Meta-analysis: Over-the-scope clips in patients at high risk of re-bleeding following upper gastrointestinal tract bleeding.

BACKGROUND: Acute non-variceal upper gastrointestinal bleeding (UGIB) is challenging in patients at high risk of re-bleeding in whom standard endoscopic treatment (ST) has limited effectiveness. Over-the-scope clips (OTSC) have shown promise in these patients although their precise role remains uncertain. AIMS: To confirm the role of OTSC in patients with UGIB at high risk of re-bleeding. METHODS: We systematically searched CENTRAL, MEDLINE and Embase from January 1st, 1970 to April 24, 2024 for randomised controlled trials (RCTs) comparing OTSC and ST in acute non-variceal UGIB with high re-bleeding risk. The GRADE framework assessed evidence certainty, while trial sequential analysis (TSA) controlled random errors and evaluated conclusion validity. RESULTS: We analysed four RCTs (319 patients); pooled risk ratio (RR) for clinical success at initial endoscopy favoured OTSC (RR = 1.30, 95% CI = 1.08-1.56, p = 0.006, I2 = 58%, moderate certainty of evidence). TSA showed the desired sample size was 410 and the cumulative Z curve crossing the trial sequential monitoring boundary. The pooled RR for re-bleeding within 30 days favoured OTSC (RR = 0.53, 95% CI = 0.30-0.94, p = 0.03, I2 = 0%, moderate certainty of evidence). There was no significant difference in 30-day mortality, or length of hospital or ICU stay. CONCLUSIONS: Moderate certainty evidence supports OTSC as a superior initial treatment for acute non-variceal UGIB with high re-bleeding risk. Further large-scale studies are needed to confirm OTSCs' role by exploring other prognostic outcomes and assessing cost-effectiveness and potential complications.

CD14 overexpression upregulates TNF-α-mediated inflammatory responses and suppresses the malignancy of gastric carcinoma cells.

CD14 mediates the inflammatory response via recognition of lipopolysaccharide, which has been implicated in Helicobacter pylori (H. pylori) infections. Increasing evidence has suggested that CD14 status significantly influences the clinical outcome of H. pylori infection, which can result in gastric carcinoma. However, there is little evidence regarding the cellular impact and associated molecular basis of CD14 on gastric carcinoma cells. To address this question, we generated a CD14-overexpressing SGC-7901 gastric carcinoma cell line and analyzed the impact of CD14 expression. Our results revealed that cells overexpressing CD14 exhibited antitumor potential, including significantly decreased clonogenic ability, proliferation, metastatic invasion, as well as enhanced apoptosis, suggesting a tumor-suppressive role of CD14 in the cells. Intriguingly, we further discovered that CD14 overexpression activated NF-κB via upregulating its expression and simultaneously stimulating DNA binding activity. Upregulated NF-κB transcriptionally elevated a series of pro-inflammatory cytokines, including TNF-α, IL-1ß, IL-6, and IL-12. Together, the current study utilized a CD14-overexpressing gastric cell model to determine the impacts of CD14 upregulation on cell viability, apoptosis, and migration and NF-κB-mediated inflammation.

[Celecoxib inhibits gastric adenocarcinoma growth via inducing expression of human nonsteroidal anti-inflammatory drug activated gene].

OBJECTIVE: To investigate the effect of cyclooxygenase2 inhibitor celecoxib on the suppression of human gastric cancer (GC) growth and the induction of nonsteroidal anti-inflammatory drug activated gene (NAG-1) expression. METHODS: Thirty-six GC patients were randomly divided into two groups before curative surgery. Celecoxib group patients (n = 20) took celecoxib orally 0.2 g, qd for 7 days before operation. Control group (n = 16) took no medication before resection. The resected specimens were used for histological and pathological study, and apoptosis of tumor cells were evaluated by the terminal deoxynucleotide transferase (TdT)-mediated dUTP nick end-labeling assay (TUNEL). COX-2 expression was assessed by immunohistochemical staining. Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) assay was used to measure NAG-1 mRNA expression in GC tissue of both groups. RESULTS: Apoptosis IOD score of the GC cells in celecoxib group was significantly higher than that in control group (180.2 +/- 42.67 vs 10.28 +/- 5.02, P < 0.05). NAG-1 mRNA expression was higher in celecoxib group (0.22 +/- 0.13) than in the control (0.12 +/- 0.08, P < 0.05). There was no significant difference of COX-2 expression rate between both groups (75.0% vs 87.6%, P > 0.05). CONCLUSION: Celecoxib can enhance apoptosis of GC cell by induction of NAG-1 gene transcription in human.