血管内皮生长因子的表达和微血管密度与结直肠癌侵袭转移的关系

目的:探讨血管内皮生长因子(VEGF)的表达和微血管密度(MVD)在结直肠癌侵袭和转移过程中的作用及其相互关系.方法:采用免疫组织化学方法检测61例结直肠癌组织中VEGF表达,用CD34染色标记血管内皮细胞,对癌组织中MVD进行计数.结果:结直肠癌组织中VEGF阳性表达率为49.2%,MVD为28.7±12.9.在肿瘤坏死区周围或肿瘤浸润边缘VEGF表达较强,MVD较密集.VEGF表达及MVD与肿瘤浸润深度、淋巴结转移、肝转移及Dukes分期密切相关(P＜0.01),而与肿瘤大小、组织病理学类型无关(P＞0.05).高血管密度组(MVD＞29)淋巴结转移、肿瘤浸润浆膜和肝转移的发生率显著高于低血管密度组(MVD≤29).VEGF阳性表达组MVD显著高于阴性表达组(P＜0.01).结论:VEGF表达和MVD与结直肠癌侵袭和转移有关,可作为反映结直肠癌生物学行为的指标.     

肾细胞癌血管内皮生长因子及微血管密度的免疫组化研究

目的　探讨血管内皮生长因子（VEGF）和微血管生成与肾癌发展的关系。　方法　应用免疫组化技术检测46例肿瘤组织中的VEGF。　结果　46例肿瘤组织中VEGF阳性表达28例 (60.8%)、微血管密度（MVD）为63.64±33.20,均显著高于正常组织。VEGF、MVD与肿瘤的组织类型无关（P＞0.05),与肿瘤的组织学分级有关（P＜0.05);VEGF阳性组MVD明显高于阴性组(P＜0.05);有淋巴结转移组VEGF、MVD均高于无淋巴结转移组(P＜0.05);VEGF阳性组术后5年复发转移率明显高于阴性组（P＜0.01)。　结论　VEGF与肾癌的血管生成有关,VEGF和MVD可作为反映肾细胞癌生物学行为的指标之一。     

血管内皮生长因子对骨肉瘤的血管生成及转移预后的影响

目的 :研究血管内皮生长因子 (VEGF)对骨肉瘤血管生成、生长、转移及预后的影响。方法 :对 69例骨肉瘤患者的临床病理资料进行回顾性研究 ,应用CD3 4、VEGF单克隆抗体对其组织切片分别进行免疫组化染色 ,应用地高辛标记的VEGF探针对 2 7例原发性骨肉瘤进行原位杂交染色。分析研究了VEGF表达与CD3 4染色阳性的血管密度的关系 ,所有上述临床病理资料及染色结果与患者预后情况进行统计学分析。结果 :在 3 9例 (5 6.5 % )VEGF表达阳性的标本中 ,CD3 4染色阳性的肿瘤微血管密度 (MVD)明显较 3 0例VEGF表达阴性的血管密度高 (P <0 .0 5 )。多元回归分析显示 ,血管密度 (MVD)增高及VEGF表达阳性与骨肉瘤患者的远隔转移发生、不良预后密切相关 (P <0 .0 5 )。临床病理资料中 ,外科手术边界微小病灶阳性情况、Enneking外科分期、肿瘤大小和患者年龄与患者预后相关 (P <0 .0 5 )。患者性别、手术方法分类以及病理亚型与预后无相关性。结论 :VEGF在骨肉瘤的血管生成和转移中起到重要作用 ,VEGF是骨肉瘤血管生成的决定性刺激因子 ,骨肉瘤微血管密度 (MVD)和骨肉瘤组织中VEGF表达情况是骨肉瘤患者的独立性预后因素。     

卵巢上皮性肿瘤微血管密度及VEGF表达的病理意义

目的：探讨血管生成与卵巢上皮性肿瘤的发展关系。方法：应用免疫组化法研究了卵巢上皮性肿瘤石蜡包埋的病理组织，其中良性腺瘤17例，交界性腺瘤15例，卵巢癌29例。结果：良性腺瘤、交界性腺瘤、卵巢癌MVD值递增，交界性肿瘤及卵巢癌组织中VEGF表达率均明显高于良性肿瘤，有淋巴结转移的VEGF表达率，MVD值较无淋巴结转移者明显增高，但两者与卵巢癌的病理分级及临床分期无关，VEGF阴性组MVD值低于VEGF阳性组。结论；VEGF表达率，MVD值在卵巢上皮性肿瘤的生长及转移中可能起着重要作用。     

肝细胞癌的MSCT征象、病理与血管生成的相关性

目的探讨肝细胞癌（HCC）的MSCT征象、病理与血管生成的关系。方法用免疫组化SP法检测48例经病理证实的HCC患者MVD和血管内皮生长因子（VEGF）的表达,分析HCC的MSCT征象（包括肿瘤直径、包膜、瘤内坏死液化、侵袭转移）、病理分级与MVD、VEGF阳性表达率的关系。结果VEGF阳性表达者的MVD高于VEGF阴性表达者（P〈0．01）。HCCⅠ级的MVD、VEGF阳性表达率低于Ⅲ、Ⅳ级,Ⅱ级低于Ⅳ级（P均〈O．05）。包膜不完整、瘤内有坏死液化及有侵袭转移的HCC的MVD及VEGF阳性表达率分别高于包膜完整、瘤内无坏死液化及无侵袭转移者（P均〈0．05）。结论HCC包膜是否完整、瘤内有无坏死液化、有无侵袭转移等MSCT征象与MVD、VEGF表达密切相关,新生血管在HCC的生长、浸润转移中起着重要作用。     

一氧化氮合酶和血管内皮生长因子在结肠癌的表达及其在肿瘤血管生成中的作用

目的探讨诱导型一氧化氮合酶(iNOS)和血管内皮生长因子(VEGF)在结肠癌中的表达特点及其与临床病理的关系。方法采用免疫组织化学SP法检测结肠腺癌iNOS、VEGF、Ⅳ型胶原及FⅧAg的表达情况。结果45例结肠癌iNOS和VEGF蛋白的阳性率分别为76%和80%。两者呈正相关共同作用于肿瘤间质血管,致微血管密度(MVD)增多。结肠癌iNOS阳性的MVD值为37.0±5.7;阴性的则为30.5±4.9。结肠癌VEGF阳性的MVD值为39.5±8.5;阴性的则为30.7±4.4。VEGF的表达与肿瘤的侵袭、分化程度及淋巴结转移有关,但与患者的年龄、性别和组织分型无关。结论iNOS和VEGF的表达与结肠癌的血管生成和侵袭转移密切相关。     

骶骨脊索瘤中Survivin、VEGF的表达及其与血管生成的相关性研究

[目的]研究骶骨脊索瘤组织中生存素(survivin)、血管内皮生长因子(vascular endothelial growth factor,VEGF)与微血管密度(microvessel density,MVD)的表达情况及三者的相关性,为骶骨脊索瘤的预后判断和靶向治疗提供理论依据.[方法]应用免疫组织化学(SP)法检测30例人骶骨脊索瘤组织和10例癌旁组织中survivin、VEGF的表达,利用CD34标记组织中的新生血管.[结果]①Survivin、VEGF在骶骨脊索瘤中的阳性表达率分别为70.0％、76.7％,均高于瘤旁组织(P＜0.05).骶骨脊索瘤中MVD值(27.2±10.70) /mm2高于瘤旁组织(8.90±3.11) /mm2(P＜0.05);②Survivin阳性表达的骶骨脊索瘤组织中MVD值(30.71±10.35) /mm2明显高于Survivin阴性组(19.00±6.25) /mm2 (P＜0.05).VEGF阳性组MVD值(29.43±10.87) /mm2明显高于VEGF阴性组(19.86±6.18) /mm2(P＜0.05);③Survivin与VEGF的表达呈正相关(r=0.499,P=0.005);④Survivin的表达与患者肿瘤有无局部浸润、是否复发相关(P＜0.05).[结论]骶骨脊索瘤组织中survivin和VEGF表达水平较高,两者的表达呈正相关且与骶骨脊索瘤中的MVD均呈正相关,二者对骶骨脊索瘤的血管生成可能起协同、正向调节作用.     

血管内皮生长因子 C表达和淋巴管生成与结肠癌进展及预后的关系

目的评估血管内皮生长因子 C( VEGF- C)、淋巴管密度( LMVD)与结肠癌临床病理指标及预后的关系.方法用免疫组织化学法检测 44例原发结肠癌 VEGF- C和 VEGF受体- 3( VEGF R- 3)表达,计数 LMVD,分析上述指标与临床病理指标和预后的关系.结果本组结肠癌 VEGF- C阳性表达率为 43.2%( 19/44), LMVD为 10.14± 4.19. VEGF- C表达与肿瘤分化程度( P=0.003)、淋巴结转移( P=0.002)和 Dukes分期( P=0.001)相关. LMVD与淋巴结转移( P=0.001)和 Dukes分期( P=0.001)相关. VEGF- C表达阳性组 LMVD为 11.34± 4.83,高于 VEGF- C表达阴性组的 9.24± 3.48,但 VEGF- C与 LMVD无相关性( P=0.105). VEGF- C阳性组患者生存率明显低于阴性组( P=0.0225), LMVD阳性组患者生存率明显低于阴性组( P=0.0036).远处转移( P=0.0004)、淋巴结转移( P=0.021)和 LMVD( P=0.0469)可以作为结肠癌独立的预后因素.结论 VEGF- C和 LMVD对于判断结肠癌侵袭性和预后有重要参考价值. LMVD可以作为判断结肠癌预后的独立指标.     

胰腺癌微血管密度及血管内皮生长因子表达

目的　探讨胰腺癌组织中微血管密度 (MVD)和血管内皮生长因子 (VEGF)表达及其与淋巴结转移的关系。方法　采用免疫组织化学法及形态半定量方法对 31例胰腺癌和 7例正常胰腺组织进行MVD记数和VEGF表达检测。结果　胰腺癌组织中MVD记数、VEGF表达率分别为 11.0 5± 4.6 2、83% ,明显高于癌旁组织 5 .40± 1.71、2 0 %和正常胰腺组 6 .19± 1.5 6、14% (P <0 .0 1) ;淋巴结转移组MVD记数 ,VEGF表达分别为 13.0 0± 4.45、2 .0 0± 0 .95 ,明显高于无转移组 9.46±4.15、1.0 5± 0 .17和正常胰腺组 6 .19± 1.5 6、0 .14± 0 .38(P <0 .0 1)。MVD与VEGF表达呈正相关 (r =0 .418,P >0 .0 5 )。结论　MVD、VEGF表达高低可作为判断胰腺癌淋巴结转移、预后的指标。     

PTEN和VEGF的表达与膀胱癌血管生成关系的研究

目的研究膀胱癌组织中抑癌基因PTEN和血管内皮生长因子（VEGF）的表达与膀胱癌血管生成的关系。方法应用免疫组织化学S-P法检测62例膀胱癌组织和18例慢性膀胱炎组织（对照组）中PTEN和VEGF的表达，同时分析不同PTEN和VEGF表达状态下，膀胱癌组织微血管密度（MVD）的变化。结果膀胱癌组和对照组PTEN阳性率分别为53．2％（33／62）和100．0％（18／18），2组比较差异有统计学意义（P＜0．01）；膀胱癌组和对照组VEGF阳性率分别为62．9％（39／62）和27．8％（5／18），2组比较差异有统计学意义（P＜0．01）；PTEN和VEGF的表达呈负相关（r=-0．832，P＜0．01）。将膀胱癌分为4组，组A为PTEN阴性VEGF阳性（n=19），组B为PTEN阴性VEGF阴性（n=10），组C为PTEN阳性VEGF阳性（n=20），组D为PTEN阳性VEGF阴性（n=13）。4组平均MVD分别为41．53、31．40、26．55、25．15，组A显著高于其他3组（P＜0．05）。结论膀胱癌PTEN基因失活可能通过增加VEGF的表达来促进血管生成，导致肿瘤恶性进展。     

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.