The identification of reliable predictors of chemotherapy sensitivity and early screening of adenocarcinoma of gastroesophageal junction (AGEJ) patients who are resistant to chemotherapy has become an important area of clinical and translational research. We aimed to investigate the predictive value of seven cancer-associated cellular proteins for neoadjuvant chemotherapy in AGEJ patients. Clinical data of 93 patients who received neoadjuvant chemotherapy for locally advanced AGEJ between June 2010 and December 2014 were reviewed. All patients were administered the combination regimen of S-1 and oxaliplatin (SOX). Expression of P-glycoprotein (P-gp), glutathione S-transferase-π (GST-π), topoisomerase II (topo II), multidrug resistance gene-associated protein (MRP), lung resistance-related protein (LRP), Ki-67, and p53 was determined by immunohistochemistry (IHC) in AGEJ tissues before neoadjuvant chemotherapy. Chemotherapeutic efficacy was evaluated according to RECIST 1.0 standards and histopathological results, and the relationship between the expression of the cellular proteins and chemotherapy efficacy was analyzed. The SOX regimen was associated with an overall response rate of 46.2%. The frequency of expression of the seven cancer-associated factors in the AGEJ tissues was as follows: P-gp, 64.5%; GST-π, 39.8%; topo II, 72.0%; MRP, 33.3%; LRP, 68.8%; Ki-67, 62.4%; and p53, 40.9%. Expression of Ki-67 (p = 0.003) and p53 (p = 0.009) was significantly correlated with chemotherapy sensitivity. Elevated Ki-67 expression and decreased p53 expression predict for SOX insensitivity in AGEJ, and the cellular expression of these respective proteins may provide a useful reference for designing individualized chemotherapy regimens for AGEJ patients in the future.
Abstract. Adenomas of the adrenal cortex are common and asymptomatic when the diameter is 3-3.5 cm. However, adrenal tumors over 4 cm in diameter are diagnosed as malignant. Adrenal adenomas with a diameter over 20 cm are rare. In the present study, we present a case of non-functional giant benign adrenal adenoma. Following surgery, an adenoma of the adrenal cortex with a diameter of 32 cm and a weight of 7,500 g was found. A detailed search of the literature revealed this to be the largest benign tumor of the adrenal cortex described to date.
The reported incidence of previous gastrectomy in patients with thoracic esophageal carcinoma ranged from 0.86% to 9.3% [1, 2] , Although, surgical treatment for these patients is more complicated, it does not result in increased mortality [3] . Hence, the active surgical intervention for these tumors has been recommended by most of the thoracic surgeons. Influenced by previous operation, the colon or jejunum is the most popular choice as a substitution in such patients. But considering the trauma and difficulty of these procedures, we performed residual stomach esophagus anastomosis in 10 patients from 2000 to 2006, which was benefited from the preserving short gastric artery. Our practice showed that the residual stomach could serve as available and viable alternative for esophagus. Materials and methods10 men with age ranging from 45 to 72 years (mean 61.3 years) were enlisted in this study. They were performed subtotal gastrectomy to cure peptic ulcer 14-27 years ago (mean 16.7 years). Among them, 9 underwent billroth II procedure (antecolic position, 5; retrocolic position, 4) while the other received billroth I procedure. From fundus to gastrojejunal anastomosis, the stomach stump measured 7.2 to 12.3 cm (mean 9.7 cm) according to X-ray examination. In terms of the location of the tumor, 3 cases were localized in mid thoracic esophagus, and the other 7 in lower thoracic. With regard to gross type, there were 5 cases belonging to ulcerative type, 3 medullary type and 2 fungating type. The diameters ranged from 3 to 6 cm. 5 patients had at least one of the following concomitant diseases: hypertension 3, COPD 2, coronary heart disease 2, diabetes mellitus 1. The procedure details were described as follows.On the condition that the carcinoma of esophagus was confirmed and the resection of lesion was qualified, the operation was arranged to be performed soon. A left thoracotomy through the 6th or 7th intercostal space was performed under the intratracheal anesthesia. If the tumor appeared to be resectable, the left diaphragm was opened and the exploration of abdominal cavity was done. Attention was paid to identify whether there was metastasis in perigastric lymph node and get the status of celiac cohesion. After the splenophrenic, splenocolic and splenonephric ligaments were divided, the spleen, splenic hilus and pancreatic tail were dissociated from the back of peritoneum, taking care not to injure the splenic and protect two to four short gastric vessels to vascularize residual stomach robustly. After dividing and ligating left gastric and posterior gastric arteries, the residual stomach could be fully mobilized. The cardia was transected and closed. The esophagus was mobilized and the upper end of esophagus was resected 5 cm above the tumors as described in sweet's esophagogastrectomy. All mediastinal lymph nodes were removed in continuity with the Abstract Objective: To investigate the value of spleen and pancreatic tail thorax translocation on the residual stomach esophagus anastomosis. Methods: 10 patie...
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