动态检测乳腺癌患者外周血中CK19表达的临床研究

目的动态检测乳腺癌患者外周血细胞角蛋白19（cytokeratin 19,CK19）的表达并探讨其临床意义。方法应用流式细胞术（flow cytometry,FCM）动态检测32例乳腺癌、10例乳腺良性疾病及10例健康人外周血CK19的表达。结果32例乳腺癌患者外周血CK19阳性的总表达率为29.73%;外周血CK19的表达与TNM分期呈显著相关（P〈0.05）;与肿瘤大小、淋巴结有无转移、HER-2、ER、PR的表达均无相关性（P〉0.05）;IV期与I、II、III期之间有统计学意义。CK19表达预测远处转移敏感性高达100%,特异性为96.3%;10例良性患者及10例健康人外周血均无CK19表达。结论乳腺癌患者外周血CK19可以作为检测乳腺癌远处转移的敏感特异性指标。     

原发性肝癌患者血清皮质醇含量变化及中药干预对其影响

目的研究原发性肝癌患者血清皮质醇水平变化的影响因素及中药治疗的机制。方法按纳入标准和排除标准选取原发性肝癌患者79例和健康人66例,采用放射免疫法检测血清皮质醇水平,采用多元回归分析的方法观察原发性肝癌患者血清皮质醇水平的影响因素;经过中医综合治疗（华蟾素、艾迪或消癌平治疗）14 d后,观察13例原发性肝癌患者血清皮质醇水平的变化。结果原发性肝癌患者血清皮质醇水平较健康人明显降低（P〈0.05）,其水平与外周血钾水平具有显著相关性。中药治疗后,原发性肝癌患者外周血皮质醇水平显著升高（P〈0.01）。结论①原发性肝癌患者外周血皮质醇水平较健康人明显降低。②中医综合治疗可以提高原发性肝癌患者皮质醇水平,提示中药对血清皮质醇的影响可能是其作用机制之一。     

循环肿瘤细胞检测在乳腺癌术后随访中的临床意义

目的：探讨循环肿瘤细胞（CTC）检测在乳腺癌术后随访中的临床意义。方法：乳腺癌Ⅱ、Ⅲ期患者120例接受手术和术后辅助化疗,进行3年随访,定期监测患者CTC数量,分析CTC与患者临床分期、转移、无病生存期（DFS）的关系,评估CTC检测对诊断乳腺癌转移的灵敏度和特异度。结果：乳腺癌患者120例中99例（82.5%）术前检测出CTC,其中Ⅱ期45例,Ⅲ期54例;有4例术前阴性、术后检测出CTC。在各个时间点Ⅲ期患者CTC数量均多于Ⅱ期患者,差异均有统计学意义（P<0.05）。转移患者在各时间点CTC数量均明显多于未转移患者,差异均有统计学意义（P<0.05）。CTC检测评估乳腺癌转移的灵敏度为73.3%,特异度为91.7%（Kappa=0.814,P<0.001）,CTC检测与影像学检查一致性较好。CTC阴性DFS优于CTC阳性患者（P=0.042）。结论：定期监测乳腺癌患者CTC计数,有助于判断治疗效果和预测预后,及时为患者制定个体化、精准化的治疗方案。     

原发性肝癌患者血清和癌组织中脯氨肽酶测定的临床意义

测定了１５４例原发性肝癌、肝硬化、慢性肝炎、肝良性占位和健康人血清脯氨肽酶活力以及１６例病理证实的肝细胞癌组织中脯氨肽酶比活力。结果发现：原发性肝癌（４５例）血清脯氨肽酶活力显著地高于肝硬化（３０例）、慢性肝炎（２２例）、良性肝占位（２５例）和健康人（３２例）（Ｐ＜０．０１）。肝细胞癌组织中脯氨肽酶比活力高于非癌肝组织（Ｐ＜０．０１）。本文结果表明：血清中脯氨肽酶可作为慢性肝病癌变的血清学辅助诊断指标之一。并有利于肝脏占位性病变的鉴别。     

AFP-mRNA在原发性肝癌患者外周血的检测及其意义

目的　探讨原发性肝癌患者外周血中甲胎蛋白信使核糖核酸 (AFP mRNA)的表达情况及其与肝癌血行播散的关系和临床应用价值。方法　采用巢式逆转录 聚合酶链反应 (RT PCR)方法 ,对肝癌细胞株HepG2细胞样本 ,4 0例原发性肝癌 ,1 2例慢性肝病 ,5例继发性肝癌患者和 7例健康人各 5ml外周血样本检测AFP mRNA。结果　AFP mRNA在 0 .5× 1 0 1 mlHepG2细胞可检出 ,在肝癌组阳性率为 5 2 .5 % ,其他各组均为阴性。肝癌患者的AFP mR NA表达与肝内播散情况、临床分期、远处转移情况具有相关性 (P <0 .0 5 )。结论　采用巢式RT PCR技术检测肝癌患者外周血AFP mRNA的表达 ,具有一定的特异性和灵敏性 ,可作为肝癌远处转移的预测性指标     

原发性肝癌组织和血清蛋白结合岩藻糖检测的初步报告

观察了５５例原发性肝癌，４０例慢性肝病，２５例肝良性占位血清蛋白结合岩藻糖的变化。４０例健康人作为对照。同时测定了１４例手术切除人肝癌组织、癌旁和远隔肝组织中蛋白结合岩藻糖的含量。结果发现：原发性肝癌血清蛋白结合岩藻糠明显地高于慢性肝病、肝良性占位和健康人（Ｐ均＜０．０１）。肝癌组织中蛋白结合岩藻糖高于癌旁和远隔肝组织（Ｐ＜０．０１）。提示血清蛋白结合岩藻糖可作为原发性肝癌辅助的诊断指标；有助于区别肝脏恶性占位。同时，还对其机制作了探讨。     

全胸腔镜下根治术与胸腔镜辅助小切口术对NSCLC患者外周血CTC细胞数量变化的影响

目的 探讨全胸腔镜下根治术与胸腔镜辅助小切口术对非小细胞肺癌(NSCLC)患者外周血循环肿瘤细胞(CTC)数量变化的影响及其与预后的关系.方法 选取四川省医学科学院·四川省人民医院2016年1月至12月收治的50例NSCLC患者为研究对象,按就诊时间分为全胸腔镜组与小切口组各25例.全胸腔镜组采用全胸腔镜下根治术,小切口组采用胸腔镜辅助小切口术.比较两组术中与术后指标,统计术后并发症发生率,对患者进行为期2年随访,统计肿瘤复发与转移发生率.于术前2 d与术后2 d检测患者外周血CTC细胞数量,分析外周血CTC细胞数量与肿瘤复发转移的关系.结果 全胸腔镜组与小切口组术后2 d外周血CTC细胞数量分别为[19(0,40)]个/5 mL、[17(0,39)]个/5 mL,与术前2 d的[13(0,28)]个/5 mL、[12(0,25)]个/5 mL比较差异有统计学意义(P<0.05).在为期2年随访中共出现11例肿瘤复发,4例远处转移,两组肿瘤复发率与转移率比较差异无统计学意义(P>0.05).NSCLC患者术后2 d外周血CTC细胞数量与随访2年内肿瘤复发转移呈正相关(rs=0.529,P<0.05).结论 NSCLC患者全胸腔镜下根治术与胸腔镜辅助小切口术后外周血CTC细胞数量均明显增多,外周血CTC细胞数量与肿瘤复发转移呈正相关,外周血CTC细胞数量可作为NSCLC患者预后预测因子.     

中晚期肝癌患者外周血淋巴细胞亚群的研究

目的探讨中晚期肝癌患者外周血淋巴细胞亚群的变化及意义。方法采用流式细胞术检测69例中晚期肝癌患者外周血淋巴细胞亚群的比例,包括CD4＋T细胞（Th1、Th17和Treg）、CD8＋T细胞、NK细胞和NKT细胞,并以20例健康人和28例早期肝癌患者作为对照。结果与健康人相比,中晚期肝癌患者外周血Th1、Th17以及Treg比例均显著升高（P〈0.05）;与早期肝癌患者相比,中晚期肝癌患者外周血Th17细胞比例也明显升高（P=0.016）,而Tc1细胞比例却显著下降（P=0.003）。结论随着肿瘤进展,中晚期肝癌患者外周血淋巴细胞亚群的平衡出现紊乱,提示肿瘤可能通过多种机制影响机体的免疫功能,进而帮助肿瘤进展和转移。     

热休克蛋白90α在 HBV 相关性肝细胞癌中表达的意义

目的：探讨热休克蛋白90α（ HSP90α）在不同转移潜能人肝癌细胞株及HBV相关性肝细胞癌（ HCC）患者血清中表达的临床意义。方法：采用Western blotting、ELISA技术检测不同转移潜能肝癌细胞株及HBV相关性肝癌患者、良性肝病患者和健康对照者血清中HSP90α表达水平;回顾性分析HSP90α表达与临床病理资料间的关系。结果：HSP90α在高转移潜能MHCC97H细胞中的表达水平显著高于无转移潜能HepG2细胞（ P＝0.0002）。肝癌患者及良性肝病患者血清中HSP90α表达水平均明显高于健康对照者（ P＝0.0001）,但肝癌与良性肝病患者间差异无统计学意义（ P＝0.990）。肝癌患者血清HSP90α表达水平女性高于男性（ P＜0.05）,患者年龄、HBeAg是否阳性、AFP水平、HBV DNA水平及TNM分期均无统计学差异（ P＞0.05）。结论：HSP90α与HBV相关性HCC转移潜能相关,可望成为HCC侵袭转移、预后评估及区分HBV相关性肝病与健康者的标志物之一。     

非小细胞肺癌患者血清鳞状细胞癌抗原水平与循环肿瘤细胞的关系研究

目的探讨非小细胞肺癌（NSCLC）患者血清鳞状细胞癌抗原（SCC-Ag）水平与循环肿瘤细胞（CTC）的关系。方法选取NSCLC患者41例（NSCLC组）、健康体检者40例（对照组）及良性疾病者30例（良性组）,采用CellSearch系统检测入选者体内CTC数,酶联免疫吸附试验检测血清SCC-Ag水平并进行对照分析。结果NSCLC组CTC数高于良性组及对照组（均P＜0.05）;NSCLC组CTC数与血清SCC-Ag水平呈正相关（r=0.782,P＜0.05）。结论对于临床可疑的NSCLC患者检测血清SCC-Ag水平与CTC数,能够提高NSCLC的临床检出率,有助于患者进行及时有效的治疗。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.