非小细胞肺癌患者血清中MALAT1表达水平及其临床意义

目的探讨肺腺癌转移相关转录因子1(MALAT1)在非小细胞肺癌(NSCLC)患者血清中的表达水平及其诊断价值。方法提取60例NSCLC患者、42例肺良性病变患者及50例健康人血清中的总RNA,用Taq Man实时荧光定量RT-PCR检测MALAT1基因的表达水平并分析其与NSCLC患者临床病理因素的关系,以受试者工作特征曲线(ROC)分析血清MALAT1的诊断效能。结果肺癌组血清MALAT1相对表达水平(0.51±0.09)低于肺良性病变组(0.80±0.12)及健康人对照组(1.01±0.30),差异有统计学意义(q分别为13.95、12.27,P0.01);肺良性病变组血清MALAT1表达水平低于健康人对照组(q=10.24,P0.01);腺癌患者血清MALAT1相对表达量(0.57±0.04)较鳞癌患者(0.45±0.07)明显增高(t=4.260,P0.01),而与TNM分期、淋巴结转移和肿瘤分布部位无显著相关性(P0.05);ROC曲线下面积(AUCROC)为0.956,当cut off值为0.62时,敏感性和特异性分别是87.5%和94.1%,诊断指数为181.6%。结论血清MALAT1检测效能好,可用于NSCLC的诊断及病理类型的鉴别。     

CD44v6、ICAM-1及E-cadherin在子宫内膜异位症中的表达及意义

目的 探讨黏附分子CD44异构体6(CD44v6)、细胞间黏附分子-1(ICAM-1)和细胞钙黏附素E(E-cadherin)在子宫内膜异位症(EMs)发生、发展中的作用.方法 通过免疫组化方法分别检测CD44v6、ICAM-1和E-cadherin在子宫内膜异位症患者在位内膜、异位内膜和正常子宫内膜中的表达.结果 EMs患者中异位内膜CD44v6表达明显高于在位内膜和正常内膜(P＜0.05);异位内膜中ICAM-1表达高于在位内膜(P＜0.05),且其在位内膜高于正常内膜(P＜0.05);异位内膜及在位内膜中E-cadherin表达显著低于正常内膜(P＜0.05).结论 子宫内膜异位症异位内膜、在位内膜中CD44v6、ICAM-1的高表达和E-cadherin的低表达在子宫内膜异位症的发生、发展中起重要作用.     

抑癌基因PTEN在子宫内膜异位症中的表达及意义

目的 检测第10号染色体缺失的磷酸酶和张力蛋白同源物基因（PTEN）在子宫内膜异位症（EMS）及其正常子宫内膜中的表达,探讨其在EMS发生、发展中的作用及在正常子宫内膜月经周期中的变化.方法 收集EMS患者术后异位内膜及在位内膜标本（其中包括卵巢巧克力囊肿30例,子宫腺肌病15例）,并收集正常子宫内膜标本40例,用SP免疫组织化学方法检测PTEN在其中的表达,并比较PTEN表达与EMS临床分期的关系.结果 PTEN主要表达于子宫内膜腺上皮细胞的胞浆中,呈棕黄色颗粒,在间质细胞中有少量表达.PTEN在正常子宫内膜中为高表达（95%）,在异位内膜中的表达水平明显降低（42.2%）,而PTEN在在位内膜中的表达（64.4%）介于正常内膜与异位内膜之间,两两比较差别有显著性;在正常内膜与在位内膜中,PTEN在增生期的表达显著低于其在分泌期的表达,有周期性的变化,而在异位内膜中增生期与分泌期PTEN的表达无差异（P＞0.05）;PTEN在卵巢巧克力囊肿与子宫腺肌病中的表达无差异（P＞0.05）;PTEN在Ⅰ-Ⅱ期EMS组织中的表达显著高于其在Ⅲ-Ⅳ期EMS中的表达（P＜0.05）.结论 PTEN表达缺失可能是EMS发生、发展的机制之一;PTEN可能参与了月经周期的调节.     

GnRHⅡ蛋白在子宫内膜异位症患者中的表达及意义

目的:检测GnRHⅡ蛋白在子宫内膜异位症患者异位子宫内膜、在位子宫内膜和正常子宫内膜中的表达情况,同时分析其表达是否与子宫内膜月经周期有关。方法:采用免疫组织化学SP法检测GnRHⅡ蛋白在异位内膜、在位内膜及正常子宫内膜组织中的表达情况,并分析和比较其表达是否有差异。结果:GnRHⅡ蛋白在子宫内膜异位症患者异位、在位子宫内膜及正常子宫内膜中均有表达,阳性表达定位于子宫内膜腺体及间质细胞的细胞质;GnRHⅡ蛋白在异位内膜、在位内膜及对照组正常内膜的表达依次增强,两两比较差异有统计学意义(P0.05);GnRHⅡ蛋白在正常子宫内膜分泌期表达强于增生期(P0.05),且以分泌早中期最强,显著强于增生期和分泌晚期(P0.01),而异位组或在位组的分泌期与增生期比较,差异无统计学意义(P0.05)。结论:GnRHⅡ蛋白在子宫内膜异位症的发病中以及在人类月经生理方面可能起重要作用。     

卵巢子宫内膜异位症患者异位和在位内膜中巨噬细胞移动抑制因子的表达及其临床意义

目的 探讨巨噬细胞移动抑制因子(MIF)在卵巢子宫内膜异位症(OEms)组织中表达的意义.方法 应用ElivisionTm plus免疫组化方法检测30例OEms异位、在位内膜和非子宫内膜异位症(Ems)子宫内膜组织(对照组)中的MIF,并应用计算机图像分析系统对结果进行体视学指标平均吸光度的检测.结果 OEms组异位内膜、在位内膜及对照组中MIF的吸光度分别为(0.180±0.013)、(0.158 ±0.022)及(0.143±0.029),3组间比较,差异有统计学意义(F =47.676,P＜0.001).MIF蛋白在OEms组在位内膜增生期和分泌期的表达均高于对照组同期水平(0.157±0.018与0.146±0.029,t=2.656,P=0.009;0.160 ±0.028与0.137±0.030,t=3.059,P=0.003).结论 MIF可能在Ems的发生、发展过程中起重要作用.     

KISS-1 mRNA和GPR54 mRNA在子宫内膜异位症中的表达及意义

目的探讨肿瘤转移抑制基因(KISS-1)和G蛋白偶联受体54(GPR54)mRNA在子宫内膜异位症(EMT)中的表达及意义。方法利用实时定量逆转录PCR方法检测EMT患者的异位/在位内膜组织及正常子宫内膜组织中KISS-1及GPR54 mRNA的表达情况。结果 KISS-1 mRNA在EMT患者异位及在位内膜中的表达水平均明显低于正常子宫内膜(P<0.01),GPR54 mRNA在EMT患者异位内膜中的表达水平略高于EMT患者在位内膜及正常子宫内膜,但差异无统计学意义(P>0.05)。结论 KISS-1下调在EMT的发生中起重要作用。     

PTEN和Beclin1在维吾尔族、汉族人群子宫内膜异位症中的相关研究

目的研究抑癌基因碱性磷酸酶(PTEN)与自噬基因(Beclin1)在新疆维吾尔族和汉族子宫内膜异位症患者中的表达差异。方法选取本院收治的56例子宫内膜异位症患者(维吾尔族患者25例,汉族患者31例),同期选取20例健康人(维吾尔族女性10例,汉族女性10例)作为对照组;56例内膜异位症患者在位内膜、异位内膜以及20例正常女性内膜组织中的PTEN、Beclin1表达水平采用免疫组化法进行测定,研究不同民族子宫内膜异位症发病情况与PTEN、Beclin1表达水平的相关性。结果异位内膜组PTEN、Bcelin1蛋白阳性检出率显著低于对照组、在位内膜组,并且在位内膜组PTEN、Bcelin1阳性率显著低于对照组(P0.05),但在组内相同组织中,维吾尔族与汉族PTEN表达结果无显著差异(P0.05)。结论 PTEN、Beclin1的低表达与子宫内膜异位症的发生发展密切相关,但在维吾尔族、汉族间比较无显著差异。     

生存素、半胱氨酸蛋白酶-3在子宫内膜异位症组织中的表达研究

选取笔者所在医院妇科26例EMS患者为研究组,分别取其异位内膜组织(A组)和在位内膜组织(B组),同时选择27例非EMS患者正常子宫内膜作为对照组(C组),采用免疫组化化学法检测survivin、cas Pase-3在各组子宫内膜组织增生期、分泌期的表达水平。A、B两组增生期、分泌期子宫内膜组织survivin表达水平均明显高于C组,差异有统计学意义(P0.05),而A组增生期、分泌期子宫内膜组织survivin表达水平与B组比较差异无统计学意义(P0.05);A、B两组增生期、分泌期子宫内膜组织cas Pase-3表达水平均明显低于C组,差异有统计学意义(P0.05),而A组增生期、分泌期子宫内膜组织cas Pase-3表达水平与B组比较差异无统计学意义(P0.05);子宫内膜组织survivin表达水平与cas Pase-3表达水平呈负相关性关系(P0.05)。survivin可能通过抑制cas Pase-3表达在EMS发生过程中发挥重要的作用。     

子宫内膜异位症组织中促血管生成素-2的表达及其意义

目的：探讨促血管生成素2在子宫内膜异位症患者异位和在位子宫内膜组织中的表达，及其在子宫内膜异位症发病中的作用。方法：采用免疫组织化学方法检测30例子宫内膜异位症患者的异位内膜和在位内膜组织及30例正常对照组内膜组织中促血管生成素-2的表达。结果：在位内膜组织中促血管生成素-2的表达高于对照组和异位内膜组，差异有统计学意义（P〈0．05），异位内膜组高于对照组，差异亦有统计学意义（P〈0．05）。在位内膜组和对照组的不同月经周期促血管生成素2的表达差异有统计学意义（p〈0．05）。结论：促血管生成素-2在子宫内膜异位症组织中的高表达可能与子宫内膜异位症的发生、发展及血管生成密切相关。     

卵巢子宫内膜异位症患者异位和在位内膜中缺氧诱导因子-1α的表达及其临床意义

目的 探讨缺氧诱导因子-1α(HIF-1α)在卵巢子宫内膜异位症组织中表达的意义.方法 应用Elivision Tm plus免疫组化方法分别检测30例卵巢子宫内膜异位症异位、在位内膜和非子宫内膜异位症(Ems)子宫内膜组织(对照组)中的HIF-1α,并应用计算机图像分析系统对结果进行体视学指标平均吸光度的检测.结果 卵巢子宫内膜异位症组异位内膜、在位内膜及对照组中HIF-1α的平均吸光度分别为(0.077±0.014)、(0.070±0.013)及(0.061±0.007),3组比较差异有统计学意义(F=37.738,P＜0.01＝.HIF-1α蛋白在卵巢子宫内膜异位症组在位内膜增生期的表达(0.076±0.007)高于分泌期(0.059±0.014)(t=6.918,P＜0.01＝,高于对照组同期水平(0.060±0.007)(t=12.724,P＜0.01＝.结论 HIF-1可能与卵巢子宫内膜异位症的发生、发展密切相关.

Abstract：

Objective To investigate the significance of hypoxia inducible factor-1(HIF-1) expression in ovarian endometriosis (Oems). Methods Elivision Tm plus Immunohistochemical and Stereology methods were used to detect HIF-1 expression in 30 cases of ectopic endometrium, 30 cases of eutopic endometrium in ovarian endometriosis and 30 cases of endometrium in ovarian teratoma as the normal control. Quantitative images analysis was performed with the aid of computer to collect and analyze the mean optical density (MOD) of HIF-1 expression. Results The MOD values of HIF-1 in ectopic and eutopic endometrium of Oems and the normal control were 0. 077 ± 0. 014, 0. 070 ± 0. 013 and 0. 061 ± 0. 007 respectively, which showed significantly differences between each other groups(F = 37. 738, P ＜ 0. 01 ＝. HIF-1 expression in proliferative phase (0.076 ±0.007) of eutopic endometrium of Oems was significantly higher than that in secretary phase (0. 059 ±0. 014) (t = 6. 918 ,P ＜0. 01 ＝; which was also significantly higher than that of the normal control in the same phase (0.060±0.007) (t=-12.724,P ＜0.01 ＝.Conclusion HIF-1 may play an important role in the pathogenesis and development of Oems.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.