血管内皮生长因子与大肠癌发生发展的关系

探讨血管内皮生长因子（ＶＥＧＦ）和大肠癌发生发展的关系。方法：免疫组化ＬＳＡＢ法对５２例大肠癌组织,１９例大肠腺瘤组织和１８例正常大肠粘膜组织的ＶＥＧＦ一 肠粘膜组织ＶＥＧＦ表达阴性,大肠腺瘤和大肠癌的ＶＥＧＦ阳性率分别为２６．３２％和５１．９２％,显著高于正常大肠粘膜（Ｐ〈０．０１）;ＶＥＧＦ在有淋巴结转移的大肠癌组织阳性率为６８．１８％,明显高于无淋巴转移组的４０．００％（Ｐ〈０．０５）;ＶＥ     

听神经瘤的微血管计数与血管内皮因子表达及其临床意义

目的　通过检测听神经瘤的微血管计数（ＭＶＣ）与血管内皮因子（ＶＥＧＦ）表达，探讨二者之间的关系及其在临床上的意义。方法　采用免疫组织化学（Ｓ－Ｐ）方法，检测８７例听神经瘤组织中Ｍ　ＶＣ与ＶＥＧＦ表达，结果进行ｘ２检验分析。结果ＭＶＣ、ＶＥＧＦ表达与肿瘤直径大小无相关性（Ｐ＞０．０５），与肿瘤生长速度呈明显正相关（Ｐ＜０．０１）；ＶＥＧＥＦ表达与ＭＶＣ之间呈明显正相关（Ｐ＜０．０１）。结论ＭＶＣ与ＶＥＧＦ表达能够反映听神经瘤的生长情况，并为制定肿瘤的治疗方案和判断预后提供重要的信息。     

食管癌ras癌基因蛋白p21抑癌基因蛋白p53和DNA的定量研究

定量分析食管癌细胞ｒａｓｐ２１，ｐ５３蛋白表达和ＤＩ，ＰＩ对食管癌早期诊断预的作用。采用ＦＣＭ，应用单克隆抗体对５０例食管鳞状细胞癌组织及３９例残端组织蜡包埋标本定量检测显示，食管癌ｒａｓｐ２１，ｐ５３平均表达量，ＤＩ和ＤＩ均明显高于正常食管（Ｐ〈０．０１），淋巴结转移阳性组与阴性组ｐ５３蛋白高表达率分别为８３．３３％，６９．２３％（Ｐ〉０．０５）。３９例残端病理证实为阴性，不典型增生及原位癌中，     

乳腺癌多耐药基因产物的表达及其与预后因素的关系

应用免疫组化ＬＳＡＢ法对５８例原发性乳腺癌组织进行了ＭＤＲ１－Ｐｇｐ检测。结果显示Ｐｇｐ在３９例（６７．２４％）中有表达。Ｐｇｐ的表达与患者年龄、肿瘤体积、淋巴结转移情况、ＥＲ和ＰＲ及ＰＣＮＡ指数无显著关系。在浸润性导管癌中，Ⅲ级组Ｐｇｐ的表达率明显低于其它各组（Ｐ＜０．０５），Ｐｇｐ表达强度与ＧＳＴ－π表达有相关性的趋势（Ｐ＝０．０５９）．Ｐｇｐ强阳性组的ｃ－ｅｒｂＢ－２表达率明显高于阴性组（Ｐ＜０．０５）．研究表明，在原发性乳腺癌中自然存在ＭＤＲ１基因，分化差的乳腺癌ＭＤＲ１－Ｐｇｐ的表达率低，ＭＤＲ１－Ｐｇｐ的表达可能与ＧＳＴ－π和癌基因的增强有关。     

ER,EGFR,p53在乳腺癌的免疫组化研究

目的检测ＥＲ、ＥＧＦＲ、ｐ５３蛋白过度表达与乳腺癌患者预后的关系，探讨其作为预后指标的可行性。方法共１２０例原发乳腺癌细针穿刺涂片标本，采用免疫细胞化学方法。结果（１）ＥＲ在腋淋巴结无转移和临床分期低的病例中表达率高。（２）ＥＧＦＲ在腋淋巴结有转移、临床分期高、ＥＲ阴性的病例中表达率高，与腋淋巴结转移、临床分期呈正相关（Ｐ＜０．０５），与ＥＲ呈负相关（Ｐ＜０．０５）。（３）ｐ５３与腋淋巴结转移、临床分期、ＥＧＦＲ呈正相关（Ｐ＜０．０５），与ＥＲ呈负相关（Ｐ＜０．０５）。结论乳腺癌患者ＥＲ过度表达者预后好，ＥＧＦＲ、ｐ５３过度表达者预后不良，它们可以作为判断乳腺癌患者预后的有效指标，将其应用于临床，辅助判断病人预后，可能具有重要意义     

胃粘膜病变患者幽门螺杆菌感染与癌基因表达的关系 (附121例资料分析)

目的：探讨幽门螺杆菌（Ｈｐ）感染与ｒａｓ原癌基因产物ｐ２１（ｒａｓｐ２１）蛋白和ｐ５３癌基因产物突变型ｐ５３蛋白表达的关系。方法：应用免疫组织化学方法，检测慢性浅表性胃炎（ＣＳＧ）３０例、胃粘膜不全结肠型肠化生（ＩＣＭ）２５例、异型增生２９例、胃癌３７例的活检标本。结果：ＩＣＭ组、异型增生组和胃癌组的Ｈｐ感染率均明显高于ＣＳＧ组（Ｐ＜０．０５）。ｒａｓｐ２１及突变型ｐ５３蛋白的阳性表达率在ＣＳＧ组均为０，而在异型增生组和ＩＣＭ组的表达均明显低于胃癌组（４５％和３８％、３２％和３２％对６０％和７０％），Ｐ＜０．０５，Ｐ＜０．０１；其中胃癌、异型增生及ＩＣＭ组中的Ｈｐ阳性组的ｒａｓｐ２１及突变型ｐ５３蛋白表达阳性率均明显高于Ｈｐ阴性组（Ｐ＜０．０５或Ｐ＜０．０１）。经根除Ｈｐ治疗后，Ｈｐ根除者的ｒａｓｐ２１及突变型ｐ５３蛋白表达由阳性转为阴性的例数比Ｈｐ未根除者多（Ｐ＜０．０５，Ｐ＜０．０１）。结论：Ｈｐ感染可能参与了ｒａｓ癌基因的激活和ｐ５３抑癌基因的突变，这可能是其致癌机制之一。     

功能独立性评测的信度与效度的初步研究

目的在本国的文化背景下，研究功能独立性评测（ｆｕｎｃｔｉｏｎａｌｉｎｄｅｐｅｎｄｅｎｃｅｍｅａｓｕｒｅ，ＦＩＭ）的重测信度与构想效度。方法使用ＦＩＭ、Ｂａｒｔｈｅｌｉｎｄｅｘ（ＢＩ）、ＰＵＬＳＥＳＡＤＬ功能评定量表（ＰＵＬＳＥＳ）、运动评估量表（ｍｏｔｏｒａｓｅｓｍｅｎｔｓｃａｌｅ，ＭＡＳ）、残疾分级量表（ｄｉｓａｂｉｌｉｔｙｒａｔｉｎｇｓｃａｌｅ，ＤＲＳ），对６８例患者（脑卒中３３例、脑外伤３０例、脊髓损伤５例）的残疾进行评定，对１８例患者（脑卒中６例、脑外伤７例、脊髓损伤５例）使用ＦＩＭ作了重复测定，同时收集相关资料如年龄、合并症、性别等。结果ＦＩＭ的重测信度高（ｒ＞０．９６，Ｐ＜０．０５）。ＦＩＭ与ＢＩ、ＭＡＳ、ＰＵＬＳＥＳ高度相关（Ｐ＜０．０５），与ＤＲＳ无关（Ｐ＞０．０５）。结论在我国的文化背景下ＦＩＭ的重测信度与构想效度高，可以在我国推广使用。     

一种新高频通气方法对实验性急性呼吸窘迫综合征的疗效观察

在高频喷射通气（ＨＦＪＶ）治疗犬实验性急性呼吸窘迫综合征（ＡＲＤＳ）时，采用连续ＨＦＪＶ基础上间歇叠加深吸气（ＨＦＪＶ＋ＤＩ）的新通气方法，以期为ＡＲＤＳ的治疗寻找一种新途径。用油酸复制犬ＡＲＤＳ模型，并随机分为３组。ＨＦＪＶ＋ＤＩ组（ｎ＝１０）：在连续ＨＦＪＶ基础上每隔１０分钟加入１次深吸气；常规机械通气组（ＣＭＶ，ｎ＝１０），给予０．７８５ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ）呼气末正压（ＰＥＥＰ）治疗；对照组（ｎ＝１０），未予通气治疗。每隔１小时测定１次氧合及血流动力学指标，共观察５小时。注射油酸后，动脉氧分压（ＰａＯ２）由１２．４００ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）降至６．５６０ｋＰａ（Ｐ＜０．０１），动脉二氧化碳分压（Ｐａ－ＣＯ２）未见明显变化。通气治疗后，ＣＭＶ和ＨＦＪＶ＋ＤＩ均使ＰａＯ２明显升高，ＰａＣＯ２无明显变化（Ｐ＞０．０５），ＨＦＪＶ＋ＤＩ的氧释放指数（ＤＯ２Ｉ）明显高于ＣＭＶ组（Ｐ＞０．０５），心脏指数（ＣＩ）在ＣＭＶ组及ＨＦＪＶ＋ＤＩ组均明显减低（Ｐ＜０．０５）。提示：ＨＦＪＶ＋ＤＩ时ＰａＯ２的提高大于ＣＩ下降所致的不利影响，在改善组织缺氧方面明显优于ＣＭＶ时加用ＰＥＥＰ     

肝动脉多普勒血流灌注指数与门静脉逆流的相关性及二者与肝癌肝内转移的关系

目的：探讨肝动脉多普勒血流灌注指数（ＤＰＩ）与门散脉逆流发生率（ＰＶＣＦ）的相关性及二者与肝癌肝内转移伯关系。方法：应用彩色多普勒检测４组不同人群的ＤＰＩ与ＰＶＣＦ;结果：①ＤＰＩ以转移组最高,依次为肝癌组、对照组、肝硬化组（Ｐ〈０．０５￣Ｐ〈０．００１）;ＰＶＣＦ以转移组最高,依次为肝癌组、肝硬化组、对照组（Ｐ〈０．０５￣Ｐ〈０．００１）;②肝癌组与转移组ＤＰＩ与ＰＶＣＦ的相关系数分别为ｒ＝０．     

中枢神经系统疾病患者脑脊液中的IL—2R

本文采用双抗体夹心酶标法检测了１０２例中枢神经系统疾病病人ＣＳＦ及３５例正常人ＣＳＦ中ｓＩＬ－２Ｒ水平。结果显示：结核性脑膜炎组（ＴＢＭＧ）、病毒性脑炎（ＤＭＧ）脱髓鞘性疾病组（ＤＭＤＧ）ｓＩＬ－２Ｒ水平明显高于其它神经系统疾病（ＯＮＤ）和正常人（ＮＣ）组（Ｐ〈０．０１）。ＴＢＭＧ进展期与恢复期比较，ｓＩＬ－２Ｒ水平有非常显著差异（Ｐ〈０．０１）。缓解期ＶＭＧ、ＤＭＤＧ的ｓＩＬ－２Ｒ水平与进展期比     

动脉瘤性蛛网膜下腔出血病人血清FSH LH PRL GH的浓度变化

目的　研究动脉瘤性蛛网膜下腔出血 (SAH)病人血清卵泡刺激素 (FSH)、黄体生成素 (LH)、泌乳素 (PRL)、生长激素 (GH)的浓度变化规律。方法　对 35例动脉瘤性SAH病人发病后 1～ 3、7～ 9、13～ 15d血清FSH、LH、PRL、GH的浓度进行动态观察 ,用TCD检测大脑中动脉血流速度 (VMCA)。结果　动脉瘤性SAH病人血清FSH、LH、PRL、GH浓度在发病后 1～3、7～ 9d各均值明显高于对照组 ,尤以发病后 7～ 9d变化最明显 ;术前、术后有脑血管痉挛 (CVS)组和非CVS组也有明显差异。结论　动脉瘤性SAH病人血清FSH、LH、GH、PRL含量与SAH的病情演变、CVS程度有关 ,并可判断预后。     

载酯蛋白A-I与急性呼吸道感染的关系

目的 探讨急性呼吸道感染患者血清载酯蛋白A-I(ApoA-I)变化及临床意义.方法 2006年12月至2007年7月入住上海交通大学附属第一人民医院急诊ICU及急诊观察室急性呼吸道感染患者为试验组(44例),根据降钙素原(PCT)的质量浓度进行分组,分为PCT＜0.5 ng/ml组,0.5ng/ml∧≤PCT＜2 ng/ml组,PCT≥2 ng/ml组.41例健康体检者为对照组.试验组和对照组均在入院24h内测定静脉血中ApoA-I、PCT、C反应蛋白(CRP)和白蛋白水平.统计学方法计量资料用均数±标准差(x±s)表示,应用SPSS 12.0软件进行统计学分析,计量资料的比较采用t检验及方差分析,相关性分析采用直线相关分析,P＜0.05为差异具有统计学意义.结果 随着PCT质量浓度增加,ApoA-I和血清白蛋白值越低而CRP值越高(P＜0.05).结论 ApoA-I与呼吸道感染的严重程度呈正相关,在较严重的呼吸道感染ApoA-I具有一定的诊断价值,表明这类患者存在脂质代谢紊乱.     

大鼠完全性脊髓损伤后降钙素基因相关肽与运动终板的关系

目的 观察大鼠完全性脊髓损伤后降钙素基因相关肽(CGRP)和乙酰胆碱酯酶(AChE)在骨骼肌运动终板中的变化特点及运动终板的变化。方法 采用Wistar大鼠制作T10脊髓横断模型，分别于损伤后1、2、4、8周取胫前肌肌腹标本，以免疫组化法检测AChE和CGRP在运动终板中的变化。结果 脊髓横断1周后CGRP在运动终板中的数量、分布即明显减少，着色变浅，而AChE在运动终板中的变化发生在损伤后4周时；运动终板中CGRP和AChE始终未完全消失。结论 上运动神经元损伤后骨骼肌运动终板存在退变现象；AChE和CGRP与运动终板的退变相关；检测CGRP能更早地显示运动终板的改变。     

Comparison of two methods based on photoplethysmography for the diagnosis of peripheral arterial disease

Aim. To examine the interchangeability of two methods for distal pressure measurement based on photoplethysmography using a truncated or full display of the arterial inflow curve, respectively. Methods. Toe and ankle pressures were obtained from 69 patients suspected of peripheral arterial disease (PAD). Observer reproducibility of the curve readings was examined by blinded reassessment of the pressure curves in a randomly selected subgroup (60 limbs). Results. There were no significant differences in mean pressures between the two methods (p for all >?.455). The limits of agreement for the differences were ?15.0–15.4?mmHg for right toe pressures, ?16.3–16.2?mmHg for left toe pressures, ?14.2–15.7?mmHg for right ankle pressures, and ?18.3–17.7?mmHg for left ankle pressures. Correlation analysis revealed intraclass correlation coefficients ≥0.960 for all measuring sites. Cohen’s Kappa showed excellent agreement in diagnostic classification, with κ?=?0.930 for the diagnosis of PAD and perfect agreement in the diagnosis of critical limb ischemia (κ?=?1.000). The analysis of intra-observer variation for curve reading showed limits of agreement of ?3.9–4.0 for toe pressures and ?7.6–7.7 for ankle pressures for the method involving truncated display and ?3.1–3.2 for toe pressures and ?6.3–8.6 for ankle pressures for the method involving full display of the signal. Conclusion. The present study shows minimal differences in diagnostic classification, as well as in ankle and toe pressures, between the full display and the truncated display of the photoplethysmographic pulse signal. Furthermore, the inter-observer variation was low for both of the photoplethysmographic methods investigated.     

新生儿缺氧缺血性脑病NO、GSH—PX和TNF的含量测定及其临床意义

目的探讨新生儿缺氧缺血性脑病(HIE)血浆和脑脊液(CSF)中的一氧化氮(NO)和谷胱甘肽过氧化物酶(GSH-PX)和肿瘤坏死因子(TNF)含量变化及其与HIE不同时期和不同程度间的相关关系.方法对HIE患儿第3天的CSF和出生初入院(HIE2h内)、第1天、第2天、恢复期的血浆中NO、SOD进行检测,并与正常对照组比较;分析NO、GSH-PX、TNF的变化原因和意义.结果HIE患儿血浆中第1天的NO含量最高,而GSH-PX相反;初入院、第1天、第3天的血浆中NO、GSH-PX含量与正常对照组对比均有显著性差异(P＜0.01),而恢复期中NO、GSH-PX含量与正常对照组对比无显著性差异(P＞0.05),血浆和HIE第3天的CSF中NO和GSH-PX水平均呈负相关;病情越重NO浓度越高,GSH-PX越低.急性期血浆TNF显著高于对照组(P＜0.01),恢复期两组无显著性差异(P＞0.05).结论NO、GSH-PX和TNF参与HIE的发病过程,在HIE的发病过程中起着重要作用;检测血浆和CSF中NO、GSH-PX、TNF含量有助于判断HIE患儿病变程度和病情进展.     

Quality management of potential chemotherapy-induced neutropenic complications: evaluation of practice in an academic medical center

Goals

Management of the risk of potential chemotherapy-induced neutropenic complications such as febrile neutropenia (FN) and severe neutropenia (SN) is a quality of care priority. How frequently does care at our institution conform to established guidelines?

Materials and methods

This retrospective chart review study included a random sample of 305 cancer patients receiving care at a single US academic medical center. Abstracted data included demographics, risk factors, and outcome variables (e.g., development of FN/SN, administration of myeloid growth factors). To evaluate quality of care, we assessed conformance between actual practice and established clinical practice guidelines for the use of myeloid growth factors from the National Comprehensive Cancer Network (NCCN).

Main results

Of the 305 cases reviewed, 8% were classified as low risk (<10%), 48% as intermediate risk (10–20%), and 44% as high risk (>20%), using the risk classifications in the NCCN guidelines modified to accommodate illness and other risk factors. Thirty-four percent received prophylactic administration of myeloid growth factors. Half of the cases had adequate documentation of mid-cycle absolute neutrophil count to determine whether FN/SN developed. Among these cases with adequate documentation, 21% developed FN/SN. Use of growth factors did not conform to established quality guidelines. Overall, 77 of 133 (58%) high-risk cases received myeloid growth factors, whereas six of 25 (24%) low-risk cases received myeloid growth factors.

Conclusions

Routine clinical practice in this academic oncology setting was poorly aligned with established guidelines; there is substantial opportunity to standardize clinical strategies and increase conformance with evidence-based guidelines.     

内皮素与经皮冠状动脉介入治疗术后再狭窄研究概况

作者从内皮素的合成、分泌、作用机制及其对血管平滑肌细胞的增殖作用等方面综述内皮素与经皮冠状动脉介入治疗术后再狭窄的研究概况。     

高同型半胱氨酸致脑血管疾病的作用机制初步探讨

目的　探讨脑卒中和暂时性脑缺血 (TIA)患者血浆同型半胱氨酸水平 (HCY)与脂质过氧化反应之间的关系 ,进一步揭示高同型半胱氨酸致动脉粥样硬化的作用机制。方法　我们采用荧光偏振免疫分析和硫代巴比妥酸的方法分别对 77例脑卒中患者 ,2 8例TIA患者和 2 0例健康查体者 (对照组 )的血浆HCY和丙二醛 (MDA)水平进行了检测。结果　脑卒中患者血浆中HCY和MDA水平与对照组比较有显著性差异 (P<0 0 5 ) ,其血浆HCY水平与MDA水平呈正相关 (r =0 2 91)。TIA患者组血浆中HCY和MDA水平与对照组比较未见显著性差异 (P >0 0 5 ) ,其血浆中HCY水平与MDA水平比较未见相关 (r =0 10 9)。结论　高HCY可能引起机体的氧化应激反应 ,产生超氧化阴离子自由基O 2 和H2 O2 。此过程在暂时性脑缺血情况作用不明显 ,而在脑卒中的发病中可能起到一定的作用。     

Feasibility and Acceptability to Patients of a Longitudinal System for Evaluating Cancer-Related Symptoms and Quality of Life: Pilot Study of an e/Tablet Data-Collection System in Academic Oncology

Programmed, notebook-style, personal computers (“e/Tablets”) can collect symptom and quality-of-life (QOL) data at the point of care. Patients use an e/Tablet in the clinic waiting area to complete electronic surveys. Information then travels wirelessly to a server, which generates a real-time report for use during the clinical visit. The objective of this study was to determine whether academic oncology patients find e/Tablets logistically acceptable and a satisfactory means of communicating symptoms to providers during repeated clinic visits. Sixty-six metastatic breast cancer patients at Duke Breast Cancer Clinic participated. E/Tablets were customized to electronically administer a satisfaction/acceptability survey, several validated questionnaires, and the Patient Care Monitor (PCM) review of symptoms survey. At each of the four visits within six months, participants completed the patient satisfaction/acceptability survey, which furnished data for the current analysis. Participant demographics were: mean age of 54 years, 77% Caucasian, and 47% with less than a college education. Participants reported that e/Tablets were easy to read (94%), easy to navigate (99%), and had a comfortable weight (90%); they found it easy to respond to questions using the e/Tablet (98%). Seventy-five percent initially indicated satisfaction with PCM for reporting symptoms; this proportion increased over time. By the last visit, 88% of participants indicated that they would recommend the PCM to other patients; 74% felt that the e/Tablet helped them remember symptoms to report to their clinician. E/Tablets offered a feasible and acceptable method for collecting longitudinal patient-reported symptom and QOL data within an academic, tertiary care, breast cancer clinic.