脑膜瘤VEGF表达与瘤周脑水肿及相关因素的关系

目的:探讨脑膜瘤血管内皮生长因子(VEGF)与表皮生长因子(EGF)蛋白表达、肿瘤良恶性程度、血管成分和瘤周脑水肿的关系。方法:应用免疫组织化学方法检测63例脑膜瘤标本的VEGF和EGF蛋白表达,根据病理学、CT或MRI表现,判定肿瘤良恶性程度、瘤周水肿的程度和肿瘤血管成分改变并计分。结果:63例脑膜瘤中,53例VEGF蛋白表达阳性(84.1%)。随组织学分级的增高,VEGF表达显著增强。血管成分不同,VEGF表达水平亦不相同(P<0.005),VEGF表达越强,血管成分计分越高;不同瘤周水肿组别间,VEGF表达强度也具有统计学差异(P<0.05),VEGF表达越强,瘤周水肿越重。EGF表达与VEGF表达密切相关。结论:VEGF蛋白的表达水平反映脑膜瘤的良恶性程度和细胞增殖能力;VEGF蛋白是脑膜瘤血管生成和瘤周水肿产生的重要因素之一。     

脑膜瘤血管内皮生长因子与肿瘤增殖活性及瘤周脑水肿关系的研究

目的：研究血管内皮生长因子（VEGF）在脑膜瘤中的表达及其与脑膜瘤增殖活性，微血管密度及瘤周脑水肿（PTBE）的关系。方法：应用免疫组化方法检测36例脑膜瘤组织中VEGF，增殖细胞核抗原（PCNA），第Ⅷ因子（F8）的表达，测定其阳性细胞数；PTBE通过术前颅脑MRI／CT来评估。结果：脑膜瘤VEGF表达率为72％（26／36），5例可疑表达；PCNA，F8全部表达，VEGF表达与PTBE和微血管密度有显著正相关关系，其r分别为0．878和0．631，VEGF表达与PCNA表达没有相关性，其r为0．087。PCNA标记指数＜25％占97％（35／36）。结论：VEGF存在于脑膜瘤组织中，在PTBE和微血管形成 方面起着重要的作用。脑膜瘤属于低增殖活性的良性肿瘤。     

血管内皮生长因子与脑膜瘤瘤周水肿的关系

目的　探讨脑膜瘤血管内皮生长因子 (VEGF)表达与肿瘤血管生成和瘤周脑水肿的关系。方法　采用免疫组织化学技术检测 40例脑膜瘤VEGF表达和微血管密度 ,用双盲法对染色结果及术前MRI和脑血管造影资料进行评估。结果　VEGF表达强阳性组与表达阴性组相比 ,水肿指数(EI =4 6与EI=1 5 ,P =0 0 0 3) ,脑水肿发生率 (88 2 %与 41 7% ,P =0 0 2 3 68)、微血管密度 (MVD =53 0与MVD =2 6 5 ,P =0 0 1 8)的差异均有显著意义 ;有软膜供血组与无软膜供血组相比水肿指数差异有显著意义 (EI=4 4与EI=1 8,P =0 0 4 4 ) ;肿瘤与脑组织重度粘连组较轻度粘连的脑水肿发生率差异有显著意义 (88 9%与 45 5 % ,P =0 0 0 4 1 7) ;肿瘤大小与水肿指数无相关关系 (r =0 2 64 ,P >0 0 5)。结论　脑膜瘤的VEGF表达、肿瘤血管生成及瘤周脑水肿形成之间有重要关系 ;VEGF能促进脑膜瘤的肿瘤血管生成及瘤周脑水肿的形成 ;肿瘤有软膜供血的、与脑组织粘连严重的脑水肿发生率高 ;肿瘤大小与脑水肿程度无相关关系     

CT灌注成像对常见脑肿瘤血管通透性的研究

目的：探讨CT灌注成像在评价脑肿瘤血管通透性中的价值。方法：应用SOMATOM PLUS4螺旋CT扫描机，对34例临床病理证实的脑肿瘤患者（转移瘤11例，胶质瘤10例，脑膜瘤13例，其中术后复发脑膜瘤2例）进行CT灌注成像扫描。使用256彩色直观地显示脑组织灌注图，并计算出脑肿瘤实质区、瘤旁水肿区和对侧脑组织的毛细血管通透性、肿瘤与对侧脑组织PM比值及瘤旁水肿区与对侧脑组织PM比值。结果：3种脑肿瘤的PM值均明显高于对侧脑组织（P〈0．01），脑膜瘤PM值及其比值高于胶质瘤和转移瘤（P〈0．05），而胶质瘤和转移瘤间差异无统计学意义（P〉0．05）。其中22例有不同程度的瘤周水肿，瘤周水肿区与对侧脑组织PM比值，脑膜瘤和转移瘤之间差异无统计学意义（P〉0．05），胶质瘤明显大于脑膜瘤和转移瘤（P〈0．01）。复发脑膜瘤2例的PM值明显增高，达正常脑组织的2．5倍以上。结论：CT灌注成像不仅能较准确地定量脑肿瘤的血管通透性，有利于肿瘤的诊断、鉴别诊断及肿瘤复发的检出，而且能精确显示肿瘤的真实轮廓，有助于肿瘤疗效的观察。     

BAG－1与脑膜瘤瘤周水肿及术后复发的关系

目的探讨BAG－1与脑膜瘤瘤周水肿及术后复发的关系。方法取158例脑膜瘤病理标本,采用免疫组化SP法直接检测BAG－1的表达情况。按染色强度和阳性范围评估免疫组化检测结果。分析BAG－1表达水平[以免疫组化评分（IHS）表示]与脑膜瘤瘤周水肿及术后复发的关系。结果WHOI级（上皮、纤维、混合、微囊、砂粒型）、Ⅱ级（不典型和脊索样型）、Ⅲ级（乳头型和间变型）的各亚型脑膜瘤BAG－1表达水平的差异有统计学意义（P〈0．05或0.01）。术后复发患者24例,呈高表达状态3例（1250％）;未复发患者134例,呈高表达状态102例（76．12％）。术后复发者IHS增高者明显少于未复发者,差异有统计学意义（P〈0．05）。瘤周水肿程度为0级与1级、2级与3级的患者其IHS高低例数分布的差异均无统计学意义（均P〉0．05）;但在0、1级与2、3级的两两比较中,差异均有统计学意义（均P〈0．05）。结论脑膜瘤瘤周水肿及术后复发均与细胞凋亡有关,脑膜瘤BAG－1表达水平越低,其瘤周水肿越重,术后更易复发。     

NF—KB与脑膜瘤组织钙化、坏死及瘤周水肿的相关性

目的：探讨核因子-KB（nuclear factor kappa binding，NF—kB）与脑膜瘤组织钙化、坏死及瘤周水肿的相关性。方法：采用免疫组化SP法测定50例脑膜瘤组织、10N正常硬脑膜组织中NF—KBp65、表皮生长因子（epidermal growth factor，EGF）、表皮生长因子受体（epidermal growth factor receptor，EGFR）的表达水平。结果：正常硬脑膜组织中NF—KBp65无表达，脑膜瘤组织中NF-KBp65有不同程度的表达，两者之间的差异存在统计学意义（P〈0．005）。NF-kBp65、EGF、EGFK在脑膜瘤组织中和正常硬脑膜组织中的表达差异均存在统计学意义（P〈0．005），NF—KBp65与EGF的表达具有相关性（r=0．4524，P=0．001〈O．005），与EGFR的表达无相关性（r=-0．2506，P=0．079〉0．05）。NF—r．13与脑膜瘤坏死（r=-0．27，P=0．15〉0．05）、钙化（r=-0．045，P=0．754〉0．05）、瘤周水肿（r=-0．043，P=0．769〉0．05）无相关性。EGF与脑膜瘤瘤周脑水肿也无相关性（P=0．754〉0．05）。结论：NF—KB在脑膜瘤组织中的表达程度与脑膜瘤坏死、钙化、瘤周水肿无相关性。EGF与脑膜瘤瘤周脑水肿也无相关性。     

脑膜瘤端粒酶的活性在判断复发和恶变中的价值

目的：探讨端粒酶作为脑膜瘤标志物，在肿瘤良恶性鉴别，恶性程度评估以及预后预测等方面的意义。方法：利用TRAP－ELISA定量检测61例（份）肿瘤标本端粒酶的活性（以ΔA＝A450－A690表示），结合肿瘤的分类和患的临床资料。分析端粒酶活性作为肿瘤良恶性及判断预后的标记物的可行性。另取正常脑组织标本20例作为对照。结果：30例脑膜瘤中，29例脑膜瘤均未测到端粒酶活性，1例端粒酶阳性（阳性率3．3％），ΔA＝0．237；全组ΔA平均值＝0．049，15例恶性脑膜瘤中14例呈端粒酶阳性（93％），ΔA＝1．237－2．516；1例端粒酶阴性，ΔA＝0．076，全组ΔA平均值＝1．630。16例复发性脑膜瘤端粒酶均阳性（100％），ΔA＝1．034－1．478，平均1．255，脑膜瘤和复发性脑膜瘤，脑膜瘤和恶性脑膜瘤的端粒酶的阳性率和酶活性表达强度方面差异明显（P分别为＜0．001，＜0．01和＜0．0005，＜0．01），20例正常脑组织中未检测到端粒酶活性。结论：端粒酶活性的激活在恶性脑膜瘤和复发性脑膜瘤中是较常见的现象。端粒酶作为肿瘤标志物，在脑膜瘤的良恶性鉴别，恶性程度评估，预后预测等方面具有重要的意义。     

血管内皮生长因子在子宫内膜异位症中的表达及意义

目的：探讨血管内皮生长因子(VEGF)在子宫内膜异位症发生、发展中的作用。方法：应用免疫组织化学(SABC)法，检测70例异位内膜组织和30例正常子宫内膜组织(对照组)中VEGF的表达。结果：VEGF在异位内膜组织及对照组中的阳性表达率分别为77．14％和43．33％(P＜0．001)，强阳性表达率分别为25．71％和3．3％(P＜0．01)。而VEGF在卵巢子宫内膜异位症组和子宫腺肌症组中的阳性表达率分别为77．78％和76．47％(P＞0．05)。结论：异位内膜组织中VEGF的过度表达与异位内膜组织的血管生成密切相关，VEGF在子宫内膜异位症的发生发展中发挥作用。     

一氧化氮合酶与鼻咽癌血管形成及患者病程的关系

【目的】探讨诱生型一氧化氮合酶（iNOS）、血管内皮生长因子在鼻咽癌组织中的表达及微血管密度与患者病程的关系。【方法】用免疫组化方法检测77例鼻咽癌患者活检石蜡包埋标本的诱生型一氧化氮合成酶、血管内皮生长因子的表达，用Ⅷ因子相关抗原（F^8）显示血管内皮细胞，根据F^8阳性的血管内皮细胞计数测定肿瘤微血管密度。【结果】诱生型一氧化氮合成酶、血管内皮生长因子在鼻咽癌组织中的阳性表达率分别为34％（26／77）、32％（25／77），诱生型一氧化氮合成酶表达与血管内皮生长因子表达、微血管密度、T／N分期均呈正相关（P〈0．05）。【结论】诱生型一氧化氮合成酶在鼻咽癌血管形成及肿瘤浸润与转移中起到促进作用。     

胆管癌中血管内皮生长因子与微血管密度检测的临床意义

目的 探讨胆管癌组织中血管内皮生长因子和肿瘤微血管密度的表达及二者之间的关系。方法 应用免疫组织化学方法测定51例胆管癌组织和10例正常胆管组织的血管内皮生长因子和微血管密度的表达水平。结果 血管内皮生长因子在胆管癌组织中的阳性表达率为80.4％,在正常胆管组织中的阳性表达率为20％,两者相比差异有统计学意义(P＜0....     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.