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1.
Medicine (Baltimore) ; 99(40): e22534, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019459

RESUMO

RATIONALE: Foreign bodies are frequently ingested, but only approximately 1% of them cause perforation. Perforations in the lesser curvature of the stomach are exceedingly rare. Here, we report a case of gastric perforation in the lesser curvature caused by a foreign body. The patient presented to the clinic complaining of abdominal skin swelling and reddening with upper abdominal discomfort as the initial symptoms. PATIENT CONCERNS: An 83-year-old female presented with a mass in the middle of the epigastrium for 10 days. Physical examination found an apparent local tenderness and inflammatory mass in the upper abdominal wall. Her body temperature was normal (37.5°C) and the white blood cell count was elevated (8.12 × 10/L [reference value 3.5-9.5 × 10/L]). DIAGNOSES: The ultrasound examination of the abdomen revealed a 4 cm strip-like hyperechoic object entangled in the muscles of the abdominal wall. The computed tomography scan revealed a thin strip of bone-like hyperdense shadow. Intraoperative findings showed a sharp fishbone protruding from the lesser curvature of the stomach into the abdominal cavity, part of which remained in the gastric cavity. The postoperative pathological report revealed chronic suppurative inflammation with abscess and sinus canal formation. INTERVENTIONS & OUTCOMES: The patient underwent a gastric foreign body removal with partial gastrectomy. Anti-inflammatory treatment post-surgery rapidly relieved the patient's symptoms of discomfort in the upper abdomen. At the 1-month follow-up, the patient showed no discomfort in the upper abdomen and the inflammatory mass was no longer present. LESSONS: A foreign body had penetrated through the lesser curvature of the stomach, an area with a flat gastric wall, which occurs infrequently. In such cases, computed tomography is the gold standard for diagnosis of foreign bodies in the digestive tract. Ultrasound can also be used as a supplemental diagnostic technique. It is recommended that people who wear dentures should exercise caution while eating, especially when the food contains bones.


Assuntos
Parede Abdominal/patologia , Corpos Estranhos/cirurgia , Inflamação/etiologia , Pele/patologia , Estômago/cirurgia , Assistência ao Convalescente , Idoso de 80 Anos ou mais , Osso e Ossos , Ingestão de Alimentos , Feminino , Corpos Estranhos/diagnóstico por imagem , Humanos , Alimentos Marinhos , Perfuração Espontânea , Estômago/microbiologia , Estômago/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos
2.
Anticancer Res ; 40(10): 5393-5397, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988858

RESUMO

BACKGROUND/AIM: We established a new patient-derived orthotopic xenograft (PDOX) model of gastric cancer liver metastasis and evaluated the efficacy of a novel combination chemotherapy, gemcitabine (GEM) plus 5-fluorouracil (5-FU), compared to a standard regimen of oxaliplatinum (L-OHP) plus 5-FU on the liver metastasis. MATERIALS AND METHODS: Patient-derived gastric cancer was established in nude mice from the patient' s surgical tumor specimen. A single tumor fragment was implanted in the liver of nude mice. The mice with tumors were treated by GEM plus 5-FU or L-OHP plus 5-FU. RESULTS: GEM plus 5-FU or L-OHP plus 5-FU significantly and similarly inhibited tumor growth on the liver compared to the untreated control (p=0.007, p=0.02, respectively). CONCLUSION: GEM plus 5-FU could be a novel future clinical alternative to L-OHP plus 5-FU in gastric cancer patients who cannot tolerate platinum drugs.


Assuntos
Desoxicitidina/análogos & derivados , Fluoruracila/farmacologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Gástricas/tratamento farmacológico , Animais , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Desoxicitidina/farmacologia , Modelos Animais de Doenças , Humanos , Neoplasias Hepáticas/patologia , Camundongos , Oxaliplatina/farmacologia , Estômago/efeitos dos fármacos , Estômago/patologia , Neoplasias Gástricas/patologia , Ensaios Antitumorais Modelo de Xenoenxerto
3.
Medicine (Baltimore) ; 99(36): e21980, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899039

RESUMO

For the diagnosis of gastric adenosquamous carcinoma (ASC), discrepancies regarding a rational diagnostic proportion of the squamous cell carcinoma (SCC) component exist among different organizations. Our study aimed to evaluate the impact of the SCC component on the survival of gastric cancer patients and identify the optimal cutoff value for the SCC component necessary for diagnosing gastric ASC.Cases of gastric cancer with an SCC component were obtained from our center and from case reports and series extracted from Medline. Univariate and multivariate analyses were conducted to compare the overall survival between groups and examine the prognostic value of various clinical parameters.We identified 45 qualified cases in published literature and 13 in our center. Forty-two of them were males and 16 females (M: F = 2.6:1). Thirty of them were Asian patients and the rest were mainly from the United States and Europe. The mean age was 61.1 years (median 64 years, range 32-84 years). The average tumor size was 6.9 cm (median 6.0 cm, range 2.0-16.0 cm). The most common location of the cancer was the lower third (39.7%). Although a statistical difference was not achieved, the Kaplan-Meier curve demonstrated that as the proportion of the SCC component in the primary lesion increased, the patients' survival risk increased (P = .489), and the presence of the SCC component in metastatic lymph nodes also increased the risk of survival (P = .259); both of these findings indicated a negative impact of the SCC component on survival. Furthermore, we identified the optimal cutoff for the SCC component as 35% (χ = 6.544, P = .011), which was subsequently validated in a Cox regression model as an independent prognostic factor (P = .026).An increased proportion of the SCC component is associated with worse survival in gastric cancer patients with an SCC component. The optimal cutoff for the proportion of the SCC component necessary for the diagnosis of gastric ASC is 35%.


Assuntos
Carcinoma Adenoescamoso/mortalidade , Carcinoma de Células Escamosas/mortalidade , Neoplasias Gástricas/mortalidade , Estômago/patologia , Carcinoma Adenoescamoso/patologia , Carcinoma de Células Escamosas/patologia , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Gástricas/patologia
4.
PLoS One ; 15(9): e0237515, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898138

RESUMO

BACKGROUND: Regional variations in gastric cancer incidence are not explained by prevalence of Helicobacter pylori, the main cause of the disease, with several areas presenting high H. pylori prevalence but low gastric cancer incidence. The IARC worldwide H. pylori prevalence surveys (ENIGMA) aim at systematically describing age and sex-specific prevalence of H. pylori infection around the world and generating hypotheses to explain regional variations in gastric cancer risk. METHODS: We selected age- and sex-stratified population samples in two areas with different gastric cancer incidence and mortality in Chile: Antofagasta (lower rate) and Valdivia (higher rate). Participants were 1-69 years old and provided interviews and blood for anti-H. pylori antibodies (IgG, VacA, CagA, others) and atrophy biomarkers (pepsinogens). RESULTS: H. pylori seroprevalence (Age-standardized to world population) and antibodies against CagA and VacA were similar in both sites. H. pylori seroprevalence was 20% among children <10 years old, 40% among 10-19 year olds, 60% in the 20-29 year olds and close to or above 80% in those 30+ years. The comparison of the prevalence of known and potential H. pylori cofactors in gastric carcinogenesis between the high and the low risk area showed that consumption of chili products was significantly higher in Valdivia and daily non-green vegetable consumption was more common in Antofagasta. Pepsinogen levels suggestive of gastric atrophy were significantly more common and occurred at earlier ages in Valdivia, the higher risk area. In a multivariate model combining both study sites, age, chili consumption and CagA were the main risk factors for gastric atrophy. CONCLUSIONS: The prevalence of H. pylori infection and its virulence factors was similar in the high and the low risk area, but atrophy was more common and occurred at younger ages in the higher risk area. Dietary factors could partly explain higher rates of atrophy and gastric cancer in Valdivia. IMPACT: The ENIGMA study in Chile contributes to better understanding regional variations in gastric cancer incidence and provides essential information for public health interventions.


Assuntos
Infecções por Helicobacter/complicações , Helicobacter pylori/isolamento & purificação , Neoplasias Gástricas/etiologia , Estômago/patologia , Adolescente , Adulto , Idoso , Atrofia/etiologia , Atrofia/microbiologia , Atrofia/patologia , Criança , Pré-Escolar , Chile/epidemiologia , Feminino , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estômago/microbiologia , Neoplasias Gástricas/microbiologia , Neoplasias Gástricas/patologia , Adulto Jovem
6.
Parasitol Res ; 119(9): 3109-3112, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32643084

RESUMO

Recent studies have described Spirocerca lupi-like nematodes in the stomach of red foxes (Vulpes vulpes) in Europe. A phylogenetic analysis of those specimens using mitochondrial DNA and their morphological reexamination allowed their characterization as a different species, Spirocerca vulpis. Between the years of 2010 and 2017, roundworms were collected from seven red foxes of northeastern Portugal found at necropsy with nodular lesions on their stomach wall. Histopathological analysis of four foxes revealed granulomatous lesions of the gastric nodules. On morphological assessment, by light microscopy, nematodes revealed the presence of six triangular teeth-like buccal capsule structures, which are absent in S. lupi. Polymerase chain reaction was run to amplify a 551 bp partial fragment of the cytochrome c oxidase subunit 1 gene. Sequences were 99% similar to S. vulpis (85% coverage) of red foxes from Spain and Bosnia and Herzegovina, 99% similar (99% coverage) to sequences of Spirocerca sp. of red foxes from Denmark and 93% similar (99% coverage) to S. lupi from South Africa. This is the first report of S. vulpis in foxes or any other host from Portugal.


Assuntos
Raposas/parasitologia , Infecções por Spirurida/veterinária , Thelazioidea/isolamento & purificação , Animais , Filogenia , Reação em Cadeia da Polimerase , Portugal , Espanha , Infecções por Spirurida/patologia , Estômago/parasitologia , Estômago/patologia , Thelazioidea/classificação , Thelazioidea/genética
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 648-652, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683824

RESUMO

Different from classical surgical anatomy which only pays attention to the morphology and structure of human organs, modern membrane anatomy focuses on not only the relationship between morphology and structure, but also the biological behavior characteristics of tumors. Membrane antomy is a theoretical system with interpretation on both the structural and disease function, so it has been accepted by more and more gastrointestinal surgeons. However, the theoretical system of gastric membrane anatomy is not mature yet. The stomach and its mesentery have undergone complex rotation and fusion in the process of embryonic development, so that surgeons have different understandings of the gastric membrane anatomy. Therefore, it is easy to cause various confusion and misunderstanding, resulting in deviations between the theory of membrane anatomy and the practice of surgery. In the present study, the mesentery of the stomach is divided into different regions, and the embryonic development process is traced back. The application and compromise encountered in the radical gastrectomy of gastric cancer will be expounded according to the membrane anatomy theory combined with the author's experience of operation.


Assuntos
Gastrectomia/métodos , Mesentério/anatomia & histologia , Mesentério/cirurgia , Neoplasias Gástricas/cirurgia , Estômago/cirurgia , Humanos , Laparoscopia , Excisão de Linfonodo/métodos , Mesentério/embriologia , Mesentério/patologia , Estômago/anatomia & histologia , Estômago/embriologia , Estômago/patologia , Neoplasias Gástricas/patologia
8.
PLoS One ; 15(7): e0236197, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32701958

RESUMO

Genome-wide association studies of gastric cancer (GC) cases have revealed common gastric cancer susceptibility loci with low effect size. We investigated rare variants with high effect size via whole-exome sequencing (WES) of subjects with familial clustering of gastric cancer. WES of DNAs from the blood of 19 gastric cancer patients and 36 unaffected family members from 14 families with two or more gastric cancer patients were tested. Linkage analysis combined with association tests were performed using Pedigree Variant Annotation, Analysis, and Search Tool (pVAAST) software. Based on the logarithm of odds (LOD) and permutation-based composite likelihood ratio test (CLRT) from pVAAST, MUC4 was identified as a predisposing gene (LOD P-value = 1.9×10-5; permutation-based P-value of CLRT ≤ 9.9×10-9). In a larger cohort consisting of 597 GC patients and 9,759 healthy controls genotyped with SNP array, we discovered common variants in MUC4 regions (rs148735556, rs11717039, and rs547775645) significantly associated with GC supporting the association of MUC4 with gastric cancer. And the MUC4 variants were found in higher frequency in The Cancer Genome Atlas Study (TCGA) germline samples of patients with multiple cancer types. Immunohistochemistry indicated that MUC4 was downregulated in the noncancerous gastric mucosa of subjects with MUC4 germline missense variants, suggesting that loss of the protective function of MUC4 predisposes an individual to gastric cancer. Rare variants in MUC4 can be novel gastric cancer susceptibility loci in Koreans possessing the familial clustering of gastric cancer.


Assuntos
Ligação Genética , Predisposição Genética para Doença , Variação Genética , Mucina-4/genética , Sequenciamento Completo do Exoma , Estudos de Coortes , Família , Feminino , Células Germinativas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Mucina-4/química , Linhagem , Reprodutibilidade dos Testes , Estômago/patologia , Neoplasias Gástricas/genética
9.
J Clin Pathol ; 73(10): 618-623, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32591353

RESUMO

BACKGROUND: Bariatric surgical procedures are employed when there is a failure of lifestyle modification in arresting obesity. Laparoscopic sleeve gastrectomy (LSG) is quickly becoming the bariatric surgical procedure of choice. LSG results in a gastric remnant that is subject to pathological examination. The objective of this paper is to review the literature in regard to histological findings identified in gastric remnants post-LSG and identify the most pertinent histological findings. MATERIALS AND METHODS: A literature search was performed to identify relevant case series. Data gathered from relevant case series then underwent statistical analysis. RESULTS: The most common histological findings in an LSG specimen were clinically indolent findings such as no pathological abnormalities identified followed by non-specific gastritis. A minority of cases demonstrated clinically actionable findings for which Helicobacter pylori represented the majority of these findings. CONCLUSION: There is a broad spectrum of pathological findings in LSG specimens, ranging from clinically indolent to clinically actionable. The most common histological findings are clinically indolent and only a small portion are of clinical significance and, hence, actionable.


Assuntos
Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgia , Estômago/patologia , Adulto , Cirurgia Bariátrica , Feminino , Gastrectomia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade
10.
J Cancer Res Ther ; 16(2): 203-208, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32474502

RESUMO

Objective: The objective of the study was to investigate the radiation damage to125 I seeds implanted in canine gastric wall tissue. Materials and Methods: Eight beagles were randomly assigned to either the treatment or control group, with four beagles per group. For each beagle in the treatment group, six125 I seeds were implanted in the gastric wall in two rows, spaced at 1.0 cm, with a seed activity of 0.5 mCi and a half-life of 60.2 d. For each beagle in the control group, six 125 I seeds were similarly implanted as a cold source. After implantation, the beagles were scanned by computed tomography (CT) (slice thickness: 2 mm), the region of interest was labeled along the seed boundaries, and postoperative doses were verified. One beagle per group was sacrificed at the 1, 2, 3, and 4 half-lives to be used as gross specimens for observing histological and ultrastructural changes using light microscopy and electron microscopy, respectively. Results: Beagles from the treatment group who had125 I radioactive seeds implanted in their stomach walls had the most radiation damage after two half-lives, damage repair began after three half-lives, and the damage was stabilized and further repaired after four half-lives. In the control group, only mild inflammatory reactions were observed around the seeds. Conclusion: Appropriate and well-planned implantation of125 I radioactive seeds in beagle stomach walls is safe and reliable.


Assuntos
Braquiterapia/efeitos adversos , Radioisótopos do Iodo/farmacologia , Neoplasias Experimentais/radioterapia , Lesões por Radiação/patologia , Estômago/patologia , Tomografia Computadorizada por Raios X/veterinária , Animais , Braquiterapia/métodos , Modelos Animais de Doenças , Cães , Feminino , Meia-Vida , Masculino , Neoplasias Experimentais/patologia , Lesões por Radiação/etiologia , Dosagem Radioterapêutica , Estômago/efeitos da radiação
11.
Top Companion Anim Med ; 39: 100403, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32482282

RESUMO

Gastric dilation-volvulus (GDV) syndrome in dogs is associated with complex metabolic, acid-base, and electrolyte abnormalities. The aim of this study was to evaluate previously analyzed factors (lactate and BE) in combination with other acid-base parameters (pH, pCO2, bicarbonate, base excess [BE], anion gap [AG], and strong ion difference) and electrolyte concentrations and to evaluate their association with the incidence of gastric necrosis and outcome in dogs with GDV. A retrospective study in 75 dogs with gastric dilation-volvulus syndrome, University veterinary teaching hospital. Medical records were reviewed including signalment, history, initial plasma lactate, acid-base parameters, and electrolyte concentrations, surgical findings and outcome. The overall mortality was 18.7%. In dogs with gastric necrosis, higher initial plasma lactate (median 5.84 vs. 3.36 mmol/L) and AG (20.7 vs. 16.55 mmol/L) and lower pH (7.29 vs. 7.36), bicarbonate (18.7 vs. 22.9 mmol/L), and BE concentration (-8.1 vs. -1.85 mmol/L) were found compared to dogs without gastric necrosis. Anorganic phosphorus was the only electrolyte investigated for which a significant difference was noted between dogs with and without gastric necrosis (1.93 vs. 1.39 mmol/L). The initial plasma lactate concentration (3.36 mmol/L vs. 9.68 mmol/L) and AG (16.8 vs. 20.95 mmol/L) were lower in survivors than nonsurvivors. Survivors had higher pH (7.35 vs. 7.27), bicarbonate concentrations (22.9 vs. 17.35 mmol/L), and BE (-1.9 vs. -9.55 mmol/L) compared to nonsurvivors. Anorganic phosphorus was ultimately the only electrolyte with a significant difference between survivors and nonsurvivors (1.4 vs. 1.84 mmol/L). A multivariate logistic regression model of combination lactate, pH, bicarbonate, BE, AG, and anorganic phosphorus identified pH ≤7.331 and bicarbonate as factors independently associated with gastric necrosis. Similarly, pH ˃7.331, bicarbonate and anorganic phosphorus were independently associated with outcome. Higher initial plasma lactate, AG and anorganic phosphorus levels, and lower pH, BE and bicarbonate concentrations were found in GDV dogs with gastric necrosis. Similarly, initially higher plasma lactate, AG and anorganic phosphorus concentrations, and lower pH, BE and bicarbonate were found in GDV dogs who required euthanasia or who died after surgery. Of these parameters, pH and bicarbonate were strongly and independently associated with gastric necrosis, and pH, bicarbonate and phosphorus were independently associated with outcome.


Assuntos
Doenças do Cão/mortalidade , Dilatação Gástrica/veterinária , Volvo Gástrico/veterinária , Animais , República Tcheca , Doenças do Cão/sangue , Doenças do Cão/patologia , Cães , Eletrólitos/sangue , Feminino , Dilatação Gástrica/mortalidade , Concentração de Íons de Hidrogênio , Ácido Láctico/sangue , Masculino , Necrose , Registros/veterinária , Estudos Retrospectivos , Estômago/patologia , Volvo Gástrico/mortalidade , Análise de Sobrevida , Síndrome
12.
PLoS One ; 15(5): e0232240, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32379763

RESUMO

AIM: That clinical trial (RAINBOW) showed that a 7.4 months overall survival benefit with the combination therapy with ramucirumab (RAM) and paclitaxel (PAC) as second-line therapy for patients with recurrent or metastatic gastric or gastro-oesophageal junction adenocarcinoma, compared with placebo (PLA) plus paclitaxel. We performed an analysis to assess the cost-effectiveness of RAM from a Chinese perspective and recognized the range of drug costs. METHODS: By building a Markov model to estimate quality-adjusted life-years (QALYs), life-years (LYs) and lifetime costs. Transition probabilities, costs and utilities were estimated for the published literature, Chinese health care system and local price setting. We performed threshold analyses and probabilistic sensitivity analyses to evaluate the uncertainty of the model. RESULTS: Compared with PLA strategy, RAM strategy provided an incremental survival benefit of 1.22 LYs and 0.64 QALYs. The probabilistic sensitivity analysis showed that when RAM costs less than $151 or $753 per 4 weeks, the incremental cost-effectiveness ratio (ICER) approximated the willingness-to-pay threshold (WTP), suggesting that there was 50% likelihood that the ICER for RAM + PAC would be less than $44528.4 per QALY or $48121 per QALY, respectively. CONCLUSIONS: For patients with advanced gastric or gastro-oesophageal junction adenocarcinoma who fail first-line chemotherapy, our results are conducive to the multilateral drug price guidance negotiations of RAM in China.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/economia , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Gástricas/tratamento farmacológico , Adenocarcinoma/tratamento farmacológico , Adulto , Anticorpos Monoclonais Humanizados/economia , Anticorpos Monoclonais Humanizados/uso terapêutico , Grupo com Ancestrais do Continente Asiático , China , Análise Custo-Benefício , Neoplasias Esofágicas/economia , Feminino , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Econômicos , Paclitaxel/economia , Paclitaxel/uso terapêutico , Intervalo Livre de Progressão , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Estômago/patologia , Neoplasias Gástricas/economia
13.
Life Sci ; 254: 117774, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32407843

RESUMO

AIMS: Gastric cancer (GC) remains one of the deadliest malignancies worldwide due to its poor prognosis. DNA methylation changes, as an early event during tumor progression, constitute attractive markers for cancer diagnostics. In the current study, CD40 DNA methylation was investigated in GC as a novel epigenetic biomarker. MAIN METHODS: We first analyzed DNA methylation microarrays from the Gene Expression Omnibus database on GC samples to evaluate the potential diagnostic value of CD40 methylation. Moreover, using q-MSP, in a set of internal samples including GC primary tumors and adjacent normal specimens, CD40 DNA methylation levels were determined. The Cancer Genome Atlas (TCGA) data on GC was also analyzed for further validation. KEY FINDINGS: Our results illustrated significant CD40 hypermethylation in GC samples compared to normal specimens which was significantly correlated with the clinical stage of malignancy. Besides, the high accuracy of CD40 methylation as a diagnostic biomarker in GC was confirmed using the ROC curve analysis with an AUC value of 0.9089. Also, gene set enrichment analysis showed that CD40 is mainly involved in biological processes regulating immune response activation in GC. Further analysis of other prevalent cancer entities in TCGA showed that CD40 hypermethylation is a common event during tumor progression and could be considered as a potential biomarker for the detection of breast, colorectal, and prostate cancers as well. SIGNIFICANCE: The finding of this study suggests that CD40 methylation as a potential pan biomarker could be a valuable target for liquid biopsy application of human cancers.


Assuntos
Antígenos CD40/genética , Metilação de DNA , Neoplasias Gástricas/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Antígenos CD40/metabolismo , DNA/metabolismo , Bases de Dados Genéticas , Epigênese Genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Regiões Promotoras Genéticas , Curva ROC , Estômago/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/patologia
14.
Surg Clin North Am ; 100(3): 523-534, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32402298

RESUMO

Gastric cancer is one of the most common cancers in the world, despite declining incidence of the disease in the United States. Because of the rare occurrence of the disease in the United States, there is significant treatment variance in use of diagnostic modalities, neoadjuvant/adjuvant therapies, and surgical techniques. The survival of patients with gastric cancer in the United States is significantly lower than those of Asian countries where the diagnosis is made at an earlier stage and uniform high-quality treatment is delivered. This article reviews pearls and pitfalls of multidisciplinary management of the gastric adenocarcinoma for best outcomes.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Adenocarcinoma/radioterapia , Biópsia , Terapia Combinada , Gastroscopia , Cirurgia Geral , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Laparoscopia , Excisão de Linfonodo , Terapia Neoadjuvante , Estadiamento de Neoplasias , Prognóstico , Estômago/patologia , Estômago/cirurgia , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Neoplasias Gástricas/radioterapia
15.
Nat Rev Endocrinol ; 16(8): 448-466, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32457534

RESUMO

Dumping syndrome is a common but underdiagnosed complication of gastric and oesophageal surgery. We initiated a Delphi consensus process with international multidisciplinary experts. We defined the scope, proposed statements and searched electronic databases to survey the literature. Eighteen experts participated in the literature summary and voting process evaluating 62 statements. We evaluated the quality of evidence using grading of recommendations assessment, development and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 33 of 62 statements, including the definition and symptom profile of dumping syndrome and its effect on quality of life. The panel agreed on the pathophysiological relevance of rapid passage of nutrients to the small bowel, on the role of decreased gastric volume capacity and release of glucagon-like peptide 1. Symptom recognition is crucial, and the modified oral glucose tolerance test, but not gastric emptying testing, is useful for diagnosis. An increase in haematocrit >3% or in pulse rate >10 bpm 30 min after the start of the glucose intake are diagnostic of early dumping syndrome, and a nadir hypoglycaemia level <50 mg/dl is diagnostic of late dumping syndrome. Dietary adjustment is the agreed first treatment step; acarbose is effective for late dumping syndrome symptoms and somatostatin analogues are preferred for patients who do not respond to diet adjustments and acarbose.


Assuntos
Consenso , Síndrome de Esvaziamento Rápido/diagnóstico , Síndrome de Esvaziamento Rápido/terapia , Acarbose/uso terapêutico , Cirurgia Bariátrica/efeitos adversos , Glicemia/análise , Dietoterapia , Síndrome de Esvaziamento Rápido/fisiopatologia , Esôfago/cirurgia , Medicina Baseada em Evidências , Gastrectomia/efeitos adversos , Esvaziamento Gástrico , Hormônios Gastrointestinais/metabolismo , Humanos , Refeições , Complicações Pós-Operatórias , Guias de Prática Clínica como Assunto , Qualidade de Vida , Estômago/patologia , Estômago/cirurgia , Perda de Peso
16.
Anticancer Res ; 40(4): 1897-1904, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234878

RESUMO

BACKGROUND/AIM: We investigated the clinical role of the molecular targets, APEX1 and Jagged-1, and the Apex1 - Jagged-1 cascade in gastric cancer cells. MATERIALS AND METHODS: We used 6 human gastric cancer cell lines (SNU-1, SNU-5, SNU-16, NCI-N87, KATO- III and AGS), and demonstrated the chemosensitivity of APEX1 and Jagged-1 through the MTT assay and immunoblotting. Tumor growth was assayed following cisplatin and 5-FU treatment using a xenograft model injected with KATO-III cells. Moreover, gastric tumor samples from 9 patients, divided in 2 groups according to chemotherapy response, were examined by immunocytochemical (IHC) staining, and protein expression levels were scored. RESULTS: Following APEX1 knockdown, the MTT assay revealed that the IC50 of cisplatin and 5-FU in AGS cells was decreased approximately 7% and 15%, respectively, however, their decrease in chemoresistant KATO-III cells was decreased by approximately 21% and 67% for cisplatin and 5-FU, respectively. The tumor volume of KATO-III/sicontrol mice treated with cisplatin and 5-FU was affected less, compared with KATO-III/siAPEX1 mice treated with cisplatin and 5-FU. Also, the expression levels of APEX1, Jagged-1 and CD133, assayed by IHC staining, were higher in the chemorefractory group than in the chemoresponsive group. CONCLUSION: Jagged-1-activated signaling by APEX1 plays a role in advanced gastric cancer.


Assuntos
DNA Liase (Sítios Apurínicos ou Apirimidínicos)/genética , Resistencia a Medicamentos Antineoplásicos/genética , Proteína Jagged-1/genética , Neoplasias Gástricas/tratamento farmacológico , Animais , Apoptose/efeitos dos fármacos , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Cisplatino/farmacologia , Fluoruracila/farmacologia , Humanos , Camundongos , Estadiamento de Neoplasias , Estômago/efeitos dos fármacos , Estômago/patologia , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologia , Ensaios Antitumorais Modelo de Xenoenxerto
17.
Int J Nanomedicine ; 15: 2529-2539, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32346290

RESUMO

Background: Peptic ulcer disease, a painful lesion of the gastric mucosa, is considered one of the most common gastrointestinal disorders. This study aims to investigate the formulation of pumpkin seed oil (PSO)-based nanostructured lipid carriers (NLCs) to utilize PSO as the liquid lipid component of NLCs and to achieve oil dispersion in the nano-range in the stomach. Methods: Box-Behnken design was utilized to deduce the optimum formula with minimum particle size. The optimized PSO-NLCs formula was investigated for gastric ulcer protective effects in Wistar rats by evaluating ulcer index and determination of gastric mucosa oxidative stress parameters. Results: PSO was successfully incorporated as the liquid lipid (LL) component of NLCs. The prepared optimum PSO-NLCs formula showed a size of 64.3 nm. Pretreatment of animals using the optimized PSO-NLCs formula showed significantly (p< 0.001) lower ulcer index compared to indomethacin alone group and significantly (p<0.05) less mucosal lesions compared to the raw oil. Conclusion: These results indicated great potential for future application of optimized PSO-NLCs formula for antiulcer effect in non-steroidal anti-inflammatory drug (NSAID)-induced gastric ulcer.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Cucurbita/química , Portadores de Fármacos/química , Lipídeos/química , Nanoestruturas/química , Óleos Vegetais/química , Úlcera Gástrica/tratamento farmacológico , Animais , Modelos Animais de Doenças , Mucosa Gástrica/efeitos dos fármacos , Mucosa Gástrica/patologia , Indometacina/uso terapêutico , Masculino , Estresse Oxidativo/efeitos dos fármacos , Tamanho da Partícula , Ratos Wistar , Reprodutibilidade dos Testes , Espectroscopia de Infravermelho com Transformada de Fourier , Estômago/efeitos dos fármacos , Estômago/patologia , Úlcera Gástrica/patologia
18.
Ann R Coll Surg Engl ; 102(5): 355-362, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32326735

RESUMO

INTRODUCTION: Gastric cancer is the fourth most common cancer in the world. By the time the patients are diagnosed with stage IV gastric cancer, many patients already have distant metastases. There is no unified systemic treatment plan in existence. The use of gastrectomy is ambiguous in patients with stage IV gastric cancer. The objective of this study was to evaluate the beneficial outcome of gastrectomy in patients with stage IV gastric cancer. METHODS: Clinical information of patients with gastric cancer from 2000 to 2010 in the Surveillance, Epidemiology, and End Results database were extracted and analysed. The risk factors for stage IV gastric cancer were also analysed. RESULTS: We observed that the median survival time for patients after surgery was greater than that for patients not treated surgically. The five-year survival rate for chemotherapy patients was higher than that of non-chemotherapeutic patients. Patients who receive both chemotherapy and surgery could achieve a more significant survival benefit. The risks following gastrectomy (partial, subtotal, hemi-) were lower than those of other surgical procedures, which provided guidance on the choice of surgical method. The numbers of regional lymph node metastasis were found to be related to prognosis. CONCLUSIONS: In patients with stage IV gastric cancer, gastrectomy (partial, subtotal or hemi) should be selected when surgery is necessary. The number of regional lymph node metastasis could be considered as a prognostic factor for patients with stage IV gastric cancer and lymph node dissection could reduce the risk of patients undergoing surgery.


Assuntos
Gastrectomia/métodos , Excisão de Linfonodo/métodos , Metástase Linfática , Neoplasias Gástricas/epidemiologia , Idoso , Feminino , Gastrectomia/estatística & dados numéricos , Humanos , Excisão de Linfonodo/estatística & dados numéricos , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Seleção de Pacientes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Programa de SEER/estatística & dados numéricos , Estômago/patologia , Estômago/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologia
19.
Medicine (Baltimore) ; 99(15): e19630, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282712

RESUMO

To investigate computed tomography and angiography findings and clinical outcomes after transcatheter arterial embolization for acute upper gastrointestinal bleeding from advanced gastric cancers.From January 2005 to December 2014, 58 patients with pathologically proven gastric cancer were treated at our institution with transcatheter arterial embolization due to acute upper gastrointestinal bleeding recalcitrant to endoscopic treatment. The electronic medical records for each patient were reviewed for clinical presentation, endoscopy history, computed tomography and angiographic findings, blood transfusion requirements, and follow-up results.Angiography findings were positive in 13 patients (22.4%): contrast extravasation was found in 9 patients and pseudoaneurysm in 4 patients. All patients with positive angiograms underwent selective embolization treatment. Those with negative angiography findings underwent empirical embolization. Gelfoam, n-butyl cyanoacrylate, coils, or a combination of these were used as embolic agents. The overall clinical success rate was 72.4% (42/58), and the success rate for patients with positive angiography was 53.8% (7/13). The median survival was 97.5 days (range, 7-1415 days), and the 1-month survival rate was 89.6% (52/58). The 1-month survival rate of the clinical success group was 95.2% (40/42), which was significantly higher than that of the clinical failure group (P = .04). The clinical success group also required significantly fewer transfusions (2.43 units, range 0-24 units) (P = .02).Transcatheter arterial embolization is a highly effective treatment for advanced gastric cancer with active bleeding. It should be considered as an additional treatment, especially when endoscopic or surgical treatment fails or when these approaches are difficult.


Assuntos
Embolização Terapêutica/métodos , Hemorragia Gastrointestinal/terapia , Neoplasias Gástricas/complicações , Tomografia Computadorizada por Raios X/métodos , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/epidemiologia , Angiografia/instrumentação , Embolização Terapêutica/tendências , Embucrilato/uso terapêutico , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/epidemiologia , Esponja de Gelatina Absorvível/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estômago/irrigação sanguínea , Estômago/patologia , Neoplasias Gástricas/patologia , Taxa de Sobrevida , Resultado do Tratamento
20.
Medicine (Baltimore) ; 99(16): e19885, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312014

RESUMO

RATIONALE: Gastrointestinal stromal tumor (GIST) is one of the most common malignant mesenchymal tumors of the gastrointestinal tract. They generally arise from the fourth layer (muscularis propria) and rarely from the second or third layer. Although the manifestations of gastric stromal tumors are diverse, to our knowledge, there are only several cases of an extra-gastric stromal tumor in the literature appearing with a pedunculation. Pedunculated large GISTs are not frequent and compress the neighboring organs. When they were huge, it is difficult to differentiate the origin of the masses. Thus, in the clinical setting, physicians should pay more attention to the pattern of manifestation of the gastric stromal tumor. PATIENT CONCERNS: A 62-year-old man had no gastrointestinal symptoms or significant medical and family histories. During the health examination with US, a cystic-solid tumor was found below liver. The results of the physical examination were unremarkable, and routine laboratory data on admission did not show any abnormal findings. DIAGNOSIS: Computed tomography of the abdomen showed a mixed echoic mass measuring 10 × 8 × 8 cm and located below the liver, adjacent to the gastric antrum. After endoscopic ultrasound-guided fine-needle aspiration, cytopathology showed that the specimen was filled with red blood cells, and it had no malignant cells. Histopathology revealed that the mass was a GIST, and immunohistochemical analysis showed the following: CD117(+), CD34(+), desmin(-), Dog-1(+), Ki-67% <1%, and smooth muscle actin(-). INTERVENTIONS: Surgical resection was performed on the patient. OUTCOMES: The lesion was diagnosed as a gastric stromal tumor with a pedicle and an old hemorrhage. The patient's recovery was uneventful. After surgery, computed tomography at the 6-month and 1-year postoperative follow-up visits did not reveal relapse or any metastasis. LESSONS: In the clinical setting, physicians should pay more attention to the pattern of manifestation of the extra-gastric stromal tumor in patients with a pedicle or hemorrhage. Additionally, endoscopic ultrasound-guided fine-needle aspiration can be used to make an accurate preoperative diagnosis of such diseases, and its findings can serve as an important basis for surgical excision of the lesions.


Assuntos
Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias Gástricas/patologia , Estômago/patologia , Assistência ao Convalescente , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas c-kit/metabolismo , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
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