Expression of gastrointestinal nesfatin-1 and gastric emptying in ventromedial hypothalamic nucleus- and ventrolateral hypothalamic nucleus-lesioned rats

AIM:To determine the expression levels of gastrointestinal nesfatin-1 in ventromedial hypothalamic nucleus(VMH)-lesioned(obese)and ventrolateral hypothalamic nucleus(VLH)-lesioned(lean)rats that exhibit an imbalance in their energy metabolism and gastric mobility.METHODS:Male Wistar rats were randomly divided into a VMH-lesioned group,a VLH-lesioned group,and their respective sham-operated groups.The animals had free access to food and water,and their diets andweights were monitored after surgery.Reverse transcription-polymerase chain reaction and immunostaining were used to analyse the levels of NUCB2 mRNA and nesfatin-1 immunoreactive(IR)cells in the stomach,duodenum,small intestine,and colon,respectively.Gastric emptying was also assessed using a modified phenol red-methylcellulose recovery method.RESULTS:The VMH-lesioned rats fed normal chow exhibited markedly greater food intake and body weight gain,whereas the VLH-lesioned rats exhibited markedly lower food intake and body weight gain.NUCB2/nesfatin-1 IR cells were localised in the lower third and middle portion of the gastric mucosal gland and in the submucous layer of the enteric tract.Compared with their respective controls,gastric emptying was enhanced in the VMH-lesioned rats(85.94%±2.27%),whereas the VLH lesions exhibited inhibitory effects on gastric emptying(29.12%±1.62%).In the VMHlesioned rats,the levels of NUCB2 mRNA and nesfatin-1protein were significantly increased in the stomach and duodenum and reduced in the small intestine.In addition,the levels of NUCB2 mRNA and nesfatin-1 protein in the VLH-lesioned rats were decreased in the stomach,duodenum,and small intestine.CONCLUSION:Our study demonstrated that nesfatin-1 level in the stomach and duodenum is positively correlated with body mass.Additionally,there is a positive relationship between gastric emptying and body mass.The results of this study indicate that gastrointestinal nesfatin-1 may play a significant role in gastric mobility and energy homeostasis.

Laterally spreading tumor-like primary rectal mucosa-associated lymphoid tissue lymphoma:A case report

BACKGROUND Colorectal mucosa-associated lymphoid tissue(MALT)lymphoma is a rare disease,and only a few cases have been reported to date.It has no specific clinical presentations and shows various endoscopic appearances.There is no uniform consensus on its treatment.With the advancement of endoscopic technology,endoscopic treatment has achieved better results in individual case reports of early-stage patients.CASE SUMMARY We report a case of rectal MALT in a 57-year-old Chinese man with no symptoms who received endoscopy as part of a routine physical examination,which incidentally found a 25 mm×20 mm,laterally spreading tumor(LST)-like elevated lesion in the rectum.Therefore,he was referred to our hospital for further endoscopic treatment.Complete and curable removal of the tumor was performed by endoscopic submucosal dissection.We observed enlarged and dilated branch-like vessels similar to those of gastric MALT lymphoma on magnifying endoscopy with narrow-band imaging.And immunopathological staining showed hyperplastic capillaries in the mucosa.Histopathological findings revealed diffusely hyperplastic lymphoid tissue in the lamina propria,with a visible lymphoid follicle structure surrounded by a large number of diffusely infiltrated lymphoid cells that had a relatively simple morphology and clear cytoplasm.In addition,immunohistochemical analysis suggested strongly positive expression for CD20 and Bcl-2.Gene rearrangement results showed positivity for IGH-A,IGH-C,IGK-B,and IGL.Taking all the above findings together,we arrived at a diagnosis of extranodal marginal zone B-cell lymphoma of MALT lymphoma. Positron emission tomography-computed tomographyexamination showed no other lesions involved. The patient will be followed byperiodic endoscopic observation.CONCLUSIONIn conclusion, we report a case of rectal MALT with an LST-like appearancetreated by endoscopic submucosal dissection. Further studies will be needed toexplore the clinical behavior, endoscopic appearance, and treatment of rectalMALT.

Application of endoscopic submucosal dissection in duodenal space-occupying lesions

BACKGROUNDEndoscopic submucosal dissection (ESD) has been advocated by digestiveendoscopists because of its comparable therapeutic effect to surgery, reducedtrauma, faster recovery, and fewer complications. However, ESD for lesions of theduodenum is more challenging than those occurring at other levels of thegastrointestinal tract due to the thin intestinal wall of the duodenum, narrowintestinal space, rich peripheral blood flow, proximity to vital organs, and highrisks of critical adverse events including intraoperative and delayed bleeding andperforation. Because of the low prevalence of the disease and the high risks ofsevere adverse events, successful ESD for lesions of the duodenum has rarelybeen reported in recent years.AIM To investigate the efficacy and safety of ESD in the treatment of duodenal spaceoccupyinglesions.METHODS Clinical data of 24 cases of duodenal lesions treated by ESD at the DigestiveEndoscopy Center of the Affiliated Hospital of Qingdao University from January2016 to December 2019 were retrospectively analyzed.RESULTS All of the 24 cases from 23 patients underwent ESD treatment for duodenal spaceoccupyinglesions under general anesthesia, including 15 male and 8 femalepatients, with a mean age of 58.5 (32.0-74.0) years. There were 12 lesions (50%) inthe duodenal bulb, 9 (37.5%) in the descending part, and 3 (12.5%) in the ball descending junction. The mean diameter of the lesion was 12.75 (range, 11-22)mm. Thirteen lesions originated from the mucosa, of which 4 were low-gradeintraepithelial neoplasia, 3 were hyperplastic polyps, 2 were chronic mucositis, 2were adenomatous hyperplasia, 1 was high-grade intraepithelial neoplasia, and 1was tubular adenoma. Eleven lesions were in the submucosa, including 5neuroendocrine neoplasms, 2 cases of ectopic pancreas, 1 stromal tumor, 1leiomyoma, 1 submucosal duodenal adenoma, and 1 case of submucosal lymphfollicular hyperplasia. The intraoperative perforation rate was 20.8% (5/24),including 4 submucosal protuberant lesions and 1 depressed lesion. The meanlength of hospital stay was 5.7 (range, 3-10) d, and the average follow-up time was25.8 (range, 3.0–50.0) mo. No residual disease or recurrence was found in allpatients, and no complications, such as infection and stenosis, were found duringthe follow-up period.CONCLUSION ESD is safe and effective in the treatment of duodenal lesions;however, theendoscopists should pay more attention to the preoperative preparation,intraoperative skills, and postoperative treatment.

Early colon cancer with enteropathy-associated T-cell lymphoma involving the whole gastrointestinal tract:A case report

BACKGROUND Enteropathy-associated T-cell lymphoma(EATL)is a rare invasive lymphoma derived from gastrointestinal epithelial T lymphocytes.EATL involving the whole gastrointestinal tract accompanied with early colon cancer is extremely rare.CASE SUMMARY We present the case of a 67-year-old man with diarrhea for more than 5 mo whose colonoscopy in another hospital showed multiple colonic polyps,which indicated moderate to severe dysplasia and focal early cancer.Therefore,he was referred to our hospital for further endoscopic treatment.Colonoscopy after admission showed that the mucosa of the terminal ileum and the entire colon were slightly swollen and finely granular.Endoscopic mucosal resection was performed for colonic polyps located in the liver flexure of the colon and descending colon,respectively.Histopathological findings revealed diffuse infiltration of mediumsized lymphoid cells in the colonic mucosa and visible lymphoepithelial lesions.The histopathology of the polyp in the descending colon indicated moderately differentiated adenocarcinoma limited to the mucosa with negative resection margins.Additionally,immunohistochemical analysis showed positive staining for CD7 and CD8.Therefore,we arrived at a diagnosis of EATL with early colon cancer.Subsequently,the patient was transferred to the hematology department for chemotherapy.The patient’s diarrhea was not significantly relieved after receiving chemotherapy,and he ultimately died of severe myelosuppression.CONCLUSION EATL should be considered in unexplained chronic diarrhea.EATL progresses rapidly with a poor prognosis,especially when accompanied with early colon cancer.

Research Progress of MicroRNAs and Related Factors in the Pathogenesis of Lichen Planus

More evidences show that microRNAs play an important role in the pathogenesis of infiammation and autoimmune diseases including Lichen planus,and are an attractive therapeutic target.MicroRNA family plays an important role in the regulation of gene expression,which involves cell proliferation,apoptosis,growth,differentiation and metabolism,vascularization,immune response and other biological processes.The changes of expression profile and expression level are closely related to the occurrence and development of many diseases,such as tumor,inflammatory disease and autoimmune disease relevant.However,there are few reports on microRNA in the pathogenasis of LP.This review summarizes the research advance of microRNAs(microRNAs-137,microRNAs-125b,microRNAs-138,microRNAs-27b,microRNAs-203)and their downstream proteins in LP.