榼藤子总皂苷抗糖尿病作用机制的初步研究

目的:探讨榼藤子总皂苷对2型糖尿病大鼠胰岛形态及骨骼肌PI3K通路相关蛋白表达的影响。方法:通过高脂饲料喂养结合注射小剂量链脲佐菌素(STZ)建立2型糖尿病大鼠模型。实验大鼠随机分为正常对照组、模型组、阳性对照组(二甲双胍,200 mg.kg-1)、榼藤子总皂苷低、高(25,50 mg.kg-1)剂量组。治疗3周后对各组大鼠胰腺HE染色病理切片胰岛形态、数目等进行观察比较,采用Western blot方法检测各组大鼠骨骼肌组织中胰岛素受体底物-1(IRS-1)、磷脂酰肌醇3激酶(PI3K)、蛋白酪氨酸磷酸酶-1B(PTP-1B)和葡萄糖转运子4(GLUT4)等蛋白的表达水平。结果:同模型组相比,榼藤子总皂苷各给药组胰腺组织病理切片均结构相对正常、胰泡细胞清晰可见、被膜结构完整,胰岛数目均接近于对照组;同时上述各给药组大鼠骨骼肌组织中IRS-1,PI3K和GLUT4蛋白表达水平均较模型组有所上调,PTP-1B蛋白表达水平均较模型组有所下调。结论:榼藤子总皂苷对2型糖尿病大鼠胰腺组织具有保护作用,并对骨骼肌组织中蛋白的异常表达具有干预作用。     

离体肾灌流技术在药理毒理研究中的应用进展

通过Pubmed和CNKI数据库查阅了近几年应用离体肾灌流(isolated perfused kidney,IPK)技术在药理毒理研究方面的文献,并进行了整理和分析.IPK技术的主要特点是一定时间内接近体内肾的外环境,通过不同时间点从输尿管和肾静脉流出的灌流液中采样,动态观察外源性物质进入肾脏所发生的变化.IPK技术可用于研究药物在肾脏的排泄过程、作用机制以及药物的联用等.此外,通过检测灌流液中蛋白质活性及含量的变化,结合肾组织病理学变化,还可用于研究药物对肾损伤特点、程度、机制等.该文对离体肾灌流的技术特点及其在药理毒理研究中的应用进行介绍,以供药物研究和临床应用参考.     

Costs and trends in pancreatic cancer treatment

BACKGROUND:

Pancreatic cancer poses a substantial morbidity and mortality burden in the United States, and predominantly affects older adults. The objective of this study was to estimate the direct medical costs of pancreatic cancer treatment in a population‐based cohort of Medicare beneficiaries, and the contribution of different treatment modalities and health care services to the total cost of care and trends in costs over time.

METHODS:

In the linked Surveillance, Epidemiology, and End Results (SEER)‐Medicare database, pancreatic cancer patients were identified who were aged 66 years or older and who were diagnosed from 2000 to 2007. Total direct medical costs were estimated from Medicare payments overall and within categories of care. Costs attributable to pancreatic cancer were estimated by subtracting the costs of medical care in a matched cohort of cancer‐free beneficiaries.

RESULTS:

A total of 15,037 patients were identified, of whom 97% were observed from diagnosis until death. Mean total direct medical costs were $65,500. Mean total costs were greater for patients with resectable locoregional disease ($134,700) than for those with unresectable locoregional or distant disease ($65,300 and $49,000, respectively). Hospitalizations and cancer‐directed procedures collectively accounted for the largest fraction of health care costs. The total cost of care appeared to increase slightly over the study period (P = .05). The mean costs attributable to pancreatic cancer were $61,700.

CONCLUSIONS:

Despite poor prognosis and short survival, the economic burden of pancreatic cancer in the elderly is substantial. Demographic trends, greater use of targeted therapies, and possible implementation of screening strategies are likely to impact treatment patterns and costs in the future. Cancer 2012. © 2012 American Cancer Society.     

Incidence of subsequent pancreatic adenocarcinoma in patients with a history of nonpancreatic primary cancers

BACKGROUND:

Several environmental risk factors are known to predispose individuals to pancreatic cancer, and up to 15% of pancreatic cancers have an inherited component. Understanding metachronous cancer associations can modify pancreas cancer risk. The objective of this study was to investigate the association of nonpancreatic cancers with subsequent pancreatic adenocarcinoma.

METHODS:

The authors used data from the US Surveillance, Epidemiology, and End Results (SEER) registries to identify 1,618,834 individuals who had a primary malignancy and subsequent pancreatic adenocarcinoma (n = 4013). Standardized incidence ratios were calculated as an approximation of relative risk (RR) for the occurrence of pancreatic adenocarcinoma after another primary malignancy.

RESULTS:

Among patients who were diagnosed with a first primary malignancy at ages 20 to 49 years, the risk of subsequent pancreatic adenocarcinoma was increased among patients who had cancers of the ascending colon (relative risk [RR], 4.62; 95% confidence interval [CI], 1.86‐9.52), hepatic flexure (RR, 5.42; 95% CI, 1.12‐15.84), biliary system (RR, 13.14; 95% CI, 4.27‐30.66), breast (RR, 1.32; 95% CI, 1.09‐1.59), uterine cervix (RR, 1.61; 95% CI, 1.02‐2.41), testes (RR, 2.78; 95% CI, 1.83‐4.05), and hematopoietic system (RR, 1.83; 95% CI, 1.28‐2.53). Among patients who had a first malignancy at ages 50 to 64 years, the risk was increased after cancers of the stomach (RR, 1.88; 95% CI, 1.13‐2.93), hepatic flexure (RR, 2.25; 95% CI, 1.08‐4.13), lung and bronchus (RR, 1.46; 95% CI, 1.16‐1.82), pharynx (RR, 2.26; 95% CI, 1.13‐4.04), and bladder (RR, 1.24; 95% CI, 1.03‐1.48). Among patients who had a primary cancer after age 65 years, the risk was increased after cancers of the stomach (RR, 1.79; 95% CI, 1.23‐2.53), hepatic flexure (RR, 1.76; 95% CI, 1.06‐2.75), biliary system (RR, 2.35; 95% CI, 1.17‐4.20), and uterus (RR, 1.23; 95% CI, 1.03‐1.47).

CONCLUSIONS:

The results from the current population‐based data set suggested that pancreatic adenocarcinoma is associated with certain primary cancers. Genetic predisposition and common environmental and behavioral risk factors all may contribute to this observation. Specific tumor associations will guide future risk‐stratification efforts. Cancer 2012. © 2011 American Cancer Society.     

Feasibility study on retinal vascular bypass surgery in isolated arterially perfused caprine eye model

Purpose

To investigate the feasibility of bypassing occluded segments of retinal venous main vessels in isolated, arterially perfused caprine eyes via the closed-sky vitrectomy approach using keratoprosthesis.

Methods

Isolated caprine eyes were used in this study. For each eye, the retinal vessel was perfused by Krebs solution via ophthalmic artery, and pars plana vitrectomy was performed using temporary keratoprosthesis. All retinal micro-vascular maneuvers were performed in a closed-sky eyeball. The main retinal vein was blocked by endodiathermy at the site of the vessel''s first branching. Two openings, several millimeters apart, were created by vascular punctures in both the main vein and its branch vein wall straddling the induced occluded segment. Catheterization was achieved using a flexible polyimide tube, with each end inserted into the vessel wall opening. A sealed connection between the vessel and the tube was obtained by endodiathermy. Bypass of the occluded retinal vein segment was thus achieved, and the patency of this vascular bypass was confirmed by intravascular staining.

Results

Puncturing, catheterization, and endodiathermy were viable by closed-sky approach using keratoprosthesis. Bypassing of the occluded retinal main vein segment was accomplished with the combination of these maneuvers. Good results were obtained in 23 of 38 (60%) caprine eyes.

Conclusions

This study demonstrated that bypassing the occluded segment of retinal main vein can be successfully performed in a closed-sky eyeball model of isolated, arterially perfused caprine eye. This early work indicated that the more advanced retinal vascular bypass surgery in in vivo eye may be feasible in the future.     

Pathological differential diagnosis of solid-pseudopapillary neoplasm and endocrine tumors of the pancreas

AIM:To investigate differential points of solid-pseudo-papillary neoplasm (SPN) of the pancreas and pancre-atic endocrine tumor (PET).METHODS:Ten cases of SPN and fourteen cases of PET were studied in this retrospective study. Clinical and pathologic features,immunostaining reactions and β-catenin gene mutations were analyzed.RESULTS:The mean age of SPN patients was 25.6 years and these patients had no specific symptoms. The mean diameter of the tumors was 11.0 cm,9/10 cases were cystic or a mixture of soli...     

An in vivo verification of the intravoxel incoherent motion effect in diffusion‐weighted imaging of the abdomen

To investigate the vascular contribution to the measured apparent diffusion coefficient and to validate the Intra Voxel Incoherent Motion theory, the signal as a function of the b‐value was measured in the healthy pancreas with and without suppression of the vascular component and under varying echo times (TE = 50, 70, and 100 msec). The perfusion fraction f and the diffusion coefficient D were extracted from the measured DW‐data using the original Intra Voxel Incoherent Motion‐equation and a modified version of this equation incorporating relaxation effects. First, the perfusion fraction f in the blood suppressed pancreatic tissue decreased significantly (P = 0.03), whereas the diffusion coefficient D did not change with suppression (P = 0.43). Second, the perfusion fraction f increased significantly with increasing echo time (P = 0.0025), whereas the relaxation time compensated perfusion fraction f′ showed no significant dependence on TE (P = 0.31). These results verify a vascular contribution to the diffusion weighted imaging measurement at low b values and support the Intra Voxel Incoherent Motion‐theory. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

An unusual case of colonic mass

Colonic metastasis due to pancreatic adenocarcinoma is extremely rare. Although it is rare, colonic metastasis should be included in the differential diagnosis of colonic mass.     

Polysplenia syndrome accompanied with situs inversus totalis and annular pancreas in an elderly patient

Polysplenia syndrome (PS) is rarely encountered in elderly. It is characterized by multiple spleens associated with various cardiac and gastrointestinal abnormalities including partial or complete agenesis of dorsal pancreas. Situs inversus totalis (SIT) is a rare congenital anomaly with mirror image of viscera combined with dextrocardia. Occurrence of SIT and PS in the same patient is exceedingly rare. We present the first case of adult PS with SIT accompanied with annular pancreas.     

壶腹周围癌MRI诊断与鉴别诊断

目的 探讨MR及MRCP成像在壶腹周围癌诊断和鉴别诊断中的价值.方法 回顾性分析经手术病理证实的54例壶腹周围癌病人的MR平扫、增强及MRCP图像,对相关结果进行χ~2检验及两独立样本t检验,并与病理结果相对照.结果 胰头癌32例,7例(21.9%)表现为"四管征";胆总管下段癌16例,9例(56.3%)表现为"三管征".2种征象在胰头癌和胆总管下段癌中差异具有显著性(P<0.05).胰头癌MRI及术中测量肿块最大面积与胆总管直径之比也明显大于胆总管下段癌(P<0.05).结论 MRI和MRCP对壶腹周围癌的诊断具有重要价值.