Survivin蛋白在肝门部胆管癌中的表达及其与p53相关性的研究

目的：检测肝门部胆管癌中凋亡抑制因子Survivin蛋白的表达，研究其与肝门部胆管癌的临床特征的关系，并探讨其与p53的相关性。方法：采用免疫组织化学方法检测86例肝门部胆管癌组织、10例癌旁组织（距肿瘤边缘约1．0cm）及10例正常胆管组织中Survivin蛋白和p53蛋白的表达，结合临床病理学资料进行统计学分析。结果：86例肝门部胆管癌组织中，Survivin蛋白阳性率为82．6％（71／86），p53蛋白阳性率为76．7％（66，86），Survivin与p53在癌旁组织和正常胆管组织中均呈阴性表达，与癌组织相比差异有统计学意义（P〈O．05）；Survivin表达与肝门部胆管癌病理分级、Bismuth分型、患者的性别及年龄和肿瘤大小均无关（P〉0．05），但淋巴结转移阳性组Survivin蛋白表达水平明显高于淋巴结转移阴性组，差异有统计学意义（P〈0．05）；p53蛋白在肝门部胆管癌中与肿瘤组织病理分级、淋巴结有无转移相关（P〈0．05），与其他病理学特征无关（P〉O．05）。71例Survivin阳性表达者中同时表达p53阳性者58例，15例阴性表达者中表达p53阳性者8例，两者差异有统计学意义（P〈0．05）。结论：肝门部胆管癌组织中Survivin和p53的表达显著高于癌旁组织和正常胆管组织，其在肝门部胆管癌的发展、转移过程中可能具有重要作用。     

Survivin蛋白在肝外胆管癌组织中的表达及其与预后的关系

目的 观察Survivin蛋白在肝外胆管癌组织中的表达,探讨Survivin蛋白表达水平与肝外胆管癌临床病理特征的相关性,研究Survivin蛋白表达与肝外胆管癌预后的关系.方法 采用免疫组化法检测59例肝外胆管癌组织和相应的20例癌旁组织中Survivin蛋白的表达,分析肝外胆管癌组织中Survivin蛋白的表达水平与患者临床病理特征、淋巴结转移的关系及其与预后的关系.结果 肝外胆管癌组织Survivin蛋白表达阳性率为67.8%(40/59),而癌旁组织为20.O%(4/20),二者有明显差别(P<0.01).Survivin蛋白表达水平与分化程度呈负相关(P<0.01),与TNM分期、淋巴管浸润、神经浸润和淋巴结转移旱正相关(P<0.05).Survivin蛋白表达阳性组血清CA19-9的水平为(290 300±55 500)U/L,阴性组为(113 300±31 400)U/L,Survivin蛋白阳性表达组高于阴性表达组(P<0.05).Survivin蛋白表达阴性组和阳性组平均生存期分别为43.5个月和21.1个月,差异有统计学意义(P<0.01).多因素生存分析结果显示,Survivin蛋白、癌残留及淋巴结转移是肝外胆管癌独立的预后因素(P<0.05,P<0.01,P<0.01).结论 Survivin蛋白表达水平与分化程度呈负相关,与淋巴浸润和血清CA19-9浓度呈正相关.Survivin蛋白表达水平为肝外胆管癌根治术后独立的预后因素.     

Survivin基因在胆管癌组织中的表达及其与bcl-2和bax相关性

目的 探讨Survivin基因在胆管癌组织中的表达以及与bel-2和bax基因表达的相关性.方法 应用逆转录-聚合酶链反应(RT-PCR)法检测Survivin mRNA在64例胆管癌,22例癌旁组织及10例正常胆管组织中的表达,免疫组织化学方法测定胆管癌组织中bcl-2和bax蛋白的表达.结果 胆管癌组织中Survivin基因阳性表达率65.6%(42/64),显著高于其在癌旁组织(9.1%,P<0.01)和正常胆管(0%,P<0.01)中的表达;Survivin基因表达与胆管癌的性别、年龄、部位、分化程度、临床分期及淋巴结转移无明显相关(P>0.05).bcl-2和bax在胆管癌组织中的表达率分别为56.3%(36/64)N45.3%(29/64),Survivin基因表达与bcl-2表达正相关(r=0.404,P<0.01),与bax表达负相关(r=-0.373,P<0.01).结论 Survivin基因在胆管癌的发生、发展过程中可能起重要作用;Survivin有可能成为胆管癌基因治疗的新靶点;在胆管癌的发展中,Survivin与bel-2和bax分别起协同和拮抗作用.     

人肝细胞癌中nm23表达的研究

目的:研究转移抑制基因nm23mRNA在人肝细胞癌中的表达及其意义.方法:应用分子杂交及RT-PCR方法对30例人肝细胞癌中nm23表达进行研究.结果:Northern blot结果表明,阳性带位于0.8Kb处;癌组织、癌旁组织中nm23的表达结果显示:癌组织中有19例表达,癌周肝组织中有3例表达.nm23在肝细胞癌组织中的表达明显高于癌周肝组织(P0.05).结论:nm23基因可能在肝癌形成及转移过程中起调节作用.     

Survivin和C-myc在肝门部胆管癌组织中的表达及其相关性研究

目的：探讨Survivin和C-myc在肝门部胆管癌中的表达、临床意义及相互关系。方法：用免疫组织化学SP法检测45例肝门部胆管癌及20例非癌胆管组织中Survivin和C-myc的表达。结果：45例肝门部胆管癌组织中Survivin和C-myc的表达率分别为68.9%（31/45）和62.2%（28/45）,非癌胆管组织中Survivin和C-myc的表达率分别为0和15%（3/20）,差异有统计学意义（P〈0.05）。肝门部胆管癌组织中Survivin的表达与淋巴结转移有关（P〈0.05）,C-myc的表达与肿瘤分化程度和淋巴结转移有关（P〈0.05）,它们的表达与患者的性别、年龄,肿瘤大小及Bismuth分型无关（P〉0.05）。Survivin、C-myc的表达呈正相关关系（P〈0.05）。结论：Survivin、C-myc在肝门部胆管癌中的表达呈正相关关系,共同在肝门部胆管癌的发生、发展、转移中起一定作用,Survivin有望成为肝门部胆管癌治疗的新靶点。     

Survivin和nm23H1及PTEN蛋白在胆囊癌组织中的表达及其相关性研究

目的:探讨Survivin(SVV)和nm23H1及PTEN蛋白在原发性胆囊癌组织中的表达与癌组织类型、病理分级和转移状况的关系,以及SVV与nm23H1和PTEN表达之间的相关性。方法:应用免疫组化方法检测52例胆囊腺癌、20例胆囊腺瘤和20例慢性胆囊炎组织中SVV、nm23H1和PTEN表达水平。结果:在胆囊癌中SVV、nm23H1和PTEN表达阳性率分别为67.3%,51.9%和42.3%。SVV高表达和nm23H1及PTEN低表达与胆囊癌的分化程度、浆膜浸润和转移密切相关(P<0.05)。SVV表达与nm23H1和PTEN蛋白表达呈负相关(P<0.05)。结论:检测SVV和nm23H1及PTEN基因蛋白表达可作为评价胆囊癌生物学行为的参考指标。     

Survivin在胆管癌中的表达

目的　探讨Survivin基因表达与胆管癌发生发展的关系。方法　应用免疫组织化学技术 (SP法 )检测Survivin基因在 3 3例胆管癌标本、2 8例癌旁胆管组织和 5例胆管良性病变标本中的表达。结果　 3 3例胆管癌组织中Survivin阳性表达率为 72 .7% ( 2 4/3 3 ) ;在癌旁胆管组织和胆管良性病变组织中未检测到Survivin的表达 ,胆管癌组织、癌旁胆管组织、胆管良性病变组织之间的Survivin基因的表达差异有非常显著性 (P <0 .0 1)。Survivin基因的表达与患者的性别、年龄、肿瘤的大小、分化及是否转移无关。结论　Survivin在胆管癌中高度表达可能与胆管癌的发生发展有关 ,与预后的关系有待进一步的探讨。     

错配修复基因hMLH1,hMSH2在肝门部胆管癌中的表达和意义

目的 检测肝门部胆管癌中错配修复基因hMLH1,hMSH2失表达情况,研究其与肝门部胆管癌临床特征的关系,并探讨其与预后的相关性.方法 用免疫组织化学技术检测54例肝门部胆管癌组织、25例正常胆管中hMLH1,hMSH2表达,结合临床病理学资料及随访统计资料进行统计学处理分析.结果 (1)在54例肝门部胆管癌组织中,hMLH1蛋白阳性表达24例,其阳性率44.4%;25例正常胆管组织中,hMLH1蛋白阳性表达23例,其阳性率92.0%;hMSH2蛋白癌组织阳性表达21例,其阳性率38.9%;hMSH2蛋白在正常胆管组织阳性表达21例,其阳性率84.0%.hMLH1,hMSH2在肝门部胆管癌组织中的表达明显减少,二者比较差异具有统计学意义(P＜0.05).(2)根据统计学检验,hMLH1,hMSH2表达与肝门部胆管癌Bismuth分型(P＞0.05)、病人性别(P＞0.05)、年龄(P＞0.05)、肿瘤大小(P＞0.05)无关,但与病理分级(P＜0.05)和淋巴结转移(P＜0.05)具有显著相关性.(3)hMLH1表达阴性组术后2年生存率明显低于表达阳性组(15%VS 45.4%,P＜0.05).hMSH2表达阴性组术后2年生存率明显低于表达阳性组(23.5%VS44%,P＜0.05).结论 hMLH1,hMSH2在肝门胆管癌中的失表达在肿瘤的发生、发展及转移中起重要作用,是判断预后有价值的指标.     

长链非编码RNA SNHG1在胆管癌中的表达与临床特征及预后的相关性分析

目的分析肝门部胆管癌病人长链非编码RNA (LncRNA)SNHG1表达水平及其与临床特征的相关性。方法肝门部胆管癌病人36例,利用实时定量PCR检测其肿瘤及对应癌旁组织中LncRNA SNHG1表达水平,根据其表达水平分为高表达与低表达组,分析影响LncRNA SNHG1表达水平的因素及其与病人生存期的关系。结果 36例肝门部胆管癌肿瘤组织中LncRNA SNHG1表达水平高于癌旁组织,差异有统计学意义(P0.05)。淋巴结转移是LncRNA SNHG1表达水平的影响因素,淋巴结转移的病人LncRNA SNHG1低表达组比率高于高表达组(P0.05)。年龄、血浆CA19-9表达水平和LncRNA SNHG1表达水平均是影响胆管癌病人预后的独立因素(P0.05)。结论 LncRNA SNHG1表达水平与肝门部胆管癌转移有一定相关性,可作为判断胆管癌病人预后的独立危险因素,也可作为肝门部胆管癌综合治疗的潜质靶点。     

联合检测大肠癌组织中PTEN与CyclinD1的表达及DNA含量的临床意义

目的:探讨大肠癌组织中PTEN和CyclinD1的表达及与DNA含量联合检测的关系及意义.方法:应用免疫组织化学SP法检测58例大肠癌及14例癌旁正常大肠黏膜组织中PTEN和CyclinD1蛋白表达;应用流式细胞术检测以上组织中PTEN和CyclinD1的DNA含量;分析它们之间及与肿瘤分期、分级的关系.结果:PTEN蛋白在大肠癌组织中的表达(65.52%)显著低于癌旁正常组织(100%),CyclinD1蛋白在大肠癌组织中的表达(60.34%)显著高于癌旁正常组织(1.72%),两种蛋白在大肠癌组织中的表达呈负相关(r =-0.71);大肠癌组织的异倍体率(68.97%)显著高于癌旁正常组织(0);PTEN阳性组的DNA指数(DNA index,DI)、S期细胞比率(S-phase fraction ,SPF)均低于阴性组(P<0.05),CyclinD1阳性组的DI及SPF均高于阴性组(P<0.05);两者的表达与肿瘤病理分级、Dukes分期及淋巴结转移相关;淋巴结转移患者的异倍体率及SPF均高于无淋巴转移患者(P<0.05).结论:PTEN和CyclinD1基因的异常改变可能参与大肠黏膜细胞的恶性转化过程,两者的变化存在相关性;DNA含量的变化可能与淋巴结转移有关.联合检测PTEN、CyclinD1蛋白及DNA含量可作为评估大肠癌病理生物学行为和预后的重要指标.     

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。