脂肪酸合成酶在乳腺良恶性病变组织中的表达

为探究脂肪酸合成酶（FAS）在乳腺良、恶性病变中表达的差异。笔者对乳腺癌和乳腺良性病变（各46例）病理石蜡标本中的FAS进行免疫组化染色，评估两组FAS的染色水平，比较其表达的差异。结果示：乳腺良性病变中FAS阳性率为15.2%，乳腺癌组织中FAS表达为71.7%（P＜0.001）;FAS染色阳性病例中，乳腺癌组FAS染色强度显著高于乳腺良性病变组（P＝0.037）。提示相对于乳腺良性病变，FAS在乳腺癌组织中明显过度表达。FAS的表达状况有可能成为乳腺良、恶性病变的鉴别方法之一。     

血管内皮生长因子在乳腺癌中的表达及意义

目的:研究血管内皮生长因子( VEGF)在乳腺癌组织中的表达并探讨其临床意义.方法:采用免疫组化方法检测74例乳腺癌、24例癌旁组织及18例正常乳腺组织中VEGF蛋白的表达情况,并计数微血管密度(MVD).结果:74例乳腺癌组织中VEGF阳性表达率为86.5％,明显高于癌旁组织(16.7％)及正常乳腺组织(11 1％)(P＜0.01),VEGF表达与肿瘤大小、组织学分级、临床分期、淋巴结转移相关,与MVD正相关(P＜0.05),与患者年龄、雌激素及孕激素受体情况无关(P＞0.05).结论:VEGF在乳腺癌发生、发展中起重要作用,可以作为判定乳腺癌恶性程度和预后的分子标记物.     

CD105表达与乳腺癌临床病理参数的关系

为探讨CD10 5标记的微血管密度 (MVD )与乳腺肿瘤临床病理和预后的关系 ,作者应用免疫组织化学SP法及CD10 5单克隆抗体测定了 5 3例乳腺癌 ,3 0例乳腺良性肿块 ,2 0例正常乳腺组织中CD10 5标记的MVD ,并对其与临床病理因素和术后生存率进行分析。结果示正常乳腺组织、乳腺良性肿块 ,乳腺癌CD10 5的表达值依次为 3 .12± 1.18,10 .5 0± 3 .41和 5 0 .0 3± 15 .41,乳腺癌组织明显高于前两组 (P <0 .0 1)。用MVD表示的CD10 5值与TNM分期、淋巴结转移等病理因素无关。单、多因素分析结果表明 ,CD 10 5标记的MVD是乳腺癌的独立预后因素。提示CD10 5是乳腺癌血管生成的重要因素 ,它在乳腺癌中的表达较良性肿块及正常乳腺明显增高 ;CD10 5标记的MVD与临床病理因素无关 ,它可作为乳腺癌的一种重要预后指标。     

胃肠道平滑肌肿瘤微血管密度的测定及其临床意义

目的　探讨微血管密度(MVD)与胃肠道平滑肌肿瘤(GISMT)良恶性、恶性程度、转移及预后的关系。　方法　采用免疫组织化学S-P法检测86例GISMT中MVD。　结果　MVD按平滑肌瘤、低度恶性平滑肌肉瘤、高度恶性平滑肌肉瘤的顺序依次明显增高,差异有非常显著性意义(P＜0.01)。同时,MVD与肿瘤良恶性生长方式、肿瘤大小、肿瘤中心有无坏死亦有明显关系,差异有非常显著性意义(P＜0.01)。MVD低表达组的5年生存率明显高于高表达组,差异有非常显著性意义(P＜0.01)。　结论　MVD是反映GISMT生物学特性的良好标志物,其测定可以作为判断GISMT良恶性、恶性程度、转移及预后的客观指标。     

乳腺不典型增生和乳腺癌中p53、ER表达的意义

目的探讨p53基因产物和雌激素受体(ER)在乳腺不典型增生和乳腺癌中表达及意义。方法用ABC免疫组化法检测乳腺不典型增生和乳腺癌细胞p53基因产物和ER表达。结果乳腺上皮不典型增生Ⅰ级者上皮细胞ER染色结果与正常乳腺上皮细胞相似，不典型增生Ⅱ级ER表达明显增强，22／24例阳性，不典型增生Ⅲ级20／22例见ER染色阳性。在乳腺上皮不典型增生Ⅰ级无p53蛋白表达，不典型增生Ⅱ级、Ⅲ级中分别有3／24和7／22例p53蛋白表达。乳腺癌59例，ER阳性率为36／59(61．02％)。乳腺癌p53蛋白表达阳性22／59(37．29％)。结论p53可促进正常细胞以不典型增生向癌的转化，ER对不典型增生癌变起重要的刺激、激活作用。p53-／ER 代表正常组织、良性增生与高分化和好的预后，p53 ／ER-多为不典型增生、低分化癌和差的预后。所以同时检测p53、ER对判断不典型增生向癌的转化及乳腺癌患者的预后有重要意义。     

微血管密度和血管内皮生长因子在胃肠道平滑肌肿瘤中的表达及其临床病理意义

目的探讨微血管密度(MVD)及血管内皮生长因子(VEGF)的表达与胃肠道平滑肌肿瘤(GISMT)的性质、恶性程度、转移及预后的关系。方法采用免疫组织化学SP法检测86例GISMT中MVD及VEGF的表达情况。结果MVD、VEGF的表达按平滑肌瘤、低度恶性平滑肌肉瘤、高度恶性平滑肌肉瘤的顺序依次明显增高(P<0.01或P<0.05)。同时,MVD、VEGF的表达与肿瘤良、恶性的生长方式、肿瘤大小、肿瘤中心有无坏死亦有明显关系(P<0.01或P<0.05)。MVD低表达组的5年生存率明显高于高表达组(P<0.01)。而VEGF高表达组的5年生存率则明显低于低表达组(P<0.01)。此外,VEGF阳性表达组的MVD明显高于VEGF阴性表达组的MVD(P<0.01)。结论MVD、VEGF是反映GISMT生物学特性的良好标志物,联合测定可以互补作为判断GISMT性质、恶性程度、转移及预后的客观指标。     

保乳术中癌及切缘组织中IDO的表达与T细胞和MVD表达的临床意义

目的探讨保乳术中癌组织、切缘组织中吲哚胺2,3-双加氧酶(IDO)的表达与调节性T细胞(Tregs)、新生血管微血管密度(MVD)表达的关系及与患者预后的关系。方法选取2008年至2011年收集的63例保乳术患者癌组织、切缘组织60例及正常乳腺组织标本30例,采用免疫组织化学法检测三组标本中IDO、Tregs、CD105标记的MVD(MVD-CD105)表达情况,数据分析在SAS 9.3软件包中处理,乳腺组织中IDO、MVD-CD105、Tregs阳性着色指数采用均数±标准差(x珋±s)表示,采用方差分析;IDO、MVD-CD105、Tregs阳性表达率、生存率比较采用卡方检验;相关性分析采用Pearson分析法;P0.05表示差异具有统计学意义。结果乳腺癌组织中IDO、MVD-CD105、Tregs阳性表达率均显著的高于切缘组织和正常乳腺组织(P0.05)。乳腺癌组织中的IDO阳性着色指数与MVD-CD105、Tregs阳性着色指数呈显著的正相关关系(P0.05)。乳腺癌组织中IDO阳性表达患者的5年总生存率71.11%显著的低于阴性患者的94.44%,差异有统计学意义(χ~2=4.050,P0.05)。结论乳腺癌组织中IDO表达水平显著的增高,并且与MVD形成有关,与患者的预后不良有一定的关系。     

乳腺疾病中微血管的观察分析

为观察乳腺良恶性疾病中微血管密度（ｍ ｉｃｒｏｖｅｓｓｅｌ ｄｅｎｓｉｔｙ， Ｍ Ｖ Ｄ）的分布以及 Ｍ Ｖ Ｄ 与乳腺癌肿瘤大小（ Ｔ）、组织学分级、雌激素受体水平（ Ｅ Ｒ）及腋淋巴结转移的关系，用Ⅷ因子抗体作病理切片的免疫组织化学染色，在显微镜下进行微血管计数。结果： 乳腺癌的 Ｍ Ｖ Ｄ均值为３０．８±１９．４ 个／２００ 倍视野，明显大于乳腺良性肿瘤的 Ｍ Ｖ Ｄ均值（１６．０９±７．９ 个／２００ 倍视野）， Ｐ＜ ０．０１； 乳腺癌中， Ｍ Ｖ Ｄ 与肿瘤大小、组织学分级及腋淋巴转移有关（ Ｐ＜ ０．０５），而与雌激素受体水平无关。本实验结果提示： 乳腺癌的 Ｍ Ｖ Ｄ 大于良性乳腺疾病者，可作为判断乳腺癌患者预后的指标之一。     

中期因子蛋白在肝外胆管癌中的表达及其临床意义

目的　探讨中期因子 (MK)的蛋白表达水平与肝外胆管癌血管生成、生物学特性和预后的关系。方法　采用免疫组织化学方法检测 3 7例肝外胆管癌组织中MK的蛋白表达和微血管密度 (MVD) ,并与临床病理及预后指标作对照分析。结果　肝外胆管癌的微血管密度平均为84.4± 3 3 .2 ,MK表达阳性率 62 .2 %。有淋巴结转移、Ⅲ～Ⅳ期和MVD高的患者 ,MK阳性表达率明显高于无淋巴结转移、Ⅰ～Ⅱ期和MVD低的患者 (P <0 .0 1)。随访结果表明 ,MK高表达患者术后生存时间比MK低表达患者明显缩短 (P <0 .0 1)。结论　MK的蛋白表达水平能反映肝外胆管癌细胞的恶性程度 ,有可能作为肝外胆管癌转移和预后分析的指标。     

乳腺癌微血管生成及nm23表达的临床意义

目的探讨乳腺癌组织中微血管生成及nm23表达的关系及其临床意义。方法应用SP免疫组织化学染色方法 ,以CD3 4单克隆抗体标记6 5例乳腺癌肿瘤组织中微血管,计数微血管密度(MVD),同时检测肿瘤组织中nm23的表达,分析乳腺癌组织血管生成和nm23的表达及两者与肿瘤生物学行为的关系。结果全部肿瘤标本有不同程度的微血管生成,并表现出明显的异质性。MVD计数为3～33个/400倍视野(平均11.6±7.0),nm23阳性表达率为81.5%。MVD与nm23的表达呈负相关(P=0.011),且两者分别与患者年龄、肿瘤大小无明显关系,而与肿瘤淋巴转移有关(P=0.0 1 4,0.0 0 5)。nm2 3的表达与肿瘤临床分期有关(P=0.0 3 8)。结论乳腺癌肿瘤组织中的微血管生成促进了淋巴转移,而nm23的表达可抑制淋巴转移;联合检测MVD及nm23对评估肿瘤淋巴转移风险具有一定的临床意义,可预测患者的预后。     

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.     

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.     

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。