C-kit和SCF基因在胆管细胞癌中的表达及意义

目的 拟通过检测C-kit、SCF基因在胆管细胞癌中的表达来了解C-kit、SCF与胆管细胞癌发生和发展之间的关系。方法采用免疫组化S-P法检测48例肝胆管细胞癌及20例肝外胆管癌标本C-kit、SCF蛋白表达情况，同时取对应的癌旁胆管组织及另取30例肝及胆管良性病变胆管组织作对照，所有数据采用X^2检验。结果48例肝胆管细胞癌组织中C-kit、SCF蛋白表达分别为39例（81．3％）和36例（75．0％），20例肝外胆管癌组织中C-kit、SCF蛋白表达分别为12例（60．0％）和13例（65．0%），癌旁胆管组织中4例C-kit、5例SCF呈弱阳性表达，30例肝及胆管良性病变胆管组织C-kit、SCF蛋白均呈阴性表达。两癌组织与癌旁胆管组织、肝及胆管良性病变胆管组织C-kit、SCF表达阳性率比较差异有显著性（P〈0．05）。Ⅲ～Ⅳ期胆管细胞癌C-kit、SCF蛋白表达阳性率高于Ⅰ～Ⅱ期（P〈0．05），中低分化癌高于高分化癌（P〈0．05），有淋巴结转移癌高于无淋巴结转移癌（P〈0．05）。而肝外胆管癌组织中C-kit、SCF蛋白表达与其临床病理各因素无明显相关（P〉0．05）。C-kit、SCF蛋白表达与胆管细胞癌病人年龄、性别、肿瘤直径无关。结论 C-kit、SCF蛋白过表达可能在胆管细胞癌的发生、发展中发挥作用。     

Survivin和C-myc在肝门部胆管癌组织中的表达及其相关性研究

目的：探讨Survivin和C-myc在肝门部胆管癌中的表达、临床意义及相互关系。方法：用免疫组织化学SP法检测45例肝门部胆管癌及20例非癌胆管组织中Survivin和C-myc的表达。结果：45例肝门部胆管癌组织中Survivin和C-myc的表达率分别为68.9%（31/45）和62.2%（28/45）,非癌胆管组织中Survivin和C-myc的表达率分别为0和15%（3/20）,差异有统计学意义（P〈0.05）。肝门部胆管癌组织中Survivin的表达与淋巴结转移有关（P〈0.05）,C-myc的表达与肿瘤分化程度和淋巴结转移有关（P〈0.05）,它们的表达与患者的性别、年龄,肿瘤大小及Bismuth分型无关（P〉0.05）。Survivin、C-myc的表达呈正相关关系（P〈0.05）。结论：Survivin、C-myc在肝门部胆管癌中的表达呈正相关关系,共同在肝门部胆管癌的发生、发展、转移中起一定作用,Survivin有望成为肝门部胆管癌治疗的新靶点。     

Survivin在胆管癌中的表达

目的　探讨Survivin基因表达与胆管癌发生发展的关系。方法　应用免疫组织化学技术 (SP法 )检测Survivin基因在 3 3例胆管癌标本、2 8例癌旁胆管组织和 5例胆管良性病变标本中的表达。结果　 3 3例胆管癌组织中Survivin阳性表达率为 72 .7% ( 2 4/3 3 ) ;在癌旁胆管组织和胆管良性病变组织中未检测到Survivin的表达 ,胆管癌组织、癌旁胆管组织、胆管良性病变组织之间的Survivin基因的表达差异有非常显著性 (P <0 .0 1)。Survivin基因的表达与患者的性别、年龄、肿瘤的大小、分化及是否转移无关。结论　Survivin在胆管癌中高度表达可能与胆管癌的发生发展有关 ,与预后的关系有待进一步的探讨。     

Survivin在胆囊癌中的表达及其与p53相关性研究

目的检测胆囊癌中凋亡抑制因子Survivin的表达，研究其与胆囊癌f临床特征的关系，并探讨其与p53的相关性。方法采用免疫组织化学技术检测45例胆囊癌组织、20例胆囊息肉、20例胆囊炎及10例正常胆囊组织中Survivin和p53表达。结果45例胆囊癌组织中40例表达Survivin蛋白，34例表达p53蛋白，表达p53的病例中，31例表达Survivin阳性。而在胆囊息肉、胆囊炎及正常胆囊组织中不表达。且Survivin的表达与胆囊癌病人性别、年龄、肿瘤大小、病理分级、Nevin分期、淋巴结转移无关（P〉0．05），而p53与淋巴结转移密切相关（P〈0．01）。结论Survivin在胆囊癌中的高表达提示其可能与肿瘤的发生有关，Survivin和p53突变对凋亡抑制的协同作用在胆囊癌的发生发展过程中起重要作用。     

联合评估凋亡相关蛋白Survivin和突变型p53在膀胱移行细胞癌中的表达及意义

目的：探讨凋亡相关蛋白Survivin和突变型p53在膀胱移形细胞癌（BTCC）中的表达及其临床意义。方法：应用SP免疫组织化学法检测50例BTCC及10例正常膀胱黏膜组织石蜡切片中Survivin和p53表达的情况,结合临床资料进行分析。结果：Survivin在BTCC的肿瘤标本中的阳性表达率为76％（38／50）,而正常对照组中无一例呈阳性表达;Survivin的表达与BTCC的组织学分级、预后显著相关（二者均P〈0．05）,但与临床病理分期无关（P〉0．05）;p53在13TCC肿瘤标本中的阳性表达率为68％（34／50）,与对照组阳性表达率30％（3／10）相比有统计学意义（P〈0．05）。p53的表达与BTCC组织学分级、临床分期及复发相关（均P％0．05）;相关性分析表明,BTCC肿瘤组织中Survivin的表达与p53表达呈正相关（r=0．317,P〈0．05）。结论：Survivin在BTCC组织中选择性表达,与BTCC的分化程度及复发密切相关;p53蛋白在BTCC中的表达与分级、分期及复发相关,联合评估Survivin和p53蛋白对于判断BTCC预后有重要临床指导意义。     

甲状腺乳头状癌侵袭转移与生存素和p53蛋白表达的关系研究

目的 探讨甲状腺乳头状癌（PTC）中生存素（survivin）和p53蛋白表达及其意义。方法 应用免疫组织化学方法检测46例PTC、20例甲状腺瘤（TA）、20例结节性甲状腺肿（NG）和15．例正常甲状腺组织（NT）中survivin和p53蛋白表达。结果 在PTC中，survivin和p53表达阳性率分别为69．6％（32／46）和65．2％（30／46）。PTC中survivin和p53阳性表达率显著高于TA、NG和NT（P〈0．05）。Survivin和p53表达与PTC的侵袭转移呈显著正相关（P〈0．05）。结论 Sur．vivin和p53阳性表达与PTC侵袭、转移密切相关，检测survivin和p53蛋白的表达可作为判断PTC生物学行为的参考指标。     

肝外胆管癌组织中PTTG和VEGF的表达及相关性研究

目的探讨PTTG和VEGF蛋白在肝外胆管癌中的表达相关性及其与胆管癌发展的关系。方法应用免疫组化技术SABC法检测PTTG和VEGF蛋白在36例胆管癌标本、30例胆管癌旁组织和12例胆管良性病变中的表达。结果胆管癌组织和癌旁组织中PTTG的阳性表达率分别为72．2％（26／36）和63．3％（19／30），VEGF的阳性表达率分别为83．3％（30／36）和76．7％（23／30）；在胆管良性病变组织中均未检测到PTTG和VEGF的表达。上述3种组织之间的PTTG和VEGF蛋白表达差异均有显著性（P〈0．05）。癌组织中PTTG和VEGF蛋白的表达呈正相关（r=0．703，P〈0．001）。PTTG和VEGF蛋白表达与肿瘤转移与否关系密切，但与患者的性别、年龄、肿瘤大小及分化无关。结论PTTG和VEGF在胆管癌中高表达，两者表达呈正相关；与胆管癌的转移与否关系密切。     

信号调节蛋白α1在胆管细胞性肝癌中的表达及生物学意义

目的 观察信号调节蛋白Sirp α1在胆管细胞性肝癌中的表达。方法 选取手术切除胆管癌和癌旁组织24例，10％甲醛固定24h后石蜡包埋切片，采用免疫组织化学方法测定胆管癌和癌旁组织Sirp α1表达。结果 Sirp α1在胆管癌细胞胞浆散在淡黄色表达，癌旁胆管细胞胞浆棕黄色表达，表达差异显著（P〈0．05），其表达程度与胆管癌肿瘤大小、组织分化程度、有无癌栓和子灶和淋巴结转移与否有关，肿瘤越大和分化程度越差，伴有子灶、胆管和门静脉癌栓者，Sirp α1表达越低（P〈0．05），而与血AFP和CA19-9高低无关（P〉0．05）。结论 Sirp α1作为一种负向调控因子参与了胆管细胞性肝癌的发生发展，但关于其详细调控机制尚待进一步研究。     

肝门部胆管癌mdr—1 mRNA的表达及与临床病理指标间的关系

目的：检测肝门部胆管癌新鲜组织中多药耐药基因（mdr-1)mRNA表达,探讨其与肝门部胆管癌和12例正常胆管mdr-1 mRNA进行了检测,并与癌组织的分化程度,病理类型,部位,浸润转移对比研究。结果：26例肝门部胆管癌组织中mdr-1 mRNA阳性表达率为65．4（17／26）,正常胆管,组织表达率为8．3（1／12）,二者差异有显著性（P＜0．01）,mdr-1 mRNA阳性表达与肝门部胆管癌的分化程度,发生部位,病理类型,浸润转移无关（P＞0．05）,结论：肝门部胆囊癌中有mdr-1 mRNA的高表达,mdr-1阳性可做为肝门部胆管癌化疗耐药的指标。     

p27蛋白在肝门部胆管癌的表达及临床意义

目的探讨p27蛋白在肝门部胆管癌的表达及临床意义。方法采用免疫组化方法测定44例肝门部胆管癌及8例正常胆管组织中p27蛋白的表达情况。结果p27表达的阳性率为77．2％，以低表达为主。p27的表达与肿瘤的分化、淋巴转移及神经浸润显著相关（P〈0．05）。p27蛋白高、低及阴性表达组的平均生存时间分别为84个月、72个月与65个月。p27蛋白低表达组与缺失组的生存曲线明显低于高表达组生存曲线。结论肝门部胆管癌中p27的表达是反映肝门部胆管癌生物学行为和判断预后的重要指标。     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.