A Case of Zollinger-Ellison Syndrome whose Pancreatic Tumor Produced Multiple Hormones and a Review of 48 Cases Reported in the Japanese Literature

A 46-year-old man developed a peptic ulcer disease and a diagnosisof Zollinger-Ellison Syndrome was strongly suspected followinggastric acid studies. Plasma gastrin level was found to be elevated.The operation revealed a pancreatic tumor localized at the pancreastail. The resected tumor tissue was proved to contain largeamounts of immunoreactive gastrin. In addition, calcitonin,VIP and insulin were found to be present either as a resultof immunofluorescence studies or the respective radioimmunoassays.Therefore, this was a case of a multiple hormone producing tumorof pancreas islet cell origin, and the symptoms due to gastrinhypersecretion were the main clinical features. In addition,48 cases of Zollinger-Ellison Syndrome reported in Japaneseliteratures were reviewed.     

High CD4/CD45RO+ and CD8/CD45RO+ frequencies in children with vaccine-modified measles

BACKGROUND: Despite availability and wide vaccine coverage, measles infections still occur especially in developing countries. An outbreak of measles occurred among previously immunized older Ghanaian children who had milder clinical symptoms with measles-specific IgG antibodies that could have been attributed to secondary vaccine failure, suggesting that the infection was vaccine-modified measles (VMM). METHODS: Two-color immunophenotyping of the peripheral blood mononuclear cells was performed at acute, recovery and convalescence phases for 19 VMM patients (mean age 6.2 +/- 3.5 years) using flow cytometry, and compared with that of 20 healthy, sex- and age-matched controls. RESULTS: The results showed a significantly higher memory helper (CD4(+)/CD45RO(+)) cell frequency and increased suppressor cell (CD8(+)/CD45R0(+)) frequency in VMM patients compared to healthy controls. There were no complications and all the patients recovered completely. CONCLUSIONS: These findings show that the mild symptoms in patients with VMM may have correlated with the increase of memory T cells, which is in sharp contrast with previous reports on acute measles infection. This may suggest that the intact immunologic memory cells could have been crucial for the resolution of VMM.     

Clinical efficacy of conservative laser therapy for early-stage cervical cancer

The objective of this study was to evaluate the clinical efficacy of conservative laser therapy for early-stage cervical cancer. Seven hundred fifty-two and 271 patients with carcinoma in situ (CIS) and microinvasive squamous cell carcinoma (MIC), respectively, were treated by laser conization with vaporization. One hundred eighty-four patients with preclinical invasive diseases underwent radical surgery without conization. Their postoperative histologic findings and clinical outcomes were evaluated retrospectively. The cone specimens of 1023 cases were reported as showing that 54 had dysplasia, 663 had CIS, 239 had stage Ia1 without lymph vascular space invasion (LVSI), 14 had stage Ia1 with LVSI, 14 had stage Ia2, and 39 had stage Ib1 diseases. Incomplete excision occurred in 4 (7.4%) of 54 dysplasia, 48 (7.2%) of 663 CIS, and 16 (6.7%) of 239 stage Ia1 cases, but failure rates were only 1 (1.9%), 8 (1.2%), and 4 (1.7%), respectively. The other 67 of 1023 cases underwent abdominal operation. Final pathology results were analyzed for 67 and 184 cases with stages Ia1 to Ib1 receiving radical surgery with or without initial laser therapy. Lymph node metastasis was not observed in 154 Ia1 and 30 Ia2 with stromal invasion of under 4 mm in depth regardless of LVSI, but was detected in 2 of 16 Ia2 with stromal invasion of over 4 mm in depth and in 9 of 51 Ib1 cases. CIS and Ia1 disease without LVSI can be treated only by laser therapy. The limit of stromal invasion for conservative laser therapy in stage Ia cancer may be 4 mm in depth regardless of LVSI.     

Improvement in delusions and hallucinations in patients with dementia with Lewy bodies upon administration of yokukansan,a traditional Japanese medicine

Background: This multicentre open‐label trial examined the efficacy and safety of the traditional Japanese medicine, or Kampo medicine, yokukansan (YKS), for behavioural and psychological symptoms of dementia (BPSD) in patients with dementia with Lewy bodies. Methods: Sixty‐three dementia with Lewy bodies patients with probable BPSD (M : W, 30 : 33; mean age, 78.2 ± 5.8 years) were enrolled and treated with YKS for 4 weeks. Results: Significant improvements in Neuropsychiatric Inventory scores (mean decrease, 12.5 points; P < 0.001) and Zarit Burden Interview‐Japanese edition tests (mean decrease, 3.6 points; P= 0.024) were observed. In patients who consented to an assessment after 2 weeks of treatment, a time‐dependent significant improvement was observed in the Neuropsychiatric Inventory score (n= 23; mean decrease, 14.4; P < 0.001), each subscale, including delusions and hallucinations, the Zarit Burden Interview‐Japanese edition (n= 22; mean decrease, 8.2; P < 0.01) and the behavioural pathology in Alzheimer's disease insomnia subscale. The Mini‐Mental State Examination and the Disability Assessment for Dementia (DAD) showed no significant change. Adverse events were observed in 11 (18%) patients. Three patients (5%) discontinued YKS due to adverse reactions, namely, spasticity and exacerbation of BPSD, edema, and nausea. Hypokalaemia (<3.5 mEq/L) was present in four patients (6%) at the study endpoint. Worsening of extrapyramidal symptoms was not observed. Conclusion: YKS improved BPSD in dementia with Lewy bodies patients and caregiver burden scores without deterioration in cognitive function. YKS is useful for the treatment of delusions and hallucinations in BPSD.     

倾向指数方法的蒙特卡罗研究

目的评价由倾向指数方法得到的暴露效果的估计量和统计性质,并探讨其实用性。方法利用计算机模拟对倾向指数方法在无模型误定和有模型误定情况下的偏度和精度进行分析,并与基于模型方法的模拟结果进行比较。结果当存在模型误定时,倾向指数方法比基于模型的方法具有较好的稳健性。结论对于大量、关系复杂的数据,应用倾向指数方法具有较大的灵活性。     

基因导向的氯吡格雷和替格瑞洛对急性冠脉综合征患者PCI术后炎症因子、血小板聚集和预后的影响

目的:探讨CYP2C19基因检测对急性冠脉综合征(ACS)经皮冠状动脉介入治疗(PCI)患者术后氯吡格雷用药的指导作用.方法:入选2016年1月至2018年12月入住郑州中心医院心血管内科ACS并行PCI采用药物洗脱支架植入的患者787例为研究对象,进行前瞻性队列研究,按是否进行CYP2C19基因检测,分为氯吡格雷组(...