PCNA在宫颈鳞癌组织中的表达及意义

目的探讨细胞核增值抗原（proliferating cell nuclear antigen,PCNA）在宫颈鳞癌和宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）组织中的表达及意义。方法采用免疫组织化学S-P法检测92例宫颈鳞癌、40例CIN和92例宫颈正常组织的PCNA蛋白表达情况。结果宫颈鳞癌组织PCNA阳性表达率为82.61%（76/92）;CINⅠ、CINⅡ和CINⅢPCNA阳性表达率分别为33.33%（5/15）、71.43%（10/14）和81.82%（9/11）,正常宫颈组织无PCNA表达。宫颈鳞癌、CINⅡ和CINⅢ组织PCNA阳性表达率明显高于CINⅠ（P〈0.01）;但宫颈鳞癌PCNA表达与CINⅡ、CINⅢ比较,差异无统计学意义（P〉0.05）。PCNA阳性表达与宫颈癌分期（r=0.634,P〈0.01）、组织学分级（r=0.654,P〈0.05）有关;而与年龄无关（r=0,P〉0.05）。结论 PCNA的阳性表达可能与宫颈癌的发生、发展及细胞增殖活性增加有关。     

CD1a和E-cadherin在宫颈上皮内瘤变中的表达

目的:探讨CD1a和E-cadherin与宫颈癌发生发展的关系及作为早期癌变生物学指标的可能性。方法:采用免疫组化SP法检测CD1a和E-cadherin在同期56例宫颈上皮内瘤变、56例宫颈鳞癌和15例正常宫颈组织中的分布及表达。结果:(1)CD1a+朗格汉斯细胞在正常宫颈、CIN和宫颈癌各组中数量逐渐减少,两两比较有显著差异(P0.01);CIN中该细胞数量随病变严重程度减少,CINⅠ和CINⅡ、CINⅠ和CINⅢ组之间两两比较有显著差异(P0.05),而CINⅡ与CINⅢ组间无显著差异(P0.05);(2)E-cadher-in在正常宫颈、CIN和宫颈癌各组中的阳性表达率及强度逐渐下降,两两比较有显著差异(P0.05);在CIN中阳性表达率及表达强度随病变严重程度呈下降趋势,CINⅠ和CINⅡ、CINⅠ和CINⅢ之间两两比较有显著差异(P0.05),而CINⅡ和CINⅢ之间无显著差异(P0.05);(3)宫颈组织中CD1a+朗格汉斯细胞的细胞数与E-cadherin的阳性表达率及强度呈正相关(r=0.912,P0.05)。结论:CD1a+朗格汉斯细胞与E-cadherin可能在宫颈癌的发生、发展过程中起重要作用。     

宫颈病变中双链RNA依赖的蛋白激酶与HPV感染的相关性

目的：通过检测双链RNA依赖的蛋白激酶（PKR）、人乳头瘤病毒（HPV）在宫颈病变组织中的表达,探讨PICR在宫颈病变发生发展中的意义及可能机制。方法：选择临床病历资料和病理资料完整的宫颈癌患者共37例、同期宫颈上皮内瘤样病变（CIN）Ⅰ-Ⅲ患者56例为研究对象,因子宫肌瘤等良性病变切除子宫的正常宫颈组织30例为对照。采用免疫组织化学SABC法检测PICR及HPV16/18E6的表达。分析二者与宫颈病变发生发展的关系。结果：宫颈癌组织中PKR表达阳性率为54．1％,高于CINⅢ。CINⅠ-Ⅱ组和正常宫颈组,差异有统计学意义（P〈O．05）;在宫颈癌组中PICR表达与HPV16／18E6表达存在负相关（r=-0．554,P〈0．05）;在CINⅢ组中PKR表达与HPV16／18E6表达存在正相关（r=0．480,P=0．032）。结论：PKR的异常表达在CINⅢ向宫颈癌发展过程中可能发挥主要作用．此外SABC法测定PKR和E6的表达有可能成为筛选子宫颈癌的早期指标。     

宫颈病变中双链RNA依赖的蛋白激酶与HPV感染的相关性

目的：通过检测双链RNA依赖的蛋白激酶（PKR）、人乳头瘤病毒（HPV）在宫颈病变组织中的表达,探讨PKR在宫颈病变发生发展中的意义及可能机制。方法：选择临床病历资料和病理资料完整的宫颈癌患者共37例、同期宫颈上皮内瘤样病变（CIN）Ⅰ～Ⅲ患者56例为研究对象,因子宫肌瘤等良性病变切除子宫的正常宫颈组织30例为对照。采用免疫组织化学SABC法检测PKR及HPV16/18 E6的表达,分析二者与宫颈病变发生发展的关系。结果：宫颈癌组织中PKR表达阳性率为54.1%,高于CINⅢ,CINⅠ～Ⅱ组和正常宫颈组,差异有统计学意义（P <0.05）;在宫颈癌组中PKR表达与HPV16/18 E6表达存在负相关 （r =-0.554,P <0.05）;在CINⅢ组中PKR表达与HPV16/18 E6表达存在正相关（r =0.480,P =0.032）。结论：PKR的异常表达在CINⅢ向宫颈癌发展过程中可能发挥主要作用,此外SABC法测定PKR和E6的表达有可能成为筛选子宫颈癌的早期指标。     

Twist2和E-cadherin在宫颈鳞癌中的表达及意义

目的：研究Twist2与E-cadherin在宫颈上皮内瘤样变（CIN）及宫颈鳞状细胞癌中的表达情况,探讨其在宫颈癌变过程中的作用及意义。方法：应用蛋白质免疫印迹（Western blot）和免疫组织化学法检测Twist2、E-cadherin在正常宫颈组织（对照组）、CINⅠ组、CINⅡ～Ⅲ组、宫颈鳞癌组中的表达情况。结果：Twist2和E-cadherin在4组中阳性表达率比较差异有统计学意义（χ2=48.163,P=0.000;χ2=43.169,P=0.000）。宫颈鳞癌Twist2、E-cadherin的阳性表达率在不同分化程度、临床分期、有无淋巴结转移组间差异有统计学意义（P＜0.05）,在不同年龄间差异无统计学意义（P＞0.05）。Twist2与E-cadherin在宫颈鳞癌组织中的表达呈负相关（r=-0.401,P=0.003）。对照组、CIN组、宫颈鳞癌组间Twist2、E-cadherin的相对表达量差异有统计学意义（F=652.225,P=0.000;F=299.112,P=0.000）。结论：Twist2、E-cadherin可能共同参与了宫颈鳞状细胞癌的恶性转化过程,联合检测Twist2与E-cadherin有助于判断宫颈癌的恶性程度及其预后。     

MicroRNA-21在宫颈癌组织中的表达及与宫颈癌恶性程度的相关性研究

目的探讨miR-21在宫颈癌组织中的表达情况及与宫颈癌恶性程度的相关性。方法选择宫颈上皮内瘤变3级和宫颈癌各20例患者作为观察组,宫颈良性病变患者20例作为对照组,采用Trizol法提取宫颈样本组织总mRNA,实时定量PCR方法分析miR-21在各组患者组织中的表达情况。结果宫颈癌组及CIN3组中miR-21的表达较对照组升高（P〈0.05）;miR-21在宫颈癌高、中分化与低分化组的表达差异均无统计学意义（P〉0.05）。结论 miR-21在宫颈鳞癌组织及宫颈上皮内瘤样病变3级中存在异常表达,提示其与宫颈癌的发生可能有关。     

探讨三维能量多普勒超声在宫颈癌与重度宫颈上皮内瘤变的应用价值

目的评价应用三维能量多普勒超声在重度宫颈上皮内瘤变（CIN3）及宫颈癌的诊断价值。方法对宫颈CIN3患者37例、宫颈癌患者37例（Ⅰ期患者21例,Ⅱ期患者16例）及对照组患者34例（宫颈细胞学正常）进行阴道三维能量多普勒超声检查并测量相关数据（宫颈体积、血管化指数VI、血流指数FI、血管化血流指数VFI及阻力指数RI）,同时对宫颈血管进行分型。结果Ⅰ期、Ⅱ期宫颈癌组宫颈体积、VI、FI、VFI均明显大于CIN3组及对照组,RI明显小于CIN3组及对照组,差异有统计学意义（P〈0.05）;Ⅱ期宫颈癌组宫颈体积、VI、VFI大于Ⅰ期宫颈癌组,有统计学差异（P〈0.05）;CIN3组与对照组比较宫颈体积、VI、FI、VFI及RI均无明显差异（P〉0.05）。血管分型显示,宫颈癌以Ⅲ、Ⅳ型血管为主,CIN3以Ⅱ型血管为主,对照组以Ⅰ型血管为主。结论三维能量多普勒超声能客观地反映宫颈的血供状态,为CIN3及宫颈癌分期提供重要参考信息,有较高的应用价值。     

p21~(WAF1/Cip1)和p27~(Kip1)在宫颈癌及癌前病变的表达及临床意义

目的:探讨细胞周期负向调控因子p21WAF1/Cip1和p27Kip1在宫颈癌及癌前病变(CIN)中的表达特点。方法:选择妇科门诊宫颈疾病专科就诊患者163例,用第二代杂交捕获试验(HCⅡ)检测高危型人乳头瘤病毒(HR-HPV)DNA负荷量,阴道镜下宫颈活检,病理确诊,并用活检组织行p21WAF1/Cip1和p27Kip1免疫组化检测,比较慢性宫颈炎、CINⅠ-Ⅲ及宫颈癌各组间HR-HPV负荷量和p21WAF1/Cip1、p27Kip1表达差异。结果:各病理类型病变(共5组)的HR-HPV阳性率分别为:慢性宫颈炎38.46%(15/39),CINⅠ80%(12/15),CINⅡ81.82%(18/22),CINⅢ93.33%(56/60),宫颈鳞癌88.89%(24/27)。慢性宫颈炎HR-HPV DNA负荷量明显低于其他4组(M=0.56pg/ml,P<0.01),CINⅠ~Ⅲ及宫颈癌4组间无显著差异(P>0.05)。p21WAF1/Cip1和p27Kip1阳性表达率在CINⅠ~Ⅲ及宫颈癌4组间无显著差异(CINⅠ40.00%、60.00%,CINⅡ54.55%、54.55%,CINⅢ56.67%、70.00%,宫颈癌51.85%、77.78%,P>0.05),但均显著高于慢性宫颈炎组(5.13%、17.95%,P<0.01);p21WAF1/Cip1和p27Kip1表达增强与HR-HPV DNA负荷量升高和宫颈病变进展呈正相关,相关系数(rs)分别为:p21WAF1/Cip1:0.27、0.34,P<0.01;p27Kip1:0.30、0.46,P<0.01。结论:p21WAF1/Cip1和p27Kip1表达增强与宫颈病变进展密切相关,对宫颈HR-HPV持续感染及高负荷量患者可行p21WAF1/Cip1和p27Kip1检测以预测细胞病变的发生和发展。     

子宫颈上皮内瘤变患者CD4＋、CD8＋T细胞表达与高危型HPV感染的关系

目的探讨不同级别宫颈上皮内瘤变（CIN）组织中CD4＋、CD8＋T细胞表达及与高危型人乳头瘤病毒（HR-HPV）的关系。方法对2005年1月至2008年8月在珠海市人民医院阴道镜下宫颈活检诊断为CIN并行宫颈锥切治疗的72例患者的资料进行分析,采用杂交捕获第二代方法（HC-Ⅱ）检测高危型HPVDNA含量;采用免疫组化检测30例CIN1、43例CIN2/3及10例正常宫颈组织中CD4＋、CD8＋T细胞的表达。结果 CIN2/3组的HR-HPV感染率显著高于CIN1组（P〈0.05）,CIN组HR-HPV感染率高于慢性宫颈炎组（P〈0.01）。慢性宫颈炎组、CIN1组和CIN2/3组CD4＋T细胞表达率分别为60.0%、43.3%和33.3%,CD8＋T细胞的表达率分别为70.0%、46.7%和31.0%;CD4＋、CD8＋T细胞在CIN1组及CIN2/3组的表达显著低于慢性宫颈炎组（P〈0.05）。结论 CD4＋、CD8＋T细胞表达下调可能促进宫颈HR-HPV感染的发生,并对宫颈癌前病变的发生、发展起一定的作用。     

细胞信号转导通路MEK在宫颈癌前病变和宫颈癌的表达及意义

目的：探讨宫颈癌前病变及宫颈癌组织中丝裂原激活细胞外信号调节激酶（mitogen-activated extracellular signal-regulated kinase,MEK）细胞信号转导通路表达的意义。方法：选择并收集2013年1月—2014年4月在天津市第一中心医院妇科诊治、临床病理资料完整的宫颈病变患者共92例,根据宫颈病变程度将患者分为正常组（30例）、高级别宫颈上皮内瘤样变（CIN）组（30例）和宫颈癌组（32例）。用免疫组织化学SP法检测MEK在不同组织中的表达。结果：MEK在正常组、高级别CIN组和宫颈癌组中阳性表达率分别为20.0%、56.7%和68.8%,其中宫颈癌组MEK阳性表达率最高,分别高于高级别CIN组及正常组,差异有统计学意义（P＜0.05）。高级别CIN组MEK的阳性表达率高于正常组（P=0.003）。MEK阳性表达率与患者年龄、宫颈癌病理类型、肿瘤组织分化程度、肿瘤大小及宫颈癌临床分期等因素无关（P＞0.05）。结论：MEK转导通路可能在宫颈癌及癌前病变的发生发展中有一定的作用。     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症(EMs)发病机制尚未完全阐明.大量研究表明,免疫因素在EMs的发病机制中起重要作用.EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变.Toll样受体(TLRs)识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应.TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深人认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段.     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症（EMs）发病机制尚未完全阐明。大量研究表明,免疫因素在EMs的发病机制中起重要作用。EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变。Toll样受体（TLRs）识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应。TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深入认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段。     

Pharmacokinetics and endometrial and tubal tissue penetration of cefalotin and cefazolin

The pharmacokinetics and concentrations of the two antibiotics cefazolin and cefalotin were studied during gynecologic operations in endometrial and tubal tissue. The patients received 0.05 g/kg of the antibiotics by intravenous injection. Under the given conditions, pharmacokinetic calculation of the plasma elimination gave half-lives of 24.8 min for cefalotin and of 63 min for cefazolin. Fitting of the tissue levels to the Bateman function showed that the two antibiotics diffuse rapidly into both tubal and endometrial tissue and attain peak concentration levels between 10 and 25 min. In both tissues the concentrations of cefazolin were higher than those of cefalotin. Higher tissue concentrations of cefazolin could also be demonstrated in experiments of longer duration.     

Psychological and pharmacological treatments of mood and anxiety disorders during pregnancy and postpartum. Review and synthesis

The aim of this article is to review the main methods of treatment of anxious and depressive disorders during pregnancy and the postpartum. To this end, we analyse recent publications about the use and efficacy of psychotherapy and psychosocial interventions (cognitive behavioural therapy, interpersonal psychotherapy, psychoanalytical therapy) in the perinatal period. We also review recent papers about the use of psychotropic medication during pregnancy and breast-feeding, with special emphasis on clinical trials. We particularly focus on the risk/benefit assessment of antidepressants, mood stabilisers, antipsychotics and benzodiazepines, in terms of teratogenicity, and impact on neonatal adaptation and neuropsychological development. Various treatment modalities are presented and discussed. It appears that psychotherapies have proved their efficiency on most pre- and postpartum anxious and depressive disorders and represent a first line treatment in most cases. Psychopharmacological treatment is indicated for severe anxious and depressive disorders. The risks of such medication, especially antidepressants, may have been overestimated in the past. Provided reasonable precautions are taken and mothers and future mothers receive clear information on the potential risks and benefits, psychotropic medication could be more broadly prescribed during pregnancy and the breast-feeding period.     

Israeli and British women's wellbeing and eating behaviours in pregnancy and postpartum

Objectives: The study had two main objectives: (a) track changes in self-esteem, eating behaviours and body satisfaction from early pregnancy to 24 months postpartum and (b) to compare changes by context (Israel vs. UK) and maternal body mass index (BMI).

Background: High maternal BMI is associated with negative body image and restrained eating, which are experienced differently across cultures.

Methods: 156 pregnant women were recruited from Israel and the UK. Seventy-three women were followed up every six months from early postpartum and until 24 months following birth. Women completed questionnaires assessing self-esteem (RSEQ), body image (BIS/BIDQ) and eating behaviours (DEBQ) and self-reported weights and heights so that BMI could be calculated.

Results: Women with higher BMI had higher levels of self-esteem and were less satisfied with their body. Healthy-weight women were more likely to lose all of their retained pregnancy weight compared to overweight and obese women. Self-esteem, body image and eating behaviours remained stable from pregnancy until 24 months postpartum. No significant differences were found for any measure by context.

Conclusion: BMI was the strongest predictor of self-esteem and body dissatisfaction and a higher BMI predicted less weight loss postpartum.     

Placental ischemia and changes in umbilical and uteroplacental arterial and venous hemodynamics

Objective: To relate Doppler velocimetry findings in fetoplacental and uteroplacental circulation to placental histomorphology. Material and methods: In 14 uncomplicated and 31 high-risk pregnancies Doppler velocimetry was performed in umbilical artery and vein, and in maternal uterine veins and arteries during the second half of gestation. Histopathology of the placentas was examined, especially for signs of ischemia and inflammation. Results: All fetuses in uncomplicated pregnancies had normal flow velocity waveforms in umbilical artery; in the high-risk group, 18 fetuses had abnormal flow (increased PI or absent/reverse end-diastolic flow). The latter group had more often high ischemic score and infarctions in the placenta than found in pregnancies with normal umbilical artery flow (p?<?0.001 and p?=?0.02, respectively). Similarly, the abnormal uterine artery flow pattern (uterine artery score 3–4) occurred more often with high ischemic score and placenta infarctions (p?<?0.001 and p?<?0.001, respectively). No significant associations were found between the uterine venous flow type and placental ischemia. Conclusion: Placental ischemic morphological changes were associated with Doppler ultrasound signs of increased resistance to arterial blood flow, both on the fetal and maternal sides of the placenta. No significant relation to the uterine venous flow velocities was found.     

Analgesia and anesthesia during labor and birth: implications for mother and fetus

Labor and birth, although viewed as a normal physiological process, can produce significant pain, requiring appropriate pain management. Systemic analgesia and regional analgesia/anesthesia have become less common, whereas the use of newer neuraxial techniques, with minimal motor blockade, have become more popular. Low- and ultra-low-dose epidural analgesia, spinal analgesia, and combination spinal-epidural analgesia have replaced the once traditional epidural for labor. The shift from regional anesthesia during labor, in which the woman became a passive participant during the labor and birth, to a collaborative approach for pain management, in which the woman becomes an active participant, has resulted in a new philosophy of labor analgesia. This article provides a review of the current systemic analgesics and regional and neuraxial analgesia/anesthesia techniques for pain management in labor and birth. Also addressed are implications for perinatal nurses who participate in pain management choices during labor and birth.