血管内皮生长因子D基因转移对胆汁性肝硬变大鼠肝纤维化和门静脉压力的影响

目的观察胆汁性肝硬变大鼠门静脉注射血管内皮生长因子D(hVEGF-D)后的促血管形成效应以及对肝纤维化和门静脉压力的影响。方法30只SD大鼠胆总管结扎法制作胆汁性肝硬变模型,治疗组门静脉注射PCHO／hVEGF-D 150μg／只,2周后比较肝组织纤维化程度(苏木素-伊红染色、浸银染色法)、门静脉压力、VEGF蛋白质表达、肝组织微血管密度改变。结果肝组织纤维化程度较注射前明显降低;门静脉压力治疗前为(15．45±1．97)cm H_2O(1 cmH_2O= 0．098 kPa);治疗后则变为(12．56±1．86),差异有统计学意义(P<0．05)。治疗组VEGF蛋白质表达平均染色积分为6．56±1．81,肝硬变对照组4．4±1．02,差异有统计学意义(P<0．01)。治疗组血管计数为14．33±3．24;肝硬变对照为9．2±1．48(P<0．01)。结论胆汁性肝硬变大鼠门静脉注射血管内皮生长因子D表达载体后可以一定程度上促进肝内血管形成、减缓肝纤维化程度降低门静脉压力。     

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。     

乳腺癌发生与演进过程中血管生成作用的评价

目的 探讨人乳腺癌前病变、原位癌及浸润性癌中CD34、血管内皮生长因子(VEGF)及其受体Flk-1/KDR的表达变化及血管生成异常与乳腺癌发生发展的关系.方法 应用免疫组织化学技术检测30例正常乳腺、30例普通性增生、30例非典型增生(AH)、20例导管内癌、50例浸润性导管癌组织中微血管密度(MVD)、VEGF及Flk-1/KDR的表达.结果 各组CD34、VEGF及Flk-1/KDR的表达程度不同,浸润性导管癌组最高.随病程演进MVD逐渐增加(P<0.05),VEGF及其受体Flk.1/KDR在血管内皮细胞表达渐进性增高(P<0.05),但在病程初期各主要指标改变不明显,显著变化始于AH阶段.MVD在AH与导管内癌组间差异无统计学意义(P>0.05),VEGF及Flk-1/KDR的表达在AH与导管内癌组间差异有统计学意义(P<0.05).结论 血管生成异常可能是乳腺癌发生过程中的早期事件.VEGF及Flk-1/KDR的表达异常可能是乳腺普通性增生-AH-乳腺癌这一癌性转化过程中血管生成异常的主要始动因素,其可能成为乳腺癌早期诊治的靶标.     

血管和淋巴管生成及淋巴转移的关系

目的探讨胃癌组织中血管表皮生长因子C(VEGF-C)表达与血管和淋巴管密度及肿瘤淋巴转移的关系. 方法采用免疫组化SP法检测68例胃癌组织中VEGF-C、CD-31及淋巴管内皮标记物VEGFR-3,计算VEGF-C表达的阳性率及肿瘤微血管和微淋巴管密度. 结果淋巴结阳性组中VEGF-C阳性率(70%)显著高于淋巴结阴性组(30%), P<0.05;与VEGF-C阴性组(24.4±2.1)比较,VEGF-C阳性组淋巴管密度(29.6±3.0)明显增高,P<0.05,而微血管密度在两组之间差异无显著意义,P>0.05;与淋巴结阴性组比较,在淋巴结转移阳性组淋巴管密度(31.6±2.1)、微血管密度(40.2±2.3)均有显著提高,P<0.05. 结论 VEGF-C主要通过调节胃癌组织微淋巴管的生成而影响胃癌淋巴结转移;微淋巴管密度与微血管密度均为胃癌淋巴结转移的重要影响因素.     

核因子kB在胆管癌中的表达及其与微血管形成的关系

目的探讨胆管癌中核因子kB（NF-κB）表达及其与微血管形成的关系。方法应用免疫组化法检测1997-2003年50例胆管癌组织、27例癌旁组织及9例正常胆管组织的微血管密度（MVD）、血管内皮生长因子（VECF）和NF-κB的表达。结果NF-κB在胆管癌和癌旁组织中阳性表达率分别为96．0％（48／50）和100．0％（27／27），高于正常组织44．4％（4／9）（P〈0．01）；NF-κB强阳性表达组MVD高于弱阳性组和阴性组（F=12．662，P〈0．01）；NF-κB表达与MVD、VECF的表达均呈正相关（rs=0、542、0．660，P〈0．01）。结论NF-κB在胆管癌中高表迭，与微血管形成呈正相关，NF-κB可能通过调节VECF等血管形成相关因子促进微血管形成。     

缺氧诱导因子-1α及相关基因在破裂性腹主动脉瘤中的表达及意义

目的研究缺氧诱导因子(hypoxia-inducible factor-1α,HIF-1α)信号转导通路在破裂性腹主动脉瘤(ruptured abdominal aorta aneurysm,RAAA)中的表达,探讨AAA破裂的分子基础。方法选取RAAA标本18例,以20例AAA标本作对照。采用Northern杂交、Western蛋白印迹及免疫组织化学方法检测HIF-1α的mRNA及蛋白产物表达,Western蛋白印迹和免疫组织化学方法检测血管内皮生长因子(VEGF)的表达,免疫组织化学抗CD34染色法检测微血管密度(microvessel density, MVD)。结果 RAAA组织中HIF-1α mRNA表达明显高于AAA组(P<0．01),免疫组化染色表明 HIF-1α阳性细胞百分率为(40．9±10．8)％,与AAA(17．6±5．2)％比较差异有统计学意义(P< 0．01);VEGF表达亦明显增强(P<0．01),与HIF-1α表达呈显著正相关(r值为0．725,P<0．01)。 HIF-1α阳性表达主要分布在AAA中层平滑肌细胞及外膜。RAAA中微血管密度明显增多(P< 0．01)。结论 HIF-1α及其相关基因过表达在RAAA的分子机制中可能发挥重要作用。     

膀胱出口部分梗阻大鼠逼尿肌微血管密度及凋亡相关因子PCNA、Bax的变化

目的探讨膀胱出口部分梗阻不同时期逼尿肌微血管密度及凋亡相关因子变化情况。方法Wistar大鼠40只,分为对照组、假手术组、梗阻2周组、梗阻5周组等4组,每组10只。采用免疫组化方法分析逼尿肌微血管密度及凋亡相关因子PCNA和Bax表达情况。结果对照组、假手术组、梗阻2周组和梗组5周组平均膀胱重量分别为(125．5±10．1)、(128．5±8．9)、(380．0±12．4)、(400．0±12．5)mg,微血管密度分别为(12．1±1．3)、(13．3±2．3)、(36．4±4．1)和(37．3±5．6)个,PCNA表达率分别为(38．2±17．2)％、(39．4±11．4)％、(64．1±11．5)％和(46．2±9．6)％,梗阻组和对照组、假手术组比较,差异均有统计学意义(P<0．01),梗阻5周和梗阻2周组比较,差异无统计学意义(P>0．05)。对照组、假手术组、梗阻2周组、梗阻5周组Bax表达率分别为(22．3±6．9)％、(23．5±11．6)％、(40．2±12．7)％和(48．5±10．6)％,梗阻组和对照组、假手术组比较,差异有统计学意义(P<0．01),梗阻5周和梗阻2周组比较,差异有统计学意义(P<0．05)。结论大鼠膀胱出口部分梗阻不同时期逼尿肌形态结构功能的变化,可能是逼尿肌微血管密度及凋亡相关因子PCNA和Bax动态变化的结果。     

胆管癌微血管计数和VEGF及MMP2的表达及其意义

目的：探讨胆管癌组织中微血管密度（MVD）、血管内皮生长因子（VEGF）、基质金属蛋白酶2（MMP2）与胆管癌转移、预后的关系。方法：应用免疫组化的方法检测45例胆管癌及8例正常肝外胆管组织的MVD，VEGF和MMP2表达。结果：（1）胆管癌组织MVD值，VEGF，MMP2阳性表达率显著高于正常胆管组织（P＜0．05）；（2）胆管癌组织MVD，VEGF，MMP2的表达强度与胆管癌的病理分期、淋巴结转移有显著相关性（P＜0．05）；结论：MVD增高提示胆管癌转移侵袭潜能增加，VEGF，MMP2可能作为预测胆管癌转移的指标。     

结肠癌早期肝转移中缺氧诱导因子与肿瘤血管生成的关系

目的研究结肠癌早期肝转移中缺氧诱导因子(HIF)和血管内皮生长因子(VEGF)表达及血管生成的相关性。方法2000年1月至2002年12月我院手术治疗的33例结肠癌息者,按术前及术后半年内有无肝转移分为早期肝转移组(15例)和早期无肝转移组(18例)。收集结肠癌组织标本,免疫组织化学方法检测肿瘤组织HIF、VEGF的表达和测定肿瘤微血管密度(MVD)。结果早期肝转移组HIF和VEGF的阳性表达率及MVD分别是86．7%、67．7%和(57．9±12．7)%；早期无肝转移组中的表达率为44．4%、27．8%和(22．3±10．2)%,早期肝转移组均显著高于早期无肝转移组(P＜0．05,P＜0．01)。结论结肠癌组织中的HIF能促进肿瘤血管形成,与早期肝转移有关。     

生长抑素和KDR表达与胰腺癌血管形成关系及临床意义

目的:探讨人胰腺癌组织生长抑素和血管内皮生长因子受体KDR(kinase insert domain con-taining receptor)的表达与血管形成的关系及其临床意义.方法:采用免疫组织化学方法检测62例人胰腺癌组织生长抑素(somatostatin SS)和KDR的表达,并对CD34+血管进行微血管密度(MVD)计数,对KDR及SS表达阳性血管进行半定量计数.结果:胰腺癌组织KDR高、中表达组的MVD明显高于KDR低表达组(P<0.01);而在SS低表达组的MVD明显高于高、中表达组(P<0.01).KDR的表达与肿瘤大小及远处转移相关(P<0.05),SS的表达与肿瘤大小及分化程度有关(P<0.05),并且KDR与SS的表达存在明显负相关(P<0.01).MVD与肿瘤大小相关(P<0.05).结论:KDR、SS在胰腺癌组织中的表达与肿瘤血管形成及调控密切相关,与胰腺癌的发生、发展及转移可能密切相关,可作为评估胰腺癌患者预后的指标.     

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.     

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。     

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.     

Erotic and sadomasochistic foot and shoe*

The foot is an erotic symbol of great power for primitive peoples as well as in highly advanced societies. The foot has always been a badly-treated organ, at the same time an inexhaustible source of contradictory praise and disparagement. The foot and the shoe are inseparable. Since more than 1000 years, the shoe is a sexual symbol and serves as a sexual mode of communication, because it is the cover of the erotic foot. The fetishism of the foot and the shoe has aroused marks of delirious love, always sensual, sometimes mystical. Foot sadomasochism, is a very ancient sexual perversion that consists in taking pleasure in inflicting physical pain to oneself or to others. * Communication submitted: In French, to the CIP International Congress in Buenos Aires (1996); in English, to the BOFSS Congress in Canterbury (2001) Published, in part, in French, in the Encyclopédie Médico-chirurgicale, Podologie, (Elsevier, Paris), 27-140-A-55, 1999,11p