[Effect of collagen sponge on the healing process of alveolar fossa after tooth extraction in rats].

PURPOSE: To investigate the effect of collagen sponge on early bone healing process of alveolar fossa after tooth extraction in rats. METHODS: A total of 16 healthy female SD rats were selected. Animal models with tooth extraction were established. The right alveolar fossa inserted with collagen sponge was as the experimental group, and the left alveolar fossa was as the control group with treatment. The rats were sacrificed 1, 2, 4 and 8 weeks after tooth extraction, and the osteogenesis of alveolar fossa was observed. Real-time quantitative PCR (qt-PCR) was used to detect the changes of osteogenesis related gene expression. SPSS 19.0 software package was used for statistical analysis. RESULTS: After surgery, alveolar cavity healing was significantly better in the experimental group than in the control group. Osterix, Runx2 and Vegf genes were expressed in the experimental group and the control group, and the expression levels of related genes in the experimental group were significantly higher than the control group 1, 2, 4 and 8 weeks after surgery(P＜0.05). CONCLUSIONS: Collagen sponge could promote early alveolar bone healing, possibly related to the expression level of osteogenic genes regulated by collagen sponge.

[Expression and clinical significance of PUMA gene in salivary adenoid cystic carcinoma].

PURPOSE: To explore the expression of p53 up-regulated modulator of apoptosis (PUMA) gene in salivary adenoid cystic carcinoma (SACC) and its clinical significance. METHODS: The expressions of PUMA gene and protein were detected in 27 SACC tumor-adjacent tissues (group A) and 27 SACC tumor tissues (group B) with real-time quantitative PCR and Western blot. Statistical analysis was performed using SPSS 19.0 software package. RESULTS: The expression of PUMA gene in groups A as calibrator was 1，and expression of PUMA gene in group B was 0.57±0.17. The expression of PUMA protein in groups A and B were 0.94±0.12 and 0.36±0.12，respectively. The expressions of PUMA gene and protein were significantly lower in group B than in group A (P<0.05). CONCLUSIONS: The expression of puma gene in SACC tissues is down-regulated, which is negatively correlated with the development of SACC.

[The clinical value of combining multiple features of CT in discriminating between benign and malignant lung lesions].

OBJECTIVE: To develop a set of combined criteria of multiple features of chest CT for discriminating between benign and malignant lung lesions. METHODS: Patients whose chest CT showed abnormalities were recruited from the West China Hospital in March and April 2010. The patients were examined with bronchoscopy and the results of CT and pathology were compared. RESULTS: A total of 105 patients participated in this study and 85 had confirmed pathological results. The CT identified 27 cases of malignant lesions, 22 of which were confirmed by the pathology. The CT identified 58 cases of benign lesions, 55 of which were confirmed by the pathology. The set of combined criteria of multiple features of chest CT had an accuracy of 90.59%, a sensitivity of 88.00%, and a specificity of 91.67% in diagnosing benign and malignant lung lesions. CONCLUSION: The combined criteria of multiple imaging signs of CT have good clinical values for diagnosing malignant lung lesions.

Distribution and patterns of lymph nodes metastases and micrometastases in the mesorectum of rectal cancer.

BACKGROUND AND OBJECTIVES: Facts buried in the mesorectum remain to be unveiled. This study investigated the number, size, and detailed distribution of lymph nodes metastases and micrometastases within the mesorectum of rectal cancer. METHODS: Thirty-one patients who underwent total mesorectal excision (TME) were treated with lymph node revealing solution to retrieve lymph nodes, which were submitted to hematoxylin and eosin (HE) examination and immunohistochemical (IHC) staining. RESULTS: The mean number of mesorectal nodes per case was 17.7. The mean size of metastatic, micrometastatic, and isolated tumor cells (ITC) harbored nodes was 5.2 mm, 4.5 mm, and 3.3 mm, respectively. Most of the metastatic (92.1%), micrometastatic and ITC-involved nodes (69.2%) were located along the superior rectal artery (SRA). Posterior-wall located tumor might spread along both sides of the mesorectum simultaneously (P = 0.34), while lateral-wall located tumor spread preferably to ipsolateral side versus contralateral side (P = 0.012). CONCLUSION: Most of the metastases and micrometastases positive lymph nodes were smaller than 5 mm and distributed along the SRA. The patterns of lymph nodes spread were related to the circumferential situation of tumor in the rectal wall. Surgical excision of the rectal cancer should completely remove the whole mesorectum, especially to avoid any damage of the mesorectum on tumor side.

Combined histology and molecular biology for diagnosis of early stage gastric MALT lymphoma.

OBJECTIVE: To establish a sequential diagnostic procedure of gastric mucosa-associated lymphoid tissue (MALT) lymphoma and provide evidence for selected optimal cases to be treated in the early stage. METHODS: Thirty-one cases of gastric lymphoid hyperplasia (GLH) were selected and multiple investigations including histology, protein level, DNA and chromosome levels, combined with clinical follow-up were performed. Histological grade was according to Isaacson's criteria of GLH; CD20, UCHL-1 (CD45RO), anti-kappa (kappa), anti-lambda (lambda) and Ki-67 were used for immunohistochemical staining; semi-nested polymerase chain reaction (PCR) was used to detect IgH gene rearrangement and reverse-transcription PCR (RT-PCR) was used to detect API2-MALT1 fusion of the chromosome translocation t(11;18)(q21;q21). Twenty-nine cases underwent eradication therapy for Helicobacter pylori. Changes in histological grade, endoscopic appearance, expression of Ki-67 and IgH gene rearrangement were compared after eradication treatment. RESULTS: Of the 31 cases of GLH with predominant chronic gastritis and gastric ulcer most were histological grade 2 and 3. Only one case had lambda light chain restriction and 10 cases had monoclonal IgH gene rearrangement. Expression of Ki-67 and monoclonal IgH gene rearrangement were significantly increased with increased lymphoid hyperplasia (P < 0.05). Two cases had API2-MALT1 fusion. Helicobacter pylori was eradicated in 25 cases and another course of treatment had to be given in 4 cases. All cases were followed up for 1.5-37 months. Of the 27 successful eradication cases, 18 showed complete regression both histologically and endoscopically, 4 had partial regression and 7 were unchanged. CONCLUSIONS: A sequential diagnostic procedure based on histology, expression of Ki-67 combined with clonality of IgH rearrangement and API2-MALT1 fusion helps to diagnosis of early stage gastric MALT lymphoma and choose the best treatment strategy.

[Establishment of an experimental animal model with alveolar bone defect by surgery in rats].

PURPOSE: To establish an animal model for experimental study of orthodontic treatment of alveolar bone defect and other relative research. METHODS: The experiment was carried out on forty SPF female Wistar rats,which were 6 weeks old. With the rats anaesthetized, one side of the alveolar bone in the maxillary first molar of the rats was removed partly. The defects were filled with Bio-glass. The tissue slices from the defects were observed under light microscope 2 weeks after surgery. RESULTS: Only one of the forty rats was infected after operation, and the survival rate was 97.5%. The wounds of the survived rats healed well, and new bone was found around the Bio-glass 2 weeks after operation. CONCLUSION: Animal model of alveolar bone defect established by surgery is simple and reliable, which can be used for further studies. Supported by National Natural Science Foundation of Shandong Province (Grant No.Y2004C13) and Medical Science and Technology Enhancement Award Project of Shangdong Province (Grant No.2005H2038).

[Correlation study between sex and age of patients and root resorption after orthodontic treatment].

PURPOSE: To investigate the relationship between root resorption related to fixed appliance and the variables including sex, age. METHODS: 44 patients were divided into four groups according to sex and age: juvenile males, juvenile females, adult males, adult females. The length of incisors was calculated according to orthopantomograph and study models of pre- and post-treatment, and the relationship between patients' sex and age and root absorption pre- and post-treatment was analyzed by paired t test. RESULTS: Root absorption occurred in every patient. There was no significant difference between the same-age groups of males and females (P<0.05); However, there was significant difference between adult groups (both males and females) and juvenile groups (P<0.01). CONCLUSION: Root absorption occurs in every fixed-appliance case. Fixed-appliance-caused root absorption has no significant correlation with sex;however, absorption of adult groups is of higher level than that of juvenile groups.

[Hemangioma and vascular malformation of small intestine: a clinicopathologic analysis of fifty-one cases].

OBJECTIVE: To investigate the clinicopathologic features of small intestinal hemangioma and vascular malformation. METHODS: A retrospective analysis was performed on 51 cases of hemangioma and vascular malformation involving the duodenum, jejunum and ileum in the past 30 years. RESULTS: The patient's age ranged from 1.4 to 75.0 years, with an average/median age of 40 years for the 51 cases. The ratio of male and female was almost equal. In most cases, the lesions were located in the ileum (18 cases) and jejunum (16 cases) accounting for 66.7%. The predominant symptoms and signs were either intestinal hemorrhage or obstruction. Grossly, the lesions appeared as polyp-like, ulcerative, varices, solitary mass, diffuse infiltration or in an occult status. Histologically, arteriovenous hemangioma also called arteriovenous malformation was more common seen accounting for 86.3%. Other less common vascular lesions included cavernous hemangioma, capillary hemangioma, Rendu-Osler-Weber syndrome and Dieulafoy disease. CONCLUSIONS: Histologic classification and denomination for hemangioma and vascular malformation of small intestine are still controversial. It is very important to correlate clinical manifestations with arteriography findings in histologic diagnosis of hemanigoma and vascular malformation of the small intestine.

[Study with large slice technique and tissue microarray on lymph node involvement and micro-metastasis of rectal cancer].

OBJECTIVE: To study lymph node involvement and micro-metastasis of rectal cancer with large slice technique and tissue microarray. METHODS: Large slice technique, combined with tissue microarray,was used in pathologic study of 31 patients after total mesorectal excision (TME) for rectal cancer. RESULTS: Nine hundred and ninety- two lymph nodes were harvested and 148 were positive. More than 40% of positive lymph nodes were located in the outer layer of the mesorectum and in the same side of the mesorectum as the primary tumor was. Circumferential margin involvement was observed in 12 cases and correlated with the numbers of metastatic lymph nodes (Beta =1.166, P=0.041). Micrometastasis was found in 9 cases with negative pathological lymph nodes, but not correlated with tumor differentiation and stage (P> 0.05). CONCLUSION: Large slice technique combined with tissue microarray facilitates the detection of lymph node involvement and micrometastasis. There is a predominance of lymph node metastasis in the outer layer and the same side of the mesorectum. Micrometastasis can be discovered in different stages of rectal cancer.

Mesorectal spread and micrometastasis of rectal cancer studied with large slice technique and tissue microarray.

BACKGROUND AND OBJECTIVES: Mesorectal tissue seems to be an ideal substrate for the spreading of tumors. The aim was to study the distribution of mesorectal neoplastic foci, examine occurrence of circumferential margin involvement and investigate micrometastasis of the lymph nodes. METHODS: A large slice technique, combined with tissue microarray, was used in the pathologic study of 31 specimens operated on following the principles of total mesorectal excision (TME). RESULTS: Three hundred and forty-nine mesorectal neoplastic foci were examined from 18 specimens. Almost one third of them were in the outer layer of mesorectum. Concerning position of primary tumor, ipsolateral neoplastic foci were significantly more than contralateral neoplstic foci. Twelve specimens were diagnosed to have circumferential margin involved. Nine hundred and ninety-two lymph nodes were harvested with 148 involved by tumor. No significant difference in occurrence of micrometastasis was observed among tumors of different stage. CONCLUSION: Combination of large slice and tissue microarray provided a more detailed method in studying the spread of rectal cancer. Complete excision of the mesorectum with fascia propria circumferentially intact is essential since there is an outer scattering and lateral discrepancy for neoplastic foci distribution. Circumferential margin involvement and micrometastasis observed suggested adoption of preoperative and/or postoperative radiochemotherapy.

Nodal spread and micrometastasis within mesorectum.

AIM: To study the distribution of positive lymph nodes within mesorectum and to investigate the possible micrometastasis in negative lymph nodes. METHODS: Large slice technique combined with tissue microarray was used in the pathologic study of 31 specimens. RESULTS: A total of 992 lymph nodes were harvested and cancer metastasis was found in 148 lymph nodes. Some positive lymph nodes were located in the outer layer of mesorectum and more at the same site of mesorectum as the primary tumor. Circumferential margin lymph node metastasis was observed in nine cases. No significant difference in occurrence of micrometastasis was observed in different stage tumors. CONCLUSION: Positive lymph nodes are distributed in mesorectum and micrometastasis can be found in negative lymph nodes.

Significance of glucocorticoid receptor expression in colonic mucosal cells of patients with ulcerative colitis.

AIM: Glucocorticoid (GC) resistant ulcerative colitis (UC) remains a serious disease and is difficult to manage. Although the molecular basis of GC insensitivity is still unknown, GC receptors (GRalpha and GRbeta) may play an important role in it. This study was aimed to investigate the relationship between the expression of GRalpha and GRbeta in colonic mucosal cells of patients with UC, the efficacy of GC therapy and the intensity of inflammation. METHODS: Twenty-five cases of UC were classified into: GC sensitive (n = 16) and GC resistant (n = 9) cases. Patients consisted of mild (n = 6), moderate (n = 8) and severe (n = 11) cases. GRalpha and GRbeta expression in colonic mucosal specimens were investigated by immunohistochemistry, and compared between GC resistant and sensitive groups, and also among various degrees of inflammation. RESULTS: All cases were positive for GRalpha and GRbeta expression. Both positive association between GRalpha expression and the response of UC to GC and strong negative association between GRbeta expression and the response of UC to GC were identified. There was no significant association between GRalpha/GRbeta expression and the degree of inflammation of UC. CONCLUSION: These findings suggest that both GRalpha and GRbeta may play an important role in the action of GC, and that GRbeta functions as a dominant negative inhibitor of GRalpha. Expression of GRalpha and GRbeta in colonic mucosal cells of patients with UC may serve as predictors of glucocorticoid response, but can not function as markers of inflammatory intensity.

[Interobserver reproducibility in the pathologic diagnosis of borderline ductal proliferative breast diseases].

OBJECTIVE: The aim of this study involving general pathologists was to assess interobserver reproducibility in the pathologic diagnosis of borderline ductal proliferative breast diseases. METHODS: Ten general pathologists independently reviewed 43 specimens chosen to represent the spectrum of borderline ductal proliferative breast lesions. All slides were blindly reviewed without given standardized criteria, and were classified as either mild usual hyperplasia, moderate-severe usual hyperplasia, mild atypical hyperplasia, moderate-severe atypical hyperplasia, ductal carcinoma in situ, or ductal carcinoma in situ with invasion. According to the years of training, these 10 general pathologists were divided into the experienced group and the less trained group. Interobserver agreement was statistically analyzed using Kappa statistic. Then, by comparing all the diagnoses of individual pathologist with the consensus opinion confirmed by two breast pathologists in terms of Page standard, we acquired the diagnostic accuracy and ascertained the undue diagnosis. RESULTS: The ten general pathologists' interobserver reproducibility in the diagnosis of borderline ductal proliferative breast diseases was rather low, especially that in their diagnosis of atypical hyperplasia. The reproducibility and accuracy were slightly higher in the experienced pathologists than in the less trained pathologists. Some pathologists made over-diagnosis or under-diagnosis of the lesions to different degrees. However, when the categories of diagnostic terms were simplified, the interobserver reproducibility increased. CONCLUSION: The use of standardized criteria is an important approach to increasing the diagnostic reproducibility and accuracy.

[Study on glucocorticoid receptor alpha and beta in colonic mucosal cell of patients with ulcerative colitis].

OBJECTIVE: To investigate the relationship of the expression of GRalpha and GRbeta in the colonic mucosal cell of patients with ulcerative colitis to the efficacy of glucocorticoid (GC) therapy and the intensity of inflammation. METHODS: GRalpha expression and GRbeta expression in the colonic mucosal specimens were assessed by means of immunohistochemistry. Then comparative analyses were made on the GRalpha and GRbeta expression between the GC resistant group and GC sensitive group at various levels of inflammation. A normal response group was observed for comparison. RESULTS: The staining intensities of both GRalpha and GRbeta in colonic mucosal specimens showed significant differences between the GC resistant group, GC sensitive group and normal response group. No association between the expression of GRalpha and GRbeta and the degree of inflammation was found. CONCLUSION: These findings suggest that both GRalpha and GRbeta play an important role in the mechanism of the action of GC, and GRbeta functions as a dominant negative inhibitor of GRalpha in there. The expression of GRalpha and GRbeta in the colonic mucosal cell of patients with ulcerative colitis may serve as predictors of glucocorticoid response, but cannot be used as the markers of the severity of inflammation.

[Mesorectal spread and circumferential margin involvement of rectal cancer studied on large slice].

OBJECTIVE: To provide the mode of cancer distribution in the mesorectum and circumferential resection margin. METHODS: Large slice technique was used in the pathologic study of 62 specimens operated on following the principles of total mesorectal excision (TME). RESULTS: More than 40% of all the observed neoplastic foci were located in the outer layer of the mesorectum in Stage III patients. Further analysis of the foci's localities with respect to the primary tumor's locality showed that ipsolateral neoplastic foci (44.44%) were significantly more than the contralateral neoplastic foci (13.33%) in the mesorectum (P<0.05). Extramural distal spread was found in 8 cases with the maximum extent of 3.5 cm. No significant difference in occurrence of circumferential margin involvement (CMI) was observed among tumors of different location, but tumors of poorer differentiation were noted to have a higher risk of CMI. CONCLUSION: Large slice technique offers a whole image of rectum, mesorectum, together with the position of neoplastic foci. There are outer preponderance and lateral discrepancy of neoplastic foci distribution in the mesorectum. A distal clearance margin of 4 cm would be mandatory. We advocate the adoption of TME as the baisc surgical principles in treating patients with rectal cancer and in avoiding surgery-related circumferential margin involvement.

Tumor micrometastases in mesorectal lymph nodes and their clinical significance in patients with rectal caner.

AIM: To investigate the number, size, and status of lymph nodes within the mesorectum and to explore the prognostic significance of lymph node micrometastases in patients with rectal cancer. METHODS: Thirty-one patients with rectal cancer undergone total mesorectal excision between October 2001 and October 2002 were included. Mesorectal nodes retrieved from the resected specimens were detected with a combination of haematoxylin and eosin (HE) staining and immunohistochemistry (IHC). The relations between lymph node metastases, micrometastases and postoperative recurrence were analyzed. RESULTS: A total of 548 lymph nodes were harvested, with 17.7+/-8.2 nodes per case. The average number of metastatic nodes in HE-positive patients and micrometastatic nodes in IHC-positive patients was 5.2+/-5.1 per case and 2.2+/-1.3 per case, respectively. The mean size of all nodes and metastatic nodes was 4.1+/-1.8 mm and 5.2+/-1.7 mm in diameter, respectively. The mean size of micrometastatic nodes was 3.9+/-1.4 mm in diameter. The size of the majority of mesorectal nodes (66.8%), metastatic nodes (52.6%), and micrometastatic nodes (79.5%) was less than 5 mm in diameter. During a median follow-up period of 24.6+/-4.7 mo, 5 patients (16.7%) had recurrence, of them 2 died and 3 survived. Another case died of tumor unrelated cause and was excluded. All 5 recurrent cases had 3 or more nodes involved, and one of them developed only lymph node micrometastases. The mean number of both metastatic and micrometastatic nodes per case differed significantly between the recurrent and non-recurrent groups (P<0.01 and P = 0.01, respectively). CONCLUSION: The majority of lymph nodes, metastatic, and micrometastatic lymph nodes within the mesorectum are smaller than 5 mm in diameter. The nodal status and the number of lymph nodes involved with tumor metastases and micrometastases are related to the rapid postoperative recurrence.

Microscopic spread of low rectal cancer in regions of mesorectum: pathologic assessment with whole-mount sections.

AIM: To assess the microscopic spread of low rectal cancer in mesorectum regions to provide pathological evidence for the necessity of total mesorectal excision (TME). METHODS: A total of 62 patients with low rectal cancer underwent low anterior resection and TME, surgical specimens were sliced transversely on the serial embedded blocks at 2.5 mm interval, and stained with hematoxylin and eosin (HE). The mesorectum on whole-mount sections was divided into three regions: outer region of mesorectum (ORM), middle region of mesorectum (MRM) and inner region of mesorectum (IRM). Microscopic metastatic foci were investigated microscopically on the sections for the metastatic mesorectal regions, frequency, types, involvement of lymphatic vessels and correlation with the original rectal cancer. RESULTS: Microscopic spread of the tumor in mesorectum and ORM was observed in 38.7% (24/62) and 25.8% (16/62) of the patients, respectively. Circumferential resection margin (CRM) with involvement of microscopic metastatic foci occurred in 6.5% (4/62) of the patients, and distal mesorectum (DMR) involved was 6.5% (4/62) with the spread extent within 3 cm of low board of the main lesions. Most (20/24) of the patients with microscopic metastasis in mesorectum were in Dukes C stage. CONCLUSION: Results of the present study support that complete excision of the mesorectum without destruction of the ORM is essential for surgical management of low rectal cancer, an optimal DMR clearance resection margin should be no less than 4 cm, further pathologic assessment of the regions in extramesorectum in the pelvis is needed.

[The early diagnosis and treatment of gastric mucosa-associated lymphoma].

OBJECTIVE: To determine the general markers for the diagnosis of gastric mucosa-associated lymphoid tissue (MALT) lymphoma and select optimal cases to be interfered in early stage. METHODS: To investigate the changes of histology, Ki-67 expression, monoclonality of IgH gene rearrangement in gastric lymphoid hyperplasia (GLH) cases before and after Helicobacter pylori (Hp) eradication treatment. Histological changes were classified according to Isaacson's criteria of GLH; L26, UCHL-1, anti-Kappa, anti-Lambda and Ki-67 were applied for immunohistochemical staining; semi-nest PCR was used to detect IgH gene rearrangement. RESULTS: Thirty-one cases of GLH with predominant chronic gastritis and gastric ulcer were studied. The ratio of male to female in the 31 cases was 1.8 and the mean course 6.8 years. Twenty-nine cases had Hp infection. Most of the cases belonged to histological grade II and III. Only 1 case had lambda light chain restriction and 10 cases had monoclonal IgH gene rearrangement. Expression of Ki-67 and monoclonal IgH gene rearrangement were significantly increased with the crescendo of lymphoid hyperplasia grading (P < 0.05). 28 cases were given antibiotics with eradication of Hp in 24 cases and 2 cases had to be given another course of treatment. These cases were followed-up on average for 4.6 months. 18 cases showed complete regression both histologically and endoscopically, 4 cases partial regression and 6 cases no change. Four cases with histological grade II, III had the decrease of expression of Ki-67 and reversed to polyclonal IgH gene rearrangement, while there was no change in 4 cases with histological grade IV. CONCLUSIONS: General considerations of histology, expression of Ki-67 and combined clonality of IgH gene rearrangement help to screen cases which need intervention early and make a diagnosis of gastric MALT lymphoma in early stage. Monoclonal IgH gene rearrangement in cases with histological grade III or IV appears to carry more clinical significance.