血管内皮生长因子在胃腺癌中的表达及意义

目的　探讨血管内皮生长因子 (VEGF)在判断胃腺癌转移和预后中的作用。方法　应用免疫组织化学S P法检测 76例胃腺癌组织和 10例正常胃组织中VEGF的表达水平 ,比较VEGF的不同表达率与生存率的关系及其与肿瘤特征的相关性。结果　胃腺癌组织中VEGF阳性表达率为 72 .4 % ,较正常组织显著增高 (P <0 .0 5 ) ,与Borrmann分型、浸润深度、肿块大小、淋巴结转移程度比较相关显著 (P <0 .0 5 ) ,与分化程度相关不显著 (P >0 .0 5 ) ,VEGF阳性表达者的生存时间较阴性者短 (P <0 .0 5 )。结论　VEGF与血管发生密切相关 ,可作为判断胃腺癌转移和预后的重要指标。     

肺癌患者血清VEGF表达水平与临床病理特征的相关性研究

目的探讨肺癌患者血清血管内皮生长因子(VEGF)表达水平变化与临床病理特征的关联性。方法选取昆明市延安医院肿瘤科2018年1-3月45例肺癌患者和35例健康者进行分析,入院后第2天晨起时抽取各组受检者空腹静脉血,以酶联免疫吸附测定(ELISA)血清VEGF水平,统计对比分析VEGF水平与分期、原发瘤大小、淋巴结转移之间的关系。结果肺癌患者血清中VEGF的表达:Ⅰ期与Ⅱ期之间差异无统计学意义(P0.05);Ⅰ期与Ⅲ、Ⅳ期相比,差异有统计学意义(P0.05);Ⅱ期与Ⅲ、Ⅳ期相比差异有统计学意义(P0.05),Ⅲ期与Ⅳ期之间比较差异有统计学意义(P0.05);T1和T2间比较差异无统计学意义(P0.05),T1与T3、T4比较差异有统计学意义(P0.05),T2分别与T3、T4比较差异有统计学意义(P0.05),T3与T1、T2、T4比较差异有统计学意义(P0.05);T4与T1、T2、T3比较差异有统计学意义(P0.05);在N0与N1之间差异无统计学意义(P0.05),N0和N2、N3之间差异有统计学意义(P0.05),N1与N2、N3比较差异有统计学意义(P0.05),N2与N3之间差异无统计学意义(P0.05)。结论 VEGF随着肺癌患者的分期、原发肿瘤大小及淋巴结转移进展其血清中的表达水平升高。     

宫颈癌患者5项相关指标的表达研究

目的探讨宫颈癌患者缺氧诱导因子-1α(HIF-1α)、血管内皮生长因子(VEGF)、基质金属蛋白酶-13(MMP-13)、凋亡抑制因子(survivin)、B细胞淋巴瘤-2(bcl-2)的表达、相互关系及临床意义。方法选取宫颈病变组织169例、正常对照组25例。采用免疫组化法检测组织中上述5项指标的表达。结果宫颈癌组织内存在HIF-1α、VEGF、MMP-13、survivin、bcl-2的表达,差异有统计学意义(P0.05);与预后呈负相关;但与年龄、性别、肿块类型无关。HIF-1α、VEGF、survivin、bcl-2与临床分期有关,随着临床分期的增高表达增强,差异有统计学意义(P0.05)。VEGF、MMP-13、survivin的表达与淋巴结转移有关,有淋巴结转移组阳性率明显高于无淋巴结转移组,差异有统计学意义(P0.05)。肿瘤中央区HIF-1α、VEGF的表达水平较周边区高,肿瘤表达水平与微血管密度密切相关,差异有统计学意义(P0.05)。HIF-1α与VEGF、survivin与bcl-2呈正相关,其余无直接相关性。结论 HIF-1α、VEGF、MMP-13、survivin、bcl-2的异常表达参与了宫颈癌的发生和发展,联合检测上述5项指标有望为宫颈癌的早期诊断、手术化疗疗效的评价、预后的判断提供有力的临床指导。     

肺癌患者PCDH20、VEGF蛋白及其与临床病理指标的关系

目的研究肺癌患者原钙黏蛋白-20(PCDH20)、血管内皮生长因子(VEGF)蛋白的变化及其与临床病理指标的关系。方法收集2013年8月至2015年7月行手术切除的原发性肺癌组织标本60例,取出10例肺癌周边相对较为正常的肺组织视为对照组。观察肺癌组和对照组的PCDH20、VEGF阳性表达情况。对肺癌组织中PCDH20、VEGF蛋白的阳性表达和年龄、性别、病变部位、临床分期、分化程度及淋巴结转移之间的关系进行分析。结果肺癌组中的PCDH20、VEGF阳性率显著高于对照组,差异均有统计学意义(P0.05)。肺癌组织中的PCDH20、VEGF蛋白的表达和临床分期、是否存在淋巴结转移有着密切的关联性(P0.05),但和患者的年龄、性别及病变部位无相关性(P0.05)。多因素Logistic回归显示,临床分期、淋巴结转移均是影响PCDH20、VEGF蛋白表达的因素(P0.05)。结论临床分期、淋巴结转移病理因素和肺癌PCDH20、VEGF蛋白的表达存在密切关联性。     

血管内皮生长因子在肺癌中的临床应用价值

目的探讨血管内皮生长因子(VEGF)在肺癌中的临床应用价值。方法采用酶联免疫吸附试验(ELISA)检测142例经病理确诊的肺癌患者、30例肺部疾病对照患者及25名正常对照者血清VEGF水平,比较不同肿瘤分期、化疗和手术前后患者VEGF的表达改变,并用受试者工作特征(ROC)曲线评价VEGF在肺癌中的应用价值,采用SPSS 13.0统计软件进行统计分析。结果肺癌患者血清VEGF水平为154.09(86.81,260.01)pg/m L,明显高于正常对照组[59.06(27.66,77.81)pg/m L,P0.01];不同病理类型肺癌患者间血清VEGF水平差异无统计学意义(P=0.493);患者化疗前后血清VEGF水平差异无统计学意义(P0.05);不同M分期和临床分期的非小细胞肺癌患者VEGF水平差异有统计学意义(P0.05);局限期与广泛期小细胞肺癌患者VEGF水平差异无统计学意义(P0.05);VEGF诊断肺癌的ROC曲线下面积为0.664,区分小细胞肺癌远处转移的ROC曲线下面积为0.666。结论 VEGF在肺癌患者血清中异常表达,与肺癌患者临床分期密切相关,对肺癌的诊断及转移的判断具有一定价值。     

细胞角蛋白和血管内皮生长因子在早期宫颈癌中的表达及意义

目的:探讨细胞角蛋白(cytokeratin,CK)和血管内皮生长因子(vascular endothelial growth factor,VEGF)在早期宫颈癌中的表达及其临床意义.方法:选择50例早期宫颈癌病例,FIGO分期(Ⅰ b-Ⅱa),术前均未行放化疗.应用免疫组化Envision方法测定淋巴结中的CK表达,免疫组化SP法测定宫颈组织中的VEGF的表达.结果:50例患者中有35例常规HE染色无淋巴结转移,35例中14例淋巴结CK表达(+),21例淋巴结CK表达(-);CK的表达与年龄、组织学类型、病理分级、临床分期、浸润深度、脉管侵犯无相关性,CK(-)组与CK(+)组相比无统计学差异(P＞0.5).宫颈癌组织VEGF表达随病理分级增加(P=0.043)、宫颈深肌层浸润(P=0.032)、淋巴脉管侵犯而增强(P=0.000),并随有无淋巴结转移,包括淋巴结微转移(lymph node micrometastases,MI)而差异有显著性(P=0.000);与临床分期无关(P=0.248);VEGF表达与CK表达正相关,14例CK(+)组,VEGF高表达(++～+++)占100%(14/14).21例CK(-)组,术后随访至今无一例复发;14例CK(+)组,有5例复发,复发率35.7%;15例常规HE染色有淋巴结转移组,术后有8例复发,复发率占53.5%.3组相比差异有统计学意义.结论:VEGF表达高低可用来预测早期宫颈癌有无盆腔淋巴结转移,尤其是VEGF高表达,而常规HE染色无淋巴转移,预示患者可能有淋巴结微转移,有不良预后,术后复发率高,需辅以术后放化疗,降低复发率.     

乳腺癌预后判断中VEGF、CA15-3、CA125和CEA的表达及其意义

目的 探讨血清中血管内皮生长因子(VEGF)、CA15-3、CA125和癌胚抗原(CEA)检测在乳腺癌预后判断中的表达及其临床意义.方法 用免疫组化(S-P)法动态监测93例乳腺癌患者的VEGF水平,用放射免疫法检测CA15-3、CA125和CEA的水平,并与25例健康体检者的各项指标进行比较,分析其与临床分期、治疗效果和复发转移的关系.结果 乳腺癌组的VEGF阳性率显著高于正常对照组,且乳腺癌Ⅰ～Ⅳ期健康状况依次升高,有淋巴结转移者较无转移患者高,差异有统计学意义(P《0.01);乳腺癌患者中Ⅲ、Ⅳ期的CA15-3、CA125和CEA水平也明显高于正常对照组和Ⅰ、Ⅱ期患者,有淋巴结转移者显著高于无淋巴结转移患者,差异均有统计学意义(P《0.05);随访中发现复发者各项指标均比无复发者高;VEGF、CA15-3、CA125和CEA的表达与临床分期、腋窝淋巴结状况有关(P《0.01),但与患者年龄、肿瘤大小和肿瘤病理学类型无关(P》0.05).结论 VEGF、CA15-3、CA125和CEA的检测对于判断乳腺癌的分期、转移情况及治疗效果的评价有一定意义,可以指导临床对乳腺癌的诊疗工作.     

肺癌患者血管内皮生长因子表达与缺氧及肿瘤生物学行为和预后的关系

目的：探讨血管内皮生长因子(vascular endothelial growth factor，VEGF)在肺癌患者的表达与缺氧诱导因子-1α(hypoxia-inducible factor-1α，HIF-1α)及肿瘤生物学行为和预后的关系。方法：随机选取青岛大学医学院附属医院1985—01／1990-12经手术切除的具有完整随访记录的75个肺癌标本，术前均未行放射治疗或应用抗肿瘤药物治疗，采用免疫组化PV-9000法检测VEGF和HIF-1α的表达。结果：不同组织学分级、不同术后生存时间组间VEGF表达强度的差异均有极显著性意义(Hc=17．019，17．616；P=0．000)。其表达强度的差异在淋巴结有、无转移组间亦有极显著性意义(Z=-3．319，P=0．001)。在不同组织病理类型间．HIF-1αd的表达差异有极显著性意义(Hc=14．021，P=0．001)，小细胞肺癌的表达强度显著高于鳞、腺癌(P=0．000，0．012)，而鳞、腺癌间的表达差异无显著性意义(P=0．113)。其阳性强度增加亦与肺癌细胞恶性程度(Hc=29．470，P=0．000)、易发生淋巴结转移(Z=2．576，P=0.010)及预后不良(胁=20．681，P=0．000)有关。肺癌组织中VEGF与HIF-1α的表达强度呈极显著性正相关(r=0．564，P=0．000)。结论：VEGF的表达强度与缺氧程度密切相关；VEGF和HIF—1α的表达均与肺癌细胞分化程度、淋巴结转移及患者生存期有关，提示两者均可作为评估肺癌生物学行为和预后的重要指标。     

Bcl-2、nm23-H1和VEGF在非小细胞肺癌组织中的表达及意义

目的 探讨Bcl-2、VFAGF和nm23-H1基因在肺癌在非小细胞肺癌组织中的表达及其与淋巴结转移的关系。方法 采用免疫组化S-P法检测123例非小细胞肺癌组织中Bcl-2、VEGF和nm23-H1基因的表达。结果 Bcl-2蛋白的阳性表达在高、中和低分化肺癌组间比较，差异有显著性（P〈0．05），与肺癌P-TNM分期组间比较，差异亦有显著性（P〈0．05）．nm23-H1蛋白在淋巴结元转移肺癌组中显著高于转移组（P〈0．05），VEGF蛋白的阳性表达在肺癌病理分级、P-TNM分期及淋巴结转移各组间均有显著性（P〈0．05）。Bcl-2、VEGF和nm23-H1基因在肺癌中的表达元相关性。结论 Bcl-2、VFAGF和nm23-H1基因在肺癌的组织发生上起着重要作用，三种基因蛋白产物的检测对肺癌患者的诊治和预后评估有积极意义。     

肺癌血管内皮生长因子表达与增强CT的相关性研究

目的：探讨肺癌组织中血管内皮生长因子（VEGF）的表达水平与肿瘤CT增强程度的关系，从影像学角度评价肺癌VEGF表达水平的临床意义。方法；选择30例经手术切除的肺癌患者，术前均做肺部病灶的CT平扫及增强扫描，术后常规送病理，并应用流式细胞技术对手术标本的VEGF表达水平进行定量测定。结果：癌组织中VEGF的表达明明显高于正常肺组织（P＜0．05）。VEGF在不同组织学类型的肺癌组织中表达无差异（P＞0．05）。VEGF在Ⅱ期和ⅢA期肺癌组织的表达量均明显高于I期（P＜0．01，P＜0．05）。淋巴结转移组的VEGF表达量高于无淋巴结转移组（P＜0．05）。肺癌病灶的CT增强程度与其VEGF表达水平呈正相关（P＜0．01）。结论：VEGF在肺癌组织中呈高度表达，与肺癌的组织学类型无关，与临床分期和淋巴结转移密切相关，可能是预后不良的标志。肺癌的CT增强程度与VEGF表达量呈线性依存关系，两者呈正相关。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.