No abstract

No abstract

Background and study aims: Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy (EUS-nCLE) has been shown to aid in the diagnosis of cystic pancreatic lesions. This is a pilot project to study its findings in patients with solid pancreatic lesions (SPLs) with a prospective single-blinded study design. Methods: Patients with SPLs undergoing trans-gastric EUS fine needle aspiration (EUS-FNA) from July 2013 to March 2014 were prospectively enrolled. The nCLE diagnoses were compared with the final diagnoses. Researchers learned about the EUS-nCLE findings from previously published studies and applied it to diagnose SPLs. In the meantime, the findings were recorded. Results: In total, 22 patients were recruited (mean age 62.7 years, SD 13.8 years; 14 men and eight women). The mean maximal tumor diameter was 36.0 mm (SD 10.9 mm). EUS-nCLE yielded satisfactory images in all patients during the first EUS procedure and diagnosed benign and malignant SPLs in 3 and 19 patients, respectively. Final diagnoses of malignant SPLs were made in 19 patients. Benign SPLs were eventually diagnosed in three patients, with confirmed the cytology and disease stability during the 12-month follow-up period. At the end of the project, based on the results of this current study, EUS-nCLE findings for malignant SPLs were dark clumping with or without dilated vessels (> 40 μm). There were two criteria for diagnosing benign lesions which were white fibrous bands and normal acini cells. The accuracy rate of EUS-nCLE was 90.9 % (20/22). One falsely diagnosed malignant SPL was an inflammatory mass from a recent acute pancreatitis. Another one with a pancreatic neuroendocrine tumor presenting with a symptomatic pseudocyst was incorrectly diagnosed as an inflammatory mass. This was likely from sampling error of the EUS-nCLE probe in an inflammatory area. Only one patient had post EUS-FNA bleeding but did not require a blood transfusion. The inter-observer agreement among three blinded endoscopists was almost perfect (Kappa 0.82). Conclusion: EUS-nCLE is a promising technique for the diagnosis of SPLs with good inter-observer agreement.Study registration‎: TCTR20140402001

OBJECTIVESTo investigate the intrarenal mRNA expression of monocyte chemoattractant protein‐1 (MCP‐1) and interleukin‐6 (IL‐6) in patients with nephrolithiasis, and to evaluate whether their expression is associated with renal function, as oxidative stress and inflammation are involved in the pathogenesis of nephrolithiasis.PATIENTS, SUBJECTS AND METHODSRenal biopsies from near the stone, and blood and 24‐h urine specimens were collected from 29 patients with nephrolithiasis. Control renal tissues were taken from non‐cancerous and cancerous portions of nephrectomy from six patients with renal cancers, and control 24‐h urine samples were obtained from 30 healthy subjects. Corrected creatinine clearance, urinary N‐acetyl‐β‐glucosaminidase activity and 8‐hydroxy‐deoxyguanosine (8‐OHdG) were determined. The mRNA expressions of MCP‐1 and IL‐6 in the tissues were measured by real time reverse transcription‐polymerase chain reaction.RESULTSPatients with nephrolithiasis had significantly greater renal tubular damage and oxidative stress than the healthy controls. Intrarenal mRNA expressions of MCP‐1 and IL‐6 in stone‐adjacent renal tissues were significantly lower than in cancerous renal tissues, but not statistically different from that in non‐cancerous renal tissues. In stone‐adjacent renal tissues, the mRNA level of MCP‐1 was significantly higher than that of IL‐6, but their expressions were significantly correlated with each other. Histological examination showed that the number of infiltrated leukocytes corresponded well with the intrarenal mRNA levels of MCP‐1 and IL‐6. Patients with nephrolithiasis and compromised renal function had significantly higher intrarenal mRNA levels of MCP‐1 and IL‐6 than those with preserved renal function. Also, the mRNA levels in patients with severe renal tubular damage were significantly greater than in those with less renal tubular damage. There was no association between intrarenal mRNA expression and urinary 8‐OHdG.CONCLUSIONNephrolithiasis was associated with low‐grade intrarenal inflammation. A greater intrarenal mRNA expression of MCP‐1 and IL‐6 was associated with enhanced renal impairment. Thus, expression of MCP‐1 and IL‐6, at least in part, contributed to the progression of nephrolithiasis.