彩色多普勒超声检测肝癌血流及其与MVD、VEGF表达的关系

目的：利用彩色多普勒超声检测肝癌血流并探讨其与微血管密度（MVD）、血管内皮生长因子（VEGF）的关系。方法：采用彩色多普勒超声检测45例肝癌肿瘤血流信号，计测阻力指数（RI）、相对灌注率，血流分级。采用免疫组织化学技术检测肿瘤MVD及VEGF表达。结果：肿瘤内阻力指数（RI）、相对灌注率、血流等级和MVD相关，相对灌注率、血流等级和VEGF表达相关，阻力指数与VEGF表达不相关。结论：彩色多普勒超声联合上述免疫组织化学指标可从不同角度反映肝癌的血管生成特征，有助于对肝癌血管生成进行评价。     

听神经瘤的微血管计数与血管内皮因子表达及其临床意义

目的　通过检测听神经瘤的微血管计数（ＭＶＣ）与血管内皮因子（ＶＥＧＦ）表达，探讨二者之间的关系及其在临床上的意义。方法　采用免疫组织化学（Ｓ－Ｐ）方法，检测８７例听神经瘤组织中Ｍ　ＶＣ与ＶＥＧＦ表达，结果进行ｘ２检验分析。结果ＭＶＣ、ＶＥＧＦ表达与肿瘤直径大小无相关性（Ｐ＞０．０５），与肿瘤生长速度呈明显正相关（Ｐ＜０．０１）；ＶＥＧＥＦ表达与ＭＶＣ之间呈明显正相关（Ｐ＜０．０１）。结论ＭＶＣ与ＶＥＧＦ表达能够反映听神经瘤的生长情况，并为制定肿瘤的治疗方案和判断预后提供重要的信息。     

胃腺癌组织中RasP21蛋白和VEGF的表达与胃癌预后

目的 探讨胃癌组织中ＲａｓＰ２１血管内皮生长因子（Ｖａｓｃｕｌａｒ ｅｎｄｏｔｈｅｌｉａｌ ｇｒｏｗｔｈ ｆａｃｔｏｒ,ＶＥＧＦ）及微血管密度（Ｍｉ－ｃｒｏｖｅｓｓｅｌ ｄｅｎｓｉｔｙ,ＭＶＤ）的关系。方法 应用免疫组化Ｓ－Ｐ法检测４０例胃癌及２０例正常胃组织中ＶＥＧＦ、ＰａｓＰ２１及ＭＶＤ。结果 （１）正常胃组织中ＶＥＧＦ表达全部阴性;在胃癌组织中ＲａｓＰ２１、ＶＥＧＦ阳性分别为７０．０％、６２．５％。（２）ＲａｓＰ２１与ＭＶＤ及淋巴结转移有显著差异（Ｐ〈０．０５）。ＶＥＧＦ的表达与细胞组织学分级、ＭＶＤ及淋巴结转移有显著差异（Ｐ〈０．０５）。在中组织中ＲａｓＰ２１和ＶＥＧＦ的阳性表达强度与ＭＶＤ、淋巴结转移呈等级正相关（Ｐ〈０．０５）。（３）ＲａｓＰ２１的表达强度与ＶＥＧＦ表达强度呈等级正相关。结论 ｒａｓ     

急性脑血管病合并多器官功能障碍综合征患者血浆血管紧张素-Ⅱ的动态变化

血管紧张素Ⅱ（ＡＴⅡ）参与脑水肿的发生,并与急性脑血管病（ＡＣＶＤ）的转归及预后有关〔１〕。我们动态监测５３例ＡＣＶＤ合并或不合并多器官功能障碍综合征（ＭＯＤＳ）患者血浆ＡＴⅡ的变化规律,并探讨ＡＴⅡ在ＡＣＶＤ及ＭＯＤＳ发生发展中的病理作用机制。１　资料与方法１１　病例：脑梗死组２３例中男１４例,女９例;平均年龄（５７４８±１０７８）岁。脑出血组１８例中男１１例,女７例;平均年龄（６２６１±８１６）岁。ＡＣＶＤ并ＭＯＤＳ组１２例中男１０例,女２例;平均年龄（６７８３±７３１）岁。诊…     

偏头痛患者血浆内皮素和一氧化氮含量的检测及其意义

目的：探讨血浆内皮素（ＥＴ）和一氧化氮（ＮＯ）含量变化在偏头痛发病中的临床意义。方法：采用经颅彩色多普勒超声（ＴＣＤ）检测具有典型脑动脉痉挛频谱表现的５０ 例偏头痛患者,测定其大脑部分动脉的收缩期血流速度（Ｖｓ）、舒张末期血流速度（Ｖｄ）和平均血流速度（Ｖｍ ）,大脑中动脉收缩峰血流速度（Ｖｓ ＭＣＡ）／颈内动脉颅外段收缩峰血流速度（Ｖｓ ＩＣＡ）以及血浆ＥＴ和ＮＯ含量,并与４０ 例健康体检者（正常对照组）作比较。结果：偏头痛组Ｖｓ〔（１３４７８±１０６８）ｃｍ ／ｓ〕、Ｖｄ〔（６３３９±５８８）ｃｍ ／ｓ〕、Ｖｍ 〔（９１３０±５５４）ｃｍ ／ｓ〕、Ｖｓ ＭＣＡ／Ｖｓ ＩＣＡ（２３２±０４４）和血浆ＥＴ〔（８２００±２５４５）ｎｇ／Ｌ〕均明显高于正常对照组〔（９１２２±１０２３）ｃｍ ／ｓ、（４６０３±６４３）ｃｍ ／ｓ、（６００３±９２９）ｃｍ ／ｓ、（１７０±０１２）和（６５７１±１１２３）ｎｇ／Ｌ,Ｐ均＜ ００１〕,血浆ＮＯ 含量〔（５６２５±２２２１）μｍ ｏｌ／Ｌ〕明显低于正常对照组〔（７４５２±２０１３）μｍ ｏｌ／Ｌ,Ｐ＜ ００１〕;且随着血管痉挛支数的增加,     

鼻咽癌组织中微血管计数及其临床意义

目的探讨鼻咽癌（ＮＰＣ）肿瘤中微血管计数（ＭＶＣ）与其生物学行为的关系。方法应用免疫组织化学ＬＳＡＢ法,对１０５例具有完整临床资料的鼻咽癌组织及１５例鼻咽部粘膜慢性炎症的石蜡块进行血管内皮细胞ＣＤ３４标记;在病理彩色图文分析系统（ＣＩＡＳ）,免疫组织化学专项分析中进行血管计数统计。结果１５例鼻粘膜慢性炎症组织中ＭＶＣ为２３．４３±４．１８,１０５例ＮＰＣ组织中ＭＶＣ为４２．６９±１１．５１,鼻咽癌ＭＶＣ较慢性炎症对照组明显升高,且具有显著性差异（Ｐ＜０．００１）;１０５例ＮＰＣ病例中颈淋巴结转移６７例,ＭＶＣ为４６．３２±１０．７４,无淋巴结转移３８例,ＭＶＣ为３６．２９±１０．０２,两组之间有显著性差异（Ｐ＜０．０１）;但１０５例ＮＰＣ病例中组织学分型间的ＭＶＣ没有显著性差异。结论提示ＭＶＣ可作为预测鼻咽癌早期颈淋巴结转移的一个指标。     

肝癌的多普勒超声与微血管密度关系的相关性观察

新生肿瘤血管是肝癌生长和转移的关键因素，肿瘤血管化程度在肝癌的诊断、治疗和预后中占重要地位。本资料采用免疫组化方法计数微血管密度（MVD），并与肝癌的多普勒检测肿瘤血管进行对照研究，评价其检测肝癌血流与肿瘤血管增生的关系。     

西宁地区肺心病急发期患者氧动力学变化与多器官功能损害的临床研究

目的：以肺心病急发期氧动力学变化的特征来研究发生多器官功能损害（ＭＯＤＳ）的可能机制及治疗效果。方法：对２０例病人行Ｓｗａｎ－Ｇａｎｚ导管监测，以热稀释法测定心输出量、计算氧输送（ＤＯ２）、氧耗量（Ｖ·Ｏ２）及氧摄取（Ｏ２ｅｘｔ）；结果：成活组及死亡组的Ｏ２ｅｘｔ均下降，但无明显差异（Ｐ＞００５）。第１天成活组的ＤＯ２和Ｖ·Ｏ２基本在正常范围，二者无相关（γ＝０２６５，Ｐ＞００５），第２～３天时，成活组的ＤＯ２和Ｖ·Ｏ２继续升高，且出现了病理性氧供依赖（γ＝０６５４，Ｐ＜００５），但当ＤＯ２超过７２０ｍｌ·ｍｉｎ－１·ｍ－２时，Ｖ·Ｏ２上升缓慢，相关关系消失（γ＝０１９４３，Ｐ＞００５），而死亡组无此种变化规律，且ＤＯ２与Ｖ·Ｏ２逐渐下降，与成活组相比差异显著（Ｐ＜００１），并出现序贯性脏器功能损害。结论：肺心病急发期时Ｏ２ｅｘｔ已明显障碍，ＤＯ２减低致Ｖ·Ｏ２下降可能是导致ＭＯＤＳ的主要原因     

沙利度胺对人肝癌细胞株SMMC-7721荷瘤鼠移植瘤作用

目的研究沙利度胺对人肝癌细胞株SMMC-7721荷瘤鼠移植瘤的生长抑制作用及可能机制。方法建立肝癌细胞株SMMC-7721的荷瘤鼠模型,观察沙利度胺组与对照组瘤体变化,应用免疫组化方法测定瘤体组织中微血管密度,ELISA法测定荷瘤鼠外周血血管内皮生长因子（VEGF）表达,并采用流式细胞仪测定瘤体组织细胞凋亡指数及瘤体细胞中Caspase-3的表达。结果成功建立肝癌细胞株SMMC-7721的荷瘤鼠模型,随着皮下移植瘤的生长,在第7天以后,对照组瘤体体积渐大于沙利度胺组,且随时间延长差值增大。实验结束时沙利度胺组抑瘤率为24.6%。沙利度胺组荷瘤鼠外周血VEGF含量及瘤体组织微血管密度均显著低于对照组（t=6.563、3.586,P〈0.01）,瘤体组织细胞凋亡指数及Caspase-3阳性表达均显著高于对照组（t=7.356、5.147,P〈0.01）。结论沙利度胺能抑制人肝癌细胞株SMMC-7721荷瘤鼠移植瘤的生长,诱导肿瘤细胞凋亡及抑制肿瘤血管形成可能为其机制,Caspase-3参与细胞的凋亡过程。     

骨桥蛋白在原发性肝癌中的表达及其与预后的关系

目的探讨骨桥蛋白（OPN）在原发性肝癌中的表达及其与临床、病理、预后之间的关系。方法采用免疫组化趼法检测32例原发性肝癌组织、4例正常肝脏组织中OPN的表达，分析其表达与肝癌及肝癌患者预后的关系。结果①原发性肝癌组织中OPN表达明显高于正常组织（P〈0．01）。②OPN的阴性表达与阳性表达在肿瘤的分级中存在差异（P〈0．05），而与患者的性别、年龄、肿瘤直径、AFP水平无关（P〉0．05）。③OPN阳性表达生存期相对缩短，为一负性预后因子。结论OPN阳性表达与肝癌的发生；发展及预后密切相关     

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.