上皮钙黏附素在胃癌中表达的意义及诱导化疗后的改变

目的：探讨上皮钙黏附素（E-cd)在胃癌中的表达与胃癌生物学行为的关系。以及术前诱导化疗后E-cd在胃癌及癌旁组织中的变化，以确定术前应用短程化疗的意义。方法：采用免疫组织化学（S－P）法测定62例胃癌组织及癌旁组织E-cd的表达水平，其中32例以15mg/(kg.d)5－氟尿嘧啶（5－FU）术前进行1－5天的化疗，余30例为对照组，术中收集胃癌及癌旁组织标本。结果：E-cd在正常胃黏膜皆表达强阳性，在胃癌组织弱阳性及阴性表达占70％（21／30），E-cd的表达与胃癌细胞分化相关。5－FU术前化疗可以明显提高胃癌组织的E-cd阳性表达率（与对照组相比，P＜0．01），而且5－FU≥3．0g组与5－FU＜3．0g组之间差异具有显著性（P＜0．025）；在癌旁组织中5－FU≥3．0g组与非化疗 之间E-cd阳性表达率差异有性（P＜0．025），结论：E-cd的存在与否可能决定胃癌细胞的分化程度，术前应用5－FU诱导化疗可以提高胃癌细胞的阳性表达率。可以提高癌旁细胞的阳性表达率，术前诱导化疗可能减弱胃癌细胞的侵袭性。     

抗癌药物对乳腺癌细胞Bcl—2、p53、Ki—67表达的影响及相互关系

目的 研究抗癌药物对乳腺癌细胞Bcl-2、p53、Ki-67表达的影响及相互关系。方法 取病理诊断为乳腺癌的手术切除标本,体外分离细胞作培养,应用四甲基偶氮唑盐（MTT）法分析多柔比星（ADM）、丝裂毒素（MMC）、5－氟脲嘧啶（5－FU）、顺铂（DDP）、长春新碱（VCR）5种化疗药物对乳腺癌细胞的相对抑制率,通过免疫细胞化学染色法和图像定量法分析乳腺细胞Bcl-2、p53、Ki-67的表达改变。结果 乳腺癌细胞在0.1XPPC药物浓度体外处理24h后出现形态改变,化疗药物对乳腺癌细胞的相对抑制率依次为VCR＞5－FU＞ADM＞MMC＞DDP,各用药组乳腺癌细胞Bcl-2、p53、Ki-67表达均有不同程度改变,与未用药组比较P＜0.001,等级相关分析P＜0.01和P＜0.05。结论 化疗药物主要通过诱导乳腺癌细胞凋亡、抑制细胞增殖等作用,而选择性地抑制和调控过度激活表达的癌基因。     

胃癌术前区域动脉化疗对肿瘤细胞形态、增殖和凋亡作用的研究

目的：探讨胃癌术前动脉化疗的效果和作用机制。方法：将进展期胃癌患者分成单纯手术组（A组,20例）和化疗加手术组（B组,20例）,后者术前行区域动脉化疗,观察化疗对手术和术后恢复的影响,检测术后标本的组织病理学改变,免疫组化法测定肿瘤增殖指标Ki-67,DNA末端标记法检测肿瘤细胞凋亡指教的变化。结果：术前区域动脉化疗,有利于手术操作分离,不增加术后并发症,化疗组出现肿瘤组织坏死,癌细胞变性,纤维组织增生等病理改变;肿瘤增殖指数Ki-67较对照组显著下降,而细胞凋亡指数则显著提高。结论：术前动脉化疗能引起癌细胞变性坏死,抑制肿瘤增殖,促进细胞凋亡,可望改善预后。     

银屑病皮损区c—myc、c—jun、Ki—67、PCNA、VEGF的表达

目的 探讨原癌基因c-myc、c-jun、ki-67、细胞核增殖性抗原（PCNA）、血管内皮细胞生长因子（VEGF）在银屑病发病中的作用。方法 采用免疫组化方法，检测了32例寻常型银屑病皮损区及5例正常人表皮中c-myc、c-jun、ki-67、PCNA、VEGF的表达及分布特点。结果 银屑病皮损区c-myc、c-jun、ki-67、PCNA、VEGF表达均较正常表皮中的表达明显增强。分布于除角质层以外的表皮各层，而正常表皮表达阴性或仅在基底层有弱阳性表达。结论 c-myc、c-jun、ki-67、PCNA在银屑病皮损中过度表达，提示其与银屑病的表皮细胞过度增殖、分化异常有关；VEGF过度表达，提示VEGF与银屑病的真皮乳头毛细血管增生扩张，炎症细胞浸润有关。     

雌激素受体和ki-67在小儿血管瘤的表达及意义

目的：探讨雌激素在血管瘤增殖与退化中的作用。方法：应用免疫组织化学方法检测42例血管瘤和17例血管畸形标本雌激素受体（ER）及细胞增殖核抗原ki-67的表达情况。结果：血管瘤组的ER，ki-67平均标记指数均高于血管畸形组及正常皮肤组，血管瘤组中增生期亚组两标记指数均高于退化期亚组（P＜0．01），血管瘤组中ER与ki-67标记指数的相关系数为0．77（P＜0．05），而血管畸形组为0．40（P＜0．05），结论：雌激素及其受体与血管瘤内皮细胞的增殖相关。     

胃癌术前动脉化疗对癌细胞凋亡和增殖的影响

胃癌手术前动脉插管化疗，可使化疗药物选择性地高浓度集中于病灶周围，减轻化疗药物的毒副作用，杀伤癌细胞使癌灶缩小，提高手术切除率，对于亚临床转移可起到预防和治疗作用，对防止手术中肿瘤医源性扩散起到积极作用。切除标本的病理组织学观察可见肿瘤组织和细胞结构发生变化及肿瘤组织坏死。将胃癌患者动脉化疗前后的癌组织标本，进行细胞凋亡及增殖细胞核抗原(Proliferating cell nuclear antigen，PCNA)单克隆抗体检测，探讨动脉化疗对胃癌细胞凋亡及增殖的影响。     

舌癌术前化疗PCNA、bcl—2、Bax基因表达及临床意义

目的：通过舌癌术前化疗增殖细胞核抗原（PCNA）和细胞凋亡相关基因bcl-2、Bax表达的研究,探讨舌癌的化疗作用机制。方法：对舌乳头状瘤、舌癌和舌癌术前化疗标本共34例,采用免疫组织化学染色技术－酶标链亲和素生物素法（LSAB）染色并进行光镜下观察。结果：PCNA在舌癌中的表达最强,在舌癌术前化疗中的表达明显减弱（P＜0．05）,其与舌乳头状瘤表达相似（P＞0．05）。bcl-2在舌癌术前化疗及舌乳头状瘤中低表达（P＞0．05）,舌癌中表达明显增强（P＜0．05）。Bax在舌癌组和乳头状瘤组中表达有明显差异（P＜0．05）。结论：化疗药物抑制肿瘤生长的可能与抑制肿瘤细胞增殖和诱导肿瘤细胞程序性死亡有关,提示舌癌术前化疗对肿瘤的预后有重要意义。     

双标记流式细胞术定量分析5-FU诱导胃癌细胞早期凋亡

目的 以Annexin V-FTTC/PI双标记流式细胞术检测5－FU诱导胃癌细胞株SCG7901早期凋亡。方法 250、125、50以及25mg/L不同浓度5－FU处理SCG7901胃癌细胞0、6、12、18、24、30h,Annexin V-FTTC/PI双标记流式细胞术检测肿瘤细胞凋亡。结果 早期（0－24h)瘤细胞凋亡比例随5－FU作用剂量增加和时间延长而显著提高（P＜0.01)；后期（24-30h)瘤细胞以坏死增加为主（P＜0.01)而凋亡比例反而降低。结论 5－FU诱导细胞凋亡呈时间以及剂量依赖关系。Annexin V/PI双标记法可以清楚区分正常、坏死、机械损伤以及凋亡细胞群落，是定量分析早期细胞凋亡的准确方法。     

c－met基因表达与胃癌增殖在幽门螺杆菌感染中的关系

目的 研究c-met基因蛋白及增殖细胞核抗原（PCNA）在幽门螺杆菌（H.pylori)感染的胃粘膜病变演进中的表达及关系。方法 145例经病理证实不同胃粘膜病变，采用免疫组化法检测c-met和PCNA基因表达，Warthin-starry法检测H.pylori感染。结果 在浅表性胃炎（CSG）、萎缩肠化性胃炎（CAG＋IM）、异型增生（ATP）、早期胃癌和进展期胃癌中，两种基因CAG＋IM、ATP、胃癌均显高于CSG（P＜0．05）。胃粘膜增殖程度与c-met和PCNA阳性表达强度有显关联（P＜0．01）。c-met和PCNA阳性表达与胃癌组织类型、浆膜浸润和淋巴结转移密切相关。c-met和PCNA－LI在胃癌中等级相关表达有极其显的相关性（P＜0．001）。c-met阳性表达与肠型胃癌H.pylori感染有关。CAG＋IM、ATP和GC组c-met阳性表达中H.pylori感染明显高于阴性。结论 c-met和PCNA基因表达与胃粘膜增殖和恶化有关。c-met基因可能成为评估胃癌恶化的一项新的重要指标。H.pylori感染和c-met表达与胃粘膜增殖和进展有关。     

术前腹腔动脉插管化疗对中晚期胃癌细胞凋亡和增殖的影响

目的　探讨术前腹腔动脉插管化疗对中晚期胃癌细胞凋亡和增殖的影响。　方法　采用切口末端标记法 (TUNEL)、增殖细胞核抗原 (PCNA)和凋亡抑制基因蛋白 (Bcl 2 )免疫组织化学检测技术 ,观察比较术前腹腔动脉插管化疗组 (治疗组 )和术前未化疗组 (对照组 )中晚期胃癌细胞的凋亡指数、增殖指数和Bcl 2蛋白表达强度的差异。　结果　治疗组与对照组凋亡指数分别为 5 .71± 0 .12和 2 .37± 0 .15(t=97.39,P <0 .0 1) ,增殖指数分别为 4 1.5 0± 0 .14和 5 8.11± 0 .13(t =4 8.8,P <0 .0 1) ,Bcl 2分值为1.5 0± 0 .6 4和 2 .38± 0 .4 9(t=4 2 .8,P <0 .0 1)。凋亡指数与Bcl 2分值呈显著负相关 (rs=- 0 .74 3,P <0 .0 1) ,凋亡指数与增殖指数呈中度正相关 (rs=0 .4 0 0 ,P <0 .0 5 )。治疗组治愈性切除率、3年生存率明显高于对照组 (χ2 =8.5 8,P <0 .0 1;χ2 =4 .0 9,P <0 .0 5 )。　结论　术前腹腔动脉插管化疗可诱导中晚期胃癌细胞凋亡 ,降低肿瘤细胞的增殖活力 ,提高治愈性切除率和患者生存率。诱导胃癌细胞凋亡可能与化疗药物降低Bcl 2基因蛋白的表达有关     

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…