Objective:The clinical factors of single-port video-assisted thoracoscopic surgery (SP-VATS) were compared with those of multi-port video-assisted thoracoscopic surgery (MP-VATS). The differences between the two surgical methods and their respective postoperative recoveries were also discussed. Methods:A total of 522 patients who underwent surgical treatment for lung cancer in Tianjin Medical University Cancer Institate and Hospital from January, 2014 to December, 2015 were retrospectively reviewed. Of these cases, 83 underwent SP-VATS and 439 underwent MP-VATS. The two surgical methods were then compared in terms of opera-tive time, operative bleeding, number of lymph node and lymph node cleaning station, pain degree, 24 h postoperative chest drain-age, and in-hospital time after operation. Results:The differences between the patients who underwent SP-VATs and those who under-went MP-VATS in term of gender, age, smoking, tumor diameter, TNM stage, pathological type, and tumor location were not statistical-ly significant. The operative time in SP-VATS group was longer than that in the MP-VATS group (P<0.01), whereas in-hospital time after operation in the former group was shorter than that in the latter (P=0.011). Furthermore, pain degree in the SP-VATS group is lower than that in the MP-VATS group (P=0.041). The differences between the two groups in terms of operative bleeding, number of lymph node and lymph node cleaning station, and 24 h postoperative chest drainage were not statistically significant. Conclusion:SP-VATS can achieve a surgical effect similar to that of MP-VATS but has a prolonged operation time. SP-VATS is beneficial to postoperative re-covery and reduces the degree of pain. Thus, it has great potential for development.

Objective:To investigate the relationship between serum carcinoembryonic antigen (CEA) and the predictive value of epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer patients, as well as to analyze further EGFR muta-tions and CEA levels affecting patient survival. Methods:From March 2009 to March 2011, a total of 387 cases were treated in the Lung Cancer Department in Tianjin Cancer Hospital. Preoperative CEA tumor marker and postoperative EGFR gene mutation were used for routine detection. The influence of CEA tumor marker on EGFR mutation and its relationship with the prognosis were ana-lyzed further. Results:A total of 168 cases involved EGFR mutations, the incidence of which is more frequent in women, non-smokers, adenocarcinoma patients, and patients below 60 years old (P<0.05). This study also determined that EGFR mutation was related with tu-mor markers and chemosensitivity indicators. Elevated Cyfra21-1, SCC, and ERCC1-positive are more common in wild-type patients (P<0.05). However, abnormal CEA was more common in EGFR mutation patients (P=0.015). The rate of EGFR gene mutations signifi-cantly increased as the serum CEA level increased. Serum CEA levels were divided into three groups (<5, 5-20, and>20). The positive rates of EGFR mutations were 40.1%, 47.5%and 66.6%(P=0.003). Logistic regression analysis determined that CEA levels are inde-pendent factors in predicting EGFR mutations and independent prognostic factors in patients with non-small cell lung cancer. Conclu-sion:Serum CEA levels can independently predict the prognosis of resected non-small cell lung cancer patients, which is has a close re-lationship with EGFR mutations.

[Objective] To explore the characteristics of the plantar pressure data of the patients with adolescent idiopathic scoliosis (AIS).[Methods] 56 AIS patients who were diagnosed from October 2015 to March 2017 in the East branch of the First Affiliated Hospital of Sun Yat-sen University divided into 3 groups,18 cases in spinal lateral bending to right,18 cases in spinal lateral bending to left,20 cases in type S who were thoracolumbar scoliosis.Another 19 healthy persons were as the control group.The left and right foot pressure,half foot pressure and other biomechanical data were compared.The changes of the plantar pressure and the Cobb angle were analyzed with the patients who wore orthopedic insoles.[Results] Compared with the control group,the mean pressure of the left foot and the pressure of the left anterior half of the right bending group were less than those of the control group,and the right half foot pressure were greater than those of the control group (P ＜ 0.017).To the left bending group,the mean pressure of right anterior half foot were less than those of the control group,and the right rear half foot pressure was greater than that of the control group (P ＜ 0.017).The pressure of the left anterior half foot of the S type scoliosis group was less than that of the control group.To the right bending group,the left foot average pressure (44.7％±6.0％) was significantly less than the average pressure of right foot (55.4％ ± 6.0％).There was no difference in bilateral plantar pressure of the left bending group,S type group and control group.There was difference with the plantar pressure distribution in patients with only one curve after they wore orthotic insoles,but there was no difference in patients with type S.There was no significant difference in the Cobb angle after the patients wearing the orthotic insoles (P =0.102).[Conclusions] The right and left foot pressure symmetry of the right bending patients is poor,but the left and right plantar pressure in the patients with type S is symmetrical.The orthotic insole can be used to adjust the plantar pressure distribution in patients with a single curved scoliosis (left or right),but their effect on the patient's spinal lateral curvature should be further observed.

BACKGROUNDThe roles of nuclear factor kappa B (NF-kappa B) and activating protein 1 (AP-1) become well-known in cell apoptosis and proliferation and oncogenesis. This study aims to explore expression of NF-kappa B and AP-1 in non-small cell lung cancer (NSCLC), the relationship between them and their function on expression of cyclin D1 and caspase 3 in NSCLC.

METHODSProtein expression of NF-kappa B, AP-1 , cyclin D1 and caspase 3 was detected by Western blot and mRNA expression of cyclin D1 and caspase 3 by RT-PCR. Correlation between NF-kappa B and AP-1 was analyzed using bivariate correlate analysis.

RESULTSOf all 45 NSCLC patients, the expression of NF-kappa B and AP-1 in NSCLC was higher than that in normal lung tissues (0.6047 versus 0.2798, P < 0.01). Protein and mRNA expression of cyclin D1 in lung cancer tissues with higher NF-kappa B and AP-1 protein expression was higher than in those with lower NF-kappa B and AP-1 protein expression (P < 0.01), while protein and mRNA expression of caspase 3 in lung cancer tissues with higher NF-kappa B and AP-1 protein expression was lower than in those with lower NF-kappa B and AP-1 protein expression (P < 0.01). There was significant correlation between NF-kappa B and AP-1 (r=0.800, P < 0.01).

CONCLUSIONSTranscription factors, NF-kappa B and AP-1 may play important roles in oncogenesis and development of NSCLC.

Objective: The expression of WNT5A is associated with aggressive tumor biology and poor clinical outcomes of various types of cancer. However, its function in the cell migration of small cell lung cancer (SCLC) should be elucidated. Methods:The expres-sion of WNT5A in SCLC and normal lung tissues was detected by immunohistochemisty. The correlation between the expression and clinical characteristics of WNT5A was analyzed. The function of WNT5A in regulating cell migration was studied in DMS153 cell line in vitro. Small interfering RNA (SiRNA) was used to knock down WNT5A. Wound healing and Transwell tests were used to determine the migration rate of DMS153. The phosphorylated JNK expression was detected by Western blot analysis. Results:The WNT5A expression was higher in SCLC tissues than that of normal lung tissues. WNT5A was correlated with clinical stages, lymph nodes, and distance me-tastasis in SCLC. The high expression of WNT5A was accompanied by abnormal levels of NSE and Pro-GRP. The WNT5A phosphoryla-tion of JNK promoted cell migration in vitro. Conclusion:The expression of WNT5A in SCLC is high and correlated with tumor metasta-sis. The influence of WNT5A/JNK on the cell migration property of DMS153 supports the concept that WNT5A can initiate the cell mi-gration of SCLC, which suggested that WNT5A may be a marker and can be potentially used as an effective therapeutic target for the SCLC metastasis.

BACKGROUNDTo explore predictors of mediastinal and intrapulmonary pathologic lymph node involvement in clinical stage I non-small cell lung cancer.

METHODSFrom July 1999 to April 2001, 159 patients with clinical stage I non-small cell lung cancer underwent lobectomy and complete mediastinal or intrapulmonary lymph node dissection. All the resected lymph nodes were pathologically analyzed to find out pathologic involvement. Univariate and multivariate analyses were used to clarify predictors of lymph node metastasis.

RESULTSOf all 159 patients, 37 (23%) had pathologic lymph node metastasis. According to logistic regression analysis, tumor size, grade of cell differentiation, and pleural invasion were the significant predictors of lymphatic metastasis ( P=0.003, P=0.004, P =0.005). Patients with 2 or more factors were more liable to have lymph node metastasis than those with less than 2 factors ( P < 0.001).

CONCLUSIONSWhen patients with clinical stage I non-small cell lung cancer have such clinical factors as tumor diameter > 2.0 cm, moderate or poor differentiation, or pleural invasion, they will be more liable to have lymph node metastasis. Therefore, it should be more prudent to select therapeutic way and judge their prognosis.

BACKGROUNDBiochemical and genetic researches suggest that ras protein plays an important role in transduction process of cell proliferation differentiation signals from activated transmembrane receptors to substream protein kinases. This study is to explore the expression of ras, p38, both of which are members of MAPK (mitogen activated protein kinases) signal transduction pathway, and STAT3 (signal transducer and activator of transcription 3) in non-small cell lung cancer, and the association among them.

METHODSForty-two resected lung cancer and paracancerous lung tissue samples were used to determine the protein expression of ras, p38 and STAT3 with Western blot, the mRNA expression of p38 and STAT3 in lung cancer tissues of various ras protein expression with RT-PCR. The location of p38 and STAT3 in lung cancer tissues was revealed with immunofluorescent staining.

RESULTSThe relative protein expressions of ras, p38 and STAT3 were 0.6012, 0.6724, 0.5119 in cancer tissues, and 0.2793, 0.3071, 0.1917 in paracancerous lung tissues, respectively (P < 0.01). The protein and mRNA expressions of p38 and STAT3 ( 0.7624 and 0.6262; 1.0309 and 1.0538) in cancer tissues with higher ras protein expression were remarkably higher than those with lower ras protein expression (0.4715 and 0.2569; 0. 6569 and 0.3437, P < 0.01). There was a significant correlation between the expression of ras, p38 and STAT3 (correlation coefficient: 0.809 and 0.842, P < 0.01), and so was the p38 and STAT3 (correlation coefficient: 0.829, P < 0.01).

CONCLUSIONSAbnormal expressions of STAT3 and some factors of ras-MAPK signal transduction pathway exist in the oncogenesis and development of non-small cell lung cancer, and many of them may have crosstalk.

BACKGROUNDSleeve recestion for lung cancer can get similar tumor and lymph node resection rate as pneumonectomy, with less influence on pulmonary function and much improvement of quality of life. The aim of this study is to compare the 5-year survival and complications of sleeve resection and pneumonectomy for lung cancer.

METHODSSurvival analysis was used to investigate the 5-year survival of 173 patients undergoing sleeve resection and 435 patients undergoing pneumonectomy from January 1990 to December 2000. Their complication and perioperative motality were also analyzed.

RESULTSThe overall 5-year survival for sleeve resection and pneumonectomy was 42.3% and 30.9%, respectively (P=0.007). 5-year survival of right lung sleeve resection was better than that of left lung [P=0.004 (N0), 0.025 (N1), 0.042 (N2)]. In left lung cancer patients without nodal involvement, the survival after sleeve resection was better than that after pneumonectomy. There was no survival difference between N1 and N2 lung cancer patients. Survival was not significantly different for bronchoplasty and pulmonary arterioplasty and pneumonectomy. The incidence rate of pneumonia and arrhythmia for sleeve resection was less than those for pneumonectomy (P=0.0019), and no significant difference of mortality was observed between the two groups.

CONCLUSIONSIn lung cancer patients suitable for sleeve resection or pneumonectomy, sleeve resection should be performed for right lung cancer and left lung cancer of stage I. Bronchoplasty and pulmonary arterioplasty don't prolong the survival of lung cancer patients compared with pneumonectomy.

Lung cancer is the most common malignant tumor in the world. In order to improve the survival rate of patients with advanced lung cancer, more effective treatment methods are needed,in which immunotherapy has a broad therapeutic prospect. In recent years, immune-checkpoint inhibitors have received extensive attention in the treatment of lung cancer. Significant progress has been made in the development of a variety of first-line and second-line treatments, and significant advances have been made in the treatment of advanced lung cancer. With the successful application of immune-checkpoint inhibitors, neoadjuvant therapy has attracted extensive attention. In addition, the successful application of combined therapies such as immune combined immunization, immune combined tyrosine kinase inhibitor (TKI) and immune combined chemotherapy improved the survival rate of patients to some extent. However, pseudo progression and drug resistance has become a non-negligible problem in the immunotherapy of non-small cell lung cancer, which is worthy of further study. Although immune-checkpoint inhibitors have once again brought attention to tumor immunotherapy, their side effects are also worthy of attention. The recent advances in the application of immune-checkpoint inhibitors in lung cancer were summarized in order to provide a theoretical basis for its clinical application.

Objective:To explore any changes in the electromyographic (EMG) signals from the deep lumbar multifidus (DM) of patients with chronic low back pain (cLBP).Methods:Twenty-five cLBP patients formed the cLBP group, while twenty-eight healthy counterparts similar in sex, age and education background were chosen as the control group. EMG signals were recorded during maximum isometric voluntary contraction of the DM. Two-way repeated measures analysis of variance was applied to compare the two groups′ signals′ Lempel-Ziv (LZ) complexity values at rest and during the maximum strength, strength endurance and relaxation stages of contraction. Pearson correlation coefficients were computed relating the LZ complexity to pain duration and intensity, as well as to Oswestry disability index (ODI) values in the cLBP group.Results:The cLBP patients reported a mean symptom duration of 5.96±4.69 years, with an average VAS score of 4.00±1.04 and ODI of 17.12±10.49. They reported greater pain intensity during needle insertions, needle removal, muscle contraction and relaxation than the healthy controls. There were significant differences in LZ complexity among the four stages of contraction with all of the subjects. The LZ complexity was significantly lower in the maximum strength and strength endurance states, but higher in the relaxation after contraction states in the cLBP group. Pain duration was negatively correlated with the nonlinear index of DM during contraction.Conclusion:Continuous pain stimulation will affect the coordinated control of the deep multifidus muscle, leading to decreased control of core muscles via the central nervous system. That provides insight into the mechanisms underlying activation and coordinated control during chronic pain.