Promoter hypermethylation of SOX11 correlates with adverse clinicopathological features of human prostate cancer.

Currently available tools for early diagnosis and prognosis of prostate cancer lack sufficient accuracy. There is a need to identify novel biomarkers for this common malignancy. SOX family genes play an important role in embryogenesis and are also implicated in various cancers. SOX11 has been recently recognized as a potential tumour suppressor that is downregulated in prostate cancer. We hypothesized that hypermethylation may be responsible for SOX11 silencing in human prostate cancer. The aim of the study was to investigate SOX11 promoter methylation in prostate adenocarcinoma by comparing it with benign prostatic hyperplasia (BPH). A total of 143 human prostate tissue samples, 62 from patients with prostate cancer and 81 from patients with BPH were examined by methylation-specific PCR. Associations between SOX11 promoter methylation and clinicopathological parameters were assessed by univariate statistics. Detection rates of SOX11 promoter methylation were 80.6% and 35.8% in prostate cancer and BPH respectively (P < 0.001). SOX11 hypermethylation was associated with adverse clinicopathological characteristics of prostate cancer, including higher PSA level (P < 0.01), Gleason score ≥ 7 (P = 0.03) and perineural invasion (P = 0.03). SOX11 methylation was positively correlated with the PSA level (P = 0.001). Our data indicated that SOX11 can be a promising methylation marker candidate for differential diagnosis and risk stratification for prostate cancer.

Combination of EUS-FNA and elastography (strain ratio) to exclude malignant solid pancreatic lesions: A prospective single-blinded study.

BACKGROUND: Negative results of EUS-FNA for solid pancreatic lesions (SPL) can be false ones. Combination with strain ratio (SR) may ensure a correct benign diagnosis of SPL. AIMS: We prospectively evaluated the sensitivity rate of EUS-FNA and EUS elastography using the strain ratio method for diagnosing SPL. METHODS: Thirty-eight patients with SPL identified by CT or MRI between January 2013 and November 2013 were included in our prospective study. EUS diagnoses were made using SR by an endosonographer who was blinded to all clinical information. In SPL with adequate cellularity, the results of EUS-FNA were combined with strain ratio to diagnose SPL and the diagnostic value was calculated. RESULTS: Benign SPL were diagnosed in nine patients with surgical or guided-biopsy pathology (n = 3) and benign cells from FNA with stable disease during the 12-month follow-up time (n = 6). Using the best cut-off strain ratio level at 3.17, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rate of EUS elastography were 86.2%, 66.7%, 89.3%, 60%, and 81.6%, respectively. For the 28 patients who underwent EUS-FNA with results of adequate cellularity; EUS-FNA alone versus combination of results of cytology and SR provided sensitivity, specificity, PPV, NPV, and accuracy rate at 90% versus 95.2, 100% versus 71.4%, 100% versus 90.9%, 80% versus 83.3, and 92.9% versus 89.3%, respectively. CONCLUSIONS: In this prospective single-blinded study, the negative results of both EUS-FNA and SR were more reliable to exclude malignant SPL. The sensitivity of EUS elastography by SR was not superior to EUS-FNA. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) in the Asia Pacific region (Round Table Forum).

Clinical Epidemiology (CE) and Evidence-Based Medicine (EBM) have become increasingly important in an era of rising costs, patient safety concerns and evidence-based health care. CE and EBM research in the Asia Pacific region have grown significantly. However, there are three main challenges such as linking evidence to practice and policy; developing a strong collaborative network; and a need for resources and technical expertise to produce evidence. The Cochrane Collaboration is a possible solution to resolve above challenges identified, particularly the challenge of transforming evidence to practice. In addition, training can be carried out to enhance technical expertise in the region and there is also the promising potential that collaborations could extend beyond systematic reviews. To improve the adoption of evidence-based health policy, selection of the best evidence for the right audience and focusing on the relevant issues through appropriate methodology are essential. Information on effectiveness and cost effectiveness needs to be highlighted for policy makers. The way forward to strengthen research and capacity building is to establish the Asia Pacific Consortium for CE and EBM. The consortium would help to create mutually rewarding scientific research and collaborations that will augur well for advances in CE and EBM.

Ectopic thymoma can mimic benign and malignant thyroid lesions on fine needle aspiration cytology: a case report and literature review.

BACKGROUND: Ectopic cervical thymomas are rare and there are few descriptions of the cytologic findings based on fine needle aspiration. Their appearances can be misinterpreted as either benign or malignant lesions of the thyroid. The authors report such a case occurring in a patient with Sotos syndrome, a genetic disorder characterized by somatic overgrowth and cognitive impairment. CASE REPORT: The patient developed a neck mass that was examined first by fine needle aspiration and then by pathologic examination of the resected specimen. On fine needle aspiration, a diagnosis of papillary carcinoma of the thyroid was favoured, based on the presence of large cohesive sheets of anastomosing papillary tissue fragments with fibrovascular cores. Pathologic examination of the resection specimen showed a thymoma, subtype B3. The cytologic findings correlated with the presence of nuclear palisading of tumour cells around perivascular spaces. CONCLUSION: To the best of our knowledge, this histologic subtype of thymoma has never been reported in ectopic cervical thymic tissue, nor these particular cytologic findings that can lead to an erroneous diagnosis of thyroid carcinoma. Moreover, this is the first description of thymoma in association with Sotos syndrome.

Glycemic index and glycemic load of common fruit juices in Thailand.

BACKGROUND: The glycemic index (GI) reflects body responses to different carbohydrate-rich foods. Generally, it cannot be simply predicted from the composition of the food but needs in vivo testing. METHODS: Healthy adult volunteers with normal body mass index were recruited. Each volunteer was asked to participate in the study center twice in the first week to consume the reference glucose (50 g) and once a week thereafter to consume the study fruit juices in a random order. The study fruit juices were Florida orange juice, Tangerine orange juice, Blackcurrant mixed juice, and Veggie V9 orange carrot juice which were already available on the market. The serving size of each fruit juice was calculated to provide 50 g of glycemic carbohydrate. The fasting and subsequent venous blood samplings were obtained through the indwelling venous catheters at 0, 15, 30, 45, 60, 90, and 120 min after the test drink consumption and immediately sent for plasma glucose and insulin. GI and insulin indices were calculated from the incremental area under the curve of postprandial glucose of the test drink divided by the reference drink. Glycemic load (GL) was calculated from the GI multiplied by carbohydrate content in the serving size. RESULTS: A total of 12 volunteers participated in the study. Plasma glucose and insulin peaked at 30 min after the drink was consumed, and then started to decline at 120 min. Tangerine orange juice had the lowest GI (34.1 ± 18.7) and GL (8.1 g). Veggie V9 had the highest GI (69.6 ± 43.3) but it was in the third GL rank (12.4 g). The insulin responses correlated well with the GI. Fructose to glucose ratio was inversely associated with GI and insulin responses for all study fruit juices. Fiber contents in the study juices did not correlate with glycemic and insulin indices. CONCLUSIONS: The GIs of fruit juices were varied but consistently showed a positive correlation with insulin indices. Fruit juices with low GI are a healthier choice for people with diabetes as well as individuals who want to stay healthy since it produces more subtle postprandial glucose and insulin responses.

Sonographic focally thick duct of breast found in screening, why is it concerning? A report of three cases.

We report three cases of focally thickened ductal lesions found on screening ultrasonography with fine needle aspiration (FNA)-proven benign cytology in order to demonstrate the different fates of this radiographic finding. All three patients, aged 74, 69 and 68 years old, had their first time mammography and concurrent ultrasonography. Their mammograms did not show abnormalities except a focal asymmetry in one case. The sonographic focally thick ducts were the lesions of concern and all the patients had long-term follow-up.One patient had a slightly decreased lesion size on follow-up, likely to be a non-proliferative alteration of the breast. One patient's FNA revealed a benign papillary lesion whose ductal diameter slightly increased in size with internal echo after two years with repeat FNA demonstrating epithelial papillae consistent with intraductal papilloma. The final patient had an alteration of the imaged ductal lesion in the third year of follow-up and the final specimen after surgical wide excision that was done in the fourth year confirmed cancer. We emphasize the importance of focally thickened ductal lesions found on screening sonography and underscore their need for scrutinized characterization and long term follow-up.

Human papillomavirus genotypes among infected Thai women with different cytological findings by analysis of E1 genes.

Cervical cytological data may not be sufficient for cervical cancer screening and prevention. In this project, we determined HPV genotype among infected Thai women with different cytological findings by characterization of E1 genes. Five hundred and thirty-five specimens were tested by PCR amplification of the E1 genes. HPV genotypes were determined by sequencing, comparison with the GenBank database and were analyzed in relation to different cytological findings. HPV-DNA by PCR were typed and revealed 32 different genotypes. HR-HPV (HPV16, 18 or 52) was detected in all samples with cervical cancer cytology. HPV16 was most prevalent irrespective of cervical cytology. Moreover, HPV31 and 52 were most prevalent in the HSIL and LSIL groups whereas HPV66 was found mostly in the LSIL group. The LSIL group displayed the highest variation of HPV genotypes. Moreover, HPV31 and 52 predominated in the HSIL and LSIL groups especially HPV52 which was found in cancer samples. We hoped that these data of HPV genotypes can be used as preliminary data of HPV in Thailand and can serve as basic data for future research into the HPV genotype in south-east Asia.

Whole-genome sequence analysis of human papillomavirus type 18 from infected Thai women.

OBJECTIVE: The aim of this study was to attain molecular knowledge of human papillomavirus type 18 (HPV18) by sequencing the whole genome of HPV18 isolated from Thai women at various clinical stages of disease progression. METHOD: Our group analyzed 9 samples of whole-genome HPV18 in infected women ranging from normal to cervical cancer by PCR, a sequencing method and bioinformatics programs. RESULTS: Phylogenetic analysis based on the whole genome showed that HPV18 samples were more closely related to the European and Asian-American type than the African type. The vaccine strain's L1 nucleotide (US patent 5820870) showed a close relationship to the African type. However, our data cannot indicate the correlation between cytological data and nucleotide or amino acid variation. CONCLUSION: Our group cannot draw any inference between the clinical stage of disease progression and amino acid alterations as there were only 1 or 2 samples available for each clinical trial. However, we hope that these new data on the HPV genome, which are representative of the entire genome of HPV in Southeast Asia, can serve as basis data for future research on the pathogenesis of cervical cancer. Additionally, the second-generation HPV18 vaccines should be tested on both HPV18-L1 and HPV18-L2 for increasing potential protection.

Relationship between hybrid capture II ratios and DNA amplification of E1, E6 and L1 genes used for the detection of human papillomavirus in samples with different cytological findings.

The hybrid capture II (HCII) assay is widely used in the detection of human papillomavirus virus (HPV). However, due to the limited number of HPV genotypes, it does not permit a comprehensive typing of viruses and "grey zone" (borderline negative or positive results) are often difficult to interpret. As such, polymerase chain reaction (PCR) should be used in parallel with HCII assays, and consensus PCR detection is capable of covering a wider detection range than with the HCII method. We examined the relationship between HCII relative light unit/cutoff (RLU/CO) ratios and PCR amplification results. This was done using previously described primer sets (MY/GP) as well as with our primers for HPV E1, L1 and E6 gene amplification, and performed on samples exhibiting different cytological findings. Together, 243 samples were divided into three groups having RLU/CO ratios of < 0.4 (n = 21), 0.4-4 (n = 64) and > or = 4 (n = 158), respectively. All samples were subjected to PCR amplification using MY/GP and the newly designed E1, L1 and E6 primers. Results were verified by direct sequencing. PCR amplification sensitivities were higher when using the E1 primers than for the MY/GP, E6 or L1 primers. The E1 assay can be used for HPV detection with a sensitivity of 10(2) copies microl(-1). Samples with RLU/CO ratios exceeding 4, and grey zone samples of 0.4-4, were amplified using E1 primers in 79.74% and 26.56% of the total cases, respectively. Cytological data of grey zone samples were primarily found to be normal (77%) whereas those with RLU/CO ratios > 4 were found in any of the cytological data categories. We concluded that HPV screening by HCII for grey zone samples should be analyzed together with cytological data, as well as with a PCR screening tool that incorporates the E1 primers.

Messenger RNA expression of monocyte chemoattractant protein-1 and interleukin-6 in stone-containing kidneys.

OBJECTIVES: To investigate the intrarenal mRNA expression of monocyte chemoattractant protein-1 (MCP-1) and interleukin-6 (IL-6) in patients with nephrolithiasis, and to evaluate whether their expression is associated with renal function, as oxidative stress and inflammation are involved in the pathogenesis of nephrolithiasis. PATIENTS, SUBJECTS AND METHODS: Renal biopsies from near the stone, and blood and 24-h urine specimens were collected from 29 patients with nephrolithiasis. Control renal tissues were taken from non-cancerous and cancerous portions of nephrectomy from six patients with renal cancers, and control 24-h urine samples were obtained from 30 healthy subjects. Corrected creatinine clearance, urinary N-acetyl-beta-glucosaminidase activity and 8-hydroxy-deoxyguanosine (8-OHdG) were determined. The mRNA expressions of MCP-1 and IL-6 in the tissues were measured by real time reverse transcription-polymerase chain reaction. RESULTS: Patients with nephrolithiasis had significantly greater renal tubular damage and oxidative stress than the healthy controls. Intrarenal mRNA expressions of MCP-1 and IL-6 in stone-adjacent renal tissues were significantly lower than in cancerous renal tissues, but not statistically different from that in non-cancerous renal tissues. In stone-adjacent renal tissues, the mRNA level of MCP-1 was significantly higher than that of IL-6, but their expressions were significantly correlated with each other. Histological examination showed that the number of infiltrated leukocytes corresponded well with the intrarenal mRNA levels of MCP-1 and IL-6. Patients with nephrolithiasis and compromised renal function had significantly higher intrarenal mRNA levels of MCP-1 and IL-6 than those with preserved renal function. Also, the mRNA levels in patients with severe renal tubular damage were significantly greater than in those with less renal tubular damage. There was no association between intrarenal mRNA expression and urinary 8-OHdG. CONCLUSION: Nephrolithiasis was associated with low-grade intrarenal inflammation. A greater intrarenal mRNA expression of MCP-1 and IL-6 was associated with enhanced renal impairment. Thus, expression of MCP-1 and IL-6, at least in part, contributed to the progression of nephrolithiasis.

Expression of E-cadherin and syndecan-1 in axillary lymph node metastases of breast cancer with and without extracapsular extension.

BACKGROUND: Extracapsular extension of axillary lymph node (ECE) has significantly increased the risk of locoregional and distant recurrence in breast cancer patients. OBJECTIVE: Identify markers with high biological aggressiveness since it may serve as a prognostic indicator or adjunct to standard treatment. MATERIAL AND METHOD: The authors immunostained 115 axillary lymph nodes of invasive ductal carcinoma with syndecan-1 and E-cadherin. RESULTS: The presented data shows a significantly higher number of positive lymph node (8.48 vs. 4.15; p < 0.0001) and larger primary tumor size (3.53 vs. 2.79; p = 0.0029) in ECE patients. Sixty-one cases had node positive and without evidence of ECE, 54 cases had ECE. Syndecan-1 was found to be of significantly high expression (p = 0.001). There was no significant difference in the expression of E-cadherin during progression into extracapsular area (p = 0.12). CONCLUSION: E-cadherin displays high expression in nodal breast cancer metastases that may have re-expression and has coordinate function with syndecan-1 while invading to the surrounding fatty tissue. The protein is, therefore, likely to play a role in the invasiveness and aggressiveness.

Aberrant promoter methylation of the PAQR3 gene is associated with prostate cancer.

Methylation markers are promising tools for diagnosis, prognosis and targeted treatment of cancer. In prostate carcinoma, aberrant promoter hypermethylation occurs earlier in the disease course and more consistently than recurrent somatic mutations. PAQR3, a tumor suppressor gene, was recently found to be downregulated in prostate cancer cell lines. We hypothesized that promoter methylation could be responsible for PAQR3 silencing in prostate cancer tissues. We aimed to investigate PAQR3 promoter methylation in prostate cancer by comparing it to benign prostatic hyperplasia (BPH). A total of 154 human prostate tissue samples, including 92 cases with prostate cancer and 62 cases with BPH, were examined by methylation-specific PCR. Clinicopathological correlation between PAQR3 promoter methylation and prognostically relevant variables was studied by statistical analysis. Promoter methylation of PAQR3 was significantly more frequent in prostate carcinoma compared to BPH (73.9% vs. 25.8%, p<0.01). The high prevalence of PAQR3 methylation in cancer foci was also confirmed with microdissection technique in 12 samples of prostate adenocarcinoma. PAQR3 hypermethylation was associated with perineural invasion (p=0.03), an adverse clinicopathological feature of prostate cancer. We concluded that PAQR3 can be a promising methylation marker candidate for the detection and monitoring of prostate cancer.

Neurovascular anatomy of the penis and pelvis in Thai males: applications to male-to-female and pelvic surgeries.

OBJECTIVE: To determine the neurovascular profiles in the pelvis and penis for applying to sex reassignment surgery. MATERIAL AND METHOD: Dissection of the pelvis and penile shaft was performed in 12 soft-preserved and 32 fresh adult male cadavers respectively. The neurovascular structures were located and documented, and the distances between anatomical landmarks were measured. Thirty-two specimens from the glans penis were obtained for immunohistochemical analysis to analyze its innervation and blood supply. RESULTS: Several anatomical variations of penile arterial supply were found. They are the presence of the accessory pudendal artery, multiple cavernous and bulbourethral arteries. The unilateral dorsal artery was observed in 10 of 32 cadavers, predominantly on the left. From the root to the neck of the penis, the dorsal nerves were divided into two groups. The first group of fibers innervating the glans coursed along the dorsolateral surface of the shaft and pierced the entire area of the corona. The other group diverged to distribute throughout the lateral surface to innervate the lateral and ventral portions. The mean distance between the left and right medial main branches that terminated in the glans was 1.18 cm. Immunohistochemical analysis revealed that the main nerves, after entering the glans, divided into terminal branches that concentrated around urethra. A mean distance from the main nerves to the epithelium was 0.71 cm. CONCLUSION: This detailed anatomy in the pelvis and along the penis should provide a valuable guide for sex reassignment surgery and intrapelvic operations.

Sensitivity of mammography and ultrasonography on detecting abnormal findings of ductal carcinoma in situ.

OBJECTIVE: To analyze the mammographic and ultrasonographic findings of ductal carcinoma in situ (DCIS) and determine the sensitivity in Thai women. MATERIAL AND METHOD: Mammograms and bilateral whole-breast ultrasonograms of 37 proven cases of DCIS were reviewed. The former was assessed for microcalcifications and soft tissue densities while the latter was evaluated for masses and thickened ducts. Ultrasonography was used to spot the areas to visualize soft tissue densities in mammogram. RESULTS: Mammography detected 22 cases of DCIS having pure microcalcifications, eight cases with mixed microcalcifications and soft tissue densities, six cases with pure abnormal soft tissue densities and one case showing negative finding. The ultrasonography detected 13 cases showing masses, seven cases as showing thickened ducts and 17 cases as negative findings. CONCLUSION: Microcalcifications are characteristic findings in mammogram accounting for 81% of DCIS in the present study. Ultrasonography shows abnormalities including mass and thickened duct lesions in 54% of DCIS. The combined modalities can give the detection of abnormalities in 97% of DCIS.

Bony spicules trapped in peri-implant soft tissue: a common unrecognized finding.

According to the study, there were unexpected tiny bone spicules being inspected in peri-implant soft tissue. These displaced autogenous bone chips were probably presented when preparing implant sites. The displaced bone spicules seemed not induced significant inflammatory reactions; on contrary, defects of specimens and dissolving bone spicules pictures were demonstrated.

Polymerase chain reaction for detection of Mycobacterium tuberculosis in papanicolaou-stained fine needle aspirated smears for diagnosis of cervical tuberculous lymphadenitis.

A polymerase chain reaction (PCR) protocol for detecting IS6110 repetitive insertion sequence of Mycobacterium tuberculosis (MTB) was tested on archival Papanicolaou (Pap)-stained fine needle aspirated (FNA) smears from 24 patients with cervical tuberculous lymphadenopathy and 30 negative controls. The protocol involved protease digestion or phenolchloroform extraction, and simple or nested PCR, with PCR amplification of human beta-globin gene for internal control of DNA quality. Sensitivity of 50% and specificity of 100% were obtained. Sensitivity in smears showing necrosis without granuloma was 70% (7/10), whereas it was 36% (5/14) in smears with presence of granuloma. On the other hand, sensitivity of 18% (4/22) was obtained using FNA acid-fast stain, 25% (1/4) for acid-fast stain in histological section, 50% (2/4) for culture, and 100% (8/8) for PCR of fresh specimens. PCR for MTB detection in Papanicolaou-stained slides is a practical and valuable method when no fresh specimen but only Pap-stained smear is available.

Integrated criteria of fine-needle aspiration cytology and radiological imaging for verification of breast cancer in nonpalpable lesions.

OBJECTIVES: To evaluate the accuracy of using radiologic, cytologic and integrated radiologic and cytologic criteria in diagnosis of nonpalpable breast lesions. MATERIAL AND METHOD: From January 2003 to May 2004, a prospective study of performing fine-needle aspiration biopsy (FNAB) was carried out at King Chulalongkorn Memorial Hospital on female patients with nonpalpable or vaguely palpable lumps that needed ultrasound localization for the direction and depth. RESULTS: There were 162 lesions from 150 patients, consisting of 29 malignant neoplasms (17.9%) and 133 benign lesions (82.1%). Of the 107 classified as subcentimeter focal lesions (< 1 x 1 cm2 in size), two of radiological malignancy were false and two others were falsely negative by cytology. While the 23 large/ill-defined lesions (> 1.5 x 1.5 cm2 in size), one hiding malignant lesion adjacent to a prominent intraduct papilloma was missed. Two others had falsely negative cytologic diagnosis. The integrated criteria achieved accuracy and sensitivity of 97.5% and 93% compared with the cytology, 96.3% and 82.8% and the better scenario of radiology, 95.7% and 82.8% respectively. CONCLUSION: The integrated criteria provide the most accuracy rate and sensitivity rate for detection of malignancy in nonpalpable breast lesions.

TROP-2 immunohistochemistry: a highly accurate method in the differential diagnosis of papillary thyroid carcinoma.

We aimed to evaluate the diagnostic utility of the novel immunohistochemical marker TROP-2 on thyroid specimens (226 tumours and 207 controls). Whole slide immunohistochemistry was performed and scored by automated digital image analysis. Non-neoplastic thyroid, follicular adenomas, follicular carcinomas, and medullary carcinomas were negative for TROP-2 immunostaining. The majority of papillary thyroid carcinoma (PTC) specimens (94/114, 82.5%) were positive for TROP-2; however, the pattern of staining differed significantly between the histopathological variants. All papillary microcarcinomas (mPTC), PTC classic variant (PTC cv), and tall cell variant (PTC tcv) were TROP-2 positive, with mainly diffuse staining. In contrast, less than half of the PTC follicular variant specimens were positive for TROP-2, with only focal immunoreactivity. TROP-2 could identify PTC cv with 98.1% sensitivity and 97.5% specificity. ROC curve analysis found that the presence of >10% of TROP-2 positive cells in a tumour supported a diagnosis of PTC. The study of intratumoural heterogeneity showed that low-volume cytological samples of PTC cv could be adequately assessed by TROP-2 immunostaining. The TROP-2 H-score (intensity multiplied by proportion) was significantly associated with PTC variant and capsular invasion in encapsulated PTC follicular variant (p<0.001). None of the baseline (age, gender) and clinical (tumour size, nodal disease, stage) parameters were correlated with TROP-2 expression. In conclusion, TROP-2 membranous staining is a very sensitive and specific marker for PTC cv, PTC tcv, and mPTC, with high overall specificity for PTC.

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of solid pancreatic lesions (ENES): a pilot study.

BACKGROUND AND STUDY AIMS: Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy (EUS-nCLE) has been shown to aid in the diagnosis of cystic pancreatic lesions. This is a pilot project to study its findings in patients with solid pancreatic lesions (SPLs) with a prospective single-blinded study design. METHODS: Patients with SPLs undergoing trans-gastric EUS fine needle aspiration (EUS-FNA) from July 2013 to March 2014 were prospectively enrolled. The nCLE diagnoses were compared with the final diagnoses. Researchers learned about the EUS-nCLE findings from previously published studies and applied it to diagnose SPLs. In the meantime, the findings were recorded. RESULTS: In total, 22 patients were recruited (mean age 62.7 years, SD 13.8 years; 14 men and eight women). The mean maximal tumor diameter was 36.0 mm (SD 10.9 mm). EUS-nCLE yielded satisfactory images in all patients during the first EUS procedure and diagnosed benign and malignant SPLs in 3 and 19 patients, respectively. Final diagnoses of malignant SPLs were made in 19 patients. Benign SPLs were eventually diagnosed in three patients, with confirmed the cytology and disease stability during the 12-month follow-up period. At the end of the project, based on the results of this current study, EUS-nCLE findings for malignant SPLs were dark clumping with or without dilated vessels (> 40 µm). There were two criteria for diagnosing benign lesions which were white fibrous bands and normal acini cells. The accuracy rate of EUS-nCLE was 90.9 % (20/22). One falsely diagnosed malignant SPL was an inflammatory mass from a recent acute pancreatitis. Another one with a pancreatic neuroendocrine tumor presenting with a symptomatic pseudocyst was incorrectly diagnosed as an inflammatory mass. This was likely from sampling error of the EUS-nCLE probe in an inflammatory area. Only one patient had post EUS-FNA bleeding but did not require a blood transfusion. The inter-observer agreement among three blinded endoscopists was almost perfect (Kappa 0.82). CONCLUSION: EUS-nCLE is a promising technique for the diagnosis of SPLs with good inter-observer agreement. Study registration : TCTR20140402001.

Direct measurement of gastric H+/K+-ATPase activities in patients with or without Helicobacter pylori-associated chronic gastritis.

AIM: The role of Helicobacter pylori (H pylori) infection in gastric acid secretion of patients with chronic gastritis remains controversial. This study was designed to elucidate the effect of H pylori on H+/K+-ATPase activities in gastric biopsy specimens. METHODS: Eighty-two patients with chronic gastritis who had undergone upper endoscopy were included in this study. H pylori infection was confirmed by rapid urease test and histology. Gastric H+/K+-ATPase activities and serum gastrin concentrations were measured by an enzymatic method and radioimmunoassay, respectively. For those patients who received triple therapy for eradicating H pylori, changes in the activity of gastric H+/K+-ATPase and serum gastrin levels were also measured. RESULTS: The mean gastric H+/K+-ATPase activity in H pylori-positive group (42 patients) was slightly higher than that in H pylori-negative group (29 patients) (169.65+/-52.9 and 161.38+/-43.85 nmol Pi/(mg.h), respectively, P=0.301). After eradication of H pylori, the gastric H+/K+-ATPase activities slightly decreased compared to prior therapy (165.03+/-59.50 and 158.42+/-38.93 nmol Pi/(mg.h), respectively, P=0.805). The mean basal gastrin concentration was slightly higher in H pylori-positive patients than in H pylori-negative patients (87.92+/-39.65 pg/mL vs 75.04+/-42.57 pg/mL, P=0.228). The gastrin levels fell significantly after the eradication of H pylori. (Before treatment 87.00+/-30.78 pg/mL, after treatment 64.73+/-18.96 pg/mL, P=0.015). CONCLUSION: Gastric H+/K+-ATPase activities are not associated with H pylori status in patients with chronic gastritis.