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].     

经内镜胰管支架置入联合肿瘤剜除术治疗胰腺颈部良性肿瘤1例报告

<正>随着影像诊断技术的不断发展,胰腺良性肿瘤不断被鉴别诊断,其中绝大多数需要及时的外科手术干预。因肿瘤部位不同,其手术术式选择各异。包括胰腺肿瘤剜除、胰腺中段切除、远端胰腺切除、胰十二指肠切除等[1]。其中,肿瘤剜除术主要适用于凸出于胰腺实质表面,且与主胰管间有一定安全距离的良性肿瘤,如胰岛素瘤[2]。当肿瘤位置较深或紧贴主胰管时,若单纯行肿瘤剜除术,极易损伤主胰管,造成术后胰漏。本团队针对1例胰腺颈部良性肿瘤患者,采用经内镜胰管支架置入联合胰腺肿瘤剜除术的治疗方式,在预防术后胰漏方面获得了     

胰腺产粘蛋白肿瘤

胰腺产粘蛋白肿瘤(mucin-producing tumor of pancreas,MTP) 是指能产生粘蛋白,主胰管或支胰管上皮有乳头状生长的胰腺肿瘤性病变.其临床病理特征有别于常见的胰腺癌[1].MTP发病率低,国外每年见零星报道,国内少见.     

胰腺癌ERCP影像学所见与肿瘤大小及分期关系的研究

目的 探讨胰腺癌ERCP所见与肿瘤大小和分期的关系。方法 选择手术和病理证实为胰腺癌、ERCP影像清晰的患者35例，根据ERCP片子测量主胰管和胆总管狭窄长度，并测量胰胆管梗阻远端直径。将胰腺癌肿瘤大小（TS）和JPST分类与ERCP所见的关系进行相关性分析。结果 35例中25例ERCP主胰管狭窄，10例中断（7例导丝通过梗阻部位显示病变长度），31例胆总管狭窄。35例肿瘤大小与胰管和胆总管狭窄长度的相关系数分别为0．709（P=0．0001）和0．540（P=0．0053），JPST分类与胰管狭窄长度的相关系数为0．514（P=0．0052）。结论 胰腺癌ERCP胰管狭窄长度与肿瘤大小和分期呈正相关，但狭窄段短者与肿瘤大小及分期并非完全一致，胆管狭窄长度对预测胰头肿瘤大小亦有作用。     

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（IPMNs）是一类以胰腺导管上皮乳头样增生和分泌大量黏液为特点的一,类肿瘤,大量黏液堵塞主胰管或分支胰管并使之扩张。近年对IPMNs的流行病学、病理特征与肿瘤基因表达、诊断处理原则方面均有了新的认识。本文就IPMN8的研究进展作一综述。     

ERCP诊治指南（2010版）（三）

胰腺疾病的ERCP诊治指南 一、ERCP对胰腺疾病的诊断作用 1．单纯胰管造影（ERP）对于慢性胰腺炎、自身免疫性胰腺炎、侵及主胰管的肿瘤病变具有较高的诊断价值,但对其他病变,尤其是仅累及胰腺实质或分支胰管的病变则敏感性较低。     

十二指肠乳头肿瘤

近年来十二指肠乳头肿瘤内镜下切除术日渐成熟,但存在较高风险,术后有肿瘤残留,且术后并发症发生率或复发率较高,是否追加外科手术仍存在争议。现报道1例行改良十二指肠乳头肿瘤内镜下切除术患者,术前通过超声胃镜评估有无胆胰管内生性生长,术中于胆胰管内放置鼻胆引流管改造的长支架预防术后并发症,术后根据病理结果组织多学科讨论,旨在为十二指肠乳头肿瘤的规范化治疗提供参考。     

经口胰管镜在胰管内疾病诊疗中的应用分析(含视频)

回顾性分析南京医科大学第一附属医院胰腺中心2020年8月—2022年10月收治的23例因考虑胰管内疾病行经口胰管镜检查的患者资料，分析术中所见、术后并发症情况及胰管镜对胰管疾病的诊疗价值。所有患者接受胰管镜检查，并达到技术成功。其中7例患者确诊为胰腺导管内乳头状黏液性肿瘤，3例确诊为胰腺恶性肿瘤，8例胰管结石患者在胰管镜下行激光或液电碎石术，2例慢性胰腺炎患者经治疗后腹痛好转，2例胰管内出血和胰肠吻合口炎症患者经保守治疗后黑便消失，1例胰肠吻合口狭窄患者经球囊扩张后症状改善。23例患者均未出现手术并发症，手术操作时间为35~90 min。经口胰管镜在胰管内疾病的诊疗中安全有效，且有独特的优势。     

内镜超声引导下胰管引流

通常,胰管高压的患者以腹痛为主要症状,常见于慢性胰腺炎、胰管结石、胰空肠吻合口狭窄及胰腺导管内乳头状黏液性肿瘤（IPMN）的患者,主要解决方式为外科手术或内镜下减压,如括约肌切开术、逆行胰管支架置入术、胰管狭窄扩张术等。一项随机试验显示,慢性胰腺炎导致胰管阻塞的治疗中外科介入的有效性优于内镜介入,然而并未考虑患者主观接受程度与创伤大小。一些由于一般条件不允许行外科手术或拒绝行手术治疗的患者会选择内镜介入治疗,但对于有解剖结构改变者,如Whipple术后患者,经典的ERCP术往往不能成功。     

超声内镜引导下胰管引流术治疗进展

各种原因引起的胰管梗阻,易诱发腹痛和胰腺炎,需要胰管引流治疗。随着内镜微创介入技术发展,无法手术切除的胰腺肿瘤和良性病变所致的胰管梗阻首选内镜下的引流已形成共识。超声内镜引导下胰管引流术(endoscopic ultrasound-guided pancreatic duct drainage, EUS-PDD)可以较好解决无法行经内镜逆行胰造影术(endoscopic retrograde pancreatography, ERP)或ERP失败的患者,丰富和完善了胰管引流的内镜下治疗手段。本文主要对病例选择、术式和手术器件选择、操作成功率、并发症及长期疗效的新进展进行总结,期望有助于临床医师对EUS-PDD有全面了解。     

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.