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*

Objective:To evaluate the clinical efficacy of inferior gluteus maximus muscle-pedicled myocutaneous flap for reconstruction of stage Ⅳ ischial pressure sores.Methods:Clinical data of patients with stage Ⅳ ischial pressure sores treated between April 2020 and September 2023 at the First People’s Hospital of Yulin were retrospectively analyzed. Underlying comorbidities were treated preoperatively to assure surgical safety. Stage Ⅰ management involved radical debridement of infected tissue followed by vacuum sealing drainage (VSD). Stage Ⅱ reconstruction was performed after inflammation control. An inferior gluteus maximus-pedicled myocutaneous flap was designed laterally to the defect. The muscle component width exceeded the skin paddle width, with the distal muscle extending about 3 cm beyond the skin island. The flap was advanced medially in a V-Y fashion to cover the defect. The donor site was sutured in layers. Postoperative flap viability, wound healing, aesthetic outcomes, and pressure sores recurrence were assessed.Results:A total of 20 patients were included in this study. Among them, 14 were males and 6 were females. The age ranged from 27 to 72 years, with a mean age of 52.3 years. The body mass index (BMI) ranged from 17.8 to 31.3 kg/m 2, with a mean BMI of 21.0 kg/m 2. All had paraplegia secondary to spinal cord injury. Comorbidities included type 2 diabetes and (or) hypertension (10 cases) and ischial osteomyelitis (3 cases). Pressure sores duration ranged from 1 month to 3 years. Defect sizes were 3 cm×4 cm to 5 cm×10 cm (depth: 3-6 cm). Flap sizes matched defects (3 cm×4 cm to 5 cm×10 cm), with muscle dimensions of 2 cm×5 cm×9 cm to 3 cm×8 cm×15 cm. Postoperatively, all 20 flaps showed good blood supply without flap necrosis. The wound healing time ranged from 12 to 22 days (mean: 15 days). Seventeen cases achieved primary wound healing. The remaining three cases developed fat liquefaction at the donor sites, but their wounds eventually healed after dressing changes on postoperative days 18, 20, and 22, respectively. During follow-up (mean: 13 months, range: 6-34 months), the flaps maintained good texture with no recurrence. Conclusion:The inferior gluteus maximus muscle-pedicled myocutaneous flap provides sufficient bulk, simple design, and reliable transposition for dead-space obliteration and surface coverage in stage Ⅳ ischial pressure sores. This technique yields favorable aesthetics and low recurrence rates.

Objective:To evaluate the clinical efficacy of inferior gluteus maximus muscle-pedicled myocutaneous flap for reconstruction of stage Ⅳ ischial pressure sores.Methods:Clinical data of patients with stage Ⅳ ischial pressure sores treated between April 2020 and September 2023 at the First People’s Hospital of Yulin were retrospectively analyzed. Underlying comorbidities were treated preoperatively to assure surgical safety. Stage Ⅰ management involved radical debridement of infected tissue followed by vacuum sealing drainage (VSD). Stage Ⅱ reconstruction was performed after inflammation control. An inferior gluteus maximus-pedicled myocutaneous flap was designed laterally to the defect. The muscle component width exceeded the skin paddle width, with the distal muscle extending about 3 cm beyond the skin island. The flap was advanced medially in a V-Y fashion to cover the defect. The donor site was sutured in layers. Postoperative flap viability, wound healing, aesthetic outcomes, and pressure sores recurrence were assessed.Results:A total of 20 patients were included in this study. Among them, 14 were males and 6 were females. The age ranged from 27 to 72 years, with a mean age of 52.3 years. The body mass index (BMI) ranged from 17.8 to 31.3 kg/m 2, with a mean BMI of 21.0 kg/m 2. All had paraplegia secondary to spinal cord injury. Comorbidities included type 2 diabetes and (or) hypertension (10 cases) and ischial osteomyelitis (3 cases). Pressure sores duration ranged from 1 month to 3 years. Defect sizes were 3 cm×4 cm to 5 cm×10 cm (depth: 3-6 cm). Flap sizes matched defects (3 cm×4 cm to 5 cm×10 cm), with muscle dimensions of 2 cm×5 cm×9 cm to 3 cm×8 cm×15 cm. Postoperatively, all 20 flaps showed good blood supply without flap necrosis. The wound healing time ranged from 12 to 22 days (mean: 15 days). Seventeen cases achieved primary wound healing. The remaining three cases developed fat liquefaction at the donor sites, but their wounds eventually healed after dressing changes on postoperative days 18, 20, and 22, respectively. During follow-up (mean: 13 months, range: 6-34 months), the flaps maintained good texture with no recurrence. Conclusion:The inferior gluteus maximus muscle-pedicled myocutaneous flap provides sufficient bulk, simple design, and reliable transposition for dead-space obliteration and surface coverage in stage Ⅳ ischial pressure sores. This technique yields favorable aesthetics and low recurrence rates.

Objective:To investigate the clinical effect of using perforator flaps with the microsurgical technique in repairing secondary wounds after resecting superficial malignant tumors.Methods:A retrospective observational study was conducted in patients with superficial malignant tumors admitted to the Yulin NO.1 People’s Hospital from January 2018 to January 2021. After comprehensive examinations and multidisciplinary consultations, tumors were completely or palliatively resected based on results of the preoperative diagnosis and the intraoperative fast pathological test of cutting edge. Perforator flaps were used to repair the secondary wounds with microsurgical technique. The type of perforator flaps, including the lateral femoral circumflex artery perforator flap, the thoracodorsal artery perforator flap, the inferior epigastric artery perforator flap, the superficial iliac circumflex artery perforator flap, were decided by the intraoperative position, the defect size, the caliber and length of the blood vessel, etc. Postoperative conditions of the patients were observed.Results:Twenty-nine cases were included, with 19 males and ten females, aged from 28 to 69 years. Locations of the tumors included head and face (13 cases), upper extremity (four cases), lower extremity (six cases), and chest wall regions (six cases). The pathological type included 12 cases of squamous cell carcinoma, four of basal cell carcinoma, nine of sarcoma, and four of advanced breast cancer. The size of the wound after tumor resection ranged from 9.0 cm×7.5 cm to 22.0 cm×17.0 cm. There were 20 cases repaired with the lateral femoral circumflex artery perforator flap, four with the thoracodorsal artery perforator flap, four with the inferior epigastric artery perforator flap, and one with the superficial iliac circumflex artery perforator flap. The size of the flap ranged from 10.0 cm×9.0 cm to 24.0 cm×18.0 cm. One case had venous reflux obstruction and survived after exploringa bridging vein. One case suffered from the arterial crisis. Since this patient refused the exploration surgery, the skin-grafting was used to repair after flap necrosis. In addition, the other flaps survived successfully. Twenty-five patients achieved R0 resection. No recurrence was observed, and the appearance of the tumor was smooth after half a year to two years of follow-up. Four cases of advanced breast cancer were treated with palliative resection. The wounds were repaired and showed no recurrence. The quality of life was improved in the survival period. The donor site was closed directly in 13 cases, and thick skin grafting was used to cover the remaining 16 cases. No dysfunction was left.Conclusions:Using perforator flaps with microsurgical technique can repair the large and composite wound after extensive resection of malignant tumors. It is an essential guarantee for surgical treatment of body surface malignant tumors.

Objective:To investigate the clinical effect of using perforator flaps with the microsurgical technique in repairing secondary wounds after resecting superficial malignant tumors.Methods:A retrospective observational study was conducted in patients with superficial malignant tumors admitted to the Yulin NO.1 People’s Hospital from January 2018 to January 2021. After comprehensive examinations and multidisciplinary consultations, tumors were completely or palliatively resected based on results of the preoperative diagnosis and the intraoperative fast pathological test of cutting edge. Perforator flaps were used to repair the secondary wounds with microsurgical technique. The type of perforator flaps, including the lateral femoral circumflex artery perforator flap, the thoracodorsal artery perforator flap, the inferior epigastric artery perforator flap, the superficial iliac circumflex artery perforator flap, were decided by the intraoperative position, the defect size, the caliber and length of the blood vessel, etc. Postoperative conditions of the patients were observed.Results:Twenty-nine cases were included, with 19 males and ten females, aged from 28 to 69 years. Locations of the tumors included head and face (13 cases), upper extremity (four cases), lower extremity (six cases), and chest wall regions (six cases). The pathological type included 12 cases of squamous cell carcinoma, four of basal cell carcinoma, nine of sarcoma, and four of advanced breast cancer. The size of the wound after tumor resection ranged from 9.0 cm×7.5 cm to 22.0 cm×17.0 cm. There were 20 cases repaired with the lateral femoral circumflex artery perforator flap, four with the thoracodorsal artery perforator flap, four with the inferior epigastric artery perforator flap, and one with the superficial iliac circumflex artery perforator flap. The size of the flap ranged from 10.0 cm×9.0 cm to 24.0 cm×18.0 cm. One case had venous reflux obstruction and survived after exploringa bridging vein. One case suffered from the arterial crisis. Since this patient refused the exploration surgery, the skin-grafting was used to repair after flap necrosis. In addition, the other flaps survived successfully. Twenty-five patients achieved R0 resection. No recurrence was observed, and the appearance of the tumor was smooth after half a year to two years of follow-up. Four cases of advanced breast cancer were treated with palliative resection. The wounds were repaired and showed no recurrence. The quality of life was improved in the survival period. The donor site was closed directly in 13 cases, and thick skin grafting was used to cover the remaining 16 cases. No dysfunction was left.Conclusions:Using perforator flaps with microsurgical technique can repair the large and composite wound after extensive resection of malignant tumors. It is an essential guarantee for surgical treatment of body surface malignant tumors.

Objective To explore the clinical effect of gluteal pressure sore repaired by superior and inferior perforating artery island flap with rotation and joint propulsion.Methods From January 2014 to April 2018,37 patients (27 males,10 females,aged 35～79 years) with hip decubitus were admitted to the First People's Hospital of Yulin City for treatment of hip decubitus.According to the situation of the wound surface,the perforating site of superior and inferior perforator arteries and the local soft tissue,the corresponding perforator arteries were selected as the pedicle to form island skin flap,and the wound surface was transferred by rotation and propulsion.Results All the flaps sur vived well.33 cases healed in the first stage,but 4 cases dehisced and infected in the incision.After dressing change,the wounds healed in the second stage and the wounds were locally smooth.Conclusions The rotational combined push type gluteal superior and inferior perforator island flap is a good method to repair gluteal pressure sore.

Objective:To explore the clinical effects of individualized free anterolateral thigh flap in repairing complex refractory wound.Methods:From July 2015 to May 2019, 19 patients with complex refractory wounds were hospitalized in Yulin NO.1 People′s Hospital of Guangxi Zhuang Autonomous Region, including 12 males and 7 female, aged 13-67 years. There were 5 patients with multiple tissue defects, 7 patients with large area of wounds, and 7 patients with wounds in special areas. The sizes of wounds after complete debridement were 8 cm×5 cm-23 cm×7 cm. According to the repair demand, the wounds in 5 patients were repaired with anterolateral thigh flaps and flow-through, the wounds in 7 patients were repaired with anterolateral thigh flaps chimed with lateral thigh muscle flaps, with vascular anastomosis in 2 patients, the wounds in 6 patients were repaired with unilateral anterolateral thigh lobulated flaps, and the wound in 1 patient was repaired with bilateral anterolateral thigh flap in series connection. The sizes of flaps were 10 cm×7 cm-25 cm×9 cm. The donor sites were sutured directly or repaired with thin split-thickness skin graft of head. The survival of the flaps, the appearance of the donor sites, and wounds repair after the operation and during follow-up were observed.Results:The lobulated flap in 1 patient had local necrosis after the operation and finally healed by debridement, dressing change, and transplanting medium split-thickness skin graft in groin. The flaps in 18 patients survived with good blood supply, and the lobulated flap tissue was swollen in 1 of 18 patients. The donor sites which were directly sutured in 18 patients only had linear scar, and the donor site which was repaired with thin split-thickness skin graft of head in 1 patient had flaky scar. Follow-up of 1-12 months showed that all the wounds healed well, the flap thinning operations were performed in 5 patients in 3 months post operation because the flaps were slightly bloated. The CT angiography after the operation showed that the anastomosed blood vessels were unobstructed in 7 patients with reconstructed local blood supply.Conclusions:The special forms of anterolateral thigh flap, such as lobulation, series connection, and chimerism can be designed according to the anatomical characteristics of the descending branch of the lateral femoral artery to meet individualized repair demand for complex refractory wounds, and achieve the double purposes of making full use of the donor site tissue and good repair of the recipient site.

Objective: To explore the clinical effect of free latissimus dorsi myocutaneous flap in the repair of head composite tissue defect. Methods: From July 2015 to April 2018, 7 patients with head composite tissue defect, which included 5 males and 2 females, aged from 10 to 52 years old were admitted in the First People′s Hospital of Yulin. The wounds were caused by various reasons 5 cases of head squamous cell carcinoma, 1 case of electric injury and 1 case of trauma. For tumor patients combined with neurosurgery to remove the lesion tissue, the latissimus dorsi myocutaneous flap were cut and transplanted to cover the wound immediately after the thorough expansion of trauma patients, and the donor area were closed directly or byskin grafts. Results: The latissimus dorsi musculocutaneous flaps were cut with areas from 16 cm×6 cm to 28 cm×20 cm, 6 cases of thoracic and dorsal vessels anastomos is with the superficial temporal vessels, and 1 case of thoracic and dorsal vessels anastomosis with occipital vessels. The blood supply of myocutaneous flaps were good in 6 cases, and venous crisis occurred in 1 case on the second day after the operation. Postoperative follow-up was conducted for 3 months to 1 year. No tumor recurrence was observed in the tumor patients, and the wound surfaces were locally smooth. Conclusions The latissimus dorsi musculocutaneous flap is a good method for repairing the defect of the head composite tissue defect with big size and good blood supply.

Objective To summarize the clinical experience of intractable epistaxis under nasal endoscope in the treatment of elderly people .Methods 312 cases of endoscope of intractable epistaxis patients were retrospectively analyzed.Results Nasal septum and olfactory corresponding head of middle turbinate bleeding site was mainly the upper part of the nasal cavity and the split-plot,back-end middle turbinate at the back of the nose and nasal were fol-lowed,as well as inferior turbinate and the rear end of inferior nasal meatus ,the Littell nasal septum of the front nose were bleeding less .After nasal endoscopic radio hemostatic therapy or local packing treatment with expansive sponge , 310 cases were cured,2 cases were invalid.The total efficiency was up to 99.4%.During the following 3 months,there was no recurrence .Conclusion For the elderly intractable epistaxis hemostatic therapy ,under nasal endoscope oper-ation method,radio hemostatic therapy or local packing treatment with expansive sponge is simple and effective ,which is worthy of popularization and application .

Objective To explore a better medication by analyzing retrospectively 179 cases with confirmed auricle pseudocyst.Methods A comparative study was carried out for the clinical effects of injecting triamcinolone acetonide in cavity with that of washing the cyst using dexamethasone and fixing it with gypsum.Results There was significant difference between the two groups(P