CD133在结直肠癌组织中的表达及其与患者预后关系的研究

目的探讨CD133作为一种癌症干细胞标志物在结直肠癌组织中的表达与结直肠癌临床病理特征的关系及与患者预后的关系。方法利用免疫组化的方法观察CD133在50例结直肠癌组织中的表达情况,并分析其与患者临床病理特征及预后的关系。结果 CD133在结直肠癌组织的表达明显高于正常黏膜组织(P0.05),其表达与肿瘤浸润深度、淋巴结转移情况及临床分期有关(P0.05)。Kaplan-Meier生存分析,CD133高表达组5年生存率为37.6%,CD133低表达组5年生存率为53.3%,两组间有明显差异(P0.05)。结论 CD133在结直肠癌组织中高表达并影响结直肠癌患者的预后,其表达水平越高预后越差。     

LAD1在结直肠肿瘤中的表达及临床意义

目的研究LAD1蛋白在结直肠肿瘤组织中的表达及与结直肠癌发生、发展及预后的关系。方法采用免疫组织化学方法检测20例结直肠癌旁正常黏膜组织、20例结直肠腺瘤、80例结直肠癌及20例结直肠癌转移灶组织中LAD1蛋白的表达,分析结肠癌组织中LAD1的表达与临床病理因素的关系。Kaplan-Meier法绘制生存曲线及Log-rank检验进行生存分析。结果 LAD1在结直肠癌旁正常黏膜组织、结直肠腺瘤组织、结直肠癌组织及结直肠癌转移灶组织中的阳性表达率分别为25%、40%、57.5%和70%。结直肠癌组织中LAD1蛋白表达与临床分期和淋巴结转移密切相关,而与患者的性别、年龄、肿瘤大小及肿瘤的组织学分级无相关性。生存分析发现,LAD1阳性结直肠癌患者的术后生存时间明显短于阴性组(P0.05)。结论 LAD1蛋白的过表达可能在结直肠肿瘤的发展及转移中起重要的作用,并与患者的不良预后相关,有望成为结直肠癌靶向治疗和预后评估的指标。     

维甲酸-干扰素联合应用诱导细胞凋亡相关基因-19表达作为结直肠癌预后新型标志物的可行性探讨

目的探讨维甲酸-干扰素联合应用诱导细胞凋亡相关基因-19(GRIM-19)表达作为结肠直肠癌预后指标的可行性。方法采用免疫组织化学方法检测94例结肠样品中GRIM-19表达情况,通过qRT-PCR方法检测15对结直肠癌组织及临近非肿瘤组织中GRIM-19表达情况,采用秩和检验和Kaplan-Meier生存分析检验GRIM-19表达作为结直肠癌疾病预后的价值。结果 GRIM-19 mRNA和蛋白在腺瘤和临近非肿瘤组织中差异无显著性,然而与正常组织相比,结直肠癌组织中的GRIM-19表达显著抑制(P=0.000)。正常组织中GRIM-19分布于细胞质和细胞核中,而在结直肠癌组织中GRIM-19仅表达在细胞质中。分化不良(P=0.013)、淋巴结转移(P=0.009)、实质器官转移(P=0.045)及血管侵入(P=0.010)的肿瘤GRIM-19显著低表达。经过为期40个月的随访,与GRIM-19阳性患者相比,GRIM-19阴性患者的肿瘤复发率和转移率显著升高(P0.05),患者的总生存期显著缩短(P0.01)。结论 GRIM-19表达水平下降的结直肠癌患者往往预后不良,GRIM-19可能作为预测结直肠癌患者预后的新型生物标志物。     

术前外周血中性粒细胞和淋巴细胞比值在结直肠癌预后中的意义

目的探索术前外周血中性粒细胞和淋巴细胞比值(NLR)在结直肠癌预后评价中的意义。方法回顾性分析2001年1月至2011年12月在我院接受手术治疗并有完整随访资料的结直肠癌患者636例。根据患者术前外周血NLR分成高NLR(>5)组和低NLR(≤5)组,分析比较其预后情况。Kaplan-Meier法进行总生存时间和无病生存时间分析,Log-rank检验比较各组的生存情况,Cox回归分析筛选结直肠癌的独立预后因素。结果高NLR者188例,占29.6%;低NLR者448例,占70.4%。高NLR组患者表现为更晚的T分期(P=0.005)、N分期(P=0.006)和TNM分期(P=0.004),更多的脉管癌栓(P=0.003);高NLR组患者接受辅助化疗的比例高(P=0.034)。高NLR组患者的5年生存率为54.9%,低NLR组患者的5年生存率为67%,存在显著性差异(P<0.001)。多因素分析显示分化程度(P<0.001)、术后TNM分期(P<0.001)、术前癌胚抗原(CEA)水平(P<0.001)、脉管癌栓(P<0.001)、辅助化疗(P=0.025)以及NLR(P=0.006)是结直肠癌的独立预后因素。结论 NLR是结直肠癌的独立预后因素,NLR>5的结直肠癌患者预后不良。     

PinX1在结直肠癌中的表达及预后意义

目的探讨Pin X1在结直肠癌中的表达及其临床意义。方法收集83例结直肠癌和癌旁组织蜡块,所有患者均接受5-氟尿嘧啶(5-Fu)及其衍生物为基础的辅助化疗4~6个周期,免疫组化检测Pin X1蛋白的表达,并分析其与临床病理特征及预后的关系,率的分析采取卡方检验,生存分析应用Kaplan-Meier法和Cox风险比例模型。结果 36例(43.4%)癌组织的Pin X1蛋白呈低表达,而在相应癌旁组织中,仅8例(9.6%)呈低表达,差异有统计学意义(P<0.05)。尽管Pin X1表达下调与临床病理参数无关,经生存分析和Cox风险比例回归模型显示,Pin X1表达下调是OS及DFS的独立预后指标。结论 Pin X1表达下调在结直肠癌发生发展中起重要作用,并可能成为5-Fu辅助化疗结直肠癌患者预后判断指标。     

黑色素瘤相关抗原-A9在结直肠癌中的表达及临床意义

目的探讨黑色素瘤相关抗原(MAGE)-A9在结直肠癌中的表达情况,并分析其在结直肠癌发生发展中的作用及预后价值。方法收集65例结直肠癌标本及35例正常对照组织进行免疫组化法检测,应用Kaplan-Meier统计方法和Cox比例风险回归模型进行生存分析,评价MAGE-A9表达及各临床指标与患者总生存期的关系。结果结直肠癌中MAGE-A9阳性表达率为43.1%,正常组织阳性率为3.1%,二者比较差异有统计学意义(χ~2=15.123,P=0.000);MAGE-A9的表达与结直肠癌组织中肿瘤分化程度、淋巴结转移及TNM分期(P<0.05)有关。单因素生存分析显示MAGE-A9表达、肿瘤分化程度、淋巴结转移及TNM分期均与患者预后密切相关(P<0.05),多因素Cox回归分析显示MAGE-A9高表达是结直肠癌独立的预后因素(P=0.047)。结论 MAGE-A9在结直肠癌组织中异常高表达,可能在结直肠癌的发生发展过程中起了重要的作用,MAGE-A9高表达的患者预后差,可作为结直肠癌预后的独立预测指标。     

LINC00261和miR-522-3p在结直肠癌中的表达及其与患者预后的关系

目的检测长链非编码RNA LINC00261、微小RNA-522-3p(miR-522-3p)在结直肠癌组织中的表达水平,并探讨两者的相关性及其与患者预后的关系。方法收集2013年1月至2014年12月在该院行手术切除治疗的68例结直肠癌组织及其配对的癌旁组织,应用实时荧光定量PCR检测结直肠癌和癌旁组织中LINC00261、miR-522-3p的表达水平;分析LINC00261、miR-522-3p的表达与结直肠癌患者临床病理参数的关系;Kaplan-Meier生存模型分析LINC00261、miR-522-3p表达对结直肠癌患者生存率的影响;多因素Cox回归分析影响结直肠癌患者预后的独立危险因素;Pearson相关分析检测LINC00261与miR-522-3p在结直肠癌组织中表达水平的相关性。结果LINC00261在结直肠癌组织中表达水平低于其在癌旁组织中的表达水平(P<0.05),miR-522-3p在结直肠癌组织中表达水平高于其在癌旁组织中的表达水平(P<0.05)。LINC00261在结直肠癌组织中的表达水平与分化程度、临床分期和淋巴结转移情况相关(P<0.05),miR-522-3p在结直肠癌组织中的表达水平与临床分期和淋巴结转移情况相关(P<0.05)。LINC00261低表达组的预后比LINC00261高表达组预后更差(P<0.05),miR-522-3p高表达组的预后比miR-522-3p低表达组的预后更差(P<0.05)。高临床分期、低分化程度、淋巴结转移、LINC00261低表达和miR-522-3p高表达是结直肠癌患者预后不良的独立危险因素(P<0.05)。结直肠癌组织中LINC00261与miR-522-3p的表达呈负相关(P<0.05)。结论结直肠癌组织中LINC00261表达下调、miR-522-3p表达上调,二者表达呈负相关,且均与结直肠癌患者的不良病理参数和预后相关。LINC00261、miR-522-3p可能是结直肠癌潜在的预后标志物和治疗靶标。     

血清CD146表达在结直肠癌早期诊断中的价值及机制

目的明确血清CD146在结直肠癌(CRC)早期筛查中的诊断价值及机制。方法收集22例新鲜结直肠癌患者的标本(癌及对应的癌旁组织各11例),对YAP及CD146进行免疫印迹法(WB)检测;在结直肠癌细胞株HCT-116及HT-29中过表达YAP后采用WB检测CD146表达;选取健康对照者40例作为对照组,腺瘤患者40例作为腺瘤组,以及167例结直肠癌患者作为CRC组,采用酶联免疫吸附试验检测血清CD146水平。结果 CD146及其调控因子YAP在结直肠癌组织中明显表达上调,HCT-116及HT-29细胞中过表达YAP可明显上调CD146表达;CRC组血清CD146水平明显高于对照组和腺瘤组,差异均有统计学意义(P0.05);CRC患者切除术后血清CD146明显低于术前。血清CD146水平与结直肠癌分化、肿瘤细胞浸润程度、远处转移呈正相关。结论血清CD146有望作为CRC诊断及预后判断的分子标志物,CD146的表达与YAP密切相关。     

病理分期对新辅助治疗直肠癌患者预后的影响

目的探讨病理分期对新辅助治疗直肠癌患者预后的影响。方法回顾性分析2004年1月至2011年12月期间我院接受新辅助治疗+根治性手术治疗的152例中晚期直肠癌患者的临床资料和术后生存状况。采用Kaplan-Meier法计算各亚组3年无病生存率(DFS),并用Log-rank检验进行比较。采用单因素和多因素Cox比例风险回归模型进行预后分析。结果全部患者的3年DFS为84.3%。T、N分期、淋巴结转移率、局部浸润因素、术前CEA、CA19-9水平的各亚组之间的3年DFS比较,差异有统计学意义(P<0.05)。N分期、淋巴结转移率、局部浸润因素和术前CEA水平是影响直肠癌患者预后的独立影响因素(P<0.05)。结论直肠癌新辅助治疗后仍然推荐进行手术治疗,术后病理分期与患者的预后密切相关,其中N分期、淋巴结转移率、局部浸润因素是其独立影响因素。     

CYP3A5、GSTP1基因多态性与转移性结直肠癌患者化疗疗效的关系

目的探讨细胞色素P450 3A5(CYP3A5)和谷胱甘肽S-转移酶P1(GSTP1)基因多态性与转移性结直肠癌患者化疗疗效及预后的关系。方法收集转移性结直肠癌病人,采用氟尿嘧啶/亚叶酸钙/伊立替康(FOLFIRI)方案化疗,患者每4周期进行疗效评估,并随访记录疾病进展时间。采用基质辅助激光解吸电离飞行时间确定基因型,用χ2检验分析CYP3A5、GSTP1基因型对客观有效率的影响,Kaplan-Meier法进行生存分析,Log-rank检验分析不同基因型患者疾病进展时间差异。结果 63例转移性结直肠癌患者中,携带CYP3A5 GG基因型患者化疗客观有效率(完全缓解+部分缓解)显著高于携带AG/AA基因型患者(57.1%vs.32.1%,P=0.048),Kaplan-Meier生存分析显示携带CYP3A5 GG基因型患者疾病进展时间显著长于AG/AA基因型患者(P=0.012)。GSTP1基因多态性与化疗客观有效率、疾病进展时间无关。结论 CYP3A5基因型与转移性结直肠患者化疗疗效及预后密切相关,为结直肠癌的个体化治疗提供了参考。     

Visiting rights only: the diplomas in nursing in the UK in the interwar period

The aim of this article is to explore the institution and organisation of the diplomas in nursing at the universities of Leeds and London, which were established in 1921 and 1926, respectively. It will be argued that the success of these courses for the individuals who undertook them, and the profession as a whole was ultimately limited. It is accepted that the purpose of the diplomas was at least in part for the nursing elite to maintain their grip on the leadership. Nevertheless, the institution of the courses, when few women in general attended university, identifies a 'radicalness' within the profession, which has rarely been considered. Moreover, that there was a body of nurses capable of university level education challenges previous assumptions.     

Pitfalls in the Care of the Psychiatric Patient in the Emergency Department

Background

Care of the psychiatric patient in the Emergency Department (ED) is evolving. As with other disease states, there are a number of pitfalls that complicate the care of the psychiatric patient.

Objective

The purpose of this article is to update Emergency Physicians concerning the pitfalls in caring for the psychiatric patient, and possible solutions to deal with these pitfalls.

Discussion

The article will address the burden of the psychiatric patient, staff attitudes, medical clearance process, treatment of the agitated patient, suicidal patients, and admission decisions.

Conclusions

Alternative care resources, collaboration with Psychiatry, staff education, improvement in the medical clearance process, proper use of restraint and seclusion, and appropriate choice of medication for agitated patients can help avoid some of the top pitfalls in the care of the psychiatric patient in the ED.     

Choosing the choices in the USA: examples in the maternity area

The concept of choice has featured prominently in both the recent united Kingdom (UK) health care reforms and in the debate relating to the care of childbearing women. An invitation to the USA facilitated contemplation of the health care system on which the recent UK reforms have been modeled. The impact of the health system on mother's choices was a source of particular interest. The implications for midwives, their practice and their relationships with their clients and colleagues emerge clearly. It may be that the United States' model of health care does not answer the needs of the UK.     

Changes in the parameters of the rhythms of the electrolyte-excreting function of the kidneys in women in relation to the seasons of the year

The characteristics (period, mesor, amplitude) of the rhythms of urinary excretion of sodium, potassium, chlorine, calcium, magnesium, and phosphorus were examined in normal women during various seasons. The urine was collected for 5 days with 4-hour intervals. The rhythms were detected and their parameters established with the use of mathematical methods for the assessment of the tested curve fragments repetitions and by the least squares nonlinear method. The rhythms of renal urinary and electrolyte excretion were found very smooth, particularly so in the fall and winter. The circadian rhythms have been found the most stable during all the seasons. Examinations of individual electrolyte excretion have shown that Na and K excretion is more stable all the year round and therefore this parameter is the most informative for the detection of disorders in renal electrolyte excretion.     

Change in the drug-metabolizing function of the liver in patients in the postoperative period in relation to the type of anesthesia]

Anesthesia-dependent changes in pharmaco-metabolic liver function have been studied in patients operated on for cosmetic facial defects. It has been established that the postoperative period in patients subjected intraoperatively to general combined anesthesia and controlled lung ventilation was characterized by inhibited drug metabolism in the liver, which required correction of the drug doses to reduce the risk of side and toxic effects of pharmacotherapy. Patients operated on under local procaine anesthesia had no considerable changes in pharmaco-metabolic liver function in the postoperative period.