Epigenetic modification plays an important role in the development and prognosis of gastric cancer.MicroRNA (miRNA) and DNA methylation are two important epigenetic control mechanisms.MiRNA inhibits the translation of target messenger RNA (mRNA),and is involved in post-transcriptional regulation.Abnormal methylation of promoter CpG island is closely related with the tumorigenesis,which can lead to abnormal expression of cancer gene,tumor-suppressor gene or other tumor-related gene.The mutual regulation between miRNA and DNA methylation plays an important role in gastric cancer,and the regulation network provides a new direction for the diagnosis and treatment of gastric cancer.

Objective To investigate the alteration of serum ghrelin and leptin in patients with functional dyspepsia (FD) and their clinical significance. Methods Sixty patients with FD [-30 patients with postprandial distress syndrome(PDS) and 30 patinets with epigastric pain syndrome(EPS)] were enrolled. Thirty healthy subjects were severed as controls. The serum ghrelin and leptin were measured by enzyme linked immunosorbent assay and radioimmunosorbent assay, respectively. Results The concentrations of serum ghrelin and leptin were both significantly lower in patients with FD than in controls (P<0.01). Meanwhile, the concentrations of serum ghrelin and leptin in PDS patients were significantly lower compared with controls (P<0.01) and EPS patients (P<0.01). There was no significant difference in levels of serum ghrelin and leptin between controls and EPS patients(P>0.05). Conclusions The alterations of serum ghrelin and leptin in PDS patients are responsible for their reduction in FD patients. The PDS may he associated with abnormalities in gastrointestinal motility. There is an interaction between serum ghrelin and leptin in development of FD. The detection of serum ghrelin or leptin is helpful in classification and treatment of FD.

Objective To evaluate miniature probe endoscopic ultrasonography (mEUS) in diagnosis of submucosal tumor (SMT) of upper digestive tract.Methods We observed 91 patients with SMT,and mEUS was performed to assess the lesions arised from the specific layer of the wall.Results Among all cases,leiomyoma was the most common,57 cases,found in esophagus more than in stomach;14 of cysts,9 of vascular lesions,5 of lipoma,and 2 cases of malignant stromal tumors.Malignant lesions and part of benign lesions were confirmed by histological examination.Conclusion mEUS is a simple,safe and effective method for SMT,and it can be clue to the location and nature of SMT.

Objective: To observe the clinical effect of Sertraline in treatment of dysthymia. Methods:63 outpatients diagnosed as dysthymia according to ICD-10 were randomly assigned to study group (n=33) and placebo group. Randomized double blind control study was done for 8 weeks with Sertraline from 50-200 mg/d. HAMA and HAMD were used to assess the effect.Results:At the end of 8 weeks, 54 patients completed the trial. Patients of both groups had lower HAMD scores than baseline from 2 weeks, and this trend continued through the 8 weeks observation. During this period, HAMD score of the study group declined more significantly than that of the placebo group. At the end of 8 weeks, the score of HAMA of the study group was also lower than that of the placebo group. The side effects of Sertraline were mild.Conclusion:Sertraline is effective in treatment of psychiatric outpatients with dysthymia.

Objective To compare the effectiveness and safety of different concentrations of elastin-like polypeptides (ELP) as novel submucosal injection material for endoscopic submucosal dissection.Methods Forty healthy New Zealand white rabbits were randomly divided into two groups (n=20).The first group by submucosal injection of different drugs were randomly divide into five groups (n=4).Four concentrations of 50 ku ELP (0.05,0.025,0.012 5,0.005 g/ml) were used separately in each group,while glycerin fructose was used for control group.Each solution (2 ml) was injected into the submucosa through the resected margin,the increase of mucosal thickness and surface changes were observed and recorded at 0,5,10,and 30 min.The subgroup by submucosal injection of different drugs were randomly divide into five groups (n=4).The injection pressure of each solution (2 ml) with the 25-gauge needle was calculated by a manometer,which was connected between the needle and syringe.Results The submucosal uplift heights in groups using the 0.05 g/ml ELP and 0.025 g/ml ELP injection were significantly thicker than that of glycerin fructose (P＜0.05),the 0.012 5 g/ml ELP and glycerin fructose injection showed no significant difference (P＞0.05),whereas the uplift height in glycerin fructose group was thicker than that of the 0.005 g/ml ELP (P＜0.05).The injection pressure correlated with the ELP concentration.The injection pressures of 0.05,0.025,0.012 5,0.005 g/ml ELP solutions were (332±36) kPa,(223±24) kPa,(174±22) kPa and (142±19) kPa,respectively,and that of glycerin fructose was (269±17) kPa.The 0.025 g/ml ELP solution was easily injected into the porcine stomach to create submucosal uplift.The injection pressure of the 0.025 g/ml ELP solution showed significantly lower value compared with that of glycerin fructose (P＜0.05).Conclusions ELP might be a promising agent for submucosal injection for endoscopic submucosal dissection (ESD),and 0.025 g/ml ELP might be efficient concentration for maintaining mucosal elevation,injection pressure and safety.

Objective To investigate the effects of peroral endoscopic myotomy (POEM) on esophageal dynamics in patients with achalasia (AC) and appraise the role of high resolution manometry (HRM)in assessment of POEM therapy.Methods From July 2011 to September 2012,20 patients with achalasia underwent POEM in the department of gastroenterology,Tianjin Medical University General Hospital.Preoperation esophageal dynamics of all the patients were evaluated by high resolution manometry (HRM) system and one month after POEM operation the test was repeated.Data of lower esophageal sphincter (LES)and esophageal body were analyzed,with 15 healthy volunteers as a contrast study.Results Mter POEM,the LES pressure (LESP) and 4-second integrated relaxation pressure (4sIRP) significantly decreased:LESP [pre-operation (24.5 ± 13.1) mm Hg vs.post-operation (8.5 ± 3.1) mm Hg,P ＜ 0.05] ; 4sIRP [pre-operation (20.7 ± 6.8) mm Hg vs.post-operation (5.0 ± 3.4) mm Hg,P ＜ 0.05].The LES relax rate (LESRR) significantly elevated [pre-operation (12.7 ± 9.8) ％ vs.post-operation (39.6 ± 18.1) ％,P ＜ 0.05].However,the esophageal aperistalsis remained after POEM.The total of 20 patiems were all type Ⅰ achalasia and responded well to POEM therapy.Post-operation data on the symptom scores markedly decreased and a significant correlation was found between the decreasing level of symptom scores and LESP,as well as the scores 4sIRP in the 20 patients (LESP:r =0.751,P ＜ 0.05 ; 4sIRP:r =0.500,P ＜ 0.05).Conclusion POEM can significantly improve esophageal dynamics in patients with achalasia and the treatment outcome is definite.HRM plays an important role in evaluation of POEM therapy on achalasia.

Objective To explore the effect of cognitive therapy for gastrointestinal carcinoma postoperative pstients to relieve nausea and vomiting.Methods 80 patients with gastrointestinal carcinoma were randomly divided into intervention group(n=40)and control group(n=40).The degree of nausea and vomiting and symptom were compared between the two groups.Results The incidence of nausea and vomiting in the intervention group was lower than that in the control group.So did the degree of nausea and vomiting.The difference was significant(P＜0.05).In SCL-90,the scores of the somatization,obsessive-compulsiwe,depression and anxiety phobicanxiety,parsnoid,psychofism were significantly different with that of the Chinese normal(P＜0.05).The scores in the intervention group were lower than that of the control group after cognitive therapy(P＜0.05).Conclusion Cognitive therapy can help to alleviate psychological health score,nausea and vomiting from gastrointestinal carcinoma postoperative,so as to improve the quality of life for patients with gastrointestinal carcinoma.

Objective To investigate the clinical characteristics of fundic gland polyps (FGPs).Methods Data of patients with FGPs diagnosed from January 2005 to May 2010 were collected and retrospectively analyzed.Results A total of 485 patients were found to have FGPs during routine upper endoscopy,accounting for 0.6％ of total upper endoscopy examinations at the same time period.It was most frequently seen in middle aged females.Clinical symptoms included abdominal distention and discomfort ( 182/485,37.5％ ),gastroesophageal reflux symptoms ( 83/485,17.1％ ) and upper abdominal pain (102/485,21.0％ ).51.3％ (249) of the polyps were located at fundus and 168 (34.6％ ) were at corpus,with most of FGPs (62.3％,302/485) were single polyp with broad base (less than 5mm),and 22.7％ (110/485 ) were multiple ones scattering throughout the fundus.The pathology typically showed cystic lesions in the fundic glands,with dysplasia in 8 and intestinal metaplasia in 3,accompanied by duodenal polyps in 11 and gastric cancer in 1.H.pyloriinfection was detected in 47.8 ％ subjects which was similar to the rate of general population (56.1％ ) in the same period (P =0.422 ).In addition,immunohistochemisty staining for adenomatous polyposis coli and cyclooxygenase-2 was performed in 12 patients,which showed all polyps were positive for adenomatous polyposis coli and 9 of them were cyclooxygenase-2 positive.Conclusion FGPs may not be correlate to H.pyloriinfection.It can be accompanied by dysplasia,intestinal metaplasia and duodenal polyps.Pathological and immunohistochemical studies may promote a better understanding and standardized diagnosis and treatment for this disease.

Objective To explore the association between DNA methyltrsansferase 3a (DNMT3a) expression and interleukin-4 (IL-4),interferon-gamma (IFN-γ) in mononuclear cells of colonic laminapropriamucosae in ulcerative colitis (UC) patients.Methods From November 2009 to March 2010,sixty colonic mucosa biopsy specimens through colon scopy were collected,specimens of active UC or normal controls were 30 in each group.The expression of DNMT3a,IL-4,and IFN-γ was detected with immunohistochemical method (SABC) in mononuclear cells of colonic laminapropriamucosae,and their relation with different degrees of colonic inflammatory response was analyzed.Results The positive expression rate of DNMT3a,IL-4,IFN-γ in mononuclear cells of colonic laminapropriamucosae in active UC group was significant higher than that in control group and there were statistically significant differences (x2 =16.596,P=0.000;x2 =42.857,P=0.000;x2 =6.667,P=0.024;).The expression of them was higher in sever inflammatory response than that in mild inflammatory response,and its expression intensity increased as inflammatory activity became more severe.There was positive correlation between IL-4,IFN-γ and DNMT3 expression in UC group (r=0.46,P=0.01 ;r=0.559,P=0.001).Conclusions The expression of DNMT3a,IL-4 and IFN-γ is associated with the degree of colonic inflammatory response.DNA methylation maybe involved in Th1/Th2 immune balance regulation in UC pathogenesis.

Objective To evaluate the valuse of endoscopic ultrasonography ( EUS ) for upper gastrointestinal submucosal lesions and the role of Photoshop in differentiating leiomyoma and stromal tumors. Methods Data of 656 patients with upper gastrointestinal submucosal lesions evaluated by EUS and receiving endoscopic submucosal dissection ( ESD ) from April 2010 to March 2015 were collected and retrospectively analyzed. The goldern standard for lesions size and origin was the intraoperative diagnosis of ESD, and that of the type of lesions ( leiomyoma, stromal tumor, ectopic pancreas, lipoma, etc.) was pathological and immunohistochemical finding. The consistency of diagnosis of the EUS was evaluated. In addition, Photoshop was used to differentiate diagnosis of leiomyoma and stromal tumors which were confirmed by pathology and immunohistochemistry. Results The consistency in diagnosing the size and lesion origins was 92?56%(560/605) and 88?43%(535/605)between EUS and ESD intraoperative result. The consistency in pathological types of EUS was 79?34%(480/605). Photoshop was used to analyze the EUS images of 177 stromal tumor and 241 leiomyoma. The gray value of stromal tumor was significantly higher than that of leiomyoma(59?97 VS 39?39, t=43?27, P<0?05).The echo of stromal tumor was higher. The standard deviation of gray value of leiomyoma were significantly lower than that of the stromal tumor ( 4?81 VS 5?42, t = 2?83, P < 0?05 ) , indicating the echo uniformity of leiomyoma was better. Conclusion EUS shows high accuracy rate for upper gastrointestinal submucosal lesions, providing more accurate basis for endoscopic therapy. EUS combined with Photoshop is helpful for differentiating stromal tumor from leiomyoma.