骨髓增生异常综合征PTEN基因表达和Akt磷酸化水平的相关性研究

目的 了解骨髓增生异常综合征（MDS）PTEN基因表达和Akt磷酸化（p-Akt）水平之间的关系，探讨MDS演进、高风险转归为急性髓系白血病的机制。方法 采用RT-PCR检测白血病细胞株K562、Jurkat，65例MDS患者骨髓细胞PTENmRNA表达情况。同时用流式细胞术检测Jurkat、HL-60细胞和30例MDS患者骨髓细胞p-Akt水平。并以21份正常人骨髓标本为健康对照。结果 ①PTEN基因阳性对照K562细胞呈阳性表达，阴性对照Jurkat细胞无表达。65例MDS患者中有27例表达阳性，阳性率41．5％，与健康对照组（85．7％）比较差异有统计学意义（P〈0．01）。RAEB（39．1％）、RAEB—t（27．8％）和MDS—AML（12．5％）PTEN阳性率均低于RA／RARS（75．O％）组，各亚型组之间比较差异有统计学意义（P〈0．01）。②阳性对照Jurkat细胞高表达p-Akt（86．9％），阴性对照HL-60细胞p-Akt阴性。30例MDS患者p-Akt水平升高（1．35％～58．23％），与健康组（0．54％～2．34％）比较差异有统计学意义（P〈0．01），且随着原始细胞比例增高p-Akt水平升高。MDS患者PTEN基因表达缺失率与p-Akt阳性率呈显著正相关（r=0．93，P〈0．01）。结论 MDS患者PTEN基因表达缺失是导致p-Akt高表达的关键因素之一，并且可能加速MDS病程进展及转化为急性髓系白血病。     

肿瘤相关基因fgfr3mRNA在白血病细胞中的表达及其临床意义

本研究旨在了解白血病细胞中fgfr3基因的表达水平及其和临床的关系。应用RT—PCR法检测4个白血病细胞系及96例白血病患者和14例对照者骨髓样本中fgfr3mRNA的表达，并分析了其与临床指标及染色体异常的相关性。96例白血病患者包括36例AML，29例ALL和31例CML。结果表明：fgfr3基因在K562和U937细胞中有表达，而在HL-60和SHI-1细胞中无表达。AL组和CML组fgfr3基因的阳性率（分别为46．15％和51．61％）与对照组相比，差异有统计学意义（P〈0．05）。AML组和ALL组fgfr3基因的阳性率（分别为44．44％和48．28％）均高于对照水平，差异有统计学意义（p〈0．05）。fgfr3基因的阳性表达与外周血高白细胞计数（≥20×10^9／L）呈显著性正相关（P〈0．05）。ALL患者中fgfr3基因的表达与bcr／abl融合基因的异常呈显著正相关（r=0．151，P〈0．05）。而AL患者fgfr3基因的阳性表达与染色体预后分组无显著相关性。结论：AL和CML患者均存在fgfr3基因的过表达，提示fgfr3基因可能参与了AL和CML的发病。     

CD66c在成人急性白血病细胞上的表达及意义

目的探讨CD66c及其基因CEACAM6在成人急性白血病细胞上的表达及意义.方法体外培养HL-60、K562、LCL721.221和Jurkat等急性白血病细胞,RT-PCR检测急性白血病患者骨髓细胞和白血病细胞中CEACAM6 mRNA的表达,并用多参数流式细胞术检测白血病细胞及白血病患者骨髓细胞CD66c分子的表达.同时对199例白血病患者骨髓细胞作细胞遗传学分析,并对25例CD66c阳性急性B淋巴细胞白血病（B-ALL）患者进行白血病微量残留病（MRD）分析.结果①HL-60、K562、LCL721.221和Jurkat细胞的细胞膜和细胞质CD66c均阴性.②127例急性髓系白血病（AML）患者中4例CD66c阳性（3.15%）,以M2、M4为主;79例ALL中CD66c阳性28例（35.44%）,均为B-ALL;CD66c只在common B-ALL（54例中有20例）和pre B-ALL（11例中有8例）亚型表达,8例Ph＋B-ALL患者CD66c均阳性.③MRD阳性与阴性组患者比较,6个月内复发率差异有统计学意义（维持治疗14周时MRD阳性者8例,其中6例复发;MRD阴性者17例,其中2例复发）.④CEACAM6 mRNA在CD66c阳性B-ALL细胞强表达,在HL-60细胞呈弱表达,在K562、LCL721.221和Jurkat细胞不表达.结论CD66c在ALL中阳性表达是白血病MRD检测的标志之一.CD66c抗原表达与CEACAM6 mRNA的表达高度相关.     

肿瘤相关基因chp2在白血病细胞中表达的研究

为了探讨人类肿瘤相关基因chp2在白血病原代细胞和白血病细胞系中表达的特点，选择24例白血病患者、4种白血病细胞系及10名正常人外周血单个核细胞（PBMNC），用实时定量PCR（RQ—PCR）方法检测chp2基因的表达水平。结果显示，10例正常对照细胞chp2mRNA的表达检出率为80％，阳性的表达量为（0．744±0．682）×10^5cps／μl。白血病原代细胞和白血病细胞系chp2mRNA的表达量较正常对照组明显增高（p〈0．05），原代细胞中的7例急性髓细胞白血病（AML）、6例慢性髓细胞白血病（CML）、7例急性淋巴细胞白血病（ALL）和4例慢性淋巴细胞白血病（CLL）的表达量分别是（11．637±5.588）、（6．122±3．785）、（4．262±2．561）和（3．434±1．974）×10^5cps／μl；白血病细胞系中K562细胞、Jurkat细胞、HL-60细胞和M07e细胞的表达量为（5．243±1.852）、（4．463±1．621）、（4．137±1．837）和（2．578±1．137）×10^6cps/μl，白血病细胞系的表达量高于原代细胞。结论：人类肿瘤相关基因chp2在白血病原代细胞和白血病细胞系中表达水平明显增高，提示其在白血病细胞生长过程中发挥着重要的作用。     

pig7基因在急性白血病细胞中的表达及其临床意义

目的检测pig7基因在急性白血病（AL）细胞中的表达水平及其临床意义，在基因甲基化调控方面探讨pig7基因表达异常的可能机制。方法应用实时定量逆转录PCR（RT—PCR）方法对138例AL患者、21名正常人骨髓标本以及6个白血病细胞株进行了pig7转录本的检测，并在全反式维甲酸（ATRA）作用下观察NB4细胞分化效应及pig7基因表达情况。进行限制性内切酶分析以鉴定白血病细胞中存在的pig7转录剪接体。通过甲基化特异性PCR（MSP）检测白血病细胞pIg7基因启动子区域是否存在过度甲基化。结果AL进展期（包括初治、复发／难治）患者骨髓细胞pig7 mRNA相对表达水平与正常骨髓细胞相比明显降低（RQ中位数分别为0．62和18．30，P〈0．01），其中急性髓系白血病（AML）与急性淋巴细胞白血病（ALL）差异无统计学意义，而初治组与复发／难治组比较pig7 mRNA水平差异有统计学意义，前者明显高于后者（RQ中位数分别为1．43和0．16，P〈0．05）。pig7低表达患者完全缓解率也较低（P〈0．05）。NB4细胞经ATRA诱导分化后pig7表达水平由1．61±0．72增至44．75±3．93（P〈0．01）。酶切结果提示白血病细胞中仅存在SIMPLE剪接体。在K562、HL-60及Nalm-6细胞pig7启动子区域存在过度甲基化，而U937、NB4和kasumi-1细胞中该区域非甲基化状态占优势。结论pig7基因在AL的表达下调为白血病发病机制的探讨和疗效预测提供了新的思路。     

RYBP在急性白血病中的表达

目的:观察RYBP(Ring1 and YY1-binding protein)在急性白血病中的表达情况,初步探索其在急性白血病中的临床意义。方法:应用蛋白质免疫印迹(western blot)技术分别检测急性单核细胞白血病细胞株SHI-1、急性早幼粒白血病细胞株HL-60、慢性粒细胞白血病细胞株K562、51例初治急性白血病(AL)患者、23例急性白血病完全缓解(ALCR)患者和21例对照(非恶性血液病)患者骨髓单个核细胞中RYBP的表达情况。结果:SHI-1、HL-60及K562细胞株RYBP表达均为强阳性;21例阴性对照中RYBP表达均为阴性。AL组RYBP表达阳性率为73%,ALCR组阳性率为13%,AL组RYBP表达阳性率及表达量比ALCR组及对照组明显增高(P<0.05)。结论:RYBP在急性白血病细胞中表达水平异常增高,提示RYBP可能与急性白血病密切相关。     

CXC亚家族趋化因子受体-4在急性白血病中的表达及临床意义

目的探讨急性白血病（AL）细胞上CXC亚家族趋化因子受体-4（CXCR4）的表达及临床意义。方法采用四色流式细胞仪检测33例AL患者和7例正常对照者骨髓单个核细胞（BMMNC）表面CX—CR4的表达情况，并分析其与临床表现及疗效的关系。结果AL患者CXCR4的表达水平明显高于正常对照组（P〈0．01）；急性淋巴细胞白血病（ALL）的表达又高于急性髓细胞白血病（AML）（P〈0．01）。髓外浸润组CXCR4表达高于无髓外浸润组（P〈0．05）。CXCR4的高表达组髓外浸润发生率高于CXCR4低表达组（P〈0．05）。CXCR4的高表达且外周血白细胞（WBC）增高组髓外浸润的发生率最高，CXCR4低表达且WBC不增高髓外浸润组的发生率最低（P〈0．05）。化疗敏感组CXCR4的表达低于耐药组（P〈0．05）。结论AL患者的BMMNC存在着CXCR4的高表达，不同类型的AL患者CXCR4的表达存在差异，ALL表达高于AML。AL患者CXCR4高表达且WBC增高预示髓外浸润的可能性大。AL患者CXCR4的高表达预示白血病细胞对化疗不敏感，是判断预后的指标之一。     

Survivin在白血病细胞中的表达及GM-CSF对其影响的研究

本研究旨在探讨凋亡存活蛋白survivin在白血病的原代细胞和白血病细胞系中的表达情况，并观察粒-巨噬细胞细胞集落刺激因子（GM-CSF）对其的影响。用RT-PCR方法检测37例白血病患者、10例正常成人骨髓和3种白血病细胞系（K562、HL-60、U937）中survivin的表达。以HL-60细胞为对象，加入合适浓度的GM-CSF，用RT-PCR和Western blot分别检测加药前后surivin mRNA和蛋白水平的变化。结果显示：37例白血病患者中有25例表达survivin，阳性率为67．6％，其中急性淋巴细胞白血病（ALL）细胞中survivin mRNA表达阳性率为73．3％，高于急性髓系白血病（AML），但均高于正常对照组（20．0％）（P〈0．05）。3种细胞系K562、HL-60和U937全部表达survivin。合适浓度的GM-CSF作用2天后，HL-60细胞中survivin的表达明显升高，其中mRNA水平升高了26％，蛋白水平升高了49％。结论：suvivin在白血病的原代细胞和细胞系中均有较高表达，而GM-CSF能显著提高HL-60细胞中survivin的水平。     

人端粒重复序列结合因子(hTRF1)蛋白质在急性白血病中的表达水平与端粒酶活性关系的研究

为了研究人端粒重复序列结合因子（TRF1）蛋白质在急性白血病（AL）及正常骨髓组织中的表达水平，AL和正常骨髓组织中端粒酶活性及TRF1蛋白质表达水平与端粒酶活性的关系，定量分析了AL患者及正常人骨髓组织中TRF1蛋白质的表达水平，并应用经倍比稀释的TRF1^33-277纯化蛋白质作为定量标准，建立以抗TRF1^33-277单克隆抗体的定量Western blot的方法，而且以该方法检测TRF1蛋白质在组织中的表达水平；另外，应用TRAP-PCR-ELISA法检测AL患者及正常人骨髓组织端粒酶活性，以研究TRF1蛋白质表达水平与端粒酶活性的关系。结果表明：20例AL患者骨髓组织中TRF1表达水平较正常人骨髓组织显著降低，差异具有显著性（P〈0．01）；急性淋巴细胞性白血病患者的TRF1表达水平较急性非淋巴细胞性白血病患者略减低，但差异无统计学意义（P〉0．05）；化疗缓解的患者TRF1表达水平较前增高，但仍低于正常（P〈0．01）；化疗后完全缓解患者的TRF1表达水平较未缓解的患者显著增高，差异具有显著性（P〈0．01）；AL患者初发未治时骨髓细胞端粒酶的活性明显高于正常人（P〈0．05）和首次缓解者（P〈0．01）；初发未治时，ALL患者骨髓细胞端粒酶活性略高于ANLL患者，但差异无统计学意义（P〉0．05）。TRF1蛋白质表达水平与端粒酶活性呈明显负相关（P〈0．001）。结论：TRF1蛋白质在AL患者骨髓细胞中的表达明显减低．且与疗效及端粒酶活性相关。     

致敏的脐血源树突状细胞诱导CTL特异杀伤白血病细胞的实验研究

探讨脐血单个核细胞（MNC）诱导的树突状细胞（DC）通过负载冻融的HL-60、K562细胞抗原体外诱导产生细胞毒性T淋巴细胞（CTL）对HL-60、K562的杀伤作用。取脐血12份,分离MNC。在MNC中加入细胞因子GM-CSF（granulocyte monocyte colony-stimulating factor）、IL-3（interleukin 3）、SCF（stemcell factor）和EPO培养4周。使用CD83、CD1a、CD11C和CDw123单克隆抗体、流式细胞仪测定培养前后脐血DC抗原变化及扩增情况。DC通过负载HL-60、K-562白血病细胞抗原致敏T淋巴细胞产生CTL^3H-TdR掺入试验测定DC免疫刺激活性,MTT法观察CTL对HL-60、K562细胞的特异性杀伤活性。结果表明：新鲜脐血CD1a^＋、CD11c^＋、CD83^＋、CDw123^＋细胞数分别为0．27×10^5／ml、5．87×10^5／ml、1．94×10^5／ml、2．73×10^5／ml。加入上述细胞因子培养的脐血MNC分化为CD1a^＋、CD11C^＋、CD83^＋、CDw123^＋DC,经培养2—4周,DC数明显增多,分别达11．02×10^5／ml、28．24×10^5／ml、10．57×10^5／ml、18．7×10^5／ml,此后逐渐减少。细胞因子诱导脐血DC具有免疫刺激活性,且DC与CBMNC细胞比例为1：40时的刺激活性最佳。冻融法得到的HL-60、K562白血病细胞抗原致敏DC诱导的CTL对HL-60、K562细胞的杀伤率分别为（42．04±8．46）％和（31．25±11．07）％,与实验组比较有显著性差异（P〈0．01）。结论：加入细胞因子GM—CSF、IL-3、SCF和EPO培养2-4周的脐血MNC可分化为cD1a^＋、CD11C^＋、CD83^＋、CDw123^＋DC。冻融法得到的HL-60、K562白血病细胞抗原致敏DC,其诱导的CTL对HL-60、K562细胞具有特异的杀伤作用。脐血DC作为抗原呈递细胞在肿瘤免疫治疗上将起到重要作用。     

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.