BACKGROUND Gastrointestinal submucosal tumors(SMTs)mostly grew in the lumen,but also some of the lesions were extraluminal,in which the stomach was the most co-mmon site.Gastrointestinal stromal tumor account for a la...BACKGROUND Gastrointestinal submucosal tumors(SMTs)mostly grew in the lumen,but also some of the lesions were extraluminal,in which the stomach was the most co-mmon site.Gastrointestinal stromal tumor account for a large proportion of SMT.Due to the deep lesion location of gastric SMT,endoscopic submucosal dissection related techniques are difficult to operate,while endoscopic full-thickness rese-ction(EFTR)has been widely used in clinical practice because it is less invasive and can preserve the physiological structure and function of the stomach.Ho-wever,complete closure of the gastrectomy site after EFTR is critical.If the closure is incomplete,it may cause peritonitis,late perforation and other conditions,and even require further surgical intervention.Although there are currently a number of suture devices and techniques that can be used to promote closure,they have the problem of requiring additional equipment or being inconvenient to use.Although metal clips are widely used,their effectiveness depends on the size and tension of the defect.Therefore,an effective and convenient endoscopic closure technique is urgently needed to solve the closure problem of gastric SMTs after treatment.AIM To investigate the effect of combined application of the preclosure technique and dental floss traction in gastric wound closure following EFTR.METHODS In this study,the data of 94 patients treated for gastric SMTs at the Gastrointestinal Endoscopy Center of the Affiliated Union Hospital of Fujian Medical University from April 2022 to May 2023 were retrospectively analyzed.The patients were divided into a preclosure group(54 patients)and a non-preclosure group(40 patients)on the basis of the timing of wound closure with titanium clips after dental floss traction-assisted EFTR.Each patient in the preclosure group had their wounds preclosed with titanium clips after subtotal lesion resection,whereas each patient in the non-preclosure group had their wounds closed with titanium clips after total lesion resection.The lesion size,wound closure time,number of titanium clips used,incidence of postoperative complications,and postoperative hospitalization time were compared between the two groups.RESULTS The wound closure time was significantly shorter in the preclosure group than in the non-preclosure group(6.69±2.109 minutes vs 11.65±3.786 minutes,P<0.001).The number of titanium clips used was significantly lower in the preclosure group(8.93±2.231)than in the non-preclosure group(12.05±4.495)(P<0.001).There was no sig-nificant difference between the two groups in terms of the need for an indwelling gastric tube or the length of postoperative hospital stay(6.41±1.31 vs 6.13±1.06 days).For all patients in the preclosure group and the non-preclosure group,resection was completed successfully without bleeding,abdominal pain,abdominal distension,or other postoperative complications.CONCLUSION Application of the preclosure technique combined with dental floss traction can be used intraoperatively to effectively close the surgical wound in patients undergoing EFTR,reliably preventing the tumor from falling into the peritoneal cavity.展开更多
BACKGROUND The incidence and mortality of colorectal cancer(CRC)are among the highest in the world,and its occurrence and development are closely related to tumor neovascularization.When the balance between pigment ep...BACKGROUND The incidence and mortality of colorectal cancer(CRC)are among the highest in the world,and its occurrence and development are closely related to tumor neovascularization.When the balance between pigment epithelium-derived factors(PEDF)that inhibit angiogenesis and vascular endothelial growth factors(VEGF)that stimulate angiogenesis is broken,angiogenesis is out of control,resulting in tumor development.Therefore,it is very necessary to find more therapeutic targets for CRC for early intervention and later treatment.AIM To investigate the expression and significance of PEDF,VEGF,and CD31-stained microvessel density values(CD31-MVD)in normal colorectal mucosa,adenoma,and CRC.METHODS In this case-control study,we collected archived wax blocks of specimens from the Digestive Endoscopy Center and the General Surgery Department of Chengdu Second People's Hospital from April 2022 to October 2022.Fifty cases of specimen wax blocks were selected as normal intestinal mucosa confirmed by electronic colonoscopy and concurrent biopsy(normal control group),50 cases of specimen wax blocks were selected as colorectal adenoma confirmed by electronic colonoscopy and pathological biopsy(adenoma group),and 50 cases of specimen wax blocks were selected as CRC confirmed by postoperative pathological biopsy after inpatient operation of general surgery(CRC group).An immunohistochemical staining experiment was carried out to detect PEDF and VEGF expression in three groups of specimens,analyze their differences,study the relationship between the two and clinicopathological factors in CRC group,record CD31-MVD in the three groups,and analyze the correlation of PEDF,VEGF,and CD31-MVD in the colorectal adenoma group and the CRC group.The F test or adjusted F test is used to analyze measurement data statistically.Kruskal-Wallis rank sum test was used between groups for ranked data.The chi-square test,adjusted chi-square test,or Fisher's exact test were used to compare the rates between groups.All differences between groups were compared using the Bonferroni method for multiple comparisons.Spearman correlation analysis was used to test the correlation of the data.The test level(α)was 0.05,and a two-sided P<0.05 was considered statistically significant.RESULTS The positive expression rate and expression intensity of PEDF were gradually decreased in the normal control group,adenoma group,and CRC group(100%vs 78%vs 50%,χ^(2)=34.430,P<0.001;++~++vs+~++vs-~+,H=94.059,P<0.001),while VEGF increased gradually(0%vs 68%vs 96%,χ^(2)=98.35,P<0.001;-vs-~+vs++~+++,H=107.734,P<0.001).In the CRC group,the positive expression rate of PEDF decreased with the increase of differen-tiation degree,invasion depth,lymph node metastasis,distant metastasis,and TNM stage(χ^(2)=20.513,4.160,5.128,6.349,5.128,P<0.05);the high expression rate of VEGF was the opposite(χ^(2)=10.317,13.134,17.643,21.844,17.643,P<0.05).In the colorectal adenoma group,the expression intensity of PEDF correlated negatively with CD31-MVD(r=-0.601,P<0.001),whereas VEGF was not significantly different(r=0.258,P=0.07).In the CRC group,the expression intensity of PEDF correlated negatively with the expression intensity of CD31-MVD and VEGF(r=-0.297,P<0.05;r=-0.548,P<0.05),while VEGF expression intensity was positively related to CD31-MVD(r=0.421,P=0.002).CONCLUSION It is possible that PEDF can be used as a new treatment and prevention target for CRC by upregulating the expression of PEDF while inhibiting the expression of VEGF.展开更多
BACKGROUND Lipid metabolism reprogramming is suspected to exist in pre-cancerous lesions,including colorectal adenoma.Screening colonoscopy frequently reveals chicken skin mucosa(CSM;white or yellow-white speckled muc...BACKGROUND Lipid metabolism reprogramming is suspected to exist in pre-cancerous lesions,including colorectal adenoma.Screening colonoscopy frequently reveals chicken skin mucosa(CSM;white or yellow-white speckled mucosa)surrounding colo-rectal polyps,caused by macrophages engulfing and accumulating the lipids decomposed by colon cells or adjacent tumors.CSM-positive colorectal polyps are associated with various diseases;however,their prognosis varies greatly.Cold snare polypectomy is commonly used to resect lesions up to 10 to 15 mm in diameter without signs of submucosal invasion but is controversial for CSM-positive colorectal polyps.Improved imaging is required to diagnose and treat CSM-positive colorectal polyps.METHODS This retrospective cohort study included 177 patients with CSM-positive colorectal polyps diagnosed using endoscopy.All patient-related information was extracted from the Goldisc soft-clinic DICOM system or electronic medical record system.Based on the pathological results,patients were classified as non-neoplastic polyps(five juvenile polyps),neoplastic polyps,non-invasive high-grade neoplasia(NHGN),or submucosal invasive carcinoma(SM stage cancer).We analyzed and compared the clinical features,suspected risk factors for malignant transformation of neoplastic polyps,and early infiltration of sub-mucosal carcinoma.RESULTS The diameters of NHGN and SM polyps were much smaller than those of neoplastic polyps.Most NHGN polyps had a deeper red mucosal color.On logistic regression analyses,diameter and deeper red mucosal color were independent risk factors for malignant transformation of neoplastic polyps.Type 1 CSM was more common in high-grade intraepithelial neoplasia and SM;type 2 CSM was more common in neoplastic polyps.Logistic regression analyses revealed no significant differences in the malignant transformation of neoplastic polyps or early submucosal invasion of CSM-positive colorectal cancer.Changes in the CSM mucosa surrounding neoplastic polyps and submucosal invasion of colorectal cancer disappeared within 12 months.No tumor recurrence was found during either partial or complete endoscopic resection of the CSM.CONCLUSION CSM-positive colorectal polyps>1 cm in diameter or with deeper red mucosa may be related to NHGN.Resection of CSM surrounding colorectal adenomas did not affect tumor recurrence.展开更多
BACKGROUND Afferent loop syndrome(ALS)is a rare complication,Aoki et al reported that the incidence of distal gastrectomy in Billroth-II is 0.3%-1.0%.The clinical manifest-ations of ALS are atypical,which can manifest...BACKGROUND Afferent loop syndrome(ALS)is a rare complication,Aoki et al reported that the incidence of distal gastrectomy in Billroth-II is 0.3%-1.0%.The clinical manifest-ations of ALS are atypical,which can manifest as severe abdominal pain,vomiting,obstructive jaundice,malnutrition,etc.CASE SUMMARY The patient was a 58-year-old man who complained of recurrent high fever for more than 1 week.Laboratory tests showed an increase in neutrophil ratio,procal-citonin,C-reactive protein,and abnormal liver function.Enhanced computed tomography scan of the abdomen showed small intestinal obstruction between the anastomosis of the gastrojejunum,bile duct,and pancreaticoduodenum.Gastroscopy revealed significant narrowing of the lumen 15 cm from the anasto-mosis into the afferent loop.After performing balloon dilation and placement of the nutrition tube,the patient did not experience further fever.CONCLUSION ALS is relatively rare after pancreaticoduodenectomy,and the treatment depends on the nature of the obstructive lesion.The traditional treatment method is surgery,and in recent years,endoscopy has provided a new treatment method for ALS.展开更多
AIM:To evaluate the potential role of Nimesulide,a selective COX-2 inhibitor,in proliferation and apoptosis of gastric adenocarcinoma cells SGC7901.METHODS:Cell counts and MYT assay were used to quantify the influence...AIM:To evaluate the potential role of Nimesulide,a selective COX-2 inhibitor,in proliferation and apoptosis of gastric adenocarcinoma cells SGC7901.METHODS:Cell counts and MYT assay were used to quantify the influence of Nimesulide in the proliferation of SGC7901cells.Transmission electron microscopy and flow cytometry were used to observe the induction of Nimesulide the apoptosis of SGC7901 cells and influence in the distribution of cell cycle.The expression of P27^(kipl) protein was observed by immunocytochemical staining.RESULTS:SGC-7901 Cells treated with Nimesulide at various concentrations exhibited a profound dose-and timedependent reduction in the proliferation rate over the 72 h test period.The highest survival rate of the cells was 78.7%,but the lowest being 22.7%.Nimesulide induced apoptosis of the cells in a dose-dependent and non-linear manner and increased the proportion of cells in the G_(0)/G_(1) phase and decreased the proportion in the S and G_(2)/M phase of the cell cycle.Meanwhile,Nimesulide could up-regulate the expression of P27kipl protein.CONCLUSION:The induction of apoptosis and cell cycle arrest are both anti-proliferative responses that likely contribute to the antineoplastic action of nimesulide on SGC7901 cells.The up-regulation of P27kipl gene may contribute to the accumulation of these cells in the G_(0)/G_(1)phase following treatment with Nimesulide.Selective COX-2 inhibitor may be a new channel of the chemoprevention and chemotherapy for gastric carcinoma.展开更多
BACKGROUND Chicken skin mucosa(CSM)surrounding colon polyps is a common endoscopic finding with pale yellow-speckled mucosa during a colonoscopy screening.Although reports about CSM surrounding small colorectal cancer...BACKGROUND Chicken skin mucosa(CSM)surrounding colon polyps is a common endoscopic finding with pale yellow-speckled mucosa during a colonoscopy screening.Although reports about CSM surrounding small colorectal cancer are scarce,and its clinical significance in intramucosal and submucosal cancers is unclear,previous studies have suggested it could be an endoscopic predictive marker for colonic neoplastic and advanced polyps.Currently,because of the inaccurate preoperative evaluation by endoscopists,many small colorectal cancers,particularly lesions with a diameter<2 cm,are improperly treated.Therefore,more effective methods are required to better assess the depth of the lesion before treatment.AIM To explore potential markers of small colorectal cancer early invasion under white light endoscopy,providing patients with better treatment alternatives.METHODS This retrospective cross-sectional study included 198 consecutive patients[233 early colorectal cancers(ECCs)]who underwent endoscopy or surgical procedures at the Digestive Endoscopy Center of Chengdu Second People’s Hospital between January 2021 and August 2022.The participants had pathologically confirmed colorectal cancer with a lesion diameter<2 cm and received endoscopic or surgical treatment,including endoscopic mucosal resection and submucosal dissection.Clinical pathology and endoscopy parameters,including tumor size,invasion depth,anatomical position,and morphology,were reviewed.Fisher’s exact test,theχ2 test,and Student’s t-test were used to analyze the patient’s basic characteristics.Logistic regression analysis was used to examine the relationship between morphological characteristics,size,CSM prevalence,and ECC invasion depth under white light endoscopy.Statistical significance was set at P<0.05.RESULTS The submucosal carcinoma(SM stage)was larger than the mucosal carcinoma(M stage)with a significant difference(17.2±4.1 vs 13.4±4.6 mm,P<0.01).M-and SM-stage cancers were common in the left colon;however,no significant differences were found between them(151/196,77%and 32/37,86.5%,respectively,P=0.199).The endoscopic features of colorectal cancer revealed that CSM,depressed areas with clear boundaries,and erosion or ulcer bleeding were more common in the SM-stage cancer group than in the M-stage cancer group(59.5%vs 26.2%,46%vs 8.7%,and 27.3%vs 4.1%,respectively,P<0.05).CSM prevalence in this study was 31.3%(73/233).The positive rates of CSM in flat,protruded,and sessile lesions were 18%(11/61),30.6%(30/98),and 43.2%(32/74),respectively,with significant differences(P=0.007).CONCLUSION CSM-related small colorectal cancer was primarily located in the left colon and could be a predictive marker of submucosal invasion in the left colon.展开更多
Pleasant touch sensation derived from hugging,cuddling,holding hands,or massage therapy can provide powerful benefits for patients with psychiatric disorders and play a crucial role in reducing pain,alleviating stress...Pleasant touch sensation derived from hugging,cuddling,holding hands,or massage therapy can provide powerful benefits for patients with psychiatric disorders and play a crucial role in reducing pain,alleviating stress,and strengthening social bonds.Revealing the underlying mechanisms of pleasant touch is an attractive topic in neuroscience[1].The peripheral pathway for pleasant touch is mainly coded by C-tactile(CT)afferents,activated by touches with velocities between 1 and 10cm/s[2].展开更多
BACKGROUND Neoadjuvant chemotherapy(NC)improves the survival outcomes of selected patients with colorectal liver metastasis(CRLM).The benefits of irinotecan-based regimens in these patients are still under debate.AIM ...BACKGROUND Neoadjuvant chemotherapy(NC)improves the survival outcomes of selected patients with colorectal liver metastasis(CRLM).The benefits of irinotecan-based regimens in these patients are still under debate.AIM To compare the benefits of irinotecan-and oxaliplatin-based regimens in patients with resectable CRLM.METHODS From September 2003 to August 2020,554 patients received NC and underwent hepatectomy for CRLM.Based on a 1:1 propensity score matching(PSM)model,175 patients who received irinotecan were matched to 175 patients who received oxaliplatin to obtain two balanced groups regarding demographic,therapeutic,and prognostic characteristics.RESULTS Chemotherapy was based on oxaliplatin in 353(63.7%)patients and irinotecan in 201(36.3%).After PSM,the 5-year progression-free survival(PFS)and overall survival(OS)rates with irinotecan were 18.0%and 49.7%,respectively,while the 5-year PFS and OS rates with oxaliplatin were 26.0%and 46.8%,respectively.Intraoperative blood loss,operating time,and postoperative complications differed significantly between the two groups.In the multivariable analysis,carbohydrate antigen 19-9,RAS mutation,response to NC,tumor size>5 cm,and tumor number>1 were inde-pendently associated with PFS.CONCLUSION In NC in patients with CRLM,irinotecan is similar to oxaliplatin in survival outcomes,but irinotecan is superior regarding operating time,intraoperative blood loss,and postoperative complications.展开更多
Tertiary alcohols are generally considered difficult to oxidize.However,in this work,it was found that catalyzed by (NH_(4))_(2)Ce(NO_(3))_(6)(CAN)and in the presence of catalytic trifluoroacetic acid(TFA),the selecti...Tertiary alcohols are generally considered difficult to oxidize.However,in this work,it was found that catalyzed by (NH_(4))_(2)Ce(NO_(3))_(6)(CAN)and in the presence of catalytic trifluoroacetic acid(TFA),the selective oxidative C-C bond cleavage of tertiary alcohols could be achieved using O_(2) flow to produce carbonyl compounds.The benefits of this method include the use of simple and inexpensive catalysts,as well as the environmentally friendly nature of the process.This research significantly broadens the scope of alcohol oxidation chemistry.Since alcohol oxidation reactions involving C-C bond cleavage have potential applications as the key unit reaction in certain industrial processes,this finding holds significant promise for organic chemical engineering.展开更多
BACKGROUND Conventional endoscopic submucosal dissection(c-ESD)is a widely used technique for rectal neuroendocrine tumors(NETs),but it poses certain challenges.To address these,we developed a pretraction-assisted end...BACKGROUND Conventional endoscopic submucosal dissection(c-ESD)is a widely used technique for rectal neuroendocrine tumors(NETs),but it poses certain challenges.To address these,we developed a pretraction-assisted endoscopic submucosal dissection(p-ESD)technique.AIM To compare the efficacy and safety of p-ESD and c-ESD for rectal NETs.METHODS This retrospective study included consecutive patients with rectal NETs measuring less than 15 mm who underwent either p-ESD or c-ESD at Fujian Medical University Union Hospital between January 2019 and December 2023.The study aimed to evaluate differences in dissection time,en bloc resection rate,R0 resection rate,and adverse event rates between the p-ESD and c-ESD groups.RESULTS In total,103 patients were enrolled(49 in the p-ESD group and 54 in the c-ESD group).The p-ESD group exhibited a significantly shorter median dissection time(9.3 minutes vs 14.9 minutes;P<0.001)and a higher R0 resection rate(100%vs 88.9%;P=0.028),while en bloc resection rates were comparable.Rates of minor intraoperative bleeding(10.2%vs 25.9%;P=0.040)and major intraoperative bleeding(4.1%vs 18.5%;P=0.030)were lower in the p-ESD group.No muscularis propria injuries occurred in the p-ESD group vs 16.7%in the c-ESD group(P=0.003).Other adverse events did not differ significantly.CONCLUSION p-ESD is safe and effective for treating rectal NETs.Compared with c-ESD,it is technically easier,requires less dissection time,achieves higher R0 resection rates,reduces intraoperative bleeding,and lowers the risk of muscularis propria injury.展开更多
The superfamily of aldo-keto reductases(AKRs)is composed of over 190 members and can be classified into 16 different families(visit www.med.upenn.edu/akr).AKR1C3(C3 subtype of aldosterone reductase family 1)refers to ...The superfamily of aldo-keto reductases(AKRs)is composed of over 190 members and can be classified into 16 different families(visit www.med.upenn.edu/akr).AKR1C3(C3 subtype of aldosterone reductase family 1)refers to the first AKR in family 1,subfamily C,and is encoded by the AKR1C3 gene.AKR1C3 was first cloned and expressed from a human prostate cDNA library.This protein is a soluble monomeric NADP(H)(nicotinamideadenine dinucleotide phosphate or reduced form of nicotinamide adenine dinucleotide phosphate)dependent oxidoreductase.展开更多
文摘BACKGROUND Gastrointestinal submucosal tumors(SMTs)mostly grew in the lumen,but also some of the lesions were extraluminal,in which the stomach was the most co-mmon site.Gastrointestinal stromal tumor account for a large proportion of SMT.Due to the deep lesion location of gastric SMT,endoscopic submucosal dissection related techniques are difficult to operate,while endoscopic full-thickness rese-ction(EFTR)has been widely used in clinical practice because it is less invasive and can preserve the physiological structure and function of the stomach.Ho-wever,complete closure of the gastrectomy site after EFTR is critical.If the closure is incomplete,it may cause peritonitis,late perforation and other conditions,and even require further surgical intervention.Although there are currently a number of suture devices and techniques that can be used to promote closure,they have the problem of requiring additional equipment or being inconvenient to use.Although metal clips are widely used,their effectiveness depends on the size and tension of the defect.Therefore,an effective and convenient endoscopic closure technique is urgently needed to solve the closure problem of gastric SMTs after treatment.AIM To investigate the effect of combined application of the preclosure technique and dental floss traction in gastric wound closure following EFTR.METHODS In this study,the data of 94 patients treated for gastric SMTs at the Gastrointestinal Endoscopy Center of the Affiliated Union Hospital of Fujian Medical University from April 2022 to May 2023 were retrospectively analyzed.The patients were divided into a preclosure group(54 patients)and a non-preclosure group(40 patients)on the basis of the timing of wound closure with titanium clips after dental floss traction-assisted EFTR.Each patient in the preclosure group had their wounds preclosed with titanium clips after subtotal lesion resection,whereas each patient in the non-preclosure group had their wounds closed with titanium clips after total lesion resection.The lesion size,wound closure time,number of titanium clips used,incidence of postoperative complications,and postoperative hospitalization time were compared between the two groups.RESULTS The wound closure time was significantly shorter in the preclosure group than in the non-preclosure group(6.69±2.109 minutes vs 11.65±3.786 minutes,P<0.001).The number of titanium clips used was significantly lower in the preclosure group(8.93±2.231)than in the non-preclosure group(12.05±4.495)(P<0.001).There was no sig-nificant difference between the two groups in terms of the need for an indwelling gastric tube or the length of postoperative hospital stay(6.41±1.31 vs 6.13±1.06 days).For all patients in the preclosure group and the non-preclosure group,resection was completed successfully without bleeding,abdominal pain,abdominal distension,or other postoperative complications.CONCLUSION Application of the preclosure technique combined with dental floss traction can be used intraoperatively to effectively close the surgical wound in patients undergoing EFTR,reliably preventing the tumor from falling into the peritoneal cavity.
基金The study was approved by the Ethics Committee of the Second People's Hospital of Chengdu.
文摘BACKGROUND The incidence and mortality of colorectal cancer(CRC)are among the highest in the world,and its occurrence and development are closely related to tumor neovascularization.When the balance between pigment epithelium-derived factors(PEDF)that inhibit angiogenesis and vascular endothelial growth factors(VEGF)that stimulate angiogenesis is broken,angiogenesis is out of control,resulting in tumor development.Therefore,it is very necessary to find more therapeutic targets for CRC for early intervention and later treatment.AIM To investigate the expression and significance of PEDF,VEGF,and CD31-stained microvessel density values(CD31-MVD)in normal colorectal mucosa,adenoma,and CRC.METHODS In this case-control study,we collected archived wax blocks of specimens from the Digestive Endoscopy Center and the General Surgery Department of Chengdu Second People's Hospital from April 2022 to October 2022.Fifty cases of specimen wax blocks were selected as normal intestinal mucosa confirmed by electronic colonoscopy and concurrent biopsy(normal control group),50 cases of specimen wax blocks were selected as colorectal adenoma confirmed by electronic colonoscopy and pathological biopsy(adenoma group),and 50 cases of specimen wax blocks were selected as CRC confirmed by postoperative pathological biopsy after inpatient operation of general surgery(CRC group).An immunohistochemical staining experiment was carried out to detect PEDF and VEGF expression in three groups of specimens,analyze their differences,study the relationship between the two and clinicopathological factors in CRC group,record CD31-MVD in the three groups,and analyze the correlation of PEDF,VEGF,and CD31-MVD in the colorectal adenoma group and the CRC group.The F test or adjusted F test is used to analyze measurement data statistically.Kruskal-Wallis rank sum test was used between groups for ranked data.The chi-square test,adjusted chi-square test,or Fisher's exact test were used to compare the rates between groups.All differences between groups were compared using the Bonferroni method for multiple comparisons.Spearman correlation analysis was used to test the correlation of the data.The test level(α)was 0.05,and a two-sided P<0.05 was considered statistically significant.RESULTS The positive expression rate and expression intensity of PEDF were gradually decreased in the normal control group,adenoma group,and CRC group(100%vs 78%vs 50%,χ^(2)=34.430,P<0.001;++~++vs+~++vs-~+,H=94.059,P<0.001),while VEGF increased gradually(0%vs 68%vs 96%,χ^(2)=98.35,P<0.001;-vs-~+vs++~+++,H=107.734,P<0.001).In the CRC group,the positive expression rate of PEDF decreased with the increase of differen-tiation degree,invasion depth,lymph node metastasis,distant metastasis,and TNM stage(χ^(2)=20.513,4.160,5.128,6.349,5.128,P<0.05);the high expression rate of VEGF was the opposite(χ^(2)=10.317,13.134,17.643,21.844,17.643,P<0.05).In the colorectal adenoma group,the expression intensity of PEDF correlated negatively with CD31-MVD(r=-0.601,P<0.001),whereas VEGF was not significantly different(r=0.258,P=0.07).In the CRC group,the expression intensity of PEDF correlated negatively with the expression intensity of CD31-MVD and VEGF(r=-0.297,P<0.05;r=-0.548,P<0.05),while VEGF expression intensity was positively related to CD31-MVD(r=0.421,P=0.002).CONCLUSION It is possible that PEDF can be used as a new treatment and prevention target for CRC by upregulating the expression of PEDF while inhibiting the expression of VEGF.
基金the Science and Technology Plan Project of Chengdu Municipal Health Commission,No.2019007.
文摘BACKGROUND Lipid metabolism reprogramming is suspected to exist in pre-cancerous lesions,including colorectal adenoma.Screening colonoscopy frequently reveals chicken skin mucosa(CSM;white or yellow-white speckled mucosa)surrounding colo-rectal polyps,caused by macrophages engulfing and accumulating the lipids decomposed by colon cells or adjacent tumors.CSM-positive colorectal polyps are associated with various diseases;however,their prognosis varies greatly.Cold snare polypectomy is commonly used to resect lesions up to 10 to 15 mm in diameter without signs of submucosal invasion but is controversial for CSM-positive colorectal polyps.Improved imaging is required to diagnose and treat CSM-positive colorectal polyps.METHODS This retrospective cohort study included 177 patients with CSM-positive colorectal polyps diagnosed using endoscopy.All patient-related information was extracted from the Goldisc soft-clinic DICOM system or electronic medical record system.Based on the pathological results,patients were classified as non-neoplastic polyps(five juvenile polyps),neoplastic polyps,non-invasive high-grade neoplasia(NHGN),or submucosal invasive carcinoma(SM stage cancer).We analyzed and compared the clinical features,suspected risk factors for malignant transformation of neoplastic polyps,and early infiltration of sub-mucosal carcinoma.RESULTS The diameters of NHGN and SM polyps were much smaller than those of neoplastic polyps.Most NHGN polyps had a deeper red mucosal color.On logistic regression analyses,diameter and deeper red mucosal color were independent risk factors for malignant transformation of neoplastic polyps.Type 1 CSM was more common in high-grade intraepithelial neoplasia and SM;type 2 CSM was more common in neoplastic polyps.Logistic regression analyses revealed no significant differences in the malignant transformation of neoplastic polyps or early submucosal invasion of CSM-positive colorectal cancer.Changes in the CSM mucosa surrounding neoplastic polyps and submucosal invasion of colorectal cancer disappeared within 12 months.No tumor recurrence was found during either partial or complete endoscopic resection of the CSM.CONCLUSION CSM-positive colorectal polyps>1 cm in diameter or with deeper red mucosa may be related to NHGN.Resection of CSM surrounding colorectal adenomas did not affect tumor recurrence.
文摘BACKGROUND Afferent loop syndrome(ALS)is a rare complication,Aoki et al reported that the incidence of distal gastrectomy in Billroth-II is 0.3%-1.0%.The clinical manifest-ations of ALS are atypical,which can manifest as severe abdominal pain,vomiting,obstructive jaundice,malnutrition,etc.CASE SUMMARY The patient was a 58-year-old man who complained of recurrent high fever for more than 1 week.Laboratory tests showed an increase in neutrophil ratio,procal-citonin,C-reactive protein,and abnormal liver function.Enhanced computed tomography scan of the abdomen showed small intestinal obstruction between the anastomosis of the gastrojejunum,bile duct,and pancreaticoduodenum.Gastroscopy revealed significant narrowing of the lumen 15 cm from the anasto-mosis into the afferent loop.After performing balloon dilation and placement of the nutrition tube,the patient did not experience further fever.CONCLUSION ALS is relatively rare after pancreaticoduodenectomy,and the treatment depends on the nature of the obstructive lesion.The traditional treatment method is surgery,and in recent years,endoscopy has provided a new treatment method for ALS.
文摘AIM:To evaluate the potential role of Nimesulide,a selective COX-2 inhibitor,in proliferation and apoptosis of gastric adenocarcinoma cells SGC7901.METHODS:Cell counts and MYT assay were used to quantify the influence of Nimesulide in the proliferation of SGC7901cells.Transmission electron microscopy and flow cytometry were used to observe the induction of Nimesulide the apoptosis of SGC7901 cells and influence in the distribution of cell cycle.The expression of P27^(kipl) protein was observed by immunocytochemical staining.RESULTS:SGC-7901 Cells treated with Nimesulide at various concentrations exhibited a profound dose-and timedependent reduction in the proliferation rate over the 72 h test period.The highest survival rate of the cells was 78.7%,but the lowest being 22.7%.Nimesulide induced apoptosis of the cells in a dose-dependent and non-linear manner and increased the proportion of cells in the G_(0)/G_(1) phase and decreased the proportion in the S and G_(2)/M phase of the cell cycle.Meanwhile,Nimesulide could up-regulate the expression of P27kipl protein.CONCLUSION:The induction of apoptosis and cell cycle arrest are both anti-proliferative responses that likely contribute to the antineoplastic action of nimesulide on SGC7901 cells.The up-regulation of P27kipl gene may contribute to the accumulation of these cells in the G_(0)/G_(1)phase following treatment with Nimesulide.Selective COX-2 inhibitor may be a new channel of the chemoprevention and chemotherapy for gastric carcinoma.
文摘BACKGROUND Chicken skin mucosa(CSM)surrounding colon polyps is a common endoscopic finding with pale yellow-speckled mucosa during a colonoscopy screening.Although reports about CSM surrounding small colorectal cancer are scarce,and its clinical significance in intramucosal and submucosal cancers is unclear,previous studies have suggested it could be an endoscopic predictive marker for colonic neoplastic and advanced polyps.Currently,because of the inaccurate preoperative evaluation by endoscopists,many small colorectal cancers,particularly lesions with a diameter<2 cm,are improperly treated.Therefore,more effective methods are required to better assess the depth of the lesion before treatment.AIM To explore potential markers of small colorectal cancer early invasion under white light endoscopy,providing patients with better treatment alternatives.METHODS This retrospective cross-sectional study included 198 consecutive patients[233 early colorectal cancers(ECCs)]who underwent endoscopy or surgical procedures at the Digestive Endoscopy Center of Chengdu Second People’s Hospital between January 2021 and August 2022.The participants had pathologically confirmed colorectal cancer with a lesion diameter<2 cm and received endoscopic or surgical treatment,including endoscopic mucosal resection and submucosal dissection.Clinical pathology and endoscopy parameters,including tumor size,invasion depth,anatomical position,and morphology,were reviewed.Fisher’s exact test,theχ2 test,and Student’s t-test were used to analyze the patient’s basic characteristics.Logistic regression analysis was used to examine the relationship between morphological characteristics,size,CSM prevalence,and ECC invasion depth under white light endoscopy.Statistical significance was set at P<0.05.RESULTS The submucosal carcinoma(SM stage)was larger than the mucosal carcinoma(M stage)with a significant difference(17.2±4.1 vs 13.4±4.6 mm,P<0.01).M-and SM-stage cancers were common in the left colon;however,no significant differences were found between them(151/196,77%and 32/37,86.5%,respectively,P=0.199).The endoscopic features of colorectal cancer revealed that CSM,depressed areas with clear boundaries,and erosion or ulcer bleeding were more common in the SM-stage cancer group than in the M-stage cancer group(59.5%vs 26.2%,46%vs 8.7%,and 27.3%vs 4.1%,respectively,P<0.05).CSM prevalence in this study was 31.3%(73/233).The positive rates of CSM in flat,protruded,and sessile lesions were 18%(11/61),30.6%(30/98),and 43.2%(32/74),respectively,with significant differences(P=0.007).CONCLUSION CSM-related small colorectal cancer was primarily located in the left colon and could be a predictive marker of submucosal invasion in the left colon.
基金supported by grants from the National Key R&D Program of China(2019YFC1709101)the Innovation Team and Talents Cultivation Program of the National Administration of Traditional Chinese Medicine(ZYYCXTD-D-202003)the Sichuan Science and Technology Program(2019YFH0108,2021ZYD0077,2022YFH0006).
文摘Pleasant touch sensation derived from hugging,cuddling,holding hands,or massage therapy can provide powerful benefits for patients with psychiatric disorders and play a crucial role in reducing pain,alleviating stress,and strengthening social bonds.Revealing the underlying mechanisms of pleasant touch is an attractive topic in neuroscience[1].The peripheral pathway for pleasant touch is mainly coded by C-tactile(CT)afferents,activated by touches with velocities between 1 and 10cm/s[2].
基金Supported by the National Nature Science Foundation of China,No.81874143 and No.31971192Beijing Hospitals Authority Youth Program,No.QMS20201105.
文摘BACKGROUND Neoadjuvant chemotherapy(NC)improves the survival outcomes of selected patients with colorectal liver metastasis(CRLM).The benefits of irinotecan-based regimens in these patients are still under debate.AIM To compare the benefits of irinotecan-and oxaliplatin-based regimens in patients with resectable CRLM.METHODS From September 2003 to August 2020,554 patients received NC and underwent hepatectomy for CRLM.Based on a 1:1 propensity score matching(PSM)model,175 patients who received irinotecan were matched to 175 patients who received oxaliplatin to obtain two balanced groups regarding demographic,therapeutic,and prognostic characteristics.RESULTS Chemotherapy was based on oxaliplatin in 353(63.7%)patients and irinotecan in 201(36.3%).After PSM,the 5-year progression-free survival(PFS)and overall survival(OS)rates with irinotecan were 18.0%and 49.7%,respectively,while the 5-year PFS and OS rates with oxaliplatin were 26.0%and 46.8%,respectively.Intraoperative blood loss,operating time,and postoperative complications differed significantly between the two groups.In the multivariable analysis,carbohydrate antigen 19-9,RAS mutation,response to NC,tumor size>5 cm,and tumor number>1 were inde-pendently associated with PFS.CONCLUSION In NC in patients with CRLM,irinotecan is similar to oxaliplatin in survival outcomes,but irinotecan is superior regarding operating time,intraoperative blood loss,and postoperative complications.
基金We thank the Cooperation Project of Yangzhou City with Yangzhou University(No.YZ2023209)Jiaxing Key Laboratory for Creation of Animal Models&Synthesis of Lead Compounds of New Drug(No.jxsz21006)Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD)for financial support.
文摘Tertiary alcohols are generally considered difficult to oxidize.However,in this work,it was found that catalyzed by (NH_(4))_(2)Ce(NO_(3))_(6)(CAN)and in the presence of catalytic trifluoroacetic acid(TFA),the selective oxidative C-C bond cleavage of tertiary alcohols could be achieved using O_(2) flow to produce carbonyl compounds.The benefits of this method include the use of simple and inexpensive catalysts,as well as the environmentally friendly nature of the process.This research significantly broadens the scope of alcohol oxidation chemistry.Since alcohol oxidation reactions involving C-C bond cleavage have potential applications as the key unit reaction in certain industrial processes,this finding holds significant promise for organic chemical engineering.
基金Supported by Fujian Province National Key Clinical Specialty Construction Project(Minwei Medical Policy Letter),No.[2023]1594.
文摘BACKGROUND Conventional endoscopic submucosal dissection(c-ESD)is a widely used technique for rectal neuroendocrine tumors(NETs),but it poses certain challenges.To address these,we developed a pretraction-assisted endoscopic submucosal dissection(p-ESD)technique.AIM To compare the efficacy and safety of p-ESD and c-ESD for rectal NETs.METHODS This retrospective study included consecutive patients with rectal NETs measuring less than 15 mm who underwent either p-ESD or c-ESD at Fujian Medical University Union Hospital between January 2019 and December 2023.The study aimed to evaluate differences in dissection time,en bloc resection rate,R0 resection rate,and adverse event rates between the p-ESD and c-ESD groups.RESULTS In total,103 patients were enrolled(49 in the p-ESD group and 54 in the c-ESD group).The p-ESD group exhibited a significantly shorter median dissection time(9.3 minutes vs 14.9 minutes;P<0.001)and a higher R0 resection rate(100%vs 88.9%;P=0.028),while en bloc resection rates were comparable.Rates of minor intraoperative bleeding(10.2%vs 25.9%;P=0.040)and major intraoperative bleeding(4.1%vs 18.5%;P=0.030)were lower in the p-ESD group.No muscularis propria injuries occurred in the p-ESD group vs 16.7%in the c-ESD group(P=0.003).Other adverse events did not differ significantly.CONCLUSION p-ESD is safe and effective for treating rectal NETs.Compared with c-ESD,it is technically easier,requires less dissection time,achieves higher R0 resection rates,reduces intraoperative bleeding,and lowers the risk of muscularis propria injury.
基金supported by the Medical Innovation Project of Fujian Province(No.2019-CX-14)the Joint Funds for the Innovation of Science and Technology,Fujian province(No.2019Y9083)the Fujian Medical University Cancer Center and the Key Clinical Specialty Discipline Construction Program of Fujian,China(No.Min Wei Ke Jiao 2012 No.149)。
文摘The superfamily of aldo-keto reductases(AKRs)is composed of over 190 members and can be classified into 16 different families(visit www.med.upenn.edu/akr).AKR1C3(C3 subtype of aldosterone reductase family 1)refers to the first AKR in family 1,subfamily C,and is encoded by the AKR1C3 gene.AKR1C3 was first cloned and expressed from a human prostate cDNA library.This protein is a soluble monomeric NADP(H)(nicotinamideadenine dinucleotide phosphate or reduced form of nicotinamide adenine dinucleotide phosphate)dependent oxidoreductase.
