大肠癌组织p27及增殖细胞核抗原的表达及其意义

目的：研究p27，增殖细胞核抗原（proliferating cell nuclear antigen,PCNA)在大肠癌组织中的表达，并探讨其生物学意义。方法：利用免疫组织化学方法对50例大肠癌患者肿瘤组织和50例正常人大肠组织P27，PCNA表达进行检测。结果：p27和PCNA在癌组织及正常组织中的表达均有显著性差异（P＜0．05），且p27,PCNA表达与大肠癌的分化程度，淋巴结转移和Dukes分期显著有关。结论：p27表达与大肠癌的临床病理学特征密切相关，可能是预测大肠癌预后的重要指标之一，PCNA是反映细胞增殖活性的重要指标。     

动脉灌注新辅助化疗对大肠癌组织PCNA、VEGF、P53及MVD表达的影响

目的检测动脉灌注新辅助化疗后大肠癌癌组织中PCNA、VEGF、P53及MVD表达的变化，探讨其对大肠癌治疗的意义。方法选取病理诊断明确的进展期大肠癌患者128例，随机分为实验组68例、对照组60例，实验组术前行动脉灌注化疗1-2周期，对照组直接行手术治疗，应用免疫组化方法分别检测治疗前病理活检标本及手术后癌组织中PCNA、VEGF、P53及MVD的表达。结果动脉灌注新辅助化疗后完全缓解22．1％，部分缓解44．1％，总有效率达66．2％。术后癌组织中PCNA、VEGF及MVD的表达实验组低于对照组（P〈0．05）。实验组动脉灌注新辅助化疗后临床有效者癌组织中PCNA、VEGF及MVD的表达降低（P〈0．05）；临床无效者化疗前后PCNA、VEGF及MVD的表达无显著性差异（P〉0．05）。P53的表达在实验组与对照组之间及实验组化疗前后均无显著性差异（P〉0．05）。实验组平均疾病无进展时间为37个月，对照组为20个月，二者相比有统计学差异（P〈0．05）。结论动脉灌注新辅助化疗对进展期大肠癌的治疗疗效肯定，PCNA、VEGF及MVD的联合检测可以作为大肠癌动脉灌注新辅助化疗疗效的客观评价指标。     

大肠癌中β-catenin、E-cadherin、c-mye和cyclinD1的表达及其临床意义

目的：探讨β-catenin、E-cadherin、C-myc和cyclinD1在大肠癌发生、发展过程中的作用。方法：应用免疫组织化学方法检测30例正常大肠黏膜、30例大肠腺瘤、30例大肠腺瘤恶变及50例大肠癌组织中pcatenin、E-cadherin、c-myc和cyclinD1蛋白的表达情况。结果：大肠癌、大肠腺瘤恶变和大肠腺瘤的pcatenin胞浆和（或）胞核异位表达率分别为：62．0％、53．3％、30．0％，显著高于正常大肠黏膜（0％）（P〈0．01）；大肠癌pcatenin异位表达率显著高于大肠腺瘤（P〈0．01）。大肠癌、大肠腺瘤恶变、大肠腺瘤c—myc和cyclinD1阳性率分别为：56．0％、66．0％；60．0％、50．0％；46．7％、30．0％，显著高于正常大肠黏膜（0％、0％）（P〈0．01），大肠癌cyclinD1阳性率显著高于大肠腺瘤（P〈0．01）。大肠癌中pcatenin、E-cadherin膜表达缺失率分别为：46．0％、34．0％，显著高于大肠腺瘤（10．0％、6．67％）和正常大肠黏膜（0％、0％）（P〈0．01），二者膜表达缺失和cy—clinD1阳性表达与大肠癌组织分化程度、浸润深度、淋巴结转移、Dukes分期有关。大肠癌中pcatenin异位表达与c-myc和cyclinD1阳性表达呈正相关关系（r=0．63，P〈0．01；r=0．57，P〈0．01）。结论：pcatenin异位表达，激活癌基因c—myc和cyclinD1阳性表达是大肠癌发生中的早期事件，并与大肠癌的发生发展密切相关；pcatenin、E—cadherin膜表达缺失和cyclinD1阳性表达与大肠癌的侵袭、转移有关。     

β-catenin,E-cadherin和c-myc在大肠癌中的表达及其意义

目的探讨β-catenin,E—cadherin和c—myc在大肠癌发生、发展中的作用。方法采用免疫组化方法检测30例正常大肠黏膜、30例大肠腺瘤、10例大肠昧瘤恶变及50例大肠癌组织中β-catenin,E—cadhcrin和c—myc蛋白的表达情况。结果大肠癌、大肠腺瘤恶变和大肠腺瘤β-catenin胞浆／胞核异位表达率分别为：62．0％,50．0％,30．0％,显著高于．rE常大肠黏膜（0％）（P〈0．01）,大肠癌β-catenin异位表达率显著高于大肠腺瘤（P〈0．01）。大肠癌、大肠腺瘤恶变、大肠腺瘤c—myc阳性率分别为：56．0％,60．0％,46．7％,显著高于正常大肠黏膜（0％）（P〈0．01）。大肠癌中β-catenin,E—cadherin膜表达缺失率分别为：46．0％,34．0％,显著高于大肠腺瘤（10．0％,6．67％）和正常大肠黏膜（0％,0％）（P〈0．01）,且与大肠癌组织分化程度、浸润深度、淋巴结转移、Dukes分期有关。大肠癌中β—catenin异位表达与c—myc阳性表达呈正相关关系（r=0．63,P〈0．01）;β-catenin与E—cadherin胞膜阳性表达呈正相关关系（r=0．69,P〈0．01）。结论β-catenin胞浆／胞核异位表达,激活癌基因c—myc过表迭与大肠癌的发生密切相关,可能是大肠癌发生的早期事件;β-catenin,E—cadtrerin膜表达缺失与大肠癌的侵袭、转移有关。     

大肠癌ET—1表达及其与肿瘤细胞增殖和微血管形成的关系

目的：研究ET－1在大肠腺癌中的表达及其与肿瘤细胞增殖和微血管形成的关系，探讨ET－1在大肠癌发生中的作用机制。方法：应用免疫组化SABC法检测41例大肠腺癌及20例大肠腺癌组织中ET－1表达、PCNA标记指数（PCNALI）及肿瘤微血管密度（MVD），分析ET－1表达与PCNALI以及MVD的关系。结果：ET－1主要分布于大肠腺癌细胞胞浆，ET－1阳表达肿瘤组织基质中血管内皮细胞也有增强表达，而癌主阴性表达的肿瘤组织基质中血管内皮细胞仅有较弱表达，腺癌的ET－1表达率及强度显著高于腺癌（P＜0．001）。等级相关分析表明，ET－1表达与PCNALI及MVD均密切相关（P＜0．001），PC－NALI与MVD亦呈正相关（P＜0．001）。结论：ET－1可能促进大肠癌微血管形成来影响肿瘤恶性生长。     

细胞凋亡及增殖细胞核抗原表达与大肠肿瘤生物学行为的关系

目的：探讨大肠肿瘤组织中细胞凋亡及增殖细胞核抗原（PCNA）表达与其生物学行为的关系。方法：应用免疫组化S－P法及凋亡细胞TUNEL检测法检测10例正常大肠黏膜，15例大肠腺和62例大肠癌标本中细胞增殖指数（PI）及凋亡指数（PI），并分析其与临床病理学参数间的关系。结果：在正常大肠黏膜，大肠腺瘤和大肠癌组织中PI，AI存在显差异（P＜0．05），腺瘤和腺癌组织AI和PI显高于正常黏膜组织；在腺瘤中，不典型增生I级与Ⅱ-Ⅲ级两组间AI和PI存在显差异（P＜0．05），且癌组织中PI高于均数，AI低于均数组淋巴结转移率明显高于其他组织（P＜0．01）。结论：细胞增殖与凋亡平衡失调是大肠黏膜上皮细胞恶性转化的重要因素，两联合检测对判断大肠肿瘤生物学行为及预后有重要意义。     

大肠癌组织胃泌素与P53蛋白表达及PCNA的相关性研究

目的：探讨大肠癌组织胃泌素与P53蛋白表达的关系及其对肿瘤增殖活性的影响。方法：放免法检测32例大肠癌血清及癌组织胃泌素含量。免疫组化标记癌组织有癌近旁黏膜胃泌素、P53蛋白、PCNA表达。结果：癌组织胃泌素与P53蛋白表达强度呈正相关（r＝0．4666，P＜0．01），且二者均与肿瘤PCNA表达强度呈正相关（r＝0．8483，r＝0．5668，P＜0．025）。二者共同表达肿瘤PCNA较各自增高。P53蛋白表达与血清、癌组织胃泌素水平升高有关。癌近旁黏膜P53蛋白表达组较未表达组PCNA表达强度增高（P＜0．05），但与血清胃泌素水平无关。结论：大肠癌胃泌素、P53蛋白独自或共同表达均可提高大肠癌增殖活性；癌近旁黏膜增殖状态与P53基因突变有关，但与胃泌素表达及血清胃泌素水平无关。     

E-cadherin在大肠腺瘤、大肠癌中表达的临床病理研究

目的探讨E-cadherin在正常大肠黏膜、大肠腺瘤及大肠癌组织中的表达及其与大肠癌侵袭、转移的关系。方法应用免疫组化法观察30例正常大肠黏膜、30例大肠腺瘤及1DO例大肠癌组织中E-cadherin的表达情况。结果E-cadherin在大肠癌组织中的阳性表达率（34．0％）明显低于在正常大肠黏膜（100．0％）和大肠腺瘤组织（70O％）中的表达率（P〈0．01）;E-cadherin低表达与肿瘤组织学类型、肿瘤分化程度、浸润深度、血管侵犯、淋巴管侵犯、淋巴结转移及Dukes分期有关（P〈001）,而与患者的性别、年龄及肿瘤大小无关（P〉005）。E-cadherin高表达的患者5年生存率明显低于低表达的患者（P〈0．01）。结论E-cadherin表达下调可能与大肠癌发生、发展有关,在大肠癌恶性演进过程中具有重要意义,可作为新的生物学标志物。     

环孢素A对血管紧张素Ⅱ诱导的血管平滑肌细胞增殖的影响

目的：观察环孢素A（CsA)对血管紧张素Ⅱ（AngⅡ）诱导的大鼠血管平滑肌细胞增殖的影响，以探讨钙调神经磷酸酶（CaN)依赖的信号通路在血管平滑肌细胞增殖中的作用。方法；以体外培养的大鼠主动脉平滑肌细胞为模型，实验分为三组：（1）AngⅡ组，（2）CsA AngⅡ组，（3）对照组。检测细胞增殖活度（MTT法），增殖细胞核抗原（PCNA）表达（免疫组化定量技术），细胞数目（直接计数法）的变化。结果：AngⅡ组血管平滑肌细胞增殖活度（吸光度表示），PCNA表达水平（光密度值表示）和细胞数目明显高于对照组（P＜0．01或P＜0．05），CsA＋AngⅡ组血管平滑肌细胞增殖活度，PCNA表达水平和细胞数目较AngⅡ组明显降低，差异显著（P＜0．01或P＜0．05）。结论：环孢素A可显著阻滞血管紧张素Ⅱ刺激的血管平滑肌细胞增殖，这种作用可能通过抑制CaN活性，阻断CaN介导的信号传导通路所致。     

大肠腺瘤—腺瘤恶变—腺癌演进过程中PCNA，p53与细胞凋亡的表达及其关系

目的：观察大肠腺瘤－腺瘤恶变－腺癌演进过程中细胞凋亡与p53,PCNA的表达状况,探讨其内在联系,方法：利用DNA缺口末端标记技术,PCNA,p53蛋白免疫组织化学染色及p53与凋亡双重染色技术,原位观察大肠腺癌,腺瘤恶变区,腺瘤非恶变区及管状绒毛状腺瘤（分别为34,27,27及27例）标本中凋亡细胞和PCNA,P53阳性表达细胞密度及分布,以非肿瘤大肠粘膜（6例）作为对照。结果：腺瘤非恶变区凋亡细胞密度分别高于腺癌,管状绒毛状腺瘤及非肿瘤粘膜（P均＜0．01）,腺癌及腺瘤恶变区P53蛋白阳性细胞密度分别高于管状绒毛状腺瘤（P均＜0．01）和腺瘤非恶变区（P均＜0．01）及非肿瘤粘膜（P分别＜0．01）,腺癌PCNA阳性细胞密度分别高于腺瘤恶变区（P＜0．05）,管状绒毛状腺瘤（P＜0．01）,腺瘤非恶变区（P＜0．01）及非肿瘤粘膜（P＜0．01）,而腺瘤恶变区亦分别高于后3组（P分别＜0．01）,双染原位观察P53蛋白与凋亡细胞的分布发现：P63低表达区凋亡细胞分布则有增加趋势。结论：P53突变可能通过抑制细胞凋亡促进大肠癌的形成,而当突变型P53蛋白表达增加时,PCNA表达亦增加,提示P53突变的肿瘤具有较高的增殖活性,其中腺癌增殖程度最高。     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.