>近几年来,直肠神经内分泌瘤的检出率越来越高,这与新检查手段的出现密切相关,如内镜检查、影像学检查等。对于直径<16 mm且无淋巴和其他脏器转移的直肠神经内分泌瘤,临床上可以使用局部切除手术如内镜切除手术进行治疗"。传统的EMR已经在临床上广泛应用,但其对直肠

Objective To study the value of EUS-FNA cytology and fluid carcinoembryonic antigen (CEA) for differential diagnosis of malignant and benign pancreatic cystic lesions.Methods Data of 27 patients who underwent EUS-FNA were reviewed.According to Youden exponent,the optimal cut-off points for cyst fluid CEA were determined by receiver operating characteristic (ROC) curve.Compared with surgical pathology,the accuracy,sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of the EUS imaging,cytology as well as cyst fluid CEA were determined.Results Of the 27 cases,14 were diagnosed as benign lesions,13 were diagnosed as malignant or premalignant lesions.The accuracy,sensitivity,specificity,PPV and NPV of EUS imaging were 77.8％ (21/27),69.2％(9/13),85.7％ (12/14),81.8％ (9/11) and 75.0％ (12/16).The accuracy,sensitivity,specificity,PPV and NPV of EUS-FNA cytology were 85.2％ (23/27),76.9％ (10/13),92.9％ (13/14),90.9％ (10/11),and 81.3％ (13/16).The corresponding values of fluid carcinoembryonic antigen under the ROCderived ideal cut-off were 74.1％ (20/27),84.6％ (11/13),64.3％ (9/14),68.8％ (11/16) and 81.8％ (9/11) (CEA ＞ 22.24 ng/ml).Conclusion EUS-FNA cytology is highly accurate and specific for differential diagnosis of malignant and benign pancreatic cystic lesions.Cyst fluid CEA shows better sensitivity.EUS-FNA cytology and cyst fluid CEA analysis can basically meet the requirement of differentiating the benign and (pre)malignant pancreatic cystic lesions.

Objective To investigate the diagnostic value of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytology in pancreatic lesions.Methods From April 2012 to August 2013,the clinical data of 117 patients received EUS FNA cytology examination was retrospectively analyzed,and the final dignosis was according to pathological examination and follow-up results.In statistical analysis,group t test was performed for comparison and Pearson x2 and CMH-x2 test were used for comparison in count data.Results According to pathological examination and follow up,a total of 95 cases were clearly diagnosed as malignant or benign lesion,in which benign lesion accounted for 47 cases and malignant lesion 48 cases.The accuracy,sensitivity and specificity of EUS-FNA cytology in the diagnosis of malignant pancreatic lesions were 80.00％,70.83％ and 89.36％,respectively.Subsequently 67 cases were clearly diagnosed by cytopathology,in which,there were 46 cases of pancreatic solid neoplasms,15 cases of cystic lesions and six cases of others diseases such as pancreatitis.The accuracy,sensitivity and specificity of EUS-FNA cytology in the diagnosis of solid neoplasm were 80.60％,71.74％ and 100.00％,respectively.Nevertheless,for cystic lesions,the diagnosis value was low,the accuracy,sensitivity and specificity of which were 73.13％,53.33％ and 78.85％,respectively.Conclusion Pancreatic malignant and benign lesions can be effectively differentiated by EUS FNA cytology examination and the diagnostic value is of which even higher in pancreatic solid neoplasms.

>患者男,48岁,因"自觉排便后有无痛性肿块脱出肛门,便血间歇性发作10年,肛门流脓3个月"前来检查。患者于10年前发现便后有无痛性坠胀物,并伴有里急后重感,于当地医院诊断为痔疮并行手术治疗,1年后复发再次手术。3个月前直肠指检发现直肠占位,于2011年7月19日行内镜检查发现距肛门4 cm处齿状线上方巨大球形增殖性病灶,病灶表面黏膜较粗糙(图1a);并于距肛门10 cm处见另一环形狭窄伴结节状增生病灶,局部可见不规则溃疡性改变,表面覆坏死物质(图1b)。EUS提示齿状线起至距肛门10 cm范围内肠壁明显增厚及结构消失,最厚处达1.5 cm,呈不均匀中-低回声,肌层部分残留,外膜不规则(图1c);病变肠段与前列腺包膜分界清楚,精囊腺等邻近器官未累及,肠外未见明显肿大淋巴结,内外括约肌分界欠规则(图1d)。

Objective To investigate the effects of over-expression of homo sapiens eukaryotic translation elongation factor 1 alpha 2 (EEF1A2) on in vitro invasion and lung metastasis of human pancreatic cancer SW1990 cells.Methods Letivirus-mediated delivery of EEF1A2 was used to enhance the expression of EEF1A2 gene in human pancreatic cancer SW1990 cells,the SW1990 cells stably over-expressing EEF1A2 protein (SW1990/EEF1A2 cells) were obtained,and the parent SW1990 cells and SW1990/GFP cells were used as the control,and the expressions of EEF1 A2 mRNA and protein were determined by Real-time PCR and Western blotting.The invasion ability of cells was determined by Transwell assay.The lung metastasis model was established by injection of SW1990 cells into the tail vein.Whole lung tissues were harvested,and visible nodules on tung surface were counted macroscopically 8 weeks later.Results The EEF1 A2 mRNA expression of SW1990/EEF1A2 was 3.252 ± 0.344,which was significantly higher than those in SW1990/GFP cells (1.000 ±0.060) and SW1990 cells (0.944 ±0.041,t =2.255,2.305,P＜0.01) ; the EEF1A2 protein expression was 0.833 ± 0.050,which was significantly higher than those in SW1990/GFP cells (0.247 ± 0.035) and SW1990 cells (0.273± 0.041,t=0.572,0.559,P＜0.01).The ability of invasion of SW1990/EEF1A2 cells was (60 ±4) cells,which was sigmificantly higher than (33 ±4) cells in SW1990/GFP group and (26 ± 3) cells in SW1990 group (t =31.33,34.78,P ＜ 0.01).Furthernore,SW1990/EEF1 A2 cells had a much higher incidence of lung metastasis in nude mice than SW1990/GFP cells and SW1990 cells in vivo (100％ vs.20％,20％,P ＜ 0.05).Conclusions EEF1 A2 over-expression can obviously increase the in vitro invasion and lung metastasis of pancreatic cancer SW1990 cells.

Background/Aims: To examine eukaryotic elongation factor1A2 (eEF1A2) expression in pancreatic ductal adenocarcinoma (PDA) and to analyze its relationship with the clinicopathology of PDA. Methodology: eEF1A2 expression was examined in 97 FDA specimens by immunohistochemistry. We also analyzed the association between eEF1A2 expression in PDAC cells and the clinicopathology of FDA patients. Results: eEF1A2 expression was absent in normal pancreatic tissue. In contrast, in PDA, eEF1A2 showed positive immunoreactivity in 76 of 97 (77.8%) FDA cases. We found significant associations between increased eEF1A2 expression and the presence of nodal metastasis (p=0.039) and perineural invasion (p=0.043). Univariate analysis of survival showed that the median overall survival time of eEF1A2-positive FDA patients (11.7 months) was significantly shorter than that of eEF1A2-negative PDAC patients (17.5 months; p<0.001). In addition, when the Cox proportion hazard model was used in multivariate survival analysis, we revealed that eEF1A2 expression (p<0.001; hazard rate, 95%CI 2.91-13.61) and TNM stage (p<0.001 hazard rate, 95%CI 0.18-0.23) still remained statistically significant. Conclusions: eEF1A2 is highly expressed in PDA, and its expression is associated with nodal metastasis and perineural invasion, as well as worse prognosis.

Background and Aim. New diagnostic or therapeutic methods in endoscopy have been used. Current clinical application of these procedures is not well known. The aim of this study is to investigate the present situation on endoscopic diagnosis and treatment of gastrointestinal disorders in East Asian countries. Method. A representative member from the International Gastrointestinal Consensus Symposium Committee provided a questionnaire to physicians in China, Indonesia, Japan, Korea, the Philippines, and Thailand. Results. In total, 514 physicians including gastroenterologists, surgeons, and general practitioners enrolled. The most frequently occurring disorder as the origin of upper gastrointestinal bleeding is gastric ulcer. Capsule endoscopy is selected as the first choice for the diagnosis of small intestine bleeding. The second choice was double-balloon endoscopy or angiography. For patients with gastric adenoma, the number of physicians who choose endoscopic mucosal resection is larger than those selecting endoscopic submucosal dissection (ESD) in China, Indonesia, the Philippines, and Thailand. ESD is chosen first in Japan and Korea. Conclusion. New instruments or techniques on endoscopy have not come into wide use yet, and there is diversity in the situation on it in Asian countries. We should unify the endoscopic diagnostic criteria or treated strategy in patients with GI disease.

目前对于酒精性或非酒精性脂肪肝的发生机制、诱因及转归,都已有较详细的阐述,而非酒精性脂肪胰(nonalcoholic fatty pancreatic disease)却未被广泛关注,不仅国内外相关的研究较少,临床医师对胰腺的脂肪浸润也缺乏认识.本文总结了近年来国内外胰腺脂肪浸润研究的前沿和进展,以期能帮助临床医师提高对脂肪胰的认识,或为研究者开展进一步的研究提供思路。

Objective To compare the value of bedside index for severity in acute pancreatitis (BISAP),Ranson score and Balthazar computed tomography severity index (CTSI) in predicting the severity and prognosis of acute pancreatitis (AP).Methods From 2005 to 2011 in Shanghai,the clinical data of 1004 AP cases from seven hospitals was collected and retrospectively analyzed.The value of BISAP score,Ranson score and Balthazar CTSI in predicting the severity and prognosis of AP were assessed with receiver operator characteristic (ROC) curve.Results Among 1004 patients,the main cause of AP was biliary disease (580 cases),about 57.77％.The incidence of pancreatic necrosis,mortality and SAP increased along with BISAP score.The risk of pancreatic necrosis in patients with CTSI ≥ three was significantly higher than that of ＜ three.The risk of pancreatic necrosis and SAP in patients with BISAP score ≥ two was significantly higher than that of ＜ two (OR:4.93,95％CI 3.62-6.70; OR 2.62,95％CI 1.59-4.31,respectively).There was no significant difference in the accuracy of predicting the progression and mortality of AP among these three score systems.However the sensitivity of BISAP score (OR:61.54,95％CI 35.09-87.99) in predicting the progression and mortality of AP was better than that of Ranson (OR:46.15,95 ％ CI 19.05-73.25) and CTSI (OR:46.15,95％CI 19.05-73.25).Conclusions BISAP score is easy to perform and when combined with CTSI,it helps to make the diagnosis and classification of AP in time,predict the prognosis accurately.Compared with Ranson score,BISAP score has higher clinical value.

Objective To explore the role of growth factor receptor-bound 2 (GRB2) in homo sapiens eukaryotic translation elongation factor 1 alpha 2 (EEF1A2) promoting the carcinogenesis and development of pancreatic cancer.Methods The human pancreatic cancer cell line SW1990 with low expression of EEF1A2,was transfected by Ad5/F35-EEF1A2 plasmid.The expression of EEF1A2 in human pancreatic cancer cell lines BxPC-3 cells with high expression of EEF1A2,was down-regulated by small interfering RNA (siRNA) interference.The expressions of GRB2 in SW1990 and BxPC-3 cells were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot before and after interference.The pancreatic cancer BxPC-3 cells were interfered by specific and efficient chemical synthesized siRNA fragment.The changes of BxPC-3 cell proliferation and migration were observed by methyl thiazoly tetrazolium (MTT) and Transwell assay before and after interference.The data were analyzed by one-way analysis of variance.Results After human pancreatic cancer cell line SW1990 was transfected with Ad5/F35-EEF1A2 plasmid,the expression of GRB2 at mRNA and protein level both increased significantly (F=5.67,6.39,both P＜0.05).After the expression of EEF1A2 was inhibited by EEF1A2-siRNA,the expression of GRB2 at mRNA and protein level both decreased significantly (F=6.59,4.69,both P＜0.05).After BxPC-3 cells was transfected with siRNA-GRB2 for 72 hours,the results of MTT assay indicated that the absorbance value was 1.22±0.14,compared with negative control group (1.42±0.15) and blank control group (1.39 ± 0.15) the difference was statistically significant (F =6.63,P＜ 0.05).The results of transwell assay showed that the migration ability of cells in siRNA-GRB2 group decreased.After 24 hours,the number of migrated cells was 24.10±4.25,compared with negative control group (54.72±5.24) and blank control group (51.26 ± 6.23) the difference was statistically significant (F=55.00,P＜ 0.05).Conclusion GRB2 is key molecule in EEF1A2 promoting the progenesis and development of pancreatic cancer.

Objective: To investigate the effect of targeted gene silencing of homo sapiens EEF1A2 (eukaryotic translation elongation factor 1 alpha 2) on migration and invasion of human pancreatic cancer cell line BxPC-3 in vitro , and to explore its possible molecular mechanism. Methods: The mRNA and protein expression levels of EEF1A2 in four strains of human pancreatic cancer cells were detected by RT-PCR and Western blotting, respectively. EEF1A2-siRNA (small interference RNA) and negative control siRNA were transfected into BxPC-3 cells, respectively. Then the mRNA and protein expressions of EEF1A2 were determined by RT-PCR and Western blotting, respectively. The abilities of migration and invasion of BxPC-3 cells were determined by wound healing assay and Transwell invasion assay, respectively. The changes of expressions of p-Akt and total Akt proteins were detected by Western blotting. Results: Of the four strains of human pancreatic cancer cells, SW1990 cells displayed a low level of EEF1A2, and the remaining three strains of human pancreatic cancer cells including BxPC-3, Patu8988 and Panc-1 all displayed high expressions of EEF1A2. At 48 h post-transfection, the expression levels of EEF1A2 mRNA and protein in BxPC-3 cells transfected with EEF1A2-siRNA were significantly decreased as compared with those transfected with negative control siRNA or without any transfection (P < 0.01). The abilities of migration and invasion of the BxPC-3 cells transfected with EEF1A2-siRNA were obviously inhibited as compared with those transfected with negative control siRNA or without any transfection (P < 0.05). The phosphorylation of Akt protein was also significantly decreased in BxPC-3 cells transfected with EEF1A2-siRNA (P < 0.05), while the total Akt protein expression level was similar among different transfection groups (P > 0.05). Conclusion: Targeted silencing of EEF 1A 2 by siRNA can obviously inhibit the migration and invasion abilities of human pancreatic cancer BxPC-3 cells in vitro . This effect may be associated with Akt signaling pathway regulated by EEF1A2. Copyright © 2012 by TUMOR.

Objective To explore the alteration of brain pain functional areas in patients with functional dyspepsia (FD) irritable bowel syndrome (IBS) overlap by rectal balloon volume stimulation and magnetic resonance imaging (MRI) and the differences with IBS alone patients and healthy individuals were compared.Methods A total of 11 IBS alone patients,16 IBS overlapped with FD patients (IBS-FD) and 10 healthy controls were recruited.Sensory thresholds and visual analogue scale (VAS) were recorded during the rectal balloon air injection process. The changes of brain activated areas were analyzed by functional MRI (fMRI) when the rectum was stimulated at the volume of 50,100 and 150 ml.The data were analyzed by least significant difference (LSD) test.Results Under rectal volumetric stimulation,the sensory thresholds of IBS-FD group and IBS alone group were (53.14 ± 16.05) ml and (59.20 ± 20.55) ml and the difference was not statistically significant (LSD test,P＞0.05).There was no significant difference in VAS score between IBS alone group and IBS-FD group (LSD test,P＞0.05).Rectal stimulated under different volume,the results of fMRI indicated the activation of anterior cingulated cortex, dorsolateral prefrontal cortex,postporietal cortex,thalamus and insular cortex in both IBS alone group and IBS-FD group.And there was no significant difference in activated areas and intensity between IBS alone group and IBS-FD group (LSD test,P＞0.05).Conclusions There was no significant difference in activations of brain areas between IBS alone and IBS-FD patients under rectal volumetric stimulation. Under rectal volumetric stimulation,although symptoms overlapped,there was no evidence of the overlap of braingut axis and visceral hypersensitivity between IBS alone and IBS-FD.

Objective To evaluate the diagnostic value of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in combination with flow cytometry (FCM) in lymphoma.Methods From January 2011 to December 2011,the cases of suspicious lymphoma with EUS-FNA examination at Shanghai Ruijin Hospital were retrospectively analyzed.The final diagnosis was according to pathological diagnosis of specimen from the surgery and follow up results.The sensitivity,specificity and accuracy of EUS-FNA combined with FCM in lymphoma diagnosis were initially analyzed.Results A total of 14 suspicious lymphoma patients were collected,eight cases were diagnosed as lymphoma by pathological examination of specimen from the surgery or.tissue from aspiration,four cases were non-lymphoma lesions and two cases still had no final diagnosis.The sensitivity and specificity of FCM alone in lymphoma diagnosis were 4/8 and 4/4 respectively.Six cases of lymphoma were detected by EUS-FNA with FCM.The sensitivity,specificity and accuracy of EUS FNA combined with FCM were 6/8,6/6 and 10/12 respectively.Conclusion EUS-FNA combined with FCM has better diagnostic value in lymphoma,especially for gastrointestinal lymphoma and those surrounding deep lesions.

Objective To compare the diagnostic yield of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for solid pancreatic masses performed with three different needle types through the cytological results.Methods All patients with solid pancreatic masses larger than 2cm from December 2010 to May 2011 were enrolled,and divided into two groups according to different access of EUS-FNA,trans-gastric approach with 19-,22-and 25-gauge needles (n =42) and trans-duodenal approach with 22-and 25-gauge needles (n =10).In both groups,EUS-FNA was performed with randomization of needle types.During the puncture,the suction,the number of movements,and the depth of insertion were fixed.At the end of the puncture,a liquid-based cytological (LBC) preparation was used to fix the specimen.One cytopathologists was assigned to make the diagnosis and comparison.Results Technical success was 100％ and no procedure related complications occurred.No statistically significant differences were observed in different needles in terms of all cytological parameters between two groups (P ＞ 0.05).However,the 25-gauge needle showed a trend towards a higher sensitivity,specificity,positive predictive value,negative predictive value and accuracy.Conclusion There is no significant difference in yield of cytological results between different needle types,although 25-gauge needle shows a relative superiority.

Objective To study the relation of esophageal motility and acid reflux between gastroesophageal reflux disease (GERD) patients with and without esophageal injury.Methods A total of 25 patients who met the GERD diagnosis criteria were conducted esophageal-gastric-duodenal endoscopy examination and followed with high-resolution esophageal manometry.The changes of esophageal pH postprandial were also detected.The differences of esophageal motility and acid reflux time between GERD patients with and without esophageal injury were compared.Patients were divided into non-acid reflux group and acid reflux group according to DeMeester score.The changes of esophageal motility indexes of these two groups were compared.Wilcoxon test and t test were used for statistical analysis.Results There was no significant difference in baseline value of lower esophageal sphincter (LES) pressure,remained LES pressure,speed of the esophageal peristalsis,the time of esophageal pH＜4 and DeMeester score between groups with and without esophageal injury (all P＞0.05).But esophageal contraction amplitude of group with esophageal injury was lower than that of group without esophageal injury (31.9 mm Hg vs 64.2 mm Hg,1 mm Hg=0.133 kPa,Z=-2.37,P=0.02).There was no significant difference in baseline value of LES pressure,remained LES pressure,speed of the esophageal peristalsis between acid reflux group and non acid reflux group (all P＞0.05).But the esophageal contraction amplitude of acid reflux group was lower than that of non acid reflux group (36.4 mm Hg vs 71.8 mm Hg,Z=-2.25,P=0.02).Conclusions There was no significant correlation between the LES pressure and esophageal acid reflux with esophageal injury in GERD patients.Esophageal peristalic contraction may be associated with esophageal injury and acid reflux.

>胃肠道是结外非霍奇金淋巴瘤最易累及的部位,其中以胃淋巴瘤最常见,约占胃肠淋巴瘤的70%左右。虽然胃淋巴瘤的发病率较低,在胃恶性肿瘤中仅占3%～5%,但有报道称其发病率有逐年增高的趋势。胃镜检查是目前诊断胃淋巴瘤的常规手段,因本病多起源于胃壁黏膜下层淋巴组织,部分病例内镜下黏膜表面可表现正常或仅有轻度糜烂等类似炎症表现,故单纯活检可出现假阴性。由于技术上的优势,内镜超声检查术(endoscopic ultrasonography,EUS)

<正>0引言随着人类基因组计划的完成,令人惊讶的是,能够编码蛋白的基因仅两万多个,其在全基因组序列中的比重不足2%。然而基于全基因组瓦片芯片

唾液分泌食物入口的第一消化液 唾液是无色无味的低渗液体,每天一个正常成人的分泌量约为O.8～1.5升,唾液中含有水、粘蛋白、免疫球蛋白、唾液淀粉酶、溶菌酶及电解质.酶类主要起化学性消化作用,可以把淀粉分解为麦芽糖,因此对于淀粉类食物如米饭在口中较长时间咀嚼时会产生甜味.