Gastrointestinal endoscopic findings in men with unexplained anemia and low normal ferritin values

BACKGROUND: Most practice guidelines recommend endoscopic evaluation of the gastrointestinal (GI) tract in men and postmenopausal women with anemia and a serum ferritin less than 20-40 ng/ml. The diagnostic yield of endoscopy in patients with anemia, no GI symptoms or signs, and low normal ferritin is not known. OBJECTIVE: The aim of this study was to investigate the yield of upper and lower GI endoscopic evaluations in anemic patients with ferritin levels between 40 and 100 ng/ml. DESIGN: A retrospective review of patients' charts was conducted. SUBJECTS AND METHODS: Patients at the Veterans Affairs Connecticut Healthcare System who underwent GI endoscopic evaluation for the sole indication of anemia and ferritin in the low normal range (40-100 ng/ml) were included in this study. MEASUREMENTS: Incidence of pathology of the upper and lower GI tract was determined. RESULTS: We identified 54 male patients who had a ferritin level of 40-100 ng/ml and no GI symptoms or known GI bleeding. Upper GI findings (malignancy, peptic ulcers, Helicobacter pylori gastritis, arteriovenous malformations) were found in 14/47 cases (30%). Lower gastrointestinal findings, including large tubular adenomas and arteriovenous malformation, were identified in 3/53 cases (6.7%). CONCLUSION: Our study supports GI endoscopy in anemic patients with ferritin between 40 and 100 ng/ml, even in the absence of GI symptoms or documented bleeding.     

Desktop simulator: key to universal training?

Background Training of skills in simulators is preferred over learning on patients so as to avoid undue injury to patients and to allow more efficient use of resources. Most simulators are costly and require a dedicated space. The aim of this study was to evaluate a simple desktop simulator, the Mirror Trainer. Methods Thirty medical students were randomly assigned to three groups. One group was taught laparoscopic suturing in the Mirror Trainer, the second group used a pelvic training box, while the third group served as a control group and did not receive any training. All suture attempts during training were recorded on video. A blinded, independent investigator analyzed the videos. At the completion of training, the suturing skills of each participant were evaluated in an animal model. Results Training with the Mirror Trainer required less time than with the pelvic trainer (p < 0.001). Compared with the control group, the Mirror Trainer group and the pelvic trainer group were significantly faster at creating three knots in the pig (p = 0.001 and p = 0.004, respectively). Both training groups performed equally well on the animal model (p = 0.99). Conclusion The Mirror Trainer and the pelvic trainer are equally effective in teaching laparoscopic suturing skills but training with the Mirror Trainer requires less time, can be done on any desktop, and is less costly.     

DNA polymerase β deficiency is linked to aggressive breast cancer: A comprehensive analysis of gene copy number,mRNA and protein expression in multiple cohorts

Short arm of chromosome 8 is a hot spot for chromosomal breaks, losses and amplifications in breast cancer. Although such genetic changes may have phenotypic consequences, the identity of candidate gene(s) remains to be clearly defined. Pol β gene is localized to chromosome 8p12‐p11 and encodes a key DNA base excision repair protein. Pol β may be a tumour suppressor and involved in breast cancer pathogenesis. We conducted the first and the largest study to comprehensively evaluate pol β in breast cancer. We investigated pol β gene copy number changes in two cohorts (n = 128 & n = 1952), pol β mRNA expression in two cohorts (n = 249 & n = 1952) and pol β protein expression in two cohorts (n = 1406 & n = 252). Artificial neural network analysis for pol β interacting genes was performed in 249 tumours. For mechanistic insights, pol β gene copy number changes, mRNA and protein levels were investigated together in 128 tumours and validated in 1952 tumours. Low pol β mRNA expression as well as low pol β protein expression was associated high grade, lymph node positivity, pleomorphism, triple negative, basal‐like phenotypes and poor survival (ps < 0.001). In oestrogen receptor (ER) positive sub‐group that received tamoxifen, low pol β protein remains associated with aggressive phenotype and poor survival (ps < 0.001). Artificial neural network analysis revealed ER as a top pol β interacting gene. Mechanistically, there was strong positive correlation between pol β gene copy number changes and pol β mRNA expression (p < 0.0000001) and between pol β mRNA and pol β protein expression (p < 0.0000001). This is the first study to provide evidence that pol β deficiency is linked to aggressive breast cancer and may have prognostic and predictive significance in patients.     

Epithelioid smooth muscle tumors of the uterus do not express CD1a: a potential immunohistochemical adjunct in their distinction from uterine perivascular epithelioid cell tumors

Uterine epithelioid smooth muscle tumors and uterine perivascular epithelioid cell tumors (PEComas) are known to display such a substantial overlap in morphologic and immunophenotypic characteristics that the existence of the latter as a distinct clinicopathologic entity at this location has been called into question. Recent research suggests that the constituent entities of the PEComa family at all anatomical locations, including lymphangioleiomyomatosis of the uterus, uniformly display immunoreactivity for CD1a. The purpose of this study is to determine the proportion of uterine epithelioid smooth muscle tumors that may similarly be CD1a-positive. Representative sections from 18 archived epithelioid smooth muscle tumors of the uterine corpus (6 epithelioid leiomyosarcomas and 12 epithelioid leiomyomas), diagnosed and classified as such based on World Health Organization criteria, were subjected to immunohistochemical stains for CD1a and HMB-45. The epithelioid component of the tissue sections evaluated ranged from 10% to 100% (mean, 70%). Two cases were composed predominantly of cells with overtly clear cytoplasm. All cases were entirely negative for CD1a. Of 18 cases, 1 (5.5%) (an epithelioid leiomyosarcoma) displayed immunoreactivity for HMB-45 in scattered lesional cells that constituted approximately 5% of the overall tumoral volume for the case. All others were HMB-45-negative. Given their rarity, future studies are required to confirm that all PEComas of the uterus are indeed uniformly positive for CD1a. However, if the latter staining pattern is confirmed, our findings herein suggest that CD1a may be a useful immunohistochemical adjunct in distinguishing uterine epithelioid smooth muscle tumors from uterine PEComas.     

是否应该在非洲医学院校中教授补充替代医学？

在非洲社会,补充替代医学疗法是家庭常用的疗法。大多数非洲人使用补充替代医学疗法替代主流医学疗法。出现这一现象的原因一是因为传统,二是因为很多人从经济上无法负担常规的治疗手段。在发达国家,补充替代医学的使用不断增长,因此,这些国家的很多医学院校将补充替代医学的课程纳入了医学本科生的课程体系。而在非洲,大部分医学院校并没有向学生教授补充替代医学。基于越来越多的非洲人开始使用补充替代医学疗法,以及潜在的补充替代医学疗法与常规疗法的相互作用,医生们有必要熟知那些常用的补充替代医学疗法。要达到这一目标,建议将补充替代医学的课程纳入非洲医学院校医学本科生的授课体系。这将有助于未来的非洲医生掌握整体治疗的手段,并与国际的发展趋势接轨。     

扁桃斑鸠菊及非洲印楝叶的提取物对链脲佐菌素致糖尿病大鼠肝脏形态学及肝毒性标志物的影响（英文）

目的：研究扁桃斑鸠菊及非洲印楝叶的提取物对链脲佐菌素致糖尿病大鼠肝脏形态学、肝脏氧化性应激标志物及部分肝脏酶类的影响。方法：大鼠腹腔注射链脲佐菌素致糖尿病。不同治疗组大鼠分别口服扁桃斑鸠菊及非洲印楝叶的提取物（500mg/kg）或二甲双胍（150mg/kg）,疗程8周,每周测量大鼠的血糖水平及体质量变化。8周后麻醉处死大鼠。取肝组织制成切片,希夫染色法染色,并测量肝匀浆中丙二醛和谷胱甘肽过氧化物酶的含量;下腔静脉采血,分离血浆,检测血浆中丙氨酸氨基转移酶和天冬氨酸氨基转移酶的活性。结果：二甲双胍及植物提取物均能显著改善糖尿病大鼠的血糖水平,且与糖尿病模型组相比,治疗组的体质量明显增加（P〈0.05）。光学显微镜下,各组大鼠的肝脏形态学无明显差别。植物提取物治疗组大鼠的血浆丙氨酸氨基转移酶及天冬氨酸氨基转移酶的活性与正常对照组相比无明显变化（P〉0.05）,而丙二醛含量明显下降（P〈0.05）。结论：扁桃斑鸠菊及非洲印楝叶的提取物对糖尿病大鼠有明显的降糖作用,而肝脏形态学及肝毒性标志物没有明显变化。