Malignant gastric lymphoma (MGL) accounts for a small proportion (upto 5%) of gastric malignancies. However, unlike for advanced gastric cancer (AGC) that requires surgical treatment, the standard treatments for MGL are chemotherapy and radiotherapy. Hence, the initial impression of the endoscopist is critical for the differential diagnosis and for planning future treatment. The purpose of this study was to assess the endoscopic diagnostic accuracy and the possibility of distinguishing between AGC and MGL depending on the endoscopist''s experience.A total of 48 patients who had MGL, and 48 age and sex-matched patients who had AGC were assessed by endoscopic review at a tertiary referral hospital between June 2008 and February 2017. Two endoscopic specialists reviewed the endoscopic findings and divided these diagnoses into 5 groups: Borrmann type (1, 2, 3, and 4) and early gastric cancer-like type. After this, 7 experts and 8 trainees were asked to complete a quiz that was comprised of 6 images for each of the 96 cases and to provide an endoscopic diagnosis for each case. The test results were analyzed to assess the diagnostic accuracy according to the pathologic results, endoscopic subgroups, and endoscopists’ experience. For inter-observer agreement was calculated with Fleiss kappa values.The overall diagnostic accuracy of endoscopic findings by the experts was 0.604 and that by the trainees was 0.493 (P = .050). There was no significant difference in the diagnosis according to the final pathology (lymphoma cases, 0.518 vs 0.440, P = .378; AGC cases, 0.690 vs 0.547, P = .089, respectively). In the subgroup analysis, the experts showed significantly higher diagnostic accuracy for the endoscopic Borrmann type 4 subgroup, including lymphoma or AGC cases, than the trainees (P = .001). Inter-observer agreement of final diagnosis (Fleiss kappa, 0.174) and endoscopic classification groups (Fleiss kappa, 0.123–0.271) was slightly and fair agreement.The experts tended to have a higher endoscopic diagnostic accuracy. Distinguishing MGL from AGC based on endoscopic findings is difficult, especially for the beginners. Even if the endoscopic impression is AGC, it is important to consider MGL in the differential diagnosis. 相似文献
In the bone marrow (BM) nucleated differential cell count (NDC), myeloblasts are enumerated as a percentage of total nucleated cells, which are inevitably diluted with peripheral blood nucleated cells (PBNC) during BM aspiration. We propose a partial NDC (PNDC) comprising only immature haemopoietic cells capable of division, i.e. myeloblasts, promyelocytes, myelocytes and erythroblasts. We show that the myeloid : erythroid (M : E) ratio of the PNDC remains approximately constant in progressively dilute aliquots of BM aspirates. We determined the PNDC in 22 healthy subjects and investigated the effect of peripheral blood dilution on disease stratification of 66 BM aspirates with myelodysplastic syndromes (MDS). NDC and PNDC myeloblast counts were compared and the equivalent PNDC myeloblast counts for NDC myeloblast threshold counts of 5, 10 and 20% were derived. Reclassification of MDS samples with the PNDC resulted in a change in disease category in 33.3% of 51 MDS samples with NDC myeloblast counts ranging from 3 to 26%. The PNDC is independent of PBNC dilution and can be determined in dilute BM samples. It alters the disease category in a significant proportion of BM aspirates with MDS and has the potential to better stratify MDS to improve clinical outcomes and treatment. 相似文献
We have investigated the effects of different patterns of administration of recombinant human growth hormone (rhGH) on weight
gain, organ growth, serum GH binding protein (GHBP) and insulin-like growth factor-l (IGF-1) levels in a series of studies
using hypophysectomized (Hx) or GH-deficient dwarf (dw/dw) rats. Animals were given rhGH either by subcutaneous (s.c.) injections
(1 or 2 per day) or s.c. infusions and rhlGF-1 (2 mg/kg/day) by s.c. infusion. In Hx rats, all rhGH regimes increased body
weight, tibial epiphyseal plate width, and organ weights in a dose-related manner. Dwarf rats showed a smaller growth response
to rhGH than Hx rats, whereas rhGH induced greater elevations in serum GHBP in drarf rats. Growth responses depended on the
pattern of rhGH administration (twice daily injections > continuous infusions > daily injections). The shape of the body growth
curves also differed; rhGH injections increased weight gain linearly, whereas infusions gave an initial rapid weight gain
which slowed with time (a curvilinear response). For both regimens, tibial epiphyseal plate width increased linearly with
rhGH dose but infusions were 5-fold more potent than daily injections. Spleen and thymus weights were markedly increased by
rhGH and were also affected by the pattern of GH exposure. At 5 mg rhGH/kg/day, thymus weights were 390±35 mg for injectionsvs. 613 ± 34 mg for infusions (P<0.001) compared with 248 ± 16 mg in vehicle-treated Hx controls. Infusions of rhlGF-1 also stimulated specific organ growth
but caused less weight gain. RhlGF-1 additively increased the weight gain caused by rhGH injections but not by rhGH infusions.
Circulating IGF-1 and GHBP levels were increased in a dose-dependent manner by rhGH infusion, whereas daily injections were
ineffective. Thus, differential organ growth could be related to the higher serum IGF-1 concentrations induced by continuous
rhGH administration. These studies show that whole body growth is best maintained by intermittent rhGH exposure, whereas,
paradoxically, differential organ growth is most pronounced with continuous rhGH administration. 相似文献
The reorganization kinetics of the “original” lamellar diblock copolymer poly(ε‐caprolactone)‐block‐poly(4‐vinylpyridine) crystals formed at 260 K is studied in the melting region from 270 K (10 K below the onset of the melting peak of original crystals) to 310 K (the melting peak temperature) on the time scale starting from 10?4 to 102 s by ultrafast differential scanning calorimetry. Different reorganization pathways are observed in this temperature range. Annealing at temperatures below 295 K leads to further stabilization of original crystals by secondary crystallization. At annealing temperatures higher than 295 K, crystals partially melt and the reorganization occurs via the melting–recrystallization. For even higher temperature, such as 310 K, the melting is completed within a few milliseconds and recrystallization starts from the nuclei formation. The sigmoidal recrystallization kinetics is analyzed by the Avrami equation. It is found that the copolymer experiences about one order of magnitude slower recrystallization rate and has higher melting peak temperatures of crystals formed after recrystallization than the homopolymer. The slower recrystallization kinetics in the copolymer is discussed from the viewpoint of the nanoscale spatial constraint and the intermediate state prior to the recrystallization.