骨肉瘤中血管生成素-2与受体Tie-2 mRNA表达及其意义

目的 探讨血管生成素-2（Ang-2）及其受体Tie-2在骨肉瘤血管生成中作用及其对骨肉瘤恶性演进的影响。方法 采用原位杂交和免疫组织化学技术，检测46例骨肉瘤、15例骨软骨瘤、5例正常骨组织中Ang-2、Tie-2mRNA表达及骨肉瘤中VEGF、CD34蛋白表达，计数微血管密度（MVD）；并与骨肉瘤主要病理学参数进行比较。结果 Ang-2、Tie-2mRNA在正常骨组织无表达，少量表达于骨软骨瘤及骨肉瘤瘤旁组织，明显表达于骨肉瘤中（69．6％、73．9％）；Ang-2、Tie-2表达水平与骨肉瘤组织学分级分型无关，转移组显著高于无转移组（P〈0．01）；高MVD组高于低MVD组（P〈0．01），Ang-2与VEGF表达相关，Ang-2与Tie-2表达正相关（r=0．445，P〈0．01）。结论 Ang-2及其受体Tie-2参与了骨肉瘤血管生成调控，与骨肉瘤浸润性生长和转移密切相关。     

环氧合酶-2及血管生成素-2在大肠癌中的表达及临床意义

目的 研究环氧合酶-2（cyclooxygenase-2，Cox-2）及血管生成素-2（angiopoietin-2，Ang-2）在大肠癌组织、癌旁组织及正常大肠组织中的表达及其与大肠癌临床病理特征之间的关系。方法 采用免疫组化SP法检测45例大肠癌组织、45例癌旁组织及15例正常大肠组织中Cox-2和Ang2的表达情况。结果 大肠癌组织中的Cox-2和Ang-2的表达阳性率（80.0％，66.7％）均分别高于癌旁组织（35．6％，11．1％）及正常大肠组织（0，0），P均〈0.01。在大肠癌组织中Cox-2和Ang-2蛋白表达与淋巴结转移及Dukes分期有关（P〈0．05），且二者的表达具有相关性（P〈0．01）。结论 Cox-2和Ang-2在大肠癌发生、发展中起重要作用，二者在表达上密切相关。     

PTEN和VEGF的表达与膀胱癌血管生成关系的研究

目的研究膀胱癌组织中抑癌基因PTEN和血管内皮生长因子（VEGF）的表达与膀胱癌血管生成的关系。方法应用免疫组织化学S-P法检测62例膀胱癌组织和18例慢性膀胱炎组织（对照组）中PTEN和VEGF的表达，同时分析不同PTEN和VEGF表达状态下，膀胱癌组织微血管密度（MVD）的变化。结果膀胱癌组和对照组PTEN阳性率分别为53．2％（33／62）和100．0％（18／18），2组比较差异有统计学意义（P＜0．01）；膀胱癌组和对照组VEGF阳性率分别为62．9％（39／62）和27．8％（5／18），2组比较差异有统计学意义（P＜0．01）；PTEN和VEGF的表达呈负相关（r=-0．832，P＜0．01）。将膀胱癌分为4组，组A为PTEN阴性VEGF阳性（n=19），组B为PTEN阴性VEGF阴性（n=10），组C为PTEN阳性VEGF阳性（n=20），组D为PTEN阳性VEGF阴性（n=13）。4组平均MVD分别为41．53、31．40、26．55、25．15，组A显著高于其他3组（P＜0．05）。结论膀胱癌PTEN基因失活可能通过增加VEGF的表达来促进血管生成，导致肿瘤恶性进展。     

血管内皮生长因子和间隙连接蛋白43在胰腺癌组织中的表达及其临床意义

目的探讨血管内皮生长因子（VEGF）和间隙连接蛋白43（Cx43）在胰腺癌组织中的表达特征及其临床意义。方法采用免疫组织化学链霉菌抗生物素蛋白-过氧化物酶连结法观察70例胰腺癌组织和癌周正常组织中VEGF和Cx43的表达情况，分析其表达与胰腺癌临床病理特点之间的关系。结果VEGF在胰腺癌组织中的阳性表达率为77．1％（54／70），在癌旁正常组织中的阳性表达率为18．6％（13／70），两者差异有统计学意义（P〈0．01）；Cx43在胰腺癌组织中的阳性表达率为30．0％（21／70），在癌旁正常组织中的阳性表达率为72．9％（51／70），两者差异有统计学意义（P〈0．01）。VEGF表达水平与胰腺癌肿瘤大小、TNM分期、淋巴结转移有关（P〈0．05），Cx43表达水平与胰腺癌组织学分化程度、TNM分期、淋巴结转移有关（P〈0．05）。结论同时检测VEGF与Cx43表达水平有助于判断胰腺癌恶性程度和预后。     

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。     

血管内皮生长因子和促血管生成素及其受体Tie2在肝细胞癌发生发展中的作用

目的探讨血管内皮生长因子(VEGF)和促血管生成素(Angiopietin)及其受体Tie2在启动肝细胞癌(HCC)血管生成中的调控机制及在HCC发生发展中的作用。方法新鲜HCC标本及癌旁肝组织38例,用实时定量逆转录-聚合酶链反应(RT-PCR)的方法检测Ang-1、Ang-2、Tie2和VEGF在各组织标本中的表达,以CD34标记新生血管内皮并计数微血管密度(MVD),分析上述因子在HCC组织和非癌肝组织中的表达差异、相互作用及其与MVD、临床病理特征之间的关系。结果Ang-1、Tie2在HCC和非癌肝组织中的表达差异无统计学意义(0．194 7±0．086 2比0．232 6±0．109 8,1．601 6±0．900 7比1．340 0±0．703 7,P均>0．05),而VEGF和Ang-2在HCC组织的表达高于非癌肝组织(1．038 0±0．572 0比0.832 3±0．182 4,0．621 3±0.417 6比0．442 9±0．330 1,P均<0．05);VEGF、Ang-2、Ang-2／1都与MVD和临床病理特征相关(P<0．01),但与组织分化程度无关(P>0．05)。结论Ang-2／1的失衡表达及其与VEGF和Tie2的共同作用是启动肝组织血管生成并诱发HCC发生、发展的重要因素;这种因素在HCC中的持续作用进一步促进了肿瘤血管生成和恶性生物学行为。     

EGFL7和VEGF在肾透明细胞癌血管生成及转移中的相关性研究及临床意义

目的：探讨表皮生长因子样结构域7（EGF_1ikedomain7,EGFL7）、血管表皮生长因子（vascularen—dothelialgrowthfactor,VEGF）在肾透明细胞癌中的表达及其与肾癌血管生成和转移的关系。方法：选取87例行根治性肾切除的肾透明细胞癌患者癌及癌旁组织标本,采用免疫化学SP法检测EGFL7、VEGF的表达,并计数血管内皮细胞表面抗原（CD34）标记的血管密度（MVD）;同时选取46例癌及癌旁组织标本,采用RT—PCR检测EGFL7mRNA的表达。结果：EGFL7和VEGF阳性表达率及MVD值在癌组明显高于癌旁组（P〈O．05）,且EGFL7、VEGF与MVD在肾透明细胞癌组织中的表达呈正相关,并与肿瘤分级、分期显著相关（P〈0．05）;EG—FL7mRNA阳性表达率明显高于癌旁组织（P〈O．05）,并与肿瘤分级、分期相关（P〈O．05）。结论：肾透明细胞癌组织中EGFL7、VEGF的表达与肾癌血管生成有关,两者可能协同肿瘤新生血管的生成。     

胆囊良、恶性病变组织中CA19-9和CA125的表达及其临床病理意义

目的研究胆囊腺癌及其癌旁组织和慢性胆囊炎组织中CA19-9和CA125表达水平并探讨其临床病理意义。方法108例胆囊腺癌、46例癌旁组织和35例慢性胆囊炎手术切除标本常规石蜡包埋切片，应用En-Vision^TM免疫组化法检测CA19-9和CA125的蛋白表达。结果胆囊腺癌组织中CA19-9和CA125的表达阳性率（49．1％、51．9％）明显高于癌旁组织（26．1％、15．2％）和慢性胆囊炎组织（14．3％、5．7％），P〈0．01。腺瘤癌变、肿块最大径〈2cm、无淋巴结转移和未侵犯周围组织者CA19-9和CA125的表达阳性率均明显低于低分化腺癌、肿块最大径≥2cm、有淋巴结转移和侵犯周围组织器官者（P〈0．05，P〈0．01）；两者在胆囊腺癌中的表达具有一致性（χ^2=44．69，P〈0．01）。结论CA19-9和CA125可能是反映胆囊腺癌发生、发展、生物学行为和预后的重要肿瘤标志物。     

反转录-聚合酶链式反应检测促血管生成素-1和促血管生成素-2及Tie-2受体的mRNA在血管瘤组织中的表达及其意义

目的研究血管瘤组织中促血管生成素-1（Ang-1）、促血管生成素-2（Ang-2）及Tie-2受体的mRNA表达水平,探讨其在血管瘤血管生成中的作用与意义。方法用反转录-聚合酶链式反应（RT—PCR）的方法分别检测30例血管瘤组织（增生期血管瘤17例,消退期血管瘤13例）以及10例小儿正常皮肤组织中Ang-1mRNA、Ang-2mRNA及Tie-2mRNA的表达水平。用免疫组织化学方法检测血管瘤组织Ki-67蛋白的表达。结果增生期血管瘤组织中Ang-2mRNA及Tie-2mRNA表达水平高于消退期血管瘤组织（P〈0．01）。血管瘤组织中Ang-1mRNA表达为阴性。结论Ang—Tie-2体系表达失衡在血管瘤的发生发展过程中可能起重要的作用。     

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。