血管内皮生长因子-C、D对大肠癌的预后判断价值

目的观察血管内皮生长因子(VEGF)-C和VEGF-D在大肠癌中的表达,探讨其在大肠癌预后判断中的价值。方法抽取1996年1月至1998年1月于我院行大肠癌根治术且接受正规随访的大肠癌病例69例;采用EnVision免疫组织化学技术检测VEGF-C和VEGF-D在69例大肠癌及20例正常大肠组织的表达;采用抗CD34免疫组织化学技术评价大肠癌微血管密度(MVD);采用Axioplan 2 imaging显微图像分析系统对免疫组织化学染色结果进行定量分析。结果69例患者平均随访(68.96±32.79)个月,中位随访87个月,108个月无病生存率与总生存率分别为51.44%和60.07%。大肠癌VEGF-C和VEGF-D表达显著高于相应正常大肠组织(P<0.01);VEGF-C表达与大肠癌淋巴结转移及临床分期显著相关(P<0.05);VEGF-D表达与大肠癌患者年龄(≤68;>68岁)、淋巴结转移及肿瘤浸润深度显著相关(P<0.05)。VEGF-C和VEGF-D表达与大肠癌MVD显著相关(P<0.05);VEGF-C和/或VEGF-D高表达的大肠癌患者组总生存期和无病生存期均显著低于VEGF-C和/或VEGF-D低表达患者组(P<0.05)。结论VEGF-C和VEGF-D在大肠癌中异常高表达,且与大肠癌淋巴结转移、临床分期、无病生存与总生存率显著相关,可作为临床大肠癌预后判断标志物。     

大肠癌组织中血管内皮生长因子D表达与预后的关系

目的研究血管内皮生长因子D（VEGF-D）在大肠癌中的表达,探讨其表达水平与大肠癌临床病理特征、微血管密度（MVD）及预后的关系.方法抽取1996年1月至1998年1月于瑞金医院外科行结直肠癌根治术且接受正规随访的大肠癌病例69例;所有病例术后第1、2年每3个月、第3年每6个月、第4年后每年1次接受门诊随访,包括体格检查、血清癌胚抗原（CEA）检测、胸片、肝脏B超、腹部CT等.采用免疫组织化学技术检测VEGF-D在69例大肠癌及20例正常大肠组织的表达;采用抗CD34免疫组织化学技术评价大肠癌MVD;采用Axioplan 2 imaging显微图像分析系统对免疫组织化学染色结果进行定量.结果所有（69/69）大肠癌组织和25%（5/20）正常大肠组织检测到VEGF-D表达,染色定位于肿瘤细胞浆.VEGF-D表达显著高于相应正常大肠组织（P＜0.01）;VEGF-D表达与大肠癌患者年龄（≤68岁;＞68岁）、淋巴结转移及肿瘤浸润深度显著相关（P＜0.05）;VEGF-D表达与大肠癌患者性别、远处转移、临床分期、分化程度及肿瘤部位相关性均无统计学意义.VEGF-D表达与大肠癌MVD显著相关（P＜0.05）;VEGF-D高表达的大肠癌患者组总生存期和无瘤生存期显著低于VEGF-D低表达患者组（P＜0.05）.结论VEGF-D在大肠癌中有异常高表达,且与无瘤生存与总生存率显著相关,可用于判断大肠癌预后.     

大肠癌组织VEGF-C表达与血管生成和细胞增殖关系的研究

目的：研究大肠癌组织血管内皮生长因子C（VEGF—C）表达与肿瘤血管生成及肿瘤细胞增殖的关系。方法：采用SP免疫组织化学方法，检测81例大肠癌VEGF-C、CD34和Ki-67的表达，并分析VEGF-C与微血管密度（MVD）、Ki-67增殖指数（Ki-67PI）的相关性。结果：81例大肠癌中，VEGF-C表达阳性45例（55．56％）；VEGFC表达阳性的肿瘤其MVD和Ki-67PI高于VEGF-C者（P〈0.05）。VEGF-C表达与MVD、Ki-67PI呈正相关（P〈0.05）。有转移组（包括淋巴结转移和远处转移）的VEGF-C表达明显高于无转移组，表达随肿瘤分期的升高而增强。结论：VEGF-C通过诱导新生血管形成，促进肿瘤细胞的增殖生长，影响着大肠癌的浸润和转移。     

大肠癌组织中促红细胞生成素受体表达与微血管密度的关系

目的：探讨大肠癌组织中促红细胞生成素受体（erythropoietin receptors,Epo-R）表达与肿瘤微血管密度（microvessel density,MVD）和临床病理特征的关系。方法：采用免疫组织化学SP法对60例大肠癌组织、20例正常大肠组织中Epo-R和MVD进行检测。结果：60例大肠癌组织均检测到Epo-R的表达。大肠癌组织MVD值为30.8±9.5,显著高于正常大肠组织的4.1±2.5（P〈0.01）。MVD水平与大肠癌患者年龄、肿瘤浸润深度、淋巴结转移、远处转移、临床分期有显著相关性（P〈0.05）。Epo-R表达与大肠癌组织MVD成正相关。结论：Epo-R在大肠癌组织中有异常高表达,且与MVD和临床病理特征成正相关,可能在肿瘤新生血管形成中有重要作用。     

血管内皮生长因子-C和生存素在胃癌组织中的表达及其临床意义

目的 探讨胃癌组织中血管内皮生长因子（vascular endothelial growth factor，VEGF）-C和生存素（sunrivin）蛋白表达及其临床意义。方法 采用免疫组织化学SP法检测97例原发性胃癌组织、癌旁组织及20例正常胃黏膜组织中VEGF-C和survivin蛋白的表达，并分析其与临床病理特征和预后的关系。结果 胃癌组织VEGF-C和survivin蛋白表达阳性率分别为66．0％和57．2％，显著高于癌旁组织和正常胃组织（P〈0．05）；VEGF-C蛋白表达与肿瘤分化程度、肿瘤部位、肿瘤直径、静脉侵犯及远处转移等无关，但与淋巴结转移、淋巴管侵犯、浆膜面受累和肿瘤TNM分期等密切相关；survivin蛋白表达与肿瘤分化程度、肿瘤部位、肿瘤直径、静脉侵犯等无关，但与浆膜面受累、淋巴管侵犯、淋巴结转移、远处转移和肿瘤TNM分期等密切相关；VEGF-C和survivin阳性表达组术后生存率明显低于阴性组；VEGF-C和survivin在胃癌组织中阳性表达呈正相关。结论 VEGF-C及survivin蛋白的阳性表达可作为胃癌预后不良的参考指标。     

食管癌病人胸导管淋巴液、血清及癌组织中VEGF-C的表达及临床意义

目的 观察血管内皮生长因子C(VEGF-c)在食管癌组织、血清及胸导管淋巴液中的表达,分析其与肿瘤淋巴结转移的关系.方法 应用免疫组织化学SP法检测76例食管癌组织中VEGF-C的表达,酶联免疫吸附(ELISA)法测定血清和胸导管淋巴液中VEGF-C含量.结果 食管癌VEGF-C表达阳性率为63.1%,VEGF-C表达与食管癌的淋巴结转移、TNM分期显著相关(P<0.01,P<0.05),与病人年龄、肿瘤长度及病理类型无关;胸导管淋巴液中VEGF-C含量明显高于血清并与淋巴结转移有显著相关性(P<0.05).结论 食管癌组织中VEGF-C表达与肿瘤TNM分期、淋巴结转移呈明显正相关.胸导管淋巴液中VEGF-C含量明显较血清中高,淋巴液和血清中VEGF-C含量同食管癌淋巴结转移正相关.     

血管内皮生长因子-C在大肠癌中的表达及其与淋巴结转移的关系

目的研究血管内皮生长因子-C(VEGF-C)在大肠癌中的表达,探讨其与淋巴结转移的关系。方法应用免疫组织化学染色法检测94例大肠癌组织标本中VEGF-C的表达,同时应用逆转录-聚合酶链反应(RT-PCR)检测其mRNA在4株大肠癌细胞株中的表达。结果VEGF-C在53.2%的大肠癌患者中呈阳性表达;VEGF-C在淋巴结转移阳性组中的表达,与阴性组比较差异有统计学意义(P<0.01);VEGF-C的表达与淋巴管浸润和Dukes分期密切相关(P<0.01),但与年龄、性别、肿瘤的位置、浸润深度和血管浸润均无明显相关。VEGF-CmRNA表达于大肠癌LoVo及LoVo-5-Fu耐药细胞株。结论VEGF-C的表达可能参与肿瘤淋巴管生成,与大肠癌淋巴结转移密切相关。     

VEGF、MVD和CEA与大肠癌病理学特征及预后相关性的临床研究

目的通过检测大肠癌组织内血管内皮生长因子(VEGF)的蛋白表达、微血管密度(MVD)及术前血清CEA值,探讨其与大肠癌病理学特征及预后的相关性。方法采用免疫组化Envision方法,对来自日本金泽医科大学一般消化器外科1990～1995年的78例手术切除大肠癌标本的癌灶、癌旁、正常大肠组织进行血管标记和染色,并进行定位观察,检测其VEGF表达及MVD计数,同时回顾分析血清CEA值变化,并与病人预后及病理特征进行比较。结果78例大肠癌病人中,48例病人(61.2%)VEGF蛋白表达阳性,MVD计数为(38.6±9.4),CEA阳性病人35例(44.7%)。它们与肿瘤浸润深度、淋巴结、血行转移及Dukes分期呈明显相关性(P<0.05)。而与肿瘤大小、组织学分型、生长方式无关(P>0.05)。而且,VEGF阳性组与阴性组5年生存率分别为66.8%、86.7%,差异显著(P<0.05);CEA阳性组与阴性组5年生存率亦有明显区别(P<0.05);VEGF /CEA 组5年生存率最低。MVD与VEGF呈明显的相关性。结论VEGF、MVD及CEA与大肠癌浸润转移,分期及生存率呈明显相关性,VEFG和CEA联合检测,对大肠癌预后的判断更具有实际意义。     

胆管癌微血管计数和VEGF及MMP2的表达及其意义

目的：探讨胆管癌组织中微血管密度（MVD）、血管内皮生长因子（VEGF）、基质金属蛋白酶2（MMP2）与胆管癌转移、预后的关系。方法：应用免疫组化的方法检测45例胆管癌及8例正常肝外胆管组织的MVD，VEGF和MMP2表达。结果：（1）胆管癌组织MVD值，VEGF，MMP2阳性表达率显著高于正常胆管组织（P＜0．05）；（2）胆管癌组织MVD，VEGF，MMP2的表达强度与胆管癌的病理分期、淋巴结转移有显著相关性（P＜0．05）；结论：MVD增高提示胆管癌转移侵袭潜能增加，VEGF，MMP2可能作为预测胆管癌转移的指标。     

MMP-2、PTEN、VEGF-C在大肠癌组织中的表达研究

【摘要】〓目的〓探讨大肠癌组织中基质金属蛋白酶-2(MMP-2)、磷酸酶基因(PTEN)、血管表皮生长因子C(VEGF-C)的表达。方法〓应用S-P免疫组化法对50例大肠癌手术切除标本进行抗人MMP-2单克隆抗体和PTEN、VEGF-C克隆抗体免疫组化染色,检测癌组织、癌旁组织区域MMP-2和PTEN、VEGF-C表达, 分析其与大肠癌临床病理特征之间的关系。结果〓大肠癌组织中MMP-2、VEGF-C 等表达明显高于正常大肠黏膜组织,PTEN表达明显低于正常大肠黏膜组织,且比较差异均有统计学意义(P<0.05);大肠癌组织分化程度愈低、临床TNM分期越晚、出现淋巴结或远处转移,则大肠癌组织中PTEN的阳性表达率就越低,而MMP-2、VEGF-C的阳性表达率就越高(P<0.05)。结论〓MMP-2和PTEN、VEGF-C与大肠癌的发生、侵袭和转移具有潜在影响作用,检测MMP-2和PTEN、VEGF-C的表达可作为判断大肠癌病变发展和转移潜能的指标。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

骨折不愈合与延迟愈合的成因与治疗

目的探讨骨折不愈合与延迟愈合的成因、报肯治疗的方法与设果。方法对1990年7月～2004年12月间收治的107例骨折不愈台、54例骨折延迟愈合2例先天性胫骨骨不连进行回顾性研究，分析原因，随访治疗结果。18例延迟愈合行保守治疗，本组其他145例行手术治疗，结果除2例先天性胫骨骨不连外，其余161例的成因中均有医源性因素。10例失去随访，153例平均随访17（6-28）个月，骨折均获骨性连接，愈合时间平均10（6-14）个月，肢体功能恢复良好，结论医源性技术缺陷是骨折不愈合与延迟愈合的主要原因，针对各种不同因素进行合理治疗可获得满意效果。     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.