Background and objective Cough is one of the main complications after pulmonary surgery,which seriously affects the postoperative quality of life.Preserving the pulmonary branch of vagus nerve may reduce the incidence of postoperative cough.Therefore,the aim of this study was to investigate whether preserving the pulmonary branch of the vagus nerve could reduce the incidence of postoperative chronic cough in patients with stage I peripheral lung adenocarcinoma.Methods A total of 125 patients who underwent single-port thoracoscopic radical resection for lung cancer in the Depart-ment of Thoracic Surgery,The First Affiliated Hospital of University of Science and Technology of China from June 2022 to June 2023 were retrospectively selected,and divided into two groups according to whether the vagopulmonary branch was preserved during the operation,namely,the vagopulmonary branch group(n=61)and the traditional group(n=64).The general clinical data,perioperative conditions,lymph node dissection,Mandarin Chinese version of The Leicester Cough Questionnaire(LCQ-MC)scores before and 8 weeks after operation were recorded in the two groups.Both the two groups were divided into tamponade group and non-tamponade group according to whether autologous fat or gelatin sponge was tamponade after lymph node dissection.LCQ-MC scores and postoperative chronic cough of both groups were calculated.Results The LCQ-MC score of the traditional group was significantly lower than that of the vagopulmonary branch group in physiological,psychological,social and total scores at 8 weeks after surgery,and the difference was statistically significant(P<0.05).There were more cough patients in the traditional group than the vagopulmonary branch group at 8 weeks after surgery,with significant difference(P=0.006).Subgroup analysis was conducted separately for the vagopulmonary branch group and the traditional group.Among the patients in the vagopulmonary branch group and the traditional group,the LCQ-MC scores of the non-tamponade group 8 weeks after surgery were lower than those of the tamponade group(P<0.05).There were more patients with cough in the group 8 weeks after surgery than in the tamponade group(P=0.001,P=0.024).Conclusion For patients with stage I peripheral lung adenocarcinoma,the preservation of the pulmonary branch of vagus nerve is safe and effective,which can reduce the incidence of postoperative chronic cough and improve the postoperative quality of life of the patients.

Background and objective With further understanding and research into non-small cell lung cancer with tumours ≤2 cm in maximum diameter,segmental lung resection is able to achieve the same long-term prognosis as lobec-tomy.However,there are few studies on the prognostic effect of wedge resection on small volume invasive lung adenocarci-noma with an invasion depth of 0.5 to 1.0 cm.Therefore,this study focuses on the clinical efficacy and prognosis of wedge re-section in patients with small-volume invasive lung adenocarcinoma.Methods A retrospective analysis of the medical records of 208 patients who underwent surgery in the Department of Thoracic Surgery of the Affiliated Provincial Hospital of Anhui Medical University from February 2016 to December 2017 was made,and the postoperative pathological results confirmed small volume invasive lung adenocarcinoma.According to their surgical methods,they were divided into lobectomy group(n=115),segmentectomy group(n=48)and wedge resection group(n=45).Kaplan-Meier survival curve estimation and Cox proportional risk regression model were used to explore the influence of different surgical methods on the prognosis of patients with small volume invasive lung adenocarcinoma.Results The wedge resection group had better perioperative outcomes compared with the segmentectomy group and lobectomy group,with statistically significant differences in intraoperative bleed-ing(P=0.036),postoperative drainage(P＜0.001),operative time(P=0.018),postoperative time with tubes(P=0.001),and postoperative complication rate(P=0.006).There were no significant differences when comparing the three groups in terms of survival rate(lobectomy group vs segmentectomy group,P=0.303;lobectomy group vs wedge resection group,P=0.742;and segmentectomy group vs wedge resection group,P=0.278)and recurrence-free survival rate(lobectomy group vs segmentec-tomy group,P=0.495;lobectomy group vs wedge resection group,P=0.362;segmentectomy group vs wedge resection group,P=0.775).Univariate and multivariate survival analyses showed that consolidation tumor ratio(CTR)was the prognostic factor of overall survival and revurrence-free survival for patients with small-volume invasive lung adenocarcinoma(P＜0.05).Conclusion Wedge resection in patients with small volume invasive lung adenocarcinoma can achieve long-term outcomes similar to segmentectomy and lobectomy.When the CTR≤0.5,wedge resection is preferred in such patients.

Objective To explore the application value of modified prophylactic ileostomy in natural orifice specimen extraction surgery(NOSES)for patients with mid-low rectal cancer.Methods We retrospectively analyzed 63 patients who received prophylactic ileostomy in NOSES for mid-low rectal cancer in our hospital from September 2017 to May 2023.The patients were divided into the observation group(those who received modified ileostomy,n=31)and the control group(those who received conventional loop ileostomy,n=32)according to different ostomy methods.The operation time of ostomy,operation time of ostomy reversal surgery,early-stage complications(stoma leakage,peristomal dermatitis,stoma pain,peristomal trocar hole infection,stoma bleeding,stoma ischaemic necrosis,stoma oedema,peristoma skin-mucosal separation and stoma proximal bowel obstruction)and long-stage complications(stoma stenosis,stoma retraction,stoma prolapse,parastomal hernia),tumor recurrence and death of the two groups were compared and analyzed.Results Both prophylactic ileostomy and ostomy reversal surgery were successfully completed in all the 63 cases.The operation time of ostomy in the observation group was 7(6-8)min,which was significantly shorter than that of 23(21-24)min in the control group(Z=-6.853,P=0.000),and the operation time of ostomy reversal surgery in the observation group was(63.2±5.7)min,which was significantly shorter than(93.5±4.7)min in the control group(t=-23.109,P=0.000).Neither stoma bleeding nor stoma ischaemic necrosis were observed in both groups.The incidence of stoma pain in the observation group was lower than that in the control group[6.4％(2/31)vs.65.6％(21/32),x2=21.766,P=0.000].The incidence of peristomal incision infection in the observation group was lower than that in the control group[0％(0/31)vs.53.1％(17/32),P=0.000].There was no stoma stenosis in both groups.There were 3 cases of parastomal hernia,1 case in the observation group and 2 cases in the control group,the difference of the incidence being not statistically significant(P=1.000).There was 1 case of stoma retraction and 1 case of stoma prolapse in the control group.All the 5 cases with complications received prompt treatment in the second ostomy reversal surgery.Follow-up visits for 6-60 months in the 63 cases showed no tumor recurrence or death.Conclusion Modified prophylactic ileostomy in NOSES for patients with mid-low rectal cancer is safe,feasible,and easy to operate,having certain practicality and promotion value.

ObjectiveTo investigate the effect of Glycyrrhizae Radix et Rhizoma （GR）-containing serum on lipopolysaccharide （LPS）-induced inflammation in human colon epithelial adenocarcinoma cells （Caco2） based on inhibition of ferroptosis by the nuclear factor erythroid 2-related factor 2 （Nrf2）/heme oxygenase-1 （HO-1） pathway. MethodCaco2 cells were divided into a normal group， a model group （LPS， 200 μg·L^-1）， low-， medium-， and high-dose GR-containing serum groups （5%， 10%， 20%）， and a ferroptosis inhibitor group （3-amino-4-cyclohexylamino-benzoic acid ethyl ester， Fer-1， 10 μmol·L^-1）. The cells in the normal group were cultured normally， while those in other groups underwent the induction of an inflammation model. The cells in the low-， medium-， and high-dose GR-containing serum groups were treated with 5%， 10%， and 20% GR-containing serum for 24 hours， respectively， and the cells in the ferroptosis inhibitor group were treated with Fer-1 for 24 hours. Transmission electron microscopy was used to observe mitochondrial morphology in each group. Flow cytometry was used to detect intracellular Fe²⁺ levels. Microplate assays were performed to measure superoxide dismutase （SOD） activity， malondialdehyde （MDA） and glutathione peroxidase （GSH-Px） levels. Enzyme-linked immunosorbent assay （ELISA） was used to measure interleukin-1β （IL-1β）， IL-6， IL-10， and tumor necrosis factor-α （TNF-α） levels. Western blot was used to measure the expression levels of Nrf2， HO-1， ferritin heavy chain 1 （FTH1）， and glutathione peroxidase 4 （GSH-Px4） proteins. Small interfering RNA （siRNA） was used to investigate the role of Nrf2 in ferroptosis regulation. The cells after interference were divided into a negative control （NC） group， a Si-Nrf2 group， a GR-containing serum （20%） + Si-Nrf2 group， and a GR-containing serum （20%） + NC group. Microplate assays were performed to measure MDA， SOD， and GSH-Px levels， and Western blot was used to measure the expression levels of Nrf2， HO-1， FTH1， and GSH-Px4 proteins. ResultCompared with the normal group， the model group showed mitochondrial contraction， increased mitochondrial membrane thickness， and smaller mitochondrial morphology， increased Fe²⁺ content （P<0.01）， blunted SOD activity （P<0.01）， decreased GSH-Px expression （P<0.01）， increased MDA content （P<0.01）， reduced expression levels of Nrf2 and HO-1 （P<0.05）， reduced FTH1 expression （P<0.01）， and down-regulated GSH-Px4 expression （P<0.01）. In the GR-containing serum groups， the medium- and high-dose groups showed a significant decrease in Fe²⁺ content （P<0.01）， potentiated SOD and GSH-Px activities （P<0.01）， and decreased MDA levels （P<0.01）. The high-dose group showed a significant increase in Nrf2 expression （P<0.05）， and the medium-dose group showed increased expression of HO-1 and GSH-Px4 proteins （P<0.05）. The expression levels of FTH1 significantly increased in the low-， medium-， and high-dose groups （P<0.01）. The study on mechanism revealed that compared with the NC group， the cells transfected with Nrf2 siRNA showed increased MDA content （P<0.01）， blunted SOD activity （P<0.01）， decreased GSH-Px activity （P<0.01）， decreased expression of Nrf2 and HO-1 （P<0.01）， and reduced levels of FTH1 and GSH-Px4 proteins （P<0.01）. Compared with the Si-Nrf2 group， the cells treated with GR-containing serum showed a decrease in MDA content （P<0.01）， an increase in SOD activity （P<0.01）， an increase in GSH-Px activity （P<0.01）， increased expression of Nrf2 and FTH1 proteins （P<0.05）， and higher expression levels of HO-1 and GSH-Px4 proteins （P<0.01）. ConclusionGR-containing serum can reduce the inflammatory cytokines and oxidative stress levels in LPS-induced Caco2 cells. Its mechanism is related to the promotion of Nrf2/HO-1 signaling pathway expression， alleviating intracellular lipid peroxidation and inhibiting ferroptosis.

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 compare the short-term efficacy and long-term survival of patients with non-small cell lung cancer (NSCLC) treated by uniportal or three portal thoracoscopic radical resection. Methods     A total of 388 patients who underwent uniportal or three portal thoracoscopic radical resection of lung cancer in the Department of Thoracic Surgery of Anhui Chest Hospital from 2015 to 2016 were analyzed retrospectively. The patients were divided into two groups including an uniportal group and a three portal group according to the procedure. The clinicopathological features, perioperative data and long-term survival of the two groups were compared. Results     Finally, we included 205 patients with 105 males and 100 females at an average age of 58.73±10.93 years. There were 102 patients in the uniportal group and 103 patients in the three portal group. There was no statistical difference in clinicopathological features between the two groups (P>0.05). But compared with the three portal group, the uniportal group had less postoperative drainage, shorter postoperative catheterization time and postoperative hospital stay (P<0.05). There was no statistical difference in the number of lymph node dissection stations between the two groups (P=0.058). The pain score at 24 hours after operation in the uniportal group was significantly lower than that in the three portal group (P<0.001). There was no  statistical difference in the total incidence of complications and the incidence of pulmonary complications between the two groups (P=0.161 and P=0.275). The median survival period and the 1st, 3rd, and 5th year survival rate in the uniportal group was 63.0 months and 95.0%, 75.2%, 51.5%, respectively. The median survival period and the 1st, 3rd, and 5th year survival rate in the three portal group was 61.0 months and 89.3%, 70.9%, 50.5%, respectively. There was no satistical difference in the survival results between the two groups (P=0.440). Conclusion     Uniportal thoracoscopic radical resection of lung cancer is more minimally invasive and safe and effective in the treatment of NSCLC. It can make patients recover faster after operation.

Objective     To compare and analyze the occurrence of acute and chronic pain after subxiphoid and transcostal thoracoscopic extended thymectomy. Methods    A retrospective analysis was performed on 150 patients who underwent thoracoscopic extended thymectomy in our hospital from July 2020 to June 2022, among whome 30 patients received subxiphoid video-assisted thoracic surgery, and 120 patients received transcostal video-assisted thoracic surgery. The patients were matched by the propensity score matching method. Postoperative pain was evaluated by numeric rating scale (NRS). The intraoperative conditions and postoperative pain incidence were compared between the two groups. Results    After matching, 60 patients were enrolled, 30 in each group, including 30 males and 30 females with an average age of 50.78±12.13 years. There was no difference in the general clinical data between the two groups (P>0.05), and no perioperative death. There were statistical differences in the intraoperative blood loss, postoperative drainage volume, postoperative catheter duration, postoperative hospital stay, postoperative pain on 1 d, 2 d, 3 d, 7 d, 3 months and 6 months after the surgery (P<0.05), but there was no statistical difference in the operation time or the postoperative 14 d NRS score (P>0.05). Further univariate and multivariate analyses for postoperative chronic pain showed that surgical method and postoperative 14 d NRS score were risk factors for chronic pain at the 3 months and 6 months after the surgery (P<0.05). Conclusion     The subxiphoid thoracoscopic extended thymectomy has advantages over transcostal thoracoscopic surgery in the postoperative acute and chronic pain.

To study an automatic plan(AP) method for radiotherapy after breast-conserving surgery based on TiGRT system and and compare with manual plan (MP). The dosimetry parameters of 10 patients and the evaluation of scoring table were analyzed, it was found that the targets dose of AP were better than that of MP, but there was no statistical difference except for CI, The V5, V20 and V30 of affected lungs and whole lungs in AP were lower than all that in MP, the Dmean of hearts was slightly higher than that of MP, but the difference was not statistically significant, the MU of AP was increase by 16.1% compared with MP, the score of AP evaluation was increase by 6.1% compared with MP. So the AP could be programmed and automated while ensuring the quality of the plan, and can be used to design the plans for radiotherapy after breast-conserving surgery.
Breast Neoplasms/surgery* ; Female ; Humans ; Mastectomy, Segmental ; Organs at Risk ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated

BACKGROUND: The mortality of lung cancer ranks first among all malignant tumors, but there are few studies on the effect of different segmentectomy on lung function in patients with early lung adenocarcinoma. The purpose of this study was to evaluate the degree of lung function preservation and short-term results of preoperative planning combined with fluorescence thoracoscopic precision segmentectomy and traditional segmentectomy in patients with early lung adenocarcinoma. METHODS: From January 1, 2020 to October 31, 2020, 60 patients underwent thoracoscopic segmentectomy in the Department of Thoracic Surgery of the First Affiliated Hospital of University of Science and Technology of China: 30 patients in precision segmentectomy group and 30 patients in traditional segmentectomy group. The clinicopathological features, perioperative data and postoperative pulmonary function of the two groups were compared. RESULTS: The operation time of the precision group was shorter than that of the traditional group, and the difference was statistically significant (P<0.05). The preoperative pulmonary function accuracy group and the traditional group in forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and carbon monoxide diffusing capacity (DLCO) were (3.65±0.63) L vs (3.54±0.64) L, (2.72±0.50) L vs (2.54±0.48) L and (20.36±3.02) mL/mmHg/min vs (19.16±3.18) mL/mmHg/min, respectively. One month after operation, the FVC, FEV1 and DLCO of pulmonary function accuracy group and traditional group were (3.35±0.63) L vs (2.89±0.57) L, (2.39±0.54) L vs (2.09±0.48) L and (17.43±3.10) mL/mmHg/min vs (15.78±2.865) mL/mmHg/min, respectively. Three months after operation, the FVC and DLCO of pulmonary function accuracy group and traditional group were (3.47±0.63) L vs (3.20±0.56) L and (19.38±3.02) mL/mmHg/min vs (17.79±3.21) mL/mmHg/min, respectively. CONCLUSIONS Preoperative planning combined with fluorescence thoracoscopic precise segmentectomy provides advantages in intersegmental plane recognition, vascular anatomy and postoperative recovery, which significantly shortens the operation time and makes the treatment more accurate.

Metformin, as a first-line drug in the treatment of type 2 diabetes, has been proved to be safe and effective. In recent years, epidemiological studies have found that metformin can inhibit the proliferation and metastasis of lung cancer cells, and is expected to become a new anti-lung cancer drug. Lung cancer is a disease that seriously endangers human health, its morbidity and mortality have been ranked first among all malignant tumors, and the prognosis is poor. In recent years, a great deal of evidence shows that metformin can reduce the risk and mortality of tumors such as lung cancer. Its mechanisms mainly include activating adenosine monophosphate-activated protein kinase pathway, improving hyperinsulinemia and insulin resistance, promoting lung cancer cell apoptosis and inhibiting related inflammatory response. The aim of this article is to reviews the study of metformin on lung cancer.