Recent studies demonstrate that the invasion and metastasis of gastric cancer (GC) is closely associated with a multi-subunit vacuolar H+-ATPase (V-ATPase). Here we investigated the expression and role of the human ATP6V1A gene that encodes the catalytic subunit A of V-ATPase in GC. We found that ATP6V1A expression level is significantly elevated in GCs compared to normals, but GC patients with higher expression levels of ATP6V1A have a better prognosis. Genomic analysis revealed that APT6V1A copy number is gained in a small fraction of GC patients and lost in a minimum number. Moreover, the ATP6V1A copy number was positively correlated with its mRNA level. To explore additional mechanisms by which ATP6V1A overexpressed in GCs, we investigated the relationship between transcription factor YY1 and ATP6V1A, and found that mRNA expression of YY1 had significant correlation with that of ATP6V1A. To validate that YY1 transcriptionally regulates ATP6V1A, we discovered that the ATP6V1A core promoter region contains three YY1 binding sites. Moreover, RNAi-mediated knockdown of YY1 in GC cells significantly decreased ATP6V1A mRNA and protein expression, while YY1 overexpression increased ATP6V1A expression level. In conclusion, YY1 may play an important regulatory role in ATP6V1A expression with potential mechanistic and clinical implications in GC.
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Rationale: Intramural esophageal squamous cell carcinoma (ESCC) without mucosal invasion is extremely rare. Endoscopic mucosal biopsy results are often negative, making diagnosis difficult. In these cases, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy is a useful diagnostic method. Patient concerns: A 78-year-old female was admitted to hospital due to dysphagia, and gastroscopy showed a concentric narrowing of the esophageal lumen with a smooth and undamaged esophageal mucosa. Diagnoses: Endoscopic ultrasound (EUS) revealed that the esophageal mucosa was thickened with a low echo, and the layers of the esophageal wall could not be clearly distinguished. Cytologic and pathologic diagnoses were obtained through EUS-FNA, which suggested ESCC. Interventions: According to the pathologic diagnosis obtained by EUS-FNA, surgery or radiotherapy were recommended for this patient. Eventually, this patient elected to seek treatment at another medical institution. Outcomes: This type of disease cannot be diagnosed according to gastroscopic biopsy alone, and the diagnosis was eventually confirmed through EUS-FNA. Lessons: When an imaging examination suggests a possible malignant lesion of the oesophagus, EUS-FNA may be considered if the surface mucosa contains no endoscopic damage. EUS-FNA has high diagnostic value with high sensitivity, minimal invasiveness, and high safety.
Background/Aims: To investigate missing diagnosis of the polyp by colonoscopy, and to reveal the endoscopic, pathological features of missed polyps and related factors inducing missing diagnosis. Materials and Methods: We reviewed the data of the patients who received colonoscopy twice within 180 days. The missing rate of the colorectal polyps ware calculated and the endoscopic and pathological features of the missed polyps were summarized. Possible related factors inducing the missing diagnosis were analyzed. Results: The missing rate of colorectal polyps in this study was 27.7%, with as high as 11.5% missing rate of advanced polyps. Most missed polyps were those of <5 mm in diameter (55.2%) or flat ones (75.9%). Most of missed polyps are located in the rectum (21.8%), sigmoid (41.4%) and transverse colon (17.2%). No significant correlation was observed between the missing rate and colonoscopic manners (p>0.05), neither between the missing rate and operators (p>0.05). But number of basal polyps was proved to be significantly correlative with number of missed polyps (r=0.694, p<0.001). Conclusion: Polyps of <5 mm in diameter or flat polyps are more likely to be missed in the endoscopy. Most of missed polyps are located in rectum, sigmoid and transverse colon. More basal polyps usually accompany with more polyps missed.
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