The machine learning is used increasingly and widely in acupuncture prescription optimization, intelligent treatment and precision medicine, and has obtained a certain achievement. But, there are still some problems remained to be solved such as the poor interpretability of the model, the inconsistency of data quality of acupuncture research, and the clinical application of constructed models. Researches in future should focus on the acquisition of high-quality clinical and experimental data sets, take various machine learning algorithms as the basis, and construct professional models to solve various problems, so as to drive the high-quality development of acupuncture research.
Acupuncture Therapy/trends* ; Machine Learning ; Humans ; Algorithms

Objective To evaluate the perioperative safety of lung surgery for patients with corona virus disease 2019 (COVID-19). Methods We retrospectively analyzed the clinical data of the patients recovered from COVID-19 infection and received lung surgery from December 2022 to February 2023 in the Department of Thoracic Surgery at Beijing Hospital. Patients who received lung surgery and without COVID-19 at the same time were selected as a control group. Perioperative data between the two groups were compared. Results A total of 103 patients were included with 44 males and 49 females at an average age of (62.2±12.1) years. All surgeries were performed by uniportal video-assisted thoracoscopic surgery (VATS). Among patients who recovered from COVID-19, 53 (51.5%) received lobectomy, 30 (29.1%) received segmentectomy, and 20 (19.4%) received wedge resection. The interval between diagnosis of infection and lung surgery was ≤1 month in 32 (31.1%) patients, and >1 month in 71 (68.9%) patients. The results of virus nucleic acid test for all patients before surgery were negative. A total of 13 (12.6%) patients had positive IgM, and 100 (97.1%) patients had positive IgG. A total of 20 patients experienced perioperative complications (13 patients with pulmonary air leakage, 3 patients with chylothorax, 2 patients with atrial fibrillation, and 2 patients with severe pulmonary complications). There was one perioperative death. Comparing the patients who recovered from COVID-19 with those without COVID-19, we found no statistical difference in perioperative outcomes including surgical duration, postoperative drainage, duration of thoracic tube, and duration of postoperative stay (P>0.05). There was no significant difference in perioperative complications between the two groups (P>0.05). Multivariable logistical regression analysis demonstrated that positive IgM before surgery (OR=7.319, 95%CI 1.669 to 32.103, P=0.008), and longer duration of surgery (OR=1.016, 95%CI 1.003 to 1.028, P=0.013) were independent risk factors of perioperative complications for patients who recovered from COVID-19. Conclusion It is safe for patients recover from COVID-19 to receive lung surgery when symptoms disappear and the nucleic acid test turn negative. However, positive COVID-19 IgM is an independent risk factor for perioperative complications. We suggest that lung surgery could be performed when the nucleic acid test and COVID-19 IgM are both negative for patients recover from COVID-19 infection.

Objective:To evaluate the safety of thymic surgery in patients aged 65 years and over.Methods:A total of 696 patients who underwent thymectomy/thymoma resection in the Department of Thoracic Surgery of Beijing Hospital from November 2011 to March 2022 were collected and divided into two groups according to the age of 65 years old.The preoperative course of disease, MG stage, dosage of pyridostigmine bromide, American College of Anesthesiologists(ASA)score, surgical method, intraoperative bleeding, postoperative drainage, postoperative complications, Clavien-dindo score(CDC), and myasthenic crisis were recorded and statistically analyzed.Results:A total of 696 patients were enrolled, including 364 males and 332 females, aged 15~86 years, with an average age of 49.1 years.There were 309 patients with thymoma, 565 patients with MG, and 178 patients with both.There were 124 cases in the elderly group(≥65 years old)and 572 cases in the non-elderly group(<65 years old). The incidence of thymoma was higher in the elderly group(54.8 % versus 42.1 %, χ2=6.664, P=0.010), while the incidence of MG was lower(67.7 % versus 84.1 %, χ2=17.827, P<0.001). The ASA score of the elderly group was higher than that of the non-elderly group( χ2=52.372, P=0.000), and the preoperative ventilation function FEV1 and FEV1/FVC were also significantly lower than those of the non-elderly group( z=8.187, 4.580, P=0.000 for all). The drainage volume in the first 3 days after operation and postoperative drainage tube time in the elderly group were significantly higher than those in the non-elderly group( P=0.018, P=0.003). The incidence of postoperative myasthenia crisis in the elderly group was higher than that in the non-elderly group( P=0.034). There was no significant difference in the incidence of postoperative complications between the two groups, but after Clavien-dindo classification, the score of the elderly group was higher than that of the non-elderly group( P=0.003). Although the ASA score and Clavien-dindo score of the elderly group were both higher than those of the non-elderly group, there was no correlation between the two. Conclusions:Although the preoperative ASA score and pulmonary function of elderly patients were poorer than those in the non-elderly group, while the incidence of postoperative myasthenia crisis was higher, and the incidence of postoperative complications was not higher, the Clavien-dindo classification, however, was higher in elderly patients than that of the non-elderly group.After careful preoperative evaluation and strengthening perioperative management, most elderly patients can receive thymus surgery safely with acceptable risks.

Objective:To proceed a comparative study of characteristics and safety of video-assisted thoracoscopic thymectomy between artificial pneumothorax combining subxiphoid-costal margin approach versus right thoracic cavity approach.Methods:From January 2018 to December 2021, 251 patients(including myasthenia gravis with thymic hyperplasia or thymoma, thymic cysts and anterior mediastinal occupying lesions)undergoing thoracoscopic extended thymectomy in our department were retrospectively studied, and their clinical data were collected.The surgical methods were divided into artificial pneumothorax combining xiphoid costal margin approach(artificial pneumothorax group, n=165)and via right thoracic approach(right thoracic group, n=86). Clinical data such as preoperative information, operative duration, blood loss, postoperative drainage, drainage duration, and surgical complication were compared between two groups.Results:There were no statistical differences in age, gender and pathology between two groups(all P>0.05). Compared with the right thoracic group, operative duration[(108.6±45.2)min vs.(127.6±42.1)min, t=-3.628, P=0.000], intraoperative blood loss[(37.9±131.7)ml vs.(107.4±284.8)ml, t=-8.215, P=0.000], postoperative drainage volume[(379.0±285.5)ml vs.(646.6±373.3 ml), t=-6.277, P=0.000]and drainage duration[(2.2±1.0)d vs.(3.1±1.0)d, t=-7.275, P=0.000]were statistically significantly decreased in the artificial pneumothorax group.No significant difference was found(all P>0.05)in phrenic nerve injury(1/165 vs.0/86, P=1.000), myasthenia crisis(3/89 vs.2/66, χ2=0.014, P=0.906), and the conversion to thoracotomy(3/165 vs.2/86, P=1.000). Conclusions:VATS thymectomy by artificial pneumothorax combining subxiphoid-costal margin approach is a safer method, having a less trauma, less bleeding and less incidence rate of complication.Especially, it is more suitable for elderly female patients who cannot be intubated in double lumen, cannot tolerate one-lung ventilation, and have pulmonary insufficiency.

Objective:To evaluate the clinical characteristics and the surgical safety in patients aged 65 years and over with thymic epithelial tumor, and analyze the prognosis of 3-10 years postoperative tumor and myasthenia gravy.Methods:A total of 228 patients diagnosed as thymic tumor and undergoing surgical surgery to remove the tumor in Beijing Hospital from Jan.2011 to Dec.2018 were retrospectively enrolled.Patients were divided into a young(≤ 65 yrs)and old(>65 yrs)groups.The operation time, intra-operative bleeding, drainage volume in the first 3 days after operation, days with drainage tube after operation, postoperative days of hospital stays, the diameter of the tumors, pathological classification, Tumor-Node-Metastasis(TNM)staging, Masaoka-Koga staging, whether or not complicated with myasthenia gravis and complications were compared between two groups.The patients were followed up by outpatient or telephone, and recurrence of thymoma, survival status and improvement of myasthenia gravis were tracked.Results:There were significant differences in pathological classification between the two groups( P=0.002). The postoperative days with drainage tube were longer in patients≥65 years old than in patients<65 years old[4(2-17)days and 3(1-9), Z=2.316, P=0.021]. Thymic atrophy was more common in patients ≥ 65 years old than in patients <65 years old(10.2% and 1.7%, χ2=5.937, P=0.015). Incidence of thymoma plus myasthenia gravis were higher in patients aged <65 years than those aged ≥65years(68.2% vs.40.8%, χ2=12.240, P<0.001), and incidence of thymic hyperplasia were higher in patients aged <65 years than those aged ≥65years(58.1% and 38.8%, χ2=2.316, P=0.016). The recurrence of thymoma was a poor prognostic factor affecting the survival of patients.Meanwhile, Masaoka-Koga stage Ⅲ and Ⅳ and TNM stage Ⅲ and Ⅳ were independent risk factors for postoperative recurrence of thymoma. Conclusions:Thymectomy is safe and effective in the patients aged 65 and over, and may have a better long-term prognosis.

Objective:To compare the surgical effect of single-utility port and three port video-assisted thoracoscopic surgery(VATS) for patients of thoracic esophageal cancer.Methods:Patients who underwent McKeown surgery with single-utility port and three port VATS in Department of Thoracic Surgery at Beijing Hospital from January 2013 to December 2018 were enrolled. During the thoracic procedure, patients were placed forwardly in left lateral decubitus position. The video port was made at the eighth mid-axillary intercostal space, and the single-utility port was at the fourth intercostal space between antero-axillary and mid-axillary line. For three port VATS, another incision was made at the eighth posto-axillary intercostal space. The posterior mediastinum was exposed by the "suture-drawing exposure" method, then the thoracic esophagus was carefully dissected and mediastinal lymphadenectomy was done. Information was collected including demographic, perioperative and pathological data. Patients were followed up by telephone or outpatient record.Results:A total of 62 patients of single-utility port VATS and 28 three port VATS were included. All cases were accomplished by VATS, and none of them were converted to thoracotomy or adding additional ports. Sex proportion and ages of the two groups were comparable( P>0.05). The surgery duration[(336.9±55.7) min vs.(319.7±66.3)min, P=0.205] and thoracic procedure duration[(112.5±36.7)min vs.(108.9±43.6)min, P=0.686] of two groups were also similar. There were no statistical differences in volume of drainage, postoperative stay, thoracic complications, number of lymph nodes dissected, and survival after surgery between two groups( P>0.05). Peripheral blood oxygen saturation in first 3 days after surgery of single-utility port VATS patients was significantly higher[ Day 1: (97.00±1.57)% vs.(96.10±1.23)%, P=0.009; Day 2: ( 96.60±1.84 )% vs.(95.70±1.19)%, P=0.020; Day 3: (97.40±1.56)% vs.(96.30±1.42)%, P=0.002] and respiratory rate was significantly lower[(19.70±1.48) times/min vs.(20.70±1.70) times/min, P=0.006]than three-port VATS patients. Conclusion:Single-utility port VATS for McKeown surgery is safe and feasible, which tends to reduce the surgical trauma and can be a routine surgical procedure for minimally invasive esophagectomy.

BACKGROUND: Interstitial lung disease (ILD) is a group of diffuse lung diseases that mainly involve the interstitial and alveolar cavities and result in loss of alveolar-capillary functional units, leading to restrictive ventilatory dysfunction and diffusion impairment. There was an increased incidence of lung cancer on the basis of ILD, and perioperative risk of patients with lung cancer combined with ILD (LC-ILD) was significantly increased. The aim of this study is to summarize the safety and experience of surgical treatment of LC-ILD. METHODS: A retrospective analysis was performed on 23 patients with LC-ILD who underwent pneumonectomy in Beijing Hospital from January 2012 to December 2019, and their clinical manifestations, image feature, pathology, surgical safety, perioperative complications and treatment experience were summarized. RESULTS: A total of 23 patients were included in this study, including 20 males (87.0%) with an average age of (69.1±7.8) years, and 19 cases (82.6%) were smokers. Of the ILD types, 14 cases (60.9%) were idiopathic pulmonary fibrosis, 7 cases (30.4%) were idiopathic nonspecific interstitial pneumonia, and 2 (8.7%) were interstitial lung disease associated with connective tissue diseases. The pathology of lung cancer included adenocarcinoma (30.4%, 7/23), small cell carcinoma (30.4%, 7/23), squamous cell carcinoma (26.1%, 6/23), small cell carcinoma mixed with squamous cell carcinoma (4.3%, 1/23) and large cell neuroendocrine carcinoma (8.7%, 2/23). Surgical approaches included video assisted thoracoscopy (69.6%, 16/23) and anterolateral thoracotomy (30.4%, 7/23), with lobectomy (52.2%, 12/23), double lobectomy (4.3%, 1/23), and sublobectomy (39.1%, 9/23). There were 11 cases (47.8%) of postoperative complications, including 8 cases (34.8%) of pulmonary complications, 4 cases (17.4%) of acute exacerbation of ILD (AE-ILD), 6 cases (26.1%) of atrial fibrillation, and 1 case (4.3%) of acute left ventricular dysfunction. The 90-day mortality is 8.7% (2/23) and the cause of death was acute exacerbation of ILD. CONCLUSIONS Most of LC-ILD were elderly patients with multiple comorbidities and decreased pulmonary function, leading to significantly increased surgical risk. The ILD should be fully evaluated and controlled before surgery, intraoperative trauma should be minimized, and special attention should be paid to pulmonary complications and AE-ILD after surgery. Postoperative AE-ILD has a poor prognosis and glucocorticoids may be effective. Early diagnosis and treatment is the key to treatment of AE-ILD.

BACKGROUND: DNA polymerase β is one of the key enzymes for DNA repair and it was reported that about 30 percent of different types of cancers carried mutations in its coding gene Polb. However, it is still controversial whether it is true or false because of the small sample size in these studies. In current study, we performed genetic screening of promoter and coding regions of Polb gene in 69 Chinese lung cancer patients using Sanger sequencing method, so as to elucidate real mutation frequency of Polb mutations in Chinese Han population. METHODS: Salting out extraction method was used to get the genome DNAs from tumor and normal matched tissues of 69 lung cancer patients. The promoter and 14 coding regions of Polb gene were then amplified using these DNAs as the template. After purification, amplicons were sequenced and aligned to the wild type Polb gene in NCBI database, in order to find out the mutated sites of Polb gene in Chinese lung cancer patients. RESULTS: In this study, we totally found only 5 mutated sites in Polb gene. In detail, 3 mutations (-196G>T, -188_-187insCGCCC, -168C>A) were located in the promoter region; 2 mutations (587C>G, 612A>T) were found in coding regions. Specially, mutations of -188_-187insCGCCC and 587C>G (resulting to the amino acid substitution of Thr to Ser at position 196) had never been reported by other groups before. However, all these 5 mutated sites could be detected in both tumor and matched normal tissues, which inferred that they are not lung tumor specific mutations. CONCLUSIONS No lung tumor specific mutations of Polb gene could be found in Chinese lung cancer patients and Polb gene mutation might not be a molecular marker for Chinese lung cancer patients.

Fetal adenocarcinoma of the lung (FLAC) is an extremely rare subtype of lung cancer, accounting for only 0.1% to 0.5% of primary pulmonary malignancy. In 2011, international multidisciplinary classification of lung adenocarcinoma developed by the International Association for the Study of Lung Cancer (IALSC), the American Thoracic Society (ATS) and the European Respiratory Society (ERS) classified FLAC as a variant of invasive adenocarcinoma. FLAC has been further divided into low-grade fetal adenocarcinoma (L-FLAC) and high-grade fetal adenocarcinoma (H-FLAC) as these two categories exhibit different clinicopathological features and biological behaviors. Here we report a case of high-grade fetal adenocarcinoma and summarize clinicopathologic features of fetal lung adenocarcinoma.
.
Adenocarcinoma of Lung ; diagnostic imaging ; pathology ; surgery ; Fetus ; Humans ; Male ; Middle Aged ; Neoplasm Grading ; Prognosis ; Tomography, X-Ray Computed

Purpose To explore the independent predictors of malignant solitary pulmonary nodule (SPN) manifesting as ground-glass nodule (GGN),and to establish a prediction model.Materials and Methods The clinical data and CT images of 362 patients (group A) with pathological-confirmed SPN appearing as GGN in Shanghai Chest Hospital Shanghai Jiaotong University from January 2014 to December 2015 were retrospectively analyzed.The independent predictors of malignant SPN were identified,and the clinical prediction model was established.Another 119 SPN patients in Affiliated Zhoushan Hospital of Wenzhou Medical University were selected as group B to verify the diagnostic efficiency of the prediction model.Results Using multivariate Logistic regression analysis,clear border (OR=6.274,P＜0.01),smooth edge (OR=0.391,P＜0.01),lobulation (OR=3.387,P＜0.01),pleural retraction sign (OR=2.430,P＜0.01),and vocule sign (OR=3.076,P＜0.01)were identified as independent predictors of malignant SPN.The area of the model under the ROC curve was 0.859 with 95％ CI (0.804-0.903).The diagnostic accuracy rate,sensitivity,specificity,positive predictive value and negative predictive value were 85.92％,91.03％,81.97％,92.03％ and 73.53％,respectively.Conclusion In this study,the independent predictors of malignant SPN appearing as GGN were identified,and the prediction model was established.The model can accurately identify SPN and provide effective help for early diagnosis of SPN.