胃癌组织中PTEN，VEGF，MMP-9的表达及相关性研究

目的　探讨胃癌中PTEN,VEGF,MMP-9的表达及其与胃癌生物学行为的关系。方法　应用免疫组织化学SP法检测 7 1例胃癌组织及 3 7 例远癌胃黏膜中PTEN,VEGF,MMP-9 的表达。结果　胃癌组织中PTEN蛋白表达 ( 7 1. 8% )显著低于远癌胃黏膜的表达 ( 1 0 0% ) (P < 0. 0 1 ) , 且与肿瘤的组织分化程度、浸润深度及淋巴结转移呈负相关 (均P< 0. 0 5 ),而与年龄、性别等无关 (均P> 0. 0 5 ) 。VEGF在胃癌中的表达 ( 6 2. 0% ) 显著高于远癌胃黏膜的表达 ( 2 9. 7% ) (P < 0. 0 1 ) ,且与淋巴结转移呈正相关 (P< 0. 0 1 ) ,而与年龄、性别、组织分化程度及肿块浸润深度无关 (均P> 0. 0 5 )。MMP-9在胃癌中的表达 ( 6 9% ) 显著高于远癌胃黏膜的表达 ( 4 0. 5% ) (P < 0. 0 1 ),且与淋巴结转移呈正相关 (P< 0. 0 5 ) , 而与年龄、性别、组织分化程度及癌组织浸润深度无关 (均P> 0. 0 5 )。PTEN在胃癌中的表达与VEGF和MMP-9呈负相关 (P < 0. 0 5 )。结论　胃癌中PTEN蛋白表达降低,其表达与肿瘤的组织分化程度、浸润深度及淋巴结转移密切相关,且与VEGF,MMP-9表达呈负相关。联合检测PTEN,VEGF,MMP-9有助于提高胃癌侵袭转移能力的评估,对胃癌的预后判断具有重要的临床意义。     

Wnt5a、MMP2和MMP14在胃癌中的表达及其对临床病理特征的影响

目的研究Wnt5a、MMP2及MMP14在胃癌原发灶中的表达,探讨三者之间的相关性及其与临床病理特征的关系。方法免疫组化染色法检测106例胃癌手术标本及其中的39例正常胃组织中Wnt5a、MMP2和MMP14的表达,2χ检验和非参数检验分析三者间的关系及其与临床病理参数的关系。结果 Wnt5a、MMP2及MMP14在胃癌原发灶中广泛表达,均明显高于正常胃组织中的表达(P0.05)。Wnt5a阳性表达者的肿瘤直径更大、浸润深度更深、区域淋巴结转移程度更高、TNM分期更晚、淋巴结转移率更高、存在淋巴管和血管浸润(P0.05)。MMP2和MMP14阳性表达者的浸润深度更深、区域淋巴结转移程度更高、TNM分期更晚及淋巴结转移率更高(P0.05),且均存在淋巴管浸润(P0.05),但均与血管浸润与否无关。此外,MMP2阳性表达者的肿瘤直径更大(P0.05)。Spearman秩相关分析显示,Wnt5a和MMP2(rs=0.240,P=0.014)、Wnt5a和MMP14(rs=0.251,P=0.010)、MMP2和MMP14(rs=0.444,P=0.000)两两之间表达均存在正相关性。结论 Wnt5a、MMP2及MMP14的表达或能促进胃癌侵袭和转移,且三者之间的表达呈正相关。     

Syndecan-1和MMP-1在胃癌组织中的表达及其临床意义

目的：探讨Syndecan-1和MMP－1在胃癌组织中的表达及意义。方法：应用SP免疫组化染色技术，检测82例胃癌、18例异型增生及36例正常胃黏膜组织中Syndecan-1和MMP－1的表达。结果：胃癌组织Syndecan-1表达阳性率为57．32％（47/82),胃异型增生组织为83．33％（15／18），正常胃黏膜组织均呈Syndecan-1阳性表达。胃癌组织的Syndecan-1表达与正常胃黏膜上皮、胃异型增生组织中的表达相比差异显著（P＜0．01）。胃癌组织的MMP－1表达阳性率为98．78％（81／82），其中强阳性表达占45例（54．88％）；胃异型增生组织MMP－1阳性率为88．89％（16／18），无强阳性表达；正常胃黏膜组织MMP－1表达阳性率为5．56％（2／36）。胃癌组织的MMP－1表达与正常胃黏膜上皮、胃异型增生组织中的表达相比差异显著（P＜0．01）。Syndecan-1表达的减弱、MMP－1表达的增强与胃癌的淋巴结转移、静脉侵犯、淋巴管仇犯、浸润深度、TNM分期显著相关（P＜0．05）。Syndecan-1表达与MMP－1表达呈负相关。结论：联合检测Syndecan-1和MMP－1对胃癌的早期诊断及判断预后有参考价值。     

P53、nm23基因变化与胃癌转移及预后的研究

目的:探讨P53、nm23基因在人胃癌组织中的表达及其与淋巴转移和预后的关系。材料和方法:胃癌切除术的手术标本(共93例)。采用免疫组织化学法。结果:P53阳性率为49.4％(46/93),nm23为56％(52/93)。P53阳性表达与胃癌患者的年龄、性别、肿瘤组织学分型、浸润深度、淋巴结转移之间无显著性差异,但与胃癌患者预后有统计学意义。nm23低表达与淋巴结转移及预后有显著的相关性。93例胃癌组织中的淋巴结转移者63例,其中nm23表达阳性28例(44％),无转移者30例,其中nm23阳性表达24例(80％),二组之间有非常显著的差异(P<0.01)。nm23表达阳性组1,3,5年生存率分别为80％、65％和24％,而表达阴性者1,3,5年生存率为68％、41％和21％。二组间生存分布差异有显著性(P<0.05)。结论:胃癌nm23低表达有发生淋巴结转移倾向,P53高表达和nm23低表达患者预后差。P53、nm23基因变化对胃癌淋巴结转移和预后起重要作用。     

抑癌基因PTEN/MMAC1/TEP1编码蛋白和血管内皮生长因子在胃癌组织表达的相关性及其意义

目的 探讨胃癌组织中抑癌基因PTEN/MMAC1/TEP1(以下简称PTEN)蛋白与血管内皮生长因子(VEGF)的表达关系及其在胃癌生物学行为和血管生成的作用。方法 应用免疫组织化学SP法检测35例胃癌及8例慢性胃炎组织中PTEN和VEGF蛋白的表达水平及CD_(34)标记的微血管密度(MVD)。结果 (1)与慢性胃炎组比较,胃癌组PTEN蛋白表达呈显著下降(t=2.45,P<0.05)而VEGF与MVD表达均显著增强(t=2.21,2.30,P<0.05);进展期胃癌PTEN蛋白表达显著下调(t=1.85,P<0.05),而VEGF表达呈明显上调(t=1.46,P>0.05),但差异无显著性;(2)PTEN蛋白表达下调主要与胃癌淋巴结转移(t=2.92,P<0.05)、浸润深度(t=1.85,P<0.05)、年龄(t=2.26,P<0.05)、TNM分期(t=1.77,P<0.10)有较密切的关系;PTEN蛋白阴性表达者MVD较阳性者显著增加(t=2.60,P<0.05),且两者呈显著负相关(γ=-0.363,P<0.05)。(3)VEGF表达与胃癌浆膜浸润、淋巴结转移及TNM分期均显著正相关(t=4.38、2.28、2.27,P<0.01、0.05、0.05),VEGF阳性表达者MVD显著增加(t=3.35,P=0.02),且两者呈显著正相关(γ=0.512,P<0.05);(4)胃癌PTEN蛋白阴性表达者VEGF表达较阳性者显著上调(t=-1.99,P=0.055),两者呈显著负相关(γ=-0.403,P<0.05)。结论 胃癌PTEN基因编码蛋白失表达可能通过上调VEGF表达途径,增强     

胃癌组织血管内皮细胞生长因子及其受体Flt-1的表达及与胃癌生物学行为的关系

目的探讨血管内皮细胞生长因子（VEGF）及其受体fms-样酪氨酸激酶（Flt-1）在胃癌组织中的表达及其与肿瘤微血管密度（MVD）、浸润转移和生存期的关系。方法应用原位杂交和免疫组织化学技术，检测118例胃癌组织中VEGF和Flt-1 mRNA及CD34蛋白的表达。结果胃癌组织中VEGF和Flt-1 mRNA的阳性表达率分别为54．24％和55．9％：浸润性生长的肿瘤组织中VEGF和Flt-1的阳性表达率和MVD值明显高于膨胀性生长者（P〈0．01），VEGF和Flt-1表达及MVD值与浸润深度、脉管侵犯、淋巴结转移和远处转移显著相关（P〈0．05）；MVD值与VEGF和Flt-1 mRNA的表达水平有关（均P〈0．01）；VEGF和Flt-1 mRNA阳性表达及MVD值超过或等于54．9个／mm^2患者的平均生存时间和5年生存率均显著低于VEGF和Flt-1 mRNA阴性表达及MVD值少于54．9个／mm^2者。结论VEGF和Flt-1 mRNA可促进胃癌血管生成。并参与肿瘤浸润转移的过程，可作为反映胃癌生物学行为和判断预后的生物学指标。     

PTEN和AKT2及CD147在胃癌组织中的表达及意义

目的：检测PTEN、AKT2和CD147在胃癌组织中的表达,并探讨其相互关系。方法：应用免疫组织化学方法检测65例胃癌及癌旁组织中PTEN、AKT2和CD147的表达情况。结果：PTEN蛋白在胃癌中表达的阳性率（58.46%）明显低于相应正常组织（100%）（P〈0.01）,其表达水平与组织分化程度、浸润深度、淋巴结转移及TNM分期有关（P〈0.05）。AKT2蛋白在胃癌组织中表达的阳性率（67.69%）明显高于相应正常组织（26.15%）（P〈0.01）,其表达与淋巴结转移有关（P〈0.01）,与浸润深度、分化程度和TNM分期无关（P〉0.05）。CD147蛋白在胃癌组织中表达的阳性率（86.15%）明显高于相应正常组织（16.92%）（P〈0.01）,其表达水平与浸润深度、淋巴结转移及TNM分期有关（P〈0.05）,与分化程度无关（P〉0.05）。胃癌组织中PTEN和AKT2、PTEN和CD147蛋白表达之间呈明显负相关（P〈0.01）。结论：PTEN的低表达或失表达,可能与AKT2、CD147的异常激活有一定联系,从而对胃癌的发生、发展起重要作用。     

胃癌微环境中树突状细胞浸润的临床意义

目的 探讨胃癌微环境中肿瘤浸润性树突状细胞(TIDC)与癌细胞浸润程度、淋巴结转移及患者术后存活时间的关系。方法 采用免疫组织化学方法,运用抗S-100检测100例胃癌组织中的TIDC,并分析其与临床病理参数及生存率的关系。结果 TIDC在胃癌组织中的阳性率为41.0％(41/100),其与癌细胞浸润程度无相关性(P>0.05)。56例有淋巴结转移的患者中,TIDC阳性者淋巴结转移率为56.1％,阴性者为43.9％,两者比较差异无显著性意义(P>0.05);第2站以上淋巴结转移率,TIDC阳性者为29.7％,而阴性者为70.3％,两者比较,差异有显著性意义(P<0.05)。TIDC阳性和阴性患者5年生存率分别为59.0％和37.7％,两者比较.差异有显著性意义(P<0.05)。结论 TIDC阳性与癌细胞浸润程度无相关性,但与第2站以上淋巴结转移和患者术后生存率密切相关。     

乳腺癌中HER2基质金属蛋白酶-2和9的表达及其相互关系

目的　研究乳腺癌中HER2基因、基质金属蛋白酶 (MMP) 2、基质金属蛋白酶(MMP) 9的表达情况、与临床病理指标之间的关系以及它们之间的相互关系。方法　采用免疫组织化学的方法对 114例乳腺癌组织标本中HER2、MMP 2、MMP 9的表达情况进行检测。结果　乳腺癌组织中HER2、MMP 2、MMP 9的表达阳性率分别是 46.49%、78.95 %、68.42 %。HER2表达与淋巴结转移相关。原发肿瘤 >2cm或有淋巴结转移的患者中 ,其MMP 2、MMP 9表达明显高于原发肿瘤≤ 2cm或无淋巴结转移的患者 (P <0 .0 5 ) ,且MMP 2表达与临床分期相关 (P <0 .0 5 )。HER2表达与MMP 2、MMP 9表达相关 (P <0 .0 5 )。结论　HER2、MMP 2、MMP 9的阳性表达提示乳腺癌有较强的浸润转移能力 ,这 3种蛋白的表达在乳腺癌浸润转移过程中可能起协同作用。     

pT1～3N0期胃癌淋巴结微转移检测的临床意义

目的 研究淋巴结微转移及临床病理因素对pT1～3N0期胃癌患者术后5年无瘤生存率的影响.方法 纳入我院2000年1月至2004年12月期间pT1～3N0期胃癌患者行根治术者120例2 106枚淋巴结,每例患者淋巴结9～28枚,平均18枚,所有淋巴结经HE染色均为阴性.应用免疫组化染色法检测淋巴结中CK20表达,并分析胃癌患者的临床病理特征及胃癌淋巴结中CK20表达对5年无瘤生存率的影响.结果 经免疫组化染色,有9.07%(191/2 106)的淋巴结出现CK20阳性表达;有26.67%(32/120)患者的淋巴结中出现CK20阳性表达,其中11例(9.17%)为微转移,21例(17.50%)为孤立肿瘤细胞巢(ITC).术后随访24～121个月(平均66.35个月).淋巴结中CK20阴性表达、ITC和微转移的患者,5年无瘤生存率分别为87.4%、78.3%和40.9%.5年无瘤生存率在淋巴结CK20出现微转移者中明显低于CK20阴性表达者(P＝0.000)和以ITC为特征者(P＝0.046),而仅以ITC为特征者与CK20阴性表达者间比较,差异无统计学意义(P＝0.253).淋巴结中CK20阳性表达与胃癌患者的肿瘤直径(P＝0.011)、浸润胃壁深度(P＝0.043)和是否有淋巴管浸润(P＝0.002)有关.所有临床病理因素对5年无瘤生存率均无明显影响(P>0.05).11例胃癌患者被检测出微转移,应划分为pN1(Mi)期,本组重新分期率9.17%.而88例胃癌患者淋巴结CK20(-)和21例表达为ITC,分别被记为pN0(I-)和pN0(I+),不建议重新分期,仍为pN0期.结论 对于pT1～3N0期胃癌,若淋巴结中检测出微转移,其预后较差,术后5年无瘤生存率较低,建议术后应予以积极的辅助治疗.     

中国近21年成人先天性胆管扩张症流行学特征及诊治经验

目的：探讨成人先天性胆管扩张症的流行病学特征和诊疗经验。方法：联合检索维普数据库和中国期刊网等多家中文数据库中1990年1月～2010年11月有关成人先天性胆管扩张症的文章，总结分析成人先天性魍管扩张症的流行病学特征和诊治经验。结果：中国近2{年共报道5146例成人先天性胆管扩张症，有准确年龄及平均年龄报道4298例，平均年龄34．84岁，男女比例约为1：2．55，43．44％分布在华东地区，68．38％有不同程度腹痛表现，25．22％有发热或高热症状，32，46％有不同程度黄疸，18．31％可触及腹部包块，具有典型三联征表现患者占15．98％。Todani分型I型8041％，II型4．27％，III型123％，IV型1155％，V型占2，54％。手术治疗为主要治疗手段，胆管囊肿切除加胆管空肠Roux—en—Y吻合术占71．63％；术后并发症以胆管炎症状为主，发生率为12．24％；术后随访率83．55％，治愈率8684％。结论：成人先天性胆管扩张症女性多发，其中以华东地区较多，Todani分型I型为主，囊肿切除加胆肠Roux—en—Y吻合术为主要治疗手段。     

Car seat belts and the eye

In a series of 22 successive victims of car accidents with eye injuries sufficiently severe to require their admission to an Eye Unit in Ayrshire, it was noted that not a single one had been wearing a seat belt, nor have any persons involved in similar accidents who were wearing seat belts, required to be admitted for any eye injury over a 3-year period.It is suggested that the wearing of seat belts could prevent injuries to the eyes, at least where the car frame remains intact.     

Diagnosis and reversal of rejection in experimental and clinical lung allografts

Experience in our patients and dogs with lung transplants has provided reliable criteria for diagnosing rejection and distinguishing it from other pathological processes such as pneumonia and ischemic injury. These criteria include fever; dyspnea; malaise; increased sputum production; decreased arterial oxygen tension; and, most importantly, the rapid development (often within hours) of a roentgenographic alveolar infiltrate without any change in the sputum bacteriology.Using these criteria we have identified multiple rejection episodes in 2 patients and in comparably immunosuppressed dogs. In almost every instance all acute manifestations of rejection, including the roentgenographic infiltrates, have been completely reversed by three to seven large intravenous doses of methylprednisolone given at 12- to 24-hour intervals. In the dogs, reversal of rejection has also been confirmed by gross and microscopical examination of the allograft. These findings show that acute rejection in lung allografts can be reliably identified by noninvasive criteria and successfully reversed.     

Injury and pregnancy

This subject receives very little attention in textbooks and most of the articles in journals report small numbers of injuries of one kind or another. One general review suggests that between 5 and 10 per cent of pregnant women suffer injury, usually with no risk to the pregnancy: for example, the incidence of abortion ascribed to accidental injury is less than 1 in 10,000. Personal and reported experience can be summarized as follows. The baby may be injured during pregnancy or during birth, or may be harmed by the effects or complications of injury to the mother, e.g. Gram-negative septicaemia or hypoxic states. Injuries inflicted on the baby during pregnancy are most often fractures, which affect the skull almost as often as any other bone, and frequently accompany fractures of the mother's pelvis. Gunshot and other penetrating injuries of the child are rare and are not always fatal. Fractures of the maternal pelvis are the most frequent of the major injuries and are serious to viscera and other parts of the body. In some patients deformation of the pelvis can be corrected or prevented by operation, but it is usually best accepted. Rigid internal fixation of fractures of the lower limbs sustained in the later months of pregnancy can make labour much easier for the patient and her attendants. If the effect of injury on pregnancy is usually obvious, the effect of pregnancy on recovery from injury is usually not.     

The effects of intravesical and intradermal application of a new B.C.G. on the dog bladder

Summary Intravesical and intradermal application of B.C.G. (Bacillus Calmette Guérin) has proven to be effective in the prophylaxis of recurrence of superficial bladder carcinoma after transurethral resection and in the treatment of carcinoma in situ (C.I.S.) in man. Different strains of B.C.G. have been used for this purpose. In this article a new strain of B.C.G. (B.C.G.-R.I.V.M.) has been tested to assess its toxicity. The effects of intravesical and intradermal application of B.C.G.-R.I.V.M. were studied on normal and on coagulated canine urothelium. In this study no general side effects of B.C.G.-R.I.V.M. were seen. Only minor local changes occurred in the bladder wall. Small granulomas were found in the suburothelial tissue. No granulomas or signs of active inflammation were observed in the pelvic lymphnodes, spleen and liver. Because B.C.G.-R.I.V.M. seemed to be a safe agent in the dog we have started to use it for prophylaxis in superficial bladder cancer in man.Grant recipient of the Koningin Wilhelmina Fonds (Dutch Cancer Foundation)     

Dehydration and factors affecting pulmonary antibacterial defenses

Since impaired intrapulmonary bacterial inactivation of Staphylococcus aureus has been described in rats which were dehydrated for 38 hr, the effect of dehydration on several factors known to influence host responses to bacteria in the lung were studied.After 38 hr of dehydration, arterial pH, pCO₂, and pO₂ were unchanged, but plasma osmolality was increased. Surfactant, measured by the bubble stability ratio, was impaired by dehydration. When macrophages were recovered from the lung by bronchial lavage, their number, viability, oxygen consumption, and enzyme (acid phosphatase, β glucuronidase, leucine aminopeptidase) contents were similar to controls. Since normal oxidative metabolism is needed for phagocytosis and normal enzyme content is needed for lytic activity, the alveolar macrophage appears capable of bactericidal activity. A cofactor, perhaps within the alveolar lining fluid, may be necessary for normal activity of the macrophage and was adversely affected by dehydration. Since in vitro studies have demonstrated the need for normal surfactant fraction for maximal bactericidal activity of the alveolar macrophage, the abnormal surface lining material with dehydration may have contributed to the impaired in vivo host defenses.     

原发性胆囊癌与胆囊结石（附84例分析）

本文分析作者收治的８４例胆囊癌的临床特点并结合文献探讨胆囊结石的关系。目前尚无证据说明胆囊结石是胆囊癌的致癌因，但它在成癌过程中很可能起着促进作用。年龄超过５０岁、女性、合并胆囊炎或接触化学致癌物质可以认为是胆囊结石者易患胆囊癌的高危因素。在目前，早期诊断胆囊癌依然十分困难，治疗预后恶劣的情况下，对于具有高危因素者如不能确认胆囊形态正常，施行预防性胆囊切除是合理的。