Fascin蛋白在非小细胞肺癌组织中的表达及临床意义

目的分析Fascin蛋白在人非小细胞肺癌(NSCLC)组织中的表达及与患者临床病理特征的关系。方法选取73例NSCLC手术后组织标本(NSCLC组)及30例癌旁组织标本,采用免疫组化法对两种组织标本进行染色和半定量检测,分析Fascin蛋白在NSCLC组织中的表达及与患者临床病理特征的关系。结果 NSCLC组织中,Fascin蛋白16例强(+),17例(+),18例弱(+),22例(-),阳性率为69.9%;癌旁组26例(-),4例弱(+),阳性率13.3%;NSCLC组织中Fascin蛋白的阳性率显著高于癌旁组织,差异显著(P0.05)。NSCLC组织中的Fascin蛋白阳性表达与患者的年龄、性别、吸烟史、肿瘤最大径、组织学类型无关(P0.05);与患者的TNM分期、淋巴结转移、组织学分化程度具有显著的关系(P0.05)。结论 NSCLC组织中Fascin蛋白高表达,并且与NSCLC的分期、分化及淋巴结转移有关。     

GRB2和Ki-67蛋白表达水平变化与结直肠癌发病相关性分析及其意义

目的探讨生长因子受体结合蛋白2(GRB2)、仅存在于增生细胞中的核蛋白(Ki-67)在结直肠癌患者中的变化及其临床意义。方法选取确诊的结直肠癌患者组织标本100例(病灶组)、癌旁组织标本50例(癌旁组),健康对象50例(对照组)进行回顾性研究,收集时间2015年2月至2017年7月。检测病灶组和癌旁组标本中的GRB2与癌症患者与健康对象血清中Ki-67蛋白水平,并分析其与临床病理学特征的关系及在临床治疗中的意义。结果结直肠癌组织中胞浆GRB2的表达显著高于癌旁组织(P0.05),而结肠癌组织、癌旁组织中胞核GRB2中的表达水平差异无统计学意义(P0.05);胞浆GRB2的表达情况与清扫淋巴结个数有关(P0.05);病灶组Ki-67蛋白阳性表达率是82%,高于对照组阳性率,有淋巴结转移者比无淋巴结转移的阳性表达率明显增高(P0.05)。结论 GRB2、Ki-67蛋白在结直肠癌组织中高表达,并且与肿瘤的发生发展关系密切。     

肝癌组织中血管内皮生长因子的表达水平及影响因素分析

目的探讨肝癌组织血管内皮生长因子(VEGF)表达水平及其影响因素。方法 80例原发性肝癌组织标本,40例癌旁组织标本,均采用免疫组化法测定组织VEGF表达情况,分析VEGF与肝癌临床病理参数的关系。结果肝癌组织VEGF表达阳性率高于癌旁组织,且中度阳性、强阳性率比例高于癌旁组织,弱阳性比例低于癌旁组织(P0.05);不同分化程度、不同TNM分期、不同肝功能分级、是否合并淋巴结转移患者VEGF阳性率比较差异均有统计学意义(P0.05);肝癌组织VEGF表达情况与肿瘤分化程度呈负相关,与TNM分期、肝功能分级、淋巴结转移呈正相关(P0.05)。结论肝癌癌组织VEGF呈高表达,且受肿瘤分化程度、TNM分期、淋巴结转移及肝功能分级的影响。     

uH2B在原发性结肠腺癌中的表达及其与临床病理参数的关系

目的探讨原发性结肠腺癌组织中组蛋白H2B单素泛化(uH2B)的表达水平及与患者临床病理参数的关系。方法选取2013年1月—2016年1月本院胃肠外科手术切除的83例结肠腺癌组织标本、癌旁组织,既往收集的20例正常结肠组织,采用免疫组化染色观察各组组织标本中uH2B蛋白的表达程度,并分析与原发性结肠腺癌患者临床病理参数的关系。结果结肠癌组织标本中uH2B蛋白的阳性表达率46.99%,低于癌旁组织的83.13%、正常结肠黏膜组织的90.00%,差异均具有统计学意义(P0.05);癌旁组织和正常结肠黏膜组织中uH2B蛋白的阳性表达率差异无统计学意义(P0.05);结肠癌组织标本中uH2B蛋白的阳性表达率与肿瘤的TNM分期、分化程度、淋巴结转移相关(P0.05),与患者的年龄、性别、肿瘤浸润深度、肿瘤最大径的关系不显著(P0.05)。结论结肠癌组织标本中uH2B蛋白表达率降低,并且与患者的肿瘤的TNM分期、分化程度、淋巴结转移具有相关性。     

结肠癌组织中PUMA和C-myb表达及其临床病理意义

目的研究结肠癌及其癌旁组织中PUMA和C-myb表达水平及其临床病理意义。方法 54例结肠癌和30例癌旁组织手术切除标本常规制作石蜡包埋切片,PUMA和C-myb染色方法为免疫组化法。结果结肠癌PUMA和C-myb表达阳性率及其评分明显高于癌旁组织（P〈0.01）。PUMA和（或）C-myb表达阳性的癌旁组织呈中至重度不典型增生。无淋巴结转移、未侵犯浆膜层及临床分期A＋B的病例PUMA和C-myb表达阳性率明显低于低分化、淋巴结转移和侵犯浆膜层及临床分期C＋D的病例（P〈0.05或P〈0.01）;高分化腺癌PUMA表达阳性率及其评分明显低于中分化或低分化腺癌（P〈0.05）;结肠癌中PUMA和C-myb表达水平呈正相关（r=0.59,P=0.000）。结论 PUMA和C-myb表达与结肠腺癌发生、临床生物学行为有密切关系。     

Ezrin、IGF1R蛋白表达情况与原发性胆囊癌的相关性研究

目的探讨原发性胆囊癌组织中埃兹蛋白(Ezrin)、胰岛素样生长因子受体1(IGF1R)蛋白的表达情况及其与胆囊癌病理学特征的关系。方法回顾性选取湖北理工学院附属医院病理科收集的80例胆囊癌组织标本、40例癌旁组织标本,收治时间2013年1月至2016年7月。应用免疫组织化学染色法检测两组标本中的Ezrin、IGF1R蛋白表达情况,并探讨二者与患者的年龄、性别、肿瘤分化程度、Nevin分期、肝脏侵犯等指标的关系。结果胆囊癌组织中的Ezrin蛋白阳性表达率53. 75%,IGF1R蛋白阳性表达率为51. 25%均显著高于胆囊癌癌旁组织中的5. 00%、10. 00%,差异均具有统计学意义(P 0. 05)。低分化、Ⅲ期和Ⅳ期、发生肝脏侵犯、发生淋巴结转移的胆囊癌患者的Ezrin蛋白阳性表达率显著高于高分化和中分化、Ⅰ期和Ⅱ期、未发生肝脏侵犯、未发生淋巴结转移的胆囊癌患者(P 0. 05)。低分化、Ⅲ期和Ⅳ期、发生淋巴结转移的胆囊癌患者的IGF1R蛋白阳性表达率显著的高于高分化和中分化、Ⅰ期和Ⅱ期、未发生淋巴结转移的胆囊癌患者(P 0. 05)。结论胆囊癌组织总Ezrin、IGF1R蛋白呈显著高表达,并且Ezrin、IGF1R蛋白表达与胆囊癌的病理学特征存在一定的相关性。     

Bcl-2、Bax蛋白在皮肤鳞状细胞癌组织中的表达水平变化及与病理学特征的关系

目的研究Bcl-2、Bax蛋白在鳞状细胞癌组织中的表达水平变化及与病理学特征的关系。方法选取我院2015年1月-2017年10月确诊的鳞状细胞癌组织标本120例为病灶组、癌旁组织标本60例为对照组,检测病灶组和癌旁组标本中的Bcl-2、Bax蛋白表达水平并分析各蛋白表达与患者临床病理参数、预后情况的关系。结果 Bcl-2蛋白在鳞状细胞癌组织中的表达水平明显高于对照组(P0.05);Bax在鳞状细胞癌组织中的表达水平明显低于对照组(P0.05);Bcl-2蛋白的表达与患者肿瘤的组织学分化程度、临床病理学分期、肿瘤的浸润深度及淋巴结转移情况有关(P0.05);Bax蛋白的表达与肿瘤的组织学分化程度有关(P0.05)。结论 Bcl-2蛋白在鳞状细胞癌组织中的表达水平升高,Bax在鳞状细胞癌组织中表达降低,并且与鳞状细胞癌的病理学特征有一定的相关性。     

甲状腺癌患者CXCR4和Ki-67表达及其与预后的相关性

目的探讨甲状腺癌患者趋化因子受体4(CXCR4)和增殖细胞核抗原Ki-67表达及其与预后的相关性。方法收集该院甲状腺癌组织标本82例(甲状腺癌组)、甲状腺癌旁组织标本82例(癌旁组织组)及甲状腺良性病变标本82例(对照组),采用免疫组化染色法检测各组标本中CXCR4、Ki-67的阳性表达情况,并分析甲状腺癌组织CXCR4、Ki-67表达与临床病理特征及预后的关系。结果甲状腺癌组CXCR4、Ki-67蛋白的阳性表达率显著高于癌旁组织组、对照组(P0.05)。甲状腺癌组织中CXCR4阳性率与病理分期、淋巴结转移有关(P0.05);Ki-67阳性率与病理分期、淋巴结转移、包膜侵犯有关(P0.05)。甲状腺癌患者的中位疾病进展时间(TTP)为37.92个月(95%CI:27.89～43.31),CXCR4、Ki-67阳性者的TTP显著高于阴性表达者(P0.05)。结论甲状腺癌患者CXCR4、Ki-67呈高表达状态,且表达水平与其临床病理特征相关,共同影响患者术后复发转移。     

Ezrin及其相关蛋白在乳腺癌组织中的表达及临床意义

目的:研究乳腺癌组织中Ezrin、CD44v6及E-cadherin蛋白的表达及其临床病理意义。方法:应用免疫组化SP法,检测56例乳腺癌组织、30例癌旁正常乳腺组织组织标本中Ezrin、CD44v6、E-cadherin的表达情况。结果:(1)乳腺癌组织中Ezrin、CD44v6和E-cadherin的表达率分别为62.50%、76.79%和26.79%,与正常乳腺组织相比差异有统计学意义(P0.05)。(2)Ezrin、CD44v6的表达与乳腺癌的原发肿瘤大小、组织学分级、临床TNM分期和淋巴结转移有关(P0.05);E-cadherin的下调表达与乳腺癌的组织学分级、临床TNM分期和淋巴结转移有关(P0.05)。(3)在浸润性导管癌中Ezrin与CD44v6表达水平呈显著正相关(P0.05),而与E-cadherin表达水平呈显著负相关(P0.05)。结论:联合检测Ezrin、CD44v6和E-cadherin的表达有助于预测乳腺癌的恶性程度和转移潜能。     

Shh在散发性甲状腺髓样癌中的表达及其临床意义研究

目的 通过检测Sonic Hedgehog信号通路关键分子Shh在散发性甲状腺髓样癌表达情况,探讨其与散发性甲状腺髓样癌临床病理特征的关系及临床意义.方法 应用免疫组织化学方法检测11例甲状腺髓样癌患者癌组织及其癌旁组织病理蜡块标本中Shh的表达情况,分析其与临床病理特征的关系.结果 Shh蛋白主要表达于细胞膜与细胞质中.甲状腺髓样癌组织中Shh阳性表达率72.7％ (8/11)明显高于癌旁组织的9.1％(1/11).癌组织中Shh的表达与患者性别及年龄均无关(P＞0.05),而与肿瘤的TNM分期有关(P＜0.05).Shh在肿瘤直径≥1 cm和直径＜1 cm的表达阳性率分别为100％和20％,差异有统计学意义(P＜0.01).Shh在有淋巴结转移的肿瘤组织中和无淋巴结转移的肿瘤组织中的表达阳性率分别为100％和40％,差异有统计学意义(P＜0.05).结论 Shh信号通路的主要配体Shh蛋白在散发性甲状腺髓样癌中表达升高,并与肿瘤发生、分期及淋巴结转移有关,提示Shh信号通路的异常激活在散发性甲状腺髓样癌中发挥一定的作用,Shh蛋白为散发性甲状腺髓样癌预后判断指标及潜在的治疗靶点.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.