562例鼻咽癌放疗10年结果分析

１９７３年１月至１９８６ 年６ 月共收治行首次根治性放疗的鼻咽癌５６２ 例。全部病人随访１０年以上。全组总的１０ 年生存率３０．８％ （１７３／５６２）。Ⅰ～Ⅳ期分别为６４．３％ （９／１４）、４５．５％ （５６／１２３）、３０．４％ （７３／２４０） 和１８．９％ （３５／１８５）, Ⅰ、Ⅱ期明显高于Ⅲ、Ⅳ期 （Ｐ＜ ０．００１）。１０ 年生存率局限于鼻咽腔为３２．５％ （１５２／４６８）, 超腔２２．３％ （２１／９４） （Ｐ＜ ０．０５）。有无颅神经受损的１０ 年生存率分别为３４．４％ 和２０％ （Ｐ＜ ０．０１）。尤以前后组颅神经同时受损和颅神经受损伴颅底骨破坏者疗效最差。颈淋巴结转移情况亦与预后明显相关, 有否淋巴结转移、颈结的固定与否、单双侧、上或全颈以及锁骨上受累均有明显不同的预后,各组间的差异均有统计学意义。照射剂量对预后亦有明显的影响,原发灶剂量６０～７５Ｇｙ 组疗效明显好于其他组。主要死因是远处转移与局部复发。认为早期诊断与早期根治性放疗是提高生存率的关键, 放疗剂量以６０～７５Ｇｙ 为佳。     

以颅神经麻痹,CT和MRI作为诊断鼻咽癌局部复发的研究

目的：进一步探索以颅神经麻痹（ＣＮＰ）以及用ＣＴ和ＭＲＩ诊断鼻咽癌局部复发（ＮＰＣＬＲ）的方法。方法：选取１００例超腔的ＮＰＣＬＲ病人仔细研究其ＣＮＰ的规律，及其ＣＴ和／或ＭＲＩ的表现。结果：７０％的ＮＰＣＬＲ病人有ＣＮＰ，主要侵犯外展神经（５１．４％）和三叉神经（６７．１％），与此相反，颅神经放射损伤，则最多侵及舌下神经（６７．４％）。在本组病人的ＣＴ和／或ＭＲＩ片上均可见鼻咽以外的深部解剖结构     

影响鼻咽癌放疗听觉诱发电位改变的因素

目的：研究鼻咽癌（NPC）病人放疗后听觉诱发电位改变的原因,方法：48例鼻咽癌病人在放疗前、放疗中（鼻咽癌DT40－48Gy)、放疗结束、放疗结束后3个月、6个月、12个月进行脑干听觉诱发电位（BAEP）的检测。用单因素及多因素COX发析BAEP改变原因。结果：鼻咽癌放疗后12个月内BAEP总异常率为64．6％（31／48）,放疗中（鼻咽癌DT40－48Gy),放疗结束以及放疗结束后3个月、6个月、12个月异常率分别为16．7％（8／48）,29．85（14／47）,25．05（12／48）,52．2％（24／46）,52．3％（23／44）。年龄≤35岁,36－50岁,＞50岁分别为25％（1／4）,56．0％（14／25）,84．2％（16／19）,差异有显著性（P＝0．03）。两耳前野组异常率为53．1％（17／32）。面颈联合野组者87．5％（14／16）,后者明显比前者高,差异有显著性（P＝0．02）。脑干（前缘）受量45－51Gy者BAEP异常率为58．6％（17／29）,52－61Gy者为73．75（14／19）,两者相比未见显著性差异（P＝0．29）。多因素分析显示影响BAEP改变的有照射面积,年龄。结论：鼻咽癌放疗后BAEP改变与年龄,照射面积有关。     

新疆维汉族鼻咽癌的预后因素分析

目的：通过对行根治性放疗的新疆地区143例维汉族鼻咽癌患者病例资料的回顾性分析，探讨影响汉族和维吾尔族鼻咽癌患者预后的临床因素以及两者的差异性。方法：选择我院1999年9月～2002年12月收治的首诊行根治性常规分割放疗的维吾尔族鼻咽癌56例，汉族鼻咽癌87例，分析年龄、性别、病理类型、T、N分期、临床分期、颅神经损伤、颅底骨质破坏、放疗后鼻咽残灶及颈淋巴结转移情况等对维汉族鼻咽癌患者预后因素的影响。结果：汉族鼻咽癌单因素分析显示：年龄、T、N分期和临床分期、颈淋巴结转移、颅底骨质破坏、颅神经损害等因素影响预后（P〈O．05）；多因素分析显示：临床分期、颅底骨质破坏是影响预后的独立因素（P〈0．05）。维吾尔族鼻咽癌单因素分析显示N分期、病理类型、颅底骨质破坏、颅神经损伤、鼻咽残灶等因素影响预后（P〈0．05）；多因素分析中，鼻咽残灶、年龄、颅底骨质破坏是影响预后的独立因素。维汉族患者的年龄、T分期、临床分期、颅神经损害、鼻咽残灶在统计学上有显著差异性（P〈0．05）。结论：年龄、临床分期、颅底骨质破坏、颅神经损伤是影响预后的主要因素。维汉族比较，维吾尔族患者年龄小，分期晚，比汉族患者预后差。     

96例青年鼻咽癌放射治疗疗效分析

目的：分析青年鼻咽癌放射治疗疗效。方法：从１９８６年１月至１９９０年１０月，使用＾６０ＣＯγ线治疗青年鼻咽癌９６例。鼻咽部ＤＴ６４￣８０Ｇｙ／６￣８周。颈部转移淋巴结ＤＴ６０￣７０Ｇｙ／６￣８周。预防剂量４５Ｇｙ以上。结果：本组５年生存率为３９．６％（３８／９６）。Ⅱ、Ⅲ、Ⅳ期５年生存率分别为８４．６％（１１／１３）、４７．４％（１８／３８）、２０．０％（９／４５）。结论：青年鼻咽癌病情进展快，颈     

鼻咽癌头痛100例临床分析

报告鼻咽癌合并头痛１００例，发生率６７．６％。根据临床表现，结合ＣＴ、核磁共振片，分析头痛的原因为：（１）与颅神经损害，颅底骨质破坏有密切关系。头痛发生率由颅底阴性组５６．０％上升到颅底阳性组７１．４％，当伴有颅神经损害时上升到１００％。（２）早期鼻咽癌浸润扩展和合并感染，可引起血管反射性头痛。（３）颈侧肿块压迫颈内静脉使血液回流受阻引起头痛。放射治疗对鼻咽癌头痛有肯定的疗效，有效率９８％，剂量一般在１０～３０Ｇｙ见效。     

鼻咽癌局部扩展途径探讨

作者通过对１９９０年￣１９９２年在本院确诊的以局部扩展为主的５３例晚期鼻咽癌临床资料及治疗前ＣＴ扫描结果进行分析，发现鼻咽癌向外周的侵袭力极强，在受侵的部位中咽旁间隙、茎突后区、岩蝶骨区别前三位，临床上应特别注意。在颅神经受损中以Ⅵ、Ⅴ、Ⅳ对最多，而后组颅神经受损最少。本组病人的２年生存率为８５％，较同期的以颈淋巴结转移为主（Ｎ２、Ｎ３）病例为高。推断在晚期鼻咽癌病人中，以局部扩展为主者相对病灶较     

鼻咽癌新辅助化疗疗效预测模型的建立

目的：建立鼻咽癌新辅助化疗近期疗效的模型,为个体化治疗提供依据。方法对鼻咽癌新辅助化疗的63例患者的临床资料进行回顾性分析,在综合分析影响疗效主要因素的基础上,采用Logistic回归分析构建预测模型。结果新辅助化疗鼻咽部病灶有效率为39．7％,颈部淋巴结转移灶有效率为50．8％。单因素分析显示,无远处转移、颅神经未受侵犯、血浆EBV阴性、Ki67高表达的患者对治疗更敏感。逐步Logistic回归分析显示,远处转移、颅神经受侵、血浆EBV情况影响新辅助化疗疗效。由此建立的预测模型为：Logit＝－0．470－2．863×远处转移＋1．328×颅神经受侵＋3．639×EBV,其预测的灵敏度为79．4％,特异性为82．8％,阳性预测值为84．4％,阴性预测值为77．4％。结论远处转移、颅神经受侵情况和EBV感染是影响晚期鼻咽癌患者新辅助化疗疗效的重要指标,由此建立的预测模型为鼻咽癌患者个体化治疗提供初步的依据。     

甲状腺功能亢进症合并甲状腺癌的临床分析

目的 了解甲状腺功能亢进症（甲亢）合并甲状腺癌的状况。方法 对本院１９８３年１月～１９９８年６月,接受手术方法治疗的３９４例甲亢和经手术病理诊断的２４５例甲状腺一并进行回顾性分析。结果 共发现甲亢合并甲状腺癌１２例,占甲亢的３．０％（１２／３９４）,占甲状腺癌的４．９％（１２／２４５）,Ｇｒａｖｅｓ病合并甲状腺癌６例,毒性结节必 腺肿合并甲状腺癌６例。１２例患者中,甲状腺呈弥漫性肿大３例甲,弥漫性     

鼻咽癌颅神经损害64例分析

目的 探讨鼻咽癌颅神经损害的特点。方法 对鼻咽癌颅神经损害６４例临床资料进行回顾性分析。结果 ６４例患者中,头痛５１例（７９．７％）;颅神经受累情况依次是：第Ⅰ对０例次,第Ⅱ对７例次,第Ⅲ对１７例次,第Ⅳ对８例次,第Ⅴ对２４例次,第Ⅵ对２９例次,第Ⅶ对８例次,第Ⅷ对７例次,第Ⅸ对１３例次,第Ⅹ对２例次,第Ⅺ对０例次,第Ⅻ对１４例次。结论 鼻咽癌神经系统表现主要是头痛和颅神经受损,临床上常见前组颅神     

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.