Safety of growth hormone replacement therapy in adults

Growth hormone (GH) is a powerful metabolic hormone that regulates fuel homeostasis through its protein anabolic and lipolytic actions. The introduction of recombinant human GH has expanded the narrow indication of treating children with severe GH deficiency (GHD) to include a broader target population of children with growth retardation and short stature and adults with hypopituitarism and severe GHD. Furthermore, because children continue to receive GH replacement therapy into adult life, the duration of treatment exposure has increased and the safety of long-term GH treatment has become increasingly important. This is of particular concern given that GH-deficient children and adults may be more vulnerable to the mitogenic stimuli of GH and insulin-like growth factor-1, both because of the underlying cause of GHD and also because of previous treatment such as radiotherapy and chemotherapy. This review focuses on the safety of treating adults with severe GHD, with specific emphasis on dose regimens, carbohydrate metabolism, neoplasia, and morbidity and mortality. Available experience from long-term replacement therapy, studies using supraphysiological doses of GH in adults and lessons learned from patients with acromegaly who have high endogenous GH levels over many years, is considered.     

派特灵治疗宫颈高危型人乳头瘤病毒感染的临床观察

目的探讨派特灵在高危型人乳头瘤病毒（HPV）感染的宫颈病变患者中的临床价值。方法2009年6月至2011年6月在南通市妇幼保健院宫颈门诊行宫颈高频电刀电圈切除术治疗，病理学诊断为宫颈上皮内瘤变Ⅱ-Ⅲ级，术后6个月细胞学、阴道镜检查正常而高危型HPV检测阳性未自然转阴患者40例，随机分为治疗组及对照组；治疗组给予派特灵局部上药，对照组不再进行任何干预治疗。停药3、6个月后再次进行细胞学及高危型HPV—DNA检测。结果治疗组停药3、6个月后抗HPV感染的总有效率为90．0％、90．0％，对照组总有效率分别为30．0％、35．0％，治疗组的疗效明显高于对照组（∥分别为3．779、3．751，均P〈0．01），3个月及6个月后治疗组HPV—DNA负荷量均较治疗前明显下降（‰分别为3．606、4．365，均P〈0．01），对照组无明显疗效（U0分别为0．947、1．407，均P0〉0．05），治疗HPV负荷的改善率明显高于对照组（U。=3．653，U2=3．147，均P〈0．01）。结论派特灵可用以治疗高危型HPV感染。     

Clinicopathology of pancreaticobiliary maljunction: relationship between alterations in background biliary epithelium and neoplastic development

Background/Purpose

Between 1988 and 2003, 38 patients underwent biliary resection for pancreaticobiliary maljunction (PBM). We reviewed the histopathologic findings for the surgically resected specimens to compare the clinical and pathologic features and assess the relationship between changes in the background biliary epithelium and the development of neoplasms.

Methods

Papillary hyperplasia (PHP) seen in the biliary epithelium of patients with PBM, was classified into grades 0–III in the gallbladder and grades 0–II in the extrahepatic bile duct, according to the extent, and was assessed for links with tumors in the same specimens.

Results

The incidence of gallbladder carcinoma was 13/21 in grades I–II, versus 0/16 in grade III, while the incidence of bile duct carcinoma was 4/20 in grade I versus 0/5 in grade II. Furthermore, these incidences for patients below age 50 years and age 50 or older were 1/18 versus 12/20, and 0/14 versus 6/17, respectively.

Conclusions

PHP of the biliary epithelium in PBM patients is an important precursor lesion, especially for gallbladder cancer, and the risk becomes greater with age, regardless of the type of pancreatobiliary junction (PBJ) and its location in the biliary tract.     

Diagnostic accuracy of novel folate receptor-mediated staining solution detection (FRD) for CIN2+: A systematic review and meta analysis

Background:Early detection and diagnosis of high-grade cervical intraepithelial neoplasia grade 2 or higher (CIN2+) is critical for a good prognosis and appropriate treatment. The chief aim of our study was to evaluate the diagnostic performance of folate receptor-mediated staining solution detection (FRD) for CIN2+.Methods:We conducted a systematic review and meta-analysis by searching the PubMed and EMBASE databases for studies published until May 2020, which assessed the diagnostic accuracy of FRD, human papilloma virus (HPV) testing, and ThinPrep cytology test (TCT) for the detection of CIN2+. Bivariate models were used to compare the diagnostic performance of FRD, HPV, and TCT.Results:Six studies involving 2817 patients were included in this meta-analysis. The pooled specificity of FRD was higher than that of HPV and TCT for detecting CIN2+ (0.65, 0.12, and 0.39, respectively). The summary area under the receiver operating characteristic curve values using FRD, HPV, and TCT for detecting CIN2+ were 0.79, 0.95, and 0.77, respectively, indicating that FRD was superior to TCT. The diagnostic odds ratios of FRD, HPV, and TCT were 6 (95% CI: 5–7), 3 (95% CI: 2–5), and 3 (95% CI: 2–4), respectively, demonstrating that FRD had good diagnostic accuracy.Conclusion:FRD showed good diagnostic accuracy and higher specificity than HPV and TCT for detecting CIN2+. Based on our results, we propose that FRD could be a candidate for cervical screening, especially in underdeveloped countries.     

门头沟区宫颈癌筛查302例宫颈不典型鳞状上皮病变结果分析

目的：总结门头沟地区妇女宫颈癌筛查宫颈不典型鳞状上皮病变的发生率与年龄的关系,并分析阴道镜检查下的病理结果。方法回顾性分析35～59岁行宫颈癌筛查巴氏涂片结果ASCUS的妇女,在阴道镜定位下多点活检的组织病理学检查。结果302例宫颈细胞学诊断为ASCUS患者,45～49岁年龄组宫颈上皮内瘤变CINI～I I的发生率（25.53%）高于其他年龄组,差异有统计学意义（P＜0.05）。40～44岁年龄组CINI～I I的发生率（16.67%）高于35～39组、50～54组、55～59组CINI～I I的发生率,差异有统计学意义（P＜0.05）。302例ASCUS患者中,阴道镜诊断的≥LSIL 119例（39.40%）,阴道镜指导下组织活检,病理学诊断109例（36.09%）,病理学和阴道镜诊断阳性符合率为91.59%。结论40～49岁ASCUS患者直接做阴道镜引导下多点取活检,其他年龄组ASCUS患者阴道镜检查若未发现病变,6个月后复查细胞学检查;阴道镜检查以及阴道镜下取活检对ASCUS的处理具有较高的临床价值。     

Tumors of the ocular surface: A review

Tumors of the Ocular Surface clinically manifest with a very wide spectrum and include several forms of epithelial, stromal, caruncular, and secondary tumors. As a group, these tumors are seen commonly in the clinical practice of a comprehensive ophthalmologist, cornea specialist, and an ocular oncologist. This review is aimed to discuss the common tumors of the ocular surface and emphasize on their clinical diagnosis and appropriate management.