65例青年乳腺癌的诊治体会

目的探讨青年乳腺癌的临床特点及预后。方法回顾性分析65例青年乳腺癌的临床分期、病理类型、淋巴结转移、治疗方式、预后情况。结果65例中浸润性非特殊癌占83．1％,浸润性特殊型癌占10．87％,非浸润性癌占6．0％,63．1％患者有腋淋巴结转移,淋巴结阳性〉3个占33．8％,3年和5年生存率为84．6％和70．8％。结论青年乳腺癌早期容易误诊,淋巴结转移率高,治疗采用以手术为主的综合疗法,保乳手术应成为早期乳腺癌的首选术式,术后规范的辅助化疗、放疗、内分泌治疗可提高生存率。     

男性乳腺癌22例病理及临床分析

报告２２例男性乳腺癌，全部病例均经病理证实，病理类型９０％为浸润性癌，其中单纯癌最多，占同期全部男性乳腺癌的４５．５％，临床特点为年高，病程长，病期晚，预后差，５年生存率为６３．７％，１０年生存率为５６．３％，首发症状为乳晕区无痛性肿块，易侵犯皮肤和胸肌，治疗主张采用以各型根治术为主的综合治疗。     

青年乳腺癌92例临床分析

目的探讨青年乳腺癌的临床特点及预后，分析常见延误诊治原因，方法对我院收治并经手术和病理证实的青年女性乳腺癌92例进行回顾性总结分析。结果临床症状隐匿，误诊率高达53％；病程最短时间为3d，最长为4年，中位时间9．6个月，病程较长；腋窝淋巴结转移高达62％，治疗以改良根治术为主，同时行综合治疗，5年生存率61．5％，结论青年乳腺癌病程较长，浸润性癌为主，腋淋巴结转移率高，预后差，且易误诊．提高青年乳腺癌的疗效．关键在于早期诊断、早期治疗，并要重视综合治疗。     

绝经前乳腺癌35例临床分析

目的探讨绝经前乳腺癌的诊治。方法回顾性分析35例绝经前乳腺癌患者的临床资料。结果35例患者病理结果以浸润性癌为主,共30例,占85．71％,其中浸润性导管癌11例,占31．43％,单纯癌19例,占54．29％;19例有腋下淋巴结转移,占54．28％;2例为妊娠哺乳期癌,35例全部手术,均得到随访。术后3年生存率75．31％,5年生存率52．85％。结论绝经前乳腺癌因雌激素水平高,肿瘤以浸润癌为主,病程长,淋巴结转移率高,肿瘤分期晚,许多患者因手术范围趋小,术后化放疗及内分泌治疗不规范,影响预后。     

30岁以下青年女性乳腺癌31例临床与病理分析

本文报道３１例３０岁以下青年妇女乳腺癌，对其临床及病理特点进行分析。结果表明：青年乳腺癌就诊较晚，＞３个月者占８０６％，肿块较大，其组织学表现大多数为浸润性癌（９０％），淋巴结转移率高（尤其是合并妊娠、哺乳）。结合文献复习，并就其原因、对策进行探讨。     

52例青年乳腺癌的临床分析

目的：探讨青年乳腺癌的临床特点及治疗方法与预后的关系。方法：回顾性分析了1988年1月－1997年5月收治的52例小于35岁的青年乳腺癌的临床分期，病理类型、肿瘤大小，淋巴结转移，治疗方式，预后情况，结果：临床Ⅱ期、Ⅲ期患者占78．8％，腋淋巴结转移率达61．5，病理类型中以浸润性非特殊性癌最多见，达76．9％，当肿瘤＞3cm，或腋淋巴结转移数≥4枚时，5年生存率明显下降，治疗以上单纯手术为多，结论：青年乳腺癌在临床上以中晚期多见，恶性程度高，淋巴结转移率高，预后差，临床上应大力提高早期发现以及规范的综合治疗。     

69例青年乳腺癌临床分析

目的：分析35岁以下青年乳腺癌临床特点及其预后。方法：收集甘肃省肿瘤医院1995年1月至2004年12月69例青年乳腺癌临床资料,对其进行回顾性统计分析。结果：浸润性导管癌49例,占73.91%;按TNM分期,Ⅱ,Ⅲ期病例58例,占82.61%;5年生存率,0期5年生存率100%、Ⅰ期5年生存率75%、Ⅱ期5年生存率64.44%、Ⅲ期5年生存率30.77%、Ⅳ期5年生存率0%。结论：青年乳腺癌多数为浸润性导管癌,TNM分期越晚,预后越差。     

82例青年女性乳腺癌临床和病理特征分析

目的探讨青年女性乳腺癌的临床和病理特征。方法回顾性分析82例青年女性乳腺癌的临床和病理资料,并且随机抽取50例中老年患者作为对照组。结果青年女性乳腺癌临床症状隐匿,误诊率为45．12％（37／82）,病理类型以浸润性癌为主。青年组在组织分级、病理分期、淋巴结转移率、ER和c-erbB-2阳性表达率与中老年组均有差异性（P〈0．05）。青年女性乳腺癌患者按病程分为6个月以内、6—12个月和12个月以上三组,病理分期和淋巴结转移率在不同组之间有差异性（P〈0．01）。结论青年女性乳腺癌侵袭性强。随病程进展,患者病理分期晚,淋巴结转移率高,早期诊断有助青年女性乳腺癌的治疗。     

脑转移癌治疗的临床观察

目的：探讨脑转移癌的治疗，提高患者的生存质量，延长生存期。方法1991—2001年间对156例脑转移癌患者经临床、B超、X线、CT、MRI、电子内窥镜、手术、病理、细胞学确诊；男113例，女43例；中位年龄67．6岁。其中肺癌132例、乳腺癌9例、鼻咽癌5例、消化道肿瘤8例，卵巢癌2例，行全脑放疗剂量DT40Gy 136例，追加缩野放疗剂量DT10-20Gy，每月服环己亚硝脲200mg，疗中给甘露醇、地塞米松脱水治疗。结果：临床症状缓解率87．18％，病灶缩小109例，完全消失18例，无变化9例；中位生存期10．8个月，3个月生存率79．55％，半年生存率59．68％；1年生存率12．18％，2年生存率2．56％。结论：脑转移癌放射治疗是首选方法，为减轻脑水肿可配合脱水治疗，同时可选择通过血脑屏障的化疗药物增效。     

青年人直肠癌28例临床分析

我院处产１９８５年１月至１９９５年１２月共收治３０岁以下直肠癌２８例，占同期收治直肠癌的９．４６％。其中男女比例为１：１．１５，平均病程８．４个月，超过６个月的５０％；误诊率为９２．８％；改良Ｄｕｋｅ＼ｓ分期Ｃ＋期病例占７１．５％；低分化腺癌、粘液癌、未分化癌占７８．５％。     

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.