Diagnosis and treatment of adult mixed-type Henoch-Schönlein purpura.

AIM OF THE STUDY: The purpose of this study was to investigate the clinical manifestations and outcomes of patients with adult mixed-type Henoch-Schönlein purpura (HSP) and imaging characteristics of the disease, and to evaluate the efficacy of combined therapy in treating symptoms of HSP. MATERIAL AND METHODS: From January 2008 to October 2015, 23 patients with adult mixed-type HSP were enrolled. Abdominal contrast-enhanced computed tomography (CT) examination and small intestinal enteroscopy were performed for all the patients. For patients with positive urine protein, ultrasonic guided renal needle biopsy with 18G biopsy needle was performed; immunofluorescence and pathologic examinations were performed. Combined therapy with antihistamine drugs, gastric acid suppressants and glucocorticoids was used to relieve abdominal pain, gastrointestinal tract bleeding and urine protein. RESULTS: The typical skin manifestation of HSP is distributed purpura in dependent areas. Abdominal contrast-enhanced CT examination exhibited the intestinal canal wall thickening and edema. Small intestinal endoscopy showed diffused hyperemia, dropsy, and erosion. All the patients with positive urine protein showed significantly higher IgA levels. With the use of combined therapy, abdominal pain and gastrointestinal tract bleeding disappeared, and urine protein decreased gradually. CONCLUSIONS: Higher IgA levels with multiorgan involvement (gastrointestinal, kidney and skin) should make one consider the diagnosis. The combined examination of abdominal contrast-enhanced CT, small intestinal endoscopy and renal needle biopsy is a valuable method for the early diagnosis of adult mixed-type HSP.

Prospective Blinded Comparison of Computed Tomographic Enterography and Small Bowel Endoscopy in Obscure Gastrointestinal Bleeding.

BACKGROUND/AIMS: This study investigated the value of computed tomographic enterography with new techniques, such as multi-planar reformation, curved planar reformation, and blood vessel reformation technique, in evaluation of obscure gastrointestinal bleeding by comparing computed tomographic enterography and small bowel endoscopy. METHODOLOGY: We retrospectively evaluated 30 patients with pathologically proven obscure gastrointestinal bleeding. Patients with acute gastrointestinal bleeding were excluded. All patients successfully underwent computed tomographic enterography and small bowel endoscopy at Yantai Yuhuangding Hospital. Results of both methods in the same patient were compared with pathologic biopsy results from clinical operations or endoscopy. RESULTS: Among the 30 patients retrospectively examined by computed tomographic enterography and small bowel endoscopy, the clinical diagnostic accuracy of the two methods was 70% (21/30) and 80% (24/30), respectively. Computed tomographic enterography and small bowel endoscopy showed no statistical difference in the diagnosis of obscure gastrointestinal bleeding (P = 0.37). CONCLUSIONS: Computed tomographic enterography can supplement or partly replace small bowel endoscopy in the diagnosis of obscure gastrointestinal bleeding. Computed tomographic enterography not only costs patients less and causes them less suffering, but is also technically easy to perform.

EUS-guided coil placement and cyanoacrylate glue injection for gastric variceal bleeding with obvious spontaneous portosystemic shunts.

Background and Objective: Ectopic embolism caused by cyanoacrylate glue for the treatment of gastric varices with obvious spontaneous portosystemic shunts is a serious complication of endoscopic therapy. This study was performed to investigate the safety and therapeutic effect of EUS-guided coil placement and cyanoacrylate glue injection for gastric varices with obvious spontaneous portosystemic shunts. Materials and Methods: Six patients with gastric variceal bleeding and obvious spontaneous portosystemic shunts were included in this study. We evaluated the success rate of variceal occlusion after intraoperative embolization, the postoperative rebleeding rate at 48 h and 2 weeks posttreatment, and the incidence of ectopic embolism and other adverse events. Gastroscopy and computed tomography portal venography (CTPV) were performed 7 months later. Results: All patients underwent successful coil placement and cyanoacrylate glue injection under EUS guidance. The blood flow was confirmed by Doppler examination, the target vessels were successfully blocked, and no rebleeding had occurred at 48 h or 2 weeks after endoscopic treatment. Gastroscopy was repeated 7 months after endoscopic treatment, revealing local ulcer formation. CTPV was also repeated 7 months after endoscopic treatment, showing that the coils were present in the target vessels with no displacement, the portosystemic shunt vessels were occluded, and no ectopic embolization had occurred. Conclusion: The coil placement combined with cyanoacrylate glue embolism is a safe and effective method for patients with gastric variceal bleeding and obvious spontaneous portosystemic shunts.

TATA-box-binding protein-associated factor 15 is a novel biomarker that promotes cell proliferation and migration in gastrointestinal stromal tumor.

BACKGROUND: Gastrointestinal stromal tumor (GIST) is a common neoplasm with high rates of recurrence and metastasis, and its therapeutic efficacy is still not ideal. There is an unmet need to find new molecular therapeutic targets for GIST. TATA-box-binding protein-associated factor 15 (TAF15) contributes to the progress of various tumors, while the role and molecular mechanism of TAF15 in GIST progression are still unknown. AIM: To explore new molecular therapeutic targets for GIST and understand the biological role and underlying mechanisms of TAF15 in GIST progression. METHODS: Proteomic analysis was performed to explore the differentially expressed proteins in GIST. Western blotting and immunohistochemical analysis were used to verify the expression level of TAF15 in GIST tissues and cell lines. Cell counting kit-8, colony formation, wound-healing and transwell assay were executed to detect the ability of TAF15 on cell proliferation, migration and invasion. A xenograft mouse model was applied to explore the role of TAF15 in the progression of GIST. Western blotting was used to detect the phosphorylation level and total level of RAF1, MEK and ERK1/2. RESULTS: A total of 1669 proteins were identified as differentially expressed proteins with 762 upregulated and 907 downregulated in GIST. TAF15 was selected for the further study because of its important role in cell proliferation and migration. TAF15 was significantly over expressed in GIST tissues and cell lines. Overexpression of TAF15 was associated with larger tumor size and higher risk stage of GIST. TAF15 knockdown significantly inhibited the cell proliferation and migration of GIST in vitro and suppressed tumor growth in vivo. Moreover, the inhibition of TAF15 expression significantly decreased the phosphorylation level of RAF1, MEK and ERK1/2 in GIST cells and xenograft tissues, while the total RAF1, MEK and ERK1/2 had no significant change. CONCLUSION: TAF15 is over expressed in GIST tissues and cell lines. Overexpression of TAF15 was associated with a poor prognosis of GIST patients. TAF15 promotes cell proliferation and migration in GIST via the activation of the RAF1/MEK/ERK signaling pathway. Thus, TAF15 is expected to be a novel latent molecular biomarker or therapeutic target of GIST.

[Retracted] Downregulation of miR­29b targets DNMT3b to suppress cellular apoptosis and enhance proliferation in pancreatic cancer.

Following the publication of this paper, it was drawn to the Editor's attention by a concerned reader that certain of the Hoechst staining data shown in Fig. 4E were strikingly similar to data appearing in different form in another article by different authors at a different research institute; moreover, an unexpectedly high degree of similarity was noted with the data featured in a couple of different data panels showing the results of apoptosis experiments in Fig. 4D. Owing to the fact that the contentious data in the above article had already been published prior to its submission to Molecular Medicine Reports, the Editor has decided that this paper should be retracted from the Journal. The authors were asked for an explanation to account for these concerns, but the Editorial Office did not receive a reply. The Editor apologizes to the readership for any inconvenience caused. [Molecular Medicine Reports 17: 2113­2120, 2018; DOI: 10.3892/mmr.2017.8145].

Small intestinal vascular malformation bleeding: diagnosis by double-balloon enteroscopy combined with abdominal contrast-enhanced CT examination.

AIM: The purpose of this study was to explore the value of double-balloon enteroscopy combined with abdominal vascular-enhanced CT examination for the diagnosis of intestinal vascular malformation bleeding, to explore a simple and effective method for the diagnosis of small intestinal vascular malformation bleeding. METHODS: Ten patients with intestinal bleeding were first examined with double-balloon enteroscopy. If active bleeding considered as vascular malformation was observed, the patient underwent abdominal vascular-enhanced CT examination. If no active bleeding was observed with double-balloon enteroscopy, the patient also underwent abdominal vascular-enhanced CT examination. When intestinal vascular malformation bleeding was diagnosed with double-balloon enteroscopy and/or abdominal vascular-enhanced CT examination, the patient underwent surgical operation and vascular malformation was confirmed with pathologic diagnosis. RESULTS: In ten patients who underwent double-balloon enteroscopy examination, active intestinal bleeding was observed in seven patients and no active bleeding was observed in three patients. All ten patients underwent abdominal vascular-enhanced CT examination and vascular malformation was detected in all the patients with confirmation by pathologic diagnosis. CONCLUSION: Double-balloon enteroscopy combined with abdominal vascular enhanced CT examination is a simple and effective method for the diagnosis of intestinal vascular malformation bleeding.

Centromere Protein I (CENP-I) Is Upregulated in Gastric Cancer, Predicts Poor Prognosis, and Promotes Tumor Cell Proliferation and Migration.

This study aimed to investigate the expression and cellular function of the centromeric family of proteins (CENPs), especially centromere protein I (CENP-I), in gastric cancer (GC) and identified its clinical significance and cellular functions. CENP-I expression in GC was studied by cDNA microarray, quantitative real-time PCR (qRT-PCR), and immunohistochemistry (IHC), and using datasets from The Cancer Genome Atlas (TCGA), UALCAN, and Gene Expression Omnibus (GEO) databases. Microarray and bioinformatic analyses identified upregulated CENP-A/E/F/H/I/K/P/W and HJURP in stomach adenocarcinoma (STAD), but not in signet ring cell carcinoma (SRCC). Significantly higher CENP-I mRNA expression was also confirmed in 40 pairs of GC tissues than in paired normal gastric tissues by qRT-PCR (P<.001). IHC showed that elevated CENP-I expression was associated with higher tumor stage, lymph node invasion, increased HER2-positive rate (36.7% vs 10.0%), and intestinal Lauren classification in 69 GC samples compared to paired paracancerous normal tissues. The survival of the high-CENP-I group members was poor compared with that of the low-CENP-I group (P = .0011). Cox univariate regression analysis identified tumor size (P = .008), HER2 status (P = .027), and CENP-I expression (P = .049) were independent prognostic factors of GC. The cellular function of CENP-I was studied in MKN45 and MKN28 GC cell lines in vitro. Cell proliferation, migration, and apoptosis were determined using CCK-8, transwell assay, TUNEL assay, and flow cytometry. Our results showed that CENP-I promoted GC cell proliferation, inhibited apoptosis, facilitated cell migration, and induced epithelial-mesenchymal transition (EMT), possibly by activating the AKT pathway. CENP-I expression was correlated with genetic signatures of the proliferative subtype of GC, characterized by intestinal Lauren classification, HER2 amplification, and TP53 mutation. In conclusion, this study revealed an elevated CENP-I expression in GC, which was associated with malignant features and poor prognosis of GC patients, and identified its function in modulating cell proliferation, apoptosis, and migration.

Development and Validation of an Automatic Image-Recognition Endoscopic Report Generation System: A Multicenter Study.

INTRODUCTION: Conventional gastrointestinal (GI) endoscopy reports written by physicians are time consuming and might have obvious heterogeneity or omissions, impairing the efficiency and multicenter consultation potential. We aimed to develop and validate an image recognition-based structured report generation system (ISRGS) through a multicenter database and to assess its diagnostic performance. METHODS: First, we developed and evaluated an ISRGS combining real-time video capture, site identification, lesion detection, subcharacteristics analysis, and structured report generation. White light and chromoendoscopy images from patients with GI lesions were eligible for study inclusion. A total of 46,987 images from 9 tertiary hospitals were used to train, validate, and multicenter test (6:2:2). Moreover, 5,699 images were prospectively enrolled from Qilu Hospital of Shandong University to further assess the system in a prospective test set. The primary outcome was the diagnosis performance of GI lesions in multicenter and prospective tests. RESULTS: The overall accuracy in identifying early esophageal cancer, early gastric cancer, early colorectal cancer, esophageal varices, reflux esophagitis, Barrett's esophagus, chronic atrophic gastritis, gastric ulcer, colorectal polyp, and ulcerative colitis was 0.8841 (95% confidence interval, 0.8775-0.8904) and 0.8965 (0.8883-0.9041) in multicenter and prospective tests, respectively. The accuracy of cecum and upper GI site identification were 0.9978 (0.9969-0.9984) and 0.8513 (0.8399-0.8620), respectively. The accuracy of staining discrimination was 0.9489 (0.9396-0.9568). The relative error of size measurement was 4.04% (range 0.75%-7.39%). DISCUSSION: ISRGS is a reliable computer-aided endoscopic report generation system that might assist endoscopists working at various hospital levels to generate standardized and accurate endoscopy reports (http://links.lww.com/CTG/A485).

How safe and successful are live demonstrations of therapeutic ERCP? A large multicenter study.

OBJECTIVES: Live demonstrations of endoscopic retrograde cholangiopancreatography (ERCP) have a high educational value and contribute significantly to endoscopy development and training. However, the success and safety of live demonstration have been questioned. The aim of this study was to evaluate the success rate and complications of therapeutic ERCP among patients who participated in live demonstrations. METHODS: Patients who underwent therapeutic ERCP during live demonstrations at gastrointestinal endoscopy conferences in China between January 2002 and December 2007 were included. The matched control for each patient was a patient admitted to the same ERCP unit with similar indication, who received ERCP by an endoscopist with similar experience as those who performed the live demonstration. Patient's age, gender, indication, success rate, and complications of ERCP were collected and compared. ERCP outcomes between local and visiting faculty were also compared. RESULTS: In total, 36 conferences with live ERCP demonstrations involving 406 patients were held in 14 endoscopy centers. There were no significant differences in patients' gender, age, and indications between live demonstrations and controls. The overall complication rate of ERCP in live demonstrations was not significantly different compared with controls (10.3% vs. 8.6%, P=0.473). However, the success rate was significantly lower in live demonstrations than in controls (94.1% vs. 97.5%, P=0.021). The success and complication rates of ERCP performed by local faculty, domestic visiting, and foreign visiting faculties were similar. CONCLUSIONS: Although the success rate of therapeutic ERCP performed during live demonstrations was lower than that of routine procedures, the overall complication rate did not significantly increase. ERCP performed by visiting endoscopists was as safe as that done by local faculty in live demonstrations.

Success rate and complications of ERCP performed during hands-on training courses: a multicenter study in China.

BACKGROUND: Hands-on endoscopy workshops are popular and valuable sources for the continuing medical education of endoscopists. Concerns, however, exist regarding clinical outcomes of procedures performed during hands-on training of ERCP. OBJECTIVE: We compared the success rates and complications between patients in the hands-on training courses and matched control patients. DESIGN: A retrospective, multicenter study. SETTING: Seven endoscopy centers in mainland China. PATIENTS: All patients who underwent ERCP during hands-on training courses at GI endoscopy conferences in China between January 2002 and December 2006 were included. MAIN OUTCOME MEASUREMENTS: Clinical and endoscopic characteristics, including age, sex, indication, therapeutic intervention, success rate, and complication, were collected. Differences in ERCP outcomes between domestic and foreign mentors were also compared. Conference, patient, and endoscopist-related variables were analyzed for potential risk factors associated with post-ERCP complications. RESULTS: Nine conferences with hands-on ERCP training, including 124 patients, were held at 7 endoscopy centers. There were no significant differences in the sex ratio, age, indication, and therapeutic intervention between patients for hands-on training (n = 124) and controls (n = 124). The success rates and overall complication rates were similar between the 2 groups (91.9% vs 92.7%, respectively, P = .811; 12.9% vs 9.7%, respectively, P = .422). Domestic mentors encountered more post-ERCP complications than foreign mentors (18.0% vs 0%, respectively, P = .001). Univariate analyses showed that a large-scale conference (P = .004), first-time mentorship (P = .015), and small case volume for the mentor (P = .015) were significantly associated with post-ERCP complications. Nominal significance in univariate testing was removed when analyzed in a comprehensive multivariate setting. LIMITATIONS: A nonrandomized retrospective trial with only 7 centers (9 conferences). CONCLUSIONS: The success rate and overall complication rate were similar between patients in the hands-on training and those who had routine ERCP procedures. A large-scale conference, first-time mentorship, and small case volume for the mentor may be associated with post-ERCP complications.

Fuji Intelligent Chromo Endoscopy and staining technique for the diagnosis of colon tumor.

BACKGROUND: Colon cancer is a common malignant tumor in the clinic with an incidence rate that is increasing in recent years. The key point for improving the survival rate is the diagnosis and treatment at an early stage. The purpose of this study was to compare the difference of the Fuji Intelligent Chromo Endoscopy (FICE) and staining technique for the diagnosis of colon tumors and non-tumor lesions. METHODS: From March to November 2007, 654 patients were examined with ordinary colonoscopy. Among them 223 patients with colon neoplasm or polypoid lesion were included. The patients were examined with a magnifying ordinary colonoscopy, a magnifying FICE technique and magnifying staining technique. The pit pattern and blood capillary form of the lesion were examined, an endoscopic diagnosis was made and it was compared with the pathologic diagnosis. RESULTS: Four hundred and fifty-one neoplasms were detected in the 223 patients, among those 91.1% (411/451) were detected with the magnifying ordinary endoscopy while 99.1% (447/451) were detected with the FICE technique; there was a significant difference between the two methods. FICE could clearly show the structure and form of mucosal blood capillaries (P < 0.01) but there was no significant difference between the two methods for showing the pit pattern. The coincident rate of FICE for the diagnosis of tumor and non-tumor lesions was 91.6% (413/451), that of the magnifying staining technique was 82.0% (370/451) (P < 0.05). CONCLUSIONS: Magnifying FICE could show the mucosal microstructure and blood capillary form and it had a superiority of high coincident rate, high sensitivity and specificity when compared with ordinary magnifying colonoscopy and magnifying staining endoscopy. In addition, it was easy to operate and a biopsy could be taken from the target, so it has a satisfactory clinical practical value.

Effect of Double-Balloon Enteroscopy on Diagnosis and Treatment of Small-Bowel Diseases.

BACKGROUND: The diagnosis and treatment of small-bowel diseases is clinically difficult. The purpose of this study was to evaluate the diagnostic and therapeutic value of double-balloon enteroscopy in small-bowel diseases. METHODS: The history and outcomes of 2806 patients who underwent double-balloon enteroscopy from July 2004 to April 2017 were reviewed, which included 562 patients with obscure digestive tract bleeding, 457 patients with obscure diarrhea, 930 patients with obscure abdominal pain, 795 patients with obscure weight loss, and 62 patients with obscure intestinal obstruction. Examinations were performed through the mouth and/or anus according to the clinical symptoms and abdominal images. If a lesion was not detected through one direction, examination through the other direction was performed as necessary. Eighty-four patients with small-bowel polyps, 26 with intestinal obstruction caused by enterolith, and 18 with bleeding from Dieulafoy's lesions in the small intestine were treated endoscopically. RESULTS: A total of 2806 patients underwent double-balloon enteroscopy, and no serious complications occurred. An endoscopic approach through both the mouth and anus was used in 212 patients. Lesions were detected in 1696 patients, with a detection rate of 60.4%; the rates for obscure digestive tract bleeding, diarrhea, abdominal pain, weight loss, and intestinal obstruction were 85.9% (483/562), 73.5% (336/457), 48.2% (448/930), 49.1% (390/795), and 62.9% (39/62), respectively. For patients with small-bowel polyps who underwent endoscopic therapy, no complications such as digestive tract bleeding and perforation occurred. Intestinal obstruction with enteroliths was relieved with endoscopic lithotripsy. Among the 18 patients with bleeding from small-bowel Dieulafoy's lesions, 14 patients were controlled with endoscopic hemostasis. CONCLUSION: Double-balloon enteroscopy is useful for diagnosing and treating some small-bowel disease.

Endoscopic full-thickness resection for gastric gastrointestinal stromal tumor originating from the muscularis propria.

OBJECTIVE: This study retrospectively reviewed 46 cases of gastric gastrointestinal stromal tumors treated by endoluminal endoscopic full-thickness resection (EFR) microsurgery in our gastrointestinal endoscopy center. We aimed to evaluate the EFR for the treatment of gastric gastrointestinal stromal tumors originating from the muscularis propria. METHODS: A total of 46 patients with gastric gastrointestinal stromal tumors originated from the muscularis propria layer from January 2012 to June 2015 were treated with EFR. The patients were followed up with gastroscope and computed tomography (CT) for evaluation of therapeutic effect and safety. RESULTS: EFR was successfully accomplished to remove all tumors in 46 patients. The mean procedure time was 82.5±39.8min (56-188min). Except in 3 leiomyomas, pathological examination confirmed gastrointestinal stromal tumor (GIST) in 43 cases. None of the patients had occurred bleeding, peritonitis and other complications after EFR. Thereafter, all patients were followed up with gastro-scope after 1, 6,12 months. CONCLUSIONS: EFR is effective and safe for patients with gastric gastrointestinal stromal tumors originated from muscularis propria layer and has the advantage of less invasive treatment and higher tumor resection rate. It should be considered for further application.

Downregulation of miR­29b targets DNMT3b to suppress cellular apoptosis and enhance proliferation in pancreatic cancer.

As one of the most aggressive types of tumor, pancreatic cancer is a principal cause of tumor­associated mortality. Negative associations between microRNA­29 (miR­29) and DNA methyltransferases (DNMT) 3a and 3b have been demonstrated to be associated with the carcinogenesis of a number of types of cancer; however, this has not been completely elucidated in pancreatic cancer. In the present study, pancreatic cancer tissues (n=15) and corresponding paracancerous tissues (n=15) were obtained and the results of reverse transcription­quantitative polymerase chain reaction analysis indicated decreased expression of miR­29b and enhanced mRNA expression of DNMT3b in pancreatic cancer tissues, compared with the corresponding paracancerous tissues. Increased protein expression of DNMT3b was demonstrated by western blotting and immunohistochemistry. In addition, the negative association between miR­29b and DNMT3b was noted in pancreatic cancer tissues, and luciferase reporter assays confirmed that miR­29b was able to directly target DNMT3b in vitro. Notably, miR­29b overexpression was able to decrease cell viability and to promote the apoptosis by targeting DNMT3b, and the knockdown of DNMT3b exhibited consistent results in vitro and in vivo. The results of the present study suggested that miR­29b, as a tumor suppressor, may be a novel target for the development of treatments for pancreatic cancer.

Embolization combined with endoscopic variceal ligation for the treatment of esophagogastric variceal bleeding in patients with cirrhosis.

BACKGROUND: Esophagogastric variceal bleeding caused by cirrhosis is a kind of emergent condition in the clinic. This study was conducted to explore the therapeutic effect and superiority of embolization of gastric fundus varices combined with endoscopic variceal ligation (EVL) of esophageal varices for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis. METHODS: Totally 172 patients were diagnosed by endoscopic examination within 24 hours of hospitalization with active gastric fundus variceal bleeding and grade II above esophageal varices caused by cirrhosis. Other causes leading to upper digestive tract bleeding were excluded. Patients were randomly divided into a control group (n = 82) and a therapy group (n = 90) following a random number table method. For the former, embolization for gastric fundus varices was performed, then an EVL for esophageal varices was performed 2 months later. For the therapy group, embolization for gastric fundus varices and EVL for esophageal varices were performed at the same time. RESULTS: The rate of emergency hemostasis in the therapy group was 100.0%, higher than that in the control group (87.8%, P < 0.05). The rate of early rebleeding in the therapy group was 6.7% while the rate in the control group was 23.6% (P < 0.05). No complications related to treatment occurred in both groups. CONCLUSION: Embolization for gastric fundus varices combined with EVL for esophageal varices is a safe and effective method for the treatment of patients with esophagogastric variceal bleeding caused by cirrhosis.

Application of double-balloon enteroscopy in the diagnosis and therapy of small intestinal diseases.

BACKGROUND: X-ray of the digestive tract and radionuclide examination could not accurately detect diseases of the small intestine. Double-balloon enteroscopy has been used to increase the detection rate of these diseases in addition to endoscopic biopsy and therapy. The purpose of this study was to determine the value of double-balloon enteroscopy in the diagnosis and treatment of diseases of the small intestine. METHODS: A total of 258 double-balloon enteroscopies via the mouth and/or anus were performed in 208 patients. If no lesion was detected on one side (mouth or anus), examination on the other side (anus or mouth) was made. If active small intestinal bleeding was detected, endoscopic hemostasis was done to treat the bleeding. RESULTS: In the 208 patients, 50 were subjected to double-balloon enteroscopy via both mouth and anus. Lesions were detected in 151 patients, giving a rate of 72.6% (151/208). The detection rates for obscure digestive tract bleeding, diarrhea, abdominal pain and weight loss were 90.2% (92/102), 64.9% (24/37), 48.5% (16/33) and 43.3% (13/30), respectively. Lesions of the 151 patients were confirmed by endoscopic biopsy, surgery, clinical studies, and follow-up. In the 102 patients with bleeding of the digestive tract, active bleeding was detected in 27 patients. Endoscopic hemostasis was successful in 25 of them (92.6%, 25/27). No serious complications occurred in all the patients, the average time for the procedure was 100 minutes. CONCLUSIONS: Double-balloon enteroscopy is safe, effective in the diagnosis of diseases of the small intestine in addition to endoscopic therapy.

Analysis of the clinical features of recurrent acute pancreatitis in China.

BACKGROUND: Since few systematic studies have focused on recurrent acute pancreatitis in China, we sought to investigate its clinical features, including etiological factors and relative frequency. METHODS: Patients were selected from a total 1471 patients with acute pancreatitis in ten cities of China. All had been admitted to a hospital with an attack of acute pancreatitis between January 1992 and December 2002. Data for each patient was recorded on a standardized form. RESULTS: Of the 1471 patients with acute pancreatitis, 157 (10.7%) had recurrent acute pancreatitis. The majority (63%) were male, with a mean age of 41 years (range, 13-82 years). Regarding the etiology, alcohol (20.4%) and cholelithiasis (20.4%) were the most frequent causes, followed by diet (13.4%), hypertriglyceridemia (8.3%), biliary tract infection (5.7%), other (5.1%), and idiopathic factors (26.8%). Alcohol was most frequent in male patients (30.3%), whereas cholelithiasis was most frequent (34.5%) in female patients. The majority of patients (79.6%) presented with their second attack of pancreatitis. Complications of recurrent acute pancreatitis in order of frequency were pancreatic pseudocyst, multiple organ failure, diabetes mellitus type 2, and shock. CONCLUSIONS: Recurrent acute pancreatitis remains a frequent disease, with cholelithiasis and alcohol being the most usual etiological factors. Alcohol is the primary etiological factor in male patients. In about 26.8% of cases, the etiology remains unknown.

Activated rat hepatic stellate cells influence Th1/Th2 profile in vitro.

AIM: To investigate the effects of activated rat hepatic stellate cells (HSCs) on rat Th1/Th2 profile in vitro. METHODS: Growth and survival of activated HSCs and CD4(+) T lymphocytes cultured alone or together was assessed after 24 or 48 h. CD4(+) T lymphocytes were then cultured with or without activated HSCs for 24 or 48 h and the proportion of Th1 [interferon (IFN)-γ(+)] and Th2 [interleukin (IL)-4(+)] cells was assessed by flow cytometry. Th1 and Th2 cell apoptosis was assessed after 24 h of co-culture using a caspase-3 staining procedure. Differentiation rates of Th1 and Th2 cells from CD4(+) T lymphocytes that were positive for CD25 but did not express IFN-γ or IL-4 were also assessed after 48 h of co-culture with activated HSCs. Galectin-9 expression in HSCs was determined by immunofluorescence and Western blotting. ELISA was performed to assess galectin-9 secretion from activated HSCs. RESULTS: Co-culture of CD4(+) T lymphocytes with activated rat HSCs for 48 h significantly reduced the proportion of Th1 cells compared to culture-alone conditions (-1.73% ± 0.71%; P < 0.05), whereas the proportion of Th2 cells was not altered; the Th1/Th2 ratio was significantly decreased (-0.44 ± 0.13; P < 0.05). In addition, the level of IFN-γ in Th1 cells was decreased (-65.71 ± 9.67; P < 0.01), whereas the level of IL-4 in Th2 cells was increased (82.79 ± 25.12; P < 0.05) by co-culturing, as measured by mean fluorescence intensity by flow cytometry. Apoptosis rates in Th1 (12.27% ± 0.99%; P < 0.01) and Th2 (1.71% ± 0.185%; P < 0.01) cells were increased 24 h after co-culturing with activated HSCs; the Th1 cell apoptosis rate was significantly higher than in Th2 cells (P < 0.01). Galectin-9 protein expression was significantly decreased in HSCs only 24 h after co-culturing (P < 0.05) but not after 48 h. Co-culture for 48 h significantly increased the differentiation of Th1 and Th2 cells; however, the increase in the proportion of Th2 cells was significantly higher than that of Th1 cells (1.85% ± 0.48%; P < 0.05). CONCLUSION: Activated rat HSCs lower the Th1/Th2 profile, inhibiting the Th1 response and enhancing the Th2 response, and this may be a novel pathway for liver fibrogenesis.

Clinical Control Study of Endoscopic Full-thickness Resection and Laparoscopic Surgery in the Treatment of Gastric Tumors Arising from the Muscularis Propria.

BACKGROUND: Gastric stromal tumors arising from the muscularis propria are located in deeper layers. Endoscopic resection may be contraindicated due to the possibility of perforation. These tumors are therefore usually removed by surgical or laparoscopic procedures. This study evaluated the curative effects, safety and feasibility of endoscopic full-thickness resection (EFR) of gastric stromal tumors originating from the muscularis propria. METHODS: This study enrolled 92 patients with gastric stromal tumors >2.5 cm originating from the muscularis propria. Fifty patients underwent EFR, and 42 underwent laparoscopic intragastric surgery. Operation time, complete resection rate, length of hospital stay, incidence of complications, and recurrence rates were compared in these two groups. RESULTS: EFR resulted in complete resection of all 50 gastric stromal tumors, with a mean procedure time of 85 ± 20 min, a mean hospitalization time of 7.0 ± 1.5 days and no complications. Laparoscopic intragastric surgery also resulted in a 100% complete resection rate, with a mean operation time of 88 ± 12 min and a mean hospitalization period of 7.5 ± 1.6 days. The two groups did not differ significantly in operation time, complete resection rates, hospital stay or incidence of complications (P > 0.05). No patient in either group experienced tumor recurrence. CONCLUSIONS: EFR technique is effective and safe for the resection of gastric stromal tumors arising from the muscularis propria.

[The clinical features of acute pancreatitis in 10 cities in Shandong Province].

OBJECTIVE: To investigate and obtain a more comprehensive view of the etiology and clinical features of acute pancreatitis (AP) in Shandong Province. METHODS: 1471 cases admitted to hospital for AP were studied and collected from the ten cities of Shandong Province from January 1992 to December 2002 retrospectively. Data of each enrolled patient was recorded in a standardized form. RESULTS: In the 1471 patients, the ratio of male: female was 854:617, and also the mean age of them and the range was 43.3 and from 13 - 82 years old. 1280 had mild AP, and 191 had sever AP. Cholelithiasis (20.2%), alcohol (17.3%) and diet-induced (12.4%) were the most frequent etiologic factors, followed by biliary tract infections (5.6%), hyperlipemia (2.3%), other factors (5.1%). But in about 36.1% cases, the etiology of AP still remains unexplained. In coastal regions, cholelithiasis is the most frequent factor but in interior regions alcohol ranked first. In male, a small predominance of alcohol over cholelithiasis was seen (27.4 vs.14.3%, P < 0.01); and in female, there was a clear predominance of cholelithiasis over alcohol (28.4 vs. 3.2%, P < 0.01). The complications of AP were pancreatic pseudocyst, ascites and peritonitis, pulmonary infections, multiple organ failure, diabetes mellitus-2 and shock, etc. according to their frequencies. CONCLUSIONS: Cholelithiasis, alcohol and diet-induced factor were main etiologic factors in Shandong Province, whereas cholelithiasis alone predominated in the females. In about 36.1% cases, the etiology remains unknown. So that more attention should be paid to study the etiology of AP.