血管形成因子在非小细胞肺癌中的表达及其临床意义

目的探讨血管形成因子在非小细胞肺癌(NSCLC)中的表达及其在NSCLC发生、生长和转移中的作用。方法在光学显微镜下计数微血管密度(MVD),用免疫组织化学链霉素抗生物素蛋白-过氧化酶(S-P)法对血管内皮细胞生长因子(VEGF)和内皮抑素进行染色观察,分析它们之间的相关关系。结果有淋巴结转移者MVD、VEGF和内皮抑素表达均较无淋巴结转移者高(P<0.05),肺癌组织MVD、VEGF和内皮抑素表达均较正常肺组织高(P<0.05);但与肺癌患者的性别和年龄无明显的关系(P>0.05);T3 T4的原发肿瘤VEGF表达水平较T1 T2者高(P<0.05)。肺癌组织MVD、VEGF积分光密度和内皮抑素积分光密度在期、期和期间两两比较差异均有统计学意义(P<0.01)。不分期时MVD与VEGF呈正相关(r=0.680,P=0.023),MVD与内皮抑素呈负相关(r=-0.700,P=0.015)。正常肺组织中VEGF与内皮抑素呈正相关(r=0.620,P=0.027)。结论新生血管的形成在NSCLC的发生、生长和转移过程中发挥着重要作用,其形成可能是由于VEGF和内皮抑素的平衡被破坏所致。     

碱性成纤维细胞生长因子和血管生成与胃癌发展的关系

目的:探讨碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)和血管生成与胃癌发展的关系.方法:应用免疫组织化学方法检测56例人胃癌组织碱性成纤维细胞生长因子表达和微血管密度(microvasculardensity,MVD),分析bFGF和MVD及其与胃癌组织学分型、浸润深度、生长方式、淋巴结转移、远处转移和预后的关系.结果:bFGF阳性者MVD值显著高于bFGF阴性者(P<0.01),MVD值和bFGF表达与胃癌浸润深度(P<0.05)、淋巴结转移(P<0.01)和远处转移(P<0.05)密切相关;MVD≥43或bFGF表达阳性的胃癌患者5年生存率较低.结论:血管生成在胃癌发展中具有重要作用,bFGF不仅与胃癌的血管生成有关,而且与胃癌的生长和浸润转移也有关,MVD或bFGF可作为判断胃癌患者预后的指标.     

骨肉瘤肺转移与血管内皮生长因子和微血管密度的关系

目的 探讨骨肉瘤盱市转移与血管内皮生长因子(VEGF)和微血管密度(MVD)的关系.方法 用免疫组织化学法检测30例骨肉瘤组织中VEGF的表达和MVD.结果 VEGF在骨肉瘤中的阳性率表达分别为70.00%(21/30),其中有肺转移的病例阳性率为92.31%(12/13).无肺转移病例的阳性率为52.94%(9/17),差异有统计学意义(P<0:05).骨肉瘤组织中VEGF阳性表达与骨肉瘤的组织学分型无明显相关(P>0.05).骨肉瘤中VEGF表达强度与MVD呈正相关(r=0.799,P<0.01);有肺转移的骨肉瘤患者其瘤组织中MVD与无肺转移的骨肉瘤患者其瘤组织中MVD差异有统计学意义(P<0.05),有肺转移的明显高于无肺转移的病例.结论 VEGF是促进微血管生成的主要细胞因子,检测VEGF表达与MVD值可作为判断肿瘤预后的重要指标.     

应用组织芯片技术检测KiSS-1基因在胆囊癌中的表达

目的 探讨转移抑制基因KISS-1在人胆囊癌转移过程中的作用及临床意义.方法 应用组织芯片和免疫组织化学(EnVision)技术检测KISS-1在59例胆囊癌(其中肝脏侵犯13例,淋巴结转移13例)、7例癌旁和6例正常胆囊组织中的表达.结果 胆囊癌组织中KISS-1的表达阳性率明显低于正常和癌旁组织(P<0.05).在胆囊癌中,KISS-1阳性表达与患者性别、年龄,肿瘤大小、组织学类型、分化程度及淋巴结转移均无关,而与胆囊癌的浸润深度、肝脏侵犯及临床分期(Nevin分期)有关(P<0.01).KISS-1在Ⅰ Ⅱ期和Ⅲ Ⅳ期以及V期胆囊癌组织中的表达阳性率分别为92.3%、57.1%和27.8%,呈明显下降趋势(P=0.002).结论 KISS-1的表达降低与人胆囊癌的发生及其侵袭、转移过程密切相关,可能参与了胆囊癌的发生、侵袭及转移过程的调控.     

增殖型腺病毒介导的人内皮抑素基因治疗胰腺癌

目的 观察携带人内皮抑素基因的双重调控增殖型腺病毒(AdTPHre-hEndo)对胰腺癌的治疗作用.方法 通过病毒重组技术将人内皮抑素基因克隆入双重调控增殖型腺病毒基因组中,获得腺病毒滴度为3.25×1010pfu/ml;通过建立SW-1990胰腺癌细胞Balb/c裸鼠皮下移植瘤模型,分析基因转导后胰腺癌组织中内皮抑素的表达情况及对肿瘤血管的抑制作用.结果 构建了AdTPHre-hEndo;AdTPHre-hEndo组荷瘤裸鼠肿瘤体积显著低于携带人内皮抑素基因的重组腺病毒(Ad-hEndo)组(P＜0.01)和选择性增殖型腺病毒(ONYX-015)组(P＜0.05);AdTPHre-hEndo组内皮抑素表达量明显高于Ad-hEndo组和对照组(P＜0.01).AdTPHre-hEndo组肿瘤微血管密度(MVD)为6.8±2.5,Ad-hEndo组和对照组MVD分别为16.0±4.6(P＜0.01)、47.2±10.0(P＜0.01).结论 所构建的AdTPHre-hEndo可有效表达具有生物学活性的内皮抑素,使肿瘤内微血管生成减少,肿瘤细胞增殖减慢,具备应用于胰腺癌临床治疗的潜力.     

胆囊癌及其良性病变组织中CCL3及其受体表达的临床病理意义

目的 研究胆囊癌、慢性胆囊炎和胆囊结石组织中CCL3及其受体CCRl表达水平及其临床病理意义.方法 108例胆囊腺癌、15例慢性胆囊炎和20例胆囊结石组织标本常规制作石蜡包埋切片,CCL3和CCR1染色方法 为SP免疫组化法.结果 胆囊腺癌CCL3和CCR1表达阳性率及其评分明显高于慢性胆囊炎和胆囊结石组织(P<0.01);腺瘤癌变或高分化腺癌、肿块最大径<2 cm、淋巴结未转移及未侵犯周围组织病例CCL3和CCR1的表达阳性率及其评分明显低于低分化腺癌、肿块最大径≥2 cm、淋巴结转移和侵犯周围组织病例(P<0.05或P<0.01);胆囊癌中CCL3和CCR1表达呈高度一致性(P<0.01),其评分值呈高度密切正相关(r=0.68,P<0.01).结论 CCL3及其受体CCR1表达可能是反映胆囊癌发生、进展、生物学行为和预后的重要生物学标记物.     

Survivin在原发性肝癌组织中的表达及与MVD的关系

目的 研究原发性肝癌组织中Survivin的表达及其与微血管密度(microvessel density,MVD)的关系,探讨它们之间及其与原发性肝癌临床病理特征的相互关系. 方法 用ABC免疫组化法测定56例原发性肝癌组织及癌旁组织中Survivin的表达水平及MVD. 结果 56例原发性肝癌组织中Survivin的阳性表达率(62.5%)和MVD计数均值[(55.43±6.72)个/HP],明显高于癌旁组织中Survivin的阳性表达率(14.3%)及MVD计数均值[(21.04±3.26)个/HP](P值均<0.05);Survivin的表达情况及MVD与原发性肝癌组织的分化程度、肿瘤有无转移、肿块直径、门静脉、肝静脉癌栓关系密切(P<0.05);原发性肝癌组织中Survivin表达评分与MVD之间存在正相关关系(P<0.01). 结论 Survivin和MVD的表达可能与原发性肝癌的发生、发展及血管生成密切相关.     

生长抑素和KDR表达与胰腺癌血管形成关系及临床意义

目的:探讨人胰腺癌组织生长抑素和血管内皮生长因子受体KDR(kinase insert domain con-taining receptor)的表达与血管形成的关系及其临床意义.方法:采用免疫组织化学方法检测62例人胰腺癌组织生长抑素(somatostatin SS)和KDR的表达,并对CD34+血管进行微血管密度(MVD)计数,对KDR及SS表达阳性血管进行半定量计数.结果:胰腺癌组织KDR高、中表达组的MVD明显高于KDR低表达组(P<0.01);而在SS低表达组的MVD明显高于高、中表达组(P<0.01).KDR的表达与肿瘤大小及远处转移相关(P<0.05),SS的表达与肿瘤大小及分化程度有关(P<0.05),并且KDR与SS的表达存在明显负相关(P<0.01).MVD与肿瘤大小相关(P<0.05).结论:KDR、SS在胰腺癌组织中的表达与肿瘤血管形成及调控密切相关,与胰腺癌的发生、发展及转移可能密切相关,可作为评估胰腺癌患者预后的指标.     

血管内皮生长相关因子在胰腺癌组织中的表达

目的 观察胰腺癌组织中的血管内皮生长相关因子:色素上皮衍生因子(PEDF)和血管内皮生长因子(VEGF)的表达以及胰腺癌中PEDF和VEGF平衡关系的变化与其预后的关系.方法 用SP免疫组织化学方法检测51例胰腺癌标本,观察PEDF和VEGF在胰腺癌中的表达以及相应的微血管密度(MVD),并和肿瘤血管密度、肿瘤浸润深度、肿瘤大小、血管侵犯、肿瘤病理TNM分期、淋巴结转移、远处转移等临床病理指标作单因素和多因素COX回归分析.结果 PEDF/VEGF与MVD之间明显关系(P<0.01),PEDF/VEGF值大小与肿瘤病理TNM分期(P<0.01)、淋巴结转移(P<0.01)、远处转移(P<0.05)有密切关系.Kaplan-Meier生存曲线分析,51例患者根据PEDF/VEGF值是否大于0.5分为两组,其中PEDF/VEGF≥0.5组生存曲线明显高于PEDF/VEGF<0.5组(log-rank test,P<0.01).PEDF/VEGF比值(风险系数0.390;P<0.05)、淋巴结转移(风险系数3.38;P<0.01)、远处转移(风险系数3.447;P<0.01)是胰腺癌独立的预后指标.结论 PEDF/VEGF比值可较好反映胰腺癌中的血管增生;它与胰腺癌患者的临床分期、淋巴结转移及远处转移相关,是胰腺癌重要的预后因子之一.     

骨肉瘤肺转移与血管内皮生长因子和微血管密度的关系

目的 探讨骨肉瘤盱市转移与血管内皮生长因子(VEGF)和微血管密度(MVD)的关系.方法 用免疫组织化学法检测30例骨肉瘤组织中VEGF的表达和MVD.结果 VEGF在骨肉瘤中的阳性率表达分别为70.00%(21/30),其中有肺转移的病例阳性率为92.31%(12/13).无肺转移病例的阳性率为52.94%(9/17),差异有统计学意义(P<0:05).骨肉瘤组织中VEGF阳性表达与骨肉瘤的组织学分型无明显相关(P>0.05).骨肉瘤中VEGF表达强度与MVD呈正相关(r=0.799,P<0.01);有肺转移的骨肉瘤患者其瘤组织中MVD与无肺转移的骨肉瘤患者其瘤组织中MVD差异有统计学意义(P<0.05),有肺转移的明显高于无肺转移的病例.结论 VEGF是促进微血管生成的主要细胞因子,检测VEGF表达与MVD值可作为判断肿瘤预后的重要指标.     

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.     

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.     

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.