人肝细胞癌中miR-23a和XIAP的表达及意义

目的 探讨miR-23a和X连锁凋亡抑制蛋白(XIAP)在人肝细胞癌(HCC)中的表达、相互关系及临床病理意义.方法 建立组织微阵列,采用原位分子杂交方法分别检测150例人HCC和136例相对应的癌旁组织中miR-23a的变化;利用免疫组化两步法检测XIAP蛋白和Ki-67蛋白的表达水平.结果 HCC组织和癌旁组织中miR-23a的高表达率分别为48.7%(73/150)和77.2%(105/136),两者差异有统计学意义(P=0.001),XIAP蛋白在HCC和癌旁组织中的高表达率分别为25.3%(38/150)和22.1%(30/136),两者差异无统计学意义;miR-23a高表达率在患者中男性高于女性(P=0.037)、HBsAg阳性高于HBsAg阴性患者(P=0.022)、大肝癌高于小肝癌(P=0.021)、Ⅰ~Ⅱ期高于Ⅲ~Ⅳ期(P=0.002);而XIAP蛋白高表达在患者中小肝癌高于大肝癌(P=0.001)、Ⅰ~Ⅱ期高于Ⅲ~Ⅳ期(P=0.009).此外两者均与患者年龄、是否合并肝硬化、组织学分级无关.经Pearson相关检验,miR-23a和XIAP蛋白在HCC中的表达呈显著负相关性(rs=-0.308,P<0.01).结论 miR-23a和XIAP可能参与HCC的发生与发展.     

肝细胞肝癌组织中p34cdc2表达及其与细胞增殖和凋亡的关系

目的:探讨p34cdc2激酶在肝细胞肝癌(HCC)发生发展中的作用及与增殖和凋亡的关系. 方法:收集HCC(含癌旁组织42)标本47例,正常肝组织10例,采用免疫组织化学SP法显示p34cdc2激酶的表达并结合增殖与凋亡特征进行分析. 结果:在肝癌组织、癌旁肝组织及正常肝组织细胞中p34cdc2表达定位于胞质中,在癌组织中过表达,差异有统计学意义(P＜0.01). 肝癌、癌旁组织中的增殖指数(PI)分别为(30.34±4.46)%与(27.88±5.89)%,肝癌组织明显高于癌旁组织(P＜0.05);肝癌、癌旁组织中的凋亡指数(AI)分别为(8.62±2.28)%与(7.38±2.61)%,肝癌组织明显高于癌旁组织(P＜0.05);p34cdc2蛋白阳性组PI(49.26±4.81)%显著高于阴性表达组(23.07±4.15)%(P＜0.05),AI无明显差异(P＞0.05). 结论:HCC中增殖与凋亡均高于癌旁组织;p34cdc2和PCNA一样可作为反映HCC细胞分裂增殖能力的有效指标;p34cdc2并不是HCC凋亡所必须.     

miR-105-1在原发性肝细胞癌中表达的研究

目的 定量分析miRNA-105-1(miR-105-1)在原发性肝细胞癌(HCC)及癌旁正常组织中表达水平的差异.方法 取患者手术新鲜组织标本(10对T-N配对组织和另外40例原发性肝癌组织)提取RNA,采用实时荧光定量PCR(RT-qPCR) 技术检测标本中miR-105-1基因表达量.并下载公共基因表达数据库(GEO)芯片数据加以验证,通过2-ΔΔCt方法计算得到.结果 实验结果表明在10对配对的HCC组织中的miR-105-1的表达量显著低于癌旁正常组织,差异有统计学意义(P=0.046).在50个HCC组织的表达量显著低于10个癌旁组织,差异有统计学意义(P=0.031).GEO数据库芯片GSE22058-GPL10457中包含96个配对的HCC与癌旁正常组织,miR-105-1在HCC中下调,差异有统计学意义(P=0.035).GSE21362中包含73个配对的HCC与癌旁正常组织,miR-105-1在HCC中也是下调的,差异有统计学意义(P=0.042).结论 miR-105-1在原发性肝癌患者中较正常人群表达量低,可能是HCC患者发生发展的重要分子之一,并可以作为判断预后的一个指标和治疗的一个新靶点.     

肝细胞性肝癌组织中Thrombin和VEGF的表达水平及其临床意义

目的:研究凝血酶(Thrombin)和血管内皮生长因子(VEGF)在人肝细胞性肝癌(HCC)组织中的表达情况,分析其与HCC临床病理特征的关系.方法:应用Western blot检测55例HCC组织及其癌旁肝组织中Thrombin和VEGF蛋白的表达.结果:HCC组织中Thrombin和VEGF蛋白的表达水平明显高于癌旁肝组织(P＜0.05),而且Thrombin和VEGF表达呈显著正相关(r =0.333,P＜0.05).HCC组织中Thrombin的表达与有无门静脉癌栓有关(P＜0.05),VEGF的表达与包膜完整性有关(P＜0.05).Thrombin高表达患者中位生存时间显著低于低表达患者(P＜0.05).结论:Thrombin和VEGF在HCC组织中的表达水平明显升高,且两者的表达水平呈正相关,提示两者在HCC的发生发展过程中有着密切关系.     

C-Jun结合蛋白在肝癌细胞组织中的高表达及其意义

目的 探讨C-Jun结合蛋白(JAB1)在肝癌细胞(HCC)组织中的表达及临床病理意义.方法 收集76例HCC及癌旁组织,10例肝血管瘤旁肝组织的临床病理档案资料,采用免疫组织化学方法检测JAB1蛋白质在这些组织中的表达,并与增殖细胞核抗原(Ki67)的表达相比较.应用统计学方法对结果进行分析.结果 HCC组织中JAB1蛋白质表达的阳性率(68.85%)显著高于癌旁组织(38.72%)(P＜0.001)和血管瘤旁肝组织(34.36%)(P＜0.001).JAB1的表达与肝癌组织分化程度,血清AFP值及转移有关(P=0.000,P=0.015及P=0.000),但与患者的年龄、性别、肿瘤组织学类型、肿瘤大小等无关.HCC组织中Ki67表达的阳性率为41.45%,明显高于癌旁组织2.11%(P＜0.1301)和血管瘤旁肝组织2.01%(P＜0.001).相关性分析表明HCC组织中JAB1蛋白质表达与Ki67表达呈正相关(r=0.6192,P＜0.001).结论 JAB1在HCC组织中呈高表达,且显著高于非癌肝组织,与HCC的发生发展有关;JAB1可作为HCC细胞增生程度的潜在临床病理标记.     

SPNS2在肝细胞性肝癌中的表达及其与上皮间质转化的关系

目的 探讨鞘氨醇-1-磷酸转运体(SPNS2)在肝细胞肝癌(HCC)中的表达及其与上皮细胞间质转化(EMT)之间的相关性.方法 收集10例HCC新鲜临床标本和70例HCC手术标本石蜡切片(包括癌组织和对应癌旁组织)及其临床相关病理资料,检测SPNS2及EMT的两个主要标志物N-钙黏蛋白(N-cadherin)、E-钙黏蛋白(E-cadherin)在癌及癌旁组织中的表达量,统计分析SPNS2与临床病理特征及EMT之间的相关性.结果 SPNS2、N-cadherin在癌组织的表达水平高于癌旁组织(P＜0.01),而E-cadherin表达低于癌旁组织(P＜0.01).分析得出,SPNS2与N-cadherin呈正相关性,与E-cadherin呈负相关性.SPNS2在HCC的表达与患者年龄、性别、分化程度无相关性,而与TNM分期和血管侵犯密切相关.结论 SPNS2在HCC中存在差异性表达,同时可能通过调控EMT的转录因子促进HCC发生.SPNS2与TNM分期和微血管侵犯密切相关,可用于临床预后评估.     

肝细胞肝癌组织中p34cdc2表达及其与细胞增殖和凋亡的关系

目的:探讨p34cdc2激酶在肝细胞肝癌(HCC)发生发展中的作用及与增殖和凋亡的关系. 方法:收集HCC(含癌旁组织42)标本47例,正常肝组织10例,采用免疫组织化学SP法显示p34cdc2激酶的表达并结合增殖与凋亡特征进行分析. 结果:在肝癌组织、癌旁肝组织及正常肝组织细胞中p34cdc2表达定位于胞质中,在癌组织中过表达,差异有统计学意义(P＜0.01). 肝癌、癌旁组织中的增殖指数(PI)分别为(30.34±4.46)%与(27.88±5.89)%,肝癌组织明显高于癌旁组织(P＜0.05);肝癌、癌旁组织中的凋亡指数(AI)分别为(8.62±2.28)%与(7.38±2.61)%,肝癌组织明显高于癌旁组织(P＜0.05);p34cdc2蛋白阳性组PI(49.26±4.81)%显著高于阴性表达组(23.07±4.15)%(P＜0.05),AI无明显差异(P＞0.05). 结论:HCC中增殖与凋亡均高于癌旁组织;p34cdc2和PCNA一样可作为反映HCC细胞分裂增殖能力的有效指标;p34cdc2并不是HCC凋亡所必须.     

p14ARF、ARF-BP1、c-myc在肝细胞癌中的表达及意义

目的:探讨肝细胞癌(Hepatocellular Carcinoma,HCC)组织及其癌旁肝组织中p14ARF、ARF-BP1、c-myc的表达及意义.方法:采用逆转录-聚合酶链反应(RT-PCR)技术、免疫组化技术对45例HCC组织及其癌旁肝组织中p14ARF、ARF-BP1、c-myc的mRNA表达和p14ARF、c-myc蛋白表达情况进行检测.结果:p14ARF、ARF-BP1、c-myc的mRNA在HCC组织中阳性表达分别为80.00%、86.67%、84.44%,在癌旁肝组织中分别为11.11%、20.00%、53.33%,三者的mRNA在癌组织中呈过表达,明显高于癌旁肝组织(P＜0.01).p14ARF、c-myc蛋白在HCC组织中表达分别为78.38%、75.68%,明显高于癌旁肝组织的13.51%(P＜0.01)和51.35%(P＜0.05).结论:p14ARF、ARF-BP1、c-myc在HCC组织中高表达,这种高表达可能与HCC的发生有相关性.     

肝细胞癌中p27、cyclin E和cyclin A的表达及相关分析

[目的]研究细胞周期调节因子P27、CyclinE和CyclinA在肝细胞癌中的表达并对其相关性进行分析.[方法]应用免疫组化SABC法,检测P27、CyclinE和CyclinA在72例肝细胞癌及48例癌旁肝组织中的表达并结合临床病理资料探讨其意义.[结果]p27标记指数(labeling index,LI)在癌组织及癌旁组织中分别为55.80±14.32和43.77±12.92(P＜0.01).p27LI与组织分化程度及侵袭转移有关(54.46±12.29 vs.80±11.36,52.00±14.10 vs 40.42±12.83,P＜0.01).CyclinE、CyclinA在HCC组织中阳性表达率分别为36.11%(26/72)、45.83%(33/72),癌旁及正常肝组织无阳性表达.CyclinE表达与组织分化,癌栓形成及侵袭转移有关(P＜0.05).CyclinA表达与组织分化、肝门淋巴结/肝外转移、癌灶数目及癌栓形成及侵袭转移均有关(P＜0.05).Cyclin E与Cyclin A表达正相关(P＜ 0.05).p27 LI在CyclinE、CyclinA阳性组均较阴性组降低(P＜0.05).[结论]p27、CyclinE、CyclinA共同参与了肝细胞癌的发生,分化及侵袭转移,检测其表达有助于协助临床诊断治疗及判断预后.     

CD105在原发性肝细胞癌血管内皮细胞的表达及临床意义

目的研究原发性肝细胞癌(hepatocellular carcinoma,HCC)组织血管内皮细胞CD105表达与根治术后早期复发的关系.方法 HCC行根治性切除术后随访1年以上患者32例(分为1年内有复发组和无复发组),用免疫组织化学法和逆转录-聚合酶链反应(RT-PCR)方法,检测肝癌组织血管内皮细胞CD105的表达情况.结果 CD105在边缘癌组织、癌旁组织及正常肝组织的阳性例数分别为21、8、2例,其差异具有显著性意义(P＜0.01);边缘癌组织CD105的阳性表达率与术后早期复发有关(P=0.004).1年复发组边缘癌组织微血管密度IMVD-CD105(53.69±12.16)明显高于1年未复发组(37.80±16.62),差别有显著意义(t=3.37,P=0.002);而癌旁组织IMVD-CD105的表达在两组之间无统计学意义(t=1.52,P=0.199).中心处癌组织中CD105 mRNA的表达水平为(0.45±0.02),明显高于正常肝组织(0.26±0.02)(P＜0.05);肿瘤边缘处癌组织中CD105 mRNA的表达水平为(0.65±0.08),明显高于中心处癌组织(P＜0.05).边缘癌组织CD105 mRNA高表达与根治术后早期复发有关(t=4.34,P＜0.01);中心处癌组织CD105 mRNA表达与根治术后早期复发无关(t=0.93,P＞0.05);边缘癌组织IMVD、CD105 mRNA表达与患者年龄、癌肿的大小、临床病理分期和病理类型等均无关(P＞0.05).结论 CD105-IMVD与原发性肝细胞癌术后早期复发密切相关,可能是肝细胞癌的一个独立的预后指标;HCC边缘处癌组织CD105 mRNA表达水平明显高于中心处癌组织及正常肝组织,且其表达与肝癌的术后早期复发有关.     

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.