过氧化物酶体增殖激活物受体-γ在肾细胞癌中的表达及其意义

目的观察过氧化物酶体增殖激活物受体(PPAR)-γ在肾细胞癌中的表达,探讨其意义。方法应用逆转录聚合酶链反应(RT-PCR)、免疫组织化学和Western blot从RNA及蛋白水平检测正常肾组织、肾癌组织和肾细胞株HK-2、HMCC;肾癌细胞株786-O、A498中PPAR-γ表达。结果肾癌组织、肾组织及细胞株中PPAR-γ mRNA普遍表达,肾癌中PPAR-γ蛋白表达量为正常肾的7.0~10.7倍;肾癌组织PPAR-γ阳性率为98.3％,肾组织中为60.0％,其表达强度差异有显著性(t=7.888,P<0.01)。PPAR-γ在肾癌的细胞核和细胞质中均表达;PPAR-γ表达和肾癌的分级、分期明显相关。结论核内受体PPAR-γ在人肾癌组织及肾癌细胞株中呈上调表达,提示PPAR-γ基因的激活可能是肾细胞癌治疗的一种新的方法。     

过氧化物酶体增殖因子活化受体γ在直肠癌组织中的表达及其意义

目的应用组织芯片技术探讨过氧化物酶体增殖因子活化受体γ(PPAR-γ)在直肠癌中的表达状况及其意义。方法利用组织芯片技术构建直肠癌组织芯片,采用免疫组织化学SP法检测80例直肠癌组织、16例良性腺瘤组织和16例正常直肠组织中PPAR-γ蛋白的表达并分析其与分化程度等临床和病理指标以及生存率的关系。结果80例直肠癌标本中PPAR-γ表达阳性57例(71.3%),16例良性腺瘤中4例(25.0%)、16例正常直肠标本中1例(6.3%),差异有统计学意义(X~2=29.76,P<0.01)。直肠癌患者不同年龄、性别、肿瘤部位、大小、血清CEA水平、组织学类型的PPAR-γ表达程度差异无统计学意义(P>0.05);不同分化程度、病理分期、淋巴转移、3年生存率的PPAR-γ表达程度差异有统计学意义(P<0.05)。结论PPAR-γ蛋白在直肠癌组织中呈高表达,其表达与直肠癌临床病理特征和生物学行为有密切关系,检测PPAR-γ蛋白,对诊断直肠腺癌、判断其恶性程度及预后均有一定参考价值。     

高糖通过ERK1/2通路对人肾小管上皮细胞脂联素表达的影响

目的通过体外培养人肾小管上皮细胞(human proximal tubular epithelial cells,HK-2),观察高糖对HK-2脂联素(adiponectin,ADPN)表达水平的影响并探讨其可能机制。方法将培养的HK-2细胞分为4组:①低糖对照组(5.6 mmol/L葡萄糖);②PD98059(职K1/2信号传导通路的抑制剂)组(5.6 mmol/L葡萄糖+50μmol/L PD98059);③高糖组(30 mmol/L葡萄糖);④高糖+PD98059组(30 mmol/L葡萄糖+50μmol/L PD98059)。各组分别培养48 h后荧光定量聚合酶链式反应(polymerase chain reaction,PCR)检测HK-2细胞过氧化物酶体增殖物激活受体γ(peroxisome proliferator activator receptor,PPAR-γ)及脂联素mRNA的表达,免疫印迹(Western blotting)法检测各组脂联素蛋白的表达水平。结果 HK-2细胞表达脂联素;PD98059组与低糖对照组相比,PPAR-γmRNA及脂联素的mRNA和蛋白表达的差异均无统计学意义(均P0.05);与低糖对照组相比,高糖组PPAR-γmRNA及脂联素mRNA和蛋白表达均显著降低,差异均有统计学意义(均P0.05);与高糖组相比,高糖+PD98059组PPAR-γmRNA及脂联素mRNA和蛋白表达均显著升高,差异均有统计学意义(均P0.05)。结论高糖可以降低HK-2细胞脂联素mRNA和蛋白的表达;高糖作用于HK-2细胞可能是通过激活ERK1/2信号传导通路降低PPAR-γ的表达,从而影响其脂联素的表达。     

淫羊藿苷对大鼠椎间盘退变的影响

[目的]研究淫羊藿苷(ICA)对大鼠尾椎椎间盘退变(IDD)的影响。[方法]体内实验部分,SD大鼠随机分为假手术组(Sham组)、空白对照组(IDD组)和3个淫羊藿苷处理组(ICAL、ICAM、ICAH)。制备椎间盘退变模型,给予相应处理,并行MIR和细胞因子检测。体内实验部分,自假手术与IDD动物椎间盘髓核分离细胞,体外培养,并给予淫羊藿苷处理(ICAL、ICAM、ICAH),检测细胞和上清的细胞因子等。[结果]体内实验表明,术后2周,与IDD组比较,ICAM组椎间盘T2加权信号强度高;术后6周,IDD组信号消失,ICAM组则无明显改变;ICAM组MRI的Pfirrmann评级均明显低于IDD组(P<0.05)。与Sham组比较,IDD组的IL-1β、IL-6蛋白表达显著增高(P<0.05);与IDD组比较,ICA组的IL-1β、IL-6蛋白表达显著降低(P<0.05)。体外实验显示:IDD组NP细胞增殖率明显降低(P<0.05);而ICA组的NP细胞增殖率明显升高(P<0.05)。与Sham组相比,IDD组NP细胞IL-1β、IL-6表达显著上调(P<0.05);与IDD组比较,ICA各组NP细胞IL-1β、IL-6表达显著下调(P<0.05)。与正常对照组相比,IDD组NP细胞Aggrecan和CollagenⅡmRNA及蛋白表达水平显著降低(P<0.05);与IDD组相比,ICA各组Aggrecan和CollagenⅡmRNA及蛋白表达水平显著升高(P<0.05)。[结论]淫羊藿苷可促进退变髓核细胞增殖、蛋白聚糖及II型胶原蛋白合成,减少IL-1β及IL-6表达,延缓椎间盘退变。     

激活PPAR-γ对脑缺血-再灌注损伤中炎症反应的影响

目的探究激活过氧化物酶体增殖物激活受体-γ(PPAR-γ)对脑缺血-再灌注损伤(CIRI)与脂多糖(LPS)诱导炎症反应的影响。方法在动物实验中,SD雄性大鼠40只,体重250～270 g,随机分成四组:假手术组(S组)、缺血-再灌注组(IR组)、二甲基亚砜(DMSO)+缺血-再灌注组(DIR组)和吡格列酮+缺血-再灌注组(PIR组)。其中S组进行假手术处理,IR组进行脑中动脉缺血(MCAO)建模处理,DIR组给予DMSO,随后进行MCAO造模处理。PIR组给予吡格列酮,随后进行MCAO造模处理。在细胞实验中,通过慢病毒转染BV2细胞使PPAR-γ过表达,将细胞培养孔随机分为三组:空白对照组(B组)、阴性对照组(L1组)、过表达组(L2组)。其中B组未做处理,L1组转染PPAR-γ阴性病毒,L2组转染PPAR-γ阳性病毒。之后将细胞培养孔随机分为四组:正常对照组(C组)、正常细胞+LPS处理组(L组)、阴性对照+LPS处理组(LL1组)和过表达+LPS处理组(LL2组)。其中C组未做处理,L组用LPS处理,LL1组转染阴性病毒并确定转染率后使用LPS处理,LL2组转染阳性病毒并确定转染率后用LPS处理。各组大鼠使用Zea Longa评分标准进行神经行为学评分,TTC染色比较脑梗死容积百分比大小,采用ELISA法检测四组大鼠和四组BV2细胞IL-1β和IL-18浓度,Western blot法检测PPAR-γ、活化的半胱天冬酶1(caspase-1)和NOD样受体家族3(NLRP3)蛋白相对含量。结果与IR组比较,PIR组大鼠行为学评分明显降低,脑梗死容积百分比明显减小,PPAR-γ的蛋白相对含量明显增高,活化的caspase-1、NLRP3蛋白相对含量明显降低,IL-1β和IL-18浓度明显降低(P0.05)。与B组比较,L2组的PPAR-γ蛋白相对含量明显增高。与C组比较,LL2组活化的caspase-1和NLRP3蛋白相对含量明显升高(P0.05),IL-1β和IL-18浓度明显升高(P0.05)。结论吡格列酮通过激活PPAR-γ减轻脑缺血-再灌注损伤,其机制是通过激活PPAR-γ,抑制NLRP3的表达,减轻炎症反应,进而使可能存在的caspase-1介导的细胞焦亡减少。     

NF-κB抑制剂对前列腺癌PC-3细胞STAT3核转位的影响

目的:观察IL-6刺激后的前列腺癌PC-3细胞STAT3和NF-κB的表达情况;验证NF-κB抑制剂咖啡酸苯乙基酯(CAPE)对PC-3细胞IL-6和STAT3表达的影响。方法:20 ng/ml IL-6分别作用于PC-3细胞0、5、10、20、30、45 min后,Western印迹和实时荧光定量PCR检测STAT3和NF-κB蛋白和mRNA水平的表达差异;流式细胞技术检测细胞周期。采用TNF-α或TNF-α联合CAPE作用于PC-3细胞,收集培养液上清,ELISA检测IL-6的表达;同时用Western印迹检测p-STAT3的表达。结果:IL-6刺激PC-3细胞后,p-STAT3蛋白的表达明显上调,细胞增殖指数明显增高。TNF-α作用于PC-3细胞后,培养液中IL-6的表达上调,同时p-STAT3蛋白的表达亦上调(P<0.05)。CAPE联合TNF-α作用于PC-3细胞后,培养液中IL-6的表达及p-STAT3蛋白的表达均明显低于TNF-α作用后的表达水平(P<0.05)。结论:CAPE能抑制TNF-α引起的IL-6的分泌,从而抑制IL-6引起的STAT3核转位;通过CAPE抑制NF-κB表达,继而影响STAT3等相关细胞信号传导途径,可能成为前列腺癌治疗的一条新途径。     

大鼠肝移植免疫耐受过程Th细胞和Treg细胞因子及信号通路蛋白的变化研究

目的探讨大鼠肝移植免疫耐受过程中,辅助性T细胞(Th)和调节性T细胞(Treg)细胞因子及相关信号通路蛋白的变化与免疫耐受的关系。方法双袖套法建立原位肝移植模型,将大鼠分为3组:手术对照组(6只),假手术不进行肝移植;短期组(10只),术后存活10 d;耐受组(10只),术后存活100 d,移植肝功能恢复正常。检测各组大鼠肝功能指标如丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST),Th1细胞因子[干扰素(IFN)-γ、白细胞介素(IL)-2、肿瘤坏死因子(TNF)-α],Th2细胞因子(IL-4、IL-5、IL-6、IL-13),Th17细胞因子[粒细胞-巨噬细胞集落刺激因子(GM-CSF)、IL-17A],Treg细胞因子[IL-10、转化生长因子(TGF)-β、IL-12p]表达水平。对各组大鼠血清进行蛋白芯片检测。结果与手术对照组比较,短期组AST明显降低,ALT明显升高(P0.05)。而耐受组与手术对照组的AST、ALT水平比较,差异均无统计学意义(均为P0.05)。各组大鼠的肝组织中,与手术对照组比较,短期组Th1细胞因子IFN-γ、IL-2表达水平明显升高(均为P0.05);耐受组Th2细胞因子IL-4的表达水平明显低于手术对照组(P0.05);短期组Th2细胞因子IL-5、IL-6、IL-13的表达水平明显低于手术对照组(P0.05);耐受组IL-17A的表达水平明显高于手术对照组(P0.05)。耐受组IL-10、IL-12p的表达水平明显高于手术对照组(均为P0.05),短期组TGF-β的表达水平明显高于手术对照组(P0.05)。与手术对照组比较,短期组细胞间黏附分子(ICAM)-1、前血小板碱性蛋白(Ppbp)、神经纤毛蛋白(Neuropilin)-2、Notch-2蛋白的表达水平明显升高(均为P0.05);耐受组趋化因子配基17(CXCL17)、ICAM-1、Neuropilin-2蛋白的表达水平明显升高(均为P0.05),而B7-1蛋白的表达水平显著减低(P0.05)。结论在大鼠肝移植自然免疫耐受过程中,Treg类细胞因子(IL-10、TGF-β、IL-12p), IL-6, IL-17以及细胞表面的跨膜信号通路分子(ICAM-1、Neuropilin-2、B7-1蛋白)在其中起到了重要的作用。     

腹膜间皮细胞过氧化物酶体增殖物活化受体γ的表达及其配体对CD40和细胞间黏附分子1的影响

目的观察过氧化物酶体增殖物活化受体γ（PPAR-γ）在大鼠腹膜间皮细胞（RPMCs）中的表达以及脂多糖（LPS）的调节作用，并探讨PPAR-γ天然配体15d-PGJ2及人工合成配体ciglitazone对RPMCs表达CD40和ICAM-1的影响。方法分离及培养RPMCs，常规传代及鉴定，取第2代细胞用于实验研究。LPS不同浓度（0．1、1．0、10、50及100μg／ml）、LPS（1μg／ml）处理后不同时间点及15d-PGJ2（3μmol／L）、ciglitazone（10μmol／L）作用细胞36h后收集细胞。RT-PCR检测PPAR-γ、CD40以及ICAM-1 mRNA表达。免疫细胞化学检测PPAR-γ在RPMCs中的分布。Western印迹检测PPAR-γ及ICAM-1蛋白表达。结果（1）常规培养的RPMCs表达一定量PPAR-γ，表达部位主要分布于RPMCs细胞核内，在细胞浆微弱表达。（2）随着LPS浓度逐渐增大，PPAR-γ蛋白表达水平呈逐渐增高的趋势，LPS浓度为10μg／ml时其表达为最高峰。LPS（1μg／ml）作用12h时PPAR-γ蛋白表达最强，PPAR-γ1表达高于PPAR-γ2；之后显著降低，持续至72h。（3）LPS刺激后RPMCs CD40mRNA表达显著增强；15d-PGJ2、ciglitazone显著降低CD40 mRNA表达（P均〈0．01）。（4）LPS刺激后RPMCs ICAM-1蛋白表达显著增加：15d-PGJ2增加LPS介导的ICAM-1 mRNA表达（P〈0.01），但显著抑制ICAM-1蛋白表达（P〈0．05）。ciglitazone对LPS介导的ICAM-1 mRNA和蛋白表达均有显著抑制作用（P均〈0．05）。结论RPMCs结构性表达PPAR-γ。LPS调节PPAR-γ表达呈现先增强后抑制趋势。PPAR-γ配体可显著抑制LPS介导的CD40mRNA和ICAM-1蛋白的表达。提示RPMCs功能性表达PPAR-γ．可能通过负性调节炎症介质分泌而参与腹腔局部防御。     

白花丹提取物对高糖诱导的肾小球系膜细胞分泌炎症因子及细胞外基质的影响

目的探讨白花丹提取物对高糖诱导的肾小球系膜细胞分泌炎症因子及细胞外基质的影响。方法体外培养大鼠肾小球系膜细胞,随机分为对照组,模型组,白花丹提取物低剂量(1 mg/L)、中剂量(2 mg/L)、高剂量(4 mg/L)组,甘露醇(24.5 mmol/L)组,收集各组细胞及细胞培养基,以酶联免疫吸附法检测各组细胞上清液中肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素6(interleukin-6,IL-6)、转化生长因子β1(transforming growth factor-β1,TGF-β1)水平;检测各组细胞超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)水平;以实时荧光定量法检测各组细胞miR-155、SOCS1 mRNA水平;采用蛋白免疫印迹法检测各组细胞纤维连结蛋白(fibronectin,FN)、Ⅳ型胶原蛋白(collagen IV,Col IV)、细胞因子信号传导抑制蛋白1(cytokine signal transduction inhibitor 1,SOCS1)蛋白表达。结果与对照组相比,模型组、甘露醇组细胞上清液中TNF-α、IL-6及TGF-β1水平升高,细胞MDA、miR-155、FN及Col IV表达升高(P0.05),细胞SOD水平、SOCS1 mRNA及蛋白表达明显降低(P0.05)。与模型组相比,白花丹提取物低、中、高剂量组细胞上清液中TNF-α、IL-6及TGF-β1水平降低,细胞MDA、miR-155、FN及Col IV表达降低(P0.05),细胞SOD水平、SOCS1 mRNA及蛋白表达升高(P0.05),且各项变化均对白花丹提取物呈剂量依赖性(P0.05)。结论白花丹提取物可抑制高糖诱导的肾小球系膜细胞分泌炎症因子及细胞外基质,下调miR-155表达、上调SOCS1表达可能是其作用机制。     

慢病毒介导PPAR-γ基因对瘢痕疙瘩成纤维细胞增殖、迁移和侵袭性的影响

目的:研究过氧化物酶体增殖物激活受体-γ(PPAR-γ)基因对体外培养的人瘢痕疙瘩成纤维细胞(keloid fibroblasts,KF)增殖、迁移、侵袭性的影响。方法:将携带PPAR-γ及绿色荧光蛋白的慢病毒载体(LV-PPAR-γ-GFP,KF-PPAR-γ组)及空载体(LV-GFP,KF-NC组)感染KF细胞,并设空白对照组(KF组),应用实时定量PCR和Western blot分别检测PPAR-γm RNA及蛋白的表达;MTT法检测KF细胞增殖情况;划痕实验和Trans-well小室实验检测KF细胞的体外迁移和侵袭能力。结果:PPAR-γ慢病毒载体感染KF细胞96 h后,KF-PPAR-γ组PPAR-γm RNA和蛋白的表达量明显高于KF-NC组和KF组,差异有统计学意义(P0.05);MTT结果显示,KF-PPAR-γ组吸光度A值明显降低,与KF-NC组和KF组比较,差异有统计学意义(P0.05);划痕实验结果显示划痕后24 h和48 h,KF-PPAR-γ组划痕愈合速度明显慢于KF-NC组(P0.05);Trans-well侵袭结果显示KF-PPAR-γ组侵袭到下室的细胞数目较KF-NC组明显减少(P0.05)。结论:慢病毒介导PPAR-γ基因能够抑制KF细胞的增殖、迁移及侵袭能力,提示靶向提高瘢痕疙瘩中PPAR-γ的含量与活性,可能为瘢痕疙瘩的防治提供有效途径。     

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。