p53 C-myc和P-gp蛋白在胃癌细胞中表达

目的研究胃癌组织中ｐ５３和Ｃｍｙｃ的表达与多药耐药性（ＭＤＲ）的关系．方法应用ＬＳＡＢ免疫组织化学方法研究６７例（男４１例，女２６例，平均年龄４６±１５８岁）胃癌标本中ｐ５３，Ｃｍｙｃ和Ｐｇｐ的表达．结果本组胃癌中ｐ５３阳性３２例（４７８％），Ｃｍｙｃ阳性３７例（５５２％），Ｐｇｐ阳性３９例（５８２％）．淋巴结转移阳性胃癌ｐ５３阳性率（５６９％）和Ｃｍｙｃ阳性率（６４７％）显著高于淋巴结转移阴性的胃癌（Ｐ＜００５）．ｐ５３的异常表达与ｍｄｒ１基因表达呈显著正相关（ｒ＝０６３，Ｐ＜００５），而Ｃｍｙｃ和ｍｄｒ１的表达无明显相关．结论ｐ５３异常表达可增加ｍｄｒ１基因的表达，从而使胃癌细胞获得ＭＤＲ表型     

胃癌中癌基因ras c-myc mRNA表达的临床意义

目的探索癌基因ｒａｓ和ｃｍｙｃｍＲＮＡ在胃癌发生中单独和协同作用关系，选择胃癌的早期诊断依据．方法应用原位分子杂交（ＩＳＨ）技术，检测８８例胃癌组织中Ｈｒａｓ，Ｋｒａｓ，ＣｍｙｃｍＲＮＡ的表达，结合临床资料综合分析．结果Ｋｒａｓ，Ｈｒａｓ，ＣｍｙｃｍＲＮＡ在肿瘤区的阳性表达分别为７８４％，７０５％和５８０％，在癌旁区的阳性表达分别为２８４％，２７３％和２０５％，呈梯度下降趋势，３种癌基因的表达与胃癌的临床分型、组织学分类及有无淋巴结转移无关，ＣｍｙｃｍＲＮＡ的表达与患者生存期关系密切（Ｐ＜００５）．结论Ｋｒａｓ，Ｈｒａｓ，ＣｍｙｃｍＲＮＡ的表达可作为胃癌早期诊断的参考依据．     

C-myc,Bcl-2与胃癌生物学行为和细胞凋亡

目的探讨癌基因Ｂｃｌ２，Ｃｍｙｃ的表达变化与胃癌生物学行为和细胞凋亡的关系．方法采用免疫组化ＬＳＡＢ法，检测６０例原发性胃癌组织（男３８例，女２２例，年龄３７岁～７５岁）癌基因Ｂｃｌ２，Ｃｍｙｃ蛋白的表达变化；在普通光学显微镜下对受检组织的ＨＥ片进行形态学测量和凋亡细胞计数．结果受检组织６０例中，Ｃｍｙｃ阳性表达３７例（６２％），其表达与分化程度和临床分期呈显著性相关，且Ｃｍｙｃ阳性组织细胞凋亡指数（０７±０３）明显高于阴性组织（０３±０２）；所检标本中，Ｂｃｌ２阳性表达率为６８％（４１／６０），其中高分化胃癌的阳性表达率明显高于低分化胃癌（３２％ｖｓ９％）（Ｐ＜００５），阳性Ｂｃｌ２组织与阴性Ｂｃｌ２组织比较，前者凋亡指数明显低于后者（０４±０３ｖｓ０９±０５）（Ｐ＜００５）．结论Ｃｍｙｃ与Ｂｃｌ２基因的异常表达是胃癌生物学行为的重要影响因素，二者在胃癌形成过程中均起着一定的作用，并对细胞增生与凋亡有重要调节作用．     

c-myc和p53在大肠腺瘤与大肠癌中的表达

目的探讨癌基因ｃｍｙｃ和ｐ５３在大肠腺瘤和大肠癌中的表达情况，及与临床病理特征的关系．方法采用免疫组化ＡＢＣ法，检测３９例大肠癌和３７例大肠腺瘤的ｃｍｙｃ表达，及６３例大肠癌和４０例大肠腺瘤的ｐ５３表达情况．结果大肠腺瘤３７例的ｃｍｙｃ阳性表达为６２２％（２３／３７），大肠癌３９例的ｃｍｙｃ阳性表达为８２１％（３２／３９）．而ｐ５３在大肠腺瘤和大肠癌的阳性表达则为４５０％（１８／４０）和８４１％（５３／６３）．ｃｍｙｃ和ｐ５３在大肠腺瘤和大肠癌中的表达均有显著的统计学意义（Ｐ＜００１）．但两个癌基因的表达均不相关于临床病理特征．结论ｃｍｙｃ与ｐ５３的异常表达大肠癌的演变过程中均有增加，而且两者起协作作用     

萎缩性胃炎中P53和PCNA的表达

目的了解Ｐ５３，ＰＣＮＡ在胃粘膜癌前病变中的表达意义．方法慢性萎缩性胃炎（ＣＡＧ）８９例，慢性浅表性胃炎（ＣＳＧ）２０例和胃腺癌２０例，作ＳＰ法观察Ｐ５３和ＰＣＮＡ的表达．结果Ｐ５３在ＣＳＧ和ＣＡＧ的单纯型、增生型和肠化型中不表达，异型性型中阳性表达率为１９０％（４／２１）．ＰＣＮＡ在ＣＳＧ和ＣＡＧ的单纯型、增生型、肠化型中无显著性差异（Ｐ＞００５）；而ＣＡＧ的异型性阳性细胞明显增多（Ｐ＞００１）．结论Ｐ５３表达与胃粘膜向癌的演变有关．ＰＣＮＡ随细胞增生活跃程度递增．二者结合对胃癌前病变的诊断、分级、治疗、预后有辅助价值．     

幽门螺杆菌cagA基因株与胃癌p53,bcl—2表达的研究

目的　通过研究幽门螺杆菌（Ｈｐ）及细胞毒蛋白相关基因Ａ 株〔ｃａｇＡ（＋ ）株〕感染与胃癌组织ｐ５３、ｂｃｌ２ 表达的相互关系，以探讨Ｈｐ 的可能致癌机制。　方法　聚合酶链反应（ＰＣＲ）检测９２ 例胃癌和２４ 例浅表胃炎组织石蜡标本Ｈｐ 和ｃａｇＡ（＋ ）株感染。用免疫组化方法检测全部标本的ｐ５３、ｂｃｌ２ 表达。　结果　（１）Ｈｐ 感染在胃癌和浅表胃炎病例间差异无显著性（７９４％ 及６６７％ ，Ｐ＞ ００５），而ｃａｇＡ（＋ ）株感染前者高于后者（９３２％ 及５００％ ，Ｐ＜ ００１）；（２）ｐ５３、ｂｃｌ２ 的表达在Ｈｐ（＋ ）与Ｈｐ（－ ）组之间差异无显著性，而ｃａｇＡ（＋ ）株感染组均显著高于ｃａｇＡ（－ ）株组（Ｐ＜００１）。　结论　胃癌的发生可能与不同Ｈｐ 菌株感染有关。产生细胞毒素的Ｈｐ 菌株〔ｃａｇＡ（＋ ）株〕与胃癌关系更密切，它可能是导致ｐ５３ 基因突变和ｂｃｌ２基因过度表达的原因之一。     

慢性糜烂性胃炎的临床病理学及免疫组织化学研究

目的观察慢性糜烂性胃炎（ＣＥＧ）的临床病理特征及粘膜上皮的ｐ２１，ＣＥＡ表达和上皮细胞增生活性．结合粘膜Ｇ细胞数，探讨胃粘膜泌酸状态与病变的关系．方法ＣＥＧ４０例粘膜活检材料经光镜观察其组织病理学特征及Ｈｐ的感染．对其中３１例采用免疫组化ＬＳＡＢ法标记ｐ２１，ＰＣＮＡ，ＣＥＡ及胃泌素．结果ＣＥＧ病变８７５％（３５／４０）见于胃窦粘膜，７５％伴有不同程度的萎缩改变．粘膜上皮轻中度不典型增生率为２００％（８／４０），肠化率为２７５％，２５０％伴活动性炎；４００％病例可见Ｈｐ感染．ＣＥＧ粘膜上皮ｐ２１表达阳性率为６７７％，ＣＥＡ表达为２９０％；明显高于对照的慢性浅表性胃炎组．ＰＣＮＡ表达以及Ｇ细胞数目，ＣＥＧ组与对照组无显著差异（Ｐ＞００５）．结论ＣＥＧ具有一定恶性转化趋势，胃窦Ｇ细胞数、泌酸状态与ＣＥＧ的发病无明显关联．     

胃粘膜癌变过程中幽门螺杆菌感染与p53,c-erbB-2基因表达的研究

目的探讨胃粘膜癌变过程中幽门螺杆菌（Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ,Ｈｐ）感染与ｐ５３,ｃｅｒｂＢ２基因表达的关系．方法浅表性胃炎１６例,肠上皮化生２２例,异型增生１４例,早期胃癌１８例及进展期胃癌４０例作为研究对象．用ＷａｒｔｈｉｎＳｔａｒｙ银染色法检测Ｈｐ,用免疫组化Ｓｐ法检测ｐ５３和ｃｅｒｂＢ２的基因表达产物．结果Ｈｐ,ｐ５３,ｃｅｒｂＢ２在浅表性胃炎的检出率各为５００％,００％,００％;在肠上皮化生的检出率各为５９１％,２２７％,１３６％;在异型增生的检出率各为８５７％,６４３％,２８６％;在早期胃癌的检出率各为１６７％,３３３％,１１１％;在进展期胃癌的检出率各为５０％,５２５％,５５０％;在癌旁粘膜的Ｈｐ检出率为８６７％;在癌前病变中,Ｈｐ阳性组的ｐ５３,ｃｅｒｂＢ２表达率均高于Ｈｐ阴性组．结论Ｈｐ感染参与了胃癌前病变的发生与发展;Ｈｐ感染可引起野生型ｐ５３基因失活和ｃｅｒｂＢ２基因激活,从而导致胃粘膜的癌变．     

肝细胞癌患者HCV感染及其致癌机理研究

目的：揭示肝细胞癌患者的ＨＣＶ感染情况及其致癌机理。方法：应用免疫组织化学ＳＰ法对４６例肝细胞癌癌组织及其３８例癌旁肝组织中丙型肝炎病毒核心抗原作了定位研究，并进一步检测其中癌基因ｒａｓ、ｃｍｙｃ和抑癌基因ｐ５３的蛋白表达。结果：核心抗原的检出率分别为２１７％和３６８％，４６例肝癌患者中１６例存在丙型肝炎病毒感染；ｐ２１、ｃｍｙｃ和ｐ５３蛋白在癌组织中的检出率分别为５８７％、６７４％和３０４％；丙型肝炎病毒感染的阳性与阴性组患者之间的ｐ２１、ｃｍｙｃ和ｐ５３蛋白的表达无显著性差异（Ｐ＞０．０５）；两组患者癌旁肝硬化的阳性率分别为８７５％和８６７％（Ｐ＞００５）。结论：上述结果提示丙型肝炎病毒致肝细胞癌的机理可能与ｒａｓ、ｃｍｙｃ和ｐ５３基因的激活或失活无关，其机理尚待进一步探索     

青老年人胃癌P53及增殖细胞核抗原表达的对比

目的通过对老人青年胃癌中ｐ５３及增殖细胞核抗原（ＰＣＮＡ）表达的研究，探讨青老年人胃癌临床表现的分子生物学异同．方法应用过氧化物酶标记的链霉卵白素（ＳＰ）染色法对６５例胃癌（青年组３５例，≤３５岁；老年组３０例，≥６０岁）进行ｐ５３蛋白及ＰＣＮＡ的免疫组织化学染色．并对胃癌细胞中ＰＣＮＡ阳性颗粒进行图象分析．结果ｐ５３和ＰＣＮＡ在青年人胃癌中的阳性率分别为６５７％和９４３％，均显著高于老年人（２６７％和５００％，Ｐ＜００１）．青年人胃癌中ＰＣＮＡ阳性颗粒平均光密度及积分光密度均显著高于老年人（Ｐ＜００５）．结论ｐ５３及ＰＣＮＡ的高表达可能是青年人胃癌恶性度高，进展快，预后差的原因     

Primary Cardiac Sarcoidosis with Syncope and Refractory Atrial Arrhythmia: A Case Report and Review of the Literature

We discuss the case of a 38-year-old black man who presented at our hospital with his first episode of syncope, recently developed atrial arrhythmias refractory to pharmacologic therapy, and a left atrial thrombus. He was diagnosed with primary cardiac sarcoidosis characterized by predominant involvement of the epicardium that caused atrial fibrillation and atrial flutter. Histologic analysis of his epicardial lesions yielded a diagnosis of sarcoidosis. This patient''s atrial arrhythmia was successfully treated with a hybrid operation that involved resection of his atrial appendage, an Epicor maze procedure, and radiofrequency ablation during a catheter-based electrophysiologic study. The cardiac sarcoidosis was successfully managed with corticosteroid therapy.Our case report shows that sarcoidosis can initially manifest itself as syncope with new-onset atrial arrhythmia. Sarcoidosis is important in the differential diagnosis because of its progressive nature and its potential for treatment with pharmacologic, surgical, and catheter-based interventions.     

汉防己甲素及维拉帕米对成纤维细胞生长增殖的影响

目的探讨汉防己甲素（Ｔｅｔ）及维拉帕米（Ｖｅｒ）抗肝纤维化的机制．方法采用细胞培养、流式细胞术和图像分析法检测Ｔｅｔ及Ｖｅｒ对３Ｔ６成纤维细胞增殖的影响．结果不同浓度的Ｔｅｔ及Ｖｅｒ可使３Ｔ６细胞Ｇ１期或Ｇ２＋Ｍ期细胞显著增多（Ｐ＜００１）；Ｔｅｔ（１５，２０μｇ）使细胞ＲＮＡ含量显著下降（Ｐ＜００１）；Ｖｅｒ（１０，２０μｇ）使细胞ＤＮＡ含量显著降低（Ｐ＜００１）；Ｔｅｔ（１５，２０μｇ）和Ｖｅｒ（５，１０μｇ）均使细胞蛋白质含量显著增加（Ｐ＜００１）．结论Ｔｅｔ及Ｖｅｒ对成纤维细胞的增殖具有抑制作用，可能是抗肝纤维化的机制之一     

Intravenous Leiomyomatosis with Intracardiac Extension: Echocardiographic Study and Literature Review

Uterine leiomyomatosis is a common disease in women; however, intravenous leiomyomatosis with intracaval and intracardiac tumor extension is rare. We sought to analyze the clinical and echocardiographic features of intracardiac leiomyomatosis.From January 2003 through July 2012, 7 women (age range, 24–59 yr) underwent surgical resection of histopathologically diagnosed intracardiac leiomyomas at our hospital. Most of the patients had histories of hysterectomy or uterine leiomyoma. We retrospectively analyzed their preoperative echocardiograms. We found that the tumors had no stalks, did not adhere to the wall of the right side of the heart, were highly mobile, and moved back and forth in the right atrium near the tricuspid orifice. All tumors originated from the inferior vena cava and had borders well demarcated from that structure''s wall. Most of the masses extended into the inferior vena cava and right atrium through the right internal and common iliac veins. Computed tomograms revealed pelvic tumors and contiguous filling defects in 6 patients.When echocardiograms reveal a right-sided cardiac mass that originates from the inferior vena cava, particularly in women who have a history of hysterectomy or uterine leiomyoma, intracardiac leiomyomatosis should be suspected. If the mass has no stalk and freely moves within the inferior vena cava and right-sided cardiac chambers without attachment to the endothelial surface or endocardium, intracardiac leiomyomatosis should be diagnosed. We discuss our findings and briefly review the relevant medical literature.     

Concurrent Aortic Valvular Disease and Pulmonary Sequestration: Clinical Implications

Pulmonary sequestration refers to segmental lung tissue that has no connection with the bronchial tree or pulmonary arteries. In adults, the clinical sequelae are usually related to infection. Patients are typically referred for sequestrectomy even when they are asymptomatic. There are no guidelines for treating patients who have pulmonary sequestration and coexisting cardiac valvular disease, in which case the venous drainage patterns of sequestra pose the additional risks of infective endocarditis and volume overload.We present the cases of 2 adult patients—one symptomatic and one asymptomatic—who had concurrent aortic valvular disease and pulmonary sequestration, and we discuss the factors involved in our evaluation of their cardiac risk and our treatment decisions. In view of the sparse data to predict cardiac risks, we think that pulmonary sequestrectomy in adult patients with concurrent valvular conditions should be considered on a case-by-case basis.     

Pheochromocytoma-Induced Atrial Tachycardia Leading to Cardiogenic Shock and Cardiac Arrest: Resolution with Atrioventricular Node Ablation and Pacemaker Placement

Pheochromocytoma should be considered in young patients who have acute cardiac decompensation, even if they have no history of hypertension. Atrioventricular node ablation and pacemaker placement should be considered for stabilizing pheochromocytoma patients with cardiogenic shock due to atrial tachyarrhythmias.A 38-year-old black woman presented with cardiogenic shock (left ventricular ejection fraction, <0.15) that did not respond to the placement of an intra-aortic balloon pump. A TandemHeart^® Percutaneous Ventricular Assist Device was inserted emergently. After atrioventricular node ablation and placement of a temporary pacemaker, the TandemHeart was removed. Computed tomography of the abdomen revealed a pheochromocytoma. After placement of a permanent pacemaker, the patient underwent a right adrenalectomy.This is, to our knowledge, the first reported case of pheochromocytoma-induced atrial tachyarrhythmia that led to cardiogenic shock and cardiac arrest unresolved by the placement of 2 different ventricular assist devices, but that was completely reversed by radiofrequency ablation of the atrioventricular node and the placement of a temporary pacemaker. We present the patient''s clinical, laboratory, and imaging findings, and we review the relevant literature.     

Osteoporosis education improves osteoporosis knowledge and dietary calcium: comparison of a 4 week and a one-session education course

Background: Education is ideal for osteoporosis because many risk factors are modifiable. However, the efficacy of shortened education courses compared to a standard 4 week course for improving osteoporosis knowledge and healthy behaviours is not known. This study aimed to assess whether education changed knowledge and healthy behaviours over 3 months of follow‐up; and whether changes in these outcomes were different between participants receiving the different education courses. Methods: Adults aged ≥ 50 years presenting to Emergency with mild to moderate trauma fractures received either the Osteoporosis Prevention and Self‐Management Course (OPSMC) (4 × 2.5 h) (n = 75) or a one‐session course (1 × 2.5 h) (n = 71) in a non‐randomised prospective study with single‐blinded allocation. Participants completed questionnaires measuring osteoporosis knowledge, dietary calcium, physical activity, calcium and exercise self‐efficacy, and osteoporosis medications at baseline and 3 months. Data were analysed using mixed models and GEE regression models. Results: Osteoporosis knowledge and calcium from food (% of RDI) increased from baseline to 3 months in both groups (P < 0.01). Use of osteoporosis medications increased between baseline and 3 months in the OPSMC group while decreasing in the one‐session group (P = 0.039). There were no differences between the groups or over time in physical activity, calcium or exercise self‐efficacy. Conclusions: Osteoporosis education (either the OPSMC or the one‐session course) improved osteoporosis knowledge and calcium intake after 3 months. Participants attending the OPSMC maintained medication compliance. We were unable to determine other differences between the courses. This study confirms the value of osteoporosis education for improving osteoporosis knowledge.     

Human intestinal and biliary cryptosporidiosis

Cryptospridiumporvum(C.porvum)isacoccidianparasiteofthephylutriApicomplexathatinfectsthegastrointestinal,biliaryandrespirat0ryepitheliumofhumansandanimals[1j.Earlyreportsdescribedadiseaseinhumanscharacterizedbyprotracted,waterydiarrheaoccurringinimmunosuppressedpatients,manywithacquiredinununodeficiencysyndrome(AlDS).Recentepidemiologicstudiesindicatethatcryptosporidiosismayals0presentasanacute,self-limiteddiarrhealdiseaseinimmunoc0mpetentindividualsandmayaccountf0rl%-10%ofdiarrhealdisease.o…     

Benefits and Limitations of Multimodality Imaging in the Diagnosis of a Primary Cardiac Lymphoma

Primary cardiac tumors are far rarer than tumors metastatic to the heart. Angiosarcoma is the primary cardiac neoplasm most frequently detected; lymphomas constitute only 1% of primary cardiac tumors.We present the case of a 55-year-old woman with a recently diagnosed intracardiac mass who was referred to our institution for consideration of urgent orthotopic heart transplantation. Initial images suggested an angiosarcoma; however, a biopsy specimen of the mass was diagnostic for diffuse large B-cell lymphoma. The patient underwent chemotherapy rather than surgery, and she was asymptomatic 34 months later.We use our patient''s case to discuss the benefits and limitations of multiple imaging methods in the evaluation of cardiac masses. Certain features revealed by computed tomography, cardiac magnetic resonance, and positron emission tomography can suggest a diagnosis of angiosarcoma rather than lymphoma. Cardiac magnetic resonance and positron emission tomography enable reliable distinction between benign and malignant tumors; however, the characteristics of different malignant tumors can overlap. Despite the great usefulness of multiple imaging methods for timely diagnosis, defining the extent of spread and the hemodynamic impact, and monitoring responses to treatment, we think that biopsy analysis is still warranted in order to obtain a correct histologic diagnosis in cases of suspected malignant cardiac tumors.