Establishment and characterization of a new human ampullary carcinoma cell line, DPC-X1

BACKGROUND

An in-depth study of the pathogenesis and biological characteristics of ampullary carcinoma is necessary to identify appropriate treatment strategies. To date, only eight ampullary cancer cell lines have been reported, and a mixed-type ampullary carcinoma cell line has not yet been reported.

AIM

To establish a stable mixed-type ampullary carcinoma cell line originating from Chinese.

METHODS

Fresh ampullary cancer tissue samples were used for primary culture and subculture. The cell line was evaluated by cell proliferation assays, clonal formation assays, karyotype analysis, short tandem repeat (STR) analysis and transmission electron microscopy. Drug resistances against oxaliplatin, paclitaxel, gemcitabine and 5-FU were evaluated by cell counting kit-8 assay. Subcutaneous injection 1 × 10⁶ cells to three BALB/c nude mice for xenograft studies. The hematoxylin-eosin staining was used to detect the pathological status of the cell line. The expression of biomarkers cytokeratin 7 (CK7), cytokeratin 20 (CK20), cytokeratin low molecular weight (CKL), Ki67 and carcinoembryonic antigen (CEA) were determined by immunocytochemistry assay.

RESULTS

DPC-X1 was continuously cultivated for over a year and stably passaged for more than 80 generations; its population doubling time was 48 h. STR analysis demonstrated that the characteristics of DPC-X1 were highly consistent with those of the patient’s primary tumor. Furthermore, karyotype analysis revealed its abnormal sub-tetraploid karyotype. DPC-X1 could efficiently form organoids in suspension culture. Under the transmission electron microscope, microvilli and pseudopods were observed on the cell surface, and desmosomes were visible between the cells. DPC-X1 cells inoculated into BALB/C nude mice quickly formed transplanted tumors, with a tumor formation rate of 100%. Their pathological characteristics were similar to those of the primary tumor. Moreover, DPC-X1 was sensitive to oxaliplatin and paclitaxel and resistant to gemcitabine and 5-FU. Immunohistochemistry showed that the DPC-X1 cells were strongly positive for CK7, CK20, and CKL; the Ki67 was 50%, and CEA was focally expressed.

CONCLUSION

Here, we have constructed a mixed-type ampullary carcinoma cell line that can be used as an effective model for studying the pathogenesis of ampullary carcinoma and drug development.

[Clinical effects of free descending branch tissue flap of lateral circumflex femoral artery in repairing Wagner grade 3 or 4 diabetic foot wounds]

Objective: To investigate the clinical effects of free descending branch tissue flap of lateral circumflex femoral artery in repairing Wagner grade 3 or 4 diabetic foot wounds. Methods: A retrospective observational study was conducted. From October 2019 to January 2022, 12 patients (10 males and 2 females, aged 38-66 years, with an average of 52 years) with diabetic foot wounds who met the inclusion criteria were admitted to the First People's Hospital of Yulin, of whom 5 cases being Wagner grade 3 and 7 cases being Wagner grade 4. Wound debridement and vacuum sealing drainage were performed to control infection, and the wound area after debridement was between 13 cm×6 cm and 28 cm×11 cm. The wounds were repaired with free descending branch tissue flaps of lateral circumflex femoral artery. Among them, the wounds of 4 cases were repaired with single flap of musculocutaneous branch or intermuscular branch of descending branch tissue flap of lateral circumflex femoral artery, 1 case with lobulated flap, 1 case with bilateral tandem flap, and 6 cases with chimeric lateral femoral muscle flap. The area of resected tissue flap was 9 cm×7 cm to 21 cm×10 cm; end-to-end anastomosis was selected between vessels in the donor sites and the recipient sites, and pressurized treatment should be performed if necessary. The donor site wounds of 10 patients were treated with cosmetic tension-relieving suture, and the donor site wounds of 2 patients were repaired with split-thickness skin graft from head. After operation, the condition of wound repair was recorded. After wound healing, the level of 2-hour postprandial blood glucose of patients was measured. During follow-up, the wound healing of the recipient site and scar formation of the donor site were observed. Before and 6 months after operation, computer tomography angiography was used to detect and compare the blood perfusion of the affected limb. At the last follow-up, the walking ability of the patients was recorded. Results: The wounds of 9 patients healed well after operation; the flaps in the recipient site of 2 patients were infected on postoperative day 5 after surgery and were repaired by suturing in stage Ⅱ after open drainage and inflammation control; the distal end of the grafted tandem flap in 1 patient gradually developed purple necrosis on postoperative day 4 and was repaired with a skin graft after debridement. After wound healing, the 2-hour postprandial blood glucose value of all patients was controlled in the range of 8-12 mmol/L. During Follow-up of 6 months to 1 year, 3 patients had partial ulceration in the plantar compression area, which healed after decompression combined with dressing change or flap repair, while the other 9 patients had no ulceration in the recipient area; the appearance of the affected foot was plump after wound healing, the transplanted flaps had good blood supply and good fit with the surrounding tissue, and were wear-resistant, but insensitive. During follow-up, only linear scar remained in the donor area of direct suture in 10 cases, and the skin grafts in the donor area were completely survived in 2 cases. Compared with the patency of the main blood vessels of the ankle joint segment of the affected limb before operation, the vascular network of the flap transplantation area in the affected foot was formed 6 months after operation. At the last follow-up, 8 patients could walk independently, and 4 patients could walk with crutches. Conclusions: The free descending branch tissue flap of lateral circumflex femoral artery is effective in repairing Wagner grade 3 or 4 diabetic foot wounds, which can shorten the course of disease and improve local blood flow.

Comparative effectiveness of interventional therapeutic modalities for unresectable hepatocellular carcinoma: A systematic review and network meta‑analysis

It is unclear whether hepatic artery infusion chemotherapy (HAIC) or transcatheter arterial chemoembolization (TACE) is more efficient in the combination therapy of hepatocellular carcinoma (HCC). Head-to-head comparisons among HAIC-related therapies are lacking. For this network meta-analysis, PubMed, EMBASE and Cochrane Library databases were searched up to April 1, 2022. Randomized controlled trials (RCTs) were eligible if they evaluated the use or prolongation of TACE or HAIC in patients with advanced HCC and reported or collected survival data. A network meta-analysis was performed to synthesize data and make direct and indirect comparisons between treatments. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to explore the efficacy of various treatment options on overall survival (OS), odds ratios (ORs) with 95% CI were used for overall response rate (ORR), whereas risk ratios (RRs) with 95% CI were used for serious adverse events (SAEs). The analysis of 7 trials including a total of 1,073 patients found that sorafenib with HAIC-oxaliplatin improved survival (HR=0.33, 95% CI: 0.25-0.44); the ORR was also improved in patients treated with sorafenib plus HAIC-oxaliplatin and sorafenib plus PF-HAIC (OR=22.18, 95% CI: 10.69-52.56; and OR=2.72, 95% CI: 1.43-5.36, respectively). The incidence of liver injury was elevated in patients treated with sorafenib plus TACE (OR=5.93, 95% CI: 2.70-15.41). However, no differences in the incidences of other SAEs were identified among the treatment groups. The present meta-analysis provides preliminary evidence for the comparative safety and efficacy of HAIC and TACE combined with sorafenib, and indicates the dominance of HAIC-oxaliplatin in HCC interventional therapy. However, high-quality RCTs are required to further confirm the efficacy of HAIC-oxaliplatin. The present study has been registered with PROSPERO (registration no. CRD42021288497).

Choledocholithiasis characteristics with periampullary diverticulum and endoscopic retrograde cholangiopancreatography procedures: Comparison between two centers from Lanzhou and Kyoto

BACKGROUND

Most of study regarding periampullary diverticulum (PAD) impact on endoscopic retrograde cholangiopancreatography (ERCP) therapy for choledocholithiasis based on data from one endoscopy center and lacked to compare the clinical characteristic of choledocholithiasis with PAD from different geographical patients.

AIM

To compare the choledocholithiasis clinical characteristics between two regional endoscopy centers and analyze impacts of clinical characteristics on ERCP methods for choledocholithiasis patients with PAD.

METHODS

Patients seen in two endoscopy centers (The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China, and Kyoto Second Red Cross Hospital, Kyoto, Japan) underwent ERCP treatment for the first time between January 2012 and December 2017. The characteristics of choledocholithiasis with PAD were compared between the two centers, and their ERCP procedures and therapeutic outcomes were analyzed.

RESULTS

A total of 829 out of 3608 patients in the Lanzhou center and 241 out of 1198 in the Kyoto center had choledocholithiasis with PAD. Lots of clinical characteristics were significantly different between the two centers. The common bile duct (CBD) diameter was wider, choledocholithiasis size was lager and multiple CBD stones were more in the Lanzhou center patients than those in the Kyoto center patients (14.8 ± 5.2 mm vs 11.6 ± 4.2 mm, 12.2 ± 6.5 mm vs 8.2 ± 5.3 mm, 45.3% vs 20.3%, P < 0.001 for all). In addition, concomitant diseases, such as acute cholangitis, gallbladder stones, obstructive jaundice, cholecystectomy, and acute pancreatitis, were significantly different between the two centers (P = 0.03 to < 0.001). In the Lanzhou center, CBD diameter and choledocholithiasis size were lower, and multiple CBD stones and acute cholangitis were less in non-PAD patients than those in PAD patients (13.4 ± 5.1 mm vs 14.8 ± 5.2 mm, 10.3 ± 5.4 mm vs 12.2 ± 6.5, 39% vs 45.3%, 13.9% vs 18.5%, P = 0.002 to < 0.001). But all these characteristics were not significantly different in the Kyoto center. The proportions of endoscopic sphincterotomy (EST), endoscopic balloon dilatation (EPBD), and EST+EPBD were 50.5%, 1.7%, and 42.5% in the Lanzhou center and 90.0%, 0.0%, and 0.4% in the Kyoto center, respectively. However, the overall post-ERCP complication rate was not significantly different between the two centers (8.9% in the Lanzhou and 5.8% in the Kyoto. P = 0.12). In the Lanzhou center, the difficulty rate in removing CBD stones in PAD was higher than in non-PAD group (35.3% vs 26.0%, P < 0.001). But the rate was no significant difference between the two groups in Kyoto center. The residual rates of choledocholithiasis were not significantly different between the two groups in both centers. Post-ERCP complications occurred in 8.9% of the PAD patients and 8.1% of the non-PAD patients in the Lanzhou Center, and it occurred in 5.8% in PAD patients and 10.0% in non-PAD patients in the Kyoto center, all P > 0.05.

CONCLUSION

Many clinical characteristics of choledocholithiasis patients with PAD were significantly different between the Lanzhou and Kyoto centers. The patients had larger and multiple stones, wider CBD diameter, and more possibility of acute cholangitis and obstructive jaundice in the Lanzhou center than those in the Kyoto center. The ERCP procedures to manage native duodenal papilla were different depending on the different clinical characteristics while the overall post-ERCP complications were not significantly different between the two centers. The stone residual rate and post-ERCP complications were not significantly different between choledocholithiasis patients with PAD and without PAD in each center.

Effect of Helicobacter Pylori on Plasma Metabolic Phenotype in Patients With Gastric Cancer

BACKGROUND

Although Helicobacter pylori (Hp) as high risk factor for gastric cancer have been investigated from human trial, present data is inadequate to explain the effect of Hp on the changes of metabolic phenotype of gastric cancer in different stages.

PURPOSE

Herein, plasma of human superficial gastritis (Hp negative and positive), early gastric cancer and advanced gastric cancer analyzed by UPLC-HDMS metabolomics can not only reveal metabolic phenotype changes in patients with gastric cancer of different degrees (30 Hp negative, 30 Hp positive, 20 early gastric cancer patients, and 10 advanced gastric cancer patients), but also auxiliarily diagnose gastric cancer.

RESULTS

Combined with multivariate statistical analysis, the results represented biomarkers different from Hp negative, Hp positive, and the alterations of metabolic phenotype of gastric cancer patients. Forty-three metabolites are involved in amino acid metabolism, and lipid and fatty acid metabolism pathways in the process of cancer occurrence, especially 2 biomarkers glycerophosphocholine and neopterin, were screened in this study. Neopterin was consistently increased with gastric cancer progression and glycerophosphocholine tended to consistently decrease from Hp negative to advanced gastric cancer.

CONCLUSION

This method could be used for the development of rapid targeted methods for biomarker identification and a potential diagnosis of gastric cancer.

Ectopic opening of the common bile duct into the duodenal bulb with recurrent choledocholithiasis: A case report

BACKGROUND

Ectopic opening of the common bile duct is a condition with low incidence. Patients with an ectopic common bile duct opening have a high incidence of common bile duct stones and acute cholangitis. Patients with atypical symptoms and imaging findings are easily misdiagnosed; moreover, it is difficult to retrieve stones by endoscopic retrograde cholangiopancreatography, and common bile duct stones are prone to postsurgical recurrence.

CASE SUMMARY

A 45-year-old male patient presented with “intermittent upper abdominal pain and elevated liver enzymes for 1 wk”. Transabdominal ultrasound indicated dilation of the common bile duct and the presence of stones. Magnetic resonance imaging showed that the common bile duct was dilated with stones and that its opening was ectopic. Endoscopic retrograde cholangiopancreatography revealed an abnormal opening of the common bile duct into the duodenal bulb and the presence of common bile duct stones. Laparoscopic extrahepatic choledochectomy and hepatoenteric anastomosis were performed. After surgery, the patient recovered well and was discharged. The patient has been followed up for 2 years since the operation. He has not experienced stone recurrence, and his liver function and quality of life are good.

CONCLUSION

Improved understanding of ectopic opening of the common bile duct is needed for clinicians to provide patients with appropriate treatment.

Clinical significance of different periampullary diverticulum classifications for endoscopic retrograde cholangiopancreatography cannulation

BACKGROUND

Different types of periampullary diverticulum (PAD) may differentially affect the success of endoscopic retrograde cholangiopancreatography (ERCP) cannulation, but the clinical significance of the two current PAD classifications for cannulation is limited.

AIM

To verify the clinical value of our newly proposed PAD classification.

METHODS

A new PAD classification (Li-Tanaka classification) was proposed at our center. All PAD patients with native papillae who underwent ERCP from January 2012 to December 2017 were classified according to three classification systems, and the effects of various types of PAD on ERCP cannulation were compared.

RESULTS

A total of 3564 patients with native papillae were enrolled, including 967 (27.13%) PAD patients and 2597 (72.87%) non-PAD patients. In the Li-Tanaka classification, type I PAD patients exhibited the highest difficult cannulation rate (23.1%, P = 0.01), and type II and IV patients had the highest cannulation success rates (99.4% in type II and 99.3% in type IV, P < 0.001). In a multivariable-adjusted logistic model, the overall successful cannulation rate in PAD patients was higher than that in non-PAD patients [odds ratio (OR) = 1.87, 95% confidence interval (CI): 1.04-3037, P = 0.037]. In addition, compared to the non-PAD group, the difficulty of cannulation in the type I PAD group according to the Li-Tanaka classification was greater (OR = 2.04, 95%CI: 1.13-3.68, P = 0.004), and the successful cannulation rate was lower (OR = 0.27, 95%CI: 0.11-0.66, P < 0.001), while it was higher in the type II PAD group (OR = 4.44, 95%CI: 1.61-12.29, P < 0.01).

CONCLUSION

Among the three PAD classifications, the Li-Tanaka classification has an obvious clinical advantage for ERCP cannulation, and it is helpful for evaluating potentially difficult and successful cannulation cases among different types of PAD patients.

Plasma microRNAs as potential new biomarkers for early detection of early gastric cancer

BACKGROUND

Early gastric cancer (EGC), compared with advanced gastric cancer (AGC), has a higher 5-year survival rate. However, due to the lack of typical symptoms and the difficulty in diagnosing EGC, no effective biomarkers exist for the detection of EGC, and gastroscopy is the only detection method.

AIM

To provide new biomarkers with high specificity and sensitivity through analyzed the differentially expressed microRNAs (miRNAs) in EGC and AGC and compared them with those in benign gastritis (BG).

METHODS

We examined the differentially expressed miRNAs in the plasma of 30 patients with EGC, AGC, and BG by miRNA chip analysis. Then, we analyzed and selected the significantly different miRNAs using bioinformatics. Reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) confirmed the relative transcription level of these miRNAs in another 122 patients, including patients with EGC, AGC, Helicobacter pylori (H. pylori)-negative gastritis (Control-1), and H. pylori-positive atrophic gastritis (Control-2). To establish a diagnostic model for the detection of plasma miRNA in EGC, we chose miRNAs that can be used to determine EGC and AGC from Control-1 and Control-2 and miRNAs in EGC from all other groups.

RESULTS

Among the expression profiles of the miRNA chips in the three groups in the discovery set, of 117 aberrantly expressed miRNAs, 30 confirmed target prediction, whereas 14 were included as potential miRNAs. The RT-qPCR results showed that 14 potential miRNAs expression profiles in the two groups exhibited no differences in terms of H. pylori-negative gastritis (Control-1) and H. pylori-positive atrophic gastritis (Control-2). Hence, these two groups were incorporated into the Control group. A combination of four types of miRNAs, miR-7641, miR-425-5p, miR-1180-3p and miR-122-5p, were used to effectively distinguish the Cancer group (EGC + AGC) from the Control group [area under the curve (AUC) = 0.799, 95% confidence interval (CI): 0.691-0.908, P < 0.001]. Additionally, miR-425-5p, miR-24-3p, miR-1180-3p and miR-122-5p were utilized to distinguish EGC from the Control group (AUC = 0.829, 95%CI: 0.657-1.000, P = 0.001). Moreover, the miR-24-3p expression level in EGC was lower than that in the AGC (AUC = 0.782, 95%CI: 0.571-0.993, P = 0.029), and the miR-4632-5p expression level in EGC was significantly higher than that in AGC (AUC = 0.791, 95%CI: 0.574-1.000, P = 0.024).

CONCLUSION

The differentially expressed circulatory plasma miR-425-5p, miR-1180-3p, miR-122-5p, miR-24-3p and miR-4632-5p can be regarded as a new potential biomarker panel for the diagnosis of EGC. The prediction and early diagnosis of EGC can be considerably facilitated by combining gastroscopy with the use of these miRNA biomarkers, thereby optimizing the strategy for effective detection of EGC. Nevertheless, larger-scale human experiments are still required to confirm our findings.

Effect of CCNB1 silencing on cell cycle, senescence, and apoptosis through the p53 signaling pathway in pancreatic cancer

Pancreatic cancer (PC) is a serious malignancy with high mortality and poor prognosis due to nonspecific incipient symptoms and early metastasis. Also, increasing evidence indicates that a panel of genes is newly identified in the pathogenesis of PC. As is a regulatory subunit, elevated cyclin B1 (CCNB1) expression has been detected in different cancers including PC. This study is designed to investigate the effects of CCNB1 silencing on cell cycle, senescence, and apoptosis through the p53 signaling pathway in PC. PC tissues and normal pancreatic tissues were collected. Cells were transfected and assigned into different groups. The expressions of CCNB1, p53, MDM2, Bax, caspase-9, caspase-3, and p21 in tissues and cells were detected by reverse transcription quantitative polymerase chain reaction and western blot analysis. β-Galactosidase staining, MTT assay, and flow cytometry were conducted to test cell senescence, proliferation, cell cycle, and apoptosis. PC tissues showed higher expressions of CCNB1 and MDM2 and lower expressions of Bax, caspase-9, caspase-3, and p21. Cells transfected with shCCNB1 had lower expressions of CCNB1 and MDM2, whereas higher expressions of Bax, caspase-9, caspase-3, p53, and p21. The shCCNB1 group had decreased proliferation and S-phase cell proportion and increased apoptosis, senescence, and G0/G1-phase cell proportion. The PFT-α group showed higher expressions of MDM2 and lower expressions of Bax, caspase-9, caspase-3, p53, and p21. The PFT-α group had increased proliferation and S-phase cell proportion and declined apoptosis, senescence, and G0/G1-phase cell proportion. CCNB1 silencing inhibits cell proliferation and promotes cell senescence via activation of the p53 signaling pathway in PC.

Epigenetic actions of environmental factors and promising drugs for cancer therapy

Carcinogenesis is known to be primarily associated with gene mutations. Recently, increasing evidence has suggested that epigenetic events also serve crucial roles in tumor etiology. Environmental factors, including nutrition, toxicants and ethanol, are involved in carcinogenesis through inducing epigenetic modifications, such as DNA methylation, histone deacetylase and miRNA regulation. Studying epigenetic mechanisms has facilitated the development of early diagnostic strategies and potential therapeutic avenues. Modulation at the epigenetic level, including reversing epigenetic modifications using targeted drugs, has demonstrated promise in cancer therapy. Therefore, identifying novel epigenetic biomarkers and therapeutic targets has potential for the future of cancer therapy. The present review discusses the environmental factors involved in epigenetic modifications and potential drug candidates for cancer therapy.

Inhibition of invasion by N-trans-feruloyloctopamine via AKT, p38MAPK and EMT related signals in hepatocellular carcinoma cells

N-trans-feruloyloctopamine (FO) isolated from Garlic skin was identified as the primary antioxidant constituents, however, the effect of which on HCC invasion is still unclear. Herein, the FO was synthesized and its antitumor activities were evaluated in HCC cell lines. Cellular functional analyses have revealed that the reformed FO owns strong abilities of inhibiting cell proliferation and invasion in HCC cells. Molecular data have further showed that FO could significantly decrease the phosphorylation levels of Akt and p38 MAPK. In addition, the expression of Slug was inhibited and the level of E-cadherin increased. Molecular docking analysis indicates that the H-bond and hydrophobic interactions were critical for FO and E-cadherin binding, but FO did not seem to act directly on phosphorylated Akt and p38 MAPK. We have thus concluded that reformed FO inhibits cell invasion might be directly through EMT related signals (E-cadherin) and indirectly through PI3K/Akt, p38 MAPK signaling pathways. FO might be a promising drug in HCC treatment and prognosis.

Malignant infiltrating intraductal papillary mucinous neoplasm with internal fistula: one case report and clinical practice

BACKGROUND

Intraductal papillary mucinous neoplasm (IPMN) is a rare tumor that originates in the pancreatic duct. The diagnosis of benign, borderline or malignant to IPMN is significant in terms of making an appropriate treatment plan and prognosis. This article summarizes our clinical experience of a case report and discussion by literature review. Methods and case report: A 73 year old male patient was admitted for an occupying lesion of the pancreas. The magnetic resonance cholangiopancreatography (MRCP) scan considered IPMN, endoscopic retrograde cholangiopancreatography (ERCP) also confirmed diagnosis of IPMN. Both the biliary and pancreatic duct stents were replaced, but we did not obtain any evidence by cytological evaluation. One month later, ERCP and intraductal ultrasonography (IDUS) showed infiltrating growth of the tumor. Endoscopic ultrasonography guided fine-needle aspiration was performed at the same time, and pathological diagnosis was suggested as borderline IPMN.

RESULTS

In the absence of pathological support, the patient presented with the clinical diagnosis of infiltrating intraductal papillary mucinous adenocarcinoma (IPMC) and was recommended for surgery. However, the patient and his family refused surgery, and were discharged. Subsequently, the patient died 6.5 months (197 days) following first diagnosis.

CONCLUSIONS

Currently, the definition and classification of IPMN is done by specification, although there remain some difficulties in diagnosing its subtypes. For diagnostic purposes, CT, MRCP, ERCP, IDUS, EUS and EUS-FNA can all be applied. Cytological negative pathology might not completely rule out malignancy, and would still require further examination and follow-up.

5-Azacytidine suppresses the proliferation of pancreatic cancer cells by inhibiting the Wnt/β-catenin signaling pathway

5-Azacytidine has been shown to be an effective anti-pancreatic cancer drug, but the mechanism remains unknown. In the current study, we explored the effect of 5-azacytidine on abnormal activation of the Wnt-β-catenin signaling pathway in pancreatic cancer cells. The human pancreatic cancer cell line Bxpc-3 was treated with different concentrations of 5-azacytidine for various times. The proliferation and early apoptosis of the cells were evaluated using the CCK8 method and flow cytometry, respectively. mRNA and protein expression of β-catenin, c-myc, and cyclinD1 were detected using real-time fluorescent quantitative polymerase chain reaction and Western blot analysis, respectively. The proliferation of Bxpc-3 cells was suppressed by 5-azacytidine. The early apoptosis of the cells was significantly enhanced over time and with increasing drug concentrations. The expression of β-catenin, c-myc, and cyclinD1 were down-regulated, showing significant differences between different concentrations and treatment times (P < 0.05). 5-Azacytidine suppressed the proliferation of pancreatic cancer cells by inhibiting the Wnt/β-catenin signaling pathway, particularly the expression of β-catenin, c-myc, and cyclinD1. This study may provide a new potential strategy for diagnosing and treating pancreatic cancer.

Pathogenesis of liver cirrhosis

Liver cirrhosis is the final pathological result of various chronic liver diseases, and fibrosis is the precursor of cirrhosis. Many types of cells, cytokines and miRNAs are involved in the initiation and progression of liver fibrosis and cirrhosis. Activation of hepatic stellate cells (HSCs) is a pivotal event in fibrosis. Defenestration and capillarization of liver sinusoidal endothelial cells are major contributing factors to hepatic dysfunction in liver cirrhosis. Activated Kupffer cells destroy hepatocytes and stimulate the activation of HSCs. Repeated cycles of apoptosis and regeneration of hepatocytes contribute to pathogenesis of cirrhosis. At the molecular level, many cytokines are involved in mediation of signaling pathways that regulate activation of HSCs and fibrogenesis. Recently, miRNAs as a post-transcriptional regulator have been found to play a key role in fibrosis and cirrhosis. Robust animal models of liver fibrosis and cirrhosis, as well as the recently identified critical cellular and molecular factors involved in the development of liver fibrosis and cirrhosis will facilitate the development of more effective therapeutic approaches for these conditions.

Effect of endoscopic retrograde cholangiopancreatography combined with laparoscopy and choledochoscopy on the treatment of Mirizzi syndrome

BACKGROUND

Mirizzi syndrome is often difficult to diagnose before surgery, and is often accompanied by extensive adhesions in the cystohepatic (Calot's) triangle and the difficulty of separating tissue can lead to bile duct injury and other intraoperative and postoperative complications. The aim of this study is to investigate minimally invasive means of treating different types of Mirizzi syndrome.

METHODS

Fifty-four patients diagnosed with Mirizzi syndrome were enrolled between July 2004 and May 2012. The diagnosis was further refined according to the Csendes classification. Twenty-seven patients were treated with a combination of endoscopic retrograde cholangiopancreatography (ERCP), laparoscopy, and choledochoscopy (tripartite approach group); type I in 16 cases, type II five cases, and type III in six cases. Twenty-seven patients were treated with laparotomy (routine approach group); type I in 19 cases, type II in six cases, and type III in two cases. The operation time, blood loss during operation, initiation of intake time of food, postoperative complications, and hospital stays were compared between two groups.

RESULTS

All patients were successfully cured in surgical operation. The operation time was (49.7 ± 27.5) minutes, blood loss during operation was (21.1 ± 15.9) ml, initiation of intake time of food was (6.3 ± 2.7) hours, postoperative complications were with two cases (7%, 2/27), and hospital stay was (6.7 ± 1.8) days in the tripartite approach group. In the routine approach group, the operation time was (85.1 ± 20.3) minutes, blood loss during operation was (150.3 ± 20.5) ml, initiation of intake time of food was (36.6 ± 10.3) hours, postoperative complications were with three cases (11%, 3/27), and hospital stay was (10.9 ± 3.4) days. Except for postoperative complications, there were significant differences in the operation time, blood loss during operation, initiation of intake time of food, and hospital stays between two groups (P < 0.05).

CONCLUSIONS

ERCP combined with laparoscopy and choledochoscopy is a safe and effective means of treating Mirizzi syndrome. The approach is minimally invasive and patients recover quickly requiring only brief hospitalization.

Cyclooxygenase-2 promoter polymorphism -899G/C is associated with hepatitis B-related liver cancer in a Chinese population of Gansu province

BACKGROUND

Hepatitis B virus infection is closely related to hepatocellular carcinoma (HCC). Cyclooxygenase-2 (COX-2) is overexpressed in HCC and considered to play a role in hepatic carcinogenesis. In this study, we analyzed the polymorphism of COX-2 promoter -899G/C in healthy controls, chronic hepatitis B (CHB) patients, liver cirrhosis patients, and hepatocellular carcinoma (HCC) patients, to investigate the relationship between COX-2 -899G/C polymorphism and the risk for hepatitis B-related liver cancer in a Chinese population from Gansu province.

METHODS

Patients were divided into four groups: 300 patients with CHB, 300 patients with liver cirrhosis, 300 patients with HCC, and 300 healthy controls. The polymorphism of COX-2 -899G/C was detected by PCR-TaqMan probes. The results were analyzed by SPSS 17.0.

RESULTS

The COX-2 -899G/C genotypes were GG, GC, and CC. Frequencies in CHB were 87.00%, 12.67%, 0.33%; in liver cirrhosis were 85.33%, 14.00%, 0.67%; in HCC were 77.00%, 21.67%, 1.33%; and in healthy controls were 90.67%, 9.00%, 0.33%, respectively. COX-2 -899C carriers may have an increased risk for hepatitis B-related liver cancer. Compared with the frequency of GG genotype, there were significant differences in the frequency of GC genotype between HCC and healthy control groups (OR = 2.835, 95%CI: 1.751 - 4.589); HCC and CHB groups (OR = 1.933, 95%CI: 1.248 - 2.994); and HCC and liver cirrhosis groups (OR = 1.175, 95%CI: 1.119 - 2.628). Stratification analyses showed that COX-2 -899C allele carriers with a drinking history are more susceptible to develop HCC.

CONCLUSION

COX-2 -899C genotype may increase the susceptibility of individuals to hepatitis B-related liver cancer in Gansu province, China.

Three initial diets for management of mild acute pancreatitis: A meta-analysis

AIM: To compare non-liquid and clear-liquid diets, and to assess whether the latter is the optimal treatment for mild acute pancreatitis.

METHODS: The Cochrane Library, PUBMED, EMBASE, EBM review databases, Science Citation Index Expanded, and several Chinese databases were searched up to March 2011. Randomized controlled trials (RCTs) that compared non-liquid with clear-liquid diets in patients with mild acute pancreatitis were included. A meta-analysis was performed using available evidence from RCTs.

RESULTS: Three RCTs of adequate quality involving a total of 362 participants were included in the final analysis. Compared to liquid diet, non-liquid diet significantly decreased the length of hospitalization [mean difference (MD): 1.18, 95% CI: 0.82-1.55; P﹤0.00001] and total length of hospitalization (MD: 1.31, 95% CI: 0.45-2.17; P = 0.003). The subgroup analysis showed solid diet was more favorable than clear liquid diet in the length of hospitalization, with a pooled MD being -1.05 (95% CI: -1.43 to -0.66; P﹤0.00001). However, compared with clear liquid diet, both soft and solid diets did not show any significant differences for recurrence of pain after re-feeding, either alone [relative risk (RR): 0.95; 95% CI: 0.51-1.87; P = 0.88] and (RR: 1.22; 95% CI: 0.69-2.16; P = 0.49), respectively, or analyzed together as non-liquid diet (RR: 0.80; 95% CI: 0.47-1.36; P = 0.41).

CONCLUSION: The non-liquid soft or solid diet did not increase pain recurrence after re-feeding, compared with the clear-liquid diet. The non-liquid diet reduced hospitalization.

Therapeutic effects of endoscopic therapy combined with enteral nutrition on acute severe biliary pancreatitis

BACKGROUND

Acute severe biliary pancreatitis (ASBP) is a severe and fatal disease, and the expenditure is huge and therapeutic effects are still not satisfactory. This study aimed to improve the therapeutic effects and reduce the expenditure of ASBP treatment.

METHODS

One hundred and five patients diagnosed with ASBP were referred to our department from January 2004 to July 2009. Diagnosis was based on the 2007 criteria of the Chinese Society of Surgery. Patients were divided into two groups; the E group: 50 patients who underwent endoscopic retrograde choledochopancreatography (ERCP) + endoscopic sphincterotomy (EST) + endoscopic lithotripsy basket (ESR) + endoscopic retrograde biliary drainage (ERBD) and enteral nutrition (EN), and the R group: 55 patients who underwent traditional treatment without ERCP. Subsequently, subjective symptoms, signs, biochemical analysis, serum endotoxin, tumor necrosis factor a, grades by computed tomography (CT), cost of hospitalization and length of stay were compared between the two groups.

RESULTS

All enrolled patients complied well with all therapeutic regimens. Endoscopic therapy that combined EN could significantly improve symptoms, clinical signs, laboratory values, tumor necrosis factor a and endotoxin while significantly reducing hospital expenditure and length of hospital stay. The experimental findings revealed that there were obvious advantages in the E group compared with the R group.

CONCLUSIONS

Endoscopic therapy combined with EN is an effective, safe and economic therapeutic regimen of ASBP.

Mn-SOD and CuZn-SOD polymorphisms and interactions with risk factors in gastric cancer

AIM

To investigate the effects of superoxide dismutase (SOD) polymorphisms (rs4998557, rs4880), Helicobacter pylori (H. pylori) infection and environmental factors in gastric cancer (GC) and malignant potential of gastric precancerous lesions (GPL).

METHODS

Copper-zinc superoxide dismutase (SOD1, CuZn-SOD)-G7958A (rs4998557) and manganese superoxide dismutase (SOD2, Mn-SOD)-Val16Ala (rs4880) polymorphisms were genotyped by SNaPshot multiplex polymerase chain reaction (PCR) in 145 patients with GPL (87 cases of gastric ulcer, 33 cases of gastric polyps and 25 cases of atrophic gastritis), 140 patients with GC and 147 healthy controls. H. pylori infection was detected by immunoblotting analysis.

RESULTS

The SOD1-7958A allele was associated with a higher risk of gastric cancer [odds ratio (OR) = 3.01, 95% confidence intervals (95% CI): 1.83-4.95]. SOD2-16Ala/Val genotype was a risk factor for malignant potential of GPL (OR = 2.04, 95% CI: 1.19-3.49). SOD2-16Ala/- genotype increased the risk of gastric cancer (OR = 2.85, 95% CI: 1.66-4.89). SOD1-7958A/- genotype, SOD2-16Ala/- genotype, alcohol drinking, positive family history and type I H. pylori infection were associated with risk of gastric cancer, and there were additive interactions between the two genotypes and the other three risk factors. SOD2-16Ala/Val genotype and positive family history were associated with malignant potential of GPL and jointly contributed to a higher risk for malignant potential of GPL (OR = 7.71, 95% CI: 2.10-28.22). SOD1-7958A/- genotype and SOD2-16Ala/- genotype jointly contributed to a higher risk for gastric cancer (OR = 6.43, 95% CI: 3.20-12.91).

CONCLUSION

SOD1-7958A/- and SOD2-16Ala/-genotypes increase the risk of gastric cancer in Chinese Han population. SOD2-16Ala/-genotype is associated with malignant potential of GPL.

Antitumor effect of matrine in human hepatoma G2 cells by inducing apoptosis and autophagy

AIM: To study the antitumor effect of matrine in human hepatoma G2 (HepG2) cells and its molecular mechanism involved in antineoplastic activities.

METHODS: 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to detect viability of HepG2 cells. The effect of matrine on cell cycle was detected by flow cytometry. Annexin-V-FITC/PI double staining assay was used to detect cellular apoptosis. Cellular morphological changes were observed under an inverted phase contrast microscope. Transmission electron microscopy was performed to further examine ultrastructural structure of the cells treated with matrine. Monodansylcadaverine (MDC) staining was used to detect autophagy. Whether autophagy is blocked by 3-methyladenine (3-MA), an autophagy inhibitor, was evaluated. Expression levels of Bax and Beclin 1 in HepG2 cells were measured by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR).

RESULTS: Matrine significantly inhibited the proliferation of HepG2 cells in a dose- and time-dependent manner, and induced G1-phase cell cycle arrest and apoptosis of HepG2 cells in a dose-dependent manner. The total apoptosis rate was 0.14% for HepG2 cells not treated with matrine. In contrast, the apoptosis rate was 28.91%, 34.36% and 38.80%, respectively, for HepG2 cells treated with matrine at the concentration of 0.5, 1.0 and 2.0 mg/mL. The remarkable morphological changes were observed under an inverted phase contrast microscope. Abundant cytoplasmic vacuoles with varying sizes were observed in HepG2 cells treated with matrine. Furthermore, vacuolization in cytoplasm progressively became larger and denser when the concentration of matrine was increased. Electron microscopy demonstrated formation of abundant autophagic vacuoles in HepG2 cells after matrine treatment. When the specific autophagic inhibitor, 3-MA, was applied, the number of autophagic vacuoles greatly decreased. MDC staining showed that the fluorescent density was higher and the number of MDC-labeled particles in HepG2 cells was greater in matrine treatment group than in control group. Fewer autophagic vacuoles were observed in the combined 3-MA and matrine treatment group when 3-MA was added before matrine treatment, indicating that both autophagy and apoptosis are activated when matrine-induced death of hepatoma G2 cells occurs. Real-time quantitative RT-PCR revealed that the expression levels of Bax gene, an apoptosis-related molecule, and Beclin 1 gene which plays a key role in autophagy were higher in matrine treatment group than in control group, indicating that Beclin 1 is involved in matrine-induced autophagy and the pro-apoptotic mechanism of matrine may be related to its upregulation of Bax expression.

CONCLUSION: Matrine has potent antitumor activities in HepG2 cells and may be used as a novel effective reagent in treatment of hepatocellular carcinoma.

Association between PARP-1 polymorphisms and susceptibility to gastric cancer

AIM: To investigate the association between the Val762Ala and Lys940Arg polymorphisms of the poly(ADP-ribose) polymerase-1 (PARP-1) gene and susceptibility to gastric cancer in a Chinese Han population in He'xi area of Gansu Province.

METHODS: All investigated subjects were divided into two groups: 150 gastric cancer patients and 152 controls. The SNaPshot single nucleotide polymorphism (SNP) genotyping method was used to analyze the genotypes of PARP-1 Val762Ala and Lys940Arg. Helicobacter pylori (H.pylori) IgG antibody was detected by enzyme-linked immunosorbent assay (ELISA). The results were analyzed using the SPSS16.0 software package.

RESULTS: PARP-1 940 Lys/Arg and 762 Val/Ala genotypes were overrepresented in gastric cancer patients compared with controls (OR = 2.917 and 1.685; 95%CI: 1.430-5.947 and 1.040-2.729; P = 0.002 and 0.034, respectively). In smoking subjects, the risk of gastric cancer in PARP-1 940 Lys/Arg genotype carriers was 8.430-fold higher than that in Lys/Lys carriers (OR = 8.340, 95%CI: 2.664-26.144, P = 0.000). In drinking subjects, PARP-1 940 Lys/Arg genotype carriers had a 3.333-fold higher risk of gastric cancer than Lys/Lys carriers (OR = 3.333, 95%CI: 1.214-9.155, P = 0.015). In H.pylori IgG-positive subjects, PARP-1 762 Ala/Ala genotype carriers had a 2.360-fold increased risk of gastric cancer than Val/Val carriers (OR = 2.360, 95%CI: 1.256-4.433, P = 0.007). The subjects carrying PARP-1 940 Lys/Arg and PARP-1 Ala/Ala or Val/Ala genotypes had a 4.2-fold increased risk of gastric cancer compared with those carrying PARP-1 940 Lys/Lys and PARP-1 762Val/Val genotypes (OR = 4.200, 95%CI: 1.430-12.338, P = 0.006).

CONCLUSION: PARP-1 940Lys/Arg and PARP-1 762Ala/Ala or Ala/Ala genotypes are associated with a higher risk of gastric cancer. There are multiplicative joint effects between PARP-1 940 Lys/Arg genotype and smoking or drinking, between PARP-1 762 Val/Ala or Ala/Ala genotypes and H.pylori infection, and between PARP-1 Lys940Arg and PARP-1 Val762Ala genotypes in increasing the risk of gastric cancer.

Association of P53 Arg72Pro polymorphism and Helicobacter pylori infection with risk of gastric cancer in a high incidence area in China

AIM: To evaluate the association of P53 Arg72Pro polymorphism and Helicobacter pylori (H. pylori) infection with risk of gastric cancer in high-incidence Hexi area of Gansu province in China.

METHODS: Blood samples were collected from 140 patients with gastric carcinoma and 125 normal individuals in Hexi area in Gansu Province. Genomic DNA was extracted by proteinase K digestion followed by the saturated hydroxybenzene/chloroform procedure. The polymorphism of P53 Arg72Pro was genotyped by real-time PCR (TaqMan). For detection of H. pylori infection, Warthin-Starry staining was performed.

RESULTS: The rates of H. pylori infection were 68.6% in gastric carcinoma patients and 50.4% in healthy controls, with a significant difference between the two groups of patients (OR = 2.147, 95%CI: 1.302-3.541). Three genotypes of P53 Arg72Pro were identified: Arg/Arg, Arg/Pro and Pro/Pro. The frequencies of these three genotypes were 15.7%, 60.0% and 24.3% in gastric cancer patients, and 25.6%, 54.4% and 20.0% in normal controls, respectively. Compared with the Arg/Arg genotype, the frequency of Arg/Pro or Pro/Pro genotype showed no significant difference between cancer patients and normal controls. However, the frequency of P53 Arg72Pro Pro carrier genotype (Arg/Pro and Pro/Pro) in gastric cancer patients was significantly higher than that in normal controls (OR = 1.846, 95%CI: 1.006-3.387). Stratification analysis indicated that the P53 Arg72Pro Pro carrier genotype with H. pylori infection or with smoking increased the risk of gastric cancer.

CONCLUSION: P53 Arg72Pro polymorphism is associated with the risk of gastric cancer in high-incidence Hexi area of Gansu province in China. P53 Arg72Pro Pro carrier genotype with H. pylori infection or with cigarette smoking increases the risk of gastric cancer.

Combination of endoscopy and enteric nutrition in treatment of acute severe biliary pancreatitis: an analysis of 31 cases

AIM: To evaluate the therapeutic efficacy of endoscopy and enteric nutrition (EN) in acute severe biliary pancreatitis at early stage.

METHODS: The clinical data of patients, who were admitted in our department from January 2005 to July 2008, were collected and the diagnoses were acute severe biliary pancreatitis (ASBP). Those patients were randomly divided into two groups (E-group and R-group): E-group's treatment protocols were ERCP + EST + ERBD and Enteral Nutritional on early stage; R-group's treatment protocol was orthodox treatment and Total Parenteral Nutrition (TPN) + EN. We compared the dates of two groups in subjective symptoms, signs, chemical examinations, endotoxin of plasma, TNF-α, computed tomography grades, cost of hospitalization, length of hospital stay. All of dates showed that E group had an advantage in comparison with R group.

RESULTS: All patients involved completed our therapy, and received the EN at early stage. Endoscopy and enteric nutrition significantly improved subjective symptoms, clinical signs, laboratory examinations, TNF-α, endotoxin, significantly reduced hospital fees, length of hospital stay.

CONCLUSION: Endoscopy and enteric nutrition at early stage is of effectiveness, safy and economic protocol in acute severe biliary pancreatitis.

Association of COX-2 genetic polymorphisms and H. pylori infection with gastric cancer in high-incidence Hexi area of Gansu Province in China

AIM: To investigate the relationship among cyclooxygenase-2 (COX-2) polymorphisms (COX-2-899G>C and COX-2 codon587G>A), H. pylori infection and susceptibility to gastric cancer in high-incidence Hexi area of Gansu Province in China.

METHODS: Blood samples were collected from 140 patients with gastric carcinoma and 125 normal persons in Hexi area of Gansu Province. Genomic DNA was extracted by phenol chloroform method and polymorphisms of COX-2-899G>C (G to C) and codon 587G>A(G to A) were genotyped by PCR-TaqMan. For detection of H. pylori infection, Warhin-starry staining was used.

RESULTS: Three kinds of COX-2-899G>C genotypes were found, including GG, GC and CC. Their frequencies in gastric cancer patients were 72.9%, 21.4%, 5.7% and their frequencies in the normal controls were 84.0%, 12.8%, 3.2%, respectively. COX-2-899C carriers had an increased risk of gastric carcinoma (OR = 1.956, 95% CI: 1.067-3.586). COX-2 587codonG>A included three genotypes: G/G, G/A and A/A. Their frequencies in the cancer patients were 86.4%, 11.4%, 2.2%, and in the normal controls were 89.6%, 9.6%, 0.8%, respectively. However, No significant differences of COX-2 587codon G>A polymorphisms were observed between the cancer patients and the normal controls in each genotype. The rate of H. pylori infection was significantly higher in the cancer patients than that in the healthy control (68.6% vs 50.4%, P = 0.003). Stratification analysis showed that COX-2 -899C carrier with H. pylori infection had a higher risk for gastric cancer (OR = 2.471, 95% CI: 1.076-5.675).

CONCLUSION: COX-2 -899C genotype may increase the susceptibility to gastric cancer in high-incidence Hexi area of Gansu province in China. In addition, H. pylori infection and COX-2 -899C play a synergic role in gastric cancer pathogenesis. However, COX-2 codon 587G>A has no relation with gastric cancer in this area.

Effect of individual Sumai 3 chromosomes on resistance to scab spread within spikes and deoxynivalenol accumulation within kernels in wheat

Two sets of substitution lines were developed by crossing individual monosomic lines of Chinese Spring (recipient) with scab (Fusarium graminearum) resistant cultivar Sumai 3 (donor) and then using the monosomics as the recurrent male parent for four backcrosses (without selfing after each backcross). The disomic substitution lines were separated from selfed BC4F2 plants. Chromosome specific SSR markers were analyzed for polymorphism between Sumai 3 and Chinese Spring. Polymorphic markers were used to identify substitution lines for specific chromosomes. Based on the specific SSR markers, chromosome substitutions occurred in thirty-six lines, and six lines segregated alleles from the two parents or were homozygous for the allele from Chinese Spring. These substitution lines were used to evaluate Type II (spread within the head) and Type V (deoxynivalenol accumulation within kernels) scab resistance. The objective was to use the substitution lines to evaluate the effect of individual chromosomes of Sumai 3 on Type 11 and Type V scab resistance in the greenhouse. Significant differences in Type II scab resistance and deoxynivalenol (DON) levels among different Chinese Spring (Sumai 3) substitution lines were detected. Positive chromosome substitution effects on Type II scab resistance were found on chromosomes 2B, 3B. 6B, and 7A from Sumai 3. Chromosomes 3B and 7A also reduced DON accumulation within the kernels, while chromosomes IB, 2D, and 4D from Sumai 3 increased DON concentration. Chromosome 7A from Sumai 3 had the largest effect on resistance to scab spread and DON accumulation. Additional research is in progress on the scab resistance conferred by chromosome 7A.

Synthesis and antiprotozoal activities of some new triazine derivatives including a new antitrypanosomal agent: SIPI-1029

Two series of compounds, 1,2-dihydro-2,2-dimethyl-4, 6-diamino-1-(omega-haloalkyloxy)-s-triazines and O, O'-bis (4, 6-diamino-1, 2-dihydro-2, 2-disubstituted-s-triazin-l-yl) alkanediols were synthesized and tested against Plasmodium berghei and Trypanosoma evansi in mice. Most title compounds showed good antimalarial activity and compounds IIc-e showed good antitrypanosomal effect. After further studies on pharmacology, toxicology, pharmacokinetics and efficacy on infected cattles compound IIe (SIPI-1029, T-46) was shown to be a new highly active antitrypanosomal agent with low toxicity and long half life in plasma.

[Clinical and experimental studies of supplemented sini san in treating chronic brucellosis]

OBJECTIVE

To observe the effect of supplemented Sini San (SSNS) in treating chronic Brucellosis (CB).

METHODS

One hundred and twenty-seven patients were randomly divided into two groups, 76 cases in the treatment group were treated with SSNS and 51 cases in the control group treated with Dioscorea Nipponica Power. The effect of SSNS on mice model of CB was also observed simultaneously.

RESULTS

The short-term effects were that the total effective rate and markedly effective rate of the treatment were 98.7% and 92.1%, which were better than those of the control group (82.4% and 41.2%) respectively, P < 0.01. The long-term follow-up result of the treatment group also showed its superiority to the control group, the total effective rates of the two groups were 98.7% and 51.0%, and the markedly effective rates were 90.8% and 21.6% respectively (P < 0.01). Animal experiments indicated SSNS has obvious effect of antibiotics and immunomodulation.

CONCLUSION

SSNS was effective in treating CB, including the long-term follow-up result.

A study on identification of the blunt lethal objects of wood, iron, brick and stone in homicide by SEM and EDAX (energy dispersive analysis x-ray)

The qualitative and semiquantitative analysis of residues on wound in homicide cases were done by using scanning electron microscope (SEM) and energy dispersive analysis X-ray system (EDAX) in this paper. It provides a new method of examination for identifying lethal objects in homicidal cases. Our experiment provides some advantages in these examinations, such as saving time, objective conclusion and exact results in practical cases.