适形放疗联合NP化疗与单纯NP化疗治疗晚期非小细胞肺癌临床疗效分析

目的回顾分析适形放疗联合化疗与单纯NP方案化疗治疗晚期非小细胞肺癌的临床疗效和毒副作用。方法76例Ⅲ期和Ⅳ期非小细胞肺癌患者资料。单纯化疗组31例，接受单纯NP方案化疗。NP方案为诺维本25mg／m^2，d1，d8；DDP25mg／m^2，d1-3，21d为1周期。放疗联合化疗组45例，接受适形放疗联合NP方案化疗，NP方案化疗两周期后续行三维适形常规分割放疗，之后再行NP方案化疗。放射源为直线加速器X线，15MV，照射剂量36—66Gy。锁骨上区预防照射，8NeV电子线，20—30Gy。结果放疗联合化疗组有效率（RR）57．8％，其中3例达到完全缓解，单纯化疗组有效率（RR）32．3％，两组间P〈0．05，其差异有统计学意义。放疗联合化疗组中鳞癌RR65．6％，腺癌RR41．7％，P〈0．05，其差异有统计学意义；ⅢA、ⅢB和Ⅳ期RR分别为83．3％，61．1％和33．3％，P〈0．05，三者间差异有统计学意义，ⅢA期与Ⅳ期有效率P〈0．01，其差异有统计学意义；初治、复治RR为60．1％、20．0％，P〈0．05，其差异有统计学意义。单纯化疗组中鳞癌与腺癌、ⅢB期与Ⅳ期、初治与复治之间有效率差异无统计学意义。放疗联合化疗组的中位疾病进展时间（TTP）为178a（60-446d）。单纯化疗组的中位TTP为82d（25—233d）。放疗联合化疗组的毒副反应较单纯化疗组多一些，重一些，主要毒副反应为骨髓抑制、胃肠道反应、放射性肺炎和放射性食管炎，均可以通过相应措施予以纠正、缓解。结论适形放疗联合NP方案化疗较单纯NP方案化疗对晚期非小细胞肺癌有较好的近期疗效，TTP也较长些，毒副反应能够予以纠正、缓解。     

同步放化疗治疗Ⅲ期非小细胞肺癌临床分析

目的观察和评价同步放化疗治疗Ⅲ期非小细胞肺癌的疗效和毒副反应。方法Ⅲ期非小细胞肺癌患者40例,随机分为同步放化疗组和序贯放化疗组,同步放化疗组行三维适形常规分割放疗,总量60-68Gy/30-34次/6-7周;放疗开始后同步进行NP方案化疗,NVB 25mg/m2,d1、8;DDP25mg/m2,d1-3,21d为1个周期,放疗后再采用该方案化疗4个周期。序贯放化疗组的放疗方案、剂量及辅助化疗同同步放化疗组。结果同步放化疗组和序贯放化疗组有效率分别为75.0%和35.0%,1、3年总生存率分别为50.0%、40.0%和40.0%、12.5%,差异有统计学意义。结论 NP方案联合同步放疗治疗Ⅲ期非小细胞肺癌的疗效确切,毒副反应可耐受,值得进一步推广。     

三维适形放疗联合化疗在非小细胞肺癌中的应用

目的观察三维适形放疗联合化疗治疗Ⅲ期非小细胞肺癌的临床疗效及毒副作用。方法对30例Ⅲ期非小细胞肺癌患者采用三维适形放疗联合化疗。放射治疗先常规放疗2Gy／（次·d），5次／周，至40Gy后改为适形放疗，3Gy／（次·d）．5次／周，共10次30Gy。化疗采用NP方案，分别于放疗前和放疗后给予2个周期，每3周重复。结果30例患者均完成治疗，CR2例，PR22例，总有效率（CR＋PR）为80％，一、二年局部控制率和生存率分别为81％、45％和78％、41％。放射性肺炎和放射性食管炎分别为19％和35％。结论三维适形放射疗法联合化疗对Ⅲ期非小细胞肺癌安全、有效，是治疗局部晚期非小细胞肺癌较理想的方案。     

吉西他滨单药化疗联合适形放疗治疗老年局限晚期非小细胞肺癌的疗效分析

目的探讨吉西他滨单药化疗联合适形放疗治疗老年局限晚期非小细胞肺癌(NSCL)的临床控制率(CCR)及毒副反应。方法选择2005年6月~2009年1月收治的Ⅲa～Ⅲb老年局限非小细胞肺癌患者40例,随机分为对照组及实验组,每组20例。对照组组采用吉西他滨单药化疗4周期,实验组吉西他滨单药化疗2周期后进行适形放疗。治疗结束后比较两组患者肿瘤控制率及毒副反应差异。方法实验组总有效率(ORR)为85.0%,对照组ORR值为35.0%,实验组ORR高于对照组,差异有统计学意义(P<0.05)。实验组化疗毒副反应发生等级低于对照组,差异有统计学意义(P<0.05),实验组中有7例出现放射性肺炎,12例出现放射性食管炎。结论采用吉西他滨单药化疗联合适形放疗治疗老年晚期非小细胞肺癌能提高肿瘤临床控制率,合理控制放疗剂量,能够避免严重放射性损伤风险,适合老年非小细胞肺癌患者应用。     

93 例Ⅲ期非小细胞肺癌同步放化疗加巩固化疗与序贯放化疗对比研究

分析Ⅲ期不能手术非小细胞肺癌同步放化疗加巩固化疗与序贯放化疗的近、远期疗效及毒副反应。方法 回顾分析2007.2~2010.6收治的Ⅲ期不能手术的非小细胞肺癌患者93例,序贯组50例,同步加巩固组43例。序贯组：先行2~6周期（中位2周期）化疗后开始放疗,放疗后再行0~4周期（中位2周期）化疗。同步组：放疗同步2周期化疗（每隔3周）,放疗后行2~4周期（中位2周期）同方案巩固化疗,均为第3代TP/NP/GP方案。放疗采用二维前后对穿野照射DT36~40Gy/18~20f后三维适形放疗推量至DT56~70Gy/28~35（f中位DT64Gy）或三维适形放疗DT50~74Gy/25~37（f中位DT62Gy）。 结果 同步加巩固与序贯组客观有效率分别为76.7%、54.0%（P<0.05）;中位无进展时间、中位生存时间分别为16.0个月、18.0个月及10.0个月、12.5个月;1、2、3 年生存率分别为 83.7%、48.8%、20.9%及 52.0%、20.0%、2.0%（P<0.05）。同步加巩固组远地转移率明显低于序贯组（P<0.05）,局部复发率两组无统计学差异。毒副反应主要为放射性肺炎、放射性食管炎、消化道反应及血液毒性,其中Ⅲ~Ⅳ级消化道反应及血液毒性同步加巩固组高于序贯组,有统计学差异。结论 对于Ⅲ期非手术NSCLC同步放化疗加巩固化疗与序贯放化疗相比,可以提高客观有效率、延长无进展生存及总生存时间、降低远地转移率,虽然消化道及血液学毒性增加,但患者可以耐受。     

Ⅲ期非小细胞肺癌同期NP方案化疗与后程大分割三维适形放射治疗

目的 探讨同期NP方案化疗与后程大分割三维适形放射(3DCRT)治疗Ⅲ期非小细胞肺癌的疗效及不良反应.方法 60例Ⅲ期非小细胞肺癌(NSCLC)随机分成后程大分割3DCRT组(A组)和常规分割放疗组(B组).A组先接受常规分割放疗(2Gy/次,5次/周)40Gy后2周行大分割适形放疗24～30Gy(4～5Gy/次,3次/周);B组均接受常规分割放疗至66Gy.两组均于放疗第1天起接受1周期NP方案化疗,放疗结束后接受3周期NP方案化疗.结果 A、B组完全缓解(CR)率分别为26.7%、16.7%(P>0.05),部分缓解(PR)率分别为50%、30%(P<0.05),有效率(CR PR)分别为76.7%、46.7%(P<0.05);1、2、3年生存率A组分别为83.3%、46.7%、36.7%,B组分别为46.7%、20%、16.7%,两组1～3年生存率比较差异有统计学意义.急性造血系统反应、放射性食管炎和放射性肺炎发生率相当.结论 后程大分割三维适形放射治疗加化疗治疗Ⅲ期NSCLC的效果优于常规分割放疗,且不良反应相当.     

93例Ⅲ期非小细胞肺癌同步放化疗加巩固化疗与序贯放化疗的对比研究

目的分析Ⅲ期不能手术非小细胞肺癌同步放化疗加巩固化疗与序贯放化疗的近、远期疗效及毒副反应。方法回顾分析2007年2月-2010年6月收治的Ⅲ期不能手术的非小细胞肺癌患者93例,序贯组50例,同步加巩固组43例。序贯组:先行2-6周期(中位2周期)化疗后开始放疗,放疗后再行0-4周期(中位2周期)化疗。同步组:放疗同步2周期化疗(每隔3周),放疗后行2-4周期(中位2周期)同方案巩固化疗,均为第3代TP/NP/GP方案。放疗采用二维前后对穿野照射DT36-40 Gy/18-20f后三维适形放疗推量至DT56-70 Gy/28-35(f中位DT64 Gy)或三维适形放疗DT50-74 Gy/25-37(f中位DT62 Gy)。结果同步加巩固与序贯组客观有效率分别为76.7%、54.0%(P<0.05);中位无进展时间、中位生存时间分别为16.0个月、18.0个月及10.0个月、12.5个月;1、2、3年生存率分别为83.7%、48.8%、20.9%及52.0%、20.0%、2.0%(P<0.05)。同步加巩固组远地转移率明显低于序贯组(P<0.05),局部复发率两组无统计学差异。毒副反应主要为放射性肺炎、放射性食管炎、消化道反应及血液毒性,其中Ⅲ-Ⅳ级消化道反应及血液毒性同步加巩固组高于序贯组,有统计学差异。结论对于Ⅲ期非手术NSCLC同步放化疗加巩固化疗与序贯放化疗相比,可以提高客观有效率、延长无进展生存及总生存时间、降低远地转移率,虽然消化道及血液学毒性增加,但患者可以耐受。     

NP方案同步化疗治疗非小细胞肺癌时常规放疗与3D-CRT放疗的临床对比分析

目的:评价长春瑞滨与顺铂(NP)作为同步化疗方案常规放疗与三维适形放疗治疗局部晚期非小细胞肺癌的疗效及毒副反应.方法:63例Ⅲ期非小细胞患者采用NP方案同步化疗,于放疗开始第1、8天使用NVB25mg/m2和DDP25mg/m2化疗,休息两周后重复直至放疗结束.放射治疗:常规放疗组(36例)纵隔野每次2Gy,每周5次,Dt40Gy/4w,然后避开脊髓加量至66-70Gy/7w.3D-CRT组(27例)常规纵隔野照射至Dt40Gy/4w后予以3D-CRT局部加量,每次2Gy,每周5次,至Dt66-70Gy.结果:常规放疗组与3D-CRT放疗组有效率分别为72.2%和74%,1生存率分别为63.3%和65.4%,两组无显著差异(P>0.05).两组患者没有发生严重的放化疗毒副反应,3D-CRT组放射性肺炎低于常规放疗组(P<0.05),其他毒副反应两组间无明显差异.结论:NP方案同步放化疗时3D-CRT较常规放疗可以减轻放射性肺炎的发生率,值得临床进一步研究.     

全身伽玛刀同步化疗治疗局部晚期非小细胞肺癌的临床观察

目的比较全身伽玛刀与普通放疗结合同步化疗治疗局部晚期非小细胞肺癌(NSCLC)的效果及毒副反应。方法将64例ⅢA/ⅢB期NSCLC患者随机分成两组,全身伽玛刀组采用三维适形放疗技术,每次3~6 Gy,1次/天,照射10~20次,肿瘤灶总生物有效量为80~90 Gy。普通放疗组放疗量在60~66 Gy。在放疗同时联合化疗,顺铂80~100mg/m2,静脉滴注;氟脲嘧啶2.5g/m2或氟脲苷2.5g/m2,静脉滴注,21~28天为1个周期,连续2~4个周期。结果全身伽玛刀组有效率为96.88%,普通放疗组有效率为75.00%,全身伽玛刀组和普通放疗组的1、2年生存率分别为84.38%、40.63%和78.13%、25.00%。全身伽玛刀组Ⅲ度放射性食管炎、放射性肺炎发生率分别为6.25%(2/32)、3.13%(1/32),低于普通放疗组的43.75%(14/32)和21.88%(7/32)。结论全身伽玛刀和同步化疗是ⅢA/ⅢB期非小细胞肺癌安全有效的治疗手段,值得进一步临床研究。     

后程三维适形放疗联合化疗治疗Ⅲ期非小细胞肺癌的临床观察

目的 观察后程三维适形放疗联合化疗治疗Ⅲ期非小细胞肺癌的临床疗效及毒副作用。方法 对46例Ⅲ期非小细胞肺癌患者采用后程三维适形放疗联合化疗。放射治疗先常规放疗2Gy／（次·天）,5次／周,至40Gy后改为适形放疗,3Gy／（次·天）,5次／周,共10次30Gy。化疗采用NP方案,分别于放疗前和放疗后给予2个周期,每3周重复。结果 46例患者均完成治疗,CR4例,PR33例,总有效率（CR＋PR）为80．5％,一、二年局部控制率和生存率分别为81％、45％和78％、41％。放射性肺炎1—2级14例,3级1例;放射性食管炎1—2级23例,3级1例。结论 此种疗法对Ⅲ期非小细胞肺癌安全、有效,近期疗效满意,远期疗效需进一步观察。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.