p27kip1及相关分子skp2在人肝癌组织中的表达变化

目的探讨细胞周期素依赖性激酶抑制蛋白27（p27^kip1）和细胞S相激酶相关蛋白2（skp2）表达与人肝癌发生的关系。方法用免疫组织化学SP法检测62例肝癌组织中p27^kip1、skp2蛋白的表达，并与22例癌旁正常肝组织作对比。结果p27^kip1蛋白阳性表达率在肝癌中为46．77％，而癌旁肝组织中为95．45％（P〈0．01）。skp2蛋白阳性表达率在肝癌中为32．26％，而癌旁正常肝组织中为13．64％（P〈0．05）。p27^kip1、skp2蛋白在肝癌中的表达呈负相关（P〈0．01）。结论p27^kip1、skp2蛋白检测有助于肝癌的临床诊断及判断预后。     

结直肠癌中抑癌基因ING1的表达研究

目的 探讨抑癌基因ING1及其蛋白p33／ING1在结直肠癌中的表达。方法 用RT-PCR检测35例散发性结直肠癌中ING1 mRNA的表达水平，并应用S-P法检测60例散发性结直肠癌及正常黏膜组织中p33／ING1蛋白的表达。结果 结直肠癌组织、正常黏膜组织中p33／ING1蛋白阳性表达率分别为43．3％（26／60）、100％（60／60），两者比较差异有统计学意义（P＜0．01）。p33／ING1在无淋巴结转移组及淋巴结转移组中的阳性表达率分别为57．6％（19／33）、25．9％（7／27），两者比较差异有统计学意义（P〈0．05）。在Dukes A、B期和Dukes C、D期患者癌组织中p33／ING1的阳性表达率分别为56．7％（17／30）、30．0％（9／30），两者比较差异有统计学意义（P＜0．05）。结论 ING1及p33／ING1蛋白的低表达与散发性结直肠癌发生、发展密切相关，临床分期越差者表达水平越低。     

原发性肝癌PTEN和p27表达的相关研究

目的：研究PTEN和p27两种抑癌基因在原发性肝癌中的表达和两者间的关系。方法：应用免疫组化方法，对43例原发性肝癌患者、21例份肝硬化患者和16例正常对照的正常肝脏组织进行PTEN和p27的免疫组化研究。结果：原发性肝癌组PTEN的阳性表达率为41．9％（18／43），比肝硬化组和正常对照组明显下降：原发性肝癌组p27的阳性表达率为86．0％，比肝硬化组和正常对照组显著升高。PTEN的表达与肿瘤数目、分化高低、有无血管侵犯有关；p27的表达与原发性肝癌的大小、肿瘤数目、分化高低、有无血管侵犯有关。PTEN蛋白和p27蛋白在原发性肝癌中无相关关系。结论：PTEN作为抑癌基顺在原发性肝癌中发挥作用，p27有其组织特异性，PTEN和p27表达在原发性肝癌中无相关性。     

PTEN和p27及cyclin D1蛋白在大肠癌组织中的表达及相关性研究

目的：研究大肠癌组织中PTEN、p27和cyclinD1蛋白的表达及三者间的关系。方法：应用免疫组铡匕学方法检测58例大肠癌组织、58例癌旁组织和14例正常大肠黏膜中PTEN、p27和cyclinD1蛋白的表达情况。结果：大肠癌组织中PTEN和p27蛋白的阳性表达率分别为65．52％（38／58）和53．45％（31／58），较癌旁组织和正常组织明显刚氏（P〈0．05）；cyclinD1蛋白的阳性表达率为60．34％（35／58）,较癌旁组织及正常组织显著升高（P〈0．05）。三者在大肠癌组织中的表达存在相关性，且均与肿瘤的分化程度、有无淋巴结转移和Dukes分期有关（P〈0．05）。结论：PTEN、p27和cyclinD1基因的异常改变参与大，且三者之间存在相关性。联合检测三者表达水平可作为评价大肠癌病理生物学行为的客观指标之一。     

大肠癌中脆性组氨酸三联体基因和Survivin基因的表达及临床意义

目的检测脆性组氨酸三联体（FHIT）基因和Survivin基因在大肠癌、正常大肠黏膜上皮组织中的表达，探讨FHIT基因和Survivin基因与大肠癌．发生发展及转移的关系，探讨其与大肠癌临床病理特征的关系。方法利用免疫组织化学法对56例大肠癌和33例正常大肠黏膜组织检测FHIT、Survivin基因的表达。结果FHIT蛋白在33例癌旁正常大肠黏膜上皮和56例发癌中的阳性表达率分别为93．9％、48．2％，原发癌中FHIT蛋白的阳性表达率明显低于癌症正常大的黏膜上皮（P〈0，01）。Survivin在56例大肠癌的表达率为48．2％，显著高于33例癌症正常大肠黏膜上皮（P〈0．01）。结论FHIT基因表达的下调与Survivin基因表达的上调可能促进了大肠癌的发生。这样临床上通过检测FHIT、Survivin的基因的表达率对患者的预后有重要的指导意义。     

RASSF1A基因在肝癌组织中的表达及其临床意义

目的观察人肝癌组织RASSF1A的表达情况。方法应用半定量反转录聚合酶联反应技术检测62例人中晚期肝癌及其癌旁正常组织中RASSF1A的表达情况。结果69．4％（43/62）的肝癌组织中RASSF1A表达缺失，而癌旁组织中仅30．6％（19／62）该基因表达缺失，两者差异有统计学意义（P〈0．05）。结论中晚期肝癌中RASSF1A表达处于失活状态，其可作为一种有潜在应用价值的生物分子指标来用于肝癌的早期发现、早期诊断以及预后的判断。     

P33ING1b在膀胱移行细胞癌中的表达及其意义

目的探讨抑癌基因p33ING1b在膀胱移行细胞癌中的表达及其与突变型P53蛋白表达的相关性。方法应用免疫组织化学链霉卵白素-过氧化物酶复合物（SP）方法,检测64例膀胱移行细胞癌组织标本中P33^ING1b、突变型P53蛋白的表达,并与15例正常膀胱黏膜组织进行对照研究。结果64例膀胱移行细胞癌组织中,P33^ING1b蛋白的阳性表达率为64.06%,而正常膀胱黏膜组织中P33^ING1b蛋白阳性表达率为93.33%。P33^ING1b蛋白的表达与膀胱移行细胞癌的WHO肿瘤分级有相关性。根据Spearman相关分析表明P33^ING1b蛋白表达与P53蛋白表达正相关（P〈0.05）。结论P33^ING1b在膀胱移行细胞癌中的表达下降,可能在膀胱移行细胞癌的发生、发展过程中起重要作用,p33ING1b与p53基因具有协同作用,同时检测P33^ING1b与P53的表达水平,将有助于膀胱移行细胞癌的诊断与治疗。     

E2F-1蛋白在胃癌中的表达及意义

目的探讨E2F-1蛋白在胃癌及正常胃黏膜组织中的表达与意义。方法采用免疫组化技术对80例原发性胃癌癌组织与癌旁黏膜中E2F-1的表达进行检测，同时对40例正常胃黏膜组织进行对照性研究，并进行统计学分析。结果E2F-1在癌组织与癌旁黏膜中的阳性表达率为72．5％（58／80）和30．0％（24／80），在正常胃黏膜组织中的阳性表达率为22．5％（9／40），差异有非常显著性（P〈0．001）。癌组织、癌旁黏膜中E2F-1的表达在不同的临床病理特征之间差异无显著性（P〉0．05）。结论E2F-1蛋白在胃癌组织中超表达，E2F-1的反常表达与胃癌的发生有关。     

Twist基因在肝细胞肝癌中的表达及意义

目的探讨转录因子Twist在人肝细胞肝癌、癌旁和肝硬化组织中的表达及其意义。方法利用免疫组化方法检测26例肝细胞肝癌标本（癌和癌旁组织）和10例肝硬化标本中Twist的表达情况;利用逆转录聚合酶链反应（RT—PCR）和Western蛋白印迹方法检测其中10例标本中的Twist mRNA和其蛋白的表达情况,分析其临床病理意义。结果免疫组化显示：Twist蛋白在肝癌、癌旁和肝硬化组织中的阳性率分别为84．6％、19．2％和20．0％,Twist在肝癌组织中的表达明显强于癌旁或肝硬化组织（P〈0．05）;大多数癌旁和肝硬化组织无Twist表达,癌旁与肝硬化组织相比阳性率无差别（P〈0．05）。与癌旁组织相比,Twist mRNA和其蛋白在肝癌组织中表达明显上调（P〈0．05）。结论Twist在肝细胞肝癌组织中的过高表达与肝癌的发生发展相关。     

骨肉瘤中Survivin蛋白表达及其与P-糖蛋白、bcl-2蛋白表达的相关性

目的探讨Survivin蛋白在骨肉瘤中的表达及其与P-糖蛋白、bcl-2蛋白表达的相关性。方法采用免疫组化S—P法检测凋亡抑制基因Survivin在骨肉瘤、骨软骨瘤和正常骨组织中的表达及P-糖蛋白、bcl-2蛋白在骨肉瘤中的表达。结果Survivin蛋白在骨肉瘤中的阳性表达率为63．15％,在骨软骨瘤和正常骨组织中未见表达;Survivin阳性表达与患者的年龄、性别及肿瘤部位无关,与Enneking分期及WHO组织学分型有相关性;P-糖蛋白和bcl-2蛋白在骨肉瘤中的阳性表达率分别为47．36％和55．26％。在骨肉瘤中．Survivin的表达与P-糖蛋白、bcl-2蛋白表达密切相关。结论①Survivin在骨肉瘤中呈高表达,与临床耐药密切相关．有望成为骨肉瘤靶向治疗的一个新靶点。②Survivin与bcl-2蛋白表达密切相关．二者协同发挥抗凋亡效应。     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.