乳腺癌患者手术前后相关实验室数据的检测意义

目的探讨乳腺癌患者手术前后可溶性细胞膜糖蛋白(Endoglin)、血管内皮生长因子(VEGF)、表皮生长因子受体(EGFR)的水平变化,分析可溶性Endoglin、VEGF和EGFR水平检测在乳腺癌患者中的临床意义。方法选取2016年10月至2018年9月在该院进行手术的乳腺癌患者52例作为观察组,以同期健康体检者50例作为对照组,分别检测观察组手术前后和对照组可溶性Endoglin、VEGF和EGFR水平,并对数据进行比较分析。结果观察组患者手术前可溶性Endoglin、VEGF和EGFR表达水平均明显高于对照组,差异均有统计学意义(P<0.05);观察组患者手术前可溶性Endoglin、VEGF和EGFR表达水平均明显高于手术后,差异均有统计学意义(P<0.05);观察组患者手术后可溶性Endoglin、VEGF和EGFR表达水平与对照组比较,差异均无统计学意义(P>0.05)。结论在乳腺癌患者中,存在可溶性Endoglin、VEGF和EGFR表达水平异常,可溶性Endoglin、VEGF和EGFR水平检测对乳腺癌患者手术前后的病情观察及预后有一定临床应用价值。     

新肿瘤标志物sB7-H4初探

目的初步探讨可溶性B7-H4(sB7-H4)作为肿瘤标志物的可行性。方法用ELISA夹心法检测61例胃癌、38例原发性肝癌、37例乳腺癌、46例子宫肌瘤患者与51例健康者血清sB7-H4水平,并分析其与临床分期、手术前后及其他血清标志物的相关性。结果 (1)sB7-H4的分析灵敏度可达3.13μg/L,3种早期恶性肿瘤患者(胃癌、肝癌和乳腺癌)血清sB7-H4水平高于健康者,差异具有统计学意义(P<0.05或P<0.01)。(2)胃癌、原发性肝癌、乳腺癌患者血清中sB7-H4水平均明显高于子宫肌瘤患者和健康者水平,差异有统计学意义(P<0.05或P<0.01);子宫肌瘤患者血清中sB7-H4水平与健康者比较,差异无统计学意义(P>0.05)。(3)Ⅲ/Ⅳ期原发性肝癌患者血清sB7-H4水平高于Ⅰ/Ⅱ期患者(P<0.01),而胃癌、乳腺癌患者血清sB7-H4水平则与临床分期无关(P>0.05)。(4)原发性肝癌、胃癌患者术前血清sB7-H4水平高于术后患者,差异有统计学意义(P<0.01)。(5)原发性肝癌、胃癌患者血清sB7-H4水平与相应血清标志物AFP、CEA、CA19-9水平呈正相关(P<0.01)。结论 sB7-H4具有较高的灵敏度和较好的特异性,基本符合肿瘤标志物应具有的条件,可能是一种新的糖蛋白类肿瘤标志物。     

VEGF和CA153表达水平与乳腺癌疾病进展的关系

目的探讨血管内皮细胞生长因子(VEGF)和糖类抗原(CA153)在乳腺癌患者血清中的表达及其与疾病进展的关系。方法检测30例乳腺癌患者、30例乳腺良性疾病患者和60例健康女性血清中VEGF、CA153的水平,对乳腺癌患者采用1997年国际抗癌联盟(UICC)公布的乳腺癌TNM分类法进行分期,并将乳腺癌患者以有无淋巴结转移分为2组,记录VEGF、CA153检测结果,用ELISA法检测VEGF,用电化学发光法检测CA153。结果乳腺癌组各项检测指标与乳腺良性疾病组和健康对照组比较差异均有统计学意义(P<0.01),而乳腺良性疾病组与健康对照组比较差异无统计学意义(P>0.05);乳腺癌患者Ⅲ期与Ⅰ期、Ⅱ期比较VEGF、CA153水平差异均有统计学意义(P<0.01);淋巴结转移乳腺癌患者有与无淋巴结转移者的血清VEGF、CA153水平比较差异有统计学意义(P<0.01)。结论联合检测血清VEGF、CA153水平对乳腺癌的诊断、病情评估、预后判断有重要价值。     

乳腺癌外周血SBEM和hMAM联合检测的临床意义

目的 探讨乳腺癌患者外周血乳腺小粘蛋白(SBEM)及人乳腺珠蛋白(hMAM)的表达及临床意义.方法 采用酶联免疫吸附试验(ELISA)定量检测68例乳腺癌患者及20例乳腺纤维腺瘤患者及20例健康志愿者术前血清SBEM和hMAM的水平.结果 乳腺癌组术前血清SBEM和hMAM水平均高于纤维腺瘤组和健康对照组(P均<0.01).有淋巴结转移的乳腺癌患者血清中SBEM和hMAM水平明显高于无淋巴结转移者,差异均有统计学意义(P均<0.05).Ⅲ期患者血清SBEM和hMAM水平显著高于Ⅰ+Ⅱ期患者(P均小于0.01).结论 SBEM及hMAM特异性表达于乳腺癌外周血,有可能作为检测乳腺癌外周血微转移的标志物,有望成为判断乳腺癌患者病情发展和预后的新指标.     

乳腺癌患者血浆神经生长因子和神经生长因子受体检测的临床意义

目的探讨乳腺癌患者血浆神经生长因子(NGF)和神经生长因子受体(NGFR)含量及其检测意义。方法采用ELISA法检测49例乳腺癌临床分期患者、30例良性乳腺疾病患者、30例健康对照者血浆NGF、NGFR含量,分析与乳腺癌不同临床分期的关系。结果血浆NGF含量:Ⅲ/Ⅳ期乳腺癌患者组、Ⅱ期乳腺癌患者组、良性乳腺疾病患者组、健康对照组分别为(62.8±2.5)、(64.0±2.8)、(63.4±2.4)、(62.1±2.1)pg/mL,各组间比较,差异无统计学意义(H=7.683,P0.05);血浆NGFR含量:Ⅲ/Ⅳ期乳腺癌患者组、Ⅱ期乳腺癌患者组、良性乳腺疾病患者组、健康对照组分别为(301.3±285.3)、(90.0±52.7)、(67.5±42.5)、(63.0±33.3)pg/mL,Ⅲ/Ⅳ期乳腺癌患者组显著高于Ⅱ期乳腺癌患者组、良性乳腺疾病患者组、健康对照组,差异有统计学意义(H=27.561,P0.01)。Ⅱ期乳腺癌患者组前后2次血浆NGFR分别为(70.8±42.9)、(109.3±55.8)pg/mL,差异有统计学意义(Z=-2.443,P=0.015);Ⅲ/Ⅳ期乳腺癌患者组前后2次血浆NGFR分别为(156.4±89.6)、(490.7±319.2)pg/mL,差异有统计学意义(Z=-2.589,P=0.01)。结论乳腺癌患者血浆NGFR水平增高可能与肿瘤发生进展相关,检测血浆NGFR水平有助于乳腺癌患者的病情评估。     

宫颈癌患者血清中肿瘤标志物检测的价值研究

目的探讨宫颈癌患者血清肿瘤标志物检测的临床价值。方法选取2015年1月至2016年12月该院收治的宫颈癌患者97例和健康体检女性47例分别作为观察组和对照组,检测两组血清鳞状细胞癌抗原(SCC-Ag)、糖链抗原125(CA125)和癌胚抗原(CEA),并对结果进行统计分析。结果观察组血清SCC-Ag、CA125、CEA水平高于对照组,差异有统计学意义(P0.05);鳞癌患者血清SCC-Ag水平高于腺癌患者,而CA125和CEA水平低于腺癌患者,差异有统计学意义(P0.05);Ⅲ~Ⅳ期患者血清SCC-Ag、CA125和CEA水平明显高于Ⅰ期、Ⅱ期患者,且Ⅱ期患者血清SCC-Ag、CA125和CEA水平明显高于Ⅰ期患者,差异均有统计学意义(P0.05);低分化患者血清SCC-Ag、CA125、CEA水平明显高于中高分化患者,差异有统计学意义(P0.05)。结论血清SCC-Ag、CA125、CEA检测有助于早期诊断宫颈癌,且它们联合检测能够提高诊断的灵敏度和特异度。     

SCCA、TSGF和CA125在宫颈癌患者血清中的表达水平及其与宫颈癌分期的相关性分析

目的探讨鳞状细胞癌抗原(SCCA)、恶性肿瘤特异生长因子(TSGF)和糖链抗原125(CA125)在宫颈癌患者血清中的表达水平及其与宫颈癌分期的相关性。方法选取2014年6月至2016年1月期间本院收治的60例宫颈癌患者作为宫颈癌组,60例宫颈上皮内瘤变患者作为宫颈上皮内瘤变组,并以同期于本院体检的60例健康体检者作为健康对照组。检测三组研究对象血清中SCCA、TSGF和CA125的表达水平,并分析其与临床分期和临床病理特征的关系。结果宫颈癌组患者血清SCCA、TSGF和CA125水平均明显高于宫颈上皮内瘤变组和健康对照组,差异有统计学意义(P0.05);肿瘤直径≥4cm患者血清SCCA、TSGF和CA125水平均明显高于肿瘤直径4cm患者,差异有统计学意义(P0.05);Ⅲ~Ⅳ期患者血清SCCA、TSGF和CA125水平均高于Ⅰ~Ⅱ期患者,差异有统计学意义(P0.05);鳞癌患者血清SCCA和TSGF水平均高于腺癌患者,而CA125水平则低于腺癌患者,差异均有统计学意义(P0.05);宫颈癌患者血清SCCA、TSGF和CA125水平随组织学分级升高而降低(P0.05);伴有淋巴结转移患者血清SCCA、TSGF和CA125水平明显高于无淋巴结转移患者,差异有统计学意义(P0.05);Spearman分析显示,宫颈癌患者血清SCCA、TSGF和CA125水平与临床分期呈正相关(P0.05)。血清SCCA+TSGF+CA125联合检测诊断宫颈癌的灵敏度、特异度和准确度均高于血清SCCA、TSGF、CA125单独检测,差异有统计学意义(P0.05)。结论宫颈癌患者血清SCCA、TSGF和CA125水平检测有助于宫颈癌患者的早期诊断、病情监测和预后评估。     

PS2,E-Cad癌变组织表达与中晚期乳腺癌治疗及预后的相关性分析

目的 PS2,E-Cad癌变组织表达与中晚期乳腺癌治疗效果及预后的相关性探究。方法收集来我院就诊的乳腺癌患者86例,均为随访5年以上的患者。采用免疫组织化学的方法,对上述乳腺癌患者癌变组织的石蜡包埋切片中的PS2,ECad表达水平进行检测,分析PS2,E-Cad表达水平与影响乳腺癌治疗及预后因素(肿瘤大小、TNM分期、组织学分级、淋巴结转移情况)的相关性。结果 86例乳腺癌患者的癌变组织中PS2、E-Cad的表达与乳腺癌患者的治疗效果、肿瘤大小、TNM分期、组织学分级、淋巴结转移情况等方面均存在明显的相关性,E-Cad与PS2的表达阳性率在SD与PD患者间存在差异,SD患者的阳性率明显高于PD患者,差异有统计学意义(P0.05);肿瘤大小≤2cm患者的E-Cad与PS2的表达阳性率明显高于肿瘤大小2cm的患者,差异有统计学意义(P0.05);TNM分期为Ⅱ期患者的E-Cad与PS2表达阳性率明显高于Ⅲ、Ⅳ期患者,差异有统计学意义(P0.05);组织学分期Ⅱ期患者的E-Cad与PS2表达阳性率明显高于Ⅲ期患者,差异有统计学意义(P0.05);发生淋巴结转移患者的E-Cad与PS2表达阳性率明显低于未发生转移的患者,差异有统计学意义(P0.05)。结论E-Cad、PS2在癌组织中的表达与乳腺癌的进程密切相关,对E-Cad、PS2的表达进行检测可以有助于判断乳腺癌的治疗及预后情况,为乳腺癌的临床治疗提供重要的理论依据。     

乳腺癌预后判断中VEGF、CA15-3、CA125和CEA的表达及其意义

目的 探讨血清中血管内皮生长因子(VEGF)、CA15-3、CA125和癌胚抗原(CEA)检测在乳腺癌预后判断中的表达及其临床意义.方法 用免疫组化(S-P)法动态监测93例乳腺癌患者的VEGF水平,用放射免疫法检测CA15-3、CA125和CEA的水平,并与25例健康体检者的各项指标进行比较,分析其与临床分期、治疗效果和复发转移的关系.结果 乳腺癌组的VEGF阳性率显著高于正常对照组,且乳腺癌Ⅰ～Ⅳ期健康状况依次升高,有淋巴结转移者较无转移患者高,差异有统计学意义(P《0.01);乳腺癌患者中Ⅲ、Ⅳ期的CA15-3、CA125和CEA水平也明显高于正常对照组和Ⅰ、Ⅱ期患者,有淋巴结转移者显著高于无淋巴结转移患者,差异均有统计学意义(P《0.05);随访中发现复发者各项指标均比无复发者高;VEGF、CA15-3、CA125和CEA的表达与临床分期、腋窝淋巴结状况有关(P《0.01),但与患者年龄、肿瘤大小和肿瘤病理学类型无关(P》0.05).结论 VEGF、CA15-3、CA125和CEA的检测对于判断乳腺癌的分期、转移情况及治疗效果的评价有一定意义,可以指导临床对乳腺癌的诊疗工作.     

胃癌患者血清中exosome的水平及临床意义

目的探讨胃癌患者血清中外体(exosome)的水平及其临床意义。方法用ELISA法检测77例胃癌患者、34例体检健康者血清中EXOSC2(exosome component 2)的含量,以评估血清中exosome的水平,并分析其与胃癌患者临床病理特征的关系。结果胃癌患者血清中EXOSC2含量为[670.92(572.49,1 287.59)]pg/mL,健康对照组为[585.49(493.63,862.10)]pg/mL,两组间差异有统计学意义(P0.05)。胃癌患者中,淋巴结转移组血清中exosome水平明显高于无淋巴结转移组(P0.01);Ⅲ、Ⅳ期exosome水平明显高于Ⅰ、Ⅱ期(P0.05);低分化组水平明显高于高分化组(P0.05)。胃癌患者不同年龄、性别、肿瘤浸润深度、有无远处转移和肿瘤大小间exosome水平差异无统计学意义(P0.05)。结论胃癌患者血清中exosome水平的升高与肿瘤淋巴结转移、TNM分期及分化程度有关,测定血清中exosome的水平有助于判断胃癌的进展。     

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.     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.