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胃癌淋巴管生成、淋巴管浸润及淋巴结微转移的临床意义   总被引:5,自引:4,他引:1  
目的探讨胃癌淋巴管生成、淋巴管浸润及淋巴结微转移的临床意义。方法免疫组化法检测68例胃癌原发灶中D2-40的表达及其中51例胃癌的791枚淋巴结中CK20和CKpan的表达,结合患者的l临床病理特征进行综合分析。结果胃癌HE染色淋巴管浸润(LVI-HE)和D240染色淋巴管浸润(LVI-IM)的阳性率分别为66.2%(45/68)和76.5%(52/68),差异无统计学意义(P=0.118)。LVI-IM阳性率与肿瘤浸润深度(P=0.044)、TNM分期(P=0.003)及存在淋巴结转移(P=0.000)有关。68例胃癌平均淋巴管密度(LVD)为(18.19±7.44)个/HP.LVD升高与LVI-HE阳性(P=0.040)、LVI—IM阳性(P=0.001)、静脉浸润(P=0.037)、TNM分期较晚(P:0.020)及存在淋巴结转移(P=0.001)有关系。LVD值≥15个/HP者近期生存率较LVD值≤14个/HP者明显降低(P=0.032)。51例胃癌HE染色和CK(CK20或CKpan)染色检出淋巴结转移率分别为74.5%(38/51)和88.2%(45/51),791枚淋巴结的转移淋巴结检出率由HE染色的32.0%(253/791)提高到CK染色的41.5%(328/791),P〈0.001。CKpan的微转移检出率明显高于CK20(P=0.003)。微转移淋巴结数量与肿瘤大小(P=0.001)、LVIHE(P=0.040)、肿瘤浸润深度(P=0.018)及TNM分期(P=0.012)有关。微转移淋巴结的检出使淋巴结转移站别及TNM分期迁移:7例N0→N1,6例N1→N2,1例N2→N3;4例Ⅰb→Ⅱ,4例Ⅱ→Ⅲa,3例Ⅲa→Ⅲb,1例Ⅲb→Ⅳ。结论D2-40及CK检测在诊断淋巴管浸润和淋巴结微转移上优于HE检查。CK20和CKpan的联合检查有利于发现微转移淋巴结。肿瘤TNM分期越晚,越易发生淋巴结微转移。LVI-IM、LVD及淋巴结微转移三者都与胃癌淋巴结转移有关。LVD值较高者近期生存率较低。  相似文献   

3.
采用S-P免疫组织化学方法检测56例胃癌组织(胃癌组)及22例良性疾病胃组织(对照组)中β-Cat和NF-κB的表达情况,分析其与胃癌的临床特征和预后的关系。结果示,β—Cat和NF—κB在胃癌组中的表达阳性率明显高于对照组(P〈0.05),分别为69.64%和66.07%。β—Cat的表达与肿瘤病理分化程度、有无淋巴结转移、病理分型及浸润深度有关(P〈0.05)。NF—KB的表达与肿瘤大小、有无淋巴结转移、病理分型及浸润深度有关(P〈0.05)。β—Cat,NF—κB在胃癌组织中的表达密切相关(rs=0.541,P〈0.01)。β—Cat和NF—κB的过表达与胃癌患者的5年生存率有关。它们是患者预后的独立影响因素。提示:β—Cat和NF—κB有可能在胃癌的发生、发展中发挥重要作用。  相似文献   

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目的探讨外周血鸟苷酸环化酶(GC.C)mRNA和细胞角蛋白20(CK20)mRNA水平与早中期结直肠癌患者肿瘤转移及预后的关系。方法应用荧光定量聚合酶链反应技术,检测74例早中期结直肠癌患者术前外周血GC.CmRNA以及CK20mRNA的表达.并结合临床和病理各项指标以及术后随访资料,对患者肿瘤转移危险因素和预后进行统计学分析和评价。结果74例结直肠癌患者外周血GC.CmRNA阳性率为33.8%(25/74),CK20mRNA阳性率为31.1%(23/74);1、2、3年无瘤生存率分别为94.6%、82.4%和78.4%。单因素预后分析发现,外周血GC.cmRNA、CK20mRNA、肿瘤分化类型、有无肠系膜根部淋巴结转移、有无脉管瘤栓和术后是否接受化疗6因素与本组患者3年无瘤生存有关(均P〈0.05);有无肠系膜根部淋巴结转移和有无脉管瘤栓是预后的独立影响因素(P〈0.05)。按肿瘤分期分层分析,外周血CK20mRNA和有无脉管瘤栓是Ⅲ期结直肠癌患者3年无瘤生存率的独立影响因素(P〈O.05)。结论检测外周血CK20mRNA、GC—CmRNA对于早期发现早中期结直肠癌转移可能具有重要的临床意义。  相似文献   

5.
目的:探讨TGF-β及其伙伴分子Smad4在胃癌组织中的表达。方法:利用逆转录(RT)-PCR技术测定胃癌组织TGF-β mRNA和Smad4mRNA水平,并分析两者与胃癌患者各项临床病理指标间的关系。结果:Smad4mRNA在胃癌组织中的阳性表达率明显下降。TGF-β和Smad4均与胃癌组织的分化程度、肿瘤大小、浸润深度、淋巴转移和TNM分期有关。Smad4 mRNA在胃癌组织分化程度高、肿瘤〈5cm、浸润深度浅、无淋巴转移、TNM分期较早的患者中阳性表达率高。TGF-β mRNA在胃癌组织中的阳性表达率明显升高。TGF-β mRNA在胃癌组织分化程度高、肿瘤〈5cm、浸润深度浅、无淋巴转移、TNM分期较早的患者中阳性表达率低。胃癌组织中TGF-β和Smad4表达间呈负相关。结论:TGF-β和Smad4共同调节胃癌的发生、发展及其生物学行为。  相似文献   

6.
目的探讨胃癌组织中Runt相关转录因子3(Runx3)基因的表达情况及其与胃癌临床病理学因素的关系。方法采用逆转录聚合酶链反应(RT—PCR)和蛋白印迹(Western blot)法分别检测52例胃癌组织和配对的正常胃黏膜组织中Runx3 mRNA以及蛋白的表达水平,并分析Runx3表达与胃癌临床病理学因素的关系。结果59.6%(31/52)的胃癌组织出现Runx3 mRNA表达缺失,48.1%(25/52)出现Runx3蛋白表达缺失,其缺失率均明显高于对应的正常胃黏膜组织(P〈0.05)。Runx3的表达缺失与肿瘤大小、组织分化程度、浸润深度、淋巴结转移及TNM分期有关(P〈0.05,P〈0.01)。Runx3 mRNA表达与蛋白表达呈正相关(r=0.840,P〈0.01)。结论Runx3基因与胃癌的发生、发展密切相关,有望成为胃癌诊断和治疗的新靶点。  相似文献   

7.
目的探讨进展期胃癌淋巴结转移率(rN)分期和转移数量(pN)分期与病理因素的关系,为合理的胃癌分期提供依据。方法回顾性分析2003年11月至2011年12月间新疆医科大学第一附属医院收治的555例进展期胃癌患者的临床病理资料,分析影响其州分期和pN分期的病理因素。结果单因素分析显示,分化程度、脉管内有无癌栓、肿瘤直径、大体形态和浸润深度与rN分期和pN分期均有关(P〈0.05);组织学类型则与rN分期有关(P〈0.05),而与pN分期无关。Logistic回归分析显示,脉管内癌栓、肿瘤直径和浸润深度是进展期胃癌淋巴结转移的独立危险因素(均P〈0.05)。ROC曲线显示,在评估进展期胃癌淋巴结转移分期的诊断价值上,rN分期和pN分期基本一致(P〉0.05)。结论无论是从淋巴结转移率还是从转移数量上看,脉管内癌栓、肿瘤直径和浸润深度都是进展期胃癌淋巴结转移的独立危险因素。rN分期对于评价进展期胃癌淋巴结转移分期在诊断价值上与pN分期一致。  相似文献   

8.
胃癌浸润深度及组织学类型与淋巴结转移的关系   总被引:1,自引:0,他引:1  
目的探讨胃癌浸润深度及组织学类型与淋巴结转移的关系,为临床进行合理的淋巴结清扫范围提供依据。方法回顾性分析1994年6月至1998年1月行根治性切除手术的268例胃癌患者的病理资料,统计胃癌浸润深度及组织学类型与淋巴结转移之间的关系。结果胃癌浸润深度在T1、T2、T3和T3时的淋巴结转移率分别为4.6%、53.1%、78.7%和100%,依次呈递增趋势(P〈0.01)。未分化癌、黏液腺癌、低分化腺癌、分化型腺癌和印戒细胞癌的淋巴结转移率分别为100%、66.7%、77.8%、48.8%和33.3%(P〈0.01)。N0、N1、N2和N3患者的5年生存率分别为84.3%、30.1%、9.1%和0,各组比较差异有统计学意义(P〈0.01)。结论胃癌的浸润深度及组织学类型与淋巴结转移相关,而淋巴结转移情况与患者的5年生存率密切相关。  相似文献   

9.
目的:检测PTEN、AKT2和CD147在胃癌组织中的表达,并探讨其相互关系。方法:应用免疫组织化学方法检测65例胃癌及癌旁组织中PTEN、AKT2和CD147的表达情况。结果:PTEN蛋白在胃癌中表达的阳性率(58.46%)明显低于相应正常组织(100%)(P〈0.01),其表达水平与组织分化程度、浸润深度、淋巴结转移及TNM分期有关(P〈0.05)。AKT2蛋白在胃癌组织中表达的阳性率(67.69%)明显高于相应正常组织(26.15%)(P〈0.01),其表达与淋巴结转移有关(P〈0.01),与浸润深度、分化程度和TNM分期无关(P〉0.05)。CD147蛋白在胃癌组织中表达的阳性率(86.15%)明显高于相应正常组织(16.92%)(P〈0.01),其表达水平与浸润深度、淋巴结转移及TNM分期有关(P〈0.05),与分化程度无关(P〉0.05)。胃癌组织中PTEN和AKT2、PTEN和CD147蛋白表达之间呈明显负相关(P〈0.01)。结论:PTEN的低表达或失表达,可能与AKT2、CD147的异常激活有一定联系,从而对胃癌的发生、发展起重要作用。  相似文献   

10.
目的检测基质金属蛋白酶(MMP)-2在胃癌组织中的表达及探讨其与淋巴结微转移的关系。方法对30例胃癌共850枚淋巴结采用CK-20mRNA RT-PCR扩增检测微转移,采用免疫组织化学染色检测该30例胃癌组织中MMP-2的表达情况。结果70%的胃癌组织MMP-2表达阳性;MMP-2表达与浸润深度、淋巴结转移和分化程度密切相关(P〈0.05),但与性别、年龄、肿瘤位置、直径、Lauren分型及淋巴管侵犯无明显相关(P〉0.05);14例77枚淋巴结检出微转移;85.7%检测出淋巴结微转移的癌组织MMP-2表达阳性,高于未检测出淋巴结微转移的癌组织的56.3%。结论MMP-2表达与胃癌侵袭、转移和分化程度密切相关。MMP-2表达阳性可能参与淋巴结微转移的发生。  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.  相似文献   

13.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

14.
Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.  相似文献   

15.
Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.  相似文献   

16.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1, n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.  相似文献   

17.
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.  相似文献   

18.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

19.
Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.  相似文献   

20.
Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg?1 · min?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min?1 · m?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO2I) and oxygen consumption index (VO2I) were also significantly increased in the dopexamine group (DO2I: from 416±91 to 717±110 ml/m2 · m2; VO2I: from 98±25 to 157±22 ml/m2 · m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.  相似文献   

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