This study reports a rare case of a 47-year-old female with a gastric glomus tumor who was admitted with epigastralgia. Endoscopic ultrasound revealed a protrusion on the posterior wall of the gastric antrum. Enhanced computed tomography confirmed the presence of a 10-mm mass. The tumor was resected, and immunohistochemistry revealed the tumor to be positive for smooth muscle actin and collagen type IV, and negative for synaptophysin, chromogranin A, laminin, S-100, cluster of differentiation (CD)34, CD31, CD99, cytokeratin (AE1/AE3), desmin and epithelial membrane antigen. The proliferation marker Ki-67 was positive in <5% of tumor cell nuclei. The clinical procedures with a review of the literature are reported.
AIMTo investigate the efficacy and safety of transcutaneous electroacupuncture (TEA) to alleviate postoperative ileus (POI) after gastrectomy.METHODSFrom April 2014 to February 2017, 63 gastric cancer patients were recruited from the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China. After gastrectomy, the patients were randomly allocated to the TEA (n = 33) or control (n = 30) group. The patients in the TEA group received 1 h TEA on Neiguan (ST36) and Zusanli (PC6) twice daily in the morning and afternoon until they passed flatus. The main outcomes were hours to the first flatus or bowel movement, time to nasogastric tube removal, time to liquid and semi-liquid diet, and hospital stay. The secondary outcomes included postoperative symptom assessment and complications.RESULTSTime to first flatus in the TEA group was significantly shorter than in the control group (73.19 ± 15.61 vs 82.82 ± 20.25 h, P = 0.038), especially for open gastrectomy (76.53 ± 14.29 vs 87.23 ± 20.75 h, P = 0.048). Bowel sounds on day 2 in the TEA group were significantly greater than in the control group (2.30 ± 2.61/min vs 1.05 ± 1.26/min, P = 0.017). Time to nasogastric tube removal in the TEA group was earlier than in the control group (4.22 ± 1.01 vs 4.97 ± 1.67 d, P = 0.049), as well as the time to liquid diet (5.0 ± 1.34 vs 5.83 ± 2.10 d, P = 0.039). Hospital stay in the TEA group was significantly shorter than in the control group (8.06 ± 1.75 vs 9.40 ± 3.09 d, P = 0.041). No significant differences in postoperative symptom assessment and complications were found between the groups. There was no severe adverse event related to TEA.CONCLUSIONTEA accelerated bowel movements and alleviated POI after open gastrectomy and shortened hospital stay.
Introduction: Gastrointestinal stromal tumors (GISTs), with a primary occurrence in the duodenum and proximal jejunum, are rare and treatment is poorly understood. This study aimed to evaluate the main factors influencing the prognosis of GIST resection in this complex anatomical structure. Materials and methods: This retrospective study included 47 patients who underwent surgery for primary GIST of the duodenum (20) and proximal jejunum (27) between 2012 and 2017. Perioperative clinical data as well as relapse and survival information were collected. Results: All patients underwent negative margin resection (R0) of duodenal and proximal jejunum GISTs. Complications occurred more frequently in treatment of duodenal GISTs than proximal jejunum GISTs (p ¼ 0.003). GISTs in D3 (the 3rd portion of duodenum) were related to larger tumor size (p ¼ 0.001), higher probability of severe complication rate (p ¼ 0.042), longer hospital stays (p ¼ 0.023) and fasting time (p ¼ 0.020). More complications were found for patients with digestive reconstruction than limited resection (p ¼ 0.010). Additionally, patients with a tumor mass larger than 5 cm or a mitotic index greater than 5 mitoses/50 HPFs showed poorer therapeutic outcomes. The 1-and 3-year overall survival was 97.9% and 86.1%, respectively and were not influenced by operation type (p ¼ 0.061) or GIST position (p ¼ 0.447). Conclusion: With negative operational margins, limited resection is a safe and feasible procedure for duodenal and proximal jejunum GIST patients and unnecessary digestive reconstruction should be avoided. Considering the severe complication rate, resection for GISTs in D3 should be performed with care.
Abstract. The prognosis of patients with peritoneal dissemination from gastric cancer is poor, and the underlying molecular mechanism remains unclear. Exosomes, as macromolecular phospholipid bilayer vesicles comprising of proteins, nucleic acids and lipids, serve as mediators of cell-cell communication. Gastric cancer tumor-derived exosomes may be involved in the pathological process of peritoneal dissemination by mediating crosstalk between cancer cells and mesothelial cells, to result in the induction of enhanced tumor growth, migratory, adhesive and invasive abilities, peritoneal fibrosis and apoptosis, mesothelial-to-mesenchymal transition, angiogenesis and chemoresistance. The present review focuses on previous studies addressing the exosome-dependent molecular transfer in peritoneal dissemination in gastric cancer and the potential clinical applications. Contents1. Introduction 2. Exosomes in peritoneal dissemination of gastric cancer 3. Early detection by exosomal miRNAs 4. Chemoresistance and exosome-based treatment of peritoneal dissemination cases of gastric cancer IntroductionPeritoneal dissemination is detected in 14% of patients with gastric cancer at the time of initial diagnosis, for whom the median survival time is 4 months (1). Gastric cancer patients with peritoneal dissemination cannot undergo radical surgery, and the chemotherapeutic effect is limited due to inadequate distribution of intravenous chemotherapy drugs, blocked by the peritoneal barrier, and tumor chemoresistance (2). The 5-year survival rate of gastric cancer patients with peritoneal dissemination is only 2% (3). Peritoneal dissemination is among the most common patterns of recurrence in gastric cancer patients (4). However, it remains unclear how peritoneal dissemination exactly occurs, and there is a need to reveal the underlying molecular mechanism, as well as to develop more effective treatment strategies. Exosomes are macromolecular, phospholipid bilayer vesicles comprised of proteins, nucleic acids and lipids (5). At 40-120 nm in diameter, exosomes are smaller than other vesicles including microvesicles (100 nm-1 µm) and apoptotic bodies (50 nm-2 µm) (6). Exosomes exist in all body fluids and are generated by secretion and budding from various types of cells, including tumor cells (7). They contain key biological molecules including proteins, RNAs and lipids, which are considered to mediate intercellular communication (6). In particular, exosomes deliver proteins and RNAs associated with different pathologies, including neurodegenerative diseases, HIV infection, heart disease and tumor progression, from host cells to recipient cells (8). Tumor-derived exosomes (TEX) may have the capacity to remodel the tumor microenvironment to make it favorable for metastatic niches (7) and, furthermore, may alter the extracellular matrix and attract more cancer cells to the niches (9). Notably, increasing studies indicate that exosomes are involved in the peritoneal dissemination of gastric cancer. The present review focuses on how exos...
Background Cancer-associated fibroblasts (CAFs) aggravate gastric cancer (GC) development. Methods Combined with bioinformatics analysis and literature review, miR-223-3p had high expression in microvesicles (MVs) derived from GC CAFs, and it could modulate SORBS1. miR-223-3p and SORBS1 mRNA levels were assessed by qRT-PCR. The levels of CAFs markers, MVs markers, epithelial-mesenchymal transition (EMT)-associated proteins, and SORBS1 protein were assessed by western blot. MVs isolated from fibroblasts were observed by transmission electron microscopy. Combined with immunofluorescence and co-culture experiments, GC cells were determined to absorb MVs carrying miR-223-3p. Cell functions were measured using CCK-8, transwell, flow cytometry and colony formation assays. The binding of miR-223-3p and SORBS1 was determined by dual-luciferase assay and RNA immunoprecipitation. The cancer-promoting effect of MVs carrying miR-223-3p on experimental animals was verified in vivo by tumor-bearing experiment in nude mice. Results miR-223-3p was upregulated in the MVs secreted by GC CAFs and could be transmitted to GC cells through MVs, to boost the malignant progression of tumor cells. Additionally, it was also revealed that miR-223-3p targeted SORBS1 and accelerated progression along with EMT in GC. Conclusions CAFs-derived MVs could carry miR-223-3p to GC cells to target SORBS1, thereby promoting the malignant progression of GC.
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