联合检测尿膀胱癌抗原和survivin诊断膀胱癌的临床应用

目的 临床评价联合检测尿液中尿膀胱癌抗原(urinary bladder cancer antigen,UBC)和survivin基因诊断膀胱癌的临床应用价值.方法 对64例膀胱癌患者、20例泌尿系其他良性疾病患者,在膀胱镜检查之前留尿将尿样分为3份,分别进行UBC、survivin和脱落细胞检测,分析比较三种方法诊断膀胱癌的临床应用价值.结果 UBC和survivin诊断膀胱癌的敏感度分别为85.9%(55/64)和93.8%(60/64),与脱落细胞学(40.6% )比较,差异有统计学意义(P＜0.01〉,三种方法诊断膀胱癌的特异度分别为85.0%(17/20)、95%(19/20) 和95%(19/20).各分级和分期UBC和survivin诊断膀胱癌的敏感度均高于尿脱落细胞学检查;UBC值和survivin检测的敏感度在各分级和分期中差异无统计学意义(P＞0.05);而尿脱落细胞学检查,肿瘤的分级越高,其敏感度越高(P＜0.01),各分期之间差异无统计学意义(P＞0.05).联合运用UBC和survivin,敏感度和特异度均达到100%.结论 尿液中的UBC和survivin是早期诊断膀胱癌较好的肿瘤标志物,联合检测能提高诊断的敏感度和特异度.     

survivin在膀胱移行细胞癌中的表达及意义

目的 探讨凋亡抑制基因survivin在膀胱移行细胞癌中的表达及意义.方法 膀胱移行细胞癌组87例,20例正常正常膀胱黏膜作为对照,采用免疫组织化学方法检测survivin蛋白表达,然后分析survivin蛋白在膀胱癌组织中的表达情况,以及随着不同临床分期和病理分级表达的变化.结果 所有膀胱 癌患者平均年龄56.1岁,其中男性患者48例.免疫组织化学分析表明,survivin蛋白表达在细胞的细胞核.膀胱癌组织中survivin表达明显高于正常对照组.随着临床分期的进展,survivin表达上升.结论 survivin 在膀胱移行细胞癌的生物学行为中起重要作用,survivin与膀胱移行细胞癌的恶性进展有关.     

尿生存素检测在膀胱癌诊断中的价值探讨

目的:探讨尿生存素(survivin)检测在膀胱肿瘤诊断中的价值。方法:收集膀胱癌患者47例,泌尿系统非尿路上皮肿瘤22例,泌尿系非肿瘤患者9例,健康志愿者8例的尿液。ELISA法检测尿中survivin浓度,并用半定量RT-PCR和Western-blot方法验证其检测结果的准确性。结果:以1ng/ml为限,膀胱癌组尿survivin测定结果和其他各组相比阳性率明显增高,χ2检验结果显示差异有统计学意义(P<0.05)。半定量RT-PCR和Western-blot结果证明检测结果的准确性较高。结论:尿survivin浓度的ELISA方法检测可能是一种敏感性高、特异性强、无创、简便的膀胱癌群体筛查和术后随访的检查方法。     

survivin基因在膀胱癌中的表达及其临床意义

目的:探讨survivin基因在膀胱癌组织中的表达情况及其临床意义。方法:采用RT-PCR方法检测膀胱癌和正常膀胱黏膜中survivin基因的表达情况,分析其表达与膀胱癌的分期、分级及复发的关系。结果:sur-vivin mRNA在膀胱癌中总阳性表达率为78.6%(33/42)。在浸润性膀胱癌中阳性表达率(95.7%)较浅表性膀胱癌中阳性表达率(57.9%)明显升高;在复发性膀胱癌中,survivin mRNA阳性表达率(95.0%)较初发膀胱癌的阳性表达率(63.6%)显著升高(P<0.05);survivin mRNA在正常膀胱黏膜中均无表达。结论:作为敏感性较强的生物瘤标,survivin基因 mRNA表达可用来预测膀胱癌的复发和浸润。     

survivin基因与肿瘤研究进展

目的 了解survivin基因在肿瘤研究中的作用。方法 采用文献回顾的方法，对survivin的分子结构。功能，作用机理，组织分布及其在肿瘤治疗中的作用进行综述。结果 survivin作为凋亡抑制蛋白（inhibitor of apoptosis protein,IAP）家族的新成员，独立于bcl-2，表达于几乎所有常见的人类恶性肿瘤组织，其表达与多种肿瘤患者预后不良密切相关。survivin通过直接抑制凋亡信号传导途径中最下游的效应分子caspase-3的活性而发挥其抑凋亡作用。抑制survivin的表达。以阻断其抑凋亡作用。可以达到治疗肿瘤的目的。结论 survivin广泛表达于多种人类恶性肿瘤组织，可作为预后不良的重要指标。并可作为抗肿瘤治疗中重要的新靶点。     

原肌球蛋白及其在膀胱癌中的表达

原肌球蛋白（tropomyosin，TM）是肌肉收缩过程中重要的调节蛋白质，其同源异构体在分布上具有组织特异性。TM有望成为一种新的肿瘤标记物。本文对TM的结构及其在膀胱癌中的表达研究进展作一综述。     

survivin和环氧化酶-2在膀胱移行细胞癌组织中的表达及其相关性

目的 探讨膀胱移行细胞癌组织中凋亡抑制蛋白survivin和环氧化酶-2（cox-2）的表达与肿瘤生物学行为之间的关系及其二者的相关性。方法应用免疫组化Envision法，检测42例膀胱移行细胞癌组织标本和10例非肿瘤正常膀胱组织（正常对照组）中survivin和cox-2的表达。结杲42例膀胱移行细胞癌组织中survivin和COX-2表达的阳性率分别为78．6％和81．0％，正常对照组中均未见表达；survivin表达强度与肿瘤分期及复发呈正相关关系（P〈O．05），而与肿瘤分级无关（P〉O．05）；cox-2表达强度与肿瘤分级和分期呈正相关关系（P〈0．05），而与肿瘤复发无关（P〉0．05）；survivin和cox-2在膀胱移行细胞癌中的表达密切相关（rs=0．327，P〈0．05）。二者的表达与患者的性别、年龄、术时肿瘤的大小、数目及部位无关（P〉0．05）。结论Survivin和cox-2在膀胱移行细胞癌组织中普遍表达，且表达密切相关，二者可能在膀胱癌的发生、发展过程中起重要作用，并与浸润关系密切。     

缺氧启动子-1а在膀胱癌中的表达及其意义

目的 检测膀胱癌组织中缺氧启动子(HIF)-1а的表达,探讨HIF-1а在膀胱癌中表达的临床意义.方法 应用免疫组织化学方法检测80例膀胱癌组织中HIF-1а的蛋白表达,并分析其表达与肿瘤I临床特征及复发的关系.结果 30例正常膀胱组织未发现HIF-1а阳性表达,80例膀胱癌组织中有43例HIF-1а表达阳性,阳性表达率占53.75%.其表达与肿瘤的大小、部位、数目、病理分级以及患者年龄无关,但与肿瘤的临床分期及复发明显相关.结论 在膀胱癌中,HIF-1а的表达均明显上调,HIF-1а在膀胱癌的侵袭等生物学过程中具有重要的作用.     

β-catenin在膀胱癌中的研究进展

β-catenin作为连接蛋白家族的一员,在肿瘤的发生及转移中起到重要的作用.本文探讨WNT信号转导系统中的β-catenin在恶性肿瘤尤其是膀胱癌发生中的作用及β-catenin通过和E-cadherin的相互联系在恶性肿瘤尤其是膀胱癌中肿瘤转移中的作用.     

DAPK基因CpG岛的异常甲基化在人膀胱癌组织中的意义

目的 探讨DAPK基因CpG岛的异常甲基化在膀胱癌组织中的意义.方法 选择临床膀胱癌组织标本24例和癌旁组织标本22例进行研究.用免疫组织化学和Western blot方法分别检测DAPK基因和DNMTl基因在不同组织中的表达情况.采用甲基化特异PCR(MSP)方法检测不同组织标本中DAPK基因的甲基化状态.结合上述结果分析DAPK基因甲基化及其表达状态与肿瘤之间的关系.结果 DAPK基因表达于细胞质及胞膜,在正常膀胱黏膜中强表达,在膀胱癌组织中弱表达或不表达.在膀胱癌组织中有14例(14/24,58.3%)检测到DAPK基因的甲基化改变,而正常组织中未检测到其甲基化.甲基化改变与肿瘤病理分级无显著相关性,但是与肿瘤肌层浸润(P＜0.05)及复发(P＜.05)明显相关.结论 DAPK基因的甲基化改变可能是肿瘤复发的一个重要预测指标.肿瘤组织中DNMTl的高表达提示其在调节肿瘤组织抑癌基因甲基化中发挥重要作用.     

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.     

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.     

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.