Metabolic syndrome in relation to Barrett⿿s esophagus and esophageal adenocarcinoma: Results from a large population-based case-control study in the Clinical Practice Research Datalink

Gastroesophageal reflux disease (GERD) causes local chronic inflammation that increases risks of Barrett⿿s esophagus (BE) and esophageal adenocarcinoma (EA), yet symptomatic GERD is absent in approximately half of all such patients. Obesity exacerbates GERD and is also a component of metabolic syndrome (MetS). We evaluated the hypothesis that MetS is a GERD-independent mechanism by which obesity is associated with increased risks of BE and EA using data from the UK Clinical Practice Research Datalink. BE cases (n = 10,215) and EA cases (n = 592) were each individually matched to five population controls based on age, sex, and general practice. MetS was defined as occurrence of at least three of the following: obesity, type 2 diabetes, hypertension, and high cholesterol. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression. MetS was marginally associated with BE (OR = 1.12, 95%CI 1.00⿿1.25). Similar effects were found for the individual component factors of obesity, hypertension, and high cholesterol. History of GERD modified the association (P-_{effect modification} <1E⿿5), with the MetS-BE association confined to patients without a history of GERD (OR = 1.33, 95%CI 1.12⿿1.58). No association between MetS and risk of EA was detected in the main or stratified analyses. In this large population-based case-control study, individuals with MetS had a marginally increased risk of BE in the absence of GERD. The systemic inflammatory state (MetS) may represent a reflux-independent inflammatory pathway that increases the risk of BE. MetS did not increase risk of EA in this study population.     

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。     

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.     

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。     

Human Core Temperature Responses during Exercise and Subsequent Recovery: An Important Interaction between Diurnal Variation and Measurement Site

Chronobiological investigations into core temperature during and after exercise can involve ambulatory measurements of intestinal temperature during actual competitions, esophageal temperature measurements in laboratory simulations, or rectal temperature, which can be measured in both the field and laboratory. These sites have yet to be compared during both morning and afternoon exercise and subsequent recovery. At 08∶00 and 17∶00 h, seven recreationally active males exercised at 70% peak oxygen uptake for 30 min and then recovered passively for 30 min. During the experiment, esophageal, rectal, intestinal, and skin temperatures, plus sweat loss, heart rate, and ratings of perceived exertion (RPE), were monitored. We found that the diurnal variation in intestinal temperature responses (0.45±0.32°C; mean±SD) was significantly larger compared with rectal (0.33±0.24°C) and, particularly, esophageal temperature responses (0.21±0.20°C; p= 0.019). This reflected a greater difference of 0.25–0.40°C between the esophagus and the other two sites in the afternoon, compared to inter‐site differences of only 0.13–0.16°C in the morning. Diurnal variation was small for skin temperature, heart rate, sweat loss, and RPE responses during exercise (p>0.05). Our data suggest that the relative differences between intestinal, rectal, and esophageal temperature during exercise and subsequent recovery depend on time of day to the extent that inferences from studies on experimental and applied chronobiology will be affected.     

兔食管静脉曲张模型的建立

目的建立新西兰兔的食管静脉曲张模型,为下一步的临床研究提供可靠的小型动物模型。方法采用门静脉左支完全夹闭法造模,并通过外观、超声、胃镜等检查检验手段对造模结果加以评估。结果术后8周存活动物100%可见食管静脉曲张。结论通过门静脉左支夹闭法,基本可以建立兔食管静脉曲张模型。     

Porphyromonas gingivalis promotes the motility of esophageal squamous cell carcinoma by activating NF-κB signaling pathway

Esophageal carcinoma, with a increasing incidence, is one of the most aggressive carcinomas in gastrointestinal tract. Epidemiologic studies demonstrate an association of oral pathogens with multiple diseases, including rheumatoid arthritis, cardiovascular diseases, diabetes, and gastrointestinal malignancies. Nevertheless, a causal relationship between oral pathogens and esophageal squamous cell carcinoma (ESCC) has not been elucidated. Here, we found that Porphyromonas was significantly enriched in the saliva of patients with ESCC, compared with that in normal human. In vitro studies showed that Porphyromonas gingivalis (P. gingivalis) promoted the proliferation and motility of ESCC cells, as evidenced by up regulated expression of key molecules implicated in NF-κB signaling pathway. These findings, for the first time, demonstrated a role of oral pathogens in inducing ESCC tumorigenesis and metastasis, which might involve regulation of NF-κB signaling pathway.     

MicroRNA-21与平滑肌蛋白22α在哈萨克族食管癌组织中的表达及其临床病理学意义

目的探讨microRNA21与SM22a基因在哈萨克族食管癌发生发展中的作用及临床意义。方法免疫组织化学法检测162例石蜡包埋食管鳞状细胞癌组织及RT-PCR方法检测47例哈萨克族食管癌标本中microRNA21、SM22a表达水平,分析这些基因与临床病理特征的关系。结果SM22a在162例食管鳞癌组织中的阳性表达率(87.0%)显著高于食管正常黏膜组织(36.0%);在47例哈萨克族食管癌组织中,SM22a表达水平较远端无癌组织增高。与远端无癌组织相比,microRNA21在哈萨克族食管癌组织中表达水平增高。MicroRNA21高表达与分化程度、淋巴结转移、临床分期相关,SM22a高表达与临床分期相关、淋巴结转移相关;microRNA21与SM22a的表达呈正相关。结论MicroRNA21、SM22a协同高表达共同参与哈萨克族食管癌的侵袭发展过程。     

LncRNA and mRNA integration network reconstruction reveals novel key regulators in esophageal squamous-cell carcinoma

Many experimental and computational studies have identified key protein coding genes in initiation and progression of esophageal squamous cell carcinoma (ESCC). However, the number of researches that tried to reveal the role of long non-coding RNAs (lncRNAs) in ESCC has been limited. LncRNAs are one of the important regulators of cancers which are transcribed dominantly in the genome and in various conditions. The main goal of this study was to use a systems biology approach to predict novel lncRNAs as well as protein coding genes associated with ESCC and assess their prognostic values. By using microarray expression data for mRNAs and lncRNAs from a large number of ESCC patients, we utilized “Weighted Gene Co-expression Network Analysis” (WGCNA) method to make a big coding-non-coding gene co-expression network, and discovered important functional modules. Gene set enrichment and pathway analysis revealed major biological processes and pathways involved in these modules. After selecting some protein coding genes involved in biological processes and pathways related to cancer, we used “LncTar”, a computational tool to predict potential interactions between these genes and lncRNAs. By combining interaction results with Pearson correlations, we introduced some novel lncRNAs with putative key regulatory roles in the network. Survival analysis with Kaplan-Meier estimator and Log-rank test statistic confirmed that most of the introduced genes are associated with poor prognosis in ESCC. Overall, our study reveals novel protein coding genes and lncRNAs associated with ESCC, along with their predicted interactions. Based on the promising results of survival analysis, these genes can be used as good estimators of patients' survival, or even can be analyzed further as new potential signatures or targets for the therapy of ESCC disease.