肺癌化疗患者癌因性疲乏影响因素及其与生存质量相关性分析

目的探讨肺癌化疗患者癌因性疲乏（CRF）影响因素及其与生存质量的关系。方法选取121例晚期肺癌化疗患者为研究对象,依据国际疾病分类标准第10版相关标准诊断CRF,使用Piper疲乏量表中文修订版（RPFS）、肺癌治疗功能评价系统（FACT-L）分别评估CRF程度及生活质量。采用多因素logistic回归分析CRF发生的影响因素,Spearman秩相关分析CRF与生存质量的相关性。结果发生CRF89例（73.6%）,以中度疲乏（59例,66.3%）为主。家庭月收入（OR=0.399）、临床分期（OR=4.809）、化疗次数（OR=5.287）及血白细胞计数（OR=0.763）、血红蛋白水平（OR=0.977）是肺癌化疗患者发生CRF的影响因素（均P＜0.05）。肺癌化疗患者RFPS总体及4个维度（行为疲乏、情感疲乏、躯体疲乏、认知疲乏）评分与FACT-L5个维度（生理状况、社会状况、情感状况、功能状态、肺癌相关症状）评分均呈负相关（均P＜0.05）。结论家庭月收入、肿瘤临床分期、化疗次数及血白细胞计数、血红蛋白水平是肺癌化疗患者发生CRF的影响因素。患者CRF程度越重,其生存质量越低。     

基于结构方程模型的肿瘤患者化疗期癌因性疲乏影响因素分析

目的　调查分析住院肿瘤患者化疗期癌因性疲乏（CRF）现状及其影响因素,为临床护士实施个体化的肿瘤专科护理干预措施提供依据。方法　采用便利抽样法,选取2015年7月—2016年6月在怀化市第一人民医院住院的符合纳入标准的674例肿瘤患者作为调查对象。采用一般资料收集表、Piper疲乏评估量表（PFS）、Morse跌倒评估量表（MFS）、机体活动能力分级量表、疼痛数字评分量表（NRS）对患者进行调查分析。分析年龄、MFS得分、机体活动能力分级量表得分、NRS得分与PFS得分的相关性及患者化疗期CRF的影响因素。结果　共发放问卷674份,收回有效问卷668份,有效回收率为99.1%。患者年龄、MFS得分、机体活动能力分级量表得分、NRS得分与PFS得分均呈正相关（r值依次为0.236、0.514、0.216、0.129,P值依次为<0.001、<0.001、<0.001、<0.001）。多元线性回归及结构方程模型分析结果显示患者年龄、住院科室、跌倒风险、机体活动能力、疼痛、陪护是肿瘤患者化疗期CRF的主要影响因素。结论　患者年龄、住院科室、跌倒风险、机体活动能力、疼痛、陪护是肿瘤患者化疗期CRF的主要影响因素,医护人员应重视对肿瘤患者化疗期CRF的评估。     

紫黄精TM片缓解化疗期间癌因性疲乏的前瞻性单臂多中心临床研究

  目的  初步探究紫黄精TM片用于化疗期间癌因性疲乏患者的疗效。   方法  本项临床研究设计为一项前瞻性、单臂、多中心临床研究，计划纳入至少接受过一个周期化疗，且存在中重度癌因性疲乏（Piper疲乏量表得分≥4分）的恶性肿瘤患者。所有入组患者将在接下来的两个化疗周期中每日按时口服紫黄精TM片（2.1 g，一天两次）并接受随访。期间入组患者分别于基线、第二周期化疗前（第21天）及第三周期化疗前（第42天）独立完成Piper疲乏量表、EORTC QLQ-C30量表的填写及部分生化免疫指标的测量。主要研究终点为从基线到第42天的Piper疲乏调查量表得分的变化情况。   结果  最终47例患者完成研究。患者在第三周期化疗前（第42天）评估Piper疲乏量表平均得分为（3.21±1.67）分，较基线时〔（5.89±1.36）分〕下降（P=0.000），癌因性疲乏得到明显改善。在生活质量方面，患者的整体生活质量评分、躯体功能、角色功能、情感功能、认知功能、社会功能得到明显改善；在症状管理方面，患者的疲劳、恶心呕吐、失眠、食欲减退等症状也得到显著改善。实验过程中未出现3～4级不良反应，余轻微不良反应经评估后认为与化疗相关，与紫黄精TM片无关。  结论  经初步研究，紫黄精TM片使用安全，具有可以改善肿瘤患者化疗期间癌因性疲乏的潜在治疗作用。但将来需开展更大规模的随机对照临床研究进一步证实紫黄精TM片的作用。     

肝癌患者肝动脉化疗栓塞术后恶心呕吐的非化疗影响因素分析

目的 分析影响肝癌患者肝动脉化疗栓塞术（TACE）后发生恶心呕吐的非化疗因素。方法 采用整群抽样法,选取2012年10月-2013年10月在中国医科大学附属第一医院介入病房住院的符合纳入与排除标准的肝癌患者272例。记录患者年龄、性别、肿瘤是否转移、肿瘤大小、碘化油注射液剂量、疼痛程度、疼痛时间、介入手术次数、发热程度、发热天数、有无腹胀等,分析上述指标与TACE后恶心呕吐的关系。结果 272例患者中恶心程度语言描述分级（NVSD）为0级169例（占62.1%）,1级59例（占21.7%）,2级44例（占16.2%）。年龄与恶心呕吐呈负相关性（r=-0.217,P＜0.05）,疼痛程度、疼痛时间、腹胀与恶心呕吐呈正相关（r=0.333、0.538、0.188,P＜0.05）。多因素Logistic回归分析显示,年龄高为患者TACE后恶心呕吐的保护因素〔OR=0.916,95%CI（0.841,0.998）,P=0.044〕,疼痛时间长、有腹胀为患者TACE后恶心呕吐的独立危险因素〔OR=373.019,95%CI（8.197,16 974.798）,P=0.002|OR=3.677,95%CI（1.064,12.702）,P=0.040〕。疼痛因素对恶心呕吐有直接正向效应（β=0.42,P＜0.01）,恶心呕吐对腹胀有直接正向效应（β=0.77,P＜0.01）;年龄对疼痛有负向效应（β=-0.01,P=0.072）,对腹胀有正向效应（β=0.01,P=0.069）;年龄及腹胀对恶心呕吐的效应均不显著（P＞0.05）。结论 年龄、疼痛时间、腹胀均对TACE后肝癌患者发生恶心呕吐有影响,患者恶心呕吐的发生是多因素共同作用的结果。     

正念训练干预对乳腺癌患者化疗后癌因性疲乏的研究

目的：探讨正念训练对乳腺癌患者癌因性疲乏（CRF）的影响。方法将2015年1～6月该院收治的200例中青年乳腺癌化疗患者分为观察组和对照组（各100例）,对照组给予常规护理,观察组在对照组的基础上给予正念训练,并参照癌症疲乏量表（CFS）评价患者的疲乏状况,并比较干预前后两组CRF各维度及总疲乏评分。结果乳腺癌术后化疗患者绝大多数存在疲乏症状,CRF发生率为97．0％,以中度疲乏为主,其次为轻度疲乏,重度疲乏最少。在第2次化疗时,两组患者躯体疲乏、认知疲乏、情感疲乏及总疲乏评分比较,差异均无统计学意义（P＞0．05）;第4、6次化疗时,观察组躯体疲乏、认知疲乏、情感疲乏及总疲乏评分均低于对照组,差异均有统计学意义（P＜0．05）。结论正念训练干预可以明显缓解患者的疲乏状态,提高患者的生活质量。     

不同年龄脐血干细胞移植患儿癌因性疲乏与生活质量的相关性调查研究

背景　癌因性疲乏（CRF）作为一种与肿瘤相关的、常见的、多维的、主观的症状,严重影响患者的生命质量。脐血干细胞移植是一种比标准化疗更强化的治疗,患者极易发生化疗毒副作用、感染、移植物抗宿主病等,增加疲乏发生的风险。目的　调查不同年龄脐血干细胞移植患儿CRF与生活质量的现状,并分析其相关性。方法　采用便利抽样方法选取2016年11月-2018年1月中国科学技术大学附属第一医院血液科住院的32例脐血干细胞移植患儿,按照年龄将其分为儿童组（8~12岁,15例）、青少年组（13~17岁,17例）。于患儿出院前1~3 d,采用中文版儿童多维疲乏量表（PedsQLTM MFS）评价患儿住院期间的疲乏水平,采用中文版儿童生存质量量表（PedsQLTM）3.0癌症模块评价患儿住院期间的生活质量。结果　儿童组与青少年组一般疲乏、认知疲乏得分及PedsQLTM MFS总分比较,差异均无统计学意义（P>0.05）;儿童组休息疲乏得分高于青少年组（P<0.05）。儿童组与青少年组疼痛、恶心呕吐、操作焦虑、治疗焦虑、担忧、认知、外貌、交流得分及PedsQLTM3.0癌症模块总分比较,差异均无统计学意义（P>0.05）。所有患儿的PedsQLTM MFS总分与PedsQLTM3.0癌症模块总分呈正相关（r=0.620,P<0.001）。所有患儿的一般疲乏得分与恶心呕吐、操作焦虑、治疗焦虑、担忧、认知得分均呈正相关,休息疲乏得分与疼痛、恶心呕吐、操作焦虑、治疗焦虑、担忧、认知得分均呈正相关,认知疲乏得分与操作焦虑、治疗焦虑、担忧、认知、外貌、交流得分均呈正相关（P<0.05）。结论　脐血干细胞移植患儿CRF较重,特别是青少年组患儿的休息疲乏更严重;生活质量水平低,且与疲乏水平呈正相关。     

成年血液肿瘤患者癌因性疲乏水平及其与生活质量关系的相关性分析

目的探讨成年血液肿瘤患者癌因性疲乏及生活质量水平,并对两者的相关性进行分析。方法应用Piper癌因性疲乏问卷及欧洲癌症研究与治疗组织的生活质量核心量表对114名成年血液肿瘤患者进行调查,问卷填写后回收。所得数据采用SPSS19．0统计软件分析。结果114名血液肿瘤患者中CRF发生率为64％,量表平均分值为5．40±2．10分;患者疲乏程度与生活质量呈显著相关（P〈0．05）。结论血液肿瘤患者癌因性疲乏发生率高,是影响患者生活质量的重要因素之一,应采取更为积极的管理措施应对血液肿瘤患者癌因性疲乏的发生。     

延续护理对乳腺癌患者术后生活质量的作用

目的：探讨延续护理对乳腺癌患者术后生活质量的作用。方法：将56例乳腺癌术后患者随机分为试验组和对照组各28例。试验组出院后给予延续护理干预,对照组患者不给予。两组患者分别在出院前和出院后6个月进行生活质量评分（EORTC QLQ －C30）测定。结果：出院6个月后,实验组患者功能领域的5个子量表评分比对照组明显提高（P ＜0．05）;症状领域中疼痛、疲乏、恶心呕吐、失眠的评分比对照组明显降低（P ＜0．05）。结论：采用延续护理模式可明显提高乳腺癌患者术后的生活质量,值得临床广泛推广。     

骨肿瘤化疗患者的癌因性疲乏现状及其影响因素

目的 探讨骨肿瘤化疗患者的癌因性疲乏（CRF）现状及其影响因素。方法 选取2020年2月至2021年1月于首都医科大学附属北京积水潭医院接受化疗的骨肿瘤患者100例,患者进行修订Piper疲乏量表中文版（RPFS-CV）、社会支持评定量表（SSRS）、一般自我效能感量表（GSES）测评。患者根据是否存在CRF分为CRF组（RPFS-CV评分>3分,26例）和非CRF组（RPFS-CV评分≤3分,74例）。比较两组临床资料,采用多因素logistic回归分析确定CRF的影响因素。结果 本研究中100例骨肿瘤化疗患者的RPFS-CV总分为（4.54±1.02）分。CRF组Ennecking分期为Ⅲ及Ⅳ期占比、病程、化疗次数高于非CRF组,SSRS、GSES评分低于非CRF组,差异有统计学意义（P<0.05）。回归分析显示,Ennecking分期（OR=1.485,95%CI:1.102～2.001）、化疗次数（OR=2.307,95%CI:1.387～3.837）、SSRS评分（OR=0.319,95%CI:0.141～0.722）、GSES评分（OR=0.512,95%CI:...     

乳腺癌患者化疗呕吐发生情况及其影响因素分析

目的：研究分析乳腺癌患者化疗呕吐发生情况及影响因素。方法：回顾性调查2016年6月—2020年12月莱西市人民医院收治的500例乳腺癌化疗患者的临床资料,将其化疗呕吐发生率进行统计。比较呕吐与未呕吐患者的年龄、焦虑自评量表（SAS）评分、营养状态、电解质情况、过敏史、晕动症史、胃肠道病史、基础疾病情况、肿瘤原发灶,病理淋巴结和转移分期（TNM分期）、分化程度、卡氏评分（KPS）、化疗前24 h恶心呕吐情况、化疗药物方案、化疗药物数量及是否首次化疗等情况,logistic回归分析乳腺癌患者化疗呕吐发生的影响因素。结果：500例化疗乳腺癌患者中呕吐者236例,发生率为47.20%。呕吐与未呕吐患者的年龄、营养状态、过敏史、基础疾病情况、TNM分期、分化程度及是否首次化疗情况比较,差异均无统计学意义（P>0.05）;呕吐者的SAS评分>50分、电解质失衡、晕动症史、胃肠道病史、KPS<80分、化疗前24 h恶心呕吐、含蒽环或铂类化疗方案及多药联合占比均显著高于未呕吐者,差异均有统计学意义（P<0.05）。logistic回归分析显示,SAS评分>50分、电解质失...     

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.