Analysis of fragment size distribution of cell-free DNA: A potential non-invasive marker to monitor graft damage in living-related liver transplantation for inborn errors of metabolism.

Graft-derived-cell-free DNA (Gcf-DNA) in plasma is a promising biomarker to monitor graft-rejection after liver transplantation (LTx). However, current methods of measuring Gcf-DNA have several limitations including high cost, long turnaround-time and the need to request donor's genetic information. In this study, eleven patients diagnosed with different inborn errors of metabolism (IEMs) who required living-related LTx were enrolled in order to establish a potentially useful noninvasive method to monitor graft damage. Circulating cell-free DNA (cfDNA) was extracted from plasma specimens serially collected at specific time points (day 0, day 1, day 7, day 14, day 30, day 60) after LTx. The distribution of Gcf-DNA fragment sizes was measured using sequencing read lengths and quantified by using Y-chromosome capture methodology in seven sex-mismatched recipients. In the analysis of fragment size distribution, we observed Gcf-DNA exhibited smaller fragment sizes than the recipient-cfDNA. Based on this phenomenon, two fragment sizes (105-145 bp, 160-170 bp) of the cfDNA pool were extracted to enrich Gcf-DNA. Accordingly, the ratio of short fragments to long fragments (S/L-Frag) in cfDNA was calculated. A high S/L-Frag ratio pointed towards an early trend of graft injury when compared to two routine liver function enzymes (ALT and AST) and Gcf-DNA, and it significantly correlated with ALT (P < 0.0001) and AST (P < 0.0001) during full-blown rejection. In conclusion, we established the Gcf-DNA size profile in patients who have undergone living-related LTx and established a potential biomarker to monitor graft function after LTx.

Outcomes of single-port gasless laparoscopic breast-conserving surgery for breast cancer: An observational study.

To compare the clinical efficacy and aesthetic perspectives between single-port gasless laparoscopic breast-conserving surgery (SGL-BCS) and traditional breast-conserving surgery (T-BCS) in early-stage breast cancer. A total of 70 patients who were diagnosed with stage I or stage II breast cancer participated in this study, which 35 patients underwent SGL-BCS, while others underwent T-BCS. There were no death or severe intraoperative complications, and none of the patients exhibited regional recurrence, distant metastases, or any critical complications after 2 years follow-up. SGL-BCS is feasible and safe surgery, and has advantages in terms of a single, shorter, hidden incision, high-satisficed aesthetic outcome and less intraoperative blood loss.

Endoscopic submucosal dissection for early esophageal squamous cell carcinoma after ligation and sclerotherapy of esophageal and gastric varices.

Esophageal cancer ranked ten of the most common cancers in China. With the advancement of high-quality endoscopy and chromoendoscopic technique, early esophageal cancer can be diagnosed more easily, even combined with esophageal-gastric fundal varices. Endoscopic resection of early esophageal cancer is a minimally invasive treatment method for early esophageal cancer, and endoscopic submucosal dissection (ESD) is one of the standard treatments for early esophageal cancer in view of the risk of bleeding, the patient in this study successfully received ESD treatment after using endoscopic variceal ligation and endoscopic injection of tissue glue and sclerosing agent before ESD surgery. ESD treatment is safe and feasible for early esophageal cancer patients with cirrhosis of esophageal-gastric fundal varices.

Laparoscopic endoscopic cooperative surgery for the duodenal neuroendocrine tumor: a single-center case series (How I Do It).

BACKGROUND: Duodenal neuroendocrine tumors (D-NETs) are uncommon. The surgical treatment for D-NETs was in debate. Laparoscopic and endoscopic cooperative surgery (LECS) is a promising approach for treating gastrointestinal tumors. The study aimed to evaluate the feasibility and safety of LECS for D-NETs. Meanwhile, the authors described the details of the LECS technique. METHODS: All patients diagnosed with D-NETs underwent LECS between September 2018 and April 2022 were retrospectively reviewed. The endoscopic procedures were performed with endoscopic full-thickness resection. The defect was manually closed under the surveillance of the laparoscopy. RESULTS: A total of seven patients were enrolled, including three men and four women. The median age was 58 years (ranging from 39-65). Four tumors were located in the bulb and three in the second portion. All cases were diagnosed as NET with grade G1. The tumor depth was pT1 in two cases and pT2 in five cases. The median specimen size and the tumor size were 22 mm (ranging from 10-30) and 8.0 mm (ranging from 2.3-13.0), respectively. En-bloc resection and curative resection rates are 100 and 85.7%, respectively. There were no severe complications. Until 1 June 2022, there was no recurrence. The median follow-up was 9.5 months (range, 1.4-45.1). CONCLUSIONS: LECS with endoscopic full-thickness resection is a reliable surgical procedure. The minimally invasive advantages of LECS enable more individualized treatment options for a specific group. Limited by the length of observation, the long-term performance of LECS for D-NETs requires additional investigation.

Gastric inverted hyperplastic polyp, an exceptional case diagnosed after endoscopic submucosal dissection.

Gastric inverted hyperplastic polyp (GIHP) is a rare type of gastric polyp that has a trend of downward growth into the submucosal layer. We present a case of a heart-shaped GIHP removed by endoscopic submucosal dissection, which needs to be distinguished from gastritis cystica profunda.

Sequencing data of cell-free DNA fragments in living-related liver transplantation for inborn errors of metabolism.

Graft derived cell-free DNA was recently reported as a non-invasive biomarker to detect graft damage or rejection after liver transplantation. There are a number of methods for quantification of Gcf-DNA, including quantitative-PCR, digital droplet PCR and massively parallel sequencing (next generation sequencing). Here we present the NGS data and fragment size distribution of cell-free DNA in the plasma of patients with inborn errors of metabolism who underwent living-related liver transplantation. For more insights please see Analysis of fragment size distribution of cell-free DNA: a potential noninvasive marker to monitor graft damage in living-related liver transplantation for inborn errors of metabolism. [1].

Application of graft-derived cell-free DNA in ornithine transcarbamylase deficiency patient after living donor liver transplantation: Two case reports.

RATIONALE: Graft-derived-cell-free DNA (Gcf-DNA) in plasma was a promising biomarker to monitor graft-rejection after liver transplantation. However, little is known about the application of Gcf-DNA in living-donor-liver-transplantation (LDLT). PATIENTS CONCERN: In this study, 2 patients diagnosed with Ornithine Transcarbamylase Deficiency (OTCD) were enrolled and indicated for LDLT. DIAGNOSES: Two patients were genetically diagnosed with OTCD, and they suffered from recurrent and uncontrollable hyper-ammonemia and failed in accepting the normalized OTCD treatments, such as decreasing dietary nitrogen intake and increasing waste-nitrogen excretion. INTERVENTIONS: LDLT was performed in the 2 patients uneventfully, and we collected circulating cell-free DNA from plasma in specific postoperative time points (day 1, day 7, day 14, day 30, day 60). Since both of the recipients were sex-mismatch with the donors, we measured Gcf-DNA through the Y-chromosome method and compared it with the routine liver function. OUTCOMES: The result showed that Gcf-DNA had the similar discrimination of graft injury trend while compared to routine liver function. The follow-up showed these 2 patients' status is stable. LESSONS: Applying Gcf-DNA to monitor graft injury in LDLT is promising, but still long term follow-up and more samples are needed for validation.

Outcomes of trans-anal natural orifice specimen extraction combined with laparoscopic anterior resection for sigmoid and rectal carcinoma: An observational study.

Colorectal carcinoma is currently the third most frequent cancer worldwide. Conventional open surgery was replaced by laparoscopic anterior resection with total mesorectal excision for the treatment of sigmoid and rectal carcinomas; however, it needed an incision to harvest the specimen, which contributed to complications. In 2013, trans-anal natural orifice specimen extraction laparoscopic anterior resection (Ta-NOSE-LAR) to treat sigmoid and rectal carcinoma was performed in our hospital for the first time. The aim of this study was to investigate the outcomes of Ta-NOSE-LAR in sigmoid and rectal carcinoma.Seventy-three patients diagnosed with sigmoid and rectal carcinoma were enrolled between September 2013 and June 2016. Thirty-five patients underwent Ta-NOSE-LAR, whereas the others underwent traditional laparoscopic anterior resection (LAR). We compared the operative data, postoperative complications, pathological evaluation results, and incision-related complications between the 2 groups.Our result showed that the operative time, specimen length, tumor size, amount of total lymph nodes, and lymph node metastasis between the 2 groups were not statistically different. Further, without abdominal scaring for harvesting the specimen, the operative blood loss (49.29 ±â€Š14.63 vs 69.29 ±â€Š13.54 mL, P < .001) and post-operation hospital stay (5.77 ±â€Š0.94 vs 6.76 ±â€Š0.75 days, P < .001) of the Ta-NOSE-LAR group were less than those of the LAR group. Besides, the follow-up data showed that 2 patients were lost to follow-up, and 1 patient had liver metastasis 2 years after surgery in the LAR group, whereas the others showed no regional recurrence, distant metastases, or critical complications.Ta-NOSE-LAR is a valuable and alternative surgical method to treat sigmoid and rectal carcinoma, with the advantages of being a scarless procedure and having a lower post-operation hospital stay duration.