Genome wide identification of novel DNA methylation driven prognostic markers in colorectal cancer.

Colorectal cancer (CRC) stands as a major contributor to cancer-related fatalities within China. There is an urgent need to identify accurate biomarkers for recurrence predicting in CRC. Reduced representation bisulfite sequencing was used to perform a comparative analysis of methylation profiles in tissue samples from 30 recurrence to 30 non-recurrence patients with CRC. Least absolute shrinkage and selection operator method was performed to select the differential methylation regions (DMRs) and built a DNA methylation classifier for predicting recurrence. Based on the identified top DMRs, a methylation classifier was built and consisted of eight hypermethylated DMRs in CRC. The DNA methylation classifier showed high accuracy for predicting recurrence with an area under the receiver operator characteristic curve of 0.825 (95% CI 0.680-0.970). The Kaplan-Meier survival analysis demonstrated that CRC patients with high methylation risk score, evaluated by the DNA methylation classifier, had poorer survival than low risk score (Hazard Ratio 4.349; 95% CI 1.783-10.61, P = 0.002). And only CRC patients with low methylation risk score could acquire benefit from adjuvant therapy. The DNA methylation classifier has been proved as crucial biomarkers for predicting recurrence and exhibited promising prognostic value after curative surgery in patients with CRC.

Platinum single atom on CsPbBr3 nanocrystals as electrocatalyst boosts electrochemical sensing of ascorbic acid.

Monitoring ascorbic acid (AA) levels in human body can provide valuable clues for disease diagnosis. Anchoring noble metal single atoms on perovskite substrate is a promising strategy to design electrocatalysts with outstanding electrocatalytic performance. Herein, we design an electrochemical method for detecting AA by utilizing Pt single atoms-doped CsPbBr3 nanocrystals (Pt SA/CsPbBr3 NCs) fixed on a glassy carbon electrode as an electrochemical catalyst. The uncharged 3,5,3',5'-tetramethylbenzidine (TMB) undergoes oxidation to form the positively charged oxidized TMB (oxTMB) owing to the exceptional electrochemical catalytic performance of Pt SA/CsPbBr3 NCs. Subsequently, the target AA reduces oxTMB to TMB, which is then electrocatalytically oxidized to oxTMB, producing significant oxidation current. In this way, such characteristic provides a sensitive electrochemical strategy for AA detection, achieving a concentration range of 50-fold with the detection limit of 0.0369 µM. The developed electrochemical method also successfully generates accurate detection response of AA in complex sample media (urine). Overall, this approach is expected to offer a novel way for early disease diagnosis.

Efficient Single-Phase Tunable Dual-Color Luminescence with High Quantum Yield Greater than 100% for Information Encryption and LED Applications.

In modern society, the investigation of highly efficient photoluminescent bulk materials with excitation-induced tunable multicolor luminescence and multiexciton generation (MEG) is of great significance to information security and the application of optoelectronic devices. In this study, two bulk Cu-based halide crystals of (C4H10NO)4Cu2Br5·Br and (C4H10NO)4Cu2I5·I·H2O, respectively, with one-dimensional structures were grown by a solvent evaporation method. Unexpectedly, (C4H10NO)4Cu2I5·I·H2O displayed excitation-induced tunable dual-color luminescence; one band is a brilliant green-yellow emission centered at 547 nm with a high photoluminescence quantum yield (PLQY) of up to 169.67%, and the other is a red emission at 695 nm with a PLQY of 75.76%. Just as importantly, (C4H10NO)4Cu2Br5·Br exhibits a strong broadband green-yellow emission at 561 nm under broad band excitation ranging from 252 to 350 nm, a long PL decay lifetime of 106.9 µs, and an ultrahigh PLQY of 198.22%. These materials represent the first two examples of 1D bulk crystals and Cu(I)-based halides that have a PLQY exceeding 100%. Combining the unusual luminescence characteristics with theoretical calculations reveals that MEG contributes to the green-yellow emission with ultrahigh PLQY > 100%, and that the red emission can be ascribed to [Cu2I5]3- cluster-centered emission. Additionally, an information encryption method was designed based on the Morse Code. The high luminescence characteristics of LED devices fabricated using the (C4H10NO)4Cu2Br5·Br and (C4H10NO)4Cu2I5·I·H2O crystals appear to lead to promising applications in solid-state lighting. This work extends the catalog of high-performance luminescent materials and also promotes application prospects of low-dimensional copper-based halides in optoelectronics.

Ultra-Broad-Band-Excitable Cu-Based Halide (C4H10N)4Cu4I8 with High Stability for LED Applications.

Currently, organic-inorganic hybrid cuprous-based halides are receiving substantial attention for their eco-friendliness, distinctive structures, and outstanding photophysical properties. Nevertheless, most of the reported cuprous-based halides demand deep ultraviolet excitation with a narrow excitation range that can meet the commercial requirement. Herein, zero-dimensional (0D) cuprous-based halide (C4H10N)4Cu4I8 single crystals (SCs) were synthesized, with an ultrabroad band excitation ranging 260-450 nm and a greenish-yellow emission band peaking at 560 nm. Excitingly, (C4H10N)4Cu4I8 also features a large Stokes shift of 300 nm, a high photoluminescence quantum yield (PLQY) of up to 84.66%, and a long lifetime of 137 µs. Furthermore, density functional theory calculations were performed to explore the relationship between structure and photophysical properties, and the photoluminescence performance of (C4H10N)4Cu4I8 originates from the electron interactions in [Cu2I4]2- clusters. Taking advantage of broad band excitation and excellent photoluminescent performances, a high luminescence characteristic UV-pumped light-emitting diode (LED) device with remarkable color stability was fabricated by employing the as-synthesized (C4H10N)4Cu4I8 SCs, which present the promising applications of low-dimensional cuprous-based halides in solid-state lighting.

Temperature-Induced Reversible Photoluminescence Switching and Ultraviolet-Pumped Light-Emitting Diode Applications of a Perovskite (C6H10N2)2MnCl6·2H2O Crystal.

Zero-dimensional (0D) organic-inorganic hybrid halides present many fascinating photophysical properties for promising optoelectronic applications such as light-emitting diodes (LEDs), X-ray imaging, photodetectors, and anticounterfeiting. Herein, a centimeter-sized single crystal (C6H10N2)2MnCl6·2H2O with a 0D perovskite structure was obtained via a solvent evaporation method. A bright red emission at 618 nm with a larger Stokes shift of more than 300 nm and a long fluorescence lifetime of 6.21 ms were measured. Notably, a reversible PL switching from red emission to nonluminescence has been presented in the cycles of heating-cooling processes from RT to 100 °C. Furthermore, the temperature-induced luminescence shows a quick recovery after 20 conversion cycles, exhibiting excellent stability and temperature sensing. According to the structural and theoretical analyses, the temperature-induced luminescence is primarily due to hydrogen-bonding interactions between (MnCl6)4- and H2O molecules. Particularly, a temperature anticounterfeiting application has been designed based on its reversible temperature-dependent PL switching. Importantly, the ultraviolet-pumped LEDs fabricated by (C6H10N2)2MnCl6·2H2O single crystals are perfectly achieved. Anyway, this work clearly demonstrates that 0D Mn-based perovskite with temperature-dependent PL switching greatly extends its potential applications in electro-optical display, temperature sensing, and anticounterfeiting devices.

A systematic review of instruments measuring the quality of dying and death in Asian countries.

PURPOSE: This study aimed to systematically identify, appraise, and summarize the psychometric properties of instruments used to measure the quality of dying and death in Asian countries. METHODS: The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) was closely followed. The literature was searched using the following keywords and their synonyms: "death and dying," "measurement," and "Asian country" in CINAHL, PubMed, PsycInfo, Web of Science, and Cochrane Library from inception to April 2021. Two reviewers independently screened titles and abstracts and reviewed the full text. Two other reviewers independently assessed the quality of the identified studies in three steps: methodological quality evaluation, good measurement properties evaluation, and quality of evidence evaluation. RESULTS: This review retrieved 37,195 studies, of which seven were finally included. Four instruments that assessed the quality of dying and death in Asian countries were identified: the Good Death Inventory (GDI), the Good Death Scale (GDS), and two versions of the Quality of Dying and Death (QODD) Questionnaires. All included studies failed to evaluate all the recommended psychometric properties, and none of the instruments provided strong evidence of their quality among Asian populations. Overall, the grade of evidence quality for the GDI was moderate, the highest among all identified instruments. CONCLUSION: The GDI is by far the most reliable instrument for assessing the quality of dying and death in Asian populations. A lack of validation studies in Asian and Western cultures, however, warrants caution when drawing conclusions from the GDI.

(C4H10NO)PbX3 (X = Cl, Br): Design of Two Lead Halide Perovskite Crystals with Moderate Nonlinear Optical Properties.

Introducing electronegative species into organic constituents was considered to be one effective strategy for adjusting crystal symmetry and designing new nonlinear optical (NLO) materials. By substitution of C4 in piperidine (C5H11N) with electronegative oxygen, organic morpholine (C4H9NO) was easily obtained. Therefore, to design NLO crystals, we focused on combinations of stereochemically active lone-pair (SCALP) cation (Pb2+)-based chloride and bromide with morpholine molecules. In this work, two lead halide hybrid perovskite (C4H10NO)PbX3 (X = Cl, Br, abbreviated as MPbCl3 and MPbBr3, respectively) single crystals with moderate nonlinear optical properties were synthesized by a slow evaporation method. The two title crystals belong to orthorhombic space group P212121 with one-dimensional (1D) chainlike perovskite structures. Theoretical calculations revealed that the second harmonic generation (SHG) responses mainly originate from distorted {PbX6} octahedrons of the inorganic framework. Remarkably, moderate phase-matching SHG effects of about 0.70 and 0.81 times KH2PO4, large birefringences of 0.098 and 0.111 at 1064 nm, and large laser damage thresholds (LDTs) of 19.94 and 46.82 MW/cm2 were estimated for MPbCl3 and MPbBr3, respectively. This work provides a novel strategy for new purpose-designed hybrid NLO crystals by adjustment and modulation of chemical modification.

New Low-Dimensional Lead-Free Perovskite (2-AMP)2BiX7·H2O (X = Cl, Br) Crystals: Synthesis, Stability, and Nonlinear Optical Properties.

Organic-inorganic hybrid Pb-halide perovskites have attracted tremendous interest due to their potential application in photovoltaic and optoelectronic fields. However, the toxicity and poor stability of Pb-halide perovskites have become key bottlenecks toward their future commercialization and industrialization. Therefore, in this work, two novel hybrid lead-free perovskite nonlinear optical (NLO) crystals (2-AMP)2BiX7·H2O (X = Cl, Br) with high stability were successfully synthesized. Both the crystals belong to the orthorhombic P212121 space group, displaying a zero-dimensional perovskite structure. The thermal, environmental, and solvent atmospheric stabilities were comprehensively investigated, with high thermal stability up to 170 °C and high environmental and high solvent atmospheric stability observed for (2-AMP)2BiBr7·H2O. First-principles calculations were carried out to study the relationship of the structure and properties. A large birefringence of 0.1368@1064 nm was determined for (2-AMP)2BiBr7·H2O, which was derived from the strong aeolotropic conjugated π-electron distribution of planar 2-aminomethylpyridium. A second-harmonic generation (SHG) effect that was 0.25 and 0.32 times that of KH2PO4 (KDP) was measured for (2-AMP)2BiCl7·H2O and (2-AMP)2BiBr7·H2O, respectively, and the stronger SHG response of bromide was attributed to the larger distortions of {BiBr6} octahedrons. This work may offer new guidance for exploration of low toxicity and high stability of perovskite NLO materials.

Intratumor heterogeneity of driver mutations and TMB distribution in 30 early-stage LUAD patients with multiple lesions.

Background: Differentiating multiple pulmonary lesions as multiple primary lung cancer (MLC) or intra-pulmonary metastasis (IPM) is critical. Lung cancer also has a high genetic heterogeneity, which influenced the treatment strategy. Genetic information may aid in tracing lineage information on multiple lung lesions. This study applied comprehensive genomic profiling to decipher the intrinsic genetics of multiple lung lesions. Methods: Sixty-six lung adenocarcinomas (LUAD) tumor lesions (FFEP) archived from 30 patients were included in this study. The 508 cancer-related genes were evaluated by targeted next-generation sequencing (MGI-seq 2000). Results: The study included a total of 30 LUADs (66 samples). The majority of tumors demonstrated intra-tumoral heterogeneity. Two hundred twenty-four mutations were detected by sequencing the 66 samples. We investigated the driver gene mutations of NSCLC patients with multiple lesions. EGFR was the most frequently (48/198) mutated driver gene. The codons in EGFR mainly affected by mutations were p.L858R (18/66 [27.3%]) and exon 19del (8/66 [12.1%]). In addition, additional driver genes were found, including TP53, BRAF, ERBB2, MET, and PIK3CA. We also found that the inter-component heterogeneity of different lesions and more than two different mutation types of EGFR were detected in seven patients with two lesions (P3, P10, P24, P25, P28, P29, and P30). The TMB values of different lesions in each patient were different in 26 patients (except P4, P5, P14, and P30). Conclusions: Comprehensive genomic profiling should be applied to distinguishing the nature of multiple lung lesions irrespective of radiologic and histologic diagnoses.

Intraoperative methods for wrapping anastomoses after airway reconstruction: a case series.

Background: Anastomosis management is the main challenge of airway resection and reconstruction, and postoperative anastomotic complications, including ischemia, stenosis, dehiscence, and separation may lead to severe outcomes and a poor prognosis. The anastomotic buttress is vital in airway reconstruction, but the selection of surgical buttress and reinforcement remains controversial. We aimed to demonstrate and evaluate the buttress options of anastomosis, including their preoperative characteristics, the intraoperative process, and the incidence of postoperative complications to help address the controversy regarding anastomosis management. Methods: This retrospective study was conducted at a single institution. Patients who underwent airway reconstruction with anastomotic wrapping from Jan. 2019 to Sep. 2021 were enrolled in this study and preoperative characteristics and operational features were collected. All patients were carefully followed up by telephone and outpatient. Their postoperative complications and postoperative status after 6 months were recorded. The surgical procedures and clinical characteristics of the buttress options of anastomosis were assessed. Results: A total of 62 patients undergoing either cervical tracheal, thoracic tracheal, carinal, or secondary carinal and main bronchus resection and reconstruction were evaluated. The anastomotic buttress used included mediastinal pleural flap (24/62, 38.7%), anterior cervical muscle (14/62, 22.6%), sternocleidomastoid (2/62, 3.2%), thymus flap (12/62, 19.4%), intercostal muscle flap (2/62, 3.2%), biological patch (2/62, 3.2%), prepericardial fat (1/62, 1.6%), thyroid gland (1/62, 1.6%), pectoralis major flap (2/62, 3.2%), and omental flap (2/62, 3.2%). All procedures produced satisfactory results without short-term anastomotic complications. A follow-up for 6 months was conducted and all patients were alive postoperatively. Tracheomalacia stenosis postoperatively occurred in 3 patients and they were subsequently treated with an endotracheal stent. One patient had tumor recurrence 3 months after surgery and received adjuvant chemotherapy. Conclusions: Various anastomotic wrapping materials are used in airway reconstruction. Different utilizations of buttress are selected according to the anatomic characteristics and the reconstruction method used. This study indicated that appropriate surgical buttresses for wrapping anastomoses are legitimate alternatives to reduce the risk of anastomotic complications.

Resection and reconstruction via median sternotomy incision for tracheal tumors.

Background: The tracheal tumor is a rare disease with low incidence in the upper airway. Surgical resection and reconstruction are effective and radical treatments for such conditions, but the approaches vary depending on the tumor location. The current report tends to illustrate the clinical practice and advantage of the median sternotomy approach for treating tracheal tumors. Methods: We summarized and demonstrated four cases of tracheal tumors patients who received tracheal resection and reconstruction via median sternotomy approach in our institute. Their clinical data and surgical procedures were also described. The follow-up would be carried on to monitor their prognosis after the operations. Results: Two patients with lower tracheal tumors involving carina received sternotomies, one with the tumor in cervical, thoracic junction, and the other one with thyroid carcinoma involving and extending to the thoracic trachea received half-sternotomies. The surgical procedures were completed smoothly with ideal surgical vision and sufficient operative space. Case 1 and 2 patients underwent tracheal-bronchial end-to-side anastomosis, while the other two patients received end-to-end anastomosis. The thymus and mediastinal tissue were used as the anastomotic buttress. They were discharged no more than 2 weeks after operations. Case 4 was suffered from aspiratory pneumonia and experienced prolonged intensive care unit (ICU) stay and antibiotic use. No other severe complications were recorded in other cases. No anastomotic dehiscence was observed in the postoperative bronchoscopy. Conclusions: Tracheal resection and reconstruction via sternotomy or half-sternotomy is a practical approach for intrathoracic tracheal lesions. It facilitates a satisfying field and anastomosis procedure. The reported cases had ideal surgical outcomes. Although it is convenient in some specific cases, further studies are warranted for its safety and efficacy.

Organic-Inorganic Hybrid Noncentrosymmetric (Morpholinium)2Cd2Cl6 Single Crystals: Synthesis, Nonlinear Optical Properties, and Stability.

To design nonlinear optical (NLO) materials, we focused on combinations of d10 metal cation (Cd2+)-based chloride and morpholine molecules to form organic-inorganic hybrids. The O of morpholine containing lone-pair electrons can be integrated with Cd2+ by a ligand-to-metal charge transfer (LMCT) strategy to build acentric structures benefiting from the second-order Jahn-Teller effect. Introduction of the high-electronegativity chlorine can make polyhedrons of acentric crystals more distorted and conducive to a strong second harmonic generation (SHG) response. Therefore, (Morpholinium)2Cd2Cl6 crystals were constructed and synthesized by a solvent evaporation method. (Morpholinium)2Cd2Cl6 belongs to the orthorhombic P212121 space group and shows a one-dimensional (1D) structure with distorted [CdCl6] and [CdCl4O2] octahedrons. The short cutoff edge of (Morpholinium)2Cd2Cl6 was determined to be about 230 nm. The SHG response of (Morpholinium)2Cd2Cl6 exhibited an intensity of approximately 0.73 × KDP as estimated by the powder second harmonic generation technique. Furthermore, related theoretical calculations were performed to study the relationship of the band structure, refractive anisotropy, electronic state, and nonlinear optical response. Besides, (Morpholinium)2Cd2Cl6 showed relatively good thermal stability. This work can serve as a guide for the design and synthesis of new large NLO hybrid crystals with d10 transition metals.

End-to-side anastomosis in complex tracheal resection and reconstruction: a case series study.

Background: The development of current anesthetic and surgical techniques has increased the success rate of complex tracheal resection and reconstruction. End-to-end anastomosis is the prevailing method, while the end-to-side approach has also been reported to be practical and suitable. The current study aimed to demonstrate the feasibility and advantages of the end-to-side anastomosis method in specific cases. Methods: We summarized 6 cases of patients with tracheobronchial tumors who received different end-to-side airway reconstructions in our center. Their clinical features and surgical procedures were also described. Postoperative follow-up was conducted to monitor their complications and prognosis. Results: Among the patients involved in the study, 2 patients with tumors involving the bronchus intermedius received auto-lung transplantations under general anesthesia, 3 patients with tumors involving the lower trachea and carina underwent reconstruction under non-intubated combined anesthesia, and 1 patient with left main bronchus (LMB) involvement received surgery under venoarterial extracorporeal membrane oxygenation (VA ECMO)-supported non-intubated anesthesia. The surgical procedures were completed successfully without surgical or anesthetic incidents. Patients 1 and 2 underwent auto-lung transplantation with distal stumps and trachea end-to-side anastomosis (right lower lobe and right basal segment). Patients 3 and 4 received right main bronchus (RMB) to lateral trachea reconstruction, while Patients 5 and 6 underwent LMB to tracheal wall anastomosis. Anastomotic buttressing was performed using the thymus and mediastinal tissue. The patients were discharged within 2 weeks of the operation. No severe postoperative complications were reported, with the exception of Patient 5, who required a prolonged intensive care unit (ICU) stay with antibiotics due to pneumonia. Anastomotic necrosis, dehiscence, or stenosis were not observed in the postoperative bronchoscopy. Conclusions: End-to-side anastomosis is a feasible and effective surgical method in airway reconstructions. This method facilitates tension-free anastomosis, which is crucial for surgical prognosis and decreasing complications. The reported cases had ideal surgical results during follow-up. The long-term outcomes of the end-to-side method require further evaluation.

Video-assisted Thoracic Surgery for Main Bronchial Rupture After Blunt Chest Trauma in Children.

Main bronchial rupture caused by blunt chest trauma is a rare injury, especially in children. Treatment is traditionally performed through an open thoracotomy, which increases the risk of musculoskeletal deformity in growing children. Video-assisted thoracic surgery has emerged as a feasible minimally invasive approach for main bronchial rupture, with lower perioperative mortality. This report demonstrates that video-assisted thoracic surgery can be safely performed for main bronchial rupture in children.

Subxiphoid Versus Unilateral Video-assisted Thoracoscopic Surgery Thymectomy for Thymomas: A Propensity Score Matching Analysis.

BACKGROUND: The appropriate approach for video-assisted thoracoscopic surgery for early stage thymoma remains unclear. The present study aimed to explore the safety and feasibility of subxiphoid and subcostal arch thoracoscopic thymectomy in comparison with unilateral thoracoscopic thymectomy for treatment of early stage thymoma. METHODS: The outcomes of 237 patients without myasthenia gravis who had undergone thoracoscopic thymectomy for Masaoka stage I and II thymoma from January 2015 to May 2019 at our center were retrospectively evaluated (subxiphoid and subcostal arch approach, 39; unilateral video-assisted thoracoscopic surgery approach, 198). A propensity score matching analysis was generated to control for selection bias due to nonrandom group assignment in a 1:1 manner. RESULTS: There was no surgery-related mortality in included patients. Matching of patients according to propensity score resulted in a cohort that consisted of 39 patients in both groups. Patients had similar clinical characteristics in both groups. Compared with patients in the unilateral group, patients in the subxiphoid group yielded lower pain scores at 24 and 72 hours after operation, respectively (P < .01). In addition, the operation time was longer in the subxiphoid group (147.5 ± 43.6 vs 93.2 ± 33.8 minutes, P < .01). There were no significant differences in blood loss, total volume and time of drainage, complications, or postoperative hospital stays between the two groups. CONCLUSIONS: Subxiphoid and subcostal arch thoracoscopic thymectomy for early stage thymoma appears to be a safe and feasible procedure. It is considered to be less invasive as it may cause minimal postoperative pain compared with the unilateral video-assisted thoracoscopic surgery approach.

Accurate diagnosis of pulmonary nodules using a noninvasive DNA methylation test.

BACKGROUNDCurrent clinical management of patients with pulmonary nodules involves either repeated low-dose CT (LDCT)/CT scans or invasive procedures, yet causes significant patient misclassification. An accurate noninvasive test is needed to identify malignant nodules and reduce unnecessary invasive tests.METHODWe developed a diagnostic model based on targeted DNA methylation sequencing of 389 pulmonary nodule patients' plasma samples and then validation in 140 plasma samples independently. We tested the model in different stages and subtypes of pulmonary nodules.RESULTSA 100-feature model was developed and validated for pulmonary nodule diagnosis; the model achieved a receiver operating characteristic curve-AUC (ROC-AUC) of 0.843 on 140 independent validation samples, with an accuracy of 0.800. The performance was well maintained in (a) a 6 to 20 mm size subgroup (n = 100), with a sensitivity of 1.000 and adjusted negative predictive value (NPV) of 1.000 at 10% prevalence; (b) stage I malignancy (n = 90), with a sensitivity of 0.971; (c) different nodule types: solid nodules (n = 78) with a sensitivity of 1.000 and adjusted NPV of 1.000, part-solid nodules (n = 75) with a sensitivity of 0.947 and adjusted NPV of 0.983, and ground-glass nodules (n = 67) with a sensitivity of 0.964 and adjusted NPV of 0.989 at 10% prevalence. This methylation test, called PulmoSeek, outperformed PET-CT and 2 clinical prediction models (Mayo Clinic and Veterans Affairs) in discriminating malignant pulmonary nodules from benign ones.CONCLUSIONThis study suggests that the blood-based DNA methylation model may provide a better test for classifying pulmonary nodules, which could help facilitate the accurate diagnosis of early stage lung cancer from pulmonary nodule patients and guide clinical decisions.FUNDINGThe National Key Research and Development Program of China; Science and Technology Planning Project of Guangdong Province; The National Natural Science Foundation of China National.

Non-intubated video-assisted thoracic surgery for subxiphoid anterior mediastinal tumor resection.

BACKGROUND: Subxiphoid approach for mediastinal tumor resection was reported to provide a better view and less postoperative pain. Non-intubated video-assisted thoracic surgery (NI-VATS) without muscle relaxant would decrease the possibility of postoperative airway collapse for anterior mediastinal mass operation. Herein, we sought to describe the use of NI-VATS through subxiphoid approach for anterior mediastinal tumor resection. METHODS: In this retrospective cohort study, patients that underwent subxiphoid VATS resection for anterior mediastinal tumor between December 2015 and September 2019 were divided into two groups: NI-VATS and intubated VATS (I-VATS). Intraoperative and postoperative variables were compared. RESULTS: A total of 40 patients were included. Among them, 21 patients received NI-VATS (52.5%) and 19 were treated with I-VATS (47.5%). In total, intraoperative (4/21 vs. 2/19; P=0.446) and postoperative complications (5/21 vs. 7/19; P=0.369) were similar between NI-VATS and I-VATS group. The anesthesia time (231.76 vs. 244.71 min; P=0.218), the operation time (152.35 vs. 143.64 min; P=0.980), chest tube duration (1.81 vs. 1.84 days; P=0.08), the total volume (351.95 vs. 348.00 mL; P=0.223), post-operative pain scores (2.79 vs. 2.93, P=0.413), and the length of stay (9.47 vs. 10.57 days; P=0.970) were all comparable between two groups. CONCLUSIONS: NI-VATS for mediastinal tumor resection via subxiphoid approach is a safe and technically feasible option in selected patients, which leads to comparable perioperative clinical outcomes when compared with I-VATS via the subxiphoid approach. This technique could be used as an alteration when intubation is not available.

Management of Brachiocephalic Vein Injury During Tubeless Subxiphoid Thoracoscopic Thymectomy.

We have reported the usefulness of the subxiphoid video-assisted thoracoscopic surgery approach in thymectomy. However, such a new method may have unknown complications that rarely occur. The brachiocephalic vein has been considered to be the vessel that is most frequently injured when performing thymectomy because of the skeletal anatomy. We herein report a case of intraoperative injury of brachiocephalic vein using tubeless subxiphoid thoracoscopic thymectomy. No additional complications have been found in the 3 months since the operation. Though subxiphoid video-assisted thoracoscopic surgery thymectomy is a safe and less invasive operation, intraoperative complications are possible, and surgeons should express caution.

Endosonography with lymph node sampling for restaging the mediastinum in lung cancer: A systematic review and pooled data analysis.

BACKGROUND: Mediastinal restaging after induction treatment is still a difficult and controversial issue. We aimed to investigate the diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound-guided fine-needle aspiration for restaging the mediastinum after induction treatment in patients with lung cancer. METHODS: Embase and PubMed databases were searched from conception to March 2019. Data from relevant studies were analyzed to assess sensitivity and specificity of endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound-guided fine-needle aspiration, and to fit the hierarchical summary receiver operating characteristic curves. RESULTS: A total of 10 studies consisting of 558 patients fulfilled the inclusion criteria. All patients were restaged by endobronchial ultrasound-guided transbronchial needle aspiration, endoscopic ultrasound-guided fine-needle aspiration, or both. Negative results were confirmed by subsequent surgical approaches. There were no complications reported during any endosonography approaches reviewed. The pooled sensitivities of endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound-guided fine-needle aspiration were 65% (95% confidence interval [CI], 52-76) and 73% (95% CI, 52-87), respectively, and specificities were 99% (95% CI, 78-100) and 99% (95% CI, 90-100), respectively. The area under the hierarchical summary receiver operating characteristic curves were 0.85 (95% CI, 0.81-0.88) for endobronchial ultrasound-guided transbronchial needle aspiration and 0.99 (95% CI, 0.98-1) for endoscopic ultrasound-guided fine-needle aspiration. Moreover, for patients who received chemotherapy alone, the pooled sensitivity of endosonography with lymph node sampling for restaging was 66% (95% CI, 56-75), and specificity was 100% (95% CI, 34-100); for patients who received chemoradiotherapy, the results seemed similar with a sensitivity of 77% (95% CI, 47-92) and specificity of 99% (95% CI, 48-100). CONCLUSIONS: Endosonography with lymph node sampling is an accurate and safe technique for mediastinal restaging of lung cancer.

Integrating Histologic and Genomic Characteristics to Predict Tumor Mutation Burden of Early-Stage Non-Small-Cell Lung Cancer.

Tumor mutation burden (TMB) serves as an effective biomarker predicting efficacy of mono-immunotherapy for non-small cell lung cancer (NSCLC). Establishing a precise TMB predicting model is essential to select which populations are likely to respond to immunotherapy or prognosis and to maximize the benefits of treatment. In this study, available Formalin-fixed paraffin embedded tumor tissues were collected from 499 patients with NSCLC. Targeted sequencing of 636 cancer related genes was performed, and TMB was calculated. Distribution of TMB was significantly (p < 0.001) correlated with sex, clinical features (pathological/histological subtype, pathological stage, lymph node metastasis, and lympho-vascular invasion). It was also significantly (p < 0.001) associated with mutations in genes like TP53, EGFR, PIK3CA, KRAS, EPHA3, TSHZ3, FAT3, NAV3, KEAP1, NFE2L2, PTPRD, LRRK2, STK11, NF1, KMT2D, and GRIN2A. No significant correlations were found between TMB and age, neuro-invasion (p = 0.125), and tumor location (p = 0.696). Patients with KRAS p.G12 mutations and FAT3 missense mutations were associated (p < 0.001) with TMB. TP53 mutations also influence TMB distribution (P < 0.001). TMB was reversely related to EGFR mutations (P < 0.001) but did not differ by mutation types. According to multivariate logistic regression model, genomic parameters could effectively construct model predicting TMB, which may be improved by introducing clinical information. Our study demonstrates that genomic together with clinical features yielded a better reliable model predicting TMB-high status. A simplified model consisting of less than 20 genes and couples of clinical parameters were sought to be useful to provide TMB status with less cost and waiting time.