Outcome of index upper gastrointestinal endoscopy in patients presenting with dysphagia in a tertiary care hospital-A 10 years review

<p>Abstract</p> <p>Background</p> <p>Patients with malignant tumours of the upper gastrointestinal tract tumours exhibit important alarm symptoms such as dysphagia that warrant clinical investigations. An endoscopic examination of the upper gastrointestinal tract will be required in most cases. This study evaluates the diagnostic potential of index endoscopy in a random population of patients with dysphagia.</p> <p>Methods</p> <p>This is a retrospective analysis of prospectively collected data over 10 years. Patients with previous endoscopic evaluation or upper gastrointestinal pathology were excluded from the study. Data was analysed to see the number and frequency of abnormal findings in upper gastrointestinal tract, and their significance in relation to the presenting symptoms.</p> <p>Results</p> <p>Total number of index endoscopies was 13, 881. 913 patients were included in the study including 465 males (age range: 17–92 years, median: 55 years) and 448 females (age range: 18–100, median: 59 years), with male to female ratio of 1.04: 1. Oesophagus was abnormal in 678 cases (74%) and biopsies were taken in 428 patients (47%). Superficial oesophagitis, Barrett's oesophagus, oesophageal cancer, and oesophageal ulcer were main histological findings. Age more than 50 years and weight loss were significant predictors of oesophageal cancer (p < 0.0001). Male gender, heartburn, epigastric pain, weight loss and vomiting were significantly related to Barrett's oesophagus. A total of 486 gastric and 56 duodenal biopsies were also taken. There were 20 cases of gastric adenocarcinoma.</p> <p>Conclusion</p> <p>OGD is an effective initial investigation to assess patients with dysphagia, especially males above the age of 50 years. Patients may be started on treatment or referred for further investigations, for example, a barium meal in the absence of any anatomical abnormality.</p

Cancer stem cells, the ultimate targets in cancer therapy

Ahmed Shabbir,1 Tuba Esfandyari,2 Faris Farassati1,3,4 1Midwest Biomedical Research Foundation, Kansas City Veterans Affairs Medical Center, 2Department of Medicine, School of Medicine, The University of Kansas, 3Saint Luke&rsquo;s Cancer Institute, 4Saint Luke&rsquo;s Marion Bloch Neuroscience Institute, Saint Luke&rsquo;s Health System, Kansas City, MO, USAThe concept of cancer stem cells (CSCs) is currently of significant interest due to its important implications in our understanding of the tumor biology as well as development of novel cancer therapeutics. Tumors, in resemblance to normal organs, contain pluripotential cells that can generate their own kind as well as cells that can further differentiate. CSCs are thought to be highly resistant to the cytotoxic effects of conventional cancer therapy regimens,1 which leads to the rise of a refractory status in tumors.1,2 Therefore, CSCs can be considered as the main drivers of tumor integrity and function. This resembles the role of normal stem cells in tissue and organ development. Therapeutic assaults that eliminate differentiated cancer cells while leaving CSCs, therefore, are doomed to fail due to the resistance of CSCs and their ability to repopulate the tumor.3 This phenomenon is indeed observed in the clinic routinely. Clinical response to a chemotherapy regimen is reduced over time as the tumor enters a refractory stage induced by enrichment of CSCs in the tumor cell population. This is even observed in cells cultured from a patient at early stage of the disease, such as in colorectal cancer (SW480, ATCC CCL-228), and recurrence of the malignancy results in a wide-spread metastasis (SW620, ATCC CCL-227). The SW260 shows a significantly higher percentage of cells positive for CD133, a marker for CSCs (data from our team). Methods for the detection of CSCs include surface markers such as CD24, CD34, CD44, CD44, CD90, CD133, ABCB5, and EpCAM that have been shown to indicate CSC subpopulations in a range of malignancies.4 Additionally, functional tests, such as detection of side population phenotype by Hoechst 33342 exclusion, the ability to grow as floating spheres in serum-free medium, and ALDH activity, have also been utilized to detect and isolate CSCs

MiR-21-dependent macrophage-to-fibroblast signaling determines the cardiac response to pressure overload.

Background: Cardiac macrophages (cMP) are increasingly recognized as important regulators of myocardial homeostasis and disease, yet the role of noncoding RNA in these cells is largely unknown. Small RNA sequencing of the entire miRNomes of the major cardiac cell fractions revealed microRNA-21 (miR-21) as the single highest expressed microRNA in cMPs, both in health and disease (25% and 43% of all microRNA reads respectively). MiR-21 has been previously reported as a key microRNA driving tissue fibrosis. Here, we aimed to determine the function of macrophage miR-21 on myocardial homeostasis and disease-associated remodeling. Methods: Macrophage-specific ablation of miR-21 in mice driven by Cx3cr1-Cre was used to determine the function of miR-21 in this cell type. As a disease model, mice were subjected to pressure overload for 6 and 28 days. Cardiac function was assessed in vivo by echocardiography, followed by histological analyses and single cell sequencing. Co-cultures of macrophages and cardiac fibroblasts were employed to study macrophage-to-fibroblast signaling. Results: Mice with macrophage-specific genetic deletion of miR-21 were protected from interstitial fibrosis and cardiac dysfunction when subjected to pressure overload of the left ventricle. Single cell sequencing of pressure-overloaded hearts from these mice revealed that miR-21 in macrophages is essential for their polarization towards a M1-like phenotype. Systematic quantification of intercellular communication mediated by ligand-receptor interactions across all cell types revealed that miR-21 primarily determined macrophage-fibroblast communication, promoting the transition from quiescent fibroblasts to myofibroblasts. Polarization of isolated macrophages in vitro towards a pro-inflammatory (M1) phenotype activated myofibroblast transdifferentiation of cardiac fibroblasts in a paracrine manner and was dependent on the rapid induction of miR-21 in cMPs. Conclusions: Our data indicate a critical role of cMPs in pressure overload-induced cardiac fibrosis and dysfunction and reveal macrophage miR-21 as a key molecule for the pro-fibrotic role of cMPs

Including crossbred pigs in the genomic relationship matrix through utilization of both linkage disequilibrium and linkage analysis1

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