108例扁桃体鳞癌治疗效果的回顾性分析

背景与目的:扁桃体鳞癌的治疗,是选择根治性放疗加外科挽救手术,还是计划性术前放疗加手术,目前尚无一致观点。在Ⅲ～Ⅳ期扁桃体鳞癌患者中,仅以肿瘤大小和淋巴结转移来判断预后显然不足。为此,本研究旨在总结我院扁桃体鳞癌的治疗效果,并探讨上述两种治疗方法的适应证及影响预后的因素。方法:回顾性总结1984年～2000年我院收治的108例扁桃体鳞癌患者的临床资料,其中根治性放疗加外科挽救手术83例(A组),计划性术前放疗加手术25例(B组)。总结两组的治疗效果及口腔功能损害情况,分析肿瘤的放疗反应与生存率的关系。结果:联合根治术导致不同程度的口腔功能损害,其发生率在A组为24.1%(20/83),在B组达88.0%(22/25)。A组患者的5年生存率为59.3%,B组为55.4%(P=0.706)。放疗后转移淋巴结消失及手术标本有重度放疗反应者,A、B两组的5年生存率分别为73.0%和76.9%(P>0.05)。结论:根治性放疗加挽救性手术使部分扁桃体鳞癌患者避免了联合根治术,在一定程度上保留了口腔功能。放疗后淋巴结的消失情况及组织放疗反应程度可以作为晚期扁桃体鳞癌的预后参考指标。     

Rivastigmine blocks voltage-activated K+ currents in dissociated rat hippocampal neurons

Rivastigmine is an acetylcholinesterase inhibitor used in Alzheimer's disease therapy. In the present study, we investigated the effects of rivastigmine on the transient outward K+ current (IK(A)) and the delayed rectifier K+ current (IK(DR)) in acutely dissociated rat hippocampal pyramidal neurons using the whole-cell patch-clamp technique. Rivastigmine inhibited the amplitudes of IK(A) and IK(DR) in a reversible and concentration-dependent manner. At a concentration of 100 mum, rivastigmine inhibited IK(A) and IK(DR), recorded when the cells were depolarized from -50 to +40 mV, by 65.9 (P<0.01) and 67.3% (P<0.01), respectively. The IC50 values for IK(A) and IK(DR) were 3.8 and 1.7 microM, respectively. The decay time constant of IK(A), recorded following a test pulse to +40 mV, was prolonged reversibly by rivastigmine at concentrations of 10 and 100 microM (both P<0.05). Rivastigmine affected the voltage dependence of IK(A) and IK(DR). At a concentration of 10 mum, it shifted the steady-state inactivation curve of IK(A) towards more negative potentials by -11 mV (P<0.05), but had no effect on the steady-state activation curve or the recovery from inactivation. Regarding the kinetic properties of IK(DR), 10 microM rivastigmine shifted the steady-state activation and inactivation curves towards more negative potentials by -10 (P<0.05) and -27 mV (P<0.01), respectively. Our findings that rivastigmine inhibits IK(A) and IK(DR) in rat hippocampal pyramidal neurons suggest that this agent has other pharmacological actions besides its antiacetylcholinesterase activity.     

《妇科常见恶性肿瘤诊断与治疗规范(草案)》的推广及执行情况分析

目的：调查对《妇科常见恶性肿瘤诊断与治疗规范（草案）》（简称《规范》）的推广及执行情况。方法：采用流行病学现况调查方法,以问卷调查形式,对参加1999年度中华医学会妇产科主任高级研修班的350名中高级妇产科医师进行调查。结果：共获取了281份可分析的有效问卷,其中90.0%的医师阅读过《规范》,96.4%的医师认为制定《规范》有必要;在阅读过《规范》的医师中,87.7%的医师按照《规范》诊断和处理妇科恶性肿瘤,96.8%的医师认为《规范》合理可行。一些医师对《规范》提出了意见和建议,主要包括建议发行《规范》单行本;增加内容;化学治疗方案应更详细;有关病理诊断应建立全国联网会诊系统;定期修订《规范》;举办《规范》的培训班等。结论：《规范》已经在全国妇产科医师中产生了一定影响,对妇科恶性肿瘤的诊治有一定指导作用,并需不断补充、修订。     

Awareness,treatment and control of hypertension in patients attending hospital clinics in China

OBJECTIVES: To determine awareness, treatment and control of hypertension in patients attending hospital clinics in China. DESIGN: A cross-sectional survey. PATIENTS AND SETTING: Patients over the age of 35 years, who were attending outpatient clinics in 18 hospitals of eight major cities of Northern and Southern China, were interviewed face-to-face between June and July 1999. METHODS: Trained fieldworkers completed questionnaires regarding demographics, hypertension knowledge and awareness, treatment history and quality of life issues. Qualified physicians performed blood pressure assessment. RESULTS: A total of 9703 volunteers enrolled, of which 4510 (46.5%) were hypertensives. Among hypertensives, 23% were unaware of their high blood pressure. Although 89% of those aware reported receiving therapy, only 56% of them were taking medication regularly, and 33% were thus controlled. Although 69% of all hypertensives measuring at examination reported taking antihypertensive therapy, only 44% of them were actually taking medication regularly. Furthermore, 73% of hypertensives believed hypertension was not a serious problem, and required no regular medication. CONCLUSIONS: The results showed that a substantial number of outpatients have a hypertensive range of blood pressure. Although most of these patients are already being treated with drug regimen, the patient's misconceptions and lack of knowledge about the disease appear to be the major cause of treatment failure. The low rate of high blood pressure control for both sexes calls for further improvements.     

中国急性心肌缺血综合征患者临床特征

目的 分析中国地区急性心肌缺血综合征病人的临床特点和治疗现状。方法 此项研究为国际性多中心关于急性心肌缺血综合征登记试验(OASIS)的一部分。采用加拿大心血管合作协会统一设计的病例记录表(CRF),自1999年4月开始,收集因急性心肌缺血入院病人的资料,记录病人主要临床特征和院内事件。结果 来自中国38家医院急性心肌缺血综合征(包括不稳定心绞痛及非Q波心肌梗死)病人2290例,平均年龄62．8岁,男性占62．3％。就诊时胸痛仍未缓解者48．9％;心电图异常89．7％,其中41．4％为相邻导联ST压低≥2mm;入院诊断不稳定心绞痛90．9％,非Q波心肌梗死9．0％。住院期间溶栓3．3％,冠状动脉(冠脉)造影34．9％,经皮冠脉腔内成形术(PTCA)17．6％,冠脉旁路移植术(CABG)4．2％,应用硝酸酯剂99．3％,抗血小板治疗94．5％。院内发生重要并发症15．2％,其中死亡1．4％。结论 中国地区急性心肌缺血病人以不稳定心绞痛就诊居多。住院期间PTCA治疗率相对较高,CABG治疗率较低。死亡主要原因为严重心律失常或猝死。     

我国人群中缺血性和出血性脑卒中发病的相对比例

目的　探讨我国人群中出血性和缺血性脑卒中发病的相对比例。方法　 1 991～ 2 0 0 0年按照世界卫生组织MONICA方案对我国 1 5组人群脑卒中事件进行监测。结果　 1 996～ 2 0 0 0年 1 5组人群的CT检查率从 1 4 .8%～ 97.5 %不等 ,缺血性和出血性脑卒中的比例从 0 .37∶1～ 3 .82∶1不等 ,两者的相关系数为 0 .71 (P =0 .0 0 3)。在CT检查率达到 80 %以上的人群 ,缺血性与出血性脑卒中的比例无一例外 ,均 >1 .0。从 1 991～ 2 0 0 0年 ,1 0年间均有资料的 1 2组人群CT检查率从 41 .1 %增加到88 3 % ,缺血性与出血性脑卒中的比例则从 1 .2 5∶1增加到 1 .85∶1 ,两者的相关系数为 0 .77(P =0 0 1 )。经CT检查的病例中 ,无论任何一年缺血性与出血性脑卒中的比例均大于 1 .0。结论　我国人群中脑卒中发病是以缺血性脑卒中为主。CT检查率偏低是造成部分人群“出血性脑卒中发病为主”假象的主要因素。     

Effects of Salvia miltiorrhiza extracts on rat hypoxic pulmonary

Objective To investigate the effects of Salvia miltiorrhiza (SM) extracts on the expression of heme oxygenase-1 (HO-1) and nitric oxide synthase (NOS) in small pulmonary arteries (SPAs) of rats with chronic hypoxia.
Methods After two weeks of hypoxia, rats were treated with diltiazem, then small, medium, and large doses of SM extracts. The lungs were tested for the expression and distribution of HO-1, endothelial NOS (eNOS) and inducible NOS (iNOS) by using immunohistochemistry and Western blot method.
Results Median and large doses of SM extracts significantly reduced hypoxia-induced media thickening in the SPA (similar with diltiazem), recovered repaired ultrastructure injury, decreased HO-1 and iNOS levels, and increased eNOS expression in the SPA.
Conclusions Median and large doses of SM extracts play significant roles in inhibiting structural remodeling in rats with hypoxic pulmonary hypertension. These effects might attribute to the suppression of HO-1 and iNOS, and the promotion of eNOS expression under the conditions of hypoxia.     

Graft patency in off-pump and conventional coronary artery bypass grafting for treatment of triple vessel coronary disease

Inanattempttoavoidthedeleteriouseffectsofcardiopulmonarybypass (CPB) ,off pumpcoronarybypasssurgeryhasrecentlybeenrediscoveredandrefined Overthepastdecade ,theuseofoff pumporbeating heartcoronaryarterybypass (OPCAB)surgeryhassincebecomemorepopularandwidelyused Intriplevesseldisease ,accesstothelateralandposteriorwallvesselstofacilitatecompleterevascularizationevolved ,accompaniedbytechnicaladvancesintheinstrumentationforstabilizationoftheheart Multiplepreviousauthorshavereportedaseriesofoff…     

体外扩增对脐血CD34+细胞粘附特性和趋化功能的影响

目的 探讨在体外扩增过程中,脐血(UCB)干／祖细胞(HSPC)的粘附特性和趋化功能的变化。方法 从新鲜UCB标本中纯化的CD34^ 细胞接种于无血清无基质悬浮扩增体系,分别于培养7、10和14d从扩增细胞中再次纯化CD34^ 细胞,比较扩增前后CD34^ 细胞的几种与归巢密切相关的功能特性,包括归巢相关粘附分子(CAM)的表达,粘附功能和趋化功能。结果 (1)表达各种粘附分子的CD34^ 细胞亚群的数量在扩增过程中明显增加(15～72倍),而且扩增后CD34^ 细胞表面粘附分子CD44、CDlla、CD49e和CD49d的表达与原代CD34^ 细胞持平或升高,CD62L、CD54和CD31的表达则有不同程度的下调;(2)在前10d的扩增中,CD34^ 细胞与FN间的自发粘附率和SDF-1诱导粘附率均呈上升趋势,0、7和10d分别为28％和63％、60%,和70％、63％,和90%,;(3)扩增1周后,CD34^ 细胞的体外迁移能力无明显变化。结论 所建立的短期培养体系可以支持扩增1周的UCB HSPC保持原有粘附和趋化功能,而继续扩增则可能在某种程度上不利于细胞这些能力的保持。     

全民食用加碘盐对甲状腺机能亢进病人药物疗效的影响

目的　了解我国全民食盐加碘 (USI)对甲状腺机能亢进 (甲亢 )病人药物疗效的影响。方法　选择未经治疗甲亢病人 10 1例。分成无碘盐组 4 5例和碘盐组 5 6例 ,开始给予相同剂量丙嘧治疗 ,观察治疗后 1、2、3、6个月用药剂量及检测血清总游离甲状腺素 (TT4)、总三碘甲状腺原氨酸(TT3 )、游离甲状腺素 (FT4)、三碘甲状腺原氨酸 (FT3 )和总三碘甲状腺原氨酸 (TSH)的水平。结果　两组治疗前尿碘含量和甲状腺激素水平的差异都无显著意义 ,无碘盐组治疗后尿碘含量 (14 8μg/L)明显低于治疗前 (2 13μg/L ,P =0 0 0 )。治疗后 ,除 1个月时TT4和TT3 无碘盐组 (15 3nmol/L± 5 0nmol/L ,3 6nmol/L± 1 2nmol/L)明显低于碘盐组 (177nmol/L± 6 4nmol/L ,2 7nmol/L± 1 5nmol/L) ,(P =0 0 4 1,0 0 33) ,其余各个时间的TT4、TT3 、FT4和FT3 在两组之间差异无显著意义 (P>0 0 5 )。治疗 1个月时两组丙嘧剂量差异无显著意义 (P >0 0 5 ) ,治疗 2、3和 6个月时碘盐组的丙嘧剂量 (2 14、189、178mg/d)明显大于无碘盐组 (190、14 7、116mg/d) ,(P =0 0 0 0 )。结论　抗甲状腺药物治疗中服用USI ,可以有效控制甲状腺功能 ,但抗甲状腺药物的治疗剂量明显增加。