PTEN和AKT2及CD147在胃癌组织中的表达及意义

目的：检测PTEN、AKT2和CD147在胃癌组织中的表达,并探讨其相互关系。方法：应用免疫组织化学方法检测65例胃癌及癌旁组织中PTEN、AKT2和CD147的表达情况。结果：PTEN蛋白在胃癌中表达的阳性率（58.46%）明显低于相应正常组织（100%）（P〈0.01）,其表达水平与组织分化程度、浸润深度、淋巴结转移及TNM分期有关（P〈0.05）。AKT2蛋白在胃癌组织中表达的阳性率（67.69%）明显高于相应正常组织（26.15%）（P〈0.01）,其表达与淋巴结转移有关（P〈0.01）,与浸润深度、分化程度和TNM分期无关（P〉0.05）。CD147蛋白在胃癌组织中表达的阳性率（86.15%）明显高于相应正常组织（16.92%）（P〈0.01）,其表达水平与浸润深度、淋巴结转移及TNM分期有关（P〈0.05）,与分化程度无关（P〉0.05）。胃癌组织中PTEN和AKT2、PTEN和CD147蛋白表达之间呈明显负相关（P〈0.01）。结论：PTEN的低表达或失表达,可能与AKT2、CD147的异常激活有一定联系,从而对胃癌的发生、发展起重要作用。     

环氧合酶-2及血管生成素-2在大肠癌中的表达及临床意义

目的 研究环氧合酶-2（cyclooxygenase-2，Cox-2）及血管生成素-2（angiopoietin-2，Ang-2）在大肠癌组织、癌旁组织及正常大肠组织中的表达及其与大肠癌临床病理特征之间的关系。方法 采用免疫组化SP法检测45例大肠癌组织、45例癌旁组织及15例正常大肠组织中Cox-2和Ang2的表达情况。结果 大肠癌组织中的Cox-2和Ang-2的表达阳性率（80.0％，66.7％）均分别高于癌旁组织（35．6％，11．1％）及正常大肠组织（0，0），P均〈0.01。在大肠癌组织中Cox-2和Ang-2蛋白表达与淋巴结转移及Dukes分期有关（P〈0．05），且二者的表达具有相关性（P〈0．01）。结论 Cox-2和Ang-2在大肠癌发生、发展中起重要作用，二者在表达上密切相关。     

大肠良恶性肿瘤PTEN/MMAC1/TEP1肿瘤抑制基因的蛋白表达研究

目的 :探讨 PTEN/ MMAC1/ TEP1与大肠癌的发生 ,发展的相关性。方法 :应用 S- P免疫组织化学方法检测 2 3例正常大肠粘膜、 2 8例大肠腺瘤和 75例大肠癌组织中 PTEN/ MMAC1/ TEP1蛋白的表达情况。结果 :2 3例正常大肠粘膜组织中PTEN蛋白表达阳性率为 91.3% (2 1/ 2 3) ,2 8例大肠腺瘤组织中 PTEN蛋白表达阳性率均为 89.3% (2 5 / 2 8) ,75例大肠癌组织中 PTEN蛋白表达阳性率为 6 8% (5 1/ 75 ) ,与正常大肠粘膜及大肠腺瘤差异有显著意义 (P <0 .0 1) ;有淋巴结转移的2 8例大肠癌阳性率为 43% (12 / 2 8) ,无淋巴结转移的 47例大肠癌阳性率为 83% (39/ 47) ,两者差异有显著意义 (P <0 .0 1) ;有远处器官转移的 2 3例大肠癌中阳性率为 43.5 % (10 / 2 3) ,无远处器官转移的 5 2例大肠癌阳性率为 78.8% (4 1/ 5 2 ) ,差异有显著意义 (P〈0 .0 1) ;6 0例大肠腺癌中蛋白表达阳性率为 81.2 % (4 9/ 6 0 ) ,15例粘液癌蛋白表达阳性率为 13.3% (2 / 15 ) ;两者之间有显著性差异 (P <0 .0 1) ;6 0例大肠腺癌中高 /中分化大肠腺癌 37例表达阳性率为 97.3% (36 / 37) ,低分化大肠腺癌 2 3例中表达阳性率为 5 6 .5 % (13/ 2 3) ,两者差异有显著意义 (P <0 .0 1)。结论 :PTEN/ MMAC1/ TEP1与大肠癌的发生、发展有相关     

大肠癌患者VEGF和Endostatin的表达及其与临床病理特征的关系

目的：探讨大肠癌患者手术前后血清血管内皮生长因子（VEGF）和Endostatin的动态变化规律及其与临床病理特征的关系。方法：ELISA法检测大肠癌患者（大肠癌组）术前及术后2周血清VEGF和Endostatin水平,并与大肠腺瘤患者（大肠腺瘤组）和健康对照者（对照组）进行比较。结果：1）大肠癌组术前血清VEGF水平显著高于大肠腺瘤组及对照组（P均〈0.01）。2）大肠癌组术前血清Endostatin水平显著高于大肠腺瘤组及对照组（P均〈0.01）。3）大肠癌组术前血清VEGF、Endostatin水平与原发肿瘤大小、细胞分化程度、区域淋巴结转移、肝转移及Dukes分期密切相关（P均〈0.05）,与性别、肿瘤部位等因素无关（P〉0.05）。4）大肠癌组术后2周血清VEGF水平较术前显著下降,而血清Endostatin水平较术前升高（P均〈0.01）。结论：大肠癌患者血清VEGF和Endostatin水平升高,且与原发肿瘤大小、细胞分化程度、区域淋巴结转移、肝脏转移及Dukes分期等因素有密切关系;血清VEGF和Endostatin水平是评价大肠癌恶性行为、预测浸润和转移程度的有效指标。     

血管内皮生长因子受体KDR在大肠癌发展中的作用

目的探讨血管内皮细胞生长因子 (vascularendothelialgrowthfactor,VEGF)受体KDR和血管生成与大肠癌发展的关系。方法应用免疫组织化学技术 ,检测 10 2例大肠癌组织KDR及VEGF蛋白表达和微血管密度 (microvesseldensity ,MVD) ,分析KDR、VEGF和MVD及其与大肠癌组织学分级、浸润深度、Dukes分期、淋巴结转移、肝转移和预后的关系。结果KDR及VEGF阳性者MVD值显著高于阴性者 (F =7 6 3及F =6 38,P <0 0 1)。KDR、VEGF表达和MVD与大肠癌Dukes分期 (χ2 =4 0 373,χ2 =39 6 3,F =10 89)、淋巴结转移 (χ2 =2 7 83,χ2 =2 1 70 ,F =5 94 )和肝转移 (χ2 =13 5 3,χ2 =8 6 8,F =6 82 )密切相关 (P <0 0 1) ,KDR及VEGF表达阳性或高MVD的大肠癌患者 5年生存率较低 (χ2 =5 7 94 ,χ2 =39 84 ,F =8 86 ,P <0 0 1)。结论KDR及VEGF与大肠癌的血管生成密切相关 ,对大肠癌的生长和浸润转移有促进作用 ,KDR、VEGF和MVD可作为反映大肠癌生物学行为的客观指标。     

syndecan-1蛋白在胃癌中的表达及其意义

目的研究syndecan-1蛋白在胃癌及正常胃黏膜组织中的表达，探讨其与胃癌临床病理特征的关系。方法应用免疫组化ABC法检测60例胃癌及正常胃黏膜组织中syndecan-1蛋白的表达水平。结果60例正常胃黏膜组织中均有syndecan-1蛋白表达，但胃癌组织中仅有10例（16．67％）呈阳性表达，正常胃黏膜组织中syndecan-1蛋白表达阳性率明显高于胃癌组织（χ^2=65．88，P〈0.05）。syndecan-1蛋白的表达与肿瘤大小、浸润深度、淋巴结转移及TNM分期有关（P〈0．05），其中无淋巴结转移的胃癌组织中syndecan～1蛋白表达阳性率明显高于有淋巴结转移者（χ^2=18．62，P〈0.05）；与胃癌患者的年龄和肿瘤部位无关（P〉0.05）。结论胃癌组织中syndecan-1蛋白低表达，并与胃癌分期和淋巴结转移有关。     

PTEN和p27及cyclin D1蛋白在大肠癌组织中的表达及相关性研究

目的：研究大肠癌组织中PTEN、p27和cyclinD1蛋白的表达及三者间的关系。方法：应用免疫组铡匕学方法检测58例大肠癌组织、58例癌旁组织和14例正常大肠黏膜中PTEN、p27和cyclinD1蛋白的表达情况。结果：大肠癌组织中PTEN和p27蛋白的阳性表达率分别为65．52％（38／58）和53．45％（31／58），较癌旁组织和正常组织明显刚氏（P〈0．05）；cyclinD1蛋白的阳性表达率为60．34％（35／58）,较癌旁组织及正常组织显著升高（P〈0．05）。三者在大肠癌组织中的表达存在相关性，且均与肿瘤的分化程度、有无淋巴结转移和Dukes分期有关（P〈0．05）。结论：PTEN、p27和cyclinD1基因的异常改变参与大，且三者之间存在相关性。联合检测三者表达水平可作为评价大肠癌病理生物学行为的客观指标之一。     

PTEN、Fas/FasL和MMP-2在胃癌组织的表达及其临床意义

目的探讨胃癌组织中第10号染色体同源缺失性磷酸酶-张力蛋白（PTEN）、Fas/FasL和基质金属蛋白酶-2（MMP-2）的表达及其与胃癌生物学行为的关系。方法选择临床及病理资料齐全的胃癌蜡块标本75例,另取正常胃黏膜组织15例作对照,采用SP免疫组化方法检测PTEN、Fas/FasL和MMP-2在其中的表达。采用χ2检验和相关分析作统计学分析。结果PTEN、Fas/FasL及MMP-2的表达与胃癌的浸润深度、淋巴结转移、TNM分期及肿瘤的组织分化程度均有关（P〈0.05）。PTEN和Fas/FasL的表达呈正相关（r=0.401,P〈0.001）,MMP-2与Fas/FasL的表达呈负相关（r=-0.720,P〈0.001）,MMP-2与PTEN的表达呈负相关（r=-0.336,P〈0.001）。结论胃癌组织中PTEN、Fas/FasL及MMP-2的表达阳性率可以成为胃癌诊断和预后的判断指标。     

大肠癌组织中促红细胞生成素受体表达与微血管密度的关系

目的：探讨大肠癌组织中促红细胞生成素受体（erythropoietin receptors,Epo-R）表达与肿瘤微血管密度（microvessel density,MVD）和临床病理特征的关系。方法：采用免疫组织化学SP法对60例大肠癌组织、20例正常大肠组织中Epo-R和MVD进行检测。结果：60例大肠癌组织均检测到Epo-R的表达。大肠癌组织MVD值为30.8±9.5,显著高于正常大肠组织的4.1±2.5（P〈0.01）。MVD水平与大肠癌患者年龄、肿瘤浸润深度、淋巴结转移、远处转移、临床分期有显著相关性（P〈0.05）。Epo-R表达与大肠癌组织MVD成正相关。结论：Epo-R在大肠癌组织中有异常高表达,且与MVD和临床病理特征成正相关,可能在肿瘤新生血管形成中有重要作用。     

Notch1/DLL4信号通路与VEGF在胃癌浸润和转移中的作用及其相关性

目的：探讨Notch1和其配体DLL4蛋白在胃癌组织中的表达及其与肿瘤血管转移之间的关系。
方法：采用免疫组织化学SP法检测45例胃癌及25例癌旁正常组织中Notch1,DLL4,VEGF的表达情况,并分析它们与各临床病理参数的关系。
结果：Notch1,DLL4,VEGF蛋白在胃癌中表达的阳性率均明显高于正常胃黏膜组织,差异均有统计学意义（P＜0.01）。Notch1蛋白在胃癌中表达与肿瘤浸润深度、淋巴结转移（P＜0.01）及远处转移（P＜0.05）有关;DLL4蛋白在胃癌中表达与肿瘤浸润深度（P＜0.01）,淋巴结转移及临床分期（P＜0.05）有关;VEGF蛋白在胃癌中表达与浸润深度（P＜0.01）、淋巴结转移、远处转移及TNM分期（P＜0.05）有关,上述各因素分组间差异有统计学意义。Notch1,DLL4,VEGF蛋白的表达三者两两间均呈正相关关系（rs=0.355,rs=0.367,rs=0.334;均P＜0.05）。
结论：Notch1/DLL4受体通路在胃癌组织中的表达上调与血管内皮生长因子有关,它们可能共同调控肿瘤新生血管形成,参与胃癌的侵袭和转移。     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.