全肝CT灌注成像对经导管动脉化疗栓塞术联合阿帕替尼治疗兔VX2肝肿瘤效果的评价

目的：探讨全肝CT灌注成像评估兔VX2肝肿瘤经导管动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)联合阿帕替尼治疗效果的价值。方法：建立36只兔VX2肝肿瘤模型,随机分为4组,每组9只。A组行TACE(0.4 mg栓塞微粒球),B组单纯口饲强服阿帕替尼50 mg/(kg.d),C组行TACE(0.4 mg栓塞微粒球)+口饲强服阿帕替尼50 mg/(kg.d),D组使用相同剂量的生理盐水行肝动脉灌注。4组均于治疗前和治疗7,14 d后行CT灌注成像(CT perfusion imaging,CTPI)获取灌注参数,包括血流量(blood flow,BF)、血容量(blood volume,BV)、肝动脉分数(hepatic arterial fracture,HAF)、平均通过时间(mean transit time,MTT)及毛细血管表面通透性(permeability surface,PS)。各组于第1次灌注扫描后分别处死1只兔,治疗14 d后行最后一次灌注扫描后处死剩余8只兔。取肿瘤边缘区组织行免疫组织化学染色,对比各组肿瘤边缘区CT灌注参数。比较各组治疗前及治疗7 d后肿瘤边缘区CT灌注参数的变化,采用多组间方差分析比较各组的肿瘤边缘区微血管密度(microvessel density,MVD)值,对各组灌注参数与MVD值行相关性分析。结果：治疗前4组间肿瘤边缘区CT灌注参数BF,BV,MTT,HAF,PS差异无统计学意义(P>0.05)。与治疗前相比,治疗后A,B,C组BF,HAF,PS明显降低(P<0.05),D组稍增高。治疗14 d后MVD值分别为A组80.1±16.4,B组50.2±11.2,C组27.4±9.7,D组68.7±12.7,C组MVD值较其他3组显著降低(P<0.01)。除A组外,其余各组兔VX2肝肿瘤边缘区CTPI参数BF,HAF,PS与MVD均呈正相关;BV,MTT与MVD无明显相关性;A组MVD与各CTPI参数无明显相关性。结论：全肝CT灌注可定量评估兔VX2肝肿瘤TACE治疗前后肝血流动力学变化,可替代MVD评价肿瘤血供生成,TACE联合口服阿帕替尼能够有效抑制肿瘤血管生长。     

肝动脉 门静脉化疗栓塞治疗兔VX2肝癌后残癌新生血管的研究

目的 研究经导管肝动脉化疗栓塞(TACE)联合选择性门静脉栓塞(SPVE)治疗兔VX2肝癌对残癌组织新生血管生成的影响.方法 42只实验兔,采用随机数表法分为实验组(A组)和对照组(B组),每组21只.A组行TACE联合SPVE治疗,B组单纯行TACE治疗.A、B两组于第14、21天,行CT平扫+增强扫描,第15天行TACE治疗,第18天分别行SPVE和门静脉数字减影血管造影(DSA)检查,第22天开腹行直接穿刺肝动脉和门静脉DSA检查并处死,取肿瘤周边残癌组织,检测血管内皮细胞生长因子(VEGF)及微血管密度(MVD)的表达情况.结果 A组VEGF、MVD值分别为(120.7±10.99)、(58.9±9.05),B组VEGF、MVD值分别为(136.5±15.45)、(71.8±12.06),两组差异均有统计学意义(P<0.05).结论 门静脉对周边的肝癌组织具有部分血供,且TACE联合SPVE能够提高肿瘤的坏死程度,抑制新生血管的生成.     

重组人血管内皮抑制素联合TACE治疗对肝癌血管的影响

目的 探讨重组人血管内皮抑制联合肝动脉化疗栓塞术(TACE)对原发性肝癌内皮生长因子(VEGF)表达和肿瘤微血管密度(MVD)的影响. 方法 46例中晚期原发性肝癌患者随机分为对照组(20例)和治疗组(26例),对照组单纯给予TACE治疗,治疗组给予重组人血管内皮抑制素联合TACE治疗.利用免疫组化法检测治疗前、后VEGF的表达变化和MVD.ELISA法检测治疗前后血清VEGF的表达水平,并进行比较. 结果 治疗组术后7d、30d血浆VEGF水平(292.34±70.74)pg/ml、(189.49±72.66)pg/ml与对照组(371.36±81.20)pg/ml、(319.24±70.54)pg/ml比较呈明显降低,差异有显著性(t=2.149,P＜0.05).术后30d治疗组和对照组的VEGF表达强度分别为(158.4±38.9)和(60.75±14.0),和MVD分别为(56.6±15.1)和(21.7±6.1),两组比较差异有显著性(t1=2.576、t2=2.328、P均＜ 0.05).结论 TACE联合重组人血管内皮抑制素治疗明显降低肝癌VEGF表达和MVD,对肿瘤再生血管有一定抑制的作用,巩固和加强了TACE的治疗.     

重组人血管内皮抑素联合TACE抗大鼠Walker-256细胞移植性肝癌血管生成的作用

目的 探讨重组人血管内皮抑素(rh-ES)联合肝动脉化疗栓塞术(TACE)对大鼠移植性Walker-256肝癌模型血管内皮生长因子(VEGF)表达和微血管密度(MVD)影响,评价rh-ES与TACE联合治疗对抑制大鼠移植性肝癌模型血管生成的疗效.方法 建立Wistar大鼠Walker-256肝癌模型,1周后随机分成治疗...     

重组人血管内皮抑制素联合肝动脉栓塞化疗治疗中晚期肝癌的临床应用

目的:研究重组人血管内皮抑制素(恩度)联合肝动脉栓塞化疗术(TACE)治疗中晚期肝癌的疗效。方法:60例中晚期原发性肝癌患者随机分为3组,单纯TACE治疗组、恩度加TACE治疗组、恩度联合TACE治疗组,每组各20例,采用免疫组织化学法检测治疗前、后肿瘤微血管密度、血管内皮生长因子(VEGF)的表达,ELISA法检测治疗前后血浆血管内皮生长因子的变化,并进行比较。结果:3组患者血清VEGF表达水平在术后3 d均显著升高,术后1个月恩度加TACE治疗组、恩度联合TACE治疗组血清VEGF表达水平、MV密度明显低于单纯TACE组(P均<0.05),恩度联合TACE治疗组明显低于恩度加TACE治疗组(P<0.05)。结论:恩度联合肝动脉化疗栓塞治疗中晚期原发性肝癌的肿瘤的近期疗效显著,安全性好,是一种值得临床推广的治疗方法。     

兔VX_2肝癌化疗栓塞前后CT灌注特征与肿瘤血管生成相关性研究

目的研究兔VX2肝癌栓塞治疗前后CT灌注特征与肿瘤微血管密度(MVD)、血管内皮生长因子(VEGF)表达的相关性。方法选60只新西兰大白兔作为实验动物。采用注射法将VX2瘤块接种于兔肝左叶。种植14d后随机分成对照组(30例)和化疗栓塞组(30例)。分别对两组动物作CT灌注成像检查及采用免疫组织化学方法测定病理标本的MVD、VEGF表达情况,并进行统计学分析。结果CT灌注参数与MVD及VEGF表达程度呈正相关;化疗栓塞治疗组灌注参数、MVD及VEGF表达程度均明显低于对照组。结论CT灌注成像特征可间接反映肿瘤血管生成,可判断化疗栓塞的效果。     

奥曲肽联合TACE对肝癌患者肿瘤增殖和血清VEGF变化的影响

目的 研究奥曲肽联合经导管肝动脉栓塞化疗（TACE）对肝细胞肝癌患者血清血管内皮生长因子（VEGF）水平变化及疗效的影响.方法 51例肝癌患者分为2组,联合治疗组给予奥曲肽＋TACE,单纯TACE组仅给予TACE.分别于TACE前和TACE后1、7、14、21、28天检测血清AFP和VEGF水平.结果 2组TACE后血清AFP均显著降低,其中联合治疗组TACE后21、28天血清AFP水平又显著低于单纯TACE组.2组TACE后1天血清 VEGF水平较治疗前显著升高,TACE后7天则显著下降,至TACE后14天再次升高;2组TACE后21、28天血清 VEGF水平又再度下降,其中联合治疗组血清VEGF水平显著低于单纯TACE组.联合治疗组的部分缓解（PR）和总有效率（RR）显著高于单纯TACE组.结论 奥曲肽联合TACE较单纯TACE能更显著抑制肝癌增殖,其协同抗癌的部分作用可能是通过降低VEGF水平.     

内皮抑素联合介入治疗肝癌中血管生成的研究

目的 探讨内皮抑素联合介入治疗肝癌中血管生成的研究。方法 2009年8月～2011年8月,27例肝癌患者中15例多次行单纯肝动脉化疗栓塞（TACE）,12例内皮抑素联合TACE,在手术切除后的病理标本中的采用免疫组化方法分析两组血管内皮生长因子（VEGF）的表达情况和平均微血管密度（MVD）值的差异。结果 单纯组VEGF的表达明显高于内皮抑素组（P〈0．05）;单纯组MVD值显著高于内皮抑素组（P〈0．05）。结论 内皮抑素联合TACE能够抑制肿瘤血管的生成,减少肿瘤增长及转移的机会,值得临床进一步的研究与推广。     

双源CT灌注成像对肺癌放化疗疗效评价及其与肿瘤血管生成的相关性研究

目的探究双源CT灌注成像对肺癌放、化疗疗效的评价及其与肿瘤血管生成的相关性。方法选择2015年7月至2017年9月于我院进行放化疗治疗的64例肺癌患者作为研究对象。在其放、化疗治疗前后行双源CT灌注成像扫描,比较治疗有效及无效患者治疗前后血流量(BF)、血容量(BV),对比剂的平均通过时间(MTT)、峰值时间(TTP)及表面通透性(PS)等灌注参数的差异;术后取患者病变组织行病理学检查及免疫组化染色,进行微血管密度(MVD)计数及血管内皮生长因子(VEGF)表达情况测定,统计分析灌注参数与MVD、VEGF的相关性。结果治疗前有效组灌注参数BF、BV值显著高于无效组(P0.05);治疗后有效组BF、BV值显著低于治疗前(P0.05),而无效组治疗前后灌注参数无显著性差异(P0.05);MDV与BF、BV呈显著性正相关(P0.05);与TTP呈显著性负相关(P0.05);VEGF与BF、BV、PS呈显著性正相关(P0.05),与TTP呈显著性负相关(P0.05)。结论双源CT灌注成像参数有助于预测肺癌患者放、化疗治疗效果,对于评价肺癌血管生成也有一定的价值。     

兔肝肿瘤模型中CT能谱成像与灌注成像的相关性研究

目的探讨兔VX2肝癌模型中CT能谱成像参数与灌注参数及微血管密度(MVD)之间的相关性。方法选取24只种植VX2肝癌的大白兔,于种瘤后第14天行能谱及灌注一站式扫描,同时获得CT灌注图像和CT能谱图像。对肿瘤周边CT强化较明显区域行CD34的免疫组化染色,根据CD34阳性结果计数测定MVD,采用Pearson相关分析能谱图像肿瘤的碘基值与灌注参数值及MVD值的相关性。结果瘤组织动脉期碘基值与BV、BF、HAF、PS及MVD值呈正相关(P均<0.05),与MTT呈负相关(P<0.05);瘤组织静脉期碘基值与BV、BF、PS及MVD值呈正相关(P均<0.05),与HAF、MTT无相关性(P均>0.05)。结论 CT能谱图像碘基值与灌注参数及MVD具有较好的相关性,可反映肿瘤的血供变化。     

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.