吉西他滨联合5-FU或卡培他滨与吉西他滨单药治疗晚期胰腺癌对比的Meta分析

目的 通过Meta分析，探讨吉西他滨联合5-FU/卡培他滨化疗在治疗晚期胰腺癌病人中的意义。方法 通过检索MEDLINE、EMBASE、ASCO论文集等数据库中国内外已发表和未发表的相关文献。收集治疗组为吉西他滨联合5-FU/卡培他滨化疗，对照组为吉西他滨单药化疗的晚期胰腺癌的随机对照试验，由2位评价者分别按上述检索策略收集资料。按纳入标准入选，主要分析指标为半年和1年生存率，次要分析指标为客观缓解率、疾病无进展生存率、临床获益反应率和毒副作用等。结果共纳入了4个临床试验，在治疗晚期胰腺癌上，吉西他滨联合5-FU或卡培他滨与吉西他滨单药相比，可以提高半年生存率10％（95％CI0．01-0．19，P=0．03），差异有统计学意义，但是在1年生存率、半年疾病无进展生存率、客观缓解率和临床获益反应率上并没有提高，同时还增加了3/4级的血液学毒性及胃肠道的毒副作用。结论 吉西他滨联合5-FU/卡培他滨并不能提高晚期胰腺癌病人疗效，吉西他滨单药化疗仍是晚期胰腺癌的标准治疗方案。     

靶向药物联合吉西他滨和吉西他滨单药化疗治疗晚期胰腺癌比较的Meta分析

目的 通过Meta分析探讨靶向药物联合吉西他滨和吉西他滨单药化疗在治疗晚期胰腺癌病人中的意义。方法 通过MEDLINE、EBM等数据库，检索国内外已发表和已注册但未发表的相关文献。选择的治疗组为吉西他滨联合靶向药物，对照组为吉西他滨单药化疗的晚期胰腺癌的随机对照实验。由2位评价者分别按上述检索策略收集资料、按选择标准入选。主要对半年生存率、1年生存率、客观缓解率和毒副反应进行Meta分析。结果 在治疗晚期胰腺癌方面，吉西他滨联合靶向药物和吉西他滨单药比较，半年生存率提高4％(P=0．27)，1年生存率提高3％(P=0．34)，客观缓解率降低了3％(P=0．17)，差异均无统计学意义。毒副反应方面，吉西他滨联合靶向药物和吉西他滨单药比较，3／4度中性粒细胞减少的发生率增加了2％(P=0．84)，差异无统计学意义，3／4度贫血发生率无变化(P=0．96)，3／4度恶心 呕吐的发生率减少了6％(P=0.02)，差异有统计学意义。结论 靶向药物联合吉西他滨不适合用于晚期胰腺癌，目前尚不推荐临床常规使用。     

吉西他滨单药和联合化学治疗晚期胰腺癌疗效的Meta分析

目的：吉西他滨单药作为一线治疗晚期胰腺癌已成为标准治疗方案,本研究通过meta分析吉西他滨为主的联合化学治疗晚期胰腺癌的生存结果,以寻找确切有效的联合化疗方案。方法：通过MEDLINE、EMBASE、ASCO、ECCO等数据库及论文集检索相关文献。主要对各亚组半年生存率、1年生存率和客观缓解率进行meta分析。结果：16个随机对照临床试验（RCT）共2058例患者纳入分析,按化疗方案分为吉西他滨联合铂类、吉西他滨联合氟尿嘧啶类、吉西他滨联合伊利替康等3个亚组,各亚组半生存率的治疗优势（RD）分别为3％（P=0．003）、8％（P=0．003）、-1％（P=0．88）：1年生存率RD为4％（P=0．06）、1％（P=0．10）、1％（P=0．89）;客观缓解率RD为2％（P=0．32）、8％（P=0．01）、10％（P=0．0003）。结论：现有的证据提示吉西他滨联合氟尿嘧啶类药物一线治疗晚期胰腺癌,有较好的应用前景,值得进一步的临床试验。在选择联合化疗时对体质状态的要求较高,带瘤生存可能是治疗晚期胰腺癌应达到的最佳疗效。     

吉西他滨联合卡培他滨治疗晚期胰腺癌26例效果观察

目的:分析吉西他滨联合卡培他滨一线治疗晚期胰腺癌的效果。方法:晚期胰腺癌接受吉西他滨联合卡培他滨方案:吉西他滨1 000 mg/m2,静脉滴注30 min,第1、8天;卡培他滨1 000mg/m2,2次/天,口服,第1～14天。每3周为1个周期,观察其总生存期、无进展生存期、客观缓解率、临床获益率、糖类抗原19-9、缓解率和毒副反应等。结果:26例中部分缓解5例,疾病稳定7例,肿瘤进展14例,总客观缓解率为19.2%,临床获益率46.2%,糖类抗原19-9缓解率61.5%,中位生存期7.8个月,中位无进展生存期为6.2个月,1年期生存率为26.3%。结论:吉西他滨联合卡培他滨治疗晚期胰腺癌的化疗方案临床获益较高,毒性可耐受,值得临床研究和应用。     

替吉奥联合吉西他滨治疗进展期胰腺癌的临床观察

目的分析替吉奥联合吉西他滨治疗进展期胰腺癌的临床疗效。方法选2015年1月至2016年11月本院接收的进展期胰腺癌患者89例,以不同治疗方法为标准分成:研究组45例予以替吉奥联合吉西他滨治疗,参照组44例予以吉西他滨单药治疗,对2组临床疗效展开比对。结果研究组总有效率33.33%,比参照组13.64%高,(P0.05);2组生存情况(中位无进展生存时长、中位总生存期、生存率)比对,有差异性(P0.05)。结论临床对进展期胰腺癌展开专业化疗治疗时,予以替吉奥联合吉西他滨治疗的临床疗效确切,可使患者生存期延长的同时,还能提升生存率,改善预后。     

三维适形放疗联合吉西他滨介入化疗治疗局部晚期胰腺癌

目的评价三维适形放疗联合吉西他滨介入化疗对局部晚期胰腺癌的治疗效果。方法将40例经手术病理或细胞学诊断的局部晚期胰腺癌患者分为治疗组、对照组各20例。治疗组采用三维适形放疗联合吉西他滨介入化疗,对照组采用吉西他滨介入化疗,观察两组疗效、生存率及毒副反应。结果在治疗组,总有效率为40%;治疗后6、12个月生存率分别为65%、45%;中位生存时间为11个月。均高于对照组(P<0.05)。毒副反应2组比较无显著差异(P>0.05)。结论三维适形放疗联合吉西他滨介入化疗对局部晚期胰腺癌患者能控制肿瘤生长,缓解疼痛,改善生存质量,且患者耐受良好。     

吉西他滨联合化疗在晚期胰腺癌中的疗效观察

目的 探讨吉西他滨联合化疗在晚期胰腺癌中的疗效.方法 资料选自2010年1月-2012年12月该院收治的80例晚期胰腺癌患者,将其分为两组,各40例,研究组行吉西他滨联合化疗治疗,对照组行吉西他滨单药治疗,观察两组患者治疗后的疗效情况、临床受益反应情况、生存情况以及不良反应情况.结果 治疗后对两组进行比较,研究组的疾病控制率为75％,临床受益反应率为70％,治疗后半年的生存率为80％、治疗后1年的生存率为45％、治疗后1年半的生存率为35％,不良反应率为100％,而对照组的疾病控制率为45％,临床受益反应率为42％,治疗后半年的生存率为70％、治疗后1年的生存率为20％、治疗后1年半的生存率为15％,不良反应率为62.5％,两组比较差异有统计学意义（P＜0.05）.结论 吉西他滨联合化疗治疗晚期胰腺癌,尽管会引起某些不良反应,但是能提升患者的疾病控制率和临床受益反应率,也能延长患者的生存时间,疗效十分显著,值得在临床上推广使用.     

吉西他滨联合希罗达治疗晚期胰腺癌的疗效比较

目的：观察吉西他滨联合希罗达治疗晚期胰腺癌的疗效和不良反应。方法：对50例晚期胰腺癌患者给予此方案化疗4个周期,按WHO标准评定疗效及不良反应,同时综合评估临床受益率指标：疼痛、体力状况及体重变化。结果：客观有效率为42.9%,中位生存时间为7.4个月,1年生存率为32%。主要不良反应为血液学毒性和脱发。结论：吉西他滨加希罗达是治疗晚期胰腺癌的一种安全有效的化疗方案,有较高的肿瘤缓解率,毒性较低,值得在临床上进一步推广应用。     

吉西他滨为基础的化疗方案治疗进展期胰腺癌的临床疗效分析

目的 分析吉西他滨为基础的化疗方案治疗进展期胰腺癌的临床疗效.方法 选取在2014年1月至2015年6月期间到我院接受化疗的进展期胰腺癌患者54例,其中21例患者接受吉西他滨单药化疗,将其作为对照组;33例患者接受吉西他滨联合其他药物化疗,将其作为观察组.比较两组患者的临床疗效、生存情况及不良反应.结果 观察组患者临床有效率为42.4％,疾病控制率为81.8％,对照组临床有效率为19.0％,疾病控制率为52.4％,两组差异有统计学意义(P＜0.05).两组中位生存时间分别为11.7个月和7.1个月,中位无进展生存时间分别为4.6个月和2.8个月,6个月生存率分别为69.7％和57.1％,两组比较,差异具有统计学意义(P＜0.05);观察组对CA199水平的影响优于对照组(P＜0.05);两组不良反应比较,差异无统计学意义(P＞0.05).结论 以吉西他滨为基础的化疗方案治疗进展期胰腺癌,较单药治疗效果更佳,可显著提高患者生存率.     

吉西他滨每周方案或联合奥沙利铂治疗老年肺癌

目的探讨吉西他滨单药或联合奥沙利铂每周方案治疗老年晚期非小细胞肺癌(NSCLC)的临床疗效及安全性。方法选择2009年10月至2012年10月在佛冈县人民医院就诊的48例老年NSCLC患者作为研究对象,按数字表随机法将患者分为吉西他滨单药组及吉西他滨联合奥沙利铂组,吉西他滨单药组给予吉西他滨单药每周方案,吉西他滨联合奥沙利铂组在吉西他滨单药组的基础上联合奥沙利铂治疗。治疗完成后对患者的生活质量、临床客观有效率(ORR)、疾病控制率(DCR)及毒性反应进行评价。结果两组患者治疗完成情况相当(χ2=0.181,P=0.671)。吉西他滨单药组患者生活质量好转情况与吉西他滨联合奥沙利铂组比较,差异有统计学意义(Z=2.272,P=0.023)。两组患者的客观有效率分别为17.4%、50.0%,疾病控制率为56.5%、83.3%,两组比较差异均有统计学意义(χ2=4.372,P=0.037;χ2=4.037,P=0.045)。两组患者的毒性反应相当,多为Ⅰ^Ⅱ度,比较差异无统计学意义(P>0.05)。结论吉西他滨联合奥沙利铂每周方案治疗老年晚期NSCLC的疗效优于吉西他滨单药,其近期疗效及安全性较好。     

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.