Milling of wheat, maize and rice: Effects on fibre and lipid content and health

During the last thirty years the main interest in the medical consequences of milling of staple carbohydrate foods, particularly wheat and maize, has been in its effect on the fibre content as a result of the milling. The late nineteenth and early twentieth centuries in the West saw great changes in milling processes, from stone milling using water or wind power, to increasingly sophisticated roller milling, with an

Multiscale mechanobiology modeling for surgery assessment

This paper discusses some of the concept of modeling surgery outcome. It is also an attempt to offer a road map for progress. This paper may serve as a common ground of discussion for both communities i.e surgeons and computational scientist in its broadest sense. Predicting surgery outcome is a very difficult task. All patients are different, and multiple factors such as genetic, or environment conditions plays a role. The difficulty is to construct models that are complex enough to address some of these significant multiscale elements and simple enough to be used in clinical conditions and calibrated on patient data. We will pro- vide a multilevel progressive approach inspired by two applications in surgery that we have been working on. One is about vein graft adaptation after a transplantation, the other is the recovery of cosmesis outcome after a breast lumpectomy. This work, that is still very much in progress, may teach us some lessons. We are convinced that the digital revolution that is transforming the working environment of the surgeon makes closer collaboration between surgeons and computational scientist unavoidable. We believe that ＂computational surgery＂ will allow the community to develop predictive model of the surgery outcome and greatprogresses in surgery procedures that goes far beyond the operating room procedural aspect.

Quantitative Analysis of Elements in Gallstones and Biles from Chinese and Japanese Patients

The concentration of 26 elements in biles and gallstones from Chi-nese patients and the concentration of 10 elements from Japanese patients withgallstones were determined by inductively coupled plasma atomic emission spec-trometry (ICAP). Comparison of the level of elements between cholesterol andpigment gallstones revealed that Ca, Na, Fe, Cu, S, and Zn were higher inpigment gallstones than those in the cholesterol gallstones. Cholesterol stones aredivided into three subtypes: pure, mixed and combinated cholesterol stone.There were no significant difference among element contents. The levels of Ca,P, S, Li, and Ba in gallbladder biles were obviously higher in control groupthan in gallstone group. The element composition in gallbladder bile were similarto those in common bile duct bile. The former were 2～3 time high than the lat-ter.

The key role of the hepatic veins collaterals in the modern liver surgery

Currently,the terminology for liver anatomy and resection was based on the updates of the Brisbane 2000 system(1).In this setting,Couinaud’s anatomical description serves as the backbone for the classification of resection(2).Based on this classification,an anatomic liver resection was defined as the complete removal of the liver parenchyma confined within the responsible portal territory.Anatomical subsegmentectomy is defined as the removal of the liver parenchyma within the portal territory of less than a Couinaud’s segment.These are also defined as cone units,and their areas can be intraoperatively assessed by using ischemic demarcation,indocyanine green(ICG)staining,or both.

小檗碱抗肿瘤作用与Wnt/-βcaten in信号转导关系

目的证明小檗碱抗肿瘤作用机制可能与信号转导过程的调控有关。方法采用细胞增殖抑制和Hoechst 33258染色凋亡实验比较小檗碱和黄连总碱对人结肠癌HCT116和SW480细胞的作用。利用Tcf-4报告基因研究小檗碱对肿瘤细胞的信号转导影响。结果小檗碱在5—40mg·L^-1浓度范围内呈浓度依赖性和时间依赖性抑制人结肠癌HCT116和SW480细胞的增殖；小檗碱（20mg·L^-1）处理72h后的HCT116和SW480细胞出现明显凋亡；相当于小檗碱浓度的黄连总碱有类似于小檗碱的作用。20—40mg·L^-1小檗碱和黄连总碱均能明显抑制β—catenin／Tcf介导的转录活性。结论黄连总碱的抗肿瘤作用可能与其主要成分小檗碱有关；其抗肿瘤作用机制至少与抑制Wnt／β-catenin信号通路有关。

乙醇抑制大鼠原代肝细胞中P70S6K和ERK1/2活性

目的研究乙醇对原代肝细胞中P70S6K和ERK1/2活性的影响。方法分离成年雄性SD大鼠的肝细胞,分别以0、50、100和200 mmol/L的乙醇处理4 h,或以200 mmol/L乙醇处理0、1、2和4 h,用Western blot法检测P70S6K和ERK1/2的活性。在细胞中加入100 nmol/L的mTOR特异抑制剂雷帕霉素或10μmol/L的MEK1/2特异抑制剂U0126,培养24 h后收集细胞,用Western blot法检测P70S6K、ERK1/2及PPARγ的表达;用EMSA检测PPARγ的活性。结果随着乙醇浓度的增加或处理时间的延长,P70S6K的表达逐渐降低;乙醇也可抑制ERK1/2的活性;U0126同时抑制ERK1/2和P70S6K的活性,而雷帕霉素虽抑制P70S6K的活性,但增强ERK1/2的活性;乙醇不影响PPARγ的表达和活性。结论在大鼠原代肝细胞,乙醇对P70S6K的活性有抑制作用,且存在量效关系和时效关系。P70S6K的活性受ERK1/2的控制,但P70S6K也可反向调节ERK1/2。

Defensin expression in chronic pouchitis in patients with ulcerative colitis or familial adenomatous polyposis coli

AIM. Pouchitis develops in ileoanal pouches in up to 50% of patients with ulcerative colitis during the first 10 years after pouch surgery while being rare in patients after proctocolectomy for familial adenomatous polyposis coil （FAP） syndrome. Defensins are major components of the innate immune system and play a significant role in gastrointestinal microbial homeostasis. Pouch defensin and cytokine expression were correlated with states of pouch inflammation to study their role in pouchitis.METHODS： Patients with ulcerative colitis and FAP syndrome were stratified into groups with pouches after surgery, pouches without or with pouchitis. Biopsies from terminal ileum from a healthy intestine or from normal terminal ileum of patients with ulcerative colitis served as controls, mRNA from pouches and controls was analysed for defensin and cytokine expression.RESULTS： Expression of defensins was increased in all pouches immediately after surgery, compared to ileum of controls. Initially, pouches in ulcerative colitis revealed higher defensin expression than FAP pouches. Defensin expression declined in both patient groups and increased again slightly in pouchitis in patients with ulcerative colitis. FAP pouches without pouchitis had strong expression of β-defensin hBD-1, while all other defensins remained at low levels. Cytokine expression in ulcerative colitis pouches was high, while FAP pouches showed moderately elevated cytokines only after surgery.CONCLUSION： Development of pouchitis correlates with decreased defensin expression in ulcerative colitis in addition to high expression of cytokines. The low incidence of pouchitis in FAP pouches correlates with increased expression of hBD-1 β- defensin in association with low cytokine levels.

Ocular injuries in industrial technical workers in Delta State,Nigeria

Objective:To identify the types and causes of eye injury in industrial workers. Methods: A cross sectional study of the pattern of ocular injuries in Delta state of Nigeria was carried out over 3 months. Five hundred workers were interviewed and examined using the Snellen's chart, pen-torch, direct ophthalmoscope, magnifying loupe and the Perkin's hand-held applanation tonometer. Results: All the 500 workers were males. One hundred and twenty-three workers (24.6%) reported a history of ocular injury at work. The most common causative agents were sand dust, 53 workers (25.1%); cake dust, 27 workers (12.8%) and chemicals, 32 workers (15.1%). The main types of ocular injury were corneal/ conjunctival foreign bodies, 79 workers (64.2%); burns, 35 workers (28.5%) and blunt injury, 9 workers (7.3%). Only 36 (7.2%) workers used protective eye devices at work. Thirteen workers (2.6%) developed monocular blindness from ocular injury. Conclusion: Ocular injury at work is common and few workers wear protective devices at work in industries in Delta state, Nigeria. Industrial workers should have regular eye services and wear eye safety devices at work.

胸腔镜-内镜并用和腹腔镜-内镜并用进行2例食管肌瘤切除手术(英文)

背景平滑肌瘤是常见的食管良性肿瘤,术前若能排除恶性的可能,则可通过胸腔镜或腹腔镜进行最小侵入性的手术治疗。方法此处报道2例手术,均借助内镜接近术位,一例通过胸腔镜切除了一个食管中部的肿瘤,另一例通过腹腔镜切除了一个食管末端的肿瘤。通过这种胸腔镜与内镜并用和腹腔镜与内镜并用的方法,切除手术较简单,也避免了在身体上做切口。结论推荐采用最小侵入性手术疗法切除良性的食管黏膜下肿瘤。位于食管中部和下部三分之一段的肿瘤可以很容易地被切除。推荐在手术中并用内镜控制以避免损伤黏膜。

Continuous Gas Outflow Is More Effective Than Carbon Filters to Evacuate Smoke in Laparoscopic Colorectal Resections: A Comparative Study

Background: Carbon filters and expensive evacuation machines are available to evacuate surgical smoke in long-lasting laparoscopic operations and achieve good visibility and patient’s safety. Methods: This study was aimed to determine which of two methods for laparoscopic smoke evacuation is most effective getting the best visibility. 20 patients submitted to elective laparoscopic colorectal resections were allocated to be operated using, either a carbon filter (Group A) or a home-made tubing with a continuous suction (Group B) connected through one of the ports to the hospital vacuum system: both methods were regulated with a roller clamp to increase smoke evacuation in order to obtain good visibility. A mono-polar hook and the LigasureV 5-mm vessel-sealing device were used. Groups were comparable for demographic characteristics, surgical techniques, and malignancy. Mann-Whitney and Fisher’s exact test were used for statistics. Results: Morbidity was 10%. There was no mortality, and there was no difference between Group A and B according to complications (p = 1.00), hospital stay (p = 0.23), duration of the operation (p = 0.79) and total consumption of CO2 (p = 0.36). However, the number of times that the clamp had to be released (Group A: 3.4 + 1 vs Group B: 1.5 + 1) (p = 0.006) and that a port had to be opened freely to quickly evacuate dense smoke (Group A: 0.9 + 0.7 vs Group B: 0) (p = 0.002) was very significantly increased in Group A as compared to Group B. Mean follow-up was 60 months and no port site metastases that could be a consequence of “chimney effect” or wound recurrence have been detected. Conclusions: The surgeon’s subjective impression that carbon filters are less effective for smoke evacuation than continuous outflow of gas through a port connected to the hospital vacuum source was confirmed. This simple method is advised for long-lasting laparoscopic procedures to improve visibility throughout the procedure.

Epithelial-mesenchymal Plasticity in Breast Cancer Metastasis

Transitions between epithelial and mesenchymal states, which we have termed Epithelial Mesenchymal Plasticity (EMP), are

胃食管反流症状发生率及其受年龄和性别的影响

Background: Most previous studies of reflux symptom prevalence are of small sample size. No reliable data concerning age-and sex-stratified prevalence are available. Methods: Among 65,363 adult participants in a public health survey in Nord-Trondelag, Norway, 58,596 (90%) responded concerning occurrence and severity of heartburn or regurgitation during the past 12 months. The prevalence of minor, severe and any reflux symptoms was calculated, including stratification for age and sex. In order to examine whether the relative risk of reflux symptoms between sexes, in different age groups, was affected by other potential risk factors for reflux, confounding effects were tested using multivariate logistic regression. Odds ratios and their 95%confidence intervals were used to estimate relative risks. Results: Total prevalence of reflux symptoms was 31.4%, whereof 26.0%were minor symptoms and 5.4%severe symptoms. The prevalence of symptoms occurring at least weekly was 11.6%. Among women, the prevalence increased gradually from 22.1%in the youngest age category to 37.5%in the oldest, while among men it gradually increased from 25.8%in the youngest age group to peak at 36.0%between the ages of 50 and 60 years, after which it declined to 33.8%after age 70. A higher prevalence among women compared to men in the oldest age groups was not explained by confounding by body mass, tobacco smoking, alcohol consumption, dietary factors, or physical exercise. Conclusions: About every third adult person suffered from reflux symptoms. The prevalence increases linearly with age among women, while among men it peaked between the age of 50 and 70 years and thereafter declined.

空肠憩室:一种潜在的危险

Although jejunal diverticulosis is a rare entity and usually asymptomatic, it may cause chronic symptoms and acute complications. Because of the rarity of the entity, diagnosis is often delayed, resulting in unnecessary morbidity and mort ality. The purpose of this studywas to drawattention to jejunal diverticula and their complications. The medical records of 8 consecutive patients with complica tions due to small-bowel diverticula treated at our department during the past 4 yearswere reviewed. All diverticula were located in the jejunum. Seven patient s had acute complications, 3 patients had an intraabdominal abscess, 2 had free perforationwith diffuse peritonitis, 1 had a bowel occlusion and 1 patient had c oncomitant bleeding and occlusion. One patient presented with chronic symptoms. A preoperative diagnosis of jejunal diverticula, before explorative laparotomy, was not reached in any of the 7 patientswith acute symptoms. In the patient with chronic symptoms, multiple jejunal diverticula complicated by a jejuno-colic f istula and foreign body were found at laparotomy. On patient died of multiorgan failure. Small-bowel diverticulosis is a rare entity, but it should not be rega rded as a clinically insignificant finding. It may be difficult to make a preope rative diagnosis. Patients with incidentally detected proximal jejunal diverticu la, at imaging studies or at laparotomy, warrant close observation and awareness that the diverticula may cause serious complications.

CT结肠成像造成的肿瘤遗漏或假阳性诊断:一项前瞻性、对照分析

Background and study aims: The aim of the present study was to analyze the reasons for false findings on computed tomographic (CT) colonography. Patients and methods: A total of 100 consecutive CT colonography examinations were carried out before conventional colonoscopies scheduled on the same day. Before the study, an experienced radiologist received training in analyzing CT colonographies. The radiologists and endoscopists were blinded to each others findings. The patients received standard polyethylene glycol bowel preparation and were scanned in the prone and supine positions using a helical CT scanner and commercially available software for image analysis. Each pair of examinations was later followed by an unblinded analysis, comparing the CT colonographies with video recordings of the conventional colonographies in order to determine the reasons for tumors being missed or false- positive diagnoses arising on CT colonography. Results: Ninety polyps were detected in 41 patients. For patients with tumors ≥ 5 mm and ≥ 10mm, the sensitivity was 67% and 75% , respectively, and the specificity was 84% and 95% , respectively. The most important reasons for the 38 false findings of tumors ≥ 5 mm were perception errors (21 of 38) and misinterpretation of flat lesions in particular, including a high- grade dysplasia and a flat elevated Dukes A carcinoma. Residual stool was frequently the reason for misinterpreting lesions ≥ 10 mm (four of 10). Conclusions: Perception errors were the main reason for false findings of lesions ≥ 5 mm, including one flat malignant lesion. Residual stool caused four of 10 false findings for lesions ≥ 10 mm. Reading CT colonographies requires a high level of expertise, and conventional colonography is still regarded as the gold standard for detecting colorectal lesions.

食管的放大色素内镜检查:应用一种细胞内检查系统的体内病理学诊断

Background and Study Aims: The aim of the present study was to observe the endoscopic characteristics of cells on the surface layer of superficial esophageal carcinomas in vivo using an endocytoscopy system and to compare the findings with those in normal squamous epithelium. Patients and Methods:Superficial esophageal cancers in 12 patients were examined with methylene blue staining using an endocytoscopy system.Results: The endocytoscopy system and methylene blue staining made it possible to observe cells on the surface of the squamous epithelium in normal esophageal mucosa. Normal cells were arranged homogeneously, and the nucleus cytoplasm ratio was uniform and low. In esophageal cancers, the density of cells was found to be much greater than that in normal squamous epithelium. The cell distribution was also irregular and the cells were extremely heterogeneous, with the nuclei having different staining, size, and shape characteristics. The nucleus cytoplasm ratio was also very irregular. Conclusions:Examining esophageal tissue using the endocytoscopy system described here makes it possible to observe detailed histological alterations in esophageal lesions in vivo.

急性胰腺炎的发病率、治疗及复发率

Background: Acute pancreatitis is a common condition that is still associated with substantial morbidity and mortality rates. Management, outcome and recurren ce rate in acute pancreatitis in a clinical setting using a conservative managem ent approach are described. Methods: A total of 1376 consecutive cases represent ing 2211 hospitalizations due to acute pancreatitis treated at the Dept. of Surgery, Lund University Hospital, Lund, were reviewed retrospectively. Management, outcome and recurrence rate wer e recorded. Results: Incidence, including recurrences, was 300 per million per y ear; 21%of patients had recurrent (≥2) attacks. In relapsing disease, two-thi rds of patients had the first attack within 3 months. Mortality decreased over t he period studied, but overall it was 4.2%; mortality in relapsing attacks was 2.5%, related to multiple organ dysfunction syndrome(MODS) in 67%and occurring within the first week in 36%. Conclusions: Despite a conservative approach in the management of acute pancreatitis, mortality is still substantial, frequently occurs early after admission, is associated with MODS and is also seen in relap sing disease. Early cholecystectomy and bile duct clearance could decrease recur rent attacks of biliary pancreatitis.

吸烟损害直肠黏膜血流的一项初步研究:对经肛门黏膜瓣内口修补术的可能意义

Transanal advancement flap repair has been advocated as the treatment of choice for transsphincteric perianal fistulas, because it enables the healing of almost all fistulas without sphincter damage and consequent continence disturbance. After initial promising reports, recently less favorable results have been reported. It remains unclear why there is such a large variety in the reported healing rates. Recently, it has been suggested that impaired wound healing caused by a diminished rectal mucosal perfusion in patients who smoke may lead to the breakdown of the advancement flap in patients undergoing flap repair for perianal fistulas. This study was designed to investigate the difference in blood flow in rectal mucosa between patients who smoke and those who do not smoke. Furthermore, we assessed the impact of the creation of a mucosa advancement flap and the difference in blood flow in the flap between smoking and nonsmoking patients. Between July 2001 and July 2002, 23 consecutive patients (19 males; median age, 46 (range, 26- 69) years) with a perianal fistula of cryptoglandular origin underwent surgery for a perianal fistula. Among them were 13 patients who smoked cigarettes. All patients underwent intraoperative laser Doppler flowmetry. Median blood flow before transanal advancement flap repair was 35 (range, 8- 70) volts in patients who did not smoke. In patients who smoked the median blood flow before transanal advancement flap repair was 18 (range, 7- 35) volts. Blood flow was significantly lower in patients who smoked (P = 0.018; Mann-Whitney). In conclusion, it seems likely that impaired wound healing caused by a diminished rectal mucosal perfusion is a contributing factor in the breakdown of advancement flaps in patients who smoke cigarettes.

动脉注射5-氟尿嘧啶联合皮下注射α干扰素治疗晚期肝癌可导致间质性肺炎

Previously we reported combined chemoimmunotherapy, using interferon (IFN) αand 5-fluorouracil (5-FU) for patients with advanced hepatocellular carcinoma (HCC), and this regimen improved the prognosis. Recently, we experienced an HCC patient who died of severe interstitial pneumonia during the combined IFN αand 5-FU therapy. This is the first report of the occurrence of interstitial pneumonia during combined IFN αand 5-FU treatment. A 60-year old man was admitted to Osaka University Hospital to receive systemic chemo immunotherapy for recurrent HCC. In the second week of the chemo immunotherapy, he showed a decreased level of consciousness, and respiratory insufficiency. Emergency roentgenogram revealed diffuse infiltration in both lungs. Respiratory dysfunction due to interstitial pneumonia was suspected, and steroid pulse therapy was started. However, the patient showed respiratory failure, and he died 32 days after the start of the therapy. Autopsy findings showed atelectasis in the bilateral lungs, which showed elastic hard solidity and a dark red color; esophageal varices were also shown, and there was cirrhosis with a large tumor in the liver. Microscopically, the alveolar wall showed marked fibrous thickness and moderate inflammatory change, which is consistent with acute interstitial pneumonia, and the acute pulmonary change was suspected to have been the cause of death. The association of IFN with the development of interstitial pneumonia has been reported. However, the prognosis of IFN induced interstitial pneumonia has mostly been favorable when the medication was discontinued. It has been postulated that interstitial pneumonia induced by the combination of IFN and 5-FU may be therapy resistant. The combination of IFN αand 5-FU is a useful therapy for patients with advanced HCC, such as that with portal vein invasion or multiple metastatic foci. Thus, interstitial pneumonia in these patients should be carefully managed.