Impact of body composition, grip strength, and physical performance on clinical outcomes for locally advanced gastric cancer during neoadjuvant chemotherapy: A prospective cohort study

Interventional effect of hesperetin on N-methyl-N'-nitro-N-nitrosoguanidine-induced exosomal circ008274 in affecting normal cells to promote gastric carcinogenesis

BACKGROUND

Hesperetin, a flavonoid predominantly present in citrus fruits, exhibits significant intervention effects on both the initiation and progression of gastric cancer. However, the specific mechanisms underlying this effect remain unclear.

AIM

To investigate the interventional role of hesperetin on N-methyl-N'-nitro-N-nitrosoguanidine (MNNG)-induced exosomes in inducing gastric carcinogenesis.

METHODS

Bioinformatics technology was used to identify the critical molecular components underlying hesperetin-mediated inhibition of MNNG induced gastric carcinogenesis through exosomal circular RNA. Biological experiments were conducted to validate these findings.

RESULTS

Exosomes derived from TGES-1 cells (TGES-1-EX) significantly enhanced the proliferation, migration, invasion, epithelial-mesenchymal transition (EMT), and stemness of GES-1 cells. The oncogenic potential of TGES-1-EX was significantly diminished following hesperetin pretreatment. TGES-1-EX with overexpressed or knocked down circ0008274 was extracted and GES-1 cells were treated in combination with hesperetin or alone. Our investigation revealed that hesperetin exerted significant inhibitory effects on MNNG-induced gastric carcinogenesis by exosomal circ0008274. Bioinformatics prediction identified microRNA (miR)-526b-5p as a potential miRNA binding to circ0008274. Functional experiments demonstrated that hesperetin may mediate its intervention in MNNG-induced gastric cancer initiation by targeting miR-526b-5p through exosomal circ0008274. TGES-1-EX circ0008274 promoted the proliferation, EMT, and cancer stem cell-like characteristics in GES-1 cells through miR-526b-5p-mediated regulatory mechanisms.

CONCLUSION

Hesperetin exerted an interventional effect on the gastric carcinogenesis process, particularly through the modulation of exosomal circ0008274 and its interaction with miR-526b-5p.

Developing a predictive model for delayed healing of esophagojejunal anastomotic fistula following total gastrectomy based on imaging and clinical inflammatory-nutritional status

BACKGROUND

Esophagojejunal anastomotic fistula (EJF) following radical total gastrectomy is a severe perioperative complication in patients with gastric cancer, particularly as delayed fistula healing increases hospitalization costs and leads to poor prognosis. Numerous factors influence the occurrence and progression of EJF, with inflammation and nutritional status being significant contributors to perioperative complications. Therefore, this study aims to investigate the prediction of delayed EJF healing based on postoperative clinical and imaging-related inflammation-nutrition status.

METHODS

We retrospectively collected data on 315 cases of EJF following radical total gastrectomy for gastric cancer from two centers between 2015 and 2023 (training group: center one with 194 cases, validation group: center two with 121 cases). EJF was diagnosed based on clinical presentation, gastrointestinal imaging, or endoscopic findings. The healing time for EJF was defined as the period from diagnosis to the removal of the abdominal drainage tube, and patients were categorized into early healing and delayed healing groups based on the median healing time. Postoperative abdominal computed tomography(CT) scans and clinical characteristics at the time of EJF diagnosis were collected. Univariate and multivariable logistic regression analyses were performed on the training group data to construct a predictive model (nomogram). The model's performance in both the training and validation groups was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curves, and decision curve analysis (DCA).

RESULT

The mean healing time for EJF was 16 ± 7 days (median time: 12 days, range: 4-43 days). Postoperative systemic immune-inflammation index (SII) > 521 × 10ˆ9/L, controlling nutritional status score (CONUT) > 4, nutritional support method, visceral fat index (VFI) < 74.42 cm2/m2, and skeletal muscle index (SMI) < 41.25 cm2/m2 were associated with delayed EJF healing times. A comprehensive model was developed, in the validation group, the model demonstrated an AUC of 0.838 (95 % confidence interval (95 % CI): 0.763-0.912). The DCA and calibration curves indicated a strong predictive consistency and clinical utility of the model.