乳腺癌VEGF-C的表达与淋巴管生成的关系及意义

目的:探讨血管内皮生长因子C(vascularendothelialgrowthfactorC,VEGF-C)在乳腺癌淋巴管生成及其与淋巴结转移中的作用。方法:采用免疫组织化学染色非生物素检测系统Polymer两步法,检测52例乳腺癌组织标本、16例正常乳腺组织VEGF-C的表达;应用酶组织化学方法检测癌周微淋巴管密度(microlymphaticvesseldensity,MLVD)。结果:乳腺癌VEGF-C的表达率为71.15%,显著高于正常对照组的12.50%(P<0.025);乳腺癌MLVD为22.32±5.36,显著高于正常对照组的6.52±2.28(P<0.001),MLVD与VEGF-C的表达具有显著正相关性(P=0.007);并且,VEGF-C的表达与淋巴结转移呈正相关,P=0.013。结论:VEGF-C在乳腺癌淋巴管生成及其淋巴结转移中具有重要作用。     

直肠癌中环氧化酶2、血管内皮生长因子C 的表达及与血管生成、淋巴管生成相关性的研究

目的 研究直肠癌中环氧化酶2(COX-2)及血管内皮生长因子C(VEGF-C)在直肠癌、癌旁组 织、正常大肠组织及癌旁淋巴结中的表达及对局部血管生成、淋巴管生成中的作用.方法 收集我院2008 年直肠癌患者30 例,取直肠癌病灶、癌旁组织、正常直肠组织和直肠周围淋巴结石蜡切片,免疫组化法检测 COX-2、VEGF-C 蛋白的表达情况及各组织中微血管密度(MVD)、微淋巴管密度(MLVD),分析COX-2、VEGF- C 的表达与直肠癌、癌旁组织、正常直肠组织和周围转移淋巴结中的MVD、MLVD 之间的关系.结果 COX- 2、VEGF-C 蛋白在直肠癌组织呈高表达状态,阳性率分别为80%(24/30)和73.3%(22/30),在癌旁组织中表 达降低,分别为60%(18/30)和66.6%(20/30),而在正常直肠组织及癌旁淋巴结中,表达率分别为20%(6/ 30)和30%(9/30).其表达在直肠癌中低分化组、TNM(Ⅲ～Ⅳ期)、淋巴结转移阳性组中表达较高分化组、TNM(Ⅰ～Ⅱ期)、及淋巴结转移阴性组中表达升高,差异具有统计学意义(P <0.05).COX-2、VEGF-C 的蛋 白表达与各组织中的MVD、MLVD 计数具有相关性,COX-2、VEGF-C 的蛋白表达较高的肿瘤组织及周围转移 淋巴结中MVD、MLVD 明显高于癌旁与正常的大肠癌组织,差异均有统计学意义(P <0.05).结论 在所取 直肠癌中COX-2、VEGF-C 均呈高表达,COX-2 与VEGF-C 蛋白的表达具有显著的相关性,两者可能在直肠癌 的血管及淋巴管生成和淋巴结转移中起协同作用.     

血管内皮生长因子C及其受体表达与乳腺癌淋巴结转移的相关性研究

目的检测乳腺癌组织中血管内皮生长因子c/血管内皮生长因子受体-3(VEGF-C/VEGFR-3)、淋巴管密度(LVD)的表达情况,探讨其表达水平淋巴结转移的相互关系,进一步研究肿瘤转移的机制,为抗淋巴管形成、进而为抗乳腺癌淋巴转移的治疗提供理论依据。方法应用免疫组织化学(SP)法检测83例乳腺癌手术标本的原发灶的VEGF-C及其受体VEGFR-3的表达及LVD。结果83例乳腺癌组织VEGF-C阳性表达者36例(43.3%),淋巴结转移组的VEGF-C阳性表达率为54.6%(24/44),显著高于无淋巴结转移组30.8%(12/39),(P<0.05);在VEGF-C表达阳性组、阴性组中LVD统计学上差异显著(P<0.05)。结论乳腺癌组织VEGF-C表达可能促进肿瘤内淋巴管的生成;乳腺癌的淋巴结转移和VEGF-C的高表达密切相关;。     

三阴性乳腺癌中VEGF-C表达与淋巴管密度的相关性研究

目的 研究三阴性(雌激素受体、孕激素受体、人表皮生长因子受体2均阴性)乳腺癌淋巴管内皮生长因子(VEGF-C)表达情况和与淋巴管密度的关系.方法 105例乳腺癌标本.其中三阴性乳腺癌42例,非三阴性乳腺癌标本63例,应用免疫组化方法检测标本的VEGF-C表达情况及应用D2-40标记检测淋巴管密度.结果 VEGF-C在三阴性乳腺癌高表达64.2%,与淋巴结有无转移、淋巴管密度、肿瘤大小、临床分期相关(P<0.05),而与年龄、病理类型无关(P<0.05);VEGF-C在三阴性和非三阴性乳腺癌表达分别为64.2%和33.3%,差异有显著性(P<0.05).结论 VEGF-C在三阴性乳腺癌中高表达与淋巴管生成和肿瘤演进相关.     

疏肝健脾方联合CTF方案化疗对乳腺癌淋巴转移的影响

目的观察复方中药疏肝健脾方对乳腺癌淋巴结转移的影响,探讨其抗肿瘤转移机制。方法 50例乳腺癌患者随机分成2组,疏肝健脾方组(试验组)30例,对照组20例,两组患者均给予CTF方案化疗2个周期,试验组在化疗的同时,口服疏肝健脾方制剂,化疗结束后行手术,标本行病理组织学和免疫组化法检测乳腺癌组织血管内皮生长因子C(VEGF-C)的表达。比较两组标本腋窝淋巴转移和VEGF-C表达的差异。结果试验组有淋巴结转移5例,无淋巴结转移25例,对照组有淋巴结转移9例,无淋巴结转移11例,组间统计差异有统计学意义(χ2=4.78,P<0.05)。试验组和对照组乳腺癌组织中化疗前VEGF-C阳性表达率分别为93.3%(28/30)、100.0%(20/20),组间比较无统计学差异(P>0.05);化疗后VEGF-C阳性表达率分别为56.7%(17/30)、85.0%(17/20),两组比较差异有统计学意义(P<0.05),试验组化疗前后VEGF-C阳性表达率有统计学差异(P<0.01)。结论疏肝健脾方可能通过干预VEGF-C的表达,影响淋巴管的生成来抑制乳腺癌淋巴转移。     

乳腺癌中微淋巴管密度与淋巴结转移间的关系

目的探讨乳腺癌中微淋巴管密度（MLVD）与淋巴结转移间的关系。方法应用免疫组化SP法,检测60例乳腺癌间质中淋巴管特异性标记物D2-40的表达,并计数MLVD。结果MLVD与腋下淋巴结转移及乳腺癌患者的临床分期明显相关,腋下淋巴结转移组的淋巴管密度明显高于腋下淋巴结无转移组（P〈0.05）;临床分期越晚,肿瘤淋巴管密度越大（P〈0.05）。结论MLVD与乳腺癌淋巴管生成及乳腺癌腋下淋巴结转移密切相关。     

环氧化酶-2与血管内皮生长因子-C在鼻咽癌中表达及其与淋巴结转移的相关性

目的 探讨环氧化酶-2(COX-2)、血管内皮生长因子(VEGF-C)在鼻咽癌组织中的表达及其与淋巴管生成及淋巴结转移的关系.方法 采用免疫组化学SP法检测2004年1月至2010年1月收治的66例鼻咽癌患者和20例正常鼻咽黏膜组织中COX-2、VEGF-C及淋巴管特异性标记物D2-40[在高倍镜(×200)下观察]的表达,通过记数淋巴管密度(LVD)并结合临床病理特征分析.结果 鼻咽癌组织COX-2(78.79%)、VEGF-C(72.73%)表达阳性率均明显高于正常组COX-2(10.00%)、VEGF-C(5.00%)表达阳性率;有淋巴结转移组COX-2(95.00%)、VEGF-C(87.50%)表达及D2-40阳性LVD(17.540±2.512)明显高于无淋巴结转移组COX-2(53.84%)、VEGF-C(50.00%)的表达及LVD(8.751±1.076)(P<0.01);VEGF-C与COX-2表达(r=0.721,P<0.01)、LVD(r=0.788,P<0.01)呈正相关,COX-2表达与LVD呈正相关(r=0.613,P<0.01).结论 VEGF-C及COX-2在鼻咽癌组织中呈高水平表达,其表达与肿瘤LVD及肿瘤淋巴结转移有重要关系.     

血管生成素-2与大肠癌淋巴管密度的相关性研究

目的：通过检测大肠癌标本的血管生成素-2（ANG-2）mRNA的表达,并进行微淋巴管计数,探讨ANG-2 mRNA的表达与微淋巴管密度（MLVD）的关系,推断其在大肠癌微淋巴管生成中的作用。方法应用RT-PCR检测癌组织、良性病变及手术切缘正常组织的ANG-2 mRNA的表达;应用免疫组化技术,以LYVE-1标记微淋巴管并计数。结果ANG-2 mRNA在癌组织内阳性表达64.0%,良性病变内阳性表达8.3%,手术切缘正常组织内阳性表达7.5%。ANG-2 mRNA表达阳性的癌旁MLVD比阴性高（P<0.01）,且ANG-2 mRNA的表达水平与癌旁MLVD存在相关性（P<0.05,r=0.493）。癌旁MLVD及手术切缘正常组织MLVD比癌组织高（P<0.01）,且癌旁MLVD比手术切缘正常组织MLVD高（P<0.01）。Duke's A、B期的癌旁MLVD较C、D期低;有淋巴结转移的癌旁MLVD比无淋巴结转移的癌旁MLVD高（P<0.05）。结论ANG-2 mRNA在大肠腺癌组织内有高表达并与癌旁MLVD的表达水平密切相关。     

胃癌组织中COX-2 VEGF-C表达与淋巴管生成的相关性研究

目的探讨COX-2、VEGF-C在胃癌组织中的表达与微淋巴管密度（MLVD）的相关性及其临床意义。方法应用免疫组织化学MaxVision法检Ncox-2、VEGF．C、D2-40在64例胃癌组织中的表达情况并行MLVD计数。结果全组COX-2阳性率为71．9％（46／64）,VEGF-C阳性率为53．1％（34／64）。MLVD的平均数目为（12．4±7．4）个／200倍视野。COX-2、VEGF-C及MLVD在胃癌组织中的表达号性别及年龄无关（P〉0．05）;COX-2、VEGF．C及MLVD在有淋巴结转移、TNM分期较高（Ⅲ＋Ⅳ期）者中的表达水平明显高于无淋巴结转移、TNM分期较低（Ⅰ＋Ⅱ期）者,差异均有统计学意义（P〈0．05）。COX-2和VEGF-C在胃癌组织中的表达具有相关性（P〈0．05）。MLVD在COX-2、VEGF．C阳性组的表达水平较阴性组高,差异有统计学意义（P〈0．05）。结论胃癌组织中存在COX-2和VEGF-C的过度表达,COX-2及VEGF-C与胃癌病理分期和淋巴管生成具有相关性。     

乳腺癌中VHL对HIF-1α表达的影响

目的 研究乳腺癌组织中VHL、HIF-1αHIF-1αmRNA的表达及VHL对后两者的影响,并探讨其意义.方法 制作80例乳腺癌组织芯片,另设20例正常乳腺组织对照组,采用免疫组织化学方法检测HIF-1α、VHL在乳腺癌中的表达.采用原位分子杂交方法检测HIF-1αmRNA在乳腺癌中的表达.结果 浸润性乳腺癌中HIF-1α、HIF-1αmRNA的表达高于非浸润性乳腺癌及正常乳腺组织对照组(P＜0.01);浸润性乳腺癌中VHL的表达低于非浸润性乳腺癌及正常乳腺组织对照组(P＜0.01).淋巴结有转移组HIF-1α、HIF-1αmRNA的阳性率高于无转移组(p＜0.01);淋巴结有转移组VHL的阳性率低于无转移组(P＜0.01).VHL在HIF-1α阳性与阴性组表达中具有明显差异.结论 HIF-1α和HIF-1αmRNA高表达及VHL低表达均与乳腺癌浸润及淋巴结转移有关.乳腺癌中VHL与HIF-1α的表达呈负相关,VHL与HIF-1αmRNA的表达无明显相关.     

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.     

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.