癌胚抗原相关细胞黏附分子-6在人肝门部胆管癌细胞株QBC939中的表达及其在侵袭转移中的作用

目的 观察癌胚抗原相关细胞黏附分子-6(CEACAM6)在人肝门部胆管癌细胞株QBC939中的表达,探讨其在侵袭转移中的作用.方法 实时定量聚合酶链反应(Real-time PCR)检测CEACAM6在QBC939细胞中的表达;构建CEACAM6的RNA干扰(RNAi)慢病毒载体,并感染QBC939细胞,Real-time PCR验证RNAi效果;Transwell侵袭试验检测QBC939细胞体外侵袭力的改变.结果 CEACAM6在QBC939细胞中高表达.成功构建CEACAM6基因RNAi慢病毒载体并转染QBC939细胞.和对照组比较,RNAi组CEACAM6 mRNA表达抑制率为93.1％ (P ＜0.05);Tran-swell实验提示RNAi后,侵袭细胞OD570 RNAi组(0.09 ±0.01)明显少于对照组(0.13 ±0.02),侵袭抑制率为69.2％ (P ＜0.05).结论 CEACAM6在QBC939细胞中高表达,其表达程度与肝门部胆管癌细胞侵袭转移能力呈正相关.     

肝内及肝外胆管癌组织表达上调microRNAs表达谱的鉴定

目的 筛选、鉴定肝内及肝外胆管癌组织表达上调的miRNAs,并探讨其在胆管癌细胞增殖中的作用.方法 利用miRNA-基因芯片方法筛选肝内、肝外胆管癌组织 特异表达上调或共同表达上调的miRNAs;利用实时PCR方法对其进行验证;选择特异miRNA抑制剂转染胆管癌细胞系QBC939并利用MTT检测方法,对上述表达上调明显的miRNAs进行初步的功能研究,探讨miRNAs表达上调与胆管细胞癌细胞增殖的关系.结果 12个miRNAs在肝外及肝内胆管癌组织共同表达上调,肝外胆管癌组织特异表达上调的miRNAs有28个,其中miR-125b与miR-19a分别表达上调3.7倍与3.6倍(P＜0.05);肝内胆管癌有12个miRNAs特异表达上调,其中miR-92a与miR-205分别表达上调约4.5倍与3.5倍(P＜0.05);在胆管癌细胞系QBC939中抑制miR-125b、miR-19a、miR 21以及miR-378*的内源性表达,可以明显抑制QBC939细胞的增殖,其抑制效率分别为71％、72％、69％与76％(P＜0.05,36 h),61％、63％、60％与59％ (P＜0.01,48 h),61％、56％、60％与59％ (P＜0.05,60 h).结论 肝内及肝外胆管癌具有不同的miRNAs上调表达谱,敲低表达上调的miRNAs可以明显抑制胆管癌细胞增殖.     

突变型ⅠkBα转染对肝门部胆管癌多药耐药基因的调控作用

目的 探讨阻断核转录因子-kB(NF-kB)活性对肝门部胆管癌细胞多药耐药基因(MDR-1)表达的影响。方法用突变核转录因子-kB抑制蛋白αⅠkBα质粒(mⅠ-kBa)转染肝门部胆管癌细胞株(QBC939)及稳定表达丙型肝炎病毒核心蛋白(HCVC)的QBC939(QBC939HCVC )，凝胶迁移率电泳(EMSA)检测mⅠkBa质粒转染的QBC939和QBC939HCVC 细胞中NF-kB DNA结合活性；逆转录-多聚酶链反应(RT—PCR)检测转染m-Ⅰ kBa质粒对肝门部胆管癌细胞中MDR-1基因及其表达产物(P—GP)表达的影响。结果 转染mⅠkBa质粒组的QBC939和QBC939HCVC 细胞放射性浓聚影明显淡于非转染组，密度计成对扫描显示，转染组和非转染组相对信号密度有明显差异；转染突变型ⅠkBa质粒的QBC939和QBC939HCVC 细胞中MDR-1mRNA和蛋白的表达水平明显低于非转染组。结论 转染mⅠkBa能明显逆转肝门部胆管癌细胞多药耐药性。阻断NF—kB活性有望成为肝门部胆管癌基因治疗新策略的“靶位”。     

丙型肝炎病毒核心蛋白激活肝门部胆管癌细胞血管内皮生长因子的表达

目的 探讨丙型肝炎病毒(HCV)核心蛋白对肝门部胆管癌生长和转移的影响。方法 首先构建表达HCV核心蛋白的真核表达载体pcDNA3-HCVcore,再将含有 pcDNA3-HCVcore的载体和不含 pcDNA3-HCV core的空载体分别导入肝门部胆管癌细胞株 QBC939中,RT-PCR和免疫组织化学检测 VEGF mRNA和蛋白表达。结果 重组质粒 pcDNA3-HCVcore在 QBC939细胞中有稳定表达;表达 HCV核心蛋白的细胞QBC939的 VEGF在蛋白水平和 mRNA水平较转染空载体的细胞QBC939明显升高。结论 HCV核心蛋白能激活VEGF表达,可能对肝门部胆管癌的生长和转移具有促进作用。     

胆管癌细胞系QBC939裸鼠肝门部胆管原位种植瘤模型的建立

目的建立胆管癌细胞系QBC939裸鼠肝门部胆管原位种植瘤模型并观察淋巴引流情况。方法应用我们前期建立的肝门部胆管癌细胞系QBC939,行裸鼠背部皮下接种,建立高转移特性胆管癌裸鼠皮下种植瘤模型,然后将高转移性种植瘤组织接种于裸鼠肝门部胆管与门静脉间组织间隙紧贴胆管处,4周及6周后行种植瘤瘤组织解剖学和病理学检查,并观察淋巴管引流情况。结果模型建立过程中,胆管癌细胞系QBC939细胞裸鼠皮下接种成瘤率为100%(10/10);原位种植4周后,肝门部胆管原位种植瘤成瘤率为100%(10/10),原位种植6周后,合并发生肝脏转移及腹腔淋巴结转移为80%(8/10)。结论成功建立了胆管癌细胞系QBC939裸鼠肝门部胆管原位种植瘤模型。     

γ-氨基丁酸对人胆管癌细胞株QBC939增殖和侵袭的影响

目的 观察抑制性神经递质γ-氨基丁酸(GABA)对人胆管癌细胞株QBC939生物学行为的影响.方法 采用MTF比色法观察GABA对人系胆管癌细胞QBC939增殖的作用,PCR-ELISA法观察其对QBC939细胞端粒酶活性的影响,Transwell小室分析GABA对胆管癌细胞侵袭能力的影响,逆转录聚合酶链反应(RT-PCR)、明胶酶谱法分析GABA对QBC939细胞分泌的基质金属蛋白酶(matrix metalloproteinase,MMP)mRNA和酶活性的影响,数据采用单因素方差分析和Dunnett法处理.结果 GABA对人胆管癌细胞QBC939的增殖有抑制作用(抑制率由2.6%增至26.8%,P＜0.05);抑制癌细胞中端粒酶的活性(0.82±0.05)vs.(0.56±0.05)(P＜0.05);抑制胆管癌细胞穿透Matrigel胶的能力(在100 μmol/L浓度的GABA作用下,穿透细胞数由(60±10)个降至(43±4)个(P＜0.05),同时胆管癌细胞分泌的基质蛋白酶MMP-2和MMP-9的mRNA和活性下降,这三种效应均成浓度依赖性.结论 GABA抑制胆管癌细胞QBC939的生长并减弱侵袭转移能力,其机制可能与其抑制端粒酶活性和基质蛋白酶MMP-2和MMP-9的分泌和活性有关.     

反义RhoC基因对胆管癌QBC939细胞株基质金属蛋白酶－2的抑制作用

目的 观察反义RhoC基因对胆管癌QBC939细胞株的基质金属蛋白酶-2(MMP-2)表达的影响.方法 将反义RhoC真核表达载体转染人胆管癌细胞株QBC939,逆转录－聚合酶链反应(RT-PCR)和Western blot检测MMP-2在QBC939细胞、转染空载体的QBC939细胞(QBC939-V)、转染反义RhoC的QBC939细胞(QBC939-AS)的mRNA和蛋白相对表达量.结果 QBC939细胞MMP－2 mRNA吸光度相对值为0.588±0.074,QBC939-V细胞为0.629±0.061,两者差异无统计学意义(P＞0.05),QBC939-AS细胞MMP-2 mRNA吸光度相对值为0.286±0.097;与QBC939及QBC939－V比较,差异有统计学意义(P＜0.05).结论 反义RhoC基因能够抑制QBC939细胞株的MMP-2表达.     

Bcl-2反义寡核苷酸对人胆管癌细胞株QBC939中Bcl-2表达的影响

胆管癌对放疗、化疗不敏感,手术效果差,如何提高其治疗效果,一直是困扰临床医师的难题。作者既往的实验显示胆管癌组织中Bcl-2高表达,胆管癌细胞株QBC939中Bcl-2阳性表达,Bcl-2反义寡核苷酸(ASODN)可抑制QBC939细胞增殖。本研究将Bcl-2 ASODN作用于人胆管癌细胞株QBC939,旨在探索Bcl-2 ASODN作用的分子机制,为胆管癌反义基因治疗提供实验依据。     

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.     

rhNIS基因转导胆管癌细胞介导125Ⅰ摄取的研究

目的 探讨人钠/碘同向转运体(hNIS)基因cDNA转导至胆管癌细胞系QBC939细胞后的表达水平及其对介导125Ⅰ摄取的影响.方法 将扩增出的hNIS基因cDNA序列克隆至pMD18-T载体;筛选后的亚克隆hNIS编码至真核表达型载体PDC316中,经脂质体途径导入胆管癌细胞(QBC939),建立新细胞系(QBC939-A).同时设立空质粒(QBC939-B)转染和空白(QBC939-C)对照组.在体外培养条件下采用半定量RT-PCR检测各组2,3,6 d细胞内hNIS.mRNA表达水平和1,2,3,6 d的125Ⅰ摄取情况.结果 建立了能稳定表达hNIS摹因的新型细胞系QBC939-A.hNIS-mRNA表达水平检测显示,Q13C939-A于3 d表达量达高峰,与QBC939-B和QBC939-C比较,有显著性差异(P＜0.05).且QBC939-A细胞的摄碘能力在转染后3 d达高峰,较QBC939-C高14倍,较QBC939-B高16倍.结论 rhNIS基因转导至胆管癌细胞足以在短期内介导125Ⅰ的摄取,为介导125Ⅰ靶向治疗胆管癌的研究奠定了基础.     

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。