内镜下尼龙绳结扎治疗胃肠道黏膜下肿瘤8例临床分析

胃肠道黏膜下肿瘤最常见的是胃肠道间质瘤，胃肠道间质瘤是消化道非上皮细胞性肿瘤，由Mazur和Clark[1]于1983年首先提出，是一类非定向分化的间叶肿瘤，起源于胃肠道固有肌层和黏膜层，由梭形细胞和上皮样细胞组成，约占该部位原发性肿瘤的1．2％。研究证明，以往诊断的胃肠道平滑肌瘤及神经鞘瘤大多属于间质瘤，间质瘤比平滑肌瘤多见。胃是消化道间质瘤的最好发部位。     

胃肠间质瘤治疗现状

胃肠间质瘤是胃肠道最常见的间叶性肿瘤，因其形态及生物学行为多变，诊断及临床治疗存在较大困难，结合目前国内外对胃肠间质瘤的最新研究进展，介绍伊马替尼对胃肠间质瘤的治疗特点，以提高对胃肠间质瘤临床诊断及治疗的认识。     

胃肠道间质瘤是癌症吗

编辑同志： 前不久，我父亲被诊断患有胃肠道间质瘤。听别人说胃肠道间质瘤是一种侵袭性的肿瘤，而癌症也具有侵袭性。请问，胃肠道间质瘤是癌症吗？     

小肠恶性间质瘤临床诊治分析

小肠恶性间质瘤属于胃肠道间质瘤(gastrointestinal stromal tumor，GIST)是一种非常少见的非上皮性肿瘤，临床变异较大，病理形态复杂多样，传统上几乎都归为平滑肌肿瘤。我们报道1例小肠恶性间质瘤并对近年来文献进行复习，以期提高对小肠恶性间质瘤认识，减少临床误诊。     

浅析对胃肠外间质瘤的诊治方法

胃肠外间质瘤是一种间叶源性肿瘤。由于胃肠外间质瘤的发病率低，且多数患者的症状较为隐匿，因此临床医生很难对此病进行快速诊断。但随着CD117和CD34等抗体在肿瘤病理诊断中的应用，有关胃肠外间质瘤的病理特征、免疫组化表型和临床特点都已逐渐被临床医生所熟识。这一改变对于提高胃肠外间质瘤的诊疗水平具有重要的现实意义。本文就我院收治的1例胃肠外间质瘤患者的诊疗资料进行了回顾性分析，旨在提高我院诊疗胃肠外间质瘤的水平。     

食管微小间质瘤1例并文献复习

目的提高对食管间质瘤的认识。方法对1例食管间质瘤患者的临床资料进行分析，并复习相关文献。结果手术完整切除肿瘤，病理及免疫组化证实，术后随访至今一年半，一般情况良好，无复发及转移征象。结论食管间质瘤临床少见，与食管平滑肌瘤鉴别诊断主要依靠免疫组织化学技术，生物学行为较发生于胃肠道的间质瘤好，首选手术治疗。     

34例胃肠道间质瘤临床分析

目的：探讨胃肠道间质瘤的临床表现、诊断和治疗方法。方法：回顾分析资料完整、病理诊断明确的34例胃肠道间质瘤患者，依据诊断标准对胃肠道间质瘤进行分类。结果：胃肠道间质瘤以老年男性多见，胃部好发，胃部良性多于恶性，而小肠恶性多于良性，本病临床表现无特异性，但常以消化道出血为首发临床表现。消化内镜、B超、CT、小肠气钡双重造影、选择性血管造影等检查可发现肿瘤，通过病理组织学及免疫组化检查可明确诊断。本病首选手术治疗，放、化疗疗效难以肯定。结论胃肠道间质瘤是一类独立的黏膜下肿瘤，过去诊断为平滑肌或神经源性的肿瘤的某些梭型细胞肿瘤，通过免疫组化检查可能为间质瘤。     

彩色多普勒超声对胃间质瘤诊断价值

目的探讨彩色多普勒超声技术诊断胃间质瘤的价值。方法对超声诊断的胃底间质瘤进行声像学特点分析，并与手术和病理结果进行对比。结果胃间质瘤其特点为低恶性肿瘤，其生物学行为不易预测，术后易复发。结论超声对胃间质瘤具有较高的诊断率，对大多数病例均可于术前作出定性、定位诊断或鉴别诊断，可为制定临床治疗方案提供重要信息。     

空肠恶性间质瘤1例

空肠恶性间质瘤是一种起源于肠道肌层的间叶性肿瘤，属于胃肠道间质瘤（GIST），较为罕见，传统上大多将它诊断为平滑肌源性或神经源性肿瘤。近年研究表明此类肿瘤是一种非定向分化的间质细胞肿瘤，我们报道1例空肠恶性间质瘤并对相关文献进行了复习，以期提高对空肠恶性间质瘤的重视和认识，减少临床误诊。     

胃肠道外间质瘤1例

胃肠道原发性梭形细胞肿瘤现经研究发现大多为间质瘤。而原发的平滑肌性肿瘤及神经纤维性肿瘤反而是很少的，许多平滑肌性肿瘤、神经纤维性肿瘤都属于间质瘤的不同分型。对间质瘤的讨论大多限于胃肠道，而胃肠道之外的间质瘤报道的就不常见了，现结合1病例分析报告如下。     

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.