115例胃肠间质瘤的临床病理及其预后影响因素分析

目的 探讨胃肠间质瘤(GIST)患者的临床、病理特点,并分析预后影响因素.方法 对115例接受外科手术治疗的GIST患者的临床、病理资料进行回顾性分析.采用免疫组织化学法检测CD117、DOG-1及CD34蛋白的表达、基因测序法进行基因突变检测,并分析影响GIST预后的因素.结果 115例GIST患者中,病理类型以梭型细胞为主型95例(82.6％),上皮细胞为主型17例(14.8％),混合细胞型3例(2.6％).CD117、DOG-1、CD34蛋白阳性表达率分别为89.6％、92.2％、84.2％.CD117、DOG-1、CD34蛋白在不同性别、肿瘤大小、危险度分级、核分裂数及是否转移分组中阳性表达率比较,差异无统计学意义.103例CD117阳性表达患者的DOG-1、CD34阳性表达率明显高于12例CD117阴性患者(P ＜0.001).109例患者获得随访,1年、3年、5年总体生存率分别为90.1％、63.4％、48.6％,其中行根治切除患者1年、3年、5年总体生存率分别为100％、84.2％、70.3％.单因素分析结果显示:肿瘤大小、NIH危险度分级、是否转移、手术方式与患者生存有关(P＜0.05).多因素分析结果显示是否转移是影响患者术后生存时间的独立危险因素(P ＜0.001).结论 影响GIST预后的因素有肿瘤大小、NIH危险度分级、手术方式、转移情况,其中否转移是影响患者术后生存时间的独立危险因素.     

局限性胃肠道间质瘤中P16表达水平与预后的关系

目的 探讨P16在局限性胃肠道间质瘤(GIST)中的表达水平及其与预后的关系.方法 收集128例手术完全切除的局限性GIST标本,构建组织芯片.EnVision免疫组化法检测P16在GIST组织芯片上的表达情况.患者采用门诊和电话随访.结果 P16的表达范围与GIST患者的性别、肿瘤核分裂象数、NIH危险度分级有关(P<0.05),与患者的年龄、肿瘤大小、原发部位无关(P>0.05);P16的表达部位与GIST患者的性别、年龄、肿瘤大小、核分裂象数、原发部位、NIH危险度分级均无关(P>0.05).经Kaplan-Meier生存分析发现,肿瘤大小、核分裂象数、NIH危险度分级和P16表达的范围、部位及模式均与患者预后相关;COX多变量回归分析显示,肿瘤大小、核分裂象数及P16的表达模式是影响患者预后的独立危险因素.结论 P16胞浆高表达型是反映局限性GIST预后不良的一个重要指标.     

胃肠间质瘤Ki-67的表达特点及其临床意义

目的 探讨胃肠间质瘤中增殖细胞核抗原Ki-67的表达特点及其临床意义。方法 回顾性分析我院胃肠外科自2012年7月至2013年9月期间收治的97例胃肠间质瘤患者的临床特征、病理免疫组化结果、治疗和随访情况,分析Ki-67的表达特点及其临床意义。结果 原始病例数112,失访15例,97例具有完整的随访和临床病理资料。随访3~24个月（中位时间15个月）,复发或转移30例（30.9%）,其中4例死亡。在不同年龄、性别分布中,Ki-67表达差异无统计学意义（ P>0.05）;在肿瘤部位、肿瘤长径、美国国立卫生研究院（NIH）危险度分级和核分裂象中,Ki-67表达差异有统计学意义（ P均<0.05）,且肿瘤越大、NIH危险度级别越高、核分裂象数越多,Ki-67表达指数越高,呈正相关（ P<0.05）;Ki-67、核分裂象和复发转移有关（r分别为0.395,0.266, P<0.05）。Cox多因素分析示:Ki-67( P<0.001,相对危险度=0.387,95%可信区间:0.229~0.654)和核分裂象（ P=0.005,相对危险度=0.494,95%可信区间:0.304~0.805）是影响术后无复发生存的独立危险因素。生存分析示:Ki-67表达指数影响中高危患者的预后。结论 Ki-67与肿瘤长径、NIH危险度分级和核分裂象相关,并能辅助评估胃肠间质瘤患者的预后。     

原发小肠间质瘤的预后影响因素分析

目的 探讨影响原发小肠间质瘤的预后影响因素.方法 回顾性分析中国医学科学院肿瘤医院1989 ～ 2009年经病理证实的100例原发小肠间质瘤的临床资料,统计学分析其预后的影响因素.结果 病例总计100例,包括男53例,女47例.其中行根治性手术85例,姑息性手术15例,总的5年生存率为77.6％;5年无病生存率为52.4％.单因素分析影响小肠间质瘤预后的因素包括:肿瘤的大小、核分裂象、Ki -67指数、R0切除、与周围组织粘连、凝固坏死;多因素分析影响小肠间质瘤预后的因素是:R0切除.结论 外科根治性切除是原发小肠间质瘤的主要治疗方法,对于Fletcher中危及以上患者,应考虑辅助靶向治疗.     

胃间质瘤围术期护理及预后影响因素分析

目的：探讨胃间质瘤的围术期护理及预后影响因素。方法：收集浙江大学医学院附属第一医院1998年1月至2007年2月收治并行手术治疗的112例有完整资料的胃间质瘤患者的围术期护理方法，单因素回顾性分析各临床病理变量与患者预后的关系。结果：随访率92．0％，中位随访时间29个月。患者1、2、5年总生存率分别为99．1％、98．1％、96．2％。对于原发患者，1、2、5年无瘤生存率分别为96．2％、93．2％、87．3％。单因素分析显示，肿瘤出血或坏死、肿瘤大小、核分裂像数目及 Fletcher 分级等因素与患者的预后相关（P＜0．001）。结论：充分的术前准备、术后严密的监护及加强体位、饮食、引流管、术后常见不适的护理，为成功的手术保驾护航。     

胃肠道间质瘤患者的病理特征及其与预后的相关性

目的：探讨胃肠间质瘤（GIST）患者的病理特征及其与预后的相关性。方法选取我院2005年10月至2012年10月期间收治的120例行手术治疗并经病理证实的胃肠道间质瘤患者,回顾性分析患者的临床病理及随访资料,并通过单因素及多因素分析明确GIST患者的病理因素与预后的相关性。结果 GIST患者的病灶形态以类圆形居多,肿块无包膜或有假包膜,部分病灶边缘呈分叶状,病灶向浆膜外或消化腔内生长,少数病灶有囊性变、坏死、出血等形态改变;免疫组化结果显示,DOG1、CD117、CD34、IGFIR、Desmin、SMA、S-100的阳性表达率分别为96.67%(116/120)、95.00%(114/120)、80.00%(96/120)、5.83%(7/120)、3.33%(4/120)、45.00%(54/120)、6.67%(8/120);单因素分析结果显示,不同肿瘤大小、核分裂数目、NIH恶性危险度以及是否接受甲磺酸伊马替尼治疗患者的3年生存率比较差异均有统计学意义(P<0.05);多因素回归分析结果显示,核分裂数目、NIH危险度、肿瘤大小、甲磺酸伊马替尼治疗均是影响患者预后的独立因素(P<0.05)。结论 GIST患者的DOG1、CD117的阳性表达率较高,CD34、CD117为弥漫性阳性表达,S-100和SMA呈局灶性分布,核分裂数目、NIH危险度、肿瘤大小及甲磺酸伊马替尼治疗均是影响患者预后的独立因素。     

局限性胃肠道间质瘤51例的临床病理及预后分析

目的探讨局限性胃肠道间质瘤（GIST）的生物学行为,分析临床病理特征对局限性GIST患者生存的影响。方法收集51例发生在胃、肠并符合局限性GIST诊断标准,以免疫组织化学染色检测CD117、CD34、SMA、Desmin及S-100 5种蛋白的表达,总结临床病理特征包括肿瘤直径、核分裂像计数、危险程度分级、肿瘤坏死、年龄、性别等,分析各临床病理变量与预后的关系。结果51例患者预后与肿瘤大小、核分裂像数因素有关,危险程度分级中的低、中、高危险组均出现比例不等的肿瘤进展,极低危险组提示可能为良性GIST。而肿瘤的坏死、肿瘤的部位、肿瘤的细胞类型也有一定关系。结论局限性GIST的生物学行为主要是依据肿瘤大小和核分裂像数评估其恶性危险程度,同时也要结合肿瘤部位,肿瘤坏死及其它病理参数进行更准确的预测。     

97例胃肠间质瘤临床分析

目的探讨胃肠间质瘤(GIST)的临床特点及影响预后的因素。方法回顾性分析2007年1月至2012年12月宁夏医科大学总医院收治的97例原发GIST患者的临床资料,比较不同因素对患者预后的影响。结果97例患者中男性50例,女性47例,中位年龄53.4岁。肿瘤发生部位:胃58例、小肠29例、结直肠6例、腹腔4例、盆腔3例。7例患者因广泛浸润未完整切除,其余均行完整切除,其中6例行腹腔镜手术。42例术后口服伊马替尼。93例患者术后获得随访,随访时间3~71个月。患者1、3、5年总体生存率分别为97.8%、77.6%、60.0%。单因素分析结果显示:肿瘤大小、手术根治性、改良NIH危险度分级和肿瘤细胞核分裂像是影响GIST患者术后预后的因素。结论手术根治性和NIH危险度分级是影响预后的主要因素,外科手术完整切除依然是有效的治疗方法,术后联合分子靶向药物治疗可使GIST患者获得满意疗效。     

212例胃肠间质瘤的临床病理特征及预后分析

目的探讨胃肠间质瘤(GIST)的临床特征和分子病理学特点,分析影响GIST预后的相关因素。方法回顾性分析2004年4月至2011年8月南方医院收治的212例GIST患者的临床病理和随访资料,应用生存分析比较不同因素对预后的影响。对接受甲磺酸伊马替尼治疗的53例患者,采用基质辅助激光解析/电离-飞行时间质谱方法检测KIT和PDGFRa基因相关位点的突变情况。结果单因素生存分析显示肿瘤大小、核分裂数、美国国立卫生研究所(NIH)危险度分级、转移、手术及甲磺酸伊马替尼影响GIST患者的生存率。多因素生存分析提示,NIH危险度分级和甲磺酸伊马替尼是影响预后的独立因素。53例GIST患者中,KIT基因突变39例(73.6%),其中外显子11突变21例(53.8%),外显子9突变13例(33.3%)。KIT外显子11突变形式主要为5’端第557-558密码子缺失最常见;外显子9突变均为插入串联重复。未检测到PDGFRa基因突变的病例。结论 NIH危险度分级和甲磺酸伊马替尼治疗与GIST患者的生存密切相关,基因突变检测对指导生物靶向治疗和预测其疗效具有重要意义。     

臭氧配合热奄包外敷治疗腰椎间关节综合征30例

【摘要】 目的 探讨与直肠间质瘤患者预后密切相关的临床病理危险因素,由此建立病理因素评分并分析其对直肠间质瘤的无瘤生存期的预测价值。 方法 收集2006年1月～2014年12月海军军医大学附属长海医院肛肠外科收治的均经完整手术切除,且术后病理确诊为直肠间质瘤的患者51例,按照危险度分级标准,肿瘤的危险度分为极低危度、低危度、中危度、高危度,将极低危度和低危度设为低危组,中危度和高危度设为高危组。收集其临床基本资料、病理数据、随访资料行回顾性分析,应用Cox单因素分析发现无瘤生存预后相关因素,Cox多因素分析发现独立的预后影响因素并利用赤池信息量准则（Akaike Information Criterion,AIC）查找最优模型,根据最优模型即临床病理因素评分评价直肠间质瘤患者的无瘤生存期。 结果 Cox单因素分析结果提示,危险度分级高、术前中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）高是直肠间质瘤患者预后不良的影响因素,进一步行Cox多因素分析结果提示,危险度分级高、NLR高是其预后不良的独立影响因素。根据AIC拟合的最优模型 临床病理因素评分低危组的无瘤生存率显著高于高危组(P＜0.05);高NLR组无癌生存率显著低于低NLR组(P＜0.05)。 结论 危险度分级高、NLR高与直肠间质瘤患者无瘤生存期密切相关,临床病理因素评分可以有效评估直肠间质瘤的患者无瘤生存状况。     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.