BACKGROUND: Lung cancer has the highest mortality rate among all malignant tumors, and non-small cell lung cancer (NSCLC) accounts for about 80%-85% of all lung cancers. Lobectomy and lymph node dissection are one of the most important treatment methods, and lymph node dissection, as an important part, has attracted much attention. And its mode and scope of dissection may affect postoperative complications, particularly the occurrence of chronic cough. The aim of this study is to investigate the effect of lymph node dissection on postoperative chronic cough in patients with NSCLC undergoing lobectomy, and to provide clinical evidence for optimizing surgical strategy and reducing postoperative chronic cough. METHODS: A retrospective analysis was conducted on the clinical data of 365 NSCLC patients who underwent lobectomy at the First Affiliated Hospital of University of Science and Technology of China from December 2020 to December 2023. The relationship between clinical characteristics and postoperative chronic cough was analyzed. The Chinese version of the Leicester Cough Questionnaire (LCQ-MC) scores were collected from the patients at 2 time points: 1 day before surgery and 8 weeks after surgery. Patients were divided according to lymph node dissection methods, to explore the relationship between lymph node dissection and chronic cough after lobectomy. Additionally, patients were divided into chronic cough and non-chronic cough groups based on the presence of postoperative chronic cough, to investigate whether perioperative data, lymph node dissection methods, and lymph node dissection regions were influencing factors. RESULTS: Patients undergoing lobectomy were more likely to have chronic cough after surgery in the systematic lymph node dissection group than in the lymph node sampling group (P<0.05). LCQ-MC scale evaluation showed that the psychological, physiological, social and total score of the patients in systematic lymph node dissection group were significantly lower than those in lymph node sampling group (P<0.05). Multivariate analysis showed that anesthesia time, operation site, lymph node dissection method, whether to perform upper mediastinal lymph node dissection, number of upper mediastinal lymph node dissection, whether to perform lower mediastinal lymph node dissection and total number of lymph node dissection were independent risk factors for postoperative chronic cough in NSCLC patients (P<0.05). CONCLUSIONS When NSCLC patients underwent lobectomy, lymph node sampling was associated with a significantly lower risk of chronic cough than systematic lymph node dissection. Dissecting lymph nodes in the upper and lower mediastinal regions and the number of lymph nodes dissected may increase the risk of postoperative cough and reduce the quality of life of patients after surgery.
Humans ; Carcinoma, Non-Small-Cell Lung/surgery* ; Male ; Female ; Lung Neoplasms/surgery* ; Middle Aged ; Cough/etiology* ; Retrospective Studies ; Lymph Node Excision/methods* ; Aged ; Chronic Disease ; Postoperative Complications/etiology* ; Adult ; Lymph Nodes/surgery* ; Pneumonectomy/adverse effects* ; Chronic Cough

Objective To analyze the risk factors for chronic cough following pulmonary surgery in patients with non-small cell lung cancer (NSCLC). Methods A retrospective analysis was conducted on 427 NSCLC patients who underwent pulmonary surgery in the Department of Thoracic Surgery, The First Affiliated Hospital of the University of Science and Technology of China, between January 2021 and June 2023. Patients were categorized into a chronic cough group (103 patients) and a non-chronic cough group (324 patients) based on the presence of cough at 8 weeks post-surgery. A comparative analysis was performed between the two groups, considering gender, age, smoking history, comorbidities, preoperative pulmonary function indicators, pleural adhesion, anesthesia duration, surgical site, operative techniques, lymph node dissection methods, tumor maximum diameter, and postoperative chest tube duration. Factors showing statistical significance in univariate analysis underwent multivariate logistic regression analysis. Results Among the 427 patients undergoing pulmonary surgery, there were 165 males and 262 females, with an average age of (59.93±12.11) years. The incidence of chronic cough was 24.12%. Univariate analysis revealed significant differences in smoking history, preoperative pulmonary function indicators, pleural adhesion, anesthesia duration ≥135.5 minutes, surgical site, operative techniques, lymph node dissection methods, tumor maximum diameter, and postoperative chest tube duration (P<0.05). Multivariate logistic regression analysis indicated that the surgical site (right upper lung), operative techniques (lobectomy), lymph node dissection, and anesthesia time ≥135.5 minutes were independent risk factors for chronic cough following pulmonary surgery. Conclusion Patients undergoing right upper lung surgery, lobectomy, lymph node dissection, and experiencing anesthesia duration ≥135.5 minutes are at a higher risk of developing chronic cough post-pulmonary surgery.

Objective:To explore the operioperative and long-term outcomes of inflatable mediastinoscopic resection of esophageal carcinoma (IVMTE) and minimally invasive Mckeown resection of esophageal carcinoma (MIME) in early esophageal cancer.Methods:This is a retrospective cohort study. A retrospectively analysis was conducted on 176 patients with cT1N0M0 esophageal cancer who underwent IVMTE or MIME at the Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University from April 2017 to April 2019. There were 128 males and 48 females, aged (66.4±7.7) years (range: 45 to 87 years). General data, perioperative outcomes, pathological data of the tumors, and complications were recorded. Independent sample t-test, χ2 test, or Wilcoxon rank-sum test was used to compare the data between the two groups. Propensity score matching was performed with gender, age, tumor location, differentiation degree, pT stage, pN stage, American Society of Anesthesiologists (ASA) classification, smoking history, and alcohol history were considered as covariates. The IVMTE group and MIME group were matched in a 1∶2 ratio using nearest neighbor match method with a caliper value of 0.02. Kaplan-Meier method was used to plot survival curves, with Log-rank test for univariate survival analysis. The Cox proportional hazards model was applied to analyze prognostic factors for overall survival, and subgroup stratification analysis was performed for pT stage. Results:After matching, the MIME group consisted of 54 cases, and the IVMTE group consisted of 27 cases. There were no statistically significant differences between the two groups in terms of gender, age, smoking history, alcohol history, ASA classification, tumor location, and other factors. The IVMTE group had shorter surgery time ( M(IQR), 220 (45) minutes vs. 245 (56) minutes, Z=2.950, P=0.003) and less intraoperative blood loss (100 (50) ml vs. 125 (100) ml, Z=2.193, P=0.028) compared to the MIME group. There were no differences between the two groups in the number and quantity of lymph node stations dissected, and the IVMTE group was not at a disadvantage in terms of the number of lymph nodes dissected around the recurrent laryngeal nerve (all P>0.05). The 1-, 3-, and 5-year overall survival (OS) rates and recurrence-free survival (RFS) rates were not significantly different between the two groups (all P>0.05). Subgroup analysis showed no significant difference in OS and RFS rates between the pT1 and pT2 subgroups (all P>0.05). Multivariate Cox regression analysis suggested that ASA classification ( HR=2.516, 95% CI: 1.126 to 5.624, P=0.025), pN stage ( HR=2.485, 95% CI: 0.984 to 6.274, P=0.046), and whether adjuvant therapy was given postoperatively ( HR=2.915, 95% CI: 1.304 to 6.515, P=0.009) were independent risk factors affecting 5-year OS rate. For 5-year RFS, pT stage ( HR=0.403, 95% CI: 0.194 to 0.838, P=0.011), pN stage ( HR=5.219, 95% CI: 2.401 to 11.346, P<0.01), and whether adjuvant therapy was given postoperatively ( HR=5.644, 95% CI: 2.691 to 11.838, P<0.01) were independent risk factors, while the surgical approach was not an independent risk factor affecting patient prognosis. Conclusion:The short-term and long-term effect of IVMTE in the treatment of early esophageal cancer is good, and it can achieve effects comparable to MIME.

Objective:To investigate the feasibility, safety, and short-term efficacy of the application of near-infrared fluorescence imaging of tharacic duct(NFITD) by indocyanine green(ICG) in minimally invasive McKeown esophagectomy(MIME).Methods:The clinical data of the patients underwent MIME for esophageal cancer in the First Affiliated Hospital of University of Science and Technology of China From January 2024 to April 2024 were restrospectively analyzed. There were divided into a indocyanine green imaging of thoracic duct(ITD) group and a non indocyanine green imaging of thoracic duct(NITD) group according to intraoperative visualization of morphological patterns of the thoracic duct. The clinicopathologic factors, preoperative adjuvant therapy, surgery-related indicators, postoperative complications were compared between the two groups.Results:In the comparison of general data between the two groups of patients, there were differences in preoperative neoadjuvant therapy between the ITD group and the NITD group. However, there were no significant differences between the two groups in terms of age, gender, tumor segmentation, degree of differentiation, smoking history, drinking history, and preoperative comorbidities. In the perioperative data, the ITD group had advantages in total pleural effusion volume on the third day after surgery, total hospitalization cost, and intraoperative discovery of thoracic duct injury( P<0.05). In terms of the number of metastatic lymph nodes, the ITD group was higher than the NITD group( P<0.05). There were no significant differences between the two groups in terms of operation time, postoperative hospital stay, total pleural effusion volume on the 1st and 2nd days after operation, whether the thoracic duct was ligated, whether there was thoracic adhesion, pTNM stage, the number of lymph node dissection stations and the number of lymph node dissections. In terms of the minor complications of chylothorax after surgery, the ITD group was significantly less than the NITD group. There was no significant difference in other complications between the two groups of patients. Conclusion:NFITD combined with MIME can be safety and effectively performed for patients with esophageal cancer with significant advantages in reducing postoperative chylothorax.

Objective:To investigate the feasibility, safety, and short-term efficacy of the application of near-infrared fluorescence imaging of tharacic duct(NFITD) by indocyanine green(ICG) in minimally invasive McKeown esophagectomy(MIME).Methods:The clinical data of the patients underwent MIME for esophageal cancer in the First Affiliated Hospital of University of Science and Technology of China From January 2024 to April 2024 were restrospectively analyzed. There were divided into a indocyanine green imaging of thoracic duct(ITD) group and a non indocyanine green imaging of thoracic duct(NITD) group according to intraoperative visualization of morphological patterns of the thoracic duct. The clinicopathologic factors, preoperative adjuvant therapy, surgery-related indicators, postoperative complications were compared between the two groups.Results:In the comparison of general data between the two groups of patients, there were differences in preoperative neoadjuvant therapy between the ITD group and the NITD group. However, there were no significant differences between the two groups in terms of age, gender, tumor segmentation, degree of differentiation, smoking history, drinking history, and preoperative comorbidities. In the perioperative data, the ITD group had advantages in total pleural effusion volume on the third day after surgery, total hospitalization cost, and intraoperative discovery of thoracic duct injury( P<0.05). In terms of the number of metastatic lymph nodes, the ITD group was higher than the NITD group( P<0.05). There were no significant differences between the two groups in terms of operation time, postoperative hospital stay, total pleural effusion volume on the 1st and 2nd days after operation, whether the thoracic duct was ligated, whether there was thoracic adhesion, pTNM stage, the number of lymph node dissection stations and the number of lymph node dissections. In terms of the minor complications of chylothorax after surgery, the ITD group was significantly less than the NITD group. There was no significant difference in other complications between the two groups of patients. Conclusion:NFITD combined with MIME can be safety and effectively performed for patients with esophageal cancer with significant advantages in reducing postoperative chylothorax.

Objective:To explore the operioperative and long-term outcomes of inflatable mediastinoscopic resection of esophageal carcinoma (IVMTE) and minimally invasive Mckeown resection of esophageal carcinoma (MIME) in early esophageal cancer.Methods:This is a retrospective cohort study. A retrospectively analysis was conducted on 176 patients with cT1N0M0 esophageal cancer who underwent IVMTE or MIME at the Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University from April 2017 to April 2019. There were 128 males and 48 females, aged (66.4±7.7) years (range: 45 to 87 years). General data, perioperative outcomes, pathological data of the tumors, and complications were recorded. Independent sample t-test, χ2 test, or Wilcoxon rank-sum test was used to compare the data between the two groups. Propensity score matching was performed with gender, age, tumor location, differentiation degree, pT stage, pN stage, American Society of Anesthesiologists (ASA) classification, smoking history, and alcohol history were considered as covariates. The IVMTE group and MIME group were matched in a 1∶2 ratio using nearest neighbor match method with a caliper value of 0.02. Kaplan-Meier method was used to plot survival curves, with Log-rank test for univariate survival analysis. The Cox proportional hazards model was applied to analyze prognostic factors for overall survival, and subgroup stratification analysis was performed for pT stage. Results:After matching, the MIME group consisted of 54 cases, and the IVMTE group consisted of 27 cases. There were no statistically significant differences between the two groups in terms of gender, age, smoking history, alcohol history, ASA classification, tumor location, and other factors. The IVMTE group had shorter surgery time ( M(IQR), 220 (45) minutes vs. 245 (56) minutes, Z=2.950, P=0.003) and less intraoperative blood loss (100 (50) ml vs. 125 (100) ml, Z=2.193, P=0.028) compared to the MIME group. There were no differences between the two groups in the number and quantity of lymph node stations dissected, and the IVMTE group was not at a disadvantage in terms of the number of lymph nodes dissected around the recurrent laryngeal nerve (all P>0.05). The 1-, 3-, and 5-year overall survival (OS) rates and recurrence-free survival (RFS) rates were not significantly different between the two groups (all P>0.05). Subgroup analysis showed no significant difference in OS and RFS rates between the pT1 and pT2 subgroups (all P>0.05). Multivariate Cox regression analysis suggested that ASA classification ( HR=2.516, 95% CI: 1.126 to 5.624, P=0.025), pN stage ( HR=2.485, 95% CI: 0.984 to 6.274, P=0.046), and whether adjuvant therapy was given postoperatively ( HR=2.915, 95% CI: 1.304 to 6.515, P=0.009) were independent risk factors affecting 5-year OS rate. For 5-year RFS, pT stage ( HR=0.403, 95% CI: 0.194 to 0.838, P=0.011), pN stage ( HR=5.219, 95% CI: 2.401 to 11.346, P<0.01), and whether adjuvant therapy was given postoperatively ( HR=5.644, 95% CI: 2.691 to 11.838, P<0.01) were independent risk factors, while the surgical approach was not an independent risk factor affecting patient prognosis. Conclusion:The short-term and long-term effect of IVMTE in the treatment of early esophageal cancer is good, and it can achieve effects comparable to MIME.

In recent years, the number of lung surgeries has increased year by year, and the number of patients with postoperative cough has also increased gradually. Chronic cough after lung surgery seriously affects patients' quality of life and surgical outcome, and has become one of the clinical problems that clinicians need to solve. However, there is currently no guideline or consensus for the treatment of chronic cough after lung surgery in China, and there is no standardized treatment method. Therefore, we searched databases such as PubMed, Web of Science, CNKI, and Wanfang databases ect. from 2000 to 2023 to collected relevant literatures and research data, and produced the first expert consensus on chronic cough after lung surgery in China by Delphi method. We gave 11 recommendations from five perspectives including timing of chronic cough treatment, risk factors (surgical method, lymph node dissection method, anesthesia method), prevention methods (preoperative, intraoperative, postoperative), and treatment methods (etiological treatment, cough suppressive drug treatment, traditional Chinese medicine treatment, and postoperative physical therapy). We hope that this consensus can improve the standardization and effectiveness of chronic cough treatment after lung surgery, provide reference for clinical doctors, and ultimately improve the quality of life of patients with chronic cough after lung surgery.

Objective To investigate the feasibility, safety, and short-term efficacy of minimally invasive McKeown esophagectomy (MIME) in patients with locally advanced thoracic esophageal squamous cell carcinoma (TESCC) after neoadjuvant immunotherapy. Methods The clinical data of the patients with locally advanced TESCC in the First Affiliated Hospital of University of Science and Technology of China from July 2022 to March 2023 were restrospectively analyzed. They were divided into a neoadjuvant immunotherapy (NI) group and a non-neoadjuvant immunotherapy (NNI) group according to different preoperative neoadjuvant therapy. The perioperative clinical data and 3-month follow-up data were compared between the two groups. Results A total of 47 patients were collected, including 31 males and 16 females with a mean age of (67.57±7.64) years. There were 29 patients in the NI group and 18 patients in the NNI group. There were no statistical differences in baseline data, perioperative complications, short-term complications, surgical time, intraoperative bleeding, postoperative adjuvant therapy, metastasis/recurrence within 3 months, R0 resection rate, postoperative pathological staging decline, or College of American Pathologists (CAP) tumor regression grade between the two groups (P＞0.05). Conclusion Neoadjuvant immunotherapy combined with minimally invasive McKeown esophagectomy can be safely and effectively performed for patients with locally advanced TESCC without increasing operation time, intraoperative blood loss and perioperative complications.

A male child aged two years and six months was admitted to the Affiliated Women and Children′s Hospital of Qingdao University in June 2023 due to wide eye distance, stubby fingers, koilosternia, cryptorchidism, and short tongue frenum. After clinical data collection, whole exome sequencing (WES) was conducted and bio-informatics analysis was performed to search for possible mutation sites on the patient. Family lineage verifications were conducted through Sanger sequencing. WES results showed that the patient carried c.2432dupT frameshift hemizygote variation of the FGD1 gene on the X chromosome (Xq11.22). Sanger sequencing confirmed that the mother was a carrier of the c.2432dupT heterozygous variant but not the father. According to the sequence interpretation guidelines of the American College of Medical Genetics and Genomics (ACMG), this variant is pathogenic (ACMG: PVS+2PP). The patient was diagnosed with Aarskog-Scott syndrome(ASS), which is a rare X-linked disorder characterized by facial, skeletal and genital anomalies. This case study has enriched the variant spectrum of the FGD1 gene and provided guidance for clinical screening and diagnosis of ASS.

Background and objective Chronic cough after pulmonary resection is one of the most common complications,which seriously affects the quality of life of patients after surgery.Therefore,the aim of this study is to explore the risk factors of chronic cough after pulmonary resection and construct a prediction model.Methods The clinical data and postoperative cough of 499 patients who underwent pneumonectomy or pulmonary resection in The First Affiliated Hospital of University of Science and Technology of China from January 2021 to June 2023 were retrospectively analyzed.The patients were randomly divided into training set(n=348)and validation set(n=151)according to the principle of 7:3 randomization.According to whether the patients in the training set had chronic cough after surgery,they were divided into cough group and non-cough group.The Mandarin Chinese version of Leicester cough questionnare(LCQ-MC)was used to assess the severity of cough and its impact on patients'quality of life before and after surgery.The visual analog scale(VAS)and the self-designed numerical rating scale(NRS)were used to evaluate the postoperative chronic cough.Univariate and multivariate Logistic regression analysis were used to analyze the independent risk factors and construct a model.Receiver operator characteristic(ROC)curve was used to evaluate the discrimination of the model,and calibration curve was used to evaluate the consistency of the model.The clinical application value of the model was evaluated by decision curve analysis(DCA).Results Multivariate Logistic analysis screened out that preoperative forced expiratory volume in the first second/forced vital capacity(FEV1/FVC),surgical procedure,upper mediastinal lymph node dissection,subcarinal lymph node dissection,and postoperative closed tho-racic drainage time were independent risk factors for postoperative chronic cough.Based on the results of multivariate analysis,a Nomogram prediction model was constructed.The area under the ROC curve was 0.954(95％CI:0.930-0.978),and the cut-off value corresponding to the maximum Youden index was 0.171,with a sensitivity of 94.7％and a specificity of 86.6％.With a Bootstrap sample of 1000 times,the predicted risk of chronic cough after pulmonary resection by the calibration curve was highly consistent with the actual risk.DCA showed that when the preprobability of the prediction model probability was be-tween 0.1 and 0.9,patients showed a positive net benefit.Conclusion Chronic cough after pulmonary resection seriously af-fects the quality of life of patients.The visual presentation form of the Nomogram is helpful to accurately predict chronic cough after pulmonary resection and provide support for clinical decision-making.