骨肉瘤中尿激酶型纤溶酶原激活因子和受体的表达

目的研究尿激酶型纤溶酶原激活因子(uPA)及其受体(uPAR)在不同外科分期骨肉瘤中的表达及意义.方法采用荧光定量RT-PCR方法检测32例骨肉瘤组织uPA和uPAR表达情况.结果肿瘤组织与癌旁组织和正常组织比较,uPA和uPAR表达的阳性率明显增高(P＜0.01).骨肉瘤Ⅰ、Ⅱ、Ⅲ期表达uPA的阳性率分别为22.2%(2/9)、76.9%(10/13)、90.0%(9/10),表达uPAR的阳性率分别为33.3%(3/9)、84.6%(11/13)、90.0%(9/10).uPA和uPAR在Ⅰ期和Ⅱ期、Ⅰ期和Ⅲ期骨肉瘤中表达差异均有显著性(P＜0.05、P＜0.01).结论uPA/uPAR在骨肉瘤组织中表达明显升高.肿瘤恶性程度越高,uPA/uPAR表达阳性率越高,提示uPA/uPAR与骨肉瘤恶性进展有高度相关性.     

膀肤癌P53基因异常表达产物的微波免疫组化研究

为探讨用微波辐射的方法重新恢复因福尔马林固定而掩敝的组织抗原及其临床意义,采用微波辐射与链霉菌素-生物素免疫组化染色法(LSAB)相结合的方法对48例膀胱移行细胞癌的P53蛋白表达进行研究.结果显示:膀胱移行细胞癌P53蛋白阳性率为60.42%;Ⅰ级、Ⅱ级和Ⅲ级阳性率间有显著性差异(P<0.05);乳头状生长与浸润性生长方式阳性率无显著性差异(P>0.05);阳性细胞均数Ⅲ级与Ⅰ级和Ⅱ级有极显著性差异(P<0.01),Ⅰ级与Ⅱ级间无显著性差异,乳头状生长与浸润性生长方式间有极显著性差异(P <0.01).提示阳性细胞的多少比单纯的阳性率具有更重要的生物学意义.     

环氧合酶-2、p53在骨肉瘤中的表达及临床意义

[目的]探讨环氧合酶-2(cyclooxygenase-2,cox-2)蛋白、p53蛋白在骨肉瘤、骨软骨瘤组织中表达的差异性、相关性及临床意义.[方法]回顾本科1998～2004年间骨肉瘤患者档案,筛选术后石蜡切片40例作为试验组.男24例,女16例;年龄8～38(18.68±6.47)岁.筛选同期骨软骨瘤患者术后石蜡切片20例作为对照组.男13例,女7例;年龄9～27(17.95±4.77)岁.应用免疫组化(S-P)进行染色.光镜下观察染色切片,cox-2蛋白染色以组织胞浆内出现棕黄色颗粒者为阳性细胞;p53蛋白染色以胞核内出现棕黄色颗粒者为阳性细胞.随机观察5个高倍视野,依照阳性细胞所占比例分为"-"阳性细胞所占比例＜5%;" "阳性细胞所占比例5%～25%;" "阳性细胞所占比例26%～50%;" "阳性细胞所占比例＞50%.分别统计两者的阳性表达情况,所得数据应用SAS v6.12统计软件处理.采用chi-square test进行x2检验,α=0.05为水准,分别统计两者在骨肉瘤、骨软骨瘤组织细胞中阳性表达的差异性.采用Spearman等级相关分析法检验两者在骨肉瘤中阳性表达之间的相关性,α=0.05为水准.[结果]骨肉瘤组织中cox-2、p53蛋白的阳性率分别为67.5%和55.0%,显著高于对照组骨软骨瘤组织(P＜0.05).cox-2、p53蛋白在骨肉瘤中的表达密切相关(rs=0.58,P＜0.05).[结论]在骨肉瘤中,cox-2、p53参与了骨肉瘤的发生、发展,两者密切相关,相互协同.临床上联合检测两者对骨肉瘤的早期诊断和预后有重要意义.     

原位杂交检测骨肉瘤中MDM2和P^53基因表达及其临床意义

目的从基因水平研究MDM2和P53基因在骨肉瘤中的表达,观察其在骨肉瘤发病中的作用及与临床病理和预后间的关系.方法用地高辛标记原位杂交技术研究40例骨肉瘤MDM2和p53表达,并分析两种基因表达间的相互关系.结果MDM2及p53表达阳性率分别为77.5%(31/40)、67.5%(27/40).MDM2与p53基因表达呈显著正相关(P＜0.05).表达阳性率及表达强度与肿瘤分化程度、转移与否及生存率差异显著(P＜0.05).结论MDM2和P53基因改变是骨肉瘤的常见现象,参与骨肉瘤的发生和发展.其阳性检出率有助于判断骨肉瘤的恶性程度及预测肿瘤的转移及预后.     

Bcl-2和Bax在皮肤血管瘤组织中的表达及意义

目的 探讨Bcl-2和Bax在皮肤血管瘤发生、发展及退化过程中的作用及意义.方法 采用免疫组织化学方法(S-P法)检测人皮肤血管瘤增生期、退化期及正常组织中Bcl-2和Bax的表达水平.结果 Bcl-2在增生期血管瘤内皮细胞的表达明显高于退化期血管瘤内皮细胞和正常皮肤组织血管内皮细胞(P＜0.01);Bcl-2在退化期血管瘤内皮细胞的表达与正常皮肤组织血管内皮细胞相比,差异无统计学意义(P＞0.05).Bax在退化期血管瘤内皮细胞的表达明显高于增生期血管瘤内皮细胞和正常皮肤组织血管内皮细胞(P＜0.01);Bax在增生期血管瘤内皮细胞的表达高于正常皮肤组织血管内皮细胞(P＜0.05).结论 Bcl-2和Bax参与了血管瘤的发生、发展和退化.Bcl-2通过抑制内皮细胞凋亡而促进血管瘤的增生.Bax通过诱导内皮细胞凋亡而促进血管瘤由增生向退化的转变.     

远隔肢体缺血预处理对兔单肺缺血-再灌注损伤细胞凋亡的影响

目的 从细胞凋亡的角度探讨远隔肢体缺血预处理影响兔肺缺血-再灌注(I-R)损伤的可能机制.方法 18只日本大耳白兔随机均分为三组:缺血-再灌注组(I-R组)、肢体缺血预处理组(R组)、假手术组(S组).建立兔在体左肺缺血-再灌注(I-R)损伤模型.通过采用脱氧核苷酸末端转移酶介导的DNA原位末端缺口标记技术(TUNEL)检测再灌注3 h时凋亡指数(AI)的变化,予Westernblotting检测肺组织中Bcl-2、Bax蛋白的表达情况.结果 与S组比较,I-R组肺组织细胞凋亡指数和Bax蛋白显著增高(P＜0.01),而Bcl-2蛋白含量显著降低(P＜0.01),Bcl-2/Bax比值降低(P＜0.05).R组细胞凋亡指数和Bcl-2蛋白表达明显高于I-R组(P＜0.01),而Bax蛋白的含量明显低于I-R组(P＜0.05),Bcl-2/Bax比值增高(P＜0.05).结论 远隔肢体缺血预处理可上调肺组织Bcl-2蛋白,下调Bax蛋白表达,增加Bcl-2/Bax比值,抑制肺组织细胞凋亡,从而对肺缺血-再灌注损伤起到保护作用.     

右美托咪定预处理对内毒素血症大鼠海马区Bcl-2、Bax表达及认知功能的影响

目的 探讨右美托咪定(dexmedetomidine,Dex)预处理对内毒素血症大鼠海马区凋亡蛋白Bcl-2、Bax的表达及认知功能的影响. 方法 健康清洁SD雄性大鼠24只,6周龄,体重200～250 g,采用随机数字表法将其分为3组(每组8只):对照组(C组)、内毒素组(E组)和Dex组(D组).D组腹腔注射Dex 50 μg/kg,30min后尾静脉注射脂多糖(lipopolysaccharide,LPS)5 mg/kg;E组腹腔注射等容量(2ml)生理盐水,30 min后尾静脉注射LPS 5 mg/kg;C组腹腔注射等容量生理盐水,30 min后尾静脉注射等容量生理盐水.各组于给药后12h,用Morris迷宫测试大鼠认知功能的变化,其后处死大鼠,取大脑海马组织.TUNEL法检测组织凋亡指数(apoptosis index,AI),免疫组织化学法分别检测Bcl-2、Bax蛋白的表达.结果 与C组比较,E组和D组潜伏期和游泳总距离增加,穿越平台次数减少(P＜0.05);与C组比较,E组Bcl-2表达差异无统计学意义(P＞0.05),Bax表达上调,Bcl-2/Bax比值降低(P＜0.05);D组Bcl-2和Bax表达上调,Bcl-2/Bax比值升高(P＜0.05).与E组比较,D组AI明显降低,Bcl-2表达上调,Bax表达下调,Bcl-2/Bax升高(P＜0.05). 结论 Dex可以改善内毒素血症大鼠的认知功能,其机制可能与调节Bcl-2和Bax蛋白表达,减轻海马区神经元凋亡有关.     

氯沙坦减少细胞凋亡延缓失神经骨骼肌萎缩的实验研究

目的 失神经骨骼肌萎缩是临床亟待解决的难题,研究旨在探讨氯沙坦能否减少细胞凋亡,以期寻找延缓失神经骨骼肌萎缩的新途径.方法 雄性SD大鼠42只,随机分成3组(n=14),分别为Ⅰ组(对照组)、Ⅱ组(失神经对照组)和Ⅲ组(氯沙坦治疗组).Ⅰ组不作处理,Ⅱ组和Ⅲ组制备失神经腓肠肌(gastrocnemius, GAS)动物模型.术后Ⅲ组大鼠采用氯沙坦以10mg/kg·d空腹灌胃4周;Ⅰ、Ⅱ组大鼠分别以等剂量生理盐水灌胃.术后4周处死大鼠,以GAS和体重(body mass, BM)之比(GAS/BM)作为骨骼肌萎缩指标;TUNEL法检测腓肠肌细胞凋亡;免疫组织化学和Western blot检测GAS Bcl-2及Bax的表达.结果 术后4周Ⅰ组腓肠肌正常粗细;Ⅱ、Ⅲ组腓肠肌明显萎缩,肌肉变细,与周围组织粘连明显.GAS/BM Ⅱ组为11.68 4±1.98,与Ⅰ组(12.86±0.74)比较,差异有统计学意义(P<0.05):Ⅲ组GAS/BM为12.11±0.65;与Ⅱ组比较,差异无统计学意义(P>0.05).TUNEL法检测:Ⅰ组罕见凋亡细胞核,凋亡率为0.56%±0.2l%;Ⅱ组凋亡细胞核较Ⅰ组明显增多,凋亡率为11.32%±4.51%,两组比较差异有统计学意义(P<0.05);Ⅲ组可见凋亡细胞核,凋亡率为7.21%±2.05%,与Ⅱ组比较差异有统计学意义(P<0.05).免疫组织化学染色观察:Bcl-2阳性率Ⅱ组为18.3%±4.9%,较Ⅰ组(27.5%±2.8%)和Ⅲ组(25.5%±3.5%)低,差异均有统计学意义(P<0.05);Ⅲ组与Ⅰ比较,差异无统计学意义(P>0.05);Bax阳性率:Ⅱ组为24.1%±3.1%,较Ⅰ组(22.1%±3.6%)和Ⅲ组(21.7%4±2.3%)高,差异均有统计学意义(P<0.05);Ⅲ组与Ⅰ组比较差异无统计学意义(P>0.05).Ⅰ、Ⅱ及Ⅲ组Bax/Bcl-2平均分别为0.8、1.3及0.8.Western blot检测:Bcl-2蛋白表达Ⅱ组为122.5±14.6,较Ⅰ组(135.3±6.2)下降(P<0.05),Ⅲ组为139.2±16.2,较Ⅱ组增加(P<0.05);Bax蛋白表达Ⅱ组为107.1±15.8,Ⅰ组为89.3±8.4,差异有统计学意义(P<0.05),Ⅲ组为94.2±9.5,较Ⅱ组下降(P<0.05);Bcl-2蛋白和Bax蛋白表达Ⅲ组与Ⅰ组比较,差异均无统计学意义(P>0.05).结论 细胞凋亡在失神经骨骼肌萎缩中发挥重要作用,可能是骨骼肌萎缩的原因之一;氯沙坦可通过抑制肌细胞凋亡延缓大鼠失神经骨骼肌的萎缩.     

Bcl—2和Fas基因在瘢痕成纤维细胞中的表达

目的研究凋亡基因Fas/Apo-1和抑凋亡相关基因Bcl-2在瘢痕形成机制中的作用.方法采用免疫组织化学方法对10例正常皮肤、10例增生性瘢痕及10例瘢痕疙瘩成纤维细胞Fas/Apo-1和Bcl-2蛋白的表达进行检测.Fas蛋白稀释为1∶50;Bcl-2蛋白稀释为1∶40,阴性对照以PBS代替一抗.随机选择五个高倍视野,计算其细胞平均阳性率.结果Bcl-2蛋白在正常皮肤、增生性瘢痕及瘢痕疙瘩中阳性率分别为6.78%、38.6%和83.2%.瘢痕疙瘩、增生性瘢痕的表达阳性率高于正常皮肤,有非常显著性差异(P＜0.01),而瘢痕疙瘩的表达阳性率明显高于增生性瘢痕(P＜0.01).Fas/Apo-1蛋白在正常皮肤、增生性瘢痕及瘢痕疙瘩中阳性率分别为78.4%、80.4%和84.4%,三组间无显著性差异(P＞0.05).结论病理性瘢痕的形成与Bcl-2基因的过度表达有关,而对Fas基因介导的凋亡不敏感或凋亡受阻,亦是导致瘢痕过度增生原因之一.     

PCNA、CD44v6在原发性肝细胞癌的表达及临床意义

目的探讨PCNA、CD44v6在肝细胞癌(HCC)组织的表达及其临床病理意义.方法采用PCNA、CD44v6单克隆抗体,对83例HCC标本进行免疫组化染色.结果PCNA、CD44v6在HCC的阳性率分别为87.95%和53.01%.PCNA在EdmondsonⅠ、Ⅱ、Ⅲ、Ⅳ级的阳性率分别为01).CD44v6在转移组的高表达率为00%,有显著性差异(P＜0.42.86%、89.47%一92.86%、139.29%.明显高于无转移组(10.91%,P＜0.01).CD44v6在包膜完整组和不完整组的阳性率分别为35.42%和77.14%,有显著性差异(P＜0.01).CD44v6阳性病人的生存期明显短于CD44v6阴性病人(P＜0.05).PCNA和CD44v6在HCC的表达呈正相关.结论PCNA、CD44v6有望成为预测HCC发生、发展、转移、预后的生物学指标.     

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.     

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。