skp2,C-myc在肝细胞肝癌中的表达及其意义

目的研究skp2和C—myc在肝细胞肝癌组织中的表达及其与临床病理指标的关系。方法用免疫组化PV9000二步法检测skp2和C—myc蛋白在48例肝细胞肝癌、20例肝硬化患者和16例正常肝组织中的表达。结果肝细胞肝癌组织中skp2的阳性表达率（33．3％）显著高于肝硬化组织（均为阴性表达）（P=0．008）和正常肝组织（均为阴性表达）（P=0．020）。skp2在肝细胞肝癌中的表达与组织分化程度及转移有关（P〈0．001及P=0．017），但与肿瘤大小无关（P=0．058），skp2在高分化肝细胞肝癌中无表达。肝细胞癌组织中C—myc蛋白的的阳性表达率为58．3％，显著高于肝硬化组织的15％（P=0．001）和正常肝组织（阴性表达）（P〈0．001）。C—myc蛋白阳性表达与组织分化程度、转移及肿瘤大小有关，组间差异依次为P〈0．001，=0．023及=0．007。肝细胞癌中skp-2蛋白的表达与C—myc的表达呈正相关（r=0．508，P〈0．001）。结论C—myc可能与肝细胞肝癌的发生发展有关。Skp2的表达提示预后不良。C—myc可能对skp2的表达起正性调节作用。     

原发性肝细胞癌Survivin,CyclinD1的表达及其临床意义

目的：探讨Survivin和CyclinD1在原发性肝细胞癌（HCC）组织中的表达及两者在肝癌发病机制中的作用和临床意义.方法：利用免疫组织化学SP法检测50例原发性肝癌组织、20例正常肝组织中Survivin和CyclinD1蛋白表达情况.结果：Survivin蛋白在肝癌中的阳性表达率为66.0%（33/50）,显著高于正常肝组织组（均为阳性表达）（P＜0.001）,阳性表达与肝癌的肝内转移和肝癌的多发性有关（P=0.019,P=0.030）.CyclinD1蛋白在肝癌中的阳性率为44.0%（22/50）,显著高于正常肝组织组（均为阴性表达）（P＜0.001）,阳性表达与肝癌的肝内转移和肝癌的分化程度有关（P=0.035,P=0.036）.Survivin的阳性表达与CyclinD1的阳性表达呈正相关（r=0.466,P＜0.001）.Survivin和CyclinD1的过表达均与患者术后＜3年生存期相关（P=0.018,P=0.013）.结论：Survivin与CyclinD1在肝细胞癌的发生及发展过程中起着不同程度的作用,联合检测Survivin与CyclinD1对判定原发性肝细胞癌预后可提供一定的依据.     

肝细胞癌端粒酶活性与细胞周期抑制蛋白p27^kip1的相关性研究

目的探讨端粒酶活性(TA)和细胞周期蛋白依赖激酶抑制蛋白p27kip1在肝癌中的表达及其相互关系。方法采用端粒重复序列扩增-酶联免疫吸附（TRAP-ELISA）方法测定27例肝细胞癌（HCC）和23例肝硬化组织中的端粒酶活性，采用免疫组织化学方法测定p27kip1在HCC中的表达。结果27例HCC中24例端粒酶阳性，3例阴性；23例肝硬化中3例阳性，20例阴性,两者差异有非常显著性（r=0.484，P<0.001）；HCC中平均p27kip1标记指数为50.30±19.83;端粒酶活性与p27kip1呈正相关（P<0.05）。结论测定端粒酶活性有利于早期发现肝癌，端粒酶的激活与p27kip1蛋白表达有关。     

Survivin和cyclinD1在原发性肝细胞癌中的表达及其相关性研究

为探讨survivin和cyclinD1在原发性肝细胞癌（HCC）组织中的表达及两者在肝癌发病机制中的作用和相关性。笔者利用免疫组织化学S P法检测50例原发性肝癌组织（HCC组）及20例正常肝组织（正常组）中survivin和cyclinD1蛋白的表达情况。 采用Spearman相关分析法分析两种蛋白表达的相关性。结果示，HCC组中survivin蛋白表达的阳性率为66.0%（33/50），显著高于正常组（均为阴性表达）（P<0.001）;其阳性表达与肝癌的肝内转移和癌灶的多发性有关（P=0.019，P=0.030）。 cyclinD1蛋白在HCC组的阳性率为44.0%（22/50），显著高于正常组（均为阴性表达）（P<0.001）;其阳性表达与肝癌的肝内转移和分化程度有关（P=0.035，P=0.036）。两种蛋白的的阳性表达呈正相关（r=0.466，P<0.001）。两者的过表达均与患者术后＜3年生存期有关（P=0.018，P=0.013）。提示survivin与cyclinD1在HCC的发生及发展过程中起着不同程度的作用; 两者的联合检测对判定原发性HCC的预后可提供一定的依据。     

肝细胞肝癌中uPA及vimentin蛋白的表达及意义

目的：探讨uPA及vimentin在肝细胞肝癌（HCC）组织中的表达及其临床病理意义。方法：应用免疫组化法检测HCC及其癌旁组织（88例）与正常肝组织（8例）中uPA及vimentin的表达情况,并分析两者与临床病理特征的关系及两者表达的相关性。结果：在HCC组织中uPA及vimentin蛋白阳性表达率分别为63.6%（56/88）和72.7%（64/88）,两者均明显高于癌旁组织（27.3%和15.9%）和正常肝组织（12.5%和12.5%）（均P<0.0125）;uPA和vimentin在HCC中的表达与门静脉癌栓及肝被膜浸润有关（P<0.05）,且两者在HCC中的表达互呈正相关（r=0.227,P=0.034）。结论：在HCC中,uPA和vimentin的表达呈正相关,且两者的阳性表达与患者不良临床特征有关。

     

p27kip1及相关分子skp2在人肝癌组织中的表达变化

目的探讨细胞周期素依赖性激酶抑制蛋白27（p27^kip1）和细胞S相激酶相关蛋白2（skp2）表达与人肝癌发生的关系。方法用免疫组织化学SP法检测62例肝癌组织中p27^kip1、skp2蛋白的表达，并与22例癌旁正常肝组织作对比。结果p27^kip1蛋白阳性表达率在肝癌中为46．77％，而癌旁肝组织中为95．45％（P〈0．01）。skp2蛋白阳性表达率在肝癌中为32．26％，而癌旁正常肝组织中为13．64％（P〈0．05）。p27^kip1、skp2蛋白在肝癌中的表达呈负相关（P〈0．01）。结论p27^kip1、skp2蛋白检测有助于肝癌的临床诊断及判断预后。     

Hes1在肝细胞癌中的表达及意义

目的：检测Hes1基因在人肝细胞癌、癌旁、肝硬化和正常肝组织中的表达情况,分析其与乙肝病毒（HBV）的关系和临床意义,探讨Hes1通路在HBV致癌过程中发挥的作用。方法通过免疫组化技术检测60例人肝细胞癌标本（癌、癌旁组织）,20例肝硬化组织和20例正常肝组织标本中Hes1蛋白的表达情况;同时利用蛋白质印迹技术（Western-Blot）技术对组化结果进行验证（分别检测10例标本）。比较Hes1在四种组织中的表达差异,分析其与HBV的相关性和与分化程度的关系。结果免疫组化显示,Hes1蛋白在肝癌组织中呈强阳性表达,癌旁和肝硬化组织中呈中度阳性表达,而正常肝组织中呈阴性表达;Hes1在肝癌、癌旁、肝硬化和正常肝组织中的阳性率分别为65．12％、40．23％、32．23％和15．00％,差异有统计学意义（P＜0．05）。Hes1在癌旁和肝硬化组织中表达无差别（P＞0．05）。在HBsAg阳性和HBsAg阴性肝组织中,前者的阳性率显著高于后者（P＜0．05）,Hes1的表达与HBV呈显著正相关（r＝0．787,P＝0．001）。低分化肝细胞癌中Hes1的表达明显强于高分化肝细胞癌（P＜0．05）。结论 Hes1在肝癌组织中表达升高与肝癌的发生发展有关,Hes1在HBV相关性肝癌的发病机制中可能起重要作用,Hes1高表达可能意味着预后较差。     

p28GANK在肝门胆管癌表达的意义及其与预后的关系

目的：探讨p28GANK在肝门胆管癌中表达的意义及其与患者术后预后的关系。 方法：用免疫组化染色检测p28GANK在肝门胆管癌组织（62例）及正常胆管组织（16例）表达,分析其表达水平与患者临床病理特征以及术后生存的关系。 结果：p28GANK在胆管癌组织中的阳性表达率为74.2%（46/62）,而在正常胆管组织中为0,两者差异有统计学意义（P<0.01）。p28GANK在癌组织表达水平与患者年龄、性别分组间差异无统计学意义（均P>0.05）,而在肿瘤分化程度、TNM分期、肝门静脉侵润、淋巴结转移分组间差异有统计学意义（均P<0.05）;p28GANK阳性表达患者术后5年生存率明显低于阴性表达者（P=0.001）。 结论：p28GANK在肝门胆管癌中表达增高,其高表达患者恶性进展程度密切相关,并提示术后预后不良。

     

LYVE-1在肝细胞癌组织中的表达及其意义

目的：探讨淋巴管内皮细胞透明质酸受体-1(LYVE-l)在肝癌组织中的表达及其临床意义。
方法：采用蛋白质印迹法检测24例低分化肝细胞癌, 6例高分化肝细胞癌和30例正常肝组织中LYVE-1的蛋白表达。
结果：肝癌组织LYVE-l表达阳性。低分化肝癌组织中LYVE-l的表达高于高分化肝癌组织二者均显著高于正常肝组织（P＜0.05）。
结论：LYVE-1可作为肝癌组织的淋巴管特异性标志物,为肝癌的预后提供了一种更有效的研究手段。

     

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。