Diagnostic value of endoscopic ultrasound guided fine needle aspiration combined with the new category of papanicolaou society of cytopathology in solid pancreatic lesions / 中华消化杂志

Objective To study the diagnostic value of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) combined with the new category of papanicolaou society of cytopathology in solid pancreatic lesions (SPL) rapid on-site evaluation (ROSE).Methods From February 2011 to October 2014,225 patients with SPL who underwent EUS-FNA and obtained the cytological diagnosis were enrolled.The lesions were finally diagnosed according to pathological results,imaging and follow-up data,and then the sensitivity,specificity,and accuracy of EUS-FNA in the diagnosis of SPL were calculated based on the new papanicolaou society of cytopathology terminology.Logistic stepwise regression analysis was performed to analyze the risk factors.Results Among 225 patients with SPL,96 cases (42.7％)had uncertain cytological diagnosis,17.3％ (39/225) could not be diagnosed,8.0％ (18/225) were atypical lesions,and 17.3％ (39/225) were suspicious malignant carcinomas.Among 129 cases (57.3％)with certain cytological diagnosis,15.1％ (34/225) were benign lesions,14.7％ (33/225) were tumors (benign or others) and 27.6％ (62/225) were malignant tumors.When atypical lesions were added into non-tumor lesions or tumor lesions,the sensitivity,specificity and accuracy of diagnosis were 87.3 ％,91.7％,88.2％,and 94.7％,72.2％,90.3％,respectively.Serum CA125≥14 kU/L (odds ratio (OR) =7.13,95％ confidence interval (CI) 2.02 to 25.22,P=0.002) and history of biliary disease (OR=3.85,95％CI 1.22 to 12.51,P=0.022) were two independent risk factors of pancreatic tumors.Conclusions Despite of a high percentage of uncertain cytological diagnosis,EUS-FNA still has high diagnostic value in SPL when combined with the new papanicolaou society of cytopathology terminology.Furthermore,serum CA125≥14 kU/L and history of biliary disease may help to diagnose pancreatic tumors.

Diagnostic value of endoscopic ultrasonography combined with detection of immunoglobulin and T-cell receptor gene rearrangements in primary gastrointestinal lymphoma / 中华消化杂志

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS ) combined with detection of immunoglobulin (Ig ) and T‐cell receptor (TCR ) gene rearrangements in primary gastrointestinal lymphoma (PGIL) .Methods From 12nd January ,2012 to 23rd May ,2014 ,the clinical data of 24 patients with suspicious PGIL under endoscopy (regular biopsy negative and without treatment) and underwent further EUS examination was retrospectively analyzed .All patients received EUS‐guided biopsy or EUS‐guided fine needle aspiration (FNA) and the tissue specimens were detected for Ig and TCR gene rearrangements .Considering biopsy result ,surgical pathological diagnosis and follow‐up result as gold standard ,the clinical significance of sensitivity ,specificity ,positive predictive value (PPV) , negative predictive value (NPV ) and accuracy of EUS combined with Ig /TCR gene rearrangements in PGIL were explored .Results Among 24 patients ,19 patients were finally diagnosed as PGIL ,which were all non‐Hodgkin′s lymphoma (NHL ) ;monoclonal gene rearrangement was found in 13 cases of the 19 cases .The left five cases were not lymphoma lesions (three cases of gastritis ,one case of leather stomach and one case of malignant melanoma) with no monoclonal gene rearrangement .In cases diagnosed as PGIL , 14 were B cell NHL ,which included eight cases of muscosa‐associated lymphoid tissue (MALT) lymphoma and six cases of diffuse large B cell lymphoma .Of which ,immunoglobulin heavy chain (IgH)/immunoglobulin kappa (IgK) gene rearrangement was found in 11 cases .A total of five cases were T cell NHL including one case of anaplastic large cell lymphoma , one case of NK /T cell lymphoma and three cases of enteropathy‐associated T‐cell lymphomas . TCR gene rearrangement was found in two cases .Because theoretically ,there was no gene rearrangement in natural killer (NK )/T cell lymphoma ,so NK /T cell lymphoma was excluded from statistical analysis .The sensitivity ,specificity ,PPV ,NPV and accuracy of EUS combined with Ig /TCR gene rearrangements detection in PGIL were 72 .2% ,100 .0% ,100 .0% , 50 .0% and 78 .3% ,respectively .Conclusion The detection of monoclonal gene rearrangement in tissues from EUS‐guided biopsy or EUS‐guided FNA had better diagnostic value in PGIL ,which improved the objectivity and accuracy of lymphoma diagnosis .

Clinical characteristics and prognostic analysis of 90 patients with primary gastro-intestinal marginal zone lymphoma / 中华血液学杂志

<p><b>OBJECTIVE</b>To evaluate the clinical characteristics and prognostic factors of patients with primary gastro-intestinal marginal zone lymphoma (MALT).</p><p><b>METHODS</b>Retrospective analysis was performed in 90 patients diagnosed with primary gastro-intestinal MALT lymphoma clinical characteristics and survival analyses.</p><p><b>RESULTS</b>Among 90 patients, 78 cases were originated from the stomach and 12 cases with extra-gastric origin. Eighty patients were classified as low-risk (IPI score 0-2), and 10 patients high-risk (IPI score 3-5). Compared to gastric MALT patients, extra-gastric cases presented with higher IPI score (7.7% vs 33.3%, P=0.025) and higher Hp infection rate (50.0% vs 87.2%, P<0.01). Treatment options for low risk patients (IPI score 0-2) included Hp eradication, surgery, radiotherapy and chemotherapy. Chemotherapy could improve progression-free survival (PFS) in low-risk patients. For high-risk patients, those receiving chemotherapy had 100% 3-year overall survival (OS). Univariate analysis revealed that ECOG (P=0.006), Mussh-off staging (P=0.008), IPI score (P=0.000), elevated LDH (P=0.019) and chemotherapy (P=0.026) were correlated with PFS. Multivariate analysis showed that higher IPI score (IPI 3-5) (OR=8.325, 95% CI 3.171-21.853, P=0.000) and chemotherapy (OR=0.319, 95% CI 0.121-0.838, P=0.020) were independent prognostic factors for PFS. ECOG (≥ 2) was independent prognostic factor for OS (OR=5.092, 95%CI 1.005-25.788, P=0.049).</p><p><b>CONCLUSION</b>Primary gastro-intestinal MALT lymphoma was an indolent subtype of non-Hodgkin's lymphoma. Patients usually had low risk IPI and achieved long-term survival. Frontline therapy for low-risk patients was radiotherapy or Hp eradication, and chemotherapy for high-risk ones.</p>

Value of EUS-FNA cytology and fluid carcinoembryonic antigen in differential diagnosis between benign or malignant pancreatic cystic lesion / 中华消化内镜杂志

Objective To study the value of EUS-FNA cytology and fluid carcinoembryonic antigen (CEA) for differential diagnosis of malignant and benign pancreatic cystic lesions.Methods Data of 27 patients who underwent EUS-FNA were reviewed.According to Youden exponent,the optimal cut-off points for cyst fluid CEA were determined by receiver operating characteristic (ROC) curve.Compared with surgical pathology,the accuracy,sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of the EUS imaging,cytology as well as cyst fluid CEA were determined.Results Of the 27 cases,14 were diagnosed as benign lesions,13 were diagnosed as malignant or premalignant lesions.The accuracy,sensitivity,specificity,PPV and NPV of EUS imaging were 77.8％ (21/27),69.2％(9/13),85.7％ (12/14),81.8％ (9/11) and 75.0％ (12/16).The accuracy,sensitivity,specificity,PPV and NPV of EUS-FNA cytology were 85.2％ (23/27),76.9％ (10/13),92.9％ (13/14),90.9％ (10/11),and 81.3％ (13/16).The corresponding values of fluid carcinoembryonic antigen under the ROCderived ideal cut-off were 74.1％ (20/27),84.6％ (11/13),64.3％ (9/14),68.8％ (11/16) and 81.8％ (9/11) (CEA ＞ 22.24 ng/ml).Conclusion EUS-FNA cytology is highly accurate and specific for differential diagnosis of malignant and benign pancreatic cystic lesions.Cyst fluid CEA shows better sensitivity.EUS-FNA cytology and cyst fluid CEA analysis can basically meet the requirement of differentiating the benign and (pre)malignant pancreatic cystic lesions.

Changes of regulatory T cells distribution in trinitrobenzene sulfonic acid induced mice colitis / 中华消化杂志

Objective To investigate the changes of regulatory T cells (Treg) distribution in trinitrobenzene sulfonic acid (TNBS) induced mice colitis and the therapeutic effects of dexamethasone (DEX).Methods A total of 40 mice were evenly divided into healthy control group,ethanol control group,model group and DEX treatment group.The model group was given 2.5 mg TNBS through enema,while healthy control group and ethanol control group were administered with 0.9％ NaCl solution and ethanol solution respectively.DEX treatment group was intraperitoneal injected with DEX (0.6 mg/kg) since the first day after modeling.Mice were executed at 3rd,5th and 7th day after modeling,mice body weight of each group were observed and the rate of both CD25+ forkhead box P3(Foxp3) positive and CD4 positive cells in spleen and mesenteric lymph nodes were measured by flowcytometry.At the 7th day,disease activity index (DAI) and colonic histopathological score were evaluated,the expression of Foxp3 in colon tissue were measured by immunohistochemistry.t-test was applied for each group comparison.Results Compared with healthy control group and ethanol control group,the mice body weight of model group significantly decreased (t=3.604 and 2.422,both P＜0.05); DAI score and colonic histopathologic score increased (t=2.630 and 2.438,both P＜0.05;t=7.910 and 6.600; both P＜0.01).Compared with the model group,DAI score decreased (t=2.076,P＞0.05) and histopathologic severity in DEX treatment group improved significantly (t =2.320,P＜0.05).At the 7th day after modeling,the rate of both CD25+ Foxp3 positive and CD4 positive cells in spleen and mesenteric lymph nodes of model group was 3.320％ ± 0.533％ and 2.888％±0.379％,lower than that of healthy control group (5.379％ ±0.518％ and 4.688％±0.553％; t=2.769 and 2.686; both P＜0.05).After DEX treatment,the rate increased.The expression of Foxp3 in colon tissue of healthy control group,model group and DEX treatment group was 3.000±0.577,7.200±0.800 and 6.000±0.931 per high power field respectively,and the expression of model group and DEX group significantly increased (t=4.257 and 2.739,both P＜ 0.05).Conclusions The distribution of Treg in spleen and colon were abnormal in TNBS-induced mice colitis model.DEX may improve the disease state of the mice model through upregulating Treg.

Relationship between microRNA-200c expression, epithelial-mesenchymal transition and the sensitivity to gefitinib in colon cancer cells / 中华消化杂志

Objective To explore the relationship between microRNA (miRNA)-200c expression,epithelial-mesenchymal transition (EMT) and the sensitivity to gefitinib in colon cancer cells.Methods The inhibitory effects of gefitinib on four types of colon cancer cell lines (HT29,SW620,HCT1116,SW480) were examined by cell counting kit-8 (CCK-8) assay.The expressions of miRNA-200c,epithelial marker (E-cadherin) and mesenchymal markers (vimentin and zinc finger Ebox binding homeobox 1 ZEB 1) at mRNA level in four types of colon cancer cell lines were detected by fluorescence quantitative polymerase chain reaction.The expressions of E-cadherin,vimentin and ZEB 1 at protein level were determined by Western blot.After up-or down-regulated the expression of miRNA-200c,the changes of the expression of EMT related genes and the sensitivity to gefitinib were observed.Results HT29 cells were most sensitive to gefitinib (IC50 =(7.70 ± 0.31) μmol/L),in which the expressions of both miRNA-200c and E-cadherin were the highest,and the expressions of vimentin and ZEB1 were extremely low.HCT116 and SW480 were moderately sensitive to gefitinib (IC50=(11.88±0.97) and (16.63±0.45) μmol/L),and the expressions of miRNA-200c and Ecadherin were moderate.SW620 cell line was most insensitive to gefitinib (IC50 =(26.43 ± 3.68)μmol/L),the expressions of miRNA-200c and E-cadherin were the lowest.The expressions of vimentin and ZEB 1 in SW620 were higher than that of the other three types of cell lines.After upregulated the expression of miRNA 200c,the expression of E-cadherin in SW620 cells increased,the expression of ZEB 1 and vimentin decreased,and the sensitivity to gefitinib increased.After downregulated the expression of miRNA-200c,the expression of E-cadherin in HT29 cells decreased,the expression of ZEB 1 and vimentin increased,and the sensitivity to gefitinib decreased.Conclusion miRNA-200c may up-regulate the expression of E-cadherin through EMT regulation,and then influence the sensitivity to gefitinib in colon cancer cells.

Endoscopic ultrasound guided fine needle aspiration in combination with flow cytometry in the diagnosis of gastrointestinal lymphoma / 中华消化杂志

Objective To evaluate the diagnostic value of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in combination with flow cytometry (FCM) in lymphoma.Methods From January 2011 to December 2011,the cases of suspicious lymphoma with EUS-FNA examination at Shanghai Ruijin Hospital were retrospectively analyzed.The final diagnosis was according to pathological diagnosis of specimen from the surgery and follow up results.The sensitivity,specificity and accuracy of EUS-FNA combined with FCM in lymphoma diagnosis were initially analyzed.Results A total of 14 suspicious lymphoma patients were collected,eight cases were diagnosed as lymphoma by pathological examination of specimen from the surgery or.tissue from aspiration,four cases were non-lymphoma lesions and two cases still had no final diagnosis.The sensitivity and specificity of FCM alone in lymphoma diagnosis were 4/8 and 4/4 respectively.Six cases of lymphoma were detected by EUS-FNA with FCM.The sensitivity,specificity and accuracy of EUS FNA combined with FCM were 6/8,6/6 and 10/12 respectively.Conclusion EUS-FNA combined with FCM has better diagnostic value in lymphoma,especially for gastrointestinal lymphoma and those surrounding deep lesions.

The study on the biological effects of interferon-α combined with gefitinib on colon cancer cell lines / 中华消化杂志

Objective To investigate the effects of interferon-α (IFN-α) and gefitinib on the proliferation and apoptosis of human colon cancer cell line HCT116. Methods Colon cancer cell line HCT116 was selected as research objective. The biological effects of IFN-α and gefitinib alone or combined on the cells were observed at different time point (after worked for 24, 48 and 72 hours). The proliferation inhibition of the medicine on the HCT116 cells was measured by methyl thiazolyl tetrazolium (MTT) assay. Morphologic changes were observed under optical microscope. Apoptosis was measured by flow cytometry (FCM). The results were analyzed with SPSS 13.0 software, two groups compare was tested by t test, and single factor variance analysis was for multiple group data compare. Results IFN-α and gefitinib alone or combined could significantly inhibit the proliferation of HCT116 cells (P<0.05), and there was a time and dose-dependent manner between the degree of inhibition and the working time and concentration of the medicine. With the work of the medicine, apoptosis morphologic changes were observed in the cells. And FCM result indicated that the apoptosis rate significantly increased. After treated with IFN-α and gefitinib alone or combined for 72h, the cell apoptosis rate were 15.6%±0.6%, 13.6%±0.4% and 31.2%±0.3% respectively, which was obviously higher than control group (6.8%±0.3%, P<0.05). Conclusion Both IFN-α and gefitinib were able to inhibit the proliferation and induce apoptosis of HCT116 cells moreover, and a synergistic effect was observed while combine used there two medicines.

Content Determination of Ursolic Acid in Pedo-stomach-invigorating&Digestion-promoting Granule by TLC-scanning Method / 中国药房

OBJECTIVE:To establish a method for the determination of ursolic acid in pedo-stomach-invigorating&digestion-promoting granule.METHODS:The determination was performed by TLC-scanning method in which chloro-form-acetone-glacial acetic acid(18∶2∶0.2)was used as developing solvent,and10%sulphuric acid ethanol solution was taken as developer,which were baked under110℃until limpid prunosus spots were occurred,the scanning method was dual wavelength reflection zigzag scanning with detection wavelength at520nm,reference wavelength at700nm,linearity parameter Sx=3and slit size at0.4mm?0.4mm.RESULTS:Ursolic acid has a good linear relation with peak area score when its sample size was within the range of2?g～10?g(r=0.9996),the average recovery is97.8%(RSD=1.4%).CONCLUSION:This me_ thod can be served as a quality control for pedo-stomach-invigorating&digestion-promoting granule.