氟他胺联合抑那通间歇性治疗手术去势后前列腺癌的临床观察

目的探讨晚期前列腺癌手术去势后间歇性雄激素阻断治疗的临床疗效。方法选取2003年1月至2010年1月晚期前列腺癌患者24例（C1、C2、D1、D2期分别为2、6、10、6例）,做睾丸去势手术后,采用间歇性内分泌治疗：氟他胺服用3～6个月,当前列腺特异性抗原（PSA）下降达到相对稳定水平（0.2～13μg/L）并维持2个月后停药,停药期间定期影像学检查及PSA监测,当PSA水平超过稳态水平2～3倍时进入下一周期氟他胺治疗,以此类推;抑那通在手术去势后18～24个月,当PSA大于稳态水平2～3倍时开始使用,1次/月,3次/疗程,以后每3年1疗程。结果 24例患者平均随访时间（38.7±14.3）月,22例生存,生存率91.7%;3例氟他胺耐药。停药间歇期〉9个月,87.5%患者重复用药后仍能有效控制,重复用药后平均治疗时间（5.0±1.1）月。与单纯手术去势或持续内分泌药物治疗比较,间歇性内分泌治疗可明显延长肿瘤对雄激素依赖的时间。结论手术去势后联合间歇性内分泌治疗,可延缓患者向雄激素难治性前列腺癌的进展,是治疗晚期前列腺癌的有效方法     

前列腺癌中晚期综合治疗的疗效研究

目的:评估睾丸切除联合氟他胺与单纯睾丸切除或药物去势对于前列腺癌中晚期疗效研究。方法:采用分析前列腺癌中晚期病人36例进行评估。其中13例行睾丸切除联合氟他胺治疗,为A组;11例行单纯睾丸切除治疗,为B组;12例药物去势治疗,为C组。分析它们的主要疗效指标包括全周身情况、远处扩散性产生的疼痛、血清前列腺特异性抗原(PAS)水平、癌肿大小以及远处转移范围,5年生存率。对3组疗效进行差异评估。结果:A组较B组、C组有显著性差异,其中3组的5年生存率60%、62%、58%没有显著性差异。结论:前列腺癌内分泌治疗的金标准仍然是睾丸切除。睾丸切除联合氟他胺治疗在患者自身症状,后期周身疼痛的缓解、前列腺标志物(PSA)的变化和病变扩散方面较单纯睾丸切除有较好的效果。     

间歇性雄激素阻断疗法对晚期前列腺癌的临床疗效分析

目的探讨间歇性雄激素全阻断疗法(intermittent hormone therapy,IHT)对治疗晚期前列腺癌中推迟前列腺癌细胞由激素依赖转变为激素非依赖型的疗效。方法选择我院2014年7月到2018年7月收治的40例晚期前列腺癌患者作为研究对象,将这40例患者随机分为治疗组和对比组,治疗组和对比组分别同时使用比卡鲁胺(抗雄)联合戈舍瑞林(去势)药物对患者实施间歇性雄激素全阻断和持续性雄激素全阻断治疗,比较两组患者病情稳定期持续的时间(即患者发展为去势抵抗型前列腺癌的时间)。结果间歇性雄激素全阻断疗法对患者发展为激素非依赖前列腺癌的时间均明显优于对比组患者,差异具有统计学意义(P0.05)。结论间歇性雄激素全阻断疗法治疗晚期前列腺癌的效果确切,可有效地延长晚期前列腺癌进展为去势抵抗型前列腺癌的时间,从而延长其生存时间。     

调强放疗加内分泌治疗前列腺癌60例临床分析

目的分析调强适形放射治疗(IMRT)联合内分泌治疗对中晚期前列腺癌的治疗效果。方法回顾性分析IMRT联合内分泌治疗中晚期前列腺癌60例的临床资料。内分泌治疗采用去势加抗雄激素治疗的联合雄激素阻断治疗,30例放射治疗前接受双侧睾丸切除,5例行睾丸放疗去势,25例应用抑那通药物去势。抗雄激素治疗药物应用氟他胺,与去势治疗同时应用。放疗采用IMRT技术,1.8～2.0Gy/次,5次/周,肿瘤量(DT)68～72Gy,平均剂量70Gy。结果1例治疗过程中突发心肌梗死死亡,1例因为急性阑尾炎而中断治疗,58例完成放射治疗。放疗结束后31例患者排尿困难等症状均不同程度改善,55例患者治疗6个月后血清PSA降至正常。平均随访30个月(6～75个月),3年和5年生存率分别为82.6%和71.1%,5年肿瘤特异生存率为83.4%,1、2、3级急性胃肠道反应发生率分别为33%、8%和3%,1、2级急性泌尿生殖系统反应发生率分别为33%、5%。结论IMRT联合内分泌治疗前列腺癌疗效满意,副反应小,是中晚期前列腺癌综合治疗的有效手段。     

手术去势联合间歇雄激素全阻断疗法治疗晚期前列腺癌的作用观察

目的：探讨手术去势联合间歇性雄激素全阻断疗法治疗局部进展期前列腺癌（ PCA）的临床价值。方法：选取我院2009年1月至2013年1月间收治的失去根治手术机会的晚期前列腺癌患者44例,随机分为观察组与对照组,观察组采用手术去势联合间歇性雄激素全阻断疗法治疗,对照组患者采用药物去势治疗,给予黄体生成素释放激素类似物（醋酸戈舍瑞林缓释植入剂）联合抗雄激素药物（比卡鲁胺）治疗,观察两组患者治疗前后EORTCQLQ-C30及QLQ-PR25评分,以评价患者生活质量评分改善情况,并对比两组患者疾病无进展生存时间（ PFStime）、总生存时间（ OS time）情况。结果：两组患者治疗后前列腺特-异性抗原（ PSA）均显著下降,但组间比较无统计学差异（ P＞0．05）;观察组患者生活质量改善较对照组更为显著（ P＜0．05）;观察组患者PFStime、OS time较对照组显著提高（ P＜0．05）。结论：手术去势联合间歇性雄激素全阻断疗法治疗局部进展期PCA安全、有效,能显著提高患者PFStime、OS time及生活质量,是老年患者及贫困地区PCA患者较好治疗选择。     

调强放疗联合内分泌治疗中晚期前列腺癌的近期疗效观察

目的：观察调强放疗联合内分泌治疗中晚期前列腺癌的近期疗效及毒副反应。方法：将患者分为 A、B、C 三组,即调强放疗+间歇内分泌治疗组（A 组）50例,采用调强放疗,同步给予间歇性内分泌治疗（给药方式同 C 组）;三维适形放疗+内分泌治疗组（B 组）50例,采用三维适形放疗,同步给予间歇性内分泌治疗（给药方式同 C 组）;两组均采用6MV 的 X 射线照射,总剂量 DT=70～76Gy,每次1.8～2Gy,每周5次;单纯内分泌治疗组（C 组）50例,亮丙瑞林,3.75mg/次,皮下注射,每28天一次+比卡鲁胺50mg口服每日一次。随访3年,评价3组的疗效及不良反应。结果：A、B 及 C 三组的有效率分别为84%、68%、46%,A、B 组分别和 C 组比较均有显著差异;A 组的毒副反应显著低于B 组,与 C 组无显著差异;A 组的1、2、3年生存率显著高于 C 组,A 组的1年生存率显著高于 B 组,而 A、B 两组比较2、3年生存率无显著差异。结论：调强放疗联合间歇性内分泌治疗中晚期前列腺癌的近期疗效好,毒副反应轻,患者大多能耐受,是一种行之有效的治疗方法。     

不同方式的睾丸切除术在进展期前列腺癌治疗中的疗效比较

目的比较保留附睾的睾丸切除术（A组）与传统睾丸切除术（B组）在进展期前列腺癌治疗中的疗效，探讨睾丸去势治疗的最佳选择方式。方法进展期前列腺癌60例，A、B组各30例。均在局麻下行单切口双侧睾丸切除术，术后第1天起口服非类固醇类雄激素阻断剂。分别于术前、术后1周及1、3、6、9、12个月，观察2组血清总睾酮、前列腺特异性抗原（PSA）变化；了解患者手术满意度等。结果去势术后12个月，A、B组血清睾酮平均水平分别为0．2nmol／L（95％置信区间0．1～0．9nmol／L）、0．3nmol／L（95％置信区间0．2～0．9nmol／L），均〈1．9nmol／L，2组均数比较，P〉0．05；A组PSA平均值0．22ng／ml，B组0．27ng／ml，2组均数比较，P〉0．05。问卷调查示A组满意度为96．7％（29／30），B组为53．3％（16／30）。结论2种睾丸切除术在进展期前列腺癌治疗中疗效无明显差异，但保留附睾的睾丸切除术、附睾成形术有助于满足患者的阴囊外观形态和心理需要。     

晚期前列腺癌的间歇雄激素阻断治疗

目的：了解间歇雄激素阻断（IAD）方法对晚期前列腺癌的治疗作用。方法：回顾性分析21例晚期前列腺癌病人,应用药物诺雷德去势加氟他胺（甲组）或康士得IAD方法（乙组）治疗的结果。结果：21例患者经IAD治疗后,绝大多数取得了较好的疗效。甲组3年生存率为72．7％,乙组为80．0％,总3年生存率为76．2％。治疗间歇中减少了抗激素药物的应用,从而明显减少了潮红、体重增加及忧郁等内分泌治疗的副作用。结论：IAD治疗能推迟雄激素依赖性前列腺癌细胞向非依赖性细胞的转化,同时减少药物用量和毒副作用,明显改善患者的生活质量并降低治疗费用。     

最大雄激素阻断治疗前列腺癌的进展

雄激素阻断疗法已被普通用于前列腺癌的治疗中，其中联合应用非类固醇类抗雄激素的最大雄激素阻断治疗（MAB or CAB)是比单一去势治疗更具优势的治疗。间歇性雄激素阻断治疗可减少非雄激素依赖性前列腺癌细胞的出现而提高CAB疗效。     

晚期前列腺癌药物去势中Gleason评分、血清PSA与疗效相关性研究

目的：探讨晚期前列腺癌（Pca）患者药物去势治疗过程中疗效与Gleason评分及血清前列腺特异性抗原（PSA）的相关性。方法：选择33例晚期Pca患者，给予黄体激素释放激素类似物（LHRH—A）＋抗雄激素药物进行药物去势治疗，根据Gleason评分分为2～5分组、6～7分组、8～10分组，对3组血清PSA变化进行分析。结呆：Gleason评分6～7分组的病人在治疗后3个月内血清PSA值下降最快，治疗后6个月时Gleason评分2～5分组病人血清PSA值恢复正常，而Gleason评分6～7分组与8～10分组病人血清PSA值则接近正常值范围。不同Gleason评分组间血清PSA水平差异有统计学意义（F=5．396，P〈O．05）。结论：（1）Gleason评分、血清PSA水平与晚期Pca患者行药物去势疗法疗效有密切关系。（2）血清PSA变化是监测Pca复发与评价疗效的可靠瘤标。     

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.