晚期喉癌患者不同治疗方法的生存率与生存质量比较

目的探讨晚期喉癌患者不同治疗方法生存率和生存质量比较。方法分析104例喉癌经单纯手术、手术加放射治疗及化学治疗加手术加放射治疗等不同方法治疗的疗效。结果综合治疗组复发率及远处转移率均低于单纯手术组(P<0.05);喉癌Ⅲ期患者5年生存率稍高于Ⅳ期(61.5% vs 56.4%);手术加放疗组和化疗加手术加放疗组5年生存率均高于单纯手术组(P<0.05);综合治疗组术后生存质量高于单纯手术组(P< 0.05)。结论对喉癌采用综合治疗的方法比单纯手术疗效好。     

胸段食管癌术后放射治疗的临床观察

目的：评价胸段食管癌术后放射治疗的价值。方法：对132例胸段食管癌患者（单纯手术59例，手术加放射治疗73例），分组比较。结果：术后放疗组1、3、5a局部控制率分别为91．8％、54．8％、39．7％；单纯手术组1、3、5a局部控制率分别为78％、20．3％、8．5％。经统计学处理有显著性差异。术后放疗组1、3、5a生存率分别为76．7％、45．2％、37％。单纯手术组1、3、5a生存率分别为50．8％、25．4％、18．6％。统计学处理有显著性差异。结论：手术加放疗能提高生存率和局部控制率。     

Ⅰ及Ⅱ期食管癌根治术与术后放疗103例分析

目的评价Ⅰ及Ⅱ期食管癌根治术后放射治疗的价值．方法收治103例术后病理确诊为Ⅰ～Ⅱ期的食管癌，单纯手术72例，加术后放疗31例，放射剂量50～60Gy．结果随访5年以上，47例复发，复发与TNM分期有关，区域淋巴结和食管瘤床失败与食管原发部位有显著关系。手术切除组：1、3、5年生存率分别为87．5％、69．4％、41．7％，术后放疗组1、3、5年生存率为90．3％、83．9％、74．2％。结论术后放疗复发率低，5年生存率术后放疗组明显高于单纯手术组。Ⅰ及Ⅱ期食管癌术后常规放疗可提高远期生存率。     

27例儿童髓母细胞瘤临床研究

目的：分析总结儿童髓母细胞瘤临床特点及其治疗效果。方法：27例经手术切除及病理确诊的儿童患者,单纯手术治疗组12倒,手术＋全脑全脊髓放疗组15例。结果：单纯手术组1年生存率33．3％,3年生存率8．3％,手术加全脑全脊髓放疗组1年生存率93．3％,3年生存率53．3％。术后全脑全脊髓放疗组生存率显著高于单纯手术组。结论：显微镜下全切除肿瘤组织,术后予以全脑加全脊髓段放射治疗,可有效的降低复发转移率,显著延长生存期。     

声门上型喉癌N0～2颈部淋巴结的治疗方法

目的：对声门上型喉癌N0～2颈部淋巴结的治疗方法进行讨论。方法：对64例声门上型喉癌颈部淋巴结N0～2行改良颈清术与改良颈清术加放疗两种治疗方法，并进行分析。结果：64例声门上型喉癌中，改良颈清术32例38侧，改是颈清术加术后放疗32例34侧，N0～N1 32例34侧，N2 32例38侧。3年总生存率64．06％，5年总生存率57．81％。N3行根治性颈清术，在此不作讨论。结论：对N01N病例，改良颈清术与改良颈清术加放疗一样有效（P〉0．05）。对于N2病例，改良颈清术加放疗明显优于单纯改良性颈清术（P〈0．05）     

喉癌122例临床分析

本文报道了我院近十年来治疗，经病理确诊的122例喉癌患者，其中手术治疗62例，放射治疗60例（手术加放射治疗18例）。50～70岁组最多性别以男性居多，占总数的84．4％，其中鳞状细胞癌199例占总数的97．5％，其它为乳头状瘤癌变及白斑癌变。手术冶疗62例中，全喉切除39例，部分喉切除21例。五年生存率：手术组五年生存率为58％，其中部分喉切除的五年生存率的28％，全喉切除为39％，而放疗组五年生存率只有13％，说明手术治疗优于放射治疗。讨论作者证实吸烟与喉癌的发病关系密切。并讨论了早诊早治与提高治愈率和五年生存率的关系，治疗方…     

喉癌、下咽癌复发的临床分析和治疗转归

目的：探讨喉癌、下咽癌术后复发的原因及挽救性手术的可行性。方法：回顾分析98例复发性喉癌、下咽癌的临床资料。68例行癌复发手术切除及术后常规放疗，其中喉部分切除术后局部复发21例，颈淋巴结转移7例，局部复发并颈淋巴结转移5例；全喉切除术后气管造瘘口复发癌8例；下咽癌切除术后局部复发2例。颈淋巴结转移15例；30例行单纯放疗或姑息性治疗。68例行癌切除术和(或)改良根治性颈清扫术，其中胸大肌皮瓣修补术29例，胃上提代食管下咽15例，游离结肠上徙代下咽食管2例。结果：喉癌手术后1年、3年生存率分别为96.10％和33.33％，下咽癌手术后1年、3年生存率分别为64.71％和5．88％，而单纯放疗或姑息治疗1年及3年的生存率仅为10％和0％。结论：复发性喉癌、下咽癌的预后较差，适当的手术治疗可延长患者生命，提高生存质量。     

肝切除加肝动脉置泵栓塞化疗联合^125I放射治疗肝癌24例

目的观察不规则肝切除加肝动脉置泵栓塞化疗联合^125I粒子植入放射治疗原发性肝癌的24例治疗效果。方法回顾性分析近10年来59例肝癌患者单纯肝切除与不规则肝切除加肝动脉置泵栓塞化疗联合^125I粒子植入放射治疗原发性肝癌的临床资料。结果单纯手术组与不规则肝切除加肝动脉置泵栓塞化疗联合^125I粒子植入放射治疗组1、3、5年术后复发率分别为67．2％＆37．5％、84．4％＆55．0％、94．8％＆72．5％，差异有显著性（P〈0．05）。两组病人1、3、5年生存率分别为58．7％＆90％、41．1％＆72．5％、13．8％＆40％，差异有显著性（P〈0．05）。结论不规则肝切除加肝动脉置泵栓塞化疗联合^125I粒子植入放射治疗原发性肝癌可明显降低术后复发率，提高生存率。     

64例喉癌治疗结果分析

对６４例被治喉癌治疗结果进行回顾性分析。治疗方法包括单纯放疗１９例、放疗加化疗１０例、手术后放疗２２例、手术后放疗加化疗１３例。随访率为９５．３％，总的５年生存率为４２．１８％。结果表明：手术后放疗加或不加化疗的生存率都高于其他方法的生存率（Ｐ＜０．００１）；单纯放疗剂量以６０～７５Ｇｙ、术后放疗剂量以５０～６０Ｇｙ为佳；Ⅰ期病人采用单纯放疗的三、五年生存率分别为９０．９％、７２．７％；有颈淋巴结转移的病人预后差。说明早期发现、合理选择治疗方法是提高喉癌生存率的关键。     

复发性喉癌42例临床分析

目的：探讨喉癌复发的相关临床因素及挽救性手术的可行性。方法：分析42例复发性喉癌的临床资料。结果：局部复发24例，颈淋巴结转移17例，局部复发并颈淋巴结转移1例。治疗采取部分喉切除、全喉切除及(或)颈廓清术。局部复发组3、5年生存率分别为66．7％(16／24)和54．2％(13／24)。颈淋巴结转移组3、5年生存率分别为35．3％(6／17)和23．5％(4／17)。结论：喉癌复发可能与原发肿瘤的临床分期以及治疗方式的选择有关。对复发性喉癌的治疗仍以手术为主，术后容易出现切口延期愈合及咽瘘，应注意防治。     

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.