E-钙黏附素和CD44v6在舌癌中的表达及其意义

目的 探讨舌癌中E－钙黏附素、CD44v6的表达特征及临床意义。方法 取我院经病理证实初诊舌癌患者45例。采用S－P法免疫组化染色检测舌癌中E－钙黏附素和CD44v6。结果 CD44v6和E－钙黏附素总的阳性率为71．1％和64．4％。E－钙黏附素在高分化鳞癌中的阳性表达率均显著高于中低分化鳞癌（P＜0．05）。CD44v6在高分化鳞癌中的阳性表达率与中低分化鳞癌无差异（P＞0．05），有转移者E－钙黏附素阳性表达率显著低于无转移者（P＜0．05），而CD44v6阳性率显著高于无转移者（P＜0．05），局部肿瘤T1－2与T3－4之间二项指标无统计学意义（P＞0．05）。E－钙黏附素阳性表达率在临床Ⅲ、Ⅳ期的病例中比I、Ⅱ期显著降低（P＜0．05）。CD44v6阳性表达率在临床Ⅲ、Ⅳ期的病例中比I、Ⅱ期显著升高（P＜0．05）。结论 E－钙黏附素和CD44v6与舌癌病理分级、转移、预后密切相关，而与肿瘤大小无明显相关性，且该两项指标表达方式相反。当E－钙黏附素阴性、CD44v6阳性时，高度怀疑患者有转移可能。     

PDGFRα和PDGFRβ在食管鳞癌中的表达及临床病理学意义

目的观察血小板衍生生长因子受体-α(platelet-derived growth factor receptor-α,PDGFRα)和血小板衍生生长因子受体-β(platelet-derived growth factor receptor-β,PDGFRβ)在食管鳞癌组织中的表达,探讨其在食管鳞癌发生中的表达以及与临床病理特征及患者预后的相关性。方法采用免疫组化EnVision法检测PDGFRα及PDGFRβ蛋白在131例食管鳞癌组织中的表达,分析二者的表达与患者年龄、性别、肿瘤大小、分化程度、T分期、淋巴结转移、远处转移、TNM分期、微血管密度、间质是否活化、CD68、复发、化疗、放疗情况和生存率的关系。结果 PDGFRα和PDGFRβ主要在食管鳞癌间质的成纤维细胞和炎症细胞中表达。PDGFRα在食管鳞癌活化的间质组织中的表达率明显高于未活化间质组织(P0.05)。PDGFRβ在低分化的食管鳞癌组织中阳性表达率明显高于高分化和中分化组织(P0.05);在进展期(T2-4)组织中的表达率明显高于早期鳞癌组织(P0.01);在活化的间质组织中的阳性表达率明显高于未活化间质组织(P0.05)。PDGFRα(P0.01)和PDGFRβ(P0.05)呈阳性的食管鳞癌患者生存率分别低于阴性者。PDGFRα和PDGFRβ蛋白在食管鳞癌组织中的表达与患者年龄、性别、肿瘤大小、淋巴结转移、远处转移、TNM分期、微血管密度、CD68、复发、化疗和放疗情况均无相关。结论 PDGFRα和PDGFRβ与食管鳞癌间质的活化、肿瘤分化程度和进展以及患者的生存率密切相关。因此,PDGFRα与PDGFRβ在食管鳞癌中的表达对评价患者的预后有一定参考价值。     

上皮型钙黏附素和β-连环素表达水平与非小细胞肺癌侵袭、转移及预后的关系

目的 探讨上皮型钙黏附素和β-连环素在非小细胞肺癌（NSCLC）发生、发展和转移中所起的作用及其表达水平与预后的关系.方法 采用免疫组化（SABC）法、检测111例NSCLC和23例肺良性病变组织中上皮型钙黏附素和β-连环素的表达水平,分析其与肺癌病理生理特征及患者预后的关系.结果 肺癌组织中上皮型钙黏附素和β-连环素表达水平均显著低于癌旁肺组织和肺良性病变组织（P＜0.01）.上皮型钙黏附素和β-连环素在鳞癌中的表达水平均显著低于腺癌和腺鳞癌,在Ⅲ期肺癌中的表达水平显著低于Ⅰ和Ⅱ期肺癌（P＜0.01）,伴有淋巴结转移肺癌中上皮型钙黏附素和β-连环素的表达水平均显著低于不伴有淋巴结转移者（P＜0.01）.低分化肺癌中上皮型钙黏附素表达水平显著低于中-高分化肺癌（P＜0.05）;β-连环素在低分化肺癌和中-高分化肺癌中的表达水平无显著性差异（P＞0.05）;上皮型钙黏附素和β-连环素高表达组（表达水平≥50%）的5年生存率显著高于低表达组（表达水平＜50%）（P＜0.01）.结论 上皮型钙黏附素和β-连环素表达水平降低与NSCLC的发生、发展、转移有密切关系,检测上皮型钙黏附素和β-连环素在肺癌中表达水平对预测患者预后有重要意义.     

胃癌ER,PR,P—gp表达及其与癌浸润转移的研究

目的探讨胃癌ＥＲ、ＰＲ、Ｐ－ｇｐ表达及其与癌浸润转移的关系。方法应用Ｓ－Ｐ免疫组化方法，观察１１７例胃癌中ＥＲ、ＰＲ、Ｐ－ｇｐ表达。结果ＥＲ、ＰＲ阳性表达分别为４７．９％和４０．２％，均与细胞的分化程度、组织学类型有关；淋巴结反应性增生中阳性表达比淋巴结伴有癌转移者高，差异有显著性（Ｐ＜０．０１）。Ｔ１期、Ｔ２期阳性表达率高于Ｔ４期，差异有显著性（Ｐ＜０．０１）。Ｐ－ｇｐ阳性表达４３．６％，与细胞的分化程度、组织学类型无显著关系；淋巴结反应性增生中阳性表达比淋巴结伴有癌转移者低，差异有显著性（Ｐ＜０．０１）。Ｔ１期、Ｔ２期阳性表达率低于Ｔ４期，差异有显著性（Ｐ＜０．０１）。结论ＥＲ和ＰＲ阳性表达有高度的一致性；ＥＲ、ＰＲ与Ｐ－ｇｐ表达在淋巴结反应性增生、淋巴结伴有癌转移者，以及癌肿浸润的深度多有相反的阳性表达，呈负相关关系     

P15和TGFβR-Ⅱ型受体在甲状腺癌中的表达及其相关性研究

目的：研究P15及TGFβR-Ⅱ的表达与甲状腺癌生物学行为和预后之间的关系。方法：应用免疫组化SABC方法检测了58例甲状腺癌与10例正常甲状腺组织中的P15及TGFβR-Ⅱ的表达情况。结果：P15及TGFβR-Ⅱ在甲状腺癌组织中的表达明显低于正常甲状腺组织，两者差异有显著性（P〈0．05）；无区域淋巴结转移者阳性表达率显著高于伴有淋巴结转移者（P〈0．05）；临床分期Ⅰ期阳性率明显高于Ⅱ、Ⅲ、Ⅳ期（P〈0．05）；但Ⅱ、Ⅲ、Ⅳ期之间差异无显著性（P〉0．05）；与组织学分型，患者年龄无明显相关性（P〉0．05）。结论：P15及TGFβR-Ⅱ与甲状腺癌生物学行为之间关系密切，可作为临床分期、判断预后的指标之一。     

DAKO—M1在胃癌组织中的表达及其意义

应用微波－LsAB法免疫组织化学技术，对胃癌、癌粘膜和正常胃粘膜组织进行DAKO－M1（DAKO－CD15、C3D1）表达研究，结果发现，DAKO－M1在癌中的阳性率最高为86．3％，显著高于癌旁粘膜和正常胃粘膜（P＜0．05和0．005）。DAKO－M1表达与胃癌分化程度及淋巴结转移有相关性，未分化型癌：＋＋－＋＋＋”反应强度显著高于分化型癌（P＜0．05）；DAKO－M1阳性胃癌淋巴结转移率显著高于阴性者（P＜0．005），结果表明：DAKO－M1对胃癌是一种良好标志物，检测基表达状况，可作为判断胃癌恶性程度，预测淋巴结转移和预后的一项很有价值的参考指标。     

肺癌中细胞黏附分子-1和L-选择素的表达及临床意义

目的：检测细胞黏附分子-1（ICAM-1）和L-选择素水平，探讨其与肺癌发展、转移、治疗、预后之间的关系。方法：采用免疫组织化学法检测48例肺癌组织ICAM-1的表达，用酶联免疫吸附试验检测48例肺癌患者、18例肺良性病变患者及20例健康志愿者血ICAM-1和L-选择素的浓度。结果：（1）Ⅲ＋IV期肺癌组织和有淋巴结转移者ICAM-1表达分别显著高于Ⅰ＋Ⅱ期和无淋巴结转移者，腺癌组织中ICAM-1表达显著高于鳞癌。（2）肺癌和肺良性病变患者血中ICAM-1和L-选择素水平明显高于健康志愿者，肺癌与肺良性病变患者ICAM-1相比差异有显著性，而L-选择素差异无显著性。Ⅲ＋Ⅳ期显著高于Ⅰ＋Ⅱ期，有转移者与无转移者相比差异均有统计学意义。结论：组织ICAM-1与肺癌的发展和转移有关．检测血ICAM-1和L-选择素含量可以作为肺癌术前诊断及术后效果评估指标之-。     

整合素αvβ5在宫颈癌组织中的表达及临床意义

目的 探讨整合素αvβ5在宫颈癌组织中的表达及其临床意义.方法 采用免疫组织化学法,分别测定15例正常宫颈、15例宫颈原位癌、60例宫颈浸润癌组织中整合素αvβ5的表达.结果 宫颈浸润癌整合素αvβ5的阳性表达与原位癌和正常宫颈比较有显著差异（P＜0.05）.宫颈癌Ⅱ期整合素αvβ5的阳性表达与I期比较,有统计学差异（P＜0.05）.组织学分级G1整合素αvβ5的阳性表达与G2、G3比较有明显差异（P＜0.05）.宫颈癌淋巴结转移组整合素αvβ5与无淋巴结转移组比较有明显差异（P＜0.05）,宫颈鳞癌整合素αvβ5表达与腺癌相比无显著差异（P〉0.05）.结论 在宫颈癌发生、发展中,整合素αvβ5表达增强与肿瘤的生物学行为密切相关.     

E-钙粘素和αvβ6整合素与卵巢上皮癌的相关性研究

目的探讨黏附分子E-钙粘素和αvβ6整合素与卵巢上皮性癌的关系。方法用免疫组化SP法和流式细胞术检测E-钙粘素和αvβ6整合素在卵巢癌原发灶及其相应转移灶的表达情况,并分析二者与临床病理特征间的关系。结果①E-钙粘素在无进展期的患者阳性表达率显著高于进展期的患者(P<0.05)。其在原发灶的表达高于转移灶(P<0.05)。②αvβ6整合素在晚期卵巢癌(FIGDⅢ-Ⅳ期)的阳性表达率显著高于早期(FIGDⅡ期),进展期患者显著高于无进展期(P<0.05);其在转移灶的表达高于原发灶(P<0.05)。结论E-钙粘素下调和αvβ6整合素上调表达与卵巢癌高转移性和不良预后有关,提示二者参与卵巢癌细胞的侵袭与转移。     

口腔鳞癌中HBD-1和HBD-2的表达与临床病理学特征的关系

目的检测β-防御素1（HBD-1）和β-防御素2（HBD-2）的表达与口腔鳞癌患者的病理组织类型、年龄、性别、肿瘤大小、组织学分级、TNM分期以及淋巴结转移的关系。方法采用免疫组化方法检测HBD-1和HBD-2的表达与口腔鳞癌患者的病理组织类型、年龄、性别、肿瘤大小、组织学分级、TNM分期以及淋巴结转移的关系。结果HBD-1在口腔鳞状细胞癌组织中的表达与病理组织类型、性别、年龄、肿瘤大小、组织学分级、TNM分期、淋巴结转移不相关（P〉0．05），HBD-2在不同病理组织类型中表达有明显差异（P〈0．05），随着细胞的恶性程度的变化，HBD-2表达逐渐加强，而且进一步分析发现其在口腔鳞状细胞癌组织中的表达与性别、年龄、肿瘤大小不相关（P〉0．05），但其表达在组织学分级高分化肿瘤组和低分化肿瘤组组间，TNM分期中Ⅰ期与Ⅱ期、Ⅰ期与Ⅲ期、Ⅰ期与Ⅳ期组间以及淋巴结是否转移组间存在显著性差异（P〈0．05）。结论HBD-1和HBD-2分别通过固有表达和诱导表达在口腔鳞癌的发生、发展中起重要作用。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.