几种栓塞剂介入栓塞子治疗子宫肌瘤的临床研究

目的：探讨不同栓塞剂行子宫动脉栓塞术（UAE）治疗子宫肌瘤后的疗效、不良反应及并发症。方法：129例子宫肌瘤患者行选择性双侧子宫动脉插管造影栓塞治疗。将患者按所用栓塞材料分为四组：真丝线段组（SS组,32例）、明胶海绵组（GS组,35例）、聚乙烯醇组（PVA组,30例）和平阳霉素碘油乳剂＋明胶海绵组（PLE组,32例）。术后随访6个月,观察临床症状改变、肌瘤大小变化、术后副反应及并发症。结果：四组患者贫血、月经量多、压迫症状均有不同程度改善。UAE后6个月,四组患者肌瘤均有不同程度减小,SS组由治疗前的（91.21±67.54）mm缩小到（39.39±11.09）mm（t=4.019 7,P〈0.01）,GS组由（95.33±71.13）mm缩小到（41.17±10.65）mm（t=4.386 1,P〈0.01）,PVA组由（89.93±65.32）mm缩小到（34.36±11.75）mm（t=4.586 1,P〈0.01）,PLE组由（92.56±62.19）mm缩小到（34.02±14.63）mm（t=5.184 3,P〈0.01）。PVA组和PLE组肌瘤体积减小程度较GS组明显,但术后下腹坠痛此二组又明显高于GS组和SS组（P=0.032 4）,而其他副反应及并发症四组间差异无显著性（P〉0.05）。结论：真丝线段和平阳霉素碘油乳剂＋明胶海绵颗粒行动脉介入栓塞治疗子宫肌瘤具有良好的疗效和安全性,可作为PVA的替代物。     

超选择性子宫动脉栓塞治疗子宫肌瘤30例临床分析

目的:观察用聚乙烯醇(PVA)颗粒或碘油 平阳霉素 明胶海绵超选择性子宫动脉栓塞治疗子宫肌瘤的临床效果.方法:30例子宫肌瘤患者均采用经皮股动脉穿刺,双侧子宫动脉插管,其中超选至双侧子宫动脉28例,单侧2例,8例用聚乙烯醇(PVA)颗粒栓塞,22例用碘油 平阳霉素 明胶海绵栓塞.结果:所有病例随访4～16个月,8例用聚乙烯醇栓塞,6例临床症状消失,1例明显改善,1例粘膜下子宫肌瘤栓塞后脱落,后经宫腔镜取出;22例用碘油 平阳霉素 明胶海绵栓塞,其中18例临床症状消失,4例有所改善.B超示瘤体缩小40%～90%.无1例严重并发症发生.结论:超选择性子宫动脉栓塞治疗子宫肌瘤是1种创伤小、安全、有效的治疗方法.     

经皮肾动脉栓塞治疗肾血管平滑肌脂肪瘤

目的回顾性评价平阳霉素碘油乳剂联合聚乙烯醇（PVA）颗粒超选择栓塞治疗肾血管平滑肌脂肪瘤（RAML）的长期结果、并发症。方法65例患者共栓塞77个肾脏的86枚肿瘤,栓塞剂为平阳霉素碘化油乳剂及PVA颗粒。随访1年时,在CT图像上测量肿瘤大小并与栓塞前比较,计算肿瘤缩小率,通过观察栓塞治疗后患者症状及并发症、肿瘤大小的变化评价栓塞效果。结果65例患者栓塞前肿瘤直径为（8.2±3.3）cm,随访1年时为（3.9±2.7）cm,平均缩小（4.3±1.6）cm,缩小率为30%～78%（中位数54.4%）,两者差异有统计学意义（P〈0.05）。38例（58.5%）术后1～3 d出现栓塞后症候群;5例（7.7%）术后3～6个月随访时肿瘤复发,进行第2次栓塞。随访期内均无血尿、再次出血或与RAML及栓塞有关的其他严重症状和肾功能衰竭。结论平阳霉素碘油乳剂联合PVA颗粒栓塞治疗RAML,安全可靠。     

子宫动脉栓塞治疗子宫肌瘤的初步临床应用

目的：研究经导管子宫动脉栓塞治疗子宫肌瘤的疗效、副反应、并发症及其防治方法。方法：对9例症状性子宫肌瘤患者进行双侧子宫动脉插管，6例用平阳霉素碘油乳剂（Pingyangmycin lipiodol emulsion,PLE）加明胶海绵颗粒栓塞，另3例用聚乙烯醇颗粒（Polyvinyl alcohol particles,PVA）加少许真丝小线段栓塞。结果：随访12-16个月，瘤块缩小30％-74％。所有子宫出血病例月经恢复正常，贫血病例，血红蛋白升至正常。瘤块所致压迫症状消失。结论：对希望保留子宫，或不愿手术的子宫肌瘤患者，子宫动脉栓塞是一种有效的治疗方法，可替代手术治疗。     

超选择性子宫动脉栓塞治疗子宫肌瘤的临床应用研究

目的 评价用10号真丝线段及聚乙烯醇（PVA）颗粒超选择性子官动脉栓塞治疗子宫肌瘤的临床效果。方法 12例子宫肌瘤患者均采用经皮股动脉穿刺，双侧子宫动脉插管，其中超选至双侧子宫动脉10例，单侧2例，4例用10号真丝线段栓塞，8例用聚乙烯醇（PVA）颗粒栓塞。结果 所有病例随访4～16个月，8例用聚乙烯醇栓塞，6例临床症状消失，2例明显改善；4例用10号真丝线段栓塞，其中3例临床症状消失，1例有所改善。B超示瘤体缩小40％～90％。无1例严重并发症发生。结论 超选择性子官动脉栓塞治疗子宫肌瘤是1种创伤小、安全、有效的治疗方法。     

子宫动脉分级层进式栓塞治疗子宫肌瘤临床研究

目的评价适量平阳霉素超液化碘油乳剂、明胶海绵微末、明胶海绵条分级序贯（层进式）栓塞子宫动脉治疗子宫肌瘤的安全性和疗效。方法回顾性分析两组栓塞剂介入治疗子宫肌瘤并发症、疗效情况,A组即研究组、B组为对照组：PVA颗粒（300～500Hm）。结果A组较B组术后疼痛程度略重、住院日稍长,而误栓的可能低于B组,子宫缺血坏死、继发感染均为零。A组缩短月经期、减少月经量、缩小肌瘤体积及缓解相关肌瘤压迫症状均优于B组,治疗后12个月、24个月复发可能性更低。结论分级序贯栓塞法治疗子宫肌瘤安全、经济、高效。     

PLE、PVA子宫动脉栓塞术治疗子宫肌瘤的护理

目的：探讨聚乙烯醇（PVA）、平阳霉素碘油乳剂（PLE）子宫动脉灌注栓塞术对子宫肌瘤治疗的护理经验及不良反应。方法：回顾性分析84例子宫动脉栓塞术治疗子宫肌瘤前后的临床资料。结果：随访4—48个月。栓塞后2d-4个月的盆腔B超或MRI，结果显示子宫肌瘤栓塞后2d-4个月一直无增强，而子宫体肌层于栓塞后7d即有增强，说明栓塞后导致肌瘤供血中断，而且无侧支循环形成。63例术后1个月子宜体积平均缩小40％-50％，临床症状明显。结论：PVA、PLE子宫动脉栓塞术治疗子宫肌瘤效果明显，安全且无严重并发症，有效率可达98％，保留子宫和卵巢，值得临床推广。     

超选择子宫动脉栓塞治疗子宫肌瘤

目的：评价超选择子宫动脉栓塞（SUAE）治疗症状性子宫肌瘤的疗效和安全性。方法：对30例症状性子宫肌瘤患者，采用聚乙稀醇微粒（PVA）和真丝线段微粒作为栓塞剂，进行SUAE，随访12-36个月，平均25个月，观察术后症状缓解情况和肌瘤缩小程度。结果：30例均成功完成双侧子宫动脉SUAE治疗。栓塞治疗后，动脉造影显示子宫动脉远端的毛细血管网消失，造影剂逆行致子宫动脉主干及髂内动脉分支显影，随访期内，月经增多和经期延长等临床症状明显改善，术后3个月，6个月和24个月最大肌瘤的中位直径缩小各为25.3%,54.8%和75.6%。其中6例壁间肌瘤超声显示已消失。副作用为栓塞综合征（90.0%)和不规则阴道出血（3例）。结论：采用PVA配合真丝线段微粒SUAE是非手术治疗子宫肌瘤安全有效的方法。     

探讨3种栓塞剂联合行子宫动脉栓塞治疗子宫肌瘤的临床价值

目的评价3种栓塞剂联合应用栓塞子宫动脉治疗子宫肌瘤的临床价值，寻找理想的栓塞剂及使用方法。方法对46例有症状的子宫肌瘤患者，行双侧子宫动脉造影，根据血供情况经导管向双侧子宫动脉注入平阳霉素碘油乳剂、真丝线段及明胶海绵进行栓塞。结果子宫肌瘤血供丰富，多数由双侧动脉供血，栓基术后3．6个月B超检查肌瘤体积均明显缩小，月经周期恢复正常、月经量恢复正常或减少占96．7％，腹痛、贫血等症状明显改善，尿频、排尿障碍和便秘等压迫症状也有不同程度的缓解。结论3种栓塞剂联合应用栓塞子宫动脉治疗子宫肌瘤效果好且廉价、安全，值得推广。     

子宫动脉栓塞治疗子宫肌瘤23例临床观察

目的：观察用选择性子宫动脉栓塞治疗子宫肌瘤的临床疗效。方法：对23例子宫肌瘤患者进行选择性子宫动脉造影及超液化碘油加平阳霉素、PVA颗粒等栓塞治疗。随访3-24个月，分析临床症状的改善、瘤体的变化及不良反应等。结果：双侧子宫动脉栓塞后，子宫肌瘤供血可完全阻断，月经血量明显减少，经期缩短，不规则阴道流血消失，腹部肿块触诊及B超检查肌瘤明显缩小，腰酸及下腹压迫症状明显改善，个别病例早期下腹痛现象两周后消失。结论：子宫动脉栓塞治疗子宫肌瘤方法行之有效，可保留子宫功能，是部分患者的良好选择，但远期疗效及对卵巢功能的影响还需进一步观察。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.