宫颈癌血管生成与癌细胞增殖及浸润转移的关系

目的　探讨早期宫颈癌血管生成与癌细胞增殖及浸润转移的关系。方法　采用免疫组织化学 SP法检测75例早期宫颈癌、18例宫颈上皮内瘤样病变 (CIN)和 15例癌旁正常宫颈上皮中微血管密度 (MVD,CD34 标记 )及 Ki- 6 7抗原的表达情况 ,探讨宫颈癌血管生成与癌细胞增殖及浸润转移的关系。结果　 CD34 主要表达于宫颈癌巢间质血管内皮细胞 ,而 Ki- 6 7主要表达于宫颈癌细胞核。从正常宫颈上皮→ CIN→宫颈浸润癌 ,MVD和 Ki- 6 7表达均显著升高 (P<0 .0 5 )。宫颈癌 MVD与盆腔淋巴结转移、脉管浸润、间质浸润和 Ki- 6 7表达有关 (P<0 .0 5 ) ;而与年龄、FIGO分期、组织学分级和组织学类型无关 (P>0 .0 5 )。有盆腔淋巴结转移、脉管浸润、≥深层间质浸润及 Ki- 6 7呈高度表达者 ,其 MVD分别显著高于无盆腔淋巴结转移、无脉管浸润、<深层间质浸润及 Ki- 6 7<高度表达者 (P<0 .0 5 )。结论　肿瘤血管生成可能在宫颈癌发生发展、癌细胞增殖和浸润转移中起重要作用。宫颈癌伴 MVD显著升高者 ,其癌细胞增殖活跃 ,易发生浸润转移 ,但并非唯一决定因素。检测宫颈癌 MVD对进一步了解宫颈癌生物学行为具有一定的临床应用价值。     

基质金属蛋白酶组织抑制物-1在宫颈癌的表达与临床意义

目的 :探讨基质金属蛋白酶组织抑制物 - 1(TIMP- 1)在早期宫颈癌的表达和临床意义。方法 :采用免疫组织化学 SP法检测 75例早期宫颈浸润癌 (宫颈癌组 )、18例宫颈上皮内瘤样病变 (CIN组 )和 15例癌旁正常宫颈上皮 (对照组 )中 TIMP- 1的表达情况 ,并检测其中微血管密度 (CD34 标记 )和癌细胞增殖标记指数 (Ki- 6 7标记 )。结果 :TIMP- 1主要表达于宫颈癌细胞膜和 (或 )细胞浆 ,Ki- 6 7主要表达于癌细胞核 ,CD34 主要表达于癌巢间质血管内皮细胞。从对照组到 CIN组再到宫颈癌组 ,TIMP- 1的阳性表达率未见显著升高 (P>0 .0 5 )。 TIMP- 1在宫颈癌中表达与 FIGO分期、组织学分级、盆腔淋巴结转移和间质浸润深度有关 (P<0 .0 5 ) ;而与年龄、组织学类型、脉管浸润、Ki- 6 7表达及微血管密度无关 (P>0 .0 5 )。 FIGO分期为 期、组织学分级为 级、有盆腔淋巴结转移及突破深肌层间质浸润者 ,其 TIMP- 1阳性表达率分别显著低于 FIGO分期为 期、组织学分级在 级以内、无盆腔淋巴结转移和浸润深度在浅肌层间质以内者 (P<0 .0 5 )。结论 :宫颈癌 TIMP- 1表达降低可能在侵袭转移中起一定作用。检测宫颈癌 TIMP- 1表达对进一步了解宫颈癌生物学行为和判断预后有一定价值。     

食管癌和淋巴结组织中生存素和CD44v6的表达及临床意义

目的研究生存素和CD44v6在食管癌组织中的表达及其与食管癌细胞发生、发展与转移的关系。方法应用免疫组化SP法检测94例食管鳞癌和83例淋巴结中生存素和CD44v6的表达情况。结果原发癌组织中生存素与浸润深度有关(P<0.05);原发癌组织中CD44v6表达率与淋巴结转移、浸润深度和临床分期等因素有关(P<0.05);原发癌组织和转移淋巴结组织中生存素和CD44v6表达率均高于无转移淋巴结组织(P<0.05);原发癌组织和转移淋巴结组织中生存素和CD44v6表达率差异无统计学意义(P>0.05);生存素和CD44v6在淋巴结中表达无相关性(P>0.05)。结论生存素和CD44v6在食管癌组织和转移淋巴结中高表达,在食管癌的发生发展过程中具有重要作用,可作为评价食管癌生物学行为的指标。     

CD44v6和nm23H1基因在甲状腺乳头状腺癌中的表达及临床意义

目的 :探讨甲状腺乳头状腺癌 (PTC)CD44v6和nm2 3H1基因表达与肿瘤侵袭转移的关系。方法 :应用催化信号放大系统原位杂交技术检测 46例PTC组织中CD44v6mRNA和nm2 3H1mRNA的表达。结果 :在PTC中CD 44v6mRNA和nm 2 3H 1mRNA表达阳性率分别为 76 1%和 63 0 % ,CD44v6mRNA表达阳性率在有浸润有淋巴结转移的PTC组织中显著高于无浸润无淋巴结转移者 (P <0 0 5 ) ;nm2 3H1mRNA表达阳性率则显著低于无浸润、无淋巴结转移者 (P <0 0 5 ) ;在PTC中CD44v6mRNA和nm2 3H1mRNA的阳性表达呈负相关 (r =-0 .3 6,P <0 0 0 5 )。结论 :CD44v6mRNA和nm 2 3H 1mRNA的表达与PTC侵袭转移密切相关 ,检测CD44v6mRNA和nm 2 3H 1mRNA的表达可作为判断PTC预后的参考指标。     

乳腺浸润性癌中MMP-9和CD44v6的表达及其与淋巴结转移的关系

目的检测MMP-9、CD44v6在乳腺浸润性癌中的表达情况,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例乳腺浸润性癌中MMP-9、CD44v6的表达情况。结果 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)。CD44v6蛋白在正常乳腺组织及乳腺癌中的阳性表达率分别为8.9%(4/45)和85.9%(79/92),而且CD44v6在淋巴结转移组中的阳性表达率(51/55)明显高于无淋巴结转移组(P<0.05)。结论 MMP-9、CD44v6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),检测MMP-9、CD44v6有助于判断乳腺癌的恶性程度和转移情况。     

VEGF、CD44v6和MMP-9在食管癌组织中的表达及临床意义

目的:探讨血管内皮生长因子(VEGF)、CD44剪接变体6(CD44v6)和基质金属蛋白酶(MMP)-9在食管癌组织中的表达及其与临床病理特征之间的关系。方法:采用免疫组化方法检测VEGF、CD44v6、MMP-9在45例食管癌患者的手术切除癌组织中的表达。结果:VEGF、CD44v6、MMP-9在食管癌组织中的表达阳性率分别为62．2％、68．9％和42．2％;VEGF、CD44v6表达与肿瘤临床分期、淋巴结转移有关(均P<0．05),与浸润深度、肿瘤大小无关(P>0．05),MMP-9表达与肿瘤临床分期、浸润深度和肿瘤大小有关(P<0．05),与淋巴结转移无关(P>0．05)。结论:VEGF、CD44v6、MMP-9与食管癌临床分期、浸润深度、淋巴结转移关系密切,提示联合检测这3项指标有助于食管癌生物学行为的判断和预后的估计。     

CD24与CD44v6在宫颈癌中的表达及意义

目的研究宫颈癌中CD24和CD44v6的表达及意义,探讨宫颈癌的发病机制及检测和治疗的新途径。方法采用免疫组化Elevision法检测正常宫颈、宫颈上皮内瘤变和宫颈癌中CD24和CD44v6的表达情况。结果 CD24在正常宫颈、宫颈上皮内瘤变、宫颈癌组织中的阳性表达率分别为0.00%、45.00%和87.50%,三者差别有统计学意义(P<0.05)。CD24与宫颈癌的病理分级、临床分期及淋巴结转移均不相关(P>0.05)。CD44v6在正常宫颈、宫颈上皮内瘤变、宫颈癌组织中的阳性表达率分别为0.00%、35.00%和76.25%,三者差别有统计学意义(P<0.05)。CD44v6与宫颈癌的病理分级、淋巴结转移相关,与临床分期不相关(P>0.05)。CD24与CD44v6在宫颈癌中无相关性(P>0.05)。结论 CD24、CD44v6与宫颈癌的发生、发展密切相关。CD44v6与宫颈癌的病理分级、淋巴结转移的相关性,提示其可能在宫颈癌的进展及转移方面起着一定的作用。     

浸润深度、VEGF-C阳性表达是显著影响宫颈癌淋巴结转移的因素

目的探讨宫颈癌淋巴转移的机制. 方法应用免疫组化二步法（Elivision）,检测VEGF-C、CD44V6在浸润性宫颈癌中的表达,结合临床病理资料进行分组比较,对实验结果进行统计学处理. 结果 VEGF-C、CD44V6的阳性表达率在有淋巴结转移、深肌层浸润组中均高于未发生淋巴结转移及深肌层浸润组（P〈0.05）.深肌层浸润组宫颈癌组织中,淋巴结转移率明显增高（P〈0.01）.Logistic回归统计结果显示淋巴结状况与CD44V6表达无明显相关,而与浸润深度、VEGF-C阳性有显著正相关（P〈0.01,B〉0）. 结论浸润深度、VEGF-C阳性表达是影响淋巴结转移的相关因子,而CD44V6所起作用相对不大.     

食管鳞癌组织中3-磷酸肌醇激酶和CD44v6的表达及其临床意义

目的 研究3-磷酸肌醇激酶(P13K)和CD44v6在食管鳞癌组织中的表达及其与食管鳞癌细胞发生、发展与转移的关系以及P13K和CD44v6两者之间的相关性.方法 应用免疫组织化学链霉卵白素-过氧化物酶法检测24例正常食管黏膜、94例食管鳞癌组织中P13K和CD44v6的表达情况.结果 食管癌组织中P13K和CD44v6的阳性表达率与正常食管黏膜组织相比差异均有统计学意义(4.2%vs 71.3%、4.2% vs 76.6%,均P<0.01).随着浸润深度和临床分期的增加,P13K和CD44v6表达增多,各组间比较差异有统计学意义(P<0.01),P13K、CD44v6在淋巴结转换阳性的癌组织中表达高于无淋巴结转移组(92.0%vs 47.7%,90.0%vs 61.4,均P<0.01),P13K与CD44v6表达呈显著正相关(r=0.230,P<0.05).结论 P13K和CD44v6表达均与食管癌发生、发展及侵袭转移有关,可作为评价食管鳞癌生物学行为的指标.在食管癌的发生发展中P13K和CD44v6协同促进肿瘤的恶性进展.     

胃癌组织中MVD计数及CD44v6，VEGF表达的意义

目的 研究CD44v6,VEGF基因蛋白和胃癌微血管密度与胃癌的发生、发展及生物学行为的关系,并探讨三者的相关性.方法 应用免疫组化MaxVisionTM染色方法检测59例胃癌,10例胃粘膜不典型增生病变和13例慢性胃炎组织的CD44v6,VEGF,CD34的表达.结果 胃癌组织中CD44v6和VEGF的阳性表达率分别为66.1%和71.2%,均高于不典型增生组及慢性胃炎组(P＜0.05).胃癌中MVD值高于不典型增生组及慢性胃炎组(P＜0.05),CD44v6和VEGF的表达及MVD与是否浸润浆膜、淋巴结转移及TNM分期有关(P<0.05).胃癌MVD计数分别与CD44v6表达,VEGF的表达存在正相关.结论 检测CD44v6和VEGF的表达和MVD计数是反映胃癌生物学特性良好的指标,对判断胃癌的浸润转移具有一定的临床意义.     

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.