68例脑胶质瘤术后治疗及相关预后因素分析

目的：探讨影响脑胶质瘤术后生存的相关因素.方法：回顾性分析68例脑胶质瘤术后患者的性别、年龄、族别、病理分级、肿瘤部位、瘤体大小及手术切除范围,根据术后治疗方案不同分为单纯放疗组和联合放化疗组,采用Kaplan-Miere绘制生存率曲线,用Log-rank检验和COX多因素回归分析法对治疗预后进行相关因素分析.结果：肿瘤的病理分级是影响生存率的预后相关因素（P=0.020）,术后单纯放疗和联合放化疗组差异无统计学意义,但从生存曲线可以看出,联合放化疗组病理Ⅲ、Ⅳ级患者术后有好于单纯放疗组的趋势.结论：脑胶质瘤的预后与病理分级密切相关.病理Ⅰ、Ⅱ级患者不提倡行术后化疗,病理Ⅲ、Ⅳ级患者一般情况较好者术后可行放化疗.     

高分级脑胶质瘤术后放疗同步替尼泊甙联合司莫司汀化疗疗效分析

目的分析高分级脑胶质瘤患者术后同步放化疗的疗效。方法对该院收治的65例高分级脑胶质瘤术后患者（其中Ⅲ级脑胶质瘤37例,Ⅳ级28例）均给予术后放疗肿瘤剂量（DT）50～60Gy,同时于DT20Gy后行同步替尼泊甙（VM-26）联合司莫司汀（Me-CCNU）化疗,于放疗开始后4～6个月内完成4～6周期的化疗。结果高分级脑胶质瘤患者总的中位生存期为24个月,1、3、5年生存率分别为70.77%、31.22%、12.65%。Ⅳ级胶质瘤生存率明显低于Ⅲ级胶质瘤（P（0.01）,Ⅳ级与Ⅲ级脑胶质瘤的中位生存期分别为14个月及36个月,1、3、5年生存率分别为60.71%、8.04%、0及78.38%、48.03%、21.76%。结论高分级脑胶质瘤患者术后行放疗同步VM-26联合Me-CCNU方案化疗可取得较好的预后,尤其是Ⅲ级脑胶质瘤患者。     

分析影响Ⅲ、Ⅳ级脑胶质瘤术后放化疗的因素及处理方法

目的对Ⅲ、Ⅳ级脑胶质瘤术后放化疗的影响因素及处理方法进行分析和探讨。方法运用随机抽样的方法选择2012年3月-2014年3月在本院进行治疗的Ⅲ、Ⅳ级脑胶质瘤术后放化疗患者98例,收集其临床资料,对其进行回顾性分析,其中40例患者采用单纯放疗治疗,40例患者采用放疗联合替莫唑胺化疗,18例患者采用放疗联合亚硝脲类化疗。患者总生存率和复发率的计算采用kaplan-Meier法,多因素预后分析采用Cox模型来进行探讨。结果本组98例患者中,复发率为70.4%,第一年生存率为44.9%,第二年生存率为8.2%;年龄60岁,术前无癫痫发作,肿瘤全切、术后放疗联合莫唑胺化疗能够有效促进肿瘤复发时间的延缓;年龄60岁,术前无癫痫发作,肿瘤全切、肿瘤病理分级Ⅲ级以及术后放疗联合莫唑胺化疗能够有效促进肿瘤复发时间的延缓。结论年龄、术前有无癫痫发作、肿瘤切除方法以及肿瘤病理分级都是Ⅲ、Ⅳ级脑胶质瘤术后放化疗长期生存的影响因素,可通过对这些因素的正确处理来提高患者预后。     

脑胶质瘤术后调强放疗联合替莫唑胺化疗的疗效分析

目的回顾性分析比较Ⅲ、Ⅳ级脑胶质瘤术后单纯调强放疗和调强放疗联合替莫唑胺治疗的疗效。方法脑恶性胶质瘤术后患者68例分为两组：单纯放疗组（38例）采用调强适形放射治疗（IMRT）,分割剂量为GTV-P每次2.0~2.2 Gy,每周5次,DT60~66 Gy/30 f,CTV-P每次1.8 Gy,每周5次,DT56 Gy/30 f;放化疗联合组（30例）,IMRT同单纯放疗组,同时配合替莫唑胺（TMZ）口服化疗,TMZ 75 mg.m-2.d-1与放疗同步,放疗结束后间隔4周再接受4~6周期TMZ辅助化疗,辅助化疗首次剂量为150 mg.m-2.d-1,连服5 d,28 d为1疗程,根据监测血常规调整其剂量。结果单纯放疗组与放化疗联合组比较,总有效率（CR＋PR）分别为39.5%和73.3%,两组差别有统计学意义（P〈0.01）;单纯放疗组与放化疗联合组比较,1、2、3年生存率分别为57.9%、76.7%、25.3%和49.5%、15.2%、25.9%,两组生存率比较均有统计学意义（P=0.039）。结论调强放疗联合TMZ治疗Ⅲ、Ⅳ级脑恶性胶质瘤术后患者的疗效优于单纯调强放疗。     

脑胶质瘤术后同步放化疗联合与单纯放疗疗效评估

目的研究脑胶质瘤患者术后放化疗联合与单纯放疗疗效。方法回顾性研究2011年‐2016年该院收治的60例不同级别脑胶质瘤患者,随机分成两组,即联合放化疗组和单纯放疗组。采用Kaplan-Meier绘制生存率曲线,用Log-Rank检验对治疗结果进行分析。结果术后同步联合放化疗疗效优于单纯放疗组,差异具有统计学意义(P0.05);肿瘤级别越高,患者预后生存越差,且随着级别的增高,进行联合放化疗的效果优于单纯放疗组。结论胶质瘤患者的预后与病理分级密切相关,肿瘤级别越高,采用联合放化疗的治疗效果明显优于单纯放疗。     

脑胶质瘤术后三维适形放射治疗的疗效分析

目的 探讨脑胶质瘤术后三维适形放射治疗的临床疗效. 方法 69例脑胶质瘤患者(WHOⅠ级2例,Ⅱ级18例,Ⅲ级18例,Ⅳ级31例)术后接受三维适形放射治疗,治疗剂量50～60 Gy/25～30次/5～6周.35例未行化疗;34例同期或放疗后接受化疗(4～6周期),其中18例口服替莫唑胺,16例为其他方案化疗.中位随访期13个月(6～31个月). 结果 69例患者中,WHOⅠ级患者生存率100%,Ⅱ级94.4%,Ⅲ级61.1%,Ⅳ级41.9%.Ⅰ、Ⅱ级和Ⅲ、Ⅳ级肿瘤无进展的中位生存期分别为14.5个月和9.0个月(P＝0.037),中位生存期分别为14.5个月和13.0个月(P＝0.131),1年生存率分别为60.0%和49.0%.手术与放疗间隔时间≤4周的患者和>4周的患者中位生存期分别为11.5个月和15.5个月(P＝0.24),1年生存率分别为47.7%和68.0%.34例化疗和35例非化疗患者中位生存期分别为13个月和13.5个月(P＝0.532),1年生存率分别为52.9%和51.4%.其中34例化疗患者中,口服替莫唑胺患者与其他方案化疗患者比较,中位生存期分别为11.5个月和15.5个月(P＝0.187),1年生存率分别为为44.4%和62.5%. 结论 三维适形放射治疗对脑胶质瘤术后患者有较高的肿瘤局部控制率,患者1年生存率较高.     

脑胶质瘤术后三维适形放射治疗的疗效分析

目的 探讨脑胶质瘤术后三维适形放射治疗的临床疗效. 方法 69例脑胶质瘤患者(WHOⅠ级2例,Ⅱ级18例,Ⅲ级18例,Ⅳ级31例)术后接受三维适形放射治疗,治疗剂量50～60 Gy/25～30次/5～6周.35例未行化疗;34例同期或放疗后接受化疗(4～6周期),其中18例口服替莫唑胺,16例为其他方案化疗.中位随访期13个月(6～31个月). 结果 69例患者中,WHOⅠ级患者生存率100%,Ⅱ级94.4%,Ⅲ级61.1%,Ⅳ级41.9%.Ⅰ、Ⅱ级和Ⅲ、Ⅳ级肿瘤无进展的中位生存期分别为14.5个月和9.0个月(P＝0.037),中位生存期分别为14.5个月和13.0个月(P＝0.131),1年生存率分别为60.0%和49.0%.手术与放疗间隔时间≤4周的患者和>4周的患者中位生存期分别为11.5个月和15.5个月(P＝0.24),1年生存率分别为47.7%和68.0%.34例化疗和35例非化疗患者中位生存期分别为13个月和13.5个月(P＝0.532),1年生存率分别为52.9%和51.4%.其中34例化疗患者中,口服替莫唑胺患者与其他方案化疗患者比较,中位生存期分别为11.5个月和15.5个月(P＝0.187),1年生存率分别为为44.4%和62.5%. 结论 三维适形放射治疗对脑胶质瘤术后患者有较高的肿瘤局部控制率,患者1年生存率较高.     

脑星形细胞瘤的临床病理与预后

８４０例脑星形细胞癌临床病理与预后的分析表明：该肿瘤是脑组织中最常见的肿瘤，高发年龄在２１～５０岁，１０岁以下儿童少见。成人发生部位多在大脑半球，小孩多发生在脑干和小脑。病理分级：星形细胞瘤Ⅰ级８４例；Ⅱ级４２５例；Ⅲ级２６５例；Ⅳ级６６例。星形细胞瘤Ⅰ～Ⅱ级肿瘤界限不清楚，手术难以完全切除，Ⅲ～Ⅳ级肿瘤有一定界限，主瘤易于切除，术后加用放疗、化疗和中草药辅助治疗，其临床观察，星形细胞瘤Ⅰ级预后较好，Ⅱ～Ⅳ级预后较差。本组５年生存１４８例，生存率为１７．６％，１０年以上生存３２例，生存率为３．９％。     

高级别脑胶质瘤术后调强放疗联合替莫唑胺化疗31例效果观察

目的：探讨调强放射治疗（IMRT）联合替莫唑胺（TMZ）治疗高级别脑胶质瘤术后疗效和不良反应。方法：高级别脑胶质瘤术后59例,根据治疗方案不同分两组：A组31例（Ⅲ级18例,Ⅳ级13例）,调强放疗联合替莫唑胺化疗;B组28例（Ⅲ级16例,Ⅳ级12例）,单纯行调强放疗,分析比较两组的近期疗效、生存率和不良反应。结果：（1）A组PR8例,CR17例,有效率为80.6%。B组PR3例,CR10例,有效率为46.4%,两组比较差异有统计学意义（P＜0.05）。（2）两组1、2、3年生存率比较：近期疗效同步放化疗组分别为71.0%、32.3%、16.1%,中位生存时间为18个月。单纯放疗组分别为46.4%、17.8%、7.1%,中位生存时间为11个月。（3）手术切除1、2、3年生存率比较：全切分别为76.0%、44.0%、20.0%,中位生存时间29个月。部分切除分别为47.1%、11.8%、5.9%,中位生存时间为11个月,两者比较差异有统计学意义（χ2=11.359,P=0.001）。（4）死亡原因：高级别脑胶质瘤59例中,死亡42例,其中38例（90.5%）死于肿瘤复发或未控,心、脑血管意外死亡2例（4.8%）,多脏器功能衰竭1例（2.4%）,肺部疾病1例（2.4%）。结论：高级别脑胶质瘤术后同步TMZ放化疗优于单纯放疗,可提高治疗的有效率和生存率,不良反应较轻。     

复发星形细胞瘤诊治

目的：研究复发星形细胞瘤的手术指征及术后综合治疗，延缓瘤体的再次复发，延长患者的生命。方法：对我科1990年～2002年113例复发星形细胞瘤患者采用再次手术、放疗及化疗等综合治疗方法。结果：100例Ⅰ-Ⅱ级星形细胞瘤手术后放疗、化疗70例，平均存活3年；单纯放疗30例，平均存活2年；Ⅲ～Ⅳ级13例手术加放疗、化疗5例．平均存活5个月。非手术治疗单纯放疗化疗．平均存活5个月。结论：对Ⅰ～Ⅱ级低度恶性的星形细胞瘤如条件允许应再次手术，术后配合放疗和化疗。     

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.