BACKGROUND: Da Vinci robotic system is currently widely used in thoracic surgery. The ports employment and procedures vary in different medical center in China. Usually, a small incision was used for assistant. METHODS: Based on clinical practice, we summarized domestic and foreign experience, combined with the characteristics of the Chinese body anatomy, employ portal technique and artificial pneumothorax, summarized a set of simplified and easier surgical method. RESULTS: Port-only artificial pneumothorax robot-assisted lobectomy has further improvement in anatomical safety, hemostatic effect and aesthetic appearance of the wound. CONCLUSIONS This study optimizes the procedure of port-only artificial pneumothorax robot-assisted lobectomy in order to serve lung cancer patients better.

Objective To evaluate the incidence of net adverse clinical and cerebral events (NACCE) 1 year after implantation of biodegradable polymer stents (BP-SES) in elderly patients with coronary artery disease.Methods The clinical data of patients inserted with BP-SES in I-LOVE-IT 2 Trial were retrospectively analyzed, including 1829 elderly patients admitted in the General Hospital of Shenyang Military Command from Oct. 2012 to Jun. 2013, of which 62 cases aged equal to and more than 65 years (elderly group) and 1202 cases less than 65 years (non-elderly group). The primary end-point of this research was target lesion failure (TLF) rate on 12 months and the secondary end-point was the incidence of NACCE, including all-cause death, all myocardial infarction, stroke and severe hemorrhage (BARC type ≥3), and then the multiple regression analysis was performed.Results The Baseline conditions of the two groups were significantly different (P<0.05) including BMI, diabetes, hypertension, hyperlipidemia, family history of coronary heart disease, smoking history, past stroke history, history of peripheral vascular disease and stable angina pectoris. When comparing elderly group with non-elderly group, marked differences existed on the incidence of NACCE (10.0%vs. 5.2%,P<0.01), all-cause mortality (2.7%vs. 0.7%,P<0.01), myocardial infarction (5.6%vs. 3.5%,P=0.03), stent thrombosis (1.9%vs. 0.5%,P<0.01) and stroke (2.2%vs. 0.8%,P=0.01). Multiple regression analysis revealed that elderly (age ≥65) was the independent predictive factor for NACCE (OR=1.904, 95%CI 1.304-2.781,P=0.001).ConclusionThe incidence of NACCE is increased significantly in elderly patients (age ≥65), and elderly is an independent predictive factors for 12-month NACCE in patients implanted with BP-SES

OBJECTIVEThe aim of this study was to investigate the effects of combination of icotinib and cetuximab on the acquired drug resistance caused by T790M mutation of EGFR in NSCLC, and provide experimental evidence for rational treatment of NSCLC.

METHODSThe effects of these two agents on cell proliferation, apoptosis, and EGFR-dependent signaling were evaluated using 3-(4, 5-dimethylthiazol-2-yl)- 5-diphenyltetrazolium bromide (MTT) assay, annexin V staining, and Western blotting. The expression of molecular markers of tumor proliferation PCNA and Ki-67 protein was further examined by immunohistochemistry, and the expression of EGFR-signaling-related proteins in tissue sections taken from H1975 tumor xenografts was assessed by Western blot assay. Sensitivity to EGFR inhibitors was detected in human H1975 tumor xenograft in nude mice.

RESULTSThe in vitro experiment showed that the proliferative ability of H1975 cells was inhibited in a dose-dependent manner, along with the increasing doses of cetuximab and icotinib, and the combination of cetuximab with icotinib resulted in a more pronounced growth inhibition of the H1975 cells. The apoptosis rate of H1975 cells after treatment with 0.5 µmol/L icotinib and 1 µg/ml cetuximab was (22.03 ± 2.41)% and that after treatment with 5 µmol/L icotinib and 10 µg/ml cetuximab was (42.75 ± 2.49)%, both were significantly higher than that after treatment with the same dose of icotinib or cetuximab alone (P < 0.05). The nude mouse experiment showed that the transplanted tumor was growing to (614.5 ± 10.8) mm(3) in the blank control group and to (611.2 ± 8.7) mm(3) at 28 days after icotinib treatment, but (30.8 ± 2.0) mm(3) in the cetuximab treatment group and 0 mm(3) in the cetuximab combined with icotinib group. There was a significantly decreased expression of Ki-67 and PCNA proteins and down-regulation of phosphorylation of EGFR signaling-related proteins in the cetuximab combined with icotinib group.

CONCLUSIONSThe combination of icotinib with cetuximab can exert synergistic inhibitory effect on the acquired drug resistance caused by T790M mutation of EGFR in NSCLC H1975 cells, interrupts the EGFR-downstream signaling pathway, and enhances the anticancer activity of chemotherapeutic drugs. Our results provide further experimental evidence for the clinical studies of combination of icotinib with cetuximab in the treatment of NSCLC patients associated with secondary drug resistance caused by T790M mutation of EGFR.

Animals ; Antibodies, Monoclonal, Humanized ; administration & dosage ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Apoptosis ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; genetics ; Cell Line, Tumor ; Cell Proliferation ; Cetuximab ; Crown Ethers ; administration & dosage ; therapeutic use ; Down-Regulation ; Drug Resistance, Neoplasm ; genetics ; Genes, erbB-1 ; genetics ; Humans ; Lung Neoplasms ; drug therapy ; Mice ; Mice, Nude ; Mutation ; Quinazolines ; administration & dosage ; therapeutic use ; Receptor, Epidermal Growth Factor ; Signal Transduction