Small bowel obstruction caused by hemorrhagic metastatic melanoma: case report and literature review.

Melanoma is one of the most common cancers and causes of death from skin cancer. It is also one of the most common malignancies to metastasize to the gastrointestinal tract. However, the incidence of gastrointestinal metastases from unknown primary cutaneous melanoma is reported to be 4-9%. Despite advances in diagnostic techniques, only 1.5-4.4% of metastases to the gastrointestinal tract are detected before death. We report a patient with no prior history of melanoma who presented with both gastrointestinal hemorrhage and small bowel obstruction. Diagnostic laparoscopy, followed by small bowel resection, was performed after a red blood cell radionuclide scan showed active hemorrhage. Pathologic examination confirmed metastatic melanoma of the jejunum. Additional small bowel resections were required for recurrent gastrointestinal bleeding, confirming two additional metastases. A review of the literature on small intestinal melanoma causing hemorrhage and obstruction is discussed.

Early weight instability is associated with cognitive decline and poor survival in amyotrophic lateral sclerosis.

OBJECTIVE: Our aim was to measure the monthly rate of weight loss during 6 months prior to a diagnosis of amyotrophic lateral sclerosis (ALS) and to explore the effect on prognosis. METHODS: We enrolled 522 patients free from eating difficulties and with short diagnostic delay between June 2014 to June 2019. The calculating formula for the monthly rate of weight loss=[(weight at baseline-weight at diagnosis)/(weight at baseline*100 %)]/time interval. We employed logistic regression analysis to reveal any association between weight loss and cognitive dysfunction. Survival analysis was performed using the Kaplan-Meier curves and Cox proportional hazard models. RESULTS: Weight loss was observed in 272 patients (52.1 %). Patients with severe weight loss had an older age of onset, a lower ALS Functional Rating Scale-Revised score, a faster disease progression rate, and higher frequencies of executive dysfunction and cognitive decline. The monthly rate of weight loss was associated with executive dysfunction and cognitive decline after adjusting for the emotional state. The stratified monthly rate of weight loss was strongly and independently related to ALS survival after adjusting for confounding factors (HR = 1.473, P trend<0.001). Each upper ladder of the rate of weight loss was correlated with worse survival and a 47.3 % (95 % CI: 25.0-73.6 %) increased risk of mortality. CONCLUSIONS: Weight loss is very common in patients with ALS and is associated with poor survival. It is also associated with executive dysfunction and cognitive decline. An important mechanism of weight loss in the early stage of this disease may be hypermetabolism.

The association between gene polymorphisms and risk of nasopharyngeal carcinoma.

Gene polymorphisms have been implicated in increased susceptibility of nasopharyngeal carcinoma, but studies have reported inconclusive results. The present study investigates the relationship between each potential gene polymorphism and the risk of nasopharyngeal carcinoma through a comprehensive series of meta-analyses. Data from Pubmed, CNKI, Wanfang and Weipu databases were collected, evaluated and analyzed. Statistical analysis was performed using the Revman 4.2 and STATA 10.0 softwares. A total of 9,705 nasopharyngeal carcinoma cases and 11,041 controls in 34 case-control studies were identified for data analysis. The results suggested that the Arg399Gln polymorphism of XRCC1 gene, the 1G/2G polymorphism of MMP-1 gene, the RsaI polymorphism of CYP2E1 gene, the -1306C>T polymorphism of MMP-2 gene and the Arg72Pro polymorphism of p53 gene might be related to increased risks of nasopharyngeal carcinoma under different genetic comparison models, while the Arg194Trp and Arg280His polymorphisms of XRCC1 gene and the 309T>G polymorphism of MDM2 gene might not contribute to the risk of nasopharyngeal carcinoma. This current meta-analysis suggests that five polymorphisms might be risk factors for nasopharyngeal carcinoma under different genetic comparison models. Future studies are needed to validate our findings.

The association between the Lys751Gln polymorphism in the XPD gene and the risk of bladder cancer.

The Lys751Gln polymorphism in the XPD gene have been suggested as a risk factor for bladder cancer, however the results were inconclusive. The aim of the current study is to assess the association by meta-analysis. A total of 15 case-control studies concerning the association between the XPD Lys751Gln polymorphism and bladder cancer risk were included in the meta-analysis. The results suggested that the Lys751Gln polymorphism was not associated with an increased risk of bladder cancer in the dominant model (OR = 1.03, 95 % CI 0.95-1.11, P = 0.53 for Lys/Gln+Gln/Gln vs. Lys/Lys) in overall analysis. In the subgroup analysis by ethnicity, no significant association was found in Caucasians or Asians. Other comparatives suggested a slight significant association between the polymorphism with the risk of bladder cancer in the recessive comparative (OR = 1.14, 95 % CI 1.02-1.29, P = 0.03). The current meta-analysis indicated that the Lys751Gln polymorphism in the XPD gene might be a risk factor for bladder cancer. In the future, more large-scale case-control studies are needed to validate our results.