Is single-operator peroral cholangioscopy a useful tool for the diagnosis of indeterminate biliary lesion? A systematic review and meta-analysis.

BACKGROUND: Differentiating between malignant and benign biliary lesions is critical in clinical practice but is difficult. OBJECTIVE: To systematically evaluate the diagnostic performance of single-operator peroral cholangioscopy on indeterminate biliary lesions. DESIGN: A systematic review and meta-analysis. PATIENTS: Patients with indeterminate biliary lesions or equivocal ERCP findings. MAIN OUTCOME MEASUREMENTS: The diagnostic performance of single-operator peroral cholangioscopy on indeterminate biliary lesions. The area under the summary receiver-operating characteristic curve was used as the main indicator for the overall diagnostic performance of single-operator peroral cholangioscopy visual impression (VI) and SpyBite biopsy (SB). The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were also synthesized. RESULTS: A total of 8 studies met the inclusion criteria, involving 335 patients who had data on VI and 337 who had data on SB. The area under the curve values on the summary receiver-operating characteristic curve of single-operator peroral cholangioscopy VI and SB were 0.94 (95% confidence interval [CI], 0.92-0.96) and 0.93 (95% CI, 0.90-0.95) respectively. The combined sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 90% (95% CI, 73%-97%), 87% (95% CI, 76%-94%), 7.1 (95% CI, 3.8-13.3), 0.12 (95% CI, 0.04-0.33) for VI and 69% (95% CI, 57%-79%), 98% (95% CI, 92%-99%), 30.1 (95% CI, 8.5-106.9), and 0.32 (95% CI, 0.23-0.44) for SB, respectively. LIMITATIONS: Small number of included studies; comparison with ERCP could not be made. CONCLUSION: Single-operator peroral cholangioscopy is a good tool for differentiating malignant and benign biliary lesions. VI is useful for detecting malignant lesion, whereas SB is better at confirming a malignant diagnosis, but VI is not perfect in excluding biliary cancer, nor is SB, and their negative results should be interpreted with caution.

Endoscopic lithotripsy for gastric bezoars by Nd:YAG laser-ignited mini-explosive technique.

Until now, there still has no standard treatment option to deal with gastric bezoars. This respective study was conducted to evaluate the safety and efficiency of Nd:YAG laser-ignited mini-explosive technique for the treatment of gastric bezoars. Two hundred sixty patients with 285 gastric bezoars were treated by endoscopic lithotripsy with Nd:YAG laser-ignited mini-explosive technique. Among the 260 patients, the 284 gastric bezoars of the 259 patients completely disappeared, with the cure rate of 99.6% after 1-2 treatments at 2-4 weeks follow-up. Only one patient, who was cured by surgery, had gastric perforation during the explosion. No intraoperative or delayed complications was found in the other 259 patients. The endoscopic lithotripsy with Nd:YAG laser-ignited mini-explosive technique is an effective, safe, and promising alternative for gastric bezoars.

[Familial adenomatous polyposis:a report of 10 cases in 3 generations of a family and literature review].

OBJECTIVE: To investigate the clinical characteristic, diagnosis and treatment of familial adenomatous polyposis (FAP). METHODS: According to family history of the proband, we surveyed the pedigree and retrospectively analyzed the clinical characteristics of 10 FAP patients in 3 generations of the family. RESULT: Among all 10 cases, 3 died of colorectal cancer including two of whom had history of intestinal obstruction.Seven people of the third generation were all diagnosed as FAP. Among them, only 2 patients had clinical symptoms. Colonoscopy was done in all 7 patients before 35 years old. However, none of them had polyps or evidence of cancer.Surgical operation was performed on 1 patient and high frequency electric cutting under endoscopy was performed on 6 patients. CONCLUSIONS: The early clinical manifestations of FAP are nonspecific. Pedigree investigation and colonoscopy screening for high-risk population are important to find early asymptomatic FAP patients.

Endoscopic holmium:YAG laser ablation of early gastrointestinal intramucosal cancer.

Various endoscopic techniques are being increasingly used in early gastrointestinal (GI) cancer. The holmium: yttrium-aluminum-garnet (Ho:YAG) laser has precise tissue cutting ability and good hemostatic properties and has been widely applicated to soft tissue, but the use of endoscopic Ho:YAG laser ablation for early gastrointestinal cancer has not been reported. Twenty patients with biopsy-proven early GI cancer who had a high surgical risk or refused surgery were treated by endoscopic Ho:YAG laser ablation. The tumors of all patients were confined to the mucosal layer without ulceration and without lymph node metastasis. The tumor diameter was not more than 2.5 cm. Endoscopy, endoscopic ultrasound, and computed tomography scan were performed 1-3 months after the treatment, and a biopsy was performed to evaluate the effects of the therapy. Long-term endoscopic follow-up was maintained. Complete eradication was achieved in all the 20 patients, including four patients with high-grade dysplasia associated with focal canceration, seven patients with well-differentiated squamous cell cancer, and nine patients with well-differentiated adenocarcinoma, resulting in a complete response rate of 100% at 1-3 months after treatment. No recurrence was found during 36-73 months of follow-up in all 20 patients. No operative or delayed complications were observed in any of the 20 patients. Preliminary study shows that endoscopic Ho:YAG laser ablation may be an effective, safe, and minimally invasive method for selected patients with early GI intramucosal cancer. Further research is required to confirm the safety and efficacy of this technique compared to its alternative techniques in a multicenter randomized controlled trial.

Change in cephalocaudal tumor cavity diameter after transsphenoidal surgery is a predictor of diabetes insipidus in pituitary adenoma.

OBJECTIVE: To assess the factors influencing the development of diabetes insipidus after transsphenoidal surgery for pituitary adenomas. METHODS: We retrospectively analyzed the clinical data of patients with pituitary adenoma who underwent transsphenoidal surgery. The pituitary gland was assessed using a 3.0 T magnetic resonance imaging, and the predictors of postoperative diabetes insipidus were determined through univariate and multivariate analyses. RESULTS: A total of 212 eligible patients with pituitary adenomas were included; 82 (38.7%) cases developed postoperative diabetes insipidus while 130 cases (61.3%) did not. Diabetes insipidus was transient in 80 (37.7%) patients and permanent in 2 (0.9%) patients. The results of logistic regression analyses showed that the change in cephalocaudal tumor cavity diameter after transsphenoidal surgery was associated with the occurrence of postoperative diabetes insipidus. CONCLUSIONS: Change in cephalocaudal tumor cavity diameter after transsphenoidal surgery may play an important role in predicting diabetes insipidus onset in patients with a pituitary adenoma.

Suppression of microRNA-130b inhibits glioma cell proliferation and invasion, and induces apoptosis by PTEN/AKT signaling.

Glioblastoma is the most common malignant brain tumor in adults and is characterized by extensive proliferation and the diffused invasion of tumor cells. Due to the intricate signaling pathways involved in glioma progression, more effective targeted therapies and prognostic biomarkers in clinical practice are required. The suppression of proto-oncogene function or recovery of tumor suppressor gene function remains one of the primary approaches in gene therapy. The close association between the abnormal expression or mutation of microRNA (miRNA) and the tumorigenesis, progression and staging in glioma have been demonstrated previously. However, the expression pattern and specific role of microRNA­130b (miR­130b) in the tumor occurrence and progression of glioma are unclear. In the present study, quantitative polymerase chain reaction was performed to determine the expression level of miR-130b in 30 brain glioma patients and 3 glioma cell lines. An miR­130b inhibitor was transfected into U87 cells to downregulate the expression of miR-130b, and assessments of cell proliferation, cell cycle, apoptosis, cell invasion and migration in vitro and nude mouse tumorigenicity in vivo were conducted. Western blotting and luciferase reporter gene technology were used to verify the downstream target gene of miR-130b, namely phosphatase and tensin homolog (PTEN). The results demonstrated that miR-130b expression was increased in glioma tissues and cell lines in comparison with non-glioma tissues or cells. The downregulated expression of miR-130b inhibited the proliferation and invasion of glioma cells, induced apoptosis of the cells in vitro and inhibited their tumorigenicity in vivo. Western blotting and luciferase reporter assays demonstrated that the PTEN gene is a direct target of miR­130b. Western blotting revealed that the miR-130b inhibitor upregulated the expression of PTEN, inhibited AKT pathway activation, upregulated the tumor suppressor gene p27, and suppressed cyclin D1, matrix metalloproteinase 2 and 9 expression. These results suggest that the miR-130b inhibitor suppressed glioma cell proliferation and invasion via the PTEN/AKT pathway. Therefore, miR­130b is suggested to be an effective therapeutic target for glioma.

Relationship between pituitary adenoma texture and collagen content revealed by comparative study of MRI and pathology analysis.

This study is to reveal the relationship between pituitary adenomas and tumor texture by comparing MRI and pathologic results. Preoperative imaging data of 38 cases of pituitary adenoma patients and collagen content of tumor specimens measured by histopathological were analyzed and compared. T2WI and diffusion coefficient assessment were used to reveal the relationship between tumor texture and collagen content. There were 13 cases of soft texture, 17 cases of medium texture and 8 cases of tough texture tumors. Signal intensity of different texture Pituitary adenomas had significant difference on T2WI and ADC map (P < 0.05). The signal intensity ratio of tumor and pons on T2WI had high consistency with tumor texture. Mean collagen contents of soft, medium and tough texture group were 1.51% ± 0.91%, 7.35% ± 2.99% and 18.10% ± 8.24%, respectively. There were significant differences in collagen content of different texture tumors (P < 0.01). The signal intensity of T2WI and ADC images have prediction value for pituitary adenomas texture and T2WI is more reliable.

The snoRNA MBII-52 regulates cocaine-induced conditioned place preference and locomotion in mice.

Cocaine dependence involves in the brain's reward circuit as well as nucleus accumbens (NAc), a key region of the mesolimbic dopamine pathway. Many studies have documented altered expression of genes and identified transcription factor networks and epigenetic processes that are fundamental to cocaine addiction. However, all these investigations have focused on mRNA and/or miRNA, which may not reflect the involvement of small nucleolar RNAs (snoRNAs), which has been implied in a broad range of biological processes and complex diseases including brain development and neuropathologocal process. To further address the role of snoRNA in cocaine addiction, we show that repeated exposure and conditioned place preference (CPP) training to cocaine negatively regulates the expression of MBII-52 mRNA level, which is a brain-specific C/D box snoRNA, but not influences the serotonin receptor 2C (5HT2CR) mRNA level in NAc. Furthemore, we show, developing lentiviral vector (LV)-expressing MBII-52 and LV-5HT2CR for stable and regulatable MBII-52 and LV-5HT2CR expression. LV-MBII-52 and LV-5HT2CR expression in NAc attenuate cocaine induced CPP and locomotor activity. Taken together, these findings show that MBII-52 and 5HT2CR exert an inhibitory influence on the behavioral responses to cocaine exposure.

Dual targeting of glioma U251 cells with nanoparticles prevents tumor angiogenesis and inhibits tumor growth.

Important advances have been made within in past few years in the treatment of glioma, however, the longterm prognosis after resection of glioma remains unsatisfactory as a result of a high incidence of recurrence. To solve this problem, many biologic therapies have been investigated. In the present study, we report a nanoparticle with properties for dual targeting of tumor cells and the neovasculature. The nanoparticle comprises encoding vasohibin and RGD 12-mer cationic peptide RKKRRQRRRRGD (Tat49-57RGD) peptides, which a nuclear nanoparticle within an extranuclear peptide envelope. Our results demonstrate that the nanoparticle could prevent tumor angiogenesis and inhibit tumor growth via attenuating neovasculature formation and inducing tumor apoptosis. Therefore, the dual targeting strategy of tumor cells and neovasculature represents an integrative approach in glioma therapy. This can be extended to additional agents to target multiple signal pathways or distinct tumor compartments.