Long Noncoding RNA CRNDE Promotes Gastric Cancer Progression through Targeting miR-136-5p/MIEN1.

Background: Long noncoding RNAs (lncRNAs) contribute to the initiation and progression of gastric cancer (GC). The purpose of this study is to examine the potential role of lncRNA colorectal neoplasia differentially expressed (CRNDE) in modulating the expression of migration and invasion enhancer 1 (MIEN1) through the suppression of miR-136-5p in GC. Methods: The biological roles of CRNDE, miR-136-5p, and MIEN1 in GC were assessed both in laboratory settings and through the examination of clinical samples. Results: CRNDE was found to be significantly increased in GC tissues, and this upregulation was associated with an unfavorable prognosis of GC patients. In vitro experiments showed that inhibiting cell growth and migration, along with promoting apoptosis in GC cells, could be achieved by either disabling CRNDE or MIEN1, or by increasing the expression of miR-136-5p. MIEN1 is a specific recipient of miR-136-5p, and the anticancer effects of miR-136-5p can be counteracted by the increased expression of MIEN1. Through the examination of clinical specimens, it has been observed that there is a significant positive correlation between the expression of MIEN1 and CRNDE. In contrast, miR-136-5p expression in GC tissues shows a negative correlation. Conclusion: A previously unexplored therapeutic target for GC involves the CRNDE/miR-136-5p/MIEN1 signal transduction cascade.

Poor Pre-operative Nutritional Status Is a Risk Factor of Post-operative Infections in Patients With Gastrointestinal Cancer-A Multicenter Prospective Cohort Study.

Objective: This study aimed to assess the prognostic value of the Nutritional Risk Score 2002 (NRS2002) and patient-generated subjective global assessment (PG-SGA) for post-operative infections in patients with gastric cancer (GC) and colorectal cancer (CRC) who underwent curative surgery. Methods: This prospective study included 1,493 GC patients and 879 CRC patients who underwent curative surgery at 18 hospitals in China between April 2017 and March 2020. The NRS2002 and PG-SGA were performed on the day of admission. The relationship between the nutritional status of patients before surgery and post-surgical incidence of infection was analyzed using univariate and multiple logistic regression analyses. Results: According to NRS2002, the prevalence of nutritional risk was 51.1% in GC patients and 63.9% in CRC patients. According to the PG-SGA, 38.9% of GC patients and 54.2% of CRC patients had malnutrition. Approximately 4.4% of the GC patients and 9.9% of the CRC patients developed infectious complications after surgery. The univariate and multiple logistic regression analyses showed that the risk of infections was significantly higher in GC patients with a high nutritional risk score (NRS2002 ≥5) than in those with a low score (NRS2002 <3), and the PG-SGA score was identified as a predictor of post-operative infection complications of CRC. Conclusion: The pre-operative nutritional status of patients with GC or CRC has an impact on post-operative infection occurrence. NRS2002 ≥5 was a risk factor for post-operative infection in patients with GC, and the PG-SGA B/C was a predictor of infections in patients with CRC.

Effect of Early vs Late Supplemental Parenteral Nutrition in Patients Undergoing Abdominal Surgery: A Randomized Clinical Trial.

Importance: The effect of and optimal timing for initiating supplemental parenteral nutrition (SPN) remain unclear after major abdominal surgery for patients in whom energy targets cannot be met by enteral nutrition (EN) alone. Objective: To examine the effect of early supplemental parenteral nutrition (E-SPN) (day 3 after surgery) or late supplemental parenteral nutrition (L-SPN) (day 8 after surgery) on the incidence of nosocomial infections in patients undergoing major abdominal surgery who are at high nutritional risk and have poor tolerance to EN. Design, Setting, and Participants: A multicenter randomized clinical trial was conducted from April 1, 2017, to December 31, 2018, in the general surgery department of 11 tertiary hospitals in China. Participants were those undergoing major abdominal surgery with high nutritional risk and poor tolerance to EN (≤30% of energy targets from EN on postoperative day 2, calculated as 25 and 30 kcal/kg of ideal body weight daily for women and men, respectively) and an expected postoperative hospital stay longer than 7 days. Data analysis was performed from February 1 to October 31, 2020. Interventions: Random allocation to E-SPN (starting on day 3 after surgery) or L-SPN (starting on day 8 after surgery). Main Outcomes and Measures: The primary outcome was the incidence of nosocomial infections between postoperative day 3 and hospital discharge. Results: A total of 230 patients (mean [SD] age, 60.1 [11.2] years; 140 men [61.1%]; all patients were of Han race and Asian ethnicity) were randomized (115 to the E-SPN group and 115 to the L-SPN group). One patient in the L-SPN group withdrew informed consent before the intervention. The E-SPN group received more mean (SD) energy delivery between days 3 and 7 compared with the L-SPN group (26.5 [7.4] vs 15.1 [4.8] kcal/kg daily; P < .001). The E-SPN group had significantly fewer nosocomial infections compared with the L-SPN group (10/115 [8.7%] vs 21/114 [18.4%]; risk difference, 9.7%; 95% CI, 0.9%-18.5%; P = .04). No significant differences were found between the E-SPN group and the L-SPN group in the mean (SD) number of noninfectious complications (31/115 [27.0%] vs 38/114 [33.3%]; risk difference, 6.4%; 95% CI, -5.5% to 18.2%; P = .32), total adverse events (75/115 [65.2%] vs 82/114 [71.9%]; risk difference, 6.7%; 95% CI, -5.3% to 18.7%; P = .32), and rates of other secondary outcomes. A significant difference was found in the mean (SD) number of therapeutic antibiotic days between the E-SPN group and the L-SPN group (6.0 [0.8] vs 7.0 [1.1] days; mean difference, 1.0 days; 95% CI, 0.2-1.9 days; P = .01). Conclusion and Relevance: In this randomized clinical trial, E-SPN was associated with reduced nosocomial infections in patients undergoing abdominal surgery and seems to be a favorable strategy for patients with high nutritional risk and poor tolerance to EN after major abdominal surgery. Trial Registration: ClinicalTrials.gov Identifier: NCT03115957.

Immediate vs. gradual advancement to goal of enteral nutrition after elective abdominal surgery: A multicenter non-inferiority randomized trial.

BACKGROUND & AIMS: The strategy of increasing the postoperative enteral nutrition dose to the target goal has not yet been clarified. This study aimed to determine whether an immediate goal-dose enteral nutrition (IGEN) strategy is non-inferior to a gradual goal-dose enteral nutrition (GGEN) strategy in reducing infections in patients undergoing abdominal surgery involving the organs of the digestive system. METHODS: This randomized controlled trial enrolled postoperative patients with nutritional risk screening 2002 scores ≥3 from 11 Chinese hospitals. Energy targets were calculated as 25 kcal/kg and 30 kcal/kg of ideal body weight for women and men, respectively. Patients were randomly assigned 1:1 to IGEN or GGEN group after enteral tolerance was confirmed (30% of the target on day 2). The IGEN group immediately started receiving 100% of the caloric requirements on day 3, while the GGEN group received 40% progressing to 80% of target on day 7. The primary endpoint was the infection rate until discharge, based on the intention-to-treat population. RESULTS: A total of 411 patients were enrolled and randomized to the IGEN and GGEN groups, and five patients did not receive the allocated intervention. A total of 406 patients were included in the primary analysis, with 199 and 207 in the IGEN and GGEN groups, respectively. Infection was observed in 17/199 (8.5%) in the IGEN group and 19/207 (9.2%) in the GGEN group, respectively (difference, -0.6%; [95% confidence interval (CI), -6.2%-4.9%]; P = 0.009 for non-inferiority test). There were significantly more gastrointestinal intolerance events with IGEN than with GGEN (58/199 [29.1%] vs. 32/207 [15.5%], P < 0.001). All other secondary endpoints were non-significant. CONCLUSIONS: Among postoperative patients at nutritional risk, IGEN was non-inferior to GGEN in regards to infectious complications. IGEN was associated with more gastrointestinal intolerance events. It showed that IGEN cannot be considered to be clinically directive. ClinicalTrials.gov (#NCT03117348).

The canonical Notch signaling was involved in the regulation of intestinal epithelial cells apoptosis after intestinal ischemia/reperfusion injury.

Notch signaling plays a critical role in the maintenance of intestinal homeostasis. The aim of the present study was to investigate the role of Notch signaling in the apoptosis of intestinal epithelial cells after intestinal ischemia reperfusion (I/R) injury. Male C57BL/6 mice were subjected to sham operation or I/R injury. Intestinal tissue samples were collected at 12 h after reperfusion. TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling) staining showed that intestinal I/R injury induced significantly increased apoptosis of intestinal epithelial cells. Meanwhile, the mRNA expression of Jagged1, DLL1, Notch2, and Hes5, and protein expression of NICD2 and Hes5 were increased significantly after I/R injury in intestinal epithelial cells. In an in vitro IEC-6 culture model, flow cytometry analyses showed that inhibition of Notch signaling by γ-secretase inhibitor DAPT and the suppression of Hes5 expression using siRNA both significantly increased the apoptosis of IEC-6 cells under the condition of hypoxia/ reoxygenation (H/R). In conclusion, the Notch2/Hes5 signaling pathway was activated and involved in the regulation of intestinal epithelial cells apoptosis in intestinal I/R injury.

[Metabolism-related risk factors of cholelithiasis among Beijing residents: a case-control study].

OBJECTIVE: To explore the metabolism-related risk factors of cholelithiasis among residents in Beijing. METHODS: The clinical data including previous disease history, findings of physical examination, and results of cholecystosonography of 2270 patients with cholelithiasis identified in the Health Screening Center of Peking Union Medical College Hospital between August 2007 and August 2010 were retrospectively reviewed (the case group). Meanwhile, 4336 healthy individuals during the same period were randomly chosen as the control group. RESULTS: Total cholesterol, triglyceride, low-density lipoprotein cholesterol, fasting blood glucose, body mass index, and systolic blood pressure were positively correlated with the incidence of cholelithiasis (P < 0.05), while high-density lipoprotein cholesterol was negatively correlated (P < 0.05). Diastolic blood pressure showed no association with cholelithiasis (P > 0.05). CONCLUSION: Cholelithiasis is resulted from multiple factors including elevated blood lipids, blood glucose, and systolic blood pressure among residents in Beijing.

[Mechanisms of gastrointestinal surgery in treatment of type 2 diabetes].

Type 2 diabetes can be treated by gastrointestinal surgery, but the underlying mechanism is unclear. This review summarizes the possible mechanisms which include weight loss, gastrointestinal hormones, foregut hypothesis, hindgut hypothesis, adipocytokines, and inflammatory factors.

[Application of laparoscopic adjustable gastric banding and a multi-disciplinary team approach in treatment of morbid obesity and its complications].

OBJECTIVE: To assess the safety and feasibility of laparoscopic adjustable gastric banding (LAGB) and a multi-disciplinary team (MDT) approach in the treatment of morbid obesity and its complications. METHODS: We retrospectively analyzed the clinical data of 16 patients who underwent LAGB and MDT approach in Peking Union Medical College Hospital from October 2009 to February 2011. RESULTS: Of these 16 patients, 15 patients completed the 3 month follow up; their body weight and body mass index (BMI) decreased significantly after treatment (both P=0.000), with an percentage of excess weight loss (%EWL) of (25.7±7.4)%. Thirteen patients completed 6 month follow up; their body weight and BMI were significantly lower than the preoperative levels (both P=0.001), while there were no significant difference between the third and sixth month measurements (P=0.103 and P=0.053, respectively); %EWL of 6 months after operation was significantly higher than that of 3 months after operation [(37.0±14.7)% vs. (29.1±6.8)%,P=0.042]. Six patients completed 12 month follow up; their body weight and BMI decreased significantly at the first 3 months after operation (P=0.007 and P=0.005,respectively) and at the second 6 postoperative months (P=0.007 and P=0.013,respectively); the BMI of 6 months after operation was significantly lower than that of 3 months after operation (P=0.045), but there was no significant difference of body weight between the third and sixth month after operation (P=0.065); meanwhile, the %EWL increased significantly within the second 3 postoperative months from (29.6±6.8é% to(42.4±14.0é%(P=0.028), and also within the second 6 postoperative months (60.4±12.6é%(P=0.001). In 9 patients with pre-operative obstructive sleep apnea hypopnea syndrome, the symptom was remarkably resolved in all these 9 patients 3 months after the treatment. Of 16 patients with preoperative metabolic syndrome, the condition was obviously improved after treatment in 10 patients. Of 9 patients with hypertension preoperatively, the blood pressure returned to normal level after the withdrawal of antihypertensive agents in 7 patients; in addition, one patient had his dose decreased and one patient switched to a milder antihypertensive agent. Of 8 patients accompanied with type 2 diabetes, 7 had their antidiabetic drugs withdrawn after the blood sugar returned normal and one patient had his dose decreased. CONCLUSION: LAGB combined with MDT approach is effective, safe, and feasible for treating morbid obesity and its complications.

[Investigation of tumor related anemia in 10,218 patients with cancer in the digestive system].

OBJECTIVE: To study the prevalence of tumor related anemia in patients with cancer in the digestive system. METHODS: A total of of 10 218 inpatients were diagnosed with cancer in the digestive system at the Peking Union Hospital from January 2000 to June 2009, which included esophageal cancer(n=1118), gastric cancer(n=2418), carcinoma of duodenum(n=134), carcinoma of small intestine(n=85), hepatocellular cancer(n=1508), cholangiocarcinoma(n=546), pancreatic cancer (n=1242), colon cancer(n=1582), and rectal cancer(n=1585). Patients with hemolytic anemia or hepatorenal dysfunction were excluded. Data pertaining to sex, age and hemoglobin were obtained by chart review. RESULTS: According to the China criteria of anemia, the overall anemia rate was 27.5% (2813/10 218). The prevalence of anemia was 64.7% for small bowel cancer, 60.5% for duodenal cancer, 42.6% for colon cancer, 36.6% for cholangiocarcinoma, 33.3% for gastric cancer, 22.6% for pancreatic cancer, 20.4% for rectal cancer, 18.7% for hepatocellular cancer, and 10.0% for esophageal cancer. Anemia was more common in older patients in those with gastric cancer, cholangiocarcinoma, pancreatic cancer, colon cancer and rectal cancer. There were more male anemic patients in those with cancer in the small intestine or cholangiocarcinoma. However, females were more commonly seen in those with hepatocellular cancer or pancreatic cancer. CONCLUSIONS: Anemia is common in patients with cancer in the digestive system. The prevalence of anemia is higher in patients with cancer in the duodenum carcinoma or small intestine, followed by colon cancer and gastric cancer, and then esophageal cancer. Anemia may be associated with age or gender in some types of cancer in the digestive system.

[Comprehensive analysis of relevant factors on colorectal cancer-related anemia].

OBJECTIVE: To analyze the risk factors of colorectal cancer-related anemia. METHOD: The clinical data of 319 patients with colorectal cancer were retrospectively analyzed for the possible risk factors of tumor-related anemia including tumor location, clinical stage, clinical symptoms, pathology, gender, and age. RESULTS: Of these 319 cases, 141 (44.20%) had anemia. The incidence of anemia was 62.20% among patients with right hemicolon cancers (including caecum cancer), and was 23.82% among patients with rectal cancer and 36.23% among those with transverse descending or sigmoid colon cancer. Cardia insufficiency, melena, tumor location, T staging, hypoproteinemia were also found to be related with anemia. Anemia and hypoproteinemia were the risk factors for perioperative blood transfusion (odds ratio = 3.004, odds ratio = 8.356, respectively). CONCLUSIONS: The colorectal cancer-related anemia is not associated with the clinical stage of the tumor, while cardiac insufficiency, melena, tumor location, tumor stage, and hypoproteinemia constitute the possible risk factors. Anemia and hypoproteinemia are the risk factors of perioperative blood transfusion.

Prevalence of metabolic syndrome and its associations with other metabolic disorders and cardiovascular changes in health examination population in Beijing.

OBJECTIVE: To investigate the prevalence of metabolic syndrome (MS) and its associations with other metabolic disorders and cardiovascular changes in health examination population in Beijing. METHODS: Totally, 10,916 individuals who received health examination in Health Examination Center of Peking Union Medical College Hospital were enrolled. The height, weight, blood pressure, serum levels of triglyceride, high-density lipoprotein cholesterol (HDL-C), and fasting blood glucose were recorded. MS was diagnosed based on the working criteria of Chinese Diabetes Society 2004 (CDS2004). Meanwhile, other metabolic disorders, including fatty liver and hyperuricemia, were recorded. The cardiovascular changes were reflected by the reports of electrocardiogram (ECG) ST-T changes and atherosclerosis of retinal arteries. RESULTS: The overall prevalence rate of MS was 6.1% (666/10,916) in the population. The prevalence rate of MS in male was much higher than that in female (9.0% vs. 2.7%, P=0.000). For individuals with MS, the prevalence rates of fatty liver and hyperuricemia were significantly higher than those without MS, respectively (70.4% vs. 35.4%, P=0.000; 29.9% vs. 17.7%, P=0.000). As for cardiovascular changes, the prevalence rates of ECG ST-T changes and atherosclerosis of retinal arteries were significantly higher in individuals with MS than those without MS, respectively (13.8% vs. 11.7%, P=0.012; 12.0% vs. 6.8%, P=0.000). CONCLUSIONS: The prevalence of MS in Beijing population is high. The individuals with MS have a higher risk for other metabolic disorders and cardiovascular changes.