A nurse-driven enhanced recovery after surgery (ERAS) nursing program for geriatric patients following lung surgery.

Enhanced recovery after surgery (ERAS) is a multiprofessional, multidisciplinary and evidence-based program that aims to reduce complications, improve overall prognosis, shorten hospital stays, and promote fast recovery following major surgery. Nurses play a crucial role in the successful implementation of the ERAS program. Therefore, this research focuses on the trajectory optimized and acquired by nurses in the enhanced recovery of elderly patients undergoing radical surgery for lung cancer. This study concludes that the implementation of the proposed ERAS preoperative point-of-care trajectory is highly beneficial for improved outcomes and enhanced recovery of geriatric patients following lung surgery.

Overexpression of ANLN in lung adenocarcinoma is associated with metastasis.

BACKGROUND: ANLN has been identified as an actin-binding protein and previous studies have suggested that ANLN is associated with actin cytoskeletal dynamics. Lung adenocarcinoma is a poor prognosis tumor. Metastasis is a very common complication and is regarded as the main cause for an unsatisfactory treatment outcome. Whether ANLN is involved in the metastasis of lung adenocarcinoma is unknown. METHODS: We performed immunohistochemical staining and analyzed the correlation between the expression level and pathological parameters. We tested the migration and invasion of A549 and PC9 cell after interference with ANLN expression by Transwell and scratch wound healing assays. Protein expression of E-cadherin, vimentin and N-cadherin were detected using Western blotting and immunofluorescence staining. The same experiment was also tested after overexpression of ANLN. RESULTS: The metastasis of patients with high expression of ANLN was significantly more than that of patients with low expression of ANLN. In vitro, after interfering with ANLN expression, E-cadherin and vimentin expression were increased and N-cadherin expression was decreased in A549 and PC9 cells. Migration and invasion ability of A549 and PC9 cells were decreased,vice versa. CONCLUSION: Our study suggests that the expression of ANLN in lung adenocarcinoma is associated with metastasis of cancer cells. ANLN may be involved in the metastasis of lung adenocarcinoma by promoting epithelial mesenchymal transformation of tumor cells.

Effect of auricular points treatment combined with acupoints application in patients with constipation after lung cancer surgery.

OBJECT: To assess the effect of auricular points treatment combined with acupoints application on patient with constipation after lung cancer surgery. METHODS: Design and participants: This is a single-center randomized controlled trial. Totally 341 after lung cancer surgery patients were randomly assigned into the experimental group (n = 174) and the control group (n = 167). The control group received routine nursing care, which was included psychological support, diet instruction, and post-operative activities guidance. The experimental group received auricular points treatment combined with acupoints application therapy in addition to the routine nursing care. All the patients had defecation within 3 days after operation. The characteristics of the stool were recorded, and the progress and performance of the incidence of constipation was recorded in two groups. RESULTS: The incidence of constipation in the control group was higher than that in the experimental group (P < 0.001). Moreover, the stool characteristics of experimental group were better than it in the control group by rank-sum test (P = 0.047). CONCLUSION: On the basis of routine measures to prevent constipation after lung cancer surgery, auricular point sticking combined with acupoint application therapy can effectively decrease the incidence of postoperative constipation.

[Current Research of the Roles of IL-35 in Tumor Progression].

Interleukin(IL)-35 is a new member of the interleukin-12 superfamily. Since its first report in 2007, IL-35 rapidly became a research highlight in the field of immunology. Like other IL-12 superfamily members, IL-35 was a heterodimer which was composed of an α chain P35 and a ß chain Epstein-Barr virus induced gene 3 (EBI3). Recent research work revealed two distinct roles of IL-35. Firstly, IL-35 is highly expressed in some kinds of inflammatory diseases and autoimmune diseases and plays import roles in the pathogenesis. Secondly, IL-35 is positively expressed in some cancers and plays some roles in the process of tumor progression. Here we demonstrate the structure and the signalling of IL-35. We reviewed the the roles of IL-35 in promoting tumor progression.

Association between serum C-reactive protein value and prognosis of patients with non-small cell lung cancer: a meta-analysis.

OBJECTIVE: C-reactive protein (CRP) has been reported, with controversy, to be associated with poor survival of patients with non-small cell lung cancer (NSCLC). This meta-analysis aimed to evaluate the prognostic role of CRP in NSCLC. METHODS: We searched PubMed, EMBASE and CNKI databases for published studies that evaluated the prognostic role of CRP in NSCLC up to March 1, 2014. The data were analyzed using STATA software (Version 12.0; Stata Corporation). Hazard ratios (HRs) with a 95% CI and 5-year survival rates were calculated to evaluate the relationships between CRP levels and the prognosis of NSCLC patients. RESULTS: Eight studies were included, totaling 1668 NSCLC patients. The results revealed that elevated CRP values might predict poor 5-year overall survival rates (RR=2.15, 95% CI: 1.78-2.59) and poor 5-year disease-specific survival rates (RR=2.12, 95% CI: 1.56-2.88). The pooled HR between stage I/II and stage III/IV patients was 0.98 (95% CI: 0.26-3.63, P=0.976), which indicated that the difference between the survival rates of the patients with elevated CRP and those with undetectable CRP was not significant. In our survival analysis, the results of Egger's testing did not demonstrate evidence of publication bias (P=0.099). CONCLUSION: Elevated CRP level is relevant to poorer survival of NSCLC patients and might be used as a prognostic biomarker for NSCLC.

A clinical trial on docetaxel and carboplatin therapy with or without nimotuzumab for the treatment of advanced nonsmall cell lung cancer.

BACKGROUND: To evaluate the role of nimotuzumab in combination with chemotherapy in patients with advanced nonsmall cell lung cancer (NSCLC) through progress-free survival, changes in tumor marker expression and adverse drug reactions. MATERIALS AND METHODS: A total of 59 NSCLC patients were randomized into two groups. The treatment group (n = 30) received nimotuzumab (200 mg) with docetaxel (60 mg/m2) and carboplatin (area under curve = 5), whereas the control group (n = 29) received chemotherapy at the same dosage. All patients received two cycles of treatment lasting for 42 days. The serum tumor biomarker levels were measured on the day before treatment and at 60 days after treatment. RESULTS: The efficacy of treatment for the treatment and control groups were 36.7% and 27.6%, respectively; this difference was not statistically significant. However, progression-free survival (PFS) was significantly prolonged by 1 month in the treatment group. Peripheral blood CYFRA21-1 decreased significantly during treatment with a more extensive decrease in the treatment group, although the difference between the groups was not statistically significant. The neuron-specific enolase levels significantly decreased across all 59 patients. The carcinoembryonic antigen levels decreased significantly in the treatment group, but remained stable in the control group throughout the treatment period. Nimotuzumab was well tolerated by patients with only three cases of Grades I and II skin rash and no other toxic symptoms. CONCLUSION: Nimotuzumab with docetaxel and carboplatin can enhance the short-term clinical efficacy by extending the duration of PFS and was generally well tolerated by patients.

Gene mutation characteristics of nonsmall-cell lung carcinoma patients with wild-type epidermal growth factor receptor and sensitivity to Tarceva therapy.

OBJECTIVE: To explore characteristic gene mutations in nonsmall-cell lung carcinoma (NSCLC) patients with wild-type epidermal growth factor receptor (EGFR) and sensitivity to Tarceva therapy; to observe the efficacy and safety of Tarceva therapy for NSCLC patients with wild-type EGFR. MATERIALS AND METHODS: NSCLC patients with wild-type EGFR and KRAS were selected. Their tumor specimens were assessed for mutations in seven key genes in pathways downstream of EGFR, including HRAS, NRAS, BRAF, PIK3CA, AKT1, MEK1, and PTEN. Then the patients were subjected to Tarceva therapy to explore the relationship between curative effects and any gene mutations. RESULTS: Among 10 cases, one NRAS mutation was detected in one patient who was resistant to Tarceva, and no mutations were detected in the other patients. Seven cases responded to Tarceva; 1 case obtained partial relief, and 6 cases were in stable condition. CONCLUSION: Patients with wild-type EGFR can also benefit from Tarceva therapy. However, an association between Tarceva therapy sensitivity and mutations in genes downstream of EGFR was not detected.

MiR-497 Suppresses YAP1 and Inhibits Tumor Growth in Non-Small Cell Lung Cancer.

BACKGROUND/AIMS: To investigate the expression, clinical significance and the cellular effects of miR-497 in non-small cell lung cancer (NSCLC). METHODS: NSCLC cells were transiently transfected with miR-497 mimics or siRNA to up-regulate or down-regulate expression. Quantitative real-time PCR (qRT-PCR) was used to detect the mRNA level of miR-497. Luciferase assays, colony formation assays and BrdU incorporation assays were performed to identify the targets and role of miR-497 in NSCLC cells. Finally, the abundance of miR-497 was analyzed in a total of 51 NSCLC specimens. RESULTS: The transcript levels of miR-497 were significantly decreased in NSCLC tissue (25/30; 83.3%). Low miR-497 levels in tumor tissue correlated with advanced pT stage. Additionally, miR-497 transcript levels correlated with overall survival of NSCLC patients (n = 51, p = 0.022). Overexpression of miR-497 inhibited the proliferation of NSCLC cell and down-regulation of miR-497 resulted in elevated NSCLC growth. Exogenous over-expression of YAP1 partially eliminated miR-497-induced cell growth. CONCLUSION: miR-497 plays an important role in inhibiting the proliferation of NSCLC by targeting YAP1. Our results suggest that miR-497 is a potential therapeutic target in treating patients with NSCLC.

Wnt2 promotes non-small cell lung cancer progression by activating WNT/ß-catenin pathway.

BACKGROUND: Wnt2 is overexpressed and able to promote tumorigenesis in many types of cancer. However, its expression and role in lung cancer has not been well clarified yet. In this study, we aims to investigate the expression pattern, clinical significance and the underlying molecular mechanism of Wnt2 in non-small lung cancer (NSCLC). METHODS: Immunohistochemical staining and ELISA assays were applied to detect Wnt2 level in tumor tissue and serum. EDU incorporation assays and colony formation assays were used to evaluate the growth-promoting effect of Wnt2 in vitro. Then we performed western blot and immunofluorescence assays to detect the activation of WNT signaling pathway. Finally mice engrafted with NSCLC tumor cells were used to assess the role of Wnt2 in vivo. RESULTS: Immunohistochemical staining consisting of 264 NSCLC tumor tissues showed that a high level of Wnt2 was associated with a poor overall survival (OS) and relapse-free survival (RFS) of NSCLC patients (P = 0.002 and 0.0005, respectively). Multivariate analysis presented that Wnt2 level in tumor tissue was an independent prognostic factor (P = 0.049 for OS and P = 0.002 for RFS, respectively). Furthermore, ELISA assays for 181 individuals (116 NSCLC and 65 controls) revealed that serum Wnt2 levels in adenocarcinoma was significantly higher than that in healthy volunteers (P < 0.0001). In vitro H460 cell line stably overexpressing Wnt2 showed enhanced growth activity than the control cells whereas knockdown of Wnt2 by siRNA in H1299 cells resulted in decreased growth activity. Additionally, Wnt2 level in tumor tissues was significantly associated with Ki-67 level (rs: 0.316; P < 0.0001). Immunofluorescence and Western blot assays detected the translocation of ß-catenin from cytoplasm into nucleus, which indicated that Wnt2 probably promotes proliferation by activating WNT/ß-catenin pathway. In vivo H460 cells expressing exogenous Wnt2 showed increased growth-promoting effect in Balb/c nude mice than control cells. CONCLUSIONS: The present study for the first time suggested that Wnt2 was both a prognostic and a diagnostic biomarker for NSCLC. Tumor-derived Wnt2 can promote growth activity of NSCLC cells through activating WNT/ß-catenin signaling pathway.

Usefulness of the neutrophil-to-lymphocyte ratio in predicting lymph node metastasis in patients with non-small cell lung cancer.

Preoperative neutrophil-to-lymphocyte ratio (NLR) is a new hotspot for its prognostic significance in many types of cancers. In this study, a novel diagnosing model-the combination of enhanced contrast computed tomography (ECCT) and NLR (COCT-NLR) was constructed to detect the lymph nodal involvement in patients with non-small cell lung cancer (NSCLC). The clinicopathological parameters and thoracic ECCT images of 353 NSCLC patients were retrospectively reviewed. The COCT-NLR model was constructed and evaluated in detecting regional lymph nodal metastasis in patients with NSCLC. Univariate and multivariate analyses of clinicopathological parameters revealed that NLR value was independently associated with regional nodal involvement rate in patients with NSCLC (odds ratio (OR) = 4.770; 95 % confidence interval (CI), 2.487-9.146; P < 0.001). Compared with ECCT and NLR, the COCT-NLR model showed the highest efficacy in predicting nodal involvement. The sensitivity and specificity of COCT-NLR were 70.59 and 74.89 %, respectively. The COCT-NLR model is a valuable tool in detecting regional lymph node metastasis in patients with NSCLC.

miR-143 inhibits NSCLC cell growth and metastasis by targeting Limk1.

MicroRNAs (miRNAs) have essential roles in carcinogenesis and tumor progression. Here, we investigated the roles and mechanisms of miR-143 in non-small cell lung cancer (NSCLC). miR-143 was significantly decreased in NSCLC tissues and cell lines. Overexpression of miR-143 suppressed NSCLC cell proliferation, induced apoptosis, and inhibited migration and invasion in vitro. Integrated analysis identified LIM domain kinase 1 (Limk1) as a direct and functional target of miR-143. Overexpression of Limk1 attenuated the tumor suppressive effects of miR-143 in NSCLC cells. Moreover, miR-143 was inversely correlated with Limk1 expression in NSCLC tissues. Together, our results highlight the significance of miR-143 and Limk1 in the development and progression of NSCLC.

[Efficacy and adverse effets of nimotuzumab plus palitaxel liposome and carboplatin in the treatment for advanced non-small cell lung cancer].

OBJECTIVE: To evaluate the efficacy of nimotuzumab combined with palitaxel liposome and carboplatin (LP) regimen for treatment of advanced non-small cell lung cancer (NSCLC), and to observe the changes of tumor markers and toxicities in the treatment. METHODS Forty-one patients with advanced NSCLC were randomly divided into 2 groups: 21 patients in the observation group were treated with nimotuzumab (200 mg per week for 6 weeks), palitaxel liposome 160 mg/m2 and carboplatin (AUC = 6). 20 patients in the control group were given LP regimen. Each group completed two cycles of chemotherapy. The level of tumor markers (CEA, CYFR21-1 and NSE) and toxicities were checked at one week before and after the treatment. Thoracic CT examinations were taken before treatment and at the fourth week and eighth week after treatment. RESULTS: In the observation group, there were 2 cases of CR, 7 cases of PR, 9 cases of SD and 3 cases of PD. The objective response rate (RR) was 42. 9% in the observation group. In the control group, there were 1 case of CR, 6 cases of PR, 8 cases of SD and 5 cases of PD, with a RR of 35.0% in this group. There was no significant difference in the RR between the two groups (P = 0.751). The time to progression (TIP) was 6. 9 months in the observation group and 5. 7 months in the control group, with a significant difference (P = 0.027). The levels of NSE decreased significantly in both groups and showed a significant difference (P = 0.039). The levels of CEA and CYFRA21 in both groups were decreased after treatment, but did not show a significant difference before and after treatment, respectively. Except 3 cases had I-II skin toxicities on the faces in the observation group, there was no significant difference in toxicities between the two groups. CONCLUSION: Nimotuzmab combined with LP regimen shows a synergistic effect, can increase the efficacy and prolong TFP in advanced NSCLC patients. The toxicities are mild and tolerable.

A novel microfluidic immunoassay system based on electrochemical immunosensors: an application for the detection of NT-proBNP in whole blood.

Electrochemical immunosensors have attracted great interest in the search for a selective, simple and reliable system for molecular recognition. Presently, electrochemical immunosensors have been widely studied for biomedical molecular's detection, but the regeneration of these immunosensors has restricted their wide application. To prepare a regeneration-free immunosensor, which may be more suitable for clinical determination, a repeatable immunoassay system was developed based on an electrochemical immunosensor with magnetic nanoparticles, biotin-avidin system (BAS) and Fab antibodies for the heart failure markers aminoterminal pro-brain natriuretic peptides (NT-proBNP). At the same time, a microfluidic system was combined into the proposed system, which enabled continuous determination. Using NT-proBNP as a model system, the proposed immunosensor exhibited rapid and sensitive amperometric response to NT-proBNP with good selectivity, stability, and a wide linear range (0.005-1.67 ng/mL and 1.67-4 ng/mL with a detection limit of 0.003 ng/mL under optimal conditions). Importantly, the proposed immunosensor was also suitable for the detection of other proteins and provided new opportunities for disease diagnosis.

[Primary malignant fibrous histiocytoma of the lung: a report of 20 cases].

BACKGROUND AND OBJECTIVE: Primary malignant fibrous histiocytoma (MFH) of the lung is a type of rare sarcoma which showed a lack of detailed guidance about treatment and prognosis. The clinical features, treatment methods and prognosis of primary MFH of the lung were analyzed by this study to reveal some information of this disease. METHODS: The clinical data and survival state of 20 patients with primary pulmonary MFH treated in Cancer Institute and Hospital of Tianjin Medical University were collected. SPSS 16.0 software was used for statistical analysis. Kaplan-Meier method was applied to figure out whether gender, size, site and post-operative chemotherapy correlated to prognosis. COX regression was employed for multivariate prognostic analysis to find the unattached prognostic factors. Statistical significance was considered at P<0.05. RESULTS: The clinical manifestations of primary pulmonary MFH mainly included cough, blood-stained sputum, chest pain, fever and chest distress. The one-year and two-year overall survival rates were 55.0% and 25.0%, respectively. Most cases died of local recurrence and distant metastasis. Multivariate COX regression analysis showed tumor size and location type were unattached prognostic factors. The patients with tumors smaller than 5 cm had a median survival of 27 months, while larger than 5 cm group's median survival was 8 months. The median survival of central tumor and the peripheral tumor were 6 months and 23 months respectively. CONCLUSION: Primary pulmonary MFH was a type of highly malignant sarcoma which had poor prognosis. The main effective treatment was surgery, yet the role of postoperative adjuvant chemotherapy in the whole course of treatment was undefined. Small mass size and peripheral type might be correlated to relatively better prognosis.

[rh-endostatin in combination with docetaxel and carboplatin as adjuvant treatment for non-small lung cancer].

OBJECTIVE: To evaluate the efficacy of Endosteal(TM) (rh-endostatin, YH-16) combined with docetaxel and carboplatin (TP) regimen for the adjuvant treatment of non-small lung cancer (NSCLC) and its impact on circulating blood markers. METHODS: 36 patients with stage Ib-IIIa postoperative NSCLC, were randomly divided into the treatment group, Endosteal(TM) plus TP regimen, and the control group, TP regimen only, respectively. DFS and toxicities of patients were observed. The numbers of CEC and the levels of tumor marker CEA, NSE and CYFR21-1 were measured. RESULTS: The numbers of CEC and the levels of CEA, NSE and CYFR21-1 decreased after treatment. There were significant differences in CEC and NSE between treatment group and control group after four cycles of treatment, respectively (P = 0.016 and 0.013). Disease-free survival time (DFS) was longer in treatment group than control group but without significant difference. CEC was significantly increased in recurrent and metastasis cases and decreased after effective treatment. CONCLUSION: Endosteal(TM) combined with TP regimen seem to be superior to TP alone in some short term index for the treatment of postoperative NSCLC even though long-term survival is still anticipated. CEC, as a biomarker, may be useful in predicting the efficacy of the such synergistic treatment.

Changes of activated circulating endothelial cells and survivin in patients with non-small cell lung cancer after antiangiogenesis therapy.

BACKGROUND: Although antiangiogenesis therapy plays an important role in anti-neoplastic treatment with its recognized efficacy and slight adverse effect, there is no prospective clinical trial to define ideal markers for predicting efficacy of antiangiogenic therapy. This study was undertaken to investigate the changes of activated circulating endothelial cells (aCECs) and survivin after anti-angiogenesis therapy and their significance in predicting the efficacy of the therapy. METHODS: Patients of non-small cell lung cancer (NSCLC) treated with chemotherapy with or without Endostar were observed. The amount of activated CECs was detected by flow cytometry, and the expression of survivin mRNA was determined by real-time polymerase chain reaction (PCR). RESULTS: After treatment, the amount of activated CECs decreased significantly in clinical benefit cases (P = 0.021 in chemotherapy alone, P = 0.001 in chemotherapy plus Endostar), increased in disease progressive cases (P = 0.015 in chemotherapy alone, but P = 0.293 in chemotherapy with Endotatar). After therapy, the expression of survivin mRNA decreased in clinical benefit cases (P = 0.001) and increased in disease progressive cases (P = 0.018). A positive correlation was found between activated CECs and survivin in the chemotherapy group pre- and post-therapy (P = 0.001 and 0.021, respectively), but only in the chemotherapy with Endostar group pre-therapy (P = 0.030) rather than post-therapy. A positive correlation was found between the decreased activated CECs after therapy and time to progression (TTP) (r = 0.322, P = 0.012); a negative correlation was found between the amount of survivin mRNA in serum post-therapy and TTP (r = -0.291, P = 0.048). CONCLUSIONS: Activated CECs and survivin may be ideal markers forecasting efficacy and prognosis of NSCLC. The former can reflect more sensitively antiangiogenic efficacy and the latter is more sensitive to shrinkage or swelling of tumors. Their combination can evaluate more accurately the efficacy of antiangiogenic therapy of NSCLC.