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AIM: Gemcitabine has been increasingly prescribed for the treatment of gallbladder cancer. However, the response rate is low. The aim of this study is to determine whether icariin, a flavonoid isolated from Epimedi herba, could potentiate the antitumor activity of gemcitabine in gallbladder cancer. METHODS: Human gallbladder carcinoma cell lines GBC-SD and SGC-996 were tested. Cell proliferation and apoptosis were analyzed using MTT assay and flow cytometry, respectively. The expression of apoptosis- and proliferation-related molecules was detected with Western blotting. Caspase-3 activity was analyzed using colorimetric assay, and NF-κB activity was measured with ELISA. A gallbladder cancer xenograft model was established in female BALB/c (nu/nu) mice. The mice were intraperitoneally administered gemcitabine (125 mg/kg) in combination with icariin (40 mg/kg) for 2 weeks. RESULTS: Icariin (40-160 µg/mL) dose-dependently suppressed cell proliferation and induced apoptosis in both GBC-SD and SGC-996 cells, with SGC-996 cells being less sensitive to the drug. Icariin (40 µg/mL) significantly enhanced the antitumor activity of gemcitabine (0.5 µmol/L) in both GBC-SD and SGC-996 cells. The mice bearing gallbladder cancer xenograft treated with gemcitabine in combination with icariin exhibited significantly smaller tumor size than the mice treated with either drug alone. In GBC-SD cells, icariin significantly inhibited both the constitutive and gemcitabine-induced NF-κB activity, enhanced caspase-3 activity, induced G(0)-G(1) phase arrest, and suppressed the expression of Bcl-2, Bcl-xL and surviving proteins. CONCLUSION: Icariin, by suppressing NF-κB activity, exerts antitumor activity, and potentiates the antitumor activity of gemcitabine in gallbladder cancer. Combined administration of gemcitabine and icariin may offer a better therapeutic option for the patients with gallbladder cancer.
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Anti-Inflamatórios/farmacologia , Antineoplásicos/farmacologia , Desoxicitidina/análogos & derivados , Flavonoides/farmacologia , Neoplasias da Vesícula Biliar/tratamento farmacológico , Vesícula Biliar/efeitos dos fármacos , NF-kappa B/antagonistas & inibidores , Animais , Anti-Inflamatórios/uso terapêutico , Antineoplásicos/uso terapêutico , Apoptose/efeitos dos fármacos , Pontos de Checagem do Ciclo Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Desoxicitidina/farmacologia , Desoxicitidina/uso terapêutico , Sinergismo Farmacológico , Medicamentos de Ervas Chinesas/farmacologia , Medicamentos de Ervas Chinesas/uso terapêutico , Feminino , Flavonoides/uso terapêutico , Vesícula Biliar/imunologia , Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/imunologia , Neoplasias da Vesícula Biliar/patologia , Humanos , Camundongos , Camundongos Endogâmicos BALB C , NF-kappa B/imunologia , GencitabinaRESUMO
OBJECTIVES: The purpose of this study was to evaluate the influence of the serum prostate-specific antigen (PSA) level, prostate volume, and PSA density on prostate cancer detection with contrast-enhanced sonography using contrast-tuned imaging technology compared with baseline imaging (combination of grayscale and power Doppler imaging). METHODS: In all, 161 patients were evaluated with grayscale, power Doppler, and contrast-tuned imaging. Biopsy was performed at 10 sites in each patient. When an abnormality was shown on any of these examinations, the biopsy was directed toward the abnormality. Cancer detection between contrast-tuned imaging and baseline imaging was compared for different subgroups according to PSA level (4-10, 10-20, and >20 ng/mL), prostate volume (<35, 35-50, 50-65, and >65 mL), and PSA density (<0.15, 0.15-0.30, 0.30-0.50, and >0.50). RESULTS: In total, 413 sites were malignant in 78 patients. By biopsy site, the accuracy was greater for contrast-tuned imaging than for baseline imaging in all PSA level, prostate volume, and PSA density subgroups except 0.30 to 0.50 (all P < .05). Contrast-tuned imaging had significantly higher sensitivity in the subgroups with PSA levels between 4 and 20 ng/mL, prostate volumes between 35 and 65 mL, and PSA densities between 0.15 and 0.50 than baseline imaging (all P < .05); it also had significantly higher specificity for all PSA level subgroups except 10 to 20 ng/mL, all prostate volume subgroups except 35 to 50 mL, and all PSA density subgroups except 0.30 to 0.50 (all P < .05). CONCLUSIONS: Contrast-tuned imaging could improve cancer detection over baseline imaging in patients with different PSA levels, prostate volumes, and PSA densities.
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Biomarcadores Tumorais/sangue , Fosfolipídeos , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Hexafluoreto de Enxofre , Ultrassonografia/métodos , Ultrassonografia/estatística & dados numéricos , Idoso , China/epidemiologia , Meios de Contraste , Humanos , Masculino , Tamanho do Órgão , Prevalência , Neoplasias da Próstata/epidemiologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Carga TumoralRESUMO
UNLABELLED: Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? The present study was to perform contrast-tuned imaging (CnTI) technology to detect prostate cancer and compare the use of CnTI technology for the detection of prostate cancer with conventional ultrasonography. The preliminary data from our study suggested that targeted biopsy of the prostate with CnTI technology could improve the cancer detection and detect higher grade prostate cancers. OBJECTIVES: To perform contrast-enhanced ultrasonography (CEUS) using contrast-tuned imaging (CnTI) technology to detect prostate cancer. To evaluate the detection of prostate cancer with CnTI compared with conventional grey-scale and power Doppler ultrasonography. PATIENTS AND METHODS: In all, 150 patients referred for prostate biopsy were evaluated using transrectal grey-scale, power Doppler and CnTI ultrasonography. Biopsy was performed at 10 sites in each patient. If an abnormality was found at any of these three ultrasonography examinations, a biopsy specimen was targeted towards from the corresponding site. The performances of the three ultrasonography techniques for prostate cancer detection were compared. RESULTS: Prostate cancer was detected at 383 sites from 73 patients. The combination of these three examinations detected more patients with prostate cancer than grey-scale (P= 0.002), power Doppler (P= 0.001) or baseline imaging (the combination of grey-scale and power Doppler; P= 0.031) alone. By biopsy site, CnTI had higher sensitivity and accuracy (73.1% and 83.7%) than grey-scale (50.9%; P < 0.001 and 78.8%; P < 0.001) or power Doppler (48.3%; P < 0.001 and 77.7%; P < 0.001), while the specificity was similar for grey-scale (88.4%), power Doppler (87.8%) and CnTI (87.3%; P > 0.05 in each case). CnTI had higher sensitivity (73.1% vs 62.9%; P < 0.001), specificity (87.3% vs 82.1%; P < 0.001) and accuracy (83.7% vs 77.2%; P < 0.001) than baseline imaging. The mean Gleason score of CnTI-positive cases was significantly higher than CnTI-negative cases (7.1 vs 6.3; P= 0.002). CONCLUSIONS: CEUS using CnTI technology enables a visualization of the microvasculature associated with prostate cancer. CnTI technology could be used to guide biopsy and improve the detection rate of prostate cancer. CnTI technology was able to detect higher grade prostate cancers.
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Meios de Contraste , Aumento da Imagem , Fosfolipídeos , Neoplasias da Próstata/diagnóstico por imagem , Hexafluoreto de Enxofre , Ultrassonografia Doppler em Cores , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes , Neoplasias da Próstata/patologiaRESUMO
PURPOSE: We prospectively compared clinical response and penile color duplex ultrasound results of oral tadalafil 20 mg plus low dose intracavernous injection of vasoactive agents with those of intracavernous injection and oral tadalafil 20 mg alone. We also observed the best approach to facilitate penile color duplex ultrasound and that most preferred by patients. MATERIALS AND METHODS: All 56 patients with erectile dysfunction underwent penile color duplex ultrasound 3 times at an interval of at least 1 week using different pharmacological induction methods, including tadalafil mode (20 mg tadalafil), intracavernous injection mode (30 to 60 mg papaverine) and mixed mode (15 mg papaverine plus 20 mg tadalafil). Ultrasound parameters included peak systolic and end diastolic velocity, resistance index and acceleration time. Clinical response was assessed by the erection hardness score. Patient preference was determined when all tests were finished. RESULTS: For penile color duplex ultrasound parameters no significant difference was observed between intracavernous injection and mixed modes. However, for tadalafil mode peak systolic velocity of the 2 cavernous arteries measured 15 minutes after induction were significantly lower than for intracavernous injection and mixed modes. Also, acceleration time of the right cavernous artery measured 5 minutes after induction and left cavernous artery measured 15 minutes after induction in tadalafil mode were significantly shorter than those in intracavernous injection and mixed modes. No severe side effect occurred in tadalafil and mixed modes but 2 patients experienced priapism in intracavernous injection mode. Of the patients 55.4% preferred tadalafil mode, an incidence significantly higher than intracavernous injection (16.1%) and mixed (28.5%) modes. CONCLUSIONS: Oral tadalafil plus low dose vasodilator led to a significantly better clinical response than high dose vasodilator. Penile color duplex ultrasound parameters showed no difference between the 2 modes. Thus, this mixed mode emerges as a possible alternative to high dose vasodilator injection.
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Carbolinas/administração & dosagem , Disfunção Erétil/diagnóstico por imagem , Disfunção Erétil/tratamento farmacológico , Pênis/diagnóstico por imagem , Inibidores da Fosfodiesterase 5/administração & dosagem , Ultrassonografia Doppler em Cores , Vasodilatadores/administração & dosagem , Administração Oral , Adulto , Idoso , Quimioterapia Combinada , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tadalafila , Adulto JovemRESUMO
BACKGROUND: To evaluate the effectiveness of contrast-enhanced sonographic micro flow imaging (MFI) in the diagnosis of prostate cancer. METHODS: A total of 74 patients referred for prostate biopsy were prospectively evaluated with MFI. The abnormalities were categorized into four patterns: pattern 1: indistinct separation between the inner and outer gland; pattern 2: asymmetrical or focally increased enhancement in the outer gland; pattern 3: enhancement with focal defect; pattern 4: enhancement in the outer gland equal to that of the inner gland. The findings were correlated with Gleason scores. RESULTS: Prostate cancer was detected in 264 sites in 41 patients. The sensitivity, specificity, accuracy, and positive and negative predictive values for MFI were 81.1%, 84.3%, 83.3%, 68.6%, and 91.3%, respectively. Positive predictive values for the four patterns were 46.0 (pattern 1), 53.6 (pattern 2), 94.3 (pattern 3), and 95.4 (pattern 4). Gleason scores of cancers with patterns 3 (7.09) or 4 (7.51) were significantly higher than those with patterns 1 (6.17) or 2 (6.59) (p = 0.001, p = 0.005, p < 0.001, p < 0.001). CONCLUSIONS: Some MFI patterns had high positive predictive values and were associated with more aggressive cancers. This could be used to reduce the number of biopsy sites and detect clinically significant cancers.
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Endossonografia/métodos , Aumento da Imagem/métodos , Antígeno Prostático Específico/análise , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Idoso , Biópsia por Agulha , Meios de Contraste , Humanos , Masculino , Microcirculação , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To study the anticancer effects of tea polyphenols on colorectal cancer with microsatellite instability (MSI) in nude mice and to explore its mechanism. METHODS: A colostomy was performed on the caecum of nude mice. Tumor fragments collected from the subcutaneous tumor of hMSH2-absence colon carcinoma Lovo cell line were surgically implanted onto the submucosa of the caecum during colostomy to establish the model. Then, the nude mice were divided into untreated group and 50, 75 and 100 mg/kg tea polyphenols groups. The mice in tea polyphenols-treated groups were given intra-abdominal injection of 50, 75 and 100 mg/kg tea polyphenols respectively. The inhibition rates of tumors were calculated, and microsatellite instability (MSI) and the alteration of transforming growth factor-beta1 (TGF-beta1), TGF-beta2 and insulin-like growth factor (IGF) were detected by Genescan method at different times after the injection. RESULTS: The tumor volumes of the three groups began to decrease at the 1st week and decreased most greatly from 2 to 3 weeks after treatment, and then the tumors tended to increase. The study found that tea polyphenols could inhibit the tumor growth. The tumor inhibition rates in the three treated groups were significantly higher than those in untreated group 1, 2, 3 and 4 weeks after treatment (P<0.01). Detection of MSI showed that the colorectal tumor in the untreated group presented with four MSI signs, including BAT-25, D2S123, D5S346 and D17S250, and TGF-beta1, TGF-beta2, IGF expressions. After using the tea polyphenols, the microsatellite tended to become stable. CONCLUSION: Tea polyphenols can inhibit the mismatch-repair-gene deficient colorectal cancer in nude mice by down-regulating the microsatellite instability.
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Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/genética , Instabilidade de Microssatélites , Polifenóis/uso terapêutico , Chá/química , Animais , Neoplasias Colorretais/metabolismo , Feminino , Masculino , Camundongos , Camundongos Nus , Somatomedinas/metabolismo , Fator de Crescimento Transformador beta1/metabolismo , Fator de Crescimento Transformador beta2/metabolismoRESUMO
OBJECTIVE: To evaluate the ability of contrast-enhanced transrectal ultrasound (CETRUS) scanning for prostate cancer detection in different area, compared with conventional transrectal ultrasound (TRUS). METHODS: 228 patients underwent TRUS-guided prostate biopsy after examinations of TRUS and CETRUS scanning. Cancer detection between CETRUS and TRUS were compared by patient and by site in different areas (right, left; base, mid-gland, apex). The receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance of CETRUS. RESULTS: 89 patients were malignant and 48 patients were significant cancer. Compared with TRUS, CETRUS could increase the detection rates of overall and significant cancer (Pâ=â0.008; Pâ=â0.031). CETRUS had higher sensitivity, specificity (except right lobe), accuracy, positive predictive value (PPV) and negative predictive value (NPV) in total, right and left lobe (Pâ<â0.05). The sensitivity were greater for CETRUS in all areas except left base and right apex (Pâ<â0.05). The accuracy were greater for CETRUS in all areas except left mid-gland and right apex (Pâ<â0.05). ROC analysis showed CETRUS totally got the AUC of 0.816. The AUC was higher in left lobe than right lobe (0.837 vs. 0.793). It was most accurate at the base (0.833), then mid-gland (0.826), and lowest in apex (0.772). CONCLUSIONS: CETRUS had a significant advantage over conventional TRUS for prostate cancer detection in different areas. CETRUS much more easily missed the cancer in apex, we must focus more on apex and may add other imaging modalities to improve the visualization and detection of prostate cancer.
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Neoplasias da Próstata/diagnóstico por imagem , Ultrassom Focalizado Transretal de Alta Intensidade/métodos , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologiaRESUMO
Purpose: To evaluate the efficacy of transrectal ultrasound five-grade scoring system (TRUS-5) in predicting prostate cancer (PCa) and high grade PCa (HGPCa), compared with TRUS two-grade scoring system (TRUS-2), and establish a TRUS-5 based nomogram for the prediction of PCa and HGPCa at initial biopsy (IPBx). Methods: Data were collected from 862 men who underwent initial TRUS-guided 12-core prostate biopsy. Age, prostate-specific antigen (PSA), percent free PSA, digital rectal examination (DRE), prostate volume (PV), PSA density (PSAD) and TRUS findings were included in the analysis. For TRUS-5, the probability of PCa was quantified on a scale from 1 (benign) to 5 (malignant). TRUS-2 used the grades "normal" and "suspicious". After univariate and multivariate logistic regression analyses, nomogram models were developed and internally validated based on independent predictors to predict the probability of PCa and HGPCa. Results: Overall PCa was detected in 42% (362/862) with 26.22% (226/862) showing HGPCa. TRUS-5 significantly outperformed TRUS-2 for the risk prediction of PCa and HGPCa (area under the receiver operating characteristic curve [AUC]: 0.787 vs. 0.694 for PCa, 0.841 vs. 0.713 for HGPCa, P<0.05). The TRUS-5 based nomogram showed higher AUCs (0.905 for PCa, 0.903 for HGPCa) than PSA alone, clinical base model, the TRUS-2 based model, and other predictive models (P<0.05). Conclusions: TRUS-5 represents a better imaging predictor than TRUS-2 for PCa and HGPCa. Our TRUS-5 based nomogram models performed well for the prediction of PCa and HGPCa at IPBx, which may help to make the decision to biopsy.
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AIM: To detect the expression of CD44 correlated with the ability of micro-metastasis in peripheral blood and bone marrow of patients with gastric cancer and to deduce its clinical significance. METHODS: Preoperative peripheral blood and bone marrow specimens from 46 patients with gastric cancer and 6 controls were studied by semi-quantitative RT-PCR amplification of CD44v6mRNA. Preoperative and postoperative peripheral blood specimens from 40 patients with gastric cancer and 14 controls were studied by quantitative RT-PCR amplification of CD44v6mRNA in the corresponding period. RESULTS: Semi-quantitative RT-PCR amplification showed that CD44v6mRNA expression of peripheral blood and bone marrow was positive in 39 (84.8%) and 40 (86.9%) of 46 patients with gastric cancer, respectively. In peripheral blood, CD44v6mRNA expression was positive for diffuse type in 30 (93.8%) of 32 patients and for intestinal type in 9 (64.3%) of 14 patients. On the other hand, in bone marrow, CD44v6mRNA expression was positive for diffuse type in 31 (96.9%) of 32 patients and for intestinal type in 10 (71.4%) of 14 patients. There was a significant difference between the diffuse type and intestinal type. Quantitative RT-PCR amplification demonstrated that CD44v6mRNA was not expressed in the peripheral blood of controls and CD44v6mRNA expression was positive for preoperative peripheral blood in 40 patients with gastric cancer, the expression levels being from 4.9 x 10(8) - 3.2 x 10(11) copies/g RNA. The average expression level of CD44v6mRNA in peripheral blood was 3.9 x 10(10) copies/g RNA. The expression levels of CD44v6mRNA in peripheral blood in gastric cancer patients after curative operation increased from 5.5 x 10(6) to 7.6 x 10(9) copies/g RNA and the average level was 2.4 x 10(8) copies/g RNA (Figure 3B) (P = 0.00496). After curative operation, the expression level decreased markedly. CONCLUSION: Semi-quantitative and quantitative RT-PCR amplification for CD44v6mRNA is a sensitive and specific method for the detection of micro-metastasis in peripheral blood and bone marrow, which might be used as an indicator of tumor burden and therapeutic effect.
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Medula Óssea/metabolismo , Glicoproteínas/genética , Receptores de Hialuronatos/genética , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Calibragem , Feminino , Glicoproteínas/sangue , Humanos , Receptores de Hialuronatos/sangue , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , RNA Mensageiro/análise , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
OBJECTIVE: To investigate the influences of patient-controlled intravenous analgesia (PCIA) with small dose of ketamine solely or combined with fentanyl during shock stage on cytokine balance in patients with severe burn. METHODS: Forty-five patients with severe burn and hospitalized within 24 hours after injury were randomly divided into three groups (n=15 in each group): conventional analgesia therapy group (group CAT), patient controlled intravenous ketamine analgesia group (group PCIKA, intravenous small dose ketamine), and patient controlled intravenous ketamine and fentanyl analgesia group (group PCIKFA, intravenous small dose ketamine combined with fentanyl). In group CAT, patients received intramuscular injection of pethidine 50 mg and phenergan 25 mg when patients complained of pain. In group PCIKA, patients received intravenous infusion with a mixture of ketamine 20 g/L + droperidol 50 mg/L, and in group PCIKFA with a mixture of ketamine 10 g/L + fentanyl 5 mg/L + droperidol 50 mg/L. In two groups of PCIA, patients received loading dose of 1 ml, with background infusion of 1.5 ml/h. Pain scores and side effects of analgesics were determined or observed at the time points of before analgesia and 1, 8, 24, 48 hours after analgesia, and serum cytokines [including interleukin-1 (IL-1), IL-6, tumor necrosis factor-alpha (TNF-alpha)] were measured at the same time points. RESULTS: Pain scores in PCIFA and PCIKFA groups were significantly lower than that of before analgesia and group CAT (all P<0.01). There were no significant differences in heart rate (HR) and mean artery pressure (MAP) in three groups. No significant difference in side effects was found in three groups. The serum levels of cytokines were significantly lower in two PCIA groups than those of group CAT (all P<0.01). CONCLUSION: Patient-controlled intravenous analgesia with small doses of ketamine or combined with fentanyl during shock stage in patients with severe burn give efficient and safe pain relief, and cytokine balance.
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Analgesia Controlada pelo Paciente , Queimaduras/terapia , Ketamina/administração & dosagem , Choque/terapia , Adulto , Queimaduras/sangue , Feminino , Humanos , Injeções Intravenosas , Interleucina-1/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Fator de Necrose Tumoral alfa/sangue , Adulto JovemRESUMO
The current study aimed to present the neuroradiological and histopathological features of intracranial hemangioendothelioma (HE). The computed tomography (CT; n=3) and magnetic resonance imaging (MRI; n=7) features, and the clinical presentations of 7 patients with pathologically documented HEs were retrospectively analyzed. Lesions were observed in the right side of the skull (the frontal bone in 1 patient and the parietal bone in 1 patient), the tentorium (2 patients), the cerebral falx (1 patient), the right cavernous sinus (1 patient) and the right temporal lobe (1 patient). The tumor was lobulated in 5 cases and round in 2 cases. The majority of tumors appeared isointense or hypointense with multiple scattered hyperintensities on T1-weighted MRI. Moreover, the lesions appeared as inhomogeneous hyperintense regions with multiple enlarged and tortuous blood flow voids on T2-weighted MRI. The lesions also showed marked gadolinium enhancement in a honeycomb pattern. CT scan results showed a isoattenuation region (32-47 HU), with numerous small, round, high-density foci. The 2 cases with skull lesions presented with local bone destruction and discontinuous bone lines of the tabula interna ossis cranii. In 1 case, MR angiography revealed abnormal vessels in the basilar region. A total of 4 cases were epithelial HE, 2 were retiform HE and 1 was kaposiform HE. Histological examination revealed endothelial cell proliferation with vascular lesions and a mucous matrix or dense fibrous mesenchyme. In conclusion, intracranial HE is rare, but should be considered in the differential diagnosis when evaluating intracranial neoplasms. A well-defined lobulated mass and imaging features that include internal heterogeneity, small scattered hemorrhages and thromboses, signal voids of vessels, and marked and delayed enhancement may confirm the diagnosis of HE.
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AIM: To study the portal hemodynamics and their relationship with the size of esophageal varices seen at endoscopy and to evaluate whether these Doppler ultrasound parameters might predict variceal bleeding in patients with liver cirrhosis and portal hypertension. METHODS: One hundred and twenty cirrhotic patients with esophageal varices but without any previous bleeding were enrolled in the prospective study. During a 2-year observation period, 52 patients who had at least one episode of acute esophageal variceal hemorrhage constituted the bleeding group, and the remaining 68 patients without any previous hemorrhage constituted the non-bleeding group. All patients underwent endoscopy before or after color Doppler-ultrasonic examination, and images were interpreted independently by two endoscopists. The control group consisted of 30 healthy subjects, matched to the patient group in age and gender. Measurements of diameter, flow direction and flow velocity in the left gastric vein (LGV) and the portal vein (PV) were done in all patients and controls using color Doppler unit. After baseline measurements, 30 min after oral administration of 75 g glucose in 225 mL, changes of the diameter, flow velocity and direction in the PV and LGV were examined in 60 patients with esophageal varices and 15 healthy controls. RESULTS: The PV and LGV were detected successfully in 115 (96%) and 105 (88%) of 120 cirrhotic patients, respectively, and in 27 (90%) and 21 (70%) of 30 healthy controls, respectively. Among the 120 cirrhotic patients, 37 had F1, 59 had F2, and 24 had F3 grade varices. Compared with the healthy controls, cirrhotic group had a significantly lower velocity in the PV, a significantly greater diameter of the PV and LGV, and a higher velocity in the LGV. In the cirrhotic group, no difference in portal flow velocity and diameter were observed between patients with or without esophageal variceal bleeding (EVB). However, the diameter and blood flow velocity of the LGV were significantly higher for EVB (+) group compared with EVB (-) group (P < 0.01). Diameter of the LGV increased with enlarged size of varices. There were differences between F1 and F2, F1 and F3 varices, but no differences between F2 and F3 varices (P = 0.125). However, variceal bleeding was more frequent in patients with a diameter of LGV >6 mm. The flow velocity in the LGV of healthy controls was 8.70+/-1.91 cm/s (n = 21). In patients with liver cirrhosis, it was 10.3+/-2.1 cm/s (n = 12) when the flow was hepatopetal and 13.5+/-2.3 cm/s (n = 87) when it was hepatofugal. As the size of varices enlarged, hepatofugal flow velocity increased (P < 0.01) and was significantly different between patients with F1 and F2 varices and between patients with F2 and F3 varices. Variceal bleeding was more frequent in patients with a hepatofugal flow velocity >15 cm/s (32 of 52 patients, 61.5%). Within the bleeding group, the mean LGV blood flow velocity was 16.6+/-2.62 cm/s. No correlation was observed between the portal blood flow velocity and EVB. In all healthy controls, the flow direction in the LGV was hepatopetal, toward the PV. In patients with F1 varices, flow direction was hepatopetal in 10 patients, to-and-fro state in 3 patients, and hepatofugal in the remaining 18. The flow was hepatofugal in 91% patients with F2 and all F3 varices. Changes in diameter of the PV and LGV were not significant before and after ingestion of glucose (PV: 1.41+/-1.5 cm before and 1.46+/-1.6 cm after; LGV: 0.57+/-1.7 cm before and 0.60+/-1.5 cm after). Flow direction in the LGV was hepatopetal and to-and-fro in 16 patients and hepatofugal in 44 patients before ingestion of glucose. Flow direction changed to hepatofugal in 9 of 16 patients with hepatopetal and to-and-fro blood flow after ingestion of glucose. In 44 patients with hepatofugal blood flow in the LGV, a significant increase in hepatofugal flow velocity was observed in 38 of 44 patients (86%) with esophageal varices. There was a relationship between the percentage changes in flow velocity and the size of varices. Patients who responded excessively to food ingestion might have a high risk for bleeding. The changes of blood flow velocity in the LGV were greater than those in the PV (LGV: 28.3+/-26.1%, PV: 7.2+/-13.2%, P < 0.01), whereas no significant changes in the LGV occurred before and after ingestion of glucose in the control subjects. CONCLUSION: Hemodynamics of the PV is unrelated to the degree of endoscopic abnormalities in patients with liver cirrhosis. The most important combinations are endoscopic findings followed by the LGV hemodynamics. Duplex-Doppler ultrasonography has no value in the identification of patients with cirrhosis at risk of variceal bleeding. Hemodynamics of the LGV appears to be superior to those of the PV in predicting bleeding.
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Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/fisiopatologia , Circulação Hepática , Ultrassonografia Doppler em Cores , Feminino , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/fisiopatologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos ProspectivosRESUMO
AIM: To investigate the relationship between methylation of Syk (spleen tyrosine kinase) gene in promoter region and oncogenesis, metastasis of gastric carcinoma. The relation between silencing of the Syk gene and methylation of Syk promoter region was also studied. METHODS: By using methylation-specific PCR (MSP) technique, the methylation of Syk promoter region in specimens from 61 gastric cancer patients (tumor tissues and adjacent normal tissues) was detected. Meanwhile, RT-PCR was used to analyse syk expression exclusively. RESULTS: The expression of the Syk gene was detected in all normal gastric tissues. Syk expression in gastric carcinoma was lower in 14 out of 61 gastric cancer samples than in adjacent normal tissues (chi(2)=72.3, P<0.05). No methylation of Syk promoter was found in adjacent normal tissues. hypermethylation of Syk gene in promoter was detected 21 cases in 61 gastric carcinoma patients. The rate of methylation of Syk promoter in gastric carcinoma was higher than that in adjacent normal tissues (chi(2)=25.1, P<0.05). In 31 patients with lymph node metastasis, 17 were found with Syk promoter methylation. A significant difference was noted between two groups (chi(2)=11.4,P<0.05). CONCLUSION: Hypermethylation leads to silencing of the Syk gene in human gastric carcinoma. Methylation of Syk promoter is correlated to oncogenesis and metastasis of gastric carcinoma. Syk is considered to be a potential tumor suppressor and anti-metastasis gene in human gastric cancer.
Assuntos
Metilação de DNA , Precursores Enzimáticos/genética , Proteínas Tirosina Quinases/genética , Neoplasias Gástricas/fisiopatologia , Neoplasias Gástricas/secundário , Adulto , Idoso , Feminino , Regulação Enzimológica da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Humanos , Peptídeos e Proteínas de Sinalização Intracelular , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Regiões Promotoras Genéticas/fisiologia , RNA Mensageiro/análise , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Neoplasias Gástricas/genética , Quinase SykRESUMO
AIM: To evaluate the tumor-positive ratio and number of perigastric lymph nodes as prognostic factors of gastric carcinoma in surgically-treated patients. METHODS: The postoperative survival of 169 patients with gastric cancer who were performed D2 curative gastrectomy was analyzed with regard to its lymph node metastasis ratio and number. Meanwhile correlation of tumor-positive ratio and number of perigastric lymph nodes with pathological parameters of these patients was studied. RESULTS: The overall 5-year survival rate of all the patients studied was 29.6%. The 5-year cumulative survival rate in patients with 1%-20% and more than 20% of tumor-positive lymph nodes was 70.6% and 12.0% respectively, and 46.6% and 17.4% in those with 1-5 and more than 5 of tumor-positive lymph nodes respectively, which were significantly decreased with the increment of involved lymph nodes assessed by either numbers or ratio (P<0.05). Multiple stepwise regression analysis showed that both the positive ratio and number of tumor-involved lymph nodes were sensitive prognostic factors in these surgically-treated patients, which were also significantly correlated with tumor size and depth of submucosal invasion (P<0.05). CONCLUSION: Tumor-positive ratio and number of perigastric lymph nodes are associated with cancer progression and five-year survival rate, and may serve as valuable prognostic factors of gastric cancer in surgically-treated patients.
Assuntos
Linfonodos/patologia , Neoplasias Gástricas , Adulto , Idoso , Feminino , Gastrectomia , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/secundário , Neoplasias Gástricas/cirurgia , Análise de SobrevidaRESUMO
AIM: To investigate the relationship between the expression of vascular cell adhesion molecule-1 (VCAM-1) and oncogenesis, tumor angiogenesis and metastasis in gastric carcinoma, and to evaluate the clinical significance of serum VCAM-1 levels in gastric cancer. METHODS: Specimens from 41 patients with gastric cancer, 8 patients with benign gastric ulcer, and 10 healthy subjects were detected for the expression of VCAM-1 by immunohistochemistry. Microvessel density (MVD) was measured by counting the endothelial cells immunostained with the monoclonal antibody CD34 at x200 magnification. Serum VCAM-1 concentrations were measured by an enzyme linked immunosorbent assay in the 41 gastric cancer patients before surgery, and at 7 days after surgery as well as in 25 healthy controls. The association between preoperative serum VCAM-1 levels and clinicopathological features, and their changes following surgery was evaluated. In addition, serum carcinoembryonic antigen (CEA) was also examined. RESULTS: Of the 41 gastric cancer tissues, 31 (75.6 %) were VCAM-1 positive. The VCAM-1 positive gastric cancers were more invasive and classified in the more advanced stage than the VCAM-1 negative ones. The VCAM-1 positive cancers were associated with more lymph node metastases than VCAM-1-negative ones (P<0.05). The expression of VCAM-1 was detected in tissues of two of the eight patients with gastric ulcer and two of the 10 healthy controls. The expression of VCAM-1 in gastric cancer patients was significantly more frequent than that in the healthy controls and ulcer group (both P<0.05). MVD in VCAM-1 expressing tissues was higher than that in VCAM-1 negative tissues (t=2.13,P<0.05). Serum VCAM-1 levels in gastric cancer patients were significantly higher than those in controls (t=3.4, P<0.05). There was a significant association between serum VCAM-1 levels and disease stage, as well as invasion depth of the tumor and the presence of distant metastases. The concentrations of serum CEA in gastric cancer were higher than normal controls. Both serum VCAM-1 and CEA levels decreased significantly after radical resection of the primary tumor (P<0.05). Furthermore, the serum levels of VCAM-1 were positively correlated with the expression of VCAM-1 in the tumor tissue (r=0.85, P<0.05). CONCLUSION: The expression of VCAM-1 is closely related to oncogenesis, tumor angiogenesis and metastasis in gastric carcinoma. Serum VCAM-1 level in gastric cancer patients is significantly increased compared with normal controls, which decreases significantly after radical resection of the primary tumor. The serum concentration of VCAM-1 may be considered as an effective marker of tumor burden of gastric cancer. Moreover, overexpression of VCAM-1 in gastric cancer tissue is likely a major source of serum VCAM-1.
Assuntos
Neovascularização Patológica/patologia , Neovascularização Patológica/fisiopatologia , Neoplasias Gástricas/fisiopatologia , Neoplasias Gástricas/secundário , Molécula 1 de Adesão de Célula Vascular/genética , Adulto , Idoso , Biomarcadores Tumorais/genética , Antígeno Carcinoembrionário/sangue , Feminino , Mucosa Gástrica/irrigação sanguínea , Mucosa Gástrica/fisiologia , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Microcirculação , Pessoa de Meia-Idade , Neovascularização Patológica/genética , Neoplasias Gástricas/genética , Úlcera Gástrica/genética , Úlcera Gástrica/patologia , Úlcera Gástrica/fisiopatologiaRESUMO
Although Pseudomonas aeruginosa is not typically susceptible to azithromycin (AZM) in in vitro tests, AZM improves the clinical outcome in patients with chronic respiratory infections, in which both the modulation of the host immune system and of bacterial virulence by AZM are thought to play an important role. However, there is currently little direct evidence showing the impact of bacteria pretreated with AZM on epithelial cells, which represents the first barrier to infecting P. aeruginosa. In this study, we pretreated P. aeruginosa with AZM and subsequently infected human bronchial epithelial cells (HBEs) in the absence of AZM. The results showed that AZM-pretreated P. aeruginosa (PAO1 and six different clinical isolates) significantly stimulated HBE cells to release IL-8, a crucial pro-inflammatory cytokine. This effect was not observed in a P. aeruginosa PAO1 mutant strain unable to produce the type III secretion system effector gene pcrV (strain PW4017). Our results suggest that AZM-pretreated P. aeruginosa could indirectly exacerbate pro-inflammation by inducing IL-8 production in HBEs.
Assuntos
Antibacterianos/metabolismo , Azitromicina/metabolismo , Células Epiteliais/imunologia , Células Epiteliais/microbiologia , Interleucina-8/metabolismo , Pseudomonas aeruginosa/imunologia , Pseudomonas aeruginosa/metabolismo , Linhagem Celular , HumanosRESUMO
OBJECTIVE: To observe the efficacy on primary osteoporosis treated with spreading moxibustion for warming yang and activating blood circulation so as to provide the effective clinical therapeutic methods for osteoporosis. METHODS: Sixty cases of primary osteoporosis were randomized into a spreading moxibustion group (30 cases) and a calcium tablet group (30 cases). In the calcium tablet group, caltrate was prescribed for oral administration, 600 mg per day. In the spreading moxibustion group, on the basis of the treatment as the calcium tablet group, the spreading moxibustion was applied at Dazhui (GV 14) to Yaoshu (GV 2) for warming yang and activating blood circulation. The duration of treatment was 12 weeks. Visual analogue scale (VAS) score, TCM clinical symptom score and bone mineral density (BMD) were observed and compared before and after treatment in the patients between the two groups. RESULTS: VAS scores were reduced apparently after treatment in the two groups (both P < 0.01) and the results in the spreading moxibustion group were obviously superior to that in the calcium tablet group (2.36 +/- 0.43 vs 4.52 +/- 0.35, P < 0.01). BMD were all increased in the two groups (P < 0.05, P < 0.01) and the results in the spreading moxibustion group were superior to those in the calcium tablet group (both P < 0.05). The total clinical effective rate was 86.67% (26/30) in the spreading moxibustion group, apparently better than 63.33% (19/30) in the calcium tablet group (P < 0.05). TCM clinical symptom scores after treatment were all reduced apparently in the two groups (both P < 0.01), and the result in the spreading moxibustion group was obviously superior to that in the calcium tablet group (4.72 +/- 1.90 vs 6.82 +/- 2.30, P < 0.01). The total effective rate of TCM symptoms was 93.33% (28/30) in the spreading moxibustion group, apparently better than 70.00% (21/30) in the calcium tablet group (P < 0.05). CONCLUSION: The combined therapy of spreading moxibustion for warming yang and activating blood circulation and the oral administration of caltrate apparently relieves pain and TCM clinical symptoms, improves BMD in the patients of osteoporosis and achieves definite clinical efficacy in the patients of osteoporosis.
Assuntos
Moxibustão , Osteoporose/terapia , Deficiência da Energia Yang/terapia , Idoso , Circulação Sanguínea , Densidade Óssea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/fisiopatologia , Deficiência da Energia Yang/fisiopatologiaRESUMO
BACKGROUND: In recent years, with social and economic development and lifestyle changes, the incidence of gastric cancer as well as the surgical results and prognoses of patients with gastric cancer have changed significantly in southeast China. METHODS: A total of 1,451 patients were divided into 2 groups according to admission time periods. Trends in clinicopathologic characteristics and operative outcomes of these patients were analyzed retrospectively. RESULTS: The numbers of old and young patients were significantly increased in period 2 compared with period 1. Tumors located in the proximal stomach increased from 20.26% to 36.83%. The incidence of early gastric cancer was significantly increased from period 1 to period 2. Lymph node metastasis was seen more prevalently in period 2 than in period 1. The rate of operation-related major complications decreased from 5.23% to 1.43%. Operative mortality was .49% in period 1 and .24% in period 2. The 5-year survival rate increased from 38.40% to 53.99%. CONCLUSIONS: Early diagnosis, standardized surgical treatment including pertinent lymph node dissection, and better perioperative care notably improve the outcomes of patients with gastric cancer.
Assuntos
Adenocarcinoma/cirurgia , Gastrectomia/tendências , Neoplasias Gástricas/cirurgia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Seguimentos , Humanos , Incidência , Estimativa de Kaplan-Meier , Excisão de Linfonodo/tendências , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/epidemiologia , Recidiva , Estudos Retrospectivos , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVES: To compare the efficiency of contrast-enhanced ultrasonographic micro flow imaging (MFI) with conventional transrectal ultrasound (TRUS) in detecting prostate cancer with serum total prostate-specific antigen (t-PSA) of 4.0-10.0 ng/mL. To evaluate the value of contrast-enhanced ultrasonographic MFI in detecting prostate cancer with t-PSA in diagnostic gray zone. METHODS: 47 patients with t-PSA 4.0-10.0 ng/mL underwent gray scale, power Doppler TRUS and MFI examinations before ultrasound guided biopsies. Biopsies were performed at twelve sites in the base, the mid-gland and the apex of the prostate in each patient, when there was no abnormal ultrasound finding. When an abnormality was present at MFI, the biopsy specimen from the corresponding site was directed toward the abnormal finding. With histological results of prostate biopsy as reference standards, we assessed the cancer detection of these three methods. RESULTS: 564 specimens were collected in this study, in which 101 were prostate cancer confirmed histologically. 152 of 564 specimens were demonstrated abnormal on MFI images, in which 71 were malignant and 81 were benign confirmed histologically. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for MFI in detecting prostate caner were 70.3%, 82.5%, 80.3%, 46.7% and 92.7%, respectively. The sensitivity and NPV for MFI were significantly better than gray scale (38.6%, 86.9%) and power Doppler (32.7%, 86.0%) (P<0.001) TRUS. CONCLUSIONS: Contrast-enhanced ultrasonographic MFI could significantly improve the detection rate of prostate cancer with t-PSA in diagnostic gray zone (4-10 ng/mL) than conventional ultrasound.
Assuntos
Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Reologia/métodos , Ultrassonografia Doppler/métodos , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Spleen tyrosine kinase (Syk) is reported to be involved in the suppression of proliferation and invasion of breast cancer. Methylation-mediated Syk gene silencing is found in a subset of breast cancer. In this study, we used a DNA methyltransferase inhibitor, 5-aza-2-deoxycytidine (AZA), to restore Syk expression of breast cancer cells. Surprisingly, we found that AZA treatment could reestablish the expression of Syk, but not affect the proliferation of breast cancer cells. Moreover, tumor formation in situ by MDA-MB-435s treated with (+) or without (-) AZA in a nude mice MFP (Mammary fat pad) model did not show significant difference, too. Interestingly, pulmonary metastasis was still significantly suppressed in MDA-MB-435s(+) group (1/9 vs. 7/9). Our findings suggested Syk may be more correlated to metastasis rather than proliferation. This study implied a potential use of Syk methylation as a valuable biomarker to detect high metastatic potential cancerous lesions and the prospect of AZA to join the arsenal of drug candidates to be developed as a new reagent for management of advanced breast cancer.