A New Fecal Calprotectin Test for Colorectal Neoplasia: Clinical Results and Comparison with Previous Method

Background: Fecal calprotectin is elevated in patients with colorectal cancer (CRC). An improved method has been developed. The aim was to evaluate sensitivity and specificity for CRC with the new fecal calprotectin method and to compare the results with those of the original method. Methods: The study comprised 453 subjects including symptomatic CRC patients and CRC high risk subjects with and without CRC. Complete colonoscopy was performed. Calprotectin was measured with an enzyme linked immunosorbent assay (ELISA) using small (50-100 mg) feces samples. Results:     

microRNA与消化道肿瘤的研究进展

肿瘤的发生是由于一系列癌基因蛋白和抑癌基因蛋白的开放读码框突变所致。microRNA的发现使人们对肿瘤形成有了新的认识，越来越多的证据表明microRNA与肿瘤的发生和发展密切相关。与消化道肿瘤相关的microRNA相继被报道。microRNA的进一步研究将会使消化道肿瘤在发病机制研究、诊断和治疗方面取得重大突破。本文就近年microRNA与消化道肿瘤的研究进展作一综述。     

他汀类药物在消化系统癌症中的使用研究进展

随着经济的快速发展、人民饮食结构的改变及环境污染,消化系统癌症的发病率及死亡率呈逐年上升趋势,对于早期癌症可行内镜下治疗,进展期可采用外科手术、放疗、化疗、免疫治疗及靶向治疗等方法。近年来,多项研究显示,他汀类药物在消化系统癌症中的使用可一定程度上降低癌症患者的死亡率及患癌风险。本文主要探讨他汀类药物在消化系统癌症中的应用研究进展,有望为癌症的治疗发现新的辅助用药。     

Sarcoidosis of Gastrointestinal Tract: A Rare Disease

Gastrointestinal (GI) tract sarcoidosis is an uncommon form of sarcoidosis. The GI tract can be involved as an isolated disease as a part of systemic sarcoidosis. Clinical manifestations of esophageal, gastric, small bowel, colon, and appendicular sarcoidosis are discussed in this review. The differential diagnosis of GI sarcoidosis is extensive. Other granulomatous diseases of the GI tract, like tuberculosis, fungal infections, parasitic diseases, inflammatory bowel disease, and Whipple’s disease, should be excluded before making the diagnosis of GI sarcoidosis. Corticosteroid therapy is effective in treatment of GI sarcoidosis. Surgical intervention may be necessary in patients with bowel obstruction, perforation, or massive hemorrhage.     

消化道上皮内瘤变和黏膜瘤变的概念和临床应用

对重度异型增生和早期癌的鉴别，日本和欧关有不同观点，活检诊断的一致率很低。近十年来国际上病理学家达成了一些共识，对异型增生提出了新的分类方案：Padova分类、Vienna分类和世界卫生组织（WHO）专家工作纽意见，共同点是均采用了两级分类法，分为低级别和高级别，但分类术语的命名法和内涵不同。WHO建议对异型增生采用上皮内瘤变的术语，高级别上皮内瘤变包括重度异型增生和原位癌，而Vienna分类的黏膜高级别瘤变包括重度异型增生／腺瘤、非浸润癌（原位癌）、疑浸润癌和黏膜内癌。本文评述新分类的异同点和临床应用注意点。     

胃肠超声造影对胃底静脉曲张的诊断价值

食管胃静脉曲张是肝硬化门静脉高压的常见并发症。近年来,超声造影在胃肠疾病诊断中的应用日益受到关注。目的：探讨胃肠超声造影对胃底静脉曲张的诊断价值。方法：收集2009年3月-2011年9月于河北省玉田县医院接受胃镜和口服胃肠超声造影检查的肝硬化门静脉高压患者79例,回顾性分析胃肠超声造影的声像图特征,并以胃镜检查结果为“金标准”,评价其对胃底静脉曲张的诊断价值。结果：79例肝硬化门静脉高压患者中41例经胃镜检查证实胃底静脉曲张,其中33例胃肠超声造影显示特征性声像图表现,曲张静脉内径（12．6±8．9）mm,血液流速（13．9±2．7）cm／s。胃肠超声造影诊断胃底静脉曲张的敏感性、特异性、准确率分别为80．5％（33／41）、100％（38／38）、89．9％（71／79）。结论：胃肠超声造影在胃底静脉曲张的诊断中具有较高应用价值,有望成为肝硬化门静脉高压患者胃底静脉曲张的初步筛查手段推广使用。     

全基因组关联分析在消化系肿瘤中的研究进展

全基因组关联分析(genome-wide association study,GWAS)是应用人类基因组中单核苷酸多态性(single nucleotide polymorphism,SNP)为标记进行分析,以期发现影响复杂性疾病发生的遗传特征的一种新策略.因其可在全基因组范围内进行整体研究,能够一次性对疾病与基因的关联进行轮廓性概览,所以在过去的5年中,全基因组关联研究方法已被证明是研究复杂疾病一种有效手段.近年,各国科学家运用全基因组关联分析在人类肿瘤,特别是在消化系肿瘤的研究中取得了一系列重要的研究成果,本文将综述消化系肿瘤GWAS研究进展,并展望GWAS所面临的挑战及可能的解决策略.     

Mechanisms of gastric distention in esophageal atresia with distal tracheoesophageal fistula

This paper explains how the chest of the crying infant with the common form of esophageal atresia is a pump for ventilating the distal esophagus and inflating the stomach. Esophageal inflation from the trachea occurs during inspiration and esophageal deflation into the stomach during cry.Dr. Arthur A. Siebens died in late January 1996, while this issue was in press.     

胰腺上皮内瘤变研究进展

胰腺癌恶性程度高,早期诊断困难,预后差.胰腺上皮内瘤变（PanIN）是胰腺导管腺癌（PDAC）最常见的非侵袭性前体病变.深入认识PanIN,能为在进展至侵袭性PDAC之前早期检出PanIN以及寻找有效治疗手段提供依据.本文对PanIN的临床、病理特征和遗传学改变作一综述.     

Clinical Outcomes and Patency of Self-expanding Metal Stents in Patients with Malignant Upper Gastrointestinal Obstruction

This study was performed to evaluate clinical outcomes and factors associated with patency of self-expanding metal stents (SEMS) in patients with malignant upper gastrointestinal (UGI) obstruction. In 83 patients with malignant UGI obstruction, 118 SEMS placements were performed. Obstruction sites were esophagus/gastro-esophageal junction (GEJ) and gastric outlet (GO) in 41 and 42 patients, respectively. Technical success was achieved in 99.2% and clinical success in 90.5%, with no procedure-related complications. Re-obstruction and migration occurred in 38.1% during a mean follow-up of 137 days; both occurred significantly more often with GO than esophageal/GEJ obstruction (49.2% vs 23.9%). Patency rates of esophageal/GEJ obstruction were 93.5, 78.1 and 67.0% at 30, 90 and 180 days, respectively, and were significantly higher than those of GO obstruction—71.7, 51.8 and 32.5%. Palliative chemotherapy or radiation therapy was not associated with stent patency. Endoscopic SEMS placement is a safe and effective palliative treatment for malignant UGI obstruction, and complications or stent patency differed according to obstruction site.     

Chemopreventive drugs:Mechanisms via inhibition of cancer stem cells in colorectal cancer

Recent epidemiological studies,basic research and clinical trials on colorectal cancer(CRC)prevention have helped identify candidates for effective chemopreventive drugs.However,because of the conflicting results of clinical trials or side effects,the effective use of chemopreventive drugs has not been generalized,except for patients with a high-risk for developing hereditary CRC.Advances in genetic and molecular technologies have highlighted the greater complexity of carcinogenesis,especially the heterogeneity of tumors.We need to target cells and processes that are critical to carcinogenesis for chemoprevention and treatment of advanced cancer.Recent research has shown that intestinal stem cells may serve an important role in tumor initiation and formation of cancer stem cells.Moreover,studies have shown that the tumor microenvironment may play additional roles in dedifferentiation,to enable tumor cells to take on stem cell features and promote the formation of tumorigenic stem cells.Therefore,early tumorigenic changes of stem cells and signals for dedifferentiation may be good targets for chemoprevention.In this review,I focus on cancer stem cells in colorectal carcinogenesis and the effect of major chemopreventive drugs on stem cell-related pathways.