血管内皮生长因子在直肠癌中的表达与临床意义

目的：探讨血管内皮细胞生长因子在直肠癌中的表达及临床意义。方法：应用免疫组化S－P法，检测124例病人直肠癌组织中血管内皮细胞生长因子（VEGF）蛋白表达和微血管密度（MVD），分析VEGF和MVD及其与直肠癌组织学分型、Dukes分期，癌肿浸润转移的关系。结果：VEGF表达强度和MVD与直肠癌的Dukes分期（P＜0．05）、淋巴结转移（P＜0．05）及远处转移（P＜0．01）密切相关，而与组织学分型无关（P＞0．05），MVD与VEGF表达两者呈达相关（r=0.89)。结论：VEGF与直肠癌的血管生成密切相关，对直肠癌的生长和浸润转移有促进作用，VEGF和MVD可作为反映直肠癌生长学行为的指标之一。     

肝外胆管癌组织中PTTG和VEGF的表达及相关性研究

目的探讨PTTG和VEGF蛋白在肝外胆管癌中的表达相关性及其与胆管癌发展的关系。方法应用免疫组化技术SABC法检测PTTG和VEGF蛋白在36例胆管癌标本、30例胆管癌旁组织和12例胆管良性病变中的表达。结果胆管癌组织和癌旁组织中PTTG的阳性表达率分别为72．2％（26／36）和63．3％（19／30），VEGF的阳性表达率分别为83．3％（30／36）和76．7％（23／30）；在胆管良性病变组织中均未检测到PTTG和VEGF的表达。上述3种组织之间的PTTG和VEGF蛋白表达差异均有显著性（P〈0．05）。癌组织中PTTG和VEGF蛋白的表达呈正相关（r=0．703，P〈0．001）。PTTG和VEGF蛋白表达与肿瘤转移与否关系密切，但与患者的性别、年龄、肿瘤大小及分化无关。结论PTTG和VEGF在胆管癌中高表达，两者表达呈正相关；与胆管癌的转移与否关系密切。     

血管内皮生长因子及微血管密度与胃癌进展的关系

目的：探讨血管内皮生长因子（VEGF）及微血管密度（MVD）与胃癌临床病理因素的关系。方法：应用免疫组织化学（SP）方法测定胃癌及胃良性病变中VEGF表达及MVD。结果：胃癌组VEGF表达阳性率为75．0％，胃良性病变组为5．0％（P＜0．05），未浸润浆膜层者为50．0％，浸润浆膜层者为95．5％（P＜0．05），有淋巴民移者为82．8％，无淋巴结转移者为54．5％（P＜0．05），伴有远处转移者为100％，不伴有远处转移者为71．0％（P＜0．05），pTNM分期属，I，II期者为53．1％，Ⅲ，Ⅳ期者为89．6％（P＜0．05），胃良性病变的MVD显著低于胃癌组（P＜0．001），浸润深度达浆膜层，有淋巴结转移和远处转移及pTNM属Ⅲ，Ⅳ期者的MVD显著升高，其差异有显著性意义，VEGF表达与MVD明显相关，结论：VEGF上调及MVD增加对胃癌生长具有促进作用。     

Survivin蛋白在肝门部胆管癌中的表达及其与p53相关性的研究

目的：检测肝门部胆管癌中凋亡抑制因子Survivin蛋白的表达，研究其与肝门部胆管癌的临床特征的关系，并探讨其与p53的相关性。方法：采用免疫组织化学方法检测86例肝门部胆管癌组织、10例癌旁组织（距肿瘤边缘约1．0cm）及10例正常胆管组织中Survivin蛋白和p53蛋白的表达，结合临床病理学资料进行统计学分析。结果：86例肝门部胆管癌组织中，Survivin蛋白阳性率为82．6％（71／86），p53蛋白阳性率为76．7％（66，86），Survivin与p53在癌旁组织和正常胆管组织中均呈阴性表达，与癌组织相比差异有统计学意义（P〈O．05）；Survivin表达与肝门部胆管癌病理分级、Bismuth分型、患者的性别及年龄和肿瘤大小均无关（P〉0．05），但淋巴结转移阳性组Survivin蛋白表达水平明显高于淋巴结转移阴性组，差异有统计学意义（P〈0．05）；p53蛋白在肝门部胆管癌中与肿瘤组织病理分级、淋巴结有无转移相关（P〈0．05），与其他病理学特征无关（P〉O．05）。71例Survivin阳性表达者中同时表达p53阳性者58例，15例阴性表达者中表达p53阳性者8例，两者差异有统计学意义（P〈0．05）。结论：肝门部胆管癌组织中Survivin和p53的表达显著高于癌旁组织和正常胆管组织，其在肝门部胆管癌的发展、转移过程中可能具有重要作用。     

环氧化酶-2和nm23H1蛋白表达及其与胆管癌的相关性

目的探讨环氧化酶-2（cyclooxygenase-2,COX-2）和nm23H1蛋白在胆管癌中的表达及临床意义。方法应用免疫组化方法检测46例胆管癌和10例正常胆管组织中COX-2及nm23H1蛋白表达水平．并结合临床病理特征进行分析。结果在胆管癌中COX-2及nm23H1蛋白阳性表达率分别为78.3％（32／46）和54．3％（25／46）。胆管癌中COX-2表达阳性率显著高于正常胆管组织（P〈0．05）,而nm23H1表达阳性率显著低于正常胆管组织fP〈0．051。COX-2表达与胆管癌的TNM分期和转移相关（心0．05）,而与胆管癌分化程度无关（P〉0．05）。nm23H1表达与胆管癌的TNM分期、分化程度和转移相关（P〈0．05）。结论检测COX-2和nm23H1基因蛋白表达可作为评估胆管癌生物学行为和预后的参考指标。     

乳腺癌组织中血管内皮生长因子mRNA的表达和微血管计数与淋巴结转移的关系

目的：探讨乳腺癌组织中血管内皮生长因子（VEGF）mRNA的表达，微血管密度（MVD）与淋巴结转移的关系。方法：采用逆转录－聚合酶链反应（RT－PCR）和免疫组织化学链霉卵白素－过氧化物酶（SP）法技术，对47例乳腺癌组织VEGF mRNA、VEGF蛋白的表达及微血管密度进行研究。结果：乳腺癌组织VEGF mRNA的表达高于癌旁组织（55．30％：17．02％）。VEGF mRNA的表达与淋巴结转移呈正相关趋势。VEGF表达和MVD与乳腺癌淋巴结转移密切相关（P＜0．05）。癌组织MVD值明显高于癌旁组织MVD值。结论：VEGF与乳腺癌血管生成密切相关，VEGF和MVD表达增高对乳腺癌淋巴结转移有促进作用。     

血管内皮生长因子D和微淋巴管密度及微血管密度与直肠癌进展的关系

目的研究血管内皮生长因子D（VEGF—D）、微淋巴管密度（MLD）和微血管密度（MVD）在直肠癌中的表达情况及它们与直肠癌发展、转移的相关性。方法选取手术切除并经病理证实的中低位直肠癌标本80例、直肠息肉标本40例和正常直肠组织80例，应用免疫组织化学方法测定其VEGF—D的表达和MLD、MVD水平。结果（1）VEGF—D在直肠癌组织中的阳性率为55％（44／80），直肠息肉和正常直肠组织则均为0（P〈0．05）；MLD在直肠癌组织中为2．80±1．31，直肠息肉中为0．50±0．72，正常直肠组织中MLD为0．25±0．44，直肠癌组织中的MLD明显高于直肠息肉和正常直肠组织（P〈0．05）；MVD在直肠癌组织中为80．10±23．18，直肠息肉中为27．00±11．01，正常直肠组织中为10．45±5．34，直肠癌组织中的MVD明显高于直肠息肉和正常直肠组织（P〈0．05）。（2）直肠癌组织中的VEGF-D表达和MLD、MVD水平与淋巴结转移、术前远处转移有明显相关性（P〈0．01，P〈0．05）。（3）直肠癌组织中的MLD与VEGF—D呈正相关，随着VEGF—D表达的增高MLD明显增高（P〈0．01）。结论VEGF-D和MLD是反映直肠癌淋巴管生成的理想指标，同时也是反映直肠癌进展程度的重要指标，直肠癌淋巴管生成及血管生成可能具有协同作用。     

促血管生成素家族在大肠腺癌中的表达及与微血管密度和临床病理特征的关系

目的 探讨促血管生成素-1（Ang-1）、促血管生成素-2（Ang-2）、促血管生成素受体（Tie-2）及血管内皮生长因子（VEGF）在大肠腺癌及癌旁正常组织中的表达，及与微血管密度（MVD）和临床病理特征的关系。方法 采用免疫组织化学方法检测Ang-1、Ang-2、Tie-2及VEGF在45例大肠腺癌及10例癌旁正常组织中的表达。结果 大肠腺癌组织中的Ang-2蛋白及VEGF蛋白明显高于癌旁正常组织（P〈0．01），腺癌的分化程度越低，Ang-2及VEGF蛋白的表达率越高（P〈0．05），Ang-2与VEGF蛋白的表达存在明显正相关性（r=0．997，P〈0．01）；大肠腺癌组织中的Ang-1蛋白明显低于癌旁正常组织（P〈0．01），腺癌的分化程度越高，Ang-1蛋白的表达率越高（P〈0．05）；Tie-2蛋白在大肠腺癌和癌旁正常组织中的表达差异无统计学意义（P〉0．05）。大肠腺癌的分化程度越低，MVD越高（P〈0．05），腺癌组织中Ang-1蛋白阳性表达组MVD明显低于阴性表达组（P〈0．01），Ang-2蛋白阳性表达组MVD明显高于阴性表达组（P〈0．01）。≥5cm及有淋巴结转移的大肠腺癌组织中，Ang-2蛋白的表达明显增加（x^2=8．889，P〈0．01；x^2=10．020，P〈0．01）。结论 在大肠腺癌组织中，相对Ang-1占优势的Ang-2的过度表达，可能在肿瘤的血管生成和进展过程中起着重要作用。     

Syndecan-1和MMP-1在胃癌组织中的表达及其临床意义

目的：探讨Syndecan-1和MMP－1在胃癌组织中的表达及意义。方法：应用SP免疫组化染色技术，检测82例胃癌、18例异型增生及36例正常胃黏膜组织中Syndecan-1和MMP－1的表达。结果：胃癌组织Syndecan-1表达阳性率为57．32％（47/82),胃异型增生组织为83．33％（15／18），正常胃黏膜组织均呈Syndecan-1阳性表达。胃癌组织的Syndecan-1表达与正常胃黏膜上皮、胃异型增生组织中的表达相比差异显著（P＜0．01）。胃癌组织的MMP－1表达阳性率为98．78％（81／82），其中强阳性表达占45例（54．88％）；胃异型增生组织MMP－1阳性率为88．89％（16／18），无强阳性表达；正常胃黏膜组织MMP－1表达阳性率为5．56％（2／36）。胃癌组织的MMP－1表达与正常胃黏膜上皮、胃异型增生组织中的表达相比差异显著（P＜0．01）。Syndecan-1表达的减弱、MMP－1表达的增强与胃癌的淋巴结转移、静脉侵犯、淋巴管仇犯、浸润深度、TNM分期显著相关（P＜0．05）。Syndecan-1表达与MMP－1表达呈负相关。结论：联合检测Syndecan-1和MMP－1对胃癌的早期诊断及判断预后有参考价值。     

胃癌组织血管内皮细胞生长因子及其受体Flt-1的表达及与胃癌生物学行为的关系

目的探讨血管内皮细胞生长因子（VEGF）及其受体fms-样酪氨酸激酶（Flt-1）在胃癌组织中的表达及其与肿瘤微血管密度（MVD）、浸润转移和生存期的关系。方法应用原位杂交和免疫组织化学技术，检测118例胃癌组织中VEGF和Flt-1 mRNA及CD34蛋白的表达。结果胃癌组织中VEGF和Flt-1 mRNA的阳性表达率分别为54．24％和55．9％：浸润性生长的肿瘤组织中VEGF和Flt-1的阳性表达率和MVD值明显高于膨胀性生长者（P〈0．01），VEGF和Flt-1表达及MVD值与浸润深度、脉管侵犯、淋巴结转移和远处转移显著相关（P〈0．05）；MVD值与VEGF和Flt-1 mRNA的表达水平有关（均P〈0．01）；VEGF和Flt-1 mRNA阳性表达及MVD值超过或等于54．9个／mm^2患者的平均生存时间和5年生存率均显著低于VEGF和Flt-1 mRNA阴性表达及MVD值少于54．9个／mm^2者。结论VEGF和Flt-1 mRNA可促进胃癌血管生成。并参与肿瘤浸润转移的过程，可作为反映胃癌生物学行为和判断预后的生物学指标。     

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。