宫颈癌泛素与细胞周期调控因子p27表达的关系

目的：研究宫颈癌组织中泛素（Ubiquitin）对细胞周期调控因子p27表达的影响及意义。方法：采用组织芯片技术制作60例宫颈癌和30例宫颈上皮内瘤变（Ⅰ～Ⅲ级）组织芯片，同时用S-P免疫组织化学和原位分子杂交方法检测组织芯片中Ubiquitin、p27、p27 mRNA的表达。结果：60例宫颈癌组织中Ubiquitin、p27、p27mRNA的阳性率分别为45．0％、38．3％、51．7％。淋巴结转移阳性宫颈癌中p27和p27mRNA阳性率明显低于淋巴结转移阴性宫颈癌（P〈0．01）。宫颈癌和CINⅢ级宫颈上皮内瘤变组织中p27和p27mRNA阳性率明显低于CINⅠ级和CINⅡ级（P〈0．05）。宫颈癌和CINⅢ级宫颈上皮内瘤变组织中Ubiquitin与p27表达密切相关，而与p27mRNA无关。结论：细胞周期调控因子p27低表达与宫颈癌密切相关，p27可作为评估宫颈癌预后的参考指标。Ubiquitin在p27蛋白质降解过程中发挥重要作用，与p27低表达有关。     

血管内皮生长因子C在宫颈癌组织表达及其意义

目的探讨血管内皮生长因子C（VEGF—C）在宫颈癌发生发展中的作用。方法选取宫颈鳞癌组织68例、宫颈上皮内瘤样变及原位癌（CIN）组织25例、正常宫颈组织12例,采用SP免疫组化染色方法检测VEGF—C的表达。结果宫颈癌组织VEGF-C表达阳性率明显高于正常宫颈组织及CIN组织,差异有显著性（x^2=4．10、4．53,P〈0．05）。有淋巴结转移宫颈癌组织的VEGF-C表达阳性率明显高于无淋巴结转移组织（x^2=6．11,P〈0．05）。VEGF-C表达与宫颈癌的病理分级有关,低分化宫颈癌组织中VEGF—C表达阳性率高于中高分化癌组织,差异有显著性（x^2=6．01,P〈0．05）。结论VEGF-C表达与宫颈癌的发生发展相关,对宫颈癌的分化及淋巴结转移可能起促进作用。     

p 16基因表达及高危 HPV 感染在宫颈癌中相关性的研究

目的：探讨 p16基因的表达和高危 HPV 感染（HR-HPV）在宫颈癌发生、发展中的意义。方法运用实时荧光定量PCR（FQ-PCR）检测 p16基因在宫颈癌组织、上皮肉瘤组织（CIN）、正常宫颈组织中的表达,原位杂交检测上述标本中 HR-HPV感染。结果p16基因在宫颈癌组织、CIN、正常宫颈组织中的表达水平分别为0．79±0．34、0．70±0．36、0．26±0．21,差异具有统计学意义（P ＜0．05）。p16基因的表达水平在不同临床分期之间的差异具有统计学意义（P ＜0．05）,但肿瘤分化程度、淋巴结转移、肿瘤大小等其他临床病理特征对其无显著影响（P ＞0．05）;HR-HPV 阳性患者的 p16基因的表达水平明显高于 HR-HPV阴性患者,差异有统计学意义（P ＜0．05）。结论p16基因在宫颈癌中呈高表达状态,并且与 HR-HPV 感染密切相关,基因的高表达可能在宫颈癌的发生和发展中发挥重要作用。     

宫颈上皮内瘤变组织人乳头瘤病毒感染与凋亡抑制基因表达的相关性研究

目的 探讨宫颈癌发生、发展过程中人乳头瘤病毒（HPV）感染与凋亡抑制基因Bcl-2表达的关系。方法 采用免疫组化法检测正常宫颈、慢性宫颈炎及宫颈上皮内瘤样病变Ⅰ级（CINⅠ）、CINⅡ、CINⅢ共116例组织中凋亡抑制基因Bcl-2的表达；聚合酶链反应法检测HPV16、18型的存在。结果 ①Bcl-2在正常宫颈、慢性宫颈炎、CINⅠ、CINⅡ、CINⅢ组织中的表达呈上升趋势，CINⅡ、CINⅢ组织中Bcl-2的阳性率显著高于正常宫颈、慢性宫颈炎、CINⅠ组织（均为P〈0.05）。②HPV阳性组中，CINⅡ、CINⅢ组织的Bcl-2的阳性率显著高于阴性率（P〈0．05）；CINⅡ、CINⅢ组织的Bcl-2的阳性表达率与HPV感染呈正相关。结论 HPV感染可能通过诱导Bcl-2的过度表达，抑制细胞凋亡，促进组织增殖从而在宫颈癌发生的早期起重要作用。     

HPV16／18、survivin与宫颈癌进展关系的相关性及临床意义

【目的】探讨HPV16／18和survivin在宫颈癌进展中的相关性及临床意义。【方法】选择高危宫颈癌患者108例做常规宫颈脱落细胞和分泌物PCR-HPV-DNA检查,并在阴道镜下行宫颈多点活检做病检和免疫组化,比较不同分级HPV感染阳性率和survivin蛋白表达阳性率,分析HPV-DNA基因表达与sur-vivin蛋白表达的相关性。【结果】宫颈上皮内瘤样病变Ⅰ级（CINⅠ）、CINⅡ、CINⅢ级和宫颈癌患者的宫颈HPV16／18感染阳性率分别为42．42％、61．90％、68．42％和82．86％,显著高于正常体检者的15．00％,其差异有统计学意义（P＜0．05）;CINⅠ、CINⅡ、CINⅢ级和宫颈癌患者的宫颈survivin蛋白表达阳性率分别为81．82％、90．48％、100％和100％,显著高于正常体检者阳性率的10．0。％,其差异均有统计学意义（P〈0．05）;CINⅠ、CINⅡ、CINⅢ级和宫颈癌患者的HPVl6／18-DNA基因表达与survivin蛋白表达存在正相关（P〈0．05）。【结论】HPVl6／18和survivin与宫颈癌进展关系密切,且均随CIN分级和宫颈癌级别的升高而表达增加,两者联合检测有利于提高宫颈癌的诊断率。     

人乳头状瘤病毒在宫颈癌及癌前病变诊断中的意义

目的检测人乳头状瘤病毒HPv在宫颈癌（CO）和各级宫颈上皮内瘤变（CIN）中的表达情况,探讨其作为宫颈癌前病变的特异性标志物的可能性。方法对我院2008年10月到2010年10月经病理确诊的19例宫颈癌、55例CIN（包括CINI级20例、CINⅡ级16例和CINHI级19例）和30例宫颈炎患者的宫颈脱落细胞,采用基因芯片技术对PCR扩增产物进行HPv检测,观察不同病情宫颈组织中HPV的感染情况及型别分布状况。结果HPV在宫颈炎、CINI级、CINⅡ级、CINIII级和宫颈癌患者组织中的检出率分别为43．3％、50％、68．8％、84．2％和94．7％。CINII／III级及宫颈癌组患者HPV检出率明显高于宫颈炎组和CINI组。检出型别主要是HPV16型,在宫颈炎症组、CINI级、CINII级、CINⅢ级和宫颈癌组宫颈刷脱细胞中HPV16型检出的阳性率分别为6．67％、15％、31．3％、42．1％、和68．42％。同时随着病情的加重,其阳性率也逐渐升高,其中在宫颈癌组中最高,与宫颈炎症组、CINI组及CINⅡ组比较,差异有显著性（P〈0．05）,与CINⅢ组比较,差别无显著性（P〉0．05）。结论HPV感染是宫颈癌前病变的主要致病因素,其中强Pv16型感染与其密切相关,随着病变程度的加重,HPV16栓出率升高。提示HPV16为宫颈癌的高危因素。     

Survivin、p27在宫颈癌组织中的表达及其与侵袭、转移的关系

目的：探讨生存素（Survivin）、027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S-P法和图像分析系统检测Survivin、p27在10例正常宫颈、10例宫颈原位癌、40例官颈鳞癌、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：从正常宫颈上皮一原住癌一浸润癌，Survivin阳性表达量显著升高，p27表达量显著降低（P〈0．05）。官颈癌Survivin表达量与盆腔淋巴结转移、局部侵袭、组织学类型、患者年龄有关（P〈0．05），而与FIGO分期、组织学分级无关（P〉0．05）；宫颈癌p27阳性表达量与盆腔淋巴结转移、局部侵袭、组织学分级有关（P〈0．05），而与FIGO分期、组织学类型、患者年龄无关（P〉0．05）。有盆腔淋巴结转移、脉管和（或）间质侵袭患者的Survivin阳性表达量增多，而p27的表达量与之相反（P〈0．05）。结论：Survivin、p27蛋白异常表达在宫颈癌中的恶化、侵袭、转移中起重要作用，检测Survivin、027蛋白表达水平，对判断宫颈癌的恶性程度、侵袭转移潜能，评估患者预后度制定优化治疗方案有一定参考价值。     

N-Myc下游调节基因1和p27在宫颈癌中的表达及临床意义

目的：探讨N-Myc下游调节基因1（N-Myc downstream regulated gene1,NDRG1）蛋白和p27蛋白在宫颈癌中的表达及其临床意义。方法：采用免疫组化SP法检测54例宫颈癌组织,32例宫颈上皮内瘤样病变（CIN）组织和28例正常宫颈组织中NDRG1蛋白和p27蛋白的表达,并分析它们与宫颈癌临床病理因素的关系。结果：宫颈癌组织中NDRG1的阳性表达率（77.8%）明显高于CIN组（46.9%）和正常宫颈组（28.9%）,P〈0.0125;表达水平与间质浸润、有无淋巴结转移有关（P〈0.05）;与临床分期、组织病理分级、组织类型无关（P〉0.05）。p27蛋白在宫颈癌组织中的阳性表达率（33.3%）明显低于CIN组（62.5%）和正常宫颈组（92.9%）,P〈0.0125;其表达水平与组织病理分级、间质浸润、淋巴结转移有关（P〈0.05）。结论：NDRG1蛋白过表达、p27蛋白低表达与宫颈癌的发生发展有关,联合检测NDRG1与p27蛋白对于早期诊断宫颈癌以及判断其侵袭转移潜能及预后有一定参考价值。     

Survivin和p16INK4a在宫颈癌及其癌前病变中的表达及相关性

【目的】探讨Survivin和p16INK4a在宫颈癌（CC）及其癌前病变中的表达及二者的相关性。【方法】采用免疫组化SP方法检测Survivin和p16INK4a在50例宫颈上皮内瘤变（CIN）50例CC和10例正常宫颈组织标本中的表达。【结果]Survivin在正常宫颈、宫颈CIN和UCC中的总阳性率分别为0％、50％和76％（X2=21.651,P〈0．05）,其中,宫颈CIN和CC标本的阳性率均高于正常宫颈标本（X2=8．571,X2=20．727,P〈0．0125）,CC组的Survivin阳性率亦高于宫颈CIN（X2=7．250,P〈0．0125）。p16INK4a“在正常宫颈、宫颈CIN和CC中的总阳性率分别为0％、62．0％和84．0％（X2=27．123,P〈0．05）,其中,宫颈CIN和CC标本的阳性率均高于正常宫颈标本（x2=12．828,x2=28．000,P〈0．0125）,CC组的p16INK4a“阳性率亦高于宫颈CIN,但差异无显著性（x2=6．139,P〉0．0125）。p16INK4a及Survivin在CINI、CINII中的表达均呈负相关,但CC中表达呈正相关（P〈0．01）。p16INK4a和Survivin表达的阳性率与CC病理学分级、临床分期及淋巴结转移相关（P〈0．05）。【结论]Survivin和p16INK4a阳性表达与CC及其癌前病变密切相关,联合检测宫颈病变中Survivin和p16INK4a的表达有助于CC的早期检出和预后预测。     

高危型HPV负荷量和端粒酶活性表达与宫颈病变意义

目的了解宫颈癌及癌前病变中高危型人乳头瘤病毒（HPV）负荷量和端粒酶活性表达的作用及临床意义。方法随机选取宫颈病变病人130例,其中宫颈上皮内瘤变（CIN）80例,宫颈癌20例,慢性宫颈炎30例（对照组）。采用第二代杂交捕获技术（HCⅡ）检测病人宫颈脱落细胞HPvDNA含量,阴道镜下定位活检,并用免疫组织化学EnVision二步法检测宫颈组织标本中端粒酶活性的表达。结果随着宫颈病变程度的加重,高危型HPV的表达阳性率和病毒负荷量均增高,宫颈癌组和CINⅢ组高危型HPV表达阳性率明显高于对照组、CINⅠ及CINⅡ组（x^2=7．414～29．501,P〈0.01）;CINⅡ、CINⅢ及宫颈癌组高危型HPV的病毒负荷量均高于CINI组,差异均有显著性（x^2=2045．871,P％0．05）。宫颈癌组端粒酶活性表达阳性率高于CINⅢ组,CINⅢ组高于CINⅡ组,CINⅡ组高于cINⅠ组,差异均有显著性（x^2=4．022～4．329,P〈0．05）。对照组、CINⅠ、CINⅡ、CINⅢ及宫颈癌组的高危型HPV感染病人中端粒酶活性表达的阳性率分别为0（0／5）、25．00％（2／8）、37．50％（6／16）、72．22％（13／18）、100．00％（19／19）。结论高危型HPV负荷量和端粒酶活性均与宫颈癌前病变及宫颈癌的发生发展密切相关,两者联合检测有望成为宫颈癌早期筛查、处理及预后判断的辅助指标。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.