肿瘤坏死因子相关凋亡诱导配体治疗肝细胞癌的研究

目的探讨肿瘤坏死因子相关凋亡诱导配体(TRAIL)与其受体在肝细胞肝癌(hepatocellularcarcinoma,HCC)中的表达及意义,及利用TRAIL对HCC的治疗作用。方法采用免疫组化技术及原位杂交方法分别检测了100例肝癌组织,100例癌旁组织,40例正常肝组织中TRAIL及TRAILR的表达,并结合临床资料进行分析;采用不同浓度TRAIL处理肝癌细胞株HepG2、SMMC7721,观察经药物处理前后肿瘤细胞的凋亡发生率。结果TRAIL在正常肝组织中无表达,癌旁组织中的表达明显高于癌组织。86例肝癌组织不表达诱捕受体DcR1(86%),55例肝癌组织不表达诱捕受体DcR2(55%),40例正常肝组织两种诱捕受体均有表达。肝癌组织中死亡受体为高表达,诱捕受体为低表达,正常肝组织则相反,两者间有显著差异性(P<0.05)。肝癌组织中死亡受体的表达与肿瘤的分化呈正相关(P<0.01),与肿瘤分级呈负相关(P<0.05),与病人的性别、年龄、AFP水平、肿瘤的大小以及是否转移无关。经TRAIL(100ng/ml)处理24h,肝癌细胞凋亡发生率约10%,而Jurkat细胞凋亡率达70%以上,胆管癌细胞QBC939凋亡发生率约50%。结论HCC时,TRAILR普遍表达,但存在受体类型的表达差异,其中DcR1大多缺失,这为利用TRAIL治疗HCC提供了理论依据,然而,单一的TRAIL治疗只能有限的诱导肝癌细胞HepG2、SMMC7721发生凋亡,HCC对TRAIL诱导的凋亡存在耐药现象。     

白细胞介素12通过抑制survivin表达加强肿瘤坏死因子相关凋亡诱导配体诱导的肝癌细胞凋亡

目的 探讨肿瘤坏死因子相关凋亡诱导配体(TRAIL)对肝细胞癌(HCC)的治疗作用,以及TRAIL耐药的可能机制和逆转耐药方案。方法 采用原位杂交方法观察HCC与正常肝组织中TRAIL的表达差异。采用不同浓度的sTRAIL(可溶性)处理HCC细胞株及真核表达质粒pIRES-EGFP-sTRAIL转染HCC细胞株,观察sTRAIL的抑癌疗效。建立裸鼠肝癌模型,观察sTRAIL的体内抑癌作用。进一步,检测HCC中survivin的表达并采用反义寡核苷酸封闭治疗。最后,观测sTRAIL和IL-12联合抗癌效果。结果 肝癌组织DR表达量显著强于正常肝组织DR表达量。60例肝癌组织中54例不表达诱捕受体DcRl,25例不表达DcR2,而20例正常肝组织均表达DcR。两种．HCC细胞株中DcR1表达缺失。经sTRAIL(100ng/ml)处理24h,HCC细胞凋亡发生率约10％,而Jurkat细胞凋亡率达70％以上。体外pIRES-EGFP-sTRAIL转染对肝癌细胞杀伤作用不敏感。体内直接瘤体注射pIRES-EGFP-sTRAIL可对裸鼠肝癌无明显抑制作用。HCC高表达survivin,反义寡核苷酸封闭可部分逆转TRAIL耐药。IL-12使survivin表达明显下调,显著加强TRAIL对HCC细胞的杀伤作用。结论 HCC对TRAIL诱导的凋亡有耐药现象。survivin参与HCC对TRAIL的耐药机制,反义寡核苷酸封闭可部分逆转TRAIL耐药。IL-12可通过抑制siurvivin表达增强TRAIL对HCC杀癌作用。联合基因治疗(如TRAIL和IL-12基因)可能成为一种有前途HCC治疗方案。     

肿瘤坏死因子相关诱导凋亡配体受体mRNA在肝癌中的表达及其意义

目的 探讨肿瘤坏死因子相关诱导凋亡配体的4种受体DR4、DR5、DcR1、DcR2在肝细胞癌肝组织中的表达状况。方法 应用半定量逆转录-聚合酶链反应（RT-PCR）方法检测40例人肝细胞癌组织、相应癌旁肝组织、23例正常人肝组织中DR4、DR5、DcR1、DcR2的mRNA表达率及表达水平。结果 （1）40例肝癌组织、癌旁组织、23例正常肝组织DR4、DR5的mRNA的表达水平差异无统计学意义（P〉0．05）；（2）40例癌旁组织、23例正常肝组织DcR1、DcR2表达水平明显高于40例肝癌组织（P〈0．05）；（3）DR4和DR5mRNA在肝细胞癌组织中表达水平与患者的年龄，肿瘤大小，有无包膜，分级程度，AFP水平，HBsAg，有无肝硬化有关系。结论 肝癌组织中存在TRAIL受体的表达，与其在正常肝组织中的表达差异有统计学意义（P〈0．05）；DR4、DR5表达水平与肝癌的病理状况有关系。     

肿瘤坏死因子相关凋亡诱导配体受体在人肝细胞肝癌的原发灶及其门脉癌栓中的表达及意义

目的 探讨肿瘤坏死因子相关凋亡诱导配体(TRAIL)受体DR4、DR5、DcR1、DcR2在人肝细胞肝癌的原发灶及其门脉癌栓中的表达及意义.方法 采用实时荧光定量逆转录-聚合酶链反应(RT-PCR)法,检测20例人肝细胞肝癌的原发灶及其门脉癌栓和20例未发生转移的原发性肝癌组织中TRAIL受体mRNA的表达水平.结果 死亡受体DR4、DB5在无转移的肝癌组织分别为(3.59±0.87)、(1.98±0.54),伴有门脉癌栓的肝癌原发灶组织(分别设定为1)及其门脉癌栓组织中的表达量分别为(0.62±0.28)、(0.31±0.12),呈递减趋势(P<0.05).诱捕受体DcR1、DcR2在伴有门脉癌栓的肝癌组织中的表达量分别为(0.29±0.04)、(0.54±0.08),显著低于无转移的肝癌组织(分别设定为1)(P<0.05).而在伴发PVTT的HCC中,门脉癌栓组织与其肝癌原发灶组织中DcR的表达量差异无统计学意义(P>0.05).DR的表达水平与肿瘤的分化程度(r=0.461,P<0.05)及门静脉浸润情况(r=0.587,P<0.05)呈显著正相关.DR的表达水平与肿瘤的大小及血清甲胎蛋白(AFP)浓度无明显相关(P>0.05).结论 TRAIL死亡受体DR的表达下调可能与肝癌的恶性进展密切相关.TRAIL 途径诱导凋亡在肝癌转移过程中可能起到重要的作用.     

化疗药上调DR4、DR5表达体外逆转人骨肉瘤对TRAIL的耐受

目的研究肿瘤坏死因子相关凋亡诱导配体（TRAIL）与化疗药对人骨肉瘤的联合作用及其受体（TRAILR）在人骨肉瘤中的表达间的关系。方法应用细胞计数、AO／EB染色、流式细胞术等方法比较检测阿霉素、顺铂、甲氨喋呤、紫杉醇单独作用和与TRAIL联合作用于MG-63及骨肉瘤组织的细胞毒效应；应用原位杂交、Western Blot方法检测人骨肉瘤细胞系MG-63及新鲜骨肉瘤组织用药前后TRAILR的表达。结果阿霉素、顺铂和紫杉醇增强死亡受体的表达，且与TRAIL联合作用诱导人骨肉瘤细胞凋亡的效率显著强于单用。结论阿霉素、顺铂、紫杉醇通过上调DR4、DR5表达逆转人骨肉瘤对TRAIL的耐受。     

肿瘤坏死因子相关凋亡诱导配体联合化疗药物杀伤胰腺癌细胞的研究

目的研究肿瘤坏死因子相关凋亡诱导配体以及联合应用亚毒性剂量的化疗药物对胰腺癌的治疗作用。方法半定量 RT-PCR 检测 TRAILR mRNA 在胰腺癌细胞株 Canpan-2中的表达。DNA 琼脂糖凝胶电泳检测细胞凋亡情况。应用不同浓度的 TRAIL 及联合亚毒性剂量的氟尿嘧啶(5-fluorouracil)、吉西他滨(gemcitabin)处理胰腺癌细胞,通过 MTT 法检测细胞毒性作用,流式细胞仪分析细胞凋亡率。结果死亡受体 DR4、DR5及诱骗受体 DcR1、DcR2在胰腺癌细胞株 Canpan-2中均有表达。DNA 琼脂糖凝胶电泳可见到典型的凋亡梯形带。TRAIL100 ng/ml 作用胰腺癌细胞24h 后,细胞杀伤率为(29.5±1.2)%,且其作用存在浓度依赖性;联合应用亚毒性剂量的氟尿嘧啶、吉西化滨能够大大提高TRAIL 的细胞毒活性,杀伤率分别为 TRAIL+氟尿嘧啶(43.7±1.4)%,TRAIL+吉西化滨(49.8±1.2)%,联合用药前后差异有显著性(P<0.01)。结论 TRAIL 受体在胰腺癌细胞普遍表达,并存在受体类型的表达差异;TRAIL 与化疗药物氟尿嘧啶、吉西他滨有协同杀伤胰腺癌细胞的作用。     

肿瘤坏死因子相关凋亡诱导配体受体对肝细胞肝癌的抑制作用

目的 研究肿瘤坏死因子相关凋亡诱导配体受体(TRAIL)对肝细胞肝癌的抑制作用。方法 构建绿色荧光蛋白融合TRAIL质粒,转染肝癌细胞株HepG2、SMMC7721细胞后,分别采用逆转录-聚合酶链反应(RT-PCR)、Western blot检测 TRAIL的表达,采用流式细胞仪检测细胞周期、凋亡,噻唑蓝(MTT)法检测细胞存活率;体内实验建立裸鼠肝癌皮下模型,pIRES-EGFP-TRAIL直接瘤体注射,并观察TRAIL的抑癌作用。结果 真核表达质粒TRAIL体外转染肝癌细胞后,RT-PCR和 Western blot证实了肝癌细胞中有 TRAIL的表达,但对肝癌细胞的生长无显著性的抑制作用。体内直接瘤体注射 pIRES-EGFP-TRAIL 2周,RT-PCR证实瘤体有 TRAIL mRNA强表达,癌旁组织 TRAIL mRNA呈弱表达,正常肝无 TRAIL mRNA表达,但两组间肿瘤大小差异无显著性(P>0.05)。结论 肝细胞肝癌对TRAIL诱导的凋亡有耐药现象,提示HCC中存在抑制TRAIL诱导凋亡的因素,单一的TRAIL治疗HCC疗效有限。     

TRAIL受体在胰腺癌中的表达及意义

目的:研究肿瘤坏死因子相关凋亡诱导配体(TRAIL)受体在胰腺癌中的表达及意义。方法:应用半定量RT-PCR,检测TRAILR mRNA在胰腺癌组织,正常胰腺组织及胰腺癌细胞系ASPC-1、Can-pan-2中的表达。结果:死亡受体DR4、DR5在所有胰腺癌组织、正常胰腺组织及胰腺癌细胞系中均有表达,诱骗受体DcR1、DcR2在所有正常胰腺组织及细胞系中均有表达。死亡受体DR4、DR5在胰腺癌组织中有较高的表达,而在正常胰腺组织中呈中低水平表达(P<0.01)。胰腺癌细胞系中死亡受体DR4、DR5呈高水平表达,而诱骗受体DcR1、DcR2仅呈中低水平表达。结论:TRAIL受体在胰腺癌普遍表达,并存在受体类型的表达差异;死亡受体在胰腺癌中高表达,可能在TRAIL诱导胰腺癌细胞凋亡的机制中发挥重要的作用。     

术前化疗对DNA修复酶hOGG1在肝癌组织中表达的影响

目的通过检测DNA修复酶hOGG1在肝癌及癌旁组织中的表达,探讨术前化疗对DNA损伤修复机制的影响。方法应用免疫组化法检测138例(术前未做化疗患者72例和术前行经肝动脉插管化疗患者66例)肝癌患者的肝癌组织和癌旁组织中hOGG1的表达。结果正常肝组织hOGG1蛋白表达阳性率为53·33%(16/30),术前化疗组肝癌组织hOGG1蛋白的阳性率为75·76%(50/66),术前未化疗组的肝癌组织阳性率为59·72%(43/72),三者之间差异有统计学意义(χ2=4·8297,χ2=4·0292,均P<0·05);在术前化疗组中,肝癌组织中的hOGG1蛋白表达率为75·76%,癌旁组织为57·58%(38/66)(χ2=4·9091;P<0·05)。结论化疗药物可能上调肝癌组织对DNA损伤的修复能力,hOGG1蛋白表达不仅能反映肝细胞内DNA修复能力,还可能成为评价化疗药物所致的氧化应激反应的指标。     

原发性肝癌及其癌旁组织、Bel-7402人肝癌细胞株生长激素受体的定量研究

目的定量测定原发性肝癌(HCC)及其癌旁组织、国内常用Bel-7402人肝癌细胞株生长激素受体(GHR)的表达水平,探讨重组人生长激素(rhGH)在原发性肝癌患者中的适用性。方法采用放射配体分析法对45例原发性肝癌组织及其癌旁组织、8例正常肝组织、Bel-7402人肝癌细胞株进行GHR的检测,肝组织及肝癌细胞的GHR受体最大结合量(RT)采用Scatchard法计算;并分析肝癌组织GHR的表达量与肝癌患者各临床病理参数的关系。结果在38例HCC组织与45例癌旁组织,以及7402肝癌细胞株均检测到GHR的存在,GHR受体结合容量(RT)在有GHR表达的肝癌组织为(19.673 00±3.876 6)fmol/mg蛋白,癌旁组织GHR的RT值为(33.628 3±3.621 8)fmol/mg蛋白,GHR在7402肝癌细胞位点数量(Site,103/cell)为7.348±0.891;同正常肝组织相比,肝癌与癌旁组织GHR的表达量均降低(P<0.05),肝癌组织GHR的表达量又低于癌旁组织;肝癌组织GHR的表达量与肿瘤大小、患者临床分期的延迟呈负相关,而与肿瘤分化程度、患者年龄、是否合并肝硬化无关;有7例肝癌组织未检测到GHR存在。结论大多数原发性肝癌组织及全部癌旁组织均表达一定水平的GHR,在它们受体功能未明的情况下,rhGH在肝癌患者中的应用可能需慎重。     

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。