肺癌化疗前后p53表达和细胞凋亡的变化

目的　探讨化疗对肺癌细胞凋亡、p5 3蛋白表达的影响。方法　收集实验组 14例肺癌病人化疗前后标本和对照组术前未作化疗肺癌标本 2 8例 ,采用免疫组化法检测p5 3蛋白表达 ,采用TUNEL法检测细胞凋亡 ,并作化疗前后的比较。结果　对照组和实验组在化疗前后p5 3阳性表达无显著差异 (P >0 0 5 ) ,而化疗后凋亡指数明显升高 (P <0 0 1)。结论　化疗可诱发肺癌细胞凋亡 ,但对p5 3蛋白表达没有影响     

乳腺不典型增生和乳腺癌中p53、ER表达的意义

目的　探讨p5 3基因产物和雌激素受体 (ER)在乳腺不典型增生和乳腺癌中表达及意义。方法　用ABC免疫组化法检测乳腺不典型增生和乳腺癌细胞p5 3基因产物和ER表达。结果　乳腺上皮不典型增生Ⅰ级者上皮细胞ER染色结果与正常乳腺上皮细胞相似 ,不典型增生Ⅱ级ER表达明显增强 ,2 2 2 4例阳性 ,不典型增生Ⅲ级 2 0 2 2例见ER染色阳性。在乳腺上皮不典型增生Ⅰ级无p5 3蛋白表达 ,不典型增生Ⅱ级、Ⅲ级中分别有 3 2 4和 7 2 2例p5 3蛋白表达。乳腺癌 5 9例 ,ER阳性率为 36 5 9( 6 1.0 2 % )。乳腺癌p5 3蛋白表达阳性 2 2 5 9( 37.2 9% )。结论　p5 3可促进正常细胞以不典型增生向癌的转化 ,ER对不典型增生癌变起重要的刺激、激活作用。p5 3- ER +代表正常组织、良性增生与高分化和好的预后 ,p5 3+ ER -多为不典型增生、低分化癌和差的预后。所以同时检测p5 3、ER对判断不典型增生向癌的转化及乳腺癌患者的预后有重要意义。     

Rb蛋白表达对术前5-氟尿嘧啶大肠癌灌注临床疗效的影响

目的　探讨Rb表达对术前 5 -氟尿嘧啶大肠癌灌注临床疗效的影响。方法　对手术切除的大肠癌 34例标本 ,用免疫组化和图像定量分析技术测定其Rb蛋白表达量 ;用末端标记法 (TUNEL)检测大肠癌的凋亡率 ;应用琼脂培养MTT法测定人大肠癌对抗癌药的药物敏感性 ;同时观察用 5 -Fu灌注大肠癌病人手术前化疗疗效。结果　⑴大肠癌细胞对 5 -Fu抗药指数 (IC5 0值与 1/ 10血浆峰浓度比值 )与凋亡率呈负相关 (γ =- 0 5 3,P <0 0 1) ,5 -Fu抗药指数以 1.0为界 ,把大肠癌病人分为耐药组 (>1 0 )和敏感组 (<1 0 ) ,两组间凋亡率有显著差异 (t =3 90 ,P <0 0 1)。⑵大肠癌细胞对 5 -Fu抗药指数与Rb蛋白表达量 (阳 /框面积比×总颗粒数 )呈负相关 (γ =- 0 84 ,P <0 0 1) ,耐药组与敏感组Rb蛋白表达量有非常显著差异 (t =6 91,P <0 0 1)。⑶Rb蛋白表达量与 5 -Fu对大肠癌术前化疗疗效积分呈正相关 (γ =0 5 3,P <0 0 1)。⑷大肠癌细胞对 5 -Fu的抗药指数与术前化疗疗效积分呈负相关 (γ =- 0 72 ,P <0 0 5 ) ,耐药组与敏感组 5 -Fu对大肠癌术前化疗疗效积分有非常显著性差异 (t =8 32 ,P <0 0 1)。⑸大肠癌细胞Rb蛋白表达量与凋亡率呈正相关 (γ =0 74 ,P <0 0 1)。结论　Rb可能通过介导     

P-gp和p53在肺癌组织中的表达及其临床预后意义

目的　探讨P -糖蛋白 (P -gp)、p5 3在肺癌组织中的表达及其临床意义。方法　应用免疫组化检测了 4 0例化疗组和 4 4例非化疗组的肺癌中P -gp、p5 3的表达水平 ,比较P -gp、p5 3的表达与生存率的关系。结果　肺癌组织中P -gp的阳性表达率为 4 0 .5 % ,p5 3的阳性表达率为 70 .2 % ;P -gp及p5 3在肺癌组织中的表达无相关性(P =0 .6 73,R =- 0 .0 4 7) ;二者表达与性别、年龄、分化程度、临床分期、病理类型无关 (P <0 .0 5 ) ;化疗组中P -gp、p5 3表达阳性者化疗后其生存时间明显短于阴性表达者 (P <0 .0 5 )。结论　P -gp和p5 3可作为临床判断化疗疗效的参考指标及预测肺癌患者预后的指标     

p53基因突变与中心型非小细胞肺癌支气管镜下肿瘤形态的关系

目的　了解p5 3基因突变与原发性中心型非小细胞肺癌支气管镜下肿瘤形态的关系。方法　对 86例中心型非小细胞肺癌手术切除标本用S -P法检测p5 3蛋白表达情况。结果　鳞癌 6 3例、腺癌 11例、腺鳞癌 12例 ,支气管镜下支气管腔内肿瘤周围黏膜无改变者 (Ⅰ型 ) 33例 (38.37% )、肿瘤周围黏膜出现充血、水肿、粗糙等改变者 (Ⅱ型 ) 5 3例 (6 1.6 3% )。支气管镜下Ⅰ型和Ⅱ型病人的p5 3蛋白阳性表达率分别为 2 4 .2 4 %和 6 7.92 % (χ2 =15 .5 3,P<0 .0 1)。结论　p5 3蛋白表达与中心型非小细胞肺癌支气管腔内肿瘤是否累及周围黏膜有关 ,即p5 3蛋白阳性表达者支气管腔内肿瘤多已累及周围黏膜 ,病变相对较晚。     

肺癌组织中GST-π和p53的表达及其相关性研究

目的　探讨酸性谷胱甘肽S -转移酶 (GST -π)和p5 3蛋白在肺癌中表达的临床病理意义和相关性。方法　应用LSAB免疫组化法对 60例肺癌组织GST -π和p5 3蛋白的表达进行研究。结果　肺癌中GST -π和p5 3蛋白的阳性率分别为5 6 67%和 3 1 67%。GST -π和p5 3蛋白表达与肿瘤分化程度明显相关 ,高中分化肺癌阳性率明显高于低分化及未分化者 (P <0 0 5 )。GST -π与p5 3蛋白表达呈明显正相关 (r =0 3 75 ,P <0 0 5 ) ,p5 3蛋白阳性者中GST -π阳性率高于p5 3蛋白阴性者。结论　GST -π和p5 3蛋白异常表达可能与肺癌的发生发展有关。检测GST -π表达对预测肺癌多药耐药、化疗疗效有一定的价值     

肝细胞癌组织中PTEN和p27蛋白的表达

目的　研究肝细胞癌 (hepatocellular carcinoma,HCC)组织中 PTEN和 p2 7蛋白的表达。　方法　利用免疫组织化学技术检测 65例 HCC中 PTEN和 p2 7蛋白的表达。　结果　在 HCC中 ,PTEN和 p2 7蛋白的阳性率分别为 60 %(3 9/ 65 )和 5 3 .85 % (3 5 / 65 ) ,PTEN蛋白阴性表达率 40 % (2 6/ 65 ) ;PTEN和 p2 7蛋白的阳性表达强度之间呈明显正相关(r=0 .7461) ;PTEN和 p2 7蛋白的阳性表达强度与 HCC的分化程度明显相关 ,分化愈差 ,表达愈强 (p<0 .0 1) ,但与患者年龄、性别及肿瘤大小无关。　结论　在 HCC的发生及进展过程中 ,PTEN蛋白表达的缺失和降低可能导致 p2 7蛋白表达减少 ,使其不能有效发挥细胞周期负调控因子的抑瘤作用 ,使得瘤细胞具有更高的恶性程度     

乳腺癌组织p16蛋白和VEGF的表达及其临床意义

目的　探讨乳腺癌组织中p16蛋白、VEGF的表达与乳腺癌临床病理指标及预后的关系。方法　采用SABC免疫组织化学技术 ,检测 5 3例乳腺癌标本中p16蛋白及VEGF的表达 ,结合临床病理和随访资料作统计分析。结果　 5 3例乳腺癌组织中p16蛋白的阳性表达率为 5 4 7%,其表达与患者的年龄、肿瘤大小、绝经状况、ER、PR的表达无关 (P >0 0 5 ) ,而与乳腺癌的组织学分级、TNM分期、淋巴结转移及 5年生存率相关 (P <0 0 5 ) ;VEGF的阳性表达率为 79 2 5 %,其表达与患者的年龄、肿瘤大小、绝经状况、ER、PR的表达、TNM分期及 5年生存率无显著相关性 (P >0 0 5 ) ,而与组织学分级及淋巴结转移密切相关 (P <0 0 5 )。结论　p16蛋白和VEGF的表达与乳腺癌的浸润、转移密切相关 ,可作为乳腺癌的生物学标记。p16可作为临床上判定乳腺癌预后的一个新指标。     

肺癌中耐药基因p170的表达及其临床意义

目的 :检测耐药基因p170在术前有、无化疗的肺癌中表达情况以探讨其临床意义。方法 :采用S -P免疫组化方法。检测 113例肺癌 (其中术前未化疗的肺癌 93例 ,术前曾化疗的肺癌 2 0例 )和 10例正常肺组织中 p170的表达水平。结果 :在 113例肺癌中p170阳性表达率为 46 % ,其中小细胞癌 (SCLC) (15 4% )明显低于非小细胞癌(NSCLC) (5 0 % )。术前曾化疗的肺癌 2 0例 ,p170阳性表达率为 75 %。术前未化疗的肺癌 93例阳性表达率39 8% ,两者有明显差异 (P <0 .0 5 )。在 10例正常呼吸道上皮中 p170阳性表达率 30 % (3/ 10 )。结论 :检测肺癌组织中 p170的表达有助评估多药耐药性 (MDR)化疗疗效对指导化疗方案有重要意义     

肝细胞癌化疗栓塞后p53蛋白表达及意义

目的　评价肝细胞癌p5 3蛋白表达在经导管动脉化疗栓塞 (transcatheterarterialchemoembolization ,TACE)中的作用。方法　经手术病理证实的肝细胞癌 13 6例 ,其中行 1～ 5次TACE后Ⅱ期手术切除 79例 (TACE组 ) ,按治疗方式不同分 4组 ,A组 ,仅灌注化疗药物 11例 ,治疗 1～ 4次 ;B组 ,化疗药加碘化油栓塞 3 3例 ,治疗 1～ 5次 ;C组 ,化疗药加碘化油加明胶海绵颗粒栓塞 2 3例 ,治疗 1～ 3次 ;D组 ,化疗药加碘化油、无水乙醇、明胶海绵颗粒栓塞 12例 ,治疗 1～ 3次。单纯手术 5 7例 (非TACE组 )。用TUNEL法检测AI ,用免疫组化检测各标本Bcl -2 ,Bax ,p5 3 ,Ki-67和PCNA蛋白表达。结果　梁索型、透明细胞型p5 3蛋白表达显著低于假腺样型、实体型、低分化或未分化型、硬化型 ( P <0 0 5 ) ;随着病理分级的增高 ,p5 3蛋白表达也逐渐增多 ( P <0 0 5 ) ;p5 3蛋白表达与PCNA和Ki-67蛋白表达显著正相关 (P <0 0 5 ) ,与AI ,Bcl-2 /Bax蛋白表达率显著负相关 (P <0 0 5 )。p5 3蛋白表达A组显著高于B、C、D组和单纯手术组 ;B组显著高于C和D组 ;D组显著低于单纯手术组 (P <0 0 5 )。结论　在肝细胞癌化疗栓塞中p5 3蛋白表达起增强癌细胞增殖、抑制细胞凋亡的作用     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Qualitative research with people with intellectual disability

Qualitative research methods are gaining popularity in disability research, in particular as a way to explore the personal experience of disability. However, using these methods can be problematic with people traditionally regarded as vulnerable in the research relationship. People with intellectual disability are often so regarded. This paper discusses ethical concerns and issues of research credibility in qualitative research with this group of disabled people. An ethnographic study about the parenting experience of parents with intellectual disability is used to illustrate strategies to achieve credibility in qualitative studies in intellectual disability research.