乳腺癌前哨淋巴结探测的临床应用研究

乳腺癌的手术治疗已有100多年的历史,起初人们认为乳腺癌是局部疾病,因而手术占据着治疗的主导地位,且手术范围越做越大.近年来,随着对乳腺癌生物学行为的深入了解,乳腺癌综合治疗水平不断提高,同时由于现代医学模式的转变,对乳腺癌本身的认识和治疗上的观念也有了很大变化.目前普遍认为清除阴性淋巴结对预后毫无益处[1].按传统观念施行根治术清扫腋窝淋巴结(axillary lymph node dissection,ALND)会带来一些严重的并发症:同侧上肢疼痛、上举困难、淋巴水肿、肢体麻木等,Aitken等[2]报告为10%～60%,徐宏等[3]报告上肢肿胀发生率为7.9%,而前哨淋巴结活检可以减少或避免这些并发症[4].因此,乳腺癌病人手术方式选择的原则是在治疗效果相同的前提下,采用最简单、损伤少、副作用小、并发症少的方式.乳腺癌前哨淋巴结活检(sentinellymph node biopsy,SLNB)技术是乳腺外科领域的一个极具意义的进展,也是当前乳腺外科研究领域的一个热点[5,6].     

中药提取物促进睡眠作用研究进展

失眠是指无法入睡或无法保持睡眠状态,导致睡眠不足。迄今大量研究显示,许多中药提取物具有促进睡眠作用,能显著改善睡眠质量,且与西药可产生协同作用。笔者现将近5年的相关文献综述如下。     

羌活化学成分研究Ⅲ羌活石油醚提取部分化学成分的分离鉴定

经硅胶柱层析,制备薄板层析分离,化学分析和光谱鉴定,从羌活的石油醚提取部分分离并鉴定了β-谷甾醇、油酸、亚油酸、哥伦比亚甙元、娠烯醇酮和阿魏酸6种化学成分。娠烯醇酮为首次从本属植物中分离鉴定。     

白血病患者造血干细胞移植前单次全身照射的预后分析

Objective To analyze the prognostic factors of patients with leukemia treated with single fraction total body irradiation (SFTBI) followed by hernatopoietic stem cell transplantation (HSCT).Methods From January 2001 to September 2008, 102 patients received HSCT. The differences of the survival rate, relapse rate and incidence of interstitial pneumonia (IP) between groups regarding different genders, ages, pathological types, transplantation methods and TBI parameters were compared and the factors related with the survival rate, relapse rate and incidence of IP were analyzed. Results The followup time ranged from 15 to 1482 days (median, 406 days). The follow-up rate was 95.1%. 86 and 55patients were followed up more than one year and three years. The 1-and 3-year survival rates were 59.0%and 44.0%. In univariate analysis, the 3-year survival rate was signifcantly different between the groups with and without relapse before transplantation (20% vs. 55%, χ2 = 6.33, P = 0. 012), allogeneictranplantation versus autologous tranplantation (39% vs. 68%, χ2 = 8.06, P = 0.005), grade 3 or more acute graft versus host disease (aGVHD) and grade 0 -2 aGVHD (0% vs. 54%, χ2 = 7.52, P = 0.006),with and without relapse after transplantation (19% vs. 58%, χ2 = 10.13, P =0.001), with and without IP (23% vs. 58%, χ2 =8.35, P=0.004). Multivariate analysis showed that grade 3 or more aGVHD was the only statistically significant prognostic factors (χ2 = 12. 74 ,P =0. 000). The l-and 3-year relapse rateswere 30. 0% and 50. 0%. The incidence of relapse was obviously higher in the group with relapse before transplantation than that without (47% vs. 16%, χ2 =7. 32, P=0. 007). Multivariate analysis showed thatrelapse before transplantation was a significant factor predicting relapse after transplantation (χ2 = 9. 39,P =0. 020). The cumulative incidence of IP was 35.0%. The incidence of IP was different between groups with dose homogeneity > 3% and ≤ 3% (27% vs. 4%, χ2 = 5. 21, P = 0. 023), with and without acute parotitis (34% vs. 3%, χ2 = 14. 15, P= 0.000), allogeneic transplantation group and autologous transplantation group (31% vs. 8%, χ2= 7.70, P= 0.006). Multivariate analysis showed that transplantation methods, acute parotitis and dose homogeneity were statistically significant factors in predictingIP (χ2 = 10. 08 , 10. 08 and 7.69 , P = 0. 002 , 0. 002 and 0. 010 , respectively) . Conclusions Patients who develop grade 3 or higher aGVHD have poor prognosis. Dose homogeneity influences the incidence of IP. Patients undergoing allogeneic transplantation are apt to have IP. Acute parotitis is related with IP and might be a predictor.     

两种质子泵抑制剂治疗幽门螺杆菌感染活动性胃溃疡的药物经济学评价

目的：应用药物经济学原理分析泮托拉唑与兰索拉唑治疗幽门螺杆菌（ Hp ）感染活动性胃溃疡成本-效果,寻找最佳治疗方案。方法：选择符合标准的患者100例,随机分为A组和B组各50例,A组应用泮托拉唑,B组应用兰索拉唑,其余治疗方案二者相同,疗程结束进行疗效评价。结果：A组患者临床治愈率80．00％,B组溃疡愈合率80．00％,差异无统计学意义（ P＞0．05）。 A组患者成本-效果比（C/E）为4．81,明显低于B组的5．81,增量成本-效果比（ΔC/ΔE）为68．33;敏感度分析A组患者C//E为4．33,明显低于B组的5．25,ΔC//ΔE为66．85。结论：泮托拉唑治疗幽门螺杆菌感染活动性胃溃疡较兰索拉唑具有更高的药物经济学价值。     

血清tPSA、fPSA、fPSA／tPSA在前列腺癌诊断中的临床价值

目的：探讨血清tPSA、fPSA、fPSA／tPSA在前列腺癌诊断中的临床价值。方法：用化学发光法检测前列腺癌（PCA）与良性前列腺增生（BPH）患者血清tPSA、fPSA、fPSA／tPSA的比值。结果：PCA组和BPH组血清tPSA、fPSA、fPSA／tPSA比值比较,差异有统计学意义（P〈0．05）。结论：当浓度在4～10ng/mL范围内因PCA与BPH有交叉．fPSA与tPSA联合检测得到fPSA／tPSA比值有利于鉴别此组病人,更适合用于临床PCA的诊断。     

超雌综合征的病例报道及文献综述

超雌综合征是一组性染色体非整倍体疾病(sex chromosome aneuploidy,SCA),其特征为比正常女性核型额外多了1条或1条以上X染色体,可由于不同时期细胞分裂的不分离事件而形成47,XXX、48,XXXX、45,X/47,XXX等多种核型,同时其表型存在较大差异,表现为不同程度的发育、心理障碍和临床疾...     

孕马尿中雌激素成分的研究

目的:了解孕马尿液中主要雌激素成分雌酮硫酸钠,马烯雌酮硫酸钠及17α-二氢马烯雌酮硫酸钠浓度在孕马孕期不同阶段浓度变化趋势,为孕马尿收集时间的选择提供科学依据.方法: 相同孕期、相同品种的9匹怀孕母马自怀孕20周～44周,隔2周连续采集尿样,采用高效液相色谱 (HPLC)法测定尿液中结合雌激素成分的含量,比较各成分浓度变化情况,并做出含量变化趋势图.结果: 雌酮硫酸钠在孕马怀孕22周尿液中浓度达到最高水平,自怀孕22周～44周呈现逐渐下降的趋势,马烯雌酮硫酸钠和17α-二氢马烯雌酮硫酸钠在采集开始阶段浓度较低,随着怀孕时间延长浓度逐渐上升,到怀孕32周达到最高值后逐渐下降.结论: 母马在孕期中形成的结合雌激素含量存在较大的个体差异,雌酮硫酸钠在母马怀孕22周尿液中浓度达到最高峰,马烯雌酮硫酸钠和17α-二氢马烯雌酮硫酸钠浓度在母马怀孕32周尿液中浓度达到最高值.     

ENBD与EPBD单用或联用的临床效果分析

目的:对比经内镜鼻胆管引流术(ENBD)、内镜下乳头括约肌球囊扩张术(EPBD)、ENBD与EPBD联用在内镜逆行胰胆管造影术(ERCP)治疗中的疗效差异。方法:回顾性分析徐州医科大学附属医院在2019年1月—2021年12月行治疗性ERCP成功的住院患者670例,根据手术处理方案将研究对象分成ENBD组、EPBD组及联合组(ENBD+EPBD组)。比较3组手术时间、住院时间、术后3 h及24 h血清淀粉酶情况,统计术后并发症发生情况及发生率、术后症状缓解时间。结果:ENBD+EPBD组手术时间及住院时间与ENBD组、EPBD组进行比较,差异有统计学意义(均P<0.05);EPBD组手术时间及住院时间与ENBD组进行比较,差异有统计学意义(均P<0.05)。在术后3 h及24 h血淀粉酶水平方面,3组对比差异有统计学意义(P<0.05);在术后症状缓解时间上,ENBD+EPBD组术后症状缓解时间短于其余2组,差异有统计学意义(均P<0.05);EPBD组与ENBD组进行比较,EPBD组术后症状缓解时间短于ENBD组,差异有统计学意义(P<0.05)。结论:...