Zhongping Gu

Repair of massive stent-induced tracheoesophageal fistula.

OBJECTIVE The purpose of this report was to discuss a new surgical procedure in treating esophageal stent related large tracheoesophageal fistula without tracheal resection. METHODS Clinical records of 5 patients with esophageal stent-related large tracheoesophageal fistulas treated in this hospital between 1997 and 2006 were reviewed. RESULT All patients had insertion of a covered self-expanding esophageal stent, 1 for benign esophageal stricture and 4 for esophageal perforation resulting from various causes. A double patch technique, in which the esophageal wall was used as a protective patch repairing the defect on the trachea, was performed with an esophagectomy and gastric replacement. No significant complications occurred in the perioperative period. All patients recovered uneventfully. CONCLUSIONS Use of the adjacent esophageal wall as a patch to close a defect on the trachea is a safe procedure with a favorable outcome. It should therefore be recommended as a reliable surgical procedure in treating massive stent-induced tracheoesophageal fistulas and other complicated tracheoesophageal fistulas that tracheal resection could not safely address. However, the esophagus was damaged to a certain degree.

Upregulated fascin1 in non-small cell lung cancer promotes the migration and invasiveness, but not proliferation

Fascin1, an actin-binding protein, is overexpressed in many kinds of tumors. However, its exact role in non-small cell lung cancer (NSCLC) is still unclear. We observed that expression of fascin1 was associated with lymph nodes metastasis and TNM staging but not proliferation in NSCLC by using immunohistochemistry. By generating A549 lung cancer clones stably overexpressing different fascin1 protein, we further confirmed that fascin1 could promote A549 cell migration and invasiveness in vitro and in vivo. Using cell proliferation assay, cell cycle analysis in vitro and tumorigenicity assay in vivo, we showed that fascin1 had little influence on proliferation in A549 cells. These results suggest that fascin1 plays a significant role in NSCLC metastasis and may be a target of intervening to prevent the metastasis of NSCLC.

Wortmannin potentiates roscovitine-induced growth inhibition in human solid tumor cells by repressing PI3K/Akt pathway.

Roscovitine has been reported to have anti-tumor effects in some cancer cell lines. The phosphatidylinositol-3-kinase (PI3K) signaling, which activates protein kinase B (PKB)/Akt, is known to mediate cell survival. The current study examined the role of wortmannin, a PI3K inhibitor, as a chemosensitizer for roscovitine and its proposed mechanism of action. The results showed that wortmannin significantly chemosensitized three human tumor cell lines (A549, HCT116 and HeLa cells). In A549 cells, wortmannin increased roscovitine-induced apoptosis in a dose-dependent manner, which was correlated with the inhibition of phosphorylated PKB/Akt level. Wortmannin enhanced the effects of roscovitine by causing pronounced reduction of mitochondrial transmembrane potential (MMP) and increases of cytochrome c release and active caspase-3, as well as enhanced activation of Bax and Bad, including Bax oligomerization and mitochondrial translocation of Bax and Bad. Taken together, these results provide evidence for the potential application of roscovitine/wormannin combination in clinical treatment for solid tumors.

Low Molecular Weight Heparin Nebulization Attenuates Acute Lung Injury

Background As acute lung injury (ALI) caused high mortality rate, it is important to explore the protection and treatment of ALI. The aim of the current study is to evaluate the effect of low molecular weight heparin (LMWH) nebulization on attenuating acute lung injury and the associated mechanism. Methods The arterial blood gas, total protein content in bronchoalveolar lavage fluid, lung wet/dry weight ratio, malondialdehyde (MDA) content, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activity, and Akt phosphorylation were evaluated after the ALI rabbits were treated with or without LMWH nebulization. Results PaO2 was increased and lung wet/dry weight ratio as well as total protein content in BALF was decreased after LMWH nebulization. After the application of LMWH nebulization therapy, the SOD and GSH-Px activity was rebounded and the increase of MDA content was significantly inhibited. The Akt protein phosphorylation level was decreased after LMWH nebulization therapy. Conclusions LMWH nebulization treatment can relieve the traumatic ALI in rabbits and inhibit oxidative stress possibly by suppressing the Akt phosphorylation.

Right middle-lower lobectomy by Video-assisted Thoracic Surgery (VATS)

Video-Assisted Thoracic Surgery (VATS) lobectomy is well established and performed all around the world. With growing experience with the technique, it is now generally accepted that the outcome of a VATS procedure is at least as good as, even more superior to lobectomy via traditional thoracotomy (1). Compared to open surgery, VATS may provide patients with a lower rate of morbidity and mortality, reduced pain, a shorter length of stay, better pulmonary function, and earlier return to regular activities without compromising the quality of the procedures (2).