Endoscopic ultrasound-guided fine needle aspiration in the differentiation of type 1 and type 2 autoimmune pancreatitis

AIM:To investigate the usefulness of endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) in the differentiation of autoimmune pancreatitis(AIP).METHODS:We retrospectively reviewed 47 of 56 AIP patients who underwent EUS-FNA and met the Asian diagnostic criteria.On 47 EUS-FNA specimens,we evaluated the presence of adequate material and characteristic features of lymphoplasmacytic sclerosing pancreatitis(LPSP) and idiopathic duct-centric pancreatitis(IDCP) mentioned in the International Consensus Diagnostic Criteria and examined if these findings make a contribution to the differential diagnosis of type 1 and type 2 AIP.A disposable 22-gauge needle was used for EUS-FNA.RESULTS:Adequate specimens including pancreatic tissue for differentiating AIP from cancer were obtained from 43 of 47 patients who underwent EUSFNA.EUS-FNA was performed from the pancreatic head in 21 cases,which is known to be technically difficult when performed by core biopsy;there was no significant difference in the results compared with pancreatic body-tail.Nine of 47 patients met level 1 findings of LPSP and 5 patients met level 2 findings of LPSP.No one met level 1 findings of IDCP,but 3 patients met level 2 findings of IDCP.Of 10 seronegative cases,2 cases were diagnosed with "definitive type 1 AIP",and 3 cases were diagnosed with "probable type 2 AIP" when considering both the level 2 histological findings and response to steroids.CONCLUSION:EUS-FNA is useful in the differentiation of type 1 and type 2 AIP,particularly in seronegative cases.

Differences in Body Composition and Physical Fitness in Elderly Men and Women

The aim of this study was to determine differences in body composition and physical fitness in elderly men and women. Five hundred twenty six subjects were included in this study, 272 were men （52%） and 254 women （48%）. To determine the trend of changes of anthropometric parameters and physical fitness in people aged over 60, the authors were divided subjects in 5 age groups： 60-64, 65-69, 70-74, 75-79 and over 80 years of age. Decrease in strength is observed with the aging process so that the respondents aged 60-64 years significantly differ in the strength of the lower extremities of elderly subjects 70-74 and 75-79 years of age. Also this difference is noticeable if they compare with men and women. In this study, they found that there was an increase in the amount of adipose tissue, reducing the level of muscle activity and decreased muscle strength and endurance of the aging process.

Spontaneous regression of pancreatic cancer: Real or a misdiagnosis?

Spontaneous tumor regression has been subject of numerous studies and speculations for many years. This phenomenon is exceptional, but well reported, in some types of tumors, but not in pancreatic cancer. Pancreatic cancer has the worst five-year survival rate of any cancer. Despite numerous molecular studies and clinical approaches, using several mouse models, this cancer responds poorly to the existing chemotherapeutic agents and progress on treatment remains elusive. Although pancreatic cancer tumors seldom undergo spontaneous regression, and some authors take that with skepticism, there are some cases reported in the literature. However, the variability in the description of the reports and technical details could make this process susceptible to misdiagnosis. Distinguishing between different types of pancreatic carcinoma should be taken with caution as they have wide differences in malignant potential. Diseases such as pancreatic benign tumors, insulinomas, or autoimmune pancreatitis could be responsible for this misdiagnosis as a pancreatic cancer. Here we review different cases reported, their clinical characteristics, and possible mechanisms leading to spontaneous regression of pancreatic cancer. We also discuss the possibilities of misdiagnosis.

Performance improvement of car body structure in 100% frontal impact

During the 100%front impact,all the parts of front car will participate in the course;the crash stiffness of bodywork will also reach the peak.During the crash,rational structure of bodywork can resist the distortion,absorb more energy and get better mode of distortion and low deceleration rate,so as to meet the performance of crash safety.The paper mainly makes optimization analysis based on the problems of front side rails,subframe,firewall,and optimization cases are confirmed which can decrease the intrusion and deceleration rate of the whole car.The structure of bodywork after optimization can meet the performance of crash safety.

数字交往论(2):元宇宙,分身与认识论

在混合现实(MR)中交往的人,因面对多重的感知、身份、行动和交往律而具有复杂的分身性;这种分身性,形成了数字交往与认知哲学的思想对话。1.数字传播建构了主体-介体融合的传播人,而虚拟交往则定义了人-物-实践融合的交往人,这是虚拟交往时代的认识论基础。2.在跨体系、变维、多分身的生存模式(MDSs)中,交往人的属性不止是技术具身:他有自我想象、又虚实相间,且其身份之间是可联结、可接替的。此即数字交往的分身性。3.分身性的认识论意义在于:交往人对世界的认识,是一与多、虚拟与现实、先验与后验的统一,也因此成为一种调谐与演化的生成。4.分身认知试图丰富演化主义的元认知,为数字交往提供更具解释力的后现象学结论。

COL4A3 mutations cause focal segmenta glomerulosclerosis

Focal segmental glomerulosclerosis （FSGS） is a histologically identifiable gtomerular injury often leading to proteinuria and renal failure. To identify its causal genes, whole-exome sequencing and Sanger sequencing were performed on a large Chinese cohort that comprised 40 FSGS families, 50 sporadic FSGS patients, 9 independent autosomal recessive Atport＇s syndrome （ARAS） patients, and 190 ethnically matched healthy controls. Patients with extrarenal manifestations, indicating systemic diseases or other known hereditary renal diseases, were excluded. Heterozygous COL4A3 mutations were identified in five （12.5%） FSGS families and one （2%） sporadic FSGS patient. All identified mutations disrupted highly conserved protein sequences and none of them was found in either public databases or the 190 healthy controls. Of the FSGS patients with heterozygous COL4A3 mutations, segmental thinning of the glomerular base membrane （GBM） was only detected in the patient with electronic microscopy examination results available. Five ARAS patients （55.6%） had homozygous or compound-heterozygous mutations in COL4.43 or COL4A4. Serious changes in the G BM, hearing loss, and ocular abnormalities were found in 100%, 80%, and 40% of the ARAS patients, respectively. Overall, a new sub- group of FSGS patients resulting from heterozygous C01.4A3 mutations was identified. The mutations are relatively frequent in famiUes diagnosed with inherited forms of FSGS. Thus, we suggest screening for C01.4A3 mutations in familial FSGS patients.