索拉非尼治疗肝细胞性肝癌45例疗效评价

目的：评价索拉非尼治疗肝细胞性肝癌的疗效及安全性。方法：总结2008年1月至2009年12月应用索拉非尼治疗的45例肝细胞性肝癌患者的临床资料。结果：33例接受过1次以上实体瘤治疗疗效评价标准（RECIST）评价者中,服药后6周RECIST评价时27例肿瘤稳定,5例肿瘤进展,1例肿瘤出现病灶缩小,10例美国东部肿瘤协作组（ECOG）体力状况评分改善;不良反应一般在服药后1～2周左右出现,在所有接受治疗的患者中,共14例发生较严重（3～4级）的不良反应,不能耐受不良反应而减少药物剂量者11例,3例停药。药物不良反应在减少剂量并予一定对症支持治疗后大多可以缓解。结论：索拉非尼可延长晚期肝细胞性肝癌患者的肿瘤无进展生存时间,且耐受性良好,是治疗晚期原发性肝癌的新选择。     

索拉非尼治疗晚期肾癌的临床疗效

目的探讨研究索拉非尼治疗晚期肾癌的临床疗效,为临床研究提供治疗依据。方法所有患者给予口服索拉非尼治疗,评价治疗效果和不良反应。结果 34例患者服用索拉非尼6个月后,完全缓解0例,部分缓解3例,稳定27例,进展4例,肿瘤控制率为88.2%,主要不良反应为手足皮肤反应和腹泻,经对症处理后均得到有效缓解。结论索拉非尼治疗晚期肾癌临床疗效良好,无严重不良反应,患者耐受性好。     

舒尼替尼治疗转移性肾癌的疗效及安全性评价

目的探讨舒尼替尼治疗转移性肾癌的有效性及安全性,并总结相关临床使用经验。方法选取我院2010年1月至2014年3月治疗的肾癌患者28例,对患者给予舒尼替尼治疗,连续用药1个月后停药2周,以6周作为一个循环。结果治疗一段时间后对患者身体状况进行观察,同时对本次治疗进行相应评价,本次治疗治愈患者1例,部分缓解6例,稳定20例,1例处于病情进展状态。治疗期间观察到患者出现了一些不良反应症状,例如高血压、口腔溃疡、腹泻、血红蛋白减少等。结论舒尼替尼对于转移性肾癌治疗效果优良,可以显著提高疾病控制率,其所产生的不良反应患者尚可接受,对临床治疗十分有利。     

索拉非尼治疗转移性肾癌的临床效果

目的探讨索拉非尼治疗转移性肾癌的临床效果。方法选取2017年1月至2019年1月郑州大学第一附属医院泌尿外科收治的50例转移性肾癌患者,采用随机数表法将其分为对照组和观察组,每组25例,对照组接受生物化学疗法治疗,观察组接受索拉非尼治疗。比较两组患者疾病控制率(DCR)、客观反应率(ORR)、肿瘤最大直径、无进展生存期(PFS)和总生存期(OS)情况。结果观察组DCR为92.0%,高于对照组的68.0%,差异有统计学意义(P<0.05);观察组ORR为64.0%,高于对照组的40.0%,差异有统计学意义(P<0.05)。治疗后,两组患者肿瘤最大直径均较治疗前缩小,且观察组肿瘤最大直径小于对照组,差异有统计学意义(均P<0.001)。观察组PFS、OS均长于对照组,差异有统计学意义(均P<0.001)。结论索拉非尼治疗转移性肾癌,可以缩小肿瘤大小,缓解病情,延长患者生存期,临床效果较好。     

索拉非尼治疗转移性肾癌的疗效评估与不良反应（附3例报告和文献复习）

 目的 以分子靶向药物索拉非尼治疗转移性肾癌（metastatic renal cell carcinoma,mRCC）,国内临床经验有限。本文探讨索拉非尼疗效评估的特点及药物不良反应的特征和处理。方法 回顾性分析我院应用索拉非尼治疗3例mRCC的临床资料,并作文献复习。结果 采用实体瘤治疗反应评价标准评估3例疗效均为病情稳定,肺转移灶的缩小或数目减少较原发灶和其他转移灶显著;药物不良反应为手足皮肤反应（HFSR）、谷丙转氨酶（ALT）异常和高血压等。结论 索拉非尼的疗效不宜以传统的肿瘤缓解标准来衡量,熟悉不良反应的特征及处理方法对持续用药有重要意义。     

后腹腔镜肾癌根治术治疗局限性肾癌的临床疗效

目的：评价后腹腔镜肾癌根治术（Laparoscopic radical nephrectomy,LRN）治疗局限性肾癌的临床疗效。方法：回顾性分析134例局限性肾癌患者的一般临床资料,比较后腹腔镜组66例（LRN组）与同期传统开放肾癌根治术（Open radical nephrec－tomy,ORN）手术组68例（ORN组）治疗局限性肾癌的临床疗效。结果：2组患者的年龄、性别、肿瘤最大直径、肿瘤部位、肿瘤分期、病理诊断差异无统计学意义（P>0.05）,而2组手术时间、术中出血量、术后肠功能恢复时间、住院时间、并发症发生率等差异有统计学意义（P<0.05）。随访3～40月,4例远处转移：2例接受免疫治疗加索拉非尼靶向治疗,病情稳定;2例接受免疫治疗,其中1例进展,1例死亡。结论：后LRN治疗局限性肾癌与传统开放手术的肿瘤控制效果相近似,但具有微创和恢复快等优点,术后复发转移者应首选索拉非尼等靶向治疗。     

术前应用索拉非尼/舒尼替尼治疗局部晚期肾癌患者的临床分析

目的：初步探讨术前索拉非尼/舒尼替尼治疗对局部晚期肾癌患者围手术期参数的影响。方法：2008年3月—2013年3月复旦大学附属肿瘤医院泌尿外科采用索拉非尼或舒尼替尼治疗局部晚期（≥ T3b期）肾细胞癌患者23例,男19例,女4例,中位年龄63岁。索拉非尼治疗12例,舒尼替尼治疗11例。结果：12例索拉非尼治疗患者中1例部分缓解,10例疾病稳定,1例疾病进展;11例舒尼替尼治疗患者中1例部分缓解,9例疾病稳定,1例疾病进展。两种靶向药物使肾脏肿瘤最大径分别缩小14.3%和11.8%。11例合并下腔静脉癌栓的病例,8例治疗后癌栓退缩,2例癌栓降级,其中7例接受手术治疗。12例T4期病例中7例肾肿瘤缩小,1例达到部分缓解并降期,其中5例接受手术治疗。术前停药时间6~19 d,手术时间120~250 min,术中出血量120~1 600 mL,术后引流量170~560 mL,术后住院6~14 d。术后并发症Clavien分级,1级3例,2级6例,无3级及以上并发症。随访至2017年3月,15例患者出现肿瘤复发或转移,中位无疾病进展生存期为22个月（3~102个月）,中位总生存时间为51个月（11~102个月）。结论：术前索拉非尼/舒尼替尼治疗局部晚期肾癌可使大部分患者的肾脏肿瘤缩小,且相对安全可行,并未显著增加围手术期并发症。     

索拉非尼治疗晚期肾癌患者33例长期临床观察

目的评估索拉非尼治疗晚期肾癌的长期疗效和安全性。方法对33例晚期肾癌患者给予索拉非尼口眼治疗,观察其肿瘤控制及长期生存状况、不良反应的发生、分级及转归。结果 33例晚期肾癌患者口服索拉非尼治疗,中位随访时间56周(12～98周)。其中完全缓解(CR)1例(3.0%)、部分缓解(PR)5例(15.2%)、疾病稳定(SD)21例(63.6%)、疾病进展(PD)6例(18.2%)。评估客观反应率(ORR)为18.2%,疾病控制率(DCR)为81.8%,中位无进展生存(PFS)时间为15.0个月(95%CI 6.5～23.5),中位总生存(OS)时间为24.0个月(95%CI 7.6～40.4)。主要不良反应包括手足皮肤反应、腹泻、高血压、皮疹、脱发和疲乏,除手足皮肤反应外,其他多为1～2级,对症处理大多可以缓解。结论索拉非尼治疗晚期肾癌的近期及远期疗效良好,长期使用不良反应可以耐受,安全性较好。     

索拉非尼治疗晚期肾癌10例临床分析

目的：初步评价索拉非尼治疗晚期肾癌的疗效和毒副反应。方法：选择2007年6月～2008年10月我科治疗的10例晚期肾癌患者,男性6例,女性4例,平均年龄48．2（22～67）岁。口服索拉非尼200～600mg,每日2次,连服不间断,如出现Ⅲ／Ⅳ级限制性毒副作用,酌情予剂量减半或停药。治疗时间1～20个月。结果：10例患者无完全缓解或进展,2例部分缓解,其余疾病稳定,其中1例稳定时间已经近2年。最常见的不良反应是手足皮肤反应、胃肠道和血液学改变。结论：索拉非尼对晚期肾癌的病情控制有较好的效果,而且其毒副作用相对较轻,患者多可很好地耐受。     

索拉非尼联合白细胞介素-2治疗转移性肾细胞癌的疗效

目的探讨索拉非尼联合白细胞介素-2治疗转移性肾细胞癌(metastatic renal cell carcinoma)的客观疗效及不良反应。方法 26例接受至少2个疗程索拉非尼联合白细胞介素-2治疗的转移性肾细胞癌患者,均经病理组织学或细胞学予以确诊。给药方法:白细胞介素-2 100万U,2次/d,皮下注射,4周为一疗程。索拉非尼400 mg/次,2次/d,连续服用4周为一疗程。2个疗程后采用RECIST实体瘤疗效评价标准评价疗效,用NCICTC 3.0评估不良反应。按MSKCC系统对危险分层评价。所有患者随访4～58个月。结果 26例转移性肾细胞癌患者获得完全缓解1例(3.8%),部分缓解4例(15.4%),疾病稳定17例(65.4%),疾病进展4例(15.4%),疾病控制率84.6%;客观有效率达到19.2%。中位生存时间(OS)为25个月(95%CI:13.9～28.1个月),中位无进展时间14个月(95%CI:5.7～16.2个月)。主要不良反应为皮疹、腹泻、发热、乏力、流感样症状、厌食、体重下降和中性粒细胞减少等。3～4度不良反应仅见于腹泻和乏力,均为1例(3.9%)。参照预后分层模型MSKCC危险因素评分,26例预后好、中等、差转移性细胞癌肾患者中,预后好组的有效率高于预后差组(P<0.05),3组的中位OS差异有统计学意义(P=0.000)。结论索拉非尼联合白细胞介素-2治疗转移性肾细胞癌的客观疗效较好,不良反应轻,患者可耐受,低危患者有可能明显获益。     

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.