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   2015| November  | Volume 11 | Issue 8  
    Online since November 26, 2015

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Clinical analysis of 64 patients with lung-cancer-associated hypercalcemia
Xu Li, Zhixin Bie, Zijin Zhang, Yuanming Li, Xueqing Hu, Wenbo Liu, Shuai Zhang, Gang Cheng, Bin Ai
November 2015, 11(8):275-279
DOI:10.4103/0973-1482.170539  PMID:26612452
Objective: This study investigated the factors influencing survival time of patients with lung-cancer-associated hypercalcemia. Data and Methods: A total of 64 pathologically confirmed patients with Stage IV lung-cancer-associated hypercalcemia were enrolled from Beijing Hospitals between August 2010 and July 2015. Clinical materials included patients' gender, age, pathological type, highest albumin-corrected calcium level, serum alkaline phosphatase level, creatinine clearance rate, organ (bone, liver, brain, and adrenal gland) metastasis, number of distal metastatic sites, and survival time after diagnosis of hypercalcemia. Univariate and multivariate analyses were performed to screen the risk factors affecting patients' survival. Results: Albumin-corrected calcium levels of the 64 patients ranged from 2.56 to 4.57 mmol/L, and the median value was 2.76 mmol/L. Survival time after diagnosis of hypercalcemia varied from 1 to 1340 days, and the median survival time was 104 days. Univariate analysis showed that gender, age (>60-year-old), albumin-corrected calcium levels, elevation of alkaline phosphatases, brain metastasis, and number of distal metastatic sites were predictors for poor survival (P = 0.026, P = 0.022, P < 0.001, P = 0.043, P = 0.041, P = 0.003). In Cox proportional hazard model analysis, corrected hypercalcemia levels and alkaline phosphatase levels were determined to be risk factors affecting patients' survival time (hazard ratio [HR] = 6.828, P = 0.000; HR = 1.957, P = 0.026). Conclusions: Patients with Stage IV lung-cancer-associated moderate and severe hypercalcemia exhibited shorter survival time and poor prognosis. After correction, moderate and severe elevations of hypercalcemia and abnormal elevation of alkaline phosphatase levels were shown to be significant factors shortening patients' survival time.
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Percutaneous computed tomography-guided lung biopsy of solitary nodular ground-glass opacity
Zheng Yi-Feng, Jiang Li-Ming, Mao Wei-Min, Han Zhi-Qiang
November 2015, 11(8):231-233
DOI:10.4103/0973-1482.162117  PMID:26612443
Objective: To evaluate the diagnostic performance and safety of percutaneous lung biopsy under computed tomography (CT)-fluoroscopic guidance for ground-glass opacity (GGO) lesions. Materials and Methods: Thirty-eight patients received core biopsy utilizing an automated cutting needle and were evaluated histologically. Results: Five patients had a bronchioloalveolar carcinoma, 3 patients had adenocarcinomas, 18 patients had pulmonary alveoli epithelial dysplasia, 1 patient had a large number of lymphocytes, and 11 patients had a small amount of fibrous connective tissue. Twenty-three lesions (23/38, 60.5%) were located in the upper lobes while 15 lesions (15/38, 39.5%) were located in the lower lobes. Twenty-five lesions (25/38, 65.8%) were located in the right lung while 13 lesions (13/38, 34.2%) were located in the left lung. Three patients had pneumothorax, appeared on CT images performed immediately after the biopsy. Four patients had mild parenchymal hemorrhage along the needle tract or within the lesion. No patient required additional therapy such as a blood transfusion, endotracheal intubation, or chest tube placement after the biopsy. None of the patients had serious complications. Conclusion: Percutaneous CT-guided aspiration can be useful and safe diagnostic procedures for evaluating GGO nodules and a guidance to make a clinical decision for further patient management.
  4,039 314 -
Combined use of radioiodine therapy and radiofrequency ablation in treating postsurgical thyroid remnant of differentiated thyroid carcinoma
Bin Long, Linfa Li, Lifang Yao, Shoucong Chen, Heqing Yi, Xuemei Ye, Dong Xu, Peng Wu
November 2015, 11(8):244-247
DOI:10.4103/0973-1482.170530  PMID:26612446
Purpose: To determine whether postoperative radioiodine (RAI) combined with radiofrequency ablation (RFA) is an effective, safe, and feasible method for elimination of excessive postsurgical thyroid remnant for differentiated thyroid carcinoma (DTC). Materials and Methods: We took a prospective study and treated 12 DTC patients (4 males, 8 females, age 20–78 years) who underwent thyroidectomy for RFA followed by 131 I ablation. The pretreatment requires iodine-free diet and thyroid hormone withdrawal for 3–4 week. All the patients showed the level of serum thyroid-stimulating hormone (TSH) <30 mU/L, and obvious thyroid remnant in 99m Technetium (99m Tc) imaging. Serum TSH level was determined 1 day before RFA and on days 1, 7, 14 after RFA, and 99m Tc imaging was performed on day 14 after RFA. Subsequently, the patients were given an oral dosage of 3700 MBq 131 I for remnant ablation, and posttreatment whole body scan was performed on day 5 after ablation. Efficacy evaluation was done 4–6 months after treatment. The changes of variants before and after RFA were analyzed using Wilcoxon signed rank sum test. Results: Serum TSH was <30 μIU/ml (mean value 10.27 ± 6.16 μIU/ml) before RFA, and increased to more than 30 μIU/ml (34.73 ± 3.93 μIU/ml) 2 weeks later (P = 0.002, Wilcoxon rank sum test). The 99m Tc uptake ratio on day 14 postRFA was (0.31 ± 0.12)%, which is significantly lower than before RFA (0.80 ± 0.16)% (P = 0.002, Wilcoxon rank sum test). The success rate of thyroid remnant ablation was 91.7% (11/12), which was assessed 4–6 months after treatment. All patients reported neck discomfort and some are self-limiting, with no hoarseness, choking, or radiation thyroiditis symptoms. Five patients had puncture area pain, among which one patient had neck edema, which was relieved after prednisone treatment. Conclusion: Combined use of RAI therapy and radiofrequency ablation in treating excessive postsurgical thyroid remnant of DTC can be an effective approach and avoids re-operation. Long-term efficacy monitoring would further determine its feasibility.
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Contribution of ultrasound-guided fine-needle aspiration cell blocks of metastatic supraclavicular lymph nodes to the diagnosis of lung cancer
Hai-Ying Tian, Dong Xu, Jun-Ping Liu, Wei-Min Mao, Li-Yu Chen, Chen Yang, Li-Ping Wang, Kai-Yuan Shi
November 2015, 11(8):234-238
DOI:10.4103/0973-1482.170544  PMID:26612444
Purposes: Routine smears of fine-needle aspiration (FNA) specimens of supraclavicular lymph nodes with ultrasound (US) real-time guidance have proven useful in lung cancer staging, but the clinical value of additional information from cell-block of FNA samples has been little researched. This study mainly focused on the contribution of cell block analysis to the diagnosis and staging in lung cancer. Materials and Methods: Clinical data about 211 lung cancer patients with supraclavicular lymph node enlargement admitted to ultrasonography in the Zhejiang Cancer Hospital and recommended a needle biopsy under US-guided, the adequacy of the specimens for preparing cell blocks was acquireded, and the additional immunohistochemistry or genetic information provided from cell block analysis was examined. Results: In 211 lung cancer patients referred for US-guided FNA (median age 61.8 ± 10.0 years, range 30-88) 279 aspirations were performed. Conventional smears could be obtained from 185 aspirates (66.3%) and contained 176 (95.1%) diagnostic smears. Cell blocks could be obtained from 94 aspirates (33.7%) and contained diagnostic material in 88 (93.6%) aspirates. Above all, cell blocks also made epithelial growth factor receptor gene mutation analysis in 17 patients with FNA samples, and the positive rate was 70.6%. Overall, cell blocks provided clinically significant information for 51 of the 211 patients participating in the study (24.2%). Conclusion: Cell-block samples from US-guided FNA is a promising, relatively noninvasive technique to provide additional information in lung cancer diagnosis. Analysis of cell blocks allows for genetic analysis of the patients with supraclavicular lymph nodes metastasis.
  3,788 199 -
Comparison of conventional laparoscopy and robotic radical hysterectomy for early-stage cervical cancer: A meta-analysis
Hao Xianhua, Han Shuzhai, Wang Yunfei
November 2015, 11(8):258-264
DOI:10.4103/0973-1482.170533  PMID:26612449
Background: Cervical cancer continues to be a global burden for women, with >500,000 cases and 275,000 deaths reported annually. Resources-rich countries have seen a dramatic reduction in the prevalence of invasive cervical cancer due to widely accessed radical hysterectomy (RH). We aimed to compare initial surgical outcomes and complication rates of conventional laparoscopic RH (LRH) and robotic RH (RRH) for treating cervical cancer through a systematic meta-analysis. Methods: PubMed, EMBASE, and the Cochrane Library databases were systematically searched for all relevant studies. Data were abstracted independently. A meta-analysis was performed to compare intra- and post-operative outcomes for the two techniques. Results: A total of 12 clinical trials were identified. Meta-analysis showed that although LRH and RRH were similar in terms of operating time, the length of hospital stay, and a number of pelvic lymph nodes resected, RRH presented less blood loss and overwhelming advantage against LRH with the respect of complications. Conclusion: RRH may be a reliable technique for treating early cervical cancer. Available evidence suggests that it is better than LRH for postoperative recovery, while the two techniques involve similar surgical outcomes and share the same limits in clinical practice.
  3,639 206 -
The comparison of anesthesia effect of lung surgery through video-assisted thoracic surgery: A meta-analysis
Jing-Dong Ke, Hai-Jun Hou, Min Wang, Yu-Jie Zhang
November 2015, 11(8):265-270
DOI:10.4103/0973-1482.170534  PMID:26612450
Objective: The epidural anesthesia and general anesthesia are the most commonly used in lung surgery through video-assisted thoracic surgery (VATS). Each of these methods has their advantages and disadvantages, so the aim of this meta-analysis is to identify which anesthesia is more conducive to lung surgery under VATS and rehabilitation of patients. Materials and Methods: The Cochrane Library Database (Issue 12, 2013), PubMed (1966–2015), and China National Knowledge Infrastructure (1950–2015) were searched without language restrictions. Meta-analyses were conducted using Review Manager 5.2 software (The Cochrane Collaboration, Software Update, Oxford). We calculated odds ratio (OR) and its confidence interval (95% CI) to estimate the difference between epidural anesthesia and general anesthesia through finishing of the collected data. Results: Due to our search results, 7 studies were included in our study. Studies among them show that different contents of these articles are not all the same about research direction. Our findings suggested that epidural anesthesia had more advantages than general anesthesia for operative time (mean difference = − 23.85, 95% CI: − 29.67–− 18.03, P = 0.0001). More than that, epidural anesthesia showed a good surgical outcome on postoperative hospital stay (mean difference = − 0.43, 95% CI: − 0.85–− 0.01, P = 0.04) than general anesthesia. But we found that there were no different on numbers of people with complications (OR = 0.45, 95% CI: 0.23–0.89, P = 0.97) and headache occurrence (OR = 2.69, 95% CI: 0.62–11.70, P = 0.91) between epidural anesthesia and general anesthesia. Conclusion: These results indicated that epidural anesthesia can save operating time and postoperative hospital stay time. But epidural anesthesia and general anesthesia have the same effect on complications.
  3,288 166 -
Effect of capilliposide for induction apoptosis in human nasopharyngeal cancer CNE-2 cells through up-regulating PUMA expression
Hua Yonghong, Hu Qiaoying, Piao Yongfeng, Tang Qiu, Feng Jiangguo
November 2015, 11(8):239-243
DOI:10.4103/0973-1482.170529  PMID:26612445
Objective: To observe the apoptosis of capilliposide against human nasopharyngeal cancer CNE-2 cells and to study its primary mechanisms. Materials and Methods: Vectors pSilencer-PUMA-small interfering RNA (siRNA) were constructed to transcribe functional siRNA specially targeting PUMA. The interfering plasmids were used to transfect CNE-2 cells with lipofectamine 2000 transfection reagent. PUMA messenger RNA (mRNA) expression levels were analyzed by polymerase chain reaction. The proliferation of CNE-2 cells was detected using MTT colorimetry. Annexin V/propidium iodide double staining was applied to detect the apoptosis rate of CNE-2 cells. The protein levels of p53, PUMA, and Bax were detected using Western blot analysis. Results: Recombinant siRNA expression vector targeting PUMA was constructed. MTT assays showed capilliposide inhibited the proliferation of CNE-2 cells in a concentration-dependent manner. The inhibition was strengthened along with increased concentrations. Apoptosis detected by flow cytometry in control group, drug group, siRNA group, and drug combined siRNA group was 9.3 ± 2.3%, 31.4 ± 5.6%, 12.3 ± 4.1%, and 13.2 ± 3.7%, respectively. After pretreated by capilliposide, PUMA protein was upregulated, and BAX was distributed to mitochondria in CNE-2 cells using Western blot analysis, but this effect can be interrupted by PUMA-siRNA. Conclusions: Capilliposide could induce the apoptosis of CNE-2 cells, which might be related with the increasing in PUMA-Bax pathway.
  3,064 182 -
Evaluation of melanoma antigen gene A3 expression in drug resistance of epidermal growth factor receptor-tyrosine kinase inhibitors in advanced nonsmall cell lung cancer treatment
Ju Jin, Bang-Zhu Liu, Zhuo-Min Wu
November 2015, 11(8):271-274
DOI:10.4103/0973-1482.170549  PMID:26612451
Objective: To investigate the correlation between melanoma antigen gene A3 (MAGE-A3) expression and progression-free survival (PFS) of nonsmall cell lung cancer (NSCLC) patients with epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKIs) therapy, aiming to provide a basis for research and treatment of EGFR-TKIs resistance. Research and Methods: Retrospective analysis is conducted of PFS of 359 NSCLC patients who have been tested positive for EGFR, and experienced drug resistance during oral treatment of icotinib. MAGE-A3 expression is tested using immunology and histology chemistry methods, and T790M and c-MeT expression are tested using mutation-enriched polymerase chain reaction. Results: (1) MAGE-A3 expression in targeted treatment of NSCLC patients shows a positive rate of 33.98%. The comparative difference between MAGE-A3 expression and T790M, c-MeT and other resistance genes was not statistically significant (P > 0.05). (2) MAGE-A3 expression was higher in patients with NSCLC targeted therapy of primary drug resistance of positive rate than acquired resistance; meanwhile the expression level differences in three modes of acquired resistance are statistically significant (P < 0.05). (3) PFS of MAGE-A3 positive expression in the targeted treatment of acquired drug resistance in patients with NSCLC is shorter than the PFS of MAGE-A3 negative expression (P = 0.01); the comparative PFS differences in the three kinds of acquired drug resistance pattern have statistical significance (P = 0.02). (4) PFS and levels of MAGE-A3 expression in NSCLC patients with the three modes of acquired resistance are negatively correlated (P < 0.01), and MAGE-A3 expression has no correlation with age, gender, pathological type or PS score (P > 0.05). Conclusion: MAGE-A3 expression in EGFR-TKIs target therapy in NSCLC patient suggests that there might be EGFR-TKIs drug resistance, and the higher the level of expression, the shorter the time of acquired drug resistance.
  2,852 130 -
Pancreatic neuroendocrine carcinoma diagnosed using endoscopic ultrasound-guided fine needle aspiration: A case report and literature review
Gan Shi, Chenming Sun, Liang Sun, Huanping Ren, Qilong Song, Jie Wu
November 2015, 11(8):280-282
DOI:10.4103/0973-1482.170535  PMID:26612453
Pancreatic neuroendocrine carcinoma (NEC) is a rare pancreatic neoplasm. In this study, we report the case of a 67-year-old male who was admitted with epigastric pain, which began during the previous week. The planar imaging of the magnetic resonance imaging sequence detected oval shapes in the neck and tail of the pancreas. Endoscopic ultrasonography showed low-echo lumps at these sites. Endoscopic ultrasound-guided fine needle aspiration was performed on the pancreatic masses. Pathology results indicated that the tissue taken from the pancreas was consistent with small cell NEC. We also review the current published literature on pancreatic NEC.
  2,750 181 -
Two endoscopic submucosal dissection procedures for stripping huge segment of the gastric mucosa to treat early gastric signet ring cell carcinoma
Shengxi Li, Meidong Xu, Chu Yuan
November 2015, 11(8):253-257
DOI:10.4103/0973-1482.170532  PMID:26612448
Aim: To introduce the method of stripping of early gastric signet ring cell carcinioma by two ESD procedures. Methods: A lesion of early gastric signet ring cell carcinoma in an elderly was removed by two consecutive ESD procedures. The pathology was analyzed and the patient was followed-up. Results: The lesion removed by first ESD procedure, which was 10cm in diameter, has tumor tissue on its edge, and the second lesion which was 5cm in diameter had an edge without tumor. There was no metastasis or recurrence during 24-month follow-up. Conclusion: We first described the method using two consecutive ESD procedures in man with gastric signet ring cell carcinoma, and the procedure was proved to be safe and efficient.
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Two different endoscopic long intestinal tube placements for small bowel obstruction: Transnasal ultrathin endoscopy versus conventional endoscopy
Shengxi Li, Chu Yuan, Mei-Dong Xu
November 2015, 11(8):248-252
DOI:10.4103/0973-1482.170531  PMID:26612447
Aim: To investigate and compare the effect on small bowel obstruction (SBO) of a long intestinal tube inserted by two different endoscopic placements which are transnasal ultrathin endoscopy and conventional endoscopy. Patients and Methods: Twenty-nine patients who had been diagnosed as suffering from SBO underwent long tube insertion placed by transnasal ultrathin endoscopy were included as subjects. Thirty-two patients who had undergone insertion of a long tube placed by conventional endoscopy were included as controls. The success rate of intubation of the small bowel, the time required for the procedure, and complications were compared between the subjects and controls. Results: The success rate of intubation was 100% (29/29) in subjects and 93.8% (30/32) in controls, without a significant difference (P = 0.493). There are 2 failed cases that the procedure was attempted near 60 min in 2 patients who had performed Billroth II anastomosis before, and the intestinal tube could not be inserted into efferent loops of jejunum in controls. The mean time required for the procedure was 15.3 min in subjects and 22.9 min in controls, respectively, and with a significant difference (P < 0.001). Epistaxis occurred in both groups, and 2 cases encountered bleeding of the gastrointestinal tract in controls. Conclusion: Long tube insertion facilitated by transnasal ultrathin endoscopy takes shorter time and has a higher success rate compared with the procedure conducted with the help of conventional endoscopy. It is safe and useful to insert a long intestinal tube assisted by transnasal ultrathin endoscopy for the decompression of small bowel.
  2,762 111 -