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2.
Aging (Albany NY) ; 11(22): 10301-10315, 2019 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-31760384

RESUMO

BACKGROUND: In this paper, we aim to explore clinical value of skeletal muscle index (SMI) and prognostic nutrition index (PNI) on resected colorectal cancer liver metastasis (CRLM). RESULTS: Among the 539 patients, 355 were males. Baseline lower SMI was associated with smaller BMI, smaller PNI, smaller pre-albumin and longer hospitalization days (P<0.05). Patients with lower SMI and PNI had significantly shorter duration of PFS and OS (P<0.05). SMI can reflect the postoperative treatment response. Postoperative 6-month's and 12-month's SMI and PNI can indicate overall prognosis. When combined SMI and PNI, prognostic AUC of ROC curves improved significantly. CONCLUSION: Combined monitor of SMI and PNI can improve the power at predicting prognosis. Postoperative 6-month's record of SMI and PNI was more accurate and predictive for CRLM prognosis. METHOD: A total of 539 resected CRLM patients between January 2013 to December 2016 with complete clinical data were included. Computed tomography image was collected from each patient. Receiver-operating characteristic (ROC) curves were constructed; area under curves (AUC) were also determined. All clinical variables were analyzed in proper way.

3.
Sci Rep ; 9(1): 13176, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511528

RESUMO

Diseases caused by Rickettsiales bacteria are a global public health problem. To better understand the diversity and origins of Rickettsiales infection in humans and animals, we sampled 134 febrile patients, 173 rodents and 43 shrews, as well as 358 ticks, from two cities in Jiangsu and Jiangxi provinces, China. Our data revealed a relatively high prevalence of scrub typhus cases in both localities. In addition, both serological tests and genetic analysis identified three patients infected with Anaplasma bovis, Rickettsia monacensis, and Orientia tsutsugamushi bacteria. Molecular epidemiological investigation revealed the co-circulation of multiple species of Rickettsiales bacteria in small mammals and ticks in both provinces, potentially including novel bacterial species. In sum, these data demonstrate the ongoing importance of Rickettsiales infection in China and highlight the need for the regular surveillance of local arthropods, mammals and humans.

4.
Cancer Manag Res ; 11: 6841-6854, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31440082

RESUMO

Aim: Lymph node ratio (LNR) seems to be more precise than classic N stage in classifying cancer stage. Thus, we aim to construct a modified classification system based on LNR for colon cancer without distant metastasis. Methods: This study enrolled two independent cohorts of patients. The primary cohort enrolled 2,152 patients from 2008 to 2013 in Zhongshan Hospital, Fudan University. The validation cohort consisted of 77,406 patients from the Surveillance, Epidemiology, and End Results (SEER) registry from 2004 to 2014. The inclusion criteria were: pathologically confirmed colon cancer, and American Joint Committee on Cancer (AJCC) stage I/II/III. The exclusion criteria included: incomplete follow-up information, rectal cancer, and multiple primary sites. The prognostic value of LNR for overall survival was evaluated. The cutoff value of LNR was determined by the X-tile. Predictive performance of modified classification was determined by the concordance index. Results: After analysis, 0.05 and 0.50 were determined as the best threshold values of LNR. A value of <0.05, 0.05-0.50 and >0.50 was reclassified as the mN0, mN1 and mN2 stage. A modified classification based on mN0, mN1, and mN2 was further constructed for stage I/II/III colon cancer. C-index of the modified classification was statistically more precise than AJCC classification (0.687 versus 0.605, P<0.001). The same results can also be determined in the validation cohort (0.715 versus 0.640, P<0.001). Furthermore, a prognostic nomogram including independent factors was constructed. The constructed nomogram showed good performance according to the calibration curve. Conclusion: The clinical value of LNR level was preferable to classic N stage in colon cancer patients. Our proposed classification based on LNR and AJCC T category can effectively differentiate patients with varied survival outcomes.

5.
Clin Nephrol ; 92(5): 243-249, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31448719

RESUMO

OBJECTIVE: To study the effects of early continuous veno-venous hemofiltration (CVVH) on organ function and intra-abdominal pressure (IAP) in severe acute pancreatitis (SAP) patients with abdominal compartment syndrome (ACS). MATERIALS AND METHODS: 48 SAP patients with ACS were included in this study. Among them, 37 patients, receiving both conventional treatment and hemofiltration therapy in the ICU, were regarded as the treatment group, and the rest, receiving only conventional treatment, were regarded as the control group. Symptoms, signs, and adverse reactions of both groups were observed and recorded during treatments. Serum and urine amylase, liver and kidney function, C-reactive protein, and intra-abdominal pressure of the patients were detected before and on days 1, 2, 3, 4, 5, and 6 after treatment. RESULTS: 1. Symptoms and signs in the treatment group disappeared quickly, and their hospitalization time was significantly shorter than those of control group (p < 0.05). 2. After treatment, on days 1, 2, 3, 4, 5, and 6, patients' serum and urine amylase levels, C-reactive protein, and intra-abdominal pressure were significantly lower, and liver and kidney function was significantly better than those of the control group (p < 0.05). CONCLUSION: Early hemofiltration in SAP with ACS can effectively reduce intra-abdominal pressure, improve symptoms, accelerate liver and renal function recovery, avoid multiple organ failure and decrease mortality rate.


Assuntos
Hemofiltração , Hipertensão Intra-Abdominal , Pancreatite , Adulto , Idoso , Feminino , Humanos , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/fisiopatologia , Hipertensão Intra-Abdominal/terapia , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite/fisiopatologia , Pancreatite/terapia
6.
Artigo em Inglês | MEDLINE | ID: mdl-28473863

RESUMO

The role of the acupoint area collagen fibers in the efficacy of acupuncture lifting and thrusting (L&T) manipulation will be explored in this paper. 30 male NZW rabbits were randomly divided into 6 groups: sham operation group (Group N), model group (Group M), acupuncture without manipulation group (Group W), acupuncture L&T manipulation group (Group A), collagenase pretreatment group (Group JM), and collagenase pretreatment + acupuncture L&T manipulation group (Group JA). The bacterial endotoxin was used to generate the rabbit fever models. Acupuncture was applied at IL-11. The levels of IL-1ß, TNF-α, and IL-4 and the rectal temperature were measured at 2 h, 4 h, and 6 h after modeling and the collagen fiber morphology at acupoint area was observed after 6 hours. Results. As compared with Group N, the levels of IL-1ß and TNF-α in Group M were significantly higher; the level of IL-4 was significantly lower (P < 0.05). As compared with Group M, IL-1ß and TNF-α in Groups W and A were significantly lower and IL-4 was significantly higher (P < 0.05). As compared with Group W, IL-1ß and TNF-α in Group A were lower and IL-4 was higher (P < 0.05). The collagen fiber in Group A was slightly rough, distorted, and fractured. As shown in studies, the endotoxin-induced inflammatory response can be significantly inhibited by acupuncture whose efficacy can also be significantly improved by the manipulations. Collagenase pretreatment may be the first receptor to the mechanical force of the L&T manipulation.

7.
Sci Rep ; 7: 44543, 2017 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-28291253

RESUMO

The molecular mechanisms underlying colorectal cancer (CRC) development remain elusive. In this study, we examined the miRNA and mRNA expressions in the adenoma-carcinoma sequence (ACS), a critical neoplastic progression in CRC development. We found that miR-137 was down-regulated in all adenoma and carcinoma tissues. Low miR-137 levels were correlated negatively with tumor progression and metastasis. Then we identified the inhibition effect of the miR-137 in CRC development, both in CRC cell lines and mouse models. MiR-137 was shown to control CRC cell proliferation, colony formation, migration and invasion and to control tumor growth and metastasis. We further confirmed the negative association between miR-137 and c-Met expression and thus validated this important oncogene as the target of miR-137 in CRC. In addition, we found a DNA methyl-CpG-binding protein, Mecp2, was up-regulated in ACS tissues via mRNA sequencing. Further experiment showed that miR-137 expression in CRC was subjected to epigenetic regulation mediated by Mecp2. We also confirmed c-Met expression can be up-regulated by silencing of miR-137 and suppressed by coexpression of Mecp2 and miR-137. These findings highlight the critical role of miR-137-c-Met nexus in CRC development and reveal Mecp2-regulated epigenetic silence causes the downregulation of miR-137 in colorectal adenoma and carcinoma.


Assuntos
Neoplasias Colorretais/genética , Proteína 2 de Ligação a Metil-CpG/genética , MicroRNAs/genética , Proteínas Proto-Oncogênicas c-met/genética , Adenoma/genética , Adenoma/patologia , Animais , Carcinoma/genética , Carcinoma/patologia , Movimento Celular/genética , Proliferação de Células/genética , Neoplasias Colorretais/patologia , Epigênese Genética , Regulação Neoplásica da Expressão Gênica/genética , Células HCT116 , Humanos , Camundongos , MicroRNAs/antagonistas & inibidores , Invasividade Neoplásica/genética , Invasividade Neoplásica/patologia , Metástase Neoplásica , Ensaios Antitumorais Modelo de Xenoenxerto
8.
J Oral Maxillofac Surg ; 74(8): 1695-705, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26973226

RESUMO

PURPOSE: The management of intraparotid facial nerve schwannoma (IFNS) is challenging because it is extremely rare and often misdiagnosed as pleomorphic adenoma or another parotid tumor. The purpose of this study was to report on the authors' experience in the treatment of IFNS and to review the literature regarding the diagnosis and management of IFNS. MATERIALS AND METHODS: From January 1997 through October 2015, 916 consecutive parotidectomies were performed at Shenzhen People's Hospital (Shenzhen, China). Of 916 parotid tumors samples, 9 cases of IFNS confirmed by histopathology were identified and analyzed retrospectively. In addition, 161 published cases from 1956 through 2015 were systematically reviewed. RESULTS: Nine cases of IFNS were identified from 916 parotid tumors samples and accounted for 0.98% of all parotid tumors. All these patients with IFNS underwent tumor removal and parotidectomy with preservation of facial nerve (FN) continuity. The mean follow-up period was 6.2 years (range, 1 to 16 yr). Facial function improved gradually from House-Brackmann grade (HBG) II to III immediately postoperatively to HBG I during the subsequent 3 to 9 months in all cases. Tumor recurrence with stylomastoid foramen involvement was observed in 1 case 3 years after surgery. The others remained free of recurrence. Of 161 IFNS cases reported in the literature, 17 cases with facial paresis were found to have intra-temporal involvement, but no facial paresis was found in patients with intraparotid involvement only. CONCLUSIONS: An IFNS is easily misdiagnosed as pleomorphic adenoma or Warthin tumor preoperatively; the correct diagnosis for IFNS depends mainly on intraoperative observation of the gross relation between the tumor and the FN or excision frozen biopsy examination. The integrity of the FN should be preserved for patients with IFNS and without facial paresis, whenever possible.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Neoplasias Parotídeas/cirurgia , Adolescente , Adulto , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/patologia , Diagnóstico por Imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/patologia , Estudos Retrospectivos , Resultado do Tratamento
9.
Int J Colorectal Dis ; 31(3): 561-70, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26700099

RESUMO

BACKGROUD: The efficacy and safety of self-expandable metallic stents (SEMSs) as a bridge for patients with acute malignant colorectal obstructions (AMCOs) are still controversial. We conducted this study to evaluate the outcomes of patients with AMCOs treated by different strategies. METHODS: From January 2010 to March 2014, a total of 171 patients with AMCOs from Zhongshan Hospital were retrospectively enrolled in this study. One hundred twenty patients successfully received stent placement followed by one-stage laparoscopic or open resection in the stent group, and 51 patients received emergency operations in the emergency group. RESULTS: The operation duration and postoperative hospital stay were significantly shorter in the stent group (114.51 ± 28.65 vs. 160.39 ± 58.94 min, P < 0.001; 8.00 ± 3.97 vs. 12.59 ± 9.07 days, P = 0.001). The stent group also had significantly reduced intraoperative blood loss and the incidence of postoperative complications compared with the emergency group (61.00 ± 43.70 vs. 121.18 ± 85.90 ml, P < 0.001; 16.7 vs. 37.3%, P = 0.003). Kaplan-Meier survival curves showed that the median survival time in the stent group was significantly longer than that in the emergency group (53 vs. 41 months, P = 0.034). In subgroup analysis of stent group, the stent laparoscopy group had significantly decreased postoperative complications (P = 0.025), and similar long-term survival (P = 0.81). CONCLUSIONS: Stent placement as a bridge to surgery is a safe and feasible procedure and provides significant advantages in terms of short-term outcomes and favorable prognoses for patients with AMCOs. Laparoscopic surgery could be considered as an optimal treatment after stent placement.


Assuntos
Neoplasias Colorretais/complicações , Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos Eletivos , Emergências , Obstrução Intestinal/complicações , Obstrução Intestinal/cirurgia , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Stents Metálicos Autoexpansíveis/efeitos adversos , Resultado do Tratamento , Adulto Jovem
10.
World J Gastroenterol ; 21(14): 4184-94, 2015 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-25892868

RESUMO

AIM: To test whether hepatic stellate cells (HSCs) at different activation stages play different roles in acetaminophen (APAP)-induced acute liver injury (ALI). METHODS: HSCs were isolated from mouse liver and cultured in vitro. Morphological changes of initiation HSCs [HSCs (5d)] and perpetuation HSCs [HSCs (p3)] were observed by immunofluorescence and transmission electron microscopy. The protective effects of HSC-derived molecules, cell lysates and HSC-conditioned medium (HSC-CM) were tested in vivo by survival and histopathological analyses. Liver injury was determined by measuring aminotransferase levels in the serum and by histologic examination of tissue sections under a light microscope. Additionally, to determine the molecular mediators of the observed protective effects of initiation HSCs, we examined HSC-CM using a high-density protein array. RESULTS: HSCs (5d) and HSCs (p3) had different morphological and phenotypic traits. HSCs (5d) presented a star-shaped appearance with expressing α-SMA at non-uniform levels between cells. However, HSCs (p3) evolved into myofibroblast-like cells without lipid droplets and expressed a uniform and higher level of α-SMA. HSC-CM (5d), but not HSC-CM (p3), provided a significant survival benefit and showed a dramatic reduction of hepatocellular necrosis and panlobular leukocyte infiltrates in mice exposed to APAP. However, this protective effect was abrogated at higher cell masses, indicating a therapeutic window of effectiveness. Furthermore, the protein array screen revealed that HSC-CM (5d) was composed of many chemokines and growth factors that correlated with inflammatory inhibition and therapeutic activity. When compared with HSC-CM (p3), higher levels of monocyte chemoattractant protein-1, macrophage inflammatory protein-1γ, hepatocyte growth factor, interleukin-10, and matrix metalloproteinase-2, but lower levels of stem cell factor and Fas-Ligand were observed in HSC-CM (5d). CONCLUSION: These data indicated that initiation HSCs and perpetuation HSCs were different in morphology and protein expression, and provided the first experimental evidence of the potential medical value of initiation HSC-derived molecules in the treatment of ALI.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Quimiocinas/metabolismo , Células Estreladas do Fígado/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Fígado/metabolismo , Comunicação Parácrina , Acetaminofen , Animais , Anti-Inflamatórios/administração & dosagem , Forma Celular , Células Cultivadas , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Doença Hepática Induzida por Substâncias e Drogas/patologia , Quimiocinas/administração & dosagem , Meios de Cultivo Condicionados/metabolismo , Modelos Animais de Doenças , Células Estreladas do Fígado/efeitos dos fármacos , Células Estreladas do Fígado/ultraestrutura , Peptídeos e Proteínas de Sinalização Intercelular/administração & dosagem , Fígado/efeitos dos fármacos , Fígado/ultraestrutura , Masculino , Camundongos Endogâmicos C57BL , Necrose , Fenótipo , Transdução de Sinais , Fatores de Tempo
11.
World J Gastroenterol ; 21(9): 2848-53, 2015 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-25759560

RESUMO

The Da Vinci Surgical System may help to overcome some of the difficulties of laparoscopy for complicated abdominal surgery. The authors of this article present a case of robot-assisted, one-stage radical resection of three tumors, including robotic anterior resection for rectal cancer, segmental hepatectomy for liver metastasis, and wedge-shaped excision for lung metastasis. A 59-year-old man with primary rectal cancer and liver and lung metastases was operated upon with a one-stage radical resection approach using the Da Vinci Surgical System. Resection and anastomosis of rectal cancer were performed extracorporeally after undocking the robot. The procedure was successfully completed in 500 min. No surgical complications occurred during the intervention and postoperative period, and no conversion to laparotomy or additional trocars were required. To the best of our knowledge, this is the first case of simultaneous resection for rectal cancer with liver and lung metastases using the Da Vinci Surgery System to be reported. The procedure is feasible and safe and its main advantages for patient are avoiding repeated operation, reducing surgical trauma, shortening recovery time, and early implementation of postoperative adjuvant therapy.


Assuntos
Hepatectomia/métodos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Metastasectomia/métodos , Pneumonectomia/métodos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Cancer Biol Ther ; 16(2): 244-52, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25602156

RESUMO

Colorectal cancer (CRC) is one of the most common cancers worldwide. The molecular mechanisms underlying CRC development involve a multistep process with the accumulation of both genetic and epigenetic changes. To deeply understand CRC tumorigenesis and progression, advances in identification of novel mechanisms and key factors are therefore in an urgent need. Here, we examined the correlation of factor inhibiting HIF-1α (FIH-1) expression with clinicopathological features of CRC. The finding that FIH-1 was not only significantly decreased in tumor tissue but also was significantly correlated with tumor invading depth, lymph node involvement, and metastasis suggested the role of FIH-1 as a tumor suppressor in CRC development. To further support the above hypothesis, we performed both in vitro and in vivo experiments to identify the role of FIH-1 in CRC development. FIH-1 was found to inhibit CRC cell proliferation, migration, invasion, and colony formation in vitro. FIH-1 was also shown to repress LOVO xenograft tumor growth in vivo. To decipher the mechanism, we examined the expression level of HIF-1α and its target genes. We found that FIH-1 was able to inhibit HIF1α mediated transcription of GLUT1 and VEGF in CRC cells. The above observation points to the possibility that loss or decreased expression of FIH-1 gene may lead to a constitutive activation of HIF1α and an alteration of HIF-1 targets such as GLUT-1 and VEGF. These findings highlight the critical role of FIH-1 in CRC and indicate FIH-1 functions as a tumor suppressor in human CRC by repressing HIF1α pathway.


Assuntos
Neoplasias Colorretais/metabolismo , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Transdução de Sinais , Proteínas Supressoras de Tumor/metabolismo , Adulto , Idoso , Animais , Linhagem Celular Tumoral , Neoplasias Colorretais/genética , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Modelos Animais de Doenças , Progressão da Doença , Regulação para Baixo , Feminino , Regulação Neoplásica da Expressão Gênica , Transportador de Glucose Tipo 1/genética , Transportador de Glucose Tipo 1/metabolismo , Xenoenxertos , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Masculino , Camundongos , Pessoa de Meia-Idade , Prognóstico , Proteínas Supressoras de Tumor/genética , Fator A de Crescimento do Endotélio Vascular/genética , Fator A de Crescimento do Endotélio Vascular/metabolismo
13.
Int J Colorectal Dis ; 30(4): 475-81, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25579161

RESUMO

PURPOSE: The purpose of this study is to investigate the influence of anesthetic methods on markers of anti-tumor immunity and intestinal functions in fast-track surgery in colon cancer (CC) patients during the perioperative period. PATIENTS AND METHODS: A total of 53 patients with American Society of Anesthesiologists (ASA) I-II status randomly received general anesthesia (G group, n = 27) or general anesthesia combined with epidural anesthesia (E group, n = 26) for surgical tumor resection. The recovery times of intestinal function were evaluated in both groups postoperatively. The frequencies of different subsets of CD4+ T cells and myeloid-derived suppressor cells and C-reactive protein (CRP) were measured by flow cytometry and enzyme-linked immunosorbent assay, respectively, before anesthesia (t0), 1 h after the beginning of surgery (t1), 1 h after the end of surgery (t2), and on day 2 (t3) and day 5 (t4) post-surgery. RESULTS: There was no significant difference in demographic characteristics between the two groups, but the E group of patients received significantly lower amounts of morphine and sevoflurane. In comparison with those in the G group, significantly greater numbers of lymphocytes and elevated frequencies of Th1 cells were detected at t3 and t4 post-surgery in the E group (p < 0.01). Significantly lower percentages of Th2 cells and regulatory T cells were detected in the E group at t2-4 post-surgery. Whereas the levels of plasma CRP increased post-surgery in both groups, the levels of CRP were significantly lower in the E group than those in the G group at t3-4 post-surgery (p < 0.05). The times to the first flatus and to tolerate a full diet were significantly shorter in the E group than those in the G group (p < 0.01). CONCLUSION: General anesthesia combined with epidural anesthesia plays an important role in fast-track surgery, mitigating the surgical stress-related impairment of anti-tumor immune responses and hastening the recovery of intestinal function. This combination might also help to improve long-term outcomes for CC patients.


Assuntos
Anestesia Epidural , Anestesia Geral , Neoplasias do Colo/imunologia , Neoplasias do Colo/cirurgia , Tolerância Imunológica , Intestinos/fisiologia , Idoso , Analgésicos Opioides/administração & dosagem , Anestésicos Inalatórios/administração & dosagem , Proteína C-Reativa/metabolismo , Linfócitos T CD4-Positivos/metabolismo , Neoplasias do Colo/fisiopatologia , Feminino , Humanos , Íleus/fisiopatologia , Masculino , Éteres Metílicos/administração & dosagem , Pessoa de Meia-Idade , Morfina/administração & dosagem , Células Mieloides/imunologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Sevoflurano
14.
World J Gastroenterol ; 20(28): 9626-30, 2014 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-25071362

RESUMO

Primary malignant melanoma originating in the colon is an extremely rare disease. Herein, we report a case of primary melanoma of the ascending colon. The patient was a 57-year-old male who was admitted to our hospital for persistent abdominal pain and episodes of bloody stool, nausea and vomiting. A computed tomography scan revealed lower intestinal intussusception and enlarged lymph nodes in the abdominal cavity and retroperitoneum. During laparoscopic operation, multiple enlarged lymph nodes were found. Several segments of the proximal small intestine were incarcerated into the distal small intestine, forming an internal hernia and obstruction. The necrotic terminal ileum was invaginated into the ascending cecum. Subsequently, adhesive internal hernia reduction and palliative right hemicolectomy were performed. Pathologic examination of the excised specimen revealed a polypoid mass in the ascending colon. Histological examination showed epithelioid and spindle tumor cells with obvious cytoplasmic melanin deposition. Immunohistochemical staining revealed that the tumor cells were positive for S-100, HMB-45 and vimentin, confirming the diagnosis of melanoma. The patient history and a thorough postoperative investigation excluded the preexistence or coexistence of a primary lesion elsewhere in the skin, anus or oculus or at other sites. Thus, we consider our case to represent an aggressive primary colon melanoma presenting as ileocecal intussusception and intestinal obstruction.


Assuntos
Neoplasias do Colo/complicações , Valva Ileocecal , Intussuscepção/etiologia , Melanoma/complicações , Biomarcadores Tumorais/análise , Biópsia , Colectomia , Neoplasias do Colo/química , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/cirurgia , Humanos , Doenças do Íleo/etiologia , Valva Ileocecal/cirurgia , Imuno-Histoquímica , Intussuscepção/diagnóstico , Intussuscepção/cirurgia , Laparoscopia , Masculino , Melanoma/química , Melanoma/diagnóstico , Melanoma/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
World J Gastroenterol ; 20(15): 4263-75, 2014 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-24764664

RESUMO

Colorectal liver metastasis (CLM) is common worldwide. Targeted therapies with monoclonal antibodies have been proven effective in numerous clinical trials, and are now becoming standards for patients with CLM. The development and application of anti-epidermal growth factor receptor (anti-EGFR) and anti-vascular endothelial growth factor (anti-VEGF) antibodies represents significant advances in the treatment of this disease. However, new findings continue to emerge casting doubt on the efficacy of this approach. The Kirsten rat sarcoma viral oncogene (KRAS) has been proven to be a crucial predictor of the success of anti-EGFR treatment in CLM. Whereas a recent study summarized several randomized controlled trials, and showed that patients with the KRAS G13D mutation significantly benefited from the addition of cetuximab in terms of progress-free survival (PFS, 4.0 mo vs 1.9 mo, HR = 0.51, P = 0.004) and overall survival (OS, 7.6 mo vs 5.7 mo, HR = 0.50, P = 0.005). Some other studies also reported that the KRAS G13D mutation might not be absolutely predictive of non-responsiveness to anti-EGFR therapy. At the same time, "new" RAS mutations, including mutations in neuroblastoma RAS viral (v-ras) oncogene homolog (NRAS) and exons 3 and 4 of KRAS, have been suggested to be predictors of a poor treatment response. This finding was first reported by the update of the PRIME trial. The update showed that for patients with non-mutated KRAS exon 2 but other RAS mutations, panitumumab-fluorouracil, leucovorin, and oxaliplatin (FOLFOX)4 treatment led to inferior PFS (HR = 1.28, 95%CI: 0.79-2.07) and OS (HR = 1.29, 95%CI: 0.79-2.10), which was consistent with the findings in patients with KRAS mutations in exon 2. Then, the update of the PEAK trial and the FIRE-III trial also supported this finding, which would reduce candidates for anti-EGFR therapy but enhance the efficacy. In first-line targeted combination therapy, the regimens of cetuximab plus FOLFOX was called into question because of the inferior prognosis in the COIN trial and the NORDIC-VII trial. Also, bevacizumab plus oxaliplatin-based chemotherapy was questioned because of the NO16966 trial. By the update and further analysis of the COIN trial and the NORDIC-VII trial, cetuximab plus FOLFOX was reported to be reliable again. But bevacizumab plus oxaliplatin-based chemotherapy was still controversial. In addition, some trials have reported that bevacizumab is not suitable for conversion therapy. The results of the FIRE-III trial showed that cetuximab led to a significant advantage over bevacizumab in response rate (72% vs 63%, P = 0.017) for evaluable population. With the balanced allocation of second-line treatment, the FIRE-III trial was expected to provide evidence for selecting following regimens after first-line progression. There is still no strong evidence for the efficacy of targeted therapy as a preoperative treatment for resectable CLM or postoperative treatment for resected CLM, although the combined regimen is often administered based on experience. Combination therapy with more than one targeted agent has been proven to provide no benefit, and even was reported to be harmful as first-line treatment by four large clinical trials. However, recent studies reported positive results of erlotinib plus bevacizumab for maintenance treatment. The mechanism of antagonism between different targeted agents deserves further study, and may also provide greater understanding of the development of resistance to targeted agents.


Assuntos
Neoplasias Colorretais/terapia , Receptores ErbB/antagonistas & inibidores , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ensaios Clínicos como Assunto , Neoplasias Colorretais/patologia , Intervalo Livre de Doença , Éxons , Fluoruracila/uso terapêutico , Humanos , Leucovorina/uso terapêutico , Mutação , Compostos Organoplatínicos/uso terapêutico , Guias de Prática Clínica como Assunto , Proteínas Proto-Oncogênicas/metabolismo , Proteínas Proto-Oncogênicas p21(ras) , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Proteínas ras/metabolismo
16.
Cancer Biol Ther ; 15(5): 516-23, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24521875

RESUMO

The molecular mechanisms underlying colorectal cancer (CRC) tumorigenesis remain incompletely understood, partially contributing to the mortality of CRC. Advances in identification of novel mechanisms are therefore in an urgent need to fill the gap of our knowledge in CRC development. Here, we performed both in vitro and in vivo experiments along with in silico analysis to identify a new regulatory circuit that stimulated CRC tumorigenesis. In this report, we, for the first time, analyzed the correlation of FIH-1 level with clinicopathological features of CRC. The finding that FIH-1 was not only significantly decreased in tumor tissue as compared with the adjacent normal tissue but also was significantly correlated with tumor T stage status, indicated the role of FIH-1 as a tumor suppressor in CRC development. Moreover, we found the expression of miR-31, a short non-coding RNA which played a critical role in CRC development, was negatively correlated with FIH-1 expression in CRC samples and cell lines. Together with the result from luciferase report assay, it was demonstrated that miR-31 could directly regulate FIH-1 expression in CRC. This miR-31/FIH-1 nexus was further shown to control cell proliferation, migration and invasion in vitro and to control tumor growth in vivo. Additionally, correlation of the miR-31 expression with clinicopathologic features in CRC samples was examined in support of the driving role of newly identified miR-31/FIH-1 nexus in CRC tumorigenesis. These findings highlight the critical role of miR-31/FIH-1 nexus in CRC and reveal the contribution of miR-31 to CRC development by targeting FIH-1.


Assuntos
Carcinogênese/patologia , Neoplasias Colorretais/patologia , MicroRNAs/metabolismo , Oxigenases de Função Mista/metabolismo , Proteínas Repressoras/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Carcinogênese/metabolismo , Linhagem Celular Tumoral , Movimento Celular , Proliferação de Células/genética , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/metabolismo , Progressão da Doença , Feminino , Xenoenxertos , Humanos , Masculino , Camundongos Nus , Pessoa de Meia-Idade , Oxigenases de Função Mista/genética , Invasividade Neoplásica/genética , Estadiamento de Neoplasias , Prognóstico , Proteínas Repressoras/genética
17.
World J Gastroenterol ; 19(33): 5513-9, 2013 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-24023495

RESUMO

AIM: To investigate the clinical advantages of the stent-laparoscopy approach to treat colorectal cancer (CRC) patients with acute colorectal obstruction (ACO). METHODS: From April 2008 to April 2012, surgery-related parameters, complications, overall survival (OS), and disease-free survival (DFS) of 74 consecutive patients with left-sided CRC presented with ACO who underwent self-expandable metallic stent (SEMS) placement followed by one-stage open (n = 58) or laparoscopic resection (n = 16) were evaluated retrospectively. The stent-laparoscopy group was also compared with a control group of 96 CRC patients who underwent regular laparoscopy without ACO between January 2010 and December 2011 to explore whether SEMS placement influenced the laparoscopic procedure or reduced long-term survival by influencing CRC oncological characteristics. RESULTS: The characteristics of patients among these groups were comparable. The rate of conversion to open surgery was 12.5% in the stent-laparoscopy group. Bowel function recovery and postoperative hospital stay were significantly shorter (3.3 ± 0.9 d vs 4.2 ± 1.5 d and 6.7 ± 1.1 d vs 9.5 ± 6.7 d, P = 0.016 and P = 0.005), and surgical time was significantly longer (152.1 ± 44.4 min vs 127.4 ± 38.4 min, P = 0.045) in the stent-laparoscopy group than in the stent-open group. Surgery-related complications and the rate of admission to the intensive care unit were lower in the stent-laparoscopy group. There were no significant differences in the interval between stenting and surgery, intraoperative blood loss, OS, and DFS between the two stent groups. Compared with those in the stent-laparoscopy group, all surgery-related parameters, complications, OS, and DFS in the control group were comparable. CONCLUSION: The stent-laparoscopy approach is a feasible, rapid, and minimally invasive option for patients with ACO caused by left-sided CRC and can achieve a favorable long-term prognosis.


Assuntos
Neoplasias Colorretais/complicações , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Obstrução Intestinal/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , China/epidemiologia , Neoplasias Colorretais/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Obstrução Intestinal/etiologia , Laparoscopia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese , Estudos Retrospectivos
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 16(8): 718-20, 2013 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-23980038

RESUMO

A variety of managements, including systemic and local chemotherapy, radiofrequency ablation and others, are used after multidisciplinary team discussion to improve the survival of patients with unresectable liver metastasis, and to enlarge the cohort of patients who can be managed with curative intent. Patients should be divided into different clinical groups according to characteristics of the patient and tumor, and then receive different treatments. For the patients who may be converted to be resectable after chemotherapy, we should choose efficient convertible chemotherapy with short courses to get the best response rate. For KRAS wild-type patients, cetuximab combined with FOLFOX/FOLFIRI, in which 5-fluorouracil is continuously infused, is recommended. In addition, resection of the primary tumor is recommended at the right time for asymptomatic patients with unresectable liver metastases. There is no consensus on the preferred treatment modality for systemic and local therapies.


Assuntos
Neoplasias Colorretais/terapia , Neoplasias Hepáticas/secundário , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia
19.
Zhonghua Yi Xue Za Zhi ; 93(15): 1153-5, 2013 Apr 16.
Artigo em Chinês | MEDLINE | ID: mdl-23902885

RESUMO

OBJECTIVE: To perform the dynamic contrast-enhanced and perfusion magnetic resonance imaging (MRI) of nasopharyngeal carcinoma (NPC) and analyze the correlation with T-staging. METHODS: A total of 46 naïve NPC patients underwent MRI. The parameters of dynamic contrast-enhanced and perfusion MRI included time to peak (TTP), Slopemax and area under the curve (AUC). RESULTS: The increasing period of signal intensity-time curve of all cases was steep. And the perfusion image of AUC could reflect the blood perfusion of tumor tissue. Parameters (TTP/Slopemax/AUC) in different T-staging were T1-staging (60.45/10.59/20 619.56), T2-staging (58.12/12.47/23 037.23), T3-staging (70.61/15.06/26 507.23) and T4-staging (41.72/19.87/30 092.27). Their statistical results were r = -0.247, P > 0.05 and r = 0.859, P < 0.050 and r = 0.963, P < 0.05 respectively. And statistical significance existed in Slopemax, AUC with T-staging. CONCLUSION: Dynamic contrast-enhanced and perfusion MRI can reflect angiogenesis of NPC. And there is a positive correlation between the parameters of dynamic contrast-enhanced and perfusion MRI (Slopemax, AUC) and T-staging.


Assuntos
Aumento da Imagem , Angiografia por Ressonância Magnética/métodos , Neoplasias Nasofaríngeas/patologia , Adulto , Carcinoma , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo , Estadiamento de Neoplasias , Adulto Jovem
20.
Clin Nephrol ; 79(3): 192-8, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23073066

RESUMO

OBJECTIVE: The aim of the present study was to determine the plasma osteoprotegerin (OPG) levels in Type 1 diabetic patients with albuminuria. METHODS: A total of 80 Type 1 diabetic subjects and 30 control subjects were enrolled. Diabetic subjects were divided into normoalbuminuric group, microalbuminuric group and macroalbuminuric group according to urinary albumin excretion rate (UAER) and serum creatinine measurements. Plasma osteoprotegerin level was measured by enzyme-linked immunoassay. RESULTS: The serum OPG levels were significantly elevated in patients with microalbuminuria (3.62 ± 0.70 ng/l) and macroalbuminuria (4.45 ± 0.76 ng/l) as compared with patients with normoalbuminuria (2.77 ± 0.78 ng/l) and control subjects (2.29 ± 0.37 ng/l). And the plasma osteoprotegerin level in macroalbuminuric group was also higher than that in microalbuminuria group. The plasma osteoprotegerin level had a positive correlation with the fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), glycohemoglobin A1c (HbA1C), highly sensitive C-reactive protein (hsCRP)and UAER. Multivariate regression analysis revealed that the plasma osteoprotegerin level was an independent factor associated with albuminuria in Type 1 diabetes. CONCLUSIONS: The plasma values of osteoprotegerin were elevated in Type 1 diabetic patients with nephropathy and gradually increased with the severity, so there is a association between plasma osteoprotegerin levels and the presence and severity of diabetic nephropathy. This finding supports the growing concept that osteoprotegerin may act as an important regulatory molecule in the angiopathy, and particularly, that it may be involved in the development of nephropathy in Type 1 diabetes.


Assuntos
Albuminúria/sangue , Diabetes Mellitus Tipo 1/sangue , Nefropatias Diabéticas/sangue , Osteoprotegerina/sangue , Adulto , Proteína C-Reativa/análise , Feminino , Humanos , Masculino
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