Quantitative analysis of imaging characteristics in lung adenocarcinoma in situ using artificial intelligence.

BACKGROUND: With the rising incidence of pulmonary nodules (PNs), lung adenocarcinoma in situ (AIS) is a critical early stage of lung cancer, necessitating accurate diagnosis for early intervention. This study applies artificial intelligence (AI) for quantitative imaging analysis to differentiate AIS from atypical adenomatous hyperplasia (AAH) and minimally invasive adenocarcinoma (MIA), aiming to enhance clinical diagnosis and prevent misdiagnosis. METHODS: The study analyzed 1215 PNs with confirmed AAH, AIS, and MIA from six centers using the Shukun AI diagnostic module. Parameters evaluated included demographic data and various CT imaging metrics to identify indicators for clinical application, focusing on the mean CT value's predictive value. RESULTS: Significant differences were found in several parameters between AAH and AIS, with nodule mass showing the highest predictive value. When comparing AIS to MIA, total nodule volume was the best predictor, followed by the maximum CT value. CONCLUSION: The mean CT value has limited discriminative power for AIS diagnosis. Instead, the maximum CT value and maximum 3D diameter are recommended for clinical differentiation. Nodule mass and volume of solid components are strong indicators for differentiating AIS from AAH and MIA, respectively.

Experience of a modified chest tube suture-fixation technique in uniportal thoracoscopic pulmonary resection.

OBJECTIVE: This study aimed to explore the feasibility and advantages of a modified chest tube suture-fixation technique in uniportal video-assisted thoracic surgery for pulmonary resection. METHODS: A retrospective analysis was conducted on 116 patients who underwent uniportal video-assisted thoracic surgery (U-VATS) for lung diseases in Zhengzhou People's Hospital between October 2019 and October 2021. Patients were stratified into two groups based on the applied suture-fixation methods, i.e., 72 patients in the active group and 44 patients in the control group. The two groups were subsequently compared in the terms of gender, age, operation method, indwelling time of chest tube, postoperative pain score, chest tube removal time, wound healing grade, length of hospital stay, incision healing grade, and patient satisfaction. RESULTS: There was no significant difference between the two groups in terms of gender, age, operation method, indwelling time of chest tube, postoperative pain score, and length of hospital stay (P = 0.167, 0.185, 0.085, 0.051, 0.927, and 0.362, respectively). However, the chest tube removal time, incision healing grade, and incision scar satisfaction in the active group were significantly better compared with those of the control group (P = < 0.001, 0.033, and < 0.001, respectively). CONCLUSION: In summary, the new suture-fixation approach can minimize the number of stitches, and time necessary for chest tube removal process, and avoid the pain experienced when removing the drainage tube. This method is more feasible, has better incision conditions, and provides a convenient tube removal, making it more suitable to patients.

Paraganglioma of the anterior superior mediastinum: Presentation of a case of mistaken diagnosis so long and review of the literature.

INTRODUCTION AND IMPORTANCE: Mediastinal paraganglioma is a rare tumor with neuroendocrine activity, highly susceptible to misdiagnosis. Herein, we present a case misdiagnosed as Castleman disease for nearly a decade, significantly enlarged, lost the opportunity of thoracoscopic surgery, and was removed by median thoracotomy. CASE PRESENTATION: A 59-year-old woman complained of having a mediastinal mass, was diagnosed with Castleman disease for nearly a decade and was admitted to the hospital due to neck tightness. The tumor size was significantly enlarged. We proceeded to interventional angiography with gelatin sponge angioembolization, and the tumor was resected through a median sternotomy on the second day. The operation was smooth, and the tumor was gray and slightly brittle. Postoperative pathology confirmed paraganglioma; lymph node metastasis was not detected (0/3). CLINICAL DISCUSSION: Mediastinal paraganglioma is a rare tumor and can be either functional or nonfunctional. It can be differentiated from many diseases. The SSTR-PET-CT labeled with 68Ga-somatostatin analog, plasma metanephrine, and normetanephrine are essential for the diagnosis. Surgical resection is the most effective form of treatment. Pre-operative embolization of the feeding artery is considered to have a low rate of intraoperative bleeding. We recommend making comprehensive preparations to ensure perioperative safety and long-term survival. CONCLUSION: When a vascularized mass is discovered in the mediastinum, surgeons should consider the possibility of a paraganglioma. Multidisciplinary consultation should be involved in the formulation of treatment plans. Lifelong surveillance for residual tumor growth and recurrence is required.

Application of bilateral simultaneous sequential single-incision video-assisted thoracic surgery in multiple nodules both lungs: a single-center experience of 10 cases.

OBJECTIVE: To discuss the application of bilateral simultaneous sequential single-incision video-assisted thoracic surgery in multiple nodules in both lungs. METHODS: A retrospective analysis of 10 patients in Zhengzhou People's Hospital who underwent single-incision thoracoscopic surgery to treat multiple nodules in both lungs at the same time from September 2019 to January 2021, and analyze the perioperative indicators (general condition, smoking history, family history, follow-up time of pulmonary nodules, size, location, height and weight, pulmonary function, intraoperative blood loss, operation time, color and volume of drainage fluid, catheterization time, perioperative complications, length of stay, pathology, patient satisfaction, etc.). RESULTS: All 10 patients used single-incision thoracoscopy to complete bilateral simultaneous sequential operations, aged 32 to 70 years, 8 female patients, 2 male patients, preoperative follow-up time ranging from 1 day to 2 years, a total of 23 lung nodules were removed except for the benign lesions in one nodule in the 2 patients, the other nodules were tumorous lesions (91.3%). The average total hospital stay was 10.5 days (8-14 days), and the average operation time was 194.5 min (145-292 min). The blood loss ranged from 10 to 280 ml, all patients had no serious complications during the perioperative period, and they recovered well and were discharged smoothly, and the satisfaction reached 100%. CONCLUSION: Single-incision bilateral simultaneous sequential thoracoscopy have certain advantages in the treatment of patients with multiple nodules in both lungs, conforms to the concept of rapid recovery, and is a feasible choice in the shared decision making of doctors and patients.

Peripheral blood oxidative stress markers for obstructive sleep apnea-a meta-analysis.

OBJECTIVES: The purpose of this study was to clarify the relationship between obstructive sleep apnea (OSA) and oxidative stress markers in blood. METHODS: We conducted a systematic literature search on databases including Pubmed and Embase for studies reporting circulating oxidative stress markers in patients with OSA and controls that were published between 1988 and June 2019. Standardized mean differences (SMDs) and 95% confidence intervals (95%CI) were calculated. RESULTS: Of the 2226 articles initially retrieved, 52 were included in our meta-analysis, covering a total of 12 oxidative stress markers. The concentrations of malondialdehyde (SMD = 1.18; 95%CI: 0.87, 1.49; p < 0.001), thiobarbituric acid reactive substances (SMD = 1.82; 95%CI: 0.79, 2.86; p = 0.001), advance oxidative protein products (SMD = 0.68; 95%CI: 0.14, 1.23; p = 0.014), total oxidant capacity (SMD = 1.32; 95%CI: 0.33, 2.31; p = 0.009), and asymmetric dimethylarginine (SMD = 0.32; 95%CI: 0.16, 0.47; p < 0.001) in the blood of patients with OSA were higher than those of the control group, whereas the concentrations of thiols (SMD = - 0.37; 95%CI: - 0.60, - 0.15; p = 0.001) and nitric oxide (SMD = - 2.61; 95%CI: - 4.02, - 1.21; p < 0.001) were lower than those of the control group. CONCLUSIONS: The oxidative stress markers in the blood of patients with OSA were aberrant, indicating an imbalanced state of oxidation and antioxidation in OSA.

A meta-analysis on the relationship of exosomes and the prognosis of lung cancer.

BACKGROUND: A lot of research evidence shows that exosomes play an indelible role in the prognosis of lung cancer, but there are many disputes. Therefore, we conduct a meta-analysis to further demonstrate. METHODS: A literature retrieval was performed through a search of PubMed, Embase, Web of Science, Cochrane, CKNI, Wanfang, and other databases to locate documents from the literature that satisfied the inclusion criteria. There were four outcome indicators: overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), and progression-free survival (PFS). Subgroup analysis was conducted according to sample size, country, detection method, analysis method, and pathological type. Stata 14.0 software was used to evaluate the prognostic value of exosomes in lung cancer. RESULTS: A total of 2456 patients with lung cancer from 29 studies in 16 articles were included. The expression level of exosomes was closely associated with the OS and DFS of patients, although no statistical difference was observed between exosomes and DSS or PFS. Eighteen studies with 2,110 patients were evaluated to examine the prognostic value of exosomes in lung cancer by exploring the association between exosomes and OS. The results showed that exosomes were strongly associated with worse OS, and the combined hazard ratio (HR) was 2.01 (95% confidence interval [CI]: 1.70-2.39, P = .000). Six studies investigated the association between exosomes and DFS, and showed a pooled HR of 2.48 (95% CI: 1.75-3.53, P = .000). CONCLUSION: Our analysis indicated that the expression level of exosomes was closely associated with the OS and DFS of patients with lung cancer, suggesting that exosomes are associated with poor prognosis of lung cancer. Exosomes may be a new biomarker for the prognosis of lung cancer, although a large number of prospective studies are still needed to support this.