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.     

胃癌血管生成及其与周围静脉血微转移的关系

目的研究胃癌组织中血管生成及其与胃癌患者外周血癌细胞微转移的关系.方法用免疫组化方法检测胃癌组织中微血管密度(MVD)和血管内皮细胞生长因子(VEGF)的表达,用巢式RT-PCR方法检测胃癌患者外周血癌细胞微转移.结果42例胃癌组织中,MVD计数范围在9～78之间,平均36.5±16.5,MVD计数与肿瘤大小和浸润深度密切相关(P＜0.05);17例(40.5%)胃癌组织VEGF表达阳性,其阳性表达与肿瘤大小、浸润深度和TNM分期密切相关(P＜0.05);13例(30.9%)患者外周血微转移阳性,微转移阳性患者的肿瘤MVD计数(47.2±19.0)和VEGF阳性率(69.2%)显著大于微转移阴性患者的MVD计数(31.7±13.0)和VEGF阳性率(27.6%)(P＜0.05).结论胃癌组织中MVD计数和VEGF表达与肿瘤进展相关;胃癌组织血管化程度与周围静脉血癌细胞微转移密切相关.     

EphA2与VEGF-C在胃癌中的表达及其与淋巴管生成的关系

目的:探讨胃癌组织中EphA2与VEGF-C的表达及临床意义。方法:用免疫组化法检测82例胃癌组织及其癌旁组织中EphA2与VEGF-C蛋白的表达,以及淋巴管密度(LVD);用real-timePCR检测20例胃癌组织及其癌旁组织中EphA2与VEGF-Cm RNA的表达。分析EphA2与VEGF-C表达与患者临床病理特点及淋巴管生成的关系。结果:EphA2与VEGF-C在胃癌组织中的阳性表达率均明显高于癌旁正常组织(65.8%vs.42.6%;71.9%vs.39.0%,均P0.05)。EphA2与VEGF-C的高表达与肿瘤浸润深度、淋巴结转移、TNM分期有关(均P0.001)。EphA2蛋白与VEGF-C蛋白高表达的胃癌组织中LVD计数分别明显高于两者低表达胃癌组织(15.25±5.41vs.10.95±5.41,P=0.001;14.87±5.71vs.11.00±5.01,P=0.006)。胃癌组织中EphA2与VEGF-C蛋白以及m RNA表达均呈正相关(r=0.375,P=0.001;r=0.559,P=0.01)。结论:EphA2与VEGF-C在胃癌组织中均呈高表达,且可能共同促进淋巴管生成与胃癌淋巴结转移。     

Slit2和Robo1蛋白表达与胃癌关系的临床研究

目的：研究胃癌组织中神经迁移因子Slit2与受体Robo1的表达，探讨两者与胃癌生物学行为和血管生成的关系。方法：免疫组织化学SP法检测54例胃癌组织及28例癌旁组织中Slit2蛋白和Robo1蛋白的表达水平，观察不同临床病理学行为下Slit2蛋白和Robo1蛋白的表达变化；检测．CD34标记的微血管密度（microvessel density，MVD），研究在胃癌组织中MVD与Slit2蛋白和Robo1蛋白的关系。结果：Slit2蛋白和Robo1蛋白在胃癌组织中的阳性表达率分别为63．0％和77．8％，在癌旁组织中的阳性表达率分别为3．6％和10.7％，两种组织中Slit2蛋白和Robol蛋白的表达水平差异有统计学意义（X^2=26．586，P〈0．01；X^2=33．491，P〈0．01）。胃癌组织中MVD显著增高（t=19．562，P〈0．01）。Slit2蛋白表达水平与肿瘤大小、TNM分期、淋巴结转移和远处转移相关；Robo1蛋白表达水平与肿瘤大小、浸润深度、TNM分期、淋巴结转移相关。Slit2与Robo1 阳性表达呈正相关（r=0．4202，P〈O．01）。Slit2和Robo１表达阳性者MVD显著增高（f=2．256，P〈０．05；t＝2．631，P〈０．05）。结论：Slit2及其受体Robo１在胃癌组织中表达增加，与肿瘤的侵袭和转移密切相关，其机制可能是Slit2／Robo１信号途径能促进肿瘤血管生成。     

胃癌组织中mTOR和HIF-1α的表达及血管生成

目的：研究胃癌组织中雷帕霉素靶蛋白（mTOR）、缺氧诱导因子1α（HIF-1α）的表达及微血管密度变化,探讨mTOR、HIF-1α在胃癌发生发展中的作用及与血管生成的关系。方法：免疫组织化学法检测70例胃癌组织及45例癌旁正常组织中mTOR和HIF-1α蛋白的表达,以CD34标记血管内皮计数微血管密度（MVD）。结果：70例胃癌组织中mTOR呈阳性表达36例,占51.4%,HIF-1α阳性表达47例,占67.1%,均显著高于癌旁组织中的10.7%和17.8%（χ2分别为19.408和26.751,P均〈0.01）;mTOR与HIF-1α的表达呈正相关（r=0.157,P〈0.05）;mTOR、HIF-1α表达与肿瘤的TNM分期、浸润深度、淋巴结转移、远处转移显著相关（P〈0.05）。胃癌组织的MVD较癌旁正常组织显著增高（t=4.358,P〈0.05）。mTOR、HIF-1α均阳性者MVD显著高于mTOR、HIF-1α均阴性者（F=23.090,P〈0.01）。结论：mTOR及HIF-1α在胃癌组织中呈阳性表达,胃癌组织的微血管密度显著高于癌旁组织。     

pAKT、HIF-1α在胃癌中的表达及与血管生成的关系

目的：研究磷酸化丝氨酸／苏氨酸蛋白激酶（pAKT）、缺氧诱导因1α（HIF-1α）在胃癌中的表达及AKT／HIF-1α途径与胃癌的发生和血管生成的相关性。方法：免疫组化法检测64例胃癌及26例癌旁正常组织中pAKT蛋白和HIF-1α的表达，以CD34标记血管内皮．计数微血管密度（MVD）。结果：64例胃癌组织中pAKT呈阳性表达48例（75％），HIF-1α阳性表达42例（65．6％），均显著高于癌旁组织X^2分别为26.936、15.950，P〈0.05）；pAKT、HIF-1α表达与肿瘤的TNM分期、浸润深度、淋巴结转移、远处转移显著相关（P〈0.05）。胃癌及癌旁组织MVD分别为43．5±12．7、26．2±12．3，P〈0.05（t=5.614）：pAKT、HIF-1α均阳性患者MVD显著多于pAKT、HIF-1α均阴性者（t=3.947，P〈.05），pAKT与HIF-1α的表达呈正相关（Pearson r=0.583，P〈0.05）。结论：pAKT蛋白过表达于胃癌组织，AKT蛋白的磷酸化可增强胃癌细胞的侵袭能力，促进胃癌的转移，又可以通过调节HIF-1α的表达促进胃癌新生血管的生成。同时检测胃癌组织中pAKT、HIF-1α和MVD的表达状态，对于胃癌的早期诊断和治疗有重要的指导价值。     

胃癌中微血管密度及一氧化氮合酶表达与肿瘤浸润、转移的相关性分析

目的研究胃癌组织中微血管密度(MVD)的高低,一氧化氮合酶(NOS)的表达及与肿瘤病理特征间的关系,探讨MVD、NOS在胃癌浸润、转移中的意义及其间的相关性。方法应用免疫组化SP法检测56例手术切除胃癌组织石蜡包埋标本的iNOS、eNOS、nNOS的蛋白表达,对肿瘤微血管以CD34抗体染色并检测MVD。结果56例胃癌组织MVD平均为(36.25±6.32);i-NOS、eNOS、nNOS的阳性表达率分别为75.0%、80.4%、83.9%;不同浸润深度、淋巴结转移程度及TNM分期的胃癌中MVD值的差异有统计学意义(P<0.01);iNOS、eNOS、nNOS的表达随胃癌浸润深度的加深,淋巴结转移程度的提高而上调(P<0.01);iNOS阳性表达胃癌组织中的MVD值为(44.76±4.16),明显高于阴性表达者的(32.14±4.89)(P<0.01)。结论随着胃癌浸润,转移程度进展,肿瘤MVD值增高,NOS的表达上调;胃癌中iNOS的表达与肿瘤MVD有关,提示iNOS在胃癌生长,浸润及转移中促进肿瘤新生血管形成。     

角质细胞生长因子和环氧化酶-2在胃癌中的表达及其与血管生成的关系

目的检测角质细胞生长因子(KGF)和环氧化酶-2(COX-2)蛋白在胃癌组织中的表达及微血管密度(MVD),探讨KGF与COX-2在胃癌发生、发展中的作用及其机理。方法采用免疫组化SP法检测64例胃癌组织及30例正常胃黏膜组织中KGF和COX-2蛋白表达,并采用CD34抗体染色检测MVD。结果 KGF和COX-2蛋白在胃癌组织中的表达阳性率分别为65.6%(42/64)和79.7%(51/64),分别高于其在正常胃黏膜组织中的表达阳性率〔23.3%(7/30)和13.3%(4/30)〕,P=0.046、P=0.008。胃癌组织MVD为31.8±8.0,明显高于正常胃黏膜组织的14.3±6.1(P=0.000);KGF与COX-2蛋白均表达阳性者MVD为35.9±5.7,明显高于两者表达均为阴性者的25.7±7.0(P=0.000)。胃癌组织中KGF和COX-2蛋白表达均与淋巴结转移、浆膜浸润及TNM分期有关(P<0.05、P<0.01),MVD与淋巴结转移和TNM分期有关(P<0.01),但均与患者年龄、性别以及肿瘤分化程度无关(P>0.05)。KGF与COX-2联合表达者与胃癌的浆膜浸润、淋巴结转移和TNM分期有关(P<0.05),与患者年龄、性别以及肿瘤分化程度无关(P>0.05)。胃癌组织中KGF与COX-2蛋白表达呈正相关(r=0.610,P=0.000);胃癌组织MVD与KGF和COX-2蛋白表达均呈正相关(r=0.675,P=0.000;r=0.657,P=0.000)。结论 KGF和COX-2蛋白在胃癌组织中高表达,可能通过促进肿瘤新生血管的生成协同参与胃癌的浸润、转移。     

HSP60在胃癌中的表达与微血管生成的关系及临床意义

目的：观察热休克蛋白（HSP60）在胃癌组织中的表达以及其与肿瘤微血管生成的关系。方法：采用免疫组化SP法检测85例胃癌组织和35例癌旁正常胃组织中HSP60蛋白的表达;通过测定CD34来衡量微血管密度（MVD）。结果：胃癌组织HSP60表达明显高于癌旁正常胃组织（P〈0.01）,其中HSP60的表达与肿瘤的大小、分化和浸润程度密切相关（P〈0.05）;胃癌组织MVD与肿瘤大小和浸润程度密切相关（P〈0.05）;MVD与HSP60的蛋白在胃癌组织中的表达高度相关（r=0.404,P〈0.05）。结论：HSP60的高表达与肿瘤微血管生成及肿瘤的进展密切相关,可作为评估胃癌患者预后的重要参考指标。     

胃癌组织中Cox-2的表达与肿瘤血管生成及周围静脉血微转移的关系

目的 研究胃癌组织中Cox-2的表达及其与肿瘤血管生成和周围静脉血微转移的关系.方法 用免疫组织化学法检测42例胃癌组织中Cox-2的表达和微血管密度(MVD),用巢式RT-PCR法检测胃癌病人外周血癌细胞微转移.结果 本组有24例胃癌组织中Cox-2表达阳性.Cox-2阳性肿瘤的MVD计数显著大于Cox-2阴性者(P＜0.01).有13例周围静脉血中CK19mRNA表达阳性.Cox-2阳性胃癌病人外周血微转移阳性率显著高于Cox-2阴性者(P＜0.05).结论 胃癌组织中Cox-2表达的增加与胃癌组织血管化程度及周围静脉血微转移密切相关.     

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。