Pancreatic invasion is a prognostic indicator after radical resection for carcinoma of the ampulla of Vater

Sixty-three patients who had undergone pancreatoduodenectomy for carcinoma of the ampulla of Vater were analyzed with respect to tumor extent and prognosis. The postoperative mortality rate was 3% and overall survival rates 3 and 5 years after surgery were 55% and 46%, respectively. pTNM stage did not reflect prognosis after resection in patients at stages 2 and 3, while pancreatic invasion and regional lymph node metastasis clearly reflected prognosis after resection. Of the 26 patients who had no pancreatic invasion, regional lymph node metastasis was seen in only 19%, whereas of the 37 patients with pancreatic invasion, 62% exhibited lymph node metastasis. These factors were significantly correlated (P<0.001). Pancreatic invasion appeared to be an indirect indicator of regional lymph node metastasis. We conclude that, to improve prognosis for patients with pancreatic invasion, extended resection including extended lymphadenectomy, is a preferable additional procedure.     

Japanese guidelines for adult asthma 2020

Bronchial asthma is characterized by chronic airway inflammation, which manifests clinically as variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma may induce airway remodeling and become intractable. The prevalence of asthma has increased; however, the number of patients who die from it has decreased (1.3 per 100,000 patients in 2018). The goal of asthma treatment is to control symptoms and prevent future risks. A good partnership between physicians and patients is indispensable for effective treatment. Long-term management with therapeutic agents and the elimination of the triggers and risk factors of asthma are fundamental to its treatment. Asthma is managed by four steps of pharmacotherapy, ranging from mild to intensive treatments, depending on the severity of disease; each step includes an appropriate daily dose of an inhaled corticosteroid, which may vary from low to high. Long-acting β₂-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonists are recommended as add-on drugs, while anti-immunoglobulin E antibodies and other biologics, and oral steroids are reserved for very severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β₂-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by selecting treatment steps for asthma based on the severity of the exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-exacerbated respiratory disease, and pregnancy are also important conditions to be considered in asthma therapy.     

Japanese guidelines for adult asthma 2017

Adult bronchial asthma is characterized by chronic airway inflammation, and presents clinically with variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma induces airway remodeling, leading to intractable asthma. The number of patients with asthma has increased; however, the number of patients who die of asthma has decreased (1.2 per 100,000 patients in 2015). The goal of asthma treatment is to enable patients with asthma to attain normal pulmonary function and lead a normal life, without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management by therapeutic agents and elimination of the causes and risk factors of asthma are fundamental to its treatment. Four steps in pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid, varying from low to high levels. Long-acting β₂-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonist are recommended as add-on drugs, while anti-immunoglobulin E antibody and oral steroids are considered for the most severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β₂-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by choosing treatment steps for asthma in accordance with the severity of exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-induced asthma, and pregnancy are also important issues that need to be considered in asthma therapy.     

Regenerative therapies in electrophysiology and pacing

The prevention and treatment of cardiac arrhythmias conferring major morbidity and mortality is far from optimal, and relies heavily on devices and drugs for the partial successes that have been seen. The greatest success has been in the use of electronic pacemakers to drive the hearts of patients having high degree heart block. Recent years have seen the beginnings of attempts to use novel approaches available through gene and cell therapies to treat both brady- and tachyarrhythmias. By far the most successful approaches to date have been seen in the development of biological pacemakers. However, the far more difficult problems posed by atrial fibrillation and ventricular tachycardia are now being addressed. In the following pages we review the approaches now in progress as well as the specific methodologic demands that must be met if these therapies are to be successful.     

改水、服硒、食用蓬灰防治大骨节病的效果观察

本实验应用改水、服硒、食用蓬灰等措施在大骨节病区对3～13岁儿童进行现场防治实验。用现患率、健康儿童新发率、X线痊愈率作为其判定指标。 通过四年的实验观察,现患率由1980年的46.40％下降到1984年的20.30％,有非常显著的差异。36名健康儿童连续四年观察未有新发病人,而对照组出现新发病例,取得了较好的防治效果。本文还对防治措施的作用进行了分析讨论。     

贮存式自体输血开展对优化妇科手术用血结构的影响

目的:总结本院2011-2013年贮存式自体输血开展前后,妇科手术用血异体少白细胞红细胞和自身贮血的应用情况。方法:对本院妇科手术台次,异体少白细胞红细胞及贮存式自体血液的使用人数、量及比例分别进行统计。结果:最近3年妇科手术台次逐年上升,异体少白细胞红细胞用量从463.5U下降至320.5U,自体输血量上升至161U。异体输血比例由手术人次的33.61%下降至19.80%,自体输血比例由0上升至22.61%。人均异体少白细胞红细胞使用量由0.783U下降至0.450U,人均自体全血用量由0上升至0.226U。结论:贮存式自体输血开展,使妇科手术用血结构得到优化,其对临床节约用血的影响,得到了规模性,量化体现。     

A long-term surviving patient with cancer of papilla of Vater after local resection

We report successful local resection for cancer of papilla of Vater in an 86-year-old woman. She was referred to our hospital because of right hypochondralgia. Abdominal ultrasonography and computed tomography showed marked dilatation of the common bile duct (CBD). Endoscopic retrograde cholangiography disclosed a small shadow defect in the terminal of the dilated CBD. Biopsy of the papilla revealed well-to-moderately differentiated adenocarcinoma. Considering her extreme old age and keeping in mind her quality of life after the operation, and the finding that the tumor was localized within the papilla and highly differentiated, we performed local resection. In addition, the intrapancreatic portion of the CBD and part of the main pancreatic duct (MPD) were further resected to secure a negative margin, confirmed by frozen section. The MPD was reapproximated to the duodenal mucosa and a choledocho-duodenostomy was performed for CBD reconstruction. Histopathological examination showed the tumor was papillary adenocarcinoma, 10 × 15 mm in size; there was no invasion beyond the sphincter of Oddi, it had partly infiltrated the CBD, but had not invaded to the pancreas or duodenum. The patient's postoperative course was not eventful and she has had good quality of life for the past 6 years since the operation, without any evidence of recurrence. Although radical pancreaticoduodenectomy is now the standard procedure in patients with malignant tumor of the papilla of Vater, local resection is a reasonable alternative for high-risk patients with highly differentiated, apparently localized carcinomas.     

The young-adult and normally aged brain. Its blood flow and oxidative metabolism. A review - part I

Blood flow and oxidative metabolism of the mature and healthy young-adult human brain account for about 20% of the cardiac output and about 20 and 25% of the requirements of oxygen and glucose, respectively, for the whole body. Normal cerebral aging is associated with only smaller reductions in the cerebral metabolic rates of oxygen and glucose while cerebral blood flow would seem to be unchanged. The age-dependent reduction in oxidative brain metabolism may be related to a decline in glycolytic flux due to a diminution of enzyme activities also involving acetylcholine synthesis. This metabolic reduction with age may be tentatively accounted for by a physiologically occurring loss of neurons, dendrites and dendritic spines in distinct brain areas. The mechanisms of autoregulation of cerebral blood flow, of CO₂ reactivity of the brain vessels, of arterial hypoxemia on cerebral blood flow and their effects on oxidative and energy metabolism are well documented in young-adult brain. There is, however, no or only minimal information on the responsiveness of the normally aged brain to changes of these important biological parameters controlling and influencing brain blood flow and metabolism.     

Influence of socio-demographic, clinical and functional factors on the severity of dementia

Dementia is one of the most relevant illnesses due to its functional impact on the elderly. The aim of the present study was to determine the influence of socio-demographic, clinical, cognitive and functional factors on the severity of dementia in elderly individuals. One hundred six elderly individuals with a diagnosis of dementia as determined by the DSM-IV/APA participated in the study. Cognition was assessed by the mini-mental state examination (MMSE); functional performance of basic and instrumental activities of daily living (BADLs and IADLs) was assessed by the Katz index (KI), Lawton-Brody index (LBI) and Pfeffer index (PI). The severity of dementia was established through the clinical dementia rating (CDR). In order to determine the influence of factors on the degree of dementia, ordinal regression analysis was performed. Age, MMSE, KI, LBI and PI scores had statistically significant associations to the severity of dementia. However, only the age (odds ratio (OR) = 0.197; confidence interval (CI) = 0.060-0.643) and performance in IADLs (LBI: OR = 1.237, CI = 1.077-1.422; PI: OR = 0.641, CI = 0.548-0.750) were maintained in the final ordinal regression model, R² = 0.818. The results show that elderly individuals over 80 years of age and those with a more compromised performance in IADLs have a greater chance of exhibiting more severe degrees of dementia. These findings suggest that the ability to perform IADLs may be an important variable in differentiating degrees of the severity of dementia.     

Recent results: biomarkers of aging

This communication reviews recent papers attempting to identify Biomarkers of Aging (BoA). A BoA is a biological parameter that will predict functional capability at some later age. Few, if any, BoA have been found and this review describes the recent search for BoA. Among others that have been put forward are IL6 and other markers of inflammation, allostatic load, and corticosterone, which have been described primarily in humans. Work in model systems as well as theoretical work are also reviewed.     

Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation

This paper considers the argument for obesity as a chronic relapsing disease process. Obesity is viewed from an epidemiological model, with an agent affecting the host and producing disease. Food is the primary agent, particularly foods that are high in energy density such as fat, or in sugar‐sweetened beverages. An abundance of food, low physical activity and several other environmental factors interact with the genetic susceptibility of the host to produce positive energy balance. The majority of this excess energy is stored as fat in enlarged, and often more numerous fat cells, but some lipid may infiltrate other organs such as the liver (ectopic fat). The enlarged fat cells and ectopic fat produce and secrete a variety of metabolic, hormonal and inflammatory products that produce damage in organs such as the arteries, heart, liver, muscle and pancreas. The magnitude of the obesity and its adverse effects in individuals may relate to the virulence or toxicity of the environment and its interaction with the host. Thus, obesity fits the epidemiological model of a disease process except that the toxic or pathological agent is food rather than a microbe. Reversing obesity will prevent most of its detrimental effects.     

德宏州 驻马店市报告的HIV/AIDS死亡病例的死因调查

目的了解云南省德宏州和河南省驻马店市艾滋病(HIV/AIDS)死亡原因构成。方法 2011年下半年,采用回顾性调查方法,利用定量的"艾滋病死亡原因调查表"获取调查对象相关信息。结果对2010年1月1日-2011年6月30日间云南省德宏州新报告的529死亡病例和河南省驻马店市新报告的631死亡病例进行调查,分别完成523例和627例,死亡病例接受高效抗反转录病毒治疗(HAART)的比例分别为28.7%和67.8%;艾滋病相关死亡病例所占比例分别为65.4%(342/523)和71.0%(445/627),艾滋病无关死亡病例所占比例分别为34.6%(181/523)和29.0%(182/627)。结论德宏州和驻马店市的艾滋病死亡病例的主要死因为艾滋病相关疾病。     

Endosonographic criteria for assessment of the depth of duodenal invasion in carcinoma of the papilla of Vater

Background: Imaging criteria by endosonography for assessment of the depth of duodenal invasion of carcinoma of the papilla of Vater (papilla carcinoma) have not been established. Methods: Twelve patients with papilla carcinoma were studied. The endosonographic findings were described in each case and depths were evaluated based on endosonographic images of the normal papilla and by comparison with endosonographic images of gastric carcinoma. The information was compared with the histopathological findings of the resected specimens. Results: Imaging criteria were proposed as follows: In d0 or T1, the papilla swelled preserving the basic structure; in d1 or T2, the papilla presented as a tumor but the non‐thickened duodenal fourth (proper muscle) layer was traceable behind the tumor; in d2 or T2, the papilla presented as a tumor fused with the thickened duodenal fourth layer; in d3 or T3–4, the papilla presented as a tumor and the duodenal fourth layer was partially or entirely untraceable behind the tumor. Accuracy of endosonography was 75% by the Japanese classification and 83.3% by the TNM system. Conclusions: Proposed endosonographic criteria are suitable for clinical application for assessing the depth of duodenal invasion of papilla carcinoma.     

Frailty and disability in the elderly: A diagnostic dilemma

Decreased reserves in multiple organ systems identify frailty syndrome in the elderly. However, its clinical diagnostic approach may be hard, particularly in patients with chronic diseases. The purpose of the study was to delineate the role of disability in the frailty syndrome in a group of hospitalized elderly people. A total of 150 consecutive patients (62 males/88 females), aged between 64 and 97 years and 1-2 days before hospital discharge, were submitted to several geriatric scales designed to assess disability and/or morbidity. All the geriatric scales used showed an elevated percentage of abnormal values both in females and in males. Nevertheless, the activities of daily living (ADL), instrumental activities of daily living (IADL), Tinetti balance index (TBI), Barthel index (BI) scores showed significantly better values in men than in women (p = 0.007, =0.02, =0.02 and =0.01, respectively). This preliminary cross-sectional study, underlines the fact that all geriatric tests employed have shown pathological scores, but those of the ADL, IADL, TBI and BI scores exploring disability were significantly better in males than in females. The mismatch between functional and morbidity tests seems to support the hypothesis that a disability state may be independent from morbidity.     

Fatal cerebral edema following angiocardiography: a case report

We describe a case of fatal reaction to angiocardiography following investigation of tetralogy of Fallot. This happening has occurred only once in 8300 procedures in our laboratory. It was due to cerebral edema. Although a recognized, but very rare, hazard following injection of contrast material, we found no way in our case of either predicting the outcome or its possible recurrence.     

TIMP-1和TIMP-2在原发性肝癌生长、浸润及转移中的作用

目的：了解基质金属蛋白酶组织抑制因子-1(tissue inhibitou of metalloproteinase-1，TIMP-1)和基质金属蛋白酶组织抑制因子-2(TIMP-2)mRNA及相关抗原在肝癌组织中的定位和表达状态，探讨TIMP-1和TIMP-2在肝癌组织生长、浸润及转移中所起的作用。方法：以TIMP-1和TIMP-2探针及单克隆抗体（McAb）为试剂，采用原位杂交技术及免疫组织化学法检测原发性肝癌、肝高分化腺癌的肝组织中TIMP-1和TIMP-2mRNA及相关抗原的表达，并与10例正常肝组织做对照。结果：20例原发性肝癌患者的肝组织中TIMP-1和TIMP-1mRNA及相关抗原表达的阳性率为90%;9例肝高分化腺癌的腺癌组织中无TIMP-1和TIMP-2mRNA及相关抗原的表达；10例正常肝组织中TIMP-1和TIMP-2mRNA及相关抗原表达均为阴性；TIMP-1和TIMP-2mRNA及相关抗原阳性信号呈现为棕黄色颗粒状，分布在肝细胞浆内，未见细胞核着色；无论是原发性肝癌癌组织还是癌周组织中,TIMP-1的表达强于TIMP-2的表达，癌周组织中TIMP-1和TIMP-2mRNA和相关抗原的表达与肝组织病理改变相关，即肝硬化者表达强，慢性肝炎者表达弱，正常肝组织无表达。结论：原发性肝癌的癌组织中存在TIMP-1和TIMP-2mRNA及相关抗原的表达，其表达强度可能与原发性肝癌的分型有关，它可能通过抑制MMP的活性使ECM降解减少从而阻止癌细胞通过基底膜移出而抑制肝癌细胞向周围浸润及转移。     

严重肺功能不全伴前列腺增生的临床治疗

目的探讨严重肺功能不全患者伴有前列腺增生的临床治疗。方法经尿道气化电切前列腺增生组织,测定患者肺功能及动脉血气分析。结果测定38例患者手术前后血气分析指标无显著差异(P>0.05);其中34例患者顺利通过围手术期,术后3例并发支气管肺炎,1例为肺不张。平均随访6月,无排尿梗阻症状。结论经尿道气化电切术适合治疗严重肺功能不全伴有前列腺增生患者。     

糖尿病Wistar大鼠腹腔内移植免疫隔离膜包囊S—D仔鼠胰岛研究

作者为解决组织移植中发生排异反应,研制了一种新的免疫隔离膜,在体外培养中,胰岛组织不断繁殖并分泌胰岛素。本文是在活体内考核其抗排异反应。在四氧嘧啶所引起的22只糖尿病Wistar大鼠腹腔内移植包囊sprague-Dawley仔鼠胰岛,观察其效果,其中20只完全缓解,完全缓解率达90％。有6只已观察至一年,血糖仍保持正常,上述效果比未包膜胰岛移植为好,在两种不同纯系大鼠间进行胰岛移植获得了较理想的效果。