Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder, which is uncommon anomaly to recurrent gastrointestinal bleeding. Although there are several forms of therapy ranging from local therapy to operations or drug therapy, there is a lack of more effective treatment for the disease. In this report, we presented a Chinese patient with recurrent melena due to gastric angiodysplasia in HHT treated successfully with thalidomide.
Pancreatic ductal adenocarcinoma (PDAC) can occur in different parts of the pancreas. This study aimed to identify clinicopathological characteristics independently correlated with the prognosis of PDAC of the pancreatic head/uncinate (PHC) or body-tail (PBTC), and to develop novel nomograms for predicting cancer-specific survival (CSS) according to different primary cancer locations.1160 PDAC patients were retrospectively enrolled and assigned to training and test sets with each set divided into PHC and PBTC groups. Comparative analysis of clinicopathologic characteristics, survival analysis, and multivariate analysis were performed. Independent factors were identified and used for constructing nomograms. The performance of the nomograms was validated in the test set.Primary tumor location was an independent risk factor for prognosis of PDAC after surgery. Specially, gender, fasting blood glucose, and preoperative cancer antigen 19-9 were significantly associated with prognosis of PHC, whereas age, body mass index, and lymph nodes were significantly correlated with the prognosis of PBTC. A significant difference in prognosis was found between PHC and PBTC in stage Ia and stage III. Three nomograms were established for predicting the prognosis for PDAC, PHC, and PBTC. Notably, these nomograms were calibrated modestly (c-indexes of 0.690 for PDAC, 0.669 for PHC, and 0.704 for PBTC), presented better accuracy and reliability than the 8th AJCC staging system, and achieved clinical validity.PHC and PBTC share the differential clinical-pathological characteristics and survival. The nomograms show good performance for predicting prognosis in PHC and PBTC. Therefore, these nomograms hold potential as novel approaches for predicting survival of PHC and PBTC patients after surgery.
Evidence indicates that metformin and pioglitazone both improve insulin resistance and hirsutism among patient with polycystic ovarian syndrome (PCOS). However, the effectiveness of pioglitazone versus metformin in the treatment of PCOS remains controversial. To summarize the relative efficacy of pioglitazone and metformin in PCOS patients, a systematic review and meta-analysis of randomized controlled trials (RCTs) was performed.The authors searched MEDLINE, EMBASE, CNKI and WANFANG DATA for articles published up to November 2011 to identify those comparing pioglitazone versus metformin as a treatment for PCOS.Of the 161 studies retrieved, six trials were included in this analysis, including a total of 278 women with PCOS. Pioglitazone was found to be significantly more effective than metformin at reducing fasting insulin level (P = 0.002, standardized mean differences [SMD] = -0.37, 95% confidence interval [CI] [-0.61, -0.13]). Similarly, pioglitazone was found to be significantly more effective than metformin at improving the HOMA-IR index (P = 0.014, SMD = -0.32, 95% CI [-0.57, -0.06]). However, pioglitazone was significantly less effective than metformin at reducing body mass index (BMI; P = 0.038, SMD = 0.25, 95% CI [0.01, 0.49]). The effect of pioglitazone on fasting glucose levels, testosterone levels, and Ferriman-Gallwey scores was not significantly different from that of metformin (P greater than 0.05 for all).This systematic review and meta-analysis suggests that pioglitazone was more suitable for treating hyperinsulinemia and insulin resistance among PCOS patients, while metformin was more effective in reducing body weight. Well designed RCTs are needed to provide better evidence.
Objective To summarize the clinical features and surgical treatment experience of primary galildadder carcinoma,and to explore the effects of different procedures on the prognosis and analyze the prognostic factors.Methods The clinical data on 23 patients with gallbladder carcinoma who had been treated in our hospital from June 2006 to June 2010 were reviewed.The association of prognosis with tumor stages and surgical procedures was analyzed.Results 21 patients were followed up.The 6-month survival rate,1 -year survival rate,and 3-year survival rate were 80.95 ％,52.38％,and 28.57％.The three different survival rates were markedly increased in the radical treatment group ( 100.00％,71.48％,and 42.85％ ),as compared with the non-radical group ( P＜ 0.05 ).Conclusions Standard radical surgery for advanced gallbladder carcinoma can significantly improve survival rate.
Key words:
Primary gallbladder carcinoma; Diagnosis; Treatment
Several studies have examined the association between the GCK -30G>A polymorphism and the risk of gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM). However, inferences from these studies are hindered by their limited statistical power and conflicting results. The aim of this meta-analysis is to provide a relatively comprehensive picture of the association of the GCK -30G>A polymorphism with GDM and T2DM risk.A literature search for eligible studies published before August 15, 2013, was conducted in PubMed, Embase, Web of Science, Cochrane Library, and CNKI (China National Knowledge Infrastructure). Pooled odds ratios with their corresponding 95% confidence intervals were used to evaluate the strength of the association under a fixed- or random-effect model according to heterogeneity test results. All analyses were performed using Stata software, version 12.0.Eighteen case-control studies from 17 published reports were included in this meta-analysis with a total of 2011 patients with GDM, 11,057 with T2DM, and 26,102 healthy controls. For GDM, the combined results showed that the risk allele of the -30G>A polymorphism may be associated with an increased risk of GDM. Stratified analyses showed that the magnitude of the effect was especially significant among whites, indicating ethnicity differences for GDM susceptibility. For T2DM, the pooled ORs were not significant in the overall population, although all the ORs >1 suggested an increased risk of T2DM for carriers of the A allele. However, whites seem to be significantly more susceptible to T2DM than Asians.This meta-analysis indicated that the risk allele of the GCK -30G>A polymorphism may increase GDM and T2DM risk in whites, whereas additional studies are needed to confirm the effect of this polymorphism on both diseases in Asians and Africans.
Tumor necrosis factor-alpha (TNF-α), a key player in cancer-related inflammation, was recently demonstrated to be involved in the lymphatic metastasis of gallbladder cancer (GBC). Vascular endothelial growth factor D (VEGF-D) is a key lymphangiogenic factor that is associated with lymphangiogenesis and lymph node metastasis in GBC. However, whether VEGF-D is involved in TNF-α-induced lymphatic metastasis of GBC remains undetermined. The expression of VEGF-D in patient specimens was detected by immunohistochemistry and the relationship between VEGF-D in the tissue and TNF-α in the bile of the matching patients was analyzed. The VEGF-D mRNA and protein levels after treatment with exogenous TNF-α in NOZ, GBC-SD and SGC-996 cell lines were measured by real-time PCR and ELISA. The promoter activity and transcriptional regulation of VEGF-D were analyzed with the relative luciferase reporter assay, mutant constructs, electrophoretic mobility shift assay (EMSA), chromatin immunoprecipitation (ChIP) assay, RNA interference and Western blotting. Inhibitors of JNK, p38 MAPK and ERK1/2 were used to explore the upstream signaling effector of AP-1. We used lentiviral vector expressing a VEGF-D shRNA construct to knockdown VEGF-D gene in NOZ and GBC-SD cells. The role of the TNF-α-VEGF-D axis in the tube formation of human dermal lymphatic endothelial cells (HDLECs) was determined using a three-dimensional coculture system. The role of the TNF-α - VEGF-D axis in lymphangiogenesis and lymph node metastasis was studied via animal experiment. TNF-α levels in the bile of GBC patients were positively correlated with VEGF-D expression in the clinical specimens. TNF-α can upregulate the protein expression and promoter activity of VEGF-D through the ERK1/2 - AP-1 pathway. Moreover, TNF-α can promote tube formation of HDLECs, lymphangiogenesis and lymph node metastasis of GBC by upregulation of VEGF-D in vitro and in vivo. Taken together, our data suggest that TNF-α can promote lymphangiogenesis and lymphatic metastasis of GBC through the ERK1/2/AP-1/VEGF-D pathway.
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