BACKGROUND: Lung adenocarcinoma is an important pathohistologic subtype of non-small cell lung cancer (NSCLC). Invasive non-mucinous pulmonary adenocarcinomas (INMA) tend to have a poor prognosis due to their significant heterogeneity and diverse histologic components. Establishing a histologic grading system for INMA is crucial for evaluating its malignancy. In 2021, the International Association for the Study of Lung Cancer (IASLC) proposed that a new histological grading system could better stratify the prognosis of INMA patients. The aim of this study was to establish a visualized nomogram model to predict INMA IASLC grading preoperatively by means of dual-energy computed tomography (DECT), fractal dimension (FD), clinical features and conventional CT parameters. METHODS: A total of 112 patients with INMA who underwent preoperative DECT were retrospectively enrolled from March 2021 to January 2025. Patients were categorized into low-intermediate grade and high grade groups based on IASLC grading. The clinical characteristics and conventional CT parameters, including baseline features, biochemical markers, and serum tumor markers, were collected. DECT-derived parameters, including iodine concentration (IC), effective atomic number (eff-Z), and normalized IC (NIC), were collected and determined as NIC ratio (NICr) and fractal dimension (FD). Univariate analysis was employed to compare differences in conventional characteristics and DECT parameters between the two groups. Variables demonstrating statistical significance were subsequently incorporated into a multivariate Logistic regression analysis. A nomogram model integrating clinical data, conventional CT parameters, and DECT parameters was developed to identify independent predictors for IASLC grading of INMA. The discriminatory performance of the model was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Multivariate analysis identified smoking history [odds ratio (OR)=2.848, P=0.041], lobulation sign (OR=2.163, P=0.004), air bronchogram (OR=7.833, P=0.005), eff-Z in arterial phase (OR=4.266, P<0.001), and IC in arterial phase (OR=1.290, P=0.012) as independent and significant predictors for IASLC grading of INMA. The nomogram model constructed based on these indicators demonstrated optimal predictive performance, achieving an area under the curve (AUC) of 0.804 (95%CI: 0.725-0.883), with specificity and sensitivity of 85.3% and 65.7%, respectively. CONCLUSIONS The nomogram model based on clinical features, imaging features and spectral CT parameters have a large potential for application in the preoperative noninvasive assessment of INMA IASLC grading.
Humans ; Nomograms ; Female ; Male ; Middle Aged ; Tomography, X-Ray Computed/methods* ; Lung Neoplasms/pathology* ; Aged ; Retrospective Studies ; Adenocarcinoma of Lung/pathology* ; Neoplasm Grading ; Adult

BACKGROUND: In inguinal hernia repair, the choice of mesh based on the characteristics of a single piece of mesh remains controversial. The long-term outcome of hernia recurrence and mesh-specific complications need to be evaluated. OBJECTIVE: To investigate the effects of 3D Max mesh versus common mesh for laparoscopic inguinal hernia repair on surgical outcomes and quality of life. METHODS: 142 patients with uncomplicated inguinal hernia who received treatment between February 2013 and January 2016 in Qinhuangdao Cerebrovascular Disease Hospital were included in this study. These patients consisted of 131 males and 11 females and were aged 18-60 years. They were randomly divided into a 3D Max mesh group (n=80) and ordinary mesh group (n=62) according to the mesh materials used. Surgical details and outcomes, recurrence rate, complications and hospitalization costs were recorded. Quality of life was evaluated before surgery, 2 weeks and 1, 6, 12 and 24 months after surgery using the Carolinas Comfort Scale. The study was approved by the Medical Ethics Committee of Qinhuangdao Cerebrovascular Disease Hospital, China (approval No. 2013-002-02). RESULTS AND CONCLUSION: (1) The operation time, time to ambulation, and hospitalization expense in the 3D Max mesh group were significantly reduced compared with the ordinary mesh group (P < 0.05). The incidence of seroma in the 3D Max mesh group was significantly lower than that in the ordinary mesh group (7.5%, 21.5%, P < 0.001). There were no significant differences in the incidences of hernia and other complications between 3D Max mesh and ordinary mesh groups (P > 0.05). (2) The pain sensation score in the 3D Max mesh group at 2 weeks and 1 month after surgery was significantly lower than that in the ordinary mesh group (P < 0.05). At 2 weeks and 1, 6, 12, and 24 months after surgery, there were no significant differences in total quality of life score, score of colic sensation, and motor limitation between 3D Max mesh and ordinary mesh groups (P > 0.05). (3) These results suggest that compared with ordinary mesh, 3D Max mesh can effectively shorten operation time, decrease hospitalization expense, and decrease the incidence of postoperative short-time chronic pain.

Objective To explore the correlation between the occurrence of pulmonary infection after thoracotomy and preoperative pulmonary function indexes in patients with esophageal cancer,and to provide clinical theoretical basis for reducing the incidence of pulmonary infection after thoracotomy.Methods The clinical data of 80 patients with esophageal cancer who underwent thoracotomy from May 2017 to May 2018 in Qinhuangdao Military Industrial Hospital of Hebei Province were retrospectively analyzed.The patients were divided into infected group and uninfected group according to whether pulmonary infection occurred after operation.The preoperative maximal voluntary ventilation (MVV),MVV as a percentage of predicted value (MVV％pred),forced vital capacity (FVC),FVC as a percentage of predicted value (FVC％ pred),forced expiratory volume in one second (FEV1),FEV1 as a percentage of predicted value (FEV1％ pred),peak expiratory flow (PEF),PEF as a percentage of predicted value (PEF％ pred) of the two groups were compared and analyzed.Logistic regression was used to analyze the correlation between pulmonary function indexes and postoperative pulmonary infection.Results Postoperative pulmonary infection occurred in 24 out of 80 patients (30.00％).There was no correlation between gender (t =1.755,P =0.086),nationality (t =2.125,P =0.073) and the severity of pulmonary infection after operation.Age (t =4.084,P =0.024),smoking history (t =5.881,P =0.001),operation duration (t =3.583,P =0.041),intraoperative bleeding volume (t =5.115,P =0.003) and combined basic diseases (t =4.574,P =0.018) were significantly correlated with the severity of pulmonary infection after operation.MVV (x2 =4.242,P =0.039),MVV％ pred (x2 =4.405,P =0.036),FVC (x2 =17.500,P ＜0.001),FVC％pred (x2 =12.382,P ＜0.001),FEV1 (x2 =12.070,P =0.001) were associated with pulmonary infection.FVC (OR =9.102,95％ CI:2.691-28.213,P =0.027),FEV1 (OR =21.621,95％ CI:8.956-81.145,P =0.002) and MVV％ pred (OR =5.648,95％ CI:2.979-15.248,P =0.001) were high risk factors for pulmonary infection.Conclusion Partial pulmonary function indexes are significantly associated with postoperative pulmonary infection.It is necessary to strengthen the detection and improvement of preoperative pulmonary function in order to reduce the incidence of pulmonary infection.

Objective This study aimed to evaluate the relationships between preservation of the intercostobrachial(ICB) nerve and abnormal sensation of the arm,the total time of the surgery,and the number of dissected nodes in patients submitted to axillary lymphadenectomy in surgical treatment of breast cancer.Methods An prospective,randomized,and double blind intervention was performed on 85 patients at the Qinhuangdao Military Hospital in Hebei Province from July 2007 to August 2010.The patients according to whether the ICB nerve was preserved or not were randomly divided into two groups.The surgeries were performed by the same two surgeons.The postoperative evaluations were performed at 2 days,30 days,and 90 days.The abnormal sensation of the arm was subjectively evaluated with an questionnaire and objectively assessed with a neurologic examination.Results In the never preserved group,questionnaire found asymptomatic patients' proportion is up to 16/42,19/41,25/41 after 2 d,30 d and 90 d respectively; while in the resection group the result is 12/43,7/43,12/42.In the never preserved group,neurologic examination reported asymptomatic patients' proportion is up to 22/42,16/41,22/41 after 2 d,30 d and 90 d respectively; while in the resection group the result is 5/43,3/43,7/42.The results suggests that the abnormal sensation propotion in the intercostobrachial nerve preserved group is significantly less than the control group at the three above time points over (P ＜ 0.05).No significant difference was observed on the total time of the surgery and the number of dissected nodes between the two groups.During the 36 months follow up,no local relapse was found in the two groups.Conclusions The research support that the preservation of the ICB nerve is feasible and can lead to a significant decrease in the alteration of abnormal sensation of the arm,without interfering with the total time of the surgery,the number of dissected nodes,and local relapse rate.