晚期和复发头颈癌立体定向放射治疗近期疗效观察

目的 探讨晚期和复发头颈癌立体定向放射治疗的近期疗效、并发症等。方法 １９９７年１０月至１９９８年１０月采用立体定向放射治疗（ＳＲＴ）晚期和复发的头颈癌２８例,其中ＮＰＣ１７例,鼻腔副鼻窦肿瘤４例,舌根癌３例,喉癌２例、颈段椎管内髓外肿瘤术后残留外侵１例,软腭癌１例,肿瘤体积在,最大径２．５￣７．０ｃｍ,中位数４．５ｃｍ,１５例患者有严重的局部疼产能等闰状,３例有鼻阻塞、照射剂量４￣８Ｇｙ／次,隔     

影响体部立体定向放射治疗摆位重复性的因素分析

立体定向放射治疗（ＳＲＴ）以具有定位精确、高剂量集中于病灶部位且周围健康组织损伤小等优势,而成为当今放射治疗的重要手段之一。在治疗过程中,准确地重复摆位是实现ＳＲＴ计划的关键。本文对影响摆位重复性的因素进行了分析。１　材料与方法１．１　临床资料　　采用ＳＲＴ技术治疗躯干肿瘤患者６２例,男４５例,平均年龄５９．１岁;女１７例,平均年龄６１．５岁,其中胸部肿瘤２５例,腹部肿瘤１９例,盆腔肿瘤１８例。所有病人均采用分次治疗,分３～７次,隔日１次。单次剂量４～８Ｇｙ,总剂量２０～４０Ｇｙ。靶区边缘等剂量…     

直线加速器立体定向放射手术治疗颅内疾患

从１９９４年７月～１９９５年２月用ＳＲＳ技术治疗３８例复发性或不能手术的颅内疾患（原发性２３例，转移性１０例，动静脉畸形５例），病灶平均直径３２ｍｍ（１０～４２ｍｍ），照射剂量取６０％～８０％等剂量线，平均剂量为２４Ｇｖ（１５～３０Ｇｙ），均为单次照射。治疗后中位时间是３个月（１～７个月）。结果：１８例患者行ＣＴ或ＭＲＩ复查，其中５例（２７．８％）病灶完全消退，７例（３８．９％）部分消退，２例（１１．１％）病灶发生囊性坏死，４例无变化。主要并发症为脑水肿，但经地塞米松和甘露醇治疗后脑水肿消退。结论：直线加速器ＳＲＳ治疗颅内疾患技术是精确的、安全可靠的，有较高的局部控制率。     

晚期肿瘤疼痛的放射治疗（附22例分析）

自１９９２年７月至１９９３年６月采用放射治疗晚期肿瘤疼痛病例２２例，其中软组织或器官转移４例，骨转移１８例。治疗方法：大剂量照射（５００ＣＧｙ～１０００ＣＧｙ／次、３次／１周）１３例；中等剂量照射（３００ＣＧｙ／次，９次／３周）６例；常规剂量照射（２００ＣＧｙ／次、１５次／３周）３例。治疗效果：疼痛完全缓解和部分缓解率９１％（２０／２２），无效９％（２／２２），认为放射治疗是晚期癌痛的有效止痛方法。     

骨巨细胞瘤的放射治疗

１９７０年至１９９３年共放射治疗骨巨细胞瘤２２例。单纯放疗３例，术后放疗１４例，术后复发放疗５例。肿瘤剂量＜４８Ｇｙ６例，４０～５０Ｇｙ１３例，＞５０Ｇｙ３例。全组５年生存率９５．％（２０／２１），１０年生存率８７．５％的（１４／１６）。２例分别于放疗后半年及７年死于肿瘤肺转移。２０例至今健在，最长者已存活２６年，均能正常生活及工作，未发现恶变成照射区内第二恶性肿瘤发生。我们认为对不能手术、手术不彻底、术后复发及病理分级商的骨巨细胞瘤思考。放射治疗为一种有效的治疗手段。     

放射治疗晚期肝癌23例

目的：探讨晚期肝癌＾６０Ｃｏ移动条野放射治疗效果。方法：采用移动条野技术放射治疗晚期肝癌２３例,中平面剂量达２０～３０Ｇｙ后,缩野对肝脏肿块局部照射２０～３０Ｇｙ／２～３周,肿瘤量ＤＴ４０～６０Ｇｙ,并观察全组放疗反应和生存情况。结果：２３例完成放疗,中位生存期１０个月。１、２、３和５年生存率分别为３９．１％、１７．４％、１１．１％和８．３％。结论：对无手术指征的中晚期肝癌,放射治疗是值得选择的治     

立体定向放射性脑水肿危险性因素分析

目的 分析立体定向放射外科（ＳＲＳ）诱导放射性脑水肿的危险因素。方法 回顾性分析接受Ｘ刀治疗且有完整影像学随访资料的病人６７例,分成两组：水肿组（２２例）、对照组（４７例）,采用单因素分析（χ＾２或Ｗｉｌｃｏｘｏｎ秩和检验）和ｌｏｇｉｓｔｉｃ回归分析方法分析年龄、性别、肿瘤体积、最大剂量、边缘剂量、肿瘤位置、靶点数目、１０Ｇｙ剂量覆盖的体积及随访时间对治疗后脑水肿的影响。结果 单因素分析提示肿瘤体     

脑干肿瘤的放射治疗

目的：探讨脑干肿瘤的放治疗效果及剂量与预后的关系。方法：采用＾６０Ｃｏ常规分割照射该当治疗１５例脑干肿瘤。观察其放疗及生存情况。结果：放疗后１、３、５年生存率分别为６６．８％、６１．７％３３．３％。照射剂量〈５０Ｇｙ和≥５０Ｇｙ１、３、５年生存数分别为４例、３例、１例和６例、５例、３例。结论：放射治疗可作为脑干肿瘤的主要治疗手段之一;为提高生存率,脑干肿瘤的治疗剂量应在５０～６０Ｇｙ／５～７周为宜     

超分割与常规连续放射治疗食管癌的对照研究

目的：比较超分割放射治疗与常规连续放射治疗食管癌的疗效，以探讨食管癌放射治疗的更为有效的方法。方法：分析１９９０年１月－１９９６年３月我科民治１０３例食管癌病人，４７例用超分割放射治疗，方法为每日２次，每次１．１Ｇｙ，每周１０叫肿瘤剂量为６６－７０．４Ｇｙ／３０－３２天。５６例用常规连续放射治疗，方法为每日１次，每次２Ｇｙ，每周５次，总肿瘤剂量为６２－６８Ｇｙ／３１－３４天。结果：超分割放射治疗组     

立体定向适形放疗治疗胰腺癌的初步报告

目的:探索立体定向适形放射治疗(SCRT)胰腺癌的效果及价值。方法:对23例胰腺癌患者给予立体定向适形放疗,采用高剂量低分割的方法,肿瘤生物等效剂量70GY～80GY,分8～12次,单次剂量4GY～6GY(生物等效剂量为4.7GY～8.2GY),间隔时间为24～48h,应用低熔点铅挡块多野非共面照射。每2～3个月随访,随访时间为2～14个月。结果:23例患者均有不同程度的症状缓解,卡氏评分平均上升17％,随访片显示19例病灶缩小,4例病灶稳定,无出现明显副作用者。结论:立体定向适形放射治疗胰腺癌定位准确,副反应小,为胰腺癌治疗的一种有效途径。     

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.