Esophageal squamous cell carcinoma and adenocarcinoma in Malaysia – Pooled data from upper gastrointestinal centers in a multiethnic Asian population

BackgroundEsophageal cancer is the sixth leading cause of cancer death worldwide with considerable geographical histological variation There is a paucity of data in esophageal cancer in demographics, histology, and survival among the multi-ethnic Malaysian population. This paper is a review of esophageal cancer epidemiology and survival among esophageal cancer patients from data collected by the Malaysian Upper Gastrointestinal Surgical Society.MethodsThis is a multicenter retrospective observational study of esophageal cancer patients from six upper gastrointestinal surgical centers in Malaysia between 2005 and 2019. Patient characteristics, histological type and stage were compared and survival analyzed.ResultsThere were 820 patients with esophageal cancer included, where 442 (53.9 %) cases had squamous cell carcinoma (SCC) and 378 (46.1 %) had adenocarcinomas (AC). Malays were the predominant ethnicity with AC (66.7 %) while Indians were the ethnic majority (74.6 %) with SCC. Majority of patients (56.8 %) presented as stage IV disease. Overall, the 1-, 3-, and 5-years’ survival were 35.8 %, 13.8 % and 11.0 %, respectively. Surgical resection with curative intent yielded the best 5-year survival (29.4 %). Intervention in stage IV AC yielded superior survival when compared to SCC (median survival, 7.9 months vs 4.8 months; p, 0.018) Our series demonstrated an increase in AC to SCC over the last 15 years.ConclusionsThere was an ethnic preponderance seen between different histology in this region, not previously discussed. An increase in AC was observed over the last 15 years. Late diagnosis seen in most patients imparts poor prognosis as curative surgery affords the best outcome.     

Personalized stent design for congenital heart defects using pulsatile blood flow simulations

Stent size selection and placement are among the most challenging tasks in the treatment of pulmonary artery stenosis in congenital heart defects (CHD). Patient-specific 3D model from CT or MR improves the understanding of the patient’s anatomy and information about the hemodynamics aid in patient risk assessment and treatment planning. This work presents a new approach for personalized stent design in pulmonary artery interventions combining personalized patient geometry and hemodynamic simulations. First, the stent position is initialized using a geometric approach. Second, the stent and artery expansion, including the foreshortening behavior of the stent is simulated. Two stent designs are considered, a regular stent and a Y-stent for bifurcations. Computational fluid dynamics (CFD) simulations of the blood flow in the initial and expanded artery models are performed using patient-specific boundary conditions in form of a pulsatile inflow waveform, 3-element Windkessel outflow conditions, and deformable vessel walls. The simulations have been applied to 16 patient cases with a large variability of anatomies. Finally, the simulations have been clinically validated using retrospective imaging from angiography and pressure measurements. The simulated pressure, volume flow and flow velocity values were on the same order of magnitude as the reference values obtained from clinical measurements, and the simulated stent placement showed a positive impact on the hemodynamic values. Simulation of geometric changes combined with CFD simulations offers the possibility to optimize stent type, size, and position by evaluating different configurations before the intervention, and eventually allow to test customized stent geometries and new deployment techniques in CHD.     

Forkhead box A1 (FOXA1) tagging polymorphisms and esophageal cancer risk in a Chinese population: a fine-mapping study

Esophageal cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death in China in 2009. Esophageal squamous cell carcinoma (ESCC) accounts for more than 90% of esophageal cancers. Besides environmental risk factors, genetic factors such as single-nucleotide polymorphisms (SNPs) play an important role in ESCC carcinogenesis. We performed a hospital-based case–control study to evaluate the Forkhead-box protein A1 (FOXA1) rs12894364 C?>?T, rs2145146 C?>?A and rs7144658 T?>?C tag SNPs in the risk of developing ESCC. We recruited 629 ESCC cases and 686 controls. Genotypes were determined using ligation detection reaction. Logistic regression analyses revealed that the three FOXA1 SNPs were not associated with ESCC risk. However, there was significantly decreased ESCC risk associated with the FOXA1 rs12894364 C?>?T and rs2145146 C?>?A polymorphisms among older patients. There was significantly increased ESCC risk associated with the FOXA1 rs7144658 T?>?C polymorphism among male patients. This study demonstrates an association between FOXA1 polymorphisms and ESCC susceptibility. Additional larger studies are required to confirm our findings.     

The effect of dynamic exercise on resting cold thermoregulatory responses measured during water immersion

The purpose of this study was to evaluate the effect of exercise on the subsequent post-exercise thresholds for vasoconstriction and shivering measured during water immersion. On 2 separate days, seven subjects (six males and one female) were immersed in water (37.5 degrees C) that was subsequently cooled at a constant rate of approximately 6.5 degrees C x h(-1) until the thresholds for vasoconstriction and shivering were clearly established. Water temperature was then increased to 37.5 degrees C. Subjects remained immersed for approximately 20 min, after which they exited the water, were towel-dried and sat in room air (22 degrees C) until both esophageal temperature and mean skin temperature (Tsk) returned to near-baseline values. Subjects then either performed 15 min of cycle ergometry (at 65% maximal oxygen consumption) followed by 30 min of recovery (Exercise), or remained seated with no exercise for 45 min (Control). Subjects were then cooled again. The core temperature thresholds for both vasoconstriction and shivering increased significantly by 0.2 degrees C Post-Exercise (P < 0.05). Because the Tsk at the onset of vasoconstriction and shivering was different during Pre- and Post-Exercise Cooling, we compensated mathematically for changes in skin temperatures using the established linear cutaneous contribution of skin to the control of vasoconstriction and shivering (20%). The calculated core temperature threshold (at a designated skin temperature of 32.0 degrees C) for vasoconstriction increased significantly from 37.1 (0.3) degrees C to 37.5 ( 0.3) degrees C post-exercise (P < 0.05). Likewise, the shivering threshold increased from 36.2 (0.3) degrees C to 36.5 (0.3) degrees C post-exercise (P < 0.05). In contrast to the post-exercise increase in cold thermal response thresholds, sequential measurements demonstrated a time-dependent similarity in the Pre- and Post-Control thresholds for vasoconstriction and shivering. These data indicate that exercise has a prolonged effect on the post-exercise thresholds for both cold thermoregulatory responses.     

不同麻醉方法对食管癌手术患者免疫及认知功能的影响

目的:探讨全麻或全麻复合硬膜外麻醉对食管癌手术患者的T细胞水平及术后认知功能的影响。方法:选择2014年1月至2015年12月于我院择期行开胸手术的食管癌患者100例为研究对象,根据手术时间顺序分为观察组(全麻复合硬膜外麻醉)和对照组(全麻),每组50例,观察记录两组患者诱导前、插管时、术中1 h、拔管后的平均动脉压(MAP)、血氧饱和度(Sp O2)和心率(HR);两组患者术前30 min、术后2 h、术后2 d和术后7 d的T细胞亚群水平,包括CD3~+、CD4~+、CD8~+、CD4~+/CD8~+;两组患者术前1 d,术后6 h,术后1 d,术后3 d的认知功能;术后认知功能障碍(POCD)发生率。结果:诱导前观察组和对照组患者的MAP、Sp O2和HR比较,差异均不显著(P0.05),插管时、术中1h和拔管后观察组患者的MAP和HR水平均明显低于对照组(P0.05),而Sp O2明显高于对照组(P0.05)。术后2 h,观察组和对照组的CD3~+、CD4~+、CD8~+、CD4~+/CD8~+值均较术前30 min明显降低(P0.05),但两组间各指标值无显著性差异(P0.05);术后2 d,观察组的CD3~+、CD4~+、CD8~+、CD4~+/CD8~+值均明显高于对照组(P0.05)。术后7 d,两组的T细胞亚群水平均较术前30 min无显著性差异(P0.05)。术后6 h和术后1 d,两组的MMSE评分均较术前1 d明显下降(P0.05),观察组术后1 d、3 d和7 d的MMSE评分均明显高于对照组(P0.05)。术后6 h,观察组的POCD发生率明显低于对照组(P0.05),术后1 d和3 d观察组的POCD发生率低于对照组,但无统计学差异(P0.05)。结论:与单凭全麻比较,全麻复合硬膜外麻醉对食管癌手术患者的T细胞水平及术后认知功能的影响较小,术后恢复快。     

TIPS治疗肝硬化食管胃底静脉曲张破裂出血的疗效及安全性研究

目的:研究经颈静脉肝内门体分流术(TIPS)治疗肝硬化食管胃底静脉曲张破裂出血的疗效及安全性。方法:选取我院2013年8月到2015年4月收治的肝硬化食管胃底静脉曲张破裂出血患者86例为研究对象,采用随机数字法将其分为对照组和观察组,每组各43例。对照组患者行经皮经肝胃冠状静脉栓塞术(PTVE)治疗,观察组患者行TIPS治疗。比较两组患者的手术成功率、各并发症发生率、远期生存率及症状缓解情况,同时观察两组患者术后的肝功能变化。结果:观察组手术后的门静脉压力、术后3个月、6个月及12个月再出血发生率均明显低于对照组(P0.05),而肝性脑病发生率与对照组比较差异无明显统计学意义(P0.05)。两组手术前、术后6个月和12个月的Child-Pugh评分、血清TBIL、DBIL水平比较均无明显差异(P0.05),术后3个月,观察组的Child-Pugh评分、血清TBIL、DBIL水平均明显高于对照组(P0.01)。两组术后1年生存率比较无明显差异(P=0.72)。结论:TIPS治疗肝硬化食管胃底静脉曲张破裂出血的手术安全性较高,术后再出血等并发症发生率低,能有效改善静脉曲张症状,对肝功能损伤控制较好,且远期生存率较高。     

支架置入技术治疗食道癌的临床疗效及预后

目的:观察支架置入法对食道癌患者的治疗效果及预后情况。方法:选取我院收治的食道癌患者共104例,根据治疗手段分为两组,其中对照组52例采用70 Gγ7/周治疗方案;实验组52例给予支架置入法治疗。对两组患者的梗阻改善情况、生存质量评分、并发症及生存情况进行统计分析。结果:1治疗后,两组患者的梗阻情况以及生存质量均得到有效改善,实验组患者的梗阻总缓解率为92.31%,生存质量评分为42.61±5.23分,均显著高于对照组,差异具有显著性(P0.05);2实验组患者的不良反应发生率(36.54%)与对照组(38.48%)比较无统计学差异(P0.05);3两组患者的3个月及6个月时的生存率相接近,但是实验组患者12个月生存率(71.7%)显著低于对照组(82.7%),差异具有统计学意义(P0.05)。结论:支架置入法能够显著改善食道癌患者的梗阻症状,提高患者生存质量,是较为安全可靠的缓解食道狭窄方法。     

双向电泳联合MALDI-TOF-MS技术在筛选食管癌铂类耐药患者中的应用研究

目的:采用基质辅助激光解吸电离飞行时间质谱(MALDI-TOF-MS)技术检测食管癌(EC)患者化疗敏感性血清蛋白质谱,指导临床EC患者化疗方案的选择。方法:收集2013年1月至2014年6月我院收治的EC术后复发并行含铂化疗的患者40例,按照化疗疗效分为敏感组和耐药组。将两组蛋白质双向凝胶电泳图谱用Image Master 2D platinum 5.0软件分析并匹配,筛选出两组差异斑点,并采用MALDI-TOF-MS技术检测EC患者化疗敏感性血清蛋白质谱。结果:两组差异斑点共有68个,以耐药组为参照,敏感组患者血清蛋白下调的斑点有42个,上调的斑点有26个。从这68个差异斑点中筛选出8个斑点进行质谱鉴定,通过数据库检索分析和鉴定最终确定上述斑点所对应的蛋白质名称分别为Kininogen-1,Alpha-2-HS-glycoprotein,Fibrinogen beta chain,Clusterin,Retinol-binding protein 4,Beta-2-glycoprotein 1,Ig kappa chain C region,Complement C4-A。结论:基于铂类化疗的EC敏感患者和耐药患者间存在差异表达蛋白。     

血管成形术介入治疗糖尿病下肢血管病变的临床效果分析

目的:探讨经皮腔内血管成形术(PTA)联合支架植入术治疗糖尿病下肢血管病变的临床效果及安全性。方法:选择2008年3月至2011年12月在我院内分泌科接受治疗的2型糖尿病合并糖尿病足的患者36例,将其随机分为观察组(19例)和对照组(17例)。观察组19例患者中,14例行PTA术,4例行PTA+腔内支架植入术,1例行截肢术;对照组17例患者,全部采用传统方法进行治疗。观察和比较两组患者术后的糖尿病下肢血管病变的特点、临床效果及并发症的发生情况。结果:观察组19例患者,共40条靶血管,实施PTA手术的成功率为87.5%。采用两种治疗方法 2周或4周后,患者的临床症状和体征均得到一定程度的缓解,且均未观察到明显的不良反应。与对照组相比,接受介入治疗的患者,其临床症状的缓解率明显升高,其中在2周时介入治疗对麻木和紫绀症状的缓解尤其显著,和对照组之间有统计学差异(P0.05)。结论:血管成形术介入治疗糖尿病下肢血管病变是一种安全可靠的方法,治疗效果好,安全性高,值得临床推广。     

血清应答因子在食管鳞癌细胞侵袭转移中的作用

目的:研究血清应答因子(serum response factor,SRF)在人食管鳞癌细胞体外侵袭转移中的意义。方法:选用EC9706-H、EC9706-L和EC109-H、EC109-L两对高低转移细胞系,采用细胞划痕实验验证食管鳞癌高低转移细胞系体外侵袭转移能力的差异;Western blot检测SRF在两对食管鳞癌高低转移细胞系中的差异表达;在EC9706-H、EC109-H细胞中加入CCG(SRF抑制剂)抑制SRF的表达后,检测其侵袭转移能力的变化。结果:细胞划痕实验验证了两对食管鳞癌高低转移细胞系侵袭转移能力的差异;Western blot结果提示SRF在EC9706-H、EC109-H细胞中的表达水平显著高于EC9706-L、EC109-L细胞;在EC9706-H、EC109-H细胞中加入CCG抑制SRF的表达后,其侵袭转移能力明显减退。结论:SRF在高转移性食管鳞癌细胞系中呈现高表达,在低转移性食管鳞癌细胞系中呈现低表达,抑制高转移性食管鳞癌细胞系中SRF的表达后,其侵袭转移能力下降,提示SRF和食管鳞癌的侵袭转移能力呈正相关。