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Evaluation of Additive Effects of Narrow Band Imaging (NBI) Magnification in Borderline Gastric Cancer Diagnosis: Randomized Comparative Study of Conventional/Dye Endoscopy With and Without NBI-Magnification Toshihisa Takeuchi*, Eiji Umegaki, Yuichi Kojima, Ken Narabayashi, Yukiko Yoda, Akira Imoto, Sadaharu Nouda, Kumi Ishida, Yosuke Abe, Daisuke Masuda, Takuya Inoue, Satoshi Tokioka, Kazuhide Higuchi 2nd Dep of Internal Medicine, Osaka Medical Collage, Takatsuki, Japan Introduction: Endoscopic submucosal dissection (ESD) is used globally for early gastric cancer, and accurate borderline lesion diagnosis is important. Current qualitative gastric cancer diagnosis involves magnification NBI. Distinguishing benign and malignant tumors by surface microstructural and capillary patterns, and diagnosing excavated gastric cancer histotypes, are reported to be possible, but there is no firm position on NBI-magnification borderline gastric cancer diagnosis. Objectives: To investigate additive effects of NBI-magnification for borderline diagnosis of ESD-target gastric cancer, and pathological characteristics of lesions not diagnosable even with NBI-magnification. Subjects and Methods: ESD-target gastric cancer cases were randomly allocated, 250 lesions each, to borderline diagnosis by conventional/dye endoscopy, with and without NBImagnification. The former used maximum magnification, structural reinforcement B8, and an Evis Lucera magnifying endoscope with a slit-tip transparent hood. Cancer and other tissues were distinguished by Yao’s VS classification system, and lesion border demarcation lines were determined. With each group, three endoscopists performed or attended pre-ESD borderline lesion diagnosis, marking approx. 5 mm outside lesions, and ESD. Preoperative borderline diagnosis and ESD specimens were compared pathologically, and the rate of failing borderline diagnosis (lateral margin positivity), and causative factors, were evaluated. Results: There were no significant inter-group differences in lesion size, shape, or position, or ESD duration. Conventional/dye endoscopy borderline diagnosis failure rate was significantly lower with than without NBImagnification, at 1.6% (4/250) and 5.6% (14/250; p 0.05). Lesions failing borderline diagnosis are (a) well-differentiated adenoma with mucosal surface layer replacement-type growth; (b) moderately differentiated adenoma dominated by mucosal middle layer invasion, with little surface layer atypia; or (c) undifferentiated cancer with mucosal middle layer invasion. Conclusions: In borderline gastric cancer diagnosis in ESD-target patients, addition of NBImagnification to conventional/dye endoscopy significantly increased diagnostic accuracy, showing the method’s additive effects. However, in histological evaluation of lesions (well-differentiated adenoma with little mucosal surface layer atypia, low-atypia cancer with mucosal middle layer invasion, etc) failing borderline diagnoses even with NBI-magnification, identification of the demarcation line was considered to be difficult.

Background and purpose Recently, the endoscopic equipment have remarkablely improved and the technique of colonoscopic inserting were also progressive, in observation of the early detection of colorectal cancer and inflammatory bowel disease. However, some patients had the severe abdominal pain and fullness during and after colonoscopy. Recently, Saito et al reported to reduce those discomfort with using CO2 insufflation in Endoscopic submucosal dissection (ESD) of colorectal neoplasm in a prospective study. In this randomised controlled trial, we aim to investigate whether use of CO2 insufflation can reduce examinee discomfort in comparison with air insufflation during and after screening colonoscopy. Patients and Methods Patients were divided into two groups or. Patient (n = 205) receiving colonoscopy examinations were divided into 2 groups based on either the standard air insufflation or CO2 insufflation . Both insufflation procedures were also evaluated according to1) round of the abdomen before or after CS, 2) the time of insertion to the caecum, 3) Study measurements included a 100-mm visual analogue scale (VAS, 0 ~ 10; 0: painless, 10: unbearable pain) for patient pain during and after colonoscopy examinations (n = 81). 4) We investigated the comparison of VAS score between using CO2 insufflation and using air insufflation in identical patient who were previously preformed by CS with air insufflation. Result 1)Patient's abdominal discomfort significantly increased after CS in CO2 insufflation compared to the standard air insufflation . 2) The time for insertion was not significantly seen among the 2 groups (average ;13.89 min V.S 12.46min). 3) VAS scores of CO2 insufflation was significantly better than the standard air insufflation(average; 3.67 V.S 4.71). 4) Also, the degree of pain and fullness was reduced in CO2 insufflation compared to the standard air insufflation.Conclusions In the use of CO2 insufflations during and after screening colonoscopy , the time for insertion to caecum was not reduced, but abdominal pain and fullness were significantly reduced. So it was very useful for the colonoscopy. From now on, when it is expected there would be a long time CS, such as we perform CS strictly and beginners perform CS, the use of CO2 insufflations in Colorectal endoscopic examination is significantly useful.

We propose the integrated biosensor chip using Si ring resonators, where different receptor is immobilized on each sensor. Signal detection is carried out by the matrix of light-input and detection waveguides, which are respectively connected to laser diodes and photodetectors. The Si rings are arranged at the cross points. The unique point of our work is to use the silicon-binding protein (designated Si-tag), which binds to SiO2 surface, as an anchoring molecule to immobilize bioreceptor on the Si rings in an oriented manner. In the integrated biosensor chip, many kinds of Si-tag-receptor fusions are required for high-throughput detection of analyte. In this paper, the Si ring biosensors were functionalized with various antibodies using the Si-tagged protein A as an intermediate binder, and the label-free detection of antigen have been achieved. We have developed the rapid functionalization method of Si-ring resonators with antibodies using Si-tagged protein A. Since various kinds of antibody can be used as receptors for biosensing, this method promises to realize the integrated biosensors for high-throughput analyte detection.

G A A b st ra ct s inflammatory cells, and submucosal edema. [Result] Serum CyA levels were significantly less elevated after oral administration of CyA-MS than only CyA (CyA, 44.7±0.8ng/ml; CyAMS, 7.7±1.3ng/ml). The differences between CyA (0) and CyA (0)-MS was not significant in body weight, the histological score, MPO activity, and realtime RT-PCR. The body weight were significantly recovered in the mice group treated with CyA (0.2)-MS, CyA (2), and CyA (2)-MS compared with CyA (0)-MS. The percent body weight at day 10 compared with day 0 were as follows: CyA (0)-MS, -26.17±3.48%; CyA (0.2), -16.763±2.52%; CyA (0.2)-MS, -8.8±2.01%; CyA (2), -13.99±3.81%; and CyA (2)-MS, -7.53±1.97%, respectively. The histological score in CyA(0.2)-MS, CyA(2), and CyA(2)-MS were significantly less than CyA(0)-MS (78.2%, 83.9%, and 80.4%, respectively). The mice group treated with CyA (0.2)-MS was equally effective in histologically compared with that of CyA (2) and CyA (2)MS. MPO activity of the group treated with CyA-MS was also significantly lower than of those treated with vehicle, and data were as follows: CyA (0)-MS, 1.22±0.17unit/mg tissue; CyA (0.2)-MS, 0.73±0.17unit/mg tissue; and CyA (2)-MS, 0.67±0.17unit/mg tissue, respectively. Gene expressions of IL-1β, IL-6, and CXCL1, in the mice treated with CyA (0.2)-MS and CyA (2)-MS were down-regulated compared with the mice treated with CyA (0)-MS (37% and 24%, 11% and 13%, 11% and 14%, respectively). [Conclusion] CyA-MS might be possible to treat ulcerative colitis effectively by decreasing the total dosage without the elevation of the serum level or the side effects of CyA.

Background: Colorectal cancer is one of the most serious complications of ulcerative colitis (UC) and the risk of UC-associated neoplasia increases as the region and duration of the disease increase. As we have shown previously, the selective cyclooxygenase (COX)-2 inhibitor is effective in diminishing carcinogenesis in an murine model of UC (DDW 2006).1 However, this might exacerbate dextran sulfate sodium (DSS) colitis in mice. The selective COX-2 inhibitor Etodolac is marketed as a racemic mixture of the Rand Senantiomers that are not metabolically interconvertible. The biochemical and pharmacological effects of Etodolac are due to the S-enantiomer, while R-enantiomer lacks COX-inhibitory activity. Therefore, R-Etodolac has potential advantage of avoiding COX-2 inhibitory adverse effects. In this study, we evaluated the effect of R-Etodolac on colitis-related mouse colon carcinogenesis. Methods: The mice received 1,2-dimethlhydrazine (DMH) at a dose of 20mg/kg body wt subcutaneously three times within 1 week of reaching 6 weeks of age. Starting 1 week after the DMH injection, chronic colitis was induced in mice by administration of 2 cycles of DSS (each cycle: 3% DSS for 7 days and then distilled water for 14 days). The mice were killed 28 days after the completion of the 2 cycles. The mice were divided into the following groups: group A served as a disease control; group B received low (2mg/kg) dose of REtodolac every 3 days by oral gavage during the whole period; group C received high (10mg/ kg) dose of R-Etodolac every 3 days by oral gavage during the whole period; group D received no agents including DSS and served as a normal control. Results: The administration of R-Etodolac decreased the disease activity index during the administration cycle of DSS. The mean number of tumors was 17.8 in group A, 15.2 in group B and 6.0 in group C. In group C, R-Etodolac significantly suppressed the occurrence of neoplasia (p