多药耐药基因产物和激素受体在乳腺癌中的表达及意义

目的：探讨多药耐药基因产物谷胱甘肽转移酶π（ GST-π）、肺耐药相关蛋白（ LRP）和DNA拓扑异构酶Ⅱ（ TopoⅡ）和雌激素受体（ ER）、孕激素受体（ PR）在乳腺浸润性导管癌组织中的表达及临床意义,并分析多药耐药基因产物与雌、孕激素受体之间是否有关联。方法应用免疫组织化学SP二步法检测194例乳腺浸润性导管癌组织中GST-π、LRP、TopoⅡ、ER、PR的表达,且结合乳腺癌临床病理因素进行分析。结果194例乳腺浸润性导管癌组织中GST-π、LRP、TopoⅡ表达的阳性率分别为62.4％、81.4％、51.5％。 LRP和TopoⅡ在伴有淋巴结转移的乳腺浸润性导管癌患者中的表达高于无淋巴结转移者（ P＜0.05）,而与患者年龄、肿块长径、组织学分级、TNM分期等临床病理因素之间无相关性（P＞0.05）;LRP和TopoⅡ的表达与ER、PR的表达均无明显相关性（ P＞0.05）。 GST-π的表达与ER、PR的表达呈负相关（ P＜0.05）,而与其它临床病理因素之间未见相关性（ P＞0.05）。 LRP、GST-π、TopoⅡ两两之间无相关性（ P＞0.05）。结论 GST-π、LRP、TopoⅡ与乳腺浸润性导管癌的多药耐药有关,且LRP和TopoⅡ与乳腺癌的转移有一定关系,GST-π与ER、PR负性相关。联合检测可为乳腺癌的临床化疗药物选择及评估预后提供依据。     

TopoⅡ、GST-π、P-gp在乳腺癌的表达及意义

目的探讨几种多药耐药机制与乳腺浸润性导管癌的耐药性及临床病理特征的关系。方法应用免疫组化S-P法检测DNA拓扑异构酶Ⅱ、谷胱甘肽-S-转移酶-π和P-糖蛋白在220例乳腺浸润性导管癌组织中的表达。结果乳腺浸润性导管癌病例GST-π、P-gp均有较高的阳性率,TopoⅡ有近一半的病例不表达。TopoⅡ、GST-π和P-gp的表达与乳腺浸润性导管癌的分级、淋巴结转移无明显相关性(P>0.05)。结论乳腺浸润性导管癌的多药耐药与TopoⅡ、GST-π、P-gp的耐药机制有关。乳腺浸润性导管癌组织TopoⅡ、GST-π、P-gp的表达可作为指导乳腺浸润性导管癌化疗的重要指标和判断乳腺浸润性导管癌预后的参考指标。     

乳腺癌中LRP、GST-π、TOPOⅡ的表达及临床意义

目的 探讨乳腺癌中LRP、GST-π、TOPOⅡ的表达及临床意义，以期为选择化疗方案提供参考，获得更有效的化疗效果。方法应用免疫组化SABC法，对80例乳腺癌的主要耐药指标LRP、GST-π、TOPOⅡ进行检测，并结合临床分期进行研究。结果乳腺癌中LRP表达率为80．00％(64／80)，临床Ⅱ、Ⅲ期表达率显著高于1期，GST-π表达率为65．00％(52／80)，临床Ⅲ期表达率显著高于Ⅰ、Ⅱ期。TOPOⅡ表达率为55．00％(44／80)，临床Ⅲ期表达率显著低于Ⅰ、Ⅱ期。LRP与GST-π间有明显相关性，说明它们对肿瘤耐药起作用具有一定的协同性。LRP、GST-π与TOPOⅡ间无明显相关性，说明它们各自的表达从不同方面对肿瘤耐药起作用。结论乳腺癌联合检测LRP、GST-π、TOPOⅡ对化疗药物的选择具有指导作用，对预后的判断有参考价值。     

乳腺浸润性导管癌耐药基因蛋白表达与化疗方案的相关性研究

目的：了解乳腺浸润性导管癌对不同化疗方案的敏感性及与耐药基因蛋白表达的关系。方法：用免疫组化法检测同一乳腺癌病例新辅助化疗前后耐药基因蛋白谷胱甘肽-S转移酶（GST-π）、拓扑异构酶Ⅱ（ToPoⅡ）、热休克蛋白（HSP）和P-糖蛋白（P—gp）的表达情况,并与3种化疗方案,即环磷酰胺＋阿霉素＋5-氟尿嘧啶（CAF）、环磷酰胺＋氨甲喋呤＋5-氟尿嘧啶（CMF）、紫杉醇＋阿霉素（TA）方案作相关性分析。结果：CAF方案对乳腺浸润性导管癌耐药表型影响最大,该组28例中11例GST-π由阴性转为阳性表达,7例化疗后ToPoⅡ表达转阴,化疗前后差异显著（P〈0．05）：CMF方案31例中,GST-π5例由阴性转为阳性表达,5例化疗后ToPoⅡ表达转阴;TA方案对乳腺癌耐药表型影响最小,但该方案24例有8例经化疗后P-gp由阳性转为阴性表达。结论：乳腺浸润性导管癌耐药基因表达受不同化疗方案的影响。     

耐药相关蛋白和雌、孕激素受体在乳腺癌组织中的表达及其临床意义

目的：检测耐药相关蛋白和雌、孕激素受体在乳腺癌中的表达情况,探讨临床乳腺癌的多药耐药问题。方法：采用免疫组化S-P法检测P-糖蛋白（P-gp）、抗凋亡因子（Bcl-2）、拓扑异构酶Ⅱ(Topo Ⅱ）、谷胱甘肽转移酶pi(GST-π）及雌激素、孕激素受体（ER、PR）在乳腺正常组织、纤维腺瘤、原位癌及浸润性癌中的表达情况,并用彩色病理图像分析系统对免疫组化结果作定量分析。结果：P-gp在乳腺正常组织及良、恶性肿瘤中均呈低水平表达;GST-π、Bcl-2在乳腺浸润性癌中呈较低水平表达,且与ER、PR呈正相关;TopoⅡ在乳腺浸润性癌中呈较高水平表达。结论：P-gp、Bcl-2、TopoⅡ在乳腺癌中的表达情况提示原发乳腺癌对化疗药物较敏感,Bcl-2可作为乳腺癌内分泌治疗的一个标志。     

多耐药基因在乳腺癌组织中表达及临床意义

目的全面了解乳腺癌内源性耐药情况,实现肿瘤病人个体化化疗。方法应用荧光定量PCR方法检测51例术前未经化疗的乳腺癌和癌旁组织中mdr1、MRP、LRP、GST-π、TOPOⅡα、BCRP基因表达。结果这6个多药耐药基因在乳腺癌组织和癌旁组织中的阳性表达率均有显著统计学意义;mdr1、LRP、GST-π、TOPOⅡα在乳腺癌组织和癌旁组织之间的表达水平无显著统计学意义（P〉0.05）;MRP和BCRP在乳腺癌组织中的表达水平显著高于其在癌旁组织中的表达水平,差异有统计学意义（P〈0.05）。结论 MRP和BCRP可能与乳腺癌的内源性耐药有关,mdr1、LRP、GST-π、TOPOⅡα的表达可能与乳腺癌的内源性耐药无关,乳腺癌患者进行术前的新辅助化疗是可行的。     

多药耐药相关蛋白在原发性肝癌患者外周血淋巴细胞及癌组织中的表达

目的探讨多药耐药相关蛋白P-糖蛋白(P-gp)、肺耐药蛋白(LRP)和谷胱甘肽巯基转移酶-π(GST-π)在原发性肝癌(HCC)患者外周血淋巴细胞及癌组织中的表达。方法选择2014年1月至2015年1月在新乡医学院第一附属医院经影像学检查及病理学确诊的HCC患者69例(HCC组),采用免疫组织化学染色检测3种耐药相关蛋白P-gp、LRP和GST-π在HCC患者外周血淋巴细胞及癌组织中的表达水平;另选择40例健康人作为对照组,检测外周血淋巴细胞中P-gp、LRP和GST-π表达水平。结果 P-gp、LRP及GST-π在HCC组患者外周血淋巴细胞中的阳性表达率均高于对照组(P<0.05)。P-gp、LRP及GST-π在外周血淋巴细胞和癌组织中的阳性表达率比较差异均无统计学意义(P>0.05)。不同TNM分期HCC患者外周血淋巴细胞与癌组织中P-gp、LRP及GST-π阳性表达率比较差异均无统计学意义(P>0.05)。结论多药耐药相关蛋白P-gp、LRP和GST-π在HCC患者外周血淋巴细胞及癌组织中的表达一致,可以使用外周血淋巴细胞检测多药耐药相关蛋白。     

乳腺癌P-gp、LRP、GST-π、TOPO-Ⅱ的表达及其与术前化疗的关系

目的:探讨P-gp、LRP、GST-π、TOPO-Ⅱ在乳腺癌中的表达以及术前化疗对乳腺癌多药耐药的影响及其临床意义.方法:采用免疫组织化学S-P法,对18例术前曾用化疗和70例术前未用化疗的88例乳腺癌组织检测P-gp、LRP、GST-π、TOPO-Ⅱ的表达.结果:88例乳腺癌中P-gp、LRP、GST-π、TOPO-Ⅱ的阳性率分别为42.0%、53.4%、48.9%、40.9%.术前应用化疗的病人乳腺癌组织P-gp、LRP、GST-π三者阳性表达率均较未用化疗的病人高.P-gp和LRP差异有显著性(P＜0.05),而GST-π差异无显著性(P＞0.05),TOPO-Ⅱ有化疗史的病人比无化疗史的病人低,但差异无显著性(P＞0.05).结论:P-gp、LRP、GST-π、TOPO-Ⅱ的耐药机制各不相同,同时检测P-gp、LRP、GST-π、TOPO-Ⅱ等多种导致多药耐药的因素,对乳腺癌化疗有重要的指导意义.     

乳腺癌骨转移与耐药基因蛋白表达的关系及临床病理意义

目的探讨乳腺癌骨转移与耐药基因蛋白（TopoⅡ、LRP和GST-π）表达的关系及临床病理意义。方法使用99m锝-亚甲基二磷酸盐（99mTc-MDP）对61例乳腺浸润性导管癌进行全身骨扫描并采用免疫组织化学法检测TopoⅡ、LRP和GST-π的表达。结果骨转移与肿瘤的大小、腋窝淋巴结转移呈显著正相关（均P＆lt;0.01）;TopoⅡ的阳性率与肿瘤的大小呈显著正相关关系（P＆lt;0.01）;骨转移阳性率与TopoⅡ的阳性表达率呈显著正相关（P＆lt;0.01）,而与LRP和GST-π无相关关系（P＆gt;0.05）。结论乳腺癌大小、腋窝淋巴结转移及TopoⅡ可作为评价患者预后的指标,对骨转移患者可用化疗药物通过干扰TopoⅡ的功能发挥其杀伤肿瘤细胞的作用。     

耐药表型P-gp,GST-π,及TOPOⅡ的表达与Ki67在肺癌中的表达及其临床意义

目的：检测P-gp,GST-π,TOPOП与Ki67在肺癌中的表达,探讨其在肺癌中的表达水平及其临床相关性.方法：用免疫组化方法检测52例术前未进行化疗的肺癌组织中P-gp,GST-π,TOPOП与Ki67的表达.结果：P-gp,GST-π,TOPOП和Ki67在肺癌中的阳性表达率分别是73%,80.5%,62.5%,23.7%.P-gp,GST-π的表达与病理组织学分型,分化程度有显著相关性（P＜0.05）;TOPOП在腺癌中的表达明显低于其他类型的肺癌（P＜0.05）;P-gp,GST-π,TOPOП的共表达率明显高于其单一表达率（P＜0.05）;P-gp,GST-π,TOPOП的表达与Ki67之间无显著相关性.结论：P-gp,GST-π,TOPOП在不同类型的肺癌中均可表达,且表达水平不同,但它们均与肺癌的耐药相关,且呈共同表达,所以以上指标可以作为临床判断预后和指导化疗的综合指标.     

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.