Circulating metabolites as potential biomarkers for the early detection and prognosis surveillance of gastrointestinal cancers.

BACKGROUND AND AIMS: Two of the most lethal gastrointestinal (GI) cancers, gastric cancer (GC) and colon cancer (CC), are ranked in the top five cancers that cause deaths worldwide. Most GI cancer deaths can be reduced by earlier detection and more appropriate medical treatment. Unlike the current "gold standard" techniques, non-invasive and highly sensitive screening tests are required for GI cancer diagnosis. Here, we explored the potential of metabolomics for GI cancer detection and the classification of tissue-of-origin, and even the prognosis management. METHODS: Plasma samples from 37 gastric cancer (GC), 17 colon cancer (CC), and 27 non-cancer (NC) patients were prepared for metabolomics and lipidomics analysis by three MS-based platforms. Univariate, multivariate, and clustering analyses were used for selecting significant metabolic features. ROC curve analysis was based on a series of different binary classifications as well as the true-positive rate (sensitivity) and the false-positive rate (1-specificity). RESULTS: GI cancers exhibited obvious metabolic perturbation compared with benign diseases. The differentiated metabolites of gastric cancer (GC) and colon cancer (CC) were targeted to same pathways but with different degrees of cellular metabolism reprogramming. The cancer-specific metabolites distinguished the malignant and benign, and classified the cancer types. We also applied this test to before- and after-surgery samples, wherein surgical resection significantly altered the blood-metabolic patterns. There were 15 metabolites significantly altered in GC and CC patients who underwent surgical treatment, and partly returned to normal conditions. CONCLUSION: Blood-based metabolomics analysis is an efficient strategy for GI cancer screening, especially for malignant and benign diagnoses. The cancer-specific metabolic patterns process the potential for classifying tissue-of-origin in multi-cancer screening. Besides, the circulating metabolites for prognosis management of GI cancer is a promising area of research.

A Comprehensive Mass Spectrometry-Based Workflow for Clinical Metabolomics Cohort Studies.

As a comprehensive analysis of all metabolites in a biological system, metabolomics is being widely applied in various clinical/health areas for disease prediction, diagnosis, and prognosis. However, challenges remain in dealing with the metabolomic complexity, massive data, metabolite identification, intra- and inter-individual variation, and reproducibility, which largely limit its widespread implementation. This study provided a comprehensive workflow for clinical metabolomics, including sample collection and preparation, mass spectrometry (MS) data acquisition, and data processing and analysis. Sample collection from multiple clinical sites was strictly carried out with standardized operation procedures (SOP). During data acquisition, three types of quality control (QC) samples were set for respective MS platforms (GC-MS, LC-MS polar, and LC-MS lipid) to assess the MS performance, facilitate metabolite identification, and eliminate contamination. Compounds annotation and identification were implemented with commercial software and in-house-developed PAppLineTM and UlibMS library. The batch effects were removed using a deep learning model method (NormAE). Potential biomarkers identification was performed with tree-based modeling algorithms including random forest, AdaBoost, and XGBoost. The modeling performance was evaluated using the F1 score based on a 10-times repeated trial for each. Finally, a sub-cohort case study validated the reliability of the entire workflow.

[Surgery for scapular neck displaced fracture].

OBJECTIVE: To study the appropriate approach and method of fixation in the surgery for scapular neck displaced fracture. METHODS: Fourteen patients with serious step-off displacement of glenoid rim, with a distance of 3 cm (2 approximately 4 cm) involving fresh scapular neck fracture, all located from the superior scapular notch to glenoid armpit rim and passing through the mesoscapula, all of the type II according to the Miller's system, 10 males and 4 females, aged 33 (21 - 60). The surgical indications included a distance of step-off displacement exceeding 1 cm and a time between the injury and operation of 3 - 10 days. RESULTS: All operations were successful without injury of nerve and blood vessels. All the wounds obtained primary healing within 6 weeks (4 - 8 weeks). X-ray plain films showed that all cases obtained complete or nearly complete anatomical reduction. Follow-up carried out for 1 - 7 years showed no complication. According to the Hardegger's evaluation, 8 cases showed excellent prognosis, 4 showed good prognosis, and 2 showed fair prognosis. CONCLUSION: Operation is necessary for step-off displacement of glenoid rim involving scapular neck fracture. Hard and with regular shape, the mesoscapula and armpit rim suits for fixation. Open reduction through posterior approach and internal fixation in prone position help recover the morphology and biomechanics characteristic of scapula. Propitious to functional recovery, dirigation should begin early.