表皮生长因子受体表达与预测葡萄胎恶变相关性研究

目的研究表皮生长因子受体（epidermal growth factor receptor,EGFR）在妊娠滋养细胞疾病中的表达,探讨EGFR对预测葡萄胎恶变的价值。方法采用免疫组化方法,检测石蜡包埋的105例妊娠滋养细胞肿瘤组织和20例正常早孕绒毛组织EGFR蛋白表达水平。结果在合体滋养层,妊娠滋养细胞肿瘤组织和正常早孕绒毛组织均强表达EGFR蛋白;在细胞滋养层,正常早孕绒毛、非恶变组葡萄胎的EGFR蛋白表达高于恶变组葡萄胎、侵蚀性葡萄胎和绒癌的表达（P〈0.05,P〈0.05,P〈0.05）;而恶变组的EGFR蛋白表达强于侵蚀性葡萄胎和绒癌的表达（P〈0.05,P〈0.05）;EGFR蛋白表达在侵蚀性葡萄胎和绒癌之间差异无显著性（P〉0.05）。结论EGFR表达降低在妊娠滋养细胞疾病发生发展过程中起重要作用,并有可能成为预测葡萄胎恶变的一项新的指标。     

滋养细胞疾病和妊娠绒毛组织中端粒酶的表达

目的 明确妊娠滋养细胞疾病和正常绒毛组织中的端粒酶表达状况。探索端粒酶经在滋养细胞肿瘤形成中的作用。方法 应用以聚合酶 反应为基础的端粒酶测定方法（ＴＲＡＰ）,对不同临床类型妊娠滋养细胞疾病及不同发育阶段正常妊发对绒毛的６１例的端粒酶活性进行检测。结果 绒毛膜癌及侵蚀性葡萄胎３６．４％（４／１１）端粒酶阳笥,葡萄胎２６．３％（５／１９）阳性,早孕６０天以内绒毛全部（１０／１０）阳性,此期以后的胎盘     

妊娠滋养细胞疾病中EMT相关蛋白CK-18、波形蛋白的表达及意义

目的 检测上皮细胞间质细胞转化（EMT）相关蛋白--细胞角蛋白18（CK-18）和波形蛋白（vimentin）在正常早孕绒毛、葡萄胎及妊娠滋养细胞肿瘤中的表达及与临床病理特征的关系。方法 采用免疫组化法（SP法）检测39例正常早孕绒毛组织、33例葡萄胎组织和32例妊娠滋养细胞肿瘤组织（侵袭性葡萄胎27例、绒毛膜癌5例）中CK-18、vimentin的定位及表达情况。结果 CK-18在各种类型滋养细胞中呈强阳性表达,正常绒毛组的CK-18表达水平高于葡萄胎组及妊娠滋养细胞肿瘤组,差异有统计学意义（P<0.01）,葡萄胎组CK-18表达高于滋养细胞肿瘤组,差异有统计学意义（P<0.01）;vimentin于各组滋养细胞中呈弱阳性表达,各组间的表达差异无统计学意义（P>0.05）。在葡萄胎滋养细胞轻度增生组,CK-18蛋白的相对表达量高于滋养细胞中或重度增生组（P<0.01）。在滋养细胞肿瘤解剖学Ⅰ期组CK-18蛋白的相对表达量高于解剖学Ⅱ期及以上组（P<0.001）。结论 伴随着滋养细胞恶性度的升高CK-18的表达逐渐降低,提示EMT可能与滋养细胞的恶性转化有相关性。     

E—cad和VEGF在妊娠滋养细胞疾病中的表达及意义

目的观察E—cad和VEGF在妊娠滋养细胞疾病中的表达变化及意义,为妊娠滋养细胞疾病早期诊断、预后判断提供理论依据。方法收集滋养细胞疾病标本50例,其中葡萄胎10例（均为完全性葡萄胎）,侵蚀性葡萄胎20例,绒毛膜癌20例,所有病例均经病理确诊。正常早孕绒毛标本10例为对照组。应用免疫组织化学技术检测E-cad和VEGF在早孕绒毛、葡萄胎、侵蚀性葡萄胎、绒毛膜癌组织中的表达情况。结果E—cad在正常早孕绒毛、葡萄胎、侵蚀性葡萄胎和绒癌中的表达逐渐降低,分别为3．521,3．1045,0．9655,0．7682,各组差异有统计学意义（P〈0．05）;VEGF在正常早孕绒毛、葡萄胎、侵蚀性葡萄胎和绒癌中的表达逐渐升高,分别为0．4219,0．7521,0．9611,1.1420,各组差异有统计学意义（P〈0.05）。结论①E-cad在滋养细胞肿瘤和葡萄胎中的表达均低于正常绒毛组织,E-cad表达减弱与GTT恶性进展有关,对于良、恶性葡萄胎鉴别有重要意义。②E—cad和VEGF的表达变化,使滋养细胞粘附异常,侵蚀性增强,是滋养细胞疾病发生的重要途径之一。     

表皮生长因子受体表达与葡萄胎恶变相关性分析

目的研究表皮生长因子受体（EGFR）在妊娠滋养细胞疾病的表达,探讨EGFR对预测葡萄胎恶变的价值. 方法采用免疫组化方法,检测石蜡包埋的105例妊娠滋养细胞疾病和20例正常早孕绒毛组织EGFR蛋白表达水平. 结果在合体滋养层中,妊娠滋养细胞疾病和正常早孕绒毛组织均强烈表达EGFR蛋白;在细胞滋养层,正常早孕绒毛、非恶变组葡萄胎的EGFR蛋白表达显著高于恶变组葡萄胎、侵蚀性葡萄胎和绒癌（P＜0.01, P＜0.01, P＜0.01）,而恶变组的EGFR蛋白表达显著高于侵蚀性葡萄胎和绒癌（P＜0.05, P＜0.05）,EGFR蛋白表达在侵蚀性葡萄胎和绒癌之间差异无显著性（P＞0.05）. 结论 EGFR表达降低在妊娠滋养细胞疾病发生发展过程中起重要作用并有可能成为预测葡萄胎恶变的一项新的指标.     

米非司酮对早孕绒毛中雌孕激素受体的影响

目的探讨米非司酮对早孕绒毛组织中雌激素受体(ER)、孕激素受体(PR)的影响.方法米非司酮配伍米索前列醇组(药流组)16例,正常早孕人工流产组(对照组)16例,取各组绒毛组织,常规苏木精-伊红染色观察滋养细胞病理变化,应用免疫组化法观察每组滋养细胞ER、PR表达的情况.结果对照组绒毛组织中ER、PR表达明显高于药流组,2组ER阳性细胞百分比分别为(81.57±7.12)%、(54.45±5.38)%,PR阳性细胞百分比分别为(84.45±6.34)%、(39.38±4.24)%.结论米非司酮可以降低人早孕绒毛组织中ER、PR表达水平,这表明米非司酮可以在受体水平拮抗孕酮,具有促进绒毛滋养细胞变性、坏死及凋亡的作用,从而达到抗早孕的目的.     

早期自然流产患者绒毛滋养细胞中CXCL14的表达及其临床意义

目的研究正常早孕妇女和早期自然流产妇女之间绒毛滋养细胞中CXCL14的表达情况,探讨其表达的临床意义。方法选取33例正常早孕妇女绒毛组织和37例早期自然流产妇女绒毛组织,HE染色后光镜下观察两组绒毛组织的形态学变化;采用免疫组化SP三步法检测两组绒毛滋养细胞中CXCL14的表达。结果HE染色下两组绒毛滋养细胞形态对比,见早期自然流产组绒毛组织滋养细胞层变薄、滋养细胞变性甚至坏死、滋养细胞嗜酸性增强、绒毛间质水肿坏死;免疫组化示正常早孕组绒毛滋养细胞CXCL14的表达量为0.07±0.05,自然流产组绒毛滋养细胞CXCL14的表达量为0.12±0.02,两组比较差异具有统计学意义（P＜0.01）;首次流产组CXCL14表达量0.116±0.067,多次流产组CXCL14表达量0.086±0.127,两组比较差异无统计学意义（P＞0.01）。结论早期自然流产绒毛滋养细胞中CXCL14表达升高,可能在自然流产的发生中起着重要作用。     

瘦素及白血病抑制因子在早孕绒毛及妊娠滋养细胞疾病的表达及意义

目的研究早孕绒毛及妊娠滋养细胞疾病中瘦素及白血病抑制因子的组织定位和表达,探讨瘦素及白血病抑制因子与妊娠滋养细胞疾病的关系。方法采用免疫组化S-P法及图像分析仪检测14例正常早孕绒毛、14例葡萄胎、12例侵蚀性葡萄胎及12例绒癌滋养细胞中瘦素及白血病抑制因子的表达。结果瘦素在正常早孕组、葡萄胎组、侵蚀性葡萄胎组及绒癌组滋养层的表达强度PU值分别为17.62±1.32,20.65±2.15,23.81±1.96,27.31±2.14;白血病抑制因子在正常早孕组、葡萄胎组、侵蚀性葡萄胎组及绒癌组滋养层的表达强度PU值分别为14.34±2.05,18.65±2.43,22.56±2.45,28.19±2.01。即瘦素及白血病抑制因子在滋养细胞的表达强度依下列顺序增加:正常早孕组、葡萄胎组、侵蚀性葡萄胎组及绒癌组,各组间的表达强度差异有统计学意义(P<0.05)。结论瘦素及白血病抑制因子表达的增强促进了妊娠滋养细胞疾病中滋养细胞浸润、转移,间接促进妊娠滋养细胞疾病的发展。     

表皮生长因子受体在滋养细胞肿瘤组织中的表达及临床意义

目的：探讨表皮生长因子受体（ＥＧＦＲ）在滋养细胞肿瘤组织中的表达情况及临床意义。方法：采用免疫组化ＳＰ法检测１０例正常早孕绒毛、２０例葡萄胎、１０例侵蚀性葡萄胎及８例绒毛膜癌组织ＥＧＦＲ的蛋白表达量,利用单因素确切概率法及多因素Ｌｏｇｉｓｔｉｃ逐步回归法并结合临床资料进行结果分析。结果：ＥＧＦＲ在正常早孕绒毛及滋养细胞肿瘤组织均有表达。在正常早孕绒毛及未恶变的葡萄胎组织表达量明显高于发生恶变的葡萄胎及恶性滋养细胞肿瘤组织（Ｐ＜０．０５）。统计分析结果表明恶性糍养细胞肿瘤临床期别与ＥＧＦＲ蛋白表达水平关系最密切（Ｐ＝０．０２６及ＯＲ＝９．８７４）。结论：ＥＧＦＲ蛋白表达量可作为葡萄胎转归、恶性滋养细胞肿瘤临床分期及预后的一项辅助判断指标。     

其它

042 2 81　E -钙粘素和β-连环素在妊娠滋养细胞疾病中的表达与意义 /黄卓敏…∥现代妇产科进展 — 2 0 0 4 ,1 3( 4 ) — 2 70～ 2 72应用RT -PCR技术检测 1 2例正常早孕绒毛和 35例妊娠滋养细胞疾病组织中E -钙粘素mR NA和β-连环素mRNA的表达。结果 :E -钙粘素和β连环素mRNA在正常早孕绒毛与葡萄胎组织的表达差异无显著性 (P >0 0 5 ) ;而在正常早孕绒毛、葡萄胎组织的表达量明显高于侵蚀性葡萄胎、绒毛组织 (P <0 0 5 ) ;在侵蚀性葡萄胎组织的表达高于绒癌组织 (P <0 0 5 )。结论 :E -钙粘连素和 β-连环素的表达下调与妊…     

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.