Objective To study the clinical experience and determine the optimal timing for periop-erative internal aortic balloon pumb (IABP) support in high-risk patients who had coronary artery bypass grafting (CABG) had been demonstrated. Methods Fifteen cases of emergency CABG with IABP were performed from September 2003 to April 2008. Eight cases were supported by IABP before operation,1 case was supported after succeeding in cardiopulmonary resuscitation,2 cases were supported by IABP for acute myocardial infarction,5 cases were supported by IABP for acute coronary syndrome. Seven cases were supported by IABP in the time of intra-or postoperation,2 cases were supported by IABP in order to help re-moving cardiopulmonary bypass in the operation. Result Three cases supported by IABP in the time of in-tra-or postoperation were dead, the other 12 cases were healed. Conclusions IABP can improve the heart function effectively and therefore can increased the success rate of operation.The beneficial effect of preoperative IABP in high-risk patients who have CABG is confirmed.

BACKGROUNDIt has been known that facilitative glucose transporter(GLUT) is the main carrier which intervenes the glucose uptake of cell,and there is a significant correlation between GLUT1 and cancer.The expression of GLUT1 in lung cancer has close relationship with the uptake of 18fluoro-2-deoxyglucose(FDG) of lung cancer,and the expression of GLUT1 is regulated by hypoxia inducible factor-1(HIF-1).The aim of this study is to investigate the relationship among expression of GLUT1,HIF-1α and the uptake of FDG in non-small cell lung cancer(NSCLC).

METHODSEighty-four patients with NSCLC were evaluated with FDG PET/CT before operation.The expression of GLUT1 and HIF-1α was detected immunohistochemically in lung cancer,and their expression level was assessed by the intensity of immunohistochemical staining.Correlation analysis was carried out among the expression level of GLUT1,HIF-1α and the value of standard uptake value(SUV) obtained from preoperative FDG PET/CT examination.

RESULTSThe range of average SUV(SUVave) of the eighty-four patients was 3.6-13.2,and the average value was 7.8±3.0.There was no significant correlation between the SUVave and the maximum diameter of the tumors,the TNM stage,pathological classification and the degree of differentiation.The positive rate of GLUT1 in the eighty-four patients was 95.2%(80/84).The average intensity of immunohistochemical staining was 4.4±1.3.The positive rate of HIF-1α in the eighty-four patients was 96.4%(81/84).The average intensity of immunohistochemical staining was 4.4±1.4.A highly significant positive correlation was found between GLUT1 expression and the SUVave(r=0.78,P < 0.01),and also between HIF-1α expression and the SUVave(r=0.73,P < 0.01).There was also a highly significant positive correlation between GLUT1 expression and HIF-1α expression(r=0.93,P < 0.01).

CONCLUSIONSGLUT1 protein and HIF-1α expressions are general in NSCLC tissues.GLUT1 may paly an important role in the glucose and FDG uptake of lung cancer cell,and HIF-1α might be one of the most important regulative factors of GLUT1 expression,which up-regulates the expression of GLUT1.

BACKGROUNDInflammatory myofibroblastic tumor (IMT) is an uncommon disease which usually occurs in the lung. Recently, several reports have suggested that IMT is a true neoplasm rather than a reactive lesion. In this retrospective study, we reviewed clinicopathological characteristics and prognoses of patients with surgically resected IMT of the lung at our department.

METHODSFrom January 1999 to December 2003, 14 patients had surgical intervention for IMT of the lung at Tongji Hospital. The resected lesions were studied histologically and immunohistochemically. One to 5 years' follow-up was completed in all patients.

RESULTSThese 14 patients included eight men and six women. They ranged in age from 11 to 46 years old. Nine patients were asymptomatic. The other five symptomatic patients had cough, hemoptysis, and dyspnea. For all these patients, the diagnostic procedure was surgical excision. The resected tumor size ranged from 1.0 to 8.0 cm in diameter. Histologically, a variety of inflammatory and spindle cells were observed. The spindle cells corresponded ultrastructurally to myofibroblasts or fibroblasts. There was no recurrence in these patients, and all of them were in good health during the follow-up.

CONCLUSIONSHistopathologically, IMT is characterized by myofibroblasts which are mixed with chronic inflammatory cells, including plasma cells, lymphocytes, and histiocytes. Surgical resection, when possible, should be chosen as the first choice and complete resection leads to excellent survival.

BACKGROUNDLymphatic dissemination is the main approach of metastasis in lung cancer, and it is also an important prognostic factor. The aim of this study is to explore the relationship between tumor size and lymph node metastasis in squamous cell carcinoma and adenocarcinoma of the lung.

METHODSA total of 240 patients diagnosed as squamous cell carcinoma and adenocarcinoma were studied. The relationship between tumor size and lymph node metastasis was analyzed.

RESULTSLymph node metastasis rate in maximum diameter (d)≤2cm, 2cm < d≤3cm, 3cm < d≤6cm, 6cm < d≤10cm, and d > 10cm groups was 50.0%, 35.1%, 52.8%, 52.1% and 71.4%, respectively. There was no correlation between tumor size and lymph node metastasis (r=0.10, P > 0.05). Lymph node metastasis occurred more frequently in adenocarcinoma (58.8%) than that in squamous cell carcinoma (42.9%) (P < 0.05). Mediastinal lymph node metastasis was found in 7 patients (16.3%) with d≤3cm, who were all diagnosed as moderate or poor differentiation.

CONCLUSIONSLymph node metastasis is not related to tumor size. Lymph node metastasis occurs more frequently in adenocarcinoma than it does in squamous cell carcinoma. Mediastinal lymph node metastasis can be found in tumor with d≤3cm, and differentiation grade may play an important role in lymph node metastasis.

BACKGROUNDThere are a lot of studies on relationship of surface adhesion molecule (CD44) and matrix metalloproteinase (MMP) with tumors in recent years, however study on osteopontin (OPN) is still few. The aim of this study is to investigate the levels of OPN, CD44v6 and MMP-2 in squamous cell carcinoma and adenocarcinoma of the lung, and to clearly understand their roles in growth, invasion and metastasis of squamous cell carcinoma and adenocarcinoma.

METHODSOPN, CD44v6 and MMP-2 were detected in 69 patients with squamous cell carcinoma and adenocarcinoma by immunohistochemical method.

RESULTSThe expression rate of OPN, CD44v6 and MMP-2 was significantly related to histological classification, TNM stages and lymph node metastasis (P < 0.05), but not to cell differentiation (P > 0.05). There was a positive correlation between OPN and CD44v6 expression (P < 0.001), as well as between OPN and MMP-2 expression (P < 0.001). There was no correlation between CD44v6 and MMP-2 expression.

CONCLUSIONSOPN, CD44v6 and MMP-2 expression is related to the histology, TNM stages and lymph node metastasis of lung cancer. They might be used as clinical indicators to predict the progress and metastatic potential for squamous cell carcinoma and adenocarcinoma of the lung.

Objective To review the effects of preventive management during the operation for post-operative chylothorax in patients with lung cancer of state Ⅲ. Methods Total 425 patients underwent pulmonary resection (at least lobectomy) and systematic mediastinal lymph node dissection for lung cancer of state Ⅲ from January 1998 to June 2005. Took some especial management during the operation to prevent post-operative chylothorax in 132 patients after March 2004. According to the surgical procedure,all patients were divided into preventive group and non-preventive group. Results There were 14 patients (4.8%) with post-operative chylothorax in the group of inchoate 293 patients before March 2004. Only 1 patient (0.07%) among 132 patients who underwent treatment for chylothorax during the operation after March 2004 had post-operative chylothorax (P

The relationship between vascular endothelial growth factor-C (VEGF-C)/vascular endothelial growth factor receptor 3 (VEGFR-3) expression and clinicopathologic features of the patients with non-small cell lung cancer (NSCLC) was investigated. The expression of VEGF-C and VEGFR-3 was assessed in 65 patients with NSCLC by immunohistochemistry. The significance of VEGF-C and VEGFR-3 expression was analyzed statistically. The results showed that VEGF-C and VEGFR-3 were highly expressed in cytoplasm and membrane in lung cancer tissues with the positive rate being 55.4 % and 52.3 % respectively, while there was no expression in the normal lung tissues. The expression of VEGF-C was significantly increased in adenocacinoma as compared to other types of NSCLC (P<0.05). The VEGFR-3 expression was closely related with lymph node metastasis (P<0.01) and TNM stage (P<0.05). There was a positive correlation between the VEGF-C and VEGFR-3 expression in NSCLC patients (r=0.658, P<0.01). It is suggested that VEGFR-3 plays an important role in the lymphatic metastasis of NSCLC. The interaction between VEGF-C and VEGFR-3 may be deeply involved in the mechanism of lung cancer metastasis.

The relationship between vascular endothelial growth factor-C (VEGF-C)/vascular endothelial growth factor receptor 3 (VEGFR-3) expression and clinicopathologic features of the patients with non-small cell lung cancer (NSCLC) was investigated. The expression of VEGF-C and VEGFR-3 was assessed in 65 patients with NSCLC by immunohistochemistry. The significance of VEGF-C and VEGFR-3 expression was analyzed statistically. The results showed that VEGF-C and VEGFR-3 were highly expressed in cytoplasm and membrane in lung cancer tissues with the positive rate being 55.4 % and 52.3 % respectively, while there was no expression in the normal lung tissues.The expression of VEGF-C was significantly increased in adenocacinoma as compared to other types of NSCLC (P＜0.05). The VEGFR-3 expression was closely related with lymph node metastasis (P＜0.01) and TNM stage (P＜0.05). There was a positive correlation between the VEGF-C and VEGFR-3 expression in NSCLC patients (r=0.658, P＜0.01). It is suggested that VEGFR-3 plays an important role in the lymphatic metastasis of NSCLC. The interaction between VEGF-C and VEGFR-3 may be deeply involved in the mechanism of lung cancer metastasis.

BACKGROUNDRecent researches have manifested that down-regulation of KAI1 relates to metastasis in various tumors, but its association with non-small cell lung cancer (NSCLC) and the mechanism for its down-regulation are not clear. The aim of this study is to investigate the expression of KAI1 in NSCLC and its relationship with clinicopathological characteristics and mutant P53 protein.

METHODSThe expression of KAI1/CD82 and mutant P53 protein was detected in 48 cases of NSCLC tissues by Western blot, and KAI1 mRNA was detected by RT-PCR method, with 20 cases of pulmonary benign disease tissues and normal lung tissues as control..

RESULTSThe positive rate of KAI1 mRNA was 52% in lung cancer group and 90% in control group, respectively (P < 0.01), KAI1/CD82 was 48% and 85% respectively (P < 0.01), and mutant P53 protein was 65% and 5% respectively (P < 0.01). The positive rate of KAI1 mRNA, KAI1/CD82 and mutant P53 protein closely related to the tumor stages, cell differentiation and lymph node metastasis status (P < 0.05 or P < 0.01). The expression of KAI1/CD82 highly related to KAI1 mRNA (P < 0.01) and mutant P53 protein (P < 0.05), while expression of KAI1 mRNA did not relate to mutant P53 protein expression (P > 0.05).

CONCLUSIONSThe down-regulation of KAI1 may relate to carcinogenesis, development and metastasis of NSCLC. Its reduction may occur mainly at transcriptional level and correlate with p53 in NSCLC. KAI1 and p53 might be helpful to predict the potential metastasis of NSCLC.

BACKGROUNDLung cancer is one of the most common malignant tumors in China. Surgical resection is still the first choice of treatment for most lung cancer patients. The prognosis of lung cancer after surgical treatment is correlated to many factors. One of them is nosocomial infection. This study is to investigate the distribution of the pathogens causing nosocomial infection and its correlative factors in patients with lung cancer.

METHODSOne hundred and thirteen cases that had hospital-acquired infection out of 1227 surgically treated patients with lung cancer were analyzed statistically.

RESULTSOf all the pathogenic species, the most prevalent species were Gram-negative bacteria with average positive detection of 64.03% (299/467). The second were Gram-positive bacteria (145/467, 31.05%) and the third were fungi (23/467, 4.92%). The results of drug sensitivity tests showed that all of strains had higher resistance rate. The rate of extended spectrum β-lactamases (ESBLs) and meticillin-resistant Staphylococcus (MRS) was very high. The incidence of nosocomial infection was seriously correlated with age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours.

CONCLUSIONSThe nosocomial infection of lung cancer patients after surgical treatment is seriously correlated with patient's age, fatness, long smoking history, complicated diseases such as diabetes, damaged renal function and using time of mechanical ventilation over 24 hours. More attentions should be paid to the pathogenic species and its correlative factors of nosocomial infection in lung cancer patients. The resistance of bacteria to the commonly used antibiotics is produced in various degrees. During clinical therapy with antibiotics, antibiotics should be selected according to the results of drug sensitivity tests. In order to reduce the production of drug-resistance, the appropriate use of antibiotics must be strengthened.