新型肿瘤标记物P504S对前列腺癌诊断的价值

目的应用新型肿瘤标记物P504S蛋白在前列腺组织中的表达，来辅助前列腺癌诊断。方法回顾性分析我院65例前列腺病理切片，50例确诊为前列腺癌。其中包括35例术前穿刺确诊为前列腺癌，15例前列腺偶发癌；l5例为良性前列腺增生。所有65例标本都进行P504S蛋白表达的免疫组织化学染色。结果P504S在确诊为前列腺癌的标本中阳性率为84％，而良性前列腺增生中未见阳性表达。P504S的表达水平与Gleason评分存在一定相关性。当Gleason评分大于等于7分时，P504S阳性表达水平较高；而Gleason评分小于7分时，P504S阳性表达水平较低。两组间构成比存在显著性差异。结论应用P504S蛋白表达检测有助于辅助前列腺癌的病理诊断，特别适合于体积较小的前列腺穿刺标本进行良恶性鉴别。同时P51MS也有助于前列腺癌的病因研究和探索。关键词P504S前列腺癌良性前列腺增生     

EZH2在前列腺癌中的表达及其与临床病理的关系

目的:探讨EZH2蛋白及其mRNA在前列腺癌中的表达以及两者与临床病理参数间的关系。方法:通过组织芯片技术,运用免疫组化(EnVision法)和原位杂交方法分别检测48例前列腺癌中EZH2蛋白及其mRNA的表达,同时检测常规石蜡组织中15例良性前列腺增生组织和12例高级别上皮内瘤变组织中的EZH2蛋白及其mRNA的表达作为对照。结果:EZH2蛋白和mRNA在前列腺癌中的阳性率(87.5%、81.25%)明显高于良性前列腺增生组织(13.33%、6.67%)和高级别上皮内瘤(16.67%、16.67%),差异有统计学意义(P<0.05)。免疫组化显示,EZH2蛋白在Gleason≥7分组阳性表达率(96.67%)明显高于Gleason≤6分组(72.22%),差异有统计学意义(P<0.05)。EZH2蛋白阳性表达率与TNM分期比较,T3～T4期(100%)明显高于T1～T2期(76.92%),亦有统计学意义(P<0.05),而EZH2蛋白表达与年龄和PSA无关(P>0.05)。原位杂交显示,EZH2mRNA的阳性表达率T3～T4期(100%)高于T1～T2期(85%),与TNM分期显著相关(P<0.05),而与年龄、PSA和Gleason分级无关(P>0.05)。分段评价预后估计较好组与预后估计较差组,两组之间EZH2蛋白及其mRNA表达阳性率均有显著性差异(P<0.05)。结论:EZH2蛋白及其mRNA在前列腺癌中高表达,提示其在前列腺癌的发生、发展过程中可能起重要作用,有可能成为判定前列腺癌恶性程度进程和预后的参考指标。     

组蛋白去乙酰化酶1和2在前列腺癌中的表达及临床意义

目的:检测组蛋白去乙酰化酶1(HDAC1)和组蛋白去乙酰化酶2(HDAC2)在前列腺癌中的表达情况,并探讨其临床意义。方法:选取82例临床资料完整的前列腺癌组织石蜡标本,免疫组化染色检测HDAC1和HDAC2蛋白的表达情况,分析其与Gleason分级、术前PSA水平、术后生存时间等指标的相关性。结果:免疫组化染色显示,前列腺癌组织中HDAC1和HDAC2的表达率分别为59.7%(49/82)、70.7%(58/82),定位于细胞核;Gleason评分高的患病组中HDAC1和HDAC2的表达高于Gleason评分低组,且在不同Gleason分级中表达差异有显著性(P均<0.05);HDAC1和HDAC2的表达在不同术前PSA水平、不同年龄分组中差异无统计学意义(P>0.05);单因素分析显示HDAC2、术前PSA水平、临床分期及Glesaon分级是影响前列腺癌患者生存的重要因素(P均<0.05);多因素回归分析表明HDAC2在前列腺癌中具有独立的预后意义(P=0.017,HR=2.265,95%CI:1.145～4.775)。结论:HDAC2在前列腺癌组织中表达升高并且具有独立的预后意义,为HDACs抑制剂在前列腺癌诊断中的应用和患者预后的判断提供了理论依据。     

前列腺癌Gleason分级评分与血清PSA、原位PSA的变化和34βE12、P504S免疫表型的研究

目的 :探讨前列腺癌Gleason分级评分与血清前列腺特异抗原 (PSA)、原位PSA及基底细胞角蛋白(34βE12 )、α 甲酰基辅酶A(P5 0 4S)免疫组织化学表达的关系。 　方法 :检测 4 0例前列腺癌患者血清PSA值 ,并根据苏木精 伊红切片进行Gleason分级评分 ,其中免疫组化标记PSA 35例 ,34βE12 12例 ,P5 0 4S 10例。 　结果 :前列腺癌Gleason分值越高 ,血清PSA值越高 (P <0 .0 1) ,原位表达PSA阳性越弱 (P <0 .0 5 ) ;肿瘤组织阳性表达P5 0 4S ,但不表达 34βE12。　结论 :前列腺癌Gleason分值与患者血清PSA呈明显的正相关性 ,与原位PSA阳性表达呈明显的负相关性 ;34βE12、P5 0 4S免疫组织化学表达对前列腺癌的病理诊断具有重要价值。     

前列腺癌组织中蛋白表达与内分泌治疗后进展的相关性研究

目的 探讨前列腺癌内分泌治疗前癌组织中多种蛋白标记表达与内分泌治疗后发生进展的相关性,筛选内分泌治疗后进展的预测因子.方法 收集116例接受内分泌治疗的前列腺癌患者的临床病理资料,检测患者内分泌治疗前癌组织中雄激素受体(AR)、上皮型钙黏附索(E-cad-herin)、嗜铬粒蛋白A(CgA)、核增殖抗原(Ki67)、凋亡抑制蛋白(Survivin)、EZH2、hepsin蛋白表达,应用Cox比例风险模型进行多因素分析.结果 Ki67、EZH2、Survivin 3种蛋白表达与传统临床病理学因素存在Spearman等级相关.单因素分析中发现临床分期(P<0.001)、Gleason评分(P=0.005)、治疗前血清PSA值(P<0.001)以及Ki67(P=0.032)、Survivin蛋白(P=0.002)表达与内分泌治疗后的进展相关,多因素分析结果 显示临床分期(T_x N_+/M_+)(P<0.001)、高病理分级(Gleason评分≥8分)(P-0.038)和Survivin蛋白高表达(p＝0.031)是内分泌治疗后进展的重要危险因素.其中T_x N_+/M_+者67例(57.8%),Gleason评分≥8分者56例(48.3%),Survivin蛋白高表达者91例(78.4%). 结论 临床分期、病理分级、Survivin蛋白表达对于预测前列腺癌内分泌治疗后进展有重要意义.     

过氧化物酶体增殖激活物受体与15-脂氧合酶-2在前列腺癌组织中的表达及其意义

目的 观察过氧化物酶体增殖激活物受体(PPAR-γ)及15-脂氧合酶-2(15-LOX-2)在前列腺癌中的表达,探讨其意义.方法 采用免疫组织化学方法检测28例前列腺癌组织中PPAR-γ及15-LOX-2蛋白的表达,取26例前列腺增生组织作为对照.结果 PPAR-γ在前列腺癌组表达阳性程度高于前列腺增生组(x2=4.84,P＜0.05);15-LOX-2在前列腺癌组表达阳性程度低于前列腺增生组(x2 =9.00,P＜0.05).T3期前列腺癌PPAR-γ的表达阳性程度明显高于T2期(H=4.103,P＜0.05);T2期与T3期前列腺癌细胞15-LOX-2的表达阳性程度差异无统计学意义(H =0.076,P＞0.05).Gleason评分≥7分前列腺癌PPAR-γ的表达阳性程度明显高于Gleason评分＜7分(H=5.306,P＜0.05);Gleason评分≥7分与Gleason评分＜7分前列腺癌15-LOX-2的表达阳性程度差异无统计学意义(H =0.313,P＞0.05).结论 PPAR-γ蛋白在前列腺癌组织中高表达,并且与病理分期及Gleason评分有关;15-LOX-2在前列腺癌组织中低表达.它提示PPAR-γ和15-LOX-2与前列腺癌发生与发展有关.     

SATB-1基因在前列腺癌中的特异表达及临床意义

目的 探讨特异性核基质结合区结合蛋白(SATB-1)在前列腺癌中的表达及临床意义.方法 收集前列腺增生、前列腺癌无骨转移、前列腺癌骨转移各30例患者的前列腺组织标本,采用免疫组织化学S-P法检测SATB-1的表达,并结合临床病理因素进行分析.结果 SATB-1表达阳性率在前列腺增生组织为0(0/30),前列腺癌组织为86.7%(52/60),两组比较差异有统计学意义(P<0.05);前列腺癌Gleason评分2～4分者SATB-1表达阳性率为76.5%(13/17),5～7分者为85.0%(17/20),8～10分者为95.7%(22/23),组间比较差异无统计学意义(P>0.05).采用双评分半定量法对SATB-1表达强度进行评分,经秩和检验SATB-1表达强度在前列腺癌无骨转移组与前列腺癌骨转移组间比较差异有统计学意义(P<0.05).SATB-1表达强度在前列腺癌不同Gleason评分组间比较差异有统计学意义(P<0.05),表达强度随Gleason评分的增加而增强.结论 SATB-1仅在前列腺癌组织中表达,且在Gleason评分高、有骨转移的前列腺癌组织中表达强度明显增加.SATB-1有望作为前列腺癌诊断和判断预后的有效指标.     

pim-1与c-myc在前列腺癌中的表达及其临床意义

目的：探讨pim-1和c—myc在前列腺癌组织中的表达及与前列腺癌临床的关系。方法：采用免疫组织化学法检测pim-1和c—rnyc在良性前列腺、高等级前列腺上皮内瘤和不同分级、分期前列腺癌组织中的表达，分析pim-1和c-myc在前列腺癌中的表达及与前列腺癌临床的关系。结果：pim-1和c-myc在前列腺癌中存在明显的高表达，pim-1表达水平与前列腺癌的病理分级与临床分期呈正相关（P〈0．01）。c—myc蛋白表达水平与前列腺癌的病理分级与临床分期无明显相关性（P〉0．05）。在前列腺癌中pim-1和c—myc的表达具有相关性（P=0．001）。结论：pim-1可作为一种新的诊断前列腺癌的肿瘤标志物。pim-1和c—myc在前列腺癌中可能产生协同作用，促进前列腺癌的发生和发展。     

前列腺癌组织中PSA、Ki-67的表达及其临床意义

目的:探讨前列腺特异性抗原(PSA)、Ki-67在前列腺癌组织中的表达与Gleason评分的相关性。方法:采用免疫组化SP法检测43例前列腺癌患者术后石蜡包埋组织中PSA、Ki-67的表达,并根据苏木精-伊红(HE)切片进行Gleason评分。同时,对患者的术前血总前列腺特异性抗原(tPSA)值和对应HE切片中的组织PSA进行比较。结果:在前列腺癌组织中PSA阳性率为93.0%(40/43),其表达量与Gleason评分呈负相关(r=-0.612,P=0.000)。Ki-67阳性表达率为90.7%(39/43),其表达与Gleason评分呈正相关(r=0.696,P=0.000)。PSA与Ki-67在前列腺癌组织中的表达呈无相关性(r=-0.163,P=0.296)。在术前取患者外周血tPSA与癌组织的PSA相比也呈明显的正相关性(r=0.814,P=0.000)。结论:Gleason评分越高,PSA表达越弱,Ki-67表达越强,前列腺癌组织分化程度越差,预后越差。明确前列腺癌Gleason分级,及检测PSA和Ki-67的表达有利于对患者的预后进行评估。     

前列腺癌肿瘤组织中E-cadherin和N-cadherin的表达及意义

目的:探讨上皮-间质转化(EMT)相关蛋白E-cadherin和N-cadherin在中低危前列腺癌和高危前列腺癌中的表达差异,以及E-cadherin和N-cadherin的表达与患者年龄、血清PSA水平、肿瘤组织Gleason评分的关系。方法:回顾性分析42例前列腺癌患者临床资料,将前列腺癌分为高危组27例和中低危组15例。免疫组化法检测两组E-cadherin和N-cadherin的表达,并比较两组有无差异;同时分析E-cadherin和N-cadherin的表达阳性率与血清PSA值、肿瘤Gleason评分及患者年龄的关系。结果:E-cadherin在中低危组的表达水平高于高危组(6.1±0.51 vs 4.2±0.37,P0.01),并且在中低危组中表达阳性率显著高于高危组(73.3%vs 25.9%,P0.01),E-cadherin在PSA20μg/L的患者中表达阳性率高于PSA≥20μg/L的患者(66.7%vs 29.6%,P0.05),在Gleason评分5~7分的患者中,其表达阳性率明显高于Gleason评分8~10分的患者(60.9%vs 21.1%,P0.05)。N-cadherin在中低危组的表达水平低于高危组(3.7±0.32 vs 7.5±0.58,P0.01),并且在中低危组中的表达阳性率低于高危组中(13.3%vs 59.3%,P0.05),在Gleason评分5~7分的患者中,其表达阳性率明显低于Gleason评分8~10分的患者(26.1%vs 63.2%,P0.05),N-cadherin在PSA20μg/L和PSA≥20μg/L的患者中表达阳性率没有差异(P0.05)。E-cadherin和N-cadherin在年龄≥70岁和70岁的患者中表达阳性率均没有明显差异(P0.05)。结论:E-cadherin和N-cadherin在高危前列腺癌和中低危前列腺癌表达阳性率及表达水平存在差异,即两者与前列腺癌的侵袭转移有关,并且E-cadherin和N-cadherin的表达可能与前列腺癌Glesaon评分、血清PSA水平有关。     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.