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Th article reports on the perioperative medications during endoscopic submucosal dissection (ESD) for gastric lesions. Topics discussed include the indications and contraindications of gastric ESD, complications of ESD, and diagnosis of perforation. Also being discussed are the aim and types of perioperative medications.

The objective of this research paper is to evaluate the effect of prophylactic nitroglycerin in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) by performing a meta-analysis of randomized controlled trials (RCTs). Electronic databases, including PubMed, EMBASE, the Cochrane library, and the Science Citation Index, were searched to retrieve relevant trials. Outcome measures were the incidence of PEP. Four RCTs, enrolling a total of 856 patients, were included. Meta-analysis of these trials indicated a significant association between the use of nitroglycerin and the reduction of PEP (RR 0.60; 95%CI: 0.39-0.92; P = 0.02). However, subsequent sensitive analysis failed to confirm that nitroglycerin was statistically superior to a placebo in reducing PEP (RR 0.68; 95%CI: 0.41-1.11; P = 0.12). Based on the limitations in this meta-analysis, prophylactic use of nitroglycerine for all patients who underwent ERCP is not recommended. Further clinical trials are required to confirm the effect of nitroglycerin in the prevention of PEP. [ABSTRACT FROM AUTHOR]

Gastric schwannomas are rare mesenchymal tumors of the gastrointestinal tract. They are usually misdiagnosed as other submucosal tumors preoperatively. Experience of the imaging features of gastric schwannomas is extremely limited. In this report, we summarize the features of a series of endoscopic ultrasound (EUS) images of gastric schwannomas in an effort to improve the diagnosis and differential diagnosis rate. We retrospectively reviewed the endosonographic features of four patients with gastric schwannomas and their computed tomography imaging results. Gastric schwannomas had heterogeneous hypoechogenicity or isoechogenicity, and a well-demarcated margin. The tumors originated from the fourth layer. Cystic changes and calcification were uncommon. Marginal hypoechoic haloes were observed in two patients. The results described here were different from those of previous studies. In the EUS evaluation, the internal echogenicity of gastric schwannomas was heterogeneous and low, but slightly higher than that of muscularis propria. These features might help us differentiate gastric schwannomas from other submucosal tumors. Further investigation is needed to differentiate these mesenchymal tumors.

Objective: To investigate the effect of metoclopramide on capsule endoscopy (CE) examination., Methods: Total 116 patients referred for CE were randomized into two groups with 58 patients in each group. In treatment group patients received 10 mg metoclopramide intramuscular injection after swallowing the capsule and in control group no metoclopramide was administered. The gastric transit time, small bowel transit time, complete endoscopy rate were observed in both groups., Results: The CE examination was completed in 51 patients of treatment group (87.9%) and 48 of control group (84.2%). Mean gastric transit time was (32.45 ± 29.63) min in treatment group and (45.81 ± 40.01)min in control group, there was significant difference between two groups (P<0.05). Mean small bowel transit time was (252.69 ± 113.29) min in treatment group and (258.75 ± 83.83) min in control group, there was no significant difference between two groups (P>0.05)., Conclusion: Metoclopramide may reduces gastric transit time, but not effect small bowel transit time,which suggests that it might increase the likelihood of complete small-bowel examination in patients undergoing capsule endoscopy.

A female patient with anemia and hypoalbuminemia was admitted to our hospital due to an over 20-year history of recurrent dizziness, fatigue and ankle edema. She was diagnosed as multiple chronic non-specific ulcer of the small intestine characterized by non-specific histology and persistent gastrointestinal bleeding.

ADP-ribosylation factor (ARF) like 7 (ARL7, also named ARL4C) is a member of ARL family and recent studies showed that it is involved in the AI-dependent cholesterol secretion process. Yet its biological function remains largely unknown. Using a MALDI-TOF/MS analysis, we identified alpha-tubulin interacted with ARL7. The interaction was confirmed by GST pull-down assay and co-immunoprecipitation in renal carcinoma cell 786-O in which we found the endogenous ARL7 is expressed. This is the second ARL member found interacting with tubulin after ARL8. In addition, ARL7Q72L, a GTP-binding form, promoted the transferrin transport from early endosome to recycling endosome significantly. The above data suggested that ARL7 might modulate the intracellular vesicular transport via interaction with microtubules.

Background: Hepatic veno-occlusive disease (HVOD) is a severe complication of chemotherapy before hematopoietic stem cell transplantation and dietary ingestion of pyrrolizidine alkaloids. Many experimental models were established to study its mechanisms or therapy, but few are ideal. This work aimed at evaluating a rat model of HVOD induced by monocrotaline to help advance research into this disease., Methods: Thirty-two male rats were randomly classified into 5 groups, and PBS or monocrotaline was administered (100 mg/kg or 160 mg/kg). They were sacrificed on day 7 (groups A, B and D) or day 10 (groups C and E). Blood samples were collected to determine liver enzyme concentrations. The weight of the liver and body and the amount of ascites were measured. Histopathological changes of liver tissue on light microscopy were assessed by a modified Deleve scoring system. The positivity of proliferating cell nuclear antigen (PCNA) was estimated., Results: The rats that were treated with 160 mg/kg monocrotaline presented with severe clinical symptoms (including two deaths) and the histopathological picture of HVOD. On the other hand, the rats that were fed with 100 mg/kg monocrotaline had milder and reversible manifestations. Comparison of the rats sacrificed on day 10 with those sacrificed on day 7 showed that the positivity of PCNA increased, especially that of hepatocytes., Conclusions: Monocrotaline induces acute, dose-dependent HVOD in rats. The model is potentially reversible with a low dose, but reliable and irreversible with a higher dose. The modified scoring system seems to be more accurate than the traditional one in reflecting the histopathology of HVOD. The enhancement of PCNA positivity may be associated with hepatic tissue undergoing recovery.

Aim: To establish the rats model of chronic fibrosing pancreatitis and to prove the anti-fibrotic effect of emodin in chronic pancreatitis with fibrosis., Methods: Fifty rats were randomly divided into five groups, 10 rats in each group. Trinitrobenzene sulfonic acid (TNBS) was infused into the pancreatic duct to induce chronic pancreatitis in rats (except for normal group). Emodin-treated rats were fed with different doses of emodin (20, 40 and 80 mg/kg body weight) for 28 d, while normal group and control group received 0.9% sodium chloride solution. Serum levels of hyaluronic acid (HA) and laminin (LN) were determined by radioimmunoassay. Histopathological alterations were studied by optical microscopy. Expression of collagen was also examined while transforming growth factor-beta-1 (TGF-beta(1)) was localized by immunochemistry., Results: In emodin-treated rats, the serum levels of HA and LN were decreased significantly (HA, 62.2 +/- 19.3 microg/L vs 112.7 +/- 26.5 microg/L, P < 0.05; LN 44.3 +/- 10.4 microg/L vs 86.2 +/- 16.5 microg/L, P < 0.05); the degree of fibrosis was ameliorated observably; the expression of collagen in pancreatic tissue was reduced especially in high-dose emodin-treated group (36% +/- 5% vs 42% +/- 6%, P < 0.05); with the increased doses of emodin, the expression of TGF-beta(1) was declined, compared with those in control group., Conclusion: Emodin has an anti-fibrotic effect on pancreatic fibrosis in rats. Because of its anti-fibrotic effect, it could be a potential herb for the treatment of chronic pancreatitis.

Objective: To study the effect of emodin on pancreatic fibrosis and potential mechanism thereof., Methods: Fifty SD rats were randomly divided into 5 equal groups: normal control group, model control group, low-dose emodin-treated group, mediate-dose emodin-treated group, and high-dose emodin-treated group. The rats of the latter 4 groups underwent infusion of trinitrobenzene sulfonic acid (TNBS) into the pancreatic duct so as to establish models of pancreatic fibrosis. The emodin-treated rats were fed with different doses of emodin (20, 40, and 80 mg/kg body weight), while the normal and model control groups received 0.9% sodium chloride solution instead. Twenty-eight days later the rats were killed, blood samples were collected, and their pancreases were taken out. The serum levels of hyaluronic acid (HA) and laminin (LN) were determined by radioimmunoassay. The histopathological alterations were studied by optical microscopy. The expression of collagen was examined by Van Gieson staining. Western blotting was used to detect the protein expression of transforming growth factor-beta(1) (TGF-beta(1))., Results: (1) The serum level of HA of the low-dose, mediate-dose, and high-dose emodin-treated groups were 87 microg/L +/- 22 microg/L, 78 microg/L +/- 25 microg/L, and 62 microg/L +/- 19 microg/L respectively, all significantly lower than that of the model control group (113 microg/L +/- 27 microg/L, P < 0.05 or < 0.01). The serum levels of laminin in the low-dose, mediate-dose, and high-dose emodin-treated groups were 67 microg/L +/- 14 microg/L, 57 microg/L +/- 12 microg/L, and 44 microg/L +/- 10 microg/L respectively, all significantly lower than that of the model control group (86 microg/L +/- 17 microg/L, P < 0.05 or P < 0.01); (2) The degrees of fibrosis of the emodin-treated groups were obviously ameliorated in comparison with the model control group, the higher the dose of emodin the more improved the pathological changes, especially in the high-dose emodin-treated group (P < 0.05). (3) The percentages of collagen positive cells of the low-dose, mediate-dose, and high-dose emodin-treated groups were 39% +/- 7%, 38% +/- 4%, and 36% +/- 5% respectively, all lower than that of the model control group (42% +/- 6%), with a significant difference between the high-dose emodin-treated group and the model control group (P < 0.05). (4) The protein content of TGF-beta(1) of the low-dose, mediate-dose, and high-dose emodin-treated groups were 44.3% +/- 2.1%, 39.2% +/- 1.8%, and 28.8% +/- 1.6% respectively, all significantly lower than that of the model control group (60.7% +/- 1.7%, all P < 0.05), and the protein content of TGF-beta(1) of the high-dose emodin-treated group was significantly lower than those of the other 2 emodin-treated groups (both P < 0.05)., Conclusion: Emoidn has an anti-fibrosis effect on pancreatic fibrosis, which maybe related to the content of TGF-beta(1) protein.

Objective: To evaluate the relationship among Helicobacter pylori (Hp)infection, blood ammonia concentrations, and hepatic encephalopathy (HE) status, and to investigate the effect of Hp eradication on blood ammonia levels and hepatic encephalopathy status in cirrhotic patients., Methods: From July 2003 to Jan 2005, cirrhotic patients in 5 regions of Zhejiang Province were enrolled. Patients were evaluated for the demographic checklists, number connection test, Hp infection, liver impairment level, blood ammonia concentrations and hepatic encephalopathy status. Patients with Hp infection were given one week therapy with omeprazole plus clarithromycin and tinidazole. (14)C urea breath test was performed and the mental symptoms and blood ammonia levels were reassessed after the eradication therapy., Results: (1) 457 cirrhotics were enrolled, the overall Hp infection rate was 60.6%, and HE happened with 47.5%. Subclinical hepatic encephalopathy (SHE) were detected 55 in 47.0% of 117 cirrhotics. (2) Blood ammonia concentration in Hp (-) and Hp (+) cirrhotics was (53.8 +/- 51.4) micromol/L and (78.4 +/- 63.6) micromol/L respectively (P < 0.01), which was significantly reduced to (53.5 +/- 37.7) micromol/L after Hp eradication (P < 0.01). HE was more frequently observed in patients with Hp infection than without it (58.5% vs 30.6%, P < 0.01). HE rate were significantly dropped to 34.1% after Hp eradication (P < 0.01). (3) Hp prevalence significantly differed among cirrhotic with HE (74.4%), those with SHE (69.1%), or without HE (53.2%) (P < 0.05). The level of blood ammonia had significant difference among the cirrhotics with HE (94.5 +/- 75.6) micromol/L, those with SHE (59.9 +/- 49.2) micromol/L, or without HE (47.3 +/- 33.5) micromol/L (P < 0.05)., Conclusions: Hp infection was an important factor of inducing with high blood ammonia concentration and hepatic encephalopathy in cirrhotic patients. Hp eradication may be helpful for treatment and prevention of HE.

Aim: To study the expression of trefoil factor 1 (TFF1) and TFF2 in precancerous condition and gastric cancer and to explore the relationship between TFFs and tumorigenesis, precancerous condition and gastric cancer., Methods: The expression of TFF1 and TFF2 was immunohistochemically analyzed in paraffin-embedded samples from 140 patients including 35 cases of chronic superficial gastritis (CSG), 35 cases of gastric ulcer (GU), 35 cases of chronic atrophic gastritis (CAG) and 35 cases of gastric cancer (GC)., Results: TFF1 and TFF2 were located in cytoplasm of gastric mucous cells. In CSG, GU, CAG and GC, the level of TFF1 expression had a decreased tendency (P < 0.05). The expression of TFF2 was higher in GU than in CSG, but the difference was not significant. The expression of TFF2 also had a decreased tendency in GU, CAG, and GC (P < 0.05)., Conclusion: The reduced expression of TFF1 and TFF2 in precancerous conditions and gastric cancer may be associated with the proliferation and malignant transformation of gastric mucosa. More investigations are needed to explore the mechanism of TFFs and the relationship between TFFs and gastric cancer.

Aim: To investigate the apoptosis of implanted primary gastric cancer cells in nude mice induced by resveratrol and the relation between this apoptosis and expression of bcl-2 and bax., Methods: A transplanted tumor model was established by injecting human primary gastric cancer cells into subcutaneous tissue of nude mice. Resveratrol (500 mg/kg, 1,000 mg/kg and 1,500 mg/kg) was directly injected beside tumor body 6 times at an interval of 2 d. Then changes of tumor volume were measured continuously and tumor inhibition rate of each group was calculated. We observed the morphologic alterations by electron microscope, measured the apoptotic rate by TUNEL staining method, detected the expression of apoptosis-regulated genes bcl-2 and bax by immunohistochemical staining and PT-PCR., Results: Resveratrol could significantly inhibit carcinoma growth when it was injected near the carcinoma. An inhibitory effect was observed in all therapeutic groups and the inhibition rate of resveratrol at the dose of 500 mg/kg, 1,000 mg/kg and 1,500 mg/kg was 10.58%, 29.68% and 39.14%, respectively. Resveratrol induced implanted tumor cells to undergo apoptosis with apoptotic characteristics, including morphological changes of chromatin condensation, chromatin crescent formation, nucleus fragmentation. The inhibition rate of 0.2 mL of normal saline solution, 1,500 mg/kg DMSO, 500 mg/kg resveratrol, 1 000 mg/kg resveratrol, and 1 500 mg/kg resveratrol was 13.68+/-0.37%, 13.8+/-0.43%, 48.7+/-1.07%, 56.44+/-1.39% and 67+/-0.96%, respectively. The positive rate of bcl-2 protein of each group was 29.48+/-0.51%, 27.56+/-1.40%, 11.86+/-0.97%, 5.7+/-0.84% and 3.92+/-0.85%, respectively by immunohistochemical staining. The positive rate of bax protein of each group was 19.34+/-0.35%, 20.88+/-0.91%, 40.02+/-1.20%, 45.72+/-0.88% and 52.3+/-1.54%, respectively by immunohistochemical staining. The density of bcl-2 mRNA in 0.2 mL normal saline solution, 1,500 mg/kg DMSO, 500 mg/kg resveratrol, 1,000 mg/kg resveratrol, and 1,500 mg/kg resveratrol decreased progressively and the density of bax mRNA in 0.2 mL normal saline solution, 1,500 mg/kg DMSO, 500 mg/kg resveratrol, 1,000 mg/kg resveratrol, and 1,500 mg/kg increased progressively with elongation of time by RT-PCR., Conclusion: Resveratrol is able to induce apoptosis of transplanted tumor cells. This apoptosis may be mediated by down-regulating apoptosis-regulated gene bcl-2 and up-regulating the expression of apoptosis-regulated gene bax.

Aim: To investigate the apoptosis in primary gastric cancer cells induced by genistein, and the relationship between this apoptosis and expression of bcl-2 and bax., Methods: MTT assay was used to determine the cell growth inhibitory rate in vitro. Transmission electron microscope and TUNEL staining were used to quantitatively and qualitatively detect the apoptosis of primary gastric cancer cells before and after genistein treatment. Immunohistochemical staining and RT-PCR were used to detect the expression of apoptosis-associated genes bcl-2 and bax., Results: Genistein inhibited the growth of primary gastric cancer cells in dose-and time-dependent manner. Genistein induced primary gastric cancer cells to undergo apoptosis with typically apoptotic characteristics. TUNEL assay showed that after the treatment of primary gastric cancer cells with genistein for 24 to 96 h, the apoptotic rates of primary gastric cancer cells increased time-dependently. Immunohistochemical staining showed that after the treatment of primary gastric cancer cells with genistein for 24 to 96 h, the positivity rates of Bcl-2 proteins were apparently reduced with time and the positivity rates of Bax proteins were apparently increased with time. After exposed to genistein at 20 micromol/L for 24, 48, 72 and 96 respectively, the density of bcl-2 mRNA decreased progressively and the density of bax mRNA increased progressively with elongation of time., Conclusion: Genistein is able to induce the apoptosis in primary gastric cancer cells. This apoptosis may be mediated by down-regulating the apoptosis- associated bcl-2 gene and up-regulating the expression of apoptosis-associated bax gene.

Objective: Trefoil factor 1 (TFF1) and trefoil factor 2 (TFF2) are members of the trefoil peptide family. To investigate the relationship between TFF1, TFF2 and tumorigenesis of precancerous conditions and gastric cancer., Methods: The expression of TFF1, TFF2 was determined by immunohistochemical method in 140 gastric specimens including 35 chronic superficial gastritis (CSG), 35 gastric ulcer (GU), 35 chronic atrophic gastritis (CAG) and 35 gastric cancer (GC)., Results: In the CSG, GU, CAG and GC, the level of TFF1 expression had a decreasing tendency (P < 0.05). The expression of TFF2 also had a decreased tendency in GU, CAG, and GC (P < 0.05)., Conclusions: The reducing expression of TFF1, TFF2 in the precancerous conditions and gastric cancer was confirmed, and the decrease of TFF1, TFF2 expression may be related to tumorigenesis, progression and the degree of tumor differentiation. Further studies will be necessary to determine the mechanisms of TFF1, TFF2 in the tumor and prospects of clinical implication.

Objective: To investigate the plasma levels of ascorbic acid and vitamin E in patients with liver cirrhosis and to explore their significance., Methods: The plasma levels of ascorbic acid,vitamin E and lipoperoxides in patients with liver cirrhosis were measured, and the results were compared with those of sex-and age-matched healthy subjects., Result: The plasma levels of ascorbic acid, vitamin E and lipoperoxides in the patients group were (42.94 +/-6.99)micromol/L, (17.99 +/-3.51)micromol/L and (14.09 +/-1.28)micromol/L, respectively, while those in the control group were (53.30 +/-9.45)micromol/L (t=9.50, P=0.000), (24.59 +/-7.22)micromol/L (t=7.94, P=0.000) and (12.11 +/-1.20)micromol/L (t=17.21, P=0.000), respectively., Conclusion: The levels of ascorbic acid and vitamin E in patients with liver cirrhosis decrease significantly,which may indicates the disturbance of balance between oxidation and antioxidation.

Objective: To determine the effects of specific cyclooxygenase-2 (COX-2) inhibitor celexibo on the formation of gallstone in rabbits by comparing both the mucosa damage and the risk of gallstone formation., Methods: 30 rabbits were equally divided into three groups: gallstone group (induced by high cholesterol diet HCD), celexibo group (treated with celexibo 10 mg.kg(-1).day(-1) in addition to HCD) and control group (fed with formal diet). After 7 weeks, bile was obtained for observing gallstone formation, and the morphologic changes of the mucosa were assessed under microscopy. The level of COX-2 in gallbladder mucosa in each group was estimated with immunohistochemical assay., Results: Celexibo group had lower risk to get gallstones than gallstone group (2/10 vs 9/10, P < 0.05). The degree of mucosa inflammation and level of COX-2 expression were significantly higher in gallstone group than in the other two groups (0.055 +/- 0.006 vs 0.017 +/- 0.003, P < 0.001; 0.055 +/- 0.006 vs 0.169 +/- 0.001, P < 0.001)., Conclusions: Specific COX-2 inhibitor celexibo can decrease the risk of gallstone formation. COX-2 is highly expressed in gallbladder mucosa of gallstone, which suggests that there is certain inflammatory mechanism in the cholesterol gallstone formation.