FOLFOX-6与肝动脉灌注化疗对结直肠癌肝转移治疗效果的比较

Objective To compare the efficacy and side effects between systemic chemotherapy and hepatic arterial infusion by combination of oxaliplatin and 5-fluorouracil (FOLFOX-6) with 5-fluorouracil in the patients who have developed hepatic metastasis after colorectal cancer operation. The factors that would affect the prognosis without operational treatment were also analyzed. Methods 46patients who had signed the informed consents were allocated into two groups: the group with general chemotherapy (Trial Group includes 26 cases) and the one with hepatic arterial infusion chemotherapy (Control Group includes 20 cases). The total effective rate, the prognosis, the cytoxicitic side effects,quality of life, the total survival rate and the responses were the main parameters determined. Kaplan-Meier was used to analyze Mono-factor to the prognostic responses and the Cox mode was used to analyze poly-factor to the prognostic responses. Results The overall survival rate was significantly higher by using systemic treatment versus HAI(median, 15. 0 v 11.2 months;P＜0.05). The difference in overall responsive rate (CR+PR) between the two groups was statistically significant (50% v 10%;P=0. 011). No significant difference was found in PS scale during the treatment. (P=0. 126). Except for myelosuppression and abdominal pain, no significant difference was found in the other side effects. Univariate analysis revealed that the invasive lesions to serosa, the distribution of liver metastases, the size and number of liver metastases, primary carcinoma involving lymph nodes and the treatment were correlated with prognoses. Cox regression analysis showed that the larger diameter of liver metastases, the number of liver lesions, primary carcinomas involved in serosal layer and the treatment modules were independent prognostic factors. Conclusions The oxaliplatin-based FOLFOX-6 chemotherapy regiment has a better responsive rate and survival rate than the traditional infusion with 5-fluorouracil to the main hepatic artery for interventional therapy. The diameter of the hepatic metastasis larger than 5em, multiple hepatic metastasis and the primary lesions penetrating serosal layer suggest the poor prognosis. The oxaliplatin-based systematic chemotherapy has a better prognosis. Therefore,it is worth carrying on further study on modification of traditional hepatic arterial infusion and on evaluation of therapy by combination of the hepatic arterial infusion with the systematic chemotherapy.     

局部固定式斜面导板在颜面不对称畸形矫治中的应用

目的：研究应用局部固定式斜面导板矫治颜面不对称畸形的临床效果。方法：在方丝弓矫治的同时,应用局部固定式斜面导板对11例以牙颌畸形为主要病因引起的颜面不对称患者进行治疗。局部固定式斜面导板主要由0．30双股正畸结扎丝和腭侧斜面导板组成,以下颌位置关系尽可能恢复到正位为准。结果：经过1．0～3．2月的治疗,11例患者的下颌位置关系均基本达到正位,正面容貌改善。结论：应用局部固定式斜面导板能快速有效地治疗以牙颌畸形为主要病因引起的颜面不对称患者。     

多奈哌齐治疗脑外伤后痴呆疗效观察

外伤性痴呆是指脑外伤引起的智能障碍综合征,包括生理、认知、行为、情感方面的障碍,其持续时间长,一般持续数周乃至数月以上.对于初中以上文化脑外伤患者,简易智能量表(mini-mental state examination,MMSE)评分≤23分者,即认为存在程度不等的腩外伤后痴呆.     

胃镜下扩张联合射频治疗食管癌性狭窄35例疗效观察

目的:观察胃镜下扩张联合射频治疗食管癌性狭窄近期疗效.方法:选取食管癌晚期患者行内镜下扩张联合射频治疗,以疏通食管,改善进食状态,观察疗效.结果:行内镜下扩张联合射频治疗后,患者食管梗阻症状可得到缓解.结论:内镜下扩张联合射频治疗食管癌性狭窄可改善食管癌晚期患者生活质量,延长生存时间.     

超声联合微泡对内皮祖细胞体外增殖、凋亡及细胞周期的影响

目的:体外探讨超声联合微泡对内皮祖细胞增殖、凋亡及细胞周期的影响,为进一步体内研究提供科学依据.方法:体外提取、分离和培养猪骨髓内皮祖细胞,随机分为对照组、超声组、超声微泡组,干预后24 h分别采用CCK-8检测细胞增殖活性,PI染色流式细胞仪分析细胞凋亡坏死及细胞周期.结果:(1)低声强超声(0.25～1.0 W·cm-2)联合微泡作用下对内皮祖细胞增殖活性无明显影响;较高声强(﹥1.0 W·cm-2)作用下,随声强逐渐增大,细胞增殖活性逐渐降低.(2)与对照组比较,超声微泡组(频率1 MHz,输出功率1.0 W·cm-2,辐照90 s)对内皮祖细胞凋亡坏死及细胞周期无明显影响,而同样条件下超声组细胞凋亡坏死明显增加,同时显著抑制细胞DNA合成.结论:1.0 W·cm-2超声联合微泡干预内皮祖细胞对细胞增殖活性、凋亡坏死及细胞周期无明显不良影响,为进一步应用超声微泡体内干预内皮祖细胞移植的研究提供可能.     

早发急性心肌梗死患者的临床和冠状动脉病变特点

目的 总结早发急性心肌梗死患者的临床和冠状动脉病变特点.方法 274例急性心肌梗死患者按年龄分为早发组72例和晚发组202例,对两组患者的心血管危险因素及冠状动脉病变特点进行比较.结果 早发组男性比例,有血脂代谢紊乱史、吸烟及冠心病家族史的比例均明显高于晚发组(P<0.05或P<0.01).与晚发组相比,早发组血清甘油三酯、总胆固醇、低密度脂蛋白胆固醇及载脂蛋白B均明显升高(P<0.05或P<0.01).冠状动脉造影显示,两组患者单支、多支血管病变比例,梗死相关动脉分布差异均无统计学意义(P>0.05).结论 对于早发急性心肌梗死高危人群应加强心血管危险因素的综合防治.     

伴行导丝技术在冠状动脉分支开口病变中的应用

目的 评价支架植入治疗冠状动脉分支开口病变过程中利用导丝伴行技术的临床疗效.方法 36例符合条件的患者,13例使用伴行导丝技术,23例予传统方法 治疗,随访12个月,比较两组手术成功率和心源性死亡事件和再次血运重建率(TLR)等情况.结果 36例均手术成功,术中主支血管追加植入支架的情况两组之间差异无统计学意义(P=0.26),在12个月的观察终点,两组皆未出现心肌梗死和心源性死亡事件,但导丝伴行技术组的TLR明显低于传统技术组(7.7% vs 43.5%,P=0.03).结论 支架植入时使用导丝伴行技术安全、可靠,且可以显著降低12个月TLR的发生率.     

临床医学导师制在卓越医生培养过程中的作用

目的:探索临床医学导师制在卓越医生培养过程中的作用。方法:在山西医科大学临床医学本科生中设立“卓越医师培养试验班”实施导师制,并逐步推广至所有临床医学本科生中,观察学习情况及成果。结果:实行导师制的学生参加多项国际项目交流,获得多项省级以上、校级项目立项,多次在大学生创新创业大赛获奖,在大学生临床技能大赛中取得了好成绩。结论:与往届未实行导师制的临床本科生相比,实行导师制后学生们的学习积极性大大提高,在教育改革、临床技能操作、治疗方法思考等方面有显著提升。导师制对于卓越医生的培养有积极意义。     

电视胸腔镜纵隔肿瘤切除术19例疗效观察

目的探讨电视胸腔镜下纵隔肿瘤切除手术的临床疗效。方法回顾性分析007年2月至2012年5月我们采用电视胸腔镜手术治疗19例纵隔肿瘤患者临床疗效。结果本组16例完成胸腔镜下纵隔肿瘤切除,3例需中转4～6cm辅助小切口完成手术;所有病例均治愈出院,无明显严重并发症发生;术后平均随访12个月,均无复发;术后病理检查确诊为:胸腺瘤7例,神经源性肿瘤5例,畸胎瘤3例,心包囊肿2例,支气管囊肿和胸腺囊肿各1例。结论电视胸腔镜手术治疗纵隔肿瘤安全、有效,具有微创、并发症少、住院时间短等优点。