甲状腺乳头状癌组织中CDKN2A/p14~（ARF）蛋白表达及其临床意义

目的通过检测CDKN2A/p14ARF蛋白在甲状腺乳头状癌组织中的表达,探讨并分析CDKN2A/p14ARF在甲状腺乳头状癌发生发展中的作用和在癌旁正常甲状腺组织与甲状腺乳头状癌之间表达的差异。方法采用免疫组织化学方法（SP法）检测甲状腺乳头状癌和癌旁正常甲状腺组织中CDKN2A/p14ARF蛋白的表达情况,并进行统计学分析。结果 CDKN2A/p14ARF在甲状腺乳头状癌组织中表达阳性率87.8%（36/41）,其中阳性程度在（＋＋）以上者20例,占48.8%（20/41）。癌旁正常甲状腺组织阳性率为75%（15/20）,甲状腺乳头状癌和癌旁正常甲状腺组织之间差异有统计学意义（P〈0.05）。在甲状腺乳头状癌中CDKN2A/p14ARF蛋白表达与患者性别、年龄之间的差异无统计学意义（P〉0.05）。结论 CDKN2A/p14ARF在甲状腺乳头状癌中表达率极高,是甲状腺乳头状癌病理诊断中非常有价值的辅助诊断指标。     

甲状腺乳头状癌组织中CDKN2A/p14ARF蛋白表达及其临床意义

目的 通过检测CDKN2A/p14ARF蛋白在甲状腺乳头状癌组织中的表达,探讨并分析CDKN2A/p14ARF在甲状腺乳头状癌发生发展中的作用和在癌旁正常甲状腺组织与甲状腺乳头状癌之间表达的差异.方法 采用免疫组织化学方法(SP法)检测甲状腺乳头状癌和癌旁正常甲状腺组织中CDKN2A/p14ARF蛋白的表达情况,并进行统计学分析.结果 CDKN2A/p14ARF 在甲状腺乳头状癌组织中表达阳性率87.8%(36/41),其中阳性程度在(++)以上者20例,占48.8%(20/41).癌旁正常甲状腺组织阳性率为75%(15/20),甲状腺乳头状癌和癌旁正常甲状腺组织之间差异有统计学意义(P＜0.05).在甲状腺乳头状癌中CDKN2A/p14ARF蛋白表达与患者性别、年龄之间的差异无统计学意义(P＞0.05).结论 CDKN2A/p14ARF在甲状腺乳头状癌中表达率极高,是甲状腺乳头状癌病理诊断中非常有价值的辅助诊断指标.     

p53和cyclin D1蛋白在甲状腺癌组织中的表达及临床意义

目的探讨p53和cyclin D1蛋白在甲状腺癌组织中的表达情况及其临床意义。方法用免疫组化方法对68例甲状腺癌、46例甲状腺腺瘤和瘤旁甲状腺组织进行p53和cyclin D1的检测。结果 p53和cyclin D1在甲状腺癌组织中的阳性表达率为58.82%和63.23%,均高于其在甲状腺腺瘤和甲状腺腺瘤旁甲状腺组织中的阳性率,差异均有显著性（P〈0.01）。不同病理类型甲状腺癌组织中,p53和cyclin D1在乳头状癌中的阳性率分别为37.83%和40.54%,低于其在滤泡癌,髓样癌和未分化癌组织中的阳性率,差异均有统计学意义（P〈0.05）。p53和cyclin D1在甲状腺癌的阳性表达呈正相关（r=7.78,P〈0.05）。结论 p53和cyclin D1在甲状腺癌组织中的表达与癌细胞分化及恶性程度似有一定的关系。     

KAI1基因在甲状腺乳头状癌组织中的表达及意义

目的 探讨KAI1基因在人类甲状腺乳头状癌组织中的表达及其与临床病理特征和预后的关系.方法 应用Real Time-PCR检测21例甲状腺乳头状癌组织及相应的21例癌旁正常组织和7例甲状腺良性病变组织中KAI1 mRNA的表达情况,同时应用免疫组织化学法检测60例甲状腺乳头状癌组织和20例甲状腺腺瘤组织中KAI1蛋白的表达水平.结果 KAI1 mRNA在甲状腺乳头状癌组织中的表达量显著高于癌旁正常甲状腺组织（P＜0.05）及甲状腺良性病变组织（P＜0.05）.KAI1蛋白在甲状腺乳头状癌组织中的阳性表达率为68.3%,在甲状腺腺瘤组织中阳性表达率为25%,二者差异有高度统计学意义（P＜0.01）.KAI1蛋白在甲状腺乳头状癌无淋巴结转移组的阳性表达率要高于有淋巴结转移组,差异有统计学意义（P＜0.05）;KAI1蛋白在男性和女性患者中的阳性表达率差异无统计学意义（P＞0.05）.KAI1蛋白的表达与患者的年龄、肿瘤大小、TNM分期及包膜侵犯均无关（P＞0.05）.结论 KAI1 mRNA及其蛋白的异常表达与甲状腺乳头状癌的发生、发展有关,有助于甲状腺乳头状癌的治疗和预后判断.     

MGMT蛋白在甲状腺癌中的表达及其临床意义

目的：探讨O6-甲基鸟嘌呤-DNA甲基转移酶（O6-methylguanine-DNA methyltransferase, MGMT）在甲状腺癌组织中的表达及其临床意义。方法：用免疫组织化学SP法检测61例甲状腺癌、21例甲状腺良性腺瘤、15例桥本氏甲状腺炎、8例结节性甲状腺肿和12例癌旁正常组织中MGMT蛋白的表达,并结合临床病理因素进行分析。结果：MGMT在甲状腺癌组织中的表达与正常组织中的表达差异有统计学意义（P＜0.05）。MGMT表达从正常组织（16.67%,10/12）、结节性甲状腺肿（25.00%,2/8）、桥本氏甲状腺炎（60.00%,9/15）、甲状腺腺瘤（52.38%,11/21）到甲状腺癌（60.66%,38/61）中表达水平基本呈上升趋势。在甲状腺乳头状癌与甲状腺滤泡癌的表达差异有统计学意义（P＜0.05）,表达水平随甲状腺癌恶性程度的增加而降低,分别为乳头状癌（72.22%,26/36）、滤泡癌（50.00%,8/16）。MGMT在性别、年龄及民族组中表达差异均无统计学意义（P＞0.05）。结论：MGMT高表达现象可能与甲状腺癌恶性程度有关,可成为候选的临床分子诊断指标。甲状腺癌组织的MGMT蛋白在性别、年龄和民族组表达均无差异,有望成为通用的临床检测指标。     

碘钠同向转运体在新疆维吾尔族甲状腺乳头状癌中的表达及其临床意义

目的研究钠碘同向转运体(NIS)在新疆维吾尔族甲状腺乳头状癌组织标本及转移淋巴结组织中的表达及其临床意义。方法选取手术切除后经临床病理证实的新疆维吾尔族甲状腺乳头状癌存档标本72例,采用免疫组织化学检测NIS在甲状腺癌组织、癌旁组织以及转移淋巴结组织中的表达,分析NIS在甲状腺癌组织中的分布特点及其与临床病理各参数间的相互关系。结果 (1)甲状腺乳头状癌组织中NIS表达阳性率为80.56%,在癌旁正常甲状腺组织中的NIS阳性表达率为30.56%,差异有统计学意义(P<0.05);(2)Ⅰ、Ⅱ期甲状腺癌组织中NIS表达阳性率为87.88%,Ⅲ、Ⅳ期甲状腺癌组织中NIS表达阳性率为74.36%,随着临床分期的递增,甲状腺癌组织中NIS表达阳性率出现降低趋势,但差异无统计学意义(P>0.05);(3)在有淋巴结转移和无淋巴结转移的甲状腺乳头状癌患者中NIS表达阳性率分别为68.97%和42.86%,差异有统计学意义(P<0.05);(4)在肿瘤直径≤2cm和>2cm的甲状腺乳头状癌组织中NIS表达阳性率分别为93.02%和62.07%,差异有统计学意义(P<0.05)。结论新疆维吾尔族甲状腺乳头状癌组织中NIS的表达随着临床分期增加而逐渐降低,在有淋巴结转移患者中NIS的表达显著增加,同时随着瘤体体积的增大NIS的表达显著下降。     

甲状腺乳头状癌中C-erbB-2、Ki-67的表达及意义

目的 探讨C-erbB-2基因蛋白、Ki-67基因蛋白在甲状腺乳头状癌的表达及临床意义.方法 应用免疫组织化学SP法检测C-erbB-2、Ki-67在45例甲状腺乳头状癌、50例结节性甲状腺肿伴乳头状增生组织的表达.结果 在甲状腺乳头状癌中C-erbB-2阳性表达率为46.67%（21/45）、Ki-67阳性表达率为42.22%（19/45）;C-erbB-2、Ki-67在甲状腺乳头状增生中均呈低表达,阳性率分别为18.00%（9/50）、12.00%（6/50）,两组间阳性表达率差异均有统计学意义（P＜0.01）.在甲状腺乳头状癌中,C-erbB-2阳性表达与淋巴结转移、分化程度及临床分期有关（P＜0.05）;Ki-67阳性表达与淋巴结转移及临床分期有关（P＜0.05）,分化较差者Ki-67阳性表达高于分化较好者,但差异无统计学意义（P＞0.05）.结论 C-erbB-2、Ki-67在甲状腺乳头状癌中起重要的调控作用,是判断其预后的重要参考指标.     

S100A4蛋白在甲状腺良恶性病变组织中的表达及其意义

目的 探讨甲状腺良恶性病变组织中S100A4蛋白的表达及其临床意义.方法 应用微波-LSAB免疫组化法检测50例甲状腺癌、45例甲状腺腺瘤和20例癌旁甲状腺组织中S100A4蛋白的表达.结果 S100A4蛋白表达阳性率在甲状腺癌组织中（78.0%）显著高于甲状腺腺瘤（15.6%）和癌旁甲状腺组织（全部阴性）（P＜0.01）.S100A4蛋白表达阳性率与甲状腺癌组织类型无关;有淋巴结转移者显著高于无淋巴结转移者（P＜0.05）;临床分期Ⅲ～Ⅳ期病例显著高于Ⅰ～Ⅱ期病例（P＜0.05）.S100A4蛋白阳性的甲状腺癌复发及病死率显著高于阴性者（P＜0.05）.结论 检测S100A4蛋白表达,有助于鉴别甲状腺良、恶性病变,作为一种预测甲状腺癌转移的分子标志物,对评估患者预后具有一定临床价值.     

CyclinD1和Bax在甲状腺微小乳头状癌中的表达及意义

目的 探究细胞周期蛋白D1 (CyclinD1)和B淋巴细胞瘤-2相关X蛋白(Bax)蛋白在甲状腺微小乳头状癌中的表达及其价值.方法 选取2014年1月至2015年6月该院病理科存档的甲状腺疾病手术病例石蜡标本,应用免疫组织化学(MaxvisionTM/HRP免疫组织化学染色法),以单克隆抗体兔抗人CyclinD1和鼠抗人Bax标记检测72例甲状腺微小乳头状癌、65例腺瘤组织和60例癌旁甲状腺正常组织,观察不同甲状腺组织中CyclinD1和Bax蛋白表达情况.结果 CyclinD1蛋白表达在甲状腺微小乳头状癌中的阳性率为79.17％,与腺瘤组织(x2=14.730,P＜0.01)、癌旁甲状腺正常组织(x2=80.404,P＜0.01)的表达差异有统计学意义,其与患者年龄、性别及淋巴结转移无明显关联(P＞0.05).Bax蛋白表达在甲状腺微小乳头状癌中的阳性率为66.67％,与腺瘤中的表达差异无统计学意义(P＞0.05),与癌旁甲状腺正常组织的表达差异有统计学意义(P＜0.01),其与淋巴结转移有关联(x2 =4.598,P＜0.05),与患者年龄、性别无明显关联(P＞0.05).甲状腺微小乳头状癌中CyclinD1与Bax蛋白表达呈正相关关联(x2=11.463,r=0.435,P＜0.01).结论 CyclinD1和Bax蛋白在甲状腺微小乳头状癌中高表达,与甲状腺微小乳头状癌的发生、发展相关,两者联合检测有助于对甲状腺微小乳头状癌的诊断.     

人甲状腺肿瘤组织中c-Met mRNA和蛋白的表达

目的:检测甲状腺良恶性肿瘤组织中c-Met mRNA和蛋白的表达.方法:应用原位杂交技术和免疫组织化学SP法检测50例甲状腺腺癌(甲状腺乳头状腺癌20例,滤泡状腺癌20例和嗜酸细胞腺癌10例)、50例甲状腺腺瘤(甲状腺乳头状腺瘤20例, 滤泡状腺瘤20例和嗜酸细胞腺瘤10例)及10例瘤旁上皮组织中c-Met mRNA及蛋白的表达.结果:甲状腺腺癌组织中c-Met mRNA(78%)和蛋白(84%)阳性表达率均明显高于腺瘤组织(48%,60%)(P＜0.01),且滤泡性腺癌组织中(70%)均明显高于滤泡性腺瘤组织(30%)(P＜0.05).结论:甲状腺癌组织中c-Met基因在mRNA和蛋白表达水平均增强,检测c-Met基因的表达有助于阐明甲状腺肿瘤的发病机制,并为甲状腺肿瘤的鉴别诊断、治疗及预后判断提供参考.     

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.