Presence of cancer cells in gastric lavage of gastric cancer patients as an indicator of advanced disease,predictor of tumour aggressive phenotype and independent prognostic factor for poor survival: The endoluminal metastatic pathway of gastric cancer and GL0/GL1 classification

Objective

As of 2017, the pathobiology of gastric cancer (GC) is far from fully understood; consequently, new methods of basic and advanced research have been proposed and tested. The presence (GL1) vs absence (GL0) of malignant cells exfoliated in gastric lavage (GL) of GC patients was formerly evaluated with diagnostic intent but not for staging or prognostic assessment. We investigated this hitherto unreported application of cytopathology.

Methods

GL was preoperatively and prospectively collected from 80 GC patients and cytologically analysed. The results were compared with the classic clinicopathological features of GC and related to survival. The prognostic value of GL1 was assessed through univariate and multivariate analyses.

Results

GL1 was detected in 36 samples (45%) and correlated with advanced tumour depth (T3‐T4), lymphatic metastasis (N+), distant metastasis (M1) and lymphovascular invasion (LVI1; P=.0317, .0024, .003 and .0028, respectively). Overall survival (OS) was significantly shorter for GL1 (23 months) vs GL0 patients (42 months; P=.005) and GL1 vs GL0 T1 subjects (12.6 vs 47.8 months, P=.0029). Univariate analysis revealed that GL1, N+, M1, LVI1 and advanced stage were significantly associated with OS. Multivariate analysis assessed GL1 as the only independent prognostic factor for worse OS and progression‐free survival (P=.0013 and .0107).

Conclusions

In the present study, GL1 was correlated with advanced disease, aggressive tumour behaviour and poor prognosis. Although additional studies are needed to confirm these findings, the GL0/GL1 classification can be applied to GC patients to achieve higher accuracy in staging, prognostic stratification and treatment selection.     

Gastric Electrical‐Stimulation Effects on Canine Gastric Emptying,Food Intake,and Body Weight

Objective: It has been reported that electrical stimulation at the distal stomach can disrupt intrinsic gastric electrical activity and delay gastric emptying. Gastric dysrhythmia and impaired gastric emptying are associated with upper gastrointestinal symptoms and weight loss. The purpose of this study was to evaluate the effect of low‐frequency/long‐pulse gastric electrical stimulation (GES), at proximal and distal stomach, on canine gastric emptying, food intake, and body weight. Research Methods and Procedures: Eight dogs were surgically implanted with four pairs of electrodes along the greater curvature and a gastric tube at the dependent part of the stomach. Liquid gastric emptying at baseline, during proximal and distal GES at 6 cycles per minute, was assessed first by a dye dilution technique. Proximal and distal GES were then randomly delivered during feeding for 10 consecutive days, and food intake and body weight were recorded daily. Results: There was no significant difference in gastric emptying parameters among the various sessions. The mean daily food consumption was significantly reduced during both sessions of GES, resulting in significant immediate weight loss. Percentage weight loss was comparable between both sessions of GES. Discussion: Short‐term GES significantly reduced canine food intake and weight. This effect may not be related to changes in gastric emptying. GES may have a potential role in the treatment of obesity.     

Non-invasive genotyping of Helicobacter pylori cagA, vacA, and hopQ from asymptomatic children

Background: Helicobacter pylori infection is usually acquired in childhood, but little is known about its natural history in asymptomatic children, primarily due to the paucity of non‐invasive diagnostic methods. H. pylori strains harboring cagA and specific alleles of hopQ and vacA are associated with increased risk for gastric cancer. Many studies of H. pylori virulence markers in children have the bias that symptomatic subjects are selected for endoscopy, and these children may harbor the most virulent strains. Our aim is to genotype cagA, hopQ, and vacA alleles in stool DNA samples of healthy Colombian children residing in an area with high incidence of gastric cancer, to avoid selection bias resulting from endoscopy. Methods: H. pylori status of 86 asymptomatic children was assessed by ¹³C‐urea breath test (UBT) and PCR. H. pylori 16S rRNA, cagA, hopQ, and vacA genes were amplified from stool DNA samples and sequenced. Results: UBT was positive in 69 (80.2%) of 86 children; in stool DNA analysis, 78.3% were positive by 16S rRNA PCR. cagA, vacA, and hopQ were detected in 66.1%, 84.6%, and 72.3% of stool DNA samples from 16S rRNA‐positive children. Of the children’s DNA samples, which revealed vacA and hopQ alleles, 91.7% showed vacA s1 and 73.7% showed type I hopQ. Type I hopQ alleles were associated with cagA positivity and vacA s1 genotypes (p < 0.0001). Conclusions: Using stool DNA samples, virulence markers of H. pylori were successfully genotyped in a high percentage of the asymptomatic infected children, revealing a high prevalence of genotypes associated with virulence. Type I hopQ alleles were associated with the presence of cagA and the vacA s1 genotype.     

Toll-Like Receptor 4 +3725 G/C Polymorphism, Helicobacter pylori Seropositivity, and the Risk of Gastric Atrophy and Gastric Cancer in Japanese

Background:  Toll-like receptor 4 (TLR4) Asp299Gly and Thr399Ile polymorphisms were reported to be a risk factor of gastric carcinoma or its precursors in Caucasian and Indian population, but these polymorphisms are absent in Japanese. We investigated the associations of TLR4 +3725 G/C polymorphism, another functional polymorphism of TLR4 , with risk of gastric cancer and gastric atrophy in Japanese.
Materials and Methods:  Study subjects were 583 histologically diagnosed gastric cancer patients and age- and sex-matched 1592 control outpatients, who visited Aichi Cancer Center Hospital from 2001 to 2005. Serum anti- H. pylori IgG antibody and pepsinogens were measured to evaluate H. pylori infection and gastric atrophy, respectively. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by a logistic model.
Results:  Among the seropositive subjects, the age- and sex-adjusted OR of gastric atrophy was 1.17 (95%CI: 0.91–1.50) for G/C , 1.20 (95%CI: 0.76–1.89) for C/C , and 1.18 (95%CI: 0.93–1.49) for G/C + C/C relative to G/G genotype. The age- and sex-adjusted OR of severe gastric atrophy among H. pylori seropositive subjects was 1.43 (95%CI: 0.99–2.06) for G/C , 1.47 (95%CI: 0.76–2.88) for C/C , and 1.43 (95%CI: 1.01–2.04) for G/C + C/C . The OR of gastric cancer compared with gastric atrophy controls was not statistically significant.
Conclusion:  Our study found that TLR4 +3725 G/C polymorphism was a risk factor of severe gastric atrophy in H. pylori seropositive Japanese. Our results underscored the significance of the variations in host innate immunity due to TLR4 polymorphism as genetic predispositions to gastric precancerous lesions in Eastern Asian populations with the same backgrounds.     

霉菌、幽门螺杆菌及双菌种感染在胃溃疡、胃癌中检出的意义

探讨霉菌、幽门螺杆菌(Hp)单菌种感染和霉菌、Hp(双菌种)同时感染在胃癌及胃溃疡中的组织病理学变化、发病情况及意义。采用常规石蜡切片,HE染色和PAS、Giemsa特殊染色、免疫组织化学染色及PCR方法,对223例慢性浅表性胃炎、111例慢性萎缩性胃炎、116例胃溃疡、121例胃癌纤维胃镜活检标本进行回顾性研究。结果显示,慢性浅表性胃炎、慢性萎缩性胃炎未检出双菌种感染。胃溃疡双菌种感染11例,检出率9.5%;胃癌双菌种感染21例,检出率17.4%。双菌种感染在胃癌及胃溃疡中的发现,表明双菌种感染可能是导致胃溃疡、胃癌发生的又一致病因素。     

The effects of predator size, temperature, and prey characteristics on gastric evacuation in whiting

No effect of prey size on gastric evacuation rate was found in whiting Merlangius merlangus .Prey energy density explained most of the data variation among fish prey, and evacuation time increased by a factor 1·6–1·7 with prey energy density increasing from 3·4 to 5·6 kJ g⁻¹. The power model expanded to include predator size, temperature, and prey energy density could describe gastric evacuation in whiting fed fish prey. Krill Meganyctiphanes norvegica was evacuated at a rate similar to fish prey of equal energy density, while the evacuation of brown shrimp Crangon crangon took almost twice as long.     

The effects of meal size, body size and temperature on gastric evacuation in pikeperch

Prey size had no effect on the gastric evacuation rate of pikeperch Stizostedion lucioperca. The gastric evacuation was adequately described applying an exponent of 0·5 in the power model. Applying length instead of weight of pikeperch in the gastric evacuation model resulted in a change of estimated parameters, in accordance with the weight–length relationship of pikeperch.     

Expression of apurinic/apyrimidinic endonuclease-1 (APE-1) in H. pylori-associated gastritis, gastric adenoma, and gastric cancer

Background and Aim: Apurinic/apyrimidinic endonuclease‐1 (APE‐1) is a key enzyme in DNA base excision repair (BER), linked to cancer chemosensitivity. However, little is known about the localization of APE‐1 in Helicobacter pylori‐infected gastric mucosa or its role in the development of gastric cancer. To investigate the role of APE‐1 in the development of gastric cancer, we examined APE‐1 expression and localization in cultured cells and gastric biopsies from patients with H. pylori‐infected gastritis or gastric adenoma, and from surgically resected gastric cancer. Methods: APE‐1 mRNA and protein expression were determined in H. pylori (CagA+) water‐extract protein (HPWEP)‐stimulated MKN‐28 cells, gastric adenocarcinoma cell‐line (AGS) cells, and human peripheral macrophages by real‐time polymerase chain reaction and Western blot analysis. APE‐1 expression and 8‐OHdG as a measure of oxidative DNA damage were evaluated by immunostaining. Localization of APE‐1 and IκBα phosphorylation in gastric adenoma and gastric cancer tissues were evaluated by single‐ and double‐label immunohistochemistry. Results: In studies in vitro, HPWEP‐stimulation significantly increased APE‐1 mRNA expression levels in both MKN‐28 cells and human peripheral macrophages. Hypo/reoxygenation treatment significantly increased APE‐1 protein expression in HPWEP‐stimulated MKN‐28 cells. HPWEP stimulation significantly increased both APE‐1 expression and IκBα phosphorylation levels in MKN‐28 and AGS cells. In human tissues, APE‐1 expression in H. pylori‐infected gastritis without goblet cell metaplasia was significantly increased as compared to that in tissues from uninfected subjects. Eradication therapy significantly reduced both APE‐1 and 8‐OHdG expression levels in the gastric mucosa. APE‐1 expression was mainly localized in epithelial cells within gastric adenoma and in mesenchymal cells of gastric cancer tissues. APE‐1 expression in gastric cancer tissues was significantly reduced compared to that in H. pylori‐infected gastric adenoma, while 8‐OHdG index and IκBα phosphorylation levels did not differ between these two neoplastic tissue types. Co‐localization of APE‐1 and IκBα phosphorylation was observed not in gastric cancer cells but in gastric adenoma cells. Conclusion: H. pylori infection is associated with increased APE‐1 expression in human cell lines and in gastric tissues from subjects with gastritis and gastric adenomas. The observed distinct expression patterns of APE‐1 and 8‐OHdG in gastric adenoma and gastric cancer tissues may provide insight into the progression of these conditions and warrants further investigation.     

Hydroferrate Fluid,MRN-100, Provides Protection against Chemical-Induced Gastric and Esophageal Cancer in Wistar Rats

In the current study, we examined the protective effect of hydroferrate fluid MRN-100 against the carcinogen methylnitronitrosoguanidine (MNNG)-induced gastric and esophageal cancer in rats. MRN-100 is an iron-based compound composed of bivalent and trivalent ferrates. At 33 weeks post treatment with MNNG, rats were killed and examined for the histopathology of esophagus and stomach; liver, spleen, and total body weight; and antioxidant levels in the blood and stomach tissues. Results showed that 17/20 (85%) gastroesophageal tissues from carcinogen MNNG-treated rats developed dysplasia and cancer, as compared to 8/20 (40%) rats treated with MNNG plus MRN-100. In addition, MRN-100 exerted an antioxidant effect in both the blood and stomach tissues by increasing levels of GSH, antioxidant enzymes SOD, CAT, and GPx, and total antioxidant capacity (TAC) level. This was accompanied by a reduction in the total free-radical and malondialdehyde levels. Furthermore, MRN-100 protected against body and organ weight loss. Thus, MRN-100 exhibited significant cancer chemopreventive activity by protecting tissues against oxidative damage in rats, which may suggest its effectiveness as an adjuvant for the treatment of gastric/esophageal carcinoma.     

Factors affecting gastric evacuation in cod, Gadus morhua L., fed single-meals of natural prey

Functional relationships were derived in order to describe the effects of fish weight (262–2066 g), temperature (1–14° C), prey size and ration size (0.4–8.4% body weight) on gastric evacuation in cod fed four natural prey types. Interindividual (unexplained) differences among voluntary fed cod were relatively large. Power functions were appropriate for describing the effects of fish weight and ration size on the half-time of evacuation. Effects of meal and/or prey size appeared to counterbalance the effects of cod size. It is suggested that when cod of different sizes are fed fixed proportions of their body weight evacuation time is constant and independent of body size. There was found to be an exponential relationship between temperature and gastric evacuation time but, observations made at similar temperatures at different times of the year suggested that seasonal effects were of minor importance.     

东、黄海鳀鱼的胃排空率及其温度影响

在室内受控条件下,以卤虫幼体为饵料,测定了不同温度下鳀鱼的胃排空率,并比较了线性、指数和平方根3种常用数学模型对其排空曲线的拟合程度.统计结果表明,3种数学模型均可较好地描述鳀鱼的胃排空曲线 (df =10, r2=0.7820～0.9629, P<0.01),综合评价结果则进一步表明,指数模型最适于定量描述其胃排空曲线,平方根模型次之,直线模型较差.在研究温度范围内,鳀鱼的胃排空率随着温度的升高而加速增大,二者之间的定量关系可以用指数函数Rt=0.0354e0.0766T (R2=0.9770)加以定量描述.     

基因MMP-2、PTEN和Fn的表达与胃癌临床病理因素的关系

为了探讨基因MMP-2、PTEN和FN与胃癌临床病理因素的关系,采用免疫组织化学方法,检测了56例胃癌中MMP-2、PTEN和Fn的表达.结果表明:MMP-2、PTEN的阳性表达和Fn的异常表达分别为58.9%、55.4%和60.7%.低分化癌中MMP-2的表达和Fn的异常高于高分化癌(P<0.05).MMP-2的表达和Fn的异常与胃癌浸润深度、淋巴结转移正相关(P<0.05),PTEN的表达与淋巴结转移负相反(P<0.05).MMP-2和PTEN的表达呈负相关(P<0.05),MMP-2表达和Fn的异常呈正相关(P<0.01),PTEN表达与Fn异常之间无明显相关性(P>0.5).通过该研究发现,检测胃癌组织中MMP-2、PTEN和Fn的表达,有助于了解胃癌的发展和评估胃癌患者的预后.     

Amylin,Food Intake,and Obesity

Amylin, also known as islet amyloid polypeptide, identified in 1987, is a naturally occurring hormone, released by the β cells of the pancreas and consists of 37 amino acids. Amylin seems to decrease food intake through both central and peripheral mechanisms and indirectly by slowing gastric emptying. The mean basal amylin concentration is higher in obese than in lean human subjects. The amylin response to oral glucose is also greater in obese subjects, whether or not they have impaired glucose tolerance. The elevated amylin levels in obesity may lead to down-regulation of amylin receptors and lessen the impact of postprandial amylin secretion on satiety and gastric emptying. Amylin administration may overcome resistance at target tissues, delay gastric emptying, and have potential for inducing weight loss in obese individuals.     

Expression of UDP-N-acetyl-D-galactosamine: polypeptide N-acetylgalactosaminyltransferase-6 in gastric mucosa, intestinal metaplasia, and gastric carcinoma

Aberrant mucin O-glycosylation is often observed in cancer and is characterized by the expression of immature simple mucin-type carbohydrate antigens. UDP-N-acetyl-d-galactosamine:polypeptide N-acetylgalactosaminyltransferase-6 (ppGalNAc-T6) is one of the enzymes responsible for the initial step in O-glycosylation. This study evaluated the expression of ppGalNAc-T6 in human gastric mucosa, intestinal metaplasia, and gastric carcinomas. Our results showed that ppGalNAc-T6 is expressed in normal gastric mucosa and in intestinal metaplasia. A heterogeneous expression and staining pattern for this enzyme was observed in gastric carcinomas. ppGalNAc-T6 was expressed in 79% of the cases, and its expression level was associated with the presence of venous invasion. Our results provide evidence that ppGalNAc-T6 is an IHC marker associated with venous invasion in gastric carcinoma and may contribute to the understanding of the molecular mechanisms that underlie aberrant glycosylation in gastric carcinogenesis and in gastric carcinoma.     

A Novel Compound,L34, Induced Apoptosis in Human Gastric Cancer Cells

Selectively apoptosis-targeting compounds in gastrointestinal cancers attract broad interest. Here, we investigated a synthetic sulfonamide, 4-bromo-N-(5-ethyl-5H-pyrido[4,3-b]indol-8-yl)benzenesulfonamide (L34). It showed high activity against gastric cancer cells SGC-7901, causing apoptosis, which was associated with downregulation of caspase-3 and XIAP, upegulation of cleaved caspase-3, and cleavage of PARP. Hence, L34 might be a potent chemotherapeutic agent against human gastric cancer.     

Helicobacter pylori Infection, Intestinal Metaplasia, and Gastric Cancer Risk in Eastern Siberia

Background: The incidence of gastric cancer (GC) is extremely high in Russia and eastern Siberia, where information on the epidemiology of Helicobacter pylori infection is fragmentary. Aims: To assess the prevalence of both H. pylori infection (including CagA status) and intestinal metaplasia (IM) in Russian and eastern Siberian populations carrying a different risk of GC. Materials and Methods: A sample of 2129 consecutive patients was considered, including 689 Europoids and 1440 Mongoloids (493 Evenks, 533 Khakass people, and 414 Tuvans), who all underwent serum sampling and upper gastrointestinal endoscopy. H. pylori status was established (ELISA, urease test, and histology), and IgG anti‐CagA antibodies were assessed (ELISA) in H. pylori‐positive cases. At least 3 biopsy samples per patient were considered, and IM was scored as present versus absent. The prevalence of H. pylori, CagA+ve status, and IM was compared with the incidence of GC according to the regional cancer registries. Results: The prevalence of H. pylori was similar for the Europoids and Mongoloids (93.6 vs 94.3%). The prevalence of CagA+ve infection was as follows: Europoids 61.2%, Evenks 36.4%, Khakass 44.0%, Tuvans 60.0% (p_1vs2 < .001; p_1vs3 < .001; p_2vs4 < .001; p_3vs4 < .001). The prevalence of IM was as follows: Europoids 10.7%, Evenks 5.1%, Khakass 9.8%, and Tuvans 23.4% (p_1vs2 = .001; p_1vs4 < .001; p_2vs4 < .001; p_3vs4 < .001). The incidence of GC (per 100,000 population/year) was as follows: Europoids 33.2; Evenks 18.2; Khakass 20.2; Tuvans 50.7 (p_1vs2 = 0.04; p_1vs3 = .05; p_2vs4 < .001; p_3vs4 < .001). Conclusion: H. pylori infection is consistently high in Russian and eastern Siberian populations; ethnicities with similar prevalence of CagA+ve status had different prevalence of IM and incidence of GC. As expected, IM prevalence correlated with the incidence of GC. Host‐related and/or environmental factors may explain discrepancies between H. pylori status, the prevalence of IM, and the incidence of GC.     

Alterations of Gastrointestinal Motility in Obesity

All nutrients are absorbed in the gastrointestinal (GI) system, and GI motility plays a very critical role in the consumption of foods, digestion, and absorption of nutrients. Various segments of the GI tract (esophagus, stomach, and intestines) coordinate in a complex yet precise way to control the process of food consumption, digestion, and absorption of nutrients. GI motility not only regulates the rates at which nutrients are processed and absorbed in the gut but also participates in the control of appetite and satiety. Altered GI motility has been associated with various disease conditions (gastroparesis, etc.) and has been frequently observed in obese patients. The significance of these GI motility alterations in obesity is not fully understood, but they have been considered as potential contributing factors in the development and maintenance of obesity and changed eating behavior. Therapies aimed at regulating GI motility are being actively explored and applied clinically for the management of obese patients. To better understand the pathophysiology of obesity, we systematically reviewed GI motility changes observed in obese conditions. The relationship and pathological significance of these findings, as well as the potential therapies by modification of GI motility, are also discussed.     

Circulating microRNA-133, microRNA-17 and microRNA-25 in serum and its potential diagnostic value in gastric cancer

Gastric cancer is one of the most common malignancies in the world and is considered as the most lethal gastrointestinal cancer. microRNAs (miRNAs) can be very important in detecting a disease at an early stage. The aim of this study was to investigate the microRNA-17 (miR-17), miR-25, and miR-133b in the serum of gastric cancer subjects. Serum samples were obtained from 120 gastric cancers and 102 healthy subjects. We evaluated expression levels of miR-17, miR-25 and miR-133b by quantitative real-time polymerase chain reaction. Our results showed that in the patients with gastric cancer, the expression level of miR-17 and miR-25 were significantly increased compared with the control group (P < 0.5), while the expression level of miR-133b was significantly decreased in patient groups compared with control cases (P < 0.5). It seems that expression of miRNAs in Iranian patients with gastric cancer is similar to other patients in other populations. These findings suggested that miR-17, miR-25 and miR-133b could be introduced as potential diagnostic candidates for the detection in gastric cancer patients in the early stage.