Appraisal of gastric stump carcinoma and current state of affairs

Gastric stump carcinoma,also known as remnant gastric carcinoma,is a malignancy arising in the remnant stomach following gastrectomy for a benign or malignant condition.Enterogastric reflux and preexisting risk factors in a patient with gastric cancer are the major contributors to the development of gastric stump carcinoma.The occurrence of gastric stump carcinoma is time-dependent and seen earlier in patients operated on for malignant rather than benign diseases.The tumor location is predominantly at the anastomotic site towards the stomach.However,it can occur anywhere in the remnant stomach.The pattern of lymph node involvement and the type of surgery required is distinctly different compared to primary gastric cancer.Gastric stump carcinoma is traditionally considered a malignancy with a dismal outcome.However,recent advances in diagnostic and therapeutic strategies have improved outcomes.Recent advances in molecular profiling of gastric stump carcinoma have identified distinct molecular subtypes,thereby providing novel therapeutic targets.Also,reports of gastric stump carcinoma following pancreatoduodenectomy and bariatric surgery highlight the need for more research to standardize the diagnosis,staging,and treatment of these tumors.The present review aims to provide an overview of gastric stump carcinoma highlighting the differences in clinicopathological profile and management compared to primary gastric carcinoma.

Comprehensive classifications for the endovascular recanalization of vertebral artery stump syndrome

Background:and purpose:To share our single-center vertebral artery stump syndrome(VASS)treatment experience and assess the role of comprehensive classification based on anatomic development,proximal conditions,and distal conditions(PAD).Materials and methods:Data were retrospectively collected from patients who underwent endovascular thrombectomy(EVT)at the Stroke Center of the First Hospital of Jilin University between January 2016 and December2021.Among patients with acute ischemic stroke in the posterior circulation,those with acute occlusion of the intracranial arteries and occlusion at the origin of the vertebral artery confirmed by digital subtraction angiography were selected.The clinical data were summarized and analyzed.Results:Fifteen patients with VASS were enrolled in the study.The overall success rate of surgical recanalization was 80%.The successful proximal recanalization rate was 70.6%,and the recanalization rates for P1,P2,P3,and P4 were 100%,71.4%,50%,and 66.67%,respectively.The mean operation times for the A1 and A2 types were124 and 120 min,respectively.The successful distal recanalization rate was 91.7%,and the recanalization rates for types D1,D2,D3,and D4 were 100%,83.3%,100%,and 100%,respectively.Five patients experienced perioperative complications(incidence rate:33.3%).Distal embolism occurred in three patients(incidence rate:20%).No dissection or subarachnoid hemorrhage occurred in any patient.Conclusion:EVT is a technically feasible treatment for VASS,and comprehensive PAD classification can,to a certain extent,help initially estimate the difficulty of surgery and provide guidance for interventional procedures.

Does gastric stump cancer really differ from primary proximal gastric cancer? A multicentre, propensity score matching-used, retrospective cohort study

BACKGROUND Although the location of proximal cancer of the remnant stomach is the same as that of primary proximal cancer of the stomach,its clinical characteristics and prognosis are still controversial.AIM To evaluate the clinicopathological features and prognosis factors of gastric stump cancer(GSC)and primary proximal gastric cancer(PGC).METHODS From January,2005 to December,2016,178 patients with GSC and 957 cases with PGC who received surgical treatment were enrolled.Patients in both groups underwent 1:1 propensity score matching analysis,and both clinical and pathological data were systematically collected for statistical purposes.Quality of RESULTS One hundred and fifty-two pairs were successfully matched after propensity score matching analysis.Of the 15 demographic and pathological variables collected,the analysis further revealed that the number of lymph nodes and positive lymph nodes were different prognostic and clinicopathological factors between PGC and GSC.Univariate and multivariate analyses showed that gender,differentiation degree and tumor-node-metastasis stage were independent risk factors for patients with GSC.Gender,vascular invasion,differentiation degree,depth of infiltration,positive lymph nodes,and tumor-node-metastasis stage were independent risk factors for patients with PGC.The 5-year overall survival and cancer-specific survival of patients with GSC were significantly lower than those in the PGC group,the scores for overall quality of life in the GSC-malignant group were lower than the GSC-benign,and the differences were statistically significant.CONCLUSION The differences in clinicopathological characteristics between GSC and PGC were clarified,and PGC had a better prognosis than GSC.

用Boosting方法组合增强Stumps进行文本分类(英文)

为提高文本分类的精度,Schapire和Singer尝试了一个用Boosting来组合仅有一个划分的简单决策树(Stumps)的方法.其基学习器的划分是由某个特定词项是否在待分类文档中出现决定的.这样的基学习器明显太弱,造成最后组合成的Boosting分类器精度不够理想,而且需要的迭代次数很大,因而效率很低.针对这个问题,提出由文档中所有词项来决定基学习器划分以增强基学习器分类能力的方法.它把以VSM表示的文档与类代表向量之间的相似度和某特定阈值的大小关系作为基学习器划分的标准.同时,为提高算法的收敛速度,在类代表向量的计算过程中动态引入Boosting分配给各学习样本的权重.实验结果表明,这种方法提高了用Boosting组合Stump分类器进行文本分类的性能(精度和效率),而且问题规模越大,效果越明显.

Management of duodenal stump fistula after gastrectomy for gastric cancer: Systematic review

AIM: To identify the most effective treatment of duodenalstump fistula(DSF) after gastrectomy for gastric cancer.METHODS: A systematic review of the literature was performed. Pub Med, EMBASE, Cochrane Library, CILEA Archive, BMJ Clinical Evidence and Up To Date databases were analyzed. Three hundred eighty-eight manuscripts were retrieved and analyzed and thirteen studies published between 1988 and 2014 were finally selected according to the inclusion criteria, for a total of 145 cases of DSF, which represented our group of study. Only patients with DSF after gastrectomy for malignancy were selected. Data about patients' characteristics, type of treatment, short and long-term outcomes were extracted and analyzed. RESULTS: In the 13 studies different types of treatment were proposed: conservative approach, surgical approach, percutaneous approach and endoscopic approach(3 cases). The overall mortality rate was 11.7% for the entire cohort. The more frequent complications were sepsis, abscesses, peritonitis, bleeding, pneumonia and multi-organ failure. Conservative approach was performed in 6 studies for a total of 79 patients, in patients with stable general condition, often associated with percutaneous approach. A complete resolution of the leakage was achieved in 92.3% of these patients, with a healing time ranging from 17 to 71 d. Surgical approach included duodenostomy, duodenojejunostomy, pancreatoduodenectomy and the use of rectus muscle flap. In-hospital stay of patients who underwent relaparotomy ranged from 1 to 1035 d. The percutaneous approach included drainage of abscesses or duodenostomy(32 cases) and percutaneous biliary diversion(13 cases). The median healing time in this group was 43 d. CONCLUSION: Conservative approach is the treatment of choice, eventually associated with percutaneus drainage. Surgical approach should be reserved for severe cases or when conservative approaches fail.

Bioinformatic analysis of cytokine expression in the proximal and distal nerve stumps after peripheral nerve injury

In our previous study,we investigated the dynamic expression of cytokines in the distal nerve stumps after peripheral nerve injury using microarray analysis,which can characterize the dynamic expression of proteins.In the present study,we used a rat model of right sciatic nerve transection to examine changes in the expression of cytokines at 1,7,14 and 28 days after injury using protein microarray analysis.Interleukins were increased in the distal nerve stumps at 1–14 days post nerve transection.However,growth factors and growth factor-related proteins were mainly upregulated in the proximal nerve stumps.The P-values of the inflammatory response,apoptotic response and cell-cell adhesion in the distal stumps were higher than those in the proximal nerve stumps,but the opposite was observed for angiogenesis.The number of cytokines related to axons in the distal stumps was greater than that in the proximal stumps,while the percentage of cytokines related to axons in the distal stumps was lower than that in the proximal nerve stumps.Visualization of the results revealed the specific expression patterns and differences in cytokines in and between the proximal and distal nerve stumps.Our findings offer potential therapeutic targets and should help advance the development of clinical treatments for peripheral nerve injury.Approval for animal use in this study was obtained from the Animal Ethics Committee of the Chinese PLA General Hospital on September 7,2016(approval No.2016-x9-07).

Prognostic factors and survival in patients with gastric stump cancer

AIM:To elucidate the clinicopathological characteristics and prognostic factors of gastric stump cancer(GSC).METHODS:The clinical data for 92 patients with GSC were collected at Fudan University Shanghai Cancer Center.The prognostic factors were analyzed with Cox proportional hazard models.RESULTS:GSC tended to occur within 25 years following the primary surgery,when the initial disease is benign,whereas it primarily occurred within the first15 years post-operation for gastric cancer.Patients with regular follow-up after primary surgery had a better survival rate.The multivariate Cox regression analysis revealed that Borrmann type?Ⅰ/Ⅱ(HR=3.165,95%CI:1.055-9.500,P=0.040)and radical resection(HR=1.780,95%CI:1.061-2.987,P=0.029)were independent prognostic factors for GSC.The overall 1-,3-,and 5-year survival rates of the 92 patients were78.3%,45.6%and 27.6%,respectively.The 1-,3-,and 5-year survival rates of those undergoing radical resection were 79.3%,52.2%,and 37.8%,respectively.The 5-year survival rates for stages?Ⅰ,Ⅱ,Ⅲ,andⅣwere 85.7%,47.4%,16.0%,and 13.3%,respectively(P=0.005).CONCLUSION:The appearance of GSC occurs sooner in patients with primary malignant cancer than in patients with a primary benign disease.Therefore,close follow-up is necessary.The overall survival of patients with GSC is poor,and curative resection can improve their prognosis.

“Wrapping the gastroduodenal artery stump” during pancreatoduodenectomy reduced the stump hemorrhage incidence after operation

Objective： After pancreaticoduodenectomy （PD）, the postoperative gastroduodenal artery stump （GDAS） hemorrhage is one of the most serious complications. The purpose of this study is to determine whether wrapping the GDAS during PD could decrease the postoperative GDAS hemorrhage incidence. Methods： A retrospective review involving 280 patients who underwent PD from 2005 to 2012 was performed. Wrapping the GDAS during PD was defined as ＂Wrapping the GDAS using the teres hepatis ligamentum during PD＂. A total of 140 patients accepted the ＂wrapping＂ procedure （wrapping group）. The other 140 patients didn＇t apply the procedure （non-wrapping group）. Age, sex, preoperative data, estimated intraoperative blood loss, postoperative complications, pathologic parameters and hospitalization time were compared between two groups. ResultsI There were no significant differences in patient characteristics between two groups. After wrapping, the incidence of postoperative GDAS bleeding decreased significantly （1/140 vs. 9/140, P=0.01）. The rates of the other complications （such as intra-abdominal infection pancreatic fistula, billiary fistula, gastrointestinal bleeding, et aL） showed no significant differences. Conclusions： Wrapping the GDAS during PD significantly reduced the postoperative GDAS hemorrhage incidence. And the ＂wrapping＂ had no obvious influence on other complications.

Protein microarray analysis of cytokine expression changes in distal stumps after sciatic nerve transection

A large number of chemokines,cytokines,other trophic factors and the extracellular matrix molecules form a favorable microenvironment for peripheral nerve regeneration.This microenvironment is one of the major factors for regenerative success.Therefore,it is important to investigate the key molecules and regulators affecting nerve regeneration after peripheral nerve injury.However,the identities of specific cytokines at various time points after sciatic nerve injury have not been determined.The study was performed by transecting the sciatic nerve to establish a model of peripheral nerve injury and to analyze,by protein microarray,the expression of different cytokines in the distal nerve after injury.Results showed a large number of cytokines were up-regulated at different time points post injury and several cytokines,e.g.,ciliary neurotrophic factor,were downregulated.The construction of a protein-protein interaction network was used to screen how the proteins interacted with differentially expressed cytokines.Kyoto Encyclopedia of Genes and Genomes pathway and Gene ontology analyses indicated that the differentially expressed cytokines were significantly associated with chemokine signaling pathways,Janus kinase/signal transducers and activators of transcription,phosphoinositide 3-kinase/protein kinase B,and notch signaling pathway.The cytokines involved in inflammation,immune response and cell chemotaxis were up-regulated initially and the cytokines involved in neuronal apoptotic processes,cell-cell adhesion,and cell proliferation were up-regulated at 28 days after injury.Western blot analysis showed that the expression and changes of hepatocyte growth factor,glial cell line-derived neurotrophic factor and ciliary neurotrophic factor were consistent with the results of protein microarray analysis.The results provide a comprehensive understanding of changes in cytokine expression and changes in these cytokines and classical signaling pathways and biological functions during Wallerian degeneration,as well as a basis for potential treatments of peripheral nerve injury.The study was approved by the Institutional Animal Care and Use Committee of the Chinese PLA General Hospital,China(approval number:2016-x9-07)in September 2016.

Surgical resection of gastric stump cancer following proximal gastrectomy for adenocarcinoma of the esophagogastric junction

BACKGROUND Proximal gastrectomy(PG) is performed widely as a function-preserving operation for early gastric cancer located in the upper third of the stomach and is an important function-preserving approach for esophagogastric junction(EGJ)adenocarcinoma. The incidence of gastric stump cancer(GSC) after PG is increasing. However, little is known about the GSC following PG because very few studies have been conducted on the disease.AIM To clarify clinicopathologic features, perioperative complications, and long-term survival rates after the resection of GSC following PG.METHODS Data for patients with GSC following PG for adenocarcinoma of the EGJ diagnosed between January 1998 and December 2016 were retrospectively reviewed. Multivariate analysis was performed to identify factors associated with overall survival(OS). GSC was defined in accordance with the Japanese Gastric Cancer Association.RESULTS A total of 35 patients were identified. The median interval between the initial PGand resection of GSC was 4.9(range 0.7-12) years. In 21 of the 35 patients, the tumor was located in a nonanastomotic site of the gastric stump. Total gastrectomy was performed in 27 patients; the other 8 underwent partial gastrectomy. Postoperative complications occurred in 6 patients(17.1%). The tumor stage according to the depth of tumor invasion was T1 in 6 patients, T2 in3 patients, T3 in 9 patients, and T4 in 17 patients. Lymph node metastasis was observed in 18 patients. Calculated 1-, 3-, and 5-year OS rates were 86.5%, 62.3%,and 54.2%, respectively. Multivariate analysis showed advanced T stage to be associated with OS.CONCLUSION This study reveals the characteristics of GSC following PG for adenocarcinoma of the EGJ and suggests that a surgical approach can lead to a satisfactory outcome.

The Early Diagnosis and Surgical Treatment of the Gastric Stump Carcinoma

The clinical data of 30 patients with GSC after partial gastrectomy for benign gastric dis- eases were analyzed retrospectively. Eleven cases accepted radical resection, 11 cases palliative resec- tion and the remaining 8 underwent exploratory laparotomy. It was emphasized that the detection of stump cancer at a relatively early stage, mainly due to screening programmes for gastrectomised pa- tients, was important in improving its prognosis.

Neuroendocrine carcinoma of the gastric stump:A case report and literature review

We herein report a case of neuroendocrine carcinoma of the gastric stump found 47 years after Billroth II gastric resection for a benign gastric ulcer. A 74-yearold man was referred to another hospital with melena. Endoscopic examination revealed a localized ulcerative lesion at the gastrojejunal anastomosis. The diagnosis by endoscopic biopsy was neuroendocrine carcinoma. A total gastrectomy of the remnant stomach with D2 lymphadenectomy was performed at our hospital. The lesion invaded the subserosa, and metastasis was found in two of nine the lymph nodes retrieved. The lesion was positive for synaptophysin and chromogranin A, and the Ki-67 labeling index was 60%. The diagnosis of neuroendocrine carcinoma of the gastric stump was confirmed using World Health Organization 2010 criteria. Subsequently, the patient underwent one course of adjuvant chemotherapy with the etoposide plus cisplatin(EP) regimen; however, treatment was discontinued due to grade 3 myelosuppression. The patient showed lymph node metastasis in the region around the gastrojejunal anastomosis in the abdominal cavity 7 mo post-surgery. He then underwent radiotherapy and platinum-based combination chemotherapy; however, the disease progressed and liver recurrence was observed on follow-up computedtomography at 16 mo post-surgery. The patient then received chemotherapy with regimens used for the treatment of small cell lung cancer in first-and secondline settings. The patient died of disease progression 31 months after surgery.

Survival and Prognostic Factors in Patients with Carcinoma of Cervical Stump

Purpose: To evaluate patients with carcinoma of cervical stump (CCS) and analyse different clinico-pathologic factors affect prognosis. Patients and Methods: This study was carried out through review of clinical records of patients. Recorded data included information on age, tumor stage, presenting symptoms, size of tumor, histopathology, grade, type, cause of subtotal hysterectomy (STH), treatment and follow-up results. Staging according to International Federation of Gynecology and Obstetrics (FIGO) staging system was done through: PHYSICAL examination, pelvic examination under anaesthesia, chest X-ray, magnetic resonance imaging (MRI) of the abdomen and pelvis, cystoscopy, rectosigmoidoscopy and intravenous pyelography. Prognostic factors as age, size of tumor, stage, lymph node (LN) involvement, pathological type, grade and type of CCS either true or coincidental were analysed through multivariate analysis. Results: 62% of patients are above 50 years with stage II in 48.7%. Squamous cell carcinoma was more common but 54% are of GIII. 89% were true CCS. Positive lymph nodes were reported in 27%. The predominant reason for STH was abnormal bleeding (73%). In about 95% of cases, women seeked medical attention because of symptoms and the most common presenting symptom was bleeding (54%). According to the stage and performance status of patients, treatment consisted of radiotherapy either external or interstitial, chemotherapy and chemoradiotherapy. Through multivariate analysis, the following was found to have adverse impact on survival: Coincidental type (P = 0.04), high grade (P = 0.03), advanced stage (P = 0.01), larger tumor size (P = 0.02), lymph node involvement (P = 0.029) and older age (P = 0.035). While pathological type was not (P = 0.52). After median follow-up of 52 months;5-year overall survival was 65%. Conclusion: CCS has a low morbidity. Adverse survival outcomes can be anticipated in those patients with: high grade lesions, advanced stages, large tumor size, coincidental type, older age and positive lymph node involvement.

Impact of Tree Stump Harvesting on Soil Carbon and Nutrients and Second Rotation Tree Growth in Mid-Wales, UK

The drive to develop renewable energy is increasing the interest in energy forestry. Woody biomass from forest residues has the potential to make a significant contribution to greenhouse gas emission reduction through fossil fuel substitution. However, there is a danger of operational practice running ahead of the understanding of the environmental impacts of such activities. Consequently, there is an urgent requirement for scientifically underpinned guidance on the best management practices to ensure soil and water protection, including sustaining forestry’s key role in carbon capture. This study addresses the main issues associated with stump harvesting practices and their impacts on soil carbon and nutrient capital and effects on the second rotation tree growth. It reports results from a clearfell site in the UK where experimental stump harvesting was carried out in 2005 before replanting with Sitka spruce Picea sitchensis (Bon.)Carr. Both stump harvested and conventional harvested areas (Control) were studied in 2009 and 2010, five years after harvesting, on the two distinct soil types at the site: podzolised brown earth and peaty gley soils. Results show impacts of stump harvesting on soil carbon and nitrogen stocks, residual water, base cations (K+, Ca2+ and Mg2+) concentrations and stocks and bulk density in both soil types. The organic peaty gley soil showed larger and deeper profile changes after stump harvesting compared with the podzolised brown mineral soil, where some of the negative changes in C, N and base cations in the top soil were compensated by increases at depth. Tree assessment showed positive effect of stump harvesting on K and Ca uptake by young seedlings, but N and P nutrient status was reduced on the peaty gley soils. The overall results support the current UK forestry guidance for stump harvesting which identifies that soil type is the most important site factor determining the sustainability of the practice.

EXPERIMENT STUDY AND CLINICAL OBSERVATION WITH LIGATION METHOD FOR CLOSING BRONCHIAL STUMP FOLLOWING LOBECTOMY FOR LUNG NEOPLASMS

Objective: Traditional method of closing bronchial stumps after lobectomy was whole layer suture by hand or by stapler. Little is known about the ligated bronchial stump following lobectomy. To evaluate the characteristics of ligation method for closing bronchial stumps. Methods: In this study 90 lobectomies on 15 mongrel dogs and 75 bronchial stump models on fresh cadaver bronchus were performed. Multivariables comparison experimental studies were made on the results of three different closing methods: simple ligation, manual suture and stapling. Results: In the ligation group, the operation time was significantly shortened (P<0.01). The depth of stump cavity between ligation group and suture group was of no difference significantly (P>0.05). The resistance against intrabronchial pressure was greater in the ligation group than in the suture group (P<0.01). Pathological studies illustrated earlier healing of mucosal membrane with milder inflammatory reactions. In clinical practice, 121 lobectomies were successfully performed with simple ligation of the stumps. Conclusion: Simple ligation is a safe, reliable, simple, and applicable method for closing bronchial stump following lobectomies.

Late onset ilio-psoas abscess due to stump appendicitis： a case report

We describe a case of right ilio-psoas abscess caused by stump appendicitis 14 years after open appendectomy.Stump appendicitis is a rare complication of appendectomy. Right ilio-psoas abscess was diagnosed in an immunecompetent patient and treated by ultrasound guided percutaneous drainage twice without identifying the cause of the abscess. The patient did not improve until diagnostic laparoscopy was performed revealing a long stump appendicitis to be the origin of infection. It was treated by completion appendectomy. Surgical exploration may be necessary in persistent or recurrent ilio-psoas abscesses. We identified 4 reported cases of post-appendectomy ilio-psoas abscess but without recognizing the cause of the abscess and its relation to appendectomy. This is the first reported case of ilio-psoas abscess that developed as a complication of stump appendicitis.

Amputation stump management:A narrative review

In this review intended for medical staff involved in patient rehabilitation,we provided an overview of the basic methods for managing amputation stumps.After the amputation surgery,it is imperative to optimize the remaining physical abilities of the amputee through rehabilitation processes,including postoperative rehabilitation,desensitization,and continuous application of soft or rigid dressings for pain reduction and shaping of the stump.Depending on the situation,a prosthesis may be worn in the early stage of recovery or an immediate postoperative prosthesis may be applied to promote stump maturation.Subsequently,to maintain the range of motion of the stump and to prevent deformation,the remaining portion of the limb should be positioned to prevent contracture.Continuous exercises should also be performed to improve muscle strength to ensure that the amputee is able to perform activities of daily living,independently.Additionally,clean wound or edema management of the stump is necessary to prevent problems associated with wearing the prosthesis.Our review is expected to contribute to the establishment of basic protocols that will be useful for stump management from the time of completion of amputation surgery to the fitting of a prosthesis to optimize patient recovery.

Characterization of Two Different Stumps of <i>Spirulina platensis</i>Drying: Assessment of Water Transport Coefficient

The sorption behaviour and water transport mechanisms inside Spirulina platensis samples were experimentally analysed during isothermal drying at 25℃ and 50℃. Two different products grown in semi-industrial farms from Burkina Faso and France with initial water contents respectively of the range from 2.73 kg w /kg dm to 3.12 kg w /kg dm were characterized. A novel procedure has been developed to determine the water content profiles inside samples during isothermal drying. At both temperatures, experimental results underlined that the physical properties of Spirulina are not sensitive to the geographical origin, Burkina-Faso or France. To keep Spirulina at an water activity below 0.6 in order to preserve it from micro-organisms development, sorption isotherm curves show that a sufficient requirement is to lower the water content until an upper limit of w = 0.075 db. The evolution of water transport coefficient as a function of water content highlights a monotonous exponential dependence with a transport coefficient ranging from 1.70 × 10–10 to 94 × 10–10 m2/s. The contribution of solid phase shrinkage to the transport of water is negligible for the last drying steps.

Characteristics of cytokines in the sciatic nerve stumps and DRG after rat sciatic nerve crush injury

Background: Cytokines are essential cellular modulators of various physiological and pathological activities, including peripheral nerve repair and regeneration. However, the molecular changes of these cellular mediators after peripheral nerve injury are still unclear. This study aimed to identify cytokines critical for the regenerative process of injured peripheral nerves.Methods: The sequencing data of the injured nerve stumps and the dorsal root ganglia(DRG) of Sprague-Dawley(SD) rats subjected to sciatic nerve(SN) crush injury were analyzed to determine the expression patterns of genes coding for cytokines. PCR was used to validate the accuracy of the sequencing data.Results: A total of 46, 52, and 54 upstream cytokines were differentially expressed in the SN at 1 day, 4 days, and 7 days after nerve injury. A total of 25, 28, and 34 upstream cytokines were differentially expressed in the DRG at these time points. The expression patterns of some essential upstream cytokines are displayed in a heatmap and were validated by PCR. Bioinformatic analysis of these differentially expressed upstream cytokines after nerve injury demonstrated that inflammatory and immune responses were significantly involved.Conclusions: In summary, these findings provide an overview of the dynamic changes in cytokines in the SN and DRG at different time points after nerve crush injury in rats, elucidate the biological processes of differentially expressed cytokines, especially the important roles in inflammatory and immune responses after peripheral nerve injury, and thus might contribute to the identification of potential treatments for peripheral nerve repair and regeneration.

Mixed neuroendocrine carcinoma of the gastric stump: A case report

BACKGROUND Gastric stump cancer,also known as gastric remnant cancer(GRC),is one of the main complications of postgastrectomy syndrome,which usually occurs following Billroth II reconstruction.The predominant histological subtype of GRC is adenocarcinoma,whereas neuroendocrine carcinoma is relatively rare.In particular,there are few recently reported cases of mixed neuroendocrine carcinoma(MNEC)in the English literature.Here,we present an extremely rare case of MNEC of the gastric stump.CASE SUMMARY A 59-year-old patient presented to our department owing to chronic constipation.He had undergone subtotal gastric resection 35 years prior to admission because of benign peptic ulcer.After admission,the patient underwent several tests,and gastroendoscopy showed evidence of Billroth II gastrectomy and local thickening of the gastric stump mucosa at the gastrojejunostomy site,with bile reflux;pathological biopsy revealed adenocarcinoma.He was then diagnosed with GRC and underwent total gastrectomy,D2 Lymphadenectomy,and esophagojejunal Roux-en-Y reconstruction.Histopathological examination of the specimen identified MNEC comprising MNEC(60%),adenocarcinoma(30%),and squamous cell carcinoma(10%).Postoperative adjuvant chemotherapy was initiated on September 17,2020.Taxol plus cisplatin was administered for only one cycle because of severe liver function damage,and the regimen was changed to etoposide plus cisplatin on October 10,2020 for five cycles.The patient recovered,with no recurrence after 6 mo of follow-up.CONCLUSION Gastric MNECs(GMNECs)is a rare type of GRC.This study presented the unusual occurrence of GMNEC in the gastric stump.This case will contribute to improvements in our understanding of the carcinogenesis,biology,pathology,and behavior of GMNEC and GRC.