新辅助化疗TEC方案治疗局部晚期乳腺癌32例

目的观察多西紫杉醇联合表柔比星、环磷酰胺新辅助化疗方案（TEC方案）治疗局部晚期乳腺癌（LABC）的客观缓解率、手术切除率及毒副作用。方法经空芯针活检组织学诊断证实的LABC 32例,Ⅲa期19例,Ⅲb期11例,Ⅲc期2例。行TEC方案术前化疗：多西紫杉醇75 mg/m2,d1静脉输注,表柔比星60 mg/m2,d1静脉输注,环磷酰胺600 mg/m2,d1静脉输注,每3周为1个治疗周期。2个治疗周期后对病灶进行首次评估,以决定是否再给予1-2个周期的TEC化疗后再接受手术或放射治疗。观察化疗效果及毒副作用。结果 32例患者接受2-4个周期TEC方案化疗后,27例降低了临床分期,降期率为84.3%（27/32）;临床完全缓解率及部分缓解率分别为21.8%（7/32）、56.2%（18/32）;手术切除率为100%。常见毒副作用有：轻中度脱发、恶心呕吐、体液潴留、肌肉关节疼痛等,对症处理均可缓解;Ⅲ、Ⅳ度中性粒细胞减少症发生率分别为21.8%（7/32）和9.4%（3/32）。结论 TEC方案治疗LABC患者是安全有效的,可以降低临床分期,为提高综合治疗效果提供了有利条件。     

局部晚期胃癌的新辅助化疗的临床研究

目的 探讨以多西紫杉醇为主联合替加氟及表柔比星的新辅助化疗方案治疗局部晚期胃癌的疗效及毒副作用。方法 自2002年2月——2006年3月,有43例局部晚期胃癌病人入组本次临床研究。入组病人接受的新辅助化疗方案：替加氟500mg／m^3／亚叶酸钙100-200mg,第1～3天,表柔比星50mg／m^,第2天;多西紫杉醇45mg／m^2,第2天,每周为一个周期,共3个周期。观察新辅助化疗后肿瘤原发病灶的缓解情况．并观察毒副反应。结果 所有接受新辅助化疗后的病人临床有效率（CR＋PR）为53,5％（23／43）,其中完全缓解（CR）占9,3％（4／43）,部分缓解（PR）占44．2％（19／43）,痰病稳定（SD）占25．6％（11／43）,疾病进展（pD）占20．9％（9／43）。手术切除率90．7％（39／43）,术后病理水平缓解率11．6％（5／43）,其中3例达到完全缓解。毒副反应主要为白细胞减少症、腹泻、恶心、呕吐、脱发。结论 以多西紫杉醇为主联合替加氟厦表柔比星的新辅助化疗方案在局部晚期胃癌的治疗中近期疗效显著,耐受性良好。     

TE与TEC新辅助化疗方案对乳腺癌的近期疗效和不良反应观察

目的：观察TE与TEC两种新辅助化疗方案对乳腺癌的近期疗效和不良反应。方法：选择2012年8月-2013年10月我院收治Ⅱ-Ⅲ期女性原发性乳腺癌患者167例,按照新辅助化疗方案分为两组,TE组85例和TEC组82例,其中（1）TE方案：多西他赛75mg／m2＋表柔比星50mg／m2,第1天静脉滴注,1个周期为21d;（2）TEC方案：多西他赛75mg／m2＋表柔比星50mg／m2＋环磷酰胺500mg／m2,第1天静脉滴注,1个周期为21d;两组化疗方案均行4个周期,评价两组患者的近期疗效和不良毒副反应。结果：TE组与TEC组临床疗效相比差异无统计学意义（P〉0．05）;两组患者中性粒细胞减少发生率（37．6％US．58．8％）具有统计学差异（χ9．001,P〈0．05）;在血小板、血红蛋白、胃肠道反应、肝功能异常、心脏毒性及脱发不良毒副反应方面差异无统计学意义（P〉0．05）。结论：在Ⅱ-Ⅲ期乳腺癌患者新辅助化疗中,TE与TEC方案近期疗效相似,但中性粒细胞减少的发生率TEC方案明显高于TE方案。     

乳腺癌的新辅助化疗的疗效及预后对比分析

目的通过新辅助化疗提高局部乳腺癌的手术切除的近期和远期疗效并比较两种不同方案新辅助化疗的效果。方法106例局部晚期乳腺癌患者分为两组,A组采取ET（表柔比星40mg／m^2,静脉滴注,第1,2天;多西他赛60mg／m^2,第1天持续1h静脉滴注,21d为1个周期）方案,B组采取CAF（5-FU 500mg／m^2,静脉滴注,第1,8天;多柔比星50mg／m^2,静脉滴注,第1天;环磷酰胺500mg/m^2,第1天,21d为1个周期）方案进行新辅助化疗,观察病理疗效及其与远期生存的关系。结果新辅助化疗总有效率为85．2％,其中ET方案组有效率为88．7％,CAF方案组为72．0％。两组5年生存率和5年无病生存率（DFS）分别为75．4％、71．4％和85．3％、58．9％。结论本研究结果表明,ET组较CAF组新辅助化疗更敏感,更易获得临床完全缓解（cCR）、病理完全缓解（pCR）,两组差异无统计学意义（P〉0．05）。ET组的5年无病生存率（DFS）为85．3％,显著优于CAF组,但5年总生存率两组无统计学差异。     

紫杉醇类新辅助化疗乳腺癌疗效观察

目的探讨含紫杉醇类新辅助化疗方案治疗乳腺癌的临床疗效。方法选取我院2002年6月至2009年11月收治的女性乳腺癌患者31例,分别采用TEC（表柔比星60mg/m2静脉滴注第一天,环磷酰胺500mg/m2静脉注射第一天,多西他赛75mg/m2静脉滴注第二天,21d为一个周期）与FEC（氟尿嘧啶500mg/m2静脉滴注第一天,表柔比星100mg/m2静脉滴注第一天,环磷酰胺500mg/m2静脉注射第一天,21d为一个周期）方案进行2-4个周期新辅助化疗,并对两组患者的疗效与不良反应进行对比分析。结果 TEC方案组有效率为93.3%,FEC方案组有效率为62.5%,两组比较差异有统计学意义（P〈0.05）;两组脱发、皮疹、静脉炎、肝功能异常等不良反应相似,TEC组白细胞下降、周围神经毒性发生率较高,FEC组恶心呕吐发生率较高。结论在乳腺癌新辅助化疗中,含紫杉醇类方案较传统方案显示出更好的疗效,而不良反应无明显增加。     

吡柔比星或表柔比星联合紫杉醇新辅助化疗治疗局部晚期乳腺癌的随机对照研究

目的观察吡柔比星或表柔比星联合紫杉醇新辅助化疗治疗局部晚期乳腺癌(LABC)的近期临床疗效和毒副反应。方法采用随机对照研究,40例LABC行吡柔比星联合紫杉醇方案(PT组)或表柔比星联合紫杉醇方案(PE组)行新辅助化疗。记录患者每周期肿块大小、术后病理以及毒副反应分度。结果两组患者均接受共6个疗程的化疗。其中39例新辅助化疗2～4个周期后行手术治疗,手术后完成剩余疗程;1例新辅助化疗6周期后行手术治疗。PT组20例病理完全缓解率(pCR)、临床完全缓解率(cCR)以及临床部分缓解率(cPR)分别为10.0%、20.0%和75.0%,PE组为5.0%、30.0%、70.0%,两组总有效率(RR)无统计学差异。化疗过程中两组心脏毒性和造血系统毒性均为Ⅰ～Ⅱ度,且无统计学差异;PT组Ⅲ度胃肠道反应(恶心、呕吐)发生率45.0%,低于PE组的90.0%(P<0.05)。结论吡柔比星或表柔比星联合紫杉类新辅助化疗治疗LABC近期疗效较好,化疗后手术切除率高,心脏毒性及骨髓抑制较轻,但PT较PE方案胃肠道毒副反应有显著改善。     

DE方案在局部晚期乳腺癌新辅助化疗中的临床疗效

目的:观察DE方案在局部晚期乳腺癌新辅助化疗中的临床疗效。方法:采用DE(DXL+EPI)联合方案:多西紫杉醇75 mg/m2,静脉滴注。第1天,表柔比星30 mg/m2静脉注射,第2天,第8天;以上方案每3周重复。化疗期间定期复查血、尿常规,肝、肾功能及心电图等评价毒副作用,必要时应用升白药物治疗,2个周期后评价疗效。结果:本组32例,CR 4例,PR 17例,SD 7例,PD 4例,总有效(CR+PR)率71.06%。治疗期间未发生严重毒副反应。结论:多西紫杉醇与表柔比星联合对于LABC是一种安全有效的新辅助化疗方案,患者治疗后可明显提高手术切除率,减少复发转移。     

紫杉醇联合表柔比星在乳腺癌新辅助化疗中的疗效

目的研究表柔比星加紫杉醇新辅助化疗方案治疗乳腺癌的近期疗效及毒副反应。方法用TE方案（紫杉醇加表柔比星）对20例乳腺癌进行新辅助化疗,3～4周为1个周期,患者完成2～4个周期后评价疗效。TE方案：表柔比星（EPI）60mg/m2,第1天,静脉注射;紫杉醇（TAX）150mg/m2,第2天,静脉点滴;3周为1个周期。结果有效率为80%,其中临床完全缓解（cCR）3例,部分缓解（PR）13例,无变化（NC）4例。结论在乳腺癌患者新辅助化疗中,表柔比星联合紫杉醇有较好的疗效。     

TE/TEC两种新辅助化疗方案治疗乳腺癌的近期疗效对比

目的：探索多西他赛联合表柔比星加/不加环磷酰胺（TE/TEC）两种新辅助化疗方案对乳腺癌的近期临床治疗效果。方法选择2012年2月—2014年2月我院收治的40例乳腺癌患者,按照化疗方案的不同将其分为观察组和对照组,每组20例患者。对照组给予多西他赛联合表柔比星辅助化疗,观察组在对照组的基础上加用环磷酰胺辅助化疗,对比分析2组患者的近期疗效。结果观察组治疗总有效率高于对照组,总不良反应率低于对照组,差异均有统计学意义（P<0.05）。结论在Ⅱ期和Ⅲ期乳腺癌患者的辅助化疗中,多西他赛联合表柔比星加环磷酰胺化疗方案的近期疗效显著,安全性较高,值得在临床推广使用。     

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.     

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.     

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.