影响临床T1乳腺癌腋窝淋巴结转移的危险因素分析

目的：探讨临床T1乳腺癌患者腋窝淋巴结转移的高危因素。方法：对156例诊断为T1乳腺癌患者的完整临床资料进行回顾性分析,并对156例乳腺癌患者腋窝淋巴结转移的危险因素进行单因素及多因素Logistic回归分析。结果：对11项临床和病理指标进行单因素Logistic回归分析显示,妊娠次数、肿瘤大小、肿瘤部位、病理类型、肿瘤分化程度、微淋巴管浸润、癌周浸润方面与腋窝淋巴结转移显著相关; 多因素Logistic回归分析结果显示,肿瘤大小、肿瘤分化程度、微淋巴管浸润和癌周浸润是预测腋窝淋巴结转移的危险因素。结论：肿瘤大小、肿瘤分化程度、微淋巴管浸润和癌周浸润是预测临床T1乳腺癌患者腋窝淋巴结转移的高危因素。     

乳腺癌患者腋窝淋巴结转移规律的回顾性分析

目的 探讨乳腺癌腋窝淋巴结转移规律及腋窝淋巴结转移高危因素.方法 回顾性分析281例经手术、病理确诊的乳腺癌患者资料,按腋窝淋巴结转移与否分为2组,进行χ2检验及多因素Logistic回归分析.结果 2组间(腋窝淋巴结转移与否)检验提示哺乳史、肿瘤家族史、肿瘤大小、病理类型与腋窝淋巴结转移与否间差异有统计学意义(P＜0.05);多因素分析显示肿瘤家族史、肿瘤大小、病理类型是影响腋窝淋巴结转移的因素(P＜0.05).结论 哺乳史、肿瘤家族史、肿瘤大小、病理类型与乳腺癌腋窝淋巴结的转移与否有统计学意义上的相关性,肿瘤大小、病理类型、肿瘤家族史是影响乳腺癌患者腋窝淋巴结转移的高危因素.     

乳腺癌腋窝淋巴结转移的多因素分析

目的　分析乳腺癌腋窝淋巴结转移的多种因素。方法　采用病例对照 ,对 12 0例乳腺癌患者进行全因素及逐步因素Logistic回归分析。结果　多因素分析显示前哨淋巴结转移、肿瘤的大小、肿瘤的部位、癌周浸润、CA15- 3等 5项指标 ,进入Logistic回归方程 ,P值分别为 0 ,0 0 0 5 3,0 0 2 17,0 0 0 6 1,0 0 2 2 5 ,0 0 30 1。结论　前哨淋巴结转移、肿瘤的大小、肿瘤的部位、癌周浸润、CA15- 3等为乳腺癌患者的高危因素 ;了解此因素有助于临床准确判断ALNM状态。     

乳腺癌肌间淋巴结转移高危因素分析

目的探讨乳腺癌肌间淋巴结（IPN）转移的高危因素。方法收集行乳腺癌改良根治术的782例患者（均行IPN切除）的资料,选择年龄、肿瘤位置、肿瘤大小、腋窝淋巴结转移、脉管（血管、淋巴管）侵犯、病理类型、分子分型、Ki-67共8个乳腺癌内乳淋巴结转移可能相关的因素,分析不同情况下IPN转移的高危因素。结果全组患者IPN检出率21.0%,转移率6.9%;单因素分析显示,IPN的转移与肿瘤大小、腋窝淋巴结转移数目、脉管（血管、淋巴管）侵犯、病理类型、Ki-67明显相关（P＜0.05）,而与年龄、肿瘤位置及分子分型无明显关系（P＞0.05）。logistic多因素回归分析显示,仅腋窝淋巴结转移和脉管侵犯是IPN转移的独立高危因素（均P＜0.01）,其中腋窝淋巴转移是最重要的危险因素。结论肿瘤大小、腋窝淋巴结转移、脉管（血管、淋巴管）侵犯、病理类型、Ki-67是乳腺癌IPN转移的危险因素,腋窝淋巴结转移及脉管侵犯与否是影响IPN转移的独立高危因素。     

152例乳腺癌腋窝淋巴结转移规律的临床研究

目的探讨乳腺癌腋窝淋巴结转移与肿瘤大小、位置、病理性质、ER、PR、HER-2基因表达以及患者年龄之间的关系、规律,以明确各因素在乳腺癌腋窝淋巴结转移中的决定地位,为临床乳腺癌根治性手术中腋窝淋巴结清扫术的指征提供理论依据。方法应用logistic回归方程分析2005.11-2007.10间152例乳腺癌患者腋窝淋巴结转移情况,筛选出危险因素并对每个危险因素进行分析。结果152例乳腺癌患者中,腋窝淋巴结存在转移者74例（48.7%）,筛选出肿瘤大小、生长部位、病理性质为腋窝淋巴结转移的危险因素,而腋窝淋巴结转移与否与患者的年龄、肿瘤ER、PR、HER-2基因的表达没有关系。结论乳腺癌腋窝淋巴结转移主要是由多因素决定的,不应以某一因素作为乳腺癌手术中放弃腋窝淋巴结清扫的依据。     

早期乳腺癌腋淋巴结转移的高危因素

目的 探讨早期乳腺癌淋巴结转移(ALNM)的高危因素.方法 收集乳腺癌病例156例,建立数据库,用Logistic回归进行多因素分析,并对有意义的指标进行相关分析,对其中的53例患者523枚阴性腋淋巴结再切片,用CK19行免疫组织化学染色.结果 多因素分析显示肿瘤大小、肿瘤部位、癌抗原153(CA153)、人类表皮生长因子受体-2(HER2)4个指标进入Logitic回归方程.53例患者中有4例患者的腋窝淋巴结CK19免疫组织化学染色体阳性.结论 肿瘤大小、肿瘤部位,CA153和HER2为乳腺癌患者ALNM的高危因素;CK19免疫组织化学染色可发现乳腺癌腋淋巴结微转移癌.     

乳腺癌腋窝淋巴结转移的危险因素分析

目的探讨乳腺癌腋窝淋巴结转移的危险因素,为术前初步预测淋巴结转移情况提供参考依据。方法回顾性分析738例乳腺癌患者的临床病理资料,进行单因素及多因素分析,筛选危险因素。结果单因素分析结果显示,肿瘤大小、肿瘤位置、脉管浸润、病理类型、组织学分级、ER、PR、Ki-67与乳腺癌腋窝淋巴结转移相关（P＜0.05或0.01）,患者年龄、家族史、Her-2状态与乳腺癌腋窝淋巴结转移无关（均P＞0.05）。多因素分析结果显示,进入模型的危险因素有7个,分别是肿瘤大小、肿瘤位置、脉管浸润、病理类型、组织学分级、ER、Ki-67（OR=1.902、0.563、2.821、0.183、1.528、2.236、1.498,P＜0.05或0.01）。结论肿瘤大小、肿瘤位置、脉管浸润、病理类型、组织学分级为乳腺癌腋窝淋巴结转移的独立危险因素。     

246例乳腺癌临床病理因素的预后分析

目的分析246例乳腺癌临床病理特性对判断预后的价值。方法选取徐州医学院附属医院1999～2001年有确切随访资料的246例乳腺癌患者,采用Kaplan-meier法与Cox回归模型评估各因素对乳腺癌预后的影响。结果本组246例乳腺癌病例5年总体生存率为79.02%,使用SPASS软件进行Pro Logistic回归分析患者5年总体生存率与绝经状况、肿瘤大小复发情况、腋窝淋巴结转移、TNM分期、化疗、内分泌治疗、放疗均显著相关而与PR、ER、病理类型和年龄无明显关系。单因素分析淋巴结状态和复发情况是乳腺癌患者独立危险因素,且多因素分析淋巴结状态和复发情况是女性乳腺癌患者最明显的预后协同危险因素。结论患者绝经状况、肿瘤大小、复发情况、腋窝淋巴结转移、TNM分期、化疗、内分泌治疗、放疗的不同水平5年生存率有显著差异。淋巴结转移和复发情况不仅是影响乳腺癌患者预后的独立危险因素,同时更是影响乳腺癌预后的联合危险因素。     

基于超声图像和临床病理特征的早期浸润性乳腺癌腋窝淋巴结转移的诊断模型

目的 基于超声图像特征和临床病理特征构建早期浸润性乳腺癌腋窝淋巴结转移的诊断模型。方法 纳入经术后病理确诊的156例早期浸润性乳腺癌患者,所有患者术前均接受超声检查。根据手术病理结果评估腋窝淋巴结转移的发生情况,将患者分为转移组47例和未转移组109例。比较两组超声图像特征和临床病理特征。采用多因素Logistic回归模型分析超声图像特征及临床病理特征与乳腺癌腋窝淋巴结转移的相关性,并建立诊断模型。通过受试者工作特征（ROC）曲线评估各个危险因素和诊断模型对乳腺癌患者发生腋窝淋巴结转移的诊断价值。结果 两组患者的肿瘤大小、有无边缘毛刺征、皮质厚度、血管分级、组织学分级、肿瘤位置差异均有统计学意义（均P<0.05）;有边缘毛刺征、皮质厚度≥3 mm、血管分级为Ⅲ级、组织学分级为Ⅱ级或Ⅲ级与患者发生腋窝淋巴结转移相关（均P<0.05）。皮质厚度、边缘毛刺征、血管分级、组织学分级诊断乳腺癌患者发生腋窝淋巴结转移的曲线下面积（AUC）为0.617～0.738,其中皮质厚度的AUC大于其他指标（均P<0.05）。基于多因素Logistic回归分析结果建立的诊断模型为P=1/(1...     

早期乳腺癌腋淋巴结转移的高危因素

目的探讨早期乳腺癌淋巴结转移（ALNM）的高危因素。方法收集乳腺癌病例156例，建立数据库，用Cogistic回归进行多因素分析，并对有意义的指标进行相关分析，对其中的53例患者523枚阴性腋淋巴结再切片，用CK19行免疫组织化学染色。结果多因素分析显示肿瘤大小、肿瘤部位、癌抗原153（CA153）、人类表皮生长因子受体-2（HER2）4个指标进入Logitic回归方程。53例患者中有4例患者的腋窝淋巴结CK19免疫组织化学染色体阳性。结论肿瘤大小、肿瘤部位，CA153和HER2为乳腺癌患者ALNM的高危因素：CK19免疫组织化学染色可发现乳腺癌腋淋巴结微转移癌。     

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.