Chinese physicians' perceptions of fecal microbiota transplantation

AIM: To explore Chinese physicians' perceptions towards fecal microbiota transplantation(FMT) and to provide information and an assessment of FMT development in China.METHODS: A self-administered questionnaire was developed according to the FMT practice guidelines and was distributed to physicians in hospitals via Internet Research Electronic Data Capture(REDcap) software and electronic mails to assess their attitudes toward and knowledge of FMT. The questionnaire included a brief introduction of FMT that was followed by 20 questions. The participants were required to respond voluntarily, under the condition of anonymity and without compensation. Except for the fill-in-the-blank questions, all of the other questions were required in the REDcap data collection systems, and the emailed questionnaires were completed based on eligibility.RESULTS: Up to December 9, 2014, 844 eligible questionnaires were received out of the 980 distributed questionnaires, with a response rate of 86.1%. Among the participants, 87.3% were from tertiary hospitals, and there were 647(76.7%) gastroenterologists and 197(23.3%) physicians in other departments(nongastroenterologists). Gastroenterologists' awareness of FMT prior to the survey was much higher than non-gastroenterologists'(54.3 vs 16.5%, P < 0.001); however, acceptance of FMT was not statistically different(92.4 vs 87.1%, P = 0.1603). Major concerns of FMT included the following: acceptability to patients(79.2%), absence of guidelines(56.9%), and administration and ethics(46.5%). On the basis of understanding, the FMT indications preferred byphysicians were recurrent Clostridium difficile infection(86.7%), inflammatory bowel disease combined with Clostridium difficile infection(78.6%), refractory ulcerative colitis(70.9%), ulcerative colitis(65.4%), Crohn's disease(59.4%), chronic constipation(43.7%), irritable bowel syndrome(39.1%), obesity(28.1%) and type 2 diabetes(23.9%). For donor selection, the majority of physicians preferred individuals with a similar gut flora environment to the recipients. 76.6% of physicians chose lower gastrointestinal tract as the administration approach. 69.2% of physicians considered FMT a safe treatment. CONCLUSION: Chinese physicians have awareness and a high acceptance of FMT, especially gastroenterologists, which provides the grounds and conditions for the development of this novel treatment in China. Physicians' greatest concerns were patient acceptability and absence of guidelines.

Reactive oxygen species: A double-edged sword in oncogenesis

Reactive oxygen species (ROS) are molecules or ions formed by the incomplete one-electron reduction of oxygen. Ofinterest, it seems that ROS manifest dual roles, cancer promoting or cancer suppressing, in tumorigenesis. ROS participate simultaneously in two signaling pathways that have inverse functions in tumorigenesis, Ras-Raf-MEK1/2-ERK1/2 signaling and the p38 mitogen-activated protein kinases (MAPK) pathway. It is well known that Ras-Raf-MEK1/2-ERK1/2 signaling is related to oncogenesis, while the p38 MAPK pathway contributes to cancer suppression, which involves oncogene-induced senescence, inflammationinduced cellular senescence, replicative senescence, contact inhibition and DNA-damage responses. Thus, ROS may not be an absolute carcinogenic factor or cancer suppressor. The purpose of the present review is to discuss the dual roles of ROS in the pathogenesis of cancer, and the signaling pathway mediating their role in tumorigenesis.

Molecular forms of trefoil factor 1 in normal gastric mucosa and its expression in normal and abnormal gastric tissues

AIM： To study the molecular forms of trefoil factor 1 （TFF1） in normal gastric mucosa and its expression in normal and abnormal gastric tissues （gastric carcinoma, atypical hyperplasia and intestinalized gastric mucosa） and the role of TFF1 in the carcinogenesis and progression of gastric carcinoma and its molecular biological mechanism underlying gastric mucosa protection. METHODS： The molecular forms of TFF1 in normal gastric mucosa were observed by Western blot. The expression of TFF1 in normal and abnormal gastric tissues （gastric carcinoma, atypical hyperplasia and intestinalized gastric mucosa） was also assayed by immunohistochemical method. The average positive AO was estimated by Motic Images Advanced 3.0 software. RESULTS： Three patterns of TFF1 were found in normal gastric mucosa： monomer, dimmer, and TFF1 compound whose molecular weight is about 21 kDa. The concentration of TFF1 compound was the highest among these three patterns. TFF1 was expressed mainly in epithelial cytoplasm of the mucosa in gastric body and antrum, especially around the nuclei. The closer the TFF1 to the lumen, the higher the expression of TFF1, The expression of TFF1 in peripheral tissue of gastric carcinoma （0.51 ± 0.07） was higher than that in normal gastric mucosa （0.44 ± 0.06, P 〈 0.001）. The expression of TFF1 in gastric adenocarcinoma was positively related to the differentiation of adenocarcinoma. The lower the differentiation of adenocarcinoma was, the weaker the expression of TFF1. No TFF1 was expressed in poorlydifferentiated adenocarcinoma. The expression of TFF1 in moderately-well differentiated adenocarcinoma （0.45 ± 0.07） was a little lower than that in normal mucosa （P 〉 0.05）. The expression of TFF1 in gastric mucosa with atypical hyperplasia （0.57 ± 0.03） was significantly higher than that in normal gastric mucosa （P 〈 0.001）. No TFF1 was expressed in intestinalized gastric mucosa. There was no statistically significant difference between the expressions of TFFI in gastric mucosa around the intestinalized tissue （0.45 ± 0.07） and normal gastric mucosa （P 〉 0.05）. CONCLUSION： TFF1 is expressed mainly in epithelial cytoplasm of the mucosa in gastric body and antrum. Its main pattern is TFF1 compound, which may have a greater biological activity than monomer and dimer. The expression of TFF1 in peripheral mucosa of gastric ulcer is higher than that in mucosa 5 cm beyond the ulcer, indicating that TFF1 plays an important part in protection and restitution of gastric mucosa. The expression of TFF1 is increased in peripheral tissues of gastric carcinoma and gastric mucosa with atypical hyperplasia, but is decreased in cancer tissues, implying that TFF1 may be related to suppression and differentiation of carcinoma. The weaker expression of TFF1 in poorly-differentiated carcinoma may be related to the destruction of glands and cells in cancer tissues and the decrease in secretion of TFF1.

Artifi cial liver support system in treatment of liverfailure after acute poisoning

BACKGROUND： Acute poisoning （AP） may cause failure of the liver and kidney, and evendeath. This study aimed to investigate the efficacy of artificial liver support system （ALSS） on thetreatment of liver failure after acute poisoning.METHODS： A total of 31 patients with liver failure caused by AP were admitted to emergency ICU,central ICU, and Department of Gastroenterology from 2005 to 2009 in Zhongshan Hospital Affi liatedto Xiamen University, China. Among them, 13 patients served as a treatment group, and used ALSS inaddition to detoxifi cation treatment and protective treatment of liver function, and the other 18 patientsserved as a control group receiving detoxifi cation treatment and protective treatment of liver function.RESULTS： In the treatment group, 10 patients （76.9%） were cured or improved, 2 died, and1 was discharged against advice. In the 18 patients in the control group, 7 （38.9%） were cured orimproved, 3 died, and 8 were discharged against advice. There was a significant difference in therates of improvement between the two groups （P〈0.05）.CONCLUSION： ALSS is a safe and effective clinical method for the treatment of acute toxicliver failure.