端粒酶PCR SCE检测对诊断膀胱癌的价值及应用

目的 探明膀胱癌患者端粒酶阳性率及姊妹染色单体互换（SCE）率，以确定其诊断及应用价值。方法 采用膀胱癌及对照正常膀胱的组织进行端粒酶活性检测（TRAP-银染法）、外周血淋巴细胞SCE检测，然后进行比较分析。结果 （1）组织标本的端粒酶阳性率：膀胱癌93．75％（30／32），正常膀胱组织0％（0／30），表明膀胱癌端粒酶高度表达，其与正常对照组比较差异有显著性（P〈0．001）。（2）外周血淋巴细胞SCE率（X）：膀胱癌32例（10．06），膀胱癌的SCE率均显著高于正常对照组（P〈0．001）；（3）膀胱癌患者的端粒酶活性与SCE率的关系：阳性组32例SCE率10．06；膀胱癌患者端粒酶阴性组30例SCE率9．17（P〈0．05）。结论 端粒酶PER及SCE检测对于膀胱癌诊断及鉴别良恶性均具有重要的价值，可作为辅助诊断及攀别诊断指标．SCE率可作为膀胱肿瘤的疗效评价指标。     

胃癌及其癌前病变中端粒酶的表达

目的探讨胃癌及其癌前病变中端粒酶的表达。方法对纤维内窥镜下活检的胃组织采用对TRAP方法加以改进的银染TRAP法,检测了端粒酶活性。结果29例胃癌中阳性率（23／29）82．7％：胃溃疡8例及胃息肉1例皆未检测到端粒酶活性,慢性萎缩性胃炎伴肠上度化生（AGIM）8例中4例有端粒酶表达。胃癌及AGIM端粒酶阳性率与良性病变阳性率比较差异显著（P＜0．05）。结论银染TRAP法具有检测标本用量少,周期短,灵敏度高,特异性强等优点。对胃活检组织进行端粒酶检测在胃癌诊断中具有重要意义。对端粒酶检测阳性者应加强随访。     

脑星形细胞肿瘤组织中内皮素—1的表达和定量分析及与预后关系的研究

目的：研究内皮素－1（ET－1）在脑星形细胞肿瘤组织中的表达及定量分析与预后的关系。方法：采用免疫组织化学S－P法及细胞图像光度术（ICM）测定70例星形细胞瘤组织中ET－1表达的阳性率和含量。结果：ET－1普遍存在于星形细胞瘤，其阳性表达主要在胞浆内。Ⅳ级和Ⅲ级星形细胞瘤ET－1阳性率与阳性细胞中的ET－1含量都明显高于Ⅱ级和I级星形细胞瘤及正常星形细胞（P＜0．05，P＜0．01）。表明肿瘤分化程度越低，ET－1的阳性率和含量越高，瘤分化程度越高，则ET－1的阳性率和含量越低。ET－1含量与肿瘤的预后呈负相关（r=-0.787,P＜0．01），与分级呈正相关，（r＝0．863，P＜0．01）。结论：ET－1可作判断星形细胞瘤预后的一个检测指标。     

端粒酶活性与肿瘤相关性研究

本研究采用TRAP－银染色法和（或）PR－ELISA技术进行端粒酶活性研究。1997－1999年对肝癌、胃癌、急性淋巴细胞白血病、子宫颈癌、鼻窦部浆细胞肉瘤、恶性甲状腺瘤、精原细胞癌、阴茎癌等22种肿瘤共115份肿瘤组织标本检测，端粒酶阳性率为80％（92／115），同时检测这些肿瘤的临近正常组织共96份，端粒酶阳性率为5．2％（5／96）；34份子宫平滑肌瘤和8份非肿瘤病变组织端粒酶阳性率为7．1％（3／42），它们的临近正常组织阳性率为2．4％（1／42）；肿瘤细胞克隆株3例均为阳性。结果表明，恶性肿瘤组织细胞中端粒酶活性明显高于良性肿瘤和正常细胞（P＜0．01）；1999－2000年对胃癌组织进行研究，得出同样结果，因此端粒酶活性的检测有望成为一种新的肿瘤标志物用于临床诊断研究。端粒酶活性的增高与恶性肿瘤高度相关，对试图通过调控端粒酶活性来达到对恶性肿瘤的治疗研究提供了一个新的靶点和可靠依据。     

脑胶质瘤端粒酶活性表达的研究

目的：探讨端粒酶在脑胶质瘤发生、发展中的作用，并研究端粒酶活性是否与其恶性程度相关。方法：应用端粒重复序列扩增技术(TRAP)对48例胶质瘤标本和8例正常脑组织的端粒酶活性进行检测。结果：8例正常脑组织端粒酶活性均为阴性表达，48例胶质瘤标本中23例为表达阳性(47．92％)，低度恶性组与高度恶性组胶质瘤之间端粒酶活性阳性率有明显差异(P=0．001)。结论：端粒酶活性与胶质瘤恶性程度明显相关，端粒酶在胶质瘤发生发展过程中可能具有重要作用。     

膀胱癌端粒酶活性表达及其意义探讨

目的探讨膀胱癌的端粒酶活性表达及其在膀胱癌中的诊断价值。方法采用端粒重复序列扩增程序──酶标法（定量）和银染法（定性）对２８例膀胱瘤、１１例癌旁膀胱、６例正常膀胱的组织标本进行端粒酶活性检测。结果膀胱癌组织的端粒酶活性阳性检出率为８９．３％（２５／２８）,癌旁膀胱组织为２７．３％（３／１１）,正常膀胱组织为０％（０／６）。膀胱癌组与癌旁组、正常组端粒酶阳性检出率经比较,有显著性差异（Ｐ＜０．０１）。端粒酶活性表达与膀胱癌病理分期、分级等无相关性（Ｐ＞０．０５）。结论端粒酶激活发生在肿瘤形成的早期阶段,有望成为检测早期初发或复发膀胱癌有用的肿瘤标志物,癌旁组织端粒酶的激活提示肿瘤微浸润可能。     

消化道恶性肿瘤端粒酶检测及其临床意义研究

目的：探讨端粒酶活性在消化道恶肿瘤中的表达意义。方法：采用改良ＴＲＡＰ－银染法,检测１００例消化道恶性肿瘤术前内镜活检标本及２０例正常消化道组织中端粒酶活性,并同时与病理检查结果对照分析。结果：１００例消化道恶性肿活检标本有８７例端粒酶阳性,阳性率８７％,其中食道癌端粒酶阳性率８６．１％（３１／３６）,胃癌为８５．４％（３５／４１）,大肠癌为９１．３％（２１／２３）;２０例正常消化道组织均为阴性。     

人脑星形细胞瘤中EphA2表达与肿瘤血管生成关系的研究

目的探讨酪氨酸蛋白激酶受体EphA2在人脑星形细胞瘤中的表达及其与肿瘤血管生成的关系。方法用免疫组化方法测定78例人脑星形细胞瘤和8例正常脑组织（NB）中EphA2蛋白表达情况。用免疫组化方法检测肿瘤微血管密度（MVD）。结果EphA2蛋白阳性染色主要定位于肿瘤细胞胞浆和细胞膜,呈棕黄色颗粒,肿瘤血管内皮细胞也呈阳性表达。在78例星形细胞瘤中,EphA2阳性表达率为93．6％,而正常脑组织中无EphA2表达,二者差异有统计学意义（P〈0．01）。而且随着肿瘤恶性程度增加,EphA2蛋白染色强度和阳性细胞数均明显升高,高级别星形细胞瘤（Ⅲ～Ⅳ）与低级别星形细胞瘤（Ⅰ～Ⅱ）相比差异有统计学意义（P〈0．05）。随着EphA2阳性表达强度增加,肿瘤组织的MVD也逐渐增加,从0～3级分别为（19．65±8．12）个／mm^3、（27．50±11．36）个／mm^3、（40．28±12．51）个／mm^3和（61．44±13．80）个／mm^3,组间差异有统计学意义（F=6．308,P=0．001）。EphA2表达与MVD显著相关（r=7．094,P〈0.01）。结论EphA2可作为判定人脑星形细胞瘤恶性程度的重要指标,与肿瘤微血管生成相关,有可能成为星形细胞瘤治疗的一个新靶点。     

端粒酶活性与P53基因突变在乳腺癌诊断上的意义

目的探讨端粒酶活性在乳腺癌诊断中的临床意义并分析端粒酶表达与P53基因突变的关系.方法采用TRAP-Hyb以及PCR/SSCP法检测乳腺肿块中端粒酶的活性和P53基因突变.结果乳腺癌标本端粒酶的阳性率88.1%,乳腺良性病变标本端粒酶的阳性率5.7%,两者差异显著(P＜0.005).端粒酶表达和肿瘤大小、淋巴结转移无相关性.P53基因突变率在乳腺癌标本中为85.7%,在乳腺良性病变标本中为2.9%,两者差异显著(P＜0.005).结论端粒酶活性在乳腺组织中可作为一种新的肿瘤标记物,在乳腺癌诊断中具有一定应用价值.其与P53基因突变有关,推测P53基因突变可能是导致端粒酶被激活的原因之一.     

星形细胞瘤中Ki-67,VEGF,bcl-2,cyclin-D1及p16的免疫组化检测

目的 观察正常大脑组织和星形细胞瘤组织（I－Ⅳ）中Ki-67、VEGF、bcl-2,cyclin-D1与p16的表达，探讨其辅助诊断的意义。方法 应用免疫组化检测13例正常脑组织和58例星形细胞瘤组织中Ki-67,VEGF,bcl-2,cyclin-D1和p16的表达。结果经χ^2检验和单因素方差分析。结果 Ki-67和VEGF在正常大脑组织中均不表达，而在所有级别的星形细胞瘤中均表达，差异极显著（P＜0．01。随着星形细胞瘤恶性程度的增高，Ki-67的表达增强，VEGF表达阳性的病例增加；肿瘤组织中微血管的形态亦出现相应的变化，每两组间的差异极显著（P＜0．01）。bcl-2在4个实验组中均表达，各组间表达差异显著（P＜0．01），且随着肿瘤恶性程度的增高表达增强。cyclin-D1的表达阳性率各组间差异不显著（P＞0．05）。正常脑组织中p16有一定的表达，阳性率69．2％；在转化为肿瘤细胞后p16的阳性率反而升高。肿瘤组织中，总的趋势是随着肿瘤恶性程度的增高p16的表达降低。结论 临床病理诊断过程中，Ki-67,bcl-2的免疫组化检测可对星形细胞瘤的分级诊断提供非常有意义的依据。而VEGF的作用需结合微血管形态的变化一起考虑。cyclin-D1和p16的免疫组化检测不够敏感，故辅助诊断意义不大。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.