Objective To explore the effect of epidermal growth factor receptor (EGFR) inhibitor on CD44+ and side population (SP) cells in colon cancer HT-29 cells.Methods The proportion and tumorigenicity of CD44+ cells and SP cells was detected by Hoechst33342 staining and flow cytometry.The effects of EGFR inhibitor gefitinib at different concentrations on the sphere formation and the proportion of CD44+ cells and SP cells were analyzed.Results EGFR inhibitor significantly inhibited the growth of CD44+ cells and SP cells.The proportion of CD44+ cells in HT29 cells was decreased after treatment with gefitinib for 24h and 48h.The proportion of SP cells in HT29 cells was decreased from (3.82 ± 0.08)％ to (0.34 ± 0.03)％ after verapamil treatment.It was also decreased significantly after gefitinib treatment:Gefitinib had an inhibitory effect on the sphere formation in HT29 cells.Conclusion There are CD44+ and SP cells subpopulation in colon cancer cells.EGFR inhibitor can inhibit the growth of CD44+ and SP cells in colon cancer HT-29 cells,which may provide information for targeting therapy of colon cancer.

Although the ultimate cause of IBD is still unknown, microbiological factors have been proposed as possible triggers.Both alterations in the patient's intestinal microbiota and infections by external agents might play important roles in the IBD onset and the IBD flares.The treatment of IBD has been revolutionized over the past decade by the improved using of immunomodulators and biologic agents, that increased intestinal superinfections and opportunistic infection in IBD patients, increase co-morbidity and aggravate the diagnostic and therapeutic burden.Thus, an early recognition of complicating infections with targeted therapeutic approach is needed and probably could ensure a better prognosis for IBD patients.This paper reviews the intestinal bacterial superinfection, opportunistic bacterial infection, the risk factors and the management of this clinical setting.

The incidence and prevalence of inflammatory bowel disease (IBD) are rising worldwide.The pathogenesis of IBD is multifactorial,involving host genetics,immune response,gut microbiota dysbiosis,environmental factors,diet,and so on.While the gut microbiota has been proposed to play a key role in disease pathogenesis,it has become a hotspot in recent years.Given this,the gut microbiome changes in IBD patients,the interaction between gut microbiome and host,and the treatment of IBD based on gut microbiota were briefly reviewed in this paper.

Background and Aim Accurately differentiating malignant diseases from benign ones in patients having bile duct obstruction is of significant importance and remains a major clinical problem. This study investigated the diagnostic yield of endoscopic retrograde cholangiography/intraductal ultrasound (ERC/IDUS) in distinguishing malignant from benign bile duct obstruction and assessed some image findings from ERC/IDUS which might be useful in differentiation. Methods From January 2008 to January 2015, patients who underwent ERC/IDUS for bile duct obstruction were enrolled. Patient’s ERC/IDUS diagnosis was compared with the final diagnosis determined by pathologic findings and/or clinical outcome of follow-up. Results One hundred and ninety-three patients with bile duct obstruction were included. IDUS correctly identified 94 of 97 malignant diseases and 76 of 96 benign diseases with sensitivity, specificity, and accuracy rate of 96.91, 79.17, and 88.08 %, respectively. Additionally, the accuracy rate of IDUS for diagnosis of proximal bile duct obstruction was higher than that of distal bile duct obstruction (98.08 vs. 82.73 %, p = 0.006). Besides, there was a significant difference in the length at the obstruction site between benign and malignant diseases (13.76 ± 7.37 vs. 19.97 ± 11.37 mm, p < 0.001) as well as thickness of bile duct wall at the site of obstruction (3.06 ± 0.92 vs. 7.03 ± 3.70 mm, p = 0.008). Biliary wall thickness >7 mm without extrinsic compression had a positive predictive value (PPV) of 100 % for including malignancy, while length ≧20 mm demonstrated a PPV of 93.44 %. Conclusions ERC/IDUS is effective in distinguishing malignant from benign bile duct obstruction, thus helping in further clinical management.

BACKGROUND AND AIM:Periampullary diverticulum (PAD) is frequently encountered in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to investigate the association of PAD with pancreaticobiliary diseases as well as the impact of PAD on the technical success of ERCP and different methods of bile duct stone extraction.PATIENTS AND METHODS:A total of 1489 cases of patients with PAD were identified from 6390 patients who underwent ERCP. These patients were compared with 1500 controls without PAD in terms of biliary stone formation, technical success, and complications of ERCP.RESULTS:Patients with PAD had increased prevalence of bile duct stones, gallstones, and cholangitis (P<0.01). Successful cannulation rates were similar in the PAD and the control group (98.59 vs. 99.07%, P=0.225). The incidence of complications did not differ between the PAD and the control group. Successful stone removal rate of endoscopic sphincterotomy (EST) was lower in the PAD group than in the control group (83.53 vs. 94.31%, P=0.005). In patients with PAD, the rate of successful stone removal was lower in the EST group than in the endoscopic papillary balloon dilation (EPBD) and EPBD combined with limited EST (ESBD) group. The rates of complications were similar among different treatments (EST, EPBD, or ESBD) in patients with PAD.CONCLUSION:PAD is associated with bile duct stones, gallstones, and cholangitis. In addition, PAD should not be considered a barrier to a successful cannulation. Moreover, EST is less effective than EPBD and ESBD in patients with PAD, whereas EST, EPBD, and ESBD are equally safe in patients with PAD.

Objective To evaluate the feasibility and acceptability of magnetically guided capsule endoscopy (MCE) as a screening or diagnostic means for upper gastrointestinal diseases.Methods One hundred and forty six patients underwent MCE during October 2013 to September 2014.All patients and endoscopists received a feedback survey with a self-administrated questionnaire;the items included the satisfaction of patients and endoscopists,the endoscopic image score,examination results,the endoscopy completion and operation time.Results Among 146 patients,145 completed MCE examination with a completion rate of 99.3％ (145/146).The operation time of MCE was (15.20 ± 4.85) min.The score of patient and endoscopist satisfaction was both 4,and patient tolerance score was 0.The divergence rate score was 3;the cleaness score of stomach was 3;and the vision relative definition was 79.31 ± 14.16.The most common examination result was chronic superficial gastritis (67/145,46.2％),followed by bile reflex gastritis (48/145,33.1％),normal stomach (39/145,26.9％),gastric polyps (20/145,13.8％),chronic atrophic gastritis (18/145,12.4％),bleeding from erosive gastritis (14/145,9.7％),reflux esophagitis (6/145,4.1％),2.7％ (4/145),gastrointestinal ulcer,(3/145,2.1％),upper gastrointestinal cancer (2/145),duodenal bulb inflammation (2/145),yellow melanoma (1/145),esophageal cyst (1/145) and esophageal varices (1/145).All patients expressed their willingness to receive the same type of upper GI endoscopy if necessary.No capsule retention,perforation or bleeding occurred.Conclusions MCE avoids the discomfort of conventional gastroscopy and can improve the compliance and acceptability of patients with excellent safety,maneuverability and feasibility.

溃疡性结肠炎(ulcerative colitis,UC)是一种病因不明的结肠直肠非特异性或特发性炎症, 病变呈连续性弥漫性分布,病程迁延不愈,轻重不等. 该病在西方国家较常见,欧美和北美的UC发病率为(10~20)/100000,而患病率达(100~200)/100000.

Objective To study the clinical value and the safety of endoscopic retrograde cholangio-pancreatography(ERCP)for chronic pancreatitis in the pediatric population.Methods Clinical data,endo-scopic reports,and radiography of chronic pancreatic patients aged from 2 to 17 years old who underwent ERCP between Jan.1,2008 and Apr.30,2014 at Endoscopy Center of Ruijin Hospital were reviewed.These patients were divided into 3 groups,patients aged from 2 to 6 years old as children group(n =27),patients aged from 7 to 12 years old as juvenile group(n =35)and patients aged from 13 to 17 as adolescent group(n =25). Their clinical data and complications were analyzed by groups.Results A total of 170 ERCP procedures were performed in 87 patients,with the success rate of 99.4%(169 /170).All patients were diagnosed as having chronic pancreatitis by ERCP.Success rates of children group,juvenile group and adolescent group were 97.6%(40 /41),100.0%(72 /72)and 100.0%(57 /57)respectively.There was no statistically significance among the three groups(P =0.207).No serious complications like bleeding or perforation occurred.No proce-dure-related mortality occurred in this study either.The rate of post-ERCP adverse events in children group, juvenile group and adolescent group were 41.5%(17 /41),25.0%(18 /72)and 24.6%(14/57),respective-ly.Children group had more adverse events than the juvenile group(P =0.039)and adolescent group(P =0.045).Conclusion Pediatric ERCP is highly effective in the pediatric population with chronic pancreatitis. The incidence of post ERCP adverse events is higher among the youngest children.

内镜逆行胰胆管造影术（ERCP）术后胰腺炎是ERCP术后最常见的并发症之一，其容易引起胰腺坏死、全身多器官衰竭等，严重者可致死。因此，识别危险因素对有效预防ERCP术后胰腺炎具有重要的临床意义，该文主要对此领域的研究进展作一综述。

Objective: To investigate the expression and significance of interleukin-12 family cytokines(IL-12, IL-23, IL-27 and IL-35) in patients with inflammatory bowel disease. Methods: One hundred and five patients with inflammatory bowel disease (65 cases of Crohn's disease,40 cases of ulcerative colitis) were enrolled and 24 cases of colon polyps were served as controls. Expression levels of serum IL-12, IL-23, IL-27 and IL-35 were detected by enzyme-linked immunosor-bent assay. Relationship between expression levels of IL-12, IL-23, IL-27, IL-35 and pathogenesis of inflammatory bowel disease were analyzed. Results:Levels of serum IL-12 and IL-27 in ulcerative colitis and levels of serum IL-12, IL-23, IL-27 and IL-35 in Crohn′s disease were significantly higher than those of control group (P<0.05). Correlation analysis showed that serum levels of IL-12 family cytokines were associated with the pathogenesis of IBD. Serum levels of IL-12, IL-27, and IL-35 were closely related with the pathogenesis of ulcerative colitis, IL-12 had positive correlation with severity of CD (P=0.042, r=0.145), while other factors didn′t have correlations. Conclusions: Levels of serumIL-12, IL-23, IL-27 and IL-35 are increased in patients with IBD and they might play an important role in IBD. However, they have no obvious cor-relation with the activity of disease.

Objective: To investigate the role of lymphotoxin α1/β2, LTβR and its signaling pathway in intestinal mucosal immunity of ulcerative colitis (UC). Methods: Forty patients who had active ulcerative colitis confirmed by biopsy and 40 normal controls had their biopsy specimens collected during colonoscopy. The expressions of lymphotoxin α1/β2, LTβR and NF-κB pathway associated protein kinase phosphorylation in UC patients and controls were detected by immunohistochemistry, real-time PCR, Western blotting and immunofluorescence assay. Results: Immunohistochemistry showed that the expressions of LTα1/β2 and LTβR in ulcerative colitis patients were higher than that in normal controls (39.84±5.24 vs 5.34±1.36, P<0.01; 40.95±11.37 vs 4.31±3.25, P<0.01). The mRNA expression level of LTα1/β2 was higher in ulcerative colitis when compared with the normal controls (1.58±0.98 vs 0.39±0.32, P<0.01); as well as the LTβR (3.12±2.22 vs 1.34±0.58, P<0.01). The protein expression level of LTβR was also higher in ulcerative colitis when compared with normal controls (3.67±1.22 vs 1.02±0.78, P<0.01); as well as the LTβR (3.45±1.74 vs 1.89±0.69, P<0.01). In UC patients, the mRNA expression levels of LTα1/β2 and LTβR were positively correlated with the severity of inflammatory bowel disease. The surface markers of dendritic cell were partially merged with the LTβR marker. Phosphorylation of Iκκβ, IκBα and the activation of NF-κBp65 were enhanced in ulcerative colitis. Conclusions: LTα1/β2 expressed on lymphocytes may activate NF-κB signaling pathway by binding with LTβR on dendritic cells,thus plays an important role in intestinal mucosal immunity of ulcerative colitis.

Objective To analyze the clinical characteristics,pathological classification and therapy strategy of rectal carcinoid and its prognostic factors.Methods Forty four patients with rectal carcinoid were diagnosed and treated in Ruijin Hospital Shanghai Jiaotong University from January 2006 to November 2013,among whom 21 patients (19 males and 2 females) were followed-up for 1-7.5 years.The clinical data of these cases were retrospectively analyzed.Results The patients underwent colonoscopy because of changed bowel habits and/or abnormal digital rectal examination,none of them had carcinoid syndrome.Colonoscopy showed that most lesions presented yellowish in color and smooth in surface; the diameter of the tumor was ≤ 1.0 cm in 12 cases (57％) ; the tumors were located at the rectum within 8 cm from anal rim in 17cases (76％); most of them were well differentiated.Immunohistochemistry demonstrated that NSE expression was highly positive.The 1 year-and 3year-survival rate were both 100％.Among 8 cases who were followed up for over 5 year,2 relapsed.Conclusions The digital rectal examination plays a key role in detecting rectal carcinoid.Though prognosis is relatively good,we should keep close following-up to detect the recurrence.The main risk factors influencing the prognosis are tumor size,depth of invasion and clinical stage.The combination measurement of CEA,TSGF,CA19-9 and NSE will either increase the sensitivity or the specificity of early detection.

Objective To compare the clinical choosing principles of sedated colonoscopy with con-ventional colonoscopy. Methods Outpatients who were willing to accept colonoscopy with or without seda-tion were prospectively recruited,which were assigned to sedated colonoscopy group(n=362)and conven-tional colonoscopy group(n=323). All patients and endoscopists were asked to answer a self-administered questionnaire. The colonoscopy completion,operation time,procedure-related discomfort,and questionnaire results of the two groups were compared and statistically analyzed. Results The completion rate was 98. 9%in the sedated colonoscopy group(358/362)and 89. 8% in the conventional colonoscopy group(290/323) ( P=0. 337 ). The operation time of sedated and conventional group were( 5. 60 ± 3. 25 ) minutes and (7. 71 ± 5. 70)minutes respectively(P<0. 001). And the average cost was CNY 886. 54 per patient in se-dated group and CNY 386. 00 per patient in the conventional group. Patient satisfaction score of conventional group and sedated group were 4(3-4)and 3(2-3)points(P<0. 001),while endoscopist satisfaction score was 4(3-4)and 4(4-4)(P<0. 001). A total of 354 patients(97. 79%)in the sedated group and 225 pa-tients(69. 66%)in the conventional group showed willingness to repeat the identical colonoscopy( P <0. 001). Patients who were male(P=0. 035),having no past abdominal operations(P<0. 001),or no ab-dominal pain during colonoscopy( P =0. 015 )in the conventional group preferred to repeat conventional colonoscopy. Conclusion Although the examination time of conventional colonoscopy is longer than sedated colonoscopy,it could reduce anesthesia risk and the cost. Conventional colonoscopy remains an irreplaceable examination of colorectal diseases in developing countries. Physicians should not only focus on patients'com-fort during endoscopy,but also help patients make a decision based on their actual situation and endoscopic indications to make the best of medical resources.

目的:探讨C型凝集素样受体Dectin-1及相关信号通路在溃疡性结肠炎(ulcerative colitis,UC)肠道黏膜免疫中的作用.方法:选取30例活动期UC患者和20名正常对照者,在内镜下于直肠乙状结肠交界处取4块标本进行研究,UC患者的活检标本取自内镜下可见的炎症活动部位.采用实时PCR、蛋白印迹检法及免疫组织化学法检测标本肠上皮中Deetin-1、IL-23p19和核转录因子-κB (NF-κB)途径相关蛋白激酶磷酸化的表达水平.结果:UC患者结肠黏膜中Dectin-l mRNA及其蛋白的表达水平均明显高于正常对照者(3.75±1.98比1.94±1.37,P＜0.05;2.26±1.49比1.28±0.93,P＜0.01);而UC患者结肠黏膜中IL-23p19 mRNA表达水平明显高于正常对照者(6.01 ±2.48比1.36±1.08,P＜0.01);且IκB和NF-κBp65蛋白磷酸化亦较正常对照者明显增加.UC患者的Dectin-l表达水平与其C反应蛋白的表达量呈正相关.结论:Dectin-1、炎症因子IL-23p19的表达及NF-κB通路活性在UC患者中明显增强,且UC患者的Dectin-1表达水平与其炎症程度呈正相关,提示Dectin-l可能在UC患者肠道黏膜免疫中发挥重要作用.

>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)。

Based on the pulverized coal boiler of the 300 MW unit,the volume changing trends of the flue gas components with different flue gas recirculation types and the boiler are leakage coefficients were calculated and analyzed.According to the flue gas recirculation type of the oxy-fuel combustion,the volume calculating model of the flue gas components were established,and the detailed volume calculation for each component of the flue gas was carried out with the iteration method.The results show that the volume ratios of oxygen and nitrogen of the flue gas in the furnace exit were mainly affected by the air leakage coefficient,but the volume ratios of water vapor and carbon dioxide of the flue gas were mainly affected by the flue gas recirculation type.These results are great significance for the design and arrangement of the heat exchangers of the oxy-fuel combustion boilers.

Crohn's disease(CD) is a relapsing systemic inflammatory disease mainly affecting the gastrointestinal tract.The introduction of biologic therapies has offered new therapeutic opportunities.The efficacy of anti-TNF αtherapy of inducing and maintaining clinical remission and prevent the risk of complications of CD has been evaluated in numerous clinical trials.Current guidelines recommend a step-up strategy consisting of a progressive treatment including biologics in severe disease.An early introduction of biologics in newly diagnosed CD has been advocated(top-down strategy).No strong evidence supports the safety and efficacy of early and long-term treatment in modifying the natural history of CD.The ultimate application of use of biologics will likely be established by risk/benefit studies according to certain individuals.

结肠癌干细胞是一小部分存在于结肠癌中具有自我更新、无限增殖和多项分化潜能的肿瘤干细胞,它与结肠癌的复发、转移和治疗耐受有着密切的联系。通过结肠癌细胞表面表达的标志分子如CD133、CD44、CD29、ALDH1和Wnt等从结肠癌中分离得到少部分具有干细胞特性的结肠癌细胞即结肠癌干细胞,以这部分肿瘤干细胞作为肿瘤治疗靶点将为肿瘤治疗带来新的治疗方向。此文就标志分子在结肠癌干细胞筛选及生物学中的功能研究作一回顾,并探讨其作为肿瘤干细胞治疗靶点的可能性。

Objective To analyze the efficacy and safety of Infliximab in treatment of ulcerative colitis(UC).Methods Randomized controlled trials of IFX in patients with UC were searched by electronic retrieve and hand retrieve.Seven studies and seven RCTs were enrolled into the analysis.The information of the trial design,characters of the subjects,results of the studies were analyzed by Revman 4.2 software.Results The long-term and short-term effects in IFX group were significantly different compared with the control group.The long-term and short-term effects in IFX 5 mg/kg group and IFX 10 mg/kg group were significantly different compared with the control group.There was no difference in long-term and short-term effect between IFX group and control group.There was no difference in side effect of medicine between IFX group and control group.Conclusion Infliximab could not only maintain the clinical remission in UC patients,but also decrease the colon resection rate for patients with moderate to severe refractory UC.It could also improve the life qualities.RCT of multiplicity centers is necessary to confirm the conclusion with large samples.