Application of Endoscopic Submucosal Excavation Assisted With Ligation Device for Treatment of Gastrointestinal Submucosal Tumors / 胃肠病学

Background: There are a variety of endoscopic techniques for treatment of gastrointestinal submucosal tumors (SMTs). However, because of the difficulties in operation, high technique needs of operator and long period of training needed, some of these techniques could not be promoted and implemented in primary hospitals. Aims: To evaluate the feasibility and safety of endoscopic submucosal excavation assisted with ligation device (ESE-LD) for treatment of small gastrointestinal SMTs. Methods: The clinical data of 75 patients who underwent ESE-LD during January 2014 to July 2019 at the Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine and Jinling Hospital for treatment of small gastrointestinal SMTs (<2 cm in diameter) were retrospectively collected and analyzed. Results: In the 75 small gastrointestinal SMTs, 42 were originated from submucosa and 33 from muscularis propria. Eighteen lesions were located in esophagus, 30 in stomach, 6 in duodenum and 21 in colorectum. All tumors (mean diameter: 13 mm±3 mm, range: 0.5-2 cm) achieved en bloc resection. The mean time of ESE-LD procedure was (16.7±3.2) min, and the mean time of hospitalization was (5.08±1.21) d. No delayed bleeding and perforation requiring further intervention occurred. There were no recurrences during the follow-up period of (33.8±5.2) months. Conclusions: ESE-LD is safe and effective for treatment of gastrointestinal SMTs less than 2 cm in diameter. Moreover, it is easy to operate with short operation time. ESE-LD might be recommended to be promoted in primary hospitals.

Expression and Significance of DNA Methyltransferases in Gastric Cancer / 胃肠病学

Background: DNA methylation plays an important role in the development of gastric cancer, but it needs the modification with DNA methyltransferases (DNMTs). Aims: To investigate the expression and clinical significance of DNMTs in the occurrence and development of gastric cancer. Methods: A total of 80 cases of gastric cancer tissues and corresponding adjacent normal tissues were collected. Immunohistochemistry was used to detect the expressions of DNMT1, DNMT3a, DNMT3b, and their correlations with clinicopathological features of gastric cancer were analyzed. mRNA and protein expressions of DNMT1, DNMT3a, DNMT3b in 4 gastric cancer cell lines and human gastric epithelial cell line were determined by qRT-PCR and Western blotting, respectively. Results: Compared with adjacent normal tissue, the positive expression rate of DNMT1 was significantly increased in gastric cancer (68.8% vs. 10.0%, P<0.01). The positive expression of DNMT1 in gastric cancer tissue was significantly higher than that of DNMT3a and DNMT3b (68.8% vs. 38.8%, 40.0%, P<0.05), while the positive expression of DNMT1 in adjacent tissue was significantly lower than that of DNMT3a and DNMT3b (10.0% vs. 60.0%, 52.5%, P<0.05). The positive expression of DNMT1 was correlated with depth of invasion, lymph node metastasis and TNM stage in patients with gastric cancer (P<0.05), while the positive expression of DNMT3a, DNMT3b were not correlated with clinicopathological features of gastric cancer. The expression of DNMT1 in gastric cancer cells was significantly higher than that in normal gastric epithelial cells, while the expressions of DNMT3a and DNMT3b were significantly decreased. Moreover, the expression of DNMT1 was related to the degree of differentiation of gastric cancer cells (P<0.05). Conclusions: DNMT1 maybe play an important role in the occurrence and development of gastric cancer.

Pellagra affecting a patient with Crohn's disease

Abstract: Pellagra is a nutritional disease caused by a deficiency of niacin. It may lead to death if not identified and treated timely. We review the literature and report a female patient presented with clinical features of pellagra as a complication of Crohn's disease.

Correlation between Simplified Endoscopic Score for Crohn's Disease (SES-CD) and Clinical and Laboratory Markers in Patients with Crohn's Disease / 胃肠病学

Endoscopic activity has been used as an endpoint in treatment of Crohn's disease (CD).Simplified Endoscopic Score for Crohn's Disease (SES-CD) is a simple and easy-to-use endoscopic scoring system for CD, however, studies evaluating the correlation between SES-CD and noninvasive inflammatory markers are scarce.Aims: To investigate the correlation between SES-CD and clinical and laboratory inflammatory markers for identifying a noninvasive surrogate marker for endoscopic activity of CD.Methods: Forty-two patients with CD were enrolled for detecting laboratory inflammatory markers including leukocyte and platelet count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin (Hb), albumin (Alb) and fecal calprotectin (FC);SES-CD and Crohn' disease activity index (CDAI) were assessed.Predictive performance of these markers for endoscopic activity of CD was analyzed by ROC curve, and the correlation of SES-CD with all these markers was evaluated.Results: The platelet count, CRP, ESR, FC and SES-CD were significantly higher in active CD than in inactive CD, while Hb and Alb were significantly lower in active CD (P all <0.05).In all the noninvasive markers, only CDAI and FC had an area under the curve (AUC) greater than 0.9 for predicting CD endoscopic activity.Taken 150 as the cut-off value of CDAI and 50 μg/g (the upper limit of normal, ULN) as the cut-off value of FC, the sensitivity of CDAI and FC were 58.8% and 100%, and the specificity were 100% and 60.0%, respectively.SES-CD had moderate correlation with CDAI, platelet count, CRP, ESR, Alb and FC, respectively (P all <0.05).Conclusions: SES-CD is correlated moderately with the clinical and laboratory inflammatory markers, however, when taken the ULN as cut-off value the conventional inflammatory markers such as CDAI, CRP and ESR are hard to predict sensitively and accurately the endoscopic activity of CD;while FC has fairly high accuracy and sensitivity and can be used as a noninvasive surrogate marker for evaluating endoscopic activity of CD.

Correlation of Sugar Molecular Probes with Inflammatory Factors and Claudin-8 in Intestinal Permeability in Colitis Rats / 胃肠病学

Background:Intestinal permeability plays an important role in the development of ulcerative colitis. Sugar molecular probes is a safe and non-invasive method to measure intestinal permeability,and its correlation with inflammatory factors and claudin-8 is not clear. Aims:To explore the correlation of sugar molecular probes with TNF-α,CRP and claudin-8 in intestinal permeability in colitis rats. Methods:Twenty-four rats were assigned randomly to model group and normal control group. Colitis model was induced by DSS solution. Expressions of TNF-α,CRP were determined by ELISA,and expression of claudin-8 was determined by immunohistochemistry. Sugar molecular probes were determined by high performance liquid chromatography. Correlations of inflammatory factors and claudin-8 with sugar molecular probes were analyzed. Results:Compared with normal control group,expressions of colonic tissue TNF-α and CRP were significantly increased while expression of claudin-8 was significantly decreased in model group(P < 0. 01);secretion of lactulose and sucrolose,ratio of lactulose/ mannitol( L/ M)were significantly increased( P < 0. 01)while mannitol secretion was significantly decreased(P < 0. 01). Secretion of lactulose and sucrolose were positively correlated with expressions of TNF-α and CRP(P < 0. 01),but negatively with expression of claudin-8(P < 0. 01). L/ M ratio and mannitol secretion were negatively correlated with expressions of TNF-α and CRP(P < 0. 01),but positively with expression of claudin-8(P <0. 01). Conclusions:Sugar molecular probes and expressions of TNF-α,CRP,claudin-8 have similar results in predicting intestinal permeability in rats. Sugar molecular probes can be used as a potential method to measure intestinal permeability.

Expression and Significance of MicroRNA-595 in Inflammatory Bowel Disease / 胃肠病学

Background:Dysregulation of microRNAs is associated with intestinal mucosal barrier injury,intestinal inflammation and intestinal dysfunction. Abnormal expression of microRNAs occurs in patients with inflammatory bowel disease(IBD). Aims:To investigate the expression and significance of microRNA-595( miR-595)in IBD. Methods:A total of 100 patients with IBD at Nanjing General Hospital of Nanjing Military Command of PLA from July 2012 to July 2014 were enrolled,in which 63 cases were ulcerative colitis(UC)and 37 cases were Crohn’s disease(CD). According to disease activity,patients were divided into active UC(aUC)group,remissive UC(rUC)group,active CD(aCD)group and remissive CD(rCD)group. A total of 42 healthy subjects were served as normal control(NC)group. Specimens of serum and intestinal tissue were collected. Expression of miR-595 in serum and intestinal tissue was determined by fluorescence quantitative PCR. Luciferase report gene plasmid containing the 3’UTR of neural cell adhesion molecule 1(NCAM1)or fibroblast growth factor receptor 2(FGFR2)and plasmid containing miR-595 were co-transfected into human colon cancer cell line HCT116 to detect the effect of miR-595 on transcriptional activities of NCAM1 and FGFR2. Results:Expression of miR-595 in serum and intestinal tissue in UC and CD groups was significantly higher than that in NC group(P < 0. 05), and that in aUC and aCD groups was significantly higher than that in rUC and rCD groups,respectively(P < 0. 05). MiR-595 could down-regulate the transcriptional activities of NCAM1 and FGFR2 through directly binding to the 3’UTR of NCAM1 and FGFR2. Conclusions:Expression of miR-595 in serum and intestinal tissue is increased in patients with IBD and correlates with disease activity. MiR-595 inhibits the expressions of tight junction protein NCAM1 and FGFR2,thereby inducing injury of intestinal mucosal barrier and promoting intestinal inflammation. MiR-595 can serve as a serum biomarker for diagnosis of IBD and disease activity evaluation.

Relationship between Peripheral Blood CD3 +,CD4 + and CD8 + T Cells and Inflammation Markers in Patients with Crohn’s Disease / 胃肠病学

Background:Abnormal immune response is involved in the pathogenesis of Crohn’s disease( CD),and T lymphocytes are the main players in the immune response. Aims:To investigate the relationship between peripheral blood CD3 + ,CD4 + and CD8 + T cells and inflammation-related markers in patients with CD. Methods:Proportions of peripheral blood CD3 + ,CD4 + and CD8 + T cells were measured by flow cytometry in 26 CD patients( including 14 patients in active stage and 12 in remission stage )and 8 healthy volunteers(control group),and their correlation with inflammation-related markers(including white blood cell count,platelet count,ESR,CRP,albumin and hemoglobin) were analyzed. Results:Proportions of CD3 + ,CD4 + and CD8 + T cells were significantly increased in patients with active CD than those with remission CD and controls( P ﹤ 0. 05),however,no significant differences were found between remission CD patients and controls(P ﹥ 0. 05). ESR and CRP in active CD patients were significantly higher than those in controls(P ﹤ 0. 05),while albumin and hemoglobin levels were significantly decreased(P ﹤ 0. 05);albumin in remission CD patients was significantly lower than that in controls(P ﹤ 0. 05). No significant differences in white blood cell count and platelet count were found between active,remission CD patients and controls(P ﹥ 0. 05). Proportions of CD3 + , CD4 + and CD8 + T cells were positively correlated with CRP,and negatively correlated with hemoglobin( P ﹤ 0. 05);CD3 + and CD4 + T cells were positively correlated with ESR(P ﹤ 0. 05). However,CD3 + ,CD4 + and CD8 + T cells were not correlated with white blood cell count,platelet count and albumin level( P ﹥ 0. 05). Conclusions:Proportions of peripheral blood CD3 + ,CD4 + and CD8 + T cells are increased with the increase of disease activity in CD,and are positively correlated with CRP,and negatively correlated with hemoglobin.

Update of the Wnt signaling path in tumor / 医学研究生学报

The Wnt signaling path has a function of delivering the growth incitement signal,and it is closely related with the growth and differentiation of cells.The unusual activation of the Wnt signaling path may cause abnormal propagation and differentiation of cells and consequently the development of tumor.Besides,this signaling path serves an interactive function in different human tumors.Understanding the contribution of this signaling path in tumor formation may afford a basis for the clinical diagnosis and early intervention of tumor.