鼻/鼻型NK/T细胞淋巴瘤的临床病理和免疫组化测定

目的 探讨鼻／鼻型NK／T细胞淋巴瘤的临床病理和免疫组化特点。方法 收集44例发生于鼻腔及口腔的非霍奇金淋巴瘤(NHL)，用免疫组化染色(S-P二步法)标记CK、LCA、CD3、CD20、CD45RO、CD56和CD79a抗体。结果 20例为鼻／鼻型NK／T细胞淋巴瘤．占45．45％(20／44)。免疫标记瘤细胞LCA、CD3(胞浆)、CD45RO、CD56全部阳性表达；不表达CK、CD20、CD79a。结论 鼻／鼻型NK／T细胞淋巴瘤是一组发生于结外．具有独特临床表现、病理组织形态的淋巴瘤，免疫组化检查在其诊断和鉴别诊断中具有重要价值。     

淋巴结鼻型NK／T细胞淋巴瘤3例临床病理学分析

目的：探讨淋巴结鼻型NK／T细胞淋巴瘤的临床病理学特点。方法：回顾性分析3例淋巴结鼻型NK／T细胞淋巴瘤的临床表现、病理组织学特点，采用免疫组化SP法检测LCA、CD3、UCHL1、CD20、CD79a、CD56，TIA-1、Granzyme B和原位杂交方法检测EBER在淋巴结鼻型NK／T细胞淋巴瘤中的表达情况。结果：3例淋巴结鼻型NK／T细胞淋巴瘤病理学组织学改变表现为淋巴结结构破坏，瘤细胞多形性，中等大小至大细胞弥漫浸润，其中2例有大片坏死。LEA、CD3、CD56、TIA-1、Granzyme B免疫标记及EBER原位杂交阳性表达率100％。结论：淋巴结鼻型NK／T细胞淋巴瘤根据特征性的病理形态学改变、免疫表型特点及EBER原位杂交阳性能准确诊断。     

NK／T细胞淋巴瘤的病理、免疫组化表型及TCRγ基因重排的检测

目的 探讨NK／T细胞淋巴瘤(NK／TCL)的临床病理学特征和免疫组化表型及TCRγ基因重排的检测。为诊断和鉴别诊断提供依据。方法 收集30例NK／TCL及其临床资料，用免疫组化S-P法标记LCA，CD56，CD3，CD45RO，CD20及CK抗体和聚合酶链式反应扩增方法检测12例NK/TCK的TCRγ基因重排。结果 NK／TCL组织学特点为多形性淋巴细胞增生。大片的凝固性坏死和血管浸润；免疫组化表达LCA、CD3、CD45RO和CD56阳性，CD20、CK阴性；12例NK／T细胞淋巴瘤TCRγ基因重排的阳性率为66．7％(8／12)。结论 NK/TCL是一组异质性肿瘤．结合其组织学特点和免疫组化表型可做出诊断；NK/TCL超过半数存在TCRγ基因重排．表明大部分为T细胞的单克隆性增生。     

鼻腔NK／T细胞淋巴瘤免疫组化表达及临床分析

目的：探讨鼻腔NK／T细胞淋巴瘤临床及病理特征,提供诊治思路。方法：对17例鼻腔NK／T细胞淋巴瘤应用临床资料,组织病理学免疫组化分析其临床特点。结果：鼻腔NK／T细胞淋巴瘤以鼻塞、鼻面肿胀溃烂,以面部中线进行性破坏、坏死性病变为特征,病理学免疫组化表达T细胞。NK细胞标记阳性,B细胞不表达。结论：鼻腔NK／T细胞淋巴瘤临床表现不典型,易误诊。病理学结合免疫组化是确诊的重要方法。本病放射治疗结合化学治疗有效。     

脾脏原发性非霍奇金氏淋巴瘤的临床病理分析

目的：回顾性观察脾脏原发性非霍奇金氏淋巴瘤（NHL）的临床病理及免疫组化特点，为临床诊治提供依据。方法：收集10例脾脏原发性非霍奇金氏淋巴瘤（NHL）手术切除标本病例，总结其临床资料及病理组织学特点，采用HE染色、免疫组化CD45、CD45RO、CD30、CD34、CD68和EMA抗体标记。结果：10例脾脏原发性NHL临床上主要表现为脾脏肿大伴左上腹隐痛，临床分期为Ⅰ期者7例（7/10）、Ⅱ期3例（3/10）。大体分型：均匀弥漫型3例、粟粒结节型2例、巨块型2例、多肿块型3例。组织学形态：弥漫型淋巴瘤7例（其中中心母细胞性1例，中心母细胞/中心细胞性3例，中心细胞性1例，小细胞性2例）、滤泡型淋巴瘤2例均为中心/中心母细胞性淋巴瘤、中小多型T淋巴细胞性淋巴瘤1例；免疫组化CD45、CD20、CD45RO标记阳性表达率分别为100％、90％、10％，余CD30、CD34、CD68和EMA标记均为阴性。结论：脾脏原发性非霍奇金氏淋巴瘤较少见，临床常表现为脾脏肿大伴左上腹隐痛，手术前不易确诊，组织学以B细胞源性多见，治疗以外科手术为主；患者预后与病期及化疗有关。     

NK细胞淋巴瘤/白血病病理特点和预后研究

目的探讨NK细胞淋巴瘤／白血病病理特点及影响预后因素。方法对38例NK细胞淋巴瘤／白血病临床病理资料进行回顾性分析，统计临床病理参数对生存期的影响。结果肿瘤细胞形态多样，易侵犯血管伴微血管透明血栓形成，嗜上皮反应；所有病例肿瘤细胞强表达CD56、TIA-1、GranzymeB，7．9％（3／38）表达CD8,94．6％（36／38）EBER阳性；Kaplan—Meier单因素分析显示：B症状、临床分期为Ⅲ—Ⅳ、乳酸脱氢酶升高、血AST升高、外周血三少、区域淋巴结累及和未治或单一治疗方式是预后差的因素，IPI分组与生存期无明显相关性。结论NK细胞淋巴瘤／白血病形态学变异大，有亲血管和上皮倾向；预后与治疗方式有关，两种以上方法联合治疗可能为治疗NK细胞淋巴瘤／白血病较好方法；IPI不是判断其预后的好工具。     

外周T细胞淋巴瘤的临床病理和免疫组织化学特征

目的 探讨外周T细胞淋巴瘤临床和病理组织特征以及免疫组织化学特征在其诊断和鉴别诊断以及分类中的价值。方法 应用组织形态学观察及免疫组织化学分析对既往诊断的64例外周T细胞淋巴瘤（PTCLs），进行HE染色和CD45RO，CD20，CD3，CD56，CD4，CD8，CD30，ALK的免疫表型测定，结合临床，根据新的WHO 2001分类标准进行分类和分析。结果 确诊了64例外周T细胞淋巴瘤，包括29例外周T细胞淋巴瘤（非特殊性），占45．3％；13例间变性大细胞淋巴瘤（ALCL），占20．3％；11例（17．2％）结外NK／T细胞淋巴瘤（鼻型）（NK／TCL）；肠病型T细胞淋巴瘤（ITCL）和皮下脂膜炎性T细胞淋巴瘤（SCPTCL）各5例，各占7．8％；1例侵袭性NK细胞白血病（ANKCL），占1．6％。临床上，男性多于女性，大于40岁多见（78％）。发生在淋巴结的有44例，其次鼻咽部10例，咽喉部5例，睾丸、腹部包决、左大腿、腰椎、甲状腺各1例，累及的部位较广。组织病理形态：瘤细胞大、中、小均可见，染色质细，胞浆浅染。免疫组织化学：64例外周T细胞淋巴瘤中70．3％，10．9％，98．4％分别表达CD45RO，CD20，CD3；13例间变性大细胞淋巴瘤中11例表达CD30，11例结外NK／T细胞淋巴瘤（鼻型）100％表达CD56，阳性率和阴性率差异有显著性。结论 外周T细胞淋巴瘤是一类异质性很强的肿瘤，必须结合临床、病理组织特征和免疫组织化学特征进行诊断和鉴别诊断以及分类。     

原发性胃肠道淋巴瘤临床病理分析

目的探讨原发性胃肠道淋巴瘤的临床表现、病理特征及免疫表型。方法回顾性分析78例原发性胃肠道淋巴瘤的临床表现、病理特征及免疫表型特点。采用免疫组化EnVision法检测CK、LCA、CD3、CD45RO、CD20、CD79a、CD5、CyclinD1、CD10、BCL6、MUM1、CD30、CD56、Ki-67,运用原位杂交检测EBER,观察其免疫表型特点和EB病毒感染情况。结果患者临床上表现为腹痛、腹部包块或便血。发生部位：胃22例、小肠24例、回盲部15例、结肠12例、直肠5例。所有病例均表达LCA,69例表达CD20和CD79a,3例表达CD5和CyclinD1,9例表达CD3和CD45RO,1例表达CD30,1例表达CD56,Ki-67阳性表达率约20％～70％不等,2例EBER原位杂交检测阳性。所有病例CK均未检测出阳性。病理组织学类型：36例粘膜相关淋巴组织淋巴瘤,30例弥漫性大B细胞淋巴瘤,3例套细胞淋巴瘤,6例非特殊型的外周T细胞淋巴瘤,肠病相关T细胞淋巴瘤、鼻型NK／T细胞淋巴瘤和间变性大细胞淋巴瘤各1例。结论原发性胃肠道淋巴瘤以B细胞淋巴瘤多见,T细胞淋巴瘤少见。临床上很难与胃肠道癌鉴别,确诊靠胃肠粘膜活检或手术切除标本及免疫组化染色,辅以原位杂交检测。     

NK／T细胞淋巴瘤的临床病理、免疫表型及其与EB病毒的相关性

目的 探讨NK／T细胞淋巴瘤的临床病理,免疫表型特点及其与EB病毒的关系。方法 用免疫组织化学染色方法（选用ED3ε、CD56等抗体）确定瘤细胞来源。用原位杂交方法检测EB病毒编码的RNA（EBER1／2）。结果 117例TCL中26例表达NK／T细胞标记（22．2％）,其中鼻部NK／T细胞淋巴瘤15例（57．7％）;肿瘤细胞的多形性（18／26、69．2％）和凝固性坏死（12／26例、46．2％）是主要的病理学特点;EB病毒感染率46．2％（12／26）,其中鼻部感染率73．3％（11／15）,非鼻部为9．1％,两组比较P＜0．005。结论 NK／T细胞淋巴瘤常发生在鼻部,呈侵袭性生长,肿瘤细胞的多形性和坏死是自组织学特点,EBV感染与鼻部NK／T细胞淋巴瘤的发生密切相关。     

鼻腔NK／T细胞淋巴瘤特异分子标志及预后相关因素研究

目的 探讨鼻腔NK／T细胞淋巴瘤的特异性免疫标志及预后的相关因素。方法 以鼻腔NK／T细胞淋巴瘤30例石蜡组织标本为研究对象．同部位B细胞淋巴瘤20例为对照，采用S—P三步法行免疫组化染色；采用PCR法对12例鼻腔NK／T细胞淋巴瘤行TCRβ、γ基因重排分析，2例B细胞淋巴瘤为对照；对全纽病例回顾性分析、比较．探讨预后的相关因素。结果 30例鼻腔NK／T细胞淋巴瘤中，CD45RO阳性26例、CIM323例、CD3ε24例阳性定位于胞浆、CD5626例、CD309例、CD20、CD45RA、CD57、CD16及CD3表面全部阴性；细胞毒颗粒蛋白TIA—1、GranzymeB、Perforin的阳性表达分别为30例、28例、24例；对照组20例B细胞淋巴瘤均不表达。背景反应性中性粒细胞和组织细胞表达TIA—1，肿瘤细胞的异型性和CD30／GranzymeB的表达密切相关。12例NK／T细胞淋巴瘤TCRβ的基因检出率为58．3％（7例），TCRγ／链基因检出率为66．7％（8例）。结论 NK／T的常规诊断可在形态学的基础上，联合使用CD45RO，CD3e、CD56，GranzymeB免疫化染色确定：全组病例超过半数存在TCRβ、TCRγ基因重排，表明大部分为T细胞单克隆性增生；肿瘤细胞的异型性和CD30／GranzymeB的表达密切相关，其意义尚待深入探讨：影响预后的相关因素主要有临床分期、肿瘤侵犯、全身症状、病理分级及治疗方法等。     

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…     

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.     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…