Fine-needle biopsy of the pancreas: Results of 204 routinely performed biopsies in 190 patients

Two-hundred and four fine-needle aspiration biopsies of the pancreas have been performed in 190 patients during a 12-year period. Sixty-one of these were performed percutaneously guided by endoscopic retrograde cholangio-pancreatography, percutaneous transhepatic cholangiography, angiography, or ultrasonography; and 143 were taken intraoperatively. In 77 (67%) out of 115 patients with pancreatic cancer, a correct cytological diagnosis was obtained. Two biopsies were reported as malignant in 1 patient who ultimately was found to have chronic pancreatitis (false positives). The frequency of not representative biopsies varied from 20.8% in patients with suspected cancer biopsied intraoperatively to 48.4% in patients biopsied preoperatively. A correct cytological diagnosis of malignancy was obtained preoperatively in 54.6% of patients with cancer, in 60.0% of patients evaluated without later operation, and in 71.1% of patients biopsied during laparotomy for suspected pancreatic cancer. The overall false-negative rate was 9.8%. The predictive value of a positive test was almost 100%, whereas the predictive value of a negative test was only 69.6% (total material). Analyses may indicate that a more aggressive approach with multiple punctures may lower the not representative biopsy rate and increase the diagnostic accuracy in patients with pancreatic cancer.

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Resumen Doscientas y cuatro biopsias pancreáticas por aspiración con aguja fina han sido realizadas en 190 pacientes en un período de 12 años. Sesenta y una de éstas fueron realizadas por vía percutánea guiada por colangiopancreatografía endoscópica retrógrada, colangiografía percutánea transhepática, angiografía, o ultrasonografía, y 143 fueron intraoperatorias. En 77 (67%) de 115 pacientes con cáncer del páncreas se obtuvo un diagnóstico citológico correcto. Dos biopsias fueron informadas como malignas en un paciente en quien finalmente se demostró pancreatitis crónica (falsas positivas). La frecuencia de biopsias no representativas varió entre 20.8% en pacientes con sospecha de cáncer y biopsia realizada intraoperatoriamente, a 48.4% en pacientes con biopsias realizadas en la fase preoperatoria. El diagnóstico citológico correcto de malignidad fue logrado preoperatoriamente en 54.6% de los pacientes con cáncer, en el 60.0% de los pacientes evaluados y sin operación posterior y en el 71.1% de los pacientes en quienes se realizó biopsia durante la laparotomía por sospecha de cáncer pancreático. La tasa global de resultados falsos negativos fue de 9.8%. El valor de predicción de una prueba positiva fue de casi 100%, mientras el valor de predicción de una prueba negativa fue de sólo 69.6% (material total). La implicación práctica de esto es que cuando se obtenga un resultado negativo se debe proceder con la toma de nuevas biopsias. En conclusión, creemos que la biopsia del páncreas con aguja fina es un procedimiento seguro que puede ser recomendado en todas las fases del proceso diagnóstico o terapéutico de lesiones pancreáticas, y que es valioso en la planeación de la terapia en pacientes con cáncer. Sinembargo, las biopsias negativas en casos de sospecha clínica de cáncer no siempre excluyen su presencia. Mayor análisis puede indicar que una actitud más agresiva, con punciones mÚltiples, puede disminuir la tasa de biopsias no representativas y aumentar la precisión diagnóstica en pacientes con cáncer pancreático.

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Résumé Deux cent quatre biopsies-aspirations à l'aiguille fine du pancréas ont été pratiquées chez 190 sujets au cours d'une période de 12 ans. Soixante et une d'entre elles ont été pratiquées par voie souscutanée en étant guidées par cathétérisme rétrograde, cholangiographie transpariétale, angiographie ou ultrasonographie et 143 ont été effectuées au cours de l'intervention. Chez 77 (67%) sujets appartenant à une série de 115 malades atteints de cancer du pancréas le diagnostic cytologique exact a été porté. Deux biopsies en faveur du diagnostic de cancer répondaient en réalité à des lésions de pancréatite chronique (faux positifs). La fréquence des biopsies ininterprétables chez les sujets suspects de cancer a varié de 20.8% lorsque l'examen a été pratiqué au cours de l'intervention à 48.4% lorsque ce mÊme examen a été effectué avant l'opération. Le taux de diagnostic cytologique exact de cancer a été respectivement de 54.6%, de 60.0% et 71.1% selon que la biopsie cytologique a l'aiguille a été pratiquée avant l'intervention, après un certain délai et au cours de l'opération. Au total, le taux des faux positifs s'est élevé à 9.8%. La fiabilité de la biopsie à l'aiguille a été proche de 100% en cas de biopsie positive mais seulement de 69.6% en cas de biopsie négative. L'analyse de l'ensemble de ces faits incite à adopter une attitude plus agressive c'est-à-dire à pratiquer des biopsies multiples au lieu d'une ponction unique pour réduire le taux des prélèvements ininterprétables et accroÎtre celui des résultats exacts.

     

氧化应激在溃疡性结肠炎中的作用及中医药防治研究进展

溃疡性结肠炎（UC）是一种临床常见的消化系统疾病,致病机制尚不明确,病情复杂多变,迁延难愈,治疗周期漫长,且无特效药。目前,UC的治疗多采用皮质类固醇、氨基水杨酸及生物制剂等西医手段,短时间起效快,疗效确切。但随着用药时间的延长,部分患者会出现耐药性和加剧病情发展,导致结肠癌的发生。有研究发现,氧化应激是UC重要的致病因素之一,影响着UC的发生、发展。氧化应激是机体内氧化产物与抗氧化系统不平衡的一种应激状态,丙二醛（MDA）、活性氧（ROS）、一氧化氮（NO）等氧化产物的过表达或者超氧化物歧化酶（SOD）、过氧化氢酶（CAT）、谷胱甘肽（GSH）抗氧化酶的不足都会导致氧化应激的发生。值得注意的是,中医药作为我国独有的医学特色,运用中医药治疗UC疾病已经取得显著的成效。研究表明,中医药一方面通过抑制代谢产物的堆积,有效抑制UC发生,另一方面,通过提高抗氧化系统,达到拮抗UC发展的治疗效果。因此,以中医药调节氧化平衡状态作为诊疗思路,可能是未来治疗UC疾病的新手段、新方向。基于上述研究,该文总结了氧化应激关键致病蛋白与UC发生、发展的作用机制,归纳了中药有效成分、单味中药、中药复方、针灸调控氧化应激上下游靶点蛋白,减轻肠黏膜病理损害,降低结肠损伤指数,以及丰富肠道菌群,增加结肠长度,改善UC临床症状,以期为扩大中医药治疗UC疾病的应用范围,提供可靠的科学理论依据。     

Postnatal Iron Supplementation with Ferrous Sulfate vs. Ferrous Bis-Glycinate Chelate: Effects on Iron Metabolism,Growth, and Central Nervous System Development in Sprague Dawley Rat Pups

Iron-fortified formulas and iron drops (both usually ferrous sulfate, FS) prevent early life iron deficiency, but may delay growth and adversely affect neurodevelopment by providing excess iron. We used a rat pup model to investigate iron status, growth, and development outcomes following daily iron supplementation (10 mg iron/kg body weight, representative of iron-fortified formula levels) with FS or an alternative, bioavailable form of iron, ferrous bis-glycinate chelate (FC). On postnatal day (PD) 2, sex-matched rat litters (n = 3 litters, 10 pups each) were randomly assigned to receive FS, FC, or vehicle control until PD 14. On PD 15, we evaluated systemic iron regulation and CNS mineral interactions and we interrogated iron loading outcomes in the hippocampus, in search of mechanisms by which iron may influence neurodevelopment. Body iron stores were elevated substantially in iron-supplemented pups. All pups gained weight normally, but brain size on PD 15 was dependent on iron source. This may have been associated with reduced hippocampal oxidative stress but was not associated with CNS mineral interactions, iron regulation, or myelination, as these were unchanged with iron supplementation. Additional studies are warranted to investigate iron form effects on neurodevelopment so that iron recommendations can be optimized for all infants.     

中风发病后6—9月的生命质量

目的 比较发病后6－9月的中风患者与正常对照的健康差异,以明确针对中风患者的社区卫生服务应着手解决的健康问题。方法 对150例中风后6－9月的患者及按照性别、年龄、居住环境进行1：1配对的正常对照,采用SF－36进行健康自评,比较不同领域的健康状况。结果 患者生命质量在躯体功能、生理性角色功能受限、 社会功能、活力4个领域（P＜0．01）随年龄的增加而降低。男性生命质量在总体健康（P＝0．017）、躯体功能（P＝0．015）、活力和精神健康（P＜0．01）等4个领域好于女性。患者与对照比较,除了疼痛（P＝0．289）领域外,患者生命质量的各个领域均差于对照（P≤0．001）。结论 患者以发病后6－9月时,除了存在严重的躯体功能障碍之外,还有严重的心理、社会功能障碍以及角色功能障碍。其中,精神健康和女性患者是工作重点。     

一种合成多肽——PLNG自由穿膜现象初探

目的 研究人工设计合成的多肽PLNG在不同作用环境条件下的跨膜运动现象。方法 体外培养不同组织来源的鼠细胞及CHO细胞、BEL细胞,用免疫荧光观察不同浓度、不同温度、不同反应时间条件下,PLNG的穿膜能力及PLNG对不同类型的细胞（CHO细胞、BEL细胞、成年大鼠肝细胞、幼大鼠肝细胞、成年大鼠心肌细胞、幼大鼠心肌细胞、成年大鼠神经细胞、幼大鼠神经细胞）的穿膜特性。结果 PLNG在不同作用环境条件下对细胞膜都有穿透作用,且进入细胞的量近乎相同。结论 实验观察到PLNG具有广谱的穿膜能力,这种穿膜能力在一定范围内对温度、时间及PLNG浓度不敏感;而且这种穿膜能力不受组织特异性的限制。     

肾衰透析患者拔牙的临床研究

目的 :探讨肾衰透析患者拔牙的安全性。　方法 :对 42例肾衰血透患者行 98次拔牙手术 ,共拔除患牙 12 2颗 ,术前采取全口洁治、服用抗生素、控制血压等措施 ,术后加强局部止血处理 ,预防出血、感染及心血管系统等并发症的发生。　结果 :透析组术后出血 44次 ,拔牙创口血块充盈不良或脱落 2 7次 ;对照组分别为 4和 5次 (94次手术 ,P<0 .0 5 )。拔牙创口定期观察 1个月 ,均愈合良好。　结论 :慢性肾衰患者通过透析 ,尿毒症得到控制和改善时 ,在作好围拔牙期处理的情况下 ,行拔牙手术是安全可行的     

Intradialytic systolic blood pressure variation can predict long-term mortality in patients on maintenance hemodialysis

International Urology and Nephrology - It is unclear which time-points of intradialytic blood pressure (BP) best predict prognosis. Thus, it is important to assess the association between different...     

Culture bovine prospermatogonia with 2i medium

Germplasm cryopreservation and expansion of gonocytes/prospermatogonia or spermatogonial stem cells (SSCs) are important; however, it's difficult in cattle. Since inhibitors of Mek1/2 and Gsk3β (2i) can enhance pluripotency maintenance, effects of 2i-based medium on the cultivation of bovine prospermatogonia from the cryopreserved tissues were examined. The testicular tissues of newborn bulls were well cryopreserved. High mRNA levels of prospermatogonium/SSC markers (PLZF, GFRα-1) and pluripotency markers (Oct4/Pouf5, Sox2, Nanog) were detected and the PLZF⁺/GFRα-1⁺ prospermatogonia were consistently identified immunohistochemically in the seminiferous cords. Using differential plating and Percoll-based centrifugation, 41.59% prospermatogonia were enriched and they proliferated robustly in 2i medium. The 2i medium boosted mRNA abundances of Pouf5, Sox2, Nanog, GFRα-1, PLZF, anti-apoptosis gene Bcl2, LIF receptor gene LIFR and enhanced PLZF protein expression, but suppressed mRNA expressions of spermatogonial differentiation marker c-kit and pro-apoptotic gene Bax, in the cultured prospermatogonia. It also alleviated H₂O₂-induced apoptosis of the enriched cells and decreased histone H3 lysine (K9) trimethylation (H3K9me3) and its methylase Suv39h1/2 mRNA level in the cultured seminiferous cords. Overall, 2i medium improves the cultivation of bovine prospermatogonia isolated from the cryopreserved testes, by inhibiting Suv39h1/2-mediated H3K9me3 through Mek1/2 and Gsk3β signalling, evidencing successful cryopreservation and expansion of bovine germplasm.     

Smoking Alters Inflammation and Skeletal Stem and Progenitor Cell Activity During Fracture Healing in Different Murine Strains

Smokers are at a higher risk of delayed union or nonunion after fracture repair. Few specific interventions are available for prevention because the molecular mechanisms that result in these negative sequelae are poorly understood. Murine models that mimic fracture healing in smokers are crucial in further understanding the local cellular and molecular alterations during fracture healing caused by smoking. We exposed three murine strains, C57BL/6J, 129X1/SvJ, and BALB/cJ, to cigarette smoke for 3 months before the induction of a midshaft transverse femoral osteotomy. We evaluated fracture healing 4 weeks after the osteotomy using radiography, micro-computed tomography (μCT), and biomechanical testing. Radiographic analysis demonstrated a significant decrease in the fracture healing capacity of smoking 129X1/SvJ mice. μCT results showed delayed remodeling of fracture calluses in all three strains after cigarette smoke exposure. Biomechanical testing indicated the most significant impairment in the functional properties of 129X1/SvJ in comparison with C57BL/6J and BALB/cJ mice after cigarette smoke exposure. Thus, the 129X1/SvJ strain is most suitable in simulating smoking-induced impaired fracture healing. Furthermore, in smoking 129X1/SvJ murine models, we investigated the molecular and cellular alterations in fracture healing caused by cigarette smoking using histology, flow cytometry, and multiplex cytokine/chemokine analysis. Histological analysis showed impaired chondrogenesis in cigarette smoking. In addition, the important reparative cell populations, including skeletal stem cells and their downstream progenitors, demonstrated decreased expansion after injury as a result of cigarette smoking. Moreover, significantly increased pro-inflammatory mediators and the recruitment of immune cells in fracture hematomas were demonstrated in smoking mice. Collectively, our findings demonstrate the significant cellular and molecular alterations during fracture healing impaired by smoking, including disrupted chondrogenesis, aberrant skeletal stem and progenitor cell activity, and a pronounced initial inflammatory response. © 2020 American Society for Bone and Mineral Research (ASBMR).