经直肠超声引导5区13针前列腺穿刺活检在前列腺癌筛查中的应用

目的评价经直肠超声引导5区13针前列腺穿刺活检在筛查前列腺癌的临床应用价值。方法对102例患者,年龄49-75岁,平均64.2岁,以前列腺特异性抗原(PSA)4-10ng/ml且游离PSA/总PSA<0.26或PSA10.1-50ng/ml或直肠指诊检查(DRE)异常或B超发现异常回声为穿刺指征,前列腺体积12-109ml,平均49ml,在直肠腔内注入1%盐酸丁卡因凝胶10ml局部粘膜麻醉下行经直肠超声引导5区13针前列腺系统穿刺活检。结果102例患者全部穿刺成功,前列腺癌活检阳性率为23.5%,PSA0-4ng/ml、PSA4.1-10ng/ml、PSA10.1-50ng/ml阳性率分别为9.1%(1/11)、15.4%(6/39)、32.1%(17/53)。前列腺体积<20、20-40ml、40-60ml及>60ml阳性率分别为62.5%(5/8)、27.0%(10/37)、14.3%(7/49)、25.0%(2/8)。术中出现血管迷走神经反应2例,3例直肠大出血,9例术后出现发热,上述患者经相关处理后恢复。结论经直肠超声引导5区13针前列腺穿刺活检术是一种筛查前列腺癌阳性率较高的方法,但在应用中有可能发生一些并发症。术后仔细观察病情变化,预防严重并发症的发生。     

经直肠超声引导下前列腺6针法加定点穿刺活检术诊断前列腺癌

目的 探讨经直肠超声(TRUS)引导下的前列腺6针法加定点穿刺活检诊断前列腺癌的临床意义.方法 对96例PSA＞4ng/ml且直肠指征阳性和(或)B超发现前列腺有异常回声结节患者,行经直肠超声引导前列腺6针法加定点穿刺活检术.即在标准的经直肠超声引导6 点前列腺系统穿刺活检术同时,增加异常回声结节的定点穿刺.结果 96例患者中确诊为前列腺癌者44 例(45.8%).44 例前列腺癌患者如仅按6 点穿刺方法,将有9 例患者漏诊,占20.5%.结论 经直肠超声(TRUS)引导下的前列腺6针法加定点穿刺活检术,可明显提高前列腺癌的临床检出率.     

血清PSA水平与前列腺癌相关性的探讨

目的:分析前列腺特异性抗原(Prostate Specific Antigen,PSA)水平与前列腺癌(Prostate Cancer,PCa)的相关性,以期PSA值水平更好指导前列腺癌穿刺活检。方法:选择经超声引导下经直肠穿刺活检证实的62例前列腺癌病例,按其PSA值水平分为4组:A组PSA<4 ng/ml,B组:4 ng/ml≤PSA<10ng/ml,C组:10ng/ml≤PSA<20ng/ml,D组:PSA≥20ng/ml。分析四组PSA值水平与前列腺癌的关系。结果:PSA水平的高低与前列腺癌有明确的相关性,高PSA水平前列腺穿刺活检的阳性率明显增高。结论:PSA水平能很好指导前列腺穿刺活检。     

影响前列腺特异性抗原数值准确性的相关因素探讨

目的分析影响前列腺特异性抗原数值准确性的相关因素。方法所有患者均行PSA检测,并均行经直肠前列腺穿刺活检术以进一步确诊。调查穿刺活检的病理结果,对可能影响PSA数值的各种因素如直肠指检、膀胱镜操作、留置导尿、前列腺炎症及良性前列腺增生等进行分析。结果 259例患者前列腺穿刺活检阳性率为40.5%。体检发现PSA增高（对照组）穿刺阳性率为60.4%。前列腺增生组穿刺阳性率41.7%。曾行侵入性器械操作组穿刺阳性率为19.0%。前列腺炎组穿刺阳性率为36.1%,肛诊组穿刺阳性率为38.6%。PSA在4-10ng/ml穿刺阳性率17.3%,10-40ng/ml阳性率65.2%,PSA〉40ng/ml阳性率90%。结论常规的直肠指检、膀胱镜操作、留置导尿、前列腺炎症、良性前列腺增等生都可影响血清的PSA值,随着PSA的增高,前列腺癌的检出率也随之增高。掌握PSA变化的各种因素及合理分析对于前列腺癌的诊断和鉴别诊断有十分重要的意义,结合临床情况、影像学检查及指检可大大提高诊断前列腺癌的特异性,减少不必要的穿刺活检。     

超声引导下前列腺活检与血清PSA及PSAD的对比研究

目的对比分析经直肠超声引导下前列腺穿刺活检与血清PSA和PSA密度的关系。方法 2006-2008年对105例因PSA升高、肛诊及超声检查阳性患者行经直肠超声引导下前列腺穿刺活检,对血清PSA和PSAD与前列腺活检的关系进行分析。结果本组105例患者,检出前列腺癌患者36例（34.3%）,前列腺增生伴或不伴慢性炎症69例（65.7%）。前列腺癌组PSA及PSAD高于良性病变组（P〈0.01）;血清PSA浓度〈4ng/ml者有1/11例（9.1%）为前列腺癌。随着血清PSA浓度升高,前列腺活检阳性率升高（r=0.912,P〈0.01）;当PSAD〈0.15时,前列腺增生的发病率明显高于前列腺癌的发病率,而当PSAD≥0.15时,前列腺癌的发病率升高（χ^2=16.377,P〈0.01）。结论血清PSA及PSAD对前列腺活检诊断前列腺癌有重要意义。     

不同水平前列腺特异抗原的前列腺癌诊断率

目的了解不同水平前列腺特异抗原（PSA）在前列腺系统穿刺下的活检阳性率,确定游离PSA／总PSA（fPSA／tPSA）在低PSA域值（PSA4～10ng／ml）的诊断价值。方法自2000年1月至2005年6月我们对1244例因PSA升高或直肠指检阳性结节的患者进行B超引导下经直肠前列腺穿刺活检,采用前列腺5区12针或13针系统穿刺方法,将PSA水平与组织学结果进行对比分析。结果根据PSA水平将患者分为：PSA〈4ng／ml,直肠指检发现结节;PSA4—10ng／ml,fPSA／tPSA〉0．16;PSA4—10ng／ml,fPSA／tPSA〈0．16;PSA10．1—20ng／ml;PSA〉20ng／ml;共5组,穿刺阳性率分别为18．1％,11．6％,17．4％,24．9％,和56．7％。随着PSA值增加,高危Gleason评分（Gleason评分≥18）的比例明显增加。结论不同PSA值的前列腺癌诊断率明显不同。直肠指检发现前列腺结节或PSA〉10ng／ml应作为前列腺穿刺的指征。PSA4—10ng／ml之间,参考fPSA／tPSA（〈0．16）有利于提高穿刺阳性率。     

经直肠食指引导鞘管定位前列腺穿刺活检

目的探讨经直肠食指引导鞘管定位前列腺穿刺活检在筛查前列腺癌中的临床意义.方法 对45例PSA＞4ng/ml或前列腺肛诊、B超发现前列腺结节者,行食指引导鞘管定位前列腺尖部,中间,底部中间共6点和触及结节处穿刺活检,穿刺结果和文献中经直肠超声引导前列腺穿刺结果进行比较.结果 有结节者19例中发现前列腺癌(PCA)6例(31.58%),PSA＞4ng的43例中,18例病检为前列腺癌(41.86%),5例为前列腺增生(BPH)合并前列腺上皮类瘤样变(PIN)(11.63%),9例为前列腺增生合并慢性炎症(20.93%),单纯前列腺增生10例(23.26%),其他3例(6.98%).对血清PSA＞4ng/ml者经直肠食指引导鞘管定位前列腺穿刺活检诊断前列腺癌阳性率与文献中经直肠超声引导前列腺穿刺活检诊断前列腺癌阳性率无明显差别(χ2=0.022,P＞0.05).结论 经直肠食指引导鞘管定位前列腺穿刺活检操作容易,无需超声设备,且穿刺并发症少,安全,便捷.可在基层医院广泛开展,对前列腺癌的筛查.     

经直肠超声引导下前列腺穿刺的临床应用

目的:探讨经直肠超声引导下前列腺穿刺活检在诊断前列腺疾病中的临床应用。方法:352例前列腺特异性抗原(PSA)>4 ng/ml或前列腺有结节的患者经直肠超声(TRUS)引导下前列腺穿刺活检以明确诊断。结果:352例中,病理检查示前列腺癌128例,前列腺增生症216例,前列腺炎和前列腺上皮内瘤各4例。结论:经直肠超声引导下前列腺穿刺活检操作简便、取材准确、成功率高、并发症少,有助于前列腺疾病的早期诊断及鉴别。     

经直肠超声引导下前列腺活检的应用分析

目的探讨经直肠超声引导下前列腺活检术在诊断前列腺疾病中的临床应用。方法对240例前列腺特异性抗原（PSA）〉4ng/ml的患者行经直肠超声引导传统6点系统穿刺活检加异常区域处1-2针活检。结果 240例经直肠超声引导下前列腺活检,病理结果检出前列腺癌61例,占25.4%,前列腺良性增生179例,占74.6%,无严重的并发症。结论经直肠超声引导前列腺活检术有助于前列腺疾病的诊断和鉴别诊断,为临床进一步诊治提供了依据,其方法简便,安全性较高,值得推广应用。     

经直肠超声引导前列腺系统穿刺活检对前列腺癌的诊断价值

目的:探讨经直肠超声引导前列腺系统穿刺活检术诊断前列腺癌的临床价值。方法:对238例行经直肠超声引导前列腺系统穿刺活检术患者的资料进行回顾性分析。结果:检出前列腺癌患者59例,临床分期T1期:0例,T2期:8例,T3期:22例,T4期:29例。穿刺阳性者血清总前列腺特异性抗原(t-PSA)水平、前列腺体积、PSA密度(PSAD)、(f/t)/PSAD、前列腺钙化率分别为82.5(2.6～490.5)ng/ml、47.6(17.2～110.6)cm3、2.5(0.05～22.0)ng.ml-1.cm-3、0.381(0.008～1.71)、33.9%,穿刺阴性者分别为12.5(0.97～54.4)ng/ml、70.1(12.3～206.6)cm3、0.23(0.01～2.39)ng.ml-1.cm-3、1.685(0.071～9.938)、4.1%,两组有统计学差异。238例患者均未发生严重并发症。结论:经直肠超声引导前列腺系统穿刺活检术易操作,前列腺癌检出率较高,必要时进一步分析PSAD、(f/t)/PSAD值可提高穿刺特异性,严重并发症少,目前仍是诊断前列腺癌的主要方法。     

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.     

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…     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.