CIG方案治疗急性髓系白血病疗效分析

目的观察阿糖胞苷(Ara-C)、去甲氧柔红霉素(IDA)和粒细胞集落刺激因子(G-CSF)联合方案(CIG方案)治疗急性髓系白血病(acute myeloid leukemia,AML)的临床疗效及不良反应。方法初治、难治/复发和老年AML患者中36例采用CIG方案治疗,完成1个疗程后评估疗效,治疗失败患者则退出观察,有效者继续接受1个疗程治疗。随访分析患者总体生存期(overall survival,OS),评判CIG方案的疗效。结果 CIG组36例中完全缓解(completely remission,CR)20例(55.5%),部分缓解(partial remission,PR)9例(25%),未缓解(non remission,NR)7例,死亡1例,总有效率80.55%。其中第1个疗程达CR者14例,第2个疗程达CR者6例。CIG组中位OS 26个月。结论初治、难治/复发和老年AML患者治疗中,CIG方案是有效且不良反应低的治疗方法。     

MEA方案治疗难治复发性成年人急性粒细胞白血病临床观察

目的:观察MEA方案治疗难治复发性成年人急性粒细胞白血病的疗效和安全性.方法:2006年1月～2009年6月收治成年人难治复发性AML患者18例,采用MEA方案化疗,米托蒽醌10mg/日,静脉滴注,第1～3天:阿糖胞苷100mg/日,静脉滴注,第1～7天;依托泊苷100mg/日,静脉滴注,第1～5天.如果第1疗程未取得完全缓解(CR),则接受第2疗程的化疗,方案同前.结果:完全缓解(CR)11例,部分缓解(PR)2例,未缓解(MR)5例,总有效率为72%.结论:MEA方案治疗难治复发性AML有较好疗效,患者不良反应轻微.     

氟达拉滨联合阿糖胞苷治疗难治及复发急性髓细胞白血病的疗效观察

目的:探讨氟达拉滨联合阿糖胞苷方案(FA)对不同类型难治及复发急性髓细胞白血病(AML)的近期疗效及不良反应.方法:32例难治及复发AML患者,初发难治性AML 14例,其中原发性AML 9例,慢性粒细胞白血病急性变者2例,骨髓增生异常综合征(MDS)转化为AML者3例;早期复发者8例,晚期复发者10例;32例患者初治前均进行白血病细胞免疫表型检测,其中CD7阳性者10例(31.3%),CD7阴性者22例(68.7%).应用FA方案:氟达拉滨30 mg/m2·d-1,静脉滴注,第1～5天;4 h后给予阿糖胞苷1 g/m2·d-1,静脉滴注,第1～5天.1疗程后如达完全缓解(CR)或部分缓解(PR),可用原方案巩固1疗程或改用其他方案强化治疗,如未缓解(NR)则退出.结果:32例患者中13例(40.6%)CR,5例(15.6%)PR,13例(40.6%)NR,早期死亡1例(6.3%);其中初发难治者4例(28.6%)CR,2例(14.3%)PR,均为原发性AML,而慢性粒细胞白血病急性变(CML-BP)者2例,MDS转化为AML者3例,均未获得缓解;早期复发者3例(37.5%)CR,2例(25.0%)PR,晚期复发者6例(60.0%)CR,1例(10.0%)PR;CD7阳性者2例(20.0%)CR,2例(20.0%)PR,CD7阴性者11例(50.0%)CR,3例(13.6%)PR,血液学不良反应主要为骨髓抑制及继发感染,其中1例患者死于感染,2例因病情加重而放弃治疗,其余均恢复,非血液学不良反应主要为胃肠道反应,轻中度肝功能异常,经对症处理后均恢复正常.结论:氟达拉滨联合阿糖胞苷方案可作为难治及复发急性髓细胞白血病的有效挽救治疗方案,不良反应可耐受,但该方案对CML急性变、MDS-AML、CD7阳性的AML疗效不佳.     

CAOLD方案治疗难治复发性血管免疫母细胞性T细胞淋巴瘤的临床观察

目的 观察CAOLD方案治疗难治复发性血管免疫母细胞性T细胞淋巴瘤(AILT)的疗效.方法 对18例难治复发性AILT患者应用CAOLD方案化疗,化疗大于或等于2个周期,评定疗效.结果 18例患者总有效率为77.7%,完全缓解(CR)率为44.4%(8/18),部分缓解(PR)率为33.3%(6/18),未缓解率为22.3%(4/18).结论 CAOLD方案治疗难治复发性AILT有较好的疗效,值得临床进一步推广.     

常规剂量DA方案治疗老年急性髓细胞白血病的近期疗效及心血管副作用分析

目的 分析常规剂量DA方案治疗老年急性髓细胞白血病AML的疗效,及心血管副作用,探讨优化治疗方案的策略.方法 对37例老年AML患者以常规剂量DA方案诱导缓解治疗,即柔红霉素45mg/m2d静脉注射,第1～3天,阿糖胞苷100～150mg./m2d静脉滴注,第1～7天.如第一疗程结束后患者未获得完全缓解(CR),则进行第二疗程诱导缓解治疗.结果 13例(35.1%)第一个疗程获得了CR,4例(10.8%)2个疗程获得了CR,8例(21.6%)2疗程获得了部分缓解(PR),3例(8.1%)死于治疗相关死亡,9例(24.3%)患者未缓解(NR),总有效率为67.6%.Ⅱ～Ⅳ度骨髓抑制的发生率为81.1%,而Ⅱ～Ⅳ度感染发生率为64.8%.单因素分析结果显示,年龄≥75岁为影响老年AML患者的CR率的最主要的预后因素(P=0.036).结论 常规剂量的DA方案治疗老年AML患者的疗效仍欠佳,对于年龄≥75岁的AML患者不宜于使用该方案治疗.     

地西他滨联合化疗对MDS及老年急性髓系白血病的效果评价

目的：分析地西他滨对相对高危组骨髓增生异常综合征(myelodysplastic syndrome, MDS)和老年急性髓系白血病(acute myeloid leukemia, AML)患者的疗效和安全性。方法：回顾性分析2013年7月—2017年3月收治的骨髓原始细胞≥5%的相对高危组MDS、老年AML患者临床资料,对比评定疗效及不良反应。结果：15例骨髓原始细胞≥5%的相对高危组MDS患者完全缓解(complete remission, CR)率60.0%,部分缓解(partial remission, PR)率13.3%,总有效率73.3%。老年AML 9例患者的CR率为55.6%,PR率为11.1%,总有效率为66.7%。MDS组和3例老年AML患者发生了严重不良反应,为中性粒细胞减少和血小板减少;骨髓原始细胞≥5%的相对高危组MDS和老年AML中位生存时间分别为30.00和21.07个月。结论：国产地西他滨联合传统化疗可作为理想的诱导缓解治疗方案,且延长生存期。     

HTA方案诱导治疗急性髓系白血病的疗效分析

目的:观察高三尖杉酯碱(HHT)、吡喃阿霉素(THP)、阿糖胞苷(Ara-C)三药联合(HTA)方案治疗初诊急性髓系白血病(AML)的疗效与安全性。方法:回顾性分析2006年8月~2013年12月我科收治的15例初诊AML患者给予HTA方案诱导化疗1个疗程的疗效及不良反应,统计完全缓解(CR+CRi)、部分缓解(PR),总有效(OR)(CR+PR)的情况。以在我科行DA方案诱导化疗的23例患者为对照。结果:HTA组15例患者1个疗程达CR为11例,PR为2例,OR为13例;DA组23例患者1个疗程达CR为14例,PR为3例,OR为17例。HTA组CR情况略优于DA组,差异无统计学意义(P>0.05)。结论:HTA方案可作为初诊AML诱导治疗方案之一,且不良反应可耐受。     

Venetoclax联合化疗治疗复发/难治性急性髓系白血病的临床研究

背景成人复发/难治性急性髓系白血病（AML）的预后较差,长期生存率和治愈率极低,化疗方案有限。目的探讨Venetoclax（VEN）联合阿扎胞苷（Aza）、HAAG〔高三尖杉酯碱（HHT）、阿糖胞苷（Ara-C）、阿克拉霉素（Acla）、粒细胞刺激因子（G-CSF）〕方案治疗复发/难治性AML的安全性和有效性。方法回顾性分析蚌埠医学院第一附属医院收治的10例复发/难治性AML患者的临床资料,包括：临床特征（年龄、性别、诊断、染色体、基因突变、预后）、外周血及骨髓细胞学、VEN+Aza+HAAG方案治疗效果。结果10例患者中男7例、女3例,平均年龄（47.9±11.3）岁;FAB分型：M24例、M56例;预后良好3例、中等2例、不良5例。化疗前中位白细胞计数（WBC）、血红蛋白（Hb）、血小板计数（PLT）、骨髓原始细胞百分比（Blasts%）分别为4.10×109/L、87.5 g/L、66.00×109/L 、63.5%,化疗后分别为3.28×109/L、107.0 g/L、78.00×109/L、5.5%。VEN+Aza+HAAG方案联合化疗前中位化疗次数为5次,化疗后完全缓解（CR）1例,形态学完全缓解而血细胞计数未完全恢复（CRi）4例,部分缓解（PR）3例,未缓解（NR）2例。10例患者客观缓解率（ORR）为80%,中位生存期（OS）为6.5（3.0,8.5）个月。毒副作用主要为骨髓抑制、感染等,无患者死于治疗相关并发症及其他毒副作用。结论与传统化疗方案相比,复发/难治性AML患者使用VEN+Aza+HAAG化疗方案可以明显提高ORR及缓解深度,延长患者生存时间,值得进一步研究并有望在临床推广应用。     

以氟达拉宾为主的联合化疗方案治疗惰性淋巴瘤的临床研究

目的观察以氟达拉宾为主的联合化疗方案对惰性淋巴瘤的疗效及临床耐受性。方法予133例惰性淋巴瘤患者氟达拉宾联合环磷酰胺(FC方案)或氟达拉宾联合米托蒽醌及地塞米松(FMD方案)治疗2～6个疗程,观察其疗效及不良反应。结果初治患者完全缓解(CR)率为55．6%(25例),部分缓解(PR)率为42．2% (19例),总体有效(OR)率为97．8%(44例)。复发难治患者的CR、PR和OR率分别为48．9%(43例)、40．9% (36例)和89．8%(79例)。完成2～4个疗程者的CR率为24%～47%,完成5～7个疗程者的CR率达59%～100%。不良反应主要为中性粒细胞减少、贫血和血小板减少。结论以氟达拉宾为主的联合化疗治疗初治及复发难治惰性淋巴瘤患者的缓解率高,且具有良好的安全性。     

硼替佐米联合地塞米松治疗多发性骨髓瘤的临床研究

目的观察硼替佐米联合地塞米松治疗多发性骨髓瘤(MM)的临床疗效及安全性。方法 12例初治MM患者及6例难治复发患者均采用硼替佐米联合地塞米松化疗(硼替唑米1.3mg/m~2,第1、4、8、11天快速静脉注射;地塞米松20～40mg,第1～4、8～11天静脉滴注或口服;3周为1个疗程)1～6个疗程,根据EBMT疗效标准评价疗效,按NCI-CTCAE标准评价不良反应。结果平均随访6个月(2～11个月),12例初治患者中3例完全缓解(CR),6例部分缓解(PR),2例轻微反应(MR),1例无变化(NC)。6例难治复发患者中2例CR,2例PR,1例NR,1例死亡。总反应率(ORR=CR+PR+MR)83.33%,总有效率(CR+PR)72.22%。主要不良反应为乏力、血小板减少、白细胞减少、腹泻、周围神经病变和阵发性房颤,经对症处理后基本缓解。结论硼替佐米联合地塞米松治疗初发或难治性多发性骨髓瘤是一种有效的新方法,不良反应较轻,患者可耐受。     

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.