Contrast-enhanced ultrasound versus conventional ultrasound in guided liver puncture biopsy: a systematic review and meta-analysis.

AIM: To evaluate the contrast-enhanced ultrasound (CEUS) versus conventional ultrasound (US) in guided liver puncture biopsy through a systematic review and meta-analysis. MATERIAL AND METHODS: Comparative studies on CEUS and US in liver puncture biopsy were systematically searched from PubMed, Embase, Cochrane library, Chinese Biomedical Literature Database. Two researchers independently screened and extracted data, and RevMan 5.3 software was used for data analysis. RESULTS: The area under the curve (AUC) for CEUS and US in diagnosing liver biopsy was 0.98 (95%CI 0.99-0.97) and 0.95 (95%CI 0.97-0.93), respectively. CEUS demonstrated significantly higher single puncture success rate (38.0% vs 36.4%) [OR=2.67; 95% CI 1.38-5 .17; p=0 .003] and pathological diagnosis rate (95.6% vs 90.5%) [OR =4.35; 95%CI 2.25 -8.39; p<0 .001] compared to the US group. The diagnostic accuracy of the CEUS group was 95.6 % (1964/2054), while that of the US group was 90.5% (1729/1909). The combined analysis indicated significant advantages for CEUS over US [(OR = 2.36). 95 %CI 1.81-3.09, p<0.001]. CONCLUSIONS: CEUS is superior to US in the diagnostic performance, single puncture success rate, pathological diagnosis rate and diagnostic accuracy of liver biopsy in patients with liver lesions.

Efficacy and safety of salvage endoscopy in the treatment of residual or recurrent colorectal neoplasia after endoscopic resection: a systematic review and meta-analysis.

OBJECTIVE: To systematically review and meta-analyze the efficacy and safety of salvage endoscopy for residual or recurrence of colorectal tumors after endoscopic resection. METHODS: Multiple databases including PubMed, EMBASE and the Cochrane Library were searched to screen for eligible studies and perform data extraction and pooled analysis. RESULTS: Sixteen studies on salvage endoscopy for residual or recurrent colorectal cancer after endoscopic resection were included, covering approximately 994 patients. The results of the meta-analysis demonstrated that salvage endoscopic therapy for residual or recurrent colorectal tumors following endoscopic resection achieved an en bloc resection rate of 92% (95% CI 0.85-0.97; I2 = 91%) and an R0 resection rate of 82% (95% CI 0.75-0.87; I2 = 78%). The rates of intraoperative or postoperative bleeding and perforation were 10%/1% and 5%/2%, and the recurrence rate was 2%. CONCLUSIONS: Salvage endoscopic resection is an effective and safe treatment strategy for residual or recurrent colorectal tumors after endoscopic resection.

[Analysis of lesions in 498 schistosomiasis patients].

OBJECTIVE: To explore the characteristics of pathological diagnosis in schistosomiasis endemic areas. METHODS: The patients were selected from the Meishan City People' s Hospital and they had the operation excisions and/or digestive endoscopic biopsy specimens from 2003 to 2012. The diagnostic criteria of schistosomiasis were finding the schistosome eggs or egg granulomas, and the relevant clinical data were also collected. RESULTS: A total of 56,237 pathological specimens were checked and 498 patients were diagnosed with schistosomiasis (0.9%). Among them, the appendix was the most common lesion (241 cases), followed by the colon and rectum (209 cases), liver (23 cases), and others (25 cases) including gallbladder (12 cases), stomach (7 cases), duodenum (2 cases), small intestine (1 case), and the outside of the portal vein system (3 cases). Appendicitis and colorectal cancer were the most common diseases in these patients. CONCLUSION: The distribution characteristics of the lesions of schistosomiasis patients can reflect the clinical and pathological process of schistosomiasis in some extent.

[The effects of p38 mitogen activated protein kinase inhibitor SB203580 on colonic mucosa tumor necrosis factor alpha expression in ulcerative colitis].

OBJECTIVE: To investigate the expression of phosphorylated p38 mitogen activated protein kinase (MAPK) in colonic mucosa of patients with ulcerative colitis (UC) and the effects of SB203580 which is a p38 MAPK inhibitor on the secretion of TNFalpha in colonic mucosa from patients with UC. METHODS: Samples of colonic mucosa were collected from 30 UC patients, 20 males and 10 females, aged (33.50 +/- 10.20) years, during enteroscopy. Samples of normal colonic mucosa 10 cm beyond the tumorous tissue were collected from 15 patients with colonic cancer, 10 males and 5 females, aged (46.64 +/- 10.49) years, as normal controls. The samples underwent pathological and immunohistochemical examination. The remaining samples of the colonic mucosa were cultured and divided into 3 groups: UC + SB203580 group (n = 10, SB203580, an inhibitor of p38 MAPK signal pathway, in a concentration of 20 micromol/L was added), UC control group (n = 10, without addition of SB203580), and peri-cancer normal colonic tissue group (n = 10). 5 hours after the culture, immunohistochemistry was used to detect the expression of phosphorylated p38 MAPK and the expression of phosphorylated transcription of activation factor-2 (ATF(2)), which is a downstream molecule of p38 MAPK. ELISA array was used to detect the content of tumor necrosis factor (TNFalpha) in the supernatant. RESULTS: (1) The A value of phosphorylated p38 MAPK in the colonic mucosa of the UC was 549.22 +/- 32.54, being significantly higher than that of the normal colonic mucosa (143.52 +/- 11.89, P < 0.01). The positive area of the UC group was (1680.61 +/- 115.30) x 10(-5) microm(2), being significantly higher than that of normal colonic mucosa (351.68 +/- 12.73) x 10(-5) microm(2), P < 0.01. (2) The level of TNFalpha in the supernatant of the UC + SB203580 group was (72.07 +/- 20.30) ng/L, being significantly lower than that of the UC control group (549.96 +/- 107.63) ng/L (P < 0.01), but still higher than that of the normal control group (19.44 +/- 3.81) ng/L (P < 0.01). (3) The A value of phosphorylated ATF(2) in the colonic mucosa biopsy specimens of the UC + SB203580 group was 265.82 +/- 40.25, being significantly lower than that of the UC control group (688.32 +/- 47.37, P < 0.01), but still higher than that of the normal control group (120.22 +/- 6.45, P < 0.01). The positive area of phosphorylated ATF(2) in the colonic mucosa biopsy specimens of the UC + SB203580 group was (1213.76 +/- 204.77) x 10(-5) microm(2), being significantly lower than that of the UC control group (2489.02 +/- 193.63) x 10(-5) microm(2), P < 0.01, but no difference in expression of phosphorylated p38 MAPK was found between UC + SB203580 group and UC control group [respectively, A value: 465.64 +/- 38.69 vs 480.34 +/- 38.87, positive area: (1486.26 +/- 165.49) x 10(-5) microm(2) vs (1536.68 +/- 182.16) x 10(-5) microm(2), both P > 0.05]. CONCLUSIONS: p38 MAPK signal transduction pathway plays an important role in the development of UC. Blockade of the signal transduction pathway could ameliorate inflammation, at least in part, by reducing secretion of proinflammatory cytokines, suggesting that p38 MAPK pathway might be a new target for treatment of UC, and SB203580 could be a hopeful novel drug for the treatment of UC.

[Expression of phosphatidylinositol 3-kinase and effects of wortmannin on the expression of tumor necrosis factor-alpha in ulcerative colitis].

OBJECTIVE: To elucidate the role of phosphatidylinositol 3-kinase (PI3K)/Akt in the pathogenesis of ulcerative colitis (UC) and provide experimental evidence that PI3K inhibitor wortmannin can be used as a possible novel approach for treatment of UC. METHODS: Samples of intestinal mucosa were collected from 30 UC patients, 22 males and 8 females, aged 35 +/- 11, during enteroscopy. Samples of normal intestinal mucosa 10 cm beyond the cancerous tissues were collected from 15 patients with intestinal cancer, 9 males and 6 females, aged 40 +/- 9, as normal controls. The samples underwent pathological examination and immunohistochemistry. Another tissues of intestinal mucosa were cultured and divided into 3 groups: UC + wortmannin group, (n = 10, wortmannin, an inhibitor of PI3K/Akt pathway, of the concentration of 0.002 nmol/microl was added), UC control group (n = 10, without addition of wortmannin), and peri-cancer normal intestinal tissue group (n = 10). 4.5 hours after the culture, immunohistochemistry was used to detect the expression of phosphorylated Akt (p-Akt) in the intestinal mucosa and ELISA was used to detect the content of tumor necrosis factor (TNF-alpha) in intestinal mucosa. RESULTS: (1) The A value of p-Akt in the intestinal mucosa of the UC control group was 73.6 +/- 5.2, significantly higher than that of the normal control group (18.0 +/- 2.6, P < 0.05), the positive area of the UC control group was 720 +/- 58, significantly larger than that of the normal control group (133 +/- 29, P < 0.05). (2) The level of TNF-alpha in intestinal mucosa of the UC + wortmannin group was 135 +/- 11, significantly lower than that of the UC control group (296 +/- 39, P < 0.05), however, still significantly higher than that of the normal control group (26 +/- 5, P < 0.05). (3) The A value of p-Akt in the intestinal mucosa biopsy specimens of the UC + wortmannin group was 35.3 +/- 5.6, significantly lower than that of the UC control group (72.3 +/- 6.2, P < 0.05), however, still significantly higher than that of the normal control group (18.0 +/- 2.2, P < 0.05); and the positive area of the UC + wortmannin group was 351 +/- 50, significantly lower than that of the UC control group (716 +/- 94, P < 0.05), however, still significantly higher than that of the normal control group (129 +/- 30, P < 0.05). CONCLUSIONS: (1) PI3K/Akt signal transduction pathway is a critical factor in regulating the expression of pro-inflammatory cytokine, and plays a role in the pathogenesis of UC. (2) Decreasing the levels of relevant cytokines in UC by inhibiting PI3K/Akt signal transduction pathway, wortmannin may be a novel approach for the treatment of UC.