survivin和caspase-3在病理性瘢痕成纤维细胞中的表达及其意义

目的 研究病理性瘢痕成纤维细胞中survivin和caspase-3的表达水平,以及两种凋亡相关因子与病理性瘢痕发生、发展机制的关系. 方法 以普通瘢痕为对照,采用RT-PCR和免疫组化方法,研究体外培养的病理性瘢痕成纤维细胞中survivin和caspase-3 mRNA和蛋白的表达变化,并进行比较分析. 结果 病理性瘢痕成纤维细胞中survivin的mRNA和蛋白(65.47%、72.43%)的表达水平高于普通瘢痕(P<0.01);caspase-3的mRNA和蛋白表达水平低于普通瘢痕(22.85%、6.34%,P<0.01);survivin、caspase-3在增生性瘢痕和瘢痕疙瘩中的表达差异有统计学意义(P<0.05). 结论 survivin和caspase-3在病理性瘢痕成纤维细胞中的表达异常,在病理性瘢痕的发生、发展中起重要的作用.     

凋亡相关基因survivin、caspase-3及cyclin-B1在胃癌发生、发展中的作用

目的 检测凋亡相关基因survivin、caspase-3和cyclin—B1在胃癌组织中的表达，探讨其表达在胃癌发生、发展中的作用。方法 采用RT—PCR方法检测survivin mRNA、caspase-3 mRNA和cyclin-B1 mRNA在30例胃癌组织、10例癌旁正常胃组织标本中的表达。结果 30例胃癌组织中有20例survivin mRNA阳性表达，10例正常胃组织中无survivin mRNA表达；30例胃癌组织和10例正常胃组织中均有caspase-3 mRNA和cyclin—B1 mRNA阳性表达；20例survivin mRNA阳性表达的胃癌组织中caspase-3 mRNA和cyclin-B1 mRNA表达水平明显低于lo例survivin mRNA阴性表达的胃癌组织（P〈0．01）和正常胃组织（P〈0．01）；10例survivin mRNA阴性表达的胃癌组织caspase-3 mRNA和cyclin—B1 mRNA表达水平亦明显低于10例正常胃组织（P〈0．01）。相关性分析表明，survivin的表达与caspase-3（r=-0．923，P〈0．01）和cyclin-B1（r=0．886，P〈0．01）表达呈负相关，caspase-3的表达与cyclin-B1表达呈正相关（r=0．892，p〈-0．01）。结论survivin促进胃癌发生、发展，caspase-3和cyclin-B1抑制胃癌发生、发展。     

As2O3对人乳腺癌中NF-kB p65、survivin和caspase-3的作用及相关性研究

目的探讨As2O3对人乳腺浸润性导管癌裸鼠移植瘤组织中NF-kB p65、survivin及caspase-3表达的影响。方法复制人乳腺浸润性导管癌裸鼠移植瘤模型，共22只，随机分为3组：对照组、顺铂组及不同浓度（1．5、3．0mg／kg）的As2O3组（简称As2O3组）。用原位杂交法检测survivin mRNA的表达；用免疫组化法检测肿瘤组织NF-kBp65、survivin及caspase-3蛋白的表达。结果人乳腺浸润性导管癌裸鼠移植瘤中NF-kB p65蛋白及survivin mRNA和蛋白表达的阳性细胞密度As2O3组明显低于顺铂组和对照组（P〈0．01），顺铂组也低于对照组（P〈0．01）；而caspase-3蛋白表达结果则相反（P〈0．01）。NF-kB p65蛋白、survivin蛋白及survivinmRNA阳性表达间相互呈正相关，而三者的表达均与caspase-3蛋白表达呈负相关。结论As2O3可能通过抑制NF-rBp65的活性抑制survivin，从而激活caspase-3，诱导人乳腺浸润性导管癌细胞的凋亡，且呈剂量依赖性。     

病理性瘢痕成纤维细胞中凋亡因子Fas、Bcl-2、survivin、caspase-3蛋白的表达及意义

目的:探讨病理性瘢痕成纤维细胞中凋亡因子Fas、Bcl-2、survivin、caspase-3蛋白的表达及意义。方法:采用Western bolt技术检测46例病理性瘢痕组织、25例非病理性瘢痕组织和22例正常皮肤组织中凋亡相关因子Fas、Bcl-2、survivin、caspase-3的阳性表达率,并分析其相关性。结果:病理性瘢痕成纤维组织中Fas、caspase-3阳性表达率分别为21.74%、23.91%低于非病理性瘢痕的60.0%、72.0%和正常皮肤组织的86.36%、90.90%,差异有统计学意义(P0.05);病理性瘢痕成纤维组织Bcl-2、survivin阳性表达率分别为78.26%、82.61%高于非病理性瘢痕的44.0%、48.0%和正常皮肤组织的13.64%、18.18%,差异有统计学意义(P0.05);且非病理性瘢痕和正常皮肤组织中上述指标也存在明显差异(P0.05);Spearman相关分析显示,Fas蛋白与Bcl-2蛋白、survivin蛋白表达呈负相关关系(r=-0.513、-0.629,P0.05),与caspase-3蛋白表达呈正相关关系(r=0.691,P0.05);Bcl-2蛋白表达与survivin蛋白表达呈正相关关系(r=0.6.16,P0.05),与caspase-3蛋白表达呈负相关关系(r=-0.638,P0.05),survivin蛋白表达与caspase-3蛋白表达呈负相关关系(r=-0.621,P0.05)。结论:病理性瘢痕成纤维组织中凋亡相关因子Fas、Bcl-2、survivin、caspase-3的异常表达,可能参与病理性瘢痕的形成。     

P53蛋白对人瘢痕疙瘩成纤维细胞基质金属蛋白酶1、3表达的影响

目的 探讨P53蛋白对人瘢痕疙瘩成纤维细胞（keloid fibroblast，KFB）基质金属蛋白酶1（MMP1）、基质金属蛋白酶3（MMP3）表达的影响；明确在人瘢痕疙瘩成纤维细胞中P53蛋白与MMP1、MMP3之间的相互关系。方法 采用腺病毒介导法将p53基因转染至人瘢痕疙瘩成纤维细胞中。将来源于瘢痕疙瘩的成纤维细胞随机分成二组，实验组转染p53基因转染至成纤维细胞中，对照组为空载转染组。分别用间接免疫荧光法和Western印迹法检测P53蛋白的表达；ELISA法检测MMP1、MMP3的表达。结果 p53基因转染组细胞中P53蛋白表达明显高于空载转染组；而MMP1、MMP3蛋白表达明显低于空载转染组（P〈0．01）。结论 P53蛋白能够抑制人瘢痕疙瘩成纤维细胞MMP1、MMP3蛋白的表达。     

WW结构域氧化还原酶和原癌基因C—JUN在瘢痕疙瘩中的表达

目的研究ww结构域氧化还原酶（WWOX）和原癌基因C—JUN在瘢痕疙瘩中的表达，探讨其在瘢痕疙瘩形成中的作用及机制。方法应用免疫组织化学sP法结合计算机病理图像分析、Western印迹和逆转录聚合酶链反应（RT-PCR）检测正常皮肤和瘢痕疙瘩组织中WWOX和C—JUN的表达，并对其表达进行统计学分析。结果瘢痕疙瘩中WWOX蛋白的表达定位于成纤维细胞细胞质中，且WWOX蛋白及其mRNA的表达减少，与正常皮肤对照组相比差异有统计学意义（P〈O．05）；C—JUN蛋白的表达定位于成纤维细胞细胞核和细胞质中，且C—JUN蛋白及其mRNA的表达增多，与正常皮肤对照组相比差异有统计学意义（P〈0．05）。两者的表达存在负相关性（r=-0．626，P〈O．01）。结论WWOX在瘢痕疙瘩中低表达，c—JUN在瘢痕疙瘩中高表达，两者是瘢痕疙瘩相关基因，两者存在明显负相关，是瘢痕疙瘩的形成机制之一。ww（）X蛋白可能是C—JUN蛋白表达的抑制因素，两者可能通过成纤维细胞在瘢痕疙瘩的形成过程中发挥着重要作用。     

Skp2和p27kip1蛋白在病理性瘢痕组织中的表达和意义

目的研究Skp2（S期激酶相关蛋白2）在病理性瘢痕中的表达情况及其与p27^kip1之间的相互关系，探讨它们在瘢痕形成中的作用及机制。方法应用免疫组化SP法检测正常皮肤、成熟瘢痕、增生性瘢痕和瘢痕疙瘩组织中Skp2、p27^kip1蛋白的表达并进行统计学分析。结果病理性瘢痕组织中Skp2蛋白表达增高，与正常皮肤、成熟瘢痕对照组比较差异有统计学意义（P〈0．01）；病理性瘢痕组织中p27^kip1蛋白表达显著低于正常皮肤、成熟瘢痕（P〈0．05）；病理性瘢痕组织中Skp2蛋白和p27^kip1蛋白呈负相关（P〈0．01）。结论Skp2在病理性瘢痕组织中表达增高，可能通过调节p27^kip1等细胞周期调控因子的降解而促进瘢痕组织中细胞的增生，对病理性瘢痕的形成可能起着重要作用。     

病理性瘢痕组织中微血管密度的测定及与survivin mRNA的表达关系

目的测定病理性瘢痕组织中CD105标记的微血管密度（microvesiel density,MVD）和survivin mRNA的表达,探讨病理性瘢痕组织中癌基因在血管形成中的作用。方法采用多相寡核苷酸探针原位杂交技术和免疫组织化学染色技术（SP法）,分别检测survivin mRNA、CD105蛋白在40例病理性瘢痕、20例非病理性瘢痕和20例正常皮肤组织中的表达,并计数CD105标记的MVD。结果CD105-MVD、survivinmRNA在病理性瘢痕较非病理性瘢痕和正常皮肤的表达差异皆具有统计学意义（P〈0.05）。病理性瘢痕组中survivin mRNA表达与CD105-MVD表达有相关性（P〈0.05）。结论病理性瘢痕组织中,凋亡抑制基因survivin表达上调可能参与了其血管形成过程。     

ILK,PI3K,PTEN蛋白在病理性瘢痕中的表达

目的：探讨病理性瘢痕组织中整合素连接激酶（ILK）,第十染色体同源丢失性磷酸酶基因（phosphatase and tensin homolog deleted on Chromosome10,PTEN）和磷酯酰肌醇3一激酶（PI3K）的表达。方法：采用免疫组化sP法检测ILK,PTEN,PI3K在40例病理性瘢痕,20例非病理性瘢痕及20例正常皮肤组织中的表达水平。结果：病理性瘢痕组织中,ILK,PI3K蛋白阳性表达率分别为67．50％,70．00％,均高于非病理性瘢痕及正常皮肤组（P〈0。0167）;PTEN蛋白阳性表达率为25．00％,低于其他两组（P〈0．0167）。PTEN的表达与ILK,PI3K的表达强度成负相关（P〈0．05,r〈0）,ILK与PI3K表达成正相关（P〈0．05,r=O．63）。结论：ILK,PI3K及PTEN可能依赖PTEN／PI3K／ILK／PKB信号传导通路共同参与病理性瘢痕的形成,且ILK,PI3K可能起协同作用,与PTEN互相拮抗。     

肾癌患者外周血中survivin mRNA的表达

目的探讨肾透明细胞癌患者外周血中survivin mRNA的表达及其临床意义。方法用RT-PCR方法检测30例肾透明细胞癌患者、10例正常健康人外周血中survivin mRNA的表达。结果30例肾透明细胞癌患者中有23例外周血中survivin mRNA表达阳性，阳性率为76．7％，与正常健康人（0％）相比差异有统计学意义（P〈0．001）；survivin mRNA的表达与临床分期密切相关（P〈0．01）；随肿瘤组织分化程度的降低，survivin阳性率有增加的趋势，但差异无统计学意义（P〉0．05）。结论肾透明细胞癌患者外周血中survivin mRNA可作为肾透明细胞癌微转移的一个监测指标。     

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.     

Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration

Ligament and tendon injuries are common problems in orthopedics. There is a need for treatments that can expedite nonoperative healing or improve the efficacy of surgical repair or reconstruction of ligaments and tendons. Successful biologically-based attempts at repair and reconstruction would require a thorough understanding of normal tendon and ligament healing. The inflammatory, proliferative, and remodeling phases, and the cells involved in tendon and ligament healing will be reviewed. Then, current research efforts focusing on biologically-based treatments of ligament and tendon injuries will be summarized, with a focus on stem cells endogenous to tendons and ligaments. Statement of clinical significance: This paper details mechanisms of ligament and tendon healing, as well as attempts to apply stem cells to ligament and tendon healing. Understanding of these topics could lead to more efficacious therapies to treat ligament and tendon injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:7–12, 2020