1,25-二羟维生素D3对单侧输尿管梗阻模型大鼠E-钙黏素表达的影响

目的探讨1,25-二羟维生素D3对单侧输尿管梗阻大鼠E-钙黏素表达的影响。方法清洁级SD大鼠96只随机分为正常组、模型组、假手术组、干预组,各24只,模型组与干预组大鼠建立单侧输尿管梗阻模型,假手术组开腹后仅游离左输尿管。干预组于建模起给予1,25-二羟维生素D30.5μg/mL灌胃,1次/d,连用14d;余3组给予花生油1mL/d,1次/d,灌胃。4组分别于术后1,3,7,14d各处死6只大鼠,取左侧肾脏标本,观察肾脏病理改变及间质纤维化损害程度,免疫组织化学法检测4组大鼠E-钙黏素和转化生长因子-β1的表达情况。结果与对照组比较,模型组E-钙黏素阳性表达量减少,转化生长因子-β1表达增多(P<0.01);干预组E-钙黏素表达量增多,TGF-β1表达减少(P<0.05)。肾小管间质病理损伤程度与E-钙黏素呈负相关(r=-0.833,P<0.01),与转化生长因子-β1呈正相关(r=0.806,P<0.01);E-钙黏素和转化生长因子-β1的表达间呈负相关(r=-0.871,P<0.01)。结论 1,25-二羟维生素D3可能通过维持肾组织E-钙黏素的表达、抑制肾组织转化生长因子-β1的表达来减轻肾脏纤维化。     

胃底腺息肉的临床和内镜特征分析

目的分析胃底腺息肉(FGPs)的临床和内镜特征。方法纳入2008年-2015年于首都医科大学附属北京世纪坛医院进行胃镜检查首次发现息肉并取活检/切除明确病理诊断的患者,进一步分析FGPs组和非FGPs组的临床和内镜特点。结果共纳入867例胃息肉患者,其中FGPs者319例(36.8%)。FGPs组与非FGPs组相比较,前者息肉更小,平均(0.40±0.15)cm、单发息肉相对少(67.7%)、存在于胃底和胃体的比例更高(88.1%)和幽门螺杆菌(HP)感染率更低(6.1%),差异均具有统计学意义(P0.05)。2008年-2015年,FGPs占胃息肉的比例和FGPs的检出率均逐年增加。结论 FGPs是胃息肉的常见类型,其检出率逐渐提高。与其他类型胃息肉相比较,FGPs好发于胃底和胃体,单发息肉相对少,且FGPs者HP感染少见。     

新疆不同民族骨肉瘤患者病变组织中p53及bcl-2和增殖细胞核抗原表达的差异

背景骨肉瘤在好发于轻少年恶性骨与软组织的肿瘤中居第一位,在临床中,发现新疆少数民族中的发病率较为多见,其发病和预后在基因水平是否存在种族差异.目的观察新疆不同民族骨肉瘤发生发展中的p53,bcl-2,增殖细胞核抗原基因表达差异情况.设计非随机临床病理标本对照的实验.单位新疆医科大学病理中心免疫组织化学实验室.对象取自新疆医科大学第一附属医院及石河子大学第一附属医院病理科1984-01-01/2001-12-31手术切除的52例骨肉瘤患者组织标本(52块),男29例,女23例;其中哈族12例,维族17例,汉族23例);另取32例瘤样病变患者组织(骨纤维结构不良,纤维异常增殖症)标本(32块),其中哈族7例,维族11例,汉族14例.所取标本患者均获完全知情同意将自己的标本用于此项研究.方法实验在新疆医科大学病理中心免疫组织化学实验室进行.两种标本中p53,bcl-2和增殖细胞核抗原表达监测应用免疫组织化学ISAB法.以磷酸盐缓冲液代替一抗作空白对照,以已知阳性的肿瘤标本作阳性对照.P53蛋白和增殖细胞核抗原阳性表达在细胞核内,有明显的红棕色颗粒状染色为阳性,而Bcl-2蛋白阳性则定位于胞浆上.主要观察指标①不同民族骨肉瘤中p53,bcl-2和增殖细胞核抗原的表达结果.②p53,bcl-2,增殖细胞核抗原在骨肉瘤和骨的瘤样病变组织的表达情况.③骨肉瘤中bcl-2与p53和增殖细胞核抗原间的相关性.结果①不同民族骨肉瘤中p53,bcI-2和增殖细胞核抗原的表达结果哈族、维族及汉各之间p53,bcl-2,增殖细胞核抗原阳性率无显著差别(P＞0.05).②p53,bcl-2,增殖细胞核抗原在骨肉瘤和骨的瘤样病变组织的表达情况骨肉瘤中P53,Bcl-2蛋白、增殖细胞核抗原表达阳性率均显著高于瘤样病变组织(42.31%比3.13%,59.62%比0.75%比31.25%,P＜0.01).③骨肉瘤中bcl-2与p53和增殖细胞核抗原间的相关性骨肉瘤中bcl-2与p53之间、bcl-2与增殖细胞核抗原之间有相关关系(X2=5.8182,4.9000,P＜0.05).结论结果表明骨肉瘤组织内p53,bcl-2和增殖细胞核抗原表达与肿瘤分化程度,民族分布未见统计学差别,说明这些基因在骨肉肿瘤发生过程中具有共同调控环节,与不同民族的遗传背景关系不大.     

1,25-二羟维生素D3对单侧输尿管梗阻模型大鼠E-钙黏素表达的影响

目的探讨1,25-二羟维生素D3对单侧输尿管梗阻大鼠E-钙黏素表达的影响。方法清洁级SD大鼠96只随机分为正常组、模型组、假手术组、干预组,各24只,模型组与干预组大鼠建立单侧输尿管梗阻模型,假手术组开腹后仅游离左输尿管。干预组于建模起给予1,25-二羟维生素D30.5μg/mL灌胃,1次/d,连用14d;余3组给予花生油1mL/d,1次/d,灌胃。4组分别于术后1,3,7,14d各处死6只大鼠,取左侧肾脏标本,观察肾脏病理改变及间质纤维化损害程度,免疫组织化学法检测4组大鼠E-钙黏素和转化生长因子-β1的表达情况。结果与对照组比较,模型组E-钙黏素阳性表达量减少,转化生长因子-β1表达增多（P〈0.01）;干预组E-钙黏素表达量增多,TGF-β1表达减少（P〈0.05）。肾小管间质病理损伤程度与E-钙黏素呈负相关（r=-0.833,P〈0.01）,与转化生长因子-β1呈正相关（r=0.806,P〈0.01）;E-钙黏素和转化生长因子-β1的表达间呈负相关（r=-0.871,P〈0.01）。结论 1,25-二羟维生素D3可能通过维持肾组织E-钙黏素的表达、抑制肾组织转化生长因子-β1的表达来减轻肾脏纤维化。     

小窝蛋白-1在骨肉瘤中的表达及其意义

目的 通过检测小窝蛋白-1在人骨肉瘤组织中的表达,探讨小窝蛋白-1在骨肉瘤发生、发展及转移中的作用及其与临床病理相关性.方法 采用免疫组化学方法检测48例骨肉瘤组织标本及24例正常骨组织中小窝蛋白-1的表达水平.并结合临床、病理特征进行分析.结果 48例骨肉瘤组织中有38例小窝蛋白-1呈弱表达或未见表达,而在24例正常的骨组织标本中小窝蛋白-1均有表达且呈强表达,骨肉瘤组织、正常骨组织中小窝蛋白-1的平均吸光度值分别为(0.2292±0.0329)和(0.6428±0.0028),骨肉瘤组织小窝蛋白-1的表达明显低于正常骨组织(t=21.48,P＜0.01),差异具有统计学意义;小窝蛋白-1的表达与患者年龄、性别、肿瘤大小、病理分级等均无相关性(P均＞0.05),而小窝蛋白-1的低表达或不表达与肺转移有关(x2 =11.84,P＜0.05).结论 小窝蛋白-1异常低表达可能参与骨肉瘤侵袭、转移机制,小窝蛋白-1可能成为判断骨肉瘤患者预后新的分子标志物及肿瘤治疗的新靶点.     

胃癌组织E-cadherin、β-catenin蛋白表达及意义

目的:通过对胃癌组织E-钙粘蛋白(E-cadherin,E-cad)、β-连环素(β-catenint,β-cat)蛋白表达结果,研究其与临床病理特征的关系及预后的关系.方法:采用免疫组化方法检测50例胃癌组织和20例正常胃黏膜组织中E-cad、β-cat的表达并分析其与临床病理因素的关系.结果:E-cad和β-cat在胃癌中的表达率(48.00％,46.00％)分别低于正常胃组织(100.00％,100.00％,P＜0.01).中低分化组、侵及肌层组及有淋巴结转移组中E-cad和β-cat的表达率低于于高分化组、未侵及肌层组及无淋巴结转移组,差异有统计学意义(P＜0.01).E-cad和β-cat的表达呈正相关(r=0.836,P＜ 0.01).结论:E-cad、β-cat在胃癌组织中的表达与肿瘤的浸润和发展有关,联合检测E-cad、β-cat有可能成为判断胃癌恶性程度和预后的重要指标.     

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.     

UHRF1在肝细胞肝癌中的表达及意义

目的:探讨UHRF1(Ubiquitin-like,containing PHD and RING finger domains 1)在肝细胞肝癌(hepatocellular carcinoma,HCC)中的表达及其与临床病理特征的关系。方法:采用免疫组织化学方法检测556例HCC组织及其癌旁组织中UHRF1的表达,分析其与HCC患者临床病理特征的关系。结果:免疫组织化学结果显示,UHRF1蛋白阳性表达定位于HCC细胞核,UHRF1蛋白在HCC组织中的表达显著高于癌旁组织。HCC组织中UHRF1蛋白阳性表达率为59%,其表达与肿瘤大小(P0.01)、肿瘤分化(P0.05)和微血管侵犯(P0.01)相关。结论:HCC中UHRF1的表达与其恶性表型相关,UHRF1可能参与HCC的侵袭和转移。     

原发性胆汁性肝硬化患者中β-arrestin 1表达增高及其意义

目的 探讨原发性胆汁性肝硬化(PBC)患者中β-arrestin 1的表达及其临床意义.方法 采用实时荧光定量PCR检测60例PBC患者、60例乙肝后肝硬化患者和60例健康体检者PBMCs中β-arrestin 1 mRNA水平,采用免疫印迹(western-blotting)技术检测β-arrestin 1蛋白表达水平.结果 PBC患者PBMCs中β-arrestin 1 mRNA的表达显著高于健康对照组和疾病对照组(P＜0.01),而疾病对照组和健康对照组PBMCs中β-arrestin 1 mRNA的表达差异无统计学意义(P＞0.05),并且β-arrestin 1表达水平与Mayo risk score正相关(Pearson r2=0.593 5,P＜0.001).PBC患者PBMCs中β-arrestin 1蛋白水平显著高于健康对照组和疾病对照组(P＜0.01),而疾病对照组和健康对照组比较差异无统计学意义(P＞0.05).结论 PBC患者中β-arrestin 1表达显著增高,提示β-arrestin 1在PBC发病机制中可能起着重要作用,有可能作为PBC疾病进程的一个新的免疫状态标志.     

ILK在非慢性排斥CAN患者移植肾组织的表达及其意义

目的 探讨非慢性排斥CAN(慢性移植肾病)患者移植肾组织中整合素连接激酶(ILK)、转化生长因子β1(TGF-β1)的表达,及与移植肾间质纤维化/肾小管萎缩(IF/TA)的关系.方法 用免疫组织化学技术和计算机真彩色图像分析系统半定量检测48例非慢性排斥CAN患者移植肾组织中ILK和TGF-β1的表达情况,分析二者间及与非慢性排斥CAN患者移植肾IF/TA病理分级之间的关系.15例正常肾组织作为对照.结果 非慢性排斥CAN各组间的移植肾组织中ILK、TGF-β1的表达比正常肾组织明显增加(P<0.01),并随IF/TA病理分级呈逐渐递增的趋势;非慢性排斥CAN移植肾组织中ILK的表达与TGF-β1呈正相关(r=0.930,P<0.01);ILK、TGF-B1表达水平分别与非慢性排斥CAN移植肾IF/TA病理分级呈正相天,(r=0.860、0.938;P<0.01);Scr与IF/TA病理分级呈正相关(r=0.790,P<0.01);ILK与SCr之间呈正相关关系(r=0.865,P<0.001).结论 ILK可能是介导TGF-β1促进非慢性排斥CAN患者移植肾细胞外基质(extra cellular matrix,ECM)异常沉积发病机制,ILK在非慢性排斥CAN患者移植肾纤维化细胞信号通路中起重要作用.     

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.