增殖细胞核抗原表达在肾细胞癌侵袭和转移性评估中的价值

侵袭和转移是影响肾细胞癌预后的重要因素 ,我们采用免疫组织化学技术检测 10 2例肾癌患者的癌细胞增殖细胞核抗原 (ＰＣＮＡ)表达 ,探讨其在肾癌侵袭和转移能力评估中的价值。1.资料和方法 :10 2例肾癌患者经根治术 ,取其肾癌标本 10 2份 ,根据是否存在浸润或转移 ,分为浸润转移组与非浸润转移组。远隔脏器转移 ,肾包膜外、肾外脏器浸润或肾、腔静脉癌栓依据术前影像学及术中探查、术后病理诊断 ;肾门淋巴结、镜下癌周组织及微静脉浸润由病理组织学检查 (图 1～ 3)确认 ,方法见李泉林等[1] 报道。应用标准过氧化物酶 链霉卵白素 (ＳＰ)免疫…     

增殖细胞核抗原在肝细胞癌中的表达及其临床意义

目的 探讨增殖细胞核抗原(PCNA)在肝细胞肝癌的发生发展中的作用及作用机制.方法 采用逆转录-聚合酶链反应(RT-PCR)和免疫组织化学法检测PCNA在肝细胞癌、相应癌旁组织和正常肝组织中mRNA和蛋白质的表达,正常肝组织、癌旁组织、肝细胞癌组织中的阳性表达率分别为20.0％、46.2％和85.7％;结合患者的年龄、性别、肿瘤大小、分化程度、有无淋巴结转移等临床病理学资料进行统计学分析,其表达与组织分化程度和淋巴结转移呈明显相关(P＜0.05).结果 PCNA在正常肝组织、癌旁组织、肝细胞癌组织中的阳性表达率分别为20.0％、46.2％和85.7％,在肝细胞癌中的阳性表达率显著高于正常肝组织和癌旁肝组织(P＜0.05);RT-PCR检测结果也证实PCNA mRNA在肝细胞癌中的表达明显高于正常肝组织和癌旁肝组织(P＜0.05).PCNA的表达与患者年龄、性别、肿瘤大小等因素无明显相关(P＞0.05),与组织分化程度和淋巴结转移呈明显相关(P＜0.05).结论 PCNA在肝细胞癌组织中的表达高于正常肝组织和癌旁肝组织,并且与肿瘤的恶性程度密切相关.     

肾盂癌增殖细胞核抗原表达的临床意义

采用免疫组化技术检测３１例肾盂癌和９例慢性能盂炎组织中增殖细胞核抗原（ＰＣＮＡ）的表达。发现肾盂癌ＰＣＮＡ阳性细胞数明显高于炎症组，随肿瘤病理分级和分期的上升而增加，且分化差的染色对肾盂良性病变的鉴别和肾盂癌生物学行为的评估具有重要意义。对肾盂癌ＰＣＮＡ阳性细胞数大于７５％得术后应定期复查膀胱镜，并行必要的膀胱灌注治疗。     

胆管癌胆囊癌增殖细胞核抗原表达及其临床意义

应用免疫组织化学方法研究胆管癌、胆囊癌及其良性病变ＰＣＮＡ蛋白的表达，结果妻现“胆管癌、胆囊癌ＰＣＮＡ蛋白阳性反应率为８３．５％和８５％，与良性病变比较差异有显著性意义，表明癌变组织有较经强增殖活性。     

增殖细胞核抗原在胃肠道平滑肌肿瘤中表达的临床意义

探讨增殖细胞核抗原表达与胃肠道平滑肌肿瘤的关系。方法 采用免疫组化Ｓ－Ｐ法检测８６例ＧＩＳＭＴ中ＰＣＮＡ的表达情况。结果 ＰＣＮＡ表达按正常胃肠道平滑肌组织，平滑肌瘤，平滑肌肉瘤Ⅰ，Ⅱ，Ⅲ级的依次明显递增，同时，ＰＣＮＡ的表达与肿瘤的性质，大小，中心有无坏死有明显关系。     

增殖细胞核抗原在大肠肿瘤中表达的临床意义

目的：探讨大肠肿瘤生物学特性及预后同增殖细胞核抗原（ＰＣＮＡ）表达的关系,方法,免疫组织化学方法。结果,ＰＣＮＡ表达状况同肿瘤的浸润深度,淋巴结转移相关,并同组织学分级呈正相关,ＤukesAB同ＤukesCD期间增殖指数有显著性差异,不同生存组间明显不同,结论,ＰＣＮＡ增殖状况是肿瘤侵裘和转移的重要特征,可以独立的预测大肠肿瘤患者的预后。     

细胞核增殖抗原与E-钙黏蛋白在膀胱移行细胞癌中的表达及临床意义

目的 探讨细胞核增殖抗原(Ki-67)、E-钙黏蛋白(E-cadherin)在膀胱移行细胞癌中的表达及其临床意义.方法 采用免疫组织化学方法检测Ki-67、E-cadherin在48例膀胱移行细胞癌组织中的表达,统计分析其表达与膀胱移行细胞癌临床病理、分期之间的关系.结果 Ki-67、E-cadherin在膀胱移行细胞癌中的阳性表达率分别是83.3％和47.9％,两者呈负相关(P＜0.05).两者表达水平与肿瘤临床分期及病理分级明显相关(P＜0.05).结论 检测Ki-67与E-cadherin有助于判断膀胱移行细胞癌侵袭和转移能力.     

肝细胞癌增殖细胞核抗原表达的图像定量分析

目的 探讨原发性肝细胞癌(简称肝癌)增殖细胞核抗原(PCNA)的表达情况及其意义.方法 采用免疫组化ABC法极测了PCNA蛋白在41例人肝癌组织和人肝癌细胞系HCC-9204的表达情况,并用图像分析仪定量分析了其表达水平与肝癌病理分级之间的关系.结果 癌旁非肿瘤性肝细胞不表达PCNA或只有微弱的表达,而各级肝癌组织的癌细胞均有不同程度的较强的PCNA表达,并且随着肝癌组织分化程度的下降PCNA表达的平均光密度和积分光密度均呈升高趋势,在不同病理分级的肝癌组织之间具有显著性差异(P<0.05).PCNA在培养的HCC-9204细胞中表达的阳性率为86.4%.结论 PCNA可作为肝癌发生和发展过程中的一个与其恶性程度密切相关的标志物,可能在肝癌细胞的增殖过程中具有重要的作用.     

胰腺癌组织中增殖细胞核抗原的表达及临床意义

目的 为了探讨增殖细胞核抗原（PCNA）的表达与胰腺癌组织生物学行为及预后的关系。方法 采用LABC法免疫组化染色检测32例胰腺癌和14例慢性胰腺炎组织中的PCNA表达。结果 PCNA在胰腺癌组织中的表达率为100％,胰腺癌组织中的PI明显高于慢性胰腺炎组织（P＜0．01）。PI 值与随肿瘤进展而逐渐增加的趋势,且PCNA表达与胰腺癌的预后呈负相关（P＜0．01）。结论ＰＣＮＡ表达能反映胰腺癌组织的增殖活性,分化程度越低,PCNA表达强度越高,它可作为预测胰腺癌病程和预后的一个有用指标。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.