Does milk have a cataractogenic effect?

We undertook a prospective study to test Simoons' hypothesis that in certain susceptible races milk exerts a cataractogenic effect. Overall milk intake in low lactase deficiency areas did not correlate with cataract occurrence. Subgrouping of cataract patients revealed that greater milk intake did show positive correlation with cortical cataracts. Cortical cataracts were also markedly more common in females. Analysis of data from three different regions showed greater milk intake in cortical cataract patients only. Our data indicate the importance of specifying cataract type in cataract studies and highlight the problem this approach brings forth. We noted no different trends in subjects from northwest and southeast India, although the number of subjects from the southeast was considerably less. Patients with early cortical cataracts may be advised to restrict milk intake.Part of this material was presented at second cataract epidemiology meeting at Bonn in March 1988. A brief report has been accepted for publication in the proceedings of the meeting to be published inDevelopment of Ophthalmology, Vol. 17, 1988.     

Cholangiopathy after short‐term administration of piperacillin and imipenem/cilastatin

Abstract: We describe a patient who suffered from intestinal perforation after abdominal trauma. Perioperatively, he was treated with a single dose of piperacillin and 9 doses of imipenem/cilastatin over 3 days. The patient was discharged 5 days after surgery in good clinical condition and with normal liver values except for a marginal elevation of alanine aminotransferase. Two weeks after discharge, he developed fatigue, fever and pruritus, necessitating rehospitalization. He was jaundiced and had elevated alkaline phosphatase and transaminases. After exclusion of an intra‐abdominal fluid collection, a vascular problem, and infectious or autoimmune liver disease, a liver biopsy was performed. The biopsy revealed centrizonal bilirubinostasis, a portal infiltrate rich in eosinophils and cholangitis. Lymphocyte transformation tests for piperacillin and imipenem/cilastatin were positive, suggesting an immunological mechanism for the observed hepatopathy. Cholestasis gradually decreased but was detectable for several weeks. The patient had a full clinical and biochemical recovery after 3 months. We conclude that short‐term therapy with piperacillin, imipenem/cilastatin or the combination of these drugs can lead to the same type of hepatopathy as described for amoxycillin/clavulanic acid or antistaphylococcal penicillins. Liver biopsy and positive lymphocyte transformation are compatible with an immunological mechanism.     

The application of the skin virome for human identification

The use of skin virome offers a unique approach for human identification purposes in instances where a viable and statistically relevant human DNA profile is unavailable. The skin virome may act as an alternative DNA profile and/or an additional form of probative genetic material. To date, no study has attempted to investigate the human virome over a time series across various physical locations of the body to identify its diagnostic potential as a tool for human identification. For this study, we set out to evaluate the stability, diversity, and individualization of the human skin virome. An additional goal was to identify putative viral signatures that can be used in conjunction with traditional forensic STR loci. In order to accomplish this, human viral metagenomes were collected and sequenced from 42 individuals at three anatomical locations (left hand, right hand, and scalp) across multiple collection periods over a 6-month window of time. Assembly dependent and independent bioinformatic approaches, along with a database centered assessment of viral identification, resulted in three sets of stable putative viral markers. In total, with the three sets combined, we identified 59 viral biomarker regions, consisting of viral species and uncharacterized viral genome assemblies, that were stable over the sampling period. Additionally, we found the abundance profiles of these 59 viral biomarkers, based on presence or absence, to be significantly different across subjects (P < 0.001). Here we demonstrate that not only is the human virome applicable to be used for human identification, but we have identified many viral signatures that can putatively be used for forensic applications, thus providing a foundation to the novel field of forensic virology.     

火针联合 308 nm 准分子激光治疗白癜风疗效分析

【摘要】 目的 研究分析火针联合 308 nm 准分子激光治疗白癜风的临床疗效。方法 选取2018年10月至2020年10月台前县夹河中心乡卫生院收治的85例白癜风患者 (255处皮损)作为研究对象,按照随机数表法将其随机分为观察组42例 (123处皮损) 和对照组43例(132处皮损),观察组患者采用火针联合308 nm 准分子激光治疗,对照组患者单纯采用308 nm 准分子激光治疗,对比观察两组患者皮损面积、复色率、见效时间、临床疗效以及不良反应发生情况。结果 治疗结束后,观察组患者皮损面积明显小于对照组 (t = 27.030,P <0.001),复色率明显高于对照组 (Z = - 17.691,P < 0.001),见效时间明显短于对照组 (Z = - 6.554,P <0.001); 观察组患者中皮损痊愈36处、显效46处、好转19处、无效22处,明显优于对照组患者的皮损痊愈25处、显效41处、好转32处、无效34处 (Z = - 2.623,P = 0.009)。其间,观察组患者不良反应发生率为1.63%,与对照组患者的不良反应发生率 0.76%无明显差异 (χ2 =0.413,P =0.520)。结论 与单纯应用308 nm准分子激光治疗相比,火针联合 308 nm 准分子激光可明显缩短白癜风皮损处肤色恢复时间,缩小皮损面积,提高复色率,疗效显著。     

Audit of the management of suspected giant cell arteritis in a large teaching hospital

Background : The diagnosis of giant cell arteritis (GCA) is often confirmed by an early temporal artery (TA) biopsy of adequate length. Treatment of this condition with high‐dose corticosteroids may be associated with significant morbidity, including osteo­porosis. Aim: To audit current management of patients with suspected GCA at Auckland Healthcare, a large teaching hospital. Methods: We performed a retrospective chart review of all TA biopsies from January 1996 to June 2000. A total of 117 biopsies from 111 patients was audited. Of these patients, 37/111 (33%) had a final clinical diagnosis of GCA (GCA patients). The areas of interest for audit were waiting time for TA biopsy, length of sample, initial corticosteroid therapy and osteo­porosis prophylaxis. Results: The mean waiting time for biopsy for all patients was 5.6 days (range 0?42 days). This time varied from 9.3 days for rheumatology patients to 2.6 days for ophthalmology patients (P = 0.003). Only 44/117 (37.6%) specimens measured more than 10 mm. For GCA patients, the median initial oral prednisone dose was 60 mg/day. Osteoporosis prophylaxis was prescribed in 24/37 (65%) GCA patients, most commonly cyclical etidronate. Conclusions: There is significant variation in the management of GCA within our institution. This audit has highlighted several areas where improvement could be made, particularly in streamlining the process of obtaining TA biopsy and in promoting the use of osteoporosis prophylaxis. (Intern Med J 2002; 32: 315?319)     

Clinicopathological analysis of lung cancer resembling malignant pleural mesothelioma

OBJECTIVE: The aim of this study was to evaluate the clinicopathological features of lung cancer resembling malignant pleural mesothelioma. METHODOLOGY: The seven patients studied had tumours showing an extensive pleural growth pattern, and were chosen from 1516 lung cancer patients diagnosed at two affiliated hospitals over a 17-year period. RESULTS: Histologically, five of these lung cancers were adenocarcinomas, one was a small cell carcinoma, and one a large cell carcinoma. Tumour markers such as carcinoembryonic antigen (CEA) were elevated in six patients at admission. However, a clinical diagnosis was difficult and these cancers could only be distinguished from malignant pleural mesothelioma by thoracentesis in two cases, pleural biopsy in two, thoracotomy in two, and in case 7 at autopsy. Treatment consisted of chemotherapy or radiation therapy in four patients, but with little clinical effect. The mean survival time was 6.7 months, which is much less than for true malignant pleural mesothelioma. CONCLUSIONS: Lung cancer resembling malignant pleural mesothelioma is most frequently observed in patients with adenocarcinoma, which is suspected to occur peripherally. To distinguish pseudomesotheliomatous carcinoma from malignant pleural mesothelioma in patients with diffuse pleural thickening and effusion, requires adequate tissue sampling by thoracotomy or video-assisted thoracoscopic surgery and a panel of immunohistochemical stains.     

煌蓝色素内镜活检和内镜检查诊断胃癌的比较

目的为了提高早期胃癌的检出率和活检阳性率,我们使用煌蓝色素内镜和普通内镜检查了54例胃癌患者。方法煌蓝色素染色方法和步骤:①给受检者肌注654—2针20 mg;②给受检者口服一杯煌蓝染色液;③40-60 min 后进行内镜检查,所有受检者均进行了普通内镜检查。结果 54例中的16例证实为早期胃癌,早期胃癌的检出率为29.6%,其中15例为煌蓝色素内镜发现,普通内镜仅诊断了5例。在早期胃癌的检出方面,前者比后者是明显敏感的方法(P<0.01)。另外,煌蓝色素内镜可将活检阳性率从70.4%(38/54)提高到94.4%(51/54)。在胃癌的诊断方面,煌蓝色素内镜的活检阳性率明显优于普通胃镜的(P<0.01)。结论在早期胃癌的检出方面,煌蓝色素内镜检查比普通胃镜更敏感,且可提高胃癌的活检阳性率。     

The Effect of Processing on Liver Biopsy Core Size

OBJECTIVES: Liver biopsy is a valuable clinical tool, but for the interpretation to be meaningful a certain core size should be obtained. This study examines the changes the liver biopsy core undergoes during processing steps. METHODS: A total of 61 consecutive percutaneous liver biopsies were obtained between November 2004 and April 2005. The needle type utilized was the 16-gauge automatic tru-cut. A measurement was made while each liver biopsy core specimen resided in the cartridge, then a measurement was made with the core placed on the tray, and a final measurement was made after the pathologist received the formalin-fixed specimen. RESULTS: The mean size of the biopsy core in the cartridge measured 15 +/- 2 mm, compared to a mean size on the tray of 19.6 +/- 3.5 mm, and a mean size after fixation of 18.3 mm. All mean sizes were statistically different from one another. The compressive effect of the cartridge was 23%. The shrinkage effect of formalin fixation was 7%. CONCLUSIONS: The liver biopsy core size changes significantly through the processing steps. It is imperative that the operator is aware of these changes so that appropriate decisions are made. As an example, if the operator underestimates the core size when measured in the cartridge, a second pass may be completed when in fact adequate tissue had been obtained on the first pass.     

双环醇治疗慢性乙型病毒性肝炎肝纤维化的临床研究

目的研究双环醇对慢性乙型病毒性肝炎(乙肝)肝纤维化的治疗作用。方法以双环醇治疗慢性乙肝患者20例,疗程6个月。分别于治疗前后检测患者血清丙氨酸氨基转移酶(ALT)、γ谷氨酰转肽酶(GGT)及血清纤维化指标层粘连蛋白(LN)、Ⅳ型胶原(CⅣ)、Ⅲ型前胶原肽(PⅢP)和透明质酸(HA)水平。同时经皮肝活检观察治疗前后肝脏组织病理学变化。结果双环醇可以显著降低慢性乙肝患者血清ALT和GGT水平,复常率分别达95%和70%,同时可以明显降低慢性乙肝患者血清LN、CⅣ和PⅢP水平,尤其PⅢP和CⅣ水平与肝组织纤维化程度呈明显正相关(相关系数分别为0.653和0.530,P<0.01)。结论双环醇可以减轻慢性乙肝患者肝脏炎症反应,保护肝细胞和抑制肝纤维化。