Expression of peroxisome proliferator-activated receptor γ,E-cadherin and matrix metalloproteinases-2 in gastric carcinoma and lymph node metastases

Background Peroxisome proliferator activated receptor γ （PPARγ） is a ligand-activated transcription factor. Activation of PPARγ has recently been demonstrated to inhibit various tumor cells growth, progression and metastasis. E-cadherin-mediated cell adhesion system is now considered to be an “invasion suppressor system” in cancer tissues. Matrix metalloproteinases-2 （MMP-2） is a prerequisite for metastasizing tumor cells. However their correlation is still unknown in gastric carcinoma. The aim of this study was to assess the expression of PPAR7, E-cadherin, MMP-2 and their correlation in gastric carcinoma and metastases. Methods Gastric carcinoma tissues and their corresponding lymph nodes with metastases and the adjacent non-tumor tissues were obtained from 54 patients with gastric cancer who underwent gastrectomy. Expression of PPARγ, E-cadherin and MMP-2 was assessed by immunohistochemical staining. Results The nuclear expression level of PPARγ in neoplastic cells was significantly lower than that in the normal controls （P〈0.001）, with the expression of PPARγ being weaker in primary tumors compared with that in metastases. In all neoplastic cells, E-cadherin was expressed with abnormal patterns （cytoplasm pattern, cytoplasm and membrane pattern or absent）, compared with normal cells where E-cadherin was expressed with a normal pattern （membrane pattern）. Compared with the normal tissues, the expression level of E-cadherin decreased in primary tumors and further decreased in metastases （P〈0.001）. Membrane staining of MMP-2 was detected in the foveolar epithelia of normal gastric mucosa, whereas predominant cytoplasm staining of MMP-2 was found in malignant tissues. The expression of MMP-2 was stronger in metastatic tissues than in primary tumors. In neoplastic foci the expression of PPARγ was negatively correlated with MMP-2 expression （P〈0.05）. However, there was no correlation between E-cadherin and PPARγ or MM P-2 expression. Conclusions Down-regulation of PPARγ and E-cadherin and up-regulation of MMP-2 in neoplastic foci might be helpful to gastric carcinogenesis and metastases. An inverse relationship between PPARγ and MMP-2 in human gastric carcinoma suggests that PPARγ might modulate MMP-2 expression and affect gastric cancer metastases.

Gastro-protecting effect of gefarnate on chronic erosive gastritis with dyspeptic symptoms

Background The role of gastro-protecting agents on symptomatic chronic gastritis is unclear. This multicenter, open, randomized trial was designed to compare the comprehensive effects of gefarnate with sucralfate on erosive gastritis with dyspeptic symptoms. Methods Totally 253 dyspepsia patients confirmed with erosive gastritis were enrolled from six centers in China. They randomly received either daily 300 mg gefarnate or 3 g sucralfate for six weeks. The primary endpoint was the effective rate of both treatments on endoscopic erosion at week six. Results Gefarnate showed an effective rate of 72% and 67% on endoscopic score and dyspeptic symptom release, which is statistically higher than sucralfate （40.1% and 39.3%, P 〈0.001, intension-to-treat）. For histological improvement, gefarnate showed both effective in decreasing mucosal chronic inflammation （57.7% vs. 24.8%, P 〈0.001, intension-to-treat） and active inflammation （36.4% vs. 23.1%, P 〈0.05, intension-to-treat） than the control. A significant increase of prostaglandins and decrease of myeloperoxidase in mucosa were observed in gefarnate group. Severity of erosion is non-relevant to symptoms but Helicobacter pylori （H. pylor status does affect the outcome of therapy. Conclusions Gefarnate demonstrates an effective outcome on the mucosal inflammation in patients with chronic erosive qastritis. Endoscopic and inflammation score should be the major indexes used in gastritis-related trials.

Natural history of liver cirrhosis in south China based on a large cohort study in one center： a follow-up study for up to 5 years in 920 patients

Background The natural history of the profile and development of the miscellaneous complications. iver cirrhosis in China has not been we complications of liver cirrhosis as we understood. This study aimed to elucidate as the mortality of those cirrhotics with Methods We assembled data from the clinical characteristics, especially from the profile complications of cirrhosis on admission, and collected information by telephone or interview with patients and/or their family members in clinic to evaluate the development of complications in 920 patients enrolled in a prospective non-randomized cohort study, and followed up from June 2006 to October 2010. Mortality was calculated using Kaplan-Meier analysis and Cox regress analysis. We employed both of the Child-Pugh scoring system and model for end-stage liver disease （MELD） scoring system to compare with the accordance and veracity between liver function and the long-term outcome. Results On admission, only 7.4% patients had no complications, 44.5% patients with one complication （ascites, esophageal/gastric varices or hepatocellular carcinoma）, 33.8% patients with two coexisting complications, and 7.5% patients had complications concurrently with ascites, esophageal/gastric varices and hepatocellular carcinoma. During the follow-up （mean follow-up time was 17 months, ranging from 1.0 to 52.2 months） of all the patients, 37.5% patients survived without new complications, 62.5% patients had new complications, and the overall mortality was 53.9%. Patients with one or more complications had higher mortality （total mortality, 1-year or 3-year mortality） and shorter mean survival time than those without any complication; the major cause of mortality of these cirrhotic patients was hepatocellular carcinoma （59%）. Evaluated with the Child-Pugh score system, the total mortality in those with the scores more than 12 （class C） was 71.4%, the 1-year and 3-year mortalities were 57.1% and 71.4% respectively; while evaluated with the MELD scoring system, the mortality of those with the scores more than 30 was 58.6%, the 1-year and 3-year mortalities were 44.2% and 57.8% respectively. Conclusions The patients with cirrhosis were prone to develop miscellaneous complications. Ascites and hepatocellular carcinoma were the most common complications and the main cause of death respectively. Cirrhotics with more complications had higher mortality rates.