Diagnostic accuracy of magnetically guided capsule endoscopy with a detachable string for detecting oesophagogastric varices in adults with cirrhosis: prospective multicentre study

OBJECTIVE

To evaluate the diagnostic accuracy and safety of using magnetically guided capsule endoscopy with a detachable string (ds-MCE) for detecting and grading oesophagogastric varices in adults with cirrhosis.

DESIGN

Prospective multicentre diagnostic accuracy study.

SETTING

14 medical centres in China.

PARTICIPANTS

607 adults (>18 years) with cirrhosis recruited between 7 January 2021 and 25 August 2022. Participants underwent ds-MCE (index test), followed by oesophagogastroduodenoscopy (OGD, reference test) within 48 hours. The participants were divided into development and validation cohorts in a ratio of 2:1.

MAIN OUTCOME MEASURES

The primary outcomes were the sensitivity and specificity of ds-MCE in detecting oesophagogastric varices compared with OGD. Secondary outcomes included the sensitivity and specificity of ds-MCE for detecting high risk oesophageal varices and the diagnostic accuracy of ds-MCE for detecting high risk oesophagogastric varices, oesophageal varices, and gastric varices.

RESULTS

ds-MCE and OGD examinations were completed in 582 (95.9%) of the 607 participants. Using OGD as the reference standard, ds-MCE had a sensitivity of 97.5% (95% confidence interval 95.5% to 98.7%) and specificity of 97.8% (94.4% to 99.1%) for detecting oesophagogastric varices (both P<0.001 compared with a prespecified 85% threshold). When using the optimal 18% threshold for luminal circumference of the oesophagus derived from the development cohort (n=393), the sensitivity and specificity of ds-MCE for detecting high risk oesophageal varices in the validation cohort (n=189) were 95.8% (89.7% to 98.4%) and 94.7% (88.2% to 97.7%), respectively. The diagnostic accuracy of ds-MCE for detecting high risk oesophagogastric varices, oesophageal varices, and gastric varices was 96.3% (92.6% to 98.2%), 96.9% (95.2% to 98.0%), and 96.7% (95.0% to 97.9%), respectively. Two serious adverse events occurred with OGD but none with ds-MCE.

CONCLUSION

The findings of this study suggest that ds-MCE is a highly accurate and safe diagnostic tool for detecting and grading oesophagogastric varices and is a promising alternative to OGD for screening and surveillance of oesophagogastric varices in patients with cirrhosis.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03748563.

NDC1 promotes hepatocellular carcinoma tumorigenesis by targeting BCAP31 to activate PI3K/AKT signaling

Hepatocellular carcinoma (HCC) is among the world's worst malignancies. Nuclear division cycle 1 (NDC1) is an essential membrane-integral nucleoporin, found in this study to be significantly increased in primary HCC. A multivariate analysis revealed that higher NDC1 expression was linked to worse outcome in HCC patients. Mouse xenograft tumors overexpressing NDC1 grew rapidly, and HCC cells overexpressing NDC1 showed enhanced proliferation, invasion, and migration in vitro. In contrast, knocking down NDC1 had the opposite effects in vitro. Furthermore, co-immunoprecipitation and liquid chromatograph mass spectrometer analyses revealed that NDC1 activated PI3K/AKT signaling by interacting with BCAP31. In summary, NDC1 and BCAP31 cooperate to promote the PI3K/AKT pathway, which is essential for HCC carcinogenesis. This suggests that NDC1 is predictive of prognosis in HCC.

[Prevalence of frailty and related factors in middle-aged and elderly people in island and mountainous areas of Taizhou, Zhejiang Province]

Objective: To compare the prevalence of frailty and related factors in middle-aged and elderly people aged ≥45 years in island and mountainous areas of Taizhou, Zhejiang Province. Methods: Based on cross-sectional design, stratified cluster sampling and quota sampling methods were adopted. One administrative district was randomly selected from each of six coastal and three inland administrative districts in Taizhou during July to August, representing two different geographical terrains. In the island area (Jiaojiang District), all residents aged ≥45 years were included by cluster sampling. In the mountainous area (Xianju County), participants were selected through quota sampling, with same gender and age distributions. Data about their demographic characteristics, lifestyle and health-related factors were collected through questionnaire surveys and laboratory examinations. The prevalence of frailty was assessed using the Fried frailty phenotype scale. Hierarchical analysis and multivariate logistic regression analysis were used to compare the influencing factors of frailty. Results: A total of 1 011 local residents were studied, in whom island and mountainous residents accounted for 48.1% (486/1 011) and 51.9% (525/1 011) respectively; men and women accounted for 45.9% (464/1 011) and 54.1% (547/1 011) respectively. Middle-aged (45-49 years), younger elderly (60-74 years), and older elderly (≥75 years) residents accounted for 38.6% (390/1 011), 44.6% (451/1 011), and 16.8% (170/1 011) respectively. The overall prevalence rate of frailty was 3.6% (36/1 011), the prevalence rate was 3.7% (17/464) in men and 3.5% (19/547) in women. The prevalence rates in age groups 45-59,60-74 years and ≥75 years were 0.3% (1/390), 2.2% (10/451), and 14.7% (25/170), respectively. The prevalence rates of frailty and pre-frailty in island area were 6.0% (29/486) and 39.1% (190/486), respectively, which was higher than those in mountainous area (1.3%, 7/525) and (30.9%, 162/525). After adjusting for potential confounding factors, the risk for frailty in island residents was significantly higher than that in mountainous residents (aOR=1.55,95%CI: 1.07-2.25,P=0.019). In island area, older age (60-74 years:aOR=2.52,95%CI: 1.56-4.13; ≥75 years:aOR=11.65,95%CI:5.38-26.70), being women (aOR=1.94,95%CI: 1.20-3.17), suffering from depression (aOR=1.09,95%CI:1.02-1.17) were associated with frailty symptoms. In mountainous area, older age was also associated with an increased risk of frailty symptoms, but the OR value was lower than those in island area (60-74 years: aOR=1.74,95%CI:1.04-2.94;≥75 years: aOR=4.78,95%CI:2.45-9.50). Polydrug use (aOR=2.08,95%CI: 1.14-3.80) and suffering from depression (aOR=1.10,95%CI: 1.02-1.18) had significant positive association with frailty symptoms. Higher education level had significant negative association with frailty symptoms (junior high school: aOR=0.40,95%CI: 0.21-0.75; senior high school and technical secondary school: aOR=0.29,95%CI: 0.15-0.53; college or above:aOR=0.22,95%CI: 0.11-0.42). Conclusions: The prevalence of frailty in middle-aged and elderly community residents was significantly higher in island area than in mountainous area in Taizhou. The frailty-related factors varied with area. The elderly people (≥75 years) and women in island area had higher risk for frailty. Older age and suffering from depression were the independent risk factors for frailty. It is necessary to pay attention to the health risk factors and special environment in island area, and take comprehensive intervention measures to delay the process of debilitation and improve the quality of life of middle-aged and elderly people.

Global burden of inflammatory bowel disease 1990-2019: A systematic examination of the disease burden and twenty-year forecast

BACKGROUND

Inflammatory bowel disease (IBD) is an idiopathic intestinal disease with various levels and trends in different countries and regions. Understanding the current burden and trends of IBD in various geographical locations is essential to establish effective strategies for prevention and treatment. We report the average annual percentage change (AAPC) and estimated annual percentage change (EAPC) in age-standardized rates (ASR) of IBD in different regions based on the Global Burden of Disease (GBD) study from 1990-2019, and the relationships between IBD and the human development index (HDI) and socio-demographic index (SDI). The prevalence trends of IBD were predicted by gender from 2019-2039.

AIM

To comprehensively investigate IBD data, providing further insights into the management of this chronic disease.

METHODS

We collected the information on the incidence of IBD from the GBD study from 1990-2019 to calculate the AAPC and EAPC in ASR of IBD in different regions. The relationships between IBD, HDI, and SDI were analyzed. The Nordpred and Bayesian age-period-cohort models were used to predict the prevalence trends of IBD by gender from 2019-2039, and the reliability of the results was validated. Statistics of all the data in this study were performed using R software (version 4.2.1).

RESULTS

North America consistently had the highest IBD ASR, while Oceania consistently had the lowest. East Asia had the fastest average annual growth in ASR (2.54%), whereas Central Europe had the fastest decline (1.38%). Countries with a low age-standardized incidence rates in 1990 showed faster growth in IBD while there was no significant correlation in 2019. Additionally, IBD increased faster in countries with a low age-standardized death rates in 1990, whereas the opposite was true in 2019. Analysis of SDI and IBD ASR showed that countries with a high SDI generally had a higher IBD ASR. Finally, the projections showed a declining trend in the incidence of IBD from 2019-2039, but a gradual increase in the number of cases.

CONCLUSION

As the global population increases and ages, early monitoring and prevention of IBD is important to reduce the disease burden, especially in countries with a high incidence of IBD.

Global burden of inflammatory bowel disease 1990-2019: A systematic examination of the disease burden and twenty-year forecast

BACKGROUND

Inflammatory bowel disease (IBD) is an idiopathic intestinal disease with various levels and trends in different countries and regions. Understanding the current burden and trends of IBD in various geographical locations is essential to establish effective strategies for prevention and treatment. We report the average annual percentage change (AAPC) and estimated annual percentage change (EAPC) in age-standardized rates (ASR) of IBD in different regions based on the Global Burden of Disease (GBD) study from 1990-2019, and the relationships between IBD and the human development index (HDI) and socio-demographic index (SDI). The prevalence trends of IBD were predicted by gender from 2019-2039.

AIM

To comprehensively investigate IBD data, providing further insights into the management of this chronic disease.

METHODS

We collected the information on the incidence of IBD from the GBD study from 1990-2019 to calculate the AAPC and EAPC in ASR of IBD in different regions. The relationships between IBD, HDI, and SDI were analyzed. The Nordpred and Bayesian age-period-cohort models were used to predict the prevalence trends of IBD by gender from 2019-2039, and the reliability of the results was validated. Statistics of all the data in this study were performed using R software (version 4.2.1).

RESULTS

North America consistently had the highest IBD ASR, while Oceania consistently had the lowest. East Asia had the fastest average annual growth in ASR (2.54%), whereas Central Europe had the fastest decline (1.38%). Countries with a low age-standardized incidence rates in 1990 showed faster growth in IBD while there was no significant correlation in 2019. Additionally, IBD increased faster in countries with a low age-standardized death rates in 1990, whereas the opposite was true in 2019. Analysis of SDI and IBD ASR showed that countries with a high SDI generally had a higher IBD ASR. Finally, the projections showed a declining trend in the incidence of IBD from 2019-2039, but a gradual increase in the number of cases.

CONCLUSION

As the global population increases and ages, early monitoring and prevention of IBD is important to reduce the disease burden, especially in countries with a high incidence of IBD.

[Regulatory effect of small nuclear ribonucleoprotein-associated protein B on proliferation and metastasis of liver cancer cells]

Objective: To study the expression and effect of small nuclear ribonucleoprotein-associated protein B (SNRPB) on proliferation and metastasis of liver cancer tissues and cells. Methods: The bioinformatics database starBase v3.0 and GEPIA were used to analyze the expression of SNRPB in liver cancer tissue and normal liver tissue, as well as the survival and prognosis of liver cancer patients. The expression of SNRPB mRNA and protein in liver cancer cell lines were analyzed by qRT-PCR and Western blot. RNA interference technique (siRNA) was used to determine SNRPB protein expression down-regulation. The proliferation effect on hepatocellular carcinoma cells was observed by MTT assay. Transwell invasion and migration assay was used to detect the changes in the metastatic ability of liver cancer cells after SNRPB down-regulation. Western blot was used to detect the changes of epithelial mesenchymal transition (EMT) markers in liver cancer cells after down-regulation of SNRPB expression. Data were compared between two groups and multiple groups using t-test and analysis of variance. Results: The expression of SNRPB was significantly higher in liver cancer tissue than normal liver tissue, and its expression level was correlated with the prognosis of liver cancer patients. Compared with the immortalized hepatocyte LO(2), the expression of SNRPB was significantly increased in the liver cancer cells (P < 0.01). siRNA-SNRPB had significantly inhibited the expression of SNRPB mRNA and protein in liver cancer cells. MTT results showed that the absorbance value was lower in SNRPB knockdown group than negative control group, and the difference at 96 h after transfection was most significant (P < 0.01). Transwell assay results showed that compared with the negative control group, the SNRPB knockdown group (MHCC-97H: 121.27 ± 8.12 vs. 46.38 ± 7.54; Huh7: 126.50 ± 6.98 vs. 41.10 ± 8.01) invasion and migration (MHCC-97H: 125.20 ± 4.77 vs. 43.18 ± 7.32; Huh7: 132.22 ± 8.21 vs. 38.00 ± 6.78) ability was significantly reduced (P < 0.01) in liver cancer cells. Western blot showed that the expression level of epithelial phenotype marker E-cadherin was decreased after down-regulation of SNRPB, while the expression levels of mesenchymal phenotype markers N-cadherin and vimentin was increased, suggesting that down-regulation of SNRPB inhibited EMT in liver cancer cells. Conclusion: SNRPB expression is significantly increased in liver cancer tissues and cells, and it is involved in regulating the proliferation, metastasis and EMT of liver cancer cells.

Endoscopic submucosal dissection treatment of metachronous early gastric adenocarcinoma in a case with diffuse large B-cell Lymphoma

Cases of primary gastric lymphoma complicated with gastric adenocarcinoma are rare in clinical practice. We report a case of metachronous early gastric adenocarcinoma diagnosed eight years after the onset of gastric diffuse large B-cell lymphoma (DLBCL) and treated with endoscopic submucosal dissection (ESD).

Establishment and validation of a computer-assisted colonic polyp localization system based on deep learning

BACKGROUND

Artificial intelligence in colonoscopy is an emerging field, and its application may help colonoscopists improve inspection quality and reduce the rate of missed polyps and adenomas. Several deep learning-based computer-assisted detection (CADe) techniques were established from small single-center datasets, and unrepresentative learning materials might confine their application and generalization in wide practice. Although CADes have been reported to identify polyps in colonoscopic images and videos in real time, their diagnostic performance deserves to be further validated in clinical practice.

AIM

To train and test a CADe based on multicenter high-quality images of polyps and preliminarily validate it in clinical colonoscopies.

METHODS

With high-quality screening and labeling from 55 qualified colonoscopists, a dataset consisting of over 71000 images from 20 centers was used to train and test a deep learning-based CADe. In addition, the real-time diagnostic performance of CADe was tested frame by frame in 47 unaltered full-ranged videos that contained 86 histologically confirmed polyps. Finally, we conducted a self-controlled observational study to validate the diagnostic performance of CADe in real-world colonoscopy with the main outcome measure of polyps per colonoscopy in Changhai Hospital.

RESULTS

The CADe was able to identify polyps in the test dataset with 95.0% sensitivity and 99.1% specificity. For colonoscopy videos, all 86 polyps were detected with 92.2% sensitivity and 93.6% specificity in frame-by-frame analysis. In the prospective validation, the sensitivity of CAD in identifying polyps was 98.4% (185/188). Folds, reflections of light and fecal fluid were the main causes of false positives in both the test dataset and clinical colonoscopies. Colonoscopists can detect more polyps (0.90 vs 0.82, P < 0.001) and adenomas (0.32 vs 0.30, P = 0.045) with the aid of CADe, particularly polyps < 5 mm and flat polyps (0.65 vs 0.57, P < 0.001; 0.74 vs 0.67, P = 0.001, respectively). However, high efficacy is not realized in colonoscopies with inadequate bowel preparation and withdrawal time (P = 0.32; P = 0.16, respectively).

CONCLUSION

CADe is feasible in the clinical setting and might help endoscopists detect more polyps and adenomas, and further confirmation is warranted.

Value of preoperative gastroscopic carbon nanoparticles labeling in patients undergoing laparoscopic radical gastric cancer surgery

BACKGROUND AND OBJECTIVES

Lymph node metastasis is crucial for gastric cancer. We aim to explore the value of preoperative gastroscopic carbon nanoparticles labeling in patients undergoing laparoscopic radical gastric cancer surgery.

METHODS

1199 cases undergoing laparoscopic radical gastric cancer surgery were retrospectively analyzed. 214 cases received preoperative gastroscopic carbon nanoparticles labeling. The number of total lymph nodes detected, positive lymph nodes, N staging, and operation time were analyzed.

RESULTS

The patients received carbon nanoparticles labeling had more total lymph nodes detected (27.9 ± 6.5 vs 22.2 ± 4.0; P ＜ 0.001) and shorter operation time (185.9 ± 27.8min vs 218.7 ± 69.2min; P ＜ 0.001) compared with the control group. In addition, preoperative endoscopic carbon nanoparticles labeling improved the diagnosis rate of synchronous multiple gastric cancer (2.8% vs 0.4%; P ＜ 0.001).

CONCLUSIONS

Preoperative endoscopic carbon nanoparticles tracer labeling is of great value in patients undergoing laparoscopic radical gastric cancer surgery. It shortens the operation time, increases the number of total lymph nodes detected for more accurate pathological TNM staging, and finds some cases of synchronous multiple gastric cancer.

[Regulatory effects of LIM kinase 1 on the proliferation and metastasis of hepatocellular carcinoma cells]

Objective: To study LIM kinase 1 (LIMK1) expressional condition, and its regulatory effects on the proliferation and metastasis of hepatocellular carcinoma cells and tissues. Methods: The online database starBase v3.0 and GEPIA were used to analyze the LIMK1 expression in hepatocellular carcinoma cells and normal liver tissues, and then the relevant survival analysis was performed. LIMK1 expression in hepatocellular carcinoma cell line was analyzed by Western blot. Hep3B and Huh7 cells were transiently transfected after LIMK1 protein expression was down-regulated by small interfering RNA (siRNA). LIMK1 effects on the proliferation of Hep3B and Huh7 cells were observed by MTT assay and colony formation assay. Transwell assay was used to detect the change in metastatic ability of hepatocellular carcinoma cell after the down-regulation of LIMK1 expression. Western blot was used to detect the changes of related indexes in the process of epithelial mesenchymal transition after the down-regulation of LIMK1 expression. Data were analyzed by one-way ANOVA. Results: The expression level of LIMK1 in liver cancer tissues was significantly higher than that of normal liver tissues, and was related with prognosis (P ​< 0.01). Furthermore, LIMK1 expression in HCC cell lines was significantly higher than that of immortalized liver L02 cells (P < 0.05). Functional correlated experiment showed that the proliferation and metastatic ability of liver cancer cells were significantly inhibited after LIMK1 expression down-regulation (P < 0.05). Simultaneously, LIMK1 was also involved in the process of epithelial-mesenchymal transition. Conclusion: LIMK1 was overexpressed in HCC tissues and cells, and may regulate the proliferation and metastasis of HCC cells and participate in epithelial-mesenchymal transition process.

Single-balloon and spiral enteroscopy may have similar diagnostic and therapeutic yields to double-balloon enteroscopy: Results from a meta-analysis of randomized controlled trials and prospective studies

BACKGROUND

Double-balloon, single-balloon, and spiral enteroscopy (DBE, SBE, and SE) have revolutionized the management of intestinal diseases. However, evidence about efficacies of these methods is lacking. We aimed to conduct a meta-analysis comparing the clinical outcomes among DBE, SBE, and SE.

METHODS

We searched randomized controlled trials and prospective studies in MEDLINE, PubMed, EMBASE, Cochrane Library, and Chinese CQVIP database. Studies referencing the comparison of at least two of these three methods were included. Primary outcome was diagnostic yield. Other outcomes were therapeutic yield, total enteroscopy, examination time, time to maximum insertion, and depth of maximal insertion (DMI).

RESULTS

Eleven studies including 727 patients were identified: DBE vs SE (n = 6), DBE vs SBE (n = 4), and SBE vs SE (n = 1). The diagnostic and therapeutic yields did not differ significantly when comparing DBE with SE [odds ratio (OR) = 1.19, 95% confidence interval (CI): 0.68-2.08; OR = 1.17, 95%CI: 0.61-2.23] and DBE with SBE (OR = 0.85, 95%CI: 0.55-1.33; OR = 1.71, 95%CI: 0.64 - 4.60). Total enteroscopy, examination time, time to maximum insertion, and DMI were similar between SBE and DBE. DBE was superior to SE with regard to DMI [mean difference (MD) = 36.76, 95%CI: 5.09-68.43], with longer time to maximum insertion (MD = 15.14, 95%CI: 12-18.27) and examination time (MD = 12.98, 95%CI: 9.57-16.38).

CONCLUSION

DBE and SBE have similar clinical outcomes. Compared with DBE, SE seems to have similar diagnostic and therapeutic yields, but shorter procedural time in cost of less depth of insertion. SE needs further evaluation vs SBE. DBE is recommended for complete enteroscopy.

Consensus on the digestive endoscopic tunnel technique

With the digestive endoscopic tunnel technique (DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria (MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal (GI) tract. At present, the tunnel technique application range covers the following: (1) Treatment of lesions originating from the mucosal layer, e.g., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis; (2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc.; and (3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment. The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism, and significance of DETT, prevention of infection and concepts of DETT-associated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract (indications and contraindications, procedures, pre- and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).

A CD44 specific peptide developed by phage display for targeting gastric cancer

OBJECTIVE

To develop a peptide probe that could be used for gastric cancer detection via binding to CD44 protein with specificity and affinity.

RESULTS

A 12-mer phage peptide library was screened against immobilized CD44 protein. Bound phage counts using ELISA were performed to identify phage clones carrying the most highly selective peptide, which termed RP-1. Immunofluorescence and flow cytometry analysis indicated that the consensus peptide RP-1 could bind to CD44-positive gastric cancer cells with mean fluorescence intensities significantly higher than that of CD44-negative cells. CD44 knockdown led to decreased binding activity of RP-1 to the same cell line. Tissue array technique was used to identify the relationship (r = 0.556) between peptide binding and CD44 detection on gastric cancer tissues. Further, the hyaluronan-binding domain of CD44 was docked with RP-1 using computer modeling/docking approaches, revealing a RP-1/CD44 interaction with geometrical and energy match (-8.6 kcal/mol).

CONCLUSIONS

The RP-1 peptide we screened exhibits affinity and specificity to CD44 on cells and has the potential to be used as a candidate probe for gastric cancer cell targeting.

Association between IL-8 -251A/T and IL-10 -1082A/G genetic polymorphisms and susceptibility to colorectal cancer: A case-control study in a population in Shaanxi

AIM: To explore the association between IL-8 -251A/T and IL-10 -1082A/G polymorphisms and susceptibility to colorectal cancer (CRC) in the population in Shaanxi, China.

METHODS: A case-control study was performed to compare the distribution of genetic frequencies and genotype of IL-8 -251A/T and IL-10 -1082A/G among colorectal cancer patients (n = 102) and control healthy individuals (n = 105) using allele specific PCR (AS-PCR). The relationship between IL-8 -251A/T and IL-10 -1082A/G polymorphisms and susceptibility to colorectal cancer was explored.

RESULTS: There was a significant difference in the distribution of genotype of IL-8 -251A/T between the healthy control group and CRC group (χ² = 8.278, P = 0.016). The genetic frequency of IL-8 -251A allele in CRC was 0.54 (111/204), which was significantly higher than that of the controls (0.43, 91/210) (χ² = 5.083; P = 0.024). The subjects carrying AA genotype were more likely to suffer from CRC (OR = 3.84, 95%CI: 1.44-10.23). Stratified analysis suggested that the association between the AA genotype of IL-8 -251A/T and the risk of CRC was more profound in subjects less than 55 years old and smokers. However, no difference was discovered in the distribution of genotype of IL-10 -1082A/G between the CRC group and healthy control group (χ² = 1.808, P = 0.405).

CONCLUSION: The IL-8 -251AA genotype may be a risk factor of CRC in the population in Shaanxi, and people with A allele may be more likely to suffer from CRC, especially in those less than 55 years old and smokers. No correlation is found between IL-10 -1082A/G polymorphism and the risk of CRC.

Advances in molecular imaging for diagnosis of digestive tract cancers

Digestive tract cancers are common cancer types and have high incidence and mortality. Currently available diagnostic methods have some limitations that make an early and accurate diagnosis and prompt treatment difficult. Molecular imaging, which has been formally defined as visualization, characterization and measurement at the molecular level instead of the anatomic level, significantly increases the sensitivity and specificity of cancer detection. Several modalities have been utilized for molecular imaging in digestive tract cancers, such as endoscopy, scintigraphy (PET/SPECT), magnetic resonance imaging (MRI), and ultrasound (US). Antibodies, peptides, and aptamers are classes of molecular probes that have been extensively used as affinity ligands. After being conjugated with various labels such as radioisotopes, fluorophore, supermagnetic or paramagnetic metals and microbubbles, the probes can specifically target tumor cells and stroma and are used with imaging modalities to detect cancers. Molecular imaging is a methodology for not only the early detection of cancer, but also the judgment of tumor staging and the guidance of therapy. With the development of new instrument and probes, as well as multi-modal platforms, molecular imaging has been gradually perfected and taken from bench to bedside, bringing opportunities for early, accurate and comprehensive diagnosis of digestive tract cancers.

[Relationship between TIM-4 polymorphism and childhood asthma]

OBJECTIVE

To elucidate whether the polymorphism of asthma immune regulator gene TIM-4 is associated with the risk of childhood allergic asthma in the southwest region of China.

METHODS

TIM-4 gene promoter region RS6882076 and intron RS4704727 were studied. PCR-RFLP was used to test the genotypes of two polymorphism loci among 579 cases (average 7.2 years old) of asthma and 524 controls (average 7.6 years old) in a case-control study.

RESULTS

There were significant differences in the frequency of gene types at RS4704727 site between the asthma and the control groups (P<0.01). The results of PCR-RFLP showed that the polyporphisms of RS6882076 and RS4704727 in TIM-4 gene were present in this study population. The frequency of T allele at the RS4704727 site in the asthma group was significantly lower than that in the control group (OR=1.603; 95%CI 1.304-1.971; P<0.01). There were no significant differences in the frequencies of gene types and allele at RS6882076 site between the two groups (P>0.05).

CONCLUSIONS

RS4704727 polymorphism of TIM-4 gene may be associated with childhood asthma, providing a better understanding of the pathogenesis of childhood asthma in the Southwest region of China.

Chemopreventive effect of saikosaponin-d on diethylinitrosamine-induced hepatocarcinogenesis: involvement of CCAAT/enhancer binding protein β and cyclooxygenase-2

Cyclooxygenase-2 (COX-2) and CCAAT/enhancer binding protein β (C/EBPβ) have been shown to be involved in inflammation and carcinogenesis, and our previous study revealed that they were co-overexpressed in human hepatocellular carcinoma (HCC) tissue and a positive correlation was found. Saikosaponin-d (SSD), a triterpene saponin extracted from Bupleurum falcatum L. (Umbelliferae), is known to exert inhibitory effects on COX-2 expression, together with inflammation and hepatic fibrosis. These findings prompted us to investigate the chemopreventive potential of SSD against hepatocarcinogenesis and its possible molecular mechanism in vivo. An experimental model with diethylinitrosamine (DEN)-treated Sprague Dawley rats was used in the present study. DEN (50 mg/kg body weight) and SSD (2 mg/kg body weight) were intraperitoneally injected weekly and daily, respectively. Administration of SSD alone had no side effects. The liver nodule formation, tumorous invasion to surrounding organs and increased cellular atypia induced by DEN were markedly reduced by SSD in the SSD + DEN group compared with the DEN group. On the other hand, immunohistochemical staining demonstrated that the expression of COX-2 and C/EBPβ proteins was significantly increased in tumor cells and macrophages of liver tissue from DEN-treated rats, whereas the expression of the two proteins was markedly lowered in the SSD + DEN group. Overall, our results suggest that SSD prevents DEN-induced hepatocarcinogenesis in rats through inhibition of C/EBPβ and COX-2, providing indispensable experimental evidence for the clinical application of SSD as a novel chemopreventive agent against HCC in the future.

Significance of COX-2 and C/EBP β expression in hepatocellular carcinoma

AIM: To investigate the expression of cyclooxygenase-2 (COX-2) and CCAAT/enhancer binding protein β (C/EBP β) and to analyze their correlation with the clinical pathological parameters in hepatocellular carcinoma (HCC).

METHODS: The expression of COX-2 and C/EBP β in 59 HCC tissue specimens and 18 normal hepatic tissue specimens were detected by immunohistochemistry.

RESULTS: The positive rate of COX-2 expression in HCC was 72.9% (P < 0.05). COX-2 expression was correlated with Child-Pugh classification, tumor diameter, TNM stage, vein invasion, lymph node metastasis, and distant metastasis (P < 0.05). The positive rate of C/EBP β expression in HCC was 47.5% (P < 0.05). C/EBP β expression was correlated with history of alcohol use, tumor diameter and TNM stage (P < 0.05). A close correlation was noted between the expression of COX-2 and C/EBP β (r = 0.580, P < 0.05).

CONCLUSION: COX-2 is overexpressed in HCC and may be involved in early hepatocarcinogenesis. C/EBP β-related signal pathway may up-regulate the expression of COX-2 in the early stage of HCC.

Effects of Salvia miltiorrhiza bunge injection on the status of lipid peroxidation in liver cirrhosis patients with massive upper gastrointestinal hemorrhage

AIM: To study the changes of lipid peroxidation in liver cirrhosis patients with massive upper gastrointestinal hemorrhage and the effects of Salvia miltiorrhiza bunge (SMB) injection on the changes.

METHODS: Ninety-one liver cirrhosis patients with massive upper gastrointestinal hemorrhage were randomly divided into group A (n = 36) and B (n = 55), treated with SMB injection and traditional method, respectively. The dynamic changes of plasma lipid peroxide (LPO) content and superoxide dismutase (SOD) activity were determined in the patients of both groups.

RESULTS: The plasma content of LPO in group B was obviously increased and reached its peak at the 72^th h (11.0 ± 4.1 nmol/L), significantly higher than that at the 12^th h (7.8 ± 3.3 nmol/L, P < 0.01), but it declined in the 1^th week, and recovered in the 4^th week to some extent. LPO content also reached its peak at 72^th h in group A, with a lower-extent change (9.9 ± 4.6 nmol/L vs 7.8 ± 3.1 nmol/L, P < 0.05) and rapid recovery. The activities of SOD in both groups were decreased and reached their lowest values at the 72^th h (group A: 0.9 ± 0.3 nkat/L vs 1.4±0.2 nkat/L, P < 0.01; group B: 0.87 ± 0.2 nkat/L vs 1.3 ± 0.2 nkat/L, P < 0.01). They also recovered in the 4^th wk with different degrees. The prognosis of patients in group A was superior to that in group B, which was correlated with Child-Pugh classification (P<0.05).

CONCLUSION: SMB injection can enhance the antioxidant capability in vivo and improve the prognosis of liver cirrhosis patients with massive upper gastrointestinal hemorrhage.

Effects of extract from Ginkgo biloba on carbon tetrachloride-induced liver injury in rats

AIM: To study the effects of extract from Ginkgo biloba (EGb) containing 22% flavonoid and 5% terpenoid on chronic liver injury and liver fibrosis of rats induced by carbon tetrachloride (CCl₄).

METHODS: All rats were randomly divided into control group, CCl₄-treated group, colchicine-treated group and EGb-protected group. Chronic liver injury was induced in experimental groups by subcutaneous injection of CCl₄ and fed with chows premixed with 79.5% corn powder, 20% lard and 0.5% cholesterol (v/v). EGb-protected group was treated with EGb (0.5 g/kg body weight per day) for 7 wk. At the end of wk 8, all the rats were killed. Liver function, liver fibrosis, oxidative stress and expression of transforming growth factor β₁ (TGF-β₁), a-smooth muscle actin (α-SMA) and type I collagens in liver were determined. In addition, pathology changes of liver tissue were observed under light microscope.

RESULTS: The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin (Alb) in EGb-protected group were notably improved as compared with the CCL₄-treated group (P < 0.01). The contents of serum hyaluronic acid (HA), type III procollagen (PCIII), type IV collagen (CIV) and the expression of hepatic tissue TGF-β₁, α-SMA and type I collagen in EGb-protected group were significantly lower than those in CCL₄-treated groups (P < 0.05, P < 0.01). The degrees of liver fibrosis in EGb-protected groups were lower than those in CCL₄-treated groups (6.58 ± 1.25 vs 9.52 ± 2.06, P < 0.05). Compared to the CCL₄-treated group, the levels of plasma glutathoine peroxidase (Se-GSH-Px), superoxide dismutase (SOD) and malondialdehyde (MDA) were strikingly improved also in EGb-protected group (P < 0.05, P < 0.01).

CONCLUSION: EGb resists oxidative stress and thereby reduces chronic liver injury and liver fibrosis in rats with liver injury induced by CCl₄.

Effect of tanshinone II A on COX-2 expression in hepatocellular carcinoma cell line SMMC-7721

AIM: To observe the effect of Tanshinone II A on the proliferation and apoptosis of human hepatocellular carcinoma cell line SMMC-7721 and its machanism.

METHODS: The human hepatocellular carcinoma cell line SMMC-7721 cultured in vitro was treated with different concentrations (final 0.5 mg/L) Tanshinone II A. The proliferation of the cells was measured by MTT assay, and the apoptosis of the cells was investigated by flow cytometry and transmission electron microscopy (TEM). The expression of Cyclooxygenase-2 (COX-2) was detected by immunocytochemistry. The levels of prostaglandin E2 (PGE2) in medium were measured by radioimmunoassay.

RESULTS: Tanshinone II A inhibited the growth of SMMC-7721 cells in a dose-dependent manner. The inhibitory rate reached the peak (69.3%) after 0.5 mg/L Tanshinone II A was used for 48 h, which was significantly higher than that in the controls (P < 0.01). Typical features of apoptosis as cell shrinkage, nuclear chromatin condensation, fragmentation, and the formation of apoptotic bodies was found by TEM in the cells treated with Tanshinone II A. FCM analysis showed the apoptotic rates for 24, 48 and 72 h were 7.45% ± 0.33%, 6.59% ± 0.45%, and 4.78% ± 1.05%, respectively, when 5 mg/L Tanshinone II A was used, which were markedly higher than those in the controls (all P < 0.01). Both the expression of COX-2 (P < 0.01) and the production of PGE2 (40.18 ± 1.37 μg/L vs 75.31 ± 1.64 μg/L, P < 0.01) were decreased significantly after Tanshinone II A treatment as compared with those in the controls.

CONCLUSION: Tanshinone II A inhibits the proliferation and increases the apoptosis of human hepatocellular carcinoma cell line SMMC-7721 by down-regulation of COX-2 protein expression.

Effects of selenium on peripheral blood mononuclear cell membrane fluidity, interleukin-2 production and interleukin-2 receptor expression in patients with chronic hepatitis

AIM: To study the effect of selenium on peripheral blood mononuclear cell (PBMC) membrane fluidity and immune function in patients with chronic hepatitis.

METHODS: PBMCs were pretreated with selenium (1.156 × 10^-7 mol/L) for 6 h in vitro or extracted directly from patients after administration of selenium-yeast continuously for 8-12 wk (200 μg/d), and then exposed to Con-A for 48 h. The membrane fluidity, interleukin-2 (IL-2) production and interleukin-2 receptor (IL-2R) expression in PBMCs and malondialdehyde (MDA) concentration in medium and lipid peroxide (LPO) in plasma were determined.

RESULTS: The PBMC membrane fluidity, IL-2 production and IL-2R expression in patients with chronic hepatitis were significantly lower than those in healthy blood donators (particle adhesive degree R, 0.17 ± 0.01 vs 0.14 ± 0.01, P < 0.01; IL-2, 40.26 ± 9.55 vs 72.96 ± 11.36, P < 0.01; IL-2R, 31.05 ± 5.09 vs 60.58 ± 10.56, P < 0.01), and the MDA concentration in medium in patients with chronic hepatitis was significantly higher than that in healthy blood donators (1.44 ± 0.08 vs 0.93 ± 0.08, P < 0.01). Both in vitro and in vivo administration of selenium could reverse the above parameters.

CONCLUSION: Supplement of selenium can suppress lipid peroxidation, and improve PBMC membrane fluidity and immune function in patients with chronic hepatitis.

Correlation between expression of cyclooxygenase-2 and angiogenesis in human gastric adenocarcinoma

AIM: To evaluate the expression of cyclooxygenase (COX-2) and the relationship with tumor angiogenesis and advancement in gastric adenocarcinoma.

METHODS: Immunohistochemical stain was used for detecting the expression of COX-2 in 45 resected specimens of gastric adenocarcinoma; the monoclonal antibody against CD34 was used for displaying vascular endothelial cells, and microvascular density (MVD) was detected by counting of CD34-positive vascular endothelial cells. Paracancerous tissues were examined as control.

RESULTS: Immunohistological staining with COX-2-specific polyclonal antibody showed cytoplasmic staining in the cancer cells, some atypical hyperplasia and intestinal metaplasia, as well as angiogenic vasculature present within the tumors and prexisting vasculature adjacent to cancer lesions. The rate of expression of COX-2 and MVD index in gastric cancers were significantly increased, compared with those in the paracancerous tissues (77.78 vs 33.33%, 58.13 ± 19.99 vs 24.02 ± 10.28, P < 0.01, P < 0.05, respectively). In 36 gastric carcinoma specimens with lymph node metastasis, the rate of COX-2 expression and MVD were higher than those in the specimens without metostasis (86.11 vs 44.44%, 58.60 ± 18.24 vs 43.54 ± 15.05, P < 0.05, P < 0.05, respectively). The rate of COX-2 expression and MVD in the specimens with invasive serosa were significantly higher than those in the specimens without invasion to serosa (87.88 vs 50.0%, 57.01 ± 18.79 vs 42.35 ± 14.65, P < 0.05, P < 0.05). Moreover, MVD in COX-2-positive specimens was higher than that in COX-2-negative specimens (61.29 ± 14.31 vs 45.38 ± 12.42, P < 0.05). COX-2 expression was positively correlated with MVD (r = 0.63, P < 0.05).

CONCLUSION: COX-2 expression might correlate with the occurance and advancement of gastric carcinoma and is involved in tumor angiogenesis in gastric carcinoma. It is likely that COX-2 by inducing angiogenesis can be one of mechanisms which promotes invasion and metastasis of gastric carcinoma. It may become a new therapeutic target for anti-angiogenesis.

Biotransformation and elimination of 1-nitropyrene in the isolated perfused lung: effects of pretreating rats with phenobarbitone, beta-naphthoflavone, benz(A)anthracene or their mixtures

The isolated perfused rat lung (IPL) was perfused with 60 ml of recirculating Krebs-Ringer solution containing 150 micrograms of 1-nitropyrene (1-NP) for 1 h. The 1-NP was administered to the IPL by the intratracheal or intravascular route. At specific time points after 1-NP administration, perfusate samples were removed from the IPL and analysed for 1-NP and its metabolites by HPLC. Monohydroxynitropyrenes, dihydroxynitropyrenes and 1-NP were found to be present in the perfusate. The time course of 1-NP concentrations in the perfusate could be described by a one-compartment pharmacokinetic model. Pretreatment of rats with beta-naphthoflavone (BNF), benz(a) anthracene (BA) or a mixture of phenobarbitone (PB) and BNF (PB + BNF) significantly enhanced the metabolism of 1-NP and decreased the mean residence time (MRT) of 1-NP in the perfusate. Pretreatment of rats with these mixed-function oxidase inducers also increased significantly the absorption of 1-NP by the lung when it was administered intratracheally. In contrast, pretreatment of rats with PB did not appear to have any effect on the pharmacokinetics of 1-NP in the IPL.

Benzo(a)pyrene toxicokinetics in the cricket following injection into the haemolymph

The metabolic disposition of (14)C-labelled benzo(a)pyrene (BP) in the cricket (Acheta domesticus) was investigated after injection into the haemolymph. (14)C-BP was taken up rapidly by the nerve cord, malpighian tubules, reproductive organs, gut, and muscle:cuticle of the cricket. The elimination half-lives of (14)C-BP in these tissues ranged from 8.9 to 17.8 h. The haemolymph (14)C-BP concentration-time curve could be described by a one-compartment open pharmacokinetic model. (14)C-BP was metabolized by the cricket mainly to unconjugated and conjugated BP metabolites since very little unchanged (14)C-BP was found in the excreta at 48 h post-dosing. GLPC-MSD and HPLC/ES-MS analyses showed the presence of at least two BP metabolites in the excreta. The BP metabolites were identified tenatively as the diol derivatives of benzo(a)pyrene and benzo(a)pyrene quinone.