[A comparative study of HRCT and pathological subtype, EGFR gene mutations of peripheral small lung adenocarcinoma].

OBJECTIVE: To investigate the relationship of the preoperative HRCT, postoperative pathological subtype and EGFR gene mutation types in the patients of small peripheral lung adenocacinoma confirmed by operation. METHODS: Between December 2011 and November 2014, Ninety-four invasive adenocarcinoma patient were selected from 156 patients with pulmonary nodule underwent operation in Beijing Chaoyang hospital. Among them, there were male 37 cases, female 57 cases, age range from 32 to 76, mean age 52.6. All patients underwent complete anatomical lobectomy or wedge resection or segmentectomy, with systematic mediastinal lymph node dissection. The detection indexes included: preoperative HRCT, postoperative pathological subtypes, lymph node; EGFR, Kras, ALK, FGF9 gene expression and so on. RESULTS: Postoperative pathologic acinar predominant accounted for 33.0% (31/94), papillary predominant type accounted for 25.5% (24/94), Lepidic predominant adenocarcinoma accounted for 19.1% (18/94), 13.8%(13/94) micro papillary predominant, 8.5% (8/94) solid predominant. 7 patients with lymph node positive included 5 cases of stations 11-12, 1 case of station 4 and 1 case of station 7. 36 cases was detected EGFR mutation after operation (38.9%, 36/94), mainly 19⁺ and 21⁺. Compared with the preoperative HRCT findings, there was no significant difference in EGFR mutation group and non mutation group (χ² = 1.411, P=0.703). For different types of mutations in EGFR gene, there was no statistical difference (P>0.05). But the rate of EGFR 21 positive in progression patients was significantly higher than that of EGFR 19 positive patients(χ² = 5.779, P=0.016). CONCLUSION: There were no significant different between the HRCT manifestations and pathological subtypes in the rate of EGFR gene mutation. EGFR 21 gene mutation was found in double lung metastasis commonly.

[Early removal of the chest tube after lobectomies: a prospective randomized control study].

OBJECTIVE: To evaluate the feasibility and safety of early chest tube removal after lobectomies for lung diseases. METHODS: A prospective randomized control study was performed with data collected from lobectomies between March 2012 and September 2012. Eligible patients (n = 70) were randomized into two groups; early removal group (removal of chest tube when drainage less than 300 ml/24 h, n = 41) and traditional management group (removal of chest tube when drainage less than 100 ml/24 h, n = 29). Criteria for early removal were established and met before chest tube removal. The volume and character of drainage, time of extracting drainage tube and postoperative hospital stay were measured. All patients received standard care during hospital admission and a follow-up visit was performed after 7 days of discharge from hospital. RESULTS: There were no differences between two groups with respect to age, sex, comorbidities, or pathologic evaluation of resection specimens. The median volume of drainage within 24 h after surgery was 300 ml and within 48 h was 250 ml, there was significantly different between two groups (Z = -2.059, P = 0.039). Patients undergoing early removal management had a shorter Chest tube duration (44 hours vs. 67 hours, Z = -2.914, P = 0.004) and a shorter postoperative hospital stay (5.0 days vs. 6.0 days, Z = -3.882, P = 0.000). Analysis of data showed no statistically significant differences between the rate of pleural effusions developed, thoracentesis and complications, one week after discharge from hospital. CONCLUSIONS: Compared to the traditional management group (drainage ≤ 100 ml/24 h), early removal of chest tube after lobectomy (drainage ≤ 300 ml/24 h) is feasible and safe. It could result in a shorter hospital stay, and most importantly, reduces morbidity without the added risk of complications.

Geometric Boundary Guided Feature Fusion and Spatial-Semantic Context Aggregation for Semantic Segmentation of Remote Sensing Images.

Semantic segmentation of remote sensing images aims to achieve pixel-level semantic category assignment for input images. This task has achieved significant advances with the rapid development of deep neural network. Most current methods mainly focus on effectively fusing the low-level spatial details and high-level semantic cues. Other methods also propose to incorporate the boundary guidance to obtain boundary preserving segmentation. However, current methods treat the multi-level feature fusion and the boundary guidance as two separate tasks, resulting in sub-optimal solutions. Moreover, due to the large inter-class difference and small intra-class consistency within remote sensing images, current methods often fail to accurately aggregate the long-range contextual cues. These critical issues make current methods fail to achieve satisfactory segmentation predictions, which severely hinder downstream applications. To this end, we first propose a novel boundary guided multi-level feature fusion module to seamlessly incorporate the boundary guidance into the multi-level feature fusion operations. Meanwhile, in order to further enforce the boundary guidance effectively, we employ a geometric-similarity-based boundary loss function. In this way, under the explicit guidance of boundary constraint, the multi-level features are effectively combined. In addition, a channel-wise correlation guided spatial-semantic context aggregation module is presented to effectively aggregate the contextual cues. In this way, subtle but meaningful contextual cues about pixel-wise spatial context and channel-wise semantic correlation are effectively aggregated, leading to spatial-semantic context aggregation. Extensive qualitative and quantitative experimental results on ISPRS Vaihingen and GaoFen-2 datasets demonstrate the effectiveness of the proposed method.

Retrospective analysis of prognostic factors after liver transplantation for intrahepatic cholangiocarcinoma in China: a single-center experience.

BACKGROUND/AIMS: This study aims to assess the prognosis of liver transplantation for ICC patients and try to identify prognostic factors that could influence survival for intrahepatic cholangiocarcinoma patients treated by liver transplantation. METHODOLOGY: Between February 1999 and February 2010, 20 patients with ICC underwent liver transplantation. The Kaplan-Meier method was used to calculate the actuarial survival rate and tumor-free survival rate. Log-rank test was used to compare the differences between groups. Univariate Cox proportional hazard regression model was used to analyze each factor that might have influenced liver transplantation prognosis in ICC patients and to identify factors with statistical significance. RESULTS: Actuarial survival rate at 1, 2, 3 and 5 years achieved 84.2%, 43.7%, 32.7% and 21.8%, respectively. Tumor-free survival at 1, 2, 3 and 5 years was 55.6%, 43.2%, 28.8% and 18.8%, respectively. In univariate analysis, lobar distribution, multiple tumors, lymph node invasion, macrovascular invasion, advanced pTNM classification stages, neoadjuvant therapy and differentiation were associated significantly with survival, especially the former 6 factors. In multivariate analysis, lymph node invasion, macrovascular invasion and multiple tumors were the independent predictors of survival, especially lymph node invasion and multiple tumors. CONCLUSION: Liver transplantation in patients with ICC should be confined to highly discreetly selected cases. Consequently, liver transplantation combined with neoadjuvant treatment for these cases may achieve an improved survival.

Dynamic and conventional electrocardiograms for diagnosing arrhythmic coronary atherosclerotic heart disease: a comparative analysis.

PURPOSE: This study aims to compare the clinical effects of dynamic electrocardiograms (ECGs) and conventional ECGs in the diagnosis of arrhythmic coronary atherosclerotic heart disease. METHODS: Fifty patients with arrhythmic coronary atherosclerotic heart disease admitted to our hospital from January 2019 to January 2020 were recruited as the study cohort. All the 50 patients were first diagnosed using conventional ECGs, and then they were diagnosed using 24-hour dynamic ECGs. The results of the conventional ECG diagnoses were taken as the control group, and the results of 24-hour dynamic ECG diagnoses were taken as the experimental group. The positive detection rates, the ventricular premature contraction rates, the supraventricular tachycardia rates, the atrioventricular block detection rates, the paired atrial premature beats, and the paired ventricular premature beats were compared between the two groups, and the diagnostic effectiveness of the dynamic electrocardiograms and the conventional electrocardiograms was analyzed. RESULTS: The positive detection rate in the experimental group was significantly higher than it was in the control group (P<0.05). The atrioventricular block, paired atrial premature beat, and paired ventricular premature beats rates in the experimental group were found to be significantly higher (P<0.05). There were no significant differences in the atrial fibrillation and premature ventricular beat rates between the two groups (P>0.05). CONCLUSION: Dynamic electrocardiograms are better for diagnosing arrhythmic coronary atherosclerotic heart disease than conventional electrocardiograms.

Photosynthetic Properties of Co-Occurring Pioneer Species on Volcanically Devastated Sites in Miyake-jima Island, Japan.

Pioneer species differing in their inherent ecological characteristics (e.g., N-fixing ability, photosynthetic pathway) can have a large impact on local ecosystems in the early stages of volcanic succession. However, it remains unclear as to how these pioneer species adapt to the extreme environment of volcanically devastated sites in terms of ecophysiological leaf traits. In this study, we compared the leaf traits (including morphological, physiological) of three co-occurring pioneer species, including a C4 non-N-fixing grass, a C3 N-fixing tree, and a C3 non-N-fixing herb from a newly created (18 years after eruption) volcanically devastated site in Miyake-jima, Japan. Our results showed that three pioneer species have different sets of leaf traits that are associated with their ecophysiological growth advantages, respectively. Miscanthus condensatus shows the highest light-saturated photosynthetic rate (Amax). The higher Amax were partially the result of higher water use efficiency (WUE) and photosynthetic N-use efficiency (PNUE). The PNUE in M. condensatus appears to be high, even for a C4 grass. Alnus sieboldiana rely on its N-fixing ability, has a higher leaf N content (Narea) that compensates for its photosynthetic machinery (Rubisco), and further ensures its photosynthetic capacity. Fallopia japonica var. hachidyoensis has a higher leaf mass per area (LMA), chlorophyll content (Chl), and maximum quantum yield of PSII (Fv/Fm), demonstrating its higher light capturing ability. These results make it possible to predict certain ecological processes that take place in the early stages of volcanic succession resulting from ecological characteristics and from some key leaf traits of pioneer species. It also provides a theoretical basis for species selection and species combination for volcanic ecological restoration.

Photosynthetic Properties of Miscanthus condensatus at Volcanically Devastated Sites on Miyake-jima Island.

How photosynthetic-related leaf traits of non-nitrogen (N)-fixing pioneer species respond to extreme habitat conditions of primary succession is still not well-elucidated, especially in volcanically N-deplete habitats. The effect of N-deplete soil on photosynthetic-related leaf traits can provide a basis for predicting how plants adjust their strategies to adapt to such habitats. To examine the responses of leaf traits to extreme conditions, we investigated Miscanthus condensatus (a non-N-fixing C4 pioneer grass) which grows on a volcanically devastated area on Miyake-jima Island, Japan, in which the volcanic ash has been deposited for 17-18 years since the 2000-year eruption. Leaf N content (Narea), light-saturated photosynthetic rate (Amax), and photosynthetic N use efficiency (PNUE) in three contrasting study sites: bare land (BL), shrub land gap (SLG), and shrub land under canopy (SLUC) were determined. Results indicated that compared to previous studies and internal comparison of Miyake Island, M. condensatus in BL was able to maintain a relatively high Amax, Narea and PNUE. The higher Amax was in part a result of the higher PNUE. This is a characteristic necessary for its successful growth in N-deplete soils. These results suggest that M. condensatus has photosynthetic-related advantages for adaptation to volcanically N-deplete habitats.

Recurrent primary spontaneous pneumothorax in a large Chinese family: a clinical and genetic investigation.

BACKGROUND: Primary spontaneous pneumothorax (PSP) is a common manifestation of Birt-Hogg-Dubé (BHD) syndrome, which is an autosomal dominant disorder caused by mutation of the folliculin (FLCN) gene. This study was established to investigate the mutation of the FLCN gene and the phenotype in a family with PSP. METHODS: We investigated the clinical and genetic characteristics of a large Chinese family with recurrent spontaneous pneumothorax. Genetic testing was performed by Sanger sequencing of the coding exons (4-14 exons) of the FLCN gene. RESULTS: Among ten affected members in a multi-generational PSP kindred, with a total of 18 episodes of spontaneous pneumothorax, the median age for the initial onset of pneumothorax was 42.5 years (interquartile range: 28.8-57.2 years). Chest computed tomography scan of the proband showed pulmonary cysts and pneumothorax. A novel nonsense mutation (c.1273C>T) in exon 11 of FLCN gene that leads to a pre-mature stop codon (p.Gln425*) was identified in the family. The genetic analysis confirmed the diagnosis of BHD syndrome in this family in the absence of skin lesions or renal tumors. CONCLUSIONS: A novel nonsense mutation of FLCN gene was found in a large family with PSP in China. Our results expand the mutational spectrum of FLCN gene in patients with BHD syndrome.

Erratum to the significance of perioperative coagulation and fibrinolysis related parameters after lung surgery for predicting venous thromboembolism: a prospective, single center study.

[This corrects the article DOI: 10.21037/jtd.2018.03.174.].

The significance of perioperative coagulation and fibrinolysis related parameters after lung surgery for predicting venous thromboembolism: a prospective, single center study.

BACKGROUND: The high incidence of venous thromboembolism (VTE) has been perceived in post thoracic surgery patients. However, the significance of perioperative coagulation and fibrinolysis related parameters after lung surgery for VTE predicting is not clear. To investigate that, we conducted a prospective single center study. METHODS: A total of 111 patients undergoing lung surgery were enrolled in this study, included 52 primary lung cancer patients and 59 benign lung disease patients from July 2016 to March 2017. Preoperative and postoperative days 1, 3, and 5 coagulation and fibrinolysis related parameters were tested, including antithrombin (AT), fibrinogen degradation product (FDP), prothrombin time (PT), prothrombin time activity (PA), prothrombin time ratio (PR), international normalized ratio (INR), activated partial thromboplastin time (APTT), plasma fibrinogen (FBG), thrombin time (TT) and D-Dimer. The Doppler ultrasonography was performed before and after surgery for deep venous thrombosis (DVT) confirmation. Patients with new postoperative DVT, unexplained dyspnea, hemoptysis, chest pain, or high Caprini score (≥9) were received further computer tomography pulmonary angiography (CTPA) for pulmonary embolism (PE). We used the area under receiver-operating-characteristic (ROC) curve to discriminate patients between those who developed VTE and those who did not. Single factor analysis was utilized to define risk factors associated with VTE. RESULTS: The overall incidence of VTE was 16.2% (18/111). The incidence of VTE in primary lung cancer patients was 23.1% (12/52), much higher than that in benign lung diseases 10.2% (6/59), but did not reach statistical significance (P=0.066). Among 18 VTE patients, 83.3% was DVT, 16.7% was DVT + PE and 72.2% was muscular veins of the calf thrombosis. D-Dimer was much higher in VTE group than that in non-VTE group preoperatively and at postoperative days 1, 3 (0.64±0.24 vs. 0.33±0.06, P=0.007; 3.14±0.75 vs. 1.51±0.09, P=0.005, and 1.88±0.53 vs. 0.76±0.05, P=0.001, respectively). And the ROC curve areas of preoperative and postoperative days 1, 3 of D-Dimer were 0.70, 0.71 and 0.74, respectively. And FDP was much higher in VTE group than that in non-VTE group at postoperative day 3 (6.78±1.43 vs. 3.79±0.15, P=0.004). But AT, PT, PA, PR, INR, APTT, FBG and TT there were no significantly difference. CONCLUSIONS: The overall incidence of VTE after lung surgery was 16.2%. The patients with preoperative high D-Dimer should receive VTE prophylaxis.

A clinical study of efficacy of polyglycolic acid sleeve after video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax.

BACKGROUND: Primary spontaneous pneumothorax (PSP) is a common disease in thoracic surgery, and a prolonged postoperative air leakage is the most frequent and troublesome early complication after video-assisted thoracoscopic (VATS) bullectomy. This study aimed to explore the efficacy of polyglycolic acid (PGA) sleeve in preventing postoperative air leakage after a VATS bullectomy for PSP. METHODS: This study was a prospectively randomised clinical study. The patients who underwent a VATS bullectomy were continuously enrolled from January 2015 to June 2016 in the Beijing Chaoyang Hospital and were randomly assigned to the experimental and control groups. The experimental group applied a PGA sleeve combined with an automatic stapler in the bullectomy, while in the control group, the bullae were resected using an automatic stapler alone during the operation. In addition, the staple lines in both groups were covered with an absorbable polyglycolic acid sheet and both groups performed pleural abrasion after the resection. Useful clinical data were recorded, including the number of cases there was no air leakage immediately after the operation and air leakage lasted more than 3 days, the average postoperative air leakage, the drainage tube removal time, the postoperative hospital stay, the postoperative complications, and the postoperative recurrence. RESULTS: A total of 134 patients were enrolled in this study. The experimental group consisted of 60 subjects, and there were 74 in the control group. No operative related mortality was observed in either group. In the experimental group, 44 of the 60 patients did not have an air leakage immediately after the operation, which was significantly higher than the control group (73.33% vs. 54.05%, P=0.031). Compared with the control group, the average postoperative air leakage (0.57±1.11 days), the chest tube removal time (3.03±0.92 days), and the postoperative hospital stay (3.98±0.92 days) were all significantly shorter in the experimental group (P=0.048, P=0.012, and P=0.010, respectively). Moreover, the rate of postoperative complications in the experimental group was lower than the control group (3.33% vs. 16.22%, P=0.021). No postoperative recurrence was observed in either group during the follow-up period that ranged from 8 to 25 months. CONCLUSIONS: The use of PGA sleeve during surgery for PSP might effectively prevent early postoperative air leakage, as well as reduce the postoperative drainage tube removal time and the postoperative hospital stay.

Clinical evaluation of postoperative chemotherapy based on genetic testing in patients with stage IIIA non-small cell lung cancer.

BACKGROUND: We performed a retrospective analysis to evaluate whether a postoperative chemotherapy selection method based on four tumoral gene expression tests would improve prognosis in patients with stage IIIA non-small cell lung cancer (NSCLC) after surgery. METHODS: Between January 2007 and July 2011, 148 patients with stage IIIA NSCLC underwent radical lobectomy with four cycles of adjuvant postoperative chemotherapy. Forty-five patients had tailored treatment plans based on the results of tumoral gene expression tests. The tests consisted of quantitative real-time polymerase chain reaction analyses to measure the messenger ribonucleic acid levels of the excision repair cross-complementing gene 1, ribonucleotide reductase Ml, type III ß-tubulin, and thymidylate synthase genes in tumor tissues. One hundred and three patients received conventional chemotherapy. Disease responses were assessed after two cycles and every three months after the first four cycles of chemotherapy. The one and two-year survival rates and diesease-free survival (DFS) rates were recorded, and the adverse effects documented. RESULTS: The one and two-year DFS rates in the genetically tested group were better than those in the non-tested group, and the differences were statistically significant (P < 0.05). The two-year Kaplan-Meier DFS curve analysis results were significantly better in the genetically tested group (X(2) = 8.228, P = 0.004). The adverse effects during the treatments were not significantly different (P > 0.05) between the two groups. CONCLUSIONS: The chemotherapy selection method based on four tumoral gene expression tests demonstrated its feasibility to improve the efficacy of adjuvant postoperative chemotherapy and benefit stage IIIA NSCLC patients by yielding better DFS without increasing the adverse effects of chemotherapy.

Ultrasound-Guided Video-Assisted Mediastinoscopic Biopsy: A Novel Approach.

Video-assisted mediastinoscopy (VAM) is the most commonly used invasive method for the preoperative mediastinal staging of lung cancer and for the diagnosis of other mediastinal diseases. However, VAM has the risk of causing life-threatening bleeding consequent to the specific mediastinal anatomy. We adopted the ultrasonic technique for VAM biopsies that can easily distinguish the lymph nodes from the surrounding great vessels and thus makes the procedure easier and safer.

Complete thoracoscopic enucleation of giant leiomyoma of the esophagus: a case report and review of the literature.

Esophageal leiomyoma is one of the most common types of benign esophagus tumors. Giant leiomyoma of the esophagus is traditionally treated by open thoracotomy, which has large incision. We report a case of complete thoracoscopic enucleation of giant leiomyoma in a chinese patient.