Effect of complete high-caloric nutrition on the nutritional status and survival rate of amyotrophic lateral sclerosis patients after gastrostomy.

OBJECTIVES: Malnutrition is an independent risk factor for the prognosis of patients with amyotrophic lateral sclerosis (ALS). Complete high-caloric nutrition is emerging as an instrument for dietary intervention in disease prevention. Our aim was to evaluate the beneficial effects of complete high-caloric nutrition on nutritional status and prognosis in ALS patients undergoing percutaneous gastrostomy. METHODS: Forty patients with ALS following percutaneous gastrostomy were randomized to receive either routine diet alone (the control group) or complete high-caloric nutrition combined with routine diet (the Ensure group) for six months. Body weight, body mass index (BMI), nutritional indicator proteins, lipid levels and total lymphocyte count were measured before intervention and after six months of intervention. At 12 months of follow-up, Kaplan-Meier survival was generated to evaluate the beneficial effects of complete high-caloric nutrition on prognosis. RESULTS: After adjustment for baseline, compared with routine diet, body weight, total lymphocyte count and nutritional indicator proteins including transferrin, albumin, hemoglobin, and prealbumin were significantly increased at six months of intervention (all P<0.05). However, we found no significant changes in total cholesterol, triglycerides, low- or high-density lipoprotein cholesterol or BMI during the intervention in either group (all P>0.05). Interestingly, the cumulative survival rate of ALS patients in the Ensure group was significantly better than that of ALS patients in the control group (P<0.05). CONCLUSIONS: The findings of our study suggest that high-caloric nutrition offers potential for improvement of nutritional status and prolonged life. However, no evidence was found for a blood lipid-improving effect of complete high-caloric nutrition.

Percutaneous Radiologic Gastrostomy in Patients with Stroke.

OBJECTIVE: To investigate the effectiveness, safety, adverse events (AEs), and outcomes of percutaneous radiologic gastrostomy (PRG) in patients with dysphagia caused by cerebral infarction. STUDY DESIGN: An interventional study. PLACE AND DURATION OF STUDY: Department of Interventional Oncology, Dahua Hospital, and the Department of Internal medicine, Changqiao Community Health Service Center, Shanghai, China, from January 2016 and December 2019. METHODOLOGY: This study included sixty patients with cerebral infarction-induced dysphagia aged between 49-79 years. All patients were equally and randomly divided into the observation group (PRG group) and the control group (NFT group). Early and long-term results of PRG and nasal feeding tube (NFT) treatment were assessed. RESULTS: No significant differences in serum albumin, prealbumin, haemoglobin, and circumference of triceps (p>0.05) were observed between the two groups before treatment. After treatment, both serum albumin, prealbumin, haemoglobin, and the circumference of the triceps increased in the PRG group compared with the NFT group (p<0.05), indicating better nutrition status. The adverse events (AEs) rate of the PRG group (3.33%, 1/30) was significantly lower than the NFT group (30%, 9/30, p=0.005). The comfort level of the PRG group (93.33%, 28/30) was significantly higher than the NFT group (53.33%, 16/30, p<0.001). CONCLUSION: Percutaneous radiologic gastrostomy can improve the nutritional status of patients with dysphagia caused by cerebral infarction. It can reduce the incidence of AE and improve the comfort level. KEY WORDS: Percutaneous Gastroscopy, Gastrostomy, Dysphagia, Nutrition status, Complications.

The correlation between magnetic resonance diffusion parameters and Ki-67 and PCNA in hepatic fibrosis and cirrhosis rats.

BACKGROUND: The aim of this study was to assess the value of different 1.5 T MRI apparent diffusion coefficient (ADC) and exponential apparent diffusion coefficient (EADC) values in diagnosing the stages of liver cirrhosis. Sprague-Dawley (SD) rats were randomly divided into the experimental group and the control group. METHODS: The experimental group was injected with thioacetamide intraperitoneally 3 times per week. After routine MR scanning, diffusion-weighted imaging (DWI) was processed by spin echo-echo planar imaging (SE-EPI) to generate the ADC value and EADC image. The liver ADC and EADC values of rats were measured in the control and experimental groups, followed by Masson staining and hematoxylin and eosin staining. Furthermore, immunohistochemistry was performed to detect Ki-67 and PCNA expression in liver tissues. RESULTS: In the control group, the differences in ADC and EADC values between the liver fibrosis and cirrhosis group were different. The ADC values of the liver fibrosis stage I-II, III-IV, and cirrhosis rats in the experimental group were lower than the control group, while the EADC values were higher than the control group. The ADC values of the liver fibrosis stage III-IV group and cirrhosis nodules group were lower than the control group. There were significant differences in EADC values between the cirrhotic nodule groups and the control group. CONCLUSIONS: DWI-ADC values showed a negative correlation between SD rat liver fibrosis and cirrhosis pathology classification.

The effects of total enteral nutrition via nasal feeding and percutaneous radiologic gastrostomy in patients with dysphagia following a cerebral infarction.

OBJECTIVE: To explore the effects of total enteral nutrition (TEN) via nasal feeding and percutaneous radiologic gastrostomy (PRG) on the nutritional status, quality of life, and prognosis in long-term bedridden patients with dysphagia after cerebral infarction. METHODS: One hundred and sixty long-term bedridden patients with dysphagia after cerebral infarction were randomly divided into a control group (CG, n=80) and an observation group (OG, n=80). The CG was administered TEN via nasal feeding, and the OG was administered TEN via PRG. The two groups' results were compared. RESULTS: The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores in the OG were lower than the corresponding scores in the CG at 3 and 6 months after the TEN (P < 0.05). The OG had a higher proportion of high compliance, but a lower proportion of both moderate and low compliance than the CG (P < 0.05). The total incidence of TEN intolerance was 8.75% in the OG, lower than the 20.00% in the CG (P < 0.05). The AST, ALB, ALT, TBIL, Scr, and BUN levels showed no significant differences between the OG and the CG at 3 and 6 months after the TEN (P > 0.05). The IgM, IgG, IgA, hemoglobin, total protein, albumin, and transferrin levels showed no significant differences between the OG and the CG at 3 and 6 months after the TEN (P > 0.05). The incidence of catheterization complications was 20.00% in the OG, higher than the 8.75% in the CG (P < 0.05). The OG had higher SF-36 scores than the CG at 6 months after the TEN (P < 0.05). CONCLUSION: Both nasal feeding and TEN via PRG can effectively improve patients' nutritional status, enhance their immune function, and improve their liver and renal function, but TEN after PRG is more effective at reducing intolerance and promoting quality of life in long-term bedridden patients with dysphagia after cerebral infarction. However, TEN after PRG will also increase the occurrence of recent complications, complications that should get additional clinical attention.

S100 Calcium Binding Protein A10, A Novel Oncogene, Promotes the Proliferation, Invasion, and Migration of Hepatocellular Carcinoma.

Hepatocarcinogenesis is a highly complicated process that is promoted by a series of oncogenes. Our study aims to identify novel oncogenes promoting hepatocellular carcinoma (HCC) by bioinformatic analysis and experimental validation. Here, we reported that S100 calcium binding protein A10 (S100A10) was screened out as a potential novel oncogene in HCC by integrated analysis of OEP000321 dataset and the Cancer Genome Atlas (TCGA)-Liver-Cancer data. Furthermore, S100A10 was highly expressed in HCC samples and observably associated with patients' overall survival (OS). Overexpression of S100A10 in Hep3B and Huh-7 increased the cell proliferation, whereas downregulation of S100A10 in SK-Hep-1 and HepG2 cells reduced the cell viability to almost stop growing. In vivo tumor growth assays showed that S100A10-overexpressing Hep3B cells had a larger tumor size than control. Moreover, S100A10 overexpression promoted Hep3B cells migration and invasion, and S100A10 knockdown inhibited SK-Hep-1 cells migration and invasion, in vitro. In conclusion, it is demonstrated that S100A10 is a novel oncogene in HCC, indicating a possible novel therapeutic strategy of HCC.

Performance Analysis for SWIPT Cooperative DF Communication Systems with Hybrid Receiver and Non-Linear Energy Harvesting Model.

In this paper, we study the outage and throughput performance for the simultaneous wireless information and power transfer (SWIPT) cooperative decode-and-forward (DF) communication systems. The hybrid receiver that uses both time switching (TS) and power splitting (PS) methods for energy harvesting (EH) and information decoding (ID), and the piece-wise linear EH model that captures the non-linear input-output characteristic of the EH circuit, are considered. We present exact analytical expressions of the outage probability (OP) and throughput, which are expressed as single definite integral on finite interval and can be easily evaluated, for the systems in Rayleigh fading channel. For further simplicity of calculation, we derive novel and closed-form approximate expressions of the OP and throughput. The impact of different system parameters on the system performance is investigated. Numerical results show the high accuracy of the proposed closed-form approximate expressions especially in the region of higher signal-to-noise ratio (SNR). It is also shown that the system performance is greatly overestimated when the ideal linear EH model is used instead of the practical non-linear EH model. A different result to the non-hybrid receiver with both linear EH model and non-linear EH model that there exists an optimal location to minimize the OP for the hybrid receiving relay node with non-linear EH model is also demonstrated.

Temperature sensitive hydrogel for preoperative treatment of renal carcinoma.

Surgical resection has been suggested as an effective and first-line treatment of renal cell carcinoma (RCC). However, operation is quite difficult for the patients with stage of middle-late or hypervascularized tumors. Transarterial chemoembolization (TACE) plays an important role in decreasing the size of tumors before surgery. In this work, we prepared an injectable drug-delivery system of doxorubicin-loaded temperature sensitive hydrogel for transarterial chemoembolization in RCC. The sol-gel transition behavior and rheologic analysis showed that the doxorubicin-loaded temperature sensitive hydrogel had good temperature sensitivity. Then, The X-ray experiment of hydrogel showed excellent visibility under the digital subtraction angiography and computed tomography scans in vitro and in vivo. Moreover, the studies of embolization in beagle's right kidney showed good properties in embolizing of renal arteries. In TACE therapy studies of rabbit VX2 renal tumors, angiography, computed tomography and histopathological analysis verified that TACE therapy of doxorubicin-loaded temperature sensitive hydrogel had excellent embolic efficiency as a result of repressing the tumor growth. This hydrogel could provide valuable option in the treatment of renal cell carcinoma before surgery.

Technical success rate and safety of radiologically inserted gastrostomy versus percutaneous endoscopic gastrostomy in motor neuron disease patients undergoing: A systematic review and meta-analysis.

OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) and radiologically inserted gastrostomy (RIG) have gained increasing popularity among clinicians and motor neuron disease (MND) patients for maintaining adequate nutritional intake. However, there is no consistent evidence of the efficacy and safety of the two techniques in MND patients. We carried out a systematic review and meta-analysis to examine the technical success rates, complication rates and 30-day mortality of MND patients receiving PEG and RIG. METHODS: We searched PubMed, EMBASE, the Cochrane Library, Web of Science and Scopus from inception to September 12, 2019 for comparative studies on the efficacy and safety of PEG and RIG in MND patients. The primary outcome was technical success rate and the secondary outcomes were complication rates and 30-day mortality. RESULTS: Seven studies (n = 603) were included. Pooled technical success rates were 90.15% in patients receiving PEG and 96.76% in patients undergoing RIG. There was a statistically significant difference in the technical success rate between RIG and PEG, strongly favoring RIG [(OR = 3.96, 95% CI (1.31to 12.02); P = .02]. Pooled major complication rates were 2.19% in patients receiving PEG and 0.07% in patients undergoing RIG, with no statistical difference (P = .08). Pooled procedure-related 30-day mortality rates were 5.31% in patients receiving PEG and 6.00% in patients undergoing RIG, with no statistically significant difference (P = .75). No publication bias was noted. CONCLUSION: The present meta-analysis demonstrated that, compared to PEG, RIG has a higher technical success rate and has a comparable mortality outcome and safety profile.

Silicone-covered biodegradable magnesium stent for treating benign esophageal stricture in a rabbit model.

BACKGROUND: Stent insertion can effective alleviate the symptoms of benign esophageal strictures (BES). Magnesium alloy stents are a good candidate because of biological safety, but show a poor corrosion resistance and a quick loss of mechanical support in vivo. AIM: To test the therapeutic and adverse effects of a silicone-covered magnesium alloy biodegradable esophageal stent. METHODS: Fifteen rabbits underwent silicone-covered biodegradable magnesium stent insertion into the benign esophageal stricture under fluoroscopic guidance (stent group). The wall reconstruction and tissue reaction of stenotic esophagus in the stent group were compared with those of six esophageal stricture models (control group). Esophagography was performed at 1, 2, and 3 weeks. Four, six, and five rabbits in the stent group and two rabbits in the control groups were euthanized, respectively, at each time point for histological examination. RESULTS: All stent insertions were well tolerated. The esophageal diameters at immediately, 1, 2 and 3 wk were 9.8 ± 0.3 mm, 9.7 ± 0.7 mm, 9.4 ± 0.8 mm, and 9.2 ± 0.5 mm, respectively (vs 4.9 ± 0.3 mm before stent insertion; P < 0.05). Magnesium stents migrated in eight rabbits [one at 1 wk (1/15), three at 2 wk (3/11), and four at 3 wk (4/5)]. Esophageal wall remodeling (thinner epithelial and smooth muscle layers) was found significantly thinner in the stent group than in the control group (P < 0.05). Esophageal injury and collagen deposition following stent insertion were similar and did not differ compared to rabbits with esophageal stricture and normal rabbits (P > 0.05). CONCLUSION: Esophageal silicone-covered biodegradable magnesium stent insertion is feasible for BES without causing severe injury or tissue reaction. Our study suggests that insertion of silicone-covered magnesium esophageal stent is a promising approach for treating BES.

Efficacy and safety evaluation of paclitaxel-loaded metal stents in patients with malignant biliary obstructions.

Paclitaxel-eluting covered metal stents (PECMSs) and metallic stents covered with a paclitaxel-incorporated membrane (MSCPMs) have been developed to increase stent patency by preventing tumor ingrowth. However, few studies have compared their efficacy and safety compared with conventional covered metal stents (CMSs). This study aimed to compare differences in efficacy and safety between PECMS/MSCPM and CMS by meta-analysis. A search of PubMed and Embase was conducted for randomized controlled trials of PECMS/MSCPM and CMS in patients with malignant biliary obstructions published between January 1966 and August 2017. A meta-analysis was performed to compare clinical outcomes and complications between stent types. A total of 221 patients from three studies were included. There were no significant differences between PECMS/MSCPM and CMS in stent patency duration (P = 0.128) or survival time (P = 0.363). Risk did not differ between PECMS/MSCPM and CMS for stent malfunction (hazard ratio [HR]: 1.13, 95% confidence interval [CI]: 0.63-2.02, P = 0.677 for all stent malfunction; HR: 1.39, 95% CI: 0.68-2.85, P = 0.362 for stent occlusion caused by tumor ingrowth; HR: 0.80, 95% CI: 0.34-1.91, P = 0.617 for stent occlusion caused by distal stent migration or sludge impaction), or complications (HR: 1.54, 95% CI: 0.70-3.39, P = 0.280 for all complications; HR: 0.42, 95% CI: 0.14-1.30, P = 0.131 for pancreatitis). The exception was cholangitis-like symptoms, the risk for which was higher in PECMS/MSCPM compared with CMS (HR: 3.93, 95% CI: 1.08-14.29, P = 0.038). Although PECMS/MSCPM may be associated with higher risk of cholangitis-like symptoms, the overall results were similar between PECMS/MSCPM and CMS. Further studies are warranted in larger populations of patients.

Polymeric Biodegradable Stent Insertion in the Esophagus.

Esophageal stent insertion has been used as a well-accepted and effective alternative to manage and improve the quality of life for patients diagnosed with esophageal diseases and disorders. Current stents are either permanent or temporary and are fabricated from either metal or plastic. The partially covered self-expanding metal stent (SEMS) has a firm anchoring effect and prevent stent migration, however, the hyperplastic tissue reaction cause stent restenosis and make it difficult to remove. A fully covered SEMS and self-expanding plastic stent (SEPS) reduced reactive hyperplasia but has a high migration rate. The main advantage that polymeric biodegradable stents (BDSs) have over metal or plastic stents is that removal is not require and reduce the need for repeated stent insertion. But the slightly lower radial force of BDS may be its main shortcoming and a post-implant problem. Thus, strengthening support of BDS is a content of the research in the future. BDSs are often temporarily effective in esophageal stricture to relieve dysphagia. In the future, it can be expect that biodegradable drug-eluting stents (DES) will be available to treat benign esophageal stricture, perforations or leaks with additional use as palliative modalities for treating malignant esophageal stricture, as the bridge to surgery or to maintain luminal patency during neoadjuvant chemoradiation.

Fabrication of a Delaying Biodegradable Magnesium Alloy-Based Esophageal Stent via Coating Elastic Polymer.

Esophageal stent implantation can relieve esophageal stenosis and obstructions in benign esophageal strictures, and magnesium alloy stents are a good candidate because of biodegradation and biological safety. However, biodegradable esophageal stents show a poor corrosion resistance and a quick loss of mechanical support in vivo. In this study, we chose the elastic and biodegradable mixed polymer of Poly(ε-caprolactone) (PCL) and poly(trimethylene carbonate) (PTMC) as the coated membrane on magnesium alloy stents for fabricating a fully biodegradable esophageal stent, which showed an ability to delay the degradation time and maintain mechanical performance in the long term. After 48 repeated compressions, the mechanical testing demonstrated that the PCL-PTMC-coated magnesium stents possess good flexibility and elasticity, and could provide enough support against lesion compression when used in vivo. According to the in vitro degradation evaluation, the PCL-PTMC membrane coated on magnesium was a good material combination for biodegradable stents. During the in vivo evaluation, the proliferation of the smooth muscle cells showed no signs of cell toxicity. Histological examination revealed the inflammation scores at four weeks in the magnesium-(PCL-PTMC) stent group were similar to those in the control group (p > 0.05). The α-smooth muscle actin layer in the media was thinner in the magnesium-(PCL-PTMC) stent group than in the control group (p < 0.05). Both the epithelial and smooth muscle cell layers were significantly thinner in the magnesium-(PCL-PTMC) stent group than in the control group. The stent insertion was feasible and provided reliable support for at least four weeks, without causing severe injury or collagen deposition. Thus, this stent provides a new stent for the treatment of benign esophageal stricture and a novel research path in the development of temporary stents in other cases of benign stricture.