Objective To explore morphological changes in evolution of colorectal pit patterns and their relation with polyp development by observing the uhrastructure of colorectal polyps. Methods Analy-ses were based on data from 50 subjects with colorectal polyps diagnosed with magnifying colonoseopy. Colonoscopy comb/ned with endoscopic lesions staining was employed to determine the pit pattern of colorec-tal lesions, according to Kudo classification. Colorectal lesions were removed through endoscopy or surgery. All samples were analyzed with histopathology, scanning and transmission electron microscopy. Results The pit pattern of 50 samples included 10 cases of type Ⅰ , 8 eases of type Ⅱ, 15 eases of type Ⅲ, 9 cases of type Ⅳ, 5 cases of type Ⅴ and 3 eases of mixed-type. The positive predictive rate and the accuracy rate of differential diagnosis of neoplastic polyps, verified with histological diagnosis, were 86% and 94%, re-spectively. Under scanning electron microscopy, crypt morphology in type Ⅰ and type Ⅱ exhibited regular round hole shape, with epithelial cells in uniform size, abundant absorptive cells with rich microvilli and goblet cells. Crypt in type Ⅲ, type Ⅳ and type Ⅴ appeared gradual deformation accompanied by increasing-ly atypical hyperplasia in the epithelial eells and heterotypic tissues. Transmission electron microscopy re-veahd epithelium of type Ⅰ and type Ⅱ ananged regularly and connected closely, with neat microvilli at the top of cells, affluent mitochondria and endoplasmic reticulum in the cytoplasm, oval nuclear at the base, and smooth and continuous basement membrane. While the epithelium of type Ⅲ, type ⅣV and type Ⅴ was char-acterized by sparse and irregular villi, swelling mitechondria and expanded endoplasmic reticuhm, lysosomes of increased number, heterotypic nuclear and mitotic nuclear, and broken and disappearing substrate. Con-dusion Morphological changes in pit pattern of colorectal polyps is affected by sudaee structure of glandular epithelial cells, the proportion and composition of the crypt surface cellsn. Ultrastrnetural changes in epithe-lial cells are the material basis of morphological changes in pit pattern and polyp development.

Objective To evaluate clinical value of tumor biomarkers in ascitic fluid and serum in differentiating benign from malignant ascites and their correlation. Methods From July 2006 to July 2009,67 patients with ascites undergone abdominal paracentesis in Renmin Hospital of Wuhan University were enrolled in the study and divided into malignant and benign groups according to their etiology. Levels of tumor biomarkers in ascitic fluid and serum were determined and their correlation were analyzed. Diagnostic sensitivity and specificity of tumor markers were evaluated. Results There was statistically significant difference in levels of cancer antigen 199 (CA199) in serum and ascitic fluid between the malignant group and the benign one ( P ＜ 0. 01 ), and level of cancer embryonic antigen (CEA) significantly increased in ascitic fluid (P ＜ 0.05 ). Levels of CA199 and CEA in serum were significantly higher than those in ascetic fluid in the benign group (P ＜ 0. 01 and P ＜ 0. 05 ), and level of CA125 was significantly lower in serum than that in ascitic fluid (P ＜ 0. 01 ). Level of alpha-fetal protein (AFP) in serum significantly correlated with that in ascitic fluid in the benign group (r =-0. 992, P ＜0. 01 ). In the malignant group, levels of CA199, CEA and CA125 were significantly higher in ascitic fluid than those in serum (P ＜0.05 or P ＜0. 01 ). Levels of CA199 and CEA in serum significantly correlated with those in ascetic fluid in the malignant group (r =0. 746 and 0. 572, respectively, P ＜0. 01 ), and level of AFP in serum also correlated with that in ascetic fluid (r=0. 384, P ＜0. 05). Ratios of levels of CA199 and CEA in ascetic fluid to those in serum (F/S) were significantly higher in the malignant group than those in the benign group (P ＜0.05 or P ＜0.01). Use of combination of CA199, CEA and CA125 determinations showed a higher sensitivity and specificity in differential diagnosis for benign and malignant ascites (P ＜0.05). Conclusions Determinations of CA199 and CEA are beneficial for differentiating benign ascites from malignant one. Determinations of tumor biomarkers in serum can not fully replace those in ascetic fluid. Combined determinations of CA199, CEA and CA125 can increase their sensitivity and specificity in diagnosis for malignant ascites.

Objective To investigate the patterns of change in serum triglyceride (TG) during the clinical course of acute pancreatitis (AP) and its clinical relevance.Methods Eighty one consecutive cases of AP were retrospectively reviewed.Based on their TG levels on admission,the patients were divided into high TG group (TG ≥ 11.3 mmol/L),median TG group (5.65 ≤ TG ＜ 11.3 mmol/L) and low TG group (TG ＜ 5.65 mmoL/L).They were additionally categorized into different treatment groups depending upon whether they received hemopurification,lipid lowering drugs or fat emulsions parenteral nutrition,and no special treatment group.The clinical characteristics and the patterns of change in TG were analyzed.Results The mean age of high,median,low TG group was (40 ± 10),(40 ±8),(51 ± 13) years old,and the difference among the high,median TG group and low TG group was statistically significant (P ＜ 0.01),but there was no significant difference between high and median TG group.In terms of sex,history of diabetes,hypertension,hypertriglyceridemia,acute pancreatitis,smoking and drinking,predisposing factors,disease onset season,severity of AP and hospitalization length,there was no significant difference among the 3 groups.Within the first 48h of admission,the TG levels of high and median TG group decreased significantly,and the percent of decline was (33.77 ± 26.57) ％,(43.46 ± 17.76) ％ in the first day,and it was (66.33 ± 17.20) ％,(57.50 ± 2.70) ％ in the second day,then it gradually decreased,but maintained a slightly higher level than normal.In contrast,no trend of decrease in TG during hospitalization was observed in low TG group.The patterns of change in TG in patients receiving hemopurification or lipid-lowering drugs were similar to those without special treatment.Fat emulsions parenteral nutrition exerted no significant influence on TG level in patients of low TG in no special treatment group.Of the patients without special treatment,the TG and total serum cholesterol level was positively correlated,while there was no correlation with other parameters.Conclusions The patterns of change in TG during the clinical course of AP vary with the patients' TG level on admission.If the decrease of TG does not reach 1/3 with routine treatment within the first 48 h,hemopurification therapy may be considered;for patients with TG ＜ 5.65 mmol/L,fat emulsions parenteral nutrition treatment can be accepted.

Objective To investigate the significance of H.pylori infection on upper gastrointestinal rebleeding in patients with long-term (≥ three months) aspirin and clopidogrel combination therapy.Methods From September 2007 to September 2011,at Yijishan Hospital of Wannan Medical College 78 patients with upper gastrointestinal bleeding and receiving long-term (≥ three months) aspirin and clopidogrel combined therapy were selected and treated with esomeprazole.The results of rapid urease test and gastric mucosal biopsy Giemsa staining of selected patients indicated 55 patients were H.pylori positive (positive group) and the other 23 cases were in negative group.The patients of positive group were randomly divided into intervention group (28 cases) and control group (22 cases) by the random allocation table method.The patients of intervention group received H.pylori eradiation treatment and the situation of H.pylori eradication was checked by 14C breath test.After treatment all patients were followed up for six months and clinical symptoms and the situation of rebleeding were observed.Categorical variables were expressed as percentage,intentional analysis and in accordance with protocol analysis were performed separately and analyzed by chi-square test.Results One patient in negative group with gastric cancer withdraw from the study.Two patients in intervention group lost.And one patient in control group lost.H.pylori of intervention group was all eradiated.In accordance with protocol analysis,the rebleeding rates of intervention group and control group were 7.69％ (2/26) and 34.62％ (9/26),respectively,and the difference was statistically significant (x2 =5.650,P=0.017).There was no significant difference between negative group (18.18％,4/22) and intervention group and no significant difference between negative group and control group (both P ＞ 0.05).In intentional analysis,the rebleeding rates of intervention group and control group were 7.14％ (2/28) and 33.33％ (9/27),respectively,and the difference was statistically significant (x2 =5.893,P =0.015).There was no significant difference between negative group (17.39 ％,4/23) and intervention group and no significant difference between negative group and control group (both P ＞ 0.05).Conclusion Eradication of H.pylori can reduce the rate of upper gastrointestinal rebleeding in patients with long-term aspirin and clopidogrel combination therapy.

Objective To investigate the predictive factors of acute pancreatitis for patients with gallstone.Methods One hundred and eighteen patients with gallstones who were admitted to Department of Gastroenterology,People's Hospital of Wuhan University were selected,the gallbladder size,number and size of gallstones,common bile duct stones were determined by imaging study.Then the patients were grouped according to the complication of acute pancreatitis.Results Sixty-one cases of acute pancreatitis occurred out of 118 patients.The gallbladder size of 74 patients was normal,and among them 49(66.2％) developed acute pancreatitis; the gallbladder size of 44 patients was increased or decreased,and among them 12(27.3％)developed AP.Thirty-one patients had a single gallstone,and 11 (35.5％) developed AP; while 87 patients had multiple gallstones,and 50 (57.5％) was complicated with AP.Among patients with AP,11 patients had a single gallstone,and the size of the gallstone in the 8 patients (72.7％) was ≥10 mm; while 50 patients had multiple gallstones,and the size of the gallstone in the 41 patients (82.0％) was ＜ 10 mm.Nineteen patients were complicated with common bile duct stones,and 17 (89.5％) developed AP; while 99 patients were not complicated with common bile duct stones,and 44 (44.4％) developed AP.The difference between the two groups was statistically significant (x2 =16.758,P =0.000 ; x2 =4.425,P =0.029 ; x2 =13.434,P =0.001 ; x2 =12.994,P =0.000).Conclusions Acute biliary pancreatitis is associated with gallstones.The size of gallbladder,size and number of gallstone,as well as the presence of common bile duct stones are related to the development of AP.

The clinical data of 26 cases with pathologically confirmed primary gastrointestinal nonHodgkin's lymphoma (PGINHL) admitted to our hospital from January 2001 to December 2010 were retrospectively analyzed.Among 26 patients,12 cases occurred in stomach,9 cases in small intestine,4 cases in colon and 1 case in multiple sites.The most common symptoms were abdominal pain (73％),followed by gastrointestinal bleeding (23％) and abdominal mass (15％).The main pathological types were MALT lymphoma (35％),diffuse large B-cell lymphoma (35％),and enteropathy-type T-cell lymphoma ( 15％ ).There were 14 patients in stage Ⅰ,6 in stage Ⅱ,1 in stage Ⅲ and 5 in stage ⅣV.Radical surgery and/or chemotherapy was the main therapy for PGINHL.

Objective The regulation on glucose transporters(GLUT1~GLUT5)by sodium butyrate was observed,and the regulation on bax and bcl-x/l by sodium butyrate and glucose was studied.This helped to learn about the possible mechanism of apoptosis of cancer cells induced by sodium butyrate.Methods The expression of GLUT1~GLUT5 mRNA was detected by RT-PCR.The expression of bax and bcl-x/l was detected by immuocytochemistry.Cell apoptosis was detected by TUNEL assay.Results In HT-29 cell line,sodium butyrate downregulated the expression of GLUT1 mRNA and the expression of bcl-x/l and induced cancer cell apoptosis,but did not regulate the expression of GLUT2,GLUT3,GLUT5 and bax.GLUT4 was not detected in HT-29 cell line.And when treated with sodium butyrate,the increase of concentration of glucose could increase the expression of bcl-x/l and reduce the effect of apoptosis induced by sodium butyrate.Without treatment with sodium butyrate,the change of glucose concentration only had a feeble regulation on apoptosis.Conclusion Sodium butyrate can obviously downregulate the expression of GLUT1 and downregulation of the expression of GLUT1 is associated with the apoptosis induced by sodium butyrate in HT-29 cell line.

Objective:To investigate the effects of alpha-lipoic acid on urinary albumin excretion in the patients with early diabetic nephropathy (DN). Methods:Totally 103 patients with early DN were randomly divided into the control group (n=59) and the treat-ment group ( n=44 ) . The two groups were both treated with dietary control and hypoglycemic drugs. The patients in the treatment group were given alpha-lipoic acid 450 mg·d-1 by intravenous infusion for 10 days on the basis of the initial therapy. The levels of HbA1c, BP, lipids, urinary 8-OHdG, urinary MCP-1 and urinary albumin were determined. Results:Compared with those in the con-trol group, urinary 8-OHdG, MCP-1 and urinary albumin were decreased significantly after alpha-lipoic acid treatment. The changes in HbA1c, BP and lipids were not significant. Conclusion:Aalpha-lipoic acid can decrease urinary albumin and 8-OHdG by lowering the expression of ROS and MCP-1.

Diarrhea can also be a symptom of many serious diseases.Diarrhea is caused by infections or illnesses that either lead to excess production of fluids or prevent absorption of fluids.There are some measures that can prevent diarrhea.There are some medications that can slow down the movement of stool through the intestines and increase intestinal water absorption.The patient may need a combination of drugs adjustments to achieve relief.This review summarizes the reasonable application of anti-diarrheal medications.