Whole genome expression profiling of gastric high-grade intraepithelial neoplasia with or without cancer / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the whole genome expression profiles between gastric high-grade intraepithelial neoplasia (HGIN) tissues with cancer and HGIN tissues without cancer.</p><p><b>METHODS</b>Gastric specimens from an upper magnifying chromoendoscopic targeted biopsy were collected at Peking Union Medical College Hospital from March 2010 to May 2013. Each of the forceps biopsies from the 21 patients was HGIN,but there were 10 HGIN and 11 HGIN with cancer after the endoscopic submucosal dissection. The whole genome expression profiling was performed on 10 HGIN samples and 11 HGIN with cancer samples using Agilent 4 × 44K Whole Human Genome microarrays. Differentially expressed genes between different types of lesions were identified using an unpaired t-test and corrected with the Benjamini and Hochberg false discovery rate algorithm. A gene ontology(GO)enrichment analysis was performed using the GeneSpring software GX 12.6.</p><p><b>RESULTS</b>The gene expression patterns were different between HGIN tissues with cancer and HGIN tissues without cancer. There were 470 significantly differentially expressed transcripts between them (P<0.05,Fold Change>2), with 180 up-regulated genes and 290 down-regulated genes in HGIN tissues with cancer. A GO enrichment analysis demonstrated that the most striking over-expressed transcripts in HGIN with cancer were in the category of triglyceride biosynthetic process,acylglycerol biosynthetic process,neutral lipid biosynthetic process,glycerol ether metabolic process,organic ether metabolic process,and glycerolipid metabolic process.</p><p><b>CONCLUSION</b>The change of lipid metabolism may contribute to the pathogenesis of gastric cancer at an early stage.</p>

Diagnostic value of CT enterography in patients with Crohn's disease / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the diagnostic value of CT enterography in patients with Crohn's disease.</p><p><b>METHODS</b>Multi-detector CT enterography and small bowel follow-through were performed in 30 patients with Crohn's disease. The locations and characteristics of the intestinal and extra-intestinal lesions detected by both two techniques were compared.</p><p><b>RESULTS</b>Skip lesions were diagnosed in 16 patients (53.3%) by CT enterography and in 9 patients (30%) by small bowel follow-through (P = 0.039). Mucosal changes were detected in 29 patients (96.7%) by CT enterography and in 18 patients (60%) by small bowel follow-through (P = 0.001). Among 11 patients whose small bowel follow-through did not show abnormal mucosal changes, 8 patients underwent endoscopy, which showed superficial ulcer with or without mucosal congestion and edema in 5 patients, mucosal congestion and edema in 2 patients, and mucosal erosion in 1 patient. CT enterography and small bowel follow-through consistently depicted fistula in 3 patients and had no significant difference in diagnosing intestinal stenosis. CT enterography also exclusively detected abdominal abscess in one patient.</p><p><b>CONCLUSIONS</b>CT enterography is superior to small bowel follow-through in diagnosing the disease location and characteristics of Crohn's disease; furthermore, it can detect more extra-intestinal lesions. CT enterography has potential to replace small bowel follow-through as the imaging examination of choice for patients with Crohn's disease.</p>

Diagnostic and therapeutic values of capsule endoscopy in Crohn's disease / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the diagnostic and therapeutic values of the capsule endoscopy (CE) in Crohn's disease (CD).</p><p><b>METHODS</b>The clinical data of 14 patients diagnosed by CE were retrospectively analyzed. The clinical features, CE findings, and medical management were evaluated.</p><p><b>RESULT</b>The severity of CD diagnosed by CE was consistent with the clinical features.</p><p><b>CONCLUSION</b>The CE findings are important indicators in CD diagnosis and may facilitate clinical decision making.</p>

Study on the relations between genetic polymorphisms in methylenetetrahydrofolate reductase, methionine synthase and the risk of pancreatic cancer / 中华流行病学杂志

<p><b>OBJECTIVE</b>To determine whether genetic polymorphisms in methylenetetrahydrofolate reductase (MTHFR C677T and A1298C), methionine synthase (MS A2756G) were associated with the risks of pancreatic cancer.</p><p><b>METHODS</b>A hospital-based, case-control study consisting of 101 incident pancreatic cancer cases and 337 controls matched on age, sex and race was conducted to investigate the association between polymorphism in MTHFR and MS, and susceptibility to pancreatic cancer. Genotypes of MTHFR C677T, A1298C and MS A2756G were analyzed by polymerase chain reasction-restriction fragment length polymorphism methods.</p><p><b>RESULTS</b>It was found that multivariate-adjusted odds ratio (ORs; 95% confidence interval) for MTHFR-677CT and 677TT compared with 677CC were 2.17 (1.26 - 3.85) and 3.53 (1.85 - 6.84) respectively, which was in a manner of allele-dose relationship. However, no significant association between the A1298C genotype alone and the risk of cancer was observed which seemed that this polymorphism had a combined effect with the C677T polymorphism. A significant gene-environment interaction was observed between C677T polymorphism and cigarette smoking or alcohol intake. Subjects with variant genotypes who smoked > 17 pack-years had highest risk for developing the cancer, with the OR of 5.58 (2.53 - 12.30). Similarly, the OR (3.27, 1.51 - 7.23) for subjects with variant genotypes of alcohol drinker was significantly higher than that for subjects either having the variant genotype or being drinkers. No association was found between MS A2756G polymorphism and risk of pancreatic cancer in the study.</p><p><b>CONCLUSION</b>These findings supported the hypothesis that genetic polymorphisms in MTHFR C677T might contribute to the risk of developing pancreatic cancer.</p>

The value of EUS in diagnosing chronic abdominal pain of suspected pancreatic origin / 中华消化内镜杂志

Objective To evaluate the diagnostic value of EUS in patients with chronic abdominal pain of suspected pancreatic origin.Methods The EUS findings and related clinical data of 106 patients with chronic abdominal pain of suspected pancreatic origin(excluding the patients with suspected pancreatic malignancies)from 1991 to 2004 in PUMCH were retrospectively analyzed.Results(1)The principal dis- ease interpreting the chronic abdominal pain of suspected pancreatic origin(excluding pancreatic malignan- cies)was chronic pancreatitis(CP)(57.5%),the following contributions were other pancreatic diseases (18.9%)and unknown diseases(11.3%).(2)The sensitivity and specificity of EUS for diagnosing CP was 95.1% and 64.4% respectively,the positive predictive value(PPV)and negative predictive value (NPV)was 78.4% and 90.6% respectively.(3)Abhormalities of pancreatic parenchyma structure based on EUS were the main findings(90.2%)in patients with CP and non-homogeneous echo pattern combined with hyper echoic dots or calcification was the predominant feature(52.5%).The value of isolated inhomo- geneity and focal enhanced eehogenicity for diagnosing CP were limited(P＞0.05).Abnormalities of pan- ereatic ductal system were presented in 63.9% of patients with CP and dilation of pancreatic duct was the major feature(34.4%).CP with focal mass(inflammatory pseudotumor)was usually presented as hypo e- choic mass in the pancreatic head based on EUS(90%),which was similar to the EUS feature of pancreatic cancer.(4)The general accordant rate based on EUS with ERCP or BT-PABA were 77.8% and 70.4% re- spectively,and the correct rate based on combine diagnosis were 100% and 95.2%.Conclusion CP is the main source of chronic abdominal pain of suspected pancreatic origin(excluding pancreatic malignancies). EUS has good sensitivity but inadequate specificity for diagnosing CP,while ERCP may be more sensitive than EUS for detecting pancreatic ductal lesions.Pancreatic parenchymal abnormalities contribute the major EUS features of CP but the value of isolated inhomogeneity and focal enhanced echogenicity for diagnosing CP are limited.

Pancreatic disease-associated portal hypertension:clinical analysis of 59 cases / 中华消化杂志

Objective To investigate the clinical features and management of pancreatic disease- associated portal hypertension.Methods A retrospective analysis was carried out in patients with portal hypertension complicating with pancreatic diseases in our hospital from January 1986 to April 2005. Medical records of these patients were reviewed,including data of demographics,etiologies,venous involvement,clinical presentation,laboratory tests,imaging studies,therapeutic modalities and out- comes.Results There were 59 cases of portal hypertension resulted from pancreatic diseases in our hos- pital,accounting for 4% of all portal hypertension in 19 years.The underlying pancreatic diseases were chronic pancreatitis(21 cases,35.6%),pancreatic carcinoma(20 cases,33.9%),acute pancreatitis (8 cases,13.6%),pancreatic pseudocyst(3 cases,5.1%).Of the 40 patients whose venous involve ment was identified,splenic vein obstruction occurred in 27 cases(67.5%),followed by portal vein obstruction(16 cases,40.0%).Mild or moderate splenomegaly was present in 48 cases(81.4%),with leukocytopenia as the most common manifestation of the 31 cases(52.5%)of concomitant hyper- splenism.Forty-five patients(76.3%)developed gastroesophageal varices(including 35 isolated gastric varices),among them,19 had bled(32.2%).Conservative treatment was effective in controlling acute bleeding,but could not prevent re-bleeding.Splenectomy was performed in 18 patients,mainly because of gastrointestinal hemorrhage.No postoperative bleeding occurred in the period of follow-up from 8 months to 9 years.Conclusions Pancreatic diseases may compromise portal vein and its tributaries, leading to generalized or regional portal hypertension.Pharmacological therapy can effectively control acute variceal bleeding,while surgical treatment is the appropriate procedure of choice in case of hemor- rhage recurrence.