金匮肾气丸辅治Ⅱ-Ⅲ期糖尿病肾病疗效观察

目的:观察金匮肾气丸辅治Ⅱ-Ⅲ期糖尿病肾病的临床疗效。方法:74例按照随机数字表法分为对照组与研究组各37例,两组均用达格列净和贝那普利治疗,研究组加用金匮肾气丸。结果:研究组总有效率与估算肾小球滤过率(eGFR)水平高于对照组(P<0.05),中医证候积分、血肌酐(SCR)、血尿素氮(BUN)、24h尿总量蛋白(TUP)和尿微量白蛋白/尿肌酐(UMA/UCR)以及空腹血糖(FBG)水平均低于对照组(P<0.05)。结论:金匮肾气丸辅治Ⅱ-Ⅲ期糖尿病肾病可提高疗效。

产妇泌乳Ⅱ期启动延迟发生率及影响因素分析

目的分析住院期间产妇泌乳Ⅱ期启动延迟的发生率和影响因素,指导母乳科学喂养。方法采用便利抽样法选取医院产科2023年4月至7月收治的分娩产妇121例,按是否发生泌乳Ⅱ期启动延迟分为延迟组(41例)和非延迟组(80例)。收集产妇一般人口学特征,分析疾病史、生育史、母乳喂养教育等因素对产妇泌乳Ⅱ期启动延迟发生的影响。结果产妇泌乳Ⅱ期启动延迟发生率为33.88%。多因素Logistic回归分析结果显示,年龄不低于35岁[OR=3.576,95%CI(1.081,11.833),P=0.037],产次为初产[OR=4.082,95%CI(1.282,12.997),P=0.017],分娩方式为剖宫产[OR=4.648,95%CI(1.347,16.041),P=0.015],妊娠期糖尿病[OR=10.893,95%CI(2.612,45.432),P=0.001],母乳喂养指导[OR=5.399,95%CI(1.458,19.988),P=0.012],母婴30 min内未早期接触[OR=4.200,95%CI(1.316,13.404),P=0.015],新生儿24 h内有效吮吸次数不超过8次[OR=3.845,95%CI(1.141,12.954),P=0.030]均为发生泌乳Ⅱ期启动延迟的影响因素。结论该院产妇泌乳Ⅱ期启动延迟发生率较高,年龄≥35岁、初产、剖宫产、妊娠期糖尿病、未接受母乳喂养指导、母婴30 min内未早期接触、新生儿24 h内有效吮吸次数≤8次均为发生泌乳Ⅱ期启动延迟的危险因素。

Prognostic and predictive significance of MSI in stages Ⅱ/Ⅲ colon cancer

In colon cancer,classic disease staging remains the key prognosis and treatment determinant.Although adjuvant chemotherapy has an established role in stageⅢcolon cancer patients,in stageⅡit is still a subject of controversy due to its restriction to a small subgroup of patients with high-risk histopathologic features.Patients with stageⅡtumors form a highly heterogeneous group,with five-year relative overall survival rates ranging from 87.5%(ⅡA)to 58.4%(ⅡC).Identifying those for whom adjuvant chemotherapy would be appropriate and necessary has been challenging,and prognostic markers which could serve in the selection of patients more likely to recur or benefit from adjuvant chemotherapy are eagerly needed.The stronger candidate in this category seems to be microsatellite instability(MSI).The recently reported European Society for Medical Oncology guidelines suggest that MSI should be evaluated in stageⅡcolorectal cancer patients in order to contribute in treatment decisionmaking regarding chemotherapy administration.Thehypothetical predictive role of MSI regarding its response to 5-fluorouracil-based adjuvant chemotherapy has proven a much more difficult issue to address.Almost every possible relation between MSI and chemotherapy outcome has been described in the adjuvant colon cancer setting in the international literature,and the matter is far from being settled.In this current report we critically evaluate the prognostic and predictive impact of MSI status in patients with stageⅡand stageⅢcolon cancer patients.

Impact of lymphatic and/or blood vessel invasion in stage Ⅱ gastric cancer

AIM： To determine the prognostic value of lymphatic and/or blood vessel invasion （LBVI） in patients with stage 11 gastric cancer. METHODS： From January 2001 to December 2006, 487 patients with histologically confirmed primary gas- tric adenocarcinoma were diagnosed with stage 11 gas- tric cancer according to the new 7th edition American Joint Committee on Cancer stage classification at the Department of Gastric Cancer and Soft Tissue Surgery, Fudan University Shanghai Cancer Center. All patients underwent curative gastrectomy with standard lymph node （LN） dissection. Fifty-one patients who died in the postoperative period, due to various complications or other conditions, were excluded. Clinicopathologicalfindings and clinical outcomes were analyzed. Patients were subdivided into four groups according to the status of LBVI and LN metastases. These four patient groups were characterized with regard to age, sex, tumor site, pT category, tumor grading and surgical procedure （subtotal resection vs total resection）, and compared for 5-year overall survival by univariate and multivariate analysis. RESULTS： The study was composed of 320 men and 116 women aged 58.9 ± 11.5 years （range： 23-88 years）. The 5-year overall survival rates were 50.7% and the median survival time was 62 too. Stage Ⅱ a cancer was observed in 334 patients, including 268 T3N0, 63 T2N1, and three TIN2, and stage Ⅱb was observed in 102 patients, including 49 patients T3N1, 51 T2N2, one TIN3, and one T4aN0. The incidence of LBVI was 28.0% in stage II gastric cancer with 19.0% （51/269） and 42.5% （71/167） in LN-negative and LN- positive patients, respectively. In 218 patients （50.0%）, there was neither a histopathologically detectable LBVI nor LN metastases （LBVI-/LN-, group I）; in 51 patients （11.7%）, LBVI with no evidence of LN me- tastases was detected （LBVILN-, group 11）. In 167 patients （38.3%）, LN metastases were found. Among those patients, LBVI was not determined in 96 patients （22.0%） （LBVI-γLN, group Ⅲ）, and was determined in 71 patients （16.3%） （LBVI＋LN＋, group Ⅳ）. Correla- tion analysis showed that N category and the number of positive LNs were significantly associated with the presence of LBVI （P 〈 0.001）. The overall 5-year sur- vival was significantly longer in LN-negative patients compared with LN-positive patients （56.1% vs 42.3%, P = 0.015）. There was a significant difference in the overall 5-year survival between LBVI-positive and LBVI- negative tumors （39.6% vs 54.8%, P = 0.006）. Overall 5-year survival rates in each group were 58.8% （ Ⅰ）, 45.8% （Ⅱ）, 45.7% （Ⅲ） and 36.9% （Ⅳ）, and there was a significant difference in overall survival between the four groups （P=-0.009）. Multivariate analysis in stage 11 gastric cancer patients revealed that LBVI in- dependently affected patient prognosis in LN-negativepatients （P = 0.018） but not in LN-positive patients （P = 0.508）. CONCLUSION： In LN-negative stage 11 gastric cancer patients, LBVI is an additional independent prognostic markeF, and may provide useful information to identify patients with poorer prognosis.

Prognostic values of chromosome 18q microsatellite alterations in stage Ⅱ colonic carcinoma

AIM: To investigate the prognostic value of chromosome 18q microsatellite alterations (MA) in stage Ⅱ colon cancer. METHODS: One hundred and six patients with sporadic stage Ⅱ colon cancer were enrolled in this study. DNA was extracted from formalin-fixed, paraffin-embedded tumor and adjacent normal mucosal tissue samples. MA, including loss of heterozygosity (LOH) and microsatellite instability (MSI), was analyzed by polymerase chain reaction, polyacrylamide gel-electrophoresis and DNA sequencing at 5 microsatellite loci on chromosome 18q (D18S474, D18S55, D18S58, D18S61 and D18S64).RESULTS: Among the 102 patients eligible for MA information, the overall frequencies of LOH, high and low frequency MSI/microsatellite stable were 49.0%, 17.6% and 82.4%, respectively. The high frequency of 18q-LOH was signif icantly associated with the poor 5-year overall survival (OS) (P=0.008) and disease free survival (P=0.006). High levels of MSI were significantly associated with a longer 5-year OS (P=0.045) while the higher frequency of 18q-LOH at the loci of D18S474 and D18S61 was significantly associated with a poorer 5-year OS (P=0.010 and 0.005, respectively). But multivariate analysis showed that only the frequency of 18q-LOH was significantly associated with the prognosis of the disease. CONCLUSION: High frequency of 18q-LOH is an independent prognostic factor indicating poor prognosis of the patients with stage Ⅱ colon cancer.

Different strategies of treatment for uterine cervical carcinoma stage ⅠB2-ⅡB

Uterine cervical cancer is the second most common gynecological malignancy. It is estimated that over 35% of tumors are diagnosed at locally advanced disease, stage ⅠB2-ⅡB with an estimated 5-year overall survival of 60%. During the last decades, the initial treatment for these women has been debated and largely varies through different countries. Thus, radical concurrent chemoradiation is the standard of care in United Sated and Canada, and neoadjuvant chemotherapy followed by radical surgery is the first line of treatment in some institutions of Europe, Asia and Latin America. Until today, there is no evidence of which strategy is better over the other. This article describe the evidence as well as the advantages and disadvantages of the main strategies of treatment for women affected by uterine cervical cancer stage ⅠB2-ⅡB.

Macroscopic appearance of TypeⅣand giant Type Ⅲ is a high risk for a poor prognosis in pathological stage Ⅱ/Ⅲ advanced gastric cancer with postoperative adjuvant chemotherapy

AIM To evaluate whether a high risk macroscopic appearance(Type Ⅳ and giant Type Ⅲ) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage Ⅱ/Ⅲ(p Stage Ⅱ/Ⅲ) gastric cancer.METHODS One hundred and seventy-two advanced gastric cancer(defined as pT2 or beyond) patients with p Stage Ⅱ/Ⅲ who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined. RESULTS Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival(RFS)(35.7%) and overall survival(OS)(34%) than an average risk appearance(P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13^(th) Japanese Gastric Cancer Association(JGCA) pT(P = 0.01), but not with the 13^(th) JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13^(th) JGCA p Stage(P < 0.0001)and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified highrisk macroscopic appearance(P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator. CONCLUSION A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13^(th) JGCA stage in p Stage Ⅱ/Ⅲ advanced gastric cancer.

Successful Treatment of Postpeak Stage Patients with ClassⅡ Division 1 Malocclusion Using Non-extraction and Multiloop Edgewise Archwire Therapy: A Report on 16 Cases

Aim To determine cephalometrically the mechanism of the treatment effects of non-extraction and multiloop edgewise archwire （MEAW） technique on postpeak Class Ⅱ Division 1 patients. Methodology In this retrospective study, 16 postpeak Class Ⅱ Division 1 patients successfully corrected using a non-extraction and MEAW technique were cephalometrically evaluated and compared with 16 matched control subjects treated using an extraction technique. Using CorelDRAW software, standardized digital cephalograms preand post-active treatments were traced and a reference grid was set up. The superimpositions were based on the cranial base, the mandibular and the maxilla regions,and skeletal and dental changes were measured. Changes following treatment were evaluated using the paired-sample t-test. Student＇s t-test for unpaired samples was used to assess the differences in changes between the MEAW and the extraction control groups. Results The correction of the molar relationships comprised 54% skeletal change （mainly the advancement of the mandible） and 46% dental change. Correction of the anterior teeth relationships comprised 30% skeletal change and 70% dental change. Conclusion The MEAW technique can produce the desired vertical and sagittal movement of the tooth segment and then effectively stimulate mandibular advancement by utilizing the residual growth potential of the condyle.

Pattern of Refractive Correction and Timing of Stage Ⅱ IOL Implantation after Congenital Cataract Extraction

Congenital cataract occurs during infancy when the axial length and corneal and visual function are in the sensitive stages of rapid development..Inappropriate surgical intervention not only fails to restore visual function,.but also causes irreversible serious influences upon eyeball development in children diagnosed with congenital cataract. At present, the uncertainty of selection of intraocular lens(IOL) degrees during the eyeball development period is averted by using a main treatment of congenital cataract that includes two-stage surgery:.stage I cataract extraction and stage II IOL implantation. However, the accurate selection of a refractive correction method and the timing of IOL implantation during stage II surgery for aphakic eyes remains controversial following stage I cataract extraction..This review retrospectively summarizes the current progress and existing problems indicated by related recent studies focusing on refractive correction pattern and IOL implantation timing.

Construction of TGP StageⅡWorks

In the construction of Three Gorges Project, the total amount of concrete is about 28 Mm\+3 , and the total amount of metal works and reinforcement is approximately 0.72 Mt . The TGP is constructed in 3 stages . The preparation period together with the first stage is 5 years , the second stage and third stage are both 6 years .In the second stage construction of 6 years (1998～2003) , there are 18.46 Mm\+3 of concrete to be placed and 0.192 Mt of metal works and embedded parts for mechanical and electric equipment to be installed . In 1999, a world record of annual concrete placement of 4.585 Mm\+3 was set . In 2000, it is planned to place 5.4 Mm\+3 of concrete and to install 38 000 t of metal works . Construction equipments and layout of construction site , concrete production and its temperature control, metal works, mechanical and electric equipments in the second stage construction are presented.

The path toward prognostication and prediction in stage Ⅱ colon cancer

Currently,there are several newer biomarkers that may be clinically useful in colon cancer. This paper focuses on a few of these biomarkers,namely microsatellite instability,loss of heterozygosity at chromosome 18q(LOH18q) and multi-gene assays,and discusses the clinical evidence behind their predictive or prognostic abilities. The results show that although there have been several newer prognostic factors identified,such as LOH18 q and multi-gene assays,none of these factors can predict benefit from treatment. Therefore,ongoing prospective clinical trials are still needed to further assess the role and optimal use of these tests.

八段锦对冠心病PCI术后Ⅱ期心脏康复负性情绪及生活质量的影响

目的探讨八段锦对冠心病经皮冠状动脉介入治疗(PCI)术后Ⅱ期心脏康复患者负性情绪及生活质量的影响。方法将冠心病PCI术后Ⅱ期心脏康复患者80例随机分为对照组及治疗组,对照组采用常规治疗,治疗组在对照组的基础上增加八段锦康复锻炼。8周后,进行NT-proBNP、LVEF、6MWT检测及SDS、SAS、SF-36评分,观察不良事件发生情况。结果治疗后治疗组NT-proBNP较本组治疗前明显降低(P<0.05),LVEF、6MWT较对照组明显升高(P<0.05),SDS评分、SAS评分较对照组降低更明显,SF-36评分较对照组升高更明显(P<0.05);2组不良事件发生率无统计学差异(P>0.05)。结论八段锦健身功法能有效增强心脏功能,增加运动耐量,缓解PCI术后的焦虑、抑郁等不良心理状态,提高生活质量,促进全面恢复。

TITE(e)-U-Keyboard两阶段Ⅰ/Ⅱ期试验设计研究

目的针对肿瘤靶向制剂和细胞免疫疗法治疗效应延迟的问题,基于Ⅰ/Ⅱ期试验设计框架,构建创新试验设计方法TITE(e)-U-Keyboard。方法采用二项近似似然法纳入尚未观测到的有效性结局信息,构建近似分布,辅助决策,并将TITE(e)-U-Keyboard同Ⅰ/Ⅱ期试验设计方法U-BOIN、BOIN12从多个角度进行模拟比较研究。结果模拟结果显示在考虑有效性结局延迟的情况下三种方法的OBD选择准确率及最优剂量分配受试者数相当,但TITE(e)-U-Keyboard所需试验时长最短;敏感性分析表明有效性观察窗会对TITE(e)-U-Keyboard试验时长产生影响,且随着有效性观察窗的增加而增加。结论TITE(e)-U-Keyboard在保持良好试验设计性能的同时显著缩短了试验时长,可以解决Ⅰ/Ⅱ期临床试验中治疗效应延迟的问题,加速临床试验进程。

瓜蒌薤白半夏汤联合运动处方在冠心病稳定型心绞痛经皮冠状动脉介入术后患者Ⅱ期康复中的应用研究

目的:观察瓜蒌薤白半夏汤联合运动处方对冠心病稳定型心绞痛(SAP)经皮冠状动脉介入(PCI)术后患者的Ⅱ期康复效果。方法:选取SAP行PCI术后患者66例,随机分为对照组和治疗组各33例。2组均给予阿司匹林、氯吡格雷、他汀类降脂药物、β-受体阻滞剂、血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)以及降糖药等治疗;对照组联合运动处方干预;治疗组在对照组的基础上加用瓜蒌薤白半夏汤内服。2组疗程均为6个月。比较2组临床疗效、治疗前后心功能指标[心率无氧阈值(AT)、每公斤耗氧量运动峰值(VO_(2max))、代谢当量(METS)、射血分数(EF)]、再狭窄发生率。结果:治疗组临床总有效率为96.97%,对照组为75.76%,2组比较,差异有统计学意义(P<0.05)。治疗前,2组心功能指标AT、VO_(2max)、METS、EF水平比较,差异无统计学意义(P>0.05);治疗后,2组AT值明显较治疗前降低(P<0.05),2组VO_(2max)、METS、EF较治疗前明显升高(P<0.05),且治疗组以上指标改善均明显优于对照组(P<0.05)。术后6个月,治疗组冠动脉再狭窄发生率为3.03%,显著低于对照组24.24%,差异有统计学意义(P<0.05)。结论:瓜蒌薤白半夏汤联合运动处方干预SAP经PCI术后患者疗效显著,可改善Ⅱ期康复患者的心功能,减少冠状动脉再狭窄的发生。

SÄNGERⅡ高超声速计划推进系统综述

介绍了世界上首次针对涡轮冲压组合循环动力开展深入论证和试验的德国桑格尔(SÄNGER Ⅱ)高超声速计划。详细阐述了SÄNGER Ⅱ空间运输系统的总体设计、两级入轨推进系统方案的关键技术及其验证、飞发一体化、热管理系统和二动力系统。尽管因各种原因,SÄNGER Ⅱ高超声速计划未能成功现实,但借助该计划研发了大量的先进技术,且在高超声速飞行器设计方案、分析方法、试验验证等方面都取得了宝贵的经验,可为我国组合动力及其他高超声速工程研制提供参考。

443例Ⅱ期结直肠癌患者预后分析及辅助化疗的必要性

背景与目的:Ⅱ期结直肠癌患者的预后差异较大,且术后辅助化疗的必要性尚无定论,本研究旨在分析Ⅱ期结直肠癌患者术后的预后影响因素并探讨术后辅助化疗的必要性。方法:对2000年1月至2005年1月在中山大学肿瘤防治中心行结直肠癌根治术的443例Ⅱ期结直肠癌患者的临床资料进行统计,用Kaplan-Meier法计算生存率、绘制生存曲线,对可能影响患者生存时间的因素进行单因素和Cox多因素模型分析。对具有2008NCCN指南所述的预后不良因素(肠梗阻或穿孔、组织学分化差、送检淋巴结少于9枚、T4分期)的结肠癌患者亚组,再按照有无术后辅助化疗(XELOX或FOLFOX方案)进行分类,同样用Kaplan-Meier法和log-rank法进行计算和检验。结果:443例患者的中位随访时间为59个月,总的3年、5年生存率分别为88.4%、82.5%。Cox单因素和多因素分析显示,术前有无肠梗阻或穿孔、有无糖尿病、大体标本切缘与肿瘤的距离、送检淋巴结是否大于9枚是Ⅱ期结直肠癌最重要的预后因素。术前有肠梗阻或穿孔、送检淋巴结少于9枚的Ⅱ期结癌患者经辅助化疗后,5年生存率(分别为80%、86%)高于未化疗组(分别为67%、64%)。结论:术前伴有梗阻或穿孔、2型糖尿病、淋巴结检出数目少于9枚和切缘小于1cm的Ⅱ期结直肠癌患者预后较差;具有肠梗阻或穿孔、淋巴结送检数目少于9枚的Ⅱ期结肠癌患者可能从辅助化疗中获益。

健脾消积口服液结合西药治疗Ⅱ、Ⅲ期肝癌40例的临床观察

目的:探讨健脾消积口服液结合西药治疗Ⅱ、Ⅲ期肝癌的临床疗效。方法:将75例Ⅱ、Ⅲ期肝癌患者按数字表法随机分为治疗组(40例)与对照组(35例),两组患者均采用相同的西药疗法,治疗组同时加用健脾消积口服液治疗。观察近期疗效、生存质量、中医证候变化、免疫学等指标变化。结果:治疗组与对照组完全缓解率分别为5％、0,稳定分别为62.5％、37.1％;生存质量:总改善率分别为47.5％、25.7％;证候改善率分别为80.0％、54.3％,两组间比较,差异均有显著性(P<0.01)。两组治疗前T淋巴细胞亚群比较差异无显著性,治疗组治疗后与治疗前比较,除CD_8外,CD_3、C_3D和CD_4。/CD_8比值改善,差异均有显著性(P<0.05或P<0.01),且优于对照组治疗后(P<0.05或P<0.01)。结论:健脾消积口服液可提高Ⅱ、Ⅲ期肝癌患者的生存质量,延长生存时间,并有提高细胞免疫功能的作用。

Ⅱ-32A育性光温反应及敏感生育期的研究

利用人工气候箱研究了广东湛江和福建提纯的Ⅱ 32A育性对温度和光长的反应以及育性的温度敏感生育期。结果表明 2 6℃以上温度可引起Ⅱ 32A育性的部分恢复 ,温度越高 ,育性恢复越大。福建提纯的Ⅱ 32A育性恢复还受短光长促进 ,并存在光温互作效应。Ⅱ 32A育性的温度敏感生育期出现得特别早 ,为第 1苞分化期至花粉母细胞形成期与减数分裂期之间 ,最敏感生育期为二次枝梗原基和颖花原基分化期至雌雄蕊原基形成期之间。因此 ,Ⅱ

Ⅰ、Ⅱ期乳腺癌保乳根治术加放疗的临床分析

目的比较Ⅰ、Ⅱ期乳腺癌保乳根治术加放疗与改良根治术的临床疗效。方法回顾性分析我院2002年1月～2006年12月实施保乳手术加放疗(保乳组)的106例及改良根治术(对照组)的131例Ⅰ、Ⅱ期乳腺癌患者的临床资料,比较两组的疗效。结果与对照组比较,保乳组术后拔管时间短、并发症发生率低,并且美容效果评价的优良率明显高于对照组;两组的5年生存率及无病生存率相似,差异无统计学意义(P>0.05)。结论保乳手术加放疗可达到与改良根治术相似的生存率,且手术并发症发生率低,美容效果好,是Ⅰ、Ⅱ期乳腺癌治疗的首选方式。

Ⅱ、Ⅲ期子宫颈癌放疗后2年内267例死因探讨

目的 探讨Ⅱ、Ⅲ期子宫颈癌患者放疗后2 年内死亡的首发原因及改进治疗的对策。方法 对山东省肿瘤防治研究院妇瘤科自1985 年初至1996 年6 月经单纯放射治疗后2 年内死亡的267例子宫颈癌患者的临床资料进行回顾性分析并复习有关文献。结果 全部患者均采用规范、全量盆腔体外照射+ 后装治疗,患者年龄30～75 岁,中位年龄52.7 岁。治疗后2 年内死亡的首发原因为局部未控及复发者122 例,占45.7 % ;盆腔未控及复发者56 例,占21.0 % ;远处转移者71 例,占26.6 % ,死于放疗并发症者18 例,占6.7 % 。结论 Ⅱ、Ⅲ期子宫颈癌患者治疗后近期内死亡原因以局部未控、复发多见,其次为远处转移,预后与年龄无明显相关。治疗剂量达常规量后再增加放疗剂量并不能提高局部或盆腔控制率,所以应重视综合疗法在高危型宫颈癌中的应用。放射性直肠炎、膀胱炎与后装治疗剂量有直接关系。