Esophageal hiatal hernia involves abnormal abdominal entry into thoracic cavity. It is classified based on orientation between esophageal junction and diaphragm. Sliding hiatal hernia (Type-I) comprises the most frequent category, emanating from right crus of diaphragm. Type-II esophageal hernia engages both left and right muscular crura. Type-III and IV additionally include the left crus. Age and increased body mass index are key risk factors, and congenital skeletal aberrations trigger pathogenesis through intestinal malrotations. Familiar manifestations include gastric reflux, nausea, bloating, chest and epigastric discomfort, pharyngeal and esophageal expulsion and dysphagia. Weight loss and colorectal bleeding are severe symptoms. Areas covered: This review summarizes updated evidence of pathophysiology, risk factors, diagnosis and management of hiatal hernias. Laparoscopy and oesophagectomy procedures have been discussed as surgical procedures. Expert commentary: Endoscopy identifies untreatable gastric reflux; radiology is better for pre-operative assessments; manometry measures esophageal peristalsis, and CT scanning detects gastric volvulus and associated organ ruptures. Gastric reflux disease is mitigated using antacids and proton pump and histamine-2-receptor blockers. Severe abdominal penetration into chest cavity demands surgical approaches. Hence, esophagectomy has chances of post-operative morbidity, while minimally invasive laparoscopy entails fewer postoperative difficulties and better visualization of hernia and related vascular damages.

Epigenetic silencing of tumor suppressor genes by promoter methylation plays vital roles in the process of carcinogenesis. The purpose of this meta-analysis was to determine whether the aberrant methylation of cyclin A1 (CCNA1) may be of great significance to human malignant tumors. By searching both English and Chinese language-based electronic databases carefully, we tabulated and analyzed parameters from each study. All human-associated case-control studies were included providing available data for CCNA1 methylation and reporting the adjusted odds ratios (ORs) and 95% confidence intervals (CI) conducted with the use of Version 12.0 STATA software. A total of 10 case-control studies (619 patients with cancers and 292 healthy controls) were included for the following statistical analysis. Pooled OR values from all articles revealed that the frequency of CCNA1 methylation in cancer tissues was significantly higher than those of normal tissues (P < 0.001). Further ethnicity indicated that the frequency of CCNA1 methylation was correlated with the development of malignant tumors among all those included experimental subgroups (all P < 0.05). These data from results indicated a significant connection of CCNA1 methylation with poor progression in human malignant tumors among both Caucasian and Asian populations.

Accumulating evidence has suggested that concentrations of blood-based circulating micro-ribonucleic acids (microRNAs, miRNAs) in breast tumor patients are significantly higher/lower than that in normal individuals, indicating that circulating miRNAs may serve as novel blood-based biomarkers for breast tumor. However, the results of previous studies on this issue have been inconclusive. Therefore, we perform a meta-analysis to determine whether aberrant miRNA expression can be used as molecular markers in blood for the diagnosis of breast tumor. PubMed and other databases were searched to identify eligible studies. The sensitivity and specificity were used to plot the summary receiver operator characteristic curve and calculate the area under the curve (AUC). Finally, 15 articles with a total of 1,428 breast tumor patients and 952 healthy individuals were involved. The summary estimates revealed that the pooled sensitivity was 76 % with 95 % confidence interval (CI) of 67-83 %; the specificity was 87 % with 95 % CI of 77-93 %; the PLR was 5.9 with 95 % CI of 3.3-10.4; the NLR was 0.28 with 95 % CI of 0.20-0.39; the DOR was 21 with 95 % CI of 10-44; and the AUC was 0.88 with 95 % CI of 0.84-0.90. The most noteworthy is that multiple-miRNA assay displayed a better diagnostic performance than single-miRNA assay. In summary, the results of the present meta-analysis suggested that blood-based miRNAs may serve as novel molecular biomarkers for breast tumor, with a relative high level of accuracy, especially based on multiple-miRNA assay. Further large-scale prospective studies are necessary to validate their potential applicability for breast tumor prognosis, treatment, and surveillance.