survivin蛋白在胃癌及癌前病变中的表达和意义

目的探讨survivin蛋白在胃癌及癌前病变中的表达程度和意义。方法收集南方医科大学南方医院消化科及佛山市三水区人民医院消化内镜室诊断并经病理确诊的病例。分为慢性浅表性胃炎组、慢性萎缩性胃炎组、慢性萎缩性胃炎伴轻度不典型增生组、慢性萎缩性胃炎伴中度不典型增生组、胃癌组共5组,每组40例,测定survivin蛋白在各组中的表达程度。结果 survivin表达在慢性浅表性胃炎组平均分值0.075±0.267,阳性率7.5%;在慢性萎缩性胃炎组平均分值0.600±0.744,阳性率45%;在慢性萎缩性胃炎伴轻度不典型增生组平均分值2.075±1.980,阳性率70%;慢性萎缩性胃炎伴中度不典型增生组平均分值4.225±2.402,阳性率95%;在胃癌组平均分值5.750±3.614,阳性率97.5%。survivin表达在胃高分化腺癌中,平均分值2.500±0.707;中分化腺癌平均分值8.750±3.495;低分化腺癌平均分值5.522±3.654;粘液腺癌平均分值3.200±0.837;印戒细胞癌平均分值6.000±0.000。结论 survivin在慢性浅表性胃炎-慢性萎缩性胃炎-不典型增生-胃癌的过程中阳性表达逐渐增高;但其在胃癌中的阳性表达与性别及肿瘤的大小和组织的分化程度无关。     

EGFR在胃肠良恶性病变表达的临床意义

收集慢性浅表性胃炎30例、胃炎伴不典型增生30例、胃癌54例、大肠癌93例、大肠良性病变76例组织标本,SABC法免疫组化染色检查表皮生长因子受体（EGFR）的表达.结果 胃肠炎组EGFR无阳性表达,胃炎伴不典型增生组阳性率43.33%,胃癌和大肠癌分别为51.85%、52.69%,癌细胞浸润深和有淋巴结转移组EGFR阳性率高.提示EGFR高表达与胃肠癌的发生、侵袭和转移有相关性.     

胃癌及癌前病变中P27和Cyclin E蛋白的表达意义

目的:探讨P27和CyclinE蛋白在胃癌及癌前病变中的表达及其与胃癌病理参数之间的关系.方法:用免疫组化技术(SP法)对正常胃黏膜(normalgastricmucosa,NGM)、慢性浅表性胃炎(chronicsuperficialgastritisCSG)、慢性萎缩性胃炎(chronicatrophiagastritis,CAG)伴肠上皮化生、慢性萎缩性胃炎伴非典型性增生各20例和胃癌(gastriccarcinoma,GC)60例标本进行免疫组织化学染色,分析P27和CyclinE蛋白表达及其与胃癌临床和病理的关系.结果:各组胃组织中P27和CyclinE蛋白表达阳性率分别为NGM组100%和5%,CSG组85%和10%,CAG伴肠化组70%和20%,CAG伴不典型增生组45%和30%,胃癌组38.3%和40%.胃癌组和CAG伴不典型增生组P27阳性率显著低于其他组(P<0.05),CyclinE阳性率则显著高于其他组(P<0.05).P27和CyclinE在胃癌中的表达分别与肿瘤分化程度、浸润深度及肿瘤临床分期相关,P27蛋白的表达尚与有无淋巴结转移相关.P27和CyclinE蛋白在胃癌中的表达呈显著负相关(r=-0.768,P<0.05).结论:检测胃癌组织中P27和CyclinE蛋白的表达有助于判断肿瘤的进展程度,两者联合检测有助于判断肿瘤预后.     

GST-π在胃腺癌与癌周组织中的表达

目的探讨π类谷胱甘肽S-转移酶（GST-π）在胃腺癌与癌周组织中的表达及其在胃癌发生发展中的意义。方法68例中晚期胃癌患者分别在胃腺癌组织及距癌灶边缘5cm以上癌周组织取活检4块，用SP免疫组化检测GST-π，比较不同分化程度胃腺癌组织及癌周组织中GST-π的表达水平。结果GST-π阳性率在胃腺癌组（82．35％）明显高于癌周组（50％），P〈0．01；癌周组织中慢性浅表性胃炎、慢性萎缩性胃炎、肠化生及不典型增生GST-π阳性率分别是20％、43．75％、52％和70．37％，不典型增生组显著高于慢性浅表性胃炎组（P〈0．05），其他各亚组间无统计学差异。结论GST-π在癌前病变组织中表达率开始上升并在癌组织中过度表达，提示GST-π可作为检测胃癌发病的指标。     

HSP60和CD44 V6在胃腺癌中的表达及其意义

目的研究热休克蛋白60(HSP60)、CD44V6在人胃癌组织中的表达.方法对60例非癌胃粘膜病变及50例胃腺癌组织手术及内镜活检石蜡标本,应用抗人HSP60,CD44V6单克隆抗体,以免疫组织化学检测方法检测HSP60,CD44V6的表达.结果 HSP60在慢性浅表性胃炎、肠上皮化生、不典型增生、胃腺癌的阳性率为30%,65%,70%,76%,过表达率为10%,25%,35%,58%.CD44V6在慢性浅表性胃炎、肠上皮化生、不典型增生、胃腺癌的阳性率为5%,25%,30%,78%,HSP60,CD44V6在肠上皮化生、不典型增生及胃腺癌中的阳性率和过表达率均明显高于慢性浅表性胃炎(P＜0.05);HSP60在胃腺癌组织的过表达率高于肠上皮化生和不典型增生(P＜0.05).HSP60在高、中、低分化胃腺癌中的阳性表达率为64.7%,77.7%,75.0%.HSP60在不同分化程度胃腺癌中表达无明显差异(P＞0.05),而CD44V6在高、中、低分化胃腺癌中的阳性表达率为64.7%,66.2%,91.7%,CD44V6在低分化胃腺癌的表达明显高于高、中度分化胃腺癌(P＜0.05).结论 HSP60,CD44V6在人胃癌及癌前情况或病变中过度表达,可能与胃腺癌的发生、发展有关,还可能有助于预测胃腺癌的分化程度.     

环氧化酶-2在胃癌和胃炎中的表达及其与幽门螺杆菌感染的关系

目的探讨环氧化酶-2(COX-2)在胃癌和胃炎中的表达及其与幽门螺杆菌(Helicobater pylori,HP)感染的关系,为胃癌的预防和治疗提供有价值的实验和理论依据。方法2004年11月至2005年4月中国医科大学附属第一医院门诊胃镜活检标本共128例,采用免疫组化技术检测COX-2在胃癌以及各型胃炎中的表达情况。结果胃癌和萎缩性胃炎伴不典型增生组织中COX-2的表达率明显高于浅表性胃炎(P<0.05),COX-2在萎缩性胃炎伴不典型增生HP感染阳性患者中的表达率明显高于HP感染阴性患者(P<0.05),高、中分化胃癌COX-2表达率高于低分化胃癌(P<0.05)。结论COX-2在胃癌组织中存在过表达,HP感染可使萎缩性胃炎伴不典型增生组织中COX-2表达增强,COX-2表达与胃癌分化程度有关。     

胃癌及癌前病变组织CD44V6表达的研究

目的:检测细胞粘附分子(CD44V6)在胃癌及癌前病变的表达,探索其与胃癌的发生、转移及预后的相关性.方法:用免疫组化方法检测30例浅表性胃炎,34例中重度萎缩性胃炎、34例不典型增生胃粘膜及64例胃癌组织中的CD44V6的表达.结果:CD44V6的阳性表达率在浅表性胃炎、中重度萎缩性胃炎、不典型增生胃粘膜及胃癌组织分别为3.33%(1/30)、14.71%(5/34)、44.12%(15/34)及60.94%(39/64).不典型增生及胃癌组阳性率明显高于浅表性胃炎组及中重度萎缩性胃炎组(均P＜0.01),中重度萎缩性胃炎与浅表性胃炎组比较差异无统计学意义;CD44V6的表达与胃癌的远处转移有关(P＜0.05),与TNM分期有关(P＜0.01),与淋巴结转移无关,与性别、肿瘤大小、大体类型、组织学分型、浸润深度间差异均无统计学意义.结论:用免疫组织化学方法检测胃活检标本中的CD44V6可能有助于胃癌早期诊断和远处转移趋势推测.     

环氧化酶-2在胃癌和胃炎中的表达及其与幽门螺杆菌感染的关系

目的探讨环氧化酶-2（Cyclooxygense-2，COX-2）在胃癌和胃炎中的表达及其与幽门螺杆菌（Helicobacter pylori，Hp）感染的关系，为胃癌的预防和治疗提供有价值的实验和理论依据。方法采用免疫组化技术检测COX-2、Hp在胃癌以及各型胃炎中的表达。结果胃癌和萎缩性胃炎伴不典型增生组织中COX-2的表达率明显高于浅表性胃炎（P〈0.05），COX-2在Hp感染阳性萎缩性胃炎伴不典型增生病人中的表达率明显高于Hp感染阴性组（P〈0．05），高、中分化胃癌COX-2表达率高于低分化胃癌（P〈0．05）。结论COX-2在胃癌组织中存在过表达，Hp感染可使萎缩性胃炎伴不典型增生组织中COX-2表达增强，COX-2表达与胃癌分化程度有关。     

胃腺癌组织中人第10号染色体缺失的磷酸酶及张力蛋白同源基因和环氧合酶-2的表达及相关性

目的探讨人第10号染色体缺失的磷酸酶及张力蛋白同源基因(PTEN)及环氧合酶(COX)-2在不同胃病变组织中的表达与胃腺癌发生及发展的关系。方法利用流式细胞术方法检测胃正常组织、萎缩性胃炎、胃不典型增生组织及胃腺癌组织中PTEN、COX-2蛋白及细胞增殖水平,分析不同分化程度胃腺癌组织中PTEN及COX-2蛋白表达水平,并分析胃腺癌组织细胞增殖与PTEN及COX-2蛋白表达的相关性。结果胃腺癌细胞增殖指数显著高于胃正常组织、萎缩性胃炎及胃不典型增生组织(P<0.01)。胃癌组织中PTEN蛋白表达水平显著低于胃正常组织、萎缩性胃炎及胃不典型增生组织(P<0.01),而胃癌组织中COX-2蛋白表达水平显著高于胃正常组织、萎缩性胃炎及胃不典型增生组织(P<0.01),不同分化程度的胃腺癌组织中PTEN及COX-2蛋白表达水平无显著差异(P>0.05),胃腺癌组织中细胞增殖指数与PTEN蛋白呈显著负相关(P<0.05),而与COX-2蛋白表达水平无显著相关性(P>0.05)。结论 PTEN及COX-2在胃组织细胞中的异常表达可能参与了胃细胞异常增生,致胃细胞增殖旺盛,从而参与了胃组织癌变的早期发生及发展。     

胃癌及癌前病变中的TFF-1、EGFR表达与血管再生的相关性研究

目的 探讨胃癌及癌前病变中三叶因子-1(trefoil factorl,TFF-1)、表皮生长因子受体(epidermal growthfactor receptor,EGFR)与血管形成的关系.方法 将121例患者存档标本分为萎缩性胃炎伴肠化生、不典型增生、高分化胃癌和低分化胃癌4组,另取29例体检正常人标本作为正常组.采用免疫组化SP方法测定TFF-1、EGFR值;同时所有对象用抗CD 34血管标记物表达测微血管密度(microvessel density,MDV)值,并进行相关性分析.结果 在正常对照组及萎缩性胃炎伴肠化生、不典型增生、高分化胃癌和低分化胃癌各组中,TFF-1阳性表达率分别为100.0%、85.18%、81.82%、64.00%、38.39%,呈逐渐减弱趋势.后4组与正常组比较有显著差异,高分化胃癌组表达高于低分化胃癌组(P<0.05);而EGFR在正常组、萎缩性胃炎伴肠化生、不典型增生、高分化胃癌和低分化胃癌组中的表达分别为24.13%、40.74%、42.42%、56.00%、72.22%,呈逐渐增加趋势.后4组与正常组比较有显著差异,高分化胃癌组表达低于低分胃癌组(P<0.05).结论 实验结果显示TFF-1与EGFR呈负相关(r=-0.913,P<0.01).EGFR值与MDV呈正相关(r=0.936,P<0.01).TFF-1与EGFR在胃癌的早期诊断中起重要作用,可以作为判断肿瘤转移与否及手术前肿瘤是否复发的评判标准.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.