白头翁汤加减灌肠治疗溃疡性直肠炎101例

目的:观察白头翁汤加减灌肠治疗溃疡性直肠炎临床疗效。方法:将152例随机分为两组,治疗组101例用白头翁汤加味灌肠治疗,辅以饮食、心理调理。对照组51例单纯用西药治疗。结果:治疗组总有效率94.06%;对照组总有效率为72.55%;两组比较,(P<0.05)。两组主要症状疗效比较,各项均有统计意义,(P<0.05)。提示:白头翁汤加减灌肠治疗溃疡性直肠炎有清热解毒,行气活血,凉血止痛的功效。

Research progresses of dual-layer spectral detector CT for preoperative evaluation on colorectal cancer

Dual-layer spectral detector CT is a new spectrum CT imaging technology based on detector being able to obtain both images similar to true plain and spectral images in one time scanning.The reconstructed multi-parameter spectral images can not only improve image quality,enhance tissue contrast,increase the visualization and detection ability of occult lesions,but also provide qualitative and quantitative analysis of the lesions,so as to provide more imaging information and multi-dimensional diagnostic basis.The research progresses of dual-layer spectral detector CT for preoperative evaluation on colorectal cancer were reviewed in this article.

四黄雷风汤联合直肠点滴治疗溃疡性结肠炎166例

目的:探讨清热解毒、祛风除湿类中药配伍治疗溃汤性结肠炎的临床疗效。方法:采用口服惠迪联合四黄雷风汤(黄芪、黄连、黄柏、雷公藤、黄芩、白芍等)治疗UC166例。结果,完全缓解110例,(占66%);总有效率达96%。提示:服用惠迪联合四黄雷风汤直肠点滴治疗UC,简单易行,安全有效。

^(18)F-DG PET/CT in detection of recurrence and metastasis ofcolorectal cancer

AIM: To evaluate the value of 18F-DG PET/CT in detecting recurrence and/or metastasis of colorectal cancer (CRC). METHODS: Combined visual analysis with semiquantitative analysis, the 18F-DG PET/CT whole- body imaging results and the corresponding clinical data of 68 postoperative CRC patients including 48 male and 20 female with average age of 58.1 were analyzed retrospectively. RESULTS: Recurrence and/or metastasis were confirmed in 56 patients in the clinical follow-up after the PET/CT imaging. The sensitivity of PET/CT diagnosis of CRC recurrence and/or metastasis was 94.6%, and the specificity was 83.3%. The positive predictive value (PPV) was 96.4% and the negative predictive value (NPV) was 76.9%. PET/CT imaging detected one or more occult malignant lesions in 8 cases where abdominal/pelvic CT and/or ultrasonography showed negative findings, and also detected more lesions than CT or ultrasonography did in 30.4% (17/56) cases. Recurrence and/or metastasis was detected in 91.7% (22/24) cases with elevated serum CEA levels by 18F-DG PET/CT imaging. CONCLUSION: 18F-DG PET/CT could detect the recurrence and/or metastasis of CRC with high sensitivity and specificity.

Identification of Lynch syndrome: How should we proceed in the 21^(st) century?

Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), is the most common form of hereditary colorectal cancer. Although great advances in the understanding of its molecular basis have taken place in the last decade, optimal selection of individuals for HNPCC genetic testing remains controversial. This is especially relevant since colonoscopy has been proven effective for reducing colorectal cancer incidence and mortality in individuals at-risk for this disorder. In this manuscript, we summarize the most significant contributions to this important issue that have appearedin the last few years.

Cytoplasmic expression of p27^(kip1) is associated with a favourable prognosis in colorectal cancer patients

AIM: To evaluate the prognostic significance of p27kip1 in colorectal cancer patients. METHODS: Cytoplasmic and nuclear p27kip1 expression was evaluated in 418 colorectal cancers using tissue microarrays. Data were associated with known patient and tumor variables and long-term patient outcomes, providing further insight into the mechanisms by which p27kip1 may influence tumor development. RESULTS: Nuclear and cytoplasmic p27Kip1 expressions were detected in 59% and 19% of tumors respectively. Cytoplasmic p27Kip1 was almost invariably associated with positive nuclear p27Kip1 expression. Neither case correlat- ed with known clinical or pathological variables, includ- ing tumor stage, grade or extramural vascular invasion. Furthermore, nuclear p27kip1 expression had no impact on survival. However, we identified a significant correla- tion between expression of cytoplasmic p27kip1 and longer disease-specific survival times. On multivariate analysis, TNM stage and extramural vascular invasion were highly significant independent prognostic factors, with positive cytoplasmic p27 expression showing a trend towards im- proved patient survival (P = 0.059).CONCLUSION: These findings support the recent evi- dence that cytoplasmic p27kip1 has a distinct and impor- tant biological role that can influence tumor outcome.

Hypermethylation of CpG island in O^6-methylguanine-DNA methyltransferase gene was associated with K-rasG to A mutation in colorectal tumor

AIM: To investigate the functions of promoter hypermethylation of O6-methylguanine-DNA methyltransferase (MGMT) gene in colorectal tumorigenesis and progression.METHODS: The promoter hypermethylation of MGMT gene was detected in 27 sporadic colorectal adenomas,62 sporadic colorectal carcinomas and 20 normal colorectal mucosa tissues by methylation-specific PCR. At the same time, the expression of MGMT protein was carried out in the same samples using immunohistochemistry. Mutantallele-specific amplification was used to detect K-rasG to A point mutation in codon 12.RESULTS: None of the normal colorectal mucosa tissues showed methylated bands. Promoter hypermethylation was detected in 40.7% (11 of 27) of adenomas and 43.5% (27 of 62) of carcinomas. MGMT proteins were expressed in nucleus and cytoplasm of normal colorectal mucosa tissues. Loss of MGMT expression was found in 22.2% (6 of 27) of adenomas and 45.2% (28 of 62) of carcinomas. The difference between them was significant (P = 0.041). In the 6 adenomas and 28 carcinomas losing MGMT expression, 5 and 24 cases presented methylation,respectively (P = 0.027, P＜0.001). Thirteen of the 19 colorectal tumors with K-rasG to A point mutation in codon 12 had methylated MGMT(P = 0.011). The frequencies of K-rasG to A point mutation were 35.3% (12 of 34) and 12.7% (7 of 55) in tumors losing MGMT expression and with normal expression, respectively.CONCLUSION: Promoter hypermethylation and loss of expression of MGMT gene were common events in colorectal tumorigenesis, and loss of expression of MGMT occurs more frequently in carcinomas than in adenomas in sporadic patients. Hypermethylation of the CpG island of MGMT gene was associated with loss of MGMT expression and K-ras G to A point mutation in colorectal tumor. The frequency of K-ras G to A point mutation was increased in tumors losing MGMT expression. It suggests that epigenetic inactivation of MGMT plays an important role in colorectal neoplasia.

Immunoscintigraphy of local recurrent rectal cancer with^(99m)Tc-labeled anti-CEA monoclonal antibody CL58

AIM: To explore a specific diagnostic method for local recurrent rectal cancer.METHODS: Immunoscintigraphy with 99mTc-labeled anti-CEA monoclonal antibody (MoAb) CL-58 was performed for patients suspected of having a postoperative local recurrent rectal cancer and the findings were compared with the results of conventional imaging and pathology.RESULTS: A total of 36 patients with a suspected local recurrent rectal cancer underwent immunoscintigraphy with 99mTc-conjugated CL58. Local recurrence of rectal cancer was identified in 31 patients and established in 30 during operation, endoscopy and pathological examination. No local recurrence was found in 5 patients without specific accumulation of 99mTc during the follow-up. Immunoscintigraphy had a positive rate of 86.11%, a specificity of 83.33%, and a sensitivity of 100%.CONCLUSION: Immunoscintigraphy has a highly specific and predictive value for detecting local recurrent rectal cancer, especially after abdominal perineal resection (APR).

Expression of p21^(WAF1) is related to acetylation of histone H3 in total chromatin in human coiorectai cancer

AIM： To explore the relationship between acetylation of histone in total chromatin and p21^WAF1 expression regulation in human colorectal carcinoma. METHODS： We analyzed the expression of tumor suppressor gene p21^WAF1 mRNA by RT-PCR or realtime PCR in 33 samples of colorectal cancerous tissue, corresponding para-cancerous tissue and normal colorectal mucosa, and also examined the level of acetylated histone H3 in total chromatin using Western blotting. RESULTS： The expression level of p21^WAF1 mRNA was significantly lower in colorectal cancerous tissue from 33 patients than in para-cancerous tissue and normal colorectal mucosa （2377.95 ± 865.80 vs 3216.58 ± 1149.42 and 3541.61 ± 1433.17 respectively, P 〈 0.01）. In addition, when p21^WAF1 mRNA expression was undectectable or at very low level （50% less than that in adjacent tissue and normal colorectal mucosa） in all tissues, the level of acetylated histone H3 in colorectal cancerous tissue was significantly lower than that in corresponding para-cancerous tissue and normal colorectal mucosa in five of seven （71.43%） cases. The transcriptional level of p21^WAF1 in colorectal carcinoma might not be associated with its biological behaviors.CONCLUSION： The down-regulation of p21^WAF1 transcription is involved in the tumorigenesis and development of colorectal carcinoma. The down-expression of p21^WAF1 mRNA in colorectal carcinoma might be associated with histone hypoacetylation in chromatin but not with biological behaviors.

辨证治疗溃疡性结肠炎55例

目的:通过临床观察分析评价中西医结合治疗溃疡性结肠炎的疗效。方法:110例溃疡性结肠炎患者随机分为对照组及治疗组,治疗8周后,分析评价各组治愈、有效和总有效率。结果:两组治愈率及总有效率差异具有显著性意义(P<0.05),治疗组疗效明显优于对照组。提示:中西医结合治疗溃疡性结肠炎具有疗程短、效果显著的优点。

Detection of Serum Aberrant CDKN2/P16 DNA in Colorectal Cancer

Objective： To search for a biomarker for colorectal cancer. Methods： The MSP, SSCP and deletion tests with serum have been taken simultaneously in 100 cases of colorectal cancer and 2 groups of controls, as well as the specimens of 26 cancer tissues and 22 paracancerous tissues and 29 cases of benign disease tissues for a contrast. Results： The aberrant methylation rate of P16 in the serum was 69.00%, deletion rate 4.00% and suspicious point mutation rate 15.00% in colorectal cancer patients. The data of cancer tissues were the same as those of the serum, but in paracancerous tissue those were significantly lower. In 10 cases, sequencing analysis revealed that there were 3 cases of missense, one case of frameshift and one case of nonsense. Among them, four cases had P16 protein deletion. As a tumor marker, the sensitivity of combined use of three methods was 88.00%, specificity 96.87% and accuracy 90.15%. The combined use of MSP and SSCP could obtain the same results. Conclusion： The content of DNA in serum is minimal, but it reflects the tumor burden of patients. The 10^-3 fragments of DNA could be detected in the serum by MSP. It can be used in the clinical diagnosis or popular investigation, and long-term postoperative follow-up.

参苓白术散加味治疗溃疡性结肠炎63例

目的:观察参苓白术散治疗溃疡性结肠炎的临床疗效。方法:观察121例,随机分为治疗组(口服参苓白术散加地塞米松保留灌肠)和观察组(口服柳氮磺胺嘧啶加地塞米松保留灌肠)。结果:治疗组63例,痊愈33例,好转24例,无效6例,有效率90.5%。对照组58例,痊愈18例,好转19例,无效21例,有效率63.8%。提示:参苓白术散配合地塞米松保留灌肠,具有抗炎、抗渗出、抗病毒、抗过敏等作用,加速了局部炎症的吸收与排泄,改善肠道内环境。

Effects of Promoter Region 5’CpG Island Demethylation on the Biological Behavior of Human Colorectal Cancer RKO Cells in Vitro

OBJECTIVE To explore the relationship between the methylation status of the promoter 5＇CpG island region and the biological behavior of human colorectal cancer RKO cells in vitro. METHODS RKO cells were treated with a selective DNA methyltransferase inhibitor-5-aza-2＇-deoxycytidine （5-aza-CdR） for 72 h. Methylationspecific PCR （MSP）, T-A cloning and DNA sequence analysis were used to determinate the 5＇CpG island methylation status of the p16/CDKN2 tumor suppressor gene. Cell growth, morphological changes and apoptosis were analyzed by the MTT assay, flow cytometry, fluorescence staining and electron microscopy. RESULTS The 5＇CpG island of the p16/CDKN2 tumor suppressor gene in RKO cells was a typically hypermethylated. The DNA methyltransferase inhibitor （5-Aza-CdR） effectively reversed the hypermethylation status of the promoter region. With demethylation, RKO cell growth was suppressed, the cells doubling times were prolonged （P〈0.01） and apoptosis was induced, which showed a relationship. CONCLUSION A selective DNA methyltransferase （DNMT） inhibitor can inhibit proliferation by demethylation in 5＇CpG islands, and may be a potential new therapy target for colorectal cancer.

中药液保留灌肠治疗慢性结肠炎65例

目的:观察清热解毒、健脾、化湿类中药配伍保留灌肠治疗慢性非特异性结肠炎的疗效。方法:采用中药基本方(金银花、黄连、大黄、蒲公英、苦参、明矾等),保留灌肠治疗本病65例,并与美沙拉嗪保留灌肠治疗60例相对照。结果:治疗组与对照组总有效率分别为92.3%和71.5%(P<.05),复发率分别为21.8%和62.5%(P<0.05)。提示:中药液保留灌肠使药物与病变部位接触,可收到表面抗炎、产生腐生肌效果。

中西医结合治疗重症溃疡性结肠炎54例

目的:观察中西医结合治疗重症溃疡性结肠炎的疗效。方法:选择本科住院病人,随机分成中药、西药及中西医结合治疗组,进行疗效对比。结果:总有效率,中药组38.9%、西药组61.1%、中西医结合组83.3%。提示:应用中西医结合治疗重症溃疡性结肠炎效果显著。

Oncoprotein expression and inhibition of apoptosis during colorectal tumorigenesis

AIMS To study bcl-2 and P53 protein expression and inhibition of apoptosis during colorectal tumorigenesis. METHODS Expression of bcl -2 and p53 in 45 colorectal ade- nomas and 61 colorectal carcinomas was detected by immunohis- tochemical staining. RESULTS The bcl-2 and P53 protein expression was uniformly negative in normal mucosa,whereas bcl-2 and p53 positive rates were significantly higher in adenoma and carcinoma than in nor- reals(P<0.01 ).The area with strong bcl-2 expression was of- ten the area with severely dysplasia.In colorectal adenoma,ex- pression of p53 increased with the increasing size and dysplasia, in adenomas≥20 mm being higher than adenomas<10 mm(77, 8% vs 35.0%,P<0.05).p53 was relevant to differentiation and Duke's staging.A significant inverse correlation was found between bcl-2 and p53 in immunostaining in the adenomas,but not in the carcinomas.Furthermore,carcinomas with a high per- centage of bcl-2 positive cells were significantly more likely to have low rates of apoptosis. CONCLUSIONS These results suggest that bcl-2 gene appears to be an early event in colorectal tumorigenesis that can inhibit apoptosis,p53 expression plays an important role in the develop- ment and malignant change of colorectal adenoma,bcl-2 and p53 may be used as a good marker relating to cell apoptosis.

Down-regulation of Wnt Antagonist,SFRP1 in Colorectal Tumorigenesis

OBJECTIVE To assess the functional change of SFRP1 （secreted frizzled-related protein1）, in colorectal tumorigenesis. METHODS Immunohistochemical investigation and the semiquantitative reverse transcription-polymerase chain reaction （RT-PCR） were used to assess the expression of SFRP1, β-catenin （β-cat） and E-caderin （E-cad） in matched samples of normal colorectal mucosa, adenomas and cancers. RESULTS SFRP1 mRNA expression was down-regulated in the neoplasms, and abnormal expressions of β-cat and E-cad were found in colorectal adenomas and colorectal cancers. CONCLUSION Down-regulation of SFRP1 observed is consistent with its acting as a tumor suppressor gene in colorectal tumorigenesis.

Perioperative Cimetidine Administration Enhances Tumor Infiltration Lymphocytes and HLA-DR Expression in Colorectal Cancer~*

Objective： It has been shown in our previous study that cimetidine （CIM） can boost the hosts＇ cellular immunity in patients with gastrointestinal cancer. This study was conducted to evaluate CIM＇s effects on tumor infiltrating lymphocytes （TIL） and HLA-DR expression in tumor stroma in colorectal cancer （CRC）, so as to investigate its role in local immune response at the tumor site in CRC. Methods： Forty-nine CRC patients were randomized into treatment group of 25 patients who took CIM 7 days before curative surgery till the operation day, and control group of 24 patients who received similar treatment except for CIM intervention. TIL responses and HLA-DR expression were studied on tumor tissues taken before and after surgical resection. Results： The percentage of significant TIL response was increased from 32% （8/25） to 76% （19/25） （P〈0.005） in the CIM treatment group, whereas there were no significant changes in TIL response in the control group [25% （6/24） at recruitment vs. 33% （8/24） at operation, P〉0.50]. Moreover, the percentages of HLA-DR expression were increased from 36% （9/25） to 72% （18/25） in the CIM treatment group, but there were no significant differences in HLA-DR expression in the control group [41.7% （10/24） before resection vs 45.8% （11/24） after resection, P〉0.50]. Conclusion： CIM used before surgery might promote TIL responses and increase the HLA-DR expression in stroma cells in CRC patients, leading to enhanced host immunity against tumor.

Reduction of the incidence and mortality of rectal cancer bypolypectomy:a prospective cohort study in Haining County

AIM: To reduce the incidence and mortality of rectal cancer and address the hypothesis that colorectal cancer often arise from precursor lesion(s), either adenomas or non-adenomatous polyps, by conducting a population-based mass screening for colorectal cancer in Haining County, Zhejiang, PRC. METHODS: From 1977 to 1980, physicians screened the population of Haining County using 15 cm rigid endoscopy. Of over 240000 participants, 4076 of them were diagnosed with precursor lesions, either adenomas or non-adenomatous polyps, which were then removed surgically. All individuals with precursor lesions were followed up and reexamined by endoscopy every two to five years up to 1998. RESULTS: After the initial screening, 953 metachronous adenomas and 417 non-adenomatous polyps were detected and removed from the members of this cohort. Further, 27 cases of colorectal cancer were detected and treated. Log-rank tests showed that the survival time among those cancer patients who under went mass screening increased significantly compared to that of other colorectal cancer patients (P【0.0001). According to the population-based cancer registry in Haining County, age-adjusted incidence and mortality of rectal cancer decreased by 41% and 29% from 1977-1981 to 1992-1996, respectively. Observed cumulative 20-year rectal cancer incidence was 31% lower than the expected in the screened group; the mortality due to rectal cancer was 18% lower than the expected in the screened group. CONCLUSION:Mass screening for rectal cancer and precursor lesions with protocoscopy in the general population and periodical following-up with routine endoscopy for high-risk patients may decrease both the incidence and mortality of rectal cancer.

Changing patterns of colorectal cancer in China over a period of 20 years

AIM： To determine whether any changes have occurred on the patterns of colorectal cancer in China. METHODS： Data from 21 Chinese articles published from 1980 to 1999, were used to analyze the time trend of colorectal cancer according to the patients＇age at diagnosis, sex, the site of the tumor, stage, and the pathology. RESULTS： From 1980s to 1990s, the mean age of the colorectal cancer patients has increased. The percentage of the female patients rose. The distribution of colorectal carcinoma shows a predominance of rectal cancer. However, the proportion of proximal colon cancer （induding transverse and ascending colon） increased significantly accompanied by a decline in the percentage of rectal cancer. Similarity in the percentage of distal colon cancer between two decades was revealed. In the 1990s, statistically more Stage B patients were found than those in 1980s. In addition, databases show a significant decrease in the Stage D cases. The proportion of adenocarcinoma increased, but the mucinous adenocarcinoma decreased during two decades. CONCLUSION： These findings indicate that the pattern of colorectal cancer in China has been changing. Especially, a proximal shift due to the increasing proportion of ascending and transverse colon cancer has occurred in China.