Optimal Colonoscopic Surveillance Interval After Normal Baseline Screening Colonoscopy.

The optimal colonoscopic surveillance interval in the Chinese population is unclear. The present study aimed to assess the optimal colonoscopic surveillance interval after normal baseline screening colonoscopy to avoid overuse or underuse of colonoscopy. This retrospective study included individuals with normal baseline colonoscopy who had undergone at least 2 follow-up colonoscopy examinations at the Digestive Endoscopy Center of our hospital between 2000 and 2013. The risk factors for adenoma and the optimal colonoscopic surveillance interval were assessed. A total of 1,005 individuals (419 men; mean age, 49.34 ± 13.29 years) were included in the study. Of these, 169 individuals had adenomas at colonoscopic surveillance (mean, 1.32 ± 0.79 procedures). The mean adenoma diameter was 0.54 ± 0.38 cm, and the mean number of adenomas was 1.76 ± 1.29. The mean adenoma surveillance interval was 4.76 ± 2.89 years. The risk factors for adenoma identification were age more than 50 years and male gender. The optimal colonoscopic surveillance interval was 4.76 years according to an adenoma detection rate of 5%. The optimal colonoscopic surveillance interval is around 5 years for individuals with normal baseline colonoscopy. Age more than 50 years and male gender are risk factors for adenoma identification.

Optimal colonoscopy surveillance interval period for the adenoma patients who had an adequate polypectomy at baseline colonoscopy.

The role of surveillance colonoscopy has long been established: it reduces both the incidence and the mortality of colorectal cancer. We aimed to assess the optimal colonoscopy surveillance interval period for the adenoma patients who underwent an adequate polypectomy at baseline colonoscopy to avoid overuse or underuse of colonoscopy. A retrospective study was carried out on the baseline adenoma patients who had had at least two completed colonoscopy examinations during the years 2000-2013 in the Digestive Endoscopy Center of the First Affiliated Hospital of Kunming Medical University. All the patients had a complete polypectomy of adenomas at baseline. Data on the patients' demographics and colorectal findings were extracted from a specially designed colonoscopy database. The end point was the finding of adenoma during the subsequent surveillance colonoscopy; an analysis was carried out to identify recurrence factors and the optimal colonoscopy surveillance interval period. A total of 765 (463 men, 302 women, average age 56.51±11.95) eligible patients were included in the study. Three hundred and twelve patients had adenoma and 453 had no adenoma after surveillance colonoscopies (the frequency of repeat colonoscopy is 1-10, average 1.73±1.24). The diameter of adenomas found on the follow-up colonoscopy was 0.2-3.0 cm (average 0.54±0.30 cm). The number of adenomas was 1-11 (2.21±1.53) and the surveillance adenoma interval period was 0.5-13 years (2.64±2.36 years). A total of 576 patients had baseline nonadvanced adenomas. Male sex, age older than 50 years, and more than two different intestine segment adenomas were the risk factors for recurrence. The optimal colonoscopy surveillance interval period is 2.85 years (95% confidence interval: 2.53-3.17) according to the recurrence rate of 5% adenomas. One hundred and eighty-nine patients had baseline advanced adenomas. Male sex, diameter of adenomas less than 1.0 cm, and adenomas in the right colon or the whole colon were the risk factors for recurrence. The optimal colonoscopy surveillance interval period is 2.06 years (95% confidence interval: 1.71-2.45) according to the recurrence rate of 5% adenomas. The optimal colonoscopy surveillance interval period is 3 years or so for the adenoma patients who had an adequate polypectomy at baseline colonoscopy. Male sex, age older than 50 years, less than 1.0 cm adenomas diameter and the right colon, or multisegment intestine adenomas were the risk factors for recurrence. This has significance for guiding the follow-up colonoscopy interval time of the patients with intestine adenomas.

Expression and clinical significance of PLUNC protein in nasal polyp and chronic sinusitis tissue.

We conducted a study to validate the expression of PLUNC (palate, lung, and nasal epithelial clone) protein in nasal polyp and chronic sinusitis tissue by immunohistochemistry. We also explored the relationship between the intensity of positive immunohistochemical staining for PLUNC protein and postoperative therapeutic efficacy. Our study population consisted of 34 patients with nasal polyps and 30 with chronic sinusitis who had undergone surgical treatment, along with 18 healthy controls who did not undergo surgery. All samples were stained according to the streptavidin-peroxidase immunohistochemical method to examine PLUNC protein expression. The surgical patients were evaluated for clinical therapeutic efficacy 6 months postoperatively. The association between efficacy and the intensity of PLUNC protein positivity was examined by the Spearman rank correlation analysis. Intensity was rated as either +++(>50% positive cells), ++ (26 to 50% positive cells),+ (≤25% positive cells), or -(no positive cells). We found that the most common levels of PLUNC positivity were + in the patients with nasal polyps, +++ in the patients with chronic sinusitis, and ++ in the controls (p< 0.01). Analysis of the Spearman rank correlation indicated that the intensity of PLUNC protein expression was significantly correlated with postoperative therapeutic efficacy (p< 0.001). We conclude that PLUNC protein is an essential factor in the innate defense mechanism of the nasal mucosa. The immunohistochemical staining of PLUNC protein could have clinical benefit in terms of predicting therapeutic efficacy and outcomes in patients with nasal polyps or chronic sinusitis.

Heterotopic gastric mucosa in the upper and middle esophagus: 126 cases of gastroscope and clinical characteristics.

BACKGROUND/AIMS: In this retrospective study, we aimed to investigate the prevalence of heterotopic gastric mucosa (HGM) in the upper and middle esophagus, to identify its macroscopic characteristics and evaluate clinical features. METHODOLOGY: One hundred and twenty-six patients (82 males, 44 females; mean age 43.08 ± 12.84 years, range 15-81) with HGM in the upper and middle esophagus diagnosed by gastroscopy and biopsies were admitted to this retrospective study. Disease histories of all patients were carefully inquired, especially the associated complaints including discomfort of throat, heartburn or dysphagia, etc. RESULTS: The prevalence was 0.21%. Patch size ranged between 5-20mm, mean diameter was 7.5 ± 3.7mm; 80 cases appeared as a single patch; 96.83% had the patch in the upper esophagus. Male gender was predominant (male:female ratio, 1.86), but age was not significant. The mean distance from the incisors to the patch was 18.83 ± 2.23cm and 17.20 ± 2.48cm in the male and the female respectively, with a significant difference (t=3.749, p<0.001). In 39 of 126 patients (26 male, 13 female), the esophageal and laryngopharyngeal symptoms were remarkable. Twelve were associated with other diseases of the esophagus. There were no correlations to esophageal symptom, gender, age, location, quantity or diameter. Among the 126 cases, 29 patients were associated with other esophageal diseases. CONCLUSIONS: HGM patches in the esophagus should not be overlooked during endoscopy because they may lead to esophageal symptoms and even important complications in relation to their acid secretions.

[Expression and significance of Cu/ZnSOD and PLUNC protein in chronic sinusitis and nasal polyp tissue].

OBJECTIVE: To validate the expression of Cu/ZnSOD and PLUNC protein in chronic sinusitis and nasal polyp tissue by immunohistochemistry. METHOD: Thirty-four nasal polyps, 30 chronic sinusitis and 18 control cases were chosen. All samples were stained with SP immunohistochemical method to examine Cu/ZnSOD and PLUNC protein respectively. RESULT: (1) Interestingly, we found the positive intensity of Cu/ZnSOD and PLUNC protein were the same in one sample, and they were both expressed in nasal epithelium mucosae, glandular epithelium and goblet cells; (2) We calculated that the constituent ratio among nasal polyps, chronic sinusitis and normal nasal mucosa was significant difference (chi2 = 30.689, P<0.01). The positive intensity of nasal polyps was mainly "+", and the positive intensity of chronic sinusitis was mainly "+++", and the positive intensity of normal nasal mucosa was mainly "++". CONCLUSION: Both Cu/ZnSOD and PLUNC protein are important part of the innate defense mechanism in nasal mucosa. Once the nasal mucosa is irritated by infectious agents or chemical factors, nasal epithelium mucosae, glandular epithelium and goblet cells will proliferate reactively, and then produce antiinflammatory agents such as Cu/ZnSOD and PLUNC protein to defend inflammation.

[Determination of differentially expressed proteins and it's significance among chronic sinusitis, nasal polyps and normal nasal mucosa].

OBJECTIVE: To investigate the differentially expressed proteins among chronic sinusitis, nasal polyps and normal nasal mucosa by means of proteomic technology, and select the candidate biomarkers of chronic sinusitis and nasal polyps. METHODS: Proteins extracted from chronic sinusitis, nasal polyps and normal nasal mucosa were separated and the differentially expressed proteins were identified by series of proteomic tools, including immobilized pH4-7 gradient two-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis, modified coomassie brilliant blue staining, images scanning by the Image Scanner apparatus, PDQuest analysis software, peptide mass fingerprinting based on matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS) by in-gel digestion extract, and Mascot searching in NCBInr and SWISS-PROT databases. RESULTS: The 2-DE patterns with high resolution and reproducibility were obtained. The protein spots separated and visualized in chronic sinusitis, nasal polyps and normal nasal mucosa gel were 1020 +/- 40, 1112 +/- 10 and 1008 +/- 25, respectively. And the match rates were (93 +/- 2)%, (95 +/- 1)% [see text] (90 +/- 3)% respectively. Thirteen differentially expressed spots were found from chronic sinusitis, nasal polyps and normal nasal mucosa gel. We selected and recommend Keratin 8 and APOA1 proteins as candidate biomarkers of nasal polyps, and PLUNC protein, PACAP protein, NKEF-B and SOD as candidate biomarkers of chronic sinusitis. CONCLUSIONS: The differentially expressed proteins among chronic sinusitis, nasal polyps and normal nasal mucosa can be efficiently and relatively reliably identified via the techniques of proteomics. These techniques will play a very important role in the researches for new objective indicators possibly employed in the future classifying, staging and prognosis.