胶质瘤患者血清CXCL12、CXCR4的表达及其临床意义

目的探讨胶质瘤患者血清中趋化因子配体12(CXCL12)和趋化生长因子受体4(CXCR4)水平及与脑胶质瘤临床病理特征的关系。方法选取深圳市龙岗区第五人民医院神经外科收治的脑胶质瘤患者75例;纳入同期在深圳市龙岗区第五人民医院健康体检者50例作为健康对照组。比较胶质瘤患者和健康对照组血清CXCL12和CXCR4水平;分析血清CXCL12和CXCR4的表达与脑胶质瘤临床病理特征的关系;比较随访期间死亡患者与存活患者间血清CXCL12和CXCR4水平。结果与健康对照组比较,胶质瘤患者血清CXCL12、CXCR4水平均明显高于健康对照组,差异有统计学意义(P0.05);胶质瘤患者血清CXCL12、CXCR4的表达与年龄、性别、瘤灶直径、肿瘤部位无明显相关性(P0.05),与病理分级和卡氏(KPS)评分呈显著相关(P0.05);所有患者1年随访结果显示,33例死亡,42例存活;死亡组患者入院时血清CXCL12和CXCR4水平均明显高于存活组,差异有统计学意义(P0.05)。结论胶质瘤患者血清CXCL12和CXCR4水平明显增高,与胶质瘤的恶性程度关系密切,可能是评价患者预后的有效指标。     

血清CXCL12及其受体CXCR4、CXCR7水平对宫颈癌复发的预测价值

目的 探讨血清趋化因子C-X-C基元配体12(CXCL12)及其受体CXCR4、CXCR7水平在宫颈癌复发中的预测价值。方法 选择2016年1月至2017年12月在该院行手术治疗的113例宫颈癌患者为宫颈癌组,另选择同期75例诊断为宫颈上皮内瘤病变(CIN)患者和45例体检健康女性分别作为CIN组和对照组。采用酶联免疫吸附试验检测各组血清CXCL12、CXCR4、CXCR7水平。结果 宫颈癌组血清CXCL12、CXCR4、CXCR7水平高于CIN组和对照组(P<0.05),CIN组血清CXCL12、CXCR4、CXCR7水平高于对照组(P<0.05)。手术后宫颈癌患者血清CXCL12、CXCR4、CXCR7水平较手术前降低(P<0.05)。血清CXCL12、CXCR4、CXCR7水平在不同临床分期、浸润深度和有无淋巴转移、血管浸润的宫颈癌患者中差异有统计学意义(P<0.05),在不同年龄、病理类型、肿瘤最大径、组织分化程度和是否绝经的宫颈癌患者中差异无统计学意义(P>0.05)。宫颈癌复发组血清CXCL12、CXCR4、CXCR7水平高于未复发组(P<...     

乳腺癌CXCL12及其受体CXCR4的表达及意义

目的分析趋化因子12(CXCL12)及其特异性受体4(CXCR 4)在乳腺癌组织中的表达,探讨其与淋巴结转移的关系。方法用组织芯片及免疫组化技术检测CXCL12、CXCR 4在84例乳腺癌组织及正常组织中的表达。结果 CXCL12、CXCR 4在乳腺癌组织的表达水平(71.4%,65.5%)较正常乳腺组织高(22.6%,20.2%)(P<0.05);淋巴结转移组CXCL12、CXCR 4表达水平84.8%(39/46)、78.3%(36/46)高于无淋巴结转移组55.3%(21/38)、50.0%(19/38)(P<0.05);CXCR 4与CXCL12阳性表达呈正相关(r=0.649,P<0.05)。CXCL12、CXCR 4表达水平与乳腺癌淋巴结转移有关(P<0.05),与患者年龄、肿瘤大小、分化程度等无关(P>0.05)。结论CXCL12、CXCR 4高表达与乳腺癌淋巴结转移密切相关,选择性阻断CXCL12、CXCR 4的作用对控制乳腺癌淋巴结转移可能是一个有效的途径。     

趋化因子CXCL12及其受体CXCR4在原发性十二指肠腺癌组织中的表达及意义

目的观察趋化因子CXCL12及其特异性受体CXCR4在原发性十二指肠腺癌组织中的表达,探讨两者在该病的发生、浸润和转移中的作用。方法应用免疫组织化学方法检测78例原发性十二指肠腺癌组织、癌旁组织以及正常十二指肠黏膜组织中CXCL12和CXCR4的表达情况,分析两者表达与患者临床病理参数和术后生存率之间的关系。结果 CXCL12和CXCR4在肿瘤组织、癌旁组织以及正常十二指肠黏膜组织中均有表达,肿瘤组织中的阳性表达率明显高于癌旁组织,癌旁组织又明显高于正常十二指肠黏膜组织(P均<0.05)。两者在肿瘤组织中的表达水平与肿瘤细胞分化程度、区域淋巴结转移情况、远处转移情况和TNM分期均有关(P均<0.05)。CXCL12和CXCR4阳性表达的患者其3年和5年生存率均明显低于阴性表达者(P均<0.05)。单因素分析还提示肿瘤细胞分化程度低、肿瘤浸润肠壁较深、区域淋巴结转移、远处转移和TNM分期较晚也为原发性十二指肠腺癌患者术后预后不良的因素,Cox多因素分析则认为其中CXCL12或CXCR4阳性、肿瘤细胞分化程度低、区域淋巴结转移和TNM分期较晚为独立影响因素。结论原发性十二指肠腺癌组织中CXCL12和CXCR4的过表达与其生物学行为及预后密切相关,检测两者表达对预测该病的转移及预后判断有一定的价值。     

系统性红斑狼疮患者外周血滤泡辅助性T细胞与CXCR5及其配体CXCL13基因表达水平的研究

目的检测滤泡辅助性T细胞(Tfh)的CXCR5、CXCL13在系统性红斑狼疮(SLE)患者外周血中的表达,探讨其与SLE的发生及病情活动性的关系。方法 90例SLE患者和60例健康对照者,采用流式细胞术检测外周血单个核细胞(PBMC)中CXCR5+PD-1+/CD4+T细胞(Tfh)比例,酶联免疫吸附试验(ELISA)法检测血清中CXCR5、CXCL13浓度,实时荧光定量RT-PCR检测PBMC中CXCR5 mRNA、CXCL13 mRNA的表达。结果活动组SLE患者外周血Tfh比例(11.01%±1.31%)、血清中CXCR5、CXCL13浓度[分别为(368.21±171.56)pg/ml、(387.59±213.54)pg/ml]和CXCR5 mRNA、CXCL13 mRNA(分别为2.15±0.63、1.71±0.37)的表达均高于健康对照组[分别为1.78%±0.11%,(210.6±100.17)pg/ml,(149.45±104.52)pg/ml,0.53±0.22,0.46±0.13;均P<0.05];SLE患者外周血Tfh比例与CXCR5 mRNA的表达水平呈正相关(r=0.68,P<0.01),与SLEDAI亦呈正相关(r=0.67,P<0.01),其中CXCR5 mRNA的表达水平与SLEDAI呈高度正相关(r=0.82,P<0.01)。SLE患者外周血Tfh比例与CXCL13 mRNA的表达水平呈正相关(r=0.73,P<0.01),与SLEDAI亦呈正相关(r=0.87,P<0.01)。结论 SLE患者外周血中Tfh细胞比例、CXCR5、CXCL13明显升高,可能在其发病过程中起了一定的作用。     

HE4、CXCL12及其受体在卵巢癌中的表达及意义

目的探讨人附睾上皮分泌蛋白4(HE4)、CXC趋化因子配体12(CXCL12)及其受体[CXC趋化因子受体4(CXCR4)]在卵巢癌中的表达及意义。方法选取2016年3月至2018年3月在山东省胶州市妇幼保健院就诊的卵巢癌患者30例纳入卵巢癌组,另外选取在山东省胶州市妇幼保健院就诊的卵巢良性肿瘤患者30例纳入良性肿瘤组。取卵巢良性肿瘤患者手术切除组织标本(良性肿瘤组织)、卵巢癌患者手术切除癌组织标本(卵巢癌组织)以及距离癌组织5cm以上癌旁组织标本(癌旁组织),进行免疫组化标记以及革兰染色。采用酶联免疫吸附试验检测卵巢癌患者和卵巢良性肿瘤患者HE4、CXCL12及CXCR4水平,采用免疫组化染色观察各组织中HE4、CXCL12、CXCR4阳性表达情况。结果与良性肿瘤组相比,卵巢癌组患者的HE4、CXCL12及CXCR4水平升高(P0.05)。Ⅲ～Ⅳ期、低分化、有淋巴结转移的患者HE4、CXCL12及CXCR4的阳性率较高(P0.05)。HE4水平与CXCL12呈正相关,HE4水平与CXCR4呈正相关,CXCL12水平与CXCR4呈正相关。结论 HE4、CXCL12及CXCR4的异常表达参与了卵巢癌的发生、发展。该研究为HE4、CXCL12及CXCR4成为治疗卵巢癌的新靶点提供了理论依据。     

CXCR7/CXCL12在不同胃癌组织中的表达及与临床病理因素的相关性分析

目的分析趋化因子受体7(CXCR7)/趋化因子配体12(CXCL12)在不同胃癌组织中的表达及与临床病理因素的相关性。方法采用回顾性研究的方法,收集凉山州第一人民医院105例胃癌组织标本及其对应的正常胃黏膜组织标本。根据组织标本类型的不同,分为对照组(正常胃黏膜组织)、胃癌组、腹膜转移癌组、肝转移癌组、淋巴结转移癌组。采用免疫组织化学法检测各组标本中CXCR7与CXCL12蛋白的表达情况,进一步分析CXCR7和CXCL12蛋白表达与胃癌患者临床病理特征的相关性。结果 CXCR7蛋白表达在各组胃癌组织中的阳性率较对照组均明显升高(P 0. 05);而不同胃癌组织中CXCR7蛋白阳性表达率的比较,差异无统计学意义(P 0. 05)。CXCL12蛋白表达在各组胃癌组织中的阳性率较对照组均明显升高(P 0. 05);而不同胃癌组织中CXCL12蛋白阳性表达率的比较,差异无统计学意义(P 0. 05)。CXCR7与CXCL12蛋白表达与胃癌患者性别、年龄、肿瘤直径及肿瘤部位均无明显相关性(P 0. 05),而与肿瘤浸润深度、肿瘤组织形态、腹膜转移、肝脏转移、淋巴结转移、肿瘤侵袭淋巴管与血管均密切相关(P 0. 05)。结论 CXCR7与CXCL12在胃癌组织中的表达水平较正常胃黏膜组织明显升高,二者表达水平与胃癌发生、发展、增殖及迁移密切相关;随着胃癌进程的推进,CXCR7与CXCL12的表达水平可进一步增高,两者过高表达可能促使胃癌细胞的侵袭性及转移性更强,二者在胃癌发生、侵袭和转移的病理过程中可能具有协同作用,有望成为评估胃癌患者预后状况的潜在肿瘤标志物。     

CXCR4-CXCL12轴在肺癌中的表达及临床意义达与LVD的关系

目的:探讨CXCR4-CXCL12轴在肺癌中的表达及临床意义。方法:选择发生或不发生纵隔淋巴结转移的肺癌组织各20例,通过免疫组化法分别检测肺癌组织中CXCR4的蛋白表达、淋巴结组织中CXCL12的蛋白表达。结果:发生淋巴结转移的肺癌组织中CXCR4蛋白的表达水平要高于不发生淋巴结转移的肺癌组织,而有癌浸润的淋巴结组织中CXCL12表达水平与无癌浸润的淋巴结中CXCL12水平相似;CXCR4的表达与肺癌患者的性别、年龄、肿瘤组织学类型和分化程度等无关,而与肺癌患者有无纵隔淋巴结转移有关。结论:CXCR4在肺癌组织中的高表达与淋巴结转移有关。     

系统性红斑狼疮患者外周血CXCL13及其受体CXCR5表达水平的研究

目的检测系统性红斑狼疮(SLE)患者血清趋化因子CXCL13水平及其受体CXCR5在外周血B细胞、滤泡辅助T细胞(TFH)上的表达,分析CXCL13、TFH细胞水平与疾病活动的相关性,探讨CXCL13及CXCR5受体在SLE发病机制中的可能作用。方法酶联免疫吸附法(ELISA)检测58例SLE患者血浆CXCL13水平,以流式细胞术检测24例SLE患者外周血中CXCR5在CD19+B细胞、TFH细胞上的表达水平。结果 1血清CXCL13SLE患者组为365.96±216.02(pg/ml),高于健康对照组145.66±207.25(pg/ml)(P0.01)与SLE缓解组167.19±145.37(pg/ml);CXCL13水平与SLE患者的SLEDAI评分、抗核抗体滴度呈正相关(P0.05)。2SLE患者B细胞CXCR5的表达率为79.03±20.59%,显著低于健康对照组94.25±4.52%,P0.05。3:SLE活动组TFH细胞水平(%)15.36±7.01高于健康对照组8.92±5.11%,P0.05;TFH细胞水平与患者的SLEDAI评分呈正相关(P0.05),与C3、dsDNA无相关性(均P0.05)。结论 SLE患者外周血CXCL13及表达其受体CXCR5的TFH细胞水平增高,并与病情的活动性相关,提示CXCL13有可能积极参与至SLE的发病机制中,并更有可能为SLE的治疗提供新的靶点。     

SDF-1及其受体CXCR4在急性白血病与淋巴瘤表达的初步研究

为了探讨血液肿瘤患者外周血基质细胞源因子-1(SDF-1)及其骨髓细胞表面特异性受体CXCR4的表达 及其临床意义,对28例血液肿瘤患者及12例正常人的骨髓及外周血指标进行了检测,采取流式细胞术检测骨髓 细胞表面CXCR4的表达,用ELISA法检测血清中的SDF-1表达。结果显示:28例血液肿瘤患者外周血SDF-1和 骨髓细胞表面CXCR4的表达均高于正常对照组(P<0.01),且SDF-1和CXCR4两因子之间的表达有相关性(r= 0.831,P<0.01)。部分存在明显的髓外转移和多个淋巴结浸润的血液肿瘤患者CXCR4的表达较高。不同类型 的血液肿瘤之间CXCR4的表达可能存在差异(P<0.01)。结论:骨髓细胞与外周血清CXCR4和SDF-1的高表达 可能作为一种特异性的血液肿瘤标志,CXCR4的高表达可能与血液肿瘤的浸润程度相关。     

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.