基质金属蛋白酶-9及血管内皮生长因子在卵巢癌中表达及其关系研究

目的:探讨基质金属蛋白酶-9及血管内皮生长因子与肿瘤侵袭发展的关系及二者相关性.方法:80例卵巢癌及30例卵巢良性肿瘤患者,采用RT-PCR和免疫组织化学方法检测基质金属蛋白酶-9及血管内皮生长因子的表达情况.结果:卵巢癌组基质金属蛋白酶-9及血管内皮生长因子mRNA的表达(1.128±0.061,0.878±0.034)明显高于卵巢良性肿瘤组(0.426±O.085,0.178±O.050)(P<0.05).卵巢癌组中基质金属蛋白酶-9与血管内皮生长因子蛋白的阳性表达(93.8%,97.5%)明显高于卵巢良性肿瘤组(43.3%,53.3%)(P<0.05),卵巢癌组中基质金属蛋白酶-9与血管内皮生长因子蛋白的表达与临床分期、有无淋巴结转移有关,二者阳性表达率成正相关(r=0.74,P<0.05).结论:基质金属蛋白酶-9及血管内皮生长因子高表达与卵巢癌侵袭性密切相关,可作为检测卵巢癌侵袭性的有效指标.在肿瘤侵袭过程中基质金属蛋白酶-9与血管内皮生长因子的产生关系密切.     

急性冠状动脉综合征患者血清基质金属蛋白酶-9及其抑制物水平变化

目的:观察不同类型冠心病患者血清基质金属蛋白酶-9、组织金属蛋白酶抑制物-1水平的变化,进一步了解血清基质金属蛋白酶-9及组织金属蛋白酶抑制物-1在冠状动脉粥样硬化发生发展中的作用及临床意义.方法:采用酶联免疫吸附法测定60例冠心病患者(急性冠状动脉综合征患者30例、稳定性心绞痛患者30例)、30例非冠心病患者(对照组)血清基质金属蛋白酶-9,组织金属蛋白酶抑制物-1的水平.结果:急性冠状动脉综合征组血清基质金属蛋白酶-9水平高于稳定性心绞痛组及对照组(P<0.01),而血清组织金属蛋白酶抑制物-1水平低于稳定性心绞痛组及对照组(P<0.01).稳定性心绞痛组血清基质金属蛋白酶-9水平高于对照组(P<0.01),血清组织金属蛋白酶抑制物-1水平低于对照组(P<0.01).急性冠状动脉综合征患者治疗后血清基质金属蛋白酶-9水平低于治疗前,组织金属蛋白酶抑制物-1高于治疗前(P<0.01).结论:血清基质金属蛋白酶-9水平增高及组织金属蛋白酶抑制物-1水平降低与粥样斑块破裂相关,可作为判断粥样斑块不稳定的血清学指标.血清基质金属蛋白酶-9水平增高及组织金属蛋白酶抑制物-1水平降低有助于评价冠状动脉病变的程度及冠心痛患者的预后.     

血管内皮生长因子在肺癌患者诊治中的临床价值

目的:探讨血清血管内皮生长因子水平在肺癌诊断和预后中的临床意义.方法:采用ELISA法对49例肺癌患者及20例健康体检者的血清血管内皮生长因子分别进行测定,同时用化学发光法测定肺癌患者血清癌胚抗原的含量.结果:肺癌患者血清血管内皮生长因子水平明显高于健康对照组(P<0.01),肺癌患者血清血管内皮生长因子水平与其生存期之间呈负相关(P<0.01).血清血管内皮生长因子对肺癌诊断的灵敏度为85.71%,特异度为70%.血清癌胚抗原、血管内皮生长因子及联合检测的阳性率分别为51.02%,85.71%,91.84%,血管内皮生长因子阳性率明显高于血清癌胚抗原.结论:血清血管内皮生长因子是一种良好的肿瘤标记物,对肺癌的诊断和评估预后具有重要的临床价值,其诊断价值优于血清癌胚抗原.     

肝细胞癌患者血清VEGF和NO含量测定及其临床意义

目的研究血管内皮生长因子(VEGF)和一氧化氮(NO)在肝细胞癌患者血清中的表达水平,并探讨其临床意义。方法分别采用酶联免疫吸附试验(ELISA)和分光光度法检测60例肝细胞癌、48例良性肝病患者和32名健康人血清中VEGF和NO的含量。结果良性肝病患者血清中VEGF和NO含量与健康人比较,差异均无统计学意义(P>0.05);而肝细胞癌患者血清VEGF和NO含量较良性肝病患者和健康人明显增高(P<0.01),且随着肝细胞癌门静脉癌栓形成、肿瘤体积增大以及临床分期愈晚而显著增高(P<0.01)。血清VEGF与NO含量呈明显正相关(r=0.836,P<0.01)。结论VEGF和NO可能与肝细胞癌的发生、发展密切相关,治疗前检测血清VEGF和NO表达水平可以作为判断肝细胞癌侵袭、生长及临床分期的有价值指标。     

肝细胞癌患者血清VEGF和NO含量测定及其临床意义

目的 研究血管内皮生长因子(VEGF)和一氧化氮(NO)在肝细胞癌患者血清中的表达水平,并探讨其临床意义.方法 分别采用酶联免疫吸附试验(ELISA)和分光光度法检测60例肝细胞癌、48例良性肝病患者和32名健康人血清中VEGF和NO的含量.结果 良性肝病患者血清中VEGF和NO含量与健康人比较,差异均无统计学意义(P>0.05);而肝细胞癌患者血清VEGF和NO含量较良性肝病患者和健康人明显增高(P<0.01),且随着肝细胞癌门静脉癌栓形成、肿瘤体积增大以及临床分期愈晚而显著增高(P<0.01).血清VEGF与NO含量呈明显正相关(r=0.836,P<0.01). 结论 VEGF和NO可能与肝细胞癌的发生、发展密切相关,治疗前检测血清VEGF和NO表达水平可以作为判断肝细胞癌侵袭、生长及临床分期的有价值指标.     

疏风解毒胶囊对社区获得性肺炎患者血清VEGF、MMP-9水平的影响

目的：探讨疏风解毒胶囊对社区获得性肺炎患者血清血管内皮生长因子、基质金属蛋白酶-9水平的影响。方法：回顾性分析2018年5月~2019年5月收治的社区获得性肺炎90例患者临床资料。将采用常规治疗的45例患者纳入A组,在A组基础上联合疏风解毒胶囊治疗的45例患者纳入B组。比较两组治疗1周后临床疗效、血清血管内皮生长因子、基质金属蛋白酶-9水平及不良反应发生情况。结果：B组总有效率较A组高,差异有统计学意义（P＜0.05）;两组治疗前血清血管内皮生长因子、基质金属蛋白酶-9水平对比,差异无统计学意义（P＞0.05）;两组治疗后血清血管内皮生长因子、基质金属蛋白酶-9水平均较治疗前降低,且B组较A组低,差异有统计学意义（P＜0.05）;B组不良反应发生率略低于A组,差异无统计学意义（P＞0.05）。结论：社区获得性肺炎采用疏风解毒胶囊治疗效果较好,可有效降低血管内皮生长因子、基质金属蛋白酶-9水平,且不良反应较少,安全性较高。     

血管内皮生长因子与基质金属蛋白酶2在血管瘤不同生长过程中的表达特征

目的:观察血管内皮生长因子与基质金属蛋白酶2在血管瘤不同分期中的表达。方法:取自承德医学院附属医院1998-01/2005-12期间血管瘤手术切除的标本共60例及正常带血管皮肤手术切除标本10例,患者家属知情同意。①实验分组:根据Mulliken标准进行病理诊断并分类,所有标本共分4组。增生组22例;退化组20例;退化完成组18例。另取10例正常带血管皮肤组织作为对照组。②采用免疫组织化学S-P法对各组标本的血管内皮生长因子、基质金属蛋白酶2进行染色。③实验评估:以正常血管上皮细胞或肿瘤细胞胞浆出现棕黄色颗粒为阳性,检测各组血管内皮生长因子与基质金属蛋白酶2的表达。结果:①随着血管瘤病理时期的变化,血管内皮生长因子与基质金属蛋白酶2出现明显不同的表达。②增生组血管内皮生长因子与基质金属蛋白酶2的阳性表达率明显高于其他各组,且随着血管瘤的退化,两者的阳性表达率逐渐下降,至退化完成期时与对照组几乎无差别。③血管内皮生长因子与基质金属蛋白酶2的表达呈正相关。结论:血管内皮生长因子与基质金属蛋白酶2在血管瘤的不同分期中起重要作用,其表达水平与血管瘤的病理分期有密切关系。     

急性心肌梗死患者血清血管内皮生长因子与一氧化氮检测的意义

目的:检测急性心肌梗死患者血清血管内皮生长因子和一氧化氮水平,探讨血管内皮生长因子和一氧化氮在急性心肌梗死发病中的作用。方法:选择冠心病患者60例,其中稳定型心绞痛30例,急性心肌梗死30例,健康人30例为对照组,均于入院第1 d抽取空腹静脉血测定血清血管内皮生长因子及一氧化氮的水平。结果:冠心病患者血清中血管内皮生长因子含量明显高于正常对照组(P<0.01);急性心肌梗死组血清中血管内皮生长因子含量明显高于稳定型心绞痛组和正常对照组(P<0.01);冠心病患者血清中一氧化氮含量低于正常对照组(P<0.01),急性心肌梗死患者血清中血管内皮生长因子含量低于稳定型心绞痛组和正常对照组(P<0.01)。结论:冠心病患者血清中血管内皮生长因子含量高而一氧化氮含量低,提示动脉发生粥样硬化的过程中,血管内皮生长因子与一氧化氮相互调节的作用可能发生障碍,血管内皮生长因子与一氧化氮调节失衡可能与动脉粥样硬化发生、发展有关。     

肾癌患者血清VEGF与MMP-9水平的变化及其意义

目的:探讨肾癌患者血管内皮生长因子(VEGF)和基质金属蛋白酶-9(MMP-9)水平的变化及其与肿瘤分期的关系。方法:采用ELISA法检测35例肾癌患者及32例健康患者血清中VEGF和MMP-9水平,用酶标仪测定MMP-9和VEGF含量。结果:肾癌组血清MMP-9和VEGF的水平分别为677.16μg/L和1084.78 ng/L,均显著高于正常对照组373.24μg/L和694.88 ng/L(P均<0.01)。血清MMP-9和VEGF水平与肿瘤分期呈正相关(r分别为0.5896、0.6624,P均<0.01);局部浸润组均显著高于包膜内组(P均<0.01);远处转移组均显著高于局部浸润组(P均<0.01);而包膜内组与对照组之间差异无统计学意义(P>0.05);血清MMP-9和VEGF水平与远处转移组呈正相关(r分别为0.6392、0.7104,P均<0.01)。结论:肾癌患者血清VEGF和MMP-9水平显著升高,并与肿瘤分期及远处转移有关,提示检测两者血清水平有助于对肾癌恶性程度的判断。     

平阳霉素碘化油乳剂超选择动脉栓塞术对肝血管瘤患者血清MMP-9、VEGF表达的影响

目的：探讨平阳霉素碘化油乳剂超选择动脉栓塞术治疗肝血管瘤患者血清基质金属蛋白酶-9、血管内皮生长因子表达的影响。方法：回顾性分析2018年9月~2019年9月收治的94例肝血管瘤患者临床资料,采用Embosphere微球超选择动脉栓塞术治疗的45例为对照组,采用平阳霉素碘化油乳剂超选择动脉栓塞术治疗的49例为观察组。对比两组临床疗效及术前、术后6个月瘤体直径、血清基质金属蛋白酶-9、血管内皮生长因子水平。结果：观察组治疗总有效率高于对照组（P＜0.05）;术后6个月观察组瘤体直径小于对照组（P＜0.05）;术后6个月观察组血清基质金属蛋白酶-9、血管内皮生长因子水平低于对照组（P＜0.05）。结论：平阳霉素碘化油乳剂超选择动脉栓塞术治疗肝血管瘤患者,可调节血清基质金属蛋白酶-9、血管内皮生长因子水平,降低瘤体直径,疗效显著。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.