Objective To explore the diagnostic value of EUS-guided aspiration biopsy for wall-thickened gastric lesions. Methods A retrospective study was performed in 45 patients who were diagnosed as having thickened gastric wall by EUS examination.Pathological and follow-up results of routine endoscopy and EUS-guided aspiration biopsy were analyzed,with the surgical results and follow-up outcome as the golden standard.The positive rate of routine endoscopy and EUS-guided aspiration biopsy were compared. Results In routine biopsy,gastric cancer was confirmed in 6,lymphoma in 3,dysplasia in 6,Menetrier′s disease in 2 and inflammatory changes in 28.EUS-guided aspiration biopsy was conducted in 45 patients,and gastric cancer was confirmed in 18,lymphoma in 5,dysplasia in 4,Menetrier′s disease in 2 and inflammatory changes in 16.The final pathological and follow-up results confirmed 21 gastric cancer,6 lymphoma,2 dys-plasia,2 Menetrier′s disease,other tumors in 4 and inflammatory changes in 10. The accuracy rate of routine biopsy and EUS-guided aspiration biopsy was 51. 11%( 23/ 45 ) and 82. 22%( 37/ 45 )respectively. Conclusion EUS-guided aspiration biopsy can yield a higher positive rate than endoscopic biopsy.

Objective To assess the accuracy of contrast-enhanced EUS in differential diagnosis of benign and malignant pancreatic masses.Methods We systematically searched the Medline,PubMed,Web of Science,Embase,Cochrane Central Trials,CNKI and VIP databases for relevant studies published.Study selection,quality assessment and data extraction were performed by two reviewers independently.Meta-Disc (version 1.4) software was used to perform this meta-analysis for sensitivity,specificity,positive likelihood ratio (LR),and negative LR.Pooling results were derived by using the fixed-effect model when significant heterogeneity was not present.The random-effect model was applied otherwise.A summary receiver-operating characteristic (SROC) curve was constructed.Furthermore,to explore the potential sources of heterogeneity,we used meta-regression to estimate the effect of the following characteristics of the studies on the diagnostic accuracy of contrast-enhanced EUS.In addition,the outliers were identified with the method described by Deville and a subgroup analysis was performed by excluding the outliers.We used Stata statistical software (version 10.0) to assess the publication bias with the Begg-Mazumdar indictor and Harbord-Egger indictor.Results Twelve studies involving 1139 patients were included.The pooled sensitivity of contrast-enhanced EUS for the differential diagnosis of pancreatic masses was 94％ (95％ CI,0.91 ～0.95),the specificity was 89％ (95 ％ CI,0.85 ～ 0.92),the positive LR was 8.09 (95 ％ CI,4.47 ～ 14.64),and the negative LR was 0.08 (95％ CI,0.06 ～ 0.10).The area under the curve (AUC) under SROC was 0.9732 (SE =0.02).The subgroup analysis by excluding two outliers provided a sensitivity of 93％ (95％ CI,0.91 ～ 0.95) and a specificity of 93％ (95％ CI,0.89 ～ 0.95).Additionally,the subgroup analysis showed that the heterogeneities were eliminated in pooled estimates when the outliers were excluded and the AUC under SROC was 0.9745 (SE =0.02).Moreover,no significant publication bias was found with the Begg-Mazumdar indictor (P =0.244) or the Harbord-Egger indictor (P =0.442).Conclusion Contrastenhanced EUS is a valuable method in the differential diagnosis of pancreatic masses.

Objective To investigate the dynamic changes and relationship between the serum levels of IL-1 β and sE-selectin in acute pancreatitis (AP) patients, and to study the predicative value for severity of AP.Methods Forty one patients with AP were divided into severe acute pancreatitis (SAP, 19 cases) group and mild acute pancreatitis (MAP, 22 cases) group.Their serum were collected at the 1st, 3rd, 7th, and 14th day after admission and the serum concentrations of IL-1 β and sE-selectin were detected by ELISA.Another 20healthy volunteers were selected as controls.Results The serum concentration of IL-1 β in control group was ( 18.71 ±2.43)ng/L, while they were (61.18 ±7.47)ng/L, (33.03 ±5.85)ng/L, (20.73 ±4.07)ng/L in MAP group at the 1st, 3rd, 7th day;and they were (86.91 ± 13.32) rng/L, (81.35 ± 12.71) ng/L,(64.93 ±5.99)ng/L, (21.40±49.13) ng/L at the 1st, 3rd, 7th and 14th day in SAP group.The serum concentration of IL - 1β of patients with SAP were markedly higher than those with MAP and normal controls on the 1st, 3rd, 7th day (P ＜0.05) and they decreased almost to normal on the 14th day.The serum concentration of sE-selectin was ( 10.69 ± 2.51 ) ng/ml, while they were ( 41.60 ± 6.85 ) ng/ml, ( 14.90 ±3.51)ng/ml, (9.85 ±2.88)ng/ml in MAP group at the 1st, 3rd, 7th day;and they were (84.73 ±15.37)ng/ml, ( 95.65 ± 13.06 ) ng/ml, ( 39.41 ± 3.73 ) ng/ml, ( 12.25 ± 2.29 ) ng/mlon the 1st, 3rd, 7 th and 14th day.The serum concentration of sE-selectin of patients with SAP were significantly higher than those with MAP and normal controls on the 1st, 3rd, 7th day (P ＜0.05 ) and there was no significant difference between SAP and control group on the 14th day.There was a positive correlation between the serum level of IL-1 β and sE-selectin in AP on the 1 st day after admission ( r = 0.851, P ＜ 0.01 ).Conclusions The serum concentrations of IL-1 β and sE-selectin are useful for AP severity predication.

Maternally expressed gene 3 (MEG3) is a tumor-suppressing gene,and MEG3 RNAs,its products,are a series of long noncoding RNAs.The MEG3 gene is lost in kinds of human tumors,further more,the methylation of related DNA region is directly associated with the deficiency of MEG3 expression.Studies show that MEG3 gene and MEG3 RNAs can inhibit cell proliferation and induce apoptosis,which is associated with the fuction of tumor suppressor gene p53.

Objective To construct a maternally expressed gene 3(MEG3)expression plasmid vec-tor,and to obtain MEG3 over-expressed human pancreatic carcinoma SW1990 cells by transfection,and to ana-lyze the effect of MEG3 overexpression on the proliferation of human pancreatic carcinoma SW1990 cells. Methods A complete gene sequence based on the sequence of MEG3 in the GenBank was designed and inser-ted into the eukaryotic expression vector pcDNA3. 0 to construct recombinant plasmid pcDNA3. 0-MEG3. It was identified by sequencing and transfected into human pancreatic carcinoma SW1990 cells. The expression of MEG3 in SW1990 cells was confirmed by RT-PCR. The effect of MEG3 on proliferation was evaluated by MTT assay. In this study,the SW1990 cells transfected by plasmid pcDNA3. 0 were named negative control group, and the usual SW1990 cells were named blank control group. Results A MEG3 expression plasmid vector-pcDNA3. 0-MEG3 was constructed successfully. And pcDNA3. 0-MEG3 vector was transfected into SW1990 cells successfully. The expression of MEG3 at mRNA in MEG3-SW1990 cells increased significantly,about 895 times(F = 73. 592,P ﹤ 0. 01). The results of MTT assay indicated that over-expressed MEG3 could obviously inhibit SW1990 cells proliferation in vitro. After SW1990 cells transfected with pcDNA3. 0-MEG3 for 72 hours, the absorbance value was 0. 81 ± 0. 06,with a statistically significance(F = 33. 489,P ﹤ 0. 01)compared with negative control group(1. 17 ± 0. 07)and blank control group(1. 08 ± 0. 03). Conclusion A MEG3 expre-ssion plasmid vector-pcDNA3. 0-MEG3 is constructed successfully. It is confirmed that MEG3 and its product have obvious inhibitory effects for the proliferation of human pancreatic carcinoma SW1990 cells.

Objective To explore the role of growth factor receptor-bound 2 (GRB2) in homo sapiens eukaryotic translation elongation factor 1 alpha 2 (EEF1A2) promoting the carcinogenesis and development of pancreatic cancer.Methods The human pancreatic cancer cell line SW1990 with low expression of EEF1A2,was transfected by Ad5/F35-EEF1A2 plasmid.The expression of EEF1A2 in human pancreatic cancer cell lines BxPC-3 cells with high expression of EEF1A2,was down-regulated by small interfering RNA (siRNA) interference.The expressions of GRB2 in SW1990 and BxPC-3 cells were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot before and after interference.The pancreatic cancer BxPC-3 cells were interfered by specific and efficient chemical synthesized siRNA fragment.The changes of BxPC-3 cell proliferation and migration were observed by methyl thiazoly tetrazolium (MTT) and Transwell assay before and after interference.The data were analyzed by one-way analysis of variance.Results After human pancreatic cancer cell line SW1990 was transfected with Ad5/F35-EEF1A2 plasmid,the expression of GRB2 at mRNA and protein level both increased significantly (F=5.67,6.39,both P＜0.05).After the expression of EEF1A2 was inhibited by EEF1A2-siRNA,the expression of GRB2 at mRNA and protein level both decreased significantly (F=6.59,4.69,both P＜0.05).After BxPC-3 cells was transfected with siRNA-GRB2 for 72 hours,the results of MTT assay indicated that the absorbance value was 1.22±0.14,compared with negative control group (1.42±0.15) and blank control group (1.39 ± 0.15) the difference was statistically significant (F =6.63,P＜ 0.05).The results of transwell assay showed that the migration ability of cells in siRNA-GRB2 group decreased.After 24 hours,the number of migrated cells was 24.10±4.25,compared with negative control group (54.72±5.24) and blank control group (51.26 ± 6.23) the difference was statistically significant (F=55.00,P＜ 0.05).Conclusion GRB2 is key molecule in EEF1A2 promoting the progenesis and development of pancreatic cancer.

Background:Conventional gastrointestinal endoscopy is incapable of determining the deriving layers,size and nature of submucosal lesions,however,mini probe ultrasonography(MPS)is effective for mural stratification and determining the deriving layers and nature of lesions within gastrointestinal wall,and is considered to be an optimal examination for suspected submucosal tumors before endoscopic or surgical operation. Aims:To assess the diagnostic value of MPS for gastrointestinal submucosal lesions and the significance of MPS-assisted endoscopic therapy. Methods:A total of 69 patients with presumed gastrointestinal submucosal protruded lesions were retrospectively enrolled. All of them underwent MPS and then endoscopic therapy,such as cyst incision,high frequency electric snare resection,endoscopic mucosal resection and endoscopic submucosal dissection were performed according to the deriving layers,size and nature determined by MPS. The ultimate diagnosis was confirmed by histopathological examination. Results:In the 69 cases of lesions,MPS showed that 15 were derived from muscularis mucosa,40 from submucosa,and 14 from muscularis propria;10 of them were considered as cyst,18 were stromal tumor,8 were leiomyoma,6 were ectopic pancreas,15 were neuroendocrine tumor,and 12 were lipoma. Compared with pathological diagnosis,an overall coincidence rate of 91. 3%(63 / 69)was achieved by MPS. Conclusions:The accuracy rate of MPS is high for determining the deriving layers and nature of gastrointestinal submucosal protruded lesions prior to the attempting of endoscopic removal. It might be helpful for selecting treatment modalities for this kind of lesions.

Objective To investigate the effects of over-expression of homo sapiens eukaryotic translation elongation factor 1 alpha 2 (EEF1A2) on in vitro invasion and lung metastasis of human pancreatic cancer SW1990 cells.Methods Letivirus-mediated delivery of EEF1A2 was used to enhance the expression of EEF1A2 gene in human pancreatic cancer SW1990 cells,the SW1990 cells stably over-expressing EEF1A2 protein (SW1990/EEF1A2 cells) were obtained,and the parent SW1990 cells and SW1990/GFP cells were used as the control,and the expressions of EEF1 A2 mRNA and protein were determined by Real-time PCR and Western blotting.The invasion ability of cells was determined by Transwell assay.The lung metastasis model was established by injection of SW1990 cells into the tail vein.Whole lung tissues were harvested,and visible nodules on tung surface were counted macroscopically 8 weeks later.Results The EEF1 A2 mRNA expression of SW1990/EEF1A2 was 3.252 ± 0.344,which was significantly higher than those in SW1990/GFP cells (1.000 ±0.060) and SW1990 cells (0.944 ±0.041,t =2.255,2.305,P＜0.01) ; the EEF1A2 protein expression was 0.833 ± 0.050,which was significantly higher than those in SW1990/GFP cells (0.247 ± 0.035) and SW1990 cells (0.273± 0.041,t=0.572,0.559,P＜0.01).The ability of invasion of SW1990/EEF1A2 cells was (60 ±4) cells,which was sigmificantly higher than (33 ±4) cells in SW1990/GFP group and (26 ± 3) cells in SW1990 group (t =31.33,34.78,P ＜ 0.01).Furthernore,SW1990/EEF1 A2 cells had a much higher incidence of lung metastasis in nude mice than SW1990/GFP cells and SW1990 cells in vivo (100％ vs.20％,20％,P ＜ 0.05).Conclusions EEF1 A2 over-expression can obviously increase the in vitro invasion and lung metastasis of pancreatic cancer SW1990 cells.

Objective To investigate the role of endoscopic ultrasonography (EUS) in diagnosis and treatment of colorectal submucosal lesions. Methods EUS were applied in 74 patients with suspected colorectal submucosal lesions. According to the origin of submucosal lesion, the patients had received biopsy, endoscopic ultrasonography-fine needle aspiration (EUS-FNA) and endoscopic treatment or surgery. The correlation between EUS and clinical pathology is analyzed retrospectively. Results In the diagnosis based on EUS, there were 28 cases of neuroendocrine tumors (occurred in the rectum), 15 lipomas (4 cases occurred in ileocecal, 1 in transverse colon, 8 in ascending colon, 2 in sigmoid colon), 2 rectal gastrointestinal stromal tumor (1 in muscularis propria and the other in muscularis mucosa), 14 external pressure changes (9 ovarian tumor, 2 lymph nodes, 3 pelvic tumor), 5 cyst (4 in transverse colon, 1 in ascending colon), 1 gas cyst, 3 sigmoid colon endometriosis, 4 rectum malignant tumor invasion, 2 intestinal lymphoma. All the patients had received biopsy, EUS-FNA, endoscopic treatment or surgery. Compared with pathology, a total coincidence rate of 91.9% (68/74) was achieved by EUS, and 2 cases were pathologically diagnosed as leiomyoma, which is considered as rectal carcinoma by EUS at first, 1 case of intestinal lymphoma instead of lipoma, 2 inflammatory mass instead of malignant tumor around the rectum, and 1 rectal carcinoma instead of endometriosis. Conclusion The digestive tract structure could be showed clearly with EUS, and the size of the colon and rectal submucosal lesions, the layer of origin and the structural relationship of adjacent tissues could also be detected. Then, the appropriate treatment against the colon and rectal submucosal lesions would be adopted after the accurate judgment of lesions with EUS.

Objective To find the related factors of the unsuccessful unsedated colonoscopy. Methods Clinical data of 1 726 consecutive subjects who underwent colonoscopy without sedation from April 2014 to January 2015 at the second affiliated hospital of Soochow university were analyzed. Data included characteristics of the patients (age, gender, body mass index, degree of education, the bowel-cleaning drugs, previous colonoscopy experience, bowel habits, history of chronic disease, history of sport, history of abdominal or pelvic surgery, the indication of colonoscopy, mood, quality of bowel preparation, and presence/absence of colonic diverticulum), the characteristics of the physicians (procedure experience, the instrument handling method). These factors were analyzed to evaluate their impact on result of unsedated colonoscopy. Results This study included 1 726 patients (male/female: 927/799). These patients' average age was 50.04 years old, the cecal intubation rate was 91.6%, and the average intubation time was 10.27 minutes. The multiple regression analysis showed the elderly patient, lower BMI, irritability, consti﹣pation, poor bowel preparation were associated with the lower cecal intubation rate. Conclusions The elderly patient, lower BMI, irritability, constipation and poor bowel preparation were associated with the failure of unsedated colonoscopy. In clinical practice, quality improvement programs are needed to improve the rate of total colonoscopy.