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Objective:Immune checkpoint inhibitors have a high remission rate in the preoperative application of resectable and potentially resectable non-small cell lung cancer when combined with chemotherapy. For the unresectable stage Ⅲ non-small cell lung cancer, whether the transformation can be achieved through this regimen to provide opportunities for surgical resection is controversial. In this study, we evaluated the pattern of transformation therapy by reviewing the efficacy and safety of preoperative therapy and surgery of this group.Methods:A review of 23 patients undergoing surgical resection after transformation therapy by preoperative immunotherapy combined chemotherapy between November 2019 and November 2021 was performed. All patients must clarify the pathological diagnosis of non-small cell lung cancer by biopsy. After the multi-disciplinary treatment team and preoperative imaging assessment, the diagnosis should be consistent with unresectable stage III as described in the Expert Consensus on Multidisciplinary Management of Stage Ⅲ Non-Small Cell Lung Cancer, 2019 Edition. After 2 to 4 cycles of preoperative anti-PD-1 monoclonal antibody combined with chemotherapy, the surgical team assessed the chance of resection and performed surgery. Important indicators such as surgical resection rate, R0 resection rate, MPR, pCR, incidence of grade 3-5 adverse reactions and various other perioperative data were counted.Results:In the whole group, initial imaging evaluation was 10 of stage cⅢA and 13 of stage cⅢB.15 cases had multiple stations N2 lymph nodes metastasis, 9 had enlarged fused N2 lymph nodes metastasis, 6 had large vessel invasion(T4), and 1 had contralateral mediastinal lymph node metastasis(N3). After preoperative neoadjuvant therapy, 17 cases achieved PR, 3 achieved SD and 3 achieved PD. The surgical resection rate of the whole group was 91.3%(21/23, 1 lobectomy combined with superior vena cava reconstruction, 2 sleeve lobectomy, 5 pneumonectomy, 12 lobectomy/combined lobectomy, 1 wedge resection and 2 unresectable cases), R0 resection rate was 95.2%(20/21). MPR was achieved in 13 cases, 8 of them reached pCR. There were no perioperative deaths, median surgical time was 260(190-460) min, median bleeding volume was 100(50-750) ml, median drainage time was 5(3-9) days, and median hospitalization was 7(5-11) days. Two cases got immunotherapy-related grade 3 adverse reactions, one was interstitial pneumonia and the other was immune-related injury involving the eye, oral and genital mucosa. Two cases got surgical complications and one was persistent lung leakage, which stopped after 46 days of conservative treatment; The other was pleural effusion, which was relieved after drainage.Conclusion:For the unresectable stage Ⅲ NSCLC, immunotherapy combined chemotherapy is an effective preoperative downstage method. It can convert 91.3% cases to resectable ones while achieving a good degree of pathological remission. Its side reactions are generally controllable and safety.
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Objective@#To analyze the clinical pathology status of minor differentiated thyroid cancer (DTC).@*Methods@#The clinical pathology data of 107 cases of DTC patients aging≤18 years old who accepted operations at Department of General Surgery, Peking Union Medical College Hospital from January 2000 to December 2016 were collected. There were 27 males and 80 females, aged (15.4±2.7) years (range: 6 to 18 years). And a randomly selected sample′s data was collected as control group, concluded 110 adult DTC patients. There were 35 males and 75 females, aged (43.2±11.8) years (range: 21 to 77 years). The clinical and pathological data of the two groups were retrospectively analyzed. The t test, Mann-Whitney U test, χ2 test and Fisher exact test was used to analyze the data, respectively.@*Results@#The minor patients had larger diameter of tumors ((16.5±9.9) mm vs. (8.7±5.1) mm, t=7.369, P=0.000), higher rate of lymph node metastasis (68.2% vs. 50.0%, χ2=7.446, P=0.006) and higher rate of lateral lymph node metastasis (36.4% vs. 11.8%, χ2=18.059, P=0.000) than adult patients. The rate of lateral lymph node metastasis was significantly higher when minor presented multiple fociin primary lesions (54.3% vs. 27.8%, χ2=7.144, P=0.008) than those with single foci lesions. Adult patients presented more capsular invasion than minor patients in primary lesions (55.6% vs. 19.2%, χ2=28.942, P=0.000).@*Conclusions@#The minor DTC patients present more progress disease status when they receive operations compared with the adult DTC patients. Minor DTC patients appeared as multiple foci should be alert to lateral lymph node metastasis.
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AIM To study the epidermal growth factor (EGF) and transforming growth factor ? (TGF ?)and the epidermal growth factor receptor(EGFR)during the course of rats gastric ulcer natural cure expressing and its possible biology meaning. METHODS We injected acetic acid to make the ulcer animal model, location expression characteristic of EGF and TGF ? and EGFR were studied by immunohistochemistry. RESULTS The normal rats stomach mucosa EGF,TGF ? and EGFR all expressed weakly at masculine. EGF and TGF ? was located at cytoplasm,and EGFR expressesed at cytoplasm and cell membrane and the expression position of the three ovrlopped with each other. EGF concentrated mainly on the cervical part of gastric gland, and TGF ? and EGFR, on the cervical and base parts of the gastric gland. Positive 9 expression cells were primarily parietal[FQ(11?46,X-WZ] and neck cells of the stamook muc. For materials taken during the course of ulcer natural recovery, regular ohanges were observed in TGF, TGF ? and EGFR expression. Higher expression was found in ulcer tissunes than in normal tissues, while the expression was not detectable in necrotic tissues and rarely detectable in granlation and scar tissnes. The expression became apparant only during healing and scar stages of ulcer but not in early stage. CONCLUSION ①TGF ?/EGFR autocrine system probably plays a leading role in maintaining rats mucosa completeness under the normal circumstances; ②EGF/EGFR and TGF ?/EGFR autocrine system may have important effect on the differentiation, hyperplasia, moving of cell and restraining the gastric acidity.
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Objective: Our aim was to evaluate the role of TGF-β1 mRNA in pulmonary fibrosis. Methods: The present study was taken to investigate the expressions of TGF-β1 mRNA in alveolar macrophage（AM) and lung tissues in different stages of bleomycin-induced pulmonary fibrosis in rats through reverse transcript polymerase chain reaction. Results: In bleomycin-treated rats, the expressions of TGF-β1 mRNA was remarkably increased in AM from 3rd day (P< 0.05) , and reached the peak on 7th day (P<0.01) , there was also a continuing high level from 14th day to 28th day (P>0.05). It showed similar pattern with that in lung tissues. Conclusion: There were TGF-β1 mRNA expression in both normal rats and pulmonary fibrosis rats. AMs seemed to be the main source of TGF-β1 mRNA in lung tissues, especially at stage of alveolitis.
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AIM: To investigate the influence and mechanism of recombinant interleukin-13 (rIL-13) on fibroblasts. METHODS: 3T3 fibroblasts were divided into two groups: the treated group was treated with rIL-13 (80 ?g/L, 24 h or 48 h) and the control was without rIL-13 treatment. Transmission electron microscope and Hoechst kit were used to observe morphology of 3T3 fibroblasts in both groups. The activity of proliferation in both groups was investigated and compared by MTT means. Western blot was used to analyze the level of collagen type I induced by rIL-13 in fibroblasts. The levels of IL-6 and IL-8 in the culture supernatants were determined by radioimmunoassay. RESULTS: The more ribosomes and mitochondrions, as well as bigger nuclei were found in the treated group. The production of IL-6 and IL-8, and proliferation ratio of fibroblasts treated with rIL-13 for 24 h or 48 h were increased obviously, compared with the control (P
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AIM: To evaluate the role of alveolar macrophage(AM)lipid peroxidation in bleomycin(BLM)-induced TNF-? and PDGF release from AM in rats. METHODS: Male SD rats were intratracheally instilled with saline or BLM(5 mg/kg body weight), and AM were isolated and analyzed for malondialdehyde (MDA) and glutathione peroxidase(GSH-Px) following 1,3,7,14 or 28 day (s).Simultaneously, TNF-? and platelet-derived growth factor(PDGF) were also determined in AM-conditoned media by ELISA and bioassay respectively. RESULTS:(1) MDA in AM was markedly increased on day 1,peaked on day 3 and then decreased to near control level on day 7; on the other hand, GSH-Px activity in AM were decreased to non-detectable levels during day 1-7 after BLM instillation, returned to the control level by day 14. (2) TNF-? and PDGF were increased significantly from the third day on and then exhibited a consectutive changes.(3)AM lipid peroxidation preceded TNF-? and PDGF release. CONCLUSION: Prior oxidative changes leading to AM lipid peroxidation,depletion of antioxidative pool might be essential for the subsequent mediators release in BLM-induced pulmonary fibrosis.