乳腺癌病人血清HER-2／neu检测及其临床意义

【目的】本研究分析晚期乳腺癌患者血清HER-2／neu的水平与预后的关系，并探讨其临床意义。【方法】酶联免疫法（ELISA）检测94例晚期乳腺癌患者血清HER-2／neu的浓度．分析血清与组织中HER-2／neu表达的相关性，并分析其与患者预后的关系。【结果】94例晚期乳腺癌患者就诊时的血清HER-2／neu浓度为0．34-275．25μg／L（平均浓度为23．69μg／L）。血清HER-2／neu浓度的高低与化疗的有效性、疾病进展时间的长短无关。晚期乳腺癌患者的血清HER-2／neu浓度与肿瘤组织中HER-2／neu表达强阳性是一致的。【结论】血清HER-2／neu尚不能确立为独立的预后指标，需要更多的病例进行分析。     

血清HER-2neu ECD水平与乳腺癌临床特征及组织中HER-2neu表达的相关性

观察乳腺癌患者血清人类表皮生长因子受体-2（HER-2neu）胞外域部分（ECD）水平,探讨其与乳腺癌临床特征及组织中HER-2neu表达的相关性。方法选取2013 年1 月-2015 年12 月浙江省肿瘤医院乳腺癌患者50 例作为乳腺癌组,健康志愿者50例作为对照组。采用化学发光法测定血清HER-2neu ECD水平。采用免疫组织化学法测定乳腺癌组织中HER-2 蛋白的表达。结果乳腺癌组血清HER-2neu ECD 水平高于对照组（ p<0.05）,乳腺癌组血清HER-2neu ECD阳性率高于对照组（ p<0.05）。50 例乳腺癌组织标本中, HER-2neu阳性表达20 例,阳性率为40.0%。乳腺癌患者TNM 分期Ⅲ期、雌激素受体（ER）阴性、孕激素受体（PR）阴性及肿瘤直径≥3 cm患者血清HER-2neu ECD阳性率高于TNM分期Ⅰ、Ⅱ期及ER 阳性、PR 阳性、肿瘤直径<3 cm患者（p <0.05）。20例乳腺癌组织HER-2阳性患者中,9例血清HER-2neu ECD阳性;30 例乳腺癌组织HER-2阴性患者中,29 例血清HER-2neu ECD阴性,两种方法一致性较好（Kappa=0.455,=0.000）。结论乳腺癌患者血清HER-2neu ECD 水平升高、乳腺癌组织中HER-2 蛋白表达的一致性较好、血清HER-2neu ECD水平与TNM 分期、ER、PR及肿瘤大小相关,可作为乳腺癌组织中HER-2 蛋白表达的补充检测方法。     

Herceptin及联合顺铂对高表达HER-2/neu卵巢癌体外作用的实验研究及机制探讨

Herceptin是针对HER-2／neu蛋白设计的人源化鼠抗，是一种新型靶向抗肿瘤药物，可明显延长高表达HER-2／neu的晚期乳腺癌患者的生存期。卵巢癌HER-2／neu蛋白的过度表达率为20％～30％，与乳腺癌相似。本研究应用Herceptin联合顺铂对高表达HER-2／neu人卵巢癌进行体外作用的实验研究，并对其作用机制进行探讨。     

血清游离HER-2在乳腺癌患者检测的临床意义

目的探讨乳腺癌患者血清HER-2水平与临床病理特征及化疗疗效的关系及临床意义。方法采用酶联免疫法(ELISA)检测40例晚期乳腺癌及30例早期乳腺癌血清HER-2的浓度,分析血清与组织中HER-2表达的相关性,探索血清中HER-2水平与年龄、月经状况、激素受体表达等临床病理特征的关系。结果在晚期乳腺癌患者中,化疗前血清HER-2的平均浓度28.09ng/ml(0.41～178.35ng/ml),血清HER-2水平与组织HER-2状态、转移部位、转移器官数目相关(P值分别为0.003,0.022,0.012)。治疗前血清HER-2浓度与化疗疗效无关。晚期复发乳腺癌患者化疗2周期后血清HER-2浓度较化疗前均有显著下降(P<0.001),与治疗疗效无关。但治疗有效组(CR+PR)较治疗无效组(SD+PD)血清HER-2下降幅度更大,有显著差异性(P=0.010)。在早期乳腺癌术后患者中,血清HER-2浓度与年龄、月经状况、ER、PR、组织HER-2、淋巴结转移、病理类型等均无明显关系。结论血清HER-2尚不能确立为独立的预后指标,需要更多的病例进行分析。     

胃癌HER-2/neu基因表达与预后的相关性

目的 研究胃癌人表皮生长因子受体（HER）-2／neu基因的表达与生存期的关系,探讨其作为胃癌预后指标的可行性。方法 应用免疫组织化学方法检测103例胃癌标本HER-2／neu基因的表达。并将检测结果与患者的随访资料及临床病理参数进行综合分析。结果 103例胃癌组织中HER-2／neu基因的阳性表达率为31.1％（32／103）：HER-2／neu基因在胃良性病变和癌旁组织中均无表达;HER-2／neu基因表达与患者的性别、年龄、肿瘤大小、部位、分化程度均无相关性（P〉0．05）,而与肿瘤的浸润深度、临床分期、淋巴结转移、远处转移及患者的生存时间相关（P〈0．05）。结论 HER-2／neu基因与胃癌的浸润、转移及预后密切相关,可作为判断胃癌生物学行为和预后的重要参考指标。     

乳腺癌患者血清HER2/neu水平与其组织HER2表达状态的关系

目的:研究乳腺癌患者血清HER2/neu水平与其组织HER2表达的相关性,探讨是否可用血清HER2/neu检测代替组织HER2检测以确定乳腺癌患者的HER2状态。方法:收集33例良性乳腺病患者、58例正常女性、59例乳腺癌患者,采用酶联免疫吸附法(ELISA)检测其血清HER2/neu水平,免疫组织化学法(IHC)检测乳腺癌患者术后癌组织标本的HER2表达情况,进行统计分析比较。结果:58例正常人、33例良性乳腺病患者、59例乳腺癌患者的血清HER2/neu水平分别为(6.81±2.19)μg/L、(6.75±2.32)μg/L、(11.73±5.64)μg/L。59例乳腺癌患者血清HER2/neu水平阳性率为30.5%(18/59),组织HER2表达阳性率为40.7%(24/59),乳腺癌患者血清HER2/neu水平与正常人和良性乳腺病患者有明显差异(P<0.01),且与肿瘤大小、临床分期有相关性(P<0.01);乳腺癌患者组织HER2表达阳性组血清HER2/neu阳性率为20.8%(5/24),乳腺癌组织HER2表达阴性组血清HER2/neu阳性率为37.1%(13/35),两者无相关性(r=-0.187...     

卵巢癌HER-2/neu表达与肿瘤免疫细胞分布关系

目的 研究上皮性卵巢癌细胞原癌基因HER-2／neu表达与肿瘤微环境免疫活性细胞分布的关系，探讨过度表达原癌基因HER-2／neu的上皮性卵巢癌临床分期晚、预后差的可能原因。了解过度表达HER-2／neu基因的上皮性卵巢癌肿瘤微环境的免疫细胞分布。方法 用流式细胞仪检测上皮性卵巢癌细胞原癌基因HER-2／neu的表达，同时用免疫组化方法检测肿瘤微环境中LCA^ 、CD^ 3细胞分布情况。结果 30％卵巢癌细胞原癌基因HER-2／neu呈过度表达，且卵巢癌细胞原癌基因HER-2／neu表达与肿瘤微环境中LCA^ 、CD^ 3细胞分布呈负相关，前者r=-0．630，P=0．0001，后者r=-0．552，P=0．0009。结论 研究结果提示过度表达原癌基因HER-2／neu的上皮性卵巢癌患者肿瘤微环境中浸润免疫细胞数减少，两者存在着一定的内在联系，可能发生肿瘤细胞的免疫逃逸。     

乳腺癌组织HER-2/neu 和RECK蛋白的表达及其意义

目的:探讨HER-2/neu和RECK蛋白在乳腺癌组织中的表达及其临床意义?方法:采用SP法,对76例乳腺癌组织标本及30例正常乳腺组织标本进行免疫组化检测,观察乳腺癌组织及正常乳腺组织中HER-2/neu和RECK蛋白表达情况,并比较不同TNM分期?病理分化程度乳腺癌组织HER-2/neu和RECK蛋白表达强度及阳性率差异,分析其两者之间的关系?结果:乳腺癌组织HER-2/neu表达强度及阳性率高于正常乳腺组织,RECK表达强度及阳性率低于正常乳腺组织,乳腺癌组织中HER-2/neu和RECK表达强度及阳性率同TNM分期及肿瘤组织分化具有相关性,乳腺癌组织HER-2/neu和RECK表达呈负相关?结论:乳腺癌组织中HER-2/neu过度表达?RECK表达减弱或缺失的现象,可能是乳腺癌发生?发展的生物学机制之一?     

细胞周期素E(CyclinE)在乳腺癌组织中的表达及意义

目的:探讨细胞周期蛋白E(CyclinE)在乳腺癌组织中的表达及其与乳腺癌预后的关系。方法:用免疫组织化学的方法检测66例乳腺癌患者及15例乳腺良性肿瘤患者的病理组织切片标本上CyclinE、ER、PR、C-erbB-2(HER-2/neu)的表达,分析CyclinE的表达与患者临床资料、ER、PR、C-erbB-2(HER-2/neu)、中位生存期的关系。结果:CyclinE的表达情况:乳腺癌明显高于乳腺良性肿瘤(P<0.01),临床分期晚者高于临床分期早者(P<0.05),雌激素受体(ER)阳性者明显低于ER阴性者(P<0.01),孕激素受体(PR)阳性者与阴性者无明显差异(P>0.05),C-erbB-2(HER-2/neu)阳性者明显高于阴性者(P<0.01),乳腺癌患者中位生存期CyclinE过表达者明显低于阴性表达或弱表达者(P<0.01)。结论:CyclinE的表达水平与乳腺癌患者的预后存在密切的关系。     

HER-2/neu蛋白在胃癌中的表达及意义

[目的] 探讨表皮生长因子受体HER-2/neu在胃癌组织表达的临床病理学意义.[方法] 采用免疫组织化学法检测67例胃癌标本HER-2/neu蛋白的表达,并分析检测结果与患者的随访资料及临床病理学参数的关系.[结果] HER-2/neu蛋白在胃癌组织的阳性表达率为22.4%(15/67),而在癌旁正常组织无表达.HER-2/neu表达与患者的性别、年龄、分化程度均无相关关系(P>0.05),而与肿瘤的Lauren分类、临床分期及淋巴结转移相关(P<0.05).HER-2/neu蛋白表达阳性患者的中位生存期为30.0个月,表达阴性的为50.0个月,二者差异有显著性意义(P<0.05).运用COX比例风险模型分析提示HER-2/neu和临床分期为胃癌独立预后因素.[结论] 检测胃癌组织中HER-2/neu蛋白的表达,有助于判断患者预后.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.