病理性瘢痕中p53和cyclin D1的mRNA表达的实验研究

目的　探讨病理性瘢痕中p5 3、cyclinD1的表达及在瘢痕疙瘩与增生性瘢痕中表达的区别,以进一步了解瘢痕疙瘩与增生性瘢痕的形成及发展的机理。方法　手术切取病理性瘢痕标本作为实验组,以普通瘢痕作为对照组,运用RT -PCR方法测定病理性瘢痕中p5 3和cyclinD1的mRNA表达情况。结果　病理性瘢痕中p5 3和cyclinD1的mRNA表达与对照组比较差异有显著意义(P <0 .0 5 ) ;而瘢痕疙瘩中p5 3的mRNA表达明显高于增生性瘢痕,两者比较差异有显著意义(P <0 .0 5 )。结论　病理性瘢痕中p5 3和cyclinD1的异常表达,在病理性瘢痕的形成及发展中起重要作用。     

病理性瘢痕中VEGF与突变型P53基因表达的关系

目的 研究病理性瘢痕中血管内皮生长因子(VEGF)与突变型抑癌基因P53的表达情况及其相互关系,探讨它们在病理性瘢痕形成中的作用及机制.方法 应用免疫组化SP法检测正常皮肤、成熟瘢痕、增生性瘢痕和瘢痕疙瘩组织中VEGF和突变型P53基因的表达及其相关性.结果 病理性瘢痕组织中VEGF的表达增高,与正常皮肤、成熟瘢痕对照组比较,差异有统计学意义(P＜0.005).增生性瘢痕与瘢痕疙瘩之间VEGF蛋白的表达,差异无统计学意义(P＞0.05).病理性瘢痕组织中突变型P53的表达增高,与正常皮肤、成熟瘢痕对照组比较差异有统计学意义(P＜0.005).增生性瘢痕与瘢痕疙瘩之间突变型P53蛋白的表达,差异无统计学意义(P＞0.05).VEGF与突变型P53蛋白表达,存在明显正相关(P＜0.01).结论 VEGF与突变型P53在病理性瘢痕组织中均表达增高,与病理性瘢痕的形成密切相关,可能对病理性瘢痕的形成起着重要作用,两者之间存在正相关.     

性激素受体在瘢痕中的表达及与细胞周期调控蛋白相互关系的研究

目的　了解雄激素受体 (AR)、雌激素受体 (ER)在病理性瘢痕中的表达及其与细胞周期调节蛋白D1(cyclinD1)、p16之间的相互关系 ,以探讨他们在瘢痕形成过程中的作用及机制。方法　采用免疫组化方法 (SP法 )对 30例瘢痕标本进行研究 ,以正常皮肤组织为对照 ,观察上述指标的表达。结果　正常皮肤及普通瘢痕成纤维细胞中所有指标均为阴性 ;增生性瘢痕与瘢痕疙瘩成纤维细胞中cyclinD1、p16、AR与正常皮肤相比差异均有显著性意义 (P <0 0 5 ) ;瘢痕疙瘩成纤维细胞cyclinD1和AR的表达高于增生性瘢痕 ,且有显著性意义 (P <0 0 5 ) ;p16在瘢痕疙瘩成纤维细胞的表达比增生性瘢痕为高 ,但两者之间差异无显著性意义。在病理性瘢痕中cyclinD1和AR的表达具有明显的相关性。结论　AR在病理性瘢痕的发生及发展中起一定的作用 ,它可能是通过与其配体结合后促使与cyclinD1有关的基因表达而发挥作用的。在瘢痕疙瘩里可能存在cyclinD1的促细胞增生作用超过P16细胞抑制 ,所以细胞呈现持续增殖状态 ;而在增生性瘢痕里cyclinD1与p16可能处于相对的平衡状态 ,细胞生长具有一定的自限性。     

内质网分子伴侣GRP94、GRP78和XBP1在病理性瘢痕中的表达初探

目的：检测内质网应激反应的关键分子葡萄糖调节蛋白94（GRP94）、葡萄糖调节蛋白78（GRP78）和X-盒结合蛋白1（XBP1）mRNA在病理性瘢痕的表达,探讨其基因表达及内质网应激反应与病理性瘢痕形成及转归的关系。方法：用RT-PCR法检测GRP94、GRP78和XBP1mRNA在：①瘢痕疙瘩（13例）、增生性瘢痕（17例）和正常皮肤（15例）组织以及体外培养的瘢痕疙瘩（5例）、增生性瘢痕（5例）和正常皮肤（6例）成纤维细胞中的表达;②体外培养瘢痕疙瘩和增生性瘢痕成纤维细胞（各5例）中经0.1mg/ml氢化可的松作用前后的表达。结果：①GRP94、GRP78和XBP1mRNA在瘢痕疙瘩、增生性瘢痕和正常皮肤组织及其成纤维细胞中的表达均无显著性差异（P〉0.05）;②0.1mg/ml氢化可的松作用后,GRP94mRNA在瘢痕疙瘩和增生性瘢痕来源的成纤维细胞中的表达量均显著下降,具有统计学意义（P〈0.01）;而GRP78和XBP1mRNA在瘢痕疙瘩和增生性瘢痕来源的成纤维细胞中的表达量改变均无显著性差异（P〉0.05）。结论：内质网分子伴侣GRP94、GRP78和XBP1在瘢痕疙瘩和增生性瘢痕组织及其成纤维细胞中基因转录与正常皮肤组织及其成纤维细胞中基因转录水平一致;GRP94mRNA的表达量显著下降可能是糖皮质激素治疗病理性瘢痕的机制之一。     

5-FU对增生性瘢痕中cyclinD_1、cdk4及p53基因表达的影响

目的探讨5-FU对增生性瘢痕组织的成纤维细胞中细胞周期蛋白因子(cyclinD1)、细胞周期蛋白依赖性激酶(cdk4)及抑癌基因(p53)的mRNA表达的影响,以阐明5-FU对病理性瘢痕的作用机制。方法组织块法培养增生性瘢痕组织及正常皮肤组织的成纤维细胞。用不同浓度的5-FU作用于体外培养的人病理性瘢痕成纤维细胞,检测MTT值;利用半定量RT-PCR分析用药前后cyclinD1、cdk4、p53的mRNA表达的变化。结果5-FU在体外能明显抑制人增生性瘢痕组织中成纤维细胞的增殖及cyclinD1、cdk4的mRNA表达;对p53的mRNA表达无影响。结论5-FU抑制病理性瘢痕成纤维细胞的机制与其抑制cyclinD1、cdk4的表达有关,而与p53表达无关。     

5-FU对增生性瘢痕中cyclinD1、cdk4及p53基因表达的影响

目的探讨5-Fu对增生性瘢痕组织的成纤维细胞中细胞周期蛋白因子（cyclinD1）、细胞周期蛋白依赖性激酶（cdk4）及抑癌基因（p53）的mRNA表达的影响，以阐明5-Fu对病理性瘢痕的作用机制。方法组织块法培养增生性瘢痕组织及正常皮肤组织的成纤维细胞。用不同浓度的5-Fu作用于体外培养的人病理性瘢痕成纤维细胞，检测MTT值；利用半定量RT—PCR分析用药前后cyclinD1、cdk4、p53的mRNA表达的变化。结果5-Fu在体外能明显抑制人增生性瘢痕组织中成纤维细胞的增殖及cyclinD1、cdk4的mRNA表达；对p53的mRNA表达无影响。结论5-Fu抑制病理性瘢痕成纤维细胞的机制与其抑制cyclinD1、cdk4的表达有关，而与p53表达无关。     

瘢痕疙瘩成纤维细胞p16、cyclinD1、CDK4、Rb的表达差异及其意义探讨

目的 探讨瘢痕疙瘩成纤维细胞中p16、cydinD1、CDK4、Rb等细胞周期调控元件的表达及其与瘢痕发生、发展的关系.方法 分别以正常皮肤和浅表性瘢痕为对照,采用RT-PCR和免疫组化方法,检测培养的成纤维细胞中p16、cyclinD1、CDK4、Rb的mRNA和蛋白表达情况及其之间的相互关系.结果 瘢痕疙瘩成纤维细胞中p16、cyclinD1、CDK4、Rb的mRNA存在过表达,与对照组比较,差异均有统计学意义(P<0.05);在蛋白表达水平上,p16、cyclinD1、CDK4、Rb阳性表达率分别为15.23%、82.43%、76.34%、45.74%,与其在对照组中的表达差异均有统计学意义(P<0.05).结论 瘢痕疙瘩中p16、cyclinD1、CDK4、Rb存在异常表达.p16与cyclinD1处于失衡状态,导致细胞的持续高增殖,在瘢痕疙瘩的发生、发展中起重要的作用.     

瘢痕成纤维细胞凋亡及p5 3基因的表达

目的探讨瘢痕成纤维细胞凋亡及p53基因表达及其意义.方法取正常皮肤和增生性瘢痕各8例、瘢痕疙瘩9例行成纤维细胞培养,应用流式细胞仪检测成纤维细胞凋亡,用p53cDNA探针对抽提的DNA点迹印迹杂交观察p53基因表达情况.结果 3组成纤维细胞凋亡细胞分别为(10.8±1.2)%,(10.6±1.8)%,(5.5±0.8)%,瘢痕疙瘩较正常皮肤和增生性瘢痕成纤维细胞凋亡少,差异具有显著性意义(P＜0.05),且p53基因有明显的表达.结论瘢痕疙瘩成纤维细胞是具有肿瘤性质的一类细胞.     

IL-18在病理性瘢痕中的表达及其生物学意义

目的:比较IL-18在正常皮肤和病理性瘢痕组织中的表达及分布情况,探讨IL-18在病理性瘢痕的形成过程中所起的生物学作用及意义。方法:收集2006年12月到2007年6月广东医学院附属医院整形外科手术切除的正常皮肤10例,增生性瘢痕组织12例,瘢痕疙瘩12例,应用免疫组织化学技术及荧光定量RT-PCR分别检测IL-18蛋白及IL-18 mRNA在它们中的表达水平及分布情况。结果:IL-18在正常皮肤、增生性瘢痕及瘢痕疙瘩中均有表达,IL-18mRNA和IL-18蛋白在瘢痕疙瘩组和增生性瘢痕组之间无明显差异(P0.05),但两者均低于正常皮肤组(P0.05)。结论:IL-18可能是病理性瘢痕组织的形成促进因素之一。     

P57kip2和Maspin在病理性瘢痕组织中的表达

目的 研究P57kip2和Maspin在病理性瘢痕组织中的表达情况及相互关系,探讨它们在病理性瘢痕形成中的作用及机制.方法 应用免疫组化SP法结合计算机病理图像分析和逆转录聚合酶链反应( RT-PCR)检测正常皮肤、成熟瘢痕、增生性瘢痕和瘢痕疙瘩组织中P57kip2和Maspin的表达并对其表达进行统计学分析.结果 病理性瘢痕组织中P57kip2蛋白的表达定位于成纤维细胞的细胞核内,且P57kip2蛋白及mRNA的表达减少,与正常皮肤、成熟瘢痕对照组比较差异有统计学意义(P＜0.05).病理性瘢痕组织中Maspin蛋白的表达定位于成纤维细胞的细胞质和细胞核内,且Maspin蛋白及mRNA的表达减少,与正常皮肤、成熟瘢痕对照组比较差异有统计学意义(P＜0.05).P57kip2与Maspin蛋白表达存在明显正相关(P＜0.O1).结论P57kip2与Maspin在病理性瘢痕组织中均表达减少,是病理性瘢痕相关基因,两者存在明显正相关,是病理性瘢痕的形成机制之一.P57kip2和Maspin可能通过成纤维细胞在病理性瘢痕的形成过程中发挥着重要作用.     

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.