肾透明细胞癌组织中泛素连接酶Pirh2蛋白的表达及其临床意义

目的 探讨肾透明细胞癌组织中泛素连接酶Pirh2蛋白(p53-induced RING-H2 protein,Pirh2)的表达及与临床病理特征和预后的关系. 方法 肾透明细胞癌标本92例,G1 29例、G2 36例、G3 24例、G4 3例,T1 55例、T2 16例、T3 20例、T4 1例;正常肾组织标本20例作为对照组.采用免疫组织化学方法检测两组标本组织中Pirh2蛋白的表达,并结合临床资料进行分析. 结果 正常肾组织中Pirh2蛋白表达率为20.0％ (4/20),肿瘤组织为52.2％(48/92),且随组织病理分级和分期增加,Pirh2蛋白表达量逐渐增高.Pirh2蛋白在G1、G2、G3、G4组织中的高表达阳性率分别为24.1％、30.6％、75.0％和66.7％,T1、T2、T3、T4期肿瘤组织中高表达阳性率分别为25.5％、50.0％、75.0％和100.0％,分级间分期间差异有统计学意义(P=0.001).随访7～70个月,平均42个月,复发10例,复发组与未复发组中 Pirh2蛋白高表达阳性率分别为80.0％和36.6％,差异有统计学意义(P=0.022).Kaplan-Meier曲线显示,Pirh2蛋白高表达组与低表达组患者术后总生存率(71.1％与94.4％)和无复发生存率(78.9％与96.3％)比较,差异均有统计学意义(P＜0.01). 结论 Pirh2蛋白高表达与肾透明细胞癌的恶性程度及预后相关,Pirh2与肾透明细胞癌的发生和发展存在相关性.     

MMP-9、Bcl-2、VEGF在肾细胞癌中的表达及意义

目的通过检测MMP-9、Bcl-2及血管内皮生长因子(VEGF)在肾细胞癌中的表达,探讨它们在肾细胞癌的发生、发展和转移中的作用及其相互之间的关系。方法用免疫组织化学方法检测68例肾细胞癌石蜡标本中MMP-9、Bcl-2和VEGF的蛋白表达情况,并进行统计学分析。结果在正常肾组织和肾细胞癌中MMP-9、Bcl-2和VEGF的表达有显著性差异(P0.05)。MMP-9、Bcl-2的阳性表达与肾细胞癌病理分级、临床分期之间无显著性差异(P0.05)。VEGF阳性表达率随病理分级、临床分期的升高而升高。VEGF在病理分级Ⅰ与Ⅱ和Ⅰ与Ⅲ之间的表达有显著性差异(P0.05),在临床分期中,早期与晚期有显著性差异(P0.05)。MMP-9和VEGF表达率在淋巴结转移阳性组显著高于淋巴结阴性组。结论 MMP-9、Bcl-2和VEGF在肾细胞癌的形成过程中可能起作用。MMP-9很可能与肾细胞癌的侵袭和转移密切相关,VEGF可作为判断肾细胞癌淋巴结转移和临床预后的生物学指标。     

肾细胞癌中Mina53的表达及其与临床病理及预后的关系

目的 探讨肾细胞癌组织中Mina53的表达水平及其与临床病理及预后的关系.方法 采用RT-PCR技术测定96例肾细胞癌组织及20例癌旁正常肾组织中Mina53的表达,免疫组化法测定其蛋白水平的表达,分析其结果与临床病理及预后的关系.结果 Mina53平均模板量在肾细胞癌组织中的表达明显高于正常肾组织的表达(P＜0.01),且在Ⅲ期、Ⅳ期肾细胞癌组织中的表达明显高于Ⅰ期、Ⅱ期的表达水平(P＜0.01),Mina53蛋白在肾细胞癌组织中的表达水平明显高于其在正常肾组织的表达水平(P＜0.01);Mina53高表达者的预后较低表达者明显要差(P＜0.01).结论 Mina53基因及蛋白的高表达与肾细胞癌临床病理分期有关,其表达水平越高,预后越差,Mina53有望成为预后判断的新指标.     

CyclinD1在肾细胞癌中的表达及其意义

目的探讨细胞周期蛋白D1（CyclinD1）在肾细胞癌中的表达及其意义。方法采用免疫组织化学技术,检测60例。肾细胞癌患者中肾癌组织及癌旁肾组织中CyclinD1的表达,并对Cyclin D1的表达与临床病理参数的关系进行分析。结果CyclinD1在肾细胞癌组织中的阳性率为83．3％,而癌旁肾组织中的阳性率为6．6％,两者具有显著性差异（P〈0．05）。Cyclin D1在肾细胞癌组织中的表达在不同性别、年龄、肿瘤体积组无显著差异（P〉0．05）。结论CyclinD1可作为判断肾细胞癌分化程度的标志物。     

肾透明细胞癌中c-FLIP mRNA表达及临床意义

目的探讨细胞型Fas相关死亡域样白介素-1β转换酶抑制蛋白（c-FLIP）在肾透明细胞癌中的表达及其临床意义。方法采用免疫组织化学及RT-PCR方法对56例肾透明细胞癌组织及10例癌旁正常肾组织中c-FLIP蛋白及c-FLIP mRNA表达进行分析,观察c-FLIP mRNA表达与临床分期及预后之间的关系。结果c-FLIP蛋白及c-FLIP mRNA在肾透明细胞癌组织中呈高表达（P〈0.05）,其表达与肾透明细胞癌的临床分期无关,但阳性表达患者的生存率低于阴性表达者（P〈0.05）。结论肾透明细胞癌组织中c-FLIP mRNA表达较高,特异性较强,可作为观察肾透明细胞癌预后的重要指标之一。     

LGL/Hugl-1在肾细胞癌及癌旁肾组织中的表达及其意义

目的 探讨肾细胞癌、癌旁肾组织中LGL( lethal giant larvae)/Hugl-1基因的表达水平及临床意义.方法 采用实时荧光定量聚合酶链反应(Real-time PCR法)方法检测肾细胞癌组织及癌旁组织各30例中LGL/Hugl-1基因的表达,同时应用统计学方法评价在肾细胞癌不同临床阶段LGL/Hugl-1基因表达的差异.结果 LGL/Hugl-1在肾细胞癌组织中平均表达(LGL/Hugl-1和18s的比值)为0.00018±0.00021,而癌旁组织中该值为0.00004±0.00003,差异有统计学意义(P＜0.05);LGL/Hugl-1基因在80.0％ (24/30)的肾细胞癌组织中表达升高,其中升高超过2倍的病例为73.3％ (22/30);LGL/Hugl-1在癌旁与肾癌的表达比值在临床分期(Ⅰ+Ⅱ)期中平均为7.2±8.7,而在(Ⅲ+Ⅳ)期中为8.9±11.1,差异无统计学意义(P＞0.05).结论 LGL/Hugl-1基因在肾细胞癌组织中表达明显高于癌旁组织.LGL/Hugl-1基因在肾细胞癌组织与癌旁组织中的表达差异与临床分期无关.肾细胞癌的发生、发展可能与LGL/Hugl-1基因有关.     

Fascin蛋白在肾细胞癌中的表达及临床意义

目的观察Fascin蛋白在肾细胞癌中的表达情况,并探讨其表达与肿瘤生物学行为及临床病理指标的关系。方法用免疫组织化学方法检测109例肾细胞癌组织、20例肾脏良性肿瘤和20例正常肾脏组织中Fascin蛋白和Ki-67的表达,分析Fascin蛋白表达与不同临床病理指标及Ki-67表达之间的关系。结果109例肾细胞癌中有58例（53．2％）Fascin蛋白呈阳性表达,20例肾脏良性肿瘤和20例正常肾脏组织中的阳性表达例数分别为2例（10．0%）和0例（0%）,肾细胞癌中Fascin蛋白表达与肾脏良性肿瘤和正常肾脏组织中Fascin蛋白表达比较差异均有统计学意义（均P〈0．01）。肾细胞癌组织中Fascin蛋白表达与肿瘤组织学分级、临床分期、淋巴结转移以及Ki-67表达均呈正相关（均P〈0．01）;与肿瘤组织学分类无相关性（P〉0．05）。结论Fascin蛋白在肾细胞癌中表达上调且和肿瘤的恶性程度及侵袭行为有关。Fascin蛋白表达与病理分级和临床分期结合能够更好地判断肾细胞癌的预后,且其有可能成为肾细胞癌治疗的一个新靶点。     

基质金属蛋白酶-9和脆性组氨酸三联体基因在人类膀胱移行细胞癌中的表达及其意义

目的 探讨基质金属蛋白酶-9(MMP-9)和脆性组氨酸三联体基因(FHIT)在膀胱移行细胞癌组织中的表达、相互关系和临床意义.方法 采用免疫组织化学链霉菌抗生物素蛋白-过氧化物酶(SP)法观察50例膀胱移行细胞癌石蜡标本和10例正常膀胱组织中MMP-9和FHIT的表达.结果 50例膀胱癌组织中的FHIT和MMP-9的阳性表达率分别为58.0％和52.0％,与正常膀胱组织中的表达比较差异有统计学意义(P＜0.05和P ＜0.01).FHIT和MMP-9的表达与膀胱移行细胞癌的临床分期、病理分级和肿瘤的复发相关;肿瘤组织中的FHIT与MMP-9的表达呈负相关(r=-0.412,P＜0.01).结论 膀胱癌组织中FHIT和MMP-9的表达在肿瘤进展中发挥重要作用.     

应用组织芯片技术检测KiSS-1基因在胆囊癌中的表达

目的 探讨转移抑制基因KISS-1在人胆囊癌转移过程中的作用及临床意义.方法 应用组织芯片和免疫组织化学(EnVision)技术检测KISS-1在59例胆囊癌(其中肝脏侵犯13例,淋巴结转移13例)、7例癌旁和6例正常胆囊组织中的表达.结果 胆囊癌组织中KISS-1的表达阳性率明显低于正常和癌旁组织(P<0.05).在胆囊癌中,KISS-1阳性表达与患者性别、年龄,肿瘤大小、组织学类型、分化程度及淋巴结转移均无关,而与胆囊癌的浸润深度、肝脏侵犯及临床分期(Nevin分期)有关(P<0.01).KISS-1在Ⅰ Ⅱ期和Ⅲ Ⅳ期以及V期胆囊癌组织中的表达阳性率分别为92.3%、57.1%和27.8%,呈明显下降趋势(P=0.002).结论 KISS-1的表达降低与人胆囊癌的发生及其侵袭、转移过程密切相关,可能参与了胆囊癌的发生、侵袭及转移过程的调控.     

肾透明细胞癌组织中T细胞淋巴瘤侵袭和转移诱导蛋白1表达及其临床意义

目的 探讨肾透明细胞癌组织中T细胞淋巴瘤侵袭和转移诱导蛋白l( T-lymphomainvasion and metastasis 1,Tiam1)的表达与临床病理特征及预后的关系. 方法 选取原发性肾透明细胞癌组织标本107例.男78例,女29例.年龄32～87岁,平均59岁.肿瘤大小按手术切除标本测量.肿瘤最大径1.4～7.6 cm,平均4.5 cm.≤2.5 cm者23例,2.6 ～5.0 cm者65例,＞5.0 cm者19例.有淋巴结转移者46例,有血管浸润者32例.Fuhrman分级:Ⅰ级22例,Ⅱ级41例,Ⅲ级27例,Ⅳ级17例.2002 AJCC TNM分期:T129例,T244例,T3 16例,T4 18例.20例正常肾组织标本作为对照组.免疫组织化学方法检测标本中Tiam1蛋白表达,结合临床病理学资料进行分析.随访5～8年,生存分析采用Kaplan-Meier法,组间差异采用Log-rank检验. 结果 20例正常肾组织中Tiam1蛋白阳性表达率为15.0％ (3/20),肿瘤组织中Tiam1蛋白阳性表达率为73.8％ (79/107),组间差异有统计学意义(P＜0.01);Ⅰ～Ⅱ级与Ⅲ～Ⅳ级肾癌组织中Tiam1蛋白高表达阳性率分别为47.6％( 30/63)、72.7％( 32/44),T1～T2期与T3 ～T4期肾癌组织分别为49.3％(36/73)、76.5％ (26/34),无淋巴结转移组与有淋巴结转移组分别为47.5％ (29/61)、71.7％ (33/46),无血管浸润组与有血管浸润组分别为48.0％(36/75)、81.3％(26/32),组间差异均有统计学意义(P＜0.01).Tiam1蛋白高表达组与低表达组患者术后5年生存率分别为46.8％(29/62)、84.4％( 38/45),组间差异有统计学意义(P＜0.05). 结论 肾癌组织中Tiam1蛋白阳性表达率明显高于正常组织,Tiam1蛋白高表达与肾癌的分期、分级、淋巴结转移、血管浸润有关,与患者性别、年龄、肿瘤大小无相关性.检测Tiam1蛋白有助于肾癌的诊断及预后评估.     

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