不同距离癌旁组织PD-1和PD-L1表达对肾部分切除术边距选择的临床意义

目的 观察程序性死亡受体-1(PD-1)和程序性死亡配体-1(PD-L1)在肾透明细胞癌及不同距离癌旁组织中的表达,为肾部分切除术中选择安全切除范围提供理论依据。 方法 选取蚌埠医学院第一附属医院泌尿外科2014年6月—2015年7月期间行根治性肾切除术且术后病理证实为透明细胞癌的肾肿瘤患者60例,记录患者一般资料及肿瘤分期,术中留取正常肾组织、肾肿瘤组织及不同距离的癌旁组织(0.5、1.0、2.0 cm),免疫组织化学染色法检测癌组织及各癌旁组织中PD-1和PD-L1表达水平,比较癌组织及不同距离癌旁组织PD-1和PD-L1的表达,并分析不同分期癌旁组织中PD-1和PD-L1的表达情况。 结果 肾透明细胞癌癌组织中存在PD-1和PD-L1表达,且高于正常肾组织;同时PD-1和PD-L1在癌组织中的表达较在各不同距离癌旁组织中表达增高,差异有统计学意义(均P<0.05);癌旁组织PD-1和PD-L1表达强度及阳性率随距癌组织的距离增加而逐渐降低,两者在距肿瘤0.5 cm癌旁组织中的表达均高于1.0 cm癌旁组织,差异具有统计学意义(P<0.05),而两者在距肿瘤1.0 cm和2.0 cm癌旁组织中的表达差异无统计学意义(P＞0.05)。此外,距肿瘤1.0 cm癌旁组织中PD-1和PD-L1在不同肿瘤分期组织中的表达差异无统计学意义。 结论 PD-1和PD-L1在肾透明细胞癌组织中表达高于癌旁组织,且与癌组织距离越近,在癌旁组织中的表达越强,癌组织边距1.0 cm是肾部分切除术中肿瘤的安全切除范围。      

HIF-1α和HIF-2α在人肾透明细胞癌中的表达及意义

目的探讨低氧诱导因子HIF-1α和HIF-2α在人肾透明细胞癌组织中的表达及其临床意义。方法应用RT-PCR的方法从转录水平检测了56例原发性散发肾细胞癌和52例正常肾组织中HIF-1αmRNA及HIF-2αmRNA的表达情况,应用Western-Blot方法从蛋白质水平检测了HIF-1α和HIF-2α的表达情况。结果HIF-1αmRNA在肾透明细胞癌标本组织中的表达率为87.5%,较对照组织中增高,差异有统计学意义(P<0.05);HIF-2αmRNA在肾透明细胞癌标本组织中的表达率为94.6%,较对照组织中增高,差异有统计学意义(P<0.05)。56例CCRCC组织标本中52例表达HIF-1α蛋白,阳性率为92.9%,较对照组织中增高,差异有统计学意义(P<0.05)。56例CCRCC组织标本中54例表达HIF-2α蛋白,阳性率为96.4%,较对照组织中增高,差异有统计学意义(P<0.05)。结论HIF-1α和HIF-2α的表达可能对肾透明细胞癌的发生和发展有重要作用。     

实时荧光定量PCR检测肾透明细胞癌hIRS-1和hIRS-2的表达及临床意义

[目的]本研究检测hIRS-1 mRNA和hIRS-2 mRNA在肾透明细胞癌组织和对应癌旁正常组织中的表达,分析其与临床病理参数之间的关系,评价hIRS-1和hIRS-2的临床意义.[方法]应用实时荧光定量PCR法对hIRS-1及hIRS-2基因在43例肾透明细胞癌组织和对应癌旁正常组织中的表达进行检测,分析其与临床病理指标的关系.[结果]hIRS-1mRNA在肾透明细胞癌和癌旁组织中均存在表达,hIRS-1基因在肾透明细胞癌组织和对应癌旁正常组织中比较无显著差异(0.612±0.127vs 0.645±0.116,P>0.05);而hIRS-2基因在肾透明细胞癌中存在高表达,hIRS-2基因在肾透明细胞癌组织和对应癌旁正常组织中比较有显著差异(1.016±0.143 vs 0.792±0.136,P<0.05);hIRS-1 mRNA的表达与患者年龄、性别、肿瘤大小、病理分级及临床分期无关(P>0.05);hIRS-2 mRNA的表达与肿瘤大小及临床分期有关(P<0.05),与患者年龄、性别、及病理分级无关(P>0.05).[结论]hIRS-1 mRNA在肾透明细胞癌和癌旁组织中均存在表达,两者比较差异无统计学意义;MRS-2 mRNA在肾透明细胞癌中存在高表达,提示hIRS-2基因在肾透明细胞癌细胞癌变过程中可能发挥重要作用.     

垂体肿瘤转化基因在人肾透明细胞癌中的表达及意义

目的 探讨垂体肿瘤转化基因(PTTG)在人肾透明细胞癌中的表达及其意义.方法 采用免疫组织化学法分别检测正常肾脏组织及肾透明细胞癌组织中PTTG蛋白的表达.结果 在正常肾脏和肾透明细胞癌组织中PTTG蛋白的表达存在显著差异(P<0.001),肾透明细胞癌中PTTG蛋白表达率(74.56%)明显高于正常肾组织(11.11%).在肾透明细胞癌组织中,PTTG蛋白表达阳性率与肾透明细胞癌的肿瘤大小、临床分期和Fuhrman分级呈正相关,差异具有显著性(P=0.009、0.008和0.035).结论 PTTG在肾透明细胞癌组织中高表达,与肾透明细胞癌的发生、发展密切相关.     

早期肾癌腹腔镜肾部分切除术安全切除边距的选择

目的:观察早期肾透明细胞癌及癌旁0.5、1.0、2.0 cm组织上皮膜抗原（epithelial membrane antigen,EMA）、肾细胞癌标志物（renal cell carcinoma marker,RCC-Ma）的表达差异,初步探讨早期肾癌行肾部分切除术时的安全切除边距。方法:构建包含44例早期肾透明细胞癌及癌旁0.5、1.0、2.0 cm肾皮质的组织芯片,采用免疫组化染色分别观察癌及癌旁（距肿瘤边缘0.5、1.0、2.0 cm）组织EMA、RCC-Ma的表达差异。结果:EMA、RCC-Ma在癌及癌旁组织均为细胞膜和（或）胞质染色。癌组织EMA和RCC-Ma强阳性表达率明显高于癌旁组织各组（15.91%/18.18% vs 84.09%/79.55%、86.36%/77.27%、79.55%/75.00%,P<0.01）;而癌旁组织各组（距肿瘤边缘0.5、1.0、2.0 cm）间差异无统计学意义（P>0.05）。结论:0.5 cm可能是早期肾透明细胞癌腹腔镜肾部分切除术安全的切除边距。     

SLIT 2在肾透明细胞癌组织中的表达及意义

目的：探讨神经迁移蛋白SLIT2蛋白在肾癌中的表达及其临床意义。方法应用免疫组织化学方法检测80例肾透明细胞癌及对应的癌旁2cm肾组织中SLIT2蛋白的表达情况,结合临床病例资料分析其临床病理意义。结果（1）在肾透明细胞癌组织及对应的癌旁2cm肾组织中,SLIT2蛋白的阳性表达率分别为28.8%（23/80）和76.3%（61/80）,组间差异有统计学意义（P＜0.01）;（2）SLIT 2蛋白的表达与肾透明细胞癌组织分级、肿瘤TNM分期及有无淋巴结转移有关（P＜0.05）,而与肾癌患者的性别、年龄,肿瘤大小无关。结论研究结果支持SLIT2在肾癌的发生、发展过程中发挥了一定作用,检测SLIT 2蛋白的表达有助于判定肾透明细胞癌的生物学行为。     

抑癌基因Pdcd4在肾透明细胞癌中的表达及生物学意义

目的研究Pdcd4 mRNA及蛋白在肾透明细胞癌中的表达及探讨其与肾肿瘤分期分级的关系。方法采用逆转录-聚合酶链反应（半定量RT-PCR）及免疫组织化学方法同时检测肾脏透明细胞癌及癌旁正常组织Pdcd4 mRNA及蛋白的表达情况。结果 Pdcd4 mRNA在肾癌及癌旁正常组织中均有表达,透明细胞癌中的表达低于癌旁正常组织。肾透明细胞癌Pdcd4蛋白表达阳性率为37.5%（15/40）,显著低于癌旁正常肾脏组织阳性表达率90%（18/20）,G1~G2期Pdcd4蛋白表达阳性率为56.5%（13/23）高于G3~G4期Pdcd4蛋白表达阳性率为11.7%（2/17）,两者差异有显著性（P〈0.05）。结论 Pdcd4基因在肾透明细胞癌中呈低表达,与肾癌的发生及恶性分化程度相关,作为抑癌基因,Pdcd4蛋白表达可作为判定肾透明细胞癌生物学行为的客观指标。     

肾透明细胞癌中β-环连蛋白抑制基因1启动子CpG岛甲基化与其失表达相关

目的:探讨肾透明细胞癌中β-环连蛋白抑制基因1(dapper homolog 1,antagonist of beta-catenin,Dact1)表达与其启动子CpG岛甲基化状态的关系,并探究他们之间的关系及在肾透明细胞癌发生中的作用。方法:采用逆转录聚合酶链反应(RT-PCR)及甲基化特异性PCR(methylation specific PCR,MSP)分别检测30例癌组织及相应的癌旁对照组织中Dact1基因mRNA的表达和其启动子甲基化状态。结果:癌组织组中,19例Dact1基因mRNA失表达(63%),7例表达低于癌旁对照组(23%);癌旁对照组织组中,2例Dact1基因mRNA低表达(6%)。Dactl基因在癌组织、癌旁对照组织中的甲基化阳性率分别为70%、6%,2组比较差异有统计学意义(P < O.001),Dactl基因mRNA的失表达或低表达与其启动子甲基化状态的相关性分析有统计学意义(P < 0.05)。结论:Dact1基因mRNA的失表达或低表达可能参与了肾透明细胞癌的发生发展,其失表达可能与Dactl启动子区异常甲基化相关。     

抑癌基因PTEN、癌基因MDM2在肾透明细胞癌中的表达及意义

目的：探讨抑癌基因PTEN蛋白、癌基因MDM2蛋白在肾透明细胞癌发生中的意义及其对肾透明细胞癌患者预后的影响。方法:采用免疫组织化学SABC法检测58例肾透明细胞癌、15例癌旁及10例正常肾组织中抑癌基因PTEN、癌基因MDM2蛋白的表达。结果:58例肾透明细胞癌组织中PTEN阳性表达率为34.4%（20/58）显著低于癌旁肾组织86.6%（13/15）及正常肾组织90%（9/10）,差异有统计学意义（P＜0.01）,癌旁肾组织和正常肾组织阳性表达率之间差异无统计学意义（P＞0.05）;Ⅰ、Ⅱ期肾透明细胞癌组织阳性表达率72.7%（16/22）显著高于Ⅲ、Ⅳ期的11.1%（4/36）,差异有统计学意义（P＜0.01）。58例肾透明细胞癌组织中MDM2阳性表达率为68.9%（40/58）显著高于癌旁肾组织0.06%（1/15）及正常肾组织的0（0/10）,差异有统计学意义（P＜0.01）, 癌旁肾组织和正常肾组织阳性表达率之间差异无统计学意义（P＞0.05）;Ⅰ、Ⅱ期肾透明细胞癌组织阳性表达率为45%（10/22）显著低于Ⅲ、Ⅳ期的83.3%（30/36）,差异有统计学意义（P＜0.01）。PTEN和MDM2二者高度相关。结论:PTEN的失表达与MDM2的过表达在肾透明细胞癌的发生中起一定的作用,且与肾透明细胞癌的发展和淋巴结转移密切相关,PTEN与MDM2可作为评价肾透明细胞癌发展和预后的生物学指标。     

PTEN和LIVIN在肾透明细胞癌中的表达及临床意义

目的:研究双特异磷酸酶活性的磷酸脂酶基因(PTEN)和黑色素瘤凋亡抑制蛋白或肾凋亡抑制蛋白(LIVIN)在肾透明细胞癌中的表达及其相关性。探讨与肾透明细胞癌临床分期及病理分级关系。方法:应用免疫组化SP法检测50例肾脏透明细胞癌、25例癌旁组织(距肿瘤边缘>1 cm)及10例正常肾组织中PTEN及LIVIN的表达。结果:PTEN在肾透明细胞癌中的阳性率明显低于癌旁及正常肾组织,差异有统计学意义(P<0.01);LIVIN在正常肾组织及癌旁组织无表达,而在肾透明细胞癌中高表达,差异有统计学意义(P<0.01)。在不同临床分期的肾透明细胞癌组织中PTEN和LIVIN的表达有显著差异性(P<0.01);并且两因子的表达呈显著负相关(r=-0.547,P<0.01)。结论:PTEN和LIVIN呈负相关性,在肾透明细胞癌的发生发展中起重要的作用,两个因子联合检测可作为判定肾透明细胞癌恶性程度的重要指标。     

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.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.