Risk of lymph node metastasis and prognostic outcome in early gastric cancer patients with mixed histologic type

BackgroundWhether early gastric cancer with mixed histologic type should be considered for endoscopic submucosal dissection (ESD) remains controversial. The objective of this study was to evaluate the risk of lymph node metastasis (LNM) and prognostic significance for early gastric cancer with mixed histologic type.MethodsWe retrospectively reviewed clinicopathologic and survival data of 302 patients who underwent surgical resection for early gastric cancer. Based on the histologic components, all patients were classified as pure differentiated type, pure undifferentiated type and mixed histologic type. The prognostic differences between different types were compared and predictive factors for LNM were evaluated.ResultsHistopathologically, the proportion of mixed histologic type was 12.3% in early gastric cancer. In terms of LNM, mixed histologic type had a more frequent incidence than pure differentiated type (32.4% vs 11.1%, P < 0.01). However, there was no significant difference between mixed type and pure undifferentiated type for LNM (32.4% vs 21.1%, P = 0.139). Multivariate analysis revealed that tumor size >2 cm (odds ratio [OR]: 2.153, 95% confidence interval [CI]: 1.113-4.164, P < 0.05), submucosal invasion (OR: 3.881, 95%CI: 1.832-8.222, P < 0.001), lymphovascular invasion (OR: 8.797, 95% CI: 2.643-29.277, P < 0.001), undifferentiated type (OR: 3.146, 95% CI: 1.352-7.320, P < 0.01), and mixed histologic type (OR: 3.635, 95% CI: 1.272-10.390, P < 0.05) were independent risk factors for LNM in early gastric cancer patients. However, mixed histologic type did not affect the survival outcome of these patients (hazard ratio: 0.629, 95% CI: 0.074-5.311, P > 0.05).ConclusionMixed histologic type was an independent risk factor for lymph node metastasis in early gastric cancer patients. The decisions regarding endoscopic submucosal dissection for mixed histologic type should be carefully considered.     

Rebleeding from a primary brain tumor manifesting as intracerebral hemorrhage (CNN 04/077, revised version)

Symptomatic spontaneous intratumoral hemorrhage is a rare event in a patient with a brain tumor (BT). Although the treatment of choice in such a case is surgical removal of both the tumor and the hemorrhage, the optimal timing for surgical intervention has not been clearly established, particularly in those who present with minimal neurological deficits and a small hemorrhage volume. Two cases of primary BTs manifesting as an intracerebral hemorrhage (ICH) are described, in which rebleeding from the tumor occurred shortly after the initial hemorrhage. The patients each presented with the sudden onset of a headache and minimal neurological deficits, and the neuroradiological workup was consistent with a diagnosis of hemorrhagic BT. Each patient remained neurologically stable, and elective surgery had been planned within 7 days of their admission, but rebleeding occurred 5 and 6 days, respectively, after admission. A BT manifesting as an ICH may rebleed shortly after the initial bleeding, and should be treated on an emergency basis instead of an elective basis regardless of the patient's neurological status on admission or hematoma volume on the initial CT scans.     

Smoking and Sleep Disorders

Snoring and sleep apnea-hypopnea syndrome (SAHS) are two disorders of considerable relevance due to their high prevalence in the general population and their notable morbidity and mortality, particularly in association with their harmful effects on the cardiovascular system. As well as sex, age, weight, craniofacial malformations, alcohol consumption, and use of hypnotic drugs, it has been suggested that smoking may be a risk factor for developing sleep-disordered breathing. While there is solid evidence for the independent association between snoring and smoking in both children and adults, it is still unclear whether smoking constitutes an independent risk factor for developing SAHS, despite the many studies carried out to assess this link. This is probably because the association, if it exists, is very weak.     

新发结直肠癌患者膳食模式分析

目的 探讨新发结直肠癌患者的膳食模式与发病的关系,为结直肠癌的发生提供科学的干预方向。方法 以2018—2019年辽宁省某肿瘤医院就诊并经病理学确诊的新发结直肠癌患者和同期在该医院体检中心参加健康体检者为研究对象,新发结直肠癌患者为病例组,按同性别、同年龄1∶1选取健康体检者作为对照组,采用主成分分析法对调查对象的膳食模式进行分析,利用Logistic回归模型分析不同膳食模式对结直肠癌发病风险的影响。结果 本研究共对新发结直肠癌患者232例、健康体检者232人进行调查,2组人群在性别、年龄、文化程度、家庭人均月收入和体力劳动强度分布差异均无统计学意义（均P>0.05）。多因素Logistic回归分析结果显示坚果薯类膳食模式（OR=0.482）、水产奶类膳食模式（OR=0.666）和果蔬素食膳食模式（OR=0.800）是结直肠癌发生的保护性因素,西式膳食模式（OR=1.441）、辛辣熏制膳食模式（OR=1.195）、肉类膳食模式（OR=1.397）和高脂肪膳食模式（OR=1.349）为结直肠癌发病的危险因素。结论 坚果薯类、水产奶类和果蔬素食是结直肠癌发生的保护性因素。西式、辛辣熏制、肉类和高脂肪膳食为结直肠癌发病的危险因素,在结直肠癌的防病宣传健康教育中应该加强饮食健康宣传,提高防病意识,有效降低发病率。     

Punicalagin from pomegranate promotes human papillary thyroid carcinoma BCPAP cell death by triggering ATM-mediated DNA damage response

Punicalagin (PUN), a component derived from pomegranate, is well known for its anticancer activity. Our previous work revealed that PUN induces autophagic cell death in papillary thyroid carcinoma cells. We hypothesized that PUN triggers DNA damage associated with cell death because DNA damage was reported as an inducer of autophagy. Our results showed that PUN treatment caused DNA breaks as evidenced by the significant enhancement in the phosphorylation of H2A.X. However, reactive oxygen species and DNA conformational alteration, 2 common inducing factors in DNA damage, were not involved in PUN-induced DNA damage. The phosphorylation of ataxia-telangiectasia mutated gene-encoded protein (ATM) but not ataxia telangiectasia and Rad3-related protein (ATR) was up-regulated in a time- and dosage-dependent manner after PUN treatment. KU-55933, an inhibitor of ATM, inhibited the phosphorylation of ATM induced by PUN and reversed the decreased cell viability caused by PUN. Thus, we demonstrated that PUN induces cell death of papillary thyroid carcinoma cells by triggering ATM-mediated DNA damage response, which provided novel mechanisms and potential targets for the better understanding of the anticancer actions of PUN.