EZH2和Ki-67在宫颈癌组织中的表达及其临床意义

目的探讨EZH2和Ki-67在宫颈癌组织中的表达及其临床意义。方法采用免疫组化法分别检测40例正常宫颈、62例宫颈上皮内瘤变(CIN)及174例宫颈癌组织中EZH2和Ki-67蛋白的表达,并分析EZH2和Ki-67与临床病理特征及预后的关系。结果宫颈癌组和CIN组中EZH2和Ki-67蛋白的阳性表达率明显高于对照组,且宫颈癌组中EZH2和Ki-67蛋白的阳性表达率明显高于CIN组。在宫颈癌组织中,EZH2和Ki-67与临床分期、淋巴结转移及浸润深度密切相关(P0.05),且EZH2蛋白与病理分级有关(P0.05)。在随访的166例宫颈癌患者中,EZH2和Ki-67蛋白阳性表达患者的无进展生存时间(PFS)和总生存时间(OS)明显短于EZH2和Ki-67阴性患者[PFS(月):(53.7±3.6)和(56.8±3.2)vs(62.8±2.4)和(64.3±2.1);OS(月):(56.2±3.0)和(58.7±2.8)vs(64.2±1.9)和(65.8±1.7),均P0.01]。COX比例风险模型多因素分析显示,临床分期、淋巴结转移、EZH2及Ki-67蛋白是影响宫颈癌患者预后的独立危险因素。结论 EZH2和Ki-67异常表达与宫颈癌临床病理特征及预后有一定的相关。     

宫颈癌VEGF-C表达和淋巴管、血管生成关系的探讨

目的:检测宫颈癌组织中血管内皮生长因子-C(VEGF-C)、受体VEGFR-3和CD34的表达,探讨VEGF-C与癌周淋巴管、血管生成和肿瘤转移的关系。方法:采用免疫组化法检测55例宫颈癌组织中VEGF-C、VEGFR-3和CD34的表达。结果:55例宫颈癌组织VEGF-C阳性率为69.1%(38/55),VEGFR-3阳性率为61.8%(34/55),二者表达高度一致(P<0.01)。淋巴结转移组中VEGF-C与VEGFR-3阳性表达明显高于无转移组(P<0.05)。低分化组VEGF-C和VEGFR-3的表达明显高于高、中分化组(P<0.05)。随着临床分期增加,VEGFR-3表达的阳性率增高(P<0.01)。淋巴结转移组中淋巴管密度(LMVD)明显高于无转移组(P<0.01)。VEGF-C表达阳性的组织中血管密度(MVD)明显升高(P<0.05)。VEGF-C和VEGFR-3表达阳性的患者生存率有降低的趋势。结论:宫颈癌中VEGF-C通过受体VEGFR-3促进组织生长、抑制分化,促进肿瘤细胞间质淋巴管和血管生成,是促使宫颈癌发生扩散和转移的重要原因。二者阳性表达可预示预后不良。     

趋化因子受体4在子宫颈癌中的表达及临床意义

目的探讨趋化因子受体4(chemokine receptor 4,CXCR4)在宫颈癌组织中的表达及其对宫颈癌预后的影响。方法采用免疫细胞ABC法检测60例宫颈癌和10例正常宫颈组织中CXCR4的表达,分析宫颈癌组织中CXCR4阳性表达与各临床病理因素及患者预后的关系。结果 CXCR4在正常宫颈组织中不表达,而在宫颈癌组织中的阳性表达率为78.3%(47/60)。宫颈癌组织CXCR4的阳性表达与盆腔淋巴结转移、淋巴血管间隙浸润、宫颈间质浸润深度有关(P<0.05),与患者年龄、病理类型、病理分级、临床分期、原发肿瘤的大小和阴道残端累及无关(P>0.05)。单因素分析显示,盆腔淋巴结转移、淋巴血管间隙浸润、CXCR4强阳性表达是影响宫颈癌患者总生存时间的危险因素。盆腔淋巴结转移和宫颈癌组织CXCR4强阳性表达是影响宫颈癌患者无瘤生存时间的危险因素。COX回归分析显示,CXCR4强阳性表达是宫颈癌患者总生存和无瘤生存时间的危险因素。结论 CXCR4在宫颈癌组织中高表达,与宫颈癌的侵袭及转移相关。并且其强阳性表达是影响宫颈癌患者预后的重要因素。     

Ki-67、PCNA及HPV在宫颈癌和宫颈上皮内瘤变的表达及意义

目的:研究Ki-67,增殖细胞核抗原(PCNA)在早期宫颈癌(IA~IIA期高分化)、宫颈上皮内瘤变(CINI、CINII、CINIII)及慢性宫颈炎中的表达,及其与HPV感染的关系,探究3者联合应用的诊断价值。方法:应用免疫组织化学S-P法检测宫颈病变中Ki-67、PCNA抗原的表达,PCR反应检测HPV感染,结合临床病理特点分析。结果:慢性宫颈炎、CIN、宫颈鳞癌中Ki-67阳性表达率分别为33.33%、89.19%、100%。PCNA阳性表达率分别为66.67%、97.30%、100%。HPV阳性率分别是13.33%、54.05%、1000%。CINI和CINII/III中Ki-67阳性表达率分别为85.00%、94.12%;PCNA阳性表达率分别为95.00%、100.00%。HPV阳性率分别是30%、82.35%。CIN和宫颈癌中的Ki7、PCNA及HPV的阳性表达与宫颈炎相比,差异均有显著性(P<0.05)。Ki-67及PCNA过表达率在CINII/III组与CINI组间差异显著(P<0.05)。HPV阳性率在CINII/III与CINI之间差异显著(P<0.01)。Ki-67及PCNA表达与HPV感染有相关性(P<0.05)。结论:Ki-67、PCNA抗原过表达与CINII/III和早期宫颈癌显著相关。Ki-67、PCNA表达与HPV感染率相关,联合检测宫颈组织中Ki-67、PCNA的过表达及HPV感染,有助于判断细胞的增殖活性,可作为诊断早期宫颈癌和CINII/III的标记物。     

CD13在宫颈癌中的表达及意义

目的:探讨CD13在宫颈癌患者中的表达及临床意义。方法:用免疫组化SP法检测60例宫颈癌、60例宫颈上皮内瘤变(CIN)和30例正常宫颈组织中的CD13表达情况。结果:CD13在宫颈癌、CIN和正常宫颈组织中的阳性表达率分别是81.7%、31.7%、20.0%,CD13在宫颈癌中的表达均显著高于CIN及正常组织(P均<0.05)。CD13表达与宫颈癌患者年龄无相关性(P>0.05),而与淋巴转移、临床分期以及分化程度有相关性(P<0.05)。结论:CD13在宫颈癌的异常表达与宫颈癌的发生、发展有关,可作为评估宫颈癌的恶性程度、指导治疗、评价预后的重要参考指标。     

宫颈癌血管内皮生长因子表达与血管生成癌细胞增殖及侵袭转移的关系

目的　研究血管内皮生长因子 (VEGF)在早期宫颈癌的表达和临床意义。方法　采用免疫组织化学SP法检测 1998年 1月至 2 0 0 2年 2月期间 75例早期宫颈癌 (ICC)、18例宫颈上皮内瘤样病变 (CIN)和 15例癌旁正常宫颈上皮 (NCE)中VEGF的表达情况 ,并检测其中微血管密度 (MVD ,CD3 4 标记 )和癌细胞增殖标记指数 (Ki 6 7标记 )。结果　从NCE→CIN→ICC ,VEGF、Ki 6 7的阳性表达率和MVD均显著升高 (P <0 0 5 )。VEGF在ICC的表达与MVD显著正相关 (r =0 6 0 2 ,P <0 0 1) ,与盆腔淋巴结转移、脉管浸润、组织学分级和Ki 6 7表达显著相关 (P <0 0 5 ) ,但与年龄、FIGO分期、组织学类型和间质浸润无关 (P >0 0 5 )。低分化、盆腔淋巴结转移、脉管浸润及Ki 6 7高度表达者 ,与VEGF阳性表达显著相关 (P <0 0 5 )。结论　VEGF阳性表达可能在宫颈癌血管生成、癌细胞增殖、癌细胞侵袭转移中起重要作用。VEGF检测对进一步了解宫颈癌生物学行为和判断其预后具有一定的临床应用价值。     

Survivin、CD44v6、MMP-2在宫颈癌组织中的表达与侵袭、转移的关系

目的探讨Survivin基因、细胞粘附分子CD44v6、基质金属蛋白酶-2(MMP-2)蛋白在人宫颈癌中的表达水平与宫颈癌组织侵袭、转移能力的关系.方法采用免疫组织化学法和图像分析系统方法检测Survivin、CD44v6、MMP-2在10例正常宫颈、10例宫颈原位癌、40例宫颈鳞癌、11例宫颈腺癌组织中的表达,分析表达结果与临床病理特征的关系.结果从正常宫颈上皮到原位癌再到浸润癌,Survivin、CD44v6、MMP-2阳性表达量显著升高(P＜0.05).有盆腔淋巴结转移、脉管或(和)间质侵袭、年龄小于35岁患者的Survivin、CD44v6、MMP-2阳性表达量较其对应组增多(P＜0.05);腺癌Survivin阳性表达量高于鳞癌,而CD44v6、MMP-2的表达在鳞癌中高于腺癌(P＜0.05).结论Survivin蛋白异常表达在宫颈癌的恶化、侵袭、转移中起重要作用,它与宫颈癌组织细胞生物学特点密切相关,并与CD44v6、MMP-2共同在宫颈癌组织中的阳性表达可能在宫颈癌发生发展、组织侵袭、转移中起重要作用.     

Shrew-1与CD147在宫颈癌组织中表达及其联合检测对早期宫颈癌复发预测价值研究

目的探讨Shrew-1和CD147在宫颈癌组织的表达及联合检测对早期宫颈癌复发的预测价值。方法选取甘肃省人民医院病理科2003年1月至2005年6月存档的石蜡包埋宫颈癌术后标本95例(全部为鳞癌)。宫颈癌组织标本为初治时的手术切除肿瘤组织。所有入组宫颈癌患者随访时间均多于5年。对照组为15例正常宫颈上皮。免疫组织化学法检测各组宫颈组织中Shrew-1与CD147的表达情况。结果免疫组化结果显示宫颈鳞癌表达Shrew-1,正常宫颈上皮组织无该蛋白的阳性表达。鳞癌复发组Shrew-1的表达阳性率(85.7%)显著高于非复发组(20.0%)(P<0.01)。Shrew-1的阳性率在病理分级G3组患者中显著高于G1组(χ2=5.569,P=0.018),且在深肌层浸润和发生淋巴结转移的患者中Shrew-1阳性率也显著高于浅肌层浸润和未发生淋巴结转移患者(χ2=4.702,P=0.034;χ2=16.792,P=0.000)。Shrew-1、CD147联合检测对宫颈癌复发的阳性预测值为65.6%,阴性预测值为77.8%,灵敏度为60.0%,特异度为81.7%。结论宫颈鳞癌表达Shrew-1,其表达阳性率与肿瘤转移因素有关,CD147与Shrew-1联合检测有利于发现早期癌的术后复发。     

分析p16、p53及Ki-67在宫颈癌患者中的表达及联合检测的诊断价值

目的 探讨p16、p53及Ki-67在宫颈癌患者中的表达意义及三项指标联合检测的诊断效能。方法 选取2019年6月至2022年10月在桂林医学院附属医院就医并确诊为宫颈癌的140例患者纳入宫颈癌组,另选取60例经本院确诊的高级别鳞状上皮病变患者纳入宫颈上皮内病变组,均为CIN2。收集本研究纳入患者的病理组织标本并检测p16、p53及Ki-67阳性表达情况,明确p16、p53及Ki-67与宫颈癌患者病理特征的关系,分析p16、p53及Ki-67三项指标联合检测对宫颈癌的诊断价值。结果 宫颈癌组病理组织标本中p16、p53及Ki-67阳性表达率均明显高于宫颈上皮内病变组（均P <0.05）;宫颈癌组中不同年龄患者的p16、p53及Ki-67阳性表达对比差异均无统计学意义（P>0.05）,不同FIGO分期及淋巴结转移患者p16、p53及Ki-67阳性表达明显升高（均P <0.05）;p16、p53、Ki-67三项联合的诊断效能包括灵敏度、特异度、阳性预测值、阴性预测值均明显高于单一指标的检测效能。结论 宫颈癌组织中p16、p53、Ki-67蛋白的阳性表达与宫颈癌患者病情的发...     

黏附分子CD44V6与唾液酸化Lewis-X抗原在宫颈癌组织中的表达及意义

目的　探讨黏附分子CD4 4V6与唾液酸化Lewis X(SLeX)抗原在宫颈癌组织中的表达及其意义。方法　 1 994年 1月至 1 999年 1月采用免疫组织化学法 (SP法 )检测CD4 4V6与SLeX在 30例正常宫颈组织及 82例宫颈癌组织中的表达。结果　正常宫颈组织CD4 4V6与SLeX均呈阴性表达。 82例宫颈癌组织中CD4 4V6与SLeX的阳性表达率分别为 6 4 6 %(5 3/ 82 )及 6 3 4 %(5 2 / 82 )。CD4 4V6与SLeX的阳性表达与宫颈癌的病灶大小、临床分期、细胞分化程度、转移及预后有关 (P <0 0 1或P <0 0 5 ) ;与宫颈癌的病理类型及患者年龄无关 (P >0 0 5 )。结论　CD4 4V6与SLeX的表达与宫颈癌的生长、浸润及转移密切相关 ,可作为反映宫颈癌恶性潜能及判断患者预后的新指标。     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症(EMs)发病机制尚未完全阐明.大量研究表明,免疫因素在EMs的发病机制中起重要作用.EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变.Toll样受体(TLRs)识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应.TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深人认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段.     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症（EMs）发病机制尚未完全阐明。大量研究表明,免疫因素在EMs的发病机制中起重要作用。EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变。Toll样受体（TLRs）识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应。TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深入认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段。     

Pharmacokinetics and endometrial and tubal tissue penetration of cefalotin and cefazolin

The pharmacokinetics and concentrations of the two antibiotics cefazolin and cefalotin were studied during gynecologic operations in endometrial and tubal tissue. The patients received 0.05 g/kg of the antibiotics by intravenous injection. Under the given conditions, pharmacokinetic calculation of the plasma elimination gave half-lives of 24.8 min for cefalotin and of 63 min for cefazolin. Fitting of the tissue levels to the Bateman function showed that the two antibiotics diffuse rapidly into both tubal and endometrial tissue and attain peak concentration levels between 10 and 25 min. In both tissues the concentrations of cefazolin were higher than those of cefalotin. Higher tissue concentrations of cefazolin could also be demonstrated in experiments of longer duration.     

Psychological and pharmacological treatments of mood and anxiety disorders during pregnancy and postpartum. Review and synthesis

The aim of this article is to review the main methods of treatment of anxious and depressive disorders during pregnancy and the postpartum. To this end, we analyse recent publications about the use and efficacy of psychotherapy and psychosocial interventions (cognitive behavioural therapy, interpersonal psychotherapy, psychoanalytical therapy) in the perinatal period. We also review recent papers about the use of psychotropic medication during pregnancy and breast-feeding, with special emphasis on clinical trials. We particularly focus on the risk/benefit assessment of antidepressants, mood stabilisers, antipsychotics and benzodiazepines, in terms of teratogenicity, and impact on neonatal adaptation and neuropsychological development. Various treatment modalities are presented and discussed. It appears that psychotherapies have proved their efficiency on most pre- and postpartum anxious and depressive disorders and represent a first line treatment in most cases. Psychopharmacological treatment is indicated for severe anxious and depressive disorders. The risks of such medication, especially antidepressants, may have been overestimated in the past. Provided reasonable precautions are taken and mothers and future mothers receive clear information on the potential risks and benefits, psychotropic medication could be more broadly prescribed during pregnancy and the breast-feeding period.     

Israeli and British women's wellbeing and eating behaviours in pregnancy and postpartum

Objectives: The study had two main objectives: (a) track changes in self-esteem, eating behaviours and body satisfaction from early pregnancy to 24 months postpartum and (b) to compare changes by context (Israel vs. UK) and maternal body mass index (BMI).

Background: High maternal BMI is associated with negative body image and restrained eating, which are experienced differently across cultures.

Methods: 156 pregnant women were recruited from Israel and the UK. Seventy-three women were followed up every six months from early postpartum and until 24 months following birth. Women completed questionnaires assessing self-esteem (RSEQ), body image (BIS/BIDQ) and eating behaviours (DEBQ) and self-reported weights and heights so that BMI could be calculated.

Results: Women with higher BMI had higher levels of self-esteem and were less satisfied with their body. Healthy-weight women were more likely to lose all of their retained pregnancy weight compared to overweight and obese women. Self-esteem, body image and eating behaviours remained stable from pregnancy until 24 months postpartum. No significant differences were found for any measure by context.

Conclusion: BMI was the strongest predictor of self-esteem and body dissatisfaction and a higher BMI predicted less weight loss postpartum.     

Placental ischemia and changes in umbilical and uteroplacental arterial and venous hemodynamics

Objective: To relate Doppler velocimetry findings in fetoplacental and uteroplacental circulation to placental histomorphology. Material and methods: In 14 uncomplicated and 31 high-risk pregnancies Doppler velocimetry was performed in umbilical artery and vein, and in maternal uterine veins and arteries during the second half of gestation. Histopathology of the placentas was examined, especially for signs of ischemia and inflammation. Results: All fetuses in uncomplicated pregnancies had normal flow velocity waveforms in umbilical artery; in the high-risk group, 18 fetuses had abnormal flow (increased PI or absent/reverse end-diastolic flow). The latter group had more often high ischemic score and infarctions in the placenta than found in pregnancies with normal umbilical artery flow (p?<?0.001 and p?=?0.02, respectively). Similarly, the abnormal uterine artery flow pattern (uterine artery score 3–4) occurred more often with high ischemic score and placenta infarctions (p?<?0.001 and p?<?0.001, respectively). No significant associations were found between the uterine venous flow type and placental ischemia. Conclusion: Placental ischemic morphological changes were associated with Doppler ultrasound signs of increased resistance to arterial blood flow, both on the fetal and maternal sides of the placenta. No significant relation to the uterine venous flow velocities was found.     

Analgesia and anesthesia during labor and birth: implications for mother and fetus

Labor and birth, although viewed as a normal physiological process, can produce significant pain, requiring appropriate pain management. Systemic analgesia and regional analgesia/anesthesia have become less common, whereas the use of newer neuraxial techniques, with minimal motor blockade, have become more popular. Low- and ultra-low-dose epidural analgesia, spinal analgesia, and combination spinal-epidural analgesia have replaced the once traditional epidural for labor. The shift from regional anesthesia during labor, in which the woman became a passive participant during the labor and birth, to a collaborative approach for pain management, in which the woman becomes an active participant, has resulted in a new philosophy of labor analgesia. This article provides a review of the current systemic analgesics and regional and neuraxial analgesia/anesthesia techniques for pain management in labor and birth. Also addressed are implications for perinatal nurses who participate in pain management choices during labor and birth.