RESUMEN: El lipoma gástrico (LG), es un tumor benigno raro que representa el 5 % de los lipomas gastrointestinales y menos del 1 % de todos los tumores gástricos. Se localizan habitualmente a nivel de la submucosa y generalmente en la región antral. La endoscopia y la tomografía computarizada son las herramientas diagnósticas más utilizadas en el proceso diagnóstico. Dada su relativa rareza, quedan a menudo fuera del diagnóstico diferencial de las masas submucosas gastrointestinales superiores. El objetivo de este manuscrito, es reportar dos casos tratados de forma consecutiva y revisar la literatura existente en esta materia. Se trata de dos pacientes de sexo masculino, de 49 y 69 años de edad, a quienes se diagnosticó una lesión submucosa gástrica por endoscopia y fueron tratados quirúrgicamente y cuyos especímenes fueron estudiados histológicamente, concluyéndose en ambos casos la existencia de un LG. Ambos pacientes evolucionaron de forma correcta y permanecen en controles clínicos y endoscópicos hasta la actualidad, sin inconvenientes. El LG es una entidad poco común, que puede simular una enfermedad maligna. Presentamos dos casos tratados quirúrgicamente con resultados satisfactorios.
Background: To demonstrate the efficacy of radiofrequency for pancreatic stump closure in reducing the incidence of postoperative pancreatic fistula (POPF) in distal pancreatectomy (DP) compared with mechanical transection methods. Despite all the different techniques of pancreatic stump closure proposed for DP, best practice for avoiding POPF remains an unresolved issue, with an incidence of up to 30% regardless of center volume or surgical expertise.Methods: DP was performed in a cohort of patients by applying radiofrequency to stump closure (RF Group) and compared with mechanical closure (Control Group). A propensity score (PS) matched cohort study was carried out to minimize bias from nonrandomized treatment assignment. Cohorts were matched by PS accounting for factors significantly associated with either undergoing RF transection or mechanical closure through logistic regression analysis. The primary end-point was the incidence of clinically relevant POPF (CR-POPF).Results: Of 89 patients included in the whole cohort, 13 case patients from the RF- Group were 1:1 matched to 13 control patients. In both the first independent analysis of unmatched data and subsequent adjustment to the overall propensity score-matched cohort, a higher rate of CR-POPF in the Control Group compared with the RF-Group was detected (25.4% vs. 5.3%, p=0.049 and 53.8% vs. 0%; p = 0.016 respectively). The RF Group showed better outcomes in terms of readmission rate (46.2% vs 0%, p=0.031). No significant differences were observed in terms of mortality, major complications (30.8% vs 0%, p=0.063) or length of hospital stay (5.7 vs 5.2 days, p=0.89).Conclusion: Findings suggest that the RF-assisted technique is more efficacious in reducing CR-POPF than mechanical pancreatic stump closure.
Aim
The aim of this study was to identify miRNAs differentially expressed between CDX2 positive and negative glands of Barrett’s esophagus and, based on this, to examine the function of specific miRNAs on the regulation of CDX2.
Background & Methods
Cardiac-type epithelium has been proposed as an intermediate stage between normal squamous epithelium and intestinal metaplasia (IM) in the development of Barrett´s esophagus. Deregulation of certain miRNAs and their effects on CDX2 expression might contribute to the intestinalization process of cardiac-type epithelium.
miRNA expression profiling using OpenArray technology in microdissected cardiac-type glands with and without fully CDX2 expression was performed in biopsies from patients who developed cardiac-type epithelium in the remnant esophagus after esophagectomy. Data were validated using real-time PCR in esophageal adenocarcinoma cell lines and in situ miRNA/CDX2 co-expression analysis in cardiac-type mucosa samples. The effect of miR-24-3p precursor transfection on CDX2 expression was assessed in the esophageal adenocarcinoma cell lines FLO-1 and KYAE-1.
Results
CDX2 positive glands were characterized by an unique miRNA profile with a significant downregulation of miR-24-3p, miR-520e-3p, miR-548a-1, miR-597-5p, miR-133a-3p, miR-30a-5p, miR-638, miR-625-3p, miR-1255b-1, miR-1260a and upregulation of miR-590 (Figure A). miRNA-24-3p was identified as potential regulator of CDX2 gene expression in three bioinformatics algorithms, and this was confirmed in esophageal adenocarcinoma cell lines (Figure C). Furthermore, miR-24-3p expression negatively correlates with CDX2 in cardiac-type mucosa samples with different stages of mucosal intestinalization (Figure B).
Conclusion
These results imply that miRNA-24-3p directly targets CDX2, and downregulation of miRNA-24-3p is associated with the acquisition of an intestinal phenotype in cardiac-type epithelium.
Figure: (A) OpenArray results showing downregulation of 10 miRNAs in CDX2 positive glands and upregulation of one miRNA (miR-590). (B) miR-24-3p in situ hybridization: intestinal metaplastic glands were characterized by a positive staining for CDX2 (red) and faint to negative miR-24-39. Adjacent non-intestinalized CDX2-negative glands showed a moderate miR-24-3p expression. (C) Transfection of KYAE-1 cells with miR-24-3p and miR-24-39 inhibitor. A significant CDX2 decrease was observed.
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