乳腺癌雌孕激素受体、癌基因蛋白和增殖细胞核抗原的表达及意义

①目的 探讨乳腺癌雌激素受体（ER）、孕激素受体（PR）、癌基因C-erbB-2、P53、P21蛋白、增殖细胞核抗原ki-67在乳腺癌中的表达情况及对预后的影响。②方法 采用免疫组化SABC法进行ER、PR、C－erbB-2、P53、P21、Ki-67的检测,并观察其表达情况及相关关系。③结果 37例乳腺癌分别以组织学分级和术后生存期为分组标准进行结果分析。ER、PR表达率在组织学I级、Ⅱ级明显高于Ⅲ级（P＜0．05）,C－erbB-2表达率在I级明显低于Ⅱ级、Ⅲ级（P＜0．05）,P53、P21、Ki-67过度表达率随组织学分级的升高而升高;ER、PR表达率在术后生存期5年以上组高于5年以下组（P＜0．05）,C－erbB-2、Ki-67表达率及P53过度表达率在术后生存期5年以上组低于5年以下组（P＜0．05）,P21表达率在术后生存期5年以上组较5年以下组低,但差异无显性（P＞0．05）;ER、PR阳性患C－erbB-2、P53阳性表达明显低于ER、PR阴性患（P＜0．05）。④结论 激素受体是指导内分泌治疗、判断预后的一项重要指标;C－erbB-2、P53、P21、Ki-67蛋白在判断预后及恶性程度中有重要意义。     

乳腺癌患者血浆D-二聚体水平的变化及其与临床病理的关系

目的探讨乳腺癌患者血浆D-二聚体水平变化的意义及其与临床病理因素的关系。方法采用免疫比浊法测定120例乳腺癌患者组和100例健康对照组的血浆D-二聚体水平,比较两组间的差异,同时分析不同临床病理因素下D-二聚体水平的差异。结果乳腺癌组血浆D-二聚体水平显著高于健康对照组（P＜0.05）,且在不同TNM分期之间有显著差异;同时血浆D-二聚体水平在三阴（ER、PR、HER2均为阴性）乳腺癌患者中要显著高于非三阴患者,在1年生存率的分组比较中也有显著差异。结论乳腺癌患者血液处于高凝和纤溶亢进状态,血浆D-二聚体的水平反映了乳腺癌的恶性程度,与乳腺癌的分期、进展和生存期密切相关,因此D-二聚体水平在乳腺癌血清学诊断和临床应用研究中均有重要价值。     

核型BAG-1在早期乳腺癌的表达及其意义

目的探讨核型BAG-1在早期乳腺癌组织中的表达与传统预后因素如临床病理特征、ER、PR、HER2的关系及其意义。方法用免疫组化二步法检测76例有完整随访资料的早期乳腺癌患者乳腺癌组织中核型BAG-1、ER、PR及HER2的蛋白表达,并进行统计学分析。结果核型BAG-1在早期乳腺癌组织中的阳性率为14．47％。核型BAG-1表达与患者的年龄、绝经状态、肿瘤的病理类型及HER2的蛋白表达无关（P〉0．05）,与ER、PR蛋白表达相关（P〈0．05）。单因素分析显示核型BAG-1、ER、HER2与预后相关,多因素分析显示只有核型BAG-1表达与预后相关。结论核型BAG-1与ER、PR相关,可能作为早期乳腺癌预后判断的指标之一。     

肺癌患者血浆纤维蛋白原、D-二聚体及抗凝血酶Ⅲ水平的变化及临床意义

目的：观察肺癌患者血浆纤维蛋白原（ FIB ）、D-二聚体及抗凝血酶Ⅲ（ AT-Ⅲ）水平变化并探讨其临床意义。方法肺癌患者73例（观察组）,健康志愿者60例（对照组）,检测两组血浆FIB、D-二聚体及AT-Ⅲ水平。结果观察组血浆FIB、D-二聚体水平显著高于对照组,而AT-Ⅲ水平显著低于对照组（ P均＜0．05）;Ⅲ、Ⅳ期患者血浆FIB、D-二聚体水平高于Ⅰ、Ⅱ期（P＜0．05）,而Ⅲ、Ⅳ期患者AT-Ⅲ水平低于Ⅰ、Ⅱ期（P＜0．05）。结论检测FIB、D-二聚体以及AT-Ⅲ的水平可作为肺癌进展的辅助诊断指标。     

恶性肿瘤患者血浆D-二聚体测定及临床意义

目的 探讨恶性肿瘤患者测定血浆D-二聚体的临床意义。方法 测定了70例恶性肿瘤患者化疗前后的血浆D-二聚体浓度。结果 化疗前未发现转移的恶性肿瘤患者血浆D-二聚体阳性率为48．7％，化疗前发现有转移的恶性肿瘤患者血浆D-二聚体阳性率为67．7％，两组间比较差异有显著性（P〈0．05）。化疗后疗效达完全缓解（CR）及部分缓解（PR）组血浆D-二聚体阳性率为28．2％，化疗后疗效为稳定（SD）组血浆D-二聚体阳性率为64．7％，化疗后疗效为进展（PD）组血浆D-二聚体阳性率为78．6％，三组间比较差异有显著性（P〈0．05）。结论 恶性肿瘤患者测定血浆D-二聚体浓度对临床分期及预后判断有一定的帮助。     

Ki67在乳腺癌组织中表达及其与C—erbB-2、ER、PR、P53基因的关系

目的：探讨Ki67基因在乳腺癌组织中的表达及其与C—erbB-2、ER、PR、P53基因的相关关系。方法：用免疫组化方法检测133例乳腺癌组织中Ki67、C—erbB-2、ER、PR、P53的表达。结果：Ki67在乳腺癌组织中总阳性率为78．2％,Ki67表达与乳腺癌肿瘤大小和I临床分期有显著相关性（P〈0．05）,与患者的年龄、腋窝淋巴结转移无显著相关性（P〉0．05）;乳腺癌组织的Ki67表达强度与C—erbB-2、1353强度的表达呈正相关（1分别为0．172、0．280,P〈0．05）,与ER强度的表达呈负相关（γ为-0．193,P〈0．05）,与PR表达强度无显著相关性（γ为-0．007,P〉0．05）。结论：Ki67表达与乳腺癌发生、发展有关,是一个不良预后因素。     

Ki67在乳腺癌组织中表达及其与C-erbB-2、ER、PR、P53基因的关系

目的：探讨Ki67基因在乳腺癌组织中的表达及其与C—erbB-2、ER、PR、P53基因的相关关系。方法：用免疫组化方法检测133例乳腺癌组织中Ki67、C—erbB-2、ER、PR、P53的表达。结果：Ki67在乳腺癌组织中总阳性率为78．2％,Ki67表达与乳腺癌肿瘤大小和I临床分期有显著相关性（P〈0．05）,与患者的年龄、腋窝淋巴结转移无显著相关性（P〉0．05）;乳腺癌组织的Ki67表达强度与C—erbB-2、1353强度的表达呈正相关（1分别为0．172、0．280,P〈0．05）,与ER强度的表达呈负相关（γ为-0．193,P〈0．05）,与PR表达强度无显著相关性（γ为-0．007,P〉0．05）。结论：Ki67表达与乳腺癌发生、发展有关,是一个不良预后因素。     

乳腺癌HER2基因IHC与FISH检测方法的比较及其与临床病理的关系

目的：比较免疫组织化学法（IHC）和荧光原位杂交法（FISH ）检测乳腺癌 HER2基因状态的一致性,并分析HER-2基因的表达状态与各临床病理指标的关系。方法应用IHC和 FISH法分别检测乳腺癌患者H ER2蛋白表达和H ER2基因扩增状况（1448例）,进行一致性分析,并分析H ER2基因的表达状态与各临床病理相关指标的关系。结果 HER2蛋白的阳性（3＋）表达率为24．5％（355/1448）,阴性（0/1＋）表达率为60．8％,可疑（2＋）表达率为14．7％。 HER2基因扩增率为27．8％（402/1448）,HER2蛋白IHC检测为0/1＋和3＋时,与HER2基因FISH检测的一致性很高,分别为99．7％（877/880）和99．2％（352/355）,2＋时结果一致性差,符合率为22％（47/213）。HER2基因扩增与ER及PR均阴性（P＜0．001）、P53阳性（P＜0．001）,Ki67高表达（P＜0．001）、组织学分级高（Ⅲ级）（ P＜0．001）、T N M分期晚（Ⅲ/Ⅳ）（ P＜0．05）、肿瘤瘤体大（≥5 cm ,P＜0．001）有相关性,与患者年龄、淋巴结是否转移、绝经状态、肿瘤部位及脉管瘤栓无相关性（P＞0．05）。结论 IHC是乳腺癌 HER2基因状态初步筛查的首选方法,但FIS H为H ER2基因检测更为可靠的方法。 H ER2基因表达状态是判断乳腺癌预后的良好指标,并为临床乳腺癌患者的用药提供可靠依据。     

P53癌基因蛋白测定与乳腺癌预后关系的探讨

采用免疫组化方法研究87例乳腺癌病人P53蛋白表达和临床病理参数、预后及ER、PR的关系．结果提示，P53表达与淋巴结转移、核分裂、病理分化、复发转移及PCNA表达呈正相关；与生存期、ER及PR表达呈负相关（P＜0．01）；与年龄、肿瘤大小、组织学类型无关（P＞0．05）．P53阳性预后差，ER阳性预后比阴性好。     

围绝经期ER/PR+HER2-浸润性乳腺癌的临床病理特征及预后分析

目的 探讨围绝经期雌激素受体(ER)和/或孕激素受体(PR)阳性及人类表皮生长因子受体2(HER2)阴性(ER/PR+HER2-)浸润性乳腺癌患者的临床病理特征及预后.方法 选择2009年1月至12月上海交通大学医学院附属第九人民医院黄浦分院收治的335例ER/PR+HER2-浸润性乳腺癌患者作为研究对象,根据月经状态将其分为绝经前组(<40岁,23例)、围绝经期组(40～60岁,228例)和绝经后组(>60岁,84例),比较3组患者的临床病理特征及预后情况,并通过单因素和多因素Cox回归分析围绝经期ER/PR+HER2-浸润性乳腺癌患者预后的危险因素.结果 不同月经状态ER/PR+HER2-浸润性乳腺癌患者肿瘤T分期、N分期、TNM分期、组织学分级、组织学类型、淋巴血管浸润情况、PR表达水平差异均无统计学意义(P均>0.05).Ki-67、ER、P53表达水平在3组患者间差异均有统计学意义(P均<0.01),围绝经期和绝经前组患者Ki-67阳性细胞百分比≥60％者和≥20％者占比均高于绝经后组,绝经前、围绝经期、绝经后组患者的ER表达水平依次增高,围绝经期和绝经前组患者的P53表达水平均高于绝经后组.绝经前、围绝经期和绝经后组患者生存率分别为87.0％(20/23)、92.1％(210/228)和91.7％(77/84),Kaplan-Meier生存曲线分析显示3组间差异无统计学意义(P>0.05).多因素Cox回归分析结果显示,淋巴结转移、Ki-67阳性细胞百分比≥60％、PR低表达是围绝经期ER/PR+HER2-浸润性乳腺癌患者预后的独立影响因素(HR=2.43、3.45、0.27,P均<0.05).结论 围绝经期ER/PR+HER2-浸润性乳腺癌有其独特的临床病理特征,但不同月经状态下患者的预后无明显差异.淋巴结转移、Ki-67阳性细胞百分比≥60％、PR低表达是围绝经期ER/PR+HER2-浸润性乳腺癌患者预后的独立影响因素.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.