车叶草苷减轻溃疡性结肠炎大鼠结肠黏膜损伤及炎症反应的机制

目的基于干扰素基因刺激因子(STING)/TANK结合激酶1(TBK1)/干扰素调节因子3(IRF3)信号通路,探究车叶草苷(ASP)对溃疡性结肠炎(UC)大鼠结肠组织病理损伤及炎症反应的影响机制。方法以肠腔内注射三硝基苯磺酸和乙醇构建UC大鼠模型,并将造模成功的大鼠分为模型组、ASP低剂量组(17.5 mg/kg)、ASP高剂量组(35 mg/kg)、ASP高剂量+STING激活剂组(35 mg/kg ASP+20 mg/kg ADU-S100),每组16只;另取16只健康大鼠,肠腔内注射生理盐水,作为对照组。各组大鼠灌胃或/和腹腔注射相应药液或生理盐水,每天1次,连续14 d。末次给药后24 h,使用疾病活动指数(DAI)和结肠黏膜损伤指数(CMDI)分别评估各组大鼠的UC严重程度和结肠黏膜损伤程度,观察其结肠组织病理改变并进行组织病理学评分,检测其结肠组织细胞凋亡情况、炎症因子[肿瘤坏死因子α(TNF-α)、β干扰素(IFN-β)、白细胞介素4(IL-4)、IL-10]水平和通路相关蛋白表达情况[STING、TBK1、IRF3、核因子κB p65(NF-κB p65)]。结果与对照组比较,模型组大鼠结肠组织黏膜及腺体结构严重受损,黏膜上皮磨损,隐窝缺失,可见明显的炎症细胞浸润;DAI、CMDI、结肠组织病理学评分,细胞凋亡率,TNF-α、IFN-β水平,以及STING蛋白的表达水平和TBK1、IRF3、NF-κB p65蛋白的磷酸化水平均显著升高;IL-4、IL-10水平均显著降低(P<0.05)。与模型组比较,ASP低、高剂量组大鼠结肠组织黏膜结构相对完整,腺体排列有序,充血和水肿减轻,炎症细胞浸润及溃疡明显减少;上述各定量指标均显著改善,且高剂量组的改善较低剂量组明显(P<0.05)。与ASP高剂量组比较,ASP高剂量+STING激活剂组大鼠的上述指标均被显著逆转(P<0.05)。结论ASP可能通过抑制STING/TBK1/IRF3信号通路来减轻UC大鼠的结肠组织病理损伤及炎症反应。

白头翁汤合黄连解毒汤加减对溃疡性结肠炎患者症状缓解及肠黏膜屏障功能的影响

目的观察白头翁汤合黄连解毒汤加减对溃疡性结肠炎患者症状缓解及肠黏膜屏障功能的影响。方法选取我院中医科自2018年1月至2020年1月收治的86例溃疡性结肠炎患者为研究对象,按照入院顺序随机分为两组。对照组43例予西医常规治疗,治疗组43例在对照组治疗基础上予白头翁汤合黄连解毒汤加减治疗。两组均连续治疗4周。治疗后统计比较两组疗效,检测并比较两组治疗前后Sutherland疾病活动指数(DAI)、肠黏膜状况和结肠组织病理状况及肠黏膜屏障功能指标变化,评价治疗方案安全性。结果治疗后治疗组临床有效率显著高于对照组(χ^(2)=5.460,P=0.019);与本组治疗前比较,治疗后两组患者腹泻、便血、黏膜表现及医师评估病情评分,肠镜评分和结肠组织病理评分,血清二胺氧化酶、D-乳酸、细菌内毒素水平均降低,且治疗组显著低于对照组(P<0.05),差异有统计学意义;两组患者在治疗期间均未发现有明显不良反应。结论白头翁汤合黄连解毒汤加减能够改善溃疡性结肠炎患者肠黏膜和组织病理状况,提高患者肠黏膜屏障功能,有助于缓解临床症状,促进疾病的预后转归。

紧密连接蛋白occludin和claudin-1在大鼠溃疡性结肠炎的表达

【目的】观察溃疡性结肠炎模型大鼠紧密连接蛋白occludin、claudin-1表达情况及其与结肠病变的关系。【方法】采用三硝基苯磺酸(TNBS)复制大鼠溃疡性结肠炎模型,于实验周期的第10、20、30天分3组(即模型1、2、3组)处死大鼠,另设正常对照组,以大鼠结肠occludin、claudin-1表达(免疫荧光法)、结肠大体和病理评分为主要检测指标。【结果】随着实验周期延长,模型组结肠大体和病理平均评分逐渐降低,occludin表达平均评分先降低后回升,但均低于正常组;occludin表达与其结肠大体和病理评分均呈负相关(P<0.05)。claudin-1表达平均评分呈降低→上升→再降低,但均与正常组比较接近;claudin-1表达与其大体和病理均无显著相关性(P>0.05)。【结论】溃疡性结肠炎大鼠occludin表达降低,且与其结肠病变呈负相关;occludin表达改变比claudin-1更显著。

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.

Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001

AIM： To evaluate how proximal colon polyps interpreted as hyperplastic polyps in 2001 would be interpreted by expert pathologists in 2007.METHODS： ≥ 5 mm in interpreted pathologists 2007 by 3 GI Forty consecutive proximal colon polyps size, removed in 2001, and originally as hyperplastic polyps by general at Indiana University, were reviewed in pathologists.CONCLUSION： Many polyps interpreted as hyperplastic in 2001 were considered sessile serrated lesions by GI pathologists in 2007, but there is substantial inter-observer variation amongst GI pathologists.

Mucosa-associated lymphoid tissue lymphoma of the transverse colon: A case report

We herein present a case of a 75-year-old female with mucosa-associated lymphoid tissue （MALT） lymphoma of the transverse colon with the stage IE （Ann Arbor classification）. Colonoscopy revealed the tumor＇s appearance as a IIa plus Ⅱ c-like early colon cancer as defined according to the macroscopic classification of the Japanese Research Society for Cancer of Colon, Rectum and Anus, measuring less than 2 cm in diameter. Histologically, the tumor was diagnosed as MALT lymphoma because of the presence of lymphoepithelial lesions consisting of diffuse proliferation of atypical lymphocytes and glandular destruction. The majority of these lymphocytes immunohistochemically stained for the B-lymphocyte marker. The patient first underwent H pylori eradication therapy with Lansap. However, the tumor size gradually increased over the next 4 mo and the patient eventually underwent surgical resection. The operative procedure included a partial colectomy with dissection of the paracolic lymph nodes. The tumor measured 45 mm × 30 mm in diameter and histological examination showed that the lymphoma cells had infiltrated the muscle layer of the colon without nodal involvement. The patient has had no recurrence postoperatively without any chemotherapy.

Comparative effectiveness of i-SCAN^(TM) and high-definition white light characterizing small colonic polyps

AIM： To evaluate accuracy of in vivo diagnosis of ad- enomatous vs non-adenomatous polyps using/-SCAN digital chromoendoscopy compared with high-definition white light. METHODS： This is a single-center comparative effec- tiveness pilot study. Polyps （n = 103） from 75 average- risk adult outpatients undergoing screening or surveil- lance colonoscopy between December 1, 2010 and April 1, 2011 were evaluated by two participating en- doscopists in an academic outpatient endoscopy center. Polyps were evaluated both with high-definition white light and with/-SCAN to make an/n vivo prediction of adenomatous vs non-adenomatous pathology. We de- termined diagnostic characteristics of/-SCAN and high- definition white light, including sensitivity, specificity, and accuracy, with regards to identifying adenomatous vs non-adenomatous polyps. Histopathologic diagnosis was the gold standard comparison. RESULTS： One hundred and three small polyps, de- tected from forty-three patients, were included in the analysis. The average size of the polyps evaluated in the analysis was 3.7 mm （SD 1.3 mm, range 2 mm to 8 mm）. Formal histopathology revealed that 54/103 （52.4%） were adenomas, 26/103 （25.2%） were hyper- plastic, and 23/103 （22.3%） were other diagnoses in- clude ＂lymphoid aggregates＂, ＂non-specific colitis,＂ and ＂no pathologic diagnosis.＂ Overall, the combined accu- racy of endoscopists for predicting adenomas was iden- tical between/-SCAN （71.8%, 95%CI： 62.1%-80.3%） and high-definition white light （71.8%, 95%CI： 62.1%-80.3%）. However, the accuracy of each endosco- pist differed substantially, where endoscopist A demon- strated 63.0% overall accuracy （95%CI： 50.9%-74.0%） as compared with endoscopist B demonstrating 93.3% overall accuracy （95%CI： 77.9%-99.2%）, irrespective of imaging modality. Neither endoscopist demonstrated a significant learning effect with i-SCAN during the study. Though endoscopist A increased accuracy using/-SCAN from 59% （95%CI： 42.1%-74.4%） in the first half to 67.6% （95%CI： 49.5%-82.6%） in the second half, and endoscopist B decreased accuracy usingi-SCAN from 100% （95%CI： 80.5%-100.0%） in the first half to 84.6% （95%CI： 54.6%-98.1%） in the second half, nei- ther of these differences were statistically significant. CONCLUSION：i-SCAN and high-definition white light had similar efficacy predicting polyp histology. Endosco- pist training likely plays a critical role in diagnostic test characteristics and deserves further study.

Jumbo biopsy is useful for the diagnosis of colonic prolapsing mucosal polyps with diverticulosis

We report here a case of multiple prolapsing mucosal polyps with diverticulosis in the sigmoid colon. A 52-year- old man was admitted to our hospital because of bloody diarrhea. Colonoscopy and barium enema showed multiple diverticula, markedly thickened mucosal folds and polypoid lesions with mucus on the top of them in the sigmoid colon. Endoscopic ultrasonography showed thickening of the mucosal and submucosal layers. Several endoscopic biopsy specimens were taken from the polypoid lesions. Histological examination revealed only chronic inflammatory cell infiltration. In order to obtain a definite diagnosis, we performed endoscopic jumbo biopsy for the polypoid lesions after obtaining informed consent. Histological examination revealed marked lymphocyte infiltration, hemosiderin deposits and fibromuscular obliteration in the lamina propria, features similar to those of mucosal prolapsing syndrome. After anti-diarrhetic treatment, clinical findings were improved. Thus, jumbo biopsy is useful for diagnosis and treatment of prolapsing mucosal polyps.

The clinical epidemiological characteristics of 704 cases of colorectal cancer from 2004-2008

Objective： The aim of the research was to study the clinical and epidemiological characteristics of incidence of colorectal cancer in North China. Methods： Analysis and summary were made for 704 colorectal cancer patients diagnosed from 2004 to 2008 in North China. Results： （1） Of 704 colorectal cancer patients, the median age was 56 years old, and the mean age was 58.2. There was no statistic difference in age between male and female cases, P 〉 0.05. （2） The male-female ratio was 1.62：1. （3） The proportion of rectal cancer was 62.92%, and incidence of the left colon cancer was higher than that of right colon cancer, P 〈 0.05. （4） Of 712 lesions, 658 cases were adenocarcinoma accounting for 92.4%, 34 were malignant adenoma accounting for 4.8%, and 20 carcinoid accounting for 2.8%. （5） The 48.9% of patients belonged to stages 0 to 11B. Conclusion： The cases of colorectal cancer in North China is mainly rectal cancers, and the incidence of left colon cancer is higher than that of right colon cancer. The histopathological classification is mainly adenocarcinoma, and the ratio of early stage is high.

Histopathological and genetic differences between polypoid and non-polypoid submucosal colorectal carcinoma

AIM： To investigate the histopathological and geneticdifferences between polypoid growth （PG） and nonpolypoid growth （NPG） submucosal invasive colorectal carcinoma （CRC）.METHODS： A total of 96 cases of submucosal CRC were divided into two groups according to their growth type;60 cases of PG and 36 cases of NPG. The size, histological degree of dysplasia, depth of submucosal invasion and lymph node metastasis were compared between the two groups. Furthermore, expression of p53 was detected by immunohistochemical staining, and K-ras gene mutation was examined by polymerase chain reaction based single-strand conformation polymorphism （SSCP）.RESULTS： The average size of the lesions in the NPG group was significantly smaller than those in the PG group （7.5 mm vs 13.8 mm, P 〈 0.001）. The histological degree of dysplasia tended to be more severe in NPG group, while the incidence of submucosal massive invasion and the lymph node metastasis were both significantly higher in the NPG type than in the PG group （64.3% vs 43.3%, P = 0.004; 43% vs 7%, P =0.008, respectively）. In addition, K-ras gene mutations were detected in 67% of lesions in the PG group, but none in the NPG group, while no difference in p53immunohistochemical expression was found between the two groups.CONCLUSION： Compared with PG submucosal CRC,NPG type demonstrates more frequent submucosal massive invasion, more lymph node metastasis and a higher degree dysplasia. Genetically, NPG type shows much less frequent K-ras mutation.

Colorectal carcinoma in Lagos and Sagamu,Southwest Nigeria:A histopathological review

AIM： To study the frequency, gender and age distribution as well as pathological characteristics of colorectal carcinoma （CRC） in Lagos and Sagamu in SW Nigeria. METHODS： This is a retrospective pathological review of histologically diagnosed CRC from 5 laboratories inLagos ＆ Sagamu. The clinical data, such as age, sex and clinical summary were extracted from demographic information. Cases of anal cancer were excluded from this study. RESULTS： There were 420 cases （237 males and 183 females） of CRC. It peaked in the 60-69 year age group （mean： 50.7; SD： 16.2）, M：F ratio 1.3：1 and 23% occurred below 40 years. The majority was well to moderately differentiated adenocarcinoma 321 （76.4%）, rnucinous carcinoma 45 （10.7%） and signet ring carcinoma 5 （1.2%）, and more common in patients under 40 years compared to well differentiated tumors. The recto-sigmoid colon was the most common site （58.6%）. About 51% and 34% of cases presented at TNM stages Ⅱand Ⅲ, respectively. CONCLUSION： CRC is the commonest malignant gastrointestinal （GIT） tumor most commonly located in the recto-sigmoid region. The age and sex prevalence and histopathological features concur with reports from other parts of the world.

Primary colonic type adenocarcinoma of the cecal appendix presented as obstructive acute abdominal syndrome

We reported a case with an obstructive acute abdomen,and emergency exploratory laparotomy was performed.Ap-pendiceal neoplasm was observed adhered to the ileum,and an ileohemicolectomy was performed.From the histopathological point of view the neoplasm was an infiltrating colonic type adenocarcinoma of the appendix,with extension to the periapendicular adipose tissue and fixation of an adjacent ileal loop secondary to infiltration of the intestinal wall.The tumor produced a moderate luminal stenosis of the intestine,this explained the clinical manifestations of the patient.Post-operative evolution was satisfac-tory and there had been no signs of recurrence in the 5 years since the operation.Based upon the comparison of clinical char-acteristics,pathological behavior(in relation to the growth and dissemination),and therapeutic considerations,possibly colonic type adenocarcinoma of the appendix is a neoplasm similar to the carcinomas of ascending colon.

Association of T cell factor-4 mRNA expression with clinicopathological characteristics of colorectal cancer

Objective： To study the expression of T-cell transcription factor-4 （Tcf-4） gene in human colorectal cancer （CRC） and the relationship between Tcf-4 gene and progression of CRC. Methods： Quantitative real time RT-PCR was used to de- tect the expression of Tcf-4 mRNA in 31 CRC and para-cancerous tissues. The correlation of expression of the Tcf-4 gene with clinicopathologicel characteristics of CRC was also analyzed. Results： Compared with normal tissues, up-regulation of Tcf4 mRNAwas observed in 31 CRC tissues （t = 2.188, P = 0.037）. The expression values of Tcf-4 mRNA in Dukes A, B, C and D were 8.38 ＋ 1.92, 6.93 ＋ 1.44, 6.00 ＋ 1.26 and 3.50 ＋ 0.71 respectively. Analyzed by one-way ANOVA, there were significant differences in the expressions of Tcf-4 in different Dukes stages （F = 6.454, P = 0.002）. Moreover, the over-expression of Tcf-4 was significantly correlated with lymph node metastases. However the expression of Tcf-4 was no correlation with the age, gender of patients and cell differentiation of CRC in this study. Conclusion： The higher expression level of Tcf-4 mRNA in CRC tissues suggested that the over-expression of Tcf-4 gene may be related to the development and invasion of CRC.