VEGF和VEGFR2在结直肠癌组织中的表达及临床意义

[目的]探讨VEGF和VEGFR2在结肠恶性病变中的表达及意义.[方法]采用免疫组化法检测62例结直肠癌和30例正常结直肠组织VEGF和VEGFR2表达水平并比较.[结果]62例结直肠癌组织中VEGF、VEGFR2阳性表达率明显高于正常结直肠组织(P＜0.05);VEGF和VEGFR2在结直肠癌中的表达与患者年龄、性别、肿瘤大小、远处转移、肿瘤发生部位均无相关性(P＞0.05),与肿瘤浸润深度和淋巴结转移相关(P＜0.05).VEGF与组织学分化程度呈负相关,分化程度越差,阳性表达率越高;VEGFR2与TNM分期呈正相关(P＜0.05).[结论]VEGFR2和VEGF是评价结直肠癌恶性程度、临床病理分期、淋巴结转移的有价值指标;通过对其进行联合检测,有助于预测结直肠癌患者的浸润、转移情况及预后,指导临床采用合理的治疗方案.     

RegⅣ、血管内皮生长因子在胃癌中表达及其与微血管密度关系的研究

[目的]探讨胃癌组织RegⅣ、血管内皮生长因子(VEGF)表达及其与微血管密度(MVD)、临床病理特征的关系.[方法] 应用免疫组织化学(S-P)染色法检测89例手术切除胃癌组织中RegⅣ、VEGF和CD34的表达,计算MVD,结合临床病理特征分析.[结果] 89例胃癌组织中RegⅣ和VEGF蛋白表达率分别为41.57％ (37/89)、75.28％ (67/89),表达均明显高于癌旁组织;胃癌组织中MVD为(54.90±2.61)个/mm2,明显高于癌旁组织(9.12±3.12)个/mm2,统计学比较差异显著(P＜0.05).RegⅣ、VEGF表达与MVD分别与肿瘤分化呈负相关(P＜0.05),与癌组织浸润深度、淋巴转移和临床分期呈正相关(P＜0.05).[结论]RegⅣ、VEGF在胃癌组织中呈高表达,并与癌细胞增殖、癌血管形成有关,联合检测可作为判断胃癌生物学行为的重要指标.     

胃癌组织微血管密度和VEGF表达的关系及其临床意义

目的探讨胃癌组织微血管密度(MVD)和血管内皮生长因子(VEGF)表达与临床病理间的关系。方法对27例胃癌组织标本行常规石蜡包埋及5μm切片,然后行MVD及VEGF免疫组化染色。结果MVD平均值为37．81±10．99(个/视野),VEGF阳性率为59．26％。VEGF阳性组中的MVD值明显高于VEGF阴性组。MVD、VEGF表达与肿瘤TNM分期及有无淋巴结转移有统计学意义相关性(P＜0．05),与组织学分化程度及浆膜层是否受侵无统计学显著性意义(P＞0．05)。结论胃癌MVD值和VEGF表达密切相关,在胃癌发生、发展和转移中起重要作用,两者均可作为反映胃癌生物学行为的有用指标。     

VEGF及微血管密度与乳腺癌淋巴结转移的关系

[目的]探讨血管内皮生长因子(Vascular endothelial growth factor,VEGF)在乳腺癌组织中的表达及微血管密度(Microvessel density,MVD)与乳腺癌淋巴结转移的相关性.[方法]利用免疫组化ABC法检测92例乳腺癌组织中VEGF和CD34蛋白的表达,将病例分成两组,其中A组68例为伴有淋巴结转移患者;B组24例为不伴淋巴结转移患者.用CD34蛋白来标记MVD.[结果]A组病例中的VEGF的表达率及表达强度及MVD值明显高于B组(P＜0.05),相关分析表明MVD与VEGF呈正相关(r=0.6352).[结论]提示VEGF在乳腺癌血管生成及促进乳腺癌转移中可能发挥重要作用,检测乳腺癌组织中VEGF的表达及MVD值可能有助于判断乳癌的预后.     

甲状腺乳头状腺癌VEGF和P53蛋白表达与淋巴结转移和微血管密度的关系

目的探讨甲状腺乳头状腺癌中血管内皮生长因子(VEGF)和p53蛋白表达与微血管密度(MVD)以及颈淋巴结癌转移的关系.方法应用免疫组化技术对37例甲状腺乳头状腺癌VEGF和p53蛋白的表达进行检测,用FⅧRAg显示MVD,行相对定量研究.结果甲状腺乳头状腺癌VEGF和p53蛋白的表达率明显高于对照组(P＜0.01);颈淋巴结癌转移组的VEGF表达率高于无癌转移组(P＜0.05);而p53蛋白的表达率在前述两组间差异无显著性意义(P＞0.05).颈淋巴结癌转移组的MVD高于无癌转移组(P＜0.05).VEGF表达与MVD呈显著正相关(P＜0.01); p53表达与MVD无关(P＞0.05).结论甲状腺乳头状腺癌VEGF的表达与颈淋巴结转移有一定关系,还与其MVD相一致,提示VEGF的表达和MVD可作为判断甲状腺乳头状腺癌预后的一项重要参考指标.     

血管内皮生长因子、p53蛋白与微血管密度在非小细胞肺癌中的表达及其相关性

目的:研究血管内皮生长因子(VEGF)、p53蛋白、微血管密度(MVD)在非小细胞肺癌中的表达及其相关性,探讨其在非小细胞肺癌发生、发展中的作用.方法:采用免疫组织化学S-P法检测80例非小细胞肺癌组织、20例肺良性病变组织中VEGF、p53蛋白的表达,并对肺癌组织中CD34单抗标记的血管计数MVD.结果:肺癌组织VEGF、p53蛋白阳性表达率明显高于肺良性病变组织(P＜0.05).VEGF、p53蛋白表达与肺癌患者的年龄、性别、组织学类型均无关(P＞0.05),与肺癌组织的分化程度、TNM分期及淋巴结转移均有关(P＜0.05).VEGF与p53蛋白表达呈正相关(P＜0.05).在肺癌组织中,VEGF、p53蛋白表达阳性组MVD分别明显高于VEGF、p53蛋白表达阴性组(P＜0.05);p53蛋白与VEGF表达均阳性组MVD明显高于p53蛋白与VEGF表达均阴性组(P＜0.05).结论:VEGF、p53可能与肺癌的发生、发展有关.VEGF与p53蛋白在肺癌组织中的表达呈正相关,提示突变型p53基因可能上调VEGF的表达.肺癌组织中MVD与VEGF、p53蛋白表达密切相关,突变型p53基因和VEGF在肺癌血管形成中具有协同作用.     

血管内皮生长因子与大肠癌淋巴结转移的关系

目的　探讨大肠癌组织中血管内皮生长因子(VEGF)与淋巴结转移的关系.方法　采用免疫组化方法检测40份大肠癌组织中VEGF的表达,采用CD34标记计数肿瘤组织微血管密度(MVD),分析VEGF与大肠癌淋巴结转移的关系,采用x2检验和Spearman等级相关分析对相应资料进行分析.结果 40例大肠癌患者淋巴结转移24例,MVD为40.65±11.80,VEGF阳性21例(87.5％);无转移16例,MVD为25.02±11.52,VEGF阳性4例(25.0％),有无淋巴结转移组MVD和VEGF阳性率比较差异均有统计学意义(t=-4.138,x2=16.00,P均＜0.01).40份大肠癌组织中VEGF蛋白表达阳性25例,MVD为41.33±11.61;VEGF阴性15例,MVD为22.84±8.88,组间比较差异有统计学意义(t=5.301,P＜0.05).大肠癌组织中VEGF的表达与MVD呈正相关(rs=0.539,P＜0.05).结论 VEGF可能促进大肠癌的血管生成,进而促进大肠癌的转移.     

乳腺癌中血管内皮生长因子和基质金属蛋白酶-9的表达与淋巴结转移的关系

目的 检测血管内皮生长因子(VEGF)和基质金属蛋白酶-9(MMP-9)在乳腺癌中的表达情况,研究两者与淋巴结转移的关系.方法 采用免疫组化SP法检测92例乳腺浸润癌中VEGF、MMP-9的表达情况.结果 VEGF蛋白在对照组和乳腺癌组中的阳性表达率分别为5.7％ (3/45)和90.2％(83/92),且VEGF在淋巴结转移组中的阳性表达率(53/55)明显高于无淋巴结转移组(P＜0.05).MMP-9蛋白在正常乳腺组织及乳腺癌中的阳性表达率分别为0(0/45)和92.4％ (85/92),而且MMP-9在淋巴结转移组中的阳性表达率(54/55)明显高于无淋巴结转移组(P＜0.05).结论 VEGF、MMP-9蛋白在乳腺癌组织中高表达,且均与淋巴结转移有关(P＜0.05),两者可能在乳腺癌的远处转移中起协同作用.     

Ang-2和VEGF在大肠癌血管生成中的作用及与其临床病理特征的关系

[目的]探讨促血管生成素-2(Ang-2)及血管内皮生长因子(VEGF)在大肠癌组织肿瘤血管生成中的作用及与其临床病理特征的关系.[方法]采用免疫组织化学方法检测Ang-2及VEGF蛋白在62例大肠癌组织中的表达水平,计数微血管密度(MVD).[结果]肠癌组织中Ang-2与MVD呈正相关(r=0.7011,P<0.05);VEGF阳性表达组Ang-2和MVD明显高于阴性组(P<0.01);浸润浆膜、淋巴结转移肠癌组织中Ang-2、VEGF水平均高于无浆膜浸润、无淋巴结转移者(P<0.05);大肠癌各Dukes分期中,(C D)期Ang-2水平和VEGF阳性表达率均高于(A B)期(P<0.05).[结论]Ang-2、VEGF及其相互作用对促进大肠癌血管生成,在大肠癌的侵袭和转移中可能起到重要作用.     

VEGF、MVD、nm-23在人乳腺癌变组织中的表达及其意义

[目的]探讨血管内皮生长因子（vascular endothelial growth factor,VEGF）、微血管密度（micro vasculadensity,MVD）和nm-23基因在乳腺恶性增生病变中的表达及意义.[方法]收集经手术切除且病理证实的乳腺癌病例65例,所有患者术前均未经放疗或化疗,记录各患者肿瘤大小,组织学类型,病理分期等临床资料,采用免疫组化S-P法检测标本中VEGF、nm-23和MVD的表达.[结果]VEGF,nm-23和MVD表达与患者的肿瘤大小、组织学类型无关（P〉0.05）.VEGF,nm-23和MVD表达与乳腺癌临床分期和淋巴结转移有关（P〈0.05）.VEGF、MVD两者阳性表达呈正相关,VEGF,nm-23两者阳性表达呈负相关,nm-23与MVD表达无相关性.[结论]3者联合检测可能有助于乳腺病变的病理学分期诊断.     

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.     

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.     

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.     

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.