Efficacy and safety of radiofrequency ablation in the treatment of inoperable patients with pulmonary malignant nodules.

BACKGROUND: Radiofrequency ablation (RFA) has been recently applied as an alternative treatment in the patients with pulmonary malignancies. The aim of our study was to assess the incidence of complications and survival rate of RFA for malignant lung nodules, and evaluate the efficacy and safety of RFA in the treatment of inoperable patients with pulmonary malignant nodules. METHODS: The clinical data of 50 patients with primary and metastatic lung malignant nodules treated with RFA from June 2015 and July 2017 in Hebei General Hospital were considered, and the characteristics and clinical data of these patients were analysed. Complications, progression-free survival and overall survival at 1, 2 and 5 years of these patients were evaluated. RESULTS: Following the procedure. There were no major complications and deaths during the operation. 26 (52%) patients presented mild-to-moderate chest pain that was easily controlled by analgesic drugs. 8 (16%) patients with pneumothorax, 4 (8%) haemoptysis, 6 (12%) pneumonia, 7 (14%) pleural effusion and 1 (2%) postoperative bronchopleural fistula. Needle-track implantation was observed in 2 (4%) patients. Median progression-free survival (PFS) was 24.6 months. The PFS at 1, 2, 5 years was 76%, 52% and 20%, respectively. Median overall survival (OS) was 35.5 months. The OS at 1, 2 and 5 years was 80%, 58% and 32%, respectively. CONCLUSION: RFA is a safe and effective alternative treatment for the inoperable patients with primary or metastatic pulmonary malignant nodules. The clinical impact and long-term results of RFA need to be further confirmed in a larger series of patients, and RFA should ideally be compared with surgery.

Total laparoscopic total gastrectomy and distal esophagectomy combined with reconstruction by transhiatal esophagojejunal Roux-en-y mediastinal anastomosis for Siewert II AEG.

PURPOSE: The optimal procedure is still controversial about Siewert type II AEG, We are attempt to explore the efficacy and feasibility of total laparoscopic total gastrectomy and distal esophagectomy combined with reconstruction by transhiatal esophagojejunal Roux-en-y mediastinal anastomosis for Siewert type II AEG. METHOD: Data of patients with Siewert type II AEG who received total laparoscopic total gastrectomy and distal esophagectomy combined with reconstruction by transhiatal esophagojejunal Roux-en-y mediastinal anastomosis in the Hebei General Hospital were collected from October 2020 to October 2021, The operation time, surgical blood loss, the number of dissected lymph nodes, duration of drainage tube, the length of stay in ICU, the resume oral feeding time, the length of postoperative hospital stay, postoperative complications and other related indicators of the patients were collected to evaluate the safety and feasibility of this operation. RESULT: A total of 17 patients received total laparoscopic total gastrectomy and distal esophagectomy combined with reconstruction by transhiatal esophagojejunal Roux-en-y mediastinal anastomosisin the treatment of Siewert type II AEG were analyzed in our research. The mean operation time was 253 ± 24.8 min (196-347 min); The median surgical blood loss was 250 ml (20-2400 ml); The average number of dissected lymph nodes were 28 ± 4.6 (17-36); The median duration of drainage tube was 5 days (3-7days); The median length of stay in ICU was 18 h(10-34 h); The median time of resume oral feeding was 6 days (5-7days); The median postoperative hospital stay was 11 days (8-15 days). Among the all enrolled patients, one patient underwent the conversion to laparotomy due to the massive intraoperative bleeding, one patient developed anastomotic stenosis at jejunum side-to-side anastomosis on the first month after surgery, there was no case of death during the operation and postoperative anastomotic fistula. All patients achieved R0 resection with an average distance of 6 cm (4-8.5 cm) from the upper margin of the tumor to the resection margin. CONCLUSION: The operation of total laparoscopic total gastric and distal esophagectomy combined with reconstruction by transhiatal esophagojejunal Roux-en-y mediastinal anastomosis is technically feasible and sufficiently safe in the treatment of Seiwert type II AEG from our primary clinical experience. This procedure could be one of the alternatives for the radical treatment of Siewert type II AEG.

Langerhans cell histiocytosis involving only the thymus in an adult: A case report.

BACKGROUND: Langerhans cell histiocytosis (LCH) is a rare disease of unknown etiology. LCH involving the thymus is mainly seen in pediatric patients and is extremely rare in adults. In this report, we describe a rare case of LCH originating from the thymus in an adult. CASE SUMMARY: A 56-year-old man was admitted in April 2022 with complaints of intermittent dizziness since 2020, which had worsened in the previous 10 d. The physical chest examination was negative, and there was a history of hypertension for > 2 years. Chest computed tomography showed a nodular soft tissue density shadow in the anterior mediastinum measuring approximately 13 mm × 9 mm × 8 mm. Postoperative pathological findings confirmed the diagnosis of LCH. CONCLUSION: It is challenging to differentiate LCH involving the thymus from thymoma in imaging features. Pathological biopsy remains the gold standard when an anterior mediastinal occupying lesion is found.

Long non-coding RNA SPRY4-IT1 as a promising indicator for three field lymph-node dissection of thoracic esophageal carcinoma.

BACKGROUND: Esophageal squamous cell carcinoma(ESCC) is one of the most common tumors worldwide. Esophagectomy with three-field lymph node dissection(3FLND) is the radical surgical procedure for esophageal cancer. However, 3FLND is not widely used due to it's higher mortality rate and higher incidence of postoperative complications. There is an urgent need to identify novel biomarkers that can guide the most proper lymph-node dissection in esophageal cancer patients. METHOD: Ninety-two patients with thoracic ESCC undergoing 3FLND were enrolled into our study from the Department of Thoracic Surgery of the Fourth Hospital affiliated to the Hebei Medical University and Hebei General Hospital between Jun 2011 and Dec 2015. Retrospectively collected data from these 92 patients was used to explore the relationship between the lymph-node metastasis、recurrence and the SPRY4-IT1 expression level and to determine whether 3FLND should be performed in patients with thoracic ESCC. RESULTS: The findings revealed that the SPRY4-IT1 expression was significantly higher in esophageal cancer tissues than in adjacent noncancerous tissues. (P < 0.01). Furthermore, the high expression of SPRY4-IT1 was significantly correlated with tumor differentiation (P = 0.029), T classification (P = 0.013), lymph node metastasis(P = 0.022) and pathological stage (P = 0.001). The increased expression of SPRY4-IT1 was associated with a higher risk of cervical and superior mediastinal lymph-node metastasis(P = 0.039).However, no significant association was observed between the risk of cervical and superior mediastinal lymph-node recurrence and the SPRY4-IT1 expression level in the thoracic ESCC patients performed 3FLND(P = 0.509). CONCLUSIONS: Our data support the assumption that the high expression of SPRY4-IT1 is associated with a high risk of lymph node metastasis and it has potential application as a indicator for guiding on three-field lymph node dissection in patients with thoracic ESCC. Randomized controlled trials with a large cohort of patients will be needed to confirm this conclusion in the future.

Long non-coding RNA (lncRNA) PGM5P4-AS1 inhibits lung cancer progression by up-regulating leucine zipper tumor suppressor (LZTS3) through sponging microRNA miR-1275.

It is necessary to explore new molecules for the improvement of precise diagnosis and antitumor therapies in lung cancer. LncRNAs (long non-coding RNAs) play an important role in the regulation of cancer cell malignant behavior and tumor development. In this work, we found that a newly discovered lncRNA, lncRNA PGM5P4-AS1, was lower expressed in lung cancer tissues than adjacent tissues. Then, the lncRNA PGM5P4-AS1 was overexpressed or knocked-down in different lung cancer cells, and its effects on the malignant phenotypes were measured by 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay, cell cycle assay, wound healing assay, and transwell assay. The results showed that the overexpression of PGM5P4-AS1 inhibited lung cancer cell proliferation, migration, and invasion activities, while these abilities were prominently promoted by the interference of PGM5P4-AS1. Further, the growth of lung cancer tumors in nude mice was also inhibited by PGM5P4-AS1 overexpression. In mechanism, PGM5P4-AS1 has the binding site of miR-1275 and could positively regulate the expression of LZTS3 via sponging miR-1275. In conclusion, PGM5P4-AS1 could be a potential precise diagnosis and therapeutic target biomarker of lung cancer.

Meta-analysis of association between CT-based features and tumor spread through air spaces in lung adenocarcinoma.

OBJECTIVE: Spread through air space (STAS) is a novel invasive pattern of lung adenocarcinoma and is also a risk factor for recurrence and worse prognosis of lung adenocarcinoma after sublobar resection. The aims of this study are to evaluate the association between computed tomography (CT)-based features and STAS for preoperative prediction of STAS in lung adenocarcinoma, eventually, which could help us choose appropriate surgical type. METHODS: Systematic research was conducted to search for studies published before September 1, 2019. The association between CT-based features of radiological tumor size>2 cm、pure solid nodule、 part-solid nodule or Percentage of solid component (PSC)>50% and STAS was evaluated. According to rigorous inclusion and exclusion criteria. Eight studies including 2385 patients published between 2015 and 2018 were finally enrolled in our meta-analysis. RESULTS: Our results clearly depicted that there is no significant relationship between radiological tumor size>2 cm and STAS with the combined OR of 1.47(95% CI:0.86-2.51). Meta-analysis of 3 studies showed that pure solid nodule in CT image were more likely to spread through air spaces with pooled OR of 3.10(95%CI2.17-4.43). Meta-analysis of 5 studies revealed the part-solid nodule in CT image may be more likely to appear STAS in adenocarcinoma (ADC) (combined OR:3.10,95%CI:2.17-4.43). PSC>50% in CT image was a significant independent predictor in the diagnosis of STAS in ADC from our meta-analysis with combined OR of 2.95(95%CI:1.88-4.63). CONCLUSION: In conclusion, The CT-based features of pure solid nodule、part-solid nodule、PSC>50% are promising imaging biomarkers for predicting STAS in ADC and may substantially influence the choice of surgical type. In future, more studies with well-designed and large-scale are needed to confirm the conclusion.

Clinical application and observation of single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal squamous cell carcinoma.

BACKGROUND: Transthoracic esophagectomy is a crucial independent risk factor for the incidence of postoperative cardiopulmonary complications in elderly or comorbid patients. To reduce postoperative cardiopulmonary complications and promote postoperative recovery. We made an attempt to adopt the single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal cancer to observe the clinical application and effect. METHOD: Data of patients with esophageal carcinoma were collected in the Hebei General Hospital from May 2018 to November 2019. The operation time, surgical blood loss, the number of dissected lymph nodes, duration of drainage tube, duration of time on the ventilator, the length of stay in ICU, postoperative complications, the length of postoperative hospital stay were collected to assess the safety and feasibility of the single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal cancer. RESULTS: A total of 22 patients with esophageal cancer were analyzed in our research. There were no cases of conversion to thoracotomy、perioperative death or postoperative cardiopulmonary complications. The average operation time of all enrolled patients was 4.26 ± 0.52 h、The surgical blood loss was 142 ± 36.50 ml、The amount of dissected lymph nodes were 21.6 ± 4.2、The duration of drainage tube was 5.8 ± 2.5 days、The duration of time on the ventilator was 6.5 ± 3.4 h、The length of stay in ICU was 1.2 ± 0.4 days、The postoperative hospital stay was 12.6 ± 2.5 days. Among all the enrolled patients, one patient (4.5%) developed anastomotic fistula on the third day after surgery. Anastomotic stricture was found in 5 patients (22.7%). Pleural effusion was found in 4 cases (18.2%). Recurrent laryngeal nerve injury caused hoarseness or cough after drinking water in 3 cases (13.6%).There was one patient (4.5%) of conversion to laparotomy as the patient had serious peritoneal adhesion. All of the patients were discharged successfully. CONCLUSION: Our results showed that this surgery of single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal squamous cell carcinoma is safe and feasible. The feasibility and safety could be further and better investigated with a RCT to achieve more conclusive results.

Prognostic Impact of Tumor Spread Through Air Spaces in Non-small Cell Lung Cancers: a Meta-Analysis Including 3564 Patients.

Surgical resection is the most effective treatment for early stage lung adenocarcinoma. However, the rate of 5-year postoperative recurrence reaches 30%, Spread Through Air Spaces(STAS) is a recently described novel invasive pattern of lung cancer, According to the 2015 WHO classification. STAS is defined as"micropapillary clusters, solid nests, or single cells spreading within air spaces beyond the edge of the main tumor, However, the prognostic role of STAS in lung cancer is not known, The aim of the current study is to evaluate the association between STAS and clinical outcome of lung cancer patients after surgical resection through a meta-analysis. Systematic research was conducted using three online databases to search for studies published before August 1, 2018. The 5-year RFS and OS for non-small cell lung cancer patients after surgical resection with or without STAS were compared. The studies were selected according to rigorous inclusion and exclusion criteria. Meta-analysis was performed using hazard ratio (HR) and 95% confidence intervals (CIs) as effective measures. Included in our meta-analysis were 12 studies, published from 2015 to 2018, with a total of 3564 patients. Our results clearly depicted that the presence of STAS predicted a worse outcome for 5-year RFS with the combined HR of 1.84(95% CI: 1.59-2.12). Meta-analysis of these 8 studies showed that patients with the presence of STAS were associated with shorter 5-year OS (the pooled HR:1.78, 95% CI: 1.51-2.11). This meta-analysis illuminated that the presence of STAS might be a unfavorable prognostic factor for patients with NSCLC. it should be paid sufficient attention and recorded in pathologic reports, which can indicate treatment choice and prognosis of patients. In future, more studies with well-designed and large-scale are needed to confirm the conclusion.

miR-181b inhibits chemoresistance in cisplatin-resistant H446 small cell lung cancer cells by targeting Bcl-2.

INTRODUCTION: MicroRNAs (miRNAs) are a group of small non-coding RNAs that affect multiple aspects of tumor biology including chemo resistance. miR-181b has been reported to modulate multidrug resistance in non-small cell lung cancer cells. This study was undertaken to determine the role of miR-181b in chemo resistance of small cell lung cancer cells. MATERIAL AND METHODS: This study was undertaken to determine the role of miR-181b in chemoresistance of small cell lung cancer cells with use of qRt-PCR, WB, bioinformatics analysis, and double luciferase reporter system. RESULTS: Our data showed that miR-181b was significantly downregulated in cisplatin-resistant H446 small cell lung cancer cells, compared to parental cells, compared to parental cells. Ectopic expression of miR-181b inhibited cell proliferation and invasion in cisplatin-resistant H446 cells (p = 0.023). Moreover, overexpression of miR-181b increased the susceptibility of cisplatin-resistant H446 cells to cisplatin. Mechanistic investigations demonstrated that miR-181b inhibited B-cell lymphoma-2 (Bcl-2) expression by binding to the 3'-untranslated region. Overexpression of Bcl-2 reversed miR-181b-mediated chemo sensitization, which is accompanied by a reduced apoptotic response. CONCLUSIONS: Taken together, this work demonstrated that miR-181b might have the ability to overcome chemo resistance of small cell lung cancer cells, and restoration of this miRNA may represent a potential therapeutic strategy for improving chemo sensitivity in small cell lung cancer.

Cytotoxic T lymphocyte-associated antigen-4 +49A>G polymorphism and the risk of non-small cell lung cancer in a Chinese population.

BACKGROUND: CTLA-4 is a potent immunoregulatory molecule and plays a pivotal role in the negative regulation of T-cell proliferation and activation. Previously, the association between CTLA-4 +49A>G polymorphism and the risk of NSCLC has been investigated in several studies, however, their results were inconsistent. Therefore, we aimed to investigated the association between CTLA-4 +49A>G polymorphism and the risk of NSCLC in a Chinese population. METHODS: We recruited 231 NSCLC patients and 250 healthy controls in the present case-control study. PCR-RFLP was used to analyze the polymorphism of CTLA-4. The chi-squared test was used to examine differences between NSCLC patients and controls. The odds ratio (OR) and its 95% confidence interval (95% CI) were obtained by logistic regression methodology to determine correlations between the CTLA-4 polymorphism and the incidence of NSCLC. RESULTS: When the AA genotype was used as the reference group, the GG genotype was significantly associated with increased risk for NSCLC (OR=2.181, 95% CI: 1.244-5.198; P=0.007), however, the AG genotype was not significantly associated with increased risk for NSCLC (OR=2.018, 95% CI: 0.826-3.881; P=0.099). Under the dominant model of inheritance, the AG+GG genotype was significantly associated with increased risk for NSCLC (OR=3.271, 95% CI: 1.827-4.559; P=0.015). In addition, the G allele had a 2.754-fold higher risk of NSCLC in comparison with the A allele (OR=2.754, 95% CI: 1.365-6.891, P=0.005). CONCLUSIONS: Our data provided evidence that the CTLA-4 +49A>G polymorphism is associated with increased risk of NSLCL in Chinese population.