An updated systematic review and meta-analysis of the efficacy and safety of early oral feeding vs. traditional oral feeding after gastric cancer surgery.

Introduction: Early oral feeding (EOF) has been shown to improve postoperative recovery for many surgeries. However, surgeons are still skeptical about EOF after gastric cancer surgery due to possible side effects. This updated systematic review and meta-analysis aimed to investigate the efficacy and safety of EOF in patients after gastric cancer surgery. Methods: Randomized controlled trials (RCTs) investigating EOF in patients after gastric cancer surgery were searched in the databases of PubMed, Embase, Clinicaltrials.gov, and Cochrane from 2005 to 2023, and an updated meta-analysis was performed using RevMan 5.4 software. Results: The results of 11 RCTs involving 1,352 patients were included and scrutinized in this analysis. Hospital days [weighted mean difference (WMD), -1.72; 95% confidence interval (CI), -2.14 to -1.30; p<0.00001), the time to first flatus (WMD, -0.72; 95% CI, -0.99 to -0.46; p<0.00001), and hospital costs (WMD, -3.78; 95% CI, -4.50 to -3.05; p<0.00001) were significantly decreased in the EOF group. Oral feeding tolerance [risk ratio (RR), 1.00; 95% CI, 0.95-1.04; p=0.85), readmission rates (RR, 1.28; 95% CI, 0.50-3.28; p=0.61), postoperative complications (RR, 1.02; 95% CI, 0.81-1.29; p=0.84), anastomotic leakage (RR, 0.83; 95% CI, 0.25-2.78; p=0.76), and pulmonary infection (RR, 0.65; 95% CI, 0.31-1.39; p=0.27) were not significantly statistical between two groups. Conclusion: This meta-analysis reveals that EOF could reduce hospital days, the time to first flatus, and hospital costs, but it was not associated with oral feeding tolerance, readmission rates, or postoperative complications especially anastomotic leakage and pulmonary infection, regardless of whether laparoscopic or open surgery, partial or total gastrectomy, or the timing of EOF initiation.

Risk factors for pathological upgrading and noncurative resection in patients with gastric mucosal lesions after endoscopic submucosal dissection.

BACKGROUND: The pathological results obtained from endoscopic forceps biopsy (EFB) do not always align with the findings of postoperative endoscopic submucosal dissection (ESD). Furthermore, as ESD becomes more widespread, the number of noncurative endoscopic cases increases; thus, an accurate preoperative diagnosis and an appropriate treatment method are crucial. The purpose of this study was to explore the risk factors for postoperative pathological upgrading and noncurative resection and to gather experience in clinical and pathological diagnosis. METHODS: From March 2016 to November 2023, 292 ESD specimens were collected from 262 patients with gastric mucosal lesions. Clinicopathological information, the coincidence rate of pathological diagnosis between EFB and ESD specimens, and risk factors related to noncurative resection were analyzed retrospectively. RESULTS: The overall upgraded pathological diagnosis rate between EFB and ESD was 26.4%. The independent predictors for the upgraded group included proximal stomach lesions, lesion size > 2 cm, surface ulceration, and surface nodules. Twenty of the 235 early gastric cancer (EGC) patients underwent noncurative ESD resection. Multivariate analysis showed that undifferentiated carcinoma and tumor infiltration into the submucosa were significantly associated with noncurative resection. CONCLUSION: Biopsy cannot fully represent the lesions of gastric intraepithelial neoplasia (GIN). When a suspected epithelial dysplasia is suspected, a careful endoscopic examination should be conducted to evaluate the lesion site, size, and surface characteristics to ensure an accurate diagnosis. Noncurative endoscopic resection is associated with undifferentiated carcinoma and submucosal infiltration. Clinicians must be familiar with these predictive factors for noncurative resection and select the appropriate treatment for their patients.

Collision Kidney Tumor Consisting of Clear Cell Renal Cell Carcinoma and Primary Renal Mantle Cell Lymphoma: A Case Report.

BACKGROUND: Non-Hodgkin's lymphoma (NHL) seldom involves the kidney, and it is even more uncommon for the kidney to be the primary renal non-Hodgkin's lymphoma (PRNHL). Due to its rarity, PRNHL is often confused with renal cell carcinoma (RCC). Tumor collision refers to the simultaneous development of two histologically distinct malignancies in the same organ or space. Collision kidney tumors have already been described but only in a few cases. Here, we report an extremely unusual case involving a collision tumor between PRNHL and RCC. CASE PRESENTATION: During a routine physical examination, a 61-year-old male was diagnosed with a tumor in his left kidney. The patient underwent a laparoscopic left partial nephrectomy. A 3.2 cm renal mass was seen on gross examination of the nephrectomy specimen, and the final pathology showed two different tumor types. The first type was a typical clear cell renal cell carcinoma (ccRCC), which made up the majority of the overall tumor. The second was composed of small- to medium-sized lymphoid monomorphic cells with uneven nuclei. Immunohistochemistry confirmed the diagnosis of a collision tumor consisting of PRNHC and ccRCC. After surgery, the patient received five courses of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) therapy. With the gradual deterioration of all aspects of his physical function, the patient finally died of respiratory failure 15 months later. CONCLUSIONS: We present a rare case of a collision tumor consisting of renal cell carcinoma and primary renal non-Hodgkin's lymphoma. Despite their rarity, it is essential to report such cases to further understand the behavior of these tumors and develop evidence-based treatment strategies.

Collision Kidney Tumor Consisting of Clear Cell Renal Cell Carcinoma and Primary Renal Mantle Cell Lymphoma: A Case Report

Background: Non-Hodgkin’s lymphoma (NHL) seldom involves the kidney, and it is even more uncommon for the kidney to be the primary renal non-Hodgkin’s lymphoma (PRNHL). Due to its rarity, PRNHL is often confused with renal cell carcinoma (RCC). Tumor collision refers to the simultaneous development of two histologically distinct malignancies in the same organ or space. Collision kidney tumors have already been described but only in a few cases. Here, we report an extremely unusual case involving a collision tumor between PRNHL and RCC. Case Presentation: During a routine physical examination, a 61-year-old male was diagnosed with a tumor in his left kidney. The patient underwent a laparoscopic left partial nephrectomy. A 3.2 cm renal mass was seen on gross examination of the nephrectomy specimen, and the final pathology showed two different tumor types. The first type was a typical clear cell renal cell carcinoma (ccRCC), which made up the majority of the overall tumor. The second was composed of small- to medium-sized lymphoid monomorphic cells with uneven nuclei. Immunohistochemistry confirmed the diagnosis of a collision tumor consisting of PRNHC and ccRCC. After surgery, the patient received five courses of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) therapy. With the gradual deterioration of all aspects of his physical function, the patient finally died of respiratory failure 15 months later. Conclusions: We present a rare case of a collision tumor consisting of renal cell carcinoma and primary renal non-Hodgkin’s lymphoma. Despite their rarity, it is essential to report such cases to further understand the behavior of these tumors and develop evidence-based treatment strategies (AU)

Application of the International System for Reporting Serous Fluid Cytopathology (ISRSFC) in reporting serous effusion: A retrospective study.

In order to develop uniform diagnostic standards and reporting terminology, the International Academy of Cytology and the American Society of Cytopathology have recommended the establishment of the International System for Reporting Serous Fluid Cytopathology (ISRSFC). ISRSFC has 5 diagnostic categories: non-diagnostic (ND), negative for malignancy (NFM), atypia of unknown significance (AUS), suspicious for malignancy (SFM), and malignant (MAL). So far, very few studies have evaluated the risk of malignancy (ROM) and performance characteristics (sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) of different categories. The purpose of this study was to reclassify serous effusions based on the ISRSFC and to assess their ROM and performance characteristics. All serous effusions from January 2017 to December 2022 were categorized according to the ISRSFC. Using histopathological diagnosis as the gold standard, the ROM and performance characteristics were calculated for each group. Finally, a total of 2103 serous effusion specimens were analyzed. After reclassification, 9 (0.4%) cases were classified as ND, 547 (26%) as NFM, 94 (4.5%) as AUS, 386 (18.4%) as SFM, and 1067 (50.7%) as MAL. The ROMs for ND, NFM, AUS, SFM and MAL were calculated to be 50%, 24.9%, 36.8%, 89.0%, and 100%, respectively. As an easy-to-grasp reporting system, ISRSFC provides a consistent standard for better communication between physicians and pathologists.

Clodronate-superparamagnetic iron oxide-containing liposomes attenuate renal injury in rats with severe acute pancreatitis.

BACKGROUND AND OBJECTIVE: It has been shown that macrophages play an important role in the development of severe acute pancreatitis (SAP), and eventually lead to multiple organ failure (MOF). Clodronate-liposome selectively depleted macrophages. This study was to investigate the role of renal macrophage infiltration in acute renal injury in rats with SAP and to evaluate the potential of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) for diagnosis. METHODS: Superparamagnetic Fe3O4 nanoparticles were prepared by chemical coprecipitation. SPIO-liposomes and SPIO-clodronate-liposomes were prepared by the thin film method. SAP models were prepared by injection of sodium taurocholate into the subcapsular space of rat pancreas. Sprague-Dawley rats were randomly divided into a control group, SAP plus SPIO-liposome (P) group, and SAP plus SPIO-clodronate-containing liposome (T) group. Kidney injury was evaluated by T2-weighted MRI scan. The levels of serum amylase (SAM), blood urea nitrogen (BUN), and serum creatinine (SCr) were measured by an automated enzymatic method. Serum tumor necrosis factor-α (TNF-α) was measured by enzyme-linked immunosorbent assay (ELISA). Pathological changes in the pancreas and kidney were observed using hematoxylin and eosin (H&E) staining, while cell apoptosis was detected with terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. In addition, the macrophage markers (CD68) of the renal tissue were detected with immunohistochemistry. RESULTS: The pathological changes in the pancreas and kidneys of rats in the T group were milder than those in the P group. The MRI signal intensity of the kidneys in the P and T groups was significantly lower than that in the control group. There were significant changes in the two experimental groups (P<0.01). The levels of SAM, Bun, SCr, and TNF-α in rats in the P group were higher than those in the control group (P<0.01) and in the T group (P<0.01). The apoptosis of the kidney in the T group was higher than that in the P group at 2 and 6 h (P<0.01). CONCLUSIONS: Clodronate-containing liposomes protected against renal injury in SAP rats, and SPIO can be used as a tracer for MRI examination to detect renal injury in SAP rats. SPIO-aided MRI provided an efficient non-invasive way to monitor the migration of macrophages after renal injury in rats with SAP.