胃黏膜相关淋巴组织淋巴瘤的临床探讨——附8例病例分析

目的探讨胃黏膜相关淋巴组织(MALT)淋巴瘤的临床诊断、病理特征和治疗。方法收集我院1999年1月～2006年12月共8例胃MALT淋巴瘤,采用胃镜、病理组织学和免疫组化标记对其临床、病理资料和治疗方面进行分析。结果8例胃MALT淋巴瘤中,男性发病率高于女性,平均年龄54.5岁(40～77岁),临床表现和辅助检查无明显特异性,诊断有赖于病理和免疫组化,病理学上以低度恶性淋巴瘤多见,免疫组化标记证实全部为B细胞性淋巴瘤。经手术、化疗和根除Hp治疗,患者6例存活。结论提高对胃MALT淋巴瘤的认识,有助于明确诊断。治疗以化疗为主,配合放疗。对幽门螺旋杆菌(Hp)的治疗可缓解胃MALT淋巴瘤。     

37例黏膜相关淋巴组织型淋巴瘤的病理、临床资料分析

目的：为开展黏膜相关淋巴组织型（MALT）淋巴瘤的标准化诊断和规范化治疗提供病理及临床依据。方法：对我院2000年1月至2002年6月诊断的37例MALT型淋巴瘤的病理、临床分期、恶性程度、预后因素及治疗进行回顾性分析。结果：442例非霍奇金淋巴瘤（NHL）中MALT型39例占8.82%（可追踪病例37例），发病中位年龄52岁，50岁以上患者占63．6％。MALT型NHL的发病部位以胃肠最多见，共28例，占71．8％；其次为甲状腺、腮腺、眼眶、肺。MALT型NHL中低度恶性占70．3％，低度恶性伴转化（中度恶性）占27％。临床分期I期占53．6％，Ⅱ期28.6%,Ⅲ期14．3％，Ⅳ期3．6％。37例可追踪MALT型NHL的病理标本中35例表达CD20抗原，2例不确定，其中4例疑难病例通过PCR检测IgH克隆性重排协助诊断。13例胃MALT型淋巴瘤行幽门螺杆菌（HP）检测，阳性率为46．15％。胃MALT型淋巴瘤患者均接受抗HP三联治疗，仅1例接受单纯抗生素治疗。28例胃肠MALT型淋巴瘤患者除5例外，均曾接受手术治疗；多数患者接受系统化疗，部分加局部放疗，尚无接受单纯胃放射治疗者。结论：MALT型淋巴瘤多发生于老年患者，以低度恶性为主，肿瘤发展进程缓慢；不同的发病部位、分类、分期及分子遗传学改变均为重要的预后风险因素，可用于协助选择合适的治疗方案。     

胃肠MALT淋巴瘤临床及病理分析

目的观察胃肠道粘膜相关淋巴组织结外边缘区B细胞淋巴瘤（MALT淋巴瘤）临床和病理特点。方法收集整理中山大学附属第二医院2000年1月-2006年12月间的MALT淋巴瘤的临床资料，通过光镜和免疫组化染色进行病理组织学观察。结果29例MALT淋巴瘤中，多发生于胃，临床主要表现为胃肠道疾病非特异性症状。镜下主要由小淋巴细胞组成，可伴有少量大细胞和淋巴上皮样病变。瘤细胞表达B淋巴细胞免疫标记：CD20和CD79α，部分病例表达CIM3和bcl-2。结论胃肠道MALT淋巴瘤好发于胃，临床症状无特异性，通过常规病理检查和免疫组化染色可以确诊。     

肺黏膜相关淋巴组织结外边缘区淋巴瘤临床分析

目的探讨肺黏膜相关淋巴组织（MALT）结外边缘区淋巴瘤的临床特点。方法收集经病理学诊断的8例肺MALT淋巴痛及其组织腊块,对组织腊块进行免疫组化染色;并回顾性总结该病临床表现、影像学改变、病理学特点、治疗、预后及复习相关文献。结果8例患者经病理证实为肺MALT淋巴瘤;其临床症状、影像学表现无特异性;4例通过手术诊断,4例通过经皮肺活检诊断;所有标本免疫组化CD20、PAX-5阳性,CD3、CD10、CD23、Bcl-6及cyclinDl阴性。4例手术患者中,3例术后无其他治疗,1例行1周期CHOP方案化疗;北手术的4例患者分别进行了不同周期以CHOP方案为基础的化疗,获得不同程度的效果。结论肺MALT淋巴瘤发病率低,病因欠清楚,临床表现及影像学无特异性,诊断依赖病理组织学及免疫组化并排除其他疾病后明确。     

幽门螺杆菌相关性胃淋巴样组织淋巴瘤85例分析

目的探讨幽门螺杆菌(Hp)相关胃淋巴样组织(MALT)淋巴瘤的临床特征及诊治措施。方法Hp相关胃MALT淋巴瘤85例,对其临床特点、病变位置、胃镜下形态、粘膜活检、组织学检查诊断、治疗等进行分析。结果临床表现以上腹饱满不适、恶心等为主,其余症状不典型;病变位置以胃角胃窦为主;恶性程度高度46例,中度7例,低度32例;所有患者均有Hp感染。手术联合术后化疗总有效率96.61%;抗Hp治疗总有效率80.77%。结论Hp相关胃MALT淋巴瘤临床症状不典型。手术联合术后化疗是有临床症状患者的首选方法,根除Hp治疗适用于无临床症状的患者。     

42例胃肠原发性淋巴瘤病理与临床

目的提高胃肠原发性淋巴瘤的病理与临床诊断和治疗效果。方法回顾分析本院近13年来收治的经病理确诊的42例胃肠原发性淋巴瘤的病理和临床资料，统计方法采用t检验。结果本组术前消化道钡餐（GI）和胃肠镜活检诊断率较低，手术切除率为95.2%，比本院胃肠癌的手术切除率(83.6%)高，本组病例经免疫组化ABC法标记均为B细胞淋巴瘤。部分胃淋巴瘤上皮内查见幽门螺杆菌(HP)。结论胃淋巴瘤部分伴有HP感染，两者可能有某种因果关系。GI和胃肠镜相结合，多块深部取材可提高术前诊断率。手术切除，正确的病理诊断，再加合理的、及时的放疗和化疗可提高胃肠淋巴瘤的生存时间。     

胃粘膜相关淋巴样组织淋巴瘤的临床探讨

目的 探讨胃粘膜相关淋巴样组织淋巴瘤(MALT)的临床表现、诊断和治疗。方法 收集三家医院1990—2001年16例胃MALT患者，采用胃镜检查、病理组织学和临床治疗资料进行分析。结果 临床表现无明显特异性，以低度恶性胃MALT多见，经手术或根除幽门螺杆菌(Hp)治疗，2例手术不能切除的高度恶性胃MALT患者死亡。结论 提高对胃MALT的认识，有助于及早确诊，手术治疗为最重要手段，对低度恶性胃MALT患者，根除Hp治疗亦能取得满意效果。     

42例胃肠原发性淋巴瘤病理与临床

目的：提高胃肠原发性淋巴瘤的病理与临床诊断和治疗效果。方法：回顾分析本院近13年来收治的经病理确诊的42例胃肠原发性淋巴瘤的病理和临床资料，统计方法采用t检验。结果：本组术前消化道钡餐（GI）和胃肠镜活检诊断率较低，手术切除率为95.2%，比本院胃肠癌的手术切除率（83.6%)高，本组病例经兔疫组化ABC法标记均为B细胞淋巴瘤。部分胃淋巴瘤上皮内查见幽门螺杆菌（HP）。结论：胃淋巴瘤部分伴有HP感染，两可能有某种因果关系。GI和胃肠镜相结合，多块深部取材可提高术前诊断率。手术切除，正确的病理诊断，再加合理的、及时的放疗和化疗可提高胃肠淋巴瘤的生存时间。     

18例胃黏膜相关淋巴组织淋巴瘤临床分析

目的  提高对胃黏膜相关淋巴组织（MALT）淋巴瘤的诊疗水平,提高其治愈率。方法  对九江学院附属医院2006~2013年胃MALT淋巴瘤病例资料进行回顾性分析。结果  胃镜检查示胃MALT淋巴瘤疑似病例67例,病理确诊胃MALT淋巴瘤18例,内镜病理诊断符合率26.9%。18例确诊中患者男女比例为1:1.25,平均年龄（54.2±8.7）岁。临床症状以上腹部疼痛最常见15例（83.3%）,恶心、呕吐14例（77.8%）,纳差11例（61.1%）、消瘦7例（38.9%）,呕血、黑便3例（16.7%）。内镜下表现为广泛、多发溃疡或结节样病变,病变位于胃窦部7例,胃体部9例,同时累及胃窦、胃体部2例。12例中7例检测幽门螺杆菌感染阳性,阳性率58.3%。18例患者中经手术+术后化疗7例;单纯化疗5例;根除HP治疗3例;根除HP治疗+手术3例。结论  胃MALT淋巴瘤临床、内镜下特点特异性差,极易误诊;胃MALT淋巴瘤治疗首选根除HP治疗,对于转移和根除HP治疗效果不佳时,需进一步放化疗或联合手术治疗。

     

原发性胃黏膜相关淋巴组织淋巴瘤的诊断和治疗

目的 探讨原发性胃黏膜相关淋巴组织(Mucosa Associated Lymphoid Tissue, MALT)淋巴瘤的临床特点和诊治方法,以提高临床确诊率.方法 对2000年8月～2010年8月在笔者所在医院经病理证实的56例胃MALT淋巴瘤的临床特点、内镜检查及病理资料进行回顾性分析.结果本组56例患者,平均年龄51.8岁.Ann Arbor临床分期为:ⅠE期31例,ⅡE期17例,ⅢE期6例,ⅣE期2例.本组患者内镜活检确诊率为48.2%,5年生存率为74.6%.结论 胃MALT淋巴瘤的临床表现缺乏特异性,确诊应根据内镜下多处活检、取材要深,结合病理特点和免疫组化结果来综合判断.抗幽门螺杆菌、放疗、化疗等非手术已经成为原发性胃MALT淋巴瘤目前主要治疗方法.     

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.     

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.     

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.