Optimal pathways involved in the treatment of sevoflurane or propofol for patients undergoing coronary artery bypass graft surgery.

The cardio-protection mechanisms of sevoflurane and propofol still remain unclear in patients undergoing coronary artery bypass grafting (CABG). We designed the present study to identify the optimal pathways through integrating differential co-expressed network (DCN)-based guilt by association (GBA) principle based on the expression data of E-GEOD-4386 downloaded from EMBL-EBI. Differentially expressed genes (DEGs) were firstly identified and then DCN and sub-DCN were established. The seed pathways were predicted through GBA principle using the area under the curve (AUC) for pathway categories, and the pathway terms with AUC >0.9 were defined as the seed pathways. KEGG pathway analysis was applied to the DEGs based on DAVIA to detect significant pathways. The final optimal pathways were identified based on the traditional pathway analysis and network-based pathway inference approach. There were 83 common, 99 sevoflurane-specific and 4 propofol-specific DEGs in the expression profile of artial samples. Finally, 8 and 4 pathway terms having the AUC >0.9 were identified and determined as the seed pathways in the propofol and sevoflurane group, respectively. TNF signaling pathway, NF-κB signaling pathway, as well as NOD-like receptor signaling pathway were the common optimal ones in these two groups. Only the pathway of cytokine-cytokine receptor interaction was unique to sevoflurane, and no pathway was specific to propofol. Our results suggested that sevoflurane and propofol might synergistically possess some cardio-protective properties in patients undergoing CABG.

Is tumor length a prognostic indicator for esophageal squamous cell carcinoma? A single larger study among Chinese patients.

OBJECTIVE: In esophageal cancer, depth of wall penetration, reflected by T classification, represents the most important prognostic variable. Our study aimed to investigate the impact of tumor length, measured as the longitudinal length, on the outcome of esophageal squamous cell carcinoma (ESCC) patients. METHODS: The survival data of 362 ESCC patients who underwent surgical resection as the primary treatment between 1999 and 2007 were collected retrospectively. Receiver-operator characteristic analysis was applied to identify the optimal cut-off values. RESULTS: 4.0 cm was identified as the optimal cut-off value within the whole group. Tumor length greater than 4.0 cm was associated with increasing T stage (P=0.001), N stage (P=0.046), and tumor differentiation (P=0.033). Univariate analysis and multivariate analysis both found that tumor length greater than 4.0 cm was associated with worse overall survival compared with shorter tumors (P<0.001). It appeared to have a greater impact on N0-N1 (P<0.001, P=0.026, respectively) than N2-N3 and appeared to have a higher impact on the lower-stage patients than the higher-stage patients. CONCLUSIONS: Tumor length proved to be an independent prognostic parameter for ESCC patients, especially for node-negative and lower-stage patients. More attention should be paid to its role in the management of ESCC.

[Application of Ivor-Lewis esophagectomy in elderly patients with carcinoma in middle and lower esophagus].

OBJECTIVE: To evaluate the safety of Ivor-Lewis procedure for middle and lower esophageal carcinoma in the elderly. METHODS: From June 2009 to June 2010, 232 cases aged over 60 years were diagnosed as esophageal carcinoma. These cases were randomly divided into two groups using table of random digits. One group underwent abdominal and right chest approaches for middle and lower esophageal carcinoma (Ivor-Lewis procedure, n=116). The other group underwent posterolateral left thoracal incisions(Sweet procedure, n=116). Intraoperative and postoperative parameters were compared. RESULTS: The radical resection rates in Ivor-Lewis and Sweet procedure were 95.7% and 92.2% respectively(P>0.05). The time required for opening the thorax was(47.2 ± 5.2) min and (105.4 ± 9.3) min(P=0.000), respectively. The respiratory failure rates were 1.7% and 6.9%(P=0.049). The incidences of supraventricular tachyarrhythmia were 3.4% and 10.3%, respectively. The overall complication rates were 22.4% and 34.5%(P=0.004). The perioperative mortalities were 1.7% and 3.4%(P>0.05). The postoperative ambulation time was (4.0 ± 2.0)d and (4.8 ± 3.7)d(P=0.046). The postoperative time in hospital was (11.5 ± 4.7)d and (13.7 ± 7.8)d(P=0.008). CONCLUSIONS: Ivor-Lewis procedure is associated with little damage to diaphragm, shorter intrathoracic operative time, minimal influence on cardiopulmonary function, less postoperative complications, and quicker recovery. This procedure should be considered as the first choice for middle and lower esophageal carcinoma in the elderly.

[RNA interference silencing excision repair cross-complementing 1 gene and affecting cisplatin sensitivity on lung cancer cell lines].

OBJECTIVE: To research the changes of cisplatin sensitivity by RNA interfering the excision repair cross-complementing (ERCC)1 gene in lung cancer cell lines. METHODS: The small interference RNA (siRNA) targeting ERCC1 gene was designed and synthesized by transcription in vitro, and transfected to lung cancer cell line A549. The mRNA and protein of ERCC1 were evaluated by means of RT-PCR, Western blot and immunocytochemistry. The changes of cisplatin sensitivity after interference were examined by methyl thiazolyl tetrazolium (MTT) assay. RESULTS: In A549 cell, the mRNA and protein levels of ERCC1 were dramatically decreased 24, 48 and 72 hours after transfection. The sensitivity to cisplatin of A549 cell line was increased by 3.07 times after disturbing the ERCC1 gene. CONCLUSIONS: The sensitivity to cisplatin of lung cancer cell lines A549 could be enhanced by RNA interfering ERCC1 gene.

[Generation of T cell-mediated antitumor response in vitro by autologous dendritic cells pulsed with tumor lysates in patients with non-small cell lung cancer].

OBJECTIVE: To investigate whether dendritic cells pulsed with whole tumor lysates (WTL) could in vitro elicit antitumor T cell responses in patients with non-small-cell lung cancer (NSCLC). METHODS: Monocyte-derived immature DCs (imDCs) generated in the presence of human recombinant granulocyte-macrophage colony stimulating factor and interleukin-4 from peripheral blood mononuclear cell of NSCLC patients, and then were induced to mature by pulsing autologous WTL (DCs/WTL) or by the addition of TNF-alpha(TNF/DCs). FACS and MLR assay were used to monitor their phenotypic changes and capacity to stimulate allogeneic and autologous T cell proliferation. DCs/WTL activated with TNF-alpha (* DCs/WTL) were cocultured in vitro with autologous T cells for eliciting antitumor CTLs. T cell mediated antitumor responses were measured by IFN-gamma enzyme-linked immunospot (ELISPOT) assay for WTL-specific IFN-gamma releasing T cells and by lactate dehydrogenase release (LDH) assay for lysis of autologous tumor cells, respectively. RESULTS: When monocytes-derived imDCs from the patients with NSCLC (n = 10) were pulsed with autologous WTL for a day at 30 microg total protein of WTL per 10(6) DCs/ml, this led to up-regulation of CD1a, CD83 and CD86 as well as HLA-DR, and also led to marked stimulation of allogeneic T cell proliferating activity, which was comparable to that of TNF/DCs. However, their capacity of stimulating autologous T cell proliferation in vitro was significantly more potent than those of TNF/DCs (P < 0.05). The numbers of WTL-specific IFN-gamma releasing T cells in 1/3 cultures after one week exposure to * DCs/WTL was increased significantly compared with those pulsing with TNF/DCs plus IL-2 or IL-2 alone (P = 0.05). T cells derived by priming of non-adherent PBMCs with * DCs/WTL after 14 days in vitro stimulation were significantly more responsive to autologous tumor cells compared with LAK (n = 3, P < 0.05), but its cytotoxicity against K562 cells was also comparable to LAK cells. CONCLUSION: Monocyte-derived DCs from NSCLC patients could serve as functional APC. The * DCs/WTL may effectively elicit T cell-mediated antitumor response in vitro and enhance NK killing activity.

[Correlation between expression of vascular endothelial growth factor and prognosis of patients with esophageal squamous cell carcinoma].

BACKGROUND & OBJECTIVES: Angiogenesis plays an essential role in tumor growth, invasion, and metastasis. Vascular endothelial growth factor(VEGF) is regarded the most important angiogenetic growth factor and it has been found in many kinds of tumors that its high expression can promote tumor progression and effect prognosis. However, there was few reports about the relationship between the VEGF expression and the progression and prognosis of the patients with esophageal carcinoma. The current study was designed to investigate the relationship between VEGF expression and the prognosis of patients with esophageal squamous cell carcinoma. METHODS: The expression of VEGF protein in 72 resected specimens from the patients with esophageal squamous cell carcinoma were examined immunohistochemically, and its effects on postoperative recurrence and survival of the patients were analyzed retrospectively. RESULTS: Fourty-five out of 72 (62.5%) samples were positive for VEGF expression. The VEGF-positive patients tend to occur postoperative recurrence than VEGF-negative patients (P < 0.001). The median survival time and 1, 3, 5-year survival rate of VEGF-positive patients was lower than those of VEGF-negative patients. And the Kaplan-Meier survival curve was worse in VEGF-positive groups than in VEGF-negtive groups(Log rank test, P = 0.021). Multivariate analysis revealed that VEGF was not an independent factor that impact on the prognosis (P > 0.05). CONCLUSIONS: The high expression of VEGF in esophageal squamous cell carcinoma may promote the tumor progression and lead to dismal prognosis. However, the value of VEGF expression for judging prognosis need further study.