Endoscopic submucosal dissection for early signet ring cell gastric cancer: A systematic review and meta-analysis

BACKGROUND

The use of endoscopic submucosal dissection (ESD) for treating early signet ring cell carcinoma (SRC) is controversial due to the risk of lymph node metastasis.

AIM

To carry out a meta-analysis to evaluate ESD for therapeutic efficacy and safety in early signet ring cell gastric cancer.

METHODS

The PubMed, Web of Science, Cochrane Library, and EMBASE databases were used to search for relevant studies evaluating the therapeutic efficacy and safety of ESD in SRC. The rates of recurrence, complete resection, incomplete resection, curative resection, en bloc resection, and adverse events were extracted and analyzed. The methodological quality of the enrolled studies was assessed using the Newcastle-Ottawa Scale. Publication bias was evaluated by the Egger’s test. Institutional review board approval and written consent were not needed for this report.

RESULTS

This meta-analysis enrolled seven studies with 653 participants undergoing ESD treatment for early SRC. The overall recurrence rate was 0.010 [95% confidence interval (CI): 0.000-0.040, Z = 1.422, P = 0.155]. The total lymphovascular invasion rate was 0.038 (95%CI: 0.007-0.088, Z = 3.026, P = 0.002). The total en bloc resection rate was estimated at 0.984 (95%CI: 0.925-1.000, Z = 19.463, P = 0.000). The total complete and incomplete resection rates were estimated at 0.785 (95%CI: 0.596-0.928, Z = 9.789, P = 0.000) and 0.188 (95%CI: 0.016-0.468, Z = 2.531, P = 0.011), respectively. The total procedure-associated gastric hemorrhage and perforation rates were estimated at 0.026 (95%CI: 0.005-0.061, Z = 3.006 P = 0.003) and 0.004 (95%CI: 0.000-0.028, Z = 0.938, P = 0.348), respectively. The curative resection, vertical margin invasion, and lateral margin invasion rates were 72.1% (145/341), 2.3% (8/348), and 34.45% (41/119), respectively.

CONCLUSION

ESD constitutes a promising therapeutic approach for early undifferentiated SRC gastric cancer. However, further improvements are required for increasing its treatment efficacy and reducing adverse outcomes.

Trametes robiniophila Murr Sensitizes Gastric Cancer Cells to 5-Fluorouracil by Modulating Tumor Microenvironment

Trametes robiniophila Murr (TRM) is a traditional Chinese medicine which has been used in clinics for enhancing immunity and improving the efficacy of chemotherapy. However, the mechanisms of action of TRM are unknown. In the previous study, we found that the Trametes robiniophila Murr n-butanol extract (TRMBE) comprises the major bioactive components of TRM. In the present study, we aimed to assess the combinational effects of TRMBE and 5-fluorouracil (5-FU) on the treatment of gastric cancer (GC) and explore its mechanism of action. It was found that TRMBE significantly potentiated the anticancer activity of 5-FU and prolonged the survival time of mice bearing Mouse Forestomach Carcinoma (MFC) xenograft tumors. We observed that the combination of TRMBE and 5-FU decreased the risk of liver metastasis in vivo. Furthermore, the combination of TRMBE and 5-FU reduced the levels of immune cytokines IL-6, IL-10, and TGF-β and increased the level of IFN-γ in peripheral blood. This combination therapy also significantly decreased the levels of polymorphonuclear myeloid-derived suppressor cells (PMN-MDSCs) and PD-1-positive CD8⁺ T cells and increased the levels of NK cells in tumor microenvironment (TME). However, TRMBE treatment was unable to enhance the chemosensitivity of GC to 5-FU in vivo after the depletion of CD8⁺ T and NK cells. Taken together, our results demonstrate that TRMBE can reshape the TME of GC by regulating PMN-MDSCs, CD8⁺ T cells, and NK cells, therefore improving the therapeutic effects of 5-FU. This study suggests that the combination of TRMBE and 5-FU could enhance immunity and could be a promising approach for GC treatment.

CD8-positive indolent T-Cell lymphoproliferative disorder of the gastrointestinal tract: A case report and review of literature

BACKGROUND

Indolent T-cell lymphoproliferative disorder of the gastrointestinal tract (ITLPD-GI), a primary tumor forming in the gastrointestinal (GI) tract, represents a rarely diagnosed clonal T-cell disease with a protracted clinical course.

CASE SUMMARY

This report presented a 45-year-old male patient with a 6-year history of anal fistula and a more than 10-year history of recurrent diarrhea who was not correctly diagnosed until the occurrence of complications such as intestinal perforation. Postsurgical histopathological analysis, combined with hematoxylin-eosin staining, immunohistochemistry and TCRβ/γ clonal gene rearrangement test, confirmed the diagnosis of CD8+ ITLPD-GI.

CONCLUSION

Individuals with this scarce lymphoma frequently show non-specific symptoms that are hard to recognize. So far, indolent CD8+ ITLPD-GI has not been comprehensively examined. The current mini-review focused on evaluating indolent CD8+ ITLPD-GI cases based on existing literature and discussing future directions for improved differential diagnosis, detection of genetic and epigenetic alterations, and therapeutic target identification.

Laparoscopic-assisted endoscopic full-thickness resection of a large gastric schwannoma: A case report

BACKGROUND

Schwannomas, also known as neurinomas, are benign tumors derived from Schwann cells. Gastrointestinal schwannomas are rare and are most frequently reported in the stomach. They are usually asymptomatic and are difficult to diagnose preoperatively; however, endoscopy and imaging modalities can provide beneficial preliminary diagnostic data. There are various surgical options for management. Here, we present a case of a large gastric schwannoma (GS) managed by combined laparoscopic and endoscopic surgery.

CASE SUMMARY

A 28-year-old woman presented with a 2-mo history of epigastric discomfort and a feeling of abdominal fullness. On upper gastrointestinal endoscopy and endoscopic ultrasonography, a hypoechogenic submucosal mass was detected in the gastric antrum: It emerged from the muscularis propria and projected intraluminally. Computed tomography showed a nodular lesion (4 cm × 3.5 cm), which exhibited uniform enhancement, on the gastric antrum wall. Based on these findings, a preliminary diagnosis of gastrointestinal stromal tumor was established, with schwannoma as a differential. Considering the large tumor size, we planned to perform endoscopic resection and to convert to laparoscopic treatment, if necessary. Eventually, the patient underwent combined laparoscopic and gastroscopic surgery. Immunohistochemically, the resected specimen showed positivity for S-100 and negativity for desmin, DOG-1, α-smooth muscle actin, CD34, CD117, and p53. The Ki-67 index was 3%, and a final diagnosis of GS was established.

CONCLUSION

Combined laparoscopic and endoscopic surgery is a minimally invasive and effective treatment option for large GSs.

Peroral endoscopic longer vs shorter esophageal myotomy for achalasia treatment: A systematic review and meta-analysis

BACKGROUND

Peroral endoscopic myotomy (POEM) has been demonstrated to be safe and effective in the treatment of achalasia. Longer myotomy is the standard POEM procedure for achalasia but when compared with shorter myotomy, its effectiveness is not as well known.

AIM

To compare the clinical effectiveness of longer and shorter myotomy.

METHODS

PubMed, EmBase, Cochrane Library, web of science and clinicaltrials.gov were queried for studies comparing shorter and longer POEM for achalasia treatment. The primary outcome was clinical success rate. Secondary outcomes comprised of operative time, adverse events (AEs) rate, gastroesophageal reflux disease (GERD) and procedure-related parameters. The Mantel-Haenszel fixed-effects model was primarily used for the analysis. Publication bias was assessed.

RESULTS

Six studies were included in this analysis with a total of 514 participants. During the follow-up period of 1-28.7 mo, longer and shorter myotomy in treating achalasia showed similar excellent effectiveness [overall clinical success (OR = 1, 95%CI: 0.46-2.17, P = 1, I²: 0%; subgroup of abstract (OR = 1.19, 95%CI: 0.38 to 3.73; P = 0.76; I²: 0%); subgroup of full text (OR = 0.86 95%CI: 0.30 to 2.49; P = 0.78; I²: 0%)]. Shorter myotomy had significantly reduced mean operative time compared with the longer procedure. There were no statistically significant differences in AEs rates, including GERD (overall OR = 1.21, 95%CI: 0.76-1.91; P = 0.42; I²: 9%; subgroup of abstract OR = 0.77, 95%CI: 0.40-1.47; P = 0.43; I²: 0%; subgroup of full text OR = 1.91, 95%CI: 0.98-3.75; P = 0.06; I²: 0%), hospital stay (overall MD = -0.07, 95%CI: -0.30 to 0.16; P = 0.55; I²: 24%; subgroup of abstract MD = 0.20, 95%CI: -0.25 to 0.65; P = 0.39; I²: 0; subgroup of full text MD = -0.16, 95%CI: -0.42 to 0.10; P = 0.23; I²: 42%), and major bleeding (overall OR = 1.25, 95%CI: 0.58-2.71; P = 0.56; I²: 0%) between the two procedures. These differences remained statistically non-significant in all sensitivity analyses.

CONCLUSION

POEM was effective in treating achalasia. Shorter and longer myotomy procedures provided similar therapeutic effects in terms of long-term effectiveness. In addition, shorter myotomy reduced the operative time.

Helicobacter pylori eradication: Exploring its impacts on the gastric mucosa

Helicobacter pylori (H. pylori) infects approximately 50% of all humans globally. Persistent H. pylori infection causes multiple gastric and extragastric diseases, indicating the importance of early diagnosis and timely treatment. H. pylori eradication produces dramatic changes in the gastric mucosa, resulting in restored function. Consequently, to better understand the importance of H. pylori eradication and clarify the subsequent recovery of gastric mucosal functions after eradication, we summarize histological, endoscopic, and gastric microbiota changes to assess the therapeutic effects on the gastric mucosa.

[Evaluation of quality of life in patients with Graves orbitopathy and its influencing factors]

Objective: To evaluate life quality of Graves orbitopathy (GO) patients using Graves orbitopathy quality-of-life questionnaire (GO-QOL) and explore the influence factors of the quality of life of GO patients. Methods: This was a cross-sectional study conducted at The Third Affiliated Hospital of Southern Medical University including 145 newly diagnosed GO patients. All the patient answered the GO-QOL and underwent ophthalmic and endocrine assessments. The main outcome measures were the scores on GO-QOL 2 subscales: visual functioning and appearance. Based on the classification in the guideline of European Group on Graves Orbitopathy (EUGOGO), the patients were divided into two groups: mild and moderate to severe groups. Then the scales between these two groups were compared and influencing factors were analyzed. Finally, the floor and ceiling effects were assessed. Results: The GO-QOL scores for the subscales of visual functioning and appearance were 70.91±27.83 and 61.29±26.37 respectively in 145 GO patients. Visual functioning and appearance were lower in moderate to severe group (62.71±28.77 and 57.52±26.49, respectively) than in mild group (85.58±18.77 and 68.02±24.99, respectively).The GO-QOL scores for the visual functioning subscale were significantly correlated with age (P=0.002), clinical active score (P=0.011) and the degree of diplopia (P=0.00, R(2)=0.373). The GO-QOL scores for the appearance were significantly correlated with sex (P=0.05) and thyroid-stimulating hormone levels (P=0.001, R(2)=0.231). No significant ceiling or floor effects were observed for either subscale of the GO-QOL. Conclusions: With the aggravation of the disease, the quality of life of GO patients is getting worse and worse. The main influencing factors of the quality of life of GO patients include age, gender, diplopia, clinical active score and thyroid-stimulating hormone levels. Close attention needs to be paid to the quality of life of GO patients.

New metal chalcogenides found in MnN-1(Gd2-xInx)SN+2 (N = 3, 4, 5): syntheses, structures, and magnetic properties

Three new metal chalcogenides have been identified in Mn_N-1(Gd_2-xIn_x)S_N+2 with N = 3, 4, and 5 via a flux-growth synthesis. All compounds crystallize in the same space group of orthorhombic Cmcm with cell constants: Mn₂GdInS₅ (1), a = 3.789(1) Å, b = 12.411(1) Å, and c = 15.489(1) Å; Mn₃Gd₂S₆ (2), a = 3.778(1) Å, b = 12.505(2) Å, and c = 19.114(2) Å; Mn₄Gd₂S₇ (3), a = 3.769(1) Å, b = 12.466(2) Å, and c = 22.289(3) Å. Compounds 1-3 form a homologous series through the modulation of the MnS unit, whose structures represent a complete system of the corresponding lillianites (^N1,N2L) of ^3,3L, ^4,4L and ^5,5L. The gradually wider slabs formed in the series result in a monotonic increase along the c dimensions from 1 to 3. Crystal 3 is the first to achieve a predicted structure of ^5,5L. Mn₂GdInS₅ (1) displays a weak antiferromagnetic (AFM) ordering at 10 K and the Weiss constant (θ) of -0.76 K. Mn₂Gd_1.5In_0.5S₅ (1a), an isostructure of 1, shifts the AFM transition temperature to 12 K and possesses a slightly larger θ constant of -6.06 K. Mn₄Gd₂S₇ (3), featuring the thickest slabs in this series, shows a significant antiferromagnetic behavior beginning at a high temperature of 70 K and has a largest θ constant of -40.25 K. A small amount of impurity α-Gd₂S₃ with an AFM transition temperature around 4 K was characterized in sample 3, which does not interfere with the magnetic ordering of 3 at much higher temperatures. These magnetic chalcogenides display band gaps of 1.66 eV for 1, 1.75 eV for 1a, and 1.44 eV for 3.

Anti-aflatoxin mutagenic factors in corn

Extracts, isolated through sequential fractionation and partition procedures described previously (Martinez et al. 1994) from aflatoxin-free corn and aflatoxin-contaminated corn with and without ammonia treatment, were investigated for mutagenic potential using the Ames test (TA 100 tester strain). 2-Aminofluorene (2-AF) and pure aflatoxin B1 (AFB1) were used as positive controls. Although TA100 showed mutagenic response to pure AFB1 at a dose of ca 10 ng/plate, all isolates tested from ammonia-treated aflatoxin-contaminated corn containing 7500 ng AFB1/g did not exhibit positive results in the Ames test. Additionally, isolates from non-ammonia-treated aflatoxin-contaminated corn failed to give positive mutagenic potentials. These results indicate that differences between the mutagenic potentials of pure aflatoxins and of aflatoxins in naturally-contaminated corn exist. CH2Cl2 extracts (the fractions containing aflatoxins) obtained from aflatoxin-contaminated corn with and without ammonia treatment were applied to preparative thin layer chromatography (TLC) in an effort to separate aflatoxins and/or ammonia/aflatoxin reaction products from the "unknown interfering materials' existing in the corn matrix. Each of the fractions separated by TLC was tested by the Ames test with S9 activation and none of them gave a mutagenic response to TA100. CH2Cl2 extracts in dimethylsulphoxide (DMSO) obtained from non-ammonia-treated aflatoxin-free corn were spiked with pure AFB1 and tested by TA100 with S9 activation. Again, no positive responses were observed. These findings provide further evidence of "unknown interfering materials' in corn which may bind with aflatoxin and/or can be extracted by CH2Cl2 together with aflatoxin, and, therefore, block the mutagenic activity of aflatoxin in the Ames test. Those materials were not separated from the aflatoxins by the TLC technique used in the present study. Possible reasons and further studies required to evaluate this phenomenon are discussed.

Efficacy and permanency of ammonia treatment in reducing aflatoxin levels in corn

Naturally contaminated yellow corn containing 12500 ng/g of aflatoxin B1 (AFB1) was ground and blended with non-contaminated corn to obtain various levels of AFB1 (7500, 6300, 400, 354, and 17 ng AFB1/g). All samples were exposed to ammonia treatment under various conditions for 60 min. Treatment variables included ammonia concentration, moisture level of the corn, temperature, and pressure applied. The moisture content of the corn (8%) was adjusted to 12% and 16%, respectively. Four ammonia treatments were conducted for each moisture level: (a) 1.5% and 2.0% gaseous NH3 at 40-45 degrees C and 55 psi; (b) aqueous NH4OH (2.0% as NH3) at 121 degrees C and 17 psi; (c) sequential treatment of (a) and (b); and (d) aqueous NH4OH (2.0% as NH3) at 25 degrees C and 55 psi. For the treatment with 2% gaseous NH3, the reduction in levels of AFB1 in samples containing 12% moisture ranged from 52.7 to 67.7%, while in samples containing 16% moisture, the reduction ranged from 79.4 to 93.1%. Treatment with NH4OH alone at elevated temperatures (b) or following gaseous NH3 treatment (c) resulted in a reduction of the AFB1 content by greater than 99%. Treatment with NH4OH at 25 degrees C (d) showed a lower efficiency in reducing AFB1 levels. The permanency of the process, i.e. reversion of inactivated AFB1 to the parent compound, was studied by exposing the ammonia-treated corn to HCl (pH = 2.0 at 37 degrees C for 2 h) to simulate stomach acidity. The results showed no significant reversion of aflatoxin (reversibility less than 0.05%). These findings suggest that at high temperature aqueous NH4OH or gaseous NH3 can be used effectively to reduce AFB1 in corn. The present study also revealed that the moisture level of the product and holding temperature were the crucial factors that influenced the efficacy of aflatoxin decontamination by ammoniation.

Distribution of ammonia/aflatoxin reaction products in corn following exposure to ammonia decontamination procedure

The distribution of aflatoxin decontamination reaction products in corn following ammonia decontamination treatment was determined. The parameters of the ammoniation procedure used to decontaminate aflatoxin contaminated corn were 2% NH3, 16% moisture, 55 psi, 40-45 degrees C, and 60 min duration. Uniformly ring-labelled 14C-aflatoxin B1 was added to corn (1.0 microCi/kg) containing 7500 micrograms naturally-incurred aflatoxin B1 (AFB1)/kg. Aflatoxin levels were reduced by ca 93% after ammonia treatment. Distribution of radiolabelled AFB1 was used to follow the modification of AFB1 and the ammonia/aflatoxin reaction products were separated and isolated through a series of chemical extraction/partition procedures. Samples of the ammoniated product were fractionated through sequential extraction with methylene chloride and methanol, then either treated with acetic acid and sodium hydroxide or exposed to proteolytic enzyme digestion followed by methylene chloride extraction. Approximately 88% of the added radioactivity was detected in the corn after treatment (i.e. 12% of aflatoxin reaction products were volatile), ca 20% was extracted with methylene chloride and ca 13% was extracted with methanol. Treatment with acid and base released 18.8% of the added radioactivity. Similar amounts (19.1%) of aflatoxin-related compounds were liberated after enzymatic digestion with Pronase E. The remaining corn matrix after acid-base treatment or Pronase digestion contained ca 37.0% of the original radioactivity. A fluorescent spot on the TLC plate represented 6.1% of the CH2Cl2-extractable compounds and contained a compound which reacts chromatographically similarly to AFB2a.

Edge technique: theory and application to the lidar measurement of atmospheric wind

The edge technique is a new and powerful method for measuring small frequency shifts. With the edge technique a laser is located on the steep slope of a high-resolution spectral filter, which produces large changes in transmission for small frequency shifts. A differential technique renders the frequency shift measurement insensitive to both laser and filter frequency jitter and drift. The measurement is shown to be insensitive to the laser width and shape for widths that are less than the half-width of the edge filter. The theory of the measurement is given with application to the lidar measurement of wind. The edge technique can be used to measure wind with a lidar by using either the aerosol or molecular backscattered signal. Examples of both measurements are presented. Simulations for a ground-based lidar at 1.06 microm using reasonable instrumental parameters are used to show an accuracy for the vector components of the wind that is better than 0.5 m/s from the ground to an altitude of 20 km for a 100-m vertical resolution and a 100-shot average. For a 20-m vertical resolution and a 10-shot average, simulations show an accuracy of better than 0.2 m/s in the first 2 km and better than 0.5 m/s to 5 km.

Mutagenic potentials of fumonisin contaminated corn following ammonia decontamination procedure

Naturally contaminated corn implicated in an outbreak of equine leukoencephalomalacia (ELEM) in southeastern Arizona was analyzed for mutagenic potential using the Salmonella/microsome mutagenicity assay before and after treatment with the ammonia procedure. Crude acetonitrile: water (1 + 1) extracts of high-pressure/ambient temperature (HP/AT) ammonia decontaminated, HP/AT plus low pressure/high temperature (LP/HT), and non-ammoniated fumonisin contaminated corn were tested for mutagenic potentials. Relatively pure (approx. 90%) fumonisin B1 standard was also tested for comparison purposes. The results of this experiment indicate that there was no mutagenic potential for the fumonisin B1 standard at the concentrations tested (100 micrograms/plate). Also, neither the naturally-contaminated corn nor the ammonia decontaminated samples elicited a positive mutagenic response. Fumonisin B1 levels, as determined by HPLC methods, were reduced by an average of 79% via the ammonia decontamination process. It is encouraging to note that, while further work is necessary to increase the efficacy of the ammonia process to reduce fumonisin levels, the ammonia process did reduce fumonisin levels and no mutagenic potentials were apparent in the treated corn.

[A study of chronic schizophrenic patients on the attention tests]

Three groups of people--schizophrenic (26 patients), affective disorder (23 patients), and normal (27 persons) were administered two attention tests--Tai Ta Attention Test and Kraepelin Test. The results indicate that the speed and duration of attention of schizophrenic patients are poorer than those of normal persons. And the attention deficit is not much different between the two psychotic group patients. This study finds that the main attention problem of schizophrenic patients is their deficit of duration of attention.

Airborne and ground based lidar measurements of the atmospheric pressure profile

The first high accuracy remote measurements of the atmospheric pressure profile have been made. The measurements were made with a differential absorption lidar system that utilizes tunable alexandrite lasers. The absorption in the trough between two lines in the oxygen A-band near 760 nm was used for probing the atmosphere. Measurements of the 2-D structure of the pressure field were made in the troposphere from an aircraft looking down. Also, measurements of the 1-D structure were made from the ground looking up. Typical pressure accuracies for the aircraft measurements were 1.5-2 mbar with a 30-m vertical resolution and a 100-shot average (20 s), which corresponds to a 2-km horizontal resolution. Typical accuracies for the upward viewing ground based measurements were 2.0 mbar for a 30-m resolution and a 100-shot average.

Differential absorption lidar technique for measurement of the atmospheric pressure profile

A new two-wavelength lidar technique for remotely measuring the pressure profile using the trough absorption region between two strong lines in the oxygen A band is described. The theory of integrated vertical path, differential ranging, and horizontal path pressure measurements is given with methods to desensitize and correct for temperature effects. The properties of absorption troughs are described and shown to reduce errors due to laser frequency jitter by up to 2 orders of magnitude. A general analysis, including laser bandwidth effects, demonstrates that pressure measurements with an integrated vertical path technique are typically fifty times more accurate than with a differential ranging technique. Simulations show 0.1-0.3% accuracy for ground and Shuttle-based pressure profile and surface pressure experiments.