Combination of preoperative plasma fibrinogen and AJCC staging improves the accuracy of survival prediction for patients with stage I-II gastric cancer after curative gastrectomy

This study aimed to determine the prognostic value of preoperative plasma fibrinogen concentration (PFC) in patients with stage I‐II gastric cancer after curative gastrectomy. The preoperative PFC and clinicopathological data of 793 patients with stage I‐II gastric cancer who underwent curative gastrectomy were analyzed retrospectively. PFC of <4.0 g/L and ≥4.0 g/L were considered as PFC0 and PFC1, respectively. The association between PFC and the clinicopathological features of gastric cancer and the value of PFC in survival prediction were investigated. PFC1 indicated poorer overall survival and cancer‐specific survival among patients with tumor‐node‐metastasis (TNM) stage I‐II, and PFC was identified as an independent indicator of survival via multivariate analysis. Importantly, PFC stage was proven to be an independent prognostic factor for stage I and T1‐4aN0 gastric cancer. PFC stage combined with the American Joint Committee on Cancer (AJCC)‐TNM stage has better accuracy for predicting disease prognosis than AJCC‐TNM stage alone. The prognosis of patients with stage I‐II gastric cancer can be further stratified by PFC level. For patients with stage I gastric cancer, PFC1 can be considered a high‐risk prognostic factor, and adjuvant chemotherapy should be recommended for patients with PFC1.

Improvement of T stage precision by integration of surgical and pathological staging in radically resected stage pT3-pT4b gastric cancer

Background

Both surgical TNM (sTNM) and pathological TNM (pTNM) staging are important clinicopathologic indexes of gastric cancer (GC). However, surgeons and pathologists might assess tumor depth differently in the same patient. To investigate the prognostic significance of sTNM status in patients with radically resected stage pT3-pT4b GC, we examined the relationship between sTNM and pTNM.

Methods

Clinicopathologic and survival data of 1289 patients with stage pT3-pT4b GC were studied retrospectively, in the aftermath of radical surgery.

Results

The unconformity for assessing tumor invasion depth were frequently exhibited between sT and pT staging. Comparison of 5-year OS among them, no significant differences were observed (pT3/sT3 vs pT3/sT4a, p=0.962; pT4a/sT4b vs pT4b/sT4b, p=0.508). Also, pT3/sT4b, pT4a/sT3 and pT4a/sT4a were homogeneity in prognosis. We proposed a revised pT stage in which surgical macroscopic T4b (sT4b) was incorporated into the pT stage, namely, patients in the pT3 stage with sT4b cancers were reclassified as being in the r-pT4a stage; patients in the pT4a stage with sT4b cancers were reclassified as being in the r-pT4b stage. In two-step multivariate analysis, revised pT stage proved more suitable for determining prognosis, surpassing both UICC/AJCC pT stage and sT stage as an independent prognostic index.

Conclusions

Surgical T stage is a significant and independent prognostic index of overall survival (OS) in patients with radically resected advanced GC. Patients in the pT3/4a stage with sT4b cancers, are potentially underestimated, and should be considered higher stage in terms of prognostic.

Overexpression of RNF126 Promotes the Development of Colorectal Cancer via Enhancing p53 Ubiquitination and Degradation

BACKGROUND

RING finger protein 126 (RNF126), as a novel E3 ubiquitin ligase, plays an oncogenic role in several solid cancers. But its potential role in colorectal cancer (CRC) that harbored 50% mutant p53, to our knowledge, is rarely reported.

MATERIALS AND METHODS

We investigated the clinical significance and relationship of RNF126 and p53 in CRC tissues and cells. Meanwhile, WB, qRT-PCR, co-IP, MTT, and transwell were used to investigate the function and molecular mechanism of RNF126 in regulating malignant biology in vitro.

RESULTS

RNF126 was overexpressed in human CRC specimens, which was tightly associated with tumor size (P=0.021), T stage (P=0.030), lymph node metastasis (P=0.006), TNM stage (P=0.001), and the poor survival (P=0.003) of CRC patients. RNF126 had no association with p53 mutation in CRC specimens, and in p53 mutant Colo-205 and SW620 cells. However, in p53 wildtype HCT116 and HCT-8 cells, RNF126 silencing upregulated p53 and p21 but inhibited Rb phosphorylation at Serine 780 (pRb), which was inhibited by p53siRNA. Conversely, RNF126 overexpression downregulated p53 and p21 but promoted pRb expression, which was reversed by a classic proteasome inhibitor, MG132. However, the mRNA levels of above target genes were unchanged, implying a ubiquitination dependent post-translational modification involving in above regulation. Meanwhile, RNF126 was co-immunoprecipitated with p53 and p21 to form a triple complex. RNF126 silencing and overexpression inhibited and promoted p53 ubiquitination and degradation in vitro, respectively. In addition, p53siRNA reversed RNF126 silencing-inhibited cell proliferation, drug resistance, and cell mobility in HCT116 cells. Conversely, MG132 inhibited RNF126 overexpression-promoted above cell biology in HCT-8 cells.

CONCLUSION

Overexpression of RNF126 was remarkably associated with multiple advanced clinical characters of CRC patients independent of mutant p53. RNF126 promotes cell proliferation, mobility, and drug resistance in CRC via enhancing p53 ubiquitination and degradation.

Profiles and Findings of Population-Based Esophageal Cancer Screening With Endoscopy in China: Systematic Review and Meta-analysis

BACKGROUND

Population-based esophageal cancer (EC) screening trials and programs have been conducted in China for decades; however, screening strategies have been adopted in different regions and screening profiles are unclear.

OBJECTIVE

We performed a meta-analysis to profile EC screening in China by positivity rate, compliance rate, and endoscopy findings, aiming to provide explicit evidence and recommendations for EC screening programs.

METHODS

English (PubMed, Embase) and Chinese (China National Knowledge Infrastructure, Wanfang) language databases were systematically searched for population-based EC screening studies in the Chinese population until December 31, 2022. A meta-analysis was performed by standard methodology using a random-effects model. Pooled prevalence rates were calculated for three groups: high-risk areas with a universal endoscopy strategy, rural China with a risk-stratified endoscopic screening (RSES) strategy, and urban China with an RSES strategy. Positive cases included lesions of severe dysplasia, carcinoma in situ, intramucosal carcinoma, submucosal carcinoma, and invasive carcinoma.

RESULTS

The pooled positivity rate of the high-risk population was higher in rural China (44.12%) than in urban China (23.11%). The compliance rate of endoscopic examinations was the highest in rural China (52.40%), followed by high-risk areas (50.11%), and was the lowest in urban China (23.67%). The pooled detection rate of positive cases decreased from 1.03% (95% CI 0.82%-1.30%) in high-risk areas to 0.48% (95% CI 0.25%-0.93%) in rural China and 0.12% (95% CI 0.07%-0.21%) in urban China. The pooled detection rate of low-grade intraepithelial neoplasia (LGIN) was also in the same order, being the highest in high-risk areas (3.99%, 95% CI 2.78%-5.69%), followed by rural China (2.55%, 95% CI 1.03%-6.19%) and urban China (0.34%, 95% CI 0.14%-0.81%). Higher detection rates of positive cases and LGIN were observed among males than among females and at older ages. The pooled early detection rate was 81.90% (95% CI 75.58%-86.88%), which was similar to the rates in high-risk areas (82.09%), in rural China (80.76%), and in urban China (80.08%).

CONCLUSIONS

Under the current screening framework, a higher screening benefit was observed in high-risk areas than in other regions. To promote EC screening and reduce the current inequality of screening in China, more focus should be given to optimizing strategies of high-risk individual assessment and surveillance management to improve compliance with endoscopic examination.

TRIAL REGISTRATION

PROSPERO CRD42022375720; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=375720.

Alteration of podocyte protein expression and localization in the early stage of various hemodynamic conditions

Given that podocalyxin (PCX) and nestin play important roles in podocyte morphogenesis and the maintenance of structural integrity, we examined whether the expression and localization of these two podocyte proteins were influenced in the early stage of various hemodynamic conditions. Mice kidney tissues were prepared by in vivo cryotechnique (IVCT). The distribution of glomeruli and podocyte proteins was visualized with DAB staining, confocal laser scanning microscopy and immunoelectron microscopy. The mRNA levels were examined by real-time quantitative PCR. The results showed the following: Under the normal condition, PCX stained intensely along glomerular epithelial cells, whereas nestin was clearly staining in the endothelial cells and appeared only weakly in the podocytes. Under the acute hypertensive and cardiac arrest conditions, PCX and nestin staining was not clear, with a disarranged distribution, but the colocalization of PCX and nestin was apparent under this condition. In addition, under the acute hypertensive and cardiac arrest conditions, the mRNA levels of PCX and nestin were significantly decreased. Collectively, the abnormal redistribution and decreased mRNA expressions of PCX and nestin are important molecular events at the early stage of podocyte injury during hemodynamic disorders. IVCT may have more advantages for morphological analysis when researching renal diseases.

Retrospective evaluation of lymphatic and blood vessel invasion and Borrmann types in advanced proximal gastric cancer

BACKGROUND

The Borrmann classification system is used to describe the macroscopic appearance of advanced gastric cancer, and Borrmann type IV disease is independently associated with a poor prognosis.

AIM

To evaluate the prognostic significance of lymphatic and/or blood vessel invasion (LBVI) combined with the Borrmann type in advanced proximal gastric cancer (APGC).

METHODS

The clinicopathological and survival data of 440 patients with APGC who underwent curative surgery between 2005 and 2012 were retrospectively analyzed.

RESULTS

In these 440 patients, LBVI+ status was associated with Borrmann type IV, low histological grade, large tumor size, and advanced pT and pN status. The 5-year survival rate of LBVI+ patients was significantly lower than that of LBVI– patients, although LBVI was not an independent prognostic factor in the multivariate analysis. No significant difference in the prognosis of patients with Borrmann type III/LBVI+ disease and patients with Borrmann type IV disease was observed. Therefore, we proposed a revised Borrmann type IV (r-Bor IV) as Borrmann type III plus LBVI+, and found that r-Bor IV was associated with poor prognosis in patients with APGC, which outweighed the prognostic significance of pT status.

CONCLUSION

LBVI is related to the prognosis of APGC, but is not an independent prognostic factor. LBVI status can be used to differentiate Borrmann types III and IV, and the same approach can be used to treat r-Bor IV and Borrmann type IV.

β-Catenin signaling contributes to platelet derived growth factor elicited bladder smooth muscle cell contraction through up-regulation of Cx43 expression

PURPOSE

Increased gap junctions contribute to bladder overactivity but the factors and mechanisms involved in gap junction regulation in the bladder are not well established. We examined whether and how platelet derived growth factor regulates connexin43 in bladder smooth muscle cells.

MATERIALS AND METHODS

Cultured rat bladder smooth muscle cells were treated with growth factors with or without agents that interfere with phosphatidylinositol 3-kinase, mitogen activated protein kinase and β-catenin signaling pathways. Connexin43 expression was examined by Western and Northern blot, and immunochemistry. Functional gap junctions were evaluated by scrape-loading dye transfer assay. Bladder smooth muscle cell contraction was measured by collagen gel contraction.

RESULTS

1) Platelet derived growth factor induced phosphatidylinositol 3-kinase and mitogen activated protein kinase dependent accumulation of nuclear β-catenin. This was followed by increased connexin43 expression. 2) Down-regulation of β-catenin by specific siRNA abolished the connexin43 increasing effect of platelet derived growth factor while β-catenin stimulation due to glycogen synthase kinase inhibition mimicked that effect. 3) Basic fibroblast growth factor and epidermal growth factor also induced connexin43 expression. Their effects were potentiated by platelet derived growth factor. 4) Gap junction inhibition attenuated the bladder smooth muscle cell contraction induced by platelet derived growth factor. Consistently fibroblasts from connexin43 knockout (Cx43-/-) mice showed a much weaker contractile response to platelet derived growth factor than cells from connexin43-wild (Cx43+/+) litter mates.

CONCLUSIONS

Platelet derived growth factor induces connexin43 expression and bladder smooth muscle cell contraction by activating β-catenin signaling. As a convergence point for many signal pathways, β-catenin may be targeted to treat bladder overactivity.

Minimally invasive percutaneous nephrolithotomy improves stone-free rates for impacted proximal ureteral stones: A systematic review and meta-analysis

Background

Urinary stones are common medical disorders and the treatment of impacted proximal ureteral stones (IPUS) is still a challenge for urologists. The aim of this study was to compare the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MI-PCNL) and ureteroscopic lithotripsy (URL) in the treatment of IPUS via a meta-analysis.

Methods

We collected studies using PubMed, Embase, and Cochrane Library from 1978 to November 2016 and analyzed them using Stata 12.0 and RevMan 5.3. Odds ratios (ORs) and standard mean difference (SMD) were calculated for binary and continuous variables respectively, accompanied with 95% confidence intervals (CIs). All study procedures followed the PRISMA guidelines.

Results

Five prospective studies were included in our meta-analysis, with 242 MI-PCNL and 256 URL cases. MI-PCNL was associated with a longer postoperative hospital stay than URL (SMD, 3.14; 95% CI, 1.27 to 5.55). However, no significant difference was observed in operative time (SMD, -0.38; 95% CI, -3.15 to 2.38). In addition, MI-PCNL had higher initial (OR, 11.12; 95% CI, 5.56 to 22.24) and overall stone-free rates (OR, 8.70; 95% CI, 3.23 to 23.45) than URL, along with lower possibilities of surgical conversion (OR, 0.11; 95% CI, 0.03 to 0.49) and postoperative shock wave lithotripsy (OR, 0.06; 95% CI, 0.02 to 0.18). Regarding complications, no significant differences were observed between MI-PCNL and URL (OR, 1.39; 95% CI, 0.93 to 2.10), except for hematuria (OR, 4.80; 95% CI, 1.45 to 15.94).

Conclusions

MI-PCNL is optimal and should be considered as the preferred treatment method for IPUS, as it has better efficacy and a safety profile similar to that of URL. However, further high quality studies with larger sample size are required in future.

Down-regulation of integrin β1 and focal adhesion kinase in renal glomeruli under various hemodynamic conditions

Given that integrin β1 is an important component of the connection to maintain glomerular structural integrity, by binding with multiple extracellular matrix proteins and mediating intracellular signaling. Focal adhesion kinase (FAK) is the most essential intracellular integrator in the integrin β1-FAK signalling pathway. Here, we investigated the changes of the two molecules and visualized the possbile interaction between them under various hemodynamic conditions in podocytes. Mice kidney tissues were prepared using in vivo cryotechnique (IVCT) and then were stained and observed using light microscopy, confocal laser scanning microscopy and immunoelectron microscopy. The expression of these molecules were examined by western blot. Under the normal condition, integrin β1 stained continually and evenly at the membrane, and FAK was located in the cytoplasm and nuclei of the podocytes. There were significant colocalized plaques of two molecules. But under acute hypertensive and cardiac arrest conditions, integrin β1 decreased and stained intermittently. Similarly, FAK decreased and appeared uneven. Additionally, FAK translocated to the nuclei of the podocytes. As a result, the colocalization of integrin β1 and FAK reduced obviously under these conditions. Western blot assay showed a consistent result with the immunostaining. Collectively, the abnormal redistribution and decreased expressions of integrin β1 and FAK are important molecular events in regulating the functions of podocytes under abnormal hemodynamic conditions. IVCT could offer considerable advantages for morphological analysis when researching renal diseases.

Eviprostat activates cAMP signaling pathway and suppresses bladder smooth muscle cell proliferation

Eviprostat is a popular phytotherapeutic agent for the treatment of lower urinary tract symptoms (LUTS). At present, the signaling mechanisms underlying its therapeutic effects are still poorly understood. Given that cAMP has been reported to suppress cell hyperplasia and hypertrophy in various pathological situations, we asked whether the effect of Eviprostat could be ascribed to the activation of the cAMP signaling pathway. In the study, exposure of cAMP response element (CRE)-secreted alkaline phosphatase (SEAP) (CRE-SEAP)-reporter cells to Eviprostat elevated SEAP secretion, which was associated with an increased phosphorylation of vasodilator-stimulated phosphoprotein (VASP) and cAMP-response element-binding protein (CREB), as well as enhanced expression of CRE-regulated protein connexin43, indicating an activation of the cAMP signaling pathway. Consistent with these observations, Eviprostat-induced expression of Cx43 was abolished in the presence of adenylyl cyclase inhibitor SQ22536 or PKA inhibitor H89, whereas it was mimicked by adenylyl cyclase activator, forskolin. Further analysis demonstrated that Eviprostat significantly potentiated the effect of phosphodiesterase 3 (PDE3) inhibitor, but not that of PDE4 inhibitor, on CRE activation. Moreover, Eviprostat suppressed PDGF-induced activation of ERK and Akt and inhibited cell proliferation and hillock formation in both mesangial cells and bladder smooth muscle cells. Collectively, activation of the cAMP signaling pathway could be an important mechanism by which Eviprostat exerts its therapeutic effects for LUTS.

Macroscopic Serosal Classification as a Prognostic Index in Radically Resected Stage pT3-pT4b Gastric Cancer

BACKGROUND

Macroscopic serosal classification (MSC) is an important clinicopathologic index of gastric cancer (GC). To investigate the prognostic significance of MSC status in patients with radically resected stage pT3-pT4b GC, we examined the relationship between MSC type and pT stage.

METHODS

Clinicopathologic and survival data of 1613 patients with stage pT3-pT4b GC were studied retrospectively, in the aftermath of radical surgery.

RESULTS

MSC types, including reactive, nodular, tendonoid, and color-diffused type, correlated significantly with overall survival (OS) in this cohort, but prognosis was similar for all stages of color-diffused type GC. We proposed a revised pT stage in which color-diffused type cancers at pT3 or pT4a stage were reclassified into pT4b stage. In two-step multivariate analysis, revised pT stage (stage pT4b for all color-diffused types) proved more suitable for determining prognosis, surpassing both Union for International Cancer Control/American Joint Committee on Cancer pT stage and MSC type as an independent prognostic index.

CONCLUSIONS

MSC type is a significant and independent prognostic index of OS in patients with radically resected stage pT3-pT4b GC. For prognostic purposes, tumors of color-diffused type at pT3 or pT4a stage should be considered stage pT4b disease.

Risk evaluation of splenic hilar or splenic artery lymph node metastasis and survival analysis for patients with proximal gastric cancer after curative gastrectomy: a retrospective study

Background

As splenectomy and spleen-preserving lymphadenectomy are performed only in some proximal gastric cancer patients, it is difficult to identify patients who have undergone radical gastrectomy with or without splenic hilar (No.10) or splenic artery (No.11) lymph node metastases. We aimed to determine the risk factors for No.10 and No.11 lymph node metastases and evaluate the survival significance of No.10 and No.11 lymph node dissection in advanced proximal gastric cancer patients.

Methods

A total of 873 advanced proximal gastric cancer patients who underwent curative gastrectomy with or without splenectomy or pancreaticosplenectomy were analyzed retrospectively. The clinicopathological characteristics of 152 patients who underwent splenectomy or pancreaticosplenectomy were analyzed to determine the risk factors for No.10 and No.11 lymph node metastases. The survival difference between patients with No.10 and No.11 lymph node dissections and those who did not undergo these dissections were compared.

Results

Patients with No.10 and No.11 lymph node metastases had very poor prognoses. Tumor invasion of the greater curvature and No.2 and No.4 lymph node metastases were independent risk factors for No.10 and No.11 lymph node metastases. No survival differences were evident between patients with No.10 and No.11 lymph node metastases who underwent No.10 and No.11 lymph node dissections and those who did not undergo these dissections but were at high risks of No.10 and No.11 lymph node metastases.

Conclusions

Splenic hilar or splenic artery lymph node dissection was not associated with increased survival, in proximal gastric cancer patients without direct cancer invasion of the spleen and pancreas, regardless of whether splenectomy, pancreaticosplenectomy, or spleen-preserving lymphadenectomy was performed.

Association of IL-8 gene promoter -251 A/T and IL-18 gene promoter -137 G/C polymorphisms with head and neck cancer risk: a comprehensive meta-analysis

Purpose

No consensus exists on the impact of polymorphisms in cytokines (such as interleukin IL-8 and IL-18) on cancer risk; moreover, there is very little evidence regarding head and neck cancer (HNC).

Methods

Thus, a meta-analysis including 22 studies with 4731 cases and 8736 controls was conducted to evaluate this association. The summary odds ratio (OR) and corresponding 95% confidence intervals (CIs) for C-X-C motif chemokine ligand 8 (CXCL8, which encodes IL-8) and IL-18 polymorphisms and HNC risk were estimated.

Results

The results showed a significantly increased risk of HNC susceptibility for IL18 −137 G/C in five genetic models, but, interestingly, no significant association was found for the CXCL8 −251 A/T polymorphism. When stratified by cancer type, an increased risk of nasopharyngeal cancer was found for both −137 G/C and −251A/T. When the studies were stratified by ethnicity and genotyping method, there were significant associations between Asian populations and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) studies for −137 G/C, and African populations for −251 A/T in some genetic models. A positive association was also found between the population-based groups in some models for −137 G/C; conversely, significantly decreased risk was found among the −251 A/T hospital-based group. Meta-regression was also conducted. The publication year, control source, and cancer type contributed to CXCL8 −251 A/T heterogeneity; however, no factors were found that contributed to IL-18 −137 G/C heterogeneity. Marginal significance was found in the recessive model for IL-18 −137 G/C by Egger’s test, whereas no publication bias was detected for CXCL8 −251 A/T.

Conclusions

The results indicate that the IL-18 −137 G/C polymorphism is associated with HNC risk, especially nasopharyngeal cancer, in Asian populations and, when using PCR-RFLP, CXCL8 −251 A/T polymorphisms play a complex role in HNC development.

Meta-analysis of the relationship between Dietary Inflammatory Index and esophageal cancer risk

INTRODUCTION

Diet is closely related to the occurrence of esophageal cancer (EC). Dietary Inflammatory Index (DII), as a novel index that describes the inflammatory potential of diet, was widely used in many diseases.

OBJECTIVE

To systematically analyze the relationship between DII and the risk of esophageal cancer.

METHODS

We mainly searched relative studies in PubMed, Cochrane library, Web of Science, and other literature database. The random-effect model was used for meta-analysis, and subgroup analysis and sensitivity analysis were used to detect the origin of heterogeneity.

RESULTS

We finally obtained 6 articles (8 studies). All studies were case-control studies which consisted of 1961 cases and 3577 controls. In this study, compared with the lowest DII category, the highest DII category had a higher risk of esophageal cancer, and the pooled odds ratio (OR) of the 8 studies were 2.54 (95% confidence interval (CI): 1.90-3.40; I = 65.7%, P = .005). Furthermore, regardless of the differences in published year, DII components, geographic location, and study quality, there was still an increased risk of esophageal cancer in the highest DII category compared with the lowest DII category.

CONCLUSIONS

Our results inferred that DII was positively correlated with esophageal cancer risk and it could be used as a tool to predict the esophageal cancer risk and evaluate human health.

Clinical significance of MSKCC nomogram on guiding the application of touch imprint cytology and frozen section in intraoperative assessment of breast sentinel lymph nodes

The widely practiced intra-operative methods for rapid evaluation and detection of sentinel lymph node (SLN) status include frozen section (FS) and touch imprint cytology (TIC). This study optimized the use of TIC and FS in the intra-operative detection of breast SLNs based on the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram. Three hundred forty-two SLNs were removed from 79 patients. SLN metastatic probability was assessed by the MSKCC nomogram. The SLNs underwent intra-operative TIC and FS, as well as routine post-operative paraffin sections (RPSs). The relationships between TIC, FS, and SLN metastatic probability were analyzed. Overall, TIC was more sensitive than FS (92.31% vs. 76.92%), while TIC specificity was inferior to FS specificity (84.85% vs. 100%). In addition, the best cut-off value for TIC based on the MSKCC nomogram was inferior to the best FS cut-off value (22.5% vs. 34.5%). All patients with a MSKCC value <22.5% in the present study were negative based on FS and RPS, while the true-negative and false-positive rates for TIC were 92.5% and 7.5%, respectively. Thus, early breast cancer patients, based on a MSKCC value <22.5%, can safely avoid FS, but should have TIC performed intra-operatively. Patients with a MSKCC value >22.5% should have TIC and FS to determine the size of metastases, whether or not to proceed with axillary lymph node dissection, and to avoid easily missed metastases.

Surgical choice of proximal gastric cancer in China: a retrospective study of a 30-year experience from a single center in China

Background: Total gastrectomy with D2 lymphadenectomy is indicated for proximal advanced gastric cancer located in the upper one-third of the stomach; however, due to preserved function and clinical benefits of a proximal gastrectomy, the choice of a surgical method for patients with proximal early-stage gastric cancer remains controversial.Methods: We conducted a retrospective study involving 649 patients with proximal gastric cancer. The clinical-pathological features, characteristics, lymph node metastatic patterns, prognosis, postoperative complications, and recurrence were compared between the patients who underwent proximal and total gastrectomies with different T and N stages.Results: The lymph node metastatic rates among T stages were significantly different. There was no difference in overall survival rates for stage Ia, Ib, and IIa patients but significant difference in T3 and T4 stages who underwent proximal and total gastrectomy. Complications were more frequently detected in patients who underwent total gastrectomy than proximal gastrectomy.Conclusion: Considering the survival benefits and preserved function, proximal gastrectomy can be performed safely in stage Ia and Ib gastric cancer (T1N0, T1N1, and T2N0) with an excellent remission rate. Proximal gastrectomy is not recommended for advanced gastric cancer.

Immunomodulatory Acidic Polysaccharide from Jujube Fruit (Zizyphus jujuba Mill.): Insight into Their Chemical Characteristics and Modes of Action

Jujube (Zizyphus jujuba Mill.) has been consumed globally as a fruit and a nutraceutical food for millennia. This study presents the isolation and purification of a novel water-soluble polysaccharide fraction, ZJMP-2, from Z. jujuba Mill. ZJMP-2 underwent characterization through Fourier transform infrared (FT-IR), high-performance gel permeation chromatography-laser light scattering (HPGPC-LLS), gas chromatography-mass spectrometry (GC-MS), scanning electron microscopy (SEM), atomic force microscopy (AFM), and nuclear magnetic resonance (NMR) analyses. It consists of glucose, galactose, arabinose, rhamnose, and galacturonic acid in molar ratios of 0.41:0.08:0.11:0.05:0.33 and boasts an average molecular weight of approximately 57.8 kDa. Its backbone features the structure →2)-α-l-Rhap-(1 → 4)-α-d-GalpA-(1 → 4)-α-d-GalpA-6OMe-(1 → 4)-α-d-GalpA-(1 → 3, 4)-α-d-Glcp-(1 →, with branching at →5)-α-l-Araf-(1 →, →4)-β-d-Galp-(1 →, and →4)-α-d-Glcp-(1→ at position O-3 of →3, 4)-α-d-Glcp-(1 →. These structural variations contribute to the pronounced immunoregulatory effects of ZJMP-2. Specifically, ZJMP-2 significantly elevated the expression levels of TLR4, NF-κB, and TRAF6 proteins, enhancing RAW264.7 cell activity, index of splenic lymphocytes, and the production of cytokines and NO, thereby activating macrophages and promoting lymphocyte proliferation. In vivo studies demonstrated that ZJMP-2 promoted the heart, spleen, and bone marrow indices, peripheral blood and spleen cell counts, and the number of heart and bone marrow cells in mice. These findings demonstrated that ZJMP-2 has potential as an immunomodulator and provides valuable insights for developing natural immunomodulators in the pharmaceutical industry.

MRT letter: application of novel "in vivo cryotechnique" in living animal kidneys

AIM

To compare the influence of different fixation procedures on morphologic studies in living mice, and to identify the advantages of the "in vivo cryotechnique" (IVCT).

METHODS

We prepared mouse kidneys using four different fixation methods: conventional immersion-fixation, quick-freezing following resection of the kidney, quick-freezing following perfusion-fixation, and IVCT.

RESULTS

Kidney glomeruli were noticeably contracted after conventional immersion-fixation or quick-freezing following resection compared to glomeruli from tissues preserved by the IVCT. With the IVCT, both albumin and IgG were colocalized exclusively along or within the glomerular capillary loops; however, immunoreactivity of these proteins in the other three methods was clearly detected in the Bowman's space and apical cytoplasm of the proximal tubules. With the IVCT, immunoreactivity of collagen type IV was very weak at the glomerular basement membrane (GBM) until microwave treatment, which increased its immunoreactivity. In contrast, the immunoreactivity was clearly detected at the GBM with or without microwave treatment with quick-freezing following perfusion-fixation. With quick-freezing following perfusion-fixation, aquaporin-1 (AQP-1) was irregularly distributed in a disorganized manner on the brush border and apical cell membrane along the proximal tubules. But AQP-1 was labeled intensely and regularly along the brush border and apical cell membrane andonly weakly along the basolateral membrane of the proximal tubules with the IVCT.

CONCLUSION

The IVCT may reliably maintain soluble serum proteins and renal intrinsic proteins such as AQP-1 in situ and capture transient structures and functional changes in vivo.

Downregulation of TRPC6 expression is a critical molecular event during FK506 treatment for overactive bladder

PURPOSE

It has been suggested that FK506 could improve some symptoms of OAB in both clinical settings and animal models; however, its mechanism of action is not well-understood. Here, we investigated the effect of FK506 on TRPC6 in bladder smooth muscle, and explored the possible involvement of TRPC6 in OAB.

METHODS

FK506 was injected intraperitoneally into rats in which OAB was induced via BOO, and urodynamic indices were recorded. Rats and human bladder smooth muscle tissues with or without OAB were examined for TRPC6 expression by western blot, RT-PCR and IF staining. Cultured BSMCs were treated with PDGF, TRPC6 siRNAs and FK506. Then the TRPC6 expression and cellular proliferation were examined, and the Ca²⁺ influx and contractility of BSMCs were examined by time-lapse Ca²⁺ imaging and collagen gel contraction. Finally, IF and Co-IP were performed to test the effects of FK506 on NFAT translocation to the nucleus and the interaction of TRPC6 with FKBP12, respectively.

RESULTS

FK506 improved urodynamic indices of OAB rats, and TRPC6 was expressed in rats and human bladder tissues. TRPC6 elevation in OAB rats was inhibited by FK506, and this inhibition coincided with improvements in urodynamic indices. PDGF enhanced TRPC6 expression, cellular proliferation, Ca²⁺ influx and contractility of BSMCs, and these effects were inhibited by TRPC6 siRNAs and FK506. FK506 inhibited NFAT translocation to the nucleus and disrupted the interaction of TRPC6 with FKBP12.

CONCLUSIONS

Our results collectively indicate that FK506 may be used to treat OAB, and that TRPC6 may serve as an attractive target for therapeutic intervention in OAB.

Prognostic significance of 14v-lymph node dissection to D2 dissection for lower-third gastric cancer

BACKGROUND

Radical gastrectomy with D2 lymph node (LN) dissection is the standard surgical procedure for patients with resectable gastric cancer (GC). In the fifteenth edition of the Japanese Classification of Gastric Carcinoma, the 14v LN (LNs along the root of the superior mesenteric vein) was defined as the regional gastric LN. The efficacy of 14v LN dissection during radical distal gastrectomy for lower-third GC remains controversial.

AIM

To analyze whether the addition of 14v LN dissection improved the survival of patients with lower-third GC.

METHODS

The data from 65 patients who underwent 14v LN dissection and 65 patients treated without 14v LN dissection were selected using the propensity score-matched method from our institute database constructed between 2000 and 2012. Overall survival was compared between the groups.

RESULTS

Overall survival was similar between patients with 14v LN metastasis and those with distant metastasis (P = 0.521). Among patients with pathological stage IIIA disease, those who were treated with 14v LN dissection had a significantly higher overall survival than those treated without it (P = 0.020). Multivariate analysis showed that age < 65 years and pT2-3 stage were independent favorable prognostic factors for prolonged overall survival in patients with pathological stage IIIA disease. Patients with No. 1, No. 6, No. 8a, or No. 11p LN metastasis were at higher risk of having 14v LN metastasis.

CONCLUSION

Adding 14v LN dissection to D2 dissection during radical distal gastrectomy may improve the overall survival of patients with pathological stage IIIA lower-third GC.

Reconstruction Methods and Complications of Esophagogastrostomy and Jejunal Interposition in Proximal Gastrectomy for Gastric Cancer: A Meta-Analysis

BACKGROUND

Proximal gastrectomy is used for the treatment of primary gastric cancer by open or laparoscopic surgery in the upper third of the stomach. Esophagogastrostomy (EG) or jejunal interposition (JI) is widely used in various reconstruction methods after proximal gastrectomy. We conducted a meta-analysis of EG and JI for treatment of gastric cancer.

MATERIALS AND METHODS

A search of PubMed, Embase, MEDLINE, J-STAGE, and Cochrane Library identified retrospective series on EG and JI. Weight mean differences (WMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were used to analyze the operation-related data and postoperative complications. Heterogeneity was evaluated by the I 2 test, and potential publication bias was assessed with Egger regression tests and sensitivity analysis.

RESULTS

Eight studies were selected, and 496 patients were included. EG group benefits were 44.81 min shorter operating time (P < 0.001), 56.58 mL less blood loss (P = 0.03), and 7.4 days shorter hospital stay time (P < 0.001) than the JI group. Between the two groups, there was no significant difference in anastomotic leakage; otherwise, the EG group had a lower risk of anastomotic stenosis (OR = 0.44, 95%CI = 0.20 to 0.97, P = 0.04), lower risk of intestinal obstruction (OR = 0.07, 95%CI = 0.01 to 0.43, P = 0.004), and higher risk of reflux esophagitis (OR = 2.47, 95%CI = 1.07 to 5.72, P = 0.03).

CONCLUSION

The results of our study indicated that EG has significant advantages during the perioperative period and in short-term outcomes compared to JI.

Subtotal gastrectomy combined with chemotherapy: An effective therapy for patients with circumscribed Borrmann type IV gastric cancer

BACKGROUND

Although Borrmann type IV (B-4) gastric cancer has a higher mortality rate and presents distant metastasis easily, especially peritoneal metastasis, when diagnosed, some B-4 patients were found to have no distant metastasis by preoperative detection and underwent curative surgery, which was defined as circumscribed B-4 in our study. In this study, we focused on the circumscribed B-4 patients without distant metastasis during surgery to identify factors related to prognosis and postoperative peritoneal cavity metastasis (PPCM), which is important for selecting an appropriate therapeutic strategy.

AIM

To identify factors related to the prognosis and PPCM of B-4 patients.

METHODS

A total of 117 B-4 patients who underwent gastrectomy between January 2005 and December 2012 were included in this study. Survival analysis was performed using Kaplan-Meier analysis and Cox multivariate models. Pearson correlation analyses were performed to identify the factors related to PPCM. All statistical analyses were performed using SPSS 20.0.

RESULTS

Lymph node status, gastrectomy type, and postoperative chemotherapy were independent prognostic factors in 117 circumscribed B-4 patients. Subtotal gastrectomy combined with chemotherapy could significantly improve the long-term survival time. Six patients who were diagnosed with pN0 and received the combination therapy had a 3-year survival rate of 100% and a median survival of 77.7 mo. Even for patients with metastatic lymph nodes (n = 13), the combination therapy also increased the 3-year overall survival rate to 57.1%. In addition, positive lymph node status was the only factor (P = 0.005) correlated with PPCM in certain B-4 patients, and chemotherapy was useful for suppressing PPCM in patients with subtotal gastrectomy but not in those with total gastrectomy.

CONCLUSION

Lymph node status is an independent prognostic factor for circumscribed B-4 patients. In addition, subtotal gastrectomy and postoperative chemotherapy could effectively improve prognosis and even suppress PPCM.

Effects of methylenetetrahydrofolate reductase single-nucleotide polymorphisms on breast, cervical, ovarian, and endometrial cancer susceptibilities

Background

Recent studies identifying methylenetetrahydrofolate reductase (MTHFR) polymorphisms associated with breast cancer (BC), ovarian cancer (OC), cervical cancer, and endometrial cancer (EC) have reported conflicting results and been underpowered. To clarify the correlation between MTHFR mutations and these common female malignancies, we conducted a comprehensive meta-analysis incorporating all eligible publications.

Methods

Relevant reports published before January 20, 2020, were retrieved from PubMed, Embase, the Cochrane Library, and the China National Knowledge Infrastructure databases. The odds ratio and 95% confidence interval summaries for the MTHFR 677C/T and 1298A/C polymorphisms in BC, OC, cervical cancer, and EC were estimated.

Results

A total of 171 studies comprising 56,675 cancer cases and 67,559 controls were included. The results showed a markedly elevated risk of cancer susceptibility related to MTHFR 677C/T based on all genetic models. Similarly, we identified a significant correlation between 1298A/C mutation and cancer risk based on overall comparisons among all models, except the heterozygous model. Moreover, subgroup analysis by cancer type revealed a significantly increased risk of BC associated with 677C/T in the five models and of cervical cancer associated with 1298A/C in some models. Based on ethnicity, significant associations were observed between Asian, African, and mixed populations for 677C/T and the Asian population for 1298A/C. With regard to the sample type used for analysis, we detected a positive association between using blood as the DNA source and cancer risk for 677C/T in all genetic models and for 1298A/C in some genetic models. Further stratification of the results revealed that a notably increased risk was associated with the use of polymerase chain reaction-restriction fragment-length polymorphism or TaqMan as the genotyping method, as well as with the use of population-or hospital-based groups as the controls for 677C/T and 1298A/C, respectively.

Conclusion

This meta-analysis suggests that MTHFR 677C/T and 1298A/C polymorphisms correlate with the risk of common gynecological cancers, with these findings potentially applicable for overall comparisons of related data.

Individualized Choice of Simultaneous Cholecystectomy in Patients with Gastric Cancer: A Systematic Review and Meta-analysis

BACKGROUND

Patients undergoing gastrectomy for gastric cancer are more likely to develop gallstones than the general population. Prophylactic cholecystectomy remains controversial.

METHODS

Studies from 2000-2022 were systematically searched in the PubMed, EMBASE, and Cochrane Library databases. The search included simultaneous cholecystectomy or risk factors for gallstone formation with gastrectomy alone. Major prognostic factors included complications and mortality, and risk factor analyses included age, sex, TNM stage, gastrectomy type, lymph node dissection, diabetes, and duodenal exclusion. Random effects regression models were used to analyze risk estimates and data were presented as odds ratios (ORs) with corresponding 95% confidence intervals (CIs).

RESULTS

There were no significant differences in postoperative morbidity (OR 1.12, 95% CI 0.90-1.39; p = 0.33, I2 = 11%) and mortality (OR 1.23, 95% CI 0.62-2.43; p = 0.56, I2 = 0%) between gastrectomy alone and simultaneous cholecystectomy. Older age (OR 1.48, 95% CI 1.36-1.59; p < 0.001, I2 = 59%), male sex (OR 1.38, 95% CI 1.10-1.71; p = 0.004, I2 = 77%), total gastrectomy (OR 1.50, 95% CI 1.25-1.81; p < 0.001, I2 = 72%), diabetes mellitus (OR 1.38, 95% CI 1.17-1.63; p < 0.001, I2 = 8%), and duodenal exclusion (OR 1.77, 95% CI 1.47-2.15; p < 0.001, I2 = 30%) were risk factors for cholecystolithiasis.

CONCLUSIONS

Simultaneous cholecystectomy did not increase the incidence of postoperative complications or mortality. Older age, male sex, total gastrectomy, duodenal exclusion, and diabetes were risk factors for gallstone development after gastrectomy.