Efficacy of befotertinib in non-small cell lung cancer harboring uncommon compound EGFR mutations G719X and S768I: a case report.

The discovery of epidermal growth factor receptor (EGFR) somatic mutations and the availability of tyrosine kinase inhibitors (TKIs) as targeted therapies have transformed the treatment landscape for advanced non-small cell lung cancer (NSCLC). p.G719X and p.S768I mutations, often present in the form of complex mutations, are considered rare. This study firstly reported the treatment outcome of a locally advanced unresectable NSCLC patient with a rare complex EGFR p.G719X/p.S768I mutations who received befotertinib. After treatment, the patient achieved partial response (PR), and no severe adverse events were observed. This case report supported befotertinib as a promising treatment option for advanced NSCLC patients with the rare p.G719X/p.S768I complex mutations.

Efficient intervention for pulmonary fibrosis via mitochondrial transfer promoted by mitochondrial biogenesis.

The use of exogenous mitochondria to replenish damaged mitochondria has been proposed as a strategy for the treatment of pulmonary fibrosis. However, the success of this strategy is partially restricted by the difficulty of supplying sufficient mitochondria to diseased cells. Herein, we report the generation of high-powered mesenchymal stem cells with promoted mitochondrial biogenesis and facilitated mitochondrial transfer to injured lung cells by the sequential treatment of pioglitazone and iron oxide nanoparticles. This highly efficient mitochondrial transfer is shown to not only restore mitochondrial homeostasis but also reactivate inhibited mitophagy, consequently recovering impaired cellular functions. We perform studies in mouse to show that these high-powered mesenchymal stem cells successfully mitigate fibrotic progression in a progressive fibrosis model, which was further verified in a humanized multicellular lung spheroid model. The present findings provide a potential strategy to overcome the current limitations in mitochondrial replenishment therapy, thereby promoting therapeutic applications for fibrotic intervention.

Mechanism of VIPR1 gene regulating human lung adenocarcinoma H1299 cells.

The vasoactive intestinal peptide receptor-1(VIPR1) has prominent growth effects on a number of common neoplasms. However, there were contradictions in the effect cross different cancers. We aimed to explore the effect of VIPR1 overexpression on a human lung adenocarcinoma cell line H1299. GEO dataset was used to screen differentially expressed genes in lung adenocarcinoma tissues. The expression of VIPR1 mRNA was determined in the cancer Genome Atlas (TCGA). Immunohistochemical analysis was performed to determine VIPR1 protein expression in lung adenocarcinoma and corresponding adjacent tissues (n = 22). Fluorescence real-time quantitative PCR detected the expression of VIPR1 in human normal lung epithelial cell line BEAS-2B and lung adenocarcinoma cell line H1299. Overexpression strategies were employed to assess functions of VIPR1 expression on several malignant phenotypes in H1299. The expression of VIPR1 was lower in lung adenocarcinoma tissues than that in adjacent tissues. Compared with the normal lung epithelial cells BEAS-2B, VIPR1 was down-regulated in lung cancer cells H1299 (P < 0.05). After the overexpression of VIPR1, we found that VIPR1 significantly inhibited growth, migration, and invasion of H1299 cells (P < 0.05). Our findings point out the tumor suppressor roles of VIPR1 in human LUAD pathogenesis.

Systematic review of CYFRA 21-1 as a prognostic indicator and its predictive correlation with clinicopathological features in Non-small Cell Lung Cancer: A meta-analysis.

AIM: To evaluate the value of Cytokeratin 19 fragment for its survival prognostic indicator and predictive correlation with clinicopathological features in Non-small Cell Lung Cancer. METHODS: Eligible studies or databases for articles were retrieved via search systematically. Pooled effect was calculated to evaluate the association between Cytokeratin 19 fragment level and long-term overall survival, as well as the tumor clinicopathological features in Non-small Cell Lung Cancer patients. A fixed-effects or random-effects model was used to calculate the Pooled risk ratios (RRs) and corresponding 95 % confidence intervals (CIs). RESULTS: Six studies were up to the selection criteria. This meta-analysis indicated that Cytokeratin 19 fragment high level expression correlated with lower 2-year overall survival (RR =0.47; 95%CI: 0.28-0.79), higher Tumor Node Metastasis stage (II+III+IV) (RR =1.43; 95%CI: 1.15-1.76) in Non-small Cell Lung Cancer. The pooled RR estimates indicated that there is no statistical significance of Cytokeratin 19 fragment level expression in the advanced Non-small Cell Lung Cancer (IIIB+IV) (RR =1.43, 95% CI: 0.85-2.43). CONCLUSION: Cytokeratin 19 fragment is a negative prognosis indicator and its high level expression indicates higher Tumor Node Metastasis pathological stage (II+III+IV) in Non-small Cell Lung Cancer. In advanced Non-small Cell Lung Cancer, the level of serum Cytokeratin 19 fragment appears to provide more prognostic information than it does for clinical Tumor Node Metastasis stage information. Further studies are required to confirm our results.

Delayed iatrogenic diaphragmatic hernia after thoracoscopic lobectomy.

Postoperative iatrogenic diaphragmatic hernia after thoracoscopic lobectomy is extremely rare. We present a 55-year-old female patient who developed an iatrogenic diaphragmatic hernia with gastric perforation several months after VATS (video-assisted thoracic surgery) left upper lobectomy with systematic lymphadenectomy. During the readmission, urgent laparotomy was performed. Intraoperatively, the choledochoscopy was introduced into left thoracic cavity through the diaphragmatic defect for dissecting the secondary inflammatory adhesions and achieving satisfactory hemostasis. It appears to be an efficient and feasible approach for the patients who have been diagnosed as delayed diaphragmatic hernia concomitant with remarkable intra-abdominal findings and have a history of thoracic surgery. We consider that delayed-onset diaphragmatic hernia should be suspected in patients complaining of nausea or vomiting after VATS procedure, although it is very rare.

Bilateral video-assisted thoracoscopic thymectomy for Masaoka stage IIIA thymomas.

BACKGROUND: Larger invasive thymomas are generally resected via an open approach with thoracotomy or sternotomy. Following accumulation of experience and modifications to the technique, certain invasive tumors can be safely resected by video-assisted thoracic surgery (VATS) without resorting to sternotomy. PATIENTS AND METHODS: Thirteen consecutive patients with large invasive thymomas, who underwent bilateral VATS thymectomy, were analyzed retrospectively. RESULTS: All patients underwent radical en bloc resection of the tumor and the involved structures, without breaching the tumor capsule or tumor seeding. In one patient, difficulties in removal of the tumors from the left brachiocephalic vein necessitated conversion to an open approach with minithoracotomy. No procedure-related hemorrhage occurred. The average operation time, including the case requiring conversion, was 132 minutes. The mean postoperative hospital stay was 4.7 days. There were no perioperative deaths. All patients completed follow up, with a mean duration of 17.4 months. Follow-up chest computed tomography showed no cases of recurrence. CONCLUSION: With proper patient selection, preoperative planning, and a standardized approach to the operative method, we believe that bilateral VATS thymectomy can be a safe and effective procedure, and may provide an attractive alternative approach to median sternotomy.

Left lower sleeve lobectomy and systematic lymph node dissection by complete video-assisted thoracic surgery.

Sleeve lobectomy for selected cases of central lung cancer has better functional outcomes comparing to pneumonectomy. With improved technology and increased experiences in complete video-assisted thoracic surgery (VATS) lobectomy, complete VATS sleeve lobectomy has been applied in major medical centers recently. A 64-year-old male patient with left lower central lung cancer underwent thoracoscopic sleeve lobectomy and systemic mediastinal lymph node dissection. The major incision, of four incisions in total, was a 4 cm mini-incision in the 4th intercostal space of anterior axillary line. The patient had recovered uneventfully after the surgery.

Video-assisted thoracoscopic superior segmentectomy of the right lower lobe.

Sublobar resections are still controversial for lung cancer, but for patients who can't tolerate lobectomy, such as those suffering from cardiopulmonary comorbidities and aged people, sublobar resections are better choices. Lobectomy and sublobar resections have similar surgical effect on patients with tumors ≤2 cm. A 64-year-old patient with chronic obstructive pulmonary disease (COPD) and poor pulmonary function on pre-operation evaluation underwent thoracoscopic superior segementectomy with systemic mediastinal lymph node dissection. Three holes were adopted, the major operation hole was a 3 cm mini-incision in the 4(th) intercostal space of anterior axillary line. The patient has recovered well after the surgery.

Successful resection of a giant subpericardial lipoma with recurrent ventricular arrhythmias.

We report a case of a giant subpericardial lipoma with ventricular arrhythmias. It was resected through a median sternotomy without cardiopulmonary bypass. The tumour was about 21x23x5 cm and weighed 2100 g. After resection the heart rhythm returned to sinus rhythm.

[Diagnosis and surgical treatment of giant intrathoracic solid tumors].

OBJECTIVE: To summarize the experience in diagnosis and surgical treatment of giant intrathoracic solid tumors. METHODS: The data of surgically treated 36 patients with giant intrathoracic solid tumors were analyzed, including 19 males and 17 females. Complete resection was achieved in 34 cases with superior vena cava angioplasty in 3 cases and ligation of the left anonymous vein in 2 cases. Six patients received postoperative radiotherapy. RESULTS: The symptoms in 32 cases were significantly improved. Two patients (5.6%) died of postoperative respiratory infection and failure. The mean postoperative hospital stay was 14.2 days. Pulmonary edema occurred in 6 cases due to rapid decompression of the lung. Pathological results showed that 25 cases had benign tumors and 11 had malignancy. During the follow-up of 1 to 22 years, all patients with benign tumors were still alive, but the patients with malignant tumors had a mean survival time of only 2.1 years. CONCLUSION: Surgical treatment for giant intrathoracic solid tumors is suggested whenever technically possible. Even though a tumor can not be completely resected, satisfied results could still be achieved if combined with postoperative radiotherapy. Proper anesthesia, satisfied exposure with a suitable incision, appropriate resection pattern and hemostatic method are the keys for successful surgical treatment.

Coronary artery bypass grafting after pneumonectomy.

When open-heart operations are necessary in patients who have undergone pneumonectomy, the unavoidable shift of mediastinal structures should be carefully considered. Surgical access, revascularization procedures, and the institution of cardiopulmonary bypass can all require approaches that differ from the usual. In particular, no general recommendations exist regarding the management of patients who undergo coronary artery bypass grafting after pneumonectomy. We successfully performed coronary artery bypass grafting in a 57-year-old man who had undergone a left pneumonectomy 7 years previously. Because the patient's heart was completely displaced into the left posterior hemithorax, access via a left posterolateral thoracotomy was chosen. Saphenous vein grafts were chosen over the internal mammary artery. The distal anastomoses were performed with use of the off-pump technique; for the proximal anastomosis, 2 venous grafts were implanted into the descending aorta. The patient's postoperative course was uneventful, and postoperative angiography revealed patent grafts. Herein, we discuss the case of this patient, and we present some considerations that can influence surgical approaches in similar circumstances.

[Effect on synthesis of nitric oxide in myocardium by local cryoablation].

OBJECTIVE: To study the effect on synthesis of nitric oxide in myocardium by local cryoablation and to investigate its mechanism. METHODS: Myocardium was cryoablated locally by a probe cooled to -60 degrees C and rewarmed by normal salt solution, nitric oxide and its synthesis enzyme were measured before and after cryoablation. L-arginine or methylene blue was added before and during cryoablation and the effect of these drugs on synthesis of nitric oxide was studied. RESULTS: Nitric oxide and its synthesis enzyme decreased after cryoablation; L-arginine preserved the synthesis of nitric oxide and methylene blue inhibited the synthesis of nitric oxide. However, nitric oxide in serum did not change. CONCLUSION: Nitric oxide and its synthesis enzyme in myocardium decrease after cryoablation.