小细胞肺癌化疗后肿瘤体积变化规律及影响因素

目的：通过分析小细胞肺癌（SCLC）化疗后肿瘤体积的变化规律及可能影响其变化的相关因素,为诱导化疗的最佳周期数选择及放射治疗的最佳介入时机提供理论依据。方法回顾性分析行多周期诱导化疗的首诊 SCLC 患者的疗效。使用治疗计划系统自带体积测量软件及 Image J 图像处理软件测量肿瘤体积,分析诱导化疗不同周期后的体积变化情况,并分析可能的影响因素（性别、年龄、大体类型、患者 ECOG 评分、化疗前肿瘤体积、T 分期）对其的影响。结果（1）共有34例 SCLC 患者入组,化疗前和化疗1、2、3、4、5、6个周期后的肿瘤绝对体积分别为63002．89（18488．99,130598．54）、40523．12（12083．03,77139．65）、12145．31（2758．06,67560．39）、18141．67（4498．78,70062．25）、13864．67（2940．28,71071．43）、20964．56（1854．63,85806．55）和19600．00（5698．36,151165．90）mm 3。（2）化疗前和化疗1个周期后绝对体积之间差异有统计学意义（t ＝3．157,P ＝0．004）,两组的相对体积（假定化疗前肿瘤体积为1）差异也有统计学意义（t ＝3．312,P ＝0．003）,第3周期较第2周期化疗无效例数明显升高（P ＝0．025）,其他各相邻周期间差异无统计学意义。（3）logistic 回归分析发现,T 分期（χ2＝5．512,P ＝0．019,OR ＝0．099）是 SCLC 化疗1个周期后肿瘤消退率的独立影响因素。结论SCLC 患者多周期化疗后体积变化呈现一定的规律。化疗1个周期后 SCLC 平均原发灶肿瘤体积明显下降,化疗3个周期后可能出现反弹。若采用诱导化疗,1个周期即可。 T3～4期较 T1～2期的第1周期肿瘤退缩效果相对较好。     

小细胞肺癌化疗后肿瘤体积变化规律及影响因素

目的:探讨小细胞肺癌(SCLC)化疗后肿瘤体积变化规律及影响因素。方法:选取小细胞肺癌化疗患者30例作为此次研究对象,对入选患者接受化疗后肿瘤体积的变化规律和影响因素展开回顾性的分析。结果:入选患者在接受为期1周期的系统性化疗后,肿瘤体积相比较未接受化疗前和其他化疗周期而言,均明显缩小,相比较治疗前,组间差异有统计学意义(P<0.05),但是在第3、第5周期时,肿瘤体积明显回升。采用Logistic回归性分析对可能影响患者肿瘤体积变化的因素进行分析后,发现对患者肿瘤体积造成独立影响的因素为T分期。结论:通过试验研究结果显示,针对小细胞肺癌患者,在T1~2期对其进行化疗,可有效实现肿瘤的缩减。     

非小细胞肺癌化疗前后肿瘤标记物水平变化及意义

目的探讨肿瘤标记物变化在非小细胞肺癌(NSCLC)患者化疗效果评价中的应用价值。方法37例NSCLC患者采用NP(长春瑞滨+顺铂)方案化疗2个周期,观察化疗前后肿瘤标记物甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原50(CA50)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)水平的变化。结果化疗后CEA、CA50、CA125水平显著下降(P<0.05);化疗有效者和肺腺癌患者化疗后CEA、CA50、CA125水平显著下降(P<0.05);鳞癌患者化疗后CA50、CA125显著下降(P<0.05)。结论肿瘤标记物CEA、CA50、CA125的水平变化有助于NSCLC化疗后的疗效判断。     

局部晚期非小细胞肺癌同步放化疗联合巩固化疗或诱导化疗的随机临床研究

目的 评价同步放化疗联合联合巩固化疗或诱导化疗治疗局部晚期非小细胞肺癌(NSCLC)的近期疗效及毒不良反应,并比较两者差异性.方法 64例ⅢA和ⅢB期的NSCLC患者随机分为两组,CCT组第1周期TP(多西他赛和顺铂)化疗第1天就开始实施放疗,同步放化疗结束后按计划从第43天开始TP巩固2周期化疗;ICT组第1天用TP诱导化疗2周期,从第3周期第1天(第43天)开始实行放化疗同步.化疗均为4个周期的TP方案, 21天为1周期.采用三维适形放疗,胸部照射2Gy/次,5次/周,共6～7周,总剂量54～66Gy,中位剂量为60Gy.结果 CCT和ICT组的有效率分别为60.0%和58.8%( P=0.924).主要毒性为血液学毒性、放射性肺损伤和放射性食管炎, 但两组并未出现明显差异.结论 局部晚期NSCLC同步放化疗前后诱导与巩固化疗的近期疗效相近,时序对不良反应的发生率没有影响.同步放化疗治疗Ⅲ期NSCLC有较好的疗效,不良反应可以耐受.     

肿瘤标记物联合检测在非小细胞肺癌化疗中的意义

目的 探讨联合检测肿瘤标记物CEA、CA125、CA19-9、CA50对于非小细胞肺癌化疗的意义.方法 对60例非小细胞肺癌病人行4个疗程化疗,化疗方案为NP、TP或GP,监测第1次化疗前和第3次化疗前肿瘤标记物CEA、CA125、CA19-9、CA50水平的变化,并根据化疗前后肺部CT改变进行分析.结果 第3次化疗前, 非小细胞肺癌病人CEA、CA125、CA50水平较第1 次化疗前下降, 差异有显著意义(t=2.367～3.125,P<0.05、0.01).化疗有效病人第3次化疗前CEA、CA125、CA50水平低于第1次化疗前,差异有显著意义(t=2.123～3.089,P<0.05、0.01).结论 监测肿瘤标记物CEA、CA125、CA50水平的变化有助于非小细胞肺癌化疗后疗效的判断.     

参芪扶正注射液对晚期非小细胞肺癌化疗患者免疫功能的影响

目的应用参芪扶正注射液配合化疗治疗晚期非小细胞肺癌(NSCLC),观察其对肺癌患者细胞免疫功能的影响。方法将56例老年肺癌患者随机分成两组,单纯化疗组(对照组)28例采用多西他赛75 mg/m2第1 d,顺铂60 mg/m2第1～3 d;联合化疗组(观察组)28例采用化疗方案及剂量同对照组,化疗开始即联合应用参芪扶正注射液250 ml,静脉滴注,连续7 d,21 d为1周期,至少治疗3周期。结果实验组白细胞介素-2(IL-2)、淋巴细胞转化率、总T淋巴细胞(CD3+)、辅助T淋巴细胞(CD4+)和自然杀伤细胞(NK)升高程度明显高于对照组(P<0.01);抑制/细胞毒T淋巴细胞(CD8+)、肿瘤坏死因子-α(TNF-α)降低程度明显低于对照组(P<0.01)。结论参芪扶正注射液对中晚期NSCLC化疗患者免疫功能有较好的调节作用。     

非小细胞肺癌中Tiam-1的表达及其临床病理意义

目的:探讨T淋巴瘤侵袭和转移诱导蛋白(Tiam-1)在非小细胞肺癌(NaSCLC)中的表达及临床意义.方法:应用免疫组化S-P法检测86例NSCLC病理标本的Tiam-1表达情况.结果:NSCLC中Tiam-1的表达阳性率为55.8%,与年龄、性别、组织学类型及分化程度间均无明显相关性(P＞0.05).Tima1阳性表达率与患者PTNM分期及淋巴结转移密切相关(P＜0.05).在获得术后随访的47例患者中,生存期＜3年者19例,阳性表达15例,生存期≥3年者28例,阳性表达9例,两组间差异有统计学意义(P＜0.01).结论:Tiam-1过度表达与NSCLC的发展、淋巴结转移及预后有密切关系,有可能作为临床评估NSCLC进展及预测肿瘤转移潜能和预后的指标.     

非小细胞肺癌中Bax和Cyclin D1的表达及意义

目的探讨促凋亡基因Bax和促增殖基因Cyclin D1在非小细胞肺癌中的表达及意义.方法用鼠抗人Bax及鼠抗人Cyclin D1单克隆抗体对40例石蜡包埋的原发性非小细胞肺癌(NSCLC)组织进行免疫组化染色,并与10例肺良性病变作对照,对它们的表达情况进行检测分析.结果 Bax蛋白在良性病变和恶性病变中表达无明显差异性,而在恶性肿块≥3cm者高于肿块＜3cm者,有淋巴结转移者高于无淋巴结转移者,Ⅲ～Ⅳ期者高于Ⅰ～Ⅱ期者,中～高分化高于低～中分化(P＜0.05).而Cyclin D1表达则是恶性病变高于良性病变(P＜0.05),与P-TNM分期及分化程度无关.结论 Bax在非小细胞肺癌发生的早期低表达,而在后期高表达,说明Bax在早期的抑制诱癌形成,晚期则加速癌细胞凋亡,参与机体的抗癌机制.Cyclin D1的过表达与肺癌的发生有关,是NSCLC的早期分子事件之一,而与NSCLC的发展和预后可能无关.     

原发于胃肠道非霍奇金淋巴瘤116例预后因素探讨

目的 探讨影响原发性胃肠道非霍奇金淋巴瘤患者的预后因素.方法 回顾分析本院1993年1月～2003年12月收治的经病理证实的116例原发性胃肠道非霍奇金淋巴瘤患者的临床资料.应用Kaplan-Meier法进行生存分析,组间比较用Log-rank检验.多因素分析采用Cox模型进行分析.结果 本组病例3、5年生存率分别为63.8%(74/116)和48.2%(40/83).单因素分析结果显示,有无B症状、肿块大小、临床分期、病理分型、肿瘤浸润深度、治疗模式是影响患者预后的因素.伴随B症状、肿块≥10 cm、临床分期ⅢE-ⅣE期、T细胞型、肿瘤突破浆膜层者的预后较无B症状、肿块＜10 cm、临床分期I E-ⅡE期、B细胞型、肿瘤未突破浆膜层者差.多因素分析显示,肿块≥10 cm、临床分期ⅢE-ⅣE-期、T细胞型、单纯手术者预后差.结论 肿瘤大小、临床分期、病理分型及治疗模式是影响原发性胃肠道非霍奇金淋巴瘤患者预后的独立危险因素.     

放射性125I粒子植入联合化疗治疗晚期非小细胞肺癌的临床观察

目的：探讨CT引导下经皮穿刺植入放射性125I粒子联合GP方案治疗晚期非小细胞肺癌（non small cell lung cancer,NSCLC）的临床疗效及不良反应.方法：术前临床和活检证实为非手术的NSCLC30例,所有病例均行粒子植入术,术后第3天开始行GP方案化疗,共完成4个周期,同时记录不良反应.4次化疗后1、3、6、12个月复查CT及肿瘤标记物评估疗效.结果：30例患者共40个病灶,1个月复查所有病灶均有所控制,3、6、12个月有效率分别为80.0%、76.7%、70.0%,1年总生存率为100.0%.结论：125I粒子植入联合全身化疗治疗晚期NSCLC疗效显著,患者耐受性较好,不良反应少,是一种安全、有效、微创的方法.     

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.