肺癌脑转移44例治疗分析

目的 比较不同治疗方法对肺癌脑转移的疗效.方法 对44例肺癌脑转移患者资料进行回顾性分析.根据治疗方法的不同分为单纯放疗组23例(全脑放疗10例,立体定向放疗13例),全脑放疗或立体定向放疗联合全身化疗(放疗+化疗)组17例,对症治疗组4例,比较其生存期和生存率.结果 单纯放疗组的中位生存期为8.3个月,1年生存率为17.4%;放疗+化疗组中位生存期为13.2个月,1年生存率为52.9%;对症治疗组的中位生存期为1.7个月,1年生存率为0%.放疗+化疗组比单纯放疗及对症治疗组具有更好的疗效(P＜0.05).结论 放疗联合化疗是肺癌脑转移患者比较有效的治疗方法,可延长生存期.     

肺癌脑转移61例临床分析

目的比较不同治疗方法对肺癌脑转移的疗效。方法对61例肺癌脑转移患者的临床资料进行回顾性分析,根据治疗方法的不同分为单纯放疗组28例,全脑放疗联合全身化疗组（放疗＋化疗）33例,比较其生存期和生存率。结果所有患者诊断脑转移的中住生存时间是8．5个月,2组总有效率无明显差异。单纯放疗组的中位生存期为7．1个月,1年生存率为14．3％;放疗＋化疗组中位生存期为11．3个月,1年生存率为39．4％,放疗＋化疗比单纯放疗具有更好的疗效（P〈0．05）。结论放疗联合化疗是肺癌脑转移患者比较有效的治疗方法,可延长生存期。     

肺癌脑转移86例预后因素分析

目的：探讨影响肺癌脑转移预后的因素。方法：回顾分析我院2007年1月至2011年12月86例肺癌脑转移患者的临床资料,根据治疗方法不同分为未治疗组（24例）、放疗组（32例）和放疗＋化疗组（30例）,随访患者的生存时间,并分析影响患者预后的因素。结果：未治疗组、单纯放疗组、放疗＋化疗组患者的中位生存期分别为2.0个月、3.5个月、15.5个月,放疗＋化疗组患者的生存期明显长于未治疗组和放疗组（P＜0.01）。Cox模型逐步法分析显示,RPA分级、诊断肺癌时有无症状、贫血、治疗方法和吸烟史是肺癌脑转移的独立预后因素。结论：积极治疗（放疗＋化疗）可延长患者生存时间;肺癌脑转移患者无吸烟史、无症状、RPA分级Ⅰ级为良好预后因素,在治疗过程中应预防或积极纠正贫血。     

用全身化疗联合同步脑放疗治疗NSCLC脑转移的疗效观察

目的：探讨用全身化疗联合同步脑放疗治疗NSCLC（非小细胞肺癌）脑转移的临床效果。方法：对2011年2月～2013年2月期间我院收治的80例NSCLC脑转移患者的临床资料进行回顾性研究。我们将这80例患者随机分为观察组和对照组,每组各有40例患者。我院使用全身化疗联合序贯脑放疗的方法对对照组患者进行治疗,使用全身化疗联合同步脑放疗的方法对观察组患者进行治疗。治疗结束后,比较两组患者治疗的效果和生存的时间。结果：经过治疗,观察组患者病情的总缓解率为20%,对照组患者病情的总缓解率为22.5%。两组患者病情的总缓解率大体相同,二者相比差异无显著性（p＞0.05）。观察组患者平均的生存时间为3.5±2.3个月,对照组患者平均的生存时间为3.6±1.1个月。两组患者平均的生存时间大体相同,二者相比差异无显著性（p＞0.05）。观察组患者1年的生存率37.5%,对照组患者1年的生存率为17.5%。观察组患者1年的生存率明显高于对照组患者,二者相比差异具有显著性（P＜0.05）。结论：用全身化疗联合同步脑放疗治疗NSCLC脑转移可有效地提高患者的1年生存率。此疗法值得在临床上推广使用。     

352例肺癌脑转移患者治疗及预后分析

目的 分析针对肺癌脑转移的治疗方法与患者预后的关系.方法 回顾性分析352例肺癌脑转移患者的临床资料.根据治疗方法的不同分为对症治疗组28例、单纯放疗或单纯化疗组(单纯放化疗组)49例和综合治疗组275例.综合治疗组又分为放疗联合化疗组(n=192)、立体定向放射治疗(γ刀)联合化疗或放化疗组(n=72)(联合化疗16例,联合放化疗56例)和手术联合化疗或放化疗组(n=11);其中111例化疗≤3周期,164例化疗≥4周期.描绘各组生存曲线,比较生存期和生存率.结果 对症治疗组、单纯放化疗组、放疗联合化疗组、γ刀联合化疗或放化疗组和手术联合化疗或放化疗组患者的中位生存期分别为1.7、3.2、9.O、11.6、17.1个月.生存率分析显示.放疗联合化疗组优于单纯放化疗组(P=0.0000);γ刀联合化疗或放化疗组优于单纯放化疗组(P=0.0000);手术联合化疗或放化疗组优于单纯放化疗组和放疗联合化疗组(P=0.0001,P=0.0229),但与γ刀联合化疗或放化疗组比较差异无统计学意义(P=0.2543);γ刀联合放化疗与γ刀联合化疗患者的生存率比较差异无统计学意义(P=0.3804);综合治疗组中,化疗≥4周期患者的生存率明显高于化疗≤3周期的患者,差异有统计学意义(P=0.0000).结论 放疗联合化疗或γ刀联合放化疗是肺癌脑转移患者合适的治疗方法,后者的生存获益有好于前者的趋势;γ刀联合放疗与否对患者的生存期无明显影响;化疗以不少于4个周期为宜.     

352例肺癌脑转移患者治疗及预后分析

目的 分析针对肺癌脑转移的治疗方法与患者预后的关系.方法 回顾性分析352例肺癌脑转移患者的临床资料.根据治疗方法的不同分为对症治疗组28例、单纯放疗或单纯化疗组(单纯放化疗组)49例和综合治疗组275例.综合治疗组又分为放疗联合化疗组(n=192)、立体定向放射治疗(γ刀)联合化疗或放化疗组(n=72)(联合化疗16例,联合放化疗56例)和手术联合化疗或放化疗组(n=11);其中111例化疗≤3周期,164例化疗≥4周期.描绘各组生存曲线,比较生存期和生存率.结果 对症治疗组、单纯放化疗组、放疗联合化疗组、γ刀联合化疗或放化疗组和手术联合化疗或放化疗组患者的中位生存期分别为1.7、3.2、9.O、11.6、17.1个月.生存率分析显示.放疗联合化疗组优于单纯放化疗组(P=0.0000);γ刀联合化疗或放化疗组优于单纯放化疗组(P=0.0000);手术联合化疗或放化疗组优于单纯放化疗组和放疗联合化疗组(P=0.0001,P=0.0229),但与γ刀联合化疗或放化疗组比较差异无统计学意义(P=0.2543);γ刀联合放化疗与γ刀联合化疗患者的生存率比较差异无统计学意义(P=0.3804);综合治疗组中,化疗≥4周期患者的生存率明显高于化疗≤3周期的患者,差异有统计学意义(P=0.0000).结论 放疗联合化疗或γ刀联合放化疗是肺癌脑转移患者合适的治疗方法,后者的生存获益有好于前者的趋势;γ刀联合放疗与否对患者的生存期无明显影响;化疗以不少于4个周期为宜.     

全脑放疗联合靶向治疗与同步放、化疗治疗非小细胞肺癌脑转移疗效分析

目的 比较全脑放疗联合靶向治疗与同步放、化疗治疗非小细胞肺癌(NSCLC)脑转移的近期疗效、远期生存率及不良反应.方法 对58例NSCLC脑转移患者的临床资料进行回顾性分析.36例患者接受全脑放疗联合靶向治疗(每日口服吉非替尼250 mg或厄洛替尼150 mg),22例患者接受全脑放疗及含铂为主的同步化疗.用Kaplan Meier法和Logrank法对患者进行生存分析,并比较两组之间的疗效差异.结果 全脑放疗联合靶向治疗组疾病控制率为66.7％,同步放、化疗组疾病控制率为36.4％,全脑放疗联合靶向治疗组明显高于同步放化疗组(P＜0.05).全脑放疗联合靶向治疗组1年生存率为68％,中位生存期23.2个月.同步放、化疗组1年生存率为41％,中位生存期7.1个月.全脑放疗联合靶向治疗组中位生存期优于同步放、化疗组(P＜0.05).结论 全脑放疗联合靶向治疗NSCLC脑转移的疾病控制率高于同步放、化疗,且患者生存时间延长.     

不同方式治疗肺癌脑转移的疗效比较

目的 :探讨对肺癌脑转移患者行手术、放疗及辅以联合化疗后的疗效比较。方法 :38例肺癌脑转移病例分成手术组 9例、放疗组 6例、手术 +化疗组 13例、放疗 +化疗组 10例 ,对治疗后中位生存期、生存率进行分析。结果 :手术 +化疗组和放疗 +化疗组的中位生存期分别为 10 7月和 8 5月 ,1年生存率为 38 5 %和 30 0 % ,明显优于单纯手术组的 6 4月和 2 2 2 %、单纯放疗组的 6月和 16 7% (P <0 0 5 )。结论 :肺癌脑转移单纯手术或单纯化疗后行联合化疗 ,能有效提高患者的生存时间和生存质量     

全脑放疗联合EGFR-TKIs与联合化疗在非小细胞肺癌脑转移治疗中的疗效评价

目的对比非小细胞肺癌脑转移治疗中应用全脑放疗联合表皮生长因子受体酪氨酸激酶抑制剂(EGFRTKIs)或者联合化疗的不同效果。方法选择2015年4月至2017年8月我院非小细胞肺癌脑转移80例患者,一组40例为观察组接受全脑放疗联合EGFR-TKIs治疗,一组40例为对照组接受全脑放疗联合化疗治疗,比较两组效果。结果观察组治疗后总有效率为65%,高于对照组治疗总有效率47.5%,P0.05;观察组无进展生存期、总生存时间均长于对照组,P0.05。结论全脑放疗联合EGFR-TKIs治疗非小细胞肺癌脑转移患者能够延长患者无进展生存时间,获得更高临床疗效,值得临床推广。     

脑转移瘤120例诊治分析

目的:探讨脑转移瘤的诊断、治疗和预后。方法:回顾性分析120例脑转移瘤的临床资料。结果:脑转移瘤多来源于肺癌,女性以乳腺癌多见,临床表现以脑瘤型为主,占55.8%,放疗加化疗组、单纯放疗组、手术加放、化疗组及对症治疗组1年生存率分别为23.7%、9.4%、37.5%和0,中位生存期分别为6.5个月、5.5个月、9.3个月和3.2个月。综合组(放疗加化疗组,手术加放、化疗组)1年生存率显著高于单纯放疗组和对症治疗组(P<0.05)。影响预后的主要因素为是否采取综合治疗、原发灶控制和放疗剂量。结论:采取以放疗为主的综合治疗,可以明显改善脑转移瘤患者的临床症状和生存期,提高患者的生存质量。     

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.