ER Bcl-2在宫颈病变发生中的相关性研究

  目的  探讨ER、Bcl-2蛋白在不同程度宫颈病变中的相关性及意义。  方法  免疫组织化学检测慢性宫颈炎20例、低度宫颈上皮内瘤变30例、高度宫颈上皮内瘤变70例及80例宫颈癌组织中ER和Bcl-2蛋白的表达。  结果  ER在慢性宫颈炎组中阳性率为75%,随着宫颈病变程度的加重,其表达率逐渐降低（χ2=24.266,P < 0.01）,与慢性宫颈炎组比较,CINⅡ~Ⅲ组和宫颈鳞癌组差异有统计学意义,CINⅠ组差异无统计学意义（χ2=0.751,P=0.386）。与肿瘤组织类型及病理分级无关;BCL-2在宫颈鳞癌组中阳性率为75.38%,随着宫颈病变程度的加重,其表达率逐渐增高（χ2=27.715,P < 0.01）,与慢性宫颈炎组比较,CINⅠ组、CINⅡ~ Ⅲ组及宫颈鳞癌组差异均有统计学意义。与宫颈鳞癌病理分级相关（χ2=4.862,P=0.027）,与肿瘤组织类型无关（P=0.500）;CIN Ⅱ~Ⅲ组中联合表达阳性率为38.57%（27/70）,宫颈鳞癌组中联合表达阳性率为15.38%（10/65）,差异具有统计学意义（χ2=9.108,P=0.003）。CINⅡ~Ⅲ组中ER与Bcl-2蛋白表达存在相关（r=0.506,P < 0.01）,其余组中无相关关系。  结论  在宫颈病变的进展中,ER和Bcl-2表达呈相反趋势,在CINⅡ~Ⅲ组中有相关性,联合表达阳性可能是宫颈高度上皮内瘤变发生的主要机制之一。      

ILK及E-钙黏蛋白的表达在宫颈鳞癌发病中的意义

目的 研究整合素连接激酶(ILK)、E-钙黏蛋白(E-cadherin)在宫颈上皮内瘤变(CIN)及宫颈鳞癌组织中的表达情况,分析其与临床病理资料的关系。方法 采用免疫组化方法检测ILK及E-cadherin在54例CIN、38例宫颈鳞癌及20例正常宫颈组织中的表达。结果 ILK在正常宫颈、CINⅠ、CINⅡ~Ⅲ及宫颈鳞癌中的阳性表达率分别为25.0%、68.8%、78.9%、97.3%。ILK在CIN及宫颈鳞癌中的阳性表达率显著高于正常宫颈(P＜0.05)。E-cadherin在正常宫颈、CINⅠ、CINⅡ~Ⅲ及宫颈鳞癌中的阳性表达率分别为100.0%、75.0%、55.3%、36.8%。E-cadherin在CIN及宫颈鳞癌中的阳性表达率显著低于正常宫颈(P＜0.05)。在宫颈鳞癌组织中ILK的表达与E-cadherin呈负相关(r=-0.531,P＜0.01)。E-cadherin阳性表达还与宫颈鳞癌临床分期、分化程度、淋巴结转移有关(P＜0.05)。结论 ILK、E-cadherin可作为区分正常宫颈组织与CIN及宫颈鳞癌的标记物,E-钙黏蛋白还与宫颈癌恶性生物学行为有关。     

宫颈癌组织中LRP16和CIAP2的表达及其意义

目的:探讨宫颈癌组织中LRP16和CIAP2蛋白的表达及其与临床病理特征的关系。方法:采用免疫组化的方法检测正常宫颈组织24例,宫颈上皮内瘤变（CIN）30例（CINⅠ+CINⅡ18例,CINⅢ12例）,宫颈癌组织66例中LRP16和CIAP2的表达,分析其与患者年龄、宫颈癌临床分期、组织学分级、病理类型及有无淋巴结转移的关系。结果:LRP16在正常宫颈组织,CINⅠ+CINⅡ、CINⅢ,宫颈癌组织中的阳性表达率分别为16.67%,33.33%,66.67%,69.70%;CIAP2为8.33%,22.22%,50.00%,53.03%。宫颈癌组和正常宫颈组、CINⅠ-Ⅱ组相比较差异均有统计学意义（P<0.05）,宫颈癌组和CINⅢ组比较差异无明显的统计学意义（P>0.05）。LRP16蛋白的表达水平与CIN及宫颈癌呈正相关,检测LRP16对了解CIN及宫颈癌生物学行为和评估预后具有一定的价值。LRP16和CIAP2的阳性表达率与临床分期、组织学分级和有无淋巴结转移均有相关性（P<0.05）;LRP16和CIAP2的表达存在正相关性（P<0.05）。结论:LRP16和CIAP2在宫颈癌组织中表达水平的上调可能在宫颈癌的发生发展和转移浸润中起着重要的作用。     

宫颈癌组织中CIP2A和HPV16-E7的表达及其临床意义分析

目的 探讨宫颈癌(Cervical cancer)、宫颈上皮内瘤变(Cervical intraepithelial,CIN)及正常宫颈组织中CIP2A、HPV16-E7的表达及其之间的相互关系。方法 应用免疫组化S-P法检测50例宫颈鳞状细胞癌、34例CINⅠ、40例CINⅡ、45例CINⅢ和12例正常宫颈组织中CIP2A、HPV16-E7蛋白的表达。结果 CIP2A在宫颈癌、CINⅢ阳性表达率分别为68%(34/50)、13.3%(6/45);而在CINⅡ、CINⅠ及正常宫颈组织中阳性表达率均为0%。CIP2A蛋白在宫颈癌中的表达明显高于宫颈上皮内瘤变及正常宫颈组织,且与组织学分级、临床分期及淋巴结转移有关,差异均有统计学意义(P＜0.05)。HPV16-E7蛋白在宫颈癌、CINⅢ、CINⅡ及CINⅠ组织中的阳性表达率分别为72%(36/50)、68.89%(31/45)、67.50%(27/40)及64.71%(22/34);而在正常宫颈组织中阳性表达率为16.67%(2/12)。HPV16-E7蛋白在宫颈癌及宫颈上皮内瘤变组织中的表达明显高于正常宫颈组织,差异均有统计学意义(P＜0.05),且与年龄有关,而与组织学分级、临床分期及淋巴结转移无关。CIP2A 与HPV16-E7蛋白的表达呈正相关(r=0.514,P＜0.05)。结论 CIP2A、HPV16-E7在宫颈鳞状细胞癌中的过表达,提示宫颈癌中CIP2A与HPV16可能相互协调,共同促进宫颈癌的发生发展。     

端粒酶在宫颈癌及其癌前病变组织中的表达及意义

目的探讨端粒酶在宫颈癌及癌前病变组织中的表达及其在宫颈癌发生、发展过程中的作用。方法采用免疫组织化学EnVision二步法,检测30例浸润性宫颈癌（ICC）、90例宫颈上皮内瘤变（CIN）和10例正常宫颈组织标本中端粒酶的表达。结果端粒酶在正常宫颈组织、CINⅠ、CINⅡ、CINⅢ及浸润性宫颈癌中的阳性表达率分别为30.0%、40.0%、43.3%、70.0%和93.3%。端粒酶表达率浸润性宫颈癌高于CINⅢ,CINⅢ高于CINⅡ,差异均有统计学意义（P〈0.05）;CINⅡ与CINⅠ,CINⅠ与正常宫颈组织比较,差异均无统计学意义（P〉0.05）。结论端粒酶的表达与宫颈癌的发生、发展密切相关。端粒酶可作为宫颈癌癌前病变转归的预测指标。     

宫颈癌中HPV16 感染与IL-6表达的关系

 目的 探讨IL-6在宫颈病变中的表达及其与癌浸润转移的关系,探讨宫颈病变组织中HPV16 DNA的表达 及临床意义,探索两者之间的 关系。 方法 采用免疫组织化学SP法检测了40例宫颈鳞状细胞癌（CSCC）、38例CIN Ⅲ、28例CIN Ⅰ~Ⅱ和 15例正常宫颈组织中IL-6的表达;采用原位杂交法检测各组中HPV16 DNA的表达。 结果 IL-6在正常对照组、CINⅠ~Ⅱ组、CINⅢ组和CSCⅣ组阳性率分别为46.7%（7/15）、 71.4%（20/28）、 81.6%（31/38）、87.5%（35/40）,CSCC组的表达高于正常对照组及CIN1 2组（P <0.05）,且与临床分期和 病理分级无关,但与淋巴结转移有关;上述各组中HPV16 DNA阳性表达率分别为6.7% （1/15）、 25%(7/28)、 65.8%(25/38)、 80%(32/40),各组明显高于正常对照组(P<0.05) ;CINⅢ组明显高于CIN Ⅰ~Ⅱ组(P<0.05) ;HPV16 DNA 的表达与CSCC临床分期、病理分级及淋巴结转移无关;IL-6和HPV16 DNA表达呈正相关（r_s=0.756, P<0.05）。 结论 IL-6在CSCC中的高表达与宫颈癌的侵袭性行为有关,可作为判断早期宫颈癌预后的指标; IL-6和HPV16感染呈正相关,二者可能协同作用导致宫颈癌的恶性发展。     

吲哚胺2，3-二氧酶在CINⅠ～Ⅲ及宫颈鳞状细胞癌组织中的表达及临床意义*

目的:探讨吲哚胺2,3- 二氧酶（indoleamine 2,3-dioxygenase,IDO ）在宫颈鳞癌发生发展中的作用。方法:选择2008年1 月至12月在昆明医学院第三附属医院病理确诊为宫颈上皮内瘤样病变（cervical intraepithelial neoplasia ,CIN）Ⅰ～Ⅲ和宫颈鳞癌的病灶组织石蜡标本116 例及转移淋巴结石蜡标本18例。以正常宫颈组织石蜡标本20例及无转移淋巴结组织石蜡标本20例作为对照,采用免疫组化方法分析组织中IDO 的表达。结果:正常宫颈（20例）及CINI 组织（10例）中IDO 表达均为阴性,20%（2/10）的CINⅡ期组织表达为弱阳性,其余为阴性（80%,8/10）,CINⅢ中有61.5%（8/13）的组织呈弱阳性表达,7.7%（1/13）的组织为阳性表达,30.8%（4/13）的组织为阴性表达,宫颈癌Ⅰ～Ⅳ的阳性表达率为100%（83/83）,ⅠA 期和ⅠB 期阳性表达率显著高于CINⅡ和CIN Ⅲ（P<0.01）,ⅡA～ⅣB 阳性表达率显著高于ⅠA 期和ⅠB 期（P<0.01）。 IDO 表达与宫颈癌进展有关（OR= 0.807,P<0.01）。 淋巴结转移阳性患者的宫颈癌组织阳性表达率显著高于淋巴结转移阴性患者（P<0.01）,淋巴结转移组织中阳性表达率显著高于淋巴结转移阴性组织（P<0.01）,IDO 阳性表达率与肿瘤分化程度无关（OR=-0.139,P>0.05）。 结论:从CIN Ⅱ开始,肿瘤组织已逐步建立有利于肿瘤发展的免疫逃逸机制,转移淋巴结IDO 表达阳性可能与机体免疫系统选择性免疫耐受有关。IDO 的表达与疾病进展有关而与肿瘤组织分化程度无关,IDO 可能成为宫颈鳞状细胞癌预后的预测因子及治疗靶点。      

CK8在宫颈上皮内瘤变和宫颈癌中的表达及意义

目的探讨CK8在宫颈上皮内瘤变及宫颈癌中的表达及其临床意义。方法应用免疫组织化学S-P法检测15例正常宫颈组织、15例CINⅠ、17例CINⅡ、21例CINⅢ和36例宫颈癌组织中CK8的表达情况。结果 CK8在正常宫颈组织中无表达,在CIN和宫颈癌中的阳性表达率分别47.2%和80.6%,三组组间相比,差异有统计学意义(χ2=28.503,P<0.05)。CIN间,CINⅡ、CINⅢ组阳性率均高于CINⅠ组,差异有统计学意义(P=0.016;P=0.002)。随着宫颈病变程度的加重,CK8的阳性表达率逐渐增高,其阳性表达率同宫颈病变程度呈正相关关系(γ=0.979,P<0.01)。结论 CK8在宫颈组织恶性转化过程中,随着病变程度的加重,阳性表达率逐渐增高。CK8可作为高级别CIN和宫颈癌诊断及预测病变进展趋势的标志物。     

新疆维吾尔族妇女宫颈病变中DAPK表达的研究

[目的]探讨DAPK基因与新疆维吾尔族妇女宫颈病变的相关关系。[方法]选取维吾尔族妇女正常或炎症的宫颈组织30例、CINⅠ30例、CINⅡ/Ⅲ30例、宫颈鳞癌组织30例采用免疫组化SP法检测DAPK蛋白表达;为了进一步验证DAPK蛋白表达水平,采用逆转录聚合酶链反应（RT-PCR）法检测正常或炎症的宫颈组织10例、CINⅠ10例、CINⅡ/Ⅲ15例、宫颈鳞癌组织20例中mRNA的表达。[结果]DAPK的蛋白表达率在正常或炎症的宫颈组织、CINⅠ、CINⅡ/Ⅲ、宫颈鳞癌组织中分别为93.3%、83.3%、60.0%、33.3%,SCC组阳性表达率明显减少（P〈0.05）;四组mRNA的表达率分别为90.0%、90.0%、46.7%、10.0%,SCC组阳性表达率明显减少（P〈0.05）。宫颈组织中DAPK在蛋白水平和mRNA水平的表达均和宫颈病变程度成负关（P〈0.05）。[结论]新疆维吾尔族妇女宫颈病变组织中DAPK蛋白和mRNA水平均随病变程度加深而减少;DAPK蛋白检测可能为宫颈癌的早期诊断提供依据。     

子宫颈癌SOX9基因甲基化早期诊断价值探讨

目的检测宫颈癌和宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）脱落细胞中SOX9基因甲基化水平,为子宫颈癌的早期诊断提供新的分子标志。方法收集2010-03-01-2011-06-30就诊于首都医科大学附属北京妇产医院肿瘤科患者的宫颈脱落细胞156例,采用双探针实时定量聚合酶链式反应（polymerase chain reaction,PCR）技术,定量检测正常宫颈组（48例）、CINⅠ组（30例）、CINⅡ-Ⅲ组（30例）和宫颈癌组（48例）的宫颈脱落细胞中SOX9基因甲基化水平,分析SOX9基因甲基化与各级别宫颈病变的关系。结果正常宫颈组SOX9基因甲基化水平（甲基化评分）17.93±4.33,CINⅠ组为10.35±4.06,CINⅡ-Ⅲ组为33.17±15.19,宫颈癌组为48.04±24.03。SOX9基因甲基化水平随宫颈病变级别的增加而升高,且在CINⅡ-Ⅲ组和宫颈癌组中显著升高。CINⅠ组和正常宫颈组脱落细胞甲基化水平差异无统计学意义,P=0.062;SOX9基因甲基化水平在其余任意两组间差异均有统计学意义,P〈0.001。SOX9基因甲基化评分可有效区分宫颈癌/CINⅡ-Ⅲ和CINⅠ/正常宫颈,受试者工作特征曲线下面积（area under the receiver operating characteristic curve,AUC）为0.961（95%CI：0.933-0.990）,P〈0.001。在最佳临界值,SOX9基因甲基化评分检测宫颈癌/CINⅡ-Ⅲ的敏感度为92.3%,特异度为89.7%。结论甲基化SOX9基因能够有效诊断宫颈癌/CINⅡ-Ⅲ,可以作为子宫颈癌早期诊断的分子标志。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

miRNA与肿瘤侵袭转移

目前,microRNA (miRNA)已成为肿瘤研究中最基本的参与者,主要通过与靶标基因3 'UTR(非翻译区)的完全或不完全配对,降解靶标基因mRNA或抑制其翻译,从而参与调控个体发育、细胞凋亡、增殖及分化等生命活动.miRNA作为调控基因表达的重要分子在肿瘤侵袭转移中的作用越来越受到重视,表明miRNA在肿瘤侵袭和转移中的作用机制具有重要的理论意义,同时也可为肿瘤的诊断和治疗提供新方法.本文就miRNA通过调控上皮间质转化及肿瘤干细胞导致肿瘤侵袭转移的最新研究进展作一综述.     

芦荟大黄素及芦荟提取物的诱变性和抗诱变性

目的:用L5178Y小鼠淋巴瘤细胞体外微核试验评价芦荟大黄素和芦荟提取物的诱变和抗诱变作用,为其安全性评价提供依据。方法:设溶剂对照、阳性对照和抗诱变对照,芦荟大黄素和芦荟提取物诱变和抗诱变试验各设4个剂量组,处理L5178Y细胞12 h后按常规方法进行体外微核试验分析。结果:较高浓度(6.67μg/ml)的芦荟大黄素可致微核细胞率增加,与对照组比较,差异有统计学意义(P0.05);而芦荟提取物未见此效应。在一定剂量范围内,芦荟大黄素(0.22～6μg/ml)和芦荟提取物(20～180μg/ml)对甲磺酸甲酯(MMS)所致微核细胞率均有一定程度的拮抗作用,与对照组比较,差异有统计学意义(P0.01)。结论:芦荟大黄素具有一定的诱变作用,而在本实验剂量范围内的芦荟提取物未见遗传毒性。两种受试物在一定范围内均能较好地拮抗MMS所致的染色体损伤。     

甲胎蛋白与自噬在肝癌发生发展中的作用及其相互关系

甲胎蛋白（AFP）作为临床诊断肝癌最常用的肿瘤标志物,有抑制免疫、促进细胞生长、抑制癌细胞凋亡的作用。自噬是一种维持细胞生存的重要途径之一,其与肝癌的发生发展及治疗有着密切联系,对肝癌既有抑制又有促进作用。PI3K/AKT作为两者共有的信号通路,它们是否有着相互关系来促进肝癌的发展尚需进一步研究。     

甲状腺手术的技巧及副损伤的预防和处置

鉴于甲状腺手术是普外科的常见手术，为求其日渐完美，以有益于病人，现根据作者的体会，并结合阅读相关文献，就其手术操作、喉返神经处理、甲状旁腺处理进行扼要阐述。     

Erythrocyte levels of cadmium and lead and risk of B-cell non-Hodgkin lymphoma and multiple myeloma

Cadmium and lead are persistent environmental toxins that are known or probable carcinogens, based on evidence for causality for nonhematologic cancers. Associations of these metals with risk of non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) are unknown but biologically plausible. To examine the associations of circulating levels of lead and cadmium exposure with risk of B-cell NHL (B-NHL) and multiple myeloma, we conducted a nested case-control study among 299 incident B-cell NHLs and 76 MM cases within the Cancer Prevention Study-II Nutrition Cohort (CPS-II NC). Each case was incidence-density matched to two eligible controls on age, race, sex and blood draw date. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) for lymphoid malignancies overall and stratified by subtype. We observed a significant positive association between high erythrocyte lead concentration and risk of lymphoid malignancies overall (RR = 1.16, 95% CI: 1.02-1.33 per 17.6 μg/L (1 standard deviation [SD])) and follicular lymphoma in particular (RR = 1.80, 95% CI: 1.15-2.80 per SD). In contrast, there was no association between erythrocyte cadmium and risk of B-NHL (RR = 0.89, 95% CI: 0.75-1.06 per 0.37 μg/L [1 SD]), or any B-NHL subtypes; but a strong inverse association with MM risk (RR = 0.59, 95% CI: 0.38-0.89, per SD). Results from our study suggest a positive association between erythrocyte lead level and risk of lymphoid malignancies and a possible inverse association between cadmium and myeloma. Additional research is needed to confirm and further explore these findings.     

Comparison of the Efficacy and Safety of Ceftibuten and Cefaclor in the Treatment of Pneumonia and Bronchiectasis

Summary

In a multicentre, international study of 187 adult patients with bacterial pneumonia or bronchiectasis, the safety and efficacy of a regimen of 200 mg ceftibuten administered twice-daily was compared with cefaclor given in a dosage of 500 mg three times a day. Of the 94 evaluable patients, 66 received ceftibuten and 28 received cefaclor. The overall bacteriological response was similar in the two treatment groups with elimination of the original pathogen in 91% and 89% of the patients receiving ceftibuten and cefaclor, respectively. The overall clinical response mirrored the bacteriological results with a successful clinical outcome in 92% of ceftibuten-treated patients compared with 93% in patients receiving cefaclor. Adverse experiences were, in general, few and mild, being reported in 8% and 17% of patients receiving ceftibuten and cefaclor, respectively.