Gastrin: From Physiology to Gastrointestinal Malignancies.

Abetted by widespread usage of acid-suppressing proton pump inhibitors (PPIs), the mitogenic actions of the peptide hormone gastrin are being revisited as a recurring theme in various gastrointestinal (GI) malignancies. While pathological gastrin levels are intricately linked to hyperplasia of enterochromaffin-like cells leading to carcinoid development, the signaling effects exerted by gastrin on distinct cell types of the gastric mucosa are more nuanced. Indeed, mounting evidence suggests dichotomous roles for gastrin in both promoting and suppressing tumorigenesis. Here, we review the major upstream mediators of gastrin gene regulation, including inflammation secondary to Helicobacter pylori infection and the use of PPIs. We further explore the molecular biology of gastrin in GI malignancies, with particular emphasis on the regulation of gastrin in neuroendocrine neoplasms. Finally, we highlight tissue-specific transcriptional targets as an avenue for targetable therapeutics.

Genome analysis identifies differences in the transcriptional targets of duodenal versus pancreatic neuroendocrine tumours.

OBJECTIVE: Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) encompass a diverse group of neoplasms that vary in their secretory products and in their location within the gastrointestinal tract. Their prevalence in the USA is increasing among all adult age groups. AIM: To identify the possible derivation of GEP-NETs using genome-wide analyses to distinguish small intestinal neuroendocrine tumours, specifically duodenal gastrinomas (DGASTs), from pancreatic neuroendocrine tumours. DESIGN: Whole exome sequencing and RNA-sequencing were performed on surgically resected GEP-NETs (discovery cohort). RNA transcript profiles available in the Gene Expression Omnibus were analysed using R integrated software (validation cohort). Digital spatial profiling (DSP) was used to analyse paraffin-embedded GEP-NETs. Human duodenal organoids were treated with 5 or 10 ng/mL of tumor necrosis factor alpha (TNFα) prior to qPCR and western blot analysis of neuroendocrine cell specification genes. RESULTS: Both the discovery and validation cohorts of small intestinal neuroendocrine tumours induced expression of mesenchymal and calcium signalling pathways coincident with a decrease in intestine-specific genes. In particular, calcium-related, smooth muscle and cytoskeletal genes increased in DGASTs, but did not correlate with MEN1 mutation status. Interleukin 17 (IL-17) and tumor necrosis factor alpha (TNFα) signalling pathways were elevated in the DGAST RNA-sequencing. However, DSP analysis confirmed a paucity of immune cells in DGASTs compared with the adjacent tumour-associated Brunner's glands. Immunofluorescent analysis showed production of these proinflammatory cytokines and phosphorylated signal transducer and activator of transcription 3 (pSTAT3) by the tumours and stroma. Human duodenal organoids treated with TNFα induced neuroendocrine tumour genes, SYP, CHGA and NKX6.3. CONCLUSIONS: Stromal-epithelial interactions induce proinflammatory cytokines that promote Brunner's gland reprogramming.

Conversion from mini bypass to laparoscopic Roux en Y gastric bypass in an emergency setting: Case report and literature review.

INTRODUCTION: It has been demonstrated that certain technique endpoints are key to the success for the OAGB and RYGB procedures but only a few texts in which post-operative complications are documented. PRESENTATION OF CASE: 42-year-old male patient admitted to the emergency department for presenting abdominal pain located in the epigastrium for 4 days, melenic evacuations and syncope on one occasion. Two years prior to admission, the patient underwent a single anastomosis bypass for grade III obesity.Gastric bypass mini revision surgery was performed an antecolic and antegastric gastrointestinal anastomosis was made with a 3 cm latero-lateral anastomosis; an intestinal-intestinal anastomosis was performed 60 cm from the gastric anastomosis. The length of the biliopancreatic loop (120 cm) and the feeding loop (60 cm) are reviewed. DISCUSSION: Performing an "en bloc" resection of the anastomosis is essential since bile reflux is one of the irritation mechanisms of the anastomosis but not the only one. The size of the gastric pouch directly influences the frequency of marginal ulcers, so during the OAGBP revision, the gastro-jejunal junction must be resected to remodel it, reducing the size of the gastric reservoir that allows to perform the new anastomosis in less inflamed tissue. Roux-en-Y reconstruction should be performed once the length of the biliopancreatic loop is verified and it does not exceed 150 cm and a short alimentary loop to avoid nutritional complications.Complications arising from bariatric procedures are varied, infrequent in well-trained surgeons, but severe in inexpert hands, leading to an increase in mortality rates. CONCLUSIONS: We propose the laparoscopic conversion of OAGB to RYGB as a safe method, and feasible in hemodynamically unstable patients.

Adrenal schwannoma in a female patient; A rare benign neoplasm: Case report and literature review.

INTRODUCTION: Schwannomas are rare, slow-growing, usually benign tumors that originate from myelin-producing Schwann cells. Adrenal schwannomas are an exceptionally rare subset of these tumors, with few cases reported in the literature. PRESENTATION OF CASE: We present the case of a 44-year old female patient being evaluated for chronic abdominal pain at the outpatient clinic. Clinical and laboratory workup was unremarkable. An abdominal CT scan was performed, revealing a left suprarenal solid mass (5 × 6 cm). Surgical resection of the adrenal gland was performed, given the patient's symptoms, the size of the tumor, and its malignant potential. The patient completed the postoperative period satisfactorily, and her symptoms improved. Histopathological findings were compatible with a benign adrenal schwannoma. DISCUSSION: Schwannomas generally appear in the head, neck and extremities, with the vestibulocochlear nerve being the most frequently involved site. Retroperitoneal schwannomas account for 1-5% of retroperitoneal masses and comprise only 1-3% of all schwannomas. Their incidence increases with age, from 4% in the general population, reaching 7% in patients over 70 years of age. CONCLUSION: Adrenal incidentalomas represent a diagnostic challenge. Because of the malignant potential of large (> 4 cm) adrenal masses and the lack of characteristic findings using conventional imaging techniques and laboratory diagnostic tools, surgical excision with histopathology and immunohistochemistry analysis are required for definitive diagnosis and optimal management.

Midgut volvulus caused by intestinal malrotation; A rare cause of acute abdomen in adults. Case report.

INTRODUCTION: Acute abdomen due to midgut volvulus with intestinal malrotation is rare event with only only few cases in the literature Butterworth et al. (2018). Intestinal malrotation presented in the adulthood is reported in 0.2-0.5 %, of cases; with only 15 % f them presenting as midgut volvulus Butterworth et al. (2018). Intestinal malrotation is casued by an alteration in embryonic development between 10-12 weeks of gestation. The main alteration is anomalous position of the bowel with the small intestine residing on the right side of the abdomen, while the colon and cecum remain on the left side due to malposition of the Treitz ligament. Additionally, the ascending colon remains attached to the abdominal wall by fibrous peritoneal bands known as Ladd bands, this being a cause of midgut volvulus and intestinal obstruction. PRESENTATION OF CASE: We present a 25-year-old male with failure to thrive who arrives at the ED with clinical signs and symptoms of intestinal occlusion and acute abdomen, initial resuscitation is made in ED and is transferred to OR, an exploratory laparoscopy evidencing intestinal malrotation with cecal volvulus and a Ladd procedure is made openly without PO complications. DISCUSSION: The gold standard for diagnosis of intestinal malrotation is the upper gastrointestinal series. However, in patients with acute abdomen associated with this pathology where is suspected intestinal ischemia and hemodynamic instability, it is essential that an emergency laparotomy be performed. CONCLUSIONS: The diagnosis of intestinal malrotation is difficult, since many patients are asymptomatic in adulthood or present with variable GI symptoms. Therefore, it is imperative to have a high index of suspicion in patients with compatible clinical characteristics in order to perform the best therapy in time and manner.

Control de asma bronquial en niños y adolescentes atendidos en establecimientos de salud de Chiclayo / Control of bronchial asthma in children and adolescents treated in health facilities in Chiclayo

Introducción: El asma es un problema frecuente en la niñez y adolescencia y es importante su adecuado control. Objetivos: Estimar el nivel de control de asma en niños y adolescentes atendidos en establecimientos de salud. Métodos: Estudio censal de tipo transversal descriptivo realizado en la ciudad de. Chiclayo, entre julio-diciembre 2013. Se incluyeron menores de edad de 5 a 18 años con diagnóstico de asma. Se identificaron a los pacientes en la base de datos de la red de salud Lambayeque y se les realizó una visita domiciliaria donde se les invitó al estudio y se aplicó el instrumento de evaluación. Resultados: Se identificaron 203 pacientes, se contactaron y reclutaron 107 individuos. Se incluyeron 89 (83,2 por ciento) niños y 18 (16,8 por ciento) adolescentes con una mediana de edad de 7 (p25= 5/p75= 9) años y 15 (p25= 15/p75= 17) años, respectivamente. Según el puntaje del instrumento de evaluación: 52 (48,6 por ciento) estaban mal controlados; 46 (43,0 por ciento) parcialmente controlados; y 9 (8,4 por ciento), bien controlados. En el caso de los niños, la frecuencia de no control fue de 48,3 por ciento, parcialmente controlado 43,8 por ciento y controlado 7,9 por ciento; y en los adolescentes fue de 50,0; 38,9 y 11,1 por ciento, respectivamente. Se observó una relación significativa entre el nivel de control y el nivel educativo del cuidador en niños (p= 0,006) y adolescentes (p= 0,005). Conclusiones: Se demuestra una frecuencia elevada de control inadecuado de asma, lo cual contrasta con otras realidades similares donde hay una mayor frecuencia de control(AU)

Introduction: Asthma is a common problem in childhood and adolescence and is important its adequate control. Objectives: To estimate the level of asthma control in children and adolescents treated in health facilities. Methods: Census data of descriptive cross-sectional type study conducted in the city of Chiclayo, from July to December, 2013. There were included children from 5 to 18 years diagnosed with asthma. Patients were identified in the database of Lambayeque health network and underwent a home visit where they were invited to the study and it was applied the assessment instrument. Results: 203 patients were identified, and there were contacted and recruited 107 individuals. 89 (83.2 percent) children and 18 (16.8 percent) adolescents were included with a mean age of 7 (p25= 5/p75= 9) and 15 (p25= 15/p75= 17) years, respectively. According to the score of the assessment instrument: 52 (48.6 percent) were poorly controlled; 46 (43.0 percent) partially controlled; and 9 (8.4 percent), well-controlled. In the case of children, the frequency of no control was of 48.3 percent, partially controlled was 43.8 percent and controlled was 7.9 percent; and in the adolescents, it was 50.0, 38.9 and 11.1 percent , respectively. It was observed a significant relationship between the level of control and the educational level of the caregiver in children (p= 0.006) and adolescents (p= 0.005). Conclusions: It is demonstrated the high frequency of inadequate control of asthma, which contrasts with other similar realities where there is a greater frequency of control(AU)

Optimizing Nutrition Education in WIC: Findings From Focus Groups With Arizona Clients and Staff.

OBJECTIVE: To understand staff and clients' experiences with delivering and receiving nutrition education in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). METHODS: Focus groups involving WIC staff, clients, and former clients in Arizona. Client and staff perceptions of WIC nutrition education, preferences, and suggestions for improvement were examined. Transcripts were analyzed using a deductive thematic approach to identify emerging themes. RESULTS: Findings from 10 focus groups with 25 WIC staff and 29 clients suggested that existing materials were time-consuming and unresponsive to client needs, and additional resources were needed to engage children while parents were in session; new delivery formats for nutrition education, including videos and interactive demonstrations focused on child-friendly preparations of WIC foods, were preferred. CONCLUSIONS AND IMPLICATIONS: Collaboration among existing nutrition education programs, including Supplemental Nutrition Assistance Program-Education, Expanded Food and Nutrition Education Program, community gardens, and Head Start, can complement and enhance WIC nutrition educations in this region.