Clinical outcomes and risk factors of non-curative endoscopic submucosal dissection for early gastric cancer: a retrospective multicenter study in Zhejiang, China.

Background: Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) does not always lead to curative resection. Risk factors of lymph node metastasis (LNM)/local cancer residue after non-curative ESD for EGC have not been fully elucidated. We therefore aimed to clarify them and evaluate whether the "eCura system" is reliable for the risk stratification of LNM after non-curative ESD. Methods: We conducted a multicenter retrospective study at seven institutions in Zhejiang, China, on 128 patients who underwent non-curative ESD for EGC. We divided the patients into two groups according to their therapeutic regimen after non-curative ESD. We analyzed the risk factors for LNM, local cancer residue, cancer recurrence, and cancer-specific mortality. Furthermore, we compared the outcomes in each risk category after applying the "eCura system". Results: Among 68 patients undergoing additional surgery, LNM was found in three (4.41%) patients, while local cancer residue was found in eight (11.76%) patients. Multivariate analysis showed that upper third location and deep submucosal invasion were independent risk factors of LNM and local cancer residue. Among 60 patients who underwent simple follow-up, local cancer recurrence was found in four (6.67%) patients and cancer-specific mortality was found in one (1.67%) patient. There were no independent risk factors of cancer recurrence and cancer-specific mortality in our study. During the follow-up period, 5-year overall survival (OS) and disease-free survival (DFS) were 93.8% and 88.9%, respectively. Additionally, LNM and cancer recurrence were significantly associated with the eCura scoring system (p = 0.044 and p = 0.017, respectively), while local cancer residue and cancer-specific mortality were not (p = 0.478 and p = 0.131, respectively). Conclusion: Clinicians should be aware of the risk factors for the prognosis of patients with non-curative ESD to determine subsequent treatment. Through the application of the "eCura system", additional surgery should be performed in patients with intermediate/high risk of LNM.

The Characterization and Osteogenic Activity of Nanostructured Strontium-Containing Oxide Layers on Titanium Surfaces.

PURPOSE: The aim of this study was to compare strontium-containing implant (Sr-Ti) surfaces with modified pure Ti (Mod Ti) on the promotion of osteogenesis in vitro and in vivo. MATERIALS AND METHODS: The Sr-Ti surfaces were fabricated by hydrothermal treatment. The Mod Ti surfaces were used as a control. These surfaces were characterized with scanning electron microscopy, x-ray diffractometer, and x-ray photoelectron spectroscopy. The biologic activity was analyzed by initial adhesion, proliferation, alkaline phosphatase (ALP), osteocalcin, and osteogenesis-related genes in vitro. Hematoxylin and eosin (H&E) staining and immunohistochemistry analysis of tissue adjacent to this implant were used to evaluate osteogenic activity in vivo. RESULTS: The results confirmed multiple nanogranules on the Sr-Ti surface composed of well-crystallized TiO2 and SrTiO3 phases. Long-term release of Sr enhanced mesenchymal stem cell (MSC) initial adhesion, the production of ALP, osteocalcin, and upregulated osteogenesis-related genes. For in vivo osteogenic evaluation, mesenchymal-like cells were adhered on these two surfaces under the electron microscope and transitory hematoma in adjacent bone tissue by H&E staining. The Stro-1-labeled MSCs were noted around the Sr-Ti surface in immunohistochemistry analysis. CONCLUSION: This study suggests that Sr-Ti surfaces with nanostructures could promote the response of MSCs in vitro, and recruit Stro-1 labeled MSCs in vivo.

Effects of storage medium and UV photofunctionalization on time-related changes of titanium surface characteristics and biocompatibility.

Storage in aqueous solution and ultraviolet (UV) photofunctionalization are two applicable methods to overcome the biological aging and increase the bioactivity of titanium. As information regarding the combined effects of storage medium and UV photofunctionalization has never been found in published literatures, this study focused on whether appropriate storage methods and UV photofunctionalization have synergistic effects on the biological properties of aged titanium surfaces. Titanium plates and discs were sandblasted and acid etched and then further prepared in five different modes as using different storage mediums (air or dH2 O) for 4 weeks and then with or without UV treatment. The surface characteristics were evaluated with scanning electron microscopy, contact angle measurements, and X-ray photoelectron spectroscopy. MC3T3-E1 cells were cultured on the surfaces, and cellular morphology, proliferation, alkaline phosphatase activity, and osteocalcin release were evaluated. The results showed that nanostructures were observed on water-stored titanium surfaces with a size of about 15 × 20 nm(2) . UV treatment was effective to remove the hydrocarbon contamination on titanium surfaces stored in either air or water. UV photofunctionalization further enhanced the already increased bioactivity of modSLA on initial cell attachment, proliferation, alkaline phosphatase activity, and osteocalcin release. Overall, UV photofunctionalization was effective in further enhancing the already increased bioactivity by using dH2 O as storage medium, and the effect of UV treatment was much more overwhelming than that of the storage medium. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 932-940, 2016.

Analysis of facial bone wall dimensions and sagittal root position in the maxillary esthetic zone: a retrospective study using cone beam computed tomography.

PURPOSE: To determine the thickness of the facial bone wall and the sagittal angulation between the long axis of the teeth and the long axis of the associated alveolar bone in the maxillary esthetic zone using cone beam computed tomography (CBCT). MATERIALS AND METHODS: A retrospective radiographic study of CBCT images was conducted in 300 patients. The distance between the cementoenamel junction (CEJ) and the facial bone crest, the thickness of the facial bone wall (4 mm apical to the CEJ and midroot), and the sagittal angle between the long axis of teeth and the long axis of the respective alveolar bone were measured. Descriptive statistics and frequency analyses were performed. RESULTS: The sample included 133 men and 167 women (mean age, 36.9 years; range, 18 to 60 years). The distance between the CEJ and the facial bone crest varied between 0.1 and 4 mm and showed an overall tendency to increase with age. Almost 80% of anterior teeth and 40% of premolars exhibited a thin facial bone wall (< 1 mm), and nearly 30% of sites had a bone wall thinner than 0.5 mm. The sagittal angle at approximately 80% of central incisor and second premolar sites was < 20 degrees, but the angle at more than 40% of canine sites was ≥ 30 degrees. There was a significant decrease in facial bone wall thickness from premolars to anterior teeth. CONCLUSION: The facial bone wall in most maxillary anterior teeth was very thin. There was a substantial sagittal angulation between the long axes of teeth and those of their respective alveolar bone in most esthetic zone positions. CBCT analyses of the facial bone wall and the sagittal angle are recommended to ensure the most appropriate dental implant treatment approach.

Bone formation at porous titanium implants coated with multiple layers of recombinant human bone morphogenetic protein-2 cDNA plasmid in the posterior mandible in dogs.

PURPOSE: The objective of this study was to evaluate peri-implant bone formation and osseointegration at titanium implants coated with multiple layers of recombinant human bone morphogenetic protein-2 (rhBMP-2) cDNA placed into canine mandibles. MATERIALS AND METHODS: The rhBMP-2 plasmid was assembled on sandblasted/dual-acid-etched pure titanium implant surfaces using layer-by-layer assembly. The rhBMP-2 plasmid-coated implants were placed into the edentulous posterior mandibles of 12 adult beagle dogs. Implants without the rhBMP-2 plasmid coating served as controls. Treatments were randomized between jaw quadrants, and four implants were placed in each mandibular quadrant. After 4, 8, and 12 weeks in situ, mandibles were retrieved and prepared for removal torque testing and histomorphometric evaluation. RESULTS: Eight layers of rhBMP-2 plasmid were assembled onto the implant surfaces. Histomorphometric analysis showed that, after 4 and 8 weeks of healing, the intrathread bone area (BA) was slightly higher for test implants (54.21% and 59.56%) than for control implants (38.48% and 54.98%), respectively, but no statistically significant differences were seen at any time points. Mechanical tests showed that the mean removal torque values of the rhBMP-2 cDNA-coated implants were greater than those of the control implants after 8 weeks of healing (91 Ncm versus 61 Ncm; P = .31). CONCLUSION: Coating implants with multiple layers of an rhBMP-2 plasmid did not promote peri-implant bone formation and osseointegration in this model.

[Measurement of facial bone wall thickness of maxillary anterior teeth and premolars on cone beam computed tomography images].

OBJECTIVE: To measure the thickness of facial bone wall of maxillary anterior teeth and premolars based on cone beam computed tomography (CBCT) images. METHODS: CBCT images from 118 patients were collected from the Affiliated Stomatology Hospital of Zhejiang University. The thickness perpendicular to the long axis of facial bone wall was measured at two locations: 4 mm apical to the cementoenamel junction (point 1) and the middle of the root (point 2). RESULTS: The thickness of the facial bone walls of central incisors, lateral incisors and canines ranged from 0.5 to 1.5 mm. A thin facial bone wall (<1.0 mm) was quite frequent in central incisors (44.1% at point 1, 56.8% at point 2), lateral incisors (65.2% at point 1, 89.8% at point 2) and canines (45.8% at point 1, 61.0% at point 2). In contrast, the majority of examined first premolars (77.1% at point 1, 68.7% at point 2) and second premolars (94.1% at point 1, 94.1% at point 2) exhibited a thick facial bone wall (>1.0 mm). CONCLUSION: A thin facial bone wall of teeth in the anterior maxilla is common. Radiographic analysis of facial bone wall using CBCT is recommended for selection of appropriate treatment approach.

Influence of multilayer rhBMP-2 DNA coating on the proliferation and differentiation of MC3T3-E1 cells seeded on roughed titanium surface.

For bone morphogenetic protein (BMP) gene therapy to be a viable approach for enhancing implant osseointegration clinically, requires the development of efficient nonviral delivery vectors that can coat the implant. This study evaluated a multilayer cationic liposome-DNA complex (LDc) coating as a delivery vehicle for recombinant human BMP-2 (rhBMP-2). Multilayered coatings, comprising hyaluronic acid (HA) and LDc, were fabricated onto titanium using a layer-by-layer (LBL) assembly technique. Preosteoblastic MC3T3-E1 cells were cultured on the roughened titanium surfaces coated with multilayers of HA/LDc, or on uncoated or HA/liposome only surfaces as controls. The amount of rhBMP-2 secreted by the MC3T3-E1 cells and the effect of the various surfaces on cell viability, proliferation, alkaline phosphatase (ALP) activity, osteocalcin (OC) secretion, and calcium deposition were evaluated. Messenger RNA levels of OC, ALP, Runx2, and Osx were also investigated. The results demonstrated that rhBMP-2 protein secreted into culture medium at 3 days was significantly higher than control groups. MC3T3-E1 cells cultured on the HA/LDc coating displayed significantly higher ALP activity and OC secretion at 7 days and 14 days culture, respectively. MC3T3-E1 cells cultured on HA/LDc upregulated expression of the osteoblast differentiation markers, especially on days 12 for OC and on days 6 and 12 for ALP and Osx. In conclusion, MC3T3-E1 cell cultured on the multilayer HA/LDc coating surface can secret rhBMP-2 protein and the protein levels were effective in inducing early osteogenic differentiation.

Chemical constituents of Euphorbia tangutica.

Sixteen known compounds isolated from the whole plants of Euphorbia tangutica, including phorbol-13-actate (1) previously synthesised and obtained from a natural source for the first time, were evaluated in vitro against a panel of human cancer cell lines using the MTT method. Among them, ergosterol (6) exhibited significant cytotoxic activity against HL-60 cell line with an IC(50) value of 3.3 µM, and 3ß,5α-dihydroxy-15ß-cinnamoyloxy-14-oxolathyra-6 Z,12 E-diene (7) also displayed moderate activity.

Microbial transformation of 3ß-acetoxypregna-5,16-diene-20-one by Penicillium citrinum.

The biotransformation of 3ß-acetoxypregna-5,16-diene-20-one (1) by using a filamentous fungus Penicillium citrinum resulted in the production of four metabolites 2-5. The structures of these compounds were elucidated by different spectroscopic analysis (1D- and 2D-NMR) and HR-ESI-MS as 3ß,7ß-dihydroxy-pregn-5,16(17)-dien-20-one (2), 3ß-hydroxy-7α-methoxy-pregn-5,16(17)-dien-20-one (3), 3ß,7ß,11α-trihydroxy-pregn-5,16(17)-dien-20-one (4), and a known 3ß,7α-dihydroxy-pregn-5,16(17)-dien-20-one (5). The 7-O-methylation is a novel reaction in the field of microbial transformation of pregnane steroids.

A minimally invasive alternative for managing large pancreatic duct stones using a modified expandable metal mesh stent.

BACKGROUND AND AIM: Endoscopic clearance of large or impacted stones in the main pancreatic duct (MPD) remains a clinical challenge. In this study, we attempted to technically modify the metallic stent to facilitate the clearance of large pancreatic stones in 4 patients, hoping to lower the operative risks and shorten hospital stay. PATIENTS AND METHODS: Four patients with chronic pancreatitis and large stones in the MPD received endoscopic treatment. Inclusion criteria were: (1) pancreatic intraductal stones (number >3; diameter >or=10 mm) and strictures identified in the distal MPD; (2) calculi mainly located in the head, neck and/or body of the pancreas, and (3) failed clearance of stones using a balloon catheter or Dormia basket. Before clearing the pancreatic calculi completely, a technically modified uncovered self-expandable metallic pancreatic stent was implanted in the MPD for 4-7 days to dilate the ductal stenosis, and then drawn out through the working channel. RESULTS: As the MPD had been sufficiently expanded by the stent, the calculi were removed completely and uneventfully by the balloon or Dormia basket in all 4 patients, without inducing major postoperative complications. A 9- to 15-month follow-up did not find major complications or recurrence of large calculi in the MPD. CONCLUSIONS: Technically modified metallic stenting is a minimally invasive and clinically feasible alternative to extracorporeal shock wave lithotripsy in the management of large pancreatic duct stones.

Two new benzochromone glycosides from the stem of Berchemia racemosa.

Two new benzochromone glycosides, rubrofusarin 6-O-alpha-L-rhamnosyl- (1 --> 6)-O-beta-D-glucopyranoside (1) and demethylflavasperone 10-O-beta-D-glucopyranoside (2), have been isolated from the stem of Berchemia racemosa Sieb. et Zucc. (Rhamnaceae). Their structures were elucidated on the basis of spectroscopic evidence.