河南贲门癌高发区贲门腺癌组织化学染色分类与癌旁肠上皮化生的关系

目的:探讨河南贲门癌高发区贲门腺癌(GCA)组织化学染色分类与癌旁肠上皮化生(IM)的关系.方法:采用爱显蓝-雪夫试剂染色法(AB-PAS)和高铁二胺-爱显蓝染色法(HID-AB)检测70例GCA及癌旁IM组织,并分析GCA组织化学染色分类与癌旁IM的关系.结果:肠型GCA、胃型GCA、混合型GCA和干细胞型GCA的检出率分别为37.1%(27/70)、5.7%(4/70)、50.0%(35/70)和7.1%(5/70);含硫化和不含硫化黏蛋白的GCA检出率分别为24.3%(17/70)和75.7%(53/70).肠型GCA癌旁IM的检出率为57.7%(15/26),明显高于非肠型GCA的27.3%(12/44)(χ2=6.383,P=0.012);含硫化黏蛋白的GCA癌旁IM的检出率为64.7%(11/17),不含硫化黏蛋白GCA癌旁IM的检出率为30.2%(16/53),含硫化黏蛋白GCA癌旁IM检出率高于不含硫化黏蛋白的GCA(χ2=6.472,P=0.011);硫化黏蛋白在癌旁IM和其相应的GCA组织中无一致性表达(Kappa=0.129,P=0.484).结论:IM可能是河南贲门癌高发区肠型GCA及含硫化黏蛋白GCA的癌前病变.     

胃黏膜肠化及胃癌中三叶因子1,2表达的组织芯片技术研究

目的:三叶因子1(trefoil factor 1,TFF1)和2(TFF2)对胃肠道黏膜保护和损伤后修复具有重要作用,在胃癌中表达降低.现探讨它们在胃黏膜肠化(intestinal metaplasia,IM)及不同组织类型胃癌发生中的作用.方法:胃癌40例,癌旁组织IM 32例,慢性萎缩性胃炎(chronic atrophic gastritis,CAG)伴IM 46例,CAG和慢性浅表性胃炎(chronic superficial gastritis,CSG)各20例,构建组织芯片.分别用高铁二铵/爱先蓝(HID/AB)及HE染色对IM及胃癌进行分型,并用免疫组化检测不同胃黏膜病变中TFFl,TFF2的表达.结果:TFFl,TFF2在不同胃黏膜病变中的表达有显著性差异(P＜0.01),CSG,CAG中的表达显著高于CAG伴IM、癌旁组织IM及胃癌(P＜0.01),而CSG与CAG之间,以及CAG伴IM、癌旁组织IM及胃癌三者之间比较均无显著性差异(P＞0.05).肠型胃癌则显著低于弥漫型胃癌(P＜0.05).结论:胃黏膜IM及胃癌中TFF1,TFF2表达显著降低.     

贲门癌癌旁和无症状人群贲门黏膜活检组织肠上皮化生检测

目的:探讨贲门癌癌旁组织及无症状人群贲门黏膜活检组织肠上皮化生(IM)的分布特征.方法:采用艾显蓝-雪夫(AB-PAS)和高铁二胺-艾显兰(HID-AB)黏液组织化学染色法,对河南贲门癌高发区70例贲门癌癌旁组织和320例无症状人群贲门黏膜活检组织中的IM进行检测.结果:贲门癌癌旁组织的IM检出率38.5%(27/70),高于无症状人群贲门黏膜活检组织中的IM检出率4.4%(14/320)(x2=71.394 5,P＜0.01).贲门癌癌旁组织IM不完全型占92.6%(25/27),完全型IM占7.4%(2/27);无症状人群贲门黏膜的IM不完全型占7.1%(1/14),完全型IM占92.9%(13/14);2者比较,差异有统计学意义(x2=29.015 7,P＜0.01).贲门癌旁组织的IM大肠型占59.2%(16/27),小肠型占40.8%(11/27);无症状人群贲门黏膜的IM小肠型占92.9%(13/14),大肠型占7.1%(1/14);2者比较,差异有统计学意义(x2=10.317 3,P＜0.01).结论:IM可能是河南贲门癌高发区贲门癌癌前病变的一种重要表现形式;不完全型和大肠型IM可能是贲门癌前病变的独特组织学类型.     

胃癌前病变与幽门螺杆菌感染

目的了解胃癌前病变组织Hp感染状况.方法采用美蓝染色检测126例慢性浅表性胃炎(CSG)、88例慢性萎缩性胃炎(CAG)、73例肠上皮化生(IM)、32例不典型增生(Dys)胃粘膜Hp感染状况.观察胃粘膜炎症反应程度.结果Hp感染率在CAG(65.9%)、IM(63.0%)、Dys(62.5%)组显著高于CSG(42.1%)组(P＜0.05;P＜0.01,P＜0.01)轻度及中度CAG(78.9%,70.4%)显著高于重度CAG组(39.1%)(I＜0.01,P＜0.05);轻度及中度IM(80%,69.6%)显著高于重度IM组(30%)(P＜0.01).胃粘膜单个核细胞、分叶核细胞浸润程度Hp阳性组较Hp阴性组显著增多(I＜0.01).结论Hp感染引起胃粘膜炎症反应,在胃癌前病变的发生中起着重要作用.随着胃粘膜萎缩和肠化的加重.Hp难于生存,其致病性减弱.     

贲门癌癌旁和无症状人群贲门黏膜活检肠上皮化生组织中p53和PCNA的表达

目的:探讨贲门癌癌旁与无症状人群贲门黏膜活检肠上皮化生(IM)组织中p53和PCNA的表达状况.方法:采用免疫组织化学ABC法研究了70例贲门癌癌旁IM与320例无症状人群贲门黏膜活检IM组织中p53和PCNA蛋白的表达.结果:无症状人群贲门黏膜活检标本中IM检出率4.4%(14/320),低于贲门癌癌旁组织中的38.6%(24/70)(P＜0.01).癌旁IM组织中p53蛋白高表达率高于无症状人群IM(x2=8.784 0,P＜0.01),但PC-NA蛋白阳性表达率差异无统计学意义(x2=1.078 8,P＞0.05).结论:贲门癌癌旁IM可能更易发生基因改变.     

河南贲门癌高发区贲门癌的组织化学染色分类及P53和PCNA研究

目的探讨贲门腺癌(Gastriccardia adenocarcinoma,GCA)的组织化学染色分类与P53和PCNA分子学特征。方法采用爱显蓝-雪夫试剂染色法(Alcianblue-Periodicacid Schiff,AB-PAS)和高铁二胺-爱显蓝染色法(High Iron Diamine-Alcianblue,HID-AB)以及ABC免疫组织化学分析(Immunohistochemistry,IHC)法研究了70例贲门癌的组织化学及P53和PCNA蛋白表达变化特征。结果肠型GCA的P53蛋白阳性表达(+~)率(73.08%)明显高于非肠型GCA(29.55%)(P<0.01);PCNA蛋白阳性高表达(~)率(96.15%)也明显高于非肠型GCA(65.91%)(P<0.01)。含硫化粘蛋白的GCA组织中P53蛋白阳性表达(+~)率(70.59%)明显高于不含硫化粘蛋白的GCA(41.51%)(P<0.05);PCNA蛋白阳性高表达(~)率(94.12%)也明显高于不含硫化粘蛋白的GCA(71.70%)(P<0.05)。结论组织化学染色可作为判断GCA不同组织类型和分类的重要指标,并可能对了解GCA临床生物学特征(如预后)具有重要意义。     

同源盒转录因子CDX2与肝肠钙粘连蛋白CDH17在肠上皮化生及胃癌组织中的表达及意义

目的:探讨同源盒转录因子CDX2及肝肠钙粘连蛋白CDH 17在慢性萎缩性胃炎(CAG)、肠上皮化生(IM)及胃癌组织中的表达及相互关系。方法:选取CAG 42例、CAG伴IM 24例、癌旁IM 17例、胃癌组织50例,应用HE染色对IM及胃癌进行组织学分型,用免疫组化法观察CDX2、CDH17蛋白在上述各种胃黏膜组织中的表达,分析两种蛋白表达与胃癌临床病理学特征之间的关系。结果:CAG组CDX2蛋白表达阳性率仅为4.80%,而CAG伴IM组、癌旁IM组和胃癌组分别为87.50%、76.47%和62.00%,CAG组显著低于胃癌组(P<0.01),CAG伴IM组显著高于胃癌组(P<0.05),癌旁IM组与胃癌组比较无统计学差异。CDX2蛋白在胃癌中的表达与患者性别、年龄和有无淋巴结转移等无关联,而与胃癌临床TNM分期、分化程度、Lauren分型及是否有浆膜浸润等有关联。CAG组CDH17蛋白表达阳性率为7.10%,而CAG伴IM组、癌旁IM组和胃癌组中分别为91.67%、70.59%和64.00%,呈逐渐下降趋势,CAG组显著低于胃癌组(P<0.01),CAG伴IM组显著高于胃癌组(P<0.01),癌旁IM组与胃癌组比较无统计学差异。CDH17蛋白在胃癌中的表达与患者性别、年龄、浸润深度等无关联,而与胃癌临床TNM分期、分化程度、Lauren分型及是否合并淋巴结转移等有关联。胃癌组织中CDX2与CDH17蛋白表达存在正相关(P<0.01),IM中CDX2与CDH17蛋白表达也存在正相关(P<0.05)。结论:CDX2可能诱导细胞分化、抑制胃癌的侵袭,CDH17高表达与胃癌恶性程度和预后有关;CDX2与CDH17表达可能在IM发生、发展及胃癌进展、浸润转移过程中起协同作用。     

河南贲门癌高发区贲门癌旁肠上皮化生组织的组织化学特征

目的 :探讨贲门癌癌旁肠上皮化生的组织化学特征。方法 :采用艾显蓝 雪夫 (AB PAS)和高铁二胺 艾显兰 (HID AB)粘液组织化学染色法研究了 49例贲门癌癌旁肠上皮化生的组织化学特点 ,并与 93例胃癌癌旁肠上皮化生做对照。结果 :贲门癌癌旁肠上皮化生的检出率 ( 4 4 9% )明显低于胃癌癌旁的肠上皮化生检出率 ( 80 64 % ) (P <0 .0 1) ;贲门癌癌旁不完全型小肠化生 ( 3 1.82 % )和不完全型大肠化生 ( 63 .64 % )所占肠化的比例均明显高于胃癌癌旁不完全型小肠化生 ( 5 .3 3 % )和大肠化生 ( 2 1.3 3 % )所占肠化的比例 (P <0 .0 1)。结论 :贲门癌旁上皮不完全型肠上皮化生检出率明显高于胃癌癌旁上皮提示其可能是一种重要的贲门癌癌前病变     

山西长治林州移民与河南林州居民食管、贲门和胃窦内镜病理结果比较

目的:比较分析河南食管癌高发区林州居民和山西长治的林州移民食管、贲门和胃窦内镜病理结果,进-一步了解遗传和环境因素对食管和贲门癌变的影响.方法:从移居到山西长治100 a的林州移民村中选择1个自然村并在河南林州选择1个与移民迁居前相近的自然村作为调查现场,随机对该2个自然村中30岁以上的居民进行食管/胃内镜检查和黏膜活检组织病理学检查.结果:①食管:移民村食管中段基底细胞过度增生(BCH)检出率高于林州居民(38%vs 28%,P＜0.05);②贲门:移民村慢性浅表性贲门炎(CSG)、不典型增生(DYS)和肠上皮化生(IM)的检出率均高于林州居民(P＜0.05),但两地区慢性萎缩性贲门炎(CAG)和贲门腺癌(GCA)的检出率相似(P＞0.05);③胃窦:移民村胃窦部DYS和IM检出率均高于林州居民(P＜0.05),但2地区胃窦部CSG、CAG和GCA检出率均相似(P＞0.05).结论:林州居民移民到山西长治100 a后,自然人群食管癌和贲门癌检出率、食管重度癌前病变检出率仍与林州原住地居民相似,而移民贲门和胃窦部重度癌前病变检出率均高于林州居民.环境和时间变化均未明显影响食管和贲门癌前病变和癌的发生率,提示遗传因素在其发生中可能起重要作用.     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

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.