乳腺癌中黏着斑激酶、抑癌基因PTEN编码蛋白的表达与生物学行为相关性分析

目的 研究乳腺癌组织中黏着斑激酶（FAK）和PTEN蛋白的表达与肿瘤分化、浸润转移的关系，揭示细胞信号转导系统与乳腺癌发生发展的关系，同时为乳腺癌的基因治疗提供依据。方法 应用免疫组织化学SP法检测92例乳腺癌组织和30例乳腺良性病变组织中FAK、PTEN的表达情况及其与临床病理参数的关系。结果 （1）在92例乳腺癌中FAK和PTEN的阳性表达率分别为69．6％和51．1％，与对照组比较，差异有统计学意义（P〈0．01）；（2）FAK表达与乳腺癌肿瘤大小、腋窝淋巴结转移、临床分期呈正相关（P〈0．01），PTEN表达与乳腺癌组织学分级、腋窝淋巴结转移、临床分期呈负相关（P〈0．05）；（3）乳腺癌组织FAK表达与PTEN表达呈负相关（P〈0．01）。结论 乳腺癌FAK的高表达和PTEN的缺失表达与肿瘤发生发展、浸润转移密切相关；检测这些指标，有助于判断乳腺癌的恶性程度及生物学行为。     

乳腺癌患者血清和肿瘤组织VEGF表达与临床预后的关系

目的探讨乳腺癌患者血清和肿瘤组织中血管内皮细胞生长因子（VEGF）的表达以及与临床预后的关系。方法以44例乳腺癌患者、13例乳腺良性疾病患者和40例正常人为研究对象，分别采用酶联免疫吸附法（ELISA）检测其血清VEGF水平，采用免疫组化LSAB法检测其组织中VEGF、雌激素受体（ER）和原癌基因C-erbB-2蛋白的表达，并分析其与临床预后因素如淋巴结转移情况及临床分期的关系。结果乳腺癌组血清和组织中VEGF表达水平（113．88pg／ml，20723．99）均明显高于乳腺良性疾病组（55．79pg／ml，3594．74），P〈0．001，而乳腺良性疾病组与正常对照组（41．30pg／ml，-）比较差异无统计学意义（P〉0．05）；且血清和组织中VEGF的表达呈正相关（r=0．48，P〈0．01）。有淋巴结转移者血清和组织中VEGF的表达水平（129．60pg／ml，28506．82）明显高于无淋巴结转移者（80．80pg／ml，14656．73），P〈0．01；血清和组织中VEGF的表达与肿瘤的临床分期有关（P〈0．01），但与患者年龄和肿瘤大小无关（P〉0．05）。乳腺癌患者血清和组织中VEGF表达水平与组织中ER表达呈负相关（r=-0．45，P〈0．05），与C-erbB-2表达呈正相关（r=0．48，P〈0．01）。结论乳腺癌患者血清和肿瘤组织中VEGF表达呈正相关，且与其临床预后有关，可作为乳腺癌患者预后判断的重要参考指标之一。     

PCNA和C-erbB-2及nm-23-H1在乳腺癌组织中的表达及临床意义

目的探讨PCNAC-erbB-2和nm-23-H1在乳腺癌组织中的表达及其与病理分型、临床分期、淋巴结转移、肿瘤大小、组织学分级的关系。方法采用免疫组织化学SP法测定76例乳腺癌组织石蜡切片中PCNAC-erbB-2和nm-23-H1蛋白的表达。结果PCNAC-erbB-2在乳腺癌组织中的表达与肿瘤的组织学分级、淋巴结转移数目、TNM分期呈正相关（P〈0．01），与病理分型、肿瘤大小无关。nm-23-H1与淋巴结转移数目、肿瘤大小、TNM分期呈负相关（P〈0．01），与病理分型、组织学分级无关。PCNA和C-erbB-2的表达呈正相关（P〈0．01）。C-erbB-2和nm-23-H1的表达呈负相关（P〈0．01）。PCNA和nm-23-H1的表达差异无统计学意义（P〉0．05）。结论PCNAC-erbB-2和nm-23-H1可以作为判断乳腺癌生物学行为，后续治疗和预后的三个重要的客观标记物。     

乳腺癌淋巴管生成与血管内皮生长因子-C、环氧化酶-2表达的关系

目的探讨血管内皮生长因子（VEGF）-C、环氧化酶（COX）-2在乳腺癌组织中的相互表达关系及与淋巴管生成和预后的关系。方法应用免疫组织化学法检测70例乳腺癌组织COX-2与VEGF-C蛋白的表达，并用淋巴管内皮细胞特异性抗体D2-40标记淋巴管，计数肿瘤淋巴管密度（LVD），结合临床病理特征和随访资料进行分析。结果（1）乳腺癌组织COX-2、VEGF-C高表达率分别为65．7％（46／70）和42．8％（30／70）。COX-2与VEGF-C蛋白表达之间存在显著相关（r=0．529，P〈0．01）。（2）COX-2蛋白的高表达与淋巴结转移、LVD和淋巴管浸润呈正相关（P〈0．05），与雌激素受体状态、无病生存率和总生存率呈负相关（P〈0．05）。VEGF-C蛋白的高表达与淋巴结转移、LVD、淋巴管浸润呈正相关（P〈0．05），与组织学分化、无病生存率和总生存率呈负相关（P〈0．05）。结论COX-2可能通过上调VEGF-C表达来促进乳腺癌淋巴管生成，从而导致淋巴结转移的发生。COX-2和VEGF-C的高表达提示乳腺癌患者容易出现淋巴结转移和预后不良。     

VEGF-C和MMP-7的表达与胃癌侵袭转移的关系

目的 探讨胃癌中血管内皮生长因子C（VEGF-C）和基质金属蛋白酶7（MMP-7）的表达及两者与胃癌侵袭和淋巴结转移的关系。方法 采用SP免疫组化技术，分别检测60例胃癌组织、癌旁组织及30例癌周区域淋巴结中VEGF-C及MMP-7的表达水平。结果 VEGF-C和MMP-7在胃癌组织中的阳性表达率明显高于正常胃黏膜及癌旁组织；在区域淋巴结癌转移组中的阳性表达率明显高于无癌转移组（P〈0．01）；伴有淋巴结转移的胃癌组织中VEGF-C，MMP-7的阳性表达率明显高于无淋巴结转移组（P〈0．05）；VEGF-C，MMP-7表达与淋巴结转移、淋巴管侵犯、浸润深度、TNM分期有密切关系（P〈0．05）。结论 VEGF-C和MMP-7在胃癌中的高表达与胃癌浸润侵袭程度、淋巴结转移有密切关系。     

乳腺癌组织中HER2、ERα、ERβ、PR的表达及其相关性分析

目的探讨雌激素受体α（ERα）、雌激素受体β（ERβ）、孕激素受体（PR）、人类表皮生长因子受体2（HER2）在乳腺癌组织中的表达及其与TNM分期和腋窝淋巴结状况的关系。方法随机选择我院在2004年12月至2007年12月收治的HER2高表达（＋＋＋）51例与无表达（-）53例乳腺浸润性导管癌病例，分别检测乳腺癌组织的ERα、ERβ、PR的表达水平，分析其与TNM分期、腋窝淋巴结转移等临床指标的相关性。结果104例乳腺癌患者，TNM分期为I期的占14．42％，Ⅱ期占62．50％，Ⅲ期占19．23％，Ⅳ期占3．85％；HER2阳性的淋巴结转移率为41．18％，HER2阴性的转移率为47．5％；ERα、ERβ、PR的阳性表达率分别为52．88％、63．46％、73．08％。ERβ与ERα、PR的表达呈正相关（P〈0．01），与HER2的表达负相关（P〈0．01）；ERα与PR的表达正相关（P〈0．01），与HER2负相关（P〈0．01），PR与HER2的表达负相关（P〈0．05）；ERα、ERβ、PR、HER2的表达与淋巴结转移情况及TNM分期无显著相关性。结论HER2作为乳腺癌预后不良的重要指标与作为乳腺癌预后良好的重要指标ERα、ERβ、PR的表达呈负相关，与TNM分期及腋窝淋巴结转移状态未显示明显相关性。     

VEGF-C与中低位直肠癌淋巴转移的相关性研究

目的 探讨中低位直肠癌组织中血管内皮生长因子-C（VEGF-C）表达与肿瘤淋巴转移的关系。方法 采用RT-PCR方法测定97例中低位直肠癌组织中VEGF浓度及组织中VEGF蛋白的表达。结果 VEGF-CmRNA在中低位直肠癌组织中的表达显著高于癌旁组织和正常组织（P〈O．01）；VEGF-C mRNA与中低位直肠癌病理分期、分化程度密切相关（P〈0．05），有淋巴转移的中低位直肠癌组织中的表达显著高于无淋巴转移者（P〈0．01）。结论 中低位直肠癌组织中VEGF-C与癌肿的浸润和转移密切相关，术前癌肿组织VEGF-C mRNA可作为评价中低位直肠癌预后的有用指标。     

VEGF-C与胃癌淋巴管新生临床病理因素的关系

目的：研究血管内皮生长因子C（VEGF-C）与胃癌淋巴管新生及其临床病理因素的关系。方法：收集65例胃癌患者围手术期一般临床资料和病理学资料,并进行随访。分析VEGF-C免疫组织化学表达与肿瘤组织淋巴管密度（LVD）计数的关系;对随访的54例患者作生存分析。结果：胃癌组织VEGF-C阳性表达率明显高于正常胃组织（P〈O,05）;胃癌组织VEGF-C阳性组、阴性组LVD计数分别为16．14±511、1011±4．55,两者差异具有统计学意义（P〈0．01）;VEGF-C的表达及LVD计数与胃癌直径、大体类型、Lauren分型、年龄、性别、饮食、区域分布无明显相关;而与肿瘤分化程度、浸润深度、淋巴结转移、远处转移及TNM分期呈正相关（P〈O．05）。胃癌组织VEGF-C阳性表达组1、2,3年复发率分别为40．1％、66．7％、79,2％,阴性表达组则分别为27。4％、31．3％、45．7％。VEGF-C阳性组1、2、3年复发率明显高于VEGF-C阴性组（P〈O．01）;54例随访患者,VEGF-C8t3,1~患者总体生存率明显低于VEGF-C阴性患者（P〈0．01）。结论：VEGF-C在胃癌淋巴管新生中起重要作用,其表达阳性率可作为胃癌术后一个新的预后指标。     

血管内皮生长因子-C和生存素在胃癌组织中的表达及其临床意义

目的 探讨胃癌组织中血管内皮生长因子（vascular endothelial growth factor，VEGF）-C和生存素（sunrivin）蛋白表达及其临床意义。方法 采用免疫组织化学SP法检测97例原发性胃癌组织、癌旁组织及20例正常胃黏膜组织中VEGF-C和survivin蛋白的表达，并分析其与临床病理特征和预后的关系。结果 胃癌组织VEGF-C和survivin蛋白表达阳性率分别为66．0％和57．2％，显著高于癌旁组织和正常胃组织（P〈0．05）；VEGF-C蛋白表达与肿瘤分化程度、肿瘤部位、肿瘤直径、静脉侵犯及远处转移等无关，但与淋巴结转移、淋巴管侵犯、浆膜面受累和肿瘤TNM分期等密切相关；survivin蛋白表达与肿瘤分化程度、肿瘤部位、肿瘤直径、静脉侵犯等无关，但与浆膜面受累、淋巴管侵犯、淋巴结转移、远处转移和肿瘤TNM分期等密切相关；VEGF-C和survivin阳性表达组术后生存率明显低于阴性组；VEGF-C和survivin在胃癌组织中阳性表达呈正相关。结论 VEGF-C及survivin蛋白的阳性表达可作为胃癌预后不良的参考指标。     

黏着斑激酶的高表达与人胃癌侵袭和转移的关系

目的 探讨胃癌侵袭和转移过程中黏着斑激酶（FAK）的表达与其生物学行为的关系。方法 用免疫组化SABC法检测10例行胃癌根治术所收集的癌组织、癌旁组织、正常胃黏膜组织和胃区域淋巴结标本中FAK的表达情况。结果FAK表达强阳性率在胃癌组织中（78．0％）明显高于正常胃黏膜组织（10．0％）及癌旁组织（20．0％），P〈0．01，正常胃黏膜组织与癌旁组织中的表达差异无统计学意义（P〉0．05）。FAK表达强阳性率在淋巴结有转移和无转移患者中分别是68．8％（22／32）和33．3％（6／18），前者明显高于后者（P〈0．05）；在有转移的淋巴结中和无转移的淋巴结中分别是87．2％（136／156）和40．9％（18／44），前者明显高于后者（P〈0．01）；FAK表达强阳性率与胃癌浸润深度和分化程度有关，浸润深度越深，细胞分化越低，表达强阳性率越高（P〈0．05）；与Borrmann分型、肿瘤部位及大小无关（P〉0．05）。结论 FAK表达与胃癌发生、发展有关，FAK表达增高是胃癌细胞浸润和转移的重要原因之一，检测癌组织中FAK表达水平，有助于进一步了解胃癌的生物学行为，有利于治疗与预后判断。     

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。