Long-term follow-up study of the malignant transformation potential of the simple renal cysts.

BACKGROUND: We conducted a multi-center study to investigate the prevalence, the malignant transformation potential of the simple renal cysts and the factors that might predict malignancy. METHODS: We defined the simple renal cysts as Bosniak class I & II (including IIF) lesions. In the prevalence study, data from 115,132 ultrasonographies was collected from individuals who participated in a multiphasic health wellness screen. In the natural history and progression study, we retrospectively reviewed 333 participants with simple renal cysts and were followed for at the least 3 years with a mean of 6.3±2.9 years (ranged from 3 to 13 years). RESULTS: About 7.2% (8,303) of the individuals who participated in the study were found to have at the least one simple renal cyst. The incidence increased with age from 0.6% in the first decade to 28.0% in the eighth or later decade of life. The Bosniak class I lesion accounted for 7,559 or 91.0% of the cysts whereas 744 or 9.0% were class II. A slower growth rate was observed in the older age group. Twenty-four patients (7.2%) had their renal cysts upgraded according to the Bosniak classification. Gender, age, initial cyst size, number of cysts and bi-laterality failed to predict the malignancy tendency. CONCLUSIONS: Most of the cysts discovered were the Bosniak class I and II lesions and they rarely progress further. Treatment for the asymptomatic simple renal cyst is not warranted. Treatment decision-making based on older age or larger initial cyst size should not be recommended.

[Open, multicenter, phase â £ clinical trial of Shenbei Guchang capsules in treatment of diarrhea type irritable bowel syndrome].

To evaluate the safety and effectiveness of Shenbei Guchang capsules in treatment of diarrhea type irritable bowel syndrome (yang deficiency of spleen and kidney) under widely used conditions, an open, multicenter, controlled, phase Ⅳ clinical trial was conducted in the drug clinical trial centers of 16 domestic hospitals. 2 123 patients from June 10, 2011 to November 29, 2012 were enrolled in the trial. Drug clinical trial was approved by Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital Ethics Committee before implementation. Before the start of trial, subjects were selected according to the research scheme and inclusion criteria, then they would step into the 14 d study after signing Informed Consent Form. All subjects were treated according to the research scheme, evaluated the conditions and filled in CFR sheet, to provide the evaluation data and information on safety and efficacy of Shenbei Guchang capsules. Shenbei Guchang capsules were used to treat diarrhea type irritable bowel syndrome in widely used conditions (2 123 cases), and 2 029 cases of them entered FAS set, cure+markedly effective in 1 921 cases, with a comprehensive curative effect rate of 94.68%; 2 010 cases of them entered PPS set, cure+markedly effective in 1 906 cases, with a comprehensive curative effect rate of 94.83%. The primary symptoms of IBS were abdominal pain and diarrhea. After treatment, both abdominal pain and diarrhea were improved, with significant differences (P<0.000 1). There were significant differences in traditional Chinese medicine symptom scores on both post-treatment day 7 and day 14 as compared with the conditions before treatment (P<0.000 1). 35 cases of adverse events occurred during the trial with an incidence of 1.65%, including 12 cases of drug-related adverse events (adverse reaction) with an incidence of 0.57%, mainly manifested as nausea, abdominal distension and dry mouth, most of which would be spontaneously relieved without any measures. No serious adverse events occurred. The commercially available Shenbei Guchang capsules are proved safe and effective for the treatment of diarrhea type irritable bowel syndrome (yang deficiency of spleen and kidney) under widely used conditions (2 123 cases), and can be continued for clinical promotion and application.

Different roles of capsule endoscopy and double-balloon enteroscopy in obscure small intestinal diseases.

AIM: To compare the roles of capsule endoscopy (CE) and double-balloon enteroscopy (DBE) in the diagnosis of obscure small bowel diseases. METHODS: From June 2009 to December 2014, 88 patients were included in this study; the patients had undergone gastroscopy, colonoscopy, radiological small intestinal barium meal, abdominal computed tomography or magnetic resonance imaging scan and mesenteric angiography, but their diagnoses were still unclear. The patients with gastrointestinal obstructions, fistulas, strictures, or cardiac pacemakers, as well as pregnant women, and individuals who could not accept the capsule-retention or capsule-removal surgery were excluded. Patients with heart, lung and other vital organ failure diseases were also excluded. Everyone involved in this study had undergone CE and DBE. The results were divided into: (1) the definite diagnosis (the diagnosis was confirmed at least by one of the biopsy, surgery, pathology or the drug treatment effects with follow-up for at least 3 mo); (2) the possible diagnosis (a possible diagnosis was suggested by CE or DBE, but not confirmed by the biopsy, surgery or follow-up drug treatment effects); and (3) the unclear diagnosis (no exact causes were provided by CE and DBE for the disease). The detection rate and the diagnostic yield of the two methods were compared. The difference in the etiologies between CE and DBE was estimated, and the different possible etiologies caused by the age groups were also investigated. RESULTS: CE exhibited a better trend than DBE for diagnosing scattered small ulcers (P = 0.242, Fisher's test), and small vascular malformations (χ(2) = 1.810, P = 0.179, Pearson χ(2) test), but with no significant differences, possible due to few cases. However, DBE was better than CE for larger tumors (P = 0.018, Fisher's test) and for diverticular lesions with bleeding ulcers (P = 0.005, Fisher's test). All three hemangioma cases diagnosed by DBE in this study (including sponge hemangioma, venous hemangioma, and hemangioma with hamartoma lesions) were all confirmed by biopsy. Two parasite cases were found by CE, but were negative by DBE. This study revealed no obvious differences in the detection rates (DR) of CE (60.0%, 53/88) and DBE (59.1%, 52/88). However, the etiological diagnostic yield (DY) difference was apparent. The CE diagnostic yield was 42.0% (37/88), and the DBE diagnostic yield was 51.1% (45/88). Furthermore, there were differences among the age groups (χ(2) = 22.146, P = 0.008, Kruskal Wallis Test). Small intestinal cancer (5/6 cases), vascular malformations (22/29 cases), and active bleeding (3/4 cases) appeared more commonly in the patients over 50 years old, but diverticula with bleeding ulcers were usually found in the 15-25-year group (4/7cases). The over-25-year group accounted for the stromal tumors (10/12 cases). CONCLUSION: CE and DBE each have their own advantages and disadvantages. The appropriate choice depends on the patient's age, tolerance, and clinical manifestations. Sometimes CE followed by DBE is necessary.

[The primary culture methods of colorectal adenoma cells].

OBJECTIVE: To improve the primary cell culture methods of colorectal adenomas. METHODS: The methods of the in vitro primary cell culture of colorectal adenomas, mainly the method for taking and preparing specimen, the methods of culture conditions and cells purification, were considered again and improved in this study. RESULTS: Of the 32 cases, of polyp, 26 were successfully cultured and 6 failed. The culture lasted 5-23 days with 50%-95% viscosity of wells. By means of immuno-histochemical staining and electromicroscopy, the cultured cells were proved to be of epithelial origin. CONCLUSION: The primary culture methods of adenoma cells have been improved, but further study on the serial transfer culture cell lines is most needed.