肝内胆管细胞癌诊治进展

肝内胆管细胞癌（ICC）是发病率仅次于肝细胞癌的肝脏恶性肿瘤，它的恶性程度高、术后易复发，且早期无典型症状，大多数患者在确诊时已处于晚期。诊断主要依赖于增强CT、MRI和实验室检查。肝切除术是ICC首选的治疗方法，完整的切缘阴性切除和保留足够残留肝是影响手术预后的重要因素。淋巴结清扫、卡培他滨辅助化疗已被证实对患者有益。局部治疗、分子靶向治疗、免疫治疗等新疗法发展迅速，为晚期ICC患者带来了希望。传统疗法与新疗法的结合为ICC提供新的诊疗思路。     

蓝激光成像及染色技术对消化道早癌诊断的研究现状

消化道早癌的研究主要集中在癌的早期发现、早期诊断、早期治疗。消化道早癌的筛查主要借助于消化道内镜技术,为提高传统内镜发现诊断消化道病变的能力,通常于内镜检查前行消化道染色以突出病变。蓝激光成像技术是新一代的消化内镜技术,相比传统的内镜技术,蓝激光成像技术具有特有的发现消化道病变的能力,不仅可以用于非癌疾病的诊断,而且具有很强的发现消化道早期癌病变的能力。近年来关于蓝激光成像技术对早期食管癌、胃癌、结直肠癌的研究日渐增多,研究表明其能显著提高消化道早癌的诊断率。本研究主要分析国内蓝激光成像技术结合染色技术对消化道早癌诊断的研究现状,以期为临床和科研提供依据。     

代谢物在肝内胆管癌诊治及预后评估中的应用探讨

肝内胆管癌(ICC)起病隐匿、恶性程度高、预后差，故早期诊断、及时评估疗效、准确判断预后对ICC患者尤为重要。ICC在发生过程中存在代谢重编程，发展过程中伴随着代谢表型的动态变化，代谢物的含量异常或比例改变是代谢变化中的重要特征，因此，将患者肿瘤组织及体液中的代谢物作为ICC早期诊断、疗效评估及预后判断的生物标志物具有广阔前景。本文就代谢物在ICC诊断、治疗及预后评估中的应用及研究进展进行梳理，并探讨代谢物、代谢紊乱与ICC之间的相互关系。     

胃肠镜诊断消化道早癌的应用分析与研究

目的研究胃肠镜诊断消化道早癌的应用分析与研究。方法选取我院120例进行胃肠镜检查的患者作为本次研究的分析对象,按照随机分配的方式将胃肠镜检查患者分为两个检查小组,每个小组60例检查患者,在其他条件相同的情况下,对照组患者采用活检取材的方法进行病理诊断,观察组患者采用胃肠镜下双重染色的相关病理诊断,比较两组胃肠镜诊断患者经过检查后的消化道早癌结果。结果对照组检查患者的胃早癌的检出率为38.3%、食道早癌的检出率为65%、结直肠早癌的检出率为43.3%,观察组患者胃肠镜检查患者的胃早癌的检出率为66.7%、食道早癌的检出率为85%、结直肠早癌的检出率为73.3%,两组胃肠镜检查患者的消化道早癌诊断差异具有统计学意义(P0.05)。结论在消化道早癌的诊断过程中使用胃肠镜诊断方法的准确率和检出率更高,能够有效地提高医生针对性治疗的效率,是一项值得推广的应用。     

消化内镜在消化道早癌患者诊断治疗中的应用效果及对患者生活质量的影响

<正>目前,人们生活水平在不断的提高,饮食习惯和生活作息习惯发生了剧烈改变,人群发生消化道癌的概率在不断提升,因此,需加强该疾病的早期诊出率。患者消化道发生病变且浸润消化道黏膜下层以内的,就表明患者已出现消化道早癌~([1])。根据临床实践表明,若想提升消化道早癌患者生存质量和生存率,需尽早给予有效的诊断治疗方法。本研究主要分析了在消化道早癌患者诊断治疗中应用消化内镜的效果及对患者生活质量的影响,现报告如下。     

超声内镜诊治上消化道早期癌21例

目的探讨超声内镜诊断和治疗上消化道早期肿瘤的可靠性。方法超声内镜诊断上消化道早期肿瘤,有手术或内镜切除标本可证实诊断的21例,并对其中12例有适应证的患者进行超声内镜指导下的早癌切除术。结果超声内镜诊断早期癌的准确性66%,12例内镜切除的早期癌切除完全,仅个别少量出血并发症。结论超声内镜对上消化道早期癌的诊断有较高敏感性,部分类型的早期癌在超声内镜指导下行内镜切除术安全、可行。     

消化内镜技术用于消化道早癌诊断治疗价值研究

当前我国癌症高发,而癌症早期诊断对于减少患者痛苦,提升癌症治愈率都有很好的作用。在消化道早癌的诊断以及治疗工作中,消化内镜技术的应用具有一定的价值。本文就多名消化道疾病患者进行了采用消化内镜技术的早癌检查对比试验,并就试验对比结果进行了研究。     

综述外阴恶性肿瘤的诊断与治疗

外阴恶性肿瘤以原发性的为主,约占女性生殖器肿瘤的4%,占妇女全身肿瘤的1%-2%.约2/3病变发生于大阴唇,1/3发生于小阴唇、阴蒂或会阴联合等处.大多数病变发生于外阴的前半部,发生于会阴部或大阴唇的外侧面者占少数.目的 综述外阴恶性肿瘤的诊断与治疗.方法 通过对患者症状的临床观察结合检查结果 进行诊断与治疗.结论 外阴癌如果早诊断早治疗,其预后相对较好,早期治疗总的5年生存率为68.9%.早期发现外阴癌主要依靠患者自身的检查.     

糖尿病与结直肠癌相关性的研究进展

目前国内外多项研究表明糖尿病是结直肠的癌独立危险因素,糖尿病与结直肠癌存在相关性,其机制与高血糖、胰岛素样生长因子、高胰岛素血症、胰岛素抵抗等因素有关,糖尿病与结直肠癌预后可能存在相关性。通过对糖尿病与结直肠癌的相关性研究,为在糖尿病患者中行肠镜等检查早期发现结直肠癌提供理论依据,对临床上早发现、早诊断、早治疗结直肠癌也有现实意义。     

肝内胆管细胞癌超声漏诊误诊分析

肝内胆管细胞癌(ICC)系由肝内胆管上皮发生的一种原发性肝癌,由于其临床表现及实验室检查缺乏特异性,术前诊断率较低,发现时大多已属晚期,预后较差.早期诊断及治疗对改善患者预后有重要意义.本文选取1990年1月至2008年12月我院收治的8例肝内胆管细胞癌漏诊、误诊患者,对其临床及随访资料进行分析,总结经验,以期提高超声肝内胆管细胞癌的诊断率.     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.