乳腺癌化疗药物性肝损伤风险预测模型构建

目的 通过收集乳腺癌患者化疗期间的各项临床数据,发现乳腺癌患者化疗时导致肝功能异常的影响因素,并建立风险预测模型.方法 对入院的乳腺癌患者进行流行病学问卷调查、临床生化检测和血样标本的收集,并分析乳腺癌患者化疗期间的年龄、肿瘤分型、肿瘤TNM分期、化疗方案等数据,使用决策树构建乳腺癌化疗药物性肝损伤风险预测模型.采用EpiData 3.0建立数据库,R软件进行统计分析.结果 共收治675例乳腺癌患者,均为女性.按照研究对象的纳入与排除标准,发现人口学信息、临床生化指标以及血样标本均收集完整的乳腺癌患者640例.经化疗后,106例乳腺癌患者发生肝损伤,占比16.56％.60～ 80岁年龄组发生药物性肝损伤的患者比例(22.82％)高于其他年龄组,且肝损伤的发生率随着年龄的增加呈上升趋势(P＜0.05).已绝经的乳腺癌患者及有长期服药史的乳腺癌患者发生肝损伤的比例分别为21.17％和17.32％,高于未绝经和无长期服药史的肝损伤患者,差异有统计学意义(P＜0.05).肿瘤病理学分型、肿瘤TNM分期及化疗方案均与乳腺癌患者药物性肝损伤发生率相关,其中化疗方案中联合用药组的肝损伤发生率为20.67％,明显高于其他药物组别,差异有统计学意义(P＜0.05).乳腺癌化疗药物性肝损伤风险的决策树模型筛选出3个预测肝损伤风险的观测指标为年龄、肿瘤TNM分期和联合用药,这三个指标对乳腺癌化疗药物性肝损伤风险预测的正确率为92.19％,其中灵敏度和特异度分别为86.36％和93.40％.结论 年龄、是否绝经、长期服药史、肿瘤病理学分型、肿瘤TNM分期及化疗方案是乳腺癌患者化疗期间发生肝损伤的影响因素.结合以上影响因素建立了乳腺癌化疗药物性肝损伤风险预测模型,从而实现患者个体化治疗,保障乳腺癌患者化疗顺利进行.     

乳腺癌化疗致药物性肝损伤1例

目的分析乳腺癌患者化疗期间致药物性肝损伤的原因,认识防治药物性肝损伤的作用与意义。方法通过分析1例乳腺癌化疗致药物性肝损伤患者的病情及治疗方案,结合指南和文献分析患者出现肝损伤的原因,协助医师制定治疗方案并进行全程药学服务及出院用药教育。结果 /结论经过系统的保肝治疗,患者病情得到控制,肝功降到正常范围,对临床用药起到了提示作用。     

双环醇片在乳腺癌化疗中防治肝损害的临床研究

目的：研究双环醇片在乳腺癌化学治疗过程中防治肝损害的作用。方法：选择确诊乳腺癌行化疗患者98例,随机分为观察组与对照组,每组49例。予FEC方案或TE方案化疗,观察组予双环醇片护肝治疗,对照组则不予药物护肝,比较两组ALT、AST、ALP、TBIL等肝功能指标及药物性肝损伤发生情况。结果：观察组乳腺癌化疗联合应用双环醇片后药物性肝损伤发生率为6.1%（3/49）,对照组则为24.5%（12/49）,两组比较差异有统计学意义（χ2=6.376,P=0.011）。观察组乳腺癌化疗联合应用双环醇片前ALT、AST、ALP、TBIL等肝功能指标与对照组分别相比较,差异均无统计学意义（P〉0.05）;治疗后ALT、AST、ALP、TBIL等肝功能指标与对照组分别相比较,差异均有统计学意义（P〈0.05）。观察组乳腺癌化疗前后ALT、AST、ALP、TBIL等肝功能指标分别相比较,差异均无统计学意义（P〉0.05）;对照组乳腺癌化疗前后ALT、AST、ALP、TBIL等肝功能指标分别相比较,差异均有统计学意义（P〈0.05）。结论：双环醇片在乳腺癌化疗过程中能够防止肝功能指标异常、降低药物性肝损伤的发生。     

抗痨药所致肝损伤的发生机制和防治研究进展

抗痨药所致肝损伤是结核患者停止治疗最常见原因之一,弄清其损伤机制,采取相应的针对措施对防治肝损伤具有重要意义.本文通过查阅有关文献资料,总结其发生机制及防治研究现状,为抗痨药所致肝损伤的研究提供参考.     

乳腺癌术后化疗患者的护理体会

乳腺癌术后化疗是目前临床上治疗乳腺癌的有效手段,但术后化疗常造成患者的身心痛苦,因此,做好乳腺癌术后化疗期的护理,预防和减少副作用的发生,减轻患者痛苦已成为其护理工作的重要目标。近年来我科对45例乳腺癌术后化疗患者进行了合理的护理并取得满意效果,现报告如下。     

浅谈乳腺化疗药物外渗的预防及护理体会

目的探讨乳腺肿瘤患者化疗药物外渗的预防与护理体会.方法针对乳腺癌患者实施有效的护理方法、防治药液外渗的发生、以及对于出现药液外渗的治疗护理.结果通过对于乳腺癌化疗的患者药液外渗的护理与预防、有效的减少了化疗药液的外渗的并发症、为患者减轻了化疗的痛苦.结论为化疗患者进行药物外渗的治疗和护理至关重要、可以减轻患者的疼痛、为患者的治疗做有利的基础条件.同时增加了患者的满意度.     

双环醇片应用于乳腺癌化学治疗肝损害作用分析

<正>乳腺癌是由于患者乳腺腺上皮组织的恶性肿瘤所引发的,作为治疗乳腺癌的重要手段,乳腺癌化学治疗被广泛应用于乳腺癌治疗中[1]。但是,乳腺癌化学治疗可引起患者肝功能异常、肝脏纤维化等药物性肝损伤,加强乳腺癌化学治疗中肝损伤防范具有重要现实意义[2]。本研究在乳腺癌化学治疗中应用双环醇片防范肝损伤,取得了良好的临床疗效,现报告如下。1资料与方法1.1临床资料:采取随机分组的方式将我院2013年3月至     

乳腺癌患者术后化疗期间的心理护理

目的探讨心理护理对乳腺癌术后化疗患者的影响。方法纳入285例乳腺癌术后患者,对其化疗期间进行心理分析和心理护理。结果全部患者均顺利完成化疗,无严重并发症发生。结论对乳腺癌术后化疗的患者进行心理护理能保证患者顺利完成化疗,有助于提高治疗效果和生存质量。     

拉米夫定对乳腺癌患者HBV再激活的防治

拉米夫定已被推荐用于化疗患者乙型肝炎病毒（HBV）再激活的防治。然而,关于乳腺癌患者的治疗信息尤其缺乏。近期发表在《Journal of the Formosan Medical Association》的一项荟萃分析的目的是在接受化疗的HBsAg阳性的乳腺癌患者中评估拉米夫定防治较未接受治疗患者的总生存获益。研究方法通过Medline、Cochrane和Embase数据库,检索关于比较HBsA g阳性乳腺癌患者接受拉米夫定预防治疗与不接受拉米夫定预防治疗的研究。     

乳腺癌循环肿瘤细胞检测的临床应用

乳腺癌是女性最常见的恶性肿瘤,其复发转移会增加患者死亡率,研究显示转移的发生发展由早期存在于外周血的循环肿瘤细胞所介导。循环肿瘤细胞是从恶性肿瘤原发部位脱落,通过血管或淋巴系统进入血液循环的癌细胞,其通常被认为是癌症发生转移的前提,而且会以单一细胞、细胞簇等形式出现于患者机体的血液中,其检测无创、方便、可重复性好,在乳腺癌的早期诊断和预后中起着重要的作用,并可监测患者辅助化疗的疗效,有助于新辅助化疗及辅助化疗方案的选择,为实现乳腺癌患者个性化治疗提供新的靶点。本文就循环肿瘤细胞检测在乳腺癌临床应用中的进展做一综述。     

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.