简介：Objective:Theexpressionoftumorbiomarkersmaychangeafterchemotherapy.However,whethersecretedproteinacidicandrichincysteine(SPARC)expressionchangesafterchemotherapyingastriccancer(GC)isunclear.ThisstudyinvestigatedtheinfluenceofchemotherapyonSPARCexpressioninGC.Methods:ImmunohistochemistrywasusedtoanalyzeSPARCexpressionin132GCcases(including54caseswithpreoperativechemotherapyand78caseswithoutpreoperativechemotherapy).SPARCexpressionofpostoperativespecimenswithandwithoutpreoperativechemotherapywasassessedtoanalyzetheinfluenceofchemotherapyonSPARCexpression.Results:SPARCwashighlyexpressedinGCcomparedwiththedesmoplasticstromasurroundingtumorcellsandnoncanceroustissues.HighSPARCexpressionwascorrelatedwithinvasiondepth,lymphnode,andTNMstage.Afterchemotherapy,alowerproportionofhighSPARCexpressionwasobservedinpatientswithpreoperativechemotherapythaninthecontrols.For54patientswithpreoperativechemotherapy,grosstype,histology,depthofinvasion,lymphnode,TNMstage,andSPARCexpressionwererelatedtooverallsurvival.Furthermultivariateanalysisshowedthatlymphnode,histology,andSPARCexpressionafterchemotherapywereindependentprognosticfactors.Conclusion:SPARCexpressionmaychangeafterchemotherapyinGC.SPARCexpressionshouldbereassessedforpatientswithGCafterchemotherapy.

简介：AIM:ToevaluatetheefficacyandsafetyofN-butyl-2-cyanoacrylateintreatingacutebleedingofgastricvaricesinchildren.METHODS:Theretrospectivestudyincluded21childrenwith47episodesofactivegastricvaricealbleedingwhoweretreatedbyendoscopicinjectionofN-butyl-2-cyanoacrylateatAsanMedicalCenterChildren’sHospitalbetweenAugust2004andDecember2011.Toreducetheriskofembolism,eachinjectionconsistedof0.1-0.5mLof0.5mLN-butyl-2-cyanoacrylatedilutedwith0.5or0.8mLLipiodol.Theprimaryoutcomewasincidenceofhemostasisaftervaricealobliterationandthesecondaryoutcomewascomplicationoftheprocedure.RESULTS:The21patientsexperienced47episodesofactivegastricvaricealbleeding,includingrebleeding,forwhichtheyreceivedatotalof52cyanoacrylateinjections.Following42bleedingepisodes,hemostasiswasachievedafteroneinjectionandfollowingfivebleedingepisodesitwasachievedaftertwoinjections.Themeanvolumeofeachsinglealiquotofcyanoacrylateinjectedwas0.3±0.1mL(range:0.1-0.5mL).Injectionachievedhemostasisin45of47(95.7%)episodesofacutegastricvaricealbleeding.Elevenpatients(52.4%)developedrebleedingevents,withthemeandurationofhemostasisbeing11.1±11.6mo(range:1.0-39.2mo).Notreatment-relatedcomplicationssuchasdistalembolismwerenotedwiththeexceptionofabdominalpaininonepatient(4.8%).Amongfourmortalities,onepatientdiedofvaricealrebleeding.CONCLUSION:Endoscopicvaricealobliterationusingasmallvolumeofaliquotswithrepeatedcyanoacrylateinjectionwasaneffectiveandsafeoptionforthetreatmentofgastricvaricesinchildren.

简介：AIMToinvestigatetheinfluenceofprotonpumpinhibitors（PPIs）exposureonthediagnosisofHelicobacterpylori（H.pylori）gastritisandintestinalmetaplasia.METHODS：ChronicPPIuseisassociatedwithmaskingofH.pyloriinfection.PatientswithH.pyloriinfectionarepredisposedtogastricandduodenalulcers,andlong-terminfectionwiththisorganismhasbeenassociatedwithgastricmucosalatrophyandseriouslong-termcomplications,suchasgastriclymphomaandadenocarcinoma.ThreehundredpatientsdiagnosedwithgastritisbetweenJanuary2008andApril2010wereincludedinourstudy.Thecomputerizedmedicaldatabaseofthesepatientswasreviewedretrospectivelyinordertoassesswhetherthetypeofgastritisdiagnosed（H.pylorivsnon-H.pylorigastritis）isinfluencedbyPPIexposure.H.pyloridensitywasgradedaslow,ifcorrespondingtomilddensityfollowingtheUpdatedSydneySystem,orhigh,ifcorrespondingtomoderateorseveredensitiesintheUpdatedSydneySystem.RESULTS：Patientswereequallydistributedbetweenmalesandfemaleswithamedianageatthetimeofdiagnosisof50yearsold（range：20-87）.ThehistologicaltypesofgastritiswereclassifiedasH.pylorigastritis（n=156,52%）andnon-H.pylorigastritis（n=144,48%）.Allpatientswithnon-H.pylorigastritishadinactivechronicgastritis.PatientswithnopreviousPPIexposureweremorelikelytobediagnosedwithH.pylorigastritisthanthosewithpreviousPPIexposure（71%vs34.2%,P〈0.001）.Intestinalmetaplasiawasmorelikelytobedetectedinthelatterpatients（1.4%vs6.5%,P=0.023）.MultivariateanalysishasalsodemonstratedthatinthepresenceofpreviousPPIexposure（OR=0.217,95%CI：0.123-0.385）,GERD（OR=0.317,95%CI：0.132-0.763,P=0.01）,alcoholintake（OR=0.396,95%CI：0.195-0.804,P=0.01）,thedetectionofH.pyloriwaslesslikely.ChronicuseofPPIsmaymaskH.pyloriinfectionspromotingthediagnosisofnon-H.pylorigastritisandleadstoasi

简介：AIM:Toidentifythosewithamicropapillarypattern,ascertainrelativefrequencyanddocumentclinicopathologicalcharacteristicsbyreviewinggastriccarcinomas.METHODS:Onehundredandfifty-onepatientsdiagnosedwithgastriccancerwhounderwentgastrectomywereretrospectivelystudiedandthepresenceofaregionalinvasivemicropapillarycomponentwasevaluatedbylightmicroscopy.Allavailablehematoxylin-eosin(HE)-stainedslideswerehistologicallyreviewedand5tumorswereselectedasp...

简介：AIM:Tostudyhowlymphnodemetastasis(LNM)riskisstratifiedinundifferentiated-typeearlygastriccancer(undiff-EGC)dependentoncombinationsofriskfactors.METHODS:Fivehundredandsixty-sevencaseswithundiff-EGCundergoinggastrectomywithlymphadenectomywereexaminedretrospectively.Usingclinicopathologicalfactorsofpatientage,location,size,anendoscopicmacroscopictumorform,ulceration,depth,histology,lymphaticinvolvement(LI)andvenousinvolvement(VI),LNMriskwasexaminedandstratifiedbyconventionalstatisticalanalysisanddatamininganalysis.RESULTS:LNMwaspositivein44of567cases(7.8%).Univariateanalysisrevealed>2cm,protrusion,submucosal(sm),mixedtype,LIandVIassignificantprognosticfactorsand>2cmandLI-positivewereindependentfactorsbymultivariateanalysis.InpreoperativelyevaluablefactorsexcludingLVI,smand>2cmwereindependentfactors.Accordingtothedepthandsize,caseswerecategorizedintothelow-riskgroup[mand≤2cm,0%(LNMincidence)],themoderateriskgroup(mand>2cm,5.6%;andsmand≤2cm,6.0%),andthehigh-riskgroup(smand>2cm,19.3%).Ontheotherhand,LNMoccurredin1.4%inallLI-negativecases,greatlylowerthan28.2%inallLI-positivecases,andLNMincidencewaslowinLInegativecaseseveninthemoderate-andhigh-riskgroups.CONCLUSION:LNM-relatedfactorsinundiff-EGCweredepthandsizepreoperativelywhilethosewereLIandsizepostoperatively.Amongthesefactors,LIwasthemostsignificantlycorrelatedfactor.

简介：SinceMurakamidefinedearlygastriccancer(EGC)asa'carcinomalimitedtothegastricmucosaand/orsubmucosaregardlessofthelymphnodestatus',severalauthorshavefocusedonthemostinfluentialhistopathologicalparametersforpredictingthedevelopmentoflymphnodemetastasesbyconsideringthelymphnodestatusasanimportantprognosticfactor.AfewauthorshavealsoconsideredthedepthofinvasionasoneofthekeystoexplainingtheexistenceofsubgroupsofpatientsaffectedbyEGCwithpoorprognoses.Inanycase,EGCisstillconsideredaninitialphaseoftumorprogressionwithgoodprognosis.Theintroductionofmodernendoscopicdeviceshasallowedaprecisediagnosisofearlylesions,whichcanleadtoimproveddefinitionsoftumorsthatcanberadicallytreatedwithendoscopicmucosalresectionorendoscopicsubmucosaldissection(ESD).Giventhewidespreaduseofthesetechniques,theJapaneseGastricCancerAssociation(JGCA)identifiedin2011thestandardcriteriathatshouldexcludethepresenceoflymphnodemetastases.Atthattime,EGCswithnodalinvolvementshouldhavebeenassertedasnolongerfittingthedefinitionofanearlytumor.Someauthorshavealsodemonstratedthatthemorphologicalgrowthpatternofatumor,accordingtoKodama'sclassification,isoneofthemostimportantprognosticfactors,therebysuggestingtheneedtoreportitinhistopathologicaldrafts.NotwithstandingtheacquiredknowledgeregardingtheclinicalbehaviorofEGC,Murakami'sdefinitionisstillbeingused.Thisdefinitionneedstobeupgradedaccordingtothemodernstagingofthediseasesothattheappropriatetreatmentwouldbeselected.

简介：AIM:Toinvestigatetheefficacyofneoadjuvantchemoradiotherapy(NACRT)forresectabilityoflocallyadvancedgastriccancer(LAGC).METHODS:BetweenNovember2007andJanuary2014,29patientswithLAGC(clinicallyT3withdistalesophagusinvasion/T4orbulkyregionalnodemetastasis)thatweretreatedwithNACRTfollowedbyD2gastrectomywereincludedinthisstudy.ResectabilitywasevaluatedwithradiologicandendoscopicexamsbeforeandafterNACRT.Usingthreedimensionalconformalradiotherapy,patientsreceived45Gy,withadailydoseof1.8Gy.Theentiretumorextentandtheregionalmetastaticlymphnodeswereincludedinthegrosstumorvolume.PatientspresentingwitharesectabletumorafterNACRTreceivedatotalorsubtotalgastrectomywithD2dissection.ThepathologictumorresponsewasevaluatedusingJapaneseGastricCancerAssociationhistologicevaluationcriteria.PostoperativemorbiditywasevaluatedusingtheNationalCancerInstitute-CommonTerminologyCriteriaforAdverseEventsversion4.0.Overallsurvival(OS)andprogression-freesurvival(PFS)rateswereestimatedusingaKaplan-Meieranalysisandcomparedusingthelog-ranktest.RESULTS:Allpatientswereassessedasunresectablecases.Twenty-fourpatients(24/29;82.8%)showedLAGConpositronemissiontomography-computedtomography(CT)andcontrast-enhancedCT,whereasfourpatients(4/29;13.8%)withvagueinvasionorabutmenttoanadjacentorganunderwentdiagnosticlaparoscopy.Onepatient(1/29;3.4%),initiallyassessedasaresectablecase,underwentan'openandclosure'afterthetumorwasfoundtobeunresectable.Abutmenttoanadjacentorgan(34.5%)wasthemostcommonreasonforNACRT.TheclinicalresponserateonemonthafterNACRTwas44.8%.AfterNACRT,69%(20/29)ofpatientshadaresectabletumor.Ofthe20patientswitharesectabletumor,18patients(62.1%)underwentaD2gastrectomy.TheR0resectionratewas94.4%andtwopatients(2/18;11.1%)showedacompleteresponse.Themedianfollow-updurationwas13.5mo.Theone-yearOSandPFS

简介：AIMToevaluatewhetherindividualswithgastriccancer（GC）arediagnosedearlieriftheyhavefirstdegreerelativeswithGC.METHODS：Atotalof4282patientsdiagnosedwithGCatNationalCancerCenterHospitalfrom2002to2012wereenrolledinthisretrospectivestudy.Weclassifiedthepatientsaccordingtopresenceorabsenceoffirst-degreefamilyhistoryofGCandcomparedageatdiagnosisandclinicopathologiccharacteristics.Inaddition,wefurtherclassifiedpatientsaccordingtospecificfamilymemberwithGC（father,mother,sibling,oroffspring）andcomparedageatGCdiagnosisamongthesepatientgroups.Baselinecharacteristicswereobtainedfromaprospectivelycollecteddatabase.Informationaboutthefamilymember＇sageatGCdiagnosiswasobtainedbyquestionnaire.RESULTS：Atotalof924patients（21.6%）hadafirstdegreefamilyhistoryofGC.ThemeanageatGCdiagnosisinpatientshavingpaternalhistoryofGCwas54.4±10.4yearsandwassignificantlyyoungerthaninthosewithoutafirst-degreefamilyhistory（58.1±12.0years,P〈0.001）.However,thisfindingwasnotobservedinpatientswhohadanaffectedmother（57.2±10.0years）orsibling（62.2±9.8years）.Amongpatientswithfamilymemberhavingearly-onsetGC（〈50yearsold）,meanageatdiagnosiswas47.7±10.3yearsforthosewithanaffectedfather,48.6±10.4yearsforthosewithanaffectedmother,and57.4±11.5yearsforthosewithanaffectedsibling.Thus,patientswithaparentdiagnosedbefore50yearsofagedevelopedGC10.4or9.5yearsearlierthanindividualswithoutafamilyhistoryofGC（bothP〈0.001）CONCLUSION：Early-onsetGCbeforeageof50wasassociatedwithparentalhistoryofearly-onsetofGC.Individualhavingsuchfamilyhistoryneedtostartscreeningearlier.

简介：AIM:Toanalyzethemismatchrepair(MMR)statusandtheARID1Aexpressionaswellastheirclinicopathologicalsignificanceingastricadenocarcinomas.METHODS:WeexaminedtheexpressionsofMMRproteinsandARID1Abyimmunohistochemistryinconsecutive489primarygastricadenocarcinomas.Theresultswerefurthercorrelatedwithclinicopathologicalvariables.RESULTS:ThelossofanyMMRproteinexpression,indicativeofMMRdeficiency,wasobservedin38cases(7.8%)andwassignificantlyassociatedwithanolderage(68.6±9.2vs60.4±11.7,P<0.001),afemalesex(55.3%vs31.3%,P=0.004),anantrallocation(44.7%vs25.7%,P=0.021),andadifferentiatedhistology(57.9%vs39.7%,P=0.023).AbnormalARID1Aexpression,includingreducedorlossofARID1Aexpression,wasobservedin109cases(22.3%)andwassignificantlycorrelatedwithlymphaticinvasion(80.7%vs69.5%,P=0.022)andlymphnodemetastasis(83.5%vs73.7%,P=0.042).ThetumorswithabnormalARID1AexpressionmorefrequentlyindicatedMMRdeficiency(47.4%vs20.2%,P<0.001).AmultivariateanalysisidentifiedabnormalARID1Aexpressionasanindependentpoorprognosticfactor(HR=1.36,95%CI:1.01-1.84;P=0.040).CONCLUSION:OurobservationssuggestthattheAIRD1Ainactivationisassociatedwithlymphaticinvasion,lymphnodemetastasis,poorprognosis,andMMRdeficiencyingastricadenocarcinomas.

简介：Objective:Humaninducedpluripotentstem(iPS)cellsexhibitgreatpotentialforgeneratingfunctionalhumancellsformedicaltherapies.Inthispaper,wereportforuseofhumaniPScellslabeledwithfluorescentmagneticnanoparticles(FMNPs)fortargetedimagingandsynergistictherapyofgastriccancercellsinvivo.Methods:HumaniPScellswerepreparedandculturedfor72h.Theculturemediumwascollected,andthenwascoincubatedwithMGC803cells.CellviabilitywasanalyzedbytheMTTmethod.FMNP-labeledhumaniPScellswerepreparedandinjectedintogastriccancer-bearingnudemice.Themousemodelwasobservedusingasmall-animalimagingsystem.Thenudemicewereirradiatedunderanexternalalternatingmagneticfieldandevaluatedusinganinfraredthermalmappinginstrument.Tumorsizesweremeasuredweekly.Results:iPScellsandthecollectedculturemediuminhibitedthegrowthofMGC803cells.FMNP-labeledhumaniPScellstargetedandimagedgastriccancercellsinvivo,aswellasinhibitedcancergrowthinvivothroughtheexternalmagneticfield.Conclusion:FMNP-labeledhumaniPScellsexhibitconsiderablepotentialinapplicationssuchastargeteddual-modeimagingandsynergistictherapyforearlygastriccancer.