Chinese consensus on surgical treatment of traumatic rib fractures (2021) / 中华创伤杂志

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

The risk factors for recurrence of peripheral solid small-nodule lung cancer (diameter≤ 2 cm) and the impact of different surgery types on survival: A propensity-score matching study / 中国胸心血管外科临床杂志

@#Objective     To identify the risk factors for postoperative recurrence of peripheral solid small-nodule lung cancer (PSSNLC) (T≤2 cm), and to explore the effects of surgery types on prognosis. Methods     We extracted data from Western China Lung Cancer Database (WCLCD), a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University, and Surveillance, Epidemiology, and End Results (SEER)  database for peripheral solid small-nodule lung cancer patients (T≤2 cm N0M0, stageⅠ) who underwent surgery between 2005 and 2016. We used univariable and multivariable logistic regression to analyze risk factors for recurrence of PSSNLC. We applied propensity-score matching to compare the long-term results of segmentectomy and lobectomy, as well as the survival of patients from WCLCD and SEER. We finally included 4 800 patients with PSSNLC (T≤2 cm N0M0)(WCLCD: SEER=354∶4 446). We matched 103 segmentectomies and 350 lobectomies in T≤1 cm, and 280 segmentectomies and 1 067 lobectomies in 1 cm<T≤2 cm at a ratio of 1∶4 according to the propensity scores. Results     The results of multivariable logistic regression showed that older age (HR=1.04, 95%CI 1.03-1.05, P<0.001), male (HR=1.60, 95%CI 1.37-1.88, P<0.001), squamous carcinoma (HR=1.65, 95%CI 1.40-1.95, P<0.001), lymph node removed (HR=0.97, 95%CI 0.96-0.99, P<0.001) were risk factors for recurrence after surgery. We found that segmentectomy and lobectomy could reach similar survival in PSSNLC patient with either T≤1 cm or 1 cm<T≤2 cm. Analyses of 1 441 patients with PSSNLC after matching (WCLCD∶SEER=325∶1 116) indicated that the 5-year overall survival rate of the patients in WCLCD was better than that in SEER database ( 89.8% vs. 77.1%, P<0.001). Conclusion     Older age, male, squamous carcinoma, and lymph node removed are the risk factors for recurrence of PSSNLC. Segmentectomy shows similar survival in PSSNLC patient with either T≤1 cm or 1 cm<T≤2 cm N0M0. The patients in the WCLCD shows better survival compared with of the patients in the SEER database.

Perioperative outcomes of uniportal versus three-port video-assisted thoracoscopic lobectomy for 2 112 lung cancer patients: A propensity score matching study / 中国胸心血管外科临床杂志

@#Objective     To analyze the perioperative outcomes of uniportal thoracoscopic lobectomy compared with three-port thoracoscopic lobectomy. Methods     Data were extracted from the Western China Lung Cancer Database, a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University. Perioperative outcomes of the patients who underwent uniportal or three-port thoracoscopic lobectomy for lung cancer during January 2014 through April 2021 were analyzed by using propensity score matching. Altogether 5 817 lung cancer patients were enrolled who underwent thoracoscopic lobectomy (uniportal: 530 patients; three-port: 5 287 patients). After matching, 529 patients of uniportal and 1 583 patients of three-port were included. There were 529 patients with 320 males and 209 females at median age of 58 (51, 65) years in the uniportal group and 1 583 patients with 915 males and 668 females at median age of 58 (51, 65) years in the three-port group. Results     Uniportal thoracoscopic lobectomy was associated with less intraoperative blood loss (20 mL vs. 30 mL, P<0.001), longer operative time (115 min vs. 105 min, P<0.001) than three-port thoracoscopic lobectomy. No significant difference was found between the two groups regarding the number of lymph node dissected, rate of conversion to thoracotomy, incidence of postoperative complication, postoperative pain score within 3 postoperative days, length of hospital stay, or hospitalization expenses. Conclusion     Uniportal video-assisted thoracoscopic lobectomy is safe and effective, and the overall perioperative outcomes are comparable between uniportal and three-port strategies, although the two groups show differences in intraoperative blood loss.

Progresses in clinical treatment of multiple rib fractures and flail chest / 中国胸心血管外科临床杂志

@#The incidence of rib fracture in patients with chest trauma is about 70%. Simple rib fractures do not need special treatment. Multiple rib fractures and flail chest are critical cases of blunt trauma, which often cause serious clinical consequences and need to be treated cautiously. Nowadays, there is a controversy about the diagnosis and treatment of multiple rib fractures and flail chest. In the past, most of the patients were treated by non-operative treatment, and only less than 1% of the patients with flail chest underwent surgery. In recent years, studies have confirmed that surgical reduction and internal fixation can shorten the hospital stay, and reduce pain and cost for patients with flail chest, but there is still a lack of relevant clinical consensus and guidelines for diagnosis and treatment, which leads to great differences in clinical diagnosis and treatment plans. This article reviewed the treatment, surgical indications and surgical timing of multiple rib fractures and flail chest.

Operating skills of surgical assistants in robotic esophagectomy / 中国胸心血管外科临床杂志

@#Surgery is an important method in the treatment of esophageal cancer. With the application of robotic surgery system, more and more surgeons have observed its huge advantages over the conventional minimally invasive surgical system in the esophageal surgery. To ensure the safety and fluency of the robotic surgery, it needs not only an experienced attending surgeon but also a well-trained assistant. This study summaries the skills of the surgical assistant in the robotic esophagectomy.

Effects of reducing FasL expression on T cell apoptosis in lung cancer cell line H460 via siRNA technology / 中国肺癌杂志

<p><b>BACKGROUND</b>Lung cancer cells can upregulate the expression of Fas ligand (FasL) and counterattack tumor-infiltration lymphocyte (TIL) expressing Fas via the FasL/Fas pathway, therefore escape from immunosurveillance and impair local anti-tumor immune capacity. The aim of this study is to investigate the effects of reducing FasL expression on T cell apoptosis in lung cancer cell line H460 via small interfering RNA (siRNA) technology.</p><p><b>METHODS</b>In vitro chemically synthesized siRNA targeting FasL as well as constructed plasmid vector were transfected into H460 cells, wherein the interfering effect and alterations in T cell apoptosis were observed.</p><p><b>RESULTS</b>Sequence-specific interfering effect was detected at RNA and protein levels by RT-PCR and Western blot in the H460 si group, and the reduction of FasL expression was capable of rescuing T cell apoptosis induced by lung cancer cells.</p><p><b>CONCLUSIONS</b>FasL can be utilized as a new target in gene therapy of lung cancer.</p>

Study on HLA-ABDR alleles in A549 and Calu-6 lung cancer cell lines with PCR-SSP / 中国肺癌杂志

<p><b>BACKGROUND</b>It has been confirmed that human leucocyte antigen (HLA) may play very important roles in the process of antigen presenting and antigen distinguishing. HLA has a close relationship with the immunity killing and immunity escape in cancer. HLA-ABDR alleles were detected in A549 and Calu-6 lung cancer cell lines by PCR-sequence specific primers (PCR-SSP) in this research.</p><p><b>METHODS</b>DNA of A549 and Calu-6 was purified and PCR-SSP was practiced. Then the gel was scanned in ultra-violet. HLA-A, HLA-B and HLA-DR were determined with special response list.</p><p><b>RESULTS</b>HLA-A and HLA-B in A549 and Calu-6 were not integral, but HLA-DR was integral. The genotype of HLA-ABDR for A549 was: HLA-A30, HLA-B44, HLA-DR7/HLA-DR53. The genotype of HLA-ABDR for Calu-6 was: HLA-A01, HLA-B08, HLA-DR17/HLA-DR52.</p><p><b>CONCLUSIONS</b>Human adenocarcinoma cell line exists both HLA-I and HLA-II genotypes. Selective loss of HLA-I gene might be occured during tumor generation, but all the HLA-II genes remain. Detection of tumor HLA is necessary to the acknowledgment of tumor immunology behavior and foundation of tumor specific cytotoxic T lymphocyte.</p>

Human lung-derived mesenchymal stem cells inhibit T lymphocyte proliferation / 第三军医大学学报

Objective To investigate the immunoregulatory ability of human lung-derived mesenchymal stem cells (MSCs) on T cells. Methods MSCs were isolated and cultured from human fetal lung. The immune phenotype was tested by flow cytometry and T lymphocyte proliferation assessed by thymidine incorporation. Results HLA-DR, CD86, and CD80 were not expressed in human lung-derived mesenchymal stem cells. The proliferation of peripherial blood-derived T cells was suppressed and this suppression seemed dependent on the concentration of MSCs. Conclusion Human lung-derived MSCs have been proved to possess immunomodulatory ability.

Expression of Fas ligand protein in human non-small cell lung cancer and its clinical significance / 第三军医大学学报

Objective　To explore the expression of Fas ligan d (FasL) protein in human non-small cell lung cancer (NSCLC) and its clinic al significance. Methods　Expression of FasL protein was detecte d by immunohistochemical method in 32 resected tumors of NSCLC. Results 　FasL protein was detected in all of these 32 resected tumors with variant pos itive expression levels ranging from 3.0% to 98.7% ［mean (62.0±32.0)%］. T here wa s significant difference between the tumors of different pathological types no s ignificant difference was found between the tumors of different differentiation nor among the tumors of different pTNM stages (P>0.05). Conclusion　 The results indicated that NSCLC can counterattack the immune cells of t he body and may be the molecular basis for the easily metastasis of adenocarcino ma to in the early stage.

Inhibition of lung cancer cells of primary culture and A549 cell line on the proliferation of tumor-infiltrating lymphocytes in vitro / 第三军医大学学报

Objective To study the inhibition of lung cancer cells of primary culture and A549 cell line on the proliferation of tumor-infiltrating lymphocytes(TIL) in vitro and its clinical implications.Methods Human lung cancer cells and TILs were isolated from 8 cases of primary lung cancer and cultured.The inhibition of isolated human cancer cells and A549 cells to TILs was detected by MTT method.Results Lung cancer cells of primary culture and A549 cells can kill TILs to various degrees.Conclusion Inhibition of lung cancer cells to TIL may be one of the mechanisms of immune escapes.