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中华临床医师杂志（电子版）

中华临床医师杂志（电子版）

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Chinese Journal of Clinicians(Electronic Edition)
《中华临床医师杂志（电子版）》经国家新闻出版总署 “十一五”国家重点出版规划批准立项，由中华人民共和国卫生部主管，中华医学会主办，中华医学电子音像出版社出版，是中国科技论文统计源期刊，中国科技核心期刊。具有标准国际、国内刊号（ISSN1674-0785 CN11-9147/R）。邮发代号：80-728。现已被“中国科技论文统计源期刊”（中国科技核心期刊）、《中国学术期刊网络出版总库》、《万方数据-数字化期刊群》、《中文科技期刊数据库（全文版）》、美国化学文摘、乌利希期刊指南、波兰哥白尼索引等数据库收录。　　本刊制作精美，编审严谨，以纸质导读附带光盘的形式面向全国出版发行，实现了传统纸版、光盘版、网络版的有机结合。本刊特有的经典术式视频，动态影像诊断、病例讨论实况等栏目大大提升了医学学术期刊的传播效率，开创了多媒体综合性医学学术期刊的先河。
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  • 发文量：13161
  • 被引量：47892
  • H指数：1
  • 开始收录时间：2007,1(1)
  • CNKI综合因子：0.0
  • 维普期刊影响因子： 0.76
  • 万方期刊影响因子：0.99
  • 创刊时间：2007
  • 国内刊号/CN：11-9147/R
    国际刊号/ISSN：1674-0785
  • 发行周期：半月刊
    邮发代号：80-728
  • 主管单位：中华人民共和国卫生部
    主办单位：中华医学会
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  • 摘要：手术是治疗肝癌的主要手段，但在我国，肝癌患者往往合并有肝炎及肝硬化，使得肝脏储备能力显著下降，加大了患者围手术期的风险性。因此，术前肝功能储备评估对肝切除手术患者的预后起着非常重要的作用。日本对肝癌的研究在全世界范围来讲一直处于比较领先的地位，但目前日本行大肝癌切除的病例有明显下降趋势，而在我国，很多肝癌患者肿瘤都比较巨大，由于术前评估不良而进行手术导致了高死亡率和高并发症发生率以及由于术前评估系统的不完善使得原本有手术切除机会的巨大肝癌患者没有选择手术治疗而错失了机会，这些问题在国内尤为显著。因此，术前准确评估肝脏储备功能对临床选择治疗方案以及降低术后肝衰竭的发生率具有重要的意义。本文将就近年来术前肝功能储备评估的研究进展作一概述。%Liver resection is the main stone for treatment of liver cancer. In our country, patients with liver cancer are always with hepatitis and/or cirrhosis. Therefore, their liver reserve capacity may be reduced. And the risk of perioperative mortality is increased. So, preoperative liver functional reserve assessment plays an important role in the prognosis of patients who will undergo hepatic resection. The treatment modality of liver cancer in Japan is in the leading position. But the rate of major hepatectomy is reduced in the last decade. While in China, many patients with liver cancer are diagnosed in late stage. Due to preoperative assessment is not comprehensively, the surgery leads to high mortality and high incidence rate of complication. Because of the imperfect preoperative evaluation system has had the huge liver cancer resection operation opportunity not choose operation treatment and missed the opportunity, these problems become more prominent in the domestic. Therefore, the preoperative accurate evaluation of liver functional reserve for clinical therapy and reduce the incidence of postoperative liver failure has important significance. In this paper, research progress of preoperative liver function reserve assessment in recent years was summarized.
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  • 摘要：Autism is a neurodevelopmental disorder with onset before the age of 3 years old, and is a subtype of pervasive developmental disorder. It has been classified as autism spectrum disorder in DSM-Ⅴ. Before 1980, autism was considered as a rare disease, in recent years, the epidemiological studies show that the incidence of autism tends to rise. In 2014, from the site of the Centers for Disease Control and Prevention of America, the overall prevalence of ASD among the ADDM sites was 14.7 per 1 000 children, which is equivalent to 68 cases of children that have one case for children with autism, we reviewed the study of epidemiology of ASD and analyzed the differences of gender, race, intelligence and regions of them, so as to provide a theoretical basis for its early detection and intervention.%儿童孤独症是一类起病于3岁以前的神经系统发育障碍，属于广泛性发育障碍的一个亚型。精神障碍诊断与统计手册第五版（DSM-Ⅴ）已将其归类为孤独症谱系障碍（ASD）。1980年以前，孤独症被认为是一种罕见性疾病，而近些年有关孤独症及ASD的流行病学研究表明，其发病率日趋上升，2014年美国疾病控制与预防中心对11个州8岁儿童的监测数据发现，ASD患病率高达14.7/1000，即相当于68例儿童中即有1例为ASD患儿，本文综述了目前ASD流行病学研究现状，并分析患儿性别、种族、智力、地域间的差异，为ASD的早期发现与早期干预提供理论依据。
  • 摘要：Objective To study the short and long effects of laparoscopic vs. open radical rectectomy and colectomy for colorectal cancer. Methods The data of 2 337 cases with colorectal cancer after curative resection from January 2007 to December 2012 were analyzed retrospectively. Results From January 2007 to December 2007, operation time and postoperative complications were better in open surgery group than in laparoscopic surgery group (P<0.05). Blood loss and incision length were better in laparoscopic surgery group than in open surgery group (P<0.05); From January 2008 to December 2012, blood loss, recovery of bowel function and incision length were better in laparoscopic surgery group than in open surgery group (P<0.05). The number of removed lymph nodes, number of metastatic lymph nodes and 5-year survival rate after surgery, there were still no difference between the two groups (P>0.05). Conclusion Laparoscopic radical resection of colorectal cancer is safety and feasibility, and it can be carried out in hospital with certain laparoscopic basis.%目的：比较腹腔镜结直肠癌根治术与开腹手术的近远期临床疗效。方法回顾性分析2007年1月至2012年12月在本院行结直肠癌根治性手术的2337例患者的临床和随访资料。结果2007年1月至12月，开腹手术组手术时间和术后并发症优于腹腔镜组（P＜0.05）；腹腔镜组失血量和切口长度优于开腹手术组（P＜0.05）。2008年1月至2012年12月，腹腔镜组失血量、排气时间和切口长度优于开腹手术组（P＜0.05）。两组清扫淋巴结数目、转移淋巴结数目和术后5年生存率比较差异无统计学意义（P＞0.05）。结论腹腔镜结直肠癌根治术具有较好的安全性及可行性，可在有一定腹腔镜手术基础的医院开展。
  • 摘要：Objective To investigate the expression of ER (estrogen receptor), PR (progesterone receptor), P53 and HER-2 (human epidermal growth factor2) in gastric cancer and the relation of these immunohistochemical parameters with the clinicopathological features of the gastric cancer. Methods The expression of ER, PR, P53 and HER-2 protein were detected in 60 cases with gastric cancer who underwent curative surgery by immunohistochemical staining (SP method). The clinical pathological data was statistically analyzed. Results ER, PR each had one positive (1.67%) in tumor samples. ER was all negative in normal tissue, while PR had two positive (4.00%) in normal tissue. P53 in cancer tissue samples from 19 cases were positive (31.67%) and P53 in normal tissue specimens were all negative;Her-2 had 5 cases positive (8.33%) in tumor samples, and 9 cases positive (18.00%) in normal tissue. Expression of Her-2 have not statistically differences in tumor tissue and normal gastric tissue (P=0.329). Conclusion This study shows that gastric cancer may not be a hormone-dependent tumors, Her-2 may be no correlation between the development of gastric cancer.%目的：研究ER、PR、P53、Her-2在胃癌患者的肿瘤组织及正常组织中的表达及临床病理特点。方法运用免疫组织化学等方法分析了南京医科大学第一附属医院综合外科2013年6月至2014年6月60例胃恶性肿瘤组织及作为对照的50例胃正常组织。结果在肿瘤组织标本中ER、PR各有1例为阳性（1.67%），正常组织中ER全部为阴性，PR有2例为阳性（4.00%）；P53在肿瘤组织标本中有19例阳性（31.67%），正常组织标本中P53均为阴性；Her-2在肿瘤组织中有5例阳性（8.33%），正常组织中Her-2有9例阳性（18.00%），Her-2在正常组织与肿瘤组织之间表达无统计学意义（P=0.329）。结论本研究表明胃癌可能不是激素依赖性肿瘤，Her-2与胃癌的发生发展之间可能无相关性。
  • 摘要：目的 探讨中国汉族人群中,肿瘤免疫调节基因TBX-21启动子区单倍型与食管鳞癌的遗传易感风险的关联性.方法 提取257例食管鳞癌患者及281例健康者外周血基因组DNA,根据前期研究中用PCR-RFLP的方法检测得到的两组人群中TBX-21基因启动子区-1499 (G/A)、-1514(T/C)两个多态性位点的基因型；采用PHASE 2.0软件构建这两个多态性位点的单倍体型,以非条件Logistic回归校正混杂因素,并进行多态性与食管鳞癌患者易感关联及临床病理特征相关性的统计学分析.结果 TBX-21基因启动子区-1499 (G/A)、-1514(T/C)两个多态性位点的单倍型在中国汉族人群中共有4种,分别为G-T、G-C、A-T、A-C.通过校正性别与年龄、吸烟与饮酒、肿瘤家族史等因素后,Logistic回归分析显示在这两个位点所构建的单倍体型中,病例组含有A-T单倍体的个体与对照组相比具有显著性差异:OR=1.56,95％ CI=1.01～2.41,P=0.044；含有A-C单倍体的个体在两组人群中的差异性更为显著:OR =7.04,95％CI=2.05～24.39,P=0.002.但这两个位点构成的4种单倍体型与肿瘤的大小、分化、TNM分期、淋巴结转移及远处转移均无相关性(P＞0.05).结论 TBX-21基因启动子区-1499(G/A)、-1514(T/C)多态性位点构成的单倍体型中,具有A-T、A-C单倍体的个体食管鳞癌的患病风险分别增加1.56倍和7.04倍,但与食管鳞癌的临床病理学特征无相关性.%Objective To investigate the association between the TBX-21 gene promoter haplotypes and the risk of esophageal squamous cell carcinoma(ESCC) and clinic-pathological characteristics in the Han ethnic group of China.Methods In our previous experiment,peripheral blood genomic DNA of 257 patients with ESCC and 281 healthy volunteers were extracted.Two polymorphism genotypes of-1499 and-1514 located in the TBX-21 promoter region were identified by the PCR-restriction fragment length polymorphism (PCR-RFLP) method.The SNPs of patients was revealed by restriction fragment length polymorphism (RFLP).Software PHASE 2.0 was used to construct the haplotypes of every individual.Unconditional Logistic regression model was used to analyze the statistical association of the haplotypes in two groups adjusted by gender and age.Results By adjusting for sex and age,smoking and drinking,family history of cancer,Logistic regression analysis revealed the A-T haplotype had a significant difference in two groups(OR =1.56,95％ CI =1.01-2.41,P =0.044).A-C haplotype was more prone to develop ESCC risk(OR =7.04,95％ CI =2.05-24.39,P =0.002).However,there was no significant correlation between the haplotypes and clinic-pathological characteristics in ESCC group.Conclusions TBX-21 gene promoter region A-T,A-C haplotypes increased susceptibility to ESCC by 1.56 and 7.04 fold respectively,but the two haplotypes were not related to the clinic-pathological characteristics.
  • 摘要：Objective To investigate the situation of anti-thrombosis therapy in patients with non-valvular atrial fibrillation ( NAF) , providing a reference for further standardization of ant-thrombosis therapy. Methods The clinical data of 293 patients with NAF who had hospitalized in our hospital from June 2010 to 2012, were analyzed retrospectively. Results There were 194 cases with hypertension, 167 cases with coronary heart disease,75 cases with chronic lung disease,38 cases with cardiomyopathy, 13 patients with thyroid dysfunction. Thrombosis risk score CHA2DS2VASc score ≥ 2 points were accounted for 267 cases (91. 1%). Thromboprophylax was accounted for 65. 5% in patients of CHA2DS2VASc Score≥2 points.in which 36. 0% patients were treated by aspirin,15. 4% by aspirin plus clopidogrel,8. 6% by the clopidogrel and 5. 6% by warfarin. Non-cardiovascular specialists who did not use any drugs for prevention from thrombosis by up to 28. 0% was significantly higher than the cardiovascular specialist group(P <0. 01) in patients whose CHA2DS2VASc Score ≥2 points. In both groups the using of warfarin was low and there was no significant statistical difference ( P > 0. 05 ). Conclusions The non-cardiovascular specialists are lack of prevention knowledge of thrombosis in atrial fibrillation, regardless of cardiovascular specialists and non-cardiovascular specialists are conservative in using of warfarin. So we should popularize the knowledge of use of anticoagulation in patients with atrial fibrillation.%目的 了解非瓣膜性心房颤动患者抗凝治疗的现状,为进一步规范化抗凝治疗提供参考.方法 对2010年6月至2012年6月在我院住院的293例非瓣膜病心房颤动患者的临床资料进行回顾性调查研究.结果 我院非瓣膜性心房颤动患者中高血压病患者194例,冠心病患者167例,慢性肺疾病患者75例,心肌病患者38例,甲状腺功能异常患者13例.非瓣膜病心房颤动患者血栓风险评分CHA2DS2VASc评分≥2分者267例(91.1%),CHA2DS2VASc评分≥2分的患者预防血栓比例为65.5%,其中阿司匹林抗血小板患者占36.0%,阿司匹林联合氯吡格雷抗血小板患者占15.4%,氯吡格雷抗血小板患者占8.6%,华法林抗栓者仅占5.6%.其中CHA2DS2VASc评分≥2分的患者中非心血管专科医师未采用任何药物预防血栓达28.0%,明显高于心血管专科医师组(P<0.01),而在应用华法林方面两组均较低,且无统计学差异(P>0.05).结论 非心血管专科医师对预防心房颤动血栓治疗认识不足,且无论心血管专科医师或非心血管专科医师应用华法林较保守.所以应普及心血管及非心血管临床医师对心房颤动引起脑卒中的认识及正确使用华法林的抗凝知识,且应提高心房颤动患者对心房颤动所致脑卒中的危险性的认识.
  • 摘要：Objective To invesligale the association of aminopeplidase regulator of TNFR1 shedding 1 (ARTS1 ) gene polymorphism with the genelic susceptibility to rheumatoid arthritis ( RA) in Guangdong Han population. Methods The allele gene frequency and genotypic frequency at single nucleotide polymorphism ( SNP) situs of ARTS1 in RA patients ( RA group) and healthy controls ( control group) of Han population in Guangdong province, China were detected by polymerase chain reaction (PCR) and restriction fragment length polymorphisms (RFLP) techniques, and analysis the association of the polymorphisms at six SNPs situs with the genetic susceptibility to RA. Multiple linear regression analysis was performed to test whether the 6 SNPs were correlated with the clinical features, age, sex, onset site, swollen joint counts ( SJC ) , tender joint counts ( TJC ) , erythrocyte sedimentation rate (ESR) ,C-reactive protein (CRP) ,morning stiffness time,rheumatoid factor (RF) and anti-cyclic citrullinated peptides (CCP) antibody. Results The frequencies of GG genotype and G allele of ARTS1 rs26653 locus were 26% and 52% respectively in RA group which were higher than those in control group, the difference had statistic significance ( r = 0. 477 ,P < 0. 05). There was no significant difference in the distribution of genotype for the ARTS1 rs26618 , rs27434, rs27640, rs27529, rs27044 locus between the RA group and the control group ( P > 0. 05). Multiple linear regression analysis showed that the SNP rs26653 was found to be significantly correlated with the SJC in RA patients ( r = 0. 477 , P < 0. 05). There was no significant correlation between the other 5 SNPs and the clinical features (age,sex,onset site,SJC,TJC ,ESR,CRP,morning stiffness time,RF and anti-CCP anlibody). Conclusions The G allele of ARTS1 rs26653 locus is possibly associated with the genetic susceptibitity Lo RA in Guangdong Han population.%目的 探讨肿瘤坏死因子受体1(tumor necrosis factor receptor 1,TNFR1)脱落调节氨肽酶1(aminopeptidase regulator of TNFR1 shedding 1,ARTS1)基因多态性与广东汉族人群类风湿关节炎(rheumatoid arthritis,RA)遗传易感性的关系.方法 采用聚合酶链反应-限制性片段长度多态性(polymerase chain reaction-restriction fragment length polymorphism,PCR-RFLP)的方法 检测广东汉族人群RA患者(RA组)和健康志愿者(对照组)ARTS1基因6个单核苷酸多态性(single nucleotide polymorphism,SNP)位点的等位基因以及基因型频率,分析6个多态性位点与RA遗传易感性的关系.采用多重线性回归分析6个SNP与RA的临床指标(包括年龄、性别、发病年龄、肿胀关节数目、压痛关节数目、红细胞沉降率、C反应蛋白、晨僵时间、类风湿因子和抗环瓜氨酸肽抗体)的相关性.结果 110例RA患者中,携带ARTS1 rs26653 GG基因型频率(26%)和G等位基因频率(52%)显著高于正常对照组(319例)GG基因型频率(18%)和G等位基因频率(48%),差异有统计学意义(P<0.05,OR=2.332,95% CI 1.244～4.371).ARTS1 rs26618、rs27434、rs27640、rs27529、rs27044 5个位点基因型以及等位基因频率与对照组比较差异无统计学意义(P>0.05).使用多重线性回归分析,6个SNP位点中rs26653与RA患者肿胀关节数目呈显著正相关(r=0.477,P<0.05),其余5个SNP与肿胀关节数目无显著相关性.6个SNP位点与其余临床指标(年龄、性别、发病年龄、压痛关节数目、红细胞沉降率、C反应蛋白、晨僵时间、类风湿因子和抗环瓜氨酸肽抗体)无显著相关性.结论 广东地区汉族人群中,与ARTS1 rs26653 CC基因型相比,携带rs26653 GG基因型可增加RA的发病风险.
  • 摘要：目的 研究垂体腺瘤细胞中核仁、核异形、核浆比例及线粒体数目与其侵袭性生长的相关性.方法 选用40例垂体腺瘤标本,根据影像学分为侵袭性垂体腺瘤(n=20)和非侵袭性垂体腺瘤(n=20),在电子显微镜下观察其核仁、核异形、核浆比例及线粒体;采用ipp 6.0计算两组标本的核仁出现率、核异形率、核浆比例及线粒体数目,并进行统计学分析.结果 侵袭组垂体腺瘤标本中核仁出现率、核异形率、核浆比例及线粒体数目均比非侵袭性垂体腺瘤组显著增高(P<0.05).结论 垂体腺瘤中核仁、核异形、核浆比例及线粒体数目与其侵袭性密切相关,可作为预测垂体腺瘤侵袭性的参考指标.%Objective To study the morphological features of nueleolus, nuclear dimorphism, nucleoplasmic ratio and mitochondrial number in pituitary adenomas and their correlation with invasiveness. Methods The morphological features of nueleolus, nuclear dimorphism, nucleoplasmic ratio and mitochondrial number in 40 patients with pituitary adenoamas (20 cases in invasive group, 20 cases in non-invasive group, grouped by their miageology performance) were observed by electron microscope;ipp 6. 0 software was used to calculate the nucleolar occurrence rate,nuclear dimorphism rate,the nucleoplasm ratio and number of mitochondria of the two groups,and the statistics analysis were carried on. Results The nueleolus occurrence rate,nuclear atypia rates,the nucleoplasm ratio and the number of mitochondrias in invasive pituitary adenomas were higher than those in the non-invasie group(P <0. 05). Conclusions The nueleolus, nuclear atypia, nucleoplasm ratio and the number of mitochondrias are closely correlated with the invasiveness of pituitary adenoma indicating,and they can be acting as predicting markers.
  • 摘要：Objective To observe the changes of visual evoked potential (VEP) in patients with migraine without aura and in patients with chronic migraine, and to explore the possible mechanism of both interietal visual cortex excitability changes. Methods The VEP recording of six sequential blocks of 100 sweeps was conducted in three groups,i. e. migraine,chronic migraine and healthy control groups. We measured the peak-to-peak amplitude of the N1-P2. We compared block 1 VEP amplitude among the three groups and the change tendency in amplitude of N1-P2 recorded during the six blocks in separate groups. Results VEP amplitude of the first block was significant different among three groups. VEP amplitude of the first block was significantly lower in the migraine group than that in the healthy group[ (6. 05 ±2. 22) μV < (6. 54 ± 1. 81 ) μV,P < 0. 05 ] ,but higher in the chronic migraine group than that in the healthy group [ (8. 32 ± 1. 74) μV > (6. 54 ± 1. 81 )μV, P < 0. 05 ]. For the change tendency in amplitude of N1-P2 recorded during the six blocks,the linear trend in the healthy group decreased from blocks 1 to 6 (r= -0.03) ,but increased from blocks 1 to 6 in the migraine group(r =0.21) , the linear trend in the chronic migraine group decreased from blocks 1 to 6(r= -0. 14). Conclusions Reduced cortical pre-activation is likely to be the cause of the habituation deficit found in migraine patients between attacks, ultimately due to the hypofunction of the brainstem. The high cortical excitability of chronic migraine may be attributed to the hypofunction of inhibitory circuits.%目的 观察非先兆性偏头痛及慢性偏头痛发作间期视觉诱发电位(VEP)的变化特点,并探讨两者发作间期视皮层兴奋性改变的可能机制.方法 对非先兆性偏头痛组、慢性偏头痛组及健康对照组(各组n=20)的个体分别进行VEP检查,每叠加100次形成一个VEP波形,连续记录6个波形,测量每个波形N1-P2的波幅,比较起始波形的N1-P2波幅在三组间有无差别,并分析每组内从第一个波形至第六个波形N1-P2波幅的变化趋势.结果 起始波形N1-P2振幅比较:非先兆性偏头痛组低于正常组[(6.05±2.22)μV<(6.54±1.81)μV,P<0.05],慢性偏头痛组高于正常组[(8.32±1.74)μV>(6.54±1.81)μV,P<0.05],均有统计学意义;各组内第一个波形至第六个波形N1-P2波幅的变化趋势分析:健康组呈下降趋势(r=-0.03),非先兆性偏头痛组呈上升趋势(r=0.21),慢性偏头痛组呈下降趋势(r=-0.14).结论 非先兆性偏头痛患者大脑皮层兴奋性适应性缺损,即兴奋性易感性升高,与皮质低预激活水平有关;不同于非先兆性偏头痛患者,慢性偏头痛患者大脑皮层兴奋性适应性升高,与抑制环路活性降低有关.
  • 摘要：Objective To discuss the activity of the phosphatase and tensin homologue deleted on chromosome 10 (PTEN)/phosphatidylinositol 3-kinase (PI3K)/AKT pathway and the clinical significance of PTEN protein expression in clear-cell renal-cell carcinoma ( CCRCC) tissues. Methods The protein of PTEN and AKT (phosphorylation at Ser473 ) of 36 paired CCRCC and adjacent non-neoplastic renal samples were analysed by Western-blot. The effect of PTEN on AKT activation was detected by Western-blot after transfected with si-RNA against PTEN in A-498 cell line. Results The significantly increased AKT ( phosphorylation at Ser473 ) with decreased PTEN protein were observed in CCRCC tissues compared with the adjacent non-neoplastic renal samples while the PTEN protein expression had no significant association with pathological parameters. Blocking PTEN resulting in up-regulation of AKT phosphorylation. Conclusions Our findings indicate that as PTEN dominantly inhibits AKT activation, the coexistence of high levels of the PTEN protein with enhanced AKT activation suggests the existence of novel mechanisms which attenuate PTEN function in CCRCC. These mechanisms may reduce PTEN function or increase AKT activation.%目的 探讨人第10号染色体缺失的磷酸酶及张力蛋白同源的基因(PTEN)/磷脂酰肌醇3-激酶(PI3K)/丝氨酸苏氨酸蛋白激酶(AKT)信号通路在肾透明细胞癌中的活性状况及其与临床特征之间的关系.方法 收集36对肾透明细胞癌及其邻近非肿瘤肾组织,Western blot检测AKT(p-S473)和PTEN蛋白表达,分析两者表达水平的相关性以及PTEN与肿瘤临床特征之间的关系.肾透明细胞癌细胞系A-498转染PTEN si-RNA,观察其对AKT(p-S473)的影响.结果 非肿瘤肾组织中AKT(p-Ser473)为0.945±0.314,PTEN为3.611±0.947.与之比较,肾透明细胞癌中PTEN表达量下降(1.975±0.648),AKT(p-S473)增加(2.751±0.832),差异有统计学意义(P<0.05).PTEN的表达水平与肿瘤临床特征之间无关(P>0.05),细胞系中下调PTEN引起AKT(p-S473)表达升高.结论 肾透明细胞癌中PTEN可以调节PI3K/AKT信号通路的活性,同时PTEN蛋白升高与AKT活性增加同时存在,提示在肾透明细胞癌中还存在使PTEN 功能下降或促进AKT活性增加的因素.
  • 摘要：目的 探讨二氯化钴(CoCl2)诱导缺氧微环境对U2OS骨肉瘤细胞端粒酶活性的影响.方法 以CoCl2诱导构建骨肉瘤细胞缺氧模型(对照组:常氧浓度;CoCl2 150 μmol/L实验组,CoCl2 300 μmol/L实验组),采用RT-PCR方法 对不同氧浓度下骨肉瘤细胞端粒酶活性进行定量测量.结果 与对照组相比,实验组骨肉瘤细胞端粒酶活性增强(P<0.05),实验组两组之间端粒酶活性表达没有差异(P>0.05).结论 CoCl2诱导缺氧后骨肉瘤细胞端粒酶活性增强,但其活性不随缺氧程度增加而增强.%Objective To investigate the effect of hypoxic microenvironment induced by two cobatt chloride (CoCl2)on U2OS osteosarcoma cell telomerase activity. Methods Osteosarcoma cell hypoxia model( control group: normoxic concentration,the experimentat group CoCL, 150 μmol/L,group CoCL, 300 μmol/L). The osteosarcoma cell telomerase activity were measured and quantified by RT-PCR method under different oxygen concentration. Results Compared with control group, osteosarcoma cell telomerase activity of the experimentat group was enhanced ( P < 0.05), the telomereae activity was not different between 150 and 300 μmol/L CoCl2 groups (P > 0.05). Conclusions CoCl2 induced osteosarcoma cell telomerase activity increased after hypoxia, but its activity is not increased with the degree of hypoxia aggravated.
  • 摘要：目的 研究应用生长分化因子-5(GDF-5)局部注射治疗大鼠尾椎间盘损伤的效果.方法 SD大鼠30只,使用20 G皮肤穿刺针对Co7/8、Co8/9、Co9/10椎间盘进行半横贯穿刺,Co7/8 和Co8/9椎间盘穿刺后各注入GDF-5 100 μg(GDF-5组),Co9/10椎间盘穿刺后不进行处理(对照组).术前及术后2、4、8周时对两组椎间盘行X线检查及HE染色观察.结果 术后第2周到第8周,GDF-5组和对照组椎间盘的高度指数呈现持续减小,但GDF-5组椎间盘的高度指数大于对照组(P<0.05).组织学检查发现GDF-5组和对照组椎间盘均有退变,但对照组椎间盘的退变比GDF-5组更严重,组织学评分更高(P<0.05).结论 GDF-5局部注射能促进椎间盘损伤的修复,延缓椎间盘损伤后的退变.%Objective To study the effect of repairing injury of rat intervertebrat discs by injecting growth differentiation factor 5 ( GDF-5). Methods Ninty intervertebrat discs of 30 rats were punctured by puncture needle ( size of 20 G) ,the intervertebrat discs of Co7/8 and Co8/9 were injected with GDF-5 (100 μg) after puncture(the group of GDF-5 ) , the intervertebrat discs of Co9/10 were injected northing ( the group of comparison ). The intervertebrat discs of two groups were shoted with X-ray and done with histologicat examination before experiment and 2,4,8 weeks after experiment. Results The height index of intervertebrat discs of two groups decreased constantly after experiment. The height index of group of GDF-5 were superior to that of group of comparison (P < 0.05). The intervertebrat discs of two groups degenerated, but degeneration of group of comparison was severe. Conclusions Injecting GDF-5 can improve reparation of injured discs and delay degeneration of injured discs.
  • 摘要：Objective To invesligate the therapeutic effect of middle and high-dose chemolherapy with autologous peripheral blood stem cells support in the trealmenl of acute leukemia ( AL). Methods Thirty eight AL palients in complete remission state were divided into trealment group and chemolherapy group. 20 patients of the treatment group couldn't perform an aulologous transplant due to insufficient number of collected aulologous peripheral blood stem cells, so transfused aulologous peripheral blood slem cells to them for the support trealment after one course high-dose chemolherapy. 18 patients of the chemolherapy group used two lo four courses middle and high-dose chemolherapy for the trealmenl. Compared the hematopoietic recovery, infection, relapse and the 3-year leukemia-free survival afler treatment of the two groups. Results Nineteen patients of the trealmenl group received hematopoielic recovery eventually,the mean time of neulrophils >0. 5 × 109 /L for 3 days and plalelels >20× 109 /L for 7 days was( 11. 80 ±0. 986) days and( 12. 80 ±0. 848 ) days,respectively. The differences with the chemotherapy group were statistically significant Pneutrophils = 0. 04,Pplatelets= 0. 042). The median follow-up lime of 38 palienls was 19(7-48)monlhs,8 cases of palienls had infections,and the differences of the infection rale with the chemolherapy group were statistically significant ( 40. 0% vs. 77. 8% , P = 0. 02 ). 7 patients presented recurrence, and the recurrence rate was 35%. 5 patients died, 15 patients were still alive(12 palienls were recurrence-free survival). According Lo Kaplan-Meier Survival Analysis, the expecled 3-year leukemia-free survival ( LFS) were ( 67. 7 ± 12.3)% ,which was higher than the chemotherapy group(47.9 ±12. 1)% ,but the differences were not statistically significant (P = 0. 075). Conclusions The effect of high-dose chemotherapy with autologous peripheral blood stem cell support cured AL palienls is safe and reliable. Hemalopoielic recovery after the trealment is faster, the recurrence rate and the infection rale are lower than the chemotherapy group. This method can improve the tife quality of AL patients, which is an another clinical selection of consolidation treatment for AL patients in remission who cannot performed transplantation after collection of autologous peripheral blood stem cell.%目的 探讨中高剂量化疗联合自体外周血干细胞支持治疗急性白血病(AL)的疗效.方法 将38例处于完全缓解状态的AL患者分为治疗组和化疗组,治疗组20例由于采集自体外周血干细胞数量不足等原因无法进行自体移植,在行1个疗程中高剂量化疗后回输自体外周血干细胞进行支持治疗,化疗组18例使用中高剂量化疗治疗2～4个疗程,比较两组治疗后造血恢复、感染发生、复发及3年无白血病生存情况.结果 治疗组19例患者最终获得造血恢复,中性粒细胞连续3 d>0.5×109/L和血小板连续7 d>20×109/L的平均时间分别为(11.80±0.986)d,(12.80±0.848)d,与化疗组比较差异有统计学意义(P中性粒=0.04,P血小板=0.042).38例患者中位随访时间19(7～48)个月,8例出现感染,感染率两组差异有统计学意义(40.0% vs.77.8%,P=0.02);7例复发,复发率为35%;5例死亡,15例仍存活(12例无复发存活),根据Kaplan-Meier生存分析,预计3年无白血病生存率(LFS)治疗组为(67.7±12.3)%,高于化疗组(47.9±12.1)%,但差异无统计学意义(P=0.075).结论 中高剂量化疗联合自体外周血干细胞支持治疗AL安全可靠,治疗后造血恢复较快,复发率及感染发生率低于化疗组,可提高AL患者生存质量,是采集自体外周血干细胞后无法进行移植的AL患者缓解后巩固治疗的又一临床选择.
  • 摘要：目的 研究Ki-67在鼻咽癌组织、乳腺癌组织中的表达及其与化疗疗效的关系,探讨Ki-67是否可以作为化疗的敏感预测因子及预测生存的独立预后因素.方法 收集2006年1月至2010年12月在广西医科大学附属肿瘤医院进行化疗的鼻咽癌患者64例,乳腺癌患者64例,应用免疫组化法检测其癌组织Ki-67表达情况,分析Ki-67表达与化疗疗效及患者远期生存的关系.结果 鼻咽癌、乳腺癌患者中,Ki-67阴性组化疗有效率与Ki-67阳性组相比差异无统计学意义.Ki-67低表达组化疗有效率与Ki-67高表达组比较差异亦无统计学意义.随着Ki-67表达级别的递增,各组间化疗疗效差异无统计学意义.在不同的化疗方案组中,均未发现Ki-67表达与化疗疗效间有明显的相关性(P>0.05).远期生存方面,Ki-67阴性组与低表达组未显示出明显的生存优势,1年、2年及3年生存率在Ki-67阳性组及高表达组比较差异均无统计学意义(P>0.05).结论 Ki-67表达水平与化疗有效率及预后间均无明显相关性,Ki-67可能并不能作为鼻咽癌和乳腺癌患者化疗敏感的预测因子及判断预后的生物学指标.%Objective To investigate the expression of Ki-67 and its relationship with response to ehemotherapy and prognosis, and to explore whether ki-67 can be used as a predictor for chemosensitivity and for prognosis in patients with nasopharyngeal carcinoma and breast cancer. Methods 64 cases of nasopharyngeal carcinoma and 64 cases of breast cancer who underwent chemotherapy from January 2006 to December 2010 in the affiliated tumor hospital of Guangxi Medical University were selected. The expression of Ki-67 was detected by the immunohistochemical technology. The correlations of the expression of Ki-67 with the response to chemotherapy and the prognosis were analyzed. Results The chemotherapy effective rate in the Ki-67 positive group was not statistically significant compared with that in the Ki-67 negative group. The statistical significant difference in the chemotherapy effective rate was not found between in the Ki-67 high expression group and in the Ki-67 low expression group. And with the expression levels of Ki-67 increasing, the difference in the chemotherapy effective rate was not statistically significant among 4 groups. In addition,among different chemotherapy regime groups, the levels of Ki-67 expression were not statistically significant associated with the chemotherapy effective rate(P >0. 05). With regard to the long-term survival, both group patients with Ki-67 negative and low expression showed no survival advantage. 1,2 and 3-year survival rate in the positive or the high expression group were not higher or lower than those in the negative or the low expression group. The differences were not statistically significant ( P > 0.05 ). Conclusions There were no significant correlations between Ki-67 expression and the effectiveness of chemotherapy and prognosis. Ki-67 expression may not be used as a predictor for chemosensitivity or prognosis in human nasopharyngeal carcinoma and breast cancer.
  • 摘要：目的 探讨用UroVysion探针标记的荧光原位杂交(FISH)技术在中国人群中诊断上尿路上皮癌的应用价值.方法 留取70例因血尿或影像学提示病变的可疑上尿路上皮癌患者尿液标本,分别行UroVysion FISH,检测尿液脱落细胞3、7、17 号染色体着丝粒探针及 9号染色体p16位点探针,同时行尿细胞学检查,比较UroVysion FISH和尿液脱落细胞二者差异.结果 70例可疑患者中术后病理确诊为上泌尿系尿路上皮癌患者共61例,其中UroVysion FISH和尿细胞学检查阳性例数分别为44例和19例,其敏感性分别为72.1%和31.1%,差异有统计学意义(P<0.005),二者的特异性均为90%.UroVysion FISH和尿细胞学检查对非肌层浸润性肿瘤和肌层浸润性肿瘤的敏感度分别为63.6%、82.1%和24.2%、39.3%,对G1、G2、G3期上尿路上皮癌患者的敏感度分别为41.2%、76.2%、91.3%和11.8%、23.8%、52.2%.结论 UroVysion FISH检查为中国人群上尿路上皮癌的早期诊断和术后监测提供了快速、安全、灵敏度高的无创伤性检测方法.%Objective To assess the clinical utility of UroVysion fluorescence insitu hybridization (UroVysion FISH) assay as a non-invasive methods for diagnosing and monitoring urothelial carcinoma( UC) in the upper urinary tract(UUT) in Chinese patients,as UroVysion FISH has been used in Western countries for detecting UC,but there are limited results in Asian populations. Methods Urine specimens from 70 consecutive patients with suspective UUTUC were collected before endoscopy or surgery, and were performed simultaneously by UroVysion FISH and cytological analysis. For UroVysion FISH analysis, labelled probes to chromosomes 3,7,9, and 17 were used to assess chromosomal abnormalities indicative of malignancy. The sensitivity and specificity were calculated by software SPSS 13. 3 based on the histology and pathology. Results Sixty one out of 70 patients had a histologically proven upper urinary tract urothelial carcinoma. The overall sensitivities of cytology and UroVysion FISH were 31.1% and 72. 1% ( P < 0. 005 ) , while their specificities were both 90. 0% . The sensitivies of UroVysion FISH were 41.2%, 76. 2%, 91. 3% for the Gl , G2 and G3 tumor, and were 11. 8%, 23. 8% and 52.2% by cytological analysis. For non-invasive tumor and invasive tumor, the sensitivities of UroVysion FISH were 63. 6% and 82. 1% , while 24. 2% and 39. 3% by cytological analysis. Conclusions UroVysion FISH assay of chromosomes 3,7,9,and 17 performed on exfoliated cells from voided urine specimens has greater sensitivity than cytology for detecting UUTUC whilst maintaining a similar specificity.

    中华临床医师杂志（电子版）的期刊信息

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