Development of a CT-Based comprehensive model combining clinical, radiomics with deep learning for differentiating pulmonary metastases from noncalcified pulmonary hamartomas, a retrospective cohort study.

BACKGROUND: Clinical differentiation between pulmonary metastases and noncalcified pulmonary hamartomas (NCPH) often presents challenges, leading to potential misdiagnosis. However, the efficacy of a comprehensive model that integrates clinical features, radiomics, and deep learning (CRDL) for differential diagnosis of these two diseases remains uncertain. OBJECTIVE: This study evaluated the diagnostic efficacy of a Clinical Features, Radiomics, and Deep Learning (CRDL) model in differentiating pulmonary metastases from noncalcified pulmonary hamartomas (NCPH). METHODS: We retrospectively analyzed the clinical and imaging data of 256 patients from Hospital A and 85 patients from Hospital B, who were pathologically confirmed pulmonary hamartomas or pulmonary metastases after thoracic surgery. Employing Python 3.7 software suites, we extracted radiomic features and deep learning attributes from patient datasets. The cohort was divided into training set, internal validation set, and external validation set. The diagnostic performance of the constructed models was evaluated using receiver operating characteristic (ROC) curve analysis to determine their effectiveness in differentiating between pulmonary metastases and NCPH. RESULTS: Clinical features such as white blood cell count (WBC), platelet count (PLT), history of cancer, carcinoembryonic antigen (CEA) level, tumor marker status, lesion margin characteristics (smooth or blurred) and maximum diameter were found to have diagnostic value in differentiating between the two diseases. In the domains of radiomics and deep learning. Of the 1,130 radiomics features and 512 deep learning features, 24 and 7, respectively, were selected for model development. The area under the ROC curve (AUC) values for the four groups were 0.980, 0.979, 0.999, and 0.985 in the training set, 0.947, 0.816, 0.934, and 0.952 in the internal validation set, and 0.890, 0.904, 0.923, and 0.938 in the external validation set. This demonstrated that the CRDL model showed the greatest efficacy. CONCLUSIONS: The comprehensive model incorporating clinical features, radiomics, and deep learning shows promise for aiding in the differentiation between pulmonary metastases and hamartomas.

Clinical efficacy and safety of adjuvant EGFR-TKIs for resected stage IB lung adenocarcinoma: A real-world study based on propensity score matching.

BACKGROUND: Adjuvant therapy for stage IB non-small cell lung cancer remains debatable. In this real-world study, we evaluate the efficacy and safety of adjuvant epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) for resected stage IB lung adenocarcinoma. METHODS: This real-world study recruited 249 patients diagnosed with stage IB disease after surgical resection between January 2013 and September 2021. Sixty-six (26.5%) patients received adjuvant targeted therapy (TKIs group), and 183 (73.5%) were enrolled in the clinical observation (CO) group. Propensity scores were matched to minimize the observed confounder effects between the two groups, and 59 patient pairs were matched. The primary endpoint was disease-free survival (DFS). RESULTS: In the TKI group, 38 (64.4%) patients chose to receive icotinib, 27.1% (16/59) received gefitinib, and 5 patients (8.5%) chose osimertinib. The median follow-up time was 30.8 months (range: 7-107 months). Two (3.4%) patients in the TKI group and 10 (16.9%) in the CO group experienced disease relapse. The 3-year DFS rates were 98.3% in the TKI group and 83.0% in the CO group (HR: 0.10; 95% CI: 0.01-0.78; p = 0.008). DFS differences were found in the entire cohort (p = 0.005) and the matched cohort (p = 0.024) between the two groups. Multivariate analysis showed that adjuvant EGFR-TKIs was an independent factor for DFS (HR: 0.211; 95% CI: 0.045-0.979; p = 0.047), along with poor cell differentiation (HR: 5.256; 95% CI: 1.648-16.769; p = 0.005), and spread through air spaces (HR: 5.612; 95% CI: 1.137-27.700; p = 0.034). None of the patients discontinued EGFR-TKIs owing to the low occurrence rate of treatment-related serious adverse events. CONCLUSION: Adjuvant EGFR-TKIs could significantly improve DFS among patients with stage IB lung adenocarcinoma compared with CO, with a safe and tolerable profile.

Clinicopathological and survival outcomes of 4L lymph node dissection in left lung adenocarcinoma and squamous cell carcinoma.

Background: Whether 4L lymph node dissection (LND) should be performed remains unclear and controversial. Prior studies have found that station 4L metastasis was not rare and that 4L LND may provide survival benefits. The objective of this study was to analyze the clinicopathological and survival outcomes of 4L LND from the perspective of histology. Methods: This retrospective study included 74 patients with squamous cell carcinoma (SCC) and 84 patients diagnosed with lung adenocarcinoma (ADC) between January 2008 and October 2020. All patients underwent pulmonary resection with station 4L LND and were staged as T1-4N0-2M0. Clinicopathological features and survival outcomes were investigated based on histology. The study endpoints were disease-free survival (DFS) and overall survival (OS). Results: The incidence rate of station 4L metastasis was 17.1% (27/158) in the entire cohort, with 8.1% in the SCC group, and 25.0% in the ADC group. No statistical differences in the 5-year DFS rates (67.1% vs. 61.7%, P=0.812) and 5-year OS rates (68.6% vs. 59.3%, P=0.100) were observed between the ADC group and the SCC group. Multivariate logistic analysis revealed that histology (SCC vs. ADC: OR, 0.185; 95% CI, 0.049-0.706; P=0.013) was independently associated with 4L metastasis. Multivariate survival analysis showed that the status of 4L metastasis was an independent factor for DFS (HR, 2.563; 95% CI, 1.282-5.123; P=0.008) but not for OS (HR, 1.597; 95% CI, 0.749-3.402; P=0.225). Conclusion: Station 4L metastasis is not rare in left lung cancer. Patients with ADC have a greater predilection for station 4L metastasis and may benefit more from performing 4L LND.

Revisiting the relationship between complement and ulcerative colitis.

Ulcerative colitis (UC) is an inflammatory bowel disorder (IBD) characterized by relapsing chronic inflammation of the colon that causes continuous mucosal inflammation. The global incidence of UC is steadily increasing. Immune mechanisms are involved in the pathogenesis of UC, of which complement is shown to play a critical role by inducing local chronic inflammatory responses that promote tissue damage. However, the function of various complement components in the development of UC is complex and even paradoxical. Some components (e.g. C1q, CD46, CD55, CD59, and C6) are shown to safeguard the intestinal barrier and reduce intestinal inflammation, while others (e.g. C3, C5, C5a) can exacerbate intestinal damage and accelerate the development of UC. The complement system was originally thought to function primarily in an extracellular mode; however, recent evidence indicates that it can also act intracellularly as the complosome. The current study provides an overview of current studies on complement and its role in the development of UC. While there are few studies that describe how intracellular complement contributes to UC, we discuss potential future directions based on related publications. We also highlight novel methods that target complement for IBD treatment.

Long-term results of postoperative unsuspected small cell lung cancer on real-world data.

BACKGROUND: In traditional opinion, solid pulmonary nodule suspected lung cancer should be confirmed by pathology before the operation to exclude small cell lung cancer (SCLC), considering SCLC tends to be aggressive and surgical effect in the management of SCLC remains controversial. The aim of this study was to evaluate the survival result and risk factors of postoperative unsuspected SCLC. METHODS: A total of 120 patients with postoperative unsuspected SCLC who were confirmed by pathology and referred to Chinese PLA General Hospital between 2000 and 2021 were retrospectively analyzed (surgery group). Additionally, 120 patients with limited-stage SCLC who underwent chemotherapy and radiotherapy in the same period were enrolled in the chemoradiotherapy group.. Kaplan-Meier method was used to estimate survival; the Log-Rank test was used to compare survival rates between different groups; a COX stepwise regression model was used for multivariate analysis. RESULTS: Among 120 patients in the surgery group, 28 were with central type and other 92 with peripheral type. The median survival (OS) was 44.85 months, and the 5-year survival rate was 46%. The 5-year survival rates for stage I, II, and III were 52.1%, 45.4%, and 27.8%, respectively. The mean disease-free survival time (DFS) was 30.63 ± 4.38 months, and the 5-year DFS rate was 31.5%. In the chemoradiotherapy group, the mean OS was 21.4 ± 4.26 months, and the 5-year survival rate was 28.3%. The 5-year survival rates for clinical stage I, II, and III were 42.5%, 39.8%, and 20.5%, respectively. The mean progression-free survival (PFS) was 10.63 ± 3.6 months. In the surgery group, one-way ANOVA revealed that the gender, symptoms, smoking history, tumor location, and postoperative radiotherapy were not associated with OS (P ≥ 0.05), while age, surgical approach, surgical method, N stage, TNM stage, and vascular tumor thrombus were related to OS (P < 0.05). Multivariate analysis indicated that the N stage was associated with OS (HR = 1.86 P = 0.042). CONCLUSION: Surgery and adjuvant therapy were found to have encouraging outcomes in postoperative unsuspected SCLC. Patients with stage I, stage II and part of stage IIIA SCLC could benefit from surgery and the standard lobectomy, and systematic lymph node dissection, is also recommended for these patients.

3,4­Dihydroxyacetophenone attenuates oxidative stress­induced damage to HUVECs via regulation of the Nrf2/HO­1 pathway.

It has been reported that oxidative stress plays a prominent role in diabetic macrovascular diseases. 3,4­Dihydroxyacetophenone (3,4­DHAP) has been found to have a variety of biological activities. However, few studies have assessed the antioxidant capacity of 3,4­DHAP and the underlying mechanisms. Thus, the aim of the present study was to explore the effects of 3,4­DHAP on oxidative stress in human umbilical vein endothelial cells (HUVECs). HUVECs were pre­treated with 3,4­DHAP and then exposed to high glucose conditions. Cell viability and cytotoxicity were measured using an MTT assay. Reactive oxygen species (ROS) levels were measured using an inverted fluorescence microscope and a fluorescent enzyme labeling instrument. Protein expression levels of nuclear factor E2­related factor 2 (Nrf2), heme oxygenase­1 (HO­1), microtubule­associated protein 1A/1B­light chain 3 (LC3) and poly ADP­ribose polymerase­1 (PARP­1) were measured using western blotting, and mRNA expression of Nrf2 and HO­1 were measured through reverse transcription­quantitative PCR (RT­qPCR). Nrf2 nuclear translocation was evaluated using immunofluorescence analysis and autophagosomes were observed using transmission electron microscope (TEM). The results of the present study demonstrated that compared with the control group, cell viability of the high glucose group was reduced and cell cytotoxicity of the high glucose group was increased. ROS production in the high glucose group was clearly enhanced. In addition, high glucose upregulated Nrf2 and HO­1 protein and mRNA expression levels. Nuclear translocation of Nrf2 in the high glucose group was also increased. The formation of autophagosomes in the high glucose group was also higher than that in the control group. Furthermore, LC3­II/LC3­I and PARP­1 protein expression levels were increased after treatment with high glucose. However, compared to the high glucose group, 3,4­DHAP (10 µmol/l) significantly enhanced cell viability. 3,4­DHAP markedly decreased the production of ROS, increased Nrf2 and HO­1 protein and mRNA expression levels, and promoted nuclear translocation of Nrf2 in HUVECs. In addition, 3,4­DHAP promoted the formation of autophagosomes, and notably increased the protein expression levels of LC3­II/LC3­I and PARP­1. Moreover, it was determined that compared to the 3,4­DHAP group, treatment with 3,4­DHAP and ML385 enhanced cell viability, and decreased ROS production, Nrf2 and HO­1 protein and mRNA expression levels, nuclear translocation of Nrf2, and LC3­II/LC3­I and PARP­1 protein expression levels. Collectively, the results of the present study showed that 3,4­DHAP protected HUVECs against oxidative stress via regulation of the Nrf2/HO­1 pathway, by increasing autophagy and promoting DNA damage repair.

[Clinicopathological characteristics and risk factors of station 4L lymph node metastasis of left non-small cell lung cancer].

OBJECTIVE: To analyze the clinicopathological characteristics and risk factors of 4L lymph node metastasis in left non-small cell lung cancer. METHODS: We retrospectively analyzed the data of 134 patients undergoing surgical resection of left non-small cell lung cancer and 4L lymph node dissection, including 60 patients with squamous cell carcinoma (SCC) and 74 with lung adenocarcinoma (ADC). The clinicopathological characteristics of the patients were analyzed, and logistic regression analysis was used to identify the predictors of station 4L metastasis. RESULTS: Of these patients, 16.4% (22/134) presented with station 4L metastasis. The patients with SCC and ADC showed significant differences in age, gender, smoking history, neoadjuvant chemotherapy, tumor size, tumor location and type, visceral pleural invasion, Ki-67 index, 4L metastasis and pathological TNM stage (stage Ⅱ). The rate of station 4L metastasis was significantly lower in SCC group than in ADC group. Univariate analysis revealed that pathological types (SCC or ADC), visceral pleural invasion, lymphovascular invasion, tumor markerabnormality, and station 5 to 10 metastasis were all high-risk factors for station 4L metastasis. Multivariate analysis suggested that the pathological type (OR=0.120, P=0.025), station 5 metastasis (OR=18.784, P=0.007) and station 10 metastasis (OR=5.233, P=0.044) were independent risk factors for 4L metastasis in patients with left non-small cell lung cancer. CONCLUSIONS: In patients with left non-small cell lung cancer, station 4L metastasis is not rare and is more likely to occur in patients with lung adenocarcinoma. Dissection of the 4L lymph nodes should be performed in cases with low risk of damages of the adjacent tissues and high risk of station 4L metastasis.

Quantitative characterization of tumor cell-free DNA shortening.

BACKGROUND: Previous studies found that cell-free DNA (cfDNA) generated from tumors was shorter than that from healthy cells, and selecting short cfDNA could enrich for tumor cfDNA and improve its usage in early cancer diagnosis and treatment monitoring; however, the underlying mechanism of shortened tumor cfDNA was still unknown, which potentially limits its further clinical application. RESULTS: Using targeted sequencing of cfDNA in a large cohort of solid tumor patient, sequencing reads harboring tumor-specific somatic mutations were isolated to examine the exact size distribution of tumor cfDNA. For the majority of studied cases, 166 bp remained as the peak size of tumor cfDNA, with tumor cfDNA showing an increased proportion of short fragments (100-150 bp). Less than 1% of cfDNA samples were found to be peaked at 134/144 bp and independent of tumor cfDNA purity. Using whole-genome sequencing of cfDNA, we discovered a positive correlation between cfDNA shortening and the magnitude of chromatin inaccessibility, as measured by transcription, DNase I hypersensitivity, and histone modifications. Tumor cfDNA shortening occurred simultaneously at both 5' and 3' ends of the DNA wrapped around nucleosomes. CONCLUSIONS: Tumor cfDNA shortening exhibited two distinctive modes. Tumor cfDNA purity and chromatin inaccessibility were contributing factors but insufficient to trigger a global transition from 166 bp dominant to 134/144 bp dominant phenotype.

Less is more in solid-dominant lung cancer? Sublobar resection versus lobectomy for solid-dominant stage IA non-small-cell lung cancer: A meta-analysis study.

Although lobectomy is well established as the standard surgical procedure for stage IA non-small-cell lung cancer (NSCLC), sublobar resection is increasingly preferred, particularly in intentional segmentectomy for radiologically less-invasive small NSCLC. However, the indication for sublobar resection of radiologically pure solid or solid-dominant NSCLC remains controversial, owing to its invasive pathological characteristics. Therefore, the present meta-analysis was conducted to compare the efficacy of sublobar resection with lobectomy for treating solid-dominant stage IA NSCLC. An electronic search was conducted using four online databases from their dates of inception to April 2017. The hazard ratio (HR) was used as a summary statistic for censored outcomes and the odds ratio (OR) was used as the summary statistic for dichotomous variables. A total of nine studies met the selection criteria, including a total of 2,265 patients (1,728 patients underwent lobectomy, 425 segmentectomy and 112 wedge resection). From the available data, patients treated with a sublobar resection had a higher risk of local recurrence compared with patients treated with lobectomy [OR=1.89; 95% confidence interval (CI), 1.02-3.50; P=0.04]. However, no obvious difference in local recurrence was found in a subgroup analysis of segmentectomy compared with lobectomy (OR=1.19; 95% CI, 0.68-2.10; P=0.61). Sublobar resection was not associated with a significantly negative impact on distant recurrence (OR=1.09; 95% CI, 0.55-2.16; P=0.796). Patients in the sublobar resection group had no significant differences in recurrence-free survival (RFS; HR=1.43; 95% CI, 0.76-2.69; P=0.27) and overall survival (OS; HR=0.96; 95% CI, 0.75-1.23; P=0.77) compared with those in the lobectomy group. In the subgroup analysis of anatomic segmentectomy compared with lobectomy, there was no significant difference in RFS, with mild inter-study heterogeneity. The current meta-analysis suggested that segmentectomy had a comparable oncologic efficacy to lobectomy for solid-dominant stage IA NSCLC. Therefore, segmentectomy may be a feasible alternative in selected cases of solid-dominant stage IA NSCLC. However, these findings should be confirmed by prospective randomized controlled trials in the future.

Cystic and solitary nodular pulmonary metastases in a patient with low-grade endometrial stromal sarcoma: A case report and literature review.

Pulmonary metastases of endometrial stromal sarcoma (ESS) are uncommon and can be difficult to diagnose. The aims of the present study were to investigate the clinical and pathological features, and enhance the awareness of pulmonary metastases in patients with low-grade ESS. The study reports a case of low-grade ESS that resulted in cystic and nodular pulmonary metastases. Furthermore, the PubMed database was searched using 'pulmonary metastases of low-grade endometrial stromal sarcoma' as the key phrase. The literature on pulmonary metastases of low-grade ESS was reviewed and 35 cases were included in the present study. The clinical manifestations, imaging data, pathological features, treatment and prognosis of the 35 previously reported cases and the current case were retrospectively analyzed. The age range of the 36 patients diagnosed with low-grade ESS was 28-65 years. The time period from confirmation of ESS to lung metastases was 1.5-27 years. In 50% of the patients, the pulmonary metastases were asymptomatic. The most common pulmonary symptom was dyspnea, followed by chest pain, pneumothorax and coughing. The most common chest imaging presentation was multiple pulmonary nodules, followed by a solitary nodule or mass. Histology was used to identify that the pulmonary metastases had the pathological features of low-grade ESS. The immunohistochemical results demonstrated strong diffuse immunoreactivity for cluster of differentiation 10, estrogen receptor and progesterone receptor in almost all the specimens. The review of the literature revealed that pulmonary metastases from low-grade ESS are rare but not negligible. Furthermore, the detailed clinical information, imaging findings and immunohistochemical detection are important for making a diagnosis.

Identification of nine microRNAs as potential biomarkers for lung adenocarcinoma.

Lung cancer is a leading global cause of cancer-related death, and lung adenocarcinoma (LUAD) accounts for ~ 50% of lung cancer. Here, we screened for novel and specific biomarkers of LUAD by searching for differentially expressed mRNAs (DEmRNAs) and microRNAs (DEmiRNAs) in LUAD patient expression data within The Cancer Genome Atlas (TCGA). The identified optimal diagnostic miRNA biomarkers were used to establish classification models (including support vector machine, decision tree, and random forest) to distinguish between LUAD and adjacent tissues. We then predicted the targets of identified optimal diagnostic miRNA biomarkers, functionally annotated these target genes, and performed receiver operating characteristic curve analysis of the respective DEmiRNA biomarkers, their target DEmRNAs, and combinations of DEmiRNA biomarkers. We validated the expression of selected DEmiRNA biomarkers by quantitative real-time PCR (qRT-PCR). In all, we identified a total of 13 DEmiRNAs, 2301 DEmRNAs and 232 DEmiRNA-target DEmRNA pairs between LUAD and adjacent tissues and selected nine DEmiRNAs (hsa-mir-486-1, hsa-mir-486-2, hsa-mir-153, hsa-mir-210, hsa-mir-9-1, hsa-mir-9-2, hsa-mir-9-3, hsa-mir-577, and hsa-mir-4732) as optimal LUAD-specific biomarkers with great diagnostic value. The predicted targets of these nine DEmiRNAs were significantly enriched in transcriptional misregulation in cancer and central carbon metabolism. Our qRT-PCR results were generally consistent with our integrated analysis. In summary, our study identified nine DEmiRNAs that may serve as potential diagnostic biomarkers of LUAD. Functional annotation of their target DEmRNAs may provide information on their roles in LUAD.

A Pilot Study of Pulmonary Segmentectomy With Indocyanine Green Near-Infrared Angiography.

OBJECTIVES: Video-assisted thoracoscopic surgery (VATS) pulmonary segmentectomy is commonly used in treating small ground-glass opacity (GGO) nodules in lung. The identification of the intersegmental plane is one of the challenges. In this pilot study, we aimed to evaluate the feasibility of indocyanine green (ICG) angiography in VATS segmentectomy. METHODS: Nineteen GGO patients were enrolled, and VATS segmentectomy with ICG near-infrared angiography were performed between July 2017 and December 2017. Conventional 3-port VATS was used. ICG was injected intravenously after dominant arties were ligated. Intersegmental plane was identified and divided by stapler and electrocautery. RESULTS: All patients had perfect intersegmental plane visualization. The mean operation time was 140.8 minutes, and the mean blood loss was 23.7 mL. No complications due to ICG occurred. The mean chest tube duration was 4.6 days. No severe complications occurred in the perioperative period. The mean chest tube drainage duration was 4.6 days. Prolonged postoperative air leak (>5 days), which required no surgical intervention, occurred in 2 cases. There were no severe complications or in-hospital deaths. CONCLUSIONS: VATS segmentectomy with ICG near-infrared angiography is a reasonable treatment option to treat small GGO in lung, especially due to its good surgical view maintenance.

Right upper sleeve lobectomy by video-assisted thoracic surgery.

With accumulation of experiences in video-assisted thoracic surgery (VATS) lobectomy, complete VATS sleeve lobectomy (SL) has been carried out in more and more medical centers. We here presented a procedure of sleeve right upper lobectomy by complete VATS for a 62-year-old male patient with central squamous cell carcinoma. Traditional three incisions VATS technique was applied and the utility incision located on anterior axillary line of the 4th intercostal space. Continuous sutures were chosen for bronchial anastomosis using 3-0 prolene sutures. The chest drainage was removed on the postoperative fourth day.

The MDM2 T309G polymorphism and risk of lung cancer: an updated meta-analysis of 10,186 cases and 14,155 controls.

INTRODUCTION: The aim of this paper was to assess the relationship between MDM2 (mouse double minute 2 homolog) T309G polymorphism and the risk and prognosis of lung cancer. EVIDENCE ACQUISITION: We did a systematic review of relevant articles from EBSCO, EMBASE, Web of science, PubMed, springer link, science direct, weipu database and CNKI (Chinese National Knowledge Infrastructure) databases up to January 7, 2016. EVIDENCE SYNTHESIS: Seventeen case-control studies and 5 cases prognosis were included. The results indicated that the MDM2 T309G polymorphism was associated with lung cancer risk. Subgroup analysis by ethnicity also showed that associations are significant in Asian. Five prognosis studies were also included. Patients with TT genotype had a higher survival rate at 20-months-follow-up compared with those who carried TG or GG genotype (TT vs. TG+GG: OR=0.34, 95% CI: 0.12-0.99, P<0.05). CONCLUSIONS: MDM2 T309G polymorphism is associated with risk and prognosis of lung cancer. TT or T genotype may be associated with the reduced risk of lung cancer, especially in Asians. Meanwhile, TT genotype is also associated with the improved prognosis of the lung cancer.

Lung cancer presenting as thin-walled cysts: An analysis of 15 cases and review of literature.

AIM: Lung cancer presenting as cysts is a rare entity in clinical practice. Differential diagnosis is difficult in the benign-like cyst. METHODS: We conducted a retrospective analysis of the clinical records of 15 patients who underwent surgery for primary lung cancer presenting as cysts (wall thickness <5 mm) in our department between 2007 and 2012. The whole group underwent postoperative follow-up. RESULTS: The subjects' age ranged from 18 to 80 years with a median age of 58.3 years. Eight cases presented with respiratory symptoms while seven showed abnormal shadows on a chest computed tomography without symptoms. Histological analysis showed that 10 cases were of adenocarcinoma, two of squamous cell carcinoma and one of large cell carcinoma. Two patients died at 13 and 26 months and the remaining 13 patients are alive and disease free at 3-38 months. CONCLUSION: Cystic lung cancer should be considered in the differential diagnosis of focal benign cyst. Cystic lung cancer could achieve a good outcome if early diagnosis can be obtained.

Choice of therapeutic strategies in intrathoracic anastomotic leak following esophagectomy.

BACKGROUND: The aim of this study was to analyze our experience with management of intrathoracic anastomotic leak after esophagectomy. METHODS: Clinical data from 33 patients who developed intrathoracic anastomotic leak were evaluated retrospectively. These patients were selected from 1867 patients undergoing resection carcinoma of the esophagus and reconstruction between January 2003 and December 2012. RESULTS: Surgical intervention and the reformed "three-tube method" were applied in 13 and 20 patients, respectively. The overall incidence of intrathoracic anastomotic leakage was 1.8%. The median time interval from esophagectomy to diagnosis of leak was 9.7 days. Sixteen patients were confirmed as having leakage by oral contrast computed tomography (CT). Age and interval from surgery to diagnosis of leak were identified as statistically significant parameters between contained and uncontained groups. Moreover, patients with hypoalbuminemia had a longer time to leak closure than patients without hypoalbuminemia. Six patients died from intrathoracic anastomotic leak, with a mortality rate of 18.2%. There was no statistically significant difference in the time to leak closure between patients who underwent surgical exploration and those who received conservative treatment. CONCLUSIONS: Intrathoracic anastomotic leak after esophagectomy was associated with significant mortality. Once intrathoracic anastomotic leakage following esophagectomy was diagnosed or highly suspected, individualized management strategies should be implemented according to the size of the leak, extent of the abscess, and status of the patient. In the majority of patients with anastomotic leak, we preferred the strategy of conservative treatment.

[Thin-walled cystic lung cancer: an analysis of 24 cases and review of literatures].

BACKGROUND: Lung cancer presenting as cystic lesions was first described by Anderson and Pierce in 1954. Lung cancer presenting as cysts is a rare entity in clinical practice. Differential diagnosis is difficult in the benign-like cyst. This study investigated the clinical characteristics, diagnosis and treatment of lung cancer presenting as cysts. METHODS: We conducted a retrospective analysis of the clinical records of 24 patients who underwent surgery for a primary lung cancer presenting as cysts in our department between 2007 and 2013. We defined a 'Thin-walled cyst' as a cavitary lesion with a wall thickness of 4 mm or less along at least 75% of the circumference of the lesion. The whole group underwent post-operative follow-up. RESULTS: The incidence of cystic lung cancer was 0.49% (24/4,897) of surgical cases. The subjects' age ranged from 19 to 77 yr with a median age of 56.5 yr. Ten cases presented with respiratory symptoms while 14 showed abnormal shadows on a chest CT without symptoms. Histological analysis showed that 18 cases were of adenocarcinoma, three of squamous cell carcinoma, one of small cell carcinoma, one of adenosquamous carcinoma and one of large cell carcinoma. Three patients were dead, and the remaining 21 patients are alive and disease free at the end of follow-up. CONCLUSIONS: Cystic lung cancer should be kept in mind during the differential diagnosis of focal benign cyst. Cystic lung cancer could achieve a good outcome if early diagnose can be obtained.

[The clinical application value of dual source CT quantification volume imaging to forecast lung cancer patients' postoperative pulmonary function changing: a prospective study].

OBJECTIVE: To probe the clinical application and value of dual source CT quantification volume imaging to forecast lung cancer patients' postoperative pulmonary function changing. METHODS: Between June 2012 and June 2013, there were 233 patients (121 male patients and 112 female patients, with a mean age of (53 ± 16) years) who accepted the thoracoscope lobectomy or unilateral holo-lungs pneumonectomy accepted pulmonary function test before and after 3 months of the surgery. CT scan was conducted at both inspiration phase and expiration phase before the surgery and the lung volume of the single lobe, the pixel exponential distribution histogram, and the average lung density were measured after CT scan. The discrepancy and correlation between the preoperative lung volume accepted by CT and preoperative, postoperative pulmonary function index were compared. RESULTS: The CT volume scan showed that average lung density of the superior part at decubitus position is -(870 ± 22) HU, the inferior part was -(767 ± 16) HU (t = 3.13, P < 0.01). The volume ratio of the right upper lobe, right middle lobe, right lower lobe, left upper lobe, left lower lobe were 20.5%, 10.3%, 23.1%, 24.6%, 21.5%, whole-right lung was 53.9% and whole-left was 46.1%. There were high correlation between CT volume index and preoperative routine pulmonary function index such as total lung capacity, forced vital capacity (FVC), forced expiratory volume in the first second (FEV(1)), residual volume, and FEV(1)/FVC. The highest correlation coefficient were 0.92, 0.76, 0.70, 0.85, 0.56 (t = 3.14, 3.05, 2.86, 3.09, 2.68; all P < 0.01). The highest correlation coefficient for the postoperative pulmonary function index were 0.87, 0.68, 0.75, 0.81, -0.64 (t = 3.10, 2.85, 3.05, 3.02, 2.79; all P < 0.01). CONCLUSIONS: It is feasible to use dual source CT quantification volume imaging to predict lung cancer patients' postoperative pulmonary function alteration, which can provide precise predictive value of these patients. CT quantification volume imaging technology has important clinical application value.

A giant aneurysmal bone cyst of the rib: Case report.

An aneurysmal bone cyst (ABC) is a benign tumor of the skeletal system, which most frequently occurs in long bones. An ABC arising from the rib is extremely rare and it is difficult to distinguish from other types of rib tumors. The present study describes an unusual case of a large ABC in the rib of a 17-year-old male. The entity is discussed with particular emphasis on the clinicopathological features, differential diagnosis and treatment. Due to difficulties in the pre-operative diagnosis, a possible diagnosis of ABC should be made aware when confronting an expansile rib mass. An en bloc resection of the mass and the affected portion of the rib is mandatory to obtain a satisfactory outcome.

THAP11, a novel binding protein of PCBP1, negatively regulates CD44 alternative splicing and cell invasion in a human hepatoma cell line.

THAP11 is an essential factor involved in ES cell pluripotency and cell growth. Here, we identified THAP11 as a novel physiological binding partner of PCBP1. In HepG2 cells, THAP11 overexpression inhibited CD44 v6 expression and cell invasion. However, when deleting the binding domain with PCBP1 or endogenous PCBP1 was knocked down, THAP11 failed to inhibit CD44 v6 expression, indicating that THAP11 regulates CD44 v6 expression through interacting with PCBP1. In HCC patients, the expression of THAP11 mRNA significantly correlated with PCBP1 mRNA expression. Our results suggest a novel role of THAP11 in CD44 alternative splicing and hepatoma invasion.