血管内皮生长因子在原发性肝细胞癌中的表达及其作用

目的：探讨血管内皮生长因子（VEGF）的表达与原发性肝细胞癌（PHCC）侵袭和转移的关系。方法：采用免疫组织化学链酶卵白素－辣根过氧化物酶（LSAB）法对30例PHCC和20例癌旁组织手术切除后的石蜡标本组织中的VEGF表达及微血管密度（MVD）进行检测.结果 VEGF表达,MVD在PHCC组织中比癌旁组织明显增高,在PHCC中,有转移者及包膜不完整者VEGF表达,MVD明显高于无转移者及包膜完整者,VEGF表达,MVD在大肿瘤（直径＞5厘米）与小肿瘤（直径小于等于5厘米）两者间无显著性差异,VEGF的表达与MVD相关,结论：PHCC组织中的VEGF表达,MVD与肿瘤的侵袭和转移行为密切相关,可作为判定PHCC发生,转移及预后的指标,为监测和治疗提供了新思路。     

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。     

基质金属蛋白酶-9和血管内皮生长因子与原发性肝癌侵袭转移关系研究

目的　探讨原发性肝癌中MMP 9和VEGF基因的表达 ,探讨其与原发性肝癌侵袭转移的关系。方法　采用逆转录 聚合酶链式反应 (RT PCR)技术 ,检测 41例原发性肝癌手术切除肿瘤组织、癌旁组织标本的MMP 9和VEGF基因表达。结果　肝癌组织和癌旁 1cm、5cm组织中分别有 70 7%、48 9%、41 5 %MMP 9表达阳性和 75 6%、5 3 7%、46 3 %VEGF表达阳性 ,癌组织的MMP 9和VEGF表达水平显著高于癌旁 5cm组织 (P <0 0 1) ,癌组织与癌旁 1cm组织MMP 9和VEGF表达水平无显著性差异。癌组织中MMP 9和VEGF的表达水平与有无包膜、门静脉癌栓有显著性差异 (P <0 0 5 )。MMP 9与复发、AFP阳性有显著性差异 (P <0 0 5 ) ,而VEGF与之无差异。结论　MMP 9和VEGF基因的过度表达与肝癌侵袭转移密切相关 ,MMP 9可作为判断预后的指标     

血管内皮生长因子和基质金属蛋白酶-9在肝细胞癌中的表达及其意义

目的研究血管内皮生长因子(VEGF)与基质金属蛋白酶-9(MMP-9)在肝细胞癌中的表达,并探讨其与肝细胞癌复发、转移的关系.方法采用免疫组化ABC法对50例肝细胞癌组织和30例正常肝组织中VEGF及MMP-9蛋白的表达进行检测.结果VEGF和MMP-9在肝细胞癌组织中的表达阳性率分别为86.0%(43/50)和68.0%(34/50),明显高于正常肝组织中的表达阳性率53.3%(16/30)和33.3%(10/30).差异有统计学意义(P＜0.05);VEGF的表达与MMP-9的表达呈显著正相关(r＝0.98,P＜0.01),二者的协同表达与肝细胞癌的淋巴结转移及包膜形成有关(P＜0.05).结论VEGF和MMP-9在肝细胞癌的生长、侵袭和转移过程中起着重要作用,对预测肝细胞癌复发、转移有一定意义.     

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.     

膜联蛋白A-10与基质金属蛋白酶-9、血管内皮生长因子在人肝细胞癌组织中表达的相关性及与临床病理特征的关系

目的 探讨膜联蛋白A10(ANXA10)在人肝细胞癌发生发展中的作用,及这些作用是否与已知的肝细胞癌侵袭转移相关的细胞因子基质金属蛋白酶-9(MMP-9)、血管内皮生长因子(VEGF)有关.方法 应用免疫组织化学二步法检测80例患者肝细胞癌(HCC)和癌旁正常组织中ANXA10、MMP-9、VEGF的表达,分析ANXA10与MMP-9、VEGF之间相关性及ANXA10与肝癌临床病理特征的关系.结果 ANXA10在HCC中阳性率为65.0%(52/80);在癌旁肝组织中阳性率为91.3%(73/80),前者明显低于后者.ANXA10表达与患者的性别、年龄、肿瘤直径、肿瘤位置、肝硬化、临床T分期无明显相关(P>0.05),与分化程度显著相关(P<0.05).ANXA10与MMP-9之间显著相关(P<0.05);ANXA10与VEGF之间无明显相关(P>0.05).结论 ANXA10表达缺失或失活可能是恶变的人肝细胞的重要特征之一.     

KAI1/CD82蛋白表达与肝细胞癌侵袭转移

目的　探讨KAI1/CD82蛋白表达与人肝细胞癌侵袭转移的关系。方法　构建肝癌组织芯片 ,收集肝细胞癌及癌旁肝组织 15 5例 ,癌栓 2 2例 ,肝内转移癌 4例 ,肝外转移癌 16例。正常对照肝组织 5例。应用免疫组织化学方法检测肝癌组织芯片中样本KAI1/CD82蛋白的表达。结果6 1% (95 /15 5 )肝细胞癌原发灶表达KAI1/CD82蛋白 ,仅有 32 % (7/2 2 )癌栓呈阳性表达 (P <0 0 5 )。不伴有肝外转移、肝内转移及癌栓形成肝细胞癌中KAI1/CD82蛋白表达率分别高于伴有肝外转移 (P =0 0 38)、肝内转移 (P <0 0 1)及癌栓形成者 (P <0 0 1)。KAI1/CD82蛋白在包膜完整与无包膜 (P <0 0 5 )、癌灶直径 <5cm与直径≥ 5cm(P <0 0 1)及血清AFP <4 0 0 μg/L与AFP≥ 4 0 0 μg/L (P =0 0 36 )肝细胞癌中表达率差异亦有显著意义。结论　肝细胞癌KAI1/CD82蛋白表达丧失可能与癌灶侵袭转移有关     

基质金属蛋白酶-10在结肠癌侵袭转移中作用的研究

目的探讨基质金属蛋白酶-10(MMP-10)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MMP-10、MMP-9、血管内皮生长因子(VEGF)、Ⅳ型胶原及FⅧAg的表达情况。结果结肠癌MMP-10、MMP-9和VEGF的阳性率分别为64%、71%和80%。3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。MMP-10的阳性表达强度较MMP-9弱,MMP-10具有激活MMP-9的功能。MMP-10的表达与肿瘤的侵袭、分化程度及淋巴结转移有关,但与患者的发病部位、性别和组织分型无关。结论MMP-10、VEGF和MMP-9的表达与结肠癌的侵袭转移密切相关。     

CD146与VEGF在人肝细胞癌组织中的表达及其临床意义

目的 该研究旨在观察人肝细胞癌(hepatocellular carcinoma,HCC)组织中CD146与VEGF的表达及其关系,探讨它们在HCC中与血管生成的关系及其临床意义.方法 采用免疫组化法检测60例HCC癌组织及癌旁肝组织中CD146、VEGF的表达情况,用CD34标记免疫组化法检测微血管密度(microvessel density,MVD),分析它们的表达与临床病理指标的关系.结果 CD146、VEGF在癌组织中的阳性率分别为66.67%和63.33%,而在癌旁组织中的阳性率分别为30%和33.33%,癌组织与癌旁组织比较差异有显著性(P＜0.05).癌组织的MVD为54.92±8.55/200倍视野,癌旁组织的MVD为21.36±6.63/200倍视野,两者差异有显著性(P＜0.05).与癌旁组织相比,癌组织中CD146、VEGF表达及MVD明显增加.CD146在人肝癌组织中的表达与临床分期、门静脉癌栓及肝外转移明显有关,而与术后复发、肿瘤个数、肿瘤直径、血清AFP水平及肿瘤分化程度无明显关系.VEGF在人肝癌组织中的表达与术后复发、肝外转移、临床分期、门静脉癌栓、肿瘤直径相关,而与肿瘤个数、血清AFP水平及肿瘤分化程度无明显关系.在癌组织中MVD与CD146、VEGF的表达呈正相关,CD146与VEGF亦呈正相关.结论 肝癌组织中CD146及VEGF高表达,与肿瘤血管形成和转移密切相关,分析它们的表达有助于综合判断HCC的预后.     

Cyclin E在肝细胞癌中的表达及其意义

目的　探讨CyclinE在肝细胞癌中的表达及其意义。方法　应用同一组织连续切片免疫组化SABC法 ,检测CyclinE在 45例肝细胞癌 (HCC)及 3 0例癌旁肝组织中的表达及其与临床病理资料的关系。其中门静脉癌栓形成者 12例 ,有转移者 11例 ,肝内肿瘤播散或有卫星结节者 12例 ,肿瘤包膜侵袭者 19例 ,以上 4项中有任何 1项阳性或 1项以上阳性者归入侵袭转移组。结果　CyclinE在HCC组织中阳性表达率 3 5 .6% (16/ 45 ) ,癌旁肝组织无阳性表达。CyclinE表达与年龄、性别、乙肝表面抗原、血清甲胎蛋白、肿瘤大小、包膜形成、肝外转移及癌灶数目无关 (P >0 .0 5 ) ,与组织分化 ,癌栓形成有关 (P <0 .0 5 )。CyclinE在侵袭转移组较非侵袭转移组表达增高 (P <0 .0 5 )。.结论　CyclinE与肝细胞癌的发生 ,分化及侵袭转移有关 ,检测其表达有助于协助临床诊断治疗及判断预后。     

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.     

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.     

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.