子宫内膜异位症患者血管内皮生长因子表达及其意义

目的　检测血管内皮生长因子(VEGF)在子宫内膜异位症(EM)中的表达,探讨其在EM发病机制中的作用。方法　应用免疫组化SP法测定35例异位内膜组织和30例正常子宫内膜组织(对照组)中VEGF的表达情况,并用组织学评分对实验结果进行半定量统计,比较其表达强度。结果　VEGF在异位内膜的腺体及间质细胞中均有表达,主要定位于细胞浆。分泌期EM患者VEGF的表达强度明显高于正常对照组,二者有显著性差异(P<0. 05)。结论　异位内膜组织中VEGF的过度表达与异位内膜组织的血管生成密切相关,VEGF在子宫内膜异位症的发生发展中发挥作用。     

关于子宫内膜异位症患者内膜中TLR4、MyD88、NF-κB表达的临床研究

目的通过观察子宫内膜异位症(EMs)患者内膜中TLR4、MyD88、NF-κB的表达,探究发生该疾病的可能机制。方法选取120例EMs患者,其中Ⅰ、Ⅱ期33例,Ⅲ、Ⅳ期87例;取异位内膜120例,在位内膜89例,取同期行宫腔镜手术患者正常内膜组织100例为正常对照组。采用蛋白免疫印迹法(Western blot)测定TLR4、MyD88、NF-κB的表达情况。结果异位内膜组、在位内膜组TLR4、MyD88、NF-κB蛋白表达水平均高于对照组,差异有统计学意义(P0.05),异位内膜组高于在位内膜组(P0.05)。不同分期EMs患者内膜组织中TLR4、MyD88、NF-κB表达水平比较,差异无统计学意义(P0.05)。结论TLR4、MyD88、NF-κB通路可能是EMs发病的重要机制。     

Caspase8和Caspase3与子宫内膜异位症发病机制的相关性研究

目的 探讨子宫内膜细胞凋亡调控和执行蛋白表达异常对卵巢子宫内膜异位症(EMS)发生、发展的作用.方法 应用免疫组化法检测非子宫内膜异位症组、子宫内膜异位症组在位子宫内膜及异位组患者卵巢子宫内膜异位症标本 Caspase-8,Caspase-3的表达.比较三组的表达.结果 Caspase-8、Caspase-3蛋白在子宫内膜异位症组的在位内膜及异位内膜中的表达值均低于非子宫内膜异位症组子宫内膜的表达值(P<0.05),其中异位内膜的蛋白表达值最低(P<0.05).两种蛋白在分泌期的表达值均高于增生期,并随着RAFS临床分期的增高而减小(P<0.05).结论 Caspase-8和Caspase-3异常表达可能与子宫内膜异位症的发生发展密切相关.     

子宫内膜异位症患者异位内膜中生存素的表达

目的:了解生存素在子宫内膜异位症患者异位病灶中的表达情况。方法:采用免疫组化抗生物素蛋白-过氧化物酶染色法(SP法)检测38例2002年12月至2004年9月在妇科住院的未治疗的子宫内膜异位症患者的40个异位内膜标本中生存素的表达及其与CA125的关系。结果:生存素在异位内膜中广泛表达,表达的强度与病灶部位无关,与分期相关(P=0.001),与CA125无明显相关性(P=0.840)。结论:未经治疗的子宫内膜异位症患者的病灶中有生存素的表达,表达强度与期别的高低有关,可能与发病机制相关。     

Bcl-2和Smac在子宫内膜异位症中的表达及相关性研究

目的探讨抗细胞凋亡基因Bcl-2、第二个线粒体来源的胱氨酸蛋白酶激活剂(Smac)在子宫内膜异位症中的表达及二者与子宫内膜异位症临床分期、月经周期的关系及相关性分析。方法选取30例子宫内膜异位症患者的内膜组织标本作为研究组,其中增生期16例,分泌期14例,30例正常内膜组织为对照组。采用免疫组化SP法检测出各组标本中Bcl-2、Smac蛋白的表达,其数据采用SPSS 16.0软件包进行统计学分析,计数资料两组间比较采用χ2检验,两个指标相关性检验采用Spearman等级相关分析,统计数据以P<0.05为具有统计学意义。结果子宫内膜异位症在位内膜与异位内膜组织中Bcl-2的表达强度较对照组显著升高,其差异有统计学意义(P<0.05);Bcl-2在子宫内膜异位症在位内膜组织和正常子宫内膜组织的各期中的表达差异有统计学意义(P<0.05),分泌期的阳性表达显著低于增生期的表达。子宫内膜异位症在位内膜与异位内膜组织中Smac的表达强度均低于正常子宫内膜的表达,差异具有统计学意义(P<0.05)。其在异位内膜的表达强度低于在位内膜的表达,差异有统计学意义(P<0.05);Smac在正常子宫内膜组织中分泌期的表达高于增生期(P<0.05)。Bcl-2、Smac的表达与子宫内膜异位症临床分期均无关(P>0.05)。Bcl-2和Smac的表达呈负相关(P<0.05)。结论 Bcl-2高表达以及Smac低表达,使异位内膜细胞增生及抗凋亡能力加强,导致子宫内膜异位症的发生及发展。     

Chemerin与子宫内膜异位症相关性分析

目的 探讨组织Chemerin及受体表达水平和血清Chemerin表达水平与子宫内膜异位症(Endometriosis,EM)的相关性。方法选择EM患者15例(EM组)和健康女性5例(对照组),采用免疫组织化学法检测在位内膜和异位内膜组织中Chemerin及受体蛋白质表达水平,采用荧光定量PCR法检测在位内膜和异位内膜组织中Chemerin及受体mRNA表达水平,采用酶联免疫法检测血清中Chemerin蛋白浓度。比较EM患者和对照组女性血清Chemerin水平以及在位内膜、异位内膜和正常内膜组织中Chemerin及受体mRNA表达水平。结果 EM患者血清Chemerin水平高于对照组(P<0.05),Pearson相关分析显示血清Chemerin水平与EM患者分期存在正相关性(r=0.638,P<0.05)。EM患者在位内膜和异位内膜组织中Chemerin mRNA相对表达水平均高于对照组内膜,而EM患者异位内膜组织中Chemerin mRNA相对表达水平高于在位内膜组织(P<0.05)。EM患者在位内膜、异位内膜和对照组内膜组织中CMKLR1 mRNA相对表达水平比...     

ERα、ERβ、pS2在子宫内膜异位症组织中的表达及意义

目的：探讨雌激素受体亚型（ERα、ERβ）、雌激素调节蛋白（pS2）在子宫内膜异位症（edometriosis，EM）组织中的表达及其在子宫内膜异位症发生和治疗中的意义。方法：采用免疫组织化学链霉菌抗生物素蛋白-过氧化酶连接法（SP法）检测子宫内膜异位症异位内膜67例、在位内膜53例及正常内膜32例ERα、ERβ、pS2蛋白的表达。结果：（1）ERα、ERβ表达：异位子宫内膜组阳性表达率及表达强度低于正常子宫内膜组和在位子宫内膜组（P〈0．01）；（2）pS2表达：在位子宫内膜组阳性表达率高于异位子宫内膜组及正常子宫内膜组（P〈0．01）；（3）ERα、ERβ、pS2在卵巢巧克力囊肿的表达较紫蓝色结节中增强（P〈0．05）。结论：ERα、ERβ、pS2在子宫内膜异位症组织的表达密切相关其异常表达可能在子宫内膜异位症的发生起着重要作用。     

芳香化酶细胞色素P450在子宫内膜异位症的表达

目的探讨芳香化酶细胞色素P450(以下简称芳香化酶)在子宫内膜异位症(EMs)发病机制中的作用。方法采用免疫组化方法检测36例EMs患者在位及异位子宫内膜组织芳香化酶的表达,并与22例正常子宫内膜进行比较。结果芳香化酶在EMs组异位内膜及在位内膜的表达明显高于对照组(P<0.05),增殖期与分泌期无明显差异(P>0.05),且与修订的美国生育协会标准(rAFS)分期无相关性(P>0.05)。结论芳香化酶在异位内膜及在位内膜的的表达可能在EMs的发病中起重要作用。芳香化酶表达与EMs的严重程度无关。     

子宫内膜异位症中金属蛋白酶9及其特异性组织抑制因子的表达及临床意义

目的:探讨基质金属蛋白酶9(MMP-9)、金属蛋白酶特异性组织抑制因子1(TIMP-1)在子宫内膜异位症患者内膜标本中表达水平的变化及其临床意义。方法:收集子宫内膜异位症患者的异位内膜56例(观察组)和非内异症患者的子宫内膜标本18例(对照组),采用RT-PCR半定量方法检测内膜标本中MMP-9、TIMP-1 mRNA表达率及表达强度。结果:观察组和对照组所有内膜标本均有TIMP-1 mRNA表达;观察组和对照组标本中MMP-9 mRNA的表达率分别为58.9%和50%;观察组异位内膜中MMP-9 mRNA的表达强度高于对照组(P<0.05);TIMP-1 mRNA的表达强度低于对照组(P<0.05);对于MMP-9/TIMP-1比值,观察组明显高于对照组(P<0.01),早期(I-II期)明显高于III、IV期(P<0.01)。结论:子宫内膜异位症患者内膜中TIMP-1 mRNA的表达减弱,降低了对MMP-9的抑制作用;同时子宫内膜异位症患者内膜MMP-9 mRNA的表达增强,加强了其侵袭能力,易于发生种植转移,这些因素可能在子宫内膜异位症的发生发展过程中发挥重要作用。     

子宫内膜异位症中Smad7的表达

目的:探讨Smad7与子宫内膜异位症关系。方法:选择因子宫内膜异位症住院行手术治疗的患者30例为研究对象,分别取其异位内膜(A组)和在位内膜(B组)进行研究,同期因子宫畸形住院手术患者30例为对照组,取其正常子宫内膜(C组)。采用免疫组织化学技术检测三组组织中Smad7的表达情况。结果:A、B组Smad7表达较C组降低,差别有统计学意义(均P<0.05),A、B组差异无统计学意义(P>0.05);三组中增生期和分泌期Smad7表达差异均无统计学意义(均P>0.05)。结论:Smad7在子宫内膜异位症的发生发展中可能起了一定作用。     

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.