A ruptured pulmonary arteriovenous fistula after laparoscopic operation.

Pulmonary arteriovenous fistula (PAVF) is a rare anomaly in the lung, and hemothorax or massive hemoptysis due to spontaneous rupture of the fistula sac is even rarer. The patient described here was a 47-year-old woman who presented with massive hemoptysis resulting from the rupture of her PAVF just after laparoscopic operation. To our knowledge, this may be the first case ever reported that the rupture of PAVF may be correlated with a laparoscopic operation. The patient survived without adverse events after emergency pulmonary lobectomy.

Synthesis of γ-Oxo-phosphonates via N-Heterocyclic Carbene-Catalyzed Acylphosphorylation of Alkenes.

In this study, we present an N-heterocyclic carbene-catalyzed method for the radical acylphosphorylation of alkenes. Electrochemical investigations were employed to identify an appropriate class of oxime phosphonates capable of undergoing a single-electron transfer (SET) with Breslow enolates. The resulting phosphoryl radicals were effectively coupled with diverse styrenes and aldehydes to yield a variety of γ-oxo-phosphonates. Both radical clock experiments and electrochemical studies support our reaction design, and a plausible mechanism for the organocatalytic transformation is proposed.

Clinical pathology and recent follow-up study on gastric intraepithelial neoplasia and gastric mucosal lesions.

BACKGROUND/AIMS: To explore the correlations between endoscopic gastric mucosal lesions and pathological gastric intraepithelial neoplasia (GIN), and to investigate outcomes of gastric intraepithelial neoplasia after treatments. METHODOLOGY: Biopsies of 18,566 Chinese patients undergoing diagnostic gastroscopy were included. Among them, 130 patients were given various treatments, including medication, endoscopic treatment and surgery. RESULTS: There were 433 patients with GIN by initial pathological diagnosis. Among them, 367 low-grade GIN and 66 high-grade GIN, 348 cases accompanied with chronic gastritis, and 85 cases accompanied with localized foci. Eighty cases of Hp-positive patients with low-grade GIN were given anti-Hp therapy. Our results showed that 45 cases of intraepithelial neoplasia disappeared when chronic inflammation left, and 33 cases were given the original diagnoses and two cases developed into high-grade GIN. Surgery was then performed, after which one case was confirmed to have early gastric carcinoma, and the other was diagnosed as advanced gastric carcinoma. Pathological examinations were carried out undergoing EMR or ESD treatment for 18 patients with localized foci accompanied with low-grade GIN. Results showed four cases of chronic inflammation, 11 cases with original diagnoses maintained, and three cases of high-grade GIN. CONCLUSIONS: GIN occurred frequently in patients with more severe pathological inflammations under endoscope, which also had certain correlations with intestinal metaplasia. After treatment, parts of low-grade GIN could be reserved. The effect of endoscopic resection on localized foci accompanied with low-grade GIN was affirmative. However, the limitation of endoscopic biopsy should be fully understood.

[Adiponectin inhibits proliferation and induces apoptosis in colorectal cancer HCT116 cells].

Objective To investigate the relationship between serum adiponectin level and risk of colorectal cancer, and to explore the effect of recombinant adiponectin on the proliferation and apoptosis of colorectal cancer HCT116 cells. Methods Serum adiponectin levels in patients with colorectal cancer and healthy controls were dectected by ELISA. With the level of adiponectin as a risk factor, ROC curve was acquired using SPSS software. HCT116 cells were treated with recombinant adiponectin (2.5, 5, 10, 20 µg/mL). Then cell proliferation activity was detected by MTT assay. Cell cycle and apoptosis were detected by flow cytometry. The protein expressions of p21, NF-κBp65, phosphorylated NF-κBp65 (p-NF-κBp65), cyclin D1 and cleaved caspase 3 (c-caspase-3) were tested by Western blot analysis. Results The levels of serum adiponectin in the patients were significantly lower than those in the healthy controls. When the level of adiponectin was used as a risk factor, the area under ROC curve was 0.887 (95% CI: 0.807-0.966). Recombinant adiponectin inhibited the survival rate of HCT116 cells in a time- and dose-dependent manner. After the treatment with recombinant adiponectin, the percentage of HCT116 cells in G1/G0 phase increased and the expression of p21 was upregulated, while the expressions of p-NF-κBp65 and cyclin D1 were down-regulated. Meanwhile, the expression of c-caspase-3 increased and the percentage of apoptotic cells also increased. Conclusion The decreased level of serum adiponectin is closely related to the risk of colorectal cancer. Recombinant human adiponectin can inhibit the proliferation of colorectal cancer HCT116 cells, induce cell arrest at G1/G0 phase and promote apoptosis, which may be related to the down-regulation of NF-κB, cyclin D1, and activation of p21 and caspase-3.

Small bowel gastrointestinal stromal tumor: a retrospective study of 32 cases at a single center and review of the literature.

BACKGROUND: Gastrointestinal stromal tumor (GIST) is a rare tumor of the small bowel, which can be difficult to diagnose and has a varied clinical outcome. PURPOSE: This is a retrospective review of the diagnosis, management, and clinical outcome of 32 patients diagnosed with primary small bowel GIST from a single center and a comparison of the findings with previously published cases. PATIENTS AND METHODS: Retrospective review of data from patient clinical records, endoscopic and imaging findings, surgical procedures, tumor histology and immunohistochemistry, and clinical outcome was conducted. RESULTS: Data of 32 patients with a median age of 56 years including 50% men and women were reviewed. The majority (29/32) were symptomatic at presentation, with the main symptom being gastrointestinal bleeding (15/32). Imaging detection rates included ultrasound (0%), magnetic resonance imaging (0%), computed tomography (54.8%), computed tomography angiography (71.4%), and double-balloon enteroscopy (88.9%). The mean tumor diameter was 5.3 cm; 4 tumors were located in the duodenum, 21 in the jejunum, and 7 in the ileum. Based on the tumor size and mitotic index, 5 (15.6%), 15 (46.9%), 0 (0%), and 12 (37.5%) patients were classified into very low-risk, low-risk, intermediate-risk, and high-risk groups. Immunohistochemistry showed positive expression for CD117 (100%), CD34 (81.2%), DOG1 (93.8%), smooth muscle actin (37.5%), S100 (9.4%), and desmin (6.2%). Twenty-five patients (78.1%) were treated with open surgical tumor resection; seven patients (21.9%) underwent laparoscopic surgery. Postoperative complications that occurred in seven patients (21.9%) were resolved with conservative management. Four patients were treated with postoperative imatinib. At median follow-up of 30 months, two patients were died. CONCLUSION: The findings from this case series, combined with the findings from previously published cases, provide an update on the current status of the diagnosis and the therapeutic approaches that might lead to improvement in prognosis for patients who present with primary small bowel GIST.

[Serum D-dimer changes and prognostic implication in acute pancreatitis].

OBJECTIVE: To investigate the role of D-dimer in human acute pancreatitis (AP) and its relation to the severity of the disease. METHODS: Plasma concentration of D-dimer was measured in 31 patients with mild AP (MAP), 30 patients with severe AP (SAP) and 30 normal people as a control group. The results of routine laboratory tests, 48-hour Ranson and 24-hour APACHE II scores were all recorded. We attempted to find a relationship between D-dimer level and the results of routine laboratory tests, 48-hour Ranson scores and 24-hour APACHE II scores. RESULTS: (1) As compared with the control group, the plasma concentration of D-dimer was much higher in MAP (0.21 +/- 0.21) mg/L (P = 0.029) and SAP patients (0.69 +/- 0.32) mg/L (P = 0.000). The D-dimer level in the SAP group was higher than that in the MAP group (P = 0.000). (2) The rise in the D-dimer level was directly related to 48-hour Ranson (P = 0.000) and 24-hour APACHE II scores (P = 0.000). (3) The rise in the D-dimer level was directly related to leukocyte count, blood glucose, creatinine, prothrombin time and partial thromboplastin time (P < 0.05) and inversely related to hematocrit, albumin and calcium (P < 0.05). CONCLUSIONS: Plasma concentration of the D-dimer rises in AP patients; D-dimer level is related to the disease severity.

Clinical, endoscopic and pathological characteristics of colorectal polyps in elderly patients: Single-center experience.

Increasing age is a risk factor for the development of colorectal adenomas and advanced adenomas. However, few studies have been published on the features of colorectal polyps in the elderly. The present study aimed to investigate the clinical, enteroscopic and pathological characteristics of colorectal polyps in Chinese elderly patients in a single center (The Central Hospital of Wuhan, Hubei, China). The endoscopic and pathological reports of colonoscopies performed in our center were retrospectively analyzed. A total of 7,795 consecutive patients referred for colonoscopy were evaluated between January 2013 and December 2014. Of the 297 who met the inclusion criteria, 279 polyps were observed in men and 230 in women. Of all the polyps, 263 were non-adenomatous polyps, 104 were non-advanced adenomas and 142 were advanced adenomas. 336 polyps were left-sided and 173 were right-sided. Polyps ≥10 mm were more likely to exhibit an adenomatous component and advanced features, and these findings continued to hold true when the size cut-off was set at 5 mm. The data shown in the present study have revealed that a significant number of polyps lie proximal to the splenic flexure. Thus, evaluation of the whole bowel is particularly important in elderly patients who are undergoing colonoscopy. In addition, the polyp size was associated with the presence of adenoma, and advanced component, diminutive and small polyps should not be ignored in elderly patients.

Epidermal growth factor and prostaglandin E2 levels in Helicobacter pylori-positive gastric intraepithelial neoplasia.

OBJECTIVE: To investigate levels of epidermal growth factor (EGF) and prostaglandin E2 (PGE2) in Han Chinese patients with Helicobacter pylori-positive gastric low-grade intraepithelial neoplasia (LGIN). METHODS: In this prospective, observational study, gastric specimens from patients with LGIN were collected by gastroscopy with consecutive biopsy. EGF and PGE2 concentrations in serum and gastric juice from patients with LGIN were measured by enzyme-linked immunosorbent assay. Presence of H. pylori infection was assessed in patients with LGIN and healthy controls. RESULTS: Out of 5 638 patients and 548 controls, H. pylori infection in patients with chronic gastritis was associated with disease type (endoscopic classification) and disease severity. Patients with H. pylori-positive LGIN had significantly higher concentrations of serum EGF and lower concentrations of serum PGE2 versus patients with H. pylori-negative LGIN. Serum EGF and PGE2 levels in patients with LGIN were not significantly associated with disease type, but were significantly associated with disease severity. CONCLUSIONS: H. pylori infection was associated with chronic gastritis type (endoscopic classification) and disease severity. Abnormal EGF and PGE2 levels may be associated with H. pylori-positive LGIN in Han Chinese patients in central China.