多排螺旋CT在鉴别老年患者肿块型胰腺炎与胰腺导管腺癌中的应用价值

目的 探讨多排螺旋CT在鉴别老年人肿块型胰腺炎(MFP)和胰腺导管腺癌(PDAC)的价值。方法 回顾性分析复旦大学附属华东医院2011年1月—2021年12月经临床手术/穿刺病理证实的24例肿块型胰腺炎与52例胰腺导管腺癌老年患者的临床及多排螺旋CT征象，采用独立样本t检验或χ²检验对数据进行统计学分析，探究具有鉴别价值的临床及影像特征。结果 2组疾病的价值的CT征象包括：直接征象：MFP与PDAC患者病灶密度均匀者分别为18例(75%)和15例(28.85%),差异具有统计学意义(2=14.328,P<0.001);病灶CT值方面：在增强扫描后，MFP组病灶的强化程度总体高于PDAC组，MFP组与PDAC组病灶动脉期CT值分别为(59.4±10.5)HU和(53.8±11.5)HU,静脉期CT值分别为(85.8±13.8)HU和(78.9±14.0)HU,差异均有统计学意义(t=2.024/2.011,P=0.047/0.048);间接征象：PDAC更容易出现胰周血管侵犯(36.54%)、胰尾部萎缩(53.85%)和远处转移征象(17.31%),比例均高于...     

β-连环蛋白在不同胰腺病变中的表达

目的 检测β-连环蛋白(β -catenin)在胰腺正常导管(NP)、胰腺上皮内瘤变(PanINs)、胰腺导管内乳头状黏液性肿瘤( IPMNs)及胰腺导管腺癌(PDAC)中的表达水平,分析其在胰腺癌发生过程中的作用.方法 收集正常胰腺组织12例、IPMN 52例(IPMA 20例,IPMB 13例,IPMC 19例)、PanINs118灶(PanIN-1 73灶,PanIN-2 29灶,PanIN-3 16灶)、PDAC 50例,采用免疫组化SP法检测β-catenin在上述组织中的表达,并分析其在胰腺癌的表达与临床病理特征及患者术后生存期的关系.结果 NP中β-catenin主要表达于细胞膜,表达量为(4.38±2.11)分;PanINs、PDAC和IPMN的β-catenin膜表达明显降低或缺失,PanIN-1、PanIN-2、PanIN-3、PDAC、IPMA、IPMB、IPMC的膜表达量分别为(5.22±2.21)、(2.24 ±2.31)、(1.44±1.37)、(2.71 ±2.08)、(4.85±2.28)、(4.15±2.51)、(2.68±2.75)分.PanIN-1的胞质表达率为12.3％ (9/73),胞核表达率为0;PanIN-2为34.5％ (10/29)和3.4％ (1/29);PanIN-3为43.8％ (7/16)和12.5％ (2/16);PDAC为44.0％ (22/50)和10.0％( 5/50).在由PanINs至PDAC的进展过程中β-catenin膜表达逐渐降低,而胞质、胞核异位表达率逐渐升高.β-catenin膜表达与肿瘤大小、神经浸润、淋巴转移有关(P＜0.05);胞质异位表达率与肿瘤大小有关(P＜0.05);胞核异位表达率与肿瘤的分化程度有关(P＜0.01);胞膜、胞质表达均与患者的术后生存期显著相关(P＜0.05).结论 Wnt/β-catenin通路异常活化导致的β-catenin膜表达减弱及异位表达率增加是PDAC发生、发展的重要机制,并促进PDAC的恶性生长与转移,β-catenin的表达与PDAC患者的预后相关.     

sFRP-1在胰腺导管腺癌组织中的表达及其临床意义

目的:检测sFRP-1在不同胰腺组织(正常胰腺导管、胰腺导管腺癌及癌前病变胰腺上皮内瘤变和胰腺导管内乳头状粘液性肿瘤)中的表达水平,分析其在胰腺癌发生过程中的作用,为胰腺癌的临床诊疗提供新线索.方法:免疫组织化学SP法检测sFRP-1在21灶正常胰腺导管(normal pancreatic duct,NP),73灶胰腺上皮内瘤变(pancreatic intraepithelial neoplasia-1,PanIN-1),29灶PanIN-2,16灶Pan I N-3,20例胰腺导管内乳头状粘液性肿瘤(IPMN-adenoma,IPMA),13例(IPMN-borderline,IPMB),19例(IPMN-carcinoma,IPMC)及50例胰腺导管腺癌(pancreatic ductal adenocarcinoma,PDAC)中的表达,并分析sFRP-1的表达与临床病理特征及患者术后生存期的关系.结果:sFRP-1的免疫组织化学评分在由NP导管→PanIN-1→PanIN-2、PanIN-3、PDAC及NP→IPMA、IPMB→IPMC→PDAC的逐级进展过程中逐渐升高,sFRP-1的表达与肿瘤分化程度、神经浸润显著相关.结论:sFRP-1的异常表达是PDAC发生中的早期事件,sFRP-1高表达是PDAC神经浸润的重要分子特征.     

胰腺3T磁共振弥散加权成像的临床应用研究

目的 探讨胰腺组织3T磁共振(MR)扩散加权成像(DWI)的可行性及其在胰腺肿瘤定性诊断中的价值。方法 应用3T MR成像仪对20名健康志愿者和47名胰腺肿块患者(胰腺癌21例,肿块型胰腺炎7例,胰腺囊性肿瘤19例)行胰腺常规MRI及两组不同扩散梯度因子(b值,500和1000 mm2/s)DWI检查,测量病灶、病灶旁胰腺DWI信号强度(signal intensity,SI)及病灶表观扩散系数(apparent diffusion coefficient,ADC)值。结果 在b=500和1000 mm2/s DWI图像上,正常胰腺实质信号均匀,胰头、体、尾各部分的ADC值差异均无统计学意义;而胰腺癌、肿块型胰腺炎均显示为高信号,且在b=1000mm2/s的DWI上胰腺癌的相对SI1000值显著高于肿块型胰腺炎(1.238 +0.448比0.371±0.293,P＜0.01)。胰腺癌与肿块型胰腺炎ADC500和ADC1000均显著低于正常胰腺(P＜0.01),且胰腺癌ADC1000显著低于肿块型胰腺炎[(1.087±0.175) mm2/s比(1.279 +0.213) mm2/s,P＜0.01]。胰腺囊性病变在b= 500 mm2/s时显示为高信号,在b=1000mm2/s的DWI上表现为低或等低信号,其ADC500和ADC1000均显著高于正常胰腺(P值均＜0.01)。结论 3T磁共振胰腺DWI有助于胰腺肿块型病变的鉴别诊断,高b值DWI对胰腺病变定性诊断更有价值。     

胰腺不同部位表观扩散系数正常值初探

目的 分析表观扩散系数(ADC)随胰腺形态学变化的特征.方法 对393例胰腺正常的志愿者行上腹部横断面单次激发平面回波扩散加权成像(SSEP-DWI,扩散敏感因子值为0,500 s/mm2).依据DWI计算出相应的ADC图,测量胰腺头、颈、体及尾部ADC.Kruskal-Wallis秩和检验和Wilcoxon配对符号秩和检验进行统计学分析.结果 393例正常胰腺头、颈、体及尾部ADC平均值分别为(1.52±0.29)×10-3、(1.64±0.34) ×10-3、(1.67 ±0.35)×10-3、(1.58±0.31)×10-3 mm2/s. Kruskal-Wallis 检验结果表明,胰腺不同部位ADC差异具有统计学意义(x2-44.8748,P＜0.0001);Wilcoxon配对符号秩和检验结果显示,胰腺头与颈部、头与体部、头与尾部、颈与尾部和体与尾部的ADC之间差异均具有统计学意义(P值分别为＜0.0001、＜0.0001、0.0008、0.0062、＜0.0001),而颈与体部ADC差异无统计学意义(P=0.1181).结论 正常胰腺ADC随胰腺形态结构不同其差异具有统计学意义,这一特征可为DWI及ADC在胰腺疾病的临床应用及研究提供参考.     

慢性胰腺炎的猫模型制作及磁共振影像表现

目的 制备猫慢性胰腺炎(CP)模型,观察其MRI与MRCP的影像学表现.方法 32只猫按数字表法随机分为对照组及制模后3、5、7周组.采用胰管不全结扎法制备CP模型,术后3、5、7周行MRI平扫及MRCP检查,观察胰腺形态,测量胰管直径及感兴趣区(ROI)的T1信号强度值(Tls),计算同层胰腺及肝脏Tls比值.结果 制模的24只猫中存活19只,其中15只形成CP,病理证实轻、中、重度CP分别为7、5、3只,制模成功率为62.5％.在MRI上,猫的正常胰腺显示清晰,T1加权像信号强度高于肝脏,T2加权像信号强度低于肝脏;在MRCP图像上,4只正常猫显示主胰管,胰管最大径(0.79±0.18)mm,并可见胰管及胆总管共同开口于十二指肠降部.正常胰腺及轻、中、重度CP感兴趣区的rTls值分别为1.03±0.06、0.95±0.08、0.90±0.10、0.80±0.11,各CP组与正常对照组间差异均有统计学意义(t=2.18,P＜0.05;t =2.89,P＜0.05;t =4.63,P＜0.01);胰管最大径分别为(0.79±0.18)、(0.95±0.24)、(1.26±0.31)、(2.67±0.71)mm,中、重度CP组与正常对照组间差异均有统计学意义(P＜0.05或＜0.01).结论 胰管不全结扎可制备猫的CP模型.猫的胰腺解剖形态、CP的MRI及MRCP表现与人类相似.     

胰腺肿瘤64层灌注CT成像特征的初步分析

目的 应用64层螺旋CT灌注扫描成像技术描述正常胰腺和胰腺肿瘤的血流动力学特征,探讨灌注CT在胰腺肿瘤诊断中的应用价值.方法 对36例非胰腺疾病(对照)、105例胰腺肿瘤和8例十二指肠乳头癌进行胰腺CT灌注扫描,分别测量血流量(BF)、血容量(BV)和表面通透性(PS)值.结果 正常胰腺组织BF、BV和PS的平均值分别为(135.24±48.36)ml·min-1·Kg-1、(200.55±54.96)ml/kg和(49.75 4±24.27)ml·min-1·kg-1;胰腺癌分别为(31.77±19.36)ml·min-1·kg-1、(66.84±39.49)ml/kg和(37.64 4±27.14)ml·min-1·kg-1;十二指肠乳头癌分别为(93.04±48.13)ml·min-1·Kg-1、(97.12±89.80)ml/kg和(41.08±18.85)ml·min-1·kg-1;胰腺囊肿的3项参数值接近零.胰腺癌的3项灌注参数均显著低于正常胰腺(P<0.05);十二指肠乳头癌的BF和BV值显著低于正常胰腺(P<0.05),而PS值与正常胰腺无显著差异;胰腺囊肿与正常胰腺差异非常显著(P<0.01).结论 正常胰腺CT灌注表现为组织血流量、血容量均匀,毛细血管表面通透性一致的实质性器官;胰腺癌表现为低灌注和毛细血管表面通透性降低的肿瘤;十二指肠乳头癌仅表现为低灌注,表面通透性不变;胰腺囊肿内无血流灌注.64层灌注CT有助于胰腺肿瘤的鉴别诊断.     

不同MR快扫序列对胰腺肿瘤的诊断价值

目的明确各种MR快扫序列对胰腺肿瘤的诊断价值,确定最佳扫描序列组合.方法对40名临床怀疑胰腺占位患者行MR检查,扫描序列包括:FS FLASH T1WI、TSE T2WI、True-FISPT2WI、MRCP及多时相动态增强3-D FLASH T1WI.测量正常胰腺与病灶的信号强度,计算胰腺-肿瘤的CNR,对各序列图像质量进行评分.最后,将各序列MRI的诊断和评价结果与手术病理相对照.结果胰腺-肿瘤的CNR:多时相动态增强3-D FLASH T1WI中,以胰腺实质期的胰腺-肿瘤CNR最高(9.7),其同期所获得的图像质量也最好(3.54±0.64),均优于平扫各序列(P＜0.05).对胰腺肿瘤的评价:动态增强3-D FLASH T1WI在检出胰腺癌及评价癌肿胰周血管受累、邻近器官受侵及转移灶方面均为最优(P＜0.05);MRCP对胰腺癌导致的胰胆管受侵最敏感,其次是True-FISP T2WI.综合各扫描序列的敏感性和准确性均优于任何单一的平扫、水成像或动态增强扫描序列.结论胰腺肿瘤的MR检查,多种扫描序列各有优缺点,联合应用能发挥最大潜力.理想的检查组合应包括:平扫屏气FS-FLASH T1WI、TSE T2WI、高分辨力的厚层及薄层MRCP、屏气的三维梯度回波序列多时相动态增强扫描.     

胰腺导管腺癌组织中人表皮生长因子受体2的表达及临床意义

目的:探讨人表皮生长因子受体2(HER2)在PDAC组织中的表达及与PDAC患者预后的关系。方法:收集2001年1月至2012年12月间复旦大学附属华东医院病理科存档的109例PDAC组织石蜡标本和27例正常胰腺组织标本,采用免疫组织化学Envision二步法检测胰腺组织HER2蛋白的表达,根据Hercep Test评...     

DNA甲基转移酶1和组蛋白脱乙酰基酶1在胰腺组织中的表达及其临床意义

背景：近年针对DNA甲基化和组蛋白乙酰化修饰的表观遗传学研究是探索胰腺癌发生机制的新热点。目的：研究DNA甲基转移酶1（DNMT1）和组蛋白脱乙酰基酶1（HDAC1）在胰腺上皮内瘤变（PanIN）和胰腺癌组织中的表达．探讨其可能的临床意义。方法：以免疫组化SP法检测DNMT1、HDAC1在10例正常胰腺组织、39例证实含有PanIN的胰腺癌旁组织和54例胰腺导管腺癌（PDAC）组织中的表达。结果：DNMT1和HDAC1在胰腺组织中的阳性表达率均随组织异型程度的增加而逐渐增高，即正常胰腺导管（0％）〈PanIN—IA（7．2％±1．2％，10．7％±5．0％）〈PanIN-1B（24．5％±9．6％，40．1％±8．0％）〈PanIN-2（30．0％±11．9％，51．2％±13．4％）〈PanIN-3（46．7％±11．2％，73．1％±11.3％）〈PDAC（56．7％±27．5％，82．5％±19.4％），差异均有统计学意义（P〈0．05）。结论：DNMT1和HDAC1表达增强是胰腺癌发生的早期事件．两者共同促进了胰腺癌的进展，可能成为胰腺癌早期诊疗的新靶点。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.