宫颈上皮内瘤变p16、p53、Ki-67的表达与高危型HPV感染及其临床意义

目的 研究p16、p53、Ki-67在宫颈上皮内瘤变(CIN)中的表达,探讨其与高危型HPV感染的关系及临床意义.方法 利用自制组织芯片对243例CIN病变上皮和30例正常上皮行免疫组化染色检测p16、p53及Ki-67表达情况,部分CIN病例用基因杂交捕获法检测高危型HPV感染情况.结果 正常鳞状上皮与腺上皮p16、Ki-67和p53染色均为阴性,而在CIN中三者均有较高表达,且随CIN级别升高而表达增强,各组间有差别并与CIN分级呈正相关(P＜0.001).同时二者阳性表达均见分层现象,在CIN1中大部分阳性细胞局限于宫颈鳞状上皮的下1/3,在CIN2中累及上皮下2/3,而CIN3则多超过上皮的下2/3或全层弥漫阳性,各组间有差别且与CIN分级呈正相关(P＜0.001).p53的阳性率及表达强度从CIN1到CIN3逐渐增加,多组之间及CIN1与CIN2比较有差别且与CIN分级呈正相关(P＜0.001),但CIN2与CIN3之间无差别.部分CIN1、CIN2及CIN3患者高危型HPV-DNA阳性率分别为37/52(71.2%)、50/58(86.2%)和50/55(90.9%),DNA相对含量多组之间及CIN1与CIN2比较有差别并与CIN分级呈正相关(P＜0.001),CIN2与CIN3之间无差别.结论 高危型HPV感染及p16、Ki-67及p53与宫颈癌前病变发生机制及病变进展相关,而联合检测p16蛋白和Ki-67抗原表达可作为CIN分级诊断的辅助方法,有较好的应用价值.     

p16基因蛋白在宫颈癌中的表达

目的:观察细胞周期调节蛋白抑制因子p16在宫颈癌组织中的表达,并探讨其与宫颈癌的关系。方法:应用SP免疫组化法检测11例正常宫颈上皮,9例宫颈上皮内瘤样病变(CIN)和48例宫颈癌石蜡包埋组织切片中p16基因蛋白表达情况。统计处理用SSPS10.0软件分析系统。结果:在正常宫颈上皮、CIN和宫颈癌组织中,p16表达的阳性率分别为18.18％、66.67％、87.50％。从正常宫颈到CIN到宫颈癌组织中p16表达呈现逐渐升高的趋势。宫颈癌组织p16表达明显高于正常宫颈组织,具有极显著性差异(P<0.001),CIN和正常宫颈上皮比较,p16表达无显著性差异(P>0.05)。p16表达与宫颈癌的临床分期、组织类型、分化程度以及淋巴结转移均无显著相关性(P>0.05)。结论:细胞周期调节蛋白抑制因子p16基因蛋白高表达参与宫颈癌的癌变过程。     

P53、P16在宫颈病变组织的表达及意义

目的 探讨P53、P16在宫颈病变组织的表达及临床意义.方法 应用免疫组化SP法检测66例官颈上皮内瘤变(CIN)和36例宫颈鳞癌P53、P16的表达,另选取20例正常宫颈组织作为对照.结果 P53在正常宫颈组织、CIN和宫颈鳞癌中阳性率分别为5.00%、60.61%及86.11%,差异有统计学意义(P<0.05);P53表达强度随宫颈CIN分级增加而增加,表达有统计学意义(P<0.05).P16在正常宫颈组织、CIN和宫颈鳞癌中阳性率分别为5.00%、89.39%及100.00%,差异有统计学意义(P<0.05);P16表达强度随宫颈CIN分级增加而增加,差异有统计学意义(P<0.05).结论 P53和p16与宫颈癌前病变发生机制及病变进展相关,其检测可作为宫颈CIN分级与鳞癌诊断的重要辅助指标.     

p16和p53蛋白在宫颈上皮内瘤变中的表达及与HPV16/18感染的关系

目的 观察p16和p53蛋白在宫颈上皮内瘤变(CIN)中的表达,以及与人乳头瘤病毒(HPV) 16/18感染的关系,探讨其在CIN演变过程中的作用及在CIN分级诊断中的应用价值.方法 应用免疫组化S-P法检测96例CIN中p16和p53蛋白的表达,HPV16/18感染通过基因芯片技术检测.结果 在CIN中p16和p53蛋白均有较高表达,且随CIN级别升高而表达增强,其差异有统计学意义(p16:x2=9.41,P＜0.05;p53:x2=11.13,P＜0.05).p16蛋白表达在HPV16/18阳性组中的阳性率明显高于HPV16/18阴性组,其差异有统计学意义(x2=6.618,P＜0.05),而p53蛋白表达在HPV16/18阳性组与阴性组间比较差异无统计学意义(x2=1.328,P＞ 0.05).结论 在CIN中HPV16/18感染可能引发了p16蛋白的异常表达,进而引起细胞的转化和癌变,而p53蛋白的异常表达可能参与了CIN的发生,但不占主导地位;另外p16和p53蛋白的表达随CIN级别的增加而增加,可作为CIN分级诊断的辅助方法,具有较好的应用价值.     

EGFR和p16在宫颈上皮内瘤变及宫颈癌中的表达

目的:探讨EGFR和p16表达在宫颈上皮瘤样病变(CIN)及宫颈癌中表达的意义。方法:对正常宫颈上皮、CIN和宫颈癌组织共99例,采用免疫组化S-P法,对宫颈癌变过程中EGFR和p16蛋白进行研究,将结果进行统计学分析。结果:EGFR在CIN和宫颈癌的表达高于正常宫颈上皮;p16蛋白在CIN和宫颈癌的表达高于正常宫颈上皮。结论:EGFR和p16蛋白的表达与宫颈癌的发生有关,可作为评价子宫颈癌恶性程度的指标。     

宫颈癌组织中Annexin A2和Ki-67蛋白的表达

目的:探讨宫颈癌组织中Annexin A2和细胞核增殖抗原(Ki-67)蛋白的表达.方法:采用免疫组化SP法检测74例宫颈癌组织、24例宫颈上皮内瘤变(CIN)组织及15例正常宫颈上皮组织中Annexin A2和Ki-67蛋白的表达,并分析其与宫颈癌患者临床病理特征的关系.结果:①从正常宫颈组织→CIN组织→宫颈癌组织,Annexin A2蛋白阳性表达率逐渐增高[(13.3%(2/15),37.5%(9/24)和71.6%(54/74)],差异有统计学意义(χ2=23.155,P＜0.001);宫颈癌组织中其阳性表达率高于CIN组织和正常宫颈组织(P均＜0.001),CIN组织与正常宫颈组织中其阳性表达率差异无统计学意义(P＞0.05);Annexin A2蛋白表达与宫颈癌患者的年龄(χ2=7.320,P=0.007)、组织类型(χ2=7.619,P=0.006)、病理分级(χ2=6.118,P=0.013)和淋巴结转移(P=0.015)有关.②从正常宫颈组织→CIN组织→宫颈癌组织,Ki-67蛋白阳性表达率逐渐增高[26.7%(4/15),37.5%(9/24)和82.4%(61/74)],差异有统计学意义(χ2=23.041,P＜0.001);宫颈癌组织中Ki-67蛋白阳性表达表达率高于CIN组织和正常宫颈组织(P均＜0.001),CIN组织与正常宫颈组织中其阳性表达率差异无统计学意义(P＞0.05);Ki-67蛋白表达与宫颈癌患者的年龄(χ2=6.830,P=0.008)、病理分级(χ2=3.972,P=0.046)和l临床分期(P=0.036)有关.结论:Annexin A2和Ki-67可作为宫颈癌诊断的辅助指标,对评价宫颈组织的恶性程度及预后可能有一定的参考价值.     

E-cadherin、p16及Ki67在宫颈上皮内瘤变诊断中的应用

目的探讨联合检测E-cadherin、p16、Ki67的表达在子宫颈上皮内瘤变(CIN)中的诊断价值。方法采用免疫组织化学方法检测20例正常宫颈组织、40例CINⅠ、40例CINⅡ及40例CINⅢ中的E-cadherin、p16和Ki67的表达。结果 E-cadherin在正常宫颈、CINⅠ、CINⅡ、CINⅢ中的表达率分别为100%,80%,40%,37.5%;p16在正常宫颈、CINⅠ、CINⅡ、CINⅢ中的表达率分别为0,65%,87.5%,95%;Ki67在正常宫颈、CINⅠ、CINⅡ、CINⅢ中的表达率分别为0,82.5%,92.5%,100%。在低级别上皮内瘤变CINⅠ中,E-cadherin表达于细胞膜,p16表达在上皮的下1/3,Ki67增殖指数较低;在高级别上皮内瘤变CINⅡ-Ⅲ中,E-cadherin异常表达于细胞膜和细胞质,p16弥漫表达于上皮的2/3到上皮全层,Ki67增殖指数较高。结论生物标志物E-cadherin、p16及Ki67对准确地诊断宫颈上皮内瘤变及其分级,并且评估病变的发展具有重要意义。     

p16蛋白在宫颈上皮内瘤变中的表达及临床意义

目的探讨p16蛋白在宫颈上皮内瘤变诊断和分级中的意义,以指导宫颈上皮内瘤变和宫颈癌的治疗。方法采用免疫组织化学方法（S-P法）检测15例正常宫颈组织、15例反应性增生、60例不同级别宫颈上皮内瘤变和20例宫颈癌中p16的表达情况。结果在正常宫颈组织中p16蛋白呈阴性表达,p16的表达强度CINⅠ〈CINⅡ〈CINⅢ〈CC;不同级别宫颈上皮内瘤变p16的表达差异有统计学意义（P〈0．01）。结论p16在不同级别宫颈上皮内瘤变的分流诊断中有重要意义,可作为早期诊断宫颈癌前病变及宫颈癌的标记物,提高宫颈癌的早期诊断率。     

CIN和宫颈浸润癌组织中p16INK4a蛋白表达检测的意义

目的 研究p16INK4a蛋白表达在宫颈浸润癌前病变(CIN)和宫颈浸润癌组织中的意义.方法 应用免疫组化技术对68例CIN和36例宫颈浸润癌病变组织中p16INK4a蛋白表达进行检测.结果 CIN组中p16INK4a蛋白表达阳性率为39.7%(27/68),其中CIN Ⅰ为24.0%(6/25),CIN Ⅱ为36.4%(8/22),CIN Ⅲ为61.9%(13/21).CIN组中p16INK4a蛋白表达阳性率3组间的差别有统计学意义(P=0.03).宫颈浸润癌组织中p16INK4a蛋白表达阳性率为66.6%(24/36).CIN组中p16INK4a蛋白表达阳性率低于宫颈浸润癌组,差别有统计学意义(P=0.009).p16INK4a蛋白阳性表达率依次为宫颈浸润癌＞CIN Ⅲ＞CIN Ⅱ＞CIN Ⅰ,差异有统计学意义(P=0.004).正常宫颈上皮和宫颈糜烂组中未发现有p16INK4a蛋白表达阳性细胞.p16INK4a蛋白过度表达现象( ～ )在CIN为23.5%(16/68),宫颈浸润癌为61.1%(22/36),两组间差别有统计学意义(P=0.0001).CIN组中p16INK4a蛋白过度表达现象分别为CIN Ⅲ(47.6%)＞CIN Ⅱ(18.2%)＞ CIN Ⅰ(8.0%),3组间的差别有统计学意义(P=0.005).p16INK4a蛋白过度表达现象在CIN Ⅲ和宫颈浸润癌明显要多于CIN Ⅱ和CIN Ⅰ.结论 p16INK4a蛋白表达的检测可能作为在CIN人群中筛选高危个体的标志物.尤其是有过度表达现象出现时的意义更大.     

p16蛋白在宫颈上皮内瘤样病变和宫颈鳞癌中的表达及意义

目的 探讨p16蛋白在宫颈鳞癌(SCC)和宫颈上皮内瘤样病变(CIN)中的表达及意义.方法 应用免疫组化技术,检测12例SCC、53例CIN和30例慢性宫颈炎中p16蛋白的表达情况.结果 p16蛋白在SCC和CIN中的阳性率(91.7%和83.0%)均高于慢性宫颈炎(13.3%),差异有显著意义(P＜0.01);CIN与SCC中的阳性率差异无显著意义(P＞0.05).结论 p16蛋白在CIN、SCC中的表达明显增加.提示它可作为发现宫颈癌早期病变的辅助标记物之一.     

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…     

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.     

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.