Clinical features and prognostic factors of duodenal neuroendocrine tumours:A comparative study of ampullary and nonampullary regions

BACKGROUND Duodenal neuroendocrine tumours(DNETs)are rare neoplasms.However,the incidence of DNETs has been increasing in recent years,especially as an incidental finding during endoscopic studies.Regrettably,there is no consensus regarding the ideal treatment of DNETs.Even there are few studies on the clinical features and survival analysis of DNETs.AIM To analyze the clinical characteristics and prognostic factors of patients with duodenal neuroendocrine tumours.METHODS The clinical data of DNETs diagnosed in the First Affiliated Hospital of Air Force Military Medical University from June 2011 to July 2022 were collected.Neuroen-docrine tumours located in the ampulla area of the duodenum were divided into the ampullary region group;neuroendocrine tumours in any part of the duo-denum outside the ampullary area were divided into the nonampullary region group.Using a retrospective study,the clinical characteristics of the two groups and risk factors affecting the survival of DNET patients were analysed.RESULTS Twenty-nine DNET patients were screened.The male to female ratio was 1:1.9,and females comprised the majority.The ampullary region group accounted for 24.1%(7/29),while the nonampullary region group accounted for 75.9%(22/29).When diagnosed,the clinical symptoms of the ampullary region group were mainly abdominal pain(85.7%),while those of the nonampullary region groups were mainly abdominal distension(59.1%).There were differences in the composition of staging of tumours between the two groups(Fisher's exact probability method,P=0.001),with nonampullary stage II tumours(68.2%)being the main stage(P<0.05).After the diagnosis of DNETs,the survival rate of the ampullary region group was 14.3%(1/7),which was lower than that of 72.7%(16/22)in the nonampullary region group(Fisher's exact probability method,P=0.011).The survival time of the ampullary region group was shorter than that of the nonampullary region group(P<0.000).The median survival time of the ampullary region group was 10.0 months and that of the nonampullary region group was 451.0 months.Multivariate analysis showed that tumours in the ampulla region and no surgical treatment after diagnosis were independent risk factors for the survival of DNET patients(HR=0.029,95%CI 0.004-0.199,P<0.000;HR=12.609,95%CI:2.889-55.037,P=0.001).Further analysis of nonampullary DNET patients showed that the survival time of patients with a tumour diameter<2 cm was longer than that of patients with a tumour diameter≥2 cm(t=7.243,P=0.048).As of follow-up,6 patients who died of nonampullary DNETs had a tumour diameter that was≥2 cm,and 3 patients in stage IV had liver metastasis.Patients with a tumour diameter<2 cm underwent surgical treatment,and all survived after surgery.CONCLUSION Surgical treatment is a protective factor for prolonging the survival of DNET patients.Compared to DNETs in the ampullary region,patients in the nonampullary region group had a longer survival period.The liver is the organ most susceptible to distant metastasis of nonampullary DNETs.

Increased Prevalence of Thyroid Nodules Across Nearly 10 Years in Shanghai,China

Objective This study aimed to determine whether the prevalence of thyroid nodules(TNs)increased due to modern lifestyles or other factors,despite the advances in screening and diagnostic tools.Methods This study included 3474 pairs of participants,who were matched by gender and age(±3 years)from two cross-sectional sampling surveys:(1)the program on the iodine nutritional status and related health status of residents in Shanghai in 2009;(2)the thyroid disease screening program for adults in Shanghai between 2017 and 2018.The prevalence of TNs and thyroid diseases in 2009 and 2017–2018 were compared,and the potential risk factors of TNs were detected.Results The prevalence of TNs in 2009 was 28.9%:22.5%in males and 34.5%in females.In 2017,this increased to 43.8%:37.9%in males and 49.1%in females.The prevalence of TNs significantly increased from 2009 to 2017(odds ratio,1.486;95%confidence interval,1.238–1.786).In addition,female gender,thyroid disease history,and age were the main risk factors for TNs after adjusting for confounders in the logistic regression across the time period.Conclusion The prevalence of TNs significantly increased across nearly 10 years in Shanghai.

Expression and function of classical protein kinase C isoenzymes in gastric cancer cell line and its drugresistant sublines

AIM: To investigate the expression and function of classicalprotein kinase C (PKC) isoenzymes in inducing MDRphenotype in gastric cancer cells.METHODS: Two cell lines were used in the study: gastriccancer cell SGC7901 and its drug-resistant cell SGC7901/VCRstepwise-selected by vincristine 0.3, 0. 7 and 1.0 mg@ L-1 ,respectively. The expression of classical PKC (cPKC)isoenzymes in SGC7901 cells and SGC7901/VCR cells weredetected using immunofluorescent cytochemistry, laserconfocal scanning microscope and Wsstern blot. The effectsof anti-PKC isoenzymes antibody of adriamycinaccumulation in SGC7901/VCR cells were determined usingflow cytometric analysis.RESULTS: (1) SGC7901 cells exhibited positive staining ofPKC-α. SGC7901/VCR cells exhibited stronger staining ofPKC-α than SGC7901 cells. The higher dosage vincristineselected, the much stronger staining of PKC-α was observedon SGC7901/VCR cells. (2) Both SGC7901 and SGC7901/VCRcells exhibited positive staining of PKC-βⅠ and PKC-βⅡ withno significant difference. ( 3 ) Compared with SGC7901,SGC7901/VCR cells had decreased adriamycin accumulationand retention. Accumulation of adriamycin in SGC7901 was5.21 + 2.56 mg@ L-1, in SGC7901/VCR 0.3 was 0.85 + 0.29 mg@L-1 , in SGC7901/VCR 0.7 was 0.81 + 0.32 og@ L-1 , and inSGC7901NCR 1.0 was 0.80 + 0.33 mg @ L-1; Retention ofadriamycin in SGC 7901 was 2.51 + 1.23 mg@L-1, in SGC7901/VCR 0.3 was 0.47 + 0.14 mg@ L-1 , in SGC7901/VCR 0.7 was 0.44 + 0.15 mg@ L-1, and in SGC 7901/VCR 1.0 was 0.41 + 0.1 1mg @ L-1 . (4) Fluorescence intensity presented adriamycinaccumulation in SGC7901/VCR cells was increased from 1.14+0.36 to 2.71 +0.94 when cells were co-incubated with anti-PKC-αbut not with anti-PKC-βⅠ, PKC-βⅡ and PKCγ antibodies.CONCLUSION: PKC-α, but not PKC-βⅠ, PKC-βⅡ or PKCγ,may play a role in multidrug resistance of gastric cancercells SGC7901/VCR.

Lamb’s tripe extract and vitamin B12 capsule plus celecoxib reverses intestinal metaplasia and atrophy:A retrospective cohort study

BACKGROUND Chronic atrophic gastritis(AG)with intestinal metaplasia(IM)significantly increases the risk of gastric cancer.Some medicines have showed definite therapeutic effects in AG and IM regression.AIM To validate the efficacy of Lamb’s tripe extract and vitamin B12 capsule(LTEVB12)initial therapy and celecoxib rescue therapy for IM and AG.METHODS A total of 255 patients were included to receive LTEVB12 initial therapy(2 capsules each time,three times daily for 6 mo)in hospital in this study.The patients with failure of IM regression continued to receive celecoxib rescue therapy(200 mg,once daily for 6 mo).After each therapy finished,the patients underwent endoscopy and biopsy examination.The regression efficiency was assessed by the operative link on gastritis assessment(OLGA)and the operative link on the gastric intestinal metaplasia assessment(OLGIM)staging system.Logistic regression analysis was applied to identify factors associated with the curative effect.RESULTS For LTEVB12 initial therapy,the reversal rates of IM and AG were 52.95%and 48.24%,respectively.Analogously,for celecoxib rescue therapy,the effective rates for IM and AG were 56.25%and 51.56%,respectively.The IM regression rate of complete therapy was up to 85.03%.In different OLGA and OLGIM stages of IM patients,therapeutic efficiency showed a significant difference in each group(P<0.05).For both therapies,patients with high stages(III or IV)of both the OLGA and OLGIM evaluation systems showed a higher IM or AG regression rate than those with low stages(I or II).Among patients with high stages(OLGIM III and IV),the IM regression rate was above 70%for each therapy.Eating habits,fresh vegetable intake,and high-salt diet were identified as independent factors for the IM reversal effect of LTEVB12 therapy,especially high-salt diet(odds ratio=1.852,P<0.05).CONCLUSION Monotherapy could reverse IM and AG.LTEVB12 initial therapy and celecoxib rescue therapy significantly increase the regression effect.IM may not be the point of no return among gastric precancerous lesions.

Recent advances of miRNAs in the development and clinical application of gastric cancer

Gastric cancer(GC)is one of the most common malignant tumors.The mechanism of how GC develops is vague,and therapies are inefficient.The function of microRNAs(miRNAs)in tumorigenesis has attracted the attention from many scientists.During the development of GC,miRNAs function in the regulation of different phenotypes,such as proliferation,apoptosis,invasion and metastasis,drug sensitivity and resistance,and stem-cell-like properties.MiRNAs were evaluated for use in diagnostic and prognostic predictions and exhibited considerable accuracy.Although many problems exist for the application of therapy,current studies showed the antitumor effects of miRNAs.This paper reviews recent advances in miRNA mechanisms in the development of GC and the potential use of miRNAs in the diagnosis and treatment of GC.

The presence of NAFLD in nonobese subjects increased the risk of metabolic abnormalities than obese subjects without NAFLD:a population-based cross-sectional study

Background:With lifestyle modification and over-nutrition,the prevalence of nonalcoholic fatty liver disease(NAFLD)has been increasing annually.Here we aimed to assess the updated prevalence of NAFLD,and to evaluate the association of NAFLD with metabolic abnormalities according to gender,body mass index and age.Methods:A population-based cross-sectional study was conducted in Shanghai from December 2016 to July 2017.With a three-stage stratified sampling strategy,3,717 eligible participants were enrolled for the analysis.Results:In total,1,217 subjects(32.7%)had NAFLD.Among them,400(16.3%)of the nonobese and 817(65.0%)of the obese subjects had NAFLD.The prevalence of NAFLD was increased according to the quartiles of age and waist circumference(WC)in the nonobese subjects.Females with nonobese NAFLD had 1.6-,2.6-,2.0-,2.3-and 3.3-fold higher risks for metabolic syndrome,diabetes mellitus,hyperglycemia,hypertriglycerdemia(high TG)and low high-density lipoprotein cholesterol than obese subjects without NAFLD,respectively.Males had comparable metabolic profiles in both groups,except for a 2.0-fold higher risk of high TG in nonobese NAFLD subjects compared with obese subjects without NAFLD.More impressively,the homeostasis metabolic assessment insulin resistance index was comparable between the two groups.Conclusions:The increase of age and WC had significant impact on the risk of NAFLD in nonobese subjects.The presence of NAFLD in nonobese subjects increased the risk of metabolic diseases than obese subjects without NAFLD,especially in female.

Is intestinal metaplasia the point of no return in the progression of gastric carcinogenesis?

Gastric cancer(GC)is one of the most common malignant tumors worldwide.In China,GC is the second most common malignant tumor,and it is the second leading cause of cancer mortality.[1]Correa model showed that the development of intestinal-type GC was a consecutive cancerous process including normal gastric mucosa,non-atrophic gastritis,atrophic gastritis(AG),intestinal metaplasia(IM),dysplasia and intestinal-type GC in sequence.[2]Epithelium-resembling intestinal morphology replaced gastric mucosa which was defined as IM.[3]Among these precancerous conditions,IM was demonstrated to be a vital risk factor for GC,especially incomplete IM and extensive IM.[4,5].