血管内皮生长因子、转化生长因子β与大肠癌血管生成及转移的关系

目的探讨血管内皮生长因子 (VEGF)、转化生长因子 β(TGFβ)与大肠癌血管生成及淋巴结转移的关系。方法应用免疫组织化学技术 ,检测 48例大肠癌组织VEGF、TGFβ1、TGFβ2 蛋白表达和微血管密度 (MVD) ,分析VEGF、TGFβ1、TGFβ2 与大肠癌MVD及临床病理的关系。结果大肠癌VEGF、TGFβ1、TGFβ2 蛋白表达阳性者 ,其MVD值均显著高于阴性者 ;VEGF、TGFβ1及MVD与其淋巴结转移密切相关 ,与患者年龄、性别及大肠癌的组织学分型、分化程度、浸润深度无关。结论VEGF、TGFβ1、TGFβ2 与大肠癌的血管生成密切相关 ,对其淋巴结转移有促进作用 ;VEGF、TGFβ1和MVD可作为反映大肠癌生物学行为的指标     

膀胱移行细胞癌组织中微血管密度与其生物学行为及预后的关系

目的:通过检测膀胱移行细胞癌组织中微血管密度(MVD),探讨肿瘤新生血管形成与膀胱移行细胞癌发生、发展及预后的关系。方法:应用免疫组织化学技术检测61例膀胱移行细胞癌组织及23例癌旁组织中第Ⅷ因子相关抗原表达,并计数MVD。结果:膀胱癌组织中的MVD明显高于正常膀胱组织,并与膀胱移行细胞癌的分级、分期密切相关(P<0.01.F=25.61,29.72)。肿瘤复发组MVD显著高于无复发组(P<0.01,t=3.20)。膀胱移行细胞癌组织高MVD病例的生存率明显低于低MVD的病例(P<0.05,χ2=26.65)。结论:MVD与膀胱移行细胞癌的发生、发展以及预后密切相关,可作为独立的膀胱移行细胞癌的预后判断指标。     

血管内皮生长因子-C在乳腺癌中表达及临床意义

目的探讨乳腺癌组织中血管内皮生长因子 C(VEGF C)蛋白表达和乳腺癌临床病理特征的关系。方法应用免疫组化ABC法对 6 5例乳腺癌组织中VEGF C蛋白表达进行检测。结果VEGF C只在乳腺癌细胞中表达 ,而在邻近的正常乳腺组织及间质细胞中不表达。VEGF C标记定位于肿瘤细胞浆 ,呈棕褐色颗粒。 6 5例乳腺癌中有 31例VEGF C呈阳性表达 (4 7.8% ) ,VEGF C的阳性率与淋巴结转移有密切关系 (P <0 .0 1)。结论VEGF C在乳腺癌中表达 ,并在肿瘤的淋巴结转移中起一定的作用 ,可作为临床判断肿瘤病人预后的参考指标     

VEGF、TSP-1在膀胱移行细胞癌中的表达

目的：研究血管内皮生长因子（VEGF）与血小板反应蛋白（TSP-1）在膀胱移行细胞癌中的表达及其与膀胱癌血管生成的关系。方法：应用免疫组织化学技术检测48例原发性膀胱移行细胞癌和10例正常膀胱组织中VEGF和TSP-1的表达，测定肿瘤组织的微血管密度（MVD），分析VEGF、TSP-1和MVD三者之间关系及它们与膀胱癌病理分级和临床分期之间的关系。结果：VEGF、TSP-1和MVD肿瘤的临床分级和临床分期密切相关。膀胱癌中，VEGF表达高的，MVD值也高；而TSP-1表达强的，MVD值低（P〈0．05）。中度或高度表达VEGF而TSP-1阴性的肿瘤，MVD均值较高；VEGF低表达而TSP-1阳性的肿瘤，MVD均值较低。中度表达VEGF的膀胱癌中，TSP-1低者，MVD值较高；TSP-1表达强者，MVD值较低（P〈0．05）。VEGF、TSP-1表达与术后复发有关（P〈0．05）。结论；VEGF、TSP-1表达与膀胱移行细胞癌的发生发展有关，是膀胱癌血管形成的重要原因。膀胱癌组织中VEGF、TSP-1的测定可作为判断预后的有用指标。从多方面着手抗血管生成治疗膀胱癌也可能更加有效。     

膀胱移行细胞癌组织中微血管密度与其生物学行为及预后的关系

目的：通过检测膀胱移行细胞癌组织中微血管密度(MVD)，探讨肿瘤新生血管形成与膀胱移行细胞癌发生、发展及预后的关系。方法：应用免疫组织化学技术检测61例膀胱移行细胞癌组织及23例癌旁组织中第Ⅷ因子相关抗原表达，并计数MVD。结果：膀胱癌组织中的MVD明显高于正常膀胱组织，并与膀胱移行细胞癌的分级、分期密切相关(P&;lt;0．01．F=25．6l，29．72)。肿瘤复发组MVD显著高于无复发组(P&;lt;0．01,t=3．20)。膀胱移行细胞癌组织高：MVD病例的生存率明显低于低：MVD的病例(P&;lt;0．05，x^2=26．65)。结论：MVD与膀胱移行细胞癌的发生、发展以及预后密切相关，可作为独立的膀胱移行细胞癌的预后判断指标。     

VEGF与膀胱尿路上皮癌微血管密度及预后的相关性研究

目的探讨血管内皮生长因子（vascular endothelial growth factor,VEGF）表达与膀胱尿路上皮癌微血管密度（microvessel density,MVD）及预后的关系。方法采用免疫组化的方法对50例原发性膀胱尿路上皮癌组织中VEGF进行染色,记数肿瘤内MVD,并观察VEGF的表达同MVD的关系。结果膀胱尿路上皮癌VEGF阳性表达率为62％（31／50）,在正常膀胱黏膜组织中未见表达。VEGF阳性表达组MVD显著高于阴性表达组（P〈0．05）。VEGF表达与肿瘤的分级分期明显相关（P〈0．05）,提示VEGF阳性表达者的预后较阴性者差。结论VEGF的异常表达是膀胱癌微血管形成能力增高的重要因素。VEGF表达与膀胱癌MVD增加及恶性进程和不良预后有关,是判断膀胱癌预后有价值的指标。     

慢性肝病、肝癌组织中TS,hTERT的表达及其临床意义

目的研究慢性肝病和肝癌组织中胸腺嘧啶合酶 (TS)、人端粒酶反转录酶 (hTERT)表达及其临床病理意义。方法正常肝组织、慢性肝病和肝癌组织标本经 1 0 %中性福尔马林固定后常规制作石蜡包埋切片 ,TS和hTERT染色方法均为常规ABC免疫组化法。结果肝癌病例TS和hTERT阳性率均明显高于正常肝组织、慢性迁延性肝炎、慢性活动性肝炎和肝硬化 ,除肝硬化外均有显著或高度显著差异 (P <0 .0 5或P <0 .0 1 ) ;高分化、淋巴结未转移和肿块最大径≤ 5cm的肝癌其TS ,hTERT阳性率均较明显低于中低分化、淋巴结转移和肿块最大径 >5cm肝癌 ,但两者阳性率与肝癌病理类型及血清HBsAg、AFP状态无明显关系。结论TS或hTERT表达可能是反映肝癌发生发展、生物学行为及预后的重要标记物 ;检测慢性肝病组织中TS ,hTERT表达可能对预防和早期发现肝癌有较重要临床意义     

膀胱癌发生、生物学行为及其预后:环氧合酶-2的表达与微血管密度的关系

目的:探讨环氧合酶-2表达与膀胱移行上皮细胞癌bladdertransition-(alcellcarcinoma,BTCC)发生及生物学行为和患者预后的关系。方法:采用免疫组织化学SP法,检测96例BTCC和10例正常膀胱黏膜组织环氧合酶-2表达及膀胱癌组织中微血管密度(microvasculardensity,MVD)。结果:膀胱癌组织环氧合酶-2阳性表达率为46.9%,而正常膀胱黏膜组织则无环氧合酶-2表达,环氧合酶-2的阳性表达率随着BTCC分期分级递增而递增。膀胱癌组织中环氧合酶-2阳性表达组的MVD明显高于环氧合酶-2阴性表达组78±20vs33±15,t=12.56,P(<0.01)。结论:膀胱癌组织中存在环氧合酶-2的表达,环氧合酶-2可促进肿瘤血管形成从而进一步促进肿瘤的生长,抑制环氧合酶-2表达有可能成为治疗BTCC的一个有利于患者预后的新途径。     

膀胱癌发生、生物学行为及其预后：环氧合酶-2的表达与微血管密度的关系

目的：探讨环氧合酶-2表达与膀胱移行上皮细胞癌(bladder transitional cell carcinoma，BTCC)发生及生物学行为和患者预后的关系。方法：采用免疫组织化学SP法，检测96例BTCC和10例正常膀胱黏膜组织环氧合酶-2表达及膀胱癌组织中微血管密度(micmvascular density，MVD)。结果：膀胱癌组织环氧合酶-2阳性表达率为46．9％，而正常膀胱黏膜组织则无环氧合酶-2表达，环氧合酶-2的阳性表达率随着BTCC分期分级递增而递增。膀胱癌组织中环氧合酶-2阳性表达组的MVD明显高于环氧合酶-2阴性表达组(784&;#177;20 vs 33&;#177;15，t=12．56，P&;lt;0．01)。结论：膀胱癌组织中存在环氧合酶-2的表达，环氧合酶-2可促进肿瘤血管形成从而进一步促进肿瘤的生长，抑制环氧合酶-2表达有可能成为治疗BTCC的一个有利于患者预后的新途径。     

膀胱移行细胞癌环氧化酶-2表达与血管生成的相关性研究

目的探讨环氧化酶-2（COX-2）及微血管密度（MVD）与膀胱移行细胞癌生物学行为的关系及其临床意义。方法采用免疫组化S-P法对103例膀胱移行细胞癌、21例慢性膀胱炎、13例正常膀胱组织标本中COX-2进行检测，同时对上述标本中微血管进行计数。结果膀胱移行细胞癌组织COX-2阳性表达率70．9％，慢性膀胱炎及正常膀胱组织COX-2表达均为阴性。低分化、侵润性、有淋巴转移以及复发癌组织中COX-2阳性表达率显著高于对照组（P〈0．05）。膀胱移行细胞癌组织中MVD与COX-2表达呈正相关（P〈0．05），但COX-2表达及MVD与肿瘤的数量、大小无关（P〉0．05）。结论COX-2表达在膀胱移行细胞癌的发生、发展、转移及复发过程中起重要作用。膀胱移行细胞癌COX-2表达与肿瘤间质微血管的形成密切相关。     

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.