Effect of early enteral nutrition on postoperative nutritional status and immune function in elderly patients with esophageal cancer or cardiac cancer

To explore the effect of early enteral nutrition （EN） on postoperative nutritional status, intestinal permeability, and immune 6anction in elderly patients with esophageal cancer or cardiac cancer. Methods： A total of 96 patients with esophageal cancer or cardiac cancer who underwent surgical treatment in our hospital from June 2007 to December 2010 were enrolled in this study. They were divided into EN group （n=50） and parenteral nutrition （PN） group （n=46） based on the nutrition support modes. The body weight, time to first flatus/defecation, average hospital stay, complications and mortality after the surgery as well as the liver function indicators were recorded and analyzed. Peripheral blood samples were collected on the days 1, 4 and 7 after surgery. The plasma diamine oxidase （DAO） activity and D-lactate level were determined to assess the intestinal permeability. The plasma endotoxin levels were determined using dynamic turbidimetric assay to assess the protective effect of EN on intestinal mucosal barrier. The postoperative blood levels of inflammatory cytokines and immunoglobulins were determined using enzyme- linked immunosorbent assay （ELISA）. Results： After the surgery, the time to first flatus/defecation, average hospital stay, and complications were significantly less in the EN group than those in the PN group （P〈0.05）, whereas the EN group had significantly higher albumin levels than the PN group （P〈0.05）. On the 7th postoperative day, the DAO activity, D-lactate level and endotoxin contents were significantly lower in the EN group than those in the PN group （all P〈0.05）. In addition, the EN group had significantly higher IgA, IgG, IgM, and CD4 levels than the PN group （P〈0.05） but significantly lower IL-2, IL-6, and TNF-a levels （P〈0.05）. Conclusions： In elderly patients with esophageal cancer or cardiac cancer, early EN after surgery can effectively improve the nutritional status, protect intestinal mucosal barrier （by reducing plasma endoxins）, and enhance the immune function

Clinical comparison of laparoscopy vs open surgery in a radical operation for rectal cancer: A retrospective casecontrol study

AIM: To assess the diverse immediate and longterm clinical outcomes, a retrospective comparison between laparoscopic and conventional operation was performed.METHODS: A total number of 916 clinical cases, from January 2006 to December 2013 in our hospital, were analyzed which covered 492 patients underwent the laparoscopy in radical resection(LRR) and 424 cases in open radical resection(ORR). A retrospective analysis was proceeded by comparing the general information, surgery performance, pathologic data, postoperative recovery and complications as well as long-term survival to investigate the diversity of immediate and long-term clinical outcomes of laparoscopic radical operation.RESULTS: There were no statistically significance differences between gender, age, height, weight, body mass index(BMI), tumor loci, tumor node metastasis stages, cell differentiation degree or American Society of Anesthesiologists scores of the patients(P > 0.05). In contrast to the ORR group, the LRR group experienced less operating time(P < 0.001), a lower blood loss(P < 0.001), and had a 2.44% probability of conversion to open surgery. Postoperative bowel function recovered more quickly, analgesic usage and the average hospital stay(P < 0.001) were reduced after LRR. Lymph node dissection during LRR appeared to be slightly more than in ORR(P = 0.338). There were no obvious differences in the lengths and margins(P = 0.182). And the occurrence rate in the two groups was similar(P = 0.081). Overall survival rate of ORR and LRR for 1, 3 and 5 years were 94.0% and 93.6%(P = 0.534), 78.1% and 80.9%(P = 0.284) and 75.2% and 77.0%(P = 0.416), respectively.CONCLUSION: Laparoscopy as a radical operation for rectal cancer was safe, produced better immediate outcomes. Long-term survival of laparoscopy revealed that it was similar to the open operation.

Enhanced MGMT expression contributes to temozolomide resistance in glioma stem-like cells

O6-methylguanine DNA methyltransferase(MGMT) can remove DNA alkylation adducts, thereby repairing damaged DNA and contributing to the drug resistance of gliomas to alkylating agents. In addition, glioma stem-like cells(GSCs) have been demonstrated to be involved in the recurrence and treatment resistance of gliomas. In this study, we aimed to investigate MGMT expression and regulatory mechanisms in GSCs and the association of MGMT with temozolomide(TMZ) sensitivity. GSCs were enriched from one MGMT-positive cell line(SF-767) and 7 MGMT-negative cell lines(U251, SKMG-4, SKMG-1, SF295, U87, MGR1, and MGR2) through serum-free clone culture. GSCs from the U251G, SKMG-4G, SF295G, and SKMG-1G cell lines became MGMT-positive, but those from the U87G, MGR1G, and MGR2G cell lines remained MGMT-negative. However, all the GSCs and their parental glioma cell lines were positive for nuclear factor-κB(NF-κB). In addition, GSCs were more resistant to TMZ than their parental glioma cell lines(P < 0.05). However, there was no significant difference in the 50% inhibition concentration(IC50) of TMZ between MGMT-positive and MGMT-negative GSCs(P > 0.05). When we treated the MGMT-positive GSCs with TMZ plus MG-132(an NF-κB inhibitor), the antitumor activity was significantly enhanced compared to that of GSCs treated with TMZ alone(P < 0.05). Furthermore, we found that MGMT expression decreased through the down-regulation of NF-κB expression by MG-132. Our results show that MG-132 may inhibit NF-κB expression and further decrease MGMT expression, resulting in a synergistic effect on MGMT-positive GSCs. These results indicate that enhanced MGMT expression contributes to TMZ resistance in MGMT-positive GSCs.

Stanniocalcin-1 Detection of Peripheral Blood in Patients with Colorectal Cancer

Objective： Stanniocalcin-1 （STC-1）, a kind of glycoprotein hormone, is universally up-regulated in various tumor tissues compared to corresponding normal tissues, suggesting it may be used as a tumor marker, whilst disseminated tumor cells usually exist in peripheral blood. The aim of this study is to investigate the mRNA expression STC-1 in peripheral blood of colorectal cancer （CRC） and analyze its clinicopathological significance. Methods： The peripheral blood mononuclear cells （PBMNCs） were isolated from 78 CRC patients and 33 cancer-free controls. The expression status of STC-1 mRNA in PBMNCs was assessed by RT-PCR, its correlation with clinicopathological parameters and 5-year overall survival was analyzed as well. Results： In the 78 blood samples from CRC patients, 33 （42.31%） showed positive expression of STC-1 mRNA, and all of 15 gastrointestinal tumor tissues were positive for STC-1 mRNA. In contrast, all the blood samples from 14 healthy donors and 19 patients with inflammatory gastrointestinal disease were negative. Furthermore, STC-1 mRNA expression status was associated with patients’ advanced stage, distant metastasis and shortened overall survival. Conclusion： The detection of STC-1 mRNA in peripheral blood by RT-PCR was highly sensitive and specific for the patients with CRC. STC-1 mRNA may be a potential biomarker for detecting tumor micrometastasis and predicting prognosis.

Effective doctor-patient communication skills training optimizes functional organization of intrinsic brain architecture:a restingstate functional MRI study

We studied the influence of doctor-patient communication skills training on brain functional architecture using resting-state functional MRI（rs-fMRI） with a regional homogeneity（ReHo） method. Ten medical students participated in the study. A 1-year long doctor-patient communication skills training program was conducted. RsfMRI data were collected at baseline, one month and one year after training. There was a significant increase in the communication skills test average scores between baseline and 1-month duration of training（P〈0.001）. After one month of communication skills training, medical students had decreased ReHo in the right superior temporal gyrus compared with the baseline. After one year of communication skills training, students had increased ReHo in multiple regions and decreased ReHo in several regions（P 〈0.05, Alphasim corrected）. The change of ReHo values in the superior temporal gyrus negatively correlated with the change of communication skills scale score between one month after communication skills training and baseline（r=-0.734, P= 0.036）. The training program we used can be an effective approach of improving doctor-patient communication skills, and the training resulted in functional plasticity of the brain’s architecture toward optimizing locally functional organization.

Rapid progression of nonculprit coronary lesions six weeks after successful primary PCI in culprit artery:a case report

We report a case of a 49-year-old man who was admitted with a 3-hour history of sudden onset of substemal chest pain. Coronary angiography revealed that the left circumflex artery （LCX） was acutely and totally occluded at the mid-portion. In addition, the proximal and mid-portion of the right coronary artery （RCA） had a 60% occlusion. We inferred that the LCX was the culprit artery and primary PCI was successfully performed. Six weeks later, the patient had an eventful course with recurrence of chest pain. Coronary angiography showed no significant ste- nosis in the previous LCX lesion, while the proximal and middle potion of the RCA had a 90% occlusion. Our case demonstrates the systemic nature of acute coronary syndromes and highlights the inherent instability of coronary artery disease.

Liver injury changes the biological characters of serum small extracellular vesicles and reprograms hepatic macrophages in mice

BACKGROUND Serum small extracellular vesicles(sEVs)and their small RNA(sRNA)cargoes could be promising biomarkers for the diagnosis of liver injury.However,the dynamic changes in serum sEVs and their sRNA components during liver injury have not been well characterized.Given that hepatic macrophages can quickly clear intravenously injected sEVs,the effect of liver injury-related serum sEVs on hepatic macrophages deserves to be explored.AIM To identify the characteristics of serum sEVs and the sRNAs during liver injury and explore their effects on hepatic macrophages.METHODS To identify serum sEV biomarkers for liver injury,we established a CCL4-induced mouse liver injury model in C57BL/6 mice to simulate acute liver injury(ALI),chronic liver injury(CLI)and recovery.Serum sEVs were obtained and characterized by transmission electron microscopy and nanoparticle tracking analysis.Serum sEV sRNAs were profiled by sRNA sequencing.Differentially expressed microRNAs(miRNAs)were compared to mouse liver-enriched miRNAs and previously reported circulating miRNAs related to human liver diseases.The biological significance was evaluated by Ingenuity Pathway Analysis of altered sEV miRNAs and conditioned cultures of ALI serum sEVs with primary hepatic macrophages.RESULTS We found that both ALI and CLI changed the concentration and morphology of serum sEVs.The proportion of serum sEV miRNAs increased upon liver injury,with the liver as the primary contributor.The altered serum sEV miRNAs based on mouse studies were consistent with human liver disease-related circulating miRNAs.We established serum sEV miRNA signatures for ALI and CLI and a panel of miRNAs(miR-122-5p,miR-192-5p,and miR-22-3p)as a common marker for liver injury.The differential serum sEV miRNAs in ALI contributed mainly to liver steatosis and inflammation,while those in CLI contributed primarily to hepatocellular carcinoma and hyperplasia.ALI serum sEVs decreased both CD86 and CD206 expression in monocyte-derived macrophages but increased CD206 expression in resident macrophages in vitro.CONCLUSION Serum sEVs acquired different concentrations,sizes,morphologies and sRNA contents upon liver injury and could change the phenotype of liver macrophages.Serum sEVs therefore have good diagnostic and therapeutic potential for liver injury.

Computed tomography imaging features for amyloid dacryolith in the nasolacrimal excretory system:A case report

BACKGROUND Nasolacrimal duct obstruction leading to epiphora is a common ophthalmologic complaint,and it may derive from amyloidosis in rare cases.There are a few reports about localized amyloidosis,and amyloidosis with involvement and obstruction of the nasolacrimal duct is exceedingly rare.CASE SUMMARY A 54-year-old male presented with a 2-year history of a lump overlying the left lacrimal sac that had grown rapidly for nearly half a year.Physical examination touched a firm lump in the left lacrimal sac.Nasal endoscopy discovered lesions in appearance of sediments with easy bleeding at the entry of the nasolacrimal duct of the left inferior nasal meatus.Computerized tomography scan revealed speckle high density in the left lacrimal sac and the dilated nasolacrimal duct.During an endoscopic exploration and excision,a large number of dacryoliths were exposed.Pathology indicated amorphous pink material and multinucleated giant cell reaction in the fibrous tissue.CONCLUSION This case showed amyloidosis in localized form mimicking dacryolith with nasolacrimal duct obstruction.In clinical practice,we should be aware of the possibility of localized amyloidosis in the nasolacrimal excretory system.

Glossopharyngeal Neuralgia Due to Vertebrobasilar Dolichoectasia Coexisting with Fusiform Aneurysm of the Basilar Artery

Glossopharyngeal neuralgia (GPN) refers to paroxysmal severe pain located to glossopharyngeal part or ear, which is a rare clinical event. In this report, we describe a patient suffered from glossopharyngeal neuralgia due to vertebrobasilar dolichoectasia (VBD). A 72-year-old Chinese male was referred to our clinic with a complaint of paroxysmal severe pain in the right external auditory canal and auricle since 1 month, which could be precipitated by feed and accompanied with the vagus nerve irritation (bradycardia, low blood pressure, syncope) sometimes. Both computed tomographic angiography and digital subtraction angiography demonstrated a VBD (maximum diameter 5.7 mm) and a large fusiform aneurysm of basilar artery (maximum diameter 13.8 mm). The diagnosis is established on clinical and radiological signs. This is the first report of this kind in the literature. Although a few cases demonstrate that VBD can cause GPN, it should be considered as a possible etiology in patients with GPN.

Differential regulation of JAK1 expression by ETS1 associated with predisposition to primary biliary cholangitis

Primary biliary cholangitis(PBC)is an autoimmune liver disease characterized by the destruction of intrahepatic small bile ducts and progressive cholestasis,eventually leading to liver cirrhosis and hepatic failure without appropriate treatment(Terziroli Beretta-Piccoli et al.,2019).

The application of Tau protein testing to gastric cancer patients treated with paclitaxel

Paclitaxel is one of the main drugs used to treat gastric cancer,but many tumors develop drug resistance,resulting in treatment failure.The levels of expression of Tau protein in breast tumors have been found to be related to paclitaxel resistance,suggesting that Tau protein expression may predict breast cancer sensitivity to paclitaxel treatment.To determine whether Tau protein expression can predict gastric cancer sensitivity to paclitaxel,we assayed Tau protein expression levels in gastric cancer specimens from 70 patients.We observed Tau protein expression in 54 of 70(77.1%)specimens.Assays in gastric cancer cell lines showed that Tau protein expression was significantly lower in BGC823 than in MKN45 cells(P=0.0147).MTT assays showed that different concentrations of paclitaxel inhibited the growth of MKN45 and BGC823 cells,but inhibition and apoptosis were more obvious in cells expressing low levels of Tau protein.Paclitaxel chemotherapy was effective in 34 of the 70 patients(48.6%)and was significantly correlated with low expression of Tau protein(P<0.01).These findings indicate that Tau protein is expressed in a high percentage of gastric cancers,with paclitaxel being more effective in tumors with low Tau expression.

Formulation optimization and in vitro antibacterial ability investigation of azithromycin loaded FDKP microspheres dry powder inhalation

Azithromycin loaded fumaryl diketopiperazine(FDKP)dry powder inhalation was designed and prepared for the treatment of community-acquired pneumonia.The solubility of FDKP and stability of azithromycin solution was investigated.Formulation of azithromycin loaded FDKP microparticle was investigated and optimized by the single factor experiment.High-pressure homogenization and spray drying conditions were also optimized to prepare the particles by spray drying azithromycin dissolved FDKP microparticle suspension at pH 4.5.The in vitro antibacterial efficiency and in vitro dispersion performance was also investigated to confirm the antibacterial efficiency,dispersion and deposition behavers.FDKP/azithromycin mass ratio(3:2)was the optimized formulation of azithromycin loaded FDKP microparticle with the maximal drug loading efficiency.High-pressure homogenization and spray drying conditions were also optimized.The in vitro antibacterial results indicated that only with the antibiotic concentration higher than mutant prevention concentration could totally inhibit the reproduction of bacteria.In vitro dispersion performance of azithromycin loaded FDKP microparticles(AZM@FDKP-MPs)also shows remarkable improvement of dispersion and deposition behavers of AZM.AZM@FDKP-MPs dry powder inhalation as a targeting delivery route has better potential for lung infection treatment.

Liver support therapy with molecular adsorbents recirculating system in liver failure： a summary of 252 cases from 14 centers in China

Background A liver support therapy, named molecular adsorbents recirculating system （MARS）, has been used for more than 700 liver failure patients in China. We made here a summary to evaluate the effects of MARS treatment in different applications with emphasis on hepatitis B virus （HBV） based liver failure. Methods This report analyzed data of 252 patients （mean age （44.9±12.7） years） in three groups： acute severe hepatitis （ASH）, subacute severe hepatitis （SSH） and chronic severe hepatitis （CSH）. The largest group was CSH （156 patients, 61.9%）, and 188 patients （74.6%, 188/252） were infected with HBV. Results MARS treatments were associated with significant reduction of albumin bound toxins and water-soluble toxins. Most of the patients showed a positive response with a significant improvement of multiple organ function substantiated by a significant increase in prothrombin time activity （PTA） and median arterial pressure （MAP）. There was a decrease in hepatic encephalopathy （HE） grade and Child-Turcotte-Pugh （CTP） scale. Thirty-nine of 188 HBV patients （20.7%） dropped out of the commendatory consecutive therapy ending with lower survival of 43.6% while the rest of the 149 patients had a survival rate of 62.4%. Survival within the ASH and SSH groups were 81.2% and 75.0%, respectively. In the CSH group, end stage patients were predominant （65/151,43%）, whereas the early and middle stage patients had a better prognosis： early stage survival, including orthotopic liver transplantation （OLT） survival of 91.7%, middle stage survival of 75%, end stage survival of 33.8%. Conclusions MARS continues to be the most favorable extracorporeal treatment for liver support therapy in China for a wide range of conditions, including the majority of hepatitis B related liver failure conditions. The appropriate application of MARS for the right indications and stage of hepatic failure, as well as the fulfillment of prescribed treatments, will lead to the optimal therapeutic result.

Exhaled breath diagnostics of lung and gastric cancers in China using nanosensors

Dear Editor,Breath analysis is a promising diagnostic approach for various conditions[1,2].It is based on the identification of volatile organic compounds(VOCs)emitted in the breath,which creates a unique volatolomic signature[3].Owing to their characteristics,VOCs can be measured non-intrusively from the breath or other body sources[3,4].Several studies have shown the diagnostic potential for a variety of conditions based on VOC analysis[5-9].Malignant diseases,where early detection is crucial,are the main focus of VOC analysis,with lung cancer(LC)and gastric cancer(GC)being the most studied.LC and GC together were responsible for approximately 2.5 million deaths globally in 2018[10].The aim of VOC analysis of the breath using sensors is to identify a“VOC-print”comprising the total abundances and ratios of the compounds in the breath,giving an overall unique chemical pattern[11].