胃癌病灶周围注射超微活性炭对淋巴结的显色效果

目的观察胃癌病灶周围注射超微活性炭后局部淋巴结的黑染效果,指导胃癌手术淋巴结的清扫。方法43例胃癌患者术前或术中肿瘤周围注射超微活性炭,82例胃癌未接受注射者作为对照组,比较其清扫淋巴结的数目、黑染淋巴结数、淋巴结黑染与注射活性炭时间的关系、淋巴结转移情况,并观察副作用的发生。结果活性炭组每例患者清扫的淋巴结数(34枚±13枚)明显高于对照组(16枚±9枚),主要是清扫的N2淋巴结数明显最多(25枚±9枚∶8枚±4枚);活性炭组黑染度为603%,N1淋巴结的黑染度(713%)高于N2(563%);局部组织内注射超微活性炭,2d后淋巴结的黑染效果才较满意;黑染淋巴结中发生淋巴结转移的阳性率(268%)明显高于未黑染淋巴结(33%)及对照组(184%);局部组织注射超微活性炭未见严重副作用发生。结论肿瘤周围局部注射超微活性炭是一种有效、易行和安全的方法,对胃癌淋巴结清扫有指导作用。     

国产纳米活性炭在胃癌根治术中的应用

目的评价国产纳米活性炭在胃癌根治术中的淋巴示踪作用。方法62例进展期胃癌患者随机分成示踪组、对照组。示踪组术前12小时经胃镜在肿瘤周围注射国产纳米活性炭混悬液,比较根治术中淋巴结清扫的数目、转移度、淋巴结的黑染及转移情况,观察不良反应。结果示踪组每例患者清扫淋巴结数(31.5±12.3)枚明显高于对照组(22.1±6.4)枚;示踪组淋巴结黑染度为68(;黑染淋巴结中发生淋巴结转移的阳性率(27.1%)明显高于未黑染的淋巴结(4.7%)及对照组(17.2%);示踪组淋巴结微转移率(33.3%)明显高于对照组(12.5%);示踪组的手术时间及手术并发症没有增加;示踪组局部注射纳米活性炭未见有局部及全身不良反应。结论胃癌病灶周围局部注射国产纳米活性炭对根治术中转移淋巴结的清除,尤其是对微转移淋巴结的清除有重要意义。     

载药国产纳米活性炭在胃癌根治术中的应用

目的 评价载药国产纳米活性炭在胃癌根治术中的淋巴示踪及淋巴化疗作用.方法 92例进展期胃癌患者随机分成载药组、示踪组和对照组.载药组术前12h经胃镜在肿瘤周围注射国产纳米活性炭-5氟尿嘧啶混悬液,示踪组术前12h经胃镜在肿瘤周围注射国产纳米活性炭混悬液,比较根治术中淋巴结清扫的数目、转移度、淋巴结的黑染、转移及细胞凋亡情况,观察不良反应.结果 载药组和示踪组每例患者清扫淋巴结数明显高于对照组,淋巴结微转移率明显高于对照组;黑染淋巴结中发生淋巴结转移的阳性率明显高于未黑染的淋巴结及对照组;载药组淋巴结细胞凋亡率明显高于示踪组和对照组.载药组和示踪组局部注射纳米活性炭未见有局部及全身不良反应.结论 胃癌病灶周围局部注射国产纳米活性炭-5氟尿嘧啶混悬液对根治术中转移淋巴结的清除,尤其是对微转移淋巴结的清除有重要意义;有淋巴化疗作用.     

纳米活性炭在肺癌外科手术中的应用

目的：评价国产纳米活性炭混悬液在肺癌病灶切除术中淋巴示踪作用。方法将65例肺癌患者分成两组,术中注射纳米活性炭混悬液的32例作为试验组,另33例为对照组。试验组开胸后在肿瘤周围注射国产纳米活性炭混悬液,比较两组淋巴结清扫数目、转移度、淋巴结的黑染及转移情况。同时观察试验组不良反应。结果试验组每例患者清扫淋巴结数（32．91±4．15）枚明显高于对照组（29．42±4．78）枚（ P＜0．05）。试验组淋巴结黑染度81．2％。黑染淋巴结发生淋巴结转移的阳性率（28．4％）明显高于未黑染淋巴结（11．3％）,也明显高于对照组中淋巴结转移的阳性率（21．4％）,同时并未延长手术时间及增加术后不良反应。结论肺癌病灶周围注射纳米活性炭对肺癌病灶切除术中转移淋巴结的清除,尤其是微转移淋巴结的清除有重要意义。     

表阿霉素-活性碳混悬液对乳腺癌腋窝淋巴结亲和性研究

目的评价淋巴化疗制剂表阿霉素-活性碳(carbonactivatedabsorbingepirubicin,Epi-CH)混悬液对乳腺癌腋窝淋巴结的亲和性。方法将活性碳微粒吸附化疗药物表阿霉素,制成Epi-CH混悬液。将30例乳腺癌病人随机分为Ⅰ组和Ⅱ组,每组各15例。在病人瘤床或肿瘤周围腺体内局部注入含表阿霉素10mg的Epi-CH混悬液,Ⅰ、Ⅱ组分别于注射后48和72h行乳腺癌改良根治术,清扫至III级腋窝淋巴结。用高效液相色谱法(highperformanceliquidchorography,HPLC)检测腋窝淋巴结中表阿霉素的浓度。结果Ⅰ组和Ⅱ组腋窝淋巴结的黑染率分别为80.01%(213/266)和85.86%(249/290),差异无显著性(P>0.05);Ⅰ组和Ⅱ组黑染淋巴结中表阿霉素的浓度分别是(440.3±70.6)ng/g和(443.0±123.1)ng/g,分别明显高于Ⅰ组和Ⅱ组未黑染淋巴结中表阿霉素浓度的(45.3±11.1)ng/g和(31.8±11.9)ng/g(P<0.01);Ⅰ组和Ⅱ组黑染淋巴结中表阿霉素浓度没有明显变化(P>0.05),而未黑染淋巴结中Ⅱ组的表阿霉素浓度较Ⅰ组时明显降低(P<0.01)。结论乳腺癌瘤床或肿瘤周围腺体内局部注入Epi-CH混悬液能显著提高并维持腋窝局部淋巴结中表阿霉素的浓度,Epi-CH混悬液是乳腺癌淋巴化疗的良好制剂。     

纳米炭淋巴结显影技术对结直肠癌根治手术淋巴结切除率及淋巴结阳性检出率的影响

目的探讨纳米炭淋巴结显影技术在术中提高淋巴结切除率及术后病理淋巴结阳性检出率中的应用价值。方法收集2017年3月至2018年2月结直肠癌患者190例,其中男93例,女97例,年龄41～83（57.89±8.65）岁。按术前是否注射纳米炭分为观察组（97例）和对照组（93例）,观察组术前24h内在肠镜引导下于肿瘤四周2cm以内的正常黏膜下选取4~5点,每点注射0.2ml左右的纳米活性炭混悬液使黏膜下隆起皮丘;对照组根据CME/TME原则行结直肠癌根治术。比较两组淋巴结检出及转移情况。结果观察组检出淋巴结（15.07±2.23）枚/例,检出直径＜5mm淋巴结（4.69±1.05）枚/例,均高于对照组的（13.04±1.47）枚/例、（2.85±0.83）枚/例（t=7.168、3.096,均P＜0.01）。观察组黑染淋巴结的转移率为32.10%,高于未黑染的20.48%（字2=9.363,P＜0.05）。观察组直径＜5mm转移淋巴结检出（1.80±0.32）枚/例,高于对照组（0.88±0.17）枚/例（t=3.128,P＜0.05）。结论纳米炭淋巴结显影可帮助术者提高术中转移淋巴结的切除率,清扫更彻底,同时还能增加微小淋巴结转移灶（＜5mm）和直肠癌术后淋巴结阳性的检出率,使病理分期的准确性判断大大提高。     

活性炭-表阿霉素混悬液对乳腺癌腋窝淋巴结转移的治疗作用

目的评价活性炭微粒-表阿霉素(Epi-CH)混悬液对乳腺癌腋窝淋巴结清扫和转移灶化疗的改进作用。方法60例II-III期乳腺癌病人随机分为两组,治疗组40例术前72h于瘤床或肿瘤周围腺体注射Epi-CH混悬液10mg,对照组20例注射表阿霉素水溶液10mg,术后清点腋窝淋巴结总数和黑染淋巴结数并计算腋窝淋巴结清除率。用高效液相色谱法检测治疗组黑染和未黑染淋巴结中表阿霉素的含量。光镜观察淋巴结组织变性坏死改变。结果治疗组平均每例清除淋巴结比对照组多4.04个(P<0.01)。治疗组中腋窝淋巴结的黑染率为86.9%(565/650);直径≤1.0cm淋巴结黑染率明显高于直径﹥1.0cm淋巴结黑染率(P<0.01);黑染淋巴结癌转移率与未黑染淋巴结转移率无显著性差异(P>0.05)。治疗组黑染淋巴结中表阿霉素的含量是未黑染淋巴结含量的14.3倍(P<0.01)。黑染淋巴结内癌细胞有明显的变性坏死改变。结论Epi-CH混悬液能增加手术清除的腋淋巴结数目,显著增加并维持表阿霉素在局部淋巴结中的高浓度。     

局部注射微粒子活性炭对胃癌根治术淋巴结切除的辅助作用

目的　探讨局部注射微粒子活性炭对胃癌淋巴清扫术的改进作用。方法　对45例进展期胃癌行局部注射微粒子活性炭加胃癌根治术(活性炭组),17例进展期胃癌行常规胃癌根治术(常规治疗组),对切除淋巴结的数量进行了对比。结果　在胃大部切除术中,活性炭组平均每例切除的N2、N3和PAL的淋巴结数量显著多于常规治疗组。在全胃切除术中,活性炭组平均每例切除的N3和PAL的淋巴结数量显著多于常规治疗组(P<0.05或P<0.01)。结论　局部注射微粒子活性炭后胃癌根治术中淋巴结切除的数量显著增加,对于彻底清扫淋巴有一定辅助作用。     

微粒子活性炭（CH40）在口腔鳞癌颈淋巴清扫中的作用

目的：探讨微粒子活性炭（ＣＨ４０）在口腔鳞癌颈淋巴清扫术中的指导作用。方法：术前对２２例口腔鳞癌患者肿瘤内或肿瘤周围注入微粒子活性炭（ＣＨ４０）混悬液,术中根据淋巴结黑染情况作为标记来指导颈淋巴清扫术。结果：术中可见颈淋巴结有广泛不同程度的黑染,甚至包埋在脂肪组织内的直径１ｍｍ大小的淋巴结;注炭组黑染及未黑染的淋巴结转移比率无显著差异;注炭组平均每侧颈部清除４２．５个淋巴结,明显高于对照组的平均２６．２个淋巴结（Ｐ＜０．０１）;注炭组根治性颈清扫与功能性颈清扫清除的淋巴结数无明显差异（Ｐ＞０．０５）。结论：术前肿瘤内或肿瘤周围注入微粒子活性炭对口腔鳞癌颈淋巴清扫术有指导意义。     

纳米炭混悬液应用于甲状腺癌颈淋巴结清扫的价值分析

目的 探讨纳米炭混悬液示踪技术在甲状腺癌颈部淋巴结清扫中的应用价值。 方法 筛选86例在温州市中医院诊治的甲状腺癌患者,采用随机数字表法将患者随机分为观察组和对照组,每组各43例,观察组采用术中注射纳米炭混悬液的示踪方法,于患侧腺体取3～5个点,使用1 ml注射器注射纳米炭,注意避开颈部大血管,注射前需要进行回抽,观察有无回血,避免注入血管中,每个点注射0.1 ml,注射完毕后用纱布按压注射点,防止纳米炭渗漏至其他组织中污染术野,淋巴结黑染后行中央区淋巴结清扫。对照组未注射。观察2组患者淋巴结清扫、甲状旁腺误切以及低钙血症的情况。 结果 观察组共检出淋巴结487枚,其中黑染458枚,未黑染29枚,平均(10.5±3.7)枚/例;对照组共检出淋巴结288枚,平均(6.1±2.8)枚/例;2组平均检出数差异具有统计学意义(t=6.218,P＜0.05)。观察组中有癌细胞转移的淋巴结208枚,平均(4.2±1.6)枚/例;对照组中有癌细胞转移的淋巴结112枚,平均(2.2±0.9)枚/例;2组平均清扫癌细胞转移的淋巴结数量差异具有统计学意义(t=7.144,P＜0.05)。观察组未发现甲状旁腺误切,对照组有5例发生误切并出现低钙血症,观察组甲状旁腺误切例数明显低于对照组,差异具有统计学意义(χ2=5.309,P＜0.05)。 结论 术中注射纳米炭混悬液可提高淋巴结检出数量,同时可以有效地避免甲状旁腺误切,值得在临床推广使用。      

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.     

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.