外周血AFPmRNA、h-TERTmRNA检测对肝细胞肝癌患者预后的意义

目的检测肝细胞肝癌（HCC）患者外周血甲胎蛋白信使核糖核酸（AFPmRNA）、人端粒酶逆转录酶（hTERT）mRNA的表达,探索其在HCC预后中的应用价值。方法FQ-PCR检测60例HCC患者外周血中AFPmR-NA、hTERTmRNA的表达量,并与对照组进行比较。结果HCC患者AFPmRNA、hTERTmRNA的表达量及阳性率均高于对照组（P〈0.01）。术后随着时间的推移,其表达数量相应减少,阳性率也明显降低,以1周后下降最为显著（P〈0.05）。在肿瘤标志物持续表达阳性的患者中,其术后复发率也明显高于阴性者（P〈0.01）。结论外周血中定量检测AFPmRNA、hTERTmRNA的表达可以及时发现患者术后HCC的微转移,预测肿瘤的复发倾向,为术后的合理治疗提供依据。     

肝细胞癌在血中微小转移的检测

目的 肝细胞癌患者术后复发常是术前不能检出微转移灶或术中癌细胞释放入血之故。建立早期检出肝细胞癌（HCC）血中微小转移的方法并评价其临床意义。方法 采用巢式RT－PCR检测肝细胞特异白蛋白（ALB）mRNA和甲胎蛋白（AFP）mRNA在HCC患者外周血有核细胞成分及组织标本中的表达情况。并以肝癌细胞系HepG2、SMMC7721,乳腺癌细胞MCF－7作为阳性，阴性对照。结果 在肝组织，无论是癌、癌旁还是正常组织，ALB mRNA的表达均为阳性（8／8），而AFP mRNA在癌组织7／8例表达，癌旁5／8例表达。外周血表达的情况为：同一组标本ALB mRNA的阳性率为75.6%（34／45，P＜0．01），AFPmRNA的阳性率为57．8％（26／45，P＜0．01）。在有肝外转移和无肝转移分组中，ALBmRNA和AFPmRNA的表达分别为100．0％，54．2％和29．2％。结论 在HCC患者外周血有核心细胞成分中检测ALBmRNA和AFPmRNA的表达，是预测转移、复发的简捷手段，若ALB与AFP二者联合使用，应用性会更强。     

乳腺癌外周血细胞角蛋白19 mRNA的检测及临床价值

目的应用荧光定量RT-PCR检测乳腺癌外周血中的表达情况,并评价其表达的临床意义。方法用荧光定量RT-PCR方法检测49例乳腺癌患者外周血CK19mRNA表达。结果49例乳腺癌患者外周血中CK19mRNA检测阳性28例,阳性率57.1%,统计结果显示乳腺癌患者外周血CK19mRNA的表达阳性率在患者不同年龄、病理类别、临床分期、ER、PR状态的各组差异无显著性(P>0.05),在淋巴结转移状态间有显著差异。结论CK19mRNA可作为RT-PCR法检测乳腺癌患者外周血微转移的分子标志物,有助于早期预测乳腺癌发生血道微转移,指导临床治疗。     

伴有肝外远处器官转移的原发性肝癌患者血液AFPmRNA表达

目的探讨伴有肝外远处器官转移的原发性肝癌周围静脉血液AFPmRNA表达情况．方法应用巢式RT－PCR检测93例伴有与不伴有肝外远处器官转移的原发性肝癌血液AFPmRNA。结果21例伴有肝外远处器官转移的原发性肝癌血液AFPmRNA均表达阳性（100％），对例不伴有肝外远处器官转移的原发性肝癌中有29例血液AFPmRNA表达阳性（40．28％，P＜0．01）结论血液AFPmRNA可以作为肝癌远处器官转移的标志性指征     

胃癌患者外周血CK20mRNA的表达及临床意义

采集55例胃癌、46例良性胃病及正常献血员50例，应用逆转录多聚酶链反应（RT－PCR）技术研究外周血CK20mRNA的表达。结果：46例良性胃病及正常献血员50例外周血CK20mRNA均呈阴性，55例胃癌中有35例外周血CK20mRNA表达阳性，I、Ⅱ期20例中有7例外周血CK20mRNA表达阳性，表达率低于Ⅲ、Ⅳ期（28／35）；低、未分化腺癌38例中，30例外周血CK20mRNA表达阳性，高于高、中分化腺癌（5／17）。认为PT－PCR检测外周血CK20mRNA敏感性和特异性较高，可作为胃癌患者术前评估的指标之一。     

外周血原发性肝癌细胞检测的临床研究

目的探讨检测肝癌患者外周血中肝癌细胞ＡＦＰｍＲＮＡ，以动态观察原发性肝癌的转移状况。方法采用套式逆转录聚会酶联反应及ｃＤＮＡ定量等方法对３０例外周血肝癌细胞ＡＦＰｍＲＮＡ进行了检测。结果外周血肝癌细胞ＡＦＰｍＲＮＡ检出率与肝癌的肝内转移、肝内静脉癌栓形成、ｎｍ２３－Ｈ１表达以及细胞分化程度等密切相关。结论外周血ＡＦＰｍＲＮＡ可能是肝癌细胞入侵体循环，即将或已经开始转移的标记之一。     

联合检测血AFPmRNA及AFP判断肝癌切除术后预后的意义

目的探讨联合检测血液AFPmRNA及AFP对判断肝癌（HCC）术后复发或转移的临床意义．方法应用巢式RT-PCA检测34例HCC患者术后2，4，6wk时周围静脉血中AFPmRNA及AFP的变化，并随访1a结果在34例手术切除的HCC患者中，13例术后6wk时周围静脉血中AFPmRNA仍呈阳性，21例患者在术后6wk内血液AFP仍持续阳性共有13例在术后1a内产生了复发或转移性病灶（38．2％），其中7例为血AFPmRNA及AFP均为（＋）的HCC患者，结论术后联合检测血AFPmRNA及AFP可以更有效地判断HCC复发或转移     

实时荧光定量PCR检测肝癌患者外周血甲胎蛋白mRNA水平

在生理状态下 ,甲胎蛋白 (AFP)基因主要由胎肝细胞表达产生 ,出生后该基因表达迅速受到抑制。肝细胞大量坏死或发生原发性肝癌时 ,AFP基因再次激活[1] 。我们采用以Taqman技术为基础的实时荧光定量PCR技术 ,检测各型肝癌患者外周血细胞中AFPmRNA水平 ,分析外周血中是否存在肝癌细胞 ,并判断该方法检测肝癌细胞血液转移的可行性。一、材料与方法1 病人与标本 :本院 2 0 0 2年 8～ 12月收治的 5 7例肝癌患者 ,血清学AFP检测阳性 ,经影像学、组织病理学检查确诊为原发性肝癌。抽取肝癌住院患者晨血 5ml,EDTA抗凝。对照组为健康体检者…     

结直肠癌患者外周血人端粒酶逆转录酶mRNA和MUC1mRNA的检测及其临床意义

背景：传统影像学检查和血清肿瘤标记物检测对结直肠癌微转移的诊断价值有限。目的：检测结直肠癌患者外周血人端粒酶逆转录酶（hTERT）mRNA和MUC1mRNA表达，探讨两者对结直肠癌微转移的诊断价值。方法：收集53例结直肠癌患者和21名健康人的外周血标本，以实时荧光定量逆转录聚合酶链反应（RT-PCR）检测hTERTmRNA和MUC1mRNA表达．分析两者表达与肿瘤临床病理特征的关系。应用接受者操作特征曲线（ROC曲线）分析hTERTmRNA、MUC1mRNA和两者联合检测对结直肠癌的诊断价值。结果：结直肠癌组外周血hTERTmRNA和MUC1mRNA表达率和表达水平显著高于正常对照组（P〈0．05），两者表达与肿瘤淋巴结转移、血行转移和TNM分期相关（P〈0．05）。hTERTmRNA、MUC1mRNA和两者联合检测诊断结直肠癌的ROC曲线下面积分别为0．806、0．778和0．861．诊断界值为Ct〈32。结论：外周血hTERTmRNA和MUC1mRNA可作为诊断结直肠癌微转移的标记物，以实时荧光定量RT-PCR联合检测两项指标优于单项检测。     

原发性肝癌患者外周血甲胎蛋白mRNA表达水平及其意义

甲胎蛋白（AFP）是肝癌发生、发展过程中表达的蛋白质,长期以来被认为是标志性蛋白而用于肝癌的早期诊断;但灵敏度和特异性均不够理想,尤其是它不能反映肝癌有无转移,而及早发现微小病灶对于原发性肝癌（PHC）患者治疗具有重要意义。近年来国外研究者用高敏感的反转录聚合酶链反应（RT—PCR）技术在肿瘤患者的循环血液中查找癌细胞,用于早期发现PHC患者外周血中是否存在肝癌细胞。这对于肝癌的早期诊断、预防及治疗有着重要的指导意义。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。