Biomarkers and potential pathogenesis of colorectal cancer-related ischemic stroke

AIM To investigate the specific biomarkers and potential pathogenesis of colorectal cancer-related ischemic stroke(CRCIS).METHODS A retrospective study was conducted on CRCIS patients(colorectal cancer patients with ischemic stroke without conventional stroke risk factors) registered at seven centers between January 2007 and December 2017. Clinical data and laboratory and imaging findings were compared with age-and sex-matched patients with colorectal cancer(CRC) without ischemic stroke that were admitted to the same hospital during the same period. Univariate and multivariate analyses were performed to analyze the independent risk factors for CRCIS. A receiver operator characteristic curve was configured to calculate the optimal cut-off value of the products of the independent risk factors for CRCIS. RESULTS A total of 114 CRCIS patients and 114 CRC patients were included. Multiple lesions in multiple vascular territories were common in CRCIS patients(71, 62.28%). The levels of plasma D-dimer, carcinoembryonic antigen(CEA), cancer antigen 125, and neutrophil count were significantly higher in CRCIS patients than in CRC patients. Multiple logistic regression analysis revealed that plasma D-dimer levels [odds ratio(OR) = 1.002, 95% confidence interval(CI): 1.001-1.003, P < 0.001], CEA levels(OR = 1.011, 95%CI: 1.006-1.015, P < 0.001), and neutrophil count levels(OR = 1.626, 95%CI: 1.268-2.087, P < 0.001) were independent risk factors for CRCIS. In addition, receiver operator characteristic curve revealed that the area under curve for the products of plasma D-dimer, CEA, and neutrophil count was 0.889 ± 0.022(95%CI: 0.847-0.932, P < 0.001), and the optimal cut-off value for the product was 252.06, which was called the CRCIS Index, with a sensitivity of 86.0% and specificity of 79.8%.CONCLUSION Hypercoagulability induced by elevated CEA and neutrophils may be an important cause of CRCIS. The CRCIS index, which serves as a biomarker of CRCIS, needs further study.

Early prevention and treatment of biliary tract complications after orthotopic liver transplantation

OBJECTIVE: To investigate the prevention and treatment of biliary complications after orthotopic liver transplantation (OLT). METHODS: OLT was performed in 18 patients with end-stage liver disease, including 6 patients with primary liver cancer. Except 1 patient was infused only through the portal vein, others were infused through the portal vein and hepatic artery of the donor. The biliary tract was reconstructed using choledochocholedostomic anastomosis in 17 patients, and using Roux-en-Y choledochojejunostomic anastomosis in 1 patient. RESULTS: Four patients with biliary complication were found. In one patient, biliary leakage was found around the T-tube on day 14 postoperatively, and disappeared after re-opening of the tube. In one patient undergoing Roux-en-Y choledochojejunostomic anastomosis, biliary leakage was found on day 12 postoperatively and reoperation was performed. The T-tube was removed from the anastomosis after reoperation, and abdominal infection was controlled, but high fever recurred on day 49 postoperatively. The patient died on day 52 postoperatively. Autopsy revealed biliary leakage and biliary tract necrosis. In another patient, biliary leakage was found on day 3 after operation, and was treated by adequate drainage. Four months after operation, biliary sludge in the common tract was found and treated successfully with oral chemolysis. But biliary sludge or stone recur on one and half year after OLT. Spincterotomy and basket extraction were performed via endoscopic retrograde cholangiopancreatography, and the biliary sludge or stone was cleared out. In case 4, biliary drainage tube cholangiogram showed anastomotic stenosis one month after operation. Three months later, biliary sludge or stone was found beyond anastomotic stenosis. After oral chemolysis (ursodeoxycholic acid) and irrigation with heparinized saline solution via the biliary drainage tube, the biliary sludge disappeared. CONCLUSIONS: To reduce the incidence of biliary complications, adequate infusion of the hepatic artery, complete slushing of the biliary tract, and reduction of injury to the blood supply of the donor biliary tract are essential. Most biliary complications can be treated successfully by non-operative treatment or minimally invasive operation.

Effect of dietary fatty acids on serum parameters,fatty acid compositions,and liver histology in Shaoxing laying ducks

The effects of different fatty acid(FA) contents in diet on serum parameters,FA compositions of eggs and meat,and liver morphological changes were studied in Shaoxing laying ducks.A total of 264 ducks at 17 weeks were fed a control diet or a diet containing 30 g/kg fish oil(FO),25 g/kg sunflower oil(SO),or 30 g/kg palm oil with 20 g/kg beef tallow(PBO).Malondialdehyde(MDA) content in the liver and the serum of ducks fed the PBO diet was significantly(P<0.05) higher than that of ducks fed the other diets.Triglyceride(TG) and total cholesterol(TC) levels were significantly lower(P<0.05) in ducks fed the FO diet.Serum TC also was lower in ducks fed the SO diet.Superoxide dismutase(SOD) activity was also affected by diets.The contents of polyunsaturated FAs(PUFAs) in eggs and meat were significantly higher(P<0.001) in ducks fed the FO and SO diets than in ducks fed the control diet.The level of C22:6(n-3) FA in ducks fed the FO diet was significantly higher than that in ducks fed the other diets.However,the conversion efficiency of the longer-chain C20:5(n-3) FA was higher than that of C22:6(n-3).Ducks fed the PBO diet exhibited lipid droplet accumulation in the liver.These results demonstrate that a diet enriched with different FAs has strong effects on serum lipid levels and the deposition of PUFAs into tissue lipids.