Evaluation of preoperative staging for esophageal squamous cell carcinoma

Esophageal squamous cell carcinoma(ESCC) is known for its rapid progression and poor outcomes. China has the highest incidence and mortality in the world. Diagnoses made at early stages and accurate staging are associated with better outcomes, all of which can play a significant role in the selection of treatment protocols. ESCC is staged according to the widely accepted TNM system. Common imaging modalities used in staging ESCC before treatment include endoscopy, computed tomography(CT), positron emission tomography(PET) and magnetic resonance imaging(MRI). Endoscopic ultrasound is useful for staging tumor depth and nodal status. Narrow band imaging is valuable for early stage disease assessment. CT and PET provide additional valuable information regarding node and metastasis staging. The ability of MRI to delineate ESCC is continuously being improved and adds information regarding locoregional status to routine examinations.

Primary intestinal non-Hodgkin's lymphoma:A clinicopathologic analysis of 81 patients

AIM:To analyze the clinicopathologic features and the prognosis of primary intestinal lymphoma.METHODS:Patients were included in the study based on standard diagnostic criteria for primary gastrointesti-nal lymphoma,and were treated at Sun Yat-sen Univer-sity Cancer Centre between 1993 and 2008.RESULTS:The study comprised 81 adults.The most common site was the ileocaecal region.Twenty-two point two percent patients had low-grade B-cell lym-phoma.Fifty-one point nine percent patients had high-grade B-cell lymphoma and 25.9% patients had T-cell lymphoma.Most patients had localized disease.There were more patients and more early stage diseases in the latter period,and the origin sites changed.The ma-jority of patients received the combined treatment,andabout 20% patients only received nonsurgical therapy.The wverall survival and event-free survival rates after 5 years were 71.6% and 60.9% respectively.The mul-tivariate analysis revealed that small intestine and ileo-caecal region localization,B-cell phenotype,and normal lactate dehydrogenase were independent prognostic factors for better patient survival.Surgery based treat-ment did not improve the survival rate.CONCLUSION:Refined stratification of the patients according to the prognostic variables may allow indi-vidualized treatment.Conservative treatment may be an optimal therapeutic modality for selected patients.

Managing esophageal fistulae by endoscopic transluminal drainage in esophageal cancer patients with superior mediastinal sepsis after esophagectomy

The management of postoperative leaks into the mediastinum after esophagectomy remains a challenge. We describe our clinical management of this complication through endoscopic transluminal drainage. Between 2008 and 2011, 4 patients with esophageal squamous cell carcinoma (ESCC) who underwent McKeown-type esophagectomy with two-field lymphadenectomy experienced complicated anastomotic fistulae in the presence of superior mediastinal sepsis. All 4 patients underwent endoscopic transluminal drainage, and all survived. The mean healing period was 50 days (range, 31 to 58 days), the mean stay in the intensive care unit was 7.3 days (range, 1 to 18 days), and the mean hospital stay was 64.5 days (range, 49 to 70 days). Endoscopically guided transluminal drainage should be considered for ESCC patients with superior mediastinal fistulae after esophagectomy.

Endoscopic ultrasonography for staging of T1a and T1b esophageal squamous cell carcinoma

AIM: To investigate the accuracy of Endoscopic ultrasound(EUS) in staging and sub-staging T1a and T1b esophageal squamous cell carcinoma(ESCC). METHODS: A retrospective analysis involving 72 patients with pathologically confirmed T1a or T1b ESCC, was undertaken between January 2005 and December 2011 in Sun Yat-sen University Cancer Center. The accuracy and efficiency of EUS for detecting stages T1a and T1b ESCC were examined. RESULTS: The overall accuracy of EUS for detecting stage T1a or T1b ESCC was 70.8%(51/72), and the sensitivity was 74.3%. 77.8%(7/9) of lesions originated in the upper thoracic region, 73.1%(38/52) in the mid-thoracic region and 72.7%(8/11) in the lower thoracic region. Multivariate analysis revealed that the diagnostic accuracy of EUS was closely related to lesion length(F = 4.984, P = 0.029). CONCLUSION: EUS demonstrated median degree of accuracy for distinguishing between stages T1a and T1b ESCC. Therefore, it is necessary to improve EUS for staging early ESCC.

鼻咽癌放疗后内镜超声引导下咽后淋巴结细针抽吸术:一种新型准确诊断技术

背景与目的鼻咽癌(nasopharyngeal carcinoma,NPC)患者接受放射治疗后普遍出现咽后淋巴结(retropharyngeal lymph nodes,RLNs)增大。病理学检查结果决定了对增大RLNs最佳治疗方案的选择。然而,在临床上RLN取样难度大。我们最近开发了一种内镜超声引导下细针抽吸(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)的新型微创技术,可取到足够的RLN组织用以病理学或细胞学诊断。方法纳入30例经核磁共振成像(magnetic resonance imaging,MRI)检测疑似放疗后出现RLN转移的NPC患者。EUS探头经鼻孔置入鼻咽,然后使用EUS扫描咽后间隙并在颈动脉鞘前定位RLN,随后进行EUS-FNA。对EUS-FNA法从RLN组织取样的安全性和有效性进行评估。结果采用EUS-FNA法成功地对所有患者进行了组织取样。在30例患者中,23例经1次EUS-FNA取样后通过病理学或细胞学检查确认了活检组织中存在癌细胞。有7例患者经1次EUS-FNA活检后未确认存在癌细胞,随后再次采用EUS-FNA活检重新分析,又有2例被确认存在癌细胞;另外5例未确认存在癌细胞的患者密切随访3个月,每月进行1次MRI。随访3个月后,3例患者由于RLNs直径保持稳定或减小而被认为未患肿瘤;剩余2例表现出疾病进展的患者进行了第3次EUS-FNA活检,进一步确认为癌细胞阳性。本文所报道的整个队列中,EUS-FNA过程无任何严重并发症发生。结论采用EUS-FNA法对疑似NPC复发患者的RLNs取样是一种安全有效的诊断方法。

External photon fields in Fermi bright blazars

The external Compton （EC） model is used to study the high energy emission of some blazars, in which the external photon field is considered to dominate inverse Compton radiation. We explore the properties of the external photon field through analyzing the FERMI LAT bright AGN sample within three months of the start of operations in sky-survey mode. In the sample, assuming the high energy radiation of low synchrotron peaked blazars is from the EC process, we find that the external photon parameter Uext/υext may not be a constant. Calculating synchrotron and inverse Compton luminosity from the quasi-simultaneous broadband spectral energy distributions, we find that they have an approximately linear relation. This indicates that the ratio of external photon and magnetic energy density is a constant in the comoving frame, implying that the Lorentz factor of the emitting blob depends on the external photon field and magnetic field. The result gives a strong constraint on the dynamic jet model.

Serum metabolic profiling of traditional Chinese medicine syndromes in patients with diarrhea-predominant irritable bowel syndrome

Objective:The clinical symptoms of diarrhea-predominant irritable bowel syndrome(IBS-D)can be effectively improved by traditional Chinese medicine(TCM)treatment,based on the usage of specific therapies for different TCM syndromes.However,in the stage of diagnosis,the standard criteria for the classification of TCM syndrome were still deficient.Through serum metabolic profiling,this study aimed to explore potential biomarkers in IBS-D patients with different TCM syndromes,which can assist in diagnosis of the disease.Methods:Serum samples were collected from healthy controls(30 cases),IBS-D patients with LiverStagnation and Spleen-Deficiency syndrome(LSSD,30 cases),Yang Deficiency of Spleen and Kidney syndrome(YDSK,11 cases)and Damp Abundance due to Spleen-Deficiency syndrome(DASD,22 cases).Serum metabolic profiling was conducted by ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry.The potential biomarkers were screened by orthogonal partial least square-discriminate analysis,while metabolic pathways undergoing alterations were identified by pathway enrichment analysis in Metabo Analyst 4.0.Results:Overall,34 potential biomarkers were identified in LSSD group,36 in YDSK group and 31 in DASD group.And the 13 metabolites shared by three groups were determined as the potential biomarkers of IBS-D.Glycerophospholipid metabolism was disturbed significantly in IBS-D patients,which may play a role in IBS-D through inflammation.What’s more,three TCM syndromes have the specific potential biomarkers in glycerophospholipid metabolism.Conclusion:The serum metabolomics revealed that different TCM syndrome types in IBS-D may have different metabolic patterns during disease progression and glycerophospholipid metabolism was one of the pathways,whose metabolism was disturbed differently among three TCM syndromes in IBS-D.Therefore,the specific potential biomarkers in glycerophospholipid metabolism of three TCM syndromes in IBS-D can serve as the objective indicators,which can facilitate the TCM-syndrome objective classification of IBS-D.

Ultrasound-guided fine needle aspiration of retropharyngeal lymph nodes after radiotherapy for nasopharyngeal carcinoma: a novel technique for accurate diagnosis

Background:Enlarged retropharyngeal lymph nodes(RLNs)are very common in patients with nasopharyngeal carcinoma(NPC)undergoing radiotherapy.The most suitable treatment option for enlarged RLNs depends on the pathological results.However,RLN sampling is difficult and imminent in the clinic setting.We recently developed a novel minimally invasive technique termed endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)for sam-pling RLN tissues sufficient for pathological or cytological diagnosis.Methods:We enrolled 30 post-radiotherapy patients with NPC with suspected RLN metastasis detected via mag-netic resonance imaging(MRI).The EUS probe was introduced into the nasopharynx via the nostrils,and EUS was then used to scan the retropharyngeal space and locate the RLN in the anterior carotid sheath.EUS-FNA was subsequently performed.The safety and efficacy of using EUS-FNA to sample the RLN tissues were assessed.Results:Strips of tissue were successfully sampled from all patients using EUS-FNA.Of the 30 patients,23 were confirmed to have cancer cells in the biopsied tissues via pathology or cytology examinations with 1 EUS-FNA biopsy session.The seven cases without confirmed cancer cells were subsequently reanalyzed by using another EUS-FNA biopsy session,and two more cases were confirmed possessing cancer cells.The other five patients without con-firmed cancer cells were closely followed with MRI every month for 3 months.After follow-up for 3 months,three patients were still considered cancer-free due to the presence of RLNs with stable or shrinking diameters.The rest two patients who showed progressive disease underwent a third EUS-FNA biopsy procedure and were further confirmed to be cancer cell-positive.In the whole cohort reported here,the EUS-FNA procedure was not associated with any severe complications.Conclusion:EUS-FNA is a safe and effective diagnostic approach for sampling tissues from the RLNs in patients with suspected recurrent NPC.