中西医结合治疗母婴血型不合50例疗效观察

目的:观察中西医结合治疗母婴ABO血型不合的临床疗效。方法:将80例患者随机分为2组。对照组30例以维生素C、维生素E治疗;治疗组50例在对照组治疗基础上配合中药煎剂茵芪合剂(药用茵陈、黄芪、栀子、黄芩、白术、续断等)治疗。结果:治疗组治愈37例,好转12例,无效1例,新生儿黄疸未发生,治愈率74.00％,总有效率98.00％。对照组治愈7例,好转13例,无效10例,新生儿黄疸发生4例,治愈率23.33％,总有效率66.67％。治疗组治愈率、总有效率明显高于对照组,差异有非常显著性意义(P<0.01)。2组治疗后IgG抗A(抗B)抗体效价比值均明显下降。与治疗前比较,差异均有显著性意义(P<0.05)。结论:中西医结合治疗母婴ABO血型不合疗效显著,可有效防治新生儿ABO溶血病的发生。     

突破传统适应需要创建中西医结合人才培养模式

湖南中医学院1993年率先开办中西医结合临床医学本科专业;创建"两个基础,一个临床"的人才培养模式和一套适应新的培养模式的课程体系;首编中西医结合临床主体课程系列教材;在教学实践中创建适应新培养模式的实践教学体系和创新思维培养方法;为保证人才培养质量,造就了一批高素质的中西医结合专业教师队伍."两个基础,一个临床"培养模式的实践产生了显著的办学效益和社会影响.     

晚期消化系肿瘤三维适形放疗近期疗效观察

目的 观察三维适形放射治疗对晚期消化系肿瘤的近期疗效。方法50例晚期消化系肿瘤行三维适形放射治疗，47例全程适形照射DT35-58Gy／5～11次；3例先常规外照射30．40Gy后行三维适形照射，IYl25～37Gy／5—7次。结果50例晚期消化系肿瘤总有效率为86％(43／50)。结论 中晚期消化系肿瘤三维适形放疗有助于提高临床疗效，改善患者生存质量。     

大肠癌细胞侵袭转移的PKC调节机制研究

目的　探讨蛋白激酶C(PKC)对大肠癌细胞侵袭转移的调节机制。方法　采用羊膜侵袭培养系统和明胶酶谱分析的方法 ,研究PKC激活剂佛波酯PMA ,对人大肠癌细胞株HT 2 9体外侵袭作用的影响及PKC抑制剂staurosporine(SP)对PMA的拮抗作用 ,研究这种体外的侵袭作用与细胞分泌 72kD的基质金属蛋白酶MMP 2和 92kD的基质金属蛋白酶MMP 9的关系。结果　PMA可显著增强HT 2 9细胞的侵袭性 ,与对照组相比 ,有显著性差异 (P <0 .0 1) ,而SP则可拮抗PMA的这种诱导作用。PMA还可增加HT 2 9细胞分泌MMP 2和MMP 9,而SP则可拮抗PMA的这种诱导作用 ,抑制MMP 2和MMP 9的分泌。结论　PKC可调节大肠癌细胞侵袭转移 ,PKC的激活可诱导大肠癌细胞侵袭性增强和增加MMP 2和MMP 9的分泌 ,PKC的抑制可促进大肠癌细胞侵袭性降低和减少MMP 2和MMP 9的分泌。MMP 2和MMP 9的分泌与肿瘤细胞侵袭性有密切关系 ,PKC可能通过调节MMP 2、MMP 9的分泌来影响肿瘤细胞侵袭和转移特性的     

多种肿瘤标志物蛋白芯片检测系统对恶性肿瘤的临床应用价值

 目的　研究多种肿瘤标志物蛋白芯片检测系统对恶性肿瘤诊断的临床意义。方法　用该检测系统测定分析 4 6 9例恶性肿瘤患者 ,130例良性疾病患者和 14 4 8例健康查体者血清中 12种常见肿瘤标志物 (CA199,NSE ,CEA ,CA2 4 2 ,CA12 5 ,CA15 3,AFP ,Ferrtin ,free PSA ,PSA ,β HCG及HGH)的水平。结果　恶性肿瘤组的阳性率为 81.4 5 % ,显著高于良性疾病组 (5 0 .0 0 % )和健康查体组 (2 9.77% ) (P <0 .0 5 )。除胰腺癌之外 ,联合检测对其余 14种恶性肿瘤的敏感性均显著高于单一标志物检测 (P <0 .0 5 )。结论　运用蛋白芯片技术联合检测多种肿瘤标志物可以明显提高恶性肿瘤诊断的敏感性 ,同时也可以作为无症状人群的早期肿瘤普查手段之一 ,尤其对肿瘤高危人群的防癌普查具有一定意义。     

多种肿瘤标志物蛋白芯片检测系统对肺癌的诊断价值

目的　研究多种肿瘤标志物蛋白芯片检测系统对肺癌的诊断价值。方法　用该检测系统测定10 8例肺癌患者、48例肺良性病变患者和 14 5例正常人血清中 12种肿瘤标志物 (CA199,NSE ,CEA ,CA2 42 ,CA12 5 ,CA15 3 ,AFP ,ferritin ,free PSA ,PSA ,β HCG及HGH)的水平。 结果　肺癌组的芯片阳性率为 83 .3 3 %( 90 / 10 8) ,显著高于肺良性病变组 ( 5 2 .0 8% ,2 5 / 48)和健康组 ( 2 8.97% ,42 / 14 5 ) (P <0 .0 0 1) ;肺癌不同分期组间阳性率存在显著性差异 ,以Ⅳ期肺癌组阳性率最高 (P =0 .0 48) ,但不同病理类型肺癌组间无显著性差异(P =0 .5 19) ;不同分期之间CA199、CEA以及CA2 42血清水平存在显著性差异 (P =0 .0 41,P =0 .0 18和P =0 .0 0 2 ) ;CEA阳性率以腺癌组最高 ,与其它组织学类型肺癌比较无显著性差异 (P =0 .0 7) ;NSE阳性率以小细胞肺癌组最高 (P <0 .0 0 1) ;联合检测在提高诊断敏感性的同时 (P <0 .0 0 1) ,特异性有所下降 (P <0 .0 0 1)。结论　运用蛋白芯片联合检测多种血清肿瘤标志物可明显提高肺癌诊断的敏感性 ,同时对于确定其临床分期 ,鉴别病理类型以及监测疗效均有一定的意义。由于该法特异性及阳性预测值偏低 ,更适合于无明显症状的门诊患者和肺癌高危人群的筛查。     

皮肤光老化动物模型的建立

目的:应用中波紫外线(UVB 290-320nm)照射无毛鼠,观察UVB对无毛鼠皮肤纹理、表皮、及真皮基质的影响,建立皮肤光老化动物模型,为临床防治皮肤光老化打下基础。方法:应用皮肤图像分析系统、皮肤组织学及特殊染色方法,对接受中波紫外线照射20周的无毛鼠进行皮肤纹理、表皮、真皮、基底膜、粘多糖、胶原纤维、弹性纤维进行对比观察。结果:无毛鼠经UVB照射20周、总计量5.9J/cm2,皮肤出现粗糙,皮纹加深、加宽。皮肤增厚,表皮增生、伴有角化过度及角化不全。真皮水肿,纤维母细胞增生,弥漫性单核细胞、肥大细胞、嗜中性白细胞侵润。基底膜不规则增厚。胶原含量减少,染色变浅,胶原纤维明显变性,均质化,形成片、块状,变性的胶原纤维延伸至真皮深层。弹性纤维增多变粗,部分增生的弹性纤维聚集、断裂、缠结。结论:中波紫外线引起的皮肤损害是一个慢性炎症过程。真皮及真皮基质的改变是紫外线引起皮肤光老化的病理基础。中波紫外线照射后的无毛鼠的皮肤所发生的变化与临床皮肤光老化疾病一致,因此该模型是较为理想的研究皮肤光老化的动物模型。     

Design and test of a vascular access device

Transarterial left ventricular assist devices (LVADs), such as the Hemopump, IABP, and PUCA-pump, are meant to be introduced into the body via the femoral or axillary artery without major surgery. For certain applications, introduction is performed directly into the aorta via an open thorax procedure. A prototype of a vascular access device has been realized that allows direct access into the aorta as an alternative for the common surgical graft anastomosis suturing technique. The device consists of a metal tube acting as a circular knife to cut a hole in the aortic wall, a screw to store the removed part of the aortic wall, and a plastic tube that is introduced through the hole and tightly connected to the aortic wall. The device could be placed without aortic clamping. The device has been tested on a slaughterhouse porcine aorta. A low-pressurized aorta appeared to be the worst case; thus, two animal experiments in the low-pressurized pulmonary artery were performed. No leakage occurred for pressures between 40 and 300 mm Hg.     

Plasmapheresis-related hypotension

Hypotension is an uncommon complication of procedures involving extracorporeal circulation, including plasmapheresis. From November 1993 to March 1999, we treated 139 patients who underwent a total of 1,137 sessions of double filtration plasmapheresis (DFP). Hypotension was defined as a systolic blood pressure (BP) < 80 mm Hg or any decrease of systolic BP with systemic reactions. A total of 17 (1.5%) episodes of hypotension were documented in 15 patients during the study period. Hypotensive episodes occurred in 2.3% of patients with inflammatory neuropathy, 1.2% of patients with myasthenia gravis, and 1.2% of patients with all other medical diseases. Involvement of the autonomic nerve system (ANS) and a low baseline BP were associated with the occurrence of hypotension. Eight (47%) of 17 episodes were symptomatic and 2 were complicated with seizure. Patients with symptomatic hypotension had a higher level of systolic BP prior to DFP and a larger drop of systolic BP and pulse rate during hypotensive attacks compared to asymptomatic patients. Most hypotensive episodes were resolved briefly after intravenous infusion of saline within 30 min. Eight (47%) of the hypotensive episodes occurred during the first session of DFP treatment. Twelve (71%) of 17 episodes occurred during the last half period of treatment; 6 of them were noted during the terminating stage of DFP. In conclusion, in this series plasmapheresis-related hypotension occurred in 1.5% of DFP sessions and had a higher prevalence in patients with ANS instability and low BP. Extra caution in monitoring BP during DFP therapy is warranted in these vulnerable patients, especially during the termination phase of the first DFP session.     

Leptomeningeal carcinomatosis from squamous cell carcinoma of the supraglottic larynx

Leptomeningeal carcinomatosis is an uncommon but devastating form of metastatic spread. To our knowledge, only 16 cases originating from a head and neck cancer have been reported. We describe the first case of a patient with leptomeningeal carcinomatosis arising from a laryngeal squamous cell carcinoma. Shortly after completing treatment for an advanced supraglottic laryngeal cancer, this 63‐year‐old man presented with lower limb neurological symptoms and signs. Radiological and cytological evidence of leptomeningeal carcinomatosis of the distal spinal canal was identified. He was treated with intrathecal methotrexate and palliative radiotherapy. Although his pain improved, his lower limb weakness worsened. He died 3 weeks after completing radiotherapy. Presumed mode of spread was via the haematogenous route. The natural history and management of leptomeningeal carcinomatosis are discussed. Clinicians should be aware of the uncommon possibility of leptomeningeal carcinomatosis in a patient presenting with an appropriate constellation of symptoms and signs, and a past history of cancer.