病理Ⅰ期非小细胞肺癌的诊断与外科治疗

目的探讨工期非小细胞肺癌（NSCLC）患者的诊断与治疗。方法回顾性分析我院1991年至2004年226例Ⅰ期NSCLC的诊疗经过。全组肺叶切除206例，肺段或楔形切除15例，袖状切除5例。结果无围手术期死亡，Ⅰ期NSCLC患者的1、3、5年生存率分别为93．6％、80．3％和66．2％。鳞癌的1、3、5年生存率均比腺癌与腺鳞癌患者的1、3、5年生存率高（P〈0．05）。肺叶切除患者的1、3、5年生存率比肺段或楔形切除患者高（P〈0．05）。结论定期体检及综合检查对Ⅰ期肺癌的早期发现与诊断极为重要。外科治疗可以获得很好的疗效，肺叶切除加纵隔淋巴结清扫是早期肺癌的有较好预后的治疗方案。     

1523例非小细胞肺癌外科治疗的多因素预后分析

目的总结分析外科治疗非小细胞肺癌的多种相关预后因素,以规范非小细胞肺癌的治疗和提高其远期疗效。方法对1991年至2003年我院手术治疗的1523例非小细胞肺癌回顾性临床分析。结果1523例NSCLC中502例Ⅰ期的5年生存率55．03％,378例Ⅱ期41．24％,598例Ⅲ期19．23％,45例Ⅳ期肺癌4．36％,689例NO肺癌的5年生存率49．97％,401例N1的23．18％,406例N2的18．44％,27例N3无5年生存,1年生存率仅21．82％,992例鳞癌的5年生存率42．97％,403例腺癌的26．32％,差异显著（P〈0．01）。结论分期因素,尤其是N因素和病理类型是肺癌预后的最重要相关因素,综合治疗尤其是新辅助化疗有新的前景。     

青年肺癌的诊断与外科治疗

报告我科手术治疗１０６例低于４０岁原发肺癌病人的治疗结果，Ｉ期肺癌５年生存率为４７．８３％，Ⅱ期为４０．００％，ⅢＡ期为１１．６２％，ⅢＢ期为０。病理以小细胞未分化癌多见，其次为腺癌。青年肺癌易误诊，本组误诊率为７８．３０％。本文强调早期诊断，早期手术治疗是改善青年肺癌预后的重要环节。     

青年非小细胞肺癌临床影像分析

目的 探讨青年非小细胞肺癌的临床及影像学特点.方法 回顾性分析78例青年非小细胞肺癌患者的临床资料、胸部影像及癌胚抗原（CEA）的特点.结果 青年非小细胞肺癌中体检发现20例,其中Ⅰ～Ⅱ期15例,Ⅲ～Ⅳ期5例;症状就诊58例,其中Ⅰ～Ⅱ期11例,Ⅲ～Ⅳ期47例,双肺多发结节或栗粒样表现10例;全组患者的中位生存时间为15.0个月,1年生存率55.7％,3年生存率16.4％; CT表现：中央型21例,周围型47例;CEA均值在Ⅰ～Ⅱ期、Ⅲ期及Ⅳ期间差异有统计学意义（P＜0.05）.结论 青年非小细胞肺癌临床症状表现多样、缺乏特异性,影像上表现不典型,但恶性程度高、转移广泛及预后差,胸部CT及CEA检查可早发现及早诊断.     

肺癌术后支气管切缘微小癌灶残留患者的预后分析

目的 探讨肺癌切除术后支气管切缘有微小癌灶残留患者的预后及其影响因素。方法 回顾总结了1965年1月至1995年12月行肺叶或全肺切除手术治疗的非小细胞肺癌患者1218例，支气管切缘微小癌灶残留患者分为黏膜内微小癌灶残留和有黏膜外浸润的微小癌灶残留两类。采用Likelihood Ratio方法对可能影响生存的因素进行差异显著性检验。结果 本组肺癌切除术后支气管切缘有微小癌灶残留患者62例（5．1％），其中MMRD21例，EMRD42例，平均生存期为44个月，5年生存率为33．9％。不同TNM分期的5年生存率分别为I期51．4％、Ⅱ期16．7％、Ⅲa期6．7％，I期明显高于Ⅱ期、Ⅲa(P=0.0011)；MMRD与EMRD的5年生存率分别为57．1％和22．0％，有显著差别（P＝0．0078）；MRD患者术后治疗组的5年生存率为42．86％，明显高于术后未治疗组的15％（P＝0．002）。结论 影响肺癌术后支气管切缘有微小癌灶残留患者预后的因素除肿瘤病理分期外，还有支气管切缘癌残留的方式。手术后放化疗可提高生存率。     

巨噬细胞炎症蛋白1β在非小细胞肺癌中的表达及临床特征

目的研究巨噬细胞炎症蛋白1β（MIP-1β）在非小细胞肺癌（NSCLC）各病理类型中表达及其与肿瘤的临床分期和淋巴结转移的关系。方法采用逆转录聚合酶链反应（RT-PCR）扩增38例新鲜NSCLC癌组织标本MIP-1βmRNA，半定量分析各病理类型MIP-1β基因表达水平。用免疫组化法（IHC）对66例NSCLC石蜡肺组织标本的MIP-1β进行检测，并通过着色面积和着色程度评估阳性率；比较不同病理类型、TNM分期和有无淋巴结转移的肺癌组织中MIP-1β蛋白的表达水平。结果MIP-1βmRNA表达在鳞癌和腺癌间比较无显著差异（1．23±0．29比1．25±0．26），但均显著高于支气管肺泡细胞癌（0．86±0.03）。在肺鳞癌和腺癌的大多数癌细胞胞浆中有MIP-1β蛋白表达，在支气管肺泡细胞癌无明显表达；MIP-1β蛋白表达阳性率在腺癌和鳞癌无显著差异（69.7％比58.6％）。MIP-1β蛋白在NSCLC不同TNM分期中的表达阳性率分别为Ⅰ期74、2％、Ⅱ期29．4％、Ⅲ期85．7％，Ⅰ期与Ⅲ期比较无显著差异（P〉0．05），但二者阳性率均显著高于Ⅱ期（P〈0．05）。MIP-1β有无淋巴结转移的肿瘤中表达阳性率分别为45．8％和76．3％，二者有显著差异。结论MIP-1β可在肺癌肿瘤细胞表达，并与肿瘤的病理类型、TNM分期和有无淋巴结转移有关。     

肾癌的疗效与预后的关系

目的探讨肾癌疗效与预后的关系。方法对100例肾癌患者根据病情选择相应的手术治疗并进行病理分型。结果100例肾癌患者，单纯肾切除10例，部分肾切除5例，肾癌根治术85例；肿瘤直径3-10cm者78例（78．0％），3cm以下者11例（11．0％），10cm以上者11例（11．0％）；Ⅰ期肾癌23例（23．0％），Ⅱ期40例（40．0％），Ⅲ期30例（30．0％），Ⅳ期7例（7．0％）；100例患者经病理检查，其中透明细胞癌71．0％（71／100），颗粒细胞癌18．0％（18／100），混合性腺癌5．0％（5／100），乳头状腺癌3．0％（3／100），集合管癌2．0％（2／100），肉瘤样肾癌1．0％（1／100）；透明细胞癌、颗粒细胞癌和混合性腺癌患者的3年和5年生存率分别为：78．5％、76．2％、77．9％和73．4％、72．7％、72．2％，三者差别无显著性意义；100例B超检查，正确率达93．3％；60例CT检查，诊断正确率100．0％；12例肾动脉造影，诊断正确率100．0％。结论85例肾癌行根治术治疗取得较好的疗效，肾癌预后与肿瘤分期、分级、病理类型和治疗措施有关。     

局部晚期宫颈腺癌及磷癌放射治疗的临床观察

目的：探讨局部晚期宫颈腺癌及磷癌放射治疗的临床疗效。方法：回顾性分析2002年1月至2008年12月本科收住62例宫颈腺癌（宫颈肿瘤中〉4cm,Ⅰb期－Ⅳa期）接受根治性放射治疗,并随机选取同期治疗的62例局部晚期鳞癌患者作为对照组进行比较分析。结果：随访时间36月－60月,局部晚期宫颈腺癌总的5年生率为49．23％,而同期宫颈鳞癌5年生存率为68．90．％（P〈0．01）;Ⅰ期病例二者生存率无显著性差异;Ⅱ期腺磷癌5年生存率为56．20％及84．5％（P=0.037）;Ⅲ、Ⅳ期腺磷癌5年生存率分别为36．2％及49．80％,统计学有显著性差异（P〈0．01）。两组放疗的不良反应接近。结论：应进一步了解宫颈腺癌的生物学行为,提倡早期多学科协作的综合治疗,为临床诊疗实践提供更多的循证医学依据。     

尿嘧啶-替加氟对肺腺癌的辅助化疗

来自西日本肺癌外科研究组的一个Ⅲ期临床试验显示，Ⅰ期、Ⅱ期或Ⅲ期非小细胞肺癌(non-small cell lung cancer，NSCLC)完全切除术后患者接受尿嘧啶—替加氟辅助化疗，能显著延长生存期，尿嘧啶—替加氟组(研究组)的5年生存率为64％，而对照组(术后观察组)仅为49％，P=0．02。亚组分析提示肺鳞癌患者研究组与对照组总生存期差异无统计学意义(P=0．24)。相反．肺腺癌患者研究组生存期明显优于对照组(P=0．009)，且大部分肺腺癌患者为Ⅰ期。因此，日本学者实施了这项Ⅰ期肺腺癌完全切除术后患者接受尿嘧啶—替加氟辅助化疗的随机对照试验。     

肺癌中nm23-H_1蛋白表达及其意义

应用免疫组化ABC法观察nm23－H1蛋白在非小细胞肺癌表达总阳性率为50％（其中鳞癌为48％，腺癌为647％，两者有显著性差异（P＜0．05）），大细胞癌阳性率为16．7％，小细胞肺癌（SCLC），肺炎性假瘤和正常肺组织未见表达。nm23－H1蛋白表达与淋巴结转移没有负相关。nm23－H1阳性病人的生存率显著低于阴性者（P＜0．05）．表明nm23－H基因在肺癌的发生、转移和预后中起着不同程度的作用。     

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.