Image guided stereotactic body radiation therapy ( SBRT) has emerged as a promising technolo-gy for early-stage non-small cell lung cancer ( NSCLC) increasingly ,particularly for patients that are unable to tolerate or deny operation ,with a trend to replace surgical resection .Abundant clinical research results have dem-onstrated that SBRT is safe to yield local control rate of more than 90%without excessive toxicity in early -stage NSCLC.In this review ,we discuss the research progress on treating stage I NSCLC with SBRT .

Objective To explore the efficacy and postoperative survival times of stereotactic radiosurgery by X-knife in the treatment of brain metastatic tumors.Methods Between March 1996 and March 2008,520 patients with brain metastatic tumors were treated in our hospital by stereotactic radiosurgery using X-knife.Among the cases,336 had single metastatic lesions,and 184 presented with multifocal tumors(2 lesions in 51 patients,3-5 lesions in 63,and 6-10 lesions in 70).The tumors sized 5 to 35 mm in diameter with a mean of 16.4 mm.Stereotactic radiosurgery was carried out in the cases with a mean central dose of 22 Gy(20 to 25 Gy),and mean marginal dose of 12 Gy(10 to 14 Gy).Over 80% of the lesions were encircled with the dosage.Results The 520 patients were followed up for 8 to 36 months(mean,20 months).CT and MRI performed in the 6th months postoperation showed complete response in 218 patients(41.9%),partial response in 182(35.0%),no response in 78(15.0%),and progressed disease in 42(8.1%).The overall control rate of the tumors were 91.9%(478/520).In this series,the 6-months survival rate was 85.0%(442/520),12-month survival rate was 68.1%(354/520),and the 1-year and 3-year survival rates were 40% and 5.5% respectively.The medium survival time was 12.6 months.Conclusions Stereotactic radiosurgery is an effective method for brain metastatic tumors.It can improve the life quality and survival time of the patients.

Objective To explore the radiosensitizatian of paclitaxel in human lung adenocareinoma cells. Methods A human lung adenocarcinoma cell line A973 was used in this study. The cytotoxicity of paclitaxel was investigated by using clonngenic assay to define the IC10,IC50 and IC90. The cells received either radiation(with different doses) alone or paclitaxel administrated before and after irradiation. Cell survival fractions were determined by clonogenic assay. Single hit multi-target model was used to determine survival curve parameters. Flow cytometry was performed to analyze the cell cycle distribution. Results The IC10, IC50 and IC90 of paclitaxel in A973 cells were 0.5,2.6 and 8.7 nmol/L,respectively. According to Do,Dq and SF2 value,the sensitivity enhancement ratio(SER) of IC10 was 0.97,1.01 and 2.00 when paclitaxel was added before irradiation, and 0.97,1.02 and 1.02 when after irradiation ; The SER of IC50 was 1.06,129.00 and 2.61 when paclitaxel was added before irradiation, and 0.94,220. O0 and 2.14 when after irradiation ;The SER of IC90 were 1.00,220. 00 and 2.09 when paclitaxel was added before irradiation,and 0.98,220.00 and 2.09 when after irradiation. The IC10 of paclitaxei failed to increase G2+M arrest of A973 cells.The maximal G2+M accumulation was reached at 2 h and 18 h after IC50 and IC90 of paclitaxel treatment,respectively. Conclusions Paclitaxel is able to enhance the radiation sensitivity of A973 cells. Sequence of treatment is not associated with radiosensitivity. Moderate and high dose of paclitaxel combined with low-dose radiation can produce the best effect of radiosensitiation.

Objective To explore the influences of decorin ( DCN) gene down-regulating on biological behavior in human lung adenocarcinoma A 549 cell line.Methods Chemically synthesis in vitro targeting DCN -siRNA was transfected into human lung adenocarcinoma A 549 cells by LipofectamineTM 2000 .The gene expres-sion of DCN was detected using Real-Time PCR ;The protein expression of DCN was investigated using Western blot;Checkout DCN-siRNA effects on lung adenocarcinoma cancer cell proliferation was detected by CCK -8;The migration and invasion ability were determined by Transwell assay .Results DCN-siRNA was successfully transfected into human lung adenocarcinoma A 549 cells.Real-Time PCR results showed that DCN mRNA ex-pression level significantly decreased ,compared with untransfected group ,negative control group .Western blot re-sults showed that DCN-siRNA transfection inhibited DCN protein expression level;CCK-8 results showed that the proliferation was enhanced in the DCN -siRNA group as compared with untransfected group ,as well as the negative control group and empty vector group .Transwell assay results showed the invasion of A 549 cells in DCN-siRNA group was significantly enhanced as compared with untransfected group [(22.6 ±1.14) vs.(5.2 ± 0.84)].Wound-Healing assay results revealed that the cell repairing rate was markedly increased in DCN -siRNA group.A549 cells were close to complete repair after 48 hours.Apoptosis was not significant in DCN -siR-NA group as compared with untransfected group (P=0.214).Conclusion Down-regulation the expression of DCN gene by DCN-siRNA may enhance the ability of invasion ,migration and proliferation of A 549 cells without affecting apoptosis ,which provides a new evidence of function for advancing research of lung cancer .

Objective To explore the status of lymph node dissection under thoracoscopic surgery and open surgery in patients with thoracic esophageal carcinoma. Methods 16 cases of thoracic esophageal cancer received thoracoscopic surgery from August 2012 to June 2015 as minimally invasive group (group M), 17 cases of thoracic esophageal cancer with the same pathological staging received traditional open surgery during the same period as control group (group C), the number of lymph nodes and the positive rate of lymph node metastasis were compared. Results In group M, the total number of 228 lymph nodes, mean (14.27 ± 5.61) pieces, the positive rate was 12.50%; while in group C, the total number of 241 lymph nodes, mean (16.20 ± 6.24) pieces, the positive rate was 11.76%. Two different pathological staging in patients with lymph nodes dissection has no significant difference ( >0.05). In group M, 7 cases with lymph node metastasis, 45 metastatic lymph nodes, metastasis rate was 43.75 %, 19.74 % degree of metastasis; while in group C, 8 cases with lymph node metastasis, 55 metastatic lymph nodes, metastasis rate was 47.06%, transfer degree was 22.82%.Conclusions Minimally invasive surgery can achieve the same effect with the traditional open chest surgery, in treatment of thoracic esophageal cancer with high operability.

[ ABSTRACT] AIM:To explore the inhibitory effects of pantoprazole sodium on epithelial-mesenchymal transition and cisplatin resistance in lung cancer cells and the underlying mechanism .METHODS: Using MTT method, wound healing assay , Transwell experiment , Western blot , the differences of morphology , invasion ability , migration ability , drug sensitivity and protein expression between A 549/DDP cells and A549 cells were determined .The effect of pantoprazole so-dium on morphology , invasion ability , migration ability , drug sensitivity and protein expression in A 549/DDP cells were al-so observed.RESULTS: Compared with A549 cells, A549/DDP cells had higher invasion and migration abilities , and lower drug sensitivity , exhibited mesenchymal phenotype and activated c-Met/AKT/mTOR pathway .Pantoprazole sodium inhibited the abilities of invasion and migration , and reversed the mesenchymal phenotype , drug resistance and the c-Met/AKT/mTOR pathway activation in A549/DDP cells.Treatment with c-Met inhibitor SU11274, PI3K inhibitor LY294002 and mTOR inhibitor rapamycin had the same effects on A 549/DDP cells as that of pantoprazole sodium .CONCLUSION:Pantoprazole sodium inhibits invasion , migration, epithelial-mesenchymal transition and cisplatin resistance in lung cancer cells by down-regulating c-Met/AKT/mTOR pathways .

Objective To investigate the feasibility and superiority of local anaesthesia video-assisted thoracoscopic surgery (LA-VATS) in diagnosis and treatment of open thoracic trauma (OTT).Methods Seventy-eight patients with OTT emergently admitted from February 2007 and June 2012 were randomized into LA-VATS group (n =37) and conventional treatment group (n =41) by the toss of a coin.In the LA-VATS group,further treatment was determined following LA-VATS.Volume of chest tube drainage,duration of chest tube placement,average length of hospital stay,and postoperative complications were measured and compared between groups.Results In the LA-VATS group,23 patients completed LA-VATS and 14 were transferred for simple VATS-assisted mini-thoracotomy under general anesthesia.In the conventional treatment group,24 cases completed debridement and chest drainage and 17 cases were transferred for thoracotomy under general anesthesia.Volume of chest tube drainage [(195.0 ± 150.8) ml/d∶ (480.0 ±212.3)ml/d] (t =-2.675,P ＜0.05),duration of chest tube placement [(2.6 ± 1.4) d∶ (3.8 ± 1.9) d] (t =-2.318,P ＜ 0.05),average length of hospital stay [(6.4 ±2.3) d ∶ (10.9 ± 3.3) d] (t =-2.471,P ＜ 0.05),and incidence rate of postoperative complications (10.8％ ∶22.0％) (x2 =4.132,P ＜0.05) were all significantly different between LA-VATS and conventional treatment groups.Conclusion LA-VATS is safe and feasible for diagnostic exploration and simple treatment of OTT.

Objective: To summarize the methods of preventing and managing the complications in thoracoscopic lobectomy. Methods:The participants of this study included 317 patients undergoing lobectomy with video-assisted thoracoscopic surgery in the Department of Thoracic Surgery between January 2007 and December 2012. Intra-operative complications were observed, and countermeasures were summarized. Results: Complications occurred 28 times (8.8%), including bleeding in 16 cases because of accidental vascular injury (5.0%), accidental injury/break of bronchus in two cases (0.6%), vascular stump errhysis from cutting stapler in four cases (1.3%), lung stump air leakage in three cases (0.9%), lung injury in two cases (0.6%), and diaphragmatic injury in one case (0.3%). Conversion to thoracotomy was conducted in 17 cases, with a conversion rate of 5.4%. Thoracoscopic repair operation was performed in 14 cases that exhibited bleeding, with a success rate of 70% (14/20). No mortality was reported during the operation. Conclusion:Thoracoscopic lobectomy is a highly difficult method in thoracic surgeries. The procedure requires substantial attention on the timely prevention and correct management of intra-operative complications, particularly the injury and bleeding of major vessels, to reduce the rate of conversion to thoracotomy and the incidence of post-operative complications, as well as to promote the surgery in clinics.

Objective To investigate the value of radiofrequency device in liver resection for the treatment of primary liver cancer.Methods The clinical data of 82 patients with primary liver cancer who received liver resection at the First Affiliated Hospital of Xi'an Jiaotong University from January 2010 to February 2012 were retrospectively analyzed.All patients were divided into radiofrequency liver resection group (41 patients) and routine liver resection group (41 patients).The clinical characteristics including Child classification,operation time,intraoperative blood loss,and postoperative complications of the 2 groups were compared.All data were analyzed using the t test or chi-square test.Results The mean operation time of the radiofrequency liver resection group was (77 ± 28 ) minutes,which was significantly shorter than ( 129 ± 34) minutes ( t =7.432,P ＜ 0.05 ).The number of patients who received inflow occlusion in the radiofrequency liver resection group was 4,which was significantly smaller than 23 in the routine liver resection group ( x2 =19.934,P ＜ 0.05 ).The volumes of operative blood loss and rate of patients who received blood transfusion were (241 ± 214)ml and 15％ (6/41) in the radiofrequency liver resection group,(751 ± 421 )ml and 49％ (20/41) in the routine liver resection group (t =6.920,x2 =11.038,P ＜ 0.05 ).There were no significant difference in the rate of postoperative blood loss and biliary leakage between the 2 groups ( x2 =0.213,1.822,P ＞ 0.05).The mean postoperative hospital stay of the radiofrequency liver resection group was ( 9 ± 4) days,which was significantly shorter than ( 12 ± 7 ) days of the routine liver resection group ( t =2.368,P ＜ 0.05 ).No patients died intraoperatively.Conclusion The radiofrequency device could effectively control blood loss,shortens operation time and postoperatively hosptial stay,and it has great value in the liver resection for the treatment of primary liver cancer.

Objective To explore the clinical values of the modified thoracic drainage devices that were applied in treatment of primary spontaneous pneumothorax patients who underwent single-port video-assisted thoracoscopic surgery. Methods Clinical data of 82 primary spontaneous pneumothorax patients who underwent single-port video-assisted thoracoscopic lung wedge resection and pleurodesis from January 1st, 2015 to August 31st, 2016 was analyzed retrospectively. These patients, according to the thoracic drainage devices, were divided into traditional group (Group A, n = 42) or modified group (Group B, n = 40). These statistical data, including duration of thoracic drainage, lengths of hospital stay, duration of using antibiotic, amounts of pleural drainage, scales of pain, and complications of the two groups of patients in postoperative stage, were compared. Results There was no significant differences (P > 0.05) in volumes of thoracic drainage while there were significant differences (P < 0.05) in duration of thoracic drainage, lengths of hospital stay, duration of using antibiotic, scales of pain, and complications in postoperative stage between the two groups. And patients in group B had shorter time of thoracic drainage, hospital stay, and using antibiotic, lower scales of pain and rates of complications when compared with group A. Conclusion There are some clinical values of application of modified thoracic drainage devices in treatment of primary spontaneous pneumothorax underwent single-port video-assisted thoracoscopic surgery, because of it could give the patients fast recovery and made the operations simpler.