Gening Jiang

The role of survivin on overall survival of non-small cell lung cancer, a meta-analysis of published literatures

The prognostic value of survivin for survival of patients with non-small cell lung cancer (NSCLC) remains controversial. The authors performed a meta-analysis of the literatures in order to clarify its impact. Published studies were identified using an electronic search in order to aggregate the available survival results. To be eligible, a study had to have dealt with survivin assessment in NSCLC patients on the primary site and have analyzed survival according to survivin expression. There were 10 eligible studies and data from eight studies where non-location specific immunohistochemistry (IHC) definition system, in situ hybridization (ISH) and RT-PCR used were combined to present the impact of survivin on overall survival (OS) of NSCLC. The level of survivin expression correlated with the OS of NSCLC patients significant (RR 1.88, 95% CI 1.31-2.70, P=0.0006). Data of seven studies were combined to demonstrate that the level of survivin correlated with the OS of NSCLC patients who had received radical surgeries (RR 1.79, 95% CI 1.45-2.20, P<0.00001). Data from three studies were combined to find that the level of nuclear survivin did not have impact on OS of NSCLC patients (RR 1.58, 95% CI 0.87-2.85, P=0.13). Positive-survivin expression might be a prognostic factor for NSCLC patients, nuclear survivin positivity could not work as a prognostic factor for NSCLC patients based on current clinical data. Larger clinical trails with widely accepted assessment methods are necessary to define the precise prognostic significance for survivin in NSCLC patients.

Pulmonary Resection in the Treatment of Multidrug-Resistant Tuberculosis: A Retrospective Study of 56 Cases

BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) has become a challenge to TB control, and surgical resection is regaining its status as an integral component of multimodal treatment. We evaluated the efficacy and risks of pulmonary resection in the treatment of MDR-TB. METHODS A retrospective review was performed of 56 patients who had undergone pulmonary resection for MDR-TB from January 1995 to July 2006. Preoperative diagnoses included cavitation in 25 patients, lung destruction in 17, endobronchial TBs in 10, and tuberculoma in 4. RESULTS Mycobacterium tuberculosis resistant to both isoniazid and rifampin was isolated from the sputum of all patients preoperatively but in only 5 patients postoperatively. Pneumonectomy was performed on 25 patients and lobectomy on 31. No patients died perioperatively, but major complications occurred in 14 patients, with a morbidity of 25%. Complications included reoperation due to uncontrollable postoperative bleeding in 1 patient, chylothorax in 1, wound infection in 1, bronchopleural fistula in 9, and chronic tuberculous empyema in 2. Analysis of variance showed that lung function was significantly correlated with the type of preoperative diagnosis. Univariate and multivariate logistic regression analyses revealed that endobronchial TB significantly contributed to the development of bronchopleural fistula, and bronchial stump reinforcement could prevent its occurrence. CONCLUSIONS Pulmonary resection plays an important role in the treatment of MDR-TB. Endobronchial TB is a significant risk factor for developing bronchopleural fistula, but bronchial stump reinforcement can effectively prevent its occurrence.

Surgical treatment for pulmonary aspergilloma: a 35-year experience in the Chinese population

The surgical treatment of pulmonary aspergilloma is challenging and controversial. This study was designed to evaluate the clinical profile, indications and surgical outcomes of pulmonary aspergilloma operated on in our institute. A total of 256 patients with pulmonary aspergilloma underwent surgical treatment from 1975 to 2010. The patients were divided into two groups: Group A (simple aspergilloma, n = 96) and Group B (complex aspergilloma, n = 160). The principal underlying lung disease was tuberculosis (71.1%). The surgical procedures consisted of 212 lobectomies in both groups; eight cavernoplasties, 10 bilobectomies, 16 pneumonectomies and six thoracoplasties in Group B; four segmentectomies and six wedge resections in Group A. Postoperative complications occurred in 40 patients (15.6%). The major complications were residual pleural space (3.9%), prolonged air leak (3.1%), bronchopleural fistula (1.6%), excessive bleeding (1.6%), respiratory insufficiency (1.9%) and empyema (1.2%). No intraoperative deaths occurred. The overall mortality within 30 days post-operation was 1.2%, occurring only in Group B. There was no statistically significant difference in the postoperative morbidity between Groups A and B (P = 0.27). With the good selection of patients, meticulous surgical techniques and good postoperative management, aggressive surgical treatment with anti-fungal therapy for pulmonary aspergilloma is safe and effective, and can achieve favourable outcomes.

Programmed cell death and its role in inflammation

Cell death plays an important role in the regulation of inflammation and may be the result of inflammation. The maintenance of tissue homeostasis necessitates both the recognition and removal of invading microbial pathogens as well as the clearance of dying cells. In the past few decades, emerging knowledge on cell death and inflammation has enriched our molecular understanding of the signaling pathways that mediate various programs of cell death and multiple types of inflammatory responses. This review provides an overview of the major types of cell death related to inflammation. Modification of cell death pathways is likely to be a logical therapeutic target for inflammatory diseases.

EGFR L858R mutation is associated with lung adenocarcinoma patients with dominant ground-glass opacity

OBJECTIVES To retrospectively identify quantitative computed tomographic (CT) features that correlate with the three major driver gene mutations in surgically resected lung adenocarcinomas with dominant ground-glass opacity (GGO) stratified by the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS) classification in a Chinese cohort of patients. MATERIALS AND METHODS Surgically resected lung adenocarcinomas from Shanghai Pulmonary Hospital were enrolled. EGFR, KRAS and EML4-ALK mutations were detected by qPCR. Clinical and pathological characteristics including gender, age, TNM stage, smoking status and CT pattern were analyzed. Histologic subtype was classified according to IASLC/ATS/ERS classification. At preoperative chest CT, the percentage of GGO volume, diameter, solid volume and total tumor volume of each tumor were measured by using a semiautomated algorithm. Distribution of driver gene mutations was evaluated by using the Fisher exact test, the Students t test, and Pearson correlation analysis. RESULTS AND CONCLUSION 788 in total and 158 GGO tumors were taken in this cohort. GGO pattern occurred at a significantly higher frequency in younger, female and non-smoking patients. EGFR/KRAS mutations and EML4-ALK fusions were similar between GGO and solid adenocarcinomas. GGO volume and diameter showed correlation with EGFR mutation. With regard to association between lung adenocarcinoma histological subtypes and GGO features, GGO proportion was significantly higher in lepidic predominant adenocarcinomas, including adenocarcinoma in situ, minimally invasive adenocarcinoma, and lepidic predominant invasive adenocarcinoma. No significant differences of driver gene mutations were found between subtypes of lung adenocarcinoma. It is important that we understand GGO lesions of lung adenocarcinoma to identify molecular biomarkers including EGFR, KRAS and EML4-ALK. These markers would offer useful information for determining the appropriate strategy to treat lung adenocarcinoma with GGO lesions detected by helical CT.

Surgical Treatment of Bronchiectasis: A Retrospective Analysis of 790 Patients

BACKGROUND The global incidence of bronchiectasis is increasing, and this disease is prevalent in rural China. This study examined operative mortality, morbidity, and outcomes of surgery for bronchiectasis at a single institution in China. METHODS We retrospectively reviewed the medical records of 790 consecutive patients who underwent surgery for bronchiectasis in our department between January 1989 and December 2008. Localized bronchiectasis was diagnosed by high-resolution computed tomography. The persistence of symptoms after failure of nonsurgical treatment was an indication for surgery. Cystic fibrosis patients were excluded from this study. RESULTS The study sample included 790 patients (466 male, 324 female) who underwent 810 operations for bronchiectasis. Mean age at time of surgery was 41.6 years (range, 6 to 79 years). Several surgical procedures were used: lobectomy (497; 62.9%), segment resection (37; 4.7%), pneumonectomy (90; 11.3%), bilobectomy (56; 7.1%), and lobectomy and segmentectomy (110; 14.0%). There were no intraoperative deaths. Nine (1.1%) patients died in the postoperative period. Univariate analysis showed that advanced age (p = 0.04) and renal failure (p = 0.001) were associated with postoperative mortality, and multivariate analysis revealed that preoperative renal failure was associated with mortality (p = 0.025). The mean follow-up time was 4.2 years (range, 10 months to 10 years). After surgery, 478 (60.5%) patients were asymptomatic, 111 (14.1%) had improved, and 117 (14.8%) showed no improvement or worsened condition. CONCLUSIONS Localized bronchiectasis is usually the indication for surgical resection, which is a safe procedure with acceptable operative morbidity, mortality, and outcomes.

Video-Assisted Thoracic Surgery for Bronchiectasis

BACKGROUND Bronchiectasis is one of the common diseases diagnosed in the world. No major improvement for the treatment approaches and limited efficacy promote a big challenge for management of this disease. Video-assisted thoracoscopic surgery (VATS) offers a new choice for the treatment of bronchiectasis. The purpose of this study was to present our experience of VATS for bronchiectasis and to compare this with thoracotomy in our institution. METHODS We reviewed the medical records of patients who underwent VATS lobectomy and general lobectomy for bronchiectasis between January 2005 and December 2009. RESULTS A total of 279 patients underwent thoracotomy, 52 patients underwent attempted VATS lobectomy. Fifty-two patients from 279 patients for thoracotomy were selected and compared with the VATS group. Pleural adhesion was observed in 15 patients (28.8%) in VATS. The VATS lobectomy was converted to open thoracotomy in 7 patients. There was no difference in the blood loss and median operative time between the two groups, but the patients with VATS had shorter length of stay in hospital (p=0.045), fewer complications (p=0.039) than those with thoracotomy. Forty-nine (94%) and 46 (88%) patients fully recovered after operation by VATS and thoracotomy, respectively. CONCLUSIONS Video-assisted thoracoscopic lobectomy in localized bronchiectasis is a safe and more efficient procedure in selected patients with better recovery.

Risk Factor Comparison and Clinical Analysis of Early and Late Bronchopleural Fistula After Non-Small Cell Lung Cancer Surgery

BACKGROUND We retrospectively analyzed risk factors for late bronchopleural fistula after non-small cell lung cancer (NSCLC) surgery and compared with those for early bronchopleural fistula. METHODS In all, 6,239 patients with NSCLC who underwent surgery were studied, and clinical risk factors were examined by univariate and multivariate analysis. This study included 23 patients (0.38%) with late bronchopleural fistula and 43 patients (0.65%) with early bronchopleural fistula among all 6,239 patients. Follow-up data were recorded until December 2005 or until death. Statistical significance was calculated using the log rank test. RESULTS By univariate analysis, patients with radiotherapy after operation, pneumonia after operation, pneumonectomy, and advanced age were related to higher risk of bronchopleural fistula. In the multiple logistic regression models, both pneumonia and operative procedure were among the independent risk factors of early and late bronchopleural fistula. Early bronchopleural fistula was observed primarily in the aged. Late bronchopleural fistula was associated with postoperative radiotherapy. The average intervals of bronchopleural fistula between pneumonectomy and lobectomy were significantly different. Compared with the mortality rate of late bronchopleural fistula (0%), the mortality rate of early bronchopleural fistula (11.6%) was significantly higher. CONCLUSIONS There are both similarities and differences between the risk factors for early and late bronchopleural fistula. We should analyze the different reasons for the occurrence of bronchopleural fistula, and adopt different preventive measures. Different follow-up should be provided for the different operations.

Surgical Management of Secondary Spontaneous Pneumothorax in Elderly Patients with Chronic Obstructive Pulmonary Disease: Retrospective Study of 107 Cases

BACKGROUND Aim of the study was to assess the results of surgery for secondary spontaneous pneumothorax (SSP) in the elderly with COPD at Shanghai Pulmonary Disease Hospital. METHODS From 1 January 1993 to 30 June 2007, the operation for SSP was performed in 107 elderly patients (> or = 60y) with COPD. All patient data was reviewed retrospectively. RESULTS Morbidity was 25.2 % and mortality was 4.7 %. The total effective rate of intrapleural injection of human fibrinogen for the treatment of postoperative persistent air leaks was 86.7 %. Multivariate analyses of postoperative air leaks suggest that patients undergoing pleurodesis (OR 0.189, 95 % CI 0.045-0.790, P = 0.022) have a decreased risk of postoperative air leaks. Multivariate analyses of postoperative complications suggest that patients with higher PaCO (2) (OR 0.890, 95 % CI 0.814-0.973, P = 0.011) have an increased risk and patients undergoing pleurodesis (OR 4.319, 95 % CI 1.398-13.349, P = 0.011) have a decreased risk. CONCLUSIONS Surgical intervention is recommended in selected elderly COPD patients with SSP, with hypercapnia known as an operative contraindication. Additionally, surgery offers the advantage of intraoperative pleurodesis for the prevention of prolonged postoperative air leaks, while intrapleural injection of human fibrinogen is an effective procedure in the treatment of air leaks.

A clinical risk model for the evaluation of bronchopleural fistula in non-small cell lung cancer after pneumonectomy.

BACKGROUND There are no reliable risk factors to predict bronchopleural fistula (BPF) formation in patients undergoing pneumonectomy for non-small cell lung cancer (NSCLC). This study aims to create a validated clinical model based on the risk factors for BPF after pneumonectomy. The model to estimate the risk of BPF may help select patients for intervention therapy to reduce the rate of BPF after pneumonectomy. METHODS This retrospective analysis included 684 patients with NSCLC who underwent pneumonectomy at our institution from 1995 to 2012. The rates of BPF were estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify the independent risk factors for the BPF and based on which a clinical model for the prediction of the incidence of BPF was formed. RESULTS The incidence of BPF was 4.4% (30 of 684 patients). Three factors were independently associated with BPF after pneumonectomy for NSCLC: neoadjuvant therapy (hazard ratio, 2.479), diabetes mellitus (hazard ratio, 1.061), and age 70 years or older (hazard ratio, 1.175). A scoring system for BPF was developed by assigning 2 points for a major risk factor (neoadjuvant therapy) and 1 point for each minor risk factor (diabetes mellitus and age ≥ 70 years). The 684 patients were divided into a low-risk group (score, 0 to 1), moderate-risk group (score, 2), and high-risk group (score, ≥ 3), with respective incidences of early BPF after pneumonectomy of 2.4%, 18.2%, and 58.3% CONCLUSIONS This model, based on readily available clinical characteristics, can estimate the risk of BPF after pneumonectomy in the NSCLC patients, independent of early BPF and late BPF classifications. This model could be used to select patients for intervention therapy (parenteral alimentation, control of blood glucose level, oxygen therapy, and strengthening the antibiotic treatment) if validated in independent data sets.