活动性嗜酸粒细胞性食管炎患者血嗜酸性粒细胞 ICAM-1 低表达。
- 作者列表："Pérez-Lucendo I","Gómez Torrijos E","Donado P","Melero R","Feo-Brito F","Urra JM
BACKGROUND AND OBJECTIVE:Eosinophilic esophagitis (EoE) is a chronic and isolated inflammation of the esophagus, defined by an important infiltration of eosinophilic leukocytes. Only the histopathological study determines the diagnosis and evolution of the disease. Therefore, patients must undergo a large number of esophageal biopsies, with the risk involved in the procedure and the necessary resources. Objective: The presence of active circulating eosinophils, quantifiable through the expression of specific proteins of cellular activation in their membrane, could be a concordant parameter with the histopathological findings that are currently the only valid parameters in EoE studies. METHODS:The activity of peripheral blood eosinophils from patients with EoE was analyzed by identifying five surface molecules (CD69, IL-5Rα, CD44, ICAM-1, CD63) expressed by the active eosinophils by flow cytometry. The results were compared with the infiltrate of eosinophils present in patient's esophageal biopsies. RESULTS:ICAM-1 significantly reduced in patients with active EoE compared to no active EoE patients, allergic patients and healthy controls. In these patients, an inverse correlation between the number of eosinophils present in the esophageal biopsy and the percentage of ICAM-1 expression in peripheral blood eosinophils was observed. For the rest of the molecules studied no difference was observed. CONCLUSION:The expression of ICAM-1 in blood eosinophils could be a non-invasive marker useful for the diagnosis and assessment of patients with EoE.
背景和目的: 嗜酸性粒细胞性食管炎 (EoE) 是一种慢性、孤立的食管炎症，定义为嗜酸性粒细胞的重要浸润。只有组织病理学研究决定了疾病的诊断和演变。因此，患者必须接受大量食管活检，手术涉及的风险和必要的资源。目的: 存在活跃的循环嗜酸性粒细胞，可通过其膜中细胞活化的特定蛋白的表达来定量, 可能是与组织病理学结果一致的参数，是 EoE 研究中目前唯一有效的参数。 方法: 采用流式细胞术鉴定 EoE 患者外周血中 5 种表面分子 (CD69 、 il-5r α 、 CD44 、 ICAM-1 、 CD63) 的表达，分析 EoE 患者外周血嗜酸性粒细胞的活性。将结果与患者食管活检中存在的嗜酸性粒细胞浸润进行比较。 结果: 与无活动性 EoE 患者、过敏患者和健康对照组相比，活动性 EoE 患者的 ICAM-1 显著降低。在这些患者中，观察到食管活检中存在的嗜酸性粒细胞数量与外周血嗜酸性粒细胞中 ICAM-1 表达的百分比呈负相关。对于研究的其余分子，未观察到差异。 结论: 血液中嗜酸性粒细胞 ICAM-1 的表达可作为诊断和评估 EoE 患者病情的无创性指标。
METHODS:PURPOSE:The purpose of this study was to compare the survival and toxicities in cervical esophageal squamous cell carcinoma (CESCC) treated by concurrent chemoradiothrapy with either three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) techniques. Materials and Methods:A total of 112 consecutive CESCC patients were retrospectively reviewed. 3D-CRT and IMRT groups had been analyzed by propensity score matching method, with sex, age, Karnofsky performance status, induction chemotherapy, and tumor stage well matched. The Kaplan-Meier method and Cox proportional hazards model were used for overall survival (OS) and progression-free survival (PFS). Toxicities were compared between two groups by Fisher exact test. RESULTS:With a median follow-up time of 34.9 months, the 3-year OS (p=0.927) and PFS (p=0.859) rate was 49.6% and 45.8% in 3D-CRT group, compared with 54.4% and 42.8% in IMRT group. The rates of grade ≥ 3 esophagitis, grade ≥ 2 pneumonitis, esophageal stricture, and hemorrhage were comparable between two groups, while the rate of tracheostomy dependence was much higher in IMRT group than 3D-CRT group (14.3% vs.1.8%, p=0.032). Radiotherapy technique (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.01 to 0.79) and pretreatment hoarseness (HR, 0.12; 95% CI 0.02 to 0.70) were independently prognostic of tracheostomy dependence. CONCLUSION:No survival benefits had been observed while comparing IMRT versus 3D-CRT in CESCC patients. IMRT with fraction dose escalation and pretreatment hoarseness were considered to be associated with a higher risk for tracheostomy dependence. Radiation dose escalation beyond 60 Gy should be taken into account carefully when using IMRT with hypofractionated regimen.
METHODS::The radial force of esophageal stents may not completely change during extraction and therefore, the procedure of stent removal may cause tissue damage. The present study reports the manufacture of 2 novel detachable stents, which were designed to reduce tissue damage through their capacity to be taken or fall apart prior to removal and evaluated the supporting properties of these stents and the extent of local mucosal injury during their removal. The stents were manufactured by braiding, heat-setting, coating and connecting. The properties of the stents were evaluated by determining the following parameters: Expansion point, softening point, stent flexibility, radial compression ratio and radial force. A total of 18 rabbits with induced esophageal stricture were randomly assigned to 3 groups as follows: Detachable stent (DS) group, biodegradable stent (BS) group and control group. The stricture rate, complications, survival, degradation and stent removal were observed over 8 weeks. The stents of the DS and BS groups provided a similar supporting effect. The stricture rate, incidence of complications and survival were also similar between the 2 groups, while significant differences were noted between the DS and control groups and between the BS and control groups. In the BS group, the stents were degraded and moved to the stomach within 7 weeks (2 in 6 weeks and 3 in 7 weeks). The debris was extracted using biopsy forceps. In the DS group, all stents were easy to remove and 2 cases exhibited minor hemorrhage. In conclusion, the 2 types of novel detachable stent provided an equally efficient supporting effect in vitro and in vivo and may reduce the incidence of secondary injury during stent removal.
METHODS:BACKGROUND:Immune imbalance and inflammation have been suggested as key factors of Barrett's esophagus (BE) pathway towards adenocarcinoma. The neutrophil-lymphocyte ratio (NLR) indirectly reflects the relation between innate and adaptive immune systems and has been studied in premalignant conditions as a biomarker for cancer diagnosis. Our aim was to investigate if increasing values of NLR correlated with advancing stages of BE progression to dysplasia and neoplasia. METHODS:We retrospectively analyzed data of patients with biopsies reporting BE between 2013 and 2017 and with a complete blood count within 6 months from the endoscopy, as well as patients with esophageal adenocarcinoma (EAC). NLR was calculated as neutrophil count/lymphocyte count. Cases (n = 113) were classified as non-dysplastic BE (NDBE, n = 72), dysplastic BE (DBE, n = 11) and EAC (n = 30). RESULTS:NLR progressively increased across groups (NDBE, 1.92 ± 0.7; DBE, 2.92 ± 1.1; EAC 4.54 ± 2.9), with a significant correlation between its increasing value and the presence of dysplasia or neoplasia (r = 0.53, p 2.27 was able to diagnose EAC with 80% sensitivity and 71% specificity (area under the curve = 0.8). CONCLUSION:NLR correlates with advancing stages of BE progression, a finding that reinforces the role of immune imbalance in EAC carcinogenesis and suggests a possible use of this marker for risk stratification on surveillance strategies.