应用荧光原位杂交(FISH)技术研究黑叶猴染色体易位

本文应用染色体荧光原位杂交(FISH)技术,利用人9号和14号染色体特异探针,对深低温冻存和长期传代的黑叶猴细胞株染色体畸变进行了分析.确定在长期冻存和传代过程中,一些黑叶猴细胞在No.12和No.17染色体之间发生了易位,一条 No.17染色体发生断裂,断裂点在17q13,断裂片段17q13-17qter易位到一条 No.12染色体长臂末端,形成一条小的中着丝粒的和一条具较长长臂的衍生染色体即 der(17) 和 der(12).结果表明,荧光原位杂交技术用人染色体特异探针不仅能检测出人类染色体畸变,也能有效地检测灵长类动物染色体畸变.     

应用荧光原位杂交(FISH)技术研究 黑叶猴染色体易位

本文应用染色体荧光原位杂交(FISH)技术,利用人9号和14号染色体特异探针,对深低温冻存和长期传代的黑叶猴细胞株染色体畸变进行了分析。确定在长期冻存和传代过程中,一些黑叶猴细胞在No.12和No.17染色体之间发生了易位,一条 No.17染色体发生断裂,断裂点在17q13,断裂片段17q13-17qter易位到一条 No.12染色体长臂末端,形成一条小的中着丝粒的和一条具较长长臂的衍生染色体即 der(17) 和 der(12)。结果表明,荧光原位杂交技术用人染色体特异探针不仅能检测出人类染色体畸变,也能有效地检测灵长类动物染色体畸变。 Abstract　In this paper,the chromosome aberration of long-term cryopreserved and subcultured Francois' monkey (Semnopithecus francoisi) cell line(KCB 92008) was analyzed by fluoresence in situ hybridizaton (FISH) using human 9 and 14 chromosome DNA probes. After compared the hybridization pattern with the G-banding pattern on the same metaphase,a translocation between Nos.12 and 17 chromosomes was identified. In some Francois'monkey cells,one of chromosome No.17 was broken into two at the breakpoint 17q13,the segment(17q13-17qter) without centromere transfered to the long arm terminal of one chromosome No.12. Thus,two derivant chromosomes der(12) and der(17) were formed,the long arm of der(12) was longer than the normal partner,while the long arm of der(17) was shorter than the normal one. The result indicated that the technique of FISH using human whole chromosome probes was not only a powerful tool to detect human chromosome rearrangements,but also a usefulmethod to study the primate chromosome aberration.     

Combined DNA-RNA Fluorescent In situ Hybridization (FISH) to Study X Chromosome Inactivation in Differentiated Female Mouse Embryonic Stem Cells

Fluorescent in situ hybridization (FISH) is a molecular technique which enables the detection of nucleic acids in cells. DNA FISH is often used in cytogenetics and cancer diagnostics, and can detect aberrations of the genome, which often has important clinical implications. RNA FISH can be used to detect RNA molecules in cells and has provided important insights in regulation of gene expression. Combining DNA and RNA FISH within the same cell is technically challenging, as conditions suitable for DNA FISH might be too harsh for fragile, single stranded RNA molecules. We here present an easily applicable protocol which enables the combined, simultaneous detection of Xist RNA and DNA encoded by the X chromosomes. This combined DNA-RNA FISH protocol can likely be applied to other systems where both RNA and DNA need to be detected.     

应用G显带染色体荧光原位杂交（FISH）技术研究复杂的染色体易位

建立常规Ｇ显带染色体标本的荧光原位杂交（ＦＩＳＨ）技术,用于分析患者复杂的染色体易位。原位杂交前,用甲醛固定Ｇ显带标本,是获得良好显带和荧光杂交效果的关键步骤。仅用常规细胞遗传学方法分析,显示一例习惯性流产患者的核型为４６,ＸＸ,ｔ（１;５;１２）（１ｐｔｅｒ→１ｑ２５：：１２ｑ２４→１２ｑｔｅｒ;５ｑｔｅｒ→５ｐ１１：：１ｑ２５→１ｑｔｅｒ,１２ｐｔｅｒ→１２ｑ２４：．５ｐ１１→５ｐｔｅｒ）,而采用本方法确定患者的核型实际为４６,ＸＸ,ｔ（１;５,１２）（１ｐｔｅｒ→１ｑ２３：：１２ｑ２２→１２ｑｔｅｒ,５ｑｔｅｒ→５ｐ１１：：１ｑ２５→１ｑｔｅｒ;１２ｐｔｅｒ→１２ｑ２２：：１ｑ２３→１ｑ２５：５ｐ１１→５ｐｔｅｒ）。结果表明,新建立的Ｇ显带染色体荧光原位杂交（ＦＩＳＨ）技术能更有效地检测患者复杂的染色体易位。     

FISH检测乳腺癌石蜡组织切片的酶消化时间的探究

目的:探讨在FISH实验中,乳腺癌石蜡组织切片的最适酶的消化时间.方法:收集42例手术切除的乳腺癌标本,经过固定、包埋和切片,其中12份标本的组织切片进行胃蛋白酶消化时间的优化实验,分别观察酶的消化时间为10分钟,15分钟,20分钟和25分钟对FISH结果的影响,随后在酶的优化条件对剩余30份组织切片继续杂交实验.结果:酶消化10min提示消化时间不足,酶消化15min提示消化时间适合,结果能很好地判读,而酶消化25min提示消化过度.对剩余的30份组织切片进行了18min的消化,杂交信号基本都能判读.结论:本实验条件下,石蜡包埋切片的最适消化时间在15-20min,不同实验室及不同的FISH处理过程会略有差异.所以建议FISH实验之前,应对酶的消化时间首先进行摸索.     

Concomitant Detection of HER2 Protein and Gene Alterations by Immunohistochemistry (IHC) and Silver Enhanced In Situ Hybridization (SISH) Identifies HER2 Positive Breast Cancer with and without Gene Amplification

Introduction

HER2 status assessment became a mandatory test assay in breast cancer, giving prognostic and predictive information including eligibility for adjuvant anti-HER2 therapy. Precise and reliable assessment of HER2 status is therefore of utmost importance. In this study we analyzed breast cancer samples by a novel technology for concomitant detection of the HER2 protein and gene copy number.

Methods

Tissue microarrays containing 589 invasive breast cancer samples were analyzed with a double immunohistochemistry (IHC) and silver labeled in situ hybridization (SISH) assay simultaneously detecting HER2 protein and gene copy number in the same tumor cells. This bright-field assay was analyzed using scores according to the modified ASCO guidelines and the results were correlated with patient prognosis.

Results

Overall concordance rate between protein expression and the presence of gene amplification was 98%. Fifty-seven of 60 tumors (95%) with IHC score 3+, 6 of 10 tumors with IHC score 2+ (60%) and only 3 of 519 tumors (0.6%) with IHC score 0/1+ were amplified by SISH. Patients with gene amplification despite IHC score 0/1+ had a tendency for worse overall survival (p = 0.088, reaching nearly statistical significance) compared to IHC score 0/1+ without amplification. In contrast, there was no difference in overall survival in IHC score 3+/2+ tumors with and without gene amplification.

Conclusions

The novel double IHC and SISH assay for HER2 is efficient in the identification of breast cancer with discordant HER2 protein and HER2 gene status, especially for the prognostically relevant groups of HER2 protein negative tumors with HER2 amplification and HER2 protein positive tumors without HER2 amplification. Breast cancer without HER2 amplification among IHC score 2+/3+ tumors (10% in our cohort) suggests that other mechanisms than gene amplification contribute to protein overexpression in these cells.     

用FISH技术对人、恒河猴、食蟹猴染色体的研究

用人类5号、 9号、13号、15号、17号、20号整条染色体探针分别对人、恒河猴和食蟹猴的中期细胞进行荧光原位杂交,结果表明:人的5号、13号、17号探针分别杂交到恒河猴的5号、16号、17号染色体上;9号探针杂交到恒河猴14号染色体的长臂及部分短臂上; 15号探针杂交到恒河猴7号染色体短臂及部分长臂上;20号探针杂交到恒河猴的13号染色体长臂上。食蟹猴的杂交结果与恒河猴完全一致。结合G带带型分析,对人与猕猴的染色体同源性及其进化进行了讨论。 Abstract:Fluorescent in situ hybridizaiton(FISH)was used on the metaphase of Macaca mulatta and Macaca fasicularis with human chromosome specific DNA libraries for chromosome 5、9、13、15、17 and 20.In Macaca mulatta,the result showed that chromosome 5、16 and 17 was entirely painted by human chromosome 5、13 and 17 specific libraries respectively.The long arm and the partial short arm of chromosome 14 and the short arm and the partial long arm of chromosome 7 were painted by human chromosome 9 and 15 specific libraries respectively.And the long arm of chromosome 13 was painted by human chromosome 20 library.The result was the same in Macaca fasicularis.Combinded with the comparative analysis of G-banding,the evolutional relationship of these chromosomes between human and macaques was discussed.     

Efficacy and Safety of HER2-Targeted Agents for Breast Cancer with HER2-Overexpression: A Network Meta-Analysis

BackgroundClinical trials of human epidermal growth factor receptor 2 (HER2)-targeted agents added to standard treatment have been efficacious for HER2-positive (HER2+) advanced breast cancer. To our knowledge, no meta-analysis has evaluated HER2-targeted therapy including trastuzumab emtansine (T-DM1) and pertuzumab for HER2-positive breast caner and ranked the targeted treatments. We performed a network meta-analysis of both direct and indirect comparisons to evaluate the effect of adding HER2-targeted agents to standard treatment and examined side effects.MethodsWe performed a Bayesian-framework network meta-analysis of randomized controlled trials to compare 6 HER2-targeted treatment regimens and 1 naïve standard treatment (NST, without any-targeted drugs) in targeted treatment of HER2+ breast cancer in adults. These treatment regimens were T-DM1, LC (lapatinib), HC (trastuzumab), PEC (pertuzumab), LHC (lapatinib and trastuzumab), and PEHC (pertuzumab and trastuzumab). The main outcomes were overall survival and response rates. We also examined side effects of rash, LVEF (left ventricular ejection fraction), fatigue, and gastrointestinal disorders, and performed subgroup analysis for the different treatment regimens in metastatic or advanced breast cancer.ResultsWe identified 25 articles of 21 trials, with data for 11,276 participants. T-DM1 and PEHC were more efficient drug regimens with regard to overall survival as compared with LHC, LC, HC and PEC. The incidence of treatment-related rash occurs more frequently in the patients who received LC treatment regimen than PEHC and T-DM1 and HC. In subgroup analysis, T-DM1 was associated with increased overall survival as compared with LC and HC. PEHC was associated with increased overall response as compared with LC, HC, and NST.ConclusionsOverall, the regimen of T-DM1 as well as pertuzumab in combination with trastuzumab and docetaxel is efficacious with fewer side effects as compared with other regimens, especially for advanced HER2+ breast cancer.ImpactThis study suggests that both T-DM1 and PEHC therapy are potentially and equally useful treatments for HER2+ breast cancer.     

Fluorescence in Situ Hybridization (FISH): DNA Probe Production and Hybridization Criteria

We describe methods for the production of fluorescence in situ hybridization (FISH) probes and the utilization of these probes for the detection of complementary DNA sequences with accuracy and sensitivity for application in both basic research and clinical diagnosis. Due to the frequent use of FISH in many laboratories, it is important to apply the most convenient and reproducible approach. This review describes some of the most recent techniques, and includes versatile, effective and simple methods of probe production and fluorescence in situ hybridization. We also describe methods for the production of region-specific and chromosome-specific DNA probes and hybridization techniques for the visualization of these probes.     

A Comparison of Visual Assessment and Automated Digital Image Analysis of Ki67 Labeling Index in Breast Cancer

Background

Ki67 labeling index (LI) is critical for treatment options and prognosis evaluation in breast cancer. Visual assessment (VA) is widely used to assess Ki67 LI, but has some limitations. In this study, we compared the consistency between VA and automated digital image analysis (DIA) of Ki67 LI in breast cancer, and to evaluate the application value of DIA in Ki67 LI assessment.

Methods

Ki67 immunostained slides of 155 cases of primary invasive breast cancer were eyeballing assessed by five breast pathologists and automated digital image analyzed by one breast pathologist respectively. Two score methods, hot-spot score and average score, were used to choose score areas. The intra-class correlation coefficient (ICC) was used to analyze the consistency between VA and DIA, and Wilcoxon signed-rank test was used to compare the median of paired-difference between VA and DIA values.

Results

(1) A perfect agreement was demonstrated between VA and DIA of Ki67 LI by ICC analysis (P<0.0001) in the whole cohort. A perfect agreement between VA and DIA of Ki67 LI was also showed in G2-G3, ER positive/HER2 negative cases. Average score and hot-spot score methods both demonstrated a perfect concordance between VA and DIA of Ki67 LI. (2) All cases were classified into three groups by VA values (≤10%, 11%-30% and >30% Ki67 LI). The concordance was relatively lower in intermediate Ki67 LI group (11%-30%) compared with high (>30%) Ki67 LI groups according to both methods. (3) All cases were classified into three groups by paired-difference (d) between VA values of hot-spot score and average score (d<5, 5≤d<10, d≥10) to evaluate the correlation between Ki67 staining distribution (heterogeneous or homogenous) and reproducibility of assessment. A perfect agreement was all demonstrated in three groups, and a slightly better Ki67 LI agreement between VA and DIA was indicated in homogenous staining slides than in heterogeneous staining ones. (4) VA values were relatively smaller than DIA values (average score: median of paired-difference -3.72; hot-spot score: median of paired-difference -9.12).

Conclusions

An excellent agreement between VA and DIA of Ki67 LI in breast cancer was demonstrated in the whole mixed cohort, suggesting that VA and DIA both could be used to assess Ki67 LI in clinical practice. Average score and hot-spot score methods both demonstrated a perfect concordance between VA and DIA of Ki67 LI. The almost perfect agreement between VA and DIA was observed in high Ki67 LI cases, displaying a homogenous staining pattern. The consistency between VA and DIA was relatively low in intermediate Ki67 LI group. The heterogeneity of tumors may slightly affect the concordance between VA and DIA of Ki67 LI. Assessment of VA provides lower Ki67 values than DIA, the biological importance of these values are not known at the moment.     

乳腺癌人类表皮生长因子受体2表达与X线表现的相关性分析

目的：对比分析人类表皮生长因子受体2（HER-2）阳性和阴性乳腺癌X线特征,探讨乳腺癌X线征象与HER-2基因之间的相关性。方法：回顾性分析经手术病理确诊的1153例女性乳腺癌患者的X线表现,根据免疫组织化学结果分为HER-2阳性组（314例）和HER-2阴性组（839例）。对比分析两组乳腺癌肿块和钙化的X线特征,肿块主要分析形态、边界及边缘,钙化主要分析形状及分布形式,并对各项分析结果进行X2检验,P〈0.05为差异性有统计学意义。结果：HER-2阳性组乳腺癌较阴性组多表现为钙化（X2=42.528,P=0.001）,HER-2阴性组乳腺癌X线表现多为单纯肿块（389/839,X2=16.374,P=0.001）。星芒状肿块在HER-2阴性组比例较高（57/514,X2=5.912,P=0.015）,两组类圆形（P=0.480）、分叶状（P=0.111）、不规则形肿块（P=0.152）分布比例则无明显统计学差异。HER-2阳性组乳腺癌肿块边界多模糊不清（X2=8.319,P=0.004）,阴性组肿块边界多为部分清楚（X2=5.818,P=0.016）。HER-2阳性组乳腺癌钙化形态多表现为沙砾状（X2=8.955,P=0.001）、多形性和不定形（X2=7.137,P=0.001）,分布形式无明显统计学差异。结论：HER-2阳性乳腺癌X线表现钙化居多,且多为沙砾状、多形性和不定形钙化,肿块边界多模糊不清;HER-2阴性乳腺癌多表现为单纯肿块,边界多为部分清楚,星芒状肿块多见。     

Positive Association of Fibroadenomatoid Change with HER2-Negative Invasive Breast Cancer: A Co-Occurrence Study

Background

Risk assessment of a benign breast disease/lesion (BBD) for invasive breast cancer (IBC) is typically done through a longitudinal study. For an infrequently-reported BBD, the shortage of occurrence data alone is a limiting factor to conducting such a study. Here we present an approach based on co-occurrence analysis, to help address this issue. We focus on fibroadenomatoid change (FAC), an under-studied BBD, as our preliminary analysis has suggested its previously unknown significant co-occurrence with IBC.

Methods

A cohort of 1667 female patients enrolled in the Clinical Breast Care Project was identified. A single experienced breast pathologist reviewed all pathology slides for each case and recorded all observed lesions, including FAC. Fibroadenoma (FA) was studied for comparison since FAC had been speculated to be an immature FA. FA and Fibrocystic Changes (FCC) were used for method validation since they have been comprehensively studied. Six common IBC and BBD risk/protective factors were also studied. Co-occurrence analyses were performed using logistic regression models.

Results

Common risk/protective factors were associated with FA, FCC, and IBC in ways consistent with the literature in general, and they were associated with FAC, FA, and FCC in distinct patterns. Age was associated with FAC in a bell-shape curve so that middle-aged women were more likely to have FAC. We report for the first time that FAC is positively associated with IBC with odds ratio (OR) depending on BMI (OR = 6.78, 95%CI = 3.43-13.42 at BMI<25 kg/m²; OR = 2.13, 95%CI = 1.20-3.80 at BMI>25 kg/m²). This association is only significant with HER2-negative IBC subtypes.

Conclusions

We conclude that FAC is a candidate risk factor for HER2-negative IBCs, and it is a distinct disease from FA. Co-occurrence analysis can be used for initial assessment of the risk for IBC from a BBD, which is vital to the study of infrequently-reported BBDs.     

乳腺癌HER2表达与乳腺X线及超声影像表现的相关性分析(英文)

目的:对比分析乳腺癌人类表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)表达阳性和阴性与乳腺癌的X线及超声影像表现的相关性。方法:对139例雌激素受体(oestrogen receptor ER)、孕激素受体(progesterone receptor PR)表达均阴性的乳腺癌患者术前行X线及超声形态学分析,术后标本测定癌细胞的人类表皮生长因子受体2(HER2)表达情况,比较并分析HER2+/ER-/PR-乳腺癌和HER2-/ER-/PR-乳腺癌影像学的特征性表现,在X线上主要分析:腺体致密度、及病变类型(肿块、钙化、结构紊乱)。其中肿块主要分析形状、边缘、大小;钙化主要分析形态、分布,在超声上主要分析:肿块边缘、有无强回声点、有无腋淋巴结转移,血流情况。结果:HER2+/ER-/PR-乳腺癌在X线上的特征性表现为单纯肿块(x2=8.067,P=0.005)或肿块伴钙化(x2=4.384,P=0.036),棒状、分枝状钙化(x2=5.723,P=0.017),簇状分布(x2=12.110,P=0.007),肿块直径多2cm(x2=4.933,P=0.026),而在腺体致密度、肿块边缘方面差异无统计学意义。超声的特征性表现为肿块伴钙化(x2=16.134,P0.001)、边界不清(x2=9.188,P=0.010)、伴腋下淋巴结转移(x2=5.210,P=0.022),血流方面差异无统计学意义。结论:HER2+/ER-/PR-乳腺癌影像学有特征性表现,X线常表现为单纯肿块或肿块伴钙化,棒状、分枝状钙化,簇状分布,肿块直径多2cm;超声常表现为低回声肿块、边界不清、其内可见点状强回声、常伴腋下淋巴结转移。     

Assessment of HER2 Status Using Immunohistochemistry (IHC) and Fluorescence In Situ Hybridization (FISH) Techniques in Mucinous Epithelial Ovarian Cancer: A Comprehensive Comparison between ToGA Biopsy Method and ToGA Surgical Specimen Method

We aimed to compare the assay performance characteristics of HER2 status in mucinous epithelial ovarian cancer (EOC) by ToGA (Trastuzumab for Gastric Cancer) biopsy versus ToGA surgical specimen methods. Forty-nine tissue microarray (TMA) samples of mucinous EOC from Asian women were analyzed by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) tests using ToGA trial HER2 scoring methods. The overall concordance between IHC and FISH by the ToGA surgical specimen method is 97.56% and by the ToGA biopsy specimen method is 97.14%. The agreements of HER2 IHC results under both biopsy and surgical specimen methods were nearly perfect (weighted kappa = 0.845). Additionally, the percentage of Her2 FISH amplification showed increasing trend with increasing HER2 IHC ordinals (negative, equivocal, positive) by both TOGA biopsy (P<0.001) and surgical specimen method (P<0.001). After excluding equivocal cases, the sensitivity (100%), PPV (88.89%) and NPV (100%) of HER2 IHC were unchanged under either surgical specimen method or biopsy method. However, the specificity (96.97%) and accuracy (97.56%) of HER2 IHC was slightly higher under the surgical specimen method than those (specificity 96.30%, accuracy 97.14%) under the biopsy method. Of the total 49 cases, the number (n = 14) of HER2 IHC equivocal results under the ToGA biopsy method was 1.75-fold higher than those (n = 8) under the ToGA surgical specimen method (28.57% vs. 16.32%). Therefore, compared to ToGA surgery specimen method, the ToGA biopsy method caused more equivocal IHC cases to be referred to FISH testing and did not increase the detection rates of Her2 FISH amplification.     

Volumetric Breast Density Estimation from Full-Field Digital Mammograms: A Validation Study

Objectives

To objectively evaluate automatic volumetric breast density assessment in Full-Field Digital Mammograms (FFDM) using measurements obtained from breast Magnetic Resonance Imaging (MRI).

Material and Methods

A commercially available method for volumetric breast density estimation on FFDM is evaluated by comparing volume estimates obtained from 186 FFDM exams including mediolateral oblique (MLO) and cranial-caudal (CC) views to objective reference standard measurements obtained from MRI.

Results

Volumetric measurements obtained from FFDM show high correlation with MRI data. Pearson’s correlation coefficients of 0.93, 0.97 and 0.85 were obtained for volumetric breast density, breast volume and fibroglandular tissue volume, respectively.

Conclusions

Accurate volumetric breast density assessment is feasible in Full-Field Digital Mammograms and has potential to be used in objective breast cancer risk models and personalized screening.     

Simultaneous Inhibition of Estrogen Receptor and the HER2 Pathway in Breast Cancer: Effects of HER2 Abundance

The estrogen receptor (ER) pathway and the epidermal growth factor receptor (EGFR) pathway play pivotal roles in breast cancer progression. Targeted therapies able to intercept ER or signaling downstream to EGFR and its kin, HER2, are routinely used to treat distinct groups of breast cancer patients. However, patient responses are limited by resistance to endocrine therapy, which may be due to compensatory HER2/EGFR signaling. This raises the possibility that simultaneous interception of HER2 and ER may enhance therapeutic efficacy. To address the question, we treated breast cancer cells with both fulvestrant (ICI 182780), an ER antagonist with no agonist effects, and lapatinib, an orally available tyrosine kinase inhibitor specific to EGFR and HER2. Our results indicate that the combination of drugs is especially effective when applied to HER2-overexpressing, ER-positive cancer cells. Interestingly, fulvestrant activated the mitogen-activated protein kinase (MAPK) pathway of these cells, but complete inhibition of MAPK signaling was observed on cotreatment with lapatinib. Taken together, our observations reinforce the possibility that the effectiveness of combining anti-ER and anti-HER2/EGFR drugs may be especially effective on a relatively small subtype of HER2-overexpressing, ER-positive tumors of the breast.     

苜蓿种质间染色体多态性的荧光原位杂交检测

利用染色体荧光原位杂交技术(FISH),将3种重复序列5S rDNA、45S rDNA和C0t-1 DNA用不同荧光物进行标记,对我国10个不同地理来源的苜蓿种质(Medicago sativa L.;2n=4X=32)进行了染色体多态性检测。结果表明,利用以上重复序列可以较好地将苜蓿32条染色体区分为16对特征不同的染色体,10份不同种质材料FISH带纹特征表现高度相似,比较不同种质间同源染色体重复序列杂交特征,揭示出种质群体内和群体间多态性染色体的存在,其中不同的同源染色体多态性表现不尽一致,1号染色体(随体染色体)多态性最高,10份材料中检出7个多态型,3、4、15号染色体保守性较强,在不同种质间表现为单态,其他染色体多态性居中。对在地理分布上自西向东的10个材料进行染色体多态性比较,结果显示分布于西藏、新疆以及分布在辽宁的材料部分染色体多态型显著区别于其他材料。     

Adjuvant Trastuzumab in HER2-Positive Early Breast Cancer by Age and Hormone Receptor Status: A Cost-Utility Analysis

BackgroundThe anti–human epidermal growth factor receptor 2 (HER2) monoclonal antibody trastuzumab improves outcomes in patients with node-positive HER2+ early breast cancer. Given trastuzumab’s high cost, we aimed to estimate its cost-effectiveness by heterogeneity in age and estrogen receptor (ER) and progesterone receptor (PR) status, which has previously been unexplored, to assist prioritisation.ConclusionsThis study highlights how cost-effectiveness can vary greatly by heterogeneity in age and hormone receptor subtype. Resource allocation and licensing of subsidised therapies such as trastuzumab should consider demographic and clinical heterogeneity; there is currently a profound disconnect between how funding decisions are made (largely agnostic to heterogeneity) and the principles of personalised medicine.     

用万能引物PCR法从YAC中分离制备荧光原位杂交探针的研究

报道了一种从微量且未知碱基顺序的YAC DNA中制备FISH探针的新方法——万能引物PCR(UP PCR),即把复性后的UP-Linker连接于PFGE分离后经Alu Ⅰ酶切的YAC DNA上,再用UP对其进行PCR扩增和标记。由于Alu Ⅰ的广谱性和UP与Linker长度不同等,使该法能根据PCR效率调节扩增产物的广泛性向特异性的转变,且产物能覆盖YAC嵌入DNA的全长。此法制备的人21号染色体FISH探针,特异性强,杂交信号明亮,21号染色体的检出率高。该法稳定简便。