Effect of comprehensive nursing intervention on perioperative anxiety and sleep quality in elderly patients with digestive tract malignancies.

OBJECTIVE: To analyze the effect of comprehensive nursing intervention on perioperative anxiety and sleep quality in elderly patients with digestive tract malignancies. METHODS: In this retrospective study, a total of 96 elderly patients with digestive tract malignancies treated in The First People's Hospital of Wenling from January 2020 to July 2021 were included into a comprehensive group (n=49, comprehensive nursing) and a conventional group (n=47, conventional nursing) according to different intervention methods. Anxiety was assessed using Self-rating Anxiety Scale (SAS) and Hamilton Anxiety Scale (HAMA), and sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI). RESULTS: The scores of SAS and HAMA of the comprehensive group on day 1 before surgery and day 7 after surgery were lower than those of the conventional group (P<0.05). After intervention, PSQI score of the comprehensive group was lower than that of the conventional group (P<0.05). The comprehensive group had a higher percentage of rapid eye movement sleep, sleep efficiency, and subjective sleep quality scores, and had lower arousal index on the 1st night after surgery than the conventional group (P<0.05). The comprehensive group had a lower incidence of complications and mortality than the conventional group (P<0.05). Univariate analysis showed that the mortality of elderly patients with digestive tract malignancies was significantly higher in patients with age over 70 years old, negative emotions, low degree of tumor differentiation, tumor stage III-IV, history of surgery, no preoperative chemoradiotherapy and conventional nursing. Poorly differentiated tumor, stage III-IV, history of surgery, and conventional nursing were independent risk factors (P<0.05). CONCLUSION: Comprehensive nursing intervention could effectively improve the perioperative anxiety and sleep quality as well as reduce the incidence of complications in elderly patients with digestive tract malignancies. Attention should be paid to the degree of tumor differentiation, tumor stage, and surgical history in the perioperative period.

Exploration of the role of serum ghrelin in the diagnosis and treatment of digestive tract malignancies.

OBJECTIVE: The incidence of digestive tract malignancies (DTMs) is increasing, early diagnosis is limited, and treatment effects are unsatisfactory. DTMs express ghrelin, which might be involved in tumor formation and development; whether serum ghrelin can provide useful guidance remains unknown. METHODS: Sera of healthy individuals were obtained from October 2017 through March 2018; serum samples from patients with gastric (GC), colon (CC), and rectal (RC) cancers were collected during the same period. Serum ghrelin was tested by ELISA and correlated with clinicopathology of patients with DTMs. RESULTS: Serum ghrelin was higher in patients (GC, 38 patients; CC, 24; RC, 26) than in 69 healthy individuals and decreased significantly after tumor resection. Nutrition Risk Screening 2002 score and neutrophil:lymphocyte ratio affected perioperative serum ghrelin levels. The epithelial cell marker AE1/AE3 (pan keratin) in patients with GC, tumor location in the colon in patients with CC, and age in patients with RC also affected perioperative serum ghrelin. CONCLUSIONS: Serum ghrelin might provide early warning of occurrence and guide prognosis of DTMs. Ghrelin can be used when screening for nutritional risk and inflammation. The clinicopathological influence on serum ghrelin in patients with DTMs is related to tumor location in the digestive tract.

Cancer stem cells in human digestive tract malignancies.

Digestive tract malignancies, including oral, pharyngeal, esophageal, gastric, and colorectal cancers, are among the top 10 most common cancers worldwide. In spite of using various treatment modalities, cancer patients still suffer from recurrence and metastasis of malignant cells. Cancer stem cells (CSCs) are undifferentiated and highly proliferative malignant cells with unique properties mediated by overexpression of stemness markers, metastasis-related proteins, drug transporters, and DNA repair machinery. Due to their salient characteristics, it has been suggested that CSCs are responsible for tumor initiation, progression, invasion, recurrence, and therapy resistance. Exploring different aspects of CSC biology has fueled a great enthusiasm in designing novel therapeutic strategies to help patients. For instance, identification of markers associated with digestive tract CSCs, such as CD44, CD133, CD24, EpCAM, LGR5, ALDH1, and BMI1, has made it possible to develop more accurate diagnosis approaches. In addition, specifically targeting CSCs by their markers imposes fewer side effects and improves therapeutic outcomes. Here, we focus on the current status of CSC biology in digestive tract cancers, with emphasis on CSC markers, and review achieved progress in eradication of digestive tract CSC cells.

Synchronous occurrence of gastrointestinal stromal tumors and other digestive tract malignancies in the elderly.

BACKGROUND/AIMS: Elderly patients with gastrointestinal stromal tumors (GISTs) synchronous with other digestive tract malignancies have been rarely reported. In this study, clinicopathological characteristics were evaluated among elderly patients with GISTs with or without coexisting digestive tract malignancies. METHODS: A total of 161 patients (≥65 years) were retrospectively reviewed at the West China Hospital, Sichuan University from January 2009 to June 2014. RESULTS: Sixty-one patients were diagnosed with synchronous digestive tract malignancies (synchronous group), whereas 100 patients were diagnosed with no synchronous condition (no-synchronous group). The synchronous group exhibited a higher percentage of males (70.49% vs. 53.00%, P = 0.028) and poorer Eastern Cooperative Oncology Group performance status than the no-synchronous group (P = 0.029). The three-year overall survival (OS) rate was significantly lower among patients with synchronous digestive tract malignancies than that among patients without synchronous condition (64.5% vs. 84.0%, P = 0.003). Multivariate analysis showed that the presence of synchronous digestive tract malignancies (P = 0.002), co-morbidity (P = 0.004), and mitotic count ≥10 mitoses/50 high power fields (P = 0.012) were associated with poor OS. CONCLUSIONS: A synchronous condition with other digestive tract malignancies is common in elderly patients with GISTs. OS primarily depends on synchronous digestive tract malignancies, mitotic count, and co-morbidity.

Concurrent gastrointestinal stromal tumor and digestive tract carcinoma: a single institution experience in China.

The aim of this study was to review the clinicopathological characteristics and survival outcomes of patients with concurrent gastrointestinal stromal tumor (GIST) and digestive tract carcinoma. Among 585 patients diagnosed with GIST from January 2005 to July 2014, 32 (5.5%) had synchronous digestive tract carcinoma, including 19 (59.4%) men and 13 (40.6%) women. The median age was 64 years (range, 43-84). GIST was located in the stomach (n=24), small intestine (n=6), duodenum (n=1) and retroperitoneum (n=1). GISTs were intra- or postoperatively discovered (n=28) or preoperatively identified (n=4). The tumor size was less than 10 mm (microGIST) in 23 (71.9%) GIST patients. The preoperatively identified GIST subgroup showed a significantly larger tumor size, more mitotic figures and a higher risk grade than the intra- or postoperatively identified GIST subgroup. Concurrent digestive tract carcinomas were most frequently located in the stomach (24 cases, 75%). The other involved sites were the esophagus (n=5), duodenum (n=2) and colon (n=1). With a median follow-up of 32 months (range, 9-80), 24 patients were alive without evidence of disease, 6 patients had died of carcinoma progression, 1 patient had died from an accident, and 1 patient experienced GIST metastasis to the liver. In summary, we discovered that 5.5% of GIST patients also developed a concurrent digestive tract carcinoma in a series of 585 GIST cases. The majority of GISTs are incidentally identified microGISTs. The concurrent carcinoma seems to have a greater unfavorable effect on prognosis than the GIST. However, for a GIST that is identified preoperatively with a high risk of progression, adjuvant therapy is warranted.

Bacteraemia due to Streptococcus gallolyticus subspecies pasteurianus is associated with digestive tract malignancies and resistance to macrolides and clindamycin.

OBJECTIVES: This study was intended to delineate the association between digestive tract malignancies and bacteraemia due to Streptococcus gallolyticus subspecies pasteurianus. METHODS: We reviewed the medical records and microbiological results of patients with bacteraemia due to Streptococcus bovis during the period 2000-2012. Species and subspecies identification of isolates originally classified as S. bovis was confirmed by 16S rRNA sequencing and PCR restriction fragment length polymorphism (PCR-RFLP) assays. Minimum inhibitory concentrations of antimicrobial agents were determined by the broth microdilution method. RESULTS: Of the 172 S. bovis complex isolates obtained from 172 patients (age range, <1-94 years, median age, 66) with bacteraemia, 31 isolates were identified to be S. gallolyticus subspecies gallolyticus, 126 were S. gallolyticus subspecies pasteurianus, and 15 were shown to be Streptococcus infantarius. The majority (n = 104, 60%) of patients were male and had underlying malignancies (n = 87, 51%). Bacteraemia due to S. gallolyticus subspecies gallolyticus was significantly associated with endocarditis while S. gallolyticus subspecies pasteurianus was more likely to be associated with malignancies of the digestive tract, including gastric, pancreatic, hepatobiliary and colorectal cancers. Septic shock at presentation was the only factor associated with mortality among patients with bacteraemia due to either subspecies of S. bovis. Isolates of S. gallolyticus subspecies pasteurianus had higher rates of resistance to macrolides and clindamycin than isolates of S. gallolyticus subspecies gallolyticus. CONCLUSION: Extensive diagnostic work-up for digestive tract malignancies and trans-esophageal echocardiogram should be investigated in patients with bacteraemia caused by S. gallolyticus.