措施;绝经前后的妇女出现不规则阴道出血等非特异性的妇科症状时。必须警惕子宫内膜癌的发生;临床病理分期、肌层浸润深度、病理组织学分级、淋巴结转移情况及孕激素的应用都是影响预后的相关因素。     

子宫内膜癌42例临床分析

目的：探讨子宫内膜癌的临床特点及预后影响因素。方法：对42例子宫内膜癌患者的临床症状、临床分期、手术病理分期及治疗方法进行回顾性分析。结果：患者年龄为30～70岁，临床表现以绝经后阴道流血最多（57．1％），其次为绝经前月经量增多或不规则阴道流血（35．7％）、下腹部胀痛（21．4％）；临床分期与手术病理分期符合率为71．48％，肌层浸润率高达85．7％，肌层浸润程度、手术病理分期、术后辅助治疗对预后有明显影响（P〈0．05），组织学类型及病理分级对预后无明显影响（P〉0．05）。结论：确定手术病理分期、肌层浸润深度、术后适当的辅助治疗（化疗、放疗）是改善子宫内膜癌预后的关键。     

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.