胰腺导管腺癌甾体激素受体的检测及其意义

目的探讨胰腺癌甾体激素受体状态及其生物学特征。方法采用Ｓ－Ｐ免疫组化方法对５０例胰腺导管腺癌雌激素受体（ＥＲ）、孕激素受体（ＰＲ）进行检测。结果胰腺导管腺癌ＥＲ阳性率５０．０％（２５／５０）ＰＲ阳性率４６．０％（２３／５０）。ＥＲ、ＰＲ状态与癌组织的分化程度密切相关（Ｐ＜０．０１），癌组织分化越好，ＥＲ、ＰＲ水平越高。无转移的胰腺癌ＥＲ水平高于有转移灶者（Ｐ＜０．０５）。ＥＲ、ＰＲ水平与性别、年龄、ＴＭＭ分期均无明显关系（Ｐ＞０．０５）。结论胰腺癌组织内存在ＥＲ、ＰＲ，其水平反映了胰腺癌的生物学特性     

黄体酮胶囊在早期先兆流产中的临床应用效果

目的 了解黄体酮胶囊在早期先兆流产中的临床应用效果.方法 随机选取19例早期先兆流产患者作研究组,给予黄体酮胶囊治疗;另选取19例早期先兆流产患者作对照组,给予肌肉注射黄体酮针治疗,对比两组患者采用不同疗法后的治疗效果.结果 研究组患者口服黄体酮胶囊治疗后的保胎成功率为94.73％,对照组患者肌注黄体酮针治疗保胎成功率为68.42％,结果比较差异有统计学意义(P＜0.05).结论 黄体酮胶囊治疗早期先兆流产可避免因针剂注射为患者带来的痛苦,效果值得肯定.     

低分子肝素钠治疗D-二聚体升高复发性流产患者的临床研究

目的:探究低分子肝素钠+注射用绒促性素+黄体酮肌注治疗D-二聚体(D-D)升高复发性流产(RSA)患者的效果.方法:选取2018年3月至2019年3月周口市第一人民医院收治的298例D-D升高RSA患者作为研究对象,按照随机抽签法分为观察组(n=149)和对照组(n=149).对照组采用注射用绒促性素+黄体酮肌注治疗,...     

218例女性乳腺癌患者行新辅助化疗及伴随分子标志物改变的临床价值

目的 探讨乳腺癌新辅助化疗(NAC)的临床价值及可能适用人群,以及NAC对雌激素受体(ER)、孕激素受体(PR)、表皮生长因子受体2(Her-2)及增殖细胞核抗原Ki-67分子标志物表达状态的影响及表达变化的预后价值。 方法 选取2009年1月至2017年12月就诊于山东大学齐鲁医院的女性乳腺癌患者2 928例,经纳入标准与排除标准筛选,最终纳入患者1 817例,使用COX回归分析NAC组与辅助化疗组年龄、初诊时肿瘤大小、初诊时淋巴结状态、是否绝经、淋巴结转移个数、分子分型的临床病理学指标对患者预后的影响;根据NAC对ER、PR、Her-2、Ki-67表达的影响,分析分子标志物改变的预后价值。 结果 与行辅助化疗相比,肿瘤≤5 cm、转移淋巴结个数≥4个及三阴性乳腺癌的患者行NAC生存获益最高;50~80岁、初诊时淋巴结为阴性、已绝经者及Her-2阳性型乳腺癌患者行NAC生存获益最低;20~49岁、肿瘤>5 cm、初诊时淋巴结为阳性、未绝经者、淋巴结转移个数<4个及Luminal型患者行NAC有高复发风险;NAC前后ER、PR、Ki-67的改变差异有统计学意义(P<0.05),Her-2的变化无统计学意义的关联(P=0.754)。NAC前后ER、PR、Her-2的改变与乳腺癌患者的OS及DFS无统计学意义的关联(P>0.05),Ki-67由低表达变为高表达患者与Ki-67表达稳定及降低患者相比,OS与DFS较差,差异有统计学意义(P<0.05)。 结论 可手术的乳腺癌患者并不一定均适合行NAC治疗,需根据患者年龄、肿瘤大小、淋巴结转移状态、分子分型等临床病理指标及保乳意愿综合判断生存获益。NAC可改变乳腺癌ER、PR及Ki-67的表达状态,Ki-67的表达变化可作为NAC疗效的有效预测因子。     

冻融胚胎移植前血清雌、孕激素水平在体外受精 -胚胎移植治疗中对妊娠结局的影响

目的 探讨冻融胚胎移植前血清雌、孕激素水平在体外受精-胚胎移植(IVF-ET)治疗中对妊娠结局的影响.方法 回顾性分析2017年8月至2018年12月于马鞍山市妇幼保健院行IVF-ET助孕治疗的病人57例68个周期的临床资料,所有病人均接受冻融胚胎移植.记录所有病人的基线资料与妊娠结局并根据不同分组情况[移植前1天雌二醇(Estradiol,E2)水平、移植前1天孕酮(Progesterone,P)水平]并进行比较,行IVF-ET助孕病人临床妊娠的危险因素采用logistic回归分析.结果 根据移植前1天E2水平将所有病人分为E2<150 pg/mL组22例(27个周期)与E2≥150 pg/mL组35例(41个周期).E2<150 pg/mL组病人移植前1天E2水平明显低于E2≥150 pg/mL组,种植率31.82％、临床妊娠率37.04％均分别明显低于E2≥150 pg/mL组,且早期流产率20.00％明显高于E2≥150 pg/mL组(均P<0.05);两组其余基线资料比较均差异无统计学意义(均P>0.05).根据移植前1天P水平将所有病人分为P<18 ng/mL组24例(30个周期)与P≥18 ng/mL组33例(38个周期).P<18 ng/mL组病人移植前1天P水平明显低于P≥18 ng/mL组,种植率34.04％、临床妊娠率36.67％均分别明显低于P≥18 ng/mL组,且早期流产率18.18％明显高于P≥18 ng/mL组(均P<0.05);两组其余基线资料之间比较均差异无统计学意义(均P>0.05).以行IVF-ET助孕病人临床妊娠为因变量,对单因素分析中临床妊娠的可能危险因素进行logistic回归分析,结果显示年龄、体质量指数、移植前1天E2、移植前1天P、移植日内膜厚度及稳态模型评估(HOMA)指数HOMA-IR为行IVF-ET助孕病人临床妊娠的独立危险因素(均P<0.05).结论 IVF-ET治疗中冻融胚胎移植前1天血清E2、P水平可预测妊娠结局,且年龄、体质量指数、移植前1天E2和P、移植日内膜厚度及HOMA指数HOMA-IR均为行IVF-ET助孕病人临床妊娠的独立危险因素.     

Breast cancer in young women and prognosis: How important are proliferation markers?

AimCompared to middle-aged women, young women with breast cancer have a higher risk of systemic disease. We studied expression of proliferation markers in relation to age and subtype and their association with long-term prognosis.MethodsDistant disease-free survival (DDFS) was studied in 504 women aged <40 years and 383 women aged ≥40 years from a population-based cohort. Information on patient characteristics, treatment and follow-up was collected from medical records. Tissue microarrays were produced for analysis of oestrogen receptor, progesterone receptor (PR), Her2, Ki-67 and cyclins.ResultsYoung women with luminal tumours had significantly higher expression of Ki-67 and cyclins. Proliferation markers were prognostic only within this subtype. Ki-67 was a prognostic indicator only in young women with luminal PR+ tumours. The optimal cut-off for Ki-67 varied by age. High expression of cyclin E1 conferred a better DDFS in women aged <40 years with luminal PR− tumours (hazard ratio [HR] 0.47 [0.24–0.92]). Age <40 years was an independent risk factor of DDFS exclusively in women with luminal B PR+ tumours (HR 2.35 [1.22–4.50]). Young women with luminal B PR− tumours expressing low cyclin E1 had a six-fold risk of distant disease compared with luminal A (HR 6.21 [2.17–17.6]).ConclusionsThe higher expression of proliferation markers in young women does not have a strong impact on prognosis. Ki-67 is only prognostic in the subgroup of young women with luminal PR+ tumours. The only cyclin adding prognostic value beyond subtype is cyclin E1. Age is an independent prognostic factor only in women with luminal B PR+ tumours.     

Neuroendocrinology of childbirth and mother–child attachment: The basis of an etiopathogenic model of perinatal neurobiological disorders

This review focuses on the neuroendocrine mechanisms in the mother and the newborn that are involved in the generation and consolidation of mother–child attachment. The role that different hormones and neurotransmitters play on the regulation of these mechanisms during parturition, the immediate postpartum period and lactation is discussed. Interferences in the initiation of mother–child attachment may have potential long-term effects for the behavior and affection of the newborn. Therefore, the possible consequences of alterations in the physiological neuroendocrine mechanisms of attachment, caused by elective Cesarean section, intrapartum hormonal manipulations, preterm delivery, mother–infant postpartum separation and bottle-feeding instead of breastfeeding are also discussed.     

Circulating levels of anticonvulsant metabolites of progesterone in women with partial epilepsy in the intercritical phase

The 3alpha-hydroxy metabolites of progesterone (P), 3alpha-hydroxy-5alpha-pregnan-20-one (allopregnanolone, A-PREG) and 3alpha-hydroxy-5beta-pregnan-20-one (pregnanolone, PREG), have been found to be among the most potent ligands of gamma-aminobutyric (GABA)-A receptors; in experimental animals, they have been found to have anxiolytic, hypnotic and anticonvulsant effects. Similar to those of the benzodiazepines and barbiturates that interact with GABA-A receptors. The present study was undertaken to determine plasma A-PREG and PREG concentrations in the luteal phase in women with partial epilepsy, in order to determine if an impaired metabolism of P occurs in this convulsive disorder. We measured plasma P, A-PREG and PREG levels in 15 women with partial epilepsy in the intercritical phase, and in 15 age-matched healthy women, during the luteal phase of the ovarian cycle (22nd-24th day). The mean plasma ± S.E. A-PREG levels (three blood samples) were 0.7±0.6 ng/ml in the epileptic women and 0.5±0.2 ng/ml in controls, with no significant difference between the two groups (p=NS); the PREG levels were also similar (1.4±1 ng/ml and 1±1.1 ng/ml, respectively: p=NS). A significant correlation was found between P levels and both A-PREG and PREG levels (r=0.72, p<0.001 and r=0.79, p<0.001, respectively). There were no significant differences between the two groups in terms of serum adrenocorticotropic hormone, cortisol, dihydroepiandrosterone-sulfate, follicle stimulating hormone, prolactin, luteinizing hormone or estradiol levels.This work was partially supported by grants from the Ministero della Università e della Ricerca Scientifica e Tecnologica (M.U.R.S.T. 40% and 60%).     

Regulation of expression of cytochrome P-450 2D mRNA in rat brain with steroid hormones

Cytochrome P-450 2D is a subfamily of the cytochrome P-450-dependent mixed function oxidase system which is widely distributed in the various tissues of mammals. Sex steroid hormones have been shown to affect the expression of CYP2D in rat brain. Testosterone treatment of ovariectomized female rats elicits a dramatic increase in CYP2D expression, estrogen treatment brings about a modest increase in brain CYP2D expression and reduces the increase in CYP2D expression elicited with testosterone when the two hormones are coadministered. Polymerase chain reaction (PCR) has been used in our laboratory, as well as other laboratories, to measure the low levels of message for various P-450s in brain [Hodgson, A.V., White, T.B., White, J.W., Strobel, H.W., 1993. Expression analysis of the mixed function oxidase system in rat brain by the polymerase chain reaction. Mol. Cell. Biochem. 120, 171–179; Omiecinski, C.J., Redlich, C.A., Costa, P., 1990. Induction and developmental expression of cytochrome P450IA1 messenger RNA in rat and human tissues: detection by the polymerase chain reaction. Cancer Res. 50, 4315–4321]. In this study, competitive PCR (cPCR) approaches have been used to determine effects of progesterone and testosterone on CYP2D expression levels in brains of intact and ovariectomized female rats. When administered for seven treatments, testosterone significantly increases the expression of CYP2D in brain from intact female rats, while repeated treatment with progesterone elicits the opposite effect. Coadministration of testosterone and progesterone causes an intermediate effect such that the net result is an increase in expression only slightly above control levels. Interestingly, when ovariectomized female rats treated with testosterone and progesterone are used as a source of brain tissue for RNA preparation a similar trend toward an intermediate value is seen but the net result is an expression level of CYP2D below the control value. This approach utilizes cPCR to analyze the levels of CYP2D mRNA, semi-quantitatively and quantitatively, in the brains of female intact and ovariectomized Sprague–Dawley rats treated with testosterone, progesterone, a combination of the two or corn oil.