NC方案治疗40例转移性乳腺癌的观察分析

目的：研究NC方案治疗转移性乳腺癌的疗效和毒性反应。方法：40例转移性乳腺癌患者接受NC方案化疗,设为化疗组,NC方案,NVB25mg/m2ivgtt,d1、8;DDP70mg/m2ivgtt,d1,21～28d为一周期,4周期为一疗程。对照组患者采用最佳支持治疗。结果：化疗组和对照组有效率分别为45.0%和2.5%,两组比较,有显著性差异（P〈0.01）;两组中位生存期（MST）分别为21.3个月和12.1个月,两组比较,有显著性差异（P〈0.01）。毒性反应方面,化疗组明显高于对照组,但大部分患者可以耐受。结论：转移性乳腺癌患者给予NC方案化疗疗效理想,毒性反应可以耐受,值得临床推广。     

动态

350 口服雌莫司汀和依托泊甙联合治疗前列腺癌效果佳、耐受性好希腊研究人员报道:口服雌莫司汀(es-tramustine)加依托泊甙(etoposide)治疗激素依赖的前列腺癌有效,并耐受良好。56例病人接受了这一治疗方案。口服雌莫司汀140 mg,3次/日,28天为1疗程,于1疗程中的第1～21天加服依托泊甙,每日50 mg/m~2,共治疗5个疗程,结果在33例可评价的病例中,5例完全有效(指 X 光照片病灶完全消失,并至少维持4周),10例部分有效(指病灶缩小50%以上),8例稳定,30/51病人在治疗7周后的 PSA 水平比治疗前下降     

吉西他滨联合厄洛替尼治疗进展期胰腺癌的疗效观察

目的 观察吉西他滨联合厄洛替尼方案治疗进展期胰腺癌的疗效、临床获益反应和毒性反应.方法 回顾性分析20例未接受过全身化疗的局部晚期和转移性胰腺癌患者的临床资料,所有患者均至少接受2个周期的吉西他滨联合厄洛替尼方案(第1、8天吉西他滨1000mg/m2 静脉滴注,厄洛替尼口服100～150mg/日,每21天重复)化疗.结果 20例患者中无达到完全缓解或部分缓解患者,11例(55%)病情稳定,9例(45%)病情进展,疾病控制率55%,临床获益率30%,中位无进展生存期4.0个月,中位生存期8.0个月.血液学毒性发生率为70%,其中3～4度白细胞下降的发生率为20%,3～4度血小板下降发生率为5%.皮疹发生率为55%,均为1～2度,1例出现2度腹泻,5例出现1度转氨酶升高.无化疗相关的死亡.结论 吉西他滨联合厄洛替尼治疗进展期胰腺癌,总体临床耐受性好,可以改善患者的生活质量,主要的不良反应是血液学毒性和皮疹.     

卡培他滨联合曲妥珠单抗治疗Her-2阳性老年转移性乳腺癌的疗效观察

目的：观察卡培他滨联合曲妥珠单抗治疗Her-2阳性老年转移性乳腺癌的疗效与安全性。方法：32例老年乳腺癌患者（≥65岁）均经病理组织学证实为复发或转移,Her-2阳性,给予卡培他滨1250 mg/m2口服,2次/d,第1~14天;曲妥珠单抗首次负荷剂量8 mg/kg,后续6 mg/kg静点,21 d为一周期,每2周期评价疗效。结果：32例患者均可评价,其中完全缓解（CR）2例（6.2%）,部分缓解（PR）10例（31.3%）,稳定≥6个月（SD）11例（34.4%）,进展（PD）9例（28.1%）,总有效率为37.5%（12/32）,临床获益率（CR＋PR＋SD）为71.9%（23/32）;中位疾病进展时间（TTP）8.5个月;主要的毒副反应为手足综合征、腹泻、口腔炎,均可耐受;1例患者出现症状性心力衰竭,停药后改善;无化疗相关死亡。结论：卡培他滨联合曲妥珠单抗治疗Her-2阳性老年转移性乳腺癌疗效确切,毒副反应轻,耐受性良好,是一种安全有效的姑息治疗方案。     

长春瑞滨联合顺铂治疗紫杉类化疗失败的复发转移性乳腺癌的临床观察

目的:观察长春瑞滨(NVB)联合顺铂(DDP)治疗复发转移性乳腺癌的疗效。方法:对28例紫杉类化疗后复发转移性乳腺癌患者采用NVB+DDP方案治疗,NVB 25 mg/m2,d₁、d₈;DDP 25 mg/m2,d₁~d₃;21天为1个周期,2个周期后评价疗效。结果:28例患者中,完全缓解2例,部分缓解11例,稳定10例,进展5例,总有效率为46.4%。1个部位转移者治疗有效率为50.0%,2个或2个以上部位转移者治疗有效率为43.8%。结论:NVB联合DDP治疗紫杉类化疗失败的复发转移性乳腺癌具有一定疗效,且不良反应可以耐受。     

长春瑞滨联合卡培他滨对蒽环类和紫杉类药物耐药的晚期乳腺癌疗效观察

目的观察长春瑞滨联合卡培他滨对蒽环类和紫杉类药物耐药的晚期乳腺癌患者的疗效和不良反应。方法32例晚期乳腺癌患者经长春瑞滨25mg/m^2,静脉滴注,d1、8;卡培他滨2000mg/（m^2·d）,早晚2次,餐后30 min口服,d1-14,21d为1个周期,每例患者至少接受2个周期化疗或至疾病进展。结果32例患者共完成161个周期化疗,中位化疗5个周期。所有患者均可评价疗效和不良反应,其中完全缓解（CR）1例,部分缓解（PR）9例,疾病稳定（SD）13例,疾病进展（PD）9例。总有效率（CR＋PR）31.2%,疾病控制率（DCR）71.9%,中位无进展生存期（TTP）8.3个月,1、2年生存率分别为66.9%和38.4%。不良反应主要为骨髓抑制、手足综合征及静脉炎,没有发生治疗相关性死亡。结论长春瑞滨联合卡培他滨方案是治疗对蒽环类和紫杉类药物耐药的晚期乳腺癌患者的有效方案,不良反应可以耐受。     

曲妥珠单抗联合PC方案治疗Her-2/neu高表达转移性乳腺癌的临床观察

目的观察曲妥珠单抗联合PC(泰素加卡铂)方案治疗Her-2/neu高表达转移性乳腺癌的疗效与毒副作用。方法24例Her-2/neu高表达转移性乳腺癌患者接受曲妥珠单抗联合PC方案治疗,曲妥珠单抗的首次剂量为8mg/kg静脉滴注(第1天),以后的剂量为6mg/kg静脉滴注(第1天),泰素的剂量为175mg/m2静脉滴注(第1天),卡铂的剂量为AUC5静脉滴注(第1天),每21天重复1次。根据WHO疗效评定及毒副反应分级标准,观察其近期疗效、中位肿瘤进展时间(TTP)、1年生存率及毒副反应。结果24例患者共接受103个周期化疗(中位数4个周期,范围2～6个周期),所有患者均可评价疗效。24例患者中完全缓解3例(12.50%),部分缓解11例(45.83%),病情稳定6例(25.00%),病情进展4例(16.67%),有效率(完全缓解加部分缓解)为58.33%,中位肿瘤进展时间8.7个月,1年生存率为70.83%。毒副反应主要为骨髓抑制、消化道毒性等。结论曲妥珠单抗联合PC方案治疗Her-2/neu高表达转移性乳腺癌近期疗效较高,不良反应较轻。     

长春瑞滨联合吉西他滨治疗复发或转移性乳腺癌的疗效观察

目的:观察长春瑞滨(NVB)联合吉西他滨(GEM)治疗复发或转移性乳腺癌的疗效及安全性。方法:对符合标准的34例复发或转移性乳腺癌患者均给予NVB 25 mg/m2静滴,第1、8天;GEM 1 000 mg/m2静滴,第1、8天,21 d为1周期,至少2个周期后评价疗效,平均完成3.4个周期。结果:34例患者中,完全缓解(CR)3例,部分缓解(PR)12例,总有效率44.1%,中位TTP 7.4个月。结论:NVB联合GEM治疗复发转移性乳腺癌有一定疗效,其毒副作用患者可以耐受,是复发或转移性乳腺癌较为理想的治疗方案。     

血清肿瘤标志物癌胚抗原对HER-2过度表达的晚期乳腺癌患者的生物化疗疗效的监测作用

目的 通过研究HER-2过表达的晚期乳腺癌患者在接受曲妥珠单抗(herceptin)联合紫杉醇治疗后随访期间血清肿瘤标志物癌胚抗原(CEA)的变化情况,探讨CEA对其生物化疗疗效的监测价值.方法 回顾性分析83例HER-2过表达晚期乳腺癌患者接受herceptin联合紫杉醇生物化疗2周期后血清CEA水平的变化,并分析其与影像学评价的生物化疗客观疗效的相关性.结果 生物化疗2周期后,临床获益率(CBR)为81.9%.在CEA下降的60例患者中,临床获益为51例(85.O%),无效为9例(15.0%);在CEA升高的23例中,临床获益为8例(34.8%),无效为15例(65.2%),两组比较,差异有统计学意义(x=20.399,P<0.05).结论 血清肿瘤标志物CEA的变化对监测HER-2过表达晚期乳腺癌患者生物化疗疗效有一定的作用.     

NP方案治疗复发、转移性乳腺癌的临床观察

为了观察NP方案治疗复发、转移性乳腺癌的近期疗效及毒副反应,对20例复发、转移性乳腺癌予以NP方案化疗,具体方案为：长春瑞滨25mg/m2ivd1.8,顺铂75mg/m2ivgttd1,每3周重复。2～3周期后评价疗效和毒副反应,全组有18例可评价疗效,其中完全缓解2例,部分缓解7例,稳定7例,进展2例,总的临床获益率（CR＋PR）为50%。化疗后骨髓抑制情况,Ⅰ度骨髓抑制为22.2%,Ⅱ度为33.3%,Ⅲ度为27.8%,Ⅳ度为11.1%,经研究结果提示,NP方案治疗复发、转移性乳腺癌近期疗效较好,值得临床进一步研究应用。     

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.