Laparoscopic resection for gastric schwannoma larger than 30 mm with long-term outcomes.

BACKGROUND AND AIMS: Laparoscopic resection has been reported as effective and safe for gastric schwannoma (GS) in the form of case reports. However, study on laparoscopic surgery in patients with GS larger than 30 mm has been rarely reported. To this end, the present study aimed to evaluate the safety and efficacy of laparoscopic resection for the treatment of GS larger than 30 mm and its long-term outcomes. METHODS: This is a retrospective case series study of patients with GS larger than 30 mm who underwent laparoscopic resection at our hospital between January 2014 and December 2020. Clinical pathology, surgical and follow-up data were collected and analyzed. RESULTS: A total of 10 patients with a mean age of 51.6 years were included. Seven tumors were located in gastric body, 2 in antrum and 1 in fundus. Laparoscopic gastric wedge resection was performed in 7 patients, while laparoscopic gastric local resection was performed in 3 patients. All patients achieved complete resection. The mean operation time was 112.6 ± 34.3 min, and the mean postoperative hospital stay was 13.8 ± 5.1 days. Postoperative gastroplegia occurred in 2 patients and was treated with conservative therapy. No recurrence, metastasis or residue was found during the follow-up of mean 45.1 months. CONCLUSIONS: Laparoscopic resection is a safe and effective method for treating GS larger than 30 mm with favorable long-term follow-up outcomes. Laparoscopic resection may be considered as the first-line treatment for GS larger than 30 mm.

Effect of Roxadustat on Factors Associated with Renal Fibrosis and Efficacy.

Objective: We investigated the effect of roxadustat on factors associated with renal fibrosis and efficacy. Methods. Sixty patients meeting the inclusion criteria between January 2021 and October 2021 were equally distributed into observation (roxadustat) group and control (Erythropoietin) group. Then, the expression of serum hypoxia-inducible factor 1-alpha (HIF-1α), transforming growth factor-ß (TGF-ß1), vascular endothelial growth factor (VEGF), fibronectin (FN), and collagen Ⅳ (C-IV) was compared at different time points (baseline, 2-week follow-up, and 4-week follow-up). The improvement degree of hemoglobin (Hb) and the change level of iron parameters and hepcidin were also compared between the two groups. Results. In the roxadustat group, the expression of HIF-1α at 2 weeks was significantly higher than the baseline and approached the baseline value at 4 weeks. At 4 weeks, TGF-ß1 and FN expression was significantly lower than baseline. In addition, the improvement of Hb in the roxadustat group was significantly higher than that in the control group at 4 weeks, and the change of ferritin, transferrin, and hepcidin indexes from baseline was better than in the control group. Conclusion: After giving roxadustat, it can change the expression of HIF-1α, TGF-ß1, and FN. Its efficacy is superior to EPO, which is worthy of clinical application.

Clinical Comparison of Proximal Gastrectomy With Double-Tract Reconstruction Versus Total Gastrectomy With Roux-en-Y Anastomosis for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction.

PURPOSE: The incidence of adenocarcinoma of the esophagogastric junction (AEG) has increased in recent years, and the optimal surgical strategy for AEG remains highly controversial. We aimed to evaluate the safety and efficacy of proximal gastrectomy with double-tract reconstruction (PG-DT) for the treatment of patients with AEG. MATERIALS AND METHODS: We retrospectively analyzed patients with Siewert type II/III AEG between January 2013 and July 2018. Clinicopathological characteristics, survival, surgical outcomes, quality of life (QOL), and nutritional status were compared between the PG-DT and total gastrectomy with Roux-en-Y anastomosis (TG-RY) groups. RESULTS: After propensity score matching, 33 patients in each group were analyzed. There were no statistical differences between the 2 groups in terms of disease-free survival and overall survival. The surgical option was not an independent prognostic factor based on the multivariate analysis. In addition, no differences were found in terms of surgical complications. There were no significant differences in QOL assessed by the Visick grade, Gastrointestinal Symptom Rating Scale, or endoscopic findings. Furthermore, the long-term nutritional advantage of the PG-DT group was significantly greater than that of the TG-RY group. CONCLUSIONS: PG-DT is a safe and effective procedure for patients with local Siewert type II/III AEG, regardless of the TNM stage.

Increased expression of methionine sulfoxide reductases B3 is associated with poor prognosis in gastric cancer.

The present study aimed to investigate the expression of methionine sulfoxide reductases B3 (MSRB3) in gastric cancer (GC) and its clinical significance. A total of 90 specimens from patients with GC were collected to evaluate MSRB3 protein expression by immunohistochemical staining. The associations between MSRB3 protein expression, clinicopathological characteristics and prognosis of patients with GC were subsequently investigated. The results demonstrated that MSRB3 protein expression in GC tissues samples was significantly higher compared with that in paired adjacent normal tissues (P=0.017). Among the 90 GC cases, 64 (71.1%) exhibited higher MSRB3 expression. In addition, the diagnostic value of MSRB3 for patients with GC was estimated with a sensitivity of 71.1% and a specificity of 46.7%. However, MSRB3 expression was not associated with clinicopathological characteristics of patients with GC. Kaplan-Meier analysis indicated that patients with high MSRB3 expression had significantly shorter overall survival (OS) times compared with those with low expression (P=0.040). Univariate Cox regression analysis indicated that maximum tumor diameter, depth of invasion, lymph node metastasis, Tumor-Node-Metastasis (TNM) stage and MSRB3 expression were significantly associated with OS time. Multivariate Cox regression analysis indicated that MSRB3 was an independent predicting factor for the OS time of patients with GC (P=0.049). In addition, analysis using The Cancer Genome Atlas (TCGA) database validated these results. Kaplan-Meier analysis revealed that higher MSRB3 mRNA expression was associated with poorer OS time in 442 patients with GC (P=0.004). Univariate analysis of the TCGA data indicated that age, depth of invasion, lymph node metastasis, distant metastasis, TNM stage and MSRB3 expression were significantly associated with OS time; however, sex and histological differentiation were not associated with OS time. Multivariate analysis demonstrated that MSRB3 was an independent prognostic factor in patients with GC (P=0.001). In conclusion, these results demonstrated that MSRB3 expression was upregulated in patients GC, which suggests that MSBR3 may serve as a potential prognostic biomarker.

The association and significance of H3K27me3 and a folate metabolic gene ACat2 in neural tube defects.

AIM: To study the association between the expression of H3K27me3 and ACat2 (a folate metabolic protein), in order to elucidate the protective mechanism of folic acid (FA) in neural tube defects (NTDs). METHODS: Eighteen female SD rats were randomly divided into normal, NTD and FA group. NTD group was induced by all-trans retinoic acid (ATRA) at E10d. FA group was fed with FA supplementation since 2 weeks before pregnancy, followed by ATRA induction. At E15d, FA level in the embryonic neural tube was determined by ELISA. Neural stem cells (NSCs) were isolated. Cell proliferation was compared by CCK-8 assay. The differentiation potency was assessed by immunocytochemical staining. H3K27me3 expression was measured by immunofluorescence method and Western blot. ACat2 mRNA expression was detected by qRT-PCR. RESULTS: Cultured NSCs formed numerous Nestin-positive neurospheres. After 5 days, they differentiated into NSE-positive neurons and GFAP-positive astrocytes. When compared with controls, the FA level in NTD group was significantly lower, the ability of cell proliferation and differentiation was significantly reduced, H3K27me3 expression was increased, and ACat2 mRNA expression was decreased (P <0.05). The intervention of FA notably reversed these changes (P <0.05). H3K27me3 expression was negatively correlated with the FA level (rs = -0.908, P <0.01) and ACat2 level (rs = -0.879, P <0.01) in the neural tube. CONCLUSION: The increased H3K27me3 expression might cause a disorder of folate metabolic pathway by silencing ACat2 expression, leading to reduced proliferation and differentiation of NSCs, and ultimately the occurrence of NTD. FA supplementation may reverse this process.