Objective To evaluate the role of nitric oxide (NO) in the spinal cord in the maintenance of diabetic neuropathic pain in rats.Methods Male Sprague-Dawley rats,aged 2 months,weighing 180-200 g,were used in the study.Diabetes mellitus was induced by intraperitoneal streptozotocin (STZ) 60 mg/kg and confirmed by blood glucose ＞ 16.7 mmol/L on day 2 after STZ injection.Twenty diabetic rats were randomly allocated into diabetes mellitus group (DM group,n =10) and L-NAME (non-selective NOS inhibitor) group (LN group,n =10).Another 10 age-matched normal rats served as control group (C group).On 21 days after STZ injection,L-NAME 10 mg/kg was injected intraperitoneally once a day for 7 consecutive days in LN group,whereas the equal volume of normal saline 5 ml/kg was given instead of L-NAME in DM group.Paw withdrawal threshold to yon Frey filament stimulation (PWT) was measured before STZ infection and on 7,14,21 and28 days after STZ injection.The rats were sacrificed after the last measurement of PWT and the lumbar segments of spinal cord were removed for determination of NO content and neuronal nitric oxide synthase (nNOS) expression (by Western blot analysis) in spinal cord tissues.Results Compared with C group,PWT was significantly decreased on 14,21 and 28 days after STZ injection,and the NO content and nNOS expression in spinal cord tissues were increased in DM and LN groups (P ＜ 0.05).Compared with DM group,PWT was significantly increased on 28 days after STZ injection,and the NO content and nNOS expression in spinal cord tissues were decreased in LN group (P ＜ 0.05).Conclusion NO in the spinal cord is involved in the maintenance of diabetic neuropathic pain in rats and the mechanism is related to the enhanced function of nNOS.

Objective To evaluate the role of mTOR in spinal cord in the development of diabetic neuropathic pain in rats.Methods Sixty adult male Sprague-Dawley rats,aged 2 months,weighing 180-220 g,were used in the study.Forty-five rats among them were chosen randomly and diabetes mellitus was induced by intraperitoneal streptozotocin (STZ) 60 mg/kg and confirmed by blood glucose ＞ 16.7 mmol/L on day 3 after STZ injection.The left 15 rats received intraperitoneal injection of the equal volume of citric acid-sodium citrate buffer and served as normal control group (group C).Paw withdrawal threshold to von Frey filament stimulation was measured in the right hind paw before STZ injection and on 3,6,9,12,15,18,and 21 days after STZ injection.The diabetic rats with mechanical pain threshold decreasing by more than 50％ of the baseline were allocated to diabetic neuropathic pain group (group DP),and by less than 25 ％ of the baseline were allocated to diabetic non-neuropathic pain group (group NP).The rats were sacrificed at 21 days after STZ injection,and their lumbar enlargements of the spinal cord were removed for determination of the expression of mTOR and phosphorylated mTOR (p-mTOR) by Western blot.Results The expression of mTOR was significantly up-regulated in DP and NP groups when compared with group C (P ＜ 0.05),the expression of p-mTOR was up-regulated in DP group,and no significant change was found in the expression of p-mTOR in group NP (P ＞ 0.05).Compared with group NP,the expression of p-mTOR was significantly up-regulated (P ＜ 0.05),and no significant change was found in the expression of mTOR in group DP (P ＞ 0.05).Conclusion Activation of mTOR in the spinal cord is involved in the development of diabetic neuropathic pain in rats.

ObjectiveTo investigate the correlation between any two of Capsule Endoscopy ScroringIndex (Lewis score),simplified Crohn Disease Activity Index (CDAI) and C-reactive protein (CRP) in small bowel Crohn disease (CD).MethodsA total of 58 consecutive patients with known small bowel CD were enrolled. We evaluated disease activity with Lewis score and simplified CDAI. Correlations among CRP,simplified CDAI and Lewis score were calculated with Spearman's rank order correlation coefficient.The optimal CRP cut-off value was calculated using the ROC curve.ResultsThe Lewis score showed inactive,mild and moderate-severe patients were 13,21 and 24,respectively.CRP of moderate-severe group was significantly higher than that in mild and inactive groups ( P ＜ 0.05 ).The optimal CRP cut-off value that differentiated patients with moderate to severe disease from the others was 13.50 mg/L with sensitivity of 87.5％ and specificity of 82.4％.The area under the ROC curve to analyze the cut-off was 0.849.Lewis score was moderately correlated with CRP (r =0.58,P ＜ 0.01 ),and weakly correlated with the simplified CDAI (r =0.40,P ＜ 0.01 ).ConclusionSerum CRP and the simplified CDAI cannot replace Lewis score for capsule endoscopy in the assessment of disease activity in small bowel CD.However,CRP may be considered as an inflammatory marker for evaluating the moderate to severe capsule endoscopic activity.

Objective To study the long-term effect of argon plasma coagulation (APC) combined with proton pump inhibitor (PPI) on Barrett esophagus (BE). Methods A total of 36 patients, histologically proven as having BE from 2004 to 2007, were enrolled to underwent a therapy of APC plus PPI. The patients were re-examined on endoscopy at 1, 6 and 12 months after first APC and once a year thereafter.Results A total of 48 APC sessions were given to 36 patients with a mean number at 1. 33 per patient. The effective rate of reversal of BE was 100%. The follow-up was accomplished for all patients in 14-51 months with a median of 36months. The total recurrence rate (RR) of BE reached 16. 7% (6/36). The 1-year and 2-year RRs were 2. 8% (1/36) and 11.1% (4/36), respectively. The logistic regression analysis suggested that 2-year and total RRs were related to APC sessions ( P ＜ 0. 01 ). Conclusion The therapy of APC combined with PPI for BE is safe and of long-term effects.

Objective To investigate diagnostic value of colon capsule endoscopy (CCE) for mucosal lesions of patients with active ulcerative colitis. Methods A total of 19 consecutive patients, including 12 males and 7 females, were enrolled from July 2009 to June 2010, with a mean age at 44. 16 + 14.64.Dominant symptoms were hematochezia, diarrhea and abdominal pain, consistent with the criteria of ulcerative colitis. All cases were scored into 3 grades according to severity of mucosal lesions. Using conventionalcolonoscopic findings as golden standard, the consistence of mucosal classification of CCE was calculated with kappa- and P-value. Meanwhile, related data such as the rate of completion, colonic cleanliness and adverse reactions were also collected and analyzed. Results CCE revealed that mild, moderate and severe cases were 2, 8 and 9, respectively, while the 3 types shown by conventional colonoscopy were 3, 8 and 8,respectively. Kappa-value was 0. 826 and P-value was less than 0. 001, which indicated good consistence. In addition, the completion rate of CCE and excellent/fine rate of the colonic cleanliness were 100% (19/19)and 79% ( 15/19), respectively. There were no adverse reactions recorded. Conclusion With high diag-nostic consistency to conventional colonoscopy in classification of mucosa severity, CCE precisely reveals the mucosal lesions of ulcerative colitis and becomes a potential alternative to partially replace conventional colonoscopy, especially in surveillance.

Objective To evaluate the clinical efficacy and safety of endoscopic mucosal resection (EMR) assisted with magnifying chromoendoscopy in treatment of colorectal neoplasms. Methods Patients who met criteria for EMR including appropriate flat or depressed type and sessile lesions were enrolled. The association of morphology of colorectal lesions with histopathology was observed and the accuracy of estimation of invasive depth by magnifying chromoendoscopy was evaluated. Results Ninety lesions of 81 patients were reseeted by EMR (25 being sessile and 65 being flat or depressed). The histological results revealed low-grade dysplasia (LGD) in 58 lesions, high-grade dysplasia (HGD) in 20 lesions, and adenocarcinoma in 12 lesions. The average size of lesions was (1.4±0.5) cm in HGD, (1.6±0.5) cm in cancer and (1.0±0.4) cm in LGD with no significant difference (P> 0.05). It was shown that the flat and depressed lesions were more likely to be HGD or cancer as compared to sessile lesions, but with no statistical difference [41.5 % (27/65)vs. 20.0% (5/25), P= 0.084]. Moreover, the lesion with central depression was more likely to be HGD or cancer as compared to those without depressed surface [51.0% (25/49) vs. 17.1 % (7/41), P<0.01)]. The accuracy of estimating invasive depth by magnifying chromoendoscopy was 97.8% (86/90). Complete resection was confirmed histologically in 95.8% (88/90) of all lesions. Conclusions Colorectal lesions of depressed and flat types with central depression are more likely to be malignant. Estimation of invasive depth of colorectal neoplasia by magnifying chromoendoscopy in EMR treatment makes it more effective and safer.

Objective To evaluate the diagnosis and management of ectopic pancreas.Methods The clinical data of 62 cases of ectopic pancreas,which were diagnosed by endoscopic uhrasonography (EUS)or pathologic findings between July 2006 and December 2007 were retrospectively analyzed.The cases were divided into 4 groups according to different ways of management.Group A included 37 patients,who were diagnosed as having ectopic pancreas(＜19mm)by EUS only and were followed up via phone call every 3 months.Eight patients in group B were diagnosed by EUS as having submucosal lesions suspected as ectopic pancreas,and underwent operation because of large size or difficulty in diagnosis.Eight patients in group C received operation for other diseases and the eetopic pancreases were found in operation.Group D included 9 patients who underwent surgery due to malignant tumors.ResultsEctopic pancreas were most commonly found as a single lesion in gastric antrum(35/62,56.5%)with mean size of 9.2±5.4 mm.All patients in group A were asymptomatic,of which 10 received followed-up endoscopy and no changes in size of the lesion were found.All patients in group B,C and D were diagnosed as ectopic pancreas pathologically.Conclusion Ectopic pancrea is relatively common and asymptomatic,only part of them could be diagnosed clinically.Carcinoma arising from the ectopic pancreas is rare and lesion of small size diagnosed by EUS could be followed up endoseopieally.

Objective To evaluate the accuracy of preoperative three-dimensional endoscopic ultra-sonography (3D-EUS) in tumor invasion depth (T-staging) of rectal cancer. Methods From May 2007 to November 2007, 21 patients with rectal cancer diagnosed by eolonoscopy and biopsy, underwent 3D-EUS, 2D-EUS and MRI before surgery to predict T-staging. The results were assessed according to post-surgical pathological findings. Results The accuracy of 3D-EUS in T-staging was 85.71%, which was significantly higher than that of MRI (57.14%, P<0.05), and similar with that of 2D-EUS (76.19%, P>0.05). Conclusion More accurate T-staging could be achieved by 3D-EUS, which could be combined with MRI to detect lymph node metastasis, and provide more information for therapy decision in rectal cancer.

Objective To evaluate the effects of curcumin pretreatment on the activity of inducible nitric oxide synthase (iNOS) during lung injury induced by intestinal ischemia-reperfusion (Ⅰ/R) in rats.Methods Twenty-four pathogen-free female Sprague-Dawley rats,weighing 180-220 g,were randomly divided into 3 groups (n =8 each) using a random number table:sham operation group (group Sham);intestinal Ⅰ/R group (group Ⅱ/R);curcumin pretreatment group (group Cur).A rat model of lung injury induced by intestinal Ⅰ/R which was produced by occlusion of superior mesenteric artery for 75 min followed by reperfusion was established.At 5 days before Ⅰ/R,curcumin 200 mg/kg (in 20 mg/ml of normal saline) was given through a gastric tube in group Cur,while the equal volume of normal saline was given instead in Sham and Ⅱ/R groups.The rats were sacrificed at 4 h of reperfusion,and the pulmonary specimens were obtained for determination of wet/dry lung weight ratio (W/D ratio),NO content (by using nitrate reductase method) and iNOS activity (using colorimetric method) and for examination of pathological changes (with light microscope).The pathological changes of the lung were scored.Results Compared with group Sham,the pathological scores,W/D ratio,NO content and iNOS activity were significantly increased in Ⅱ/ R and Cur groups.Compared with Ⅱ/R group,the pathological scores,W/D ratio,NO content and iNOS activity were significantly decreased in group Cur.The pathological changes of lungs were significantly attenuated in group Cur as compared with H/R group.Conclusion The mechanism by which curcumin pretreatment attenuates lung injury induced by intestinal Ⅰ/R is related to decrease in iNOS activity in rats.

Objective To evaluate the effect of curcumin preconditioning on the activation of mast cells during intestinal ischemia/reperfusion (I/R) in rats.Methods Twenty-four female Sprague-Dawley rats,weighing 180-220 g,were randomly divided into 3 groups (n =8 each) using a random number table:sham operation group (S group),intestinal I/R group (I/R group),and curcumin preconditioning group (Cur group).Intestinal I/R was produced by occlusion of superior mesenteric artery (SMA) for 75 min followed by reperfusion.At 5 days before I/ R,curcumin 200 mg/kg (in 20 mg/ml normal saline) was given through a gastric tube in Cur group,while the equal volume of normal saline was given instead in S and I/R groups.All the rats were sacrificed at 4 h of reperfusion,and the intestinal specimens were obtained for microscopic examination and for determination of tryptase expression and β-hexosaminidase content.Intestinal damage was assessed and scored according to Chiu.Results Compared with S group,Chiu's score and β-hexosaminidase content were significantly increased,and the expression of tryptase was up-regulated in I/R and Cur groups.Compared with I/R group,Chiu' s score and β-hexosaminidase content were significantly decreased,and the expression of tryptase was down-regulated in Cur group.Conclusion The mechanism by which curcumin preconditioning attenuates intestinal I/R injury is related to inhibited activation of mast cells of rats.