Antigens, Tumor-Associated, Carbohydrate ; blood ; Female ; Ganoderma ; Gastrointestinal Neoplasms ; blood ; metabolism ; Humans ; Male ; Middle Aged ; Spores

Gastroenteropancreatic neuroendocrine neoplam (GEP-NEN) is a rare group of tumors with its incidence rising significantly in recent decades. Because of the late presentation of the disease and limitations in conventional biomarkers, about 50% of GEP-NEN patients manifests advanced disease when diagnosed. Therefore, it is vital to identify circulating biomarkers which can not only be used for early diagnosis but also accurately evaluating the biological behavior of GEP-NEN. This review summarizes the advances of circulating biomarkers in diagnosing and evaluating efficacy of treatment in GEP-NEN. Well-known circulating biomarkers include chromogranin A (CgA), pancreastatin (PST), chromogranin B (CgB), neuron-specific enolase (NSE) and pancreatic peptide(PP). Novel biomarkers including circulating tumor cell(CTC), microRNA and NETest are promising biomarkers with potential clinical benefit, but further researches are needed before their clinical applications.
Biomarkers, Tumor ; blood ; Chromogranin A ; blood ; Chromogranin B ; blood ; chemistry ; Gastrointestinal Neoplasms ; blood ; chemistry ; diagnosis ; genetics ; Humans ; MicroRNAs ; blood ; Neoplastic Cells, Circulating ; Neuroendocrine Tumors ; blood ; chemistry ; diagnosis ; genetics ; Pancreatic Neoplasms ; blood ; chemistry ; diagnosis ; genetics ; Pancreatic Polypeptide ; blood ; Phosphopyruvate Hydratase ; blood

BACKGROUND/AIMS: Pyruvate kinase (PK) is a key enzyme of glycolysis. Different isoforms of this enzyme are tissue-specifically expressed (M2-PK, M1-PK, R-PK, L-PK). The concentration of the dimeric M2-PK is increased in a metabolic state of tumor cells. In this case, the dimeric M2-PK is termed Tumor M2-PK. We investigated EDTA-plasma of 73 patients with gastrointestinal (GI) cancer and 61 healthy controls to evaluate its significance in diagnosing GI cancer. METHODS: Plasma Tumor M2-PK was measured using an ELISA assay based on two monoclonal antibodies which specifically react with the dimeric Tumor M2-PK. RESULTS: The sensitivity of Tumor M2-PK was 67.1% for all GI cancers, that of CA 19-9 was 38.4% and that of CEA was 34.3%. The specificity of Tumor M2-PK was 91.8% (cutoff=20 U/mL). Tumor M2-PK showed a high sensitivity in gastric cancer (62.2%), colorectal cancer (66.7%) and bile duct cancer (75.0%). In colorectal cancer, the combination of Tumor M2-PK with CEA resulted in a remarkable increase in the sensitivity (86.2%). The average Tumor M2-PK levels were generally elevated in the metastatic GI cancer patients compared to nonmetastatic patients, especially in stomach cancer with statistical significance (p=0.005). CONCLUSIONS: Tumor M2-PK in EDTA-plasma seems to be a new valuable tumor marker in GI cancer.
Adult ; Aged ; Digestive System Neoplasms/*diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Gastrointestinal Neoplasms/diagnosis ; Humans ; Male ; Middle Aged ; Pyruvate Kinase/*blood ; Sensitivity and Specificity ; Tumor Markers, Biological/*blood

OBJECTIVETo explore the effect of acupuncture-anesthetic composite anesthesia (AACA) on the incidence of postoperative cognitive dysfunction (POCD) and changes of TNF-alpha, IL-1beta, and IL-6 in elderly patients.

METHODSTotally 83 patients undergoing surgical resection of gastrointestinal tumor were randomly assigned to the simple anesthesia group (A group, 41 cases) and the AACA group (B group, 42 cases). Patients in Group A received endotracheal general anesthesia. Those in Group B were induced by acupuncture anesthesia for 30 min by needling at Baihui (DU20), Neiguan (PC6), Zusanli (ST36). The electro-acupuncture (EA) apparatus was connected after arrival of qi, with the wave pattern of density 2/100 Hz. The stimulus intensity was set by patients' tolerance, with the peak current of 5 mA. Then the endotracheal general anesthesia was performed and the EA lasted till the end of the surgery. The cognitive function of all patients was assessed before operation and at day 3 after operation using mini-mental state examination (MMSE). POCD was confirmed if with one or more decreased stand- ard. The peripheral venous blood was collected before anesthesia induction (TO), immediately at the end of surgery (T1), 24 h after operation (T2), and 48 h after operation (T3), and serum concentrations of IL-1beta, IL-6, and TNF-alpha were correspondingly measured using ELISA.

RESULTSThe postoperative anesthesia awakening time was shorter in Group B than in Group A [(20.37 +/- 6.09) min vs (29.24 +/- 7.48) min, P < 0.05]. The remifentanil dose used during the operation was less in Group B than in Group A (P < 0.05). The incidence of POCD at day 3 was lower in Group B than in Group A [10/41 (23.8%) vs 15/42 (36.5%), P < 0.05]. The concentrations of IL-1beta, IL-6, and TNF-alpha at T1-T3 were higher than those at TO in the two groups (P < 0.05). The increment of TNF-alpha and IL-1beta was less in Group B than in Group A (P < 0.05). CONCLUSION AACA could reduce the incidence of POCD and inhibit postoperative release of TNF-alpha, IL-1beta, and IL-6 in elderly patients undergoing colorectal cancer resection.

Acupuncture Analgesia ; Aged ; Cognition Disorders ; etiology ; prevention & control ; Gastrointestinal Neoplasms ; surgery ; Humans ; Interleukin-1beta ; blood ; Interleukin-6 ; blood ; Postoperative Complications ; prevention & control ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVETo study the change of the serum gastrin (GAS) and plasma motilin (MTL) levels as well as the gastric motility in gastric cancer patients after subtotal gastrectomy.

METHODSWe used radioimmunoassay method to detect the levels of serum GAS and plasma MTL in 39 healthy volunteers (control group) and 39 gastric cancer patients before and after gastrectomy (gastric cancer group). Electrogastrography (EGG) was measured at the same time points.

RESULTSThe levels of serum GAS and plasma MTL in gastric cancer group before operation were significantly higher than those in control group (P = 0.000), and the levels of serum GAS and plasma MTL in gastric cancer stage II patients were also significantly higher than those in stage III patients (P <0.05). The levels of serum GAS and plasma MTL in gastric cancer group significantly decreased on the first post-operative day (P = 0.000), but returned to the pre-operative levels on the seventh post-operative day. The incidence of the abnormity of gastric motility in gastric cancer group on the seventh post-operative day was significantly higher than the pre-operation incidence (89.7% vs. 43.6%; chi2 = 18.692, P <0.01).

CONCLUSIONSThe levels of serum GAS and plasma MTL transiently decreased in gastric cancer patients. Subtotal gastrectomy could affect the gastric motility in gastric cancer patients.

Adult ; Aged ; Female ; Gastrectomy ; methods ; Gastrins ; blood ; Gastrointestinal Motility ; physiology ; Humans ; Male ; Middle Aged ; Motilin ; blood ; Radioimmunoassay ; Stomach Neoplasms ; blood ; surgery ; Treatment Outcome

We analyzed the peripheral blood of patients with gastrointestinal tract cancer at different stages to assess the presence of carcinoembryonic antigen (CEA) mRNA by reverse transcriptase-polymerase chain reaction (RT-PCR), which we used as an indicator for micrometastatic malignant cells. A total of 35 gastric, 24 colorectal, 4 esophageal and 4 biliary tract cancer patients and nine normal healthy subjects were studied. No CEA mRNA was detected in the nine normal healthy volunteers. CEA mRNA was detected in 100% (10/10) of metastatic, 33.3% (3/9) of early gastric cancer (EGC), and 18.8% (3/16) resectable gastric cancer patients, respectively. In colorectal cancer, 55.6% (5/9) of metastatic cancers were positive for CEA mRNA, and 26.7% (4/15) Duke stage B/C showed positive. One patient with stage III gastric cancer who was negative CEA mRNA initially and turned positive during follow-up, developed multiple bone metastasis one month later. Another stage III patient, who was positive for CEA mRNA, preoperatively revealed early relapse in two months. These results suggest that the identification of circulating tumor cells using RT-PCR for the detection of CEA mRNA is feasible and this analysis may be a promising tool for early detection of micrometastatic circulating malignant cells in patients with gastrointestinal tract cancer.
Adult ; Aged ; Carcinoembryonic Antigen/blood* ; Colorectal Neoplasms/pathology ; Esophageal Neoplasms/pathology ; Female ; Gastrointestinal Neoplasms/pathology* ; Gastrointestinal Neoplasms/blood ; Human ; Male ; Middle Age ; Neoplasm Circulating Cells* ; Neoplasm Metastasis/diagnosis ; RNA, Messenger/blood ; Reverse Transcriptase Polymerase Chain Reaction ; Stomach Neoplasms/pathology ; Tumor Markers, Biological/blood*

OBJECTIVETo investigate whether ulinastatin can alleviate the side effect in patients with gastrointestinal cancer undergoing adjuvant chemotherapy,and to explore the probable mechanism of its protective efficacy.

METHODSForty consecutive patients with gastrointestinal cancer who underwent surgical operations from May 2004 to October 2004 were recruited. The patients were randomly divided into therapeutic group and control group, receiving ulinastatin 150,000 U per day or 250 ml hydrochloric sodium before chemotherapy for 5 continuous days respectively. The prevalence of side effects and the levels IL-6 and TNF-alpha were compared between the two groups.

RESULTSThere were no differences in the clinicopathological characteristics between the two groups. The prevalences of white blood cell decline (41.2% versus 13.1%), pigmentation (23.5% versus 4.3%), baldness (17.6% versus 4.3%) were higher in the control group than those in therapeutic group (all P< 0.05). In therapeutic group, IL-6 level was significantly decreased after ulinastatin treatment, but not in the control group while the levels of TNF-alpha were not changed in the both groups.

CONCLUSIONUlinastatin can reduce the common side effects of chemotherapy, and the mechanism may be associated with the decrease of IL-6.

Aged ; Chemotherapy, Adjuvant ; methods ; Female ; Gastrointestinal Neoplasms ; drug therapy ; Glycoproteins ; therapeutic use ; Humans ; Interleukin-6 ; blood ; Male ; Middle Aged ; Postoperative Period ; Tumor Necrosis Factor-alpha ; blood

Blue rubber bleb nevus syndrome (BRBNS) is a rare congenital disorder characterized by multiple venous malformations in the skin, soft tissues and gastrointestinal (GI) tract. Patients with this syndrome may develop iron deficiency anemia from chronic GI hemorrhage and require lifelong treatment with iron and blood transfusions. In addition, GI lesions can be treated using endoscopic techniques such as sclerotherapy, band ligation, coagulation, and polypectomy. We describe here the anesthetic management of a 12-year-old male patient with BRBNS for endoscopic polypectomy under general anesthesia.
Anemia, Iron-Deficiency ; Anesthesia ; Blister ; Blood Transfusion ; Child ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Gastrointestinal Neoplasms ; Hemorrhage ; Humans ; Iron ; Ligation ; Male ; Nevus ; Nevus, Blue ; Rubber ; Sclerotherapy ; Skin ; Skin Neoplasms

OBJECTIVETo investigate the angiographic feature and its diagnostic value in gastrointestinal stromal tumor (GIST).

METHODSTwelve patients with pathologically proved GIST underwent angiography using PUCK and DSA one week before operation. The origin, size, morphology and angiographic appearance of the lesion were retrospectively analyzed.

RESULTSIt was found that two tumors originated from stomach, eight from jejunum, and two from ileum. Seven cases were benign but five malignant. Obviously thickened and enlarged feeding artery was detected in eight tumors, and early-developed vein was found in three. Two types of angiographic changes of GIST were observed: 1) twisted irregular neoplastic vessels with partially coarse and indistinct margin were found in four cases, which were all malignant; 2) ball-like neoplastic vessels with homogeneous stain in tumor were found in eight cases, seven of them were benign but one was malignant.

CONCLUSIONAngiography may be helpful in localization and diagnosis as well as defining the size of GIST, and especially in patients with melena of unknown origin.

Adult ; Aged ; Angiography ; methods ; Female ; Gastrointestinal Stromal Tumors ; blood supply ; diagnostic imaging ; Humans ; Jejunal Neoplasms ; blood supply ; diagnostic imaging ; Male ; Mesenteric Arteries ; diagnostic imaging ; Middle Aged ; Stomach Neoplasms ; blood supply ; diagnostic imaging

BACKGROUNDAs the clinical value of cytokeratin-19 (CK19) and thymidine kinase-1 (TK1) in advanced gastrointestinal cancer remains controversial, we investigated their expression and clinical significance in this disease.

METHODSA total of 171 advanced gastrointestinal cancer patients were prospectively enrolled in this study. The mRNA level of CK19 was detected using quantitative real-time reverse transcription-polymerase chain reaction (PCR) in all patients, along with a control group of fifty healthy individuals. Furthermore, detection of TK1 protein was carried out in 96 patients using a chemiluminescence dot blot assay. The primary endpoint was overall survival (OS) time.

RESULTSPositive CK19 mRNA expression was detected in 74 (43.3%) of the 171 patients and positive TK1 expression was detected in 66 (68.8%) of the 96 patients. Furthermore, of the 96 patients, 36 (37.5%) were positive for both TK1 protein and CK19 mRNA, 30 (31.3%) were negative for TK1 protein, and 15 (15.6%) were negative for TK1 protein and positive for CK19 mRNA. The results indicated that patients who were positive for CK19 mRNA expression had significantly shorter OS times than those who were negative for it (median OS 7.7 vs. 9.7 months, respectively; P = 0.02). Moreover, patients who were positive for CK19 mRNA and TK1 protein expression had shorter OS times (median OS 6.1 months) than those who were positive for CK19 mRNA and negative for TK1 protein expression (median OS 9.1 months; P = 0.028). Positive CK19 mRNA expression was significantly associated with shorter OS in the univariate analysis (P = 0.027). Based on a multivariate Cox regression analysis, CK19 mRNA together with TK1 protein expression (P = 0.024) was an independent predictor for OS in gastrointestinal cancer patients.

CONCLUSIONSOur results suggest that positive expression of CK19 mRNA and TK1 protein is closely correlated with poor prognosis in advanced gastrointestinal cancer. Furthermore, both CK19 and TK1 are possible gastrointestinal cancer biomarkers.

Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor ; blood ; genetics ; Female ; Gastrointestinal Neoplasms ; blood ; genetics ; mortality ; Humans ; Keratin-19 ; blood ; genetics ; Male ; Middle Aged ; Prospective Studies ; Thymidine Kinase ; blood ; genetics