Long Non-Coding RNA CASC9 And HIF-1α Form A Positive Feedback Loop To Facilitate Cell Proliferation And Metastasis In Lung Cancer.

BACKGROUND: The long noncoding RNA cancer susceptibility 9 (CASC9) has been recognized as an important modulator of cell growth and metastasis in many cancers. However, its detailed roles in lung cancer remain unclear. In this study, we aimed to investigate its functions and molecular mechanism in lung cancer progression. METHODS: Expression of CASC9 was determined in lung cancer tissues and cell lines by real-time PCR. CCK-8, colony formation, wound healing and transwell assays were done to evaluate the cell proliferation, migration and invasion capacities in vitro. Real-time PCR, Western blot and RNA immunoprecipitation (RIP) assays were performed to dissect the mechanisms. RESULTS: CASC9 was overexpressed in lung cancer specimens and cell lines. Knockdown of CASC9 inhibited cell proliferation, migration, invasion and EMT in lung cancer cells. While overexpression of CASC9 in normal lung epithelial cells did the opposite. CASC9 interacted with HIF-1α and enhanced its protein stability. They formed a positive feedback loop by reciprocally inducing each other expression and regulated cell proliferation and metastasis. CONCLUSION: Our findings demonstrated a novel regulatory signaling pathway, namely the CASC9/HIF-1α axis, which was involved in lung cancer progression. These findings can provide valuable insights on the potential therapy application for lung cancer.

Cardiac penetrating injury: a rare complication associated with the lung nodule localization by hookwire.

A 48-year-old woman with small lung nodule received transthoracic lung nodule localization by hookwire and subsequent lung resection. At the time of lung nodule localization, computed tomography (CT) scan showed that the localization was successful without any complication. However, cardiac penetrating injury caused by hookwire localizer was unexpectedly observed during surgery. This has occurred because the hookwire was placed too close to the anterior pulmonary vein and became inserted into left ventricle under the influence of blood flow and lung manipulation.

Uniportal Subcostal Video-Assisted Thoracoscopic Surgery: A Feasible Approach for a Challenging Middle Lobectomy in an Obese Patient.

Subcostal access is a novel approach for anatomical lung resection. To perform surgery via this access, specially designed long instruments are required. Subcostal access provides excellent visualization of the mediastinum and anterior lung hilum. We exhibit here a subcostal middle lobectomy with systematic en-block mediastinal lymphadenectomy in an obese 52-year-old male patient with body mass index (BMI=37.7) performed via this single incision. The operation was completed efficiently within 30 minutes with negligible postoperative pain.

Behavior of primary tracheal glomus tumor, uncertain malignant potential subtype.

The behavior of the pathological subtypes of tracheal glomus tumor (benign, uncertain malignant potential UMP, malignant) is vague. In a 51-year-old gentleman, suffering from cough for 4 months, computed tomography scan showed a mass at lower third of the trachea and the bronchoscope revealed exophytic mass at the tracheal lumen. Segmental tracheal resection was done using special modified endotracheal tube for the distal lung ventilation. The tracheal glomus tumor was also diagnosed based on the immunohistochemical staining. The tumor was 2 cm in diameter, deeply located, mitotic phase was difficult to identify, and a diagnosis of UMP subtype was made. There was no recurrence after 2 years follow-up. This is the first reported case of UMP subtype in lower trachea and we studied the treatment options with the clinic-pathological behavior of this tumor and its sequel by regular follow-up.

[Application of Digital Drainage System in Postoperative Refractory Prolonged Air Leaks after Pulmonary Surgery].

BACKGROUND: Postoperative prolonged air leaks is one of the most common complications secondary to pulmonary resections. Digital drainage system (DDS) is considered as an accurate and objective device which has been found to be comfortable and well tolerated by patients, economical as well. The aim of this study is to explore the application of DDS in patients with postoperative refractory prolonged air leaks after pulmonary surgery. METHODS: Prolonged air leak (PAL) is defined as air leaks lasting for more than 5 d after video-assisted surgery or more than 7 d after thoracotomy. Postoperative refractory prolonged air leak is defined as a kind of air leak lasting for twice than PAL with grade 2 or 3 air leak, or air leak with severe complications such as subcutaneous or mediastinal emphysema in our study. A total of 8 patients who had postoperative refractory prolonged air leaks after pulmonary resection were treated with digital drainage system combined with pleurodesis from January to December in 2016 in Department of Thoracic Surgery, Shanghai Pulmonary Hospital. All the relevant clinical data of patients were collected for analysis. RESULTS: In our study, 6 patients accepted lobectomy, the other 2 patients underwent segmentectomy. The average air leak and chest tube duration of the patients with postoperative refractory prolonged air leaks after pulmonary resection was (17.3±5.1) d. The average postoperative DDS duration was (5.6±3.7) d. The mean drainage volume of the patients was (2,615.6±1,741.2) mL and (935.0±242.7) mL before and after the application of DDS. The average length of hospital stay was (18.1±5.0) d. CONCLUSIONS: It is safe and feasible to apply digital drainage system to patients with postoperative refractory prolonged air leaks after pulmonary resection. Compared with the conventional drainage system, digital drainage system is more accurate and objective which can offer a larger suction pressure and promote lung recruitment maneuver for pleurodesis, shortening the drainage time and length of hospital stay.

Survivin protein expression is involved in the progression of non-small cell lung cancer in Asians: a meta-analysis.

BACKGROUND: Surviving expression might serve as a prognostic biomarker predicting the clinical outcome of non-small cell lung cancer (NSCLC). The study was conducted to explore the potential correlation of survivin protein expression with NSCLC and its clinicopathologic characteristics. METHODS: PubMed, Medline, Cochrane Library, CNKI and Wanfang database were searched through January 2016 with a set of inclusion and exclusion criteria. Data was extracted from these articles and all statistical analysis was conducted by using Stata 12.0. RESULTS: A total of 28 literatures (14 studies in Chinese and 14 studies in English) were enrolled in this meta-analysis, including 3206 NSCLC patients and 816 normal controls. The result of meta-analysis demonstrated a significant difference of survivin positive expression between NSCLC patients and normal controls (RR = 7.16, 95 % CI = 4.63-11.07, P < 0.001). To investigate the relationship of survivin expression and clinicopathologic characteristics, we performed a meta-analysis in NSCLC patients. Our results indicates survivin expression was associated with histological differentiation, tumor-node-metastasis (TNM) stage and lymph node metastasis (LNM) (RR = 0.80, 95 % CI = 0.73-0.87, P < 0.001; RR = 0.75, 95 % CI = 0.67-0.84, P < 0.001; RR = 1.14, 95 % CI = 1.01-1.29, P = 0.035, respectively), but not pathological type and tumor size. (RR = 1.00, 95 % CI = 0.93-1.07, P = 0.983; RR = 0.95, 95 % CI = 0.86-1.05, P = 0.336, respectively). CONCLUSION: Higher expression of survivin in NSCLC patients was found when compared to normal controls. Survivin expression was associated with the clinicopathologic characteristics of NSCLC and may serves as an important biomarker for NSCLC progression.

Diagnosis and Treatment Evaluation of 48 Cases of Broncholithiasis.

Background Broncholithiasis is a rare disease with various clinical classifications. The aim of this study was to evaluate the imaging diagnosis and surgical treatment of broncholithiasis. Methods and Materials Forty-eight patients with broncholithiasis were enrolled in this retrospective study between January 1985 and December 2009. Patients were classified into intraluminal, transluminal, and extraluminal broncholith according to the anatomy between the calculus and the bronchial lumen confirmed by chest computed tomography (CT), bronchoscopy, and pathology after operation. Result Forty-eight patients were enrolled, with 33 males and 15 females. The sex ratio (male:female) was 2.2:1, and average age was 54.3 ± 13.6 years. There were 8, 19, and 21 patients in intraluminal, transluminal, and extraluminal broncholith group, respectively. Cough, hemoptysis, and chest pain were the most common symptoms. Four patients with intraluminal broncholith and two with transluminal broncholith underwent broncholith removal via bronchoscopy, and the other 42 patients underwent thoracotomy. Conclusion Bronchoscopy combined with CT examination is helpful in diagnosing and typing broncholithiasis. An optimal treatment method, either bronchoscopic removal of broncholithiasis or thoracotomy, according to the clinical typing and indications, is the key to improve the treatment effect.

Common genetic variants on 3q28 contribute to non-small cell lung cancer susceptibility: evidence from 10 case-control studies.

The association between common variations (rs10937405, rs4488809) on 3q28 and lung cancer has been widely evaluated in various ethnic groups, since it was first identified through genome-wide association approach. However, the results have been inconclusive. To derive a more precise estimation of the relationship and the effect of factors that might modify the risk, we performed this meta-analysis. The random-effects model was applied, addressing heterogeneity and publication bias. A total of 10 articles involving 36,221 cases and 58,108 controls were included. Overall, the summary per-allele OR of 1.19 (95 % CI 1.14-1.25, P < 10(-5)) and 1.17 (95 % CI 1.10-1.23, P < 10(-5)) was found for the rs10937405 and rs4488809 polymorphisms, respectively. Significant results were also observed in heterozygous and homozygous when compared with wild genotype for these polymorphisms. Significant results were found in East Asians when stratified by ethnicity, whereas no significant associations were found among Caucasians. After stratifying by sample size, study design, control source and sex, significant associations were also obtained. In addition, our data indicate that these polymorphisms are involved in lung cancer susceptibility and confer its effect primarily in lung adenocarcinoma when stratified by histological subtype. Furthermore, significant associations were also detected both never-smokers and smokers for these polymorphisms. In conclusion, this meta-analysis demonstrated that rs10937405 and rs4488809 are a risk factor associated with increased non-small cell lung cancer susceptibility, particularly for East Asian populations.

Surgical treatment of bronchiectasis: a retrospective observational study of 260 patients.

OBJECTIVE: This study aims to demonstrate our surgical experience for bronchiectasis and analyze the risk factors related with the surgery outcome. METHODS: We retrospectively reviewed medical records of 260 consecutive patients who underwent surgery for bronchiectasis between January 2000 and December 2010. The factors related with the outcome were analyzed and the candidate factors were screened by χ(2) test and t test. Furthermore, logistic regression analysis was used for multiple factor analysis to obtain the independent factors that affected the surgical outcome. RESULTS: Complications occurred in 30 (11.5%) patients during perioperative period. The univariate analysis showed that significant differences can be observed in age (P = 0.000), sputum volume (P = 0.000), smoking history (P = 0.033), pulmonary function (P = 0.003), Gram-negative bacillus infection (P = 0.000), bronchial stump coverage (P = 0.016) using intercostals muscles or pedicle pleura embedding and surgical approach (P = 0.003) between the patients with excellent and poor outcome. The multivariable analyses showed that sputum volume (P = 0.000), Gram-negative bacillus infection (P = 0.000) and bronchial stump coverage (P = 0.000) were the three independent factors related with surgical outcome. CONCLUSION: Surgery is an effective treatment option for bronchiectasis. Sputum volumes lower than 30 mL, negative proof of Gram-negative bacteria and bronchial stump coverage using intercostals muscles or pedicle pleura embedding are the key factors for successful treatment. Special attention has to be given to any complications in elderly patients.