Lung cancer is one of the most lethal tumors in the world with a 5-year overall survival rate of less than 20%, mainly including lung adenocarcinoma (LUAD). Tumor microenvironment (TME) has become a new research focus in the treatment of lung cancer. The TME is heterogeneous in composition and consists of cellular components, growth factors, proteases, and extracellular matrix. The various cellular components exert a different role in apoptosis, metastasis, or proliferation of lung cancer cells through different pathways, thus contributing to the treatment of adenocarcinoma and potentially facilitating novel therapeutic methods. This review summarizes the research progress on different cellular components with cell-cell interactions in the TME of LUAD, along with their corresponding drug candidates, suggesting that targeting cellular components in the TME of LUAD holds great promise for future theraputic development.
Humans ; Tumor Microenvironment/drug effects* ; Adenocarcinoma of Lung/drug therapy* ; Lung Neoplasms/pathology* ; Adenocarcinoma/metabolism* ; Animals ; Apoptosis/physiology*

With the advancement of comprehensive treatment and minimally invasive technology, patients with originally unresectable gallbladder cancer are expected to undergo surgical treatment after transformational therapy, which can achieve the effect of increasing R0 resection rate and improving long-term prognosis. Conversion therapy as a new option for patients with gallbladder cancer who are difficult to undergo radical surgery is still subject to much debate. Patients with locally progressive gallbladder cancer at the initial diagnosis may be the target population for conversion therapy. Gemcitabine+ cisplatin is still used as the standard first-line chemotherapy regimen. The use of multiple chemotherapeutic agents in combination also shows new vitality. High-throughput sequencing and the use of precision targeting drugs will become new trends in the future. The use of immune drugs is still needed. And the use of immunotherapy drugs is still in demand. High-throughput sequencing and the use of precision-targeted drugs will become a new trend in the future, the use of immunologic drugs still needs more evidence-based medical support, and the use of post-translational minimally invasive techniques may bring benefits to patients.

Patients with glioblastoma (GBM) generally have a bad prognosis and short overall survival after being treated with surgery, chemotherapy or radiotherapy due to the histological heterogeneity, strong invasive ability and rapid postoperative recurrence of GBM. The components of GBM cell-derived exosome (GBM-exo) can regulate the proliferation and migration of GBM cell via cytokines, miRNAs, DNA molecules and proteins, promote the angiogenesis via angiogenic proteins and non-coding RNAs, mediate tumor immune evasion by targeting immune checkpoints with regulatory factors, proteins and drugs, and reduce drug resistance of GBM cells through non-coding RNAs. GBM-exo is expected to be an important target for the personalized treatment of GBM and a marker for diagnosis and prognosis of this kind of disease. This review summarizes the preparation methods, biological characteristics, functions and molecular mechanisms of GBM-exo on cell proliferation, angiogenesis, immune evasion and drug resistance of GBM to facilitate developing new strategies for the diagnosis and treatment of GBM.
Humans ; Glioblastoma/genetics* ; Exosomes/metabolism* ; MicroRNAs/metabolism* ; Prognosis ; Cell Proliferation ; Brain Neoplasms/genetics* ; Cell Line, Tumor

Objective:To investigate the perioperative efficacy of robot surgical system assisted anatomic and non-anatomic hepatectomy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinical data of 103 patients who underwent robot surgical system assisted hepatectomy in Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine from March 2016 to December 2021 were collected. There were 54 males and 49 females, aged 56(range, 44?64)years. Of the 103 patients, 55 cases undergoing robot surgical system assisted anatomic hepatectomy were divided into the anatomic group, and 48 cases undergoing robot surgical system assisted non-anatomic hepatectomy were divided into the non-anatomic group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative conditions; (3) perioperative complications. Propensity score matching was done by the 1:1 nearest neighbor matching method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were expressed as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the rank sum test. Results:(1) Propensity score matching and compari-son of general data of patients between the two groups after matching. Of the 103 patients, 94 cases were successfully matched, including 47 cases in the anatomic group and 47 cases in the non-anatomic group. The elimination of preoperative body mass index, preoperative platelet and preoperative albumin confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative conditions. After propensity score matching, the operation time and volume of intraoperative blood loss were 175(range, 120?240)minutes and 50(range, 50?100)mL in patients of the anatomic group, versus 155(range, 105?190)minutes and 100(range, 50?200)mL in patients of the non-anatomic group, showing significant differences in the above indicators between the two groups ( Z=1.97, 2.49, P<0.05). (3) Perioperative complications. After propensity score matching, cases with pleural fluid and/or ascites, case with biliary fistula, case with thrombosis, case with peritoneal infection, case with incision infection were 11, 1, 2, 4, 1 in patients of the anatomic group, versus 12, 0, 4, 1, 0 in patients of the non-anatomic group, showing no significant difference in the above indicators between the two groups ( P>0.05). Cases with complications classified as grade Ⅰ, grade Ⅱ, grade Ⅲ, grade Ⅳ of the Clavien-Dindo classification were 33, 14, 0, 0 in patients of the anatomic group, versus 28, 14, 3, 2 in patients of the non-anatomic group, showing no significant difference in the above indicators between the two groups ( Z=?1.38, P>0.05). Conclusions:Robotic surgical system assisted anatomic and non-anatomic hepatectomy are safe and feasible for clinical application. Compared with robot surgical system assisted non-anatomic hepatectomy, patients under-going robot surgical system assisted anatomic hepatectomy have long operation time and less volume of intraoperative blood loss.

Objective:To explore the efficacy of digital and 3D printing technologies on design of superficial iliac circumflex artery flap for coverage the donor site of anterolateral thigh flap(ALTF).Methods:Clinical data of 8 patients were studied retrospectively for treatment of soft tissue defects of hand in the Department of Hand Surgery, Wuxi NO.9 People's Hospital Affiliated to Soochow University, from April 2017 to October 2021. The patients were 6 males and 2 females, aged from 29 to 59 years(mean, 45.8 years). Cause of injury: 3 patients were crushed, 2 by hot pressing, and 3 by machine strangulation. Site of injury included: 5 cases were dorsal hand defects and 3 cases were palm defects. All the wounds were contaminated to varying degrees with soft tissue defects. The areas of soft tissue defect ranged from 11 cm×10 cm to 22 cm×14 cm. Four patients had combined injuries of open fracture of metacarpals and phalanges and 3 with tendon defects. All wounds were repaired by free ALTF transplantation. And the donor sites in the thigh were repaired by superficial iliac circumflex artery flaps. The secondary wounds caused by flap harvesting on abdominal wall were closed directly. The targeted perforator vessels were detected preoperatively by CTA combined with CDU. 3D printed models of the affected hand were obtained before operation for individualised repairs according to the shape and area of the wounds. After the operation, all patients entered scheduled follow-ups at the outpatient clinic and via internet by observing the flap shape and testing the recovery of sensory and movement of adjacent joint.Results:The shapes and sizes of the wounds and the flaps were found basically in accordance with those in the preoperative simulative designs. All flaps in 8 patients survived and the wounds healed completely. All patients entered follow-ups for 8 to 24(average, 17.5) months. The donor thighs presented good appearance and colour, pliability without bloating. The range of motion of the hips and knees was not affected. Only linear scars remained in the abdominal donor sites, with natural colour and appearance.Conclusion:Digital and 3D printing technologies in preoperative design of flaps can help to locate the perforator vessels intraoperatively and guide the individualised design of the flaps with improved operation efficiency and satisfactory appearance of the flaps.

Humans ; Nerve Tissue Proteins ; Epithelial-Mesenchymal Transition/genetics* ; Constriction, Pathologic ; Receptors, Immunologic ; Epithelial Cells/metabolism* ; Smad3 Protein/metabolism* ; Transforming Growth Factor beta1/metabolism*

Objective:To explore the predictive value of pre-biopsy serum inflammatory markers on positive prostate biopsy results, establish a nomogram model based on pre-biopsy inflammatory markers combined with other parameters, and evaluate its predictive ability for prostate biopsy results.Methods:The clinical data of 601 patients undergoing transperineal prostate biopsy who were admitted to the Second Hospital of Tianjin Medical University from August 2019 to August 2021 were retrospectively analyzed. The median age was 68(35, 89)years, and the median tPSA was 9.56(4.01, 19.95)ng/ml. The median fPSA was 1.36(0.88, 2.02)ng/ml, the median PSAD was 0.16(0.11, 0.26)ng/ml 2, and the median platelet-to-lymphocyte ratio(PLR)was 129.90(98.95, 169.89). PI-RADS v2.1 score<3 points in 189 cases(31.45%), 3 points in 174 cases(28.95%), 4 points in 190 cases(31.61%), and 5 points in 48 cases(7.99%). A simple randomization method was used to obtain 421 cases(70.00%)in the modeling group and 180 cases(30%)in the validation group.There was no significant difference in the clinical data between the two groups ( P>0.05). Univariate and multivariate logistic regression analysis were performed in the modeling group to screen independent influencing factors for the prediction of positive prostate biopsy results. A nomogram model was established and internal verification was conducted. External validation of the model was performed in the validation group. Receiver operating characteristic(ROC)curve was used to verify model discrimination, Hosmer-Lemeshow goodness-of-fit test was used to verify model calibration, and decision curve analysis (DCA) was used to evaluate the net benefit and clinical utility of the predictive model. Results:The results of univariate analysis showed that the age( OR=1.060, P<0.01), histological inflammation( OR=0.312, P<0.01), the number of biopsy needles( OR=0.949, P=0.009), f/tPSA( OR=0.954, P=0.003), PV( OR=0.973, P<0.01), PSAD( OR=29.260, P<0.01), PI-RADS v2.1 score(3-point OR=3.766, P=0.001; 4-point OR=11.800, P<0.01; 5-point OR=57.033, P<0.01), lymphocyte count( OR=1.535, P=0.013), NLR( OR=0.848, P=0.044), PLR( OR=0.994, P=0.005)and SII( OR=0.999, P=0.009)were statistically different between the prostate patients and non-prostate cancer patients in the modeling group; Multivariate analysis showed that age( OR=1.094, P<0.001), fPSA( OR=0.605, P=0.002), histological inflammation ( OR=0.241, P<0.001), PSAD ( OR=7.57, P=0.013), PLR ( OR=0.994, P=0.005) and PI-RADS v2.1 Score(3-point OR=2.737, P=0.016; 4-point OR=8.621, P<0.001; 5-point OR=47.65, P<0.001) was an independent influencing factor for prostate cancer at initial biopsy; a nomogram model based on age, fPSA, PSAD, PLR and PI-RADS v2.1 scores was established. The AUC of the modeling group was 0.849(95% CI 0.810-0.888), and the sensitivity was 80.9%, and the specificity was 76.1%; the AUC of the validation group was 0.862(95% CI 0.809-0.915), and the sensitivity was 91.9%, and the specificity was 67.8%, suggesting that the diagnostic prediction model had a good discrimination. The calibration curve showed that the prediction model was well calibrated ( χ2=6.137, P=0.632). The decision curve analysis (DCA) of the modeling and validation groups indicated a larger net benefit of the predictive model. Conclusions:The nomogram model established in this study based on age, fPSA, PSAD, PLR and PI-RADS v2.1 score showed good predictive efficacy for prostate biopsy in patients with PSA between 4-20 ng/ml.

Objective:To investigate the effectiveness of radial dorsal digital artery flap with part short thumb extensor tendon in repairing dorsal skin defects of the thumb.Methods:The clinical data of patients with thumb wounds complicated with extensor tendon defect who were repaired with radial dorsal digital artery flap with part short thumb extensor tendon in the Department of Hand Surgery, Wuxi No.9 People's Hospital from August 2018 to August 2020 were analyzed retrospectively. After the operation, the shape and function of the thumb were followed up by testing the two-point discrimination of chimeric flap, the sensory function and the thumb opposition function. The function of the thumb was evaluated with the reference of the total active movement (TAM) of fingers of the Chinese Medical Association Hand Surgery Branch.Results:A total of 10 cases with soft tissue defect of thumb were treated, whose tendon defect ranged 1.0-1.7 cm in length. There were 6 males and 4 females, aged from 20 to 67 years (mean, 41 years). The left hand was involved in 6 cases and the right in 4 cases. Radial dorsal digital artery flap with part short thumb extensor tendon were used to reconstruct extensor tendon and wound with the size of 2.0 cm×1.5 cm-3.0 cm×2.5 cm. The size of flap harvest was 2.5 cm× 1.8 cm-3.5 cm× 3.0 cm, and the tendon was 2.0-3.4 cm in length. All flaps in 10 patients were survived with primary healing.All patients were followed-up from 6 to 12 months, with the average of 8 months. Flaps presented good appearance and color, pliability. The two-point discrimination of chimeric flap was 7-10 mm (mean, 9 mm), and the thumb opposition function was good. The flap sensory function reached S3. The interphalangeal joint flexion of thumb was 60°-90 °, and the thumb opposition function was good. According to the total active movement system, excellent result was achieved in 8 cases and good in 2 cases.Conclusions:Radial dorsal digital artery flap with part short thumb extensor tendon was an ideal clinical method for repair of dorsal skin defects of the thumb, which can repair skin and tendon defects in one stage. The operation is simple with reliable blood supply. This method could also restore the appearance and function of fingers.

Objective:To investigate the effectiveness of radial dorsal digital artery flap with part short thumb extensor tendon in repairing dorsal skin defects of the thumb.Methods:The clinical data of patients with thumb wounds complicated with extensor tendon defect who were repaired with radial dorsal digital artery flap with part short thumb extensor tendon in the Department of Hand Surgery, Wuxi No.9 People's Hospital from August 2018 to August 2020 were analyzed retrospectively. After the operation, the shape and function of the thumb were followed up by testing the two-point discrimination of chimeric flap, the sensory function and the thumb opposition function. The function of the thumb was evaluated with the reference of the total active movement (TAM) of fingers of the Chinese Medical Association Hand Surgery Branch.Results:A total of 10 cases with soft tissue defect of thumb were treated, whose tendon defect ranged 1.0-1.7 cm in length. There were 6 males and 4 females, aged from 20 to 67 years (mean, 41 years). The left hand was involved in 6 cases and the right in 4 cases. Radial dorsal digital artery flap with part short thumb extensor tendon were used to reconstruct extensor tendon and wound with the size of 2.0 cm×1.5 cm-3.0 cm×2.5 cm. The size of flap harvest was 2.5 cm× 1.8 cm-3.5 cm× 3.0 cm, and the tendon was 2.0-3.4 cm in length. All flaps in 10 patients were survived with primary healing.All patients were followed-up from 6 to 12 months, with the average of 8 months. Flaps presented good appearance and color, pliability. The two-point discrimination of chimeric flap was 7-10 mm (mean, 9 mm), and the thumb opposition function was good. The flap sensory function reached S3. The interphalangeal joint flexion of thumb was 60°-90 °, and the thumb opposition function was good. According to the total active movement system, excellent result was achieved in 8 cases and good in 2 cases.Conclusions:Radial dorsal digital artery flap with part short thumb extensor tendon was an ideal clinical method for repair of dorsal skin defects of the thumb, which can repair skin and tendon defects in one stage. The operation is simple with reliable blood supply. This method could also restore the appearance and function of fingers.

Objective: To summarize 7 adjacent V-Y advanced perforator flaps for defects at donor sites leaving by six commonly-used flaps. Methods: From May 2007 to Jan. 2014, 66 cases with hands and feet skin defects, tendon and bone exposure were treated with reverse island flap(15 cases), thumb dorsal artery island flaps (9 cases), dorsal metacarpal artery island flaps (9 cases), abdominal pedicle flaps (9 cases), free anterolateral thigh flaps (15 cases), sural nerve retrograde island flaps (9 cases). The defects at donor sites were covered by adjacent V-Y advanced perforator flaps, including dorsal metacarpal perforator flap, snuffbox perforator flap, dorsal carpal perforator flap, deep iliac circumflex artery musculocutaneous perforating branches flap, outer knee perforator flap, medial thigh perforator flap, proximal posterior tibial artery. Results: All the six common flaps survived with average healing period of 15 days. Only one adjacent V-Y advanced outer knee perforator flap underwent partial necrosis at the proximal flap end which healed after dressing. All the other V-Y advanced flaps survived. The patients were followed up for 5-24 months (8 on average) with satisfactory flap texture and color both at reconstructed area and donor sites. The adjacent joints had normal movement function. Conclusions Adjacent V-Y advanced perforator flap is an important method for closure of defects at donor sites. It has the advantages of no sacrifice of main artery, satisfactory result and easy performance.