76例外阴癌临床特征及预后影响因素分析

目的：分析外阴癌临床特征及预后影响因素。方法：回顾性分析2000年1月-2008年12月山西省肿瘤医院收治的76例外阴癌患者的临床病理资料。结果：临床分期、病理分化程度及腹股沟淋巴结转移为外阴癌的预后影响因素。Ⅰ、Ⅱ、Ⅲ、Ⅳ期3年生存率分别为84．6％、75％、37．5％、60％（3／5）,高、中、低分化3年生存率分别为81．8％、62．9％、33．3％,死亡风险为2．261,说明肿瘤分级每增加一级,死亡风险增加为原来的2．261倍。有淋巴结转移的死亡风险是没有淋巴结转移的3．065倍。结论：病理分化程度及腹股沟淋巴结转移为外阴癌的独立预后影响因素。应做到早发现、早诊断,配合正规的治疗是提高外阴癌生存率的关键。     

早期胃癌51例临床诊治分析

目的 探讨早期胃癌的治疗效果。方法 对1989年2月至2000年8月间早期胃癌患者51例的临床资料及生存预后的情况进行回顾性分析。结果 早期胃癌大体类型以凹陷型多见，其次为浅表型，全组淋巴结转移率为13．73％，早期胃癌最常见症状是上腹不适或隐痛，3年和5年生存率为98．04％和92．15％，全组术后复发率为11．7％。复发均发生于D1术式。结论 早期诊断、早期治疗是提高生存率的关键，建议对早期胃癌尤其是癌细胞分化差侵犯黏膜下层者行D2术式。     

86例早期胃癌预后因素分析

目的：探讨分析对早期胃癌预后影响的因素。方法：回顾性分析1997年1月-2007年1月我院收治86例早期胃癌患者的临床资料及术后随访资料,统计分析早期胃癌影响预后的因素。结果：本组早期胃癌病例5年生存率为90．9％,其预后主要与肿瘤大小、淋巴结转移相关,肿瘤直径〈2cm、2～4cm、〉4cm以上5年生存率分别为100．0％、71．6％,50．5％,有淋巴结转移者5年生存率（73．4％）明显低于无淋巴结转移者（91．3％）。相关性分析表明年龄、性别、病理分型与预后因素问无明显相关性。结论：毕I或毕Ⅱ式根治术后患者,淋巴结转移、肿瘤大小是早期胃癌重要的预后因素,对肿瘤直径大、淋巴结转移广泛的早期胃癌患者应采用以根治术为主的综合治疗方案,对指导早期胃癌预后及手术选择有实际应用价值。     

71例老年早期胃癌的临床分析

目的：研究老年早期胃癌患者的临床病理特征、手术治疗方式及预后因素。方法：回顾性分析我院1996年1月～2005年12月干部病房收治的71例老年早期胃癌的临床病理资料。结果 ：本组病例占同时期收治胃癌患者的33.8%,57.7%的患者无症状;本组手术切除率为100.0%,手术死亡率为1.4%;术后5年生存率为94.1%,10年生存率为91.5%。单因素分析表明肿瘤浸润深度、淋巴结转移、淋巴管癌栓显著影响老年早期胃癌患者的预后（P〈0.05）。结论：规律胃镜检查能有效提高早期胃癌发现率;年龄不是老年早期胃癌患者根治切除的禁忌证;浸润深度、淋巴结转移、淋巴管癌栓是影响老年早期胃癌预后的重要因素。     

pN0早期胃癌淋巴结微转移的临床分析

目的探讨pN0早期胃癌淋巴结微转移状况及其与临床病理特征的关系。方法收集61例pN0早期胃癌患者手术后石蜡标本,采用免疫组化MaxVision法检测pN0早期胃癌868颗HE染色阴性淋巴结细胞角蛋白CK8及CK18的联合抗原（CAM5．2）的表达情况,评估61例pN0早期胃癌的淋巴结微转移率;分析pN0早期胃癌淋巴结微转移与临床病理特征的关系。结果61例pN0早期胃癌有10例（16．4％）发现淋巴结微转移,868颗HE染色阴性淋巴结共有15颗（1．73％）发现微转移灶。黏膜下癌淋巴结微转移率高于黏膜内癌（P〈0．05）,脉管侵犯组淋巴结微转移率高于无侵犯组（P〈0．05）;而不同性别、年龄及癌灶大小、部位、大体分型、分化程度问淋巴结微转移率的差异无统计学意义（均P〉0．05）。结论免疫组织化学是检测胃癌淋巴结微转移的有效手段,评估早期胃癌的淋巴结微转移状态有助于早期胃癌的准确分期、预后判断及治疗方案的合理选择。     

85例早期胃癌的临床病理特征研究

目的观察85例早期胃癌的临床病理特征。方法记录早期胃癌肿瘤大小、浸润深度、肉眼分型、组织学分型和淋巴结转移状况。结果早期胃癌发病高峰为40～59岁,以男性多见;肉眼分型以凹陷型、浅表型为主;组织学分型以高、巾分化腺癌为主;7．06％患者伴胃周淋巴结转移;5年生存葺墨为94．12％,不伴胃周淋巴结转移的黏膜内癌患者5年生存率为100％。结论提高胃癌的早期诊断率是改善胃癌预后的关键。     

早期胃癌的临床病理特征及治疗

目的研究早期胃癌（EGC）淋巴结转移规律。方法回顾分析1988年3月-2008年9月手术治疗51例EGC的临床病理资料。结果8例存在淋巴结转移的EGC均为胃下部癌,粘膜下癌淋巴结转移率为23．6％,粘膜癌为10．0％。≤1cm的微小胃癌和小胃癌的淋巴结转移率为7．1％,直径1．1—3．5cm胃癌淋巴结转移率为12．5％,〉3．5cm胃癌的淋巴结转移率为60％（P〈0．05）。高分化EGC未见淋巴结转移,中分化及低分化癌淋巴结转移率分别为15．3％和20．0％。粘膜下癌可转移至N2。脉管受侵19例,淋巴结阳性率36．8％（7／19）,明显高于无脉管受侵者（P〈0．05）。结论EGC的淋巴结转移主要与肿瘤浸润深度、病变大小及脉管受侵有关,应根据淋巴结转移的风险合理选择EGC的治疗。     

宫颈鳞癌组织中血管内皮生长因子表达的临床意义

目的探讨子宫颈鳞状细胞癌组织中血管内皮生长因子（VEGF）表达的临床意义。方法对1994年1月-1998年7月就诊、放疗、手术根治并能建立随访关系的官颈癌患者103例,采取免疫组化S-P法检测官颈鳞状细胞癌组织中VEGF的表达水平,分析官颈鳞癌患者复发、转移、生存期以及癌的分化程度、生长方式的关系。结果官颈癌组织中VEGF表达的阳性率为55．3％（75／103）,在高分化鳞状细胞癌中VEGF阳性表达率为31．5％（10／32）．低分化鳞状细胞癌阳性表达率为60．4％（26／43）,未分化鳞状细胞癌阳性表达率为75％（21／28）,分化程度越低,阳性率越高（P〈0．01）。生长方式中外生浸润型阳性表达率为45．1％（35／51）,内生浸润型阳性表达率为65．4％（34／52）,VEGF阳性随生长方式不同而有显著性差异（P〈0．05）。手术根治患者中有淋巴结转移的VEGF阳性表达率为76．2％（16／21）,无淋巴结转移VEGF阳性表达率为33．3％（3／9）（P〈0．05）。VEGF阳性表达者5年内复发率为61．4％（35／57）,VEGF阴性表达者5年内复发率为34．8％（16／46）（P〈0．05）。VEGF阳性患者5年生存率为43．8％（25／57）。VEGF阴性患者5年内生存率为69．7％（32／46）,两者有显著性差异（P〈0．05）。结论官颈鳞状组织中VEGF表达与分化程度、生长方式、复发、淋巴结转移及生存期密切相关,VEGF阳性表达者预后较差。检测官颈癌组织中VEGF表达水平是判断官颈癌预后的重要指标。     

Fhit蛋白在下咽癌中的表达及其与临床病理的关系

目的：探讨下咽癌组织中脆性组氨酸三联体(fragile histidine triad，FHIT)基因蛋白Fhit的表达以及和临床病理指标的关系。方法：采用兔抗人Fhit蛋白抗体和枸橼酸-微波-SP免疫组化方法检测60例福尔马林固定，石蜡包埋的下咽癌标本中Fhit的表达并分析其与组织学分级，淋巴结转移的关系。结果：(1)下咽癌组织Fhit表达阳性率为45．0％(27／60)，正常下咽组织表达阳性率为88．3％(53／60)，二者差异有显著性(P=0．000)。癌组织Fhit表达强度较正常下咽部组织高13例(21．7％)；较正常下咽部组织低3l例(51．7％)，其中阴性11例(18．3％)，与正常组织相等16例(26．6％)。Fhit蛋白低表达下咽癌组织中Fhit染色的阳性细胞数量及强度较正常下咽部组织明显减少及降低；(2)高分化鳞癌Fhit蛋白表达阳性率为62．5％(15／24)，中分化鳞癌为36．8％(7／19)，低分化鳞癌为29．4％(5／17)，各病理分级之间的差异有显著性(rs=-0．2843，P=0．0277)；(3)无淋巴结转移下咽癌Fhit蛋白表达阳性率为75％(9／12)，伴淋巴结转移癌组为37．5％(18／48)，差异有显著性(P=0．02)。结论：下咽癌Fhit的表达较正常组织降低，其表达状况和病理分级及淋巴结的转移相关，提示Fhit表达降低可能对下咽癌的演化和进展具有重要作用并有可能成为一个新的预后指标。     

分化型甲状腺癌的治疗进展

分化型甲状腺癌占甲状腺癌的绝大多数，起源于甲状腺滤泡细胞，包括乳头状癌和滤泡细胞癌。乳头状癌是最常见的甲状腺癌，呈多中心性，无包膜，有1／3的患者可发生转移，最常转移的部位是淋巴结，其次是肺。滤泡细胞癌占甲状腺癌的5％～10％，有包膜，侵犯包膜是肿瘤扩散的特征，其预后依赖于肿瘤分化的程度和是否发生了扩散。滤泡细胞癌可转移至骨，引起溶骨性破坏。总的来说，分化型甲状腺癌的预后很好，即使在5％～20％有淋巴结转移的患者和10％～15％的有远处转移的患者，其10年生存率仍达80％～95％。导致预后较差的因素有：男性、高龄、肿瘤较大、分化较差、已有局部侵犯和远处转移。     

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.     

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.     

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.