North American journal of medicine & science最新文献

英文中文

CD5-positive, Small B-Cell Lymphoproliferative Disorders: Aberrant Findings of CLL/SLL and MCL cd5阳性，小b细胞淋巴增生性疾病:CLL/SLL和MCL的异常发现

North American journal of medicine & science

Pub Date : 2010-10-31 DOI: 10.7156/V3I4P181

Youjun Hu, M. Golightly

Most common CD5-positive, small B cell lymphoproliferative disorders include chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and mantle cell lymphoma (MCL). Among these cases, atypical morphology, immunophenotype, and/or cytogenetic abnormalities are not uncommon. As an aberrant marker, CD5 expression is not limited to the cells of CLL/SLL or MCL and has been found in other B cell lymphomas ( both low grade and more aggressive types). CD5-negative CLL/SLL and MCL also are well documented, as are reports of other aberrant immunophenotypes of CLL/SLL and MCL. In addition, monoclonal B-cell lymphocytosis (MBL) of unknown significance has recently been reported in otherwise healthy individuals. We review here the findings that do not fulfill the current definitions of CLL/SLL or MCL. It is imperative that a pathologist should be familiar with these aberrant findings when considering CLL/SLL or MCL as a possible diagnosis. Furthermore, these aberrant findings may be clues to further understanding these entities .

最常见的cd5阳性小B细胞淋巴增生性疾病包括慢性淋巴细胞白血病/小淋巴细胞淋巴瘤(CLL/SLL)和套细胞淋巴瘤(MCL)。在这些病例中，非典型形态、免疫表型和/或细胞遗传学异常并不罕见。作为一种异常标志物，CD5的表达不仅局限于CLL/SLL或MCL细胞，而且在其他B细胞淋巴瘤(包括低级别和更具侵袭性的类型)中也有表达。cd5阴性的CLL/SLL和MCL也有很好的文献记载，CLL/SLL和MCL的其他异常免疫表型也有报道。此外，单克隆b细胞淋巴细胞增多症(MBL)的未知意义最近已报道在其他健康个体。我们在这里回顾了不符合CLL/SLL或MCL当前定义的研究结果。当考虑将CLL/SLL或MCL作为可能的诊断时，病理学家必须熟悉这些异常的发现。此外，这些异常的发现可能是进一步了解这些实体的线索。

引用次数: 1

A New Connection: Myeloid Mineralocorticoid Receptor and Cardiovascular Disease 髓系矿物皮质激素受体与心血管疾病的新联系

North American journal of medicine & science

Pub Date : 2010-10-31 DOI: 10.7156/V3I4P167

S. Duan, R. Mortensen

Mineralocorticoid Receptor (MR) is a classic steroid hormone receptor. Its traditional role is to mediate aldosterone to control electrolyte homeostasis and blood pressure via renin-angiotensin system. Besides aldosterone, MR can also bind to glucocorticoids. In aldosterone sensitive tissues such as kidney, 11β-hydroxysteroid dehydrogenase type 2 (11βHSD2) inactivates glucocorticoids and makes MR binding to aldosterone possible. In tissues lack 11βHSD2, MR is presumably occupied by glucocorticoids. The functions of MR in these tissues are largely unknown. Randomized Aldactone Evaluation Study (RALES) and Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) successfully demonstrated cardiovascular benefits of blocking MR with antagonists. However, the mechanisms have not been clearly delineated. Macrophage polarization, a phenotype that macrophages polarize to distinct functional states such as classically activation and alternatively activation, has emerged as an important control element in cardiovascular diseases (CVD). Recent studies have shown that MR controls macrophage polarization and that deletion of MR in myeloid cells protects cardiac and vascular damages under pathological stress. These studies present a great opportunity for developing new antagonists to target myeloid MR specifically in order to improve specificity and effectiveness of this class of drug in CVD.

矿物皮质激素受体(MR)是一种典型的类固醇激素受体。其传统作用是通过肾素-血管紧张素系统介导醛固酮控制电解质稳态和血压。除了醛固酮，MR还能与糖皮质激素结合。在醛固酮敏感组织如肾脏中，11β-羟基类固醇脱氢酶2型(11βHSD2)使糖皮质激素失活，使MR与醛固酮结合成为可能。在缺乏11βHSD2的组织中，MR可能被糖皮质激素占据。MR在这些组织中的功能在很大程度上是未知的。随机Aldactone评估研究(RALES)和Eplerenone急性心肌梗死后心力衰竭疗效和生存研究(EPHESUS)成功证明了拮抗剂阻断MR对心血管的益处。然而，其机制尚未被明确描述。巨噬细胞极化是一种巨噬细胞极化到不同功能状态(如经典激活和选择性激活)的表型，已成为心血管疾病(CVD)的重要控制因素。最近的研究表明，MR控制巨噬细胞极化，髓细胞中MR的缺失可以保护病理性应激下的心脏和血管损伤。这些研究为开发新的靶向髓系MR的拮抗剂提供了一个很好的机会，以提高这类药物在CVD中的特异性和有效性。

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引用次数: 1

Oncocytoma of the Parotid Gland and its Mimickers: A Comprehensive Review 腮腺嗜瘤细胞瘤及其拟态细胞:综述

North American journal of medicine & science

Pub Date : 2010-10-31 DOI: 10.7156/V3I4P171

S. Prabakaran, Frank Chen, A. Aguirre

Oncocytomas are benign neoplasms composed of oncocytes; the large eosinophilic cuboidal to columnar cells with more than 60% of their cytoplasm occupied by mitochondria. Oncocytomas represent less than 1% of the salivary gland neoplasms and 82% to 90% of them occur in the parotid gland. Salivary gland oncocytomas constitute 2.5% of the parotid gland tumors. Despite the well-recognized morphology of this tumor, there is a wide range of neoplasms that may mimic oncocytoma and hence need to be considered in its differential diagnosis. A predominantly clear cell variant of oncocytoma may resemble a number of salivary gland neoplasms where clear cells may be prominent. In addition, oncocytic metaplasia may be a focal or an extensive component of other distinct salivary gland neoplasms. An awareness of all the possible “mimickers” of clear cell oncocytoma becomes more significant in view of the fact that most are malignant neoplasms with a poor prognosis.

嗜瘤细胞瘤是由嗜瘤细胞组成的良性肿瘤;大的嗜酸性立方到柱状细胞，其细胞质的60%以上被线粒体占据。肿瘤细胞瘤占唾液腺肿瘤的不到1%，其中82%至90%发生在腮腺。涎腺癌细胞瘤占腮腺肿瘤的2.5%。尽管这种肿瘤的形态得到了广泛的认可，但仍有许多肿瘤可能与嗜瘤细胞瘤相似，因此需要在鉴别诊断中加以考虑。癌细胞瘤的主要透明细胞变体可能类似于许多唾液腺肿瘤，其中透明细胞可能突出。此外，嗜酸细胞化生可能是其他不同的唾液腺肿瘤的局灶性或广泛组成部分。鉴于大多数透明细胞癌是预后不良的恶性肿瘤，对所有可能的“模仿者”的认识变得更加重要。

引用次数: 22

Characterization of Lung Cancer: A 10-Year Experience from a Tertiary Hospital in Yaounde, Cameroon 肺癌的特征:喀麦隆雅温得一家三级医院的10年经验

North American journal of medicine & science

Pub Date : 2010-10-31 DOI: 10.7156/V3I4P208

E. Bell, P. Ndom, Albertine Eloundou, Germaine Um, G. E. Orock, A. Doh, D. Huo

The incidence rate of lung cancer in Africa is low. However, there are few studies reporting clinical characteristics of lung cancer in African countries. We did a study of lung cancer at the Medical Oncology Service of the Yaounde General Hospital, Cameroon, from January 1998 to December 2007. Out of the 2,355 cancer patients seen at this hospital over a 10-year period, 48 patients (28 men and 20 women) were diagnosed with lung cancer. The average age (SD) of patients was 53 (13) years and ranged from 25 to 80 years. Seven patients were cigarette smokers. The median duration from initial symptoms to visiting doctors was 5 months (interquartile range: 3-11 months). The most common histology types were squamous cell carcinomas (31, 65%), followed by adenocarcinomas (8, 17%), large cell carcinomas (4, 8%), small cell carcinomas (4, 8%), and fibrosarcoma (1, 2%). Of the 19 patients with stage classification, 8 had stage IV and 11 had stage III disease. Only 14 patients reported having received treatment, including chemotherapy, radiotherapy, and/or surgery. In conclusion, lung cancer was uncommon in Yaounde, Cameroon, but most of patients presented with advanced stage due to long delay in seeking diagnosis. Less than half of the patients received chemotherapy, radiotherapy, or surgery.

非洲的肺癌发病率很低。然而，很少有研究报道非洲国家肺癌的临床特征。1998年1月至2007年12月，我们在喀麦隆雅温得总医院内科肿瘤科做了一项肺癌研究。10年间，在该医院就诊的2355名癌症患者中，有48名患者(28名男性，20名女性)被诊断为肺癌。患者平均年龄(SD)为53(13)岁，年龄范围为25 ~ 80岁。7例患者吸烟。从出现症状到就诊的中位持续时间为5个月(四分位数范围:3-11个月)。最常见的组织学类型是鳞状细胞癌(31.65%)，其次是腺癌(8.17%)、大细胞癌(4.8%)、小细胞癌(4.8%)和纤维肉瘤(1.2%)。在19例分期患者中，8例为IV期，11例为III期。只有14例患者报告接受了治疗，包括化疗、放疗和/或手术。综上所述，肺癌在喀麦隆雅温得并不常见，但由于就诊时间长，大多数患者表现为晚期。不到一半的患者接受了化疗、放疗或手术。

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引用次数: 0

Plasma Amyloid-β Peptides and Homocysteine in Depression in the Homebound Elderly. 血浆淀粉样蛋白-β肽和同型半胱氨酸在居家老年人抑郁症中的作用。

North American journal of medicine & science

Pub Date : 2010-04-30 DOI: 10.7156/V3I1P061

W. Qiu, Xiaoyan Sun, D. M. Mwamburi, Jacqueline Haker, David K. Lisle, A. Rizal, Yu-Min Lin, L. Qiao, P. Summergrad, M. Folstein, I. Rosenberg

OBJECTIVESBoth plasma amyloid-β peptide 40 (Aβ40) and homocysteine (tHcy) are linked to vascular disease, which is related to depression in the elderly. We sought to study whether the relationship between tHcy and plasma Aβ40 differs in those with and without depression.STUDY DESIGN AND METHODSIn a cross-sectional study of 1058 homebound elders, vascular depression was defined as a score ≥ 16 on the Center for Epidemiological Studies Depression scale (CES-D) along with self-reported cardiovascular disease (CVD). Plasma Aβ40 and Aβ42, and serum tHcy and creatinine were measured.RESULTSElders with high tHcy had higher concentrations of plasma Aβ40 (median: 147.5 vs. 123.1 pg/ml, P < 0.0001) and Aβ42 (median: 20.2 vs. 16.6 pg/ml, P < 0.0001) than those with low tHcy. In elders with depression, the relationship between logarithm of plasma Aβ40 (LogAβ40), but not LogAβ42, and tHcy was significant (β = +0.010, SE = 0.004, P = 0.007); in contrast, this relationship was not observed in those without depression. Subjects with vascular depression had the highest concentration of tHcy (mean ± SD: 12.8 ± 4.6 vs. 11.7 ± 4.5 vs. 11.9 + 5.5, P = 0.008) compared to those without CVD and those without depression. Depressed subjects without CVD had the lowest concentration of plasma Aβ42 (median: 15.5 vs. 19.1 vs. 18.7, P = 0.01) compared to those with CVD and those without depression.CONCLUSIONSVascular depression, which is associated with tHcy and Aβ40 in blood, appears to be different from depression that is associated with low plasma Aβ42. This suggests that reducing tHcy and Aβ40 may be an adjunct treatment for vascular depression.

目的血浆淀粉样蛋白-β肽40 (a -β 40)和同型半胱氨酸(tHcy)均与血管疾病有关，而血管疾病与老年人抑郁症有关。我们试图研究tHcy和血浆a - β40之间的关系是否在抑郁症患者和非抑郁症患者中有所不同。研究设计与方法在一项对1058名居家老年人的横断面研究中，血管性抑郁症定义为流行病学研究中心抑郁量表(CES-D)得分≥16分，同时伴有自报心血管疾病(CVD)。测定血浆a - β40、a - β42、血清tHcy、肌酐。结果tHcy高的患者血浆Aβ40浓度(中位数:147.5 vs. 123.1 pg/ml, P < 0.0001)和Aβ42浓度(中位数:20.2 vs. 16.6 pg/ml, P < 0.0001)高于tHcy低的患者。老年抑郁症患者血浆Aβ40 (LogAβ40)的对数与tHcy的关系显著(β = +0.010, SE = 0.004, P = 0.007);相比之下，这种关系在没有抑郁症的人身上没有观察到。与无CVD和无抑郁的受试者相比，有血管性抑郁的受试者tHcy浓度最高(平均±SD: 12.8±4.6比11.7±4.5比11.9 + 5.5,P = 0.008)。无心血管疾病的抑郁症患者血浆Aβ42浓度最低(中位数:15.5 vs. 19.1 vs. 18.7, P = 0.01)。结论与血浆中tHcy和Aβ40相关的血管性抑郁与低血浆Aβ42相关的抑郁不同。这表明减少tHcy和a - β40可能是血管抑制的辅助治疗方法。

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引用次数: 1

Plasma Amyloid-β Peptides and Homocysteine in Depression in the Homebound Elderly. 居家老人抑郁症中的血浆淀粉样蛋白-β肽和同型半胱氨酸。

North American journal of medicine & science

Pub Date : 2010-04-01

Wei Qiao Qiu, Xiaoyan Sun, D Mkaya Mwamburi, Jacqueline Haker, David Lisle, Abishek Rizal, Yu-Min Lin, Liyan Qiao, Paul Summergrad, Marshal Folstein, Irwin Rosenberg

Objectives: Both plasma amyloid-β peptide 40 (Aβ40) and homocysteine (tHcy) are linked to vascular disease, which is related to depression in the elderly. We sought to study whether the relationship between tHcy and plasma Aβ40 differs in those with and without depression.

Study design and methods: In a cross-sectional study of 1058 homebound elders, vascular depression was defined as a score ≥ 16 on the Center for Epidemiological Studies Depression scale (CES-D) along with self-reported cardiovascular disease (CVD). Plasma Aβ40 and Aβ42, and serum tHcy and creatinine were measured.

Results: Elders with high tHcy had higher concentrations of plasma Aβ40 (median: 147.5 vs. 123.1 pg/ml, P < 0.0001) and Aβ42 (median: 20.2 vs. 16.6 pg/ml, P < 0.0001) than those with low tHcy. In elders with depression, the relationship between logarithm of plasma Aβ40 (LogAβ40), but not LogAβ42, and tHcy was significant (β = +0.010, SE = 0.004, P = 0.007); in contrast, this relationship was not observed in those without depression. Subjects with vascular depression had the highest concentration of tHcy (mean ± SD: 12.8 ± 4.6 vs. 11.7 ± 4.5 vs. 11.9 + 5.5, P = 0.008) compared to those without CVD and those without depression. Depressed subjects without CVD had the lowest concentration of plasma Aβ42 (median: 15.5 vs. 19.1 vs. 18.7, P = 0.01) compared to those with CVD and those without depression.

Conclusions: Vascular depression, which is associated with tHcy and Aβ40 in blood, appears to be different from depression that is associated with low plasma Aβ42. This suggests that reducing tHcy and Aβ40 may be an adjunct treatment for vascular depression.

研究目的血浆淀粉样β肽40（Aβ40）和同型半胱氨酸（tHcy）都与血管疾病有关，而血管疾病又与老年人抑郁症有关。我们试图研究 tHcy 和血浆 Aβ40 之间的关系在抑郁症患者和非抑郁症患者中是否存在差异：在一项对 1058 名居家老人进行的横断面研究中，血管性抑郁症的定义是流行病学研究中心抑郁量表（CES-D）得分≥ 16 分，同时自述患有心血管疾病（CVD）。对血浆Aβ40、Aβ42、血清tHcy和肌酐进行了测定：高tHcy老人的血浆Aβ40（中位数：147.5 vs. 123.1 pg/ml，P < 0.0001）和Aβ42（中位数：20.2 vs. 16.6 pg/ml，P < 0.0001）浓度高于低tHcy老人。在患有抑郁症的长者中，血浆 Aβ40 的对数（LogAβ40）与 tHcy 之间的关系显著（β = +0.010，SE = 0.004，P = 0.007），而在非抑郁症患者中则没有这种关系。与无心血管疾病和无抑郁症的受试者相比，血管性抑郁症受试者的 tHcy 浓度最高（平均值±标度：12.8 ± 4.6 vs. 11.7 ± 4.5 vs. 11.9 + 5.5，P = 0.008）。与有心血管疾病和无抑郁症的受试者相比，无心血管疾病的抑郁症受试者血浆Aβ42浓度最低（中位数：15.5 vs. 19.1 vs. 18.7，P = 0.01）：结论：血管性抑郁症与血液中的tHcy和Aβ40有关，似乎不同于与低血浆Aβ42有关的抑郁症。这表明，降低 tHcy 和 Aβ40 可能是治疗血管性抑郁症的辅助疗法。

{"title":"Plasma Amyloid-β Peptides and Homocysteine in Depression in the Homebound Elderly.","authors":"Wei Qiao Qiu, Xiaoyan Sun, D Mkaya Mwamburi, Jacqueline Haker, David Lisle, Abishek Rizal, Yu-Min Lin, Liyan Qiao, Paul Summergrad, Marshal Folstein, Irwin Rosenberg","doi":"","DOIUrl":"","url":null,"abstract":"Objectives: Both plasma amyloid-β peptide 40 (Aβ40) and homocysteine (tHcy) are linked to vascular disease, which is related to depression in the elderly. We sought to study whether the relationship between tHcy and plasma Aβ40 differs in those with and without depression.Study design and methods: In a cross-sectional study of 1058 homebound elders, vascular depression was defined as a score ≥ 16 on the Center for Epidemiological Studies Depression scale (CES-D) along with self-reported cardiovascular disease (CVD). Plasma Aβ40 and Aβ42, and serum tHcy and creatinine were measured.Results: Elders with high tHcy had higher concentrations of plasma Aβ40 (median: 147.5 vs. 123.1 pg/ml, P < 0.0001) and Aβ42 (median: 20.2 vs. 16.6 pg/ml, P < 0.0001) than those with low tHcy. In elders with depression, the relationship between logarithm of plasma Aβ40 (LogAβ40), but not LogAβ42, and tHcy was significant (β = +0.010, SE = 0.004, P = 0.007); in contrast, this relationship was not observed in those without depression. Subjects with vascular depression had the highest concentration of tHcy (mean ± SD: 12.8 ± 4.6 vs. 11.7 ± 4.5 vs. 11.9 + 5.5, P = 0.008) compared to those without CVD and those without depression. Depressed subjects without CVD had the lowest concentration of plasma Aβ42 (median: 15.5 vs. 19.1 vs. 18.7, P = 0.01) compared to those with CVD and those without depression.Conclusions: Vascular depression, which is associated with tHcy and Aβ40 in blood, appears to be different from depression that is associated with low plasma Aβ42. This suggests that reducing tHcy and Aβ40 may be an adjunct treatment for vascular depression.","PeriodicalId":19338,"journal":{"name":"North American journal of medicine & science","volume":"3 2","pages":"61-67"},"PeriodicalIF":0.0,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678954/pdf/nihms314820.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31507060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Genomic Instability Induced By Human Papillomavirus Oncogenes. 人乳头瘤病毒致癌基因诱导的基因组不稳定性。

North American journal of medicine & science

Pub Date : 2010-04-01 DOI: 10.7156/v3i2p043

Jason J Chen

Cervical cancer is one of the leading causes of cancer death in women worldwide. Human papillomavirus (HPV) infection is necessary but not sufficient for the development of cervical cancer. Genomic instability caused by HPV allows cells to acquire additional mutations required for malignant transformation. Genomic instability in the form of polyploidy has been implicated in a causal role in cervical carcinogenesis. Polyploidy not only occurs as an early event during cervical carcinogenesis but also predisposes cervical cells to aneuploidy, an important hallmark of human cancers. Cell cycle progression is regulated at several checkpoints whose defects contribute to genomic instability.The high-risk HPVs encode two oncogenes, E6 and E7, which are essential for cellular transformation in HPV-positive cells. The ability of high-risk HPV E6 and E7 protein to promote the degradation of p53 and pRb, respectively, has been suggested as a mechanism by which HPV oncogenes induce cellular transformation. E6 and E7 abrogate cell cycle checkpoints and induce genomic instability that leads to malignant conversion.Although the prophylactic HPV vaccine has recently become available, it will not be effective for immunosuppressed individuals or those who are already infected. Therefore, understanding the molecular basis for HPV-associated cancers is still clinically relevant. Studies on genomic instability will shed light on mechanisms by which HPV induces cancer and hold promise for the identification of targets for drug development.

宫颈癌是全世界妇女癌症死亡的主要原因之一。人乳头瘤病毒(HPV)感染是必要的，但不是宫颈癌发展的充分条件。由HPV引起的基因组不稳定允许细胞获得恶性转化所需的额外突变。多倍体形式的基因组不稳定性与宫颈癌发生的因果关系有关。多倍体不仅作为宫颈癌发生的早期事件发生，而且还使宫颈细胞易发生非整倍体，这是人类癌症的重要标志。细胞周期进程在几个检查点受到调控，这些检查点的缺陷导致基因组不稳定。高危hpv编码两个致癌基因E6和E7，这两个基因对于hpv阳性细胞的细胞转化至关重要。高风险的HPV E6和E7蛋白分别促进p53和pRb降解的能力已被认为是HPV癌基因诱导细胞转化的机制。E6和E7取消细胞周期检查点，诱导基因组不稳定，导致恶性转化。虽然预防性HPV疫苗最近已经可用，但它对免疫抑制的个体或已经感染的人无效。因此，了解hpv相关癌症的分子基础仍具有临床意义。对基因组不稳定性的研究将揭示HPV诱导癌症的机制，并为确定药物开发的目标提供希望。

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引用次数: 33

An Aggressive Psammomatoid Ossifying Fibroma Presenting as a Sphenoethmoidal Mass 侵袭性沙瘤样骨化纤维瘤表现为蝶筛肿块

North American journal of medicine & science

Pub Date : 2010-01-31 DOI: 10.7156/V3I1P024

N. Nwizu, M. George, Frank Chen

Aggressive psammomatoid ossifying fibromas are rare, benign fibro-osseous tumors characterized by the presence of numerous calcified spherules within an actively proliferating connective tissue stroma. They are mainly seen in the sino-naso-orbital region of young individuals. CT scans tend to show a relatively well delineated heterogeneous mass with varying degrees of radiodensity depending on the amount of calcification present. As the name implies, they are prone to aggressive behavior and a high rate of recurrence. We report a case of an aggressive psammomatoid ossifying fibroma presenting as a sphenoethmoidal mass. The relevant histopathological differential diagnoses are also discussed. [N A J Med Sci. 2010;3(1):24-27.]

侵袭性沙砾样骨化纤维瘤是一种罕见的良性纤维骨性肿瘤，其特征是在活跃增生的结缔组织间质内存在大量钙化小球体。它们主要见于年轻个体的中鼻眶区。CT扫描倾向于显示一个相对清晰的非均匀肿块，其放射密度取决于存在的钙化程度。顾名思义，他们容易有攻击性行为，复发率高。我们报告一例侵袭性沙沫样骨化纤维瘤表现为蝶筛肿块。并讨论了相关的组织病理学鉴别诊断。[J] .中华医学杂志，2010;3(1):24-27。

引用次数: 8

Diagnostic Challenges of Benign Fibro-Osseous Lesions and Psammomatous Meningiomas of the Craniofacial Region: A Comparative Review of their Clinico-pathological Features 颅面区良性纤维骨性病变和沙质脑膜瘤的诊断挑战:临床病理特征的比较回顾

North American journal of medicine & science

Pub Date : 2010-01-31 DOI: 10.7156/V3I1P017

Bds MMSc Ngozi N. Nwizu, Dds Ms Alfredo Aguirre, Frank Chen

Conventional ossifying fibroma (COF), juvenile psammomatoid ossifying fibroma (JPOF), juvenile trabecular ossifying fibroma (JTOF), fibrous dysplasia (FD), cemento-osseous dysplasia (COD) and psammomatous meningioma (PM) share overlapping clinico-pathologic characteristics. This can be diagnostically challenging for pathologists. Although remarkable progress has been made over the years using ancillary studies like immunohistochemistry and molecular cytogenetics to distinguish histologically similar diseases; such diagnostic aids are yet to be successfully employed within this group of lesions. The implication is that pathologists have to rely heavily on traditional H&E stained sections in differentiating these lesions. It is important to make the distinction because of differences in their clinical behavior, modes of treatment and prognosis. In this article, the clinico-pathologic features of each entity are reviewed.

常规骨化性纤维瘤(COF)、幼年沙砾样骨化性纤维瘤(JPOF)、幼年小骨骨化性纤维瘤(JTOF)、纤维结构不良(FD)、骨质增生不良(COD)和沙砾性脑膜瘤(PM)具有重叠的临床病理特征。这对病理学家来说可能是诊断上的挑战。尽管近年来利用免疫组织化学和分子细胞遗传学等辅助研究来区分组织学上相似的疾病取得了显著进展;这种诊断辅助尚未成功地应用于这组病变。这意味着病理学家必须在很大程度上依赖传统的H&E染色切片来鉴别这些病变。由于它们的临床行为、治疗方式和预后不同，因此区分它们是很重要的。在本文中，每个实体的临床病理特征进行审查。

引用次数: 12

Physician Frustrations and the ‘Economics’ of Growth Hormone Therapy Prior-Authorization Requests and Their Denial by Insurance Payers 医生的挫折和“经济学”的生长激素治疗事先授权请求和他们的拒绝保险支付者

North American journal of medicine & science

Pub Date : 2010-01-31 DOI: 10.7156/V3I1P036

S. Mustafa-Kutana, Chb

Growth hormone has been approved by the Food and Drug Administration (FDA) for treating short children with growth failure due to a variety of causes, including growth hormone deficiency (GHD), Turner Syndrome, Prader-Willi Syndrome, idiopathic short stature (ISS), chronic renal insufficiency and children born small for gestational age (SGA) with inadequate growth by their second birthday. Children with GHD tend to be the largest proportion of short children with growth failure. Growth hormone has a very short half-life in serum with a pulsatile pattern of release, like most pituitary hormones. A random blood draw for growth hormone is thus impractical as a means of diagnosing GHD. The diagnosis of GHD must be established usually by performing a growth hormone stimulation test. This is done by ‘provocation’ with pharmacological agents that cause the anterior pituitary to release stored growth hormone. The conventional cut off for diagnosing GHD under testing conditions is currently 5 micrograms/dL for adults and 10 micrograms/dL for children. Generally, growing children secrete higher levels of growth hormone than do adults, and thus would have higher serum levels under physiological conditions. Endocrinologists utilize various agents for the provocative tests; these include arginine, levodopa, clonidine, glucagon and insulin. Insulin is considered the ‘gold standard’ for growth hormone provocation tests though it is the least utilized, because of the associated danger of hypoglycemia and the need for the presence of qualified staff throughout the testing procedure to monitor and prevent such a complication.

生长激素已被美国食品和药物管理局(FDA)批准用于治疗由于各种原因导致的生长衰竭的矮小儿童，包括生长激素缺乏症(GHD)，特纳综合征，普瑞德-威利综合征，特发性身材矮小(ISS)，慢性肾功能不全和出生时小于胎龄(SGA)的儿童2岁时生长不足。在发育不良的矮个子儿童中，GHD患儿所占比例最大。生长激素在血清中的半衰期很短，与大多数垂体激素一样，呈搏动式释放。因此，随机抽血检测生长激素作为诊断GHD的手段是不切实际的。GHD的诊断通常必须通过进行生长激素刺激试验来确定。这是通过药理学试剂的“挑衅”来完成的，这些药理学试剂会导致垂体前叶释放储存的生长激素。在测试条件下，诊断GHD的常规临界值目前为成人5微克/分升，儿童10微克/分升。一般来说，生长中的儿童分泌的生长激素水平比成人高，因此在生理条件下血清中的生长激素水平也会更高。内分泌学家使用各种药物进行刺激性测试;这些药物包括精氨酸、左旋多巴、可乐定、胰高血糖素和胰岛素。胰岛素被认为是生长激素激发试验的“金标准”，尽管它是使用率最低的，因为它有低血糖的危险，而且在整个试验过程中需要有合格的工作人员在场，以监测和预防这种并发症。

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引用次数: 0

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