A novel method of cardia visualization and comfort level enhancement during magnetic capsule gastroscopy via sugar-glued tether-assisted technique: a randomized pilot study inspired by a Chinese snack-making process (with video).

BACKGROUND: Magnetic capsule gastroscopy (MCG) is a non-invasive diagnostic method for the digestive tract. However, its efficiency in visualizing the gastric cardia is often compromised due to the capsule's rapid passage. This study introduces a novel sugar-glued tether-assisted technique inspired by a traditional Chinese snack-making process to enhance cardia visualization and patient comfort during MCG. METHODS: This pilot, open-label, single-center, randomized controlled, non-inferiority study was conducted at Binzhou Medical University Hospital. Seventy-eight patients were enrolled and divided into three groups: conventional MCG, suction cup tether-assisted MCG, and sugar-glued tether-assisted MCG. The primary outcomes included safety, comfort level, and gastric cardia visualization quality. Secondary outcomes assessed technique-associated performance and clinical factors. RESULTS: The sugar-glued tether-assisted MCG demonstrated comparable cardia visualization quality to the suction cup method, with significantly better results than conventional MCG. Comfort levels were significantly higher in the sugar-glued group compared to the suction cup group. The number of swallow attempts was significantly lower in the sugar-glued group, with no adverse events reported. Secondary outcomes showed no significant differences in MCG assembly time and ingestion-to-detachment period between the suction cup and sugar-glued groups. CONCLUSION: The sugar-glued tether-assisted MCG is a feasible and safe modification that enhances gastric cardia visualization while improving patient comfort. This technique provides a cost-effective alternative to the suction cup method, warranting further investigation in larger, multi-center studies.

Achalasia Cardia: A Case Series.

ABSTRACT: Achalasia cardia is a rare disorder that impacts the lower esophageal sphincter and esophageal body. Due to its wide range of symptoms, it can be difficult to diagnose. Here we report three cases of Achalasia Cardia during a period of 9 months. The first patient, an 18-year-old male, presented with dysphagia and was evaluated with barium swallow and high-resolution manometry (HRM) revealing Achalasia Cardia. In the second case, a 37-year-old female had a prolonged diagnostic journey due to multiple comorbidities before a barium swallow finally revealed achalasia cardia. The third patient, a 47-year-old female was promptly diagnosed with barium swallow. All the cases were successfully treated with laparoscopic Heller's myotomy with anterior Dor's fundoplication. This case series highlights the potential for delayed diagnosis and the importance of early recognition, tailored diagnostic approaches, and the efficacy of surgical management.

Visceral to subcutaneous fat area ratio predicts early postoperative small bowel obstruction after total gastrectomy for cardia cancer.

OBJECTIVE: We aimed to investigate the relationship between the visceral to subcutaneous fat area ratio (V/S ratio) and incidence of early postoperative small bowel obstruction (EPSBO) following total gastrectomy for cardia cancer. METHODS: We conducted a retrospective analysis among patients with cardia cancer who underwent elective total gastrectomy with esophagojejunostomy Roux-en-Y anastomosis at Nanjing Yimin Hospital between November 2019 and April 2024. Preoperative, intraoperative, and postoperative factors were meticulously monitored. The V/S ratio was calculated using computed tomography scans at the umbilical level with Slice-O-Matic software (Tomovision, Montreal, Canada). Statistical analyses included logistic regression and receiver operating characteristic (ROC) curve analysis. RESULTS: Among 175 patients, 27 (15.4%) developed EPSBO. The V/S ratio was significantly higher in the EPSBO group (1.76 ± 1.05 vs. 1.01 ± 0.54). Logistic regression identified the V/S ratio as a significant predictor of EPSBO (odds ratio [OR] = 1.612, 95% [CI]: 1.102-1.605). ROC curve analysis demonstrated high sensitivity (92%) and specificity (100%) for the V/S ratio in predicting EPSBO, with a 0.83 AUC. CONCLUSIONS: Our findings indicated a higher V/S ratio was a significant predictor of EPSBO following total gastrectomy for cardia cancer. Preoperative assessment of the V/S ratio can inform risk stratification and guide targeted interventions to improve postoperative outcomes.

Neonatal Achalasia Cardia: A Case Report.

Achalasia cardia is more common in adults between the ages of 30 and 60 years. It is relatively uncommon in children and very rare in infants. Only a few cases of infants with achalasia have been reported till now. It is a motility disorder of the esophagus due to a failure to relax the lower esophageal sphincter. The common clinical presentations in infants are regurgitation, vomiting, respiratory symptoms, and failure to thrive. This can be easily misdiagnosed as gastroesophageal reflux disease. Surgical management is the mainstay of treatment. Here, we present the case of a female newborn with symptoms suggestive of achalasia from day one of life and successfully treated with Heller's esophagocardiomyotomy and Nissen's fundoplication, following which the baby is asymptomatic and thriving well.

Novel DNA methylation markers for early detection of gastric cardia adenocarcinoma and esophageal squamous cell carcinoma.

Gastric cardia adenocarcinoma (GCA) and esophageal squamous cell carcinoma (ESCC) present significant health challenges in China, often diagnosed at advanced stages with poor prognoses. However, effective biomarkers for early detection remain elusive. This study aimed to integrate methylome and transcriptome data to identify DNA methylation markers for the early detection of GCA and ESCC. In the discovery stage, we conducted Infinium MethylationEPIC array analysis on 36 paired GCA and non-tumor adjacent tissues (NAT), identifying differentially methylated CpG sites (DMCs) between GCA/ESCC and NAT through combined analyses of in-house and publicly available data. In the validation stage, targeted pyrosequencing and quantitative real-time RT-PCR were performed on paired tumor and NAT samples from 50 GCA and 50 ESCC patients. In the application stage, an independent set of 438 samples, including GCA, ESCC, high- and low-grade dysplasia (HGD/LGD), and normal controls, was tested for selected DMCs using pyrosequencing. Our analysis validated three GCA-specific, two ESCC-specific, and one tumor-shared DMCs, exhibiting significant hypermethylation and decreased expression of target genes in tumor samples compared with NAT. Leveraging these DMCs, we developed a GCA-specific 4-marker panel (cg27284428, cg11798358, cg07880787, and cg00585116) with an area under the receiver operating characteristic curve (AUC) of 0.917, effectively distinguishing between cardia HGD/GCA patients and cardia LGD/normal controls. Similarly, an ESCC-specific 3-marker panel (cg14633892, cg04415798, and cg00585116) achieved an AUC of 0.865 in distinguishing esophageal HGD/ESCC cases. Furthermore, integrating cg00585116, age, and alcohol consumption yielded a tumor-shared logistic model with good discrimination for two cancer/HGD (AUC, 0.767; 95% confidence interval, 0.720-0.813). The mean AUC of the model after 5-fold cross-validation was 0.764. In summary, our study identifies novel DNA methylation markers capable of accurately distinguishing GCA/ESCC and HGD from LGD and normal controls. These findings offer promising prospects for targeted DNA methylation assays in future minimally invasive cancer screening methods.

Developing a prognostic signature: identifying differentially expressed genes in cardia and non-cardia gastric cancer for immunity and therapeutic sensitivity analysis.

Background: Gastric cancer (GC) can be anatomically categorized into two subtypes; that is, cardia gastric cancer (CGC) and non-cardia gastric cancer (NCGC), which have distinct molecular mechanisms and prognoses. At present, the majority of pharmacological interventions for GC adhere to non-specific treatment regimens. The stratification of GC based on molecular disparities between CGC and NCGC has important clinical guidance value and could help in the development of precision therapies tailored to individual patient needs. Nevertheless, research in this specialized field remains notably limited. This study aims to investigate the molecular differences between CGC and NCGC and to leverage these differences to develop a prognostic risk scoring model (PRSM). Methods: We used patient data from The Cancer Genome Atlas (TCGA) and performed a differentially expressed gene (DEG) analysis between CGC and NCGC. A PRSM was developed from the prognosis-associated DEGs identified through Cox regression analyses and was well validated using Gene Expression Omnibus (GEO) data. Results: A total of 339 DEGs were identified between CGC and NCGC, and four prognosis-associated genes were used to construct the PRSM. Using the risk coefficients and expression levels of signature genes, a median risk score (RS) was calculated to classify patients into high- and low-risk groups. The high-risk group had a significantly worse prognosis than the low-risk group. An in-depth analysis revealed that TP53 mutations were more prevalent in the high-risk group, and MUC16 mutations were more prevalent in the low-risk group. A gene set enrichment analysis (GSEA) and the CIBERSORT algorithm were used to assess the differences in the significantly enriched pathways and immune microenvironment in the high- and low-risk groups, respectively. The inhibitory concentration (IC50) values of the chemotherapy drugs for GC also varied between the two groups. Conclusions: This study elucidated the unique molecular characteristics of GC subtypes based on the anatomical site and provided a preliminary contribution for the development of precision medicine for GC.

Physical activity and the risk of developing 8 age-related diseases: epidemiological and Mendelian randomization studies.

BACKGROUND: We aimed to characterize the associations between physical activity levels and the risk of developing age-related diseases in the Coronary Artery Risk Development in Young Adults (CARDIA) study and used Mendelian randomization (MR) to assess whether there are causal relationships between physical activity levels and the risk of developing 8 age-related diseases (coronary atherosclerosis, ischemic heart disease, angina, Alzheimer's disease, hypertension, type 2 diabetes, hyperlipidemia, and venous thromboembolism). METHODS: Based on the data available in the CARDIA, we obtained data related to five disease states: coronary heart disease, hypertension, diabetes, hyperlipidemia, and venous thromboembolism. Binary logistic regression analysis estimated the multivariable-adjusted associations between different physical activity statuses and diseases. For the MR study, we used summary-level data from a recently published genome-wide association study on physical activity (including vigorous physical activity and accelerometer-based physical activity) conducted with participants from the UK Biobank study. We selected the above 8 age-related diseases as our outcomes. RESULTS: In the CARDIA-based analysis, the risk of developing coronary heart disease [OR (95% CI): 0.562 (0.397-0.795)], hypertension [OR (95% CI): 0.703 (0.601-0.821)], diabetes [OR (95% CI): 0.783 (0.620-0.988)], and hyperlipidemia [OR (95% CI): 0.792 (0.662-0.949)] was negatively related to physical activity status when participants achieved the physical activity target. Our MR results support a negative causal association between genetically determined vigorous physical activity levels and the risk of developing 3 age-related diseases, namely, angina, hypertension and type 2 diabetes. Moreover, our results also support a negative causal association between genetically determined accelerometer-based physical activity levels and the risk of developing angina. CONCLUSIONS: Promotion of physical activity is likely to prevent specific age-related diseases.

BBOX1-AS1 promotes gastric cardia adenocarcinoma progression via interaction with CtBP2 to facilitate the epithelial-mesenchymal transition process.

It is recognized that lncRNA BBOX1-AS1 exerts a crucial oncogenic property in several cancer types. However, the functions and underlying mechanisms of BBOX1-AS1 in the epithelial-mesenchymal transition (EMT) process of gastric cardia adenocarcinoma (GCA) have remained unclarified. The findings of this study demonstrated that GCA tissues had elevated BBOX1-AS1 expression levels, which was associated with a worse prognosis in GCA patients. BBOX1-AS1 dramatically enhanced cell proliferation, invasion, and TGF-ß1-induced the EMT process in vitro. Further mechanism analysis revealed that BBOX1-AS1 could combine with CtBP2 and strengthen the interaction of CtBP2 and ZEB1. BBOX1-AS1 might regulate the E-cadherin expression through CtBP2/ZEB1 transcriptional complex-mediated transcriptional repression, further affecting the activation of the Wnt/ß-catenin pathway and the EMT process. Overall, our findings demonstrate that BBOX1-AS1 might act as an lncRNA associated with EMT for facilitating GCA advancement via interaction with CtBP2 to facilitate the activation of Wnt/ß-catenin pathway and the EMT process, which indicated that it might function as an exploitable treatment target for GCA patients.

Detection of early hidden carcinoma of cardia by reversely entering the esophagus with magnetically controlled capsule endoscopy: A case report.

Magnetically controlled capsule endoscopy (MCE) is a non-invasive method for gastropathy examination. However, due to the influence of gravity and lumen structure, the traditional capsule endoscopy rapidly passes through the cardia, leading to insufficient observation of the cardia mucosa. Case Summary. The patient, a 53-year-old male, had a history of subarachnoid hemorrhage for 5 years, and it has been 5 years since the aneurysm embolization.Computed Tomography Angiography (CTA) indicated the presence of an anterior cruciate aneurysm. Given the risks associated with traditional intubated gastroscopy, magnetic controlled capsule gastroscopy was chosen for gastric examination. Following the standard operating procedure, routine magnetic controlled capsule endoscopy was performed, and no lesions were detected.We combined magnetic force and patient posture adjustment to guide the capsule to pass through the cardia slowly and return to the esophagus, successfully detecting a concealed cardia lesion.Afterwards, the lesions of the cardia were treated with a magnifying gastroscope and endoscopic submucosal dissection (ESD).Pathological findings showed that adenocarcinoma was confined to the mucosa membrane, and in the postoperative pathological study, no tumor remnants or metastasis were discovered. This paper reports a case of a patient undergoing a physical examination, but no lesion was found during a routine examination using the magnetically controlled capsule gastroscope. However, we discovered a case of hidden early cardia cancer after guiding the capsule gastroscope back into the esophagus under magnetic control.

Transverse versus longitudinal mucosal incision during POEM for esophageal motility disorders: a randomized trial.

BACKGROUND: Longitudinal incision is the commonly used incision for entry into the submucosal space during peroral endoscopic myotomy (POEM) for esophageal motility disorders. Transverse incision is another alternative for entry and retrospective data suggest it has less operative time and chance of gas-related events. METHODS: This was a single-center, randomized trial conducted at a tertiary care hospital. Patients undergoing POEM for esophageal motility disorders were randomized into group A (longitudinal incision) and group B (transverse incision). The primary objective was to compare the time needed for entry into the submucosal space. The secondary objectives were to compare the time needed to close the incision, number of clips required to close the incision, and development of gas-related events. The sample size was calculated as for a non-inferiority design using Kelsey method. RESULTS: Sixty patients were randomized (30 in each group). On comparing the 2 types of incisions, there was no difference in entry time [3 (2, 5) vs 2 (1.75, 5) min, p = 0.399], closure time [7 (4, 13.5) vs 9 (6.75, 19) min, p = 0.155], and number of clips needed for closure [4 (4, 6) vs 5 (4, 7), p = 0.156]. Additionally, the gas-related events were comparable between the 2 groups (capnoperitoneum needing aspiration-5 vs 2, p = 0.228, and development of subcutaneous emphysema-3 vs 1, p = 0.301). CONCLUSION: This randomized trial shows comparable entry time, closure time, number of clips needed to close the incision, and gas-related events between longitudinal and transverse incisions. REGISTRATION NUMBER: CTRI/2021/08/035829.

Risk, Predictive Factors, and Nomogram of Liver Metastatic Gastroesophageal Junction Cancer: A New Study Based on the Surveillance, Epidemiology, and End Results Database.

BACKGROUND AND OBJECTIVES:  Liver metastases are associated with a poor prognosis in gastroesophageal junction (GEJ) cancer patients. The high rate of liver involvement is attributed to the unique anatomical location of the GEJ, which is close to the liver. Patients with liver metastasis typically have advanced, unresectable disease and limited treatment options. Therefore, early detection and prediction are crucial to guide appropriate treatment planning and improve the outcomes for patients with GEJ cancer at risk of liver metastases. Using data from the Surveillance, Epidemiology, and End Results (SEER) database, the present study aimed to elucidate the incidence and risk factors of liver metastases in GEJ cancer patients diagnosed between 2010 and 2019. METHODS: This research employed univariable and multivariable logistic regression models to identify risk factors for the development of liver metastases. A predictive nomogram for liver metastases was developed and assessed. Patients' overall survival (OS) with liver metastases was analyzed using the Kaplan-Meier method. RESULTS: The study included 1,322 eligible patients with GEJ cancer, 181 (13.6%) of whom were diagnosed with liver metastases. The median overall survival (mOS) for patients with liver metastasis was approximately eight months, compared to a shorter mOS for patients without liver metastasis (P < 0.001). Factors significantly associated with the occurrence of liver metastasis included N3 stage (OR: 1.84; 95% CI: (1.13-2.96); P < 0.001), surgery (OR: 0.09; 95% CI: (0.06-0.14); P < 0.001), lung metastasis (OR: 2.88; 95% CI: (1.78-4.63); P < 0.001), chemotherapy (OR: 0.54; 95% CI: (0.32-0.87); P < 0.001), and radiation therapy (OR: 0.33; 95% CI: (0.25-0.45); P < 0.001). The nomogram demonstrated good performance in predicting liver metastases in GEJ cancer patients (c-index: 0.820). CONCLUSIONS: The study identified lymph node status, surgical, lung metastasis, chemotherapy, and radiation as important predictors of outcomes for patients with GEJ cancer. The developed nomogram might be a valuable tool for predicting the risk of liver metastases in GEJ cancer patients, potentially enhancing clinical decision-making processes. By predicting the risk of liver metastasis occurrence, clinicians might intervene in patients with GEJ cancers as early as possible.

Gastroesophageal reflux following per-oral endoscopic myotomy: Can we improve outcomes?

This editorial is an analysis the review article by Nabi et al recently published in this journal. Achalasia Cardia is a disease whose pathophysiology is still unclear. It is known that there is inflammation of unknown aetiology leading to loss of ganglion cells in the muscularis propria. The end result is lower oesophageal sphincter spasm, loss of receptive relaxation, decreased oesophageal peristalsis, all leading on to varying degrees of dysphagia. The treatment of this condition is palliative in nature, performed by myotomy of the lower oesophagus either surgically or endoscopically. Gastroesophageal reflux disease (GERD) has been associated with the myotomy performed, particularly with the Peroral Endoscopic Myotomy (POEM) procedure. Nabi et al have provided an excellent overview of the latest developments in predicting, preventing, evaluating, and managing GERD subsequent to POEM. Based on this theme, this review article explores the concept of using histology of the oesophageal muscle layer, to grade the disease and thereby help tailoring the length/type of myotomy performed during the POEM procedure. In the future, will a histology based algorithm available preoperatively, help modify the POEM procedure, thereby decreasing the incidence of GERD associated with POEM?

Risk of Second Primary Cancer Among Patients with Cardio-Esophageal Cancer in Finland: A Nationwide Population-Based Study.

Purpose: The occurrence of a second primary cancer (SPC) after primary esophageal carcinoma (EC) or gastric cardia carcinoma(GCC) is well acknowledged. However, previous research on the risk of SPC among these patients has been predominantly conducted in Asian countries. Yet, notable population-dependent variation in histological types and risk profiles exists. This register-based study assesses the histology-specific risk of SPC among individuals initially diagnosed with a first primary EC or GCC. Patients and Methods: We obtained data on 7197 patients diagnosed with EC/GCC in Finland between 1980 and 2022 from the Finnish Cancer Registry. Standardized incidence ratios (SIR) of SPC were subsequently calculated relatively to the cancer risk of the general population. Results: The average and median follow-up times were 2.8 years and 10.5 months. Adenocarcinomas and squamous cell carcinomas comprised 57.8% (n = 4165) and 36.6% (n = 2631) of all cases, respectively. An increased SIR was noted among EC/GCC patients after 15-20 years of follow-up (SIR 1.49, 95% CI: 1.01-2.11). Among adenocarcinoma patients, an increased SIR for SPCs of the digestive organs was seen in the 40-54-year-old group (SIR 9.86, 95% CI: 3.62-21.45). Squamous cell carcinoma patients displayed increased SIRs for cancer of the mouth/pharynx (SIR 3.20, 95% CI: 1.17-6.95) and respiratory organs (1.77, 1.07-2.76). Conclusion: Healthcare professionals should be aware of the increased risk of SPCs occurring in the mouth/pharynx, respiratory and digestive organs in survivors of EC/GCC. Patients should be advised about this risk and remain alert for symptoms, even beyond the standard 5-year follow-up period.

Right ventricle pierced by a traditional sharp hair straightener: a case report.

The case presents a traumatic ventricular perforation of a girl, accidentally felt on a sharp instrument. The uniqueness of the case presented is due to the very high infrequency of injuries with this type of sharp object. The 7-year-old girl was transported to the hospital after accidentally falling on a sharp instrument. The child had no signs of heart failure. On opening the chest, it was found that the metal object was lodged in the right ventricle. Quickly proceeded to remove the object and suture the entry hole. After a short hospitalization, the child was discharged completely cured.

Cardiovascular Autonomic Deficits in Different Types of Achalasia.

Background and objective Achalasia cardia is a primary esophageal motility disorder, and the etiopathology of this disease's progression is not known. Moreover, autonomic dysfunction has not been studied in different types of achalasia. In light of this, we aimed to address this lack of data in this study. Methods The diagnosis of achalasia was done using high-resolution esophageal manometry (HRM)-based Chicago classification v4.0. Autonomic function tests (AFT) such as the head-up tilt test, deep breathing test (DBT), Valsalva maneuver (VM), handgrip test (HGT), and cold pressor test (CPT), as well as the heart rate variability (HRV) test, were performed among the cohort and the results were compared with those of 39 age- and sex-matched healthy controls. Results AFT and HRV tests were done on 62 patients (30 achalasia type I, 28 type II, and 4 type III) and compared with 39 age- and sex-matched healthy controls. The mean duration of symptoms, high Eckardt score, and dysphagia were most common in type I achalasia, followed by type II and III. The results of AFT showed a generalized loss of parasympathetic and baroreflex-independent sympathetic reactivity in all types of achalasia. However, baroreflex-dependent cardiovascular adrenergic reactivity was normal. Regarding cardiac autonomic tone, there was a loss of parasympathetic and sympathetic influence, but sympathovagal balance was maintained. The severity of the loss of autonomic functions was higher in type I, followed by type II. Conclusions In all types of achalasia, parasympathetic reactivity, baroreflex-independent sympathetic reactivity, and cardiac autonomic tone were lower compared to healthy controls, and the severity of dysfunction increased during the progression of the disease from type II to type I.

Case Report: The molecular fingerprint and the clinical implication of an exceptional response to neoadjuvant therapy in a metastatic cardia adenocarcinoma.

Background: Globally, gastric cancer holds the fifth position in terms of prevalence among malignant tumors and is the fourth leading cause of cancer-related mortality. Particular attention should be paid to cardia adenocarcinoma (CA) due to its increasing incidence and poor prognosis. Diagnosis of CA frequently occurs in advanced stages because of its late symptoms. In such cases, neoadjuvant chemotherapy is the primary treatment option. The response to chemotherapy depends on multiple variables including the tumor's molecular profile, the patient's performance status, and the feasibility of using targeted therapy. Patients exhibiting an exceptional response, defined as a complete response to medical therapy lasting more than 1 year, or a partial response or stable disease lasting more than 2 years, are rarely described. This case report presents one of the longest-lasting exceptional responses to chemotherapy in metastatic cardia adenocarcinoma and discusses its clinical implications. Case presentation: A 49-year-old male patient presented with cardia adenocarcinoma (human epidermal growth factor receptor 2 negative, mismatch repair proficient) and liver metastases. Molecular profiling identified a pathogenic mutation in the TP53 gene (R123W; Arg123Trp) as the sole alteration found. Five months after initiating the neoadjuvant chemotherapy with fluorouracil-leucovorin-oxaliplatin-docetaxel, the patient achieved a complete clinical response. The molecular profile was compared with others previously documented in an international data portal, revealing a similar pattern. At 4 years and 3 months from diagnosis, the exceptional response was still confirmed. The patient underwent a cumulative number of 33 cycles of chemotherapy, leading to chemotherapy-induced liver damage. Conclusions: Exceptional responses to neoadjuvant chemotherapy in cardia adenocarcinomas are rarely reported. The documentation of exceptional responses to cancer therapies should be included in large data repositories to explore the molecular fingerprint of these tumors. In such cases, the clinical implications of long-term chemotherapy should always be taken into account.

Impact of optimal cholesterol levels on subclinical atherosclerosis in the absence of risk factors in young adults.

BACKGROUND AND AIMS: We aimed to assess the association of blood lipids with the prevalence, incidence, and progression of subclinical atherosclerosis among young individuals without dyslipidemia and other traditional cardiovascular risk factors (CVRFs). METHODS: A total of 1270 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study aged 32-46 years free of cardiovascular disease, diabetes, hypertension, current smoking, and dyslipidemia (total cholesterol [TC] ≥ 240 mg/dL, triglycerides [TG] ≥ 150 mg/dL, low-density lipoprotein cholesterol [LDL-C] ≥ 160 mg/dL, high-density lipoprotein cholesterol [HDL-C] < 40 mg/dL, or taking lipid-lowering medications) were included. A subgroup with optimal lipids within the low-CVRF group was defined with TC < 200 mg/dL, LDL-C < 100 mg/dL, non-HDL-C < 130 mg/dL, and women with HDL-C ≥ 50 mg/dL. RESULTS: 1-SD higher TC (25.9 mg/dL), LDL-C (24.7 mg/dL), and non-HDL-C (26.6 mg/dL) were associated with a greater risk of presence (hazard ratios: 1.30-1.36), incidence (1.30-1.32), and progression (1.31-1.35) of coronary artery calcium (CAC) and a 42-44% greater odds of composite mean carotid intima-media thickness (CIMT) ≥ 75th percentile [780 µm] (p < 0.05). Repeating the analyses in a subset of participants with a CAC score of zero did not alter the association of TC, LDL-C, and non-HDL-C with CIMT. In the subgroup with optimal lipids, these lipid indices remained associated with an increased risk of presence and incidence of CAC and greater CIMT measures. CONCLUSIONS: Among adults aged 32-46 years, in the absence of traditional CVRFs, elevated cholesterol levels, even within what is considered optimal, are associated with atherosclerosis and arteriopathy.

The association between dietary fiber intake and gastric cancer: a pooled analysis of 11 case-control studies.

PURPOSE: Gastric cancer (GC) is among the leading causes of cancer mortality worldwide. The objective of this study was to investigate the association between dietary fiber intake and GC. METHODS: We pooled data from 11 population or hospital-based case-control studies included in the Stomach Cancer Pooling (StoP) Project, for a total of 4865 histologically confirmed cases and 10,626 controls. Intake of dietary fibers and other dietary factors was collected using food frequency questionnaires. We calculated the odds ratios (OR) and 95% confidence intervals (CI) of the association between dietary fiber intake and GC by using a multivariable logistic regression model adjusted for study site, sex, age, caloric intake, smoking, fruit and vegetable intake, and socioeconomic status. We conducted stratified analyses by these factors, as well as GC anatomical site and histological type. RESULTS: The OR of GC for an increase of one quartile of fiber intake was 0.91 (95% CI: 0.85, 0.97), that for the highest compared to the lowest quartile of dietary fiber intake was 0.72 (95% CI: 0.59, 0.88). Results were similar irrespective of anatomical site and histological type. CONCLUSION: Our analysis supports the hypothesis that dietary fiber intake may exert a protective effect on GC.