乳腺癌组织中血管内皮生长因子mRNA的表达和微血管计数与淋巴结转移的关系

目的：探讨乳腺癌组织中血管内皮生长因子（VEGF）mRNA的表达，微血管密度（MVD）与淋巴结转移的关系。方法：采用逆转录－聚合酶链反应（RT－PCR）和免疫组织化学链霉卵白素－过氧化物酶（SP）法技术，对47例乳腺癌组织VEGF mRNA、VEGF蛋白的表达及微血管密度进行研究。结果：乳腺癌组织VEGF mRNA的表达高于癌旁组织（55．30％：17．02％）。VEGF mRNA的表达与淋巴结转移呈正相关趋势。VEGF表达和MVD与乳腺癌淋巴结转移密切相关（P＜0．05）。癌组织MVD值明显高于癌旁组织MVD值。结论：VEGF与乳腺癌血管生成密切相关，VEGF和MVD表达增高对乳腺癌淋巴结转移有促进作用。     

肾细胞癌血管内皮生长因子及微血管密度的免疫组化研究

目的　探讨血管内皮生长因子（VEGF）和微血管生成与肾癌发展的关系。　方法　应用免疫组化技术检测46例肿瘤组织中的VEGF。　结果　46例肿瘤组织中VEGF阳性表达28例 (60.8%)、微血管密度（MVD）为63.64±33.20,均显著高于正常组织。VEGF、MVD与肿瘤的组织类型无关（P＞0.05),与肿瘤的组织学分级有关（P＜0.05);VEGF阳性组MVD明显高于阴性组(P＜0.05);有淋巴结转移组VEGF、MVD均高于无淋巴结转移组(P＜0.05);VEGF阳性组术后5年复发转移率明显高于阴性组（P＜0.01)。　结论　VEGF与肾癌的血管生成有关,VEGF和MVD可作为反映肾细胞癌生物学行为的指标之一。     

骨桥蛋白及其相关因子在乳腺癌组织中的表达及其临床意义

目的检测骨桥蛋白（OPN）、乳腺肿瘤激酶（Brk）和血管内皮生长因子（VEGF）在乳腺癌组织、癌旁近端非癌乳腺组织及癌旁远端正常乳腺组织中表达的差异并分析其临床意义。方法采用免疫组织化学方法检测40例乳腺癌组织、癌旁近端（2 cm）非癌乳腺组织及癌旁远端（〉5 cm）正常乳腺组织中OPN、Brk和VEGF的表达情况。结果①OPN、Brk和VEGF蛋白在乳腺癌组织中的表达阳性率均明显高于其在癌旁近端非癌乳腺组织和癌旁远端正常乳腺组织中的表达（P〈0.01）,Brk在癌旁近端非癌乳腺组织中的表达明显高于其在癌旁远端正常乳腺组织中的表达（P〈0.05）,而OPN、VEGF在癌旁近端非癌乳腺组织中和癌旁远端正常乳腺组织中的表达差异均无统计学意义（P〉0.05）。②OPN和Brk蛋白表达与患者年龄、肿瘤直径及组织学分级均无关（P〉0.05）,与淋巴结转移及TNM分期有关（P〈0.05）;VEGF与患者年龄及肿瘤直径无关（P〉0.05）,与组织学分级、淋巴结转移及TNM分期有关（P〈0.05）。③在乳腺癌组织中OPN、Brk和VEGF表达之间两两呈正相关性（P〈0.05）,在癌旁近端非癌乳腺组织和癌旁远端正常乳腺组织中OPN、Brk和VEGF表达之间均无明显相关性（P〉0.05）。结论位于同一信号传导通路上的OPN、Brk在癌旁远端正常乳腺组织、癌旁近端非癌乳腺组织和乳腺癌组织中的表达依次递增。OPN可能通过VEGF、Brk刺激内皮细胞黏附和迁移而加速血管修复,通过参与肿瘤血管生成与肿瘤的侵袭与转移有关。     

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.     

血管内皮生长因子在直肠癌中的表达与临床意义

目的：探讨血管内皮细胞生长因子在直肠癌中的表达及临床意义。方法：应用免疫组化S－P法，检测124例病人直肠癌组织中血管内皮细胞生长因子（VEGF）蛋白表达和微血管密度（MVD），分析VEGF和MVD及其与直肠癌组织学分型、Dukes分期，癌肿浸润转移的关系。结果：VEGF表达强度和MVD与直肠癌的Dukes分期（P＜0．05）、淋巴结转移（P＜0．05）及远处转移（P＜0．01）密切相关，而与组织学分型无关（P＞0．05），MVD与VEGF表达两者呈达相关（r=0.89)。结论：VEGF与直肠癌的血管生成密切相关，对直肠癌的生长和浸润转移有促进作用，VEGF和MVD可作为反映直肠癌生长学行为的指标之一。     

EGFL7和VEGF在肾透明细胞癌血管生成及转移中的相关性研究及临床意义

目的：探讨表皮生长因子样结构域7（EGF_1ikedomain7,EGFL7）、血管表皮生长因子（vascularen—dothelialgrowthfactor,VEGF）在肾透明细胞癌中的表达及其与肾癌血管生成和转移的关系。方法：选取87例行根治性肾切除的肾透明细胞癌患者癌及癌旁组织标本,采用免疫化学SP法检测EGFL7、VEGF的表达,并计数血管内皮细胞表面抗原（CD34）标记的血管密度（MVD）;同时选取46例癌及癌旁组织标本,采用RT—PCR检测EGFL7mRNA的表达。结果：EGFL7和VEGF阳性表达率及MVD值在癌组明显高于癌旁组（P〈O．05）,且EGFL7、VEGF与MVD在肾透明细胞癌组织中的表达呈正相关,并与肿瘤分级、分期显著相关（P〈0．05）;EG—FL7mRNA阳性表达率明显高于癌旁组织（P〈O．05）,并与肿瘤分级、分期相关（P〈O．05）。结论：肾透明细胞癌组织中EGFL7、VEGF的表达与肾癌血管生成有关,两者可能协同肿瘤新生血管的生成。     

CD146与VEGF在人肝细胞癌组织中的表达及其临床意义

目的 该研究旨在观察人肝细胞癌(hepatocellular carcinoma,HCC)组织中CD146与VEGF的表达及其关系,探讨它们在HCC中与血管生成的关系及其临床意义.方法 采用免疫组化法检测60例HCC癌组织及癌旁肝组织中CD146、VEGF的表达情况,用CD34标记免疫组化法检测微血管密度(microvessel density,MVD),分析它们的表达与临床病理指标的关系.结果 CD146、VEGF在癌组织中的阳性率分别为66.67%和63.33%,而在癌旁组织中的阳性率分别为30%和33.33%,癌组织与癌旁组织比较差异有显著性(P＜0.05).癌组织的MVD为54.92±8.55/200倍视野,癌旁组织的MVD为21.36±6.63/200倍视野,两者差异有显著性(P＜0.05).与癌旁组织相比,癌组织中CD146、VEGF表达及MVD明显增加.CD146在人肝癌组织中的表达与临床分期、门静脉癌栓及肝外转移明显有关,而与术后复发、肿瘤个数、肿瘤直径、血清AFP水平及肿瘤分化程度无明显关系.VEGF在人肝癌组织中的表达与术后复发、肝外转移、临床分期、门静脉癌栓、肿瘤直径相关,而与肿瘤个数、血清AFP水平及肿瘤分化程度无明显关系.在癌组织中MVD与CD146、VEGF的表达呈正相关,CD146与VEGF亦呈正相关.结论 肝癌组织中CD146及VEGF高表达,与肿瘤血管形成和转移密切相关,分析它们的表达有助于综合判断HCC的预后.     

促血管生成素家族在大肠腺癌中的表达及与微血管密度和临床病理特征的关系

目的 探讨促血管生成素-1（Ang-1）、促血管生成素-2（Ang-2）、促血管生成素受体（Tie-2）及血管内皮生长因子（VEGF）在大肠腺癌及癌旁正常组织中的表达，及与微血管密度（MVD）和临床病理特征的关系。方法 采用免疫组织化学方法检测Ang-1、Ang-2、Tie-2及VEGF在45例大肠腺癌及10例癌旁正常组织中的表达。结果 大肠腺癌组织中的Ang-2蛋白及VEGF蛋白明显高于癌旁正常组织（P〈0．01），腺癌的分化程度越低，Ang-2及VEGF蛋白的表达率越高（P〈0．05），Ang-2与VEGF蛋白的表达存在明显正相关性（r=0．997，P〈0．01）；大肠腺癌组织中的Ang-1蛋白明显低于癌旁正常组织（P〈0．01），腺癌的分化程度越高，Ang-1蛋白的表达率越高（P〈0．05）；Tie-2蛋白在大肠腺癌和癌旁正常组织中的表达差异无统计学意义（P〉0．05）。大肠腺癌的分化程度越低，MVD越高（P〈0．05），腺癌组织中Ang-1蛋白阳性表达组MVD明显低于阴性表达组（P〈0．01），Ang-2蛋白阳性表达组MVD明显高于阴性表达组（P〈0．01）。≥5cm及有淋巴结转移的大肠腺癌组织中，Ang-2蛋白的表达明显增加（x^2=8．889，P〈0．01；x^2=10．020，P〈0．01）。结论 在大肠腺癌组织中，相对Ang-1占优势的Ang-2的过度表达，可能在肿瘤的血管生成和进展过程中起着重要作用。     

血小板内波衍生因子在乳腺癌中的表达和临床意义

目的：探讨血小板内波衍生因子（PDGF）在乳腺癌中的表达及与肿瘤血管生成，转移和预后的关系。方法：采用免疫组织化学方法检测60例乳腺癌组织中DGF表达和微血管密度（MVD）分布。结果：乳腺癌中PDGF表达阳性率为65．0％，PDGF表达与组织学分级，临床分期，淋巴结转移，远处转移，早期死亡密切相关（P＜0．05），与MVD有显著性相关（P＜0．05）。与肿瘤大小，ER、PR无关（P＞0．05）。结论：PDGF在乳腺癌血管生成中具有重要作用，PDGF阳性的乳腺癌易发生转移，预后不良。     

TP、HIF-1α、VEGF在乳腺癌中的表达及与血管生成关系的研究

目的:探讨TP、HIF-1α、VEGF在乳腺癌中的表达及其与血管生成关系.方法:免疫组化法检测15例正常乳腺组织标本和37例浸润性乳腺癌组织中HIF-1α、VEGF、TP的表达情况,同时以CD34为标记检测微血管密度(MVD).结果:乳腺癌组织中TP、HIF-1α、VEGF均存在高表达,与正常乳腺组织相比,差异具有显著性.TP、HIF-1α、VEGF表达阳性组的MVD值明显高于表达阴性组(P＜0.01).HIF-1α表达与VEGF呈正相关(rs＝0.357,P＜0.05),且HIF-1α阳性组TP表达明显高于阴性组(t﹦9.778,P＜0.01),随HIF-1α与VEGF表达的增加,TP逐渐增高.TP、HIF-1α、VEGF表达与乳腺癌有无淋巴结转移及组织学分级均呈正相关.结论:TP、HIF-1α、VEGF在乳腺癌组织存在高表达,并与肿瘤血管生成有关.     

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。