目的 探讨长期应用恩替卡韦治疗的乙型肝炎肝硬化患者血清水通道蛋白8(AQP8)和水通道蛋白9(AQP9)水平变化及其临床意义.方法 2019年1月～2020年6月我院收治的长期接受恩替卡韦治疗的乙型肝炎肝硬化患者83例,继续接受恩替卡韦治疗,使用全自动电化学发光分析仪检测血清AQP8和AQP9水平.采用Logistic逻辑回归模型分析代偿期与失代偿期肝硬化患者各临床因素差异的异同.结果 27例失代偿期肝硬化患者在病程≥10年(63.0％对33.9％)、抗病毒治疗时间≥5年(25.9％对62.5％)、血清白蛋白(31.4±1.9 g/L对37.9±2.3 g/L)、血小板计数(73.8±7.5×109/L对109.6±6.8×109/L)、血清AQP8水平(20.5±2.8μg/L对12.6±2.1μg/L)、血清AQP9水平(10.1±1.7μg/L对6.0±1.0μg/L)和MELD评分(21.5±3.5对13.6±2.9)方面,与56例代偿期肝硬化患者存在显著性差异(P<0.05);多因素Logistic回归分析显著抗病毒治疗时间短、血清AQP8≥15.2μg/L和MELD评分≥19.5分是影响疾病进展的危险因素(P<0.05);19例有腹水患者血清AQP8和AQP9水平分别为(19.5±2.8)μg/L和(10.7±1.3)μg/L,显著高于64例无腹水患者[分别为(13.9±2.1)μg/L和(6.3±0.9)μg/L,P<0.05];13例有肝性脑病患者血清AQP8和AQP9水平分别为(20.3±2.6)μg/L和(9.7±1.3)μg/L,显著高于70例无肝性脑病患者[分别为(14.2±2.4)μg/L和(6.9±1.1)μg/L,P<0.05].结论 长期接受恩替卡韦治疗的乙型肝炎肝硬化患者血清AQP8和AQP9水平升高提示病情进展,可能与不良预后有关,值得进一步研究.

In order to explore whether NF-κB activation correlates to the prognosis, chemoresistance, and sex hormone receptors status in ovarian serous carcinoma, we analyzed the expression of NF-κB, ER, and PR by immunohistochemistry in 72 cases of ovarian serous carcinoma, investigated the association among these markers, and evaluated their relations to clinicopathologic factors and prognosis. The positive rates were 88.9% for NF-κB cytoplasmic expression, 45.8% for NF-κB nuclear expression, 41.7% for ER, and 29.2% for PR. NF-κB nuclear expression was positively correlated with the 4th edition WHO grade (P=0.045) and tumor stage (P=0.001). NF-κB cytoplasmic expression was associated with preoperative serum CA125 level (P=0.015) and ascites (P=0.042). Neither cytoplasmic nor nuclear staining of NF-κB showed any association with survival. PR expression was correlated with tumor stage (P=0.023) and omental metastasis (P=0.022). Omental metastasis occurred more frequently in ER−/PR− tumors (P=0.009). No correlation between NF-κB expression and ER, PR expression was observed. In conclusion, in ovarian serous carcinoma, NF-κB nuclear expression correlated with the 4th edition WHO grade and PR was a favorable prognostic factor for ovarian serous carcinoma.

Objective:To investigate the expression pattern and prognostic values of CD44 and CK18 in ovarian serous carcinoma. Methods:Immunohistochemical evaluation inclu-ding CD44 and CK18 was performed in paraffin wax-embedded tissues of 72 cases of ovarian se-rous carcinoma. The expression and the relationship with clinical parameters of these markers were analyzed. Results:The positive rates were 66. 7% for CD44 and 100% for CK18. Clusters of CD44+cells scattered in tumor tissue,and the expression pattern was more prominent in high-grade serous carcinoma. CK18 expression significantly correlated with age (P=0. 014) and lymph node metastasis ( P=0 . 015 ) . CD44 and CK18 expression levels neither were correlated with chemotherapeutic effects and overall disease free survival time,nor showed any mutual re-lationship between each other. Conclusion:The expressions of CD44 and CK18 are correlate with the prognosis of ovarian serous carcinoma,but they are not satisfactory indicators for che-motherapeutic effects and survival time.

OBJECTIVE:To compare the efficiency of three different estrogen receptor (ER) immunostaining scoring systems by analyzing the correlation between ER status and clinicopathologic features for prediction of prognosis of patients with endometrial carcinoma (EC). METHODS:ER immunostaining (EnVision method) was performed in 160 type I EC and 39 type II EC paraffin samples and was scored by ASCO/CAP criterion, H-Score and Allred scoring system. Correlation between ER status and clinicopathologic features was statistically analyzed. RESULTS:ASCO/CAP criterion, H-Score and Allred (cutoff point: 4-8) scoring system showed high concordance in the following aspects. In EC patients, ER status was significantly associated with presurgical CA125 levels (P = 0.015, P = 0.007, P = 0.023), histologic grades (all P < 0.01) and PR status (all P < 0.01). In type I EC cohort, ER status was significantly correlated with PR status (P = 0.008, P < 0.01, P < 0.01) and p53 status (P = 0.042, P = 0.001, P < 0.01). As of the predictive value of ER status for type I EC patient age, ASCO/CAP (P = 0.027) and H-Score criteria (P = 0.035) were both superior to Allred score system (P = 0.064). Among well-known predictive clinicopathologic parameters, including FIGO stage, lympho-vascular involvement, lymph node metastasis, depth of myometrial invasion and omental involvement, ASCO/CAP scoring offered a better correlation (P = 0.005, P = 0.002, P = 0.021, P = 0.067, and P = 0.067, respectively) than H-Score (P > 0.05) and Allred scoring system (P > 0.05). CONCLUSIONS:Compared with H-Score and Allred scoring system, ASCO/CAP criterion is more closely correlated with predictive clinicopathologic parameters. Therefore it may be used as a simple, highly efficient prognostic indicator for EC patients in routine practice.

Objective:To investigate the expressions and its significances of E-cadherin and p120 catenin(p120) in serous ovarian carcinoma.Methods:Using immunohistochemical technique,the expressions of E-cadherin and p120 in 31 cases of low-grade ovarian serous carcinoma and 70 cases of high-grade ovarian serous carcinoma were examined.Their relationship with clinicopathological data was analyzed.Results:The positive expression rates of E-cadherin in low-grade and high-grade serous carcinoma were 71.0% and 61.4% respectively(P=0.356).The positive expression rates of p120 in low-grade and high-grade serous carcinoma were 83.9% and 60.0% respectively(P=0.018).In the group of high-grade serous carcinoma,the expressions of E-cadherin and p120 were significantly correlated with FIGO staging(P=0.015,P=0.011),lymph node metastasis(P=0.001,P=0.001) and invaded omentum(P=0.028,P=0.018).E-cadherin expression was correlated with age(P=0.011) while p120 was not(P=0.226).In the group of low-grade serous carcinoma,only the expression level of p120 showed significant association with lymph node metastasis(P=0.042),invaded omentum(P=0.048) and preoperative CA125 level(P=0.042).Conclusion:Expression of p120 protein in high-grade serous ovarian carcinoma is significantly reduced.And only in high-grade serous ovarian carcinoma,loss of E-cadherin and p120 expression are correlated with FIGO staging,invasion and tumor metastasis,suggesting that E-cadherin and p120 may have different functions in the development of different types of ovarian serous carcinoma.

Objective To reflect,through chronic kidney diseases (CKD) screening in community risk population,the confusion and challenges that general practitioners are facing in the prevention and treatment of CKD.Methods Conventional kidney function test was conducted in 608 hypertensive out-patients in our hospital from May 2008 to October 2009.Internationally accepted MDRD formula was used to calculate glomerular filtration rate (eGFR),early CKD was screened,and relevant health education and management performed.Results Of 608 hypertensive patients,287 had varying degrees of impaired renal function,accounting for 47.2%;145 met the diagnostic criteria for CKD,and CKD prevalence rate of hypertensive population was 23.8%.The kidney function calculated by the formula was less than 90 ml/min in 58 hypertensive patients with normal serum creatinine who had not been diagnosed as CKD,including 27 with eGFR of 60～89ml/min (16 males,11 females,8 with abnormal routine urinanaysis) and 31 with eGFR of 30～59 ml/min (10 males,21 were females;7 with abnormal routine urinalysis).Fifteen patients were complicated by diabetes.After lifestyle changes and primary disease treatment,23 patients improved.Conclusion CKD prevalence is relatively high in community hypertensive population,a considerable number of whom have normal serum creatinine.If general practitioners provide this population with early screening,intervention and standard health management,CKD can be greatly slowed down or controlled,thus to reduce huge consumption of medical resources and help to guide treatment,monitor patients'conditions and improve prognoses.

OBJECTIVE To evaluate the two-tier MDACC grading system for ovarian serous carcinoma by comparing with the WHO grading system, and to investigate the role of p53 immunostaining in ovarian serous carcinoma grading. METHODS 72 cases ovarian serous carcinoma of ovary were graded basing on the MDACC and WHO grading systems, respectively. Statistic analyses were made for the relationship between the data obtained from two grading systems and their clinical significance. All the cases were examined immunohistochemically by using antibody against p53 protein and the immunohistochemistry findings were analyzed with the two grading systems and clinical parameters. RESULTS There was a good correlation between the MDACC and WHO grading system (r=0.543, P=0.000). Neither system has a definite relationship with the disease-free survival time (P=0.170 vs. P=0.075), cytoreduction (P=0.478 vs. P=0.120), and the curative effect of platinum-based chemotherapy (P=0.418 vs. P=0.403). However, compared with the WHO grading system, MDACC grading system has a better correlation with tumor stage (P=0.041 vs. P=0.002), 3-year disease-free survival rate (P=0.077 vs. P=0.004), overall survival time (P=0.080 vs. P=0.046), and p53 immunohistochemistry results (P=0.334 vs. P=0.035). No significant difference was found between p53 immunohistochemistry results with other clinical characteristics and prognostic factors. CONCLUSIONS Compared with the WHO system, the MDACC system showed a better prognostic value and was more likely correlated with the novel dualistic model for ovarian serous carcinogenesis. Although p53 immunostaining was valuable in assisting MDACC grading, it should be cautious to use it alone as an independent indicator in predicting the prognosis of ovarian serous carcinoma.

Objective To compare the pathologic diagnosis accuracy and the specimen quality between endometrial sampling device and conventional suction dilation and curettage (DC).Methods All 157 outpatients presenting for the endometrial biopsy were enrolled prospectively. An endometrial biopsy collected by endometrial sampling device was performed before DC. Diagnosis was given by professional pathologists.Results Considering the pathologic diagnosis from the samples obtained by DC as control,pathologic diagnosis accuracy rate by the endometrial sampling device was 89.8% (141/157,P0.05) . Similar results were shown for menstrual phase endometrial evaluation in infertility women group (97.9%,95/97) and for endometrial carcinoma screening in non-symptom postmenopausal women (100%,17/17). However,the sensitivity of endometrial sampling device was significantly lower (P0.05) compared with that by DC in patients with fibroids (69.0%,11/16) and with endometrial hyperplasia (61.5%,17/26). Six endometrial carcinoma cases were successfully diagnosed or suspected by endometrial sampling device. The specimen quality was evaluated in 17 non-symptom postmenopausal women undergoing routine endometrial carcinoma screening and 97 infertility patients undergoing menstrual phase endometrial evaluation. No significant difference was shown between two procedures (P0.05).Conclusions The endometrial sampling device is comparable to DC evaluating menstrual phase endometrial in infertility patients and routine endometrial carcinoma screening in non-symptom postmenopausal women,which it may be a promising device for endometrial sampling in endometrial carcinoma patients,while a negative finding should be caution.

Purpose: To investigate the manifestation and clinical application value of ultrasound in limbs muscle granular cell tumor.Materials and Methods: Clinical manifestation,pathological feature and ultrasonic manifestation of two cases of limbs muscle granular cell tumors were reviewed retrospectively.Results: Ultrasonic manifestations of granular cell tumor are ill-defined irregular hypoechoic masses with homogeneous inner echo.These masses always show posterior enhancement and surrounding hyperechoic irregular area.And there are no rich flow signals detected.Histologically,some malignant granular cell tumors are very similar with benign varieties.Ultrasonic follow-up can find the recurrence and metastasis of the tumor.Conclusions: It is hard to differentiate between benign and malignant granular cell tumors by pathological ways only.The final diagnose always needs information of medical history and imaging examination.Ultrasound has significant value for detection of metastasis and recurrence of granular cell tumors and for differentiation between benign and malignant tumors.

目的了解某医学高校报考研究生学生的健康状况,为报考研究生学生的预防保健提供依据。方法统计2006-2008年间,在某高校医院接受健康体检的1 358名报考硕士或博士研究生的体检结果(内外科、眼科、实验室检查),将不同性别进行比较。结果尿酮体阳性检出率为3.24%,其中女生占4.04%,显著高于男生。尿中白细胞和尿潜血的检出率分别为6.19%和10.68%,女生均显著高于男生。尿蛋白阳性检出率为3.60%,男女生差异无统计学意义。外周血白细胞总数低于正常值者占受检者的8.98%,男女差异无统计学意义。血红蛋白低于正常值者占受检者的2.21%,女生显著高于男生。转氨酶高于正常值者占受检者的8.17%,乙肝表面抗原阳性者占受检者的4.71%,男生均显著高于女生。高血压或正常高限者占受检者的3.76%,男性显著高于女性。结核和色弱者分别占受检者的0.37%和0.29%,均为男性。结论女生需要注意泌尿系统疾病的预防,男生需要注意肝脏的保护,预防高血压,有规律锻炼身体以增强自身抵抗力。

我们自1998年5月至2000年12月,以中医辨证治疗为主,结合西药治疗2型糖尿病118例,并设治疗前后对照,疗效满意.现将结果报告如下.