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Non-small cell lung cancer(NSCLC) is one of the most common malignancies worldwide. Not only the complex molecular components but also the cellular heterogeneity in NSCLC tissues pose a great barrier for its clinical treatment. Recent years has witnessed the widespread application of single-cell sequencing in the studies regarding tumor heterogeneity. However, the disadvantages of single-cell sequencing technology itself could not be neglected. Spatial transcriptome(ST) technology allows in situ transcriptome sequencing of tissues to achieve high-throughput transcriptomic information of tissue cells with their spatial information available. In other words, ST makes it possible to acquire cellular composition and gene expression patterns without breaking intercellular communication network, which distinguishes itself from conventional single-cell sequencing, since mechanical separation and enzymatic digestion of tissue cells into single-cell suspension used to be inevitable during the performance of single-cell sequencing. To gain new insights into the spatial heterogeneity of NSCLC, we reviewed and summarized the latest progress in ST technology which has been applied to tumor sample analysis, especially to the field of NSCLC.
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BACKGROUND@#At present, an ultrafine chest tube combined with a traditional thick tube were often used after pulmonary uniportal video-assisted thoracoscopic surgery (U-VATS). However, the thick tube was often placed in the incision, which increased the risk of poor wound healing and postoperative pain. The aim of this study is to investigate the feasibility and safety of using two ultrafine chest tubes (10 F pigtail tube) for drainage after pulmonary U-VATS.@*METHODS@#The medical records of patients who underwent pulmonary U-VATS during June 2018 and June 2020 in the department of cardiothoracic surgery of the second affiliated hospital of Soochow university were retrospectively reviewed to compare two different drainage strategies, receiving two 10 F pigtail tubes as chest tube (group A) or one 10 F pigtail tube as lower chest tube combined with one 24 F tube as upper chest tube (group B).@*RESULTS@#106 patients in group A receiving two 10 F pigtail tubes during June 2019 and June 2020 and 183 patients in group B receiving one 10 F pigtail tube as lower chest tube combined with one 24 F tube as upper chest tube during June 2018 and June 2019 were included. There was no significant difference between two groups in terms of the postoperative thoracic drainage (mL) (1st: 199.54±126.56 vs 203.59±139.32, P=0.84; 2nd: 340.30±205.47 vs 349.74±230.92, P=0.76; 3rd: 435.19±311.51 vs 451.37±317.03, P=0.70; 4th: 492.58±377.33 vs 512.57±382.94, P=0.69; Total: 604.57±547.24 vs 614.64±546.08, P=0.88), drainage time (d) (upper chest tube: 2.54±2.20 vs 3.40±2.07, P=0.21; lower chest tube: (2.24±2.43 vs 3.82±2.12, P=0.10), postoperative hospital stays (d) (6.87±3.17 vs 7.06±3.21, P=0.63), poor wound healing (0 vs 3.28%, P=0.09), replacement of lower chest tube (0.94% vs 2.19%, P=0.66) and the VAS1 (3.00±0.24 vs 2.99±0.15, P=0.63). Notably, there were significant differences between two groups in terms of the VAS₂ (2.28±0.63 vs 2.92±0.59, P<0.01) and VAS₃ (2.50±1.58 vs 2.79±1.53, P=0.02), as well as the frequency of using additional analgesics (25.47% vs 38.25%, P=0.03) and replacement of the upper chest tube (0 vs 4.37%, P=0.03).@*CONCLUSIONS@#It's feasible and safe to use two 10 F pigtail tubes for drainage after pulmonary U-VATS, which can achieve less postoperative pain and lower frequency of replacement of the upper chest tube on some specific patients.
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Lung adenocarcinoma (LUAD) is the most common subtype of lung cancer and one of the main causes of cancer-related deaths. In the past decade, with the widespread use of computed tomography (CT) in routine screening for lung cancer, the incidence of LUAD presenting as small pulmonary nodules radiologically, has increased remarkably. The mechanisms of the occurrence and progression of LUADs are complex, and the prognoses of patients with LUAD vary significantly. Although significant progress has been made in targeted therapy and immunotherapy for LUADs in recent years, the drug resistance of tumor cells has not been effectively overcome, which limits the benefits of patients. With the accomplishment of the Human Genome Project, sequencing-based genomic and transcriptomics have come into the field of clinical and scientific researches. Single-cell sequencing, as a new type of sequencing method that has captured increasing attention recently, can perform specific analysis of cell populations at single-cell level, which can reveal the unique changes of each cell type. Single-cell sequencing can also provide accurate assessment on heterogeneous stromal cells and cancer cells, which is helpful to reveal the complexity of molecular compositions and differences between non- and malignant tissues. To sum up, it is an urgent need for clinicians and basic scientists to deeply understand the pathogenesis and development of LUAD, the heterogeneity of tumor microenvironment (TME) and the mechanism of drug resistance formation through single-cell sequencing, so as to discover new therapeutic targets. In this paper, we reviewed and summarized the application and progress in single-cell sequencing of LUADs. .
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The morbidity of lung cancer ranks top in the world. At present, lung adenocarcinoma (LUAD) is the most common histologic type of lung cancer. However, the prognoses of LUAD patients with the same subtype remain heterogeneous. Histological heterogeneity is one of the main causes of diverse prognoses of patients with LUAD. Studies have shown that there are other histologic patterns that affect the clinical outcomes of LUAD patients, in addition to the five growth patterns of invasive LUAD classified by the World Health Organization (WHO) in 2015. The cribriform component (CC) is one of the research hotspots among histopathology of LUAD. Previous studies have shown that the presence of CC can further stratify the prognoses of patients with LUAD. Along with the progressively deep insights into the aforementioned topic, researchers are dedicating to unveiling the relationships among CC and and other clinicopathological factors as well as their joint influence on the survival of LUAD patients. The review manages to generalize the latest research progress in the CC in LUAD patients.
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The clinical assessment of the risk of rupture and dissection of thoracic aortic aneurysm(TAA) is mainly dependent on the measurement of the maximum diameter and growth rate of the aneurysm itself. The use of aortic size alone may ignore the role of vascular heterogeneity in assessing the risk of catastrophic complications. Biomechanics could help predict the risk of TAA in a more sophisticated way. In this paper, we reviewed the latest advances in biomechanical assessment of risk characteristics of TAA.
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In recent years, convolutional neural network(CNN) has exhibited its promising prospect and research value in assisting the analysis of lung cancer. The CNN can automatically learn from the images to extract specific clinically relevant features. This review summarized the construction of CNN by inputting CT images for end-to-end analysis to predict lung cancer risk and the efficacy of clinical treatment, as well as the application of CNN for analyzing pathological slides of resected pulmonary nodules via inputting histopathologic images.
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The frozen section (FS) technology has been widely used in the process of surgical pathology since its time-saving nature exhibited superiority over traditional paraffin method. Therefore FS, of great value in providing preliminary pathological diagnosis, offers guidance in the extension of surgical resection. However, it remains controversial whether the early-stage lung adenocarcinoma could be accurately identified in FS. This review aims to generalize the studies concerning the accuracy of FS in identifying early-stage lung adenocarcinoma, analyzing the interference factors, comparing the similarities and differences between frozen sections and traditional paraffin sections. It also gives insight into whether FS can provide significant guidance for surgeons to perform resection on early-stage lung adenocarcinoma.
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Lung cancer leads to the highest cancer-related morbidity and mortality worldwide. With the development of multi-slice spiral computed tomography technology and the implement of lung cancer screening, more and more lung nodules have been discovered, many of which are multiple pulmonary nodules. These pulmonary nodules are usually diagnosed as multiple primary lung adenocarcinomas from a pathological perspective. For multiple nodules with different imaging features, the preferred treatment methods are different, and the treatment of each lung nodule is still controversial. In recent years, the interactions between multiple lesions and the evolution of the lesions as well as the inter-tumoral and intratumoral homogeneity and heterogeneity of the genomics also arouse attention. Our review gathered the research progress in multiple pulmonary nodules from the points of histopathology, genomics and surgical management. .
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Humans , Diagnostic Imaging , Genotype , Multiple Pulmonary Nodules , Diagnostic Imaging , Genetics , TherapeuticsABSTRACT
As a pattern of lymph node metastasis , extracapsular lymph node involvement has occurred in many malignant tumors,including the esophageal carcinoma.This paper reviewed the research on extracapsular lymph node involvement in e-sophageal carcinoma worldwide including the development mechanism , clinical diagnosis, incidence and the prognosis signifi-cance, etc.The research progress and clinical significance of extracapsular lymph node involvement in esophageal carcinoma were fully explored and summarized.
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The incidence and mortality of lung cancer rank top in China. One important factor is the occurrence of metastasis. With the development of science technology, the effect of surgical treatment on lung cancer is improved. Moreover, the use of targeted therapy has achieved a new height for the treatment of lung cancer. However, the recurrence rate remains high even the tumor was completely resected at early stage. The occurrence of lymph node micrometastasis is considered as one of the plausible explanations. The difficulty indetecting micrometastasis has been greatly reduced. Although studies dig deeper into the lymph node micrometastasis, there are still some controversies including the selection of surgical procedures, the pathological staging and prognosis about patients with lymph node micrometastasis. This review manages to generalize the latest research progress of lymph node micrometastasis. .
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Humans , Biomarkers, Tumor , Metabolism , Carcinoma, Non-Small-Cell Lung , Metabolism , Pathology , Lung Neoplasms , Metabolism , Pathology , Neoplasm Micrometastasis , Risk FactorsABSTRACT
BACKGROUND@#It has been confirmed that high-frequency chest wall oscillatory (HFCWO) is a new type of auxiliary sputum discharge device. However, up to now, the specific therapeutic effect of HFCWO is still uncertain. This study aimed to compare the changes of the sputum volume before and after the treatment of HFCWO, and to investigate the effect of HFCWO on lung function and arterial blood gas analysis after single port video-assisted thoracoscopic surgery lobectomy (S-VATS).@*METHODS@#A total of 90 patients with S-VATS lobectomy were collected in the Second Affiliated Hospital of Soochow University from January 2017 to December 2017, which were randomly divided into the experimental group with HFCWO (n=45) and the control group (n=45) with routine clapping, respectively. The sputum volume of the two groups was measured 5 days before operation. Lung function and arterial blood gas analysis was measured before and 7th days after surgery.@*RESULTS@#The sputum volume was higher in the experimental group than that of the control group after surgery, there was statistically significant difference for the first three days (P0.05); Compared with those before surgery, FEV₁, FVC and PaO₂ decreased in both groups after surgery (P0.05).@*CONCLUSIONS@#HFCWO can significantly increase the amount of sputum excretion, improve lung function and alleviate hypoxia status after S-VATS lobectomy. This study provides a promising approach for HFCWO toward hypoxia status after S-VATS lobectomy. .
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Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Case-Control Studies , Forced Expiratory Volume , High-Frequency Ventilation , Lung , General Surgery , Lung Neoplasms , General Surgery , Pneumonectomy , Respiratory Function Tests , Thoracic Surgery, Video-Assisted , Thoracic Wall , General SurgeryABSTRACT
BACKGROUND@#A retrospective review of the surgical treatment of refractory chest tumors involving the heart or large vessels with cardiopulmonary bypass (CPB).@*METHODS@#To summarize 11 cases of chest tumor patients who had undergone cardiopulmonary bypass surgery from January 2008 to May 2017 in our hospital, and analyze the general condition, clinical characteristics, treatment methods, postoperative hospitalization time, complications and follow-up results of all patients.@*RESULTS@#All 11 patients were operated with cardiopulmonary bypass. Total resection of tumors in 8 cases and most of the excision in 3 cases. 1 case of left atrial metastatic leiomyosarcoma were excised in the left atrium, and then the right lung resection was performed. 1 case of left lung central lung cancer resection through the median sternum incision. 2 cases underwent pulmonary artery repair at the same time, 3 cases underwent partial pericardiectomy and 3 cases underwent pulmonary wedge resection at the same time. All the patients were effectively relieved after the operation. No death rate in hospital and 30 days after operation. 3 cases of postoperative pulmonary infection were recovered after the treatment of antibiotics. 1 case of lymphoma relapsed 6 months after surgery and died one year later. 1 case of pericardial fibrosarcoma had local recurrence and extensive metastasis at 13 months after operation, and died after 15 months. 1 case of pulmonary leiomyosarcoma were found to have local recurrence 15 months after the operation and were relieved after chemotherapy. The remaining 8 patients survived, and no obvious recurrence and distant metastasis were found in the computed tomography (CT) examination.@*CONCLUSIONS@#The CPB assisted surgical treatment can be performed for patient of refractory chest tumors involving the heart or large vessels. It can improve the surgical resection rate of refractory chest tumors, effectively alleviate the effects on respiratory and circulatory functions, and significantly prolong the survival period of these patients.
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Adult , Female , Humans , Male , Middle Aged , Cardiopulmonary Bypass , Lung Neoplasms , Diagnostic Imaging , Mortality , General Surgery , Postoperative Complications , Pulmonary Artery , Diagnostic Imaging , General Surgery , Retrospective StudiesABSTRACT
Objective To analyze prognostic factors of surgical treatment for elderly patients with non-small cell lung cancer,in order to provide a theoretic basis for improving the prognosis of patients with non-small cell lung cancer.Methods Clinical data of 145 elderly patients with non-small cell lung cancer who had received surgical treatment at our hospital from January 2012 to September 2012 were retrospectively analyzed.The survival rates of patients were investigated.Results The median survival time was 31.5 months,and 1-year,2-year and 3-year survival rates were 61.4％,45.5％ and 40％,respectively.Single factor analysis showed that lesion size,number of metastatic lymph nodes,clinical stage,pathological type and radiotherapy were among the factors affecting prognosis.Multiple COX regression analysis showed that a lesion size ＞3cm,number of lymph nodes with metastasis ＞ 2 and pathological type were independent risk factors for patient prognosis,and radiotherapy was a protective factor for prognosis.Conclusions Surgical treatment has good curative effects on non-small cell lung cancer in elderly patients.Lesion size,number of lymph nodes with metastasis,pathological type and radiotherapy are important factors affecting prognosis,and can be used for prognosis assessment.
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Hypertension in children and adolescents is defined as systolic blood pressure(SBP)and/ or dias-tolic blood pressure(DBP)≥95th percentile for age,gender and height,on at least 3 occasions. Primary hypertension is more common among children of older age or adolescents,while secondary hypertension accounts for more cases for younger children. Among causes of secondary hypertension,renovascular diseases,renal parenchymal diseases,cardio-vascular diseases,and endocrine diseases are common. An initial evaluation can be reached after history taking and physical examination,to decide whether it should be primary or secondary hypertension. Laboratory tests and procedures can further confirm the classification and etiology. There is an increase in prevalence of hypertension in children and adolescents,and an in - time diagnosis and evaluation of hypertension is important to help patients receive a better management of their conditions.
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Objective To compare the incidence of cardiopulmonary complications between treatment of video assisted thoracoscopic operation and traditional thoracotomy operation in elderly patients with non-small cell lung cancer.Methods 122 cases of elderly patients with non small cell lung cancer were treated in our hospital from Mar 2010 to Jun 2014,and randomly divided into observation group (therapeutic lobectomy by video assisted thoracoscopic operation) and control group (therapeutic lobectomy by traditional thoracotomy operation) (n=61,each).The postoperative cardiopulmonary complications and relevant indexes of cardiopulmonary function were analyzed and compared between the two groups.Results Before operation,there was no significant difference in the relevant indexes of cardiopulmonary function between the two groups (P＞0.05).After operation,the forced expiratory volume in one second (FEV1) and maximal ventilatory volume (MMV) were higher and the heart rate was lower in observation group than in control group (t=3.682,2.243,5.677,all P＜0.05).The incidence of cardiopulmonary complication was lower in observation group than in control group (13.1％ vs.27.9％,x2 =4.075,P=0.044).Conclusions Video assisted thoracoscopic operation is better for the recovery of cardiopulmonary function,and can reduce cardiopulmonary complication in elderly patients with non-small cell lung cancer.
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Objective To summarize the results of a new pancreaticojejunostomy technique designed to decrease incidence of pancreatic leakage in pancreatoduodenectomy.Methods The clinical data of 11 cases of pancreatoduodenectomy using remnant pancreatico-jejunum end-to-end anastomosis with external drainage of full pancreatic juice was analyzed retrospectively.Briefly,5-0 bioabsorbable suture was penetrated through the pancreatic stump and stent and then circulated the pancreatic stump for 2 circles and ligated.Octreotide was not administered in any cases post-operation.Results The operation was simple and timespared.Neither pancreatic leakage nor postoperative bleeding occurred in the cases.From 4 months to 3 years following operation,no other complications were found in all cases.Conclusions The method was safe,feasible and effective to decrease incidence of pancreatic leakage in pancreatoduodenectomy.
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Objective To investigate the effect of human lung cancer-associated fibroblasts (CAF) on the radiosensitivity of lung cancer cells when CAF is placed in direct contact co-culture with lung cancer cells.Methods Human lung CAF was obtained from fresh human lung adenocarcinoma tissue specimens by primary culture and subculture and was then identified by immunofluorescence staining.The CAF was placed in direct contact co-culture with lung cancer A549 and H1299 cells,and the effects of CAF on the radiosensitivity of A549 and H1299 cells were evaluated by colony-forming assay.Results The human lung CAF obtained by adherent culture could stably grow and proliferate,and it had specific expression of α-smooth muscle actin,vimentin,and fibroblast activation protein,but without expression of cytokeratin-18.The plating efficiency (PE,％) of A549 cells at 0 Gy irradiation was (20.0 ± 3.9) ％ when cultured alone versus (32.3 ± 5.5) ％ when co-cultured with CAF (t =3.16,P ＜ 0.05),and the PE of H1299 cells at 0 Gy irradiation was (20.6 ± 3.1) ％ when cultured alone versus (35.2 ± 2.3) ％ when co-cultured with CAF (t =6.55,P ＜0.05).The cell survival rate at 2 Gy irradiation (SF2) of A549 cells was 0.727 ±0.061 when cultured alone versus 0.782 ± 0.089 when co-cultured with CAF (t =0.88,P ＞ 0.05),and the SF2 of H1299 cells was 0.692 ±0.065 when cultured alone versus 0.782 ± 0.037 when co-cultured with CAF (t =2.08,P ＞0.05).The protection enhancement ratios of human lung CAF for A549 cells and H1299 cells were 1.29 and 1.25,respectively.Conclusions Human lung CAF reduces the radiosensitivity of lung cancer cells when placed in direct contact co-culture with them,and the radioprotective effect may be attributed to CAF promoting the proliferation of lung cancer cells.
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ObjectiveTo discuss the treatment of complications post-pancreticoduedenectomy by reviewing the experiences from 62 cases.MethodsSixty-two cases of pancreticoduedenectomy from March 2001 to April 2011,mean age 59.3 ±4.1 years,were reviewed.All cases were divided into early group 24 cases and recent group (38 cases) by the difference in following aspects:perioperative management,the way of pancreatic bowel anastomosis and material choice,the vessels management,materials using in preventing leakage and bleeding.The differences in leakage,bleeding,infection,the stomach retention,biliary infections,liver abscess and incision infection in two groups were compared.ResultsThe early group showed pancreatic leakage in 10 cases,bleeding in 4 cases,celiac infection in 10 cases,gastric retention in 9 cases,biliary infections in 11 cases,liver abscess in 6 and infection of incision in 7 cases,respectively.Recent groups were in 4,0,0,0,1,2 and 3 cases,respectively.The comparisons showed the complications had reduced significantly in recent group than in the early group (x2 =77.08,P ＜ 0.001 ).ConclusionsMinimally invasive and high quality materials use,strengthening the perioperative management are the effective measures to reduce the postoperative complications.
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Objective The efficacy and safety of off-pump coronary artery bypass grafting (OPCAB) as comparing with conventional coronary artery bypass grafting(CCABG) remain inconclusive in randomized, controlled trials and retrospective studies. We tried to assess the incidence of myocardial infarction (MI) after OPCAB and CCABG. with a meta analysis based on published data in randomized ,controlled trials. Methods Relevant randomized controlled trials, published in English and Chinese before January 2009, were searched in Medline, the Science Citation Index Expanded, the Cochrane Central Register of Controlled Trials (CENTRAL) and CBMdisc. Manual searching of bibliographies were performed, with key words "oronary artery bypass graft", "off-pump" and "myocardial infarction". Two reviewers selected eligible trials independently, performed quality assessment and collected relevant data. Meta-analysis was performed with software RevMan 5. Results 22 trials were considered to be eligible for the meta analysis. The incidence of MI was 2.81% (42/1494) in the OPCAB group as compared with 3.57% (54/1512) in the CCABG group. No significant difference was present between the two groups (OR =0.80,95% CI =0.54 - 1.20, P =0.28). Conclusion Our meta analysis of current available randomized controlled trials involving OPCAB and CCABG in patients with coronary artery diseases suggests that the difference in the incidence of postoperative MI between CCABG and OPCAB groups is not significant.