嗜铬蛋白A和神经特异性烯醇化酶及突触素在肾上腺皮质中的分布特点

目的:通过免疫组化方法,研究肾上腺皮质分泌物嗜铬蛋白A(CgA)、神经特异性烯醇化酶(NSE)和突触素(SYN)在肾上腺皮质的分布特点,为进一步深入研究皮髓质之间的相互作用奠定基础. 方法:运用免疫组化方法对肾上腺髓质增生、嗜铬细胞瘤和嗜铬细胞癌56份组织标本进行CgA、NSE和SYN染色,以正常肾上腺作为对照,观察其在皮质中的分布特点. 结果:肾上腺嗜铬细胞瘤和嗜铬细胞癌的皮质中均可见CgA染色阳性细胞,髓质增生和正常肾上腺病例皮质CgA染色阴性;肾上腺髓质增生和嗜铬细胞癌皮质NSE染色呈阳性,嗜铬细胞瘤和正常肾上腺皮质NSE染色呈阴性;肾上腺髓质增生、嗜铬细胞瘤的皮质中SYN染色呈阳性,正常肾上腺嗜铬细胞癌皮质SYN染色呈阴性. 结论:①肾上腺皮质CgA、NSE和SYN分布特点可以帮助鉴别肾上腺髓质增生、嗜铬细胞瘤和嗜铬细胞癌的异同;②肾上腺皮髓质之间联系紧密,受共同机制所调控,除经典的下丘脑-垂体-肾上腺轴和肾素-血管紧张素-醛固酮系统外,肾上腺皮髓质之间存在相互调节的解剖学和内分泌学基础.     

Ki67和P16在肾上腺皮质肿瘤组织中的表达

目的:联合检测肿瘤增殖抗原Ki67(Ki67)和抑癌基因P16(P16)在肾上腺皮质肿瘤中的表达,研究Ki67及P16与肾上腺皮质肿瘤的关系.方法:应用免疫组化方法检测77例.肾上腺皮质肿瘤(腺瘤70例、腺癌7例)及10例瘤旁正常组织标本中Ki67及P16的标记指数(Labeling Index,LI).结果:Ki67在正常肾上腺组织不表达,在腺癌表达最高,腺瘤次之;P16在正常肾上腺组织表达最高,腺瘤次之,腺癌最低,Ki67和P16在肾上腺皮质肿瘤表达的结果比较差异有统计学意义(P<0.001),且存在负相关关系(r=-0.736,P<0.05).Ki67的LI在肾上腺皮质腺瘤、腺癌的界定值为5%;P16的LI在肾上腺皮质腺瘤、腺癌的界定值为12%.结论:Ki67及P16的表达与肾上腺肿瘤显著相关,Ki67的LI>5%和P16的LI<12%时,提示为腺癌.联合检测Ki67和P16在肾上腺皮质肿瘤的表达,为难以判断良、恶性的肾上腺皮质肿瘤提供较为客观、简捷的诊断方法.     

胃癌组织中神经内分泌标记的表达及其与临床病理的关系

目的:探讨神经元特异性烯醇化酶(NSE)、突触素(Syn)、嗜铬素A(CgA)与胃癌临床病理和预后的关系.方法:对168例普通型胃癌病例随访5 a以上,用免疫组织化学二步法对胃癌组织分别进行NSE、Syn、CgA标记,分析NSE、Syn、CgA的表达与临床病理参数包括胃癌分化程度、浸润深度、脉管内癌栓、临床TNM分期、淋巴细胞浸润量等的关系,绘制Kaplan-Meier生存曲线.结果:168例神经内分泌表达阳性率为52.98%(89/168),NSE表达与胃癌分化程度有关(P＜0.05),CgA表达与胃癌临床分期有关(P＜0.05),神经内分泌表达与其余参数无关;NSE、Syn、CgA标记阴性组的5 a生存率表现出高于标记阳性组的趋势,其中以CgA最为明显,但差异无统计学意义(P＞0.05).结论:NSE、Syn、CgA与胃癌术后生存率无明显关系.     

原发性肾上腺皮质肿瘤组织中间隙连接蛋白32和43的表达及其临床意义

目的研究间隙连接蛋白(Cx)32和43在原发性肾上腺皮质肿瘤中的表达,探讨其在原发性肾上腺皮质肿瘤的临床诊断及预后评估中的价值。方法应用免疫组化NovolinkTMPolymer法检测21份正常肾上腺组织、45份肾上腺皮质腺瘤及14份肾上腺皮质癌标本中Cx32、Cx43的表达水平,运用SPSS13.0统计软件进行统计学处理。结果 Cx32和Cx43在肾上腺皮质癌中表达阳性率分别为21.4%和35.7%,明显低于肾上腺皮质腺瘤中的68.9%和75.6%(P=0.002,P=0.010)及正常肾上腺组织中的85.7%和100%(P=0.000,P=0.000);肾上腺皮质腺瘤中Cx43表达的阳性率低于正常肾上腺组(P=0.013)。Cx43的表达与肾上腺皮质腺癌患者的预后相关(P<0.05),Cx43表达越低患者预后越差。在肾上腺皮质癌中,Cx32和Cx43之间的表达呈明显正相关(P=0.015)。结论联合检测Cx32和Cx43的表达对鉴别良、恶性肾上腺皮质肿瘤具有重要的参考意义。Cx43在原发性肾上腺皮质癌组织的表达与患者预后相关,增加其表达可能改善患者预后。     

卵巢上皮性肿瘤的神经内分泌分化及其机制初探

目的 初步探讨卵巢上皮性肿瘤神经内分泌分化及其机制.方法 应用免疫组织化学SP法、双重免疫组织化学SAP法检测79例卵巢上皮性肿瘤和22例人正常卵巢组织嗜铬素A(CgA)、突触素(Syn)及CgA/上皮细胞膜抗原(EMA)表达,应用图像分析仪定量分析其表达情况.结果 (1)卵巢上皮性肿瘤中CgA表达阳性率59.4%,Syn表达阳性率65.36%,在恶性肿瘤其表达与临床分期及组织分级有关(P＜0.01);明显高于正常卵巢组(P=0.000,＜0.01),正常卵巢组织见少量的神经内分泌细胞(NECs),卵巢上皮性肿瘤NECs数量及染色强度均高于正常卵巢组(P＜0.05);(2)卵巢上皮性肿瘤组织中可见CgA/EMA双重表达的细胞.结论 卵巢上皮性肿瘤的神经内分泌分化是肿瘤异质性的表现之一,卵巢上皮性肿瘤中存在着可向上皮和/或向神经内分泌分化的"多向分化细胞",提示卵巢上皮性肿瘤的神经内分泌分化可能是上皮细胞恶性转化过程中多向分化的结果.     

肾上腺皮质腺瘤的神经内分泌分化

目的 探讨肾上腺皮质腺瘤发生学，为临床治疗方式的改进提供实验依据。方法 通过免疫组化方法观察了39例肾上腺皮质腺瘤（20例醛固酮症，10例库欣综合征，9例无功能腺瘤），10例正常肾上腺皮质的3种神经内分泌指标：神经丝蛋白（NF）、神经特异性烯化酶（NSE）、突触胞蛋白（SYN）的阳性表达。结果 10例正常肾上腺皮质仅2例NSE在肾上腺皮质球状带有少量阳性表达。39例肾上腺皮质腺瘤NF阳性14例（35．89％）。NSE阳性26例（66．66％）。SYN阳性24例（61．53％）。以3种不同临床表现形式的肾上腺皮质腺瘤的神经内分泌指标阳性表达率差异无显性意义（P＞0．05）。结论 肾上腺皮质腺瘤相对正常肾上腺皮质有神经内分泌分化；3种不同临床表现形式的肾上腺皮质腺瘤，其神经内分泌蛋白表达差异无显性变化。     

肾上腺皮质肿瘤中PPARγ与PTEN蛋白的表达及相互关系

目的:探讨PPARγ和PTEN在肾上腺皮质组织中的表达及相互关系.方法:应用免疫组化方法检测43例肾上腺皮质肿瘤(腺瘤30例、腺癌13例)及7例瘤旁正常组织标本中PPARγ及PTEN的表达,观察二者相互关系以及与肾上腺皮质病变病理学参数的联系.结果:肾上腺皮质癌与腺瘤和正常肾上腺组织比较,PPARγ表达明显增高(阳性率分别为76.9%、23.3%、0),PTEN表达减低(阳性率分别为7.7%、43.3%、85.78%);PPARγ表达与肿瘤大小、淋巴结转移相关,PTEN与淋巴结转移相关(均P<0.05);在肾上腺皮质肿瘤中PPARγ与PTEN表达存在负相关(P<0.05).结论:PPAR7在肾上腺皮质肿瘤中高表达且与PTEN的表达显著相关,提示PPARγ与PTEN存在相互调控机制作用于肾上腺皮质肿瘤的发生发展,检测PPARγ及PTEN对肿瘤的早期诊断和良恶性鉴别有一定价值.     

直肠神经内分泌肿瘤G1内镜及病理学特征分析

目的探讨直肠神经内分泌肿瘤(NEN)G1的内镜和病理学特征。方法回顾性分析2007年1月-2012年12月行内镜活检并参考2010年WHO消化系统肿瘤分类标准病理诊断为NEN G1 18例患者临床资料,结合内镜观察结果及显微镜下组织学形态变化进行综合分析,免疫组化方法检测细胞广谱角蛋白(AE1/AE3)、细胞角蛋白(CK8/18)、嗜铬粒素A(CgA)、突触素(Syn)、神经元特异性烯醇化酶(NSE)、核抗原(Ki-67)表达情况。结果NEN G1在内镜下多为黏膜隆起性肿物,活动度尚可,质地偏硬。显微镜下肿瘤细胞排列成片状、巢状、条带状等结构;细胞较小,形态一致,核深染,无或很少有核分裂相。AE1/AE3、CK8/18、CgA、Syn及NSE的阳性率分别为100.0%、88.9%、83.3%、77.8%及55.6%,Ki-67阳性率均≤2%。结论 NEN G1缺乏特异性临床表现,通常体积较小,内镜观察不易明确诊断,AE1/AE3、CK8/18、CgA、Syn等的免疫组化检测对于辅助病理诊断尤为重要。     

小细胞肺癌组织中神经细胞黏附分子、嗜铬蛋白A及突触素的表达及临床相关分析

目的检测神经细胞黏附分子(NCAM/CD56)、嗜铬蛋白A(CgA)及突触素(Syn)在小细胞肺癌(SCLC)组织中的表达,探索其在SCLC组织中表达的意义与价值。方法应用组织反转录聚合酶链反应(RT-PCR)及免疫组织化学方法检测CD56、CgA及Syn在15例SCLC、15例非小细胞肺癌(NSCLC)和10例正常组织中的表达,并应用Fisher确切概率法检验分析表达结果。结果 CD56、CgA、Syn基因在SCLC组织中表达的阳性率高于NSCLC及正常组织,差异均有统计学意义(P<0.05);3项指标联合检测SCLC的敏感性为93.3%,特异性为96.0%,准确性为90.0%;CgA基因在SCLC广泛期的表达(77.8%)高于局限期的表达(0.0%),在有淋巴结转移组织的表达(70.0%)高于无淋巴结转移组织的表达(0.0%)。CD56和Syn蛋白在SCLC组织中的表达高于NSCLC组织和正常组织(P<0.05);但是CgA蛋白在SCLC、NSCLC及正常组织中表达的阳性率比较,差异均无统计学意义(P>0.05)。结论 CD56、CgA、Syn的检测对SCLC的诊断具有重要意义,CgA基因的表达水平可以间接反映SCLC分期。     

甲状腺乳头状癌伴神经内分泌分化细胞的超微结构观察

目的:观察甲状腺乳头状癌伴神经内分泌分化细胞的超微结构特征.方法:对手术切除石蜡包埋的103例甲状腺乳头状癌,分别进行CgA、Syn、NSE免疫组化标记,CgA、Syn、NSE阳性的乳头状癌66例分别进行电镜观察.临床病理参数包括:乳头状癌细胞分化程度、核特征、砂粒体、年龄、肿瘤直径、淋巴结转移、包膜及周围组织侵犯.用STATA8.0医学统计软件对资料进行统计分析.结果:18.2%的甲状腺乳头状癌病例电镜下可找到神经内分泌颗粒.乳头状癌细胞分化程度及肿瘤的大小与神经内分泌分化有关(P<0.05),其余参数与神经内分泌分化无关.结论:部分甲状腺乳头状癌存在神经内分泌分化现象,伴神经内分泌分化的肿瘤组织分化较差、体积较大.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.