BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct p...BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct prognoses and potential treatments.We report a clinical case of a patient with mixed type adenocarcinoma of the ampulla of Vater,with predominantly intestinal histology,associated with an isolated and synchronous peritoneal carcinomatosis.It is the only case reported in the literature of duodenal ampulla cancer with synchronous peritoneal metastases,with long-term survival.CASE SUMMARY A 53-year-old male patient with non-insulin-dependent diabetes presented with acute abdominal pain in the right hypochondrium.Images revealed dilatation of the biliary tract and the duct of Wirsung,without a clear obstructive factor.Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla.Biopsies confirmed an adenocarcinoma.In the first surgical step,a biliodigestive bypass was performed in association with resection of the carcinomatosis.Peritoneal metastases was found during the intraoperative period.Subsequently,chemotherapy with the folinic acid,fluorouracil,and oxaliplatin regimen was administered based on histology,and a favorable response was achieved.After a multidisciplinary discussion,the Whipple procedure was performed.A delayed biopsy showed disease-free margins.The patient achieved 5 years of overall survival in August 2024,and 4 years of disease-free survival in September 2024.CONCLUSION We conclude that an important value of this work is showing individualized treatment for a patient with cancer.展开更多
A 14-year-old presented with an asymptomatic left testicular mass after a brief episode of pain.Examination showed a non-tender left testis that was significantly larger than the right.Ultrasound revealed a 4.5-cm ava...A 14-year-old presented with an asymptomatic left testicular mass after a brief episode of pain.Examination showed a non-tender left testis that was significantly larger than the right.Ultrasound revealed a 4.5-cm avascular mass and an absence of normal testicular parenchyma.Tumor markers were unremarkable.A CT scan demonstrated no lymphadenopathy but identified a prominent left spermatic cord.Due to a suspicion of chronic torsion vs.malignancy,a left radical orchiectomy was performed.Pathology identified a hemorrhagic paratesticular venous malformation without signs of germ cell neoplasia,a rare entity.展开更多
Background: Obesity is a chronic complex disease defined by excessive fat deposits that can impair health. Obesity occurs as a result of an imbalance in diet (energy intake) and physical activity (energy expended), mu...Background: Obesity is a chronic complex disease defined by excessive fat deposits that can impair health. Obesity occurs as a result of an imbalance in diet (energy intake) and physical activity (energy expended), multifactorial diseases due to obesogenic environment (availability of convenience food, media influence, etc.), psycho-social factors (social support systems, cultural/environmental influence, etc.) and genetic variants. Other causes are a subgroup of etiological factors (medications, diseases, immobilization, iatrogenic procedures, monogenic disease/genetic syndrome). Obesity is measured clinically by several common tools apart from body mass index (BMI), such as waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio, and neck circumference. WC and WHR are common tools for measuring central obesity while BMI measures generalized obesity. Aims: The goal of this study is to assess the prevalence of obesity amongst health workers of David Umahi Federal University Teaching Hospital, Uburu, Ebonyi state, Southeast Nigeria and to note the prevailing factors. A reliable estimate of the prevalence of obesity among health workers will contribute to the statistics needed to sway policymakers in the country to take urgent and substantial action on the increasing prevalence of obesity, especially in the healthcare industry. Methodology: The study was carried out between May 2024 and June 2024 at the David Umahi Federal University Teaching Hospital situated in Uburu, Ohaozara Local government area of Ebonyi state, Southeast Nigeria. The questionnaire was designed using the Finnish diabetic risk score (FINDRISC). It contained basic comprehending questions on age, gender, exposure to high blood pressure medication, and anthropometric measurement amongst others. Weight was taken with a portable weighing scale and height, with a stadiometer. Both were taken with shoes and headgear removed. The BMI was calculated using the weight (kg) divided by the square of the height (m2). Result: Generally, the prevalence of obesity (>30 kg/m2) in this study was low 17.6% (38), Overweight (BMI 25 - 30), 38.9%, (84) healthy Weight, (BMI 18.5 - 24.9), 43.5% (94). The study revealed that a family history of diabetes was significantly related to higher BMI, with participants more likely to be overweight or obese (p = 0.00030). Similarly, participants with a personal history of diabetes were predominantly in the obese category (p = 0.00038). Waist circumference also showed a strong association with BMI, as larger waist measurements were more common among obese individuals (p = 9.2 × 10−8). In contrast, the analysis found no significant relationships between BMI and age, gender, high blood pressure, or exercise habits. Conclusion: The socio-demographic determinants of obesity in this study were gender, age < 45 years and exposure to exercise. These determinants should form the areas of focus for interventions such as health education and the design of work environments as environments designed to promote physical activities while working will reduce the prevalence of obesity in tertiary institutions.展开更多
AIM: To investigate the association of colorectal adenomas with both Helicobacter pylori (H. pylori) infection and metabolic syndrome. METHODS: Using a cross-sectional hospital-based study, we analyzed physical examin...AIM: To investigate the association of colorectal adenomas with both Helicobacter pylori (H. pylori) infection and metabolic syndrome. METHODS: Using a cross-sectional hospital-based study, we analyzed physical examination data from 9311 healthy subjects with overnight physical examinations performed between January 2004 and December 2006. Examined data included gender, age, life style, anthropometric measurements, blood pressure, biochemical and hematological studies, H. pylori infection detected by esophagogastroduodenoscopy and biopsy urease tests, and colorectal adenomas detected with a complete total colonoscopy. RESULTS: The prevalence values for H. pylori infection, metabolic syndrome, and colorectal adenoma were39.2%, 18.7%, and 20.7%, respectively. Colorectal adenoma risk factors included male gender [odd ratio (OR): 2.005, 95% conf idence interval (CI): 1.740-2.310, P < 0.001], advanced age (OR: 1.046, 95% CI: 1.040-1.052, P < 0.001), smoking (OR: 1.377, 95% CI: 1.146-1.654, P = 0.001), increased body fat (OR: 1.016, 95% CI: 1.007-1.026, P = 0.001), higher white blood cell count (OR: 1.038, 95% CI: 1.005-1.073, P = 0.025), H. pylori infection (OR: 1.366, 95% CI: 1.230-1.517, P < 0.001), and metabolic syndrome (OR: 1.408, 95% CI: 1.231-1.610, P < 0.001). In addition, concomitant H. pylori infection with metabolic syndrome further increased the probability of colorectal adenomas. CONCLUSION: Our study revealed H. pylori infection with concomitant metabolic syndrome might further increase the risk of colorectal adenomas.展开更多
AIM: To evaluate and compare detection of lymphatic and blood vessel invasion (LVI and BVI) by hematox-ylin-eosin (HE) and immunohistochemistry (IHC) in gastric cancer specimens, and to correlate with lymph node statu...AIM: To evaluate and compare detection of lymphatic and blood vessel invasion (LVI and BVI) by hematox-ylin-eosin (HE) and immunohistochemistry (IHC) in gastric cancer specimens, and to correlate with lymph node status. METHODS: IHC using D2-40 (a lymphatic endothelial marker) and CD34 (a pan-endothelial marker) was performed to study LVI and BVI in surgical specimens froma consecutive series of 95 primary gastric cancer cases. The results of the IHC study were compared with the detection by HE using McNemar test and kappa index. The morphologic features of the tumors and the presence of LVI and BVI were related to the presence of lymph node metastasis. A χ2 test was performed to obtain associations between LVI and BVI and other prognostic factors for gastric cancer. RESULTS: The detection rate of LVI was considerably higher than that of BVI. The IHC study identified eight false-positive cases and 13 false-negative cases for LVI, and 24 false-positive cases and 10 false-negative cases for BVI. The average Kappa value determined was moderate for LVI (k=0.50) and low for BVI (k=0.20). Both LVI and BVI were statistically associated with the presence of lymph node metastasis (HE: P=0.001, P=0.013, and IHC: P=0.001, P=0.019). The mor-phologic features associated with LVI were location of the tumor in the distal third of the stomach (P=0.039), Borrmann's macroscopic type (P=0.001), organ inva-sion (P=0.03) and the depth of tumor invasion (P=0.001). The presence of BVI was related only to the depth of tumor invasion (P=0.003). CONCLUSION: The immunohistochemical identification of lymphatic and blood vessels is useful for increasing the accuracy of the diagnosis of vessel invasion and for predicting lymph node metastasis.展开更多
AIM： Minimal deviation carcinoma of the uterine cervix, otherwise known as extremely well-differentiated adenocarcinoma （EWDA）, is characterized by its benign microscopic appearance in contrast to its aggressive be...AIM： Minimal deviation carcinoma of the uterine cervix, otherwise known as extremely well-differentiated adenocarcinoma （EWDA）, is characterized by its benign microscopic appearance in contrast to its aggressive behavior. In order to elucidate the clinicopathological features and biological behavior of the gastric counterpart of EWDA, we, using immunohistochemistry, analyzed nine lesions for the phenotypic expression, proliferative activity, and the expression of oncogene-associated products. METHODS： Clinicopathological features, including preoperative biopsy diagnosis, were reviewed. Using immunohitstochemistry, Ki-67 labeling index and expression of p53 and c-erbB-2 protein in the gastric lesions were detected.RESULT： Locations in the middle or upper third of the stomach and polypoid macroscopic features are characteristic of EWDA of the stomach. Although 4 of the 9 lesions showed only focal lymphatic or venous invasion, lymph node metastasis was not present and none of the patients died of the lesions （mean follow-up period, 56 too）. All 9 cases of EWDA could be classified into gastric phenotype （5 lesions） and intestinal phenotype （4 lesions）. The former resembled gastric foveolar epithelium, mucous neck cells or pyloric glands, but their papillary structures were frequently elongated and the tumor cellsand their nuclei were slightly larger and more hyperchromatic compared to normal epithelium. The latter resembled intestinal metaplasia with minimal nulcear atypia and irregular glands; two of these lesions demonstrated complete intestinal phenotype, while two demonstrated incomplete intestinal phenotype. Ki-67 labeling index was low and none of the cases revealed over-expression of p53 and c-erbB-2 protein. CONCLUSION： Unlike minimal deviation carcinoma of the cervix, these findings suggest that EWDA of the stomach is a lesion of low-grade malignancy. This favorable biological behavior is supported by the data of a low Ki-67 labeling index and a lack of p53 or c-erbB-2 protein over-expression. Because of its resemblance to normal gastric mucosa or mucosa with intestinal metaplasia, EWDA is often misdiagnosed. To prevent the misdiagnosis of such lesions, the clinical and pathologic characteristics should be taken into consideration.展开更多
AIM: To characterize tumor necrosis factor receptor-associated protein 1 (TRAP1) expression in the progression of ulcerative colitis (UC)-associated colorectal cancer.
AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 wer...AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients(41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines(TG13) for the severity of cholecystitis, 86 and 14 patients had grade Ⅰ and grade Ⅱ acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients(89%). Conversion laparotomy was performed in 12 patients(12%). Postoperative complications of Clavien-Dindo grade Ⅲ or greater were observed in 4 patients(4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.展开更多
Cholestatic liver diseases(CLD)begin to develop after an impairment of bile flow start to affect the biliary tree.Cholangiocytes actively participate in the liver response to injury and repair and the intensity of thi...Cholestatic liver diseases(CLD)begin to develop after an impairment of bile flow start to affect the biliary tree.Cholangiocytes actively participate in the liver response to injury and repair and the intensity of this reaction is a determinant factor for the development of CLD.Progressive cholangiopathies may ultimately lead to end-stage liver disease requiring at the end orthotopic liver transplantation.This narrative review will discuss cholangiocyte biology and pathogenesis mechanisms involved in four intrahepatic CLD:Primary biliary cholangitis,primary sclerosing cholangitis,cystic fibrosis involving the liver,and polycystic liver disease.展开更多
Extranodal natural killer/T-cell lymphoma(ENKTL) is a distinct subtype of non-Hodgkin's lymphoma and is rare in the colon.Synchronous adenocarcinoma and ENKTL of the colon has not been reported in the literature.I...Extranodal natural killer/T-cell lymphoma(ENKTL) is a distinct subtype of non-Hodgkin's lymphoma and is rare in the colon.Synchronous adenocarcinoma and ENKTL of the colon has not been reported in the literature.In the present study,we report a 63-year-old male who suffered from intermittent bloody stools for 2 mo.He did not have fever,body weight loss or night sweat.Endoscopic and imaging studies revealed a 4.5-cm ulcerative mass in the ascending colon and a 3.0-cm polypoid,easy bleeding mass in the sigmoid colon,respectively.Thought to have double carcinoma of the colon,he received simultaneous right hemicolectomy and sigmoidectomy.The pathological diagnosis was a synchronous ENKTL(ascending colon) and adenocarcinoma(sigmoid colon).The literature on synchronous adenocarcinoma and malignant lymphoma of the colon was also reviewed.展开更多
AIM:To determine the effects of genetic variants associated with gallstone formation and capsaicin (a pungent component of chili pepper) metabolism on the risk of gallbladder cancer (GBC).METHODS: A total of 57 patien...AIM:To determine the effects of genetic variants associated with gallstone formation and capsaicin (a pungent component of chili pepper) metabolism on the risk of gallbladder cancer (GBC).METHODS: A total of 57 patients with GBC, 119 patients with gallstones, and 70 controls were enrolled in this study. DNA was extracted from their blood or paraffi n block sample using standard commercial kits. The statuses of the genetic variants were assayed using Taqman SNP Genotyping Assays or Custom Taqman SNP Genotyping Assays.RESULTS:The non-ancestral T/T genotype of apolipoprotein B rs693 polymorphism was associated with a decreased risk of GBC (OR:0.14,95% CI:0.03-0.63). The T/T genotype of cholesteryl ester transfer protein (CETP) rs708272 polymorphism was associated with an increased risk of GBC (OR:5.04,95% CI:1.43-17.8).CONCLUSION: Genetic variants involved in gallstone formation such as the apolipoprotein B rs693 and CETP rs 708272 polymorphisms may be related to the risk of developing GBC in Chilean women.展开更多
Several risk factors,which include heredity,ultra-violet (UV) light and chronic inflammation,contribute to pterygium development.However,there is no report integrating these factors in the pathogenesis of pterygium.Th...Several risk factors,which include heredity,ultra-violet (UV) light and chronic inflammation,contribute to pterygium development.However,there is no report integrating these factors in the pathogenesis of pterygium.The aim of this review is to describe the connection between heredity,UV,and inflammation in pterygium development.Existing reports indicate that sunlight exposure is the main factor in pterygium occurrence by inducing growth factor production or chronic inflammation or DNA damage.Heredity may be a factor.Our studies on factors in pterygium occurrence and recurrence identify that heredity is crucial for pterygium to develop,and that sunlight is only a trigger,and that chronic inflammation promotes pterygium enlargement.We propose that genetic factors may interfere with the control of fibrovascular proliferation while UV light or(sunlight)most likely only triggers pterygium development by inducing growth factors which promote vibrant fibrovascular proliferation in predisposed individuals.It also just triggers inflammation and collagenolysis,which may be promoters of the enlargement of the fibrovascular mass.Pterygium probably occurs in the presence of exuberant collagen production and profuse neovascularisation.展开更多
Basaloid squamous cell carcinoma （BSC） of the esophagus is a rare malignant disease. We report here a patient with recurrent esophageal BSC, who was successfully treated by systemic chemotherapy containing 5-fluorou...Basaloid squamous cell carcinoma （BSC） of the esophagus is a rare malignant disease. We report here a patient with recurrent esophageal BSC, who was successfully treated by systemic chemotherapy containing 5-fluorouracil （5-FU） and cisplatin （CDDP）. A 57-year-old woman was diagnosed as having SCluamous cell carcinoma of the esophagus upon endoscopic examination. Curative esophagectomy with lymph node dissection was performed under the thoracoscope. The pathological diagnosis of the surgical specimen was BSC. Five months after operation, the patient was diagnosed as having a recurrence of the BSC with metastases to the liver and spleen, and a right paraclavicular lymph node. She was given systemic chemotherapy consisting of continuous infusion of 800 mg/d of 5-FU and 3 h infusion of 20 mg/d of CDDP for 5 consecutive days every 4 wk. The metastatic lesions in the spleen and right paraclavicular lymph node disappeared, and the liver metastasis was apparently reduced in size after 2 courses of chemotherapy. The tumor regression was seen over 6 courses, with progression afterwards. Although subsequent treatment with CPT-11 and CDDP was not effective, docetaxel and vinorelbine temporarily controlled the tumor growth for 2 mo. 5-FU and CDDP combination may be useful for the patients with advanced BSC.展开更多
AIM： To evaluate how proximal colon polyps interpreted as hyperplastic polyps in 2001 would be interpreted by expert pathologists in 2007.METHODS： ≥ 5 mm in interpreted pathologists 2007 by 3 GI Forty consecutive p...AIM： To evaluate how proximal colon polyps interpreted as hyperplastic polyps in 2001 would be interpreted by expert pathologists in 2007.METHODS： ≥ 5 mm in interpreted pathologists 2007 by 3 GI Forty consecutive proximal colon polyps size, removed in 2001, and originally as hyperplastic polyps by general at Indiana University, were reviewed in pathologists.CONCLUSION： Many polyps interpreted as hyperplastic in 2001 were considered sessile serrated lesions by GI pathologists in 2007, but there is substantial inter-observer variation amongst GI pathologists.展开更多
BACKGROUND Primary sclerosing cholangitis(PSC)associated inflammatory bowel disease(IBD)is a unique form of IBD(PSC-IBD)with distinct clinical and histologic features from ulcerative colitis(UC)and Crohn disease(CD).I...BACKGROUND Primary sclerosing cholangitis(PSC)associated inflammatory bowel disease(IBD)is a unique form of IBD(PSC-IBD)with distinct clinical and histologic features from ulcerative colitis(UC)and Crohn disease(CD).In patients with PSC and IBD,the severity of the two disease processes may depend on each other.AIM To study the histologic and clinical features of PSC patients with and without IBD.METHODS We assessed specimens from patients with UC(n=28),CD(n=10),PSC and UC(PSC-UC;n=26);PSC and CD(PSC-CD;n=6);and PSC and no IBD(PSC-no IBD;n=4)between years 1999-2013.PSC-IBD patients were matched to IBD patients without PSC by age and colitis duration.Clinical data including age,gender,age at IBD and PSC diagnoses,IBD duration,treatment,follow-up,orthotopic liver transplantation(OLT)were noted.RESULTS PSC-UC patients had more isolated right-sided disease(P=0.03),and less active inflammation in left colon,rectum(P=0.03 and P=0.0006),and overall(P=0.0005)compared to UC.They required less steroids(P=0.01)and fewer colectomies(P=0.03)than UC patients.The PSC-CD patients had more ileitis and less rectal involvement compared to PSC-UC and CD.No PSC-CD patients required OLT compared to 38%of PSC-UC(P=0.1).PSC-IBD(PSC-UC and PSCCD)patients with OLT had severe disease in the left colon and rectum(P=0.04).CONCLUSION PSC-UC represents a distinct form of IBD.The different disease phenotype in PSC-IBD patients with OLT may support liver-gut axis interaction,however warrants clinical attention and further research.展开更多
AIM:To investigate the role of nuclear factor of activated T cell 2(NFAT2),the major NFAT protein in peripheral T cells,in sustained T cell activation and intractable inflammation in human ulcerative colitis(UC). METH...AIM:To investigate the role of nuclear factor of activated T cell 2(NFAT2),the major NFAT protein in peripheral T cells,in sustained T cell activation and intractable inflammation in human ulcerative colitis(UC). METHODS:We used two-dimensional gel-electrophoresis, immunohistochemistry,double immunohistochemical staining,and confocal microscopy to inspect the expression of NFAT2 in 107,15,48 and 5 cases of UC, Crohn's disease(CD),non-specific colitis,and 5 healthy individuals,respectively. RESULTS:Up-regulation with profound nucleo- translocation/activation of NFAT2 of lamina propria mononuclear cells(LPMC)of colonic mucosa was found specifically in the affected colonic mucosa from patients with UC,as compared to CD or NC(P<0.001,Kruskal- Wallis test).Nucleo-translocation/activation of NFAT2 primarily occurred in CD8+T,but was less prominent in CD4+T cells or CD20+B cells.It was strongly associated with the disease activity,including endoscopic stage (τ=0.2145,P=0.0281)and histologic grade(τ=0.4167, P<0.001). CONCLUSION:We disclose for the first time the nucleo-translocation/activatin of NFAT2 in lamina propria mononuclear cells in ulcerative colitis.Activation of NFAT2 was specific for ulcerative colitis and highly associated with disease activity.Since activation of NFAT2is implicated in an auto-regulatory positive feedback loop of sustained T-cell activation and NFAT proteins play key roles in the calcium/calcineurin signaling pathways,our results not only provide new insights into the mechanism for sustained intractable inflammation,but also suggest the calcium-calcineurin/NFAT pathway as a new therapeutic target for ulcerative colitis.展开更多
BACKGROUND Intraductal papillary mucinous neoplasms(IPMNs)are non-invasive pancreatic precursor lesions that can potentially develop into invasive pancreatic ductal adenocarcinoma.Currently,the International Consensus...BACKGROUND Intraductal papillary mucinous neoplasms(IPMNs)are non-invasive pancreatic precursor lesions that can potentially develop into invasive pancreatic ductal adenocarcinoma.Currently,the International Consensus Guidelines(ICG)for IPMNs provides the basis for evaluating suspected IPMNs on computed tomography(CT)imaging.Despite using the ICG,it remains challenging to accurately predict whether IPMNs harbor high grade or invasive disease which would warrant surgical resection.A supplementary quantitative radiological tool,radiomics,may improve diagnostic accuracy of radiological evaluation of IPMNs.We hypothesized that using CT whole lesion radiomics features in conjunction with the ICG could improve the diagnostic accuracy of predicting IPMN histology.AIM To evaluate whole lesion CT radiomic analysis of IPMNs for predicting malignant histology compared to International Consensus Guidelines.METHODS Fifty-one subjects who had pancreatic surgical resection at our institution with histology demonstrating IPMN and available preoperative CT imaging were included in this retrospective cohort.Whole lesion semi-automated segmentation was performed on each preoperative CT using Healthmyne software(Healthmyne,Madison,WI).Thirty-nine relevant radiomic features were extracted from each lesion on each available contrast phase.Univariate analysis of the 39 radiomics features was performed for each contrast phase and values were compared between malignant and benign IPMN groups using logistic regression.Conventional quantitative and qualitative CT measurements were also compared between groups,viaχ2(categorical)and Mann Whitney U(continuous)variables.RESULTS Twenty-nine subjects(15 males,age 71±9 years)with high grade or invasive tumor histology comprised the"malignant"cohort,while 22 subjects(11 males,age 70±7 years)with low grade tumor histology were included in the"benign"cohort.Radiomic analysis showed 18/39 precontrast,19/39 arterial phase,and 21/39 venous phase features differentiated malignant from benign IPMNs(P<0.05).Multivariate analysis including only ICG criteria yielded two significant variables:thickened and enhancing cyst wall and enhancing mural nodule<5 mm with an AUC(95%CI)of 0.817(0.709-0.926).Multivariable post contrast radiomics achieved an AUC(95%CI)of 0.87(0.767-0.974)for a model including arterial phase radiomics features and 0.834(0.716-0.953)for a model including venous phase radiomics features.Combined multivariable model including conventional variables and arterial phase radiomics features achieved an AUC(95%CI)of 0.93(0.85-1.0)with a 5-fold cross validation AUC of 0.90.CONCLUSION Multi-phase CT radiomics evaluation could play a role in improving predictive capability in diagnosing malignancy in IPMNs.Future larger studies may help determine the clinical significance of our findings.展开更多
AIM:To find a new concept to show whether or not apoptosis of retinal ganglion cells(RGCs)canbe determined in the histology of acute hyperglycemia in the role of expressed Brn3b gene related to nitric oxide(NO),caspas...AIM:To find a new concept to show whether or not apoptosis of retinal ganglion cells(RGCs)canbe determined in the histology of acute hyperglycemia in the role of expressed Brn3b gene related to nitric oxide(NO),caspase-3,nuclear factor kappa-B(NF-κB),and tumor necrosis factor-α(TNF-α)as an early predictor of primary open angle glaucoma(POAG)eyes and their associations.METHODS:Experimental in vivo study was carried out using adult male,white Sprague-Dawley rats aged≥2 mo,weighing 150-200 g.The animals were divided into two groups,one group receiving intraperitoneal injection of streptozotociz 50 mg/kg in 0.01 mol/L citricbuffer and p H 4.5 and a comparison made with the control group.Retinal tissue was divided into two parts(both experimental and control groups respectively):a)right retina for immunohistochemistry(IHC;caspase-3 and TNF-α);b)left retina was divided into two parts for the purpose of real-time polymerase chain reaction(PCR)test(RNA extraction for Brn3b gene expression analysis)and ELISA test(NO and NF-κB).RESULTS:The experimental group showed a decrease in Brn3b gene expression compared to the control group(1.3-fold lower in 2nd month;1.1-fold lower in 4th month and 2.5-fold lower in 6th month).However,there was a decrease of NO,caspase-3,and an increase of NF-κB and TNF-αquantity.CONCLUSION:The expression of m RNA Brn3b gene is inversely proportional to apoptosis in RGCs.The quantity of NO,caspase-3,NF-κB and TNF-αis influential in expression of Brn3b in RGCs caused by hyperglycemia in diabetic rats.展开更多
BACKGROUND Reactive lymphoid hyperplasia(RLH)of the liver is a rare liver lesion.It is considered difficult to differentiate radiologically from hepatocellular carcinoma,metastatic liver tumor and other pathologies.CA...BACKGROUND Reactive lymphoid hyperplasia(RLH)of the liver is a rare liver lesion.It is considered difficult to differentiate radiologically from hepatocellular carcinoma,metastatic liver tumor and other pathologies.CASE SUMMARY A 54-year-old woman presented to our hospital with RLH of the liver.The patient had a diagnosis of metastatic carcinoma of the liver from an unknown origin and subsequently underwent partial hepatectomy.However,histopathological analysis revealed RLH.The lesion showed perinodular enhancement in the arterial phase on contrast-enhanced computed tomography and magnetic resonance imaging.On diffusion-weighted imaging(DWI),we encountered linear hyperintensity along the portal tract consecutive to the liver lesion,which is a new characteristic radiologic finding.This finding corresponded to the lymphoid cell infiltration of the portal tract.Furthermore,there was strongly restricted diffusion on the apparent diffusion coefficient map.We used these characteristic radiologic findings to diagnose the lesion as a lymphoproliferative disease.CONCLUSION The linear hyperintensity consecutive to the liver lesion on DWI provided additional valuable diagnostic information.展开更多
AIM:To compare the sensitivity and specificity of CDX2 and alcian blue(AB) p H 2.5 staining in identifying esophageal intestinal metaplasia.METHODS:One hundred and ninty-nine biopsies from 186 patients were retrospect...AIM:To compare the sensitivity and specificity of CDX2 and alcian blue(AB) p H 2.5 staining in identifying esophageal intestinal metaplasia.METHODS:One hundred and ninty-nine biopsies from 186 patients were retrospectively reviewed and categorized as Barrett's esophagus(BE)(n =108); non-Barrett's esophagus(NBE)(n =48); columnar blue cells(CB) and esophageal glands(EG)(n =43).The biopsies were stained with AB and immunostained for CDX2 using a mouse monoclonal antibody from Biogenex(clone CDX2-88) and the Ventana Discovery X automated immunostainer.The positive and negative predictive value of each group was used to determine the predictive power of CDX2 and AB in diagnosing intestinal metaplasia.RESULTS:All of the 108 BE biopsies(100%) were positive for AB and 102 of them(94.4%) were positive for CDX2.The six BE patients(5.6%) who failed to stain with CDX2 were found to have lost the focus of intestinal metaplasia upon deeper sectioning for immunostaining.Both AB and CDX2 were negative in 43 out of 48(89.6%) NBE cases.Five NBE patients(10.4%) were falsely positive for AB due to the presence of EG and CB in these biopsies.These cases were all CDX2 negative.In addition,5 AB negative NBE were found to be CDX2 positive.Based on these results the CDX2 immunostain had similar sensitivity but higher specificity(100% vs about 91%) than AB in detecting intestinal type metaplasia in these samples.Our data shows that CDX2 has a better PPV in detecting intestinal metaplasia as compared to AB(95.6% vs 71.5%,respectively).CONCLUSION:CDX2 has a better positive predictive value than AB in detecting intestinal metaplasia.CDX2may be useful when challenged by gastro-esophageal biopsies containing mimikers of BE.展开更多
文摘BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct prognoses and potential treatments.We report a clinical case of a patient with mixed type adenocarcinoma of the ampulla of Vater,with predominantly intestinal histology,associated with an isolated and synchronous peritoneal carcinomatosis.It is the only case reported in the literature of duodenal ampulla cancer with synchronous peritoneal metastases,with long-term survival.CASE SUMMARY A 53-year-old male patient with non-insulin-dependent diabetes presented with acute abdominal pain in the right hypochondrium.Images revealed dilatation of the biliary tract and the duct of Wirsung,without a clear obstructive factor.Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla.Biopsies confirmed an adenocarcinoma.In the first surgical step,a biliodigestive bypass was performed in association with resection of the carcinomatosis.Peritoneal metastases was found during the intraoperative period.Subsequently,chemotherapy with the folinic acid,fluorouracil,and oxaliplatin regimen was administered based on histology,and a favorable response was achieved.After a multidisciplinary discussion,the Whipple procedure was performed.A delayed biopsy showed disease-free margins.The patient achieved 5 years of overall survival in August 2024,and 4 years of disease-free survival in September 2024.CONCLUSION We conclude that an important value of this work is showing individualized treatment for a patient with cancer.
基金VMR is funded by the AUA and Urology Care Foundation(Research Scholars Award)as well as an NIH NRSA training grant(5T32DK060442-20)HT is funded by the AUA and Urology Care Foundation(Research Scholars Award),SUFU(Chemodenervation Grant),and the Office of Faculty Development at Harvard Medical School.
文摘A 14-year-old presented with an asymptomatic left testicular mass after a brief episode of pain.Examination showed a non-tender left testis that was significantly larger than the right.Ultrasound revealed a 4.5-cm avascular mass and an absence of normal testicular parenchyma.Tumor markers were unremarkable.A CT scan demonstrated no lymphadenopathy but identified a prominent left spermatic cord.Due to a suspicion of chronic torsion vs.malignancy,a left radical orchiectomy was performed.Pathology identified a hemorrhagic paratesticular venous malformation without signs of germ cell neoplasia,a rare entity.
文摘Background: Obesity is a chronic complex disease defined by excessive fat deposits that can impair health. Obesity occurs as a result of an imbalance in diet (energy intake) and physical activity (energy expended), multifactorial diseases due to obesogenic environment (availability of convenience food, media influence, etc.), psycho-social factors (social support systems, cultural/environmental influence, etc.) and genetic variants. Other causes are a subgroup of etiological factors (medications, diseases, immobilization, iatrogenic procedures, monogenic disease/genetic syndrome). Obesity is measured clinically by several common tools apart from body mass index (BMI), such as waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio, and neck circumference. WC and WHR are common tools for measuring central obesity while BMI measures generalized obesity. Aims: The goal of this study is to assess the prevalence of obesity amongst health workers of David Umahi Federal University Teaching Hospital, Uburu, Ebonyi state, Southeast Nigeria and to note the prevailing factors. A reliable estimate of the prevalence of obesity among health workers will contribute to the statistics needed to sway policymakers in the country to take urgent and substantial action on the increasing prevalence of obesity, especially in the healthcare industry. Methodology: The study was carried out between May 2024 and June 2024 at the David Umahi Federal University Teaching Hospital situated in Uburu, Ohaozara Local government area of Ebonyi state, Southeast Nigeria. The questionnaire was designed using the Finnish diabetic risk score (FINDRISC). It contained basic comprehending questions on age, gender, exposure to high blood pressure medication, and anthropometric measurement amongst others. Weight was taken with a portable weighing scale and height, with a stadiometer. Both were taken with shoes and headgear removed. The BMI was calculated using the weight (kg) divided by the square of the height (m2). Result: Generally, the prevalence of obesity (>30 kg/m2) in this study was low 17.6% (38), Overweight (BMI 25 - 30), 38.9%, (84) healthy Weight, (BMI 18.5 - 24.9), 43.5% (94). The study revealed that a family history of diabetes was significantly related to higher BMI, with participants more likely to be overweight or obese (p = 0.00030). Similarly, participants with a personal history of diabetes were predominantly in the obese category (p = 0.00038). Waist circumference also showed a strong association with BMI, as larger waist measurements were more common among obese individuals (p = 9.2 × 10−8). In contrast, the analysis found no significant relationships between BMI and age, gender, high blood pressure, or exercise habits. Conclusion: The socio-demographic determinants of obesity in this study were gender, age < 45 years and exposure to exercise. These determinants should form the areas of focus for interventions such as health education and the design of work environments as environments designed to promote physical activities while working will reduce the prevalence of obesity in tertiary institutions.
基金Supported by Buddhist Dalin Tzu Chi General Hospital
文摘AIM: To investigate the association of colorectal adenomas with both Helicobacter pylori (H. pylori) infection and metabolic syndrome. METHODS: Using a cross-sectional hospital-based study, we analyzed physical examination data from 9311 healthy subjects with overnight physical examinations performed between January 2004 and December 2006. Examined data included gender, age, life style, anthropometric measurements, blood pressure, biochemical and hematological studies, H. pylori infection detected by esophagogastroduodenoscopy and biopsy urease tests, and colorectal adenomas detected with a complete total colonoscopy. RESULTS: The prevalence values for H. pylori infection, metabolic syndrome, and colorectal adenoma were39.2%, 18.7%, and 20.7%, respectively. Colorectal adenoma risk factors included male gender [odd ratio (OR): 2.005, 95% conf idence interval (CI): 1.740-2.310, P < 0.001], advanced age (OR: 1.046, 95% CI: 1.040-1.052, P < 0.001), smoking (OR: 1.377, 95% CI: 1.146-1.654, P = 0.001), increased body fat (OR: 1.016, 95% CI: 1.007-1.026, P = 0.001), higher white blood cell count (OR: 1.038, 95% CI: 1.005-1.073, P = 0.025), H. pylori infection (OR: 1.366, 95% CI: 1.230-1.517, P < 0.001), and metabolic syndrome (OR: 1.408, 95% CI: 1.231-1.610, P < 0.001). In addition, concomitant H. pylori infection with metabolic syndrome further increased the probability of colorectal adenomas. CONCLUSION: Our study revealed H. pylori infection with concomitant metabolic syndrome might further increase the risk of colorectal adenomas.
基金Supported by Grants from Coordenao de Aperfeioamentode Pessoal de Nível Superior
文摘AIM: To evaluate and compare detection of lymphatic and blood vessel invasion (LVI and BVI) by hematox-ylin-eosin (HE) and immunohistochemistry (IHC) in gastric cancer specimens, and to correlate with lymph node status. METHODS: IHC using D2-40 (a lymphatic endothelial marker) and CD34 (a pan-endothelial marker) was performed to study LVI and BVI in surgical specimens froma consecutive series of 95 primary gastric cancer cases. The results of the IHC study were compared with the detection by HE using McNemar test and kappa index. The morphologic features of the tumors and the presence of LVI and BVI were related to the presence of lymph node metastasis. A χ2 test was performed to obtain associations between LVI and BVI and other prognostic factors for gastric cancer. RESULTS: The detection rate of LVI was considerably higher than that of BVI. The IHC study identified eight false-positive cases and 13 false-negative cases for LVI, and 24 false-positive cases and 10 false-negative cases for BVI. The average Kappa value determined was moderate for LVI (k=0.50) and low for BVI (k=0.20). Both LVI and BVI were statistically associated with the presence of lymph node metastasis (HE: P=0.001, P=0.013, and IHC: P=0.001, P=0.019). The mor-phologic features associated with LVI were location of the tumor in the distal third of the stomach (P=0.039), Borrmann's macroscopic type (P=0.001), organ inva-sion (P=0.03) and the depth of tumor invasion (P=0.001). The presence of BVI was related only to the depth of tumor invasion (P=0.003). CONCLUSION: The immunohistochemical identification of lymphatic and blood vessels is useful for increasing the accuracy of the diagnosis of vessel invasion and for predicting lymph node metastasis.
基金Supported by Grants-in-aid for Cancer Research from the Ministry of Education, Science and Culture, Japan and the Fukuoka Cancer Society, Fukuoka, Japan
文摘AIM： Minimal deviation carcinoma of the uterine cervix, otherwise known as extremely well-differentiated adenocarcinoma （EWDA）, is characterized by its benign microscopic appearance in contrast to its aggressive behavior. In order to elucidate the clinicopathological features and biological behavior of the gastric counterpart of EWDA, we, using immunohistochemistry, analyzed nine lesions for the phenotypic expression, proliferative activity, and the expression of oncogene-associated products. METHODS： Clinicopathological features, including preoperative biopsy diagnosis, were reviewed. Using immunohitstochemistry, Ki-67 labeling index and expression of p53 and c-erbB-2 protein in the gastric lesions were detected.RESULT： Locations in the middle or upper third of the stomach and polypoid macroscopic features are characteristic of EWDA of the stomach. Although 4 of the 9 lesions showed only focal lymphatic or venous invasion, lymph node metastasis was not present and none of the patients died of the lesions （mean follow-up period, 56 too）. All 9 cases of EWDA could be classified into gastric phenotype （5 lesions） and intestinal phenotype （4 lesions）. The former resembled gastric foveolar epithelium, mucous neck cells or pyloric glands, but their papillary structures were frequently elongated and the tumor cellsand their nuclei were slightly larger and more hyperchromatic compared to normal epithelium. The latter resembled intestinal metaplasia with minimal nulcear atypia and irregular glands; two of these lesions demonstrated complete intestinal phenotype, while two demonstrated incomplete intestinal phenotype. Ki-67 labeling index was low and none of the cases revealed over-expression of p53 and c-erbB-2 protein. CONCLUSION： Unlike minimal deviation carcinoma of the cervix, these findings suggest that EWDA of the stomach is a lesion of low-grade malignancy. This favorable biological behavior is supported by the data of a low Ki-67 labeling index and a lack of p53 or c-erbB-2 protein over-expression. Because of its resemblance to normal gastric mucosa or mucosa with intestinal metaplasia, EWDA is often misdiagnosed. To prevent the misdiagnosis of such lesions, the clinical and pathologic characteristics should be taken into consideration.
基金Supported by Grants from National Institutes of Health,No.R21CA164548from Crohn’s and Colitis Foundation of America
文摘AIM: To characterize tumor necrosis factor receptor-associated protein 1 (TRAP1) expression in the progression of ulcerative colitis (UC)-associated colorectal cancer.
文摘AIM: To assess the safety of single-incision laparoscopic cholecystectomy(SILC) for acute cholecystitis.METHODS: All patients who underwent SILC at Sano Hospital(Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients(41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines(TG13) for the severity of cholecystitis, 86 and 14 patients had grade Ⅰ and grade Ⅱ acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients(89%). Conversion laparotomy was performed in 12 patients(12%). Postoperative complications of Clavien-Dindo grade Ⅲ or greater were observed in 4 patients(4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.
文摘Cholestatic liver diseases(CLD)begin to develop after an impairment of bile flow start to affect the biliary tree.Cholangiocytes actively participate in the liver response to injury and repair and the intensity of this reaction is a determinant factor for the development of CLD.Progressive cholangiopathies may ultimately lead to end-stage liver disease requiring at the end orthotopic liver transplantation.This narrative review will discuss cholangiocyte biology and pathogenesis mechanisms involved in four intrahepatic CLD:Primary biliary cholangitis,primary sclerosing cholangitis,cystic fibrosis involving the liver,and polycystic liver disease.
基金Supported by The Buddhist Dalin Tzu-Chi General Hospital
文摘Extranodal natural killer/T-cell lymphoma(ENKTL) is a distinct subtype of non-Hodgkin's lymphoma and is rare in the colon.Synchronous adenocarcinoma and ENKTL of the colon has not been reported in the literature.In the present study,we report a 63-year-old male who suffered from intermittent bloody stools for 2 mo.He did not have fever,body weight loss or night sweat.Endoscopic and imaging studies revealed a 4.5-cm ulcerative mass in the ascending colon and a 3.0-cm polypoid,easy bleeding mass in the sigmoid colon,respectively.Thought to have double carcinoma of the colon,he received simultaneous right hemicolectomy and sigmoidectomy.The pathological diagnosis was a synchronous ENKTL(ascending colon) and adenocarcinoma(sigmoid colon).The literature on synchronous adenocarcinoma and malignant lymphoma of the colon was also reviewed.
基金Supported by (in part) A Grant-in-Aid for Scientific Research (C) (2007,#19590582) from the Japanese Ministry of Education,Science,Sports and Culture
文摘AIM:To determine the effects of genetic variants associated with gallstone formation and capsaicin (a pungent component of chili pepper) metabolism on the risk of gallbladder cancer (GBC).METHODS: A total of 57 patients with GBC, 119 patients with gallstones, and 70 controls were enrolled in this study. DNA was extracted from their blood or paraffi n block sample using standard commercial kits. The statuses of the genetic variants were assayed using Taqman SNP Genotyping Assays or Custom Taqman SNP Genotyping Assays.RESULTS:The non-ancestral T/T genotype of apolipoprotein B rs693 polymorphism was associated with a decreased risk of GBC (OR:0.14,95% CI:0.03-0.63). The T/T genotype of cholesteryl ester transfer protein (CETP) rs708272 polymorphism was associated with an increased risk of GBC (OR:5.04,95% CI:1.43-17.8).CONCLUSION: Genetic variants involved in gallstone formation such as the apolipoprotein B rs693 and CETP rs 708272 polymorphisms may be related to the risk of developing GBC in Chilean women.
文摘Several risk factors,which include heredity,ultra-violet (UV) light and chronic inflammation,contribute to pterygium development.However,there is no report integrating these factors in the pathogenesis of pterygium.The aim of this review is to describe the connection between heredity,UV,and inflammation in pterygium development.Existing reports indicate that sunlight exposure is the main factor in pterygium occurrence by inducing growth factor production or chronic inflammation or DNA damage.Heredity may be a factor.Our studies on factors in pterygium occurrence and recurrence identify that heredity is crucial for pterygium to develop,and that sunlight is only a trigger,and that chronic inflammation promotes pterygium enlargement.We propose that genetic factors may interfere with the control of fibrovascular proliferation while UV light or(sunlight)most likely only triggers pterygium development by inducing growth factors which promote vibrant fibrovascular proliferation in predisposed individuals.It also just triggers inflammation and collagenolysis,which may be promoters of the enlargement of the fibrovascular mass.Pterygium probably occurs in the presence of exuberant collagen production and profuse neovascularisation.
文摘Basaloid squamous cell carcinoma （BSC） of the esophagus is a rare malignant disease. We report here a patient with recurrent esophageal BSC, who was successfully treated by systemic chemotherapy containing 5-fluorouracil （5-FU） and cisplatin （CDDP）. A 57-year-old woman was diagnosed as having SCluamous cell carcinoma of the esophagus upon endoscopic examination. Curative esophagectomy with lymph node dissection was performed under the thoracoscope. The pathological diagnosis of the surgical specimen was BSC. Five months after operation, the patient was diagnosed as having a recurrence of the BSC with metastases to the liver and spleen, and a right paraclavicular lymph node. She was given systemic chemotherapy consisting of continuous infusion of 800 mg/d of 5-FU and 3 h infusion of 20 mg/d of CDDP for 5 consecutive days every 4 wk. The metastatic lesions in the spleen and right paraclavicular lymph node disappeared, and the liver metastasis was apparently reduced in size after 2 courses of chemotherapy. The tumor regression was seen over 6 courses, with progression afterwards. Although subsequent treatment with CPT-11 and CDDP was not effective, docetaxel and vinorelbine temporarily controlled the tumor growth for 2 mo. 5-FU and CDDP combination may be useful for the patients with advanced BSC.
文摘AIM： To evaluate how proximal colon polyps interpreted as hyperplastic polyps in 2001 would be interpreted by expert pathologists in 2007.METHODS： ≥ 5 mm in interpreted pathologists 2007 by 3 GI Forty consecutive proximal colon polyps size, removed in 2001, and originally as hyperplastic polyps by general at Indiana University, were reviewed in pathologists.CONCLUSION： Many polyps interpreted as hyperplastic in 2001 were considered sessile serrated lesions by GI pathologists in 2007, but there is substantial inter-observer variation amongst GI pathologists.
文摘BACKGROUND Primary sclerosing cholangitis(PSC)associated inflammatory bowel disease(IBD)is a unique form of IBD(PSC-IBD)with distinct clinical and histologic features from ulcerative colitis(UC)and Crohn disease(CD).In patients with PSC and IBD,the severity of the two disease processes may depend on each other.AIM To study the histologic and clinical features of PSC patients with and without IBD.METHODS We assessed specimens from patients with UC(n=28),CD(n=10),PSC and UC(PSC-UC;n=26);PSC and CD(PSC-CD;n=6);and PSC and no IBD(PSC-no IBD;n=4)between years 1999-2013.PSC-IBD patients were matched to IBD patients without PSC by age and colitis duration.Clinical data including age,gender,age at IBD and PSC diagnoses,IBD duration,treatment,follow-up,orthotopic liver transplantation(OLT)were noted.RESULTS PSC-UC patients had more isolated right-sided disease(P=0.03),and less active inflammation in left colon,rectum(P=0.03 and P=0.0006),and overall(P=0.0005)compared to UC.They required less steroids(P=0.01)and fewer colectomies(P=0.03)than UC patients.The PSC-CD patients had more ileitis and less rectal involvement compared to PSC-UC and CD.No PSC-CD patients required OLT compared to 38%of PSC-UC(P=0.1).PSC-IBD(PSC-UC and PSCCD)patients with OLT had severe disease in the left colon and rectum(P=0.04).CONCLUSION PSC-UC represents a distinct form of IBD.The different disease phenotype in PSC-IBD patients with OLT may support liver-gut axis interaction,however warrants clinical attention and further research.
基金a grant from Chang Gung Memorial Hospital,No.CMRPG33074a grant from National Science Council,Taiwan
文摘AIM:To investigate the role of nuclear factor of activated T cell 2(NFAT2),the major NFAT protein in peripheral T cells,in sustained T cell activation and intractable inflammation in human ulcerative colitis(UC). METHODS:We used two-dimensional gel-electrophoresis, immunohistochemistry,double immunohistochemical staining,and confocal microscopy to inspect the expression of NFAT2 in 107,15,48 and 5 cases of UC, Crohn's disease(CD),non-specific colitis,and 5 healthy individuals,respectively. RESULTS:Up-regulation with profound nucleo- translocation/activation of NFAT2 of lamina propria mononuclear cells(LPMC)of colonic mucosa was found specifically in the affected colonic mucosa from patients with UC,as compared to CD or NC(P<0.001,Kruskal- Wallis test).Nucleo-translocation/activation of NFAT2 primarily occurred in CD8+T,but was less prominent in CD4+T cells or CD20+B cells.It was strongly associated with the disease activity,including endoscopic stage (τ=0.2145,P=0.0281)and histologic grade(τ=0.4167, P<0.001). CONCLUSION:We disclose for the first time the nucleo-translocation/activatin of NFAT2 in lamina propria mononuclear cells in ulcerative colitis.Activation of NFAT2 was specific for ulcerative colitis and highly associated with disease activity.Since activation of NFAT2is implicated in an auto-regulatory positive feedback loop of sustained T-cell activation and NFAT proteins play key roles in the calcium/calcineurin signaling pathways,our results not only provide new insights into the mechanism for sustained intractable inflammation,but also suggest the calcium-calcineurin/NFAT pathway as a new therapeutic target for ulcerative colitis.
基金Supported by National Cancer Institute of the National Institutes of Health,No. R37CA229810Biostatistics Core Facility at the H.Lee Moffitt Cancer Center and Research Institute,an NCI designated Comprehensive Cancer Center,No. P30-CA076292
文摘BACKGROUND Intraductal papillary mucinous neoplasms(IPMNs)are non-invasive pancreatic precursor lesions that can potentially develop into invasive pancreatic ductal adenocarcinoma.Currently,the International Consensus Guidelines(ICG)for IPMNs provides the basis for evaluating suspected IPMNs on computed tomography(CT)imaging.Despite using the ICG,it remains challenging to accurately predict whether IPMNs harbor high grade or invasive disease which would warrant surgical resection.A supplementary quantitative radiological tool,radiomics,may improve diagnostic accuracy of radiological evaluation of IPMNs.We hypothesized that using CT whole lesion radiomics features in conjunction with the ICG could improve the diagnostic accuracy of predicting IPMN histology.AIM To evaluate whole lesion CT radiomic analysis of IPMNs for predicting malignant histology compared to International Consensus Guidelines.METHODS Fifty-one subjects who had pancreatic surgical resection at our institution with histology demonstrating IPMN and available preoperative CT imaging were included in this retrospective cohort.Whole lesion semi-automated segmentation was performed on each preoperative CT using Healthmyne software(Healthmyne,Madison,WI).Thirty-nine relevant radiomic features were extracted from each lesion on each available contrast phase.Univariate analysis of the 39 radiomics features was performed for each contrast phase and values were compared between malignant and benign IPMN groups using logistic regression.Conventional quantitative and qualitative CT measurements were also compared between groups,viaχ2(categorical)and Mann Whitney U(continuous)variables.RESULTS Twenty-nine subjects(15 males,age 71±9 years)with high grade or invasive tumor histology comprised the"malignant"cohort,while 22 subjects(11 males,age 70±7 years)with low grade tumor histology were included in the"benign"cohort.Radiomic analysis showed 18/39 precontrast,19/39 arterial phase,and 21/39 venous phase features differentiated malignant from benign IPMNs(P<0.05).Multivariate analysis including only ICG criteria yielded two significant variables:thickened and enhancing cyst wall and enhancing mural nodule<5 mm with an AUC(95%CI)of 0.817(0.709-0.926).Multivariable post contrast radiomics achieved an AUC(95%CI)of 0.87(0.767-0.974)for a model including arterial phase radiomics features and 0.834(0.716-0.953)for a model including venous phase radiomics features.Combined multivariable model including conventional variables and arterial phase radiomics features achieved an AUC(95%CI)of 0.93(0.85-1.0)with a 5-fold cross validation AUC of 0.90.CONCLUSION Multi-phase CT radiomics evaluation could play a role in improving predictive capability in diagnosing malignancy in IPMNs.Future larger studies may help determine the clinical significance of our findings.
文摘AIM:To find a new concept to show whether or not apoptosis of retinal ganglion cells(RGCs)canbe determined in the histology of acute hyperglycemia in the role of expressed Brn3b gene related to nitric oxide(NO),caspase-3,nuclear factor kappa-B(NF-κB),and tumor necrosis factor-α(TNF-α)as an early predictor of primary open angle glaucoma(POAG)eyes and their associations.METHODS:Experimental in vivo study was carried out using adult male,white Sprague-Dawley rats aged≥2 mo,weighing 150-200 g.The animals were divided into two groups,one group receiving intraperitoneal injection of streptozotociz 50 mg/kg in 0.01 mol/L citricbuffer and p H 4.5 and a comparison made with the control group.Retinal tissue was divided into two parts(both experimental and control groups respectively):a)right retina for immunohistochemistry(IHC;caspase-3 and TNF-α);b)left retina was divided into two parts for the purpose of real-time polymerase chain reaction(PCR)test(RNA extraction for Brn3b gene expression analysis)and ELISA test(NO and NF-κB).RESULTS:The experimental group showed a decrease in Brn3b gene expression compared to the control group(1.3-fold lower in 2nd month;1.1-fold lower in 4th month and 2.5-fold lower in 6th month).However,there was a decrease of NO,caspase-3,and an increase of NF-κB and TNF-αquantity.CONCLUSION:The expression of m RNA Brn3b gene is inversely proportional to apoptosis in RGCs.The quantity of NO,caspase-3,NF-κB and TNF-αis influential in expression of Brn3b in RGCs caused by hyperglycemia in diabetic rats.
文摘BACKGROUND Reactive lymphoid hyperplasia(RLH)of the liver is a rare liver lesion.It is considered difficult to differentiate radiologically from hepatocellular carcinoma,metastatic liver tumor and other pathologies.CASE SUMMARY A 54-year-old woman presented to our hospital with RLH of the liver.The patient had a diagnosis of metastatic carcinoma of the liver from an unknown origin and subsequently underwent partial hepatectomy.However,histopathological analysis revealed RLH.The lesion showed perinodular enhancement in the arterial phase on contrast-enhanced computed tomography and magnetic resonance imaging.On diffusion-weighted imaging(DWI),we encountered linear hyperintensity along the portal tract consecutive to the liver lesion,which is a new characteristic radiologic finding.This finding corresponded to the lymphoid cell infiltration of the portal tract.Furthermore,there was strongly restricted diffusion on the apparent diffusion coefficient map.We used these characteristic radiologic findings to diagnose the lesion as a lymphoproliferative disease.CONCLUSION The linear hyperintensity consecutive to the liver lesion on DWI provided additional valuable diagnostic information.
文摘AIM:To compare the sensitivity and specificity of CDX2 and alcian blue(AB) p H 2.5 staining in identifying esophageal intestinal metaplasia.METHODS:One hundred and ninty-nine biopsies from 186 patients were retrospectively reviewed and categorized as Barrett's esophagus(BE)(n =108); non-Barrett's esophagus(NBE)(n =48); columnar blue cells(CB) and esophageal glands(EG)(n =43).The biopsies were stained with AB and immunostained for CDX2 using a mouse monoclonal antibody from Biogenex(clone CDX2-88) and the Ventana Discovery X automated immunostainer.The positive and negative predictive value of each group was used to determine the predictive power of CDX2 and AB in diagnosing intestinal metaplasia.RESULTS:All of the 108 BE biopsies(100%) were positive for AB and 102 of them(94.4%) were positive for CDX2.The six BE patients(5.6%) who failed to stain with CDX2 were found to have lost the focus of intestinal metaplasia upon deeper sectioning for immunostaining.Both AB and CDX2 were negative in 43 out of 48(89.6%) NBE cases.Five NBE patients(10.4%) were falsely positive for AB due to the presence of EG and CB in these biopsies.These cases were all CDX2 negative.In addition,5 AB negative NBE were found to be CDX2 positive.Based on these results the CDX2 immunostain had similar sensitivity but higher specificity(100% vs about 91%) than AB in detecting intestinal type metaplasia in these samples.Our data shows that CDX2 has a better PPV in detecting intestinal metaplasia as compared to AB(95.6% vs 71.5%,respectively).CONCLUSION:CDX2 has a better positive predictive value than AB in detecting intestinal metaplasia.CDX2may be useful when challenged by gastro-esophageal biopsies containing mimikers of BE.
