The Society for Translational Medicine: clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy.

Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e.g., volume controlled (VCV) versus pressure controlled (PCV)]; (III) use of therapeutic hypercapnia; (IV) use of alveolar recruitment (open-lung) strategy; (V) pre-and post-operative application of positive end expiratory pressure (PEEP); (VI) Inspired Oxygen concentration; (VII) Non-intubated thoracoscopic lobectomy; and (VIII) adjuvant pharmacologic options. The recommendations of class II are non-intubated thoracoscopic lobectomy may be an alternative to conventional one-lung ventilation in selected patients. The recommendations of class IIa are: (I) Therapeutic hypercapnia to maintain a partial pressure of carbon dioxide at 50-70 mmHg is reasonable for patients undergoing pulmonary lobectomy with one-lung ventilation; (II) PV with a tidal volume of 6 mL/kg and PEEP of 5 cmH2O are reasonable methods, based on current evidence; (III) alveolar recruitment [open lung ventilation (OLV)] may be beneficial in patients undergoing lobectomy with one-lung ventilation; (IV) PCV is recommended over VCV for patients undergoing lung resection; (V) pre- and post-operative CPAP can improve short-term oxygenation in patients undergoing lobectomy with one-lung ventilation; (VI) controlled mechanical ventilation with I:E ratio of 1:1 is reasonable in patients undergoing one-lung ventilation; (VII) use of lowest inspired oxygen concentration to maintain satisfactory arterial oxygen saturation is reasonable based on physiologic principles; (VIII) Adjuvant drugs such as nebulized budesonide, intravenous sivelestat and ulinastatin are reasonable and can be used to attenuate inflammatory response.

MiR-33a suppresses proliferation of NSCLC cells via targeting METTL3 mRNA.

Methyltransferase like 3 (METTL3) was incipiently known as a methyltransferase which was responsible for N6-methyladenosine (m6A) methylation. METTL3 can promote the expression of several crucial oncoproteins and its high expression enhanced proliferation, survival, and invasion of human lung cancer cells. However, how METTL3 was regulated is seldom understood in non-small-cell lung carcinoma (NSCLC). In the present study, miR-33a was suspicious to target to the 3'-untranslated region (3'UTR) of METTL3 mRNA via in silico prediction. Besides, the expressions of METTL3 were higher in NSCLC tissues than those in adjacent tissues, and METTL3 expressions were positively related to the expressions of miR-33a in NSCLC tissues which confirmed by quantitative real-time polymerase chain reaction (qRT-PCR). MiR-33a can directly target to the 3'UTR of METTL3 mRNA which examined by luciferase reporter gene assay. Moreover, we found that miR-33a can reduce the expression of METTL3 at both mRNA and protein levels using reverse transcription-polymerase chain reaction (RT-PCR) and Western blot analysis. Functionally, miR-33a can reduce the proliferation of A549 and NCI-H460 cells. Conversely, inhibition of miR-33a by anti-miR-33a can rescue that using 4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) and 5-ethynyl-2-deoxyuridine (EdU) assay. Similarly, miR-33a can reduce cellular anchorage-independent growth of A549 cells. Additionally, the negative influences of miR-33a on the downstream genes of METTL3 were examined by Western blot analysis. Thus, we concluded that miR-33a can attenuate NSCLC cells proliferation via targeting to the 3'UTR of METTL3 mRNA. Our findings provide new insights into the mechanism of METTL3 regulation by micro RNA, and supports METTL3 as a therapeutic target in NSCLC.

[Comparison of thoracoscopic anatomical partial-lobectomy and thoracoscopic lobectomy on the patients with pT1aN0M0 peripheral non-small cell lung cancer].

OBJECTIVE: To compare the short-term outcomes and pulmonary function loss between thoracoscopic anatomical partial-lobectomy and thoracoscopic lobectomy on the patients with pT1aN0M0 peripheral non-small cell lung cancer. METHODS: The clinical data of 191 patients with pT1aN0M0 peripheral non-small cell lung cancer received thoracoscopic anatomical pneumonectomy between January 2013 and July 2013 in Department of Thoracic Surgery, Cancer Hospital Chinese Academy of Medical Sciences was analyze retrospectively. There were 71 patients underwent thoracoscopic anatomical partial-lobectomy and 120 patients underwent thoracoscopic lobectomy. Demographic features, operation time, blood loss, number of dissected lymph nodes, chest tube duration, drainage volume, postoperative hospital stay, postoperative complications, two-year progress and pulmonary function loss of FEV1% (percentage of the predicted forced expiratory volume in 1 second) at 6 months were retrospectively reviewed and compared by t test, rank-sum test, χ² test and Fisher exact test. RESULTS: There were no significant differences in operation time, blood loss, number of dissected lymph nodes, chest tube duration, drainage volume, postoperative hospital stay, and postoperative complication rate (P > 0.05). The two-year progress rate between two groups did not differ significantly either (1.4% vs. 1.7%, χ² = 0.000, P = 1.000). Pulmonary function loss of FEV1% at 6 months was significantly smaller in thoracoscopic anatomical partial lobectomy group than thoracoscopic lobectomy group (14% ± 4% vs. 16% ± 4%, t = 2.408, P = 0.017). CONCLUSIONS: Thoracoscopic anatomical partial-lobectomy is safe and feasible for patients with pT1aN0M0 peripheral non-small cell lung cancer. It could achieve equal short-term effect and reserve more pulmonary function compared with thoracoscopic lobectomy.