Gestational trophoblastic neoplasia: diagnosis with Doppler US

The sonographic appearance of gestational trophoblastic neoplasia is nonspecific and also seen in complete or partial hydatidiform mole, hydropic degeneration, degenerating fibroids, or ovarian dysgerminomas. Correlation with the serum human chorionic gonadotropin (hCG) level may be helpful since levels exceeding 100,000 IU/L are strongly suggestive of gestational trophoblastic neoplasia. However, low hCG levels may also be found in the presence of this disease. The authors studied six patients who were suspected of having gestational trophoblastic neoplasia. Three of the six proved to have incomplete abortions or molar degeneration. Doppler ultrasound (US) was used to record the signal in the uterine arteries of these patients. The signals were compared with those of three nongravid volunteers and three patients in the first trimester of pregnancy. Analysis of the signals in the uterine artery showed higher systolic and diastolic Doppler shifts in gestational trophoblastic neoplasia when compared with postabortal, gravid, and nongravid signals. These preliminary results indicate that Doppler US has the potential to be clinically useful in the diagnosis of gestational trophoblastic neoplasia.     

Linkage of polymorphic congenital cataract to the gamma-crystallin gene locus on human chromosome 2q33-35

Cataract is one of the major causes of blindness in humans. We describe here an autosomal dominant polymorphic congenital cataract (PCC) which is characterised by wide variations in phenotype of non-nuclear lens opacities, even among affected members of the same family. PCC families included a large, unique pedigree (254 members, 103 affected individuals), and genetic linkage was conducted using a variety of polymorphic markers. Evidence for linkage was found for chromosome 2q33- 35 with PCC mapping near D2S72 and TNP1. A tri-nucleotide microsatellite marker for gamma-crystallin B gene (CRYG1) was found to co-segregate with PCC and yielded a maximum lod score of 10.62 at (theta = 0). A multipoint analysis demonstrated that the most probable location of the PCC gene was within an 8 cM genetic interval containing the gamma-crystallin gene cluster. These data provide strong evidence of the existence of an autosomal dominant mutation for PCC in or near the gamma-crystallin gene cluster. This defect is characterised by complete penetrance but variable expression of the cataract phenotype. Our study also suggests that non-nuclear human cataracts might be caused by some abnormality in gamma-crystallin genes.      

THE PHYSICIAN IN COURT: A VIEW FROM THE BENCH

Only lawyers and judges-and not even all of them-look forward to being in court. For the physician it is usually not an experience sought or savoured. Yet some physicians are in court more frequently than some lawyers because they are expert witnesses or because they have treated a person who is before the court in a civil or criminal case. There is also the physician who is sued and is thus a defendant. I believe it important that physicians know the basic ingredients of a civil action. I will be drawing on my experience as a trial judge for eight years and an Alberta Court of Appeal judge for five, and as a former professor in the faculties of law and medicine at the University of Alberta, to present the perspective from the bench on civil non-jury actions.     

p53、C-erbB-2癌基因蛋白在涎腺粘液表皮样癌中的表达及其临床病理学意义

目的探讨癌基因蛋白p53、C-erbB-2（p185）过度表达与粘液表皮样癌生物学行为的关系。方法利用微波免疫组织化学方法对32例人粘液表皮样癌的癌基因蛋白p53、C-erbB-2进行检测。结果正常诞腺组织p53、C-erbB-2均为阴性反应。癌旁导管上皮细胞两者阳性率分别为10.0％及15.0％,但腺泡细胞阴性。粘波表皮样癌组织中p53、C-erbB-2阳性率分别为40.6％及46.9％。p53、C-erbB-2在粘液细胞、表皮样细胞及中间细胞内均有表达。p53、C-erbB-2的表达与粘液表皮样癌肿瘤组织学类型、分化程度及肿瘤复发等肿瘤生物学行为密切相关（P＜0.01）。结论p53、C-erbB-2可作为粘液表皮样癌的分化性标志物,用于监测病情、判断预后等。     

美罗华联合CTOP方案治疗B 细胞非霍奇金淋巴瘤35例临床分析

目的:评价美罗华联合环磷酰胺、吡柔比星、长春新碱、泼尼松（R-CTOP 方案）治疗B 细胞非霍奇金淋巴瘤的疗效及不良反应,分析影响疗效的相关因素。方法:回顾性分析我院35例经病理证实为CD20+ 的B 细胞非霍奇金淋巴瘤患者的临床资料,评估R-CTOP 方案化疗的疗效及不良反应,分析性别、年龄、疾病分期、病理类型、LDH 水平及IPI 评分等影响疗效的相关因素。结果:35例患者中33例可评价疗效,其中完全缓解（CR）17例（51.5%）,部分缓解（PR）11例（33.3%）,有效率（CR+PR）84.8% 。23例初治患者中,CR13例（56.5%）,PR8 例（34.8%）,有效率（CR+ PR）91.3% ;10例复发难治患者中,CR4 例（40%）,PR3 例（30%）,有效率70% 。疗效与性别、疾病分期、病理类型、LDH 水平及IPI 评分等因素无显著相关,年龄对疗效有一定影响（P=0.012 ）。 35例患者中无治疗相关死亡,不良反应主要为骨髓抑制（Ⅲ～Ⅳ度白细胞下降32.1%）,心脏毒性和脱发较轻,主要为Ⅰ～Ⅱ级反应。其它不良反应经对症处理后均可耐受。结论:R-CTOP 方案治疗B 细胞非霍奇金淋巴瘤有效率高且不良反应轻微,可作为治疗B 细胞非霍奇金淋巴瘤特别是老年非霍奇金淋巴瘤患者的优先选择。      

人sTRAIL基因的克隆、表达纯化及对人A549细胞的抗肿瘤活性作用

目的人TRAIL基因胞外区片段(114-281氨基酸残基,sTRAIL)的克隆、表达、纯化及对人肺腺癌A549细胞的抗肿瘤活性研究。方法采用PCR技术从人胎盘和肺cD-NA文库中扩增出全长人TRAIL基因,克隆到pUC19质粒载体上进行测序。然后再采用PCR技术,以全长人TRAIL基因为模板,扩增出sTRAIL基因片段并定向克隆到pET-11 a表达载体中,转化大肠杆菌BL21进行表达。表达后的产物经变性、复性和分离纯化,纯化后的sTRAIL用结晶紫染色法和流式细胞仪法测定其对人肺癌细胞A549的细胞毒性作用。结果从人胎盘和肺cDNA文库中都能扩增出全长人TRAIL基因,经测序表明与已发表的人TRAIL基因序列一致。扩增出的人sTRAIL基因克隆到表达质粒载体pET-11a,经IPTG诱导表达,表达量占细菌全菌蛋白的50%,纯化后的sTRAIL纯度大于98%,结晶紫法测定对人A549肺癌细胞的细胞毒性作用的IC50为(24±5.2)μg.L-1,流式细胞仪法测定对人A549肺癌细胞的细胞毒性具有明显的效应-时间依赖关系。结论本实验成功地克隆了人sTRAIL基因并实现其高表达,摸索出包涵体sTRAIL的变性、复性及其纯化方法,纯化后的sTRAIL蛋白对人A549肺癌细胞具有明显的细胞毒性作用,为进一步研究其功能与临床应用奠定了基础。     

Endoscopic Mucosal Resection for Esophageal Cancer: EMR‐C Procedure

As a therapeutic modality for superficial esophageal cancer, endoscopic mucosal resection (EMR) is now thoroughly established. We routinely perform EMR using a cap (EMR‐C) procedure as a developer. In EMR‐C procedure, injection of a large volume of saline and a certain prelooping along the inner rim of the cap are vital issues for safe and reliable resection. In multi‐sessions of EMR, submucosal injection of saline prior to every session is essential, in order to avoid perforation. In such a manner, total circumferential EMR can be performed safely and easily by the EMR‐C procedure.