Role of digital X-ray study in the current diagnosis of gastric cancer

The authors attempted to assess and provide evidence for the expedience of using a digital radiography CR system in clinical gastroenterology. The prerequisite for this was the results of large-scale diagnostic studies of different organ and systemic diseases. The authors underline the specific features of application of this digital system: the latter allows several analogue X-ray apparatuses to be transformed to digital ones, provides economic efficiency as compared with apparatuses with the direct digitization of an image, shows telemedical prospects, and has low radiation loads as evidenced by research and experimental studies even in comparison with green systems, which makes the use of these digital systems in X-ray gastroenterology highly tempting. Based on a great body of data from 126 studies, the authors could show the effectiveness of the digital radiography CR system in the diagnosis of gastric cancer, demonstrate a modernized approach to formatting an obtained digital image, the possibility of postprocessor treatment that can enhance the validity of existing X-ray symptoms. This all permitted the authors to recommend using the CR systems in the diagnosis of gastric cancer, by taking into account the current obvious predominance of its morphological diffuse and mixed forms and corresponding difficulties of their endoscopic diagnosis.     

Current problems in the diagnosis of gastric cancer

Based on their own long-term experience in diagnosing gastric cancer and by taking into account the fact that clinicians and diagnosticians analyze this problem insufficiently objectively, the authors of the paper try to convince the reader that it is necessary to revert to the problems of its diagnosis again. They proceed from recent new reports on gastric cancer pertaining to both its morphological forms and diagnostic capacities wherein current radiation diagnosis requires its active return to the problem of its detection. This standpoint of the authors is based on the date of over 6000 comprehensive studies of the stomach, of them 2800 cases have been diagnosed as having tumor lesions. In addition to the assessment of current radiation diagnosis of gastric cancer, which involves both routine X-ray study and ultrasonography, X-ray computed tomography, and magnetic resonance imaging of the stomach, the authors express their opinion on some organizational issues without which the diagnosis of this disease cannot be improved.     

Current X-ray diagnosis of stomach cancer (comparison of radiologic and morphological methods of investigation)

By using the principles of wide comparisons of the data of radiation diagnosis (routine X-ray study, ultrasonography (USG), CT, MRI) with the morphological findings of resected gastric specimens from patients with endophytic gastric cancer (EGC) (n = 85), the authors propose some points in the problem associated with its diagnosis. They believe that by taking into account the fact that there is an obvious growth of endophytic parietally growing gastric cancer with the concurrent reduction in its intestinal forms, it is necessary to restore current radiation to its leading place, along with endoscopy, in detecting the cancer. The authors makes a highly positive assessment of USG, CT, MRI in addition to routine X-ray study and endoscopy particularly in those cases when difficulties emerge in histological verification of the existing signs of parietally growing cancer. The paper makes indications for USG, CT, MRI concrete. The authors also show how to stage gastric cancer.     

Performance of Different Gastric Cancer Screening Methods in Korea: A Population-Based Study

Background

There is a lack of agreement on which gastric cancer screening method is the most effective in the general population. The present study compared the relative performance of upper-gastrointestinal series (UGIS) and endoscopy screening for gastric cancer.

Methods

A population-based study was conducted using the National Cancer Screening Program (NCSP) database. We analyzed data on 2,690,731 men and women in Korea who underwent either UGIS or endoscopy screening for gastric cancer between January 1, 2002 and December 31, 2005. Final gastric cancer diagnosis was ascertained through linkage with the Korean Central Cancer Registry. We calculated positivity rate, gastric cancer detection rate, interval cancer rate, sensitivity, specificity, and positive predictive value of UGIS and endoscopy screening.

Results

The positivity rates for UGIS and endoscopy screening were 39.7 and 42.1 per 1,000 screenings, respectively. Gastric cancer detection rates were 0.68 and 2.61 per 1,000 screenings, respectively. In total, 2,067 interval cancers occurred within 1 year of a negative UGIS screening result (rate, 1.17/1,000) and 1,083 after a negative endoscopy screening result (rate, 1.17/1,000). The sensitivity of UGIS and endoscopy screening to detect gastric cancer was 36.7 and 69.0%, respectively, and specificity was 96.1 and 96.0%. The sensitivity of endoscopy screening to detect localized gastric cancer was 65.7%, which was statistically significantly higher than that of UGIS screening.

Conclusion

Overall, endoscopy performed better than UGIS in the NCSP for gastric cancer. Further evaluation of the impact of these screening methods should take into account the corresponding costs and reduction in mortality.     

Cancer of the stomach--new and "old" problems of diagnosis]

The author discusses present-day potentialities of radiodiagnosis of gastric carcinoma. Analysis of more than 2000 case histories brings him to a conclusion that the problem of the detection of this condition is particularly intricate for two reasons: the absence of active screening for gastric carcinoma in high-risk groups and inadequate attention to its endophytic forms. The author's data evidence that intramural growth of gastric carcinoma is responsible for up to 75% of all its anatomic forms. So high an incidence of endophytic carcinomas of the stomach necessitates a combination of the x-ray and endoscopic methods in gastro-oncology. Making use of the total scope of present-day diagnostic methods, including routine techniques, double-contrast examination, and, in recent years, x-ray computer-aided tomography and ultrasonic examinations, the author gives recommendations that will help solve quite a number of problems in radiodiagnosis of gastric carcinoma.     

Organization of lung digital X-ray fluorography and its introduction into the health care services of Russia

Based on comprehensive study of the capacities of digital X-ray fluorography (DXRF), the authors give their views on two main aspects of its use. These are firstly the most acceptable organizational forms of lung DXRF into the health care services of Russia and, secondly, its place in the diagnosis of pulmonary tuberculosis, lung cancer, chronic nonspecific lung diseases, and mediastinal tumors. As for its organization and introduction, the authors are against the fact that film fluorography should be rapidly replaced by DXRF. They give recommendations based on the reasonable and stepwise introduction of DXRF, which may rule out their negative perception versus the present attitude to the so-called prophylactic film fluorography. In the part dealing with diagnosis that analyzes 955 cases of various lung diseases (from over 8000 DXRFs) verified by different studies (morphological, cytological, etc.) and chest X-ray computed tomography, the authors show the results of monitoring imaging, by demonstrating all its potentialities. At the same time they recommend that image printing fixing should be also rather widely employed. In the authors' opinion, DXRF may become the method of choice in detecting pulmonary tuberculosis, lung cancer, chronic nonspecific lung diseases, and mediastinal tumors.     

To differential diagnosis of esophageal cancer and other diseases with the similar clinical symptoms, by using traditional X-ray study

The principal purpose of the paper is to assess the role of the X-ray section of current radiation diagnosis in obtaining objective information and interpreting it in esophageal cancer. The study was methodically based on its serial studies, by comparing the data of clinical, radiation, and endoscopic diagnosis with those of morphological studies of the biopsy specimens taken at resection for cancer of the esophagus and the upper stomach, and histologically examined them in diseases running with the similar clinical symptoms. The complex of radiation techniques included traditional X-ray study (compact filling, double contrasting). A specially developed procedure that allowed physicians the opportunity to examine the cardioesophageal area in the fragmentary fashion was used during morphological studies. In cancer of the upper stomach, the lower esophageal segments were also involved in the process in 79.9%. It should be also noted that this number of observations includes some cases that clinical symptomatology and endoscopy strongly suggest cancer of the lower third of the esophagus. The authors have arrived at the conclusion that the present-day X-ray semiotics of esophageal diseases running with the similar clinical symptomatology permits their differential diagnosis just before the use of endoscopy and histology of biopsy specimens and that the unique advantage of radiation diagnosis over endoscopy is to specify the initial site of a tumor, namely, to detect primary gastric damage in cardioesophageal carcinoma.     

Cancer of the upper stomach: current problems of its diagnosis

Data on 1248 cases of stomaches radically operated on for cancer at the surgical departments of the Moscow Regional Research Clinical Institute in 1971 to 2000 were used to study a number of problems associated with cancer of the upper stomach, by regarding the present-day role of radiation diagnosis as of paramount importance. The following radiation diagnostic techniques were assessed. Among them there were traditional X-ray studies (in each case), the new radiation diagnostic techniques: ultrasound study and computed tomography (CT) (750 studies), magnetic resonance imaging (MRI) (120 studies). The potentialities of radiation diagnosis and endoscopy performed in all cases are compared. A specially developed procedure for exploring endophytic forms of gastric cancer was employed in the morphological studies of the material. The incidence of cancer of the upper stomach and its association with the esophagus are presented; some aspects of the morphogenesis of cancer of this site are discussed. The relationship of its clinical symptoms and its radiation image has been studied. In the authors' opinion, the past two decades' rise in the incidence of proximal gastric cancer is one of the main problems in diagnosing gastric cancer that continues holding its stand in the general structure of cancer morbidity. The tendency for diffuse and mixed forms to increase in the morphogenesis of gastric cancer provides evidence that radiation techniques should be actively used in its diagnosis. It is necessary to apply classical double-contrasting X-ray study and endoscopy on equal grounds as basic diagnostic methods at early stages. Only their concord use may change the poor situation associated with the diagnosis of cancer at this site. CT and MRI as additional techniques may substantially provide more required diagnostic information. This is first and foremost associated with difficulties in gastric endoscopic study when esophageal cancer is apparently proved.     

Novel biomedical applications of Cerenkov radiation and radioluminescence imaging

The main goals of this review is to provide an up-to-date account of the different uses of Cerenkov radiation (CR) and radioluminescence imaging for pre-clinical small animal imaging. We will focus on new emerging applications such as the use of Cerenkov imaging for monitoring radionuclide and external radiotherapy in humans. Another novel application that will be described is the monitoring of radiochemical synthesis using microfluidic chips.Several pre-clinical aspects of CR will be discussed such as the development of 3D reconstruction methods for Cerenkov images and the use of CR as excitation source for nanoparticles or for endoscopic imaging.We will also include a discussion on radioluminescence imaging that is a more general method than Cerenkov imaging for the detection using optical methods of alpha and gamma emitters.     

血清胃蛋白酶原Ⅰ/Ⅱ、铁蛋白及肿瘤坏死因子-alpha对胃癌的诊断价值

目的：探讨血清胃蛋白酶原Ⅰ/Ⅱ(PGⅠ/Ⅱ)、铁蛋白、肿瘤坏死因子-alpha联合检查诊断胃癌的临床意义。方法：选择2013 年5 月至2014 年10 月收治的胃病住院患者及健康体检者,根据胃镜及病理组织学结果,将其分良性胃病组、胃癌组以及健康组,比 较三组血清胃蛋白酶原Ⅰ/Ⅱ、铁蛋白及肿瘤坏死因子-alpha水平,分析血清胃蛋白酶原Ⅰ/Ⅱ(PGⅠ/Ⅱ)、铁蛋白、肿瘤坏死因子-alpha单 独和联合诊断胃癌的敏感性、特异性和准确性。结果：与健康组比较,良性胃病组以及胃癌组的血清PGⅠ/Ⅱ水平较低(P＜0.05), 与良性胃病组比较,胃癌组血清PGⅠ/Ⅱ水平较低(P＜0.05);与健康组比较,良性胃病组以及胃癌组的血清铁蛋白以及TNF-alpha水 平较高(P＜0.05),与良性胃病组比较,胃癌组血清铁蛋白以及TNF-alpha水平较高(P＜0.05)。PGⅠ/Ⅱ、铁蛋白以及TNF-alpha联合检测 诊断胃癌的敏感度以及准确度分别为88.4％以及83.1％,高于单一检测。结论：血清PGⅠ/Ⅱ、血清铁蛋白、肿瘤坏死因子-alpha联合 检测诊断胃癌的效能优于单一检测。     

窄带成像技术联合放大内镜在早期胃癌诊断中的价值

目的:评估比较窄带成像技术联合放大内镜(narrow band imaging-magnifying endoscopy,NBI-ME)在早期胃癌诊断中价值。方法:115例早期胃癌患者行NBI-ME观察,采集照片并做出内镜下诊断,于病灶最明显处取活检并行病理检查。所有患者接受内镜下治疗,术后行病理活检。分别计算NBI-ME、内镜活检诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率。结果:115例患者纳入本研究,最终术后切除病理示低级别上皮内瘤变(low-grade neoplasia,LGIN)16例,高级别上皮内瘤变(high-grade neoplasia,HGIN)30例,分化型胃癌59例,未分化型胃癌10例。NBI-ME诊断早期胃癌的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为98.0%、81.3%、97.0%、86.7%、95.7%,内镜活检的对应值分别为82.8%、87.5%、97.6%、45.2%、83.5%。NBI-ME诊断早期胃癌的敏感度及准确率均明显高于内镜活检(P0.05)。结论:NBI-ME对早期胃癌具有较高诊断价值。     

Prospective comparison of double-contrast barium meal examination and fibreoptic endoscopy in acute upper gastrointestinal haemorrhage.

Fibre-optic endoscopy was compared prospectively with double-contrast radiology in 53 consecutive patients admitted with acute gastrointestinal haemorrhage. The bleeding site was correctly identified by endoscopy in 94% of patients and the final diagnosis was correctly given in 89%. The corresponding figures with radiology were 83% and 74%. Among the 50 patients with a final diagnosis of a bleeding site in the upper gastrointestinal tract endoscopy indicated the site of bleeding in all and radiology indicated it in 88%. Both investigations were well tolerated by patients. Endoscopy is the investigation of choice, but when it is not available double-contrast radiology will show the site of bleeding in 80-90% of patients.     

Aquatic prey capture in ray-finned fishes: a century of progress and new directions

The head of ray-finned fishes is structurally complex and is composed of numerous bony, muscular, and ligamentous elements capable of intricate movement. Nearly two centuries of research have been devoted to understanding the function of this cranial musculoskeletal system during prey capture in the dense and viscous aquatic medium. Most fishes generate some amount of inertial suction to capture prey in water. In this overview we trace the history of functional morphological analyses of suction feeding in ray-finned fishes, with a particular focus on the mechanisms by which suction is generated, and present new data using a novel flow imaging technique that enables quantification of the water flow field into the mouth. We begin with a brief overview of studies of cranial anatomy and then summarize progress on understanding function as new information was brought to light by the application of various forms of technology, including high-speed cinematography and video, pressure, impedance, and bone strain measurement. We also provide data from a new technique, digital particle image velocimetry (DPIV) that allows us to quantify patterns of flow into the mouth. We believe that there are three general areas in which future progress needs to occur. First, quantitative three-dimensional studies of buccal and opercular cavity dimensions during prey capture are needed; sonomicrometry and endoscopy are techniques likely to yield these data. Second, a thorough quantitative analysis of the flow field into the mouth during prey capture is necessary to understand the effect of head movement on water in the vicinity of the prey; three-dimensional DPIV analyses will help to provide these data. Third, a more precise understanding of the fitness effects of structural and functional variables in the head coupled with rigorous statistical analyses will allow us to better understand the evolutionary consequences of intra- and interspecific variation in cranial morphology and function.     

Contact‐free endoscopic photoacoustic sensing using speckle analysis

Photoacoustic endoscopy (PAE) is an emerging imaging modality, which offers a high imaging penetration and a high optical contrast in soft tissue. Most of the developed endoscopic photoacoustic sensing systems use miniaturized contact ultrasound transducers or complex optical approaches. In this work, a new fiber‐based detection technique using speckle analysis for contact‐free signal detection is presented. Phantom and ex vivo experiments are performed in transmission and reflection mode for proof of concept. In summary, the potential of the technique for endoscopic photoacoustic signal detection is demonstrated. The new technique might help in future to broaden the applications of PAE in imaging or guiding minimally invasive laser procedures.      

Proteome analysis of multidrug resistance in vincristine-resistant human gastric cancer cell line SGC7901/VCR

In order to elucidate the mechanisms of multidrug resistance (MDR) of vincristine-resistant human gastric carcinoma cell line SGC7901/VCR, 2-DE was used to separate the total proteins of SGC7901/VCR and its parental cell line SGC7901. PDQuest software was applied to analyze 2-DE images, and the differential protein spots were identified by both MALDI-TOF-MS and ESI-Q-TOF-MS. Then the differential expressional levels of partially identified proteins were determined by Western blot analysis and real-time RT-PCR. Furthermore, the association of heat shock protein (HSP27), one of the highly expressed proteins in sgc7901/vcr, with MDR was analyzed using antisense inhibition of HSP27. In this study, the well-resolved, reproducible 2-DE patterns of SGC7901/VCR and SGC7901 were established, and yielded about 1100 protein-spots each. All the 24 differential proteins between the two cell lines were identified, and the differential expression levels of the partial proteins were confirmed. The suppression of HSP27 expression by HSP27 antisense oligonucleotides could enhance vincristine chemosensitivity in sgc7901/vcr and induce the cells to exhibit apoptotic morphological features after vincristine treatment. The differentially expressed proteins could be divided into six groups based on their functions: calcium-binding proteins, chaperones, proteins involved in drug detoxification or repair of DNA damage, metabolic enzymes, proteins related to cellular structure, and proteins relative to signal transduction, some of which may contribute to MDR of human gastric carcinoma cell line SGC7901/VCR. These data will be valuable for further study of the mechanisms of MDR in human gastric cancer.     

Design and planned analyses of an ongoing randomized trial assessing the preventive effect of Helicobacter pylori eradication on occurrence of new gastric carcinomas after endoscopic resection

BACKGROUND: A causal relationship between Helicobacter pylori infection and gastric cancer has been established. A nonrandomized study has shown eradication of H. pylori after endoscopic resection (ER) of early gastric cancer inhibits development of new carcinomas. SUBJECTS AND METHODS: Eligible subjects are patients with H. pylori infection who are newly diagnosed with early gastric cancer and plan to have ER or who are in the post-resection follow-up phase after ER time of enrollment. Patients are randomly allocated to the eradication or the control arms (no eradication and standard of care). Patients will be evaluated by endoscopy at 0.5, 1, 2, and 3 years after randomization. Diagnosis of a new carcinoma at another site of the stomach is defined as primary endpoint, and recurrence of tumors at the resection site as a secondary endpoint. In addition to intention-to-treat and per-protocol analyses using proportional hazards models, time to recurrence will be compared between treatment and control using multiple logistic regression analyses. In the latter two situations, the models will be adjusted for the factors exerting significant influences on the results. RESULTS: Five hundred and forty-two subjects have been enrolled into the study and are being followed-up. CONCLUSIONS: This study will have the statistical power to demonstrate whether H. pylori eradication therapy exerts any clinically relevant inhibitory effects on occurrence or recurrence of gastric cancer. In addition, it will be able to test the hypothesis that H. pylori infection is a promoter in gastric carcinogenesis.     

原发性胃淋巴瘤临床与内镜特征分析

目的:探讨影像学检查及胃镜、超声内镜对原发性胃淋巴瘤的术前诊断方法,以提高该疾病的术前诊断率。方法:总结我院经手术及病理证实的21例原发性胃淋巴瘤资料,评估胃镜活检、超声内镜及CT对该病诊断的作用。结果:21例术前CT检查,误诊为浸润型胃癌11例,间质瘤2例,未见明显异常3例。CT术前诊断率为23.8%(5/21)。全部患者均实施胃镜检查,活检病理诊断淋巴瘤14例,胃镜活检诊断率为66.7%(14/21)。其中10名患者实施超声胃镜检查,判断胃淋巴瘤6例、胃癌3例、间质瘤1例;术前诊断率为60.0%(6/10)。结论:胃镜及超声内镜是原发性胃淋巴瘤的主要术前诊断方式;CT扫描能明确有无纵隔及腹腔内淋巴结肿大,为原发性胃淋巴瘤提供诊断依据。     

癌症液体活检新思路：数字PCR检测DNA甲基化

癌症的早期诊断可提高患者生存率.微创采集人体体液的液体活检方法可避免传统肿瘤组织活检方法侵入性和异质性的问题,逐渐成为癌症诊断的新方式.另外,DNA甲基化作为预测癌症发生发展的标志物,引起了越来越多研究者的关注.但传统DNA甲基化的检测方法灵敏度不高,且容易出现假阳性.近年来,数字PCR技术因其超高的检测灵敏度和精确度、无需标准曲线即可进行核酸绝对定量检测的优势,被用于DNA甲基化的定量检测中.本文首先介绍了DNA甲基化与癌症发生发展的关系,总结了传统DNA甲基化检测方法及其在癌症临床诊断中的应用,阐述了基于不同核酸样本分散方法的数字PCR技术及其在微量DNA甲基化检测中的优势,总结了采用数字PCR技术检测癌症患者体液中DNA甲基化的具体步骤,列举了数字PCR技术在癌症DNA甲基化检测中的研究成果及应用进展,最后提出了数字PCR技术检测癌症DNA甲基化未来可能面临的挑战,并对数字PCR技术在癌症液体活检方面的应用前景进行了展望.     

X-ray diagnosis of injuries to the posterior part of the pelvic ring in children]

Proceeding from morphoroentgenological investigation of 48 isolated pelvic specimens from dead children, a new method for radiodiagnosis of fractures of lateral sacral masses (LSM) and rupture of sacroiliac joints (SIJ), based on quantitative assessment of pelvic ring deformity has been developed. Limitations of the method were established. The introduction of this roentgenometric method into clinical practice for diagnosis of injury of the posterior pelvic semiring permitted an increase in x-ray detection of LSM fractures 10-fold and SIJ ruptures 2.5-fold.     

Rapid screen of human genes for relevance to cancer using fission yeast

A total of 437 human full-length cDNAs isolated by microarray analysis of liver and/or gastric cancer tissues were evaluated for their relevance to cancer using the fission yeast Schizosaccharomyces pombe. Overexpression of 161 human cDNAs in S. pombe caused growth inhibition and/or morphological changes, which can be considered as cancer-related phenotypes of S. pombe. Sixteen genes causing growth defects and morphological changes at the same time were chosen to validate their ostensible oncogenic properties. They were highly expressed in liver and/or gastric cancer cell lines. Also, when the mouse embryonic fibroblast cell type NIH3T3 was transfected with these genes, the proliferation rates of cells were increased by 32% to 120%. This study demonstrates that fission yeast can be used as an advantageous and powerful tool for the rapid screening of human genes relevant to cancer. Furthermore, the human genes screened can be tested further as diagnostic markers and potential therapeutic targets for liver and stomach cancers. They also can be studied further for the elucidation of mechanisms involved in carcinogenesis.