奥沙利铂联合替吉奥方案治疗晚期胃癌的临床观察

目的 观察奥沙利铂联合替吉奥(SOX)方案治疗晚期胃癌患者的疗效.方法 选择该科2008年9月至2010年2月收治的晚期胃癌患者12例,治疗第1天奥沙利铂130 mg/m2静脉滴注2 h;第1～14天餐后口服替吉奥40 mg/m2,每日2次;28 d为1个疗程,至少完成2个疗程.按实体瘤疗效评价标准(RECIST)评价客观疗效.结果 部分缓解(PR)5例,病情稳定(SD)3例,病情进展(PD)4例.有效率(CR+PR)为41.67%,疾病控制率(CR+PR+SD)为66.67%.疾病进展时间(TTP)8.3个月,中位生存时间(MST)10.7个月.Ⅲ/Ⅳ度不良反应较少.结论 SOX方案治疗晚期胃癌不良反应较轻,患者耐受良好.     

替吉奥胶囊联合奥沙利铂治疗晚期胃癌的临床观察

目的观察替吉奥胶囊(S-1)联合奥沙利铂方案治疗晚期胃癌的临床疗效及不良反应。方法 42例晚期胃癌患者采用联合化疗:替吉奥胶囊每天80mg/m2,分2次,餐后口服,d1~14;奥沙利铂130mg/m2,静脉滴注3h,d1;28d为1个周期。结果 CR3例(7.1%),PR17例(40.5%),SD12例(28.6%),PD10例(23.8%),CR+PR(47.6%)。不良反应主要是骨髓抑制,胃肠道反应及外周神经毒性。结论替吉奥胶囊(S-1)联合奥沙利铂方案治疗晚期胃癌的近期疗效较好,不良反应可以耐受,可改善患者的生存质量。     

奥沙利铂联合替吉奥或卡培他滨治疗老年晚期胃癌的临床观察

目的对比分析奥沙利铂联合替吉奥或卡培他滨联合化疗方案治疗老年晚期胃癌的疗效和不良反应。方法 72例老年晚期胃癌患者,其中31例接受奥沙利铂联合替吉奥方案化疗（SOX组,奥沙利铂130 mg/m2,静脉滴注2 h,第1天;替吉奥40 mg/m2,口服,2次/d,连用14 d,每3周重复）;41例接受奥沙利铂联合卡培他滨方案治疗（XELOX组,奥沙利铂130 mg/m2,静脉滴注2 h,第1天;卡培他滨1 200 mg/m2,口服,2次/d,连用14 d,每3周重复）。结果 SOX组总有效率为43.33%,XELOX组总有效率为41.03%,差异无统计学意义（P〉0.05）;SOX组无手足综合征发生,XELOX组手足综合征发生率为17.07%,差异有统计学意义（P〈0.05）;其余毒副作用,如白细胞下降、贫血、乏力、恶心呕吐、肝毒性等相似,差异无统计学意义（P〉0.05）。结论奥沙利铂联合替吉奥或卡培他滨方案治疗老年晚期胃癌,效果基本相似,奥沙利铂手足综合征发生率较高,但患者基本耐受。氟尿嘧啶口服剂型,有利于提高老年患者的化疗依从性,改善患者生活质量。     

奥沙利铂联合ELF治疗40例晚期胃癌的临床近期疗效及不良反应观察

目的:研究奥沙利铂(L-OHP)联合鬼臼乙叉甙(VP-16)、醛氢叶酸(CF)和5-氟尿嘧啶(5-Fu)治疗晚期胃癌的疗效和不良反应。方法:晚期胃癌患者40例,化疗方案为:奥沙利铂130mg/m2静滴2h(第1天),醛氢叶酸100mg/m2静滴2h(第1～5天),5-Fu500mg/m2静滴22h(第1～5天),鬼臼乙叉甙60mg/m2静滴(第1～3天)。每4周重复1次。结果:完全缓解(CR)3例(7.5%),部分缓解(PR)23例(57.5%),总有效率(CR PR)为65%,无变化(NC)10例(25%),进展(PD)4例(10%)。疾病中位进展时间(TTP)为6.1个月(2～15个月)。毒副反应以骨髓抑制及感觉性神经毒性为主,无Ⅳ°不良反应。Ⅰ°～Ⅱ°反应中,神经毒性表现较明显,无化疗相关死亡。结论:奥沙利铂联合鬼臼乙叉甙、CF/5-FU治疗晚期胃癌疗效肯定,即使对于老年晚期胃癌的患者也表现出了较好的耐受性。值得临床进一步观察试用。     

DCF方案与替吉奥联合奥沙利铂治疗晚期胃癌疗效的比较

目的比较替吉奥(S-1)联合奥沙利铂(OXA)与DCF方案(多西紫杉醇+顺铂+氟尿嘧啶)治疗晚期胃癌的疗效及安全性。方法将62例晚期胃癌患者回顾性分为S-1联合OXA组与DCF组。S-1联合OXA组31例,替吉奥40～60 mg,每天两次,早、晚餐后服用,第1～第14天;奥沙利铂130 mg/m2静脉滴注2 h,第1天;3周为一周期。DCF组31例,多西紫杉醇75 mg/m2静脉滴注1 h,第1天;顺铂25 mg/m2,静脉滴注,第1～第3天;氟尿嘧啶500 mg/m2,静脉滴注,第1～第5天;3周为一周期。每例患者至少完成2周期化疗。按RECIST1.1标准评价客观疗效和不良反应。结果所有患者均可以评价疗效,S-1联合OXA组有效率(ORR)48.4%,疾病控制率(DCR)80.6%;DCF组ORR 51.6%,DCR 77.4%;两组疗效比较差异无显著性(P>0.05)。两组主要毒副反应是骨髓抑制,胃肠道反应及神经毒性。S-1联合OXA组骨髓抑制、恶心/呕吐较DCF组明显降低,特别是3～4度骨髓抑制,1～2度恶心/呕吐,两组比较差异有显著性(P<0.05);神经炎的发生S-1联合OXA组居多,两组比较,差异无显著性(P>0.05)。结论替吉奥联合奥沙利铂方案与DCF方案治疗晚期胃癌的疗效相近,毒副反应减轻,值得临床进一步推广应用。     

奥沙利铂联合卡培他滨治疗晚期胃癌的21例临床探讨

目的观察奥沙利铂联合卡培他滨治疗晚期胃癌的疗效和安全性。方法21例晚期胃癌患者,静脉滴注奥沙利铂130mg/m2,d1;卡培他滨2500 mg/m2,分早晚2次口服,d1-14,21天为1周期。结果21例患者中,CR 2例,PR10例,SD3例,PD6例,近期有效率（CR+PR）为57.1%,中位生存期9个月,中位疾病进展时间为7个月。不良反应为手足综合征、神经毒性,多为Ⅰ-Ⅱ度。结论奥沙利铂联合卡培他滨化疗方案,缓解率高,能提高生活质量,毒副反应小,患者易耐受。     

SOX新辅助化疗方案结合手术治疗局部晚期胃癌的临床观察

目的:探讨替吉奥胶囊联合奥沙利铂(SOX方案)治疗局部晚期胃癌术前的临床近期疗效及不良反应。方法:回顾性分析32例符合人组条件的进展期胃癌患者临床病例资料。SOX方案具体为:替吉奥胶囊80 mg/(m2.d),第1～14天,奥沙利铂注射液130 mg/m2,第1天给药。21 d为1个周期,每2个周期后进行化疗有效性和安全性评估。按RECIST 1.1标准评价客观疗效和不良反应。结果:32例患者接受新辅助化疗后的患者临床有效率(CR+PR)为12例(37.5%),SD 10例(31.3%),PD 10例(31.3%),疾病控制率(CR+PR+SD)为68.8%。不良反应主要是骨髓抑制、胃肠道反应及外周神经毒性,且均在Ⅰ～Ⅱ。32例患者均进行了手术,2例无法手术切除,手术切除率为93.7%(30/32)。结论:替吉奥胶囊联合奥沙利铂方案治疗在局部进展期胃癌的治疗中近期疗效较好,能显著提高手术切除率,且耐受性良好,值得临床推广应用。     

替吉奥联合奥沙利铂治疗晚期胃癌的近期疗效观察

目的:观察国产替吉奥(S-1)联合奥沙利铂(L-OHP)治疗晚期胃癌的近期疗效及安全性。方法:回顾性分析62例晚期胃癌患者,治疗组患者S-1+L-OHP方案30例,具体为:S-1 40⁶0mg/次口服,2次/d,d1-d14,L-OHP 130mg/m2静滴3h,d1,3周为1周期。对照组患者FOL-FOX方案32例:氟尿嘧啶500mg/m2微量泵持续24h静滴,d1-d5,亚叶酸钙200mg/m2静滴,d1-d5,L-OHP130mg/m2静滴3h,d1,3周为1周期,2周期后评价疗效及观察不良反应。结果:62例患者均可评价疗效和不良反应,治疗组和对照组的有效率分别为53.3%和40.6%,差异无统计学意义(P>0.05),但治疗组患者的疾病控制率为83.3%,优于对照组65.6%,差异有统计学意义(P<0.05);治疗组患者的不良反应发生率低于对照组。结论:替吉奥联合奥沙利铂化疗方案治疗晚期胃癌的近期疗效较好,不良反应轻。     

曲妥珠单抗联合SOX方案治疗晚期胃癌临床研究

目的 探讨曲妥珠单抗联合奥沙利铂及替吉奥(SOX方案)治疗人类表皮因子受体-2(HER-2)阳性晚期胃癌的临床疗效及安全性.方法 经病理组织学确诊为晚期胃癌患者,经免疫组化(IHC)和/或荧光原位杂交法(FISH)检测HER-2阳性者共48例,其中对照组24例,单用SOX方案化疗,S-1用量依体表面积而定:体表面积＜ 1.25 m2的患者,每次40 mg;体表面积≥1.25 m2但＜1.50m2者,每次50 mg;体表面积≥1.50 m2者,每次60 mg,2次/d,第1～14天;奥沙利铂130 mg,/m2,第1天,每21天重复1次.试验组24例,采用SOX方案+曲妥珠单抗,曲妥珠单抗第1周8 mg/kg静脉滴注,此后每3周6mg/kg静脉滴注.所有患者至少完成2周期治疗,按照RECIST1.1标准进行疗效评价,NCI-CTC第3版评价不良反应.结果 试验组客观有效率(ORR)为62.5％ (15/24),疾病控制率(DCR)为83.3％ (20/24);对照组分别为33.3％(8/24)和54.2％ (13/24),两组ORR及DCR差异有统计学意义(P＜0.05).两组患者治疗后不良反应均较轻,发生率差异无统计学意义(P＞0.05).结论 曲妥珠单抗联合SOX方案治疗HER-2阳性晚期胃癌近期疗效较好,不良反应发生率低,值得临床推广应用.     

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.     

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.     

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.