原发性卵巢癌组织中肺耐药相关蛋白的表达及其临床价值

目的研究肺耐药相关蛋白(LRP)在原发性卵巢癌组织中的表达状况,探讨其在卵巢癌化学治疗耐药中的作用机制,以及与临床病理生物学特征间的相关性。方法应用免疫组织化学技术对52例原发性卵巢癌、12例卵巢良性肿瘤和10例正常卵巢组织中肺耐药相关蛋白表达状况进行测定。结果肺耐药相关蛋白(LRP)在卵巢癌组织中阳性表达率均显著高于良性肿瘤和正常组织对照组。LRP阳性表达与卵巢癌组织类型、肿瘤分化程度无关,但与临床病理分期及化疗敏感性相关显著,Ⅲ、Ⅳ期组织中LRP阳性表达率显著高于Ⅰ、Ⅱ期。结论LRP在原发性卵巢癌中存在较稳定的表达。检测LRP对前瞻性预测化疗药物敏感性和判断化疗疗效具有一定的临床指导价值。     

MDR1基因在上皮性卵巢癌组织中的表达及临床意义

目的:探讨多药耐药基因(MDR1)在上皮性卵巢癌组织中的表达及临床意义。方法:采用逆转录-聚合酶链反应(RT-PCR)测定了37例上皮性卵巢癌,32例卵巢上皮性良性肿瘤和30例正常卵巢组织中MDR1的表达,并分析其临床意义。结果:正常卵巢组织不表达MDR1基因,卵巢良性肿瘤组织MDR1基因表达率为15.6%,上皮性卵巢癌组织表达率为75.7%。上皮性卵巢癌组织中MDR1基因表达与卵巢良性肿瘤相比较,差异有统计学意义(P<0.01)。化疗无效者MDR1的阳性表达率是94.1%,明显高于化疗有效者的57.1%(P<0.05)。结论:MDR1在上皮性卵巢癌组织中的表达高于正常卵巢组织及卵巢良性肿瘤,并与化疗疗效有关。     

卵巢癌组织多药耐药性的临床研究

目的：研究多个耐药基因P－糖蛋白（P－gp)、谷胱甘肽S－转移酶（GST－π）、DNA拓朴异构酶Ⅱ（Topo-Ⅱ）在卵巢癌组织中表现，探讨其在卵巢癌化学治疗耐药中的作用及与临床病理学特征间的关系。方法：应用免疫组织化学技术（SP法）对37例卵巢癌，10例卵巢良性肿瘤和8例卵巢组织中P－gp、GST－π、Topo-Ⅱ表达状况进行测定。结果：P－gp、GST－π和Topo-Ⅱ在卵巢癌组织中阳性表达均高于良性肿瘤和正常组织对照组；GST－π、Topo-Ⅱ在低分化癌中阳性率明显高于中高分化癌，但与肿瘤组织类型无关。GST－π与临床分期有关。P－gp表达与卵巢癌组织类型、分化、分期均无关。3者在卵巢癌组织中存在共同表达.结论：卵巢癌存在原发性耐药并涉及多个耐药基因的共同表达。联合检测对前瞻性预测化疗药物敏感性和判断化疗疗效具有指导意义。     

卵巢癌组织多药耐药性的临床研究

目的 :研究多个耐药基因P -糖蛋白 (P -gp)、谷胱甘肽S -转移酶 (GST -π)、DNA拓朴异构酶Ⅱ (Topo -Ⅱ )在卵巢癌组织中表达 ,探讨其在卵巢癌化学治疗耐药中的作用及与临床病理学特征间的关系。方法 :应用免疫组织化学技术 (SP法 )对 37例卵巢癌 ,10例卵巢良性肿瘤和 8例正常卵巢组织中P -gp、GST -π、Topo -Ⅱ表达状况进行测定。 结果 :P -gp、GST -π和Topo -Ⅱ在卵巢癌组织中阳性表达均高于良性肿瘤和正常组织对照组 ;GST -π、Topo -Ⅱ在低分化癌中阳性率明显高于中高分化癌 ,但与肿瘤组织类型无关。GST -π与临床分期有关。P -gp表达与卵巢癌组织类型、分化、分期均无关。 3者在卵巢癌组织中存在共同表达。结论 :卵巢癌存在原发性耐药并涉及多个耐药基因的共同表达。联合检测对前瞻性预测化疗药物敏感性和判断化疗疗效具有指导意义     

上皮性卵巢癌ERCC1表达与顺铂化疗耐药的关系

目的探讨切除修复交叉互补基因（ERCC1）在原发性上皮性卵巢癌顺铂化疗耐药中的意义。方法用组织芯片仪制备组织芯片并结合免疫组织化学技术,检测56例上皮性卵巢癌病人癌组织中ERCC1蛋白的表达情况,并以38例正常卵巢组织作为对照,分析其与顺铂化疗耐药的关系,同时分析ERCC1在原发性上皮性卵巢癌中的表达与临床手术-病理分期（FIGO,2000）、病理学类型、分化程度、发病年龄、发生部位以及疾病发生的相关性。结果38例正常卵巢组织中ERCC1阳性表达者17例（44.74%）,56例上皮性卵巢癌组织ERCC1阳性表达者31例（55.36%）,二者比较差异无显著性（χ^2=1.022,P〉0.05）。上皮性卵巢癌中ERCC1的表达与临床手术-病理分期、病理学类型、分化程度、发病年龄、发生部位及发病率均无明显的相关性（P〉0.05）。上皮性卵巢癌顺铂化疗耐药组ERCC1的阳性表达率为76.67%,明显高于敏感组的30.77%,差异有显著性（χ^2=11.87,P〈0.05）。结论上皮性卵巢癌ERCC1表达与顺铂化疗耐药相关。     

TGF-β1与MDR1在上皮性卵巢癌中的表达及相关性分析

目的探讨转化生长因子β1(TGF-β1)、多药耐药基因1(MDR1)在上皮性卵巢癌中的表达及临床意义。方法选取我院2015年1月1日—2017年12月31日收治的上皮性卵巢癌100例(上皮性卵巢癌组)和卵巢良性肿瘤40例(卵巢良性肿瘤组)病理组织切片,采用免疫组织化学染色法检测两组TGF-β1和MDR1的表达情况,并探讨MDR1、TGF-β1与上皮性卵巢癌临床病理特征的关系及二者阳性表达的相关性。结果上皮性卵巢癌组织中TGF-β1阳性表达率为76.00%明显高于卵巢良性肿瘤组织中的40.00%(P0.01);在Ⅲ～Ⅳ期上皮性卵巢癌组织TGF-β1阳性表达率为88.24%高于Ⅰ～Ⅱ期癌组织中的50.00%(P0.01)。MDR1在上皮性卵巢癌组织中的阳性表达率为72.00%高于在卵巢良性肿瘤组织中的27.50%(P0.01);MDR1在Ⅲ～Ⅳ期及低分化上皮性卵巢癌组织中的阳性表达率明显高于Ⅰ～Ⅱ期及高中分化上皮性卵巢癌组织,差异均有统计学意义(P0.05或P0.01)。TGF-β1与MDR1在上皮性卵巢癌组织中的表达呈正相关(r=0.693,P0.001)。结论 TGF-β1、MDR1在卵巢肿瘤由良性向恶性发展过程中起重要的协同作用,随卵巢肿瘤恶性程度进展TGF-β1与MDR1的表达均上调,且二者表达呈正相关。     

LRP和P—gp在卵巢上皮性癌组织中的表达及与化疗耐药关系的探讨

目的 探讨肺耐药蛋白 (Lungresistanceprotein,LRP)及P-糖蛋白 (P-glycoprotein,P -gp)在原发性卵巢上皮性癌 (primaryo varianepithelialcancer,POEC)组织中的表达及其与化疗耐药的关系。方法 采用SP组化法检测LRP和P-gp的表达。结果 (1)交界性卵巢肿瘤及POEC组织中LRP阳性表达率明显高于良性卵巢肿瘤 (P<0.01)。 (2)LRP、P-gp表达与POEC患者年龄、组织学类型、病理分级、临床分期和术后残存灶大小均无关 (P>0.05) ;(3)LRP阳性表达组患者近期化疗疗效明显低于阴性表达组 (P<0.05) ;P-gp表达与POEC患者近期化疗疗效无关 (P>0.05) ;(4)LRP、P -gp表达与患者术后生存时间均无关 (P>0.05) ;(5)LRP、P-gp表达无相关 (P>0.05) ;(6)经化疗后POEC组织中LRP、P -gp表达率均明显高于化疗前 (P<0.05)。结论 (1)检测LRP可预测化疗近期疗效 ,指导临床化疗方案的选择 ;(2)联合检测LRP与P-gp对POEC患者的预后可能无明显价值 ;(3)铂类化疗可诱导POEC组织中LRP及P -gp的表达。     

RhoC与MMP2在卵巢癌侵袭与转移中的相互作用

目的 研究RhoC、MMP2蛋白在卵巢上皮性癌中表达及其在卵巢癌转移中的相互关系.方法 采用免疫组织化学方法检测10例正常卵巢组织、12例卵巢上皮性良性肿瘤及91例卵巢癌组织中RhoC与MMP2蛋白的表达情况,并与临床特征相比较.结果 RhoC,MMP2蛋白在卵巢良性肿瘤和卵巢正常组织中均无表达;在卵巢上皮性癌中阳性表达率分别为37.3%和68.1%.在组织分化程度上中、低分化的阳性表达率明显高于高分化程度的肿瘤(P＜0.005),在临床分期中Ⅲ-Ⅳ期肿瘤的阳性率明显高于Ⅰ-Ⅱ期(P＜0.005),有转移的RhoC和MMP2蛋白的表达率明显高于无转移的蛋白表达率(P＜0.005),卵巢癌中RhoC阳性表达与MMP2阳性表达呈现出协同作用,表现出一致的正相关性(r=0.492,P＜0.05).结论 RhoC、MMP2蛋白的表达与卵巢癌的细胞分化程度、临床分期及有无转移密切相关,说明在卵巢癌的侵袭与转移中协同发挥着重要作用.     

真核细胞起始因子3和人附睾蛋白4在卵巢癌组织中的表达及临床意义

目的探讨真核细胞起始因子3(el F3a)和人附睾蛋白4(HE4)在卵巢癌组织中的表达及其与卵巢癌发生发展的关系。方法采用免疫组织化学染色法检测79例卵巢癌术后组织表标本、40例卵巢良性肿瘤组织标本、40例正常卵巢组织标本中的el F3a、HE4蛋白表达水平,分析el F3a、HE4蛋白表达与卵巢癌患者的临床病理学关系。结果卵巢癌中el F3a、HE4蛋白阳性表达率64.56%、39.25%,卵巢良性肿瘤中el F3a、HE4蛋白阳性表达率22.50%、7.50%,正常卵巢组织中el F3a、HE4蛋白阳性表达率0%、0%。3种组织el F3a、HE4蛋白阳性表达率有显著差异(P0.05)。卵巢癌中el F3a、HE4蛋白阳性表达呈显著的正相关性(P0.001);卵巢癌中el F3a蛋白阳性表达与患者的发生淋巴结转移、组织分化程度有关(P0.05);卵巢癌中HE4蛋白阳性表达与患者的发生淋巴结转移有关(P0.05)。结论卵巢癌组织中el F3a、HE4蛋白阳性表达显著升高,二者呈正相关关系。     

RRM1在卵巢癌中的表达及意义

目的探讨核糖核苷酸还原酶亚单位1(RRM1)在上皮性卵巢肿瘤组织中的表达及其意义。方法免疫组织化学(SP法)检测99例上皮性卵巢癌、30例卵巢良性肿瘤及18例正常卵巢组织中RRM1的表达,并分析其异常表达与卵巢癌临床病理特征的关系。结果 RRM1在正常卵巢、卵巢良性肿瘤及卵巢癌组织的阳性表达率分别为5.56%(1/18)、30.00%(9/30)及61.62%(61/99),差异有统计学意义(P0.05),三组间两两比较发现,卵巢癌RRM1阳性表达率明显高于卵巢良性肿瘤及正常卵巢组织,差异有统计学意义(P0.05)。RRM1表达与病理分级有相关性(P0.05),与患者年龄、FIGO分期、病理类型、淋巴结转移及大网膜转移无关(P0.05)。结论 RRM1在卵巢癌中表达高于卵巢良性肿瘤和正常卵巢组织,有望成为卵巢癌新的早期诊断指标。     

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.