Background and purpose:For stageⅠ non-small cell lung cancer (NSCLC), video-assisted thoracic segmentectomy is given much attention to by thoracic surgeon because of the less tissue damages. However, video-assisted thoracic lobectomy is still considered as the standard treatment in the world. Therefore, this study was to evaluate the clinical effect after video-assisted thoracic segmentectomy and lobectomy in patients with stageⅠ NSCLC in order to provide reference for clinical application.Methods:The comparative studies on video-assisted thoracic segmentectomy and lobectomy treating stage I NSCLC were retrieved from PubMed, Web of Science, EMBASE, the Cochrane Library, CNKI, CBM, VIP, and Wanfang Data. All data were acquired until July 2015. Literature screening according to data extraction and quality assessment was completed by two reviewers independently. Meta-analysis was conducted by RevMan 5.3 software which was offered by Cochrane network.Results:A total of 11 articles involving 1 677 patients were ifnally included. The results of meta-analysis indicated that: for stageⅠ NSCLC, compared with video-assisted thoracic lobectomy, the effect of video-assisted thoracic segmentectomy was alike in total mortality (OR=0.77, 95%CI: 0.48 to 1.21,P=0.25), 5-year mortality (OR=0.77, 95%CI: 0.52 to 1.14,P=0.19) and systemic complications (OR=0.76, 95%CI: 0.53 to 1.09,P=0.13), but could reduce blood loss [difference in means (MD)=-41.16, 95%CI: -59.46 to -22.86,P<0.000 1], chest tube duration (MD=-0.29, 95%CI: -0.49 to -0.09,P=0.005) and the length of hospital stay (MD=-0.74, 95%CI: -1.44 to -0.05,P=0.04).Conclusion:Compared with video-assisted thoracic lobectomy, video-assisted thoracic segmentectomy can signiifcantly reduce blood loss, chest tube duration and length of hospital stay. However, the two kinds of operation methods achieved the same effects on the total mortality, 5-year mortality and systemic complications. Thoracoscopic segmentectomy may be an alternative to thoracic lobectomy.

Objective To summarize the clinical experiences of video-mediastinoscopy followed by stenting procedure in treating the superior vena cava syndrome (SVCS),and to investigate their application significant.Methods Nine patients with SVCS without clear histologic diagnosis before procedure were reviewed retrospectively,who were admitted into hospital from November 2007 to October 2013.All of 9 patients were received video-mediastinoscopy and they did not performed pathological check.They were placed the endovascular stent.Results Video-mediastinoscopy followed by stenting procedure 6 cases,parasternal TN mediastinoscopy 2 cases,joint neck and parasternal TV mediastinoscopy 1 case.Nine cases have received a clear pathological diagnosis.There was no death case in-hospital.The operative complication was hemorrhage of 1 case.The cubital venous pressures were (18.6±5.1) cmH2O at stending,(13.5±3.3) cmH2O,(11.3±2.5) cmH2O,(10.3± 2.0) cmH2O at 24,48,72 h after stending,and down to the normal at 72 h (F =67.245,P ＜0.01).The clinical symptoms were obviously relieved.All of them were remained free from SVCS during the follow-up.Conclusion The hybrid procedure of video-mediastinoscopy followed by stenting placement is a highly effective and safe treatment.It can accurately provide informations on diagnosis and treatment.

Objective:To evaluate the effect of postoperative adjuvant therapy on patients with locally advanced pathologic T3N0M0 (pT3N0M0)esophageal squamous cell carcinoma(ESCC).Methods:In this retrospective study,we evaluated patients who underwent esophagectomy at Lanzhou University Second Hospital.Patients were divided into 4 groups:surgery-alone(S),surgery+radiotherapy group(S+RT),surgery+chemotherapy(S+CT),and surgery+chemoradiotherapy(S+CRT)groups.Both the clinicopathologic informa-tion and the long-term follow-up results were analyzed.Results:From January 2010 to April 2014,a total of 177 patients with a medi-an age of 61 years(range 43-78),were enrolled into the study.Among them,79 received surgery alone;the remaining 98 patients re-ceived adjuvant therapy,of whom 28 patients received adjuvant radiotherapy,38 received adjuvant chemotherapy,and 32 received ad-juvant chemoradiotherapy.Overall survival and disease-free survival were better in Group S+Adjuvant than in Group S(P=0.012,P=0.007,respectively).Comparisons among the four groups showed that the overall survival was higher in Group S+CRT than in Group S (P=0.031).Group S+RT was associated with better overall survival and disease-free survival than Group S(P=0.038,P=0.011,respec-tively).Conclusions:Patients with pT3N0M0 ESCC could benefit from adjuvant radiotherapy and chemoradiotherapy,as radiotherapy could help achieve better locoregional control.

We reported a 32 years female patient in whom lung metastasis from breast cancer was presented as solitary pulmonary pure ground-glass opacity (GGO) lesion. The patient received rational preoperative examinations and surgery though the preoperative diagnosis was not accurate. Because of different therapy strategies and purposes, it is crucial to make distinction of atypical metastases from primary cancers. Thus, for patients with a history of malignancy, possible metastasis should be taken into consideration if new GGO was found on the CT. Besides this, the follow-up interval of CT should be shortened appropriately, preoperative examinations and surgical procedures should be made according to the suggestions of multidisciplinary team.

Objective To observe the growth of xenografted tumor in nude mice after DDX46 expression decreased, and to further study the role of DDX46 in the development and progression of esophageal squamous cell carcinoma. Methods DDX46-shRNA mediated RNAi was applied to silencing DDX46 in Eca-109 cells. Twenty-five female BALB/c nude mice were divided into 3 groups: an experiment group (DDX46-shRNA-LV, n=10), a control group (Control-LV, n=10) and a blank control group (Het-1A, n=5). The prepared Eca-109 cells of DDX46-shRNA-LV and Control-LV were subcutaneously injected into the right armpit of mice (4×106 cells per mouse), while Het-1A cells were subcutaneously injected into the bilateral armpits of mice (4×106 cells per side). Tumor growth was monitored twice a week on the 14th day after injection. Tumor volume was measured with calipers, in vivo imager to observe the fluorescence of each group. Further, western blotting analysis was used to detect the changes of apoptosis signaling molecules in xenografted tumor after DDX46 silence. Results The growth of xenografted tumor in nude mice was significantly slower in the DDX46-shRNA-LV group than that in the Control-LV group throughout the study period (P<0.001). Western blotting analysis showed that silencing DDX46 effectively suppressed the expression of DDX46, and upregulated the expression of cleaved Caspase-3 and cleaved PARP-1 in xenografted tumor (P<0.01). Conclusion DDX46 is involved in the development and progression of esophageal squamous cell carcinoma, and the silence of DDX46 expression can inhibit the growth of esophageal squamous cell carcinoma, which probably by positive regulation of apoptosis signaling pathway.

Objective To explore the research state and topics of lung cancer with chronic obstructive pulmonary disease (COPD) in China using the visualization methods. Methods Literature about lung cancer with COPD was searched through WanFang, CNKI, CBM, PubMed, The Cochrane Library and EMbase databases from inception to March 2018 by computer. We used BICOMS software to analyze the main information and produce co-word matrix, gCLUTO software to cluster, and NetDraw and Cytoscape software to draw the pictures. Results There were 304 studies related to lung cancer with COPD which originated from 173 journals including 23 indexed by Chinese Science Citation Database (CSCD) with 42 articles published, accounting for 13.8% of the total number of studies. There were 37 articles from 24 journals indexed by Science Citation Index (SCI) accounting for 12.2% of the total number of studies. The studies grew rapidly since 2012. The study involved 32 provinces, municipalities, and autonomous regions, among which Beijing, Sichuan, Shanghai, Guangzhou and Jiangsu provinces and cities were the main research areas. Sixty-nine high-frequency keywords were obtained with frequency 2 as the threshold, which was clustered into 5 categories by dual cluster analysis. Among them, topic 0 showed pathogenesis and radiological diagnosis of lung cancer with COPD, topic 1 was about the clinical characteristics of different pathological types of lung cancer with COPD and Chinese medicine treatment, topic 2 aimed at the impact of risk factors on surgical complications and the relationship between chemotherapy or targeted therapies and patient survival prognosis, topic 3 involved the pigenetic correlation between lung cancer and COPD and topic 4 was about clinical studies of perioperative comprehensive management of lung cancer patients with COPD. Conclusion The bibliometrics results show that there are considerable-amount achievements on lung cancer combined with COPD in China, and the researches have gradually increased since 2012. Horizontal research topics are extensive, and the focus of the study is to explore the perioperative comprehensive management and basic research of lung cancer with COPD, but the longitudinal themes need to be further studied. The results of some studies have not yet reached a consensus. There are few high-quality multi-center studies and a lack of clinical-directed achievement.

BACKGROUND: Lung cancer is the cancer with the highest mortality at home and abroad at present. The detection of lung nodules is a key step to reducing the mortality of lung cancer. Artificial intelligence-assisted diagnosis system presents as the state of the art in the area of nodule detection, differentiation between benign and malignant and diagnosis of invasive subtypes, however, a validation with clinical data is necessary for further application. Therefore, the aim of this study is to evaluate the effectiveness of artificial intelligence-assisted diagnosis system in predicting the invasive subtypes of early‑stage lung adenocarcinoma appearing as pulmonary nodules. METHODS: Clinical data of 223 patients with early-stage lung adenocarcinoma appearing as pulmonary nodules admitted to the Lanzhou University Second Hospital from January 1st, 2016 to December 31th, 2021 were retrospectively analyzed, which were divided into invasive adenocarcinoma group (n=170) and non-invasive adenocarcinoma group (n=53), and the non-invasive adenocarcinoma group was subdivided into minimally invasive adenocarcinoma group (n=31) and preinvasive lesions group (n=22). The malignant probability and imaging characteristics of each group were compared to analyze their predictive ability for the invasive subtypes of early-stage lung adenocarcinoma. The concordance between qualitative diagnostic results of artificial intelligence-assisted diagnosis of the invasive subtypes of early-stage lung adenocarcinoma and postoperative pathology was then analyzed. RESULTS: In different invasive subtypes of early-stage lung adenocarcinoma, the mean CT value of pulmonary nodules (P<0.001), diameter (P<0.001), volume (P<0.001), malignant probability (P<0.001), pleural retraction sign (P<0.001), lobulation (P<0.001), spiculation (P<0.001) were significantly different. At the same time, it was also found that with the increased invasiveness of different invasive subtypes of early-stage lung adenocarcinoma, the proportion of dominant signs of each group gradually increased. On the issue of binary classification, the sensitivity, specificity, and area under the curve (AUC) values of the artificial intelligence-assisted diagnosis system for the qualitative diagnosis of invasive subtypes of early-stage lung adenocarcinoma were 81.76%, 92.45% and 0.871 respectively. On the issue of three classification, the accuracy, recall rate, F1 score, and AUC values of the artificial intelligence-assisted diagnosis system for the qualitative diagnosis of invasive subtypes of early-stage lung adenocarcinoma were 83.86%, 85.03%, 76.46% and 0.879 respectively. CONCLUSIONS Artificial intelligence-assisted diagnosis system could predict the invasive subtypes of early‑stage lung adenocarcinoma appearing as pulmonary nodules, and has a certain predictive value. With the optimization of algorithms and the improvement of data, it may provide guidance for individualized treatment of patients.
Adenocarcinoma/pathology* ; Adenocarcinoma of Lung/pathology* ; Artificial Intelligence ; Humans ; Lung Neoplasms/pathology* ; Multiple Pulmonary Nodules ; Neoplasm Invasiveness ; Retrospective Studies

The incidence of rib fracture in patients with chest trauma is about 70%. Simple rib fractures do not need special treatment. Multiple rib fractures and flail chest are critical cases of blunt trauma, which often cause serious clinical consequences and need to be treated cautiously. Nowadays, there is a controversy about the diagnosis and treatment of multiple rib fractures and flail chest. In the past, most of the patients were treated by non-operative treatment, and only less than 1% of the patients with flail chest underwent surgery. In recent years, studies have confirmed that surgical reduction and internal fixation can shorten the hospital stay, and reduce pain and cost for patients with flail chest, but there is still a lack of relevant clinical consensus and guidelines for diagnosis and treatment, which leads to great differences in clinical diagnosis and treatment plans. This article reviewed the treatment, surgical indications and surgical timing of multiple rib fractures and flail chest.