Surveillance interval of endoscopic examinations for colorectal cancer screening

Background: There have been a few evidence‐based studies concerning the relationship between the length of the surveillance interval of colonoscopic examinations and the risk of colorectal cancer (CRC). The aim of the present study was to assess the appropriate interval between endoscopic examinations for CRC screening in a retrospective cohort study. Methods: The cohort included subjects in whom cancer was not detected at the initial endoscopic examination and in whom endoscopic examination(s) was subsequently performed one or more times. The results of the endoscopic examinations performed in the mass screening for CRC between November 1983 and March 1999 were analyzed. The study end point was the detection of CRC and the detection rates of cancer were assessed among those who underwent examinations at various intervals between successive endoscopic examinations. Results: Among the 117 636 cohort subjects, 63 invasive cancer cases and 112 mucosal cancer cases were found. The odds ratio (OR) for invasive cancer was not significantly elevated even when the interval between successive examinations was over 5 years. The OR for mucosal or invasive cancer was significantly elevated among the subjects in whom the interval between successive examinations was over 5 years (OR, 1.71; 95% confidence interval (CI), 1.07–2.73), than among those in whom the interval was 1 year. Conclusions: Since prolongation of the interval between endoscopic examinations of up to 5 years did not result in any change in the cancer risk among persons who are at average risk for CRC, 5 years may be an adequate interval between endoscopic examinations in the mass screening for CRC.     

Selective effector mechanisms for the expulsion of intestinal helminths

In the middle of the era of molecular biology, much less attention is paid to in vivo phenomena. However, carefully designed experimental systems in vivo still can provide valuable information as to the mechanisms underlying the establishment and maintenance of host-parasite relationships. In this review we describe the advantage of using concurrent infections with appropriately chosen combinations of different genera or different maturation stages of parasites to segregate the cellular responses of the host. By means of simple experimental approaches we have found that mucosal mast cells and goblet cells, both of which have long been considered as non-specific effectors, are in fact highly selective and specific effector cells of the host defence mechanisms capable of acting on the establishment and the expulsion of intestinal helminths.     

消炎痛能部分翻转脂多糖诱导的加压素能及去甲肾上腺素能神经元的Fos表达

目的　探讨消炎痛对脂多糖诱导的下丘脑视上核、室旁核加压素能神经元及脑干蓝斑去甲肾上腺素能 (酪氨酸羟化酶阳性 )神经元的Fos表达的影响。方法　采用双重免疫组织化学的研究方法 ,观察脂多糖诱导大鼠脑内Fos的表达。结果　两种剂量 (0 0 2 5mg·kg-1,1 2 5mg·kg-1)的脂多糖均可以诱导视上核和室旁核内部分加压素能神经元和蓝斑的部分去甲肾上腺素能神经元Fos表达 ,静脉给予消炎痛 (10mg·kg-1)能抑制低剂量脂多糖诱导的上述核团加压素及去甲肾上腺素能神经元Fos表达 ,而对高剂量脂多糖诱导的Fos表达无效。结论　脂多糖能激活下丘脑视上核和室旁核加压素能神经元及脑干蓝斑去甲肾上腺素能神经元 ,参与神经内分泌免疫的中枢反应 ,前列腺素至少部分地参与这种激活过程     

Prevalence of primary sclerosing cholangitis and other liver diseases in Japanese patients with chronic ulcerative colitis

An association between primary sclerosing cholangitis (PSC) and chronic ulcerative colitis (CUC) is well known in Western countries, but there have been no reports on this association in Japan. We reviewed 163 consecutive CUC patients (91 males and 72 females) diagnosed from 1984 to 1990 at Tokyo Women's Medical College. Abnormal liver function tests were found in 42 patients with CUC (25.8%), but chronic liver disease was only diagnosed in seven patients (4.3%). Among these seven patients, there were four with PSC, one with small-duct PSC, one with transfusion-associated chronic hepatitis and one with Type B liver cirrhosis. No relationship was found between the documented colonic manifestations of CUC and the presence of PSC. The four PSC patients did not have a longer history of CUC at the time of diagnosis of PSC than CUC patients without PSC. At the time of PSC diagnosis, two patients were asymptomatic, one presented with right upper quadrant pain, and the other had fatigue. Three patients were diagnosed as having CUC before the onset of PSC (range 2–13 years), and the other patient had both diseases simultaneously. All four had a good prognosis. Thus PSC was the most common chronic liver disease associated with CUC in our series, and it was present in all our CUC patients with alkaline phosphatase levels exceeding twice the upper limit of normal and mild transaminase elevation.     

整合素信号通路可能参与大鼠束缚应激后的恢复过程(英文)

目的筛选与束缚应激大鼠应激反应恢复速度相关的基因,探讨应激反应个体恢复的分子机制。方法观察大鼠2小时束缚应激后血浆促肾上腺皮质激素(adrenocorticotropic-hormone,ACTH)及皮质酮的变化规律,根据应激结束后1小时的血浆ACTH及皮质酮下降程度将大鼠分为快速恢复组与慢速恢复组。采用微阵列技术检测快速恢复组与慢速恢复组下丘脑组织基因表达的差异,用实时逆转录-聚合酶链反应验证部分基因的表达差异。结果基因芯片分析结果显示:大部分基因在两组间并无差异表达,在11个差异表达的基因中,快速恢复组中参与整合素信号通路的踝蛋白(talin)、整合素α6和丝/苏氨酸蛋白磷酸酶PP1β催化亚基(serine/threonine pro-tein phosphatase PP1-beta catalytic subunit,PP1B)基因有1.5倍上调,而结合粘附分子1(junctional adhesion mol-ecule 1, F11r)基因有 1.5 倍下调。实时逆转录 - 聚合酶链反应结果与芯片分析结果一致。结论本研究构建了束缚应激大鼠恢复过程的下丘脑基因表达谱,结果提示整合素信号通路可能参与应激的恢复过程。     

Phase I and Preliminary Phase II Studies on Aclacinomycin A in Patients with Acute Leukemia

Eight patients with acute nonlymphocytic leukemia (ANLL) andfive patients with acute lymphocytic leukemia were treated withaclacinomycin A. It was given daily by one-hour infusion indoses ranging from 0.33 to 0.70 mg/kg for seven to 20 days withoutother antileukemic agents. Two patients with ANLL achieved completeremission and one with ANLL achieved partial remission. Itsmajor toxic effects were myelosuppression and gastrointestinalsymptoms.     

Evaluation of cardiac reserved function by high-dose dobutamine-stress echocardiography in asymptomatic anthracycline-treated survivors of childhood cancer

BACKGROUND: The aim of this study was to evaluate cardiac function and cardiac reserved function in asymptomatic anthracycline-treated long-time survivors of childhood cancer using dobutamine (DOB) stress echocardiography. METHODS: A total of 26 patients (19 males and 7 females) were divided into four groups according to cumulative dose of anthracycline (ATC): non-anthracycline group (N group), seven cases; low anthracycline cumulative dose group (L group), five cases (or=400 mg/m(2)). DOB infusion was begun at 5 microg/kg per min (gamma) and increased up to 30 gamma. Cardiac function and cardiac reserved function at rest, after low-dose and high-dose DOB stress, were estimated. RESULTS: In the H group, % left ventricular posterior wall thickening (%PWT) at rest and ratio of maximum early filling peak velocity (E) and atrial contraction peak velocity (A) from the left ventricular transmitral flow wave (E/A) and %PWT at DOB 5 gamma stress were significantly lower than in other groups (P<0.05). After DOB 30 gamma stress in groups given>00 mg/m(2) end-systolic wall stress was significantly higher and E/A and %PWT were significantly lower than those of other groups (P<0.05). ATC cumulative dose strongly correlated with %PWT after DOB 30 gamma stress (P<0.001). CONCLUSIONS: Subclinical ATC cardiotoxicity was detected by high-dose DOB stress echocardiography at lower cumulative doses than with other methods. %PWT appears to be a useful index for detection of ATC cardiotoxicity.     

慢性乙型肝炎患者肝组织内CD4+CD25+Foxp3+调节性细胞的作用

目的 观察慢性乙型肝炎患者肝内调节性T细胞(Treg)与病情活动、肝细胞损伤的关系.方法 对日本长崎大学医学院附属医齿学病院第一内科26例住院慢性乙型肝炎患者进行肝组织活检,采用免疫组织化学方法以单抗Foxp3、单抗CD3检测肝组织内Foxp3+细胞和CD3+细胞频率,计算Foxp3+/CD3+细胞比率,结合肝组织学炎症活动指数(HAI,采用Knodell评分系统)、ALT、AST、HBV DNA水平进行分析.数据用SPSS 13.0软件进行统计分析.结果 Foxp3+Treg主要分布在门脉区;Foxp3+/CD3+细胞(%)在肝实质重度炎症组明显高于轻度炎症组(P=0.007 6);Foxp3+/CD3+细胞(%)的增高与血清ALT、AST水平呈正相关,相关系数分别0.438、0.436(P值分别为0.025、0.026),与血清HBV DNA水平有相关趋势,但差异无统计学意义.结论 CD4+CD25+Foxp3+Treg在慢性乙型肝炎患者的发病机制中参与肝细胞的免疫损伤.     

内吗啡肽—1的镇痛作用

目的：研究内吗啡肽－1（EM－1）的镇痛作用。方法：采用电刺激鼠尾－嘶叫法、扭体法、佐剂性关节炎以及神经源性疼痛等多种疼痛模型,观察腹腔注射EM－1的镇痛作用,并和脊髓蛛网膜下腔注射和侧脑室注射EM－1的镇痛作用进行比较。结果：1）EM－1能剂量依赖地提高大鼠电刺激鼠尾－嘶叫法的痛阈;能抑制醋酸引起的小鼠扭体反应;在佐剂性关节炎所致的炎症性痛觉过敏及坐骨神经部分结扎所引起的神经源性痛觉过敏中,EM－1与有镇痛作用。2）中枢给EM－1的镇痛作用比外击给药出现得较快,而且较强。3）阿片受体拮抗选择性拮抗剂cyprodime也能翻转EM－1的镇痛作用;反复给予EM－1具有确切的镇冯作用,其镇痛作用由中枢μ阿片受体介导。     

Oncological outcome of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma

OBJECTIVE: To report the oncological outcome of retroperitoneoscopic nephroureterectomy (RNU) with bladder cuff excision for upper urinary tract transitional cell carcinoma (TCC), and to compare the outcome with that of the traditional open nephroureterectomy (ONU). PATIENTS AND METHODS: From January 2001, 48 patients with upper urinary tract TCC were enrolled in the study; 25 had RNU and 23 had ONU. Oncological parameters (disease-free survival and disease-specific survival) were calculated from the time of surgery to the date of last follow up and were analysed by the Kaplan-Meier method. RESULTS: Mean follow up was 24.3 months in the RNU group, significantly shorter than in the ONU group. Bladder recurrence was identified in two patients with grade 3 pathological stage pT3, one patient with grade 3 stage pT2 disease and two patients with grade 2 stage pT2 disease. Multiple organ metastases in the lung, liver and lymph nodes were associated with bladder recurrence in two cases (grade 2 stage pT3, and grade 3 stage pT3). The recurrence rate was 20% (5 of 25 cases) and mean time to recurrence was 9.5 months. In the ONU group, bladder recurrence and metastases developed in four and three patients, respectively. The recurrence rate was 17% (4 of 23 cases) and mean time to recurrence was 23.4 months. No significant difference was detected in the disease-free survival rate and cancer-specific survival rate between the two groups (P=0.759 and P=0.866, respectively). CONCLUSION: The oncological outcome of RNU appears to be equivalent to that of ONU. Moreover, long-term follow up is necessary to evaluate the oncological outcome in comparison to ONU.