Knockdown of TRIM15 inhibits the proliferation, migration and invasion of esophageal squamous cell carcinoma cells through inactivation of the Wnt/β-catenin signaling pathway

TRIM15 is a member of tripartite motif-containing protein (TRIM) protein family, which plays important roles in several cancers. The aim of the present study was to evaluate the role of TRIM15 in esophageal squamous cell carcinoma (ESCC). Our results showed that TRIM15 was upregulated in human ESCC tissues and cell lines. In vitro studies showed that knockdown of TRIM15 significantly inhibited the proliferation, migration, and invasion of ESCC cells. Knockdown of TRIM15 caused a significant increase in E-cadherin expression, as well as decreases in expression of N-cadherin and Vimentin proteins. Moreover, in vivo assay proved that tumor growth was suppressed by knockdown of TRIM15. Furthermore, the protein expression levels of β-catenin, C-myc, and CyclinD1 were markedly decreased in sh-TRIM15-infected ESCC cells. Additionally, treatment with LiCl reversed the inhibitory effects of TRIM15 knockdown on ESCC cells. In conclusion, these findings indicated that knockdown of TRIM15 blocked the growth and metastasis of ESCC in part through inhibiting the Wnt/β-catenin signaling pathway. Thus, TRIM15 might serve as a promising therapeutic target for ESCC.

A DFT-based microkinetic study on methanol synthesis from CO2 hydrogenation over the In2O3 catalyst

In this work, we performed density functional theory (DFT)-based microkinetic simulations to elucidate the reaction mechanism of methanol synthesis on two of the most stable facets of the cubic In2O3 (c-In2O3) catalyst, namely the (111) and (110) surfaces. Our DFT calculations show that for both surfaces, it is difficult for the H atom adsorbed at the remaining surface O atom around the O vacancy (Ov) active site to migrate to an O adsorbed at the Ov due to the very high energy barrier involved. In addition, we also find that the C-O bond in the bt-CO2* chemisorption structure can directly break to form CO with a lower energy barrier than that in its hydrogenation to the COOH* intermediate in the COOH route. However, our microkinetic simulations suggest that for both surfaces, CO2 deoxygenation to form CO in both pathways, namely the COOH and CO-O routes, are kinetically slower than methanol formation under typical steady state conditions assuming a CO2 conversion of 10% and a CO selectivity of 1%. Although these results agree with previous experimental observations at relatively low reaction temperature, where methanol formation dominates, they cannot explain the predominant formation of CO at relatively high reaction temperature. We tentatively attribute this to the simplicity of our microkinetic model as well as possible structural changes of the catalyst at relatively high reaction temperature. Furthermore, although the rate-determining step (RDS) from the degree of rate control (DRC) analysis is usually consistent with that judged from the DFT calculated energy barriers, for CO2 hydrogenation to methanol over the (111) surface, our DRC analysis suggests homolytic H2 dissociation to be the rate-controlling step, which is not apparent from the DFT-calculated energy barriers. This indicates that CO2 conversion and methanol selectivity over the (111) surface can be further enhanced if homolytic H2 dissociation can be accelerated for instance by introducing transition metal dopants as already shown by some experimental observations.

Formulation composition, manufacturing process, and characterization of poly(lactide-co-glycolide) microparticles

Injectable long-acting formulations, specifically poly(lactide-co-glycolide) (PLGA) based systems, have been used to deliver drugs systemically for up to 6 months. Despite the benefits of using this type of long-acting formulations, the development of clinical products and the generic versions of existing formulations has been slow. Only about two dozen formulations have been approved by the U.S. Food and Drug Administration during the last 30 years. Furthermore, less than a dozen small molecules have been incorporated and approved for clinical use in PLGA-based formulations. The limited number of clinically used products is mainly due to the incomplete understanding of PLGA polymers and the various variables involved in the composition and manufacturing process. Numerous process parameters affect the formulation properties, and their intricate interactions have been difficult to decipher. Thus, it is necessary to identify all the factors affecting the final formulation properties and determine the main contributors to enable control of each factor independently. The composition of the formulation and the manufacturing processes determine the essential property of each formulation, i.e., in vivo drug release kinetics leading to their respective pharmacokinetic profiles. Since the pharmacokinetic profiles can be correlated with in vitro release kinetics, proper in vitro characterization is critical for both batch-to-batch quality control and scale-up production. In addition to in vitro release kinetics, other in vitro characterization is essential for ensuring that the desired formulation is produced, resulting in an expected pharmacokinetic profile. This article reviews the effects of a selected number of parameters in the formulation composition, manufacturing process, and characterization of microparticle systems. In particular, the emphasis is focused on the characterization of surface morphology of PLGA microparticles, as it is a manifestation of the formulation composition and the manufacturing process. Also, the implication of the surface morphology on the drug release kinetics is examined. The information described here can also be applied to in situ forming implants and solid implants.

Impact of Membranes on In Vitro Release Assessment: a Case Study Using Dexamethasone

In vitro release studies are commonly used to assess the product performance of topical dosage forms. In such studies, the mass transport of drugs through synthetic membranes into a receiving chamber filled with a release medium is measured. The release medium is also passed through filtration membranes prior to chromatographic analysis. There are no official guidelines directing membrane selection for in vitro release studies or for filtration. Considering the diversity in membrane materials and their physical properties, the aim of this study was to investigate membrane-drug binding and the effect of various membranes on the release performance of a model drug dexamethasone (DEX) using USP dissolution apparatus IV. Seven membranes of different pore sizes (0.45 and 1.2 μm) and materials (cellulose acetate, polyethersulfone, and nylon) were assessed. Two different methods, syringe filter and 24-h incubation, were used for the determination of membrane-drug binding effects at low drug concentrations and saturated concentration conditions. Cellulose acetate and nylon membranes showed significant drug binding after 24-h incubations at both drug concentrations. DEX diffusion through membranes was significantly slowed down in all the tested membranes when compared with DEX solution without membranes. The extent of the retardation varied due to the differences in membrane structures. In conclusion, materials and sources of membranes affected drug dissolution profiles and the results showed membrane-drug binding effects. Proper selection of membranes with low drug binding ability and low diffusion resistance is essential to ensure appropriate and reproducible in vitro release assessments and filtration studies. Graphical Abstract.

Potential Roles of the Glass Transition Temperature of PLGA Microparticles in Drug Release Kinetics

Poly(lactic-co-glycolic acid) (PLGA) has been used for long-acting injectable drug delivery systems for more than 30 years. The factors affecting the properties of PLGA formulations are still not clearly understood. The drug release kinetics of PLGA microparticles are influenced by many parameters associated with the formulation composition, manufacturing process, and post-treatments. Since the drug release kinetics have not been explainable using the measurable properties, formulating PLGA microparticles with desired drug release kinetics has been extremely difficult. Of the various properties, the glass transition temperature, T_g, of PLGA formulations is able to explain various aspects of drug release kinetics. This allows examination of parameters that affect the T_g of PLGA formulations, and thus, affecting the drug release kinetics. The impacts of the terminal sterilization on the T_g and drug release kinetics were also examined. The analysis of drug release kinetics in relation to the T_g of PLGA formulations provides a basis for further understanding of the factors controlling drug release.

Exogenous melatonin reduces the inhibitory effect of osmotic stress on antioxidant properties and cell ultrastructure at germination stage of soybean

Understanding the relationship between exogenous melatonin and water deficit stress is crucial for alleviating the effects of water deficit stress at germination stage of soybean (Glycine max (L.) Merrill) in agriculture. This study investigated the effects of exogenous melatonin on soybean antioxidant properties and cell ultrastructure under water deficit stress induced by polyethylene glycol (PEG) 6000. The drought-sensitive soybean variety Suinong 26 was used as the material to study the effects of different concentrations of melatonin (0, 300, 500 μmol·L-1) soaking soybean seeds under drought stress (PEG-6000: 3% and 6%). The results showed that the germination rate (GR), germination potential (GP), germination index (GI) and radicle shape of soybean were affected negatively to different degrees under PEG stress. Moreover, stress induced by different PEG concentrations overproduced the content of reactive oxygen species (H2O2, O2·-) in cells, leading to increased lipid membrane peroxidation as electrolyte leakage (EL) and malondialdehyde (MDA) content, which resulted in impaired cell integrity. However, after seeds soaking with melatonin, the lipid peroxidation of the cell membrane was reduced, and the activities of antioxidant enzymes such as superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), and ascorbate peroxidase (APX) further increased to minimize the excessive generation of ROS. Similar results were obtained for soluble protein and proline, that may help in regulating the osmotic pressure and maintain cellular integrity. With the interaction of these enzymes, compared with 300 μmol·L-1 melatonin, 500 μmol·L-1 melatonin could more effective to remove the ROS and reduce cell peroxidation. Overall, 500 μmol·L-1 melatonin performed better than 300 μmol·L-1. In conclusion, the seed soaking with melatonin promoted the germination of soybean seeds under water stress.

Accuracy of Endoscopic Diagnosis of Helicobacter pylori Based on the Kyoto Classification of Gastritis: A Multicenter Study

Background

There is lack of clinical evidence supporting the value of the Kyoto classification of gastritis for the diagnosis of Helicobacter pylori (H. pylori) infection in Chinese patients, and there aren’t enough specific features for the endoscopic diagnosis of past infections, which is of special significance for the prevention of early gastric cancer (GC).

Methods

This was a prospective and multicenter study with 650 Chinese patients. The H. pylori status and gastric mucosal features, including 17 characteristics based on the Kyoto classification and two newly-defined features unclear atrophy boundary (UAB) and RAC reappearance in atrophic mucosa (RAC reappearance) were recorded in a blind fashion. The clinical characteristics of the subjects were analyzed, and the diagnostic odds ratio (DOR), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under the receiver operating characteristics curve (ROC/AUC), and 95% confidence intervals were calculated for the different features, individually, and in combination.

Results

For past infection, the DOR of UAB was 7.69 (95%CI:3.11−19.1), second only to map-like redness (7.78 (95%CI: 3.43−17.7)). RAC reappearance showed the highest ROC/AUC (0.583). In cases in which at least one of these three specific features of past infection was considered positive, the ROC/AUC reached 0.643. For current infection, nodularity showed the highest DOR (11.7 (95%CI: 2.65−51.2)), followed by diffuse redness (10.5 (95%CI: 4.87−22.6)). Mucosal swelling showed the highest ROC/AUC (0.726). Regular arrangement of collecting venules (RAC) was specific for no infection.

Conclusions

This study provides evidence of the clinical accuracy and robustness of the Kyoto classification of gastritis for the diagnosis of H. pylori in Chinese patients, and confirms UAB and RAC reappearance partly supplement it for the diagnosis of past infections, which is of great benefit to the early prevention of GC.

STAT3 decoy oligonucleotide-carrying microbubbles with pulsed ultrasound for enhanced therapeutic effect in head and neck tumors

Signal transducer and activator of transcription-3 (STAT3) is an oncogenic transcription factor implicated in carcinogenesis, tumor progression, and drug resistance in head and neck squamous cell carcinoma (HNSCC). A decoy oligonucleotide targeting STAT3 offers a promising anti-tumor strategy, but achieving targeted tumor delivery of the decoy with systemic administration poses a significant challenge. We previously showed the potential for STAT3 decoy-loaded microbubbles, in conjunction with ultrasound targeted microbubble cavitation (UTMC), to decrease tumor growth in murine squamous cell carcinoma. As a next step towards clinical translation, we sought to determine the anti-tumor efficacy of our STAT3 decoy delivery platform against human HNSCC and the effect of higher STAT3 decoy microbubble loading on tumor cell inhibition. STAT3 decoy was loaded on cationic lipid microbubbles (STAT3-MB) or loaded on liposome-conjugated lipid microbubbles to form STAT3-loaded liposome-microbubble complexes (STAT3-LPX). UTMC treatment efficacy with these two formulations was evaluated in vitro using viability and apoptosis assays in CAL33 (human HNSCC) cells. Anti-cancer efficacy in vivo was performed in a CAL33 tumor murine xenograft model. UTMC with STAT3-MB caused significantly lower CAL33 cell viability compared to UTMC with STAT3-LPX (56.8±8.4% vs 84.5±8.8%, respectively, p<0.05). In vivo, UTMC with STAT3-MB had strong anti-tumor effects, with significantly less tumor burden and greater survival compared to that of UTMC with microbubbles loaded with a mutant control decoy and untreated control groups (p<0.05). UTMC with STAT3 decoy-loaded microbubbles significantly decreases human HNSSC tumor progression. These data set the stage for clinical translation of our microbubble platform as an imaged-guided, targeted delivery strategy for STAT3 decoy, or other nucleotide-based therapeutics, in human cancer treatment.

[Effect of L-cysteine on colonic motility and the underlying mechanism]

The purpose of the present study is to investigate the effect of L-cysteine on colonic motility and the underlying mechanism. Immunohistochemical staining and Western blot were used to detect the localization of the H₂S-generating enzymes cystathionine-β-synthase (CBS) and cystathionine-γ-lyase (CSE). Organ bath system was used to observe the muscle contractile activities. Whole-cell patch-clamp technique was applied to record ionic channels currents in colonic smooth muscle cells. The results showed that both CBS and CSE were localized in mucosa, longitudinal and circular muscle and enteric neurons. L-cysteine had a dual effect on colonic contraction, and the excitatory effect was blocked by pretreatment with CBS inhibitor aminooxyacetate acid (AOAA) and CSE inhibitor propargylglycine (PAG); L-cysteine concentration-dependently inhibited L-type calcium channel current (I_Ca,L) without changing the characteristic of L-type calcium channel (P < 0.01); In contrast, the exogenous H₂S donor NaHS increased I_Ca,L at concentration of 100 μmol/L, but inhibited I_Ca,L and modified the channel characteristics at concentration of 300 μmol/L (P < 0.05); Furthermore, L-cysteine had no effect on large conductance calcium channel current (I_BKCa), but NaHS significantly inhibited I_BKCa (P < 0.05). These results suggest that L-cysteine has a potential dual effect on colonic smooth muscle and the inhibitory effect might be directly mediated by L-type calcium channel while the excitatory effect might be mediated by endogenous H₂S.

An optimized test bolus for computed tomography pulmonary angiography and its application at 80 kV with 10 ml contrast agent

Computed tomography pulmonary angiography (CTPA) is usually used for pulmonary embolism (PE) detection. However, the determination of scan timing remains a challenge due to the short scan duration of CTPA. We aimed to develop an optimized test bolus to determine scan delay in CTPA. The time-enhancement curves were obtained by measuring the enhancement within a region of interest in the main pulmonary artery and vein. A total of 70 patients were randomly divided into two groups (n = 35 each): the control group underwent CTPA using the test bolus approach and the test group underwent CTPA using the biphasic time-enhancement curves approach. Tube voltages of 100 kVp and 80 kVp and 20 ml and 10 ml contrast agent were adopted in the control and test groups, respectively. The CT numbers, image quality, PE detection was evaluated. There was a point of intersection between the pulmonary artery and vein test bolus enhancement curves. The scan delay time (T_DELAY) was obtained based on the time at intersection (T_CROSS) and the scan duration (T_SD): T_DELAY = T_CROSS − T_SD. The mean CT numbers for pulmonary vein in the control were higher than those in the test group (all p < 0.001). The image quality for the pulmonary arteries in the test group was better than that in the control group (p < 0.01), with artifact reduction in the superior vena cava. Segmental PE could be detected using the optimized protocol. The radiation dose and iodine load in the test group were all lower than those in the control (p < 0.01). We established an approach to calculate the scan delay of CTPA, and this approach could be used for CTPA at 80 kVp with 10 ml contrast agent.

Rationally designed indium oxide catalysts for CO2 hydrogenation to methanol with high activity and selectivity

Renewable energy-driven methanol synthesis from CO2 and green hydrogen is a viable and key process in both the "methanol economy" and "liquid sunshine" visions. Recently, In2O3-based catalysts have shown great promise in overcoming the disadvantages of traditional Cu-based catalysts. Here, we report a successful case of theory-guided rational design of a much higher performance In2O3 nanocatalyst. Density functional theory calculations of CO2 hydrogenation pathways over stable facets of cubic and hexagonal In2O3 predict the hexagonal In2O3(104) surface to have far superior catalytic performance. This promotes the synthesis and evaluation of In2O3 in pure phases with different morphologies. Confirming our theoretical prediction, a novel hexagonal In2O3 nanomaterial with high proportion of the exposed {104} surface exhibits the highest activity and methanol selectivity with high catalytic stability. The synergy between theory and experiment proves highly effective in the rational design and experimental realization of oxide catalysts for industry-relevant reactions.

Effects of Blast Wave-induced Biomechanical Changes on Lung Injury in Rats

OBJECTIVE

To observe the dynamic impacts of shock waves on the severity of lung injury in rats with different injury distances.

METHODS

Simulate open-field shock waves; detect the biomechanical effects of explosion sources at distances of 40, 44, and 48 cm from rats; and examine the changes in the gross anatomy of the lungs, lung wet/dry weight ratio, hemoglobin concentration, blood gas analysis, and pathology.

RESULTS

Biomechanical parameters such as the overpressure peak and impulse were gradually attenuated with an increase in the injury distance. The lung tissue hemorrhage, edema, oxygenation index, and pathology changed more significantly for the 40 cm group than for the 44 and 48 cm groups. The overpressure peak and impulse were significantly higher for the 40 cm group than for the 44 and 48 cm groups ( P < 0.05 or P < 0.01). The animal mortality was significantly higher for the 40 cm group than for the other two groups (41.2% vs. 17.8% and 10.0%, P < 0.05). The healing time of injured lung tissues for the 40 cm group was longer than those for the 44 and 48 cm groups.

CONCLUSIONS

The effects of simulated open-field shock waves on the severity of lung injuries in rats were correlated with the injury distances, the peak overpressure, and the overpressure impulse.

Voxel-wise meta-analysis of structural changes in gray matter of Parkinson's disease patients with mild cognitive impairment

Evidence from previous voxel-based morphometry (VBM) studies indicates that widespread brain regions are involved in Parkinson’s disease with mild cognitive impairment (PD-MCI). However, the spatial localization reported for gray matter (GM) abnormalities is heterogeneous. The aim of the present study was to quantitatively integrate studies on GM abnormalities observed in PD-MCI in order to determine whether a pattern exists. Eligible whole-brain VBM studies were identified by a systematic search of articles in PubMed and EMBASE databases spanning from 1995 to January 1, 2019. A meta-analysis was performed to investigate regional GM abnormalities in PD-MCI. The anisotropic effect size version of seed-based d mapping (AES-SDM) meta-analysis was conducted to explore the GMV differences of PD-MCI compared with PD patients with normal cognitive function (PD-NC). A total of 12 studies comprising 243 PD-MCI patients and 326 PD-NC were included in the meta-analysis. PD-MCI patients showed a robust GM decrease in the left insula and left superior temporal gyrus. Moreover, meta-regression analysis demonstrated that age, PD duration and stage, and Unified Parkinson’s Disease Rating Scale III and Mini-Mental State Examination scores might be partly correlated with the GM abnormalities observed in PD-MCI patients. The convergent findings of this quantitative meta-analysis revealed a characteristic neuroanatomical pattern in PD-MCI. The findings provide some evidence that MCI in PD may result in the breakdown of the insula and temporal gyrus, which may serve as specific regions of interest for further investigations.

A Sleeping rs-fMRI Study of Preschool Children with Autism Spectrum Disorders

OBJECTIVES

The brain functional network of autism spectrum disorders (ASDs) in the earlier stages of life has been almost unknown due to difficulties in obtaining a resting-state functional magnetic resonance imaging (rs-fMRI). This study aimed to perform rs-MRI under a sedated sleep state and reveal possible alterations in the brain functional network.

METHODS

Rs-fMRI was performed in a group of preschool children (aged 2-6 years, 53 with ASD, 63 as controls) under a sedated sleeping state. Based on graph theoretical analysis, global and local topological metrics were calculated to investigate alterations in brain functional networks. Besides, correlation analyses were conducted between the abnormal attribute values and the Childhood Autism Rating Scale (CARS) scores.

RESULTS

The graph theoretical analysis showed that the nodal degree of the right medial frontal gyrus and the nodal efficiency of the right lingual gyrus in the ASD group were higher than those in the control group (P<0.05). There was a statistically significant positive correlation (R=0.318, P<0.05) between the right midfrontal gyrus nodal degree values and CARS scores in the ASD patients.

CONCLUSION

Alterations of some nodal attributes in the brain network occurred in preschool autistic children which could serve as potential imaging biomarkers for evaluating ASD in earlier stages.

Microencapsulation of luteinizing hormone-releasing hormone agonist in poly (lactic-co-glycolic acid) microspheres by spray-drying

A spray drying technique was developed to prepare injectable and biodegradable poly(lactic-co-glycolic acid) (PLGA) microspheres encapsulating a model luteinizing hormone-releasing hormone agonist (LHRHa)-based peptide, leuprolide. Various spray drying parameters were evaluated to prepare 1-month controlled release formulations with a similar composition to the commercial Lupron Depot® (LD). A single water-in-oil emulsion of aqueous leuprolide/gelatin solution in PLGA 75/25 acid capped (13 kDa Mw) dissolved in methylene chloride (DCM) was spray-dried before washing the microspheres in cold ddH2O and freeze-drying. The spray-drying microencapsulation was characterized by: particle size/distribution (span), morphology, drug/gelatin loading, encapsulation efficiency, and residual DCM and water content. Long-term release was tested over 9 weeks in PBS + 0.02% Tween 80 + 0.02% sodium azide pH 7.4 (PBST) at 37 °C. Several physical-chemical parameters were monitored simultaneously for selected formulations, including: water uptake, mass loss, dry and hydrated glass transition temperature, to help understand the related long-term release profiles and explore the underlying controlled-release mechanisms. Compared with the commercial LD microspheres, some of the in-house spray-dried microspheres presented highly similar or even improved long-term release profiles, providing viable long-acting release (LAR) alternatives to the LD. The in vitro release mechanism of the peptide was shown to be controlled either by kinetics of polymer mass loss or by a second process, hypothesized to involve peptide desorption from the polymer. These data indicate spray drying can be optimized to prepare commercially relevant PLGA microsphere formulations for delivery of peptides, including the LHRHa, leuprolide.

Design and optimization of beam optics for a superconducting gantry applied to proton therapy

PURPOSE

Proton therapy (PT) is a precise and effective radiotherapy method for tumors. To reduce the weight and footprint of normal conducting gantries applied to PT, a lightweight superconducting (SC) gantry with large momentum acceptance is studied at Huazhong University of Science and Technology.

METHODS

To limit the frequency of field changing in SC magnets, a local-achromaticity beamline is designed with large momentum acceptance. Based on the analysis of high order aberrations, the lattice of the gantry beamline is composed of two symmetric bending sections to limit high-order aberrations, and sextupole fields are superimposed to further eliminate dispersion up to second order.

RESULTS

We presented a second order beam optics design of a SC gantry. The optics fitting is completed with COSY Infinity and the result of particle tracking shows a momentum acceptance of ±8%. Alternating gradient canted-cosine-theta (CCT) magnets are applied to implement combined functions of beam bending and focusing. Some methods are proposed to minimize the field distortion in curved CCT magnets.

CONCLUSIONS

The beam optics with high order considerations of a lightweight SC gantry with large momentum acceptance is presented.

Design of a light and fast energy degrader for a compact superconducting gantry with large momentum acceptance

PURPOSE

Proton therapy is a precise radiation cancer treatment with low side effects. To reduce the cost and footprint of the facility, the superconducting gantry with large momentum acceptance becomes a potential solution. Benefit from this feature, beam delivery time depends largely on the energy-switching process and short time is helpful for increasing the number of volume repaintings.

METHODS

This note introduces an energy degrader with lightweight moving parts and a new hybrid structure (wedge-block-block). The total energies are separated into three stages and are degraded at fixed rates in two boron carbide blocks. As only one pair of graphite wedges is used for energy modulation, the energy switching at each step reaches a 10 ms level.

RESULTS

The transport process in the degrader was simulated in TOPAS. After the degradation, the maximum energy spread (1σ) was approximately 5.5%, and the distance between successive energy layers can be increased for treating non-sensitive tissues. Six configurations of the hybrid degrader achieved distinctly higher transmission efficiencies than the usual graphite multi-wedge degrader. Finally, the configuration that maximized the beam transmission in the lower-energy range (namely, the W-B₁-B₂ configuration) was chosen as the degrader.

CONCLUSIONS

This new degrader not only improved the transmission efficiency, but also reduced the energy-switching time by virtue of its light and compact structure.

Effects of Peroral Endoscopic Myotomy on Esophageal Function in the Treatment of Achalasia

Peroral endoscopic myotomy (POEM) is a new technique to treat achalasia, but the effects on esophageal motor function and structure are still unclear. This study aimed to examine the esophageal function and anatomical changes of patients with achalasia treated with POEM. This was a retrospective study of 43 patients with achalasia treated with POEM between January 2013 and January 2016 at the Second Affiliated Hospital of Xi'an Jiaotong University. The patients were grouped as previous treatments for achalasia (n = 19) versus no previous treatment (n = 24). Surgical success (defined as Eckardt score ≤3 points or decreased by >3 points compared with baseline), recurrence, and reintervention were analyzed. Three patients (7.0%) were Eckardt grade I, 16 (37.2%) were grade II, and 24 (55.8%) were grade III. Operation time was 35 to 150 (median = 49) minutes. Both groups showed improvements in the Eckardt score after surgery (both P < .001), without a difference between the 2 groups (P = .749). The maximal mean diameter of the esophagus was reduced, and the lower esophageal sphincter pressure was improved after surgery (both groups, all P < .001), without difference between the 2 groups (all P > .05). One case of failure was probably due to the presence of an esophageal stent. POEM has a high success rate and is possibly unaffected by previous treatments, except maybe stent implantation. Clinical symptoms of achalasia are significantly relieved by POEM; the function of the esophageal sphincter and the esophagus structure are improved. Previous esophageal stent implantation could increase failure likelihood, but this will have to be confirmed.