肝细胞癌并门静脉癌栓组织PDGFR的表达及意义

目的 探讨肝细胞肝癌(HCC)并门静脉癌栓(PVTT)组织中血小板衍生生长因子受体(PDGFR)的表达与微血管密度(MVD)的相关性及其临床意义.方法 采用免疫组织化学方法检测36 例HCC并PVTT组织、12例正常肝脏标本中PDGFR的表达与MVD计数.结果 HCC 并PVTT组织中PDGFR的表达阳性率及MVD计数明显高于癌旁组织及正常肝组织(÷2=4.732、6.321,t=5.432、6.852,P<0.05).PDGFR在TNM Ⅲ～ⅥA期肿瘤组织中的阳性率明显高于TNM Ⅱ期(P=0.008).分化差、肿瘤直径≥5 cm 和TNM Ⅲ～ⅥA期肿瘤组织MVD计数明显高于分化好、肿瘤直径< 5 cm 和TNM Ⅱ期者 (t=5.842~6.764,P<0.01).PDGFR表达阳性肿瘤组织的MVD明显高于PDGFR表达阴性组织(t=7.236,P<0.01).结论 HCC并PVTT 中PDGFR表达上调,可能通过促进肿瘤血管形成而参与HCC并发PVTT的发生和发展.     

肝癌组织中PTEN的表达及其与p53、细胞增殖和凋亡的关系

目的:研究肝细胞肝癌(HCC)组织中PTEN的表达与细胞增殖及凋亡的关系及其与p53的相关性,明确PTEN是否参与HCC的发生、发展. 方法:利用免疫组织化学技术检测47例经术后病理学证实的HCC组织、42例癌旁肝组织及10例健康肝组织中PTEN,p53,增殖性核抗原(PCNA)的表达;用TUNEL法检测HCC中细胞凋亡水平. 结果:10例正常肝组织、42例癌旁肝组织中PTEN全部阳性表达(100%);53%(25/47)的HCC组织PTEN蛋白表达缺失. PTEN的表达与肝癌细胞的增殖指数和凋亡指数无相关性,与肝癌的浸润转移具有相关性,与p53的表达有相关性. 结论:肿瘤抑制基因PTEN和p53有相互作用. PTEN蛋白表达缺失可能在HCC的进展过程中发挥主要作用.     

原发性肝癌Angiopoietin-2的表达与血管生成的关系

[目的]观察Angiopoietin-2在原发性肝癌中的表达情况及其与微血管密度(Micro-vessel density,MVD)的关系.[方法]免疫组化S-P法检测30例原发性肝癌组织的表达情况,并应用免疫组化S-P法检测An-giopoietin-2、CD34的表达,以CD34标记肿瘤微血管,并在显微镜下计数微血管密度(MVD).[结果]癌旁组织中无Angiopoietin-2表达,Angiopoietin-2在原发性肝癌表达阳性率为67%,其表达与原发性肝癌恶性程度、淋巴结转移相关(P＜0.01),而与侵犯深度组织学类型无关(P＞0.05);CD-34的表达与原发性肝癌的侵食性相关,而与有无包膜无关.Angiopoietin-2的表达与MVD呈正相关,Angiopoietin-2阳性表达组中MVD明显高于Angiopoietin-2阴性表达组(P＜0.01).[结论]Angiopoietin-2在原发性肝癌中高表达,在原发性肝癌的发生、发展中起重要的作用,与原发性肝癌的分化程度、侵袭性高低、血管生成有关.     

肝细胞肝癌组织中PTEN、CyclinD1及C-myc的表达及相关性研究

目的:通过检测PTEN、CyclinD1及C-myc蛋白在肝细胞肝癌(HCC)中的表达,了解其与HCC发生和发展的关系.方法:采用EnVisionTM plus免疫组织化学方法检测PTEN、Cyclin D1及C-myc蛋白在52例HCC及癌旁肝组织中的表达情况.结果:52例HCC中PTEN、CyclinD1及C-myc蛋白染色阳性表达率分别为42.3％(22/52)、48.1％(25/52)及53.8％(28/52),癌旁肝组织的阳性表达率为92.3％(48/52)、25.0％(13/52)及32.7％(17/52),PTEN、CyclinD1及C-myc在HCC及癌旁肝组织两者间差异有统计学意义(P＜0.05).在HCC中,PTEN与CyclinD1、C-myc的阳性表达均呈负相关(r=-0.3631,P=0.0197;r=-0.3697,P=0.0172);PTEN、CyclinD1及C-myc在人HCC组织中的阳性表达率与肝外转移、术后复发及肿瘤分化程度有关(P＜0.05).CyclinD1和PTEN的阳性表达率与门静脉癌栓有关(P＜0.05).结论:PTEN、CyclinD1及C-myc蛋白在HCC中过表达.PTEN与CyclinD1及C-myc阳性表达呈负相关,与HCC转移复发及肿瘤细胞分化有明显相关性.     

肝细胞肝癌组织中FN和PTEN基因表达水平及意义*

目的：研究FN和PTEN基因在肝细胞肝癌中的表达情况,探讨其在肝细胞肝癌发生发展中的作用及意义。方法：应用荧光实时定量PCR方法,检测84例肝细胞肝癌及癌旁组织中FN蛋白、PTEN蛋白、mRNA表达情况。分析FN和PTEN基因表达及肝细胞肝癌的关系。结果：FN蛋白主要定位于肝癌细胞外基质中。FN mRNA在肝细胞肝癌中的阳性率为79.76%,高于癌旁肝组织的阳性率9.52%,差异具有统计学意义（P<0.05）。PTEN蛋白明确定位于肝细胞胞质内。PTEN mRNA在肝细胞肝癌中的阳性率为38.09%,明显低于癌旁肝组织的阳性率100%,差异具有统计学意义（P<0.05）。FN在合并癌栓,淋巴结转移,AFP阳性,肿瘤数目多发的肝癌组织中的表达高,而在不同分化程度及不同肿瘤直径的肝癌组织中表达差异无统计学意义;PTEN在低分化肝癌细胞,合并癌栓,AFP阳性,淋巴结转移,肿瘤直径≥2cm的肝癌组织中表达较低,而在不同肿瘤数目的肝癌组织中表达无统计学意义,PTEN蛋白表达与HBsAg无关,与组织学分级及转移有关。结论：肝癌组织中FN mRNA的表达量高于癌旁组织,而肝癌组织中PTEN mRNA的表达量低于癌旁组织,FN和PTEN基因可能与肝细胞肝癌的发生发展有关,其可能在肝癌的发生发展、侵袭转移中起一定的促进或抑制作用。     

肝癌组织中PTEN蛋白及hTERT表达相关性研究

目的　探讨肝癌组织及癌旁肝组织中 10号染色体上缺失与张力蛋白同源的磷酸酯酶 (PTEN)蛋白的表达与人端粒酶逆转录酶 (hTERT)的相关性。方法　采用免疫组织化学法检测 76例肝细胞癌 (HCC)及癌旁肝组织中PTEN蛋白和hTERT的表达。结果　①HCC中PTEN蛋白的阳性率 (38 2 % )和阳性强度明显低于癌旁肝组织(96 1% ) (P <0 0 1) ,且阳性信号强度与HCC分化程度相关 (P <0 0 1) ,即HCC分化愈差 ,PTEN蛋白表达愈弱。②HCC中hTERT的阳性率 (89 5 % )和表达强度明显高于癌旁肝组织 (7 9% ) (P <0 0 1) ,且阳性信号强度与HCC分化程度有关 (P <0 0 1)。③相关性分析表明 ,HCC及癌旁肝组织中PTEN蛋白表达强度和hTERT呈明显负相关 (P <0 0 1)。结论　提示在HCC发生中 ,可能由于PTEN蛋白表达降低或缺失 ,不能有效地抑制由致癌因子异常激活的hTERT ,从而使肝细胞异常增殖和发生恶性转化。     

肝细胞性肝癌中DcR3的表达及其对微血管密度的影响

目的:研究在肝细胞性肝癌中陷阱受体3(DcR3)的表达及其对微血管密度的影响。方法:收集40例肝癌患者肿瘤组织,及其癌旁组织,20例正常肝组织,用RT-PCR法检测组织中DcR3 mRNA的表达,流式细胞技术检测组织细胞凋亡,免疫组化S-P法检测肝组织中CD34的表达,得到微血管密度(MVD)值。结果:27例(67.5%)肝癌患者可以检测到DcR3mRNA,而癌旁肝组织及正常肝组织均未检测出DcR3mRNA。肝癌组平均凋亡率高于癌旁组和正常对照组(p<0.05)。肝癌患者DcR3表达与性别和年龄无关(p>0.05);在较大肿瘤、TNM分期高、有淋巴结转移、肿瘤侵犯门静脉和包膜不完整的情况下表达增高(p<0.05)。肝癌组织中血管内皮细胞均有不同程度的黄染,肝癌组MVD明显高于癌旁组和正常对照组(p<0.05)。27例DcR3阳性患者MVD值为142.65±45.63,明显高于13例阴性患者MVD值110.37±42.82(p<0.05)。结论:DcR3在肝癌组织中表达明显增高,可能促进肝癌发生与发展;DcR3可能在评估肝癌肿瘤分化、浸润深度、淋巴结转移,血管形成以及TNM分期中十分重要。     

肝癌组织中CD146、微血管密度与临床病理关系的研究

目的:探讨肝细胞癌(hepatocellular carcinoma,HCC)组织中CD146(MCAM)和微血管密度(microvessel desity,MVD)与临床病理及血管生成的关系.方法:采用荧光实时定量聚合酶链反应(Real time PCR)技术和免疫组化法检测60例HCC癌组织及癌旁肝组织中CD146mRNA及其蛋白的表达情况,用CD34标记免疫组化法检测MVD.结果:CD146mRNA在HCC组织中的表达水平(0.0406±0.0135)明显高于癌旁肝组织中的表达水平(0.035 6±0.012 7)(P＜0.05);CD146蛋白在HCC组织中的阳性率为66.67%,而在癌旁组织中的阳性率为30%,两者差异有统计学意义(P＜0.05).癌组织的MVD为54.92±8.55/200倍视野,癌旁组织的MVD为21.36±6.63/200倍视野,两者差异有统计学意义(P＜0.01).CD146蛋白在HCC组织中的表达与临床分期、门静脉癌栓及肝外转移明显相关,MVD在HCC组织的水平与肝外转移、肿瘤直径、肿瘤个数相关.CD146表达阴性的HCC组织MVD(51.18±7.32/200倍视野)明显低于阳性组织MVD(56.28±8.88/200倍视野)(P＜0.05).结论:CD146高表达可能与HCC的发生、发展及术后复发有关;与HCC血管形成有关.     

PTEN和p53在肝细胞癌中的表达及其相关性

目的：探讨肝细胞癌（hepatocellular carcinoma,HCC）第10号染色体缺失的磷酸酶张力蛋白同源物基因（gene of phosphate and tension homology deleted on chromsome ten,PTEN）和p53蛋白的表达及其临床意义.方法：采用免疫组织化学EliVision方法测定70例HCC组织和40例相应的癌旁组织中PTEN和p53蛋白的表达,分析两个指标与临床病理特征之间的关系以及它们之间的相关性.结果：PTEN在HCC组织中的阳性率为57.1%,显著低于癌旁组织的95.0%（P＜0.01）.在肿瘤分期晚和有淋巴结转移的患者中,PTEN表达均降低（P〈0.01）.p53蛋白在HCC组织中表达率为60.0%,显著高于癌旁组织的15.0%（P＜0.01）.在肿瘤大小、病理分级、TNM分期和淋巴结转移等临床病理指标上,p53蛋白表达差异均无统计学意义（P〉0.05）.PTEN与p53蛋白表达在HCC组织中呈负相关关系（P＜0.05）.结论：PTEN低表达与HCC进展有关,有可能作为评价肝癌预后的指标.     

陷阱受体3在肝细胞性肝癌中的表达及其对血管生成的影响

目的 研究陷阱受体3(DcR3)在肝细胞性肝癌中的表达及对血管生成的影响.方法 收集40例肝癌患者肿瘤组织,40例癌旁组织,20例正常肝组织,用RT-PCR法检测组织中DcR3 mKNA的表达,流式细胞技术检测组织细胞凋亡,免疫组织化学SP法检测肝组织中CD34的表达,得到微血管密度(MVD)值.结果 27例(67.5%)肝癌患者可以检测到DcR3 mRNA,而癌旁肝组织及正常肝组织均未检测出DcR3 mR-NA.肝癌组平均凋亡率高于癌旁组和正常对照组(P＜0.05).肝癌患者DcR3表达与性别和年龄无关(P＞0.05);在较大肿瘤、TNM分期高、有淋巴结转移、肿瘤侵犯门静脉和包膜不完整的情况下表达增高(P＜0.05).肝癌组织中血管内皮细胞均有不同程度的黄染,肝癌组MVD明显高于癌旁组和正常对照组(PP＜0.05).27例DcR3阳性患者MVD值为(142.65±45.63).明显高于13例阴性患者MVD值(110.37±42.82)(P＜0.05).结论 DcR3在肝癌组织中表达明显增高,可能促进肝癌发生与发展;DcR3可能在评估肝癌肿瘤分化、浸润深度、淋巴结转移,血管形成以及TNM分期中十分重要.     

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.