维甲酸治疗急性早幼粒细胞白血病继发白细胞增多症的观察和处理

目的 观察维甲酸治疗急性早幼粒细胞白血病继发白细胞增多症及结合化疗的作用。方法 ２０例急性早幼粒细胞白血病患者分２组；单用维甲酸组１１例，结合化疗组９例，观察２组白血细胞增高及疗效情况。结果 白细胞增高程度结合化疗组氏于单用维甲酸组，降低了早期死亡率。结论 维甲酸结合化疗治疗急性早幼粒细胞白血病继发白细胞增多症有效。     

全反式维甲酸治疗急性早幼粒细胞白血病60例

总结全反式维甲酸治疗急性甲幼粒细胞白血病经验，探讨如何降低治疗中的早期死亡率。方法；选择６０例确诊为ＡＰＬ。的患者，采用ＡＴＲＡ治疗。结果：５３例达完全缓解。２９例出现白细胞增多症。９例出现高白细胞综合征，加用小剂量三尖杉酯碱，羟基脲或米托蒽醌，８例症状消失。６例出现维甲酸综合征，使用甲基强的松龙或地塞米松并用小剂量ＡＴＲＡ治疗后４例好转。     

急性坏死性胰腺炎的早期非手术与手术治疗

为了确立急性坏死性胰腺炎（ＡＮＰ）的治疗方案，总结了５８例ＡＮＰ患者的治疗经验。１９９３年５月以前以早期手术为主，１９９３年５月以后以早期非手术治疗为主。结果显示，早期手术组２７例，死亡８例（２９．６％），早期非手术治疗组３１例（包括５例延期手术），死亡４例（１２．９％），因此作者对ＡＮＰ患者采取早期非手术治疗明显优于早期手术治疗，并对早期非手术治疗的优点，要点及手术治疗的地位，指证和方式进行了讨     

维甲酸并化疗治疗急性早幼粒细胞白血病

对２２例急性早幼粒细胞白血病（ＡＰＬ）患者单用全反式维甲酸（ＡＴＲＡ）进行诱导缓解，２０例（９０．９％）达到完全缓解（ＣＲ），平均时间４２天。２０例白细胞升高，平均２６．４４×１０~９／Ｌ白细胞升到最高值所需时间中位数为１１天。ＣＲ后用阿糖胞苷、阿霉素、三尖杉进行２个疗程的巩固化疗。ＡＴＲＡ的副作用包括皮肤粘膜干燥、头痛、骨骼肌肉酸痛等，患者一般能耐受。     

血管紧张素Ⅱ加压化疗治疗恶性实体瘤53例临床及实验分析

本文共治疗恶性实体瘤１０４例，其中血管紧张素Ⅱ（ＡＴ－Ⅱ）加压化疗组５３例，静脉化疗组５１例。对两组病例各１０例于用药后以同位素方法检测了肿瘤组织、血、尿内的药物浓度。结果显示：加压化疗组肿瘤组织内抗癌药物浓度是静脉化疗组的２．６３倍（Ｐ＜０．０１）。血药浓度维持时间长，肾脏药物排泄量明显低于静脉化疗组（Ｐ＜０．０５）。临床疗效：加压化疗组的完全缓解率为６７．９％（３６１５３），３年存活率为５８．８％（２０／３４），静脉化疗组分别为４９％（２５／５１），３４．４％（１１／３２）。两组差异显著（均为Ｐ＜０．０５）。本结果表明ＡＴ－Ⅱ加压化疗对恶性实体瘤的局部强化治疗有相当的实用价值。     

全反式维甲酸治疗急性早幼粒细胞白血病中的致命性副作用

用全反式维甲酸（ＡＴＲＡ）治疗８２例急性早幼粒细胞白血病（ＡＰＬ）,其中３５例（４２７％）出现白细胞增多症,２２例（２６８％）出现致命性副作用。后者包括维甲酸综合征１５例,颅内出血７例。提示：在ＡＴＲＡ治疗ＡＰＬ过程中,白细胞增多是致命性副作用发生的重要危险因素;ＡＴＲＡ与小剂量三尖杉酯碱相结合,可降低因白细胞增多导致颅内出血的发生率;肾上腺皮质激素能显著降低维甲酸综合征的死亡率。     

全反式维甲酸治疗急性甲幼粒细胞白血病中的致命性副作用

用全反式维甲酸（ＡＴＲＡ）治疗８２便急性早幼粒细胞白血病（ＡＰＬ）,其中３５例（４２．７％）出现白细胞增多症,２２例（２６．８％）出现致命性副作用。后者包括维甲酸综合征１５例,颅内出血７例。提示：在ＡＴＲＡ治疗ＡＰＬ过程中,白细胞增多是致命性副作用发生的重要危险因素;ＡＴＲＡ与小剂量三尖杉酯碱相结合,可降低因白细胞增多导致颅内出血的发生率;肾上腺皮质激素显著降低维甲酸综合征的死亡率。     

小剂量全反式维甲酸治疗急性早幼粒细胞白血病15例

１９９５年２月～１９９８年１２月,我们应用小剂量全反式维甲酸（ＡＴＲＡ）治疗急性早幼粒细胞白血病（ＡＰＬ）１５例,疗效满意,现报告如下。１　材料和方法１．１　病例　根据病史、体征,经外周血和骨髓象确定诊断。１５例中男９例,女６例,年龄１９～５３岁,平均３２岁。１．２　方法　ＡＴＲＡ２５ｍｇ／（ｍ２·ｄ）,分２次口服,治疗前ＷＢＣ＞１０×１０９／Ｌ者开始加小剂量化疗,ＷＢＣ＜１０×１０９／Ｌ者ＡＴＲＡ治疗后ＷＢＣ＞１０×１０９／Ｌ时再加小剂量化疗（高三尖杉酯硷１ｍｇ／ｄ静滴１４～２１ｄ）,ＣＲ后继…     

ALL甲氧柔红霉素与柔红霉素治疗的比较

目的 提高成人ＡＬＬ的有效治疗,尝试应用去甲氧柔红霉素（ＩＤＡ）治疗成人ＡＬＬ。方法 初发成人病例共２８例;和标准的ＶＤＰ或ＶＤＬＰ方案：ＩＤＡ治疗组（１７组）和柔红霉素（ＤＮＲ）治疗组（１１例）;并对两组的近期疗效进行比较。结果 诱导化疗ＩＤＡ组缓解率为８２．４％（１４／１７）,早期死亡率１７．６％;ＤＮＲ）治疗组缓解率９０．９％,早期死亡率９．１％,两组无明显差异（Ｐ〉０．０５）。巩固化疗疗效     

全反式维甲酸治疗急性早幼粒细胞白血病的严重副反应

采用全反式维甲酸治疗性早幼粒细胞白血病６３例,其高白细胞综合征、高颅压综合征及维甲酸综合征的发生率分别为５７．１％,９．５％和３．２％,其死亡率为１１．１％;高白细胞综合征导白细胞壅滞是死亡的原因。笔者建议：ＡＴＲＡ治疗ＡＰＬ时,当白细胞在第６天〉５．０＊１０＾９．Ｌ＾－１,第１０天〉１０．０＊１０＆－９．Ｌ＾－１,第１５天〉１５．０＊１０＾９．Ｌ＾－１时应加用高三尖杉酯碱治疗;当患者的白细胞在Ａ     

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.