表皮细胞生长因子及其受体在难愈性溃疡组织中的表达特征

目的 :探讨表皮细胞生长因子 (EGF)及其受体 (EGFR)在正常皮肤、溃疡边缘和溃疡组织中的分布、表达特征及其与溃疡形成的关系。方法 :采用常规病理技术和免疫组织化学方法鉴定这两种蛋白在 8例难治性皮肤溃疡患者 8份不同类型的皮肤溃疡组织及其对应溃疡边缘和周围正常皮肤组织中的定位及表达量的变化规律。结果 :在正常皮肤中 ,EGF主要存在于表皮细胞、真皮成纤维细胞、毛囊上皮细胞和内皮细胞的胞浆和胞外基质中 ;而 EGFR的阳性信号则分布于这些细胞的细胞膜和胞浆中。从正常皮肤经溃疡边缘到溃疡中心 ,EGF及其受体的蛋白表达呈降低趋势 ,在溃疡组织中 ,EGF和 EGFR呈弱阳性表达 ,两种蛋白的阳性表达率分别降低至正常皮肤的 (7.1± 5 .2 ) %和 (8.8± 5 .5 ) % ,呈非常显著性差异 (P均 <0 .0 1)。结论 :溃疡创面难愈性修复可能与 EGF及其受体蛋白表达下降 ,细胞因子与受体结合发生障碍 ,修复信号不能正常传递有关。     

实时定量RT—PCR检测临床肝组织标本中CXCL16及其受体的表达

[目的]建立实时定量RT—PCR方法并检测不同病理状态的肝脏组织中CXCL16趋化因子及其受体CXCR6的表达变化。[方法]建立外参照标准和灵敏的荧光实时定量RT—PCR方法，检测人正常肝组织、癌旁肝组织及癌组织标本中的趋化因子CXCL16及其受体的表达变化，进一步测定和比较其它相关的趋化因子表达谱的表达情况。[结果]获得了灵敏特异的实时定量RT—PCR方法，CXCL16及其受体在癌旁肝损伤组织中显著上调表达，显著高于趋化因子表达谱中其它趋化因子的表达变化，提示它在淋巴细胞尤其是T细胞介导的肝脏损伤过程中可能发挥重要作用。[结论]简便可靠的实时定量RT—PCR适用于检测病理组织中特异基因的表达变化，趋化因子表达谱改变尤其是CXCL16及其爱体CXCR6的显著变化可能与肝脏疾病的病理发生发展密切相关。     

低氧诱导因子-1α在银屑病中的研究进展

银屑病(psoriasis)是一种慢性复发性炎症性皮肤疾病,也是一种遗传和环境刺激等多种因素作用的多基因遗传病,而免疫介导在其发病机制中起重要作用.最初的炎症刺激可能是遗传、环境刺激等因素作用的结果.该疾病皮损中真皮乳头层微血管增生和表皮角质层过度增殖,可能与低氧诱导因子-1α(hypoxia-inducible factor-1α,HIF-1α)过度表达有关,HIF-1α通过调控靶基因如血管内皮生长因子(VEGF)、环氧合酶-2(COX-2)、诱导型一氧化氮合成酶(iNOS)、基质金属蛋白酶-2(MMP-2)、葡萄糖转运蛋白(GLUT-1)等多个途径引起真皮乳头层微血管增生和表皮角质层过度增殖,致使银屑病发生发展.     

白癜风患者皮损与正常皮肤疱液中抗氧化酶和脂质过氧化物水平比较

目的　收集白癜风患者皮损部位及自身正常皮肤部位的疱液进行抗氧化酶和脂质过氧化物水平测定 ,探讨氧化性损伤和白癜风发生的关系。方法　分别对 2 6例白癜风表皮移植的患者抽取皮损部位及正常皮肤部位的疱液进行超氧化物歧化酶 (SOD)、过氧化氢酶 (CAT)、谷胱甘肽过氧化物酶 (GSH -Px)、谷胱甘肽还原酶 (GR)、丙二醛 (MDA)测定 ,并对比分析上述 2部位各项指标的变化。结果　皮损主要分布于暴光部位的患者 ,其皮损部位的SOD及CAT活性显著低于正常皮肤部位 (P <0 .0 1、0 .0 5 ) ,MDA水平显著高于正常皮肤部位(P <0 .0 1 ) ,而皮损主要分布于非暴光部位的患者 ,皮损部位仅SOD活性显著低于正常皮肤部位 (P <0 .0 5 )。结论　自由基导致的氧化性损伤与白癜风的发病有关     

高频超声在烧伤创面深度诊断中的应用

目的　探讨应用高频超声检测烧伤部位真皮肿胀度和真度 皮下界面是否失去连续性与烧伤创面深度的关系。方法　以病理组织学检查作为烧伤创面深度的诊断标准 ,应用 13MHz高频超声检测 41例烧伤患者 62个烧伤部位的真皮肿胀度和真皮 皮下界面是否失去连续性。结果　烧伤后 6h内 ,2 7个部位浅Ⅱ度烧伤创面真皮肿胀度为 ( 3 2 .75± 13 .2 3 ) % ,2 0个部位深Ⅱ度烧伤创面真皮肿胀度为 ( 76.0 9± 15 .88) % ,Ⅱ度烧伤创面真皮 皮下界面完整 ,15个部位Ⅲ度创面真皮肿胀度为 ( 15 0 .46± 2 4.0 6) % ,且部分Ⅲ度创面 ( 13 /15 )真皮 皮下界面被破坏。经统计学处理 ,三组间真皮肿胀度差异有显著性 (P <0 .0 1)。结论　随着烧伤深度增加 ,真皮肿胀度亦增加 ,部分Ⅲ度创面真皮 皮下界面被破坏。高频超声作为一种无创、准确、客观的方法 ,可望在烧伤创面深度的诊断中得到广泛应用。     

中药对低密度脂蛋白受体基因表达的影响

目的 :探讨中药对低密度脂蛋白受体基因表达的影响。方法 :应用逆转录聚合酶链反应 (RT PCR)技术检测 30例高脂血症患者外周血淋巴细胞低密度脂蛋白受体 (L DL R)信使核糖核酸 (m RNA)水平在用药前后的变化。结果 :中药组 15例患者用药后的 L DL R m RNA水平 (0 .6 2 5 4± 0 .16 6 9)较用药前 (0 .2 46 5±0 .1316 )明显升高 (P<0 .0 1)。结论 :中药复方颗粒剂可增强高脂血症患者外周血淋巴细胞 L DL R基因表达水平 ,在分子水平上 ,为中药降脂作用的机制研究提供科学依据。     

内源性TGF-β_1、TNF-α在三氧化二砷诱导HL-60细胞凋亡中作用的研究

目的　探讨内源性TGF β1、TNF α在三氧化二砷 (As2 O3)诱导HL 6 0细胞凋亡过程中的作用。方法　建立As2 O3 诱导HL 6 0细胞凋亡模型 ,应用RT PCR、定量PCR、ELISA、缺口末端标记(TUNEL)法、片段化DNA分析等方法研究As2 O3 诱导HL 6 0细胞凋亡过程中内源性TGF β1、TNF α及其受体基因以及TGF β1蛋白表达的变化 ;进而研究TGF β1、TNF α反义磷酸硫代脱氧寡核苷酸 (PSODN)对细胞凋亡的干预作用。结果　①As2 O3 诱导HL 6 0细胞凋亡过程中伴有TGF β1、TNF α表达上调 (处理前后mRNA拷贝数分别为 135 46± 12 4,4972 16± 187和 2 32 73± 2 2 9,6 742 17± 189) ,bcl 2表达下调 (处理前、后分别为 10 42 4± 2 74和 336 1± 89) ,细胞培养 2 4h上清中TGF β1蛋白水平明显提高 ,上升为对照组的 2 .0倍。②TGF β1、TNF α反义PSODN能够明显抑制As2 O3 诱导细胞凋亡的发生 ,并使细胞bcl 2mRNA及蛋白表达恢复到处理前的水平。结论　内源性TGF β1、TNF α在As2 O3 诱导HL 6 0细胞凋亡中起重要作用 ,两者均可通过下调bcl 2表达促进细胞凋亡。     

血管紧张素转化酶基因插入/缺失多态性与冠心病危险因素的关系

目的探讨血管紧张素转化酶 ( ACE)基因插入 /缺失 ( I/D)多态性与冠心病 ( CAD)危险因素间的关系。方法对 5 3例健康男性患者用PCR方法行 ACE基因内含子 1 6插入 /缺失多态性的检测。结果 1 LDL水平在 DD基因型组最高 ( 2 .74± 0 .3 2 ) ,DI基因型组中等 ( 2 .5 7±0 .3 1 ) ,II基因型组最低 ( 2 .45± 0 .2 6 ) ;2 Apo B水平在 DD基因型组最高 ( 0 .77± 0 .2 1 ) ,DI基因型组中等 ( 0 .72± 0 .2 0 ) ,II基因型组最低( 0 .6 9± 0 .1 7) ;D等位基因组血压水平比 II基因型组高。结论 ACE基因 D/I多态性对 CAD的影响可能与危险因素有关     

低氧诱导因子-1α和环氧合酶-2在豚鼠银屑病样模型皮损中的表达及意义

目的 研究低氧诱导因子-1α(HIF-1α)和环氧合酶-2(COX-2)在豚鼠银屑病样动物模型皮损表皮中的表达,探讨其在银屑病发病机制的作用.方法 用5%普萘洛尔乳剂外涂豚鼠耳背部皮肤诱导银屑病样动物模型,应用免疫组化法检测正常豚鼠表皮和豚鼠银屑病样动物模型皮损表皮中HIF-1α和COX-2表达.结果 5%普萘洛尔外涂所致豚鼠银屑病样动物模型皮损中HIF-1α和COX-2表达水平较正常对照组明显增高,有显著性差异(P均<0.05).结论 HIF-1α和COX-2在豚鼠银屑病样动物模型皮损的表皮中表达明显增高,不仅在组织病理学而且在分子水平上与人类银屑病皮损基本一致.     

以cDNA为内参标RT-PCR定量检测心肌细胞内p53和Bcl-2基因mRNA表达量的方法研究

目的 :探讨 p5 3和 Bcl 2基因在急性心肌梗死时心肌细胞中 m RNA表达量的检测方法。方法 :用以c DNA为内参标的逆转录聚合酶链反应 (RT PCR)方法检测 p5 3和 Bcl 2基因的 m RNA表达量。结果 :p5 3基因 m RNA表达量〔m RNA/总 RNA(ng/ g)〕依次为 :冠脉结扎后 4小时组 (5 76 4 8.78± 19776 .96 ) ng/ g>结扎后 6小时组 (339.0 6± 10 4 .11) ng/ g>结扎后 3小时组 (16 5 .4 4± 33.36 ) ng/ g>结扎后 2小时组 (88.2 5±16 .6 5 ) ng/ g>未结扎 (0 )组 (3.16± 0 .6 9) ng/ g和结扎后 1小时组 (16 .37± 2 .73) ng/ g、8小时组 (2 3.13±7.0 3) ng/ g、 12小时组 (6 .75± 2 .86 ) ng/ g,P均 <0 .0 5 ;Bcl 2基因 m RNA表达量〔m RNA/ g总 RNA(ng/ g)〕:冠脉结扎后 3小时组 (4.5 3± 1.5 9) ng/ g、 4小时组 (0 .0 2± 0 .0 1) ng/ g和 6小时组 (3.4 6±0 .39) ng/ g<结扎后 2小时组 (5 2 .4 8± 14 .18) ng/ g、8小时组 (5 9.2 4± 2 .91) ng/ g<结扎后 1小时组 (77.2 0±12 .4 8) ng/ g和未结扎 (0小时 )组 (81.77± 9.6 2 ) ng/ g<结扎后 12小时组 (99.6 0± 4 .71) ng/ g,P均 <0 .0 5。该种方法能对不同的样本检出不同量的 m RNA含量 ,其特异性强 ,且能检出 0 .0 2 ng/ g的 m RNA含量 ,敏感性高。结论     

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.