Depth of tumor invasion in locally advanced rectal cancer correlates with patients’ prognosis: The usefulness of elastic stain for its measurement

Purpose The relationship between the prognosis and the extent of colorectal carcinoma (CRC) is still unclear. As a simple parameter of the local invasion of CRC, we assessed the extent of tumor invasion beyond the outer border of the muscularis propria (MP). Methods We examined 147 cases of CRC using a slight modification of the procedure established by the Japanese Society for Cancer of the Colon and Rectum. For the statistical analysis, the patients were divided into two groups, namely, a “shallow” group and a “deep” group, using a specific cut-off value (COV). A multivariate analysis to identify independent prognostic factors was performed. Results Significant differences in the 5-year survival rate were observed between the “shallow” and “deep” groups in 39 cases of rectal carcinoma (COV 4 mm; 72.4% vs. 30.0%, hazard ratio = 3.204), but not observed in 147 cases of CRC. In addition, the outcome for patients with “deep” cancer in the lower rectum was markedly worse than that for patients with “shallow” cancer (COV 4 mm; 81.8% vs. 12.5%, hazard ratio = 5.371). Conclusions The depth of tumor invasion beyond the MP is thus considered to be an important prognostic factor for patients with T3/T4 rectal carcinoma, especially in the lower rectum. A careful follow-up is required for the patients with rectal carcinoma that has invaded more than 4 mm beyond the MP.     

Freehand real-time elastography: impact of scanning parameters on image quality and in vitro intra- and interobserver validations

Real-time elastography is a method for visualization of the elastic properties of soft tissue and may potentially enable differentiation between malignant and benign pathologic lesions. Our aim was to validate the method on a tissue-mimicking (TM) phantom and to evaluate the influence of different scanning parameters and investigator variability. A TM-phantom containing eight spherical inclusions with known storage modulus was examined using two different transducers on an ultrasound (US) scanner equipped with software for real-time elasticity imaging. The ultrasound transducers were moved vertically in a repetitive manner to induce strain. Two investigators performed series of standardized elastography scans applying a 0-4 categorical quality scale to evaluate the influence of seven parameters: dynamic range of elasticity, region-of-interest, frequency of transducer movement, rejection of elastogram noise, frame rate, persistence and smoothing. Subsequently, repeated examinations of four selected inclusions were performed using a visual analog scale (VAS) where investigators marked a 100 mm horizontal line representing the span in image quality based on experience from the first examination. The hardest and softest inclusions were imaged more clearly than the inclusions with elasticity more similar to the background material. Intraobserver agreement on elastogram quality was good (kappa: 0.67 - 0.75) and interobserver agreement average (kappa: 0.55 - 0.56) when using the categorical scale. The subsequent VAS evaluation gave intraclass-correlation coefficients for the two observers of 0.98 and 0.93, respectively, and an interclass-correlation coefficient of 0.93. Real-time elastography adequately visualized isoechoic inclusions with different elastic properties in a TM-phantom with acceptable intra- and interobserver agreement. Dynamic range of elasticity was the parameter with most impact on the elastographic visualization of inclusions.     

A development of atheromatous plaque is restricted by characteristic arterial wall structure at the carotid bifurcation

BACKGROUND: It is said atheromatous plaque is located very focally, but there have been few reports regarding this matter. Various aspects of the pathogenesis of the development of atheromatous plaque at the carotid bifurcation have previously been discussed. We have noted the correlation of plaque localization with characteristics of the cervical carotid artery wall. METHODS: Morphological and histopathologic changes in the carotid bifurcation were examined in 72 cadaver cases with or without atheromatous plaque. We determined the level at which the wall structure changed to muscular artery from elastic artery and analyzed its influence on the development of atheromatous plaque. RESULT: Atheromatous plaques at the distal site of the ICA extended within 0 to 37 mm from the carotid bifurcation. The proximal side of the CCA more than 5 mm away from the bifurcation was elastic artery, whereas the distal side of the ICA more than 15 mm from the bifurcation was muscular artery. The area of the carotid bifurcation between elastic artery and muscular artery was a transitional zone. Approximately 80% of them were located within 15 mm, and these areas were coincident with the transitional zone. CONCLUSION: Most atheromatous plaque was located in the transitional zone. The arterial wall structure is related to the development of atheromatous plaque at the cervical carotid bifurcation.     

Variations of microstructure, mineral density and tissue elasticity in B6/C3H mice

200-MHz scanning acoustic microscopy (SAM) and synchrotron radiation μCT (SR-μCT) were used to assess microstructural parameters, acoustic impedance Z and tissue degree of mineralization of bone (DMB) in site-matched regions of interest in femoral bone of two inbred strains. Transverse femoral sections taken from 5 C57BL/6J@Ico (B6) and 5 C3H/HeJ@Ico (C3H) mice (5.5 months old) were explored. Mass density ρ, elastic coefficient c₁₁ and Young's modulus E₁ were locally derived in the distal epiphysis, distal metaphysis for trabecular bone and mid-diaphysis for cortical bone using a rule-of-mixture model. Structural parameter estimations obtained from X-ray tomographic and acoustic images were almost identical. Both strains had the same bone diameter, but the C3H mice had greater cortical thickness and smaller cancellous diameter than did B6 mice. The average DMB and impedance values were in the range between 1.13 and 1.33 g cm^− 3 and 5.8 and 7.8 Mrayl, respectively. All tissue parameters were lower in B6 mice than in C3H mice. However, interstrain differences of DMB were much less (up to 3.8%) than differences of Z (up to 13.2%). SAM and SR-μCT fulfill the requirement for a simultaneous evaluation of cortical bone microstructure and material properties at the tissue level. However, SAM provides a quantitative estimate of elastic properties at the tissue level that cannot be captured by SR-μCT. The strong differences in the measured acoustic impedances among the two inbred strains indicate that the impedance is a good parameter to detect genetic variations of the skeletal phenotype in small animal models.     

Left-ventricular pressure gradients: a computer-model simulation

Both invasive left-ventricular pressure measurements and non-invasive colour M-mode echographic measurements have shown the existence of intraventricular pressure gradients (IVPGs) during early filling. The mechanisms responsible for these IVPG cannot be completely explained by the experiments. Therefore a one-dimensional numerical model is developed and validated. The model describes filling (both velocities and pressures) along a left ventricular (LV) base-apex axis. Blood-wall interaction in the left ventricle with moving boundaries is taken into account. The computational results for a canine heart indicate that the observed IVPGs during filling are the consequence of a complex interaction between, on the one hand, pressure waves travelling in the LV and, on the other hand, LV geometry, relaxation and compliance. The computational results indicate the pressure dependency of wavespeed (0.77–1.90 m⁻¹ s) for different mean intraventricular pressures (0.88–5.00 mmHg) and IVPGs up to 2 mmHg, independent of the ratio of end systolic volume and equilibrium volume. Increasing relaxation rate not only decreases minimum basal pressure (2.8 instead of 3.6 mmHg) but also has a strong influence on the time delay between the minimum basal and apical pressures (14 ms instead of 49 ms). The results sustain the hypothesis that pressure-wave propagation determines IVPGs and that IVPGs are no proof of elastic recoil.     

如何提高我国对内分泌肿瘤的临床诊治和研究水平

内分泌肿瘤是一组既有肿瘤特点又有内分泌功能的双重特性的肿瘤,临床表现多样,呈高度异质性.本文分析了此类肿瘤的特点,也提出了提高此类疾病诊治和研究水平的五条途径.     

饲料中不同水平的铜对大鼠骨折愈合的影响

目的 探讨饲料中添加铜的化合物对大鼠骨折愈合的影响。方法 120只SD大鼠,手术造成右胫骨的部分缺损后,分为4组,每组30只,分别饲喂每公斤饲料含铜1.3,5.0,21.0和82.8mg的人工半合成饲料。手术后第14,21和28天时,每组分别断头处死10只大鼠。取胫骨,并于骨痂段行计算机断层扫描(CT),定量测定胫骨骨痂处骨灰度值;三点弯曲力学实验测定胫骨的生物力学参数:最后,测定其中钙、磷、镁、铜、锌和铁的含量。结果 随着饲料中铜水平的增加,骨痂灰度值增加,饲料含铜最高的第4组大鼠骨痂灰度值(652±131)HU显著高于其他3组[(490±80.0),(468±98.9)和(508±86.6)HU];从反映骨质内在硬度的弹性模量的测定结果可以看到,饲料含铜较高的3个实验组大鼠均高于第1组,其中第3组(1809±321)N/mm2显著高于第1组(1305±666)N/mm2(P<0.05);对胫骨中矿物质元素的测定表明,术后28 d,第3,4组骨中钙、镁、磷的含量均高于第1,2组。结论 饲料中适量补铜,对骨折的愈合有较好的效果。     

胃肠道间质性肿瘤的病理学研究

胃肠道间质性肿瘤是一类发生于胃肠道的异质性肿瘤。包括起源于平滑肌、雪旺氏细胞及胃肠道肌神经丛的三大类肿瘤的它们的组织学形态十分相似，极易沸淆。本文报告４８例，用通常的病理组织学诊断标准分类，并用Ｍａｓｓｏｎ二色染及四种不同的单克隆抗体作免疫组织化学检查，试图说明它们的形态特征及组织发生。     

中国神经管畸形高低发地区季节及性别分布特征

目的：分析中国高低发区神经管畸形(NTDs)的流行病学分布特点。方法：利用1992—1994年期间“中美预防神经管畸形合作项目”监测资料，按照国际上采用的脊柱裂高低位不同损害水平分类方法，将NTDs分为四类，即无脑畸形、脑膨出、高位和低位脊柱裂(SB)，同时再将每一类按照是否合并其他畸形分为单纯与合并型，比较中国南北方、城乡、季节、性别NTDs发生率。分析中对城乡、季节、NTDs种类、性别分别进行调整，计算调整率。结果：32 6874名新生儿(包括孕20周及以上的活产、死胎和死产)中，NTDs 784例，北方NTDs发生率为5．57‰，南方为0．88‰。各类NTDs发生率存在南北方差别(P＜0．01)。调整其他影响因素后，北方总NTDs发生率大约是南方的3—7倍；NTDs发生率存在城乡差别(P＜0．01)，调整后北方农村NTDs发生率大约是城市的3—4倍，调整后南方农村NTDs发生率大约是城市的1．6—1．9倍；北方高位阳发生率在9—11月有季节性升高现象，南方无脑畸形率9—11月低于其他季节，其他类型NTDs在南北方无明显季节变化。结论：中国北方是世界上NTDs高发地区。NTDs发生率存在南北方、城乡差别，北方高位阳发生率有季节升高现象。不同类型NTDs之间在流行病学特征和表型上存在病因异质性。     

Embrochage élastique stable

Résumé L'embrochage élastique stable est une autre conception de l'ostéosynthèse qui allie stabilité et élasticité. La stabilité est nécessaire à une reprise précoce de la fonction sans aucune contention plâtrée. La mobilité élastique du foyer de fracture élimine les contraintes néfastes de cisaillement en les transformant en contraintes favorables de compression-traction. Le cal externe ainsi favorisé permet une consolidation osseuse extrêmement précoce du foyer de fracture. La technique qui consiste en la mise en place à foyer fermé de broches centro-médullaires béquillées et cintrées, peut s'adapter à presque toutes les fractures diaphysaires et métaphysaires de l'enfant.

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Stable elastic skewering

Summary The stable elastic skewering is another conception of the osteosynthesis which combines stability with elasticity. The stability is necessary for an early return to the function without any plaster restraint. The elastic mobility of the seat of the fracture eliminates the harmful constraints of shearing off by transforming them into favorable constraints of traction-compression. The external callus thus favoured allows an extremely early osseous consolidation of the fracture seat. The technique consisting in the placing under closed seat of centro-medullar pins propped up and bent can be adapted to almost all diaphyseal and metaphyseal fractures of the child.

Travail présenté au Séminaire d'Enseignement -Actualités en Orthopédie Pédiatrique, organisé du 19 au 21 mars 1992 à 68150 Aubure par le Docteur Claude Karger