Crohn's disease in adults: Observations in a multiracial Asian population

AIM： To determine the demography and clinical presentation of CD and secondly to determine any differences in the prevalence between the different ethnic groups in a multiracial Asian population. METHODS： Patients with CD who were seen in 2001- 2003 in the University of Malaya Medical Centre （UMMC） were enrolled in this study. Prevalence of disease was calculated for the group as a whole and by race with hospital admissions per ethnic group as the denominator. RESULTS： Thirty-four patients were diagnosed to have CD. Basic demographic data of patients; male：female 17：17; mean age 29.1 years （±13.5 years）; ethnic group： Malays 5 （14.7%）, Chinese 12 （35.3%） and Indians 17 （50%）. Twenty-six （76.5%） were diagnosed under the age of 40 and 8 （23.5%） were diagnosed over the age of 40. Location of the disease was as follows： ileocolonic 13 （38.2%）, terminal ileum only 9 （26.5%）, colon only 8 （23.5%）, and upper gastrointestinal 4 （11.8%）. Sixteen （47.1%） had penetrating disease, 9 （26.5%） had stricturing disease and 9 （26.5%） had nonpenetrating and non-stricturing disease. The hospital admission prevalence of CD was 26.0 overall, Indians 52.6, Chinese 6.9, and Malays 9.3 per 10^5 admissions per ethnic group. The difference between Indians and Malays： [OR 5.67 （1.97, 17.53）P〈 0.001] was statistically significant but not between the Indians and the Chinese [OR 1.95 （0.89, 4.35） P= 0.700]. The difference between the Chinese and the Malays was also not statistically significant. [OR 2.90 （0.95, 9.42）P= 0.063]. CONCLUSION： The clinical presentation of CD is similar to the Western experience. Although the overall prevalence is low, there appears to be a clear racial predominance among the Indians.

Racial differences in the anatomical distribution of colorectal cancer:a study of differences between American and Chinese patients

AIM: To compare the racial differences of anatomical distribution of colorectal cancer (CRC) and determine the association of age, gender and time with anatomical distribution between patients from America (white) and China (oriental).METHODS: Data was collected from 690 consecutive patients in Cleveland Clinic Florida, U.S.A. and 870consecutive patients in Nan Fang Hospital affiliated to the First Military Medical University, China over the past 11years from 1990 to 2000. All patients had colorectal adenocarcinoma diagnosed by histology and underwent surgery.RESULTS: The anatomical subsite distribution of tumor,age and gender were significantly different between white and oriental patients. Lesions in the proximal colon (P＜0.001) were found in 36.3 % of white vs 26.0 % of oriental patients and cancers located in the distal colon and rectum in 63.7 % of white and 74 % of oriental patients (P＜0.001). There was a trend towards the redistribution from distal colon and rectum to proximal colon in white males over time, especially in older patients (＞80 years).No significant change of anatomical distribution occurred in white women and Oriental patients. The mean age at diagnosis was 69.0 years in white patients and 48.3 years in Oriental patients (P＜0.001).CONCLUSION: This is the first study comparing the anatomical distribution of colorectal cancers in whites and Chinese patients. White Americans have a higher risk of proximal CRC and this risk increased with time. The proportion of white males with CRC also increased with time.Chinese patients were more likely to have distal CRC and developed the disease at a significantly earlier age than white patients. These findings have enhanced our understanding of the disease process of colorectal cancer in these two races.

Cytochrome P450 2E1 genetic polymorphism and gastric cancer in Changle,Fujian Province

AIM: Genetic polymorphism in enzymes of carcinogen metabolism has been found to have the influence on the susceptibility to cancer. Cytochrome P450 2E1 (CYP2E1) is considered to play an important role in the metabolic activation of procarcinogens such as N-nitrosoamines and low molecular weight organic compounds. The purpose of this study is to determine whether CYP450 2E1 polymorphisms are associated with risks of gastric cancer. METHODS: We conducted a population based case-control study in Changle county, Fujian Province, a high-risk region of gastric cancer in China. Ninety-one incident gastric cancer patients and ninety-four healthy controls were included in our study. Datas including demographic characteristics, diet intake, and alcohol and tobacco consumption of individuals in our study were completed by a standardized questionnaire.PCR-RFLP revealed three genotypes:heterozygote (C1/C2) and two homozygotes (C1/C1 and C2/C2) in CYP2E1. RESULTS: The frequency of variant genotypes (C1/C2 and C2/C2) in gastric cancer cases and controls was 36.3% and 24.5%, respectively. The rare homozygous C2/C2 genotype was found in 6 individuals in gastric cancer group(6.6%), whereas there was only one in the control group (1.1%). However, there was no statistically significant difference between the two groups (two-tailed Fisher's exact test P=0.066). Individuals in gastric cancer group were more likely to carry genotype C1/C2 (odds ratio, OR=1.50) and C2/C2 (OR=7.34) than individuals in control group (chi(2) =4.597, for trend P=0.032). The frequencies of genotypes with the C2 allele (C1/C2 and C2/C2 genotypes) were compared with those of genotypes without C2 allele (C1/C1 genotype) among individuals in gastric cancer group and control group according to the pattern of gastric cancer risk factors. The results show that individuals who exposed to these gastric cancer risk factors and carry the C2 allele seemed to have a higher risk of developing gastric cancer. CONCLUSION: Polymorphism of CYP2E1 gene may have some effect in the development of gastric cancer in Changle county, Fujian Province.

Individualized prostate biopsy strategy for Chinese patients with different prostate-specific antigen levels

Aim： To evaluate the best individualized prostate biopsy strategies for Chinese patients with suspected prostate cancer. Methods： The present study included 221 Chinese patients who underwent transrectal ultrasound guided prostate biopsies for the first time. All patients underwent the same 10-core biopsy protocol. In addition to the Hodge sextant technique, four more biopsies were obtained from the base and middle regions of bilateral peripheral zones. The differences between 10-core and sextant strategies in cancer detection among patients with different prostate specific anitgen （PSA） levels were evaluated. The relationship between PSA level, number of positive biopsy cores and organ-confined cancer rate in prostate cancer patients was also analyzed. Results： The overall prostate cancer detection rate was 40.7% in the 221 patients. The 10-core strategy increased cancer detection by 6.67% （6/90） in our patients （P 〈 0.05）. The increased cancer detection rates decreased significantly when the patient PSA level increased from 0-20 ng/mL to 20.1-50 ng/mL and 〉 50 ng/mL （P 〈 0.01）. The number of positive biopsy cores in prostate cancer patients increased significantly with increasing patient PSA level （P 〈 0.01）. The rate of organ-confined prostate cancer decreased significantly with increasing patient PSA level （P 〈 0.01）. Conclusion： The extended 10- core strategy is recommended for Chinese patients with PSA 〈 20 ng/mL and the sextant strategy is recommended for those with PSA〉 50 ng/mL. For patients with PSA ranging from 20.1 ng/mL to 50 ng/mL, the 10-core strategy should be applied in patients with life expectancy 〉 10 years and the sextant strategy should be applied in those with life expectancy 〈 10 years. （Asian J Androl 2008 Mar; 10： 325-331）

Metabolic syndrome is directly associated with gamma glutamyl transpeptidase elevation in Japanese women

AIM:This study aimed to determine whether metabolic syndrome is directly or indirectly,through fatty liver,associated with elevated gamma-glutamyl transpeptidase (GGT) levels in Japanese women. METHODS:From 4 366 women who received their annual health check-up,4 211 women were selected for analysis. All 4 211 women were negative for both hepatitis B surface antigen and antibody to hepatitis C virus.Clinical and biochemical variables were examined by using univariate and multivariate analysis. RESULTS:A raised GGT level (>68 IU/L) was seen in 258 (6.1%) of the 4 211 women.In univariate analysis,all variables examined (age,body mass index,blood pressure, hemoglobin concentration,fasting blood glucose, glycosylated hemoglobin Alc,cholesterol,triglyceride,and uric acid) were associated with the elevated GGT level, whereas in multivariate analysis,four variables (age≧50 yr, hemoglobin≧14 g/dL,triglyceride≧150 mg/dL,and presence of diabetes) were significantly and independently associated with raised GGT level.Clinical variables predicting the presence of ultrasonographic evidence of fatty liver were also examined by multivariate analysis;four variables were associated with the presence of fatty liver:BMI≧25 kg/m^2, hemoglobin≧14 g/dL,triglyceride≧150 mg/dL,and uric acid ≧ 7 mg/dL.There was no significant association between the raised GGT level and the presence of fatty liver. Hypertriglyceridemia was significantly and independently associated with both the raised GGT level and the presence of fatty liver. CONCLUSION:Metabolic syndrome seemed to be directly, not indirectly through fatty liver,associated with the raised GGT level in Japanese women.

Clinicopathological and molecular genetic analysis of 4 typical Chinese HNPCC families

AIM: To study the clinicopathological and molecular genetic characteristics of typical Chinese hereditary nonpolyposis cotorectal cancer (HNPCC) families. METHODS: Four typical Chinese HNPCC families were analyzed using microdissection, microsatellite instability analysis, immunostaining of hMSH2 and hMLH1 proteins and direct DNA sequencing of hMSH2 and hMLH1 genes. RESULTS: All five tumor tissues of 4 probands from the 4 typical Chinese HNPCC families showed microsatellite instability at more than two loci (MSI-H or RER+ phenotype). Three out of the 4 cases lost hMSH2 protein expression and the other case showed no hMLH1 protein expression. Three pathological germline mutations (2 in hMSH2 and 1 in hMLH1), which had not been reported previously, were identified. The same mutations were also found in other affected members of two HNPCC families,respectively. CONCLUSION: Typical Chinese HNPCC families showed relatively frequent germline mutation of mismatch repair genes. High-level microsatellite instability and loss of expression of mismatch repair genes correlated closely with germline mutation of mismatch repair genes. Microsatellite instability analysis and immunostaining of mismatch repair gene might serve as effective screening methods before direct DNA sequencing. It is necessary to establish clinical criteria and molecular diagnostic strategies more suitable for Chinese HNPCC families.

Nuclear and mitochondrial DNA microsatellite instability in hepatocellular carcinoma in Chinese

AIM：To study the nuclear microsatellite instability (nMSI) at BAT26 and mitochondral microsalellite instability (mtMSI) in the occurrence and development of hepatocellular carcinoma and the relationship between nMSI and mtMSI.METHODS: nMSI was observed with PCR and mtMSI with PCR-SSCP in 52 cases of hepatocellular carcinoma.RESULTS:mtMSI was detected in 11 out of the 52 cases of hepatocellular carcinoma (21.2%). Among the 11 cases of hepatocellular carcinoma with mtMSI, 7 occured in one locus and 4 in 2 loci. The frequency of mtMSI in the 52 cases of hepatocellular carcinoma showed no correlation to sex, age,infection of hepatitis B, liver cirrhosis as well as positive AFP of the patients (P>0.05). In addition, nMSI was detected in 3 out of 52 cases of hepatocellular carcinoma (5.8%) and there was no correlation of the incidence of mtMSI to that of nMSI (P>0.05).CONCLUSION:mtMSI may be involved in the coccurrence and development of hepatocellular carcinoma and it is independent of nMSI.

A Comparison between the Chinese and European Patients in Acupuncture Treatment

Based on my teaching and working experience in Europe, I have made a comparison between the Chinese and European patients in acupuncture treatment, and hope it is of some significance in acupuncture clinical practice.

Primary angle closure glaucoma in Chinese and Western populations

OBJECTIVE: To review the major progress in primary angle closure glaucoma (PACG). METHODS: Contents of this article were selected from the original papers or reviews related to primary angle closure glaucoma published in Chinese and foreign journals. A total of 76 articles were selected from several hundred original articles or reviews. The content of selected articles is in accordance with our purpose and the authors are authorized scientists in the study of glaucoma. RESULTS: Primary angle closure glaucoma is the most common type of glaucoma in the Sino-Mongoloid population. PACG in Chinese can be classified into three types depending on the mechanism of angle closure: 1. Multimechanism: 54.8% of Chinese PACG is caused by co-existing factors. The pattern of angle closure appears to mainly be creeping closure. After iridectomy, almost 40% of the cases still manifest a positive response to the darkroom provocative test and progressive synechial closure or recurrent angle closure may occur. Several mechanisms are involved in this form of PACG such as pupillary blocking component, iris crowding component and anterior positioned ciliary body. These factors can coexist in the follow patterns: pupillary blocking and iris crowding coexist; pupillary blocking and anterior positioned ciliary body coexist or three of them co-exist. 2. Pupillary block: (38.1% of Chinese PACG) is caused by iris bombe due to pupillary block with acute or subacute attack. It responds well to iridectomy or laser iridotomy. 3. Non-pupillary blocking: (7.8% of Chinese PACG). They usually have a deeper anterior chamber, and tend to be younger (below 40 years of age). Angle closure in this form of PACG is caused by: iris crowding mechanism or/and anteriorly positioned ciliary body against iris root to angle. It is critical to distinguish multi-mechanism PACG from other types. The initial treatment for this type of PACG is also iridectomy, but after the pupillary block component is eliminated by iridectomy, the residual non-pupillary blocking components should be highlighted by a diagnostic treatment procedure or by a ultrasound biomicroscopy (UBM) provocative test. Finally, the role of UBM in the observation and evaluation of the mechanism of angle closure is discussed and future research directions on PACG in Asians are proposed. CONCLUSION: Chinese eyes have been recognized to be prone to the development of creeping angle closure. There is some direct evidence that creeping angle closure is caused by multiple mechanisms. Further study on this topic is needed.

Real world clinical performance of the zotarolimus eluting coronary stent system in Chinese patients： a prospective, multicenter registry study

Background Early clinical trials with the Endeavor zotarolimus eluting stent （ZES） in western populations demonstrated low rates of target lesion revascularization with a favorable safety profile including low late stent thrombosis with up to 5 years of follow-up. The aim of this clinical registry study was to evaluate real world clinical performance of the ZES coronary system in Chinese patients. Methods The China Endeavor Registry is a prospective, multicenter registry assessing the safety of the ZES system in a real world patient population. It was conducted at 46 centers in China in routine treatment of patients with coronary artery stenosis, including patients with clinical characteristics or lesion types that are often excluded from randomized controlled trials. The registry included 2210 adult patients who underwent single-vessel or multi-vessel percutaneous coronary intervention. The primary end point was the rate of major adverse cardiac events （MACE） at 12 months. Results The 12-month rate of MACE for all patients in the registry was 3.03%. Cardiac death or myocardial infarction rate was 1.28% and target lesion revascularization rate was 1.66%, non-target lesion target vessel revascularization （TVR） was 0.52%, TVR was 2.18%, and target vessel failure was 3.22%. There was only one case of emergent cardiac bypass surgery. The 12-month overall incidence of all Academic Research Consortium （ARC）-defined stent thrombosis was 0.43%. Conclusion Mid-term results from the real-world China Endeavor Registry suggest that Endeavor ZES was safe and effective in Chinese patients.