Role of pancreatic juice cytology in diagnosis of high-grade pancreatic intraepithelial neoplasia

High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.

Clinical profile and outcomes of ocular surface squamous neoplasia at the Philippine General Hospital:a retrospective study

AIM:To evaluate the demographics,clinical characteristics,treatments,and outcomes of patients with ocular surface squamous neoplasia(OSSN)at the Philippine General Hospital.METHODS:This was a single-center,11-year retrospective,cross sectional case series on 18 cases of OSSN seen between January 2012 to June 2023.The patient’s demographics,presenting symptoms,tumor characteristics,histopathologic diagnosis,treatment,outcomes,and duration of follow-up were reviewed.RESULTS:Out of 33 identified cases of OSSN,only 18 were eligible for inclusion in the study.Mean age was 60.78y(range 31 to 80),with male predominance(66.67%).The left eye was most commonly affected(61.11%)with most presenting with fleshy mass(83.33%).Most tumors were located nasally(66.67%)and were predominantly papilliform(44.44%)in morphology with associated hyperpigmentation(38.89%).Squamous cell carcinoma(SCCA)was the most common histopathologic diagnosis(72.22%).The main primary treatment was surgical excision(94.44%)with or without adjunctive therapy,with only 1 patient undergoing first-line topical chemotherapy.Only 3 recurrences(16.67%)were noted with a median followup of 7.5mo.A statistically significant recurrence-free odds leaning towards the utilization of cryotherapy was noted.CONCLUSION:OSSN seen at the Philippine General Hospital is presented as a limbal papilliform mass,most commonly affecting elderly males.Surgical excision with adjuvant cryotherapy and/or chemotherapy is the preferred mode of treatment.

Multiple endocrine neoplasia type 1:Early diagnosis is very important

In this manuscript,we comment on a recent publication by Yuan et al.This article provides a detailed scientific diagnostic process for a multiple endocrine neo-plasia type 1 patient,thus offering strong guidance for clinical practice.However,we believe that the authors should also provide information on the patient's long-term prognosis.

Multimodal artificial intelligence system for detecting a small esophageal high-grade squamous intraepithelial neoplasia: A case report

BACKGROUND Recent advancements in artificial intelligence(AI)have significantly enhanced the capabilities of endoscopic-assisted diagnosis for gastrointestinal diseases.AI has shown great promise in clinical practice,particularly for diagnostic support,offering real-time insights into complex conditions such as esophageal squamous cell carcinoma.CASE SUMMARY In this study,we introduce a multimodal AI system that successfully identified and delineated a small and flat carcinoma during esophagogastroduodenoscopy,highlighting its potential for early detection of malignancies.The lesion was confirmed as high-grade squamous intraepithelial neoplasia,with pathology results supporting the AI system’s accuracy.The multimodal AI system offers an integrated solution that provides real-time,accurate diagnostic information directly within the endoscopic device interface,allowing for single-monitor use without disrupting endoscopist’s workflow.CONCLUSION This work underscores the transformative potential of AI to enhance endoscopic diagnosis by enabling earlier,more accurate interventions.

小尺寸CT试样断裂行为的GTN细观损伤模型研究

基于国产A508-Ⅲ钢的单轴拉伸测试,构建了Ramberg-Osgood力学本构模型和GTN(Gurson-Tvergaard-Needleman)细观损伤模型,并对模型参数进行了标定,开展了不同温度下小尺寸CT(1/6CT)试样的断裂韧性测试,采用规则化方法计算得到裂纹扩展阻力曲线(J-R曲线),分析了测试温度对材料断裂性能的影响。结果表明,随着温度从-100℃度降低至-130℃,断口韧窝区的宽度由43μm缩减至10μm,平均韧窝尺寸从0.3μm缩小至0.05μm,材料的塑性变形能力随着温度的降低而脆化。基于构建的力学本构模型和GTN细观损伤模型,采用有限元法分析了1/6CT试样从裂纹萌生、扩展至失效断裂的过程。结果表明,J-R曲线随着温度的下降而降低,断裂韧性(J_(IC)值)和裂纹扩展量(Δa)的降幅分别为43%和3%,相对误差不超过5%。这表明,基于GTN细观损伤模型的数值方法是研究小尺寸CT试样断裂行为的一种简便、有效的方法。

15-15Ti奥氏体不锈钢热老化小尺寸试样单轴拉伸行为的GTN微观损伤模型研究

通过加速热老化试验模拟了15-15Ti奥氏体不锈钢的辐照效应,构建了Ramberg-Osgood力学本构模型和GTN(Gurson-Tvergaard-Needleman)微观损伤模型。结合有限元方法,探讨了热老化不同时间的15-15Ti奥氏体不锈钢小尺寸试样在不同温度拉伸试验过程中的应力-应变响应行为和损伤断裂过程。结果表明:热老化小尺寸试样中有少量碳化物析出和大量σ相形成,导致其抗拉强度和屈服强度显著下降;未热老化试样的拉伸断口中有大量韧窝,为韧性断裂,而热老化试样的拉伸断口中韧窝数量明显减少,析出相周围有撕裂棱,为脆性断裂;热老化试样标距段的应力集中和颈缩均延迟发生;热老化试样的断裂应变明显小于未热老化试样;热老化能促使小尺寸试样中孔洞的聚集和增多,从而加速失效。

DP780双相钢剪切修正GTN模型损伤参数确定

目的为了准确预测DP780双相钢在低应力三轴度时出现的剪切断裂,建立了损伤参数与断裂时载荷和位移的响应面模型,并根据此模型研究损伤参数变化对双相钢剪切断裂的影响,得到最佳损伤参数,以提高预测双相钢发生断裂的精确性。方法以DP780为研究对象,建立了剪切修正GTN模型,以孔洞体积分数fN、孔洞形核时平均应变εN、剪切系数kw为因素,分别以断裂时载荷和位移为响应值,基于试验设计得到对应的响应函数,并在此基础上建立误差评价函数,通过最小二乘法对误差评价函数进行求解得到最佳损伤参数。结果建立了基于断裂载荷和位移的误差评价函数,在此基础上结合试验验证,确定fN=0.025、εN=0.198、kw=2是最佳损伤参数组合。孔洞体积分数和剪切系数对断裂影响较大,随着孔洞体积分数fN的增大,发生断裂时的载荷减小,随着剪切系数kw的增大,发生断裂时的位移缩短。结论基于Abaqus软件,建立了剪切试样有限元模型并对其进行断裂仿真,断裂时平均减薄率为1.4%,与断裂试验结果吻合,表明了获得的损伤参数的准确性,为双相钢在车身结构件中的生产应用提供理论依据。

Early detection of multiple endocrine neoplasia type 1: A case report

BACKGROUND Multiple endocrine neoplasias(MENs)are a group of hereditary diseases invol-ving multiple endocrine glands,and their prevalence is low.MEN type 1(MEN1)has diverse clinical manifestations,mainly involving the parathyroid glands,gastrointestinal tract,pancreas and pituitary gland,making it easy to miss the clinical diagnosis.CASE SUMMARY We present the case of a patient in whom MEN1 was detected early.A middle-aged male with recurrent abdominal pain and diarrhea was admitted to the hos-pital.Blood tests at admission revealed hypercalcemia and hypophosphatemia,and emission computed tomography of the parathyroid glands revealed a hy-perfunctioning parathyroid lesion.Gastroscopy findings suggested a duodenal bulge and ulceration.Ultrasound endoscopy revealed a hypoechoic lesion in the duodenal bulb.Further blood tests revealed elevated levels of serum gastrin.Surgery was performed,and pathological analysis of the surgical specimens revealed a parathyroid adenoma after parathyroidectomy and a neuroendocrine tumor after duodenal bulbectomy.The time from onset to the definitive diagnosis of MEN1 was only approximately 1 year.CONCLUSION For patients who present with gastrointestinal symptoms accompanied by hyper-calcemia and hypophosphatemia,clinicians need to be alert to the possibility of MEN1.

C634Y mutation in RET-induced multiple endocrine neoplasia type 2A:A case report

BACKGROUND Multiple endocrine neoplasia type 2(MEN2)is a rare,autosomal dominant endocrine disease.Currently,the RET proto-oncogene is the only gene implicated in MEN2A pathogenesis.Once an RET carrier is detected,family members should be screened to enable early detection of medullary thyroid carcinoma,pheochromocytoma,and hyperparatitity.Among these,medullary thyroid carcinoma is the main factor responsible for patient mortality.Accordingly,delineating strategies to inform clinical follow-up and treatment plans based on genes is paramount for clinical practitioners.CASE SUMMARY Herein,we present RET proto-oncogene mutations,clinical characteristics,and treatment strategies in a family with MEN2A.A family study was conducted on patients diagnosed with MEN2A.DNA was extracted from the peripheral blood of family members,and first-generation exon sequencing of the RET protooncogene was conducted.The C634Y mutation was identified in three family members spanning three generations.Two patients were sequentially diagnosed with pheochromocytomas and bilateral medullary thyroid carcinomas.A 9-yearold child harboring the gene mutation was diagnosed with medullary thyroid carcinoma.Surgical resection of the tumors was performed.All family members were advised to undergo complete genetic testing related to the C634Y mutation,and the corresponding treatments administered based on test results and associated clinical guidelines.CONCLUSION Advancements in MEN2A research are important for familial management,assessment of medullary thyroid cancer invasive risk,and deciding surgical timing.

基于GTN模型的2195铝锂合金板材反复弯曲成形特性及变形损伤

以商用2195-T6铝锂合金板材为研究对象,借助单向拉伸试验,获得了其真应力-真应变曲线;以此为基础,建立了能够表征2195铝锂合金变形损伤的GTN模型和反复弯曲成形的数值仿真模型,对反复弯曲成形过程中弯曲次数和压下量对板材的回弹和损伤特征的影响进行分析,并通过试验验证了反复弯曲对回弹的影响。结果表明:在单次弯曲变形中,随着弯曲压下量的增加,塑性弯曲变形区逐渐增大;当压下量大于临界值时,随着压下量的增加,回弹量逐渐减小。在相同的压下量条件下,随着弯曲次数增加,板材的塑性变形区逐渐增加,回弹量逐渐减小;但是随着弯曲次数的增加,板材的损伤逐渐增大,因此,通过反复弯曲成形抑制弯曲回弹需要将板材的内部损伤控制在许可范围内。

新型铝合金材料GTN损伤本构参数标定

基于某新型铝合金材料,设计了圆棒和平板试件,利用电子万能拉伸机对其进行动态单轴拉伸实验。基于GTN损伤本构模型,利用ABAQUS软件对损伤参数演化过程进行仿真分析,揭示了损伤参数对载荷-位移曲线变化趋势及材料断裂时刻的影响规律;基于圆棒拉伸实验,利用中心复合实验设计和反向优化法,标定该新型铝合金GTN损伤本构模型各损伤参数,即初始孔洞体积分数值为0.0015,孔洞形核体积分数为0.02,临界孔洞体积分数为0.15,完全断裂孔洞体积分数为0.25。利用标定的GTN损伤本构参数对平板试件失效断裂过程及断裂位置进行仿真与实验,结果表明实验与仿真载荷-位移曲线吻合良好。

Characteristics and risk factor analyses of high-grade intraepithelial neoplasia in older patients with colorectal polyps

BACKGROUND According to the degree of intradermal neoplasia in the colorectal exhalation,it can be divided into two grades:Low-grade intraepithelial neoplasia(LGIN)and high-grade intraepithelial neoplasia(HGIN).Currently,it is difficult to accurately diagnose LGIN and HGIN through imaging,and clinical diagnosis depends on postoperative histopathological diagnosis.A more accurate method for evaluating HGIN preoperatively is urgently needed in the surgical treatment and nursing intervention of colorectal polyps.AIM To explore the characteristics and risk factors of HGIN in older patients with colorectal polyps.METHODS We selected 84 older patients diagnosed with HGIN as the HGIN group(n=95 colonic polyps)and 112 older patients diagnosed with LGIN as the LGIN group(n=132 colonic polyps)from Shandong Provincial Hospital Affiliated to Shandong First Medical University.The endoscopic features,demographic characteristics,and clinical manifestations of the two patient groups were compared,and a logistic regression model was used to analyze the risk factors for HGIN in these patients.RESULTS The HGIN group was older and had a higher number of sigmoid colon polyps,rectal polyps,pedunculated polyps,polyps≥1.0 cm in size,polyps with surface congestion,polyps with surface depression,and polyps with villous/tubular adenomas,a higher proportion of patients with diabetes and a family history of colorectal cancer,patients who experienced rectal bleeding or occult blood,patients with elevated carcinoembryonic antigen(CEA)and cancer antigen 199(CA199),and lower nutritional levels and higher frailty levels.The polyp location(in the sigmoid colon or rectum),polyp diameter(≥1.0 cm),pathological diagnosis of(villous/tubular adenoma),family history of colorectal cancer,rectal bleeding or occult blood,elevated serum CEA and CA199 levels,lower nutritional levels and higher frailty levels also are independent risk factors for HGIN.CONCLUSION The occurrence of high-grade neoplastic transformation in colorectal polyps is closely associated with their location,size,villous/tubular characteristics,family history,elevated levels of tumor markers,and lower nutritional levels and higher frailty levels.

Pregnancy and Obstetrical Outcomes Following Treatment for Cervical Intra-Epithelial Neoplasia (CIN) in Two Hospitals of a Low-Resource Country

Objective: In Cameroon, more than 80% of women suffering from cervical intraepithelial neoplasia (CIN) are within the reproductive age. This study intended to analyze the pregnancy outcomes following cervical treatment in Cameroon. Methods: This was a cohort study with two years retrospective data collection involving 82 women who underwent cervical treatment for CIN in two Cameroonian hospitals from January 2015 to December 2017. Data were collected from CIN treatment to end of pregnancy where applicable. Data analysis was done using Epi Info software version 3.5.4. Results: We collected data from 82 patients aged 27 to 48 years, with a mean age of 36.5 (SD: 5.3) years. During the study period, 33 out of 82 participants became pregnant 40.2 [29.56 - 51.66]%. The factor associated with pregnancy occurrence after treatment was age less than 35 years (Odds ratio = 4.37 [1.7 - 11.2]. From the 33 pregnancies recorded, 17 (51.5%) ended in a delivery, amongst which 15 (88.2%) were vaginal. Conclusion: Pregnancy frequency over two years following cervical treatment for CIN was relatively good, and younger women (age 35 years) were significantly more like to have conceived compared to their older counterparts. Post-treatment delivery outcomes seem to be similar to those in the general population.

Improving early diagnosis of multiple endocrine neoplasia type 1 by assessing the gastrointestinal symptoms,hypercalcemia,and elevated serum gastrin

Despite advancements in the field,early diagnosis of multiple endocrine neoplasia type 1(MEN1)remains unachievable.This letter to the editor highlighted the importance of carefully assessing gastrointestinal symptoms,hypercalcemia,and elevated serum gastrin levels,as suggested by Yuan et al in their paper.They focused on a patient with recurrent abdominal pain and diarrhea whose diagnostic path led to establishing a MEN1 diagnosis within a year.This emphasized the need for clinicians to consider MEN1 in patients with similar presentations,particularly when gastrointestinal symptoms persist or recur after discontinuation of proton pump inhibitors,especially knowing that early recognition and intervention are crucial for improving patient outcomes.

Adverse Pregnancy Outcomes Following Cryotherapy, Thermal Ablation and Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia Treatment: A Pilot Study among Zambian Women

Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who according to literature may be at risk of adverse pregnancy outcomes. This pilot study is part of a study investigating adverse pregnancy outcomes among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443 treated and n = 443 untreated) women aged 15 - 49 years. The women were either screened with Visual Inspection with Acetic Acid or treated for Cervical Intraepithelial neoplasia at the Adult Infectious Disease Centre between January 2010 and December 2020. Women meeting the criteria were identified using the Visual Inspection with Acetic Acid screening records and telephone interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA version 16 to determine the prevalence and obtain frequency distribution of outcomes of interest. Univariate and multivariable binary logistic regression estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were observed to be more prevalent in the treatment group (18.5%) compared to the untreated group (5.4%). Normal pregnancy outcomes were lower in the treated (46.3%;n = 443) than the untreated (53.7%;n = 443). The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority of still births (72.7%). Women treated with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003) had two-, six- and ten-times higher odds of adverse pregnancy outcomes respectively, relative to women who required no treatment. Conclusion: Adverse pregnancy outcomes are prevalent among women who have received treatment in Zambia. The findings indicate that treating Cervical Intraepithelial Neoplasia has been linked to higher chances of experiencing abortion, delivering low birth weight babies and enduring prolonged labor that may result in a caesarean section delivery. Cervical neoplasia treatments, particularly Loop Electrosurgical Excision Procedure, are associated with significantly increased odds of adverse pregnancy outcomes. It is essential to include information about prior Cervical Intraepithelial neoplasia treatment outcomes in obstetric care.

Molecular diagnostic approaches in detecting rearranged during transfection oncogene mutations in multiple endocrine neoplasia type 2

Different types of neuroendocrine cancer,including medullary thyroid cancer(MTC)and thyroid C-cell hyperplasia,are part of multiple endocrine neoplasia type 2(MEN2).A proto-oncogene mutation of the rearranged during transfection(RET)gene changes the way that receptor tyrosine kinases work.Multiple endocrine neoplasia,a pathological condition,involves these kinases.When the RET protooncogene changes,it can cause endocrine adenomas and hyperplasia to happen at the same time or one after the other.Pheochromocytoma,medullary thyroid carcinoma,and hyperparathyroidism,alone or in combination,are present in MEN2A patients.Some patients may also have skin lichen amyloidosis or Hirschsprung's disease.Patients with MEN2A often present with MTC.MTC is aggressive and has the worst prognosis,as most patients exhibit lymph node metastasis.MTC is one of the important causes of death in patients with MEN2A.RET mutation analysis aids in identifying MEN2A symptoms and monitoring levels of calcium,thyroid hormones,calcitonin,normetanephrine,fractionated metanephrines,and parathyroid hormone.The earlier diagnosis of MTC significantly improves survival and prompts better management of MEN2A.In this editorial,we will discuss the significance of molecular diagnostic approaches in detecting RET oncogene mutations in MEN2A.

剪切修正GTN模型在小冲杆试验中的应用研究

小冲杆试验作为一种非标准的微试样测试技术,能有效地获取薄板结构的材料参数。而选用合适的损伤模型对准确表征材料变形到断裂的整个过程有着重要影响。基于NAHSHON提出的含剪切修正项的Gurson-Tvergaard-Needleman(GTN)模型,通过有限元软件ABAQUS及用户自定义子程序VUMAT考察不同应力三轴度对断裂失效的影响。采用有限元模拟和拉伸试验获得冷轧硅钢材料的无损伤弹塑性力学参数以及GTN损伤演化模型中的形核参数和临界断裂参数,通过纯剪切试验和数值模拟的对比确定出材料中微孔洞的剪切变形对材料损伤演化的贡献。运用剪切修正的GTN模型对小冲杆试验进行模拟,结果表明,由于修正GTN模型考虑了微孔洞剪切畸变的对材料损伤影响,模拟结果比原GTN模型更接近于试验数据,可更好地应用于小冲杆试验的研究。

基于GTN模型的20钢孔洞扩张比数值模拟

孔洞扩张比VG可以作为描述钢材损伤时微孔洞演化情况的细观损伤变量,GTN模型可用于金属塑性材料的细观损伤有限元模拟。应用GTN模型模拟20钢圆棒型缺口试件拉伸过程的不同阶段,得到细观损伤参量应力三轴度Rσ、等效塑性应变εp、孔洞体积百分数f及孔洞扩张比VG在试件中心截面的变化规律。结果表明:在整个拉伸过程中,上述参数的数值随着载荷的增加而增大,且εp对VG的影响较大。当试件断裂时,试件缺口截面中心位置的细观损伤参量值大于缺口根部的值,此时20钢的临界孔洞扩张比VGC为3.134。

基于响应面法剪切修正GTN模型损伤参数的确定

采用Nahshon-Hutchinson剪切修正GTN损伤模型对小冲杆试验进行有限元仿真。以硅钢板为研究对象,基于有限元仿真和因子试验设计方法,研究了损伤演化参数对小冲杆试验载荷-位移曲线的影响程度,得出影响模拟准确性的关键参数为fN、εN、ks,并应用响应曲面法确定了这些参数的取值;断裂参数fc、fF以小冲杆试验载荷-位移曲线模拟和实验结果对比的方法进行标定。最后,基于不同厚度的小冲杆试样进行实验和模拟结果对比,验证了所确定参数的有效性。

基于试验与模拟的修正GTN模型参数反求分析

设计6种不同应力三轴度的试样,进行拉伸试验并得到不同工况下的载荷-位移曲线.运用Voce+Voce流动应力模型外推拉伸试验数据得到材料的力学性能曲线.运用有限元软件ABAQUS/Explicit模块及用户子程序VUMAT将Nahshon提出的含剪切修正项的GTN(Gurson-Tvergaard-Needlemen)模型应用到有限元模拟中,研究各组试样的损伤演化和断裂过程.为使GTN模型更准确地应用到不同应力状态下,假定损伤参数εn为关于应力三轴度η的指数函数.运用反求法分析不同缺口半径的拉伸试验,确定GTN模型中面向高应力三轴度情况的损伤参数,同时结合数值模拟与剪切试验的对比确定剪切系数Kw.结果表明,确定的修正GTN模型参数可以应用到较宽的应力三轴度范围包括纯剪状态.