子宫内膜癌分子标志物与临床病理特征及预后的关系

目的：探讨子宫内膜癌中雌激素受体(estrogen receptor,ER)、孕激素受体(progestin receptor,PR)、第10染色体同源缺失性磷酸酶 张力蛋白基因 (phosphatase and tension homology deleted on chromosome ten,PTEN)、p53及Ki 67的表达与临床、病理特征及预后的关系。方法：收集200例原发性子宫内膜癌患者的临床信息、组织病理、免疫组织化学结果及随访资料,进行统计学分析。结果：（1）子宫内膜癌病例中ER、PR、PTEN、p53的阳性表达率分别为86.5%、85.5%、82.1%和49.2%;Ki 67在癌灶中的阳性表达率为46.9%±24.7%。（2）妊娠次数与PR阳性表达呈负相关(r=-0.191, P=0.007),而发病年龄、分娩次数与p53阳性表达呈正相关 (r=0.184, P=0.041; r=0.255, P=0.004)。（3）子宫内膜样腺癌中ER、PR、p53阳性率与其他类型内膜癌比较差异有统计学意义(P<0.01)。（4）ER阳性表达与手术病理分期呈负相关(r=-0.176, P=0.013),其中Ⅰ期患者的ER阳性率高于Ⅱ期及以上患者(P=0.015)。（5）ER、PR阳性表达与组织学分级呈负相关(r=-0.217, P=0.002; r=-0.317, P=0.000),但p53、Ki-67表达与其呈正相关(r=0.327, P=0.000; r=0.465, P=0.000);组织学Ⅲ级的ER、PR、p53、Ki-67表达与其他级别比较差异有统计学意义(P<0.01)。（6）ER阳性表达与肌层浸润深度呈负相关(r=-0.142, P=0.047),有或无深肌层浸润两者比较,ER、PR表达率差异均有统计学意义(P<0.05)。（7）多因素生存分析显示,PR表达的差异对总生存时间的影响有统计学意义（P=0.011）。结论：术前对诊断性刮宫标本进行免疫组织化学研究有助于全面了解子宫内膜癌的临床病理特征;除PR外,ER、PTEN、p53及Ki 67的表达情况对患者临床预后的预测意义较小。     

子宫内膜样腺癌组织MMP-2和Ki67表达及其意义

目的 探讨基质金属蛋白酶-2(MMP-2)和Ki67在子宫内膜样腺癌组织的表达及其临床意义.方法 采用SP方法检测MMP-2和Ki67在20例正常增生期子宫内膜、60例子宫内膜增生症和80例子宫内膜样腺癌组织中的表达.结果 MMP-2、Ki67阳性表达率在子宫内膜样腺癌、子宫内膜不典型增生组中的表达均高于增生期子宫内膜及子宫内膜增生过长组,差异均有显著性(χ2=5.406～38.649,P均<0.05);而MMP-2、Ki67阳性表达率在子宫内膜样腺癌、子宫内膜不典型增生组中比较差异均无显著性(P均>0.05);其在增生期子宫内膜、子宫内膜增生过长组之间比较差异也无显著性(P均>0.05).子宫内膜样腺癌组织中MMP-2的强阳性表达与病理组织学分级、淋巴转移及手术病理分期均有关(χ2=9.263～17.939,P均<0.05);Ki67的强阳性表达与病理分级有关(χ2=11.302,P<0.05),而与淋巴结转移及手术病理分期无关(P均>0.05).在80例子宫内膜样腺癌组织中,MMP-2与Ki67蛋白阳性表达水平呈正相关关系(r=0.878,P<0.05).结论 MMP-2与Ki67协同促进子宫内膜腺上皮生长、增殖,可能在子宫内膜样腺癌的发生、发展过程中起重要作用,两者联合检测对于筛选癌前高危个体可能具有更大意义.     

芳香化酶蛋白在子宫内膜病变中的表达

目的 研究芳香化酶蛋白、雌激素受体（ER）、孕激素受体（PR）及细胞核增殖相关抗原Ki67在子宫内膜病变中表达的规律，探讨其在子宫内膜腺癌早期诊断、内分泌治疗中的临床价值。方法 用免疫组化法（S-P）检测子宫内膜增殖症30例，轻、中、重度非典型增生各10例，子宫内膜腺癌88例，共148例为实验组；增生期及分泌期子宫内膜各30例做对照组，观察芳香化酶蛋白、雌激素受体、孕激素受体及细胞核增殖相关抗原Ki67在不同内膜病变及正常内膜中的阳性表达率。结果 芳香化酶蛋白和ER、PR、Ki67在子宫内膜增殖症、非典型增生中阳性表达与增生期内膜相比无统计学差异（P〉0.05）。而在子宫内膜腺癌中，芳香化酶蛋白的阳性表达明显升高，与良性病变组、对照组比较有统计学意义（P〈0.01）；芳香化酶蛋白的阳性率与临床分期，细胞分化级别、淋巴转移无关。在子宫内膜腺癌中ER、PR阳性表达降低，Ki67阳性表达增高，与对照组比较有意义。子宫内膜腺癌中芳香化酶蛋白与ER、PR及Ki67无一致性。结论芳香化酶基因与子宫内膜腺癌发生密切相关，芳香化酶、PR、ER及Ki67表达为子宫内膜腺癌的早期诊断及内分泌治疗提供理论基础。     

子宫内膜样腺癌与ER、PR、p53及PCNA表达的相关性研究

目的 研究子宫内膜样腺癌中雌激素受体(ER)、孕激素受体(PR)、p53蛋白的表达情况及p53蛋白的表达与增殖细胞核抗原(PCNA)的相关性,探讨其临床意义.方法 应用免疫组织化学S-P方法检测48例子宫内膜样腺癌组织中ER、PR、p53蛋白及PCNA蛋白的表达,并结合临床病理因素进行分析.结果 48例子宫内膜样腺癌组织中,p53蛋白的阳性表达为21例,阳性率为43.75%,ER的阳性表达为32例,PR的阳性表达为33例,阳性率分别为66.67%和68.75%,进一步分析发现p53蛋白的阳性表达与手术病理分期、组织学分级及肌层浸润深度呈正相关(P＜0.05);而ER、PR的阳性表达与临床分期、组织学分级及肌层浸润深度呈负相关(P＜0.05).在p53蛋白表达阳性的病例,PCNA计数明显高于阴性表达者,差异有统计学意义(P＜0.05).结论 ER、PR、p53及PCNA的异常表达与子宫内膜样腺癌的生物学行为密切相关,p53阳性表达、ER、PR缺失表达及p53阳性表达组织中PCNA的高表达均提示肿瘤组织的分化差,恶性程度高,预后不良.综合分析上述指标,有助于判断子宫内膜样腺癌的恶性程度及预后,指导临床治疗.     

SATB1与p53,Ki-67在子宫内膜样腺癌中的表达及临床意义

目的 检测核基质结合区结合蛋白质1（SATB1）在子宫内膜样腺癌中的表达情况,探讨其对子宫内膜样腺癌病程演变的作用及临床意义.方法 应用免疫组织化学方法（SP法）检测20例子宫内膜增生症、56例子宫内膜样腺癌组织中SATB1与p53,Ki-67的表达情况,分析其与肿瘤生物学行为的相关性.结果 SATB1在子宫内膜增生症、子宫内膜样腺癌组织中的阳性表达率分别为15％与69.6％,其在两组中的表达差异具有统计学意义（P=0.000）.SATB1的表达与子宫内膜样腺癌的组织学分级、临床分期及淋巴结转移呈正相关（P=0.009,P=0.007,P=0.031）,与是否绝经无关（P=0.494）.SATB1与p53,Ki-67在子宫内膜样腺癌中的表达呈正相关（P =0.016,P=0.005）.结论 SATB1的表达与子宫内膜样腺癌病程演变及p53,Ki-67的表达密切相关,联合检测SATB1与p53,Ki-67对子宫内膜样腺癌早期诊断及靶向治疗有着重要的临床意义.     

子宫内膜样癌P53、ER和PR的表达及其临床意义

目的探讨子宫内膜样癌组织中P53、雌激素受体（ER）、孕激素受体（PR）的表达及其临床意义。方法采用免疫组化S-P法检测36例正常子宫内膜、29例不典型增主内膜和67例内膜样癌组织中P53、ER、PR的表达,并与其病理特征进行对比分析。结果P53、ER、PR在子宫内膜样癌组织中的表达率分别为44．8％、56．7％、61．2％。P53的表达明显高于正常子宫内膜和不典型增生内膜组织,ER、PR的表达明显低于正常子宫内膜和不典型增生内膜组织,差异均有统计学意义（P〈0．05）。P53的表达与内膜样癌组织学分级、浸润深度或淋巴结转移呈正相关,ER、PR的表达与内膜样癌组织学分级、浸润深度或淋巴结转移呈负相关。结论P53、ER、PR的表达与子宫内膜样癌的发生、发展过程密切相关,其测定对估计患者预后,指导临床选择激素治疗具有重要临床意义。     

ER、PR、Her-2、VEGF、p53和Ki67在乳腺癌中的表达及临床病理意义分析

目的探讨雌激素受体(ER)、孕激素受体(PR)、原癌基因人类表皮生长因子受体-2(Her-2)、血管内皮生长因子(VEGF)、p53基因(p53)和增殖细胞核抗原(Ki67)在乳腺癌中的表达及临床病理意义分析。方法收集乳腺癌根治术标本213例,通过免疫组织化学法检测ER、PR、Her-2、VEGF、p53和Ki67在乳腺癌组织中的表达,探讨这些免疫组化指标与临床病理特征之间的关系。结果 (1)ER、PR和Ki67与组织学分级及临床分期有关(P<0.05)。(2)Her-2与组织学分级及组织学分类有关(P<0.05)。(3)p53与组织学分级及是否存在淋巴结转移有关(P<0.05)。(4)VEGF与肿瘤组织学分级、临床分期及是否存在淋巴结转移有关(P<0.05)。进一步Pearson相关分析显示,ER和PR与乳腺癌组织分化程度呈负相关(r=-0.221,r=-0.258,P<0.05);Her-2、p53、Ki67和VEGF与乳腺癌组织分化程度呈正相关(r=0.231,r=0.288,r=0.063,r=0.217,P<0.05)。结论通过检测ER、PR、Her-2、VEGF、p53和Ki67多项免疫组化指标的表达情况,可为临床有效判断乳腺癌患者的恶性程度及转移情况提供参考依据。     

MMP-26和ER在子宫内膜样腺癌中的表达及相关分析

目的:研究基质金属蛋白酶-26(MMP-26)和雌激素受体(ER)在子宫内膜样腺癌组织中的表达,探讨其与子宫内膜样腺癌浸润转移的关系。方法:应用免疫组化S-P法检测40例正常子宫内膜组织和50例子宫内膜样腺癌组织中MMP-26和ER的表达情况。结果:MMP-26和ER在正常子宫内膜和子宫内膜样腺癌组织中均有阳性表达。在子宫内膜样腺癌组织中MMP-26和ER阳性表达率明显低于正常子宫内膜组织,差异具有显著性(P<0.05)。二者的表达强度均与组织学病理分级、手术-病理分期、肌层浸润程度和淋巴结转移有关。在子宫内膜样腺癌组织中,MMP-26的表达与ER的表达则存在正相关(r=0.844;P=0.017)。结论:MMP-26和ER在子宫内膜癌组织中呈低表达,其表达随病理分级的升高、肌层浸润程度的加深及有淋巴结的转移而下降,且二者的表达呈正相关。联合检测二者在子宫内膜癌组织中的表达可为子宫内膜癌的早期诊断、指导临床治疗及预后判断提供一些新的思路。     

子宫内膜浆液性腺癌和子宫内膜样腺癌的鉴别

目的 研究免疫组化标记组合(p53、PR和PTEN)对鉴别子宫内膜样腺癌和子宫内膜浆液性腺癌的意义.方法 观察我院病理科2009年6月—2014年6月72例子宫内膜癌组织切片,按WHO子宫内膜癌分类分组,子宫内膜样腺癌(EEA)65例,子宫内膜浆液性腺癌(USC)7例.采用免疫组织化学标记检测p53、PR和PTEN表达并加以比较.结果子宫内膜样腺癌中PR均阳性表达、p53和PTEN表达缺失或微弱,子宫内膜浆液性腺癌中p53过表达、PR和PTEN表达缺失.结论 p53和PTEN表达缺失或微弱而PR阳性表达,倾向诊断子宫内膜样腺癌;而p53过表达、PR和PTEN表达缺失则倾向诊断子宫浆液性腺癌.     

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.