An approach to post‐radical trachelectomy vaginal‐isthmus cytology

Radical trachelectomy (RT) is the surgical amputation of the uterine cervix with paracervical lymphadenectomy, performed in reproductive age women to treat invasive squamous‐cell carcinoma or endocervical adenocarcinoma while preserving the uterine corpus for potential child bearing. Post‐RT patient monitoring includes isthmic‐vaginal cytology. This study reviews our experience with liquid based preparation of post‐RT cytology samples. Fifty‐four post‐RT vaginal‐isthmic cytology specimens were reviewed from nine patients, seven with adenocarcinoma, and two with squamous‐cell carcinoma. Five patients had normal (NILM) or normal with reactive changes on all cytology samples. Two patients had isolated squamous abnormalities (atypical squamous‐cells of uncertain significance (ASC‐US) and low‐grade squamous intraepithelial lesion (LSIL)); both follow‐up biopsies were negative. Two patients had repeatedly abnormal specimens interpreted as atypical glandular cells (AGC), one of whom also had a concurrent ASC‐US. Only one sample was tested for high risk human papilloma virus (hrHPV), with negative results. All patients with abnormal cytology went on to have biopsies which were interpreted as benign. The cytology specimens most often interpreted as AGC contained many groups of hyperchromatic crowded glandular cells and/or stromal cells derived from direct sampling of the lower uterine segment. The crowding often limits visualization of all the cells in a group, plus sampled endometrium may harbor mitoses, adding to the atypical appearance. Cytologists should become familiar with the spectrum of changes in the post‐RT cytology. Testing for hrHPV should be considered for use in the management of abnormal cytology results. Post RT cytology should be compared with presurgical cytology since one would anticipate similarities in post‐RT true positive cases. In particular, a primary diagnosis of adenocarcinoma makes differentiating benign reactive glandular cells from recurrence a critical issue. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

股深动脉穿支皮瓣应用于乳房再造的解剖学研究

目的　为股深动脉穿支皮瓣应用于乳房再造提供解剖学依据。  方法　5例10侧成人新鲜下肢尸体标本进行乳胶或氧化铅动脉灌注,解剖观察后区域血管的形态及分布,测量股深动脉穿动脉穿支血管数量、管径、血管蒂长度及伴行静脉管径。在此基础上进行了股后区穿支皮瓣切取的手术模拟。 结果　股深动脉第1穿动脉发出4~9支穿支供应股后区皮肤,以肌皮穿支为主,偶可见肌间隔穿支;降支优势较多,优势穿支多发自股后内侧。血管蒂长为(10.6±2.6)cm,其外径为(2.2±1.0)cm,伴行静脉外径分别为(1.8±0.8)mm与(2.1±1.8)mm。   结论　股深动脉穿支皮瓣血供存在个体差异,尤以第1穿动脉对其影响较大,有待进一步研究确保皮瓣切取的安全性与精确性。     

Comparison of Ultrasound-Accelerated versus Pigtail Catheter–Directed Thrombolysis for the Treatment of Acute Massive and Submassive Pulmonary Embolism

Purpose

To compare the technical and clinical effectiveness of ultrasound-accelerated endovascular thrombolysis (USAT) versus pigtail catheter–directed thrombolysis (PCDT) for the treatment of acute pulmonary embolism (PE).

Tamoxifen induces resistance to activated protein C

Introduction

The estrogen antagonist tamoxifen (TAM) increases the thrombotic risk similar to estrogen containing oral contraceptives (OC). In OC users this risk is attributed to alterations of hemostasis resulting in acquired resistance to activated protein C (APC). TAM-induced APC resistance has not been reported yet.

Materials and Methods

Blood samples were collected prospectively from women with breast cancer before (n = 25) and monthly after start of adjuvant TAM treatment (n = 75). APC resistance was evaluated on basis of the effect of APC on the endogenous thrombin generation potential. To detect increased in vivo APC generation APC plasma levels were measured using a highly sensitive oligonucleotide-based enzyme capture assay. Routine hemostasis parameters were measured additionally.

Results

APC sensitivity decreased by 41% (p = 0.001) compared to baseline after one month of TAM application and remained significantly decreased during the study period. Free protein S increased (p = 0.008) while other analyzed procoagulant factors, inhibitors, and activation markers of coagulation decreased or did not change significantly. In five patients the APC concentration increased to non-physiological levels but an overall significant increase of APC was not observed.

Conclusions

This is the first study showing acquired APC resistance under TAM therapy. Acquired APC resistance might explain the increased thrombotic risk during TAM treatment. Observed changes of hemostasis parameters suggest different determinants of TAM-induced APC resistance than in OC-induced APC resistance. The presence of acquired APC resistance in TAM patients warrants further evaluation if these patients may benefit from antithrombotic prophylaxis in the presence of additional thrombotic risk factors.     

左旋18－甲基炔诺酮T型宫内节育器对子宫内膜血管内皮细胞因子Ⅷ活性的影响

本研究检测了３４例正常育龄妇女放置左旋１８－甲基炔诺酮宫内节育器（ＬＮＧ－ＩＵＤ－２０）前、后子宫内膜血管内皮细胞因子Ⅷ（ＦⅧ）的活性。ＰＡＰ法染色，计算机数字化图象分析系统测定ＦⅧ活性的灰度值。结果：置器１２个月后，子宫内膜血管内皮细胞ＦⅧ活性大部分较放器前明显减弱（Ｐ＜０．００１），少数前后不变。提示ＬＮＧ－ＩＵＤ－２０可能干扰了子宫内膜血管内皮细胞ＦⅧ的合成、释放。     

Pulmonary arterial hypertension: the key role of echocardiography

Given the nonspecific nature of its early symptoms and signs, pulmonary arterial hypertension (PAH) is often diagnosed in its advanced stages. Although clinical assessment is essential when initially evaluating patients with suspected PAH, echocardiography is a key screening tool in the diagnostic algorithm. It not only provides an estimate of pulmonary pressure at rest and during exercise, but it may also help to exclude any secondary causes of pulmonary hypertension, predict the prognosis, monitor the efficacy of specific therapeutic interventions, and detect the preclinical stage of the disease.     

High resolution X-ray structure of potent anti-HIV pokeweed antiviral protein-III

Pokeweed antiviral protein III (PAP-III), a naturally occurring protein isolated from late summer leaves of the pokeweed plant (Phytolacca americana), has potent anti-HIV activity by an as yet undetermined molecular mechanism. PAP-III belongs to a family of ribosome-inactivating proteins that catalytically deadenylate ribosomal and viral RNA. The chemical modification of PAP-III by reductive methylation of its lysine residues significantly improved the crystal quality for X-ray diffraction studies. Trigonal crystals of the modified PAP-III, with unit cell parameters a=b=80.47A, c=76.21A, were obtained using 30% PEG400 as the precipitant. These crystals contained one enzyme molecule per asymmetric unit and diffracted up to 1.5A, when exposed to a synchrotron source. Here we report the X-ray crystal structure of PAP-III at 1.6A resolution, which was solved by molecular replacement using the homology model of PAP-III as a search model. The fold typical of other ribosome-inactivating proteins is conserved, despite several differences on the surface and in the loop regions. Residues Tyr(69), Tyr(117), Glu(172), and Arg(175) are expected to define the active site of PAP-III. Molecular modeling studies of the interactions of PAP-III and PAP-I with a single-stranded RNA heptamer predicted a more potent anti-HIV activity for PAP-III due to its unique surface topology and more favorable charge distribution in its 20A-long RNA binding active center cleft. In accordance with the predictions of the modeling studies, PAP-III was more potent than PAP-I in depurinating HIV-1 RNA.     

Potential allergenicity research of Cry1C protein from genetically modified rice

With the development of genetically modified crops, there has been a growing interest in available approaches to assess the potential allergenicity of novel gene products. We were not sure whether Cry1C could induce allergy. We examined the protein with three other proteins to determine the potential allergenicity of Cry1C protein from genetically modified rice. Female Brown Norway (BN) rats received 0.1 mg peanut agglutinin (PNA), 1 mg potato acid phosphatase (PAP), 1 mg ovalbumin (OVA) or 5 mg purified Cry1C protein dissolved in 1 mL water by daily gavage for 42 days to test potential allergenicity. Ten days after the last gavage, rats were orally challenged with antigens, and physiologic and immunologic responses were studied. In contrast to sensitization with PNA, PAP and OVA Cry1C protein did not induce antigen-specific IgG2a in BN rats. Cytokine expression, serum IgE and histamine levels and the number of eosinophils and mast cells in the blood of Cry1C group rats were comparable to the control group rats, which were treated with water alone. As Cry1C did not show any allergenicity, we make the following conclusion that the protein could be safety used in rice or other plants.