Study of controlling acute hemorrhage from esophageal varices rupture with technique of traditional Chinese medicine

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长链非编码RNA反义RNA 1靶向微小RNA-501-3p对食管癌细胞恶性生物学行为影响的实验研究

目的探讨长链非编码RNA(lncRNA)胸腺生成素反义RNA 1(TMPO-AS1)对食管癌细胞恶性生物学行为的影响及其机制。方法2016年6月至2019年12月,实时荧光定量聚合酶链反应(RT-qPCR)检测20例食管癌组织和癌旁组织中lncRNA TMPO-AS1和微小RNA(miR)-501-3p的水平,食管癌Eca109细胞分为lncRNA TMPO-AS1干扰组(转染si-NC和si-TMPO-AS1);miR-501-3p过表达组(转染miR-NC和miR-501-3p);lncRNA TMPO-AS1过表达组(转染pcDNA和pcDNA-TMPO-AS1);lncRNA TMPO-AS1和miR-501-3p共抑制组(转染si-TMPO-AS1+anti-miR-NC和si-TMPO-AS1+anti-miR-501-3p)。噻唑蓝(MTT)法、流式细胞术和Transwell实验分别检测食管癌Eca109细胞增殖、凋亡率、细胞迁移和侵袭能力,蛋白质印迹法(Western blot)检测相关蛋白水平,双荧光素酶报告系统验证lncRNA TMPO-AS1与miR-501-3p的调控关系。两组间比较采用独立样本t检验,多组间比较采用单因素方差进行分析。结果食管癌组织组中的lncRNA TMPO-AS1水平(2.64±0.26)高于癌旁组织(1.00±0.09,t=26.657,P<0.05),miR-501-3p水平(0.44±0.04)低于癌旁组织(1.00±0.07,t=31.063,P<0.05);干扰lncRNA TMPO-AS1的Eca109细胞24 h增殖(0.36±0.03)低于si-NC组(0.39±0.03,t=2.121,P<0.05),48 h增殖(0.45±0.04)低于si-NC组(0.75±0.07,t=11.163,P<0.05),72 h增殖(0.57±0.05)低于si-NC组(1.16±0.09,t=17.191,P<0.05),迁移细胞数[(54.14±5.65)个]低于si-NC组[(113.02±9.87)个,t=15.531,P<0.05],侵袭细胞数[(47.69±5.01)个]低于si-NC组[(96.32±9.88)个,t=13.169,P<0.05],细胞凋亡率[(22.15±2.22)%]高于si-NC组[(6.98±0.69)%,t=19.576,P<0.05];过表达miR-501-3p的Eca109细胞48 h增殖(0.51±0.05)低于miR-NC组(0.77±0.07,t=9.067,P<0.05),72 h增殖(0.65±0.06)低于miR-NC组(1.15±0.09,t=13.867,P<0.05),迁移细胞数[(61.23±6.33)个]低于miR-NC组[(115.25±9.25)个,t=14.458,P<0.05],侵袭细胞数[(53.14±5.33)]低于miR-NC组[(98.32±8.47)个,t=13.543,P<0.05],细胞凋亡[(19.58±1.74)%]高于miR-NC组[(7.23±0.77)%,t=19.471,P<0.05],差异均有统计学意义。结论lncRNA TMPO-AS1通过靶向miR-501-3p促进食管癌细胞的恶性生物学行为,可被视为食管癌患者的潜在治疗靶标。     

Is barium esophagram enough? Comparison of esophageal motility found on barium esophagram to high resolution manometry

BackgroundThe aim of the study is to determine if barium esophagram (BE) alone is sufficient to diagnose esophageal dysmotility when compared to the gold standard, high-resolution manometry (HRM).MethodsThis is a retrospective review of patients that underwent laparoscopic fundoplication by two surgeons at a single institution from 10/1/2015-6/29/2019. Patients with large paraesophageal hernias and patients without both BE and HRM were excluded.ResultsForty-six patients met the inclusion criteria. BE was found to be concordant with HRM for esophageal motility in only 21 patients (46%). Setting HRM as the gold standard, BE had a sensitivity of 14% (95% CI: 5%–35%), specificity of 72% (95% CI: 52%–86%), PPV of 30% (95% CI: 11%–60%), and NPV of 50% (95% CI: 35%–66%). The accuracy was 46%, while a McNemar test showed p = 0.028.ConclusionTraditional BE should not be used in place of HRM for assessing pre-operative motility in patients undergoing anti-reflux surgery.     

Is the placement of jejunostomy tubes in patients with esophageal cancer undergoing esophagectomy associated with increased inpatient healthcare utilization? An analysis of the National Readmissions Database

BackgroundPatients undergoing esophagectomy often receive jejunostomy tubes (j-tubes) for nutritional supplementation. We hypothesized that j-tubes are associated with increased post-esophagectomy readmissions.Study designWe identified esophagectomies for malignancy with (EWJ) or without (EWOJ) j-tubes using the 2010–2015 Nationwide Readmissions Database. Outcomes include readmission, inpatient mortality, and complications. Outcomes were compared before and after propensity score matching (PSM).ResultsOf 22,429 patients undergoing esophagectomy, 16,829 (75.0%) received j-tubes. Patients were similar in age and gender but EWJ were more likely to receive chemotherapy (24.2% vs. 15.1%, p < 0.01). EWJ was associated with decreased 180-day inpatient mortality (HR 0.72 [0.52–0.99]) but not with higher readmissions at 30- (15.2% vs. 14.0%, p = 0.16; HR 0.9 [0.77–1.05]) or 180 days (25.2% vs. 24.3%, p = 0.37; HR 0.94 [0.79–1.10]) or increased complications (p = 0.37). These results were confirmed in the PSM cohort.ConclusionJ-tubes placed in the setting of esophagectomy do not increase inpatient readmissions or mortality.     

Esophageal adenocarcinoma after sleeve gastrectomy: actual or potential threat? Italian series and literature review

BackgroundSleeve gastrectomy (SG) leads to esophageal mucosal damage in an elevated percentage of cases, configuring a clinical condition of Barrett’s esophagus (BE) in a proportion as high as 15–18.8%. BE may rarely evolve into esophageal adenocarcinoma (EAC).ObjectivesTo raise awareness of BE as a precancerous lesion which may progress toward malignancy after this popular bariatric procedure.SettingBariatric referral centers, Italy.MethodsAll patients referred to our bariatric center who developed an EAC after SG between 2012 and 2019 were reviewed and consecutively included in this study. The available scientific literature regarding this complication is additionally reviewed.ResultsThe 3 male patients comprised in this case series underwent laparoscopic SG between 2012 and 2015 in different bariatric referral centers. Age and body mass index at baseline ranged from 21–54 years and 43.1–75.6 kg/m², respectively. All patients were lost to follow-up early after surgery (3.7 ± 1.4 months), and were diagnosed with EAC at a mean of 27.3 ± 7.6 months after SG. The 4 reported cases in the scientific literature developed an EAC at a mean of 32.5 ± 23 months from SG. Overall, a diagnosis of EAC was made approximately 30.3 ± 17.1 months postoperatively, which seems relatively and worryingly early after surgery.ConclusionAlthough the rate and probability of progression from BE to EAC is still not well defined, assuming that the rising popularity and execution of SG leads to a growth in the BE incidence, then the preoperative identification and stratification of cancer risk factors in this subset of patients is strongly encouraged. Clinical and endoscopic follow-ups are essential to allow for prevention and early diagnosis and for epidemiologic data collection purposes.     

生长抑素对肝硬化食道胃底静脉曲张破裂出血作用的临床研究

目的 观察生长抑素制剂（施他宁、善得定）对于肝硬化食道胃底静脉曲张破裂出血的治疗效果,并与垂体后叶素进行比较。方法 ６４例患者随机分为垂体后叶素组（ｎ＝２１）、施他宁组（ｎ＝２０）、盖得定组（ｎ＝２３）进行治疗。结果 垂体后叶素组、施他宁组和善意得定组患者自接诊后至完全止血时的出血量,及接诊后至止血后４８小时生命 体征基本平稳时的输血量无显著性差异（Ｐ〉０．０５）。各治疗组２４小时内的止血率均为８     

食管癌与心理社会因素的关系探讨

目的 :本文采用 1:1配对的病例对照研究方法 ,探讨食管癌与病前心理社会因素的关系。方法 :采用 C型行为问卷和生活事件量表 ,调查病例和对照共 10 0对。结果 :食管癌病人 C型行为的 OR值为 3.0 9,明显高于对照组 ,P<0 .0 0 1;生活事件量表中病例与对照配对得分差的均数为 118.4 2± 52 .36 (LEU) ,食管癌病人得分明显高于对照组 ,P<0 .0 0 1。结论 :食管癌与不良的心理社会因素有关。     

奥曲肽及垂体后叶素治疗食管胃底静脉曲张破裂出血的效果观察

①目的 比较奥曲肽和垂体后叶素治疗肝硬化食管胃底静脉曲张破裂出血的临床效果。②方法 将９２例（１０５次）食管胃底静脉曲张破裂出血病人随机分为奥曲肽组（５０例５８次）和垂体后叶素组（４２例４７次）,分别给予奥曲肽和垂体后叶素治疗,每隔０．５ｈ冲洗胃腔吸取胃液１次,比较两组止血率。③结果 奥曲肽组和垂体后叶素组８ｈ内止血率分别为６０．３％,１７．０％,差异有极显著性（Ｘ＾２＝２０．１５,Ｐ〈０．０１）     

Dysphagia in Parkinson's disease: Pharyngeal manometry and fiberoptic endoscopic evaluation

ObjectiveDysphagia is a common symptom in Parkinson's disease (PD) and it represents a negative prognostic factor because of its complications. This study is to evaluate pharyngeal dysphagia for boluses of various consistencies with Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and Pharyngeal High-Resolution Manometry (PHRM) in a group of PD patients, making a comparison between the information provided by the two exams.MethodsGroup of 20 patients affected by PD was selected and initially subjected to a qualitative evaluation of the swallowing performing FEES. Subsequently, they were evaluated by PHRM to identify quantitative measures associated with pressures expressed by pharyngeal organs during swallowing. Values obtained in the study group were compared with those recorded in a group of 20 healthy subjects.ResultsStudy showed that Pmax (the maximum pressure elicited by the single pharyngeal muscle structures involved in swallowing) was significantly lower than the control group (p<0.05) for all the boluses and consistency tested, in particular for the Tongue base and the Cricopharyngeal muscle. Pmean pre-swallowing pressure (represents the mean value of a contraction in which basal and maximal pressure where normally calculated) was significantly higher compared to normal subjects for the Tongue base and the Cricopharyngeal muscle (p<0.05). Mean intra-swallowing pressure was higher for the Velopharynx and the Cricopharyngeal muscle, but lower for the tongue base. Pmax and Pmean at PHRM were altered independently to the degree of dysphagia detected at FEES, and they did not correlate either with the location of the residue or with the type of bolus. Images displayed at the FEES, found the corresponding biomechanical explanations in the PHRM, which also allowed us to quantify the extent of the dysfunction, through the calculation of the pressures generated in the various structures studied.ConclusionPHRM is particularly useful in the early detection of dysphagia, when FEES may still show no evidence of abnormal swallowing.