Combinatorial Chemistry & High Throughput Screening - Volume 22, Issue 3, 2019

Background: Only a limited number of studies considered the combined chemo-radiation therapy after surgery for treating locally advanced rectal cancer. Comparative studies on laparoscopic and open procedures indicated that laparoscopy surgery may be associated with fewer postoperative complications. Despite encouraging results from rectal cancer patients who received neoadjuvant chemo-radiotherapy prior to laparoscopic surgery, the acceptance of this procedure remains controversial, and conflicting evidence exists only in the form of retrospective trials. Objectives: Since laparoscopic surgery was introduced into clinical practice to treat rectal cancer after neoadjuvant chemo-radiotherapy, it has been discussed controversially whether laparoscopic surgery can be performed as effectively as an open procedure. To overcome the biases inherent in any nonrandomized comparison, we analyzed the propensity-matched analysis and randomized clinical trial. In this study, we set out to determine whether laparoscopic resection was non-inferior to open resection in treatment outcomes of rectal cancer after neoadjuvant chemo-radiotherapy. Methods: Publications on laparoscopic surgery in comparison with open thoracotomy in treatment outcomes of rectal cancer after neo-adjuvant chemo-radiotherapy to November 2017 were collected. Summary hazard ratios (HRs) of endpoints of interest such as 3-OS (overall survival), 3-DFS (disease-free survival), and individual postoperative complications were analyzed in all trials. By using fixed- or random-effects models according to the heterogeneity, meta-analysis Revman 5.3 software was applied to analyze combined pooled HRs. Results: A total of 6 trials met our inclusion criteria. The pooled analysis of 3-DFS showed that laparoscopic surgery did not improve disease -free survival, compared with open thoracotomy (OR =1.48, 95% CI 0.95 – 2.29; P = 0.08), as well with the 3-OS (OR=0.96, 95%CI=0.66-1.41, P=0.084). The pooled result of duration of surgery indicated that laparoscopic surgery had a tendency towards a longer surgery time (SMD= 43.96, 95% CI 34.04– 53.88; P < 0.00001) and a shorter hospital stay (SMD= -0.97, 95% CI -1.75– -0.18; P=0.02). However, no significant differences between laparoscopic surgery and open thoracotomy were observed in terms of the meta-analysis on the number of removed lymph nodes (SMD =-0.37, 95% CI -0.1.77 – 1.03; P = 0.60), blood loss (SMD =-21.30, 95% CI -0.48.36 – 5.77; P = 0.12), positive circumferential resection margin (OR =0.73, 95% CI 0.22– 2.48; P = 0.61) or postoperative complications (OR =0.89, 95% CI 0.67 – 1.17; P = 0.40) l. Conclusion: The current data supported the concept that laparoscopic surgery had correlated with a longer operative time but a shorter hospital stay, without superior advantages in short-term survival rates or oncologic efficiency for locally treating advanced rectal cancer after neoadjuvant chemoradiotherapy. However, prospective investigation on long-term oncological results from laparoscopic surgery is required in the future to verify the benefits of laparoscopic surgery over open surgery after chemo-radiation therapy for treating locally advanced rectal cancer.

Background: The study aimed to evaluate the efficacy and safety of invasivenoninvasive sequential ventilation versus invasive ventilation in the treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Methods: PubMed, Cochrane, Embase, Wanfang, CNKI, VIP database were searched by the index words to identify the qualified RCTs, and relevant literature sources were also searched. The latest research was conducted in June 2017. Relative Risks (RR), and Mean Difference (MD) along with 95% confidence interval (95% CI) were used to analyze the main outcomes. Results: Twenty-nine RCTs were involved in this analysis of 1061 patients in the invasivenoninvasive sequential ventilation group (In-non group) and 1074 patients in the invasive ventilation group (In group). The results indicated that compared with the invasive ventilation, invasive-noninvasive sequential ventilation would significantly decrease the incidence of VAP (RR:0.20, 95%CI: 0.16-0.26), mortality (RR:0.38, 95%CI: 0.26-0.55), reintubation (RR:0.39, 95%CI: 0.27-0.55); and statistically reduced the duration of invasive ventilation (MD:-9.23, 95%CI: -10.65, -7.82), the total duration of mechanical ventilation (MD:-4.91, 95%CI: -5.99, -3.83), and the length of stay in the ICU (MD:-5.10, 95%CI: -5.43, -4.76). Conclusion: The results demonstrated that the application of noninvasive sequential ventilation after invasive ventilation at the pulmonary infection control window has a significant influence on VAP incidence, mortality, and the length of stay in the ICU, but further well-designed, adequately powered RCTs are required to validate the conclusion.

Background: In the past decade, many researchers focused on Robotic- Assisted Thoracoscopic Surgery (RATS), which has been introduced as an alternative minimally invasive approach, versus Video- Assisted Thoracoscopic Surgery (VATS) for lung lobectomy in patients with non-small cell lung cancer. However, the advantage of RVATS compared to VATS is still under investigation. The results are unclear. Aim: The aim of this study is to compare the efficacy and safety of Robot-assisted Thoracic Surgery (RATS) lobectomy versus Video-assisted Thoracic Surgery (VATS) for lobectomy in patients with Non- Small Cell Lung Cancer (NSCLC). Methods: A systematic electronic search of online electronic databases: Pubmed, Embase, Cochrane library updated in June 2017. The meta-analysis was performed including the studies are designed as randomized or non- randomized controlled. Results: Twenty retrospective cohort studies met our inclusion criteria. The pooled analysis of mortality showed that RATS lobectomy significantly reduced the mortality rate when compared with VATS lobectomy (RR =0.53, 95% CI 0.37 – 0.76; P = 0.0005). With the pooled result of duration of surgery indicated that RATS has a tendency towards longer surgery time (SMD= 0.52, 95% CI 0.23– 0.81; P < 0.0004=). However, the meta-analysis on the median length of hospital stay (MD =0.00, 95% CI -0.03 – 0.03; P = 0.91), number of dissected lymph nodes station (SMD =0.39, 95% CI -0.60 – 1.38; P = 0.44), the number of removed lymph nodes (SMD =0.98, 95% CI -0.61 – 2.56; P = 0.23), mean duration of drainage (SMD =0.29, 95% CI -0.15 – 0.73; P = 0.20), prolonged air leak (RR =1.01, 95% CI 0.84 – 1.21; P = 0.93), arrhythmia (RR =1.06, 95% CI 0.88 – 1.26; P = 0.54) (P= 0.54), pneumonia (RR =0.89, 95% CI 0.69 – 1.13; P = 0.33), the incidence of conversion (RR =0.82, 95% CI 0.54 – 1.26; P = 0.37) and morbidity (RR =1.05, 95% CI 0.90 – 1.23; P = 0.055) all showed no significant differences between RATS and VATS lobectomy. Conclusions: RATS result in better mortality as compared with VATS. However, robotics seems to have longer operative time and higher hospital costs, without superior advantages in morbidity rates and oncologic efficiency. Since the advantages of RATS has been performed in some area, the continuation of a comparative investigation with VATS may be necessary. And some efforts need to be taken into consideration to reduce the operative time and cost.

Aim: To compare the surgical outcomes of laparoscopic surgery for lower rectal cancer with open surgery. Methods: The multiple databases including PubMed, Springer, EMBASE, EMBASE, OVID were adopted to search for the relevant studies, and full-text articles involving the comparison of unilateral and bilateral PVP surgery were reviewed. Review Manager 5.0 was adopted to estimate the effects of the results among the selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. Results: Finally, 1186 patients were included in the 10 studies, which eventually satisfied the eligibility criteria, and laparoscopic and open surgery group were 646 and 540, respectively. The meta-analysis suggested that there was no significant difference of the operation time between laparoscopic and open surgery group, while the time to solid intake, hospital stay time, blood loss and complication rate of laparoscopic group are much less than those of open surgery. Conclusion: Although both these two punctures provide similar operation time, we encourage the use of the laparoscopic surgery as the preferred surgical technique for treatment of lower rectal cancer due to less time to solid intake, hospital stay time, blood loss and lower complication rate.

Background: Patients undergoing surgery for non-small cell lung cancer (NSCLC) are often elderly and have co-morbidity conditions and decreased performance status. Compared with open thoracotomy, video-assisted thoracoscopic lobectomy is associated with fewer postoperative complications. Despite encouraging results for patients with NSCLC who underwent VATS, the procedure is still not widely accepted, and large retrospective studies have yielded conflicting results. Objectives: In video-assisted lobectomy for NSCLC, it has remained controversial whether mediastinal lymphadenectomy can be performed as effectively as an open procedure via thoracotomy. To deal with inherent biases in any non-randomized comparison, we analyzed propensity-matched studies and randomized controlled trials. The aim of this study was to evaluate the treatment outcomes of VATS and open thoracotomy for NSCLC patients. Methods: We collected publications on comparison of VATS versus open thoracotomy for NSCLC patients from 2007 to 2017. All trials analyzed the summary Hazard Ratios (HRs) of the endpoints of interest, including perioperative mortality and morbidity, and individual postoperative complications. Revman 5.3 software was used to analyze the combined pooled HRs using fixed- or random-effects models according to heterogeneity. Results: A systematic literature search was conducted including 15 studies. The results indicated that VATS was associated with lower postoperative morbidity and mortality, and significantly lower rates of prolonged pneumonia, atrial arrhythmias and renal failure. Conclusions: Compared with lobectomy by thoracotomy, thoracoscopic lobectomy is associated with a lower incidence of major complications, including lower rates of prolonged pneumonia, atrial arrhythmias and renal failure. Lobectomy via VATs may be the preferred strategy for appropriately selected NSCLC patients. The determinants of this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures.

Background: Chinese herbal monomer hairy Calycosin is a flavonoid extracted from Radix astragali. Aims and Scope: The aim of the research was to investigate the effect and mechanism of Hairy Calycosin on Non-Alcoholic Fatty Liver Dieases (NAFLD) in rats. Materials and Methods: 60 rats were randomly divided into 6 groups, then NAFLD rat models were prepared and treated with different doses of Hairy Calycosin (0.5, 1.0, 2.0 mg/kg) or Kathyle relatively. Results: Both 1.0 mg/kg and 2.0 mg/kg Hairy Calycosin treatment could significantly increase the serum Superoxide Dismutase (SOD) content of the model rats and reduce the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), Free Fatty Acid (FFA), IL-6, tumor necrosis factor-alpha (TNF-α) and liver homogenate malondialdehyde (MDA), while 2.0 mg/kg Hairy Calycosin can down-regulate liver tissue cytochrome p450 2E1 (CYP2E1). In the electron microscope, compared with the model control group, the mitochondrial swelling in the hepatocytes of Hairy Calycosin (1.0, 2.0 mg/kg) treatment group was significantly reduced, the ridge on the inner membrane of mitochondria increased, and the lipid droplets became much smaller. Conclusion: Hairy Calycosin can effectively control the lipid peroxidation in liver tissues of rats with NAFLD, and reduce the levels of serum TNF-α, IL-6, MDA and FFA, effectively improve the steatosis and inflammation of liver tissue, and down-regulate the expression of CYP2E1, inhibit apoptosis of hepatocytes.

Objective: To investigate the expression of long-chain non-coding RNA MINCR (LncRNAMINCR) and Cyclin-Dependent Kinase 2 (CDK2) mRNA in primary hepatocellular carcinoma, and to analyze the relationship between its expression and clinical pathological parameters and prognosis of hepatocellular carcinoma. Methods: Seventy-five surgically resected primary hepatocellular carcinoma tissues and paracancerous tissues were selected. Real-time PCR was used to detect the expression of LncRNA-MINCR and CDK2 mRNA in hepatocellular carcinoma tissues and adjacent tissues. The relationship of clinicopathological parameters and prognosis between hepatocellular carcinoma and LncRNA-MINCR and CDK2 mRNA were analyzed. Pearson correlation coefficient describes the correlation between LncRNA-MINCR and CDK2 mRNA. Results: The expression of LncRNA-MINCR and CDK2 mRNA in primary hepatocellular carcinoma tissues was higher than that in the adjacent tissues [(5.51±0.62) vs (1.62±0.51), (4.52±0.73) vs (1.85±0.95), P<0.05]. The expression of LncRNA-MINCR in the primary hepatocellular carcinoma group was positively correlated with CDK2 mRNA (r=0.352, P<0.05), and the expression of LncRNA-MINCR in the paracancerous tissue group was not correlated with CDK2 mRNA (r=0.024, P>0.05). LncRNA-MINCR expression was associated with TNM staging, lymph node metastasis, and cirrhosis (P<0.05). CDK2 mRNA expression was associated with tumor diameter, TNM stage, lymph node metastasis, and serum alpha-fetoprotein levels (P<0.05). The 3-year survival rate of patients with high expression of LncRNAMINCR was lower than that of LncRNA-MINCR low expression group [53.49% vs 77.38%, 2=13.024, P<0.05). The 3-year survival rate of patients with high CDK2 mRNA expression was lower than that of CDK2 mRNA low expression group [51.29] % vs 80.38%, 2 = 10.15, P < 0.05]. Conclusion: The expression of LncRNA-MINCR and CDK2 mRNA in primary hepatocellular carcinoma tissues increased significantly. The two play a synergistic role in the invasion, invasion and metastasis of hepatocarcinoma cells. High expression of LncRNA-MINCR and CDK2 mRNA indicates poor prognosis in patients with hepatocellular carcinoma.

Objective: This study investigated the expression of MAPK-activating death domaincontaining protein (MADD) in lung adenocarcinoma and its impact on lung adenocarcinoma SPCA- 1 cell proliferation and apoptosis. Methods: Clinicopathological lung specimens were collected. MADD expression levels in normal human lung and human lung adenocarcinoma tissues were detected by immunohistochemistry. Lung adenocarcinoma SPC-A-1 cells were cultured, and IG20 gene expression in the SPC-A-1 cells was detected using reverse-transcription PCR. SPC-A-1 cells were transfected with a plasmid carrying the MADD gene and a lentiviral vector capable of silencing MADD expression. CCK-8 assay, western blot and flow cytometry were performed to detect MADD expression, proliferation and apoptosis in the SPC-A-1 cells. Results: MADD expression levels in the lung adenocarcinoma tissue were significantly higher than those in the normal lung tissue and lung squamous carcinoma cells. MADD can be expressed in lung adenocarcinoma SPC-A-1 cells. High MADD expression can inhibit SPC-A-1 cell apoptosis and enhance SPC-A-1 cell proliferative activity, while silencing MADD expression can promote apoptosis and reduce SPC-A-1 cell proliferation. Conclusion: MADD expression is significantly upregulated in lung adenocarcinoma tissue. MADD can promote lung adenocarcinoma cell growth by inhibiting apoptosis. This study may improve lung adenocarcinoma levels in patients and, thus, is worthy of clinical promotion.