Clinicopathological features and trend changes of gastric carcinoma in Southern China

AIM: To investigate the clinicopathological features of gastric carcinoma in southern China and disease trends changes over the last 18 years.

METHODS: We designed a retrospective study in the Department of Gastrointestinal Surgery, the first affiliated hospital, Sun Yat-sen University. A total of 2100 adult patients with definitely diagnosed, histologically proven gastric carcinomas treated with radical gastrectomy from 1994 to 2013 were examined retrospectively. In all cases patient age, gender, tumor location, Borrmann type, histopathological type and grade, and pTNM stage were identified and recorded. The information was obtained from hospital records. The data were analyzed with Stata12.0 software.

RESULTS: In this study, the mean age of patients was 57 years with a range from 19-89 years. A higher incidence was found in patients over 60 years of age. In the study population, 67.38% of patients were male and 32.62% were female. Women had a higher disease incidence than men in patients less than 40 years of age (P < 0.001). No obvious change of patient age and gender was observed in the last 18 years. The rates of disease by location were the following: antrum (44.57%), followed by fundus/ body (24.95%) and cardia/gastroesophageal junction (23.00%). The mean tumor diameter was 5.57 cm, and advanced gross type Borrmann III was most common. Most patients were at advanced stages when first diagnosed, and patients with early stage disease were relatively rare. More early stage patients were detected in recent years, especially after 2000 (P < 0.001). Gastric carcinoma has different features in young and old patients. The young patients had the following features: more frequently female, tumors in the antrum, larger tumor size, poorly differentiated carcinoma, high rate of metastasis to other sites and advanced stages (P < 0.05).

CONCLUSION: In southern China, gastric carcinoma was more frequent in old men and young women. Young and old patients should be treated differently for having different features.

Early adenocarcinoma mixed with a neuroendocrine carcinoma component arising in the gastroesophageal junction: A case report

BACKGROUND

Early adenocarcinoma mixed with a neuroendocrine carcinoma (NEC) component arising in the gastroesophageal junctional (GEJ) region is rare and even rarer in young patients. Here, we report such a case in a 29-year-old Chinese man.

CASE SUMMARY

This patient presented to our hospital with a 3-mo history of dysphagia and regurgitation. Upper endoscopy revealed an elevated nodule in the distal esophagus 1.6 cm above the GEJ line, without Barrett's esophagus or involvement of the gastric cardia. The nodule was completely resected by endoscopic submucosal dissection (ESD). Pathological examination confirmed diagnosis of intramucosal adenocarcinoma mixed with an NEC component, measuring 1.5 cm. Immunohistochemically, both adenocarcinoma and NEC components were positive for P53 with a Ki67 index of 90%; NEC was positive for synaptophysin and chromogranin. Next-generation sequencing of 196 genes demonstrated a novel germline mutation of the ERCC3 gene in the DNA repair pathway and a germline mutation of the RNF43 gene, a common gastric cancer driver gene, in addition to pathogenic somatic mutations in P53 and CHEK2 genes. The patient was alive without evidence of the disease 36 mo after ESD.

CONCLUSION

Early adenocarcinoma with an NEC component arising in the distal esophageal side of the GEJ region showed evidence of gastric origin.

Value of red blood cell distribution width in prediction of diastolic dysfunction in cirrhotic cardiomyopathy

BACKGROUND

Clinical diagnosis of cirrhotic cardiomyopathy (CCM) often encounters challenges of lack of timeliness and disease severity, with the commonly positive indicator usually associated with advanced heart failure.

AIM

To explore suitable biomarkers for early CCM prediction.

METHODS

A total of 505 eligible patients were enrolled in this study and divided into four groups according to Child-Pugh classification: Group I, Class A without CCM (105 cases); Group II, Class A with CCM (175 cases); Group III, Class B with CCM (139 cases); and Group IV, Class C with CCM (86 cases). Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to determine whether red blood cell distribution width (RDW) was an independent risk factor for CCM risk. The relationships between RDW and Child-Pugh scores, Model for End-Stage Liver Disease (MELD) scores, and N-terminal pro-brain natriuretic peptide (NT-proBNP) were analyzed by Pearson correlation analysis.

RESULTS

A constant RDW increase was evident from Group I to Group IV (12.54 ± 0.85, 13.29 ± 1.19, 14.30 ± 1.96, and 16.25 ± 2.13, respectively). Pearson correlation analysis showed that RDW was positively correlated with Child-Pugh scores (r = 0.642, P < 0.001), MELD scores (r = 0.592, P < 0.001), and NT-proBNP (r = 0.715, P < 0.001). Furthermore, between Group I and Group II, RDW was the only significant index (odds ratio: 2.175, 95% confidence interval [CI]: 1.549-3.054, P < 0.001), and it reached statistical significance when examined by ROC curve analysis (area under the curve: 0.686, 95%CI: 0.624-0.748, P < 0.001).

CONCLUSION

RDW can serve as an effective and accessible clinical indicator for the prediction of diastolic dysfunction in CCM, in which a numerical value of more than 13.05% may indicate an increasing CCM risk.

Mechanism, diagnosis, and treatment of portal vein thrombosis in cirrhosis

Portal vein thrombosis (PVT) is one of the common complications of cirrhosis. Its formation is influenced by many factors, such as liver function grade, blood coagulation state, portal vein pressure, and blood flow velocity. The treatment of patients with PVT is more difficult than that of patients without PVT, and the prognosis is poor. However, the presence of PVT is usually asymptomatic, thus early detection and intervention are important. Currently, there are different views on the mechanism of PVT. This review will discuss the mechanism of PVT and summarize its pathogenesis, diagnosis, and treatment, with an aim to provide evidence for clinical practice.

Effect of Dendrobium nobile powder combined with conventional therapy on mild to moderate fatty liver

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) encompasses a variety of liver conditions impacting individuals who consume minimal or no alcohol. Recently, traditional Chinese medicine has been gradually used to treat mild to moderate fatty liver, among which Dendrobium nobile Lindl. powder has been affirmed by many doctors and patients to be effective. However, there is limited research on combining this treatment with standard therapies for mild to moderate NAFLD.

AIM

To survey the effect of combining Dendrobium nobile Lindl. powder with standard treatment on liver function and lipid metabolism disorder in patients with mild to moderate NAFLD.

METHODS

Eighty patients with mild to moderate NAFLD participated in this retrospective study, classified into two groups: The observation group (n = 40) and the control group (n = 40). In November 2020 and November 2022, the study was conducted at People's Hospital of Chongqing Liang Jiang New Area. The control group received standard treatment, while the observation group received Dendrobium nobile Lindl. powder based on the control group. The study compared differences in traditional Chinese medicine clinical syndrome scores, liver fibrosis treatment, liver function indicators, lipid levels, and serum inflammatory factor levels before and after treatment, and we calculated the incidence of adverse reactions for both groups.

RESULTS

The total effective rate was 97.50% in the observation group and 72.5% in the control group. After 8 weeks of treatment, the main and secondary symptom scores remarkably decreased, especially in the observation group (P < 0.05), and there was a significant reduction in the serum levels of hyaluronic acid (HA), laminin (LN), human rocollagen III (PC III), and collagen type IV (CIV). The levels of HA, LN, PC III, and CIV were significantly lower in the observation group (P < 0.05). After 8 weeks, both groups indicated remarkable improvements in liver function and blood lipid levels, with the observation group having even lower levels (P < 0.05). Serum levels of interleukin-1β, tumor necrosis factor-α, and interleukin-8 also dropped significantly. The observation group had a lower rate of adverse reactions (5.00%) compared to the control group (22.50%).

CONCLUSION

Adding Dendrobium nobile Lindl. powder to standard treatment has been found to remarkably improve symptoms and reduce inflammation in patients with mild to moderate fatty liver disease. It also enhances hepatic function and lipid profile, ameliorates liver fibrosis indices, and lowers the risk of side effects. Consequently, this therapeutic protocol shows promise for clinical implementation and dissemination.

C-reactive protein to albumin ratio predict responses to programmed cell death-1 inhibitors in hepatocellular carcinoma patients

BACKGROUND

Over the years, programmed cell death-1 (PD-1) inhibitors have been routinely used for hepatocellular carcinoma (HCC) treatment and yielded improved survival outcomes. Nonetheless, significant heterogeneity surrounds the outcomes of most studies. Therefore, it is critical to search for biomarkers that predict the efficacy of PD-1 inhibitors in patients with HCC.

AIM

To investigate the role of the C-reactive protein to albumin ratio (CAR) in evaluating the efficacy of PD-1 inhibitors for HCC.

METHODS

The clinical data of 160 patients with HCC treated with PD-1 inhibitors from January 2018 to November 2022 at the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed.

RESULTS

The optimal cut-off value for CAR based on progression-free survival (PFS) was determined to be 1.20 using x-tile software. Cox proportional risk model was used to determine the factors affecting prognosis. Eastern Cooperative Oncology Group performance status [hazard ratio (HR) = 1.754, 95% confidence interval (95%CI) = 1.045-2.944, P = 0.033], CAR (HR = 2.118, 95%CI = 1.057-4.243, P = 0.034) and tumor number (HR = 2.932, 95%CI = 1.246-6.897, P = 0.014) were independent prognostic factors for overall survival. CAR (HR = 2.730, 95%CI = 1.502-4.961, P = 0.001), tumor number (HR = 1.584, 95%CI = 1.003-2.500, P = 0.048) and neutrophil to lymphocyte ratio (HR = 1.120, 95%CI = 1.022-1.228, P = 0.015) were independent prognostic factors for PFS. Two nomograms were constructed based on independent prognostic factors. The C-index index and calibration plots confirmed that the nomogram is a reliable risk prediction tool. The ROC curve and decision curve analysis confirmed that the nomogram has a good predictive effect as well as a net clinical benefit.

CONCLUSION

Overall, we reveal that the CAR is a potential predictor of short- and long-term prognosis in patients with HCC treated with PD-1 inhibitors. If further verified, CAR-based nomogram may increase the number of markers that predict individualized prognosis.

Reduction of portosystemic gradient during transjugular intrahepatic portosystemic shunt achieves good outcome and reduces complications

BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) is placed important role in the therapy of complications of portal hypertension, there is still no suitable criterion for a reduction in portosystemic gradient (PSG), which can both reduce PSG and maximize clinical results and minimize hepatic encephalopathy (HE).

AIM

To compare the clinical outcomes and incidence of HE after one-third PSG reduction during TIPS in patients with variceal bleeding and refractory ascites.

METHODS

A total of 1280 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2016 to January 2019 were analyzed retrospectively. Patients were divided into group A (variceal hemorrhage and PSG reduced by one third, n = 479); group B (variceal hemorrhage and PSG reduced to < 12 mmHg, n = 412); group C (refractory ascites and PSG reduced by one third, n = 217); and group D (refractory ascites and PSG reduced to < 12 mmHg of PSG, plus medication, n = 172). The clinical outcomes were analyzed.

RESULTS

By the endpoint of follow-up, recurrent bleeding was no different between groups A and B (χ² = 7.062, P = 0.374), but recurrent ascites did differ significantly between groups C and D (χ² = 14.493, P = 0.006). The probability of total hepatic impairment within 3 years was significantly different between groups A and B (χ² = 11.352, P = 0.005) and groups C and D (χ² = 13.758, P = 0.002). The total incidence of HE differed significantly between groups A and B (χ² = 7.932, P = 0.016), groups C and D (χ² = 13.637, P = 0.007). There were no differences of survival rate between groups A and B (χ² = 3.376, P = 0.369, log-rank test), but did differ significantly between groups C and D (χ² = 13.582, P = 0.014, log-rank test).

CONCLUSION

The PSG reduction by one third may reduce the risk of HE, hepatic function damage and achieve good clinical results.

Research progress on drug delivery systems for curcumin in the treatment of gastrointestinal tumors

Curcumin is a natural compound with a diketone structure, which can control the growth, metastasis, recurrence, neovascularization, invasion, and drug resistance of gastrointestinal tumors by inhibiting nuclear factor κB, overexpression of tumor cells, vascular endothelial growth factor, etc. However, due to the low bioavailability of curcumin formulation, it did not fully exert its pharmacological effects, and its application and development in the treatment of various malignant tumors are still limited. This review summarizes the research on drug delivery systems of curcumin combating digestive tract tumors in order to further reduce the toxic side effects of curcumin-containing drugs and fully exert their pharmacological activities, and improve their bioavailability and clinical value.

Risk factors for myocardial injury during living donor liver transplantation in pediatric patients with biliary atresia

BACKGROUND

Cold ischemia-reperfusion of the liver is an inevitable occurrence in liver transplantation that may also cause damage to the heart. Perioperative myocardial injury during liver transplantation can increase the incidence of postoperative mortality, but there is little research on the incidence of myocardial injury in children who undergo living donor liver transplantation (LDLT). Therefore, this study mainly explores the independent risk factors for myocardial injury in children who undergo LDLT.

AIM

To analyze the data of children who underwent LDLT to determine the risk factors for intraoperative myocardial injury.

METHODS

We retrospectively analyzed the inpatient records of pediatric patients who underwent LDLT in Tianjin First Central Hospital from January 1, 2020, to January 31, 2022. Recipient-related data and donor-related data were collected. The patients were divided into a myocardial injury group and a nonmyocardial injury group according to the value of the serum cardiac troponin I at the end of surgery for analysis. Univariate analysis and multivariate logistic regression were used to evaluate the risk factors for myocardial injury during LDLT in pediatric patients.

RESULTS

A total of 302 patients met the inclusion criteria. The myocardial injury group had 142 individuals (47%), and the nonmyocardial injury group included 160 patients (53%). Age, height, and weight were significantly lower in the myocardial injury group (P < 0.001). The pediatric end-stage liver disease (PELD) score, total bilirubin, and international standardized ratio were significantly higher in the myocardial injury group (P < 0.001). The mean arterial pressure, lactate, hemoglobin before reperfusion, duration of the anhepatic phase, cold ischemic time, incidence of postreperfusion syndrome (PRS), and fresh frozen plasma transfusion were significantly different between the two groups (P < 0.05). The postoperative intensive care unit stay and peak total bilirubin values in the first 5 d after LDLT were significantly higher in the myocardial injury group (P < 0.05). The pediatric patients with biliary atresia in the nonmyocardial injury group who underwent LDLT had a considerably higher one-year survival rate than those in the myocardial injury group (P = 0.015). Multivariate logistic regression revealed the following independent risk factors for myocardial injury: a high PELD score [odds ratio (OR) = 1.065, 95% confidence interval (CI): 1.013-1.121; P = 0.014], a long duration of the anhepatic phase (OR = 1.021, 95%CI: 1.003-1.040; P = 0.025), and the occurrence of intraoperative PRS (OR = 1.966, 95%CI: 1.111-3.480; P = 0.020).

CONCLUSION

A high PELD score, a long anhepatic phase duration, and the occurrence of intraoperative PRS were independent risk factors for myocardial injury during LDLT in pediatric patients with biliary atresia.

Progress in research of factors associated with esophageal and gastric variceal rebleeding in cirrhosis

Rebleeding of esophageal varices in cirrhosis is the focus of secondary prevention in patients with esophageal varices, which can significantly increase the risk of death and seriously affect the prognosis of patients with cirrhosis. At present, clinical focus is not only on the factors affecting the first bleeding and prognosis of esophageal and gastric varices in cirrhosis, but also on the analysis and summary of the factors related to rebleeding. This paper will summarize the impact of epidemiological and laboratory indexes, endoscopy and imaging, and common scoring systems on rebleeding in liver cirrhosis patients with esophageal varices, with an aim to help clinicians formulate individualized treatment plans and preventive strategies, reduce rebleeding rate and fatality rate, and improve patient prognosis.

Predictive value of preoperative albumin-bilirubin score and other risk factors for short-term outcomes after open pancreatoduodenectomy

BACKGROUND

Pancreatoduodenectomy represents a complex procedure involving extensive organ resection and multiple alimentary reconstructions. It is still associated with high morbidity, even in high-volume centres. Prediction tools including preoperative patient-related factors to preoperatively identify patients at high risk for postoperative complications could enable tailored perioperative management and improve patient outcomes.

AIM

To evaluate the clinical significance of preoperative albumin-bilirubin score and other risk factors in relation to short-term postoperative outcomes in patients after open pancreatoduodenectomy.

METHODS

This retrospective study included all patients who underwent open pancreatic head resection (pylorus-preserving pancreatoduodenectomy or Whipple resection) for various pathologies during a five-year period (2017-2021) in a tertiary care setting at University Medical Centre Ljubljana, Slovenia and Cattinara Hospital, Trieste, Italy. Short-term postoperative outcomes, namely, postoperative complications, postoperative pancreatic fistula, reoperation, and mortality, were evaluated in association with albumin-bilirubin score and other risk factors. Multiple logistic regression models were built to identify risk factors associated with these short-term postoperative outcomes.

RESULTS

Data from 347 patients were collected. Postoperative complications, major postoperative complications, postoperative pancreatic fistula, reoperation, and mortality were observed in 52.7%, 22.2%, 23.9%, 21.3%, and 5.2% of patients, respectively. There was no statistically significant association between the albumin-bilirubin score and any of these short-term postoperative complications based on univariate analysis. When controlling for other predictor variables in a logistic regression model, soft pancreatic texture was statistically significantly associated with postoperative complications [odds ratio (OR): 2.09; 95% confidence interval (95%CI): 1.19-3.67]; male gender (OR: 2.12; 95%CI: 1.15-3.93), soft pancreatic texture (OR: 3.06; 95%CI: 1.56-5.97), and blood loss (OR: 1.07; 95%CI: 1.00-1.14) were statistically significantly associated with major postoperative complications; soft pancreatic texture was statistically significantly associated with the development of postoperative pancreatic fistula (OR: 5.11; 95%CI: 2.38-10.95); male gender (OR: 1.97; 95%CI: 1.01-3.83), soft pancreatic texture (OR: 2.95; 95%CI: 1.42-6.11), blood loss (OR: 1.08; 95%CI: 1.01-1.16), and resection due to duodenal carcinoma (OR: 6.58; 95%CI: 1.20-36.15) were statistically significantly associated with reoperation.

CONCLUSION

The albumin-bilirubin score failed to predict short-term postoperative outcomes in patients undergoing pancreatoduodenectomy. However, other risk factors seem to influence postoperative outcomes, including male sex, soft pancreatic texture, blood loss, and resection due to duodenal carcinoma.

Prediction model establishment and validation for enteral nutrition aspiration during hospitalization in patients with acute pancreatitis

BACKGROUND

Acute pancreatitis (AP) is a disease caused by abnormal activation of pancreatic enzymes and can lead to self-digestion of pancreatic tissues and dysfunction of other organs. Enteral nutrition plays a vital role in the treatment of AP because it can meet the nutritional needs of patients, promote the recovery of intestinal function, and maintain the barrier and immune functions of the intestine. However, the risk of aspiration during enteral nutrition is high; once aspiration occurs, it may cause serious complications, such as aspiration pneumonia, and suffocation, posing a threat to the patient's life. This study aims to establish and validate a prediction model for enteral nutrition aspiration during hospitalization in patients with AP.

AIM

To establish and validate a predictive model for enteral nutrition aspiration during hospitalization in patients with AP.

METHODS

A retrospective review was conducted on 200 patients with AP admitted to Chengdu Shangjin Nanfu Hospital, West China Hospital of Sichuan University from January 2020 to February 2024. Clinical data were collected from the electronic medical record system. Patients were randomly divided into a validation group (n = 40) and a modeling group (n = 160) in a 1:4 ratio, matched with 200 patients from the same time period. The modeling group was further categorized into an aspiration group (n = 25) and a non-aspiration group (n = 175) based on the occurrence of enteral nutrition aspiration during hospitalization. Univariate and multivariate logistic regression analyses were performed to identify factors influencing enteral nutrition aspiration in patients with AP during hospitalization. A prediction model for enteral nutrition aspiration during hospitalization was constructed, and calibration curves were used for validation. Receiver operating characteristic curve analysis was conducted to evaluate the predictive value of the model.

RESULTS

There was no statistically significant difference in general data between the validation and modeling groups (P > 0.05). The comparison of age, gender, body mass index, smoking history, hypertension history, and diabetes history showed no statistically significant difference between the two groups (P > 0.05). However, patient position, consciousness status, nutritional risk, Acute Physiology and Chronic Health Evaluation (APACHE-II) score, and length of nasogastric tube placement showed statistically significant differences (P < 0.05) between the two groups. Multivariate logistic regression analysis showed that patient position, consciousness status, nutritional risk, APACHE-II score, and length of nasogastric tube placement were independent factors influencing enteral nutrition aspiration in patients with AP during hospitalization (P < 0.05). These factors were incorporated into the prediction model, which showed good consistency between the predicted and actual risks, as indicated by calibration curves with slopes close to 1 in the training and validation sets. Receiver operating characteristic analysis revealed an area under the curve (AUC) of 0.926 (95%CI: 0.8889-0.9675) in the training set. The optimal cutoff value is 0.73, with a sensitivity of 88.4 and specificity of 85.2. In the validation set, the AUC of the model for predicting enteral nutrition aspiration in patients with AP patients during hospitalization was 0.902, with a standard error of 0.040 (95%CI: 0.8284-0.9858), and the best cutoff value was 0.73, with a sensitivity of 91.9 and specificity of 81.8.

CONCLUSION

A prediction model for enteral nutrition aspiration during hospitalization in patients with AP was established and demonstrated high predictive value. Further clinical application of the model is warranted.

Radiofrequency ablation combined with transcatheter arterial chemoembolization for recurrent liver cancer

BACKGROUND

The recurrence rate of liver cancer after surgery is high. Radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) is an effective treatment for liver cancer; however, its efficacy in recurrent liver cancer remains unclear.

AIM

To investigate the clinical effect of TACE combined with RFA in the treatment of recurrent liver cancer.

METHODS

Ninety patients with recurrent liver cancer were divided into 2 groups according to treatment plan: Control (RFA alone); and experimental [TACE combined with RFA (TACE + RFA)]. The incidence of increased alanine aminotransferase levels, complications, and other indices were compared between the two groups before and after the procedures.

RESULTS

One month after the procedures, the short-term efficacy rate and Karnofsky Performance Status scores of the experimental group were significantly higher than those of the control group (P < 0.05). Alpha-fetoprotein (AFP) and total bilirubin levels were lower than those in the control group (P < 0.05); The overall response rate was 82.22% and 66.67% in the experimental and control groups, respectively; The disease control rate was 93.33% and 82.22% in the experimental and control groups, respectively, the differences are statistically significant (P < 0.05). And there were no statistical differences in complications between the two groups (P > 0.05).

CONCLUSION

TACE + RFA was effective for the treatment of recurrent liver cancer and significantly reduced AFP levels and improved various indices of liver function.

Hepatitis B virus markers in hepatitis B surface antigen negative patients with pancreatic cancer: Two case reports

BACKGROUND

Hepatitis B virus (HBV) is a known carcinogen that may be involved in pancreatic cancer development. Detection of HBV biomarkers [especially expression of HBV regulatory X protein (HBx)] within the tumor tissue may provide direct support for this. However, there is still a lack of such reports, particularly in non-endemic regions for HBV infection. Here we present two cases of patients with pancreatic ductal adenocarcinoma, without a history of viral hepatitis, in whom the markers of HBV infection were detected in blood and in the resected pancreatic tissue.

CASE SUMMARY

The results of examination of two patients with pancreatic cancer, who gave informed consent for participation and publication, were the source for this study. Besides standards of care, special examination to reveal occult HBV infection was performed. This included blood tests for HBsAg, anti-HBc, anti-HBs, HBV DNA, and pancreatic tissue examinations with polymerase chain reaction for HBV DNA, pregenomic HBV RNA (pgRNA HBV), and covalently closed circular DNA HBV (cccDNA) and immunohistochemistry staining for HBxAg and Ki-67. Both subjects were operated on due to pancreatic ductal adenocarcinoma and serum HBsAg was not detected. However, in both of them anti-HBc antibodies were detected in blood, although HBV DNA was not found. Examination of the resected pancreatic tissue gave positive results for HBV DNA, expression of HBx, and active cellular proliferation by Ki-67 index in both cases. However, HBV pgRNA and cccDNA were detected only in case 1.

CONCLUSION

These cases may reflect potential involvement of HBV infection in the development of pancreatic cancer.

Therapeutic effects of recombinant retrovirus mediated antisense K-ras gene on pancreatic cancer

AIM: To isolate and clone antisense K-ras gene fragments and to clarify its effect on proliferation and apoptosis of pancreatic cancer cells and expression of K-ras mRNA and p21 protein.

METHODS: Polymerase chain reaction (PCR) was used to amplify K-ras gene exon 1 and 4 as well as the flanking sequences, taking pancreatic carcinoma cell line BxPC-3 and PC-3 genomic DNA as the template. The target gene was cloned into retroviral vector pLXSN to construct the recombinant plasmid. After packaged in PT-67 cells the retrovirus was obtained. Then BxPC-3 and PC-3 cells were transfected with the recombinant retrovirus. Proliferation, apoptosis of pancreatic carcinoma cells and the expression of p21 protein were detected by MTT, flow cytometry and immunohistochemistry respectively. The therapeutic effect of retrovirus on hepatocellular carcinoma was observed in mice.

RESULTS: The antisense K-ras gene was successfully cloned into the vector pLXSN. Proliferation of PC-3 cells was significantly inhibited at day 1, 2, 3, 4, and 5 after transfected with pLXSN-AS-exon1/4B, compared with that of non-transfected cells and pLXSN-transfected group (F = 4.716, P < 0.05; F = 6.914, P < 0.05; F = 15.115, P < 0.05; F = 16.883, P < 0.05; F = 15.134, P < 0.05; repectively). BxPC-3 showed no significant difference among different groups. Expression of K-ras mRNA and p21 protein in PC-3 cells obviously decreased while those in BxPC-3 cells not so obviously. Apoptotic rates of PC-3 cells transfected with pLXSN-AS-exon1 and pLXSN-AS-exon4B were significantly higher than those with pLXSN and non-transfection (10.28%, 6.7% vs 2.86%, 3.24%; P < 0.01). Apoptosis of BxPC-3 cells were not significant among different groups. The size of hepatocellular carcinoma significantly decreased after treated with pLXSN-AS-exon1 and pLXSN-AS-exon4B, compared with that treated with pLXSN (0.32 ± 0.09 g, 0.352 ± 0.05 g vs 0.60 ± 0.09 g; P < 0.01).

CONCLUSION: The retrovius-mediated antisense K-ras gene can inhibit proliferation and induce apoptosis of pancreatic carcinoma cells. The mechanism may relate to down-regulating expression of K-ras mRNA and p21 protein.

Expression of MGMT, hMLH1 and hMSH2 and its clinopathological significance in pancreatic carcinoma tissues

AIM: To study the expression of MGMT, hMLH₁ and hMSH₂ and their clinicopathological significances in the tissues of chronic pancreatitis and pancreatic adenocarcinoma.

METHODS: The expression levels of MGMT, hMLH₁ and hMSH₂ were assayed by immunohistochemical method of avidin-biotin complex on the formalin-fixed and routinely paraffin-embedded sections of surgical resected specimen with chronic pancreatitis (n = 10) and pancreatic carcinoma (n = 51).

RESULTS: The positive rates and the scores of MGMT, hMLH₁ and hMSH₂ were significantly higher in chroinic pancreatitis than those of pancreatic carcinoma (MGMT: 100.0% vs 39.2%,3.8±0.8 vs 1.8±1.4; hMLH1: 100.0% vs 45.1%, 3.8±1.0 vs 1.7±1.6; hMSH2: 90.0% vs 50.9%, 3.5±0.9 vs 1.9±1.7). The positive rates and the scores of MGMT, hMLH₁ and hMSH₂ were significantly higher in well-differentiated adenocarcinomas than those of poorly differentiated adenocarcinomas (P < 0.05 or P < 0.01). The positive rates and the scores of MGMT, hMLH₁ and hMSH₂ were higher in metastasis-free cases than those of ones with metastasis, but no statistic difference was found (P>0.05). There was also no difference among the expression of three proteins and the other clinicopathological characteristics of pancreatic carcinoma.

CONCLUSION: The expression of MGMT, hMLH₁ or hMSH₂ may be related to the carcinogenesis and progression, and have inhibifory effects on the carcinogenesis and progression of pancreatic carcinoma.

Regular hepatic segmentectomy for giant hemangioma of the liver: An analysis of 26 cases

AIM: To evaluate the safety of regular hepatic segmentectomy for giant hemangioma of the liver.

METHODS: The clinical data for patients with giant hemangioma of the liver who underwent surgical resection between January 2008 and December 2010 in Nanjing Drum Tower Hospital were analyzed retrospectively.

RESULTS: A total of 26 patients were included in the study. All patients underwent regular hepatic segmentectomy. There were no deaths, but 4 patients developed complications. The intraoperative bleeding ranged from 100 to 2 600 mL (average, 775 mL ± 132 mL), and intraoperative blood transfusion ranged between 0 and 2 200 mL (average, 384 mL ± 123 mL).

CONCLUSION: Regular hepatic segmentectomy is safe in the management of giant hemangioma occupying the liver lobe or segment.

Recombinant adenovirus-mediated Hsp70 gene expression inhibits tumor growth in a rat xenograft model of pancreatic cancer

AIM: To observe the effect of recombinant adenovirus Ad5-pCEA-Hsp70-mediated Hsp70 gene expression on tumor growth in a rat xenograft model of pancreatic cancer, and to analyze the underlying mechanism.

METHODS: A rat xenograft model of pancreatic cancer was established, and model animals were randomly divided into three groups, which were given Ad5-pCEA-Hsp70, Ad5-control and PBS treatment, respectively. Antitumor effect was evaluated by comparing tumor size at different time points among the three groups. ELISA was used to detect the peripheral blood levels of Hsp70 protein, INF-g, TNF-a and IL-6. HE staining was used to detect lymphocyte infiltration. Animal spleen mononuclear cells were isolated to determine the proportion of CD83+ cells by flow cytometry. Cell-killing ability of spleen lymphocytes was observed in vitro.

RESULTS: At 4, 6, and 8 weeks after treatment, tumor volume in the Ad5-CEA-Hsp70 group was significantly lower than that in the Ad5-control group and PBS group (724.4 mm³ ± 81.6 mm³vs 901.3 mm³ ± 103.9 mm³, 987.5 mm³ ± 126.0 mm³; 681.3 mm³ ± 64.9 mm³vs 1 270.6 mm³ ± 131.6 mm³, 1 398.5 mm³ ± 193.0 mm³; 648.0 mm³ ± 65.9 mm³vs 1 487.0 mm³ ± 243.0 mm³, 1 660.0 mm³ ± 167.0 mm3; all P < 0.01). The levels of Hsp70 protein and cytokines INF-g, TNF-a and IL-6 in peripheral blood in the Ad5-pCEA-Hsp70 group were significantly higher than those in the Ad5-control group and PBS group (all P < 0.01). Compared to the Ad5-control group and PBS group, Ad5-pCEA-Hsp70 group had more lymphocytic infiltration. The proportion of CD83+ cells in the Ad5-pCEA-Hsp70 group was significantly higher than that in the Ad5-control group and PBS group (10.8% ± 1.3% vs 5.1% ± 0.6%, 4.8% ± 0.6%; both P < 0.01). In the lymphocyte-mediated CTL experiment, when the cell ratio of effect: target was 1:1, there was no significant difference in the cell killing ability among the three groups (P > 0.05), but with the increase in the effect: target cell ratio, the cell killing ability in the Ad5-pCEA-Hsp70 group was significantly increased (P < 0.05, P < 0.01).

CONCLUSION: Hsp70 gene expression mediated by recombinant adenovirus Ad5-pCEA-Hsp70 could inhibit tumor growth in a rat xenograft model of pancreatic cancer via mechanisms that are related to the promotion of dentritic cell maturation, induction of cytokine secretion, and promotion of lymphocyte infiltration.

Liver abscess and tracheal fistula induced by transcatheter arterial chemoembolization for hepatocellular carcinoma: A case report

BACKGROUND

Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC). The complications of TACE include biliary tract infection, liver dysfunction, tumor lysis syndrome, biloma, partial intestinal obstruction, cerebral lipiodol embolism, etc. There are few reports about tracheal fistula induced by TACE.

CASE SUMMARY

A 42-year-old man came to our hospital with cough and expectoration for 1 month after TACE for HCC. Laboratory test results showed abnormalities of albumin, hemoglobin, prothrombin time, C-reactive protein, D-dimer, and prothrombin. Culture of both phlegm and liver pus revealed growth of Citrobacter flavescens. Computed tomography showed infection in the inferior lobe of the right lung and a low-density lesion with gas in the right liver. Liver ultrasound showed that there was a big hypoechoic liquid lesion without blood flow signal. Drainage for liver abscess by needle puncture under ultrasonic guidance was performed. After 1 month of drainage and anti-infection therapy, the abscess in the liver and the infection in the lung were reduced obviously, and the symptom of expectoration was relieved.

CONCLUSION

Clinicians should be alert to the possibility of complications of liver abscess and tracheal fistula after TACE for HCC. Drainage for liver abscess by needle puncture under ultrasonic guidance could relieve the liver abscess and tracheal fistula.

N/A

N/A

Application of surface-enhanced laser desorption/ionization time-of-flight mass spectrometry for early detection of pancreatic cancer

Pancreatic cancer is a devastating and lethal disease. Early detection continues to be a serious, unsolved problem. However, proteomics is emerging as a powerful new tool for the diagnosis of pancreatic cancer. Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) is a new technique that allows for rapid high-throughput screening of protein expression in clinical samples. The progress and challenges in applying SELDI-TOF MS to protein biomarker discovery in pancreatic cancer are reviewed in this paper.

Burden landscape of hepatobiliary and pancreatic cancers in Chinese young adults: 30 years’ overview and forecasted trends

BACKGROUND

Hepatobiliary and pancreatic (HBP) cancers impose a considerable burden on young populations (aged 15 to 49 years), resulting in a substantial number of new cases and fatalities each year. In young populations, the HBP cancers shows extensive variance worldwide and the updated data in China is lacking.

AIM

To investigate the current status, trends, projections, and underlying risk factors of HBP cancers among young populations in China.

METHODS

The Global Burden of Disease Study 2019 provided data on the annual incidence, mortality, disability-adjusted life years (DALYs), age-standardized incidence rate (ASIR), mortality rate (ASMR), and DALYs rate (ASDR) of HBP cancers in young Chinese adults between 1990 and 2019. Temporal trends were assessed using estimated annual percentage change and hierarchical clustering. Sex-specific mortality and DALYs caused by various risks were analyzed across China and other regions, with future trends until 2035 projected using the Bayesian age-period-cohort model.

RESULTS

From 1990 to 2019, incident cases, deaths, DALYs, ASIR, ASMR, and ASDR for liver cancer (LC) in young Chinese individuals decreased, classified into 'significant decrease' group. Conversely, cases of gallbladder and biliary tract cancer and pancreatic cancer rose, categorized as either 'significant increase' or 'minor increase' groups. The contribution of risk factors to mortality and DALYs for HBP tumors increased to varying degrees. Healthy lifestyle behaviors, such as tobacco control, weight management, alcohol moderation, and drug avoidance, could lower HBP cancers incidence. Moreover, except for LC in females, which is likely to initially decline slightly and then rise, the forecasting model predicted that the ASIR and ASMR for all HPB cancers subtypes by gender will increase among young adults.

CONCLUSION

HBP cancers burden among young adults in China is expected to increase until 2035, necessitating lifestyle interventions and targeted treatment strategies to mitigate the public health impact of these cancers.

Sodium-dependent glucose transporter 2 inhibitors: Transforming diabetic cardiomyopathy management

This article addresses the substantial findings of a study on sodium-dependent glucose transporter 2 inhibitors (SGLT2is) and their effects on myocardial function in patients with type 2 diabetes and asymptomatic heart failure. The editorial explores the broader implications of the study findings for clinical practice, thus highlighting the pivotal role of SGLT2is in improving cardiac function, reducing oxidative stress, and attenuating inflammation. It emphasizes the importance of early intervention with SGLT2is in preventing the progression of diabetic cardiomyopathy; hence, these inhibitors have the potential to transform the management of asymptomatic heart failure in patients with diabetes.

Effects of high-quality nursing on surgical site wound infections after colostomy in patients with colorectal cancer

BACKGROUND

Colostomy is important in the treatment of colorectal cancer. However, surgical site wound infections after colostomy seriously affect patients' physical recovery and quality of life.

AIM

To investigate the ability of high-quality nursing care to prevent surgical site wound infections and reduce post-colostomy complications in patients with colorectal cancer.

METHODS

Eighty patients with colorectal cancer who underwent colostomy at our hospital between January 2023 and January 2024 were selected as research subjects. The random number table method was used to divide the participants into control and research groups (n = 40 each). The control group received routine nursing care, while the research group received high-quality nursing care. The differences in indicators were compared between groups.

RESULTS

The baseline characteristics did not differ between the research (n = 40) and control (n = 40) groups (P > 0.05). The incidences of wound infection, inflammation, and delayed wound healing were significantly lower in the research (5.00%) vs control (25.00%) group (P = 0.028). The incidence of postoperative complications, including fistula stenosis, fistula hemorrhage, fistula prolapse, peristome dermatitis, urinary retention, pulmonary infection, and intestinal obstruction, was significantly lower in the research (5.00%) vs control (27.50%) group (P = 0.015). In addition, the time to first exhaust (51.40 ± 2.22 vs 63.80 ± 2.66, respectively; P < 0.001), time to first bowel movement (61.30 ± 2.21 vs 71.80 ± 2.74, respectively; P < 0.001), and average hospital stay (7.94 ± 0.77 vs 10.44 ± 0.63, respectively; P < 0.001) were significantly shorter in the research vs control group. The mean Newcastle satisfaction with nursing scale score was also significantly higher in the research (91.22 ± 0.96) vs control (71.13 ± 1.52) group (P < 0.001).

CONCLUSION

High-quality nursing interventions can effectively reduce the risk of wound infections and complications in patients undergoing colostomy, promote their postoperative recovery, and improve their satisfaction with the nursing care received.

Current evidence on artificial intelligence in regional anesthesia

The recent advancement in regional anesthesia (RA) has been largely attributed to ultrasound technology. However, the safety and efficiency of ultrasound-guided nerve blocks depend upon the skill and experience of the performer. Even with adequate training, experience, and knowledge, human-related limitations such as fatigue, failure to recognize the correct anatomical structure, and unintentional needle or probe movement can hinder the overall effectiveness of RA. The amalgamation of artificial intelligence (AI) to RA practice has promised to override these human limitations. Machine learning, an integral part of AI can improve its performance through continuous learning and experience, like the human brain. It enables computers to recognize images and patterns specifically useful in anatomic structure identification during the performance of RA. AI can provide real-time guidance to clinicians by highlighting important anatomical structures on ultrasound images, and it can also assist in needle tracking and accurate deposition of local anesthetics. The future of RA with AI integration appears promising, yet obstacles such as device malfunction, data privacy, regulatory barriers, and cost concerns can deter its clinical implementation. The current mini review deliberates the current application, future direction, and barrier to the application of AI in RA practice.