Making local pay helpful--Part 2: Using action research to address the challenge

Second part of an item featuring action research with four different trusts to investigate factors relating to the implementation of the local pay policy. Describes methodologies used, such as clinical team diagnosis and cognitive mapping. Looks at the way forward, listing critical factors in ensuring successful implementation.     

Varus deformity of the distal end of the femur secondary to a focal fibrous lesion

Severe unilateral varus deformity of the distal end of the femur secondary to a focal fibrous lesion is reported. It is a malformative process rare at this level, this being the first report of it in the radiological literature. The conventional radiograph is pathognomonic and CT is useful in the confirmation of the fibrous tissue. Osteotomy is indicated only if the deformity progresses or the angle of varus is severe.     

聚丙烯酰胺凝胶电泳分析615纯系小鼠血清蛋白

目的：根据各种蛋白质在一定的泳动条件下,都有一定的相对迁移率不同的特点,分析６１５ 纯系小鼠血清中的蛋白质在聚丙烯酰胺凝胶上的分布,进行了定位分析。方法：采用高ｐＨ 不连续性聚丙烯酰胺凝胶电泳及蛋白质特殊染色法。结果：６１５ 鼠血清蛋白质在聚丙烯酰胺凝胶上可分离出１３ ～１５ 条区带,脂蛋白３ 条、白蛋白２ 条、糖蛋白５ 条、铜蓝蛋白１ 条、血红蛋白１ 条、结合珠蛋白３ 条。根据每种蛋白质的Ｒｍ 值定位顺序从阳极到阴极依次为１ ．糖蛋白、２．脂蛋白、３ ．白蛋白、４．脂蛋白、５ ．糖蛋白、６ ．巨球蛋白（ 根据其它资料） 、７ ．铜蓝蛋白、８ ．结合珠蛋白、９ ．Ｈｂ、１０ ．运铁蛋白（ 根据其它资料）、１１ ．脂蛋白、１２ ～１４ ．均为糖蛋白。光密度扫描６１５ 鼠血清蛋白质相对面积比分别为白蛋白为４８－４、α１ 球蛋白为６－９、α２ 球蛋白２３－８ 、β球蛋白为５－０ 、γ球蛋白为１３－８ 。结论：６１５ 鼠血清蛋白质的定位分析对于６１５ 鼠可移植性淋巴细胞型白血病鼠的蛋白质研究具有一定的实际意义,利用Ｒｍ 值来作蛋白质定位分析简单易行,关键在于掌握实验条件的恒定。     

Cytotoxicity of urushiols isolated from sap of Korean lacquer tree (Rhus vernicifera stokes)

Cytotoxicities of four urushiols, congeners isolated from the sap of Korean lacquer tree (Rhus vernicifera Stokes), to 29 human cancer cell lines originated from 9 organs were evaluated. Their values of 50% growth inhibition were below 4 microg/ml, and showed cell line specific cytotoxicity. The present result is the first report on the cytotoxicity of urushiols suggesting that they would have an anticancer activity to human cancer cells.     

基层医院胰腺损伤15例的手术治疗

目的 探讨基层医院如何提高诊治胰腺损伤的水平。方法 对1992年1月至2002年12月10年间本院收治的15例胰损伤的病人进行回顾性分析。结果 术前经B超诊断4例，单纯胰腺缝合、引流5例，远端胰及脾切除 近端胰空肠Roux—Y吻合术4例。胰近、远断端空肠双口Roux—Y吻合术5例，胰头十二指肠切除1例，治愈14例，术后死亡1例。结论 胰损伤临床表现隐匿，基层医院技术和设备条件相对较差，术中认直细致探查及合理的手术方式是提高胰损伤病人生存率的关键。     

透明质酸在宫颈上皮及宫颈癌组织中的表达

目的 :探讨透明质酸 (HA)在正常宫颈上皮及宫颈癌中的表达及其与肿瘤发生发展的关系。方法 :用免疫组化法检测 5 9例宫颈浸润癌、35例宫颈上皮内瘤样病变 (CIN)及11例正常宫颈组织中HA和CD4 4v6的表达。结果 :正常宫颈上皮不表达HA。慢性炎症者上皮底层细胞以及细胞间质表达HA ,随病变加重及CIN发生 ,HA表达增强。癌旁组织的上皮细胞HA呈强阳性表达 ,伴有基质HA强阳性染色。癌细胞HA阳性率为 6 7.2 7% ,与病理类型有关 ,角化癌高表达 ,而腺癌不表达 ,在低分化鳞癌中多见不规则灶性HA阴性区。宫颈鳞癌的肿瘤基质HA表达普遍增强。肿瘤基质的HA表达与CD4 4v6呈正相关。结论 :正常宫颈上皮不表达HA ,但炎症与致瘤因素可促使HA表达 ,HA的代谢失衡可能与宫颈癌的发生及浸润行为有关     

Abrogation of head and neck squamous cell carcinoma growth by epidermal growth factor receptor ligand fused to pseudomonas exotoxin transforming growth factor alpha-PE38.

PURPOSE: This study was undertaken to determine whether low intratumoral doses of the epidermal growth factor receptor ligand-transforming growth factor alpha (TGF-alpha) fused to Pseudomonas exotoxin (TGF-alpha-PE38)-abrogated head and neck squamous cell carcinoma (HNSCC) tumor growth in vitro and in vivo. EXPERIMENTAL DESIGN: In vitro cytotoxicity assays were carried out to determine the sensitivity of HNSCC cells to TGF-alpha-PE38. TGF-alpha-PE38-treated HNSCC cells were examined by immunoblotting for cleaved poly(ADP-ribose) polymerase to evaluate apoptosis. Nude mice bearing established HNSCC xenografts were treated with several doses of TGF-alpha-PE38 to evaluate the antitumor efficacy in vivo. Tumor sections were stained with terminal deoxynucleotidyl transferase-mediated nick end labeling for apoptosis. To determine the effect of oral administration of TGF-alpha-PE38, gavage injections of TGF-alpha-PE38 were administered, and the esophagus and surrounding soft tissue were then stained for apoptotic cells. RESULTS: HNSCC cell lines examined were sensitive to low doses of TGF-alpha-PE38 (EC(50) in the range of 1.6 to 10 ng/mL). HNSCC cells treated with TGF-alpha-PE38 undergo apoptosis. Antitumor effects were observed using 0.1 and 0.03 microg of TGF-alpha-PE38 administered intratumorally. At these doses, the treatment was well tolerated. Tumors treated with the toxin had a higher number of apoptotic cells compared with the control tumors. No apoptotic cells were observed in the pharyngoesophageal tissues of the mice after gavage administration of the toxin suggesting that the toxin could be orally administered without toxicity. CONCLUSIONS: These results indicate that topical or intratumoral administration of low doses of TGF-alpha-PE38 may demonstrate antitumor effects in HNSCC without associated systemic toxicity.     

c-raf-1反义寡核苷酸对人卵巢癌细胞放射敏感性的影响

目的　探讨癌基因 c- raf- 1的反义寡核苷酸对人卵巢癌细胞放射敏感性的影响。方法　设立 c- raf- 1正义寡核苷酸组和非处理组 (仅加入等量的脂质体 )作对照 ,用 RT- PCR检测卵巢癌细胞处理前后 c- raf- 1表达水平的变化。用平板克隆形成试验检测人卵巢癌细胞株 SKOV3在脂质体 - c- raf- 1反义寡核苷酸作用前后受 6 0 Coγ射线不同剂量照射后的集落形成率。结果　 c- raf- 1反义寡核苷酸能抑制 c- raf- 1癌基因的表达 ,经脂质体介导的 c- raf- 1反义寡核苷酸作用的卵巢癌细胞经γ射线照射后其集落形成率较转染正义寡核苷酸组及单纯照射组明显下降 (P<0 .0 1) ,而转染 c- raf- 1正义寡核苷酸组的集落形成率与单纯照射组相比无明显差异 (P>0 .0 5 )。结论　 c- raf- 1反义寡核苷酸通过抑制 c- raf- 1的表达降低人卵巢癌细胞株 SKOV 3放射抗拒性。该作用可能与 c- raf- 1反义寡核苷酸抑制了引起细胞辐射抗拒的细胞信号转导途径有关     

非小细胞肺癌中细胞周期蛋白D1与E的作用及相互关系

目的 :研究细胞周期蛋白D1与E在非小细胞肺癌 (NSCLC)发生、发展中的作用及相互关系。方法 :免疫组化方法检测 87例NSCLC肿瘤组织中细胞周期蛋白D1、E的表达及PCNA估计增殖指数 (PI) ,并将上述结果与临床病理及预后资料进行对比分析。结果 :87例NSCLC中细胞周期蛋白D1、E阳性率分别为 4 4 .8% (39/87)、4 8.3% (42 /87) ,细胞周期蛋白D1阳性组的PI值显著高于阴性组 (P〈0 .0 5 ) ,细胞周期蛋白E阳性组PI值与阴性组无显著差异 (P〉0 .0 5 ) ;细胞周期蛋白D1阳性组肿瘤直径、淋巴结转移率和生存率均与阴性组有显著差异(P〈0 .0 1、〈0 .0 5、〈0 .0 1) ,细胞周期蛋白E阳性组淋巴结转移率、临床分期和生存率均与阴性组有显著差异 (P〈0 .0 5、〈0 .0 5、〈0 .0 1) ;细胞周期蛋白D1阳性组中细胞周期蛋白E的阳性率显著高于其阴性组 (P〈0 .0 5 ) ;细胞周期蛋白D1与细胞周期蛋白E双阳性组的PI值、肿瘤直径、淋巴结转移率显著高于非双阳性组 (P值均〈0 .0 5 ) ,生存率显著低于非双阳性组 (P〈0 .0 1)。结论 :细胞周期蛋白D1、细胞周期蛋白E均参与NSCLC的发生、发展 ,并影响其预后 ,但两者在其中所起作用不同 :细胞周期蛋白D1是调节NSCLC增殖的主要因素 ,细胞周期蛋白E主要与NSCLC进展有关 ;细胞周期蛋白D1可促     

Peroxiredoxins in breast carcinoma.

PURPOSE: Peroxiredoxins (Prxs) are a novel group of peroxidases containing high antioxidant efficiency and some of them having also effects on cell differentiation and apoptosis. The mammalian Prx family has six distinct members located in various subcellular locations, including peroxisomes and mitochondria, places where oxidative stress is most evident. EXPERIMENTAL DESIGN: We examined immunohistochemically a large set of samples from patients with breast carcinoma and investigated associations with parameters such as tumor-node-metastasis classification, hormone receptor status, and patient survival. Three biopsies of healthy breast tissue were used as controls. RESULTS: Expression of peroxiredoxins I, III, IV, and V was found in >or=80% of cases, whereas the expression of Prx II and VI was less frequent. Increased expression of Prx III was found to associate with the presence of progesterone (P = 0.02) and estrogen (P = 0.03) receptors, and Prxs IV (P = 0.009) and VI (P = 0.04) were overexpressed in progesterone receptor positive cases. Prx V was the only isoform that associated with items of tumor-node-metastasis classification, it was connected to a larger tumor size (P = 0.05) and positive lymph node status (P = 0.04). Prx V positivity was also connected with shorter survival (P = 0.04), whereas Prxs III (P = 0.002) and IV (P = 0.02) were related to better prognosis, probably resulting from their connection with a positive hormone receptor status. CONCLUSIONS: In conclusion, we found that expression of peroxiredoxins, especially III, IV and V, is increased in breast malignancy, suggesting the induction of Prxs as response to increased production of reactive oxygen species in carcinomatous tissue.