Blood biomarkers of mild traumatic brain injury: State of art

BackgroundMild traumatic brain injury (mTBI) is one of the most common causes of emergency department visits around the world. Up to 90% of injuries are classified as mTBI. Cranial computed tomography (CCT) is a standard diagnosis tool to identify intracranial complications in adults with mTBI. Alternatively, children can be admitted for inpatient observation with CCT scans performed only on those with clinical deterioration. The use of blood biomarkers is a supplementary tool for identifying patients at risk of intracerebral lesions who may need imaging.MethodWe realised a bibliographic state of art providing a contemporary clinical and laboratory framework for blood biomarker testing in mTBI management.ResultsThe S100B protein is the only biomarker that can be used today in the clinical routine for management of mTBI with appropriate evidence-based medicine. Due to its excellent negative predictive value, S100B protein is an alternative choice to CCT scanning for mTBI management with considered, consensual and pragmatic use. In this state of art, we propose points to help clinicians and clinical pathologists use serum S100B protein in the clinical routine. A state of art on the different biomarkers (GFAP, UCH-L1, NF [H or L], tau, H-FABP, SNTF, NSE, miRNAs, MBP) is also conducted. Some of these other biomarkers, used alone (GFAP, UCH-L1) or in combination (GFAP + H-FABP ± S100B ± IL10) can improve the specificity of S100B.ConclusionUsing a bibliographic state of art, we highlighted the added values of the blood biomarkers for the clinical management of mTBI.     

Association of angiotensin Ⅱ type 1 receptor gene polymorphism with essential hypertension

Objective To determine whether the polymorphism A1166C in the angiotensin Ⅱ type 1 receptor (AT1R) gene is associated with essential hypertension.Methods A case-control study was carried out using 125 hypertensive and 103 normotensive subjects. The A→C variant at position 1166 (A1166C) of t he AT1R gene was identified by polymerase chain reaction (PCR) and PCR/ restriction fragment length polymorphism (PCR/RFLP) analysis. The digestion products were separated on 2% agarose gels and visualized with ethid ium bromide under ultraviolet ray.Results The differences in C1166 allele frequency and in the AC genotype dist ribution of the AT1R gene between the hypertensive and normotensive groups were statistically significant (C allele: 0.092 vs 0.034, χ(2) =6.1 86, P<0.05; AC genotype: 0.184 vs 0.068, χ(2) =6.654, P<0.05).Conclusion The AC genotype is associated with essential hypertension, and the C a llele may be a marker for predisposition to hypertension in Chinese H an population.     

Influence of growth hormone-insulin-like growth factor Ⅰ axis on normal pregnancy

Objective To investigate the role of growth hormone-insulin-like growth factor Ⅰ (IGF-Ⅰ) axis in normal pregnancy. Methods Totally, 116 normal pregnant women were recruited from January 1997 to June 1998, with 20 normal nonpregnant women as controls. Maternal growth hormone (GH) and IGF-Ⅰ concentrations were assayed by RIA and enzyme-linked immunosorbent assay, respectively. Results Maternal serum levels of GH increased throughout gestation, reached a peak at 25 weeks of pregnancy and remained fairly high (χ[2]=40.458, P<0.0001).There was a significant difference between samples at 5-9 week gestational age and the controls (3.45 μg/L vs 1.61 μg/L, P<0.05). The maternal serum levels of IGF-Ⅰincreased rapidly throughout gestation from 29-week gestation and reached a peak of 188.86 μg/L at term delivery (χ[2]=50.224, P<0.0001). Conclusions Maternal GH levels increased progressively throughout gestation, which correlated with fetal growth. Maternal GH may regulate nutrition supply among mother, placenta and the fetus and play an important role in transporting nutritional substrates by the placenta. The maternal IGF-Ⅰin the third trimester may promote fetal growth and placental functions.     

晚期肿瘤的治疗及其价值

晚期肿瘤是否有治疗意义的讨论越来越受到社会的关注。作者从医学及伦理学两方面论述晚期肿瘤的治疗意义,认为治疗有助于疾病的控制,有利于提高患者的生存质量。指出晚期肿瘤的治疗并非无效治疗,患者能从治疗中得益。     

参麦注射液对非小细胞肺癌化疗减毒作用的观察

进一步探讨参麦注射液对化疗的减毒作用。方法 :对肺癌患者 2 0 3例进行回顾性分析。结果 :化疗后 OKT1值参麦组略上升 ,对照组下降 ( P<0 .0 5) ;OKT4 / OKT8比值治疗后参麦组明显高于对照组 ( P<0 .0 5)。参麦组 s IL - 2受体水平下降 ( P<0 .0 5) ,LAK细胞、NK细胞略上升( P<0 .0 5) ,对照组 s IL - 2受体水平下降不明显 ( P<0 .0 5) ,L AK细胞、NK细胞均下降 ( P <0 .0 5) ;化疗后参麦组外周血白细胞和血小板降低程度明显小于对照组 ( P<0 .0 5) ,全身体力状况也优于对照组。结论 :参麦液对化疗有一定的减毒作用 ,使化疗计划更易于完成。     

病人图书馆是医院图书服务的新领域

建立病人图书馆,以“图书治疗”、“图书护理”为患者提供服务,是现代医学模式转变的需要。国外病人图书馆的发展对病人治疗康复已起到了积极的作用。我国应根据国情建立不同模式的病人图书馆,为患者提供多种多样的服务。     

复方三根制剂对MDR细胞株K562/ADR和K562/VCR逆转作用的研究

目的：研究复方中药——复方三根制剂对多药耐药(MDR)细胞株的逆转作用。方法：应用MTT比色法，观察复方三根制剂对MDR细胞的逆转作用。运用流式细胞仪(FCM)，测定其对耐药细胞积聚和外排阿霉素(ADR)的影响，以及对耐药株细胞表达P=gp的影响。结果：复方三根制剂可部分恢复K562／ADR和K562／VCR耐药细胞对ADR的敏感性，而对VCR抗药性的逆转作用不明显；可增加K562／ADR和K562／VCR耐药细胞内ADR的积聚，并对外排ADR有一定影响；可部分下调p-gp的表达。结论：复方三根制剂可部分逆转耐药细胞的抗药性。     

氯氮平在体内代谢与细胞色素P450 1A2-2964位点多态性的关系

目的：探讨氯氮平在精神分裂症患者体内代谢和细胞色素P450 1A2－2964位点多态性关系，指导临床对不同患者合理使用氯氮平。方法：采用固定剂量给药，用高效液相色谱法（HPLC）测定血药浓度，用限制性片段长度多态性（RFLPs）分析基因型。结果：吸烟组和非吸烟组之间比较，吸烟组血浆氯氮平浓度低，去甲氯氮平／氯氮平比值高（P＜0．05，P＜0．01），P450 1A2-2964位点等位基因G的频率为0．75，A的频率为0．25，在非吸烟患者中，去甲氯氮平／氯氮平在w/w基因型与非w/w基因型(w/m m/m)之间无显著的统计学意义（P＞0．05），在吸烟患者中，w/w基因型去甲氯氮平／氯氮平要高于非w/w基因型（P＜0．05），在吸烟患者和非吸烟患者中w/w基因型之间比较，吸烟患者的去氯氮平／氯氮平明显高于非吸烟患者（P＜0．01）；而非w/w基因型之间无显著的统计学意义（P＞0．05），结论：吸烟能诱导P450 1A2的活性。P450 12-2964位点等位基因均为G（w/w)时诱导能力最强，发生G→A突变时，诱导能力降低，分析患者P450 1A2 G－2964A的多态性，对合理使用氯氮平有意义。     

外阴癌中HPV感染与p53、MDM2表达的关系

目的 :探讨HPV6/ 11、16/ 18在外阴癌组织中的感染情况及与p5 3、MDM2蛋白表达的关系。方法 :用原位杂交法 (ISH)检测HPV6/ 11、16/ 18在 30例外阴癌、2 1例外阴上皮内瘤变 (VIN)及 10例外阴正常皮肤组织中的表达。同时用免疫组化SP法检测p5 3、MDM2蛋白的表达。结果 :HPV6/ 11、16/ 18在外阴癌、VIN中的阳性表达率分别为 60 % (18/30 )、33.33% (10 / 30 ) ,4 2 .86% (9/ 2 1)、2 8.5 7% (6/ 2 1) ,正常对照组没有表达。p5 3、MDM2蛋白在外阴癌、VIN、正常对照组中的阳性表达率分别为 63.33% (19/ 30 )、4 0 .0 0 % (12 / 30 ) ,4 7.62 %(10 / 2 1)、5 2 .38% (11/ 2 1) ,0 % (0 / 10 )、0 % (0 / 10 )。HPV6/ 11的表达在外阴癌组、VIN组与正常组差异有显著性 (P <0 .0 5 ) ,外阴癌组HPV16/ 18表达与正常组差异有显著性 (P <0 .0 5 )。外阴病变各组p5 3、MDM2与正常组差异有显著性 (P <0 .0 5 )。结论 :HPV6/ 11、HPV16/ 18、p5 3、MDM2蛋白在外阴组织的不同病变中表达均差异有显著性 ,在外阴癌的发生发展中HPV感染、p5 3突变和MDM2表达可能起一定的作用     

DIAGNOSTIC IMPLICATIONS OF IMMUNOHISTOCHEMICAL MARKERS IN UTERINE SMOOTH MUSCLE TUMORS

Objective: To evaluate the diagnostic implications of immunohistochemieal markers in uterine smooth muscle tumors. Methods: Formalin-fixed paraffin-embedded tissue blocks were selected from 17 uterine leiomyosarcomas, 40 uterine unusual leiomyomas and 25 uterine usual leiomyomas. Utilizing immunohistochemical techniques with antigen retrieval, serial sections of each tumor for immunoreactivity with myogenic markers, ovarian steroid receptors, CD44v3, proliferating cell nuclear antigen and mast cells were assessed. Results: Although the myogenic markers and CD44v3 showed less frequent positivity in uterine leiomyosarcomas than those in unusual leiomyomas,they were not reliable markers for differentiating leiomyosarcoma from leiomyoma. Uterine leiomyosarcoma tended to have lower ovarian steroid receptors immunoreactivity rates than leiomyoma. Leiomyoma tended to have a higher quantity of intratumoral mast cells than leiomyosarcoma, while the expression of proliferating cell nuclear antigen was lower in them. Conclusion: Because the estimation of mitotic count was subject to significant variation, the immunohistochemical expression of ovarian steroid receptors, mast cells and proliferating cell nuclear antigen seemed to be helpful for the discrimination of unusual leiomyoma from leiomyosarcoma.