术前胸腺肽α_1新辅助化疗对老年食管癌患者术后免疫功能的影响

目的:探讨术前胸腺肽α_1新辅助化疗对老年食管癌患者术后免疫功能的影响。方法:选取Ⅱ、Ⅲ期老年食管癌患者46例为研究对象,随机分为对照组与治疗组组,各23例,所有患者术前均进行常规DP(多西他赛+奈达帕)方案化疗,治疗组采用DP结合胸腺肽α_1新辅助化疗方案,而对照组只采用常规DP方案化疗,分别于化疗前1天、化疗1周期、2周期后及手术后7 d抽取患者外周血,采用流式细胞技术检测NK细胞含量变化及T细胞亚群(CD4+、CD8+、CD4+/CD8+、CD3+)的百分率。结果:化疗1周期、2周期及术后7 d,治疗组CD3+、CD4+、CD8+、CD4+/CD8+水平显著高于对照组,差异有统计学意义(P<0.05),且2周期化疗和术后7 d后,治疗组NK细胞含量显著高于对照组,差异有统计学意义(P<0.05),治疗组CD3+、CD4+、CD8+、CD4+/CD8+水平较前增加幅度显著;在粒细胞减少上,治疗组更显著低于对照组,差异有统计学意义(P=0.001),治疗组化疗不良反应显著低于对照组,差异有统计学意义(P<0.05);治疗组肺部感染发生率显著低于对照组,差异有统计学意义(P<0.05);在术后并发症方面,两组总发生率差异无统计学意义(P=0.356)。结论:胸腺肽α_1新辅助化疗应用于Ⅱ、Ⅲ期老年食管癌术后,可有效提高患者对化疗及手术的耐受性,增强患者免疫功能,不良反应小,有利于改善患者生活质量。     

针刺治疗对晚期胃癌患者免疫功能的影响研究

目的观察针刺治疗对晚期胃癌患者中机体免疫系统的效果。方法无放化疗、无手术和靶向治疗指针的患者,针刺治疗每周2次,6次为1疗程,共2个疗程。检测淋巴细胞、T淋巴细胞亚群(CD3~+、CD4~+、CD8~+和CD4~+/CD8~+)和NK细胞。结果实验组患者淋巴细胞、CD3~+、CD4~+、CD8~+、CD4~+/CD8~+和NK细胞治疗前后比较差异均具有显著性(P0.01)。第一疗程针刺治疗结束后免疫系统均明显恢复,各指标差异具有统计学意义(P0.05)。第二疗程针刺治疗后,各指标与治疗前差异具有统计学意义(P0.05)。对照组患者淋巴细胞、CD3~+、CD4~+、CD8~+、CD4~+/CD8~+和NK细胞治疗前后比较差异无统计学意义(P 0.05)。结论对无法手术、无法放化疗和靶向治疗的晚期胃癌患者,针刺治疗能够明显促进免疫功能的恢复。在晚期无特效治疗手段时,针刺治疗可作为一种辅助抑制肿瘤进展的有效方法,值得临床推广应用。     

甘露聚糖肽联合SOX方案化疗对晚期胃癌患者免疫功能的影响

目的:观察甘露聚糖肽联合SOX方案化疗对晚期胃癌患者免疫功能的影响。方法:选择2017年4月-2019年3月本院治疗的晚期胃癌患者78例。按随机数字表法将其分为观察组和对照组,各39例。对照组接受SOX方案化疗,观察组在对照组基础上加用甘露聚糖肽注射液治疗。观察两组近期疗效、免疫功能指标[CD4~+、CD8~+、CD4~+/CD8~+]及不良反应发生情况。结果:观察组总有效率为87.18%,虽略高于对照组的74.36%,但两组比较差异无统计学意义(P0.05)。治疗后,观察组CD4~+、CD4~+/CD8~+均高于对照组,CD8~+低于对照组,差异均有统计学意义(P0.05)。观察组消化道反应、乏力发生率均低于对照组,差异均有统计学意义(P0.05);两组骨髓抑制、口腔溃疡发生率比较,差异均无统计学意义(P0.05)。结论:晚期胃癌患者接受甘露聚糖肽联合SOX方案化疗在改善患者免疫功能方面效果较佳,具有较好的治疗效果,不良反应较少,具有较高的安全性。     

复方斑鳌胶囊辅助化疗治疗胃癌的增效减毒效果观察

目的观察复方斑鳌胶囊辅助化疗治疗胃癌(GC)患者的增效减毒效果。方法将我院90例GC患者随机分为治疗组与对照组各45例。治疗组采用复方斑鳌胶囊辅助替吉奥胶囊化疗,对照组采用替吉奥胶囊化疗。比较两组近期疗效、毒副反应、免疫功能和肿瘤标志物的表达情况。结果治疗组客观缓解率、疾病控制率均高于对照组(P0.05);治疗后,治疗组白细胞减少、血小板减少、胃肠道反应、肝肾功能异常、外周神经毒性发生率低于对照组(P0.05)对照组CD3~+、CD4~+、CD4~+/CD8~+、自然杀伤细胞(NK)降低,CD8~+增高治疗组CD3~+、CD4~+、CD4~+/CD8~+、NK增高,CD8~+降低且治疗组CD3~+、CD4~+、CD4~+/CD8~+、NK高于对照组,CD8~+低于对照组(P0.05);两组癌胚抗原(CEA),糖链抗原125(CA125),糖链抗原199(CA199)降低,且治疗组CEA、CA125、CA199低于对照组(P0.05)。结论复方斑鳌胶囊辅助化疗治疗GC患者的近期疗效较好,能降低化疗的毒副反应,增强免疫功能,较大程度地降低肿瘤标志物的表达。     

培美曲塞联合顺铂化疗对非鳞状非小细胞肺癌患者基质金属蛋白酶、VEGF、NK细胞水平及免疫功能的影响

目的:探讨培美曲塞联合顺铂化疗对非鳞状非小细胞肺癌患者基质金属蛋白酶(MMPs)、血管内皮生长因子(VEGF)、NK细胞及免疫功能的影响。方法:86例非鳞状非小细胞肺癌患者依据随机分为对照组(n=44)和观察组(n=42),对照组给予多西他赛联合顺铂化疗,观察组行培美曲塞联合顺铂化疗。比较治疗前后两组MMP-2、MMP-9、VEGF、NK细胞及免疫功能等指标水平。结果:治疗前,两组MMP-2、MMP-9、VEGF、NK细胞、CD3~+、CD4~+、CD8~+、CD4~+/CD8~+水平比较,差异无统计学意义(P>0.05)。治疗后,两组MMP-2、MMP-9、VEGF、CD8~+水平均显著低于组内治疗前(P<0.05),且观察组显著低于对照组,差异有统计学意义(P<0.05);治疗后两组NK细胞、CD3~+、CD4~+及CD4~+/CD8~+水平较组内治疗前均显著升高(P<0.05),且观察组治疗后NK细胞、CD3~+、CD4~+及CD4~+/CD8~+水平均显著高于治疗后对照组水平,差异有统计学意义(P<0.05)。结论:培美曲塞联合顺铂化疗治疗非鳞状非小细胞肺癌,可有效降低患者的血清MMPs、VEGF水平,升高NK细胞水平,调节免疫功能,具有一定的临床价值。     

腹腔镜胃癌根治术对机体炎性反应和免疫功能的影响

目的:探讨腹腔镜胃癌根治术对机体炎性反应和免疫功能的影响。方法:选择2014年1月-2015年1月于本院接受腹腔镜胃癌根治术患者30例作为腹腔镜组,对照组30例为同期行开腹胃癌根治术患者,比较两组手术前后TNF-α、IL-6水平以及两组手术前后CD4+、CD8+,CD4+/CD8+的变化。结果:两组术前TNF-α、IL-6水平比较差异无统计学意义(P0.05),术后第2天,两组TNF-α、IL-6水平均高于术前,对照组TNF-α、IL-6水平高于腹腔镜组,比较差异均有统计学意义(P0.05);术后第1天,两组CD4+、CD4+/CD8+水平低于术前,比较差异有统计学意义(P0.05),但两组间比较差异无统计学意义(P0.05);两组术后第1天、第7天的CD8+水平比较差异无统计学意义(P0.05)。术后第7天,对照组CD4+、CD4+/CD8+水平低于术前及术后第1天,比较差异有统计学意义(P0.05);但观察组术后第7天CD4+、CD4+/CD8+水平与术前比较,差异无统计学意义(P0.05);观察组术后第7天的CD4+、CD4+/CD8+水平高于对照组,比较差异有统计学意义(P0.05)。结论:腹腔镜胃癌根治术创伤小,对全身炎性反应及免疫功能影响小,较开腹手术能更好地保护患者的免疫功能。     

参芪扶正注射液联合EOX新辅助化疗对进展期胃癌患者的治疗效果

目的探讨参芪扶正注射液联合表柔比星+奥沙利铂+卡培他滨(EOX新辅助化疗)对进展期胃癌患者的治疗效果。方法选取解放军第91中心医院2016年1月至2017年1月收治的68例进展期胃癌患者,随机数表法分为观察组和对照组,各34例,对照组术前接受EOX新辅助化疗,观察组术前接受参芪扶正注射液+EOX新辅助化疗,治疗后对比两组血清T细胞亚群水平及不良反应发生率,统计两组化疗后肿瘤分期及手术切除率。结果治疗后观察组CD4~+、CD3~+/CD4~+水平高于对照组,不良反应发生率(32.35%)低于对照组(58.82%),差异有统计学意义(P<0.05)。化疗后两组肿瘤分期降低,但两组Ⅰ、Ⅱ期例数比较,差异无统计学意义(P>0.05)。两组手术切除率均较高,组间比较,差异无统计学意义(P>0.05)。结论参芪扶正注射液联合EOX新辅助化疗治疗进展期胃癌患者,可提高患者免疫力,降低不良反应发生率,提高手术切除率。     

T淋巴细胞亚群和NK细胞对非霍奇金淋巴瘤患者疗效的预测价值

目的:探讨T淋巴细胞亚群和NK细胞对非霍奇金淋巴瘤(NHL)患者疗效的预测价值.方法:选取本院收治的NHL患者120例为NHL组,另选同期体检人群60例作为对照组.所有NHL患者均单用化疗.于化疗前及化疗后1个月,检测T细胞及NK细胞水平.结果:化疗前,NHL组CD3+、CD4+细胞比例及CD4+/CD8+比值均明显低于对照组,CD8+、CD25+、CD4+ CD25+ Treg及NK细胞比例均明显高于对照组,差异具有统计学意义(P＜0.05);化疗后,CD4+细胞比例、CD4+/CD8+比值较化疗前明显升高,CD4+ CD25+ Treg比例明显降低,与对照组比较差异具有统计学意义(P＜0.05);不同临床分期及临床结局的NHL患者化疗前T细胞及NK细胞比例比较,差异具有统计学意义(P＜0.05);临床分期越高、疗效越差,CD3+、CD4+细胞比例及CD4+/CD8+比值越低,CD8+、CD25+、CD4+CD25+ Treg及NK细胞比例越高.结论:NHL患者外周血中T细胞及NK细胞与NHL存在密切关联,有望通过动态监测NHL患者外周血中T细胞及NK细胞水平来观察疾病发展及化疗的效果,指导临床治疗.     

原发性胃癌根治术后化疗对外周血T细胞亚群、NK细胞的影响及意义

目的:探讨原发性胃癌患者胃癌根治术后化疗对患者外周血T细胞亚群及NK细胞的影响及临床意义.方法:选择2010年11月～2013年11月入住我院35例行胃癌根治术的原发性胃癌患者作为观察组,采用EP化疗方案:100 mg/m2足叶乙苷,d13,静脉滴注;25 mg/m2顺铂,d1-3,静脉滴注.另外选择同期于我院进行体检的健康者35名作为对照组.比较化疗前后外周血白细胞总数、淋巴细胞百分比、淋巴细胞绝对值、外周血T细胞亚群相关指标(CD3+、CD4+、CD8+、CD4 +/CD8+及CD45RA+/RO+)及NK细胞.结果:(1)观察组化疗前后白细胞总数、淋巴细胞百分比及淋巴细胞绝对值差异均具有统计学意义(P＜0.05),但观察组化疗后上述指标与对照组相比,差异无统计学意义(P＞0.05);(2)观察组化疗后外周血T细胞亚群相关指标(CD3+、CD4+、CD8+及CD4+/CD8+、CD45RA+、CD45RA+绝对值、CD45RO+绝对值、CD45RA+/RO+)及NK细胞水平均显著高于化疗前(P＜0.05).结论:原发性胃癌根治术后化疗可有效提高机体外周血T细胞亚群及NK细胞水平,对患者生活质量的改善及疾病的康复具有十分重要的临床意义.     

复方苦参注射液联合化疗对晚期非小细胞肺癌患者免疫功能的影响

目的:观察复方苦参注射液联合化疗对晚期非小细胞肺癌(NSCLC)患者细胞免疫功能的影响。方法:将80例晚期NSCLC患者随机分为治疗组(n=40)和对照组(n=40),治疗组采用复方苦参注射液联合NP化疗;对照组采用单纯NP化疗方案。21d为1个周期,使用2个周期后比较两组免疫功能变化。结果:治疗组和对照组化疗前,检测外周血CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞,差异无统计学意义(P>0.05);治疗组和对照组化疗后,外周血CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞活性均较化疗前降低,差异有统计学意义(P<0.05)。化疗后治疗组外周血CD3+、CD4+、CD4+/CD8+及NK细胞均高于对照组,差异有统计学意义(P<0.05)。结论:晚期NSCLC患者化疗后免疫功能下降,复方苦参注射液联合化疗能提高晚期NSCLC患者机体的免疫功能。     

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.