血管内皮生长因子、p53蛋白与微血管密度在非小细胞肺癌中的表达及其相关性

目的:研究血管内皮生长因子(VEGF)、p53蛋白、微血管密度(MVD)在非小细胞肺癌中的表达及其相关性,探讨其在非小细胞肺癌发生、发展中的作用.方法:采用免疫组织化学S-P法检测80例非小细胞肺癌组织、20例肺良性病变组织中VEGF、p53蛋白的表达,并对肺癌组织中CD34单抗标记的血管计数MVD.结果:肺癌组织VEGF、p53蛋白阳性表达率明显高于肺良性病变组织(P＜0.05).VEGF、p53蛋白表达与肺癌患者的年龄、性别、组织学类型均无关(P＞0.05),与肺癌组织的分化程度、TNM分期及淋巴结转移均有关(P＜0.05).VEGF与p53蛋白表达呈正相关(P＜0.05).在肺癌组织中,VEGF、p53蛋白表达阳性组MVD分别明显高于VEGF、p53蛋白表达阴性组(P＜0.05);p53蛋白与VEGF表达均阳性组MVD明显高于p53蛋白与VEGF表达均阴性组(P＜0.05).结论:VEGF、p53可能与肺癌的发生、发展有关.VEGF与p53蛋白在肺癌组织中的表达呈正相关,提示突变型p53基因可能上调VEGF的表达.肺癌组织中MVD与VEGF、p53蛋白表达密切相关,突变型p53基因和VEGF在肺癌血管形成中具有协同作用.     

乳腺癌中血管内皮生长因子和基质金属蛋白酶-9的表达与淋巴结转移的关系

目的 检测血管内皮生长因子(VEGF)和基质金属蛋白酶-9(MMP-9)在乳腺癌中的表达情况,研究两者与淋巴结转移的关系.方法 采用免疫组化SP法检测92例乳腺浸润癌中VEGF、MMP-9的表达情况.结果 VEGF蛋白在对照组和乳腺癌组中的阳性表达率分别为5.7％ (3/45)和90.2％(83/92),且VEGF在淋巴结转移组中的阳性表达率(53/55)明显高于无淋巴结转移组(P＜0.05).MMP-9蛋白在正常乳腺组织及乳腺癌中的阳性表达率分别为0(0/45)和92.4％ (85/92),而且MMP-9在淋巴结转移组中的阳性表达率(54/55)明显高于无淋巴结转移组(P＜0.05).结论 VEGF、MMP-9蛋白在乳腺癌组织中高表达,且均与淋巴结转移有关(P＜0.05),两者可能在乳腺癌的远处转移中起协同作用.     

胃癌中p53基因与血管内皮生长因子表达的关系

[目的]探讨P53蛋白和血管内皮生长因子(VEGF)在胃癌中的表达及其与临床病理特征的关系.[方法]采用免疫组化S-P法检测45例手术切除胃癌组织中P53蛋白、VEGF的表达和微血管密度(MVD),分析其与肿瘤浸润、淋巴结转移和远处转移的关系.[结果]在45例胃癌中P53蛋白的阳性表达率为51.11%(23/45),VEGF的阳性表达率为66.67%(30/45),MVD计数为43.6士12.5(x±s);在VEGF高表达的区域,P53蛋白的表达亦增强,二者密切相关(P＜0.05);P53蛋白、VEGF表达阳性的病例,其肿瘤组织中MVD明显高于阴性者(P＜0.05或P＜0.01);P53蛋白、VEGF的表达与肿瘤的淋巴结转移、远处转移密切相关(P＜0.05).[结论]胃癌组织中VEGF的表达与P53蛋白的阳性率呈正相关,二者在肿瘤组织的血管生成和侵袭转移中起重要作用.     

甲状腺乳头状癌中BRAF基因突变与相关蛋白表达的相关性

目的研究甲状腺乳头状癌(PTC)中BRAF基因突变和D2-40、CK19、cyclinD 1蛋白表达的临床意义。方法应用扩增阻碍突变系统(ARMS法)检测63例PTC和34例甲状腺乳头状增生组织中BRAF基因突变情况;应用免疫组化SP法检测上述组织中D2-40,CK19,cyclinD 1蛋白表达水平,分析其相关性。结果BRAF基因突变率和D2-40、CK19和cyclinD 1蛋白阳性率在甲状腺乳头状癌组中显著高于乳头状增生组(P0.05);在甲状腺乳头状癌组中,BRAF基因突变率和D2-40、cyclinD 1蛋白阳性率在淋巴结转移组高于无淋巴结转移组(P0.05);CK19蛋白阳性率在甲状腺乳头状癌中有、无淋巴结转移组之间差异不显著(P0.05)。结论BRAF基因突变和D2-40、CK19,cyclinD 1蛋白表达的联合检测有助于甲状腺乳头状癌与甲状腺乳头状增生的诊断与鉴别诊断,同时可作为预测甲状腺乳头状癌预后的重要指标。     

基质金属蛋白酶-9与血管内皮细胞生长因子在大肠腺癌中的表达及临床病理学意义

目的 检测基质金属蛋白酶-9(MMP-9)和血管内皮细胞生长因子(VEGF)在大肠腺癌中的表达,探讨其临床病理学意义.方法 应用免疫组化法检测74例大肠腺癌组织和15例正常肠黏膜组织中MMP-9和VEGF基因的表达,分析其与大肠腺癌的分化、浆膜浸润、淋巴结转移的关系及两者的相关性.结果 MMP-9和VEGF在大肠腺癌组织中的表达明显高于正常肠黏膜(P＜0.05),在侵及浆膜组中的表达明显高于未侵及浆膜组(P＜0.05),在有淋巴结转移组中表达明显高于无淋巴结转移组(P＜0.05),在高分化组和低分化组的表达差异无显著性(P＞0.05);两者的表达具有相关性(r=0.2,P＜0.05).结论 MMP-9和VEGF在大肠腺癌组织中的表达和浸润深度、淋巴结转移有关,和分化无关,两者的表达具有相关性.     

P53、nm23蛋白和血管内皮生长因子在鼻咽癌微血管生成中的作用

目的探讨p53、nm23基因和血管内皮生长因子(VEGF)在鼻咽癌微血管生成及转移中的作用。方法通过免疫组化SP法对64例鼻咽癌标本中p53、nm23蛋白、VEGF及CD34抗体进行了检测。结果鼻咽癌中P53、nm23蛋白及VEGF的阳性表达率分别为65.63%、53.12%和68.75%。p53蛋白表达和VEGF有一致性,呈正相关(P<0.01)。在有淋巴结转移的肿瘤中p53蛋白和VEGF阳性表达率及微血管密度(MVD)明显高于非转移组(P<0.05)。nm23基因和VEGF在鼻咽癌标本中无一致性和直接相关性,在nm23基因表达阴性和VEGF阳性标本中MVD较高,这种现象多见于有淋巴结转移的鼻咽癌中。结论p53基因通过调控VEGF的表达影响瘤内MVD,促使鼻咽癌发生转移;而nm23基因可能不是通过调控VEGF的表达,而是通过其它途径影响鼻咽癌转移。     

甲状腺乳头状癌B-raf基因突变及cyclinD1、p16蛋白表达的相关性及临床病理意义

目的研究甲状腺乳头状癌中B-raf基因突变率及cyclinD1、p16蛋白表达水平,探讨关键信号分子基因突变对相关细胞周期调控因子表达的影响及意义。方法分别应用免疫组化SP法及实时荧光定量PCR法检测100例甲状腺乳头状癌和20例甲状腺良性病变中cyclinD1、p16蛋白的表达及B-raf基因的突变情况。结果甲状腺癌中cyclinD1、p16蛋白表达明显高于良性(P0.05);其B-raf基因突变率为72%,良性病变组织中未检出突变(P0.05)。Raf基因突变与患者发病年龄、淋巴结转移及包膜侵犯相关(P0.05);cyclinD1蛋白阳性与患者年龄、淋巴结转移及B-raf突变相关(P0.05)。p16蛋白表达仅与患者年龄相关(P0.05),而与其他指标均无关。甲状腺乳头状癌组织中cyclinD1与p16蛋白的表达具有负相关性(P0.05)。结论 B-raf基因突变及cyclinD1、p16蛋白高表达均为甲状腺乳头状癌发生的重要分子事件,与肿瘤浸润及转移密切相关,对其进行联合检测有助于甲状腺乳头状癌的预后评估及早期诊断。     

p27和cyclin D1在甲状腺乳头状癌中的表达及其与淋巴结转移的关系

目的:研究p27、细胞周期蛋白D1(cyclin D1)在甲状腺乳头状癌中的表达及其与甲状腺乳头状癌淋巴结转移的关系。方法:采用免疫组织化学EnVision法检测60例甲状腺良性病变(其中结节性甲状腺肿30例,甲状腺腺瘤30例)和92例甲状腺乳头状癌(其中无淋巴结转移者50例,淋巴结转移者42例)组织中p27、cyclin D1的表达情况。结果:p27在甲状腺良性病变和甲状腺乳头状癌中的阳性表达率分别为91.7%、62.0%,而cyclin D1的阳性表达率分别为28.3%、63.0%,差异均有统计学意义(P0.01)。p27在无淋巴结转移和有淋巴结转移的甲状腺乳头状癌中的阳性表达率分别为76.0%、45.2%,而cyclin D1的阳性表达率分别为50.0%、78.6%,差异均有统计学意义(P0.01)。有淋巴结转移的甲状腺乳头状癌中p27和cyclin D1的表达呈负相关(r=-0.46,P0.01)。结论:甲状腺乳头状癌中p27低表达、cyclin D1高表达,且二者与甲状腺乳头状癌的淋巴结转移相关,并对预后判断有指导意义。     

甲状腺乳头状癌中TROP2、 p-Akt及vimentin的表达及临床意义

目的:探讨TROP2、p-Akt及vimentin在甲状腺乳头状癌中的表达及临床意义。方法:采用免疫组织化学方法检测76例甲状腺乳头状癌、36例甲状腺瘤组织、36例正常甲状腺组织中TROP2、p-Akt及vimentin的表达,并对性别、年龄、肿瘤大小、临床TNM分期及淋巴结转移等因素进行分析。结果 :76例甲状腺乳头状癌中TROP2、p-Akt及vimentin蛋白的阳性表达率分别为65.8%、68.4%、69.7%,与甲状腺瘤组织、正常甲状腺组织相比,差异均有统计学意义(P<0.05)。TROP2、p-Akt及vimentin蛋白在淋巴结转移组的阳性表达率均高于淋巴结无转移组(P<0.05);TROP2、p-Akt及vimentin蛋白在Ⅲ+Ⅳ期中的阳性表达率均明显高于Ⅰ+Ⅱ期(P<0.05)。经Spearman等级相关性分析表明,TROP2与p-Akt、vimentin的表达均呈正相关(r=0.313,P=0.038;r=0.402,P=0.031);p-Akt与vimentin的表达也呈正相关(r=0.464,P=0.026)。结论:TROP2的表达与甲状腺乳头状癌的恶性侵袭及转移有关,可作为靶向治疗甲状腺乳头状癌的潜在基因。     

Dicer基因的表达与甲状腺乳头状癌的分期及转移的相关性研究

目的研究Dicer基因的表达与甲状腺乳头状癌的分期及转移的相关性。方法选取60例甲状腺乳头状癌患者,利用免疫组织化学链菌素抗生物素蛋白-过氧化物酶法对Dicer蛋白在甲状腺乳头状癌及其非癌上皮组织中的表达进行检测,通过实时荧光定量逆转录聚合酶链反应法对Dicer mRNA在甲状腺乳头状癌及其非癌上皮组织中的表达进行检测。结果 Dicer蛋白在甲状腺乳头状癌中的表达上调的比率(76.67%)明显高于非癌上皮组织(8.33%)(P0.05);Dicer mRNA在甲状腺乳头状癌中的表达上调的比率(81.67%)明显高于非癌上皮组织(11.67%)(P0.05);Dicer蛋白与Dicer mRNA在甲状腺乳头状癌患者中的表达与其分期、淋巴结转移密切相关(P0.05)。Dicer蛋白与其mRNA在甲状腺乳头状癌患者中的表达存在显著相关性(P0.05)。结论 Dicer蛋白与Dicer mRNA在甲状腺乳头状癌患者中表达上调,二者的表达存在显著相关性,与其TNM分期、淋巴结转移密切相关。     

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.