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Objective:To investigate the effects of thoracic segment epidural anesthesia on inflammatory factors in patients undergoing lung cancer surgery.Methods:The clinical data of 136 patients who underwent lung cancer surgery in the Second People's Hospital of Liaocheng from June 2020 to May 2022 were retrospectively analyzed. According to anesthesia methods, these patients were divided into an observation group ( n = 89) and a control group ( n = 47). The observation group was given thoracic segment epidural anesthesia, while the control group was given remifentanil infusion anesthesia. The tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels in the epithelial lining fluid collected from the non-dependent lung, the plasma levels of TNF-α, IL-6, and malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, the incidence of complications, the incidence of re-operations, numeric rating scale score, and the length of hospital stay were compared between the two groups. The effects of different anesthesia methods on lung cancer surgery were evaluated. Results:In each group, TNF-α, IL-6, and IL-10 levels in the epithelial lining fluid were significantly increased 30 minutes after termination of one-lung ventilation (T2) compared with those measured before one-lung ventilation (T1) ( t = 7.71, 77.10, 7.59, 3.41, 57.51, 5.74, all P < 0.05). In the observation group, TNF- α [(1.59 ± 0.53) ng/L, (1.89 ± 0.64) ng/L] measured at T1 and T2, IL-6 [(2.96 ± 0.82) ng/L] and IL-10 [(1.99 ± 0.53) ng/L] measured at T1 were significantly higher compared with those measured at the corresponding time points in the control group ( t = 10.45, 2.59, 2.00, 7.19, all P < 0.05). In the observation group, IL-6 measured at T2 [(38.91 ± 5.84) ng/L] was significantly lower than that in the control group ( t = 33.25, P < 0.001), and IL-10 measured at T2 [(2.51 ± 0.67) ng/L] was slightly, but not significantly higher than that in the control group ( P > 0.05). There was no significant difference in the plasma level of TNF- α measured at T1 and T2 between the two groups (both P > 0.05). Plasma levels of IL-6 in the two groups [(42.98 ± 5.29) ng/L, (27.93 ± 4.17) ng/L] measured at T2 were significantly increased compared with those measured at T1 ( t = 54.14, 61.06, both P < 0.001). In the observation group, TNF-α measured at T2 [(1.60 ± 0.56) ng/L] and IL-6 measured at T1 and T2 [(0.92 ± 0.16) ng/L, (27.93 ± 4.17) ng/L] were significantly lower compared with the control group ( t = 3.39, 6.96, 18.20, all P < 0.05). There were no significant differences in plasma level of malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, numeric rating scale score, the incidence of complications, the incidence of re-operation, and the length of hospital stay between the two groups (all P > 0.05). Conclusion:Thoracic segment epidural anesthesia can reduce the local inflammatory response of the lung during lung cancer surgery.
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According to the global cancer observatory (GLOBOCAN), there were 16,485 new cases of pancreatic cancer in Southeast Asia in 2020, with men (9458 cases) having the highest incidence compare to woman (8320 cases). The death rate from 16,485 cases was 16,167cases (98%). A person's chance of developing pancreatic cancer in addition to other cancers is between 1% to 20%. In this study, we reported a case of pancreatic tumor with lung tumor. A 68 years old woman presented with right quadrant abdominal pain since 1 month ago. The pain occurs randomly, but mostly occur during night. The pain didn’t occur after eat fatty food and during exercise. The pain didn’t relieve by rest. The patient also experienced nausea and vomit. The vomit consist of food and blood. Shecomplains black colored stools and dark yellow urine. She also lost weight from 62 kg to 47 kg. There was history of gastric bleeding in 4 month ago. She was passive smoker. We then did several tests such as complete blood count, blood chemistry, serology, chest x-ray and abdominal CT-scan. The test showed pancreatic tumor with suggestive primary lung tumor. Patient with multiple primary tumor are an extremely rare type of cancer, which need comprehensive approach to both diagnosis and treatment of these numerous primary tumors.
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Objective:Simultaneous integrated boost radiation technique in limited-stage small cell lung cancer is lack of evidence. This prospective study aims to evaluate whether the simultaneous integrated boost is as efficacious and safe as conventional fractionated radiotherapy.Methods:Patients diagnosed with treatment-naive and confirmed limited-stage SCLC were eligible. Participants were randomly assigned (1: 1) to receive simultaneous integrated boost radiotherapy (PGTV 60.2 Gy/2.15 Gy/28F, PTV 50.4 Gy/1.8 Gy/28F) or conventional fractionated radiotherapy (PTV 60 Gy/2 Gy/30F). The primary endpoint was 2-year progression-free survival, and the secondary endpoints were 2-year overall survival, 2-year local-regional recurrence-free survival and toxicity.Results:Between February 2017 and July 2019, 231 patients were enrolled. We analyzed 216 patients whose follow-up time was more than 2 years or who had died, among whom 106 patients in the conventional fractionated radiotherapy group and 110 patients in the simultaneous integrated boost radiotherapy group. The median follow-up time was 37 months (95% CI: 35.2-38.7). The 2-year progression-free survival rates were 45.2% vs. 38.2%( HR=1.22, 95% CI: 0.87-1.72, P=0.2). The 2-year overall survival rates were 73.5% vs. 60.9%( HR=1.35, 95% CI: 0.90-2.04, P=0.14). The 2-year local-regional recurrence-free survival rates were 68.7% vs. 69.9%( HR=0.98, 95% CI: 0.62-1.56, P=1.0). Multivariate analysis showed that early radiotherapy yielded better 2-year progression-free survival, overall survival and local-regional recurrence-free survival than delayed radiotherapy in two groups ( HR=1.69, 95% CI: 1.18-2.41, P=0.003; HR=1.72, 95% CI: 1.09-2.70, P=0.018; HR=1.66, 95% CI: 1.01-2.73, P=0.046). Tumor staging was an influencing factor of overall survival (stage Ⅲ vs. stage Ⅰ-Ⅱ, HR=3.64, 95% CI: 1.15-11.57, P=0.028). The most common grade 3-4 adverse events were myelosuppression (21.7% vs. 15.4%, P=0.83), radiation pneumonitis (4.7% vs. 2.7%, P=0.44) and radiation esophagitis (3.8% vs. 1.8%, P=0.51). Conclusions:Simultaneous integrated boost radiotherapy yields equivalent efficacy and toxicities to conventional fractionated radiotherapy for limited-stage small cell lung cancer. Early radiotherapy can enhance clinical prognosis.
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The lung is one of the most common sites for cancer metastasis. Collagens in the lung provide a permissive microenvironment that supports the colonization and outgrowth of disseminated tumor cells. Therefore, down-regulating the production of collagens may contribute to the inhibition of lung metastasis. It has been suggested that miR-29 exhibits effective anti-fibrotic activity by negatively regulating the expression of collagens. Indeed, our clinical lung tumor data shows that miR-29a-3p expression negatively correlates with collagen I expression in lung tumors and positively correlates with patients' outcomes. However, suitable carriers need to be selected to deliver this therapeutic miRNA to the lungs. In this study, we found that the chemotherapy drug cisplatin facilitated miR-29a-3p accumulation in the exosomes of lung tumor cells, and this type of exosomes exhibited a specific lung-targeting effect and promising collagen down-regulation. To scale up the preparation and simplify the delivery system, we designed a lung-targeting liposomal nanovesicle (by adjusting the molar ratio of DOTAP/cholesterol-miRNAs to 4:1) to carry miR-29a-3p and mimic the exosomes. This liposomal nanovesicle delivery system significantly down-regulated collagen I secretion by lung fibroblasts in vivo, thus alleviating the establishment of a pro-metastatic environment for circulating lung tumor cells.
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Introducción: El melanoma maligno es un tumor de etiología multifactorial, cuando afecta al sistema respiratorio su origen es casi siempre metastásico, y como tumor primario es muy infrecuente, constituye el 0,07 por ciento de los tumores pulmonares malignos. Objetivo: Presentar un caso clínico con diagnóstico de melanoma maligno primario de pulmón. Presentación del caso: Se presenta el caso de una mujer de 64 años de edad, exfumadora, sin antecedentes de melanoma, que presenta tos seca asociada a disnea, los esfuerzos físicos y dolor torácico. Además de astenia y pérdida de peso. Se le realizó biopsia pulmonar mediante broncoscopia y se le diagnosticó melanoma. Conclusiones: El melanoma primario pulmonar es uno de los más raros del tipo de melanoma visceral, es una entidad neumológica infrecuente y el diagnóstico preciso requiere una investigación detallada y el cumplimiento de criterios clínicos y anatomopatológicos específicos(AU)
Introduction: Malignant melanoma is a tumor of multifactorial etiology, when it affects the respiratory system its origin is almost always metastatic, and as a primary tumor it is very infrequent, it constitutes 0.07 por ciento of malignant lung tumors. Objective: To report a clinical case with a diagnosis of primary malignant melanoma of the lung. Case report: We report the case of a 64-year-old woman, former smoker, with no history of melanoma, who had dry cough associated with dyspnea with physical exertion and chest pain. In addition to asthenia and weight loss, she had a lung biopsy by bronchoscopy and was diagnosed with melanoma. Conclusions: Primary pulmonary melanoma is one of the rarest of the visceral melanoma type, this is an infrequent pneumological entity and the precise diagnosis requires detailed investigation and the fulfillment of specific clinical and pathological criteria(AU)
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Humans , Female , Bronchoscopy/methods , Lung Neoplasms/diagnosis , Melanoma/diagnosisABSTRACT
Objective To investigate the prognostic value of the platelet-lymphocyte ratio (PLR) in non-small cell lung cancer patients treated with PD-1/PD-L1 inhibitors. Methods PubMed, EMBASE, Web of Science, Medline, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP, WanFang and other databases were searched online for eligible studies about evaluating the relation between PLR and the prognosis of NSCLC patients treated with PD-1/PD-L1 inhibitors from the establishment of database to April 2020. The relevant data of literatures that met the inclusion criteria were extracted. Pooled estimates of HR and 95%CI were calculated using Stata 15.0. Results We included six studies involving 551 patients. Elevated PLR was associated with worse OS and PFS of NSCLC patients treated with PD-1/PD-L1 inhibitors. The subgroup analysis of OS showed the prognostic value of high PLR in Caucasian race, cutoff value ≤169.05, PLR cutoff value determination according to previous literature and multi-center retrospective study (P < 0.05). Subgroup analysis of PFS showed the prognostic value of high PLR in East Asian race, cutoff value ≤169.05, PLR cutoff value determination according to previous literature and single-center retrospective study (P < 0.05). Conclusion Among NSCLC patients treated with PD-1/PD-L1 inhibitors, elevated blood PLR is associated with shorter OS and PFS, indicating that it may be a potential biomarker for PD-1/PD-L1 treatment on NSCLC patients.
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@#Objective To explore the independent risk factors for postoperative retention of urinary catheters in the ward of lung tumor patients due to urinary retention under the concept of enhanced recovery after surgery (ERAS). Methods Seventy-five patients with lung tumors who had urinary catheters left in the postoperative ward between June 2019 and August 2019 were selected as a case group, and 75 patients with lung tumors who did not have urinary catheters in the perioperative period as a control group. Independent risk factors for indwelling urinary catheters in the postoperative ward were screened by univariate and multiple-variate logistic stepwise regression analysis. Results There were 45 males and 30 females in the case group with an average age of 55.33±10.78 years, 28 males and 47 females in the control group with an average age of 57.12±10.06 years. Univariate analysis showed that gender, operative time>2 h, intraoperative fluid volume≥1 200 mL, and fluid volume within 6 h of returning to the ward after surgery>1 200 mL were associated with the occurrence of indwelling urinary catheters in patients with lung tumors in postoperative wards (P<0.05). Multiple-variate logistic regression showed that male (OR=2.311, 95%CI 1.173-4.552, P=0.015), infusion volume within 6 h of returning to the ward after surgery>1 200 mL (OR=2.491, 95%CI 1.149-5.401, P=0.021) and intraoperative infusion volume≥1 200 mL (OR=2.105, 95%CI 1.022-4.340, P=0.044) were independent risk factors for postoperative retention of urinary catheters in patients with lung tumors. Conclusion The occurrence of indwelling urinary catheter in lung tumor patients under the ERAS concept is the result of a combination of factors, and patients who are male, have infusion volume>1 200 mL within 6 h of returning to the ward after surgery, and have intraoperative infusion volume≥1 200 mL are the high-risk group for postoperative ward indwelling urinary catheter, and health care personnel should strengthen the assessment and observation, provide targeted health education, appropriately control the perioperative fluid volume, and take other measures to reduce the occurrence of indwelling urinary catheters due to urinary retention postoperatively in ward.
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@#Objective To investigate the predictive value of preoperative radiological features on spread through air spaces (STAS) in stage cⅠA lung adenocarcinoma with predominant ground-glass opacity, and to provide a basis for the selection of surgical methods for these patients. Methods The clinical data of 768 patients with stage cⅠA lung adenocarcinoma undergoing operation in our hospital from 2017 to 2018 were reviewed, and 333 early stage lung adenocarcinoma patients with predominant ground-glass opacity were selected. There were 92 males and 241 females, with an average age of 57.0±10.0 years. Statistical analysis was performed using SPSS 22.0. Results STAS-positive patients were mostly invasive adenocarcinoma (P=0.037), and had more micropapillary component (P<0.001) and more epidermal growth factor receptor (EGFR) gene mutations (P=0.020). There were no statistically significant differences between the STAS-positive and STAS-negative patients in other clinicopathological features. Univariate analysis showed that the maximum diameter of tumor in lung window (P=0.029), roundness (P=0.035), maximum diameter of solid tumor component in lung window (P<0.001), consolidation/tumor ratio (CTR, P<0.001), maximum area of the tumor in mediastinum window (P=0.001), tumor disappearance ratio (TDR, P<0.001), average CT value (P=0.001) and lobulation sign (P=0.038) were risk factors for STAS positive. Multivariate logistic regression analysis showed that the CTR was an independent predictor of STAS (OR=1.05, 95%CI 1.02 to 1.07, P<0.001), and the area under the receiver operating characteristic (ROC) curve was 0.71 (95%CI 0.58 to 0.85, P=0.002). When the cutoff value was 19%, the sensitivity of predicting STAS was 66.7%, and the specificity was 75.2%. Conclusion CTR is a good radiological feature to predict the occurrence of STAS in early lung adenocarcinoma with predominant ground-glass opacity. For the stage cⅠA lung adenocarcinoma with predominant ground-glass opacity and CTR ≥19%, the possibility of STAS positive is greater, and sublobar resection needs to be carefully considered.
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Introducción: La linfangioleiomiomatosis pulmonar constituye un desafío, tanto en su manejo diagnóstico como en la atención de sus complicaciones. Es una enfermedad rara que se caracteriza por la proliferación del músculo liso alrededor de las estructuras bronco-vasculares, linfáticos y en el intersticio pulmonar, unido a la dilatación quística de los espacios aéreos terminales. Objetivo: Describir la evolución clínica y el tratamiento de un paciente con linfangioleiomiomatosis pulmonar. Presentación de caso: Se presenta un caso de linfangioleiomiomatosis pulmonar que desde el punto de vista clínico se manifestó por neumotórax a repetición. Se llegó a diagnóstico definitivo mediante la realización de una biopsia de pulmón. Desarrollo: La linfangioleiomiomatosis es una entidad rara que afecta fundamentalmente a mujeres en edad fértil y que se caracteriza por la presencia de un patrón quístico difuso. Su prevalencia e incidencia es desconocida. Conclusiones: Se puede concluir que la presencia de neumotórax espontáneo o recidivante en una mujer en edad fértil, o embarazada, debe sospecharse linfangioleiomiomatosis(AU)
Introduction: Pulmonary lymphangioleiomyomatosis constitutes a challenge, both in its diagnostic management and in the care of complications. It is a rare disease characterized by the proliferation of smooth muscle around the bronchovascular and lymphatic structures and in the pulmonary interstitium, together with cystic dilation of the terminal air spaces. Objective: To describe a diagnosed case of pulmonary lymphangioleiomyomatosis. Case report: A case of pulmonary lymphangioleiomyomatosis is reported, which was clinically showed as recurrent pneumothorax. A definitive diagnosis was reached by performing a lung biopsy. Discussion: Lymphangioleiomyomatosis is a rare entity that mainly affects women of childbearing age and is characterized by the presence of a diffuse cystic pattern. Its prevalence and incidence is unknown. Conclusions: It can be concluded that the presence of spontaneous or recurrent pneumothorax in a woman of childbearing age, or pregnant, should be suspected lymphangioleiomyomatosis(AU)
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Humans , Female , Adult , Pneumothorax/complications , Lymphangioleiomyomatosis/diagnosis , Lymphangioleiomyomatosis/mortality , Lymphangioleiomyomatosis/pathologyABSTRACT
Aims: This study aims to observe the preliminary clinical efficacy of percutaneous interstitial brachytherapy using iodine-125 seeds for the treatment of advanced malignant lung tumors. Subjects and Methods: This retrospective study enrolled 24 patients in our hospital with advanced malignant lung tumors between June 2013 and November 2017. Computed tomography (CT)-guided iodine-125 seed implantation therapy was administered to these patients. All patients were followed up at 3, 6, and 12 months after the operation. The clinical efficacy was evaluated by CT. Results: Among the 24 patients, the objective response rates at 3, 6, and 12 months after the procedure were 50.0%, 50.0%, and 33.3%, respectively. Recent occurrence of adverse reactions were observed, including four cases of pneumothorax, three cases of hemoptysis, and two cases of particle displacement. Conclusions: CT-guided percutaneous interstitial brachytherapy with iodine-125 seeds can be used for the treatment of lung malignant tumors. Its clinical curative effect is remarkable and it results in limited trauma, reducing the incidence of adverse reactions and improving patient quality of life
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Early detection and accurate diagnosis are critical for the prognosis of lung cancer. Radiological imaging could reflect tumor heterogeneity in a non-invasive and comprehensive manner. Deep mining of high throughput imaging data is a big challenge for radiologists. Artificial intelligence (AI) methods excel at processing large quantities of high-dimensional information and analyzing data using algorithm. It can automatically recognize complex patterns in imaging data, provide quantitative assessments of radiographic characteristics, and is promising in tumor detection and diagnosis. Precision medicine could be made when AI was integrated into the clinical workflow as a tool to assist radiologists. Here we review the current progress and discuss the challenges and future directions of AI applications in lung tumor imaging diagnosis.
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BACKGROUND@#The patients with advanced lung adenocarcinoma should select targeted drugs based on the type of tumor epidermal growth factor receptor (EGFR) gene mutation. However, it is difficult to collect tumor tissue of advanced lung adenocarcinoma, and some experts agree that peripheral blood can be used as a substitute for tumor tissue as a test specimen. This paper aimed to investigate the clinical value of ddPCR and super-amplification refractory mutation system (ARMS) in detecting EGFR gene mutation in peripheral blood of patients with advanced lung adenocarcinoma.@*METHODS@#A total of 119 patients diagnosed in Beijing Chest Hospital Affiliated to Capital Medical University from February 2016 to February 2019 were collected, and the sensitivity and specificity of plasma ctDNA EGFR gene mutation detected by ddPCR and super-arms were compared. Some patients with positive EGFR gene mutations received oral treatment with first-line EGFR tyrosine kinase inhibitors (EGFR-TKI). The patients were divided into subgroups according to the test results. In group 1, both ddPCR and super-arms showed positive EGFR gene mutation results, with 21 cases. In group 2, ddPCR and super-arms detection of EGFR gene mutation were all negative, with 16 cases. In group 3, the ddPCR test was positive and the super-arms test was negative, with 5 cases. In group 4, the ddPCR test result was negative while the super-arms test result was positive. Since the number of patients in group 4 was 0, no statistics were included. Objective response rate (ORR) and disease control rate (DCR) were used to evaluate the short-term outcome, and progression-free survival (PFS) was compared with survival analysis to evaluate the long-term outcome.@*RESULTS@#EGFR mutations were detected in 58 (48.7%) of 119 patients with advanced lung adenocarcinoma. The coincidence rate between ddPCR and EGFR gene mutation in tumor tissues was 82.4% (Kappa=0.647, P0.05). Survival analysis showed that the PFS of the three groups was compared. The difference was not statistically significant (χ²=2.221, P=0.329).@*CONCLUSIONS@#ddPCR, as a high sensitivity and specificity liquid gene detection method, can be used as a reliable method to detect the mutation of plasma ctDNA EGFR gene in patients with advanced lung adenocarcinoma. The results of plasma genetic testing can also be used as the basis for predicting the efficacy of EGFR-TKIs in patients.
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Objective@#To analyze the causes and correlative factors of high perioperative blood transfusion demand in patients with lung tumor, and to discuss the influence of high blood transfusion demand on patients’ postoperative recovery and its predictive factors.@*Methods@#From November 2007 to October 2017, clinical data of patients who had underwent surgery for lung tumors in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences were collected. A total of 83 cases with perioperative transfusion of red blood cells ≥5U were classified as high transfusion demand group. Another 83 cases were selected from the rest of the patients with transfusion of red blood cells <5U as normal transfusion demand group. Related clinical and transfusion data were summarized to analyze the causes of high blood transfusion demand and its effect on postoperative recovery, univariate and multivariate logistic regressions were used to analyse correlative factors.@*Results@#From November 2007 to October 2017, 23 898 patients with lung tumor underwent surgery in our department and the high blood transfusion demand rate was 0.35%. In the last 10 years, the ratio of high transfusion demand was 0.61%(46/7 503) in the first 5 years versus 0.23%(37/16 395) in the later 5 years(P<0.01). By contrasting high transfusion demand group and normal transfusion demand group, the ratio of thoracoscopic surgery was 42.17%(35/83) vs. 26.51%(22/83)(P<0.05), the ratio of postoperative blood transfusion was 39.76%(33/83) vs. 22.90%(19/83)(P<0.05) and the ratio of left upper lung surgery was 24.10%(20/83) vs. 12.05%(10/83)(P<0.05). The ratio of patients with preoperative comorbidities was 21.69%(18/83) in the high transfusion demand group versus 8.43%(7/83) in the normal transfusion demand group(P<0.05), and the ratio of patients with anemia was 57.83%(48/83) vs. 52.63%(30/83)(P<0.05). The incidence of complications was 39.76%(33/83) in the high transfusion demand group versus 18.07%(15/83) in the normal transfusion demand group(P<0.01), and the incidence of Infection-related complication were 25.30%(21/83) vs. 8.43%(7/83)(P<0.01).@*Conclusion@#For perioperative high blood transfusion demand in lung tumors, there were significant differences between different operation approaches, site of operation and phase of blood transfusion. The perioperative high blood transfusion demand may also increase the risk of postoperative complications, comorbidities or anemia were its predictive factors.
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Objective@#To introduce our experience of 4L lymph node dissection in left lung cancer and to analyze the pattern of 4L LN metastasis. To investigate the prognostic impact of 4L lymph node dissection.@*Methods@#171 patients with left lung cancer who underwent pulmonary resection andsystematic mediastinal lymph node dissection from March 2016 to March 2019 were collected retrospectively. There were 106 males and 65 females endolled, aged(64.1±7.7) years. 54.4% had a history of smoking. The diameter of the tumors was(3.3±1.9) cm; Central-type tumor were 59 cases(34.5%), peripheral 112 cases(65.5%), upper lobe 95 cases(55.6%) and lower lobe 76 cases(44.4%). The clinical and perioperative data as well as the pattern of lymph node metastasis were analyzed. t test or Mann-Whiteney U test was used for continuous variables, and χ2 test or Fisher test was used for categorical variables. Multivariate analysis was performed using a logistic regression model to evaluate the risk factors.@*Results@#The metastasis rate of station 4L was 21.6%. Tumor size, locations(central type/upper lobe), operative type, micropapillary/entity components and vascular invasion were risk factors for 4L LN metastasis in univariate analysis. Tumor size(OR=1.611, P=0.032) and location of upper lobe(OR=2.823, P=0.008) were independent risk factors in multivariate logistic analysis. Through the analysis of ROC curve, the optimal cutoff point of tumor size was 2.5cm. The metastatic rate of 4L was 32.6% when tumor size larger than 2.5 cm and 7.9% when tumor size smaller than 2.5cm.Tumor located in upper lobe tended to metastasize to upper mediastinal lymph nodes, including station 4L, 5 and 6, while the one located in lower lobe tended to metastasize to station 7.@*Conclusion@#Station 4L LN involvement is commen in left lung cancer. The dissection of the 4L LN is important, especially for the tumor larger than 2.5 cm or located at upper lobe.
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Objective To analyze the causes and correlative factors of high perioperative blood transfusion demand in pa-tients with lung tumor, and to discuss the influence of high blood transfusion demand on patients' postoperative recovery and its predictive factors. Methods From November 2007 to October 2017, clinical data of patients who had underwent surgery for lung tumors in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences were collected. A total of 83 cases with perioperative transfusion of red blood cells≥5U were classified as high transfusion demand group. Anoth-er 83 cases were selected from the rest of the patients with transfusion of red blood cells <5U as normal transfusion demand group. Related clinical and transfusion data were summarized to analyze the causes of high blood transfusion demand and its effect on postoperative recovery, univariate and multivariate logistic regressions were used to analyse correlative factors. Results From November 2007 to October 2017, 23898 patients with lung tumor underwent surgery in our department and the high blood transfusion demand rate was 0. 35％. In the last 10 years, the ratio of high transfusion demand was 0. 61％(46/7503) in the first 5 years versus 0. 23％(37/16395) in the later 5 years(P<0. 01). By contrasting high transfusion demand group and normal transfusion demand group, the ratio of thoracoscopic surgery was 42. 17％(35/83) vs. 26. 51％(22/83)(P<0.05),theratioofpostoperativebloodtransfusionwas39.76％(33/83) vs. 22.90％(19/83)(P<0.05) andtheratioof left upper lung surgery was 24. 10％(20/83) vs. 12. 05％(10/83)(P<0. 05). The ratio of patients with preoperative comor-bidities was 21. 69％(18/83) in the high transfusion demand group versus 8. 43％(7/83) in the normal transfusion demand group(P<0.05),andtheratioofpatientswithanemiawas57.83％(48/83) vs. 52.63％(30/83)(P<0.05). Theinci-dence of complications was 39. 76％(33/83) in the high transfusion demand group versus 18. 07％(15/83) in the normal transfusion demand group(P<0. 01), and the incidence of Infection-related complication were 25. 30％(21/83) vs. 8. 43％(7/83)(P <0. 01). Conclusion For perioperative high blood transfusion demand in lung tumors, there were significant differences between different operation approaches, site of operation and phase of blood transfusion. The perioperative high blood transfusion demand may also increase the risk of postoperative complications, comorbidities or anemia were its predictive factors.
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Objective To introduce our experience of 4L lymph node dissection in left lung cancer and to analyze the pattern of 4L LN metastasis. To investigate the prognostic impact of 4L lymph node dissection. Methods 171 patients with left lung cancer who underwent pulmonary resection andsystematic mediastinal lymph node dissection from March 2016 to March 2019 were collected retrospectively. There were 106 males and 65 females endolled, aged(64. 1 ± 7. 7) years. 54. 4％ had a historyofsmoking. Thediameterofthetumorswas(3.3±1.9)cm;Central-typetumorwere59cases(34.5％),peripheral 112 cases(65. 5％), upper lobe 95 cases(55. 6％) and lower lobe 76 cases(44. 4％). The clinical and perioperative data as well as the pattern of lymph node metastasis were analyzed. t test or Mann-Whiteney U test was used for continuous variables, and χ2 test or Fisher test was used for categorical variables. Multivariate analysis was performed using a logistic regression model to evaluate the risk factors. Results The metastasis rate of station 4L was 21. 6％. Tumor size, locations(central type/upper lobe),operative type, micropapillary/entity components and vascular invasion were risk factors for 4L LN metastasis in univari-ate analysis. Tumor size(OR=1. 611,P=0. 032) and location of upper lobe(OR=2. 823,P=0. 008) were independent risk factors in multivariate logistic analysis. Through the analysis of ROC curve, the optimal cutoff point of tumor size was 2. 5cm. The metastatic rate of 4L was 32. 6％ when tumor size larger than 2. 5 cm and 7. 9％ when tumor size smaller than 2. 5cm. Tumor located in upper lobe tended to metastasize to upper mediastinal lymph nodes, including station 4L, 5 and 6, while the one located in lower lobe tended to metastasize to station 7. Conclusion Station 4L LN involvement is commen in left lung cancer. The dissection of the 4L LN is important, especially for the tumor larger than 2. 5 cm or located at upper lobe.
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Objective@#To establish Kunming mouse models of lung tumor rapidly induced by urethane and butylated hydroxytoluene（BHT）.@*Methods@#Two hundred Kunming mice of SPF grade were randomly assigned to one control group and three experimental groups. The mice in the experimental groups were intraperitoneally injected with urethane at the dosage of 50,100 and 200 mg/kg（low,medium and high dose）,after one week,they were fed with fodder containing 0.75% BHT every day for two weeks;while the mice in the control group were injected with distilled water and were fed with normal fodder without BHT. At the 15th week,the lungs of all the mice were removed,tumors were counted and collected. The remaining lung tissue was cut into blocks of 1-2 mm thick,followed by paraffin section,HE staining,and was observed under light microscope.@*Results@#The incidence rates of lung tumors in Kunming mice of the low-,meidium-,high-dose group and the control group were 14.00%,24.00%,38.00% and 2.00%;the number of tumors were 1,8,22 47;the proportion of malignant tumors were 12.50%,18.18%,27.66% and 0. The incidence rate and the number of tumors in medium- and high-dose group were significantly higher than those in the control group（P<0.05）. The incidence rate,the number of tumors and the proportion of malignant tumors increased with the dosage of urethane,which indicated a dose-response relationship（P<0.05）.@*Conclusion@#The Kunming mouse models of lung tumor rapidly induced by urethane and BHT were established successfully,with significant dose-response relationship and tumorigenesis.
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Introducción: el cáncer de pulmón es el tumor maligno más frecuente en el mundo, en Cuba es la segunda causa de muerte, su pronóstico depende de diferentes factores entre ellos el intervalo entre el primer síntoma y el inicio del tratamiento. Objetivo: determinar los factores que influyen en la demora en el diagnóstico de los pacientes con neoplasia de pulmón. Métodos: se realizó un estudio descriptivo, retrospectivo y longitudinal de los pacientes egresados vivos con diagnóstico de neoplasia de pulmón en el Hospital Militar Dr. Carlos J. Finlay en el período comprendido entre enero 2016 a enero 2017. Resultados: la neoplasia de pulmón fue más frecuente en mayores de 50 años, del sexo masculino y con estrecha relación con el hábito de fumar, la falta de aire fue el principal síntoma por el que acudieron los pacientes después de un mes de inicio de la sintomatología. La estadía hospitalaria fue superior a los 20 días y se realizó el diagnóstico histológico en pocos pacientes. Conclusiones: la demora en el diagnóstico de la neoplasia de pulmón influye en su supervivencia, pues no se les puede realizar un tratamiento oncoespecífico(AU)
Introduction: lung cancer is the most frequent malignant tumor in the world, in Cuba it is the second cause of death, its prognosis depends on different factors including the interval between the first symptom and the start of treatment. Objective: to determine the factors that influence the delay in the diagnosis of patients with lung neoplasia. Methods: a descriptive, retrospective and longitudinal study of live patients with diagnosis of lung neoplasm was performed at the Military Hospital Dr. Carlos J. Finlay in the period from January 2016 to January 2017. Results: lung neoplasia was more frequent in men over 50 years of age, and with a close relationship with smoking, lack of air was the main symptom for which patients came after a month of onset of smoking symptomatology. The hospital stay was longer than 20 days and the histological diagnosis was made in a few patients. Conclusions: the delay in the diagnosis of lung neoplasia influences their survival, since they cannot be treated onco-specific(AU)
Subject(s)
Humans , Male , Middle Aged , Smoking/physiopathology , Delayed Diagnosis/prevention & control , Lung Neoplasms/epidemiology , Epidemiology, Descriptive , Retrospective Studies , Longitudinal StudiesABSTRACT
Objective: To investigate the regulatory effects of inflammatory signaling pathway on the expression of G protein-coupled receptor class C group 5 member A (GPRC5A). Methods: Nuclear factor κB (NF-κB)-driven luciferase mice were intraperitoneally injected with lipopolysaccharide (LPS) to evaluate the activation of NF-κB in lungs. GPRC5A expression in lungs was assessed by Western blotting in the C57BL/6J mice injected with LPS. In vitro tests, human lung tumor cell lines Calu-1 and H322, and human embryonic kidney cell line HEK293T were administered with tumor necrosis factor α (TNF-α) or transfected with p65 expression plasmid; Western blotting, RT-PCR, luciferase reporter gene experiment and immunofluorescence assay were used to analyze the effect of inflammation on GPRC5A expression. Results: Intraperitoneal injection of LPS induced activation of NF-κB pathway in lung tissues, which suppressed the expression of GPRC5A in mice lungs. In Calu-1 cells, TNF-α treatment greatly suppressed the expression of GPRC5A protein and mRNA. In HEK293T cells, transfection of p65 subunit of NF-κB suppressed the expression of GPRC5A promoter-driven luciferase reporter. The H322 cells transfected with green fluorescent protein-p65 almost did not express GPRC5A. Conclusion: NF-κB pathway acts at the promoter of GPRC5A and suppresses its mRNA and protein expression.
ABSTRACT
Objective · To investigate the regulatory effects of inflammatory signaling pathway on the expression of G protein-coupled receptor class C group 5 member A (GPRC5A).Methods· Nuclear factor κB (NF-κB)-driven luciferase mice were intraperitoneally injected with lipopolysaccharide (LPS) to evaluate the activation of NF-κB in lungs.GPRC5A expression in lungs was assessed by Western blotting in the C57BL/6J mice injected with LPS.In vitro tests,human lung tumor cell lines Calu-1 and H322,and human embryonic kidney cell line HEK293T were administered with tumor nccrosis factor α (TNF-α) or transfected with p65 expression plasmid;Western blotting,RT-PCR,luciferase reporter gene experiment and immunofluorescence assay were used to analyze the effect of inflammation on GPRC5A expression.Results · Intraperitoneal injection of LPS induced activation of NF-κB pathway in lung tissues,which suppressed the expression of GPRC5A in mice lungs.In Calu-1 cells,TNF-α treatment greatly suppressed the expression of GPRC5A protein and mRNA.In HEK293T cells,transfection of p65 subunit of NF-κB suppressed the expression of GPRC5A promoter-driven luciferase reporter.The H322 cells transfected with green fluorescent protein-p65 almost did not express GPRC5A.Conclusion · NF-κB pathway acts at the promoter of GPRC5A and suppresses its mRNA and protein expression.