卵巢恶性生殖细胞肿瘤预后相关因素分析

目的：分析影响卵巢恶性生殖细胞肿瘤（MOGCT）预后的相关因素。方法：回顾性分析1985年1月至2007年12月在我科治疗的卵巢恶性生殖细胞肿瘤患者的临床资料,运用Life—Table法计算生存率,应用Log—rank法和Cox比例风险模型对可能影响卵巢恶性生殖细胞肿瘤预后的因素进行单因素和多因素分析。结果：MOGCT的1、3、5年生存率分别为86％、67％、56％。单因素分析显示手术病理分期、残余病灶、化疗方案及化疗疗程是影响预后的因素（P均〈0．05）。多因素分析显示手术-病理分期、残余病灶及化疗疗程数是决定预后的因素（P均〈0．05）。结论：手术一病理分期、残余病灶和化疗疗程是影响MOGCT预后的独立因素。治疗应以保留患者的生育功能手术为主,术后采用标准PEB／PVB方案化疗,以改善患者的预后。     

结直肠癌肝转移患者临床预后分析

目的：探讨影响结直肠癌肝转移病人生存率的临床预后因素。方法：分析新疆医科大学附属肿瘤医院1997～2002年间诊治的结直肠癌肝转移病人88例临床资料,选择性别、年龄、血型、原发肿瘤大小、组织类型、治疗方式、T分期（肠壁浸润深度）、N分期（淋巴结转移情况）、癌胚抗原（CEA）、转移灶大小、转移灶数目等临床因素,寿命表法计算生存率,用Cox比例风险模型（SPSS 13．0统计软件）进行多因素分析。结果：单因素分析显示,治疗方式、原发灶大小、T分期、N分期等为预后影响因素（按a=0．1水平）,多因素分析均显示,仅治疗方式、T分期为影响结直肠癌肝转移预后的重要因素。所有病例总的1、3、5年累计生存率分别为88．6％、12．9％、0％。单纯外科治疗组（31．8％）、综合治疗组（45．5％）及单纯辅助治疗组（9．1％）与未治组（13．6％）比较,1年、3年生存率有显著差异（P均〈0．05）。结论：综合治疗方式为结直肠癌肝转移患者预后的独立保护性因素,可延长患者生存期;T分期是独立的预后危险因素。T分期越大,预后越差。     

影响大肠癌预后相关因素CoX回归分析

目的探讨影响大肠癌预后相关因素，为临床医师评估及预测大肠癌患者预后提供一定的科学依据。方法选取根治术大肠癌厉发病例120例，查阅病历及5年以上随访资料。并取病例样本存档石蜡块，切片后进行SP免疫组化方法检测CD44v6、p16、Ki67、MMP-9四个蛋白表达物。结果CD44v6、p16、Ki67、MMP-9蛋白在120例大肠癌组织中阳性表达率分别为31．70％（38／120），、40．80％（49／120）、55．80％（67／120）和46．70％（56／120）。将分子生物学标志物主临床病理指标相结合，经Cox单因素分析，大体分型、组织学分型、浸润深度、淋巴结转移、Dukes，分期、CD44v6、p16、Ki67和MMP-9为有意义的预后因素（a=0．05）；经CoX多因素分析，最终进入模型的因素为Dukes分期、p16和MMP-9，RR值分别为3，138、0．444和1．841，由此建立的大肠癌术后生存预测模型为：h（t，x）=h0（t）exp（1．144X9＋0，610X13-0．813X11），其预测预后的灵敏度为79．10％，特异度为67．92％，Kappa值（K）为0．4731。结论Dukes’分期、p16和MMP-9很可能是影响大肠癌患者预后的独立因素，显示预后预测模型具有较高的效度和信度，可为临床医师判断大肠癌患者的预后提供一定的参考依据。     

清热解毒类中药单体的体外内抗肝癌作用研究

目的：探讨5种清热解毒中药单体对SMMC-7721肝癌细胞增殖和对H22荷瘤小鼠移植瘤的抑制作用。方法 SMMC-7721人肝癌细胞分别经不同浓度的迷迭香酸、黄芩苷、橙黄决明素、绿原酸和黄连素作用48 h后,四甲基偶氮唑盐法检测细胞增殖抑制率并筛选出有效中药单体。采用H22肝癌细胞建立小鼠移植性肝癌模型,给予H22荷瘤小鼠不同浓度的迷迭香酸（300 mg／kg、150 mg／kg、75 mg／kg）和黄芩苷（200 mg／kg、100 mg／kg、50 mg／kg）10 d后,剥取瘤块、胸腺、脾脏称重,并计算抑瘤率、胸腺指数和脾脏指数。结果迷迭香酸500 mg／L、250 mg／L、125 mg／L 浓度组和黄芩苷500 mg／L、250 mg／L浓度组吸光度A值均明显低于对照组（ P＜0．05）,且细胞增殖抑制率均达到30％以上;橙黄决明素及黄连素组的细胞增殖抑制率均低于30％,绿原酸组细胞增殖抑制率＜0。各剂量迷迭香酸组的瘤重均较模型组明显下降（P＜0．05）,对H22移植瘤的抑制率分别为48．2％、43．0％和39．0％,迷迭香酸各剂量组的胸腺指数和脾脏指数与模型组比较,差异无统计学意义（P＞0．05）。300 mg／kg黄芩苷组肿瘤重均低于模型组（P＜0．05）,抑瘤率达到55．7％,黄芩苷各剂量组的脾脏、胸腺指数与模型组比较无显著性差异（P＞0．05）。结论迷迭香酸和黄芩苷体外对SMMC-7721肝癌细胞和体内对H22移植瘤均有明显的抑制作用。     

可手术男性和女性乳腺癌的配对比较及临床特点

目的探讨男性乳腺癌及与之配对的女性乳腺癌患者的临床病理、治疗特点,生存率差异及影响男性乳腺癌患者预后的因素。方法收集天津市肿瘤医院1995年1月至2008年12月63名男性乳腺癌的病例资料,并与126名同期的女性乳腺癌相匹配。匹配的标准是年龄、确诊时间、临床分期均相似。男性乳腺癌和女性乳腺癌患者临床病理指标的比较采用）（2检验和Fisher精确检验。生存分析采用Kaplan—Meier生存分析,2组生存率比较采用Log—rank检验,多因素分析采用Cox风险回归模型。结果10年无病生存率（DFS）男性乳腺癌患者为53．9％,女性乳腺癌患者为65．1％（P=0．047）;10年总生存率（OS）男性乳腺癌患者的为61．9％,女性乳腺癌患者为77％（P=0．032）。单因素分析结果：临床分期、手术方式及复发是影响男性患者预后的因素;多因素分析结果：临床分期是影响男性乳腺癌患者预后的独立因素。结论女性乳腺癌患者10年无病生存率和总生存率较男性乳腺癌患者好。临床分期是影响男性乳腺癌患者预后的独立因素。     

生物信息学分析构建自噬基因相关的肝癌预后评估模型

目的采用生物信息学分析自噬相关基因差异表达和肝癌预后的关系,构建自噬基因相关的肝癌预后评估模型。方法采用R语言Limma软件包分析癌症基因组图谱（TCGA）肝癌数据库中肝癌组织及癌旁组织中自噬相关基因的表达,发现差异表达基因（DEGs）。采用基因本体论（GO）和京都基因与基因组百科全书（KEGG）富集分析DEGs。采用单因素分析和多因素Cox回归分析构建自噬基因相关的肝癌预后评估模型。结果对比肝癌组织与癌旁组织,发现了60个自噬相关的DEGs;DEGs主要在自噬、HPV感染、凋亡和p53信号通路中富集。单因素分析发现81个与肝癌预后相关的自噬基因。多因素Cox回归分析发现一组4个自噬基因（HDAC1、ATIC、EIF2S1和RAB7A）与肝癌患者的总生存时间显著相关,基于此构建了自噬基因相关的肝癌预后评估模型。该模型高风险评分的肝癌患者的总生存时间明显短于低风险评分患者（P＜0.05）。进一步的多因素Cox回归分析显示,该预后评估模型独立于肿瘤分期、转移分期、临床分期、淋巴结状态和病理分级,可独立预测肝癌患者的预后。结论本研究构建的自噬基因相关的肝癌预后评估模型可独立预测肝癌患者预后,有助于临床医生选择精准化的肝癌预防和治疗策略。     

Aurora—A在喉鳞癌中表达的临床意义

【目的】了解基因Aurora—A在喉癌中的表达情况及了解其作为预测喉癌预后的新指标的可能性。【方法】用免疫组化的方法检测我科1995—1999年77例喉癌标本中Aurora—A的表达，随访3-136月，中位随访时间为71．93月．用统计软件SPSS11．0分析Aurora—A的表达与喉癌患者年龄、性别、临床分期、临床分型、肿瘤分化程度等的关系及其与预后的关系。【结果】Aurora—A在喉癌标本中的表达率为71．4％（55／77）；在晚期的喉癌中表达率为87．9％（29／33），高于早期喉癌中表达率（59．1％，26／44），P=0．006。K—M法计算分析，Aurora—A表达阳性者生存时间（中位生存时间46月）与Aurora—A表达阴性者生存时间（中位生存时间85月）有明显差异，P〈0．05。Cox多因素回归分析显示切缘情况、肿瘤分化程度、临床分期及Aurora—A表达与喉鳞癌的预后有关，P值均小于0．05。【结论】Aurora—A在喉癌组织中有一定程度表达，其表达与喉癌临床分期及预后相关。     

肝癌术后生存和临床病理因素的关系

目的探寻影响肝癌术后生存的因素,为临床制定治疗措施提供参考依据。方法将78例肝癌手术患者分为术后生存5年以上组（A组）与3年内死亡组（B组）进行临床病理因素比较研究。结果提示两组术前AFP（＋）、HBsAg（＋）、有临床症状、肿瘤单结节、肿瘤距切缘〉1cm及癌组织学分级（Ⅰ、Ⅱ级）比较无统计学意义;而A组术后AFP转阴为82．05％（32／39）、临床TNM（Ⅰ-Ⅱ）分期87．18％（34／39）、普查发现69．23％（27／39）、癌周有包膜76．92％（30／39）、肿瘤长径≤5cm53．85％（21／39）、无癌栓率87．18％（34／39）、癌周有中重度硬化15．38％（6／39）,显著或极显著地优于B组的AFP术后转阴率25．64％（10／39）、临床TNM（Ⅰ～Ⅱ）分期30．77％（12／39）、普查发现35．90％（14／39）、癌周有包膜20．51％（8／39）、肿瘤长径≤5cm20．51％（8／39）、无癌栓率30．77％（12／39）、癌周中重度硬化35．90％（14／39）,（P〈0．05或P〈0．01）。结论除了部分临床及病理因素与术后生存时间长短无关外．极大多数临床病理因素与术后生存密切相关,与文献报道一致。     

57例原发鼻腔NK—T细胞淋巴瘤临床分析

目的探讨原发鼻腔NK—T细胞淋巴瘤临床特征、治疗及影响预后因素。方法收集蚌埠医学院附属医院1995年1月-2003年7月收治的原发鼻腔NK—T细胞淋巴瘤57例,按照AnnArbor分期标准,ⅠE期30例,ⅡE期21例,Ⅲ期4例,Ⅳ期2例。单纯放疗27例,放化疗30例。结果全组中位生存62个月,5年总生存率单纯放疗组、放化疗联合治疗组分别为64．0％、56．0％;中位生存期分别为64个月、61个月,差异无统计学意义（P〉0．05）。分析显示,硬腭和／或鼻中隔穿孔、PS评分、发热等B症状与预后关系密切,AnnArbor分期仍然是影响生存率的主要因素（P〈0．05）。结论原发鼻腔NK／T细胞淋巴瘤早期治疗是关键,放疗联合化疗未改善预后。     

透明细胞型肝细胞癌的外科治疗与预后分析

目的：分析原发性透明细胞型肝细胞癌（PCCCL）的治疗及临床预后特点。方法：回顾分析32例原发性透明细胞型肝癌患者的临床病例资料。按治疗方法分为根治性手术组（20例）,根治性手术＋术后化疗（亚叶酸钙＋替加氟）组（12例）。按照透明细胞比例的不同分为透明细胞的比例／〉70％组（18例）和〈70％组（14例）。对照分析两组的中位生存期。Kaplan—Meier生存单因素和COX多因素分析影响预后的危险因素。结果：单纯手术组中位生存期为38个月,手术＋化疗组中位生存期为41个月。术后应用辅助化疗对患者中位生存期无统计学意义（JP〉0．05）;透明细胞的比例〉170％组中位生存期为41个月,透明细胞比例〈70％组中位生存期为29个月,两组生存期差异有统计学意义（P〈0．05）。Kaplan—Meier生存单因素分析显示：包膜形成、TNM分期、术前肝功能状态、HCV感染、肿瘤大血管浸润,肿瘤多发是影响患者无瘤生存时间的危险因素。透明细胞比例、TNM分期、术前肝功能状态、伴有肝硬化、HCV感染、肿瘤大血管浸润、肿瘤多发和包膜形成是影响患者生存时间的危险因素;COX多因素分析显示透明细胞比例、包膜形成、术前肝功能状态、肿瘤大血管浸润与预后有关。结论：术后辅助化疗对于患者的生存时间无明显作用;肿瘤包膜形成、大血管侵犯、透明细胞比例、术前肝功能是影响患者预后的危险因素。     

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.