Prediction of Esophageal Stricture after Endoscopic Submucosal Dissection in Patients with Early Esophageal Cancer.

BACKGROUND: Endoscopic submucosal dissection (ESD) treatment of early esophageal cancer is effective and safe. It is currently the first-line treatment for early esophageal cancer. However, a common side effect is the development of esophageal strictures after ESD. This study was designed to identify the risk factors for esophageal stricture development and to predict its occurrence after ESD. METHODS: In this retrospective study, 150 consecutive patients with early esophageal cancer treated with ESD at Daping Hospital, Chongqing, were enrolled between January 2016 and December 2020. Data on patient demographics, esophageal tumor characteristics, procedure-related factors, and postoperative situations were collected. We identified independent risk factors of esophageal stricture formation using univariate analysis and multivariate logistic regression. The predictive probability was obtained after multivariate logistic analysis. In addition, patients were divided into six groups based on these risk factors and the rate of esophageal stricture in each group was analyzed. RESULTS: The postoperative esophageal stricture rate was 14% (21/150). Tumor location (OR = 5.655, 95% CI: 1.245-25.691, P = 0.025) and circumferential resection range (OR = 16.113, 95% CI: 4.294-60.466, P < 0.001) are independent risk factors for the development of esophageal strictures. According to predictive probability analysis and the rates of stricture in six groups, we developed a possible flow chart to predict stricture formation. CONCLUSIONS: Tumor location and circumferential resection range are reliable risk factors to predict the occurrence of esophageal strictures. Our prediction flow chart suggests that tumors with a circumferential resection range of 1/2-3/4 and located above the upper thoracic segment or a circumferential resection range of > 3/4 have a high risk of postoperative stricture. Thus, timely and effective preventive measures should be taken in these patients following ESD.

Kank1 and Ki67 expression are associated with poor prognosis in human pulmonary adenocarcinoma.

KN motif and ankyrin repeat domains 1 (Kank1) and ki67 are associated with tumorigenesis and progression. This paper researched the expression of Kank1 and Ki67 and their clinicopathologic significance in pulmonary adenocarcinoma (PA). We monitored the expression of KanK1 and ki67 in 94 cases of human PA and 31 cases of paracancerous tissue by the immunohistochemical method. The results showed that Kank1 protein was detected in 74.2% (41/94) of PA tissues, and they were associated with differentiation (P = 0.025) and lymphatic metastasis (P = 0.002). Kaplan-Meier analysis suggested that patients with low Kank1 expression had shorter overall survival in PA (P = 0.020). Ki67 protein was detected in 79.8% (75/94) of PA tissues, and they were associated with differentiation (P < 0.001), TNM classification (P = 0.007), and lymphatic metastasis (P = 0.044). Furthermore, Kaplan-Meier analysis showed that patients with overexpression of Ki67 had shorter overall survival (P = 0.014). Cox multivariate analysis showed that tumor differentiation, TNM classification, lymphatic metastasis, Kank1, and ki67 expression were independent factors for prognosis of PA (P = 0.012, 0.016, 0.007, 0.021 and P = 0.003 respectively). In conclusion, compared with paracancerous tissues, Kank1 had low expression, while Ki67 was overexpressed in PA. They are closely related to its occurrence and development, and the prognosis of patients with low expression of Kank1 or overexpression of ki67 was poor in PA. Kank1 and Ki67 can be helpful for diagnosing and detecting the prognosis of patients with PA.

Prognostic and clinicopathologic significance of PAQR3 and VEGF-A expression in pulmonary adenocarcinoma.

Progesterone and adipoQ receptor family member 3 (PAQR3) and vascular endothelial growth factor (VEGF)-A are associated with tumorigenesis and progression. The aim of this study is to investigate the expression of PAQR3 and VEGF-A in pulmonary adenocarcinoma (PA) and explore their clinical and pathologic significance. The expressions of PAQR3 and VEGF-A protein were detected in 86 cases of human PA and 26 cases of tumor-adjacent tissue by immunohistochemistry. The positive rate of PAQR3 was 39.5% in PA, which was lower than that in tumor-adjacent tissues (80.8%), P=0.001. Negative expression of PAQR3 was obviously linked to tumor TNM stage, differentiation, and lymphatic metastasis; and P values were 0.013, 0.025, and 0.034, respectively. The positive expression rate of VEGF-A was 68.6% in human PA whichwas higher than that of tumor-adjacent tissues (11.5%), P<0.001. The positive expression of VEGF-A was correlated with tumor TNM stage, differentiation, and lymphatic metastasis, and P values were 0.026, 0.001 and P=0.001, respectively. The expression of PAQR3 was negatively correlated with the expression of VEGF-A (r=-0.698, P<0.001). Log-rank test statistical analysis suggested that patients with negative expression of PAQR3 or positive expression of VEGF-A had shorter overall survival. Cox multivariate analysis indicated that tumor TNM stage, differentiation, and lymphatic metastasis, and PAQR3 and VEGF-A expression were independent factors for prognosis of PA, and P values were 0.021, 0.017, 0.006, 0.018 and P=0.007 respectively. In conclusion, negative expression of PAQR3 and positive expression of VEGF-A are markedly correlated with tumor TNM classification, histologic grade, and lymphatic metastasis. Tumor TNM stage, differentiation, and lymphatic metastasis, negative expression of PAQR3, and positive expression of VEGF-A are risk factors for prognosis of patients with PA. Detection of PAQR3 and VEGF-A may be helpful to evaluate prognosis and infiltrative capability of PA.

Comparison of procedural sequences in same-day painless bidirectional endoscopy: Single-center, prospective, randomized study.

BACKGROUND AND AIM: To compare the efficacy and safety of esophagogastroduodenoscopy (EGD)-colonoscopy and colonoscopy-EGD sequences for patients subjected to same-day bidirectional endoscopy under remifentanil and propofol sedation. METHODS: A total of 209 eligible outpatients scheduled for diagnostic same-day bidirectional endoscopy between 16 February 2016 and 30 April 2016 were randomly assigned to the EGD-colonoscopy (n = 106) and colonoscopy-EGD (n = 103) sequence groups. Primary endpoint was total dose of propofol required for the procedure. Secondary endpoints included duration of endoscopy, patient satisfaction, adverse effects, endoscopy findings, and cardiopulmonary responses of the patients. RESULTS: Patients in the two groups were similar in terms of demographic and clinical data (P > 0.05). EGD-colonoscopy sequence group had lesser requirement of propofol for sedation (P < 0.05), faster recovery (P < 0.001), and lesser influence on mean arterial pressure (MAP) during the endoscopy (P < 0.05). Duration of EGD and colonoscopy, patient satisfaction, adverse effects, and pathological findings did not differ between the two groups. CONCLUSIONS: The EGD-colonoscopy sequence may be considered the preferred sequence for same-day bidirectional endoscopy as a result of less cardiovascular stress, lessened need for sedation with propofol, and faster recovery.

Prognostic role of YB-1 expression in breast cancer: a meta-analysis.

OBJECTIVE: In published studies, Y-box binding protein-1 (YB-1) correlated with the prognosis of patients with breast cancer (BC), but the specific role of YB-1 is still unclear. Our study aimed to evaluate the prognostic value of YB-1 in BC patients using meta-analysis based on the published studies. METHODS: We searched the relevant literatures deadline for June 2014 in databases, including PubMed, Embase, Medline and Cochrane library, and finally 8 studies were included in our study. Our study contained 1094 BC patients with 398 YB-1 positive and 696 YB-1 negative. RESULTS: Our results showed that YB-1 abnormal expression did not correlated with the lymph node status [OR = 1.258, 95% CI = 0.895-1.769, P = 0.186], high histological grade [OR = 2.709, 95% CI = 0.861-8.530, P = 0.089], histological type [OR = 0.837, 95% CI = 0.526-1.331, P = 0.452], P53 status [OR = 2.006, 95% CI 0.686-5.865, P = 0.203] and PR [OR = 0.607, 95% CI = 0.347-1.061, P = 0.080] in BC patients. But YB-1 over-expression was associated with other unfavorable factors: ER negativity [OR = 0.604, 95% CI = 0.388-0.941, P = 0.026], HER2 positivity [OR = 3.841, 95% CI = 2.637-5.594, P = 0.000], and high tumorous T stage [OR = 2.169, 95% CI = 1.295-3.632, P = 0.003]. In addition, our data suggested that high YB-1 expression had an adverse impact on 5-year OS [RR = 2.767, 95% CI = 2.054-3.727, P = 0.000] in BC patients. CONCLUSIONS: Our findings implied that YB-1 might a novel biomarker to predict the prognosis of BC, and could be a potential direction for developing diagnostic and therapeutic approaches in BC.

Suppression of the Epidermal Growth Factor-like Domain 7 and Inhibition of Migration and Epithelial-Mesenchymal Transition in Human Pancreatic Cancer PANC-1 Cells.

BACKGROUND: Epidermal growth factor-like domain multiple 7 (EGFL7), a secreted protein specifically expressed by endothelial cells during embryogenesis, recently was identified as a critical gene in tumor metastasis. Epithelial-mesenchymal transition (EMT) was found to be closely related with tumor progression. Accordingly, it is important to investigate the migration and EMT change after knock-down of EGFL7 gene expression in human pancreatic cancer cells. MATERIALS AND METHODS: EGFL7 expression was firstly testified in 4 pancreatic cancer cell lines by real-time polymerase chain reaction (Real-time PCR) and western blot, and the highest expression of EGFL7 was found in PANC-1 cell line. Then, PANC-1 cells transfected with small interference RNA (siRNA) of EGFL7 using plasmid vector were named si-PANC-1, while transfected with negative control plasmid vector were called NC-PANC-1. Transwell assay was used to analyze the migration of PANC-1 cells. Real-time PCR and western blotting were used to detect the expression change of EGFL7 gene, EMT markers like E-Cadherin, N-Cadherin, Vimentin, Fibronectin and transcription factors like snail, slug in PANC-1, NC- PANC-1, and si-PANC-1 cells, respectively. RESULTS: After successful plasmid transfection, EGFL7 gene were dramatically knock-down by RNA interference in si-PANC-1 group. Meanwhile, migration ability decreased significantly, compared with PANC-1 and NC-PANC-1 group. Meanwhile, the expression of epithelial phenotype marker E-Cadherin increased and that of mesenchymal phenotype markers N-Cadherin, Vimentin, Fibronectin dramatically decreased in si-PANC-1 group, indicating a reversion of EMT. Also, transcription factors snail and slug decreased significantly after RNA interference. CONCLUSIONS: Current study suggested that highly-expressed EGFL7 promotes migration of PANC-1 cells and acts through transcription factors snail and slug to induce EMT, and further study is needed to confirm this issue.

Expression of epidermal growth factor-like domain 7 is increased by transcatheter arterial embolization of liver tumors.

BACKGROUND: Epidermal growth factor-like domain multiple 7 (EGFL7), recently identified as a secreted protein regulated by oxygen exposure, plays a critical role in promoting metastasis of hepatocellular carcinoma (HCC). Transcatheter arterial embolization (TAE) is widely used for treatment of HCC, resulting in hypoxia in tumors and surrounding liver tissues. Accordingly, we proposed the hypothesis that there could be a relationship between expression of EGFL7 and response to TAE. MATERIALS AND METHODS: We established a rabbit VX2 liver tumor model using percutaneous puncture technique guided by computed tomography. TAE and sham embolization were performed and the results were confirmed by MRI 3 weeks after inoculation. We investigated the EGFL7 expression of the two groups at 6h and 3 days after intervention by means of immunohistochemistry and Western blotting. RESULTS: Immunohistochemical staining demonstrated that the levels of EGFL7 protein significantly increased in the TAE-treated tumors compared with the control group at 6 hours (P=0.031) and 3 days (P=0.020) after intervention. Meanwhile, the relative EGFL7 protein detected in TAE group also up-regulated compared with the control group at 6 hours (P=0.020) and 3 days (P=0.024) after intervention. CONCLUSIONS: This study reveals an increase of EGFL7 expression in rabbit VX2 liver tumors after TAE. The role of EGFL7 in HCC, especially its biological behavior after TAE, needs further investigation.

Etomidate-remifentanil is more suitable for monitored anesthesia care during gastroscopy in older patients than propofol-remifentanil.

BACKGROUND: This prospective and randomized study was designed to compare safety, potential complications, and patient and examiner satisfaction of 2 anesthetic combinations - etomidate-remifentanil and propofol-remifentanil - in elderly patients undergoing diagnostic gastroscopy. MATERIAL AND METHODS: A group of 720 patients, aged 60-80 years, scheduled for diagnostic gastroscopy under sedation were prospectively randomized. After 0.4-0.6 µg kg⁻¹ of remifentanil was infused, etomidate or propofol was administered. Patients in the etomidate group received doses of etomidate at 0.1-0.15 mg kg⁻¹ followed by 4-6 mg. Patients in the propofol group received doses of propofol at 1-2 mg kg⁻¹ followed by 20-40 mg. Physiological indexes were evaluated for the 715 of 720 patients that completed the treatment. The onset time, duration time, and discharge time were recorded. Physicians, anesthetists, and patients were surveyed to assess their satisfaction. RESULTS: Systolic pressure and diastolic pressure decreased significantly after the procedure in the propofol group (P<0.001). The average heart rate was significantly lower in the propofol group (P<0.05). No periods of desaturation (SpO2 <95%) were observed in either group. The onset time was earlier in the etomidate group (P=0.00). All adverse events, with the exception of myoclonus, were greater in the propofol group, and physician and patient satisfaction in both groups was similar. CONCLUSIONS: Etomidate-remifentanil administration for sedation and analgesia during gastroscopy resulted in more stable hemodynamic responses and less adverse events in older patients.