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Background: This study was designed to evaluate the clinical efficacy, safety, and feasibility of endoscopic full-thickness resection (EFR) for gastric submucosal tumors (SMTs) originated from the muscularis propria., Methods: Twenty-six patients with gastric SMTs originated from the muscularis propria were treated by EFR between July 2007 and January 2009. EFR technique consists of five major procedures: (1) injecting normal saline into the submucosa and precutting the mucosal and submucosal layer around the lesion; (2) a circumferential incision as deep as muscularis propria around the lesion by the endoscopic submucosal dissection (ESD) technique; (3) incision into serosal layer around the lesion with Hook knife; (4) completion of full-thickness incision to the tumor including the serosal layer with Hook, IT, or snare by gastroscopy without laparoscopic assistance; (5) closure of the gastric-wall defect with metallic clips., Results: EFR was successfully performed in all 26 patients without laparoscopic assistance. The complete resection rate was 100%, and the mean operation time was 105 (range, 60-145) min. The mean resected lesion size was 2.8 (range, 1.2-4.5) cm. Pathological diagnosis of these lesions included gastrointestinal stromal tumors (GISTs) (16/26), leiomyomas (6/26), glomus tumors (3/26), and Schwannoma (1/26). No gastric bleeding, peritonitis sign, or abdominal abscess occurred after EFR. No lesion residual or recurrence was found during the follow-up period (mean, 8 months; range, 6-24 months)., Conclusions: EFR seems to be an efficacious, safe, and minimally invasive treatment for patients with gastric SMT, which makes it possible to resect deep gastric lesion and provide precise pathological diagnosis of it. With the development of EFR, the indication of endoscopic resection may be expanded.

Aim: To clarify the usefulness of the self-expanding metallic stents (SEMS) in the management of acute proximal colon obstruction due to colon carcinoma before curative surgery., Methods: Eighty-one colon (proximal to spleen flex) carcinoma patients (47 males and 34 females, aged 18-94 years, mean = 66.2 years) treated between September 2004 and June 2010 for acute colon obstruction were enrolled to this study, and their clinical and radiological features were reviewed. After a cleaning enema was administered, urgent colonoscopy was performed. Subsequently, endoscopic decompression using SEMS placement was attempted., Results: Endoscopic decompression using SEMS placement was technically successful in 78 (96.3%) of 81 patients. Three patients' symptoms could not be relieved after SEMS placement and emergent operation was performed 1 d later. The site of obstruction was transverse colon in 18 patients, the hepatic flex in 42, and the ascending colon in 21. Following adequate cleansing of the colon, patients' abdominal girth was decreased from 88 ± 3 cm before drainage to 72 ± 6 cm 7 d later, and one-stage surgery after 8 ± 1 d (range, 7-10 d) was performed. No anastomotic leakage or postoperative stenosis occurred after operation., Conclusion: SEMS placement is effective and safe in the management of acute proximal colon obstruction due to colon carcinoma, and is considered as a bridged method before curative surgery.

Objective: The study aimed to evaluate the efficacy of endoscopic therapy for early postoperative anastomotic hemorrhage., Methods: Fourteen patients experienced an episode of early postoperative anastomotic hemorrhage and were treated endoscopically from January 2005 to June 2010. The clinical data was analyzed retrospectively., Results: Fourteen patients(9 males and 5 females, median age 57.5 years, range 26-74 years) were diagnosed with postoperative hemorrhage between 6 hours to 14 days after surgery. The blood loss ranged from 500 to 1500 ml. Sclerosing agent injection, electrocoagulation, and hemoclips were attempted to control the bleeding. Endoscopic approach to control early postoperative anastomotic hemorrhage was successful in all the patients. No recurrent bleeding was observed during the follow-up. No complications associated with endoscopic therapy., Conclusion: Endoscopic approach for the management of early postoperative anastomotic hemorrhage is feasible with high success rate and associated with no complications.

The bone morphogenetic proteins (BMPs) Smad4 and Id2 exert their effect on colorectal carcinoma via several uncharacterized mechanisms. In this study, we investigated whether the transcription factor Id2, which has been implicated in colorectal carcinoma proliferation and metastasis, is involved in BMP-7/Smad4 signaling, or whether it is regulated by BMP-7 via another mechanism in this cell type. A Smad4-cDNA vector was constructed and stably transfected into SW480 cells. Protein levels of Smad4 and Id2 were examined by Western blotting. Inhibitory effects on cellular proliferation activity were determined by the methyl thiazolyl tetrazolium (MTT) assay, and invasion and migration potential was detected using the in vitro Matrigel-coated invasion and migration assay. Levels of Smad4 protein were significantly increased in SW480 cells transfected with Smad4-cDNA, compared to those transfected with empty vector. Growth curve analysis revealed that live cell numbers were lower in the Smad4-expressing group than in the control group after 36 h, and that BMP7 treatment caused an increase in live cell numbers in Smad4-expressing cells. Transwell chamber analysis revealed that migration/invasion activity was significantly suppressed when Smad4 was expressed. Finally, Smad4-expressing cells treated with BMP7 expressed a higher level of Id2 protein than the controls. The results indicate that Smad4 expression may inhibit the growth and invasion of SW480 cells, and that BMP7 affects Id2 levels through Smad4. Therefore, BMP7-Smad4-Id2 signaling may play a significant role in the development of colorectal carcinoma.

Objective: To explore the effects of continuous renal replacement therapy (CRRT) on serum cytokines and prognosis in multiple organ dysfunction syndrome (MODS) patients based on different therapeutic opportunities., Methods: A total of 34 MODS patients in the treatment of CRRT after admission to ICU of our hospital between July 2008 and October 2010 were recruited. Based on the time interval from the onset of MODS to the initiation of CRRT, the patients were stratified into early group (0 - 3 days, n = 16) and late group (4 - 10 days, n = 18). Both groups of MODS patients received conventional treatment in addition to 72 hours of high-volume hemofiltration (HVHF). The serum levels of such inflammatory mediators as interleukin (IL)-1β, interleukin-1 receptor antagonist (IL-1Ra), IL-6, tumor necrosis factor (TNF)-α, soluble tumor necrosis factor receptor1 (sTNFR1) and IL-10 were detected by enzyme linked immunosorbent assay (ELISA) before CRRT (0 h) and 6, 12, 18, 24, 48 and 72 h during the treatment of CRRT. Dynamic APACHEII scores were also evaluated., Results: (1) The early group had lower serum levels of IL-1β, IL-6, IL-10 and higher IL-1Ra, L-1Ra/IL-1β ratio at 72 h than those of 0 h (P < 0.05). And the late group had a declining serum level of IL-1β, IL-6, TNF-α and IL-10 and a rising ratio of IL-1Ra and IL-1Ra/IL-1β during the first 24 h (P < 0.05). As compared with the late group, the early group had a lower level of IL-10 [(25 ± 12) vs (51 ± 33) ng/L] and higher ratios of IL-1Ra and IL-1Ra/IL-1β at 72 h [(1382 ± 899 vs (683 ± 188) ng/L, (54 ± 10) vs (23 ± 6)] (both P < 0.05). (2) The early group had a lower APACHEIIscore than the late group at 0 h (P < 0.05). APACHEII score at 72 h was significantly lower than 0 h in the early group. And there was no obvious change in the late group. There was no statistical difference in the numbers of MODS patients with dysfunctional organs number ≥ 4 at 0 h in both groups. The number of MODS patients with dysfunctional organs number ≥ 4 at 72 h was lower than 0 h in the early group (P < 0.05). And there was no statistical difference in the late group., Conclusion: Regulating the ratio of anti-inflammatory/pro-inflammatory mediators is critical in the immunomodulation of CRRT. And CRRT may provide more clinical benefits in the early phase (0 - 3 days) of MODS.

Objective: To explore whether injury and repair occur in the trachea and the lung after intra-tracheal administration of different drugs., Methods: Wistar rats were randomly divided into 5 groups, a normal group, a blank control (BC) group, a normal saline (NS) group, a lidocaine (LD) group and an amikacin (AK) group. For the latter 3 groups, normal saline, lidocaine and amikacin were injected into trachea by needle puncture. Scanning electron microscope was used to observe the ultra-structural changes of the epithelium, and the percentage of the area of damage (PAD) in tracheal mucosa was calculated. Moreover, pathological changes of the mucous membrane of bronchioles and alveolar epithelial cells were also examined, and the degree of lung pathology was semi-quantified., Results: Two hours after the injection of the 3 drugs, derangement and edema of the cilia were evident by scanning electron microscopy. The PAD of the NS group, the LD group and the AK group were (94.2 ± 3.2)%, (93.1 ± 3.0)% and (95.5 ± 1.8)%, respectively; all being significantly higher than that of the BC group (1.3 ± 0.3)%. For the NS group and the LD group, the PAD decreased significantly after 24 h, which were (73.7 ± 7.8)% and (81.0 ± 4.6)% respectively, and returned to normal at 48 h and 96 h. While for the AK group, the damage began to improve at 72 h [PAD (62.1 ± 5.2)%], and recovered at 96 h. Airway epithelial derangement and cell edema in the alveoli and the bronchioles also occurred 2 h after drug injection, and inflammatory cell infiltration became evident at 24 h. At this time, the score of pathology was 1.80 ± 0.84, 2.60 ± 0.55 and 2.80 ± 0.45 for the NS group, the LD group and the AK group, respectively; all being higher than that of the BC group (0). These pathological changes recovered totally after 72 h for the NS and the LD groups, and 96 h for the AK group., Conclusions: Intra-tracheal administration of normal saline, lidocaine and amikacin in rats led to reversible airway mucosal and lung tissue damages.

Objective: To investigate the prevalence rate of thalassemia among children of 0 - 7 years old, from six ethnic groups in Xishuangbanna and Dehong, Yunnan province., Methods: 4973 blood samples from children under 7 years old were automatically undergone blood cell count, red cell osmotic fragility and hemoglobin electrophoresis testings., Results: The incidence rates of thalassaemia, β-thalassemia was 37.4%, and α-thalassaemia were 22.6% and 14.7% respectively. The thalassaemia incidence rates were significantly different among age groups but not in gender. The incidence of α-thalassaemia was decreasing along with the increase of age, while the incidence of β-thalassaemia was increasing along with the increase of age. Xishuangbanna had the higher incidence than in Dehong and the differences were significant between counties, The incidence of thalassemia of Mengla ranked the first (52.2%) in Xishuangbanna, The differences between different regions and different nationalities were significant, with β-thalassemia of Achang ranked the first (40.6%), The incidence of α-thalassemia among Han ranked the first as 45.5% while α-thalassaemia and β-thalassemia were different in regions. α-thalassaemia and β-thalassemia were significantly different between different ethnic people in the same regions. Multiple factor analysis showed that region seemed to be a risk factor and the mother's ethnicity was a protective factor and dependent variable on thalassaemia., Conclusion: The incidence of thalassaemia in Yunnan Xishuangbanna and Dehong was high among children under the age of 7 and were related to ethnic and regional differences in the areas. Specific genes were proliferated along with the extension of time. Our data provided valuable information on prevention and genetic studies on thalassaemia in the minorities of Xishuangbanna and Dehong in Yunnan province.

Glomus tumors, as a type of quite rare neoplasms, originate from modified smooth muscle cells of the glomus body whose function is to regulate blood flow within arteries according to the body temperature. Although these tumors most commonly occur in the peripheral soft tissues, especially in the distal parts of extremities, there have been rare reports of visceral involvement (Lorber et al., 2005) [1]. We report a case of gastric glomus tumor, which was preoperatively diagnosed by ultrasonic endoscopy as a gastric stromal tumor and treated by endoscopic submucosal dissection (ESD)., (Copyright © 2011. Published by Elsevier Masson SAS.)

Objective: To assess the application value of emergency colonoscopy in the diagnosis and treatment of acute colorectal obstruction., Methods: A total of 459 patients with acute colorectal obstruction received emergent colonoscopy from July 2002 to July 2010. The safety and effective rates were analyzed., Results: The diagnostic rate of successful emergency colonoscopy was 100% (459/459) without any complication. Colorectal cancer were found in 71.3% cases (327/459), volvulus of sigmoid in 11.3% (52/459), diaphragmatocele in 0.4% (2/459), megacolon congenitum in 0.6% (3/459), fecal obstruction in 2.7% (12/459) and none in 13.7% (63/459). The therapeutic rate of colonoscopy was 83.2% (385/459). There were colorectal cancer (n = 327), volvulus of sigmoid (n = 52) and megacolon congenitum (n = 3). The successful treatment rate was 95.8% (369/385) and the complication rate 1.4% (5/385). Among all colorectal cancers, 93.9% (307/327) received endoscopic drainage (mental stents or drainage tube) so as to avoid emergency operations and stoma. And 232 cases underwent phase I operation and another 75 cases received chemotherapy or supportive treatment., Conclusion: Emergency colonoscopy is an effective, safe, minimal invasive approach for diagnosing and managing acute colorectal obstruction.

Objective: To investigate clinical significance and application of modified pelvic floor reconstruction developed by Peking Union Medical College Hospital (MPFR) in treatment of severe pelvic organ prolapse (POP) by comparing the effectiveness, quality of postoperative sexual life, life satisfaction and risk factors for POP recurrence with the following two surgical procedures: traditional total vaginal hysterectomy with anterior-posterior colporrhaphy (TVH-APC) and total vaginal hysterectomy with lateral colporrhaphy and sacrospinous ligament fixation and vaginal bridge repair and episiotomy (TVH-LC-SSLF-VBR-EP)., Methods: Totally 173 patients with severe POP and at least two compartments defects of pelvic floor underwent surgeries in the study, 86 patients (group A) were treated by MPFR with polypropylene mesh application, 58 (group B) were treated by TVH-APC, and 29 patients (group C) were treated by TVH-LC-SSLF-VBR-EP. Peri-operative data and outcomes of postoperative courses at 6, 12, 18 months were collected and analyzed, in the meantime, the risk factors of recurrence were studied., Results: (1) No statistical difference was observed among the above 3 groups in terms of length of operation, amount of blood loss, length of hospital stay, and morbidity after surgery (P > 0.05). (2) Cost hospitalization was (11 448 ± 3049) Yuan in group A, which was significantly higher than (7262 ± 1607) Yuan in group B and (7140 ± 1817) Yuan in group C (P < 0.05). (3) The length of vaginal cuff of (7.5 ± 1.4) cm in group A and (5.6 ± 1.1) cm in group C were significantly longer than (7.1 ± 0.6) cm in group B (P < 0.05). The width of vaginal cuff of (4.3 ± 0.3) cm in group A was larger than (3.4 ± 0.3) cm in group B and (3.3 ± 0.4) cm in group C (P < 0.05). (4) The recurrence rate at 12 months after surgery was 12.8% (11/86) in group A, which was similar with 17.2% (5/29) in group C (P > 0.05) and significantly less than 36.2% (21/58) in group B (P < 0.05). The rate of active sexual life of 16.3% (14/86) in group A was significantly higher than 1.7% (1/58) in group B and 0 in group C (P < 0.05). The index of life quality improvement at 12 months after surgery was 48 ± 12 in group A, which was no less than 53 ± 16 in group C (P > 0.05) and higher than 27 ± 9 in group B (P < 0.05). (5) Mesh rejection was observed in 6 patients in group A within 3 months after surgery, while the posterior vaginal wall was exclusively involved. No difference was found in urinary retention or urinary incontinence among three groups (P > 0.05). (6) The severe degree of POP, type of surgical procedure (TVT-APC), anterior compartment defect of pelvic floor, and early days of performing pelvic floor reconstruction surgeries were high risk factors for POP recurrence (P < 0.05)., Conclusions: MPFR has a better curative effect and lower recurrence rate on patients with POP. It can help patients regain integrity of anatomical structure and functions of pelvic floor. TVH-LC-SSLF-VBR-EP is also effective.

Background: Endoscopic submucosal dissection (ESD) is a new, widely accepted method for the treatment of early gastric cancer and was developed to increase the en bloc resection rate. This study aimed to evaluate the efficacy and safety of ESD compared with conventional endoscopic mucosal resection (EMR) for small rectal carcinoid tumors., Methods: A retrospective study was carried out that included 43 patients with small rectal carcinoid tumors (< 10 mm). The cohort comprised two groups: Group A (N = 23) underwent conventional EMR from January 2004 to August 2005, while group B (N = 20) underwent ESD with needle-knife from September 2005 to December 2006. The rate of curative en bloc resection, the procedure time, and the incidence of complications were evaluated., Results: The en bloc resection rate and the rate of completeness of resection of group B were higher than those of group A (100 vs. 87%, 100 vs. 52.5%, respectively). The average operation time required for resection was significantly longer in group B (28.4 ± 17.2 min) compared with group A (12.3 ± 15.4 min) (p < 0.05). None of the patients had immediate or delayed bleeding during the procedure. Perforation occurred in one case of group B and the patient recovered after several days of conservative treatment. Three patients had local recurrence after EMR, while no patient experienced recurrence after ESD., Conclusion: ESD, compared with conventional EMR, increased en bloc and histologically complete resection rates and may reduce local recurrence rate for small rectal carcinoid tumors. Increased operation time and complication risks with ESD remain problematic. Further technique and investigation are required to confirm the safety and to assess the long-term prognosis of ESD.

Background: The few studies on MR colonography with air enema involved feasibility of bowel distention and imaging quality and lacked detection sensitivity of colorectal neoplasms. The purpose of this prospective study was to assess the detection sensitivity of colorectal neoplasms with the three-dimensional Fourier transform fast spoiled gradient-recalled MR colonography with air enema., Methods: A total of 30 patients scheduled for optical colonoscopy due to rectal bleeding, positive fecal occult blood test results or altered bowel habits were recruited and successfully underwent entire colorectal examinations with three-dimensional Fourier transform fast spoiled gradient-recalled MR colonography and subsequent optical colonoscopy on the same day. Detection sensitivity of colorectal neoplasms with MR colonography was statistically analyzed on a per-neoplasm size basis by using findings from optical colonoscopy and histopathological examinations as the reference standards., Results: Seventy-six neoplasms were detected with optical colonoscopy, consisting of 1 mm-5 mm (n = 11), 6 mm-9 mm (n = 29) and ≥ 10 mm (n = 36) in diameter. Detection sensitivities of 1 mm-5 mm, 6 mm-9 mm, ≥ 10 mm and ≥ 6 mm colorectal neoplasms with MR colonography were 9.1%, 75.9%, 100% and 89.2%, respectively; overall detection sensitivity for all sizes colorectal neoplasms was 77.6%., Conclusions: Detection sensitivity of three-dimensional Fourier transform fast spoiled gradient-recalled MR colonography with air enema is low for 1 mm-5 mm colorectal neoplasms, but the detection sensitivity is 89.2% for ≥ 6 mm neoplasms, and all ≥ 10 mm neoplasms could be detected.

Objective: To explore the relationship between imatinib resistance and genes MDR1 and KIT in gastrointestinal stromal tumor (GIST) cells., Methods: The MDR1 and KIT mRNA level in GIST882-R and GIST882-S cells were detected by RT-PCR. Immunocytochemistry and Western blot were employed to detect P-gp and CD117 expression in GIST882-R and GIST882-S cells., Results: The relative expression of MDR1 mRNA was 0.321 + or - 0.033 in GIST882-R and 0.157 + or - 0.056 in GIST882-S cells, and the difference was statistically significant (P<0.05). The relative expression of KIT mRNA was 0.389 + or - 0.063 in GIST882-R and 0.339 + or - 0.067 in GIST882-S, and the difference was not statistically significant (P>0.05). The relative density of P-gp was 0.443 + or - 0.058 in GIST882-R and 0.237 + or - 0.094 in GIST882-S, and the difference was statistically significant (P<0.05). The relative density of CD117 was 0.744 + or - 0.123 in GIST882-R and 0.704 + or - 0.094 in GIST882-S, and the difference was not statistically significant (P>0.05)., Conclusions: Over-expression of gene MDR1 may be associated with imatinib resistance in GIST. KIT may not be involved in imatinib resistance.

Objective: To explore the diagnostic value of bone marrow biopsy for bone marrow metastatic tumor with unknown primary tumor site., Methods: Thirty-eight cases of metastatic bone marrow tumors were diagnosed by light microscopy, and the bone marrow samples from these cases with unknown primary tumor sites were examined by immunohistochemistry., Results: In all the cases, the bone marrow was infiltrated by tumor cells between the bone trabecula. Twenty patients were identified to have poorly differentiated adenocarcinomas, 6 had mucinous adenocarcinomas, 6 had mucinous carcinomas, 4 had poorly differentiated squamous cell carcinomas, and 2 had melanoma. Immunohistochemistry identified the primary tumor sites in these cases, including 12 stomach cancers, 10 breast cancers, 8 prostate cancers, 4 lung cancers, 1 dorsal melanoma, 1 left foot melanoma, and 2 nasopharyngeal cancers., Conclusion: Proper immunohistochemistry can help determine the primary tumor sites in patients with metastatic bone marrow tumor with unknown primary tumor sites.

Objective: The aim of this study was to evaluate the effect of herb-partition moxibustion on rectal sensory thresholds and to analyse possible mechanism of herb-partition moxibustion in treating chronic visceral hypersensitivity rats., Methods: Herb-partition moxibustion was administered to chronic visceral hypersensitivity rats for 7 days (once daily). Two moxa cylinders were used for each point in one treatment. Chronic visceral hypersensitivity rats without herb-partition moxibustion and normal rats were chosen as the control groups. Detection of abdominal withdrawal reflex was performed during 30-90 minutes after the first treatment. After seven treatments, a segment of distal colon (5 cm in length) was harvested, and 5-hydroxytryptamine concentration in the colon tissue was detected by enzyme-linked immunosorbent assay., Results: Herb-partition moxibustion significantly depressed abnormally increased AWR scores from the rectus abdominis in response to colorectal distention stimulation at strengths of 40 and 60 mmHg. Herb-partition moxibustion decreased 5-hydroxytryptamine concentration in colon tissue of chronic visceral hypersensitivity rats., Conclusion: Herb-partition moxibustion enhances the pain threshold of chronic visceral hypersensitivity rats and restores normal sensitivity by 5-hydroxytryptamine concentration decreased in the colon tissue. However, whether herb-partition moxibustion could enhance the pain threshold of IBS patients or not is not concluded in this study because of only small sample rats experiment.

Objective: To investigate the role of CD40 ligand (CD40L) in dendritic cells (DC) of CEA transgenic mice and to evaluate the specific cellular immunity induced by activated DC., Methods: Bone marrow cells of the CEA transgenic mice were used to generate immature dendritic cells under the condition of GM-CSF and IL-4. CD40L was added to activate dendritic cells into mature phenotype. Dendritic cells cancer vaccine was pulsed with CEA526-533 peptide which made the vaccine specific for cancer immunity. The immunophenotype molecules were identified by flow cytometry. The cytokines produced by cells were determined by ELISA. T cells proliferation was measured by (3)H-thymidine essays., Results: Immunophenotype molecules expressions of CD40L-activated dendritic cells were significantly higher than those in control group. IL-12 secretion by CD40L-activated dendritic cells was (937.81+/-51.99) pg/10(6) DC, significantly higher than that in control group [(83.06+/-8.58) pg/10(6) DC, P<0.01]. CD8(+) T cells proliferation induced by CD40 L-activated dendritic cells was stronger as compared to control group (P<0.05), and the secretion of IFN-gamma was(33.900+/-4.550) ng/L, significantly higher than that in control group [(5.226+/-0.460) ng/L, P<0.01]. Splenocytes proliferation induced by CD40 L-activated dendritic cells was stronger as compared to control group (P<0.01), and the secretion of IFN-gamma was (69.802+/-11.407) ng/L, significantly higher than that in control group [(2.912+/-0.562) ng/L, P<0.01]., Conclusion: The method of using CD40L to stimulate bone marrow-delivered dendritic cells promotes the maturation and activation of dendritic cells, which enhances the cellular immunity in CEA transgenic mice.

Background: Endoscopic submucosal dissection (ESD), a new widely accepted method for treating early gastric cancer, was developed to increase the en bloc rate, especially for lesions larger than 20 mm in diameter. This study aimed to evaluate the efficacy and safety of ESD for colorectal epithelial neoplasms., Methods: From July 2006 to December 2007, ESD was indicated for patients with colorectal epithelial neoplasms larger than 20 mm in diameter. The rates of curative en bloc resection, the procedure time, and the incidence of complications were investigated., Results: A total of 74 colorectal epithelial neoplasms were resected by ESD. The mean diameter of these lesions was 32.6 mm (range, 20-85 mm). The rate of en bloc resection was 93.2% (69/74), and the mean ESD procedure time was 110 min (range, 80-185 min). None of patients had massive hemorrhage during ESD, and only one patient (1.4%) bled 8 days after ESD. Six patients experienced perforation, and all except one recovered after several days of conservative treatment. The patient who did not recover underwent urgent surgery. The perforation rate was 8.1% (6/74). All the patients were followed up. Healing of the artificial ulcer was confirmed, and with no lesion residue or recurrence was found., Conclusions: The findings show ESD to be effective for colorectal epithelial neoplasm, making it possible to resect the whole lesion in one piece and to provide precise histologic information.

Neovascularization is essential for tumor growth and metastasis. An adequate vasculature feeds tumor growth and enhances the potential of metastasis. For many years, tumor vessels were thought to be lined exclusively by endothelial cells (ECs). However, therapeutic benefits from the promising antiangiogenic strategy targeting genetically stable ECs are frequently limited by the development of resistance, implying an oversimplified view of tumor vasculature. In fact, latest studies have revealed that in addition to ECs, other cells including bone marrow-derived and plastic tumor cells do contribute to tumor vascularization, which is also indicated in ovarian cancer, the most lethal gynecologic malignancy characterized by widespread metastases within the peritoneal cavity upon diagnosis. Given the principle that tumor progression and metastasis are dependent on a persistent blood supply, it is logical that the capability of generating neovessels through diverse mechanisms of ovarian cancer is associated with its malignant potential. This review will discuss the diverse origins of ovarian cancer vascular cells and emphasize their clinical relevance (in the hope of providing insight into the prognostic assessment of women at risk for aggressive disease behavior) and alternative targets for therapeutic intervention.

Experiments in rats have shown that chronic visceral hyperalgesia can be relieved by electro-acupuncture, but the efficacy of suspended moxibustion for relieving chronic visceral hyperalgesia is still unclear. The present study aimed to evaluate the effect of suspended moxibustion on rectal sensory thresholds and to analyze its possible mechanisms when treating chronic visceral hypersensitivity rats. Suspended moxibustion was administered once daily to 37-day-old chronic visceral hypersensitivity rats for 7 days. The two acupoints (ST25, bilateral) were simultaneously given suspended moxibustion. Each treatment lasted for 15 min. Rats in treatment of suspended moxibustion was not anesthetized. Untreated chronic visceral hypersensitivity rats and normal rats were used as controls. The abdominal withdrawal reflex was determined during 30-90 min after the first treatment. A 5-cm long segment of distal colon was harvested after seven treatments and 5-hydroxytryptamine concentrations in the colon were assayed by enzyme-linked immunosorbent assay. Abdominal withdrawal reflex scores from the rectus abdominis in response to colorectal distention were increased in rats with chronic visceral hypersensitivity, and the stimulation at strength of 20 mmHg was significantly depressed by suspended moxibustion. Suspended moxibustion increased the pain threshold and restored normal sensitivity by reducing 5-hydroxytryptamine concentrations in the colon of chronic visceral hypersensitivity rats.

Objective: To assess the clinical efficacy of endoscopic treatment for colorectal adenomatous polyps and early-stage carcinomas., Methods: Between January 2006 and October 2007, 245 patients with colorectal adenomatous polyps and early-stage carcinomas with lifting sign(+) were treated by such endoscopic techniques as polypectomy, endoscopic mucosal resection (EMR), endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD)., Results: Two hundred and fifty-three lesions ranged from 0.5 to 8.5 cm and the mean resected size was 2.3 cm, of which 157 were smaller than 2 cm and 96 larger than 2 cm. Confirmed pathologically, 249 lesions were successfully resected and the resection rate was 98.4% (249/253). None of patients had massive hemorrhage during the procedure and 2 had delayed bleeding. 1 had a little free air in abdominal cavity, 2 patients had subcutaneous emphysema due to deep tearing of the muscle layer, all 3 recovered after several days' conservative treatment. Visible perforation occurred in 4 cases during the dissection, of which 3 were typically closed with metallic endo-clip without surgical treatment, and 1 was managed surgically with obvious distention and much abdominal free air. The rate of resectional complication was judged to be 3.6% (9/253). Eight cases were transferred to surgery altogether after endoscopic procedure. Two hundred and thirty-one cases were followed up with confirmed healing of the large artificial ulcer after ESD except for local recurrence in 3 cases after EPMR., Conclusions: Endoscopic resection appears to be an efficacious procedure to treat adenomatous polyp and early-stage carcinoma and provide pathological information about the whole lesion. Measures should be taken to reduce the complication rate of endoscopic resection in the future.

Objective: To evaluate the long-term efficacy of endoscopic excision for rectal carcinoids., Methods: Clinical data of 91 patients with rectal carcinoids treated by endoscopic excision from 2000 to 2007 were analyzed retrospectively., Results: The average size of the primary tumor was 0.8 cm(range 0.3 to 2.3 cm). All the tumors were localized within the submucosal layer showing typical histology without lymphatic or vessel infiltration. Follow-up was available for 80 patients with mean 32.5 months (range 6 to 96 months). There was no recurrence in 65 patients with tumor size < 1.0 cm. Recurrence occurred in 3 cases among 25 patients with tumor size from 1.0 to 2.0 cm, and 1 died of hepatic metastasis. The 1-, 3-, and 5-year survival rates of the patients were 100%, 98.0%, and 91.4% respectively., Conclusions: Tumor size and depth of invasion are two important prognostic factors of rectal carcinoids. Endoscopic excision is useful for rectal carcinoid patients with tumor size < 1.0 cm and located within the submucosal layer.

Objective: To evaluate the efficacy of endoscopic self-expanded metal stent for the treatment of gastric outlet obstruction., Methods: Fifty-six cases of gastric outlet obstruction, collected from March 1999 to January 2008, were treated by endoscopic self-expanded metal stents. The success rate, complication rate and survival were evaluated., Results: Among the 56 cases, the male to female ratio was 33 to 23, and the average age was [65+/-14 (24-86)] years. Seventeen cases were gastric cancer, 4 duodenal carcinoma, 7 peri-ampulla carcinoma, 13 metastasis cancer and 15 presented recurrence after operations. The success rate of stent implantation was 98.2% (55/56). Forty-nine cases (87.5%) could eat liquid food 1-3 days after operations and eat semifluid food 4-9 days later. Forty-two cases (76.4%)could eat normal food after 10-16 days. The main complications included 14.5% of cases with pain, 1.8% with stent shift, 25.5% with bleeding and no one with perforation. Until January 20, 2008, 53 cases (96.4%) had been followed up. The mean survival time was [139+/-15 (14-332)] days, and the median survival time was 135 days. The re-stenosis rate was 5.7%, including 3 cases, happened in 143, 158 and 190 days after the operations respectively, and was successfully treated by second stent implantation., Conclusion: Endoscopic implantation of self-expanded metal stent is a micro-invasive, safe, effective method for the treatment of gastric outlet obstruction.

The aim of this study is to investigate the plasticity of human epithelial ovarian cancer cell SKOV3ip and formation of vasculogenic mimicry (VM) in vivo. SKOV3ip was transfected with lentiviral vector carrying green fluorescence protein (GFP). Female nude mice were implanted intraperitoneally with GFP-labled SKOV3ip. When the transplanted tumor reached a volume of approximately 1 cm(3), paraffin-embedded, formaldehyde-fixed tissue was prepared and stained with hematoxylin and eosin (H & E). Tumor tissues were also studied by electron microscopy and fluorescence microscopy. The results of H & E staining, electron microscopy, and fluorescence microscopy indicated SKOV3ip formed patterned networks with erythrocytes in them, in the absence of vascular epithelial cells, which was a sign that SKOV3ip engaged in VM in vivo. Expression of vascular epithelium marker CD31 was investigated by immunohistochemical staining, immunofluorescence assay, semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR), and flow cytometric analysis (FACS). Factor VIII and vascular endothelial growth factor (VEGF) were also analyzed by FACS. Weak and focal CD31 immunohistochemical staining was found along the channels of tumor cells. Immunofluorescence assay and RT-PCR demonstrated that CD31 was expressed in primary-cultured SKOV3ip. CD31 and Factor VIII, but not VEGF were detected in primary-cultured SKOV3ip by FACS. The present study has shown that human ovarian cancer cell line SKOV3ip may be able to express some specific markers of vascular epithelial cells and has plasticity to form VM in vivo. In the following study, we indicated that hypoxia-inducible factor (HIF)-1alpha inhibitor, rapamycin, could possibly prevent VM and phenotype transformation of SKOV3ip, reflected by down-regulating expression of CD31 and Factor VIII. HIF-1alpha protein expression correlated with CD31 and Factor VIII protein expression in SKOV3ip. These results indicated that VM might be associated with HIF-1alpha.

Objective: To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the removal of small gastrointestinal stromal tumor (GIST)., Methods: GIST diagnosed by endoscopic ultrasonography (EUS) was managed by ESD with the needle knife as follows:(1)Injecting normal saline into the submucosa. (2)Pre-cutting the surrounding mucosa of the lesion. (3) Dissecting the submucosal tissue to display GIST and resecting the lesion completely., Results: Of 20 GISTs, 12 located in gastric fundus, and 1 in gastric antrum, 3 in gastric body and 4 in rectum. Lesion diameter ranged from 0.5 to 3.2 cm and the mean resected size was 1.6 cm. Among 20 lesions, 19 were resected with ESD completely, and 1 received additional operation because of tumor residual in the wound after ESD. The success rate of ESD was 95.0% (19/20). The mean ESD procedure time was 87.5 min (ranging from 60 to 150 min). None of the patients had delayed bleeding after ESD. Perforations occurred in 3 cases after the dissection of the GIST, which were closed with metallic endoclips without additional surgical suture. The perforation rate of ESD was 15.0% (3/20). The follow up ranged from 2 to 12 months, and no recurrence was observed by EUS except the above-mentioned case undergone additional operation., Conclusion: ESD is effective and safe for small GIST, which can resect the whole lesion and provide pathological information.

Objective: To summarize the experience of diagnosis and treatment of gastrointestinal lipoma., Methods: The clinical data of 34 patients with gastrointestinal (GI) lipoma from 1993 to 2007 were analyzed retrospectively., Results: GI lipoma produced a variety of symptoms including gastrointestinal bleeding, abdominal pain, anemia, intussusception, and bowel obstruction. The diagnostic accuracy of endoscopic ultrasonography(EUS) for GI lipoma was 93.8%. Twelve GI lipomas were resected under endoscopy, the remainder at laparotomy, partial resection, gastrectomy or enterectomy being performed. Twenty-eight cases were followed up from 1 month to 168 months. No recurrence and metastasis were observed except one case dying of gastric liposarcoma., Conclusions: EUS is an effective method for diagnosing GI lipomas. The treatment of GI lipomas is surgical resection, and endoscopic removal of GI lipomas is safe following the guidance of the present therapeutic strategy.

Objective: To assess the clinical value of endoscopic submucosal dissection(ESD)for rectal carcinoid tumors., Methods: Endoscopic miniprobe ultrasonography was performed in patients with rectal submucosal tumors under colonoscope. ESD was carried out with the needle knife for lesions diagnosed as rectal carcinoid as following: (1)Fluid was injected into the submucosal layer in the rectum to elevate the lesion from the muscle layer. (2)The surrounding mucosa of the lesion was pre-cut. (3)The connective tissue of the submucosa beneath the lesion was dissected., Results: Five rectal carcinoids ranged from 0.4 to 1.2 cm and the mean resected size was 1.1 cm. All rectal carcinoid tumors were verified by pathological examination with lateral and basal resection margins free of tumor. The mean ESD procedure time (from fluid injection to complete dissection) was 35 min (ranged from 20 to 45 min). Minor bleeding occurred in all of the tumors, and none of patients had massive hemorrhage requiring blood transfusion or emergency colonoscopy due to hematochezia after ESD. One patient had subserosal emphysema due to deep tearing of the muscle layer, and recovered after several days' conservative treatment. All patients were followed up with colonoscopy 1 month after ESD,which confirmed the healing of artificial ulcers., Conclusions: ESD is a novel endoscopic treatment that makes it possible to resect the whole rectal carcinoids. Rectal carcinoid tumors can now be treated by ESD to achieve the same therapeutic effect as operation.

Objective: To assess the value of endoscopic submucosal resection with ligation (ESMRL) in rectal carcinoids., Methods: 45 patients with rectal carcinoids, 20 males and 25 females, aged 58 +/- 18 (19 - 73), were treated with ESMRL from April, 2002 to April, 2006. The radical resection rate, complication rate, relapse rate, and metastasis rate were analyzed., Results: Carcinoids accounted for 1.8% of the 24,600 cases undergoing colonoscopy at the same time. All the carcinoids were located 2 - 15 cm from anal border, with a mean diameter of (1.4 +/- 0.3) cm (0.3 - 2.0 cm). The endoscopic ultrasonographic (EUS) characteristic was a hypoechoic solid tumor in the superficial submucosa (24 cases, 53%) or in both the mucosa and submucosa (21 cases, 47%) without involvement of the muscularis propria. All patients received ESMRL of the rectal carcinoids, of which 34 cases (75.6%) needed more hemostasis of the incision margin. The mean operation time was (25 +/- 4) min. 7 cases (15.6%) with tardy bleeding 2 - 7 days after ESMRL needed endoscopic re-hemostasis, of which 3 cases (43%) showed oozing of blood from the muscle layer and another 4 showed oozing of blood or arterial bleeding from the incision border. No perforation or inflammatory was reported. 39 cases (86.7%) had negative margin in pathological examination, and the incision margins of the other 6 patients, as normal submucosal layer could not be seen outside the tumor envelope, could not be evaluated. But the tumor envelope was integrated without involvement of tumor and other biopsy results 7 days after ESMRL was negative. So no more therapies were selected. All 45 patients were followed up for 31 months (6 - 52 months), there was no metastasis, relapse and dead cases., Conclusion: ESMRL is an effective, safe, and minimally invasive method to deal with rectal carcinoids.

A few highly aggressive and malignant tumor cells could acquire identities by turning on genes expressed by endothelial cells and recruit blood vessels to sustain tumor growth. Hypoxia was reported recently to play an essential role in these events. These 'plastic' tumor-cell phenotypes and the exact mechanism driving transendothelial differentiation by hypoxia-inducible factor (HIF)-1alpha is unclear. In this study, epithelial ovarian carcinoma cells were exposed to hypoxia and the tumor cells were transformed into endothelial cells-like (ECs-like). Typical endothelial features such as cell markers and uptaking of acetylated low density lipoprotein were identified constantly. Small interference RNA was used to block the expression of HIF-1alpha. Analysis revealed that hypoxia promotes transendothelial differentiation through stimulating HIF-1-dependent transcriptional expression of vascular endothelial growth factor (VEGF), VEGF receptor-2 (Flk-1) and P53, and through decreasing HIF-1-independent transcriptional expression of Cyclin D1. These results demonstrate that ECs-like derived from epithelial ovarian cancer cells are similar to endothelial progenitor cells rather than endothelial cells. HIF-1alpha is crucial but not unique in alternation of tumor cells towards ECs-like.

Background: Getting directly into the common bile duct (CBD) is the most important step for successful therapeutic biliary endoscopy. In 5%-10% of cases, the CBD remains inaccessible, necessitating pre-cut papillotomy or fistulotomy with a needle-knife. The aim of this study was to assess the value of early application of the needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography (ERCP)., Methods: Patients with failed biliary cannulation after 10 minutes or guide wire entering the pancreatic tube 3 times were randomly divided into group of needle-knife cut and group of persistent cannulation by standard techniques. The cannulation times, success rates and complication rates were compared between the two groups., Results: A total of 948 therapeutic biliary ERCP procedures were performed between October 2004 and February 2006. Of 91 patients with difficult biliary cannulation, 43 patients underwent needle-knife cut: the cannulation success rate was 90.7%, the mean cannulation time was 5.6 minutes, and the complication rate was 9.3%. The other 48 patients underwent persistent cannulation by standard techniques: the cannulation success rate was 75%, the mean cannulation time was 10.2 minutes, and the complication rate was 14.6%. Significant differences were observed in cannulation success rate and cannulation time but in complication rate between the two groups., Conclusion: The early application of the needle-knife in difficult biliary cannulation is time-saving, safe and effective, with no increase in complication rate.

Objective: The transcription factor Snail, which is implicated in the triggering of epithelial-mesenchymal transitions (EMT), plays an important role in adhesion, invasion and metastasis of tumor cells. In the present study, we assessed 17beta-Estradiol (E2)'s effect on Snail, E-cadherin and MMP-2 expression of epithelial ovarian cancer cell line ES-2 and SKOV3. Then we induced Snail gene silencing by RNA interference to explore the effect of E2 on E-cadherin and MMP-2 expression when Snail gene expression was blocked., Methods: Treated by 10(-8) M E2, Snail, E-cadherin and MMP-2 mRNA expression of the cells was measured by RT-PCR; Snail, MMP-2 protein expression was detected by IHC; and MMP-2 activity was determined by Zymography. E-cadherin protein level was measured by Western blot. We constructed the small interfering dsRNA expression vector (pRNAT-U6.1/Neo-Snail) targeting Snail gene, as well as a negative control vector (pRNAT-U6.1/Neo-Neg). Then the cells were transiently transfected with the vectors. Western blot and zymography were conducted to determine E-cadherin protein level and matrix metalloproteinase activity of the cells transfected with pRNAT-U6.1/Neo-Snail or pRNAT-U6.1/Neo-Neg after treated with E2 for 24 h., Results: The expression of ER alpha mRNA and protein was negative in ES-2 cells and positive in SKOV3 cells, and ER beta expression was positive in both cell lines. 10(-8) mol/l E2 elevated expression of Snail and MMP-2 mRNA and protein in both ES-2 and SKOV3 cells, and reduced expression of E-cadherin mRNA and protein in SKOV3 cells. While in the RNAi group transfected with the small interfering dsRNA expression vector (pRNAT-U6.1/Neo-Snail) targeting Snail gene, E2 treatment did not have a significant effect on MMP-2 activity or E-cadherin protein in ES-2 and SKOV3 cells., Conclusions: 17beta-Estradiol increased Snail expression in both ER alpha-negative ES-2 cells and ER alpha-positive SKOV3 cells independent of the existence of ER alpha. The increase of MMP-2 expression in ES-2 and SKOV3 cells and decrease of E-cadherin expression in SKOV3 cells induced by E2 were associated with up-regulation of Snail.

Objective: To assess the estrogen and progestin's effect on protein expression of metastasis repression gene nm23-H1 via regulation of phosphorylation signaling in epithelial ovarian cancer cell line ES-2., Methods: Ovarian clear cell adenocarcinom cell line ES-2 was treated by different doses of 17beta-estradiol (estrogen), medroxyprogestogen (progestin) and dimethyl sulfoxide (control group), and then the following experiments were conducted. (1) Change of the cell migration capacity after treatment with estrogen and progestin for 24 and 48 hours was measured by in vitro wound healing assay. (2) Transwell experiments were used to detect the ability of cell invasion, which was also used to inhibit the phosphorylation of protein kinase B (AKT) pathway with estrogen and progestin. (3) Change of nm23-H1, AKT and phosphorylated protein kinase B (pAKT) protein level of ES-2 cells after treated with estrogen and progestin was detected by western blot. (4) Cells were transfected with the small interfering RNA (siRNA) expression vector targeting AKT. The efficiency of cells transfected was calculated according to the number of cells with green fluorescent produced by cells transfected. Change of nm23-H1 expression was assessed., Results: ES-2 cells treated with estrogen, progestin or vehicle all migrated into the wound surface after 24 and 48 hours. The migration of the cells treated with estrogen was (1.39 +/- 0.08) mm, significantly elevated (P = 0.029), and that of the cells treated with progestin was (1.96 +/- 0.07) mm, significantly decreased compared with cells treated with vehicle (P = 0.014). The cells were cultured in transwell after 24 hours. The invasion of the cells treated with estrogen was 119 +/- 13, significantly elevated (P = 0.015), and that of the cells treated with progestin was 78 +/- 8, significantly decreased compared with cells treated with vehicle (P = 0.006). Western blot results showed that 17beta-estradiol decreased nm23-H1 expression, and both effects were dose and time dependent (P = 0.020, P = 0.001). Progestin increased nm23-H1 expression in ES-2 cells, and both effects were dose and time dependent (P = 0.003, P = 0.002). 17beta-Estradiol elevated the expression of pAKT, which was also dose and time dependent (P = 0.001, P = 0.007), while progestin repressed pAKT expression which was also dose and time dependent (P = 0.012, P = 0.039). When cells were transfected with the siRNA expression vector targeting AKT, the effects of estrogen and progestin on nm23-H1 expression were both attenuated., Conclusions: Estrogen downregulates the expression of nm23-H1 via activation of the phosphorylation signaling, thus participated in the regulation of invasion and metastasis of epithelial ovarian cancer cells. Progestin upregulates the expression of nm23-H1, and might repress invasion and metastasis of tumor cells.

Objective: To evaluate stenosis of the lower rectum following PPH with special respect to potential predictive factors or stenotic events., Methods: A retrospective analysis of 554 consecutive patients, which underwent PPH from July 2000 to December 2004 was performed., Results: Only patients with follow-up check were evaluated, thus the analysis includes 489 patients (489/554, 88.3%) with a mean follow-up of (324 +/- 18) days. Rectal stenosis was observed in 12 patients (12/489, 2.5%), the median time to stenosis was 89 - 134 (125 +/- 5) days. All the patients complained of obstructive defecation and underwent strictureplasty with electrocautery or balloon dilation through colonoscopy. A statistical analysis revealed that patients with stenosis had significantly more often prior sclerosis therapy for hemorrhoids (58.3% vs. 20.0%, P = 0.02) and severe postoperative pain (25.0% vs. 6.7%, P = 0.003). Other factors, such as gender (P = 0.32), prior surgery for hemorrhoids (P = 0.11), histological evidence of squamous skin (P = 0.77) or revision (P = 0.53) showed no significance., Conclusion: Rectal stenosis is an uncommon event after PPH. Early stenosis will occur within the first four months after surgery. The majority of the stenosis can be cured through colonoscopy surgery. The predictive factors for stenosis are previous sclerosis therapy for hemorrhoids and severe postoperative pain.

Objective: To evaluate the clinical use of endoscopic ileus tube drainage in preoperative therapy for acute low malignant colorectal obstruction., Methods: From Nov. 2004 to Dec. 2005, 15 cases with acute low malignant colorectal obstruction received emergency colonoscopy and endoscopic ileus tube drainage was performed. Radical resection was then performed after seven days of drainage., Results: Endoscopic ileus tube drainage was successful in 13 cases, and failed in 2 cases because the guide wire cannot be inserted through the tumor in one case, and in the other case the tumor was located in the middle of the transverse colon so that the ileus drainage tube was not long enough. Abdominal girth decreased from (91+/- 4) cm to (82+/- 2) cm after tube drainage. The everyday drainage volume minus rinsing volume ranged from - 600 ml to 3200 ml. Abdominal X ray showed that obstruction was relieved. Intra-operative exploration revealed that colon edema was not evident, which increased resection rate., Conclusion: Endoscopic ileus tube drainage is effective, safe and maybe the first choice of acute low malignant colorectal obstruction.

Twelve patients with unilateral polycystic ovarian morphology demonstrated milder degrees of ovarian and other endocrine dysfunction than polycystic ovary syndrome patients and had fewer incidences of hyperprolactinemia and hyperandrogenism.

Objective: To evaluate the feasibility and clinical value of endoscopic interventional treatment of malignant gastrointestinal obstruction., Methods: With the aid of X ray, 32 cases with malignant gastrointestinal obstruction were treated with endoscopic metal stenting. There were 8 cases with gastric outlet obstruction, 7 with duodenal obstruction, 13 with rectal obstruction, and 4 with sigmoid obstruction., Results: Among the 32 patients, metal stenting was successfully performed in 30 cases (93.7%, and obstructive symptoms were relieved within 1-3 days. Metal stent placement was permanent in 15 cases with gastric outlet or duodenal obstruction. Twelve cases with colorectal obstruction received stent placement as palliative treatment, while other 3 cases underwent subsequent elective surgical resection. Metal stent placement failed in one case with recurrent rectal carcinoma, and perforation occurred in another one case with wide spread metastatic sigmoid colon carcinoma and Hartmann operation was performed. During the follow-up period, no stent migration was detected., Conclusion: Endoscopic interventional treatment of malignant gastrointestinal obstruction is a feasible, safe, effective and well tolerated method. It can reduce the patients trauma and pain, and improve the quality of life.

Objective: To explore possibility of vasculogenic mimicry induced by hypoxia and the inhibitive effect by sirolimus in epithelial ovarian carcinoma in vitro., Methods: Based on three-dimensional cell culture system developed by Matrigel, ovarian cell lines SKOV3 and ES2 were induced under conditions of hypoxia, hypoxia added with sirolimus and no-hypoxia, respectively. Potential formation of tumor channels and their characterization of network were observed by light microscopy and scanning electronic microscopy. Relative hypoxia-inducible factor (HIF) 1alpha mRNA expression was detected by RT-PCR simultaneously., Results: The micrograph showed both SKOV3 and ES2 cells appeared expanded and re-shaped, then formed blood vessel-like structures such as cavity, channel, branch and network. These capabilities of cells were inhibited by sirolimus and no-hypoxia. The levels of HIF-1alpha mRNA expression of SKOV3 and ES2 were 0.801 +/- 0.034 and 0.736 +/- 0.059 under hypoxia, which were significantly higher than under hypoxia added with sirolimus (0.025 +/- 0.007, 0.231 +/- 0.035; P < 0.01, P < 0.05), and those under no-hypoxia (0.010 +/- 0.004, 0.011 +/- 0.002; both P < 0.01)., Conclusions: Hypoxia plays a key role in development of vasculogenic mimicry in epithelial ovarian carcinoma. Sirolimus can inhibit vasculogenic mimicry effectively by blocking HIF-1alpha at transcription level.

Objective: To investigate the feasibility and safety of percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic jejunostomy(PEJ)., Methods: From June 1996 to April 2005, clinical data of 121 patients treated with PEG or PEJ were analyzed retrospectively., Results: A total of 121 patients experienced 134 times of PEG or PEG plus PEJ, including 90 cases (103 times) treated with PEG and 31 patients treated with PEG plus PEJ. Thirteen patients treated with PEG had fistula replacement 6-10 months after PEG. All patients had quick nutrition recovery after fistula tube insert,therefore parenteral nutrition was not required. No severe complications occurred in all patients after 10 months of following-up. Four patients had subcutaneous infection around fistula 4-10 days after PEG., Conclusion: PEG and PEJ are safe and new methods for gastrointestinal decompression and enteral nutrition, which can be substitutes for nasogastric tube.

Objective: To evaluate the effect of titanoreine on early postoperative symptoms after procedure for prolapse and hemorrhoids (PPH)., Methods: From November 2002 to July 2003, 80 patients who received PPH were randomly divided in to titanoreine group (n=42) and control group without titanoreine (n=38). Symptom relief was recorded 24 hours, 6 days and 12 days after PPH, urine retention 24h after PPH, first stool time, wound healing time, mean hospital stay were also recorded., Results: The score of symptom was lower in titanoreine group (4.4) than that in the control group (6.1) 24 hours after PPH (P< 0.05), but no significant difference in symptom grade was found between the two groups 6 days and 12 days after PPH (P> 0.05). Decrements of symptom grade were lower in titanoreine group than those of control group at any point after PPH (P< 0.05). There was no significant difference in urine retention rate and mean hospital stay between two groups(P> 0.05)., Conclusions: Titanoreine can effectively relieve the early postoperative symptoms after PPH.

Objective: To evaluate and compare the efficacy and safety of titanoreine cream with compound carraghenates suppository in the treatment of mixed hemorrhoids., Methods: Two hundred and fifty-two patients with mixed hemorrhoids were enrolled in this randomized,open, multicentral trial. Patients applied titanoreine cream (study group, n=133) or compound carraghenates suppository (control group, n=119). The symptomatic relief including pain,bleeding and edema was evaluated by scoring system at 30 minutes, 3 hours, 6 hours, 1 day, 2 days, 3 days, 4 days, 6 days after administration., Results: Symptoms were significantly improved in both groups (87.3%, 94.8%, respectively) excepting symptom of pain relief, but there was no significant difference between two groups (P > 0.05). The pain scores were lower at every observing point in the study group than those in the control group (P< 0.05). The proportions of the patients with pain relief and all symptoms relief were both higher in the study group than that in the control group at 30 min, 3 h after drug used (both P< 0.01). No side effect was found during the triad., Conclusion: Titanoreine cream has predominance of relieving pain and response time compared with compound carraghenates suppository, but other effects on mixed hemorrhoid are similar between the two groups.

Objective: To study the mental health status and its affecting factors in nurses of general hospitals., Methods: Four hundred and seventy nurses in general hospitals were investigated with SCL-90, Self-Rating Life Events and coping style questionnaires., Results: The scores of SCL-90 factors, such as anxiety, obsessive-compulsion, phobia, somatization, were higher than the norm (P < 0.05). 22% of the nurses had two factors higher than 2, and 5.3% ever had suicidal idea. The total score of SCL-90 and some factorial scores in < 40 years age group were higher than in older age groups (P < 0.01), and in III grade hospital nurses were also higher than in II grade hospital nurses (P < 0.01). The scores of negative life events, negative coping style and work load from abnormal psychology group were higher than normal group, while positive coping score was lower than normal group (P < 0.05, P < 0.01). Stepwise regression analysis showed that, negative life events, coping style, hospital grade had predictive value for total score of SCL-90 and anxiety, depression etc factorial scores (P < 0.01). Age had negative predictive value for anxiety, hostility and phobia (P < 0.05). The total score from work events had predictive value for obsession and hostility, and positive events from work had predictive value for anxiety and the total score of SCL-90 (P < 0.01). The total interpersonal relationship events and negative interpersonal relationship events had predictive value for hostility and interpersonal sensitivity., Conclusion: General hospital nurses especially in ages < 40 group had higher incidences of mental health problems. The main influencing factors are negative life events, coping style, work load, interpersonal relationship, age and hospital grade.

Objective: To detect CD(36) expressions in polycystic ovary (PCO), and to explore its correlation with local androgen and insulin at transcription level., Methods: From August 2002 to February 2003, 12 patients with asymmetric PCO, 15 primary or secondary infertile patients without endocrine disorders and 8 polycystic ovary syndrome (PCOS) with bilateral PCO were recruited. Extraction of follicular fluid and detection of testosterone (T), dehydroepiandrosterone sulfate (DHEAS), insulin (INS) and androstenedione (A(2)) were performed. Relative CD(36) mRNA expression level of human ovarian inner thecal cells was analyzed by auto image analysis system (IAS) after RT-PCR., Results: The level of CD(36) mRNA expression in thecal cells was 0.24 +/- 0.07 in polycystic ovary of PCO group and 0.21 +/- 0.05 in bilateral ovaries of PCOS group, respectively, which were significantly lower than 0.83 +/- 0.13 in normal ovaries (P < 0.01). T and INS levels of follicle fluid in PCO were significantly higher than that in normal ovaries (P < 0.01). T and INS levels of follicle fluid were negatively related to CD(36) mRNA expression of follicular theca interna (r = -0.6810, r = -0.6708, P < 0.01)., Conclusion: Decrease of scavenger receptor gene CD(36) mRNA may play a role in the pathogenesis of PCO by increasing the level of T and INS in follicular fluid.

Aim: To evaluate the role of miniprobe ultrasonography under colonoscope in the diagnosis of submucosal tumor of the large intestine, and to determine its imaging characteristics., Methods: Thirty-five patients with submucosal tumors of the large intestine underwent miniprobe ultrasonography under colonoscope. The diagnostic results of miniprobe ultrasonography were compared with pathological findings of specimens by biopsy and surgical resection., Results: Lipomas were visualized as hyperechoic homogeneous masses located in the submucosa with a distinct border. Leiomyomas were visualized as hypoechoic homogeneous mass originated from the muscularis propria. Leiomyosarcomas were shown with inhomogeneous echo and irregular border. Carcinoids were presented as submucosal hypoechoic masses with homogenous echo and distinct border. Lymphangiomas were shown as submocosal hypoechoic masses with cystic septal structures. Malignant lymphomas displayed as hypoechoic masses from mucosa to muscularis propria, while pneumatosis cystoids intestinalis originated from submucosa with a special sonic shadow. One large leiomyoma was misdiagnosed as leiomyosarcoma., Conclusion: Endoscopic miniprobe ultrasonography can provide precise information about the size, layer of origin, border of submucosal tumor of the large intestine and has a high accuracy in the diagnosis of submucosal tumor of the large intestine. Pre-operative miniprobe ultrasonography under colonoscope may play an important role in the choice of therapy for submucosal tumor of the large intestine.

Aim: To evaluate the value of postprocessing techniques of CT colonography, including multiplanar reformation (MPR), virtual colonoscopy (VC), shaded surface display (SSD) and Raysum, in detection of colorectal carcinomas., Methods: Sixty-four patients with colorectal carcinoma underwent volume scanning with spiral CT. MPR, VC, SSD and Raysum images were obtained by using four kinds of postprocessing techniques in workstation. The results were comparatively analyzed according to circumferential extent, lesion length and pathology pattern of colorectal carcinomas. All diagnoses were proved pathologically and surgically., Results: The accuracy of circumferential extent of colorectal carcinoma determined by MPR, VC, SSD and Raysum was 100.0%, 82.8%, 79.7% and 79.7%, respectively. There was a significant statistical difference between MPR and VC. The consistent rate of lesion length was 89.1%, 76.6%, 95.3% and 100.0%, respectively. There was a statistical difference between VC and SSD. The accuracy of discriminating pathology pattern was 81.3%, 92.2%, 71.9% and 71.9%, respectively. There was a statistical difference between VC and SSD. MPR could determine accurately the circumference of colorectal carcinoma, Raysum could determine the length of lesion more precisely than SSD, VC was helpful in discriminating pathology patterns., Conclusion: MPR, VC, SSD and Raysum have advantage and disadvantage in detection of colorectal carcinoma, use of these methods in combination can disclose the lesion more accurately.

Aim: To investigate the effect of acupuncture and moxibustion on epithelial cell apoptosis and expression of Bcl-2, Bax, fas and FasL proteins in rat ulcerative colitis., Methods: A rat model of ulcerative colitis was established by immunological methods and local stimulation. All rats were randomly divided into model control group (MC), electro-acupuncture group (EA), herbs-partition moxibustion group (HPM). Normal rats were used as normal control group (NC). Epithelial cell apoptosis and expression of Bcl-2, Bax, fas and FasL proteins were detected by TUNEL and immunohistochemical method respectively., Results: The number of epithelial cell apoptosis in MC was significantly higher than that in NC, and was markedly decreased after the treatment with herbs-partition moxibustion or electro-acupuncture. The expression of Bcl-2, Bax, fas and FasL in colonic epithelial cells in MC was higher than that in NC, and was markedly down- regulated by herbs-partition moxibustion or electro-acupuncture treatment., Conclusion: The pathogenesis of ulcerative colitis in rats involves abnormality of apoptosis. Acupuncture and moxibustion can regulate the expression of Bcl-2, Bax, fas and FasL proteins and inhibit the apoptosis of epithelial cells of ulcerative colitis in rats by Bcl-2/Bax, fas/FasL pathways.

Objective: To investigate the effect of magnetic doxorubicin liposome (MDL) in the targeting treatment of nude mice bearing colon cancer., Methods: Human colon cancer line LoVo cells were implanted hypodermically into nude mouse. Two weeks after the mouse was killed and the tumor was taken out and cut into small pieces to be retransplanted into nude mice so as to establish an experimental model. MDL was prepared by reverse-phase evaporation method. The particle size and structure of MDL were evaluated. Eighteen nude mice with colon cancer were divided into 3 groups of 3 mice: free DOX group, MDL (-) group (no magnetic field was added to the tumor surface), and MDL (+) group (magnetic field with the strength of 4,500 G was added). DOX of the dosage of 5 mg/kg was injected through the caudal vein in these 3 groups. Then the mice were killed 30 minutes after. Fluorescence spectrophotometry was used to examine the concentrations of DOX in the tissues and plasma. Another 36 nude mice with colon cancer were divided into 6 groups of 6 mice: normal saline group (as controls), DOX group, blank liposome group, magnetic liposome group, MDL (-) group (non-magnetic alloy was implanted into the tumor), and MDL (+) group (rare earth magnet was implanted into the tumor). The body weight, longest diameter of tumor, and short diameter vertical to the longest diameter were calculated regularly. The mice were killed 11 days after. The tumors were taken out to undergo staining and light microscopy. Flow cytometry was used to examine the apoptosis of tumor cells., Results: The particle size of MDL was 230 nm and the magnetic particles (Fe(3)O(4)) were evenly distributed within the liposome. The DOX concentration in tumor tissue of the MDL (+) group was remarkably higher than those of the DOX and MDL (-) groups (both P < 0.05). The DOX concentration in heart and kidney of the DOX group were higher than those of the other 2 groups, and the plasma DOX concentrations of the DOX group was significantly lower than those of the other groups (all P < 0.05). The growth speed of tumor in the MDL (+) group was significantly lower, and the tumor weight was significantly less than in other groups., Conclusion: Magnetic doxorubicin liposome, as a carrier of anticancer drug, has a good targeting function toward the magnetite and has a significant anticancer effect.

Objective: To improve the successful rate of endoscopic biliary drainage., Methods: Three hundred and fifty-two patients with biliary obstruction were given biliary drainage via duodenoscope from January 1998 to December 2002. 258 patients received endoscopic naso-biliary drainage (ENBD), 51 endoscopic retrograde biliary drainage (ERBD), and 43 endoscopic metal biliary endoprothesis (EMBE)., Results: Of the 352 patients with biliary obstruction, 337 succeeded in drainage by endoscopy and 15 failed. Ten ENBD failed patients were handled successfully by readjustment of the site of the naso-biliary tube. In 3 ERBD failed patients, 2 were given plastic stents with appropriate length and got a fluent drainage. Percutaneous transhepatic biliary drainage (PTBD) was performed in one patient after failure of endoscopic management. In 2 patients with failed EMBE, one stent could not exceed the site of tumor stricture and one was obstructed by tumor implantation only one month after EMBE. Placement of another metallic stent and a plastic stent through the previous prothesis for each patient ensured a successful drainage., Conclusions: The effect of endoscopic biliary drainage for biliary obstruction is definite. Drainage failure can be avoided or remedied as early as possible by taking some active measures.