Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

p38 mitogen-activated protein kinase (MAPK) signaling has been implicated in the cancer development and progression. However, the precise mechanism of this association remains unknown. The aim of the present study was to evaluate the association between p38 and cancer progression, including investigations into the effects on cell proliferation, resistance to thalidomide, indoleamine 2,3-dioxygenase (IDO) expression and prognosis in patients with esophageal cancer. The present retrospective study included patients with stage I-III esophageal cancer. A total of 228 patients with esophageal cancer were recruited to analyze the expression of phosphorylated (p)-p38 and IDO in tumor, and normal tissues through immunohistochemistry. Depression status was measured using the Zung Self-Rating Depression Scale. P38 cDNA was transfected into esophageal cancer cells to assess tumor cell viability, sensitivity to thalidomide treatment and IDO gene expression. Western blotting and flow cytometry was used to analyze protein expression alterations, and apoptosis in esophageal cancer cells. P-p38 protein was expressed in 68.9% of cancer tissues, and was significantly associated with depressive symptoms, tumor recurrence and poor survival of patients. In vitro experiments revealed that the expression of p-p38 induced esophageal cancer Eca-109 and TE-1 cell viability, and resistance to thalidomide treatment, as well as in the expression of IDO without the application of lipopolysaccharides. Further follow-up of patients revealed that depression was also an independent factor for early recurrence and overall survival rate. Altered p38 MAPK expression was associated with poor outcome in patients with esophageal cancer. p38 may be a potential biomarker for the prediction of depressive symptoms and prognosis in patients with esophageal cancer.
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PMID:p38 predicts depression and poor outcome in esophageal cancer. 2934 59

Although esophagectomy is a standard treatment for esophageal cancer, anastomotic leak after esophagectomy is a relatively common complication and its incidence is 10-25% for cervical anastomosis. Endoscopic vacuum therapy (EVT) is a feasible primary treatment of esophageal perforations and leaks. Currently, there are no anesthesia guidelines for EVT, however, it is usually performed under general anesthesia with endotracheal intubation, especially for cervical EVT. Here, we report a successful EVT under monitored anesthesia care (MAC) without any complication, which doesn't need to intubate the patient. A 64-year-old male with upper esophageal cancer underwent an Ivor-Lewis operation with cervical anastomosis. Vacuum assisted closure (VAC) was performed for cervical leak under general anesthesia, but there was no further improvement. Although EVT was attempted under sedation with midazolam in an endoscopy room, the procedure was discontinued because of desaturation. Furthermore, the thoracic surgeon was concerned about the possibility of dyspnea and hypoxia even after the procedure. EVT was scheduled under MAC at the request of a thoracic surgeon and medical doctor, as EVT was expected to lead to patient discomfort and difficult airway. EVT was performed successfully with no respiratory depression or patient movement using target controlled infusion with 2% propofol and remifentanil. The patient was discharged on the 78th POD without any other complications. EVT for cervical leak after esophagectomy can be successfully performed with MAC, and understanding the general condition of the patient, cooperation with the patient and the surgeon, and providing continuous oxygen supply to the patient are necessary for a successful procedure under MAC.
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PMID:Endoscopic vacuum therapy for cervical leakage following esophagectomy under monitored anesthesia care: a case report. 3318 21


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