人肝癌转移模型体系的建立

原发性肝癌(以下简称肝癌)的死亡率在全世界所有癌症中占第三位，是我国第二位癌症死亡原因。经过几十年的努力，肝癌临床和基础研究取得了许多进展，手术切除是肝癌获得长期生存的主要手段，在某些临床中心，肝癌根治性切除后5年生存率可达到40％．以上(我所治疗的肝癌病人的5年生存率在小肝癌切除术者中约为60％，大肝癌切除术者约为30％)。但术后5年复发率高达60％以上(小肝癌也达40％～50％)。转移复发已成为进一步延长肝癌病人生存期、提高远期疗效的瓶颈问题，也是最终攻克肝癌的关键。     

肝癌切除术120例疗效分析

目的 总结肝癌外科手术切除治疗的经验，探讨提高外科治疗效果的途径。方法 回顾性总结行手术切除治疗的120例肝癌患者的临床资料，分析手术并发症产生的原因，并计算生存时间。结果术后并发症的发生率与肝功能明显相关，1、2、3、4年生存率分别为90．6％、72．76％和51．44％，直径〈5cm肝癌的长期生存率显著高于直径≥5cm的肝癌。结论 钳夹法＋彭氏刮吸法＋必要时配合水刀切割肝实质和解剖肝门，是安全有效的肝切除方法。合理把握各种手术切除的适应证、加强术前保肝治疗和术后综合治疗，熟练掌握肝脏切除技术以及早期肿瘤切除是减少手术并发症和延长患者生存期的有效手段。     

肝外胆管癌41例不同术式与预后

对肝外胆管癌41例的临床特点、诊断、手术方法和随诊结果进行回顾性分析。结果术前早期诊断率低，总手术切除17例(41．5％)，其中根治性切除13例(31．7％)，姑息性切除4例(9．8％)。随访38例，根治性切除5例平均生存时间达12个月，姑息性切除组次之，胆肠吻合术者平均生存期明显长于单纯外引流。积极手术治疗和正确的围手术期处理是提高肝外胆管癌疗效的关键，根治性切除术可显著延长患者生存期。     

原发性肝癌术后生存10年以上94例分析

目的 探讨与原发性肝癌术后获长期生存的有关因素.方法 对该院原发性肝癌手术切除生存10年以上94例患者的术前术后情况作回顾性分析.结果 能获长期生存的重要因素是:(1)肿瘤直径小于或等于5 cm(占73.4％),外周型肝癌(占70.2％);(2)对复发患者行有效治疗;(3)术后长期行抗肝纤维化联合抗肿瘤治疗(以服用中药为主);(4)坚持随访.结论 原发性肝癌根治术后,尤其是肿瘤直径小于或等于5 cm、外周型肝癌患者,坚持随访,坚持行抗纤维化联合抗肿瘤为主的治疗是获得长期生存的重要因素.     

不能手术切除的转移性肝癌降期后切除的疗效分析

目的探讨不能手术切除的转移性肝癌经降期治疗(双插管介入治疗)后手术切除的疗效及预后影响因素。方法回顾性分析经降期治疗后手术切除的21例转移性肝癌患者的临床及随访资料。结果 21例总1、3和5年累计生存率分别为74.1%、54.7%和29.2%。术前介入次数、肝转移类型、肿瘤最大直径及转移瘤数目等因素对生存率均无显著影响。结论不能手术切除的转移性肝癌经降期后手术切除可使患者获得长期生存。     

脊髓髓内肿瘤36例显微外科术后随访与观察

目的：探讨运用显微外科技术切除脊髓髓内肿瘤的方法、技巧和临床效果。方法：对我院神经外科手术治疗的36例脊髓髓内肿瘤患者的病历资料进行回顾性分析，对肿瘤部位、病理类型、手术切除程度、手术前后临床症状和体征变化进行长期随访。结果：室管膜瘤的全切除率为87．5％，近全切除及大部切除率12．5％；星形细胞瘤的全切除率为33．3％．近全切除及大部切除率33．3％，部分切除及椎管减压者33．3％；海绵状血管瘤的全切除率为100％；表皮样囊肿的全切除率为60％，近全切除及大部切除率40％；其他肿瘤的全切除率为100％。33例(91．7％)病人获得2个月～11年随访，其中25例存活，8例死亡。结论：决定脊髓髓内肿瘤患者生存的主要因素是肿瘤病理特点．早期手术预后较好．应力争在脊髓功能未出现严重损害前手术．以取得较好手术疗效。     

原发性肝癌合并糖尿病病人的介入治疗围手术期处理

原发性肝癌(简称肝癌)是我国最常见的恶性肿瘤之一，手术切除仍是治疗肝癌的首选方法。然而，由于其本身的病理特点，早期常无症状．一经发现，多已至中晚期，能手术切除者仅达10％—15％。近年来，用介入放射学的方法治疗肝癌，已获得令人鼓舞的疗效，并逐渐成为非手术治疗中最有效且最成熟的一种治疗方法。本文总结了本人2003—2004在广州军区广州总医院肝胆外科进修时收治的34例肝癌合并糖尿病病人的介入围手术期处理的成功经验．提出了处理该类病人的基本原则和方法。现报告如下。     

肝癌Ⅱ期切除的治疗体会

原发性肝癌的治疗，首选手术，且效果最佳。但中晚期肝癌获得切除者仅占20％～30％，绝大多数患者失去手术的机会．非手术者中位生存期仅2．5个月。如何延长这些患者的生存期是目前迫切需要解决的问题。本院自1994年以来采用肝动脉插管化疗加碘油及明胶海绵栓塞治疗不能1期手术切除的患者，使10．96％的患者肿瘤缩小，全身改善，获得Ⅱ期手术切除的机会，生存期明显延长，给不能Ⅰ期手术切除的肝癌患者提供了一种非常可取的积极方法。一、资料与方法本院共有77例中晚期肝癌患者作肝动脉插管化疗加栓塞术。男66例、女11例；年龄对20～72岁，…     

48例原发性肝癌手术切除的临床分析

目的探讨提高我国原发性肝癌手术治疗的安全性及疗效的措施。方法回顾分析本院2000年1月至2005年10月手术治疗的48例原发性肝癌的情况。结果48例均获手术切除。无手术死亡。术后并发症包括胆漏2例、膈下积液6例、术后腹腔出血1例、术后上消化道出血1例、术后肝功能障碍1例，经对症处理后均治愈。31例AFP阳性患者术后AFP均转阴。全组均临床治愈出院并进行定期化疗。随访1年生存41例，3年生存30例。．死亡均为肝癌复发。术后1、2、3年复发率分别为14．5％、33．3％、43．8％。结论手术切除是原发性肝癌首选的治疗方法。对术后复发的预防和治疗，以及选择合理的综合治疗手段可延长中、晚期肝癌患者的生存时间。     

27例肾上腺皮质腺癌的诊断与治疗

目的：对肾上腺皮质腺癌临床诊治进行回顾分析，提高对肾上腺皮质腺癌的诊断和治疗水平。方法：本组27例患者中有分泌功能肿瘤15例，无分泌功能12例，均通过B超、CT检查诊断。行手术治疗22例中，17例完整切除肿瘤，5例包膜内剜除；另5例行化疗和（或）放疗。结果：经1～5年随访，17例完整切除肿瘤者中9例生存，5例包膜内剜除肿瘤者中2例生存，5例行化疗和（或）放疗者有1例生存。结论：早期诊断、及时行根治性手术是目前治疗肾上腺皮质腺癌最有效的方法。完整切除肿瘤者生存期明显长于包膜内剜除或姑息性治疗者。肾上腺皮质腺癌预后与肿瘤分期、手术情况及病理类型密切相关，辅助治疗可提高患者生存率。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.