目的:探讨ΔNp63和Ki67在膀胱移行上皮癌(transitional cell carcinoma of bladder,TCCB)中的免疫组化表达及与膀胱癌病理分级、临床病理分期和预后的相关性。方法:随机选择2006～2007年间56例TCCB和12例正常膀胱黏膜病理切片用SP免疫组化行ΔNp63和Ki67检测,将结果与病理分级、分期和预后进行分析。结果:ΔNp63和Ki67在膀胱移行细胞癌中的阳性表达率明显高于正常膀胱黏膜(Plt;005)。ΔNp63和Ki67在低分化、浸润性癌组织中的阳性表达率明显高于高分化、浅表性癌组织,在膀胱癌的病理分级和临床分期之间表达差异有统计学意义(Plt;005)。ΔNp63和Ki67在复发病例中的阳性表达率显著高于初发病例(Plt;005)。采用Spearman等级相关性分析对ΔNp63和Ki67在TCCB中的表达进行比较,ΔNp63与Ki67呈正相关,rs′为0316,且Plt;005。结论:ΔNp63和Ki67与膀胱癌的临床病理分级和分期及预后密切相关,随膀胱癌分化程度的降低和浸润程度的增加而增强。ΔNp63和Ki67在TCCB的进展中可能有相互协同作用,ΔNp63可能通过促进细胞增殖发挥促癌作用,联合检测ΔNp63和Ki67可以作为判断TCCB的预后的肿瘤标记物。
【Abstract】 Objective To compare the effect of PLGA and collagen sponge combined with rhBMP-2 on repairing ofarticular cartilage defect in rabbits respectively. Methods PLGA and collagen sponge were made into cyl inders which were 4 mm in diameter and 3 mm in thickness, and compounded with rhBMP-2 (0.5 mg). Defect 4 mm in diameter were made in both of femoral condyles of 24 two-month-old New Zealand white rabbits. The defects in right 18 knees were treated with PLGA/rhBMP-2 composites (experimental group 1), and the left 18 knees were treated with collagen sponge/rhBMP-2 composites (experimental group 2), the other 12 knees were left untreated as control group. At 4, 12 and 24 weeks after operation, the animals were sacrificed and the newly formed tissues were observed macroscopically and microscopically, graded histologically and analyzed statistically. Results From the results of macroscopical and microscopical observation, in the experimental group 1, the defects were filled with smooth and translucent cartilage; while in the experimental group 2, the white translucent tissues did notfill the defects completely; and in the two experimental groups, the new cartilage tissues demarcated from the surrounding cartilage,chondrocytes distributed uniformly but without direction; a l ittle fibrous tissue formed in the control group 4 weeks postoperatively. In the experimental group 1, the defects were filled completely with white, smooth and translucent cartilage tissue without clear l imit with normal cartilage; while in the experimental group 2, white translucent tissues formed, the boundary still could be recognized; in the two experimental groups, the thickness was similar to that of the normal cartilage; the cells paralleled to articular surface in the surface layer, but in the deep layer, the cells distributed confusedly, the staining of matrix was positive but a l ittle weak; subchondral bone and tide mark recovered and the new tissue finely incorporated with normal cartilage;however, in the control group, there was a l ittle of discontinuous fibrous tissue, chondrocytes maldistributed in the border andthe bottom of the defects 12 weeks postoperatively. In the experimental group 1, white translucent cartilage tissues formed, the boundary disappeared; in the experimental group 2, the color and the qual ity of new cartilage were similar to those of 12 weeks; in the two experimental groups, the thickness of the new cartilage, which appeared smooth, was similar to that of the normal cartilage, the chondrocytes arranged uniformly but confusedly; the staining of matrix was positive and subchondral bone and tide mark recovered, the new tissue finely incorporated with normal cartilage; in the control group, a layer of discontinuous fibrous tissue formed in the bottom of the defects 24 weeks postoperatively. Results of histological grade showed that there were significantdifference between experimental group (1 and 2) and control group at any time point (P lt; 0.01); the scores of 12 weeks and 24 weeks in experimental group 1 and 2 had a significant difference compared with that of 4 weeks (P lt; 0.01), there was no significant difference between 12 weeks and 24 weeks (P gt; 0.05), and there were no significant difference between the two experimental groups at the same time point (P gt; 0.05). Conclusion Both PLGA and collagen sponge as a carrier compounded with rhBMP-2 can repair articular cartilage defects.
ObjectiveTo study the effect and feasibility of poly-lactide-co-glycolide (PLGA) loaded with recombinant human bone morphogenetic protein 2 (rhBMP-2) on repairing articular cartilage defect in rabbits. Methods PLGA was made into cylinders which were 4 mm in diameter and 3 mm in thickness. rhBMP-2 was fully homogenated before used. PLGA combined with 0.5 mg rhBMP-2 under the condition of vacuum(700 mmHg),and then lyophilized, packed ,sterilized with ethylene oxide and reserved. Defects of 4 mm in diameter and reaching medullary cavity were made in femoral condyles of 72 two-month-old New Zealand white rabbits. The 36 right defects were repaired with PLGA-rhBMP-2 composites as the experimental group, the 36 left defects with PLGA only as PLGA group, the other 36 left defects were left untreated as control group, and the other 36 right defects with PLGA-MSCs composites as cell group. At 4, 8, 12, 24, 36 and 48 weeks after operation, macroscopical and microscopical observations were made, and the histological grade wasdone.Results After 4 weeks of operation: In the experimental group and cell group, defects were filled with white translucent tissue which appeared smooth and soft; the matrix around chondrocytes was weakly metachromatic, the newly formed cartilage tissue was thicker than normal cartilage tissue; there was no formed tissue in the PLGA group and the blank control group. After 8 weeks of operation: In the experimental group and cell group, the new tissue was white, translucent, tenacious and smooth. The boundary with normal cartilage became vague. New cartilage cells distributed evenly. The cells of the surface layerparalleled, but the deeper layer lost directivity. The matrix dyed weakly. The new cartilage gradually became thinner, but it still thicker than the normal cartilage ones. The PLGA degraded besides some drops.In the blank control group and PLGA group, a little white membrane formed at the bottom of the defect. After 1224 weeks of operation: In the experimental group and cell group, defects were filled with new tissues which were white, translucent, tenacious and smooth. The boundary disappeared.The thickness of the new cartilage was similar to that of the normal ones. The cells of the surface layer paralleled to each other,but the cells of the deeper layer tended to arrange vertically. The matrix around chondrocytes was metachromatic,but the color was lighter than that of the normal cartilage. Bone under the cartilage and the tide mark recovered. The new cartilage linked with nomal cartilage finely.In the blank control group and PLGA group, there was a little fibrous tissue at the bottom of the defect withe obvious boundary. After 36 weeks and 48 weeks of operation：in the experimental group and the cell group, the new cartilage was slightly white，continuous and less smooth. The boundary disappeared. There was no proliferated synovial membrane.The thickenss of the new cartilage was thinner than that of the normal ones. The matrix around chondrocytes was weakly metachromatic. In the blank control group and PLGA group, the defect still existed, but became smaller.At the bottom of the defect, fibrous tissues formed. Some cartilage denudated and became less smooth.Some bone under cartilage exposed,and the synovial membrane became thick. The histologic grade of the repair tissue at 12 weeks and 24 weeks of operation in experimental group and cell group was significantly different from that at 4, 8 and 48 weeks of operation(Plt;0.01). There was also significant difference in the experimental group and cell group compared with the blank control group and PLGA group at each time after operation(Plt;0.01). But there was no significant difference between the experimental group and the cell group. Conclusion In the course of degradation。。。。。。.
Objective To investigate the effect of the semi-joint prosthesis replacement in treating malignant tumors around the children’s knees. Methods Five children (aged 8-12 years) with malignant tumors around the proximal end ofthe tibia underwent the semi-joint prostheses replacement from March 2000 to June 2005. All the children had been diagnosed with osteosarcoma, which was graded as ⅡB by the Enneking staging system. The pathologic changes involved the upper segment of the tibia 9-11 cm in length. Before operation all the patients underwent puncture biopsy and standard chemotherapy. The lesion extent was determined by X-ray, CT and MRI, and then the size of the prosthesis was determined. The length of the prosthesis was 1-2 cm longer than that of the excised bone. After operation the patients were given neoadjuvant chemotherapy for 2 courses and they could walk with the help of a special brace 4 weeks postoperatively. Results All the 5 patients had a successful semi-joint prosthesis replacement exceptone patient who had a skin flap necrosis, and the wound healed after a flap grafting. The remaining patients had their wounds healed by first intention. The12-36 months’ follow-up revealed that all the patients had no metastasis or recurrence of the tumor and they were living and well except one patient who died oflung metastasis 8 months after operation. Conclusion The semi-joint prosthesis replacement in the limb salvage surgery for maligant tumors around the children’s knees has advantages of avoiding a damage to the normal osteoepiphysis, stabilizing the knee joint, and facilitating elongation of the limb in future. Italso creates the condition for total knee replacement in adults.
ObjectiveTo explore the safety-related factors for total thyroidectomy in differentiated thyroid carcinoma. MethodsThe clinical data of 72 patients with differentiated thyroid carcinoma treated by total thyroidectomy from January 2002 to January 2010 were retrospectively analyzed, the laryngeal recurrent nerve injury and hypoparathyroidism were observed. ResultsThe incidences of hypoparathyroidism and laryngeal recurrent nerve injury were 15.28% （11/72) and 4.17%（3/72）, respectively. The hypoparathyroidism was significantly related to the thyroid reoperation, the lymph nodes metastases of central compartment, or the extraglandular invasion of the primary tumor (Plt;0.05), but not to the dissection of neck lymph nodes (Pgt;0.05). The laryngeal recurrent nerve injury was not relative to those factors (Pgt;0.05). ConclusionThe safetyrelated factors of total thyroidectomy in differentiated thyroid carcinoma include thyroid reoperation, the lymph node metastasis of central compartment, and the extraglandular invasion of the primary tumor.
Mechanical stress modulates almost all functions of cells. The key to exploring its biological effects lies in studying the perception of mechanical stress and its mechanism of mechanotransduction. This article details the perception and mechanotransduction mechanism of mechanical stress by extracellular matrix, cell membrane, cytoskeleton and nucleus. There are two main pathways for the perception and mechanotransduction of mechanical stress by cells, one is the direct transmission of force, and the other is the conversion of mechanical signal into chemical signal. The purpose of this study is to provide some reference for the exploration of precise treatment of mechanical stress-related diseases and the optimization of construction of tissue engineered organs by mechanical stress.
Objective To explore the feasibility of clinical application of hepatic artery （HA） or proper hepatic artery （PHA） anastomosing with superior mesenteric artery （SMA） and internal iliac vein （IIV） anastomosing with superior mesenteric vein （SMV） or portal vein （PV） in the extended pancreaticoduodenectomy combined with vascular resection．Methods The HA，PHA，SMA， SMV， PV， and IIV were dissected on 20 adult corpses， and the length， thickness，and lumen diameter of blood vessels were measured and compared with the results of multislice spiral CT scan，magnetic resonance angiography，or color Doppler in 25 patients with pancreatic head carcinoma．The extended pancreaticoduodenectomy was carried out on 5 patients of pancreatic head carcinoma with vascular invasion according to the mathcing results，and the reconstructions of HA or PHA with SMA and IIV with SMV or PV were performed．Results According to autopsy，HA-PHA was （5.50±1.50） cm in length，（0.20±0.01） mm in thickness，（5.02±1.32） mm in lumen diameter；and SMA was （4.00±1.00） cm in length，（0.21±0.01） mm in thickness，（6.05±1.06） mm in lumen diameter．The lumen diameter of left IIV，right IIV，and PV or SMV was （11.06±0.16） mm，（11.10±0.13） mm，and （11.56±0.20） mm，respectively．The thickness of left IIV，right IIV，and PV or SMV was （0.10±0.01） mm，（0.10±0.02） mm，and （0.10±0.02） mm，respectively．The multislice spiral CT scan，magnetic resonance angiography，color Doppler，and selective arteriography in vivo showed that the thickness and lumen diameter of HA-PHA and SMA were wider （0.1 mm and 0.3 mm） than those of the autopsy results，and there were no statistic significances （P＞0.05），but the length of HA-PHA was longer （1－2 cm） than that of SMA，and there was statistic significance （P＜0.05）. The survival of 5 patients with extended pancreaticoduodenectomy combined with PHA or SMA and IIV-PV/SMV resection and reconstruction was longer than that of palliative surgery patients or giving-up patients at the same period，and no long-term complications occurred．Conclusions The vascular invasion of pancreatic head carcinoma is not an absolute contraindication of radical pancreaticoduodenectomy．The survival of 5 patients with vascular invasion of pancreatic head carcinoma in this group is prolonged by extended pancreaticoduodenectomy combined with vascular resection and reconstruction as compared with palliative surgery group at the same period．HA，PHA，and IIV are the best autologous vascular alternative materials without more complications． Being familiar with regional anatomy will guide the surgeons in extended pancreaticoduodenectomy.
ObjectiveTo explore the expressions of survivin, p53, and Ki67 in recurrence or metastasis breast cancer tissue, and explore their correlations and clinical significance. MethodsEighty-six patients with the chest wall local recurrence, axillary or supraclavicular lymph node metastases get treated in this hospital between January 2005 and January 2010 were excised and the expressions of survivin, p53, and Ki67 were detected by immunohistochemistry test, then compared them between the recurrence and metastasis breast cancer tissues and the primary breast cancer tissues. ResultsThe positive expression rate of survivin, p53, and Ki67 in the recurrence and metastasis breast cancer tissues were significantly higher than those in the primary breast cancer tissues, survivin: 90.70% (78/86) versus 61.63% (53/86), χ2=20.014 895, Plt;0.001; p53: 68.60% (59/86) versus 52.33% (45/86), χ2=4.766 968, Plt;0.05; Ki67: 62.79% (54/86) versus 46.51% (40/86), χ2=4.597 927，Plt;0.05. The positive expression rates of survivin in the recurrence and metastasis patients with p53, Ki67 negative expression were significantly higher than those of the primary breast cancer tissue (70.37% versus 24.39%, χ2=14.071 113, Plt;0.05; 75.00% versus 39.13%, χ2=6.540 373, Plt;0.05). The correlation coefficient of survivin with p53 and Ki67 positive expressions in the recurrence and metastasis breast cancer tissue and the primary breast cancer tissue were 0.876 214, 0.773 643 and 0.725 164, 0.698 112, respectively, Plt;0.05. ConclusionThe positive expression rates of survivin, p53, and Ki67 which increase in recurrence and metastasis breast cancer tissue indicate bad prognosis.
Objective To explore value of multidisciplinary team (MDT) model in diagnosis and treatment of patients with advanced special thyroid cancer who lost chance of operation. Method Two patients with the advanced special thyroid cancer who lost chance of operation were treated by low dose apatinib (250 mg/d) after the MDT discussion. Results One medullary thyroid cancer patient with the compressing of the trachea for mediastinal metastatic lymphadenopathy and inability to lie down underwent the multiple surgical treatment, the therapeutic effect was poor. Then low dose apatinib (250 mg/d) was performed, the patient could supine, breathe smoothly, and move freely, whose life quality was obviously improved, the mediastinal lymph nodes reduced and no serious drug toxicity occurred on month 1 after the treatment. One undifferentiated thyroid cancer patient with the lung metastasis, hemoptysis, and tumor invasion resulted in the inability to lie down and having difficulty in breathing, these symptoms still existed and more pleural effusion occurred after the resection of the invaded trachea. Then low dose apatinib (250 mg/d) was performed, the patient could supine, the pleural effusion disappeared, the hemoptysis stopped, the breathing was smooth, and could do some minor housework, no drug toxicity occurred on month 1 after the treatment. Conclusion After MDT discussion, low dose apatinib in treatment of advanced special thyroid cancer is reliable and safe and has a good short-term effect, which could be used as a new remedy, but long-term effect should be further researched by increasing case samples and a long-term following-up.
Objective To explore therapeutic effect of endocrine therapy in breast cancer patients with negative hormone receptor (HR–) of primary lesion and positive HR (HR+) of metastatic axillary lymph node lesion. Methods Sixty-seven cases of breast cancer with HR– of primary lesion and HR+ of metastatic axillary lymph node lesion from January 2011 to January 2016 were selected. All the patients were randomly divided into endocrine therapy group (33 cases) and control group (34 cases). The patients were given the oral drug of tamoxifen on the basis of conventional chemotherapy in the endocrine therapy group after the surgery, 10 mg/time, twice daily, 5 years; while the patients in the control group were not given the oral drug of tamoxifen but the other therapy same as the endocrine therapy group. The survivals were compared in both groups. Results There were no significant differences in the age, menstrual condition, tumor diameter, preoperative TNM stage, and so on between the endocrine therapy group and the control group (P>0.05). All the patients were followed up for 12–60 months with a 48.5 months of median time. There were no significant differences in the rates of the local recurrence and metastasis, or death rate due to the recurrence and metastasis in both groups (P>0.05). The progression-free survival and overall survival in the endocrine therapy group were significantly higher than those in the control group (P<0.05). The 5-year cumulative progression-free survival and overall survival in the endocrine therapy group were significantly better than those in the control group (P<0.05). Conclusion Pay attention to molecular classification of primary lesion and metastatic axillary lymph node lesion in patients with breast cancer, and endocrine therapy might be able to improve survival rate of breast cancer patients with primary lesion HR– and metastatic axillary lymph node lesion HR+.