Abstract： Objective To explore the value of serum Dickkopf-related protein 1 （DKK1）for the early diagnosis of esophageal cancer， and provide theoretical evidence for the diagnosis and treatment of esophageal cancer. Methods A total of 145 patients who were admitted to the Affiliated Hospital of Jiangnan University between October 2009 and April 2011 were included in this study and divided into four groups. There were 72 patients in the esophageal cancer group （54 males and 18 females with their median age of 60.4 years），13 patients in the precancerosis group （9 males and 4 females with their median age of 58.6 years），30 patients in the benign esophageal lesion group （23 males and 7 females with their median age of 56.4 years），and 30 healthy people in the volunteer group （19 males and 11 females with their median age of 58.6 years）. Serum DKK1 protein concentration was measured by enzyme linked immunosorbent assay （ELISA）. Receiver operating characteristics （ROC） curve was drawn to determine the cutoff level with optimal diagnostic accuracy. Results Serum DKK1 protein levels were significantly higher in the esophageal cancer group and precancerosis group than those in the volunteer group and benign esophageal lesion group ［（37.5±2.8） μg/L， （19.7±2.7） μg/L vs. （5.7±0.8） μg/L， （6.5±0.8） μg/L，t=47.391， P＜0.05］. There was no statistical difference in serum DKK1 protein level between the volunteer group and benign esophageal lesion group ［（6.5±0.8） μg/L vs. （5.7±0.8） μg/L， t=4.215，P=0.374］. When the level of serum DKK1 protein was 13.4 μg/L， the diagnostic sensitivity and specificity of esophageal cancer were 74.1% and 96.7%， respectively. Conclusion Overexpression of serum DKK1 protein could be related to the pathogenesis and progression of esophageal cancer. DKK1 protein may be a potential serologic biomarker for the early diagnosis of esophageal cancer.
ObjectiveTo explore the expressions of P27Kip1, RalA, and SPOCK1 in cancer tissues of the elderly patients with colorectal cancer (CRC) and the relations between their expressions and clinical pathological characteristics as well as prognosis. MethodsThe clinicopathologic data of elderly CRC patients treated and underwent surgical resection in Kailuan General Hospital Linxi Hospital from May 2019 to May 2022 were collected in a retrospective manner. The immunohistochemistry was used to detect the expressions of P27Kip1, RalA, and SPOCK1 proteins in the CRC tissues and corresponding adjacent tissues. The Kaplan-Meier method was applied to analyze the survival of CRC patients with p27Kip1, RalA, and SPOCK1 positive and negative expressions. The multivariate Cox risk regression model was applied to analyze the influencing factors of prognosis in the patients with CRC. The test level was set as α=0.05. ResultsA total of 149 elderly CRC patients were enrolled. All patients were followed up for 2 years, and 45 cases died of cancer during the follow-up period. The positive rate of p27Kip1 protein expression in the CRC tissues was lower than that in the corresponding adjacent tissues (P<0.05), while the positive rates of RalA and SPOCK1 protein expressions were higher than those in the corresponding adjacent tissues (P<0.05). The proportions of mucinous carcinoma, TNM stages Ⅲ–Ⅳ, low differentiation, positive lymph node metastasis, and T staging T2–T4 in the patients with negative p27Kip1 and positive RalA and SPOCK1 expressions were higher than those in the patients with positive p27Kip1 and negative RalA and SPOCK1 expressions (P<0.05). The proportions of patients with TNM stages Ⅲ–Ⅳ, negative p27Kip1 and positive RalA and SPOCK1 expressions in the death group were higher than that in the survival group (P<0.05). The survival curves plotted by the Kaplan-Meier method showed that the survival curves of patients with positive expression of p27Kip1 and negative expression of RalA and SPOCK1 in the cancer tissues were significantly better than those with negative expression of p27Kip1 and positive expression of RalA and SPOCK1 (respectively: log-rank χ²=11.678, P=0.001; log-rank χ²=10.836, P=0.001; log-rank χ²=10.792, P=0.001). The multivariate Cox proportional hazards regression model analysis revealed that the negative expression of p27Kip1 [HR(95%CI)=2.807(1.490, 5.287)], positive expression of RalA [HR(95%CI)=2.769(1.493, 5.134)], and positive expression of SPOCK1 [HR(95%CI)=3.075(1.610, 5.871)] were independent risk factors for postoperative mortality in CRC patients. ConclusionThe results of this study suggest that the positive rate of p27Kip1 protein expression is low in CRC tissues, while the positive rates of RalaA and SPOCK1 protein expression are high, and the protein expression of these three indicators are associated with tissue type, TNM stage, degree of differentiation, lymph node metastasis, and T stage. Negative expression of p27Kip1 and positive expression of RalA and SPOCK1 are unfavorable for the prognosis of CRC patients.
ObjectiveTo summarize the clinical experience in the prevention and treatment of novel coronavirus (2019-nCoV, SARS-CoV-2) disease (COVID-19) in the department of thoracic surgery of large grade A tertiary hospitals in Wuhan, and to provide feasible clinical practice strategies.MethodsThe clinical data of 41 COVID-19 patients in the department of thoracic surgery of 7 large grade A tertiary hospitals in Wuhan from December 15, 2019 to February 15, 2020 were analyzed retrospectively. There were 20 surgical patients (10 males and 10 females at an average age of 54.35±10.80 years) and 21 medical personnel (7 males and 14 females at an average age of 30.38±6.23 years).ResultsThe main clinical manifestations of COVID-19 patients were fever (70.73%) and cough (53.66%). Normal or reduced peripheral white blood cells and reduced lymphocyte counts were found in the COVID-19 patients, and some patients may have increased C-reactive protein. COVID-19 patients showed limited ground-glass opacities in early chest CT, which was evident in the edge band of lung. The disease could further develop into multiple pulmonary infiltrations, and pulmonary consolidation was found in severe cases. At the time of confirmed diagnosis, most of the medical personnel were ground-glass shadows and unilateral lesions, and even no obvious abnormalities were found in the lungs. The diagnosed COVID-19 patients were transferred to the isolation ward immediately and treated according to the "Diagnosis and Treatment Program of Novel Coronavirus Pneumonia", which was released by the National Health Commission of the People's Republic of China. At the end of follow-up on February 20, 2020, seven surgical patients (35.00%) were discharged and seven (35.00%) were dead, 13 (61.90%) medical personnel were discharged and no death was found.ConclusionsOf all COVID-19 patients in the department of thoracic surgery of hospitals in Wuhan, the proportion of severe degree and mortality in surgical patients are significantly higher than that of the general population, and medical personnel are prone to nosocomial infections. Early oxygen therapy and respiratory support may improve prognosis. During the epidemic period of COVID-19, elective or limited surgery is suggested to be postponed and the indications for emergency operation should be strictly controlled. Emergency operation is suggested to be treated in accordance with tertiary prevention. On the consideration of specialty in the department of thoracic surgery, all people of the ward should be carefully investigated for infection once one case is confirmed with COVID-19. Early detection, isolation, diagnosis, and treatment are the best preventive measures to improve the prognosis of COVID-19.