内镜下光动力治疗胰腺导管内乳头状黏液性肿瘤2例

胰腺导管内乳头状黏液性肿瘤是一种以导管扩张、导管内乳头状生长和黏液分泌为特征的肿瘤,具有一定的恶变潜能。内镜下光动力治疗是一种腔内局部治疗肿瘤的新技术,可使肿瘤组织坏死、脱落,达到局部杀灭肿瘤的作用。本文报道了2例内镜下光动力治疗该病的病例,总体疗效满意。     

胰腺导管内乳头状黏液瘤

胰腺导管内乳头状黏液瘤（intraductal papillary mucinous neoplasm,IPMN）是胰管内来源的肿瘤,由日本Ohhashi等于1982年首先报道,随后陆续有一些文献出现,但命名上未统一,较常用的有导管内乳头状肿瘤、导管高分泌黏液肿瘤、导管产黏液肿瘤、导管扩展型黏液性囊腺瘤等。1996年WHO将胰腺囊性产粘蛋白肿瘤分为两类：胰腺导管内乳头状黏液瘤（intraductal papillary mucinous tumor,IPMT）和黏液性囊腺瘤（mucinous cystic tumor）。2000年,WHO将IPMT修正为IPMN。     

胰腺导管内乳头状黏液性肿瘤的研究进展

胰腺导管内乳头状黏液性肿瘤（IPMN）是指起源于主胰管或分支胰管内上皮细胞,形成大体可见的乳头状（偶见扁平状）、产黏液的,并伴有不同程度胰管扩张的一类肿瘤,是最常见的胰腺囊性肿瘤.1982年由Ohashi等首先报道,并命名为产黏液胰腺癌;IPMN曾被称为绒毛状腺瘤、乳头状肿瘤、乳头状癌、胰腺黏液导管扩张症及胰腺产黏液性肿瘤等[1].2000年,WHO将胰腺产黏液性肿瘤分成IPMN及黏液性囊性肿瘤（MCN）.根据细胞及组织异型程度,IPMN又被分成非浸润性IPMN（包括低级别、中等级别及高级别异型增生）和浸润性IPMN;根据累及胰管的范围,IPMN又被分为主胰管型（20％）、分支胰管型（40％）及混合型（40％）[2].     

胰腺导管内乳头状黏液瘤

胰腺导管内乳头状黏液瘤(intraductal papillary mucinous neoplasm,IPMN)是胰管内来源的肿瘤,由日本Ohhashi等[1]于1982年首先报道,随后陆续有一些文献出现,但命名上未统一,较常用的有导管内乳头状肿瘤、导管高分泌黏液肿瘤、导管产黏液肿瘤、导管扩展型黏液性囊腺瘤等.     

胰腺导管内乳头状黏液性肿瘤诊治进展

胰腺最常见的恶性肿瘤是胰腺导管腺癌,其预后很差。然而,胰腺导管上皮发生的另一类肿瘤,胰腺导管内乳头状黏液性肿瘤(intraductal papillary mucinous tumors,IPMT) 却有着较好的预后,以前临床及病理医师对其尚不熟悉,直至近几年才逐渐被认识。Kimura等曾以以下特点作了报道:(1)胰腺导管内大量的黏液产生和潴留;(2)乏特乳头部开口由于黏液流过而扩大;(3)主要在主胰管内发展和播散;     

胰腺导管内乳头状黏液瘤的研究进展

胰腺导管内乳头状黏液瘤(intraductal papillary mucinous neoplasm,IPMNs)为来源于胰腺导管上皮的分化程度多样的胰腺肿瘤,位于主胰管或其分支内,可分泌黏液,为胰腺癌的癌前病变.区分IPMNs的良恶性对制定治疗方案,预估患者预后意义重大.随影像学和内镜的发展,IPMNs发现率逐年提...     

胰腺肿瘤的病理诊断和鉴别诊断

胰腺肿瘤发病率近年呈上升趋势,本文仅就胰腺外分泌的上皮性肿瘤的主要类型加以介绍。其中包括胰腺导管腺癌及其主要的变型和腺泡细胞癌、胰母细胞瘤等。文中还包括了浆液性囊性肿瘤、黏液性囊性肿瘤、导管内乳头状黏液肿瘤（IPMN）和导管内乳头状嗜酸性肿瘤以及实性一假乳头状肿瘤,对上述个性肿瘤的免疫组化特点和分子特征也进行了阐述。     

异位胰腺临床症状以及内镜下特点分析

目的探讨异位胰腺胃镜及超声胃镜下的表现。方法回顾性分析2012年3月至2015年3月经病理结果证实为异位胰腺的57例患者的临床资料,总结其临床症状、内镜及超声内镜下表现。结果 57例异位胰腺患者中,位于胃窦部最多为52例(52/57,91.2%),其余位于胃角4例,十二指肠1例。胃镜下均表现隆起病变,49例可见隆起顶部有脐样开口。超声内镜下,隆起边界不清50例,48例为不均匀混合回声病灶,低回声或等回声6例,3例为高回声病灶。6例病变位于黏膜层,47例病变为黏膜下层,2例病变累及肌层,2例病变突破肌层。结论异位胰腺无明显特异性临床表现,胃镜联合超声内镜对其诊断有重要意义。     

胃异位胰腺1例并文献复习

异位胰腺(HP)是一种少见疾病,是指与正常胰腺完全分离的孤立胰腺组织,与正常胰腺组织间没有组织、神经和血管相连。胃HP无特异的临床表现,常在胃镜检查时发现,由于病变多位于黏膜下层,胃镜病理活检很难确诊,诊断依赖超声内镜及内镜治疗术后的病理结果。HP与黏膜下肿瘤如胃肠道间质瘤难以区分,常行外科手术切除。本文报道了1例胃镜检查示胃部肿块最后确诊为胃HP的病例。     

异位胰腺的超声内镜特征和内镜治疗作用

目的 探讨异位胰腺超声内镜(endoscopic ultrasonography,EUS)的特征和内镜黏膜下肿物切除术对异位胰腺的治疗作用。方法 选取2012年10月至2018年9月哈尔滨医科大学附属第二医院收治的黏膜下肿物患者,经EUS检查后行内镜黏膜下肿物切除术,病理诊断为异位胰腺者。观察其EUS下的特征,并对患者进行追踪随访。结果 本研究共纳入31例患者,17例(54.84%)病变位于胃窦,6例(19.35%)位于胃体,5例(16.13%)位于十二指肠,2例(6.45%)位于胃底,1例(3.23%)位于食管;4例(12.90%)表面有中央凹陷;24例(77.42%)呈低回声;14例(45.16%)起源于黏膜下层,8例(25.81%)起源于固有肌层,7例(22.58%)起源于黏膜肌层,2例(6.45%)累及多层;18例(58.06%)内部回声均匀;26例(83.87%)边界清晰。17例(54.84%)患者行内镜固有肌层剥离术(endoscopic mucosal dissection, EMD),14例(45.16%)行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD),均一次性切除,术后随访均无瘤体残留及复发。结论 异位胰腺好发于胃窦,胃体、十二指肠为次,以低回声为主,内部回声多均匀,边界大多清晰,多起源于黏膜肌层、黏膜下层、固有肌层。内镜黏膜下肿物切除术可以为异位胰腺提供病理诊断的标本,同时也是一种安全有效的治疗手段。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.     

Morphological and immunocytochemical heterogeneity of cultured pinealocytes from one-week-and two-month-old rats: Planimetric and densitometric investigations

Abstract: In vitro preparations of rat pinealocytes are widely used for biochemical analyses of signal transduction processes. This paper deals with morphological and immunocytochemical features of such preparations. Special attention was paid to the problems of whether pinealocytes represent a heterogeneous cell population and how such heterogeneity may develop during ontogeny. The investigations were performed with cells which were obtained from the pineal organ of one-week-and two-month-old rats, attached to synthetic peptide-coated coverslips or tissue culture chamber slides, and maintained under in vitro conditions overnight. The attached cells were then fixed with paraformaldehyde. These preparations yielded monolayers of spherical cells of different sizes; most cells were isolated, but some of them were aggregated and formed small clusters. On the average, the cells from the one-week-old animals were smaller than the cells from the two-month-old animals. Immunocytochemical demonstration of S-antigen, a pinealocyte-specific marker, showed that the majority of the cells from two-month-old animals were intensely or moderately labelled. Pinealocytes from one-week-old animals were less S-antigen immunoreactive. Only very few cells (less than 1% displayed glial fibrillary acidic protein (GFAP)-immunoreactivity. Planimetric investigations of the cell size and semiquantitative densitometric investigations of the intensity of the S-antigen immunoreaction revealed that (i) pinealocytes kept in vitro form a heterogeneous cell population, and that (ii) this heterogeneity increases during postnatal development from one-week-old to two-month-old animals. Two groups of pinealocytes can be distinguished based on their developmental fate: pinealocytes of one group grow dramatically, but show only a moderate increase in S-antigen immunoreactivity, and pinealocytes of the other group retain their size, but display a distinct increment in S-antigen immunoreacti vitv.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.