The Therapeutic Effects of Rehmannia Oral Liquid for the Syndrome of Heat Accumulation with Yin Consumption in Esophagus Cancer Patients Undergoing Radiotherapy——A Report of 60 Cases

Objective: To observe the clinical therapeutic effects of Rehmannia Oral Liquid on the syndrome of heat accumulation with Yin consumption in intermediate or late esophagus cancer patients undergoing radiotherapy. Methods: The IFN-α, TNF-α, IL-1β and TGF-β1 levels in sera were determined by the method of ABC-WLISA before and after the treatment with Rehmannia Oral Liquid. At the same time, the observation was carried out on the patient's general condition, symptoms and signs, barium meal or CT examinations, and biopsy. Another 30 cases of esophagus cancer were treated singly with radiotherapy as the control group. Results: Rehmannia Oral Liquid could obviously improve the patient's general condition, and the symptoms and signs after radiotherapy. Based on the X-ray examination and biopsy, the short-term local control rate of the treatment group and the control group was 70.0% and 40.0% respectively, showing a significant difference (P<0.05). Before the treatment, the level of serum IFN-α of both cancer groups was lower and the levels of TNF-α, IL-1β and TGF-β1 were higher than that of normal group. After treatment, the level of IFN-α in both treatment group and control group increased significantly (P<0.01), and the treatment group improved more obviously than the control group (P<0.05). The level of TNF-α of both groups decreased significantly (P<0.01) after treatment, and the level of IL-1β decreased in treatment group and increased in control group without the significant difference as compared with that before treatment. The level of TGF-β1 was significantly increased in control group (P<0.05) and decreased in treatment group (P>0.05) after treatment. The difference between groups was significant (P<0.05). Conclusion: Rehmannia Oral Liquid can obviously reduce the radiotherapy reaction, improve the quality of life, and raise the therapeutic effects. The action mechanism of the Liquid may lie in balancing the cytokine network and regulating the disordered signal transmission.

Is endoscopic ultrasound examination necessary in the management of esophageal cancer?

Despite substantial efforts at early diagnosis, accurate staging and advanced treatments, esophageal cancer(EC) continues to be an ominous disease worldwide. Risk factors for esophageal carcinomas include obesity, gastroesophageal reflux disease, hard-alcohol use and tobacco smoking. Five-year survival rates have improved from 5% to 20% since the 1970 s, the result of advances in diagnostic staging and treatment. As the most sensitive test for locoregional staging of EC, endoscopic ultrasound(EUS) influences the development of an optimal oncologic treatment plan for a significant minority of patients with early cancers, which appropriately balances the risks and benefits of surgery, chemotherapy and radiation. EUS is costly, and may not be available at all centers. Thus, the yield of EUS needs to be thoughtfully considered for each patient. Localized intramucosal cancers occasionally require endoscopic resection(ER) for histologic staging or treatment; EUS evaluation may detect suspicious lymph nodes prior to exposing the patient to the risks of ER. Although positron emission tomography(PET) has been increasingly utilized in staging EC, it may be unnecessary for clinical staging of early, localized EC and carries the risk of false-positive metastasis(over staging). In EC patients with evidence of advanced disease, EUS or PET may be used to define the radiotherapy field. Multimodality staging with EUS, crosssectional imaging and histopathologic analysis of ER, remains the standard-of-care in the evaluation of early esophageal cancers. Herein, published data regarding use of EUS for intramucosal, local, regional and metastatic esophageal cancers are reviewed. An algorithm to illustrate the current use of EUS at The University of Texas MD Anderson Cancer Center is presented.

DNMT3B 579 G>T promoter polymorphism and risk of esophagus carcinoma in Chinese

AIM:To investigate the relationship between 579 G>T polymorphisms in the DNMT3B gene, which is involved in de novo methylation and associated with the risk of esophagus cancer (EC) in Chinese. METHODS:DNMT3B 579 G>T genotypes were determined by PCR-RFLP in 194 EC patients and 210 healthy controls matched for age and sex, who did not receive radiotherapy or chemotherapy for newly diagnosed and histopathologically confirmed EC. RESULTS:In control subjects, the frequency of T/T and G/T genotypes, and T and G alleles was 81.4%, 18.1%, 90.05% and 9.55%, respectively. The distribution of genotypes and allelotypes in the EC patients was not significantly different from that in the controls. When stratified by sex and age, there was still no significant association between the risks of EC and GT and GG genotypes. This study also showed a distinct difference in the distribution of DNMT3B and single nucleotide polymorphism (SNP) between Chinese and Koreans.CONCLUSION:DNMT3B 579 G>T polymorphism may not be a stratification marker to predict the susceptibility to EC, at least in Chinese. DNMT3B promoter SNP is diverse in ethnic populations.

Induction chemotherapy with albumin-bound paclitaxel plus lobaplatin followed by concurrent radiochemotherapy for locally advanced esophageal cancer

BACKGROUND Albumin-bound paclitaxel(ABP)has been used as second-and higher-line treatments for advanced esophageal cancer,and its efficacy and safety have been well demonstrated.Lobaplatin(LBP)is a third-generation platinum antitumor agent;compared with the first two generations of platinum agents,it has lower toxicity and has been approved for the treatment of breast cancer,small cell lung cancer,and chronic granulocytic leukemia.However,its role in the treatment of esophageal cancer warrants further investigations.AIM To investigate the efficacy and safety of induction chemotherapy with ABP plus LBP followed by concurrent radiochemotherapy(RCT)for locally advanced esophageal cancer.METHODS Patients with pathologically confirmed advanced esophageal squamous cell carcinoma(ESCC)at our hospital were enrolled in this study.All patients were treated with two cycles of induction chemotherapy with ABP plus LBP followed by concurrent RCT:ABP 250 mg/m^(2),ivgtt,30 min,d1,every 3 wk;and LBP,30 mg/m^(2),ivgtt,2 h,d1,every 3 wk.A total of four cycles were scheduled.The dose of the concurrent radiotherapy was 56-60 Gy/28-30 fractions,1.8-2.0 Gy/fraction,and 5 fractions/wk.RESULTS A total of 29 patients were included,and 26 of them completed the treatment protocol.After the induction chemotherapy,the objective response rate(ORR)was 61.54%,the disease control rate(DCR)was 88.46%,and the progressive disease(PD)rate was 11.54%;after the concurrent RCT,the ORR was 76.92%,the DCR was 88.46%,and the PD rate was 11.54%.The median progression-free survival was 11.1 mo and the median overall survival was 15.83 mo.Cox multivariate analysis revealed that two cycles of induction chemotherapy followed by concurrent RCT significantly reduced the risk of PD compared with two cycles of chemotherapy alone(P=0.0024).Non-hematologic toxicities were tolerable,and the only grade 3 non-hematologic toxicity was radiation-induced esophagitis(13.79%).The main hematologic toxicity was neutropenia,and no grade 4 adverse event occurred.CONCLUSION Induction chemotherapy with ABP plus LBP followed by concurrent RCT is effective in patients with locally advanced ESCC,with mild adverse effects.Thus,this protocol is worthy of clinical promotion and application.

Meta-analysis of Barrett's esophagus in China

AIM: To investigate the epidemiology and characteristics of Barrett&#x02019;s esophagus (BE) in China and compare with cases in the west.

Artificial intelligence for cancer detection in upper gastrointestinal endoscopy, current status, and future aspirations

This minireview discusses the benefits and pitfalls of machine learning,and artificial intelligence in upper gastrointestinal endoscopy for the detection and characterization of neoplasms.We have reviewed the literature for relevant publications on the topic using PubMed,IEEE,Science Direct,and Google Scholar databases.We discussed the phases of machine learning and the importance of advanced imaging techniques in upper gastrointestinal endoscopy and its association with artificial intelligence.

Confocal Laser Endomicroscopy in the Field of Esophageal Diseases

Confocal laser endomicroscopy (CLE) is a new endoscopic imaging technology that allows real-time, high-resolution observation of tomographic images of mucosal cells and subcellular levels in vivo, detecting microscopic structural changes in mucosal morphology, and its in vivo immediate pathological diagnostic capability can avoid delays in mucosal pathological diagnosis and reduce the pain caused by repeated biopsies. CLE is known as “optical biopsy” and compared with other endoscopic techniques, it has obvious advantages. CLE systems include probe-based confocal laser endomicroscopy (pCLE) and endoscope-based confocal laser endomicroscopy (eCLE). Since 2006, CLE has been widely used for the evaluation of various lesions in the digestive system, including esophageal, gastric, and colonic neoplasia, pancreatic cysts and solid lesions, and inflammatory bowel disease. The advent of CLE has made in vivo microscopic imaging possible, which has changed the endoscopic screening and diagnosis of multiple gastrointestinal (GI) lesions. However, the value of its use in GI diseases is still controversial. In this review, we focus on the application of CLE in the field of esophageal diseases.

A new approach to endoscopic treatment of tumors of the esophagogastric junction with individually designed self-expanding metal stents

The incidence of adenocarcinoma of the esophago-gastric junction is constantly increasing. Curative treatment is no longer possible at the time of diagnosis in more than 50% of patients with esophageal carcinoma,and palliative treatment focusing on eliminating dysphagia is required. Endoscopic therapy with stent implantation is an established method of achieving this. It can be carried out quickly,with a low rate of early complications,and leads to fast symptomatic improvement,assessed using the dysphagia score. The relatively high rate of late complications such as stent migration,hemorrhage,and gastroesophageal mucosal prolapse has led to recent debate on the role of metal stents in palliative therapy. We present here a new type of stent design for transcardial application,which is intended to prevent bleeding due to mechanical mucosal lesions caused by the distal end of the stent extending into the stomach. The further intention of this case report is to force the discussion on individually designed nitinol stents in special anatomic conditions.

Clinical Research Regarding the Ratio of Lymph Node Metastasis and the Reasonable Extent of Lymphadenectomy in Middle Third Thoracic Esophageal Squamous Cell Carcinoma

OBJECTIVE To explore the extent of lymphadenectomy deemed reasonable by analyzing the influence of the regular pattern and ratio of lymph node metastasis on the prognosis of the patients with middle third thoracic esophageal squamous cell carcinoma. METHODS Clinical data from 129 patients with middle third thoracic esophageal squamous cell carcinoma who underwent curative esophagectomy with modem two-field lymphadenectomy were retrospectively analyzed. RESULTS The rate of lymphatic metastasis in EC patients was 56.6% in all groups, and the ratio of lymph node metastasis （RLNM, i.e. positive nodes/total dissected nodes） was 11.3%, with a lymphatic metastasis rate of 43.4% in the superior mediastinum. The most commonly involved regions included the sites around the esophagus, the right recurrent laryngeal nerve and the left- sided blood vessels of stomach, as well as the cardia and the inferior tracheal protuberance. The main factors influencing lymphatic metastasis were the depth of tumor infiltration, differentiation of tumor cells and the size of the tumor. The 5-year survival rate for patients in the groups without lymphatic metastasis, with a RLNM 〈 20%, and a metastasis ratio 〉 20% was 50.4%, 31.0% and 6.8%, respectively. The differences were statistically significant among the groups （P = 0.000）. CONCLUSION The RLNM is one of the key factors affecting the prognosis of EC patients. For conventional therapy for patients with middle third thoracic esophageal carcinoma, modern 2-field lymphadenectomy, including node dissection in the bilateral superior mediastinum, should be performed.

Carcinoma of the gastroesophageal junction in Chinese patients

Carcinoma of the gastroesophageal junction(GEJ) is defined as carcinoma that crosses the GEJ line,irrespective of where the tumor epicenter is located.This group of cancer is rare but controversial.Based on study results from the majority of epidemiologic and clinicopathologic investigations carried out in Western countries,this cancer is believed to arise from Barrett's esophagus(BE) and includes both distal esophageal and proximal gastric carcinomas because of similar characteristics in epidemiology,clinicopathology,and molecular pathobiology in relation to BE.As such,the most recent American Joint Committee on Cancer staging manual requires staging all GEJ carcinomas with the rule for esophageal adenocarcinoma(EA).This mandate has been challenged recently by the data from several studies carried out mainly in Chinese patients.The emerging evidence derivedfrom those studies suggests:(1) both BE and EA are uncommon in the Chinese population;(2) almost all GEJ cancers in Chinese arise in the proximal stomach and show the features of proximal gastric cancer,not those of EA;(3) application of the new cancer staging rule to GEJ cancer of Chinese patients cannot stratify patients' prognosis effectively;and(4) prognostic factors of GEJ cancer in Chinese are similar,but not identical,to those of EA.In conclusion,the recent evidence suggests that GEJ cancer in Chinese shows distinct clinicopathologic characteristics that are different from EA.Further investigations in molecular pathology may help illustrate the underlying pathogenesis mechanisms of this cancer in Chinese patients and better manage patients with this fatal disease.

LARYNGOTRACHEAL FLAP FOR RECONSTRUCTION OF HYPOPHARYNX AND UPPER ESOPHAGUS AFTER RESECTION OF ADVANCED PYRIFORM SINUS CANCER

Reconstruction of the hypopharynx and upper esophagus after resection of advanced pyriform sinus cancer. is usually complicated and time-consuming. Laryngotracheal flap was used in hypopharyngaesophageal reconstruction for 26 elderly patients with advanced pyriform sinus cancer Pharyngocutaneous fistula developed in 5 patients and healed spontaneously without further surgery. Full diet was resumed in all the patients. The surgical technique and its advantages and disadvantages are discussed. The laryngotracheal flap in the reconstruction of hypopharyngoesophageal defect for elderly patients is a procedure of choice.

Burden of six major types of digestive system cancers globally and in China

Background:Digestive system cancers constitute a significant number of cancer cases,but their burden is not uniform.As Global Cancer Observatory(GLOBOCAN)2022 has recently updated its estimates of cancer burden,we aimed to investigate the burden of six major digestive system cancers both worldwide and in China,along with geographical and temporal variations in cancer-specific incidence and mortality.Methods:We extracted data on primary cancers of the esophagus,stomach,colorectum,liver,pancreas,and gallbladder from the GLOBOCAN database for 2022.Age-standardized incidence and mortality rates were calculated and stratified by sex,country,region,and human development index(HDI).We used the 2022 revision of the World Population Prospects(United Nations)to obtain demographic data for various age groups in China from 1988 to 2012 and used the joinpoint model and the average annual percentage change(AAPC)to analyze cancer incidence trends in China.Results:In 2022,the estimated global incidence of digestive system cancers reached 4,905,882,with an estimated 3,324,774 cancer-related deaths.Colorectal cancer was most prevalent in terms of incidence and mortality.There was a significant correlation between the burden of gastrointestinal cancers and country HDI.From 1988 to 2012,the incidence of esophageal,gastric,and liver cancers declined in China,whereas colorectal and pancreatic cancer incidences continued to increase.By 2050,colorectal and liver cancers are projected to remain the leading cancer types in China in terms of incidence and mortality,respectively.Conclusions:Digestive system cancers remain a significant public health challenge globally and in China.Although progress has been made in the prevention and control of some cancers,the burden of digestive system cancers persists.The implementation of tertiary prevention strategies must be intensified to reduce the incidence and mortality of digestive system cancers,mitigating their impact on public health.

Pyonex in treatment of 23 patients with delayed gastric emptying after esophagectomy

Objective To evaluate the effect of Pyonex in treatment of patients with delayed gastric emptying after esophagectomy.Methods Twenty-three patients were treated with Pyonex at Pishu（脾俞 BL 20,bilateral）,Weishu（胃俞 BL 21,bilateral）,Neiguan（内关 PC 6）,Zusanli（足三里 ST 36）,Sanyinjiao（三阴交 SP 6） and Shidao（食道 CO 2） on the basis of conventional treatment.The pyonexs were changed every four days,and change for five times was considered as one course of treatment.The efficacy was evaluated after treatment for one course.Results One patient was cured after treatment for one time,with the effective rate of 4.4%;two patients were cured after treatment for two times,with the effective rate of 8.7%;ten patients were cured after treatment for three times,with the effective rate of 44.5%;seven patients were cured after treatment for four times,with the effective rate of30.4%;and three patients were cured after treatment for five times,with the effective rate of 13.0%.23 patients were cured after treatment for five times,with the total effective rate of 100%.Conclusion Pyonex has sound effect in treatment of patients with delayed gastric emptying after esophagectomy.