食管鳞状上皮癌变过程中p16与Fhit的表达及其意义

目的 探讨食管鳞状上皮癌变过程中p16与Fhit蛋白表达变化及其相互关系。方法 采用免疫组化SP法对17例正常食管鳞状上皮、16例轻度不典型增生（Ⅰ级组）、16例中度不典型增生（Ⅱ级组）、17例重度不典型增生（Ⅲ级组）、10例原位癌、18例鳞状细胞癌组织中抑癌基因P16及Fhit的蛋白表达进行检测与分析。结果 ①从食管鳞状上皮→不典型增生→原位癌→鳞状细胞癌，随着食管病变的加重，p16及nlit蛋白表达率呈逐渐降低趋势。②正常组除与不典型增生Ⅰ级组相比p16与F11it蛋白表达差异无显著性（P〉0．05）外，正常组与其余各组相比上述指标差异均有显著性（均为P〈0．05）；鳞状细胞癌组与不典型增生Ⅱ组、Ⅲ组、原位癌组相比p16与Fhit蛋白表达差异无显著性（P〉0．05），鳞状细胞癌组与正常组、不典型增生Ⅰ级组比较上述指标差异均有显著性（P〈0．05）。③p16与Fhit蛋白阳性表达率下降趋势一致。结论 p16与Fhit蛋白表达的缺失在食管癌变过程的早期阶段就已经发生。p16与Fhit蛋白表达呈正相关，可能在食管上皮癌变过程中起到协同作用。     

MDM2在食管鳞癌中的表达及其意义

目的探讨MDM2蛋白在食管鳞癌中的表达及其意义。方法采用免疫组化SP法分别对49例食管鳞癌组织、30例癌旁非典型增生组织及49例正常黏膜组织中MDM2蛋白的表达进行检测。结果正常食管黏膜组织MDM2蛋白阳性表达率为30．61％（15／49）,非典型增生组织MDM2蛋白阳性表达率为60．33％（19／30）,食管鳞癌组织中MDM2蛋白阳性表达率为87．76％（43／49）;三者两两相比,差异均有统计学意义（P〈0．05）。结论MDM2蛋白表达与食管鳞癌的发生发展有关。     

细胞周期抑制蛋白p16INK4a在喉鳞状上皮病变中的异常表达

目的探讨喉鳞状细胞癌、喉鳞状上皮不典型增生及喉慢性炎中p16INK4a蛋白表达水平的变化及意义。方法应用免疫组化方法检测86例喉鳞状上皮病变（喉鳞状细胞癌16例、喉上皮不典型增生48例,喉慢性炎22例）组织中p16INK4a蛋白的表达,进行半定量分析及统计学检验。结果16例喉鳞状细胞癌中,p16INK4a全部阳性表达;48例喉上皮内瘤变中,35例p16INK4a阳性表达,阳性率为72．92％,其中轻度不典型增生,中度不典型增生,重度不典型增生p16INK4a阳性表达率分别是33．3％（4／12）、75％（15／20）、100％（16／16）,且三者间差异有统计学意义（P〈0．05）。22例喉慢性炎中,p16INK4a阳性表达6例,阳性表达率为27．27％。p16INK4a阳性蛋白在喉鳞状细胞癌、喉鳞状上皮不典型增生及喉慢性炎组织中表达水平依次降低,且差异有统计学意义（P〈0．05）。结论喉鳞状细胞癌、喉鳞状上皮不典型增生中p16INK4a阳性表达明显高于喉慢性炎。p16INK4a在喉鳞状细胞癌、喉鳞状上皮不典型增生中过表达,提示其在喉鳞状细胞癌、喉鳞状上皮不典型增生发生发展中起重要作用。     

宫颈癌前病变和宫颈鳞状细胞癌中HPV16／18感染与P16INK4A表达的临床意义

目的探讨P16INK4A在宫颈鳞状细胞癌及癌前病变中的表达规律及其与人乳头状瘤病毒（HPV）感染之间的关系。方法采用免疫组织化学supervision二步法和原位杂交HPV16／18DNA检测,在60例慢性宫颈炎,58例宫颈低级别上皮内瘤变,62例高级别上皮内瘤变和62例宫颈鳞状细胞癌中的表达。结果P16INK4A在慢性宫颈炎中呈阴性,与宫颈低级别上皮内瘤变（阳性表达率为13．79％,8／58）之间差异无统计学意义（P〉0．05）。随着上皮病变级别升高,表达也逐渐增强,在宫颈鳞状细胞癌中表达更强;HPV16／18DNA在四组中阳性表达率,除高级别上皮内瘤变和宫颈鳞状细胞癌两组间差异无统计学意义外（均为96．77％）,其余各组之间差异均有统计学意义（P〈0．01）;在宫颈低级别上皮内瘤变中P16INK4A蛋白表达和HPV感染相关无统计学意义,但在高级别上皮内瘤变和宫颈鳞状细胞癌两组中均呈正相关（r高级别=0．373,r鳞癌=0．416,P〈0．05）。结论P16INK4A过表达及HPV16／18感染在宫颈鳞状细胞癌形成的中晚期起作用,提示两者均可作为一个早期诊断恶性病变的指标。     

P16在子宫颈鳞状上皮内瘤变、子宫颈鳞癌的表达及临床意义

目的：检测P16蛋白在子宫颈鳞状上皮病变的表达情况，探讨其在诊断子宫颈上皮内瘤变及子宫颈鳞癌的意义。方法：采用免疫组织化学技术S—P法，检测16例子宫颈鳞癌、60例子宫颈上皮内瘤变、12例子宫颈鳞状上皮反应性增生及10例正常子宫颈的P16蛋白表达情况。结果：正常子宫颈鳞状上皮及子宫颈鳞状上皮反应性增生P16蛋白阳性表达率为0，（0／22）。CIN Ⅰ P16蛋白阳性表达率为57．1％（8／14），均表现为弱阳性表达，表达方式主要为胞浆表达；CINⅡ阳性表达率为83．3％（15／18），主要表现为阳性表达，表达方式为胞核／胞浆共同表达；CINⅢ（原住癌）阳性表达率为100％（28／28），主要表现为强阳性表达，表达方式为胞核／胞浆共同表达，以胞浆表达为明显。P16蛋白在CIN中总阳性表达率为80．5％（51／60），与对照组（正常子宫颈及鳞状上皮反应性增生组）阳性率为0（0／22）相比，差异有统计学意义（P〈0．01）。P16蛋白在子宫颈鳞癌阳性表达率为100％，均为强阳性表达，表达方式为胞核／胞浆共同表达，并以胞浆表达为明显，P16蛋白在宫颈鳞癌的表达中，与癌细胞的分化程度无关（P〉0．05）。结论：P16蛋白的阳性表达情况与CIN的分级关系密切，尤其是高度CIN和鳞状细胞癌，可作为一个免疫组织化学标志物，辅助诊断CIN及子宫颈鳞癌。     

宫颈癌前病变中HPV16/18与p16的关系

目的 研究宫颈癌的各个阶段中人乳头状瘤病毒（Human papillomavirus,HPV）和抑癌基因p16的表达,探讨HPV致癌的机理.方法 利用免疫组织化学技术检测20例正常宫颈组织、30例宫颈低度鳞状上皮内病变（LSIL）、30例宫颈高度鳞状上皮内病变（HSIL）和20例宫颈鳞状细胞癌中PHV16/18和p16的表达水平.结果 正常宫颈组织没有HPV16/18和p16的表达;LSIL、HSIL和宫颈鳞状细胞癌中HPV16/18的阳性率分别为16.7%（5/20）、53.3%（16/30）和75%（15/20）;p16的阳性率分别为36.7%（11/30）、73.3%（22/30）和100%（20/20）.HPV16/18和p16在HSIL的表达均明显高于LSIL.16例HPV16/18阳性的HSIL中14例发现p16的高表达.结论 宫颈癌前病变存在p16的过度表达;HPV16/18阳性的宫颈癌及HSIL常伴随p16蛋白的高表达,提示HPV16/18有可能引起自然抑癌基因p16突变,而导致细胞癌变.     

热休克蛋白70阳性表达与食管鳞癌临床预后分析

【目的】探讨热休克蛋白70（HSP70）与食管鳞癌预后的关系。【方法】收集100例石蜡包埋食管癌肿瘤组织，用免疫组化方法研究其HSP70的表达情况。【结果】食管鳞癌组织中HSP70蛋白表达阳性率为90％，高于正常黏膜表达（13．3％），差畀有显著性（P〈0．01），食管鳞癌组织中HSP70蛋白的表达水平比正常食管黏膜明显升高。在伴有与不伴有淋巴结转移的食管鳞癌病例中，HSP70阳性表达率分别为84％和96％，差异有显著性（P〈0．05）。在术后生存期〈3年的食管鳞癌病例中，83．3％表达HSP70，而在生存期〉5年的病人中，HSP70阳性表达率为96．1％，阳性率差异有显著性（P〈0．05）。【结论】HSP70蛋白的表达与预后有关，HSP70高表达者预后好，HSP70可以作为判断食管鳞状细胞癌预后的重要生物指标之一。     

癌前食管与食管鳞状细胞癌表达CD44及CD44v6的差异

目的通过免疫组化研究CD44及CD44v6在癌前食管及食管鳞状细胞癌中的表达情况,探讨其与食管鳞状细胞癌的关系及临床意义。方法收集潮州市中心医院病理科存档的食管病例蜡块（所有病例术前均未接受放、化疗）。采用免疫组化PV-9000二步法（非生物素）检测癌前食管63例,食管鳞状细胞癌140例。SPSSl6．0统计软件分析实验结果。对于各组之间表达情况的数据统计采用多独立样本非参数检验：Kruskal．WallisH检验;各组中两两比较采用两独立样本非参数检验：Kruskal—WallisH检验的方法进行比较。结果CD44及CD44v6在正常的鳞状上皮,只表达于上皮基底层3～5层细胞,随着上皮的增生,表达的细胞层数逐渐增加,在非典型增生的上皮则主要表达于有异型的上皮,而原位癌则几乎表达于上皮的全层。CD44及CD44v6在各种食管癌前病变组织与食管鳞状细胞癌中的表达均存在差异（均P〈0．01）,其中从正常食管组织及伴上皮增生但无细胞异型的食管组织至食管鳞状细胞癌之间,其表达强度逐渐增强,而从非典型增生及原位癌至食管鳞状细胞癌之间的表达强度逐渐减弱。结论CD44及CD44v6在癌前食管及食管鳞状细胞癌中的表达差异,提示它们可能与食管鳞状细胞癌的发生及发展有关,为食管癌干细胞的进一步研究提供线索。     

HPV16／18感染及其致癌基因与宫颈癌的关系

目的 研究端粒酶活性、人乳头瘤病毒16／18（HPV16／18）感染及致癌基因与宫颈癌的相关性。方法 对30例浸润型宫颈癌、58例宫颈内瘤形成（CINⅢ20例、CINⅡ20例、CINⅠ18例）及16例正常女性的宫颈新鲜组织，采用端粒酶重复序列扩增法（TRAP-PCR）检测端粒酶活性，用荧光定量多聚酶链式反应（FQ-PCR）检测HPV16／18DNA，用PCR方法对HPV16／18DNA阳性组织作HPV16型致癌基因E6、E7检测。结果 宫颈癌组中端粒酶阳性22例（73．33％）（HPV16／18＋15例，7例有E6、E7表达），端粒酶阴性8例（HPV16／18＋1例，无E6、E7表达）。CINⅢ级中端粒酶阳性13例（46．4％）（HPVl6／18＋6例，2例有E6、E7表达），端粒酶阴性15例（无HPV16／18＋）；CINⅡ级中端粒酶阳性6例（25％）（HPV16／18＋2例，1例有E6、E7表达），端粒酶阴性18例（无HPV16／18＋）；CINⅠ级中端粒酶阳性2例（10．00％）（HPV16／18＋2例，无E6、E7表达）。而16例正常宫颈组织仅1例（6．25％）端粒酶活性表达，此例HPV也呈阳性而无E6、E7表达。宫颈癌和癌前病变（CINⅢ）组织端粒酶活性表达频率（P〈0．01）和HPV16／18感染率（P〈0．01）及其致癌基因表达（P〈0．01）均显著高于良性损伤（CINⅠ和CINⅡ）和正常对照。结论 端粒酶活性在宫颈癌发生中可能起到重要作用，在子宫颈损伤中端粒酶激活与HPV感染及其致癌基因的表达密切相关；对于探讨宫颈病变的进展和宫颈癌的发生具有重要意义。     

人乳头瘤病毒检测在宫颈高级别鳞状上皮内病变锥切术后随诊的临床意义

【目的】探讨高危型人乳头瘤病毒（HPV）基因与宫颂液基薄层细胞学（TCT）检测在宫颈高级别鳞状上皮内病变（HSIL）锥切术后随诊中的临床意义。【方法】收集本院因宫颈HSIL住院行宫颈冷刀锥切手术治疗,保留子宫者、术后能定期随诊并有完整资料者共80例,分析术后3、4、5、6、12、18、24个月残留率并比较。【结果180例患者术后半年内高危型HPV-DNA阳性18例患者,在阴道镜下行宫颈活检提示有宫颈上皮内瘤变（CIN）6例,符合率33．3％（6／18）,TCT提示ASC-US以上病变者10例,阴道镜下行宫颈活检提示有宫颈鳞状上皮内瘤病变6例,符合率60．0％（6／10）,两者符合率比较差异有统计学意义（P〈0．05）;半年后高危型HPV-DNA阳性16例,在阴道镜下行宫颈活检提示有宫颈鳞状上皮内瘤病变6例,符合率37．5％（6／16）,TCT提示ASC-US以上病变者6例,在阴道镜下行宫颈活检提示有宫颈鳞状上皮内瘤病变1例,符合率16．7％（1／6）,两者符合率比较差异有统计学意义（P〈0．05）。【结论】宫颈HSIL锥切术后半年内采取TCT筛查宫颈早期病变,术后半年后提倡行HPV基因检测,采取TCT和HPV基因联合检测更能提高术后病变残留或复发的诊断意义。     

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.