Evaluation of the prognostic performance of different cutoff values of lymph node ratio staging system for stage III colorectal cancer.

This study attempted to compare the prognostic performance of lymph node ratio (LNR) staging system with different cutoff values relative to American Joint Committee on Cancer (AJCC) pN staging system in stage III colorectal cancer (CRC). Overall, 45,069 patients from the SEER dataset and 69 patients from the Second Affiliated Hospital of Nanjing Medical University (the External set) who underwent surgical resection of the primary tumor and were diagnosed with stage III CRC by postoperative pathology were included. Patients were divided into three subgroups based on the LNR cutoff used in previous studies, Kaplan-Meier curves were plotted, and log-rank test was used to compare the differences among groups in terms of cancer-specific survival (CSS). Cox regression model was applied for survival analysis. To evaluate the discriminatory power of different lymph node staging systems, Harrell's C statistic(C-index) and Akaike's Information Criterion (AIC) were applied. A set of optimal cutoff values (0.11; 0.36; 0.66) of LNR staging system with the most considerable discriminatory power to the prognosis in patients with stage III CRC (SEER set: C-index = 0.714; AIC = 58,942.46, External set: C-index = 0.809; AIC = 164.36) were obtained, and both were superior to the AJCC pN staging system (SEER set: C-index = 0.708; AIC = 59,071.20, External set: C-index = 0.788; AIC = 167.06). For evaluating the prognostic efficacy of patients with stage III colorectal cancer, the cutoff value (0.11; 0.36; 0.66) of LNR staging system had the best discrimination and prognostic ability, which was superior to LNR staging system under other cutoff values and AJCC pN staging system.

Analysis of prognostic factors in different grades of histologic differentiation in colorectal cancer patients receiving preoperative neoadjuvant chemotherapy and establishment of prognostic nomograms for moderately differentiated grade.

OBJECTIVE: The aim of this study is to analyze the differences in independent prognostic factors of cancer-specific survival (CSS) and overall survival (OS) in patients with different grades of histologic differentiation of colorectal cancer (CRC) who received preoperative neoadjuvant chemotherapy (NAC) and to establish a nomogram for predicting postoperative survival based on moderately differentiated CRC. METHODS: We analyzed CRC patients from the SEER database who received NAC before operation between 2010 and 2015. The Kaplan-Meier curves were drawn to describe the differences in CSS and OS of CRC patients with different histologic grades of differentiation. Cox regression analysis was used to determine the independent prognostic factors. Nomograms were established to predict CSS and OS at 3 and 5 years by integrating independent prognostic factors. The calibration curve, receiver operating characteristic (ROC) curve, and C-index were used to verify nomograms. RESULTS: A total of 6481 patients with CRC who received preoperative NAC were included in this study. Patients with different grades of histologic differentiation had significant differences in CSS and OS (P < 0.001), and the independent prognostic factors of different grades of histologic differentiation showed heterogeneity. In patients with moderately differentiated grade CRC, the independent prognostic factors for CSS and OS were age, race, marital status, serum carcinoembryonic antigen (CEA) level before treatment, site of primary tumor, histologic type, pT stage, pN stage, liver metastasis, and lung metastasis. Nomograms were established based on the independent prognostic factors of moderately differentiated grade CRC, and its calibration curves, area under the curve (AUC), and C-index showed good prediction accuracy. CONCLUSIONS: The independent prognostic factors of CSS and OS are different in patients with different grades of histologic differentiation of CRC who received NAC before the operation. Nomograms can be used to predict the survival of patients with moderately differentiated grade CRC who received preoperative NAC and to assist clinicians in making clinical decisions.

Construction of a novel mRNA-miRNA-lncRNA network and identification of potential regulatory axis associated with prognosis in colorectal cancer liver metastases.

Liver metastasis is a leading cause of death in patients with colorectal cancer (CRC). Increasing evidence demonstrates that competing endogenous RNA (ceRNA) networks play important roles in malignant cancers. The purpose of this study was to identify molecular markers and build a ceRNA network as a significant predictor of colorectal liver metastases (CRLM). By integrated bioinformatics analysis, we found that apolipoprotein C1 (APOC1) was upregulated in CRLM and associated with prognosis in patients with CRC and thereby established an APOC1-dependent ceRNA network. By survival analysis, expression analysis, and correlation analysis of each element in the ceRNA network, we identified that ZEB1-AS1, miR-335-5p and APOC1 regulated each other. We further experimentally confirmed that ZEB1-AS1 promoted a CRC progression via regulating the expression of miR-335-5p that controlled the expression of APOC1. Our findings indicate that the ZEB1-AS1-miR-335-5p-APOC1 ceRNA regulatory network is significantly valuable for better prognosis of patients with CRC and as a new therapeutic target for the treatment of CRLM.

tRNA-Derived Fragments in Podocytes with Adriamycin-Induced Injury Reveal the Potential Mechanism of Idiopathic Nephrotic Syndrome.

Idiopathic nephrotic syndrome (INS) is a disease involving injury to podocytes in the glomerular filtration barrier, and its specific causes have not been elucidated. Transfer RNA-derived fragments (tRFs), products of precise tRNA cleavage, have been indicated to play critical roles in various diseases. Currently, there is no relevant research on the role of tRFs in INS. This study intends to explore the changes in and importance of tRFs during podocyte injury in vitro and to further analyze the potential mechanism of INS. Differentially expressed tRFs in the adriamycin-treated group were identified by high-throughput sequencing and further verified by quantitative RT-PCR. In total, 203 tRFs with significant differential expression were identified, namely, 102 upregulated tRFs and 101 downregulated tRFs (q < 0.05, ∣log2FC | ≥2). In particular, AS-tDR-008924, AS-tDR-011690, tDR-003634, AS-tDR-013354, tDR-011031, AS-tDR-001008, and AS-tDR-007319 were predicted to be involved in podocyte injury by targeting the Gpr, Wnt, Rac1, and other genes. Furthermore, gene ontology analysis showed that these differential tRFs were strongly associated with podocyte injury processes such as protein binding, cell adhesion, synapses, the actin cytoskeleton, and insulin-activate receptor activity. KEGG pathway analysis predicted that they participated in the PI3K-Akt signaling pathway, Wnt signaling pathway, and Ras signaling pathway. It was reported that these pathways contribute to podocyte injury. In conclusion, our study revealed that changes in the expression levels of tRFs might be involved in INS. Seven of the differentially expressed tRFs might play important roles in the process of podocyte injury and are worthy of further study.

Giant ventral hernia simultaneously containing the spleen, a portion of the pancreas and the left hepatic lobe: A case report.

BACKGROUND: Ventral hernia, also known as incisional hernia, is a common complication of previous surgery. The contents of ventral hernia may include omentum, preperitoneal fat, small intestine or colon. However, ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare, and its repair is very complex and difficult. Surgeons should make a comprehensive assessment based on their own experience and the individual characteristics of the hernia. In addition, psychological therapy should be emphasized in the whole treatment process. CASE SUMMARY: We report a rare case of asymptomatic giant ventral hernia for 15 years in a 21-year-old female. The patient underwent umbilical hernia repair at the age of 1 year. Approximately 5 years later, ventral hernia recurred and repair with Mesh was performed, but the operation failed due to postoperative infection, and a huge mass appeared in the left abdominal wall. The mass increased gradually with the development and maturity of the body. Computerized tomography scan demonstrated that the patient's total spleen, part of the pancreas and left lobe of the liver were simultaneously herniated through the abdominal incisional hernia. As the patient was unable to endure the inconvenience of life and the potential risk of spleen or liver rupture, she underwent a ventral hernia repair with Mesh at our hospital. The operation was successful and the patient had a good recovery. During a 3-mo follow-up, the patient remained asymptomatic and the appearance of the surgical incision was greatly improved. CONCLUSION: Ventral hernia is a common complication of abdominal surgery. Ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare. Surgeons should pay attention to the psychological treatment while restoring the abdominal physiological function in ventral hernia patients.

Girdin interaction with vimentin induces EMT and promotes the growth and metastasis of pancreatic ductal adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant cancer of the digestive tract that has a high potential for metastasis and a poor prognosis. Girdin was first reported in 2005 as an actin­binding protein and was designated as Akt­phosphorylation enhancer (APE); thus, Girdin has been revealed to have an important role in regulating cancer development. There is additional evidence indicating that Girdin is associated with cell proliferation, migration, invasion and survival in certain cancers. However, the potential mechanisms involving Girdin and mobility in pancreatic cancer have not been elucidated. In the present study, it was revealed that Girdin was highly expressed in pancreatic cancer tissue and was associated with tumor grade. The present study, to the best of our knowledge, is the first aimed at investigating the unknown role of Girdin in PDAC metastasis. A short hairpin RNA for Girdin (sh­Girdin) was successfully constructed with recombinant adenoviral vectors to suppress the expression of Girdin in pancreatic cancer cell lines (PANC­1 and BXPC­3). The silencing efficiency of the Girdin shRNA was determined by RT­qPCR and western blot analysis, and decreased Girdin expression in the cytoplasm was revealed by immunofluorescence detection. Then, sulforhodamine B (SRB) and colony formation assays were used to confirm that the knockdown of Girdin inhibited proliferation in vitro, and Transwell assays were used to examine the influence of Girdin knockdown on cellular mobility. Animal experiments also confirmed that silencing the expression of Girdin in pancreatic cancer cells inhibited the growth and metastasis of pancreatic cancer in vivo. Transforming growth factor­ß (TGF­ß) is a common inducer of epithelial­mesenchymal transition (EMT) and can effectively induce EMT in PDAC. Notably, TGF­ß­treated cells exhibited changes in the classic biological markers of EMT. The expression of E­cadherin, a marker of the epithelial phenotype, increased, and the expression of N­cadherin and vimentin, markers of the interstitial phenotype, decreased in response to sh­Girdin. According to these experiments, Girdin may affect pancreatic cancer progression and development by interacting with vimentin. Therefore, there is evidence indicating that Girdin could be designated as a prognostic biological indicator and a candidate therapeutic target for pancreatic cancer.

microRNA-501-5p promotes cell proliferation and migration in gastric cancer by downregulating LPAR1.

In spite of the achievement in treatment, the gastric cancer (GC) mortality still remains high. MicroRNAs (miRNAs) are a group of small noncoding RNAs that play a crucial part in tumor progression. In this study, we explored the expression and function of microRNA-501-5p (miR-501-5p) in GC cell lines. Quantitative real-time polymerase chain reaction assay results suggested that miR-501-5p was significantly upregulated in GC tissues and cell lines. And, the Cell Counting Kit-8 colony formation and cell migration assay results showed that the downregulation of miR-501-5p decreased GC cell proliferation and migration. Besides that, we found that GC cell cycle was arrested in G2 phase and cell apoptosis rate was increased by silencing the expression of miR-501-5p in GC cell lines using the flow cytometry. We also found that miR-501-5p could directly target lysophosphatidic acid receptor 1 (LPAR1) and negatively regulate LPAR1 expression in GC cell lines by performing dual-luciferase reporter gene assay and Western blot analysis. And, LPAR1 was significantly downregulated in GC tissues and inversely correlated with miR-501-5p expression. Furthermore, LPAR1 downregulation promoted cell proliferation and migration, which were attenuated by cotransfection of miR-501-5p inhibitor in GC cells. In conclusion, miR-501-5p can promote GC cell proliferation and migration by targeting and downregulating LPAR1. miR-501-5p/LPAR1 may become a potential therapeutic target for GC treatment.

Intermittent abdominal pain accompanied by defecation difficulties caused by Chilaiditi syndrome: A case report.

We report a case of intermittent lower abdominal pain and distension accompanied by defecation difficulties for 3 years due to Chilaiditi syndrome in a 59-year-old male. Before admission to our hospital, the patient had undergone gastroscopy, which showed gastritis and duodenitis, and colonoscopy, which showed cecum deformation and cicatricial changes of the mucous membrane in the colon hepatic flexure. A computed tomography (CT) scan of the abdomen at our hospital confirmed right hepatic atrophy and interposition of the colon. Moreover, CT simulation endoscopy identified cystic dilatation in the colon hepatic flexure with the widest diameter of 8.2 cm. The patient was diagnosed with Chilaiditi syndrome. As the patient was unable to endure his defecation difficulties, he underwent a laparoscope-assisted right hemicolectomy. The patient had a good recovery. During the follow-up period of 9 mo, the patient remained symptom-free.

Modularized laparoscopic regional en bloc mesogastrium excision (rEME) based on membrane anatomy for distal gastric cancer.

BACKGROUND: The purpose of the study was to evaluate the safety and feasibility of a new surgical procedure named modularized laparoscopic regional En bloc mesogastrium excision (rEME) based on the membrane anatomy in distal laparoscopic radical gastrectomy for gastric cancer. METHODS: From January 2014 to June 2017, 92 consecutive cases of patients with stages I-III distal gastric cancer were divided into 2 groups: laparoscopic radical gastrectomy plus standard D2 lymph node dissection (SD group, n = 44) and modularized rEME (rEME group, n = 48). Evaluations were made in terms of the operative data, pathological results, recovery time of digestive tract functions, complications, and length of stay. RESULTS: 85 patients (SD group, n = 40 and rEME group, n = 45) were finally included for analysis. There were no significant differences in the median total numbers of dissected LNs (31.98 ± 10.48 vs. 34.93 ± 13.12, p = 0.261), LNs in the greater curvature (12.18 ± 6.55 vs. 13.62 ± 8.09, p = 0.444), LNs in the lesser curvature (19.55 ± 7.40 vs. 17.98 ± 8.31, p = 0.365) between the SD and rEME groups. The rEME group showed lower loss of blood volume (107.11 ± 60.13 ml vs. 146.25 ± 85.78 ml, p = 0.019). No significant differences were found in recovery time of digestive tract functions, postoperative complication rates and length of hospital stay between the two groups. CONCLUSION: Laparoscopic radical gastrectomy plus modularized rEME based on the membrane anatomy is a safe and feasible procedure for distal gastric cancer.

Girdin regulates the proliferation and apoptosis of pancreatic cancer cells via the PI3K/Akt signalling pathway.

Girdin functions as an Akt phosphorylation enhancer (APE), which expedites the proliferation and survival of many types of tumours. However, the influence of Girdin on pancreatic cancer and the underlying molecular mechanisms have yet to be uncovered. Hence, in the present study, we sought to elucidate the function of Girdin in pancreatic cancer malignancy, particularly its role in pancreatic cancer cell proliferation, migration and apoptosis. Immunohistochemistry (IHC) was used to evaluate Girdin expression in pancreatic cancer tissues and to analyse its correlation with pathological grade. Girdin expression was further validated in pancreatic cancer cell lines (AsPC­1, BxPC­3 and PANC­1), and human pancreatic ductal epithelial (HPNE) cells were used as a control. Recombinant adenovirus vectors containing Girdin­siRNA were constructed to inhibit Girdin expression and were used in subsequent experiments to determine the effects of Girdin silencing on pancreatic cancer cells. Girdin silencing suppressed pancreatic cancer cell proliferation and induced pancreatic cancer cell apoptosis in vitro and in vivo. According to the results of further mechanistic investigations, Girdin may regulate cell processes through the phosphatidylinositol­3­kinase/protein kinase B (PI3K/Akt) signalling pathway to exert additive effects on pancreatic cancer.

Xiaozhi decoction reduced posthemorrhoidectomy pain and analgesic medication consumption: a prospective study.

OBJECTIVE: The aim of this study was to investigate the effect of Xiaozhi decoction (XZD) on posthemorrhoidectomy pain and analgesic medication consumption. METHODS: From May 2013 to March 2015, 315 patients who underwent open hemorrhoidectomy in our hospital were enrolled in this study, of whom, 160 patients were randomly assigned to accept sitz bath with warm water after hemorrhoidectomy (control group) and 155 patients were randomly assigned to accept sitz bath with XZD (XZD group) after hemorrhoidectomy. Postoperative pain at 12 hours after surgery and on postoperative days (PODs) 1, 2, 7, 14 and 28 was evaluated by Visual Analog Scale (VAS). Pain on defecation on PODs 1, 2, 7, 14 and 28 was also recorded using the VAS. The consumption of analgesics was also analyzed. RESULTS: No significant difference was found in baseline characteristics between the two groups. Postoperative pain score of the XZD group was significantly lower on POD 2 (6.04±1.11 vs 6.33±1.14, P=0.0229), POD 7 (3.35±0.75 vs 4.22±0.87, P=0.0000) and POD 14 (2.87±0.64 vs 3.64±0.77, P=0.0000) than that of the control group. Similarly, patients in the XZD group experienced significantly less pain on defecation on POD 2 (5.02±1.34 vs 5.43±1.56, P=0.0130), POD 7 (3.08±1.17 vs 3.52±1.29, P=0.0017) and POD 14 (2.31±0.85 vs 2.68±0.99, P=0.0004). Patients in the XZD group consumed significantly less analgesic medication on POD 2 (P=0.0136), POD 7 (P=0.0074) and POD 14 (P=0.0046) than the control group. CONCLUSION: XZD could effectively relieve postoperative pain and reduce analgesic medication consumption after hemorrhoidectomy.

14-3-3η is a novel growth-promoting and angiogenic factor in hepatocellular carcinoma.

BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. The continued search for novel therapeutic strategies for HCC is urgently required. In this study, we aimed to investigate the functions and clinical significance of 14-3-3η protein in HCC. METHODS: Expressions of genes and proteins were determined by quantitative reverse transcription polymerase chain reaction, Western blot, and immunohistochemistry. Their functions were assessed by endothelial cell recruitment, tube formation, wound healing, flow cytometry, immunostaining, immunoprecipitation, and xenograft assay. A tissue microarray followed by univariate and multivariate analyses was performed to indicate the clinical significance. RESULTS: In HCC specimens, overexpression of 14-3-3η was observed not only in tumors but also in intratumoral vessels. In HCC and vascular endothelial cells, 14-3-3η stimulated proliferation and angiogenesis, but attenuated the functions of sorafenib. Briefly, 14-3-3η facilitated the phosphorylation of extracellular signal-regulated kinase1/2 (ERK1/2). Then, by binding to the phosphorylated-ERK1/2 (p-ERK1/2), formed a functional positive feed-back loop. A xenograft model showed that, blockage of either 14-3-3η or ERK1/2 inhibited the tumor growth. Finally, tissue microarray analyses showed that overexpression of 14-3-3η, either in tumors or intratumoral vessels, contributed to the poor survival. CONCLUSIONS: The 14-3-3η-ERK1/2 feedback loop played a characteristic growth-promoting role in HCC, not only in tumors but also in intratumoral vessels. Further, 14-3-3η could be a potential therapeutic target for HCC and a biomarker for predicting sorafenib treatment response. LAY SUMMARY: Here we found that, 14-3-3η protein exhibited a characteristic growth-promoting effect in both tumor and intratumoral vessels of hepatocellular carcinoma by interacting with ERK1/2 signaling.

Decorin-mediated inhibition of cholangiocarcinoma cell growth and migration and promotion of apoptosis are associated with E-cadherin in vitro.

Emerging evidences have shown that decorin expression is significantly reduced in many cancer tissues and cancer cells. However, its biological role and clinical significance in cholangiocarcinoma development and progression are unknown. In this study, immunohistochemistry was conducted to investigate the expression of decorin in cholangiocarcinomas. The results showed that decorin levels markedly decreased in 44 cholangiocarcinoma tissues compared to 40 adjacent normal tissues. The analysis between decorin expression and clinicopathological characteristics in cholangiocarcinoma patients showed that patients with low levels of decorin expression had a relatively poor prognosis. Moreover, recombinant human decorin treatment and overexpression of decorin in cholangiocarcinoma cells could inhibit cell proliferation, migration, and invasion and promote apoptosis. Furthermore, the E-cadherin expression significantly increased after decorin overexpression or use of recombinant human decorin in cholangiocarcinoma cells. Our findings indicated that downregulation of decorin may be identified as a poor prognostic biomarker in cholangiocarcinomas. Also, decorin-mediated inhibition of cholangiocarcinoma cell growth, migration, and invasion and promotion of cell apoptosis might be through regulation of the expression of E-cadherin in vitro.