A Rapid On-Line Evaluation (ROLE) Protocol in the Diagnostic Performance Improvement in Endoscopic Ultrasound-Guided Tissue Acquisition for Solid Pancreatic Lesions.

We assessed the rapid on-line evaluation (ROLE) protocol as a modification to the conventional rapid on-site evaluation (ROSE) in the diagnostic performance improvement in endoscopic ultrasound-guided tissue acquisition (EUS-TA) for solid pancreatic lesions. This single-center, retrospective study involved consecutive patients with solid pancreatic lesions undergoing EUS-TA at Peking University First Hospital between October 2017 and March 2021. Among 137 patients enrolled, 75 were in the ROLE group and 62 were in the non-ROSE group. The diagnostic yield (97.3% vs. 85.5%, p = 0.023), accuracy (94.7% vs. 82.3%, p = 0.027), and sensitivity (95.7% vs. 81.1%, p = 0.011) were significantly higher in the ROLE group compared to the non-ROSE group. However, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) showed no significant differences (all p-values > 0.05). Additionally, there was a noteworthy reduction in the number of needle passes required in the ROLE group compared to the non-ROSE group (two vs. three, p < 0.001). In a subgroup analysis, fine needle biopsy (FNB) combined with ROLE demonstrated superior diagnostic accuracy compared to FNB with non-ROSE (100% vs. 93.1%, p = 0.025). Compared with the non-ROSE protocol, the ROLE protocol might improve the diagnostic performance of EUS-TA for solid pancreatic lesions, and potentially reduce the number of needle passes requirement.

Effectiveness of Inner Traction-Facilitated Endoscopic Submucosal Dissection Using Rubber Band and Clips for Colorectal Neoplasms: A Propensity Score-Matched Study.

BACKGROUND: Colorectal endoscopic submucosal dissection is a technically demanding but effective treatment for superficial neoplasms. We conducted a study to compare the effectiveness and safety of inner traction-facilitated endoscopic submucosal dissection using rubber band and clip with conventional endoscopic submucosal dissection. METHODS: We retrospectively evaluated 622 consecutive patients who underwent colorectal endoscopic submucosal dissection between January 2016 and December 2019. To overcome selection bias, we used propensity score matching (1:4) between endoscopic submucosal dissection using rubber band and clip and conventional endoscopic submucosal dissection. The frequency of en bloc resections, R0 resections, curative resections, procedure speed, and complications were evaluated. RESULTS: After propensity score matching, 35 patients were included in the endoscopic submucosal dissection using rubber band and clip group and 140 were included in the conventional endoscopic submucosal dissection group. Endoscopic submucosal dissection using rubber band and clip resulted in a significant increase in resection speed (0.14 vs. 0.09 cm2/min; P = .003). There were no significant differences in en bloc, R0, and curative resection rates between the 2 groups. In subgroup analysis, the resection speed of endoscopic submucosal dissection using rubber band and clip was significantly higher than that of conventional endoscopic submucosal dissection when the lesions were equal to or larger than 2 cm, macroscopically presenting as lateral spreading tumor, and located in transverse colon to ascending colon. CONCLUSIONS: Endoscopic submucosal dissection using rubber band and clip is safe and effective in treating colorectal neoplasms, especially in lesions presenting a particular difficulty.

Autophagy-related IFNG is a prognostic and immunochemotherapeutic biomarker of COAD patients.

Background: Numerous studies have shown autophagy affects cellular immune responses. This study aims to explore prognosis and immunotherapeutic biomarkers related to autophagy in colon adenocarcinoma (COAD). Methods: Based on R software, we performed the ssGSEA, differential expression analysis, Kaplan-Meier survival analysis, correlation analysis, and enrichment analysis. For wet experiment, we did qRT-PCR, immunohistochemistry and CCK-8 experiments. Results: Using autophagy-related genes (ARGs) and the ssGSEA, COAD patients were divided into low and high autophagy groups. For immune score, stromal score, tumor purity, tumor infiltrating immune cells, co-signaling molecules, tumor mutational burden, microsatellite instability, mismatch repair, immune-related pathways, immune signatures, somatic mutations and subtype analysis, high autophagy group might benefit more from immunotherapy. Among 232 ARGs, IFNG was generally significantly correlated with tumor immunotherapy biomarkers (PD-L1, CD8A and cytotoxic T lymphocytes (CTL)). The disease-free survival of high IFNG group was significantly longer than that of low group. On above-mentioned immune-related research, the high IFNG group reached the same conclusion. The qRT-PCR and IHC analysis confirmed that IFNG was significantly higher expressed in dMMR samples compared to pMMR samples. For chemotherapy, the autophagy and IFNG were significantly negatively related to the chemosensitivity to cisplatin; IFNG inhibitor glucosamine increased cisplatin chemoresistance while IFNG increased cisplatin chemosensitivity; IFNG could reverse glucosamine induced chemoresistance. The functional enrichment analysis of IFNG, PD-L1, CD8A and 20 similar proteins were related to the activation of the immune system. The GSEA and ceRNA network partly described interaction mechanisms of IFNG with PD-L1 and CD8A. Conclusion: Autophagy score and IFNG expression were novel immunotherapy predictive biomarkers, which might play predictive effects through the JAK-STAT signaling pathway. IFNG might be a potential targeted therapy for cisplatin resistant colon cancer. Besides, IFNG was also a prognostic indicator.

Primary Epstein-Barr Virus-Positive Mucocutaneous Ulcer of Esophagus: A Rare Case Report.

Primary EBV-positive mucocutaneous ulcer (EBVMCU) is a rare and indolent disorder occurring in the oropharynx, skin, and gastrointestinal tract, with remission after removal of the immunosuppressive causes. We present a 69-year-old woman with heartburn, regurgitation of gastric acid, enlarged lymph nodes, and parotid glands. The endoscopic examination showed a circumscribed ulcer in the lower esophagus. A biopsy pathology indicated an esophageal EBV-associated lymphoproliferative disorder and a parotid gland/lymph node indolent B-cell lymphoma. Interestingly, the patient did not undergo any treatment, but the endoscopic ulcer improved significantly after more than 2 months. The last pathology showed EBV negativity, and EBVMCU was considered in combination with clinical and endoscopic manifestations. We followed up with the patient at 6 months, and the symptoms of acid reflux and heartburn had disappeared. Our case demonstrates that EBVMCU may occur in the esophagus with spontaneous regression.

Comparison of Performance of Two Stool DNA Tests and a Fecal Immunochemical Test in Detecting Colorectal Neoplasm: A Multicenter Diagnostic Study.

BACKGROUND: The most widely used noninvasive screening tests for colorectal cancer are fecal occult blood tests. Stool DNA test was developed in recent years. However, direct comparative analyses of these tests within the same population are still sparse. METHODS: A total of 2,842 participants who visited outpatient clinics or cancer screening centers were enrolled. Stool DNA test-I (KRAS, BMP3, NDRG4, and hemoglobin immunochemical tests), stool DNA test-II (SDC2 and SFRP2 tests), and fecal immunochemical test (FIT) alone were performed and colonoscopy was used as the gold standard among 2,240 participants. Forty-two and 302 participants had colorectal cancer and advanced adenomas (AA), respectively. RESULTS: The sensitivity for colorectal cancer of stool DNA test-I, -II, and FIT was 90.5%, 92.9%, and 81.0%, respectively. The sensitivity for advanced neoplasm (AN; colorectal cancer plus AA) of stool DNA test-I, -II, and FIT was 34.9%, 42.2%, and 25.9%, respectively. The specificity of stool DNA test-I, -II, and FIT was 91.4%, 93.3%, and 96.8%, respectively, among those with negative results on colonoscopy. When the specificity of FIT was adjusted to match that of stool DNA tests by changing the threshold, no significant difference was seen in the sensitivities among the three tests for detecting colorectal cancer. For AN, the sensitivity of FIT was higher than DNA test-I and similar to DNA test-II under the same specificities. CONCLUSIONS: There was no significant advantage of the two stool DNA tests compared with FIT in detecting colorectal cancer or AN in this study. IMPACT: Our findings do not support extensive use of stool DNA tests instead of FIT.

Plasma proteomics-based identification of novel biomarkers in early gastric cancer.

BACKGROUND: Identification and treatment in the early stage can significantly improve the prognosis of gastric cancer (GC). However, to date, there is still no ideal biomarker that can be used for the screening of early stage GC (EGC). The proteomics supported by mass spectrometry offers more possibilities for discovering tumor biomarkers. The aim of this study was to explore candidate protein biomarkers for EGC screening with mass spectrometry and bioinformatics technology. METHODS: Plasma samples were collected from 15 EGC patients and 15 healthy controls. After a selective immune-depletion to remove high abundance proteins, plasma samples were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) combined with the tandem mass tags (TMT) labeling. RESULTS: A total of 2040 proteins were identified, and 11 proteins were found to be differentially expressed. The results of the logistic regression model and orthogonal signal correction-partial least squares discriminant analysis (OPLS-DA) model showed that the changed proteins identified by plasma proteomics could help distinguish EGC patients from healthy controls. CONCLUSION: The proteins identified by plasma proteomics using LC-MS/MS combined with TMT labeling could help distinguish EGC from healthy controls.

IL-21-secreting hUCMSCs combined with miR-200c inhibit tumor growth and metastasis via repression of Wnt/ß-catenin signaling and epithelial-mesenchymal transition in epithelial ovarian cancer.

BACKGROUND: Epithelial ovarian cancer (EOC) with insidious characteristic manifests no symptoms in its early onset but most patients have advanced and distant cancer metastasis at diagnosis. Innovative early diagnosis and effective treatment of EOC are urgently needed. METHODS: In the study, we developed a novel agent of IL-21-secreting human umbilical cord mesenchymal stem cells (hUCMSCs) combined with miR-200c to evaluate its effects on SKOV3 EOC in vitro and in vivo. RESULTS: hUCMSCs-LV-IL-21 combined with miR-200c significantly inhibited the SKOV3 cell mobility and tumorigenesis compared with hUCMSCs-LV-IL-21, hUCMSCs-LV-vector, and hUCMSCs, respectively. These were reflected in decreasing the tumor sizes and elongating the tumor bearing nude mouse survival, accompanied with increasing the serum cytokine levels of IFN-γ, IL-21 and TNF-α as well as the splenocyte cytotoxicity. In addition, the expression of ß-catenin, cyclin-D1, Gli1, Gli2, and ZEB1 was decreased but the E-cadherin expression was increased in tumor tissues of mice treated with hUCMSCs-LV-IL-21 plus miR-200c. CONCLUSION: We demonstrated that the synergistic effect of fighting SKOV3 EOC is attributable to repression of Wnt/ß-catenin signaling and epithelial-mesenchymal transition in SKOV3 EOC. The findings may provide a new strategy for therapy of EOC.

[Efficacy comparison between surgical resection and endoscopic submucosal dissection of early gastric cancer in a domestic single center].

OBJECTIVE: To compare the clinical efficacy of endoscopic submucosal dissection (ESD) and surgical resection for early gastric cancer (EGC). Method The retrospective case-control study was conducted. Clinical and pathological data of 246 patients who were diagnosed as early gastric cancer and received ESD or surgery for EGC at Peking University First Hospital from 2010 to 2015 were collected, including 171 males and 75 females with average age of (63.6±10.8) years. Eighty-one patients received ESD according to the following indications: no peritoneal lymph node metastasis in preoperative CT; differentiated mucosal cancer without ulcer findings, irrespective of tumor size; differentiated mucosal cancer with diameter ≤30 mm and ulcer; differentiated minimal submucosal invasive cancer (≤500 µm from the muscularis mucosa) with diameter ≤30 mm and without ulcer; undifferentiated mucosal cancer with diameter ≤20 mm and without ulcer; high grade intraepithelial neoplasia with diameter >20 mm; mucous lesion recurrence after EMR without chance of EMR again. One-hundred and sixty-five cases received surgery according to the findings of peritoneal lymph node metastasis in preoperative CT or the growth of carcinoma beyond the expanding criteria of ESD (surgery group). En block resection rate (removing all the lesion at once) and curative resection rate [standard: negative horizontal and vertical surgical margins; negative vessel carcinoma embolus; pT1a and pT1b (SM1); lesion diameter <3 cm with differentiated type, pT1a with ulcer or pT1b(SM1); lesion diameter <2 cm with undifferentiated type, pT1a without ulcer] were compared between two groups. According to pathological results, including tumor location, macrographic type, size, pathological type, differentiated type, invasive depth, surgical margin, vessel carcinoma embolus and lymph node metastasis, all the patients meeting the ESD curative resection criteria in both groups were subgrouped in order to compare the baseline information, surgical conditions, postoperative complications, recovery, follow-up and survival. The end of follow up was December 2016. RESULTS: The en block resection rate was 93.8%(76/81), while curative resection rate was 91.4% (74/81) in ESD group. The en block resection rate and curative resection rate was both 100% in surgery group. According to the pathological results, 170 cases were confirmed to be in accordance with the curative resection standard, including 74 cases in ESD group and 96 cases in surgery group. Subgroup analysis showed that ESD group had older cases (t=2.939, P=0.004) and more cases with lesion in upper 1/3 of stomach (χ2=8.992, P=0.011), while no significant differences in tumor size, invasion depth, degree of differentiation (t=1.875, 2.393, 3.074, all P>0.05) were observed. Compared to surgery group, ESD group had significantly shorter operative time [(76.4±46.3) minutes vs. (271.9±92.6) minutes, t=17.950, P=0.000], shorter fasting period [(3.2±1.4) days vs. (8.8±5.4) days, t=9.801, P=0.000], shorter hospital stay [(9.0±5.8) days vs. (22.1±9.1) days, t=11.471, P=0.000], less costs [(2.6±2.2) ten thousand yuan vs (7.4±3.0) ten thousand yuan, t=12.235, P=0.000] and lower morbidity of early-stage postoperative complication [1.4%(1/74) vs. 20.8%(20/96), χ2=14.502, P=0.013]. One-hundred and sixty-two of 170 patients (95.3%) were followed up for median time of 28 months (range, 11 to 84 months). The recurrence rate was 2.7% (2/74) in ESD group and 4.2% (4/96) in surgery group respectively without significant difference(χ2=1.787, P=0.409). Five-year overall survival rate was 97.5% and 96.5% respectively without significant difference as well (χ2=0.115, P=0.735). CONCLUSIONS: ESD is an effective and safe treatment of early gastric cancer. It can be used as the first protocol for well-differentiated mucosal or SM1 EGC without ulcer as well as undifferentiated mucosal EGC with diameter less than 2 cm.

[Efficacy analysis of endoscopic therapy for early colorectal carcinoma: a retrospective study of 113 cases].

OBJECTIVE: To analyze the clinical efficacy of endoscopic therapy for early colorectal cancer. METHODS: Clinical data of 113 early colorectal mucosal carcinoma or submucosal carcinoma receiving endoscopic therapy were retrospectively analyzed and compared with 39 early colorectal cancer cases receiving surgery during the same time. RESULTS: All the cases were well-moderately differentiated adenocarcinoma. Size of tumors in endoscopic group was (26.2±21.5) mm, and that was (30.9±24.3) mm in surgery group (P=0.257). Baseline data between the two groups were not significantly different (all P>0.05). Significantly shorter median operating time [15.0 minutes vs. 203.0 minutes, χ2=69.322, P=0.000] and median hospital stay [3.0 days vs. 17.0 days, χ2=76.180, P=0.000] were observed in endoscopic group compared with surgery group. The en bloc resection rate, curative resection rate, lymph node metastatic rate and complication rate were not significantly different between two groups (all P>0.05). Ten patients in endoscopic group were referred to additional surgery for deep invasion and/or incomplete resection, of whom 7 received radical surgery, and the other 3 cases without radical surgery did not develop recurrence during follow-up of (20.5±0.9) months. After follow-up for (17.5±15.8) months, the local recurrence rate was 5.3% (6/113) in endoscopic group and 0 (0/39) in surgery group without significant difference (χ2=0.983, P=0.321). There was no significant difference in 5-year tumor-free survival rate between two groups (91.8% vs. 97.0%, χ2=1.533, P=0.216). CONCLUSION: Endoscopic therapy possesses shorter operating time, shorter hospital stay and similar efficacy as compared to surgery in the treatment of early colorectal cancer.

[Diagnosis and surgical treatment of solitary fibrous tumor of the pelvis].

OBJECTIVE: To explore the clinical diagnosis and surgical treatment of pelvic solitary fibrous tumor (SFT). METHODS: The data of nine cases of pelvic solitary fibrous tumor from April 2008 to February 2012 were reviewed retrospectively. RESULTS: There were 7 male and 2 female patients in this group with a median age of 56 years, of whom 6 were asymptomatic. Their CT showed the tissue density was inhomogencous. Multivisceral resections were performed in 5 patients. Microscopically, the tumor cells were shuttle-shaped, short spindle-shaped or round, and mitoses was rare, immunohistochemistry: CD34, CD99, Bcl-2, Vimentin positive rates were 100%. One patient died 34 months after the surgery, and there was no recurrence in other patients. CONCLUSION: Pelvic SFT is rare. It is difficult to make an accurate diagnosis. Surgery is the most effective therapy. Multivisceral resections are needed sometimes. The prognosis is good for most patients.

[Microscope observation of the microbial distribution on the wall of different pipe material in water supply system].

Scanning electron microscope, atomic force microscope and confocal laser scanning microscope were used to observe the microbial distribution and biofilm structure on the surface of stainless steel plugs and the wall of PPR pipe in the water distribution system. The results show that, it is not easy for microbial to attach on the surface of stainless steel plugs. Little bacteria was observed in a short period of time (less than 3 months). Bacteria can be easily observed in the sediment of the PPR pipe wall at the end of water supply system. Bacteria was tightly adhered to the surface of the PPR pipe wall. Combination of scanning electron microscope and atomic force microscope is a practical way to observe the surface structure of discontinuous biofilm in the pipeline. The inner and three-dimensional structure of the pipe biofilm can be simultaneously observed by confocal laser scanning microscope.

[Effect of ammonia-oxidizing bacteria (AOB) on chloraminated disinfection attenuation in drinking water distribution system].

The growth of microbe and formation of biofilm in water distribution system were important factors affecting the security of water quality. The number of ammonia-oxidizing bacteria (AOB) in biofilm of a chloraminated drinking water distribution system in Shanghai was detected by MPN-Griess method, and the relations among AOB, nitrification and chloraminated disinfection were analyzed. Meanwhile, the effects of AOB on chloraminated disinfection fastness and attenuation by simulation experiment were studied. The result indicated that the number of ammonia-oxidizing bacteria in pipe biofilm was between 1.0 x 10(2)-4.3 x 10(5) MPN/g dry biofilm. Correlation coefficients of AOB with ammonia, nitrite and nitrate were -0.563, 0.603 and -0.563. Correlation coefficients of AOB with total chlorine and mono-chloramine were -0.659 and -0.571. Fastness of AOB to chloramine was higher than heterotrophic bacteria and AOB can deplete more chloramine than HPC.