Inhibition of miR-22 enhanced the efficacy of icotinib plus pemetrexed in a rat model of non-small cell lung cancer.

OBJECTIVES: To investigate the role of miR-22 in the efficacy of combined icotinib (BPI-2009H) and pemetrexed (LY-231514) on tumor growth and apoptosis in rats with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Rats were injected with HCC827 cells, which were transfected with anti-miR-22, followed by the treatment of BPI-2009H and/or LY-231514. MTT assay was used to detect the inhibition rate of HCC827 cells. qRT-PCR was performed to examine miR-22 expression in HCC827 cells and lung tumor tissues. Moreover, immunohistochemistry and Western blotting were performed to detect the related-molecule expressions, while TUNEL staining was used to observe cell apoptosis of lung tumor tissues. RESULTS: MiR-22 expression was decreased in HCC827 cells after the treatment of BPI-2009H or LY-231514 in a dose-dependent manner. Both BPI-2009H and LY-231514 increased the inhibition rate of HCC827 cells, which was enhanced by anti-miR-22 with decreased IC50 values. Furthermore, the decreased expression of miR-22 was found after the treatment of BPI-2009H or/and LY-231514 in lung tumor tissues. In addition, the expressions of PCNA, Ki67, and Bcl-2 were reduced, but Bax and Caspase-3 were increased in treated rats, typically in those rats treated with the combination of anti-miR-22, BPI-2009H, and LY-231514. CONCLUSION: Inhibition of miR-22 could enhance the efficacy of icotinib combined with pemetrexed in rats with NSCLC, providing a new perspective for NSCLC therapy.

Diagnosis and comprehensive treatment of esophageal leiomyoma: clinical analysis of 77 patients.

To investigate the diagnosis and comprehensive treatment of esophageal leiomyoma. The clinical data of 77 cases of esophageal leiomyoma patients were analyzed between 2005 and 2013. Its diagnosis, treatment and prognosis were analyzed. 39 cases of patients were with eating choking feeling, 18 cases presented with chest pain and weight loss and 20 cases without any symptoms. Preoperative endoscopic ultrasonography of each patient was diagnosed as possibility of esophageal submucosal tumor. 3 All patients underwent tumor enucleation, in which tumor electrotomy under gastroscope were done for 2 cases, complete video-assisted thoracoscopic (CVATS) resection of tumor for 24 cases, thoracoscope assisted small incision tumor resection for 29 cases, conventional thoracic tumor resection for 22 cases. The comparison and the difference of complete video-assisted thoracoscopic surgery group and the thoracoscope assisted small incision group for the operation time, bleeding volume, drainage volume, extubation time, hospitalization time and fasting time were not statistically significant (P < 0.05). All the patients recovered well and postoperative pathology of each patient was esophageal leiomyoma. They were followed up for 6 months to 8 years, average for 4 years, not recurrence of esophageal leiomyoma. Endoscopic ultrasonography is the most accurate method in diagnosis of esophageal leiomyoma. Esophageal leiomyoma which less than 1.0 cm in diameter, regular shape, originated in the muscularis mucosa, endoscopic electrotomy can be used as the preferred; Surgical operation is the main treatment of esophageal leiomyoma, three kinds of operation way has its own corresponding clinical indications, according to the clinical characteristics of patients and operator' habits to choose the corresponding operation way, all can achieve good treatment effect.

Diagnosis and multi-modality treatment of adult pulmonary plastoma: Analysis of 18 cases and review of literature.

The clinical data of 18 patients with PB from April 1989 to April 2013 was analyzed retrospectively, including 11 men and 7 women, aged 45 and 76 years old (mean 53 years). There were 12 cases of PB occurring in right lung and other cases in left lung. Among them, 3 patients had no symptoms, and 15 patients displayed symptoms of cough, chest pain, asthenia or minor haemoptysis. Overall, 11 patients had a preoperative diagnosis of lung cancer, 7 patients were preoperatively diagnosed as the other diseases, which included lung benign tumor (n=5) and mediastinal mass (n=2). All patients received a radical resection. Six patients received postoperative cisplatin-based chemotherapy, and two patients received postoperative irradiation with the dose of 55 Gy. Histologically, 14 cases of 18 patients had biphasic pulmonary blastoma and four cases had well differentiated fetal adenocarcinoma. A total of 12 patients died in a period of 6-36 months after operation, and 1 case was lost after 2 years of follow up. The median survival time was 19 months. PB is a rare primary lung malignant embryonal neoplasm. Despite its assumed embyonal origin, the tumor has a predilection for adults. A preoperative correct diagnosis is very difficult in spite of modern diagnostic imaging and biopsy techniques. Surgical resection is the main method for diagnosis and treatment. Postoperative chemotherapy or irradiation can help eliminate tumor remnants. Its prognosis is very poor, especially for the biphasic type.

Treatment of 336 cases of chest trauma.

OBJECTIVE: To summarize the clinical features, diagnosis and treatment of chest trauma. METHODS: A retrospective analysis was conducted among 336 cases of chest trauma admitted to our hospital from January 2009 to May 2011. RESULTS: Out of all cases, 325 were cured, accounting for 96.7%; 11 died, accounting for 3.3%. Among the dead cases, one died of hemorrhagic shock, three of acute respiratory distress syndrome, three of multiple organ failure, and four of severe multiple traumas. CONCLUSIONS: (1) For patients with severe chest trauma, early emergency treatment is crucial to save life. (2) Open thoracic surgery is needed for acute cardiac tamponade, intrapulmonary vascular injuries, progressive intrathoracic bleeding, lung laceration, tracheal breakage, and diaphragmatic injury. In addition, operative timing and method should be well chosen. (3) Pulmonary contusion is one of common complications in chest trauma, for which the combination of strong anti-infection therapy and mechanical ventilation is an effective treatment strategy.

Surgical treatment and prognosis of octogenarians with non-small cell lung cancer.

OBJECTIVE: To explore the clinical characteristics, surgical treatment and prognosis of non-small cell lung cancer (NSCLC) among elderly patients over 80 years. METHODS: The clinical data, surgical methods, perioperative management, postoperative complications and prognosis of 52 NSCLC patients aged over 80 years were retrospectively analyzed. RESULTS: Out of 52 cases, 27 had a long-term smoking history (51.9%) and 44 were with other diseases (84.6%). Lobectomy was done in 32 cases (65.4%), sub-lobectomy in 20 cases (38.5%), including pulmonary wedge resection in 16 cases (30.8%) and lung segment resection in 4 cases (7.7%). The postoperative complication rate was 44.2% (23/52); the complication rate after lobectomy was 62.5% (20/32) and that after sub-lobectomy was 25% (5/20), with significant difference between lobectomy and sub-lobectomy (P<0.05). Postoperative mortality was 3.8% (2/52). Pathological TNM staging: I a 27 cases (51.9%), I b 12 cases (23.1%), II a 8 cases (15.4%), II b 3 cases (5.8%) and III a 2 cases (3.8%). The 1-, 3- and 5-year survival rate after operation was 87.1%, 59.8%, 19.1%. The 1-, 3- and 5-year survival rate was 86.0%, 61.8%, 21.5% in the patients after lobectomy; that was 89.0%, 58.3%, 18.7% in the patients after sub-lobectomy, with no significant difference between two surgical methods (P>0.05). CONCLUSIONS: Octogenarians with NSCLC are often afflicted with comorbidity, so perioperative management is more complex. Strictly adhering to indications, surgery is still an important treatment of NSCLC patients over 80.

[Comparative study on molecular staging of lymph nodes in non-small cell lung cancer patients].

BACKGROUND AND OBJECTIVE: The postoperative survival of patients with non-small cell lung cancer (NSCLC) is mainly determined by clinical pathologic stage. However, recurrence is not rare in stage I NSCLC patients. This study was to explore whether conventional pathologic stages of some NSCLC were underestimated. METHODS: A total of 195 lymph nodes were taken from 25 NSCLC patients during operation. Each lymph node was cut into two parts equally: one part was subjected to hematoxylin-eosin (HE) and immunohistochemical (IHC) staining; the other part of the lymph nodes in the same region in a given patient was mixed for reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: With HE staining, 30 of the 195 lymph nodes showed gross nodal metastasis, and none showed micrometastasis. IHC staining was performed on 135 lymph nodes that were identified as free of metastasis by HE staining, 31 showed micrometastasis; none showed gross nodal metastasis. Of 39 groups of mixed regional lymph nodes which were diagnosed to be free of metastasis by HE staining, 11 groups were found to be positive by RT-PCR. There was a correlation between IHC staining and RT-PCR for detection of nodal micrometastasis of NSCLC (U=7.682, P<0.001). CONCLUSIONS: HE staining can accurately detect gross nodal metastasis in NSCLC patients, but is unfit for detecting nodal micrometastasis. IHC staining can improve the detection rate of occult nodal micrometastasis. RT-PCR has similar value to IHC staining in detecting nodal micrometastasis.

[Comparative study for detecting micrometastases of lymph nodes in patients with lung cancer].

OBJECTIVE: To set up a new method to detect occult micrometastases of lymph nodes in patients with no-small-cell lung cancer (NSCLC). METHODS: We had detected 195 lymph node samples taken from 25 patients with NSCLC during the operations. Each lymph node sample was divided into two same parts in size. The one half part of lymph node should be examined by conventional histopathologic examination and immunohistochemical (IHC) staining. All the remaining lymph node samples of each patient should be mixed together for the reverse transcriptase-polymerase chain reaction (RT-PCR) if they located in the same region. As long as the presence of metastatic tumor in one lymph node was found by H&E staining, all other lymph node samples in the same region should not be detected by IHC staining or RT-PCR techniques. RESULTS: Frozen tissue sections of 135 lymph nodes that were staged as free of metastases by conventional histopathologic examination were screened by IHC staining. 31 lymph nodes showed single cell or cells clusters. Of 39 groups mixed regional lymph nodes which were diagnosed to be devoid of metastases by conventional histopathologic examination, 11 groups were found to have positive reactions to cytokeratin 19-mRNA by RT-PCR. There was a correlation between IHC staining and RT-PCR for detection of nodal micrometastases of NSCLC (U = 7.682, P = 0.0001). CONCLUSION: IHC staining analysis can facilitate the detection of occult micrometastases in lymph nodes of NSCLC, and its assessment of nodal micrometastases can provide a refinement of TNM stage for partial patients with stage I to II. RT-PCR has the same value as IHC staining in detection of lymph nodal micrometastases. RT-PCR technique can reduce expense of the detecting micrometastases in lymph nodes.

[Clinical pathological study on nodal micrometastases of non-small-cell lung cancer].

OBJECTIVE: To investigate the practicability of detecting the micrometastases in lymph nodes of no-small-cell lung cancer (NSCLC) by means of the immunohistochemical (IHC) staining. METHODS: The lymph node samples were taken from the patients with NSCLC during the operations. Firstly, each resulting tissue block was processed for routine paraffin embedding. Then the 6 approximately 10 serial sections were chosen, each 5 microm thick, from every paraffin block of the lymph node. Finally, the first and the second last sections of each lymph node were stained by hematoxylin eosin (HE), and the other serial sections were used for the IHC staining examination with the monoclonal antibody against cytokeratin 19. RESULTS: The paraffin embedded sections of 195 regional lymph nodes from 25 patients with NSCLC were examined by HE staining. Thirty lymph nodes in 9 patients revealed gross nodal metastases, and none of lymph node in 25 patients showed micrometastatic tumor cells. Frozen tissue sections from 135 regional lymph nodes that were staged as free of metastases by HE staining were screened by IHC staining. Thirty-one lymph nodes in 9 patients showed micrometastatic tumor cells. Five of sixteen patients staged as PN(0) had hilum lymph nodal micrometastases, versus four of nine patients with stage PN(1) had mediastinal lymph nodal micrometastases. There was a significant difference between two groups (chi(2)=52.900, P=0.0193). CONCLUSIONS: Conventional HE staining can accurately detect gross nodal metastases in the lymph nodes of patients with NSCLC, but is unfit for detecting lymph nodal micrometastases. IHC staining analysis can significantly facilitate the detection of occult micrometastatic tumor cells in lymph nodes of NSCLC, and its assessment of nodal micrometastases can provide a refinement of TNM stage for partial patients with stage I to II NSCLC.

[Clinicopathological study on nodal molecular staging of non-small-cell lung cancer].

OBJECTIVE: To investigate the practicability of detecting the micrometastasis in lymph nodes of no-small-cell lung cancer (NSCLC) by means of reverse transcriptase-polymerase chain reaction (RT-PCR). METHODS: Regional lymph node samples were collected during operation from 25 patients with NSCLC randomly selected. The lymph node sample from each patient was divided into 2 groups: lymph nodes of hilum of lung and of mediastinum. Every lymph node was divided into two parts of the same size. One half part of the lymph node was examined by hematoxylin eosin (H&E) staining. If HE staining discovered metastasis, further examination was not needed. If HE staining failed to discover metastasis, then all the remaining lymph node samples of each patient were mixed together to undergo RT-PCR for cytokeratin 19 (CK(19)), a tissue marker of epithelium and epithelial tumors. RESULTS: (1) 195 lymph nodes from 25 patients with NSCLC were examined by H&E staining. 30 lymph nodes in 9 patients showed gross nodal metastasis and none showed micrometastatic tumor cells. (2) Of the 39 groups of mixed regional lymph node samples which were diagnosed to be devoid of metastases by H&E staining, 11 groups were found to have positive reactions to CK(19) mRNA. (3) Six of the sixteen patients staged as PN(0) had hilum lymph nodal micrometastasis, while 5 of nine patients with stage PN(1) had mediastinal lymph nodal micrometastasis (chi(2) = 54.063, P = 0.0043). CONCLUSION: (1) H&E staining can accurately detect gross nodal metastasis in the lymph nodes of the patients with NSCLC, but is unfit for detecting lymph nodal micrometastasis. (2) RT-PCR can facilitate the detection of occult micrometastatic tumor cells in the lymph nodes of NSCLC, and its assessment of nodal micrometastasis can provide a refinement of molecular stage for partial patients with stage I to II.

[Long-term outcome of bronchoplastic procedures in the treatment of lung cancer].

OBJECTIVE: To assess the value of bronchoplastic procedures in surgical treatment for bronchogenic carcinoma. METHODS: Bronchoplastic procedures were performed in 78 patients with bronchogenic carcinoma from August 1976 to December 2002. There were 67 patients with squamous cell carcinoma (86%). Of the total, 57 patients underwent sleeve resection of the right upper lobe (including 2 undergoing bronchoplasty and angioplasty; 2 undergoing partial carinal plus lobar resection); 1 patient had sleeve bilobectomy of the right upper and middle lobes; 2 patients had sleeve bilobectomy of the right middle and lower lobes. Sleeve resection of the left upper lobe was accomplished in 12 patients (including 3, undergoing bronchoplasty and angioplasty), 5 patients had sleeve lobectomy of the left lower lobe. Postoperative pathological staging: 47 in stage I (60.2%), 23 in stage II (29.5%), 8 in stage III (10.3%). RESULTS: No operative death occurred in 30 days. Complications were noted in 5 patients (6.6%), including pneumonia (2 patients) and atelectasis (3 patients). The overall 5-year survival for 78 patients was 57.8% (26/45), 43% (6/14) respectively. The 5-year survival for patients in stage I, II and III was 68.7% (22/32), 36.4% (4/11) and 0 (0/2) respectively. CONCLUSION: Bronchoplastic procedures for bronchogenic carcinoma extends operative indication to some patients with complication rates comparable to pneumonectomy and improve life quality.