Profiles of PhD students' satisfaction and their relationships with demographic characteristics and academic career enthusiasm.

The satisfaction of doctoral students is very important for the quality of higher education. Based on two-factor theory (also known as Herzberg's motivation-hygiene theory), this study used a person-centered approach to examine possible doctoral student satisfaction profiles. In total, 4,964 participants were included in the study, and the results of latent profile analysis showed that they could be classified into four subgroups: (i) the low-motivation-low-hygiene group (700 participants, 14.1% of the sample), (ii) the low-motivation-high-hygiene group (979, 19.7%), (iii) the high-motivation-low-hygiene group (1,554, 31.3%), and (iv) the high-motivation-high-hygiene group (1,731, 34.9%). Analyses showed that the PhD students differed significantly in their satisfaction-profile membership depending on their gender, age, country, study-abroad status, work status, and caring responsibilities. Specifically, male students, younger students, and students studying abroad tended to be more satisfied with both motivation and hygiene factors. Besides, regarding maintaining and stimulating doctoral students' academic career enthusiasm, motivation factors can compensate for the negative impact of the absence of hygiene factors, not the other way around. Therefore, it can be seen that two-factor theory has a certain explanatory power for changes in academic career enthusiasm, but it must be adjusted in a certain way considering the special characteristics of the population.

Folate receptor-positive circulating tumor cells in the preoperative diagnosis of indeterminate pulmonary nodules.

BACKGROUND: The use of FR + CTC to distinguish lung cancer from benign lung disease has been well studied. However, the effective method to differentiate precursor glandular lesions from benign/malignant pulmonary diseases is rare. METHODS: 380 patients with indeterminate pulmonary nodules were prospectively recruited. Peripheral blood samples were collected from all participants before surgery for analyzing FR + CTC levels. The performance of FR + CTC to identify lung precursor lesions were analyzed by receiver operating characteristic (ROC) curve. RESULTS: FR + CTC can effectively differentiate precursor from benign pulmonary diseases in all included patients (cutoff: 9.22 FU/3 ml, AUC = 0.807, (p < 0.0001, sensitivity: 69.17%, specificity: 82.46%) and patients with single pulmonary lesion (cutoff: 9.03 FU/3 ml, AUC = 0.842, p = 0.0001, sensitivity: 75.20%, specificity: 83.00%). However, FR + CTC cannot differentiate precursor from benign pulmonary diseases in multiple lesions patients (p = 0.110). FR + CTC neither differentiate precursor from malignant pulmonary lesions in all included patients (p = 0.715), single nor multiple lesions patients (p = 0.867, p = 0.692, respectively). Total number of pulmonary nodules, MTD, location (lower vs upper) were independent risk factors for malignancy (AOR, 95% CI: 3.104 (1.525, 6.316), 3.148 (1.722, 5.754), 2.098 (1.132, 3.888), respectively. CONCLUSION: Preoperative FR + CTC can be identified in precursor glandular lesions and utilized to differentiate from benign pulmonary diseases. Total number of pulmonary nodules, MTD, location (lower vs upper) were independent risk factors for malignancy.

Left sleeve pneumonectomy via uniportal video-assisted thoracoscopic approach.

Left sleeve pneumonectomy is a rarer intervention compared with right sleeve pneumonectomy. It is a challenging surgical therapeutic strategy even when performed through open thoracotomy. Here, we report a case of uniportal video-assisted thoracoscopic surgery (VATS) left sleeve pneumonectomy in a patient with non-small cell lung cancer. The tumor, located at the opening of left upper lobe bronchus, submucosally invaded the orifice of lower lobe extending upward to 4 to 5 cartilage rings of the left main bronchus and to the level of the carina. Left sleeve pneumonectomy and airway reconstruction was performed through video-assisted thoracoscopic completely with an incision of 4 cm. The total operative time was 220 minutes and the estimated intraoperative blood loss was 300 mL. Chylothorax occurred after surgery, which was well handled, and no other severe complication was observed. Three months after the surgery, the follow-up bronchoscopy revealed good healing of the anastomosis. No signal of tumor recurrence was observed by follow-up examination 1 year after the surgery. To our knowledge, this is the first reported uniportal VATS left sleeve pneumonectomy in the world. It was indicated that uniportal VATS might be a feasible approach for left sleeve pneumonectomy, with less surgical trauma compared with other approaches.

Subxiphoid uniportal video-assisted thoracoscopic pulmonary segmentectomy: effect of learning curve and future perspectives.

OBJECTIVES: Subxiphoid uniportal video-assisted thoracoscopic segmentectomy (SU-VATs) has been widely adopted because it is associated with better postoperative pain scores. Nevertheless, it also has had some limitations that have gradually been decreasing. Therefore, our goal was to evaluate the change in perioperative results with SU-VATs as the learning curve developed to outline the current status and the points that should be of future concern. METHODS: Three hundred patients who underwent SU-VATs from September 2014 to May 2018 were divided chronologically into 2 groups; group 1 comprised the first 150 cases and group 2 comprised the last 150 cases. Different perioperative variables were analysed and compared between the 2 groups. In addition, the cumulative sum analysis and multivariable logistic regression were conducted to identify the cut-off point and predictors of significant improvement in operative time. RESULTS: The cumulative sum analysis showed significant improvement in the operative time after the 148th case. Group 2 showed a statistically significant decrease in operative time (104.3 ± 36.7 vs 132 ± 43.1 min; P < 0.001), amount of operative blood loss [50 (80 ml) vs 100 (50 ml); P < 0.001], chest drain duration (2.6 ± 1.6 vs 3.2 ± 1.4 days; P = 0.004) and hospital stay (3.7 ± 1.7 vs 4.2 ± 1.7 days; P = 0.008). The number of dissected lymph nodes was significantly higher in the second group [11 (4) vs 9 (4); P < 0.001]. CONCLUSIONS: Limitations of SU-VATs are being overcome by the improvement in the learning curve and in the expertise of the surgeons. Our future concerns should focus on examining the long-term survival rate, the oncological efficacy and the effect on quality of life.

Subxiphoid uniportal thoracoscopic pulmonary segmentectomy for stage I non-small cell lung cancer: Feasibility, quality of life and financial worthiness.

BACKGROUND: Subxiphoid uniportal video-assisted thoracoscopic surgery (SVATS) is more technically challenging than intercostal uniportal video-assisted thoracoscopic surgery (UVATS), especially in more complex procedures such as segmentectomy. We therefore aimed to investigate the worthiness of undertaking the more demanding subxiphoid approach in patients who had undergone anatomical segmentectomy for stage IA non-small cell lung cancer (NSCLC). METHODS: A total of 491 patients were included in our study who had undergone anatomical segmentectomy for stage IA non-small cell lung cancer from September 2014 to April 2018. They were divided into two groups; 278 patients in the UVATS group and 213 patients in the SVATS group. Different perioperative variables, postoperative pain, quality of life and cost were analyzed and compared between both groups. RESULTS: The SVATS group showed a significantly longer operative time (P = 0.007) and more operative blood loss than the intercostal group (P = 0.004). There was no significant difference between both groups regarding postoperative drainage, duration of chest tube, postoperative hospital stay, operative conversion or postoperative complications. The SVATS group showed a significantly lower pain score postoperatively (P < 0.001). In addition, the SVATS group showed a significantly better postoperative quality of life score along the first postoperative year (P < 0.001). UVATS segmentectomy appeared to be significantly cheaper than SVATS segmentectomy (P < 0.001). CONCLUSIONS: SVATS segmentectomy for stage IA lung cancer is a safe procedure that is worth proceeding with as it is associated with better postoperative pain and better quality of life in the first postoperative year. Further studies are recommended to evaluate the actual cost-effectiveness of SVATS segmentectomy. KEY POINTS: • Significant findings of the study Subxiphoid uniportal approach for pulmonary segmentectomy is safe and feasible approach. It has better postoperative pain and better quality of life than the uniportal intercostal approach; however, it is more expensive. • What this study adds Subxiphoid uniportal approach for pulmonary segmentectomy gives a better quality of life in Chinese patients than the intercostal approach; however, it is more expensive.

Favorable prognosis and high discrepancy of genetic features in surgical patients with multiple primary lung cancers.

OBJECTIVE: Multiple primary lung cancers are detected with increasing frequency, but the ideal strategy for diagnosis and treatment remains disputable. This study evaluated both clinical characteristics and genetic alterations to investigate the appropriate strategy for patients with multiple primary lung cancer. METHODS: A total of 96 patients in our practice were diagnosed with multiple primary lung cancer over 7 years by clinical-pathologic criteria. According to consolidation/tumor ratio, they were classified into 3 groups: group A (multiple ground-glass opacity-dominant nodules, consolidation/tumor ratio ≤0.5), group B (1 solid-dominant nodule, consolidation/tumor ratio >0.5 with other ground-glass opacity-dominant nodules), and group C (2 solid-dominant nodules). A series of somatic genetic mutations and fusions were analyzed in a portion of the patients. RESULTS: There were 24, 35, and 37 patients in groups A, B, and C, respectively. During follow-up, 23 patients had recurrence. The 5-year recurrence-free survival was 100% in patients with multiple ground-glass opacity, 68% in those with 1 solid lesion, and 51.4% in those with 2 solid tumors (P = .001). Eighteen patients died of lung cancer. The 5-year overall survival was 100% in group A, 80.5% in group B, and 59.9% in group C (P = .002). A total of 77 driver mutations were detected in 61 of the 82 lesions. A high rate of discordance of genetic alterations (89.7%) was found between cancers within individual patients. Two patients in group C had concordant driver mutations between the 2 lesions, and both of them harbored tumor recurrence. CONCLUSIONS: A high discordance of driver mutations between tumors in individual patients and a favorable prognosis were identified in patients with multiple primary lung cancers diagnosed by clinical-pathologic criteria, which support different strategies from those with metastatic disease.