21例乳腺分叶状肿瘤临床诊治分析

目的:探讨乳腺分叶状肿瘤临床诊断治疗分析.方法:回顾我院收治乳腺分叶状肿瘤21例临床资料进行总结分析.结果:术后100%获随访,平均随访时间20个月(6～38个月).复发5例,复发率为23.8%,复发时间为术后6～15个月.结论:掌握乳腺分叶状肿瘤临床特征提高诊断,正确选择手术方式减少复发率.     

乳腺叶状肿瘤的诊断和治疗

目的探讨乳腺叶状肿瘤的临床病理特点、治疗原则,选择合理治疗方案。方法回顾性分析1997年3月至2006年6月收治的21例乳腺叶状肿瘤患者的临床资料,包括诊断年龄,临床症状,肿瘤大体及组织学特征,手术方式,术后放射及化学治疗,复发率,死亡率,比较良性、恶性、交界性肿瘤的不同。结果23例患者平均年龄38岁,按WHO分类标准,其中良性11例,交界性4例,恶性8例。14例行局部切除术,5例行乳腺单纯切除术,4例按乳腺癌改良根治术术式。随访18例,平均随访时间22个月(12～96个月),2例按乳腺癌改良根治术术后1年死于远处转移,4例行局部切除术后复发再次按乳腺癌改良根治术手术。结论保证1～2cm切缘的扩大局部切除术是治疗乳腺分叶状肿瘤的首选方案,局部复发的交界性和恶性肿瘤要选择乳房单纯切除术式或按乳腺癌改良根治术。     

乳腺叶状肿瘤临床病理与预后分析

目的 探讨乳腺叶状肿瘤的临床病理特点与预后.方法 回顾性分析2011年3月—2014年3月在该院治疗的62例乳腺叶状肿瘤患者临床病例资料,参照WHO 2003制定的组织学分类标准该研究将这些患者分为良性乳腺叶状肿瘤组39例/交界性和恶性肿瘤组23例,总结其病理特征以及预后情况.结果 良性叶状肿瘤在发病时间/平均病程时长以及肿瘤直径大小等方面与交界性和恶性肿瘤疾病相比均差异有统计学意义(P<0.01);采用钼靶/彩超或冰冻病理组织切片检查对乳腺叶状肿瘤的诊断符合率较低,而术前空心针活检的诊断符合率要高;所有患者均经手术治疗,后期随访(33.3±0.6)个月发现肿瘤复发率为12.9%(8/62),平均复发时间为(11.0±1.4)个月.结论 良性乳腺叶状肿瘤比恶性和交界性乳腺叶状肿瘤发病早/进展慢/浸润能力弱/恶性程度要低,乳腺叶状肿瘤的预后与病理类型/手术方式/间质生长以及核分裂等情况有关.     

41例乳腺分叶状肿瘤的诊断和治疗

目的探讨乳腺分叶状肿瘤的临床表现、病理特点、治疗原则和影响预后的因素.方法回顾1997年6月至2005年6月收治的41例乳腺分叶状肿瘤患者的临床资料.结果41例患者平均年龄35岁,其中良性20例,恶性16例,交界性5例.19例行局部广泛切除术,7例行局部切除术,9例行单纯乳房切除术,6例行乳腺癌改良根治术;4例患者给予术后放疗.随访35例,平均随访26个月(5～101个月),1例术后3a死于远处转移,2例行局部切除术后复发.结论合理的手术方式是治疗乳腺分叶状肿瘤的方法.     

乳腺叶状肿瘤42例临床分析

目的探讨乳腺叶状肿瘤的诊断及治疗方法。方法回顾性分析我院门诊及住院收治的42例乳腺叶状肿瘤患者的临床资料。观察并评估乳腺叶状肿瘤的疗效及预后。结果 42例患者病理诊断良性25例(59.52%),交界性11例(26.19%),恶性6例(14.29%)。单纯肿块扩大切除术术后复发11例,复发时间为上次治疗后3～25个月。单纯乳房切除组1例局部复发,复发时间为术后8个月。单纯乳房切除加低位淋巴结切除术12例,随访4～37个月均未见复发。结论乳腺叶状肿瘤是乳腺疾病中少见的一种纤维上皮性肿瘤,属于潜在恶性肿瘤,具有复发及远处转移的风险,预后较好,目前乳腺叶状肿瘤的治疗首选手术治疗,其余辅助治疗效果仍在探讨中。     

乳腺分叶状肿瘤的外科诊治分析

目的探讨乳腺分叶状肿瘤的临床病理特点及治疗原则。方法总结17例乳腺分叶状肿瘤的诊治状况及预后。结果所有患者均施行术中冰冻病理切片及术后病理检查,其中良性11例,交界性4例,恶性2例。3例行局部切除术,5例行乳腺单纯切除术,8例行局部扩大切除术,1例行乳腺癌改良根治术。全部患者获随访;复发4例,1例行乳腺癌改良根治术后2年半死于肺转移。结论乳腺分叶状肿瘤术前诊断困难,细针穿刺细胞学检查及术中冰冻切片诊断价值有限,合理的手术方式是避免复发的关键。     

乳腺分叶状肿瘤的15例临床治疗体会

目的:探讨乳腺分叶状肿瘤的临床病理特点及治疗原则。方法:总结15例乳腺分叶状肿瘤的诊治状况及预后。结果:所有患者均施行术中冰冻病理切片及术后病理检查,其中良性11例,交界性2例,恶性2例。3例行局部切除术,3例行乳腺单纯切除术,8例行局部扩大切除术,1例行乳腺癌改良根治术。全部患者获随访:复发3例,1例行乳腺癌改良根治术后2年半死于肺转移。结论:乳腺分叶状肿瘤术前诊断困难,细针穿刺细胞学检查及术中冰冻切片诊断价值有限,合理的手术方式是避免复发的关键。     

乳腺分叶状肿瘤诊疗分析

目的探讨乳腺分叶状肿瘤的临床特点、治疗方法以及影响预后的因素。方法回顾性分析我院2003年6月-2008年6月收治的23例乳腺分叶状肿瘤患者的诊疗资料。结果 23例患者中行局部肿块切除术16例,行乳房单纯切除术6例,行乳腺癌改良根治术1例。术后全部随访,随访时间10-56个月,平均21个月,1例行乳腺癌改良根治术后4年死亡,1例行局部切除术后复发。结论局部扩大切除术治疗乳腺分叶状肿瘤是确实可行的。临床须结合病史、肿块大小及病理类型等各种因素,选择合理有效的治疗方案。     

乳腺叶状肿瘤28例临床诊疗分析

目的探讨乳腺叶状肿瘤的临床特点、治疗方法以及影响预后的可能因素。方法回顾性分析我院2007年6月~2011年8月收治的28例乳腺叶状肿瘤患者的临床资料。结果 28例患者平均年龄34岁,但发病年龄两极分布较明显。其中19例为良性,9例为交界性。全部患者均手术治疗,其中乳腺区段切除术12例,扩大区段切除术15例,乳房单纯切除术1例。全部病例均术后随访,时间为6~48个月,2例复发,无死亡病例。结论乳腺叶状肿瘤发病率较低,发病年龄较广,青春期及围绝经期发病较为集中,需结合病史、影像学检查及穿刺/冰冻病理等因素明确诊断。规范手术治疗乳腺分叶状肿瘤效果确切。     

乳腺分叶状肿瘤的临床分析

目的 探讨患有乳腺分叶状肿瘤的患者其发病原因、临床症状、阳性体征、鉴别诊断、正确诊断、治疗方案及其预后.方法 回顾性分析笔者所在科室2000年5月~2010年7月收治的45例乳腺分叶状肿瘤患者临床资料.结果 在45例乳腺分叶状肿瘤患者中,良性占11例,交界性占3例,恶性占31例,依据患者其发病的年龄、肿瘤的大小以及是否有腋窝淋巴结的转移等相关因素,对其中14例患者行局部切除术,对25例患者行乳腺单纯切除术,对6例患者行乳腺癌改良根治术;41例患者获得随访,6例患者局部复发,3例患者经远处转移后死亡.结论 乳腺分叶状肿瘤在临床上较为少见,并且非常容易误诊与漏诊,因为其临床症状、体征以及辅助检查均缺乏特异性.所以在治疗上应该严格结合患者的病史、其肿瘤的大小以及其病理类型等相关因素,合理的选择术式与治疗方案,对患者加强术后的随访,从而提高患者手术其预后.     

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.