KL-6黏蛋白在肝癌组织和血清中的表达及临床意义

目的 检测KL-6黏蛋自在不同类型肝癌患者癌组织和血清中的表达水平,并探讨其作为肿瘤标志物在临床诊断中应用的价值.方法 采用免疫组织化学方法检测81例肝细胞癌(HCC)、21例胆管细胞癌(CC)、12例混合型肝细胞-胆管细胞癌(HCC-CC)和56例原发性结直肠癌肝转移(MLC)患者癌组织中KL-6黏蛋白的表达水平.用ELISA法测定其中34例HCC患者、8例CC患者、30例MLC患者和19例健康自愿者血清中KL-6黏蛋白的表达水平,并用t检验分析其结果.结果 免疫组织化学分析结果表明,所有的CC患者和HCC-CC患者中,CC组织(12/12,100%)KL-6黏蛋白均呈阳性染色,而MLC患者的癌组织(56/56,100%)显示数个癌细胞或部分癌组织呈阳性染色.另外,在HCC和HCC-CC患者的HCC组织以及所有的非癌组织中KL-6黏蛋白没有发现阳性染色.CC患者的血清KL-6黏蛋白表达水平比健康自愿者、HCC患者和MLC患者高(t=5.58,5.34,4.00,P＜0.01).MLC患者和健康自愿者的血清KL-6黏蛋白表达水平比较,差异有统计学意义(t=2.77,P＜0.01).健康自愿者和HCC患者,以及MLC患者和HCC患者之间的血清KL-6黏蛋白表达水平比较,差异无统计学意义(t=2.03,1.89,P＞0.05).结论 KL-6黏蛋白在CC患者癌组织和血清中的表达水平均比HCC患者、MLC患者和健康自愿者高,可成为CC患者的特异性肿瘤标志物.     

Reliability and validity of A Quick Test of Cognitive Speed for detecting early‐stage dementia in elderly Japanese

Aim: The aim of this study was to evaluate the reliability and validity of A Quick Test of Cognitive Speed (AQT) for detecting early‐stage dementia in the elderly Japanese population. Methods: A total of 280 clinical participants (180 with mild Alzheimer's disease, 43 with amnestic mild cognitive impairment, 32 with non‐amnestic mild cognitive impairment and 25 control subjects) and 22 community‐dwelling elderly individuals without dementia were recruited. The Clinical Dementia Rating, the Mini‐Mental State Examination, and AQT were administered to all participants. The Neurobehavioral Cognitive Status Examination was also administered to clinical participants. Results: The intraclass correlation coefficient for the test–retest reliability of colour‐form naming time on AQT was 0.88 (95% CI, 0.74–0.95, P < 0.001). AQT colour‐form naming time was significantly correlated with the Clinical Dementia Rating, the total score on the Mini‐Mental State Examination, and the total score on the Neurobehavioral Cognitive Status Examination and most of its subscales. AQT colour‐form naming time was significantly longer in elderly individuals with mild Alzheimer's disease, amnestic mild cognitive impairment, and non‐amnestic mild cognitive impairment than in control subjects. The receiver operating characteristic curve analysis indicated that AQT colour‐form naming time significantly distinguished subjects with early‐stage dementia (mild Alzheimer's disease, amnestic mild cognitive impairment, and non‐amnestic mild cognitive impairment) from controls. The area under the curve was estimated to be 0.88 (95%CI = 0.82–0.95). A cut‐off of 71/72 seconds yielded the best sensitivity/specificity trade‐off: sensitivity = 85% and specificity = 76%. Conclusions: AQT is a useful brief screening tool for detecting early‐stage dementia in elderly Japanese individuals.     

EFFECTIVE DETECTION OF PLANTAR MALIGNANT MELANOMA

Background: As the sole of the foot is the most prevalent site of malignant melanoma in non-Caucasians, early detection of the neoplasm at this anatomical site is very important. In our previous study, we proposed a clinical guideline that acquired melanocytic lesions on the sole larger than 7 mm in maximum diameter should be examined histologically. Methods: Eighty-one Japanese patients with the complaint of plantar pigmented lesions were screened at our dermatology clinic during 3 years using the 7-mm criterion. Results: Of the total 80 melanocytic lesions on the sole, 14 lesions were larger than 7 mm in maximum diameter, excluding congenital lesions. Diagnoses of the 14 “large” lesions were as follows: advanced malignant melanoma, 8 lesions; early malignant melanoma (malignant melanoma in situ), 1 lesion; acquired melanocytic nevus, 4 lesions, and volar melanotic macule, 1 lesion. Conclusions: The present study confirmed the validity of the 7-mm criterion for the early effective detection of plantar malignant melanoma.     

A long-term follow-up study of serial magnetic resonance images in patients with delayed encephalopathy after acute carbon monoxide poisoning

Abstract  Serial magnetic resonance (MR) images were obtained for 18 months in the follow-up of a patient with delayed encephalopathy after acute carbon monoxide (CO) poisoning. The characteristic findings on T2-weighted MR images (T2WI) were high intensity in the bilateral periventricular white matter and pallidal regions, and low intensity in the striatum. Although the neurological symptoms had improved by about 5 months after exposure, the high signal intensity In the white matter remained visible for 18 months. In addition, low signal intensity in the putamen seen on T2WI, which suggested iron deposition, was seen throughout the 18 months.     

Procainamide Induced Change of the Width of the Zone of Entrainment and its Relation to the Inducibility of Reentrant Ventricular Tachycardia

Procainamide depresses conduction velocity and prolongs refractoriness in myocardium responsible for reentrant VT, but the mechanism by which the induction of VT is suppressed after procainamide administration remains to be determined. In the present study, the relationship between electrophysiological parameters and the noninducibility of VT was assessed during procainamide therapy with a special reference to the change of an excitable gap. Clinically documented monomorphic sustained VT was induced in 30 patients and, utilizing the phenomenon of transient entrainment. the zone of entrainment was measured as the difference between the cycle length of VTand the longest paced cycle length interrupting VT (block cycle length) which was determined as the paced cycle length decreased in steps of 10 ms, and used as an index of the excitable gap. The effective refractory period was measured at the pacing site and the paced QBS duration was used as an index of the global conduction time in the ventricle. The cycle length of VT, the block cycle length, and the width of the zone of entrainment were determined and compared between the responders and nonresponders. In 15 patients, these parameters were determined at the intermediate dose and related to subsequent noninducibility at the final dose. At the final doses of procainamide, VT was suppressed in 8 (26.7%) of 30 patients. However, the cycle length of VT, the block cycle length, and the width of the zone of entrainment were unable to predict the drug efficacy, i.e., noninducibility. The change in the effective refractory period at the pacing site or the width of the paced QRS duration was not different between the responders and nonresponders. Among the variables, only the width of the zone of entrainment showed a significant narrowing in the responders at the intermediate dose of procainamide, and it was smaller than that of the nonresponders. The significant narrowing of the width of the zone of entrainment was associated with the subsequent noninducibility of VT at the final dose. The present study showed that the baseline cycle length of VT, the block cycle length, the drug induced change of the effective refractory period, or the paced QRS duration was not a predictor of the noninducibility after procainamide administration. However, a significant narrowing of the width of the zone of entrainment at the intermediate dose was associated with the noninducibility of VT at the final dose.     

Tongue Granulomatous Lesion Caused by Mandibular Primary Incisors Eruption

Abstract:   The aim of this report was to present a case of granulomatous lesion on the ventral surface of the tongue in a 9-month-old, healthy, infant girl, caused by the habit of scraping the tongue on mandibular central incisors. Clinical treatment consisted of manual smoothing of the sharp edges of both incisors and excision of the 2-cm pediculate ulcerative granulomatous mass localized on the ventral surface of the tongue. After 3 weeks, the child could be properly fed and a complete healing of the lesion was observed.     

An early-onset case of multiple sclerosis with thalamic lesions on MRI

We present here an early-onset case of multiple sclerosis (MS) with thalamic lesions. The patient first experienced an episode of ataxic gait at 2 years 3 months of age, with spontaneous remission within 1 month. At 5 years 4 months, she was admitted because of cerebellar ataxia, oculomotor restriction and feeding difficulty. Magnetic resonance imaging (MRI) showed multiple well-defined lesions in the white matter of the cerebellum, mid-brain, periventricle and right frontal lobe. Cerebrospinal fluid (CSF) showed a mild elevation of both immunoglobulin G (IgG) and myelin basic protein (MBP). Serum anti-myelin antibody was also positive, although leukocytosis and elevation of C-reactive protein were not found. Methylprednisolone pulse therapy relieved symptoms within 2 weeks and the abnormal MRI and CSF findings gradually improved. At 6 years 6 months of age, she incurred a third episode of cerebellar ataxia and disturbance of consciousness. Magnetic resonance imaging revealed recurrence and extension of the previous lesions as well as new lesions in the thalamus and internal capsule. CSF IgG and MBP level showed a higher elevation than in the second episode. The combination of the cerebellar, brain-stem, cerebral and thalamic lesions with remission and exacerbation, supported by MRI and CSF findings, allowed the diagnosis of clinically definite MS to be made. This is one of the youngest cases of MS yet described, with the first attack occurring at 27 months of age. In addition, this case is unique for the involvement of the gray matter in the thalamus.     

Inhibitory effect of sera from patients with liver cirrhosis on natural killer activity

The effect of sera from patients with liver cirrhosis (LC) and from healthy donors on natural killer (NK) activity of normal peripheral blood mononuclear cells (PBMC) was investigated. PBMC from a healthy donor were pre-incubated for 3 h at 37°C in media containing 50% test sera and washed twice with phosphate-buffered saline (PBS). Cytotoxic activity was determined using ⁵¹Cr-labelled K-562 cells as target. It was demonstrated that sera from both healthy donors and patients with LC suppressed the NK activity of normal PBMC compared with a PBS control. But the level of inhibition caused by patients’ sera (n= 30) was significantly higher than that caused by normal sera (n= 30; P < 0.001, Wilcoxon rank sum test). Sera from a patient with LC and a healthy subject were fractionated by a Sephacryl S-300 column and the effect of five fractions on NK activity of normal MNC was assessed. Fractions 3 and 4 from both sera had inhibitory effects although Fraction 5 revealed an enhancing effect. These results suggest that human sera contain factors which both inhibit and enhance NK activity and that their net effects are inhibition. Since it is known that IgG is eluted in Fraction 4, IgG was separated from sera with a DEAE-Sephacel column and its effect on NK activity was examined. IgG from patients’ sera was observed to suppress NK activity more often than those from healthy donors at the same concentrations.