Catamenial pneumothorax due to bilateral pulmonary endometriosis

Co-existence of catamenial pneumothorax and hemoptysis is rare. We present a case of catamenial pneumothorax due to bilateral pulmonary endometriosis in a 45-year-old woman. The patient presented with a 3-year history of intermittent productive cough with blood-tinged sputum, chronic anemia, loss of appetite, and general weakness associated with menstruation. Three years prior to this presentation the patient had undergone a sigmoidectomy as treatment for endometriosis of the sigmoid colon with bleeding. Chest radiographs and computed tomography (CT) scan revealed multiple nodules in both lung parenchyma and recurrent pneumothorax. CT-guided biopsy revealed chronic inflammation of those pulmonary nodules, and laboratory studies disclosed elevated serum levels of carbohydrate antigen 19-9 (CA 19-9) and CA 125. Thoracoscopic wedge resection of the pulmonary nodules was performed, and histopathological examination of the resected nodules revealed endometriosis. At one-year follow-up there was no evidence of recurrence of gastrointestinal bleeding or pneumothorax.

Sumoylation of eukaryotic elongation factor 2 is vital for protein stability and anti-apoptotic activity in lung adenocarcinoma cells

By screening mouse monoclonal antibody libraries for Kelch repeats, we serendipitously identified monoclonal antibodies to eukaryotic elongation factor 2 (eEF2). Interestingly, eEF2 was highly expressed in lung adenocarcinoma (LADC), but not in the neighboring non-tumor lung tissue. Normally, eEF2 is involved in the peptidyl-tRNA translocation during protein synthesis. Overexpression of eEF2 would implicate an association with disease progression of LADC. In the present study, we investigated the prognostic significance of eEF2 in patients with LADC. Expression of eEF2 was detected by immunoblotting, immunohistochemistry and confocal immunofluorescence microscopy. Our results show that patients with high eEF2 expression had a significantly higher incidence of early tumor recurrence (67.8%vs 18.2%, P = 0.016), and a significantly worse prognosis (P < 0.001). In an in vitro study, silencing of eEF2 expression increased mitochondrial elongation, cellular autophagy and cisplatin sensitivity. Moreover, eEF2 was sumoylated in LADC cells, and eEF2 sumoylation correlated with drug resistance. These results suggest that eEF2 is an anti-apoptotic marker in LADC. However, biological function and involvement of eEF2 in the disease progression of LADC require further studies.

Proteomic identification of differentially expressed proteins in curcumin-treated MCF-7 cells

Curcumin (CM), a well-known dietary pigment derived from Curcuma longa L., possess anticancer activities against a variety of tumors including human breast carcinoma. In combination with docetaxel, CM has been used in breast cancer management in the clinic. In order to explore the possible mechanism of anticancer activity of CM, in the present study, we aimed to identify proteins involved in the anticancer activity of CM in human breast cancer cell line MCF-7 using the two-dimensional electrophoresis (2-DE)-based proteomic analysis. MCF-7 cells were cultured at 37°C in an atmosphere of 5.0% CO(2). All the following experiments were repeated three times. Cell viability assay showed that after a 48-h incubation CM dose-dependently inhibited cell growth with an IC(50) value of 47.42 μM. Treatment of CM at 47.42 μM for 48 h induced apoptosis as determined by nuclear morphologic changes of Hoechst stained cells and flow cytometric analysis of Annexin V-FITC/PI stained cells. Proteomic analysis identified 12 differentially expressed proteins which contributed to multiple functional activities such as DNA transcription, mRNA splicing and translation, amino acid synthesis, protein synthesis, folding and degradation, lipid metabolism, glycolysis, and cell motility. Among them 7 proteins were up-regulated and 5 down-regulated. The up-regulated ones were verified by quantitative real-time PCR. The down-regulated proteins, TDP-43, SF2/ASF and eIF3i, as well as up-regulated ones, 3-PGDH, ERP29, and platelet-activating factor acetylhydrolase IB subunit beta positively contribute to the anticancer activity of CM in MCF-7 cells. These molecules are implicated in the bioactivities of CM for the first time. The findings of this study would shed new insights for systematically understanding the mechanisms of CM in breast cancer intervention.

Single-incision thoracoscopic surgery for primary spontaneous pneumothorax

OBJECTIVE

Single-incision laparoscopic surgery had been proven effective for appendectomy, cholecystectomy, and inguinal hernia repair. However, single-incision thoracoscopic surgery (SITS) in primary spontaneous pneumothorax (PSP) has not been reported.

METHODS

We prospectively enrolled 30 PSP patients who received thoracoscopic surgery in the division of Thoracic Surgery of China Medical University Hospital. Ten patients received SITS and 20 patients received traditional three-port thoracoscopic surgery. The operative time, blood loss, wound size, visual analog scale (VAS) pain score, and patient satisfaction score were compared.

RESULTS

There was no significant difference in the operative time and blood loss between the two groups. However, the VAS pain scores were significantly better in the SITS group in first 24 hours after surgery. Patient satisfaction scores in the SITS group were also significantly better in the first 24 and 48 hours after operation.

CONCLUSION

Although three-port thoracoscopic surgery for PSP is well established, SITS results in better patient satisfaction and decreased postoperative pain in the treatment of PSP.

Expression of xeroderma pigmentosum complementation group C protein predicts cisplatin resistance in lung adenocarcinoma patients

DNA repair has been suggested to be a major cause of spontaneous drug resistance in patients with lung adenocarcinomas (LADC). Among the DNA repair-related proteins, excision repair cross-complementation group 1 (ERCC1) has been shown to be essential for repairing cisplatin-induced interstrand cross-linkage. However, the role of other DNA repair-related proteins in drug resistance has not been clearly elucidated. In this study, we used suppression subtractive hybridization and microarray analysis to identify the DNA repair-related genes associated with cisplatin resistance. We focused on the association of XPC protein expression, which plays a pivotal role in the earliest response to global genomic repair, with the survival of LADC patients. Using suppression subtractive hybridization and a microarray analysis to identify drug resistance-associated DNA repair-related genes, we found that the mRNA levels of ERCC1, MSH-3, MSH-6 and XPC were significantly increased in LADC patients. Since the results of ERCC1 mRNA expression corresponded well with those in previous reports, in this study we focused on the clinical correlation between XPC expression and patient survival. The level of XPC protein was determined by immunohistochemical and immunoblotting analyses. We detected the XPC protein in 46 (43%) of 107 pathological LADC samples. XPC protein expression correlated with tumor stage, cigarette smoking and poor survival. In the in vitro experiments with LADC cell lines, increased XPC expression was associated with elevated drug resistance, and silencing of XPC expression reduced cisplatin resistance. Our results suggest that XPC expression predicts drug resistance in LADC.

Expression of 53BP1 as a cisplatin-resistant marker in patients with lung adenocarcinomas

DNA repair is one of the major causes of spontaneous drug and radiation resistance in patients with lung adenocarcinomas (LADC). 53BP1 is a mediator that relays signals from DNA damage sensors and activates various effectors for the DNA repair and cell survival. In this study we investigated the clinical and biological significance of 53BP1. Expression of 53BP1 was detected by immunoblotting and immunohistochemistry. Our data showed that 53BP1 was detected in 166 (75.8%) of 219 LADC patients. Expression of 53BP1 correlated with tumor stage, cigarette smoking, lymphovascular invasion and poor clinical outcome. In vitro, increased 53BP1 expression elevated drug resistance, and silencing of 53BP1 expression reduced cisplatin resistance. Our results suggest that 53BP1 expression plays an important role in cisplatin resistance and predicts the prognosis for LADC.

Lung abscess predicts the surgical outcome in patients with pleural empyema

OBJECTIVES

Most cases of pleural empyema are caused by pulmonary infections, which are usually combined with pneumonia or lung abscess. The mortality of patients with pleural empyema remains high (up to 20%). It also contributes to higher hospital costs and longer hospital stays. We studied pleural empyema with combined lung abscess to determine if abscess was associated with mortality.

METHODS

From January 2004 to December 2006, we retrospectively reviewed 259 patients diagnosed with pleural empyema who received thoracscopic decortications of the pleura in a single medical center. We evaluated their clinical data and analyzed their chest computed tomography scans. Outcomes of pleural empyema were compared between groups with and without lung abscess.

RESULTS

Twenty-two pleural empyema patients had lung abscesses. Clinical data showed significantly higher incidences in the lung abscess group of pre-operative leukocytosis, need for an intensive care unit stay and mortality.

CONCLUSION

Patients with pleural empyema and lung abscess have higher intensive care unit admission rate, higher mortality during 30 days and overall mortality than patients with pleural empyema. The odds ratio of lung abscess is 4.685. Physician shall pay more attention on high risk patient of lung abscess for early detection and management.

Inflammatory myofibroblastic tumor of the lung--a case report

A 45-year-old man presented with a six-month history of progressive dyspnea with productive cough and wheezing. The patient was a heavy smoker and had a history of tongue cancer, hypertension, and asthma. Chest X-ray and computed tomography showed a mass lesion in the left hilar region and total collapse of the upper left lobe of the lung. Bronchoscopy revealed a whitish solid tumor obstructing the left upper lobe bronchus. Positron emission tomography showed increased tracer uptake in the lesion. A thoracoscopic lobectomy of the left upper lobe of the lung was performed. The final pathologic diagnosis was inflammatory myofibroblastic tumor.

ATPase family AAA domain-containing 3A is a novel anti-apoptotic factor in lung adenocarcinoma cells

AAA domain-containing 3A (ATAD3A) is a member of the AAA-ATPase family. Three forms of ATAD3 have been identified: ATAD3A, ATAD3B and ATAD3C. In this study, we examined the type and expression of ATAD3 in lung adenocarcinoma (LADC). Expression of ATAD3A was detected by reverse transcription-polymerase chain reaction, immunoblotting, immunohistochemistry and confocal immunofluorescent microscopy. Our results show that ATAD3A is the major form expressed in LADC. Silencing of ATAD3A expression increased mitochondrial fragmentation and cisplatin sensitivity. Serum deprivation increased ATAD3A expression and drug resistance. These results suggest that ATAD3A could be an anti-apoptotic marker in LADC.

The effects of power on–off durations of pulsed ultrasound on the destruction of cancer cells

PURPOSE

Low-intensity ultrasound irradiation is a potential method for suppressing cancer cell proliferation, inducing apoptosis and delivering specific cytotoxic genes or drugs into tumors topographically in future cancer therapies. However, ultrasound attenuates rapidly in tissue and produces heat. Pulsed ultrasound is frequently used to minimize pain and possible thermal damage to the surrounding normal tissue during therapy, since it results in smaller temperature increases. This study compared three pulsed-ultrasound strategies for destroying cancer cells, measuring their induced temperature increases to determine the optimal pulsing parameters.

MATERIALS AND METHODS

We performed three types of experiment, involving ultrasound with (1) a fixed duty cycle of 50% with variable on- and off-times, (2) a fixed off-time with variable on-times, and (3) a fixed on-time with variable off-times.

RESULTS

The results show that for different types of cultured cells (HeLa, HT-29, Ca9-22 and fibroblast) exposed to ultrasound of the same frequency (1 MHz) and energy, long pulses combined with off-times that are 5-10 times longer (on-/-off-times pairs of 5/25, 25/250, or 250/2500 ms/ms) cause significant cell destruction whilst avoiding temperature increases of more than 1.5 degrees C. Furthermore, the correlation between the temperature increase and the percentage of surviving cells is low.

CONCLUSIONS

Pulsed ultrasound with a long on-time and an even longer off-time exerts a high cytotoxic effect but a smaller temperature increase compared with non-pulsed ultrasound. This indicates that the cytotoxic effects observed in the current study were not purely due to the thermal effects of the ultrasound.

Overexpression of dihydrodiol dehydrogenase as a prognostic marker in resected gastric cancer patients

The cytoplasmic enzyme dihydrodiol dehydrogenase (DDH) plays an important role in detoxification. Patients with DDH overexpression have a significantly higher incidence of early tumor recurrence and distant metastasis. This study evaluated the correlation between clinicopathological data and DDH expression and the prognostic significance of DDH expression in patients with resected gastric cancer. Between January 1998 and September 2004, we retrospectively enrolled 81 patients who received surgical treatment for gastric cancer. Pathology samples were immunostained with monoclonal antibody to DDH. The relationship between DDH expression and clinicopathological data (age, gender, histological type, stage) was analyzed by chi-square analysis. Survival curves were plotted using the Kaplan-Meier method and compared using a log-rank test. The overexpression rate of DDH was 41.9%. Of patients with overexpressed DDH, 13% had stage I, 24% had stage II, 52% had stage III, and 78% had stage IV tumors. Among patients who died, DDH expression level differed significantly between high and low-expression groups (P = 0.042). Survival was significantly better in patients with low DDH expression (P = 0.048). Thus, DDH expression may be useful in identifying high-risk gastric cancer patients and distinguishing future candidates for curative and palliative treatment.

Plasma nuclear DNA and mitochondrial DNA as prognostic markers in corrosive injury patients

STUDY OBJECTIVES

Ingestion of a corrosive substance produces an injury to the gastrointestinal tract and it is often difficult to evaluate the severity and prognosis of this injury. Increased concentrations of plasma nuclear DNA and mitochondrial DNA (mtDNA) have been found to be associated with the area of corrosion. This study examined the level of plasma DNA as it relates to the severity of corrosive injury.

METHODS

Forty-eight consecutive patients were enrolled prospectively. The concentrations of plasma nuclear DNA and mtDNA were measured by real-time quantitative polymerase chain reaction assay at presentation to the emergency room and 12 h later.

RESULT

The median age of the patients enrolled was 55 years (20 men and 28 women) with an overall mortality rate of 21%. Nineteen patients underwent operative intervention secondary to perforation. Findings included significantly elevated plasma nuclear DNA and mtDNA in the mortality group at presentation and 12 h after injury compared to the survival group.

CONCLUSION

The concentrations of plasma nuclear DNA and mtDNA were elevated within 4 h after corrosive injury. The elevated concentrations of plasma nuclear DNA and mtDNA could be useful prognostic markers to correlate with the clinical outcome in corrosive patients.

Effect of rainfall regime and slope on runoff in a gullied loess region on the Loess Plateau in China

Runoff was measured from seven plots with different slopes nested in Tuanshangou catchment on the Loess Plateau to study effect of slopes on runoff in relation to rainfall regimes. Based on nine years of field observation and K-mean clusters, 84 rainfall events were grouped into three rainfall regimes. Rainfall regime A is the group of events with strong rainfall intensity, high frequency, and short duration. Rainfall regime C consists of events with low intensity, long duration, and infrequent occurrence. Rainfall regime B is the aggregation of events of medium intensity and medium duration, and less frequent occurrence. The following results were found: (1) Different from traditional studies, runoff coefficient neither decreased nor increased, but presented peak value on the slope surfaces; (2) For individual plot, runoff coefficients induced by rainfall regime A were the highest, and those induced by rainfall regime C were the lowest; Downslope, the runoff coefficients induced by three rainfall regimes presented the same changing trend, although the peak value induced by regime A occurred on a shorter slope length compared to those by regime B and C; (3) Scale effect on runoff induced by rainfall regime A was the least, and that induced by rainfall regime C was the largest. These results can be explained by the interactions of crusting, soil moisture content, slope length and gradient, and erosion units, etc., in the context of different rainfall regimes.

Expression of SRG3, a chromatin-remodelling factor, in the mouse oocyte and early preimplantation embryos

SRG3 (Smarcc1) is a core subunit of the SWI/SNF complex. In the absence of SRG3, embryonic development ceases during peri-implantation stages, indicating that SRG3, as well as the chromatin-remodelling process, plays an essential role in early mouse development. To gain a better understanding of chromatin remodelling during the early stages of development, we examined SRG3 expression during oogenesis and preimplantation stages using immunofluorescence and western blot assays. SRG3 was detected in nuclei of oocytes during growth and maturation. Following fertilization, SRG3 was detected in pronuclei shortly after their formation. Nuclear concentrations of SRG3 increased in a time-dependent fashion and were found to be greater in the male pronucleus than in the female pronucleus. The increase in nuclear SRG3 was partially inhibited by a protein synthesis inhibitor, but not by a transcriptional inhibitor. Expression of SRG3 is accompanied by expression of Brg1 and Ini1, two other core subunits of the SWI/SNF complex. The expression of these three remodelling factors parallels that of SP1 and TBP, both spatially and temporally, in the mouse embryo, suggesting a role for remodelling factors in chromatin structure and function during early development.

Limited hepatic resection by laparoscopy-assisted mini-laparotomy for the treatment of hepatocellular carcinoma in cirrhotic patients

Surgical resection is standard treatment for hepatocellular carcinoma but is often not possible in the presence of cirrhosis or poor liver function. We present a method of performing limited hepatectomy in patients with hepatocellular carcinoma and cirrhosis. We call this method laparoscopy-assisted mini-laparotomy (LAML). The site of the tumor is localized by ultrasound through a laparoscope, and a small skin incision is made over that site to facilitate removal of the portion of liver containing the tumor. Eleven patients underwent limited hepatic resection by LAML. The tumors were on the margin of the liver. There was no hospital mortality or serious complications. The average length of hospital stay was 6.4 days. LAML can be safely performed for hepatocellular carcinoma in cirrhotic patients. It decreases operating time, length of hospital stay, and blood loss.

Inducible heat shock protein 70, interleukin-18, and tumor necrosis factor alpha correlate with outcomes in spontaneous intracerebral hemorrhage

Inducible heat shock protein 70 (HSP70), a stress protein detected in the central nervous system, is expressed when a cell or organism is under stress. Interleukin-18 (IL-18) and tumor necrosis factor alpha (TNF-alpha) are multipotential early proinflammatory cytokines. Our objective was to determine protein levels of HSP70, IL-18, and TNF-alpha as well as mRNA levels of HSP70, IL-18, and TNF-alpha in the plasma and CSF of spontaneous intracerebral hemorrhage (ICH) patients, and to correlate these with disease outcome. Serial measurement of the proteins in CSF and plasma and of the mRNAs in peripheral blood mononuclear cells was conducted in 43 patients (mean age, 64+/-9 years; 23 men and 20 women). Ten (23%) patients died. We found that the damaged brain releases TNF-alpha and HSP70 to the peripheral blood and that plasma levels of these are highly associated with mortality in spontaneous ICH patients.

Aberrant promoter methylation of EDNRB in lung cancer in Taiwan

Hypermethylation has been shown in the promoter region of the endothelin receptor B (EDNRB) gene in several human tumors, but its role in lung cancer formation is unclear. In this study, genomic DNA from lung cancer patients was subjected to methylation-specific PCR to determine the methylation status of the EDNRB gene in lung cancer. Aberrant methylation of the EDNRB gene was detected in 32.9% (26 of 79) lung cancer patients. Promoter hypermethylation of EDNRB was found to significantly differ with histological type but was not correlated to other clinicopathological characteristics. Decreased mRNA transcripts were correlated to aberrant methylation. Treatment with 5-aza-deoxycytidine reversed the methylation status and re-expression of the EDNRB gene in the H1355 human lung cancer cell line. Our results suggest that inactivation of the EDNRB gene through epigenetic alteration is highly prevalent in lung cancer in Taiwan.