This review is part two of three, which will present an update on the classification of gastrointestinal submucosal tumors. Part one treats of the diagnosis and part three of the therapeutic methods regarding gastroin...This review is part two of three, which will present an update on the classification of gastrointestinal submucosal tumors. Part one treats of the diagnosis and part three of the therapeutic methods regarding gastrointestinal submucosal tumors. In the past there has been some confusion as to the classification of gastrointestinal submucosal tumors. Changes in classifications have emerged due to recent advances in mainly immunohistochemistry and electron microscopy. The aim of this paper is to update the reader on the current classification. Literature searches were performed to find information related to classification of gastrointestinal submucosal tumors. Based on these searches the twelve most frequent submucosal tumor types were chosen for description of their classification. The factors that indicate whether tumors are benign or malignant are mainly size and number of mitotic counts. Gastrointestinal stromal tumors are defined mainly by their CD117 positivity. In the future, there should be no more confusion between gastrointestinal stromal tumors and other types of submucosal tumors.展开更多
AIM: To evaluate spiral computed tomography (CT) including virtual gastroscopy for diagnosis of gastric carcinoma in comparison with upper gastrointestinal series (UGI),fiberoptic gastroscopy (FG) and histopathology.M...AIM: To evaluate spiral computed tomography (CT) including virtual gastroscopy for diagnosis of gastric carcinoma in comparison with upper gastrointestinal series (UGI),fiberoptic gastroscopy (FG) and histopathology.METHODS: Sixty patients with histologically proven gastric carcinoma (54 advanced and 6 early) were included in this study. The results of spiral CT were compared with those of UGI and FG. Two observers blindly evaluated images of spiral CT and UGI and video recording of FG with consensus in terms of diagnostic confidence with a five-point scale.Sensitivities of lesion detection, Borrmann′s classification of spiral CT, UGI and FG, as well as the accuracy of TNM staging of spiral CT were determined by comparing them to surgical and histological findings.RESULTS: The lesion detection rate was 98 % (59/60),95 % (57/60) and 98 % (59/60) for spiral CT, UGI and FG,respectively. There were no statistical differences in the detection sensitivity among the three techniques (P＞0.05).For the sensitivity in Borrmann′s classification, spiral CT was higher than that of UGI (P=0.025) and similar to that of FG (P＞0.05). The accuracy of spiral CT in staging the gastric carcinoma was 76.7 %. Six cases of early gastric carcinoma were all detected by spiral CT as well as FG.CONCLUSION: Spiral CT is equivalent to UGI and FG in the detection of gastric carcinoma, and superior to UGI but similar to FG in the Borrmann′s classification of advanced gastric carcinoma. Spiral CT is more valuable than FG in the staging of gastric carcinoma.展开更多
AIM: To report 3 of 120 patients on the German MALT lymphoma trial with H. pylori associated gastric MALT lymphoma who developed early gastric cancer 4 and 5 years, after complete lymphoma remission following cure of ...AIM: To report 3 of 120 patients on the German MALT lymphoma trial with H. pylori associated gastric MALT lymphoma who developed early gastric cancer 4 and 5 years, after complete lymphoma remission following cure of H. pylori infection. PATIENTS AND RESULTS: Three patients (two men, 74 and 70 years; one women, 77 years) with H. pylori-associated low-grade MALT lymphoma achieved complete lymphoma remission after being cured. Surveillance endoscopies were performed twice a year in accordance to the protocol. Four years after complete lymphoma remission in two patients, and after 5 years in the other, early gastric adenocarcinoma of the mucosa-type, type IIa and type IIc, respectively, was detected, which were completely removed by endoscopic mucosa resection. In one patient, the gastric cancer was diagnosed at the same location as the previous MALT lymphoma, in the other patients it was detected at different sites of the stomach distant from location of the previous MALT lymphoma. The patients were H. pylori negative during the whole follow-up time. CONCLUSION: These findings strengthen the importance of regular Long-term follow-up endoscopies in patients with complete remission of gastric MALT lymphoma after cure of H. pylori infection. Furthermore, gastric adenocarcinoma may develop despite eradication of H. pylori.展开更多
AIM： To investigate the relationship between the inhibited growth （cytotoxic activity） of berberine and apoptotic pathway with its molecular mechanism of action. METHODS： The in vitro cytotoxic techniques were com...AIM： To investigate the relationship between the inhibited growth （cytotoxic activity） of berberine and apoptotic pathway with its molecular mechanism of action. METHODS： The in vitro cytotoxic techniques were complemented by cell cycle analysis and determination of sub-G1 for apoptosis in human gastric carcinoma SNU-5 cells. Percentage of viable cells, cell cycle, and sub431 group （apoptosis） were examined and determined by the flow cytometric methods. The associated proteins for cell cycle arrest and apoptosis were examined by Western blotting. RESULTS： For SNU-5 cell line, the IC （50） was found to be 48 μmol/L of berberine. In SNU-5 cells treated with 25-200 μmol/L berberine, G2/M cell cycle arrest was observed which was associated with a marked increment of the expression of p53, Wee1 and CDk1 proteins and decreased cyclin B. A concentration-dependent decrease of cells in G0/G1 phase and an increase in G2/M phase were detected. In addition, apoptosis detected as sub-Go cell population in cell cycle measurement was proved in 25-200 μmol/L berberine-treated cells by monitoring the apoptotic pathway. Apoptosis was identified by sub-Go cell population, and upregulation of Bax, downregulation of Bcl-2, release of Ca^2＋, decreased the mitochondrial membrane potential and then led to the release of mitochondrial cytochrome C into the cytoplasm and caused the activation of caspase-3, and finally led to the occurrence of apoptosis. CONCLUSION： Berberine induces p53 expression and leads to the decrease of the mitochondrial membrane potential, Cytochrome C release and activation of caspase-3 for the induction of apoptosis.展开更多
D2 procedure has been accepted in Far East as the standard treatment for both early(EGC) and advanced gastric cancer(AGC) for many decades. Recently EGC has been successfully treated with endoscopy by endoscopic mucos...D2 procedure has been accepted in Far East as the standard treatment for both early(EGC) and advanced gastric cancer(AGC) for many decades. Recently EGC has been successfully treated with endoscopy by endoscopic mucosal resection or endoscopic submucosal dissection, when restricted or extended Gotoda's criteria can be applied and D1+ surgery is offered only to patients not fitted for less invasive treatment. Furthermore, two randomised controlled trials(RCTs) have been demonstrating the non inferiority of minimally invasive technique as compared to standard open surgery for the treatment of early cases and recently the feasibility of adequate D1+ dissection has been demonstrated also for the robot assisted technique. In case of AGC the debate on the extent of nodal dissection has been open for many decades. While D2 gastrectomy was performed as the standard procedure in eastern countries, mostly based on observational and retrospective studies, in the west the Medical Research Council(MRC), Dutch and Italian RCTs have been conducted to show a survival benefit of D2 over D1 with evidence based medicine. Unfortunately both the MRC and the Dutch trials failed to show a survival benefit after the D2 procedure, mostly due to the significant increase of postoperative morbidity and mortality, which was referred to splenopancreatectomy. Only 15 years after the conclusion of its accrual, the Dutch trial could report a significant decrease of recur-rence after D2 procedure. Recently the long term survival analysis of the Italian RCT could demonstrate a benefit for patients with positive nodes treated with D2 gastrectomy without splenopancreatectomy. As nowadays also in western countries D2 procedure can be done safely with pancreas preserving technique and without preventive splenectomy, it has been suggested in several national guidelines as the recommended procedure for patients with AGC.展开更多
AIM:To test the Genval recommendations and the usefulness of a short trial of proton pump inhibitor(PPI) in the initial management and maintenance treatment of gastroesophageal reflux disease(GERD)patients. METHODS:Fi...AIM:To test the Genval recommendations and the usefulness of a short trial of proton pump inhibitor(PPI) in the initial management and maintenance treatment of gastroesophageal reflux disease(GERD)patients. METHODS:Five hundred and seventy seven patients with heartburn were recruited.After completing a psychometric tool to assess quality of life(PGWBI)and a previously validated GERD symptom questionnaire (QUID),patients were grouped into those with esophagitis(EE,n=306)or without mucosal damage (NERD,n=271)according to endoscopy results. The study started with a 2-wk period of high dose omeprazole(omeprazole test);patients responding to this PPI test entered an acute phase(3 mo)of treatment with any PPI at the standard dose.Finally,those patients with a favorable response to the standard PPI dose were maintained on a half PPI dose for a further 3-mo period. RESULTS:The test was positive in 519(89.9%)patients,with a greater response in EE patients(96.4%) compared with NERD patients(82.6%)(P=0.011). Both the percentage of completely asymptomatic patients,at 3 and 6 mo,and the reduction in heartburn intensity were significantly higher in the EE compared with NERD patients(P<0.01).Finally,the mean PGWBI score was significantly decreased before and increased after therapy in both subgroups when compared with the mean value in a reference Italian population. CONCLUSION:Our study confirms the validity of the Genval guidelines in the management of GERD patients. In addition,we observed that the overall response to PPI therapy is lower in NERD compared to EE patients.展开更多
Objective and methods To evaluate synaptic changes using synaptophysin immunohistochemstry in rat and mouse, which spinal cords were subjected to graded compression trauma at the level of Th8-9. Result...Objective and methods To evaluate synaptic changes using synaptophysin immunohistochemstry in rat and mouse, which spinal cords were subjected to graded compression trauma at the level of Th8-9. Results Normal animals showed numerous fine dots of synaptophysin immunoreactivity in the gray matter. An increase in synaptophysin immunoreactivity was observed in the neuropil and synapses at the surface of motor neurons of the anterior horns in the ThS-9 segments lost immunoreactivity at 4-hour point after trauma. The immunoreactive synapses reappeared around motor neurons at 9-day point. Unexpected accumulation of synaptophysin immunoreactivity occurred in injured axons of the white matter of the compressed spinal cord. Conclusion Synaptic changes were important components of secondary injuries in spinal cord trauma. Loss of synapses on motor neurons may be one of the factors causing motor dysfunction of hind limbs and formation of new synapses may play an import,ant role in recovery of motor function. Synaptophysin immunohistochemistry is also a good tool for studies of axonal swellings in spinal cord injuries.展开更多
Inflammatory bowel diseases(IBDs), particularly Crohn's disease(CD) and ulcerative colitis(UC), are associated with a variety of extra-intestinal manifestations(EIMs).About 36% of IBD patients have at least one EI...Inflammatory bowel diseases(IBDs), particularly Crohn's disease(CD) and ulcerative colitis(UC), are associated with a variety of extra-intestinal manifestations(EIMs).About 36% of IBD patients have at least one EIM, which most frequently affect the joints, skin, eyes and the biliary tract.The EIMs associated with IBD have a negative impact on patients with UC and CD, and the resolution of most of them parallels that of the active IBD in terms of timing and required therapy;however, the clinical course of EIMs such as axial arthritis, pyoderma gangrenosum, uveitis, and primary sclerosing cholangitis is independent of IBD activity.The peripheral and axial arthritis associated with IBD have traditionally been treated with simple analgesics, non-steroidal anti-inflammatory drugs, steroids, sulfasalazine, methotrexate, local steroid injections and physiotherapy, but the introduction of biological response modifi ers such as tumor necrosis factor-α blockers, has led to further improvements.展开更多
AIM: To evaluate the value of administration of hyoscine-N-butyl-bromide (HBB) for image quality magnetic resonance imaging (MRI) of the prostate. METHODS: Seventy patients were retrospectively included in the study. ...AIM: To evaluate the value of administration of hyoscine-N-butyl-bromide (HBB) for image quality magnetic resonance imaging (MRI) of the prostate. METHODS: Seventy patients were retrospectively included in the study. Thirty-five patients were examined with administration of 40 milligrams of HBB (Buscopan ; Boehringer, Ingelheim, Germany); 35 patients were examined without HBB. A multiparametric MRI protocol was performed on a 3.0 Tesla scanner without using an endorectal coil. The following criteria were evaluated independently by two experienced radiologists on a five-point Likert scale: anatomical details (delineation between peripheral and transitional zone of the prostate, visualisation of the capsule, depiction of the neurovascular bundles); visualisation of lymph nodes; motion related artefacts; and overall image quality.RESULTS: Comparison of anatomical details between the two cohorts showed no statistically significant difference (3.9 ± 0.7 vs 4.0 ± 0.9, P = 0.54, and 3.8 ± 0.7 vs 4.2 ± 0.6, P = 0.07) for both readers. There was no significant advantage regarding depiction of local and iliac lymph nodes (3.9 ± 0.6 vs 4.2 ± 0.6, P = 0.07, and 3.8 ± 0.9 vs 4.1 ± 0.8, P = 0.19). Motion arte- facts were rated as 'none' to 'few' in both groups and showed no statistical difference (2.3 ± 1.0 vs 1.9 ± 0.9, P = 0.19, and 2.3 ± 1.1 vs 1.9 ± 0.7, P = 0.22). Overall image quality was rated 'good' in average for both cohorts without significant difference (4.0 ± 0.6 vs 4.0 ± 0.9, P = 0.78, and 3.8 ± 0.8 vs 4.2 ± 0.6, P = 0.09). CONCLUSION: The results demonstrated no significant effect of HBB administration on image quality. The study suggests that use of HBB is not mandatory for MRI of the prostate at 3.0 Tesla.展开更多
AIM:To investigate whether targeting proteasome might reverse intestinal fibrosis in rats.METHODS:Chronic colitis was induced in rats by repeated administration of increasing dose of2,4,6-trinitrobenzene sulfonic acid...AIM:To investigate whether targeting proteasome might reverse intestinal fibrosis in rats.METHODS:Chronic colitis was induced in rats by repeated administration of increasing dose of2,4,6-trinitrobenzene sulfonic acid(TNBS,15,30,45,60,60,60 mg)by rectal injection for 6 wk(from day0 to day 35),while control rats received the vehicle.TNBS+bortezomib(BTZ)rats received intraperitoneal injections of BTZ twice weekly(from day 37 to day44)at a dose of 25 mg/kg,whereas the control and TNBS groups received the same amount of the vehicle.Histologic scoring of inflammation and fibrosis was performed.Colonic production of transforming growth factor(TGF)-βwas measured by ELISA.Colon fibrosisrelated proteins such as phospho-p38,phosphoSMAD2/3,Akt and peroxisome proliferator activated receptorγ(PPARγ)were studied by western blot.Expression of the tight junction proteins,occludin and claudin-1,were assessed by Western blot.Colon proteasome activities(chymotrypsin-like and trypsinlike activities)were assessed.RESULTS:TNBS-treated rats had a higher colon weight/length ratio compared to control rats(P<0.01).Furthermore,fibrosis and inflammation scores were higher in TNBS-treated rats compared to control rats(P<0.01 for both).Colonic production of TGF-βproduction tended to be higher in TNBS-treated rats(P<0.06).Fibrosis-related proteins such as phospho-p38,phospho-SMAD2/3,and PPARγwere significantly higher in TNBS-treated rats compared to control rats(all P<0.05).TNBS rats had a higher expression of Akt compared to control rats(P<0.01).Tight junction proteins were modified by repeated TNBS challenge:colon occludin expression rose significantly(P<0.01),whereas claudin-1 expression fell(P<0.01).Bortezomib inhibition significantly decreased chymotrypsin-like activity(P<0.05),but had no significant effect on trypsin-like activity(P>0.05).In contrast,bortezomib had no effect on other studied parameters such as fibrosis score,TGF-βsignaling,or tight junction expression(P>0.05 for all).CONCLUSION:Rats with TNBS-induced chronic colitis exhibited colon fibrosis associated with higher TGF-βsignaling.Proteasome inhibition by bortezomib had no effect on fibrosis in our experimental conditions.展开更多
Perichondritis of the external ear is referred to inthe literature as pinna perichondritis as well as auricularperichondritis. Pinna （auricular） perichondritis is aninfection involving cartilage and subcutaneous tis...Perichondritis of the external ear is referred to inthe literature as pinna perichondritis as well as auricularperichondritis. Pinna （auricular） perichondritis is aninfection involving cartilage and subcutaneous tissue.The resulting infection produces swelling which canbe severe, and can lead to focal ear necrosis. The termperichondritis may even be considered a misnomer＂as the cartilage is almost always involved.＂[1] Pinna（auricular） perichondritis presents with signs andsymptoms that can include pain。展开更多
AIM： To determine how glucocorticoids （GCs） may affect the growth and chemosensitivity of common carcinoma cells. METHODS： The effect of dexamethasone （DEX） on growth and chemosensitivity was assessed in 14 carc...AIM： To determine how glucocorticoids （GCs） may affect the growth and chemosensitivity of common carcinoma cells. METHODS： The effect of dexamethasone （DEX） on growth and chemosensitivity was assessed in 14 carcinoma cell lines. The function of GC receptors （GR） was assessed by MMTV reporter assay. Overexpression of GR was done by in vitro transfection and expression of a GR-expressing vector. Immunohistochemical stain of tissues and ceils were done by PA1-511A, an anti-GR monodonal antibody. RESULTS： DEX inhibited cell growth of four （MCF-7, MCF- 7/MXR1, MCF-7/TPT300, and HeLa）, increased cisplatin cytoxicity of one （SiHa）, and decreased dsplatin cytotoxicity of two （H460 and Hep3B） cell lines. The GR content of the seven cell lines affected by DEX was significantly higher than those of the seven cell lines unaffected by DEX （5.2±2.5×10^4 sites/cell vs1.3±1.4×10^4 sites/cell, P= 0.005）. Only two DEX-unresponsive cell lines {NPC-TW01 and NPC- TW04） oontained high GR amounts in the range （1.9-8.1×10^4 sites/cell） of the seven DEX-responsive cell lines. The GR function of NPC-TW01 and NPC-TW04, however, was foundto be impaired. The importance of high cellular amount of GR in mediating DEX susceptibility of the cells was further exemplified by GR dose-dependent drug resistance to cisplatin of AGS, a cell line with low GR content and was unaffected by DEX before transfection of GR-expressing vector. Immunohistochemical studies of human cancer tissues showed that 5 of the 45 （11.1%） breast cancer and 43 of the 85 （50.6%） non-small cell lung cancer had high GR contents at the ranges of the GC-responsive carcinoma cell lines. CONCLUSION： The growth and chemosensitivity of human carcinomas with high GR contents may be affected by GC. However, in light of the heterogeneous and even contradictive effects of GC on these cells, routine examination of GR contents of human carcinoma tissues may not be clinically useful until other markers that help predict the ultimate effect of GC on individual patients are identified.展开更多
Dear Editor,I am Dr. Jungyul Park from the Division of oculoplasty, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea. I write to discuss a case of myeloid sarcoma of the eyelid mimicking p...Dear Editor,I am Dr. Jungyul Park from the Division of oculoplasty, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea. I write to discuss a case of myeloid sarcoma of the eyelid mimicking pre-septal cellulitis in acute myeloid leukemia(AML).展开更多
AIM： To investigate the molecular events involved in liver regeneration following subtotal hepatectomy （SH） as previous studies have largely focused on partial hepatectomy （PH）. METHODS： Male Wistar rats were su...AIM： To investigate the molecular events involved in liver regeneration following subtotal hepatectomy （SH） as previous studies have largely focused on partial hepatectomy （PH）. METHODS： Male Wistar rats were subjected to 70% PH or 90% SH, respectively, and sacrificed at different times after surgery. Untreated and sham-operated animals served as controls. Serum and liver samples were obtained to investigate liver function, apoptosis （TUNEL assay） and transcription factors （NF-KB, Stat3; ELISA） or cytokines （HGF, TNF-α, IL-6, TGF-α, TGF-β; quantitative RT-PCR） involved in liver regeneration. RESULTS： Serum levels of ALT and AST in animals with 70% PH differed significantly from sham-operated and control animals. We found that the peak concentration 12 h after surgery returned to control levels 7 d after surgery. LDH was increased only at 12 h after 70% PH compared to sham. Bilirubin showed no differences between the sham and 70% resection. After PH, early NF-kB activation was detected 12 h after surgery （313.21 ± 17.22 ng/mL）, while there was no activation after SH （125.22 ± 44.36 ng/mL） compared to controls （111.43 ± 32.68 ng/mL） at this time point. In SH, however, NF-kB activation was delayed until 24 h （475.56 ± 144.29 ng/mL）. Stat3 activation was similar in both groups. These findings correlated with suppressed and delayed induction of regenerative genes after SH （i.e. TNF-α 24 h postoperatively： 2375 ± 1220 in 70% and 88 ± 31 in 90%; IL-6 12 h postoperatively： 2547 ± 441 in 70% and 173 ± 82 in 90%）. TUNEL staining revealed elevated apoptosis rates in SH （0.44% at 24 h; 0.63% at 7 d） compared to PH （0.27% at 24 h; 0.15% at 7 d）. CONCLUSION： The molecular events involved in liver regeneration are significantly influenced by the extent of resection as SH leads to suppression and delay of liver regeneration compared to PH, which is associated with delayed activation of NF-kB and suppression of proregenerative cytokines.展开更多
Eight genotypes(A-H) of hepatitis B virus(HBV) have been identified.However,the impact of different genotypes on the clinical course of hepatitis B infection remains controversial.We investigated the frequency and cli...Eight genotypes(A-H) of hepatitis B virus(HBV) have been identified.However,the impact of different genotypes on the clinical course of hepatitis B infection remains controversial.We investigated the frequency and clinical outcome of HBV genotypes and genotype mixtures in HBV-infected patients from Vietnam,Europe,and Africa.In addition,we analyzed the effects of genotype mixtures on alterations in in vitro viral replication.In Asian patients,seven genotypes(A-G) were detected,with A,C,and D predominating.In European and African patients,only genotypes A,C,D,and G were identified.Genotype mixtures were more frequently encountered in African than in Asian(P =.01) and European patients(P =.06) .In Asian patients,the predominant genotype mixtures included A/C and C/D,compared to C/D in European and A/D in African patients.Genotype A was more frequent in asymptomatic compared with symptomatic patients(P <.0001) .Genotype C was more frequent in patients with hepatocellular carcinoma(HCC;P =.02) .Genotype mixtures were more frequently encountered in patients with chronic hepatitis in comparison to patients with acute hepatitis B(P =.015) ,liver cirrhosis(P =.013) ,and HCC(P =.002) .Viral loads in patients infected with genotype mixtures were significantly higher in comparison to patients with a single genotype(P =.019) .Genotype mixtures were also associated with increased in vitro HBV replication.In conclusion,infection with mixtures of HBV genotypes is frequent in Asia,Africa,and Europe.Differences in the replication-phenotype of single genotypes compared to genotype-mixtures suggest that co-infection with different HBV-genotypes is associated with altered pathogenesis and clinical outcome.展开更多
文摘This review is part two of three, which will present an update on the classification of gastrointestinal submucosal tumors. Part one treats of the diagnosis and part three of the therapeutic methods regarding gastrointestinal submucosal tumors. In the past there has been some confusion as to the classification of gastrointestinal submucosal tumors. Changes in classifications have emerged due to recent advances in mainly immunohistochemistry and electron microscopy. The aim of this paper is to update the reader on the current classification. Literature searches were performed to find information related to classification of gastrointestinal submucosal tumors. Based on these searches the twelve most frequent submucosal tumor types were chosen for description of their classification. The factors that indicate whether tumors are benign or malignant are mainly size and number of mitotic counts. Gastrointestinal stromal tumors are defined mainly by their CD117 positivity. In the future, there should be no more confusion between gastrointestinal stromal tumors and other types of submucosal tumors.
基金ECR 2000-EAR-ECR Research & Education Fund Fellowship Grant
文摘AIM: To evaluate spiral computed tomography (CT) including virtual gastroscopy for diagnosis of gastric carcinoma in comparison with upper gastrointestinal series (UGI),fiberoptic gastroscopy (FG) and histopathology.METHODS: Sixty patients with histologically proven gastric carcinoma (54 advanced and 6 early) were included in this study. The results of spiral CT were compared with those of UGI and FG. Two observers blindly evaluated images of spiral CT and UGI and video recording of FG with consensus in terms of diagnostic confidence with a five-point scale.Sensitivities of lesion detection, Borrmann′s classification of spiral CT, UGI and FG, as well as the accuracy of TNM staging of spiral CT were determined by comparing them to surgical and histological findings.RESULTS: The lesion detection rate was 98 % (59/60),95 % (57/60) and 98 % (59/60) for spiral CT, UGI and FG,respectively. There were no statistical differences in the detection sensitivity among the three techniques (P＞0.05).For the sensitivity in Borrmann′s classification, spiral CT was higher than that of UGI (P=0.025) and similar to that of FG (P＞0.05). The accuracy of spiral CT in staging the gastric carcinoma was 76.7 %. Six cases of early gastric carcinoma were all detected by spiral CT as well as FG.CONCLUSION: Spiral CT is equivalent to UGI and FG in the detection of gastric carcinoma, and superior to UGI but similar to FG in the Borrmann′s classification of advanced gastric carcinoma. Spiral CT is more valuable than FG in the staging of gastric carcinoma.
文摘AIM: To report 3 of 120 patients on the German MALT lymphoma trial with H. pylori associated gastric MALT lymphoma who developed early gastric cancer 4 and 5 years, after complete lymphoma remission following cure of H. pylori infection. PATIENTS AND RESULTS: Three patients (two men, 74 and 70 years; one women, 77 years) with H. pylori-associated low-grade MALT lymphoma achieved complete lymphoma remission after being cured. Surveillance endoscopies were performed twice a year in accordance to the protocol. Four years after complete lymphoma remission in two patients, and after 5 years in the other, early gastric adenocarcinoma of the mucosa-type, type IIa and type IIc, respectively, was detected, which were completely removed by endoscopic mucosa resection. In one patient, the gastric cancer was diagnosed at the same location as the previous MALT lymphoma, in the other patients it was detected at different sites of the stomach distant from location of the previous MALT lymphoma. The patients were H. pylori negative during the whole follow-up time. CONCLUSION: These findings strengthen the importance of regular Long-term follow-up endoscopies in patients with complete remission of gastric MALT lymphoma after cure of H. pylori infection. Furthermore, gastric adenocarcinoma may develop despite eradication of H. pylori.
基金Supported by The Grant CMU92-CM-02 from China Medical University
文摘AIM： To investigate the relationship between the inhibited growth （cytotoxic activity） of berberine and apoptotic pathway with its molecular mechanism of action. METHODS： The in vitro cytotoxic techniques were complemented by cell cycle analysis and determination of sub-G1 for apoptosis in human gastric carcinoma SNU-5 cells. Percentage of viable cells, cell cycle, and sub431 group （apoptosis） were examined and determined by the flow cytometric methods. The associated proteins for cell cycle arrest and apoptosis were examined by Western blotting. RESULTS： For SNU-5 cell line, the IC （50） was found to be 48 μmol/L of berberine. In SNU-5 cells treated with 25-200 μmol/L berberine, G2/M cell cycle arrest was observed which was associated with a marked increment of the expression of p53, Wee1 and CDk1 proteins and decreased cyclin B. A concentration-dependent decrease of cells in G0/G1 phase and an increase in G2/M phase were detected. In addition, apoptosis detected as sub-Go cell population in cell cycle measurement was proved in 25-200 μmol/L berberine-treated cells by monitoring the apoptotic pathway. Apoptosis was identified by sub-Go cell population, and upregulation of Bax, downregulation of Bcl-2, release of Ca^2＋, decreased the mitochondrial membrane potential and then led to the release of mitochondrial cytochrome C into the cytoplasm and caused the activation of caspase-3, and finally led to the occurrence of apoptosis. CONCLUSION： Berberine induces p53 expression and leads to the decrease of the mitochondrial membrane potential, Cytochrome C release and activation of caspase-3 for the induction of apoptosis.
文摘D2 procedure has been accepted in Far East as the standard treatment for both early(EGC) and advanced gastric cancer(AGC) for many decades. Recently EGC has been successfully treated with endoscopy by endoscopic mucosal resection or endoscopic submucosal dissection, when restricted or extended Gotoda's criteria can be applied and D1+ surgery is offered only to patients not fitted for less invasive treatment. Furthermore, two randomised controlled trials(RCTs) have been demonstrating the non inferiority of minimally invasive technique as compared to standard open surgery for the treatment of early cases and recently the feasibility of adequate D1+ dissection has been demonstrated also for the robot assisted technique. In case of AGC the debate on the extent of nodal dissection has been open for many decades. While D2 gastrectomy was performed as the standard procedure in eastern countries, mostly based on observational and retrospective studies, in the west the Medical Research Council(MRC), Dutch and Italian RCTs have been conducted to show a survival benefit of D2 over D1 with evidence based medicine. Unfortunately both the MRC and the Dutch trials failed to show a survival benefit after the D2 procedure, mostly due to the significant increase of postoperative morbidity and mortality, which was referred to splenopancreatectomy. Only 15 years after the conclusion of its accrual, the Dutch trial could report a significant decrease of recur-rence after D2 procedure. Recently the long term survival analysis of the Italian RCT could demonstrate a benefit for patients with positive nodes treated with D2 gastrectomy without splenopancreatectomy. As nowadays also in western countries D2 procedure can be done safely with pancreas preserving technique and without preventive splenectomy, it has been suggested in several national guidelines as the recommended procedure for patients with AGC.
文摘AIM:To test the Genval recommendations and the usefulness of a short trial of proton pump inhibitor(PPI) in the initial management and maintenance treatment of gastroesophageal reflux disease(GERD)patients. METHODS:Five hundred and seventy seven patients with heartburn were recruited.After completing a psychometric tool to assess quality of life(PGWBI)and a previously validated GERD symptom questionnaire (QUID),patients were grouped into those with esophagitis(EE,n=306)or without mucosal damage (NERD,n=271)according to endoscopy results. The study started with a 2-wk period of high dose omeprazole(omeprazole test);patients responding to this PPI test entered an acute phase(3 mo)of treatment with any PPI at the standard dose.Finally,those patients with a favorable response to the standard PPI dose were maintained on a half PPI dose for a further 3-mo period. RESULTS:The test was positive in 519(89.9%)patients,with a greater response in EE patients(96.4%) compared with NERD patients(82.6%)(P=0.011). Both the percentage of completely asymptomatic patients,at 3 and 6 mo,and the reduction in heartburn intensity were significantly higher in the EE compared with NERD patients(P<0.01).Finally,the mean PGWBI score was significantly decreased before and increased after therapy in both subgroups when compared with the mean value in a reference Italian population. CONCLUSION:Our study confirms the validity of the Genval guidelines in the management of GERD patients. In addition,we observed that the overall response to PPI therapy is lower in NERD compared to EE patients.
基金This study was approved by the Uppsala Ethical Committee for Animal Research. It was supported by grants from the Swedish Association of Neurologically Disabled the Swedish Society for Medical Research (project no.950006) and the National Natural Scien
文摘Objective and methods To evaluate synaptic changes using synaptophysin immunohistochemstry in rat and mouse, which spinal cords were subjected to graded compression trauma at the level of Th8-9. Results Normal animals showed numerous fine dots of synaptophysin immunoreactivity in the gray matter. An increase in synaptophysin immunoreactivity was observed in the neuropil and synapses at the surface of motor neurons of the anterior horns in the ThS-9 segments lost immunoreactivity at 4-hour point after trauma. The immunoreactive synapses reappeared around motor neurons at 9-day point. Unexpected accumulation of synaptophysin immunoreactivity occurred in injured axons of the white matter of the compressed spinal cord. Conclusion Synaptic changes were important components of secondary injuries in spinal cord trauma. Loss of synapses on motor neurons may be one of the factors causing motor dysfunction of hind limbs and formation of new synapses may play an import,ant role in recovery of motor function. Synaptophysin immunohistochemistry is also a good tool for studies of axonal swellings in spinal cord injuries.
文摘Inflammatory bowel diseases(IBDs), particularly Crohn's disease(CD) and ulcerative colitis(UC), are associated with a variety of extra-intestinal manifestations(EIMs).About 36% of IBD patients have at least one EIM, which most frequently affect the joints, skin, eyes and the biliary tract.The EIMs associated with IBD have a negative impact on patients with UC and CD, and the resolution of most of them parallels that of the active IBD in terms of timing and required therapy;however, the clinical course of EIMs such as axial arthritis, pyoderma gangrenosum, uveitis, and primary sclerosing cholangitis is independent of IBD activity.The peripheral and axial arthritis associated with IBD have traditionally been treated with simple analgesics, non-steroidal anti-inflammatory drugs, steroids, sulfasalazine, methotrexate, local steroid injections and physiotherapy, but the introduction of biological response modifi ers such as tumor necrosis factor-α blockers, has led to further improvements.
文摘AIM: To evaluate the value of administration of hyoscine-N-butyl-bromide (HBB) for image quality magnetic resonance imaging (MRI) of the prostate. METHODS: Seventy patients were retrospectively included in the study. Thirty-five patients were examined with administration of 40 milligrams of HBB (Buscopan ; Boehringer, Ingelheim, Germany); 35 patients were examined without HBB. A multiparametric MRI protocol was performed on a 3.0 Tesla scanner without using an endorectal coil. The following criteria were evaluated independently by two experienced radiologists on a five-point Likert scale: anatomical details (delineation between peripheral and transitional zone of the prostate, visualisation of the capsule, depiction of the neurovascular bundles); visualisation of lymph nodes; motion related artefacts; and overall image quality.RESULTS: Comparison of anatomical details between the two cohorts showed no statistically significant difference (3.9 ± 0.7 vs 4.0 ± 0.9, P = 0.54, and 3.8 ± 0.7 vs 4.2 ± 0.6, P = 0.07) for both readers. There was no significant advantage regarding depiction of local and iliac lymph nodes (3.9 ± 0.6 vs 4.2 ± 0.6, P = 0.07, and 3.8 ± 0.9 vs 4.1 ± 0.8, P = 0.19). Motion arte- facts were rated as 'none' to 'few' in both groups and showed no statistical difference (2.3 ± 1.0 vs 1.9 ± 0.9, P = 0.19, and 2.3 ± 1.1 vs 1.9 ± 0.7, P = 0.22). Overall image quality was rated 'good' in average for both cohorts without significant difference (4.0 ± 0.6 vs 4.0 ± 0.9, P = 0.78, and 3.8 ± 0.8 vs 4.2 ± 0.6, P = 0.09). CONCLUSION: The results demonstrated no significant effect of HBB administration on image quality. The study suggests that use of HBB is not mandatory for MRI of the prostate at 3.0 Tesla.
文摘AIM:To investigate whether targeting proteasome might reverse intestinal fibrosis in rats.METHODS:Chronic colitis was induced in rats by repeated administration of increasing dose of2,4,6-trinitrobenzene sulfonic acid(TNBS,15,30,45,60,60,60 mg)by rectal injection for 6 wk(from day0 to day 35),while control rats received the vehicle.TNBS+bortezomib(BTZ)rats received intraperitoneal injections of BTZ twice weekly(from day 37 to day44)at a dose of 25 mg/kg,whereas the control and TNBS groups received the same amount of the vehicle.Histologic scoring of inflammation and fibrosis was performed.Colonic production of transforming growth factor(TGF)-βwas measured by ELISA.Colon fibrosisrelated proteins such as phospho-p38,phosphoSMAD2/3,Akt and peroxisome proliferator activated receptorγ(PPARγ)were studied by western blot.Expression of the tight junction proteins,occludin and claudin-1,were assessed by Western blot.Colon proteasome activities(chymotrypsin-like and trypsinlike activities)were assessed.RESULTS:TNBS-treated rats had a higher colon weight/length ratio compared to control rats(P<0.01).Furthermore,fibrosis and inflammation scores were higher in TNBS-treated rats compared to control rats(P<0.01 for both).Colonic production of TGF-βproduction tended to be higher in TNBS-treated rats(P<0.06).Fibrosis-related proteins such as phospho-p38,phospho-SMAD2/3,and PPARγwere significantly higher in TNBS-treated rats compared to control rats(all P<0.05).TNBS rats had a higher expression of Akt compared to control rats(P<0.01).Tight junction proteins were modified by repeated TNBS challenge:colon occludin expression rose significantly(P<0.01),whereas claudin-1 expression fell(P<0.01).Bortezomib inhibition significantly decreased chymotrypsin-like activity(P<0.05),but had no significant effect on trypsin-like activity(P>0.05).In contrast,bortezomib had no effect on other studied parameters such as fibrosis score,TGF-βsignaling,or tight junction expression(P>0.05 for all).CONCLUSION:Rats with TNBS-induced chronic colitis exhibited colon fibrosis associated with higher TGF-βsignaling.Proteasome inhibition by bortezomib had no effect on fibrosis in our experimental conditions.
文摘Perichondritis of the external ear is referred to inthe literature as pinna perichondritis as well as auricularperichondritis. Pinna （auricular） perichondritis is aninfection involving cartilage and subcutaneous tissue.The resulting infection produces swelling which canbe severe, and can lead to focal ear necrosis. The termperichondritis may even be considered a misnomer＂as the cartilage is almost always involved.＂[1] Pinna（auricular） perichondritis presents with signs andsymptoms that can include pain。
基金Supported by grants from the National Science Council No.NSC 93-2314-B-002-006, Taiwan, and grants from National Taiwan University Hospital 91-N006
文摘AIM： To determine how glucocorticoids （GCs） may affect the growth and chemosensitivity of common carcinoma cells. METHODS： The effect of dexamethasone （DEX） on growth and chemosensitivity was assessed in 14 carcinoma cell lines. The function of GC receptors （GR） was assessed by MMTV reporter assay. Overexpression of GR was done by in vitro transfection and expression of a GR-expressing vector. Immunohistochemical stain of tissues and ceils were done by PA1-511A, an anti-GR monodonal antibody. RESULTS： DEX inhibited cell growth of four （MCF-7, MCF- 7/MXR1, MCF-7/TPT300, and HeLa）, increased cisplatin cytoxicity of one （SiHa）, and decreased dsplatin cytotoxicity of two （H460 and Hep3B） cell lines. The GR content of the seven cell lines affected by DEX was significantly higher than those of the seven cell lines unaffected by DEX （5.2±2.5×10^4 sites/cell vs1.3±1.4×10^4 sites/cell, P= 0.005）. Only two DEX-unresponsive cell lines {NPC-TW01 and NPC- TW04） oontained high GR amounts in the range （1.9-8.1×10^4 sites/cell） of the seven DEX-responsive cell lines. The GR function of NPC-TW01 and NPC-TW04, however, was foundto be impaired. The importance of high cellular amount of GR in mediating DEX susceptibility of the cells was further exemplified by GR dose-dependent drug resistance to cisplatin of AGS, a cell line with low GR content and was unaffected by DEX before transfection of GR-expressing vector. Immunohistochemical studies of human cancer tissues showed that 5 of the 45 （11.1%） breast cancer and 43 of the 85 （50.6%） non-small cell lung cancer had high GR contents at the ranges of the GC-responsive carcinoma cell lines. CONCLUSION： The growth and chemosensitivity of human carcinomas with high GR contents may be affected by GC. However, in light of the heterogeneous and even contradictive effects of GC on these cells, routine examination of GR contents of human carcinoma tissues may not be clinically useful until other markers that help predict the ultimate effect of GC on individual patients are identified.
文摘Dear Editor,I am Dr. Jungyul Park from the Division of oculoplasty, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea. I write to discuss a case of myeloid sarcoma of the eyelid mimicking pre-septal cellulitis in acute myeloid leukemia(AML).
文摘AIM： To investigate the molecular events involved in liver regeneration following subtotal hepatectomy （SH） as previous studies have largely focused on partial hepatectomy （PH）. METHODS： Male Wistar rats were subjected to 70% PH or 90% SH, respectively, and sacrificed at different times after surgery. Untreated and sham-operated animals served as controls. Serum and liver samples were obtained to investigate liver function, apoptosis （TUNEL assay） and transcription factors （NF-KB, Stat3; ELISA） or cytokines （HGF, TNF-α, IL-6, TGF-α, TGF-β; quantitative RT-PCR） involved in liver regeneration. RESULTS： Serum levels of ALT and AST in animals with 70% PH differed significantly from sham-operated and control animals. We found that the peak concentration 12 h after surgery returned to control levels 7 d after surgery. LDH was increased only at 12 h after 70% PH compared to sham. Bilirubin showed no differences between the sham and 70% resection. After PH, early NF-kB activation was detected 12 h after surgery （313.21 ± 17.22 ng/mL）, while there was no activation after SH （125.22 ± 44.36 ng/mL） compared to controls （111.43 ± 32.68 ng/mL） at this time point. In SH, however, NF-kB activation was delayed until 24 h （475.56 ± 144.29 ng/mL）. Stat3 activation was similar in both groups. These findings correlated with suppressed and delayed induction of regenerative genes after SH （i.e. TNF-α 24 h postoperatively： 2375 ± 1220 in 70% and 88 ± 31 in 90%; IL-6 12 h postoperatively： 2547 ± 441 in 70% and 173 ± 82 in 90%）. TUNEL staining revealed elevated apoptosis rates in SH （0.44% at 24 h; 0.63% at 7 d） compared to PH （0.27% at 24 h; 0.15% at 7 d）. CONCLUSION： The molecular events involved in liver regeneration are significantly influenced by the extent of resection as SH leads to suppression and delay of liver regeneration compared to PH, which is associated with delayed activation of NF-kB and suppression of proregenerative cytokines.
文摘Eight genotypes(A-H) of hepatitis B virus(HBV) have been identified.However,the impact of different genotypes on the clinical course of hepatitis B infection remains controversial.We investigated the frequency and clinical outcome of HBV genotypes and genotype mixtures in HBV-infected patients from Vietnam,Europe,and Africa.In addition,we analyzed the effects of genotype mixtures on alterations in in vitro viral replication.In Asian patients,seven genotypes(A-G) were detected,with A,C,and D predominating.In European and African patients,only genotypes A,C,D,and G were identified.Genotype mixtures were more frequently encountered in African than in Asian(P =.01) and European patients(P =.06) .In Asian patients,the predominant genotype mixtures included A/C and C/D,compared to C/D in European and A/D in African patients.Genotype A was more frequent in asymptomatic compared with symptomatic patients(P <.0001) .Genotype C was more frequent in patients with hepatocellular carcinoma(HCC;P =.02) .Genotype mixtures were more frequently encountered in patients with chronic hepatitis in comparison to patients with acute hepatitis B(P =.015) ,liver cirrhosis(P =.013) ,and HCC(P =.002) .Viral loads in patients infected with genotype mixtures were significantly higher in comparison to patients with a single genotype(P =.019) .Genotype mixtures were also associated with increased in vitro HBV replication.In conclusion,infection with mixtures of HBV genotypes is frequent in Asia,Africa,and Europe.Differences in the replication-phenotype of single genotypes compared to genotype-mixtures suggest that co-infection with different HBV-genotypes is associated with altered pathogenesis and clinical outcome.
