Myoelectric activity and motility of the Roux limb after cut or uncut Roux-en-Y gastrojejunostomy

AIM: To explore the mechanisms of uncut Roux-en-Y gastrojejunostomy, which is used to decrease the occurrence of Roux stasis syndrome.METHODS: The changes of myoelectric activity, mechanic motility and interstitial cells of Cajal (ICC) of the Roux limb after cut or uncut Roux-en-Y gastrojejunostomy were observed. RESULTS: When compared with the cut group, the amplitude (1.15 ± 0.15 mV vs 0.48 ± 0.06 mV, P < 0.05) and frequency (14.4 ± 1.9 cpm vs 9.5 ± 1.1 cpm, P < 0.01) of slow waves and the incidence (98.2% ± 10.4% vs 56.6% ± 6.4%, P < 0.05) and amplitude (0.58 ± 0.08 mV vs 0.23 ± 0.06 mV, P < 0.01) of spike potential of the Roux limb in the uncut group were significantly higher. The migrating myoelectric complexes (MMC) phase Ⅲ duration in the uncut group was significantly prolonged (6.5 ± 1.1 min vs 4.4 ± 0.8 min, P < 0.05), while the MMC cycle obviously shortened (42.5 ± 6.8 vs 55.3 ± 8.2 min, P < 0.05). Both gastric emptying rate (65.5% ± 7.9% vs 49.3% ± 6.8%, P < 0.01) and intestinal impelling ratio (53.4% ± 7.4% vs 32.2% ± 5.4%, P < 0.01) in the uncut group were significantly increased. The contractile force index of the isolated jejunal segment in the uncut group was significantly higher (36.8 ± 5.1 vs 15.3 ± 2.2, P < 0.01), and the expression of c-kit mRNA was significantly increased in the uncut group (0.82 ± 0.11 vs 0.35 ± 0.06, P < 0.01). CONCLUSION: Uncut Roux-en-Y gastrojejunostomymay lessen the effects of operation on myoelectric activity such as slow waves, spike potential, and MMC, decrease the impairment of gastrointestinal motility, and remarkably increase the expression of c-kit mRNA.

Clinical significance and management of Barrett's esophagus with epithelial changes indefinite for dysplasia

Barrett's esophagus(BE) is defined as the extension of salmon-colored mucosa into the tubular esophagus ≥1 cm proximal to the gastroesophageal junction with biopsy confirmation of intestinal metaplasia. Patients with BE are at increased risk of esophageal adenocarcinoma(EAC), and undergo endoscopic surveillance biopsies to detect dysplasia or early EAC. Dysplasia in BE is classified as no dysplasia, indefinite for dysplasia(IND), low grade dysplasia(LGD) or high grade dysplasia(HGD). Biopsies are diagnosed as IND when the epithelial abnor-malities are not sufficient to diagnose dysplasia or the nature of the epithelial abnormalities is uncertain due to inflammation or technical issues. Specific diagnostic criteria for IND are not well established and its clinical significance and management has not been well studied. Previous studies have focused on HGD in BE and led to changes and improvement in the management of BE with HGD and early EAC. Only recently, IND and LGD in BE have become focus of intense study. This review summarizes the definition, neoplastic risk and clinical management of BE IND.

Somatic mutations in FAT cadherin family members constitute an underrecognized subtype of colorectal adenocarcinoma with unique clinicopathologic features

BACKGROUND The FAT cadherin family members(FAT1,FAT2,FAT3 and FAT4)are conserved tumor suppressors that are recurrently mutated in several types of human cancers,including colorectal carcinoma(CRC).AIM To characterize the clinicopathologic features of CRC patients with somatic mutations in FAT cadherin family members.METHODS We analyzed 526 CRC cases from The Cancer Genome Atlas PanCancer Atlas dataset.CRC samples were subclassified into 2 groups based on the presence or absence of somatic mutations in FAT1,FAT2,FAT3 and FAT4.Individual clinicopathological data were collected after digital slide review.Statistical analysis was performed using t tests and chi-square tests.RESULTS This CRC study cohort had frequent mutations in the FAT1(10.5%),FAT2(11.2%),FAT3(15.4%)and FAT4(23.4%)genes.Two hundred CRC patients(38.0%)harbored somatic mutations in one or more of the FAT family genes and were grouped into the FAT mutated CRC subtype.The FAT-mutated CRC subtype was more commonly located on the right side of the colon(51.0%)than in the rest of the cohort(30.1%,P<0.001).It showed favorable clinicopathologic features,including a lower rate of positive lymph nodes(pN1-2:33.5%vs 46.4%,P=0.005),a lower rate of metastasis to another site or organ(pM1:7.5%vs 16.3%,P=0.006),and a trend toward an early tumor stage(pT1-2:25.0%vs 18.7%,P=0.093).FAT somatic mutations were significantly enriched in microsatellite instability CRC(28.0%vs 2.1%,P<0.001).However,FAT somatic mutations in microsatellite stable CRC demonstrated similar clinicopathologic behaviors,as well as a trend of a better diseasefree survival rate(hazard ratio=0.539;95%confidence interval:0.301-0.967;log-rank P=0.073).CONCLUSION FAT cadherin family genes are frequently mutated in CRC,and their mutation profile defines a subtype of CRC with favorable clinicopathologic characteristics.

2D Co metal-organic framework nanosheet as an oxidase-like nanozyme for sensitive biomolecule monitoring

Nanozyme-based biomolecules sensitive and quantitative detection is an attractive strategy due to their high chemical,thermal stability and reactive activity.Here,we have synthesized a significant number of two-dimensional(2D)cobalt-metal-organic framework(Co-MOF)nanosheets with oxidase(OXD)-like activity using a facile solvothermal method in one pot for biomolecule monitoring.

A flexible electrochemical sensor for paracetamol based on porous honeycomb-like Ni Co-MOF nanosheets

The overdose of 4-aminophenol(AP) threatens human health,and the determination of AP is crucial.Here,we report a flexible electrochemical sensor for highly sensitive and precise determination of AP.The ultrathin honeycomblike NiCo-MOF nanosheets were in situ grown on freestanding flexible carbon cloth(CC) electrode.The porous structure among nanosheets and rich porosity of NiCoMOF shorten the transport path of electrolyte ions and reactants,ensuring fast electron transport.

Inflammatory bowel disease-and Barrett’s esophagus-associated neoplasia:the old,the new,and the persistent struggles

Early diagnosis of and adequate therapy for premalignant lesions in patients with inflammatory bowel disease(IBD)and Barrett’s esophagus(BE)has been shown to decrease mortality.Endoscopic examination with histologic evaluation of random and targeted biopsies remains the gold standard for early detection and adequate treatment of neoplasia in both these diseases.Although eventual patient management(including surveillance and treatment)depends upon a precise histologic assessment of the initial biopsy,accurately diagnosing and grading IBD-and BE-associated dysplasia is still considered challenging by many general as well as subspecialized pathologists.Additionally,there are continuing updates in the literature regarding the diagnosis,surveillance,and treatment of these disease entities.This comprehensive review discusses the cancer risk,detailed histopathological features,diagnostic challenges,and updates as well as the latest surveillance and treatment recommendations in IBD-and BE-associated dysplasia.

Risk factors for colorectal neoplasia in patients with underlying inflammatory bowel disease:a multicenter study

Background:This study sought to evaluate the risk factors for the development of colitis-associated neoplasia(CAN)in Chinese patients with inflammatory bowel disease(IBD).Methods:IBD patients who developed CAN between 1999 and 2016 were identified from eight medical centers.In addition to initial pathology evaluation,a CAN diagnosis was confirmed by two expert pathologists.Patients with CAN(n=29)were compared with non-CAN controls(n=87).Matching was performed for gender and IBD type with a ratio of three controls to one subject.Results:Of the 29 patients with CAN,8(27.6%)had colorectal cancer(CRC),20(69.0%)had a final diagnosis of low-grade dysplasia and 1(3.4%)had high-grade dysplasia.Multivariate analysis revealed that an older age at the time of IBD diagnosis and a longer IBD duration were independent risk factors for the development of CAN,with odds ratios of 1.09[95%confidence interval(CI):1.04–1.14,P<0.001]and 1.14(95%CI:1.03–1.27,P=0.013),respectively.Comparison between IBD patients with CRC and those with dysplasia indicated that the former were older at the time of IBD diagnosis(P=0.012)and had longer IBD durations(P=0.019).Conclusions:Older age at the time of IBD diagnosis and longer IBD duration were found to be associated with the development of CAN in IBD patients.