Multimodal treatment of gastric cancer in the west: Where are we going?

The incidence of gastric cancer (GC) is decreasing worldwide, especially for intestinal histotype of the distal third of the stomach. On the contrary, proximal location and diffuse Lauren histotype have been reported to be generally stable over time. In the west, no clear improvement in long-term results was observed in clinical and population-based studies. Results of treatment in these neoplasms are strictly dependent on tumor stage. Adequate surgery and extended lymphadenectomy are associated with good long-term outcome in early-stage cancer; however, results are still unsatisfactory for advanced stages (III and IV), for which additional treatments could provide a survival benefit. This implies a tailored approach to GC. The aim of this review was to summarize the main multimodal treatment options in advanced resectable GC. Perioperative or postoperative treatments, including chemotherapy, chemoradiotherapy, targeted therapies, and hyperthermic intraperitoneal chemotherapy have been reviewed, and the main ongoing and completed trials have been analyzed. An original tailored multimodal approach to non-cardia GC has been also proposed

2-Dimensional ultra-high performance liquid chromatography and DMT-MM derivatization paired with tandem mass spectrometry for comprehensive serum N-glycome characterization.

Glycosylation is a prominent co- and post-translational modification which contributes to a variety of important biological functions. Protein glycosylation characteristics, particularly N-glycosylation, are influenced by changes in one's pathological state, such as through the presence of disease, and as such, there is great interest in N-glycans as potential disease biomarkers. Human serum is an attractive source for N-glycan based biomarker studies as circulatory proteins are representative of one's physiology, with many serum proteins containing N-glycosylation. The difficulty in comprehensively characterizing the serum N-glycome arises from the absence of a biosynthetic template resulting in great structural heterogeneity and complexity. To help overcome these challenges we developed a 2-dimensional liquid chromatography platform which utilizes offline weak anion exchange (WAX) chromatography in the first dimension and hydrophilic interaction liquid chromatography (HILIC) in the second dimension to separate N-glycans by charge, corresponding to degree of sialylation, and size, respectively. Performing these separations offline enables subsequent derivatization with 4-(4,6-Dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride (DMT-MM) for sialic acid linkage determination and the identification of sialic acid linkage isomers. Subsequent tandem mass spectrometry analysis revealed the identification of 212 complete and partial N-glycan structures including low abundant N-glycans containing acetyl and sulphate modifications. The identifications obtained through this platform were then applied to N-glycans released from a set of stage 3 gastric cancer serum samples obtained from patients before (pre-op) and after (post-op) tumour resection to investigate how the serum N-glycome can facilitate differentiation between the two pathological states

Distinct element geomechanical modelling of the formation of sinkhole clusters within large-scale karstic depressions

The 2-D distinct element method (DEM) code (PFC2D_V5) is used here to simulate the evolution of subsidence-related karst landforms, such as single and clustered sinkholes, and associated larger-scale depressions. Subsurface material in the DEM model is removed progressively to produce an array of cavities; this simulates a network of subsurface groundwater conduits growing by chemical/mechanical erosion. The growth of the cavity array is coupled mechanically to the gravitationally loaded surroundings, such that cavities can grow also in part by material failure at their margins, which in the limit can produce individual collapse sinkholes. Two end-member growth scenarios of the cavity array and their impact on surface subsidence were examined in the models: (1) cavity growth at the same depth level and growth rate; (2) cavity growth at progressively deepening levels with varying growth rates. These growth scenarios are characterised by differing stress patterns across the cavity array and its overburden, which are in turn an important factor for the formation of sinkholes and uvala-like depressions. For growth scenario (1), a stable compression arch is established around the entire cavity array, hindering sinkhole collapse into individual cavities and favouring block-wise, relatively even subsidence across the whole cavity array. In contrast, for growth scenario (2), the stress system is more heterogeneous, such that local stress concentrations exist around individual cavities, leading to stress interactions and local wall/overburden fractures. Consequently, sinkhole collapses occur in individual cavities, which results in uneven, differential subsidence within a larger-scale depression. Depending on material properties of the cavity-hosting material and the overburden, the larger-scale depression forms either by sinkhole coalescence or by widespread subsidence linked geometrically to the entire cavity array. The results from models with growth scenario (2) are in close agreement with surface morphological and subsurface geophysical observations from an evaporite karst area on the eastern shore of the Dead Sea

Shear wave reflection seismic yields subsurface dissolution and subrosion patterns: application to the Ghor Al-Haditha sinkhole site, Dead Sea, Jordan

Near-surface geophysical imaging of alluvial fan settings is a challenging task but crucial for understating geological processes in such settings. The alluvial fan of Ghor Al-Haditha at the southeast shore of the Dead Sea is strongly affected by localized subsidence and destructive sinkhole collapses, with a significantly increasing sinkhole formation rate since ca. 1983. A similar increase is observed also on the western shore of the Dead Sea, in correlation with an ongoing decline in the Dead Sea level. Since different structural models of the upper 50 m of the alluvial fan and varying hypothetical sinkhole processes have been suggested for the Ghor Al-Haditha area in the past, this study aimed to clarify the subsurface characteristics responsible for sinkhole development. For this purpose, high-frequency shear wave reflection vibratory seismic surveys were carried out in the Ghor Al-Haditha area along several crossing and parallel profiles with a total length of 1.8 and 2.1 km in 2013 and 2014, respectively. The sedimentary architecture of the alluvial fan at Ghor Al-Haditha is resolved down to a depth of nearly 200 m at a high resolution and is calibrated with the stratigraphic profiles of two boreholes located inside the survey area. The most surprising result of the survey is the absence of evidence of a thick (> 2–10 m) compacted salt layer formerly suggested to lie at ca. 35–40 m depth. Instead, seismic reflection amplitudes and velocities image with good continuity a complex interlocking of alluvial fan deposits and lacustrine sediments of the Dead Sea between 0 and 200 m depth. Furthermore, the underground section of areas affected by sinkholes is characterized by highly scattering wave fields and reduced seismic interval velocities. We propose that the Dead Sea mud layers, which comprise distributed inclusions or lenses of evaporitic chloride, sulfate, and carbonate minerals as well as clay silicates, become increasingly exposed to unsaturated water as the sea level declines and are consequently destabilized and mobilized by both dissolution and physical erosion in the subsurface. This new interpretation of the underlying cause of sinkhole development is supported by surface observations in nearby channel systems. Overall, this study shows that shear wave seismic reflection technique is a promising method for enhanced near-surface imaging in such challenging alluvial fan settings

Joint interpretation of explosive and vibroseismic surveys on cold firn for the investigation of ice properties

Two seismic surveys were carried out on the high-altitude glacier saddle, Colle Gnifetti, Monte Rosa, Italy/Switzerland. Explosive and vibroseismic sources were tested to explore the best way to generate seismic waves to deduce shallow and intermediate properties (<100 m) of firn and ice. The explosive source (SISSY) excites strong surface and diving waves, degrading data quality for processing; no englacial reflections besides the noisy bed reflector are visible. However, the strong diving waves are analyzed to derive the density distribution of the firn pack, yielding results similar to a nearby ice core. The vibrator source (ElViS), used in both P-and SH-wave modes, produces detectable laterally coherent reflections within the firn and ice column.We compare these with ice-core and radar data. The SH-wave data are particularly useful in providing detailed, high-resolution information on firn and ice stratigraphy. Our analyses demonstrate the potential of seismic methods to determine physical properties of firn and ice, particularly density and potentially also crystal-orientation fabric

Influence of ice crystal anisotropy on seismic velocity analysis

In 2010 a reflection seismic survey was carried out on the Alpine glacier Colle Gnifetti. The processed and depth-converted data could be compared to a nearby ice core, drilled almost to the bed. Comparisons showed that the depth of the P-wave bed reflection was too shallow, while the depth of the SH-wave bed reflection fitted the ice-core length well. We are now able to explain the major part of these differences using the existing crystal orientations of the ice at Colle Gnifetti. We calculate anisotropic velocities for P- and SH-waves that are usually picked for stacking and compare them with zero-offset velocities needed for the depth conversion. Here we take the firn pack at Colle Gnifetti into account for P- and S-wave analysis. To incorporate the S-wave analysis we first derive a new equation for the relationship between density and S-wave velocity from diving waves. We show that anisotropic fabrics observed at Colle Gnifetti introduce a difference of only 1% between stacking and depthconversion velocities for the SH-wave, but 7% for the P-wave. We suggest that this difference in stacking and depth-conversion velocity for the P-wave can be used to derive information about the existing anisotropy by combining our seismic data with, for example, radar data

Meta-analysis of microsatellite instability in relation to clinicopathological characteristics and overall survival in gastric cancer

Background: Several associations between microsatellite instability (MSI) and other clinicopathological factors have been reported in gastric cancer, but the results have been ambiguous. This systematic review and meta-analysis investigated the relationship between MSI and overall survival and clinicopathological characteristics of patients with gastric cancer. Methods: A systematic literature search of the PubMed, Cochrane and Ovid databases until 31 January 2016 was performed in accordance with the PRISMA statement. The articles were screened independently according to PICO (population, intervention, comparator, outcome) eligibility criteria. All eligible articles were evaluated independently by two reviewers for risk of bias according to the Quality In Prognosis Study tool. Results: Overall, 48 studies with a total of 18 612 patients were included. MSI was found in 9·2 per cent of patients (1718 of 18 612), and was associated with female sex (odds ratio (OR) 1·57, 95 per cent c.i. 1·31 to 1·89; P<0·001), older age (OR 1·58, 2·20 to 1·13; P<0·001), intestinal Laure´n histological type (OR 2·23, 1·94 to 2·57; P<0·001), mid/lower gastric location (OR 0·38, 0·32 to 0·44; P<0·001), lack of lymph node metastases (OR 0·70, 0·57 to 0·86, P<0·001) and TNM stage I-II (OR 1·77, 1·47 to 2·13; P<0·001). The pooled hazard ratio for overall survival of patients with MSI versus those with non-MSI gastric cancer from 21 studies was 0·69 (95 per cent c.i. 0·56 to 0·86; P<0·001). Conclusion: MSI in gastric cancer was associated with good overall survival, reflected in several favourable clinicopathological tumour characteristics

Preoperative oral immunonutrition in gastrointestinal surgical patients: How the tumour microenvironment can be modified

Background &amp; aims: This study is focused on the impact of enteral immunonutrition on the cell-mediated immune response in the microenvironment of gastric and colorectal cancers. Methods: This is a prospective pilot study approved by the local Ethics Committee. The immunophenotypic structure of the immune cells before (on the biopsy) and after (on the surgical sample) the administration of the immunonutrition in 16 patients is compared with 8 patients receiving regular diet. The samples of non-tumour tissue from sleeve-gastrectomy are used as non-neoplastic control. Antibodies were tested: CD4, CD8, PD-1, FOX-P3, CD68, CD163, CD80, CD21, CD56, PD-L1. We applied already well-known scoring systems for the evaluation of the immunohistochemistry and compared our data in the different groups by statistical analysis. Results: In treated patients, we detected a modulation of the immune response with higher number of cytotoxic and helper T-lymphocytes in the tumour microenvironment of the surgical specimens compared to the pre-operative biopsy, and a lower number of lymphocytes presenting an exhausted (i.e. double positive CD8 and PD-1 lymphocytes) and regulatory (i.e. double positive CD4 and FOX-P3 lymphocytes) phenotype. Moreover we observed the M1 polarization with a lower number of CD163 positive macrophages and the inhibition of the PD-1/PD-L1 pathway in treated patients. Conclusions: The immunonutrition impacts on the tumoral microenvironment of gastric and colorectal cancer activating the inflammatory pathway, in terms of humoral and cellular response. © 2020 European Society for Clinical Nutrition and Metabolis