胃癌组织COX-2和VEGF的表达与临床病理特征相关性研究

目的探讨环氧化酶-2(COX-2)和血管内皮生长因子(VEGF)的表达与胃癌临床病理特征之间的关系以及COX-2与VEGF在胃癌组织中表达的相关性。方法采用免疫组化EnVision两步法检测胃癌组织61例及相应的癌旁组织COX-2、VEGF的表达。结果胃癌组织中COX-2及VEGF的阳性表达率均明显高于癌旁组织(P<0.05);胃癌中COX-2、VEGF的表达与浸润深度、淋巴结转移、TNM分期和病理分化程度显著相关(P<0.05)。VEGF与COX-2表达呈明显相关(P<0.05)。结论COX-2、VEGF在胃癌组织中高表达,COX-2、VEGF的表达与胃癌的发生、发展密切相关,COX-2、VEGF的检测有助于判断胃癌的预后。COX-2表达与VEGF显著相关,两者联合检测有望成为判断胃癌恶性程度的重要生物学指标。     

胃癌彩色多普勒血流分级与微血管密度、血管内皮生长因子的表达及其相关性研究

目的探讨彩色多普勒超声检测胃癌血流分级与病理微血管密度（MVD）和血管内皮生长因子（VEGF）表达的临床病理关系。方法术前测定60例各期胃癌患者肿瘤区域和正常胃壁的彩色多普勒血流显像（CDFI）,根据血流显示情况进行血流分级;术后免疫组化技术检测相对应标本内MVD、VEGF的表达。结果随着胃癌病灶区域内血流信号增多,血流分级增高,病理MVD计数和VEGF表达呈上升趋势（P=0．000）;胃癌癌组织血流分级和MVD计数均高于癌旁正常组织（P〈0．05）,进展期高于早期（P〈0．05）;VEGF表达水平癌组织则低于癌旁正常组织（P=0．000）,进展期高于早期（P=0．000）;MVD值同VEGF表达密切相关（P〈0．05）,而胃癌癌旁正常组织进展期与早期血流分级、MVD值和VEGF表达比较差异均无统计学意义（P〉0．05）。结论彩色多普勒超声所检测的胃癌内血流信号与病理MVD测值和VEGF表达有较好的相关性,胃癌术前CDFI血流检测可间接评价肿瘤组织内的血管生成状态,为胃癌的预后评估提供有益的信息。     

COX-2和MMP-2在胃癌组织中的表达及临床意义

目的研究环氧合酶-2（Cydooxygenase-2，COX-2）和基质金属蛋白酶-2（Matrix metalloproteinase-2，MMP-2）的表达以及与胃癌浸润转移的关系，探讨二者间的相互关系。方法采用SP免疫组织化学技术，取吉林大学第一临床医院病理科存档的胃癌石蜡标本46例及正常胃组织15例，每例切片2张，分别检测COX-2和MMP-2的表达情况，分析其与胃癌浸润转移的关系。结果用SPSS10．0统计软件进行分析。结果15例正常胃组织中COX-2和MMP-2的表达为阴性，46例胃癌组织中COX-2的阳性表达率为60．9％（28／46），显著高于正常胃组织（P〈0．05），COX-2阳性表达与胃癌淋巴结转移、临床分期相关（P〈0．05），与胃癌大小、浸润程度、分化程度无关（P〉0．05）。MMP-2的阳性表达率为71．7％（33／46），显著高于正常胃组织（P〈0．05），MMP-2阳性表达与胃癌淋巴结转移、临床分期、浸润深度相关（P〈0．05），与肿瘤大小及分化程度无关（P〉0．05），COX-2与MMP-2表达密切相关（P〈0．05）。结论COX-2和MMP-2在胃癌组织中的表达密切相关，COX-2和MMP-2的高表达促进了胃癌的浸润和转移，提示COX-2和MMP-2可作为判断预后的指标和化学治疗的靶点。     

COX-2和VEGF在胃癌组织中的表达及与血管发生的关系

目的探讨COX-2、VEGF在胃癌中的表达及与血管发生的关系。方法采用免疫组织化学S-P法检测56例胃癌和28例正常胃黏膜组织中COX-2、VEGF的表达，计算MVD值，并进行统计学分析。结果56例胃癌中COX-2、VEGF的阳性率分别为67．86％（38／56）和69．64％（39／56），与正常胃黏膜表达相比有统计学差异（P〈0．05）。胃癌中MVD的表达量（51．04±13．26）高于正常胃黏膜表达量（18．34±8．26），有统计学差异（P〈0．05）。胃癌中COX-2、VEGF的表达在不同临床分期、淋巴结转移状态有统计学差异（P〈0．05）。COX-2、VEGF与MVD表达呈正相关（r=0．763，P〈0．01；r=0．825，P〈0．01），COX-2与VEGF的表达也呈正相关（r=0．621，P〈0．01）。结论COX-2、VEGF在胃癌的发生、发展中起着重要作用，对胃癌的血管新生和发生发展有促进作用     

还氧化酶-2、血管内皮长因子-C在食管癌中的表达变化

目的：探讨食管癌组织中还氧化酶-2（COX-2）、血管内皮生长因子-C（VEGF—C）表达变化及其相互关系，以及在淋巴结转移过程中的作用和可能机制。方法：收集该院2003年4月～2005年5月胃镜检查及手术标本。应用免疫组化法检测44例食管癌组织及17例癌旁组织中COXL2、VEGF—C的表达水平。结果：食管癌组织中COX-2、VEGF—C阳性表达率分别为88％、72％，显著高于非癌组织；COX-2、VEGF—C蛋白的表达与食管癌的侵润部位、淋巴结转移（P〈0．05或P〈0．01）有关；COX-2、VEGF—C的表达呈正相关（r=0．543，P〈0．01）。结论：COX-2、VEGF—C表达与食管癌的发展和淋巴转移有关，并有重要的预后意义。     

人胃癌组织CCR7和COX-2的表达及意义

【目的】检测胃癌患者癌组织中趋化因子受体7（CCR7）和环氧化酶-2（cox-2）的表达及意义。【方法】检测43例胃癌患者癌组织和35例癌旁正常胃组织中CCR7mRNA和COx-2mRNA的表达情况。【结果】胃癌组织中CCR7mRNA和COX-2mRNA的表达阳性率分别为62．79％和58．14％,相对表达量分别为0．59±0．28和0．66±0．21,均明显高于癌旁正常胃组织阳性率（分别为14．29％和8．57％）和相对表达量（分别为0．13±0．05和0．09土0．01）,两组比较差异均有显著性（P〈0．05）。CCR7mRNA和COX-2mRNA在胃癌组织中的阳性表达率和相对表达量均随癌细胞浸润程度的加深、临床分期的增加及淋巴结转移明显增高（P〈0．05）,但与性别和肿瘤分化程度无明显相关（P〉0．05）。【结论】CCR7和COX-2在胃癌组织中高表达,可能与癌细胞的浸润与淋巴转移有关。     

VEGF及其受体Flt、KDR表达与胃癌临床病理特征的关系

【目的】4g讨血管内皮生长因子（VEGF）及其受体Fit、KDR的表达与胃癌临床病理特征的关系。【方法】选取本院手术切除的胃癌标本112例及癌旁组织作为对照,采用免疫组织化学方法检测VEGF及其受体Flt、KDR表达。【结果】胃癌组织VEGF、Fh和KDR阳性表达率分别为70．54％、59．82％和64．29％,均高于癌旁组织的16．07％、25．89％和22．32％,且差异有显著性（P〈0．05）;有淋巴转移纽VEGF、Fit和KDR阳性表达率高于无淋巴转移组（P〈0．05）;浸润程度超过肌层组的EGF、Flt和KDR阳性表达率高于未超过肌层组（P〈0．05）。在不同性别、年龄、肿瘤分化程度、组织类型中VEGF、Flt和KDR表达差异无显著性（P〉0．05）;VEGF表达与Flt和KDR表达呈一定的正相关关系（rs=0．233和O．418,P〈0．05）,Fit和KDR表达同样呈正相关关系（rs=0．263和P〈0．05）。【结论】胃癌中广泛表达VEGF及其受体Fit、KDR,且与胃癌淋巴结转移和浸润程度有一定关系。     

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。     

COX-2、HER-2和VEGF在乳腺癌中的表达及其临床意义

【目的】研究环氧化酶-2（cOx-2）在乳腺癌组织中的表达情况与,临床病理指标及预后之间的相关性及与VEGF和HER-2表达的关系。【方法】检测120例乳腺癌石蜡包埋组织中COX-2、HER-2和VEGF的表达。【结果】120例中cox-2的高表达率为38．3％（46／120）。淋巴结转移阳性组和阴性组以及不同临床分期的病人之间COX-2的表达差异有显著意义（P〈0．05）,而与病人年龄、肿瘤大小、病理类型、ER、PR等差异无显著意义（P〉0．05）。COX-2在乳腺癌组织中的表达与HER-2／neu、VEGF的表达密切相关（P〈0．01）。COX-2和HER-2共同表达的患者与两者单独表达的患者相比,前者的TNM分期较晚,有显著差异（P=0．027）。COx_2和VEGF共同表达与单独表达的TNM分期无显著差异（P=0．479）。COX-2低表达的患者总生存期较长,与高表达患者的总生存期有显著差异（P〈0．005）。【结论】乳腺癌组织中COX-2的高表达可提示恶性程度高和预后不良。乳腺癌组织中COX-2与HER-2、VEGF的表达相关,且COX-2和HER-2／neu同时高表达时预后更差。     

胃癌及区域淋巴结VEGF、bFGF表达及与临床生物学行为关系的研究

目的研究VEGF、bFGF在胃癌组织和区域淋巴结中的表达，探讨其与胃癌临床生物学行为的关系，以及在胃癌侵袭转移及预后判断中的意义。方法选择经病理证实的胃癌患者62例，癌组织和区域淋巴结各62例，正常胃黏膜30例。SP免疫组织化学方法分别对VEGF和bFGF表达水平进行检测。结果①胃癌患者组织中的VEGF和bFGF表达明显高于正常胃黏膜组织（P〈0．05）。②胃癌组织中VEGF、bFGF表达分别与患者性别、年龄、肿瘤部位及大小、Bomnann分型、分化程度、淋巴结转移无关，而与浸润深度、5a生存期有关；其中VEGF表达还与临床分期有关（P〈0．01或P〈0．05）。③胃癌区域淋巴结中转移淋巴结组较无转移淋巴结组的VEGF和bFGF表达均明显增高，有显著性差异（P〈0．01）。④胃癌区域淋巴结中VEGF和bFGF阳性表达组的淋巴结转移率均明显高于阴性表达组，有显著性差异（P〈0．01）。⑤胃癌区域淋巴结中VEGF、bFGF阳性表达组的5a生存率明显低于阴性表达组，有显著性差异（P〈0．01或P〈0．05）。结论①胃癌组织中的VEGF、bFGF蛋白表达异常，提示检测VEGF、bFGF表达有望成为胃癌诊断的分子生物学指标。②胃癌组织中VEGF表达增高与胃癌浸润深度、临床分期、进展及预后不良有关；胃癌组织中bFGF表达增高与胃癌浸润深度、预后不良有关，提示检测胃癌组织中VEGF、bFGF表达将有助于判断胃癌的转移、复发及预后。③胃癌区域淋巴结中VEGF和bFGF表达增高是胃癌淋巴结转移及预后不良的重要因素。     

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.     

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.