三维适形放疗治疗非小细胞肺癌20例临床观察

目的：研究三维适形放疗（3-DCRT）治疗非小细胞肺癌（NSCLC）的临床效果.方法：选择不愿或不能手术的非小细胞肺癌患者20例,分别通过CT立体定位,将资料输入TPS,制定出最佳放疗计划,然后进行三维适形放疗（3-DCRT）.结果：20例患者中CR 4例（20%）,PR 14例（70%）,CR＋PR 18例（90%）,急性放射性食管炎1例（5%）,急性放射性肺炎2例（10%）,均为Ⅰ～Ⅱ级.治疗后KPS评分提高者16例.结论：3-DCRT治疗非小细胞肺癌取得了较好的临床近期效果,明显改善了患者的生存质量,而且急性放射性反应轻,患者可耐受.     

三维适形放射治疗非小细胞肺癌的临床观察

目的：探讨三维适形放射治疗（3DCRT）非小细胞肺癌（NSCLC）的临床近期疗效和毒副反应。方法：对三维适形放疗的24例非小细胞肺癌患者（3DCRT组）临床资料进行分析，并与同期行常规放疗（RT）的18例非小细胞肺癌患者（对照组）的疗效和毒副反应进行对比。2组均每周照射5次，每次照射2Gy。结果：3DCRT组有效率（CR＋PR）为87．5％，常规放疗组为55．5％．两组差异无统计学意义（P〉0．05）。两组急性放射性食管炎发生率分别为33．3％和50％；放射性肺炎发生率分别为29．1％和44．4％；白细胞下降发生率分别37．5％和61．1％，两组差异均无统计学意义（P〉0．05）。结论：三维适形放射治疗NSCLC有较好的近期疗效．毒副反应较轻，远期疗效有待进一步观察。     

全身化疗配合适形放疗治疗Ⅲb期非小细胞肺癌疗效观察

目的：观察全身化疗配合适形放疗治疗Ⅲb期非小细胞肺癌（NSCLC）的近期疗效及不良反应。方法：67例经病理诊断为NSCLC临床分期为Ⅲb期患者,至少完成2个周期全身化疗,方案为TP,然后行适形放疗,治疗后4周评价疗效。结果：完全缓解（CR）为4例部分缓解（PR）32例,总有效率（CR＋PR）53．7％。血液毒性主要为白细胞下降,总发生率100％。 其中3～4度白细胞下降为20．8％,放射性肺炎发生率26．8％,放射性食管炎发生率为23．8％为1～2度。结论：全身化疗配合适形放疗治疗NSCLC近期疗效满意,其毒副反应相互避让无治疗相关性死亡     

长春瑞滨联合异环磷酰胺治疗晚期非小细胞肺癌

目的：评价长春瑞滨（NVB）＋异环磷酰胺（IFO）治疗晚期非小细胞肺癌的临床疗效及毒副作用。方法：化疗方案为NVB25mg／m^2第1、8天iv;IFO 1．5g／m^2,第1-5天iv．drop。结果：全组均完成2周期以上化疗。完全缓解（CR）Ⅰ例,占3．33％;部分缓解（PR）17例占56．6％;无变化（NC）6例,占20％;进展（PD）6例,占20％;总有效率（CR＋PR）为59．9％。不良反应主要是骨髓抑制、轻度胃肠道症状、脱发、静脉炎及周围神经病变。结论：长春瑞滨＋异环磷酰胺治疗晚期NSCLC,疗效较好,总有效率为59．9％,且毒副作用可耐受。     

后程三维适形放射治疗局部晚期非小细胞肺癌的疗效分析

目的 探讨局部晚期非小细胞肺癌（NSCLC）的放射治疗方法,观察后程三维适形放射治疗（3DCRT）和常规放射治疗的近远期疗效及毒副反应。方法将局部晚期NSCLC85例患者随机分为后程3DCRT组（A组）和常规放疗组（B组）。A组先接受常规分割放疗36-40Cy,然后接受后程3DCRT60-66Gy;B组接受常规分割放疗60—64Gy;全部患者均行同步NP方案化疗。NP方案为长春瑞滨25mg／m2第1、8天,顺铂30mg／m2第1—3天。结果全部患者均完成治疗计划。后程3DCRT组和常规放疗组总有效率（CR＋PR）分别为73％和52％,2组比较有显著性差异（P〈0．05）;后程3DCRT组和常规放疗组放射性食管炎发生率分别为24％和45％,2组比较有显著性差异（P〈0．05）;1、2、3年局部控制率和生存率比较无显著性差异。结论后程3DCRT联合化疗治疗局部晚期NSCLC可提高近期疗效和减少不良反应,但局部控制率和生存率尚需进一步观察。     

Ⅲ期肺癌适形放疗与常规放疗结合治疗疗效分析

目的Ⅲ期肺癌立体适形放疗的研究。方法36例Ⅲ期非小细胞癌常规放射治疗38-40Gy（平均39Gy）后的残留病灶再行适形放疗，肿瘤单次处方剂量平均为2Gy／次，每周5次，总照射剂量20-35Gy。结果近期肿瘤退缩率分别为CR33．3％（12／36）、PR52．8％（19／36）、NR8．3％（3／36）和PD5．6％（2／36），总有效率（CR＋PR）86．1％，1年生存率分别为69．4％（25／36）。急性放射性肺炎Ⅰ-Ⅱ级22．2％（8／36），Ⅲ级5．6％（2／36），Ⅳ级0（0／36）。急性放射性食管炎Ⅰ-Ⅱ级27．8％（10／36），Ⅲ-Ⅳ级0（0／36）。骨髓抑制Ⅰ-Ⅱ级25％（9／36），Ⅲ-Ⅳ级2．8％（1／36）。晚期放射性肺损伤Ⅱ级1例。结论对Ⅲ期非小细胞肺癌常规放疗后再行适形放疗局部加量照射，患者可耐受，疗程短，提高肿瘤控制率，延长生存期，是局部剂量升级的有效方法。     

同步放疗、化疗联合沙利度胺治疗小细胞肺癌的临床研究

目的：探讨同步放疗、化疗联合沙利度胺治疗小细胞肺癌的临床效果。方法：我科收治小细胞肺癌22例，所有病例均经病理证实，采用三维适形放疗（3DCRT），放疗单次DT1．2～1．5Gy，2次／d，2次间隔6h，每周5d，总剂量DT 5000～5600 cGy。同步行EP方案化疗，依托泊苷100mg／m^2，d1～d3静滴，顺铂75mg／m^2.d1静滴，每3周重复1次，每例患者化疗4～6个周期。口服沙利度胺，每次25mg，3次，d。按WHO实体瘤近期疗效评价标准分为CR、PR、NC、PD。正常组织急性放射反应按美国肿瘤放射治疗协作组（RTOG）标准评价。结果：全组22例均可评价，CR为50．0％，PR为31．8％．有效率（CR＋PR）为81．8％，放射性肺炎发生率为22．7％，放射性食管炎为31．8％，白细胞下降发生率为86．4％，中位随访期17（4～28）个月。结论：同步放疗、化疗联合沙利度胺治疗小细胞肺癌的临床治疗近期疗效好，能明显改善患者的生活质量，毒副作用患者可接受，远期疗效有待于进一步随诊及临床研究。     

IMRT／3DCRT结合锎252中子腔内治疗新疆地区中晚期食管癌临床报道

目的观察IMRT／3DCRT配合锎252（Cf252）中子腔内放射治疗中晚期食管癌的疗效及不良反应。方法收集我院2007年1月～2011年2月间收治的38例经病理检查证实食管鳞癌的患者,临床分期Ⅱ、Ⅲ、Ⅳ期分别为14、19、5例,全部患者KPS评分≥80分,无远处转移,均为首程放疗,放疗采用体外照射序贯腔内模式。先采用6MVX线直线加速器IMRT／3DCRT技术照射,95％等剂量线覆盖95％PTV体积,95％PTV≥50Gy,然后采用ZH-1000型Cf252中子后装治疗机治疗,总吸收剂量10～16Gy。放疗后3个月进行近期疗效评估。结果进食哽噎症状明显改善,35例症状完全消失,3例好转。急性毒副反应以放射性食管炎为主。Ⅰ级放射性食管炎发生率为23．7％（9／38）,Ⅱ级为7．9％（3／38）。近期疗效评价有效率（CR＋PR）92．1％,全组1、2年生存率分别为68％、19％。结论IMRT／3DcRT结合Cf252中子照射是安全有效的治疗方法,具有一定的临床应用前景。     

盖诺加顺铂适形放疗治疗Ⅲa期非小细胞肺癌疗效观察

目的 观察盖诺加顺铂联合三维适形放射治疗（3DCRT）局部晚期非小细胞肺癌的耐受性及近期疗效。方法 36例局部晚期非小细胞肺癌（Ⅲa）患者进入化疗加三维适形放射治疗组，全部患者均行盖诺加顺铂方案（盖诺25mg／m。第1，8天给予；顺铂25mg／m。第1～3天给予；21d为1个周期）化疗加3DCRT同步治疗。结果 36例均完成治疗患者，肺原发灶CR占16．7％，PR占75．0％，NR＋PD占8．3％，总有效率为91．7％；纵隔转移淋巴结CR占36．4％，PR占63．6％，NR＋PD占0％，总有效率为100％；白细胞下降发生率为95．8％，其中3，4级白细胞下降为36．1％；放射性食管炎和放射性肺炎的发生率分别为54．2％和12．5％，均为1，2级。结论 盖诺加顺铂联合适行放疗治疗局部晚期非小细胞肺癌能为绝大多数患者耐受。有较好的近期疗效。     

卡铂加鸦胆子治疗恶性积液的临床观察

目的观察卡铂加鸦胆子治疗恶性积液的临床疗效及毒副作用。方法对54例恶性积液（包括胸腔积液25例,心包积液8例,腹水21例）患者应用卡铂200mg＋鸦胆子油乳30ml,腔内注入治疗,每周1次,共4周。结果25例恶性胸腔积液患者中完全缓解（CR）7例（28．0％）,部分缓解（PR）11例（44．0％）,总有效率72．0％;恶性心包腔积液CR2例（25．0％）,PR2例（25．0％）,总有效率50．0％;恶性腹水CR4例（19．O％）,PR10例（47．6％）,总有效率66．7％。结论卡铂加鸦胆子治疗恶性积液有效,安全,没有明显毒副作用。     

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.