LHPP在人胃腺癌组织中的表达及意义

目的通过检测LHPP(phospholysine phosphohistidine inorganic pyrophosphate phosphatase)在人胃腺癌组织和胃腺癌细胞系,以及幽门螺杆菌(Helicobacter pylori,H.pylori)感染正常胃上皮细胞系后的表达水平,评估LHPP表达及LHPP与胃腺癌的关系。方法 (1)使用TCGA(The Cancer Genome Atlas)数据库和GEO(Gene Expression Omnibus)数据库中的胃腺癌基因表达数据,分析LHPP在胃腺癌组织和正常胃黏膜组织中的表达差异。(2)选取2017年3月至2018年5月行胃部分切除术或全胃切除术的41例胃腺癌患者,取胃癌组织及匹配的正常胃黏膜上皮组织,应用免疫组化检测LHPP在胃腺癌组织和正常胃黏膜组织中的表达差异。(3)取常规传代培养的第三代正常胃黏膜上皮细胞系GES-1和胃腺癌细胞系AGS,qRT-PCR检测两组LHPP基因表达差异。(4)应用H.pylori P12标准菌株以感染复数(multiplicity of infection,MOI)50感染GES-1细胞系6、12、18和24 h后,Western blot检测各个时间点LHPP和H.pylori毒力蛋白CagA表达量。结果 TCGA数据库中的LHPP表达数据表明LHPP在胃腺癌中表达下调(t=7.064,P0.0001),来自GEO数据库中GSE65801表达数据的芯片测序结果得到相同的结论(P=0.001)。免疫组化证实LHPP在低分化胃腺癌中低表达,且表达与分化程度相关(χ~2=5.559,P=0.018),而与性别(χ~2=2.304,P=0.129)、年龄(χ~2=0.001,P=0.986)、浸润深度(χ~2=1.007,P=0.316)、淋巴结转移(χ~2=0.693,P=0.405)及肿瘤分期(χ~2=0.003,P=0.953)不相关。LHPP在胃腺癌细胞系AGS中表达低于正常胃上皮细胞系GES-1(t=10.38,P=0.005)。H.pylori感染GES-1细胞后LHPP表达随着感染时间延长总体有升高趋势。结论 LHPP在胃腺癌中低表达并与腺癌分化程度相关,有望成为胃腺癌诊断治疗的新靶点。     

中西医结合治疗对 幽门螺杆菌感染性胃溃疡患者胃黏膜的影响

目的探讨中西医结合治疗对H. pylori感染性胃溃疡(Hp-GU)患者胃黏膜形态的影响及疗效。方法选择2016年1月至2018年4月在我院内科治疗的Hp-GU患者74例,随机分为观察组与对照组各37例。两组患者均予以泮托拉唑肠溶片(40 mg/次,2次/d)、阿莫西林胶囊(1.0 g/次,2次/d)、左氧氟沙星片(0.2 g/次,2次/d)和枸橼酸铋钾胶囊(240 mg/次,2次/d)进行治疗,连用2周,2周后继续使用泮托拉唑肠溶片40 mg/次,1次/d,再用4周。观察组患者在此基础上加用半夏泻心汤加减治疗,连用6周。观察两组患者治疗前后胃黏膜形态的变化,并比较溃疡愈合情况、H. pylori清除率及患者不良反应。结果治疗6周后,两组患者胃黏膜厚度、腺体密度及慢性炎症细胞浸润和活动性炎症细胞浸润评分较治疗前明显下降(P0.05),且观察组患者下降的幅度较对照组更显著(P0.05)。两组患者溃疡愈合率比较差异无统计学意义(P0.05),观察组患者H. pylori清除率显著高于对照组(χ~2=4.39,P0.05)。结论中西医结合治疗对Hp-GU患者的疗效确切,能显著改善患者胃黏膜形态,提高H. pylori清除率,且患者不良反应少,安全性较高。     

Impact of bariatric surgery on type 2 diabetes

The management and prevention of diabetes through lifestyle modifications and weight loss should be the mainstay of therapy in appropriate candidates. Although the results from the Diabetes Prevention Trial and the Finnish Prevention Study support this approach, over 95% of patients not participating in a prevention research study are unable to achieve and maintain any significant weight loss over time. Bariatric surgery for weight loss is an emerging option for more sustainable weight loss in the severely obese subject, especially when obesity is complicated by diabetes or other co-morbidities. The two most common types of procedures currently used in the United States are adjustable gastric bands and Roux-en-Y gastric bypass. These procedures can be performed laparoscopically, further reducing the perioperative morbidity and mortality associated with the surgery. While the gastric bypass procedure usually results is greater sustained weight loss (40–50%) than adjustable gastric banding (20–30%), it also carries greater morbidity and nutritional/metabolic issues, such as deficiencies in iron, B12, calcium, and vitamin D. Following bariatric surgery most subjects experience improvements in diabetes control, hypertension, dyslipidemia, and other obesity-related conditions. In patients with impaired glucose tolerance most studies report 99–100% prevention of progression to diabetes, while in subjects with diabetes prior to surgery, resolution of the disease is reported in 64–93% of the cases. While improvements in insulin resistance and beta-cell function are related to surgically induced weight loss, the rapid post-operative improvement in glycemia is possibly due to a combination of decreased nutrient intake and changes in gut hormones as a result of the bypassed intestine. Post-prandial hyperinsulinemic hypoglycemia associated with nesidioblastosis has been described in a series of patients following gastric bypass surgery, and may be related to the described changes in GLP-1 and other gut hormones.     

Nitric oxide involvement in the effect of acute lithium administration on the nonadrenergic noncholinergic-mediated relaxation of rat gastric fundus

INTRODUCTION: Lithium has largely met its initial promise as the first drug to be discovered in the modern era of psychopharmacology. However, the mechanism for its action remains an enigma. The aim of the present study was to verify the effect of acute lithium administration on the nonadrenergic noncholinergic (NANC)-mediated relaxation of rat isolated gastric fundus and to evaluate the role of nitric oxide pathway in this manner. MATERIALS AND METHODS: The isolated rat gastric fundus strips were precontracted with 0.5 microM serotonin and electrical field stimulation (EFS) was applied at 5 Hz frequency to obtain NANC-mediated relaxation in the presence or absence of lithium (0.1, 0.5, 1 and 5 mM). Also, effects of combining lithium (0.1 mM) with the NO synthase (NOS) inhibitor L-NAME (0.03 microM) or the guanylyl cyclase inhibitor ODQ (1 microM) on relaxant responses to EFS was investigated. Moreover, effects of combining lithium (1 mM) with 0.1 mM L-arginine (a precursor of NO) on neurogenic relaxation were assessed. Also, the effect of lithium (1 mM) on relaxation to sodium nitroprusside (SNP; 1 nM-0.1 mM) and glyceryltrinitrate (GTN; 0.1-10 microM) was investigated. RESULTS: The NANC-mediated relaxation was significantly (P<0.001) reduced by lithium in a dose- and time-dependent manner. Combination of lithium (0.1 mM) with L-NAME (0.03 microM), which separately had partial inhibitory effect on relaxations, significantly (P<0.001) reduced the NANC-mediated relaxation of gastric fundus. ODQ (1 microM) significantly inhibited the neurogenic relaxations in the presence or absence of lithium (0.1 and 1 mM). Although L-arginine at 0.1 mM had no effect on relaxation to EFS, it prevented the inhibition by lithium (1 mM) of relaxant responses to EFS. Also, SNP and GTN produced concentration-dependent relaxation in precontracted rat gastric fundus which was not altered by lithium incubation (1 mM). DISCUSSION: Our experiments indicated that lithium likely by interfering with L-arginine/NO pathway in nitrergic nerve can result in impairment of NANC-mediated relaxation of rat gastric fundus.     

Gastric cancer & prospects of cancer in Saudi Arabia peninsula

Gastric cancer is classified to be an aggressive disease with poor treatment outcome, as most cases remain undetected until later stages, wherein surgery and few chemotherapeutics become the only recommended treatment course. The process of cancer development is multistep involving many stages and types of precancerous lesions, and hence, routine monitoring becomes a necessity in those detected with these or exposed to risk factors. Studying the pattern of gastric cancer for any geographical region is also important to control mortality and focus on implementation of efficient management and treatment guidelines. The cause for gastric cancer can be genetic, racial as well as environmental, and hence the pattern of this malignancy differs across geographical regions and between the developing and the developed nations. In case of the Kindgom of Saudi Arabia, very few hospital-based reports have been published highlighting the pattern of gastric cancer, and the associated incidence and mortality rates. However, classified to be one of the most crucial cancer forms in Saudi Arabia, research pertaining to epidemiology, presentation and pathological features are limited. Studying gastric cancer occurrence from public health viewpoint is important also because eradication of causative agents like those that H. pylori has also shown been not reduce the risk of cancer development among individuals with atrophic metaplastic gastritis. In case of Saudi Arabia, many inherent risks for this malignancy exists like waterpipe smoking and shift in diet pattern from the traditional Mediterranean diet. Our review focusses on pattern of gastric cancer on a global scale in comparison to scenario in Saudi Arabia. The aim is to encompass all of the less stressed upon facts about this malignancy in the Kingdom, paving way for future work in this regards.     

Pulicaria crispa mitigates gastric ulcer induced by ethanol in rats: role of treatment and auto healing

Context: Stomach ulcers are the common gastrointestinal disorders worldwide.

Objective: This study aimed to investigate the therapeutic impact of Pulicaria crispa aerial parts ethanol extract against gastric ulcer in rats.

Materials and methods: Ulcer was induced by one oral dose of ethanol (0.5?ml/100g body weight) on 24?hours empty stomach, then the plant extract (500?mg/kg b.wt.) was orally administered daily for one week. Ranitidine (100?mg/kg b.wt.); as a reference drug was evaluated. Stomach acidity and volume, as well as lesion counts were measured. Levels of malondialdehyde (MDA), glutathione (GSH) and superoxide dismutase (SOD) were estimated. Assay of different marker enzymes; succinate dehydrogenase (SDH), lactate dehydrogenase (LDH), glucose-6-phosphatase (G-6-Pase), acid phosphatase (AP) and 5′-nucleotidase (5′NT) were determined. Interlukin-10 (IL-10), intracellular adhesion molecule-1 (ICAM-1) and tumor necrosis factor alpha (TNF-α) were also determined. Stomach histopathological assessment was detected.

Results: Gastric ulcer showed drastic changes in oxidative stress, cell organelles and inflammatory markers. These biomarkers served as good tools to identify the presence of gastric ulcer. Treatment with P. crispa recorded amelioration in most parameters exceeding the auto healing effect.

Conclusion: Healing potency of P. crispa is possibly related to its content of glycosides, coumarins, flavonoids, tannins, sterols and triterpenes.     

循环肿瘤细胞在胃癌化疗预后评估中的临床意义

目的:探讨检测循环肿瘤细胞对评估胃癌患者化疗敏感性和预后的临床价值。方法:选取行根治术的胃癌患者112例,术前留取血液标本进行循环肿瘤细胞检测。选取病理分期为Ⅲ期的36位患者进行术后6周期Xelox化疗,在化疗前和化疗结束后检测循环肿瘤细胞。分析循环肿瘤细胞检测值和肿瘤分期、化疗预后的关系。结果:在胃癌患者中,循环肿瘤细胞阳性率(2)为39.29%(44/112),并且和肿瘤分期与淋巴结转移明显相关(P0.05)。在术后行辅助化疗的胃癌患者中,循环肿瘤细胞阳性率和化疗敏感性明显相关,循环肿瘤细胞检测值动态增高的患者比降低的患者预后差(P0.05)。结论:循环肿瘤细胞的动态监测有助于预测胃癌患者的化疗预后。     

氨基酸转运载体SLC1A5在胃癌组织中的表达及其临床病理学意义

目的:研究氨基酸转运载体溶质载体家族1成员5(Solute Carrier Family 1 Member 5, SLC1A5)蛋白在胃癌组织中的表达情况,并探讨其与胃癌临床病理特征及预后的相关性。方法:收集进展期胃癌组织及对应癌旁组织90例,应用免疫组化技术检测SLC1A5在上述组织中的表达情况,并统计分析其表达与胃癌临床病理特征及预后的关系。同时通过基因数据库分析SLC1A5在胃癌组织和癌旁组织中表达情况及其对胃癌患者预后的影响。结果:与癌旁组织相比,胃癌组织中SLC1A5表达明显上调(P0.0001)。数据库研究也显示SLC1A5在胃癌组织中表达明显上调(GSE 65801,P=0.0046;GSE 63809,P0.0001;GSE 27342,P=0.0147)。胃癌组织中SLC1A5高表达与肿瘤大小(P0.05)、肿瘤浸润深度(P0.01)、淋巴结转移(P0.05)、TNM分期(P0.05)和Ki-67(P0.01)相关,而与年龄、性别、肿瘤位置及分化程度均无显著相关性(P0.05)。胃癌组织中SLC1A5表达强度与患者预后相关,表达越高,患者预后越差(总体生存率,P=0.0131;无复发生存率,P=0.0293)。数据库分析也显示SLC1A5高表达可明显缩短患者的总体生存期(GSE 14210,P=0.011;GSE 22377,P=0.0015)和无进展生存期(GSE 14210,P=0.0095;GSE 22377,P=0.0012)。结论:SLC1A5蛋白表达在胃癌组织中明显上调,且与肿瘤大小、肿瘤浸润深度、淋巴结转移及TNM分期有关。SLC1A5高表达与胃癌患者预后不良密切相关。     

多层CT灌注成像参数与胃癌患者病理分化程度和血清CEA、AFP、CA72-4的关系研究

目的:探讨多层CT灌注成像参数与胃癌患者病理分化程度和血清癌胚抗原(CEA)、甲胎蛋白(AFP)、糖抗原72-4(CA72-4)的关系。方法:选取2016年5月到2018年5月期间在我院接受治疗的胃癌患者60例作为胃癌组,根据患者肿瘤细胞不同病理分化程度将患者分成中高分化组(34例)和低分化组(26例),另选取同期于我院进行健康检查的60例健康志愿者作为对照组。比较不同病理分化程度的胃癌患者多层CT灌注成像参数[血流量(BF)、达峰时间(TTP)、Patlak血容量(PBV)、Patlak表面通透性(PPS)],比较胃癌组和对照组血清CEA、AFP、CA72-4水平,分析胃癌患者多层CT灌注成像参数与血清肿瘤标志物的相关性。结果:胃癌组血清CEA、AFP、CA72-4水平明显高于对照组,差异有统计学意义(P0.05)。中高分化组PBV、PPS均明显低于低分化组,TTP明显高于低分化组,差异有统计学意义(P0.05),中高分化组和低分化组的BF比较差异无统计学意义(P0.05)。经Pearson法分析显示,胃癌患者的BF、TTP、PBV与CEA、AFP、CA72-4无明显的相关性(P0.05),PPS与CEA、AFP、CA72-4呈正相关(P0.05)。结论:胃癌患者的多层CT灌注成像参数与患者的病理分化程度有关,且部分参数还与血清肿瘤标志物CEA、AFP、CA72-4呈正相关。     

胃癌组织中HER2、PD-L1的表达与临床病理特征的相关性

目的:检测胃癌组织中人表皮生长因子受体2(HER2)、程序性死亡因子1配体(PD-L1)的表达,并分析其与胃癌患者临床病理特征的相关性。方法:采用分层整群抽样回顾性分析的方法抽取我院2016年1月至2018年12月经手术病理诊断为胃癌的100例原发性胃癌患者,全部患者术后均经病理组织切片免疫组化染色检测其HER2、PD-L1表达,对比不同性别、年龄、肿瘤大小、肿瘤部位、分化程度、病理类型等临床病理特征胃癌患者HER2、PD-L1的表达,分析二者与胃癌患者临床病理特征的相关性。结果:100例胃癌患者中男女比例为2.8:1,年龄60岁占比高,肿瘤大小多超过4 cm,WHO分型以分化不良与分化较好为主,肿瘤部位主要位于胃下2/3,浸润深度多为T4,TNM分期集中在Ⅰ～Ⅲ期,多伴淋巴结转移,几乎无远处转移,多存在脉管侵犯,部分有神经侵犯。100例胃癌患者胃癌组织HER2表达阴性、弱阳性、强阳性检出率分别为42.00%、31.00%、27.00%;PD-L1阴性、阳性检出率分别为57.00%、43.00%。胃癌组织HER2阳性表达、PD-L1阳性表达均高于癌旁正常胃组织,差异有统计学意义(P0.05)。胃癌组织中HER2表达与疾病分化程度呈负相关(r0,P0.05),PD-L1的表达与肿瘤分化程度、浸润深度、与远处转移均呈显著正相关(r0,P0.05)。结论:HER2的阳性表达可能提示胃癌患者较低的恶性程度,PD-L1的高表达可能提示胃癌患者存在远处转移、浸润深度深、恶性程度高。HER2和PD-L1有望成为胃癌患者诊断参考指标及药物干预的靶点。