OTSC assisted EFTR for the treatment of GIST: 40 cases analysis

BACKGROUND AND AIMS

To verify the safety and efficacy of over-the-scope clip (OTSC)-assisted endoscopic full-thickness resection (EFTR) for the excision of stromal tumors.

MATERIAL AND METHODS

Forty patients with gastric stromal tumors treated in the Department of Gastroenterology, Binzhou Medical University Hospital from December 2015 to March 2017 were included in this study. The surgical procedures included marking the lesion boundaries, cutting open the top surface of the lesion, installing an OTS, sucking the lesion into the transparent cap of the anatomical clip which was then released, application of an endoloop for EFTR, and confirming the complete resection and pathological examination of the lesion. Statistical analysis of the tumor site and size, operation time, success rates, complications, pathological examination results, and follow-up status was performed.

RESULTS

The average operation duration was 38.40 ± 24.9 min. Three cases had an incomplete resection, but the lesion was later found to have fallen off together with the OTSC. Therefore, the treatment success rate was 100%. Postoperative pathological examination revealed leiomyomas in four cases and stromal tumors in the remaining 36 cases.

CONCLUSIONS

OTSC-assisted EFTR is safe and effective for resection of gastrointestinal stromal tumors, especially for those <20 mm in size.

[Effectiveness of health education interventions targeting taeniasis and cysticercosis among primary school students in disease-elimination pilot areas of Henan Province]

OBJECTIVE

To compare the changes of knowledge, attitude and practice (KAP) related to taeniasis and cysticercosis among primary school students before and after health education interventions in disease-elimination pilot areas of Henan Province, so as to evaluate the effectiveness of health education interventions.

METHODS

A primary school was selected from each of Dushu, Bowang and Yangji townships, Fangcheng County, Henan Province from 2017 to 2019; then, 2 to 3 classes were randomly selected from grade 4 to 6 in each primary school, and finally, all students in these classes were enrolled as study subjects. A thematic health education lecture pertaining to taeniasis and cysticercosis was given once each year by means of "health education in class". The KAP towards taeniasis and cysticercosis was investigated among primary school students using selffilled structured questionnaires, and the changes of awareness of taeniasis and cysticercosis control knowledge and percentage of healthy behaviors formation were compared in primary school students among years and following various frequencies of health education interventions.

RESULTS

More than 10 thousand person-time primary school students received health education interventions during the period from 2017 to 2019, and a total of 1 223 person-time primary school students were investigated during the 3-year study period, including 633 person-time men and 590 person-time women and 88.55% of primary school students at ages of 10 to 12 years. The proportion of households raising pigs and using dry toiliets decreased from 5.30% (24/453) and 18.10% (82/453) in 2017 to 3.60% (13/361) and 11.08% (40/361) in 2019, respectively. The awareness rate of taeniasis and cysticercosis control knowledge increased significantly from 0.22% (1/453) in 2017 to 62.59% (256/409) in 2018 and 76.73% (277/361) in 2019 (χ² = 567.60, P < 0.001), and the awareness rate was 85.25% (104/122) among primary school students attending the thematic special health education courses for successive three times. The awareness rates of taeniasis and cysticercosis control knowledge were 0.44% (1/225), 58.00% (116/200) and 71.63% (149/208) among male students and 0 (0/338), 66.99% (140/209) and 83.66% (128/153) among female students from 2017 to 2019, and there was a significant difference in the awareness of taeniasis and cysticercosis control knowledge between male and female students in 2019 (χ² = 7.14, P = 0.01). On-site teaching by doctors was the students' favorite way to receive health education interventions (70.07%, 857/1 223), followed by watching health education videos (58.63%, 717/1 223) and seeing parasite specimens (48.9%, 598/1 223). The proportion of students' families who used cutting boards for raw and cooked food separately increased from 7.28% (33/453) in 2017 to 47.37% (171/361) in 2019, was 67.21% (82/122) among students attending the health education courses for successive three times. The proportion of students who frequently washed their hands before meals and after using toilet increased from 71.96% (324/453) in 2017 to 89.47% (319/361) in 2019 and was 95.90% (117/122) among students attending the health education courses for successive three times. In addition, the percentage of students washing hands frequently in families using dry toilets was significantly lower in those who did not use dry toilets (χ² = 9.21, P = 0.002), and the proportion of students with a habit of eating raw or undercooked meat decreased significantly from 35.76% (162/453) in 2017 to 6.65% (24/361) in 2019 (χ² = 69.11, P < 0.01).

CONCLUSIONS

The thematic health education activity of "health education in class" contributes greatly to the increase in the awareness of taeniasis and cysticercosis control knowledge and the rate of healthy behaviors formation among primary school students in diseaseelimination pilot areas of Henan Province.

[Susceptibility of Anopheles sinensis to insecticides in Puyang City, Henan Province]

OBJECTIVE

To investigate the susceptibility of Anopheles sinensis to malathion, deltamethrin and lambda-cyhalothrin in Puyang City, Henan Province, so as to provide the scientific basis for local malaria vector control.

METHODS

An. sinensis was captured from Puyang County, Puyang City of Henan Province in September 2018 and July 2020, and the susceptibility of field captured An. sinensis to malathion, deltamethrin and lambda-cyhalothrin was tested using the filter-paper bioassay recommended by WHO. The insecticide resistance level was assessed based on the WHO criteria.

RESULTS

In 2018 and 2010, the half knock-down times (KT₅₀) of malathion were 91.08 min and 40.95 min for An. sinensis, with knock-down rates of 37.50% and 60.87% 60 min post-exposure to malathion and 24-hour mortality rates of 90.91% and 100%, respectively, and the insecticide resistance levels were moderately resistant (M) and susceptible (S). The KT₅₀ of deltamethrin were 415.56 min and 341.19 min for An. sinensis in 2018 and 2020, with knock-down rates of 22.92% and 16.98% 60 min post-exposure to malathion and 24-hour mortality rates of 22.92% and 16.98%, and the insecticide resistance levels were all resistant (R). The KT₅₀ of lambda-cyhalothrin were 164.22 min and 236.22 min for An. sinensis in 2018 and 2020, with knock-down rates of 30.39% and 38.30% 60 min postexposure to malathion and 24 h mortality rates of 19.60% and 21.28%, respectively, and the insecticide resistance levels were all R.

CONCLUSIONS

An. sinensis is relatively susceptible to malathion but has developed high-level resistance to deltamethrin and lambda-cyhalothrin in Puyang City, Henan Province..

[Anterior segment OCT-assisted PTK combined with PRK in the treatment of myopia associated with cornea macula: a case report]

Nowadays, myopia morbidity keeps increasing in China. As the improvements of technique and safety in corneal refractive surgeries, an increasing number of patients with refractive error tend to choose these treatments. The 26-year-old woman with myopia in this case, whose UCVA was 0.1 in OD and 0.2 in OS, had corneal macula in the nasal side of the left eye owing to a corneal trauma occurred more than 10 years ago. After sufficient preoperative examinations, FS-LASIK was performed on the right eye and PTK combined with PRK was performed on the left eye. The UCVA was 1.2 in both eyes 3 months postoperatively, and the corneal macula was mostly cleared in the left eye. It is demonstrated that PTK combined with PRK is an effective and safe way to correct the diopter as well as remove the lesions for the lowly or moderately myopic patients accompanied with superficial corneal opacity. (Chin J Ophthalmol, 2021, 57: 614-617).

Impulse Control and ERP Characteristics of Patients with Mental Disorder Caused by Traumatic Brain Injury

Abstract

Objective To explore the impulse control and event-related potential （ERP） characteristics of patients with mental disorders caused by traumatic brain injury （TBI） in forensic psychiatry identification and to provide objective auxiliary indicators for forensic psychiatry identification. Methods Thirty patients （TBI group） with mental disorders caused by traumatic brain injury, who were identified as mild psychiatric impairment by judicial psychiatry, including 24 males and 6 females, as well as the thirty people in the control group participated in the study. All the participants completed Barratt Impulsiveness Scale-11 （BIS-11） and ERP induced by Go/NoGo tasks. BIS-11 and ERP data were collected and analyzed. Results The results of the BIS-11 showed that the total score and subscale scores of the TBI group were higher compared to the control group （P<0.05）. Moreover, the TBI group exhibited significantly lower NoGo-N2 amplitude and lower NoGo-P3 amplitude than the control group. The NoGo-N2 amplitude was larger than the Go-N2 amplitude, and the NoGo-P3 amplitude was larger than the Go-P3 amplitude in both groups （P<0.05）. Conclusion Traumatic brain injury could impair impulse control of mild psychiatric impairment patients, and the amplitudes of NoGo-N2 and NoGo-P3 could be important parameters to evaluate the impulse control of patients with mental disorders caused by traumatic brain injury.

[Endoplasmic reticulum stress regulates autophagy and tumor necrosis factor-α secretion of RAW264.7 cells induced by silica]

Objective: To investigate the role of endoplasmic reticulum stress (ERS) in the autophagy of RAW264.7 cells induced by SiO(2) and its effect on the secretion of tumor necrosis factor-α. Methods: RAW264.7 cells stimulated by 200 μg/ml SiO(2) were used as an vitro cell model, and different treatment times of SiO(2) were used as variables. They were divided into 0 h treatment group (blank control group) , 6 h, 12 h, 24 h, and 48 h treatment group. The formation of autophagospores was detected by acridine orange and mondane-sulfonate (MDC) staining. Application of real-time quantitative PCR (Real-time PCR) to detect autophagy related molecular Beclin1 mRNA expression and protein immunoblot (Western Blotting) detecting autophagy related proteins LC3Ⅰ, LC3Ⅱ and expression of Beclin1. Real-time PCR and Western blotting were used to detect the expression of ERS specific marker BiP. Secretion of RAW 264.7 cell transforming growth factor-β1 (TGF-β1) and tumor necrosis factor-α (TNF-α) was detected by enzyme-linked immunosorbent assay (ELISA) . ERS inhibitors 4-PBA intervention experiment, including blank control group, SiO(2), 1 μmol/L 4-PBA+SiO(2), 10 μmol/L 4-PBA+SiO(2), 20 μmol/L 4-PBA+SiO(2) treatment group, Western blotting testing LC3Ⅰ, LC3Ⅱ and expression of Beclin1 changes. Results: Compared with the control group, SiO(2)-induced fluorescence intensity in RAW264.7 cells was significantly increased, with statistically significant differences (P<0.05) . Compared with control group, with SiO(2) processing time prolonged, LC3Ⅰ, LC3Ⅱ Beclin1 mRNA and protein expression and protein expression increased, 6 h, 24 h, the height of the differences were statistically significant (P<0.05) ; Compared with the control group, the mRNA and protein expression level of BiP reached the peak for 6 h, and the expression level in 6 h, 12 h and 24 h groups increased significantly, and the difference was statistically significant (P<0.05) . Compared with the SiO(2) stimulation group, the LC3Ⅱand Beclin 1 protein levels of RAW264.7 cells were gradually down-regulated by increasing the dose of 4-PBA. With the increase of 4-PBA concentration, the down-regulated levels were more significant, and the difference was statistically significant (P<0.05) . Compared with the SiO(2) stimulation group, the TNF-α secretion level of RAW264.7 cells significantly decreased of 1, 10, 20 μmol/L 4-PBA+SiO(2) treatment group, and the difference was statistically significant (P<0.05) . Conclusion: ERS induced by SiO(2) is involved in the secretion of autophagy and TNF-α in RAW264.7 cells.

[Comparison of the visual quality at 1 year following femtosecond laser-assisted LASIK, wavefront-guided femtosecond LASIK and small incision lenticule extraction for myopia and astigmatism]

Objective: To investigate mesopic contrast sensitivity (CS) and high-order aberrations after femtosecond laser-assisted LASIK (FS-LASIK), wavefront-guided femtosecond LASIK (WF-LASIK) and small incision lenticule extraction (SMILE) for myopia and astigmatism. Methods: In this case-control study, 212 eyes of 108 patients with myopia and astigmatism from September 2014 to September 2016 were treated by refractive surgery. There were 34 males (66 eyes) and 74 females (146 = eyes), aged 27 (24, 32) years. They were divided into 3 groups, with 37 patients (71 eyes), 35 patients (69 eyes) and 36 patients (72 eyes) treated by FS-LASIK, WF-LASIK and SMILE, respectively. Refraction diopters, corneal tomography, wavefront aberrations and contrast sensitivity were evaluated before and at 12 months after surgery. The results of different groups were compared by rank sum test. Results: At 12 = months of follow-up, 69 eyes (97.18%) treated by FS-LASIK, 67 eyes (97.10%) by WF-LASIK and 69 eyes (95.83%) by SMILE had the uncorrected distance visual acuity of 20/20 or better. Fifty-nine eyes (83.10%) treated by FS-LASIK, 60 eyes (86.96%) by WF-LASIK and 61 eyes (84.72%) by SMILE had better postoperative uncorrected distance visual acuity than preoperative corrected distance visual acuity. Surface regularity index of the WF-LASIK group decreased from 0.11 (0.07, 0.28) to 0.07 (0.06, 0.20) (Z=-2.662, P=0.008), which was less than that of the FS-LASIK and SMILE groups (Z=-3.236, -3.118, P=0.001, 0.000). Surface asymmetry index of the WF-LASIK group increased from 0.34 (0.25, 0.43) to 0.38 (0.30, 0.52) (Z=-2.140, P=0.032), which was less than that of the FS-LASIK and SMILE groups (Z=-2.910, -3.779, P=0.004, 0.000). The root mean square of high-order of the FS-LASIK group increased from 0.32 (0.27, 0.41) to 0.53 (0.40, 0.65) (Z=-6.228, P=0.000), which was more than that of the WF-LASIK and SMILE groups (Z=-3.595, -4.806, P=0.000, 0.000). Coma of the WF-LASIK group increased from 0.16 (0.11, 0.24) to 0.26 (0.15, 0.37) (Z=-3.816, P=0.000), which was less than that of the FS-LASIK group (Z=-3.528, P=0.000). Spherical aberration of the FS-LASIK and WF-LASIK groups increased from 0.10 (0.05, 0.21) and 0.08 (0.04, 0.12) to 0.24 (0.13, 0.34) and 0.15 (0.09, 0.26), respectively (Z=-5.141, -4.864, P=0.000, 0.000), which were more than that of the SMILE group (Z=-2.549, -4.682, P=0.011, 0.000). CS of the WF-LASIK group at 12 cycles per degree (c/d) increased from 1.34 (1.18, 1.48) to 1.48 (1.34, 1.63) (Z=-2.985, P=0.003), which was more than that of the FS-LASIK and SMILE groups (Z=-3.194, -2.977, P=0.001, 0.003). CS with glare of the WF-LASIK group at 12.0 c/d increased from 1.26 (1.18, 1.34) to 1.34 (1.34, 1.63) (Z=-3.608, P=0.000), which was more than that of the FS-LASIK and SMILE groups (Z=-4.033, -2.913, P=0.000, 0.004). Conclusions: FS-LASIK, WF-LASIK and SMILE achieved ideal visual outcomes at 12 months postoperatively. WF-LASIK treated eyes showed the best corneal symmetry, the least increase of high-order aberrations and the best visual quality among three kinds of surgeries. (Chin J Ophthalmol, 2020, 56: 118-125).

[Consistency of ALK Ventana-D5F3 immunohistochemistry interpretation in lung adenocarcinoma among Chinese histopathologists]

Objective: To understand the consistency of ALK Ventana-D5F3 immunohistochemistry (IHC) interpretation in Chinese lung adenocarcinoma among histopathologists from different hospitals, and to recommend solution for the problems found during the interpretation of ALK IHC in real world, with the aim of the precise selection of patients who can benefit from ALK targeted therapy. Methods: This was a multicenter and retrospective study. A total of 109 lung adenocarcinoma cases with ALK Ventana-D5F3 IHC staining were collected from 31 lung cancer centers in RATICAL research group from January to June in 2018. All cases were scanned into digital imaging with Ventana iSCANcoreo Digital Slide Scanning System and scored by 31 histopathologists from different centers according to ALK binary (positive or negative) interpretation based on its manufacturer's protocol. The cases with high inconsistency rate were further analyzed using FISH/RT-PCR/NGS. Results: There were 49 ALK positive cases and 60 ALK negative cases, confirmed by re-evaluation by the specialist panel. Two cases (No. 2302 and No.2701) scored as positive by local hospitals were rescored as negative, and were confirmed to be negative by RT-PCR/FISH/NGS. The false interpretation rate of these two cases was 58.1% (18/31) and 48.4% (15/31), respectively. Six out of 31 (19.4%) pathologists got 100% accuracy. The minimum consistency between every two pathologists was 75.8%.At least one pathologist gave negative judgement (false negative) or positive judgement (false positive) in the 49 positive or 60 negative cases, accounted for 26.5% (13/49), 41.7% (25/60), respectively, with at least one uncertainty interpretation accounted for 31.2% (34/109). Conclusion: There are certain heterogeneities and misclassifications in the real world interpretation of ALK-D5F3 IHC test, which need to be guided by the oncoming expert consensus based on the real world data.

Diagnosis of gastric duplication cyst by positron emission tomography/computed tomography: A case report

BACKGROUND

Gastric duplication cysts (GDCs) are extremely uncommon lesions and the definitive diagnosis of GDCs is challenging for gastrointestinal specialists. It is important that a differential diagnosis is performed to rule out the possibility of other diseases, mainly malignancies with a cystic component. Despite the use of multiple diagnostic modalities including endoscopy, the preoperative diagnosis of GDCs is challenging.

CASE SUMMARY

A 53-year-old female patient with a GDC was confirmed by positron emission tomography/computed tomography (PET/CT) instead of more conventional procedures such as endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA). We propose that ¹⁸F-FDG-PET/CT has higher accuracy than EUS-FNA and may be an effective technique for the characterization of duplication cysts.

CONCLUSION

Preoperative diagnosis of GDCs in adults is difficult largely due to their rarity and the absence of characteristic findings. In addition, few endoscopists include GDCs in the differential diagnosis when they encounter a lesion with cystic characteristics. ¹⁸F-FDG-PET/CT with additional imaging data, may complement EUS-FNA in the diagnosis of GDCs.

Farnesoid X receptor agonist INT-767 attenuates liver steatosis and inflammation in rat model of nonalcoholic steatohepatitis

Introduction

Nonalcoholic steatohepatitis (NASH) is largely driven by the dysregulation of liver metabolism and inflammation. Bile acids and their receptor Farnesoid X receptor (FXR) play a critical role in the disease development. Here, we investigated whether INT-767, the newly-identified dual FXR/TGR5 agonist, can protect rat from liver injury during NASH.

Materials and methods

NASH model was established by feeding the male SD rats with high-fat diet for 16 weeks. INT-767 was given by gavage to NASH rats from week 13 to week 16. At the end of 16 weeks, liver and serum were harvested, and bile acids, glucose and lipid metabolism, liver injury and histological features were evaluated.

Results

INT-767 treatment significantly alleviates high-fat caused liver damage characterized with lipid accumulation and hepatic infiltration of immune cells. INT-767 robustly restores the lipid, glucose metabolism to normal level, attenuates insulin resistance through upregulating FXR level and reverting the dysregulation of its target genes in liver metabolism. Molecularly INT-767 also attenuates the pro-inflammatory response by suppression of TNF-α and NF-κB signaling pathway.

Conclusion

INT-767 may be an attractive candidate for a potential novel strategy on the treatment of NASH.

Correlation of endoscopic images and histological findings of a high grade dysplasia developed in a gastric xanthoma

Gastric neoplasia developed in a xanthoma is very rare. We herein report a high grade dysplasia (HGD) arising in a gastric xanthoma removed by endoscopic submucosal dissection (ESD). A 57-year-old man was referred to our hospital for removal of rectal polyps. During surveillance esophago-gastro-duodenoendoscopy before polypectomy, an irregularly shaped gastric xanthoma with unusual color was found in the stomach. Although, magnifying narrow band imaging showed no typical neoplastic vessel or surface pattern on the surface and endoscopic biopsies revealed no tumor, diagnostic ESD was performed because of its irregular shape and unusual color for a commonly seen xanthoma. Histologically, a high grade dysplasia, 6 mm×6 mm in size, was detected within a gastric xanthoma. This is the first report of correlation of endoscopic images and histological findings of a HGD in a gastric xanthoma.

[Association between elective cesarean section and infants' developmental behaviors: a cohort study]

Objective: To investigate the effect of elective cesarean section (ECS) on infants' developmental behaviors. Methods: A total of 3 474 pregnant women living in Ma'anshan more than 6 months and accepting obstetric examination in Ma'anshan Maternal and Child Care Center were recruited from May 2013 to September 2014. Excluding participants with pregnancy termination (162), twin pregnancy (39), assisted delivery (14), emergency cesarean section (76) and unclear delivery mode (141), 3 042 pair of mother and infant entered the final analysis. Information of maternal basic demographic characteristics, pregnancy histories, pregnancy life style and pregnancy-related diseases were collected by using self-complied Maternal and Child Health Questionnaire. Information of infants' general condition and delivery modes were acquired from obstetric record. The Ages and Stages Questionnaires-third edition was used to assess infants' communication, gross motor, fine motor, problem solving and person-social function, which was completed at age of 6 months old and 18 months old, respectively. And multi-factor non-conditional logistic regression model was used to analyze the association between ECS and infants' developmental behaviors. Results: The prevalence of ECS was 47.5% (1 443/3 042), among which ECS without medical indication and ECS with medical indication were 27.2% (826/3 042) and 20.3% (617/3 042), respectively. After maternal demographic characteristics, pregnant exposure and infants' basic information adjusted, compared to women with vaginal delivery, both ECS with medical indication and without medical indication increased the risk of a delay in gross motor on infants at 6 months old (RR (95%CI: 1.72 (1.08-2.77) and 1.87 (1.11-3.15), respectively.) ECS without indication decreased the risk of a delay in fine motor on infants at 6 months old (RR (95%CI):0.48 (0.28-0.82)), both ECS without medical indication and with medical indication had no statistically significant effect on 18 months infants' communication, gross motor, fine motor, problem solving and person-social function, the RR (95%CI) for ECS without medical indication were 0.86 (0.43-1.74), 1.55 (0.86-2.78), 0.74 (0.49-1.15), 1.10 (0.68-1.78) and 1.17 (0.66-2.08), respectively; and the RR (95%CI) for ECS with medical indication were 0.33 (0.12-1.02), 1.10 (0.55-2.21), 0.79 (0.48-1.29), 0.58 (0.29-1.13) and 1.48 (0.78-2.81), respectively. Conclusion: ECS affected motor development in infants at the age of 6 months old, and no influence was found in infants at the age of 18 months old.

[Value of non-invasive models of liver fibrosis in judgment of treatment timing in chronic hepatitis B patients with ALT < 2×upper limit of normal]

Objective: To investigate the value of non-invasive liver fibrosis models, FIB-4, S index, aspartate aminotransferase to platelet ratio index(APRI), globulin-platelet(GP)model, aspartate aminotransferase/platelet/gamma-glutamyl transpeptidase/alpha-fetoprotein(APGA), and platelet/age/phosphatase/alpha-fetoprotein/aspartate aminotransferase(PAPAS), in the diagnosis of marked liver fibrosis in chronic hepatitis B(CHB)patients with ALT < 2×upper limit of normal(ULN), as well as treatment timing for this population. Methods: A total of 389 CHB patients with ALT < 2×ULN who were admitted to Beijing Ditan Hospital and whose treatment timing was difficult to judge were enrolled. Transdermal liver biopsy was performed to obtain pathological results, and routine serological tests were performed, including routine blood test, serum biochemical parameters, hepatitis B virus(HBV)markers, and HBV DNA. According to liver pathology, the patients were divided into non-marked liver fibrosis group(S < 2)with 324 patients and marked liver fibrosis group(S≥2)with 65 patients. The non-invasive models for predicting liver fibrosis was established with reference to original articles. SPSS 19.0 software was used for statistical analysis, and the receiver operating characteristic(ROC)curve was used to compare the value of different non-invasive models in predicting marked liver fibrosis in this population. Results: All the non-invasive models had a certain diagnostic value for liver fibrosis degree in these patients, and the areas under the ROC curve for APRI, FIB-4, APGA, S index, PAPAS, and GP model were 0.718, 0.691, 0.758, 0.729, 0.673, and 0.691, respectively. APGA had the largest area under the ROC curve(0.758, 95% CI 0.673-0.844), and gamma-glutamyl transpeptidase was significantly positively correlated with liver fibrosis degree. Conclusion: The non-invasive models of liver fibrosis can identify marked liver fibrosis in CHB patients with ALT < 2×ULN in whom it is difficult to judge treatment timing and help to determine treatment timing for them. APGA model has the highest value and can reduce the need for liver biopsy to the certain degree.

Overexpression of NDUFA4L2 is associated with poor prognosis in patients with colorectal cancer

BACKGROUND

NDUFA4L2 (NADH dehydrogenase (ubiquinone) 1 alpha subcomplex, 4-like 2, also called NADH-ubiquinone oxidoreductase MLRQ subunit homologue) was clearly enriched in the mitochondrial fraction under hypoxic conditions, and immunofluorescence showed a clear colocalization of NDUFA4L2 and cytochrome c in some tumour cells. However, little study has investigated its prognostic value in colorectal cancer (CRC).

METHODS

In our study, mRNA-NDUFA4L2 and protein expression were analysed in 150 cases of CRC and adjacent normal tissues using immunohistochemistry, semi-quantitative reverse transcriptase-polymerase chain reaction. The correlation between NDUFA4L2 expression and clinicopathological factors was evaluated by the Chi-square test. Overall survival of patients was analysed by the Kaplan-Meier method.

RESULTS

NDUFA4L2 overexpression was observed in 84% (126/150) of CRC tissues, but only in 24.7% (37/150) of adjacent normal tissues (P < 0.05). Semi-quantitative reverse transcriptase-polymerase chain reaction showed average mRNA expression levels to be 23.34 ± 1.356 and 4.34 ± 1.132 for CRC tissue and adjacent normal tissue (P < 0.05). Statistical analysis showed a significant correlation of NDUFA4L2 expression with histological grade, Dukes' stages, lymph node metastasis and liver metastasis. More importantly, multivariate analysis indicated that overexpression of NDUFA4L2 was an independent prognostic factor for CRC patients (P = 0.002). NDUFA4L2-negative patients had a higher tumour-free/overall survival rate than patients with high NDUFA4L2 expression (P = 0.001 and 0.002, respectively).

CONCLUSIONS

Our data suggest that NDUFA4L2 overexpression is associated with tumour progression and a poor prognosis in CRC patients.

Integration of US/Fe(2+) and photo-Fenton in sequencing for degradation of landfill leachate

The landfill leachate treated by sonication in presence of Fe(2+) (US/Fe(2+)) and then by photo-Fenton achieved the highest total organic carbon (TOC) removal efficiency among the screened processes. The lower initial pH, dosage of Fe(2+) and initial concentration of leachate were helpful in raising TOC removal efficiency of leachate by US/Fe(2+). The optimal conditions for the US-photo-Fenton process were as follows: initial pH at 3.0, [H2O2]/[TOC0] at 2, [H2O2]/[Fe(2+)] at 5 and initial concentration of landfill leachate at 600 mg/L. The removal efficiency of TOC, chemical oxygen demand (COD) and 5-day biochemical oxygen demand (BOD5) were 68.3, 79.6 and 58.2%, while the BOD5/COD rose from 0.20 to 0.43 at optimum condition. Based on gas chromatography-mass spectrometry (GC-MS) results, 36 of a total of 56 pollutants were completely degraded by US-photo-Fenton treatment.

In Vivo and In Vitro Silica Induces Nuclear Factor Egr-1 Activation Mediated by ERK 1/2 in RAW264.7 Cell Line

The transcription factor early growth response gene (Egr-1) is a stress response gene activated by various forms of stress. The effect of silica on transcription and expression of Egr-1 was investigated in rat lung and in RAW264.7 cells. Silica induced the expression of Egr-1 in vivo and was mainly located in alveolar macrophage cells and lung epithelial cells. Furthermore, silica induced Egr-1 mRNA and protein expression in cultured RAW264.7 cells. Immunofluorescence microscopy revealed translocation of Egr-1 to the nucleus in response to silica. The contribution of the extracellular signal-regulated kinase (ERK) pathway to the activation of Egr-1 in response to silica was examined. Exposure to silica resulted in a rapid phosphorylation of ERK 1/2 kinases in RAW264.7 cells. MAP Kinase Kinase (MEK) inhibitor U0126 prevented Egr-1 induction by silica. The results suggest that silica could induce Egr-1 activation in macrophages in vivo and in vitro and that phosphorylated ERK 1/2 may be involved in this action.

Silica Induces Plasminogen Activator Inhibitor-1 Expression through a MAPKs/AP-1-Dependent Mechanism in Human Lung Epithelial Cells

ABSTRACT Plasminogen activator inhibitor-1 (PAI-1) plays an important role in the silica-induced pulmonary fibrosis. The effect of silica on the expression of PAI-1 was investigated in human lung epithelial cells (A549). Silica induced PAI-1 expression in a concentration-(50-200 mug/mL) and time-(4-24 h) dependent manner in A549 cells. Furthermore, the roles of mitogen-activated protein kinase (MAPK)/activator protein-1 (AP-1) signaling pathways in silica-induced PAI-1 expression were examined. We found that silica (200 mug/mL) treatment for 4 to 24 h resulted in AP-1 activation in A549 cells. Cells were pretreated with the AP-1 inhibitor curcumin (10, 25, 50 muM), and silica-induced PAI-1 expression was reduced by 20%, 63%, and 65%, respectively. In addition, dominant-negative mutant c-Jun (TAM67) down-regulated silica-induced PAI-1 expression by 59%. P38 kinase inhibitor SB203580 (20 muM) and Erk inhibitor PD98059 (50 muM) suppressed silica-induced PAI-1 expression by 35% and 51%, respectively. Additionally, PD98059 but not SB203580 inhibited the AP-1 DNA binding activity induced by silica. The results suggest that the PAI-1 expression induced by silica may be involved in the activation of MAPKs/AP-1 signaling pathways in human lung epithelial cells.

Protective effects of SP600125 in a diet-induced rat model of non-alcoholic steatohepatitis

OBJECTIVE. To investigate the protective effect of SP600125, a selective c-Jun N-terminal kinase inhibitor, in a diet-induced rat model of non-alcoholic steatohepatitis (NASH). MATERIAL AND METHODS. Sprague-Dawley rats were randomly divided into three groups: a normal control group (NC group), a high-fat model group (HF group) and an SP600125 treatment group (SP group). All animals were subjected to a percutaneous superior mesenteric vein retention catheter operation and fed with a standard diet for 10 days. The HF group was then fed with an HF diet and treated with dimethyl sulfoxide while the SP group was fed with an HF diet and treated with SP600125 (50 mg/kg) once per day. RESULTS. Feeding rats with an HF diet established a model of NASH, with varying degrees of hepatic steatosis and hepatic inflammation. SP600125 treatment substantially decreased the incidence of insulin resistance, reduced lipotoxicity, inhibited oxidative stress and alleviated hepatocellular injury. CONCLUSIONS. SP600125 has the potential to remarkably attenuate steatosis and inflammation and may be a novel therapeutic drug against NASH.

Mechanisms of non-alcoholic steatohepatitis: pathophysiology and molecular biology

Non-alcoholic steatohepatitis (NASH), characterized by liver fatty infiltration, inflammation, hepatocellular injury and fibrosis, may easily develop into liver cirrhosis and hepatocellular carcinoma. The increased flow of FFAs (free fatty acids) to the liver and the de novo lipogenesis in the liver lead to fat overload. Lipotoxicity can induce oxidative stress, inflammatory reaction and apoptosis. Subsequently chronic liver injury activates a fibrogenic response that accelerates the evolution of NASH towards end-stage liver disease. Further research on pathophysiology and molecular biology is beneficial to clinical diagnosis and management of NASH.

Site-specific kondo effect at ambient temperatures in iron-based molecules

Kondo resonances are a very precise measure of spin-polarized transport through magnetic impurities. However, the Kondo temperature, indicating the thermal range of stability of the magnetic properties, is very low. By contrast, we find for iron phthalocyanine a Kondo temperature in spectroscopic measurements which is well above room temperature. It is also shown that the signal of the resonance depends strongly on the adsorption site of the molecule on a gold surface. Experimental data are verified by extensive numerical simulations, which establish that the coupling between iron states and states of the substrate depends strongly on the adsorption configuration.

Modified synthetic siRNA targeting tissue inhibitor of metalloproteinase-2 inhibits hepatic fibrogenesis in rats

BACKGROUND/AIMS

Fibrosis occurs in most chronic liver injuries and results from changes in the balance between synthesis and degradation of extracellular matrix (ECM) components. Matrix metalloproteinases (MMPs) and their endogenous inhibitors (TIMPs) are known to regulate the ECM turnover. We investigate the effect of modified synthetic small interfering RNA (siRNA) targeting TIMP-2 in rat model of liver fibrosis.

METHODS

Rat hepatic fibrosis was induced by CCl4 for 8 weeks. After the 2-week CCl4 injection period, rats in the three siRNA groups simultaneously received a different dosage (0.05, 0.1 and 0.2 mg.kg(-1), respectively) of modified synthetic siRNA targeting TIMP-2 via the tail vein every 3 days for 6 weeks. The pathological changes in liver tissues were observed by light microscopy and transmission electron microscopy. Portal vein pressure and proliferating cell nuclear antigen were measured. Expression of TIMP-2, MMP-2, MT1-MMP, MMP-13, hepatocyte growth factor, collagen type I, collagen type III and alpha-SMA were evaluated by quantitative real-time polymerase chain reaction or Western blotting or gelatin zymography.

RESULTS

Modified synthetic siRNA targeting TIMP-2 induced a dose-dependent inhibition of the TIMP-2 expression in the rat model of liver fibrosis with a similar trend in MMP-2 and MT1-MMP, but an increase in MMP-13. Rats administered siRNA targeting TIMP-2 showed promotion of ECM degradation, reduction in activated hepatic stellate cells and enhancement of hepatocyte regeneration. Furthermore, portal hypertension was also ameliorated after treatment with siRNA targeting TIMP-2.

CONCLUSIONS

Knock-down of TIMP-2 expression attenuates CCl4-induced liver fibrosis and is a potential pharmacological target for gene therapy in liver fibrosis.

Effects of chemically modified small interfering RNA targeting tissue inhibitor of metalloproteinase-2 on carbon tetrachloride-induced liver fibrosis in rats

AIM: To probe the effects of chemically modified small interfering RNA (siRNA) targeting tissue inhibitor of metalloproteinase-2 (TIMP-2) on liver fibrosis as well as its possible mechanism in rats.

METHODS: A total of 42 male rats were randomly and averagely divided into 7 groups: a normal group, a negative control group, a sham-operated group, a model group and three siRNA-treated groups (treated with 0.05, 0.1, and 0.2 mg/kg siRNA via portal vain, respectively). Carbon tetrachloride (CCl₄) was used to induce liver cirrhosis. All the rats were sacrificed at 8 wk to collect liver tissue specimens, and the portal vein pressure (PVP) was measured. The pathological changes of liver tissues were observed after HE and Van Gieson (VG) staining. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), hyaluronic acid (HA), laminin (LN), procolagen type Ⅲ (PCⅢ), collagen type Ⅳ (CIV) and hydroxyproline (Hyp) were measured. The mRNA expression of TIMP-2, collagen type I (COLI), collagen type Ⅲ (COLⅢ) and a-smooth muscle actin (a-SMA) were detected by quantitative real-time polymerase chain reaction (QRT-PCR). The protein expression of TIMP-2, a-SMA and MMP-2 were analyzed by Western blott or gelatin zymography.

RESULTS: In comparison with those in the model group, the pathological changes in the three siRNA-treated groups (treated with 0.05, 0.1, and 0.2 mg/kg siRNA, respectively) were markedly attenuated, and the levels of PVP (2.2 ± 0.1, 1.9 ± 0.1, 1.6 ± 0.1 kPa vs 2.7 ± 0.1 kPa, P < 0.05), ALT (2089.3 ± 154.5, 1869.8 ± 138.0, 1422.5 ± 139.7 nkat/L vs 2717.2 ± 193.8 nkat/L, P < 0.05), AST (3634.1 ± 242.7, 2739.4 ± 141.3, 2286.6 ± 145.5 nkat/L vs 4067.5 ± 251.5 nkat/L, P < 0.05), HA (176.0 ± 10.2, 160.6 ± 9.3, 109.9 ± 9.4 mg/L vs 206.3 ± 17.0 mg/L, P < 0.05), LN (93.1 ± 8.2, 71.4 ± 7.5, 55.9 ± 7.3 mg/L vs 116.6 ± 10.8 mg/L, P < 0.05), PCⅢ(71.2 ± 6.1, 64.1 ± 5.1, 53.6 ± 4.3 mg/L vs 91.2 ± 8.9 mg/L, P < 0.05), CIV (64.3 ± 5.4, 50.7 ± 5.8, 41.6 ± 4.4 mg/L vs 80.3 ± 6.8 mg/L, P < 0.05) and Hyp (328.7 ± 17.6, 279.7 ± 16.3, 230.4 ± 16.1 mg/g vs 380.7 ± 20.6 mg/g, P < 0.05) were significantly lowered. QRT-PCR showed that the mRNA expression of TIMP-2, COLI, COLⅢ and a-SMA in the three siRNA-treated groups were decreased significantly as compared with those in the model group (7.53 ± 0.83, 5.04 ± 0.75, 1.30 ± 0.49 vs 23.23 ± 2.14, P < 0.05; 33.38 ± 2.85, 22.80 ± 2.48, 11.45 ± 1.27 vs 43.18 ± 3.32, P < 0.05; 19.23 ± 1.95, 13.21 ± 1.35, 10.11 ± 1.09 vs 25.90 ± 2.23, P < 0.05; 23.76 ± 2.06, 15.33 ± 1.25, 10.53 ± 1.02 vs 34.85 ± 3.16, P < 0.05). Western blot or gelatin zymography showed that the protein expression of TIMP-2, MMP-2 and a-SMA in the three siRNA-treated groups were also decreased significantly as compared with those in the model group (23.27 ± 3.06, 14.13 ± 1.86, 9.16 ± 1.33 vs 44.83 ± 5.45, P < 0.05; 23.80 ± 2.14, 15.58 ± 1.52, 9.52 ± 0.93 vs 39.90 ± 3.23, P < 0.05; 24.58 ± 2.59, 19.29 ± 2.31, 13.40 ± 1.98 vs 57.19 ± 7.07, P < 0.05).

CONCLUSION: Chemically modified siRNA targeting TIMP-2 can down-regulate the expression of TIMP-2, decrease the contents of extracellular matrix, and inhibit the activation of hepatic stellate cells.

Interventional study of high dose folic acid in gastric carcinogenesis in beagles

BACKGROUND

A decrease in folic acid and subsequent DNA hypomethylation may be involved in gastric carcinogenesis. Epidemiological and nutritional studies have indicated that folate status modulates the risk of developing cancers.

AIMS

To investigate whether folic acid plays an important role in the chemoprevention of gastric carcinogenesis induced by N-ethyl-N-nitrosoguanidine (ENNG) in beagles.

METHODS

Sixteen male beagles were randomly divided into two groups: folic acid treated group and control group. In both groups beagles were fed ENNG 75 mg per day for eight months and in the treated group 20 mg folic acid was given to beagles for 15 months. Gastroscopy and biopsies were performed before and every 2-3 months after administration of ENNG until the end of the experiment. Histopathological lesions were diagnosed with regard to the criteria for human gastric mucosal biopsies. Serum and gastric mucosal tissue folic acid concentrations were measured.

RESULTS

In the control group, all beagles developed gastric cancer (8/8) compared with only 3/8 in the folic acid treated group (p<0.05). Moreover, serum and gastric mucosal tissue folic acid concentrations were markedly elevated 15 months after folic acid administration. The difference was statistically significant between the two groups (p<0.05).

CONCLUSIONS

Our results indicate that high dose folic acid plays an important role in the chemoprevention of gastric carcinogenesis induced by a chemical carcinogen ENNG in beagles.

Does eradication of Helicobacter pylori alone heal duodenal ulcers?

BACKGROUND

Eradication of Helicobacter pylori infection prevents duodenal ulcer (DU) relapse, but it remains uncertain whether eradication of H. pylori alone heals duodenal ulceration.

AIM

To test the hypothesis that eradication of H. pylori infection is accompanied by healing of duodenal ulcer.

METHODS

A total of 115 consecutive patients with endoscopically confirmed H. pylori-infected duodenal ulcer were randomly assigned to one of two groups. Group BTC patients received a 1-week course of colloidal bismuth subcitrate 220 mg b.d., tinidazole 500 mg b.d., clarithromycin 250 mg b.d. Group OBTC patients received omeprazole 20 mg daily for 4 weeks with the BTC regimen during the first week. Endoscopy with antral biopsies and 13C-urea breath test (UBT) were performed before and 4 weeks after completion of the 7-day triple or quadruple therapy.

RESULTS

Eight patients dropped out (four in BTC and four in OBTC). Duodenal ulcer healing rates on an intention-to-treat basis in BTC and OBTC were 86% (95% CI: 77-95%) and 90% (95% CI: 82-98%), respectively. The eradication rates of H. pylori on an intention-to-treat basis in BTC and OBTC were 88% (95% CI: 79-96%) and 91% (95% CI: 84-99%), respectively. There were no statistically significant differences in ulcer healing rates and eradication rates between these two groups (P > 0.05). Epigastric pain resolved more rapidly in patients assigned to OBTC compared with those assigned to BTC. Both of the two regimens were well tolerated with only minor side-effects (3% of the 115 patients) and the compliance was good.

CONCLUSIONS

BTC is a very effective H. pylori eradication regimen. Almost all duodenal ulcers heal spontaneously after cure of H. pylori infection using a 1-week low-dose bismuth-based triple therapy. Treating duodenal ulcer with simultaneous administration of omeprazole achieves ulcer pain relief more rapidly.

Pneumoconiosis: the changes of peripheral airways

Ultrathin bronchofiberscope (Olympus BF-1.8T) was applied to the observation of the peripheral airways of total 87 cases, including 73 cases of quartz-exposed and asbestos-exposed workers with/without pneumoconiosis (exposure groups), and 14 cases of controls. The changes of peripheral airways in exposure group of non-smokers was found, mainly to be pigmentation, elevation, irregularity and lustlessness on the surface of the bronchiole walls, and predominantly stenosis and ectasis of the lumen. The detectable rate was higher in peripheral airways than in central airways. Some changes existed in early stage and some had a tendency of increasing detectable rate with category progressing. Some factors such as smoking could influence the results of analysis.

Cytophotometric DNA analysis on canine stomach carcinogenesis induced by ENNG

DNA content and nuclear area were measured by microspectrophotometry in gastric carcinogenesis of three adult wolfdogs induced by N-ethyl-N'-nitro-N-nitrosoguanidine (ENNG). The mean values and standard deviations of DNA content and nuclear area in normal gastric mucosa were 10.03 +/- 2.30 AU and 28.76 +/- 5.85/microns2; those in atrophic gastritis were 12.04 +/- 3.34 AU and 28.69 +/- 8.02/microns2; in mild dysplasia 13.52 +/- 3.73 AU and 28.23 +/- 8.12/microns2; in moderate dysplasia 20.88 +/- 4.57 AU and 47.58 +/- 10.74/microns2; in severe dysplasia 24.01 +/- 4.48 AU and 56.64 +/- 12.53/microns2; in well-differentiated adenocarcinoma 33.07 +/- 9.38 AU and 72.99 +/- 15.57/microns. These figures were different (P less than 0.01). The nuclear area of gastric carcinoma increased with DNA content (r = 0.73, P less than 0.01). The distribution patterns of DNA content in the histogram showed that diploidy was decreased and polyploidy increased in cancer cells. These findings indicate that DNA ploidy patterns and nuclear area can be useful indices for differentiating carcinoma from precancerous lesions.

Pernicious anemia and type A atrophic gastritis in the Chinese

Pernicious anemia has been considered a rare disease among the Chinese. But in recent years, by wide-spread use of gastroscopy, more cases of Type A atrophic gastritis associated with pernicious anemia have been discovered. Among 28 patients with Type A atrophic gastritis, we had identified 20 cases of pernicious anemia, 18 in frank form and 2 in latent form. This paper presented the results of our studies on clinical, endoscopic, and laboratory examinations of these patients. The findings suggest that pernicious anemia was not so rare among the Chinese. If we keep an alertness on this disease, more such cases could be diagnosed.