Postoperative development of sarcopenia is a strong predictor of a poor prognosis in patients with adenocarcinoma of the esophagogastric junction and upper gastric cancer

Background

There were few studies assessed the postoperative sarcopenia in patients with cancers. The objective of present study was to assess whether postoperative development of sarcopenia could predict a poor prognosis in patients with adenocarcinoma of esophagogastric junction, (AEG) and upper gastric cancer (UGC).

Occurrence of BMAA Isomers in Bloom-Impacted Lakes and Reservoirs of Brazil,Canada, France,Mexico, and the United Kingdom

The neurotoxic alkaloid β-N-methyl-amino-l-alanine (BMAA) and related isomers, including N-(2-aminoethyl glycine) (AEG), β-amino-N-methyl alanine (BAMA), and 2,4-diaminobutyric acid (DAB), have been reported previously in cyanobacterial samples. However, there are conflicting reports regarding their occurrence in surface waters. In this study, we evaluated the impact of amending lake water samples with trichloroacetic acid (0.1 M TCA) on the detection of BMAA isomers, compared with pre-existing protocols. A sensitive instrumental method was enlisted for the survey, with limits of detection in the range of 5–10 ng L⁻¹. Higher detection rates and significantly greater levels (paired Wilcoxon’s signed-rank tests, p < 0.001) of BMAA isomers were observed in TCA-amended samples (method B) compared to samples without TCA (method A). The overall range of B/A ratios was 0.67–8.25 for AEG (up to +725%) and 0.69–15.5 for DAB (up to +1450%), with absolute concentration increases in TCA-amended samples of up to +15,000 ng L⁻¹ for AEG and +650 ng L⁻¹ for DAB. We also documented the trends in the occurrence of BMAA isomers for a large breadth of field-collected lakes from Brazil, Canada, France, Mexico, and the United Kingdom. Data gathered during this overarching campaign (overall, n = 390 within 45 lake sampling sites) indicated frequent detections of AEG and DAB isomers, with detection rates of 30% and 43% and maximum levels of 19,000 ng L⁻¹ and 1100 ng L⁻¹, respectively. In contrast, BAMA was found in less than 8% of the water samples, and BMAA was not found in any sample. These results support the analyses of free-living cyanobacteria, wherein BMAA was often reported at concentrations of 2–4 orders of magnitude lower than AEG and DAB. Seasonal measurements conducted at two bloom-impacted lakes indicated limited correlations of BMAA isomers with total microcystins or chlorophyll-a, which deserves further investigation.     

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内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)作为一种治疗早期胃癌新技术,同样适用于治疗食管胃结合部(esophagogastric junction,EGJ)的浅表癌。ESD治疗食管胃结合部腺癌(adenocarcinoma of the esophagogastric junction,AEG)及EGJ处癌前病变,与外科剖腹手术及内镜黏膜切除术(endoscopic mucosal resection,EMR)等内镜治疗方法相比,具有明显优势。但ESD治疗EGJ处病变,手术难度较高,手术时间更长,手术并发症发生率更高,对操作者的技术要求较高。     

浅谈食管胃结合部腺癌的中医病机特点及治疗

介绍笔者对食管胃结合部腺癌(Adenocarcinomas of the Esophagogastric Junction,AEG)即近端胃癌的中医病机特点的认识,认为食管胃结合部结构与功能不同于胃体及幽门,食管胃结合部主司贲门的契合开闭与食物的传输,是食物、药物进入胃内的狭窄通道,同时也是预防胃内容物返流进入食道的重要防线。其法天而用阳,主受纳通降,易耗气伤阴,受损胃络,表现为气滞、气逆、气虚等气机失调及由此而来痰、热、瘀、毒积聚,最终导致贲门枢机不利,进食不畅、哽噎、呕吐白色痰涎,甚至不能进食等症状。其病机特点是气机失调、痰毒郁结。治疗的关键是调理气机,驱邪扶正,把握贲门开合和降的生理,当补则补,当降则降。     

18FDG-PET-CT improves specificity of preoperative lymph-node staging in patients with intestinal but not diffuse-type esophagogastric adenocarcinoma

Introduction

The accuracy of preoperative lymph-node staging in patients with adenocarcinoma of the esophagogastric junction (AEG) or gastric cancer (GC) is low. The aim of this study was to assess the accuracy of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT) for lymph-node staging in patients with AEG or GC, with or without neoadjuvant treatment.

AEG-1表达下调对脑胶质瘤U373细胞的放射增敏效应

目的:探讨AEG-1基因表达下调对人脑胶质瘤细胞U373放射敏感性的影响。方法:以人MTDH/AEG-1（NM-178812）为靶标设计shRNA序列,慢病毒介导将AEG-1 shRNA转染至胶质瘤U373细胞中。荧光定量PCR及Western blot测定转染前后AEG-1 mRNA及蛋白的表达;克隆形成实验评估AEG-1基因下调后U373细胞放射敏感性;流式细胞术检测AEG-1下调后U373细胞凋亡及细胞周期分布。结果:通过慢病毒介导的shRNA转染,构建了AEG-1表达稳定下调的U373-shAEG-1细胞系,有效抑制了胶质瘤U373细胞中AEG-1的表达(抑制率84%,P<0.05),增加了凋亡细胞的比例（13.07%±0.28%,P<0.05）,并提高细胞周期中S期细胞比例（58.18％,P<0.01）,且AEG-1基因表达下调后U373细胞的D0值 （1.60Gy） 和Dq值 （1.06Gy）均明显低于空白对照组及阴性对照组细胞（P<0.05）。结论:下调AEG-1可以增强人脑胶质瘤U373细胞的放射敏感性,其机制与诱导细胞凋亡及干预细胞周期分布有关。     

AEG-1和Caspase-3在三阴基底样乳腺癌中的表达及其临床病理相关性的研究

目的 着重探讨AEG-1和Caspase-3在三阴基底样癌组织中的表达及其相关性。方法 HE染色对66例检测对象的病理学诊断进行验证;免疫组化检测66例三阴基底样癌中AEG-1和Caspase-3的表达,分析其与临床病理参数的关系及二者的相关性。结果 66例检测对象均为三阴基底样癌;AEG-1和Caspase-3蛋白在三阴基底样癌组织中的阳性表达率分别为73%和60%;AEG-1在三阴基底样癌中的表达随着肿瘤分化程度的降低而增强,在血清学CA153阳性中的表达率显著高于阴性中的表达率,表达差异具有统计学意义(P＜0.05);Caspase-3在三阴基底样癌中的表达随着肿瘤分化程度的降低而减弱,在血清学CA153阳性中的表达率显著低于阴性中的表达率,表达差异具有统计学意义(P＜0.05);AEG-1和Caspase-3在三阴基底样癌组织中表达无相关性。结论 AEG-1和Caspase-3参与三阴基底样癌的发生和发展。但是AEG-1不能单独直接抑制Caspase-3的表达,可能与CA153相互作用,共同抑制Caspase-3的表达。     

Efficacy analysis of Cheng’s GIRAFFE reconstruction after proximal gastrectomy for adenocarcinoma of esophagogastric junction

ObjectiveReconstruction of the digestive tract for adenocarcinoma of esophagogastric junction (AEG) is in dispute. This study evaluated Cheng’s gastric tube interposition esophagogastrostomy with reconstruction of His angle and fundus (Cheng’s GIRAFFE anastomosis) in laparoscopic/open proximal gastrectomy for Siewert type II AEG, which was performed at Zhejiang Cancer Hospital and the First Affiliated Hospital of Zhejiang Chinese Medical University. Here, we discuss the preliminary results of gastric emptying and anti-reflux.MethodsFrom a retrospective database, 74 patients with advanced Siewert type II AEG underwent curative proximal gastrectomy with GIRAFFE anastomosis, and their gastric emptying and anti-reflux outcomes were evaluated by the Reflux Disease Questionnaire (RDQ) score, nuclide gastric emptying, 24-h impedance-pH monitoring and gastroscopy.ResultsSeventy-four patients successfully completed proximal partial gastrectomy with Cheng’s GIRAFFE esophagogastric anastomosis. RDQ score six months after the operation was 2.2±2.5. Results of nuclide gastric emptying examinations showed that the gastric half-emptying time was 67.0±21.5 min, the 1-h residual rate was (52.2±7.7)%, the 2-h residual rate was (36.4±5.1)%, and the 3-h residual rate was (28.8±3.6)%; 24-h impedance-pH monitoring revealed that the mean DeMeester score was 5.8±2.9. Reflux esophagitis was observed by gastroscopy in 7 patients six months after surgery.ConclusionsCheng’s GIRAFFE anastomosis is safe and feasible for Siewert type II AEG.     

微创与开放Sweet食管切除术治疗Siewert Ⅱ型食管胃结合部腺癌的疗效比较

目的比较微创与开放Sweet食管切除术治疗Siewert Ⅱ型食管胃结合部腺癌(AEG)的疗效。方法选取2015年3月至2017年9月安徽医科大学附属省立医院收治的137例AEG患者的临床资料,根据接受手术方式的不同分为微创Sweet食管切除术(MISE)组38例,开放Sweet食管切除术(OSE)组99例。比较两组术中指标及术后疗效情况。结果与OSE组相比,MISE组术中出血量较少,手术时间更长,淋巴结清扫总数及腹腔淋巴结清扫数更多,差异有统计学意义(P <0.05)。两组共有45例(32.85%)患者术后发生2级以上并发症,均以肺部感染为最常见; 4级以上严重并发症主要为严重吻合口瘘和呼吸衰竭。OSE组2～3级并发症发生率高于MISE组,差异有统计学意义(P <0.05)。MISE组和OSE组的1年生存率分别为92.1%和87.9%,3年生存率分别为68.2%和59.6%,两组术后生存情况比较差异无统计学意义(P=0.383)。两组术后复发、转移的发生情况比较差异无统计学意义(P>0.05)。Cox回归分析结果显示,以N₀期为参考,N     

食管胃结合部腺癌65例形态超声及其分型和病理诊断

目的 探究体表超声诊断食管胃结合部腺癌(AEG)的分型及肿块大小的准确性.方法 选取65例AEG病人,均术前行体表超声及CT检查,结合术后病理进行分析对比.结果 65例AEG病人,大体标本BorrmannⅢ型31例,占47.7%,组织学标本低分化腺癌29例,占44.6%;参照Siewert分型,体表超声和CT对AEG临床分型诊断正确率分别为90.8%、92.3%,其中Ⅰ型85.7%、92.9%,Ⅱ型91.4%、88.6%,Ⅲ型93.8%、100%,两者诊断AEG分型存在一致性,差异有统计学意义(Kappa=0.852,P<0.05);体表超声测量肿块最长径为(4.00±1.84) cm,术后病理测量肿块最长径为(4.41±2.52) cm,两者差异无统计学意义 (t=-1.512,P>0.05).结论 体表超声可以作为诊断AEG分型及测量AEG肿块大小的可靠检查手段,对于指导手术以及判断预后有很大意义.