Treatment and prognosis of patients of G3 nonfunctional pancreatic neuroendocrine tumors with proliferation index of Ki-67<55% / 中华消化外科杂志

Objective:To investigate the treatment and prognosis of patients of G3 non-functional pancreatic neuroendocrine tumors (pNETs) with proliferation index of Ki-67 <55%.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 15 G3 non-functional pNETs patients with proliferation index of Ki-67<55% who were admitted to Zhongshan Hospital of Fudan University from April 2014 to April 2020 were collected. There were 11 males and 4 females, aged (58±10)years. All patients underwent radical resection of the primary lesion. Obser-vation indicators: (1) treatment; (2) postoperative pathological characteristics; (3) follow-up. Measure-ment data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers. The Pearson correlation analysis was used to verify the correlation between variables. Kaplan-Meier method was used to draw survival curve and calculate survival rate. Log-Rank test was used for survival analysis. Results:(1) Treatment. All 15 G3 nonfunctional pNETs patients underwent radical resection of the primary lesion of pancreas, including 5 cases receiving pancreati-coduodenectomy, 10 cases receiving distal pancreatectomy with splenectomy. There were 5 patients with simultaneous liver oligometastasis who underwent combined segmental (lobectomy) hepatectomy. All 15 patients had negative tumor margin, and the operation time and volume of intraoperative blood loss of 15 patients was 120(90,210)minutes and 200(50,300)mL, respectively. None of patient had complications ≥Ⅲ grade of the Clavien-Dindo classification during the postoperative 30 days. Of the 15 patients, there were 5 cases receiving comprehensive treatment based on CAPTEM chemo-therapy (temozolomide combined with capecitabine), 2 cases receiving local interventional therapy, 2 cases receiving CAPTEM chemotherapy, 1 case receiving local interventional therapy combined with molecular targeted therapy, 1 case receiving local interventional therapy combined with long acting somatostatin therapy, 1 cases receiving long acting somatostatin therapy combined with molecular targeted therapy, and 3 cases without postoperative treatment. (2) Postoperative patholo-gical characteristics. The tumor diameter of 15 patients was 3.3(range, 0.5-6.0)cm. There were 2 cases with tumor diameter <2 cm, 13 cases with tumor diameter ≥2 cm. The number of lymph nodes dissected and number of lymph nodes metastatic was 6(4, 10) and 2(1,3) in 15 patients, respectively, including 12 cases with positive lymph node metastasis. Of the 15 patients, there were 5 cases with tumor invasion of adjacent organ, 5 cases with simultaneous liver metastasis, 8 cases with perineural invasion and 8 cases with vascular invasion. There were 3, 7, and 5 patients with stage Ⅱ, stage Ⅲ, and stage Ⅳ of pathological TNM staging, respectively. The proliferation index of Ki-67 and mitotic count was 32%±9% and (11±9)/10 high power field in the primary lesion of 15 patients, respectively, and there was no correlation between proliferation index of Ki-67 and mitotic count ( P>0.05). (3) Follow-up. All 15 patients were followed up after surgery for (55±24)months. The median survival time of 15 patients was 78(range, 43-113)months, with 1-, 3-, 5-year overall survival rate as 100%, 92%, 62%, respectively. During the follow up, 9 of the 15 patients underwent tumor recurrence, with the recurrence time as 20(14, 44)months. There were 8 patients died of tumor recurrence or metastasis. The median survival time was 86(range, 51-120)months in 5 patients receiving comprehensive treatment based on CAPTEM chemotherapy, versus 53(range, 45-60)months in 10 patients receiving other postoperative adjuvant therapy or without postoperative treatment, showing a significant difference between them ( χ2=4.21, P<0.05). Conclusion:The prognosis of patients of G3 nonfunctional pNETs with proliferation index of Ki-67<55% undergoing radical resection combined with postoperative comprehensive treatment based on CAPTEM chemotherapy in better than that of patients receiving other postoperative adjuvant therapy or without posto-perative treatment.

Propuesta de requisitos generales para el sistema de gestión documental de la Universidad de La Habana / Proposal of general requirements for the document management system at the University of Havana

El objetivo de la presente investigación fue proponer una especificación de requisitos generales para el sistema de gestión documental de la Universidad de La Habana consecuente con un ejercicio de gobierno más responsable, abierto, transparente e inclusivo, con un enfoque orientado a la rendición de cuentas y a un mayor control social. La investigación presentó un diseño descriptivo y un enfoque mixto, con predominio cualitativo. Para contribuir al desarrollo de un sistema de información que creara capacidades sobre la base de información de calidad en esta institución, el estudio se basó en la triangulación de dos metodologías: una desde el dominio de la gestión documental y otra desde la ingeniería de requisitos. Como resultado, se presentaron 22 elementos y 201 requisitos, entre funcionales y no funcionales, con un carácter flexible y modular, que deben ser establecidos para el funcionamiento efectivo del sistema de gestión documental de esta Universidad(AU)

The purpose of the study was to propose a general requirements specification for the document management system at the University of Havana, in keeping with more responsible, open, transparent and inclusive governance, an accountability-oriented approach and greater social control. The research had a descriptive design, a mixed approach and qualitative predominance. To contribute to the development of an information system which would build capacities on the basis of quality information in this institution, the study was based on the triangulation of two methodologies: one from the document management domain and the other from requirements engineering. As a result, 22 items and 201 requirements were presented, both functional and non-functional, of a flexible and modular nature, which should be established for the effective operation of the document management system at this university(AU)

Large non-functional adrenocortical oncocytoma with uncertain malignant potential: case report and review of literature

Adrenocortical oncocytomas are a very rare group of adrenal tumors. Unless functional, these tumors are incidentally diagnosed for clinical manifestations that are unrelated to the adrenal gland. The majority of these oncocytomas are benign and nonfunctional. Very few cases of uncertain malignant potential are reported. Here we present such a rare case of a 60 years old man presenting with voiding lower urinary tract symptoms but on contrast enhanced computed tomography (CECT) abdomen and pelvis a fairly large well defined heterogeneously enhancing retroperitoneal mass lesion with calcifications in the left anterior pararenal space (measuring 10.8×9.7×9 cm) was detected. On excision a well encapsulated solid mass of size approximately 12×10×9 cm was present in left suprarenal region. Histopathological examination confirmed the diagnosis of adrenocortical oncocytoma with uncertain malignant potential. As the incidence of adrenal oncocytoma is less, the knowledge regarding its clinical pattern, confirmatory imaging or histopathological diagnostic tools and chances of recurrence or turning malignant is limited.

Analysis of the clinical features of 20 cases of non-functioning pancreatic neuroendocrine tumors / 中国医师进修杂志

Objective To investigate the clinical features of non- functioning pancreatic neuroendocrine tumors and to summarize experiences in the diagnosis and treatment. Methods The clinical pathology and follow-up data of 20 patients with non-functioning pancreatic neuroendocrine tumors treated in Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, from January 2008 to February 2018 were retrospectively analyzed. Results Among the 20 patients, 9 patients (9/20) were asymptomatic, and the tumor was found unexpectedly by physical examination. Eleven patients (11/20) with symptoms were admitted to the hospital due to non-specific gastrointestinal symptoms or compression symptoms caused by tumor space occupying. None of the patients had endocrine disorders. There were nineteen patients who received surgical treatment. According to the grading system, there were 7 patients (7/19) with G1, and 12 patients (12/19) with G2 . Among the 14 patients with diameter of tumor greater than 2 cm, there are 4 patients (4/14) with lymph node metastasis, and 4 patients (4/14) with liver metastasis. Five patients with diameter of tumor less than or equal to 2 cm had no distant metastasis. Conclusions NF-pNETs is often with nonspecific symptoms. Imaging examination is an important diagnostic method. Operation is the primary therapy for NF-pNETs. Because most of the small NF-pNETs with no symptoms are benign and grow slowly, and the metastatic rate is very low. It is important to weigh the pros and cons of surgical treatment for these patients.

Surgical treatment of non-functional pancreatic neuroendocrine neoplasms / 中国实用外科杂志

The incidence of non-functional pancreatic neuroendocrine neoplasms(NF-pNENs)constantly increases due to the development of imaging techniques and the popularity of routine medical examination.WHO classification system,ENETS and AJCC grading systems,widely used in clinical practice,are independent prognostic factors.According to the G grading system,NF-pNENs are classified into benign,low-grade malignant and high-grade malignant tumors.Operative indications and treatments are absolutely different for each subgroup.Lymph node metastasis closely correlates with the position and size of tumor,lymphovascular invasion and Ki-67 index.Pre-operative determination of the presence of lymph node metastasis provides significant instructions for the choice of surgery since it indicates early tumor relapse and metastasis.The advance of ultrasoundguide biopsy provides more sensitive indictors for preoperative pathological grade and lymph node metastasis.Both domestic and foreign guidelines consider the tumor size as the critical factors for surgery.For those NF-pNENs2 cm,even with local vascular and organs invasion,a routine pancreatic surgery is recommended(distal pancreatectomy or pancreatic duodenectomy according to the tumor position).Lymph node sampling or regional lymphadenectomy should be routinely performed during surgeries.For those with liver metastasis,surgical resection,locoregional ablative therapy or liver transplantation is suggested according to the situation of metastatic sites.

Item analysis of multiple choice questions of undergraduate pharmacology examinations in a medical college in Belagavi, Karnataka, India

Background: Multiple choice questions (MCQs) are a common method of assessment of medical students. The quality of MCQs is determined by three parameters such as difficulty index (DIF I), discrimination index (DI), and Distractor efficiency (DE). Item analysis is a valuable yet relatively simple procedure, performed after the examination that provides information regarding the reliability and validity of a test item. The objective of this study was to perform an item analysis of MCQs for testing their validity parameters.Methods: 50 items consisting of 150 distractors were selected from the formative exams. A correct response to an item was awarded one mark with no negative marking for incorrect response. Each item was analysed for three parameters such as DIF I, DI, and DE.Results: A total of 50 items consisting of 150 Distractor s were analysed. DIF I of 31 (62%) items were in the acceptable range (DIF I= 30-70%) and 30 had ‘good to excellent’ (DI >0.25). 10 (20%) items were too easy and 9 (18%) items were too difficult (DIF I <30%). There were 4 items with 6 non-functional Distractor s (NFDs), while the rest 46 items did not have any NFDs.Conclusions: Item analysis is a valuable tool as it helps us to retain the valuable MCQs and discard or modify the items which are not useful. It also helps in increasing our skills in test construction and identifies the specific areas of course content which need greater emphasis or clarity.

Item analysis to identify quality multiple choice questions/items in an assessment in Pharmacology of II MBBS students in Guntur Medical College of Andhra Pradesh, India

Background: In medical education, multiple choice questions/Items are the more frequently used assessment tools to assess the knowledge abilities and skills of medical students, for being their objectivity, wide coverage in less time. However only the Quality Items gives a valid and reliable assessment. The quality of an Item is determined by difficulty index (DIF I), Discrimination Index (DI) and Distractor efficiency (DE). Aim of the study was to know the quality of Items in pharmacology by Item analysis and to develop a MCQs bank with quality Items.Methods: The present study was conducted on 150 II MBBS students of Guntur Medical College, AP, India. A class test containing 50 Items with 150 distractors from topic chemotherapy was conducted. Item with the correct choice/response was awarded with one mark and with the wrong choice zero marks, no negative marks. Each test Item was analysed with DIF I, DI and DE and the results were tabulated and tested statistically, with unpaired "t" test.Results: Mean DIF I, DI, DE values with standard deviations in the present study are 44.72+17.63%, 0.30+0.12%, 84.48+24.65 respectively. DIF I of 32 (64%) items was good to excellent range (31%-60%) 9 (18%) Items were easy (>61%) and 9(18%) Items were difficult (>30%). DI of 10 (20%) Items was good (0.15 to 0.24.) 29 (58%) Items were excellent with DI > 0.25 and 11 (22%) Items were poor with DI <0.15. Among 150 distractors, 127 (85%) were functional distractors (FDs) and 23 (15%) were non-functional distractors (NFDs). DE of 33 (66%) items with nil NFDs was 100%, for 12 (24%) Items with one NFD, was 66.6%, for 4 (8%) items with 2 NFDs was 33.3% and for 1 (2%) Item with 3NFDs DE was 0%. When unpaired "t" test was applied to the means of "difficult" and "easy" Items, 96.22+11.33% SD, 51.44+29.31% SD respectively, the p-value obtained was 0.00058, which was highly significant.Conclusions: The study showed that Item analysis is a valid tool to identify quality Items, which assess, the students� knowledge abilities and discriminate different levels of performance abilities of students effectively.

Diagnosis and treatment of 3 cases of typical nonfunctional pancreas neuroendocrine tumor / 天津医药

@#Non-functional pancreatic neuroendocrine tumors (NF-PNETs) are rare in clinic. In this paper, three cases of typical NF-PNETs patients with pathological diagnosis in Tianjin First Central Hospital from July 2012 to February 2017 were analyzed retrospectively. The clinical manifestations, pathological and immunohistochemical features, diagnosis and treatment and prognosis of NF-PNETs were discussed.

Clinical analysis of bilateral macronodular adrenal hyperplasia / 中华内分泌代谢杂志

Objective To investigate the clinical characteristics in patients with bilateral macronodular adrenal hyperplasia ( BMAH). Methods We enrolled 357 patients with adrenal tumors including 42 BMAH, 167 cortisol-producing adrenal adenoma (CPA), and 148 non-functional adenomas (NFA). The clinical manifestations, hormonal explorations and complications were compared among groups. Results (1) Age at diagnosis of BMAH group was significantly higher than that of CPA group [(53.7±8.3 vs 41.1±13.1)years], female proportion of BMAH group was lower that that of CPA group(54.8%vs 88.0%, P＜0.01). Both were similar to NFA group. (2) Compared to NFA group, metabolic abnormalities were severer in BMAH and CPA groups. Prevalence of hypertension, diabetes mellitus, and hypokalemia were the highest in BMAH group. ( 3) BMAH patients had lower midnight serum cortisol, 24 hour urine free cortisol, and adrenocorticotrophic hormone levels than CPA patients (P＝0.008, 0.010, and P＝0.001, respectively). The suppression rate of serum cortisol after low-dose dexamethasone suppression test was significantly higher in BMAH group ( P＝ 0. 005). Conclusion BMAH patients were at higher age at diagnosis. Although hypercortisolism in BMAH patients is relatively slight, metabolic abnormalities are more severe. Besides functional diagnosis, physicians should pay more attention to the assessment of complications related to hypercortisolism.

Item Analysis, Reliability Statistics And Standard Error Of Measurement To Improve The Quality And Impact Of Multiple Choice Questions In Undergraduate Medical Education In Faculty Of Medicine At Unisza

Multiple-choice question as one best answer (OBA) is considered as a more effective tool to test higher order thinking for its reliability and validity compared to objective test (multiple true and false) items. However, to determine quality of OBA questions it needs item analysis for difficulty index (PI) and discrimination index (DI) as well as distractor efficiency (DE) with functional distractor (FD) and non-functional distractor (NFD). However, any flaw in item structuring should not be allowed to affect students’ performance due to the error of measurement. Standard error of measurement (SEM) to calculate a band of score can be utilized to reduce the impact of error in assessment. Present study evaluates the quality of 30 items OBA administered in professional II examination to apply the corrective measures and produce quality items for the question bank. The mean (SD) of 30 items OBA = 61.11 (7.495) and the reliability (internal consistency) as Cronbach’s alpha = 0.447. Out of 30 OBA items 11(36.66%) with PI = 0.31-0.60 and 12 items (40.00%) with DI = ≥0.19 were placed in category to retain item in question bank, 6 items (20.00%) in category to revise items with DI ≤0.19 and remaining 12 items (40.00%) in category to discard items for either with a poor or with negative DI. Out of a total 120 distractors, the non-functional distractors (NFD) were 63 (52.5%) and functional distracters were 57 (47.5%). 28 items (93.33%) were found to contain 1- 4 NFD and only 2 (6.66%) items were without any NFD. Distracter efficiency (DE) result of 28 items with NDF and only 2 items without NDF showed 7 items each with 1 NFD (75% DE) and 4 NFD (0% DE), 10 items with 2 NFD (50% DE) and 4 items with 3 NFD (25% DE). Standard error of measurement (SEM) calculated for OBA has been ± 5.51 and considering the borderline cut-off point set at ≥45%, a band score within 1 SD (68%) is generated for OBA. The high frequency of difficult or easy items and moderate to poor discrimination suggest the need of items corrective measure. Increased number of NFD and low DE in this study indicates difficulty of teaching faculty in developing plausible distractors for OBA question. Standard error of measurement (SEM) should be utilized to calculate a band of score to make logical decision on pass or fail of borderline students.

Modified Right Ventricular Obliteration Technique for Fontan Candidates with Non-functional Right Ventricle / 日本心臓血管外科学会雑誌

<b>Introduction</b> : Right atrial (RA) and right ventricular (RV) dilatation that are associated with severe tricuspid regurgitation, and severe high RV pressure that is associated with pulmonary atresia and intact ventricular septum cause left ventricular (LV) dysfunction and hypoplastic lung. We have applied a modified RV obliteration technique that excludes non-functional enlarged RV for these diseases. <b>Objectives</b> : To evaluate the efficacy of our procedure. <b>Methods and Results</b> : Five patients (six operations) underwent the procedure without complications. Cardiothoracic ratio significantly decreased from 71±10% to 61±5% (<i>p</i>=0.017), and fractional shortening ended to increase from 27±17% to 37±5% (<i>p</i>=0.071). All of them achieved Fontan completion finally. One patient who underwent this procedure as a neonate experienced RV re-dilation 19 months later. He additionally received the same procedure in a Fontan operation, and then RV reduced again and good LV function was maintained. <b>Conclusion</b> : The application of modified RV obliteration technique is effective for Fontan candidates with nonfunctional RV.

Clinical and pathological features of nonfunctional pituitary adenomas: Analysis of 220 cases / 中华内分泌代谢杂志

A retrospective analysis was carried out in 220 cases of nonfunctional pituitary adenoma (NFA).The diagnosis was based on negative immunohistochemical staining,no elevation of plasma hormone level,and no symptom caused by increased hormone level.Incidence of NFA was the highest(33.13％) among the pituitary tumors.It was more common in males than in females (132 ∶ 88).The highest prevalence resided in the elder group.N FA often caused pituitary apoplexy,and mainly presented as compression symptoms including visual field abnormalities (85.00％),headache (80％),hypopsia (68.66％),and other symptoms of hypopituitarism (44.04％).Imaging features showed tumor size usually within 2-4 cm (71.82％),and aggregated degree Ⅲ or Ⅳ (83.64％).

Nonfunctional islet cell tumor: a report on 26 cases and review of the literature / 中华肝胆外科杂志

Objective To review our experience in the diagnosis and treatment of nonfunctional islet cell tumors(NICT).Method The clinicopathological data of 26 cases of NICT were retrospectively analysed and the medical literature was reviewed.Results In addition to the 26 cases seen in our center,there were 569 cases published in 37 articles in the medical literature.In China,NICT was more common in women.The male to female ratio was about 3 ∶ 7.The mean age of onset of the disease was 35 years old.Most NICT were solitary and malignant,surgery was effective in prolonging long-term survival.Conclusions NICT is rare and it had no specific clinical presentation.BUS and CT are useful for diagnosis and surgery is effective.

Clinical efficacy evaluation of retroperitoneal and transperitoneal laparoscopic nephrectomy for nonfunctional kidney with giant hydronephrosis / 中国医师进修杂志

Objective To evaluate the technical feasibility and clinical efficacy of retroperitoneal and transperitoneal laparoscopic nephrectomy for nonfunctional kidney with giant hydronephrosis. Methods The clinical data of retroperitoneal group (26 patients) and transperitoneal group (23 patients) who underwent laparoscopic nephrectomy for nonfunctional kidney with giant hydronephrosis were analyzed retrospectively. Compared with operating time,kidney size, blood loss, postoperative intestinal function recovery time, postoperative hospital stay and operative efficacy of the two groups. Results All the operations were performed successfully. Operating time,kidney size and blood loss were not significantly different between two groups(P＞ 0.05). While in retroperitoneal group, postoperative intestinal function recovery time and postoperative hospital stay were significantly reduced than those in transperitoneal group [( 18.0 ± 1.2)h vs. (48.0 ±2.0) h, (5.5± 1.6) d vs. (7.5 ± 1.6) d](P＜0.05). All patients were followed up 1 -3months,no abnormal. Conclusions The retroperitoneal and transperitoneal laparoscopic nephrectomy for nonfunctional kidney with giant hydronephrosis can be performed efficiently and effectively. Retroperitoneal laparoscopic is better than transperitoneal laparoscopic on postoperative recovery aspects.

Nonfunctional Parathyroid Carcinoma: A Case Report / 대한방사선종양학회지

Parathyroid carcinoma is a rare endocrine malignancy accounting for 0.5% to 4.0% of all cases of hyperparathyroidism and commonly present as hypercalcemia and parathyroid hormone (PTH) elevation. Nonfunctional parathyroid carcinoma does not show symptoms of hyperparathyroidism and only showed a vague indication of being pathologic, even when detected late. The optimal treatment is en bloc resection of the cancer, but frequent local recurrence after surgery has been reported. Adjuvant local treatment such as radiotherapy may improve the likelihood local control in cases with incompletely resected or microscopic residual tumor. The results of this study point to a case of nonfunctional parathyroid carcinoma treated by external beam radiotherapy after en-bloc resection of cancer.

Histomorphometric analysis of an immediate non-functional loaded implant in dogs

The purpose of this study was to investigate the effects of immediate non-functional loading by analyzing histomorphology around the implant tissues in dogs. Five eight- to nine-month-old full-grown dogs weighing around 12 kg were used in the study. Group I (control group) comprised those in which delayed loading was applied to the right side of the mandible, and Group II (experimental group) consisted of dogs in which immediate loading was performed on the left side of the mandible. Resorbable blast media (RBM)-treated double-threaded US III implants measuring 3.5 mm in diameter and 11 mm long were used in the study. Each animal received four implants in each group, for a total of 40 implants. Cemented type abutments were used after implantation. An 8-week period was allowed for bone healing and an abutment was placed after exposing the periosteum for loading. An implant sample was obtained from bone blocks taken when the dogs were killed at 16 weeks after loading. A Mann-Whitney U-test was performed to evaluate statistical significance. Student's t-test was used for the histological evaluation. The bone formation ratio in Groups 1 and 2 was 88.23 and 86.41%, respectively. No significant difference in new bone formation was observed in the two groups. As no significant difference was seen in new bone formation between the delayed and immediate loading groups, early loading might be possible after implant placement.

Nonfunctional malignant adrenal tumor(report of 12 cases) / 中华泌尿外科杂志

Objective To review the clinical features,diagnosis,management and prognosis of patients with nonfunctional malignant adrenal tumors. Methods 12 patients admitted with nonfunctional malignant adrenal tumors from 1990 to 2000 were reviewed.Among them 6 cases had symptoms of fever,ostealgia,etc.The tumor measured 3 cm in 1 case,5 to 10 cm in 9 cases and more than 10 cm in 2 cases.Ten cases developed local invasion and (or) matastasis. Results Five cases underwent tumor excision or enucleation and 5 underwent biopsy only.Of these 10 cases,4 were pathologically diagnosed as cortical adenocarcinoma,4 as metastatic carcinoma,1 as mucous liposarcoma and 1 as lymphoma.The remaining 2 cases had no operation.One case died during hospital stay.Ten cases died within 2 years.One case of adrenocortical carcinoma experienced relapse 3 years after initial operation and died next year. Conclusions Nonfunctional malignant adrenal tumor is rare and difficult to diagnosis in early stage,indicating an extremely poor prognosis.Tumor diameter is an important factor to be considered regarding surgical indication.

MRI follow-up after transsphenoidal surgery in patients with nonfunctional pituitary macroadenoma / 中国微创外科杂志

Objective To study the optimal time of MRI follow-up after transsphenoidal surgery in patients with nonfunctional pituitary macroadenoma. Methods MRI records of 50 patients before surgery,within 1 postoperative week (early stage),at 3 months (intermediate stage) and 1 year after surgery (late stage),respectively,were retrospectively analyzed.Dynamic changes in the sella turcica were observed and the degrees of tumor excision were studied before and after MRI T 1-weighted enhanced scans at different postoperative stages. Results In the early stage MRI images showed that the size of sellar contents decreased by 8%～32%,tumor disappeared in 22 cases,and suspected residual tumor was found in 28 cases.At 3 months after surgery,MRI scans revealed that sellar contents decreased by 11%～85% in size.On coronal position MRI scans,the size of sellar contents decreased more than 50% in 11 cases,30%～50% in 9 cases,less than 30% in 8 cases.Out of the 28 cases that were suspected of residual tumor in the early stage,confirmation of residual tumor in the sella turcica was made in 23 cases.MRI findings 1 year after surgery showed no change in the sella turcica in 46 cases and continuing to decrease in 4 cases. Conclusions Re-examination of MRI in intermediate stage after transsphenoidal surgery in patients with nonfunctional pituitary macroadenoma facilitates the detection of residual tumor and recurrence.

Increased levels of multiple forms of dihydrofolate reductase in peripheral blood leucocytes of cancer patients receiving haematopoietic colony-stimulating factors: interim analysis

The precise mechanism whereby granulocytes proliferate when haematopoietic colony stimulating factors (CSFs) are used in neutropenic cancer patients is poorly understood. The purpose of this study was to investigate whether these cytokines bring about leucocyte proliferation by increasing the levels of multiple forms of dihydrofolate reductase (DHFR). Blood samples were collected from 36 cancer patients (25 males and 11 females) with chemotherapy-induced neutropenia. One sample of blood from each patient was obtained before therapy either with CSF, such as granulocyte colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF) or with placebo, and another one at the time of resolution of neutropenia. Peripheral blood leucocytes in these blood samples were counted, separated and lysed. From lysates, cytoplasmic samples were prepared and analyzed for active DHFR by a methotrexate-binding assay and for total immunoreactive DHFR by an enzyme linked immunosorbent assay. The increase in total leucocyte count (TLC) was most prominent (P < 0.005) in the CSF group and less so (P < 0.05) in the placebo group. The mean +/- SD concentration values of active DHFR before and after stimulation with GM-CSF found were to be 0.34 +/- 0.4 ng/mg protein and 0.99 +/- 0.82 ng/mg protein, respectively, and in the group treated with G-CSF, 0.24 +/- 0.32 ng/mg protein and 1.18 +/- 2.4 ng/mg protein, respectively. This increase in active DHFR after stimulation with CSF was statistically significant (P <0.05). Similarly, concentration values of immunoreactive but nonfunctional form of DHFR (IRE) were 110 +/- 97 ng/mg protein and 605 +/- 475 ng/mg protein before and after stimulation with GM-CSF, and 115 +/- 165 ng/mg protein and 1,054 +/- 1,095 ng/ mg protein before and after stimulation with G-CSF. This increase in concentration of IRE after stimulation with GM-CSF or G-CSF was statistically significant (P < 0.005). In the control group, there was an increase in the concentration of both active DHFR and IRE after treatment with placebo. However, this was not statistically significant. Resolution of neutropenia was quicker in the groups treated with CSF compared to the control group. Results of this study indicate that colony stimulating factors (G-CSF and GM-CSF) induce white cell proliferation by increasing the levels of multiple forms of DHFR.

CT diagnosis of non-functional islet cell tumor / 中国普通外科杂志

Objective To explore the CT manifestations of non-functional islet cell tumor(NFICT)Methods The findings of plain and enhancement CT scanning from 17 cases with NFICT,which were confirmed by the surgeries and pathological sections,were analyzed retrospectively.Ninty ml of non-ioniodine contrast reagent with 3ml/s injection flow rate was employed as the enhancer for measuring the arteriovenous double phase CT value of the pancreas and tumor.Results Tumors were found in all the cases who received CT scan.Compared with pancreatic substance in the CT plain scan,tumors with low density were found in 2 cases,tumors with mixed low density in 11 cases and tumors with isodensity in 4 cases.Local calcification in tumor was found in 5 cases.Various degrees of strengthening were showed in 17 cases with enhancement scanning.Obvious enhancement in arterial phase presented in 5 cases,moderate enhancement in 6 cases and slight enhancement in 6 cases.Conclusions CT plain scan of NFICT shows that the tumor margins are clear and some tumors have calcification.All tumors in the CT enhancement scanning show various degrees of enhancement,the persistent enhancement from arterial phase to portal vein phase is the characteristic manifestation of NFICT.