Endoscopic ultrasonography-related diagnostic accuracy and clinical significance on small rectal neuroendocrine neoplasms

This research aimed to examine the diagnostic accuracy and clinical significance of endoscopic ultrasonography(EUS)in the context of small rectal neuroendocrine neoplasms(NENs).A total of 108 patients with rectal subepithelial lesions(SELs)with a diameter of<20 mm were included in the analysis.The diagnosis and depth assessment of EUS was compared to the histology findings.The prevalence of NENs in rectal SELs was 78.7%(85/108).The sensitivity of EUS in detecting rectal NENs was 98.9%(84/85),while the specificity was 52.2%(12/23).Overall,the diagnostic accuracy of EUS in identifying rectal NENs was 88.9%(96/108).The overall accuracy rate for EUS in assessing the depth of invasion in rectal NENs was 92.9%(78/84).Therefore,EUS demonstrates reasonable diagnostic accuracy in detecting small rectal NENs,with good sensitivity but inferior specificity.EUS may also assist physicians in assessing the depth of invasion in small rectal NENs before endoscopic excision.

Current Status and Clinical Research Progress of Immunotherapy for Advanced Gastric Cancer

Advanced gastric cancer is a common digestive system tumor,and its treatment has always been a difficult problem.In recent years,with the rapid development of immunotherapy,the treatment effect of advanced gastric cancer has been significantly improved.This article introduces the current status and clinical research progress of immune checkpoint inhibitors in advanced gastric cancer.Commonly used immunotherapy methods include chemical drug therapy,biological therapy,and gene therapy,among which the immune checkpoint inhibitors are currently one of the most popular immunotherapy methods,including nivolumab,pembrolizumab,and atezolizumab,which target programmed death ligand 1(PD-L1)low expression(1%–49%)and PD-L1 high expression(≥50%).The results of clinical studies have shown that immunotherapy can significantly prolong the survival of patients with advanced gastric cancer while having lower toxic side effects and better tolerance.However,immunotherapy also has some problems,such as drug resistance and repeated infection.Future research directions include exploring new immunotherapy methods,combination therapy,and individualized therapy.

Mild hypothermia combined with a scaffold of Ng Rsilenced neural stem cells/Schwann cells to treat spinal cord injury

Because the inhibition of Nogo proteins can promote neurite growth and nerve cell differentiation, a cell-scaffold complex seeded with Nogo receptor （NgR）-silenced neural stem cells and Schwann cells may be able to improve the microenvironment for spinal cord injury repair. Previous studies have found that mild hypothermia helps to attenuate secondary damage in the spinal cord and exerts a neuroprotective effect. Here, we constructed a cell-scaffold complex consisting of a poly（D,L-lactide-co-glycolic acid） （PLGA） scaffold seeded with NgR-silenced neural stem cells and Schwann cells, and determined the effects of mild hypothermia combined with the cell-scaffold complexes on the spinal cord hemi-transection injury in the T9 segment in rats. Compared with the PLGA group and the NgR-silencing cells ＋ PLGA group, hindlimb motor function and nerve electrophysiological function were dearly improved, pathological changes in the injured spinal cord were attenuated, and the number of surviving cells and nerve fibers were increased in the group treated with the NgR-silenced cell scaffold ＋ mild hypothermia at 34℃ for 6 hours. Furthermore, fewer pathological changes to the injured spinal cord and more surviving cells and nerve fibers were found after mild hypothermia therapy than in injuries not treated with mild hypothermia. These experimental results indicate that mild hypothermia combined with NgR gene-silenced cells in a PLGA scaffold may be an effective therapy for treating spinal cord injury.

CXCR7/CXCL12 axis is involved in lymph node and liver metastasis of gastric carcinoma

AIM To investigate the role of CXC chemokine receptor (CXCR)-7 and CXCL12 in lymph node and liver metastasis of gastric carcinoma. METHODS In 160 cases of gastric cancer, the expression of CXCR7 and CXCL12 in tumor and matched tumoradjacent non-cancer tissues, in the lymph nodes around the stomach and in the liver was detected using immunohistochemistry to analyze the relationship between CXCR7/CXCL12 expression and clinicopathological features and to determine whether CXCR7 and CXCL12 constitute a biological axis to promote lymph node and liver metastasis of gastric cancer. Furthermore, the CXCR7 gene was silenced and overexpressed in human gastric cancer SGC-7901 cells, and cell proliferation, migration and invasiveness were measured by the MTT, wound healing and Transwell assays, respectively. RESULTS CXCR7 expression was up-regulated in gastric cancer tissues (P = 0.011). CXCR7/CXCL12 expression was significantly related to high tumor stage and lymph node (r = 0.338, P = 0.000) and liver metastasis (r = 0.629, P = 0.000). The expression of CXCL12 in lymph node and liver metastasis was higher than that in primary gastric cancer tissues (chi(2) = 6.669, P = 0.010; chi(2) = 25379, P = 0.000), and the expression of CXCL12 in lymph node and liver metastasis of gastric cancer was consistent with the positive expression of CXCR7 in primary gastric cancer (r = 0.338, P = 0.000; r = 0.629, P = 0.000). Overexpression of the CXCR7 gene promoted cell proliferation, migration and invasion. Silencing of the CXCR7 gene suppressed SGC-7901 cell proliferation, migration and invasion. Human gastric cancer cell lines expressed CXCR7 and showed vigorous proliferation and migratory responses to CXCL12. CONCLUSION The CXCR7/CXCL12 axis is involved in lymph node and liver metastasis of gastric cancer. CXCR7 is considered a potential therapeutic target for the treatment of gastric cancer.

Effects of soil moisture and light intensity on ecophysiological characteristics of Amorpha fruticosa seedlings

We investigated the combined effects of soil moisture and light intensity on the growth, development and ecophysiological characteristics of one-year old Amorpha fruticosa seedlings. Soil moisture and light intensity influenced the ecophysiological characteristics of Amorpha fruticosa seedlings. Soil moisture resulted in the decreases of growth rate, individual size, net photosynthetic rate, transpiration rate, leaf water loss rate （WLR）, and biomass accumulation of plant parts, and led to increased leaf water saturation deficit （WSD）. Under water stress, more photosynthetic products were allocated to root growth. With decreasing light intensity, net photosynthetic rate, transpiration rate, chla/b, water saturation deficit, water use efficiency, water loss rate and biomass accumulation declined, while Chla, Chlb, Chla＋b and carotenoids （Car） increased and more photosynthetic products were allocated to stem and leaf growth. Maximum growth vigor, net photosynthetic rate and total biomass accumulation in Amorpha fruticosa seedlings was recorded at 75 80% soil water-holding capacity and 100% light density in greenhouse environments.

ALPPS in the treatment of liver cancer with insufficient future liver remnant

To the Editor:In 2007,Schlitt firstly reported that the rapid compensatory increase of future liver remnant (FLR) after surgery can be achieved in a very short time which is known as a revolutionary breakthrough of liver surgery for huge or multiple liver cancer therapy^([1]).de Santibanes and Clavien later proposed the medical term"ALPPS"^([2]).

Reorganization characteristics of speech cortex during speech restoration following total laryngectomy A functional magnetic resonance imaging follow-up

During speech restoration following laryngectomy, language-related cortical areas develop connections with new primary motor neurons. The present study followed up 18 patients after total resection of laryngeal carcinoma. According to an evaluation of pronunciation, patients were assigned to three groups： poor, moderate and good pronunciation. Functional magnetic resonance imaging revealed significant increases in the number of activated voxels and the intensity of activation changes in the left middle frontal gyrus, left precentral gyrus, left postcentral gyrus, left supplementary motor area, left anterior cingulate gyrus and right fusiform gyrus between the moderate pronunciation group compared with the poor and good pronunciation groups. We propose that these brain regions play an important role in the progress of speech restoration, and improvements in pronunciation learning for patients following laryngectomy. However, during the later period of speech restoration, the number of activated voxels and intensity changes in these regions decreased to the level of healthy controls, indicating that the learning and instruction effects weakened once patients had mastered pronunciation techniques

Nine-year survival of a 60-year-old woman with locally advanced pancreatic cancer under repeated open approach radiofrequency ablation:A case report

BACKGROUND Radiofrequency ablation(RFA)is gaining popularity as an additional therapy for pancreatic ductal adenocarcinoma.RFA appears to be an attractive treatment option for patients with unresectable,locally advanced and nonmetastatic pancreatic cancer.CASE SUMMARY A 60-year-old woman with 2 mo intermittent upper abdominal pains was admitted to hospital.She had undergone radical gastrectomy(Billroth II)for gastric antral cancer.Contrast-enhanced computed tomography(CECT)and abdominal ultrasound displayed a primary tumor in the neck of the pancreas.Pathological examination showed that the lesion was a pancreatic ductal adenocarcinoma.According to the results of the imaging,open approach RFA was selected to treat the primary tumor.Eight months later,CECT follow-up revealed local recurrence of the tumor,and another open RFA was performed.Although there is evidence that RFA for recurrence of other cancers such as hepatocellular carcinoma may prolong patient survival,it remains unclear whether repeat RFA for local recurrence of pancreatic cancer is feasible.The patient continued to enjoy 9 years of life following the first RFA.CONCLUSION RFA of locally advanced,nonresectable,nonmetastatic,pancreatic tumor is characterized by feasibility-based treatment giving rise to tumor reduction based on improvement of quality of life.

Functions and mechanisms of chemokine receptor 7 in tumors of the digestive system

Chemokine(C-X-C motif)receptor 7(CXCR7),recently termed ACKR3,belongs to the G protein-coupled cell surface receptor family,binds to stromal cellderived factor-1[SDF-1,or chemokine(C-X-C motif)ligand 12]or chemokine(CX-C motif)ligand 11,and is the most common chemokine receptor expressed in a variety of cancer cells.SDF-1 binds to its receptor chemokine(C-X-C motif)receptor 4(CXCR4)and regulates cell proliferation,survival,angiogenesis and migration.In recent years,another new receptor for SDF-1,CXCR7,has been discovered,and CXCR7 has also been found to be expressed in a variety of tumor cells and tumor-related vascular endothelial cells.Many studies have shown that CXCR7 can promote the growth and metastasis of a variety of malignant tumor cells.Unlike CXCR4,CXCR7 exhibits a slight modification in the DRYLAIV motif and does not induce intracellular Ca^2+release following ligand binding,which is essential for recruiting and activating G proteins.CXCR7 is generally thought to work in three ways:(1)Recruitingβ-arrestin 2;(2)Heterodimerizing with CXCR4;and(3)Acting as a“scavenger”of SDF-1,thus lowering the level of SDF-1 to weaken the activity of CXCR4.In the present review,the expression and role of CXCR7,as well as its prognosis in cancers of the digestive system,were investigated.

miR-30b inhibits autophagy to alleviate hepatic ischemiareperfusion injury via decreasing the Atg12-Atg5 conjugate

AIM: To explore the role and potential mechanism of miR-30 b regulation of autophagy in hepatic ischemiareperfusion injury(IRI).METHODS: An animal model of hepatic IRI was generated in C57BL/6 mice. For in vitro studies, AML12 cells were immersed in mineral oil for 1 h and then cultured in complete Dulbecco's Modified Eagle's Medium(DMEM)/F12 to simulate IRI. Mice and cells were transfected with miR-30 b agomir/mimics or antagomir/inhibitor to examine the effect of miR-30 b on autophagy to promote hepatic IRI. The expression of miR-30 b was measured by real-time polymerase chain reaction. Apoptotic cells were detected by terminal uridine nickend labeling(TUNEL) staining, and cell viability was detected by methylthiazole tetrazolium assay. The expression of light chain 3, autophagy-related gene(Atg)12, Atg5, P62, and caspase-3 were detected by western blotting analysis.RESULTS: miR-30 b levels were significantly downregulated after hepatic IRI, and the numbers of autophagosomes were increased in response to IRI both in vivo and in vitro. These findings demonstrate that low levels of miR-30 b could promote hepatic IRI. Furthermore, we found that miR-30 b interacted with Atg12-Atg5 conjugate by binding to Atg12. Overexpression of miR-30 b diminished Atg12 and Atg12-Atg5 conjugate levels, which promoted autophagy in response to IR. In contrast, downregulation of miR-30 b was associated with increased Atg12-Atg5 conjugate levels and increased autophagy.CONCLUSION: miR-30 b inhibited autophagy to alleviate hepatic ischemia-reperfusion injury via decreasing the Atg12-Atg5 conjugate.

Neural stem cell transplantation with Nogo-66 receptor gene silencing to treat severe traumatic brain injury

Inhibition of neurite growth, which is mediated by the Nogo-66 receptor （NgR）, affects nerve regeneration following neural stem cell （NSC） transplantation. The present study utilized RNA interference to silence NgR gene expression in NSCs, which were subsequently transplanted into rats with traumatic brain injury. Following transplantation of NSCs transfected with small interfering RNA, typical neural cell-like morphology was detected in injured brain tissues, and was accompanied by absence of brain tissue cavity, increased growth-associated protein 43 mRNA and protein expression, and improved neurological function compared with NSC transplantation alone. Results demonstrated that NSC transplantation with silenced NgR gene promoted functional recovery following brain injury.

Plasma exchange-centered artificial liver support system in hepatitis B virus-related acute-onchronic liver failure:a nationwide prospective multicenter study in China

BACKGROUND： Plasma exchange （PE）-centered artificial liver support system reduced the high mortality rate of hepa titis B virus （HBV）-related acute-on-chronic liver failure （ACLF）. But the data were diverse in different medical centers. The present prospective nationwide study was to evaluate the effects of PE on patients with HBV-ACLF at different stages.

Clinical Course and Outcome Patterns of Acute-on-chronic Liver Failure:A Multicenter Retrospective Cohort Study

Background and Aims:Acute-on-chronic liver failure(ACLF)is acute decompensation of liver function in the setting of chronic liver disease,and characterized by high short-term mortality.In this study,we sought to investigate the clinical course of patients at specific time points,and to propose dynamic prognostic criteria.Methods:We assessed the clinical course of 453 patients with ACLF during a 12-week follow-up period in this retrospective multicenter study.The clinical course of patients was defined as disease recovery,improvement,worsening or steady patterns based on the variation tendency in prothrombin activity(PTA)and total bilirubin(TB)at different time points.Results:Resolution of PTA was observed in 231 patients(51%)at 12 weeks after the diagnosis of ACLF.Among the remaining patients,66(14.6%)showed improvement and 156(34.4%)showed a steady or worsening course.In patients with resolved PTA,the clinical course of TB exhibited resolved pattern in 95.2%,improved in 3.9%,and steady or worse in 0.8%.Correspondingly,in patients with improved PTA,these values for TB were 28.8%,27.3%,and 43.9%,respectively.In patients with steady or worsening PTA,these values for TB were 5.7%,32.3%,and 65.6%,respectively.Dynamic prognostic criteria were developed by combining the clinical course of PTA/TB and the clinical outcomes at 4 and 12 weeks after diagnosis in ACLF patients.Conclusions:We propose the following dynamic prognostic criteria:rapid progression,slow progression,rapid recovery,slow recovery,and slow persistence,which lay the foundation for precise prediction of prognosis and the improvement of ACLF therapy.

Primary hepatic angiosarcoma manifesting as hepatic sinusoidal obstruction syndrome:A case report

BACKGROUND Primary hepatic angiosarcoma(PHA)is a rare malignancy with a poor prognosis.It is difficult to diagnose PHA because of the lack of specific symptoms or tumour markers,and it rapidly progresses and has a high mortality.To our knowledge,PHA has not been reported to mimic hepatic sinusoidal obstruction syndrome.Herein,we present a case of PHA manifesting as hepatic sinusoidal obstruction syndrome,diagnosed using transjugular liver biopsy,that resulted in the death of the patient.CASE SUMMARY A 71-year-old man was admitted with the primary complaint of abdominal distension,decreased appetite,fatigue in the previous month,and loss of 10 kg of weight in the past 2 years.Both the liver and spleen were enlarged,and the liver had a medium-hard texture on percussion.Laboratory examinations were performed,and abdominal plain computed tomography(CT)and contrastenhanced CT showed hepatomegaly and splenomegaly,as well as diffuse lowdensity shadows distributed in the liver and spleen.Contrast-enhanced CT revealed diffuse,hypodense,nodular or flake shadows in the liver and heterogeneous enhancement in the spleen.A transjugular liver biopsy was performed.Based on the pathology results,the patient was diagnosed with hepatic sinusoidal obstruction syndrome secondary to PHA.The patient’s status further deteriorated and he developed serious hepatic failure.The patient was discharged,and died 3 d later.CONCLUSION PHA is rare and has a poor prognosis;however,transjugular liver biopsy can be safely performed to aid in diagnosis.

Isolated right ventricular noncompaction caused recurrent pulmonary embolism

Clinically, pulmonary embolism （PE） mostly comes from the lower extremity deep vein system, but if such pa- tients have no evidence of deep venous thrombosis （DVT）, other sources of emboli should be considered. It is very rare that embolus comes from the right heart system （in situ thrombosis）, Isolated fight ventricular noncompaction （iRVNC） can cause PE, but it has not been reported so far. Ventricular noncompaction （VNC） is an unusual cause of cardiomyopathy.

Tumor recurrence after pathological complete response in locally advanced gastric cancer after neoadjuvant therapy:Two case reports

BACKGROUND The pathological complete response(ypCR)rate following neoadjuvant chemotherapy for advanced gastric cancer remains low and lacks a universally accepted treatment protocol.Immunotherapy has achieved breakthrough progress.CASE SUMMARY We report two female patients with gastric cancer defined as clinical stage cT4N1-2M0.Detection of mismatch repair protein showed mismatch repair function defect,and perioperative treatment with programmed death protein 1 inhibitor combined with S-1+oxaliplatin achieved ypCR.Surprisingly,the patients underwent clinical observation after surgery but developed different degrees of metastasis at~6 mo after surgery.CONCLUSION PD-1 inhibitor combined with chemotherapy provides a more strategic choice for comprehensive perioperative treatment of gastric cancer.

Clinical Features and Clonal Origin of Diffuse Hepatocellular Carcinoma

To the Editor：Diffuse hepatocellular carcinoma （D-HCC）,also known as cirrhosis-like HCC,is a rare and peculiar type of HCC.[1] The World Health Organization （WHO） defines D-HCC as follows：small tumor nodules distributed diffusely all over the liver presents like cirrhotic-associated regenerative nodules.[2] Surgical resection,radiotherapy,and medication cannot bring good results for D-HCC,and the prognosis of D-HCC is poor.

Hemophagocytic lymphohistiocytosis complicated by polyserositis:A case report

BACKGROUND Hemophagocytic lymphohistiocytosis(HLH)is a rare group of disorders of immune dysregulation characterized by clinical symptoms of severe inflammation.There are basically two types of clinical scenarios:Familial HLH and sporadic HLH.It is thought that the syndrome is implicated in the development of infections,malignancies,and autoimmune diseases.HLH,whether primary or secondary,is characterized by activated macrophages in hematopoietic organs,hepatosplenomegaly,cytopenia,and fever;however,HLH complicated with polyserositis(PS)has never been reported.CASE SUMMARY We present a case of fever in a 46-year-old previously healthy Chinese woman complicated by pericardial,pleural,and abdomen effusions.She had no contact with sick individuals,recent travel,illicit drug use,or new sexual contacts.She did not consume alcohol or tobacco and lacked a family history of other diseases.Antibiotics were prescribed for suspected infection,and acute liver injury subsequently occurred.Contrast-enhanced computed tomography showed mild pericardial effusion,pleural effusion,hepatosplenomegaly,and a large amount of ascites.A full blood count revealed leukopenia and thrombocytopenia.Increased ferritin and triglyceride levels were observed.The test for Epstein-Barr(EB)virus DNA was positive.This suggests that EB virus replication and EB virus infection existed.Additional studies showed hemophagocytosis in bone marrow biopsy specimens.The patient’s condition progressed rapidly.After providing symptomatic support treatment,eliminating immune stimuli,and administering comprehensive cyclosporine and dexamethasone treatment,the patient’s condition continued to progress,and the patient’s family members decided to stop treatment;the patient subsequently died.CONCLUSION This case shows the significance of considering HLH as part of the evaluation of unexplained fever and PS of unknown origin.

Acute inferior ST-segment elevation myocardial infarction cryptogenic stroke caused by a paradoxical embolism with pulmonary embolism and previous a concomitant

A 61-year-old woman was hospitalized for a chief complaint of sudden chest tightness with sweating for two hours. The chest tightness and sweating occurred suddenly and without remission after a morning stool. Electrocardiography showed a complete atrioventricular （AV） block and arc-like elevation of the ST-segment in leads Ⅱ, Ⅲ, AVF, V7-V9, and V3R-V5R, at about 0.05-0. 15 mV. After being administered 1 mg of atropine in the emergency room （ER）, the patient was admitted to the cardiology department. The patient had been found in a cyanotic state two years previously, but did not receive any treatment; she was diagnosed with a transient ischemic attack （TIA） 1.5 years previously because of limb dyskinesia accompanied by slurred speech.

Recommendations for the timing,dosage,and usage of corticosteroids during cytokine release syndrome(CRS)caused by chimeric antigen receptor(CAR)-T cell therapy for hematologic malignancies

Clinical question What are the recommendations for the timing,dosage,and usage of corticosteroids during cytokine release syndrome(CRS)caused by chimeric antigen receptor(CAR)-T cell therapy for hematologic malignancies?