食管鳞状细胞癌EMMPRIN蛋白的表达及临床意义

目的 探讨食管鳞状细胞癌（ESCC）中细胞外基质金属蛋白酶诱导因子（EMMPRIN）蛋白的表达及临床意义。方法 免疫组织化学染色法检测85例ESCC、18例癌旁不典型增生（AH）、38例癌旁“正常”鳞状上皮（NSEBC）和15例正常食管鳞状上皮（NSE）中EMMPRIN蛋白的表达。结果ESCC、AH、NSEBC和NSE中EMMPRIN蛋白的阳性率分别为80％（68／85）、39％（7／18）、66％（25／38）和20％（3／15）；ESCC中EMMPRIN蛋白阳性率高于非癌肿组织（P＜0．01，r=0．35）且阳性细胞分布区域不同；高、中度分化组ESCC中EMMPRIN蛋白阳性率高于低分化组（P＜0．01，r=0．29）；ESCC中EMMPRIN蛋白的表达与肿瘤浸润食管壁的深度、临床分期和淋巴结转移均无明显相关（P＞0．05）。结论 EMMPRIN蛋白在ESCC组织的表达与在非癌肿组织的表达存在显著不同，且它与癌肿的组织分化程度有密切关系。     

线粒体丝氨酸蛋白酶Omi/HtrA2在食管鳞癌组织中的表达及临床意义

目的 探讨Omi/HtrA2与食管鳞状细胞癌(ESCC)临床病理生理特征的关系.方法 采用免疫组织化学En Vinsion system法检测40例食管鳞癌组织、40例癌旁组织及13例食管良性病变黏膜组织中Omi/HtrA2的表达.结果 Omi/HtrA2的阳性表达率在食管癌组织中为70.00％,癌旁组织Omi/HtrA2为27.50％,食管良性病组织为23.08％ (P ＜0.05)；在中高分化癌中表达阳性率为83.33％,低分化癌中表达阳性率50.00％ (P ＜0.05)；无淋巴结转移组的阳性表达率为88.23％,有淋巴结转移组为56.52％ (P＜0.05) Omi/HtrA2阳性表达组5年生存率为47.8％,阴性表达组为15.0％(P＜0.05). 结论 Omi/HtrA2可能作为促癌基因参与了食管癌的发生发展.     

TPX2在食管胃交界部腺癌中的表达及临床意义

目的研究TPX2在食管胃交界部腺癌组织中的表达,并探讨其临床意义。方法采用免疫组织化学法分析80例食管胃交界部腺癌、41例癌旁不典型增生组织及48例正常胃黏膜组织中TPX2蛋白的表达;运用RT-PCR法检测TPX2mRNA在40例食管胃交界部腺癌、36例癌旁不典型增生组织和28例正常胃黏膜组织中的表达水平。结果食管胃交界部腺癌、癌旁不典型增生组织及正常胃黏膜组织中的TPX2蛋白阳性率分别为71.2%(57/80)、53.7%(22/41)和31.2%(15/48),三组间比较差异有统计学意义(χ~2=10.315,P=0.018);TPX2 mRNA阳性率分别为77.5%(31/40)、69.4%(25/36)和7.1%(2/28),三组间比较差异也有统计学意义(χ~2=7.468,P=0.025)。TPX2蛋白及mRNA在食管胃交界部腺癌组织中表达的阳性率随着肿瘤浸润深度增加、淋巴结转移和肿瘤分期增高而逐渐增高(P0.05),而与性别、年龄及组织分化程度均无关(P0.05)。结论 TPX2的异常表达可能是食管胃交界部上皮细胞癌变与浸润转移的重要因素,TPX2的检测有利于食管胃交界部腺癌的早期诊断和预后判断。     

食管鳞癌与细胞因子信号转导负调控因子3及其DNA甲基化的关系

目的 检测食管鳞癌(ESCC)组织中细胞因子信号转导负调控因子3(SOCS3)的DNA甲基化、mRNA及蛋白表达水平,探讨其在食管鳞癌发生、发展、浸润和转移中的作用.方法 采用甲基化特异性聚合酶链反应(MSP)、Real-Time聚合酶链反应(PCR)和Western blot法分别检测43例食管鳞癌组织中SOCS3的DNA甲基化、mRNA和蛋白表达水平,并与相应的癌旁正常食管组织进行对照研究,分析其与临床病理参数的关系.结果 (1)食管鳞癌组织SOCS3 DNA甲基化的阳性率(79.1%)明显高于癌旁组织(14.0%,P＜0.01);(2)食管鳞癌组织SOCS3 mRNA相对表达强度比值(0.53±0.30)明显低于癌旁组织(1.15±0.44,P＜0.01),食管鳞癌组织中甲基化组的SOCS3 mRNA表达(0.45±0.24)显著低于非甲基化组(0.86±0.29,P＜0.05);(3)食管鳞癌组织SOCS3蛋白表达(1.66±0.22)显著低于癌旁组织(1.83±0.15,P＜0.01),食管鳞癌组织中甲基化组SOCS3蛋白表达(1.61±0.21)显著低于非甲基化组(1.87±0.15,P＜0.01);(4)在TNM分期中Ⅲ期组表达均低于Ⅰ～Ⅱ期组(P＜0.05),伴有淋巴结转移组表达也都低于无淋巴结转移组(P＜0.05),未发现其在性别、年龄、家族史、吸烟史中有明显差异(P＞0.05);(5)食管鳞癌组织中SOCS3mRNA表达及其蛋白表达水平与肿瘤分化级别呈正相关(0.301＜r＜1,P＜0.05),与TNM分期、淋巴结转移呈负相关(-1＜r＜-0.301,P＜0.05).结论 食管鳞癌组织中SOCS3 DNA甲基化阳性率高,导致SOCS3基因表达下调,与食管鳞癌的分化、浸润和转移密切相关.     

Survivin mRNA和蛋白在肝母细胞瘤组织中的表达

目的 观察肝母细胞瘤组织中Survivin mRNA与蛋白表达.方法 采用逆转录-聚合酶链反应(RT-PCR)方法检测16例肝母细胞瘤及相应癌旁组织中Survivin mRNA的表达,免疫组织化学SP法及Western blot法检测Survivin蛋白在肝母细胞瘤中的表达.结果 在肝母细胞瘤及其相应的癌旁组织中Survivin mRNA表达的阳性率分别为62.5％和11.1％,Survivin蛋白表达的阳性率分别为81.3％和22.2％,肝母细胞瘤组均远高于癌旁组,差异有统计学意义(P＜0.01);Survivin蛋白在肝母细胞瘤组织中的表达随肿瘤分期增高而增加;Ⅲ、Ⅳ期肝母细胞瘤组织Survivin mRNA 的表达量分别为2.390±0.071和4.506±0.309,明显高于早期肝母细胞瘤组织(P＜0.05).结论 Survivin 基因的高表达可能在肝母细胞瘤的发生及发展中起重要作用.     

BDNF|TrkB在原发性肝癌中的表达及BDNF对肝癌细胞株Bel-7402的作用

目的探讨脑源性神经营养因子(BDNF)及其受体TrkB在原发性肝癌中的表达及BDNF对肝癌细胞株Bel-7402的作用。方法 (1)检测肝癌组织、癌旁组织及正常肝组织中BDNF和TrkB的表达,分析BDNF和TrkB的表达与临床病理因素之间的关系。(2)检测BDNF,TrkB,Bcl-2在肝癌细胞株Bel-7402及正常肝细胞株L-02的表达及其对Bel-7402细胞增殖、失巢凋亡、黏附、浸润转移能力的影响。结果 (1)肝癌组织中BDNF呈高表达(60.4%,29/48),与Edmondson分级、有无包膜有关(P0.05);TrkB表达率为52.1%(25/48),与Edmondson分级及肿瘤结节数有关(P0.05);BDNF与TrkB在肝癌中的表达呈正相关(r=0.332,P0.05)。BDNF和TrkB在正常肝组织中均无表达。两者在肝癌组织中表达远高于癌旁组织中的表达(P0.01)。肝癌组织中BDNF和TrkB呈高表达者,其2年内复发率增高(P0.05)及生存率下降(P0.01)。(2)外源性BDNF均能增强Bel-7402细胞的增殖、黏附、体外迁移、侵袭能力及抵抗失巢凋亡的能力(P0.01);(3)各浓度的BDNF均可上调Bel-7402细胞Bcl-2 mRNA及其蛋白的表达(P0.05)。结论 (1)BDNF及TrkB在肝癌中高表达,可能与复发、生存率有关;(2)BDNF可调节肝癌细胞的生长、黏附、迁移和侵袭;(3)BDNF可上调Bcl-2的表达,抑制肿瘤细胞的失巢凋亡。     

Hedgehog信号通路在胰腺癌中的表达与表皮生长因子受体的关系

目的 探讨胚胎发育信号通路Sonic hedgehog(SHH)在胰腺癌组织中的表达及其与表皮生长因子受体(EGFR)的关系.方法 逆转录-聚合酶链反应(RT-PCR)和Western blot法分别检测胰腺癌组织及癌旁组织中SHH和EGFR的mRNA和蛋白表达.结果 SHH mRNA和蛋白在胰腺癌组织中的阳性率分别为81.6%和79.6%,与癌旁组织比较,差异有统计学意义(P＜0.05).EGFR mRNA和蛋白在胰腺癌组织中的阳性率均为73.5%,与癌旁组织比较,差异有统计学意义(P＜0.05).SHH和EGFR蛋白表达与年龄、肿瘤大小、组织学类型和肿瘤部位等病理因素均无明显相关(P＞0.05),而在不同淋巴结转移状况和TNM分期的病例组中,两者表达差异有统计学意义(P＜0.05).配对资料的Spearman相关分析显示,SHH表达与EGFR表达呈正相关(r=0.232,P＜0.05).结论 SHH和EGFR信号通路在胰腺癌组织中呈活化状态,两者之间的相互作用对胰腺癌的发生发展可能有重要影响.     

Sonic hedgehog和β-连环蛋白在胰腺癌组织中的表达及其相关性研究

目的 研究胚胎发育信号通路Sonic hedgehog(SHH)和WNT/β-catenin在胰腺癌组织中的表达及其临床意义.方法 逆转录聚合酶链反应(RT-PCR)和Western印迹法检测胰腺癌组织及癌旁组织中SHH和β-catenin的mRNA和蛋白表达情况.结果 SHH mRNA和蛋白在胰腺癌组织中的阳性率分别为81.6%和79.6%,与癌旁组织相比,差异有统计学意义(P＜0.05).β-catenin蛋白在胰腺癌组织中的阳性率为71.4%,与癌旁组织相比,差异有统计学意义(P＜0.05).而β-catenin mRNA在胰腺癌组织和癌旁组织中的表达水平均较低,差异无统计学意义(P＞0.05).SHH和β-catenin蛋白表达与年龄、肿瘤大小、组织学类型和肿瘤部位等病理因素均无关(P＞0.05),而在不同淋巴结转移状况和TNM分期的病例组中,二者表达差异有统计学意义(P＜0.05).配对资料的Spearman相关分析显示,SHH表达与β-catenin表达呈正相关关系(r=0.352,P＜0.05).结论 SHH和WNT/β-catenin信号通路在胰腺癌组织中呈活化状态,二者之间的交叉对话对胰腺癌的发生发展可能起重要作用.     

水通道蛋白4在食管鳞癌中的表达

目的 观察水通道蛋白4(AQP4)在食管鳞癌组织中的表达并探讨其在食管癌发病中的作用.方法 取食管鳞癌组织、癌旁正常鳞状上皮组织各16例,应用免疫组织化学,逆转录.聚合酶链反应(RT-PCR)技术检测AQP4的表达及分布.结果 免疫组织化学显示,AQP4表达于正常食管黏膜鳞状上皮细胞,在食管鳞癌组中主要表达于肿瘤上皮细胞和癌巢中.RT-PCR法结果 显示,AQP4在癌旁正常组织和食管癌组织中的mRNA表达平均相对A值分别为0.45±0.12、0.70±0.23,差异有统计学意义(P＜0.05).结论 AQP4在正常食管黏膜鳞状上皮细胞以及食管鳞癌组中均有表达,而且在癌组织中表达增加;AQP4可能对人食管癌的发生、发展起促进作用.     

血管内皮生长因子-C蛋白和mRNA在胆管癌中的表达及其意义

目的 检测胆管癌和癌旁0.5 cm胆管组织及手术切缘的正常胆管组织血管内皮生长因子(VEGF)-C蛋白及mRNA的表达,探讨其在胆管癌发生发展中的作用.方法 应用免疫组织化学过氧化物酶标记链霉卵白素法(SP)检测42例胆管癌组织及20例正常组织中VEGF-C蛋白的表达,同时应用逆转录-聚合酶链反应(RT-PCR)技术检测42例术中所取的新鲜的胆管癌、17例同个体癌旁胆管黏膜和20例正常胆管组织中VEGF-C的mRNA表达,并与临床资料进行相关分析.结果 正常胆管组织、癌旁组织、胆管癌组织中VEGF-C mRNA相对表达量分别0.6105±0.0577、0.6270 ±0.0664、0.6930±0.1078,VEGF-C mRNA在3组之间表达呈上升趋势(P＜0.05).VEGF-C蛋白表达趋势同其相对应的基因表达趋势一致,即VEGF-C mRNA在胆管癌组织中高表达(P＜0.05).胆管癌组织、正常胆管组织中VEGF-C表达的阳性率分别为83.33%和30.00%.结论 VEGF-C基因转录和蛋白可能参与了胆管癌的发生发展过程.     

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。