Periampullary duodenal neuroendocrine tumor in a patient with neurofibromatosis-1:A case report

BACKGROUND Patients with neurofibromatosis type 1(NF1)are exposed to a higher risk of developing neuroendocrine tumors(NETs).Periampullary neuroendocrine neoplasms(NENs)in NF1 patients primarily affect the duodenum and periampullary region.CASE SUMMARY A 50-year-old male patient was admitted to our hospital due to progressive skin and scleral yellowing for over 6 months.An abdominal contrast-enhanced computed tomography scan revealed a tumor in the periampullary region,which measured 1.2 cm×1.4 cm in size and showed a progressive enhancement.Magnetic resonance cholangiopancreatography indicated the dilation of intrahepatic and extrahepatic bile ducts.The patient was diagnosed with an ampullary tumor with the possibility of malignancy.A Whipple procedure was performed.Microscopically,the duodenum tumor was found to invade the mucosa,sphincter,and muscular layer of the duodenal papilla.Histologic hematoxylin and eosin staining confirmed the presence of duodenal G1 NET.Subsequently,a bibliometric analysis was performed to evaluate the state of NEN research.Publications about periampullary NENs showed an annual increase,with most of them focusing on the treatment and diagnosis of NENs.CONCLUSION This article reported a case of periampullary duodenal NET in a patient with NF1,and a bibliometric analysis was conducted.

Metronomic capecitabine inhibits liver transplant rejection in rats by triggering recipients’T cell ferroptosis

BACKGROUND Capecitabine(CAP)is a classic antimetabolic drug and has shown potential antirejection effects after liver transplantation(LT)in clinical studies.Our previous study showed that metronomic CAP can cause the programmed death of T cells by inducing oxidative stress in healthy mice.Ferroptosis,a newly defined non-apoptotic cell death that occurs in response to iron overload and lethal levels of lipid peroxidation,is an important mechanism by which CAP induces cell death.Therefore,ferroptosis may also play an important role in CAP-induced T cell death and play an immunosuppressive role in acute rejection after transplantation.AIM To investigate the functions and underlying mechanisms of antirejection effects of metronomic CAP.METHODS A rat LT model of acute rejection was established,and the effect of metronomic CAP on splenic hematopoietic function and acute graft rejection was evaluated 7 d after LT.In vitro,primary CD3+T cells were sorted from rat spleens and human peripheral blood,and co-cultured with or without 5-fluorouracil(5-FU)(active agent of CAP).The levels of ferroptosis-related proteins,ferrous ion concentration,and oxidative stress-related indicators were observed.The changes in mitochondrial structure were observed using electron microscopy.RESULTS With no significant myelotoxicity,metronomic CAP alleviated graft injury(Banff score 9 vs 7.333,P<0.001),prolonged the survival time of the recipient rats(11.5 d vs 16 d,P<0.01),and reduced the infiltration rate of CD3+T cells in peripheral blood(6.859 vs 3.735,P<0.001),liver graft(7.459 vs 3.432,P<0.001),and spleen(26.92 vs 12.9,P<0.001),thereby inhibiting acute rejection after LT.In vitro,5-FU,an end product of CAP metabolism,induced the degradation of the ferritin heavy chain by upregulating nuclear receptor coactivator 4,which caused the accumulation of ferrous ions.It also inhibited nuclear erythroid 2 p45-related factor 2,heme oxygenase-1,and glutathione peroxidase 4,eventually leading to oxidative damage and ferroptosis of T cells.CONCLUSION Metronomic CAP can suppress acute allograft rejection in rats by triggering CD3+T cell ferroptosis,which makes it an effective immunosuppressive agent after LT.

Risk factors for myocardial injury during living donor liver transplantation in pediatric patients with biliary atresia

BACKGROUND Cold ischemia-reperfusion of the liver is an inevitable occurrence in liver trans-plantation that may also cause damage to the heart.Perioperative myocardial injury during liver transplantation can increase the incidence of post-operative mortality,but there is little research on the incidence of myocardial injury in children who undergo living donor liver transplantation(LDLT).Therefore,this study mainly explores the independent risk factors for myocardial injury in children who undergo LDLT.factors for intraoperative myocardial injury.METHODS We retrospectively analyzed the inpatient records of pediatric patients who underwent LDLT in Tianjin First Central Hospital from January 1,2020,to January 31,2022.Recipient-related data and donor-related data were collected.The patients were divided into a myocardial injury group and a nonmyocardial injury group according to the value of the serum cardiac troponin I at the end of surgery for analysis.Univariate analysis and multivariate logistic regression were used to evaluate the risk factors for myocardial injury during LDLT in pediatric patients.RESULTS A total of 302 patients met the inclusion criteria.The myocardial injury group had 142 individuals(47%),and the nonmyocardial injury group included 160 patients(53%).Age,height,and weight were significantly lower in the myocardial injury group(P<0.001).The pediatric end-stage liver disease(PELD)score,total bilirubin,and interna-tional standardized ratio were significantly higher in the myocardial injury group(P<0.001).The mean arterial pressure,lactate,hemoglobin before reperfusion,duration of the anhepatic phase,cold ischemic time,incidence of postreperfusion syndrome(PRS),and fresh frozen plasma transfusion were significantly different between the two groups(P<0.05).The postoperative intensive care unit stay and peak total bilirubin values in the first 5 d after LDLT were significantly higher in the myocardial injury group(P<0.05).The pediatric patients with biliary atresia in the nonmyocardial injury group who underwent LDLT had a considerably higher one-year survival rate than those in the myocardial injury group(P=0.015).Multivariate logistic regression revealed the following independent risk factors for myocardial injury:a high PELD score[odds ratio(OR)=1.065,95%confidence interval(CI):1.013-1.121;P=0.014],a long duration of the anhepatic phase(OR=1.021,95%CI:1.003-1.040;P=0.025),and the occurrence of intraoperative PRS(OR=1.966,95%CI:1.111-3.480;P=0.020).CONCLUSION A high PELD score,a long anhepatic phase duration,and the occurrence of intraoperative PRS were independent risk factors for myocardial injury during LDLT in pediatric patients with biliary atresia.

Overexpression of kallikrein gene 10 is a biomarker for predicting poor prognosis in gastric cancer

AIM:To analyze the expression of kallikrein gene 10(KLK10)in gastric cancer and to determine whether KLK10 has independent prognostic value in gastric cancer.METHODS:We studied KLK10 expression in 80 histologically confirmed gastric cancer samples using realtime quantitative reverse transcription-PCR and hK10expression using immunohistochemistry.Correlations with clinicopathological variables(lymph node metastasis,depth of invasion and histology)and with outcomes(disease-free survival and overall survival)during a median follow-up period of 31 mo were assessed.Gastric cancer tissues were then classified as KLK10 positive or negative.RESULTS:KLK10 was found to be highly expressed in 57/80(70%)of gastric cancer samples,while its expression was very low in normal gastric tissues.Positive relationships between KLK10 expression and lymph node metastasis(P=0.048),depth of invasion(P=0.034)and histology(P=0.015)were observed.Univariate survival analysis revealed that gastric cancer patients with positive KLK10 expression had an increased risk for relapse/metastasis and death(P=0.005 and0.002,respectively).Cox multivariate analysis indicated that KLK10 was an independent prognostic indicator of disease-free survival and overall survival in patients with gastric cancer.CONCLUSION:KLK10 expression is an independent biomarker of unfavorable prognosis in patients with gastric cancer.

The effect of advance care planning in patients with dementia: a protocol of systematic review and meta-analysis

Aim:To comprehensively synthesize and compare the effect of advance care planning for dementia patients.Design:Systematic review and meta-analysis.Methods:Ten electronic databases will be searched:the Cochrane Library,PubMed,Medline,Embase,PsycINFO,CINAHL PLUS,Scopus,Web of Science,British Nursing Index,clinical Trials,and grey literature sources.Individually or cluster randomized controlled trials that evaluated advance care planning in people with dementia will be incorporated.The research screening flow diagrams will be detailed in the PRISMA flow chart.Data extraction will be carried out in Microsoft Excel 2019 independently by two researchers,any disagreements will be discussed with the third researcher and resolved.We will use the Cochrane Risk of Bias tool to assess the methodological quality.Review Manager 5.3 Software will be used for data synthesis.If sufficient data from studies are available,we will conduct a subgroup analysis of the main outcomes.Conclusion:The systematic review will combine existing trials which may contribute to more convincing conclusions,providing new ideas for medical workers to implement palliative therapy in dementia patients,and further promoting the application of advance care planning for dementia patients.

Key role of interferon regulatory factor 1(IRF-1)in regulating liver disease:progress and outlook

Interferon regulatory factor 1(IRF-1)is a member of the IRF family.It is the first transcription factor to be identified that could bind to the interferon-stimulated response element(ISRE)on the target gene and displays crucial roles in the interferoninduced signals and pathways.IRF-1,as an important medium,has all of the advantages of full cell cycle regulation,cell death signaling transduction,and reinforcing immune surveillance,which are well documented.Current studies indicate that IRF-1 is of vital importance to the occurrence and evolution of multifarious liver diseases,including but not limited to inhibiting the replication of the hepatitis virus(A/B/C/E),alleviating the progression of liver fibrosis,and aggravating hepatic ischemiareperfusion injury(HIRI).The tumor suppression of IRF-1 is related to the clinical characteristics of liver cancer patients,which makes it a potential indicator for predicting the prognosis and recurrence of liver cancer;additionally,the latest studies have revealed other effects of IRF-1 such as protection against alcoholic/non-alcoholic fatty liver disease(AFLD/NAFLD),cholangiocarcinoma suppression,and uncommon traits in other liver diseases that had previously received little attention.Intriguingly,several compounds and drugs have featured a protective function in specific liver disease models in which there is significant involvement of the IRF-1 signal.In this paper,we hope to propose a prospective research basis upon which to help decipher translational medicine applications of IRF-1 in liver disease treatment.