Risk factors for delayed gastric emptying in patients undergoing esophagectomy without pyloric drainage.

BACKGROUND: The incidence of delayed gastric emptying (DGE) after esophagectomy is 10%-50%, which can interfere with postoperative recovery in the short-term and result in poor quality of life in the long term. Pyloric drainage is routinely performed to prevent DGE, but its role is highly controversial. The aim of this study was to report the rate of DGE after esophagectomy without pyloric drainage and to investigate its risk factors and the potential effect on recovery. MATERIALS AND METHODS: Between January 2010 and January 2015, we analyzed 285 consecutive patients who received an esophagectomy without pyloric drainage. Possible correlations between the incidence of DGE and its potential risk factors were examined in univariate and multivariate analyses, respectively. The outcomes of DGE were reviewed with a follow-up of 3 mo. RESULTS: The overall rate of DGE after esophagectomy was 18.2% (52/285). Among perioperative factors, gastric size (gastric tube versus the whole stomach) was the only significant factor affecting the incidence of DGE in the univariate analysis. The patients who received a whole stomach as an esophageal substitute were more likely to develop DGE than were patients with a gastric tube (13.2% versus 22.4%; P = 0.05). No independent risk factor for DGE was found in the multivariate analysis. The incidence of major postoperative complications, including anastomotic leak, respiratory complications, and cardiac complications, was also not significantly different between both groups, with or without DGE. Within 3 mo of follow-up, most patients could effectively manage their DGE through medication (39/52) or endoscopic pyloric dilation (12/52), with only one patient requiring surgical intervention. CONCLUSIONS: In our study, the overall incidence of DGE is about 20% for patients undergoing esophagectomy without pyloric drainage. Compared with prior findings, this does not result in a significantly increased incidence of DGE. In patients with symptoms of DGE after esophagectomy, prokinetic agents and endoscopic balloon dilation of the pylorus can be effective, as indicated by the high success rate and lack of significant complications.

[A comparative study of HRCT and pathological subtype, EGFR gene mutations of peripheral small lung adenocarcinoma].

OBJECTIVE: To investigate the relationship of the preoperative HRCT, postoperative pathological subtype and EGFR gene mutation types in the patients of small peripheral lung adenocacinoma confirmed by operation. METHODS: Between December 2011 and November 2014, Ninety-four invasive adenocarcinoma patient were selected from 156 patients with pulmonary nodule underwent operation in Beijing Chaoyang hospital. Among them, there were male 37 cases, female 57 cases, age range from 32 to 76, mean age 52.6. All patients underwent complete anatomical lobectomy or wedge resection or segmentectomy, with systematic mediastinal lymph node dissection. The detection indexes included: preoperative HRCT, postoperative pathological subtypes, lymph node; EGFR, Kras, ALK, FGF9 gene expression and so on. RESULTS: Postoperative pathologic acinar predominant accounted for 33.0% (31/94), papillary predominant type accounted for 25.5% (24/94), Lepidic predominant adenocarcinoma accounted for 19.1% (18/94), 13.8%(13/94) micro papillary predominant, 8.5% (8/94) solid predominant. 7 patients with lymph node positive included 5 cases of stations 11-12, 1 case of station 4 and 1 case of station 7. 36 cases was detected EGFR mutation after operation (38.9%, 36/94), mainly 19⁺ and 21⁺. Compared with the preoperative HRCT findings, there was no significant difference in EGFR mutation group and non mutation group (χ² = 1.411, P=0.703). For different types of mutations in EGFR gene, there was no statistical difference (P>0.05). But the rate of EGFR 21 positive in progression patients was significantly higher than that of EGFR 19 positive patients(χ² = 5.779, P=0.016). CONCLUSION: There were no significant different between the HRCT manifestations and pathological subtypes in the rate of EGFR gene mutation. EGFR 21 gene mutation was found in double lung metastasis commonly.

[Early removal of the chest tube after lobectomies: a prospective randomized control study].

OBJECTIVE: To evaluate the feasibility and safety of early chest tube removal after lobectomies for lung diseases. METHODS: A prospective randomized control study was performed with data collected from lobectomies between March 2012 and September 2012. Eligible patients (n = 70) were randomized into two groups; early removal group (removal of chest tube when drainage less than 300 ml/24 h, n = 41) and traditional management group (removal of chest tube when drainage less than 100 ml/24 h, n = 29). Criteria for early removal were established and met before chest tube removal. The volume and character of drainage, time of extracting drainage tube and postoperative hospital stay were measured. All patients received standard care during hospital admission and a follow-up visit was performed after 7 days of discharge from hospital. RESULTS: There were no differences between two groups with respect to age, sex, comorbidities, or pathologic evaluation of resection specimens. The median volume of drainage within 24 h after surgery was 300 ml and within 48 h was 250 ml, there was significantly different between two groups (Z = -2.059, P = 0.039). Patients undergoing early removal management had a shorter Chest tube duration (44 hours vs. 67 hours, Z = -2.914, P = 0.004) and a shorter postoperative hospital stay (5.0 days vs. 6.0 days, Z = -3.882, P = 0.000). Analysis of data showed no statistically significant differences between the rate of pleural effusions developed, thoracentesis and complications, one week after discharge from hospital. CONCLUSIONS: Compared to the traditional management group (drainage ≤ 100 ml/24 h), early removal of chest tube after lobectomy (drainage ≤ 300 ml/24 h) is feasible and safe. It could result in a shorter hospital stay, and most importantly, reduces morbidity without the added risk of complications.

Effect of perioperative aspirin continuation on bleeding after pneumonectomy.

BACKGROUND: To investigate the effect of continuous oral aspirin in perioperative period on bleeding in pneumonectomy. METHODS: A total of 170 patients who underwent pneumonectomy in our hospital from March 2021 to March 2022 were selected as the study objects. All patients took oral aspirin before surgery and did not take other antiplatelet agent or anticoagulants at the same time. The continuation group included 85 cases and continued to take aspirin 100 mg/day during the perioperative period, and the interruption group included 85 cases who stopped aspirin for 7 days before surgery and 3 days after surgery, without bridging therapy. The intraoperative blood loss, operation time, conversion to thoracotomy rate, postoperative bleeding rate, blood transfusion rate, thrombotic events, postoperative drainage volume, length of hospital stay, and total hospital cost of the two groups were compared. RESULTS: There were no statistically significant differences in intraoperative blood loss, operative time, rate of conversion to open, postoperative drainage, hospital stay, and cost between the two groups (p > 0.05), and there were no reoperations due to bleeding between the two groups. CONCLUSIONS: Aspirin should be continued throughout the perioperative period in all high-risk patients requiring pneumonectomy after balancing ischemic-bleeding risks.

Elevated circulating levels of osteopontin are associated with metastasis in advanced non-small cell lung cancer.

OBJECTIVE: To investigate the relationship between postoperative metastasis and circulating levels of osteopontin in non-small cell lung cancer (NSCLC). METHODS: The expression of osteopontin mRNA were detected with RT-PCR technique. The circulating levels of osteopontin were measured through ELASA in 46 NSCLC cases that had not been received any anti-cancer treatment at the time of sampling. The tissues from fifteen patients with benign pulmonary diseases were studied as control group. RESULTS: The overall median mRNA expression level of osteopontin was approximately 70-fold higher in tumor tissues than in matched normal lung tissues (P<0.001). Over-expression of osteopontin mRNA was significantly associated with clinical stage (P=0.009). Advanced disease states had higher circulating level of osteopontin (stage I+II versus stage III+VI). In multivariate analysis, stage was the only independent factor influencing circulating levels of osteopontin. All patients were followed up for 12 months, 2 of the 46 patients with both osteopontin mRNA expression and elevated plasma osteopontin levels had local recurrence and 10 had distant metastasis. There was a significant difference in the osteopontin levels between metastasis group and non-metastasis group. CONCLUSION: Preoperative plasma levels of osteopontin are significantly associated with post-operative metastasis in advanced NSCLC.

[A hospital-wide intervention program to optimize the utilization quality of carbapenems and glycopeptides].

OBJECTIVE: To investigate the impact of intervention program upon improvement of utilization quality of carbapenems and glycopeptides. METHODS: Multifaceted intervention program of carbapenems and glycopeptides was conducted at our hospital. It involved written justification forms, expert consultation committee meetings, audit, feedback and re-feedback. From November 1, 2007 until October 31, 2008, retrospective audit and feedback were performed on all patients dosed with carbapenems or glycopeptides. Case reports were reviewed and data of ratio of appropriate antibiotic use, length of hospital stay, total cost, mortality and rate of vancomycin-resistant Enterococci (VRE) were collected and compared between the first and second half year of antibiotic intervention program. RESULTS: A total of 397 cases were reviewed, 75 cases discussed at expert committee meetings and 58 feedback letters delivered to responsible doctors. The consumption of both carbapenems and glycopeptides decreased. The appropriate use of carbapenems and glycopeptides increased from 37.8% (45/119) to 53.5% (48/127, P < 0.05) and from 45.6% (36/79) to 63.9% (46/72, P < 0.05) respectively. The total cost and mortality of patients dosed with glycopeptides decreased from a median of RMB 65,700 (30,300 - 146,900) yuan to 55,700 (36,700 - 90,900) yuan, and from 39.2% to 26.4% respectively. The rate of VRE decreased from 5.63% in 2007 to 3.80% during the second half year of 2008. CONCLUSION: Antibiotic intervention program of carbapenems and glycopeptides is effective in decreasing the inappropriate antibiotic use.

[The expression of galectin-3 and osteopontin in occult metastasis of non-small cell lung cancer].

OBJECTIVE: To study the relationship between expression of galectin-3 (Gal-3) and osteopontin (OPN) in occult metastasis in non-small cell lung cancer. METHODS: Forty-six patients of non-small cell lung cancer (NSCLC) from January 2006 to October 2007 were selected. There were 28 males and 18 females, aged from 33 to 77 years old. The levels of lung tissues Gal-3 and OPN were detected by RT-PCR, and the levels of blood plasma's were measured by ELISA. RESULTS: There were 12 patients who had metastasized. In un-metastasis group the Gal-3 and OPN mRNA expression levels were significantly lower than that in metastasis group: mean value were 0.07 +/- 0.17 and 0.17 +/- 0.25 in un-metastasis group, while 0.73 +/- 0.23 and 0.79 +/- 0.24 in metastasis group. Blood plasma levels of Gal-3 (18.8 +/- 7.9) microg/L and OPN (153.5 +/- 63.5) microg/L in NSCLC which were detected from metastasis group were higher than un-metastasis group of (9.2 +/- 5.6) microg/L and (89.2 +/- 24.0) microg/L. CONCLUSIONS: High serum levels of Gal-3 and OPN and high expression of Gal-3 and OPN mRNA in NSCLC are closely related to the occurrence and metastasis of NSCLC. They may be indexes of evaluating the occult metastasis in NSCLC.

Experimental study of the inhibition effect of CXCL12/CXCR4 in malignant pleural mesothelioma.

Previous studies have demonstrated that CXCL12/CXCR4 axis is closely related to tumors such as malignant pleural mesothelioma (MPM). This research was conducted in order to detect whether CXCL12/CXCR4 inhibitors could restrain MPM and have a synergistic effect with chemotherapy, also to investigate the relationship of CXCL12/CXCR4 with other gene expressions in MPM. Forty mice were injected MPM cells and randomly divided into four groups: the PBS (control group), AMD3100 (CXCR4-CXCL12 antagonist), pemetrexed and AMD3100 plus pemetrexed. The mice were treated respectively for duration of 3 weeks. The size, bioluminescence and weight of tumors were measured. The differences between gene expressions in each group were analyzed. The tumor weights of each treatment group were lower than that of the control group (p<0.05). The bioluminescence of the tumor of the AMD3100 treatment group and the AMD3100 plus pemetrexed treatment group were lower than that of the control group (p<0.05), and AMD3100 was shown to have synergistic effects with pemetrexed (p<0.05). Among the 2.5 billion genes, several hundreds of genes expressed differently between groups. Results show that AMD3100 and pemetrexed can inhibit the growth of MPM in vivo, also that there is a better result if both are used together. Our findings suggest that CXCL12/CXCR4 axis affects a certain amount of gene expression in MPM.

Clinical study of inflammatory factors in sputum induced early after lung volume reduction surgery.

BACKGROUND: The aim of this study was to prospectively study the changes in neutrophil elastase (NE), fibroblast growth factor 9 (Fgf9), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1) in sputum induced during the early period after lung volume reduction surgery (LVRS). METHODS: From April to October 2005, ten consecutive patients with chronic obstructive pulmonary disease (COPD) underwent LVRS. Ten non-small cell lung cancer patients (stage II - IIIa) received lobectomy as a control group. The induced sputum was collected from both groups at six different times (two weeks before operation and postoperatively at 1, 2, 4, 6 and 10 days). The level of NE, Fgf9, MMP-9 and TIMP-1 were measured using enzyme-linked immunosorbent assay. RESULTS: The pulmonary function (FEV(1)%) and arterial blood gases (PaO(2) and PaCO(2)) were significantly different between the groups. There were no significant differences in age, ejection fraction (EF), and operation duration, but hemoglobin in the LVRS group was statistically higher than in the controls. At certain times, there were significant differences in NE, MMP-9, TIMP-1 and MMP-9/TIMP-1 (P < 0.05) but not in Fgf9 between the two groups. The levels of NE and TIMP-1 were maximal at 2 days postoperatively and that of MMP-9 and MMP-9/TIMP-1 at 4 days postoperatively in the LVRS group. In the control group, maximal levels of NE and TIMP-1 occurred at 2 days postoperatively and that of MMP-9 and MMP-9/TIMP-1 at 1 day postoperatively. Ten days after surgery, all values of the control group were not significantly different from the baseline. In the LVRS group, the levels were significantly different from the pre-operative values (P < 0.05) apart from TIMP-1. CONCLUSION: The levels of NE, MMP-9, TIMP-1 and MMP-9/TIMP-1 of the LVRS group were different from those of the control group. The time course of these changes may be related to LVRS and the underlying process of COPD.

Lung volume reduction surgery in hypercapnic patients: a single-center experience from China.

BACKGROUND: Lung volume reduction surgery (LVRS) has shown early promise as a palliative therapy in severe emphysema, but with a controversy over its indications. The aim of this study was to evaluate whether patients with hypercapnia should be excluded from LVRS. METHODS: Total 15 cases of severe emphysema with the level of PaCO2 exceeding 50 mmHg were retrospectively studied. Their basic characteristics, pulmonary function, preoperative and postoperative PaCO2 level as well as postoperative complications were calculated statistically. RESULTS: All of the 15 patients received video-assisted thoracoscopic LVRS and finally discharged uneventfully from hospital after the surgical procedures. Nine cases were supported by mechanical ventilation after surgery with the median duration of 44 hours. One of them was treated by extracorporeal membrane oxygenation (ECMO) both during surgery and the first 4 days after surgery. The result of blood gas analysis on 3 months after hospital discharge decreased than that before surgery (60.07 vs. 55.61 mmHg, P=0.076), but without statistical significance. CONCLUSIONS: The emphysematous patients with hypercapnia should not be excluded from the benefits of LVRS.

Erratum to the significance of perioperative coagulation and fibrinolysis related parameters after lung surgery for predicting venous thromboembolism: a prospective, single center study.

[This corrects the article DOI: 10.21037/jtd.2018.03.174.].

Transfer of multiple loci of donor's genes to induce recipient tolerance in organ transplantation.

Donor organ rejection remains a significant problem. The present study aimed to assess whether transferring a donor's major histocompatibility complex (MHC) genes to the recipient could mitigate rejection in organ transplantation. Seven loci of MHC genes from donor mice were amplified and ligated into vectors; the vectors either contained one K locus, seven loci or were empty (control). The vectors were subsequently injected into the thymus of recipients (in heterotransplants, recipient rats received the vector containing one K locus), following which donor mouse hearts were transplanted. Following the transplantation of allograft and heterograft, electrocardiosignals were viable for a significantly longer duration in recipient mice and rats receiving the donor histocompatibility-2 complex (H-2)d genes compared with those in controls, and in mice that received seven vectors compared with those receiving one vector. Mixed lymphocyte cultures containing cells from these recipients proliferated significantly less compared with mixed lymphocyte cultures containing controls. Also, hearts from H-2d genes-treated recipients demonstrated less lymphocyte infiltration and necrosis compared with the control recipient. The present study concluded that allograft and heterograft rejection may be mitigated by introducing the donor's MHC into the recipient; transferring seven loci has been demonstrated to be more effective than transferring one locus.

The significance of perioperative coagulation and fibrinolysis related parameters after lung surgery for predicting venous thromboembolism: a prospective, single center study.

BACKGROUND: The high incidence of venous thromboembolism (VTE) has been perceived in post thoracic surgery patients. However, the significance of perioperative coagulation and fibrinolysis related parameters after lung surgery for VTE predicting is not clear. To investigate that, we conducted a prospective single center study. METHODS: A total of 111 patients undergoing lung surgery were enrolled in this study, included 52 primary lung cancer patients and 59 benign lung disease patients from July 2016 to March 2017. Preoperative and postoperative days 1, 3, and 5 coagulation and fibrinolysis related parameters were tested, including antithrombin (AT), fibrinogen degradation product (FDP), prothrombin time (PT), prothrombin time activity (PA), prothrombin time ratio (PR), international normalized ratio (INR), activated partial thromboplastin time (APTT), plasma fibrinogen (FBG), thrombin time (TT) and D-Dimer. The Doppler ultrasonography was performed before and after surgery for deep venous thrombosis (DVT) confirmation. Patients with new postoperative DVT, unexplained dyspnea, hemoptysis, chest pain, or high Caprini score (≥9) were received further computer tomography pulmonary angiography (CTPA) for pulmonary embolism (PE). We used the area under receiver-operating-characteristic (ROC) curve to discriminate patients between those who developed VTE and those who did not. Single factor analysis was utilized to define risk factors associated with VTE. RESULTS: The overall incidence of VTE was 16.2% (18/111). The incidence of VTE in primary lung cancer patients was 23.1% (12/52), much higher than that in benign lung diseases 10.2% (6/59), but did not reach statistical significance (P=0.066). Among 18 VTE patients, 83.3% was DVT, 16.7% was DVT + PE and 72.2% was muscular veins of the calf thrombosis. D-Dimer was much higher in VTE group than that in non-VTE group preoperatively and at postoperative days 1, 3 (0.64±0.24 vs. 0.33±0.06, P=0.007; 3.14±0.75 vs. 1.51±0.09, P=0.005, and 1.88±0.53 vs. 0.76±0.05, P=0.001, respectively). And the ROC curve areas of preoperative and postoperative days 1, 3 of D-Dimer were 0.70, 0.71 and 0.74, respectively. And FDP was much higher in VTE group than that in non-VTE group at postoperative day 3 (6.78±1.43 vs. 3.79±0.15, P=0.004). But AT, PT, PA, PR, INR, APTT, FBG and TT there were no significantly difference. CONCLUSIONS: The overall incidence of VTE after lung surgery was 16.2%. The patients with preoperative high D-Dimer should receive VTE prophylaxis.

[Comparison of changes in early pulmonary function and hemodynamic between unilateral and bilateral lung volume reduction for chronic obstructive pulmonary disease].

OBJECTIVE: To compare changes in early pulmonary function and hemodynamics between unilateral and bilateral lung volume reduction (LVRS) for severe chronic obstructive pulmonary disease (COPD). METHODS: Eighty-six patients with severe COPD underwent LVRS, 61 underwent unilateral LVRS and 25 underwent lateral LVRS. The results of lung function (FEV(1), RV, TLC), arterial blood gas analysis (PaO(2), PaCO(2)) and color Doppler echocardiography (CO, CI, EF, PAP) were evaluated preoperatively and 3, 6 months postoperatively. RESULTS: Six patients died. FEV(1), RV and TLC were improved significantly after (P < 0.05). PaO(2) increased (P < 0.05) and PaCO(2) decreased postoperatively (P < 0.05). According to the Doppler echocardiography there were no statistic difference in cardia functions (CO, CI, EF, PAP) between unilateral and bilateral LVRS preoperatively and 3, 6 months postoperatively. CONCLUSIONS: Unilateral and bilateral LVRS is safe and effective in the treatment of patients with severe COPD, the pulmonary function significantly improved postoperatively, but the results of bilateral LVRS is better than unilateral. Both unilateral and bilateral LVRS showed no significant deterioration in hemodynamics, there were no significant difference between preoperatively and postoperatively.

The dynamic of nasogastric decompression after esophagectomy and its predictive value of postoperative complications.

BACKGROUND: To investigate the regularity and the influence factors of nasogastric decompression volume after esophagectomy, and explore whether the volume of nasogastric decompression can be employed as a predictor for postoperative complications of esophageal carcinoma. METHODS: Consecutive 247 patients with esophageal cancer who underwent esophagectomy were retrospectively evaluated. The volume of postoperative nasogastric decompression was recorded and the regularity based on it was described. The single and multiple factors regression analysis were used to find out relative factors of the nasogastric decompression volume among the patients without postoperative complication. Gender, age, height, weight, tobacco or alcohol exposure, location of the tumor, histological type, pathological staging, operation time, surgical procedures, anastomotic position and gastric conduit reconstruction were considered as the independent variable. Then, verify the former regression models using the data of patients with postoperative complications. RESULTS: In trend analysis, the curve estimation revealed a quadratic trend in the relationship between nasogastric decompression volume and postoperative days (R(2) =0.890, P=0.004). The volume of postoperative nasogastric decompression was described by daily drainage (mL) =82.215 + 69.620 × days - 6.604 × days(2). The results of multiple linear stepwise regression analysis showed that gastric conduit reconstruction (ß=0.410, P=0.000), smoking (ß=-0.231, P=0.000), age (ß=-0.193, P=0.001) and histological type of the tumor (ß=-0.169, P=0.006) were significantly related to the volume of nasogastric decompression. The average drainage in 5 days after surgery =262.287 + 132.873 × X1 - 72.160 × X2 - 27.904 × X3 - 36.368 × X4 (X1, gastric conduit reconstruction; X2, smoking; X3, histological type; X4, age). The nasogastric decompression of the patients with delayed gastric emptying, and lung infection statistically differ from their predictive values respectively according to the former equation (P<0.01), but the data of anastomotic leakage cases had no significance difference (P=0.344). CONCLUSIONS: It is found that the volume of postoperative nasogastric decompression presents a quadratic trend based on the days after esophagectomy. Gastric conduit reconstruction, smoking history, age and histological type were independent factors affecting on the volume of postoperative nasogastric decompression. Also, the volume of nasogastric decompression has validity and application value for predicting postoperative complications.

Abnormal bone mineral density and bone turnover marker expression profiles in patients with primary spontaneous pneumothorax.

BACKGROUND: To examine the bone mineral density (BMD) and the role of bone biomarkers, including bone formation marker procollagen type I aminoterminal propeptide (PINP) and N-terminal midmolecule fragment osteocalcin (N-MID), bone resorption marker b-C-telopeptides of type I collagen (b-CTX) and tartrate-resistant acid phosphatase 5b (TRACP5b) in the pathogenesis of PSP. METHODS: Eighty-three consecutive primary spontaneous pneumothorax (PSP) patients (PSP group) and 87 healthy individuals (control group) were enrolled in this study. General data, including gender, age, height, weight, and body mass index (BMI), were recorded. Dual-energy X-ray absorptiometry, electrochemiluminescence immunoassay (ECLIA), and ELISA were used to evaluate bone mineral density and expression levels of bone metabolism markers, including PINP, b-CTX, TRACP5b, N-MID, and 25-hydroxyvitamin D (25-OH VD). RESULTS: Mean height was significantly greater in the PSP group compared with the control group, whereas weight and BMI were lower. Patients in the PSP group had significantly lower average bone mineral density, which mainly manifested as osteopenia (11/12, 91.7%); however, only one patient (8.3%) developed osteoporosis. Serum overexpression of PINP, b-CTX, TRACP5b, and N-MID were found in PSP patients. Expression of 25-OH VD was low in PSP patients. Bone resorption markers showed positive linear relationships with bone formation markers in all participants; whereas only TRACP5b expression negatively correlated with 25-OH VD. Expression levels of all bone turnover markers negatively correlated with BMI. Regression analysis identified risk factors of PSP as age, height, weight, and TRACP5b and 25-OH VD expression levels; whereas gender and PINP, b-CTX, and N-MID expression levels were not significantly associated with the onset of PSP. CONCLUSIONS: It had lower bone mineral density in PSP patients. Bone formation marker PINP, N-MID and bone resorption marker b-CTX, TRACP5b were upregulated in PSP patients. 25-OH VD expression was relatively low in this population of PSP patients. Age, height, weight, and expression levels of TRACP5b and 25-OH VD may be risk factors for PSP.

[Combined therapy for stage IIIa non-small cell lung cancer].

OBJECTIVE: To evaluate the long-term outcome of combined therapy for stage IIIa non-small cell lung cancer (NSCLC). METHODS: Eight and twelve patients with stage IIIa NSCLC, 662 males and 150 females, aged 58.6 (24-79), underwent surgical resection, 326 of which received pre- and postoperative chemotherapy and/or radiotherapy, and 486 of which received surgery alone. The patients were classified according to the TNM staging, and the specimens of resected cancer were examined pathologically. The clinical data of these patients were analyzed. RESULTS: The overall 5-year survival rate was 16.4%. The 5-year survival rate of the combined therapy group was 23.5%, significantly higher than that of the surgical resection alone group (P < 0.01). The 5-year survival rate was 27.6% for the squamous cell carcinoma (SCC), and 23.5% for adenocarcinoma (AC) in the combined therapy group; and was 115.2% for SCC and 9.9% for AC in the surgical resection alone group (all P < 0.01). CONCLUSION: The curative effectiveness of combined therapy is significantly better than surgical resection alone for stage IIIa NSCLC. However, The combination should be based on the TNM staging and pathological type.

Silencing of tripartite motif (TRIM) 29 inhibits proliferation and invasion and increases chemosensitivity to cisplatin in human lung squamous cancer NCI-H520 cells.

BACKGROUND: TRIM29 belongs to the tripartite motif (TRIM) protein family. It has been reported to be a tumor suppressor or have oncogenic function in many cancer types. The aim of this study was to investigate whether downregulation of TRIM29 by small interfering ribonucleic acid (siRNA) could inhibit cell proliferation and invasion and increase chemosensitivity to cisplatin in human lung squamous cancer NCI-H520 cells in vitro. METHODS: We transformed TRIM29 siRNA into NCI-H520 cells. Real time reverse transcriptase polymerase chain reaction and Western blotting assay were employed to determine TRIM29 messenger (m)RNA and protein expressions. MTT assay was used to determine the cell proliferation. Transwell invasion assay was used to determine the cell invasion. An Annexin V-propidium iodide (AnnV/PI) staining apoptosis test was used for detecting apoptosis. RESULTS: TRIM29 siRNA could specifically and efficiently suppress TRIM29 expression at both mRNA and protein levels. Silencing of the TRIM29 by siRNA in NCI-H520 cells inhibited cell proliferation and invasion in vitro. TRIM29 knockdown resulted in chemosensitivity enhancement in NCI-H520 cells. CONCLUSION: Downregulation of TRIM29 can lead to potent antitumor activity and chemosensitizing effect in human lung squamous cancer NCI-H520 cells.

Application of extracorporeal membrane oxygenation in giant bullae resection.

A patient with chronic obstructive pulmonary disease and lung bullae was admitted to our hospital. He suffered respiratory failure and was given mechanical ventilation. However, the bullae became more and more large and compressed the lungs on both sides. We managed extracorporeal membrane oxygenation (ECMO) to maintain the patient's blood oxygenation, and performed bullae resection surgery successfully. The patient's pulmonary function recovered gradually after the operation and he returned home. In our experience with this case, ECMO can be used in bullae resection.

Successful extracorporeal membrane oxygenation therapy as a bridge to sequential bilateral lung transplantation for a patient after severe paraquat poisoning.

CONTEXT: Paraquat is a widely used herbicide that can cause severe to fatal poisoning in humans. The irreversible and rapid progression of pulmonary fibrosis associated with respiratory failure is the main cause of death in the later stages of poisoning. There are infrequent reports of successful lung transplants for cases of severe paraquat poisoning. We expect that this successful case will provide a reference for other patients in similar circumstances. CASE DETAILS: A 24-year-old female was sent to the hospital approximately 2 hours after ingesting 50 ml of paraquat. She experienced rapidly aggravated pulmonary fibrosis and severe respiratory failure. On the 34th day after ingestion, she underwent intubation and invasive mechanical ventilation. The patient was evaluated for lung transplantation, and veno-venous extracorporeal membrane oxygenation (ECMO) was established as a bridge to lung transplantation on the 44th day. On the 56th day, she successfully underwent a bilateral sequential lung transplantation. Through respiratory and physical rehabilitation and nutrition support, the patient was weaned from mechanical ventilation and extubated on the 66th day. On the 80th day, she was discharged. During the 1-year follow-up, the patient was found to be in good condition, and her pulmonary function improved gradually. CONCLUSION: We suggest that lung transplantation may be an effective treatment in the end stages of paraquat-induced pulmonary fibrosis and consequential respiratory failure. For patients experiencing a rapid progression to a critical condition in whom lung transplantation cannot be performed immediately (e.g., while awaiting a viable donor or toxicant clearance), ECMO should be a viable bridge to lung transplantation.