骨桥蛋白在宫颈组织中的表达及与宫颈癌进展的相关性研究

目的探讨骨桥蛋白(osteopontin,OPN)在正常宫颈、CIN及宫颈癌组织中的表达与宫颈癌发生、发展、侵袭和转移关系。方法采用免疫组织化学S-P法检测正常宫颈组织、CIN和宫颈癌组织中OPN的表达情况。结果 OPN在正常宫颈组织、CIN和宫颈癌中的阳性表达率呈上升趋势,三组比较有显著性差异(P<0.05);在CINⅠ组和CINⅡ-Ⅲ组中的阳性表达率呈上升趋势,但两组比较无显著性差异(P>0.05)。在宫颈癌组织中表达:OPN的阳性表达率随临床期别的增加、组织分化程度的降低而增高,差异有显著性;OPN在无淋巴结转移宫颈癌组织中的阳性表达率显著高于有淋巴结转移组(P<0.05)。结论OPN在组织中的阳性表达率由正常宫颈组织→CIN→宫颈癌呈递增趋势,表明了OPN在宫颈癌的发生、发展中发挥了重要的作用。OPN在宫颈癌组织中的表达与宫颈癌的临床分期、组织分化程度及淋巴结转移有一定的相关性,为OPN可望成为判断宫颈癌预后的肿瘤标志物及成为宫颈癌治疗的靶基因奠定基础。     

PI3K表达与宫颈鳞状细胞癌局部血管生成和浸润转移及预后的关系

目的探讨PI3K在宫颈鳞状细胞癌(SCC)组织的表达及其临床意义。方法采用免疫组化SP法检测PI3K在28例宫颈正常上皮(NCE)、36例宫颈上皮内瘤变(CIN)和68例SCC组织的表达,并检测其中Ki-67标记的增殖指数(PI)和CD34标记的微血管密度(MVD)。结果 PI3K在NCE、CIN及SCC组的阳性表达率分别为25.00%、55.56%及85.29%。PI3K在SCC组的阳性表达率分别显著高于CIN和NCE组(P0.05)。PI3K在SCC组表达分别与PI及MVD显著正相关。PI3K在SCC组表达分别与FIGO分期、组织学分级及有否盆腔淋巴结转移有关(P0.05),而与患者年龄、有否脉管浸润、间质浸润深度及生存率无关(P0.05)。宫颈鳞癌FIGO分期为Ⅱ期、组织学分级为Ⅲ级及有盆腔淋巴结转移者,其PI3K阳性表达率分别显著高于FIGO分期为Ⅰ期、组织学分级在Ⅱ级以内及无盆腔淋巴结转移者(P0.05)。结论 PI3K过度表达可能上调宫颈鳞癌细胞增殖及间质血管新生,可能促进宫颈鳞癌转移、从而促进其病程进展。     

KiSS-1蛋白和MMP-2在宫颈癌中的表达及临床意义

目的探讨KiSS-1蛋白和基质金属蛋白酶-2（MMP-2）在宫颈癌前病变及宫颈癌组织中的表达及其意义。方法应用免疫组织化学法检测KiSS-1蛋白和MMP-2在正常宫颈组织、宫颈上皮内瘤变（CIN）组织及宫颈癌组织中的表达情况。结果 KiSS-1蛋白和MMP-2在正常宫颈组织、CIN组织及宫颈癌组织中的阳性表达率分别为77.8%、86.4%、44.7%、16.7%、31.8%、63.2%,随着宫颈疾病的进展,KiSS-1蛋白的阳性表达率逐渐下降,而MMP-2呈相反趋势,差异均具有显著性（P〈0.05）。在宫颈鳞癌组织中KiSS-1蛋白的阳性表达率与肿瘤的组织学分级、浸润深度及临床分期有关（P〈0.05）,而与是否伴有淋巴结无关（P〉0.05）。在宫颈鳞癌组织中MMP-2的阳性表达率与肿瘤的浸润深度及临床分期有关（P〈0.05）,而与组织学分级及是否伴有淋巴结转移无关（P〉0.05）。宫颈癌组织中KiSS-1蛋白和MMP-2的阳性表达程度呈负相关（γ=-0.427,P〈0.05）。结论 KiSS-1对宫颈癌的浸润及转移有抑制作用;MMP-2则对宫颈癌的转移有促进作用,联合检测KiSS-1和MMP-2的表达有望成为判定宫颈癌浸润及转移能力的重要指标之一。     

转录因子Twist、Snail在宫颈鳞癌中的表达及其与血管生成的关系

目的探讨Twist、Snail蛋白在宫颈鳞癌组织中的表达情况及其与微血管密度的关系。方法采用免疫组织化学方法对60例宫颈鳞癌组织Twist及Snail蛋白的表达进行检测,分析其与临床病理特征的关系。CD34抗体标记癌组织内血管内皮细胞数量,计算微血管密度(MVD)。结果宫颈鳞癌组织中Twist及Snail的阳性表达均与患者的组织学分级及临床分期无关(P0.05),与淋巴结转移有关(P0.05)。Twist及Snail阳性表达组MVD显著高于Twist、Snail阴性组。在宫颈鳞癌组织中Twist及Snail蛋白的表达之间存在显著正相关(r=0.529,P0.05)。结论宫颈鳞癌组织中存在Twist及Snail蛋白的高表达,两者的联合表达可能增加肿瘤细胞的侵袭力,并且可以通过微血管生成在宫颈鳞癌的浸润、转移过程中发挥促进作用。     

p53,Ki-67及E-钙黏蛋白在三阴性乳腺癌中的表达及预后

目的:探讨p53,Ki-67及E-钙黏蛋白(E-cadherin)在三阴性乳腺癌(triple negative breast cancer,TNBC)组织中的表达及预后的关系。方法:采用免疫组织化学法检测52例TNBC和52例非三阴性乳腺癌(non-triple-negative breast cancer,NTNBC)组织中p53,Ki-67及E-cadherin表达情况,观察3个指标与TNBC患者临床病理学特征及预后的关系。结果:TNBC组织中p53,Ki-67及E-cadherin的阳性表达率分别为67.3%,80.8%,26.9%;而在NTNBC组织中为44.2%,61.5%,48.1%(均P0.0 5)。在TNBC组织中,p 5 3表达阳性与肿瘤大小、TNM分期及组织学分级有关(均P0.0 5);Ki-67表达阳性与TNM分期、淋巴结转移有关(均P0.05);E-cad her in表达阳性与肿瘤大小、TNM分期、淋巴结转移有关(均P0.05)。在TNBC患者中,p53,Ki-67及E-cadherin表达阳性者与阴性者总体生存率(overall survival,OS)的差异均有统计学意义(P0.05)。Cox回归分析多因素显示:淋巴结转移、p53、Ki-67及E-cadherin表达是影响TNBC患者总体生存率的独立预后因素(均P0.05)。结论:TNBC组织中,p53、Ki-67高表达,其表达阳性者预后差,E-cadherin低表达,其表达阳性者预后良好。联合检测p53、Ki-67及E-cadherin表达可为TNBC患者的治疗提供新靶点。     

Ezrin及其相关蛋白在乳腺癌组织中的表达及临床意义

目的:研究乳腺癌组织中Ezrin、CD44v6及E-cadherin蛋白的表达及其临床病理意义。方法:应用免疫组化SP法,检测56例乳腺癌组织、30例癌旁正常乳腺组织组织标本中Ezrin、CD44v6、E-cadherin的表达情况。结果:(1)乳腺癌组织中Ezrin、CD44v6和E-cadherin的表达率分别为62.50%、76.79%和26.79%,与正常乳腺组织相比差异有统计学意义(P0.05)。(2)Ezrin、CD44v6的表达与乳腺癌的原发肿瘤大小、组织学分级、临床TNM分期和淋巴结转移有关(P0.05);E-cadherin的下调表达与乳腺癌的组织学分级、临床TNM分期和淋巴结转移有关(P0.05)。(3)在浸润性导管癌中Ezrin与CD44v6表达水平呈显著正相关(P0.05),而与E-cadherin表达水平呈显著负相关(P0.05)。结论:联合检测Ezrin、CD44v6和E-cadherin的表达有助于预测乳腺癌的恶性程度和转移潜能。     

检测骨桥蛋白的表达与声门上型喉鳞状细胞癌临床病理指征的相关性

目的探讨声门上型喉鳞状细胞癌(SGLSCC)组织中骨桥蛋白(OPN)表达及其临床意义。方法采用免疫组化方法检测在37例SGLSCC组织、15例喉正常组织中的OPN蛋白表达,探讨OPN蛋白表达与患者的临床分期、病理学组织分级及淋巴结转移等临床病理指征的相关性。结果 OPN在SGLSCC中的阳性表达率为67.57%,显著高于正常喉组织中的阳性表达率(13.33%),两者对比P<0.05;且OPN在SGLSCC中的表达与临床分期、病理组织学分级、颈部淋巴结转移有明显相关(P<0.05)。结论 OPN在SGLSCC中的表达明显高于喉正常组织,且与患者的临床分期、病理学分级、颈部有无淋巴结转移密切相关,提示OPN蛋白可能参与声门上型喉癌的发生、发展及转移。     

CyclinD1和P27在宫颈鳞癌中的表达及临床意义

目的研究CyclinD1和P27蛋白在宫颈鳞状细胞癌发生、发展中的作用及其与宫颈鳞癌临床病理特征的关系。方法应用SP免疫组化法检测40例宫颈鳞癌,25例宫颈不典型增生组织中CyclinD1和P27蛋白的表达,取正常宫颈组织10例作为对照。结果CyclinD1在宫颈鳞癌中呈高表达,P27在宫颈鳞癌中呈低表达,与对照组均有组间差异(P<0.05)。在鳞癌组中,CyclinD1与P27的异常表达与组织学分级,临床分期和淋巴结转移有关(P<0.05),且二者在宫颈鳞癌中的表达呈负相关(rs=-0.397)。结论CyclinD1癌基因和P27抑癌基因突变协同作用于鳞状细胞癌的发生与发展。二者的检测可作为评价宫颈鳞状细胞癌恶性程度和判断预后的重要指标。     

BRCA1和E-cadherin在食管鳞癌中的表达及意义

目的探讨乳腺癌易感基因1(BRCA1)和E-cadherin在食管癌组织中表达情况并探讨其意义。方法采用SP免疫组织化学法检测120例食管鳞癌以及60例上皮内瘤变患者BRCA1和E-cadherin的表达情况,分析两者的临床病理关系。结果 BRCA1在正常食管黏膜、食管上皮内瘤变和食管鳞癌中阳性表达率分别为27.5%、58.3%、80.8%,食管鳞癌病例中的BRCA1的阳性表达明显高于食管上皮内瘤变组和正常食管黏膜组(P<0.05)。食管鳞癌病例中的BRCA1的阳性表达与大体类型和淋巴结转移情况有关(P<0.05)。E-cadherin在正常食管黏膜、食管上皮内瘤变和食管鳞癌中阳性表达率分别为100%、30.0%、16.7%。E-cadherin在食管鳞癌组织的阳性表达明显低于正常食管黏膜组和上皮瘤变组(P<0.05)。食管鳞癌组中E-cadherin的阳性表达随着肿瘤分化程度的增高而降低以及有无淋巴结转移和肿瘤有关(均P<0.05)。相关性分析显示在食管鳞癌组中,BRCA1和E-cadherin的表达呈负相关(P<0.05)。结论 BRCA1在食管鳞癌中的阳性表达与患者预后不良有关,有望成为评估食管鳞癌生物学行为的新的生物标记物。     

E-钙黏蛋白、β-连环蛋白于宫颈癌中的表达情况及临床意义

目的:探讨E-钙黏蛋白(E-cadherin)、β-连环蛋白(β-catenin)于宫颈癌中的表达情况及临床意义。方法:收集2014年12月～2018年5月我病理中心通过病理检查证实的72例宫颈癌、46例宫颈上皮内瘤变(CIN)和38例正常宫颈组织石蜡包埋标本,以免疫组织化学SP法测定3组标本E-cadherin、β-catenin表达,并分析E-cadherin、β-catenin表达和宫颈癌患者临床病理参数之间的关系。结果:宫颈癌组织中E-cadherin阳性表达率均明显低于CIN及正常宫颈组织,β-catenin阳性表达率均明显高于CIN及正常宫颈组织,P0.05;临床分期是Ⅱ期、组织分化程度是低分化及有淋巴结转移患者E-cadherin在宫颈癌组织中的阳性表达率均明显低于临床分期是Ⅰ期、组织分化程度是高、中分化及无淋巴结转移患者,P0.05;临床分期是Ⅱ期、组织分化程度是低分化及有淋巴结转移患者β-catenin在宫颈癌组织中的阳性表达率均明显高于临床分期是Ⅰ期、组织分化程度是高、中分化及无淋巴结转移患者,P0.05。结论:E-cadherin在宫颈癌中呈低表达,β-catenin呈高表达,且两者表达水平与肿瘤临床分期、组织分化程度及淋巴结转移情况密切相关。     

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.     

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。     

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.     

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.