Mirizzi syndrome: Problems and strategies

Mirizzi syndrome is a serious complication of gallstone disease. It is caused by the impacted stones in the gallbladder neck or cystic duct. One of the features of Mirizzi syndrome is severe inflammation or dense fibrosis at the Calot's triangle. In our clinical practice, bile duct, branches of right hepatic artery and right portal vein clinging to gallbladder infundibulum are often observed due to gallbladder infundibulum adhered to right hepatic hilum. The intraoperative damage of branches of right hepatic artery occurs more easily than that of bile duct, all of which are hidden pitfalls for surgeons. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are the preferable tools for the diagnosis of Mirizzi syndrome. Anterograde cholecystectomy in Mirizzi syndrome is easy to damage branches of right hepatic artery and bile duct due to gallbladder infundibulum adhered to right hepatic hilum. Subtotal cholecystectomy is an easy, safe and definitive approach to Mirizzi syndrome. When combined with the application of ERCP, a laparoscopic management of Mirizzi syndrome by well-trained surgeons is feasible and safe. The objective of this review was to highlight its existing problems: (1) low preoperative diagnostic rate, (2) easy to damage bile duct and branches of right hepatic artery, and (3) high concomitant gallbladder carcinoma. Meanwhile, the review aimed to discuss the possible therapeutic strategies: (1) to enhance its preoperative recognition by imaging findings, and (2) to avoid potential pitfalls during surgery.

Causal roles of gut microbiota in cholangiocarcinoma etiology suggested by genetic study

BACKGROUND

Cholangiocarcinoma (CCA) is a highly malignant biliary tract cancer with poor prognosis. Previous studies have implicated the gut microbiota in CCA, but evidence for causal mechanisms is lacking.

AIM

To investigate the causal relationship between gut microbiota and CCA risk.

METHODS

We performed a two-sample mendelian randomization study to evaluate potential causal associations between gut microbiota and CCA risk using genome-wide association study summary statistics for 196 gut microbial taxa and CCA. Genetic variants were used as instrumental variables. Multiple sensitivity analyses assessed result robustness.

RESULTS

Fifteen gut microbial taxa showed significant causal associations with CCA risk. Higher genetically predicted abundance of genus Eubacteriumnodatum group, genus Ruminococcustorques group, genus Coprococcus, genus Dorea, and phylum Actinobacteria were associated with reduced risk of gallbladder cancer and extrahepatic CCA. Increased intrahepatic CCA risk was associated with higher abundance of family Veillonellaceae, genus Alistipes, order Enterobacteriales, and phylum Firmicutes. Protective effects against CCA were suggested for genus Collinsella, genus Eisenbergiella, genus Anaerostipes, genus Paraprevotella, genus Parasutterella, and phylum Verrucomicrobia. Sensitivity analyses indicated these findings were reliable without pleiotropy.

CONCLUSION

This pioneering study provides novel evidence that specific gut microbiota may play causal roles in CCA risk. Further experimental validation of these candidate microbes is warranted to consolidate causality and mechanisms.

[Association of lifestyle and apolipoprotein E gene with risk for cognitive frailty in elderly population in China]

Objective: To investigate the impact of lifestyle, apolipoprotein E (ApoE) gene, and their interaction on the risk for cognitive frailty in the elderly population in China. Methods: The study participants were from the Chinese Longitudinal Healthy Longevity Survey. The information about their lifestyles were collected by questionnaire survey, and a weighted lifestyle score was constructed based on β coefficients associated with specific lifestyles to assess the combined lifestyle. ApoE genotypes were assessed by rs429358 and rs7412 single nucleotide polymorphisms. Cognitive frailty was assessed based on cognitive function and physical frailty. Cox proportional hazards regression model was used to analyze the association of lifestyle and ApoE gene with the risk for cognitive frailty and evaluate the multiplicative and additive interactions between lifestyle and ApoE gene. Results: A total of 5 676 elderly persons, with median age [M (Q1, Q3)] of 76 (68, 85) years, were included, in whom 615 had cognitive frailty. The analysis by Cox proportional hazards regression model indicated that moderate and high levels of dietary diversity could reduce the risk for cognitive frailty by 18% [hazard ratio (HR)=0.82, 95%CI: 0.68-1.00] and 28% (HR=0.72, 95%CI: 0.57-0.91), respectively; moderate and high levels of physical activity could reduce the risk by 31% (HR=0.69, 95%CI: 0.56-0.85) and 23% (HR=0.77, 95%CI: 0.64-0.93), respectively. Healthy lifestyle was associated with a 40% reduced risk for cognitive frailty (HR=0.60, 95%CI: 0.46-0.78). ApoE ε4 allele was associated with a 26% increased risk for cognitive frailty (HR=1.26, 95%CI: 1.02-1.56). No multiplicative or additive interactions were found between lifestyle and ApoE gene. Conclusions: Dietary diversity and regular physical activity have protective effects against cognitive frailty in elderly population. Healthy lifestyle can reduce the risk for cognitive frailty in elderly population regardless of ApoE ε4 allele carriage status.

[Research progress in the promotion of peri-implant soft tissue integration of dental titanium implant based on immune microenvironment regulation]

A good integration of dental implants and the surrounding soft tissue is essential to ensure the long-term effect of implant. In this review, we summarized the research progress of peri-implant soft tissue integration of dental titanium implants, with emphasis on the modification of the gingival interface of implants based on immune microenvironment regulation. This method influences the immune response around the implant by promoting the surface properties of implants, so as to enhance the peri-implant soft tissue integration. The purpose of this review is to provide reference for the related research and clinical application in the field of dental implantation.

Three-dimensional versus two-dimensional laparoscopic surgery for rectal cancer: better promote postoperative sexual and urinary function of a propensity-matched study

Laparoscopic total mesorectal excision (TME) with autonomic nerve preservation (ANP) is a common procedure for rectal cancer (RC), associated with a high prevalence of postoperative urogenital and anorectal dysfunctions. Compared to 2D laparoscopy, 3D laparoscopy provides better depth perception of the surgical field and hand-eye coordination to achieve better outcomes. We compared the performance of 2D and 3D laparoscopy on preserving urogenital and anorectal function in TME+ANP surgery for rectal cancer using propensity-score matching. Data were collected from consecutive male patients who underwent 3D or 2D laparoscopic TME+ANP for primary RC at our institution between March 2012 and December 2020. The primary outcome was sexual and urinary function 1 year after surgery. A total of 450 male patients were eligible. After 1:1 matching, 146 cases were included in each group for analysis. One year after surgery, the prevalence of sexual dysfunction (International Index of Erectile Function score <26) was 8.22% in the 3D laparoscopic group and 44.52% in the 2D laparoscopic group, respectively (P=0.000) and a significant difference in the incidence of urinary retention was observed (n=3 and 24, respectively (P=0.000)). Moreover, blood loss, operative time, duration of hospital stay, and the time to first flatus in the 3D laparoscopic group were significantly less than in the 2D laparoscopic group. In conclusion, 3D laparoscopic TME is associated with lower incidences of postoperative sexual and urinary dysfunction than 2D laparoscopic TME for rectal cancer in male patients.

Design and optical performance research of a fully customizable collimating lens based on total internal reflection

An optical design method of a fully customizable collimating lens is proposed. The initial model of the complete lens is constructed by two parts. One part is calculated by the total internal reflection algorithm; the other part is constructed by trial-and-error method. The lens is further optimized by normal vector correction and high- and low-angle compensation. The optical performance of the fully customizable collimating lens is studied. It is proven to have good collimation performance with a divergence angle of 1.8° at 50% of the maximum luminous intensity; the uniformity is as high as 98.4%.

Inflammatory myofibroblastic tumor of the pancreatic neck: A case report and review of literature

BACKGROUND

Pancreatic inflammatory myofibroblastic tumor (IMT) is a relatively rare disease that is often confused with pancreatic cancer or pancreatic neuroendocrine tumors. The histological features of IMTs show that tissue from this type of tumor contains an intermingling of fibroblast and myofibroblast proliferation, accompanied by a varying degree of inflammatory cell infiltration.

CASE SUMMARY

The management of an IMT occurring at the neck of the pancreas is presented in this paper. A 66-year-old female patient was diagnosed with a pancreatic neck mass after a series of tests. The patient underwent enucleation of the pancreatic neck tumor after a pathological diagnosis of IMT. Previous research on the clinical features, pathological diagnosis and treatment of pancreatic IMTs was reviewed. Compared with previous reports, this is a unique case of enucleation of a pancreatic IMT.

CONCLUSION

The enucleation of pancreatic IMTs may be a safe and efficient surgical method for managing such tumors with a better prognosis. Further cases are required to explore surgical measures for pancreatic IMTs.

The psychological impact of COVID-19 outbreak on medical staff and the general public

To assess the psychological effects of the novel coronavirus disease (COVID-19) on medical staff and the general public. During the outbreak of COVID-19, an internet-based questionnaire included The Self-rating Depression Scale (SDS), Perceived Stress Scale (PSS-10), and Impact of Event Scale-Revised (IES-R) was used to assess the impact of the pandemic situation on the mental health of medical staff and general population in Wuhan and its surrounding areas. Among the 1493 questionnaires completed, 827 (55.39%) of these were men, and 422 (28.27%) of these were medical personnel. The results suggest that the outbreak of COVID-19 has affected individuals significantly, the degree of which is related to age, sex, occupation and mental illness. There was a significant difference in PSS-10 and IES-R scores between the medical staff and the general population. The medical staff showed higher PSS-10 scores (16.813 ± 4.87) and IES-R scores (22.40 ± 12.12) compared to members of the general population PSS-10 (14.80 ± 5.60) and IES-R scores (17.89 ± 13.08). However, there was no statistically significant difference between the SDS scores of medical staff (44.52 ± 12.36) and the general public (43.08 ± 11.42). In terms of the need for psychological assistance, 50.97% of interviewees responded that they needed psychological counseling, of which medical staff accounted for 65.87% and non-medical staff accounted for 45.10%. During the ongoing COVID-19 outbreak, great attention should be paid to the mental health of the population, especially medical staff, and measures such as psychological intervention should be actively carried out for reducing the psychosocial effects.

Small bowel perforation caused by pancreaticojejunal anastomotic stent migration after pancreaticoduodenectomy: A case report

INTRODUCTION

Pancreaticoduodenectomy (PD) has been widely applied as a standard surgical procedure to treat periampullary diseases. The placement of a pancreaticojejunal anastomotic stent is considered an effective and safe method for preventing pancreatic fistula after PD. Recently, the role of pancreaticojejunal anastomotic stents has been challenged, as gradually increasing complications have been observed. Stent-related small bowel perforation has only occurred in 2 cases as long-term complications but has not been reported to occur within 1 week after surgery.

PATIENT CONCERNS

Here, we report the case of a 71-year-old female patient complaining of painless jaundice who underwent PD with a pancreaticojejunal anastomotic stent for a duodenal papillary adenocarcinoma (T4N1M0). Four days after surgery, she had a sudden rise in temperature, high white blood cell count, significantly elevated C-reactive protein and 400 ml green-brown drainage fluid. Enhanced computed tomography showed hydrops abdominis.

DIAGNOSIS

Small bowel perforation caused by stent migration was considered first.

INTERVENTIONS

An emergency exploratory laparotomy was performed. We located the pancreaticojejunal anastomotic stent, which extended 2 cm from the small bowel, and sutured the jejunum hole after cutting away the protruding part of the stent.

OUTCOMES

The patient recovered smoothly and was discharged on the 7th day after the second surgery. After more than 12 months of follow-up, the patient is doing well and is free of any symptoms related to the procedure.

CONCLUSION

We caution that stent-related complications can occur when perioperative patients suffer from unexplained or sudden changes in vital signs after PD. In addition, the function of the pancreaticojejunal anastomotic stent needs to be reevaluated by future studies.

[Feasibility, safety and long-term efficacy of laparoscopic total gastrectomy combined with distal pancreaticosplenectomy for T4b gastric cancer]

Objective: To explore the feasibility, safety and long-term efficacy of laparoscopic total gastrectomy combined with distal pancreaticosplenectomy for the treatment of T4b gastric cancer. Methods: A retrospective cohort study was performed. Clinical data of consecutive patients with T4b gastric cancer invading pancreatic tail undergoing laparoscopic or open total gastrectomy combined with distal pancreaticosplenectomy from January 2010 to December 2014 were analyzed retrospectively. Enrollment criteria: (1) primary gastric cancer confirmed by pathology as T4b adenocarcinoma; (2) chest+abdominal+pelvic enhanced CT indicated cancer invading pancreatic tail without distant metastasis, and R0 resection was evaluated as feasible before operation; (3) physical status was ECOG score 0 to 2, and was tolerant to operation. Patients with peritoneal implant metastasis and tumor invasion of other organs during operation, or changes in surgical methods for other reasons were excluded. All the operations were performed by the same surgical team, which had the experiences of more than 100 cases of laparoscopic and 100 cases of open radical gastrectomy with D2 lymph node dissection. The choice of surgical procedure was discussed by the surgeon and the patient, and decided according to the patient's intension. Patients were divided into the laparoscopic group and open group according to the surgical method. Intraoperative and perioperative findings were compared between the two groups. The 3-year disease-free survival rate were analyzed with Kaplan-Meier survival curve and compared by using log-rank test. Results: A total of 37 consecutive patients were enrolled, including 21 in the laparoscopic group and 16 in the open group, and no one receiving laparoscopic procedure was converted to open surgery. The baseline data of two groups were comparable (all P>0.05). Compared with the open group, the laparoscopic group had significantly longer operation time [(264.0±35.1) minutes vs. (226.6±49.9) minutes, t=2.685, P=0.011], significantly less intraoperative blood loss [(65.7±37.4) ml vs. (182.2±94.6) ml, t=-4.658, P<0.001], significantly shorter time to postoperative flatus [(2.8±0.7) days vs. (4.1±0.7) days, t=-5.776, P<0.001] and significantly shorter postoperative hospital stay [(13.3±2.8) days vs. (16.6±4.3) days, t=-2.822, P=0.008]. Morbidity of postoperative complications, including anastomotic leakage, pancreatic fistula, abdominal abscess, intraperitoneal hemorrhage and duodenal stump leakage, in two groups was similar [19.0% (4/21) vs. 4/16, P=0.705]. There were no cases of anastomotic bleeding or stenosis. The 30-day postoperative mortality was 0 in the laparoscopic group and 1/16 in the open group, respectively (P=0.432). The 3-year disease-free survival rates were 38.1% and 37.5% in the laparoscopic and open group, respectively (P=0.751). Conclusion: Laparoscopic total gastrectomy combined with distal pancreaticosplenectomy performed by experienced surgeons for T4b gastric cancer is safe and effective.

Long Non-Coding RNA STARD13-AS Suppresses Cell Proliferation And Metastasis In Colorectal Cancer

Background

Dysregulation of long non-coding RNAs (lncRNAs) is closely related with the progression of cancer in humans. The functional and regulatory roles of lncRNAs in colorectal cancer (CRC) are still largely unclear. The purpose of this study is to explore the function of lncRNA STARD13-AS in CRC.

Methods

The bioinformatics tool “GEPIA” was used to predict the potential expression of STARD13-AS in CRC. qRT-PCR was used to evaluate the relative expression level of STARD13-AS in CRC cells lines and tissues samples. The functional involvement of STARD13-AS in the CRC cells was assessed using MTT assay, flow cytometry, and Transwell assay. The expression levels of cyclin D, cyclin E, E-cadherin, N-cadherin, and vimentin were assessed using Western blot.

Results

Bioinformatics prediction and qRT-PCR results showed that STARD13-AS expression was decreased in CRC tissues. Patients with low STARD13-AS expression exhibited distant and lymphatic metastasis as well as enhancement in tumor size. STARD13-AS expression was downregulated in CRC cell lines compared to normal human colon mucosal epithelial cell line NCM460 and STARD13-AS expression in SW620 and LoVo cell lines was lowest. Moreover, we observed that while STARD13-AS overexpression suppressed the cell cycle, proliferation, migration, and invasion, while promoted apoptosis both in LoVo and SW620 cells. In addition, STARD13-AS overexpression inhibited Cyclin E, Cyclin D, N-cadherin and vimentin expression, and promoted E-cadherin expression both in LoVo and SW620 cells.

Conclusion

Expression of STARD13-AS suppresses cell proliferation and metastasis in CRC, suggesting that STARD13-AS might act as a potential target for CRC treatment.

[Expression profiles of microRNA related to atherosclerosis in patients with OSA]

Objective:Recent studies have demonstrated that obstructive sleep apnoea(OSA) may lead to atherosclerosis(AS), but the underlying mechanism remains unclear. MicroRNA(miRNA) may be involved in the gene regulation of AS and also in the occurrence and progression of OSA. The purpose of our study was to investigate the expression of atherosclerosis related serum miRNAs in OSA patients.Method: We screened 116 participants including normal controls(n=24), OSA alone(n=32),OSA patients with AS(n=32),and patients with AS but without OSA(n=28).qRT-PCR to analyze the microRNA profile was performed in these subjects.Clinical and blood test with lipid parameters were analysed using Spearman correlations.Result:Compared to normal controls, miRNA-148a-5p, miRNA-378c, miRNA-127-3p and miRNA-365a-3p were upregulated in the OSA, OSA-AS, and AS groups; miRNA-134-5p was only upregulated in the AS group, miRNA-365a-3p in the OSA-AS group was higher than that in the OSA alone group. The circulating atherosclerosis related miRNAs, including miRNA-148a-5p, miRNA-378c, miRNA-127-3p, miRNA-134-5p and miRNA-365a-3p all correlated with the carotid intima media thickness. Conclusion: Upregulation of miRNA-148a-5p, miRNA-365a-3p, miRNA-378c, miRNA-127-3p may be an early warning marker of atherosclerosis in OSA patients.

[An analysis of influencing factors for brucellosis in major occupational groups in Bayannur, China]

Objective: To investigate the current status of brucella infection in major occupational groups in Bayannur, China, and to analyze the risk factors for brucellosis. Methods: From January to March, 2015, a questionnaire survey and the serological testing were performed to investigate the current status of brucella infection in 649 workers in 13 slaughter and breeding plants in 7 counties in Bayannur, China. The items in the questionnaire survey included general information, related occupational information, living habits, medical history, and awareness of related knowledge. Results: A total of 112 workers (17.26%) had brucella infection. Brucella infection was associated with sex, age, years of exposure to hazardous substances, job, educational background, usage of protective equipment, the presence or absence of a wound at the exposure site, and whether to smoke during the work clearance (P<0.05) . The multivariate analysis showed that the risk factors for brucellosis were meat processing work (OR=1.812) , >5 years of exposure to hazardous substances (OR=1.363) , improper use or nonuse of protective equipment (OR=1.957) , smoke during work (OR=2.027) , and the presence of a woundat the exposure site (OR= 1.231) ; the protective factors for brucellosis were high school and college education and above (OR=0.521) and high rate of awareness of brucella-related knowledge (OR=0.648) . Conclusion: The brucella infection rate is high in the major occupational groups in Bayannur, China. The main influencing factors for brucellosis are job, years of exposure to hazardous substances, usage of protective equipment, whether to smoke during work, and the presence or absence of a wound at the exposure site.

Visible light communication using dual camera on one smartphone

Dual camera is becoming increasingly prevalent among smartphone camera schemes these days. This paper demonstrates a system prototype by using the color and monochrome cameras on one smartphone simultaneously for visible light communication. To achieve this, we propose a novel dual-modulation scheme. The baseband signal is firstly modulated by color ratio modulation-color shift keying (CRM-CSK) to broadcast color ratio information that can be distinguished by the color camera. Next to it, gray level modulation (GLM) is utilized to generate CRM symbols with gray levels that can be distinguished by the monochrome camera. Our experiment shows a significant improvement in the downlink data rate of the optical camera communication (OCC) using a single light source.

High-efficient catalytic reduction of 4-nitrophenol based on reusable Ag nanoparticles/graphene-loading loofah sponge hybrid

Noble metal nanoparticles (NPs) such as Au and Ag have shown many applications in the field of catalysis, sensing etc. due to their excellent photoelectric properties. But agglomeration and a low recovery rate are big problems for their applications. In this research, a novel Ag NPs/graphene (reduced graphene oxide)-loading loofah sponge (Ag NPs/RGO-LS) was synthesized through a one-step reduction method. Where the RGO is used as a nano-support with the high specific surface area and the high conductivity to prevent the agglomeration of Ag NPs and provide a conductive layer. The natural, green, low-cost and high-yield LS is designed as a macro-support to reduce the loss of Ag NPs during recycling. The as-prepared Ag NPs/RGO-LS is stable, uniform, and exhibits high efficiency and reusability in the catalytic reduction of 4-nitrophenol (4-NP) with a high rate constant of 1.893 min^-1 as well as an average conversion of 98% in 6 min during five cycles. The results have not only paved the way for the wide application of Ag NPs but also provide a new road for the application of other metal NPs.

Facile preparation of surfactant-free Au NPs/RGO/Ni foam for degradation of 4-nitrophenol and detection of hydrogen peroxide

The application of Au nanoparticles (Au NPs) often requires surface modification with chemical surfactants, which dramatically reduce the surface activity and increase the chemical contamination and cost of Au NPs. In this research, we have developed a novel Au NPs/reduced graphene oxide/Ni foam hybrid (Au NPs/RGO/NiF) by in situ reduction through ascorbic acid and replacement reaction. This method is green, facile and efficient. The Au NPs are free of chemical surfactants and are homogeneously distributed on the surface of the RGO/NiF. The as-prepared Au NPs/RGO/NiF hybrid is uniform, stable and exhibits not only a high reduction efficiency for the reduction of 4-nitrophenol with a catalytic kinetic constant of up to 0.46 min^-1 (0.15 cm³ catalysis) but also a sensitive and selective detection of H₂O₂ with a detection limit of ∼1.60 μM.

Circulating miR-125a but not miR-125b is decreased in active disease status and negatively correlates with disease severity as well as inflammatory cytokines in patients with Crohn’s disease

AIM

To determine the association of circulating miR-125a/b expression with the risk and disease severity of Crohn’s disease (CD), and with inflammatory cytokines.

METHODS

Plasma samples were collected from patients with active CD (A-CD), or CD in remission (R-CD) and from healthy controls (HCs). The levels of the inflammatory cytokines interleukin-17 (IL-17), tumour necrosis factor-α (TNF-α), and interferon-γ (IFN-γ) were measured by enzyme-linked immunosorbent assay. The expression of miR-125a/b was assessed by quantitative polymerase chain reaction (qPCR).

RESULTS

Twenty-nine A-CD patients, 37 R-CD patients, and 37 HCs were included in the study. Plasma miR-125a expression was decreased in A-CD patients compared with that in R-CD patients (P < 0.001) and HCs (P < 0.001). miR-125a expression levels enabled the differentiation of A-CD from R-CD patients [area under curve (AUC) = 0.854] and from HCs (AUC = 0.780), whereas miR-125b expression did not. miR-125a was negatively correlated with C-reaction protein (CRP) (P = 0.017), erythrocyte sedimentation rate (ESR) (P = 0.026), Crohn’s disease activity index (CDAI) (P = 0.003), IL-17 (P = 0.015), and TNF-α (P = 0.004) in A-CD patients. Furthermore, miR-125a was negatively associated with CRP (P = 0.038) and CDAI (P = 0.021) in R-CD patients. Regarding miR-125b, no association with CRP, CDAI, IL-17, TNF-α, or IFN-γ was found in A-CD or in R-CD patients. miR-125a levels gradually increased in A-CD patients who achieved clinical remission (P = 0.009) after 3-mo treatment, whereas they remained unchanged among patients who failed to achieve remission. No changes in miR-125b expression were detected in remission or non-remission patients after treatment.

CONCLUSION

Circulating miR-125a but not miR-125b is decreased in patients with active disease status and negatively correlates with disease severity and inflammatory cytokines in patients with CD.

Clinical characteristics of colorectal polyps and adenocarcinoma: Analysis of 2273 cases

AIM

To determine the onset age, location and pathological type of colorectal polyps.

METHODS

The χ² test was used to analyze the relationship between age and the pathological type of polyps (including adenocarcinoma), as well as between the location and pathological type of adenomas.

RESULTS

Of the 2273 patients included, 1245 (54.8%) were aged over 60 years, and 887 (39%) were aged between 45-59 years. Among 925 cases with non-neoplastic polyps, 420 (45.4%) were aged between 45-59 years, and 419 (45.5%) were aged over 60 years. Villous adenoma most commonly underwent malignant transformation (37.5%). Age was not related to the pathological type of adenoma. Adenocarcinomas mainly affected the rectum, sigmoid colon, and ascending colon, accounting for 34.1% (134/393), 21.1% (83/393), and 15.8% (62/393) of all adenocarcinomas, respectively. The rate of malignant transformation was highest in the hepatic flexure [58.5% (20/34)], followed by the ileocecal valve [52.8% (19/36)] and ascending colon [45.6% (62/136)].

CONCLUSION

The occurrence of polyps and adenocarcinoma is related to age, which may be due to metabolic factors such as obesity and diabetes and long-term inflammatory response.

Formal total synthesis of the akuammiline alkaloid (+)-strictamine

An asymmetric formal total synthesis of the akuammiline alkaloid (+)-strictamine is reported.

DEC2 suppresses tumor proliferation and metastasis by regulating ERK/NF-κB pathway in gastric cancer

Differentiated embryonic chondrocyte expressed gene 2 (DEC2; BHLHE41/Sharp1) is a helix-loop-helix (bHLH) transcription factor, and its deregulation has been observed in several tumors. However, this gene's effects on tumor progression are controversial, and its roles in gastric cancer (GC) remain unclear. In the present study, we found that DEC2 expression level is lower in GC tissues compared with adjacent non-tumor tissues, and negatively correlated with tumor invasion, lymph node metastasis, TNM stage, and poor survival of GC patients. Positive clinical correlations of DEC2 with EMT regulator, E-cadherin, were also observed in the tissue sections. Overexpression of DEC2 inhibits cell proliferation and EMT in vitro, as well as tumor growth and metastasis in vivo. DEC2 expression also induces cell apoptosis. Furthermore, the anti-metastatic effect of DEC2 was mediated by inhibiting ERK/NF-κB/EMT axis. After treatment with ERK1/2 chemical inhibitor (U0126), DEC2's inhibitory effect on ERK/NF-κB/EMT was further decreased. Collectively, these data helped to characterize DEC2, which might be a potential molecular target for diagnostic and therapeutic approaches for GC.

Clinical pathology and recent follow-up study on gastric intraepithelial neoplasia and gastric mucosal lesions

BACKGROUND/AIMS

To explore the correlations between endoscopic gastric mucosal lesions and pathological gastric intraepithelial neoplasia (GIN), and to investigate outcomes of gastric intraepithelial neoplasia after treatments.

METHODOLOGY

Biopsies of 18,566 Chinese patients undergoing diagnostic gastroscopy were included. Among them, 130 patients were given various treatments, including medication, endoscopic treatment and surgery.

RESULTS

There were 433 patients with GIN by initial pathological diagnosis. Among them, 367 low-grade GIN and 66 high-grade GIN, 348 cases accompanied with chronic gastritis, and 85 cases accompanied with localized foci. Eighty cases of Hp-positive patients with low-grade GIN were given anti-Hp therapy. Our results showed that 45 cases of intraepithelial neoplasia disappeared when chronic inflammation left, and 33 cases were given the original diagnoses and two cases developed into high-grade GIN. Surgery was then performed, after which one case was confirmed to have early gastric carcinoma, and the other was diagnosed as advanced gastric carcinoma. Pathological examinations were carried out undergoing EMR or ESD treatment for 18 patients with localized foci accompanied with low-grade GIN. Results showed four cases of chronic inflammation, 11 cases with original diagnoses maintained, and three cases of high-grade GIN.

CONCLUSIONS

GIN occurred frequently in patients with more severe pathological inflammations under endoscope, which also had certain correlations with intestinal metaplasia. After treatment, parts of low-grade GIN could be reserved. The effect of endoscopic resection on localized foci accompanied with low-grade GIN was affirmative. However, the limitation of endoscopic biopsy should be fully understood.

Association between protein tyrosine phosphatase nonreceptor type 22 gene rs2488457 polymorphism and ulcerative colitis

AIM: To evaluate the association between protein tyrosine phosphatase nonreceptor type 22 (PTPN22) gene polymorphisms (-1123G/C in the promoter and +788G/A in exon 10) and disease susceptibility and phenotypes of ulcerative colitis (UC), and to investigate PTPN22 mRNA expression in colonic biopsies of UC patients.

METHODS: A total of 165 UC patients and 300 healthy controls were enrolled in this study. PTPN22 gene -1123G/C and +788G/A polymorphisms were genotyped by polymerase chain reaction-based restriction fragment length polymorphism. PTPN22 mRNA expression in colonic biopsies of UC patients and controls was determined by quantitative RT-PCR.

RESULTS: The frequencies of "CC + CG" genotypes and C allele were higher in UC patients than in healthy controls (66.7% vs 53.3%, P = 0.005, OR = 1.75, 95%CI: 1.18-2.60; 41.5% vs 33.5%, P = 0.015, OR = 1.41, 95%CI: 1.07-1.86), and were associated with extensive colitis (P = 0.029). In UC patients, PTPN22 mRNA expression levels were elevated in active disease compared to inactive disease (P = 0.005). There was no association between PTPN22 mRNA expression levels and -1123G/C polymorphism in UC patients. PTPN22 gene +788G/A polymorphism did not show any association with UC.

CONCLUSION: Our study demonstrates a potential association between PTPN22 -1123G/C polymorphism and UC in central China. PTPN22 mRNA is highly expressed in active UC, suggesting that PTPN22 may play an important role in the pathogenesis of UC.

Glutathione-functionalized graphene quantum dots as selective fluorescent probes for phosphate-containing metabolites

Bright blue fluorescent glutathione-functionalized graphene quantum dots (GQDs@GSH) were prepared by a one-step pyrolysis method with a fluorescence quantum yield as high as 33.6%. Futhermore, the obtained GQDs@GSH can be used as a probe to estimate the ATP level in cell lysates and human blood serum.

Overexpression of metastasis-associated protein 1 is significantly correlated with tumor angiogenesis and poor survival in patients with early-stage non-small cell lung cancer

BACKGROUND

The aims of this work are to detect the expression levels of metastasis-associated protein 1 (MTA1) in patients with early-stage non-small cell lung cancer (NSCLC), and to investigate the relationship of MTA1 protein with clinicopathologic factors, tumor angiogenesis, and prognosis.

METHODS

One hundred and two patients with pathologic stage I NSCLC who successfully underwent curative surgical resection were enrolled in this study. Immunohistochemical staining for MTA1 and CD34 was performed using the streptavidin-peroxidase method, and intratumoral microvessel density (MVD) was recorded by counting CD34-positive immunostained endothelial cells. All statistical analyses were performed with SPSS statistical software to determine the effects of MTA1 protein on clinicopathologic factors, tumor angiogenesis, and prognosis.

RESULTS

MTA1 protein overexpression was detected in 41 cases and was significantly associated with MVD (P = 0.008). MTA1 protein overexpression and high MVD were significantly associated with tumor relapse (P = 0.004 and 0.007) and poor 5-year disease-free survival (P = 0.001 and 0.004). Patients with MTA1 protein overexpression and high MVD had significantly poor overall survival (P = 0.005 and 0.043) and disease-specific survival (P = 0.006 and 0.031) at 5 years after operation. Multivariate analysis demonstrated that MTA1 protein overexpression was an independent prognosticator for unfavorable disease-free, overall, and disease-specific survival (P = 0.011, 0.024, and 0.046).

CONCLUSIONS

MTA1 protein overexpression is common in early-stage NSCLC and is significantly associated with tumor angiogenesis and poor survival. These findings suggest that MTA1 may have clinical potential as a promising predictor to identify individuals with poor prognostic potential and as a possible novel target molecule of antiangiogenic therapy for patients with early-stage NSCLC.

[A novel microemulsion electrokinetic chromatography for measuring lipid-water partition coefficients of pharmaceuticals]

AIMS

To establish a novel microemulsion electrokinetic chromatography (MEEKC) method for measuring lipid-water partition coefficients ( logP(ow)) of pharmaceuticals without using microemulsion phase marker in order to avoid the error from tracing the migration time of microemulsion phase.

METHODS

The migration time of microemulsion phase (t(me)) was obtained by non-linearity fitting with logP(ow) values from literature and measured migration time (t(m)) of a series of organic compounds, a calibration curve for estimating logP(ow) of pharmaceuticals was thus obtained. In addition, the accuracy of the values measured by MEEKC was evaluated.

RESULTS

The logP(ow) values of 4 pharmaceuticals measured by MEEKC method presented in this paper were close to those determined by shake-flask method, and the average error between values from two methods was 0.15 logarithm units. Furthermore, according to the suggested theory, the measurement accuracy of logP(ow) is correlated with different t(m) in MEEKC.

CONCLUSION

The proposed method is simple, rapid, reproducible, and reliable with high measurement accuracy, which can be useful to estimate lipid-water partition coefficients of pharmaceuticals.

[Study on effect of qingkailing injection and its active principle in inducing cell apoptosis in human acute promyelocytic leukemia]

OBJECTIVE

To investigate the mechanism of Qingkailing (QKL) Injection in treating acute promyelocytic leukemia.

METHODS

Using MTT technique, cell morphologic method, DNA gel electrophoresis and flow-cytometry to study the human acute promyelocytic leukemia (HL-60) cell apoptosis induced by QKL and its active principle.

RESULTS

QKL and its active principle, Baicalin and hyodeoxycholic acid, showed strong cytotoxicity in inhibiting HL-60 cell, the Bezoar cholic acid showed a weaker effect. Apoptosis could be induced after being treated for 6 hrs by the former three principles, showing a typical apoptosis peak under flow-cytometry, but could not be induced by the latter one.

CONCLUSION

QKL could induce leukemia cell apoptosis in vitro, which may be one of the mechanisms of QKLI in curing acute promyelocytic leukemia.

Sesquiterpene esters of aristolochic acid from the root and stem of Aristolochia heterophylla

Three novel sesquiterpene esters of aristolochic acid, aristoloterpenate-II (2), -III (3), and-IV (4), together with known aristoloterpenate-I (1), were isolated and characterized from the root and stem of Aristolochia heterophylla. Their structures were elucidated by spectroscopic methods. The absolute configuration of these compounds at C-4' was determined as R by circular dichroic studies. These compounds showed cytotoxicity against hepatoma G2, 2, 2, 15 cells.

[The role of oxygen radicals in adult respiratory distress syndrome]

A traumatic adult respiratory distress syndrome (ARDS) model was made with 3 intravenous bolus of homologous bone marrow extract in rabbits. Variables were then measured including the metabolites of oxygen radicals in plasma and expired gases, serum lactic dehydrogenase (LDH) isoenzymes and plasma fibronectin (Fn). A two peak increase was found in expired ethane and plasma conjugated dienes following decrease of periphery white blood and polymorphonuclear neutrophil (PMN) differential count; continuous increase of serum LDH3 and severe descent of plasma Fn were also found after the trauma. The above results suggest that PMN releasing oxygen radicals play an important role in RDS pathogenesis; and expired ethane, circulating conjugated dienes, LDH3 and Fn may be useful for making diagnosis and prognosis assessment of ARDS.

Induction of heat-shock response and alterations of protein phosphorylation by a novel topoisomerase II inhibitor, withangulatin A, in 9L rat brain tumor cells

Withangulatin A is a newly identified in vitro topoisomerase II inhibitor isolated from the Chinese antitumor herb Physalis angulata. In vivo, it was found to be cytotoxic, capable of suppressing general protein synthesis and of inducing the synthesis of a small set of proteins including those generated by heat-shock treatment. The 70 kDa protein generated by withangulatin A was unequivocally identified as the heat-shock protein 70 (HSP70) since both proteins migrated to the same position on two-dimensional polyacrylamide gels, could be recognized by a monoclonal antibody to human HSP70, and exhibited identical peptide maps. The induction of protein synthesis by withangulatin A was regulated at the transcriptional level since it was aborted in cells pre-treated with actinomycin D. However, the initiation of this process did not require de novo protein synthesis since it was not affected by cycloheximide. Other cellular effect of withangulatin A was alterations of protein phosphorylation including an enhancement of phosphorylation of a 65 kDa protein which was also detected in the heat-shocked cells. Moreover, this process was observed within 7.5 min after the initial heat treatment which is much faster than the onset of HSP synthesis. Therefore, increased phosphorylation of the 65 kDa protein may represent one of the earliest signals generated by both heat-shock and withangluatin A and may be involved in the upstream regulation of heat-shock response in cells.

[Effect of herbal tonic on the membrane fluidity of the mice suffered from lymphatic leukemia]

By using fluorescence polarization technology, the authors have studied variations in the membrane fluidity of red blood cell and spleen lymphocytes of the mice with lymphatic leukemia (L7212) untreated or treated by the compound tonic of traditional Chinese medicine decoction of reinforcing Qi and nourishing Yin and decoction of reinforcing Qi and nourishing blood. It was not only confirmed that the membrane fluidity of malignant lymphocytes increased more greatly, but also discovered that the variations could appear in early period of leukemia. The membrane fluidity of lymphocytes of the mice with leukemia treated by the herbal tonic could drop to normal level. But the membrane fluidity of the red blood cell between the normal mice (615) and the leukemia mice (L7212), untreated or treated by the herbal tonic, had no significant difference.

RESULT

the above mentioned suggests the herbal tonic could resist leukemia by reducing the membrane fluidity of the lymphocytes and improving structure and function of the membrane.

Importance of acid-base strategy in reducing myocardial and whole body oxygen consumption during perfusion hypothermia

During induced hypothermia with cardiopulmonary bypass, acid-base management usually follows one of two strategies: the so-called ectothermic or alpha-stat strategy, in which the pH of the arterial blood increases 0.015 pH units for every degree Celsius decrease in body temperature, or the pH-stat strategy, in which pH remains 7.4 at all temperatures. It has been assumed that oxygen consumption decreases approximately equally during hypothermia with either strategy, although there are biochemical reasons to hypothesize that oxygen consumption would be better maintained with the alpha-stat strategy. We also hypothesized that venous oxygen tension would be lower with the more alkaline alpha-stat strategy than with the pH-stat acid-base strategy, because of the Bohr effect. We tested these hypotheses by placing 10 anesthetized immature domestic pigs on cardiopulmonary bypass. We measured whole body oxygen consumption and myocardial oxygen consumption. Control measurements were made at 37 degrees C. Then the animals were cooled to 27 degrees C and the measurements were repeated. The alpha-stat strategy (pH 7.554 +/- 0.020 at 27 degrees C) was used in five animals and five animals received pH-stat management (pH 7.409 +/- 0.012 at 27 degrees C). Whole body and myocardial oxygen consumption rate decreased in both groups, but more so in the alpha-stat animals than in the pH-stat animals. The unexpectedly high oxygen consumption in the pH-stat animals also resulted in a lower than expected venous oxygen tension. Thus the effect of hypothermia in reducing oxygen consumption was less pronounced with pH-stat acid-base management.

[Comprehensive observation of a canine model of respiratory distress syndrome induced with bone marrow]

An animal model of respiratory distress syndrome (RDS) was made with homologous bone marrow extraction in dogs, which had a similar alter to clinic ARDS patients in blood gases, chest X-ray films and pulmonary pathologic findings. Its pathogenetic key point was extensive pulmonary fat emboli, while active oxygen and neutrophil elastase also play an important role in it. Our results indicate that this model is a rather better one, and anisodamine has some therapeutic effects on the experimental RDS model.