Moderate Hypothermic Circulatory Arrest with Antegrade Cerebral Perfusion for Rapid Total Arch Replacement in Acute Type A Aortic Dissection.

BACKGROUND: The optimal hypothermic level during circulatory arrest is controversial. The aim of our study was to comprehensively assess the impact of moderate hypothermic circulatory arrest with antegrade cerebral perfusion (ACP) on total aortic arch replacement. METHODS: From 2010 to 2013, data were collected from 99 consecutive patients with acute type A aortic dissection. All patients underwent total arch replacement plus frozen elephant trunk procedure. There were 51 patients in the deep hypothermia circulatory arrest (DHCA) group and 47 in the moderate hypothermia circulatory arrest (MHCA) group. Either unilateral or bilateral ACP was applied for cerebral protection. Perioperative data and measured outcomes were compared. RESULTS: Overall mean circulatory arrest time was 29.9 ± 6.0 minutes. Temporary neurologic dysfunction incidence was lower in the MHCA group compared with the DHCA group (21.3 vs. 40.4%, p = 0.041). The total 30-day mortality was 17.2% (14.9 vs. 19.2%, p = 0.568) and permanent neurologic dysfunction morbidity was 3.0% overall. In MHCA, less blood products were used than in DHCA. Moderate hypothermia was a protective factor for the composite outcome of temporary and permanent neurologic dysfunctions (odds ratio = 0.385; 95% confidence interval = 0.162-0.919). Hypothermic level did not significantly affect the perioperative alanine aminotransferase and serum creatinine levels. CONCLUSION: Within a short circulatory arrest time, MHCA combined with ACP seemed to be a safe and effective method to protect cerebral and visceral organs during total aortic arch replacement.

Androgen receptor promotes esophageal cancer cell migration and proliferation via matrix metalloproteinase 2.

Esophageal squamous cell carcinoma (ESCC) is one of the most common malignancies worldwide. Androgen receptor (AR) plays an important role in many kinds of cancers. However, the molecular mechanisms of AR in ESCC are poorly characterized. In the present study, Western blot analysis and real-time quantitative PCR were performed to identify differentially expressed AR in 40 ESCC tissue samples, which revealed that the messenger RNA (mRNA) and protein expression of AR is upregulated in the ESCC tissue samples. AR overexpression induced increases in ESCC cell invasion and proliferation in vitro. Silencing of AR inhibited the proliferation of KYSE450 cells which have a relatively high level of AR, and the invasion of KYSE450 cells was distinctly suppressed. Furthermore, AR knockdown led to substantial reductions in matrix metalloproteinase 2 (MMP2) and p-AKT levels in ESCC cell lines, but no significant change in AKT and MMP9 expression. These results suggest that AR is involved in tumor progression, and thus, AR could represent selective targets for the molecularly targeted treatments of ESCC.

Minimally invasive esophagectomy with right bronchial occlusion under artificial pneumothorax.

AIMS: To assess the safety and feasibility of minimally invasive esophagectomy and selected three-field lymphadenectomy with the right bronchial occlusion in left semi-prone position under artificial pneumothorax. METHODS: Thoracoscopic-laparoscopic subtotal esophagectomy and selected three-field lymphadenectomy were performed in 166 patients with esophageal carcinoma by the right bronchial occlusion in left semi-prone position under artificial pneumothorax. RESULTS: 109 patients received two-field lymphadenectomy and 57 received three-field lymphadenectomy. The average operative time was 202.5 ± 21.3 min; the average thoracoscopic operative time was 98.4 ± 15.5 min. The average blood loss was 39.6 ± 4.2 ml, and no blood transfusion was needed during the surgery. The mean lymph node harvest was 28.4 ± 5.2 nodes. Hospital stay ranged from 7 to 95 days and the average was 11.3 days. The postoperative complication rate was 29.5%, and the mortality rate was 1.2%. CONCLUSIONS: It is feasible and safe to perform thoracoscopic-laparoscopic subtotal esophagectomy and selected three-field lymphadenectomy with the right bronchial occlusion in left semi-prone position under artificial pneumothorax for esophageal carcinoma. The procedure shows advantages in improved visibility and accessibility of the surgical field, and better subsequent surgical outcomes.

Nicotine upregulates microRNA-21 and promotes TGF-ß-dependent epithelial-mesenchymal transition of esophageal cancer cells.

A consistent positive association between cigarette smoking and the human esophageal cancer has been confirmed all over the world. However, details in the association need to be more focused on and be identified. Recently, aberrantly expressed microRNAs (miRNAs) have been shown to be promising biomarkers for understanding the tumorigenesis of a wide array of human cancers, including the esophageal cancer, and the deregulation on the epithelial to mesenchymal transition (EMT) by miRNAs is involved in the tumorigenesis. In present study, we were going to identify the role of nicotine-induced miR-21 in the EMT of esophageal cells. We found that there was an overexpression of miR-21 in esophageal specimens, having an association with cigarette smoking, and the upregulation of miR-21 was also induced by nicotine in esophageal carcinoma cell line, EC9706. Moreover, the upregulated miR-21 by nicotine promoted EMT transforming growth factor beta (TGF-ß) dependently. Thus, the present study reveals a novel oncogenic role of nicotine in human esophageal cancer.

Resistance to cetuximab in EGFR-overexpressing esophageal squamous cell carcinoma xenografts due to FGFR2 amplification and overexpression.

Esophageal carcinoma is one of the most virulent malignant diseases and a major cause of cancer-related deaths worldwide. Despite improvements in surgical techniques and perioperative management and surgery combined with chemotherapy and/or radiotherapy, the prognosis of esophageal squamous cell carcinoma (ESCC) at an advanced stage remains poor. ESCC shows a relatively high incidence of EGFR (50% - 70%), and the humanized monoclonal antibody (mAb) cetuximab against EGFR has been undergoing clinical development. However, all responding patients eventually developed acquired resistance to cetuximab. In the current study, we described a cetuximab-sensitive ESCC xeongraft model that developed resistance to cetuximab as a result of FGFR2 gene amplification and overexpression. Inhibition of FGFR2 signaling in this xenograft model restored its sensitivity to cetuximab. The antitumor effect may be induced by inhibition of AKT phosphorylation. These findings suggest that combination therapyincluding cetuximab and FGFR2 inhibition may be a promising strategy to treat ESCC.

Multimodality FDG PET/CT appearance of pulmonary tuberculoma mimicking lung cancer and pathologic correlation in a tuberculosis-endemic country.

OBJECTIVES: Differentiation between pulmonary tuberculoma and malignancy by preoperative diagnostic imaging sometimes proves difficult. The purpose of this study is to investigate variable manifestations of pulmonary tuberculoma mimicking lung cancer on fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) image and pathologic correlation. PATIENTS AND METHODS: Twenty-five patients with a high suspicion of malignancy and histopathologically diagnosed as pulmonary tuberculoma were included. Their FDG PET/CT images, clinical data, and pathologic findings were investigated. RESULTS: There were 18 men and seven women. The mean age was 52 ± 8.8 years. The maximal diameter of pulmonary tuberculoma ranged from 1.7 to 4.2 cm. CT scan revealed that abnormal signs associated with malignancy such as spicular radiation, notching, and pleural indentation also frequently manifested in tuberculoma. During early imaging, positive FDG uptake was identified in 21 patients (84%), intermediate uptake in 3 patients (12%) and negative uptake in 1 patient (4%). During delayed imaging, 16 patients (64%) showed persistent elevated FDG accumulation and 8 patients (32%) experienced a slight drop of FDG accumulation. Pathologically active tuberculoma showed significantly higher FDG radioactivity during both early and delayed imaging than inactive lesion (P < 0.05). Lymphadenopathy with positive FDG uptake was identified in nine patients (36%). CONCLUSION: Pulmonary tuberculomas mimicking lung cancer, most of which were pathologically active lesions, commonly displayed abnormal appearances in CT scan and an increase in FDG uptake, similar to changes seen on malignancy. Coexistent lymphadenopathy made differential diagnosis even more complicated. These results suggested that positive FDG PET/CT findings should be interpreted with caution in tuberculosis-endemic regions.

[The relationship of expression of GLUT1,HIF-1α and the uptake of FDG in non-small cell lung cancer].

BACKGROUND: It has been known that facilitative glucose transporter(GLUT) is the main carrier which intervenes the glucose uptake of cell,and there is a significant correlation between GLUT1 and cancer.The expression of GLUT1 in lung cancer has close relationship with the uptake of 18fluoro-2-deoxyglucose(FDG) of lung cancer,and the expression of GLUT1 is regulated by hypoxia inducible factor-1(HIF-1).The aim of this study is to investigate the relationship among expression of GLUT1,HIF-1α and the uptake of FDG in non-small cell lung cancer(NSCLC). METHODS: Eighty-four patients with NSCLC were evaluated with FDG PET/CT before operation.The expression of GLUT1 and HIF-1α was detected immunohistochemically in lung cancer,and their expression level was assessed by the intensity of immunohistochemical staining.Correlation analysis was carried out among the expression level of GLUT1,HIF-1α and the value of standard uptake value(SUV) obtained from preoperative FDG PET/CT examination. RESULTS: The range of average SUV(SUVave) of the eighty-four patients was 3.6-13.2,and the average value was 7.8±3.0.There was no significant correlation between the SUVave and the maximum diameter of the tumors,the TNM stage,pathological classification and the degree of differentiation.The positive rate of GLUT1 in the eighty-four patients was 95.2%(80/84).The average intensity of immunohistochemical staining was 4.4±1.3.The positive rate of HIF-1α in the eighty-four patients was 96.4%(81/84).The average intensity of immunohistochemical staining was 4.4±1.4.A highly significant positive correlation was found between GLUT1 expression and the SUVave(r=0.78,P < 0.01),and also between HIF-1α expression and the SUVave(r=0.73,P < 0.01).There was also a highly significant positive correlation between GLUT1 expression and HIF-1α expression(r=0.93,P < 0.01). CONCLUSIONS: GLUT1 protein and HIF-1α expressions are general in NSCLC tissues.GLUT1 may paly an important role in the glucose and FDG uptake of lung cancer cell,and HIF-1α might be one of the most important regulative factors of GLUT1 expression,which up-regulates the expression of GLUT1.

[Surgical treatment for tumors of trachea, carina and main bronchus].

OBJECTIVE: To review the experience in surgical treatment for tumors of trachea, carina and main bronchus. METHODS: From Jan. 1996 to Jun. 2004, 27 patients with tumor of trachea, carina or main bronchus underwent surgery including resection and reconstruction of trachea in 8, right/left pneumonectomy and carinal resection and reconstruction in 9 (6/3), right sleeve upper lobectomy and carnial resection with reconstruction of trachea and carina in 2, carina resection and reconstruction in 3, tumor removal through tracheal windows in 5. CPB (cardiopulmonary bypass) was used in 2 patients during surgery. RESULTS: There were 3 peri-operative deaths caused by acute respiratory failure in 2 and severe postoperative bleeding in 1 case. After follow-up of more than 6 months, no death or post-operative complication occurred. CONCLUSION: Resection and reconstruction for patients with tumor of trachea, main bronchus or carina can be performed with excellent results using effective surgical and anaesthetic methods with or without CPB assistance.

[Value of cardiopulmonary bypass for locally advanced lung cancer involving the left atrium].

OBJECTIVE: To review the experience and assess the value of cardiopulmonary bypass (CPB) in the treatment of locally advanced lung cancer involving the left atrium. METHODS: From Jan. 1999 to Dec. 2002, lobectomy or pneumonectomy combined with partial resection of the left atrium were carried out in 52 such patients, which included 13 with assistance of CPB and 39 without. RESULTS: There was one postoperative death in each of the CPB and non-CPB groups due to brbonchopleural fistula and pulmonary infection. Six patients in CPB and 14 in non-CPB groups developed postoperative cardiac complication including arrhythmia, pneumonia and heart failure. The 1-, 3-year survival rate of CPB and non-CPB groups was 69.3%, 66.7% and 38.5%, 38.5%, respectively. CONCLUSION: Combined resection of locally advanced lung cancer with partially involved left atrium through cardiopulmonary bypass was safe and effective, and may not increase the postoperative complication and risk.

Clinical significance of VEGF-C and VEGFR-3 expression in non-small cell lung cancer.

The relationship between vascular endothelial growth factor-C (VEGF-C)/vascular endothelial growth factor receptor 3 (VEGFR-3) expression and clinicopathologic features of the patients with non-small cell lung cancer (NSCLC) was investigated. The expression of VEGF-C and VEGFR-3 was assessed in 65 patients with NSCLC by immunohistochemistry. The significance of VEGF-C and VEGFR-3 expression was analyzed statistically. The results showed that VEGF-C and VEGFR-3 were highly expressed in cytoplasm and membrane in lung cancer tissues with the positive rate being 55.4 % and 52.3 % respectively, while there was no expression in the normal lung tissues. The expression of VEGF-C was significantly increased in adenocacinoma as compared to other types of NSCLC (P<0.05). The VEGFR-3 expression was closely related with lymph node metastasis (P<0.01) and TNM stage (P<0.05). There was a positive correlation between the VEGF-C and VEGFR-3 expression in NSCLC patients (r=0.658, P<0.01). It is suggested that VEGFR-3 plays an important role in the lymphatic metastasis of NSCLC. The interaction between VEGF-C and VEGFR-3 may be deeply involved in the mechanism of lung cancer metastasis.

[Simultaneous off-pump coronary artery bypass surgery and pulmonary resection].

OBJECTIVE: To summarize the experience of combined off-pump coronary artery bypass grafting (OPCAB) and pulmonary resection. METHODS: Seven patients with unstable angina or a history of myocardial infarction and pulmonary disease underwent combined OPCAB and pulmonary resection. All of them underwent coronary angiography, and neither coronary angioplasty nor stenting was feasible. OPCAB preceded the lung resections. The preferred approach to the heart and lung was by sternotomy. Left upper lobectomy was performed in 2 patients, right upper lobectomy was performed in 1 patient, right lower lobectomy was performed in 1 patient, right upper and middle bilobectomy was performed in 1 patient, left lung volume reduction surgery (LVRS) was performed in 1 patient and bilateral LVRS was performed in 1 patient. RESULTS: There were no hospital mortality in this group of patients, however there were one late death. Sternal dehiscence occurred in 1 patient which was observed with a need for re-sternotomy and atrial fibrillation was observed in 1 patient. Five patients were diagnosed as malignant tumor by pathology test, and 2 patients were severe chronic obstructive pulmonary disease (COPD). Follow-up ranging from 2 months to 31 months was available for these patients. None of the patients showed evidence of myocardial ischemia after surgery. In one patient, who underwent right upper and middle bilobectomy, local recurrence was found at 19 months after surgery. CONCLUSIONS: OPCAB carried out simultaneously with lung resection is a safe and effective approach in patients diagnosed with concomitant coronary artery and pulmonary disease. OPCAB may decrease the incidence of postoperative complications.

[Needlescopic thoracic sympathectomy for palmar hyperhidrosis].

OBJECTIVE: To evaluate the safety and efficacy of needlescopic thoracic sympathectomy for palmar hyperhidrosis. METHODS: From March 2004 to April 2005, 62 patients, including 23 men and 39 women with a mean age of 23 years (ranged from 12 to 53 years), underwent bilateral needlescopic thoracic sympathectomy. Among all the patients 8 cases had accompanied axillary hyperhidrosis. The degree of palmar sweating was moderate in 16 cases and severe in 46 cases. The sympathetic chain on the body of the second and third ribs in all patients was cauterized and divided; the chain on the fourth rib in those with axillary hyperhidrosis was also severed. Intraoperative changes in palmar temperature and blood flow were recorded. RESULTS: Sympathectomies were successful, and dry limbs were immediately achieved in all patients after surgery. There were no mortality or life-threatening complication, however 1 patient developed moderate pneumothorax which resolved soon after chest drainage. After all procedures, palmar blood perfusion increased significantly and mean palmar temperature elevated by 2.4 degrees C. The mean operative duration was 65 min, and the mean postoperative hospital stay was 1.2 days. No recurrence of palmar hyperhidrosis occurred after a mean follow-up of 6.3 months (ranged from 1 to 13 months). Compensatory sweating was found in 26 patients, but the symptoms were mostly tolerable and required no further treatment. CONCLUSION: Needlescopic thoracic sympathectomy is a safe and effective technique for palmar hyperhidrosis, which is less invasive than conventional video-assisted thoracic surgery.

[A clinicopathological study of 14 cases of pulmonary inflammatory myofibroblastic tumor].

BACKGROUND: Inflammatory myofibroblastic tumor (IMT) is an uncommon disease which usually occurs in the lung. Recently, several reports have suggested that IMT is a true neoplasm rather than a reactive lesion. In this retrospective study, we reviewed clinicopathological characteristics and prognoses of patients with surgically resected IMT of the lung at our department. METHODS: From January 1999 to December 2003, 14 patients had surgical intervention for IMT of the lung at Tongji Hospital. The resected lesions were studied histologically and immunohistochemically. One to 5 years' follow-up was completed in all patients. RESULTS: These 14 patients included eight men and six women. They ranged in age from 11 to 46 years old. Nine patients were asymptomatic. The other five symptomatic patients had cough, hemoptysis, and dyspnea. For all these patients, the diagnostic procedure was surgical excision. The resected tumor size ranged from 1.0 to 8.0 cm in diameter. Histologically, a variety of inflammatory and spindle cells were observed. The spindle cells corresponded ultrastructurally to myofibroblasts or fibroblasts. There was no recurrence in these patients, and all of them were in good health during the follow-up. CONCLUSIONS: Histopathologically, IMT is characterized by myofibroblasts which are mixed with chronic inflammatory cells, including plasma cells, lymphocytes, and histiocytes. Surgical resection, when possible, should be chosen as the first choice and complete resection leads to excellent survival.

[Relationship between tumor size and lymph node metastasis in squamous cell carcinoma and adenocarcinoma of the lung].

BACKGROUND: Lymphatic dissemination is the main approach of metastasis in lung cancer, and it is also an important prognostic factor. The aim of this study is to explore the relationship between tumor size and lymph node metastasis in squamous cell carcinoma and adenocarcinoma of the lung. METHODS: A total of 240 patients diagnosed as squamous cell carcinoma and adenocarcinoma were studied. The relationship between tumor size and lymph node metastasis was analyzed. RESULTS: Lymph node metastasis rate in maximum diameter (d)≤2cm, 2cm < d≤3cm, 3cm < d≤6cm, 6cm < d≤10cm, and d > 10cm groups was 50.0%, 35.1%, 52.8%, 52.1% and 71.4%, respectively. There was no correlation between tumor size and lymph node metastasis (r=0.10, P > 0.05). Lymph node metastasis occurred more frequently in adenocarcinoma (58.8%) than that in squamous cell carcinoma (42.9%) (P < 0.05). Mediastinal lymph node metastasis was found in 7 patients (16.3%) with d≤3cm, who were all diagnosed as moderate or poor differentiation. CONCLUSIONS: Lymph node metastasis is not related to tumor size. Lymph node metastasis occurs more frequently in adenocarcinoma than it does in squamous cell carcinoma. Mediastinal lymph node metastasis can be found in tumor with d≤3cm, and differentiation grade may play an important role in lymph node metastasis.

[Expression and clinicopathologic significance of OPN, CD44v6 and MMP-2 in squamous cell carcinoma and adenocarcinoma of the lung].

BACKGROUND: There are a lot of studies on relationship of surface adhesion molecule (CD44) and matrix metalloproteinase (MMP) with tumors in recent years, however study on osteopontin (OPN) is still few. The aim of this study is to investigate the levels of OPN, CD44v6 and MMP-2 in squamous cell carcinoma and adenocarcinoma of the lung, and to clearly understand their roles in growth, invasion and metastasis of squamous cell carcinoma and adenocarcinoma. METHODS: OPN, CD44v6 and MMP-2 were detected in 69 patients with squamous cell carcinoma and adenocarcinoma by immunohistochemical method. RESULTS: The expression rate of OPN, CD44v6 and MMP-2 was significantly related to histological classification, TNM stages and lymph node metastasis (P < 0.05), but not to cell differentiation (P > 0.05). There was a positive correlation between OPN and CD44v6 expression (P < 0.001), as well as between OPN and MMP-2 expression (P < 0.001). There was no correlation between CD44v6 and MMP-2 expression. CONCLUSIONS: OPN, CD44v6 and MMP-2 expression is related to the histology, TNM stages and lymph node metastasis of lung cancer. They might be used as clinical indicators to predict the progress and metastatic potential for squamous cell carcinoma and adenocarcinoma of the lung.

[Cardiac valve MCSF-1 and its receptor expression changes in Staphylococcus aureus induced infective endocarditis].

OBJECTIVE: To explore the cellular immunology mechanism of infective endocarditis (IE), we investigated the effects of Staphylococcus aureus (S. aureus) on MCSF-1 and its receptor (c-fms) gene expression in cardiac valves. METHODS: Thirty-two rabbits were divided into 4 groups: mitral or tricuspid valve artificial lesions with 5 x 10(4) CFU or 5 x 10(6) CFU S. aureus injection. Control rabbits (n = 7) received 5 x 10(6) CFU S. aureus injection. IE after operation were confirmed by naked eyes and electron microscope observations. MCSF-1, c-fms in mitral and tricuspid valves were detected by RT-PCR. RESULTS: Twenty-six rabbits survived the operation and 14 rabbits developed IE (2 with 5 x 10(4) CFU and 12 with 5 x 10(6) CFU S. aureus injection) one day post operation. S. aureus injection alone did not induce IE. Compared to control rabbits, MCSF-1 mRNA was significantly upregulated and c-fms mRNA significantly downregulated after 5 x 10(4) CFU S. aureus injection with heart valve artificial lesion in mitral valves or tricuspid valves. MCSF-1 expression in mitral valves was further increased while remained unchanged in tricuspid valve after 5 x 10(6) CFU S. aureus injection compared to that in 5 x 10(4) CFU S. aureus injection group. CONCLUSION: High dose bacterial invasion and heart valves lesion were the main factors for inducing infective endocarditis. Development of infective endocarditis was associated with valve MCSF-1/c-fms expression changes in this rabbit model.

[Expression of KAI1 gene in non-small cell lung cancer and its relationship with P53].

BACKGROUND: Recent researches have manifested that down-regulation of KAI1 relates to metastasis in various tumors, but its association with non-small cell lung cancer (NSCLC) and the mechanism for its down-regulation are not clear. The aim of this study is to investigate the expression of KAI1 in NSCLC and its relationship with clinicopathological characteristics and mutant P53 protein. METHODS: The expression of KAI1/CD82 and mutant P53 protein was detected in 48 cases of NSCLC tissues by Western blot, and KAI1 mRNA was detected by RT-PCR method, with 20 cases of pulmonary benign disease tissues and normal lung tissues as control.. RESULTS: The positive rate of KAI1 mRNA was 52% in lung cancer group and 90% in control group, respectively (P < 0.01), KAI1/CD82 was 48% and 85% respectively (P < 0.01), and mutant P53 protein was 65% and 5% respectively (P < 0.01). The positive rate of KAI1 mRNA, KAI1/CD82 and mutant P53 protein closely related to the tumor stages, cell differentiation and lymph node metastasis status (P < 0.05 or P < 0.01). The expression of KAI1/CD82 highly related to KAI1 mRNA (P < 0.01) and mutant P53 protein (P < 0.05), while expression of KAI1 mRNA did not relate to mutant P53 protein expression (P > 0.05). CONCLUSIONS: The down-regulation of KAI1 may relate to carcinogenesis, development and metastasis of NSCLC. Its reduction may occur mainly at transcriptional level and correlate with p53 in NSCLC. KAI1 and p53 might be helpful to predict the potential metastasis of NSCLC.

[Pathogen spectrum and correlative factors of nosocomial infection in patients with lung cancer].

BACKGROUND: Lung cancer is one of the most common malignant tumors in China. Surgical resection is still the first choice of treatment for most lung cancer patients. The prognosis of lung cancer after surgical treatment is correlated to many factors. One of them is nosocomial infection. This study is to investigate the distribution of the pathogens causing nosocomial infection and its correlative factors in patients with lung cancer. METHODS: One hundred and thirteen cases that had hospital-acquired infection out of 1227 surgically treated patients with lung cancer were analyzed statistically. RESULTS: Of all the pathogenic species, the most prevalent species were Gram-negative bacteria with average positive detection of 64.03% (299/467). The second were Gram-positive bacteria (145/467, 31.05%) and the third were fungi (23/467, 4.92%). The results of drug sensitivity tests showed that all of strains had higher resistance rate. The rate of extended spectrum ß-lactamases (ESBLs) and meticillin-resistant Staphylococcus (MRS) was very high. The incidence of nosocomial infection was seriously correlated with age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours. CONCLUSIONS: The nosocomial infection of lung cancer patients after surgical treatment is seriously correlated with patient's age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours. More attentions should be paid to the pathogenic species and its correlative factors of nosocomial infection in lung cancer patients. The resistance of bacteria to the commonly used antibiotics is produced in various degrees. During clinical therapy with antibiotics, antibiotics should be selected according to the results of drug sensitivity tests. In order to reduce the production of drug-resistance, the appropriate use of antibiotics must be strengthened.

Tongxinluo Prevents Endothelial Dysfunction Induced by Homocysteine Thiolactone In Vivo via Suppression of Oxidative Stress.

Aim. To explore whether Chinese traditional medicine, tongxinluo (TXL), exerts beneficial effects on endothelial dysfunction induced by homocysteine thiolactone (HTL) and to investigate the potential mechanisms. Methods and Results. Incubation of cultured human umbilical vein endothelial cells with HTL (1 mM) for 24 hours significantly reduced cell viabilities assayed by MTT, and enhanced productions of reactive oxygen species. Pretreatment of cells with TXL (100, 200, and 400 µg/mL) for 1 hour reversed these effects induced by HTL. Further, coincubation with GW9662 (0.01, 0.1 mM) abolished the protective effects of TXL on HTL-treated cells. In ex vivo experiments, exposure of isolated aortic rings from rats to HTL (1 mM) for 1 hour dramatically impaired acetylcholine-induced endothelium-dependent relaxation, reduced SOD activity, and increased malondialdehyde content in aortic tissues. Preincubation of aortic rings with TXL (100, 200, and 400 µg/mL) normalized the disorders induced by HTL. Importantly, all effects induced by TXL were reversed by GW9662. In vivo analysis indicated that the administration of TXL (1.0 g/kg/d) remarkably suppressed oxidative stress and prevented endothelial dysfunction in rats fed with HTL (50 mg/kg/d) for 8 weeks. Conclusions. TXL improves endothelial functions in rats fed with HTL, which is related to PPARγ-dependent suppression of oxidative stress.

Cardioprotective effects of melatonin on recovery of rat donor hearts after 12-hour preservation.

The cardioprotective effects of melatonin on recovery of rat donor hearts after 12 h of preservation were investigated. Wistar rats weighing 200 to 250 g (n=24) were randomly divided into 3 groups. In the non-storage group (n=8), donor hearts were not stored. In the melatonin group (n=8), donor hearts were stored in 4 degrees C St. Thomas solution with melatonin (0.1 mmol/L). In the control group (n=8), donor hearts were stored in 4 degrees C St. Thomas solution only. The coronary flow (CF), cardiac function, coronary vasodilatory response, creatine kinase (CK) and high energy phosphate levels were measured after the hearts had been preserved for 12 h. Transmission electron microscopy was used to examine the microstructural changes after 12 h of preservation. The recovery of cardiac function and coronary vasodilatory response were significantly improved in the melatonin group (P<0.01). CK release decreased greatly in the melatonin group (P<0.01). High energy phosphate levels were significantly better preserved in the melatonin group (P<0.01). Histological findings were much better in the melatonin group than in the control group. These results suggest that melatonin has cardioprotective effects on the recovery of rat donor hearts after 12 h of preservation.