肿瘤转移抑制基因KAI1在宫颈鳞状细胞癌中的表达及临床意义

目的:探讨肿瘤转移抑制基因KAI1在宫颈鳞癌组织中的表达及其与临床病理特点的关系。方法:采用免疫组化LsAB法检测53例浸润性宫颈鳞癌、15例原位癌、20例正常宫颈组织以及23例转移淋巴结中KAI1蛋白的表达。结果:KAI1基因在宫颈鳞癌及原位癌组织中的蛋白表达与正常宫颈上皮中的表达相比明显下调(P<0.05),原位癌与浸润癌中的表达差异无统计学意义(P>0.05);KAI1的蛋白表达与宫颈鳞癌的临床分期、淋巴结转移、脉管浸润以及宫颈间质肌层浸润深度均无相关性(P>0.05);KAI1在高中分化组中的蛋白表达高于低分化组(P<0.05),在淋巴结转移灶中的表达与其原发灶中的表达相比差异无统计学意义(P>0.05)。结论:肿瘤转移抑制基因KAI1对宫颈鳞癌组织的恶性侵袭行为可能不是一个主要影响因素。     

凋亡抑制蛋白XIAP、Survivin在子宫颈癌组织中的表达及意义

目的:比较正常宫颈及宫颈癌组织中凋亡抑制基因XIAP、Survivin的表达.探讨其与宫颈癌发生、发展的关系.方法:应用RT-PCR方法,在20例宫颈癌及癌旁组织中检测XIAP、Sunrvivin的表达情况.结果:Survivin在宫颈癌旁组织中表达阳性率为60%(12/20),在宫颈癌组织中Survivin阳性率为90%(18/20),Survivin mRNA含量在两组中有显著差异(P<0.05).XIAP在宫颈癌组织和癌旁组织中表达相当,差异无统计学意义(P>0.05).宫颈癌survivin mRNA及XIAP mRNA表达与患者临床分期、淋巴结转移、组织分化程度均无显著关系.结论:survivin可能通过抑制细胞凋亡对宫颈癌的发生、发展起重要作用.     

KAI1在宫颈鳞癌中的表达及临床意义

目的探讨研究KAI1在正常宫颈、宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）及宫颈鳞癌中的表达及其与宫颈鳞癌临床病理特征之间的关系,探讨其在宫颈鳞癌发生、发展和转移等方面的作用和意义。方法随机选取大庆龙南医院2009年1月-2010年10月间妇科门诊及住院手术切除的组织标本：10例正常宫颈组织、40例宫颈上皮内瘤变组织、36例宫颈鳞癌组织,应用免疫组织化学法对组织进行染色,以检测KAI1的表达情况。结果 KAI1主要在细胞膜和（或）细胞浆内表达,其在正常宫颈组织、CINⅠ、Ⅱ、Ⅲ、宫颈鳞癌组织中阳性表达呈递减趋势,依次为100%、87.5%、73.3%、63.1%、19.4%。KAI1在宫颈鳞癌表达与细胞分化程度及淋巴结转移相关,与组织浸润深度、临床分期、年龄、癌灶大小无关。提示KAI1可以抑制宫颈鳞癌的浸润和转移。结论 KAI1的高表达抑制宫颈鳞癌的发生发展,低表达可能预示着该肿瘤更具有侵袭性,预后差。     

宫颈癌中fascin和galectin-3表达的临床意义

目的 探讨fascin和galectin-3在宫颈癌中的表达,了解其在宫颈癌淋巴道转移及临床判断预后方面的作用.方法 应用免疫组化法检测fascin和galectin-3在10例正常宫颈组织、32例宫颈上皮内瘤变及108例宫颈癌组织中的表达情况,并分析fascin和galectin-3表达与相关病理参数的关系.结果 宫颈癌组织中fascin蛋白的表达显著高于宫颈上皮内瘤变及正常宫颈组织,宫颈上皮内瘤变中fascin蛋白的表达显著高于正常宫颈组织;fascin 表达与肿瘤大小、淋巴结转移密切相关;其在宫颈腺鳞癌的表达高于宫颈腺癌(P＜0.05).galectin-3蛋白在宫颈癌、宫颈上皮内瘤变及正常宫颈组织的表达差异不显著(P＞0.05),在宫颈非鳞癌的表达显著高于正常宫颈组织、宫颈上皮内瘤变及宫颈鳞癌;galectin-3表达与深肌层浸润和淋巴结转移密切相关;其在宫颈腺鳞癌中的表达高于宫颈腺癌以及宫颈鳞癌中的表达.fascin与galectin-3在宫颈癌中的表达成正相关.结论 fascin和galectin-3参与了宫颈癌的发生发展、浸润和淋巴道转移,两者在宫颈癌的淋巴转移过程中可能有协同作用;fascin在鉴别宫颈腺鳞癌与腺癌时可能有一定的参考价值,galectin-3今后可能成为诊断宫颈腺鳞癌的重要检测指标之一.     

诱导型一氧化氮合酶与血管内皮生长因子C在宫颈癌中表达及其与淋巴结转移的相关性研究

目的探讨诱导型一氧化氮合酶(inducible nitric oxide synthase,iNOS)与血管内皮生长因子(vascularendothelial growth factor,VEGF)-C在宫颈癌组织中的表达及其与淋巴结转移之间的关系。方法 55例宫颈癌组织(宫颈癌组)与10例正常宫颈组织(对照组),采用免疫组织化学SP法检测2组iNOS和VEGF-C的表达情况。结果宫颈癌组iNOS与VEGF-C阳性率分别为69.09%和63.64%,对照组分别为20.00%和10.00%,差异有统计学意义(P<0.05);iNOS表达与VEGF-C呈正相关(r=0.78,P<0.01);宫颈癌组iNOS(+)VEGF-C(+)者淋巴转移的发生率(54.55%)明显高于iNOS(-)VEGF-C(-)者(27.27%)(P<0.05)。结论 iNOS、VEGF-C与宫颈癌的淋巴转移关系密切;针对iNOS、VEGF-C的靶向治疗可能成为宫颈癌治疗的新靶点。     

食管鳞癌组织中MUC15基因和蛋白质的表达及其与临床病理因素的关系

目的探讨MUC15在食管鳞状细胞癌(鳞癌)中的表达及其与鳞癌发生、发展的关系。方法采用RT-PCR法及免疫组织化学SP法检测53例正常食管黏膜组织、20例不典型增生组织及53例食管鳞癌组织中MUC15 mRNA的相对含量及蛋白质的阳性表达率,并比较其在不同临床病理因素下的差异。结果在正常食管黏膜组织、癌旁不典型增生组织及食管鳞癌组织中MUC15 mRNA相对表达量分别为0.281±0.017、0.322±0.029、0.790±0.038;蛋白质表达阳性率分别为20.7%、35.0%、88.7%,差异均有统计学意义(P0.05)。临床分期0~Ⅱ期及Ⅲ~Ⅳ期的食管鳞癌组织中MUC15 mRNA相对表达量分别为0.498±0.029、0.832±0.045;蛋白质表达阳性率分别为70.0%、93.0%,差异均有统计学意义(P0.05)。有淋巴结转移组与无淋巴结转移组之间mRNA相对表达量分别为0.829±0.031、0.501±0.042;蛋白质表达阳性率分别为90.2%、75.0%,差异有统计学意义(P0.05)。结论食管鳞癌组织中MUC15表达量较正常食管组织有明显升高,其异常高表达可能与食管鳞癌的发生、发展有关。     

宫颈鳞状上皮癌变过程中Id-1和NF-κB的表达及其相关性

目的:检测宫颈鳞癌组织中Id-1和NF-κB的表达及其相关性,探讨其在宫颈鳞状上皮癌变过程中的作用和临床意义。方法:采用免疫组化SP法检测15例慢性宫颈炎、17例CINⅠ、25例CINⅡ~Ⅲ和79例宫颈鳞癌组织中Id-1和NF-κB表达水平,分析Id-1表达水平与宫颈癌临床病理特征的关系及与NF-κB表达水平的相关性。结果:Id-1和NF-κB p65/p50表达阳性率在慢性宫颈炎、CINⅠ、CINⅡ~Ⅲ和宫颈鳞癌组织中均逐渐升高(P<0.05),各组中Id-1表达阳性率分别为0、11.8%、40.0%和74.7%;宫颈鳞癌组织分化级别越低、间质浸润程度越深和有盆腔淋巴结转移者Id-1表达阳性率越高,差异有统计学意义,P<0.01;在宫颈鳞状上皮癌变过程中Id-1和NF-κB表达水平呈正相关,Id-1与p65/p50的Spearman相关系数分别为rs=0.532和rs=0.257,P<0.01。结论:Id-1过表达在宫颈鳞癌发生发展中起重要作用;宫颈癌变过程中Id-1和NF-κB表达呈正相关。     

SOX-2和OCT-4在宫颈鳞癌中的表达及临床意义

目的探讨SOX-2及OCT-4表达与宫颈鳞癌病理分级的关系及其在宫颈癌发生、发展等方面的作用和意义.方法应用免疫组织化学技术和RT-PCR方法在蛋白及核酸水平检测SOX-2及OCT-4在正常宫颈及宫颈鳞癌组织中的表达.结果(1)免疫组化染色显示,正常宫颈组织与中、低分化宫颈鳞癌组织中SOX-2的表达差异有显著性(P<0.05);OCT-4在正常宫颈和宫颈鳞癌组织表达差异有显著性(P<0.01).(2)RT-PCR示SOX-2mRNA在正常宫颈及中、低分化宫颈鳞癌组织中的表达差异有显著性(P<0.01),并且SOX-2的表达随着病理学分级的下降而表达上调;OCT-4mRNA在正常宫颈及宫颈鳞癌组织中的表达差异有显著性(P<0.01),但OCT-4的表达与病理学分级无关.结论 SOX-2和OCT-4可能在宫颈鳞癌的发生、发展中起重要作用.     

转移相关基因1蛋白在子宫颈病变组织中的表达及临床意义

目的 :研究转移相关基因1(metastasis associated gene 1,MTA1)蛋白在子宫颈(以下简称宫颈)不同病变组织中的表达情况及其临床意义。方法:应用SP免疫组织化学染色法检测40例宫颈癌、45例宫颈上皮内瘤变(cervical intraepithelial neoplasias,CIN)、30例慢性宫颈炎和20例正常宫颈组织的石蜡标本中MTA1蛋白的表达情况,并对其表达水平与宫颈癌的病理类型、分化程度、临床分期及是否有淋巴结转移等生物学行为间的相关性进行分析。结果:MTA1的高表达率在正常宫颈组(0)、CIN组(57.78%)、宫颈癌组(87.50%)间的比较,差异有统计学意义(P0.05),而慢性宫颈炎组(10%)与正常宫颈组相比,MTA1高表达率差异无统计学意义(P0.05)。慢性宫颈炎组与CIN组、宫颈癌组3组间两两相比,MTA1高表达率差异均具有统计学意义(P0.05)。MTA1的高表达率在鳞状上皮内低度病变(low grade squamous intraepithelial lesion,LSIL)、鳞状上皮内高度病变(high grade squamous intraepithelial lesion,HSIL)、宫颈鳞癌3组间比较,也具有显著差异(P0.05)。MTA1的高表达率与病理类型无关(P0.05),而与宫颈癌的分化程度、淋巴结转移及临床分期有关(P0.05)。结论:MTA1在正常宫颈组织及慢性宫颈炎组织中呈低表达,而MTA1在CIN及宫颈癌中呈现高表达,其高表达率与宫颈癌的分化程度、淋巴结转移及临床分期有关。     

宫颈鳞癌组织中EZH2和PTEN蛋白的表达

目的探讨宫颈良恶性病变组织中EZH2和PTEN蛋白的表达水平及其临床意义。方法采用免疫组织化学SP法检测正常宫颈组织30例(对照组)、宫颈上皮内瘤变组织78例(CIN组)和宫颈鳞癌组织78例(宫颈鳞癌组)中EZH2和PTEN的表达情况。结果宫颈鳞癌组EZH2蛋白表达阳性率明显高于CIN组与对照组,PTEN蛋白表达阳性率明显低于CIN组与对照组(P<0.01);宫颈鳞癌中EZH2与PTEN蛋白表达在组织学分期、淋巴转移及浸润深度上差异有统计学意义(P<0.01),在年龄、临床分期上差异无统计学意义(P>0.05);EZH2的表达与PTEN呈负相关(r=-0.675,P<0.05)。结论 EZH2和PTEN蛋白可能在宫颈鳞癌发生、发展过程中起重要作用,可作为判定宫颈鳞癌恶性程度及进程的重要参考指标。     

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.