Smac和Apollon基因在胃癌中的表达及与细胞凋亡的关系

目的研究Smae、Apollon基因在胃癌组织表达及两者在胃癌发生中的作用关系。方法逆转录．聚合酶链式反应（RT-PcR）检测Smac、Apollon的mRNA在38例胃癌组织，15例癌旁组织和10例正常组织的表达情况。结果38例胃癌标本中表达Smac有20例（52．6％），而除3例癌旁组织外，其他癌旁组织和正常胃组织中均见Smae表达，可见8m8c在胃癌组织中低表达和非胃癌组织中高表达，具有统计学意义（P〈0．05）。Apollon在癌组织、癌旁组织和正常胃组织中分别有29例（76．3％）、4例（26．7％）和0例（0％）表达，Apollon在胃癌组织、癌旁组织和正常组织中Apollon的表达差异具有统计学意义（P〈0．05）。结论Apollon在胃癌组织中高表达，其表达和Smac呈明显的负相关，两者的互相作用可能是导致胃癌发生、发展的重要因素。     

胃癌及癌旁组织中IGF2蛋白表达及其与临床病理特征的关系及意义

【目的】探讨胃癌组织中胰岛素样生长因子2（IGF2）蛋白表达及其与临床病理特征的意义。【方法】选取在本院病理科保存完好的胃癌患者组织标本48例,同时取相应癌旁正常胃黏膜组织48例作为对照,比较胃癌组织和癌旁正常胃黏膜组织 IGF2表达的差异;分析胃癌组织 IGF2表达与年龄、性别、肿瘤大小、分化程度、TNM 分期、淋巴结转移等病理参数的相关性。【结果】胃癌组织中 IGF2阳性表达率为77．09％（37／48）,癌旁正常胃黏膜组织中 IGF2阳性表达率为27．09％（13／48）,胃癌组织中 IGF2蛋白阳性表达率显著高于癌旁正常胃黏膜组织（χ2＝24．042,P ＜0．05）。胃癌组织中 IGF2阳性表达与患者的胃癌细胞分化程度、TNM 分期、淋巴结转移显著相关,差异具有统计学意义（ P ＜0．05）。 IGF2表达阳性的胃癌患者的5年随访中位生存时间为32个月（95CI％＝31．08～32．92）低于 IGF2表达阴性者的54个月（95CI％＝52．49～55．51）,且差异具有统计学意义（log‐rank ＝25．566,P ＜0．001）。【结论】胃癌组织中 IGF2阳性率表达高于正常胃黏膜组织,且与胃癌分化程度、TNM 分期、淋巴结转移显著相关。     

人胃癌组织CCR7和COX-2的表达及意义

【目的】检测胃癌患者癌组织中趋化因子受体7（CCR7）和环氧化酶-2（cox-2）的表达及意义。【方法】检测43例胃癌患者癌组织和35例癌旁正常胃组织中CCR7mRNA和COx-2mRNA的表达情况。【结果】胃癌组织中CCR7mRNA和COX-2mRNA的表达阳性率分别为62．79％和58．14％,相对表达量分别为0．59±0．28和0．66±0．21,均明显高于癌旁正常胃组织阳性率（分别为14．29％和8．57％）和相对表达量（分别为0．13±0．05和0．09土0．01）,两组比较差异均有显著性（P〈0．05）。CCR7mRNA和COX-2mRNA在胃癌组织中的阳性表达率和相对表达量均随癌细胞浸润程度的加深、临床分期的增加及淋巴结转移明显增高（P〈0．05）,但与性别和肿瘤分化程度无明显相关（P〉0．05）。【结论】CCR7和COX-2在胃癌组织中高表达,可能与癌细胞的浸润与淋巴转移有关。     

miR-124在胃癌中的表达及其临床意义

【目的】探讨miR-124（Homo sapiens miR-124）在胃癌组织中的表达及临床意义。【方法】收集胃癌患者手术标本176例（研究组）,以相应癌旁组织作为正常对照（对照组）,制成组织芯片,运用原位杂交检测胃癌及癌旁组织中miR-124的表达,分析其与胃癌临床病理参数之间的关系。【结果】研究组miR-124阳性表达率18．18％显著低于癌旁对照组86．36％,差异有统计学意义（P〈0．01）;miR-124的表达随着胃癌临床分期演进和浸润深度的增加而下调,各组比较差异均有统计学意义（P〈0．01）;miR-124的表达与胃癌的分化程度相关,分化越差其表达越低,各组比较差异均有统计学意义（P〈0．01）;且有淋巴结转移的miR-124的表达显著低于无淋巴结转移组,差异有统计学意义（P〈0．05）。【结论】miR-124的表达下调可能是胃黏膜恶性转变及胃癌发生浸润转移的重要生物学标志。     

胃癌中PTEN、cyclin E蛋白表达及临床意义

目的探讨第10号染色体上磷酸酶和张力蛋白同源缺失的基因（PTEN）及cyclin E蛋白在胃癌及癌旁组织中的表达及其临床意义。方法选择70例胃癌及相应距癌组织5cm外的正常胃黏膜组织，采用免疫组织En Vision两步法检测癌及癌旁组织中PTEN、cyclinE蛋白的表达情况。结果PTEN及cyclin E在胃癌组织中阳性率，与癌旁组织组比较，差异均有统计学意义（X^2分别=32．46、4．83，P均〈0．05）；PTEN及cyclin E在高分化、中分化、低分化腺癌比较，差异均有统计学意义（X^2分别=20．59、5．47，P均〈0．05）；PTEN、Cyclin E在胃癌TNM分期中Ⅰ-Ⅱ期的阳性率与Ⅲ-Ⅳ期的阳性率比较，差异有统计学意义（X^2分别=6．57、4．02，P均〈0．05）：同样在淋巴结有转移的胃癌组织中阳性率与无淋巴结转移的胃癌组织中阳性率比较，差异也均有统计学意义（X^2分别=7．46、5．16，P均〈0．05）。结论PTEN及cyclin E蛋白表达与胃癌的发生、发展及生物学行为有关。     

结直肠癌组织cripto基因mRNA水平及临床意义

目的检测cripto基因mRNA在结直肠癌及其癌旁组织中mRNA表达情况，并探讨其在结直肠癌发生发展中的意义。方法提取36例人大肠癌及癌旁正常组织中总mRNA，采用实时荧光定量PCR法检测其中cripto mRNA表达情况；并分析其表达与患者淋巴结转移、肿瘤分化程度和Dukes’s分期相关性。结果cripto mRNA表达在大肠癌组织中阳性表达率为86．1％（31／36），而正常肠组织未见cripto mRNA表达，统计学差异显著（P〈0．0001）。criptomRNA表达与浆膜侵袭、淋巴结转移和Duke’s分期密切相关（P〈0．05，P〈0．05，P〉0．05），而与患者肿瘤发生部位和分化程度无关（P〉0．05，P〉0．05）。结论cripto基因在结直肠癌组织中高表达，可能与大肠侵袭痈转移有关。     

T淋巴瘤侵袭转移诱导因子1表达水平与胃癌生物学行为的关系

目的探讨T淋巴瘤侵袭转移诱导因子1（Tiam1）在胃癌组织、癌旁组织、胃良性病变组织中的表达水平，及其与胃癌转移等生物学行为的关系。方法用实时荧光定量逆转录PCR（FQ-Rt-PCR）方法，对66例胃癌患者的癌组织、癌旁组织及11例胃良性病变患者的组织标本中Tiam1 mRNA进行定量检测。结果66例胃癌患者的癌组织、癌旁组织中Tiam1 mRNA表达阳性率分别为92．4％、19．7％，11例胃良性病变患者的组织标本中有1例患者有Tiam1 mRNA表达，3类组织标本的差异有统计学意义（χ^2=78．96，P〈0．01）；胃癌组织中Tiam1 mRNA表达量高于癌旁组织，且与患者性别、年龄、肿瘤大小、肿瘤原发部位无关（P〉0．05），但随着淋巴结转移的发生、浸润深度加深、分化程度降低、TNM分期增高，而呈现增高趋势（P〈0．05）。结论FQ-Rt-PCR检测Tiam1表达具有较高的敏感性和特异性，Tiam1与胃癌生物学行为密切相关，有可能成为胃癌转移的基因治疗新靶点。     

p27在胃癌组织中表达及临床意义

目的观察p27在不同病理类型胃癌组织中表达情况及其在胃癌发生中的作用。方法应用SP法检测p27在135例胃癌组织及45例正常胃黏膜组织中表达情况,其中高、中分化腺癌55例,低分化腺癌53例,黏液癌27例。结果胃癌组p27阳性表达率（45．93％）低于对照组（84．44％）;胃高、中分化腺癌p27阳性表达率（65．45％）高于胃低分化腺癌（33．96％）和黏液癌（40．74％）（P均〈0．05）,胃低分化腺癌与黏液癌间p27阳性表达率差异无统计学意义（P〉0．05）;无淋巴结转移者胃癌组织中p27阳性表达率（48．00％）明显高于有淋巴结转移者（22．50％）（P〈0．05）;术后生存期≥5a者胃癌组织中p27阳性表达率（52．63％）高于术后生存期〈5a者（16．67％）（P〈0．05）。结论p27在胃癌中的低表达可能与胃癌的发生、恶性程度、淋巴结转移及生存期有关;检测胃癌组织中p27的表达有助于判断肿瘤进展及预后。     

高迁移率族蛋白在肺癌转移中的作用

目的探讨高迁移率族蛋白1（high-mobilitygroupboxlprotein,HMGBl）在非小细胞肺癌（non-smallcelllungcancer,NSCLC）发生、发展和转移中的作用。方法采用免疫组织化学方法检测95例NSCLC和27例癌旁正常肺组织（对照组）中HMGBl的表达,并分析其与临床参数的关系。结果HMGBl在转移组的高表达（65．5％）显著高于非转移组（21．6％）,且差异有统计学意义（尸〈0．01）。HMGBl在不同组织学分型、分化程度、TNM分期患者中,其表达差异均有统计学意义（P〈0．05或P〈0．01）。HMGBl在NSCLC癌组织中的高表达（48．4％）明显高于癌旁正常肺组织（25．9％）,差异有统计学意义（P〈0．05）。HMGBl在鳞癌组织间质高表达率为78_3％。腺癌组织间质高表达率为40．9％,二者差异有统计学意义（P〈0．05）。结论HMGBl高表达与NSCLC的转移有关,可作为肺癌患者转移、治疗和预后判断指标。     

NF-kB表达与胃癌的相关性研究

目的探讨NFkB在胃癌发生过程中的作用以及NFkB p^65与胃癌临床病理学参数之间的关系。方法采用免疫组织化学En Vision二步法，检测52例胃癌与癌旁组织，20例胃肠化粘膜及20例正常胃粘膜中的NFkB p^65亚单位蛋白的阳性表达情况。结果在胃癌、胃肠化组织、癌旁组织和正常胃粘膜中，NFkB p^65阳性表达率分别为59.71％，40％，17．31％，0（P〈0.01）。在胃癌、胃肠化组织、癌旁组织中的NFkB p^65表达与正常胃粘膜相比存在显著性差异（P〈0．05）。在低级别分化胃癌组中，NFkB p^65表达明显高于高级别分化组（P〈0．05）。结论NFkB p^65是胃癌相关的一种蛋白，其阳性表达与胃癌细胞的分化程度呈负相关。NFkB p^65的检测可作为对胃癌癌前病变、胃癌转移的一项判断指标。     

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.