Promotion of stem cell-like phenotype of lung adenocarcinoma by FAM83A via stabilization of ErbB2.

Lung cancer stands as the leading cause of mortality among all types of tumors, with over 40% of cases being lung adenocarcinoma (LUAD). Family with sequence similarity 83 member A (FAM83A) emerges as a notable focus due to its frequent overexpression in LUAD. Despite this, the precise role of FAM83A remains elusive. This study addresses this gap by unveiling the crucial involvement of FAM83A in maintaining the cancer stem cell-like (CSC-like) phenotype of LUAD. Through a global proteomics analysis, the study identifies human epidermal growth factor receptor 2 (HER2 or ErbB2) as a crucial target of FAM83A. Mechanistically, FAM83A facilitated ErbB2 expression at the posttranslational modification level via the E3 ubiquitin ligase STUB1 (STIP1-homologous U-Box containing protein 1). More importantly, the interaction between FAM83A and ErbB2 at Arg241 promotes calcineurin (CALN)-mediated dephosphorylation of ErbB2, followed by inhibition of STUB1-mediated ubiquitin-proteasomal ErbB2 degradation. The maintenance of the CSC-like phenotype by FAM83A, achieved through the posttranslational regulation of ErbB2, offers valuable insights for identifying potential therapeutic targets for LUAD.

Detection of lung cancer through SERS analysis of serum.

Early detection and postoperative assessment are crucial for improving overall survival among lung cancer patients. Here, we report a non-invasive technique that integrates Raman spectroscopy with machine learning for the detection of lung cancer. The study encompassed 88 postoperative lung cancer patients, 73 non-surgical lung cancer patients, and 68 healthy subjects. The primary aim was to explore variations in serum metabolism across these cohorts. Comparative analysis of average Raman spectra was conducted, while principal component analysis was employed for data visualization. Subsequently, the augmented dataset was used to train convolutional neural networks (CNN) and Resnet models, leading to the development of a diagnostic framework. The CNN model exhibited superior performance, as verified by the receiver operating characteristic curve. Notably, postoperative patients demonstrated an increased likelihood of recurrence, emphasizing the crucial need for continuous postoperative monitoring. In summary, the integration of Raman spectroscopy with CNN-based classification shows potential for early detection and postoperative assessment of lung cancer.

Multidirectional characterization of cellular composition and spatial architecture in human multiple primary lung cancers.

Multiple primary lung cancers (MPLCs) pose diagnostic and therapeutic challenges in clinic. Here, we orchestrated the cellular and spatial architecture of MPLCs by combining single-cell RNA-sequencing and spatial transcriptomics. Notably, we identified a previously undescribed sub-population of epithelial cells termed as CLDN2+ alveolar type II (AT2) which was specifically enriched in MPLCs. This subtype was observed to possess a relatively stationary state, play a critical role in cellular communication, aggregate spatially in tumor tissues, and dominate the malignant histopathological patterns. The CLDN2 protein expression can help distinguish MPLCs from intrapulmonary metastasis and solitary lung cancer. Moreover, a cell surface receptor-TNFRSF18/GITR was highly expressed in T cells of MPLCs, suggesting TNFRSF18 as one potential immunotherapeutic target in MPLCs. Meanwhile, high inter-lesion heterogeneity was observed in MPLCs. These findings will provide insights into diagnostic biomarkers and therapeutic targets and advance our understanding of the cellular and spatial architecture of MPLCs.

Analysis of risk factors and management of unexpected intraoperative bleeding during video-assisted thoracic surgery for non-small cell lung cancer: a case-control study.

Background: Intraoperative bleeding is one of the most dangerous complications of thoracoscopic surgery and seriously endangers the life of patients. How to prevent and manage intraoperative bleeding is a core concern for every thoracic surgeon. The aim of our study was to analyze the related risk factors of unexpected intraoperative bleeding during video-assisted thoracoscopic surgery (VATS) and the strategies for managing bleeding. Methods: A total of 1,064 patients who underwent anatomical pulmonary resection were analyzed retrospectively. According to the presence or absence of intraoperative bleeding, all cases were divided into an intraoperative bleeding group (IBG) and a reference group (RG). Clinicopathological characteristics and perioperative outcomes were compared in both groups. In addition, the sites, reasons, and coping strategies of intraoperative bleeding were summarized and analyzed. Results: After rigorous screening, 67 patients with intraoperative bleeding and 997 patients without intraoperative bleeding were included in our study. Compared with the RG, among patients in the IBG, there was a higher incidence of history of chest surgery (P<0.001), higher incidence of pleural adhesion (P=0.015), higher incidence of squamous cell carcinoma (P=0.034), and the fewer early T-stage cases (P=0.003). In the multivariate analyses, a history of chest surgery (P=0.001) and T stage (P=0.010) were independent risk factors of intraoperative bleeding. The IBG was associated with the longer operative time, the more blood loss, the higher rates of intraoperative blood transfusion and conversion, the longer hospital stay and the more complications. There were no significant differences in the duration of chest drainage (P=0.066) between IBG and RG. The most common injury site of intraoperative bleeding was the pulmonary artery (72%). The commonest cause of intraoperative bleeding was the accidental injury of energy device (37%). The most frequently used method for managing intraoperative bleeding was suturing of the bleeding site (64%). Conclusions: Although unexpected intraoperative bleeding during VATS is unavoidable, it can be controlled provided that positive and effective hemostasis are achieved. However, prevention is the priority.

Anatomical segmentectomy under uniportal video-assisted thoracoscopic surgery for early staged non-small cell lung cancer: a case report.

Background: Anatomical segmentectomy has become more and more universal in thoracic surgery because of the increasing detection of pulmonary nodules with ground-glass opacity (GGO), most of which proved early staged non-small cell lung cancer (NSCLC) postoperative. With the advantage of preservation of normal lung tissues, segmentectomy may be performed by surgeons when computed tomography (CT) scan shows pure GGO or multiple GGOs appearing. Especially when the patients with poor cardiopulmonary function or severe comorbidities or in the circumstance of bilateral pulmonary GGOs, segmentectomy can provide opportunities to radically resect all lesions. With the development of minimally invasive surgery technology, uniportal video-assisted thoracoscopic surgery (VATS) has become the regular operative route in many medical centers because it can provide less access trauma, less stress response, less pain, shorter hospital stays, and a lower postoperative complication rate and corresponds well with the idea of "minimally invasive". However, all of the procedures must be performed in one tiny portal, so uniportal VATS anatomical segmentectomy not only needs the skill and patience of surgeons but the effective cooperation of assistants, nurses and anesthetists, and plenty of details must be paid special attention. Case Description: Here we present a video of a patient undergoing S1 segmentectomy of right upper lobectomy (RUL) under uniportal VATS. The chief complaints of the patients was that two pure GGOs in the bilateral upper lobe were found by physical examination for 26 months and he had no symptoms. We performed S1 segmentectomy of RUL under uniportal first time and performed trisegmentectomy of left upper lobectomy (LUL) 3 months later. With routinely follow-up, no evidence of relapse and metastasis disease was found. Conclusions: We think anatomical segmentectomy under uniportal VATS can be a feasible and safe procedure that reduces trauma and has equivalent oncology outcomes to lobectomy in early-stage lung cancer but need a more experienced medical center to perform. Keywords: Uniportal video-assisted thoracoscopic surgery (uniportal VATS); segmentectomy; non-small cell lung cancer (NSCLC); case report.

Comparison of efficacy and safety of hybrid video-assisted thoracoscopic surgery vs. thoracotomy sleeve lobectomy for non-small cell lung cancer: a propensity score matching study.

Background: It is unclear whether hybrid video-assisted thoracoscopic surgery (VATS) sleeve lobectomy (SL) could be an alternative to thoracotomy SL for non-small cell lung cancer (NSCLC) treatment. The aim of the study is to investigate the safety and efficacy of hybrid VATS SL. Methods: We collected 112 patients who received hybrid VATS SL or thoracotomy SL for primary treatment of NSCLC at Liaoning Cancer Hospital & Institute from November 2016 to September 2021. Perioperative and survival data were collected, and retrospective analysis was conducted on 91 thoracotomy and 21 hybrid VATS SL patients to evaluate the safety and efficacy of two approaches. Propensity score matching (PSM) was used to minimize selection bias. The Kaplan-Meier method was applied to compare overall survival (OS) and recurrence-free survival (RFS). Follow-up data were obtained by outpatient clinical visit and nurse-led telephone. Results: A total of 112 patients were included in this study, including thoracotomy patients (n=91) and hybrid VATS patients (n=21). In the non-match analysis, the baseline data of patients was similar between the two groups, except regarding the receipt of neoadjuvant therapy (P=0.087). After PSM (2:1), a total of 39 thoracotomy patients and 19 hybrid VATS patients were enrolled. The baseline variables were quite similar in both groups. In the hybrid group, the number of lymph nodes (25.9±8.5 vs. 32.9±9.7, P<0.01) and positive lymph nodes (3.7±2.9 vs. 5.6±4.0, P=0.045) were significantly higher than those in the thoracotomy group. The hybrid group was associated with significantly shorter postoperative hospital stay (9.5±3.5 vs. 7.3±2.9, P=0.021) and chest tube duration time (6.6±3.1 vs. 5.3±1.5, P=0.031). No statistical difference in complications, reoperation, and recurrence were observed between the hybrid VATS SL and thoracotomy SL (P=1.0, P=1.0, P=0.472). The 30- and 90-day mortalities showed no differences between approaches (2.6% vs. 0%, P=1.0; 5.1% vs. 5.3%, P=1.0). No significant differences were found between thoracotomy and hybrid VATS SL in 3-year OS (P=0.614) and 3-year RFS (P=0.750). Conclusions: Hybrid VATS SL lobectomy may be a safe and feasible approach associated with similar oncologic prognosis and better postoperative recovery compared with thoracotomy SL for NSCLC treatment.

Site-Specific Hypermethylation of SST 1stExon as a Biomarker for Predicting the Risk of Gastrointestinal Tract Cancers.

BACKGROUND: DNA methylation is an important epigenetic modification in tumorigenesis, and similar epigenetic regulation mechanisms have been found in the gastrointestinal tract (GIT) cancers. Somatostatin (SST) has been confirmed to be expressed throughout the GIT. This study aimed to simultaneously explore the relationships between the SST methylation and the risks of three GIT cancers (esophageal cancer (EC), gastric cancer (GC), and colorectal cancer (CRC)) and to evaluate its diagnostic value. METHODS: Differentially methylated regions (DMRs) of the SST gene, including TSS200, 1stExon, and the gene body, were identified in GIT cancers by The Cancer Genome Atlas (TCGA) database analysis. Further analyses were conducted in tissue samples of EC (n = 50), GC (n = 99), and CRC (n = 80). The SST methylation was detected by bisulfite-sequencing PCR (BSP), and the SST expression was detected by quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR). RESULTS: In GIT cancers, DMR-related CpG islands were mainly located in the 1stExon. The methylation status of the SST 1stExon in the tumor tissues was significantly higher than that in the adjacent noncancerous tissues, and the methylation rates of the specific CpG sites were correlated with clinical phenotypes. The average methylation rate (AMR) of the SST 1stExon was negatively correlated with the SST gene expression in GC and CRC (both P < 0.001). For the diagnosis of GIT cancers, the combined detection of methylation at CpG sites +18 and +129 showed the highest area under the curve (AUC 0.698), with a sensitivity of 59.3% and a specificity of 72.8%. CONCLUSIONS: The site-specific hypermethylation of the SST 1stExon increases the risk of GIT cancers and might be a potential predictive marker for pan-GIT cancers.

Comparison of cost effectiveness between video-assisted thoracoscopic surgery (vats) and open lobectomy: a retrospective study.

BACKGROUND: Lung cancer is highly prevalent in Chinese population. The association of operative approach with economic burden in these patients remains unknown. OBJECTIVES: This institution-level cohort study aimed to compare the cost-related clinical outcomes and health care costs among patients undergoing video-assisted thoracoscopic surgery (VATS) and open lobectomy, and to investigate the factors associated with the costs. METHODS: This retrospective cohort study included patients who underwent VATS or open lobectomy in a provincial referral cancer center in China in 2018. Propensity score matching (PSM) method was applied to balance the baseline characteristics in VATS lobectomy and open lobectomy group. Clinical effectiveness measures included post-operative blood transfusion, lung infection, and length of stay (LOS). Hospitalization costs were extracted from hospital information system to assess economic burden. Multivariable generalized linear model (GLM) with gamma probability distribution and log-link was used to analyze the factors associated with total costs. RESULTS: After PSM, 376 patients were selected in the analytic sample. Compared to open lobectomy group, the VATS lobectomy group had a lower blood transfusion rate (2.13% vs. 3.19%, P = 0.75), lower lung infection rate (21.28% vs. 39.89%, P < 0.001) and shorter post-operative LOS (9.4 ± 3.22 days vs. 10.86 ± 4.69 days, P < 0.001). Total hospitalization costs of VATS lobectomy group and open lobectomy were similar: Renminbi (RMB) 84398.03 ± 13616.13, RMB 81,964.92 ± 16748.11, respectively (P = 0.12). Total non-surgery costs were significantly lower in the VATS lobectomy group than in the open lobectomy group: RMB 41948.40 ± 7747.54 vs. RMB 45752.36 ± 10346.42 (P < 0.001). VATS approach, lung infection, longer post-operative length of stay, health insurance coverage, and lung cancer diagnosis were associated with higher total hospitalization costs (P < 0.05). CONCLUSIONS: VATS lobectomy has a lower lung infection rate, and shorter post-operative LOS than open lobectomy. Future studies are needed to investigate other aspects of clinical effectiveness and the economic burden from a societal perspective.

Label-free surface-enhanced Raman spectroscopy for diagnosis and analysis of serum samples with different types lung cancer.

Screening and detection of early lung cancer is important for diagnosis and prognosis. Intervention in early stage of lung cancer can significantly improve the cure and survival of patients. Surface-enhanced Raman spectroscopy (SERS) is an increasingly popular method of diagnosing cancer. We used silver nanoparticles (AgNPs) as the Raman-enhanced substrate to increase Raman signals, which contributes to the subsequent classification of lung cancer and normal serum. SERS acquired from the serum indicated the difference in biochemical components between cancerous (n = 51) lung serum and normal (n = 18) serum. Principal component analysis (PCA) and partial least-squares discriminant analysis (PLS-DA) were utilized to establish the identification model, and the various indicators of PLS-DA were all superior to those of the PLS model. Our study offers a new proposal for the universal applicability of analysis and identification with SERS of serum samples in clinical diagnosis.

Pectus excavatum requiring temporary pacemaker implantation before Nuss procedure: a case report.

Pectus excavatum is the most common chest wall deformity, and some patients also have it combined with cardiac arrhythmias. It is a rare occurrence for there to be a severe conduction block that requires a temporary pacemaker implantation before the surgical correction. Here we reported a case of pectus excavatum with a second-degree atrial-ventricular (AV) block (Mobitz II) who had temporary pacemaker implantation before the Nuss procedure. The young patient had a chest wall deformity for 6 years and it got worse with age. The Haller index was 4.21, and we evaluated that he should receive the Nuss procedure. An AV block was found during the preoperative electrocardiogram examination; furthermore, Holter monitor proved that he had first-degree AV block and a second-degree AV block (Mobitz II). After consultation with the anesthesiologist and cardiologist, we suggested that a temporary pacemaker placement should be performed under local anesthesia before the minimally invasive operation and removed as soon as the patient revived from general anesthesia. A postoperative Holter monitor was implemented, and the conduction defect disappeared shortly after the operation. However, the Holter monitor showed that the conduction defect was still existed during the follow-up period, which indicated that severe conduction defects should be originated from the conduction system itself, rather than the compression to the heart. The temporary pacemaker was essential to ensure the conducting of the operation went smoothly.

How to optimize the treatment strategy for patients of pulmonary sequestration with an elevated risk of fatal hemorrhage during operation: case discussion.

Video-assisted thoracoscopic surgery (VATS) lobectomy, especially uniportal VATS, is increasingly used for pulmonary sequestration (PS). However, there are few descriptions of safe handling of the aberrant artery with atherosclerosis, especially the diameter of arteries exceeds than 2.0 cm, under uniportal VATS approach. Here we report a 56-year-old man who was diagnosed with pulmonary sequestration following trauma. The patient had a long history of cough with purulent sputum. One month before the trauma, he had copious expectoration with foul smell again. A contrast CT scan revealed a 7.5 cm mass in his right lower lobe. The mass was supplied by a thick aberrant atherosclerotic artery (over than 2 cm in diameter), which stemmed from the thoracic aorta with multiple calcifications on both. After adequate preoperative evaluation, we performed a right lower lobectomy under uniportal VATS approach. No surgical-associated complications occurred, and the patient was discharged on the 5th days after the operation. We organized an iMDT (international multidisciplinary team) to discuss the reasonability and optimal treatment pattern for this patient. We found that fully assess the quality of the aberrant arteries of PS following blocking and cutting off in an appropriate way are crucial to avoid the happening of fatal bleeding during the operation.

Identification of methylated-differentially expressed genes and pathways in esophageal squamous cell carcinoma.

Methylation, as an epigenetic modification, can affect gene expression and play a role in the occurrence and development of cancer. This research is devoted to discover methylated-differentially expressed genes (MDEGs) in esophageal squamous cell carcinoma (ESCC) and explore special associated pathways. We downloaded GSE51287 methylation profiles and GSE26886 expression profiles from GEO DataSets, and performed a comprehensive bioinformatics analysis. Totally, 19 hypermethylated, lowly expressed genes (Hyper-LGs) were identified, and involved in regulation of cell proliferation, phosphorus metabolic process and protein kinase activity. Meanwhile, 17 hypomethylated, highly expressed genes (Hypo-HGs) were participated in collagen catabolic process, metallopeptidase and cytokine activity. Pathway analysis determined that Hyper-LGs were enriched in arachidonic acid metabolism pathway, while Hypo-HGs were primarily associated with the cytokine-cytokine receptor interaction pathway. IL 6, MMP3, MMP9, SPP1 were identified as hub genes based on the PPI network that combined 7 ranked methods included in cytoHubba, and verification was performed in human tissues. Our integrated analysis identified many novel genetic lesions in ESCC and provides a crucial molecular foundation to improve our understanding of ESCC. Hub genes, including IL 6, MMP3, MMP9 and SPP1, could be considered for use as aberrant methylation-based biomarkers to facilitate the accurate diagnosis and therapy of ESCC.

Clinical application of enhanced recovery after surgery (ERAS) in pectus excavatum patients following Nuss procedure.

BACKGROUND: Evaluate the effect of enhanced recovery after surgery (ERAS) protocol on postoperative recovery quality of pectus excavatum patients with Nuss procedure. METHODS: A retrospective study was performed on patients undergoing Nuss procedure from the Department of Thoracic Surgery of The Cancer Hospital of China Medical University between September 2016 and September 2019. Patients were divided into 2 groups by perioperative management: the traditional procedure group (T group) and the ERAS strategy group (E group). The outcome measures were postoperative drainage time, postoperative hospital time, and postoperative complications measured by the Clavien-Dindo method. RESULTS: Of the 168 patients from this time period, 148 met the inclusion criteria (75 in Group T and 73 in Group E). All operations involved in this study were completed successfully. There was no statistical difference between the 2 groups with respect to baseline demographics (P>0.05). In Group E, postoperative drainage time (2.53±0.72 vs. 3.45±2.07 days) and postoperative hospitalization time (4.96±1.48 vs. 7.71±7.78 days) were statistically significantly better than those in Group T (P<0.05). There was no difference in overall postoperative complications as measured by Clavien-Dindo score. CONCLUSIONS: The measures of no indwelling urinary catheter (IDUC), laryngeal mask anesthesia, and indwelling tubule drainage can improve postoperative recovery quality of pectus excavatum patients following Nuss procedure.

LncRNA SBF2-AS1 affects the radiosensitivity of non-small cell lung cancer via modulating microRNA-302a/MBNL3 axis.

Background: Long non-coding RNAs (lncRNAs) have been reported to participate in many diseases including non-small cell lung cancer (NSCLC), thus our objective was to investigate the impact of lncRNA SBF2-AS1 modulating microRNA-302a (miR-302a) expression on radiosensitivity of NSCLC.Methods: The expression of SBF2-AS1, miR-302a and muscleblind-like 3 (MBNL3) in NSCLC tissues of the radiotherapy-sensitive and radiotherapy-resistant groups was tested. The radiosensitivity of parent and resistant strains (NCI-H1299 and NCI-H1299R cells) was detected. Further, cells were treated with si-SBF2-AS1 and miR-302a mimics to determine their roles in proliferation and apoptosis of parent strain and resistant strain cells as well as transfected cells. The in-vivo growth capacity of the cells and the effect of radiotherapy on tumor size of NSCLC were detected.Results: Up-regulated SBF2-AS1 and MBNL3 and down-regulated miR-302a in NSCLC tissues of the radiotherapy resistant group. Overexpression of SBF2-AS1 and MBNL3 and low expression of miR-302a were witnessed in NCI-H1299R cells. Down-regulated SBF2-AS1 or up-regulated miR-302a suppressed the proliferation while boosted the apoptosis of NCI-H1299 cells and decreased the radioresistance of the NCI-H1299R cells. Silencing SBF2-AS1 or up-regulating miR-302a restrained tumor growth in vivo.Conclusion: Our study presents that high expression of miR-302a or inhibition of SBF2-AS1 can enhance the radiosensitivity and apoptosis of NSCLC cells through downregulation of MBNL3, which is a therapeutic target for NSCLC.

Feasibility of nodal classification for non-small cell lung cancer by merging current N categories with the number of involved lymph node stations.

INTRODUCTION: The aim of this study was to assess the prognoses of patients with non-small cell lung cancer (NSCLC) according to the current nodal (N) categories of the tumor, node and metastasis (TNM) classification and the number of involved lymph node stations. METHODS: Five hundred and seventy patients with NSCLC underwent surgery from 1 January 2005 to 31 December 2009 and were analysed retrospectively. Postoperative overall survival was analysed according to two nodal classifications: the current N0, N1, N2 and N3 categories and those based on the number of involved nodal stations: N0, N1a (single N1), N1b (multiple N1), N2a1 (single N2 without N1), N2a2 (single N2 with N1), N2b1 (multiple N2 without N1) and N2b2 (multiple N2 with N1). RESULTS: Five-year survival rates were 76.1%, 53.4% and 26.3% for N0, N1 and N2, respectively (P < 0.001). When survival was analysed by the number of involved nodal stations, the groups with significant differences were maintained; otherwise, they were merged, and new codes were assigned as follows for exploratory analyses: NA (N0), NB (N1a), NC (N1b, N2a (i.e., N2a1 and N2a2) and N2b1) and ND (N2b2). Five-year survival rates were 76.1%, 60.0%, 39.1%, and 11.4% for NA, NB, NC and ND, respectively, and there were significant differences among them. This N classification was an independent prognostic factor in multivariate analyses. CONCLUSION: Pending prospective and international validation, it is practical to merge the current N categories with the number of involved lymph node stations when evaluating the postoperative prognosis of NSCLC patients.

Cost-effectiveness of standard utilization of zoledronic acid for bone metastases from advanced lung cancer in China.

Aim: To assess the cost-effectiveness of standard utilization of zoledronic acid (ZA) relative to real-world utilization of ZA for bone metastasis (BM) in Chinese patients with advanced lung cancer. Materials & methods: A decision analytic model was constructed to simulate health benefits and medical costs associated with standard and real-world utilization of ZA for BM in Chinese patients with advanced lung cancer. Results: Compared with real-world utilization of ZA, standard utilization of ZA reduced cumulative risk of skeletal-related events (45.7 vs 63.6%), increased quality-adjusted life years (0.673 vs 0.626 QALY) and saved cumulated medical costs (¥343,163 vs ¥376,943). Conclusion: Standard utilization of ZA dominated real-world utilization of ZA for BM in Chinese patients with advanced lung cancer from cost-effectiveness perspective.

Two-step method for creating a gastric tube during laparoscopic-thoracoscopic Ivor-Lewis esophagectomy.

AIM: To introduce a two-step method for creating a gastric tube during laparoscopic-thoracoscopic Ivor-Lewis esophagectomy and assess its clinical application. METHODS: One hundred and twenty-two patients with middle or lower esophageal cancer who underwent laparoscopic-thoracoscopic Ivor-Lewis esophagectomy at Liaoning Cancer Hospital and Institute from March 2014 to March 2016 were included in this study, and divided into two groups based on the procedure used for creating a gastric tube. One group used a two-step method for creating a gastric tube, and the other group used the conventional method. The two groups were compared regarding the operating time, surgical complications, and number of stapler cartridges used. RESULTS: The mean operating time was significantly shorter in the two-step method group than in the conventional method group [238 (179-293) min vs 272 (189-347) min, P < 0.01]. No postoperative death occurred in either group. There was no significant difference in the rate of complications [14 (21.9%) vs 13 (22.4%), P = 0.55] or mean number of stapler cartridges used [5 (4-6) vs 5.2 (5-6), P = 0.007] between the two groups. CONCLUSION: The two-step method for creating a gastric tube during laparoscopic-thoracoscopic Ivor-Lewis esophagectomy has the advantages of simple operation, minimal damage to the tubular stomach, and reduced use of stapler cartridges.

Anti­lung cancer effect of glucosamine by suppressing the phosphorylation of FOXO.

Lung cancer is the most common cause of cancer­associated mortality worldwide, and glucosamine has the potential to exhibit antitumor activity. To reveal its anti­lung cancer mechanism, the present study investigated the effect of glucosamine on the transcriptional activity of forkhead box O (FOXO)1 and FOXO3, and associated signal transduction pathways in A549 cells. An MTT assay was performed to investigate cell viability and immunoblotting was performed to detect protein levels of FOXO1/3, phosphorylated (p)­FOXO1/3, AKT, p­AKT, extracellular signal­regulated kinase (ERK) and p­ERK, and the levels of ß­O­linked N­acetylglucosamine (O­GlcNAc)­modified FOXO1 protein. Immunoprecipitation was performed to purify O­GlcNAc­modified protein prior to immunoblotting. Glucosamine inhibited FOXO1­ and FOXO3­specific amino acid phosphorylation, which was correlated with its translocation from the nucleus to cytoplasm, indicating a possible anti­lung cancer mechanism of glucosamine. The present study also examined the phosphoinositide 3­kinase (PI3K)/AKT and mitogen­activated protein kinase (MAPK)/ERK pathways, which induce FOXO1­ and FOXO3­specific site phosphorylation. The data showed that glucosamine suppressed the translocation of FOXO from the cytoplasm to the nucleus via glucosamine­induced O­GlcNAc modification. These observations suggested that glucosamine modulated A549 cell proliferation, possibly via O­GlcNAc modification­induced downregulation of the PI3K/AKT and MAPK/ERK pathways and their downstream signaling molecules, FOXO1 and FOXO3.

Short-Term Outcome of Three-Dimensional Versus Two-Dimensional Video-Assisted Thoracic Surgery for Benign Pulmonary Diseases.

BACKGROUND: It is unclear whether three-dimensional (3D) video-assisted thoracic surgery (VATS) pulmonary resections are comparable to two-dimensional (2D) VATS pulmonary resections in patients with potentially operable benign pulmonary diseases. METHODS: We analyzed the clinical data of patients who underwent 2D and 3D VATS pulmonary resections for benign diseases in our hospital from November 2013 to August 2014. Perioperative factors (estimated blood loss and operative time) and postoperative factors (postoperative hospital length of stay, postoperative complications, and duration of chest tube drainage) were evaluated. RESULTS: VATS was performed in 278 patients during the 10-month study period. The 2D VATS system was used in 142 patients (51.08%), and the 3D VATS system was used in 136 (48.92%). Operative time was significantly different between the two groups (p = 0.007). However, no significant differences were found in estimated blood loss (p = 0.75), chest drainage tube placement time (p = 0.852), rate of postoperative complications (p = 0.566), or postoperative hospital length of stay (p = 0.951). CONCLUSIONS: The use of 3D VATS appears to facilitate precise execution of surgical techniques in specific operative tasks and, as a result, reduces lung resection performance time in patients with benign pulmonary diseases.