Pulmonary mucinous adenocarcinoma: An overview of pathophysiology and advancements in treatment.

Pulmonary mucinous adenocarcinoma (PMA), a distinct subtype of non-small cell lung cancer (NSCLC), is characterized by an abundance of mucin-producing cells. Although this subtype comprises a relatively small fraction of lung adenocarcinomas, PMA stands apart due to its unique clinical, pathological, and molecular features. This review comprehensively discusses the pathophysiology and etiology, clinical features, diagnostic methods, treatment strategies, prognosis, and future directions for PMA, drawing from relevant literature and existing studies. Advances in PMA treatment includes surgical intervention, targeted therapy, immunotherapy, and adjuvant therapy. Particularly, we discussed factors influencing the prognosis of PMAs, such as molecular markers, pathological features, and the impact of the latest treatment advances on prognosis. Moreover, we intended this review to be a comprehensive reference for diagnosing, treating, and assessing the prognosis of PMA, providing valuable guidance for clinical practice.

Case report: Combined cervical incision with an intercostal uniportal video-assisted thoracoscopic surgery approach for mediastinal brachial plexus schwannoma.

Mediastinal neurogenic tumors primarily originate from the intercostal and sympathetic nerves, whereas schwannomas originating from the brachial plexus are rare. Surgical intervention for such tumors is complex and associated with the risk of postoperative upper limb dysfunction due to their unique anatomical location. In this report, we present the case of a 21-year-old female diagnosed with a mediastinal schwannoma, who underwent a novel surgical approach combining cervical incision and intercostal uniportal video-assisted thoracoscopic surgery (VATS). Our study reviewed the patient's clinical presentation, treatment approach, pathology, and prognosis. The findings of this study demonstrate that the cervical approach, combined with intercostal uniportal VATS, is a feasible surgical method for the removal of mediastinal schwannomas originating from the brachial plexus.

Clinical applications of minimally invasive uniportal video-assisted thoracic surgery.

BACKGROUND: In recent years, the field of minimally invasive thoracic surgery has experienced significant advancements driven by improvements in video-assisted thoracoscopic surgery (VATS) techniques and surgical instruments. These advances have given rise to uniportal VATS as a new area of exploration in minimally invasive thoracic surgery. This technique presents several potential advantages, including reduced access trauma, less postoperative pain, improved cosmesis, fewer complications, shorter hospital stays, and faster rehabilitation, ultimately leading to an improvement in patient quality of life. PURPOSE: This article reviews the evolutionary history of minimally invasive thoracic surgery, highlights novel techniques, explores possible applications and obtained results, and discusses future prospects of uniportal VATS. CONCLUSION: Experienced thoracic surgeons have demonstrated the capacity to perform uniportal VATS with a high level of safety and efficacy. Further studies are necessary to assess its long-term efficacy, address limitations, and enhance clinical decision-making for optimal treatment of thoracic conditions.

Advantages and feasibility of intercostal nerve block in uniportal video-assisted thoracoscopic surgery (VATS).

OBJECTIVES: Uniportal video-assisted thoracic surgery (VATS) has been successfully used worldwide as a minimally invasive method of thoracoscopic surgery. Although pain was significantly reduced after VATS, acute postoperative pain was still significant. This study aimed to assess the advantages and feasibility of intercostal nerve block in uniportal VATS. METHODS: We conducted a retrospective analysis of perioperative data from 280 consecutive patients who underwent uniportal VATS at our institution between May 2021 and February 2022. The patients were assigned to either Group A (142 patients with 3 intercostal nerves blocked) or Group B (138 patients with 5 intercostal nerves blocked). We analyzed the perioperative data of both groups and utilized repeated measures ANOVA to determine the difference in postoperative pain between the two groups across time. RESULTS: A total of 280 patients underwent successful uniportal VATS during the study period. There were no significant differences between Group A and Group B in terms of age, gender, pulmonary function, arterial blood gas analysis, laterality, incision location, nodule size, nodule location, operative time, blood loss, drainage time, length of hospital stays, tumor stage, or postoperative complications. Furthermore, no surgical or 30-day postoperative mortalities occurred. Using repeated measures ANOVA, we found that the intercostal nerve block had significant effects on the group, time, and interaction terms group × time (P < 0.05). CONCLUSION: Intercostal nerve block is safe and effective, and is associated with simple, accurate, and high patient satisfaction as opposed to other postoperative analgesics in uniportal VATS. Blocking five intercostal nerves may be more beneficial for effective postoperative pain management. Nevertheless, further confirmation through prospective randomized controlled trials is required.

Would the width of a metal rib spreader affect postoperative pain in patients who undergo video-assisted mini-thoracotomy (VAMT)?

Background: Hitherto, no study has evaluated postoperative pain in patients with non-small cell lung cancer (NSCLC) treated with video-assisted mini-thoracotomy (VAMT). In this study, we aimed to assess postoperative pain related to the width of the metal rib spreader in patients who underwent lobectomy using VAMT. Methods: We retrospectively analysed the data of 94 consecutive patients with NSCLC who underwent lobectomy using VAMT at our institution between March 2019 and May 2022. We divided the patients into groups according to the width ratio of the rib spreader to that of a single intercostal space. Patients with width ratios ≤ 2.5 times were assigned to group A, and those with width ratios > 2.5 times were assigned to group B. Pre-, intra-, and postoperative data were collected and reviewed. Results: We successfully performed VAMT in 94 patients with NSCLC. Forty-five patients were in group A, and 49 were in group B. There were no intraoperative mortalities, although one patient, due to respiratory failure, experienced 30-day mortality. There were no significant differences between the two groups in terms of the blood loss volume, operative time, drainage time, postoperative complications, length of hospital stay, or number of lymph node stations explored and retrieved. The drainage volumes (Day 1-Day 3) were higher in group B than in group A (P < 0.05). The postoperative visual analogue scale (VAS) pain scores were significantly lower in Group A than in Group B at 12, 24, and 48 h (P < 0.05), although there was no significant difference in the VAS scores between the two groups at 72 h and 1 week postoperatively (P > 0.05). Conclusion: The smaller the width of the metal rib spreader used in surgery, the less pain experienced by the patient and the faster the recovery. Multicentre, randomised, controlled trials should be conducted in the future.

Clinical characteristics and survival outcomes of patients with pneumonectomies: A population-based study.

Background: Prognostic factors in a pneumonectomy (PN) are not yet fully defined. This study sought to analyze and evaluate long-term survival after pneumonectomies (PNs) for patients with non-small cell lung cancer (NSCLC). Methods: We obtained data from the Surveillance, Epidemiology, and End Results (SEER) database for patients who underwent PNs between 2004 and 2015. Propensity score matching (PSM) analysis and Kaplan-Meier curves were used to estimate overall survival (OS), while univariate and multivariable Cox proportional hazards regression analyses were applied to create a forest plot. Results: In total, 1,376 patients were grouped according to right/left PNs. Before matching, OS was worse after a right PN [hazard ratio (HR): 1.459; 95% CI 1.254-1.697; P < 0.001] and after matching, survival differences between groups were not significant (HR: 1.060; 95% CI 0.906-1.240; P = 0.465). Regression analysis revealed that age, gender, grade, lymph node dissection, N-stage, and chemotherapy were independent predictors of OS (P < 0.05). Chemotherapy was associated with improved OS (P < 0.001). Conclusions: Laterality was not a significant prognostic factor for long-term survival after a PN for NSCLC. Chemotherapy was a significant independent predictor of improved OS. Long-term survival and outcomes analyses should be conducted on larger numbers of patients.

Lobectomy versus segmentectomy in patients with stage T (> 2 cm and ≤ 3 cm) N0M0 non-small cell lung cancer: a propensity score matching study.

BACKGROUND: The safety and effectiveness of lung segmentectomy in patients with early non-small cell lung cancer (NSCLC) remains controversial. We have therefore reviewed the clinicopathologic characteristics and survival outcomes of patients treated with lobectomy or segmentectomy for early T (> 2 and ≤ 3 cm) N0M0 NSCLC. METHODS: We obtained data from the Surveillance, Epidemiology, and End Results database for patients who underwent lobectomy or segmentectomy between 2004 and 2015. To reduce bias and imbalances between the treatment groups, propensity score matching analysis was performed. We used Kaplan-Meier curves to estimate overall survival (OS) and lung cancer-specific survival (LCSS). We conducted univariate and multivariate Cox proportional hazards regression analyses to identify independent prognostic factors for OS and cancer-specific survival, and applied the Cox proportional hazards model to create forest plots. RESULTS: Before matching, both univariate and multivariate Cox regression analyses revealed that patients who underwent lobectomy exhibited better OS (P < 0.001) and LCSS (P = 0.001) than patients who underwent segmentectomy. However, after matching, survival differences between the groups were not significant; OS (P = 0.434) and LCSS (P = 0.593). Regression analyses revealed that age and tumor grade were independent predictors of OS and LCSS (P < 0.05). CONCLUSIONS: Patients with stage T (> 2 and ≤ 3 cm) N0M0 NSCLC undergoing segmentectomy can obtain OS and LCSS similar to those obtained with lobectomy. Further studies are required considering the solid component effects and pathologic tumor types regarding segmentectomies. Additional long-term survival and outcome analyses should be conducted with larger cohorts.

Probiotic effect on Helicobacter pylori attachment and inhibition of inflammation in human gastric epithelial cells.

Helicobacter pylori (H. pylori) is a major cause of chronic gastritis, gastric ulcers and gastric cancer. Recent studies have identified that probiotics are beneficial to human health due, in part, to their anti-H. pylori activities. Therefore, the present study investigated the antagonistic and local immunoregulatory activities of seven commercial probiotic strains and explored their mechanisms of actions. The human gastric epithelial cell line-1 (GES-1) was used to assess the effects of probiotics on the adhesion ability of H. pylori. GES-1 cells were infected with H. pylori plus lipopolysaccharide (HP-LPS) or the drug-resistant H. pylori strain (HP021) in the presence or absence of live probiotics. Following this, the growth rate and the adhesion ability of GES-1 cells were detected using MTT and urease activity assay. Toll-like receptor 4 (TLR4), NFKB inhibitor-α (IκBα) and nuclear factor (NF)-κB levels were measured by western blot analysis. The amount of interleukin (IL)-8 in the cell culture medium was determined by ELISA. Amongst the seven probiotic strains studied, live Lactobacillus acidophilus (L. acidophilus) and Lactobacillus bulgaricus (L. bulgaricus) inhibited H. pylori adherence to GES-1 cells most significantly. L. bulgaricus inhibited IL-8 production by GES-1 cells through modulation of the TLR4/IκBα/NF-κB pathway. Therefore, the present results suggested that consumption of food containing L. acidophilus and L. bulgaricus may be used as an adjuvant therapy for H. pylori-associated gastritis.

Combination of subxiphoid and intercostal uniportal video-assisted thoracoscopic surgery for bilateral lung lesions: report of two cases and review of the literature.

Uniportal video-assisted thoracic surgery (VATS) is carried out to reduce postoperative pain after treatment of thoracic diseases. Here, we report a novel method that combines a subxiphoid and intercostal uniportal VATS approach that can be used to treat bilateral pulmonary lesions simultaneously. The first case is a 50-year-old female with bilateral pulmonary lesions who received left lower lobectomy associated with right middle lobe wedge resection synchronously; the other case is a 14-year-old male who was admitted for resection of bilateral lung metastases as a result of previous osteosarcoma. We combined a subxiphoid approach with intercostal uniportal surgical procedure for bilateral pulmonary lesions. Less postoperative pain, faster postoperative recovery, and a better aesthetic effect are possible superiorities of this method if patients are selected carefully. Our results show that the combining of a subxiphoid approach with intercostal uniportal VATS is a feasible and efficient surgical procedure for bilateral pulmonary lesions, with good outcomes. Moreover, this procedure is more suitable for patients with bilateral pulmonary lesions.