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Ortiz R, Kershaw KN, Zhao S, Kline D, Brock G, Jaffee S, Golden SH, Ogedegbe G, Carroll J, Seeman TE, Joseph JJ. Evidence for the Association Between Adverse Childhood Family Environment, Child Abuse, and Caregiver Warmth and Cardiovascular Health Across the Lifespan: The Coronary Artery Risk Development in Young Adults ( CARDIA) Study. Circ Cardiovasc Qual Outcomes 2024; 17:e009794. [PMID: 38258561 DOI: 10.1161/circoutcomes.122.009794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 09/19/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND This study aimed to quantify the association between childhood family environment and longitudinal cardiovascular health (CVH) in adult CARDIA (Coronary Artery Risk Development in Young Adults) Study participants. We further investigated whether the association differs by adult income. METHODS We applied the CVH framework from the American Heart Association including metrics for smoking, cholesterol, blood pressure, glucose, body mass index, physical activity, and diet. CVH scores (range, 0-14) were calculated at years 0, 7, and 20 of the study. Risky Family environment (range, 7-28) was assessed at year 15 retrospectively, for childhood experiences of abuse, caregiver warmth, and family or household challenges. Complete case ordinal logistic regression and mixed models associated risky family (exposure) with CVH (outcome), adjusting for age, sex, race, and alcohol use. RESULTS The sample (n=2074) had a mean age of 25.3 (±3.5) years and 56% females at baseline. The median risky family was 10 with ideal CVH (≥12) met by 288 individuals at baseline (28.4%) and 165 (16.3%) at year 20. Longitudinally, for every 1-unit greater risky family, the odds of attaining high CVH (≥10) decreased by 3.6% (OR, 0.9645 [95% CI, 0.94-0.98]). Each unit greater child abuse and caregiver warmth score corresponded to 12.8% lower and 11.7% higher odds of ideal CVH (≥10), respectively (OR, 0.872 [95% CI, 0.77-0.99]; OR, 1.1165 [95% CI, 1.01-1.24]), across all 20 years of follow-up. Stratified analyses by income in adulthood demonstrated associations between risky family environment and CVH remained significant for those of the highest adult income (>$74k), but not the lowest (<$35k). CONCLUSIONS Although risky family environmental factors in childhood increase the odds of poor longitudinal adult CVH, caregiver warmth may increase the odds of CVH, and socioeconomic attainment in adulthood may contextualize the level of risk. Toward a paradigm of primordial prevention of cardiovascular disease, childhood exposures and economic opportunity may play a crucial role in CVH across the life course.
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Affiliation(s)
- Robin Ortiz
- Departments of Pediatrics and Population Health, New York University, Grossman School of Medicine (R.O.)
- Institute for Excellence in Health Equity, New York University Langone Health (R.O., G.O.)
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (K.N.K.)
| | - Songzhu Zhao
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus (S.Z., G.B.)
| | - David Kline
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (D.K.)
| | - Guy Brock
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus (S.Z., G.B.)
| | - Sara Jaffee
- Department of Psychology, The University of Pennsylvania, Philadelphia (S.J.)
| | - Sherita H Golden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (S.H.G.)
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity, New York University Langone Health (R.O., G.O.)
- Department of Medicine, New York University, Grossman School of Medicine (G.O.)
| | - Judith Carroll
- The University of California, Los Angeles, David Geffen School of Medicine, Jane and Terri Semel Institute for Neuroscience and Human Behavior, Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Sciences (J.C.)
| | - Teresa E Seeman
- Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (T.E.S.)
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus (J.J.J.)
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Cheng YQ, Zhang XW, Zhuang SH, Zhou XL, Huang Q. Clinicopathological significance of intestinal metaplasia in endoscopically resected early gastric carcinoma. J Dig Dis 2023; 24:660-670. [PMID: 38100304 DOI: 10.1111/1751-2980.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To investigate the clinicopathological and prognostic significance of intestinal metaplasia (IM) in endoscopically resected early gastric carcinoma (EGC). METHODS Altogether 136 consecutive cases with EGC resected by endoscopic submucosal dissection over 5 years were included and divided into the early gastric cardiac (EGCC; n = 60) and non-cardiac carcinoma (EGNCC; n = 76) groups. Goblet cell IM and subtypes were determined with histology and immunostaining. Recurrence-free survival (RFS) was compared among various IM groups. RESULTS IM was identified in 128 (94.1%) EGC cases, including complete IM (n = 39), incomplete IM (n = 27), and mixed IM (n = 62). Incomplete IM was significantly more common in EGCC and exhibited a lower frequency of en bloc resection than the complete subtype. The frequency of synchronous or metachronous gastric tumor was significantly more common in EGCC with complete IM than in those with incomplete IM. Compared to EGC without IM, EGC with IM showed a significantly higher frequency of non-poorly cohesive carcinoma, en bloc resection, and non-eCuraC-1 grade. EGNCC with IM was significantly associated with negative resection margins and en bloc resection. The 5-year RFS was significantly lower in EGNCC patients with incomplete IM compared with those with mixed IM. The independent risk factors for RFS included tumor size >2 cm and eCuraC-1 grade. CONCLUSIONS Subtyping IM in EGC helped predict endoscopic resectability, prognosis, and risk of synchronous or metachronous gastric tumor. The significance of IM differed between EGCC and EGNCC. Large studies with longer follow-up are warranted to validate our findings.
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Affiliation(s)
- Yu Qing Cheng
- Department of Pathology, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Xin Wen Zhang
- Department of Pathology, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China
- Graduate School of Dalian Medical University, Dalian, Liaoning Province, China
| | - Shao Hua Zhuang
- Department of Gastroenterology, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Xiao Li Zhou
- Department of Pathology, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Qin Huang
- Department of Pathology, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, China
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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3
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Sunderraj A, Wong M, Gutiérrez OM, Wolf M, Akhabue E, Carnethon MR, Yancy CW, Isakova T. Associations of FGF23 with 10-Year Change in eGFR and UACR and with Incident CKD in the CARDIA Cohort. Kidney360 2023; 4:e1236-e1244. [PMID: 37265357 PMCID: PMC10547221 DOI: 10.34067/kid.0000000000000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 05/12/2023] [Indexed: 06/03/2023]
Abstract
Key Points FGF23 has a nonlinear positive association with incident CKD among healthy, middle-aged adults. The relationship between FGF23 and incident CKD was only significant among participants with cFGF23 levels in the highest quartile. FGF23 is not associated with 10-year change in eGFR or 10-year change in UACR among healthy, middle-aged adults. Background The relationship of fibroblast growth factor 23 (FGF23) with incident CKD has been examined in older but not younger populations. Methods Linear regression models were used to examine the associations of c-terminal FGF23 (cFGF23) and intact FGF23 (iFGF23) with 10-year change (1995–96 to 2005–06) in eGFR and urine albumin-to-creatinine ratio (UACR) in the Coronary Artery Risk Development in Young Adults cohort. Cox proportional hazard models were used to assess the association of cFGF23 with incident CKD, defined as eGFR <60 ml/min per 1.73 m2 or UACR ≥30 mg/g. Multivariable models were adjusted for age, sex, race, education, field center, physical activity, body mass index, diabetes, smoking, and systolic BP. Results Among 2511 participants, the mean age was 45±3.6 years; mean eGFR was 96.5±14.0 ml/min per 1.73 m2; and median UACR was 4.3 (interquartile range, 3.0–6.7) mg/g. Most (62.6%) participants were nonsmokers; the prevalence of diabetes was low (6.6%); and median values for 10-year changes in eGFR and UACR were modest (−5.50 ml/min per 1.73 m2 and 0.70 mg/g, respectively). No consistent associations between cFGF23 and 10-year change in eGFR and UACR were observed. During a median follow-up of 9.98 years, incident CKD developed in 258 participants. There was a nonlinear association of cFGF23 with incident CKD, and relative to the lowest quartile of cFGF23, a significant relationship was detected only among participants in the highest quartile (hazard ratio, 1.58; 95% confidence interval, 1.09 to 2.27). Similar findings were observed for iFGF23. Conclusion Among middle-aged adults in the Coronary Artery Risk Development in Young Adults cohort, median eGFR and UACR changes were modest and cFGF23 and iFGF23 were not consistently associated with 10-year change in eGFR or UACR. A nonlinear relationship was observed between cFGF23 and incident CKD, with individuals with highest cFGF23 levels being at risk of developing CKD.
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Affiliation(s)
- Ashwin Sunderraj
- Department of Medicine and Clinical and Translational Immunocardiology Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mandy Wong
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Orlando M. Gutiérrez
- Department of Medicine and Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Myles Wolf
- Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Ehimare Akhabue
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Clyde W. Yancy
- Department of Medicine and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tamara Isakova
- Department of Medicine and Center for Translational Metabolism and Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Collatuzzo G, Pelucchi C, Negri E, Kogevinas M, Huerta JM, Vioque J, de la Hera MG, Tsugane S, Shigueaki Hamada G, Hidaka A, Zhang ZF, Camargo MC, Curado MP, Lunet N, La Vecchia C, Boffetta P. Sleep Duration and Stress Level in the Risk of Gastric Cancer: A Pooled Analysis of Case-Control Studies in the Stomach Cancer Pooling (StoP) Project. Cancers (Basel) 2023; 15:4319. [PMID: 37686594 PMCID: PMC10486543 DOI: 10.3390/cancers15174319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
The association between sleep and stress and cancer is underinvestigated. We evaluated these factors in association with gastric cancer (GC). Five case-control studies from the Stomach Cancer Pooling (StoP) Project were included. We calculated the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) for sleep duration and stress level in association with GC through multiple logistic regression models adjusted for several lifestyle factors. The analysis included 1293 cases and 4439 controls, 215 cardia and 919 noncardia GC, and 353 diffuse and 619 intestinal types. Sleep duration of ≥9 h was associated with GC (OR =1.57, 95% CI = 1.23-2.00) compared to 8 h. This was confirmed when stratifying by subsite (noncardia OR = 1.59, 95% CI = 1.22-2.08, and cardia OR = 1.63, 95% CI = 0.97-2.72) and histological type (diffuse OR = 1.65, 95% CI = 1.14-2.40 and intestinal OR = 1.24, 95% CI = 0.91-1.67). Stress was associated with GC (OR = 1.33, 95% CI = 1.18-1.50, continuous). This relationship was selectively related to noncardia GC (OR = 1.28, 95% 1.12-1.46, continuous). The risk of diffuse (OR = 1.32, 95% CI = 1.11-1.58) and intestinal type (OR = 1.23, 95% CI = 1.07-1.42) were higher when stress was reported. Results for the association between increasing level of stress and GC were heterogeneous by smoking and socioeconomic status (p for heterogeneity = 0.02 and <0.001, respectively). In conclusion, long sleep duration (≥9 h) was associated with GC and its subtype categories. Stress linearly increased the risk of GC and was related to noncardia GC.
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Affiliation(s)
- Giulia Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy (E.N.)
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, University of Milan, 20133 Milan, Italy; (C.P.); (C.L.V.)
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy (E.N.)
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, University of Milan, 20133 Milan, Italy; (C.P.); (C.L.V.)
| | - Manolis Kogevinas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (M.K.); (J.V.); (M.G.d.l.H.)
- Barcelona Institute for Global Health—ISGlobal, 08036 Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
- Department de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
| | - José María Huerta
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (M.K.); (J.V.); (M.G.d.l.H.)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30120 Murcia, Spain
| | - Jesus Vioque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (M.K.); (J.V.); (M.G.d.l.H.)
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernandez (ISABIAL-UMH), 03010 Alicante, Spain
| | - Manoli García de la Hera
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (M.K.); (J.V.); (M.G.d.l.H.)
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernandez (ISABIAL-UMH), 03010 Alicante, Spain
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo 104-0045, Japan
- National Institute of Biomedical Innovation, Health and Nutrition, Tokyo 566-0002, Japan
| | | | - Akihisa Hidaka
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo 104-0045, Japan
| | - Zuo-Feng Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, USA;
| | - M. Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | - Maria Paula Curado
- Centro Internacional de Pesquisas, A.C.Camargo Cancer Center, São Paulo 01509-010, Brazil
| | - Nuno Lunet
- EPIUnit—Instituto de Saúde Pública da Universidade do Porto, 4050-091 Porto, Portugal;
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, 4200-450 Porto, Portugal
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, University of Milan, 20133 Milan, Italy; (C.P.); (C.L.V.)
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy (E.N.)
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794, USA
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5
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Collatuzzo G, Santucci C, Malvezzi M, La Vecchia C, Boffetta P, Negri E. Trends in gastric cancer mortality 1990-2019 in 36 countries worldwide, with predictions to 2025, and incidence, overall and by subtype. Cancer Med 2023; 12:9912-9925. [PMID: 36815614 PMCID: PMC10166912 DOI: 10.1002/cam4.5685] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/21/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Gastric cancer (GC) incidence is declining heterogeneously worldwide. We aimed to calculate updated mortality trends for GC. METHODS We investigated time trends for selected countries using the World Health Organization database. We computed age-standardized mortality rates (ASMR) per 100,000 persons over the 1990-2019 period. We reported rates for the 2010-2014 and 2015-19 calendar periods, and the corresponding percent changes. We used joinpoint regression analysis to identify changes in the slope of mortality trends, and predict the number of deaths and rates for 2025. We also reported 2008-2012 incidence rates of cardia and noncardia GC. RESULTS Mortality trends from GC have been favorable since 1990 for all countries analyzed and the European Union (EU 27), in both sexes and all ages. GC mortality is predicted to decline in all countries for both sexes, except for French and US women aged 35-64 years, and Canadian men aged 35-64. The highest proportions of cardia GC were observed in Northern and Central Europe while the lowest ones in Southern and Eastern Europe. Elsewhere, the highest proportions were registered in countries with low incidence and mortality rates, whereas high-mortality countries showed lower proportions of cardia GC. CONCLUSION Observed and predicted GC mortality trends declined in most countries in both sexes, with few exceptions, likely due to the control of GC risk factors, in particular Hp infection.
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Affiliation(s)
- Giulia Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Claudia Santucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Matteo Malvezzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Abstract
Pseudoachalasia accounts for up to 4% of patients who present with achalasia-like picture and most often relates to occult malignancy at the cardia or gastroesophageal junction. Thus, any delay in diagnosis might lead to more advanced disease and less chance for curative therapy, not to mention the risk of serious complications resulting from the treatment of supposed achalasia instead of the true underlying cause. The entity should be suspected in patients with advanced age of onset, a shorter duration of symptoms, profound weight loss and difficulty in passing the gastroesophageal junction on endoscopy. The diagnosis of pseudoachalasia can be challenging as upper endoscopy with biopsy might be false negative in 25% of cases and lesions cannot always be detected on computerized tomography scan. Endoscopic ultrasound and guided biopsy play an increasingly important role in the workup of this condition. Treatment of pseudoachalasia depends on the underlying cause. The aim of this review is to highlight the clinicopathological features that distinguish pseudoachalasia from achalasia and the most appropriate diagnostic workup as well as the subsequent management for this condition.
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Affiliation(s)
- Sara N Haj Ali
- Department of Internal Medicine, Faculty of Medicine, Al-Balqa Applied University, Salt, Jordan
| | - Nam Q Nguyen
- Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia
| | - Awni T Abu Sneineh
- Department of Gastroenterology, Jordan University Hospital, Amman, Jordan
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7
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Pai SM, Huang KH, Chen MH, Fang WL, Chao Y, Lo SS, Li AFY, Wu CW, Shyr YM. Cardia Gastric Cancer Is Associated With Increased PIK3CA Amplifications and HER2 Expression Than Noncardia Gastric Cancer According to Lauren Classification. Front Oncol 2021; 11:632609. [PMID: 34168977 PMCID: PMC8217656 DOI: 10.3389/fonc.2021.632609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background To date, few reports have investigated genetic alterations and clinicopathological features in cardia and noncardia gastric cancer (GC). Methods In total, 435 GC patients receiving curative surgery were included. The clinicopathological features, recurrence patterns, prognoses and genetic alterations were compared between cardia and noncardia GC patients. Results Among the 435 enrolled patients, 47 (10.8%) had cardia GC. Compared with noncardia GC, cardia GC was associated with more intestinal-type tumors and similar initial recurrence patterns and 5-year overall survival (OS; 50.8% vs. 50.5%, P = 0.480) and disease-free survival (DFS; 48.6% vs. 48.9%, P = 0.392) rates. For both intestinal-type GC and diffuse-type GC, the clinicopathological features and 5-year OS and DFS rates were not significantly different between the cardia and noncardia GC patients. Multivariable analysis showed that cardia GC was not an independent prognostic factor. Compared with noncardia GC, cardia GC was associated with increased PIK3CA amplification than in patients with intestinal-type GC and was associated with increased HER2 expression in patients with diffuse-type GC. Conclusions Cardia GC is not an independent prognostic factor. In cardia GC patients with intestinal-type GC, PIK3CA amplification was more common, and in those with diffuse-type GC, HER2 expression was more common. Targeted therapy may be beneficial for these patient subgroups.
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Affiliation(s)
- Shih-Min Pai
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuo-Hung Huang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Huang Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Liang Fang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yee Chao
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Su-Shun Lo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Surgery, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Anna Fen-Yau Li
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chew-Wun Wu
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Ming Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Abstract
The classification of gastric cardiac carcinoma (GCC) is controversial. It is currently grouped with esophageal adenocarcinoma (EAC) as an adenocarcinoma of the gastroesophageal junction (GEJ). Recently, diagnostic criteria for adenocarcinoma in the GEJ were established and GCC was separated from EAC. We viewed published evidence to clarify the GCC entity for better patient management. GCC arises in the cardiac mucosa located from 3 cm below and 2 cm above the GEJ line. Compared with EAC, GCC is more like gastric cancer and affects a higher proportion of female patients, younger patients, those with a lower propensity for reflux disease, a wider histopathologic spectrum, and more complex genomic profiles. Although GCC pathogenesis mechanisms remain unknown, the two-etiology proposal is appealing: in high-risk regions, the Correa pathway with Helicobacter pylori infection, chronic inflammation, low acid and intestinal metaplasia, dysplasia and carcinoma may apply, while in low-risk regions the sequence from reflux toxin-induced mucosal injury and high acid, to intestinal metaplasia, dysplasia and carcinoma may occur. In early GCC a minimal risk of nodal metastasis argues for a role of endoscopic therapy, whereas in advanced GCC, gastric cancer staging rules and treatment strategy appear to be more appropriate than the esophageal cancer staging scheme and therapy for better prognosis stratification and treatment. In this brief review we share recent insights into the epidemiology, histopathology and genetics of GCC and hope that this will stimulate further investigations in order to improve the clinical management of patients with GCC.
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Affiliation(s)
- Qin Huang
- Department of Pathology, Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China.,Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Matthew Read
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jason S Gold
- Department of Surgery, Veterans Affairs Boston Healthcare System, Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Xiao Ping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China
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9
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Laszkowska M, Tramontano AC, Kim J, Camargo MC, Neugut AI, Abrams JA, Hur C. Racial and ethnic disparities in mortality from gastric and esophageal adenocarcinoma. Cancer Med 2020; 9:5678-5686. [PMID: 32573964 PMCID: PMC7402817 DOI: 10.1002/cam4.3063] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background Racial/ethnic differences in mortality have not been well studied for either non‐cardia gastric cancer (NCGC) or cardia gastric cancer (CGC). The aim of this study was to examine the US mortality rates for these cancer subtypes, as well as esophageal adenocarcinoma (EAC) as a comparator. Methods We identified 14 164 individuals who died from NCGC, 5235 from CGC, and 13 982 from EAC in the Surveillance, Epidemiology, and End Results database between 2004 and 2016. Age‐adjusted incidence‐based mortality rates and corresponding annual percent changes (APCs) were calculated. Analyses were stratified by race/ethnicity, age, and stage of disease at diagnosis. Results The mortality rate in NCGC was two‐ to threefold higher in blacks, Hispanics, and Asians/Pacific Islanders (PI) than non‐Hispanic whites, and was significant across all age groups and stages of disease (P < .01). Mortality in CGC was higher in non‐Hispanic whites than blacks and Asians/PI, particularly in individuals in the 50‐64 year age group and those with stage IV disease. Mortality in EAC was two‐ to sixfold higher in non‐Hispanic whites than all other groups across all age groups and stages of disease. From 2004 to 2016, mortality rates were stable across all racial/ethnic groups in NCGC and CGC, and in minority groups with EAC, but have been rising in non‐Hispanic whites with EAC (APC 3.03, 95% CI 0.17‐5.96). Conclusions This is the largest study of incidence‐based mortality in CGC and NCGC and demonstrates racial/ethnic differences in mortality between these subtypes. Mortality rates for NCGC are highest in minority groups, and have been stable in recent years despite declining incidence. Mortality rates for CGC are marginally higher in middle‐aged non‐Hispanic whites with advanced disease, though have remained stable. In contrast, mortality in EAC has been rising for non‐Hispanic whites, in parallel to incidence. Further studies are needed to refine prevention strategies for high‐risk individuals dying from these specific cancer subtypes.
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Affiliation(s)
- Monika Laszkowska
- Division of Digestive and Liver Diseases, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Angela C Tramontano
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Judith Kim
- Division of Digestive and Liver Diseases, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - M Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Alfred I Neugut
- Department of Medicine, Division of Hematology/Oncology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Julian A Abrams
- Division of Digestive and Liver Diseases, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Chin Hur
- Division of Digestive and Liver Diseases, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
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10
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Huang Q, Shi J, Liu TY, Cheng YQ, Wang YH, Du MZ, Li L, Fan XS, Zhou XL, Zhang YF, Guo LC, Xu GF, Zou XP. Marked thickening of muscularis mucosae and submucosa in the gastric cardia: A histopathological study of 110 surgical resection cases. J Dig Dis 2020; 21:205-214. [PMID: 32223013 DOI: 10.1111/1751-2980.12860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate histopathologic changes of muscularis mucosae (MM) and submucosa in the gastric cardia. METHODS We performed a histopathology study of 50 distal esophagectomies with proximal gastrectomies for esophageal squamous cell carcinoma as the study (non-cancerous cardiac) group and 60 gastrectomies for early gastric cardiac carcinoma as the cancer group. The gastroesophageal junction was defined as the distal end of squamous epithelium, multilayered epithelium, or deep esophageal glands or ducts. Gastric cardia (n = 110) was defined as the presence of cardiac and cardio-oxyntic mucosae distal to the gastroesophageal junction. RESULTS The average thickness of MM and submucosa in the cardia was 1.04 and 1.41 mm, respectively, which was significantly thicker than that in distal stomach (n = 34) (0.22 and 0.99 mm) or distal esophagus (n = 92) (0.60 and 1.15 mm). In the cardia, thickened MM displayed frayed muscle fibers (93.3%) with a significantly higher prevalence of entrapped glands, cysts, and lymphoid follicles than in the distal stomach or distal esophagus. In the submucosa fatty changes, cysts, and abnormal arteries were significantly more common in the cardia than in the distal stomach or distal esophagus. Compared with the study group, the cardia in the cancer group showed significantly thicker MM (average 1.31 vs 0.72 mm) and submucosa (average 1.61 vs 1.16 mm), more frequent frayed MM (93.3% vs 60.0%), prolapse-like changes (50.0% vs 2.0%), and cysts (26.7% vs 4.0%). CONCLUSION MM and submucosa of the cardia were significantly thickened, especially in early gastric cardiac carcinomas.
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Affiliation(s)
- Qin Huang
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China.,Department of Pathology and Laboratory Medicine, VA Boston Healthcare System and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jiong Shi
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Tian Yun Liu
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Yu Qing Cheng
- Department of Pathology, Changzhou Second Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yao Hui Wang
- Department of Pathology, Jiangsu Provincial Hospital of Traditional Chinese Medicine Affiliated to Nanjing Medical University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Ming Zhan Du
- Department of Pathology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Lin Li
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Xiang Shan Fan
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Xiao Li Zhou
- Department of Pathology, Changzhou Second Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yi Fen Zhang
- Department of Pathology, Jiangsu Provincial Hospital of Traditional Chinese Medicine Affiliated to Nanjing Medical University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Ling Chuan Guo
- Department of Pathology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Gui Fang Xu
- Department of Gastroenterology, Nanjing Drum Tower Hospital Affiliated to Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Xiao Ping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital Affiliated to Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
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11
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Abstract
There are still many controversies about the characteristics and prognosis of gastric cardia cancer. We aimed to evaluate the clinical characteristics and outcome between cardia and noncardia cancer. Also, we evaluated the clinical outcome according to etiologic factors.We performed a retrospective cohort study of 92 patients with gastric cardia cancer from January 2003 to December 2013. The patients with noncardia cancer were selected as age- and sex-matched control.The frequencies of gastroesophageal reflux disease (GERD) and negative Helicobacter pylori infection without atrophy were significantly higher in gastric cardia cancers, but there was no difference in the frequency of obesity. The frequency of early gastric cancers was 40.0%, which was significantly lower than that of noncardia cancer. The rate of recurrence, disease-free survival, and overall survival duration were significantly lower in gastric cardia cancers (P < .01), even though there was no significant difference in the rate of curative resection (R0). In terms of the etiologic factors, there were no differences of disease prognosis, regardless of the presence of GERD, obesity, and H pylori infection with associated gastritis.Gastric cardia cancer showed distinct clinical characteristics and a negative prognostic impact compared with gastric noncardia cancer.
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12
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Colquhoun A, Hannah H, Corriveau A, Hanley B, Yuan Y, Goodman KJ. Gastric Cancer in Northern Canadian Populations: A Focus on Cardia and Non-Cardia Subsites. Cancers (Basel) 2019; 11:E534. [PMID: 30991639 PMCID: PMC6520747 DOI: 10.3390/cancers11040534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/29/2019] [Accepted: 04/04/2019] [Indexed: 12/24/2022] Open
Abstract
In northern Canada where there is a high prevalence of Helicobacter pylori infection, there is a paucity of information on gastric cancer by the topographical subsites cardia (CGC) and non-cardia (NCGC). Here we describe the incidence of CGC and NCGC, separately, among northern Canadian populations. We used data from the Cancer Incidence in Five Continents Volumes X (CI5X) and XI (CI5XI) to obtain CGC and NCGC incidence for Canada and for Yukon (YT), a northern Canadian territory. Using these data with those provided by the Government of the Northwest Territories (NT), we estimated standardized incidence ratios comparing northern populations to Canada as a whole. We also estimated age-standardized incidence rates to permit comparisons across populations globally. NT and YT populations were disproportionately impacted by gastric cancer, particularly NCGC. This was especially true for Indigenous populations: NCGC incidence rates among NT Indigenous men were 2.7 times the rates among all men in Canada, while rates among NT Indigenous women were 3.1 times the rates among all women in Canada. Similarly, age-standardized rates of NCGC among Indigenous NT residents were comparable to global regions where there is a high burden of NCGC. This study has, for the first time, quantified the incidence of CGC and NCGC for the NT and YT, providing new insights into the burden of these cancers among northern Canadian populations.
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Affiliation(s)
- Amy Colquhoun
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada; (Y.Y.); (K.J.G.)
| | - Heather Hannah
- Department of Health and Social Services, Government of the Northwest Territories, Yellowknife, NT X1A 2L9, Canada; (H.H.); (A.C.)
| | - André Corriveau
- Department of Health and Social Services, Government of the Northwest Territories, Yellowknife, NT X1A 2L9, Canada; (H.H.); (A.C.)
| | - Brendan Hanley
- Department of Health and Social Services, Government of Yukon, Whitehorse, YT Y1A 1Z4, Canada;
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada; (Y.Y.); (K.J.G.)
| | - Karen J. Goodman
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada; (Y.Y.); (K.J.G.)
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2E1, Canada
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13
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Wang J, Yang Z, Zheng J, Hu W, Feng X, Yao X, Li Y. Total-Laparoscopic Intragastric Surgery for Cardia Endogenous Gastric Submucosal Tumors: A Single-Center Short-Term Experience. J Laparoendosc Adv Surg Tech A 2018; 29:374-378. [PMID: 30289344 DOI: 10.1089/lap.2018.0334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Total-laparoscopic intragastric surgery (T-LIGS) has gradually been accepted for the treatment of endogenous gastric submucosal tumors. However, it is difficult to perform T-LIGS when the tumor is located at the esophagogastric junction (cardia endogenous gastric submucosal tumor [CEGSMT]) without special laparoscopic instruments that are not available in most developing countries. We have successfully treated 12 cases of CEGSMTs using conventional laparoscopic instruments and achieved acceptable outcomes. This study was conducted to evaluate the surgical techniques for CEGSMT management. METHODS A retrospective analysis was conducted involving all the CEGSMT patients who were treated with T-LIGS in the General Surgery Department of Guangdong General Hospital from August 2014 to June 2016. RESULTS There were 12 patients successfully treated with T-LIGS. The surgical time ranged from 56 to 108 minutes, and the blood loss was 5-70 mL. The distance to the tumor from the dentate line was 12-24 mm, and the tumor diameter was 17-28 mm. The tumor margins were 9-15 mm, and the eating time was 2-4 days. The drainage tube indwelling time was 2-4 days, and the discharge time was 4-6 days. The follow-up exams revealed no recurrences, dysphagia, acid reflux, or other digestive symptoms. CONCLUSIONS It is safe and feasible to perform T-LIGS using conventional laparoscopic instruments to treat CEGSMTs. We suggest that T-LIGS can be performed for endogenous mucosal tumors within 3 cm from the cardiac dentate line and less than 3 cm in size.
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Affiliation(s)
- Junjiang Wang
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China .,2 The Second School of Clinical Medicine, Southern Medical University , Guangzhou, China
| | - Zifeng Yang
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiabin Zheng
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weixian Hu
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China .,2 The Second School of Clinical Medicine, Southern Medical University , Guangzhou, China
| | - Xingyu Feng
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xueqing Yao
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China .,2 The Second School of Clinical Medicine, Southern Medical University , Guangzhou, China
| | - Yong Li
- 1 Guangdong General Hospital , Guangdong Academy of Medical Sciences, Guangzhou, China .,2 The Second School of Clinical Medicine, Southern Medical University , Guangzhou, China
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14
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Song S, Feng M, Zhou H, Liu M, Sun M. Submucosal Tunneling Endoscopic Resection for Large and Irregular Submucosal Tumors Originating from Muscularis Propria Layer in Upper Gastrointestinal Tract. J Laparoendosc Adv Surg Tech A 2018; 28:1364-1370. [PMID: 30256158 DOI: 10.1089/lap.2017.0607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The majority of submucosal tumors (SMTs) are benign. However, large SMTs with irregular outer shapes are proved to harbor a higher risk for malignancy. Submucosal tunneling endoscopic resection (STER) has emerged as a feasible technique for resecting SMTs. OBJECTIVE To evaluate the safety and efficacy of STER for large and irregular SMTs with a diameter no <35 mm originating from the muscularis propria layer, and to share the technical skills of STER for complete and en bloc resection. PATIENTS AND METHODS We retrospectively reported 10 cases in which the new technique of STER was performed to remove large and irregular SMTs with a diameter no <35 mm of upper gastrointestinal tract in our hospital between April 2014 and April 2017. RESULTS All 10 (100%) patients underwent STER successfully, with a mean operation time of 156 minutes. Among the 10 SMTs, 3 (30%) were located in the esophagus, 7 (70%) were in the cardia. All the SMTs had a maximum diameter no <35 mm, ranging from 35 to 100 mm. The mean size was 57.2 mm. En bloc resection was achieved in 8 (80%) of the tumors. Only two (20%) of the SMTs were resected into more than one piece. Complication occurred in 1 (10%) of the patients as a representation of pneumothorax. No recurrence was noted during a median follow-up of 15 months. CONCLUSION In this retrospective study, STER may be an effective and safe technique resecting large and irregular SMTs with a diameter no >40 mm in transverse diameter and no >100 mm in longitudinal diameter.
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Affiliation(s)
- Shunzhe Song
- Department of Gastroenterology, The First Hospital of China Medical University , Shenyang, China
| | - Mingliang Feng
- Department of Gastroenterology, The First Hospital of China Medical University , Shenyang, China
| | - Huan Zhou
- Department of Gastroenterology, The First Hospital of China Medical University , Shenyang, China
| | - Mengyuan Liu
- Department of Gastroenterology, The First Hospital of China Medical University , Shenyang, China
| | - Mingjun Sun
- Department of Gastroenterology, The First Hospital of China Medical University , Shenyang, China
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15
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Martín-Vega D, Garbout A, Ahmed F, Ferrer LM, Lucientes J, Colwell DD, Hall MJR. Micro-computed tomography visualization of the vestigial alimentary canal in adult oestrid flies. Med Vet Entomol 2018; 32:378-382. [PMID: 29451298 DOI: 10.1111/mve.12301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/10/2018] [Accepted: 01/21/2018] [Indexed: 06/08/2023]
Abstract
Oestrid flies (Diptera: Oestridae) do not feed during the adult stage as they acquire all necessary nutrients during the parasitic larval stage. The adult mouthparts and digestive tract are therefore frequently vestigial; however, morphological data on the alimentary canal in adult oestrid flies are scarce and a proper visualization of this organ system within the adult body is lacking. The present work visualizes the morphology of the alimentary canal in adults of two oestrid species, Oestrus ovis L. and Hypoderma lineatum (de Villiers), with the use of non-invasive micro-computed tomography (micro-CT) and compares it with the highly developed alimentary canal of the blow fly Calliphora vicina Robineau-Desvoidy (Diptera: Calliphoridae). Both O. ovis and H. lineatum adults showed significant reductions of the cardia and the diameter of the digestive tract, an absence of the helicoidal portion of the midgut typical of other cyclorrhaphous flies, and a lack of crop and salivary glands. Given the current interest in the alimentary canal in adult dipterans in biomedical and developmental biology studies, further understanding of the morphology and development of this organ system in adult oestrids may provide valuable new insights in several areas of research.
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Affiliation(s)
- D Martín-Vega
- Department of Life Sciences, Natural History Museum, London, U.K
- Department of Life Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - A Garbout
- Imaging and Analysis Centre, Natural History Museum, London, U.K
| | - F Ahmed
- Imaging and Analysis Centre, Natural History Museum, London, U.K
| | - L M Ferrer
- Department of Animal Pathology, University of Zaragoza, Zaragoza, Spain
| | - J Lucientes
- Department of Animal Pathology, University of Zaragoza, Zaragoza, Spain
| | - D D Colwell
- Agriculture and Agri-Food Canada, Lethbridge, AB, Canada
| | - M J R Hall
- Department of Life Sciences, Natural History Museum, London, U.K
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16
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Chen L, Wang YH, Cheng YQ, Du MZ, Shi J, Fan XS, Zhou XL, Zhang YF, Guo LC, Xu GF, He YM, Zhou D, Zou XP, Huang Q, Team TJPEGCMS. Risk factors of lymph node metastasis in 1620 early gastric carcinoma radical resections in Jiangsu Province in China: A multicenter clinicopathological study. J Dig Dis 2017; 18:556-565. [PMID: 28949436 DOI: 10.1111/1751-2980.12545] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/22/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate risk factors of lymph node metastasis (LNM) in early gastric carcinoma (EGC) in four tertiary medical centers in Jiangsu Province, China. METHODS Among 10 097 consecutive combined gastric cancer radical resections, 1903 EGC were identified and reviewed, 283 excluded and 1620 included in the study. All pathological and some endoscopic reports were reviewed for patients' characteristics, tumor location, gross features, and the number of lymph nodes retrieved and involved. Two pathologists independently investigated the pathological features of tumor type, differentiation, invasion depth, lymphovascular invasion (LVI), and perineural invasion. The data were statistically analyzed to identify risk factors for LNM. RESULTS The average number of lymph nodes retrieved was 17.5 per patient. LNM was diagnosed in 15.5%. By univariate analysis, significant risk factors for LNM included age ≥ 41 years, female sex, size over 1 cm, submucosal invasion, poor differentiation, poorly cohesive carcinoma, micropapillary adenocarcinoma, adenocarcinoma mixed with signet-ring cell carcinoma, LVI, perineural invasion, and distal gastric location. By multivariate analysis, independent risk factors for LNM were size ≥ 3 cm (odds ratio [OR] 1.9), poor differentiation (OR 2.5), adenocarcinoma mixed with signet-ring cell carcinoma (OR 1.7), LVI (OR 5.8) and submucosal invasion (OR 2.9). In contrast, size < 3 cm and ulcer were not significant risk factors. Early cardiac carcinoma (OR 0.4) had significantly lower risk. CONCLUSIONS Independent risk factors for LNM in EGC in Chinese patients included tumor size ≥ 3 cm, poor differentiation, submucosal invasion, adenocarcinoma mixed with signet-ring cell carcinoma and LVI. Early cardiac carcinoma had a significantly lower risk for LNM.
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Affiliation(s)
- Ling Chen
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China
| | - Yao Hui Wang
- Department of Pathology, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Yu Qing Cheng
- Department of Pathology, Changzhou Second Hospital, Changzhou, Jiangsu Province, China
| | - Ming Zhan Du
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jiong Shi
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China
| | - Xiang Shan Fan
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China
| | - Xiao Li Zhou
- Department of Pathology, Changzhou Second Hospital, Changzhou, Jiangsu Province, China
| | - Yi Fen Zhang
- Department of Pathology, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Ling Chuan Guo
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Gui Fang Xu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China
| | - Ya Min He
- Department of Pathology, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Dan Zhou
- Quality Care Medical Consulting, LLC, Lexington, Massachusetts, USA
| | - Xiao Ping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China
| | - Qin Huang
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China.,Department of Pathology and Laboratory Medicine, Boston VA Healthcare System, Harvard Medical School, West Roxbury, Massachusetts, USA
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Mao XL, Ye LP, Zheng HH, Zhou XB, Zhu LH, Zhang Y. Submucosal tunneling endoscopic resection using methylene-blue guidance for cardial subepithelial tumors originating from the muscularis propria layer. Dis Esophagus 2017; 30:1-7. [PMID: 28375471 DOI: 10.1093/dote/dow023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Indexed: 12/11/2022]
Abstract
Submucosal tunneling endoscopic resection (STER) of subepithelial tumors (SETs) originating from the muscularis propria (MP) layer in the cardia is rarely performed due to the difficulty of creating a submucosal tunnel for resection. The aim of this study is to evaluate the feasibility of STER using methylene-blue guidance for SETs originating from the MP layer in the cardia. From January 2012 to December 2014, 56 patients with SETs originating from the MP layer in the cardia were treated with STER using methylene-blue guidance. The complete resection rate and adverse event rate were the main outcome measurements. Successful complete resection by STER was achieved in all 56 cases (100%). The median size of the tumor was 1.8 cm. Nine patients (15.3%) had adverse events including subcutaneous emphysema, pneumoperitoneum, pneumothorax, and pleural effusion. These nine patients recovered successfully after conservative treatment without endoscopic or surgical intervention. No residual or recurrent tumors were detected in any patient during the follow-up period (median, 25 months). The adverse event rate was significantly higher for tumors originating in the deeper MP layers (46.7%) than in the superficial MP layers (4.9%) (P < 0.05), differed significantly according to tumor size (5.4% for tumors < 2.0 cm vs. 36.8% for tumors ≥ 2.0 cm; P < 0.05), and also differed significantly in relation to the tumor growth pattern (4.1% for the intraluminal growth vs. 100% for the extraluminal growth; P < 0.001). STER using methylene-blue guidance appears to be a feasible method for removing SETs originating from the MP layer in the cardia.
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Affiliation(s)
- X-L Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
| | - L-P Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
| | - H-H Zheng
- Department of Pathology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
| | - X-B Zhou
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
| | - L-H Zhu
- Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
| | - Y Zhang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, Zhejiang Province, China
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18
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Mao XL, Ye LP, Zheng HH, Zhou XB, Zhu LH, Zhang Y. Submucosal tunneling endoscopic resection using methylene-blue guidance for cardial subepithelial tumors originating from the muscularis propria layer. Dis Esophagus 2017; 30:1-7. [PMID: 27671744 DOI: 10.1111/dote.12536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Submucosal tunneling endoscopic resection (STER) of subepithelial tumors (SETs) originating from the muscularis propria (MP) layer in the cardia is rarely performed due to the difficulty of creating a submucosal tunnel for resection. The aim of this study was to evaluate the feasibility of STER using methylene-blue guidance for SETs originating from the MP layer in the cardia. From January 2012 to December 2014, 56 patients with SETs originating from the MP layer in the cardia were treated with STER using methylene-blue guidance. The complete resection rate and adverse event rate were the main outcome measurements. Successful complete resection by STER was achieved in all 56 cases (100%). The median size of the tumor was 1.8 cm. Nine patients (15.3%) had adverse events including subcutaneous emphysema, pneumoperitoneum, pneumothorax, and pleural effusion. These nine patients recovered successfully after conservative treatment without endoscopic or surgical intervention. No residual or recurrent tumors were detected in any patient during the follow-up period (median, 25 months). The adverse event rate was significantly higher for tumors originating in the deeper MP layers (46.7%) than in the superficial MP layers (4.9%) (P < 0.05), differed significantly according to tumor size (5.4% for tumors < 2.0 cm vs. 36.8% for tumors ≥ 2.0 cm; P < 0.05), and also differed significantly in relation to the tumor growth pattern (4.1% for the intraluminal growth vs. 100% for the extraluminal growth; P < 0.001). STER using methylene-blue guidance appears to be a feasible method for removing SETs originating from the MP layer in the cardia.
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Affiliation(s)
- Xin-Li Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Hai-Hong Zheng
- Department of Pathology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Xian-Bin Zhou
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Lin-Hong Zhu
- Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
| | - Yu Zhang
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China
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Yousefi-Banaem H, Rabbani H, Adibi P. Barrett's Mucosa Segmentation in Endoscopic Images Using a Hybrid Method: Spatial Fuzzy c-mean and Level Set. J Med Signals Sens 2016; 6:231-236. [PMID: 28028499 PMCID: PMC5156999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Barrett's mucosa is one of the most important diseases in upper gastrointestinal system that caused by gastro-esophagus reflux. If left untreated, the disease will cause distal esophagus and gastric cardia adenocarcinoma. The malignancy risk is very high in short segment Barrett's mucosa. Therefore, lesion area segmentation can improve specialist decision for treatment. In this paper, we proposed a combined fuzzy method with active models for Barrett's mucosa segmentation. In this study, we applied three methods for special area segmentation and determination. For whole disease area segmentation, we applied the hybrid fuzzy based level set method (LSM). Morphological algorithms were used for gastroesophageal junction determination, and we discriminated Barrett's mucosa from break by applying Chan-Vase method. Fuzzy c-mean and LSMs fail to segment this type of medical image due to weak boundaries. In contrast, the full automatic hybrid method with correlation approach that has used in this paper segmented the metaplasia area in the endoscopy image with desirable accuracy. The presented approach omits the manually desired cluster selection step that needed the operator manipulation. Obtained results convinced us that this approach is suitable for esophagus metaplasia segmentation.
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Affiliation(s)
- Hossein Yousefi-Banaem
- Department of Biomedical Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Hossein Rabbani
- Department of Biomedical Engineering, Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Department of Internal Medicine, Faculty of Medicine, Isfahan University of Medical Science, Isfahan, Iran
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Chen G, Liu M, Malik TH, Li S, Tang Y, Xu H. Giant cystic lymphangioma originating from the cardia of the stomach: A case report. Exp Ther Med 2016; 11:1943-1946. [PMID: 27168832 DOI: 10.3892/etm.2016.3090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 01/11/2016] [Indexed: 01/29/2023] Open
Abstract
Cystic lymphangiomas are rare benign tumors involving the neck, head, and axilla, and most frequently occur in children before the age of 5 years. In the present study, the case of a giant cystic lymphangioma originating in the cardia of the stomach was reported in an 18-year-old female complaining of abdominal distention. Contrast-enhanced computed tomography and endoscopic ultrasonography revealed a large, multilobulated cystic mass located between the cardia and esophagogastric junction with a diameter of 4.0 cm. The lesion was successfully removed by endoscopic submucosal dissection. Subsequent immunohistochemical analysis of the lymphatic endothelium-specific O-linked sialoglycoprotein D2-40 confirmed the diagnosis of cystic lymphangioma. No complications associated with the tumor dissection occurred, and the patient did not report any further complaints or any signs of recurrence at 6- and 18-month follow-up. The present case demonstrates that a diagnosis of cystic lymphangioma should be considered in non-pediatric patients suffering aspecific abdominal complaints.
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Affiliation(s)
- Geng Chen
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Mingqing Liu
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Tayyab Hamid Malik
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shouying Li
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ying Tang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Hong Xu
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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21
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VanWagner LB, Wilcox JE, Colangelo LA, Lloyd-Jones DM, Carr JJ, Lima JA, Lewis CE, Rinella ME, Shah SJ. Association of nonalcoholic fatty liver disease with subclinical myo cardial remodeling and dysfunction: A population-based study. Hepatology 2015; 62:773-83. [PMID: 25914296 PMCID: PMC4549239 DOI: 10.1002/hep.27869] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/22/2015] [Indexed: 12/21/2022]
Abstract
UNLABELLED Nonalcoholic fatty liver disease (NAFLD) and heart failure (HF) are obesity-related conditions with high cardiovascular mortality. Whether NAFLD is independently associated with subclinical myocardial remodeling or dysfunction among the general population is unknown. We performed a cross-sectional analysis of 2,713 participants from the multicenter, community-based Coronary Artery Risk Development in Young Adults (CARDIA) study who underwent concurrent computed tomography (CT) quantification of liver fat and comprehensive echocardiography with myocardial strain measured by speckle tracking during the Year-25 examination (age, 43-55 years; 58.8% female and 48.0% black). NAFLD was defined as liver attenuation ≤40 Hounsfield units after excluding other causes of liver fat. Subclinical left ventricular (LV) systolic dysfunction was defined using values of absolute peak global longitudinal strain (GLS). Diastolic dysfunction was defined using Doppler and tissue Doppler imaging markers. Prevalence of NAFLD was 10.0%. Participants with NAFLD had lower early diastolic relaxation (e') velocity (10.8 ± 2.6 vs. 11.9 ± 2.8 cm/s), higher LV filling pressure (E/e' ratio: 7.7 ± 2.6 vs. 7.0 ± 2.3), and worse absolute GLS (14.2 ± 2.4% vs. 15.2 ± 2.4%) than non-NAFLD (P < 0.0001 for all). When adjusted for HF risk factors or body mass index, NAFLD remained associated with subclinical myocardial remodeling and dysfunction (P < 0.01). The association of NAFLD with e' velocity (β = -0.36 [standard error = 0.15] cm/s; P = 0.02), E/e' ratio (β = 0.35 [0.16]; P = 0.03), and GLS (β = -0.42 [0.18]%; P = 0.02) was attenuated after controlling for visceral adipose tissue. Effect modification by race and sex was not observed. CONCLUSIONS NAFLD is independently associated with subclinical myocardial remodeling and dysfunction and provides further insight into a possible link between NAFLD and HF.
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Affiliation(s)
- Lisa B. VanWagner
- Departments of Preventive Medicine and Medicine, Northwestern University
- Division of Gastroenterology & Hepatology, Northwestern University
| | - Jane E. Wilcox
- Departments of Preventive Medicine and Medicine, Northwestern University
- Division of Cardiology, Northwestern University
| | - Laura A. Colangelo
- Departments of Preventive Medicine and Medicine, Northwestern University
| | - Donald M. Lloyd-Jones
- Departments of Preventive Medicine and Medicine, Northwestern University
- Division of Cardiology, Northwestern University
| | - J. Jeffrey Carr
- Departments of Radiology, Cardiovascular Medicine and Biomedical Informatics, Vanderbilt University School of Medicine
| | - Joao A. Lima
- Departments of Medicine and Radiology, Johns Hopkins University School of Medicine
| | - Cora E. Lewis
- Department of Medicine, Division of Preventive Medicine, University of Alabama Birmingham School of Medicine
| | - Mary E. Rinella
- Division of Gastroenterology & Hepatology, Northwestern University
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22
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Kwiatkowski AP, Paśnik K. Large inflammatory fibroid polyp of cardia managed laparoscopically - a case report and review of the literature. Wideochir Inne Tech Maloinwazyjne 2014; 9:623-6. [PMID: 25562003 PMCID: PMC4280427 DOI: 10.5114/wiitm.2014.46448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 08/24/2013] [Accepted: 09/14/2014] [Indexed: 11/24/2022] Open
Abstract
Inflammatory fibroid polyp or Vanek's tumor of the gastrointestinal tract is a rare, benign neoplasm. The lesion may occur at any age but is commonest in the sixth and seventh decades and is more often found in women. It is mostly situated in the stomach, especially in the antrum. Symptoms depend on the location and the size of the lesion. We present a case of a 67-year-old woman with a large inflammatory polyp of the cardia with a diameter of 10 cm × 5.5 cm × 7.5 cm imitating gastrointestinal stromal tumor (GIST). The patient complained of abdominal pain, nausea and mild anemia. We performed laparoscopic topical excision of the tumor. The postoperative course was uneventful. The 6-month follow-up did not reveal recurrence. The clinical image of a large Vanek's tumor can imitate symptoms of gastric cancer or GIST. Topical laparoscopic excision with a 1-2 cm healthy wall margin is a sufficient and adequate way of treatment.
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Affiliation(s)
- Andrzej P Kwiatkowski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Krzysztof Paśnik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
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23
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Shoji H, Yamaguchi N, Isomoto H, Minami H, Matsushima K, Akazawa Y, Ohnita K, Takeshima F, Shikuwa S, Nakao K. Oral prednisolone and triamcinolone injection for gastric stricture after endoscopic submucosal dissection. Ann Transl Med 2014; 2:22. [PMID: 25332998 DOI: 10.3978/j.issn.2305-5839.2014.02.09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/21/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND The expansion of the indications for endoscopic submucosal dissection (ESD) to include early gastric cancers has enabled extensive resection. However, post-ESD stenosis after large resections applied to the gastric cardia or pylorus is often difficult to manage. The aim of this study was to evaluate the benefit of oral prednisolone and triamcinolone injection for stenosis after gastric ESD. METHODS Eight patients who underwent ESD for large neoplastic lesions that extended more than three-fourths of the luminal circumference were enrolled in this study. Four patients underwent ESD for gastric cardia cancer, and four patients were treated for pyloric lesions. To prevent post-ESD stricture, oral prednisolone was started at 30 mg daily on the second day after ESD and then tapered gradually in two cases, while topical injection of 80 mg triamcinolone was performed once immediately after ESD in six cases. Endoscopic balloon dilatation (EBD) was used for stricture-related symptoms or signs including nausea, vomiting, or food residuals observed on endoscopy. EBD was also applied if a 10-mm-diameter endoscope was not able to pass through the lumen. The incidence of stenosis, the frequency and period required for EBD, the duration required for ulcer healing after ESD, and the incidences of post-procedural bleeding and perforation were assessed. RESULTS One of the eight patients had post-ESD stenosis requiring EBD. The median ulcer healing period after ESD was 87.5 (range, 56-133) days. No patients experienced post-procedural bleeding or perforation. There were no adverse events due to steroid therapy. CONCLUSIONS The results of the present study showed the safety and usefulness of steroid therapy for management of stenosis after large ESD in the gastric cardia or pylorus.
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Affiliation(s)
- Hiroyuki Shoji
- 1 Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501, Japan ; 2 Sankokai Miyazaki Hospital, 1575-1 Kuyama, Isahaya, Nagasaki 854-0066, Japan
| | - Naoyuki Yamaguchi
- 1 Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501, Japan ; 2 Sankokai Miyazaki Hospital, 1575-1 Kuyama, Isahaya, Nagasaki 854-0066, Japan
| | - Hajime Isomoto
- 1 Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501, Japan ; 2 Sankokai Miyazaki Hospital, 1575-1 Kuyama, Isahaya, Nagasaki 854-0066, Japan
| | - Hitomi Minami
- 1 Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501, Japan ; 2 Sankokai Miyazaki Hospital, 1575-1 Kuyama, Isahaya, Nagasaki 854-0066, Japan
| | - Kayoko Matsushima
- 1 Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501, Japan ; 2 Sankokai Miyazaki Hospital, 1575-1 Kuyama, Isahaya, Nagasaki 854-0066, Japan
| | - Yuko Akazawa
- 1 Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501, Japan ; 2 Sankokai Miyazaki Hospital, 1575-1 Kuyama, Isahaya, Nagasaki 854-0066, Japan
| | - Ken Ohnita
- 1 Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501, Japan ; 2 Sankokai Miyazaki Hospital, 1575-1 Kuyama, Isahaya, Nagasaki 854-0066, Japan
| | - Fuminao Takeshima
- 1 Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501, Japan ; 2 Sankokai Miyazaki Hospital, 1575-1 Kuyama, Isahaya, Nagasaki 854-0066, Japan
| | - Saburo Shikuwa
- 1 Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501, Japan ; 2 Sankokai Miyazaki Hospital, 1575-1 Kuyama, Isahaya, Nagasaki 854-0066, Japan
| | - Kazuhiko Nakao
- 1 Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501, Japan ; 2 Sankokai Miyazaki Hospital, 1575-1 Kuyama, Isahaya, Nagasaki 854-0066, Japan
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Zhou Y, Zang Y, Xiang J, Tang F, Chen Z. Adenoid cystic carcinoma of the cardia: Report of a rare case and review of the Chinese literature. Oncol Lett 2014; 8:726-730. [PMID: 25013491 PMCID: PMC4081280 DOI: 10.3892/ol.2014.2153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 03/14/2014] [Indexed: 02/04/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) is a relatively common head and neck tumor, however, is rare in the digestive tracts. There have been <100 cases of esophageal ACC reported to date and no cases of gastric ACC. The present study reports the exceptional case of a 53-year-old male with a primary ACC of the cardia. The patient underwent a radical total gastrectomy with D2 lymphadenectomy and Roux-en-Y esophagojejunal reconstruction. Immunohistochemical analysis identified a case of primary ACC that exhibited a positive expression for cytokeratin, calponin, cluster of differentiation 117, p63 and smooth muscle actin, with typical cribriform foci. No signs of recurrence have been detected during the 30-month follow-up. Thus, a precise diagnosis of ACC is primarily based on the results of immunohistochemical analysis and radical resection is considered to be the best treatment option for ACC of the digestive tracts. The current study also reviewed 17 cases of ACC of the esophagus reported in China, with special reference to the criteria for histological diagnosis and therapeutic options. The prognosis of esophageal ACC is poor due to early metastasis, mainly relying on the resectability of the tumor
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Affiliation(s)
- Yiming Zhou
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
| | - Yiwen Zang
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
| | - Jianbin Xiang
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
| | - Feng Tang
- Department of Pathology, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
| | - Zongyou Chen
- Department of General Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, P.R. China
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25
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Gory G, Rault DN, Gatel L, Dally C, Belli P, Couturier L, Cauvin E. Ultrasonographic characteristics of the abdominal esophagus and cardia in dogs. Vet Radiol Ultrasound 2014; 55:552-60. [PMID: 24629089 DOI: 10.1111/vru.12156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/01/2014] [Indexed: 11/29/2022] Open
Abstract
Differential diagnoses for regurgitation and vomiting in dogs include diseases of the gastroesophageal junction. The purpose of this cross-sectional study was to describe ultrasonographic characteristics of the abdominal esophagus and gastric cardia in normal dogs and dogs with clinical disease involving this region. A total of 126 dogs with no clinical signs of gastrointestinal disease and six dogs with clinical diseases involving the gastroesophageal junction were included. For seven euthanized dogs, ultrasonographic features were also compared with gross pathology and histopathology. Cardial and abdominal esophageal wall thicknesses were measured ultrasonographically for all normal dogs and effects of weight, sex, age, and stomach filling were tested. Five layers could be identified in normal esophageal and cardial walls. The inner esophageal layer was echogenic, corresponding to the cornified mucosa and glandular portion of the submucosa. The cardia was characterized by a thick muscularis, and a transitional zone between echogenic esophageal and hypoechoic gastric mucosal layers. Mean (±SD) cardial wall thicknesses for normal dogs were 7.6 mm (±1.6), 9.7 mm (±1.8), 10.8 mm (±1.6), 13.3 mm (±2.5) for dogs in the <10 kg, 10-19.9 kg, 20-29.9 kg and ≥30 kg weight groups, respectively. Mean (±SD) esophageal wall thicknesses were: 4.1 mm (±0.6), 5.1 mm (±1.3), 5.6 mm (±1), and 6.4 mm (±1.1) for the same weight groups, respectively. Measurements of wall thickness were significantly correlated with dog weight group. Ultrasonography assisted diagnosis in all six clinically affected dogs. Findings supported the use of transabdominal ultrasonography as a diagnostic test for dogs with suspected gastroesophageal disease.
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Affiliation(s)
- Guillaume Gory
- Azurvet, Referral Center in Veterinary Diagnostic Imaging and Neurology, 06800, Cagnes-sur-Mer, France
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Abstract
OBJECTIVE To investigate the type of cardiac mucosa and its relationship with age and gender of the participants and to determine the coincidence of endoscopic and pathological diagnosis of carditis as well as its etiology. METHODS The data of 70 patients with carditis (the carditis group) and 30 individuals with endoscopically normal-appearing cardiac mucosa (the control group), including their baseline characteristics and histopathological findings, were reviewed. Their Helicobacter pylori (H. pylori) status was also reviewed. RESULTS Three main types of cardiac mucosa: mucous, oxyntic and mixed types, were found in 45.0%, 40.0% and 15.0% of all the participants, respectively. The distribution of these types was related to the age of the participants but not to their gender. Moderate to severe mucosal inflammation was detected in 60.0% (18/30) of the control group. The etiologies of cardiac inflammation were H. pylori infection and gastroesophageal reflux disease (GERD). For antral H. pylori-negative participants, cardiac mucosal inflammation was correlated with esophageal mucosal inflammation (P < 0.05), while for those with antral H. pylori infection it was associated with antral mucosal inflammation (P < 0.01). CONCLUSIONS The distribution of different cardiac mucosal types was related to the participants' age. Normal-appearing cardiac mucosa under endoscopy might present with histopathologically moderate to severe cardiac inflammation. The etiologies of cardiac inflammation were H. pylori infection and GERD. Different causes of carditis may result in the different histological performance of the cardia.
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Affiliation(s)
- Qi Miao
- Department of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Divison of Gastrointestinal Pathology, Shanghai Institute of Digestive Disease, Shanghai, China
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Camargo MC, Freedman ND, Hollenbeck AR, Abnet CC, Rabkin CS. Height, weight, and body mass index associations with gastric cancer subsites. Gastric Cancer 2013; 17:463-8. [PMID: 24174008 PMCID: PMC4007380 DOI: 10.1007/s10120-013-0312-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/05/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although excess body weight has been associated with cancers of the gastric cardia, relationships with gastric cancer at other anatomic subsites are not well defined. Furthermore, subsite-specific associations with attained height have not been fully assessed. METHODS In 1995-1996, 483,700 Whites enrolling in the multi-state NIH-AARP Diet and Health Study self-reported height and weight. Gastric cancers occurring through 31 December 2006 were ascertained from regional population-based registries. We used Cox regression models to estimate cancer hazard ratios (HRs) for sex-specific tertiles of height and weight and for body mass index (BMI) categories of the World Health Organization. RESULTS One thousand incident cancers (48 % localized to the cardia, 4 % fundus, 6 % corpus, 3 % greater curvature, 6 % lesser curvature, 10 % antrum, 2 % pylorus, 5 % overlapping lesion, and 16 % unspecified) occurred an average of 5.4 years after enrollment. After controlling for effects of age, sex, education, and smoking, we found an inverse association between height and total noncardia cancers (i.e., fundus, corpus, greater and lesser curvatures, antrum, and pylorus), with HRs vs. tertile 1 of 0.65 and 0.71 for tertiles 2 and 3, respectively (p trend = 0.016). Trends were consistent for individual noncardia subsites. In contrast, although weight and BMI were each associated with risk of cardia cancer, neither was associated with total noncardia cancer nor individual subsites. CONCLUSION Noncardia gastric cancer is associated with short stature but not with high body weight or obesity. The excess risk for shorter adults would be consistent with the known association of chronic H. pylori infection with growth retardation during childhood.
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Affiliation(s)
- M Constanza Camargo
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr., BG 9609/6E206, Rockville, MD, 20850, USA,
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Xun P, Liu K, Morris JS, Jordan JM, He K. Distributions and determinants of mercury concentrations in toenails among American young adults: the CARDIA Trace Element Study. Environ Sci Pollut Res Int 2013; 20:1423-1430. [PMID: 22926255 PMCID: PMC3556188 DOI: 10.1007/s11356-012-1126-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/10/2012] [Indexed: 05/28/2023]
Abstract
Since data on mercury (Hg) levels in Caucasians and African Americans (AAs) of both genders are lacking, this study aims to present toenail Hg distributions and explore the potential determinants using data from the Coronary Artery Risk Development in Young Adults Trace Element Study. Data from 4,344 Americans, aged 20-32 in 1987, recruited from Oakland, Chicago, Minneapolis, and Birmingham were used to measure toenail Hg levels by instrumental neutron-activation method. The Hg distribution was described with selected percentiles and geometric means. Multivariable linear regression (MLR) was used to examine potential determinants of Hg levels within ethnicity-gender subgroups. The geometric mean of toenail Hg was 0.212 (95 % CI = 0.207-0.218) μg/g. Hg levels varied geographically with Oakland the highest [0.381 (0.367-0.395) μg/g] and Minneapolis the lowest [0.140 (0.134-0.147) μg/g]. MLR analyses showed that male gender and AA ethnicity were negatively associated with toenail Hg levels, and that age, living in Oakland city, education level, alcohol consumption, and total fish intake were positively associated with toenail Hg concentrations within each ethnicity-gender subgroup. Current smokers were found to have higher Hg only in AA men. This study suggested age, gender, ethnicity, study center, alcohol, education level, and fish consumption consistently predict toenail Hg levels. As fish consumption was the key determinant, avoiding certain types of fish that have relatively high Hg levels may be crucial in reducing Hg intake.
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Affiliation(s)
- Pengcheng Xun
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Kiang Liu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - J. Steve Morris
- Research Reactor Center, University of Missouri-Columbia, Columbia, MO, 65211, USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Ka He
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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29
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Hamidovic A, Goodloe RJ, Bergen AW, Benowitz NL, Styn MA, Kasberger JL, Choquet H, Young TR, Meng Y, Palmer C, Pletcher M, Kertesz S, Hitsman B, Spring B, Jorgenson E. Gene-centric analysis of serum cotinine levels in African and European American populations. Neuropsychopharmacology 2012; 37:968-74. [PMID: 22089314 PMCID: PMC3280653 DOI: 10.1038/npp.2011.280] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To date, most genetic association studies of tobacco use have been conducted in European American subjects using the phenotype of smoking quantity (cigarettes per day). However, smoking quantity is a very imprecise measure of exposure to tobacco smoke constituents. Analyses of alternate phenotypes and populations may improve our understanding of tobacco addiction genetics. Cotinine is the major metabolite of nicotine, and measuring serum cotinine levels in smokers provides a more objective measure of nicotine dose than smoking quantity. Previous genetic association studies of serum cotinine have focused on individual genes. We conducted a genetic association study of the biomarker in African American (N=365) and European American (N=315) subjects from the Coronary Artery Risk Development in Young Adults study using a chip containing densely-spaced tag SNPs in ∼2100 genes. We found that rs11187065, located in the non-coding region (intron 1) of insulin-degrading enzyme (IDE), was the most strongly associated SNP (p=8.91 × 10(-6)) in the African American cohort, whereas rs11763963, located on chromosome 7 outside of a gene transcript, was the most strongly associated SNP in European Americans (p=1.53 × 10(-6)). We then evaluated how the top variant association in each population performed in the other group. We found that the association of rs11187065 in IDE was also associated with the phenotype in European Americans (p=0.044). Our top SNP association in European Americans, rs11763963 was non-polymorphic in our African American sample. It has been previously shown that psychostimulant self-administration is reduced in animals with lower insulin because of interference with dopamine transmission in the brain reward centers. Our finding provides a platform for further investigation of this, or additional mechanisms, involving the relationship between insulin and self-administered nicotine dose.
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Affiliation(s)
- Ajna Hamidovic
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA.
| | - Robert J Goodloe
- Center for Human Genetics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew W Bergen
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Neal L Benowitz
- Division of Clinical Pharmacology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Mindi A Styn
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jay L Kasberger
- Research Informatics Core, Ernest Gallo Clinic and Research Center, University of California, San Francisco, CA, USA
| | - Helene Choquet
- Department of Neurology, Ernest Gallo Clinic and Research Center, University of California, San Francisco, CA, USA
| | - Taylor R Young
- Biological Samples Platform, Broad Institute of MIT and Harvard University, Cambridge, MA, USA
| | - Yan Meng
- Metabolic Disease Initiative, Broad Institute of MIT and Harvard University, Cambridge, MA, USA
| | - Cameron Palmer
- Biological Samples Platform, Broad Institute of MIT and Harvard University, Cambridge, MA, USA
| | - Mark Pletcher
- Department of Epidemiology and Biostatistics and Department of Medicine, University of California, San Francisco, CA, USA
| | - Stefan Kertesz
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Eric Jorgenson
- Department of Neurology, Ernest Gallo Clinic and Research Center, University of California, San Francisco, CA, USA
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Janicki-Deverts D, Cohen S, Matthews KA, Jacobs DR Jr, Adler NE. Occupational mobility and carotid artery intima-media thickness: findings from the Coronary Artery Risk Development in Young Adults Study. Psychosom Med 2011; 73:795-802. [PMID: 22021461 DOI: 10.1097/PSY.0b013e3182365539] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine whether a 10-year change in occupational standing is related to carotid artery intima-media thickness (IMT) 5 years later. METHODS Data were obtained from 2350 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Occupational standing was measured at the Year 5 and 15 CARDIA follow-up examinations when participants were 30.2 (standard deviation = 3.6) and 40.2 (standard deviation = 3.6) years of age, respectively. IMT (common carotid artery [CCA], internal carotid artery [ICA], and bulb) was measured at Year 20. Occupational mobility was defined as the change in occupational standing between Years 5 and 15 using two semicontinuous variables. Analyses controlled for demographics, CARDIA center, employment status, parents' medical history, own medical history, Year 5 Framingham Risk Score, physiological risk factors and health behaviors averaged across the follow-up, and sonography reader. RESULTS Occupational mobility was unrelated to IMT save for an unexpected association of downward mobility with less CCA-IMT (β = -0.04, p = .04). However, associations differed depending on initial standing (Year 5) and sex. For those with lower initial standings, upward mobility was associated with less CCA-IMT (β = -0.07, p = .003), and downward mobility was associated with greater CCA-IMT and bulb-ICA-IMT (β = 0.14, p = .01 and β = 0.14, p = .03, respectively); for those with higher standings, upward mobility was associated with greater CCA-IMT (β = 0.15, p = .008), but downward mobility was unrelated to either IMT measure (p values > .20). Sex-specific analyses revealed associations of upward mobility with less CCA-IMT and bulb-ICA-IMT among men only (p values < .02). CONCLUSIONS Occupational mobility may have implications for future cardiovascular health. Effects may differ depending on initial occupational standing and sex.
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Seeman T, Gruenewald T, Karlamangla A, Sidney S, Liu K, McEwen B, Schwartz J. Modeling multisystem biological risk in young adults: The Coronary Artery Risk Development in Young Adults Study. Am J Hum Biol 2010; 22:463-72. [PMID: 20039257 PMCID: PMC3727401 DOI: 10.1002/ajhb.21018] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Although much prior research has focused on identifying the roles of major regulatory systems in health risks, the concept of allostatic load (AL) focuses on the importance of a more multisystems view of health risks. How best to operationalize allostatic load, however, remains the subject of some debate. We sought to test a hypothesized metafactor model of allostatic load composed of a number of biological system factors, and to investigate model invariance across sex and ethnicity. Biological data from 782 men and women, aged 32-47, from the Oakland, CA and Chicago, IL sites of the Coronary Artery Risk Development in Young Adults Study (CARDIA) were collected as part of the Year 15exam in 2000. These include measures of blood pressure, metabolic parameters (glucose, insulin, lipid profiles, and waist circumference), markers of inflammation (interleukin-6, C-reactive protein, and fibrinogen), heart rate variability, sympathetic nervous system activity (12-hr urinary norepinephrine and epinephrine) and hypothalamic-pituitary-adrenal axis activity (diurnal salivary free cortisol). A "metafactor" model of AL as an aggregate measure of six underlying latent biological subfactors was found to fit the data, with the metafactor structure capturing 84% of variance of all pairwise associations among biological subsystems. There was little evidence of model variance across sex and/or ethnicity. These analyses extend work operationalizing AL as a multisystems index of biological dysregulation, providing initial support for a model of AL as a metaconstruct of inter-relationships among multiple biological regulatory systems, that varies little across sex or ethnicity.
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Affiliation(s)
- Teresa Seeman
- Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1687, USA.
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Janicki-Deverts D, Cohen S, Matthews KA, Gross MD, Jacobs DR Jr. Socioeconomic status, antioxidant micronutrients, and correlates of oxidative damage: the Coronary Artery Risk Development in Young Adults ( CARDIA) study. Psychosom Med 2009; 71:541-8. [PMID: 19414620 DOI: 10.1097/PSY.0b013e31819e7526] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine whether socioeconomic status (SES) (education, occupation, income), is associated both cross sectionally and prospectively with circulating concentrations of a) two correlates of oxidative damage, F(2)-isoprostanes (F(2)-IsoPs) and gamma-glutamyltransferase (GGT); and b) antioxidant nutrients (ascorbic acid and carotenoids). We also examine whether the proposed associations are mediated by smoking, alcohol consumption, and depression. Risk for chronic disease increases with decreasing SES. One pathway by which low SES might influence disease risk is by promoting oxidative stress. METHODS Data from 1278 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study were used to examine the association of SES with oxidation correlates and antioxidant nutrients. Education, occupation, health behaviors, and body mass index (BMI) were assessed during Years 0, 10, and 15 of the study; income and depression were evaluated at Years 10 and 15. F(2)-isoprostanes were measured at Year 15, gamma-glutamyltransferase (GGT) at Years 0 and 10, carotenoids at Years 0 and 15, and ascorbic acid at Years 10 and 15. RESULTS Cross sectionally, oxidation correlates decreased and antioxidant nutrients increased with increasing SES, estimated in several ways, independent of age, sex, race, and BMI. Prospectively, lower Year 0 education and occupation predicted greater increases in GGT and greater decreases in carotenoids over 10 to 15 years. Prospective associations of Year 0 SES with Year 15 carotenoids were independent of Year 15 SES. Smoking, drinking, and depression symptoms partially mediated these effects. CONCLUSIONS Circulating oxidation correlates increase and antioxidant nutrients decrease with decreasing SES, both cross sectionally and prospectively.
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Singaporewalla RM, Moiz SR, Baladas GH, Ganesan BH, Lee TDE. Laparoendoscopic removal of a benign gastric stromal tumor at the cardia. JSLS 2006; 10:117-21. [PMID: 16709375 PMCID: PMC3015683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Gastrointestinal stromal tumors are the most common submucosal masses in the stomach and are mostly benign. Minimally invasive surgery is being increasingly used for their excision. Tumors close to the cardia often require a stapled resection of stomach. We report a technique for enucleating a 4-cm, well-circumscribed gastric submucosal tumor at the cardia, avoiding gastric transection. METHODS A gastroscope was introduced to distend the stomach. A laparoscope was inserted through the umbilicus after pneumoperitoneum was created. Two 5-mm metal trocars were inserted into the stomach under vision. A 10-mm trocar was passed through the umbilical incision into the stomach for the camera. Dilute epinephrine was injected submucosally. The tumor was enucleated after incising the overlying mucosa. A gastroscope snare helped in grasping the tumor for retraction and final removal in a plastic bag. The submucosal defect and gastric port-site defects were sutured laparoscopically with Vicryl 3-0. RESULTS Contrast studies showed no leakage. Final histology indicated a benign leiomyoma. The patient was discharged on the sixth day. No recurrence was noted at 6-month follow-up. CONCLUSION Benign stromal tumors at the cardia can be safely enucleated by this method. This technique is cost-effective as it avoids expensive staplers or self-retaining gastric balloon ports.
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Meining A, Ott R, Becker I, Hahn S, Mühlen J, Werner M, Höfler H, Classen M, Heldwein W, Rösch T. The Munich Barrett follow up study: suspicion of Barrett's oesophagus based on either endoscopy or histology only--what is the clinical significance? Gut 2004; 53:1402-7. [PMID: 15361485 PMCID: PMC1774245 DOI: 10.1136/gut.2003.036822] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of distal oesophageal adenocarcinoma is rising, with chronic reflux and Barrett's oesophagus being considered risk factors. Reliable detection of Barrett's oesophagus during upper endoscopy is therefore mandatory but requires both endoscopy and histology for confirmation. Appropriate management of patients with endoscopic suspicion but negative on histology, or vice versa, or of patients with no endoscopic suspicion but with a biopsy diagnosis of intestinal metaplasia at the gastro-oesophageal junction, has not yet been studied prospectively. PATIENTS AND METHODS In a prospective multicentre study, 929 patients (51% male, mean age 50 years) referred for upper gastrointestinal endoscopy were included; 59% had reflux symptoms. The endoscopic aspect of the Z line and any suspicion of Barrett's oesophagus were noted, and biopsies were taken in all patients from the Z line (n = 4), gastric cardia (n = 2), and body and antrum (n = 2 each). Biopsies positive for specialised intestinal metaplasia (SIM) were reviewed by a reference pathologist for a final Barrett's oesophagus diagnosis. All patients with endoscopic and/or histological suspicion of Barrett's oesophagus were invited for a follow up endoscopy; the remaining cases (no endoscopic or histological suspicion of Barrett's oesophagus) were followed clinically. RESULTS Of 235 patients positive for Barrett's oesophagus on endoscopy and/or histology, 63% agreed to undergo repeat endoscopy (mean follow up period 30.5 months). 46% of patients with an endoscopic Barrett's oesophagus diagnosis but no histological confirmation (group A) showed the same distribution, a further 42% did not have Barrett's oesophagus, and 11% had confirmed Barrett's oesophagus on both endoscopy and biopsy on follow up. In the group with a histological Barrett's oesophagus diagnosis but negative on initial endoscopy (group B), follow up showed the same in 26% whereas 46% had no Barrett's oesophagus, and confirmed Barrett's oesophagus (endoscopy plus histology) was diagnosed in 17%. Of the study population, 16 patients had Barrett's oesophagus on initial endoscopy confirmed by histology which remained constant in 70% at follow up (group C). Of the remaining patients without an initial Barrett's oesophagus diagnosis on either endoscopy or histology (group D) and only clinical follow up (mean follow up period 38 months), one confirmed Barrett's oesophagus case was found among 100 patients re-endoscoped outside of the study protocol. However, no single case of dysplasia or cancer of the distal oesophagus was detected in any patient during the study period. CONCLUSIONS Even in a specialised gastroenterology setting, reproducibility of presumptive endoscopic or histological diagnoses of Barrett's oesophagus at follow up were poor. Only 10-20% of cases with either endoscopic or histological suspicion of Barrett's oesophagus had established Barrett's oesophagus after 2.5 years of follow up. The risk of dysplasia in this population was very low and hence meticulous follow up may not be required.
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Affiliation(s)
- A Meining
- Central Interdisciplinary, Endoscopy Unit, Department of Gastroenterology, Campus Virchow, Charité University Hospitals, Berlin, Germany.
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Abstract
BACKGROUND Saliva has a high nitrite concentration, derived from the enterosalivary recirculation of dietary nitrate, and is the main source of nitrite entering the acidic stomach. Acidification of nitrite in the presence of secondary amines or amides generates potentially carcinogenic N-nitroso compounds. The reaction is inhibited by ascorbic acid and catalysed by thiocyanate. AIM To determine whether there is intragastric regional variation in the chemical conditions promoting luminal nitrosation following nitrate ingestion. METHODS Using microdialysis probes, we measured concentrations of nitrite, ascorbic acid, total vitamin C, and thiocyanate simultaneously in saliva, the distal oesophagus, cardia, and the proximal and distal stomach of 17 healthy volunteers before and following intragastric nitrate (2 mmol) administration. RESULTS The median pH in the distal oesophagus, cardia, and proximal and distal stomach were 7, 2.6, 1.9, and 1.7, respectively, before, and were similar following nitrate administration. Mean nitrite concentration in the distal oesophagus was similar to that of saliva, being 29.1 micro M and 36.7 micro M, respectively, before nitrate and increasing to 181.6 micro M and 203.3 micro M after nitrate ingestion. Within the stomach, mean (SEM) nitrite concentration following nitrate was higher in the cardia (45.5 (12.7) micro M) than in the mid (7.8 (3.1)) (p<0.01) or distal (0.8 (0.6)) (p<0.1) stomach, and ascorbic acid concentration was lower at the cardia (13.0 (6.1)) than in the mid (51 (19.2)) (p<0.02) or distal (86 (29)) (p<0.01) stomach. Consequently, the median ascorbic acid to nitrite ratio was lowest at the cardia (0.3) (p<0.01) versus the mid (7.8) or distal (40) stomach. Thiocyanate concentration was similar throughout the stomach. CONCLUSIONS The conditions favouring luminal generation of N-nitroso compounds from dietary nitrate are maximal at the most proximal cardia region of the acidic stomach and may contribute to the high incidence of mutagenesis at this site.
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Affiliation(s)
- H Suzuki
- Section of Medicine, Gardiner Institute, Western Infirmary, Glasgow, UK
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Ekström AM, Hansson LE, Signorello LB, Lindgren A, Bergström R, Nyrén O. Decreasing incidence of both major histologic subtypes of gastric adenocarcinoma--a population-based study in Sweden. Br J Cancer 2000; 83:391-6. [PMID: 10917557 PMCID: PMC2374560 DOI: 10.1054/bjoc.2000.1205] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
While the overall incidence of gastric cancer has fallen, presumably to a large extent in parallel with Helicobacter pylori infection, the occurrence of the diffuse histologic type is thought to have remained more stable, questioning the aetiologic role of H. pylori. We have analysed the incidence of the intestinal and diffuse types separately, while considering subsite (cardia/non-cardia). With an extensive prospective effort we identified all incident cases of gastric adenocarcinoma (n = 1337) in a well-defined Swedish population (1.3 million) 1989-1994. Tumours were uniformly classified histologically and topographically. Subgroup-specific incidence rates were computed and modelled using multivariate logistic regression. Site-specific trends were clearly discrepant. The overall incidence of adenocarcinoma distal to the gastric cardia declined by 9% (95% confidence interval 6-12%) per year, while cardia cancer remained stable. Thus, the feared rise in cardia cancer could not be confirmed despite clear site-specific trend discrepancies. The intestinal type predominated, especially in high-risk areas, while diffuse tumours prevailed among young patients and women. Both main histologic types of gastric adenocarcinoma declined markedly, at similar rapidity, and with no significant trend differences between the intestinal and diffuse types, even after multivariate adjustments. Our results are consistent with an aetiologic role of environmental factors including H. pylori also for diffuse-type gastric cancers.
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Affiliation(s)
- A M Ekström
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden
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