Objective To evalulate the clinical value of magnifying endoscopy(ME)in combination with pit pattern in the detection and diagnosis of colorectal lesions.Methods Once the lesions were detected by ME,Indigo Carmine was sprayed,the pit pattern observed and the type of the lesion determined according to the Kudo' criteria for classification.The pathology diagnosis was as contrast.Results The accuracies of ME in detection of inflammatory polyps,tubular adenomas,villous adenomas or colorectal cancer were 100%,93.3%,90.9% and 100% respectively,as compared with those of the pathology outcomes.And the total accuracy was 96.1%.Conclusion ME examination, which appears to be sensitive in distinguishing the neoplasms from the non-neoplasms,or the benign from the malignant,can also be applied for predicting the depth of cancers and choosing the strategy of therapy.It is,therefore,of value to the detection and diagnosis of colorectal lesions.

Objective Comparing three screening schemes of colorectal cancer in general population to provide scientific basis for coiorectal cancer screening in communities. Methods Questionnaire screening among high-risk population and immunoassay fecal occult blood test (FOBT) were used for colorectal cancer detection. Colonescopy and pathological test were considered as gold standard of screening results. Results Nine coloreetal cancers and 796 colorectal adenomas were detected in 68 953 participants. Mean onset age of coloreetal adenoma was 7. 7 years earlier than colorectal cancer. For questionnaire and FOBT,the sensitivity was 44.4% ,77.8% and 100.0% ,while the specificity was 98.6%, 95.5% and 94.4%, respectively. The Youden index of questionnaire, FOBT, and questionnaire-FOBT sequential method was 0.4,0.7,and 0.9,and the likelihood ratio ( +/- ) was 32.7/0.6,17. 2/0.2,and 17.8/0.0,respectively. When 50 was used as initial age of screening, screening receivers accounted for 9.7% ,and 66. 7% colorectal cancer could be detected. When 40 was used as initial age of screening, screening receivers and cost increased by 57.1% ,and only 11.1% more patients with colorectal cancer could be detected. Conclusions Questionnaire-FOBT sequential method has high sensitivity and specificity of colorectal cancer screening. Screening at 50 year-old may be better for community residents. The time of colorectal adenoma developed to colorectal cancer is about 8 years.

Objective To study the genetic regulation mechanism of colorectal LST,polypoid adenomas and clolrectal cancer by detecting the expression of p53,c-myc and Ki-67 in these three lesions.Methods The expressions of p53,c-myc,Ki-67 were determined via two-step of immunohistochemistry method in LST,polypoid adenomas,invasive colorectal cancer and their significant difference were compared.Statistical analyses were used to analyze the correlation among Ki-67 expression and p53,c-myc expression in these three group lesions.Results Immunohistochemical staining was performed in 38 LST,62polypoid adenomas and 36 colorectal cancer.For p53 and c-myc,the positive rates in LST,polypoid adenomas and colorectal cancer were significantly different from each other.For Ki-67,the positive rates in LST and polypoid adenomas were significantly lower than that in colorectal cancer,but there was no statistical significant difference between LST and polypoid adenomas.The expression of Ki-67 did not correlate with p53and c-myc both in LST and polypoid adenomas.But in colorectal cancer,the expression of Ki-67 was strongly related to p53 and c-myc.Conclusion The expressions of p53,c-myc and Ki-67 were different in LST,polypoid adenomas and colorectal cancer,indicating that their genetic regulation mechanism might be different,and the genetic avenue for LST may be different from polypoid adenomas.

Objective To explore the pathogenesis of thrombocytopenia in chronic type B hepatitis. Methods The serum thrombopoietin (TPO) levels, bone marrow megakaryocyte (MK) count, platelet-associated immunoglobulin G (PAIgG), splenic index (SPI), prothrombin activity (PTA) were measured in 76 chronic type B hepatitis patients with thrombocytopenia. Results The regression analysis revealed that the platelet count was correlated with parameters including the serum TPO levels, bone MK count, SPI and PTA (r was 0.450, 0.521, -0.438, 0.428 respectively, P<0.05). The regression equation was Pt=36.38+0.23 TPO-0.57 SPI+0.69 MK, R<'2>=0.57, F=18.78, P<0.01. Conclusion It suggests that decline of thrombopoiedn, myelosuppression and hypersplenism may contribute to thrombocytopenia in chronic type B hepatitis patients.

Objective To evaluate the use of endoscopy in assessment of invasion depth of colorectal flat lesions and in choice of treatment strategy. Methods The invasion depth of 222 colorectal flat lesions from 188 patients was endoscopically estimated by pit patterns, air-induced deformation testing and/or lifting sign. The lesion was endoscopically rosected if both tests were positive, otherwise, surgery was applied. The pathological evaluation of resected lesion was made according to WHO criteria and was used as a reference of tumor invasion depth. The sensitivity, specificity, positive and negative predictive value of airinduced deformation testing and lifting sign in prediction of invasion depth of tumors were calculated. Results The air-induced deformation testing and lifting sign were both positive in 212 cases, in which 192 were treated with endoscopic mucosal resection (EMR), 15 with endoscopic piecemeal mucosal resection (EPMR), 2 with additional surgery after EPMR and 3 with surgery only. Either air-induced deformation tesring or lifting sign was negative in 10, in which 4 cases underwent surgical resection. The sensitivity, specificity, positive and negative predictive value of air-induced deformation testing and lifting sign in prediction of invasion depth of tumors were 97.2%, 44. 4%, 97.6% and 40. 0%, respectively. Conclusion Endoscopic air-induced deformation testing and lifting sign can be used to predict invasion depth of colorectal flat tumors, which can guide instant therapeutic strategies and avoid excessive or insufficient treatments.

Objective To assess the performance of the methylation‐sensitive high‐resolution melting curve analysis (MS‐HRM analysis) on the detection of the methylation in stool DNA for colorectal cancer screening .Methods Eighty‐two qualified stool samples were collected from 27 patients with colorectal cancer patients (CRC group) ,25 patients with advanced adenomas (AA group) ,and 30 healthy people (control group) .The methylation status of vimentin gene in all of the stool samples was detected by the MS‐HRM analysis on the LightCycler 480 platform .The fecal occult blood test (FOBT) was also used for the same samples . Results The positive rates of the MS‐HRM assay in the CRC group ,AA group ,and control group were 81 .5% (22/27) ,80 .0%(20/25) ,and 6 .7% (2/30) respectively .The positive rates of FOBT in the three groups were 37 .0% (10/27) ,12 .0% (3/25) and 3 .3% (1/30) respectively .The diagnostic sensitivity of the MS‐HRM assay for colorectal cancer and advanced adenomas (80 .8% , 42/52) was significantly higher than that of FOBT (25 .0% ,13/52)(P<0 .05) .No significant difference was found in the diagnos‐tic specificity between the MS‐HRM assay (93 .3% ,28/30) and the FOBT (96 .7% ,29/30) (P>0 .05) .Conclusion MS‐HRM performs better than FOBT and has great application potential in the detection of stool DNA methylation for colorectal cancer screening .

Objective To evaluate the efficacy and safety of 10-day moxifloxacin,esomeprazole plus furazolidone triple therapy as first-line treatment to eradicate Helicobacter pylori (Hp)in comparison with the 14-day quadruple therapy containing esomeprazole,amoxicillin, clarithromycin and colloidal bismuth pectin. Methods A total of 1 26 cases of endoscopically confirmed Hp-positive chronic active gastritis or peptic ulcer were randomly assigned to the treatment group to receive esomeprazole,moxifloxacin plus furazolidone triple therapy for 1 0 days;or to the control group to receive esomeprazole, amoxicillin,clarithromycin,and colloidal bismuth pectin quadruple therapy for 14 days.Clinical efficacy and safety were evaluated after 4-week treatment.Results At the end of treatment,the Hp eradication rate was 89.4%in the treatment group, and 88.3% in the control group(P>0.05).The incidence of adverse reactions in the treatment group (16.7%)was significantly lower than that in the control group (36.7%)(P<0.05).Conclusions The 10-day moxifloxacin,esomeprazole plus furazolidone triple therapy is effective and well-tolerated as first-line treatment to eradicate Hp with samilar efficacy and fewer adverse reactions compared to the 14-day bismuth-based quadruple therapy.

Objective To investigate the feasibility and clinical significance of fecal DNA tests for colon tumor diagnosis and screening,we inspected the mutations of APC,p53 and K-ras genes in the tissue and feces of patients with colorectal tumor.Methods We collected 46 patients with colorectal cancer(CRC),60 patients with colorectal adenomas( CRA) and 30 cases of normal person in Huizhou First People Hospital in Guangdong Province from Nov.2011 to Aug.2012.Then all the tumor tissues and feces of these people were detected the mu-tation rate about the APC,p53 and K-ras genes using polymerase chain reaction single strand conformation poly-morphism analysis method(PCR-SSCP).Results The mutation rates of APC,p53,K-ras genes of feces in CRC group,CRA group and normal group were 58.7%(27/46),65.2%(30/46)and 60.9%(28/46),20.0%(12/60),25.0%(15/60)and 23.3%(14/60),3.33%(1/30),0%(0/30)and 0%(0/30),respectively.How-ever the mutation rate in tissues were 63.0%(29/46),69.6%(32/46)and 63.0%(29/46),25.0%(15/60), 26.7%(16/60)and 26.7%(16/60),0%(0/30),0%(0/30) and 0%(0/30).Corresponding mutations could be found in feces and tumor tissues.Consistency checking for mutations rate in feces and tumor tissues of CRC group and CRA group showed that the Kappa value were 0.818(P<0.001),0.901(P<0.001),0.862(P<0.001)and 0.857(P<0.001),0.870(P<0.001),0.822(P<0.001).It means an excellent consistency.Con-clusion Fecal DNA testing is expected to become an effective noninvasive colon tumor early diagnosis and screening method.

Objective To investigate whether the colonoscopy skills could be retained after the endoscopy simulator training,and to find evidence for curriculum design.Methods A total of 14 trainees received virtual reality simulator colonoscopy training and took a standardized VR colonoscopy test at the end of training and at 6 months later without practice during the time period.Results Scores drastically decreased at 6 months after training when compared to those right after the training.Although there was no difference in safety or accuracy,there was significant difference in the residual air volume,intestinal loop and procedure time.Conclusion Some skills acquired by using the Endoscopy Simulator can be retained,but other skills may be lost,which requires more practice.