胃癌组织中血管内皮生长因子C的表达与淋巴结微转移的关系

目的：检测胃癌患者血管内皮因子C（VEGF-C）蛋白及mRNA在胃癌组织中的表达情况,探讨其与胃癌淋巴结微转移的关系。方法应用免疫组织化学法及RT-PCR法检测80例胃癌组织、癌旁组织及正常组织中的VEGF-C蛋白及mRNA表达情况;免疫组化法检测淋巴结微转移情况,比较有无淋巴结微转移的VEGF-C蛋白和mRNA的表达差异,明确存在的关联性。结果VEGF-C蛋白及mRNA两者在胃癌组织中明显高于癌旁组织和正常组织（P＜0.05）。结论胃癌组织中的VEGF-C蛋白及mRNA与胃癌淋巴结微转移相关,基因检测优于蛋白,可作为评价胃癌患者是否存在淋巴结微转移的优选指标。     

Bmi-1在胃癌中的表达及其意义

目的 探讨Bmi-1在胃癌组织中的表达及其与临床病理因素之间的关系.方法 采用RT-PCR和Western blot技术检测44例胃癌组织和癌旁正常组织中Bmi-1的表达.结果 胃癌组织Bmi-1mRNA阳性表达率为72.73％,显著高于癌旁正常组织(13.64％)(P＜0.05);Bmi-1蛋白在胃癌组织中表达显著高于癌旁正常组织(P＜0.05);在有淋巴结转移以及远处转移的患者中Bmi-1的表达显著高于无淋巴结转移和无远处转移阴性患者(P＜0.05).但Bmi-1的表达与患者的性别、年龄、肿瘤大小及分化程度无关,该4因素的分组间差异无统计学意义(P＞0.05).结论 Bmi-1的表达上升可能与胃癌的发生及浸润、转移有关.     

Pim-1在胃癌组织中的表达及其临床意义

探讨Pim-1在胃癌组织中的表达及其临床意义。收集2014年10月—2015年11月手术切除的胃癌石蜡标本和癌旁组织59例。采用实时荧光定量技术(RT-PCR)检测胃癌组织和癌旁组织中Pim-1、VEGF-A mRNA的表达情况。胃癌组织Pim-1、VEGF-A mRNA水平高于癌旁组织,差异有统计学意义(t=20.05,17.39,P=0.000,0.000)。随着TNM分期的增加和分化程度的降低,胃癌组织Pim-1、VEGF-A mRNA水平呈升高趋势(P0.05)。出现远处转移和淋巴结转移者的胃癌组织Pim-1、VEGF-A mRNA水平高于未出现远处转移和淋巴结转移者(P0.05)。胃癌组织中Pim-1、VEGF-A mRNA水平呈正相关(r=0.402,P=0.012)。胃癌组织中Pim-1、VEGF-A的表达高于癌旁组织。Pim-1、VEGF-A的表达与胃癌的病理及预后密切相关,Pim-1、VEGF-A可能共同在胃癌发病中起作用。     

miR-130b和RUNX3mRNA在胃癌组织中的表达及其临床意义

目的 研究miR-130b和RUNX3mRNA在胃癌组织中的表达,并评价miR-130b对抑癌基因RUNX3表达的影响.方法 用荧光定量PCR技术检测40对胃癌组织及其对应的癌旁正常胃黏膜组织中miR-130b和RUNX3mRNA的表达量;用免疫组织化学SP法检测RUNX3蛋白的表达.结果 胃癌组织中miR-130b的表达显著高于对应的癌旁组织(2.18±3.75)比(2.59±3.45),P＜0.05;而胃癌组织中RUNX3mRNA的表达显著低于对应的癌旁组织(8.76±2.82)比(7.58±2.87),P ＜0.05.miR-130b和RUNX3mRNA的表达与胃癌的淋巴结转移、临床分期有关(P＜0.05),而与患者的年龄、性别、肿瘤大小、远处转移、有无浸润周边器官组织无关(均P ＞0.05).miR-130b的表达与RUNX3蛋白的核表达、细胞核+细胞质的表达存在负相关(P＜0.05),而与RUNX3mRNA、RUNX3蛋白的细胞质表达无相关性(P＞0.05).结论 miR-130b和RUNX3mRNA的异常表达与胃癌预后有关;miR-130b可能通过减少RUNX3蛋白的表达水平导致肿瘤的发生.     

miR-155和miR-30a在胃癌组织中的表达及临床意义

目的 探讨胃癌组织和癌旁组织miR-155和miR-30a的表达差异及其临床意义.方法 收集手术切除的胃癌标本52例,采用实时荧光定量逆转录-聚合酶链反应( RT-qPCR)检测癌及癌旁组织标本miR-155和miR-30a的表达水平,分析其与临床病理的关系.结果 miR-155在胃癌组织中表达量(0.84 ±2.27)显著高于其在配对癌旁组织中的表达值(0.28 ±0.56,P＜0.05);miR-155高表达与淋巴结转移有关(P＜0.05).miR-30a在胃癌组织中表达量(3.16±8.11)显著低于其在配对癌旁组织中的表达值(15.87±35.58,P＜0.05).miR-30a的低表达与肿瘤侵犯层次、淋巴结转移有关(P＜0.05).结论 miR-155和miR-30a与胃癌发生发展密切相关,可能成为胃癌的潜在诊断及治疗靶点.     

Ezrin在胃癌组织中的表达及其临床意义

目的 探讨Ezrin在胃癌发生及发展过程中的作用.方法 收集2008年6月至2009年5月第三军医大学西南医院全军普通外科中心收治的60例胃癌患者的胃癌组织及正常胃黏膜组织标本,分别采用RT-PCR和Western blot法检测标本中Ezrin mRNA及蛋白的表达情况,分析Ezrin与患者性别、年龄、肿瘤分化程度、病理分期、浸润深度及淋巴结转移间的关系.采用t检验、x2检验、Spearman等级相关检验进行统计学分析.结果 60例正常胃黏膜组织中有33例(55％) Ezrin mRNA表达水平升高,45例(75％)Ezrin蛋白表达水平升高;60例胃癌组织中有21例(35％) Ezrin mRNA表达水平升高,22例(37％) Ezrin蛋白表达水平升高.Ezrin mRNA及蛋白在正常胃黏膜组织中的表达水平分别为1.30±0.04和3.57±0.45,在胃癌组织中的表达水平分别为0.53±0.36和0.96±0.18,两者比较,差异有统计学意义(t=5.309,22.617,P＜0.05).胃癌组织中Ezrin mRNA及蛋白表达水平呈正相关(r=0.602,P＜0.05).Ezrin mRNA和蛋白表达在胃癌不同病理分期、不同浸润深度、有无淋巴结转移方面差异有统计学意义(x2=6.41,6.49,4.62;5.40,8.87,4.12,P＜0.05),而在性别、年龄和分化程度方面差异无统计学意义(x2=0.50,0.07,1.07;0.01,1.16,1.96,P＞0.05).结论 胃癌组织中Ezrin表达水平降低,这可能是胃癌的发生、发展及转移的机制之一.     

TIP30在胃癌组织中的表达及其对胃癌血管生成的影响

目的: 研究Tat作用蛋白30(Tat-interactive protein 30, TIP30)基因在胃癌组织中的表达及其对胃癌血管生成的影响.方法:运用免疫组织化学方法检测52例胃癌组织及47例癌旁正常组织中TIP30蛋白的表达水平,同时检测CD34标记的微血管密度(microvessel density,MVD).结果: TIP30在胃癌和癌旁正常组织中的阳性率分别为53.8%和85.1%,两者相比较差异有统计学意义(χ2=11.22,P﹤0.01),TIP30表达水平与患者年龄、性别、病理分化程度及肿瘤大小无关,与有无淋巴结转移及TNM分期有关.胃癌组织和癌旁正常组织中MVD值分别为27.37±2.68和21.87±4.11,两者比较差异有统计学意义(t=7.95,P<0.01),胃癌组织中TIP30表达阳性者较阴性者MVD值显著降低(t=-3.18,P=0.003).结论: TIP30在胃癌组织中表达降低,其可能通过抑制胃癌血管生成影响胃癌的发生发展.     

EphA7基因在原发性肝细胞癌中的表达及其临床意义

目的 探讨原发性肝细胞癌中EphA7 mRNA的表达及其临床意义.方法 应用逆转录-聚合酶链反应(RT-PCR)及实时荧光定量PCR法检测EphA7 mRNA在40例肝癌及相应的癌旁肝组织和10例正常肝组织中的表达,并分析其与肝癌临床病理因素之间的关系.结果 40例肝癌组织及相应的癌旁肝组织和10例正常肝组织中均有EphA7 mRNA的表达.实时荧光定量PCR分析显示EphA7 mRNA在肝癌组织(20.0711±32.0232)中的表达显著高于癌旁肝组织(4.5184±9.4738,P＜0.05)和正常肝组织(4.1764±4.7193,P＜0.05),而在癌旁肝组织和正常肝组织中的表达差异无统计学意义(P＞0.05).EphA7 mRNA的过表达与肝癌细胞的分化程度、门静脉癌栓的形成及淋巴结转移等临床病理因素有关(P＜0.05).结论 EphA7的过表达与原发性肝细胞癌的生物学行为密切相关,可能在肝癌的恶性转化、侵袭和转移过程中发挥作用.     

增殖细胞核抗原在肝细胞癌中的表达及其临床意义

目的 探讨增殖细胞核抗原(PCNA)在肝细胞肝癌的发生发展中的作用及作用机制.方法 采用逆转录-聚合酶链反应(RT-PCR)和免疫组织化学法检测PCNA在肝细胞癌、相应癌旁组织和正常肝组织中mRNA和蛋白质的表达,正常肝组织、癌旁组织、肝细胞癌组织中的阳性表达率分别为20.0％、46.2％和85.7％;结合患者的年龄、性别、肿瘤大小、分化程度、有无淋巴结转移等临床病理学资料进行统计学分析,其表达与组织分化程度和淋巴结转移呈明显相关(P＜0.05).结果 PCNA在正常肝组织、癌旁组织、肝细胞癌组织中的阳性表达率分别为20.0％、46.2％和85.7％,在肝细胞癌中的阳性表达率显著高于正常肝组织和癌旁肝组织(P＜0.05);RT-PCR检测结果也证实PCNA mRNA在肝细胞癌中的表达明显高于正常肝组织和癌旁肝组织(P＜0.05).PCNA的表达与患者年龄、性别、肿瘤大小等因素无明显相关(P＞0.05),与组织分化程度和淋巴结转移呈明显相关(P＜0.05).结论 PCNA在肝细胞癌组织中的表达高于正常肝组织和癌旁肝组织,并且与肿瘤的恶性程度密切相关.     

胆囊恶性病变组织中癌干细胞标记物的表达及临床病理意义

目的 研究胆囊腺癌、癌旁组织和慢性胆囊炎组织中CD24和CD44v6表达水平及其临床病理学意义.方法 将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制作石蜡包埋切片,CD24和CD44v6染色方法均为EnvisionTM免疫组化法.将实验数据输入SPSS13.0统计软件包行x2检验和t检验及Fisher's精确概率法.结果 胆囊腺癌CD24和CD44v6表达阳性率(52.8%,55.6%)及其评分(2.43±1.65,2.52±1.61)明显高于癌旁黏膜组织(CD24:17.4%,x2=16.56,P＜0.01;0.78±0.82,t=5.89,P＜0.01.CD44v6:19.6%,X2=16.90,P＜0.01;0.82 ±1.39,t=6.07,P＜0.01)和慢性胆囊炎(CD24:11.4%,x2=18.48,P＜0.01,0.54±1.44;t=6.10,P＜0.01.CD44v6:17.1%,x2=15.69,P＜0.01;0.58±1.46,t=6.26,P＜0.01).腺瘤癌变或高分化腺癌、肿块最大径＜2 cm、无淋巴结转移和未侵犯周围组织病例CD24和CD44v6表达阳性率及其评分明显低于低分化腺癌、肿块最大径≥2 cm、淋巴结转移和侵犯周围组织病例(P＜0.05或P＜0.01);胆囊腺癌中CD24与CD44v6表达具有高度一致性(x2=48.21,P＜0.01),其评分值之间呈高度密切正相关(r=0.48,P＜0.01).结论 CD24和CD44v6是反映胆囊腺癌发生、进展及生物学行为的重要的癌干细胞标记物,阳性或高水平表达者临床预后不良.     

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。