Endoscopic ultrasound-guided fine-needle aspiration cytology in pancreaticobiliary carcinomas:diagnostic efficacy of cell-block immunocyto-chemistry

BACKGROUND： Endoscopic ultrasound-guided fine-needle aspiration cytology was demonstrated to be a useful tool for the diagnosis and staging of pancreaticobiliary neoplastic le- sions. Nonetheless, the diagnostic value of this procedure may be limited by low cellularity of the specimen, contamination of intestinal cells and unfeasibility of ancillary immunocy- tochemical procedures. The present study was to evaluate its usefulness in the diagnosis of neoplastic lesions.

Adhesion molecule and proinflammatory cytokine gene expression in hepatic sinusoidal endothelial cells following cecal ligation and puncture

INTRODUCTIONMultiple organ dysfunction syndrome (MODS) isthought to be a frequent consequence of sepsis[1-3].Despite substantial advances in our knowledge and understanding of the basic pathophysiologic mechanisms[4-7], in critically ill patients infections and sepsis are still associated with a high mortality[8,9].

Precise robust motion control of cell puncture mechanism driven by piezoelectric actuators with fractional-order nonsingular terminal slidingmode control

A novel robust controller is proposed in this study to realize the precise motion control of a cell puncture mechanism(CPM)driven by piezoelectric ceramics(PEAs).The entire dynamic model of CPM is constructed based on the Bouc–Wen model,and the nonlinear part of the dynamic model is optimized locally to facilitate the construction of a robust controller.A model-based,nonlinear robust controller is constructed using time-delay estimation(TDE)and fractional-order nonsingular terminal sliding mode(FONTSM).The proposed controller does not require prior knowledge of unknown disturbances due to its real-time online estimation and compensation of unknown terms by using the TDE technology.The controller also has finite-time convergence and high-precision trajectory tracking capabilities due to FONTSM manifold and fast terminal sliding mode-type reaching law.The stability of the closed-loop system is proved by Lyapunov stability theory.Computer simulation and hardware-in-loop simulation experiments of CPM verify that the proposed controller outperforms traditional terminal sliding mode controllers,such as the integer-order or model-free controller.The proposed controller can also continuously output without chattering and has high control accuracy.Zebrafish embryo is used as a verification target to complete the cell puncture experiment.From the engineering application perspective,the proposed control strategy can be effectively applied in a PEA-driven CPM.

Fine-needle aspiration cytology of an intrathyroidal nodule diagnosed as squamous cell carcinoma: A case report

BACKGROUND Both squamous cell carcinoma(SCC)and papillary thyroid carcinoma(PTC)are common malignant tumors in the neck.However,seldom has SCC of the thyroid been diagnosed.Further,cytological features of SCC and PTC have rarely been reported.The significance of fine-needle aspiration cytology(FNAC)in the diagnosis of neck masses has been established.Herein,we present an exceedingly rare case of an intrathyroidal SCC diagnosed using FNAC,along with its cytological features.CASE SUMMARY A 66-year-old man presented with a left-sided neck mass.Ultrasound examination showed an ill-defined nodule.The appearance was hypoechoic with a few hyperechoic spots.FNAC of the left thyroid nodule was performed.A cellular smear was obtained,and it showed a large number of neoplastic cells with rich cytoplasm and poor cell adhesion.Tumor cell nuclei showed coarse nuclear chromatin and a few enlarged prominent nucleoli.An increased nuclear/cytoplasm ratio was observed.Thus,malignancy was diagnosed without a confirmed tumor type.Percutaneous tumor biopsy was performed to make a definite diagnosis.The tumor cells showed typical squamous cell characteristics.CONCLUSION Head and neck SCC and PTC have different cytologies.Measures are needed to ensure accurate diagnosis using FNAC.

Value of thyroglobulin combined with ultrasound-guided fine-needle aspiration cytology for diagnosis of lymph node metastasis of thyroid carcinoma

BACKGROUND Surgery for thyroid carcinoma offers a good prognosis;however,cervical lymph node metastasis may occur in the early stage.An effective diagnostic method can accurately guide clinical surgical planning and the scope of lymph node dissection,ultimately improving patient prognosis.AIM To explore the diagnostic value of fine-needle aspiration of thyroglobulin(FNATg)combined with ultrasound(US)-guided fine-needle aspiration cytology for cervical lymph node metastasis in thyroid carcinoma.METHODS We enrolled 209 pathologically confirmed thyroid carcinoma patients who visited our hospital between Jan 2017 and Dec 2020.Patients were tentatively diagnosed with cervical lymph node enlargement using preoperative US.They underwent US-guided fine-needle aspiration cytology and FNA-Tg.The value of single and combined application of the two methods for the diagnosis of cervical lymph node metastasis was calculated.The factors affecting FNA-Tg for diagnosis were analyzed using univariate and multivariate methods.RESULTS FNA-Tg values were significantly higher among patients with positive cervical lymph node metastasis.The sensitivity and specificity of US-guided fine-needle aspiration cytology,FNA-Tg,and US-guided fine-needle aspiration cytology+FNA-Tg were 85.48%and 90.59%,83.06%and 87.06%,and 96.77%and 91.76%,respectively.The area under the receiver operating characteristic curve for USguided fine-needle aspiration cytology,FNA-Tg,and the two combined,was 0.880,0.851,and 0.943,respectively.A long diameter/short diameter ratio<2,an insufficient number of acquired cells,a low serum thyroglobulin level,and an absence of typical metastatic US features increased the risk of cervical lymph node metastasis in thyroid carcinoma patients misdiagnosed using FNA-Tg.CONCLUSION The diagnostic value of FNA-Tg for detecting cervical lymph node metastasis is not high;however,combined with US-guided fine-needle aspiration cytology,it is significantly improved.

穿刺垫棉绑缚法治疗浆细胞性乳腺炎脓肿的临床研究

[目的]评价穿刺垫棉绑缚法治疗浆细胞性乳腺炎脓肿的临床疗效及安全性。[方法]应用随机对照临床试验方法,共纳入患者72例,分为穿刺垫棉绑缚组和切开常规换药组两组,按2∶1进行分配,穿刺垫棉绑缚组纳入48例,采用穿刺抽脓后垫棉绑缚的方法治疗,切开常规换药组纳入24例,切开引流后根据疮口情况换药治疗,疗程均为8周,分别观察两组患者脓肿缩小程度、疼痛持续时间、视觉模拟评分(VAS)、乳房外形改善、换药次数、不良反应。[结果]穿刺垫棉绑缚组在脓肿缩小程度、乳房疼痛时间、VAS评分,乳房外形改善、换药次数方面与切开常规换药组相比,差异有统计学意义(P<0.05),未见明显不良反应。[结论]穿刺抽脓、垫棉绑缚法治疗浆细胞性乳腺炎脓肿临床有效,值得推广应用。

Strategic insights into the cultivation of pancreatic cancer organoids from endoscopic ultrasonography-guided biopsy tissue

BACKGROUND The frequent suboptimal efficacy of endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB)to culture pancreatic cancer(PC)organoids(PCOs)poses a major challenge in the advancement of personalized medicine for advanced PC.AIM To explore how to obtain appropriate puncture tissues from EUS-FNB and optimize the strategy for efficiently constructing PCOs,providing an efficient tool for the advancement of personalized medicine.METHODS Patients who underwent EUS-FNB for the diagnosis of PC tissue were prospectively enrolled.We refined the endoscopic biopsy procedures and organoid cultivation techniques.All tissue specimens verified by on-site pathological assessment were cultured in a semi-suspended medium in a microfluidic environment.We assessed differences in PCOs cultured beyond and below five generations examining patient demographics,specimen and organoid attributes,and the sensitivity of organoids to a panel of clinical drugs through cell viability assays.RESULTS In this study,16 patients with PC were recruited,one sample was excluded because onsite cytopathology showed no tumor cells.Successful organoid generation occurred in 93.3%(14 of 15)of the EUS-FNB specimens,with 60%(9 of 15)sustaining over five generations.Among these patients,those with a history of diabetes,familial cancer,or larger tumors exhibited enhanced PCO expandability.The key factors influencing longterm PCOs expansion included initial needle sample quality(P=0.005),rapid initiation of organoid culture postisolation(P≤0.001),and high organoid activity(P=0.031).Drug sensitivity analysis revealed a partial response in two patients following therapeutic intervention and surgery and stable disease in four patients,indicating a moderate correlation between organoid response and clinical outcomes.CONCLUSION Optimal initial needle sampling,rapid and precise biopsy sample processing,process isolated samples as soon as possible,and sufficient cellular material are crucial for successful cultivating PCOs.High organoid activity is an important factor in maintaining their long-term expansion,which is essential for shortening the time of drug sensitivity analysis and is the basis of PC research.

Stage IV malignant transformation of mature cystic teratoma palliatively treated with concurrent chemoradiotherapy:A case report

BACKGROUND Malignant transformation(MT)of mature cystic teratoma(MCT)has a poor prognosis,especially in advanced cases.Concurrent chemoradiotherapy(CCRT)has an inhibitory effect on MT.CASE SUMMARY Herein,we present a case in which CCRT had a reduction effect preoperatively.A 73-year-old woman with pyelonephritis was referred to our hospital.Computed tomography revealed right hydronephrosis and a 6-cm pelvic mass.Endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB)revealed squamous cell carci-noma.The patient was diagnosed with MT of MCT.Due to her poor general con-dition and renal malfunction,we selected CCRT,expecting fewer adverse effects.After CCRT,her performance status improved,and the tumor size was reduced;surgery was performed.Five months postoperatively,the patient developed dis-semination and lymph node metastases.Palliative chemotherapy was ineffective.She died 18 months after treatment initiation.CONCLUSION EUS-FNB was useful in the diagnosis of MT of MCT;CCRT suppressed the disea-se and improved quality of life.

黄芪甲苷调控CD45 PTPase介导抗脓毒症免疫机制的研究

目的研究黄芪甲苷(Astragaloside IV,ASI IV)抗脓毒症效应及免疫学机制,为黄芪临床应用脓毒症治疗提供科学依据。方法采用盲肠结扎穿刺术(Cecal ligation and puncture,CLP)构建脓毒症小鼠模型,随机分为假手术组、模型组、黄芪甲苷组、Anti-CD45单抗组、Anti-CD45单抗+黄芪甲苷组。H&E染色检测肺组织病理损伤;流式细胞术检测脾脏Th1细胞表达水平;实时荧光定量PCR(Real-time PCR)检测Th1细胞相关基因(IL-2、Tbet、STAT1和STAT4)mRNA的表达。结果与模型组比较,黄芪甲苷干预显著提高脓毒症模型小鼠生存率,减轻模型小鼠肺组织病理损伤。CD45抗体干预后,阻断了黄芪甲苷提高生存率和减轻肺组织病理损伤的作用。机制研究结果表明,黄芪皂苷显著增加模型小鼠Th1细胞(CD4+IFN-γ+)比例,上调Th1细胞相关基因(IL-2、T-bet、STAT1、STAT4)mRNA表达,CD45抗体干预后,减少了黄芪甲苷促脾淋巴细胞Th1细胞比例,阻断黄芪皂苷促Th1细胞相关基因。结论黄芪甲苷通过调控CD45分子,提高Th1细胞介导的免疫反应,介导抗脓毒症效应。

Ultrasound guided neural stem cell transplantation through the lateral ventricle for treatment of cerebral palsy in children

A total of 24 children with cerebral palsy were enrolled in this study and underwent ultrasound guided transplantation of neural stem cells through the lateral ventricle. Neural stem cells （3.8 x 106-7.3 x 107） were injected into the lateral ventricles. Mild injury of lateral ventricular blood vessels occurred in only two cases （8.3%）. Seven cases （29.2%） experienced a fever. Clinical manifestations were improved to varying degrees in eight cases （28.0%） within 3 months after transplantation. Patient condition did not worsen, and no patient experienced severe adverse reactions.

Accuracy of endoscopic ultrasound-guided needle aspiration specimens for molecular diagnosis of non-small-cell lung carcinoma

BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)and endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)are highly sensitive for diagnosing and staging lung cancer.In recent years,targeted therapy has shown great significance in the treatment of non-small cell lung carcinoma(NSCLC).Using these minimally invasive techniques to obtain specimens for molecular testing will provide patients with a more convenient diagnostic approach.AIM To evaluate the feasibility and accuracy of tissue samples obtained using EUSFNA and EBUS-TBNA for molecular diagnosis of NSCLC.METHODS A total of 83 patients with NSCLC underwent molecular testing using tissues obtained from EUS-FNA or EBUS-TBNA at the Tianjin Medical University Cancer Hospital from January 2017 to June 2019.All enrolled patients underwent chest computed tomography or positron emission tomography/computed tomography prior to puncture.We detected abnormal expression of EGFR,KRAS,MET,HER2,ROS1 and anaplastic lymphoma kinase protein.Two patients failed to complete molecular testing due to insufficient tumor tissue.The clinical features,puncture records,molecular testing results and targeted treatment in the remaining 81 patients were summarized.RESULTS In a total of 99 tissue samples obtained from 83 patients,molecular testing was successfully completed in 93 samples with a sample adequacy ratio of 93.9%(93/99).Biopsy samples from two patients failed to provide test results due to insufficient tumor tissue.In the remaining 81 patients,62 cases(76.5%)were found to have adenocarcinoma,11 cases(13.6%)had squamous cell carcinoma,3 cases(3.7%)had adenosquamous carcinoma and 5 cases(6.2%)had NSCLC-not otherwise specified.The results of molecular testing showed EGFR mutations in 21 cases(25.9%),KRAS mutations in 9 cases(11.1%),ROS-1 rearrangement in 1 case(1.2%)and anaplastic lymphoma kinase-positive in 5 cases(6.2%).Twentyfour patients with positive results received targeted therapy.The total effectiveness rate of targeted therapy was 66.7%(16/24),and the disease control rate was 83.3%(20/24).CONCLUSION Tissue samples obtained by EUS-FNA or EBUS-TBNA are feasible for the molecular diagnosis of NSCLC and can provide reliable evidence for clinical diagnosis and treatment.

Management of Priapism in Sickle Cell Patients: Experience of the Urology Department of the University Hospital Centre of Libreville

Introduction: Priapism is a rare pathology, known since antiquity. Sickle cell disease is the main aetiology in Africa. The aim of our work was to report our experience in its treatment. Material and Methods: This is a prospective, descriptive study carried out at the urology department of the Libreville University Hospital from January 2018 to December 2020. All sickle cell patients admitted to urology for priapism were included. The parameters studied were socio-demographic, clinical and therapeutic parameters as well as the evolution after treatment. Result: We collected 19 priapisms in sickle cell patients. The average age was 20.9 years with extremes of 4 and 53 years. Fifteen patients were homozygous SS. All patients had stasis priapism. The average consultation time was 22.4 hours. All patients had perioperative medical management combining hyperhydration, analgesia and antibiotic prophylaxis. A vasoactive drug was administered to 13 patients. Sixteen patients had a puncture of the corpus cavernosum. A distal cavernosal-spongiosum shunt under penile block was performed in 6 patients. The outcome was favorable from the outset in 12 cases, marked by complete detumescence of the corpus cavernosum. Partial detumescence was noted in 7 patients with the need for a new puncture of the cavernous body. A complication such as edema of the penis was in only one of our patients. A recurrence was noted in 2 patients. After an average follow-up of 6 months, no sequelae erectile dysfunction was observed. Conclusion: Priapism is a frequent complication among sickle cell patients in Libreville. Medical management associated with a cavernous puncture with administration of vasoactive drugs allows a favourable evolution without after-effects.

Co-Inhibitors of Second Signal of Lymphocyte Response in Human Renal Transplants: PD-L2, GITR, and ILT-2/3/5 Positive Cells from Aspiration Biopsies Associate with Acute Rejection-Freedom

Following organ transplantation, the outcome of the encounter between an APC and a T lymphocyte is strongly dependent on the presence of costimulatory and co-inhibitory molecules, the former associated with allograft rejection and the latter with allograft acceptance. We evaluated the expression of PD-L2, GITR, ILT-2/3/5, and ILT-4 on graft-infiltrating cells procured by Fnab from human KTx under different immunosuppressive regimens. Methods: Fnab biopsies were performed on days 7 or 14 - 30 in stable KTx and on the day of acute rejection diagnosis. Cytopreparations were studied by the enzymatic avidin biotin complex staining. Results: Acute rejection group showed a significant down-regulated expression of PD-L2, GITR, and ILT-2/3/5 as compared to stable group, while for ILT-4 we did not find significant difference. Anti-IL2αR and rapamicyn treatment trend to down-regulate ILT-4 expression, although meaningless. A significantly positive correlation was observed between PD-L2 and GITR expression in Fnab. The PPV for acute rejection diagnosis for both PD-L2 and GITR was clearly above 0.8. Conclusions: Our findings point to an early entrance of cells expressing PD-L2, GITR and ILT-2/3/5 inside human KTx who are going to remain rejection-free. Both PD-L2 and GITR shared a high ability to rule-in and rule-out acute rejection.

成人左侧腮腺区软组织巨细胞瘤1例

患者男,41岁,左侧腮腺区无痛性肿物1年余,无不适感;既往体健,无吸烟史及头部外伤史。查体:左耳屏前触及4cm×3cm肿物,边界欠清,位置固定,无压痛,局部皮肤颜色、温度无异常。实验室检查未见明显异常。腮腺超声:左侧腮腺区35mm×21mm低回声肿块,边界尚清,形态尚规则,紧邻腮腺但与之分界尚清,内部回声均匀,CDFI未见明显血流信号(图1A),考虑为左侧腮腺区良性占位。

微创旋切术、开放手术、穿刺抽液术治疗脓肿期浆细胞性乳腺炎的疗效分析

目的探讨微创旋切术、开放手术、穿刺抽液术治疗脓肿期浆细胞性乳腺炎的临床疗效。方法2018年1月~2021年7月收治的脓肿期浆细胞性乳腺炎病人90例,根据治疗方式分为三组:微创组38例,采用微创旋切术;开放组30例,采用常规开放手术;穿刺组22例,采用经皮穿刺抽液术。对三组病人围手术期相关指标、治疗效果满意度,随访1年后复发率进行对比分析。结果微创组和开放组对比,微创组手术时间(17.92±4.44)分钟、切口长度(0.37±0.06)cm、切口愈合时间(5.84±1.90)天、术中出血量(5.79±2.61)ml,优于开放组差异均有统计学意义(P<0.05)。微创组治疗效果满意度(89.47%)优于开放组(73.33%)及穿刺组(54.55%),随访1年的复发率微创组(7.89%)低于开放组(26.67%)及穿刺组(36.36%),差异有统计学意义(P<0.05)。结论针对脓肿期浆细胞性乳腺炎的治疗,超声引导下微创旋切术具有切口小、创伤小、病人满意度高、治疗周期短、治愈率高、不影响外观等优点,是目前容易被病人接受、操作简单且治疗效果好的一种微创治疗手段,值得临床推广。

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas diagnosed by endoscopic ultrasonography-guided fine-needle aspiration

Undifferentiated carcinoma with osteoclast-like giant cells, also formerly known as osteoclast-like giant cell tumor, is a rare neoplasm of the pancreas and usually diagnosed after pancreatectomy. The presence of non-neoplastic osteoclast-like giant cells is the histological hallmark of this tumor and the diagnosis is usually not difficult on tissue sections. However there have been relatively few reports regarding the cytological features of this type of tumor in literatures. Here we present a case of undifferentiated pancreatic carcinoma with osteoclast-like giant cells coexisting with ductal adenocarcinoma diagnosed by endoscopic ultrasonography （EUS）-guided fine-needle aspiration （FNA） and liquid-based cytology test. To our knowledge,

早期浆细胞性乳腺炎超声引导穿刺抽液与区段切除的效果对比

目的探讨早期浆细胞性乳腺炎超声引导穿刺抽液与区段切除肿块的复发性及治疗效果满意度,寻求更加有效、经济的治疗方法。方法选取哈励逊国际和平医院2013年6月至2016年12月收治的89例超声引导穿刺抽液(治疗组)和101例区段手术切除(对照组)的浆细胞性乳腺炎患者,将两组患者复发率及治疗满意度进行对照分析。结果 (1)超声引导穿刺抽液和区段切除肿块的总复发率为29.21%和21.78%,治疗组的总复发率高于对照组,差异无统计学意义(χ~2=5.437;P=0.285)。(2)疼痛程度和治疗时间在两组治疗效果满意度上的差异均无统计学意义(P=0.323;P=0.102),外表美观在治疗组中满意度优于对照组且差异有统计学意义(P=0.01)。结论穿刺抽液治疗既具有区段切除的治疗效果,且有更好的患者满意度。穿刺抽液作为更有效、更经济的诊治方法,对治疗早期浆细胞性乳腺炎具有重要意义。

脓毒症模型大鼠循环内皮细胞与肝功能状态间关系的相关性研究

目的探讨大鼠脓毒症中循环内皮细胞(circulating endothelial cells,CEC)数量的变化及其与肝功能改变的关系。方法利用盲肠结扎穿孔模型(CLP)在大鼠制作脓毒症模型。观察CEC数量、白细胞数量的变化、以及肝组织病理组织学、血天冬氨酸转氨酶(AST)和丙氨酸转氨酶(ALT)的改变。并探讨CEC数量与AST和ALT的相关关系。结果CLP6h后动物肝细胞明显肿胀,24h组肝细胞大量空泡变性,乃至坏死。CLP3h组白细胞和CEC数量比对照组明显升高。而CLP6h后AST、ALT才出现明显增高。CEC数量与AST和ALT水平呈负相关,Pearson相关系数(r)分别为-0·774和-0.734(P<0·01)。用非线性回归分析CEC数量与AST和ALT的关系,发现CEC数量对ALT的最佳拟合曲线为幂函数(P<0·05),其方程为ALT=33.052681+24.097309CEC-1。CEC数量对AST的最佳拟合曲线为对数函数,但无统计学意义(P=0.607)。结论在大鼠脓毒症模型中,比起常规肝功能指标,CEC数量更能敏感反映肝脏病理进程。当肝功能指标高于正常阈值时肝细胞已经出现了显著损伤。因此,早期监测CEC数量结合已有的肝功能指标有助于早期提示肝功能损害,及时针对治疗。

超声引导脑室内神经干细胞移植治疗小儿脑瘫

目的探讨超声引导下经皮侧脑室穿刺脑室内神经干细胞（NSCs）移植治疗脑瘫的方法及近期疗效。方法 45例脑瘫患儿接受超声引导下经皮穿刺脑室内NSCs移植术。NSCs来自自然流产的孕12周人胚胎前脑组织。采用常规彩色多普勒超声诊断仪,普通扇扩探头,频率2.0~4.0 MHz,带有穿刺架和引导软件。结果 45例患儿共接受56次超声引导下侧脑室穿刺,1次穿刺成功率为100%,脑室内注入NSCs 0.3~1.2 ml,平均（0.8±0.5）ml,细胞计数3.8×106~7.2×107个,平均（12.0±6.8）×106个;3例患儿有轻度脑室血管损伤,14例术后出现发热,经对症处理体温恢复正常。术后21例（21/45,46.67%）近期临床表现有不同程度好转,无术后病情加重病例。结论超声引导下脑室内NSCs移植术安全、准确、穿刺成功率高,有助于改善脑瘫患儿的临床症状。

针刺防治玉环柚裂果的细胞、生理学基础研究

对针刺防治玉环柚裂果的细胞、生理学基础进行了研究。结果表明 ,针刺引起POD和PAL活性上升 ,使木质素大量沉积在细胞壁上 ,果顶变硬 ,从而防止裂果。