Are there any stem cells in the pancreas?

A vast number of studies indicate the presence of stem/progenitor cells virtually in all tissues in adult organs, particularly in bone marrow. Recent studies, however, cast doubt about the existence of true stem cells in adult tissue. The complex integrity of several cells with distinct morphologic and functional properties in the mature pancreas confers an appropriate status for stem cell research. Several different types of cells residing in the islets or in the ductal epithelium have been proposed as adult pancreatic stem cells or progenitor cells. However, these reports do not provide conceivable proof for the presence of true pancreatic stem cells. On the other hand, there is considerable evidence indicating transdifferentiation of all adult pancreatic cells into each other, and under proper conditions, to nonpancreatic cells including oncocytes and hepatocytes. Observations pertaining to the putative pancreatic stem cells, transdifferentiation ability of the differentiated mature pancreatic cells in the normal and diseased pancreas will be discussed, and our own findings supporting the transdifferentiation pathway are presented in this article.     

Are there any news about the antipsychotic medications in the elderly?

Antipsychotic drugs are widely used in people with dementia to treat neuropsychiatic symptoms such as aggression, agitation and psychosis. Using antipsychotic agents in older patients is difficult, because it depends on co-morbid conditions, side effects, dosing strategies, duration of treatments and combinations of various medications. This paper discusses the use of atypical antipsychotics in a 1-year-observation on a group of patients followed by an expert dementia center.     

Are there any contraindications to the transradial approach?

The transradial approach is the most frequent access used in France for coronarography and percutaneous coronary intervention. This access permits a reduction of local complications in comparison with femoral access. There are very few real contraindications of transradial approach. The use of Allen's test before coronarography remains controversial in the transradial catheterization community. It remains a standard practice in some institutions, however many centers have stopped using Allen's test considering that there is no evidence supporting its use.     

Are there lymphatic vessels in the placenta?

The role of lymphatics in placentation has been scantily studied and the true existence of placental lymphatics is under debate. Numerous blood and lymphatic-lineage molecule markers are now available and they are expressed in human placental tissue. D2-40 expression at the placental stromal level seems to indicate that network-forming, podoplanin-expressing cells may act as a reticular-lymphatic-like conductive network. This exciting area at the intersection of perinatology and lymphology needs further investigation.     

Is there any indication for aortic valvuloplasty in the elderly?

Elderly patients with severe symptomatic calcific aortic stenosis do poorly with medical management. The optimal treatment for this group of patients is surgical valve replacement. Balloon valvuloplasty may be useful as a bridge to aortic valve replacement in hemodynamically unstable patients, in patients undergoing emergent noncardiac surgery, and in patients with severe comorbidities who are too ill to undergo cardiac surgery. Balloon valvuloplasty often results in symptomatic improvement; however, the postvalvuloplasty valve area is usually <1.0 cm², the major periprocedural complication rate is roughly 5%, and the 6-month restenosis rate is quite high. There is no evidence that balloon valvuloplasty alters the natural history of aortic stenosis, although no randomized study has been performed.     

Are there any causes for increased thyroid volume in women with prolactinoma?

PurposeThe aim of this study was to evaluate thyroid volume in women with prolactinoma and investigate the relationship between anabolic hormones [insulin, insulin like growth factor (IGF-1), estrogen] and thyroid volume in the patients.Material-methodSixty-three euthyroid women with prolactinoma and 60 healthy euthyroid women were included. Serum prolactin (PRL), thyroid-stimulating hormone (TSH), thyroxine (free T4), free tri-iodothyronine (free T3), insulin resistance (IR) which was estimated by the homeostasis model assessment, thyroidal microsome (anti-TPO), antithyroglobulin antibodies (TgAb), estradiol (E2), and insulin like growth factor (IGF-1) were evaluated, and thyroid volume was calculated by B-mode doppler USG.ResultsThe mean thyroid volume was significantly higher in women with prolactinoma (82.5 ± 15.1 mL) than in healthy women (76 ± 15.1 mL)(P = 0.014), but no correlation was found between thyroid volume and serum PRL levels (P = 0.967). There were also no differences between thyroid volume, anabolic hormones (E2, IGF-1), and insulin resistance in women with prolactinoma (P = 0.776, P = 0.786, P = 0.647, respectively).ConclusionsOur study did not show an association between anabolic hormones and increased thyroid volume in women with prolactinoma.     

Fertility of tomorrow: Are there any restrictions left?

As the concepts of society, parenthood and family evolve, the French law on bioethics has recently been updated by authorizing oocyte and sperm cryopreservation for all individuals who wish to do so, in the absence of medical indications. For women, aging irremediably impairs reproductive competence, both quantitatively and qualitatively. For men, aging has a negative impact on sperm parameters. Hence, this possibility of social oocyte/sperm freezing is a real breakthrough, offering to all the opportunity to better anticipate age-related fertility decline and be better actors of one's reproductive life. In its current form, the new French bioethics law allows unrestricted access to fertility preservation techniques to all women and men that fulfill the age criteria. In light of the lack of official recommendations, many questions remain. In clinical practice, it is therefore up to centers to determine on a case-by-case basis the limits of these procedures, notably to define when to stop fertility preservation. This also questions the place of the patient as a decision maker in the procedure and to which extent these procedures should be performed according to patient preference. Altogether, despite the wide range of possibilities enabled by these major legal and technical advances, it is essential to make clear to all that undergoing fertility preservation procedures is not a guarantee of future pregnancy and does not replace timely care of fertility issues.     

Are there gender differences in diabetes care among elderly medicare enrolled veterans?

OBJECTIVE: To examine gender differences in diabetes care process measures and intermediate outcomes among veteran clinic users. DESIGN: A retrospective cohort study using Veterans Health Administration (VHA) and Medicare files of VHA clinic users with diabetes. Diabetes care process measures were tests for hemoglobin A1c (HbA1c), low-density lipoprotein (LDL-C) values, and eye exams. Intermediate outcomes were HbA1c and LDL-C values below recommended thresholds. Chi-square tests and logistic regressions were used to assess gender differences. PARTICIPANTS: Study population included 3,225 women and 231,922 men veterans with diabetes, enrolled in Medicare fee-for-service and alive at the end of fiscal year 2000. RESULTS: Overall, there were no significant gender differences in HbA1c or LDL-C testing. However, women had higher rates in these process measures than men among the non-African American minorities. Women were more likely to have completed eye exams (odds ratio [OR]=1.11; 99% confidence interval [CI]=1.10, 1.23) but were less likely to have LDL-C under 130 mg/dL (OR=0.77; 99% CI=0.69, 0.87). CONCLUSIONS: Among VHA patients with diabetes, clinically significant gender inequality was not apparent in most of diabetes care measures. However, there was evidence of better care among nonwhite and non-African American women than their male counterparts. Further research on interaction of race and gender on diabetes care is needed. This includes evaluation of integrated VHA women’s health programs as well as cultural issues. Lower LDL-C control among women suggests areas of unmet needs for women and opportunities for future targeted quality improvement interventions at system and provider levels.     

Are there any functional differences of nitric oxide between the transitional segment in Hirschsprung's disease and the diseased colon in hypoganglionosis?

BACKGROUND/AIMS: In histological studies, there are no significant differences between the transitional segment (TS) of Hirschsprung's disease (HD) and the diseased segment in patients with hypoganglionosis (Hypo). In contrast, there are no reports whether or not TS show impaired motility like Hypo. Nitric oxide (NO) has recently been shown to be a neurotransmitter in the non-adrenergic noncholinergic (NANC) inhibitory nerves in the human gut. To clarify the significance of NO in TS and Hypo, enteric nervous responses in colonic tissue obtained from TS and Hypo were investigated. METHODOLOGY: This study investigated responses of the enteric nervous system including NANC inhibitory nerves in colonic tissue obtained from TS in 10 patients with HD (8 boys and 2 girls, aged from 6 months to 2 years) and diseased colon in 6 patients with Hypo (6 boys, aged from 6 months to 2 years). Normal colons obtained from patients with HD and Hypo (n = 16) were used as controls. Mechanography was used to evaluate in vitro colonic responses to electrical field stimulation (EFS) of adrenergic and cholinergic nerves before and after treatments with various autonomic nerve blockers, N(G)-monomethyl-L-arginine (L-NMMA), and L-arginine. RESULTS: Non-adrenergic non-cholinergic (NANC) inhibitory nerves were found to act on the normal colon and to a lesser extent both in the TS and Hypo. In addition, there were no significant differences between the TS and Hypo. Nitric oxide (NO) mediates the relaxation reaction of the NANC inhibitory nerve in the normal colon and to a lesser extent both in the TS and Hypo. In addition, there were no significant difference between the TS and Hypo. CONCLUSIONS: Diminution of NO mediation of NANC inhibitory nerves may be largely related to the impaired motility observed in patients with TS and diseased colon of Hypo.