原发性肝癌肝动脉化疗栓塞联合三维适形放射治疗的临床应用

目的探讨肝动脉化疗栓塞（TACE）联合三维适形放疗（3D-CRT）对原发性肝癌（PHC）的临床应用及疗效。方法对30例原发性肝癌患者,先采用TACE后行3D-CRT。TACE1次者12例,2-3次以上者18例,放射治疗单次分割剂量3-5Gy,总剂量54-64Gy。结果治疗后1年、2年的肿瘤有效率分别为90%、68%。1、2年生存率分别为90%、46.7%。中位生存期20个月,无严重并发症。结论 PHC进行TACE联合3D-CRT治疗是一种有效临床应用方法。     

肝动脉栓塞联合三维适形放疗治疗原发性肝癌30例

目的:探讨肝动脉栓塞化疗(TACE)联合三维适形放疗(3D-CRT)治疗原发性肝癌的疗效及副作用。方法:对30例原发性肝癌患者行TACE联合3D-CRT治疗,TACE灌注药物:羟基喜树碱50mg,5-氟尿嘧啶1.0～1.25,丝裂霉素(MMC)6～10mg,栓塞剂用40%超液态碘化油5～10ml和丝裂霉素(MMC)6～10mg的混悬液;三维适形放疗采用6MV-X,使用WD-CFMTPS2000(1.00A版)治疗计划系统进行计划设计:90%等剂量线包绕PTV,15～20f,3～5次/周,总剂量DT 40～60Gy,在两次TACE后行3D-CRT。结果:TACE联合3D-CRT治疗,3年生存率为33%,3年局部控制率为36.6%,且无明显副作用。结论:肝动脉栓塞化疗联合三维适形放疗治疗原发性肝癌疗效较好,且安全、无明显副作用,3年生存率高。     

三维适形放疗联合介入治疗原发性肝癌的疗效观察

目的 评价肝动脉化疗栓塞(TACE)结合三维适形放射治疗(3D-CRT)原发性肝癌的疗效.方法 48例患者随机分为两组,介入治疗联合3D-CRT组(A组)24例,行TACE术2次后加3D-CRT治疗,总剂量45～54 Gy.单纯行介入治疗组(B组)24例,行TACE术3～4次.结果 近期疗效,A组有效率(CR+PR)为70.8%,1、2年生存率分别为83.3%、54.2%.B组有效率(CR+PR)为33.3%,1、2年生存率分别为54.2%、25%.两组比较有显著性差异(P<0.05).结论 ACE联合三维适形放疗是不能手术切除的晚期肝癌的一种有效的治疗方法.     

三维适形放射治疗联合肝动脉化疗栓塞治疗原发性肝癌32例

目的:评价三维适形放射治疗(3-DCRT)联合肝动脉化疗栓塞(TACE)对原发性肝癌(PHC)综合治疗的疗效。方法:对32例PHC进行TACE合并3-DCRT序贯治疗。先采用TACE 1～3次,再进行3-DCRT。每次分割剂量4～7Gy,肿瘤剂量40～55 Gy,隔日1次。结果:32例患者中,部分缓解17例,稳定12例,进展3例,总有效率53.1%。1、2、3年生存率分别为56.3%、27.1%和15.5%,中位生存时间11个月。T分期、GTV和分割剂量对生存率的影响无显著差异,Child-Pugh肝硬化分级是患者独立的预后因子。结论:3DCRT联合TACE综合治疗PHC安全、有效,值得进一步研究。     

三维适形放射治疗中晚期原发性肝癌近期疗效观察

目的:分析三维适形放疗(3D-CRT)治疗中晚期原发性肝癌的近期疗效。方法:对15例中晚期原发性肝癌采用采用高剂量低分割的方法。每周3次,每次3.5GY～4.0GY,肿瘤总剂量45GY～55GY。3个月～6个月随访。疗效按WHO肿瘤近期疗效标准进行。结果:15例均完成治疗,CR5例PR6例NC3例PD1例。结论:三维适形放疗对中晚期原发性肝癌有较好的姑息治疗作用,能够延长中晚期原发性肝癌的生存期。     

介入化疗联合三维适形放疗治疗原发性肝癌的临床疗效

目的探讨肝动脉介入化疗栓塞术（TACE）联合三维适形放疗（3DCRT）综合治疗原发性肝癌的疗效。方法42例原发性肝癌患者随机分为A组、B组,A组21例先予TACE治疗1～2次,3周后进行3DCRT,放射剂量为2～3GY/次,5次/周,总剂量为48～54GY;B组21例单纯行TACE治疗2～3次。结果A组有效率85.7%,B组有效率61.9%,A组有效率明显高于B组（P〈0.05）,A组1、2年生存率为71.4%和52.4%,B组的1、2年生存率分别为42.9%和19%。A组生存率明显高于B组（P〈0.05）。两组毒副作用无明显差异。结论TACE结合3DCRT能提高不能手术切除原发性肝癌的疗效,而毒副作用不增加,可以耐受。     

TACE联合大分割3D-CRT治疗原发性肝癌的初步临床研究

目的初步观察原发性肝癌经皮肝动脉栓塞化疗(TACE)联合大剂量分割的三维适形放射治疗(3D-CRT)的疗效和毒性,探讨这种治疗模式的可行性与价值。方法对8例患者共13个病灶行1～4程TACE后,采用大分割模式的共面或非共面多野X线3-DCRT治疗,3～8Gy/次,3次/周,总剂量40～60Gy,LQ模型生物等效剂量52～84Gy。结果放疗结束1个月后复查,全部病灶中完全消退、部分消退和稳定者各占23.1%(3/13)、46.1%(6/13)和30.8%(4/13)。总有效率69.2%(9/13),临床获益率100%。随访1～5个月,全组中有1例发生放射性肝病。结论TACE联合大剂量分割3-DCRT治疗原发性肝癌安全并有好的近期疗效,值得设置前瞻性随机临床试验研究其远期疗效及影响预后的因素。     

立体定向放疗结合TACE治疗原发性肝癌的临床研究

目的观察评价立体定向放疗体部伽玛刀联合经肝动脉栓塞化疗（TACE）治疗原发性肝癌（PHC）的临床疗效。方法对36例不能手术切除的原发性肝癌患者，随机分为2组：单纯TACE组（A组）20例，TACE＋伽玛刀组（B组）16例，观察比较肝癌患者治疗后的近期疗效、局控率、生存期及并发症。36例患者中单发病灶21例，多结节病灶15例。TACE1次者22例，1次以上者14例。伽玛刀放射治疗剂量在36～42Gy间。结果A、B组治疗后3个月、1年肿瘤局部控制率分别为75.0％（15／20）、93．8％（15／16）和65．0％（13／20）、81．3％（13／16）；其中A组完全缓解7例，部分缓解6例，稳定2例．进展5例，B组完全缓解8例。部分缓解5例，稳定0例。进展3例。A、B组1年生存率分别为70．1％和92．2％，中位生存期9，2个月和11．8个月。结论新型立体定向放疗印-伽刀治疗联合TACE是治疗PHC的有效的无创治疗手段。     

中晚期贲门癌的三维适形放射治疗疗效分析

目的分析比较中晚期贲门癌三维适形放射治疗与手术治疗的疗效。方法 2000年1月至2006年1月间将83例中晚期贲门癌患者随机分为3D-CRT组和手术组进行对比治疗。3D-CRT组50例,4～5.5GY/次,隔日1次,10～12次完成治疗,肿瘤灶总剂量DT48～62GY;手术组33例（手术切除25例、探查术8例）。结果 3D-CRT组梗阻症状改善率100%,治疗结束后3个月复查CT,肿块完全消失34例,缩小1/2以上者11例,不足1/2者5例。完全缓解（CR）35例,部分缓解（PR）15例。3D-CRT组和手术组1、2、3年生存率分别为86%和69.7%,56%和45.4%,44%和18.2%。结论 3D-CRT组的疗效明显优于手术组,3D-CRT是中晚期贲门癌的重要治疗手段。     

肝癌介入治疗联合三维适形放疗的疗效观察

目的探讨原发性肝癌（PHC）采用动脉化疗栓塞（TACE）联合三维适形放疗（3D-CRT）的临床疗效,为更好地进行临床应用提供依据。方法将该院收治的PHC患者55例,随机分为观察组28例和对照组27例。观察组行TACE联合3D-CRT治疗;对照组行单纯TACE治疗。结果观察组近期有效率（71.43%）明显高于对照组（29.63%）,1年内观察组患者生存率（60.71%）明显优于对照组（29.63%）,两组比较差异有统计学意义（P〈0.05）;两组不良反应比较,差异无统计学意义（P〉0.05）,经治疗后缓解。结论 PHC采用TACE联合3D-CRT进行非手术治疗效果显著,可进一步在临床推广应用。     

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.