Search

Objective: Rare disease Background: Schwannomas are tumors that arise from Schwann cells that surround and support nerve cells. Most common sites for presentations are head, neck, and extremities. Schwannomas of gastrointestinal tract are rare, slowgrowing tumors, usually benign, arising from gastrointestinal tract's neural plexus. They are histologically distinguishable from conventional schwannomas that arise in soft tissue or the central nervous system. Preoperative diagnosis of gastrointestinal schwannoma is challenging, requiring immunohistological confirmation of the nature of the tumor. Here, we report a case of 57-year-old woman with an incidental finding of an asymptomatic submucosal jejunal schwannoma. Case Report: A 57-year-old woman with a medical history of hematological disorder underwent a contrast abdominal computed tomography as part of medical follow-up. The imaging revealed the presence of a jejunal mass. The patient underwent laparoscopic surgical resection of the lesion, followed by side-to-side jejuno-jejunal anastomosis with 4-cm clear surgical margins. The final pathologic study revealed the presence of jejunal schwannoma, as tested positive for S-100 protein. The patient was discharged home on the fourth postoperative day, having an uneventful recovery. Conclusions: Jejunal schwannoma are usually benign and asymptomatic, and they are often discovered incidentally during diagnostic tests for other conditions; therefore, it should be included in the differential diagnosis of gastrointestinal tumors. Surgical treatment appears to be necessary to achieve a definitive diagnosis through a biopsy of the tumor tissue. Benign jejunal schwannomas have a good prognosis. [ABSTRACT FROM AUTHOR]

Muscle weakness, assessed by grip strength, has been shown to predict postoperative mortality in older patients with cancer. Because lower extremity muscle strength well reflects physical performance, we examined whether lower knee extension muscle strength predicts postoperative mortality better than grip strength in older patients with gastrointestinal cancer. Prospective, observational study in a single institution. A total of 813 patients (79.0 ± 4.2 years, 66.5% male) aged 65 years or older with gastrointestinal cancer who underwent preoperative evaluation of grip strength and isometric knee extension muscle strength between April 2012 and April 2019 were included. The study participants were prospectively followed up for postoperative mortality. Muscle weakness was defined as the lowest quartile of grip strength or knee extension strength (GS-muscle weakness and KS-muscle weakness, respectively). Among the study participants, 176 patients died during a median follow-up of 716 days. In the Kaplan-Meier analysis, we found that patients with both GS-muscle weakness and KS-muscle weakness had a lower survival rate than those without muscle weakness. As expected, higher clinical stages and abdominal and thoracic surgeries compared with endoscopic surgery were associated with increased all-cause mortality. In addition, we found that KS-muscle weakness, but not GS-muscle weakness, was an independent prognostic factor after adjusting for sex, body mass index, cancer stage, surgical technique, and surgical site in the Cox proportional hazard model. In older patients with gastrointestinal cancer, muscle weakness based on knee extension muscle strength can be a better predictor of postoperative prognosis than muscle weakness based on grip strength. [ABSTRACT FROM AUTHOR]

Neoplasms are one of the most concerned public health problems worldwide. Digestive system neoplasms, with a high morbidity and mortality, is one of the most common malignant tumors in human being. It is found that exosomes act as an intercellular communication media to carry the metabolic and genetic information of parental cells to target cells. Likely, exosomes participate in lipid metabolism and regulates multiple processes in digestive system neoplasms, including the information transmission among cancer cells, the formation of neoplastic microenvironment, and the neoplastic biological behaviors like metastasis, invasion, and the chemotherapy resistance. In this review, we firstly introduce the main mechanisms whereas exosomes act as intercellular lipometabolic communication mediator in digestive system neoplasms. Thereafter we introduce the relationship between exosomes lipid metabolism and various type of digestive system neoplasms, including gastric cancer, hepatocellular carcinoma, pancreatic cancer, and colorectal cancer. Eventually, we summarized and prospected the development and implication of exosomes in digestive system neoplasms. The further research of exosomes as intercellular lipid metabolism mediator will contribute to accurate and efficient diagnosis and treatment of digestive system neoplasms. [Display omitted] • Exosomes affect the development of digestive neoplasms through lipid metabolism. • Gastric cancer cell derived exo-lncFERO reduces the unsaturated fat in GCSCs. • Exosomes affect the lipid metabolism of HCC cell via miRNA signaling. • CRC cells-derived exosomes affect the development of CRC through lipid metabolism. [ABSTRACT FROM AUTHOR]

Purpose: Claudin 18.2 (CLDN18.2) is a reliable target for lesion detection and could have clinical implications for epithelial tumors, especially digestive system neoplasms. However, there is no predictive technology for accurate whole-body mapping of CLDN18.2 expression in patients. This study assessed the safety of the 124I-18B10(10L) tracer and the feasibility of mapping whole-body CLDN18.2 expression using PET functional imaging. Methods: The 124I-18B10(10L) probe was synthesized manually, and preclinical experiments including binding affinity and specific targeting ability were conducted after testing in vitro model cells. Patients with pathologically confirmed digestive system neoplasms were enrolled in an ongoing, open-label, single-arm, first-in-human (FiH) phase 0 trial (NCT04883970). 124I-18B10(10L) PET/CT or PET/MR and 18F-FDG PET were performed within one week. Results: 124I-18B10(10L) was successfully constructed with an over 95% radiochemical yield. The results of preclinical experiments showed that it had high stability in saline and high affinity in CLDN18.2 overexpressing cells (Kd = 4.11 nM). Seventeen patients, including 12 with gastric cancers, 4 with pancreatic cancers, and 1 with cholangiocarcinoma were enrolled. 124I-18B10(10L) displayed high uptake in the spleen and liver, and slight uptake in the bone marrow, lung, stomach and pancreas. The tracer uptake SUVmax in tumor lesions ranged from 0.4 to 19.5. Compared with that in lesions that had been treated with CLDN18.2-targeted therapy, 124I-18B10(10L) uptake was significantly higher in lesions that had not. Regional 124I-18B10(10L) PET/MR in two patients showed high tracer uptake in metastatic lymph nodes. Conclusions: 124I-18B10(10L) was successfully prepared and exhibited a high binding affinity and CLDN18.2 specificity in preclinical studies. As an FiH CLDN18.2 PET tracer, 124I-18B10(10L) was shown to be safe with acceptable dosimetry and to clearly reveal most lesions overexpressing CLDN18.2. Trial registration: NCT04883970; URL: https://register.clinicaltrials.gov/. Registered 07 May 2021. [ABSTRACT FROM AUTHOR]

Background An association between inflammatory bowel disease (IBD) and pancreatic cancer has been suggested in the literature. We aimed to determine the trend in prevalence of pancreatic cancer amongst patients hospitalized for Crohn's disease (CD) or ulcerative colitis (UC) in the United States. Methods An analysis of the National Inpatient Sample database was performed to identify adults diagnosed with pancreatic cancer and CD or UC, using validated ICD-9 and ICD-10 codes, from 2003-2017. Age, sex, and racial demographics were also collected. Surveillance, Epidemiology and End Results registry (SEER) data were analyzed for trends in the incidence and mortality of pancreatic cancer amongst the general population in the United States. Results From 2003-2017, there was a significant increase in the hospitalizations related to pancreatic cancer, from 0.11% to 0.19% (PTrend<0.001), representing a 72.73% increase, in CD patients, and from 0.08% to 0.38% (PTrend<0.001), representing a 375.00% increase, in UC patients. According to the SEER 13 data on pancreatic cancer in the general population, the incidence of pancreatic cancer increased from 11.34 per 100,000 cases in 2003 to 12.74 per 100,000 cases in 2017, thus representing only a 12.35% increase over the study period. Conclusions Our study indicates a trend for increasing prevalence of pancreatic cancer in patients hospitalized with CD and UC from 2003-2017 in the United States. This increasing trend observed in the IBD population parallels the increase in the incidence of pancreatic cancer reported among the general population, but at a much greater rate. [ABSTRACT FROM AUTHOR]

Thyroid metastatic tumors are a series of rare clinical disease with an incidence of approximately 1.4-3%, of which metastatic tumor from the digestive system is even rarer. Thyroid metastatic tumor from the digestive system is characterized by a rapid growth tumor with high invasiveness and poor prognosis. Ultrasound (US) and contrast-enhanced ultrasound (CEUS) could provide more information for making diagnosis, determining lesion range, and offering biopsy guidance. Ultrasoundguided core needle biopsy (CNB) should be used instead of fine needle aspiration (FNA) to confirm the pathological diagnosis. Here, we report two cases of thyroid metastatic tumor from the digestive system. By describing these cases, we aimed to assess the clinical value of conventional US and CEUS in the diagnosis and treatment of these tumors. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical features of patients with cardiac metastases from digestive system tumors. Methods This retrospective study collected and analyzed the medical records of patients with cardiac metastases from digestive system tumors who received treatments in the Cancer Hospital, Chinese Academy of Medical Sciences between January 1999 and January 2021. Kaplan-Meier method was used for survival analysis. Results A total of 19 patients were identified. The primary tumors were esophageal squamous cell carcinoma ( n = 7), gastric or gastroesophageal junction adenocarcinoma (n = 6), hepatobiliary cancers ( n = 3 ) and colorectal cancers ( n = 3 ). 16 patients had pericardial metastases, 2 patients had right atrium metastases, and 1 patient had left ventricle metastasis. The most common symptom was dyspnea, which was present in 8 cases. 7 patients received locoregional treatment, while 11 patients underwent systemic therapies. The median overall survival from diagnosis of primary cancer was 31.4 months, and the median overall survival time from diagnosis of cardiac metastasis was 4.7 months. Conclusion Cardiac metastasis from digestive system tumors is associated with low incidence and a poor prognosis. Systemic treatment remains the cornerstone of management, while novel anti-tumor drugs may improve therapeutic efficacy. [ABSTRACT FROM AUTHOR]

Objective To investigate the association of biliary, pancreatic, and ampullary tumors with the onset of acute pancreatitis (AP) and the clinical features of tumor-induced AP by retrospectively analyzing the clinical data of patients with tumor-induced AP. Methods Related clinical data were collected from the patients with AP who were admitted to The First Affiliated Hospital of Zhengzhou University from January 2013 to August 2021. The etiological composition of AP was analyzed, as well as the change in the incidence rate of tumor-induced AP; the clinical features of AP were compared between tumor-induced and non-tumor-induced AP and between the tumors at different locations to explore the pathogenesis of tumor-induced AP. For normally distributed continuous data, the t-test was used for comparison between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the SNK-q test was used for further comparison between two groups. For non-normally distributed continuous data, the Mann-Whitney U test was used for comparison between two groups; the Kruskal-Wallis H test was used for comparison between multiple groups, and the Wilcoxon rank-sum test was used for further comparison between two groups. The chi-square test or the Fisher's exact test was used for comparison of dichotomous categorical data between groups, and the goodness-of-fit test was used for comparison of polytomous categorical data between groups. The receiver operating characteristic (ROC) curve was used to evaluate the differential factors for pancreatic tumor-induced AP, and a multivariate logistic regression analysis was used to investigate the independent predictive factors for tumor-induced AP. Results A total of 8106 patients with AP were enrolled, among whom 84 patients (1.04%) had tumor-induced AP (tumor group). The tumor group had a significantly higher mean age than the non-tumor group (t=6.050, P < 0.001). The mean time from initial onset of AP to tumor diagnosis was 7.38 months. Among the 84 patients with tumor-induced AP, 75 (89.2%) had mild AP (MAP), 8 (9.5%) had moderate severe AP, and 1(1.2%) had severe AP; as for the origin of tumor, 11(13.1%) had tumor originating from the lower biliary tract, 13(15.5%) had tumor originating from the ampulla, and 60(71.4%) had tumor originating from the pancreas. Recurrence of AP (risk ratio [RR]=8.362, 95% confidence interval [CI]: 3.162-22.115, P < 0.001), pancreatic duct dilatation (RR=10.996, 95%CI: 3.871-31.236, P < 0.001), bile duct dilatation (RR=7.738, 95%CI: 2.521-23.752, P < 0.001), and leukocyte count (RR=0.766, 95%CI: 0.666-0.881, P < 0.001) were independent predictive factors for tumor-induced AP. Conclusion Tumor-induced AP is common in middle-aged and elderly men, with the clinical manifestations of MAP, easy recurrence, pancreatic duct dilatation/bile duct dilatation, and a persistent increase in the tumor marker CA19-9. Imaging examination of the biliary, pancreatic, and ampullary regions should be enhanced for AP with the above characteristics and no apparent trigger, and follow-up should be strengthened to avoid the missed diagnosis of tumor and the influence on prognosis. [ABSTRACT FROM AUTHOR]

Background: Cancer, like other chronic pathologies, is associated with the presence of hypoxic regions due to the uncontrolled cell growth. Under this pathological hypoxic condition, various molecular signaling pathways are activated to ensure cell survival, such as those that govern angiogenesis, erythropoiesis, among others. These molecular processes are very similar to the physiological response caused by exposure to altitude (natural hypobaric systemic hypoxia), the use of artificial hypoxia devices (systemic normobaric simulated hypoxia) or the delivery of vascular occlusion to the extremities (also called local hypoxia by the blood flow restriction technique). "Tumor hypoxia" has gained further clinical importance due to its crucial role in both tumor progression and resistance to treatment. However, the ability to manipulate this pathway through physical exercise and systemic hypoxia-mediated signaling pathways could offer an important range of therapeutic opportunities that should be further investigated. Methods: This review is focused on the potential implications of systemic hypoxia combined with exercise in digestive system neoplasms prognosis. Articles included in the review were retrieved by searching among the three main scientific databases: PubMed, Scopus, and Embase. Findings: The findings of this review suggest that exercise performed under systemic hypoxic conditions could have a positive impact in prognosis and quality of life of the population with digestive system cancers. Conclusions: Further studies are needed to consider this paradigm as a new potential intervention in digestive oncological population. [ABSTRACT FROM AUTHOR]

Background: The FIGHTDIGO study determined the feasibility and acceptability of handgrip strength (HGS) measurement in digestive cancer outpatients. Purpose: To assess the relationship between muscle strength and markers of functional and nutritional status in this population. Design: In this prospective study, a total of 201 patients were followed during 6 months and were asked to perform HGS measurement at each hospitalization. Anthropometric measurements, laboratory tests, and performance status (PS) evaluation were collected. The modified Glasgow Prognostic Score (mGPS) was calculated using CRP and albumin levels. Severe malnutrition was defined as body mass index (BMI) < 18 kg/m2 in patients > 70 years old, and BMI < 16 kg/m2 in those < 70 years old. Dynapenia was defined as HGS < 30 kg (men) and < 20 kg (women). Mixed logistic regressions and mixed linear regressions were performed to study factors associated with dynapenia and HGS value, respectively. Results: A total of 879 HGS measurements were analyzed. Dynapenia occurred in 177 measurements (20.1%). BMI and HGS were significantly associated in univariate analysis (p = 0.001). In multivariate analysis, mGPS score (β = − 0.54 ± 0.31; p = 0.06) and severe malnutrition (β = − 2.8 ± 1.4; p = 0.08) tended to be associated with HGS. Dynapenia was only associated with functional status impairment in univariate analysis (n = 140/803, 17.4% in ECOG 0 and 1 versus n = 37/76, 58.7% in ECOG 2 and 3; p = 0.002). Conclusions: Identification of dynapenia using HGS measurement may be useful to predict nutritional vulnerability in digestive cancer outpatients undergoing chemotherapy. Patients could then benefit from nutritional support, adapted physical activity programs, and early therapeutic adjustments. Trial registration ClinicalTrials.gov, NCT02797197. [ABSTRACT FROM AUTHOR]

Tumour necrosis factor-related apoptosis-inducing ligands (TRAIL) can inhibit tumour proliferation, infiltration and metastasis by specifically recognising tumour cell death receptors and inducing and initiating various apoptotic mechanisms. TRAIL is not sensitive to the treatment of digestive malignancies such as oesophageal, gastric and colorectal cancers. TRAIL can improve its anti-cancer ability by combining some small molecular compounds or by regulating the expression of apoptosis-related proteins. However, its exact mechanism of action is not yet clear. This article reviews the research progress of tumor necrosis factor-related apoptosis-inducing ligand in the treatment of digestive system tumors. [ABSTRACT FROM AUTHOR]

Background: Mixed adenoneuroendocrine carcinoma is a rare clinical manifestation, especially in the gastric and ampullary. The purpose of this study was to investigate the clinicopathological features and prognosis of mixed adenoneuroendocrine carcinoma in the gastric and ampullary and summarize related treatment suggestions.Methods: In all, 32 cases of mixed adenoneuroendocrine carcinoma in the gastric and ampullary that were diagnosed from resected specimens were analyzed from 2009 to 2015. The corresponding demographic, clinicopathological and survival data were retrospectively reviewed.Results: The 1-year, 3-year and 5-year survival rates were 78.1%, 28.1 and 9.4%, respectively, and the median overall survival was 28.0 months. In all, 75.0% (24/32) had lymph node metastasis at the time of initial diagnosis. A multivariate analysis revealed that TNM stage (HR 6.444 95%CI 1.477-28.121 P = 0.013), lymph nodes metastasis (HR10.617 95%CI 1.409-79.997 P = 0.022), vascular invasion (HR 5.855 95%CI 1.719-19.940 P = 0.005), grade of the adenocarcinoma component (HR 3.876 95%CI 1.451-10.357 P = 0.007) and CD56 positivity (HR 0.265 95%CI 0.100-0.705 P = 0.008) were independent predictors of overall survival.Conclusions: Mixed adenoneuroendocrine carcinoma is an aggressive clinical entity with a poor prognosis. Taking both the neuroendocrine component and the adenocarcinoma component into consideration of optimal treatment is strongly recommended. [ABSTRACT FROM AUTHOR]

Introduction: In the process of the Gastroenterology resident training there are limitations in the care to patients with digestive neoplasms, which have their base in an scarce dynamics, while a visible polarization doctor-tools in the healthcare practice is observed, which is addressed towards the diagnostic and therapeutical digestive endoscopy more than to the preventive digestive endoscopy, as an indispensable part of the training process. Objective: To propose a pedagogical strategy, for the training of the Gastroenterology resident in the holistic and endoscopic care to patients with neoplasms of the digestive system. Development: A pedagogical strategy is proposed to systematize the preventivediagnostic- therapeutical and holistic care in the training of the gastroenterology resident, which becomes a practical and flexible instrument, that includes stages and substages, methodological orientations and an evaluation system which allows to articulate the clinical and endoscopic contents, in an comprehensive movement, through the diagnosis, elaboration, implementation and evaluation of actions for the training of the future specialist. Conclusions: This practical instrument proposed is aimed at systematizing the praxiological-endoscopic training of these specialists in the holistic, preventivediagnostic- therapeutic treatment to patients with digestive neoplasms, so as to reach professional excellence in the profession. [ABSTRACT FROM AUTHOR]

Pancreatic cancer will become the second leading cause of cancer-related death in the United States by 2030. Survival improves when it is identified at an early-stage and resected. Increasing public attention and cross-section imaging may shift detection to earlier stages. We found a small total increase in the proportion of stage-I cancer relative to all stages and a significant increase compared to distant disease in the Surveillance, Epidemiology, and End Results (SEER) database. Despite this, our ability to screen and identify early-stage disease is still lacking. Additional research and population-based interventions are necessary to improve early detection. [ABSTRACT FROM AUTHOR]

Introduction: In the training of the Gastroenterology resident are still limitations perceived as for the treatment, prevention and investigation of the digestive system neoplasms, what indicates the necessity of a pedagogic process that typifies and elevate the importance of a more coherent and committed assistance practice with the population's health needs. Development: The epistemological referents on this topic reveal a limited systematization of the assistance dimension regarding care to patients with digestive tumors, because it has not been possible to integrate the diagnosis, prevention and therapy in the holistic endoscopic intervention of the specialists of this branch of medicine. Conclusions: The praxiologic, endoscopic and assistance dynamic that is suggested in this investigation becomes logic of training systematizing that favors the improvement of this specialist's clinicoendoscopic-assistance practice in the holistic care to patients with gastrointestinal tract neoplasms. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinicopathological features and prognostic factors of periampullary carcinomas( PACs) in the pre-jaundice stage. Methods A retrospective analysis was performed for the clinical data of 518 patients with PACs who were admitted from January 2012 to December 2017,and according to jaundice symptom and serum total bilirubin on admission,they were divided into pre-jaundice group with 125 patients and jaundice group with 393 patients. The two groups were compared in terms of clinical data,pathological features,and 5-year survival rate,and prognostic factors were analyzed. The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to calculate survival rates and plot survival curves. The log-rank test was used for univariate analysis,and the Cox proportional-hazards regression model was used for multivariate analysis. Results Compared with the jaundice group,the pre-jaundice group had a significantly higher proportion of patients with the manifestation of abdominal distension and pain,a significantly longer duration of abdominal distension and pain,and significant increases in red blood cell count,albumin,and prealbumin( χ2= 14. 786,Z =-6. 023,t =-2. 247,-4. 688,and-3. 873,all P < 0. 05),as well as significantly lower alanine aminotransferase,aspartate aminotransferase,gamma-glutamyl transpeptidase,and alkaline phosphatase( Z =-75. 647,-55. 567,-52. 583,and-61. 501,all P < 0. 05). The detection rates of space-occupying lesions by ultrasound,computed tomography,magnetic resonance imaging/magnetic resonance cholangiopancreatography,and endoscopic retrograde cholangiopancreatography were 45. 0%,77. 7%,79. 2%,and 100%,respectively. As for pathology,compared with the jaundice group,the pre-jaundice group had a significantly longer mean tumor diameter,a significant difference in the proportion of patients with different primary sites,and significantly lower T stage and positive rate of pancreatic invasion( Z =-3. 063,χ2=10. 641,3. 991,and 4. 708,all P < 0. 05). The pre-jaundice group had a significantly higher 5-year survival rate than the jaundicegroup( χ2= 4. 582,P < 0. 05). The multivariate analysis showed that intravascular tumor thrombus,degree of tumor differentiation,and adjuvant chemotherapy were independent influencing factors for the prognosis of PACs. Conclusion PACs patients in the pre-jaundice stage has better clinicopathological features and long-term( ≥5 years) survival rate than those with jaundice,and therefore,early identification,diagnosis,and treatment can improve the survival rate of patients with PACs. [ABSTRACT FROM AUTHOR]

Background: FIGHTDIGO study has shown the feasibility of handgrip strength (HGS) measurements in 201 consecutive digestive cancer patients undergoing chemotherapy. Objective: This study focuses on a secondary aim of FIGHTDIGO study: the relationship between muscle mass and HGS. Design: Two consecutive bilateral measures of HGS were performed using a Jamar dynamometer before the start of each chemotherapy. The highest value was chosen for final evaluation. Dynapenia (loss of muscle strength) was defined as HGS < 30 kg (men) and < 20 kg (women). Muscle mass was measured at lumbar level (L3) on Computed Tomography (CT) scans performed less than 3 weeks before or after the measurement of HGS. Muscle mass loss was defined by skeletal muscle index (SMI) < 53 cm2/m2 (in men with a body mass index (BMI)> 25 kg/m2), < 43 cm2/m2 (in men with a BMI < 25 kg/m2), and < 41 cm2/m2 (in women regardless of BMI). Sarcopenia was defined by the association of a dynapenia and a loss of muscle mass. Results: A total of 150 patients were included in this analysis (mean age: 65.6 ± 10.9 years, 87 males (58%), colorectal cancer (47.3%), metastatic stage (76.7%)). A total of 348 CT scans were evaluated. For the 348 measurements, mean SMI and HGS were 41.8 ± 8.7 cm2/m2 and 32.1 ± 11.0 kg, respectively. Muscle mass loss, dynapenia, or sarcopenia were reported at least once, in 120 (80%), 45 (30%), and 30 (20%) patients, respectively. SMI was significantly correlated with HGS (Pearson coefficient = 0.53, P < 0.0001). At concordance analysis, 188 dyad SMI/HGS (54%) were in agreement (Kappa = 0.14 [95% CI, 0.07‐0.21]). Conclusion: Correlation between the measurements of HGS and SMI is strong but the concordance between dynapenia and muscle mass loss is poor. Further studies should be performed to confirm the diagnostic thresholds, and to study the chronology of dynapenia and loss of muscle mass. [ABSTRACT FROM AUTHOR]

Background: FIGHTDIGO study showed the feasibility and acceptability of handgrip strength (HGS) measure in routine in 201 consecutive patients with digestive cancer treated with ambulatory chemotherapy. The present study focuses on the second aim of FIGHTDIGO study: the relationships between pre-therapeutic dynapenia and chemotherapy-induced Dose-Limiting Toxicities (DLT).Methods: In this ancillary prospective study, DLT were analyzed in a sub-group of 45 chemotherapy-naive patients. Two bilateral consecutive measures of HGS were performed with a Jamar dynamometer before the first cycle of chemotherapy. Dynapenia was defined as HGS < 30 kg (men) and < 20 kg (women). DLT and/or Dose-Limiting Neurotoxicity (DLN) were defined as any toxicity leading to dose reduction, treatment delays or permanent treatment discontinuation.Results: Two-thirds of chemotherapies were potentially neurotoxic (n = 31 [68.7%]) and 22 patients (48.9%) received FOLFOX (5FU, leucovorin plus oxaliplatin) regimen chemotherapy. Eleven patients (24.4%) had pre-therapeutic dynapenia. The median number of chemotherapy cycles was 10 with a median follow-up of 167 days. Twenty-two patients experienced DLT (48.9%). There was no significant association between pre-therapeutic dynapenia and DLT (p = 0.62). Nineteen patients (42.2%) experienced DLN. In multivariate analysis, dynapenia and tumoral location (stomach, biliary tract or small intestine) were independent risk factors for DLN (HR = 3.5 [1.3; 9.8]; p = 0.02 and HR = 3.6 [1.3; 10.0]; p = 0.01, respectively).Conclusions: Digestive cancer patients with pre-therapeutic dynapenia seemed to experience more DLN. HGS routine measurement may be a way to screen patients with frailty marker (dynapenia) who would require chemotherapy dose adjustment and adapted physical activity programs.Trial Registration: NCT02797197 June 13, 2016 retrospectively registered. [ABSTRACT FROM AUTHOR]

Abstract: The Fontan procedures, designed to treat paediatric patients with functional single ventricles, have markedly improved the patient’s survival into adulthood. The physiology of the Fontan circuit inevitably increases systemic venous pressure, which may lead to multi-system organ failure in the long-term follow-up. Fontan-associated liver disease (FALD) can progress to liver cirrhosis with signs of portal hypertension. Focal nodular hyperplasia-like nodules commonly develop in FALD. Imaging surveillance is often performed to monitor the progression of FALD and to detect hepatocellular carcinoma, which infrequently develops in FALD. Other abdominal abnormalities in post-Fontan patients include protein losing enteropathy and pheochromocytoma/paraganglioma. Given that these abdominal abnormalities are critical for patient management, it is important for radiologists to become familiar with the abdominal abnormalities that are common in post-Fontan patients on cross-sectional imaging.Teaching points: • Fontan procedure for functional single ventricle has improved patient survival into adulthood.• Radiologists should be familiar with unique imaging findings of Fontan-associated liver disease.• Focal nodular hyperplasia-like nodules commonly develop in Fontan-associated liver disease.• Hepatocellular carcinoma, protein-losing enteropathy, pheochromocytoma/paraganglioma may develop. [ABSTRACT FROM AUTHOR]

Background: Handgrip strength (HGS) is a widely studied noninvasive test. Weak strength (dynapenia) seems to be associated with high morbidity and mortality in different populations, notably oncology populations. Despite this, HGS testing is not used in daily practice in oncology. The study was aimed at evaluating the feasibility and acceptability of HGS testing in patients with digestive cancer treated with ambulatory chemotherapy.Methods: In this prospective, single-center study, enrolled patients were followed for 6 months. Two consecutive bilateral measures were performed with a Jamar dynamometer during each patient's appointments in the unit for intravenous treatment. A questionnaire was completed by patients and medical team members.Results: There were 203 consecutive patients, and 201 were recruited. In all, 1704 of 1716 measurements (99.3%) were performed, and 201 patients (99.0%) performed at least 1 measure; 190 (94.5%) performed all expected measures. One hundred sixty-four of 171 participating patients (95.9%) found the test easy to perform, and 167 (97.7%) did not find the test restrictive. All of the 14 medical team members found the test easy to perform, unrestrictive, and undisruptive in their daily practice.Conclusions: HGS testing is routinely feasible, inexpensive, and well accepted by patients and medical teams in an ambulatory digestive cancer unit. Cancer 2018;124:1501-6. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Objective To study the clinical characteristics, strategy of treatment and prognosis of multiple primary cancers(MPC) diagnosed of digestive system malignant tumor firstly. Methods From January, 2000 to December, 2015, the clinical, follow-up and prognostic data of 138 MPC patients diagnosed of digestive system malignant tumor firstly were retrospectively analyzed. Results 138 cases were found in 10 580 cases with malignant tumors, and the incidence was 1.30%. There were 129 cases of duplex primary cancers, 8 cases of triple primary cancers and 1 case of quintuple primary cancers. The repetitive primary cancer was occurred in digestive system (61 cases, 44.2%) most frequently, with the next in respiratory system (46 cases, 33.3%). 52.2% (72 cases) suffered second primary cancer in 2 years after first primary cancer diagnosed, and 75.4% (104 cases) in 5 years. The median overall survival in patients with all cancer lesions radically treated was 168 months, better than any other treatment (68 months, P<0.05). Conclusions The second primary cancers of MPC cases initially diagnosed of digestive system malignant tumor most frequently occurred in the digestive system and respiratory system. More concern should be attracted in follow-up, especially in the first 5 years. The key to improve patient′ prognosis was radical treatment to every primary cancer. [ABSTRACT FROM AUTHOR]

Insulin-like growth factor I (IGF-I) is a main mediator of growth hormone's (GH) action. Under physiological conditions, IGF-I is responsible for growth and development of organism through influence on proliferation and differentiation of cells. IGF-I is produced in almost all tissues of organism and its activity is determined by interaction with specific receptors (IGF-IR, IGF-IIR) and IGF-binding proteins (IGFBP-1 - IGFBP-6), and by proteases hydrolyzing IGFBPs as well.///Currently, a surge of interest on insulin-like growth factor I as a potential factor contributing to the development of neoplasms, including neoplasms of digestive system, is observed. IGFBPs and IGF-IR may also be of importance in etiology and pathogenesis of cancer. It is assumed that high serum concentration of IGF-I may increase the risk of cancer development whereas high serum concentration of IGFBP-3 may inhibit the progression of the disease.///Until recently, attempts of modulating the concentration of IGF-I with the use of pharmacological agents of diverse mechanisms of action under innovative anti-cancer therapies, have been made. Lately, it is pointed to the possibility of application of IGF-I in the management of certain diseases of digestive system. It was observed that IGF-I not only contributes to the maintenance of normal structure and function of epithelium in the gastrointestinal tract but also stimulates repair processes in damaged mucosa. Results of preliminary studies on the treatment of short bowel syndrome, gastric ulcer disease, enteritis induced by chemo- and radiotherapy, and inflammatory bowel disease with the use of exogenous IGF-I are encouraging. [ABSTRACT FROM AUTHOR]

Aim We aimed to assess the overall cancer risk among contemporary menopausal hormone therapy (MHT) users in Sweden and the risk for different cancer types. Methods A nationwide Swedish population-based cohort study including all 290,186 women aged ≥ 40 years having used systemic MHT during the study period (July 2005 and December 2012), compared with the Swedish female background population. MHT ever-use (all MHT, oestrogen-only MHT [E-MHT] and oestrogen plus progestin MHT [EP-MHT]) was based on the nationwide Prescribed Drug Registry. Cancer diagnoses were grouped into 16 different anatomical locations, for which standardised incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated. Results The SIR of any cancer was 1.09 (95% CI: 1.07–1.11) following ever MHT, 1.04 (95% CI: 1.01–1.06) for E-MHT and 1.14 (95% CI: 1.12–1.17) for EP-MHT. The highest SIR was found for EP-MHT among users aged ≥70 years (SIR = 1.33, 95% CI: 1.26–1.40). The risk for invasive breast, endometrial or ovarian cancer combined was increased for any MHT (SIR = 1.31, 95% CI: 1.28–1.34). The risk of invasive breast cancer was increased following MHT and increased with age for EP-MHT users. The risk of gastrointestinal cancers combined was decreased (SIR = 0.90, 95% CI: 0.86–0.94), particularly the oesophagus (SIR = 0.81, 95% CI: 0.64–1.00), liver (SIR = 0.81, 95% CI: 0.65–0.99) and colon (SIR = 0.90, 95% CI: 0.84–0.95). Conclusions MHT, notably EP-MHT, was associated with a limited increase in overall cancer risk. The increased risk of female reproductive organ cancers was almost balanced by a decreased risk of gastrointestinal cancers. [ABSTRACT FROM AUTHOR]

Background and Aim The role of octamer-binding transcription factor 4 (Oct4) has been implicated in the clinical prognosis of various kinds of digestive system cancers, but the results remain controversial. The purpose of this meta-analysis is to assess the potential role of Oct4 as a prognostic marker in digestive system tumors. Methods Relevant articles were retrieved from Pubmed, Web of Science, and Cochrane Library up to July 2016. The software Stata 12.0 was used to analyze the outcomes, including overall survival (OS), disease-free survival, recurrence-free survival, and clinicopathological characteristics. Results A total of 13 eligible studies with 1538 patients were included. Elevated Oct4 expression was significantly associated with poor OS (pooled hazard ratio [HR] = 2.183, 95% confidence interval [CI]: 1.824-2.612), disease-free survival (pooled HR = 1.973, 95% CI: 1.538-2.532), and recurrence-free survival (pooled HR = 2.209, 95% CI: 1.461-3.338) of digestive system malignancies. Subgroup analyses showed that cancer type, sample size, study quality, and laboratory detection method did not alter the significant prognostic value of Oct4. Additionally, Oct4 expression was found to be an independent predictive factor for OS (HR = 2.068, 95% CI: 1.633-2.619). No significant association was found between Oct4 and clinicopathological features of digestive system malignancies. Conclusion This study provided evidence of Oct4 and/or its closely related homolog protein as a predictive factor for patients with digestive system cancers. More large-scale clinical studies on the prognostic value of Oct4 are warranted. [ABSTRACT FROM AUTHOR]

Objective To compare the effectiveness and safety of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)in the treatment of early gastrointestinal cancer and precancerous lesions, and to discuss the therapeutic value of ESD in the treatment of early gastrointestinal cancer and precancerous lesions. Methods A total of 225 patients with early gastrointestinal cancer and precancerous lesionswas were the study objects in the hospital from March 2014 to October 2016, which were divided into ESD group(n=115)and EMR group(n=110)according to different operation ways. The surgical time, intraoperative blood loss, hospitalization time, wound healing time, postoperative pain degree, postoperative complication rate, postoperative complete resection rate and recurrence rate, QLQ-C30 life quality scores followed-up 3, 6, 12 months were compared between two groups. Results The postoperative pain degree of ESD group was significantly lower than that of EMR group, the difference was statistically significan(Z=6.683, P=0.004). The postoperative complication rate of ESD group was significantly lower than that of EMR group, the postoperative complete resection rate of ESD group was significantly higher than that of EMR group, the differences were statistically significan(χ2=10.352, 7.528, P=0.000, 0.005). Following-up 3, 6, 12 months, there were no statistical significance of recurrence rate between two groups(P>0.05), the QLQ-C30 life quality scores of ESD group was significantly higher than that of EMR group, the differences were statistically significan(t=6. 634, 4.128, 5.776, P=0.000, 0.000, 0.000). Conclusion ESD has better effectiveness and safety in the treatment of early gastrointestinal cancer and precancerous lesions. [ABSTRACT FROM AUTHOR]

Objective To analyze the preventive effect of mecobalamin combined with glutathione on neurotoxicity induced by FOLFOX4 chemotherapy. Methods Ninety-four patients receiving FOLFOX4 chemotherapy between January 2012 and December 2013 were randomized into experimental group and control group. Patients in the experimental group were given mecobalamin tablets and glutathione injection during chemotherapy while the patients in control group received glutathione injection only. The status of neurotoxicity was evaluated by the Levi neurotoxicity criteria 1992. Results After six cycles of chemotherapy, the incidence of grade Ⅰ-Ⅱ neurotoxicity in the experimental and control groups were 34.7% (17/49) and 55.6%(25/45), respectively (P=0.042), the incidence of grade Ⅲ neurotoxicity in the experimental and control groups were 2.0%(1/49) and 13.3%(6/45), the difference is also statistically significant (P=0.037). After nine cycles of chemotherapy, significantly less grade Ⅰ-Ⅱ neurotoxicity was observed in the experimental group (44.6%) than that in the control group(70.3%, P=0.019). Incidence of grade Ⅲ neurotoxicity in the experimental group was significantly lower(4.26%) than that in the control group(18.9%, P=0.031). Conclusion Mecobalamin combined with glutathione can significantly reduce the incidence and severity of neurotoxicity induced by FOLFOX4 chemotherapy, therefore, worthy of clinical application. [ABSTRACT FROM AUTHOR]

Background: Understanding the predictors of a quick death following diagnosis may improve timely access to palliative care. The objective of this study was to explore whether factors in the 24 months prior to a colorectal cancer (CRC) diagnosis predict a quick death post-diagnosis. Methods: Data were from a longitudinal study of all adult persons diagnosed with CRC in Nova Scotia, Canada, from 01Jan2001-31Dec2005. This study included all persons who died of any cause by 31Dec2010, except those who died within 30 days of CRC surgery (n = 1885 decedents). Classification and regression tree models were used to explore predictors of time from diagnosis to death for the following time intervals: 2, 4, 6, 8, 12, and 26 weeks from diagnosis to death. All models were performed with and without stage at diagnosis as a predictor variable. Clinico-demographic and health service utilization data in the 24 months pre-diagnosis were provided via linked administrative databases. Results: The strongest, most consistent predictors of dying within 2, 4, 6, and 8 weeks of CRC diagnosis were related to health services utilization in the 24 months prior to diagnosis: i.e., number of specialist visits, number of days spent in hospital, and number of family physician visits. Stage at diagnosis was the strongest predictor of dying within 12 and 26 weeks of diagnosis. Conclusions: Identifying potential predictors of a short timeframe between cancer diagnosis and death may aid in the development of strategies to facilitate timely and appropriate referral to palliative care upon a cancer diagnosis. [ABSTRACT FROM AUTHOR]

Background: Understanding the predictors of a quick death following diagnosis may improve timely access to palliative care. The objective of this study was to explore whether factors in the 24 months prior to a colorectal cancer (CRC) diagnosis predict a quick death post-diagnosis. Methods: Data were from a longitudinal study of all adult persons diagnosed with CRC in Nova Scotia, Canada, from 01Jan2001-31Dec2005. This study included all persons who died of any cause by 31Dec2010, except those who died within 30 days of CRC surgery (n = 1885 decedents). Classification and regression tree models were used to explore predictors of time from diagnosis to death for the following time intervals: 2, 4, 6, 8, 12, and 26 weeks from diagnosis to death. All models were performed with and without stage at diagnosis as a predictor variable. Clinico-demographic and health service utilization data in the 24 months pre-diagnosis were provided via linked administrative databases. Results: The strongest, most consistent predictors of dying within 2, 4, 6, and 8 weeks of CRC diagnosis were related to health services utilization in the 24 months prior to diagnosis: i.e., number of specialist visits, number of days spent in hospital, and number of family physician visits. Stage at diagnosis was the strongest predictor of dying within 12 and 26 weeks of diagnosis. Conclusions: Identifying potential predictors of a short timeframe between cancer diagnosis and death may aid in the development of strategies to facilitate timely and appropriate referral to palliative care upon a cancer diagnosis. [ABSTRACT FROM AUTHOR]

Background: Understanding the predictors of a quick death following diagnosis may improve timely access to palliative care. The objective of this study was to explore whether factors in the 24 months prior to a colorectal cancer (CRC) diagnosis predict a quick death post-diagnosis. Methods: Data were from a longitudinal study of all adult persons diagnosed with CRC in Nova Scotia, Canada, from 01Jan2001-31Dec2005. This study included all persons who died of any cause by 31Dec2010, except those who died within 30 days of CRC surgery (n = 1885 decedents). Classification and regression tree models were used to explore predictors of time from diagnosis to death for the following time intervals: 2, 4, 6, 8, 12, and 26 weeks from diagnosis to death. All models were performed with and without stage at diagnosis as a predictor variable. Clinico-demographic and health service utilization data in the 24 months pre-diagnosis were provided via linked administrative databases. Results: The strongest, most consistent predictors of dying within 2, 4, 6, and 8 weeks of CRC diagnosis were related to health services utilization in the 24 months prior to diagnosis: i.e., number of specialist visits, number of days spent in hospital, and number of family physician visits. Stage at diagnosis was the strongest predictor of dying within 12 and 26 weeks of diagnosis. Conclusions: Identifying potential predictors of a short timeframe between cancer diagnosis and death may aid in the development of strategies to facilitate timely and appropriate referral to palliative care upon a cancer diagnosis. [ABSTRACT FROM AUTHOR]

Background Understanding the predictors of a quick death following diagnosis may improve timely access to palliative care. The objective of this study was to explore whether factors in the 24 months prior to a colorectal cancer (CRC) diagnosis predict a quick death post-diagnosis. Methods Data were from a longitudinal study of all adult persons diagnosed with CRC in Nova Scotia, Canada, from 01Jan2001-31Dec2005. This study included all persons who died of any cause by 31Dec2010, except those who died within 30 days of CRC surgery (n = 1885 decedents). Classification and regression tree models were used to explore predictors of time from diagnosis to death for the following time intervals: 2, 4, 6, 8, 12, and 26 weeks from diagnosis to death. All models were performed with and without stage at diagnosis as a predictor variable. Clinico-demographic and health service utilization data in the 24 months pre-diagnosis were provided via linked administrative databases. Results The strongest, most consistent predictors of dying within 2, 4, 6, and 8 weeks of CRC diagnosis were related to health services utilization in the 24 months prior to diagnosis: i.e., number of specialist visits, number of days spent in hospital, and number of family physician visits. Stage at diagnosis was the strongest predictor of dying within 12 and 26 weeks of diagnosis. Conclusions Identifying potential predictors of a short timeframe between cancer diagnosis and death may aid in the development of strategies to facilitate timely and appropriate referral to palliative care upon a cancer diagnosis. [ABSTRACT FROM AUTHOR]

Objective To derive a more precise estimation on the safety and efficacy of calcium and magnesium ( Ca and Mg) infusions in the prevention of oxaliplatin-induced sensory neuropathy. Methods A total of 16 studies including 1765 individuals were involved in this meta-analysis. Odds ratio ( OR) and its 95% confidence interval ( CI) were calculated. Results The difference in the incidence of oxaliplatin-induced neuropathy grade ≥ 1 was statistically significant between the Ca and Mg infusions treatment group and the untreated group (National Cancer Institute common toxicity criteria [ NCI CTC]: OR 0.44, 95% CI 0.31-0.62, P = 0.000; oxaliplatin-specific scale [ OSS]: OR 0.30, 95% CI 0.20-0.45, P = 0.000). Similar results were found in the incidences of oxaliplatin-induced neuropathy grade ≥ 2 ( NCI CTC: OR 0.60, 95% CI 0.46-0.77, P = 0.000; OSS: OR 0.45, 95% CI 0.30-0.67, P = 0.000). However, we did not detect a trend of fewer oxaliplatin-induced neuropathy grade ≥ 3 incidences in the Ca and Mg infusions treatment group than the untreated group ( NCI CTC: OR 0.67, 95% CI 0.44-1.01, P = 0.054; OSS: OR 0.66, 95% CI 0.34-1.29, P = 0.224). There was no difference in the response rate between the Ca and Mg treated group and the untreated group ( OR 0.89, 95% CI 0.67-1.17, P = 0.391). Conclusion Ca and Mg infusions do not alter the efficacy of oxaliplatin-based chemotherapy in gastrointestinal cancers, which may be reasonable to add them to lessen the incidence of neuropathy. [ABSTRACT FROM AUTHOR]

Objective. Describe a case series of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (EUS-CD) associated with duodenal self-expandable metal stents (SEMS) placement using solely the linear echoendoscope in seven patients with obstructive jaundice and duodenal obstruction due to unresectable periampullary cancer. Material and methods. EUSCD in the first portion of the duodenum, associated with duodenal SEMS placement was performed in seven patients with unresectable periampullary cancer with obstructive jaundice and invasive duodenal obstruction. Laboratory tests and clinical follow-up were performed until patient's death. The procedure was performed by an experienced endoscopist under conscious sedation. The puncture position was chosen based on EUS evaluation, at the common bile duct (CBD) above the tumor, through the distal part of the duodenal bulb. After that, the needle was withdrawn and a wire-guided needle knife was used to enlarge the site puncture in the duodenal wall. Then, a partially covered SEMS was passed over the guide, through the choledochoduodenal fistula. Duodenal SEMS placement was performed during the same endoscopic procedure. Results. The procedure was performed in seven patients, ranging between 34 and 86 years. Technical success of EUS-CD, by the stent placement, occurred in 100% of the cases. There were no early complications. Duodenal SEMS placement was effective in 100% of the cases that remained alive after a follow-up of 7 and 30 days. Conclusion. The results suggest therapeutic EUS one-step procedure drainage as an alternative for these patients, with good clinical success, feasible technique and safety. [ABSTRACT FROM AUTHOR]

Chronic gastrointestinal and liver infections account for a significant percentage of human cancer deaths. Rodent models help elucidate how infection can lead to malignancy. Helicobacter pylori, the leading cause of human gastric tumors, produces similar disease in Mongolian gerbils. H. pylori, H. felis, and H. hepaticus induce stomach, lower bowel, or liver tumors in susceptible wild-type and genetically engineered mice. Immune dysregulated mice recapitulate features of inflammatory bowel disease including colon carcinoma. Hepatitis B and C virus transgenic mice provide insights into viral hepatitis and hepatocellular carcinoma. Rodent models enhance our understanding of infectious cancer pathogenesis and suggest novel targets for intervention. [ABSTRACT FROM AUTHOR]

Introduction During 2004, there were 6 patients with leiomyomas diagnosed and treated at the Department of Gastroenterology and Clinical Pathology of the Zemun Clinical Center. The most common location of these benign submucosal tumors is stomach, followed by small intestine and large intestine. Case report The most common symptoms of these patients were massive intestinal hemorrhage, with haematemesis and melaena. Hemorrhages resulted from superficial lesions, caused by pressure of the tumour on the intestinal blood vessels. A significant contribution in reaching the final diagnosis and selecting appropriate therapeutic approach was provided by CT and arteriography. Most patients underwent surgical treatment, which provided precise diagnosis (based on histopathological findings), and at the same time a definite therapeutic procedure. Discussion and conclusion According to the literature data, gastrointestinal leiomyomas account for 20%-30% of all types of gastrointestinal tumors. Our research revealed that the incidence of leiomyomas was significantly lower within our group of patients, accounting for 12% of all benign gastrointestinal tumors. They were also the main cause of hemodynamic instability in our patients having massive and recurrent intestinal hemorrhages, which is not often seen in practice. All of them originated either from muscularis propria or muscularis mucosae. These tumors are often an accidental finding at autopsy, especially if they are smaller than 3 centimeters and not followed by consequential complications. Presently, endoscopic ultrasonography is considered to be the the most accurate procedure in the diagnosis of leiomyoma, with a diagnostic specificity that is superior to other imaging techniques. [ABSTRACT FROM AUTHOR]