结肠腺瘤组织中P^53蛋白表达及其临床意义

目的评估结肠腺瘤组织中Ｐ５３蛋白表达的临床意义。方法应用免疫组化ＬＳＡＢ方法,采用单克隆抗体ＤＯ－７检测５６例结肠腺瘤组织中Ｐ５３蛋白的表达。结果增生性息肉和轻度异型增生腺瘤Ｐ５３表达均为阴性,随着腺瘤不典型增生程度的加重。Ｐ５３表达阳性率增高,染色逐渐加深。当腺瘤癌变时Ｐ５３反应最强,不同类型腺瘤中Ｐ５３表达显著不同（Ｐ＜００５）。结论检测结肠腺瘤组织中Ｐ５３蛋白表达,对判断腺瘤的癌变倾向有重要意义。     

大肠癌组织p16蛋白表达与临床病理关系的探讨

 目的研究大肠癌组织p 16蛋白表达及其与临床病理学特征的关系.方法采用免疫组织化学ABC法检测53例大肠癌组织中p 16蛋白的表达.结果大肠癌组织中p 16蛋白表达率为35.8%,p 16表达随肿瘤分化程度的降低而减弱(P＜0.05).Dukes分期,AB期p 16表达率高于CD期,分别为51.5%和10.0%,有显著性差异(P＜0.05).结论p 16蛋白表达缺失与大肠癌发生有关,并可作为临床判断肿瘤分化程度及Dukes分期的重要参考指标.     

大肠癌E2F -1、CyclinD1的表达及其意义

 目的 探讨E2F -1和cyclinD1在大肠腺癌组织中的表达及其意义 方法 采用脱氧核糖核酸末端转移酶介导的TUNEL法缺口末端标记和免疫组化SP法检测大肠腺癌78例、正常大肠黏膜20例、大肠息肉30例,以及大肠腺瘤细胞30例的原位凋亡(Al)及E2F-1和cyclin D1的表达情况.结果 E2F-1和cyclin D1在大肠腺癌中的阳性率显著高于正常大肠黏膜、大肠息肉以及大肠腺瘤(P＜0.05).E2F-1表达与大肠腺癌的病理分化程度、淋巴结转移和临床分期具有相关性(P＜0 05).从正常大肠黏膜、大肠息肉、大肠腺瘤到大肠腺癌细胞凋亡呈梯度降低.结论 E2F -1和cyclinD1的表达与大肠腺癌发生关系密切,是大肠腺癌发生、发展的重要生物学标记物     

Survivin在结直肠腺癌、腺瘤和癌旁正常组织中的表达及临床意义

目的通过对Survivin蛋白在结直肠腺癌组织、腺瘤组织和癌旁正常组织中表达的研究,探索Survivin在结直肠腺癌发生发展过程中的表达水平。方法应用免疫组化法(immunohistochemistry,IHC)、原位杂交法(in situhybridization,ICH)检测Survivin在30例癌旁正常组织,60例结直肠腺瘤(37例伴中低度异型增生、23例伴重度异型增生),60例结直肠腺癌组织标本中的表达情况;结合临床资料分析其表达与临床病理特征间的关系。结果Survivin在癌旁正常组织、腺瘤伴中低度异型增生,腺瘤伴重度异型增生和结直肠腺癌组织中的阳性表达率分别为10.00%、13.51%、52.17%和73.34%。Survivin mRNA在癌旁正常组织、腺瘤伴中低度异型增生、腺瘤伴重度异型增生和结直肠腺癌组织中的阳性表达率分别为6.67%、10.81%、43.48%和63.33%。Survivin的表达与结直肠癌的肿瘤淋巴结转移(tumor node metastasis,TNM)分期、浸润深度、淋巴转移和肝转移具有相关性,而与患者性别、年龄、肿瘤大小、部位、分化程度和组织学类型无关。结论 Survivin在结直肠组织中不同程度的表达与结直肠黏膜癌变的发生、发展有密切关联,有望成为结直肠癌临床诊断及监测的一个特异性生物标志物。     

黑斑息肉综合征中Axin表达研究

目的研究Axin在结直肠腺癌、结直肠腺瘤、黑斑息肉综合征(PJS)息肉及正常结直肠黏膜组织中的表达,探讨其在PJS息肉演变中的作用。方法随机选取手术中切除的正常结直肠黏膜、PJS息肉、结直肠腺瘤息肉和结直肠腺癌组织标本各32份,采用免疫组织化学方法分别检测不同组织中Axin蛋白的表达与分布;反转录聚合酶链反应(RT-PCR)检测各组织(各16份)标本中Axin mRNA的表达,并比较其表达水平的差异。结果上述各种组织中,Axin蛋白阳性表达均位于胞质,阳性表达强度以正常结直肠黏膜组织最强,结直肠腺癌组织最弱,各组差异具有显著性(P<0.05);RT-PCR所得产物电泳后经Image-Pro Plus软件分析,得到各组织中Axin基因积分光密度值(IOD)/内参IOD值(Axin IOD/GAPDH IOD):正常结直肠黏膜组织为0.991±0.120,PJS息肉组织为0.794±0.119,结直肠腺瘤组织为0.598±0.116,结直肠腺癌组织为0.313±0.087,不同组织的Axin mRNA表达水平有显著性差异(P<0.05)。结论正常结直肠黏膜、PJS息肉、结直肠腺瘤、和结直肠腺癌组织中Axin mRNA及蛋白表达水平呈依次减弱趋势,与其病理改变程度呈负性相关,PJS息肉中Axin的表达变化可能是PJS发生和演变的特征之一。     

检测BRIT1基因对诊断结肠癌的临床价值

目的：研究BRIT1基因在结肠癌组织中mRNA表达水平及其临床意义。方法：采用逆转录聚合酶链反应（RT-PCR）,检测了BRIT1基因在40例结肠癌组织及其对应的切缘正常结肠组织中mRNA的表达水平,并分析BRIT1基因表达水平与结肠癌临床病理特征的关系,研究其临床意义。结果：RT-PCR结果显示BRIT1基因在结肠癌组织中的表达较切缘正常结肠组织显著下调（P〈0.05）。BRIT1mRNA表达水平与患者年龄、性别、肿瘤大小无明显相关性（P〉0.05）,但与结肠癌Dukes分期、细胞分化程度及有无淋巴结转移相关（P〈0.05）。结论：BRIT1基因在结肠癌组织中显著的下调,其表达水平与结肠癌发生发展过程密切相关。     

P53、MVD在非小细胞肺癌中的表达及其相关性

目的:研究P53、MVD在非小细胞肺癌中的表达及其相关性,探讨其在非小细胞肺癌发生、发展中的作用。方法:采用免疫组织化学SP法检测80例非小细胞肺癌组织、20例肺良性病变组织中P53蛋白的表达,并对肺癌组织中CD34单抗标记的血管计数MVD。结果:肺癌组织P53阳性表达率明显高于肺良性病变组织(P<0.05)。P53表达与肺癌患者的组织学类型无关(P>0.05),与肺癌组织的分化程度、TNM分期及淋巴结转移均有关(P<0.05)。在肺癌组织中,P53蛋白表达阳性组MVD明显高于P53蛋白表达阴性组(P<0.05)。结论:P53可能与肺癌的发生、发展有关。肺癌组织中MVD与P53表达密切相关,突变型p53基因在肺癌血管形成中具有重要作用。     

大肠腺癌组织中Ezrin蛋白的表达及意义

目的 研究探讨大肠腺癌组织Ezrin的表达,并分析其与临床病理特征之间的关系.方法 运用免疫组化检测大肠腺癌70例、大肠腺瘤20例和正常大肠黏膜10例中Ezrin 的表达情况.结果 在大肠腺癌中的阳性表达率为77.1%( 54 /70)、大肠腺瘤中的阳性表达率为25.0%(5 /20),正常大肠粘膜中阳性表达率为00.0%(0/10);Ezrin的表达在大肠腺癌与大肠腺瘤、正常大肠粘膜中差异有统计学意义(P<0.05,P<0.01).大肠腺癌中Ezrin的阳性表达率随肿瘤分化程度的降低而升高,高分化腺癌为70.0%(14/20),中分化腺癌为78.0%(32/41),低分化腺癌为88.9%(8/9).(P<0.05),与患者性别、年龄、肿瘤大小、浸润深度、淋巴结是否转移及TNM分期均无相关性(P>0.05).结论 Ezrin在大肠腺癌、大肠腺瘤及大肠正常粘膜中的阳性表达率依次递减,提示Ezrin可能参与了大肠腺癌的发生与发展.Ezrin的阳性表达与肿瘤分化程度存在相关性,可作为判定其预后的生物学指标.     

P16INK4A及Ki-67在宫颈腺癌组织中的表达及意义

目的 探讨P 16INK4A及Ki-67蛋白在宫颈腺癌组织中的表达及其临床意义.方法 选取61例宫颈腺癌(官颈腺癌组)及34例正常官颈组织(对照组)的石蜡标本,采用SP免疫组化法测定P16INK4A及Ki-67蛋白的表达,并对61例浸润性宫颈腺癌的临床及病理资料进行回顾性分析.结果 对照组正常宫颈腺上皮P16INK4A及Ki-67表达阳性率分别为23.53％、20.59％,而宫颈腺癌组分别为80.33％、81.97％,两组比较差异有统计学意义(P＜0.05).P16INK4A的表达与宫颈腺癌的临床分期、宫颈间质浸润深度、肿瘤直径有关(P＜0.05),与宫颈腺癌的病理分型、肿瘤恶性程度及淋巴结转移无关(P＞0.05).Ki-67的表达与宫颈腺癌的病理分化程度、肿瘤直径及淋巴结转移有关(P＜0.05).子宫颈腺癌组织中P16INK4A与Ki-67的表达相关(P＜0.01).结论 联合检测P16INK4A及Ki-67蛋白表达可作为宫颈腺癌的辅助诊断方法,有较好的临床应用价值.     

EGFR信号通路的活化状态与结肠癌细胞对吉非替尼敏感性的关系

达最弱(P<0.05).结论 Akt、MAPK及其磷酸化蛋白的表达水平与结肠癌细胞对吉非替尼的敏感性不一致,提示结肠癌对吉非替尼的反应性不能完全由EGFR表达和活性决定,也与其下游信号蛋白Akt、MAPK无关.     

Palliation of Obstructing Malignant Colonic Lesions Using Self-Expanding Metal Stents: A Single-Center Experience

To evaluate the efficacy, risks, and survival after palliative colorectal stenting at a single center, we conducted a retrospective review of consecutive patients who had colorectal self-expanding metal stents (SEMSs) inserted over an 8-year period (September 1998 to September 2006) to relieve an obstructing colorectal tumor. All patients either had proven distant metastases or were unfit for surgical decompression. A single interventional radiologist (R.M.) inserted the stents, which were either Memotherm or WallFlex. Ninety-one patients with a median age of 73 years had a colorectal stent inserted for palliation of an obstructing colorectal malignancy. Technical success was achieved in 81 of 91 (89%) patients, and clinical success in 80 of 81 (99%). At the time of analysis (December 2006), 13 of 91 (14.2%) patients were alive. The patients who died had a median survival of 59 days, IQR 17–181 days. Seven (7/81) patients suffered stent migration, which occurred 10.3 days (IQR, 5–14 days) after the procedure. Three patients (3/81) re-presented with intestinal obstruction secondary to tumor ingrowth and 10 (10.9%) patients suffered bowel perforation. Ten patients (10.9%) had two stents inserted coaxially and overlapping in one procedure. This was performed in cases where the stricture was too long to be easily crossed by a single stent. We conclude that colorectal SEMS is a safe and effective mode of treatment for the palliation of obstructing colorectal cancers, which avoids high-risk surgery.     

Effect of investigator experience in CT colonography

The aim of this study was to determine the impact of the learning curve on the diagnostic performances of CT colonography. Two blinded teams, each having a radiologist and gastroenterologist, prospectively examined 50 patients using helical CT scan followed by colonoscopy. Intermediate data evaluation was performed after 24 data sets (group 1) and compared with data from 26 subsequent patients (group 2). Parameters evaluated included sensitivity, specificity, false-positive and false-negative findings, time of data acquisition and interpretation. Using colonoscopy as the gold standard, sensitivity for CT colonography was for lesions >5 mm 63% for both teams for group 1 patients; for group 2 patients sensitivity was 45% for team 1 and 64% for team 2. Specificity per patients was for patient group 1 42% for team 1 and 58% for team 2; for patient group 2 it was 79% for both teams ( p=0.04 for team 1; p=0.2 for team 2). Comparing group 1 with group 2, the number of false-positive findings decreased significantly ( p=0.02). Furthermore, the mean time of data evaluation decreased from 45 to 17 min ( p=0.002) and the mean time of data acquisition from 19 to 17 min. With increasing experience, specificity and the time required for data interpretation improved and false positives decreased. There was no significant change of sensitivity, false-negative findings and time of data acquisition. A minimum experience of the readers is required for data interpretation of CT colonography.     

Can the localization of primary colonic tumors be improved by staging CT without specific bowel preparation compared to optical colonoscopy?

Objectives

To investigate the ability of staging computed tomography (CT) without bowel preparation to accurately localize colonic tumors compared to optical colonoscopy.

Methods

The local institutional review board approved this retrospective and HIPAA-compliant study. Forty-six patients with colonic adenocarcinoma, preoperative colonoscopy, and staging CT within 60 days of resection were included. Patients underwent contrast enhanced CT imaging without bowel preparation or oral contrast. The colon was divided into four segments with the operative reports used as the standard. Rectal and cecal cancers were excluded. CT scans were reviewed by 5 readers in a segmental binary fashion using a 5-point confidence scale in two sessions blinded and unblinded to the colonoscopy report.

Results

At surgery 49 tumors were found in 46 patients. Readers detected 86.1%, 74.3%, and 66.9% of lesions with 92.0%, 94.1%, and 95.4% accuracy for confidence scores of ≥3, ≥4, and 5. CT interobserver agreement was good (κ = 0.82) for the unblinded and moderate (κ = 0.60) for the blinded read. Colonoscopic localization was only 78.7% accurate with 2 tumors undiscovered. Colonoscopic accuracy was low in the descending colon (57.1%) and the transverse colon (55.6%).

Conclusions

Preoperative staging CT is more accurate than colonoscopy in the localization of colonic tumors.     

结肠癌和结肠息肉的多排螺旋CT检查进展

结肠癌和结肠息肉是结肠常见疾病,其影像学检查方法有多种,各有优缺点。近年来随着多排螺旋CT(multi-detector spiral CT,MSCT)的技术进步,特别是后处理软件不断改进,在诊断结肠病变方面取得了巨大进展。本文就MSCT在结肠癌和结肠息肉的研究进展作一综述。     

大肠息肉679例临床特征及内镜、病理学特点分析

 目的 研究大肠息肉患者的年龄,息肉的发生部位、大小、病理类型以及息肉癌变的相关规律.方法 对电子肠镜检查中检出的大肠息肉患者的临床表现、内镜特点及病理资料进行总结和分析.结果 在3 680例肠镜检查者中,发现大肠息肉679例,其中男468例,女211例,检出率18.45%; 好发年龄以30～69岁为主,占80.41%;炎性、增生性、腺瘤性、错构瘤性、幼年性息肉分别占33.87%、32.11%、31.37%、1.77%、0.59%;息肉部位分别为直肠34.18%、乙状结肠23.12% 、降结肠14.96%、横结肠12.13%、升结肠11.49%、盲肠4.11%.679例大肠息肉患者中有30例发生癌变,癌变率为4.42%.管状腺瘤、混合性腺瘤、绒毛状腺瘤癌变率分别为5.88%、4.21 %、23.08%.息肉直径≤1.0 cm,无癌变发生;1.1～1.9 cm息肉,癌变率4.24%;≥2.0 c m息肉,癌变率21.37%.结论 30～69岁大肠息肉发病率较高,年龄大于50 岁为危险因素,男性较女性更容易患大肠息肉;息肉好发部位为左半结肠;病理类型以炎性息肉、增生性息肉和腺瘤性息肉常见;左半结肠、直径≥2.0 cm息肉、绒毛状腺瘤容易癌变 ;发现大肠息肉应尽可能切除,并应建立良好的随访机制,内镜下切除大肠息肉可预防息肉癌变.     

Colorectal Stenting: An Effective Therapy for Preoperative and Palliative Treatment

Purpose To demonstrate the effectiveness of preoperative and palliative colorectal stent placement in acute colonic obstruction. Methods Sixty-seven consecutive patients (mean age 67.3 years, range 25–93 years) with clinical and radiological signs of colonic obstruction were treated: 45 (67%) preoperatively and 22 (33%) with a palliative intent. In 59 patients (88%) the obstruction was malignant, while in 8 (12%) it was benign. A total of 73 enteric Wallstents were implanted under combined fluoroscopic/endoscopic guidance. Results Forty-five patients were treated preoperatively with a technical success rate of 84%, a clinical success rate of 83%, and a complication rate of 16%. Of the 38 patients who were successfully stented preoperatively, 36 (95%) underwent surgery 2–22 days (mean 7.2 days) after stent insertion. The improved general condition and adequate bowel cleansing allowed single-stage tumor resection and primary end-to-end anastomosis without complications in 31 cases (86% of all operations), while only 5 patients had colostomies. Stent placement was used as the final palliative treatment in 22 patients. The technical success rate was 95%, the clinical success rate 72%, and the complication rate relatively high at 67%, caused by reocclusion in most cases. After noninvasive secondary interventions (e.g., tube placement, second stenting, balloon dilatation) the secondary patency of stents was 71% and mean reported survival time after stent insertion was 92 days (range 10–285 days). Conclusion Preoperative stent placement in acute colonic obstruction is minimally invasive and allows an elective one-stage surgery in most cases. Stent placement also proved a valuable alternative to avoid colostomy in palliation.     

CT colonography polyp matching: differences between experienced readers

The purpose of this study was to investigate if experienced readers differ when matching polyps shown by both CT colonography (CTC) and optical colonoscopy (OC) and to explore the reasons for discrepancy. Twenty-eight CTC cases with corresponding OC were presented to eight experienced CTC readers. Cases represented a broad spectrum of findings, not completely fulfilling typical matching criteria. In 21 cases there was a single polyp on CTC and OC; in seven there were multiple polyps. Agreement between readers for matching was analyzed. For the 21 single-polyp cases, the number of correct matches per reader varied from 13 to 19. Almost complete agreement between readers was observed in 15 cases (71%), but substantial discrepancy was found for the remaining six (29%) probably due to large perceived differences in polyp size between CT and OC. Readers were able to match between 27 (71%) and 35 (92%) of the 38 CTC detected polyps in the seven cases with multiple polyps. Experienced CTC readers agree to a considerable extent when matching polyps between CTC and subsequent OC, but non-negligible disagreement exists.     

Diagnostic performance of radiographers as compared to radiologists in magnetic resonance colonography

Purpose

To evaluate the diagnostic performance of radiographers compared to radiologists in the detection of colorectal lesions in MR colonography.

Material and methods

159 patients at increased risk of colorectal cancer were included. Four different experienced observers, one MR radiologist, one radiologist in training and two radiographers evaluated all MR colonography examinations. The protocol included T1-weighted and T2-weighted sequences in prone and supine position. Colonoscopy was used as reference standard. Mean sensitivity rates with 95% confidence intervals (CIs) were determined on a per-patient and per-polyp basis, segmented by size (≥6 mm and ≥10 mm). Specificity was calculated on a per-patient basis. The McNemar and chi-square (χ²) test was used to determine significant differences.

Results

At colonoscopy 74 patients (47%) had normal findings; 23 patients had 40 polyps with a size ≥6 mm. In 10 patients at least 1 polyp ≥10 mm was found (20 polyps in total). Similar sensitivities for patients with lesions ≥10 mm were found for radiologists and radiographers (65% (95%CI: 44-86%) vs. 50% (95%CI: 28-72%)) (p = n.s.). For lesions ≥10 mm combined per-patient specificity for radiologists and radiographers was 96% (95%CI: 94-98%) and 73% (95%CI: 68-79%) (p < 0.0001). Combined per-patient sensitivity for lesions ≥6 mm differed significantly between both groups of observers (57% (95%CI: 42-71%) vs. 33% (95%CI: 19-46%)) (p = 0.03).

Conclusion

Radiographers have comparable sensitivity but lower specificity relative to radiologists in the detection of colorectal lesions ≥10 mm at MR colonography. Adequate training in evaluating MR colonography is necessary, especially for readers with no prior experience with colonography.     

LncRNA CRNDE靶向miR-384影响结直肠癌细胞放射敏感性的研究

目的 研究长链非编码RNA （Lnc RNA）结直肠肿瘤差异表达基因（CRNDE）对结直肠癌细胞放射敏感性的影响及其机制。方法 以结直肠癌HT-29细胞作为体外研究对象,转染CRNDE shRNA,实时定量PCR测定干扰效果。以8 Gy X射线照射转染CRNDE shRNA后的HT-29细胞,四甲基偶氮唑盐（MTT）比色法和流式细胞术分别检测细胞增殖和凋亡水平。平板克隆实验检测放射敏感性。生物信息学软件预测CRNDE与miR-384有互补结合位点,荧光素酶报告系统鉴定靶向关系。将CRNDE shRNA和miR-384 inhibitor共转染至HT-29细胞中,以8 Gy剂量照射处理,MTT和流式细胞术检测细胞增殖和凋亡变化。结果 CRNDE shRNA能够降低HT-29细胞中CRNDE表达水平（1.00±0.08 vs. 0.42±0.06,t=10.051,P<0.05）。CRNDE shRNA和放射均可以抑制HT-29细胞增殖并诱导细胞凋亡,并且二者联合具有协同作用[凋亡率：（2.27±0.13）%、（23.58±2.35）%、（26.91±2.81）%、（36.84±3.24）%,F=24.66,P<0.05;吸光度（A）值：0.45±0.06、0.30±0.02、0.28±0.03、0.20±0.02,F=106.21,P<0.05]。CRNDE shRNA转染后可以提高HT-29细胞放射敏感性,放射增敏比为1.374。CRNDE靶向负调控miR-384表达。miR-384 inhibitor能够拮抗CRNDE shRNA对放射处理的结直肠癌细胞增殖抑制和凋亡促进的作用。结论 下调LncRNA CRNDE表达可增强结直肠癌细胞的放射敏感性,其作用机制与靶向负调控miR-384表达有关。