Objective To analyze the clinical outcomes of extended thymectomy for myasthenia gravis (MG) patients under different surgical approaches, and to determine the factors affecting the prognosis of MG. Methods The MG patients who underwent extended thymectomy from January 2014 to March 2021 in our hospital were retrospectively collected. According to the surgical approach, they were divided into a subxiphoid group and an intercostal group, and the perioperative results and prognosis were compared between the two groups. A “good outcome” was defined as complete stable remission (CSR), pharmacological remission (PR) or minimal manifestations state (MMS); a “poor outcome” was defined as outcomes worse than MMS. Univariate and multivariate logistic regression analyses were performed to assess the factors associated with the good outcomes. Results A total of 187 MG patients were included in the study, including 82 males and 105 females, with a median age of 50 (36, 60) years. There were 134 patients in the intercostal group and 53 patients in the subxiphoid group. Compared with the intercostal group, although the operation time of the subxiphoid group was longer [200.0 (172.0, 232.0) min vs. 141.0 (118.0, 169.0) min, P<0.001], the intraoperative blood loss was less [10.0 (10.0, 20.0) mL vs. 20.0 (10.0, 50.0) mL, P<0.001], the postoperative hospital stay was shorter [3.0 (2.5, 4.0) d vs. 5.0 (3.0, 7.0) d, P<0.001], and the incidence of complications was lower [1 (1.9%) vs. 26 (19.4%), P=0.001]. A total of 159 (85.0%) patients were followed up for a median period of 46 (13, 99) months, with a good outcome rate of 90.6% and CSR rate of 33.3%. There were no statistical differences in PR, MMS or overall good outcome rates between the two groups (P>0.05). Multivariate logistic analysis showed that age≤50 years was an independent predictor for "good outcome" of MG patients. Conclusion Extended thymectomy via subxiphoid for MG is a safe, feasible and effective surgical approach.

Objective To investigate the application of low-dose computed tomography virtual colonoscopy(LDCTVC)in colorec-tal tumor.Methods Forty-seven colorectal tumor were given low-dose CT abdominal scan(low-dose group),15 patients with normal body mass index(BMI)who received routine-dose CT abdominal scan at the same period(routine-dose group).Volume CT dose index(CTDIvol),dose length product(DLP),virtual colonoscopy and optical colonoscopy results were recorded.Results The effective dose with normal BMI was(2.86±0.47)mSv and(4.87±1.15)mSv in the low-dose and routine-dose groups,respectively.The CTDIvol and DLP between the two groups were statistically significant(P＜0.05).There were 14 cases of true positive,4 cases of false positive,5 cases of false negative and 24 cases of true negative in the low-dose group.The sensitivity,specificity and Kappa value of LDCTVC in the diagnosis of colorectal mucosal lesions were 73.7％,85.7％,and 0.6.Conclusion LDCTVC can reduce the effective dose by 50％and has a good diagnostic value for colorectal mucosal lesions,which can make up for the deficiency of colonoscopy and make accurate judgment of extra-mucosal lesions of the bowel wall.

Enzyme-driven micro/nanomotors consuming in situ chemical fuels have attracted lots of attention for biomedical applications. However, motor systems composed by organism-derived organics that maximize the therapeutic efficacy of enzymatic products remain challenging. Herein, swimming proteomotors based on biocompatible urease and human serum albumin are constructed for enhanced antitumor therapy via active motion and ammonia amplification. By decomposing urea into carbon dioxide and ammonia, the designed proteomotors are endowed with self-propulsive capability, which leads to improved internalization and enhanced penetration in vitro. As a glutamine synthetase inhibitor, the loaded l-methionine sulfoximine further prevents the conversion of toxic ammonia into non-toxic glutamine in both tumor and stromal cells, resulting in local ammonia amplification. After intravesical instillation, the proteomotors achieve longer bladder retention and thus significantly inhibit the growth of orthotopic bladder tumor in vivo without adverse effects. We envision that the as-developed swimming proteomotors with amplification of the product toxicity may be a potential platform for active cancer treatment.

Patients with operable non-small cell lung cancer (NSCLC) receiving neoadjuvant or adjuvant chemotherapy have a very limited improvement in 5-year survival rate. Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) have made a breakthrough in the treatment of EGFR-mutant advanced NSCLC, which shed light for the exploration of perioperative targeted therapy in NSCLC patients. Significant progress has been made in the research of targeted therapy of the first and third generation EGFR-TKI in perioperative patients. The availability of novel potent and less toxic targeted therapy has brought new treatments for the operable NSCLC. This article reviews the progress and existing problems of adjuvant and neoadjuvant targeted therapy in NSCLC harboring EGFR mutation.

BACKGROUND: As a new technique developed in recent years, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has the advantages of simple operation, minimal invasive, high accuracy, safety and repeatability. It has become a new standard for lung cancer diagnosis and mediastinal staging. Because small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) have different biological characteristics and treatment methods, it is very important to diagnose and differentiate the types of lung cancer in the early stage of lung cancer for the staging, treatment and prognosis of lung cancer. This article evaluated the accuracy and sensitivity of EBUS-TBNA in the diagnosis of SCLC and NSCLC. METHODS: From January 2012 to December 2018, the clinical data of 85 patients with SCLC and NSCLC who performed EBUS-TBNA in Xuan Wu Hospital CMU were retrospectively analyzed and the differences between the two groups were compared. RESULTS: 45 cases of SCLC were confirmed by immunohistochemistry and pathology. 42 cases of SCLC were diagnosed by EBUS-TBNA. The accuracy and sensitivity of diagnosis were 93.3% (42/45) and 100.0% (42/42), respectively. The positive rate of diagnosis was 48.9% (22/45) in 22 cases diagnosed by cytology, and 40 cases diagnosed by pathology, including 35 cases diagnosed by EBUS-TBNA. The accuracy and sensitivity of diagnosis were 87.5% (35/40) and 100.0% (35/35), respectively. The positive rate of diagnosis was 27.5% (11/40) in 11 cases diagnosed by cytology. The diagnostic sensitivity of EBUS-TBNA in SCLC group was significantly higher than that in NSCLC group (P<0.05). CONCLUSIONS EBUS-TBNA is more sensitive in the diagnosis of SCLC than NSCLC. As a minimally invasive technique, EBUS-TBNA can assist SCLC in early diagnosis and timely treatment.

BACKGROUND: Lung cancer is one of the most dangerous diseases to human health, with high morbidity and mortality. It can be cured by surgery at early stage, therefore, the early detection and early treatment of lung cancer are especially important. Serum tumor markers play an important role in the detection and diagnosis of lung cancer. Galectin-3 is known to be expressed in a variety of malignant tumors. This study was to explore the serum levels of Galectin-3 and its clinical significance in non-small cell lung cancer (NSCLC) patients. METHODS: The serum levels of Galectin-3 in peripheral blood were detected by enzyme linked immunosorbent assay (ELISA) in 69 NSCLC patients and 77 cases of healthy control subjects, and compared between the two groups. Then we analyze the correlations between the serum levels of Galectin-3 and the clinical features of lung cancer. RESULTS: The serum levels of Galectin-3 in NSCLC patients were significantly higher than those of healthy control subjects (P<0.01). The serum levels of Galectin-3 with lymph node metastasis were significantly higher than those of patients without lymph node metastasis (P<0.01), and N2 lymph node metastasis had higher levels of serum Galectin-3 than those of N1 lymph node metastasis (P<0.01). Clinical stage III and stage IV patients had higher levels of serum Galectin-3 than those of clinical stage I and clinical stage II (P<0.05). CONCLUSIONS Our study showed the serum levels of Galectin-3 are highly expressed in NSCLC patients and are significantly related to lymph node metastasis. It may be a potential tumor marker for lung cancer.

Postoperative cognitive dysfunction (POCD) is one of the most common complications after surgery under general anesthesia and usually manifests as newly presented cognitive impairment. However, the mechanism of POCD is still unclear. In addition to neurons, glial cells including microglia, astrocytes and oligodendrocytes, represent a large cell population in the nervous system. The bi-directional communication between neurons and glia provides basis for neural circuit function. Recent studies suggest that glial dysfunctions may contribute to the occurrence and progress of POCD. In this paper, we review the relevant work on POCD, which may provide new insights into the mechanism and therapeutic strategy for POCD.
Anesthesia, General ; Humans ; Microglia ; Postoperative Cognitive Complications ; Postoperative Complications

Objective    To analyze the risk factors of myasthenia gravis crisis after thymectomy with myasthenia gravis (MG). Methods    Sixty-five myasthenia gravis patients who had myasthenia crisis after thymectomy in Xuanwu Hospital, Capital Medical University from June 2006 to June 2019 were retrospectively enrolled, including 31 males and 34 females, aged 15-78 (45.7±17.8) years. The relationship between myasthenia crisis after thymectomy and surgical option, operation time, pathological type, et al. were anylyzed. Results    Operation time and pathological type were the predictive factors of postoperative myasthenic crisis. The area under receiver operating characteristic curve (AUC) of MG type (Osserman) was 0.676, the cut-off value wasⅡB type, the sensitivity was 37.5%, the specificity was 90.5%, and the Youden’s index was 0.280. The AUC of thymoma stage (Masaoka) was 0.682, cut-off value was stageⅡ, sensitivity was 62.5%, specificity was 66.7%, and Youden’s index was 0.292. The AUC of blood loss was 0.658, the cut-off value was 90 mL, the sensitivity was 87.5%, the specificity was 69.6%, and the Youden’s index was 0.304. Conclusion    Preoperative MG classification, pathological type, operation time and blood loss are the risk factors of postoperative myasthenic crisis. Therefore, adequate preoperative preparation, rapid and careful intraoperative operation and active postoperative management can reduce the occurrence of postoperative myasthenic crisis.

Objective: To investigate the value of the folate receptor (FR)-positive circulating tumor cell (CTC) detection in the diagnosis of benign and malignant subcentimeter pulmonary nodules(the maximum diameter ≤10 mm). Methods: Thirty-seven patients with subcentimeter pulmonary nodules (the chest CT showed the maximum diameter was ≤10 mm) in the Xuanwu Hospital of Capital Medical University from July to December 2018 were collected. Among them, 22 cases were diagnosed with early stage lung adenocarcinoma by postoperative pathological diagnosis and another 15 cases were benign lung lesion. Venous blood samples from these patients were collected before surgery and then utilized to detect FR⁺ CTC level (defined unit as FU/3 ml) by novel ligand-targeted polymerase chain reaction (LT-PCR), and the enzyme-linked immunosorbent assay was used to detect the levels of tumor markers, including carcinoembryonic antigen (CEA), neuron-specific enolase(NSE), cytokeratin 19 fragment CYFRA21-1, carbohydrate antigen 125 (CA125), CA199, pro-gastrin releasing peptide (pro-GRP), etc. The t-test was used to compare the measurement values between the groups. The CTC value 8.70 FU/3 ml described in the detection kit instruction was used as the threshold. The binary logistic regression was used to analyze the risk factors of malignant pulmonary nodules. The kappa consistency test was used to identify the consistency of the diagnosis results obtained by the FR⁺ CTC level and the pathological results of surgically resected specimens. The receiver operating characteristic curve (ROC) was drawn to evaluate the efficiency of each index for the diagnosis of benign and malignant subcentimeter pulmonary nodules. Results: The level of FR⁺ CTC in patients with early stage lung cancer was higher than that in patients with benign lung lesion, and the difference was statistically significant [(11.0±3.0) FU/3 ml vs. (7.0±3.7) FU/3 ml, t=-3.327, P = 0.001]. The level of FR⁺ CTC was not related to the age, gender and smoking history of patients (all P>0.05). Logistic regression analysis indicated that high-level FR⁺ CTC was one of the risk factors for malignant pulmonary nodules (OR = 37.333, 95% CI 3.994-349.010, P = 0.002). The kappa consistency test indicated that the level of FR⁺ CTC used for the diagnosis of lung subcentimeter nodules presented a certain accuracy (κ = 0.627, P < 0.01). ROC illustrated that the FR⁺ CTC was better than CEA, NSE and CYFRA21-1 when it was used as an indicator for the diagnosis of malignant pulmonary nodules. The area under the curve(AUC) of FR⁺ CTC was 0.830 (95% CI 0.639-0.968), and the diagnostic sensitivity and specificity were 72.7% (95% CI 49.6%-88.4%) and 93.3% (95% CI 66.0%-99.7%), respectively. When FR⁺ CTC, CEA, NSE and CYFRA21-1 were combined for lung cancer diagnosis, the AUC, sensitivity and specificity were 0.776 (95% CI 0.614-0.938), 86.4% and 73.3%, respectively. Conclusion The detection of FR⁺ CTC has a high value in the diagnosis of benign and malignant subcentimeter pulmonary nodules.

Objective To explore the effect of microRNA-613 (miR-613)/Wee1 axis on the radiosensitivity of colorectal cancer cells.Methods A total of 20 patients with radiosensitive colorectal cancer and 20 patients with radioresistance were selected from Yan'an Hospital Affiliated to Kunming Medical University from November 2016 to May 2017.Human colorectal cancer cell lines LoVo and HCT116 were selected and the radioresistant cell lines LoVo/R and HCT116/R were established for subsequent experiments.Real-time fluorescence quantitative PCR (qRT-PCR) was used to detect the expression of miR-613 and Wee1 in colorectal cancer tissues and cell lines.The radioresistant cells were transfected by miR-613 mimic,and non-transfected cells were used as control group.The effects of miR-613 overexpression on the proliferation,invasion and cell cycle of radiation resistance of colorectal cancer cells at different radiation doses were evaluated by CCK-8 assay,Transwell assay and Western blotting,respectively.Furthermore,dual-luciferase reporter gene assay was used to verify whether Wee1 was a target gene of miR-613.si-Wee1 was transfected into radioresistant cells of colorectal cancer,or co-transfected with si-Wee1 and miR-613 inhibitor,and non-transfected cells were used as control group.The effects of miR-613/Wee1 axis on cell proliferation,invasion and cell cycle were detected by CCK-8,Transwell and Western blotting at different radiation doses.Results The expression of miR-613 was downregulated in the radiation resistance group of patients (1.54 ± 0.25 vs.2.64 ± 0.45;t =3.140,P =0.009) and radiation resistance cell lines (LoVo/R vs.LoVo:1.03 ± 0.12 vs.3.05 ± 0.15;t =8.944,P =0.006;HCT116/R vs.HCT116:1.01 ±0.11 vs.2.85 ±0.16;t =8.050,P =0.008).Overexpression of miR-613 was significantly inhibited the proliferation (LoVo/R:t6 Gy =6.018,P =0.013;HCT116/R:t6Gy =5.634,P =0.015) and invasion (LoVo/R:45.00 ± 8.95 vs.180.15 ± 6.95,t6 Gy =11.93,P =0.003;HCT116/R:49.97 ±6.21 vs.170.20 ±7.03,t6 Gy =12.82,P =0.006) of LoVo/R and HCT116/R cells and decreased the expression levels of G2-M phase cell cycle correlated proteins (CDK1 and cyclin B).Moreover,dual-luciferase reporter gene assay confirmed that Wee1 was a target of miR-613.Mechanistically,overexpression of miR-613 promoted the radiosensitivity of LoVo/R and HCT116/R cells through inhibiting cell proliferation (compared with si-Wee1 group,co-transfected with si-Wee1 and miR-613 inhibitor,and control group,LoVo/R:F8 Gy =40.742,P =0.007;HCT116/R:F8 Gy =28.958,P =0.011),invasion (LoVo/R:F8 Gy =55.413,P =0.004;HCT116/R:F8 Gy =65.634,P =0.003) and arresting cell at G2-M phase via downregulating Wee1.Conclusion miR-613/Wee1 axis plays a certain role in regulating the radiation resistance of colorectal cancer cells,overexpression of miR-613 may reverse the radiation resistance of colorectal cancer cells.