Document Of World Medical AssociationWorld medical association declaration of Helsinki Ethical principles for medical research involving human subjects
Intraductal papillary neoplasm of the bile duct(IPNB) is a rare bile duct neoplasm mostly found in far eastern nations where hepatolithiasis and clonorchiasis infections are endemic. In western countries,it is very ra...Intraductal papillary neoplasm of the bile duct(IPNB) is a rare bile duct neoplasm mostly found in far eastern nations where hepatolithiasis and clonorchiasis infections are endemic. In western countries,it is very rare and the etiology is unknown. In this article,we report the first IPNB patient we encountered in our clinic and a literature review. The patient is a 38-yearold female with a history of choledocholithiasis who presented with obstructive jaundice. She was found to have a papillary mass at the junction of the right hepatic duct and common hepatic duct with six masses in the liver parenchyma. The immunophenotypic and histologic features of the tumor are consistent with IPNB,gastric subtype. The patient had a partial hepatectomy and has been receiving palliative chemotherapy. In a search of Pub Med database,we collected 354 IPNB patients reported in 22 articles. In these patients,52.8% were from Japan and 27.7% were from western countries including the United States(11.0%). The age of the patients ranged from 35 to 80 years old with an average of 64.6. Male/female ratio was 1.5. Macroscopically,57.5% of the tumors were in the left lobe and 29.5% were in the right lobe. The average size of the tumor were 4.2 cm at the time of diagnosis. Histologically,pancreato-biliary subtype accounted for 41.8%,intestinal 28.0%,gastric 13.5% and oncocytic 16%. An invasive component is most often present in the pancreato-biliary and gastric subtypes. Despite recent advanced technologies,diagnosis of IPNB is still challenging,especially in western countries due to its rarity. Defined clinicopathologic features are in demand for the accurate diagnosis and proper treatment.展开更多
Future quantitative assessments will be expected to estimate quantities, values, and locations of undiscovered mineral resources in a form that conveys both economic viability and uncertainty associated with the reso...Future quantitative assessments will be expected to estimate quantities, values, and locations of undiscovered mineral resources in a form that conveys both economic viability and uncertainty associated with the resources. Historically, declining metal prices point to the need for larger deposits over time. Sensitivity analysis demonstrates that the greatest opportunity for reducing uncertainty in assessments lies in lowering uncertainty associated with tonnage estimates. Of all errors possible in assessments, these affecting tonnage estimates are by far the most important. Selecting the correct deposit model is the most important way of controlling errors because of the dominance of tonnage-deposit models are the best known predictors of tonnage. Much of the surface is covered with apparently barren rocks and sediments in many large regions. Because many exposed mineral deposits are believed to have been found, a prime concern is the presence of possible mineralized rock under cover. Assessments of areas with resources under cover must rely on extrapolation from surrounding areas, new geologic maps of rocks under cover, or analogy with other well-explored areas that can be considered training tracts. Cover has a profound effect on uncertainty and on methods and procedures of assessments because geology is seldom known and geophysical methods typically have attenuated responses. Many earlier assessment methods were based on relationships of geochemical and geophysical variables to deposits learned from deposits exposed on the surface-these will need to be relearned based on covered deposits. Mineral-deposit models are important in quantitative resource assessments for two reasons: (1) grades and tonnages of most deposit types are significantly different, and (2) deposit types are present in different geologic settings that can be identified from geologic maps. Mineral-deposit models are the keystone in combining the diverse geoscience information on geology, mineral occurrences, geophysics, and geochemi展开更多
Background: An easily accessible and valid surrogate marker for interventional stroke trials is needed. Objective: To investigate the usefulness of various S100B serum measures to predict long-term outcome and infarct...Background: An easily accessible and valid surrogate marker for interventional stroke trials is needed. Objective: To investigate the usefulness of various S100B serum measures to predict long-term outcome and infarct volume in patients with acute stroke. Design: Inception cohort study. Setting: Tertiary care university hospital. Patients: Thirty-nine patients (mean±SD age, 69.1±11.5 years) with acute nonlacunar middle cerebral artery infarction presenting less than 6 hours after symptom onset. Main Outcome Measures: Functional outcome 6 months after stroke (modified Rankin scale score) and final infarct volume on day 7 by means of standardized volumetry of brain images. Serum S100B level was determined at hospital admission and 24, 48, 72, 96, 120, and 144 hours after symptom onset. Results: Single S100B measures obtained 48 and 72 hours after stroke onset demonstrated the highest Spearman rank correlations with modified Rankin scale scores (p=0.68 and p=0.67, respectively; P < .001) and infarct volume (p=0.95 and p=0.94, respectively; P < .001). A 48-hour S100B value of 0.37 μg/L or less revealed a sensitivity of 0.87 and a specificity of 0.78 in predicting an independent functional outcome. In a multivariate model, S100B emerged as an outcome predictor that was independent of age, sex, stroke severity, etiology, lesion side, and risk factors. Conclusions: Single S100B values obtained 48 and 72 hours after stroke onset provide the highest predictive values with respect to functional outcome and infarct volume in nonlacunar middle cerebral artery infarction. More complex measures of the S100B kinetic (ie, area under the curve or peak value) were not superior. Therefore, these single S100B measures appear to be useful surrogate end points in acute interventional stroke trials.展开更多
AIM:To investigate predilection sites of recurrence of pancreatic cancer by computed tomography(CT)in follow-up after surgery. METHODS:Seventy seven patients with recurrence after pancreatic cancer surgery were retros...AIM:To investigate predilection sites of recurrence of pancreatic cancer by computed tomography(CT)in follow-up after surgery. METHODS:Seventy seven patients with recurrence after pancreatic cancer surgery were retrospectively identified.The operative technique,R-status,T-stage and development of tumor markers were evaluated. Two radiologists analyzed CT scans with consensus readings.Location of local recurrence,lymph node recurrence and organ metastases were noted.Surgery and progression of findings on follow-up CT were con-sidered as reference standard. RESULTS:The mean follow-up interval was 3.9± 1.8 mo,with a mean relapse-free interval of 12.9± 10.4 mo.The predominant site of recurrence was local (65%),followed by lymph node(17%),liver metastasis (11%)and peritoneal carcinosis(7%).Local recurrence emerged at the superior mesenteric artery(n=28),the hepatic artery(n=8),in an area defined by the surrounding vessels:celiac trunk,portal vein,inferior vena cava(n=22),and in a space limited by the mesenteric artery,portal vein and inferior vena cava(n=17). Lymph node recurrence occurred in the mesenteric root and left lateral to the aorta.Recurrence was confirmed by surgery(n=22)and follow-up CT(n=55).Tumor markers[carbohydrate antigen 19-9(CA19-9),carcinoembryonic antigen(CEA)]increased in accordance with signs of recurrence in most cases(86%CA19-9;79.2% CEA). CONCLUSION:Specific changes of local and lymph node recurrence can be found in the course of the cardinal peripancreatic vessels.The superior mesenteric artery is the leading structure for recurrence.展开更多
AIM： To determine the effect of Prepacol, a combination of sodium phosphate and bisacodyl, on transit and quality of capsule endoscopy （CE）. METHODS： Fivety two consecutive patients were included in this prospecti...AIM： To determine the effect of Prepacol, a combination of sodium phosphate and bisacodyl, on transit and quality of capsule endoscopy （CE）. METHODS： Fivety two consecutive patients were included in this prospective study. CE was performed following a 12 h fasting period. Twenty six patients were randomized for additional preparation with Prepacol. The quality of CE was assessed separately for the proximal and the distal small bowel by 3 experienced endoscopists on the basis of a graduation which was initially developed with 20 previous CE. RESULTS： Preparation with Prepacol accelerated small bowel transit time （262 ± 55 rain vs 287 ± 97 min）, but had no effect on the quality of CE. Visibility was significantly reduced in the distal compared to the proximal small bowel. CONCLUSION： The significantly reduced visibility of CE in the distal small bowel allocates the need for a good preparation. Since Prepacol has no beneficial effect on CE the modality of preparation and the ideal time of application remains unclear. Further standardized examinations are necessary to identify sufficient preparation procedures and to determine the impact of the volume of the preparation solution.展开更多
AIM： To investigate interleukin-18 （IL-18） in patients with chronic panreatitis （CP）. METHODS： We studied 29 patients with CP and 30 healthy controls. Peripheral blood mononuclear cells （PBMC） were isolated an...AIM： To investigate interleukin-18 （IL-18） in patients with chronic panreatitis （CP）. METHODS： We studied 29 patients with CP and 30 healthy controls. Peripheral blood mononuclear cells （PBMC） were isolated and incubated with 50 mmol/L ethanol, lipopolysaccharide （LPS） （doses 25 g/L, 250 g/L, 2500 g/L） and both agents for 24 h. Levels of IL-18 in the supernatants, and levels of IL-18, IL-12, interferon （IFN）-T and soluble CD14 in the serum were analysed by EI_ISA technique. Expression of IL-18 in PBMC was investigated by reverse-transcription （RT）-PCR. IL-18 protein levels in CP tissue and in normal pancreas were studied by ELISA technique. IL-18 levels in PBMC and pancreatic tissue were determined by Westernblot. Immunohistochemistry for pancreatic IL-18 expression was performed.RESULTS： In patients, IL-18 serum levels were significantly enhanced by 76% （mean： 289.9 ± 167.7 ng/L） compared with controls （mean： 165.2 ± 43.6 ng/L; P 〈 0.0005）. IL-12 levels were enhanced by 25% in patients （18.3 ± 7.3 ng/L） compared with controls （14.7 ± 6.8 ng/L, P = 0.0576） although not reaching the statistical significance. IFN-γ, and soluble CD14 levels were not increased. In vitro, LPS stimulated significantly and dosedependently IL-18 secretion from PBMC. Incubation with ethanol reduced LPS-stimulated IL-18 secretion by about 50%. The mRNA expression of IL-18 in PBMC and the response of PBMC to ethanol and LPS was similar in CP patients and controls. In PBMC, no significant differences in IL-18 protein levels were detected between patients and controls. IL-18 protein levels were increased in CP tissues compared to normal pancreatic tissues. IL-18 was expressed by pancreatic acinar cells and by infiltrating inflammatory cells within the pancreas. CONCLUSION： IL-18 originates from the chronically inflammed pancreas and appears to be involved in the fibrotic destruction of the organ.展开更多
Whether using a shallow neural network with one hidden layer,or a deep network with many hidden layers,the training data must represent subgroups of the deposit type being explored to be useful.Published examples of n...Whether using a shallow neural network with one hidden layer,or a deep network with many hidden layers,the training data must represent subgroups of the deposit type being explored to be useful.Published examples of neural networks have mostly been limited to one individual mineral deposit for training.Variation of geologic features among deposits within a type are so large that a single deposit cannot provide proper information to train a neural net to generalize and guide exploration for other deposits.Models trained with only one deposit tend to be academic successes but are not of practical value in exploration for other deposits.This is why it takes much experience examining many deposits to properly train an economic geologist—a neural network is not any different.Two examples of shallow neural networks are used to demonstrate the power of neural networks to possibly locate undiscovered deposits and to provide some suggestions of how to deal with missing data.The training data needs to include information spatially related to known deposits and hopefully information from many different deposits of the type.Lessons learned from these and other examples point to a proposed sampling plan for data that could lead to a generalized neural network for exploration.In this plan,10 or more well-explored gold-rich porphyry copper deposits from around the world with 100 or more sample sites near and some distance from each deposit would probably capture important variability among such deposits and provide proper data to train and test a shallow neural network to predict locations of undiscovered deposits.展开更多
AIM: To evaluate the fractal feature of the retinal vasculature of normal eyes on a stereographic projected and montaged ultra-wide field(UWF) fluorescein angiography(FA).METHODS: Prospective, observational, cross-sec...AIM: To evaluate the fractal feature of the retinal vasculature of normal eyes on a stereographic projected and montaged ultra-wide field(UWF) fluorescein angiography(FA).METHODS: Prospective, observational, cross-sectional study. Totally 59 eyes of 31 normal subjects were imaged using the Optos 200 Tx. Images obtained at different gaze angles stereographically projected and montaged. The early-phase UWF FA frames were processed to segment the retinal vasculature and the results were exported as binary masks. The fractal dimension(FD) was calculated using the box-counting method.RESULTS: The global FD for the entire retina was 1.6±0.04, with no difference between males and females(1.59±0.04 vs 1.61±0.04, P=0.084) or between right and left eyes(1.6±0.04 vs 1.6±0.05, P=0.61). FD was nonuniformly distributed among four quadrants(P<0.001) and decreased as the distance from the fovea increased(P<0.001). A negative association was observed between FD and age(R=-0.37, P=0.006), and this relationship was observed in the posterior and mid-peripheral retina(P<0.05) but absent in far-periphery(P>0.05).CONCLUSION: Fractal geometry is non-uniformly distributed across the retina in normal eyes and decreases from the fovea to the far-periphery. Subjects with an older age tend to have a smaller FD, however, the FD in the farperiphery does not appear to be influenced by age.展开更多
文摘Document Of World Medical AssociationWorld medical association declaration of Helsinki Ethical principles for medical research involving human subjects
文摘Intraductal papillary neoplasm of the bile duct(IPNB) is a rare bile duct neoplasm mostly found in far eastern nations where hepatolithiasis and clonorchiasis infections are endemic. In western countries,it is very rare and the etiology is unknown. In this article,we report the first IPNB patient we encountered in our clinic and a literature review. The patient is a 38-yearold female with a history of choledocholithiasis who presented with obstructive jaundice. She was found to have a papillary mass at the junction of the right hepatic duct and common hepatic duct with six masses in the liver parenchyma. The immunophenotypic and histologic features of the tumor are consistent with IPNB,gastric subtype. The patient had a partial hepatectomy and has been receiving palliative chemotherapy. In a search of Pub Med database,we collected 354 IPNB patients reported in 22 articles. In these patients,52.8% were from Japan and 27.7% were from western countries including the United States(11.0%). The age of the patients ranged from 35 to 80 years old with an average of 64.6. Male/female ratio was 1.5. Macroscopically,57.5% of the tumors were in the left lobe and 29.5% were in the right lobe. The average size of the tumor were 4.2 cm at the time of diagnosis. Histologically,pancreato-biliary subtype accounted for 41.8%,intestinal 28.0%,gastric 13.5% and oncocytic 16%. An invasive component is most often present in the pancreato-biliary and gastric subtypes. Despite recent advanced technologies,diagnosis of IPNB is still challenging,especially in western countries due to its rarity. Defined clinicopathologic features are in demand for the accurate diagnosis and proper treatment.
文摘Future quantitative assessments will be expected to estimate quantities, values, and locations of undiscovered mineral resources in a form that conveys both economic viability and uncertainty associated with the resources. Historically, declining metal prices point to the need for larger deposits over time. Sensitivity analysis demonstrates that the greatest opportunity for reducing uncertainty in assessments lies in lowering uncertainty associated with tonnage estimates. Of all errors possible in assessments, these affecting tonnage estimates are by far the most important. Selecting the correct deposit model is the most important way of controlling errors because of the dominance of tonnage-deposit models are the best known predictors of tonnage. Much of the surface is covered with apparently barren rocks and sediments in many large regions. Because many exposed mineral deposits are believed to have been found, a prime concern is the presence of possible mineralized rock under cover. Assessments of areas with resources under cover must rely on extrapolation from surrounding areas, new geologic maps of rocks under cover, or analogy with other well-explored areas that can be considered training tracts. Cover has a profound effect on uncertainty and on methods and procedures of assessments because geology is seldom known and geophysical methods typically have attenuated responses. Many earlier assessment methods were based on relationships of geochemical and geophysical variables to deposits learned from deposits exposed on the surface-these will need to be relearned based on covered deposits. Mineral-deposit models are important in quantitative resource assessments for two reasons: (1) grades and tonnages of most deposit types are significantly different, and (2) deposit types are present in different geologic settings that can be identified from geologic maps. Mineral-deposit models are the keystone in combining the diverse geoscience information on geology, mineral occurrences, geophysics, and geochemi
文摘Background: An easily accessible and valid surrogate marker for interventional stroke trials is needed. Objective: To investigate the usefulness of various S100B serum measures to predict long-term outcome and infarct volume in patients with acute stroke. Design: Inception cohort study. Setting: Tertiary care university hospital. Patients: Thirty-nine patients (mean±SD age, 69.1±11.5 years) with acute nonlacunar middle cerebral artery infarction presenting less than 6 hours after symptom onset. Main Outcome Measures: Functional outcome 6 months after stroke (modified Rankin scale score) and final infarct volume on day 7 by means of standardized volumetry of brain images. Serum S100B level was determined at hospital admission and 24, 48, 72, 96, 120, and 144 hours after symptom onset. Results: Single S100B measures obtained 48 and 72 hours after stroke onset demonstrated the highest Spearman rank correlations with modified Rankin scale scores (p=0.68 and p=0.67, respectively; P < .001) and infarct volume (p=0.95 and p=0.94, respectively; P < .001). A 48-hour S100B value of 0.37 μg/L or less revealed a sensitivity of 0.87 and a specificity of 0.78 in predicting an independent functional outcome. In a multivariate model, S100B emerged as an outcome predictor that was independent of age, sex, stroke severity, etiology, lesion side, and risk factors. Conclusions: Single S100B values obtained 48 and 72 hours after stroke onset provide the highest predictive values with respect to functional outcome and infarct volume in nonlacunar middle cerebral artery infarction. More complex measures of the S100B kinetic (ie, area under the curve or peak value) were not superior. Therefore, these single S100B measures appear to be useful surrogate end points in acute interventional stroke trials.
文摘AIM:To investigate predilection sites of recurrence of pancreatic cancer by computed tomography(CT)in follow-up after surgery. METHODS:Seventy seven patients with recurrence after pancreatic cancer surgery were retrospectively identified.The operative technique,R-status,T-stage and development of tumor markers were evaluated. Two radiologists analyzed CT scans with consensus readings.Location of local recurrence,lymph node recurrence and organ metastases were noted.Surgery and progression of findings on follow-up CT were con-sidered as reference standard. RESULTS:The mean follow-up interval was 3.9± 1.8 mo,with a mean relapse-free interval of 12.9± 10.4 mo.The predominant site of recurrence was local (65%),followed by lymph node(17%),liver metastasis (11%)and peritoneal carcinosis(7%).Local recurrence emerged at the superior mesenteric artery(n=28),the hepatic artery(n=8),in an area defined by the surrounding vessels:celiac trunk,portal vein,inferior vena cava(n=22),and in a space limited by the mesenteric artery,portal vein and inferior vena cava(n=17). Lymph node recurrence occurred in the mesenteric root and left lateral to the aorta.Recurrence was confirmed by surgery(n=22)and follow-up CT(n=55).Tumor markers[carbohydrate antigen 19-9(CA19-9),carcinoembryonic antigen(CEA)]increased in accordance with signs of recurrence in most cases(86%CA19-9;79.2% CEA). CONCLUSION:Specific changes of local and lymph node recurrence can be found in the course of the cardinal peripancreatic vessels.The superior mesenteric artery is the leading structure for recurrence.
文摘AIM： To determine the effect of Prepacol, a combination of sodium phosphate and bisacodyl, on transit and quality of capsule endoscopy （CE）. METHODS： Fivety two consecutive patients were included in this prospective study. CE was performed following a 12 h fasting period. Twenty six patients were randomized for additional preparation with Prepacol. The quality of CE was assessed separately for the proximal and the distal small bowel by 3 experienced endoscopists on the basis of a graduation which was initially developed with 20 previous CE. RESULTS： Preparation with Prepacol accelerated small bowel transit time （262 ± 55 rain vs 287 ± 97 min）, but had no effect on the quality of CE. Visibility was significantly reduced in the distal compared to the proximal small bowel. CONCLUSION： The significantly reduced visibility of CE in the distal small bowel allocates the need for a good preparation. Since Prepacol has no beneficial effect on CE the modality of preparation and the ideal time of application remains unclear. Further standardized examinations are necessary to identify sufficient preparation procedures and to determine the impact of the volume of the preparation solution.
基金Supported by a grant to MVS, Forschungsfonds, project number 098200/99-234, Faculty of Clinical Medicine, University of Heidelberg at Mannheim, Germany by a grant "Landesforschungsschwerpunkt-Molekulare Mechanismen alkoholassoziierter Erkrankungen", project number 23-7532, Baden-Württemberg, Germany and by the Dietmar-Hopp-Foundation, Walldorf, Germany
文摘AIM： To investigate interleukin-18 （IL-18） in patients with chronic panreatitis （CP）. METHODS： We studied 29 patients with CP and 30 healthy controls. Peripheral blood mononuclear cells （PBMC） were isolated and incubated with 50 mmol/L ethanol, lipopolysaccharide （LPS） （doses 25 g/L, 250 g/L, 2500 g/L） and both agents for 24 h. Levels of IL-18 in the supernatants, and levels of IL-18, IL-12, interferon （IFN）-T and soluble CD14 in the serum were analysed by EI_ISA technique. Expression of IL-18 in PBMC was investigated by reverse-transcription （RT）-PCR. IL-18 protein levels in CP tissue and in normal pancreas were studied by ELISA technique. IL-18 levels in PBMC and pancreatic tissue were determined by Westernblot. Immunohistochemistry for pancreatic IL-18 expression was performed.RESULTS： In patients, IL-18 serum levels were significantly enhanced by 76% （mean： 289.9 ± 167.7 ng/L） compared with controls （mean： 165.2 ± 43.6 ng/L; P 〈 0.0005）. IL-12 levels were enhanced by 25% in patients （18.3 ± 7.3 ng/L） compared with controls （14.7 ± 6.8 ng/L, P = 0.0576） although not reaching the statistical significance. IFN-γ, and soluble CD14 levels were not increased. In vitro, LPS stimulated significantly and dosedependently IL-18 secretion from PBMC. Incubation with ethanol reduced LPS-stimulated IL-18 secretion by about 50%. The mRNA expression of IL-18 in PBMC and the response of PBMC to ethanol and LPS was similar in CP patients and controls. In PBMC, no significant differences in IL-18 protein levels were detected between patients and controls. IL-18 protein levels were increased in CP tissues compared to normal pancreatic tissues. IL-18 was expressed by pancreatic acinar cells and by infiltrating inflammatory cells within the pancreas. CONCLUSION： IL-18 originates from the chronically inflammed pancreas and appears to be involved in the fibrotic destruction of the organ.
文摘Whether using a shallow neural network with one hidden layer,or a deep network with many hidden layers,the training data must represent subgroups of the deposit type being explored to be useful.Published examples of neural networks have mostly been limited to one individual mineral deposit for training.Variation of geologic features among deposits within a type are so large that a single deposit cannot provide proper information to train a neural net to generalize and guide exploration for other deposits.Models trained with only one deposit tend to be academic successes but are not of practical value in exploration for other deposits.This is why it takes much experience examining many deposits to properly train an economic geologist—a neural network is not any different.Two examples of shallow neural networks are used to demonstrate the power of neural networks to possibly locate undiscovered deposits and to provide some suggestions of how to deal with missing data.The training data needs to include information spatially related to known deposits and hopefully information from many different deposits of the type.Lessons learned from these and other examples point to a proposed sampling plan for data that could lead to a generalized neural network for exploration.In this plan,10 or more well-explored gold-rich porphyry copper deposits from around the world with 100 or more sample sites near and some distance from each deposit would probably capture important variability among such deposits and provide proper data to train and test a shallow neural network to predict locations of undiscovered deposits.
文摘AIM: To evaluate the fractal feature of the retinal vasculature of normal eyes on a stereographic projected and montaged ultra-wide field(UWF) fluorescein angiography(FA).METHODS: Prospective, observational, cross-sectional study. Totally 59 eyes of 31 normal subjects were imaged using the Optos 200 Tx. Images obtained at different gaze angles stereographically projected and montaged. The early-phase UWF FA frames were processed to segment the retinal vasculature and the results were exported as binary masks. The fractal dimension(FD) was calculated using the box-counting method.RESULTS: The global FD for the entire retina was 1.6±0.04, with no difference between males and females(1.59±0.04 vs 1.61±0.04, P=0.084) or between right and left eyes(1.6±0.04 vs 1.6±0.05, P=0.61). FD was nonuniformly distributed among four quadrants(P<0.001) and decreased as the distance from the fovea increased(P<0.001). A negative association was observed between FD and age(R=-0.37, P=0.006), and this relationship was observed in the posterior and mid-peripheral retina(P<0.05) but absent in far-periphery(P>0.05).CONCLUSION: Fractal geometry is non-uniformly distributed across the retina in normal eyes and decreases from the fovea to the far-periphery. Subjects with an older age tend to have a smaller FD, however, the FD in the farperiphery does not appear to be influenced by age.
