细胞周期蛋白E和p27kip1在膀胱癌中的表达及意义

目的　探讨细胞周期蛋白E(cyclinE)和p2 7kip1在膀胱移行细胞癌中的表达及临床意义。　方法　采用免疫组化SP法观察 69例膀胱癌石蜡标本中cyclinE和 p2 7kip1的表达情况 ,结合临床资料进行分析。　结果　膀胱癌组织中cyclinE和 p2 7kip1阳性表达率分别为 42 %和 51 %。cy clinE阳性表达率在复发肿瘤中及随病理分级升高而升高 (P <0 .0 5) ,但与临床分期无关 (P >0 .0 5) ;p2 7kip1阳性表达率随病理分级、临床分期升高及在复发肿瘤中下降 (P <0 .0 1 )。cyclinE与 p2 7kip1二者的阳性表达有显著相关性 (P <0 .0 1 )。　结论　cyclinE和p2 7kip1表达可能是判断膀胱癌生物学行为的重要指标     

TGFβ_1及PCNA在肾细胞癌中的表达及其临床意义

目的 :探讨肾细胞癌中转化生长因子 β1 (TGFβ1 )及增殖细胞核抗原 (PCNA)的表达及其价值。方法 :采用免疫组织化学技术 (SP法 )对 46例肾细胞癌和 11例正常肾组织标本中 TGFβ1 、PCNA进行检测 ,并结合临床资料进行分析。结果 :肾癌组 TGFβ1 表达量较正常组高 (P <0 .0 5 ) ;PCNA在肾癌组高表达 (P <0 .0 1) ,且在高分期、高分级肾细胞癌中表达量较低分期、低分级肾细胞癌高 (P <0 .0 5 ) ;TGFβ1 表达量与 PCNA表达量呈负相关关系 (P <0 .0 1) ;TGFβ1 表达量低及 PCNA表达量高的肾癌患者预后差 (P <0 .0 5 )。结论 :TGFβ1 对处于增殖状态的肾细胞癌是一种重要负性调节因子 ,可抑制肾癌发展 ;TGFβ1 及 PCNA表达可作为判断肾细胞癌预后的指标     

Caveolin-1和HDAC1蛋白在肾细胞癌中的表达及意义

目的探讨Caveolin-1和HDAC1蛋白在肾细胞癌(renal cell carcinoma,RCC)及正常肾组织中的表达及临床意义,并探讨其与肿瘤生物学行为之间的关系。方法采用免疫组织化学方法检测51例RCC、15例正常肾组织及26例癌旁组织中Caveolin-1和HDAC1蛋白的表达,并分析其与患者临床病理特征的关系。51例RCC中组织学分级:高分化13例,中分化24例,低分化14例;临床分期:Ⅰ期16例,Ⅱ期20例,Ⅲ期10例,Ⅳ期5例。结果 Caveolin-1在正常肾组织、癌旁组织和RCC中的阳性表达率分别为33%(5/15)、42%(11/26)、65%(33/51),逐渐升高(P<0.05)。在51例RCC中,Caveolin-1的阳性表达率临床分期Ⅲ期和Ⅳ期高于Ⅰ期和Ⅱ期,低分化高于中、高分化,有淋巴结转移组高于无淋巴结转移组。Caveolin-1表达与病理学分期、分级和淋巴结转移均相关(P值分别为0.001、0.038和0.006,P均<0.05),随着肿瘤分期、分级的升高,Caveolin-1表达增强。RCC中Caveolin-1表达与年龄、性别、肿瘤所在部位均无关(P>0.05)。HDAC1在正常肾组织、癌旁组织和RCC中的阳性表达率分别为13%(2/15)、19%(5/26)、75%(38/51),呈现显著升高的趋势(P<0.05)。在51例RCC中,HDAC1的阳性表达率临床分期Ⅲ期和Ⅳ期高于Ⅰ期和Ⅱ期,低分化高于中、高分化,有淋巴结转移组高于无淋巴结转移组,肾癌组织中HDAC1表达率随肾癌TNM分期的增高和病理分级的增加而升高。RCC中HDAC1表达与年龄、性别、肿瘤所在部位均无关(P>0.05)。RCC中Caveolin-1的表达与HDAC1表达呈正相关。结论 Caveolin-1和HDAC1在RCC中高表达,可能是RCC发生、发展及浸润转移的重要因素之一,联合检测对判断RCC预后有指导意义。     

CD44v6和PCNA在肾透明细胞癌的表达及其预后价值

目的　探讨CD4 4v6和PCNA与肾透明细胞癌 (CCRCC)分级、分期和预后的关系 ,以及两者相互之间的关系。方法　采用免疫组化技术检测 5 8例CCRCC标本中CD4 4v6和PCNA的表达 ,比较两者同Fuhrman分级、病理分期和预后的关系 ,以及两者相互之间的关系。结果　CD4 4v6表达阳性率为 4 4 .8% (2 6 / 5 8) ,为细胞膜染色 ;PCNA表达阳性率为 5 6 .9% (33/ 5 8) ,为细胞核染色。两者表达与分级 (P <0 .0 0 1)和患者生存率 (P <0 .0 1和P <0 .0 5 )均显著相关 ,与病理分期无关 (P >0 .0 5 )。两者相互之间亦无关 (P >0 .0 5 )。结论　CD4 4v6和PCNA表达可能在CCRCC进展中发挥作用 ,并为判断预后提供了有用的信息     

VEGF和PCNA在肾细胞癌中的表达及意义

目的 研究肾细胞癌中血管内皮生长因子(VEGF)和增殖细胞核抗原(PCNA)表达与肾癌临床分期、病理分级、组织学类型、预后之间的关系. 方法 采用免疫组织化学技术检测40例肾细胞癌和10例正常肾组织标本中VEGF和PCNA的表达. 结果 正常肾组织与肾细胞癌组织中VEGF和PCNA阳性表达率比较差异均有统计学意义(P＜0.01,P＜0.05).在不同病理分级肾细胞癌中,高分化组、中分化组的VEGF和PCNA阳性表达率分别与低分化组比较差异有统计学意义(P＜0.01,P＜0.05).在不同临床分期肾细胞癌中,VEGF阳性表达率随临床分期的升高而逐渐升高;PCNA阳性表达率随临床分期的升高有升高的趋势.在不同组织类型肾细胞癌中,VEGF和PCNA阳性表达率差异均无统计学意义(P>0.05). 结论 VEGF在肾细胞癌组织中的表达与肾癌的病理分级及临床分期有相关性,其高表达与肾细胞癌的浸润转移密切相关.PCNA的表达与肾癌的病理分级具有相关性,能较为客观、准确地反映肾癌的恶性程度.     

肾癌相关蛋白G250mRNA在肾细胞癌中表达的研究

目的探讨肾癌相关蛋白G250 mRNA在肾细胞癌(RCC)中的表达及其临床意义.方法采用RT-PCR方法检测7例正常肾组织和33例RCC组织中G250 mRNA的表达.33例RCC中透明细胞癌28例,非透明细胞癌5例;T1 8例、T2 13例、T3 12例;G1 11例、G2 15例、G37例. 结果33例RCC组织中G250 mRNA表达阳性28例(84.8%),7例正常组织G250表达均为阴性,2组间差异有统计学意义(P＜0.01).肾透明细胞癌组织G250 mRNA表达率高于非透明细胞癌[96.4%(27/28)和20.0%(1/5),P＜0.05].T1、T2、T3 RCC G250 mRNA表达量分别为0.32±0.21、0.41±0.16、0.38±0.14,表达量与临床分期无相关性(P＞0.05).G1、G2、G3 RCC G250 mRNA表达量分别为0.48±0.32、0.23±0.16、0.11±0.11,表达量与病理分级呈负相关(P＜0.05).结论G250mRNA表达与RCC恶性程度有相关性,有望成为RCC诊断及预后判断的指标.     

肾细胞癌肾外症状和体征的临床预后意义

作者报道了肾细胞癌 (RCC)肾外表现的发生几率 ,并评价其在预后判断方面的临床意义。收集 10 4 6例 1989至2 0 0 1年行肾切除术RCC患者的病历资料 ,采用单因素和多因素方差分析 ,将TNM分期、Fuhrman分级和美国东部癌症协作组日常生活状态评价 (ECOG PS)纳入影响因素 ,检验通过术前体检和实验室检查发现的肾外表现的预后意义。所有患者平均随访 4 0 .3个月 ,平均存活时间 19.3个月。贫血 (5 2 .1% )、血尿 (35 .2 % )和肝功能异常 (31.5 % )是肾细胞癌最常见的临床表现。其他包括消瘦 (2 2 .9% )、低蛋白血症 (19.9% )、肾区疼痛(19.5…     

肾癌组织中CD44v6和P16蛋白的表达及临床意义

目的　探讨评估肾细胞癌预后因素的指标。方法　应用免疫组化方法 ,对 6 0例肾癌组织进行CD4 4v6和P16蛋白检测。结果　在肾癌细胞中CD4 4v6和P16蛋白表达阳性率分别为 6 6 .7%和 5 1.7%。肾细胞癌分级、分期和淋巴结转移与CD4 4v6高表达和P16低表达相关 (P <0 .0 5 )。CD4 4v6表达与P16表达呈负相关 (r=- 0 .4 3,P <0 .0 5 )。结论　CD4 4v6和P16表达对判断肾细胞癌恶性程度及预测淋巴结转移有一定的参考价值     

子宫内膜癌热休克蛋白70、90的表达及其临床意义

目的 :探讨子宫内膜癌中热休克蛋白 ( HSP) 70、90的表达及意义。方法 :用免疫组化 Envision法及图象分析仪检测了 3 0例正常子宫内膜、3 0例增生过长子宫内膜和 53例子宫内膜癌中 HSP70、90的表达情况。结果 :子宫内膜癌中 HSP70的表达为( 2 0 9.0 6± 5.3 6 ) ,明显高于正常内膜 ( 1 45.2 1± 4.0 9)和增生过长内膜 ( 1 48.59± 4.2 3 ) ,P均 <0 .0 1 ;子宫内膜癌中 HSP90的表达为 ( 1 6 6 .98± 5.71 ) ,明显低于正常子宫内膜( 2 0 8.57± 3 1 .1 4)和增生过长子宫内膜 ( 2 49.73± 4.94) ,分别为 P<0 .0 5、P<0 .0 1。子宫内膜癌中 HSP70表达随肿瘤病理分级升高而增强 ( P<0 .0 1 ) ,非内膜样癌较内膜样癌表达增强 ( P<0 .0 1 ) ;子宫内膜癌中 HSP90表达随肿瘤病理分级升高而表达减弱 ( P<0 .0 1 ) ,非内膜样癌较内膜样癌表达减弱 ( P<0 .0 1 )。但子宫内膜癌中 HSP70、90表达与肌层浸润深度、术后病理分期、淋巴结转移未见显著相关性 ( P>0 .0 5)。结论 :HSP70、90可能与子宫内膜癌发生及预后有关     

表浅性膀胱移行细胞癌中p53和Bcl-2同时表达的临床意义

目的 :探讨表浅性膀胱移行细胞癌中Bcl 2和 p5 3的同时表达与膀胱癌预后之间的关系。 方法 :应用免疫组化技术 (SABC法 )检测 4 2例表浅性膀胱癌蜡块标本中Bcl 2和p5 3的表达。患者术后平均随访 36个月 ,14例复发 ,其中复发 2次以上 9例 ,有转移者 4例。结果 :4 2例中 ,31例 (73.8% ) p5 3阳性表达 ,与G1(6 2 .5 % )和G2 (72 .2 % )相比较 ,G3 (81.2 % )更多见 ;pT1期 (78.6 % )p5 3阳性率较 pTa期 (6 4 .3% )高。 12例(2 8.6 % )发现有Bcl 2表达 ,Bcl 2表达阳性率G3 (37.5 % )明显高于G2 (2 2 .2 % )和G1(2 5 .0 % ) ,与分期无关 (P>0 .0 5 )。膀胱癌复发率p5 3基因表达阳性者高于阴性者 (P <0 .0 5 ) ,而Bcl 2基因表达阳性者与阴性者的差别无统计学意义 (P >0 .0 5 ) ,但 p5 3和Bcl 2同时呈阳性表达者 (8例 )明显高于其他患者 (P <0 .0 1)。Bcl 2和p5 3的阳性表达与肿瘤侵袭性和淋巴结及远处转移有关。结论 :p5 3和Bcl 2同时阳性表达的肿瘤患者预后较差 ,两者同时检测对判断膀胱癌复发及预后更具有指导意义。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.