肝动脉化疗栓塞对肝癌肿瘤新生血管生成及血管内皮细胞生长因子表达的影响

目的研究肝细胞癌(hepatocellularcarcinoma,HCC)经导管动脉化疗栓塞(transcatheterarterialchemoembolization,TACE)后残癌组织微血管密度(microvesseldensity,MVD)、微血管直径、血管内皮细胞生长因子(vascularendothelialgrowthfactor,VEGF)的表达情况及其意义。方法经病理证实的HCC63例,包括单纯手术切除42例(对照组),TACE术后行Ⅱ期手术切除21例(TACE组)。TACE组患者手术前接受1~2次不等的TACE治疗,均按统一规范标准给予化疗药物灌注+栓塞治疗。对手术切除标本进行免疫组织化学染色,其中TACE组取病灶边缘残存肿瘤部分,检测肿瘤组织的MVD、微血管直径及肿瘤细胞VEGF的表达。结果对照组MVD值为(5169±1817)条,TACE组MVD值为(5857±1575)条,二者之间比较差异无统计学意义(t=148,P>005);对照组微血管直径为(1762±1054)μm,TACE组微血管直径为(1579±765)μm,二者之间比较差异无显著性意义(t=071,P>005)。对照组VEGF阳性染色细胞数为13826±6524,TACE组VEGF阳性染色细胞数为24366±8888,二者之间比较差异有统计学意义(t=534,P<001),TACE显著上调了VEGF蛋白的表达;VEGF阳性染色细胞数与MVD明显相关(r=04936,t=44329,P<005)。结论化疗栓塞术后残癌组织存在丰富的肿瘤血供,残癌组织肿瘤细胞VEGF表达明显升     

肝动脉化疗栓塞术后残癌组织血管内皮生长因子表达的研究

目的研究肝细胞癌(HCC)经导管动脉化疗栓塞(TACE)后残癌组织血管内皮细胞生长因子(VEGF)的表达情况及其意义.资料与方法经病理证实的HCC63例,包括单纯手术切除42例(对照组),TACE术后行Ⅱ期手术切除21例(TACE组),TACE组患者手术前接受1～2次不等的TACE术治疗,均按统一规范标准给予化疗药物灌注 栓塞治疗,术中所用药物及栓塞材料为:5-Fu750～1500mg/次,顺铂80～120mg/次,吡柔比星20～40mg/次,羟基喜树碱20～30mg/次,40%超液化碘油20～30ml/次,明胶海绵1/5～1/3块/次.对手术切除标本进行免疫组织化学染色,其中TACE组取病灶边缘残存肿瘤部分,检测肿瘤组织VEGF的表达.结果 对照组VEGF阳性染色细胞数为138.26±65.24,TACE组残存肿瘤组织VEGF阳性染色细胞数为243.66±88.88,二者之间比较有显著性差异(t=5.34,P＜0.01),TACE显著上调了VEGF蛋白的表达.结论 TACE治疗后残癌组织存在丰富的肿瘤血供,残存肿瘤细胞VEGF表达明显升高,新生血管生成及VEGF的表达可能在栓塞后残癌组织血供重建中起到重要的作用.     

不同化疗栓塞方式对肝细胞癌血管生成的影响

目的 探讨不同化疗栓塞方式对肝细胞癌(HCC)血管生成的影响.方法 搜集手术切除后病理证实的HCC标本136例,单纯手术57例(A组),灌注化疗+手术11例(B组),经导管动脉化疗栓塞(TACE)+手术68例(TACE组).TACE组按栓塞方式又分为:化疗药+碘油33例(C组),化疗药+碘油+明胶海绵23例(D组),化疗药+碘油+无水乙醇+明胶海绵12例(E组).按手术切除距末次栓塞时间分为≤30 d组(24例)、31～60 d组(25例)、61～90 d组(13例)、＞90 d组(6例).标本采用免疫组织化学法染色,并检测各组CD31和血管内皮生长因子(VEGF)的表达情况,对CD31阳性血管内皮进行微血管密度(MVD)计数.结果 MVD:A、B、TACE组残余肿瘤组织平均MVD分别为(44±18)、(48±23)、(55±22)个/高倍视野,A组与B组比较,差异无统计学意义(t=-0.057,P＞0.05);TACE组高于A组(t=-2.897,P＜0.05);TACE组(C组、D组、E组)残余肿瘤组织平均MVD分别为(56±22)、(54±24)、(52±19)个/高倍视野,各TACE组之间(C组、D组、E组)比较差异无统计学意义(F=0.152,P＞0.05).≤30 d组、31～60 d组、61～90 d组、＞90 d组平均MVD分别为(50±19)、(55±24)、(62±29)、(53±10)个/高倍视野,均比A组高(假设A组为TACE术后第0天所采集的标本,以此作为对照组),但≤30 d组(t=-1.39,P＞0.05)和＞90 d组(t=-1.11,P＞0.05)差异无统计学意义;31～60 d组(t=-2.06,P＜0.05)和61～90 d组(t=-2.19,P＜0.05)差异有统计学意义.VEGF:A组、B组、TACE组比较,残癌组织中VEGF表达强度依次增加,差异有统计学意义(x2=12.629,P＜0.05),TACE各亚组(C组、D组、E组)之间比较,差异无统计学意义(x2=2.310,P＞0.05).对所有标本VEGF表达强度与MVD值进行Pearson相关分析,随着VEGF表达强度的增强,MVD增高,两者之间呈正相关(r=0.445,P＜0.05).结论 TACE治疗后HCC残存癌细胞VEGF的表达强度增高,肿瘤组织MVD增多.不同栓塞方式对血管生成的影响无显著性差异.栓塞后肿瘤组织MVD的多少可能与栓塞后经历的时间有一定关系.     

肝癌化疗栓塞术后残癌和癌旁组织血管内皮生长因子受体2及其磷酸化状态的表达水平

目的 了解肝癌经动脉化疗栓塞术后残癌及癌旁组织的血管内皮生长因子受体2(VEGFR-2)表达水平及其磷酸化状态水平的差别和意义.方法 取经导管肝动脉化疗栓塞术(TACE)后行二期手术切除的肝癌及其周围组织标本43例份(TACE加手术组)和未经任何治疗直接手术切除的肝癌及周围组织标本20例份(单纯手术组),用免疫组织化学染色方法,检测残癌及癌旁组织VEGFR-2、磷酸化VEGFR-2、缺氧诱导因子1α(HIF-1α)的表达水平和微血管密度[MVD(CD31标记)];采用方差分析及χ2检验比较2组间各指标的差异.结果 TACE加手术组残癌组织磷酸化VEGFR-2和HIF-1α的吸光度值(A值)分别为(0.034±0.016)、(0.047±0.021),单纯手术组分别为(0.024±0.009)、(0.035±0.016),2组间差异均有统计学意义(F值分别为6.75、4.77,P值均＜0.05);TACE加手术组癌旁组织VEGFR-2、磷酸化VEGFR-2和HIF-1α的A值分别为(0.040±0.017)、(0.031±0.011)和(0.037±0.015),单纯手术组分别为(0.030±0.015)、(0.020±0.008)和(0.024±0.014),2组间差异均有统计学意义(F值分别为4.60、13.72、11.65,P值均＜0.05);TACE加手术组和单纯手术组的癌旁组织MVD分别为(58.3±15.2)、(44.4±10.5)个/高倍视野,2组差异有统计学意义(χ2=13.64,P＜0.05).结论 肝癌经动脉化疗栓塞术后残癌组织与癌旁组织缺氧程度加重,VEGFR-2表达增加且功能增强.     

原发性肝癌TACE后FAK、NF-κBp65表达及意义

目的 探讨原发性肝癌(HCC)经动脉化疗栓塞术(TACE)后FAK、NF-κBp65表达的水平及其意义.方法 收集经TACE后手术切除的肝癌组织标本28例﹙TACE组﹚和未经任何治疗直接手术切除的肝癌组织标本30例(单纯手术组).采用免疫组化SP法,检测残癌组织中FAK、NF-κBp65的表达水平.结果 TACE组肝癌...     

核糖核酸酶抑制因子联合化疗栓塞对Walker-256移植性肝癌微血管密度的影响

目的研究核糖核酸酶抑制因子(RI)与肝动脉化疗栓塞(TACE)联合栓塞对Walker-256移植性肝癌微血管密度(MVD)及坏死面积的影响。材料与方法将30只Walker-256荷瘤大鼠于种植后第14d随机分成TACE组、RI与TACE联合栓塞组和对照组,每组10只。各组分别经肝动脉注入:5-Fu20mg/kg体重加超液态碘油0.4ml;RI200U加5-Fu20mg/kg体重加超液态碘油0.4ml;生理盐水0.4ml。结果在栓塞后7dTACE组、联合栓塞组和对照组肿瘤MVD的平均值分别为89.60±40.43、21.16±29.47和84.78±28.40。联合栓塞组MVD明显少于TACE组和对照组(P<0.01)。肿瘤坏死面积TACE组、联合栓塞组明显大于对照组(P<0.01),TACE组、联合栓塞组无明显差别(P>0.05)。结论RI与TACE联合栓塞可使肿瘤的MVD明显减少,但对坏死的影响与TACE无明显差别。     

原发性肝癌肿瘤微血管形态特征研究

目的　探讨原发性肝癌 (HCC)肿瘤微血管形态特征。方法　收集手术切除前做过血管造影且未做栓塞治疗的HCC标本32例 ,男性 2 6例 ,女性 6例 ,年龄 2 8～ 76岁 (5 0 5 6± 10 5 2岁 ) ,肿瘤直径为 2～ 2 3cm(8 0 5± 6 17cm)。对不同大小和不同分化程度的HCC肿瘤微血管进行分型 ,计数肿瘤微血管密度 (MVD) ,测量肿瘤微血管直径、梁索直径和病灶大小 ,并做相关统计学分析。结果　肝癌大小与肿瘤微血管分型、直径和肿瘤梁索直径呈正相关 ,与MVD呈负相关 ,与肿瘤微血管梁索直径比不相关。结论　肝癌肿瘤MVD、形态及分布不均匀 ;肝癌在生长的不同阶段 ,其肿瘤微血管特征是不同的 ,并有一定的发展规律     

经导管动脉化疗栓塞联合内皮抑素对兔VX2肝移植瘤新生血管生成的影响

目的 探讨兔VX2肝移植瘤经介入治疗联合应用内皮抑素(endostatin,ES)治疗后,残瘤组织微血管密度(micmvagcular density,MVD)和血管内皮生长因子(vascular endothelial growth factor,VEGF)的表达情况及其相关性.方法 建立兔VX2肝移植瘤模型,随机分为对照组(n=10)、经导管动脉化疗栓塞(TACE)组(碘油+阿霉素,n=10)和TACE联合抗血管生成组(碘油+阿霉素+ES,n=10),术后1周取出病理标本,用免疫组织化学染色分别检测残瘤组织VEGF和MVD的表达,3组间的比较采用方差分析.结果 对照组、TACE组和TACE联合抗血管生成组的VEGF平均吸光度值(A)分别为0.130 ±0.038、0.200±0.049和0.120±0.047(F=9.42,P＜0.01),TACE组表达水平最高,与其余两组比较差异有统计学意义(q值分别为4.93、5.63,P＜0.01),TACE联合抗血管生成组VEGF的表达水平低于对照组,但两组之间差异无统计学意义(q=0.70,P＞0.05);各组MVD值分别为(80 ±17)、(84±16)和(57±13)个/高倍镜(F=8.70,P＜0.01),TACE联合抗血管生成组MVD值最低,与其余两组比较均有统计学意义(q值分别为4.63、5.48,P＜0.01),对照组和TACE组之间差异无统计学意义(q=0.85,P＞0.05).结论 TACE联合应用内皮抑素治疗较单纯化疗栓塞可以明显降低肿瘤VEGF的表达,并可显著减少肿瘤微血管的形成,影响肿瘤的预后.     

肝动脉化疗栓塞对肝癌细胞黏附分子CD44v6和ICAM-1表达的影响

目的:研究肝细胞癌(hepatocellular carcinoma,HCC)经导管肝动脉化疗栓塞(transcatheter arterial chemoemboli-zation,TACE)后残癌组织细胞黏附分子CD44v6和ICAM-1(intercelluar adhesion molecule-1,ICAM-1)的表达情况。方法:经病理证实的HCC 50例,包括单纯手术切除30例(对照组),TACE术后行Ⅱ期手术切除20例(TACE组)。TACE组患者术前接受1~2次不等的TACE治疗,均按统一规范标准给予化疗药物灌注+栓塞治疗。对标本行免疫组织化学PV-9000染色,其中TACE组取病灶边缘残存肿瘤部分,检测肿瘤组织CD44v6和ICAM-1的表达,将两组结果进行对照分析。结果:对照组和TACE组CD44v6和ICAM-1均有不同程度的表达。对照组CD44v6表达阳性22例(22/30,73.33%),TACE组CD44v6表达阳性13例(13/20,65%),两者间无显著性差异(P>0.05);对照组ICAM-1表达阳性19例(19/30,63.33%),TACE组ICAM-1表达阳性12例(12/20,60%),两者间亦无显著性差异(P>0.05)。对照组和TACE组中CD44v6和ICAM-1表达间均呈正相关(P<0.05)。结论:TACE术后残癌组织CD44v6和ICAM-1仍有较高的表达,TACE并不能有效降低肝癌组织CD44v6和ICAM-1的表达;两者表达呈正相关。     

肝右叶前、后段原发性肝癌TACE后VEGF及CD34的表达水平

目的探讨肝右叶后段原发性肝癌病灶较前段易发生侧支循环的可能机制。方法取经导管肝动脉化疗栓塞术(TACE)后手术切除的肝细胞癌组织标本57份和未经任何治疗直接手术切除的肝细胞癌组织标本40份(单纯手术组),按影像学检查符合筛选标准3l例分两组。A组:13例,病灶位于肝右叶前段(V、Ⅷ段);B组:18例,病灶位于肝右后段(Ⅵ、Ⅶ段)。采用免疫组化联酶卵白素染色(SP)法,检测残癌组织血管内皮生长因子(VEGF)表达水平和微血管密度[MVD(CD34标记)]。结果 TACE组VEGF蛋白阳性表达率显著高于单纯手术组,分别为86.0%和65.0%,差异有统计学意义(p=0.015);TACE组MVD值较单纯手术组显著增高,分别为79.37±15.36和43.23±14.98,差异有统计学意义(p=0.000)。TACE组VEGF蛋白阳性表达与MVD值变化呈正相关(r_s=0.493,P<0.01)。B组病灶周围MVD略高于A组,分别为80.44±13.74和78.08±15.33,但差异无统计学意义(P>0.05)。结论 TACE诱导的新生血管生成理论可能并非肝右叶前后段病灶侧支循环建立差异的机制。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.