抑癌基因PTEN和血管内皮生长因子在大肠癌中的表达及相关性研究

目的探讨抑癌基因PTEN和血管内皮生长因子（VEGF）蛋白在大肠癌中表达的意义。方法采用免疫组化sP法检测48例大肠癌中PTEN和VEGF蛋白的表达，并分析其与临床和病理特点的关系。结果大肠癌中PTEN蛋白表达阳性率为45．8％（22／48），显著低于正常大肠黏膜组织的阳性率（P〈0．01）；VEGF蛋白表达阳性率为72．9％（35／48），显著高于正常大肠黏膜组织的阳性率（P〈0．01）；PTEN和VEGF蛋白表达呈负相关（P〈0．01）；PTEN蛋白低表达和VEGF蛋白高表达与大肠癌Dukes分期、浆膜浸润、淋巴结转移有关（均P〈0．01），而与年龄和组织学类型无关（P〉0．05）。结论PTEN和VEGF蛋白表达与大肠癌临床病理特征和生物学行为有密切关系，联合检测PTEN和VEGF蛋白的表达，对大肠癌的恶性程度及预后判断具有重要的临床意义。     

VEGF、STAT3在大肠癌组织中的表达及其相关性研究

目的探讨血管内皮生长因子（VEGF）和信号转导子与转录活化子3（STAT3）表达在大肠癌中的变化，以及与大肠癌临床病理的关系，并研究两者的相关性。方法采用免疫组化方法检测大肠癌中VEGF、STAT3的表达情况。结果大肠癌中VEGF、STAT3蛋白表达阳性率分别为66．7％（22／33）和63．6％（21／33），显著高于正常大肠组织的阳性率（P〈0．01）；VEGF的表达与Duke’s分期及有无淋巴结转移有关（P〈0．05）；而STAT3的表达与肿瘤的分化程度、Duke’s分期有关及有无淋巴结转移有关（P〈0．05）。相关分析表明VEGF和STAT3正相关（P〈0．05）。结论大肠癌组织中存在VEGF和STAT3的高表达，VEGF的表达与大肠癌病程的发展及淋巴转移关系相关，而STAT3的表达除与大肠癌病程的发展及淋巴转移相关外，还与大肠癌组织的分化程度有关。另外，大肠癌的发生过程中VEGF可能受STAT3的调控，STAT3可能会成为大肠癌的抗血管生成新的治疗靶点。     

MMP-9和VEGF在大肠癌组织中的表达及其与血管生成的关系

目的 探讨MMP-9、VEGF,CD34在大肠癌组织中的表达及与血管生成的关系。方法 采用免疫组织化学S—P法检测68例大肠癌组织，常规石蜡包埋进行MMP-9、VEGF、CD34免疫组织化学染色。结果 MMP-9在大肠癌组中的阳性表达率为67．6％（46/68），与正常大肠组织比较有非常显著性差异（P〈0．01）；MMP-9表达随Duke8分期而增强；大肠癌组织VEGF阳性表达率显著高于正常大肠组（P〈0．01），大肠癌组织中MMP-9表达与VEGF表达有一致性（P〈0．05）。结论 MMP-9有明显的促血管作用，可能与激活VEGF有关，并在大肠癌发生发展中起重要作用。     

PTEN与CDX2在结直肠癌组织中的表达及临床意义

目的通过对张力蛋白同源物基因（PTEN）和同源盒转录因子（COX2）在大肠癌中表达的研究,探讨PTEN和CDX2的相关性。方法应用免疫组织化学S-P法检测58例大肠癌组织及20例正常大肠组织中PTEN和CDX2的表达。结果大肠癌组织中PIEN与CDX-2蛋白表达显著低于正常大肠组织中表达（P〈0．01）,且与淋巴结转移及Dukes分期相关（P〈0．05）,而与大肠癌组织分化程度不相关（P〉0．05）。结论在调节肠上皮细胞增殖分化方面nEN对CDX2有调控作用。CDX2与PIEN在结直肠癌发生、发展中起着重要作用。     

大肠癌术后复发与血管内皮细胞生长因子及其受体表达的关系

目的：研究血管内皮细胞生长因子（VEGF）及其受体（KDR）与大肠癌术后复发的关系。方法：应用免疫组化SP法检测94例大肠癌标本VEGF及KDR蛋白表达，分析VEGF和KDR与临床病理因素、微血管密度（MVD）及术后复发的关系。结果：VEGF和KDR表达与大肠癌Duke分期、淋巴结转移密切相关（P＜0．01），而与组织学分型无关（P＞0．05）。VEGF和KDR表达阳性组MVD显著高于阴性组（P＜0．01）。大肠癌术后复发与VEGF、KDR密切相关，VEGF组（P＜0．01），KDR组（P＜0．05）。但各复发转移部位的关系并不密切（P＞0．05）。结论：VEGF和KDR与大肠癌血管生成相关，在大肠癌的发生、发展及术后复发中起重要作用，可反映大肠癌的进展情况，并可作为判断预后的指标。     

MMP-2和TIMP-2在大肠癌组织中的表达及其意义

目的探讨基质金属蛋白酶（MMP-2）及其抑制物（TIMP-2）的表达与大肠癌浸润，转移的关系。方法应用免疫组织化学S-P法对58例大肠癌组织中MMP-2和TIMP-2进行检测，并以大肠腺瘤组织标本20例作为对照。结果MMP-2的表达率在大肠癌为74．1％，高于大肠腺癌瘤的35％（P〈0．05）。其表达与大肠癌的浸润深度，Dukes分期和淋巴结转移均密切相关（P〈0．05）。TIMP-2的表达在大肠腺瘤及大肠癌组织中无显著性差异（P〉0．05），但其表达与大肠癌组织学类型。分化程度，淋巴结有无转移密切相关，大肠癌MMP-2和TIMP-2蛋白表达存在显著负相关（r=-0．3684，P〈0．05）。结论MMP-2和TIMP-2对大肠癌浸润、转移均有明显影响。MMP-2蛋白阳性表达促进大肠癌浸润和转移，MMP-2和TIMP-2的检测可作为临床判断大肠癌的恶性程度、转移及估计预后的重要参考指标。     

大肠癌组织中COX-2，iNOS，VEGF的表达及其临床意义

目的探讨COX-2,iNOS,VEGF在大肠癌组织中的表达及其临床意义。方法采用免疫组化方法检测58例大肠癌组织中COX-2,iNOS,VEGF的表达,并分析其临床意义。结果58例大肠癌组织中COX-2,iNOS,VEGF的阳性表达率分别为79．31％（46／58）、84．48％（49／58）和79．31％（46／58）,显著高于正常大肠组织（P〈0．01）,与患者年龄、有无淋巴结转移、肿瘤体积及组织学类型差异无统计学意义（P〉0．05）,COX-2与VEGF的表达存在一定相关性（P〈0．05）,COX-2与iNOS的表达也存在一定相关性（P〈0．05）。结论大肠癌组织COX-2、iNOS的表达与肿瘤血管生成密切相关,二者可能与VEGF协同促进肿瘤血管生成,是判断肿瘤恶性程度及预后的的重要生物学指标。     

PTEN与VEGF在乳腺癌中的表达及其意义

目的探讨抑癌基因PTEN蛋白在人乳腺癌中的表达情况及其与VEGF表达的相关性。方法应用免疫组织化学染色S—P法。检测44例乳腺癌组织和10例乳腺纤维瘤石蜡切片中PTEN蛋白、VEGF蛋白的表达情况，比较PTEN蛋白表达与VEGF蛋白表达的相关性及二者与临床病理指标的关系。结果PTEN蛋白表达定位于细胞质，乳腺癌组织PTEN蛋白表达阴性者占47．7％（21／44），表达阳性者占52．3％（23／44）。PTEN在乳腺癌腋淋巴结是否转移（P〈0．01）或ER状态（P〈0．05）组间比较有统计学意义。PTEN与VEGF蛋白表达呈副相关，但差异不显著（rH=-0．236P=0．122）。结论PTEN对乳腺癌预后判定有一定价值，乳腺癌患者PTEN蛋白低表达与预后不良有关。VEGF可能是PTEN的主要下游基因，二者对乳腺癌发生发展起重要作用。     

血管内皮生长因子在乳腺浸润性导管癌中的表达及意义

目的 检测乳腺浸润性导管癌中血管内皮生长因子（VEGF）的表达水平及肿瘤微血管密度（MVD）值，探讨VEGF、MVD水平及与临床病理学特征之间的相关性。方法 采用免疫组化染色法（SP法）分别检测88例乳腺癌患者术后标本中VEGF的表达水平、MVD值以及C-erbB-2表达情况。结果 88例标本中VEGF阳性62例，阳性率为70．45％；淋巴结转移组中VEGF表达水平高于未转移组（P〈0．05）；相对中晚期组（Ⅱb-Ⅲ）中VEGF表达水平高于相对早期组（Ⅰ-Ⅱa）（P〈0．05）；C-erbB-2阳性组中VEGF表达水平高于阴性组（P〈0．05）；随着癌组织学分级的升高，VEGF表达水平也有逐渐升高趋势（P〈0，05）。随着癌组织学分级的升高，MVD值也呈现出逐渐增高趋势（P〈0．01）；MVD值随着VEGF表达水平增高而增高（P〈0．01）。结论 VEGF在乳腺浸润性导管癌的肿瘤血管生成及转移过程中可能发挥重要的调控作用。VEGF和MVD值可作为反映乳腺癌生物学行为的指标之一。以VEGF为靶点的抗血管生成治疗策略有望成为治疗C-erbB-2阳性患者的一条新的途径。     

抑癌基因DPC4蛋白在大肠癌组织中缺失表达及临床意义研究

目的探讨抑癌基因DPC4（deletedinpancreaticcancerlocus4）蛋白在大肠癌组织中的缺失表达特征及临床意义，阐明DPC4蛋白缺失表达与大肠癌发生的关系。方法采用免疫组化（SP法）检测50例大肠癌组织、癌旁组织及正常大肠组织中DPC4的表达，以20例正常大肠组织作为对照分析。结果50例大肠癌组织中DPC4阳性率为32％，癌旁组织中DPC4阳性率为34％，正常大肠组织DPC4阳性率100％，癌和癌旁的DPC4表达与正常大肠组织DPC4表达的差异有统计学意义（P〈0．01）。大肠癌组织中DPC4蛋白表达随着病理组织学分化程度下降而降低，淋巴结转移组DPC4的阳性表达低于淋巴结无转移组，但差异无统计学意义。结论DPC4蛋白表达缺失是大肠癌的发生发展的重要因素之一。     

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.     

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.     

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.     

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.