Clinical Characteristics and Manifestations of Fungal Esophagitis: A Single-Center Experience in South China.

Fungal esophagitis is a common infectious disease, although the pathogenic clinical characteristics remain incompletely clear, especially in South China. The goal of this study was to investigate the pathogenic clinical characteristics of fungal esophagitis and the efficacy of different therapeutic strategies at a tertiary hospital in South China. A retrospective study was conducted from January 2007 to December 2017. Data from 113,390 patients who were treated in the endoscopic unit were retrieved and analyzed. To further understand the pathogen and risk factors for fungal esophagitis, we performed a case-control analysis of 101 patients and 202 controls. Of the 113,390 patients, 932 (0.82%) were positive. The annual detection rate ranged from 0.345% to 1.106%, showing an initially increasing and subsequently decreasing trend. The patients' median age was 49 years (range from 8 to 85), and most were men (615/932, 65.99%). Candida albicans was found in samples collected from 36 patients, without any drug-resistant strains. Age (P = 0.018), malignancy (OR = 4.031, 95% CI: 1.562~10.407), cigarette smoking (OR = 3.017, 95% CI: 1.645~5.533), and the use of antibiotics (OR = 2.178, 95% CI: 1.078~4.400) or immunosuppressants (OR = 6.525, 95% CI: 1.089~39.105) were independently associated with esophageal candidiasis. Fluconazole had a better curative effect than nystatin (OR = 4.047, 95% CI: 1.282~12.772) or simple observation (OR = 8.91, 95% CI: 2.61~30.49). In conclusion, fungal esophagitis primarily affects men and elderly individuals; it develops in the setting of malignancy, smoking, and certain previous medication use. Candida albicans is the most common pathogen and is sensitive to antifungal agents. Fluconazole has a good therapeutic effect.

Angioimmunoblastic T-cell lymphoma-associated pure red cell aplasia with abdominal pain.

Angioimmunoblastic T-cell lymphoma (AITL) is a unique type of peripheral T-cell lymphoma with a constellation of clinical symptoms and signs, including weight loss, fever, chills, anemia, skin rash, hepatosplenomegaly, lymphadenopathy, thrombocytopenia and polyclonal hypergammaglobulinemia. The histological features of AITL are also distinctive. Pure red cell aplasia is a bone marrow failure characterized by progressive normocytic anemia and reticulocytopenia without leucopenia or thrombocytopenia. However, AITL with abdominal pain and pure red cell aplasia has rarely been reported. Here, we report a rare case of AITL-associated pure red cell aplasia with abdominal pain. The diagnosis was verified by a biopsy of the enlarged abdominal lymph nodes with immunohistochemical staining.

Tumor necrosis factor-α mediates JNK activation response to intestinal ischemia-reperfusion injury.

AIM: To investigate whether tumor necrosis factor-α (TNF-α) mediates ischemia-reperfusion (I/R)-induced intestinal mucosal injury through c-Jun N-terminal kinase (JNK) activation. METHODS: In this study, intestinal I/R was induced by 60-min occlusion of the superior mesenteric artery in rats followed by 60-min reperfusion, and the rats were pretreated with a TNF-α inhibitor, pentoxifylline, or the TNF-α antibody infliximab. After surgery, part of the intestine was collected for histological analysis. The mucosal layer was harvested for RNA and protein extraction, which were used for further real-time polymerase chain reaction, enzyme-linked immunosorbent assay and Western blotting analyses. The TNF-α expression, intestinal mucosal injury, cell apoptosis, activation of apoptotic protein and JNK signaling pathway were analyzed. RESULTS: I/R significantly enhanced expression of mucosal TNF-α at both the mRNA and protein levels, induced severe mucosal injury and cell apoptosis, activated caspase-9/caspase-3, and activated the JNK signaling pathway. Pretreatment with pentoxifylline markedly downregulated TNF-α at both the mRNA and protein levels, whereas infliximab pretreatment did not affect the expression of TNF-α induced by I/R. However, pretreatment with pentoxifylline or infliximab dramatically suppressed I/R-induced mucosal injury and cell apoptosis and significantly inhibited the activation of caspase-9/3 and JNK signaling. CONCLUSION: The results indicate there was a TNF-α-mediated JNK activation response to intestinal I/R injury.

[Shikonin down-regulates CXCR4 expression and inhibits CXCL12-induced migratory responses in colorectal carcinoma cell line SW480].

OBJECTIVE: To investigate the effects of shikonin on the proliferation, expression of CXCR4 and the migratory responses to CXCL12 in colorectal carcinoma cell line SW480. METHODS: The proliferation of SW480 cells was assessed by MTT assay. Cell surface expression of CXCR4 was determined by flow cytometry. The migratory ability was determined by Transwell. RESULTS: Shikonin inhibited the proliferation of SW480 cells in time- and concentration-dependent manner. The expression rate of CXCR4 in SW480 cells was 99.1%. After application of shikonin 0.01 micromol/L, 0.1 micromol/L and 1.0 micromol/L for 24 h, the expression rate of CXCR4 decreased to 76.0%, 59.1% and 35.5% respectively (F=1098.041, P <0.001), and the CXCL12-induced SW480 cell migratory inhibition rate was 25.2%, 38.5% and 55.7% respectively (F=48.970, P <0.001). CONCLUSION: Besides having inhibiting tumor cell proliferation effect, Shikonin may also play a role in anti-metastasis via down-regulating the expression of CXCR4 and reducing the CXCL12-induced migratory response in colorectal carcinoma cell.

[Expression of APRIL in colorectal carcinoma tissues and effects of chemotherapeutic agents on APRIL expression in colorectal carcinoma SW480 cells].

BACKGROUND & OBJECTIVE: A proliferation-inducing ligand (APRIL), a new member of the tumor necrosis factor (TNF) family, can stimulate tumor cell growth and proliferation both in vitro and in vivo. This research was to detect the expression of APRIL in colorectal carcinoma tissues, and to compare the effects of 5-fluorouracil (5-FU) and cisplatin (DDP) on the expression of APRIL in colorectal carcinoma SW480 cells. METHODS: The protein and mRNA levels of APRIL in 56 specimens of human colorectal carcinoma and para-tumor tissues and in SW480 cells were determined by immunohistochemistry and real-time fluorescence quantitative reverse transcription-polymerase chain reaction (FQ-RT-PCR). SW480 cells were treated with 5-FU and DDP at various concentrations for 24 h, 48 h and 72 h. The changes of APRIL mRNA level were analyzed by FQ-RT-PCR. RESULTS: Both positive rate and mRNA level of APRIL were significantly higher in colorectal carcinoma tissues than in para-tumor tissues (76.8% vs. 16.1%, 0.16+/-0.05 vs. 0.71+/-0.08, both P<0.001). The expression of APRIL was strong in SW480 cells. When treated with different concentrations of 5-FU, the mRNA level of APRIL in SW480 cells raised gradually and reached the highest levels at 72 h after treatment (0.85+/-0.10, 0.81+/-0.09, 0.83+/-0.11, and 0.90+/-0.12 at the concentrations of 25, 50, 100 and 200 microg/mL, respectively), which were significantly higher than those in blank control group (P<0.001). When treated with different concentrations of DDP, the mRNA level of APRIL in SW480 cells did not increase when compared with that in control group (P>0.05). After 72-hour treatment, the mRNA level of APRIL in SW480 cells was significantly lower in 10 microg/mL and 20 microg/mL DDP groups than in blank control group (0.44+/-0.05 and 0.40+/-0.07 vs. 0.57+/-0.06, P<0.05). CONCLUSIONS: APRIL may promote the development of colorectal carcinoma. When chemotherapy is conducted to treat colorectal carcinoma, especially when 5-FU is included in the regimen, anti-APRIL therapy might be an important assistant treatment to counter the impact of APRIL caused by antitumor drugs.

[Changes of RANTES levels in livers of patients with chronic hepatitis B: the clinical significance and the possible mechanisms].

OBJECTIVES: To study the relationship between intra-hepatic levels of regulated on activation, normal T-cell expressed and secreted (RANTES) and the disease severity and liver inflammatory degrees in patients with chronic hepatitis B and the possible mechanism of the changes of intra-hepatic levels of RANTES. METHODS: The expression of RANTES of the livers was studied using immunohistochemical stainings and morphometric quantitative measurements in liver specimens from 10 normal subjects and 64 patients with chronic hepatitis B with different degrees of liver inflammation and different clinical severity. The expressions of RANTES protein and mRNA in cell line HepG2, HepG2.2.15 and HepG2 treated with 10 ng/ml TNFa at different times were quantified by ELISA and one-step RT-PCR. RESULTS: The expression of RANTES of the livers in patients was significantly higher than that in the normal controls. Hepatic RANTES levels increased significantly and the increases were parallel to the increases of the severity of the hepatitis, from mild, moderate to severe hepatitis (the positive units were 3.7+/-1.5, 15.6+/-6.9, 24.0+/-4.0, 37.9+/-11.1, respectively) and from G0 degree to G4 degrees of liver inflammation (the positive units were 3.7+/-1.5, 15.0+/-5.7, 21.6+/-5.9, 30.3+/-8.2, 40.9+/-12.3, respectively). The expressions of RANTES protein and mRNA of HepG2.2.15 were higher than that of HepG2. RANTES protein and mRNA were induced in HepG2 by TNFa. CONCLUSION: RANTES may have an important role in the pathogenesis of chronic hepatitis B. The elevation of hepatic RANTES may be caused by hepatitis B virus and TNFa.

[Changes of Toll-like receptor (TLR) 2 and TLR4 on the peripheral blood mononuclear cells in patients with chronic hepatitis B and chronic severe hepatitis B].

OBJECTIVE: To study the changes of TLR2 and TLR4 on peripheral blood mononuclear cells (PBMCs) and their role in the pathogenesis of chronic hepatitis B and chronic severe hepatitis B. METHODS: The expressions of TLR2 and TLR4 on 10000 CD14+ PBMCs were determined by flow cytometry in 30 healthy controls, in 31 patients with chronic hepatitis B and in 30 patients with chronic severe hepatitis B. The level of serum tumor necrosis factor alpha (TNF alpha) was determined by ELISA. The differences of expression of TLR2 and TLR4 on PBMCs and serum TNFalpha among the three groups of study subjects were determined by Student-t test. The correlations between TLR2, TLR4 and TNF alpha were determined by linear correlation test. RESULTS: The values of mean fluorescence intensity (MFI) of TLR2 on PBMCs of the healthy controls, patients with chronic hepatitis B and patients with chronic severe hepatitis B groups were 21.5+/-2.7, 39.0+/-4.1, and 47.7+/-21.4; TLR4 of those groups was 2.3+/-1.1, 3.7+/-2.3, and 6.9+/-4.1. The serum TNF alpha(ng/L) of the respective groups was 53.8+/-38.1, 164.3+/-89.9, and 359.8+/-140.0. There was a gradual increase of these values from the group of healthy controls to the group of patients with chronic hepatitis B and patients with chronic severe hepatitis B. No significant positive correlations between TLR2, TLR4 and serum TNFalpha were found. CONCLUSION: TLR2 and TLR4 may have a role in the pathogenesis of chronic hepatitis B and chronic severe hepatitis B.

[The practical value of endoscopic retrograde cholangiography in biliary complications after liver transplantation].

OBJECTIVE: To investigate the practical value of endoscopic retrograde cholangiography (ERC) in biliary complications after liver transplantation. METHODS: The data of 71 biliary complications after liver transplantation were analyzed retrospectively. All patients were diagnosed and treated by ERC in our center from October 2003 to March 2006. The biliary complications included 52 cases of biliary stricture, 6 biliary leakage and 13 biliary stone. RESULTS: The diagnostic rate of ERC for biliary stricture, leakage and stone was 98.1% (51/52), 100% (6/6) and 100% (13/13), respectively. The cure rate of interventional therapy through therapeutic ERC for anastomotic, extrahepatic, hilar, intrahepatic and diffuse biliary stricture was 66.7% (4/6), 66.7% (10/15), 0 (0/7), 0 (0/2) and 0 (0/21), respectively. And that for biliary leakage, common bile duct and intrahepatic bile duct stone was 66.7% (4/6), 77.8% (7/9) and 0 (0/4), respectively. CONCLUSIONS: ERC is effective for diagnosis of biliary complications after liver transplantation. The effect of interventional therapy through ERC varies with the type of biliary complications. Only part of biliary complications (anastomotic stricture, extrahepatic biliary stricture, gently and moderate biliary leakage, common bile duct stone) can be cured by interventional therapy through ERC.