Preoperative CT-guided localization of pulmonary nodules with low-dose radiation.

Background: Video-assisted thoracoscopic surgery (VATS) has been widely accepted for the treatment of pulmonary nodules. Prior to VATS, pulmonary nodules can be labeled by computed tomography (CT)-guided hook wire localization, but multiple scans are required, which increases the total radiation dose. We aimed to assess the effectiveness and risks of using low-dose radiation CT to locate lung nodules prior to VATS. Methods: This study included 158 patients who underwent VATS resection after CT-guided hook wire localization. Based on the CT tube voltage, patients were split into two groups: the low-voltage group (Group A) received 80 kV, while the high-voltage group (Group B) received 120 kV. The two groups' image quality, radiation exposure, localization success and complication rates were compared. The frequencies of intraoperative complications and the types of lung nodules were also compared between the groups. Results: Successful nodule mapping was obtained in 158 patients. There was no significant difference in age, sex ratio or BMI between the two groups. Subjective imaging quality in both groups met the requirements for location (≥2 points). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in Group A were lower than those in Group B (P<0.05). Furthermore, the dose length product (DLP) and effective dose (ED) in Group A were lower than those in Group B (P<0.05). Conclusions: Low-dose radiation CT-guided localization is safe and feasible for identifying uncertain pulmonary nodules before VATS, enabling a significant radiation dose reduction while maintaining mapping accuracy and not increasing complication risk.

The risk and prognostic factors for brain metastases in esophageal cancer patients: an analysis of the SEER database.

BACKGROUND: Brain metastases were rare in esophageal cancer patients. Using the Surveillance, Epidemiology, and End Results (SEER) database, the present study investigated the incidence, risk and prognostic factors of brain metastases in esophageal cancer patients. METHODS: Retrieving esophageal cancer patients diagnosed between 2010 and 2018 from the SEER database, univariable and multivariable logistic and cox regression models were used to investigate the risk factors for brain metastases development and prognosis, respectively. The brain metastases predicting nomogram was constructed, evaluated and validated. The overall survival (OS) of patients with brain metastases was analyzed by Kaplan-Meier method. RESULTS: A total of 34,107 eligible esophageal cancer patients were included and 618 of them were diagnosed with brain metastases (1.8%). The median survival of the brain metastatic esophageal cancer patients was 5 (95% CI: 5-7) months. The presence of bone metastases and lung metastases were the homogeneously associated factors for the development and prognosis of brain metastases in esophageal cancer patients. Patients younger than 65 years, American Indian/Alaska Native race (vs. White), overlapping lesion (vs. Upper third), esophageal adenocarcinoma histology subtype, higher N stage, and liver metastases were positively associated with brain metastases occurrence. The calibration curve, ROC curve, and C-index exhibited good performance of the nomogram for predicting brain metastases. CONCLUSIONS: Homogeneous and heterogeneous factors were found for the development and prognosis of brain metastases in esophageal cancer patients. The nomogram had good calibration and discrimination for predicting brain metastases.

Perioperative outcomes of combined heart surgery and lung tumor resection: a systematic review and meta-analysis.

OBJECTIVE: The prevalence of patients with concomitant heart and lung lesions requiring surgical intervention is increasing. Simultaneous cardiac surgery and pulmonary resection avoids the need for a second operation. However, there are concerns regarding the potentially increased mortality and complication rates of simultaneous surgery and the adequacy of lung exposure during heart surgery. Therefore, we performed a meta-analysis to evaluate the perioperative mortality and complication rates of combined heart surgery and lung tumor resection. METHODS: A comprehensive literature search was performed in July 2020. The PubMed, Embase, and Web of Science databases were searched to identify studies that reported the perioperative outcomes of combined heart surgery and lung tumor resection. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias of included studies. Pooled proportions and 95% confidence intervals (95% CI) were calculated by R version 3.6.1 using the meta package. RESULTS: A total of 536 patients from 29 studies were included. Overall, the pooled proportion of operative mortality was 0.01 (95% CI: 0.00, 0.03) and the pooled proportion of postoperative complications was 0.40 (95% CI: 0.24, 0.57) for patients who underwent combined cardiothoracic surgery. Subgroup analysis by lung pathology revealed that, for patients with lung cancer, the pooled proportion of anatomical lung resection was 0.99 (95% CI: 0.95, 1.00) and the pooled proportion of systematic lymph node dissection or sampling was 1.00 (95% CI: 1.00, 1.00). Subgroup analysis by heart surgery procedure found that the pooled proportion of postoperative complications of patients who underwent coronary artery bypass grafting (CABG) patients using the off-pump method was 0.17 (95% CI: 0.01, 0.43), while the pooled proportion of complications after CABG using the on-pump method was 0.61 (95% CI: 0.38, 0.82). CONCLUSION: Combined heart surgery and lung tumor resection had a low mortality rate and an acceptable complication rate. Subgroup analyses revealed that most patients with lung cancer underwent uncompromised anatomical resection and mediastinal lymph node sampling or dissection during combined cardiothoracic surgery, and showed off-pump CABG may reduce the complication rate compared with on-pump CABG. Further researches are still needed to verify these findings.

miR­379 inhibits cell proliferation and epithelial­mesenchymal transition by targeting CHUK through the NF­κB pathway in non­small cell lung cancer.

An increasing body of evidence has demonstrated that microRNA (miR) deregulation serves pivotal roles in tumor progression and metastasis. However, the function of miR­379 in lung cancer remains understudied, particularly in non­small cell lung cancer (NSCLC). Bioinformatics and luciferase reporter analyses confirmed that conserved helix­loop­helix ubiquitous kinase (CHUK) is a target of miR­379, which may directly bind to the 3'­untranslated region of CHUK and significantly downregulate its expression in NSCLC cells. Transwell assays were used to evaluate the role of miR­379 in cell migration and invasion, and western blotting was used to address the association between miR­379 and epithelial­mesenchymal markers, including E­cadherin, cytokeratin and Vimentin. In the present study, miR­379 expression in NSCLC tissues and cell lines was downregulated, which may be associated with the poor survival of patients with NSCLC. miR­379 may act as a tumor suppressor in NSCLC, potentially by suppressing cell growth and proliferation, delaying G1­S transition, enhancing cell apoptosis and suppressing NSCLC cell migration and invasion. Furthermore, it was also observed that CHUK may function as an oncogene, and downregulation of CHUK induced by miR­379 may partially rescue the malignant characteristics of tumors, indicating that miR­379 may be suppressed in tumorigenesis. The overexpression of miR­379 may prevent the growth of NSCLC tumors via CHUK suppression and the downstream nuclear factor­κB pathway. The results of the present study demonstrated that miR­379 may act as a tumor suppressor, and may constitute a potential biomarker and a promising therapeutic agent for the treatment for NSCLC.

[Systemic Therapy for Low-grade Pulmonary Neuroendocrine Tumor].

The lung is the second most common site of neuroendocrine tumors (NETs). Typical and atypical carcinoids are low-grade NETs of the lung. These rare tumors have received little attention and education is needed for treating physicians. The article describes the classifcation of lung NETs, the epidemiology and pathological characteristics. When lung NETs are diagnosed at an early stage, surgical intervention is often curative. For advanced lung NETs patients, different treatment methods including chemotherapy, somatostatin analogs, m-TOR inhibition, peptide receptor radioligand therapy, and biologic systemic therapy are discussed. The conclusions are generally extrapolated from the outcome of extra-pulmonary carcinoids. Prospective randomized well-designed trials are urgently needed to inform current recommendations on systemic treatment.
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Thoracoscopic lobectomy for massive hemoptysis caused by complete pulmonary vein occlusion after radiofrequency ablation for atrial fibrillation.

Complete pulmonary vein occlusion is a rare complication of transcatheter radiofrequency ablation for atrial fibrillation. We here report a 37-year-old man who presented with massive hemoptysis as a result of left superior pulmonary vein occlusion caused by transcatheter radiofrequency ablation for paroxysmal atrial fibrillation. The patient was successfully managed with thoracoscopic left upper lobectomy with a satisfactory outcome.

Rosuvastatin postconditioning protects isolated hearts against ischemia-reperfusion injury: The role of radical oxygen species, PI3K-Akt-GSK-3ß pathway, and mitochondrial permeability transition pore.

AIMS: Glycogen synthase kinase-3ß (GSK-3ß) and mitochondrial permeability transition pore (mPTP) play an important role in myocardial ischemia-reperfusion injury. The aim of this study was to investigate whether postconditioning with rosuvastatin is able to reduce myocardial ischemia-reperfusion injury and clarify the potential mechanisms. METHODS: Isolated rat hearts underwent 30 minutes of ischemia and 60 minutes of reperfusion in the presence or absence of rosuvastatin (1-50 nmol/L). The activity of signaling pathway was determined by Western blot analysis, and Ca2+ -induced mPTP opening was assessed by the use of a potentiometric method. RESULTS: Rosuvastatin significantly reduced myocardial infarct size and improved cardiac function at 5 and 10 nmol/L. Protection disappeared at higher concentration and reverted to increased damage at 50 nmol/L. At 5 nmol/L, rosuvastatin increased the phosphorylation of protein kinase B (Akt) and GSK-3ß, concomitant with a higher Ca2+ load required to open the mPTP. Rosuvastatin postconditioning also significantly increased superoxide dismutase activity and reduced malondialdehyde and radical oxygen species level. LY294002, phosphatidylinositol-3-kinase (PI3K) inhibitors, abolished these protective effects of rosuvastatin postconditioning. CONCLUSION: Rosuvastatin prevents myocardial ischemia-reperfusion injury by inducing phosphorylation of PI3K-Akt and GSK-3ß, preventing oxidative stress and subsequent inhibition of mPTP opening.

New approach to treating spinal cord injury using PEG-TAT-modified, cyclosporine-A-loaded PLGA/polymeric liposomes.

Cyclosporine-A (CsA) is an immunosuppressant agent that has shown effectiveness as a neuroprotective drug; however, it does not readily cross the blood-spinal cord barrier (BSCB), which constrains the clinical applications of CsA for the treatment of spinal cord injury (SCI). Our group recently tested the ability of novel polyethylene glycol (PEG)-transactivating-transduction protein (TAT)-modified CsA-loaded cationic multifunctional polymeric liposome-poly(lactic-co-glycolic acid) (PLGA) core/shell nanoparticles (PLGA/CsA NPs) to transport and deliver CsA across the BSCB to treat SCI. The PLGA/CsA NPs were successfully constructed. In vitro drug release studies have demonstrated that the sustained release of CsA from PLGA/CsA NPs occurs over ∼25 h. The in vivo study presented here showed that injured animals that received PLGA/CsA NPs through the tail vein, exhibited a significant up-regulation of growth-associated protein-43 (GAP-43) expression and an increased number of GAP-43-stained neurons compared with animals that received CsA or the vehicle alone. The improvement in neurological function was also evaluated by the Basso-Beattie-Bresnahan (BBB) open-field test. Moreover, fluorescein isothiocyanate (FITC)-attached PLGA/CsA NPs were successfully aggregated in the intact spinal cord 4 h after injection. Our data suggest that PLGA/CsA NPs have the potential for use as a new treatment method for SCI.

Overexpression of micro ribonucleic acid-591 inhibits cell proliferation and invasion of malignant pleural mesothelioma cells.

BACKGROUND: Malignant pleural mesothelioma (MPM) is an aggressive cancer refractory to current therapies. Reduced expression of micro ribonucleic acid (miR)-591 in a range of cancer types has suggested it is a potent tumor suppressor, and overexpression has been shown to inhibit tumor cell growth. The role of miR-591 in MPM is largely unknown. METHODS: miR-591 was over-expressed in vitro using micro RNA mimics in three MPM cell lines (H513, H2052, H2373), and effects on tumor cell growth, proliferation, invasion, and target gene expression were assessed. RESULTS: miR-591 mimic was introduced into MPM cell lines to overexpress this microRNA. The cellular growth, proliferation, and invasive capability was significantly inhibited after overexpression of miR-591. Growth inhibition caused by miR-591 correlated with upregulation of p21 and Bax. Reduced invasive capability correlated with downregulation of matrix metalloproteinase-2 and transforming growth factor-ß1. CONCLUSION: miR-591 is a potent tumor suppressor in MPM. Overexpression of miR-591 may represent a novel therapeutic approach for MPM.

Treatment of giant pharyngoesophageal diverticulum by video-assisted thoracoscopy.

A 67-year-old woman presented with a giant pharyngoesophageal diverticulum (Zenker's diverticulum) that extended deep into the chest. Surgery, using either an open or endoscopic approach, was difficult. We stapled the common wall between the diverticulum and the esophagus using video-assisted thoracoscopic surgery. The patient exhibited good anatomic and functional results at 6 months' follow-up.