经皮肺内注射无水乙醇的动物实验研究

为观察经皮穿刺注射无水乙醇对组织的局部作用和全身影响，为经皮穿刺注射无水乙醇（ＰＥＩ）治疗肺癌的安全性和可行性提供依据，我们进行了家兔肺内ＰＥＩ的初步实验研究。结果显示：ＰＥＩ后的第１天至第３天，注射局部的肺组织发生凝固性霈死周围肺水肿、充血、伴大量中嗜中性白细胞浸润。１￣２周后，肺局灶性上皮细胞肉芽组织增生，最后纤维化，ＰＥＩ早期既无大面积组织坏死，亦无明显的全身副作用。本研究结果提示，肺内ＰＥ     

局部无水乙醇注射后兔血清酶及肝组织中乙醇代谢酶变化及意义

目的通过监测局部无水乙醇注射(PEI)前后兔血清AST、ALT、ADH及兔肝组织ADH、ALDH变化,探讨PEI后酒精是否通过肝脏酶学水平引起肝损伤,以对PEI的安全性进行实验分析。方法家兔20只,随机分为三组:注射无水乙醇1ml组(A组,8只);注射无水乙醇2ml组(B组,8只);不做任何处理的空白对照组(C组,4只)。B超引导下在兔肝内单点单次注射规定剂量无水乙醇,在PEI后1、3、7、14天处死A、B组动物各2只,C组1只。在PEI前及PEI后1、3、7、14天清晨分别取耳缘静脉血测定血清ALT、AST及ADH。处死动物后,取注射坏死灶边缘(0cm)、距离坏死灶1cm处(1cm)及非注射肝叶(Xcm)肝组织0.1g匀浆后测组织ADH、ALDH活性。结果 B组PEI后1天血清ALT、AST、AST/ALT较A、C组明显增加(P<0.05);A、B组血清ALT、AST、AST/ALT在PEI前后比较差异具有显著性(P<0.05);ALT、AST随时间推移而降低;肝组织ADH及ALDH在不同时点活性有差异。结论 PEI在肝脏酶学水平对兔肝细胞造成损伤,其损伤程度与酒精注入量有关,剂量越大对兔肝损伤越大;其损伤具有时间性和一定空间性。     

肾上腺转移瘤CT引导下乙醇消融治疗

目的:探讨CT引导下经皮穿刺无水乙醇消融术(PEI)对肾上腺转移瘤的治疗价值.方法:25例肾上腺转移性肿瘤,共计31个病灶.病灶直径1.5～7.2 cm.采用CT引导下无水乙醇瘤内注射进行治疗,治疗次数≥2次,治疗后1～2个月,行CT增强扫描,观察肿瘤大小、坏死情况.结果:PEI治疗后CT增强扫描复查,20个病灶直径≤3 cm的病灶18个(90%)完全坏死; 11个＞3 cm的病灶绝大部分坏死,经过再次重复治疗,2个病灶彻底坏死.结论:CT引导下经皮穿刺乙醇消融疗法治疗肾上腺转移瘤,疗效确切,且简便、创伤小.     

静脉化疗联合PEI治疗乳腺癌术后肝转移15例疗效观察

目的:观察静脉化疗联合经皮穿刺无水乙醇瘤内注射(PEI)治疗乳腺癌伴肝转移的疗效。方法:15例均为乳腺癌术后并确诊有肝转移,给予化疗(TP方案):紫杉醇135 mg/m2,第1天,静脉输注;顺铂40 mg/d,第2~4天,静脉输注。28 d为1周期,均用4疗程以上。同时化疗前、后肝转移瘤灶给予彩超引导下PEI治疗,每个病灶最少2次,最多4次。结果:完全缓解3例,部分缓解12例,有效率100%;均存活6个月以上,10例病死患者中最长存活22个月。不良反应为食欲低下、恶心呕吐、白细胞减少、肝功能一过性异常和穿刺部位疼痛。结论:PET和TP方案静脉全身化疗对乳腺癌术后肝转移有一定疗效。     

经皮肺穿刺直接介入治疗晚期非小细胞肺癌的研究

目的评价经皮肺穿刺瘤体内注射无水乙醇和化疗药物治疗晚期非小细胞肺癌(NSCLC)的临床疗效.方法对26例晚期NSCLC患者,在电视透视导引下经皮肺穿刺瘤体内注射无水乙醇14例(注射乙醇组),注射化疗药物12例(局部化疗组).结果注射乙醇组和局部化疗组的有效率分别为57%和50%,中位生存期分别为(16.3±9.1)个月和(14.8±7.6)个月.治疗后两组患者的血清癌胚抗原(CEA)和多糖抗原50(CA50)水平均明显下降.结论经皮肺穿刺瘤体内直接介入治疗对于失去手术机会及对化疗和放疗不能耐受或不接受的NSCLC患者不失为另一可供选择的治疗方法.     

化疗联合PEI治疗肺癌伴肝转移的疗效观察

目的观察静脉化疗联合经皮穿刺无水酒精肝转移瘤内注射（PEI）治疗肺癌伴肝转移的疗效。方法 20例确诊为肺癌伴肝转移患者中,2例小细胞肺癌采用MxEP方案[足叶乙甙（VP-16）100 mg/d,第1至3～5天;顺铂（DDP）40 mg/d,第1至3～4天;米托蒽醌（MxT）10 mg,第2天]化疗;余18例非小细胞肺癌采用NP方案[长春瑞滨（NVB）25mg/m2,第1,8天;DDP 40 mg/d,第1至3～4天]或GP方案[吉西他滨（GEM）1000 mg/m2,第1,8天;DDP 40 mg/d,第1至3～4天]化疗。28 d为一周期,均用4个疗程以上。同时肝转移瘤灶给予彩超引导下瘤体内注射无水酒精治疗。结果肺原发病灶的疗效11例为PR,无一例CR和PD;肝内转移灶经PEI治疗每个病灶最少2次,最多8次,无水酒精用量平均为6 ml;均达到治疗有效。毒副反应为食欲低下、恶心呕吐,白细胞减少,肝功能一过性异常和穿刺部位疼痛。结论无水酒精局部注射治疗和静脉全身化疗的结合对肺癌伴肝转移的治疗可能有一定疗效,有待进一步研究和随访。     

经皮肝穿刺注射无水乙醇治疗原发性肝癌疗效分析

目的：分析无水乙醇肿瘤内注射治疗原发性肝癌的疗效。方法：在超声引导下对36例原发性肝癌患者,用细针经皮肝穿刺向肝肿瘤内注射无水乙醇,5—7d注射1次,注射3次后休息1个月,再重复注射。使癌细胞变性坏死,使肝癌肿瘤逐渐缩小或消失。结果：36例原发性肝癌患者经注射无水乙醇治疗后临床症状均明显好转,原血清甲胎蛋白值升高者均有不同程度的下降。肿瘤逐渐缩小或消失,不良反应仅有短暂的局部灼热痛、低热、一过性转氨酶轻度升高。无出血、肝破裂、气胸、黄疸、血压下降等严重并发症发生。无死亡病例。33例（91．7％）患者存活时间超过1年。结论：超声引导下经皮肝穿刺注射无水乙醇治疗原发性肝癌操作简便,并发症少,比较安全,患者生存期长,并能提高患者生活质量。     

CT引导下经皮肝穿刺注射乙醇加肝动脉化疗栓塞治疗巨块型肝癌23例分析

如何进一步提高疗效,降低副作用已成为晚期不能手术肝癌治疗面临的现实问题。经皮肝穿刺注射无水乙醇（PEI）治疗小肝癌,疗效与外科手术相仿,但对大的肝癌,由于无水乙醇不能渗透整个瘤体而影响疗效。目前国内外许多研究表明小剂量肝动脉化疗栓塞（TACE）同样可以取得较好的疗效。笔者在CT引导下经皮肝穿刺注射无水乙醇（PEI）加小剂量TACE治疗巨块型肝癌23例,取得了较满意的疗效,现报告如下。     

超声导引下大鼠经皮肝内乙醇注射模型的建立及动态观察

目的：探讨建立在超声导引下大鼠经皮肝内乙醇注射（PEI）的模型,并动态观察肝功能恢复特点。方法：取SD大鼠40只,在超声引导下确定肝中叶后,注射无水乙醇0．1ml,分别在第1、3、5、7d取血,检测血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）含量,并取注射部位肝组织做病理组织学检查。结果：PEI术后第1d大鼠血清ALT、AST的含量升高最明显,随后开始下降,第7d恢复术前水平。大体观察及HE病理染色均可显示肝组织部分坏死。结论：在超声导引下对大鼠肝脏进行乙醇注射,其乙醇局限性扩散可导致肝细胞坏死,是研究PEI治疗肝脏疾病的可靠动物模型。     

双途径介入治疗肝癌的疗效观察

目的 评价综合应用肝动脉灌注化疗栓塞术(TACE)和经皮穿刺瘤内无水乙醇注射术(PEI)治疗肝癌的临床效果.方法 60例原发性肝癌随机分为2组:TACE PEI组(n=32)先行肝动脉化疗栓塞(TACE),1周内再于瘤体内注射无水酒精,每周1～2次;TACE组(n=28)单纯行肝动脉化疗栓塞术.两组病例均每4～6周重复行TACE,每例治疗2～4次.结果 TACE PEI组肿瘤治疗的有效率为68.8%,TACE组肿瘤治疗的有效率为39.3%.TACE PEI组和TACE组甲胎蛋白(AFP)下降率分别为75%、46.4%,2年生存率分别为35%、21%,差异均有显著性(P<0.05).结论 综合应用肝动脉化疗栓塞术和经皮穿刺瘤内无水乙醇注射是治疗肝癌的有效方法.     

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.     

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.     

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.