BACKGROUND: Molecular subtyping is an essential complementarity after pathological analyses for targeted therapy. This study aimed to investigate the consistency of next-generation sequencing (NGS) results between circulating tumor DNA (ctDNA)-based and tissue-based in non-small cell lung cancer (NSCLC) and identify the patient characteristics that favor ctDNA testing. METHODS: Patients who diagnosed with NSCLC and received both ctDNA- and cancer tissue-based NGS before surgery or systemic treatment in Lung Cancer Center, Sichuan University West China Hospital between December 2017 and August 2022 were enrolled. A 425-cancer panel with a HiSeq 4000 NGS platform was used for NGS. The unweighted Cohen's kappa coefficient was employed to discriminate the high-concordance group from the low-concordance group with a cutoff value of 0.6. Six machine learning models were used to identify patient characteristics that relate to high concordance between ctDNA-based and tissue-based NGS. RESULTS: A total of 85 patients were enrolled, of which 22.4% (19/85) had stage III disease and 56.5% (48/85) had stage IV disease. Forty-four patients (51.8%) showed consistent gene mutation types between ctDNA-based and tissue-based NGS, while one patient (1.2%) tested negative in both approaches. Patients with advanced diseases and metastases to other organs would be suitable for the ctDNA-based NGS, and the generalized linear model showed that T stage, M stage, and tumor mutation burden were the critical discriminators to predict the consistency of results between ctDNA-based and tissue-based NGS. CONCLUSION ctDNA-based NGS showed comparable detection performance in the targeted gene mutations compared with tissue-based NGS, and it could be considered in advanced or metastatic NSCLC.
Humans ; Carcinoma, Non-Small-Cell Lung/pathology* ; Circulating Tumor DNA/blood* ; High-Throughput Nucleotide Sequencing/methods* ; Female ; Male ; Lung Neoplasms/pathology* ; Middle Aged ; Mutation/genetics* ; Aged ; Adult ; Aged, 80 and over

Objective To compare the analgesic effect and the effect on the success rate of reduc-tion of three doses of remifentanil combined with dexmedetomidine in the clamping reduction of cricoarytenoid joint dislocation.Methods Fifty-one patients with cricoarytenoid joint dislocation,30 males and 21 females,aged 18-80 years,BMI 18.5-30.0 kg/m2,ASA physical status Ⅰ-Ⅲ,were selected from April 2021 to December 2022 in the department of otolaryngology,head and neck surgery.The patients were randomly divided into three groups according to remifentanil dose:remifentanil 0.5 μg·kg-1·min-1 group(group A,n=17),remifentanil 1.0 μg·kg-1·min-1 group(group B,n=18),and remifentanil 1.5 μg·kg-1·min-1 group(group C,n=16).After admission,dexmedetomidine 0.6 μg·kg 1·h-1 was injected intravenously,and an ear,nose and throat anesthetic spray(2％lidocaine 2 ml)was used to administer surface anesthesia to the base of the tongue.A second surface anesthesia was administered to the throat at 5 minutes,and dexmedetomidine was stopped at 10 minutes.The supraglottic and periarticular cri-coarytenoid joints were subjected to superficial anesthesia for a third time under visual laryngoscope,and then remifentanil at corresponding doses was injected intravenously in three groups for 5 minutes,and the reduction operation began after the pumping was stopped.The success of the first reduction,the anesthesia quality satisfaction score of the surgeon and the recovery of remifentanil during the operation were recorded.VAS pain scores were recorded at the time of entry,3 minutes,30 minutes,and 6 hours after operation.The adverse reactions during operation and recovery were recorded.Results Compared with group B,the success rate of first reduction and the score of anesthesia quality satisfaction were significantly decreased in groups A and C(P＜0.05).Compared with group A,the ratio of additional remifentanil supplementation in groups B and C was significantly reduced,and the VAS pain score 3 minutes after surgery was significant-ly decreased(P＜0.05).Compared with group C,the proportion of mandibular manipulation ventilation in groups A and B was significantly reduced(P＜0.05).There was no significant difference in the incidence of bradyheart rate,nausea and vomiting,agitation,delirium and laryngeal spasm between the three groups.Conclusion Compared with remifentanil 0.5 and 1.5 μg·kg-1·min-1,remifentanil 1.0 μg·kg-1·min-1 combined with dexmedetomide sequential pumping provided good analgesic effect for the clamping reduction of cricoarytenoid joint dislocation,improved the success rate of the first reduction,more stable respiratory circulation and fewer perioperative adverse reactions.

Objective:To explore the surgical intervention strategy for metastatic cervical lymph nodes surrounding the carotid artery in head and neck squamous cell carcinoma.Methods:A total of 62 patients with advanced head and neck tumors and carotid wrap by disease treated in Department of Otorhinolaryngology and Head and Neck Surgery, the Affiliated BenQ Hospital of Nanjing Medical University between June 2019 and December 2023 were reviewed, of whom 9 patients presented with metastatic squamous cell carcinoma in cervical lymph nodes of unknown primary or with no recurrence of primary lesion and all the 9 patients were males, aged from 48 to 79 years old, with≤level 2 of Eastern Cooperative Oncology Group-Performance Status (ECOG-PS). Radiographically common carotid artery (CCA) and/or internal carotid artery (ICA) were surrounded by≥270° with tumor. All the 9 patients received implantation of covered stent in carotid artery and radical resection of metastatic cervical lymph nodes. The success rate, complications, surgery-related complications, local recurrence rate, quality of life (QOL) and overall survival (OS) were analyzed. The QOL of patients was compared by paired rank sum test, and P<0.05 indicated statistically significant difference. The OS was analyzed by Kaplan-Meier. Results:The success rate of stent implantation was 100%, with no implantation-related complications. R0 resection was performed in 8 cases and R1 resection in 1 case. The QOL of patients after surgery was improved, and the improvements in "pain", "mood" and "anxiety" were statistically significant( Z values were -2.236, -2.460 and -2.200, respectively, and all P values were<0.05). Follow-up was 1-18 months, with a median of 7 months, and 1 case was lost to follow-up. Local recurrence occurred in 3 patients with an incidence of 37.5% (3/8). OS was 59.9% at 12 months after surgery. Conclusion:Implantation of covered stent in carotid artery combined with radical resection is an effective method for the treatment of cervical lymph node metastasis.

Objective:To investigate the value of three-dimensional (3D) CT in diagnosing cricoarytenoid dislocation.Methods:From January 2021 to December 2021, 31 patients with unilateral cricoarytenoid dislocation who had been treated by reduction forceps at the Affiliated BenQ Hospital of Nanjing Medical University were collected retrospectively, and their voice recovered or improved significantly after therapy. The preoperative CT images were reconstructed by volume rendering (VR). The dislocated side (left and right), type of dislocation (total dislocation and subluxation), and dislocation direction (anterior, posterior, internal and external dislocation) of cricoarytenoid dislocation were observed. According to arytenoid articular surface of cricoid cartilage exposed completely or not (caused by arytenoid displacement), they were divided into complete dislocation and subluxation. According to the direction of arytenoid displacement and the part of arytenoid articular surface of cricoid cartilage exposed, they were divided into anterior, posterior, internal and external dislocation. According to the shape of the vocal cords on laryngoscope, anterior and posterior dislocation of each case was judged, and then compared with that of CT.Results:On VR images, there were 28 cases of cricoarytenoid subluxation (90.3%, 28/31) and 3 cases of complete dislocation (9.7%, 3/31). Left cricoarytenoid dislocation was 26 cases (83.9%, 26/31) and right cricoarytenoid dislocation was 5 cases (16.1%, 5/31). Posterior dislocation was 28 cases (90.3%, 28/31) and anterior dislocation was 3 cases (9.7%, 3/31). There were 23 cases of internal dislocation (74.2%, 23/31), 2 cases of external dislocation (6.4%, 2/31), and 6 cases without obvious internal and external dislocation (19.4%, 6/31). Three cases of complete dislocation were left posterior internal dislocation.There were 24 cases of left posterior dislocation (77.4%, 24/31), 4 cases of right posterior dislocation (12.9%, 4/31), 2 cases of left anterior dislocation (6.4%, 2/31) and 1 case of right anterior dislocation (3.2%, 1/31). On laryngoscope, there were 19 cases of posterior dislocation (61.3%, 19/31), 9 cases of anterior dislocation (29.0%, 9/31), 3 cases were difficult to assess (9.7%, 3/31) because of aryepiglottic fold covering. Sixteen cases (55.2%, 16/28) were consistent with 3D CT, and 12 cases (42.8%, 12/28) were inconsistent.Conclusion:The 3D CT is a reliable method to evaluate cricoarytenoid dislocation, which can show dislocated side, type and direction of cricoarytenoid dislocation clearly.

Female stress urinary incontinence （SUI） caused by support structure damage or relaxation of the urethra and bladder belongs to the category of “channel sinew disease” in traditional Chinese medicine （TCM）. The pathogenesis of this disease is “loss of nourishment in the channel sinews， and failure to contract because of relaxation”， which can be divided into two situations： deficiency syndrome mainly refers to qi deficiency， closely related to the three zang （脏） organs including lung， spleen， and kidney； and the excess syndrome mainly refers to heat pathogen and blood stasis. Therefore， the treatment principle of “nourishing the channel sinews， regulating sinews and controlling fluid” is proposed. The acupoints in the lower abdomen， lumbosacral region， and lower limbs are mainly selected in the treatment of SUI with channel sinew needling， such as Qihai （RN 6）， Guanyuan （RN 4）， and Baliao. The selection of acupoints also emphasizes the pain area. Channel sinew needling includes floating needling， round-sharp needling， penetrating needling， and prickly needling， which reflects the integrity of channel sinew system， and emphasizes the local therapeutic effects highlighting arrival of needling effects at the location of disease. The theory of channel sinew opens up new ideas for treating SUI with acupuncture and moxibustion.

Objective To investigate the potential of a novel preservation solution,raffinose-low potassium dextran lung preservation solution with blood (BR-LPDS) in the preservation of the isolated lungs in rats,when compared to low-potassium dextran solution (LPDS).Methods Fifty donor lungs of Sprague-Dawley rats were randomly flushed with either R-LPDS (R-LPDS group,n =25) or RLPDS modified by the addition of blood (BR-LPDS group,n =25).After reperfusion,the double lungs were kept half inflate and then the pulmonary artery and bronchus were clamped.Then the grafts were flushed with and submerged in cold preservation solution at 4 C for 24 h.And they were excised for measurement of wet-to-dry ratio,as well as histologic examination to evaluate pulmonary edema,inflammation and cleaved caspase-3 expression at 0,2,4,5,6,8,10,12,14,16,24 h.Results As compared with the R-LPDS group,the mean wet-to-dry ratio of lungs in the BR-LPDS group was significantly reduced from 4 to 10 h after reperfusion.Upon histologic examination,less inflammatory cell aggregates and lower caspase-3 activity were seen in the lungs of the BR-LPDS group from 10 to 12 h and 10 to 14 h after reperfusion,respectively.Conclusion The addition of blood to the R-LPDS solution was shown to be more effective in reducing swelling,inflammation and caspase-3 expression of donor lungs than the R-LPDS solution.Further investigation is needed to evaluate lung preservation in BR-LPD solution as a viable option for transplant.

OBJECTIVEThis research aimed to observe the expression of heat shock protein 27 (HSP27) in human gingival fibroblasts (HGFs) cell injury induced by different concentrations of cigarette smoke extract (CSE).

METHODSThe third to eighth generations of cultured HGFs were treated with serially diluted CSE of different concentrations (0, 2.5%, 5.0%, 12.5%, 25.0%, 50.0%). Wound-healing assay was performed to determine the migration of HGFs, and Western blot was used to determine the expression of HSP27.

RESULTSThe migration capability of HGFs weakened with the increase of CSE concentration. HSP27 expression was negative in normal HGFs but positive in CSE-intervened HGFs in a concentration-dependent manner.

CONCLUSIONHSP27 concentration increased in the CSE-induced injury of HGFs. This finding suggests that HSP27 plays an important role in CSE-induced epithelial injury.

Objective This research aimed to observe the expression of heat shock protein 27 (HSP27) in human gingival fibroblasts (HGFs) cell injury induced by different concentrations of cigarette smoke extract (CSE). Methods The third to eighth generations of cultured HGFs were treated with serially diluted CSE of different concentrations (0, 2.5%, 5.0%, 12.5%, 25.0%, 50.0%). Wound-healing assay was performed to determine the migration of HGFs, and Western blot was used to determine the expression of HSP27. Results The migration capability of HGFs weakened with the increase of CSE concentration. HSP27 expression was negative in normal HGFs but positive in CSE-intervened HGFs in a concentration-dependent manner. Conclusion HSP27 concentration increased in the CSE-induced injury of HGFs. This finding suggests that HSP27 plays an important role in CSE-induced epithelial injury.

OBJECTIVE: To investigate the feasibility of endoscope assisted resection of submandibular gland through a dermatoglyph incision. METHOD: We choose 5 patients diagnosed as benign diseases of submandibular gland from 2005 to 2010 in Beijing Tongren Hospital. Each patient was given a careful design of dermatoglyph incision preoperatively and an endoscope assisted surgery on the submandibular gland. The details of surgery procedure were described as follow. The inferior edge of the capsule of the submandibular gland was incised, and the traveling characteristics of facial artery, submandibuar gland branch of submental artery, branches of anterior facial vein were identified with endoscopic assistance. Branches of vascular and submandibular postganglionic fibers were treated with bipolar coagulation hemostasis. The submandibular duct was identified and isolated, teased downward from the floor of the mouth, and then ligated. The gland was lifted off the digastric tendon and removed. Suction drainage was used with a plastic tube and the incision was closed with mattress suture. The incision length, intraoperative bleeding, complication and operation duration were retrospectively, reviewed in the traditional group. RESULT: Of the endoscopic group, the incision lengths varied from 2.0-2.5 cm with an average of 2.3 cm. The operation durations varied from 41-87 min, with an average of 64 min. The total intraoperative bleeding was about 5 to 10 ml. No facial paralysis nor infection occurred both intra-and post-operatively. No relapse was detected in the long-term follow-up (4 months to 5 years). Compared with the traditional group, the incision length and bleeding decreased dramatically while the operational duration increased. CONCLUSION Endoscope assisted resection of submandibular gland through dermatoglyph incision will minimize the damage to surrounding tissue and obtain good cosmetic results.
Adolescent ; Adult ; Aged ; Endoscopes ; Endoscopy ; methods ; Feasibility Studies ; Female ; Humans ; Male ; Retrospective Studies ; Submandibular Gland ; surgery