中期因子在胰腺癌组织中的定位与表达特点

目的 探讨中期因子(MK)的mRNA及其蛋白在胰腺癌(PC)组织中的定位与表达特点。方法采用原位杂交和免疫组织化学方法检测52例PC、12例慢性胰腺炎及6例正常胰腺组织中MK mRNA及蛋白的定位与表达水平。结果MK mRNA及蛋白水平在PC组织均呈过度表达,表达阳性率分别为71.2％和73.1％,都定位于PC细胞质,有淋巴结转移和Ⅱ-Ⅳ期的患者,MK阳性表达率明显高于无淋巴结转移和Ⅰ期患者(P<0.01)。在PC细胞外组织中也有MK表达,尤其在血管密集处明显。而在慢性胰腺炎及正常胰腺组织中MK表达阴性。结论 MK mR-NA及其蛋白在PC组织中呈过度表达,并可能与促进PC血管生成和转移有关。检测MK表达情况可作为PC的辅助诊断指标之一。     

中期因子mRNA在原发性肝癌中的表达及其意义

目的：探讨中期因子（MK）mRNA在原发性肝细胞癌（HCC）中的表达及其意义。方法：收集33例人肝细胞癌组织、配对癌旁肝组织及10例肝良性肿瘤组织、5例正常肝组织、采用TRIzol一步抽提法提取总RNA，应用逆转录－聚合酶链反应（RT－PCR）检测MKmRNA的表达。结果：28例肝细胞癌可见MKmRNA表达，阳性率为84．8％，而配对的癌旁组织中仅见3例表达，正常肝脏和肝脏良性肿瘤细胞无1例阳性。统计学分析表明，肝细胞癌肝细胞癌MKmRNA表达率与其他各组的差异有非常显著性（P＜0．01），但肝细胞癌MKmRNA表达与其组织学类型、病理分级、瘤体大小、包膜状况及其甲胎蛋白（AFP）值之间差异无显著性（P＞0．05）。结论：肝细胞癌在mRNA水平上表达MK增加，检测MK表达情况可作为HCC的辅助诊断指标之一，对术后制定进一步治疗方案也有参考价值。     

中期因子蛋白在肝外胆管癌中的表达及其临床意义

目的　探讨中期因子 (MK)的蛋白表达水平与肝外胆管癌血管生成、生物学特性和预后的关系。方法　采用免疫组织化学方法检测 3 7例肝外胆管癌组织中MK的蛋白表达和微血管密度 (MVD) ,并与临床病理及预后指标作对照分析。结果　肝外胆管癌的微血管密度平均为84.4± 3 3 .2 ,MK表达阳性率 62 .2 %。有淋巴结转移、Ⅲ～Ⅳ期和MVD高的患者 ,MK阳性表达率明显高于无淋巴结转移、Ⅰ～Ⅱ期和MVD低的患者 (P <0 .0 1)。随访结果表明 ,MK高表达患者术后生存时间比MK低表达患者明显缩短 (P <0 .0 1)。结论　MK的蛋白表达水平能反映肝外胆管癌细胞的恶性程度 ,有可能作为肝外胆管癌转移和预后分析的指标。     

Snail蛋白表达与肝细胞癌术后预后的相关性研究

目的研究Snail蛋白在肝细胞癌(HCC)中的表达及其与临床病理特征和术后预后的关系。方法应用免疫组织化学SP法,检测Snail蛋白在103例肝细胞癌及25例正常肝组织中的表达及其在细胞中的定位。结果Snail蛋白高度表达于肝癌组织的细胞核、细胞质,正常肝组织中表达较少甚至不表达,阳性率分别为51.5%和16%,两者差异有统计学意义(P0.05)。Snail在肝癌中的高表达与肝癌的pTNM分期、肿瘤有无包膜和微血管侵犯有关(P0.05)。结论HCC患者的术后的预后与Snail蛋白的表达有关,Snail蛋白有可能成为肝癌术后预测复发判断预后的生物学标志。     

抑癌基因FHIT在肝细胞癌中的研究

目的　探讨原发性肝细胞癌 (HCC)中FHIT基因的表达。方法　采用免疫组织化学技术 (SP法 )检测 4 0例HCC及其癌旁组织、32例肝外伤后正常肝组织中FHIT的表达情况。结果　 4 0例HCC中有 1 1例FHIT表达缺失 ,而相应的癌旁组织中只有 2例FHIT蛋白表达缺失 ;正常肝组织中全部呈阳性表达 ;HCC组织中FHIT蛋白缺失率显著高于相应癌旁及正常肝组织 (P <0 .0 1 ) ,并与肿瘤的病理学分级、TNM分期、门静脉癌栓及HBsAg阳性表达有密切关系 (P <0 .0 5 )。结论　FHIT蛋白的缺失与HCC的发生、发展有关     

Livin蛋白在原发性肝细胞癌组织中的表达和意义

目的 探讨凋亡抑制蛋白(inhibitor of apoptosis protein,IAP)Livin在人原发性肝癌(HCC)组织中的表达及其与HCC血管生成的关系.方法 应用免疫组织化学法检测42例HCC及对应癌旁组织和12例正常肝组织内Livin的表达情况,观察Livin蛋白与HCC病理学特点及微血管密度(microvessel density,MVD)之间的关系.结果 免疫组织化学(SP)染色结果显示,Livin蛋白在正常肝组织中均不表达,而在42例HCC中的阳性表达率(73.81%)显著高于癌旁组织(4.76%)和正常肝脏组织,有显著统计学意义(X2=39.13,P＜0.05;X2=17.89,P＜0.05);Livin蛋白在病理分级Ⅲ～Ⅳ组阳性表达率(85.12%)强度明显高于病理分级Ⅰ～Ⅱ组(53.33%),两者比较差异有显著统计学意义(X2=4.690,P＜0.05);Livin蛋白在有转移HCC中的阳性表达率(89.47%)明显高于无转移组(60.89%),有统计学意义(X2=4.404,P＜0.05);Livin蛋白阳性表达HCC中的MVD值明显高于Livin蛋白阴性表达HCC中MVD值(23.56±5.12/17.63±4.86;P＜0.05).结论 Livin蛋白基因在原发性肝癌组织中高表达,提示该基因可能参与了肝癌的发生发展过程;Livin蛋白在HCC组织中的表达明显上调且与血管生成和浸润转移有关.     

肝细胞癌组织中p16,p27蛋白的表达及其意义

为探讨p16,p2 7蛋白在肝细胞癌 (HCC )中的表达情况、相互关系及其临床病理学意义。笔者应用免疫组织化学方法 (SABC法 ) ,检测 49例HCC组织及癌旁组织中 p16,p2 7蛋白表达水平。结果示 49例HCC中 ,p16,p2 7蛋白阳性表达率分别为 3 6.73 %和 40 .82 % ;而癌旁组织阳性表达率为89 .80 %和 91.84%。p16蛋白表达与HCC的分化程度密切相关 (P <0 .0 5 ) ,高分化I～II级中p16阳性率为 5 5 .5 6% ,显著高于III～IV级的 2 5 .81%。p2 7蛋白表达与HCC有无淋巴结、远处转移有显著相关性 (P <0 .0 1)。提示 p16与p2 7蛋白的表达缺失在HCC发生中可能起重要作用。p2 7蛋白可作为衡量HCC预后的有用指标。     

肝细胞肝癌Survivin与血管内皮生长因子表达相关性及其临床意义

目的　探讨肝细胞肝癌 (HCC)Survivin与血管内皮生长因子 (VEGF)的表达相关性及其临床意义。方法　应用链霉抗生物素蛋白 过氧化物酶免疫组织化学 (SP)法检测 5 6例HCC中Survivin与VEGF的表达。结果　HCC中 3 4例Survivin表达阳性 ,阳性率为 60 .7%。 3 5例VEGF表达阳性 ,阳性率为 62 .5 %。HCC组织Survivin与VEGF的表达阳性率高于癌旁组织及正常肝组织 (P <0 .0 5 )。Survivin的表达与HCC肿瘤镜下门静脉癌栓发生密切相关 (P <0 .0 5 )。VEGF的表达与HCC肿瘤大小、肿瘤镜下门静脉癌栓发生以及肿瘤病理分期密切相关 (P <0 .0 5 )。相关性检验示Survivin与VEGF之间有相关性 (χ2 =4.491,P <0 .0 5 )。结论　HCC中Survivin、VEGF蛋白表达均上调 ,共同参与HCC发生和发展 ,VEGF与Survivin有协同表达关系。     

新生血管生成与肝细胞癌侵袭、转移和预后的关系

目的　探讨原发性肝细胞癌 (HCC)新生血管生成与临床病理指标的关系及其可否用于预测HCC侵袭、转移和预后。方法　采用免疫组织化学方法 ,检测了 2 0例正常肝组织、2 0例肝硬化组织、85例HCC及癌旁组织中CD34的表达 ,以及HCC的微血管密度 (MVD)。结果　CD34的染色定位在血管内皮细胞上 ,HCC窦样血管CD34表达为强阳性 ;除门管区小血管分支及中央静脉外 ,癌旁肝组织、肝硬化组织、正常肝组织基本不表达CD34 ;HCC的MVD范围 (18～ 36 0 ) / 0 74mm2 、(15 6 5±6 2 4) / 0 74mm2 。HCC的MVD与肿瘤大小、病灶数目、分化程度、门静脉瘤栓形成、包膜状况均有显著关系 (P <0 0 5或 0 0 1) ;与HBsAg是否阳性、术前AFP水平无关 (P >0 0 5 ) ;与预后亦有关 ,少血管组(MVD <15 6 )预后显著优于多血管组 (MVD≥ 15 6 ) ,术后平均无瘤生存期少血管组为 5 3个月 ,多血管组为 14个月 ,(P <0 0 0 1)。结论　CD34的表达反映了HCC的新生血管化 ,与HCC的发展有关。MVD可作为判断HCC侵袭、转移和预后的指标。     

Survivin在肝细胞性肝癌中的表达及其临床意义

为研究survivin 与肝细胞肝癌（HCC）临床特征的关系，探讨其对HCC的早期诊断及治疗的意义。笔者应用免疫组织化学(SABC)法,检测survivin在39例HCC组织、4例正常肝组织和8例肝硬化组织中的表达，并分析HCC及不同病理学特征与survivin蛋白表达的关系。结果示， HCC组织、正常肝组织、肝硬化组织中survivin基因的阳性表达率依次为61.3%，0%和0%;HCC组织与后2组间差异有显著性(P<0.05);随HCC分化程度的降低, survivin的阳性表达率明显上升(P<0.05)。提示survivin的表达水平在HCC的发生、发展中具有重要意义,有望成为一新的肿瘤标志物而应用于临床。     

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.     

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.     

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.     

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.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.