血管内皮生长因子-C与D2-40在膀胱移行细胞癌的表达及临床意义

目的 检测膀胱移行细胞癌(BTCC)组织中血管内皮生长因子-C(VEGF-C)与D2-40阳性表达的淋巴管密度(LVD),探讨BTCC中淋巴管生成与淋巴结转移的相互关系.方法 采用免疫组织化学方法检查45例BTCC和10例正常膀胱组织中VEGF-C与D2-40标记的淋巴管密度表达情况.结果 VEGF-C在45例BTCC中阳性表达35例,正常膀胱组织中无表达,淋巴结转移阳性组VEGF-C和LVD明显高于淋巴转移阴性组(P<0.05)和正常膀胱黏膜组织组(P<0.05).结论 VEGF-C促进淋巴管新生,淋巴管新生可能进一步促进肿瘤淋巴结转移.     

环氧化酶-2与血管内皮生长因子-C在鼻咽癌中表达及其与淋巴结转移的相关性

目的 探讨环氧化酶-2(COX-2)、血管内皮生长因子(VEGF-C)在鼻咽癌组织中的表达及其与淋巴管生成及淋巴结转移的关系.方法 采用免疫组化学SP法检测2004年1月至2010年1月收治的66例鼻咽癌患者和20例正常鼻咽黏膜组织中COX-2、VEGF-C及淋巴管特异性标记物D2-40[在高倍镜(×200)下观察]的表达,通过记数淋巴管密度(LVD)并结合临床病理特征分析.结果 鼻咽癌组织COX-2(78.79%)、VEGF-C(72.73%)表达阳性率均明显高于正常组COX-2(10.00%)、VEGF-C(5.00%)表达阳性率;有淋巴结转移组COX-2(95.00%)、VEGF-C(87.50%)表达及D2-40阳性LVD(17.540±2.512)明显高于无淋巴结转移组COX-2(53.84%)、VEGF-C(50.00%)的表达及LVD(8.751±1.076)(P<0.01);VEGF-C与COX-2表达(r=0.721,P<0.01)、LVD(r=0.788,P<0.01)呈正相关,COX-2表达与LVD呈正相关(r=0.613,P<0.01).结论 VEGF-C及COX-2在鼻咽癌组织中呈高水平表达,其表达与肿瘤LVD及肿瘤淋巴结转移有重要关系.     

甲状腺乳头状腺癌VEGF和P53蛋白表达与淋巴结转移和微血管密度的关系

目的探讨甲状腺乳头状腺癌中血管内皮生长因子(VEGF)和p53蛋白表达与微血管密度(MVD)以及颈淋巴结癌转移的关系.方法应用免疫组化技术对37例甲状腺乳头状腺癌VEGF和p53蛋白的表达进行检测,用FⅧRAg显示MVD,行相对定量研究.结果甲状腺乳头状腺癌VEGF和p53蛋白的表达率明显高于对照组(P＜0.01);颈淋巴结癌转移组的VEGF表达率高于无癌转移组(P＜0.05);而p53蛋白的表达率在前述两组间差异无显著性意义(P＞0.05).颈淋巴结癌转移组的MVD高于无癌转移组(P＜0.05).VEGF表达与MVD呈显著正相关(P＜0.01); p53表达与MVD无关(P＞0.05).结论甲状腺乳头状腺癌VEGF的表达与颈淋巴结转移有一定关系,还与其MVD相一致,提示VEGF的表达和MVD可作为判断甲状腺乳头状腺癌预后的一项重要参考指标.     

血管内皮生长因子C及其受体表达与乳腺癌淋巴结转移的相关性研究

目的检测乳腺癌组织中血管内皮生长因子c/血管内皮生长因子受体-3(VEGF-C/VEGFR-3)、淋巴管密度(LVD)的表达情况,探讨其表达水平淋巴结转移的相互关系,进一步研究肿瘤转移的机制,为抗淋巴管形成、进而为抗乳腺癌淋巴转移的治疗提供理论依据。方法应用免疫组织化学(SP)法检测83例乳腺癌手术标本的原发灶的VEGF-C及其受体VEGFR-3的表达及LVD。结果83例乳腺癌组织VEGF-C阳性表达者36例(43.3%),淋巴结转移组的VEGF-C阳性表达率为54.6%(24/44),显著高于无淋巴结转移组30.8%(12/39),(P<0.05);在VEGF-C表达阳性组、阴性组中LVD统计学上差异显著(P<0.05)。结论乳腺癌组织VEGF-C表达可能促进肿瘤内淋巴管的生成;乳腺癌的淋巴结转移和VEGF-C的高表达密切相关;。     

肺癌组织中肿瘤转移相关基因1和血管内皮生长因子C表达与肿瘤分期和预后的关系

目的分析肺癌癌组织中肿瘤转移相关基因1(MTA1)和血管内皮生长因子C(VEGF-C)表达水平及其与肿瘤分期和预后的关系。方法我院收治的108例肺癌患者癌组织及癌旁组织标本,检测MTA1及VEGF-C表达水平并收集临床相关资料。结果癌组织中VEGF-C及MTA1阳性表达率均高于癌旁组织(P<0.05);MTA1与VEGF-C在肿瘤III~IV期、低分化、有淋巴结转移患者中阳性表达率较高(P<0.05)。VEGF-C表达与MTA1呈正相关(P<0.05);VEGF-C阳性组和MTA1阳性组1年总生存率及无进展生存率均低于阴性组(P<0.05)。结论VEGF-C与MTA1在NSCLC癌组织中存在阳性表达,两者在肿瘤血管和淋巴结生成中可能存在协同作用,共同促进肿瘤细胞的恶性发展,其阳性水平表达越高,患者预后越差。     

整合素β1与β3在非小细胞性肺癌及其淋巴结中的表达

[目的]了解整合素β1与β3在非小细胞性肺癌(NSCLC)及其淋巴结组织中的表达,分析其与临床病例特征之间的关系.[方法]随机抽取42例术前未接受任何辅助治疗NSCLC及其淋巴结和10例癌旁正常肺组织,采用免疫组织化学SABC(链霉素-生物素-酶复合物)法检测的石蜡切片标本中的整合素β1与β3的表达并进行比较.[结果]①整合素β1与β3在NSCLC组织组中阳性率高于癌旁正常肺组织组;在转移性淋巴结组中阳性率表达高于非转移性淋巴结组.②整合素β1及β3在原发病灶的阳性表达率与NSCLC分化程度、淋巴结转移情况及其病理分级等临床病例因素不同而有显著差异.[结论]整合素β1与β3在NSCLC和转移淋巴结中的表达明显强于癌旁正常肺组织和非转移性淋巴结;整合素β1与β3在NSCLC中的表达与NSCLC的组织分化程度和恶性程度有关,并可能参与了NSCLC的发生,发展及淋巴结转移过程.     

Ang-2和VEGF在大肠癌血管生成中的作用及与其临床病理特征的关系

[目的]探讨促血管生成素-2(Ang-2)及血管内皮生长因子(VEGF)在大肠癌组织肿瘤血管生成中的作用及与其临床病理特征的关系.[方法]采用免疫组织化学方法检测Ang-2及VEGF蛋白在62例大肠癌组织中的表达水平,计数微血管密度(MVD).[结果]肠癌组织中Ang-2与MVD呈正相关(r=0.7011,P<0.05);VEGF阳性表达组Ang-2和MVD明显高于阴性组(P<0.01);浸润浆膜、淋巴结转移肠癌组织中Ang-2、VEGF水平均高于无浆膜浸润、无淋巴结转移者(P<0.05);大肠癌各Dukes分期中,(C D)期Ang-2水平和VEGF阳性表达率均高于(A B)期(P<0.05).[结论]Ang-2、VEGF及其相互作用对促进大肠癌血管生成,在大肠癌的侵袭和转移中可能起到重要作用.     

淋巴管新生在膀胱移行细胞癌淋巴结转移中的意义

目的:探讨血管内皮生长因子-D(VEGF-D)和D2-40阳性表达的淋巴管密度(LVD)在膀胱移行细胞癌淋巴结转移中的意义。方法:采用免疫组织化学SP法测定15例正常膀胱黏膜组织和53例膀胱移行细胞癌组织的VEGF-D和LVD。结果:VEGF-D在15例正常膀胱黏膜中表达均为阴性,淋巴转移阳性组与淋巴转移阴性组之间比较,差异有统计学意义(P<0.01)。淋巴转移阳性组LVD明显高于淋巴转移阴性组(P<0.01)和正常膀胱黏膜组织(P<0.01)。另外,VEGF-D与LVD之间存在正相关(rs=0.747,P<0.01)。结论:VEGF-D阳性表达及LVD值的高低与膀胱移行细胞癌转移密切相关,并且VEGF-D可能促进淋巴管的新生。     

VEGF-C、BcI-xI蛋白在前列腺癌患者癌组织内表达水平变化及意义研究

目的探讨前列腺癌组织中的血管内皮生长因子-C(VEGF-C)、抗凋亡蛋白(Bcl-xl)的表达变化及其临床意义。方法选取我院2016年1月-2017年6月收集的80例前列腺癌组织(癌组织)、40例前列腺增生组织(BPH组),采用免疫组化染色(SP)检测两组标本中的VEGF-C、Bcl-xl蛋白表达情况,并分析这两种蛋白与前列腺癌的TNM分期、淋巴结转移、Gleason评分的关系。结果癌组织中的VEGF-C蛋白、Bcl-xl蛋白阳性率分别为76.25%、72.50%,BPH组织中的VEGF-C蛋白、Bcl-xl蛋白阳性率分别为12.50%、20.00%,两组比较差异具有统计学意义(P0.05);癌组织中的VEGF-C蛋白在TNM分期(T_3～T_4期)、发生淋巴结转移的组织中阳性表达率高于TNM分期(T_1～T_2期)、未发生淋巴结转移的组织(P0.05);癌组织中的Bcl-xl蛋白在TNM分期(T_3～T_4期)、发生淋巴结转移的组织中阳性表达率高于Bcl-xl分期(T_1～T_2期)、未发生淋巴结转移的组织(P0.05)。结论前列腺癌组织中的VEGF-C、Bcl-xl阳性表达率显著的增高,并且与前列腺癌的病理分期及是否发生淋巴结转移具有相关性。     

环氧化酶-2、血管内皮生长因子-C和CD105在喉癌组织中的表达及与临床病理特征的关系

目的探讨环氧化酶-2(COX-2)、血管内皮生长因子-C(VEGF-C)和CD105三者在喉癌组织中的表达及与临床病理特征的关系。方法采用免疫组织化学方法,检测40例喉癌组织COX-2、VEGF-C的表达和CD105标记的微血管密度(MVD)情况,并与临床病理资料比较,分析三者之间的关系及与喉癌临床病理特征的关系。结果在喉癌组织中COX-2阳性率为80.0%,VEGF-C的阳性率为72.5%,CD105的MVD值为8.63±1.85;VEGF-C、CD105和COX-2的表达在TNM分期及有无淋巴结转移组间比较P<0.01;VEGF-C阳性表达组的MVD显著高于VEGF-C阴性表达组的MVD(P<0.01),CD105与VEGF-C在喉癌中的表达有相关性;COX-2阳性表达组的MVD显著高于COX-2阴性表达组的MVD(P<0.01),CD105与COX-2在喉癌中的表达有相关性;COX-2和VEGF-C在喉癌组织中的表达有一致性(κ=0.521)。结论喉癌组织中存在COX-2、VEGF-C和CD105的高表达一致现象,其阳性表达与TNM分期及淋巴结转移有相关性,对于CD105标记的MVD较高患者及COX-2...     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

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.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.