喉癌、喉良性病变及声带息肉组织HPV-DNA及P16蛋白的表达差异

目的:检测喉癌、喉良性病变组织及声带息肉组织中HPV-DNA及P16蛋白的表达水平,探讨HPV感染与喉癌发生的相关性。方法:收集2011年5月至2015年7月就诊于复旦大学附属金山医院耳鼻咽喉-头颈外科的256例患者,其中喉鳞状细胞癌34例、喉良性病变(非声带息肉)15例、声带息肉207例,男性184例、女性72例,中位年龄56岁。采用实时荧光PCR法检测喉鳞状细胞癌组织和喉良性病变组织HPV-DNA水平。采用免疫组化法观察喉癌组织、喉良性病变及声带息肉中P16蛋白的表达。结果:实时荧光PCR检测发现34例喉鳞状细胞癌组织中HPV-DNA阳性率为8.8%(3/34),喉良性病变均为阴性(0/15),两组间HPV-DNA阳性率差异无统计学意义。免疫组化染色显示喉鳞状细胞癌、喉良性病变、声带息肉组织P16蛋白阳性表达率分别为32.4%(11/34)、46.7%(7/15)和47.8%(99/207),其中声带息肉组织P16蛋白阳性率高于喉癌组织,差异有统计学意义(P=0.046)。结论:喉癌组织HPV-DNA阳性率略高于喉良性病变;P16蛋白在喉癌组织的表达略低于喉良性病变,明显低于声带息肉。     

AML和喉鳞状细胞癌患者血浆中hTERT mRNA的定量检测及其临床意义

目的建立定量检测肿瘤患者血浆中hTERT mRNA水平的实时荧光RT-PCR方法,探讨其在急性髓细胞性白血病(AML)和喉鳞状细胞癌的诊断与疗效观察中的应用价值。方法采用TriZOLLS提取21例AML患者、23例喉鳞状细胞癌患者以及25例健康志愿者血浆总RNA,逆转录后利用Taqman技术对hTERT mRNA进行实时定量检测。结果健康志愿者血浆hTERT mRNA水平(NhTERT)为1.2±0.8,喉鳞状细胞癌患者手术前与手术后2天,NhTERT分别为11.8±8.3和8.0±5.7(P=0.03),AML首次治疗前与完全缓解患者分别为13.5±8.5和2.4±2.0(P<0.001)。与健康志愿者比较,AML首治患者与手术前喉鳞状细胞癌患者血浆hTERT mRNA水平显著升高。结论采用实时荧光RT-PCR能够有效地检测血浆中hTERT mRNA水平,为AML和喉鳞状细胞癌患者的诊断与疗效观察提供信息。     

Fra-2基因在喉鳞状细胞癌中的表达研究

目的探讨Fra-2(Fos-related antigen-2)基因在喉鳞状细胞癌(LSCC)中表达情况。方法采用免疫组化SP法及逆转录-多聚酶链反应(RT-PCR)检测47例LSCC组织和21例癌旁正常组织中Fra-2基因蛋白及mRNA水平的表达情况,在癌组织当中针对这些基因表达和相关临床病理参数之间存在的关系进行分析。结果 Fra-2基因蛋白水平在LSCC阳性表达率高于癌旁正常组织(P0.01),其表达与临床分期、淋巴结转移、吸烟均相关,与病理分级、年龄、解剖分区均无关;mRNA水平表达量高于癌旁正常组织(P0.01),此水平表达仅与病理分级相关,与临床分期、淋巴结转移、吸烟、年龄、解剖分区无关。结论喉鳞状细胞癌中Fra-2基因在蛋白及mRNA水平均表达增高,此基因活化表达增加可能促进喉癌的发生与发展。     

实时荧光定量RT-PCR检测乳腺癌VEGF mRNA的表达

目的：建立实时荧光定量逆转录一多聚酶链反应（real—timequantitative，RT—PCR）检测乳腺癌患者肿瘤组织VEGFmRNA表达的方法，并验证其与免疫组织化学LsAB方法检测VEGF蛋白表达的相关性。方法：提取组织总RNA，逆转录成mRNA，采用实时荧光定量RT—PCR检测44例乳腺浸润性导管癌、25例癌旁正常小叶组织、13例乳腺良性疾病组织中VEGFmRNA表达；采用免疫组织化学LSAB法和彩色图像病理分析系统半定量检测其VEGF蛋白表达。结果：乳腺癌组织中VEGFmRNA表达水平显著高于癌旁和良性病组织（｜P〈0．001），而后两者之间无明显差异（P〉0．05）；VEGF蛋白表达在癌组织，癌旁和良性病组中的分布特点与VEGFmRNA完全一致。结论；本研究所建立的用于检测人乳腺组织VEGFmRNA表达的实时荧光定量RT—PCR方法，是一种快速有效、灵敏度高、特异性好的定量检测方法，与免疫组化LSAB方法检测的VEGF蛋白表达具有良好相关性，在乳腺癌的早期诊断和良恶性鉴别诊断中具有重要的参考价值。     

TaqMan实时荧光定量逆转录聚合酶链反应检测新型趋化因子巨噬细胞炎症蛋白-2γmRNA表达水平

目的　建立TaqMan实时荧光定量逆转录聚合酶链反应 (RT PCR)法检测新型趋化因子巨噬细胞炎症蛋白 2γ(MIP 2γ)mRNA表达水平 ,并对方法进行评估。方法　TaqMan实时荧光定量RT PCR检测MIP 2γmRNA的表达。结果　线性检测范围达 6个数量级 ,最低检测下限为 6× 10 2 拷贝 ,最高检测上限为 6× 10 7拷贝 ,批间及批内变异 <12 2 %。正常Balb/c小鼠心脏、肝脏、肾脏组织均可检测到MIP 2γmRNA表达 ,以心脏表达水平最高。结论　采用TaqMan实时荧光定量RT PCR检测MIP 2γmRNA表达水平准确、特异、灵敏、快速、操作简便 ,具有临床推广价值。     

△Np73基因在食管癌中的表达及生物学意义

目的探讨△Np73mRNA及其蛋白在食管癌组织中的表达与食管癌发生的关系。方法采用逆转录聚合酶链反应（RT—PCR）及流式细胞术（FCM）检测47例食管鳞状细胞癌组织及与其相对应的癌旁组织和正常食管组织中△Np73mRNA及其蛋白的表达水平。结果△Np73mRNA及其蛋白在食管癌组织中的表达水平明显高于癌旁组织和正常食管组织（P〈0．01）;且△Np73mRNA及其蛋白的表达水平与肿瘤的浸润深度呈负相关（P〈0．05）。结论△Np73基因的表达可能与食管癌的发生发展有关。     

JMJD3与CyclinD1基因在喉鳞状细胞癌组织中的表达及意义

目的 探讨Jumonji结构域包含蛋白3(JMJD3)与细胞周期素D1(CyclinD1)基因在喉鳞状细胞癌组织中的表达及意义。方法 选取2016年12月至2021年12月该院肿瘤科收治的80例喉鳞状细胞癌患者作为研究对象,术中取喉鳞状细胞癌组织与癌旁正常组织,采用免疫组织化学染色法检测JMJD3和CyclinD1基因的表达情况,分析JMJD3和CyclinD1表达与临床病理特征的关系。结果 喉鳞状细胞癌组织与癌旁正常组织JMJD3阳性率分别为48.75%、17.50%,CyclinD1阳性率分别为60.00%、20.00%,喉鳞状细胞癌组织JMJD3和CyclinD1的表达均高于癌旁正常组织,差异均有统计学意义(P<0.05);不同年龄、性别、吸烟史的喉鳞状细胞癌患者JMJD3和CyclinD1阳性率比较,差异均无统计学意义(P>0.05);非声门型、分化程度为中低分化、有淋巴结转移及TNM分期为Ⅲ～Ⅳ期的喉鳞状细胞癌患者JMJD3与CyclinD1阳性率更高;癌组织JMJD3与CyclinD1表达呈正相关(r=0.661,P<0.05)。结论 JMJD3和Cycl...     

淋巴组织表达受体在食管鳞状细胞癌中表达水平与临床病理参数及预后的关系

目的观察淋巴组织表达受体(receptor expressed in lymphoid tissue, RELT)在食管鳞状细胞癌组织中的表达水平,探讨其与临床病理参数及预后的关系。方法食管鳞状细胞癌患者83例,取手术切除的鳞状细胞癌组织和癌旁正常组织标本,采用实时荧光定量PCR法检测2种组织RELT mRNA相对表达量,采用免疫组织化学法检测2种组织RELT蛋白阳性表达率,采用Western blot法检测2种组织RELT蛋白相对表达量。根据RELT mRNA相对表达量中位数将患者分为低表达组42例和高表达组41例,比较2组临床资料,采用Kaplan-Meier生存分析比较2组患者无病生存期;采用多因素COX比例风险回归模型分析食管鳞状细胞癌患者预后不良的危险因素。结果食管鳞状细胞癌组织RELT mRNA(8.022±2.301)、RELT蛋白(0.867±0.085)相对表达量及RELT蛋白阳性表达率(78.31%)均高于癌旁正常组织(3.080±0.754、0.634±0.123、16.87%)(P<0.05);高表达组患者年龄<60岁(68.29%)、T₃~T₄期(75.61%)、TNM分期ⅡB~Ⅲ期(68.29%)、有淋巴结转移(58.54%)和脉管侵犯(63.41%)发生率高于低表达组(38.10%、45.24%、42.86%、26.19%、28.57%)(P<0.05);高表达组患者中位无病生存期(16个月)短于低表达组(>30个月)(P<0.05);RELT mRNA相对表达量≥8.009(HR=2.120,95%CI:1.102~4.078,P=0.024)、TNM分期ⅡB~Ⅲ期(HR=36.348,95%CI:2.202~599.976,P=0.012)是食管鳞状细胞癌患者预后不良的危险因素。结论食管鳞状细胞癌患者RELT高表达与不良预后有关,可能参与食管鳞状细胞癌的发生和发展过程。     

P21ras蛋白在喉鳞状细胞癌中的表达及临床病理意义

目的通过检测喉鳞状细胞癌组织、声带息肉、癌旁组织中P21ras蛋白的表达水平,探讨P21ras蛋白在喉鳞状细胞癌发生发展中作用及其机制,为喉鳞状细胞癌早期诊断供新的思路。方法收集60例喉鳞状细胞癌石蜡包埋组织,30例声带息肉及癌旁石蜡包埋组织,通过两步法免疫组织化学技术检测P21ras蛋白的表达水平,分析喉鳞状细胞中P21ras蛋白的表达及其与临床病理特征的关系。结果 P21ras蛋白在癌旁组织、声带息肉以及喉鳞状细胞癌中的阳性表达率分别为6.7%、36.7%和68.3%,三组间阳性率依次升高,三组间差异有统计学意义(P0.05)。P21ras蛋白在中、高分化喉鳞状细胞癌中的阳性表达率为57.5%,在低分化喉鳞状细胞癌中的阳性表达率为90%,低分化组阳性表达率明显高于中、高分化组,两组间差异有统计学意义(P=0.011)。P21ras蛋白在Ⅰ期、Ⅱ期喉鳞状细胞癌中的阳性表达率为56.3%,在Ⅲ期、Ⅳ期喉鳞状细胞癌中的阳性表达率为83.1%,Ⅲ期、Ⅳ期组阳性表达率明显高于Ⅰ期、Ⅱ期组,两组间差异有统计学意义(P=0.021)。P21ras蛋白的表达与患者的性别、年龄、发病部位、有无淋巴结转移、有无远处转移无关(均P0.05)。结论 P21ras蛋白在喉鳞状细胞癌中表达高于息肉及癌旁组织,并与肿瘤的分化及临床分期密切相关,表明P21ras蛋白可能在喉鳞状细胞癌的发生发展中发挥重要作用,检测P21ras蛋白对患者的早期诊断及预后有一定的指导意义。     

逆转录实时荧光定量PCR检测p73 mRNA在结肠癌的表达

目的:建立一种实时定量PCR方法检测p73mRNA的表达水平,探讨其与结肠癌发生、发展的可能关系。方法:采用SYBRGreenⅠ逆转录实时荧光定量PCR检测39例结肠癌组织和其癌旁组织中p73mRNA的表达。结果:p73基因在结肠癌肿瘤组织的表达水平高于其在癌旁组织的表达(P<0.01);表达水平与肿瘤的恶性程度、分化及淋巴结转移显著相关(P<0.05)。结论:p73的高表达可能与结肠癌的发生、发展及预后有联系。     

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.     

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.     

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.     

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.     

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.