膀胱移性细胞癌p16基因缺失、突变、甲基化及其蛋白表达的研究

目的对25例膀胱移性细胞癌(bladder transitional cell carcinoma,简称膀胱癌)患者的p16基因第一、第二外显子纯合性缺失,第二外显子的点突变,第一外显子区5＇CpG岛的甲基化情况及p16蛋白表达进行检测,探讨p16基因在膀胱癌中失活的方式及p16蛋白表达与膀胱癌之间的关系. 方法取患者膀胱癌组织,用酚/氯仿法提取癌组织基因组DNA,设计p16基因第一、二外显子引物,采用聚合酶链反应(polymerase chain reaction,PCR)、PCR-单链构象多态性 (PCR-single strand conformational polymorphism, PCR-SSCP)、甲基化敏感限制性内切酶-PCR分析方法,对25例膀胱癌患者的癌组织基因组DNA的p16基因第一、二外显子的纯合性缺失、第二外显子点突变及第一外显子区5＇CpG岛的甲基化情况进行分析.应用S-P免疫组织化学方法检测25例膀胱癌和6例正常膀胱黏膜组织中p16基因的表达情况,并分析其意义. 结果在这25例膀胱癌患者中,发现p16基因第二外显子缺失者有4例,第一外显子和第二外显子共同缺失者有1例,第一外显子缺失者1例,p16基因的缺失率为24%(6/25);未发现p16基因第二外显子的点突变; p16基因第一外显子区5＇CpG岛的甲基化率为69.6%(16/23).p16基因表达在膀胱癌组织中阳性率为52%(13/25),6例正常膀胱黏膜组织中均阳性,两者比较差异有显著性(P<0.01).随病理分级、临床分期的上升和预后的不良,p16基因的阳性表达率有下降趋势,但差异无显著性(P＞0.05).结论 p16基因的失活方式主要有三种:纯合性缺失、点突变和5＇CpG岛的甲基化,但外显子2的纯合性缺失在安徽区域发生的膀胱癌中可能不是一个较频繁发生的"事件";通过p16基因第一外显子区5＇CpG岛异常甲基化失活可能是膀胱癌p16基因失活的主要机制.在这25例膀胱癌患者中,未发现p16基因的点突变,但仍不能排除这种失活机制,我们将通过扩大样本,进一步研究p16基因的点突变情况.p16基因表达产物与膀胱癌的发生发展及预后可能有关系,也有待于扩大例数进一步研究.p16基因表达产物可作为诊断膀胱癌的指标之一.     

γ射线诱发小鼠白血病模型中p16基因的改变

目的：研究γ射线诱发小鼠白血病模型中p16基因的失活机制。方法：应用聚合酶链反应(PcR)扩增39例γ射线诱发的白血病和对照小鼠胸腺组织中p16基因第1、第2外显子，检测等位基因纯合性缺失；用限制性内切酶-PCR法检测p16基因的甲基化发生情况；并应用PCR-单链构象多态性分析银染方法检测p16基因碱基突变的发生。结果：在白血病模型中，外显子2的缺失率为33．3％，甲基化的发生率为23．1％。结论：γ射线诱发的小鼠白血病模型发生、发展过程中伴有p16基因的改变，其失活以纯合性缺失和甲基化为主。     

急性淋巴细胞白血病p16基因纯合性缺失、点突变及启动子甲基化变异

目的 探讨急性淋巴细胞白血病(ALL)患者p16基因的失活机制。方法 从29例患者外周血提取白细胞基因组DNA,采用PCR、PCR—SSCP、MSP分析方法,对p16基因第二外显子的纯合性缺失、点突变及启动子区CpG岛的甲基化变异进行分析。结果 p16基因第二外显子的缺失率为27．6％(8／29),未见其点突变;p16基因启动子区CpG岛的甲基化率为13．8％(4／29)。结论 p16基因的失活和ALL的发生发展有一定的关系。     

脑星形细胞瘤p16基因缺失及5'CpG岛甲基化检测

目的探讨p16基因异常与脑星形细胞瘤发生、发展的关系。方法利用PCR及PCR-based甲基化技术检测了56例不同级别的脑星形细胞瘤组织p16基因缺失及5'CpG岛甲基化状况。结果18例高病理级别的脑星形细胞瘤发生了p16基因缺失,而低病理级别的脑星形细胞瘤无一例发生缺失（P<0.05）;6例脑星形细胞瘤发生了p16基因5'CpG岛甲基化。结论p16基因失活可能参与脑星形细胞瘤的病理发生、恶性进展。p16基因纯合缺失是p16基因失活的主要机制。     

原发性肝细胞癌中p16、p15、p53基因缺失、突变以及HBV DNA在肝细胞癌中整合的研究

目的构建人p16基因第二外显子cDNA克隆,制备其cDNA探针，建立p16基因第二外显子PCR-Southern Blot分析方法。研究原发性肝细胞癌(HCC)p16基因第一、二外显子、p15基因第二外显子纯合性缺失，p53基因第七外显子纯合性缺失、点突变以及HBV 前C区、S区、X区在HCC中整合情况。方法用RT-PCR获得p16基因第二外显子cDNA，将其插入质粒pGEM-T中，构建为重组质粒pGEM-pl6。经蓝白选择、限制性内切酶酶切图谱分析、DNA序列分析筛选获得重组质粒的阳性克隆，插入片段经限制性内切酶酶切、纯化后，用随机引物法标记地高辛，以此为探针，用Southern Blot方法分析p16第二外显子PCR产物。应用PCR、PCR-SSCP和PCR-RFLP等方法，对临床38例HCC手术后标本中的p16基因第一、二外显子、p15基因第二外显子、p53基因第七外显子纯合性缺失和点突变进行分析。应用PCR和3' 末端碱基特异性PCR分析肝细胞癌基因组HBV前C区野生型和突变型、PCR分析S区和X区整合的情况。同时检测了血清中HBV 前C区的阳性率。结果重组质粒的限制性内切酶酶切图谱分析表明其酶切位点与原设计相符，插入片段大小为307bp，与引物区间大小一致；地高辛标记探针可与p16 PCR产物杂交。发现在这38例HCC患者中，p16基因第二外显子的缺失率为34.2%，p16基因第一外显子和p15基因第二外显子未发现缺失；未发现p53基因第七外显子纯合性缺失，但4例存在p53基因249密码子点突变，且均为杂合型突变，突变率为10.53%。HBV前C区野生型阳性率为42.1%, 其中10例伴有突变型阳性(26.3%)。HBV X区阳性率为44.7%，HBV S区阳性率为50%。患者血清中，HBV 前C区野生型阳性率为15.8%, 突变型阳性率为18.4%。结论所获重组质粒为pGEM-pl6设计构建，并成功地获得p16第二外显子的cDNA探针和建立了p16 Southern Blot分析方法。所获结果提示在肝细胞癌中p16基因第二外显子的纯合性缺失是p16基因失活的一个重要方式，而纯合性缺失不是p15基因在肝细胞癌中的失活方式，但并不排除存在其它失活方式。p53基因第七外显子的杂合性突变提示有肿瘤遗传倾向。未发现纯合性点突变提示在肝细胞癌发生机制中p53基因第七外显子的点突变并不占据主导地位。HBV DNA 在原发性肝细胞癌基因组中可能存在整合,并在HCC发生过程中起一定作用。     

神经母细胞瘤p16基因甲基化研究

目的：明确在神经母细胞瘤中p16基因是否发生甲基化及其频率，阐明p16基因在神经母细胞瘤的作用机制，方法：应用PCR技术结合限制性内切酶FnuDII,SacII,HpaII为工具，对14例神经母细胞癌患者的14个原发灶及其中5例肿瘤周围正常组织p16基因第1外显子CpG岛进行了甲基化修饰的研究。结果：5例正常组织的p16基因第1外显子CpG岛未发生甲基化，而4例原发灶在II（1例），III（2例），IV（1例）期有甲基化发生。结论：神经母细胞瘤组织DNA中不存在p16基因的纯合性缺失，p16基因甲基化不可能为期失活的一种形式，II、III、IV期均有发生，可能是肿瘤发生的早期事件，同一患者的原发灶和转移灶，可有不同的甲基化模式，反映了肿瘤的异质性。     

神经母细胞瘤p16基因甲基化研究

目的　明确在神经母细胞瘤中p16基因是否发生甲基化及其频率,阐明p16基因在神经母细胞瘤中的作用机制。方法　应用PCR技术结合限制性内切酶FnuDⅡ、SacⅡ、HpaⅡ为工具,对14例神经母细胞瘤患者的14个原发灶及其中5例肿瘤周围正常组织p16基因第1外显子CpG岛进行了甲基化修饰的研究。结果　5例正常组织的p16基因第1外显子CpG岛未发生甲基化,而4例原发灶在Ⅱ(1例)、Ⅲ(2例)、Ⅳ(1例)期有甲基化发生。结论　神经母细胞瘤瘤组织DNA中不存在p16基因的纯合性缺失,p16基因甲基化可能为其失活的一种形式,Ⅱ、Ⅲ、Ⅳ期均有发生,可能是肿瘤发生的早期事件。同一患者的原发灶和转移灶,可有不同的甲基化模式,反映了肿瘤的异质性。     

原发性非小细胞肺癌中p16/MTS1基因外显子纯合性缺失的研究及临床意义

目的 检测原子性非小细胞肺癌（Non-small Cell Lung Cancer,NSCLC)手术标本p16基因（Multiple Tumor Suppressor Gene,MTS1)第一、二外显子纯合性缺失并探讨其与肿瘤细胞分化程度、组织类型、转移和预后的关系。方法 收集我院1999年1月－12月原发性支气管肺癌且手术病理证实为非小细胞肺癌32例。提取DNA,建立PCR方法分析p16基因第一、二外显子纯合性缺失,用Southern Blotting方法对p16第二外显子的PCR产物进行鉴定。结果 32例NSCLC患者中9例发生p16基因第二外显子的缺失,缺失率为28％（9／32）,p16第一外显子未发现缺失。结论 在原发性非小细胞肺癌中,p16基因第二外显子的纯合性缺失是p16基因失活的一个重要方式,且影响肺癌细胞其他生物学行为。     

成人急性白血病患者骨髓中p16基因的表达

目的：研究成人急性白血病患者p16基因纯合缺失和甲基化变化与其表达之间的关系，探讨其成人急性白血病发生发展中的生物学意义，方法：分别用多重聚合酶联反应（PCR）技术及甲基化敏感限制性内切酶－PCR技术检测了71例成人急性白血病患者DNA中p16基因纯合缺失及甲基情况；应用原位杂交及免疫技术检测p16基因mRNA及p16基蛋白表达，结果：71例成人急性白血病患者中，2例检测出p16基因纯合缺失，在无p16基因纯合缺失的病例中，5例急性淋巴细胞白血病（5／26）和9例急性髓性白血病（9／43）患者测出p16基因甲基化，p16mRNA及p16蛋白的阳性率分别为70．4％（50／71例）、61．9％（44／71例），结论：在成人急性白血病的发生发展中，p16基因甲基化比p16基因纯合缺失更具有意义；p16基因表达异常与成人急性白血病的发生发展密切相关。     

卵巢癌p16基因的纯合性缺失、突变及表达异常的研究

目的：研究p16基因的纯合性缺失，突变及表达异常与卵巢癌的发生是否存在相关关系。方法：采用PCR-SSCP检测卵巢癌p16基因的纯合性缺失和突变；采用RP-PCR定性及半定量分析p16基因；采用免疫组化技术检测p16蛋白。结果：32例卵巢癌中检测到1例外显子1突变，未检测到p16基因的纯合性缺失；RT-PCR分析卵巢癌中p16基因mRNA均有表达，半定量分析卵巢癌与正常卵巢组织中p16基因mRNA表达水平无差别；免疫组化检测9例卵巢癌中的p16蛋白为阴性（28.2%)。结论：卵巢癌的发生与p16基因的纯合性缺失和突变无相关关系，与p16基因异常表达有相关关系。     

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.