甲状腺乳头状癌端粒酶活性的表达

目的　观察端粒酶在甲状腺良恶性组织中的表达情况,探讨端粒酶表达在甲状腺乳头状癌的潜在临床价值。　方法　采用ＴＲＡＰ酶标定量检测法和ＴＲＡＰ凝胶电泳定性分析法,对２３例甲状腺乳头状癌组织,８ 例甲状腺滤泡性腺瘤,８ 例甲状腺肿和１０例正常甲状腺组织进行端粒酶活性的检测。　结果　（１）甲状腺乳头状癌组,甲状腺滤泡性腺瘤组,甲状腺肿组和正常甲状腺组织组中端粒酶阳性检出率分别为８６．７％ ,１２．５％ ,１２．５％ ,０％ 。甲状腺乳头状癌组较其他组差异有显著性（Ｐ＜ ０．０５）。（２）甲状腺乳头状癌中端粒酶活性检出率与病灶大小、年龄、淋巴结转移及组织学分级无关,病理分期晚期的检出率较早期的高（Ｐ＜ ０．０５）。（３）甲状腺乳头状癌组的端粒酶活性水平明显高于甲状腺良性病变组和甲状腺正常组织组（Ｐ＜ ０．０５）。（４）甲状腺乳头状癌端粒酶活性水平与组织学分级无关。病灶越大,年龄越大,病期越晚,端粒酶活性水平越高,伴淋巴结转移的高于无淋巴结转移者（Ｐ＜ ０．０５）。　结论　端粒酶是特异性较强的恶性肿瘤标记物,可作为甲状腺乳头状癌鉴别诊断和预后评估的良好的参考指标,深入研究端粒酶有助于发展新的肿瘤诊断方法。     

甲状腺肿瘤增殖细胞核抗原表达的免疫组化研究

目的探讨增殖细胞核抗原（ＰＣＮＡ）表达在甲状腺肿瘤病理学诊断和鉴别诊断中的意义及应用价值。方法采用 免疫组化ＬＳＡＢ法检测１４例甲状腺腺瘤,１０例不典型腺瘤,１５例乳头状腺癌,１０例滤泡性腺癌,１０例髓样癌,１０例未 分化癌。结果 ＰＣＮＡ增殖指数在甲状腺腺瘤为 １２．８,不典型腺瘤为 １９．８,乳头状癌为 １９．２,滤泡性腺癌为 ２６．４,髓样癌 为２７．９,未分化癌为４４．３。各组间比较：不典型腺瘤与乳头状癌之间无差异;腺瘤与不典型腺瘤和乳头状癌间有显著性 差异（Ｐ＜０．０５）,与其余各组有极显著性差异（Ｐ＜０．０１）。结论ＰＣＮＡ增殖指数可作为判断甲状腺肿瘤良恶性的指标,并 可反映其临床生物学行为,为预后提供重要信息。     

甲状腺肿瘤组织中IL-8的表达及意义

目的 探讨ＩＬ－８在甲状腺肿瘤组织中的表达及意义。方法 应用免疫组织化学方法,观察１２例甲状腺腺瘤和１６例甲状腺瘤（其中８例甲状乳头状瘤,４例甲状腺滤泡状织中ＩＬ－８的表达及分布。结果 甲状腺腺瘤和甲状腺瘤者甲状腺组织中ＩＬ－８表达阳性率分别为２５％和６１％（Ｐ〈０．０１）,甲状腺瘤中ＩＬ－８免疫染色强度显著异异（Ｐ〈０．０１）,其中术分化癌染色强度较高,其次为滤泡状癌,砂状癌和随样癌染色强度较低     

甲状腺肿瘤ras—p21及EBV LMP—1的表达及意义

目的：研究ras癌基因及EBV感染在甲状癌中的意义。方法：应用SABC免疫组化法对88例甲状腺肿瘤（乳头状癌34例,滤泡性癌17例,髓样癌5例,未分化癌8例,腺瘤24例）进行研究,观察ras癌基因蛋白产物p21及EBVLMP－1的表达情况。结果：甲状腺癌p21的表达与甲状腺肿瘤良恶性有关,甲状腺癌p21阳性率（６２．５％）明显高于甲状腺腺瘤（３３．３％）（Ｐ＜０．０５）。甲状腺癌p21组织学分型无关。ＬＭＰ－２在甲状腺癌中的表达率为１５．６％,癌周组织无表达。结论：ras癌基因突变为甲状腺癌发生中的早期事件,p21检测可作为甲状腺泡性肿良恶性鉴别的辅助指标,提示ＥＢＶ感染与甲状腺癌的发生有关。     

着丝粒蛋白A和内皮素在甲状腺肿瘤鉴别及诊断中的应用研究

目的研究着丝粒蛋白A（CENP—A）和内皮素（ET）在甲状腺肿瘤中的表达，探讨其在甲状腺肿瘤鉴别及诊断中的意义。方法将患者标本固定、石蜡包埋、切片、免疫组化染色，通过半定量计分法判断结果，镜检采用双盲原则，由两位不同医师进行评分。结果CENP—A免疫组化染色结果表明，滤泡状癌总阳性率为75．00％；乳头状癌总阳性率为68．97％；滤泡状腺瘤总阳性率为16．33％。ET免疫组化染色结果表明，滤泡状癌总阳性率为66．67％；乳头状癌总阳性率为8621％；滤泡状腺瘤总阳性率为20．41％；髓样癌、未分化癌总阳性率均为0。结论CENP—A可能与甲状腺肿瘤分化增殖有关，ET可能参与血管的形成，维持肿瘤的生长。     

甲状腺肿瘤增殖细胞核抗原表达的免疫组化研究

目的 探讨增殖细胞核抗原（ＰＣＮＡ）表达在甲状腺肿瘤病理学诊断和鉴别诊断中的意义及应用价值。方法 采用免疫组化ＬＳＡＢ法检测１４例甲状腺腺癌,１０例不典型腺瘤,１５例乳头状腺癌,１０例滤泡性腺癌,１０例髓样癌,１０例未分化癌。结果 ＰＣＮＡ增殖指数在甲状腺腺瘤为１２．８,不典型腺瘤为１９．８,乳头状癌为１９．２,滤泡性腺癌为２６．４,髓样癌为２７．９,未分化癌为４４．３。各组间比较：不典型腺瘤与乳头状癌之间无差异;腺瘤与不典型腺瘤和乳头状癌间有显著性差异（Ｐ〈０．０５）,与其余各组有极显著性差异（Ｐ〈０．０１）。结论 ＰＣＮＡ增殖指数可作为判断甲状腺肿瘤良恶性的指标,并可反映其临床生物学行为,为预后提供重要信息。     

甲状腺肿瘤中着丝粒蛋白A和内皮素表达的临床意义

目的 观察甲状腺肿瘤中着丝粒蛋白A(CENP-A)和内皮素(ET)的表达情况,探讨它们在甲状腺肿瘤中的鉴别诊断价值.方法 采用免疫组化S-P法,对320例甲状腺外科手术标本进行CENP-A、ET和Ki-67染色观察.结果 乳头状癌组与腺瘤组CENP-A阳性率、ET阳性率差异均有统计学意义(均P＜0.01)；乳头状癌组与滤泡状癌组CENP-A阳性率、ET阳性率差异均无统计学意义(均P＞0.05)结论 CENP-A和ET在甲状腺癌细胞的生长、增殖过程中起重要作用,对良、恶性甲状腺肿瘤的鉴别诊断有重要价值.     

Doppler超声时间指标评价高血压病、冠心病左室功能

采用Ｄｏｐｐｌｅｒ超声测量ＣＨＤ、ＨＤ、ＨＣＤ－ＣＨＤ及ｓ四组ＡＴ、ＥＴ、ＡＴ／ＥＴ、ＩＣＴ、ＰＥＰ／ＥＴ、ＰＥＰ、ＩＶＲＴ、ＡｃＴＥ、ＡｃＴＥ／ＭＶＯＴ，结果ＣＨＤ、ＨＤ、ＨＣＤ－ＣＨＤ三组ＩＶＲＴ明显升高（Ｐ＜０．０１），ＨＤ、ＣＨＤ与ＨＣＤＣＨＤ之ＩＶＲＴ差异有显著性（Ｐ＜０．０１），ＮＳ、ＣＨＤ、ＨＤ与ＨＣＤ－ＣＨＤ组ＰＥＰ／ＥＴ、ＩＣＴ、ＰＥＰ差异均有显著性（Ｐ＜０．０５），ＨＣＤ－ＣＨＤ组ＰＥＰ／ＥＴ、ＩＣＴ、ＰＥＰ值升高，ＮＳ、ＨＤ与ＣＨＤ、ＨＣＤ－ＣＨＤ、ＡＴ／ＥＴ差异有显著性（Ｐ＜０．０５），ＣＨＤ及ＨＣＤ－ＣＨＤ组ＡＴ／ＥＴ下降，ＨＲ、ＡＴ、ＥＴ、ＡＣＴＥ各组间差异均无显著性（Ｐ＞０．０５），Ｄｏｐｐｌｅｒ超声时间指标评价左室功能具有一定价值。     

益气活血方对肿瘤坏死因子诱导血管内皮细胞释放反应的影响

以体外原代培养的人脐静脉内皮细胞（ＨＵＥＣ）为受试对象，观察肿瘤坏死因子（ＴＮＦ）作用于ＨＵＥＣ后不同时相条件培养液中６－ｋｅｔｏ－ＰＧＦ１α和血栓烷Ｂ２（ＴＸＢ２）含量的变化及中药益气活血方的作用。结果显示：作用８小时后，ＴＮＦ组６－ｋｅｔｏ－ＰＧＦ１α显著升高，而ＴＸＢ２明显下降（Ｐ＜０．０１），Ｔ／Ｋ比值明显下降（Ｐ＜０．０１），益气活血方对６－ｋｅｔｏ－ＰＧＦ１α升高具有协同作用（Ｐ＜０．０１），对ＴＸＢ２及Ｔ／Ｋ比值下降具有拮抗作用（Ｐ＜０．０５，Ｐ＜０．０１）；２４小时后，ＴＮＦ组６－ｋｅｔｏ－ＰＧＦ１α显著升高（Ｐ＜０．０１），ＴＸＢ２无明显变化（Ｐ＞０．０５），Ｔ／Ｋ比值明显下降（Ｐ＜０．０１），益气活血方对６－ｋｅｔｏ－ＰＧＦ１α升高具有协同作用（Ｐ＜０．０１），但对ＴＸＢ２及Ｔ／Ｋ比值下降无明显影响（Ｐ＞０．０５）。提示ＴＮＦ作为炎症介质能导致血管扩张、管壁通透性增大，而益气活血方在一定时间内具有对抗作用。     

CK19和CKH在甲状腺病变的表达及诊断价值

目的研究分析细胞角蛋白（CK）19、高分子量细胞角蛋白（CKH）在甲状腺结节的表达及诊断价值。方法采用免疫组化SP法检测62例甲状腺癌（56例乳头状癌,6例滤泡癌）、12例甲状腺腺瘤,20例结节性甲状腺肿和10例桥本甲状腺炎中CK19和CKH的表达。结果CK19和CKH在甲状腺乳头状癌中的阳性率分别为100％和89.3％,与良性病变中的表达率14．3％和0％差异有统计学意义（P〈0.05）。CK19和CKH在滤泡型乳头状癌与滤泡癌之间进行比较,差异有统计学意义（P〈0．05）。CK19、CKH检测在鉴别甲状腺乳头状癌和良性病变时的敏感性、特异性及诊断正确率分别为100％、89．3％,85.7％、100％,93．8％、87．8％;CK19的敏感性高,而CKH的特异性高。结论CK19和CKH有助于甲状腺乳头状癌与甲状腺良性增生性病变、甲状腺滤泡型乳头状癌与滤泡癌的诊断与鉴别诊断;而且CK19、CKH联合检测有助于提高甲状腺良性病变的诊断正确率。     

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.