生长抑素受体在乳腺癌组织中表达及其临床意义

目的研究生长抑素受体(SSTR)在原发性浸润性乳腺癌组织中的表达情况,以及与临床病理因素的关系。方法应用免疫组化法(IHC)检测82例原发性乳腺浸润性导管癌组织中SSTR的表达,分析其与临床病理因素的关系。结果原发性乳腺浸润性导管癌组织中SSTR阳性表达率为74.4%(61/82)。SSTR阳性表达强度与年龄(P>0.05)、肿瘤大小(P>0.05)无关,不同肿瘤病理分期(P<0.001)、分化程度(P<0.05)的肿瘤组织中SSTR表达强度有显著性差异。结论原发性乳腺浸润性导管癌组织中SSTR阳性表达率为74.4%,因此,对大多数疑为乳腺癌的患者可应用生长抑素受体显像技术(SRS)进行筛选。     

人胃癌组织中SSTR2、SSTR5亚型与p-ERK的表达及其相关性

目的：检测生长抑素受体（SSTR）亚型SSTR2、SSTR5和p-ERK在人胃癌及正常胃组织中的 mRNA 和蛋白表达差异,从而探讨三者之间的相关性。方法应用免疫组化方法检测23例胃癌组织和20例正常胃组织中SSTR2、SSTR5和p-ERK的蛋白表达差异,应用real time PCR技术检测三者的mRNA表达差异。结果在蛋白水平,胃癌与胃正常组织 SSTR2的表达差异无显著性（P＞0.05）,胃癌 SSTR5的表达高于胃正常组织（P＜0.05）,胃癌p-ERK的表达高于胃正常组织（P＜0.05）;在mRNA水平,胃癌与胃正常组织SSTR2的表达差异无显著性（P＞0.05）,胃癌SSTR5的表达高于胃正常组织（P＜0.05）,胃癌ERK的表达高于胃正常组织（P＜0.05）;胃癌中SSTR2与ERK表达无相关性（P＞0.05）,SSTR5与ERK表达呈正相关（P＜0.05）。结论人胃癌组织中,高表达SSTR5与p-ERK,低表达SSTR2、SSTR5与ERK在胃癌的发生发展中起重要作用,且二者之间可能通过某种机制相互关联。     

活动期溃疡性结肠炎患者结肠黏膜中生长抑素受体的表达及其临床意义

目的:研究生长抑素受体(somatostatin receptor,SSTR)在活动期溃疡性结肠炎(ulcerative colitis,UC)中的表达及其临床意义.方法:取36份活动期UC患者的结肠黏膜标本(结肠炎组)及30份体检者的结肠黏膜标本(对照组),采用免疫组织化学法检测两组SSTR的表达情况.结果:SSTR的表达主要定位于结肠黏膜的上皮细胞、纤维细胞、淋巴细胞和小血管的内皮细胞的细胞质中.SSTR在UC结肠黏膜中的阳性表达率为92%,明显高于对照组的73%(P＜0.05).中、重度UC患者结肠黏膜SSTR的阳性表达率均明显高于轻度UC患者(均为P＜0.05).便血明显(肉眼可见)的UC患者结肠黏膜SSTR的阳性表达率明显高于便血不明显(肉眼不可见,但潜血试验阳性)的UC患者(P＜0.05).结论:活动期UC患者结肠黏膜的SSTR的表达上调,其上调程度在病情较重或伴明显便血患者中更高.     

SSTR2和SSTR5在喉癌中的表达及意义

目的 研究生长抑素受体（somatostatin receptor，SSTR）亚型SSTR2和SSTR5在喉癌组织及癌旁组织中的表达情况，以及与临床病理特征的关系。方法 应用免疫组化方法检测46例喉癌组织与30例癌旁组织中SSTR2和SSTR5的表达，分析其与临床病理因素的关系。结果 在46例喉癌中SSTR2和SSTR5的表达率分别为58．70％和82．61％，癌旁组织中分别为83．33％和90．00％。喉癌中SSTR2的表达低于癌旁组织（P〈0．05），SSTR5的表达与癌旁组织无差异（P〉0．05），SSTR2和SSTR5的表达与喉癌的临床分期（P〈0．05）、病理分化程度（P〈0．05）有明显相关。结论大多数喉癌肿瘤组织中有一种以上生长抑素受体亚型基因的表达，其表达随喉癌恶性程度呈下降趋势。     

人涎腺癌细胞系MEC-1和Mc3生长抑素受体表达及RC-160的结合特性与预后康复相关

背景人涎腺粘液表皮样癌发生发展的机制目前仍不清楚,深入研究SSTR的生物学特性及亚型分布模式是该领域研究热点之一.目的探讨人涎腺粘液表皮样癌细胞系(MEG-1)及人粘液表皮样癌高转移细胞株(Mc3)生长抑素受体(SSTR)两种亚型(SSTR1、SSTR2)的表达与SSTR的放射配基125I-RC-160的结合差异与预后康复的相关性.设计非随机非对照的研究.地点和材料实验地点在第四军医大学口腔生物学教研室和西京医院核医学科.细胞系采用第四军医大学口腔生物学教研室建立的人涎腺粘液表皮样癌细胞MMEC-1、人涎腺粘液表皮样癌细胞株高转移细胞克隆Mc3.RPMI 1640培养基及胰蛋白酶为Gibco产品;寡核苷酸探针由中科院微生物所制备;RC-160由北京赛百盛公司提供.方法采用细胞计数法、软琼脂法等观察MEC-1及Mc3细胞株生物学特性;以原位杂交法检测MEC-1,Mc3细胞株SSTR1及SSTR2两种亚型的表达情况;以放射配基结合分析法分析MEC-1,Mc3细胞与125I-RC-60的结合情况.主要观察指标MEC-1及Mc3细胞生物学特性,MEC-1,Mc3细胞SSTR1,SSTR2两种亚型的表达及MEC-1,Mc3细胞与125I-RC-160结合的情况.结果MEC-1,Mc3细胞生长稳定,Mc3较MEC-1生长速度略快,克隆形成率高;MEC-1细胞高度表达SSTR1及SSTR2(82.6%和81.7%);Mc3细胞无两种亚型表达.MEC-1和Mc3细胞与125I-RC-160的特异结合率分别为(23.8±9.4)%和(3.2±2.3)%,差异有显著性意义(P＜0.01).结论MEC-1高度表达SSTR1及SSTR2,与RC-160的特异结合率显著高于Mc3细胞,而恶性程度则低.     

生长抑素受体在乳腺癌组织中表达及其临床意义

目的 研究生长抑索受体（SSTR）在原发性浸润性乳腺癌组织中的表达情况。以及与临床病理因素的关系。方法 应用免疫组化法（IHC）检测82例原发性乳腺浸润性导管癌组织中SSTR的表达，分析其与临床病理因索的关系。结果 原发性乳腺浸润性导管癌组织中SSTR阳性表达率为74．4％（61／82）。SSTR阳性表达强度与年龄（P〉0.05）、肿瘤大小（P〉0.05）无关，不同肿瘤病理分期（P〈0．001）、分化程度（P〈0．05）的肿瘤组织中SSTR表达强度有显著性差异。结论 原发性乳腺浸润性导管癌组织中SSTR阳性表达率为74．4％，因此，对大多数疑为乳腺癌的患者可应用生长抑索受体显像技术（SRS）进行筛选。     

颅咽管瘤中生长抑素受体2蛋白的表达及其意义

目的 检测颅咽管瘤组织中生长抑素受体2(SSTR2)蛋白的表达并探讨其临床意义。方法 采用免疫组化法和Western blot检测22例对照组和36例颅咽管瘤组中SSTR2蛋白的表达情况。结果免疫组化法测得SSTR2蛋白在36例颅咽管瘤组中阳性率[47.22%(17/36)]高于对照组[16.67%(3/22)]、在釉质上皮型(AE)颅咽管瘤中的阳性率[57.74%(12/21)]高于鳞状乳头型(SP)[33.33%(5/15)],差异均有统计学意义(P0.05)。Western blot测得颅咽管瘤组中SSTR2蛋白表达[(0.423±0.019)]强于对照组[(0.122±0.007)]、AE组[(0.531±0.025)]高于SP组[(0.316±0.014)],差异均有统计学意义(P0.05)。结论 SSTR2蛋白在颅咽管瘤中高表达,且在不同亚型中存在差异,提示生长抑素及其类似物可能成为颅咽管瘤治疗的靶向药物以及生长抑素受体显像可能辅助颅咽管瘤亚型的诊断以及预后。     

血管内皮细胞生长因子及受体在乳腺癌组织的表达研究

目的 探讨血管内皮细胞生长因子（VEGF）及其受体在乳腺癌组织中表达的意义.方法 使用逆转录聚合酶链反应（RT-PCR）及计算机条带分析半定量方法检测了VEGF异构体及受体mRNA在乳腺癌组织及癌周组织的表达水平.对VEGF121 mRNA及KDRmRNA表达水平和肿瘤大小,淋巴结转移及绝经前后的关系进行统计学分析.结果 在乳腺癌组织及癌周组织均检测到VEGF121和KDR,flt-1的mRNA表达,VEGF121和KDR在癌组织表达水平明显高于癌周组织,在癌组织及癌周组织,VEGF121 mRNA表达和KDR121 mRNA表达之间有明显直线正相关及回归依存关系,VEGF121,KDR的mRNA表达在肿瘤≥2cm;淋巴结阳性及绝经前组病人明显高于淋巴结阴性、肿瘤＜2cm和绝经后组病人.结论 VEGF、KDR在乳腺癌组织的表达水平明显高于癌周组织,VEGF积极参与乳腺癌的新生血管增殖过程.     

甲状腺滤泡性肿瘤中核转录因子过氧化物酶体增殖物激活受体γ表达与临床意义

目的 研究核转录因子过氧化物酶体增殖物激活受体7(peroxisome proliferator-activated receptor γ,PPAR γ)在甲状腺滤泡性肿瘤中表达及其与病变的关系.方法 分别应用免疫组化方法及原位杂交方法检测42例原发性甲状腺滤泡性肿瘤(滤泡性腺癌19例,腺瘤23例)标本中PPAR 7蛋白及tuRNA表达.结果 PPAR γ蛋白及PPAR TmRNA在甲状腺滤泡性腺癌表达与甲状腺滤泡性腺瘤的表达差异无统计学意义,11例vs 8例(P＞0.05).PPAR γ蛋白在无肿瘤转移、低预后指数的甲状腺滤泡性腺癌表达阳性率升高,7例vs 4例,6例vs 5例(均P＜0.05),PPAR γmRNA在无转移甲状腺滤泡性腺癌表达阳性率增高,7例vs 5例(P＜0.05).PPARγ蛋白和PPARγmRNA表达水平呈显著正相关(rs=0.771,P=0.000).结论 检测PPAR γ蛋白及PPAR TmRNA水平可能是判断甲状腺癌预后的观测指标.     

Shh在散发性甲状腺髓样癌中的表达及其临床意义研究

目的 通过检测Sonic Hedgehog信号通路关键分子Shh在散发性甲状腺髓样癌表达情况,探讨其与散发性甲状腺髓样癌临床病理特征的关系及临床意义.方法 应用免疫组织化学方法检测11例甲状腺髓样癌患者癌组织及其癌旁组织病理蜡块标本中Shh的表达情况,分析其与临床病理特征的关系.结果 Shh蛋白主要表达于细胞膜与细胞质中.甲状腺髓样癌组织中Shh阳性表达率72.7％ (8/11)明显高于癌旁组织的9.1％(1/11).癌组织中Shh的表达与患者性别及年龄均无关(P＞0.05),而与肿瘤的TNM分期有关(P＜0.05).Shh在肿瘤直径≥1 cm和直径＜1 cm的表达阳性率分别为100％和20％,差异有统计学意义(P＜0.01).Shh在有淋巴结转移的肿瘤组织中和无淋巴结转移的肿瘤组织中的表达阳性率分别为100％和40％,差异有统计学意义(P＜0.05).结论 Shh信号通路的主要配体Shh蛋白在散发性甲状腺髓样癌中表达升高,并与肿瘤发生、分期及淋巴结转移有关,提示Shh信号通路的异常激活在散发性甲状腺髓样癌中发挥一定的作用,Shh蛋白为散发性甲状腺髓样癌预后判断指标及潜在的治疗靶点.     

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.