Distinct impacts of radiological appearance on lymph node metastasis and prognosis based on solid size in clinical T1 non-small cell lung cancer.

BACKGROUND: Solid nodules (SN) had more aggressive features and a poorer prognosis than part-solid nodules (PSN). This study aimed to evaluate the specific impacts of nodule radiological appearance (SN vs. PSN) on lymph node metastasis and prognosis based on solid size in cT1 non-small cell lung cancer (NSCLC). METHODS: Patients with cT1 NSCLC who underwent anatomical resection between 2010 and 2019 were retrospectively screened. Univariable and multivariable logistic regression analyses were adopted to evaluate the associations between nodule radiological appearance and lymph node metastasis. The log-rank test and Cox regression analyses were applied for prognostic evaluation. The cumulative recurrence risk was evaluated by the competing risk model. RESULTS: There were 958 and 665 NSCLC patients with PSN and SN. Compared to the PSN group, the SN arm had a higher overall lymph node metastasis rate (21.7% vs. 2.7%, P < 0.001), including nodal metastasis at N1 stations (17.7% vs. 2.1%), N2 stations (14.0% vs. 1.6%), and skip nodal metastasis (3.9% vs. 0.6%). However, for cT1a NSCLC, no significant difference existed between SN and PSN (0 vs. 0.4%, P = 1). In addition, the impacts of nodule radiological appearance on lymph node metastasis varied between nodal stations. Solid NSCLC had an inferior prognosis than part-solid patients (5-year disease-free survival: 79.3% vs. 96.2%, P < 0.001). The survival inferiority only existed for cT1b and cT1c NSCLC, but not for cT1a. Strikingly, even for patients with nodal involvement, SN still had a poorer disease-free survival (P = 0.048) and a higher cumulative incidence of recurrence (P < 0.001) than PSN. Specifically, SN had a higher recurrence risk than PSN at each site. Nevertheless, the distribution of recurrences between SN and PSN was similar, except that N2 lymph node recurrences were more frequent in solid NSCLC (28.21% vs. 7.69%, P = 0.041). CONCLUSION: SN had higher risks of lymph node metastasis and poorer prognosis than PSN for cT1b and cT1c NSCLC, but not for cT1a. SN exhibited a greater proportion of N2 lymph node recurrence than PSN. SN and PSN needed distinct strategies for nodal evaluation and postoperative follow-up.

Pancreatic cancer cluster region identified in BRCA2.

Pancreatic cancer has a poor prognosis. Lack of diagnostic markers prevents its early diagnosis and treatment. Pathogenic germline variation in BRCA1 and BRCA2 (BRCA) is genetic predisposition for cancer. The location of variants in different regions in BRCA is non-randomly enriched in different types of cancer as shown by the breast cancer cluster region (BCCR), ovarian cancer cluster region (OCCR) and prostate cancer cluster region (PrCCR). Although pathogenic BRCA variation also contributes to pancreatic cancer, no pancreatic cancer cluster region (PcCCR) in BRCA1 or BRCA2 has been identified due to the relatively low incidence of pancreatic cancer and the lack of sufficient variation data from pancreatic cancer. Through comprehensive data mining, we identified 215 BRCA pathogenic variants (PVs) (71 in BRCA1 and 144 in BRCA2) from 27 118 pancreatic cancer cases. Through mapping the variants, we identified a region non-randomly enriched in pancreatic cancer between BRCA2 c.3515 and c.6787. This region contained 59 BRCA2 PVs and included 57% of pancreatic cancer cases (95% CI 43% to 70%). The PcCCR did not overlap with the BCCR and PrCCR but overlapped with the BRCA2 OCCR, highlighting that this region may play similar aetiological roles in pancreatic cancer and ovarian cancer.

Three-Dimensional Guided Cone-Shaped Segmentectomy Versus Lobectomy for Small-sized Non-Small Cell Lung Cancer in the Middle Third of the Lung Field.

BACKGROUND: Segmentectomy has been recommended for peripheral small-sized non-small cell lung cancer (NSCLC). This study aimed to evaluate whether three dimensionally (3D) guided cone-shaped segmentectomy can achieve long-term outcomes comparable with lobectomy for small-sized NSCLC in the middle third of the lung parenchyma. METHODS: This study retrospectively screened patients with small NSCLC (≤2 cm) who underwent segmentectomy or lobectomy between January 2012 and June 2019. Tumor location was determined by 3D multiplanar reconstruction. The cone-shaped segmentectomy was performed with the guidance of 3D computed tomographic bronchography and angiography. The log-rank test, Cox hazard proportional regression, and propensity score-matching analyses were adopted for prognostic evaluation. RESULTS: After screening, 278 patients with segmentectomy and 174 subjects undergoing lobectomy were selected. All the patients had R0 resection, and no 30- or 90-day mortality was observed. The median follow-up time was 47.3 months. The 5-year overall survival (OS) was 99.6 %, and the disease-free survival (DFS) was 97.5 % for the patients undergoing segmentectomy. After propensity score-matching, the patients with segmentectomy (n = 112) had an OS (P = 0.530) and a DFS (P = 0.390) similar to those of the patients who underwent lobectomy (n = 112). The multivariable Cox regression analysis indicated no significant survival differences between segmentectomy and lobectomy [DFS: hazard ratio, 0.56 (95 % confidence interval (CI) 0.16-1.97, P = 0.369); OS: HR, 0.35 (95 % CI 0.06-2.06, P = 0.245)] after adjustment for other factors. Further analysis showed that segmentectomy achieved comparable OS (P = 0.540) and DFS (P = 0.930) for NSCLC in the middle-third and peripheral lung parenchyma (n = 454). CONCLUSIONS: For selected NSCLCs size 2 cm or smaller in the middle third of the lung field, 3D-guided cone-shaped segmentectomy was able to achieve long-term outcomes comparable with lobectomy.

Control over Berry Curvature Dipole with Electric Field in WTe_{2}.

Berry curvature dipole plays an important role in various nonlinear quantum phenomena. However, the maximum symmetry allowed for nonzero Berry curvature dipole in the transport plane is a single mirror line, which strongly limits its effects in materials. Here, via probing the nonlinear Hall effect, we demonstrate the generation of Berry curvature dipole by applied dc electric field in WTe_{2}, which is used to break the symmetry constraint. A linear dependence between the dipole moment of Berry curvature and the dc electric field is observed. The polarization direction of the Berry curvature is controlled by the relative orientation of the electric field and crystal axis, which can be further reversed by changing the polarity of the dc field. Our Letter provides a route to generate and control Berry curvature dipole in broad material systems and to facilitate the development of nonlinear quantum devices.

Superconducting Proximity in Intrinsic Magnetic Topological Insulator MnBi2Te4-NbN Hybrid Device Modulated by Coulomb Blockade Effect.

The combination of nontrivial topology, magnetism, and superconductivity could offer the potential to realize exotic excitations of quasiparticles. MnBi2Te4, as an intrinsic magnetic topological insulator, may be a good platform to create Majorana fermions if coupled to an s-wave superconductor. Here, we report the transport properties of a MnBi2Te4-NbN hybrid device. This device exhibits clear Coulomb blockade oscillations. We observe a large zero-bias conductance peak that exists over considerable changes in gate voltage, magnetic field, and temperature, which is interpreted as a not fully developed supercurrent. The zero-bias peak shows a nonmonotonic evolution with a magnetic field and an abrupt π phase shift with changing temperature. Zero-energy bound states and a topological phase transition may exist in this hybrid system. Our results provide the first experimental investigation into the properties of the intrinsic magnetic topological insulator/superconductor hybrid structures modulated by the Coulomb blockade effect.

Study on auxiliary operation control of machine learning in multiobjective complex drainage system.

Recently, urban waterlogging prevention and treatment of black-odorous rivers have become a social concern and the upgradation of drainage system and the development of river runoff pollution control projects have accelerated. The use of deep tunnels to upgrade old drainage systems and achieve pollution control-related engineering designs has complicated the drainage system operation control. The traditional operation control mainly relies on human experience or model simulation. This study provides a perspective of machine learning for controlling the operation of the drainage system and exploring whether the operation suggestions regarding facilities in this system can be given in real time while relying only on real-time data and avoiding the complex model simulation process. Herein, five drainage systems were used as examples: the initial water level of a pipeline, key point water level flow, pump station front pool water level, and most unfavorable point water level were selected as relevant variables and four machine-learning discrimination methods were used for to analyze the weir-lowering operation of a deep tunnel. This study found that the average error rate of the linear discrimination method was <10%, thereby exhibiting satisfactory performance. This study provides insights for improving the operation of complex drainage systems.

Enhancing the performance of optical camera communication via accumulative sampling.

Deemed as a practical approach to realize Visible Light Communication on commercial-off-the-shelf devices, the Optical Camera Communication (OCC) is attracting increasing attention, thanks to its readiness to be built purely upon ubiquitous LED illuminating infrastructure and handy smartphones. However, limited by the low sampling ability of the built-in camera on a smartphone, the performance of existing OCC systems is still far away from the requirements of practical applications. To this end, we further investigate the reception ability of the smartphone's camera and propose an accumulative sampling scheme to improve the performance of the OCC system. Essentially, the proposed scheme can use all the grayscale information of the pixels projected by the LED transmitter, whereas the conventional ones normally use single row (or column) pixels for demodulating. By implementing the lightweight demodulation algorithm with accumulative sampling, we experimentally verify its effectiveness for supporting higher transmission frequency hence better performance in terms of data rate. Extensive evaluations have shown the BERs of the proposed method are over 87% and 96% lower than that provided by the baselines at a maximum transmission frequency of 5 kHz for the Samsung S8 and iPhone 8 Plus receivers, respectively.

Towards Low-Cost Yet High-Performance Sensor Networks by Deploying a Few Ultra-fast Charging Battery Powered Sensors.

The employment of mobile vehicles to charge sensors via wireless energy transfer is a promising technology to maintain the perpetual operation of wireless sensor networks (WSNs). Most existing studies assumed that sensors are powered with off-the-shelf batteries, e.g., Lithium batteries, which are cheap, but it takes some non-trivial time to fully charge such a battery (e.g., 30⁻80 min). The long charging time may incur long sensor dead durations, especially when there are many lifetime-critical sensors to be charged. On the other hand, other studies assumed that every sensor is powered with an ultra-fast charging battery, where it only takes some trivial time to replenish such a battery, e.g., 1 min, but the adoption of many ultra-fast sensors will bring about high purchasing cost. In this paper, we propose a novel heterogeneous sensor network model, in which there are only a few ultra-fast sensors and many low-cost off-the-shelf sensors. The deployment cost of the network in the model is low, as the number of ultra-fast sensors is limited. We also have an important observation that we can significantly shorten sensor dead durations by enabling the ultra-fast sensors to relay more data for lifetime-critical off-the-shelf sensors. We then propose a joint charging scheduling and routing allocation algorithm, such that the longest sensor dead duration is minimized. We finally evaluate the performance of the proposed algorithm through extensive simulation experiments. Experimental results show that the proposed algorithm is very promising and the longest sensor dead duration by it is only about 10% of those by existing algorithms.

Optimization of magnetic coupling mechanism of dynamic wireless power transfer based on NSGA-II algorithm.

Optimization of magnetic coupling mechanism is an important way to improve the performance of a dynamic wireless power transfer system. Inspired by the common radial magnetic core for circular coils, a new radial magnetic core for rectangular coils is adopt. Through simulation and experimental results comparison, which has higher coupling coefficient with the same core area. Combined with the magnetic circuit analysis, the magnetic flux leakage and conduction regions are divided into magnetic fluxes with different shapes, which magnetic resistances are calculated respectively. Based on the simulation results, parameter distributions of fluxes under different conditions are obtained. Therefore, the expressions of the coupling coefficient k of the adopt magnetic cores and coils and the design parameters of coils and cores are obtained. Taking the maximum k and the minimum rate of change of coupling coefficient with 100 mm displacement as the optimization objectives, a multi-objective optimization solution is carried out by using NSGA-II algorithm. The coil optimization scheme is obtained and verified by experiments. k and Δk are 0.442 and 6.8% respectively, and the errors are less than 5%. In the optimization process, there is no simulation model constructed. The optimization modeling combined of magnetic field segmentation method and parameter fitting has lower complexity and calculation time of optimization.

Anatomical distribution and clinical significance of translobar bronchi, arteries, and veins hidden in the interlobar fissure.

Background: The interlobar bronchovascular structures hidden in the incomplete interlobar fissures (IFs) are often inadvertently transected during pulmonary resections, which could inevitably lead to accidental injury and potentially compromise the function of the preserved area. A thorough examination of the anatomical distribution of translobar bronchi, arteries, and veins holds significant clinical importance. Methods: Three-dimensional computed tomography bronchography and angiography (3D-CTBA) data from patients who underwent pulmonary resection between December 2018 and November 2019 were retrospectively analyzed. The translobar bronchi, arteries, and veins were categorized based on their origin and distribution. Surgical results of patients who underwent surgery involving translobar structures were further reviewed. Results: Among the 310 enrolled patients, incomplete IFs (IIFs) were most frequently observed in horizontal fissures (68.7%), followed by right upper oblique fissures (42.3%), left lower oblique fissures (32.6%), left upper oblique fissures (12.9%), and right lower oblique fissures (11.0%). The incidence of bronchovascular structures was significantly higher in IIFs than in complete IFs (CIFs; 85.5% vs. 5.2%, χ2=1,021.1, P<0.001). A total of three subtypes of translobar bronchi, five subtypes of translobar arteries, and 14 subtypes of translobar veins were identified. Primary subtypes of translobar arteries (frequency >5%) included the left A4/5 (18.7%) that branched from A7/8/7+8 and the common trunk of right Asc.A2+A6 (6.1%). Primary subtypes of translobar veins (frequency >5%) included the right V2 draining into inferior pulmonary vein (IPV) (5.8%), the interlobar V3b (58.4%) within horizontal fissures, the right V4/5 draining into V2/3 (26.1%), the left V4/5 draining into IPV (7.4%), the right V6 draining into V2 (38.4%), and the common trunk of left IPV and superior pulmonary vein (SPV; 9.4%). Moreover, 12.0% of translobar arteries and 75.0% of translobar veins were mistransected during anatomical pulmonary resection, resulting in gas-exchanging dysfunction in the preserved territory. Conclusions: Translobar bronchovascular structures exhibited a high incidence and were more commonly present in IIFs. Surgeons should pay increased attention to these structures to prevent accidental injuries during anatomical pulmonary resection.

Sublobar resection for small-sized non-small cell lung cancer: A comprehensive comparison between subsegmentectomy, segmentectomy and wedge resection.

OBJECTIVES: Subsegmentectomy has been adopted for non-small cell lung cancer (NSCLC) for decades. This study aimed to compare the features between subsegmentectomy, segmentectomy and wedge resection for NSCLC. MATERIALS AND METHODS: NSCLC patients who underwent subsegmentectomy, segmentectomy, or wedge resection between 2014 and 2019 were retrospectively screened. Demographic, radiomic, and perioperative characteristics between patients were compared. Further, log-rank test, univariate and multivariate Cox regression were used for prognostic evaluation. RESULTS: There were 276, 670, and 494 patients undergoing subsegmentectomy, segmentectomy, and wedge resection, respectively. Patients with segmentectomy and subsegmentectomy had larger tumor sizes and greater distances to the pleura than those with wedge resection. Subsegmentectomy and segmentectomy were more likely to achieve adequate surgical margins than wedge resection (82.0 % vs. 79.5 % vs. 64.7 %, P < 0.001), which was especially true for nodules away from the pleura (80.2 % vs. 81.4 % vs. 55.8 %, P < 0.001). In addition, anatomic resection allowed for more lymph node dissection and required less preoperative localization than wedge reception. Subsegmentectomy preserved about two subsegments than segmentectomy (P < 0.001). The incidence of prolonged air leakage after subsegmentectomy (3.3 %) and wedge (1.8 %) was similar (P = 0.308). Notably, 66.8 % of patients who underwent segmentectomy or subsegmentectomy were considered unsuitable for wedge. During the follow-up (55.1 months), no tumor recurrence or death occurred in patients undergoing subsegmentectomy. No significant recurrence-free survival (P = 0.140) or overall survival (P = 0.370) difference existed between these groups. CONCLUSIONS: Subsegmentectomy could achieve more adequate surgical margins than wedge resection and showed superiority for deep nodules. Compared to segmentectomy, subsegmentectomy could preserve more lung parenchyma.

Three-dimensional imaging anatomical research and clinical implications of V1 +2 d in the left upper lung.

BACKGROUND: To investigate the distribution pattern of V1+2 d in the left superior pulmonary vein and its clinical significance. METHODS: A retrospective analysis was conducted using three-dimensional computed tomographic bronchography and angiography (3D-CTBA) data from 500 lung cancer patients. Statistical analyses were performed to evaluate the incidence and drainage patterns of the three sub-branches of V1+2 d, namely V1+2 d1, V1+2 d2 and V1+2 d3. Furthermore, clinical data from 10 patients' lesions involving V1+2 d were reviewed to illustrate the impact of adjacency to V1+2 d on the surgical approach. RESULTS: The incidences of V1+2 d1, V1+2 d2 and V1+2 d3 were 100%, 76.4% and 100% respectively. The relative interlobar distribution sizes of B3 a and B1+2 c and the left upper division (LUD) vein type influenced the incidence of V1+2 d2 (p < 0.05; p < 0.001). V1+2 d2 predominantly occurred in B3 a = B1+2 c and B1+2 c > B3 a patterns. V1+2 d2 was entirely absent in the B3 a > B1+2 c pattern. V1+2 d2 exhibited a higher incidence in both the central vein (CV) type and the noncentral vein (NCV) type when compared to the semi-central vein (SCV) type (100% vs. 100% vs. 64.8%). The most prevalent venous drainage pattern was the three sub-branches of V1+2 d constituting a major trunk to drain (41.2%). All 10 cases with lesions involving V1+2 d successfully underwent sublobar resection with no complications, and the surgical margin was ≥2 cm. CONCLUSIONS: The three sub-branches of V1+2 d exhibit a high incidence with diverse distribution patterns, yet a discernible pattern exists. For inter- or multi-intersegmental nodules involving V1+2 d, combined segmentectomy and subsegmentectomy or combined subsegmentectomy can ensure the safe margin.

CoT-UNet++: A medical image segmentation method based on contextual transformer and dense connection.

Accurate depiction of individual teeth from CBCT images is a critical step in the diagnosis of oral diseases, and the traditional methods are very tedious and laborious, so automatic segmentation of individual teeth in CBCT images is important to assist physicians in diagnosis and treatment. TransUNet has achieved success in medical image segmentation tasks, which combines the advantages of Transformer and CNN. However, the skip connection taken by TransUNet leads to unnecessary restrictive fusion and also ignores the rich context between adjacent keys. To solve these problems, this paper proposes a context-transformed TransUNet++ (CoT-UNet++) architecture, which consists of a hybrid encoder, a dense connection, and a decoder. To be specific, a hybrid encoder is first used to obtain the contextual information between adjacent keys by CoTNet and the global context encoded by Transformer. Then the decoder upsamples the encoded features by cascading upsamplers to recover the original resolution. Finally, the multi-scale fusion between the encoded and decoded features at different levels is performed by dense concatenation to obtain more accurate location information. In addition, we employ a weighted loss function consisting of focal, dice, and cross-entropy to reduce the training error and achieve pixel-level optimization. Experimental results demonstrate that the proposed CoT-UNet++ method outperforms the baseline models and can obtain better performance in tooth segmentation.

Tumor size, but not consolidation-to-tumor ratio, is an independent prognostic factor for part-solid clinical T1 non-small cell lung cancer.

BACKGROUND: Tumor size and consolidation-to-tumor ratio (CTR) are crucial for non-small cell lung cancer (NSCLC) prognosis. However, the optimal CTR cutoff remains unclear. Whether tumor size and CTR are independent prognostic factors for part-solid NSCLC is under debate. Here, we aimed to evaluate the prognostic impacts of CTR and tumor size on NSCLC, especially on part-solid NSCLC. METHODS: We reviewed 1366 clinical T1 NSCLC patients who underwent surgical treatment. Log-rank test and Cox regression analyses were adopted for prognostic evaluation. The "surv_cutpoint" function was used to identify the optimal CTR and tumor size cutoff values. RESULTS: There were 416, 510, and 440 subjects with pure ground-glass opacity (pGGO), part-solid, and pure solid nodules. The 5-year overall survival (disease-free survival) for patients with pGGO, part-solid, and pure solid nodules were 99.5% (99.5%), 97.3% (95.8%), and 90.4% (78.9%), respectively. Multivariate Cox regression analysis indicated that CTR was an independent prognostic factor for the whole patients, and the optimal CTR cutoff was 0.99. However, for part-solid NSCLC, CTR was not independently associated with survival, even if categorized by the optimal cutoffs. The predicted optimal cutoffs of total tumor size and solid component size were 2.4 and 1.4 cm for part-solid NSCLC. Total tumor size (HR = 6.21, 95% CI: 1.58-24.34, p = 0.009) and solid component size (HR = 2.27, 95% CI: 1.04-5.92, p = 0.045) grouped by the cutoffs were significantly associated with part-solid NSCLC prognosis. CONCLUSIONS: CTR was an independent prognostic factor for the whole NSCLC, but not for the part-solid NSCLC. Tumor size was still meaningful for part-solid NSCLC.

Segmentectomy versus lobectomy for small-sized pure solid non-small cell lung cancer.

BACKGROUND: Segmentectomy has been recommended for ground glass opacity (GGO)-dominant small-sized non-small cell lung cancer (NSCLC) or those with GGO component. Pure solid NSCLC is a special sub-type and has an inferior prognosis. Whether segmentectomy could achieve comparable long-term outcomes with lobectomy for pure solid small-sized NSCLC remained controversial. This study aimed to compare the prognosis of segmentectomy and lobectomy for pure solid NSCLC. METHODS: NSCLC patients with a pure solid nodule (≤2 cm) who received segmentectomy or lobectomy between January 2010 and June 2019 were retrospectively screened. Log-rank test, univariable, and multivariable Cox regression analyses were used for prognostic comparison. Further, the propensity score matching analysis was adopted to yield a matched cohort. RESULTS: After screening, 344 pure solid NSCLC patients with a median follow-up time of 56 months were reserved. Among them, 98 patients underwent segmentectomy and the other 246 subjects received lobectomy. The lobectomy group had a larger tumor size, a higher rate of lymph node metastasis than the segmentectomy arm. Generally, patients with segmentectomy had a better disease-free survival (DFS) (p = 0.011) and overall survival (OS) (p = 0.028) than those with lobectomy. However, the multivariable Cox regression analysis indicated that no significant survival difference existed between segmentectomy and lobectomy after adjusting the potential confounding factors (DFS: hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.30-1.77, p = 0.476; OS: HR, 0.36; 95% CI, 0.08-1.59, p = 0.178). Consistently, in the propensity score matched cohort, segmentectomy (n = 74) yielded similar DFS (p = 0.960) and OS (p = 0.320) with lobectomy (n = 74). CONCLUSIONS: Segmentectomy could achieve comparable oncological outcomes with lobectomy for pure solid small-sized NSCLC.

Surgical outcomes of anatomical sublobar resections of left upper lobe and a technique of subsegmentectomy based on bronchovascular patterns.

BACKGROUND: Anatomical sublobar resection was widely performed for small-sized nodule located in the deep field of the lung. In this study, we compared surgical outcomes between anatomical sublobar resection in left upper lobe including segmentectomy and subsegmentectomy. We also applied a technique based on bronchovascular patterns for subsegmentectomy. PATIENTS AND METHODS: A hundred and fifty-one patients underwent anatomical sublobar resection of left upper lobe in our hospital in the period from January 2018 to December 2019 and they were retrospectively reviewed. Patients' characteristics and surgical outcome of the subsegmentectomy group (n = 71) were analyzed and compared to those of patients of the segmentectomy group (n = 80). The bronchovascular patterns of left upper lobe in these patients were also classified, and a technique of subsegmentectomy was introduced by cases description. RESULTS: Compared to segmentectomy, the subsegmentectomy group had longer operative time [141min, interquartile range (IQR): 125-161 vs. 127.5 min, interquartile range (IQR): 114.75-148.25; P = 0.001] and more estimated blood loss [50 mL, IQR: 30-50 vs. 30 mL, IQR: 20-50; P = 0.02]. Branching pattern of bronchus was classified into 3 types in left upper division, and 2 types in lingular division. Branching pattern of pulmonary artery was classified into 7 types in left upper division and 2 types in lingular division. Branching pattern of pulmonary vein was classified into 3 types in left upper division and V3 b was classified into 4 types. CONCLUSION: Subsegmentectomy is a safe procedure with surgical outcome comparable to the one of segmentectomy except operative time and estimated blood loss. Subsegmentectomy based on bronchovascular patterns in left upper lobe is feasible.

Segmentectomy versus lobectomy for deep clinical T1a-bN0M0 non-small cell lung cancer.

OBJECTIVES: Whether segmentectomy could yield similar oncological outcomes with lobectomy for cT1a-bN0M0 non-small cell lung cancer (NSCLC) in the deep lung parenchyma remained unclear. This study aimed to compare the long-term prognosis of segmentectomy and lobectomy for deep NSCLC. MATERIALS AND METHODS: We retrospectively screened cT1a-bN0M0 NSCLC patients who underwent segmentectomy or lobectomy between 2012 and 2019. The 3D multiplanar reconstruction software was used to determine the tumor location. Log-rank test, Cox hazard proportional regression, and propensity score matching analyses were adopted for prognostic evaluation. RESULTS: In total, 321 patients with segmentectomy and 239 subjects undergoing lobectomy with a median follow-up time of 48.2 months remained. All the patients had a R0 resection, and no 30-day or 90-day mortality was observed. The 5-year overall survival and disease-free survival were 99.0% and 96.6% for patients undergoing segmentectomy. No significant survival differences existed between segmentectomy and lobectomy after adjusting other factors (disease-free survival, DFS: HR = 1.20, 95%CI: 0.49-2.99, P = 0.688; overall survival, OS: HR = 1.09, 95%CI: 0.30-3.95, P = 0.892). After propensity score matching, patients with segmentectomy (n = 128) had a similar OS (P = 0.870) and DFS (P = 0.900) with those receiving lobectomy (n = 128). To further evaluate the outcomes of segmentectomy for deep lung cancer, 557 peripheral lung cancer patients who underwent segmentectomy at the same period were taken as the reference. As expected, segmentectomy for deep lesions achieved equivalent OS (P = 0.610) and DFS (P = 0.580) with the peripheral lesions. CONCLUSIONS: Segmentectomy could achieve comparable long-term outcomes with lobectomy for deep cT1a-bN0M0 NSCLC with careful preoperative design and 3D navigation.

Branching patterns and variations of the bronchus and blood vessels in the superior segment of the right lower lobe: a three-dimensional computed tomographic bronchography and angiography study.

Background: Superior segmentectomy is classified as simple due to the single intersegmental plane between the superior and basal segments. However, oncological outcomes in patients undergoing superior segmentectomy tend to be worse compared to those receiving other segmentectomy. The aim of this study is to determine the branching patterns and variations of the bronchus and blood vessels of the superior segment of the right lower lobe (RS6). Methods: Three-dimensional computed tomographic bronchography and angiography (3D-CTBA) was reconstructed in 316 patients who underwent enhanced chest computed tomography (CT) and subsequent surgery in our center from November 2018 to March 2021. Results: The bronchus in RS6 consisted of a single stem in 96.5% cases (305/316), and 2 separate stems in the remaining 3.5% cases (11/316). The artery in RS6 consisted of a single stem in 59.5% cases (188/316), 2 separate stems in 37.0% cases (117/316), and 3 separate stems in the remaining 3.5% cases (11/316). The vein in RS6 consisted of a single stem in 94.3% cases (298/316) and 2 separate stems in the remaining 5.7% cases (18/316). B6 variation was noted in 1.6% cases (5/316). A6 variation was noted in 18.0% cases (57/316), including the following: (I) coexistence of A6 and A2 (n=25); (II) A6b originating from A9+10/A10 alone (n=20); (III) A6c originating from A9+10 (n=10); and (IV) co-draining of A6 and A7 (n=2). V6 variation was noted in 11.7% cases (37/316), including the following: (I) co-draining of V6 and V2 (n=20); (II) co-draining of V6 and V4 (n=5); (III) V6 and V8+9 co-draining (n=3); (IV) V6 draining into the superior pulmonary vein (n=4); and (V) direct V6 draining into the left atrium (n=5). Conclusions: Variation of A6 and V6 in RS6 is much more common than previously reported. 3D-CTBA reconstruction is useful for pre-surgery planning.

Integration of Distinct Analysis Strategies Improves Tissue-Trait Association Identification.

Integrating genome-wide association studies (GWAS) with transcriptomic data, human complex traits and diseases have been linked to relevant tissues and cell types using different methods. However, different results from these methods generated confusion while no gold standard is currently accepted, making it difficult to evaluate the discoveries. Here, applying three methods on the same data source, we estimated the sensitivity and specificity of these methods in the absence of a gold standard. We established a more specific tissue-trait association atlas by combining the information captured by different methods. Our triangulation strategy improves the performance of existing methods in establishing tissue-trait associations. The results provide better etiological and functional insights for the tissues underlying different human complex traits and diseases.