尿AMACR mRNA定量检测在前列腺癌诊断中的价值

目的探讨前列腺按摩后尿沉渣中AMACR mRNA含量在前列腺癌诊断中的价值。方法前列腺癌（PCa）患者30例和良性前列腺增生（BPH）患者41例，在前列腺穿刺活检前收集前列腺按摩后的尿液，离心取细胞沉淀物，用实时荧光定量RT-PCR检测AMACR mRNA的含量，并用PSA mRNA进行校正，即用AMACR mRNA表达量／PSA mRNA表达量比值来表示AMACR mRNA的含量。结果AMACR mRNA在PCa组患者尿液中的含量明显高于BPH组，差异具有统计学意义（P〈0．01）。ROC曲线分析结果显示，曲线下面积为0．763，以0．277为截断值时，其诊断PCa的总体灵敏度和特异度分别为66．7％和75．6％。如果血清PSA以10ng／ml为临界值，其总体特异度为58．5％（24／41），尿液AMACR mRNA较血清PSA具有更高的特异性。不同临床分期、不同病理分级之间，AMACR mRNA表达量及检测阳性率均不具有统计学意义（P值均〉0．05）。结论尿液中AMACR mRNA的表达量可以作为前列腺癌诊断的一种非损伤性指标，而且在PCa的早期诊断中也有潜在的临床价值。     

Smad4蛋白和Smad3蛋白在前列腺癌组织中的表达及意义

目的探讨Smad3、Smad4蛋白在正常前列腺组织和前列腺癌中的表达，以及与临床分期、病理分级、预后的关系。方法采用免疫组织化学ABC法对正常前列腺组织和前列腺癌组织中Smad3和Smad4蛋白进行检测。结果Smad4在正常前列腺中阳性表达率为83．3％（10／12），在Gleasons评分≤5者，6-8者及≥9者肿瘤中的阳性表达率，分别为56．5％（13／23），44．4％（8／18）和25％（2／8），在T1—T2和T3-T4肿瘤中的表达为52．4％（11／21）和42．8％（12／28）。Smad4表达在病理分级间有显著性差异，在临床分期间无显著性差异，Smad3在前列腺组织和前列腺缩的表达间无显著性差异。T1-T2期与正常前列腺组织相比P〈0．05：T3-T4期与正常前列腺组织相比P〈0．05：高分化前列腺癌与正常前例腺组织相比P〉0．05：中分化前列腺癌与正常前列腺组织相比P〈0．05；低分化前列腺癌与正常前列腺组织相比P〈0．01：低分化腺癖与高分化腺癌相比P〈0．05。结论前列腺癌中Smad4蛋白表达减低，与肿瘤分级、分期有关，其异常表达与预后不良有关，Smad3与正常组织相比无显著性差异。     

组织芯片检测Claudin-3在前列腺癌中的表达

目的：检测Claudin-3在前列腺癌中的表达情况,探讨其与前列腺癌发生发展的关系。方法：采用组织芯片技术构建包含64例前列腺癌和39例前列腺增生组织的64点阵石蜡组织芯片,用免疫组化sP法检测该芯片中Claudin-3的表达,分析其与前列腺癌Gleason评分和临床分期的关系。结果：前列腺癌Claudin-3阳性表达率为60．94％（39／64）,前列腺增生表达率17．95％（7／39）（P〈0．05）;Claudin-3与前列腺癌Gleason评分和临床分期明显相关。结论：Claudin-3异常表达与前列腺癌发生发展有密切关系。     

AMAER/P504S回顾与展望

为了寻找前列腺癌早期诊断、临床分期、疗效评价以及随访等有价值的指标，本文就前列腺癌组织的阳性标记物α-甲基酰基辅酶A消旋酶（AMACR／P504S）的发现、发展、运用等作了相关综述。AMACR／P504S选择性在前列腺腺癌中过表达的发现，是现代微序列技术的一个令人振奋的成功，也是方法学运用到促进诊断学相关抗体发展的有力证明。抗P504S的免疫组织化学染色在前列腺癌诊断中的价值已被证实，其应用使前列腺癌的活检检出率显著提高。适用范围涵盖细针穿刺标本、经尿道前列腺切除以及前列腺切除术等各种外科前列腺标本。P504S和前列腺基底细胞标记物高分子量细胞角蛋白34βE12与p63在前列腺穿刺活检标本中的联合运用越来越受到各方的重视和推荐。虽然仍然存在特异性和敏感性上的问题，但P504S已经成为前列腺病理诊断中协同诊断前列腺癌以及一些非典型病变的标准辅助染色，可以及早的发现癌前病变，也大大提高了前列腺癌诊断的正确率，从而为前列腺癌的早诊断、早治疗提供病理学依据。     

α-甲基酰基辅酶A消旋酶与前列腺癌的研究进展

前列腺癌生物学行为具有特殊性，其早期诊断、鉴别诊断、治疗及预后评价的需要，促进了前列腺癌肿瘤标志物研究的迅猛发展。本文综述了新近发现的有价值的前列腺特异性AMACR基因，人类AMACR基因位于人类染色体5p13．2-q11．1上，AMACR在人前列腺癌组织高度表达，其特异性、敏感性分别为89．2％、92．3％，与前列腺癌组织发生和发育有关，有可能成为一种新的临床诊断指标和治疗前列腺癌的有效工具。     

肿瘤标记物P504s在前列腺癌中的表达及应用价值

目的探讨肿瘤标记物P504s在不同前列腺组织中的表达情况,及在诊断前列腺癌中的应用价值。方法采用免疫组化二步法,观察P504s和基底细胞标记物p63在不同前列腺病变组织中的表达情况。结果①P504s表达在前列腺癌根治标本、高等级上皮内瘤标本、前列腺增生标本中的阳性率分别为91.4%（32/35）、87.0%（20/23）和0（0/30）,良恶性组织的差别有显著性,在前列腺癌穿刺标本中阳性率85.7%（72/84）。p63染色在全部前列腺癌中呈阴性,在高等级上皮内瘤中为不连续或连续的阳性染色,在前列腺增生中为连续的阳性染色。②P504s表达与前列腺癌的分化程度、激素治疗、转移有关。结论P504s是一个特异的前列腺癌标记物,结合p63在鉴别诊断前列腺癌中有重要的临床应用价值。     

AMACR(P504S)、P63、34βE12联合检测在前列腺癌早期诊断中的应用

目的:探讨AMACR(P504S)、P63、34βE12联合检测在前列腺癌(PCa)早期诊断中的临床应用价值。方法:应用即用型组合式单克隆抗体和双酶标记的免疫组化MaxvisionTM一步法检测42例PCa、12例高级别前列腺上皮内瘤变(HGPIN)和30例良性前列腺增生(BPH)穿刺活检标本中AMACR、P63、34βE12的表达情况。比较Glea-son评分各组中AMACR阳性表达情况。结果:AMACR、P63、34βE12抗原在PCa和BPH穿刺标本中的表达差异均有极显著性(P<0.01),PCa组织中AMACR阳性表达率为100%,无P63和34βE12表达;BPH组织中均无AM-ACR表达,P63和34βE12均高表达。HGPIN中AMACR的阳性表达率(91.67%)与BPH差异有极显著性(P<0.01),与PCa差异无显著性(P>0.05);P63和34βE12阳性表达率HGPIN(100%)与PCa差异有极显著性(P<0.01),而与BPH差异无显著性(P>0.05)。AMACR表达强弱与PCa的Gleason评分无关(P>0.05)。结论:AMACR是PCa高度敏感和特异的标志物,P63和34βE12联合标记基底细胞的特异性高,3者联合检测能增加前列腺穿刺活检标本诊断的准确性,在PCa早期诊断中具有重要的临床应用价值。     

雄激素受体在前列腺癌中表达和意义的探讨

目的 探讨雄激素受体（AR）在PCa中的表达和意义。方法 应用免疫组化Elivison法，检测45例PCa和10例前列腺增生组织标本中AR的表达，并探讨AR蛋白表达与PCa分期、分级、术前PSA、内分泌治疗效果及预后的关系。结果 AR在PCa和前列腺增生中阳性表达率分别为90％和93、3％，阳性表达率和表达程度无显著性差异（P〉0.05）；D期和A-C期PCa中阳性表达率分别为100％和87．5％，无显著差异（P〉0．05）．但D期PCa AR阳性表达程度显著增强（P〈0．05）；Gleason评分≤7和Gleason评分〉7PCa中阳性表达率分别为85.7％和100％，无显著差异（P〉0.05），但低分化PCa（Gleason评分〉7）AR阳性表达程度显著增强（P〈0．05）：PSA≤10ng／ml和PSA〉10ng／mlPEa中阳性表达率分别为80％和97.1％，阳性表达率和表达程度无显著性差异（P〉0．05）：在内分泌治疗有效和无效PCa中阳性表达率分别为87．5％和90、9％，阳性表达率和表达程度无显著性差异（P〉0．05）。结论 AR阳性表达程度与PCa分期、分级有关，对判断PCa生物学行为有参考价值。     

PTEN蛋白和VEGF在前列腺癌组织中的表达及其临床意义

目的：探讨第10号染色体缺失的磷酸酶和张力蛋白同源物基因（PTEN）与血管内皮生长因子（VEGF）在前列腺癌组织中的表达及其临床意义。方法：应用免疫组织化学S-P法检测39例前列腺癌（Pca组）组织和20例BPH（对照组）组织中PTEN和VEGF的表达。结果：PTEN蛋白在PCa组和BPH组中阳性率分别为38．46％（15／39）和100％（20／20）,两组差异有统计学意义（P〈0．01）;VEGF在PCa组和BPH组中阳性率分别为56．41％（22／39）和25％（5／20）,两组差异有统计学意义（P〈0．05）;PTEN蛋白的表达与前列腺癌患者临床分期和病理分级呈负相关（P％0．05）,与年龄无显著相关性;而VEGF的表达则与前述临床、病理特征呈正相关（P〈0．05）,前列腺癌组织中PTEN蛋白与VEGF表达呈密切负相关（r=-0．735,P〈0．01）。结论：PTEN蛋白低表达和VEGF高表达在前列腺癌的发生、发展中起重要作用。PTEN蛋白和VEGF可作为判断前列腺癌生物学行为的重要指标,联合检测PTEN蛋白和VEGF的表达水平有助于前列腺癌患者病情判断及预后评估。     

前列腺癌组织中p53、bcl-2和E-cadherin蛋白的表达水平及临床意义

目的探讨不同前列腺组织中p53、bcl-2和E-cadherin蛋白的表达水平及临床意义。方法收集活检或手术切除的人前列腺组织标本,按病理诊断分为前列腺癌组46例、前列腺增生组25例;其中前列腺癌组又分为高分化组(11例)、中分化组(13例)、低分化组(22例)。应用免疫组织化学SP法检测上述标本中p53、bcl-2和E-cadherin蛋白的表达情况。结果前列腺癌组织中p53和bcl-2的阳性表达率(50.0%和58.7%)显著高于前列腺增生组织的p53和bcl-2的阳性表达率(12.0%和8.0%),差异具有统计学意义(P0.05)。bcl-2在前列腺癌高分化组的阳性表达率(36.4%)显著低于低分化组(72.7%)(P0.05)。前列腺增生组织中E-cadherin蛋白表达阳性表达率为100.0%,前列腺癌组织中阳性表达率为43.5%,两组E-cadherin蛋白表达阳性率相比较,差异具有统计学意义(P0.05)。E-cadherin蛋白在前列腺癌高、中、低分化3组中的阳性表达率分别为90.9%、46.2%、18.2%,高分化组阳性表达率显著高于低分化组,差异具有统计学意义(P0.05)。结论 p53、bcl-2和E-cadherin蛋白的异常表达与前列腺癌的发生发展密切相关,检测p53、bcl-2和E-cadherin蛋白表达水平对前列腺癌鉴别诊断及临床预后具有重要价值。     

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。