结直肠癌组织HPV16 E7 DNA及蛋白表达的研究

目的　分析不同部位、分期的结直肠癌及正常黏膜组织中人乳头状瘤病毒(human papilloma virus,HPV)16型E7的表达状况。方法　应用PCR及免疫组化方法检测82例手术切除的结直肠癌新鲜标本及距肿瘤近端10 cm以远的正常黏膜组织中HPV16 E7 DNA及蛋白的表达。结果　结直肠癌组织HPV16 E7 DNA表达阳性率为51.22%(42/82),明显高于正常黏膜组织的4.88%(4/82),P<0.01; 直肠癌组织中HPV16 E7 DNA表达阳性率为64.10%(25/39),明显高于升结肠癌的18. 18%(2/11), P<0. 05; HPV16 E7 DNA表达阳性率与Dukes分期有关(P<0.01),与癌组织分化程度无关。免疫组化染色显示,HPV16 E7蛋白主要为细胞核表达,胞浆也可见少量表达,进一步确认了HPV16的感染,且HPV16 E7蛋白与HPV16 E7 基因的表达具有相关性,免疫组化敏感性较PCR方法为低。结论　结直肠癌组织HPV16 E7 DNA及蛋白的表达阳性率明显高于正常黏膜组织,提示部分结直肠癌存在HPV16感染。癌灶部位距肛门越近,感染率越高; Dukes分期越晚感染率越高。     

食管癌组织人乳头瘤病毒感染与人端粒酶RNA基因表达的关系

目的 探讨食管癌组织中人乳头瘤病毒(HPV)感染与人端粒酶RNA(hTERC)基因表达的关系.方法 82例经病理确诊的食管癌患者组织标本,聚合酶链反应(PCR)技术结合等离子谐振技术检测食管癌组织中HPV感染,荧光原位杂交技术检测食管癌组织中hTERC基因的表达.结果 食管癌组织中存在HPV感染,感染率为43.7％,主要以混合型为主,包括高危亚型HPV16、18;食管癌组织中hTERC 基因的表达率为80.1％;HPV感染与hTERC基因表达关系密切(x2=9.834,P＜0.05).结论 食管癌组织中HPV感染与hTERC基因表达是食管癌发病的重要因素,它可能通过hTERC基因途径引起癌变结果.     

人膀胱癌组织中p16与HPV的相关表达

目的 探讨膀胱癌组中抑癌基因p16及高危性人乳头瘤病毒之间的关系。方法 选取40例人膀胱癌标本,分别采用免疫组化染色方法-LSAB法检测p16及聚合酶链反应技术检测人乳头瘤病毒DNA。结果抑癌基因p16阳性表达率为52.5％(21/40),HPV-DNA阳性表达率为55.0％(22/40),9例标本p16与HPV-DNA同时表达阳性。结论 抑癌基因p16蛋白的表达随着膀胱癌病理分级、临床分期的上升其阳性表达率下降。HPV在病理分级低恶性的组织中表达阳性率高,说明HPV所致的膀胱癌大多数其分化程度较高。在病理分化较好、临床分期早期的同一膀胱癌的9份标本中,HPV-DNA与p16蛋白可同时表达阳性。抑癌基因p16与人乳头瘤病毒在膀胱癌的发生、发展过程中无明显相关性。     

GPAA1在结直肠癌中表达增强及其意义

目的 通过检测GPAA1在结直肠癌组织中的表达以探讨其与结直肠癌增殖、侵袭、转移的关系.方法 取新鲜结直肠癌原发灶组织(52例)、正常结直肠黏膜(52例)和肝转移灶组织标本(11例)分别行免疫组织化学检测;实时定量PCR检测每个组织样本中GPAA1基因表达水平;高表达GPAA1 mRNA结直肠癌组织和低表达GPAA1 mRNA结直肠癌组织行原代细胞培养,将培养获得的原代细胞进行Boyden小室体外增殖、侵袭实验.结果 52例结直肠癌患者标本经免疫组织化学检测,GPAA1在结直肠正常肠黏膜、癌原发灶、肝转移灶中的表达阳性率分别为21.15% ( 11/52)、55.76% (29 /52)、和72.73% ( 8/11).GPAA1在结直肠癌原发灶、肝转移灶中表达阳性率均高于正常肠黏膜组织(P＜0.01).通过实时定量PCR检测发现GPAA1 mRNA表达水平在结直肠癌原发灶、肝转移灶中均高于结直肠正常肠黏膜(P＜0.01);在肝转移灶中的GPAA1 mRNA水平高于癌原发灶(P＜0.05);高表达GPAA1 mRNA的原代细胞穿透Matrigel微孔滤膜细胞数明显高于低表达GPAA1 mRNA组.结直肠癌组织中GPAA1 mRNA的表达水平与组织分化程度相关,而与年龄、性别及Dukes分期无明显相关,(P<0.05).结论 GPAA1表达增强与结直肠癌的发生、侵袭、转移有密切关系.     

不同人群人乳头瘤病毒感染情况分析

目的:分析门诊患者人乳头瘤病毒(HPV)的感染情况、年龄特征、性别差异、亚型分布特点,为制定HPV感染的预防策略提供依据。方法:采用实时多重荧光核酸扩增技术,对1 180例门诊就诊者进行HPV基因型的分型检测。结果:330例男性患者,共检出HPV阳性157例,其中高危亚型101例(64.33%);低危亚型106例(67.50%);年龄分布:21~30岁阳性71例(46.41%);31~40岁阳性47例(45.19%);41~50岁阳性29例(50.00%);51岁以上阳性10例(66.67%)。男性患者中检出率最高的3种亚型依次为39型、16型59型。850例女性共检出HPV阳性243例,其中高危亚型198例(81.48%);低危亚型79例(32.51%);年龄分布情况:21~30岁阳性113例(41.09%);31~40岁阳性58例(21.25%);41~50岁阳性43例(24.57%);50~60岁阳性24例(26.09%);61岁以上阳性5例(14.29%)。女性患者中检出率最高的3种亚型依次为58型、16型和52型。结论:女性HPV感染高发于育龄期妇女并呈年轻化趋势,应加大对21~30岁已婚妇女的HPV筛查,同时加大男性HPV感染的筛查对有效降低宫颈癌的发生率和致死率有重要意义。     

男性人乳头瘤病毒检测方法的建立及临床应用

目的:建立一种适合临床男性人乳头瘤病毒(HPV)基因亚型检测的新方法,并通过检测棉拭子采集男性尿道口分泌物来验证该方法的临床检测效果。方法:通过计算机辅助,参考经典通用引物(MY09/11)和加以改进的PGMY09/11设计23种HPV基因亚型的PCR扩增引物,根据GenBank中的HPV的型特异性序列设计及合成探针,制备可同时对18种高危型:HPV-16,18,31,33,35,39,45,51,52,53,56,58,59,66,68,73,83,MM4和5种低危型:6,11,42,43,44进行分型检测的特定纸质膜芯片,并且对112例采用棉拭子采集的男性尿道口分泌物进行检测加以验证,同时,对单一阳性标本进行测序验证,对标准品进行灵敏度检测。结果:112例男性尿道口分泌物中检测出25例HPV阳性标本,其中单一HPV亚型感染13例,多重感染12例,检测出的男性HPV基因亚型有:HPV-6,11,16,18,33,35,43,56和73型九种。灵敏度可达10个拷贝HPVDNA分子。结论:该方法适用于临床进行男性HPV感染的诊断以及为开展相应的流行病、病因学调查提供切实可行的检测手段。     

高危型HPV16/18感染与前列腺癌的相关性分析

目的:通过检测高危型人乳头瘤病毒(HPV)16/18在前列腺癌(PCa)和良性前列腺增生(BPH)中的表达,探讨HPV16/18与PCa发病之间的相关性,并分析其与临床相关病理参数之间的关系。方法:选取75例PCa和73例BPH组织标本,通过免疫组化和PCR结合反向斑点杂交(RDB)技术,检测HPV16/18的感染情况。结果:免疫组化检测显示,75例PCa标本中16例HPV16/18阳性,阳性率为21.3%;73例BPH标本中7例阳性,阳性率为9.6%,两者比较差异有统计学意义(P=0.049)。PCR结合RDB技术检测显示,75例PCa标本中HPV16阳性17例(22.7%)、HPV18阳性13例(17.3%),其中有4例HPV16/18均阳性;73例BPH标本中HPV16阳性6例(8.2%),HPV18阳性3例(4.1%),无共同阳性例数,两者HPV16/18感染率比较差异有统计学意义(P=0.001)。对比免疫组化和PCR结合RDB 2种方法,两者比较无统计学差异(P=0.069)。HPV16/18感染与PCa临床病理参数中的临床T分期、Gleason评分、临床危险因素等级有一定相关性(P均0.05),而与年龄、PSA值、有无淋巴结转移等参数无相关性。结论:高危型HPV16/18感染与PCa存在一定的相关性。     

鸟苷蛋白在结直肠癌组织中的差异表达

目的探讨鸟苷蛋白（guanylin）在人结直肠癌组织中的表达规律。方法应用RT—PCR和半定量分析方法对20例结直肠癌组织标本进行检测．并结合临床病理特点进行分析。结果guanylin基因在肿瘤组织和正常组织中的阳性表达率分别为35％（7／20）及80％（16／20）,差异有统计学意义（P〈0．01）。其中14例具有差异表达的结直肠癌标本guanylin表达较正常肠黏膜明显降低．差异有统计学意义（P〈0．01）。guanylin的差异表达与结直肠患者的肿瘤TNM分期相关,而与患者性别、肿瘤大体类型和分化类型无关。结论guanylin在结直肠癌组织中呈低表达,其差异表达与肿瘤的TNM分期相关。     

男性人乳头瘤病毒检测方法的建立及临床应用

目的：建立一种适合临床男性人乳头瘤病毒（HPV）基因亚型检测的新方法，并通过检测棉拭子采集男性尿道口分泌物来验证该方法的临床检测效果。方法：通过计算机辅助，参考经典通用引物（MY09／11）和加以改进的PGMY09／11设计23种HPV基因亚型的PCR扩增引物，根据GenBank中的HPV的型特异性序列设计及合成探针，制备可同时对18种高危型：HPV-16，18，31，33，35，39，45，51，52，53，56，58，59，66，68，73，83，MM4和5种低危型：6，11，42，43，44进行分型检测的特定纸质膜芯片，并且对112例采用棉拭子采集的男性尿道口分泌物进行检测加以验证，同时，对单一阳性标本进行测序验证，对标准品进行灵敏度检测。结果：112例男性尿道口分泌物中检测出25例HPV阳性标本，其中单一HPV亚型感染13例，多重感染12例，检测出的男性HPV基因亚型有：HPV-6，11，16，18，33，35，43，56和73型九种。灵敏度可达10个拷贝HPV DNA分子。结论：该方法适用于临床进行男性HPV感染的诊断以及为开展相应的流行病、病因学调查提供切实可行的检测手段。     

805例肛门直肠常见病变中人乳头瘤病毒16型和18型感染率的分析

目的分析高危16型和18型人乳头瘤病毒（HPV）在肛门直肠常见病变的鳞状及柱状细胞中的感染情况。方法对南京中医药大学第三附属医院全国肛肠医疗中心的肛门直肠常见病变切除的805例石蜡标本采用实时荧光定量PCR仪进行16和18两种高危型HPVDNA的分型检测。结果肛门直肠常见病变总的HPV感染阳性率为66．1％（532／805）,混合痔阳性率为82．6％（95／115）,月T乳头状纤维瘤阳性率为76．5％（88／115）,内痔阳性率为74．8％（86／115）,肛瘘阳性率为72．2％（83／115）,外痔阳性率为69．6％（80／115）,肛周脓肿阳性率为47.8％（55／115）,肛裂阳性率为39．1％（45／115）。结论肛门直肠常见病变中高危16型和18型HPV的感染率较高,提示肛门直肠是又一个人乳头瘤病毒的高感染区。     

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。