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Objective:Immune checkpoint inhibitors have a high remission rate in the preoperative application of resectable and potentially resectable non-small cell lung cancer when combined with chemotherapy. For the unresectable stage Ⅲ non-small cell lung cancer, whether the transformation can be achieved through this regimen to provide opportunities for surgical resection is controversial. In this study, we evaluated the pattern of transformation therapy by reviewing the efficacy and safety of preoperative therapy and surgery of this group.Methods:A review of 23 patients undergoing surgical resection after transformation therapy by preoperative immunotherapy combined chemotherapy between November 2019 and November 2021 was performed. All patients must clarify the pathological diagnosis of non-small cell lung cancer by biopsy. After the multi-disciplinary treatment team and preoperative imaging assessment, the diagnosis should be consistent with unresectable stage III as described in the Expert Consensus on Multidisciplinary Management of Stage Ⅲ Non-Small Cell Lung Cancer, 2019 Edition. After 2 to 4 cycles of preoperative anti-PD-1 monoclonal antibody combined with chemotherapy, the surgical team assessed the chance of resection and performed surgery. Important indicators such as surgical resection rate, R0 resection rate, MPR, pCR, incidence of grade 3-5 adverse reactions and various other perioperative data were counted.Results:In the whole group, initial imaging evaluation was 10 of stage cⅢA and 13 of stage cⅢB.15 cases had multiple stations N2 lymph nodes metastasis, 9 had enlarged fused N2 lymph nodes metastasis, 6 had large vessel invasion(T4), and 1 had contralateral mediastinal lymph node metastasis(N3). After preoperative neoadjuvant therapy, 17 cases achieved PR, 3 achieved SD and 3 achieved PD. The surgical resection rate of the whole group was 91.3%(21/23, 1 lobectomy combined with superior vena cava reconstruction, 2 sleeve lobectomy, 5 pneumonectomy, 12 lobectomy/combined lobectomy, 1 wedge resection and 2 unresectable cases), R0 resection rate was 95.2%(20/21). MPR was achieved in 13 cases, 8 of them reached pCR. There were no perioperative deaths, median surgical time was 260(190-460) min, median bleeding volume was 100(50-750) ml, median drainage time was 5(3-9) days, and median hospitalization was 7(5-11) days. Two cases got immunotherapy-related grade 3 adverse reactions, one was interstitial pneumonia and the other was immune-related injury involving the eye, oral and genital mucosa. Two cases got surgical complications and one was persistent lung leakage, which stopped after 46 days of conservative treatment; The other was pleural effusion, which was relieved after drainage.Conclusion:For the unresectable stage Ⅲ NSCLC, immunotherapy combined chemotherapy is an effective preoperative downstage method. It can convert 91.3% cases to resectable ones while achieving a good degree of pathological remission. Its side reactions are generally controllable and safety.
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The morbidity and mortality of lung cancer are always at the forefront of malignant tumors. To improve the therapeutic effects and overall survival of lung cancer patients is one of the key areas both in clinical medicine and basic research. With the development of precision medicine, targeted treatment based on the characteristics of DNA mutation and immunotherapy targeting PD-1/PD-L1, CTLA-4 and other pathways have promoted the progress of the overall diagnosis and treatment level of lung cancer, which has been widely used in clinical practice. While making the continuous achievements in the above fields, the researchers committed to lung cancer research are gradually shifting their attention to the exploration of RNA level. Some results have been accumulated in the effects of RNA epigenetic modifications on the biological behavior of lung cancer. N6-methyladenosine(m6A) is the most abundant form of mRNA methylation. The dysfunction of m6A modification mediated by related regulatory proteins has been reported to play an important role in the development and progression of lung cancer. This paper focuses on the detection methods of m6A modification, related regulatory proteins and their mode of action, and reviews the effects on the onset, diagnosis, treatment and prognosis of lung cancer. The aim is not only to summarize the researchers' latest understanding of the epigenetic regulatory mechanism, but also to provide new perspectives for the early diagnosis, effective drug use and prognosis judgment of lung cancer.
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Polyhydroxyalkanoates (PHA) synthesis by activated sludge using volatile fatty acids (VFAs) in fermentation liquid of excess sludge as carbon source is a hotspot in the field of environmental biotechnology. However, there is no unified conclusion on the effects of non-VFAs, mainly dissolved organic matter (DOM), on PHA production. Thus, this critical review mainly introduces the main characteristics and common analysis methods of DOM in anaerobic fermentation liquid. The effects of DOM on PHA production are analyzed from the aspects of microbiology, metabolic regulation and sludge properties. The results of different studies showed that high concentration of DOM is bad for PHA production, but an appropriate amount of DOM is conducive to the stability of sludge properties, reducing the final PHA purification cost. Finally, suitable strategies were proposed to regulate the PHA synthesis by activated sludge with DOM for PHA production by anaerobic fermentation liquid.
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Anaerobiose , Reatores Biológicos , Ácidos Graxos Voláteis , Fermentação , Poli-Hidroxialcanoatos , EsgotosRESUMO
Objective@#To introduce our experience of 4L lymph node dissection in left lung cancer and to analyze the pattern of 4L LN metastasis. To investigate the prognostic impact of 4L lymph node dissection.@*Methods@#171 patients with left lung cancer who underwent pulmonary resection andsystematic mediastinal lymph node dissection from March 2016 to March 2019 were collected retrospectively. There were 106 males and 65 females endolled, aged(64.1±7.7) years. 54.4% had a history of smoking. The diameter of the tumors was(3.3±1.9) cm; Central-type tumor were 59 cases(34.5%), peripheral 112 cases(65.5%), upper lobe 95 cases(55.6%) and lower lobe 76 cases(44.4%). The clinical and perioperative data as well as the pattern of lymph node metastasis were analyzed. t test or Mann-Whiteney U test was used for continuous variables, and χ2 test or Fisher test was used for categorical variables. Multivariate analysis was performed using a logistic regression model to evaluate the risk factors.@*Results@#The metastasis rate of station 4L was 21.6%. Tumor size, locations(central type/upper lobe), operative type, micropapillary/entity components and vascular invasion were risk factors for 4L LN metastasis in univariate analysis. Tumor size(OR=1.611, P=0.032) and location of upper lobe(OR=2.823, P=0.008) were independent risk factors in multivariate logistic analysis. Through the analysis of ROC curve, the optimal cutoff point of tumor size was 2.5cm. The metastatic rate of 4L was 32.6% when tumor size larger than 2.5 cm and 7.9% when tumor size smaller than 2.5cm.Tumor located in upper lobe tended to metastasize to upper mediastinal lymph nodes, including station 4L, 5 and 6, while the one located in lower lobe tended to metastasize to station 7.@*Conclusion@#Station 4L LN involvement is commen in left lung cancer. The dissection of the 4L LN is important, especially for the tumor larger than 2.5 cm or located at upper lobe.
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Objective To introduce our experience of 4L lymph node dissection in left lung cancer and to analyze the pattern of 4L LN metastasis. To investigate the prognostic impact of 4L lymph node dissection. Methods 171 patients with left lung cancer who underwent pulmonary resection andsystematic mediastinal lymph node dissection from March 2016 to March 2019 were collected retrospectively. There were 106 males and 65 females endolled, aged(64. 1 ± 7. 7) years. 54. 4％ had a historyofsmoking. Thediameterofthetumorswas(3.3±1.9)cm;Central-typetumorwere59cases(34.5％),peripheral 112 cases(65. 5％), upper lobe 95 cases(55. 6％) and lower lobe 76 cases(44. 4％). The clinical and perioperative data as well as the pattern of lymph node metastasis were analyzed. t test or Mann-Whiteney U test was used for continuous variables, and χ2 test or Fisher test was used for categorical variables. Multivariate analysis was performed using a logistic regression model to evaluate the risk factors. Results The metastasis rate of station 4L was 21. 6％. Tumor size, locations(central type/upper lobe),operative type, micropapillary/entity components and vascular invasion were risk factors for 4L LN metastasis in univari-ate analysis. Tumor size(OR=1. 611,P=0. 032) and location of upper lobe(OR=2. 823,P=0. 008) were independent risk factors in multivariate logistic analysis. Through the analysis of ROC curve, the optimal cutoff point of tumor size was 2. 5cm. The metastatic rate of 4L was 32. 6％ when tumor size larger than 2. 5 cm and 7. 9％ when tumor size smaller than 2. 5cm. Tumor located in upper lobe tended to metastasize to upper mediastinal lymph nodes, including station 4L, 5 and 6, while the one located in lower lobe tended to metastasize to station 7. Conclusion Station 4L LN involvement is commen in left lung cancer. The dissection of the 4L LN is important, especially for the tumor larger than 2. 5 cm or located at upper lobe.
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Objective To evaluate the effect of recurrent laryngeal nerve detector on the operation of upper or middle-thoracic esophageal carcinoma. Methods A total of 60 patients with resectable esophageal carcinoma in Beijing Tsinghua Changgung Hospital from January 2015 to December 2017 were recruited. These patients were randomly divided into experimental group and control group by using random number table method.The experimental group used recurrent laryngeal nerve detector to assist in the nerve exploration and separation. The control group was treated by routine operation method, and the operation effect of the two groups was compared. Results In the experimental group, the time spent on the confirmation of recurrent laryngeal nerve was significantly shorter than that in the control group [right side: 1.50 min (1.00, 1.63 min) vs. 5.50 min(4.88, 6.50 min), Z= -6.715, P < 0.05; left side: 1.75 min (1.50, 2.00 min) vs. 7.85 min (6.50, 9.00 min), Z= -6.726, P< 0.05]. The rate of recurrent laryngeal nerve injury in the experimental group was significantly lower than that in the control group [3.3 % (1/30) vs. 20.0 % (6/30), χ 2= 4.043, P < 0.05]. Conclusion The use of recurrent laryngeal nerve detector in the neck anastomosis of upper or middle-thoracic esophageal carcinoma can significantly shorten the time spent on confirming of the recurrent laryngeal nerve and reduce the rate of recurrent laryngeal nerve injury.
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Objective Lung cancer has been the most common cause of cancer death worldwide.More than three quarters is diagnosed at advanced stage.Nearly one half has distant metastases outside the chest cavity.It has been recognized that oligometastatic state exists in natural history of malignant tumors,which has significantly better prognosis than those with polymetastases.The eighth edition of TNM staging system defined NSCLC with a single metastasis as a new separated stage(M1 b).Long-term survival of oligometastatic NSCLC patients treated with local control methods has been reported in literatures.But whether surgical resection of liver metastasis has benefit or not remains unknown.We performed a systematic review of surgical therapy for NSCLC with limited liver metastases.