多囊性肾细胞癌临床病理诊断

目的:研究多囊性肾细胞癌的病理形态学特征及鉴别诊断.方法:对2例多囊性肾细胞癌进行光镜观察及免疫组化标记,并进行文献复习.结果:肿瘤由厚的假纤维包膜围绕,切面见大小不等的囊腔.镜下见囊腔上皮为无明显异性的透明细胞,纤维性囊壁中可见透明细胞巢.癌细胞免疫表型CK、EMA、Vimentin阳性,CD68阴性,P53弱阳性.结论:多囊性肾细胞癌是一种罕见的肾癌类型,是一种低度恶性潜能肿瘤.术前易与肾细胞癌伴囊性变、多囊肾、节段性囊性疾病、囊性肾瘤等混淆.     

肾癌干细胞的培养鉴定及其凋亡的实验研究

目的探讨肾癌干细胞在肾癌的发生发展中的作用。方法收集肾癌细胞检测其CD133表达情况,并研究其凋亡特性;然后将其悬浮于含有表皮生长因子(EGF)和成纤维生长因子(bFGF)的无血清培养基中培养7d,收集干细胞球,同时收集利用含10%胎牛血清培养基培养的肾癌细胞作阴性对照,分别检测其CD133表达情况,并研究其凋亡特性。结果悬浮培养2d后出现肾癌干细胞球,培养7d后干细胞球明显增多,收集干细胞球,用流式细胞仪检测发现表达CD133+细胞约占(8.25±1.43)%,阴性对照中CD133+细胞只占(1.22±0.34)%,并且较前者具有较高的凋亡率。结论利用无血清体外培养并收集悬浮生长的肾癌细胞的方法可以从肾癌细胞中获取肾癌干细胞;肾癌干细胞较一般瘤组织有较低的凋亡率,维持着肿瘤的无限增殖。     

人肾癌干细胞的培养鉴定及其端粒酶活性的分析

目的:研究分析人肾癌干细胞的培养鉴定及其端粒酶活性情况。方法:应用含有碱性成纤维生长因子(英简b FGF)、表皮生长因子(英简EGF)的DMEM/F12的培养基对分离的肾癌干细胞进行无血清悬浮培养,并以正常的肾组织细胞及含血清培养的肾癌细胞作为对照。通过端粒重复序列扩增法(英简TRAP)对肾癌干细胞端粒酶活性进行实时、定量的检测。结果:无血清悬浮培养组的CD133~+CD34~+的表达率显著高于含血清培养组,差异P0.05有统计学意义。并且,肾癌干细胞球、肾癌细胞端粒酶活性均显著高于正常肾组织细胞,差异P0.05有统计学意义。结论:无血清悬浮培养相比含血清培养,肾癌干细胞CD133~+的表达率更高,但二者培养的肾癌细胞的端粒酶活性均明显高于正常肾组织细胞。     

囊性肾癌11例临床分析

目的 提高对囊性肾癌的认识.方法 回顾性分析我院2001年1月至2007年1月收治的235例肾癌中11例囊性肾细胞癌病人的临床资料.结果 11例病人中8例行肾癌根治术,3例行肾部分切除术;多房囊性肾癌8例,单房囊性肾癌3例;透明细胞癌9例,嫌色细胞癌2例.11例均获随访,随访时间3～61个月,平均27.9个月,无瘤存活10例.结论 囊性肾癌采用肾癌根治或肾部分切除术治疗效果满意,预后佳.     

多囊性肾透明细胞癌临床病理分析

目的:探讨多囊性肾透明细胞癌的临床病理特点,以加深对本瘤的认识。方法:对2例多囊性肾透明细胞癌的临床及病理特点进行分析,并结合文献复习。结果:本瘤生长缓慢,临床上患者多无自觉症状;病理检查大体见肿物由大小不等的囊腔构成。镜下囊内壁主要由单层立方或柱状上皮被覆,部分为多层上皮并有乳头形成,瘤细胞胞质空亮,无明显异型性。癌细胞免疫组化示:cytokeratin、CEA和vimentin阳性表达。结论:多囊性肾透明细胞癌是一种罕见的肾癌的病理类型,临床极易误诊,分化程度高,属低度恶性的肿瘤,预后较好。     

悬浮法培养C6胶质瘤细胞系和该细胞系中脑肿瘤干细胞的分离

目的研究应用无血清培养基悬浮法培养C6胶质瘤细胞系的方法;并分离该细胞系中的脑肿瘤干细胞,观察其生长方式和分化特征.方法应用培养大鼠神经干细胞的培养基和培养方法,在无血清培养基中采用悬浮法培养大鼠C6胶质瘤细胞系;再将分离获得的悬浮生长的脑肿瘤干细胞接种于含血清培养基,观察其分化;应用有限稀释和单克隆形成实验确定该细胞系中肿瘤干细胞的比例.结果C6胶质瘤细胞系中有约1.18%的肿瘤细胞在无血清培养基中能够存活、增殖,形成自由漂浮的细胞球;这种细胞球具有人脑肿瘤干细胞球的特征,并可连续传代,若重新接种于含血清培养基中可重新贴壁分化,贴壁分化后细胞形态与直接在含血清培养基中培养的C6胶质瘤细胞系无明显差别.结论C6大鼠胶质瘤细胞系中含有比例较低的、具有增殖和分化能力脑肿瘤干细胞(约1.18%),该细胞系可在含生长因子的无血清培养基中悬浮生长,并维持细胞系.     

肾癌遗传学研究进展

肾癌是一类具有多种组织类型及不同遗传背景的癌症.目前至少有10种类型的肾细胞癌.其中最常见的是透明肾细胞癌,其次是乳头状肾细胞癌、嫌色肾细胞癌和集合管细胞癌.而其它的较少见.由于肾癌具有高度的遗传异质性,现在已发现了很多染色体畸变和基因的突变都可导致肾癌.而且不同类型的肾癌,其致癌基因也不同.如VHL基因突变一般引起透明肾细胞癌,而FH基因则导致乳头状肾细胞癌.近年来,新技术的发展和应用,新的肾癌相关基因的数目也在增加.如最近的外显子组序列分析就找到了一批与透明肾细胞癌有关的基因,包括PBRM1、BAP1、SET2和JARID1c等重要的肾癌相关基因.有些透明肾细胞癌同时带有两个以上基因的突变.随着新技术的出现和研究的深入,越来越多的肾癌基因及各类肾癌标记将会被发现.     

SPOP蛋白在肾透明细胞癌中的表达

目的 检测SPOP蛋白在人肾透明细胞癌细胞株、肾透明细胞癌组织及正常肾组织中的表达,探讨其表达与肾透明细胞癌的关系。方法 采用免疫细胞化学EnVision二步法检测肾癌细胞株A498中SPOP的表达情况。取山东大学第二医院泌尿外科肾癌患者手术标本,采用HE染色明确肿瘤病理分级,分别采用免疫组织化学EnVision二步法、蛋白质印迹法定性及定量检测肾透明细胞癌及正常肾组织中SPOP的表达水平。结果 SPOP在人肾癌细胞株A498、肾透明细胞癌组织中均为阳性表达,正常肾组织中SPOP表达为阴性。结论 SPOP可能是一种肾透明细胞癌的分子标记物,对其监测将有可能协助肾透明细胞癌的诊断。     

采用体外侵袭实验分离侵袭性人原代肾细胞癌细胞

目的:体外分离肾细胞癌原代侵袭性和非侵袭性细胞.方法:消化法或植块法对32例临床新鲜肾细胞癌进行原代培养.在预实验确定铺胶浓度、消化回收时间的基础上,采用涂有Matrigel的Transwell对3例原代培养的肾细胞癌细胞进行体外侵袭实验,分离回收侵袭性和非侵袭性细胞.结果:(1)原代培养成功率为90.6%(29/32).(2)以1.0 mg/ml、20 μl/孔对Transwell铺胶,固定细胞悬液密度(5×105/ml),第5天消化回收细胞较为理想.非侵袭性细胞散在生长,侵袭性细胞多呈克隆样生长.侵袭性细胞倍增时间为36.1 h,非侵袭性细胞为50.6 h.结论:Transwell可体外快速分离及回收、培养不同侵袭性的肾癌原代细胞群.用原代肿瘤细胞进行体外侵袭实验代表性好,但难以突破肿瘤细胞的有限生存期.     

胶质瘤细胞中干细胞分离的实验研究

目的研究应用无血清培养基悬浮法培养U-251胶质瘤细胞系的方法;并分离该细胞系中的脑肿瘤干细胞,鉴定其特异性标志物CD133+的表达并观察其生长和分化特征.方法应用培养大鼠神经干细胞的培养基和培养方法,在无血清培养基中采用悬浮法培养人U-251胶质瘤细胞系;再将分离获得的悬浮生长的脑肿瘤干细胞利用免疫荧光法检测脑肿瘤干细胞特异性标志物CD133+在脑肿瘤干细胞球中的表达.再将脑肿瘤干细胞接种于含血清培养基,观察其分化生长和分化特征.结果 U-251胶质瘤细胞系中有约(2.56±0.2)%的肿瘤细胞在无血清培养基中能够存活,增殖,形成自由漂浮的细胞球;其细胞表达CD133+神经干细胞的标志物,并可连续传代,若重新接种于含血清培养基中可重新贴壁分化,贴壁分化后细胞形态与直接在含血清培养基中培养的U-251胶质瘤细胞系无明显差别.结论用悬浮无血清培养法从U-251人胶质瘤细胞系中成功培养出脑肿瘤干细胞,其肿瘤干细胞能够产生为多种细胞形态的分化细胞,脑肿瘤干细胞的分离培养成功对脑肿瘤的基础和临床研究具有重要价值     

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.