Yifeng Sun

Effect of hyperoside on the apoptosis of A549 human non‑small cell lung cancer cells and the underlying mechanism

Hyperoside (HY) is a major pharmacologically active component from Prunella vulgaris L. and Hypericum perforatum. The present study aimed to determine the anticancer effect of HY and determine the underlying mechanisms involved. Human A549 cells were treated with HY (10, 50 and 100 µM), and cell viability was detected by an MTT assay. Cell apoptosis and mitochondrial membrane potential were determined by flow cytometry. Western blot analysis was used to identify the expression of apoptosis-associated proteins and phosphorylation of MAPK. The present study demonstrated that HY significantly inhibited the viability of A549 cells in a time- and dose-dependent manner, and enhanced the percentage of apoptotic cells. HY also significantly increased the protein phosphorylation of p38 mitogen-activated protein kinase (MAPK) and c-Jun N-terminal kinase (JNK), disrupted mitochondrial membrane penetrability, and triggered the release of mitochondrial cytochrome c and apoptosis-inducing factor into the cytosol. Treatment with HY also activated the expression of caspase-9 and caspase-3. These results suggested that HY-induced apoptosis was associated with activation of the p38 MAPK- and JNK-induced mitochondrial death pathway. HY may offer potential for clinical applications in treating human non-small cell lung cancer and improving cancer chemotherapy.

Integrin αv promotes proliferation by activating ERK 1/2 in the human lung cancer cell line A549

Lung cancer is a leading cause of cancer-related death worldwide, and non-small cell lung cancer (NSCLC) constitutes ~85% of lung cancers. However, the mechanisms underlying the progression of NSCLC remain unclear. In this study, we found the mRNA and protein expression levels of integrin αv are both increased in NSCLC tissues compared to healthy ones, which indicates that integrin αv may play an important role in NSCLC progression. To further investigate the roles of integrin αv in NSCLC, we overexpressed the integrin αv gene in the NSCLC cell line A549, and found that the cell proliferative ability increased. The apoptosis of A549 cells was inhibited with overexpression of integrin αv. To elucidate the molecular mechanism underlying the role of integrin αv in promoting NSCLC progression, we studied the expression of proteins from a number of important pathways associated with tumorigenesis, and found that the extracellular signal regulated protein kinase (ERK)1/2 signaling pathway may be involved in the mediation of the observed integrin αv effects. component of an important pathway for tumorigenesis, the ERK 1/2. Following inhibition of ERK 1/2 signaling, the proliferation of A549 cells induced by integrin αv was reduced, while the inhibition of apoptosis was attenuated. Our findings demonstrate that integrin αv promotes the proliferation of the human lung cancer cell line A549 by activating the ERK 1/2 signaling pathway, which suggests that this pathway may be a promising target for the treatment of human lung cancer.

Reconstruction of mediastinal vessels for invasive thymoma: A retrospective analysis of 25 cases

BACKGROUND Discuss an appropriate strategy for treatment of invasive thymoma invading adjacent great vessels. METHODS A retrospective study on 25 patients with invasive thymoma invading neighboring great vessels was performed. The corresponding data including clinical presentation, operation procedure, adjuvant radio-chemotherapy and follow-up were reviewed. RESULTS Twenty of 25 (80%) patients with invasive thymoma underwent complete resection of the tumor along with vessel reconstruction. Intraoperatively, different types of operation were conducted, namely, brachiocephalic vein (BCV)-right atrial appendage (RAA) reconstruction in 11 cases, complex vessel reconstruction (more than one graft) in 1 case and superior vena cava (SVC)-SVC reconstruction in the remaining cases. Ringed polytetrafluoroethylene (PTFE) grafts were used for vessel reconstruction. Postoperatively, three cases suffered from pulmonary infection, and three cases had haemothorax, chylothorax and atelectasis, respectively. Two patients died due to acute respiratory distress syndrome within 90 days after the surgery. Within the remaining patients, 11 cases (44%) experienced a relapse and finally 8 (32%) patients died. Compared to R1 resection group, R0 resection group had a better prognosis (Log-rank P=0.0196). The 3- and 5-year survival rates were 79.6% and 59.1%, with median survival time of 84 months. CONCLUSIONS Reconstruction of mediastinal vessels for invasive thymoma is a feasible technology method. Radical resection of the tumor with involved neighboring structures is the key to prolong overall survival for patients suffered from invasive thymoma.

Impact of unplanned events on early postoperative results of minimally invasive esophagectomy

Minimally invasive esophagectomy (MIE) is increasingly performed worldwide. Unplanned events during thoracoscopy or laparoscopy can jeopardize the procedure, sometimes necessitating conversion to open surgery. The aim of this study was to evaluate the impact of unplanned events on early postoperative outcomes after MIE.

ERAS prior to minimally invasive esophagectomy

The concept and pattern of enhanced recovery after surgery (ERAS) have been used for nearly 20 years. However, the clinical application and popularization of ERAS in the esophagectomy have been greatly restricted due to the complexity of operation and the high incidence of postoperative complications. In recent years, with the growing maturity of the minimally invasive technique of thoracic laparoscopy, the attention of the concept of tissue and organ protection, the improvement of making gastric tube and the presentation and application of new concepts, ERAS has made a breakthrough in the field of esophagectomy. In this paper, the ERAS clinical pathway prior to minimally invasive esophagectomy (MIE) of Shanghai chest hospital was summarized, including preoperative preparation and evaluation, preoperative education and so on. The aim is to continuously improve and popularize the clinical pathway of ERAS in MIE, applying in more and more centers, so as to benefit more and more patients.

Evaluation and patient selection for minimally invasive esophagectomy

Minimally invasive esophagectomy (MIE) is an evolving surgical alternative to traditional open esophagectomy. Despite considerable technical challenges, it was considered that MIE could be performed effectively by surgeons experienced in open esophageal resection and advanced laparoscopic surgery. This chapter illustrates the preoperative evaluation and operative indications of MIE for esophageal cancer. Firstly, a complete history and physical exam is required for counseling on preoperative optimization. Then, the operation can be conducted after standard preoperative work-up includes several parts, such as positron-emission tomography (PET), endoscopic ultrasound (EUS), esophagography and computed tomography (CT). To our knowledge, the operative indications for MIE is now extended due to the rapid development of surgical technique and detailed preoperative evaluation. Limited node invasion and neoadjuvant chemoradiation are not rigorous contraindications for MIE any more. Optimal results require elaborate evaluation, appropriate patient selection and a multidisciplinary team experienced in the management of esophageal cancer.

The era of minimally invasive esophagectomy

Minimally Invasive Esophagectomy (MIE) has become a standard surgical approach for esophageal cancer in the world. In this report, we introduce the history of MIE which is different between eastern and western countries. With the development of surgical techniques, including single-lumen endotracheal intubation, CO2 artificial pneumothorax, and surgical positioning, the MIE has made great progress. It was approved that due to significantly reduced surgical trauma, MIE lowers postoperative morbidity and mortality while achieving a tumor resection efficacy comparable with the conventional open esophagectomy. The improvement of surgical instruments and modification of surgical approaches are the keys to gaining greater clinical advantage in the future of MIE, especially the popularity of robotic surgery.

Minimally invasive esophagectomy for esophageal squamous cell carcinoma—Shanghai Chest Hospital experience

Esophageal cancer is a common gastrointestinal cancer and ranks sixth in tumor-related death. Esophageal adenocarcinoma is prevalence in European countries and the United States, while esophageal squamous cell carcinoma is frequently observed in Asian countries (1). Radical surgical resection combined with systematic lymph node dissection has always been used as a significant approach for treating esophageal cancer.

Robot assisted esophagectomy for esophageal squamous cell carcinoma

Background This study aims to report our experience with robot assisted esophagectomy (RAE) for the treatment of resectable esophageal squamous cell carcinoma (ESCC). Methods A series of 249 consecutive patients diagnosed with ESCC who underwent RAE from November 2015 to December 2017 at Shanghai Chest Hospital were evaluated, and their clinical data were reviewed retrospectively. One hundred patients were equally divided into four groups according to the surgery order, and the short-term outcomes in each group were analyzed. Results Overall, 249 patients (201 males and 48 females) with a mean age of 63.4±7.3 years who underwent RAE were analyzed. The thoracic procedure was successfully performed with the assistance of a robot. The mean total duration was 250.6±58.4 mins, and the estimated blood loss was 215.5±87.6 mL. R0 resection was performed in 232 (93.2%) patients with a mean total number of dissected lymph nodes of 18.5±9.1 and mean yield of lymph nodes along the recurrent laryngeal nerve (RLN) of 4.4±3.2. The median postoperative hospital stay was 11 days, and no 90-day mortality was observed. Forty-five (18.1%) patients experienced pulmonary complications, and the recurrent laryngeal nerve injury were observed in 38 (15.3%) patients. A significant reduction in thoracic duration was observed after the initial 25 cases (P<0.001). After 50 cases, the dissection of total lymph nodes, mediastinum lymph nodes and lymph nodes along the RLN were significantly improved (P<0.001, P<0.001, P=0.001, respectively) with a shorter postoperative hospital stay (P=0.005). Conclusions RAE is a safe and feasible alternative surgical approach for resectable esophageal carcinoma and is associated with a large yield of lymph nodes, especially along the RLN. The surgeon will reach a plateau of operative duration after 25 cases and a plateau of lymphadenectomy after 50 cases.

Surgical management of acquired tracheo/bronchoesophageal fistula associated with esophageal diverticulum

Background The reports on acquired tracheoesophageal fistulas (TEFs) or bronchoesophageal fistulas (BEFs) associated with traction esophageal diverticula (TED) are rare. Here, we present our experience of six cases. Methods Between Jan. 2015 and Jun. 2016, 6 patients were admitted to our department for TEF/BEFs combined with esophageal diverticula. Clinical data of the 6 patients were retrospectively reviewed. Results All orifices of TEF/BEF in the esophagus side opened at the diverticula wall. The orifices in the airway side were 2 at the carina and 4 at the right intermediate bronchus. All six patients received the same intervention: a limited diverticulectomy with the fistula resection was done in the esophagus; separate layers of repair were performed for the defect in the esophagus; the muscle flap interposition was used in all six cases. All postoperative courses were uneventful. No recurrence fistula and symptomatic diverticula occurred. The airway and esophagus were patency during a median of 9-month follow-up. Conclusions Acquired TEF/BEFs caused by esophageal diverticula can be treated successfully by surgery. A limited diverticulectomy is sufficient to ensure enough esophagus remodeling. Keywords Tracheo/bronchoesophageal fistula (TEF/BEF); esophagus diverticulum; acquired.