卵巢癌患者组织中lncRNA NEAT1和CTBP2表达水平及其与临床病理特征的关系

目的探讨卵巢癌患者组织中长链非编码RNA(lncRNA)NEAT1和羧基末端结合蛋白2(CTBP2)表达水平及其与临床病理特征的关系。方法采集2013年1月至2016年1月收治的60例卵巢癌患者的癌组织及其配对的癌旁组织。采用实时荧光定量PCR方法检测lncRNA NEAT1和CTBP2在癌组织及癌旁组织的表达,并分析二者表达与卵巢癌患者临床病理特征及预后的关系。结果 lncRNA NEAT1和CTBP2在卵巢癌组织中的表达量明显高于癌旁组织(P0.05);lncRNA NEAT1和CTBP2表达与年龄、组织学类型、肿瘤直径均无相关性(P0.05);与FIGO分期、肿瘤分级、淋巴结转移密切相关(P0.01);随着癌组织中lncRNA NEAT1表达水平升高,CTBP2表达呈明显升高趋势,lncRNA NEAT1与CTBP2表达呈显著正相关(r=0.562,P=0.001);lncRNA NEAT1高表达组预后2年存活率为55.50%,lncRNA NEAT1低表达组预后2年存活率为70.00%,lncRNA NEAT1高表达组存活率显著低于低表达组存活率,两组比较差异有统计学意义(χ~2=5.00,P=0.025);CTBP2高表达组预后2年存活率为51.70%,CTBP2低表达组预后2年存活率为68.30%,CTBP2高表达组存活率显著低于低表达组存活率,两组比较差异有统计学意义(χ~2=6.106,P=0.013)。结论 lncRNA NEAT1和CTBP2在卵巢癌患者组织中高表达,两者具有相关性,且与FIGO分期、肿瘤分级、淋巴结转移以及预后密切相关,可作为卵巢癌的早期诊断标记与治疗靶点。     

乳腺癌组织中lncRNA PVT1 的表达与患者临床特征及总体生存率的关系

目的　探讨乳腺癌组织中lncRNA PVT1 的表达与患者临床特征及总体生存率的关系。方法　采用实时荧光 定量PCR 法检测乳腺癌组织及其相应癌旁正常组织中lncRNA PVT1 的相对表达量;分析lncRNA PVT1 表达水平与 乳腺癌患者临床特征与总体生存率间的关系。结果　lncRNA PVT1 在乳腺癌组织中的相对表达量显著高于癌旁正常 组织(0.007 5 vs 0.003),其差异具有统计学意义(P=0.0186)。lncRNA PVT1 表达水平与乳腺癌患者的年龄(χ2=5.948, P=0.015)、临床分期(χ2=12.349,P=0.006)、淋巴结转移(χ2=20.942,P<0.001)、远端转移(χ2=5.330,P=0.021) 和 Her2(χ2=5.221,P=0.022) 显著相关。lncRNA PVT1 高表达组患者的总体生存率(overall survival, OS) 显著低于lncRNA PVT1 低表达组,差异具有统计学意义(P=0.036)。结论 　lncRNA PVT1 是一种可预测乳腺癌患者预后的有潜力的生物 学指标。     

长链非编码RNA ZFAS1在非小细胞肺癌患者组织中表达及作用

目的检测非小细胞肺癌(NSCLC)患者癌组织中锌指结构反义转录本1(zinc finger antisense 1,ZFAS1)表达水平,探讨ZFAS1在NSCLC进展中的生物学作用。方法实时荧光定量RT-PCR检测ZFAS1在NSCLC患者癌组织和癌旁组织中的表达水平。RNA干扰ZFAS1在A549细胞中表达,细胞计数和克隆形成实验检测细胞增殖情况,流式分析检测细胞周期和细胞凋亡,Transwell迁移和基质胶侵袭实验检测细胞迁移和侵袭能力,实时荧光定量RT-PCR检测Cyclin D1、Bcl2、N-cadherin、ZEB1、Slug和Twist基因表达水平变化。结果 ZFAS1在NSCLC患者癌组织中的平均表达水平[0.01(0.002,0.054)]较癌旁组织[0.002(0.001,0.012)]明显升高(Z=-2.638,P0.01)。ZFAS1基因敲减后,A549细胞增殖能力明显减弱(P0.01);A549细胞周期G1期比例升高,S期比例下降(P0.01);A549细胞凋亡比例明显增加(P0.01);A549细胞迁移和侵袭能力明显下降(P均0.01);A549细胞中Cyclin D1、Bcl2、N-cadherin、ZEB1、Slug和Twist基因表达水平均降低(P均0.05)。结论 ZFAS1在NSCLC患者癌组织中呈高表达。ZFAS1基因敲减诱导细胞周期阻滞、凋亡和抑制上皮-间质转变(EMT),减弱NSCLC细胞增殖、迁移和侵袭能力。     

长链非编码RNA 91H对食管鳞癌组织中IGF2表达的调控作用及机制研究

目的探索长链非编码RNA(lncRNA)91H对食管鳞癌(ESCC)组织中胰岛素样生长因子2(IGF2)异常表达的调控机制,评价其在ESCC发生、发展中的作用。方法收集232例ESCC患者癌组织和癌旁组织标本以及食管鳞癌细胞系TE-1和Eca-109,用实时荧光定量PCR及免疫荧光法检测其91H和IGF2的表达水平,亚硫酸氢盐修饰后测序法(BSP)检测印记基因H19调控区域(ICR)的甲基化程度。结果肿瘤患者浸润程度越深、肿瘤等级和TNM分期越高,91H的表达量越低而IGF2表达量越高(P0.05),用91H RNA干扰后,TE-1细胞IGF2 mRNA的表达水平为4.91±1.68,明显高于阴性对照组1.38±0.61(P0.05);Eca-109细胞IGF2 mRNA的表达水平为3.62±1.44,明显高于阴性对照组1.75±1.00(P0.05);经5-aza-CdR去甲基化处理后,细胞甲基化程度越低,91H表达水平越高(P0.05)。结论 lncRNA 91H的表达与H19 ICR区甲基化程度密切相关,其对IGF2表达起抑制作用,提示lncRNA 91H可作为一个新的遗传学标志物。     

结合基序蛋白6在结直肠癌组织中的表达及临床意义

目的探讨RNA结合基序蛋白6(RBM6)在结直肠癌(CRC)中表达水平及临床病理学意义。方法应用免疫组织化学方法检测92例配对的CRC及癌旁组织石蜡包埋标本RBM6表达水平,观察其与CRC病人临床病理学参数的关系;再以Western印迹和qRT-PCR检测28例配对冷冻保存的新鲜CRC及癌旁组织中RBM的蛋白和mRNA表达水平。结果免疫组化结果显示:RBM6在92例CRC表达明显高于癌旁组织表达水平(癌组织30.4%,28/92vs癌旁10.9%,10/92;P0.01)。卡方检验显示:RBM6的表达与CRC肿瘤的大小、分化程度、浸润深度及淋巴结转移无明显相关性(P0.05),但与患者TNM分期和远处转移呈正相关(P=0.026,P=0.021)。单因素分析发现:RBM6高表达CRC患者预后更差(P=0.024)。qRT-PCR和Western印迹结果显示:RBM6在CRC中蛋白和mRNA表达均高于配对癌旁组织(P0.01;P=0.009)。结论 RBM6在CRC中呈高表达,并与患者临床分期、远处转移及不良预后相关,可能参与CRC的恶性进展。     

PTPN12蛋白表达下调与原发性肝细胞癌患者复发和预后关系研究

目的探讨非受体蛋白酪氨酸磷酸酶12(PTPN12)在肝癌组织与其癌旁组织中的表达并研究其表达与原发性肝细胞癌预后的关系。方法以肝癌组织与其癌旁组织为研究对象,用免疫组化法检测肝癌组织及癌旁肝组织的PTPN12蛋白的表达。用等级相关和Cox比例风险回归模型等评估PTPN12蛋白的表达与原发性肝细胞癌预后的关系。结果与癌旁肝组织相比,在肝癌组织中的PTPN12蛋白表达明显下调(55.83%vs.43.12%,P0.005)。进一步的相关分析表明PTPN12蛋白表达降低与肿瘤复发密切相关(χ~2=4.346,P=0.015);单因素分析结果表明肝癌PTPN12表达降低与肝癌肿瘤特异生存率和肝癌复发相关(χ~2=5.687,P0.001);多变量Cox比例风险回归模型分析发现PTPN12表达是肝癌患者预后的独立因素(χ~2=6.687,P0.05)。结论 PTPN12蛋白在人肝癌组织中表达下降或缺失,PTPN12表达可能作为肝细胞癌患者复发和预后的生物标志物。     

高表达miR-155对结直癌患者预后影响的研究

目的探究高表达的micro RNA-155(mi RNA-155,mi R-155)对结直肠癌(CRC)患者临床预后的影响。方法利用q RT-PCR对94例CRC患者病理标本中mi R-155的表达水平进行定量检测,取中位表达水平为截断值将全部病例分为mi R-155高表达组和mi R-155低表达组,随后分别运用t检验、χ2检验或绘制Kaplan-Meier曲线研究不同表达情况的mi R-155与CRC患者临床病理特征和五年生存率的关系。结果研究结果表明:(1)mi R-155在CRC患者癌组织中的表达水平明显高于癌旁正常组织,差异具有统计学意义(t=11.35,P=0);(2)相比mi R-155低表达组,mi R-155高表达组与CRC患者的淋巴转移(χ2=8.436,P=0.004)、远处转移(χ2=4.398,P=0.036)、较高的TNM分期(χ2=6.198,P=0.013)以及肿瘤复发(χ2=4.663,P=0.031)有着显著的关系,而与年龄、性别、肿瘤尺寸、肿瘤位置、浸润深度和分化程度无显著的联系;(3)进一步绘制Kaplan-Meier曲线表明,mi R-155高表达组与mi R-155低表达组CRC患者的五年生存率分别为40.4%和61.7%,并且差异具有统计学意义(P=0.026)。结论高表达的mi R-155与CRC患者多种糟糕的临床病理特征和较差的五年生存率有着显著的联系,故mi R-155可能成为CRC患者潜在预后评估标记物。     

miR-494在乳腺癌中的表达及其临床意义

目的探讨miR-494在乳腺癌组织和乳腺癌细胞系中的表达及其与乳腺癌临床分期、转移和预后的关系。方法实时荧光定量聚合酶链反应(qRT-PCR)检测5种乳腺癌细胞系MDA-MB-231、MDA-MB-453、HCC-1937、MDA-MB-468、MCF-7和乳腺上皮细胞系HBL-100中miR-494的表达水平;收集54对乳腺癌组织和癌旁组织,用qRT-PCR法检测其miR-494的表达水平,并分析其与乳腺癌临床分期、转移和预后的关系。结果 qRT-PCR检测结果显示,与正常乳腺上皮细胞HBL-100相比,MDA-MB-231、MDA-MB-453、HCC-1937、MDA-MB-468、MCF-7乳腺癌细胞系中miR-494的表达水平均明显降低(t分别为212.9、37.73、27.53、10.61、19.46,P均0.05)。此外,miR-494在乳腺癌组织中的表达水平亦明显低于癌旁组织(t=5.80,P0.01),且与临床分期(χ2=17.41,P0.05)、组织病理分级(χ2=5.33,P0.05)、C-erb B-2表达情况(χ2=9.83,P0.05)、Ki-67阳性细胞百分比(χ2=6.13,P0.05)有关。结论 miR-494在乳腺癌组织和乳腺癌细胞系中低表达,且与乳腺癌临床分期、转移和预后关系密切,可成为乳腺癌辅助诊断和预后判断的分子标志。     

肾细胞癌组织Pax-2表达临床意义的初步研究

目的研究Pax-2在各类型肾细胞癌中的表达的差异,探讨它与肾细胞癌的临床诊断及预后的意义。方法运用免疫组织化学SP法检测Pax-2在73例肾细胞癌和19例癌旁正常肾组织中的表达,结合实验数据及相关研究资料,分析其与肾细胞癌病理特征关系。结果 Pax-2在肾细胞癌中总的阳性表达率为73.97%(54/73),透明细胞癌中的阳性表达率为84.85%(28/33),在乳头状细胞癌中的阳性表达率为70.00%(14/20),在嫌色细胞癌中的阳性表达率为60.00%(12/20),正常肾组织中阳性表达率为10.53%(2/19)。肾细胞癌的总阳性表达率明显高于正常肾脏组织,两者差异具有统计学意义(χ2=25.479,P=0.000)。Pax-2在肾细胞癌中的表达与临床分期(χ2=4.852,P=0.026)、病理分级(χ2=5.532,P=0.019)、淋巴结转移(χ2=3.886,P=0.049)有关;而与患者性别(χ2=1.301,P=0.254)、年龄(χ2=0.723,P=0.394)及病理类型(χ2=4.219,P=0.121)无关。结论 pax-2可能为肾细胞癌的诊疗及预后的评估提供了分子水平方面的参考新指标。     

外周血游离线粒体DNA定量检测在结直肠癌患者中的表达及意义

目的评价外周血游离线粒体DNA(circulating cell free mitochondrial DNA, CCF mtDNA)在结直肠癌(colorectal cancer, CRC)患者组织中的表达及其临床意义。方法收集102例CRC患者的癌组织及癌旁组织标本、30例原发性CRC患者及体检健康者血浆标本,实时荧光定量PCR检测各组CCF mtDNA的表达水平,并分析CCF mtDNA含量与CRC患者临床病理参数的关系。ROC曲线分析其作为CRC筛查标志物的效能。结果 CRC患者癌组织中的CCF mtDNA含量(85.94±4.54)明显低于癌旁组织(183.10±7.59),差异有统计学意义(t=11.04,P0.05)。低分化癌组织中的CCF mtDNA含量(57.75±5.26)明显低于中分化(92.64±5.68)及高分化(110.00±14.95)癌组织,差异有统计学意义(F=8.42,P0.05)。CCF mtDNA含量高低与CRC患者的预后无关(χ~2=0.261,P=0.610)。CCF mtDNA筛查CRC的AUC~(ROC)为0.921,敏感性为0.833,特异性为0.933。结论 CCF mtDNA含量在癌组织中下降,但与预后无关,可能作为CRC的筛查标志物。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.