ObjectiveTo explore the safety and efficacy of robot-assisted minimally invasive esophagectomy （robot-assisted minimally invasive esophagectomy， RAMIE） and thoracic laparoscopy combined with minimally invasive esophageal resection （minimal invasive esophagectomy， MIE）. MethodsThe data of 188 patients treated with Da Vinci robot assisted minimally invasive esophageal resection （RAMIE） from April 2021 to December 2022 were analyzed. In the RAMIE group， 69 patients， 49 males and 20 female， age （67.2 ± 7.2）； 119 in the MIME group， respectively， 89 males and 30 female， age （69.1 ± 7.0）. At 1 ∶ 1， including 58 patients in the RAMIE group and 58 patients in the MIE group. The t-test， Wilcoxon rank-sum test， χ² test， and so on. ResultsAfter PSM treatment， the clinical data between the two groups. There was no significant difference in operation time， postoperative tube days， and total number of lymph node dissection between the RAMIE and MIE groups （P <0.05）； the RAMIE group was better in terms of intraoperative bleeding and the MIE group， statistically significant （P <0.05）； the MIE group was better in drainage flow and lymph node dissection for three days （P <0.05）. In terms of postoperative complications， there was no statistical difference between RAMIE and MIE groups （P>0.05）. ConclusionThe recent efficacy of robot-assisted minimally invasive esophagectomy is comparable to that of thoracic laparoscopy and minimally invasive Mckeown esophagectomy； robotic-assisted minimally invasive esophagectomy can reduce intraoperative bleeding and have more advantages in left recurrent laryngeal nerve lymph node dissection.

Background Dibutyl phthalate (DBP) is a common plasticizer in daily life and has been proved to be related to the exacerbation of allergic asthma. Domestic and foreign studies have shown that lipid peroxidation is closely related to the severity of asthma, which can be used as a basis for the diagnosis and treatment of asthma. Whether DBP can induce lipid peroxidation in allergic asthma remains to be further studied. Objective To investigate whether DBP aggravates allergic asthma by inducing lipid peroxidation in allergic asthma mice. Methods Eighty male BALB/c mice were randomly divided into 4 groups, namely control group, DBP group (40 mg·kg⁻¹), 50 μg ovalbumin (OVA) group (allergic asthma model group), and DBP+OVA group. The DBP group and the DBP+OVA group were given DBP by gavage from Day 1 to 28, and the OVA group and the DBP+OVA group were sensitized by intraperitoneal injection of OVA, once every 3 d, a total of 5 injections, from Day 9 to 21. From Day 29 to 35, the OVA group and the DBP+OVA group were challenged by OVA atomization. After the exposure, samples of blood and lung were collected. The airway hyperresponsiveness of mice was observed by lung function analysis. The serum contents of immunoglobulin E (IgE), OVA-specific immunoglobulin E (OVA-IgE), and lung homogenate levels of interleukin 4 (IL-4) were detected by enzyme-linked immunosorbent assay (ELISA) to evaluate airway allergic inflammation. The pathological changes of lung tissues were observed after hematoxylin-eosin (HE) staining and collagen fiber (Masson) staining. The contents of reactive oxygen species (ROS), lipid ROS, glutathione peroxidase 4 (GPX4), reduced glutathione (GSH), malondialdehyde (MDA), and 4-hydroxynonenal (4-HNE) in lung homogenates were detected by ELISA to evaluate lipid peroxidation. Results The results of lung function analysis showed that compared with the control group, the inspiratory resistance (Ri) and expiratory resistance (Re) of the OVA group and the DBP+OVA group were increased, and the lung compliance (Cldyn) was decreased. The DBP + OVA group was more severe, and the difference between the OVA group and the DBP + OVA group was statistically significant (P<0.05 or P<0.01). Compared with the control group, the contents of IgE, OVA-IgE, and IL-4 in the OVA group and the DBP+OVA group were increased (P<0.05 or P<0.01), which indicated more severe allergic airway inflammation. The HE sections of the OVA group and the DBP+OVA group showed inflammatory cell infiltration around the airway, airway wall hyperplasia and thickening, and severe airway deformation, and the presentation of the DBP+OVA group was the most serious. After Masson staining, the OVA group and the DBP+OVA group showed depositions of a large number of collagen fibers, and the blue collagen fibrosis in the DBP+OVA group was even more serious. ROS, lipid ROS, MDA, and 4-HNE levels increased and GSH and GPX4 levels decreased in the OVA and DBP+OVA groups (P<0.05 or P<0.01), with the most severe effect in the DBP+OVA group. Conclusion DBP may induce lipid peroxidation in mice allergic asthma by producing excessive ROS which may aggravate the allergic asthma in mice.

BACKGROUND: Pre-operative accuracy of subcentimeter ground glass nodules (SGGNs) is a difficult problem in clinical practice, but there are few clinical studies on the benign and malignant prediction model of SGGNs. The aim of this study was to help identify benign and malignant lesions of SGGNs based on the imaging features of high resolution computed tomography (HRCT) and the general clinical data of patients, and to build a risk prediction model. METHODS: This study retrospectively analyzed the clinical data of 483 patients with SGGNs who underwent surgical resection and were confirmed by histology from the First Affiliated Hospital of University of Science and Technology of China from August 2020 to December 2021. The patients were divided into the training set (n=338) and the validation set (n=145) according to 7:3 random assignment. According to the postoperative histology, they were divided into adenocarcinoma group and benign lesion group. The independent risk factors and models were analyzed by univariate analysis and multivariate Logistic regression. The receiver operator characteristic (ROC) curve was constructed to evaluate the model differentiation, and the calibration curve was used to evaluate the model consistency. The clinical application value of the decision curve analysis (DCA) evaluation model was drawn, and the validation set data was substituted for external verification. RESULTS: Multivariate Logistic analysis screened out patients' age, vascular sign, lobular sign, nodule volume and mean-CT value as independent risk factors for SGGNs. Based on the results of multivariate analysis, Nomogram prediction model was constructed, and the area under ROC curve was 0.836 (95%CI: 0.794-0.879). The critical value corresponding to the maximum approximate entry index was 0.483. The sensitivity was 76.6%, and the specificity was 80.1%. The positive predictive value was 86.5%, and the negative predictive value was 68.7%. The benign and malignant risk of SGGNs predicted by the calibration curve was highly consistent with the actual occurrence risk after sampling 1,000 times using Bootstrap method. DCA showed that patients showed a positive net benefit when the predictive probability of the predicted model probability was 0.2 to 0.9. CONCLUSIONS Based on preoperative medical history and preoperative HRCT examination indicators, the benign and malignant risk prediction model of SGGNs was established to have good predictive efficacy and clinical application value. The visualization of Nomogram can help to screen out high-risk groups of SGGNs, providing support for clinical decision-making.
Humans ; Retrospective Studies ; Lung Neoplasms/surgery* ; Adenocarcinoma ; China ; Hospitals ; Multiple Pulmonary Nodules

Objective: To explore the effect and mechanism of lycorine on oxaliplatin ( OXA) induced chemotherapy pain in mice． Methods : 40 mice were randomly divided into 4 groups，10 mice per group，which were respectively divided into control group，model group，administration group，and inhibitor group．A mouse model of chemotherapy induced pain was established by intraperitoneal injection of OXA for 5 consecutive days．Intrathecal administration of lycorine was performed．Behavioral changes and expression levels of inflammatory related proteins were detected . Results : Compared with control group，model group mice exhibited the increased number of spontaneous flinches，decreased mechanical nociceptive threshold，decreased movement distance and latency，and up-regulated expression levels of interleukin-1 β (IL-1 β) ，astrocytic marker glial fibrillary acidic protein ( GFAP) ，cyclooxygenase-2( COX-2) ，NOD-like receptor protein 3 ( NLRP3 ) ，cysteinyl aspartate and specific proteinase 1 ( Caspase- 1) ．Compared with model group，lycorine administration reduced the number of spontaneous flinches，increased mechanical nociceptive threshold ，enhanced the movement distance and latency ，bound and reduced COX-2 expression，down-regulated the expression levels of IL-1 β , GFAP ，NLRP3 and Caspase-1． Conclusion Lycorine reduces COX-2 expression，inhibits NLRP3 inflammasome activation，suppresses spinal inflammation，consequently alleviates pain behaviors and improved motor ability of mice.

BACKGROUND: Small pulmonary nodules are usually difficult to identify during thoraco-scopic resection, and preoperative computed tomography (CT)-guided percutaneous puncture assisted localization can be helpful. The purpose of this study is to compare the localization effect and complication rates of two different methods by microcoil placement and sclerosing agent injection (Lauromacrogol). METHODS: A retrospective analysis of the clinical data of 371 patients with preoperative pulmonary nodules percutane us puncture localization was performed. According to the use of different materials, they were divided into the microcoil group (167 cases with 196 localized nodules ) and the sclerosing agent group (204 cases with 239 localized nodules). The localization effect, complication, pathological results and operation relates data were statistically analyzed. RESULTS: The localization failure rate (2.4%) was higher in the microcoil group than in the sclerosing agent group (0.5%) (P=0.011), and the localization time of sclerosing agent group was significantly shorter than the microcoil group [(18.78±6.91) min vs (11.99±3.77) min, P=0.000], but the distance between the selected localized nodules and the pleura was deeper in the microcoil group than in the sclerosing agent group [(9.59±8.62) mm vs (8.13±6.49)mm, P=0.002]. The overall complications in the microcoil group were significantly higher than those in the sclerosing agent group (P=0.000), in which pneumothorax was the most common. Through the analysis of related risk factors, we revealed that different positioning methods was independent risk factors. Wedge resection was the main type of surgical method and non-invasive carcinomas were the majority of postoperative pathological results. CONCLUSIONS Our study suggests that both microcoil placement and sclerosing agent injection are suitable for preoperative pulmonary nodule localization equivalently, however, compared with microcoils placement, injection of lauromacrogol, the sclerosing agent, had lower failure rate, less complications, shorter localization time and it is worthy of promotion also by easy operation and low cost.

OBJECTIVE: To assess the association of Eph-receptor tyrosinekinase-type A2 (EphA2) gene polymorphisms with susceptibility to age-related cataract (ARC) among ethnic Han Chinese from Hubei Province. METHODS: 280 patients with cortical ARC and 200 healthy controls were recruited. Polymorphisms at four loci (rs3768293, rs3754334, rs477558 and rs7548209) of the EphA2 gene were detected by PCR-restriction fragment length polymorphism (PCR-RELP) assay. Allelic and genotypic frequencies of the two groups were compared. RESULTS: Compared with the control group, the AA genotype of rs3768293 locus was more common, while the AC genotype was much rarer (P< 0.05). No significant difference was found in allelic and genotypic frequencies of rs3754334 locus between the two groups (P> 0.05). The AA genotype of the rs477558 locus was more common in the patient group, while the AG genotype was much rarer (P< 0.05). The genotype GG of the rs7548209 locus was more common in the patient group, while the CG genotype was rarer (P< 0.05), though no significant difference in allelic or haplotypic frequencies between the two groups (P> 0.05). CONCLUSION Polymorphisms of rs477558, rs7548209 and rs3768293 loci of the EphA2 gene are associated with susceptibility to ARC among ethnic Han Chinese from Hubei province.
Asian Continental Ancestry Group ; Cataract ; genetics ; China ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Haplotypes ; Humans ; Polymorphism, Genetic

Objective: To evaluate the oncolytic effect of herpes simplex virus type 1 which carried recombined human granulocyte-macrophage colony-stimulating factor (HSV1-hGM-CSF) on the mouse breast cancer cell line 4T1 and compare the anticancer effects of HSV1-hGM-CSF, doxorubicin alone or combination on the breast cancer in mice. Methods: We investigated the cytotoxic effect on 4T1 cells in vitro, the cell growth, cell apoptosis and cell cycle of 4T1 cells treated with oncolytic HSV1-hGM-CSF at different MOIs (0, 0.5, 1 and 2) and doxorubicin at different concentrations (0, 2, 4 and 8 μg/ml). The effects of oncolytic HSV1-hGM-CSF and doxorubicin on the tumor growth, survival time and their side effects on the mouse breast cancer model were observed. Results: Both oncolytic HSV1-hGM-CSF and doxorubicin significantly inhibited the proliferation of 4T1 cells in vitro. Doxorubicin induced the G₂/M phase arrest of 4T1 cells, while the cytotoxicity of oncolytic HSV1-hGM-CSF was no cell cycle-dependent.At day 16 after treatment with doxorubicin and HSV1-hGM-CSF, the tumor volume of 4T1 tumor bearing mice were (144.40±27.68)mm^3, (216.80±57.18)mm^3, (246.10±21.90)mm^3, (327.50±44.24)mm^3, (213.30±32.31)mm³ and (495.80±75.87)mm³ in the groups of doxorubicin combined with high dose HSV1-hGM-CSF, doxorubicin combined with low dose HSV1-hGM-CSF, doxorubicin alone, high dose HSV1-hGM-CSF alone, low dose HSV1-hGM-CSF alone and control, respectively.Compared with the control group, both doxorubicin and HSV1-hGM-CSF treatment exhibited significant reduction of primary tumor volume in vivo (P<0.001). The median survival times were 48, 50, 40, 42, 43 and 37 days in the six groups mentioned above, respectively. The median survival period of doxorubicin alone, high dose HSV1-hGM-CSF alone and low dose HSV1-hGM-CSF alone were significantly longer than that of control (P<0.05). Conclusion Synergistic effect of sequential treatment with doxorubicin and oncolytic HSV1-hGM-CSF is observed in 4T1 mouse breast cancer.

OBJECTIVETo discuss the safety and feasibility of gastric tube in construction technique in total thoracoscopic and laparoscopic Ivor-Lewis esophagectomy.

METHODSClinical data of 358 patients with esophageal cancer who underwent the Ivor-Lewis procedure by the same surgical team in our department from June 2015 to June 2016 were retrospectively analyzed. Patients were divided into two groups: group MI (mini-incision): 92 patients undergoing extracorporeally gastric tube through a 4-cm abdominal mini-incision after gastric mobilization; group TL (total laparoscopy): 266 patients undergoing gastric tube made by total laparoscopy and jejunostomy. Intra-operative and postoperative data were compared between two groups.

RESULTSOf 358 patients, 290 were male and 68 were female. The average age was (62.3±15.6) years. The tumor location ratio of group TL and group MI was 27.1%(72/266) and 25.0%(23/92) in middle thoracic esophageal cancer, 35.3%(94/266) and 34.8%(32/92) in mid-lower thoracic esophageal cancer, and 37.6%(100/266) and 40.2%(37/92) in lower thoracic esophageal cancer, respectively. In group TL and group MI, 42.1% (112/266) and 46.7%(43/92) patients were stage I( to II(a; 57.9%(154/266) and 53.3%(49/92) patients were stage II(b to III(a, respectively. All the patients from two groups received successful Ivor-Lewis esophagectomy. There were no significant differences between group TL and MI in operative time [abdominal operative time: (65.6±25.8) min vs. (62.3±25.6) min; thoracic operative time: (180.3±37.4) min vs. (178.1±39.2) min; time of making gastric tube:(16.1±3.2) min vs.(15.7±3.5) min], blood loss [abdominal: (60.5±19.8) ml vs. (62.3±20.9) ml; thoracic: (228.7±47.3) ml vs. (231.6±46.8) ml], and the number of lymph nodes dissection (abdominal: 8.9±1.8 vs. 8.7±1.6; mediastinal: 21.2±3.6 vs. 20.8±3.8)(all P>0.05). And there were no significant differences in occurrence of postoperative anastomotic leakage [4.5%(12/266) vs. 4.3%(4/92), χ=0.845, P=0.948], postoperative hospital stay [(12.2±4.8) d vs. (13.1±5.1) d, t=1.525, P=0.128] and average hospitalization cost(5.5±2.1 vs. 5.3±1.2, t=0.865, P=0.172) (ten thousand yuan, RMB) between group TL and MI.

CONCLUSIONDuring minimally invasive Ivor-Lewis esophagectomy, gastric tube by total laparoscopy is safe and reliable.

Objective: To investigate whether neutrophil to lymphocyte ratio (NLR) in peripheral blood can be an independent prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC). Methods: Clinical data of 97 HNSCC patients who received surgical treatment in our department between January 2008 and January 2012 were analyzed retrospectively. The 97 patients were divided into low NLR group (NLR≤5, n=69) and high NLR group (NLR>5, n=28) according to the NLR in preoperative peripheral blood. The relationships of NLR and clinicopathological features were analyzed. Kaplan-Meier method was used for univariate survival analysis and Cox proportional hazard model for multivariate survival analysis. Results: The clinical stages were significantly different between high NLR group and low NLR group (P<0.05), however, the age, gender, location, lymph node metastasis, smoking and alcohol of the two groups showed no significant differences (P> 0.05 of all). Univariate survival analysis showed that smoking, lymph node metastasis, clinical stage and NLR value were risk factors for 3-year overall survival (OS) rate and relapse-free survival (RFS) rate of HNSCC patients (P<0.05). The OS rate of high NLR and low NLR groups was 42.9% and 91.3%, and the RFS rate was 44.2% and 80.1%, respectively, with a statistically significant difference (P<0.05 for both). Cox multivariate survival analysis showed that clinical stage and NLR were independent factors for prognostic evaluation of HNSCC patients (P<0.05 for both). Conclusions NLR level is significantly associated with clinical stage of HNSCC. High NLR is an independent prognostic rick factor and plays an important role in prognostic evaluation of HNSCC patients.

Objective: To identify the long-term outcome of patients with myasthenia gravis (MG) after extended thymectomy, and to analyze the prognostic factors. Methods: The medical data and follow-up results in 72 patients with MG who underwent extended thymectomy in Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University from January 2006 to October 2015 were retrospectively reviewed and analyzed. There were 32 male and 40 female patients, aging from 10 to 70 years with a mean age of 39.5 years. The outcome-related factors including gender, age while being operated on, duration of preoperative period, whether taking steroid before operation, modified Osserman classification, pathology type of thymus were analyzed by χ² test and multivariate regression analysis. Results: All patients were followed up from 6 to 75 months (median 37 months). Among them, 21 patients (29.2%) achieved complete stable remission, 18 patients (25.0%) experienced pharmacological remission, 20 patients (27.8%) improved, 9 patients (12.5%) reminded stable and 4 patients (5.6%) deteriorated. Both univariate and multicariate analysis revealed that duration of preoperative period (OR=22.871, 95% CI: 2.813 to 185.917, P=0.003) and Osserman classification (OR=0.103, 95% CI: 0.014 to 0.774, P=0.027) showed significantly associated with the surgical curative effect. Conclusions Extended thymectomy is an efective measure for MG. The duration of preoperative period and Osserman classification are prognostic factors for thymectomized MG. Those patients with generalized MG or whose duration of preperative period is less than 6 months are likely to have better prognosis.