Regulated expressions of MMP-2, -9 by diterpenoids from Euphorbia formosana Hayata.

Two new abietane type diterpenoids, namely seco-helioscopinolide (1) and 3b,7b-dihydroxy-ent-abieta-8,13-diene-12,16-olide (2) were isolated from the aerial parts of Euphorbia formosana Hayata together with helioscopinolide A (3), helioscopinolide B (4), helioscopinolide C (5) and ent-(5b,8a,9b,10a,12a)-12-hydroxyatis-16-ene-3,14-dione (6). The structures of compounds 1-6 were elucidated by analyzing their spectroscopic data and comparison with the literature. Further biological tests by gelatin zymographic analysis revealed that 3-5 significantly up-regulated the expressions and activation of MMP-2 and -9 in human fibrosarcoma cell line HT1080.

Comparative study of conventional colonoscopy, magnifying chromoendoscopy, and magnifying narrow-band imaging systems in the differential diagnosis of small colonic polyps between trainee and experienced endoscopist.

BACKGROUND: Removal of colorectal neoplastic polyps can reduce the incidence of colorectal cancers. It is important to distinguish neoplastic from nonneoplastic polyps. We compared the ability of a trainee and an experienced endoscopist in distinguishing between neoplastic polyps and nonneoplastic polyps by conventional white-light, magnifying narrow-band imaging (NBI), and magnifying chromoendoscopy. MATERIALS AND METHODS: One hundred and sixty-three small colorectal polyps from 104 patients were studied. All polyps were diagnosed by trainees and experienced endoscopists using conventional white-light, magnifying NBI, and magnifying chromoendoscopy. The kappa values of interobserver agreement between trainees and experienced endoscopists were evaluated before this study. Sensitivity, specificity, and diagnostic accuracy were assessed by reference to histopathology. The first 50 polyps were diagnosed by the trainee as the first stage and the rest 113 polyps were diagnosed as the second stage. RESULTS: Magnifying NBI and magnifying chromoendoscopy were significant better than conventional white-light by the experienced endoscopist (diagnostic accuracy: NBI 85.3%, chromoendoscopy 87.7%, conventional view 74.8%). No significant differences were found for the trainee. The kappa values (0.77 approximately 0.85) were good for each endoscopic modality for the experienced endoscopist. However, only NBI and chromoendoscopy had acceptable kappa values (0.40 approximately 0.48) for the trainee. The trainee improved diagnostic accuracy in the second stage, but not yielded the level of the experienced endoscopist. CONCLUSION: Magnifying NBI and magnifying chromoendoscopy had a better interobserver agreement than conventional white-light among trainees and experienced endoscopists. The trainee needs learning time to improve diagnostic ability, even using a new modality such as magnifying NBI.

Overexpression of protein kinase Calpha mRNA may be an independent prognostic marker for gastric carcinoma.

BACKGROUND AND OBJECTIVES: The variability of the prognosis of gastric carcinoma drives extensive researches for novel prognostic markers. The aims of this study were to correlate the expression of protein kinase Calpha (PKCalpha) mRNA with clinicopathological parameters and to evaluate the significant value of PKCalpha in gastric carcinoma prognosis. METHODS: PKCalpha mRNA levels were analyzed in tumor/non-tumor pairs of gastric tissues from surgical specimens of 41 patients with gastric carcinoma employing quantitative real-time polymerase chain reaction. Expression of PKCalpha in gastric carcinoma was also examined using immunohistochemistry. RESULTS: PKCalpha mRNA expression was significantly upregulated in gastric carcinoma (P = 0.007). Overexpression of PKCalpha mRNA was correlated with distant metastasis (P = 0.040). Patients with high PKCalpha mRNA expression had a significantly poorer overall survival compared with patients with low PKCalpha mRNA expression (P = 0.0113). The uni-variate Cox regression analysis showed that high PKCalpha mRNA expression (P = 0.0363) and depth of invasion (P = 0.0443) were two significant prognostic markers for gastric carcinoma. In backward stepwise multi-variate analysis, PKCalpha mRNA overexpression was also proved to be an independent prognostic marker for gastric carcinoma (P = 0.0275). CONCLUSIONS: Our results suggest that overexpression of PKCalpha mRNA has correlation with distant metastasis and may be an independent prognostic marker for gastric carcinoma.

Metachronous esophageal cancer and colon cancer treated by endoscopic mucosal resection.

Most cases of esophageal cancer and colorectal cancer in Taiwan are diagnosed in the advanced stage and treated by surgery or concurrent chemoirradiation. The detection rates of early esophageal cancer and early colorectal cancer are still low in Taiwan. Metachronous early esophageal cancer and early colorectal cancer have rarely been reported. Endoscopic mucosal resection (EMR) is a well-established method for treatment of early gastrointestinal cancer in Japan. We report a 77-year-old man with metachronous early esophageal cancer and early colorectal cancer detected by chromoendoscopy with 3% Lugol's iodine and 0.2% indigo carmine, respectively. These two lesions were successfully treated by EMR. Endoscopic mucosal resection of early cancer in the gastrointestinal tract may be considered in patients who are not suitable for open surgery.

Large early gastric cancers treated by endoscopic submucosal dissection with an insulation-tipped diathermic knife.

It is difficult to remove a large early gastric cancer (> or = 3 cm) in one-piece resection using conventional endoscopic mucosal resection. We tried to use an insulation-tipped (IT) diathermic knife to dissect these lesions. IT-endoscopic submucosal dissection (ESD) was performed in four aging patients with gastric malignancy. All lesions could be removed in one-piece resection by IT-ESD, although three of them exhibited remarkable fibrosis and ulceration. Three cases experienced curative treatment with IT-ESD after the pathologic evaluation, but it was not curative in one case because the pathology showed angiolymphatic invasion. This patient refused additional surgery in consideration of existing major systemic diseases. At 3 months to 1 year of follow-up, endoscopy showed no evidence of residual cancer. IT-ESD is effective in the treatment of large early gastric cancer and is an alternative treatment for early gastric cancer patients who are at risk for major operation.

Premedication with pronase or N-acetylcysteine improves visibility during gastroendoscopy: an endoscopist-blinded, prospective, randomized study.

AIM: To assess the efficacy of premedicaton with pronase or N-acetylcysteine (NAC) at 20 min before upper gastrointestinal (UGI) endoscopy and to determine whether pronase or NAC pretreatment influences the reliability of the rapid urease test. METHODS: A total of 146 patients were prospectively and randomly assigned into the study groups according to different premedications before endoscopy. One endoscopist assessed mucosal visibility (MV) with scores ranged from 1 to 4 at four sites in the stomach. The sum of the MV scores from these four locations was defined as the total mucosal visibility (TMV) score. Identification of H pylori was performed using CLO test, histology, and serology. RESULTS: The Group with pronase premedication had a significantly lower TMV score than did the groups with gascon and gascon water (P < 0.001 and P < 0.01, respectively). The group with NAC had a significantly lower TMV score than the group with gascon (P < 0.01) and a trend of a lower MV score than the group with gascon water (P = 0.06). The TMV score did not significantly differ between the group with pronase and the group with NAC (P = 0.39 and P = 0.14, respectively). The sensitivity and specificity of the CLO test were 92.5% and 93.9%, respectively, in groups premedicated with pronase and NAC together. CONCLUSION: Premedication with pronase or NAC at 20 min before UGI endoscopy improves the mucosal visibility of the stomach. Neither pronase nor NAC produces any obvious interference with the CLO test for the identification of H pylori infection.

It is difficult to eradicate Helicobacter pylori from dental plaque by triple therapy.

BACKGROUND: Dental plaque has been suggested as a permanent reservoir of Helicobacter pylori (H. pylori) and a potential source of reinfection. The aims of this study were to investigate the presence of H. pylori in both dental plaque and the stomach and to evaluate the therapeutic effect of triple therapy on H. pylori in dental plaque. METHODS: Dental plaque and gastric biopsy samples were obtained from 65 patients with dyspeptic symptoms for endoscopic examination. The prevalence of H. pylori in dental plaque and stomach was determined with rapid urease test, histologic examinations and polymerase chain reaction assay based on the primer pair derived from the cagA gene of H. pylori. Triple therapy was administered to patients infected with H. pylori. H. pylori status was re-evaluated after eradication therapy. RESULTS: Prior to treatment, H. pylori was found in the stomach in 38 of 65 (58%) patients and in dental plaque in 28 of 65 (43%) patients. The coexisting infection rate of H. pylori in both stomach and dental plaque was 74%. After triple therapy, H. pylori was eradicated from the stomach in 32 of 38 (84%) patients, but only 2 of 28 (7%) patients with coexisting H. pylori infections of stomach and dental plaque showed the elimination of H. pylori from dental plaque. CONCLUSIONS: The high coexisting infection rate of H. pylori in both stomach and dental plaque implies that dental plaque can serve as another reservoir of H. pylori. H. pylori in dental plaque was hardly eradicated by triple therapy. Dental plaque may be a potential source for recrudescence of gastric infection after successful systemic therapy.