Analysis of sleep quality,disease uncertainty,and psychological tolerance in patients undergoing chemotherapy for digestive tract malignancies

BACKGROUND Colorectal cancer is the second leading cause of cancer-related deaths among digestive tract malignancies,following gastric cancer.Sleep is of great significance for maintaining human health.The incidence of sleep disorders in patients with cancer is approximately twice that observed in the general population.Lack of sleep can prolong hospital stays,increase the likelihood of infection,and increase mortality rates.Therefore,studying the factors related to sleep quality is significant for improving the quality of life of patients with malignant tumors of the digestive tract.AIM To investigate the relationships among sleep quality,disease uncertainty,and psychological resilience in patients undergoing chemotherapy for digestive tract malignancies.METHODS A total of 131 patients with malignant digestive tract tumors who were treated at Hefei BOE Hospital between April 2021 and September 2022 were selected as research participants.Based on their Pittsburgh Sleep Quality Index(PSQI)scores,participants were divided into either the sleep disorder group(PSQI score>7)or the normal sleep group(PSQI score≤7).The clinical data—together with the Mishel Uncertainty in Illness Scale for Adults(MUIS-A)and Connor-Davidson Resilience Scale(CD-RISC)scores—were compared.RESULTS In this study,78(59.54%)patients with digestive tract malignancies developed sleep disorders after chemotherapy.Sleep disorder incidence was higher in patients with colorectal cancer than in those with gastric and esophageal cancers(P<0.05).The total MUIS-A score and those for each item in the sleep disorder group were higher than those in the normal sleep group.The total CD-RISC score and those for each item in the sleep disorder group were lower than those in the normal sleep group(P<0.05).The PSQI scores of patients with malignant digestive tract tumors were positively correlated with the scores for lack of disease information,disease uncertainty,and unpredictability in the MUIS-A and negatively correlated with the scores for tenacity,self-improvement,and optimism in the CD-RISC(P<0.05).CONCLUSION Patients undergoing chemotherapy for digestive tract malignancies are prone to sleep problems related to disease uncertainty and psychological resilience.Therefore,interventions can be implemented to improve their sleep quality.

Analysis of load status and management strategies of main caregivers of patients with malignant tumors of digestive tract

Caregiver load refers to the subjective and objective negative impact of caregivers in the care of patients,and excessive load will have a serious impact on patients and caregivers themselves and can reduce their quality of life.For the main caregivers,it not only needs to care for the patients in life and daily life,but also needs to pay the cost of treatment for the patients,coupled with the need to carry out their own original work,life,etc.excessive life pressure,economic pressure,work pressure,emotional pressure,etc.lead to heavy load of the main caregivers,which can easily cause caregivers to have different degrees of psychological problems,which will cause serious adverse effects on the caregivers themselves and cancer patients,not conducive to the construction of a harmonious family and society.This article analyzes the current situation of primary caregiver burden in patients with gastrointestinal malignant tumors,analyzes its influencing factors,and specifies specific treatment strategies.It is hoped to provide scientific guidance for later related research and application.

Prevention of malignant digestive system tumors should focus on the control of chronic inflammation

Chronic inflammation,through a variety of mechanisms,plays a key role in the occurrence and development of digestive system malignant tumors(DSMTs).In this study,we feature and provide a comprehensive understanding of DSMT prevention strategies based on preventing or controlling chronic inflammation.The development and evaluation of cancer prevention strategies is a longstanding process.Cancer prevention,especially in the early stage of life,should be emphasized throughout the whole life course.Issues such as the time interval for colon cancer screening,the development of direct-acting antiviral drugs for liver cancer,and the Helicobacter pylori vaccine all need to be explored in long-term,large-scale experiments in the future.

Clinical analysis of multiple primary gastrointestinal malignant tumors:A 10-year case review of a single-center

BACKGROUND Multiple primary malignant tumors(MPMTs)was first described by Billroth as early as 1889,with the first report published by Warren and Gates in 1932.Since then,numerous cases have been reported.A literature review of 1104269 patients with cancer revealed that the incidence of MPMTs ranged from 0.73 to 11.7%.In recent years,however,there has been a significant upward trend in the incidence of this phenomenon,which may be associated with many different factors,including the advancement of modern diagnostic procedures facilitating the examination and diagnosis of more MPMTs,increased exposure to chemotherapy and radiotherapy that exacerbate the risk of new malignant tumors in patients with cancer,and prolonged survival of patients with cancer allowing sufficient time for the development of new primary cancers.AIM To analyze the incidence,clinical features,treatment factors,prevalence,and prognosis of patients with MPMTs in the gastrointestinal tract treated in a single center.Additionally,we analyzed the different tumor combinations,time interval between the occurrence of tumors,and staging.METHODS This retrospective cohort study analyzed 8059 patients with pathologically confirmed gastrointestinal malignant tumors treated at the Gansu Province Hospital in Lanzhou,Gansu,China between June 2011 and June 2020.Of these,85 patients had MPMTs.The clinical features,treatment factors,prevalence,and prognosis of this latter cohort were analyzed.RESULTS The incidence of MPMTs in patients with gastrointestinal malignant tumors was 1.05%(85/8059),including 83 double primary malignant tumors and two triple primary malignant tumors of which 57(67.06%)were synchronous MPMTs(SMPMTs)and 28(32.94%)were metachronous MPMTs(MMPMTs).The most frequent associations were found between the rectum colon cancers within the SMPMT category and the gastric-colon cancers within the MMPMT category.For the MMPMTs,the median interval was 53 months.The overall 1-,3-and 5-year survival rates from diagnosis of the first primary cancer were 91.36%,65.41%,and 45.97%,respectively;those from diagnosis of the second primary cancer were 67.90%,29.90%,and 17.37%,respectively.CONCLUSION MPMTs in the gastrointestinal tract have a high incidence and poor prognosis.Thus,it is necessary to perform both gastroscopy and colonoscopy in patients with gastrointestinal tumors.Multidisciplinary comprehensive diagnosis and treatment may improve the diagnosis rate and treatment efficiency of MPMTs.

Role of tumor-associated macrophages in common digestive system malignant tumors

Many digestive system malignant tumors are characterized by high incidence and mortality rate.Increasing evidence has revealed that the tumor microenvironment(TME)is involved in cancer initiation and tumor progression.Tumor-associated macrophages(TAMs)are a predominant constituent of the TME,and participate in the regulation of various biological behaviors and influence the prognosis of digestive system cancer.TAMs can be mainly classified into the antitumor M1 phenotype and protumor M2 phenotype.The latter especially are crucial drivers of tumor invasion,growth,angiogenesis,metastasis,immunosuppression,and resistance to therapy.TAMs are of importance in the occurrence,development,diagnosis,prognosis,and treatment of common digestive system malignant tumors.In this review,we summarize the role of TAMs in common digestive system malignant tumors,including esophageal,gastric,colorectal,pancreatic and liver cancers.How TAMs promote the development of tumors,and how they act as potential therapeutic targets and their clinical applications are also described.

Tumor circulome in the liquid biopsies for digestive tract cancer diagnosis and prognosis

Digestive tract cancer is one of the main diseases that endanger human health.At present,the early diagnosis of digestive tract tumors mainly depends on serology,imaging,endoscopy,and so on.Although tissue specimens are the gold standard for cancer diagnosis,with the rapid development of precision medicine in cancer,the demand for dynamic monitoring of tumor molecular characteristics has increased.Liquid biopsy involves the collection of body fluids via noninvasive approaches,and analyzes biological markers such as circulating tumor cells,circulating tumor DNA,circulating cell-free DNA,microRNAs,and exosomes.In recent years,liquid biopsy has become more and more important in the diagnosis and prognosis of cancer in clinical practice due to its convenience,non-invasiveness,high specificity and it overcomes temporal-spatial heterogeneity.Therefore,this review summarizes the current evidence on liquid biopsies in digestive tract cancers in relation to diagnosis and prognosis.

Clinicopathological significance and prognostic value of claudin10 expression in primary malignant tumors of digestive system:A metaanalysis

Objective:To investigate the correlation between claudin10 expression and clinicopathological characteristics and prognosis of primary malignant tumors of digestive system.Methods:We searched the PubMed,Web of Science,Ovid MEDLINE,CNKI,CQVIP,and WanFang Data databases.The data between claudin10 expression and clinical characteristics as well as survival outcome were extracted.RevMan 5.3 and Stata 15.1 software were employed for metaanalysis.Results:A total of 6 studies containing 512 patients with primary malignant tumors of digestive system were analyzed.The analysis showed that high expression of claudin10 was more common in cancer tissue than in normal tissue[OR=3.22,95%CI(2.26,4.60),P<0.01],and was associated with increasing tumor size[OR=6.21,95%CI(2.44,15.83),P<0.01],high differentiation[OR=0.56,95%CI(0.32,0.99),P=0.05],positive lymph node metastasis[OR=3.41,95%CI(1.09,10.65),P=0.03].The expression of claudin10 was not associated with sex[OR=1.62,95%CI(0.91,2.90),P=0.10],age[OR=1.72,95%CI(0.97,3.07),P=0.06],distant metastasis[OR=4.51,95%CI(0.55,36.70),P=0.16],or prognosis[HR=1.99,95%CI(0.93,4.23),P=0.08].Conclusion:The expression of claudin10 is correlated with the clinicopathological features of primary malignant tumors of digestive system and is a potential tumor marker.

Chinese expert consensus and practice guideline of totally implantable access port for digestive tract carcinomas

Totally implantable access port is a fully implantable drug delivery system that is implanted subcutaneously and can be retained for a long time.Advantages of ports include a simple nursing process,low risk of infection and embolism,and high patient comfort.In order to promote the standardized application of ports in the treatment of digestive tract tumors and reduce port-related complications,the Chinese Research Hospital Association Digestive Tumor Committee,the Chinese Association of Upper Gastrointestinal Surgeons,the Chinese Gastric Cancer Association,and the Gastrointestinal Surgical Group of Chinese Surgical Society Affiliated to Chinese Medical Association have organized multidisciplinary expert discussions at the General Hospital of the People’s Liberation Army and nationwide expert letter reviews and on-site seminars,and formulated an expert consensus of the operation guidelines.

Prognostic relevance of circulating CK19 mRNA in advanced malignant biliary tract diseases

AIM: To determine the role of circulating tumor cells (CTCs) in prediction of the overall survival of patients with advanced malignant biliary tract obstruction. METHODS: We investigated the prognostic value of CTCs by examining two markers, cytokeratin (CK) 19 and human telomerase reverse transcriptase (hTERT) mRNA, in 40 patients diagnosed with advanced malig- nant biliary tract diseases. Quantitative real-time re- verse transcription polymerase chain reaction was used to detect CK19 and hTERT mRNA in the peripheral blood of these patients. Overall survival was analyzed using the Kaplan-Meier method and Cox regression modeling.RESULTS: Positive CK19 and hTERT mRNA expression was detected in 45% and 60%, respectively, of the 40 patients. Univariable analysis indicated that positive CK19 mRNA expression was significantly associated with worse overall survival (P = 0.009). Multivariable analysis determined that positive CK19 mRNA expres- sion, patient's age and serum bilirubin were each inde- pendently associated with overall survival. CONCLUSION: CK19 mRNA expression levels in pe- ripheral blood appear to provide a valuable marker to predict the overall survival of patients with advanced malignant biliary tract obstruction.

Two-photon excitation fuorescence lifetime imaging microscopy:A promising diagnostic tool for digestive tract tumors

Digestive tract tumors acount for 15%and 19.3%of the cancer incidence and deaths,respec-tively.Early detection of digestive tract tumors is crucial to the reduction of global cancer burden.Two-photon excitation fuorescence lifetime imaging microscopy(TP-FLIM)allows non-invasive,label free,three-dimensional,high-resolution imaging of living tisues with not only histological but also biochemical characterization ability in both qualitative and quantitative way.Benefiting from these advantages,this technology is protmising for clinical diagnosis of digestive tract tumors.In recent years,many efforts have'been made in this field and some remarkable progress has been achieved.In this paper,we overview the recent progress of TP-FLIM-based researches on digestive tract tumor detection.Among them,our latest results on the gastric cancer and esophageal cancer are elaborately depicted.Finally,we outlook and discuss the potential advantages and challenges of TP-FLIM in future clinical applications.

Research progress on drug delivery systems for curcumin in the treatment of gastrointestinal tumors

Curcumin is a natural compound with a diketone structure,which can control the growth,metastasis,recurrence,neovascularization,invasion,and drug resistance of gastrointestinal tumors by inhibiting nuclear factorκB,overexpression of tumor cells,vascular endothelial growth factor,etc.However,due to the low bioavailability of curcumin formulation,it did not fully exert its pharmacological effects,and its application and development in the treatment of various malignant tumors are still limited.This review summarizes the research on drug delivery systems of curcumin combating digestive tract tumors in order to further reduce the toxic side effects of curcumin-containing drugs and fully exert their pharmacological activities,and improve their bioavailability and clinical value.

Research Progress of HOXA13/HOTTIP Gene and Digestive Tract Cancer

The occurrence and development of digestive tract tumors are mainly caused by the interaction of genetic and environmental factors, multiple incentives, multiple genes involved, and multi-step regulation. With the development of gene sequencing technology, precise treatment of tumor era has arrived. Studies have shown that the HOXA13 gene in the homeobox gene is abnormally expressed in digestive system tumors. Studies have shown that HOXA13 may have a certain relationship with the occurrence, development and prognosis of the tumor, pending the diagnosis and treatment of digestive tract tumors with a new gene target.

Different percutaneous transhepatic biliary stent placements and catheter drainage in the treatment of middle and low malignant biliary obstruction

BACKGROUND For cases of middle and low biliary obstruction with left and right hepatic duct dilatation,the type of approach and whether different approaches affect the difficulty of puncture operation and intraoperative and postoperative complications have not been discussed in detail.AIM To compare the efficacy of different percutaneous transhepatic biliary stent placements and catheter drainage in treating middle and low biliary obstruction.METHODS A retrospective analysis was performed on the medical records of 424 patients with middle and low biliary obstruction who underwent percutaneous liver puncture biliary stent placement and catheter drainage at the Department of Interventional Radiology,Shaanxi Provincial People’s Hospital between March 2016 and March 2022.Based on the puncture path,patients were categorized into two groups:Subxiphoid left hepatic lobe approach group(Group A,224 cases)and right intercostal,right hepatic lobe approach group(Group B,200 cases).Liver function improvement,postoperative biliary bleeding incidence,postoperative pain duration,and abdominal effusion leakage around the drainage tube were compared between the two groups at 3 d and 1 wk after the surgery.Patient survival time was recorded during follow-up.RESULTS All 424 surgeries were successful without adverse events.Group A comprised 224 cases,and Group B had 200 cases.There was no statistically significant difference in basic data between Group A and Group B(P>0.05).No significant difference in postoperative biliary bleeding incidence was observed between the groups(P>0.05).The decreased rates for total bilirubin(Group A:69.23±4.50,Group B:63.79±5.65),direct bilirubin(Group A:79.30±11.19,Group B:63.62±5.64),and alkaline phosphatase(Group A:60.51±12.23,Group B:42.68±23.56)in the 1st wk after surgery were significantly faster in Group A than in Group B.The decreased rate of gamma-glutamyl transpeptidase was also significantly faster in Group A at both 3 d(Group A:40.56±10.32,Group B:32.22±5.12)and 1 wk(Group A:73.19±7.05,Group B:58.81±18.98)after surgery(P<0.05).Group A experienced significantly less peritoneal effusion leakage around the drainage tube than Group B(P<0.05).The patient survival rate was higher in Group A compared to Group B(P<0.05).CONCLUSION In treating jaundice patients with middle and low biliary obstruction,a percutaneous left liver puncture demonstrated better clinical efficacy than a percutaneous right liver puncture.

Associations between the Serum Zinc Levels and Digestive Tract Tumors:A Meta-Analysis

Background The incidence and mortality rates of digestive tract tumors are among the top ten worldwide.Notably,studies have shown that zinc may be significantly related to digestive tract tumors.This meta analysis was conducted to explore whether the serum zinc level of patients is associated with gastrointestinal cancer.Methods We systematically searched PUBMED,the Cochrane Library,the Web of Science and EMBASE from their start dates up to October 2022 for studies on the association between the serum zinc concentration and digestive tract tumors.The I^(2)statistic was used to assess the heterogeneity.A sensitivity analysis,subgroup analysis and meta-regression analysis were also used to analyze heterogeneity.Moreover,Begg’s and Egger’s tests were adopted to assess potential publication bias.Results In total,we identified 24 eligible studies with 1,499 total participants with digestive tract tumors and 6,039 participants without tumors.The average serum zinc concentration in patients with digestive tract tumors was lower than that in the control group(SMD=-0.98,95%CI:-1.29~-0.66,I^(2):94.1%,P<0.001).Specifically,the serum zinc concentration of patients with esophageal cancer(SMD=-2.08,95%CI:-2.89~-1.26,I^(2):92.9%,P<0.001),gastric cancer(SMD=-0.74,95%CI:-1.16~-0.33,I^(2):92.1%,P<0.001),and colorectal cancer(SMD=-0.85,95%CI:-1.51~-0.19,I^(2):95.9%P<0.05)were significantly different from the controls.Conclusion Our review showed that the serum zinc concentration in patients with digestive tract tumors was lower than that in patients without tumors,and further studies are needed to explore how zinc affects the occurrence and development of digestive tract tumors.

Role of microRNA-7 in digestive system malignancy

There are several malignancies of the digestive system(including gastric, pancreatic and colorectal cancers, and hepatocellular carcinoma), which are the most common types of cancer and a major cause of death worldwide. MicroRNA(miR)-7 is abundant in the pancreas, playing an important role in pancreatic development and endocrine function. Expression of miR-7 is downregulated in digestive system malignancies compared with normal tissue. Although there are contrasting results for miR-7 expression, almost all research reveals that miR-7 is a tumor suppressor, by targeting various genes in specific pathways. Moreover, miR-7 can target different genes simultaneously in different malignancies of the digestive system. By acting on many cytokines, miR-7 is also involved in many gastrointestinal inflammatory diseases as a significant carcinogenic factor. Consequently, miR-7 might be a biomarker or therapeutic target gene in digestive system malignancies.

谷胱甘肽过氧化物酶4在消化系统恶性肿瘤中的研究进展

消化系统恶性肿瘤的发病率居全球肿瘤的首位,其发病机制涉及多个基因和信号通路的改变。目前消化系统恶性肿瘤的治疗方式多样,但患者的病死率仍居高不下,亟须寻找更加有效的治疗手段。铁死亡是近年肿瘤研究的热点方向,谷胱甘肽过氧化物酶4(GPX4)是铁死亡的关键调控因子,其失活可导致脂质过氧化积累,进而诱导细胞铁死亡。消化系统恶性肿瘤组织中GPX4表达水平显著升高,参与和调控肿瘤的发生发展。因此,深入研究GPX4在消化系统肿瘤中的作用机制,可以为疾病的治疗提供理论支持。

陈寿菲治疗消化道恶性肿瘤验案3则

消化道恶性肿瘤是临床中常见的肿瘤,它包括胃癌、结肠癌、直肠癌等。临床上可采用中西医结合方法治疗,以提高治疗效果和患者的生活质量。陈寿菲主任擅用中药治疗消化道恶性肿瘤,疗效显著。兹分析3则陈主任使用中药疗消化道恶性肿瘤验案,以飨同道。

New insights into digestive tract tumors

Digestive tract tumors,ranging from esophageal to colorectal cancers(CRCs),pose a substantial challenge in oncology because of their high global incidence and mortality.1,2 The heterogeneity of these malignancies underscores the complexity of their etiology,which is influenced by a combination of genetic,epigenetic,and environmental factors.3 Unraveling the molecular complexities and clinical implications of these tumors is of growing importance,as they provide insights that can inform the development of more effective diagnostic,therapeutic,and preventative approaches.The Special Issue,titled“Basic research and clinical practice on gastrointestinal cancer”,aims to highlight the recent advances in molecular mechanisms and clinical research in the field of digestive tract oncology.We hope that by presenting these findings we can foster collaboration and dialog among experts in the field,ultimately leading to innovative perspectives on the diagnosis and treatment of these cancers.

Expression of hMSH2 gene and mutant p53 in sporadic digestive tract tumors

Objective To investigate the role of mutated mismatch repair gene hMSH2 and mutant p53 gene in the carcinogenesis and development of sporadic digestive tract tumors. Methods hMSH2 gene in normal and tumor tissue of 30 digestive tract tumor specimens was examined using polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) silver staining. The PCR product with an abnormal strand was sequenced directly. Mutant p53 protein in the tumor tissue was analyzed immunohistochemically. Results Six patients were identified as having mutated strands, three on hMSH2 exon 1 and three on hMSH2 exon 5. DNA sequencing revealed that all 6 patients had mutated basic groups that led to decrease in function of the hMSH2 protein. Forty percent (12/30) of patients were p53 positive. The frequency of mutated hMSH2 in p53 positive patients (41.7%) was significantly higher than in p53 negative patients (5.6%, P<0.05). Conclusion The mutation of hMSH2 plays an important role in the carcinogenesis and development of digestive tract tumors through stimulating p53 mutation.

Total laparoscopic segmental gastrectomy for gastrointestinal stromal tumors: A case report

BACKGROUND Gastrointestinal stromal tumors are lesions that originate from digestive tract walls.Several laparoscopic techniques,including local resections,wedge resections and partial gastrectomies,have been used successfully.However,there are no reports on laparoscopic segmental gastrectomy for gastrointestinal stromal tumors.CASE SUMMARY We present our analysis of 17 patients who were admitted to our hospital from January 2014 to December 2018.All tumors were located in the corpus and antrum of the stomach,close to the lesser curvature of the stomach.The tumors originated from the anterior wall in nine cases and from the posterior wall of the stomach in eight cases.Laparoscopic segmental gastrectomy and end-to-end anastomosis between the proximal and the distal residual stomach were used in all patients.The mean operative time was 112.4 min.The mean length of hospital stay was 4.6 d.Mean operative blood loss was 73.5 mL.There were no leaks,no postoperative bleeding nor need for reintervention.Mean postoperative follow-up was 35.4 mo.The Visick grading index showed fewer gastrointestinal symptoms 3 mo after surgery.Two patients(11.8%)had reflux esophagitis and gastritis.CONCLUSION Laparoscopic segmental gastrectomy may be a new function-preserving gastrectomy that is feasible for treatment of gastrointestinal stromal tumors that grow in the middle third of the stomach and on the lesser stomach curvature.