通过医疗档案分析胃肠道间质瘤预后因素

目的分析胃肠道间质瘤预后因素。方法回顾性分析76例胃肠道间质瘤患者的临床病理资料,并建立了随访档案,分析临床病理因素与预后的关系。结果预后因素与危险度分层、核分裂象、肿瘤大小、Ki-67有关（P〈0．05）,与患者年龄、性别、部位无关（P〉0．05）。结论危险度分层、核分裂象、肿瘤大小、Ki-67可作为预测胃肠道间质瘤预后的有用指标,中、高危险度组患者应定期复查,健全随访档案,积极治疗。     

胃肠道间质瘤34例临床病理学分析

目的 探讨胃肠道间质瘤的临床表现、病理组织形态学和免疫组织化学特点及良恶性参考指标.方法 对34例胃肠道间质瘤患者的手术标本采用免疫组化PV-9000法进行CD117、CD34、S-100、SMA、Des、Ki-67标记、分析.结果 34例胃肠道间质瘤免疫组化CD117阳性率95％,CD34阳性率70％,S-100、SMA、Des局灶弱阳性或阴性表达,Ki-67表达不一.临床表现为腹部不适、腹痛、腹胀、上消化道出血及腹部包块.结论 胃肠道间质瘤多发于中老年,肿瘤细胞形态多样,结构多样,免疫组化CD117和CD34阳性表达是确诊胃肠道间质瘤最有诊断价值的依据,但胃肠道间质瘤良、恶性诊断须结合肿瘤大体、组织学形态及生物学行为等综合考虑.     

儿童肾上腺皮质癌21例临床病理分析

目的 探讨儿童肾上腺皮质癌（ACC）的临床病理学特点及鉴别诊断。方法 对21例儿童肾上腺皮质癌回顾病史，并进行HE染色及免疫组化标记。结果 21例儿童发病年龄1～12岁，平均4．9岁，男女之比为1：3．2，85．7％的患儿合并有皮质醇激素增高的体征。肿瘤体积普遍较大，52．4％的病例肾上腺肿瘤重量〉300g，〉80％的肿瘤镜下可见透明细胞稀少，病理性核分裂，静脉及被膜的浸润。免疫组化：21例vimentin、Syn和PCNA（＋），7例CK（AE1／AE3）（＋），11例Ki-67（＋），CEA、EMA（-），其中PCNA阳性率为28.8％～98．2％，Ki-67为1．1％～23．1％。结论 儿童肾上腺皮质癌恶性度高，预后差，多见于女童，患者大多合并有皮质醇激素增高的体征。在儿童ACC的诊断中，肿瘤的重量多数〉300g，瘤组织透明细胞稀少、病理性核分裂、静脉和被膜的浸润是相对重要的指标。PCNA阳性率〉30％、Ki-67阳性率〉10％对儿童ACC的诊断有辅助作用。     

胃肠道间质瘤中Ki一67、cyclinD1和bcl-2的表达与危险度及预后的关系

目的探讨胃肠道间质瘤（GIST）中Ki-67增殖指数（u）、cyclinDl和bcl-2的表达与危险度及预后的关系。方法对76例确诊的GIST应用免疫组化SP法检测Ki--67、cyclinD1和bcl-2的表达,分析与危险度和预后的关系。结果危险度极低、低、中和高度分别为10、23、18和25例;随访61例,其中42例健在,12例死于GIST,7例死于其他原因。Ki-67LI〉5％与核分裂象〉5／50HPF、肿瘤直径〉5cm及危险度中高有关（P〈0．05）;cyclinD1和bcl-2的阳性表达与核分裂象、肿瘤大小无关而与中高危组相关（P〈0．05）。结论Ki-67、cyclinD1和bcl-2在GIST中、高危险度组高表达,可作为预测危险度和预后有用的指标,Ki-67LI可作为独立指标。     

胃肠道间质瘤——附4例报告

目的 探讨胃肠道间质瘤的组织发生，病理诊断与鉴别诊断。方法 对4例胃肠道间质瘤标本，用10％福尔马林固定，常规石蜡切片，经HE、免疫组化染色，光镜观察等方法进行研究。结果 瘤细胞呈鱼骨状、栅栏状，车辐状和编织状排列，肿瘤内以梭形细胞为主，上皮样细胞占少数，核呈胖梭形、椭圆形，核染色质较细，核仁不明显。恶性的瘤细胞丰富（例1、3、4），排列紧密，核分裂象（6-20）／50HFP，有粘液和坏死。良性的细胞较少，排列疏松，核分裂象少或无。免疫组化（ABC法）染色：CD1174例均为弥漫强阳性，S-100蛋白（侈14）、α-SMA（例2）为局灶性阳性，CD34均为阴性。例1、3、4诊为恶性胃肠道间质瘤。例2诊为良性间质瘤。结论 胃肠道间质瘤形态结构与平滑肌、神经鞘肿瘤不易鉴别，免疫组化有助于诊断。恶性胃肠道间质瘤，切除后复发率高而且预后差。     

原发性心横纹肌肉瘤临床病理观察

目的探讨心横纹肌肉瘤的临床病理学特征及诊断、鉴别诊断要点。方法对1例心横纹肌肉瘤进行临床病理分析及免疫组化研究,并复习相关文献。结果镜下见瘤细胞弥漫生长,疏密不等,部分区域有黏液样基质,部分区域为红染基质。瘤细胞大部分为大圆形、短梭形,核深染,不均匀成块状。部分细胞分化较好,核分裂象易见,可见少量瘤巨细胞。肿瘤组织结节样突向心肌内。免疫组化：PAS和CD68（＋）、desmin、vimentin、CD68和CD117（＋＋＋）,MyoD1（＋＋）,CK、PCNA68%（＋）,myoglobin、S-100、p53和Ki-67（-）。结论原发性心横纹肌肉瘤罕见,恶性程度高、侵袭性强,组织形态学及临床表现有较大差异,免疫组化检测能增加诊断的正确性。     

VEGF、Ki-67在胃肠间质瘤中的表达及其意义

目的探讨VEGF和Ki-67在胃肠间质瘤中的表达及与临床病理因素的关系。方法采用免疫组化S-P法检测44例胃肠间质瘤组织中VEGF、Ki-67表达分析二者与临床病理因素的相关性。结果VEGF、Ki-67在GIST组织中阳性表达分别为77．3％、63.6％，VEGF、Ki-67表达在不同大小的肿块之间有极显著性差异（P〈0.01）。结论VEGF促进GIST组织中的新生血管形成，为肿瘤组织提供了丰富的血液和营养，并使细胞增殖活性增强；Ki-67PI为GIST的预后判断提供比较客观的依据。     

CD133在胃肠道间质瘤中的表达及临床意义

目的探讨胃肠道间质瘤(GIST)CD133蛋白的表达及其与临床病理特征。方法采用免疫组织化学法检测363例GIST组织中CD133的表达情况,并分析与临床病理指标的相关性。结果CD133主要在细胞膜表达,可少量表达于细胞质,染色黄色或棕黄色细胞代表阳性,细胞核为蓝色,底物呈现白色;CD133的表达量与肿瘤直径、危险分度以及肿瘤位置差异有统计学意义(P<0.05);GIST肿瘤位置、肿瘤直径、核分裂象、危险分度、肿瘤是否转移、Ki-67的表达与生存预后之间存在相关性(P<0.05),而CD133表达量的高低与GIST患者预后无关(P=0.717)。Cox多因素分析提示GIST肿瘤位置、Ki-67>5%以及CD133高表达是影响患者预后的独立危险因素(P<0.05)。结论CD133表达量在不同肿瘤大小、核分裂象及肿瘤是否转移的GIST患者中存在差异,提示CD133可能参与了肿瘤的增殖与迁移的调控,从而加速肿瘤的生长与转移;CD133高表达是GIST预后的独立危险因素。     

结肠腺瘤及腺癌间质FAP-α的表达

目的:通过观察结肠腺癌及腺瘤间质成纤维细胞激活蛋白(fibroblast activation protein-α,FAP-α)的表达情况,探讨结肠肿瘤间质在肿瘤发生发展中的作用,及其在诊断治疗及预后判断中的意义。方法:收集结肠腺瘤60例,结肠腺癌60例,其中p53阴性腺瘤组30例,p53阳性腺瘤组30例,p53阴性腺癌组30例,p53阳性腺癌组30例,用免疫组织化学检测肿瘤间质FAP-α的表达情况及肿瘤成分Ki-67的表达情况,用Image Pro Plus 6.0软件进行半定量分析,SPSS软件进行统计学分析。结果:间质FAP-α表达从弱到强依次为p53阴性结肠腺瘤、p53阳性结肠腺瘤、p53阴性结肠腺癌、p53阳性结肠腺癌(P0.05);Ki-67值从低到高依次为p53阴性结肠腺瘤、p53阳性结肠腺瘤、p53阴性结肠腺癌、p53阳性结肠腺癌(P0.05);p53阴性结肠腺癌与p53阳性结肠腺癌组FAP-α的表达与Ki-67呈正相关(P0.05),p53阴性与p53阳性结肠腺瘤组FAP-的表达与Ki-67无明显相关性(P0.05)。结论:结肠腺瘤与腺癌间质的FAP-α表达水平与肿瘤的生物学行为有关,进一步研究肿瘤间质对肿瘤的诊断及治疗有潜在价值。     

胃肠道间质细胞瘤CD117、Nestin和Ki-67表达及其临床意义

目的探讨CD117、Nestin、Ki-67在胃肠道间质细胞瘤（gastrointestinal stromal tumor,GIST）中的表达及其与临床意义之间的关系。方法应用免疫组织化学S-P法检测27例胃肠道间质细胞瘤切片中CD117、Nestin和Ki-67的表达情况,对这些病例进行良恶性鉴别,并分析上述免疫组织化学指标与病人生物学行为之间的相关因素（性别、年龄、发生部位、组织学分型）和良恶性之间的鉴别。结果CD117和Nestin的阳性表达率分别为88.9%和92.6%,Ki-67增殖指数〈1%、1%~5%和〉5%的例数分别为6例、9例和12例;CD117、Nestin和Ki-67在不同性别、年龄、组织学分型之间均无统计学意义;良性,潜在恶性,恶性的病例分别为6例、9例和12例,CD117和Nestin的阳性表达率在不同的肿瘤分级之间无统计学意义,而Ki-67增殖指数在不同的肿瘤分级之间存在显著性差异（P〈0.01）。结论CD117和Nestin在胃肠道间质细胞瘤中呈高表达,对胃肠道间质细胞瘤的诊断具有重要的意义,但不能作为判断胃肠道间质细胞瘤肿瘤分级的指标;而Ki-67的增殖指数是判断胃肠道间质细胞瘤肿瘤分级和预测预后的可靠指标之一。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.