Helicobacter pylori eradication attenuates oxidative stress in human gastric mucosa

OBJECTIVE: Helicobacter pylori infection causes gastric diseases, but the responsible mechanisms are not completely understood. They can involve DNA and tissue damage induced by reactive oxygen and nitrogen species. Our aim is to investigate the effects of bacterial eradication on oxidative stress by measuring changes of relevant markers. METHODS: Antral biopsies were obtained from 34 patients with chronic atrophic gastritis and peptic ulcer disease before and after bacterial eradication. The expression of inducible nitric oxide synthase (iNOS) and levels of nitrotyrosine (NTYR) and 8-hydroxy-2'-deoxyguanosine were assessed immunohistochemically as markers of nitric oxide (NO) production and of damage to proteins and DNA, respectively. RESULTS: Before treatment, the percentages of patients with staining were: 56 for iNOS in inflammatory cells, 79 and 61 for NTYR and 8-hydroxy-2'-deoxyguanosine in foveolar cells, respectively, and 82 for 8-hydroxy-2'-deoxyguanosine in lymphoid follicles. NTYR staining was associated with the intensity of inflammation (p = 0.04) and gastritis activity (p = 0.07). The prevalence of 8-hydroxy-2'-deoxyguanosine tended to be associated with that of NTYR. After successful H. pylori eradication, the prevalence of iNOS and NTYR (in mild gastritis) staining decreased (p < 0.001 and p < 0.06, respectively). 8-Hydroxy-2'-deoxyguanosine staining disappeared in 24% of cases but appeared in 18% of previously negative cases despite eradication. CONCLUSION: Targets of oxidative stress associated with H. pylori infection are inflammatory and deep foveolar cells and lymphoid follicles. This is the first report of 8-hydroxy-2'-deoxyguanosine localization in gastric mucosa. Oxidative stress is reduced by bacterial eradication in the first stages of mild gastritis. Moderate-severe gastritis may be a step that is reversible for iNOS, but partly irreversible for NTYR and 8-hydroxy-2'-deoxyguanosine.     

Role of nitric oxide and peroxynitrite anion in lung injury induced by intestinal ischemia－reperfusion in rats

AIM: To evaluate effects of nitric oxide (NO) and peroxynitrite anion (ONOO-) on lung injury following intestinal ischemia-reperfusion (IR) in rats. METHODS: A rat model of intestinal ischemia was made by clamping superior mesenteric artery and lung injury was resulted from reperfusion. The animals were randomly divided into 3 groups: sham operation (Sham), 2 h ischemia followed by 2 h reperfusion (IR) and IR pretreated with aminoguanidine (AG) - an inhibitor of inducible NO synthase (iNOS) 15 minutes before reperfusion (IR+AG). The lung malondialdehyde (MDA) and nitrate/nitrite (NO2/NO3)contents and morphological changes were examined.Western blot was used to detect the iNOS protein expression.Immunohistochemical staining was used to determine the change of nitrotyrosine (NT)- a specific "footprint" of ONOO-. RESULTS: The morphology revealed evidence for lung edema, hemorrhage and polymorphonuclear sequestration after intestinal IR. Compared with sham group, lung contents of MDA and NO2-/NO3- in IR group were significantly increased (12.00±2.18 vs23.44±1.25 and 76.39±6.08 vs140.40±4.34,P＜0.01) and the positive signals of iNOS and NT were also increased in the lung. Compared with IR group, the contents of MDA and NO2/NO3 in IR+AG group were significantly decreased (23.44±1.25 vs14.66±1.66 and 140.40±4.34 vs 80.00±8.56, P＜0.01) and NT staining was also decreased. CONCLUSION: Intestinal IR increases NO and ONOO production in the lung, which may be involved in intestinal IR-mediated lung injury.     

YB-1和P53蛋白在结直肠肿瘤中的表达及意义

目的:探讨YB-1和P53蛋白在结直肠肿瘤不同发展阶段表达水平的差异及其与结直肠癌临床病理特征的关系.方法:采用免疫组织化学方法检测结直肠20例正常组织、30例低级别上皮内瘤变组织、30例高级别上皮内瘤变组织和50例癌组织中YB-1和P53蛋白的表达.结果:YB-1蛋白在结直肠正常组织(NCM)、低级别上皮内瘤变组织(LGIN)、高级别上皮内瘤变组织(HGIN)和癌组织(CRC)中的强阳性率分别为0%、76.7%、80.0%、80.0%,低级别、高级别上皮内瘤变组织和癌组织中的强阳性表达率均与正常组织比较差异有统计学意义(P<0.05),且在癌组织中其强阳性表达与淋巴结转移和TNM分期有关(P<0.05);P53蛋白在结直肠正常组织、低级别上皮内瘤变组织、高级别上皮内瘤变组织、癌组织中表达分别为0%、6.7%、40.0%、60.0%,高级别上皮内瘤变组织和癌组织中其表达率均与正常组织和低级别上皮内瘤变组织比较差异有统计学意义(P<0.05),其在癌组织中的表达与分化程度、淋巴结转移和TNM分期有关(P<0.05).在癌组织中YB-1和P53的表达呈正相关性(r=0.306,P<0.05).结论:YB-1和P53蛋白在结直肠癌的发生发展、转移中起重要作用,YB-1和P53蛋白的联合检测可能为判断结直肠癌恶性程度和转移提供重要参考.     

Effects of endogenous nitric oxide induced by 5-fluorouracil and L-Arg on liver carcinoma in nude mice

AIM： To study the effects of endogeous nitric oxide induced by 5-fluorouracil （5-FU） and L-arginine （L-Arg） on the human liver carcinoma model in nude mice. METHODS： The human liver carcinoma model in nude mice was established with BEL-7402 cells and normal saline （NS）, 5-FU and 5-FU ＋ L-Arg injected intraperitoneally. The tumor size was measured. The necrotic degree and range were observed under microscope. The apoptosis of cancer cell was detected by turmina deoxynucleotidyl transferanse mediated dUTP nick end labeling （TUNEL） method. Immunohistochemical method was performed to determine the expression of iNOS, P16, BAX. The chemical colorimetry was used to test the activity and nitrate reductase method was adopted to test the concentration of nitric oxide （NO） in the tumor tissue. The BI2000 pathological image analyzer was used to analyze the result of immunohistochemistry. RESULTS： 5-FU combined with L-Arg could inhibit the tumor growth apparently. In NS, 5-FU and 5-FU＋L- Arg groups, the changes of tumor volumes were 257.978 ± 59.0, 172.232 ± 66.0 and 91.523 ± 26.7 mm3, respectively （P 〈 0.05 5-FU vs 5-FU ± L-Arg group;P 〈 0.05 NS ys 5-FU ± L-Arg group; P 〈 0.05, NS ys 5-FU group）. The necrotic range and apoptosis index were significantly increased after the drug injection. The necrotic range was biggest in 5-FU ＋ L-Arg group （X^2= 15.963, P 〈 0.05）. The apoptosis indexes were as follows： NS, 17.4% ± 6.19%; 5-FU, 31.3% ± 12.3%; and 5-FU ± L-Arg, 46% ± 15.24% （P 〈 0.05, 5-FU ys 5-FU ± L-Arg; P 〈 0.05, NS ys 5-FU ± L-Arg; P 〈 0.05, NS ys 5-FU）. The expression and activity of iNOS were increased in the tumor tissue. The concentration of NO was also increased. F of opticaldensity of iNOS, iNOS activity and NO concentration are 31.693, 21.949, and 33.909, respectively, P 〈 0.05. The concentration of NO was related to the expression of PI6 and BAX. The correlation coefficient was 0.764 and 0.554. CONCLUSION： 5-FU combined with L-Arg can inhi     

Chronic epithelial NF-κB activation accelerates APC loss and intestinal tumor initiation through iNOS up-regulation

The role of NF-κB activation in tumor initiation has not been thoroughly investigated. We generated Ikkβ(EE)(IEC) transgenic mice expressing constitutively active IκB kinase β (IKKβ) in intestinal epithelial cells (IECs). Despite absence of destructive colonic inflammation, Ikkβ(EE)(IEC) mice developed intestinal tumors after a long latency. However, when crossed to mice with IEC-specific allelic deletion of the adenomatous polyposis coli (Apc) tumor suppressor locus, Ikkβ(EE)(IEC) mice exhibited more β-catenin(+) early lesions and visible small intestinal and colonic tumors relative to Apc(+/ΔIEC) mice, and their survival was severely compromised. IEC of Ikkβ(EE)(IEC) mice expressed high amounts of inducible nitric oxide synthase (iNOS) and elevated DNA damage markers and contained more oxidative DNA lesions. Treatment of Ikkβ(EE)(IEC)/Apc(+/ΔIEC) mice with an iNOS inhibitor decreased DNA damage markers and reduced early β-catenin(+) lesions and tumor load. The results suggest that persistent NF-κB activation in IEC may accelerate loss of heterozygocity by enhancing nitrosative DNA damage.     

肝癌组织中诱导型一氧化氮合酶的表达

为了解诱导型一氧化氮合酶(induce nitricoxide synthase,iNOS)在肝癌发病中的作用,用免疫组织化学方法检测了肝癌组织中iNOS的表达。32例肝癌和10例正常肝组织进行HE染色、iNOS检测。10例正常肝组织内均未见iNOS阳性信号。肝癌组织iNOS表达高于正常对照肝组织(26/32vs 0/10,x2=31.328,P<0.01)。肝癌组织和癌旁肝组织均表达iNOS(23/32vs 25/32,x2=0.333,P=0.564)。iNOS通过多种途径参与肝癌的发病。     

来氟米特对狼疮患者树突状细胞作用机制的初探

目的　探讨来氟米特(LEF)处理前后系统性红斑狼疮(SLE)患者树突状细胞(DC)表面标志及功能的改变,揭示LEF治疗SLE的作用机制,为开展“抑制性DCs”治疗SLE奠定实验基础。方法　(1)分离SLE患者外周血单核细胞,用细胞因子诱导DC成熟, LEF组再加入A7717262(来氟米特的活性代谢产物)培养。第9天收集DC细胞,流式细胞仪检测CD80、CD83、CD86和HLA DR的表达。(2)分别将A771726处理或不处理的第9天DC和T细胞进行培养, 72h后用MTT法检测DC刺激淋巴细胞增殖的能力,FACS检测T细胞亚群和ELISA检测培养上清中IL 10和IFNγ水平。结果A771726处理后虽DC形态无改变,但DC表达CD83、CD86和HLA DR百分数较对照组均明显降低(72 70±1 77vs 79 36±4 80, 63 50±14 06vs. 83 91±9 81, 80 44±12 56vs. 90 51±8 63,P值均<0 01)。A771726处理后的DC,其刺激T细胞增殖相应的吸光度值明显降低,混合培养的上清液中IL 10水平较无A771726处理的DC与T细胞的混合培养上清液明显降低,而IFNγ两者间无显著差异;但见CD 4 CD 25CTLA 4 T细胞百分比增高。结论　LEF在体外可抑制SLE患者外周血DC的成熟;未成熟DC能抑制T细胞增殖及T细胞向Th2 细胞转化,诱导CD 4 CD 25CTLA 4 T细胞产生,从而纠正SLE患者的部分免疫紊乱。     

Isolation and sequencing of a novel tropomyosin isoform preferentially associated with colon cancer

BACKGROUND & AIMS: Nonmuscle human tropomyosin (hTM) isoforms have distinct functions and may play important roles in various disease processes. METHODS: In an attempt to identify colon epithelial tropomyosin isoform, a complementary DNA library prepared from a human colon cancer cell line T84 was screened by an oligonucleotide probe complementary to messages of all known hTM isoforms. A novel clone called TC22 was obtained. The amino acid sequence of TC22 isoform is identical to isoform 5 (hTM5) apart from the C terminal domain, amino acids 222-247 coding the exon 9. RESULTS: Northern blot analysis showed that TC22 message is expressed in transformed epithelial cell lines and tumor tissues but not in normal epithelial cells. We developed a monoclonal antibody specific to TC22 isoform (TC22-4). By Western blot and immunoperoxidase assays, we analyzed 105 colonic specimens (fresh frozen and formalin fixed) from 96 patients with colon polyps (hyperplastic) or adenomas with or without dysplasia and cancer. Twenty-one of 22 (95%) of colon cancer specimens showed the presence of TC22, compared with only 1 of the 17 normal colon specimens and none of the 13 hyperplastic polyps (P < 0.0001). As assayed by immunoperoxidase staining, TC22 expression progressively increased in benign adenomatous polyps (35%) and polyps with mild and severe dysplasia (57% and 100%, respectively). CONCLUSIONS: We cloned and sequenced a novel hTM isoform, TC22, which is strongly associated with colonic neoplasia and carcinoma. TC22 may provide a useful biomarker for surveillance of colon cancer.     

Ultrasonic interventional analgesia in pancreatic carcinoma with chemical destruction of celiac ganglion

AIM: To detect the therapeutic effects of chemical destruction of celiac ganglion in patients with pancreatic carcinoma with intractable pain. METHODS: Ninety-seven cases with advanced pancreatic carcinoma received chemical destruction of celiac ganglion-5 mL pure alcohol injection around celiac artery under ultrasonic guidance. The changes of visual analogue scale (VAS), serum substance P (Sub P),β-endopeptide (β-EP) and T-lymphocyte subtypes level were compared between pre- and post-therapy. RESULTS: Successful rate of puncture was 98.7%, with one failure. No serious complications such as traumatic pancreatitis, pancreatic fistula, abdominal cavity hemorrhage or peritoneal infection occurred. VAS, serum Sub P andβ-EP level significantly changed after treatment (8.0±2.3 vs 4.6±2.1, 254.1±96.7 vs 182.4±77.6, 3.2±0.8 vs 8.8±2.1, P < 0.01, P < 0.05, P < 0.01) with complete relief rate 54.2%, partial relief rate 21.9%, ineffective rate 12.5% and recurrent rate 10.7%. The T-lymphocyte subtypes level remarkably increased when compared with that of pre-therapy (46.7±3.7 vs 62.5±5.5, P< 0.01). CONCLUSION: Our study suggests that chemical destruction of celiac ganglion under ultrasonic guidance is highly safe, and can evidently relieve cancer pain and improve the cellular immunity in patients with advanced pancreatic carcinoma.     

Relationship between the expression of iNOS, VEGF, tumor angiogenesis and gastric cancer

AIM: To investigate the relationship between theexpression of inducible nitric oxide synthase(iNOS),vascular endothelial growth factor(VEGF),themicrovascular density(MVD) and the pathologicalfeatures and clinical staging of gastric cancerMETHODS: Immunohistochemical staining was used fordetecting the expression of iNOS and VEGF in 46resected specimens of gastric carcinoma; themonoclonal antibody against CD34 was used fordisplaying vascular endothelial cells, and MVD wasdetected by counting of CD34-positive vascularendothelial cells.RESULTS: Of 46 resected specimens of gastriccarcinoma,the rates of expressions of iNOS and VEGFwere 58.70% and 76.09%, respectively,and MVDaveraged 55.59± 19.39.Judged by the standard TNMcriteria, the rate of expression of iNOS in stage ⅣV(84.46%) was higher than those in stage Ⅰ, Ⅱ, Ⅲ(Fishexact probabilities test, P=0.019,0.023 and 0.033,respectively);the rates of expression of VEGF in stageⅢ, Ⅳ (76.0%,92.31%, respectively) were higher thanthose in stage Ⅰ, Ⅱ (Fish exact probabilities test,P=0.031,0.017,0.022 and 0.019). MVDs in stage Ⅲ, Ⅳ(64.72 ± 14.96,67.09± 18.29,respectively) werehigher than those in stage Ⅰ ,Ⅱ(t=2.378,4.015,2.503and 2.450,P＜0.05,P＜0.001,P＜0.001,P＜0.05,respectively). In 37 gastric carcinoma specimens withlymph node metastasis, MVD(68.69±18.07) and therates of expression of iNOS and VEGF(70.27%,83.78%,respectively) were higher than those in the specimenswith absence of metastasis (t=2.205, x2=6.3587,x2=6.2584,P＜0.01, P＜0.05,P＜0.05, respectively). MVDand the expressions of iNOS and VEGF were notcorrelated to the location ,size or grade of tumor, nor withthe depth of invasion of tumor; MVDs in the positive iNOSand VEGF specimens(59.88±18.02,58.39±17.73,respectively) were higher than those in the negative iNOSand VEGF specimens (x2=6.3587 and 6.1574, P＜0.05,P＜0.05,respectively) ;thus the expressions of iNOS andVEGF was correlated to MVD, but the expression of iNOSwas not correlated to that of VEGF. In addition,of the46 surviving patients, the 5-year survival rate ofpatients with positive iNOS or VEGF tumors wassignificantly less than that of patients with negativeiNOS-or VEGF tumors(x2=4.3842 and 5.4073,P＜0.05,P＜ 0.05,respectively).CONCLUSION: The expressions of iNOS and VEGF areclosely related to tumor angiogenesis, and are involvedin the advancement and the lymph node metastasis;thus MVD and the expressions of iNOS and VEGF mayserve indexes for evaluating staging of gastriccarcinoma and forecasting its risk of metastasis, whichwill help establish a comprehensive therapeuticalmeasure of post-operative patients and provide a newapproach to tumor therapy.     

Proliferation of alpha-smooth muscle actin-containing stromal cells (myofibroblasts) in the lamina propria subjacent to intraepithelial carcinoma of the esophagus

BACKGROUND: The lamina propria of the digestive tract is the space containing vessels, myofibroblasts, and other interstitial components. The present study was undertaken to elucidate the relationships between the proliferation of myofibroblasts within this space and other histological features such as inflammatory cell infiltration and proliferation of blood vessels. METHODS: Thirty-eight cases in total-comprising 19 cases of early and 19 cases of advanced esophageal squamous cell carcinoma with intraepithelial extension (the former including 10 lesions of carcinoma in situ and 15 lesions of carcinoma with invasion only into the lamina propria)-were examined using H&E staining, Azan Mallory staining, and immunostaining for the characterization of mesenchymal cells in the lamina propria against alpha-smooth muscle actin (alphaSMA), desmin, vimentin, factor VIII, collagen type IV, laminin, or inflammatory cells (L26, UCHL1, Kp1, and c-kit). The proliferative potential of myofibroblasts was evaluated by measuring the total length of the bundles of myofibroblasts per case. RESULTS: Proliferation of alphaSMA-containing stromal cells: i) occurred in the lamina propria subjacent either to intraepithelial carcinomas (64%) or to the intraepithelial extension of carcinoma tissue (47%), and ii) showed a significant correlation with both the degree of mononuclear cell infiltration (mostly UCHL1-positive T cells) and the total length of the carcinoma tissue in each case. CONCLUSIONS: Proliferation of alphaSMA-containing stromal cells in the lamina propria may be involved in altering the endoscopic features of the esophagus in cases with intraepithelial carcinoma or an intraepithelial extension of carcinoma tissue.     

Oesophageal intraepithelial and invasive neoplasia of squamous cell type: epidemiology and outcome in Luxembourg, 1980-2001

BACKGROUND AND STUDY AIMS: Oesophageal intraepithelial neoplasia of squamous cell type (INSC) and invasive oesophageal squamous cell carcinoma (IOSCC) are infrequent diseases in Western Europe. The aim of the present study was to collect population-based data of both entities over a 20 year-period and to look for concomitant neoplastic affections in order to define an adequate diagnostic strategy. PATIENTS AND METHODS: The National Morphologic Tumour Registry allowed to review the data of all patients with INSC and IOSCC diagnosed between 1980 and 2001 and to record the time trends in incidence, the oncologic co-morbidity and the outcome of the patients. RESULTS: 29 patients with INSC and 363 cases of IOSCC were identified. The overall age-standardized (world) incidence rate of intraepithelial neoplasia and invasive squamous cell carcinoma were 0.2 and 4.2 per 10(5), respectively, the M/F-ratio for both 3:1. During the study period, the incidence rate of invasive cancer remained stable in males but showed a 3-fold increase in females. There was a 2-fold increase of the intraepithelial neoplasia incidence in the last decade. The precancerous/cancerous-ratio increased slightly over the last 5 years. 31% of the patients with an INSC and 17.6% of those with IOSCC had concomitant precancerous and cancerous lesions especially of head and neck (laryngopharyngeal) or pulmonary origin. The observed 5-year survival rate was 8.8 +/- 3% (95% confidence interval) for IOSCC and 27.6% +/- 17% for INSC. CONCLUSIONS: The incidence of invasive oesophageal squamous cell carcinomas remains stable whereas that of detected intraepithelial squamous cell neoplasias is remarkably low, indicating potential underdiagnosis. Considering the overall low incidence rates, mass screening for oesophageal cancer does not seem reasonable in Luxembourg. Nevertheless, patients at high-risk for oesophageal or head and neck or broncho-pulmonary cancer should be identified and surveilled by endoscopy, possibly with vital staining.     

Epidemiology and long term survival of gastric carcinoma in the French district of Finistere between 1984 and 1995

OBJECTIVES: The aims of this study were to evaluate trends in incidence, clinical characteristics, treatment regimen and prognosis of gastric carcinoma in the area of Finistere (France) during a 12-year period. METHODS: Between 1984 and 1995, the Finistere Registry of GastroIntestinal Tract Tumors listed 2 139 patients with gastric carcinoma in a population of 838 627 inhabitants. Curative resection and operative mortality were analyzed by logistic regression. Prognostic factors were determined using the Kaplan-Meier method and the Cox model. RESULTS: When comparing the second period (1990-1995) to the first period (1984-1989) we observed: a) a decrease of standardized incidence (13.2 vs. 15.6/100 000 inhabitants/year in males and 5.4 vs. 7.0/100 000 inhabitants/year in females); b) a significant increase of linitis plastica (21.4% vs. 10.9%) and infiltrative tumors (53.1 vs. 31.2%) (P<0.0001); c) no variation in tumor stage at diagnosis; d) a significant increase in curative resection (65.7% vs. 45.0%; P<0.0001); e) no variation in operative mortality; f) the absence of improvement of survival rate; the latter was 29% at 2 years, 19% at 5 years and 11% at 10 years during the second period. Multivariate analysis showed that the main prognostic factors of gastric carcinoma were age, tumor stage and the type of surgical procedure. CONCLUSION: This study showed a decrease in the incidence of gastric carcinoma over time and an increase of linitis plasticia and infiltrative forms. Despite improvement in management of patients, the global prognosis of gastric carcinoma did not improve significantly over a 12-year period of observation.     

Expression of tight and adherens junction proteins in ulcerative colitis associated colorectal carcinoma: upregulation of claudin-1, claudin-3, claudin-4, and β-catenin

Background  Tight junction (TJ) proteins play a critical role in cellular adhesion, glandular differentiation, and cellular proliferation. The function of these proteins is compromised in a number of intestinal diseases, including ulcerative colitis that has an increased incidence for colorectal carcinoma (CAC). The aim of this study was to determine the expression of TJ proteins, claudin-1–4, occludin, ZO-1, and the adherens junction (AJ) protein β-catenin in CAC. Methods  Sixteen colectomy specimens with CAC, adjoining intraepithelial neoplasia, and normal mucosa were studied by immunofluorescence. A semiquantitative evaluation of all investigated proteins was performed by scoring the staining intensity, and the TJ and AJ protein expression in neoplastic cells was compared to normal and intraepithelial neoplastic colonic mucosa. Results  Using an intensity scoring system, mucosa of crypts and surfaces of CAC exhibited significantly elevated expression levels of claudin-1, claudin-3, claudin-4, and β-catenin compared to intraepithelial neoplasia and normal mucosa (p < 0.05). These data were confirmed by a comparative score. The expression of claudin-2, occludin, and ZO-1 showed no differences between the groups. Conclusion  TJ proteins claudin-1, claudin-3, claudin-4, and the AJ protein β-catenin are overexpressed in CAC. This suggests that these proteins may become potential markers and targets in CAC. Grant:  Supported by a grant from the Deutsche Forschungsgemeinschaft (BR 2093/4-1).     

Hepatocyte hepatitis B surface antigen expression in chronic hepatitis B virus carriers in Singapore: Correlation with viral replication and liver pathology

The hepatocyte hepatitis B surface antigen (HBsAg) expression in 149 liver biopsies from 124 chronic hepatitis B virus (HBV) carriers was correlated with serum HBV DNA status and histologic activity. Hepatocyte HBsAg was stained by the peroxidase-antiperoxidase method and serum HBV DNA was determined by dot blot hybridization. Sixty-five biopsies (44%) showed minimal changes (MC), 82 biopsies (55%) showed chronic liver disease (CLD) and 2 biopsies (1%) showed hepatocellular carcinoma. Hepatocyte HBsAg was found in 144 biopsies (97%). It was present in the cytoplasm of 141 specimens (95%) and/or plasma membrane of 48 specimens (32%). Approximately half (45%) of the cytoplasmic HBsAg-positive biopsies showed discrete distribution, while the other half (55%) were grouped. Fifty-five per cent (77 of 141) of cytoplasmic HbsAg-positive biopsies had CLD, while 44% (62 of 141) showed MC. There was no relationship between the presence of cytoplasmic HBsAg or its topographic distribution with disease activity. Membrane HBsAg distribution was similar for both groups of patients (MC vs CLD: 25 of 65 (38%) vs 23 of 82 (28%); P = NS). Serum HBV DNA was detected in 98 patients (66%) and was seen mostly in association with CLD (CLD vs MC: 61% vs 39%, P less than 0.001). It was also detected more often in the sera of patients with membrane HBsAg than in those with cytoplasmic HBsAg staining (41 of 48 (85%) vs 97 of 141 (67%); P less than 0.02). However, discrete distribution of cytoplasmic HBsAg was associated with positive serum HBV DNA when compared with grouped distribution (52 of 63 (83%) vs 43 of 78 vs (55%); P less than 0.005).     

Angiogenic markers, neovascularization and malignant deformation of Barrett's esophagus.

The molecular events underlying progression of Barrett's esophagus to adenocarcinoma remain an area of active investigation. Neovascularization and angiogenesis have been studied in esophageal adenocarcinomas by counting of microvessels after staining with vascular markers, and by immunohistochemistry for vascular endothelial growth factor. Angiogenesis appears to be increased early in the neoplastic process, but has poor prognostic value. We have demonstrated that expression levels of two important genes that regulate cell growth, namely inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX)-2, are frequently upregulated in Barrett's esophagus and associated adenocarcinomas. COX-2 expression may be related to reflux of bile salts, which induce COX-2 expression in Barrett's tissues and esophageal adenocarcinoma cells in vitro. COX-2 inhibition induces apoptosis and blocks proliferation in COX-2-expressing esophageal adenocarcinoma cells in vitro, and blocks angiogenesis in both in vivo and in vitro models. Although controversial, recent evidence suggest that iNOS-derived NO can inhibit angiogenesis in some model systems. In conclusion, both iNOS and COX-2 appear to be involved in Barrett's-associated neoplastic progression, but COX-2 inhibition is more promising as a chemopreventive strategy. COX-2 inhibition may exert beneficial effects by decreasing angiogenesis and epithelial proliferation, and by facilitating apoptosis of epithelial cells that have undergone DNA damage.     

Flow cytometry of polypoid neoplasms of the colon resected by endoscopy

Sixty-one neoplastic polypoid lesions of the large bowel and rectum, obtained by endoscopic resection, were submitted to cytofluorometric measurements. This study was performed on archival formalin fixed and paraffin embedded material using the method of Hedley. Coefficient of variation, DNA Index, DNA aneuploidy, proliferative activity were statistically correlated to histological grading (according to U.I.C.C.) and to the presence of trophic changes (epithelial displacement, hemorrhage, mucus discharge. Compared with morphological findings, cytofluorometric results revealed that DNA aneuploidy appeared only when intraepithelial carcinomatous changes were present, and was found in 50 percent of microinvasive carcinoma. The proliferative activity was significantly increased in intraepithelial carcinomas, with a significant enlargement of the coefficient of variation. This change may reflect initial disorders in DNA content of neoplastic cells. On the other hand, there was no significant difference between lesions with and without trophic alterations. These findings confirm that this increase is an independent phenomenon during tumor progression.     

Current status and limitations of the newly developed endocytoscope GIF-Y0002 with reference to its diagnostic performance for common esophageal lesions

Objectives: To investigate both neoplastic and non‐neoplastic lesions of the esophagus and to clarify the features of the surface cell morphology using a newly developed endocytoscope, the GIF‐Y0002. Methods: The surface cell morphology was examined with toluidine blue staining, and histological features of 53 patients with 54 lesions, including 39 patients with esophageal squamous cell carcinoma (ESCC) and 14 patients with 15 non‐neoplastic esophageal lesions, were compared. One endoscopist classified the lesions using type classification, and we consulted one pathologist to evaluate the endocytoscopy pictures with regard to neoplasia or non‐neoplasia. Results: The overall sensitivity for ESCC of the findings by the endoscopist and pathologist based on GIF‐Y0002 observation were 100.0% and 94.9%, respectively; while the specificity was 80.0% and 46.7%. For the 3 cases of low‐grade intraepithelial neoplasia, 2 were diagnosed as Type 2 and one case as suspected neoplasia by the endoscopist while the pathologist considered 2 cases to be neoplastic. Among the 9 cases of esophagitis, the endoscopist diagnosed 2 cases as Type 2 or 3, which was suggestive of neoplasia, whereas the pathologist diagnosed 6 cases to be neoplastic. Conclusion: The low percentage of specificity for the pathologist's diagnosis was considered to be attributed to the low magnification power of the GIF‐Y0002. A further increase in the magnifying power of this instrument will be necessary to broaden its clinical applications.     

Histologic results of EMR for esophageal lesions diagnosed as high-grade intraepithelial squamous neoplasia by endoscopic biopsy

BACKGROUND: Biopsy specimens obtained from esophageal lesions detected in endoscopic screening with iodine staining have often been diagnosed as high-grade intraepithelial squamous neoplasia (WHO 2000). However, a management strategy for such lesions has not been established. The purpose of this study was to perform EMR for such lesions and to determine the actual tumor stage in patients with complete resection and the outcomes after EMR. PATIENTS: During the study period, 51 patients were found to have esophageal lesions diagnosed as high-grade intraepithelial squamous neoplasia by using endoscopic iodine staining in biopsy specimens. All of the patients underwent EMR, and resected specimens were reviewed microscopically. RESULTS: Histologic examination of totally resected specimens revealed that 12 (23.5%) of the 51 patients had tumor invasion of the lamina propria mucosae and that 4 (7.8%) had tumor invasion of the muscularis mucosae. The remaining 35 patients (68.6%) were confirmed to have high-grade intraepithelial squamous neoplasia. The invasive focus in all of the 16 lesions of invasive squamous-cell carcinoma was surrounded by high-grade intraepithelial squamous neoplasia. After a median of 23 months of follow-up, there were two recurrences, and those patients required second EMR. CONCLUSIONS: Histologic results suggested that high-grade intraepithelial squamous neoplasia of the esophagus has characteristics of carcinoma in the preinvasive stage. EMR should be performed for esophageal lesions diagnosed by endoscopic biopsy as high-grade intraepithelial squamous neoplasia, not only because of its probable malignant potential but also because more than 30% of such lesions are actually invasive carcinoma.