KRT19 and CEACAM5 mRNA-marked circulated tumor cells indicate unfavorable prognosis of breast cancer patients.

AIM: To investigate the clinical and prognostic significance of circulated tumor cells (CTC) marked by cytokeratin 19 coding gene KRT19 mRNA and carcinoembryonic antigen coding gene CEACAM5 mRNA in preoperative peripheral blood of breast cancer patients and provide molecular markers for breast cancer metastasis risk. METHODS: The mRNA levels of KRT19 and CEACAM5 in preoperative peripheral blood of breast cancer patients without (n = 603) and with (n = 76) distant metastases at the time of initial diagnosis were detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The relationship between CTCKRT19, CTCCEACAM5 and clinicopathological features, local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), or overall survival (OS) was statistically analyzed. RESULTS: In different pathological stages of breast cancer, the rates of CTCKRT19-pos and CTCCEACAM5-pos increased with the increase of the stages (P = 0.077 and P = 0.004). Preoperative CTCKRT19-pos in breast cancer patients was closely related to the lymph node metastasis statues (P < 0.0001), and had no significant correlation with other clinicopathological features. There was no significant correlation between CTCCEACAM5 and the clinicopathological features. Patients with high levels of CTC double-marked by KRT19 and CEACAM5 mRNA had shorter DMFS (P < 0.0001) and OS (P = 0.016) for patients with breast cancer. The 7-year DMFS rates for the low-, intermediate-, and high-risk groups were 90.7%, 67.5%, and 59.1%, respectively (P < 0.0001). The prognosis of patients with decreased KRT19 and CEACAM5 mRNA after treatment is better than that of patients who have not decreased, and the combination of the two indicators is better than the single one for predicting PFS (P = 0.002 compare with P = 0.036 or P = 0.047). CONCLUSION: Double-marked CTC by KRT19 and CEACAM5 mRNA is a prognostic index of breast cancer patients before surgery and after chemotherapy. Single-marked CTC by KRT19 mRNA indicates lymph node statues of preoperative patients. Therefore, the RT-qPCR-based molecular diagnosis of CTC could be used for prognostic prediction of breast cancer patients and guiding clinical treatment.

Quality of life in colorectal cancer patients with diarrhoea after surgery: a longitudinal study.

AIMS AND OBJECTIVES: The purposes of this study were to examine how quality of life in colorectal cancer patients with diarrhoea changes with time after surgery and to identify variables influencing patients' quality of life three months following surgery. BACKGROUNDS: Colorectal cancer is one of the most common cancers in the world. Literature that focuses on the impact of the basic attributes, disease characteristics and diarrhoea distress on the quality of life in diarrhoea patients is quite rare. DESIGN: Survey. METHODS: A longitudinal study design was employed with a three-month tracking period. Data were collected in structured, one-on-one interviews at one week and one, two and three months after surgery. Variance and effects of quality of life were analysed by repeated-measures analysis of variance and generalised estimating equation. RESULTS: Results showed that colorectal cancer patients (n = 35) with diarrhoea after surgery will over time be gradually satisfied with their overall quality of life. Physical health satisfaction is lowest at 1 week after surgery, and it will over time gradually increase. Satisfaction with mental health has the lowest score and does not improve with time. Satisfaction with social relationships is highest between one week and two months after surgery. Satisfaction of environmental relationship will improve with time after surgery. The study results also indicate that patients with lower quality of life satisfaction are younger, women, have had R hemicolectomy and experience higher diarrhoea distress. CONCLUSIONS: Colorectal cancer patients with diarrhoea after surgery will become more satisfied with their overall quality of life with time. Physical and environmental satisfaction will all improve with time. Younger patients will be more dissatisfied with their social and environmental health. More severe diarrhoea distress will impact patients' quality of life the most. RELEVANCE TO CLINICAL PRACTICE: These results can serve as reference for clinical care providers to patients with colorectal cancer after surgery.

ANP reduced Hedgehog signaling-mediated activation of matrix metalloproteinase-9 in gastric cancer cell line MGC-803.

OBJECTIVE: Gastric cancer is the most common malignant tumor. Most patients suffering from gastric cancer die of metastasis. The role of Atrial natriuretic peptide (ANP) in inhibiting and eliminating kinds of cancer cells has been reported. Aberrant activation of Hedgehog (Hh) signaling pathway contributes to initiation and progression of various malignancies. We have previously reported that the inhibitor of Hh, cyclopamine, reduces the metastatic activity of MGC-803 via inhibiting the expression of matrix metalloproteinases (MMP)-9. It remains to be further demonstrated that ANP has the suppressive effects on invasion and metastasis in gastric cancer via Hh-mediated MMP-9 production. METHODS: Transwell, western blot, qRT-PCR were used after application of ANP on MGC-803 gastric cancer cells to determine the levels of cell migration and invasion, protein levels of MMP-9 and Hh, as well as mRNAs of MMP-9 and Hh, respectively. RESULTS: It was demonstrated that the migration and invasion were significantly lower, MMP-9 and Hh as well as their mRNAs were lower as well, in ANP-treated MGC-803 gastric cancer cells than those in control. CONCLUSIONS: The expression of MMP-9 induced by aberrant activation of Hh in MGC-803 was inhibited by ANP, which may contribute to the inhibition of cell migration and invasion. These results suggested the potential of ANP to be used in gastric cancer therapy as an inhibitor targetting Hh signaling pathway to inhibit the proliferation as well as invasion and metastasis of gastric cancer.

Improvement of Urinary Incontinence, Life Impact, and Depression and Anxiety With Modified Pelvic Floor Muscle Training After Radical Prostatectomy.

Prostate cancer ranks second among male cancers in the United States in terms of death rate. Robot-assisted surgery (RAS) is now offered as the standard surgical procedure performed for radical prostatectomy. Urinary incontinence and erectile dysfunction were common complications after RAS prostatectomy. Patients felt ill-prepared after surgery, resulting in negative impacts on their quality of life. Pelvic floor muscle exercise is prioritized for patients with mild-to-moderate incontinence. The purpose of this study was to examine the effects of using resistance band pelvic floor muscle exercise for patients after RAS prostatectomy. A preexperimental single-group study was conducted for this study. A total of 43 patients completed the program. Urinary incontinence scale, Incontinence Impact Questionnaire, and Hospital Anxiety and Depression Scale were assessed at 0.5 months, 1 month, 2 months, and 3 months after urinary catheter removal. The results revealed that urinary incontinence, life impact, and depression and anxiety improved significantly as time went on. This study suggests that using simple and easy-to-learn resistance band pelvic floor muscle exercise program at home can benefit patients financially and reduce travel time.

Preventive effect of Qianggan-Rongxian Decoction on rat liver fibrosis.

AIM: To study the preventive effects of Qianggan-Rongxian Decoction on liver fibrosis induced by dimethylnitrosamine (DMN) in rats. METHODS: Male Wistar rats were randomly divided into hepatic fibrosis model group, control group and 3 treatment groups (12 rats in each group). Except for the normal control group, all the rats received 1% DMN (10 muL/kg body weight, i.p), 3 times a week for 4 wk. The rats in the 3 treatment groups including a high-dose DMN group (10 mL/kg), a medium-dose DMN group (7 mL/kg), and a low-dose DMN group (4 mL/kg) were daily gavaged with Qianggan-Rongxian Decoction, and the rats in the model and normal control groups were given saline vehicle. Enzyme-linked immunosorbent assay (ELISA) was used to determine the changes in serum hyaluronic acid (HA), laminin (LN), and type IV collagen levels. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured using routine laboratory methods. Pathologic changes, particularly fibrosis, were examined by hematoxylin and eosin (HE) and Sirius red staining. Hepatic stellate cells (HSC) were examined by transmission electron microscopy. RESULTS: Compared with the model control group, the serum levels of HA, LN, type IV collagen, ALT and AST were decreased markedly in the other groups after treatment with Qianggan-Rongxian Decoction, especially in the medium-dose DMN group (P < 0.05). Moreover, the area-density percentage of collagen fibrosis was lower in the Qianggan-Rongxian Decoction treatment groups than in the model group, and a more significant drop was observed in the medium-dose DMN group (P < 0.05). CONCLUSION: Qianggan-Rongxian Decoction can inhibit hepatic fibrosis due to chronic liver injury, delay the development of cirrhosis, and notably ameliorate liver function. It may be used as a safe and effective thera-peutic drug for patients with fibrosis.

Localization of ANP-synthesizing cells in rat stomach.

AIM: To study the morphological positive expression of antrial natriuretic peptide (ANP)-synthesizing cells and ultrastructural localization and the relationship between ANP-synthesizing cells and microvessel density in the stomach of rats and to analyze the distribution of the three histologically distinct regions of ANP-synthesizing cells. METHODS: Using immunohistochemical techniques, we studied positive expression of ANP-synthesizing cells in rat stomach. A postembedding immunogold microscopy technique was used for ultrastructural localization of ANP-synthesizing cells. Microvessel density in the rat stomach was estimated using tannic acid-ferric chloride (TAFC) method staining. Distribution of ANP-synthesizing cells were studied in different regions of rat stomach histochemically. RESULTS: Positive expression of ANP-synthesizing cells were localized in the gastric mucosa of rats. Localization of ANP-synthesizing cells identified them to be enterochrochromaffin cells (EC) by using a postembedding immunogold electron microscopy technique. EC cells were in the basal third of the cardiac mucosa region. ANP-synthesizing cells existed in different regions of rat stomach and its density was largest in the gastric cardiac region, and the distribution order of ANP-synthesizing cells in density was cardiac region, pyloric region and fundic region in mucosa layer. We have also found a close relationship between ANP-synthesizing cells and microvessel density in gastric mucosa of rats using TAFC staining. CONCLUSION: ANP-synthesizing cells are expressed in the gastric mucosa. EC synthesize ANP. There is a close relationship between ANP-synthesizing cells and microvessel density in gastric mucosa of rats. The distribution density of ANP-synthesizing cells is largest in the gastric cardiac region.

Symptom distress and self-care strategies of colorectal cancer patients with diarrhea up to 3 months after surgery.

BACKGROUND: Diarrhea is common after colorectal surgery, but its severity and self-care methods have not been examined in depth. OBJECTIVE: To understand changes in and factors influencing diarrhea distress and self-care strategies of patients 1 week and 1, 2, and 3 months after colorectal cancer surgery. METHODS: For this descriptive, longitudinal study, 35 cancer patients were recruited from a teaching hospital in northern Taiwan. Data were collected in structured, one-on-one interviews at 1 week and 1, 2, and 3 months after surgery. Variance and effects of diarrhea distress and number of self-care strategies were analyzed by repeated-measures analysis of variance and generalized estimating equation. Effectiveness scores for self-care strategies were analyzed by Wilcoxon signed rank test. RESULTS: Participants' overall level of diarrhea symptom distress was low. Distress level was highest 1 week after surgery, but gradually decreased thereafter. Over time after surgery, patients' frequency of using self-care strategies did not differ, but self-care strategies changed. Dietary modification and exercise were rated as the most effective strategies. Self-care information for hospitalized patients was primarily provided by medical personnel. The major factor affecting diarrhea distress was defecation frequency, and the major factors affecting self-care strategies were age, cancer stage, defecation frequency, and diarrhea distress. CONCLUSION: Diarrhea distress level gradually decreased, and self-care strategies changed with time after colorectal cancer surgery. IMPLICATIONS FOR PRACTICE: Because health care personnel were the primary source of self-care information for hospitalized patients after colorectal cancer surgery, nurses should use these findings to provide supportive treatment and educate patients and their family members about the cause and severity of diarrhea. Such education should include treatment-induced adverse effects as the basis for treating diarrhea.