RASSF1A基因在膀胱移行细胞癌中的表达及其临床意义

目的:探讨RASSF1A基因在膀胱移行细胞癌中的表达及其与膀胱移行细胞癌的发生发展复发的关系.方法:采用逆转录-聚合酶链反应(RT-PCR)检测29例膀胱移行细胞癌组织及5例正常膀胱组织中RASSF1A mRNA的表达水平.结果:①RASSF1A mRNA在所有正常膀胱组织中均呈阳性表达,而在膀胱移行细胞癌组织中表达缺失率为79.3%(23/29),两者比较差异有统计学意义(P＜0.01).②RASSF1A mRNA表达缺失与膀胱移行细胞癌的分级无显著相关性(P＞0.05).RASSF1A mRNA表达在浸润性膀胱中表达缺失率为90%(9/10)明显高于在表浅性膀胱移行细胞癌中的表达缺失率73.7%(14/19),但两者比较差异有无统计学意义(P＞0.05).③RASSF1A mRNA表达与膀胱移行细胞癌复发密切相关(P＜0.05).结论:①RASSF1A mRNA在膀胱移行细胞癌中表达缺失提示RASSF1A基因可能参与膀胱移行细胞癌的发生过程.②RASSF1AmRNA表达缺失可能与膀胱移行细胞癌进展相关.③RASSF1A mRNA的表达缺失与膀胱移行细胞癌的复发密切相关,可以作为复发预后标志物.     

MCM5和PCNA在膀胱移行细胞癌中的表达及临床意义

目的：研究微型染色体维持蛋A5（MCM5）和增殖细胞核抗原（PCNA）在膀胱移行细胞癌中的表达及临床意义。方法：采用免疫组化S—P法检测56例膀胱移行细胞癌和10例正常膀胱黏膜中MCM5及PCNA的表达，分析它们的相关性及与膀胱移行细胞癌分化、分期和预后的关系。结果：①MCM5和PCNA在膀胱移行细胞癌与正常组织中皆有表达，两者在膀胱移行细胞癌组的表达明显高于正常组（P〈0．01）。②MCM5和PCNA的表达均与膀胱移行细胞癌的组织分级、临床分期、术后复发有关（P〈0．05）。③MCM5表达和PCNA表达呈正相关（相关系数r=0．854，P〈0．05）。结论：MCM5蛋白是膀胱移行细胞癌的一种可靠标志物，MCM5的表达可以预示膀胱移行细胞癌的恶性程度高低和复发倾向，并有助于临床判断患者的预后以及选择合适的治疗方法。     

凋亡相关蛋白Survivin及Caspase-3在膀胱移行细胞癌中表达及临床意义

目的：探讨凋亡相关蛋白Survivin及Caspase-3在膀胱移形细胞癌表达及其临床意义。方法：应用SP免疫组织化学法检测45例膀胱移行细胞癌及10例正常膀胱黏膜组织石蜡切片中Survivin和Caspase-3表达的情况,结合临床资料进行分析。结果：Survivin在膀胱移形细胞癌标本中的表达阳性率为68．9%（31/15）．而正常对照组中无一例呈阳性表达;Caspase-3在膀胱移行细胞癌标本中的表达阳性率为37．8%（17/45）．与对照组阳性率90％（9／10）相比差异有统计学意义（P〈O．05）。Survivin的表达与膀胱移行细胞癌的组织学分级、初发和复发显著相关（P〈O．05）,但与临床病理分期、肿瘤数日无关;Caspase-3的表达与膀胱移行细胞确的初发复发相关,但与组织学分级、肿瘤数目、临床分期均无关。相关性分析表明,膀胱移行细胞癌中Survivin的表达与Caspase-3表达呈负相关。结论：Survivin在膀胱癌组织中选择性表达与膀胱移行细胞癌的分化程度密切相关．Caspase-3蛋白在膀胱移行细胞癌中表达下降,Survivin及Caspase-3蛋白对于判断膀胱移行细胞确预后有重要临床指导意义。     

葡萄糖转运蛋白-1在膀胱移行细胞癌中的表达及其临床意义

目的:探讨葡萄糖转运蛋白-1(GLUT-1)的表达与膀胱移行细胞癌生物学行为的关系。方法:应用免疫组化方法对50例膀胱移行细胞癌以及正常膀胱组织中的GLUT-1进行检测,并用计算机图像分析系统对膀胱移行细胞癌中GLUT-1的表达水平进行定量分析。结果:正常膀胱组织中GLUT-1不表达,50例膀胱移行细胞癌中有38例GLUT-1阳性表达(76%),高分级组GLUT-1平均光密度明显高于低分级组(P<0.01),T4期GLUT-1平均光密度明显高于Ta-1期及T2期(P<0.01,P<0.05),复发组GLUT-1平均光密度高于初发组(P<0.05)。结论:膀胱移行细胞癌中GLUT-1的表达与肿瘤的发展密切相关,并预示着一种侵袭性的生物学行为,GLUT-1可作为了解膀胱移行细胞癌生物学行为的参考指标。     

膀胱移行细胞癌Mta-1基因与蛋白表达及其临床意义

目的:检测膀胱移行细胞癌(BTCC)中Mta-1mRNA与蛋白表达,分析其与BTCC临床分期、病理分级、转移及复发的关系。方法:原位杂交、免疫组化方法检测42例BTCC组织Mta-1mRNA与蛋白的表达;CD34标记血管内皮细胞,计数肿瘤组织微血管密度(MVD);结合临床病理资料,分析Mta-1与BTCC的侵袭转移、血管生成及复发间的关系。结果:①Mta-1mRNA与蛋白在BTCC中高度表达,其表达阳性率分别为78.6%、73.8%,与正常组织比较差异有统计学意义(P<0.01),且随BTCC临床分期及病理分级的升高而增加,肿瘤复发组高于无复发组,肿瘤转移组高于无转移组(P<0.05)。②经非参数相关分析发现,Mta-1蛋白与Mta-1mR-NA表达呈高度正相关,Rs为0.945,P=0.000;CD34标染的微血管密度(MVD)与Mta-1mRNA与蛋白表达亦呈正相关,相关系数分别为0.712、0.683,P=0.000。结论:①Mta-1在膀胱移行细胞癌中高度表达,并随着肿瘤临床分期和病理分级的升高而增加,与肿瘤的转移及复发密切相关。②Mta-1参与膀胱移行细胞癌的侵袭、转移,可能与促进血管生成有关。     

膀胱移行细胞癌中凋亡相关蛋白survivin及caspase3的表达及相关性

目的探讨凋亡相关蛋白survivin及caspase3的表达与膀胱移行细胞癌发生及发展的关系。方法应用SP免疫组织化学法检测69例膀胱移行细胞癌石蜡切片,应用免疫印迹法（Western blotting）检测33例膀胱移行细胞癌新鲜组织中survivin和caspase3表达的情况,结合临床资料进行分析。结果免疫组化结果显示,survivin在膀胱移行细胞癌标本中的表达阳性率为88．4％（61／69）,而正常对照组均呈阴性;caspase3在膀胱移行细胞癌标本中的表达阳性率为59．4％（41／69）,但是与对照组相比无明显差异。Western blotting结果显示,93．9％（31／33）的肿瘤组织可见survivin蛋白表达,而对照组全部阴性表达;81．8％（27／33）的肿瘤标本可见caspase3蛋白表达,对照组中阳性表达率为80％（8／10）,实验组与对照组间无明显差异。在Ⅲ级膀胱移行细胞癌中survivin的表达强度较Ⅰ级为高,二者之间差异有显著性（P〈0．05）。survivin和caspase3的表达与肿瘤的临床分期无关（P〉0．05）,而且survivin的表达与easpase3的表达之间也没有相关性。结论survivin蛋白在膀胱移行细胞癌中特异性表达,其表达的上调可能提示肿瘤分化不良。Caspase3蛋白的表达情况与膀胱移行细胞癌关系不密切。     

错配修复基因hMLH1在膀胱移行细胞癌中的表达及其意义

目的 观察错配修复基因hMLH1在膀胱移行细胞癌中的表达,探讨hMLH1与膀胱移行细胞癌的关系.方法 通过免疫组织化学方法 测定hMLH1在80例膀胱移行细胞癌中及20例正常膀胱组织中的表达.结果 hMLH1在膀胱移行细胞癌中的低表达率(32.5%)明显高于在正常膀胱组织中的低表达率(0%),差异有统计学意义(P＜0.05),且hMLH1在膀胱移行细胞癌中的低表达与肿瘤的分期分级有关(P＜0.05).结论 hMLH1的低表达与膀胱移行细胞癌的发生有关,与肿瘤的高分期和高分级有关,hMLH1的低表达在浸润性及分化差的膀胱移行细胞癌多见.     

uPA、uPAR和PTEN在膀胱移行细胞癌中的表达及其与肿瘤侵袭和转移的关系

目的研究膀胱移行细胞癌uPA、uPAR及抑癌基因PTEN蛋白的表达及其与肿瘤侵袭、转移的关系。方法应用免疫组织化学SP法检测60例膀胱移行细胞癌组织uPA、uPAR和PTEN蛋白的表达。结果uPA、uPAR和PTEN阳性表达率分别为50.00%、50.00%和41.67%。uPA和uPAR的高表达与膀胱移行细胞癌的分化程度、浸润和转移关系密切(P<0.05);PTEN蛋白的低表达与膀胱移行细胞癌的分化程度、浸润和转移密切相关(P<0.05);膀胱癌中uPA和uP-AR与PTEN蛋白表达呈负相关(r=-0.481,P<0.05)。结论uPA和uPAR的高表达可能作为膀胱移行细胞癌侵袭、转移的指征之一,PTEN可能作为膀胱移行细胞癌预后不良的指标;uPA和uPAR对肿瘤细胞侵袭转移的作用可能在一定程度上受到PTEN的调控。     

膀胱移行细胞癌组织中p16、p53和PCNA的表达及其意义

目的:探讨p16、p53蛋白及PCNA在膀胱移行细胞癌的表达及其与病理分级和临床分期关系.方法:采用免疫组化SABC法并结合图像分析方法检测40例膀胱移行细胞癌中p16、p53蛋白及PCNA的表达.结果:3种蛋白在膀胱肿瘤中的表达与正常膀胱组织均有显著差异.p16与病理分级及临床分期呈负相关,p53、PCNA与病理分级呈正相关.结论:p16与p53可作为膀胱移行细胞癌分化程度和预后判断的参考指标,而PC-NA可作为预后判断辅助指标.     

缺氧诱导因子-1α和葡萄糖转运蛋白-1在膀胱移行细胞癌中的表达及其意义

目的:探讨缺氧诱导因子-1α(HIF-1α)和葡萄糖转运蛋白-1(GLUT-1)在膀胱移行细胞癌中的表达及与膀胱移行细胞癌生物学行为的关系.方法:应用免疫组化方法对50例膀胱移行细胞癌及正常膀胱组织中HIF-1α和GIUT-1的表达进行检测,并用计算机图象分析系统对其表达水平进行定量分析.结果:正常膀胱组织中HIF-1α和GLUT-1均不表达,50例膀胱移行细胞癌中,HIF-1α和GLUT-1的阳性表达率分别为52%和76%.HIF-1α的表达水平与膀胱移行细胞癌的分级和复发密切相关(P＜0.05),但与分期无关;GLUT-1的表达水平与膀胱移行细胞癌的分级、分期和复发均密切相关(P＜0.05).HI-1α和GIUT-1在膀胱移行细胞癌中的表达水平亦呈正相关(r=0.381,P=0.029).结论:膀胱移行细胞癌中HIF-1α和GLUT-1的表达与肿瘤的恶性进展密切相关.联合检测HIF-1α和GLUT-1可作为了解膀胱移行细胞癌生物学行为的参考指标,并有可能为膀胱移行细胞癌的基因治疗提供新的靶点和新的思路.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.