Short-term and Long-term Postoperative Safety of Off-Pump versus On-Pump Coronary Artery Bypass Grafting for Coronary Heart Disease: A Meta-analysis for Randomized Controlled Trials.

OBJECTIVE: The aim was to compare the short-term (30 days after surgery) and long-term (over 6 months' follow-up) postoperative safety of off-pump and on-pump coronary artery bypass grafting (CABG) for patients with coronary heart disease (CHD). METHODS: Relevant randomized controlled trials (RCTs) were obtained from PubMed, Embase, Springer, Ovid, and Cochrane library up to July 2013. Odds ratios (ORs) with their 95% confidence intervals (CIs) were used to access effect sizes. RESULTS: Seven RCTs involving 9,128 patients were included. Results suggested no significant difference in all the short-term outcomes (mortality, OR = 0.90, 95% CI: 0.69 to 1.16, p = 0.41; myocardial infarction, OR = 0.95, 95% CI: 0.79 to 1.15, p = 0.61; stroke, OR = 0.78, 95% CI: 0.56 to 1.07, p = 0.12; renal failure, OR = 0.84, 95% CI: 0.60 to 1.18, p = 0.43; revascularization: OR = 1.95, 95% CI: 0.79 to 4.85, p = 0.15) and some long-term outcomes (mortality, OR = 1.02, 95% CI: 0.86 to 1.22, p = 0.81; myocardial infarction, OR = 0.86, 95% CI: 0.70 to 1.04, p = 0.12; stroke, OR = 0.89, 95% CI: 0.67 to 1.19, p = 0.44) between off-pump and on-pump CABG. However, off-pump CABG had a significantly higher revascularization rate (OR = 1.45; 95% CI: 1.02 to 2.06; p = 0.04) than on-pump CABG in long-term follow-up. CONCLUSION: Short-term postoperative safety was similar between off-pump and on-pump CABG. A high revascularization rate was the drawback of off-pump CABG for CHD patients in long-term follow-up.

Peripheral mycotic pulmonary artery aneurysms.

Mycotic pulmonary artery aneurysms are rare but potentially fatal complications of infective endocarditis. The literature on this rare condition was reviewed and its management is discussed.

[Expression and function of ECRG4 in hepatocellular carcinoma].

OBJECTIVE: To investigate the expression of esophageal cancer related gene 4 (ECRG4) in human hepatocellular carcinoma and the role of ECRG4 in proliferation, apoptosis and migration of hepatoma cells. METHODS: ECRG4 expression was investigated in normal or tumor liver cell lines including QSG7701 and HepG2 cells, and in 24 pairs of fresh samples of hepatocellular carcinoma by quantitative real-time PCR or Western blot. ECRG4-pcDNA3.1 expressing plasmid was transfected into HepG2 cells, of which cellular proliferation, apoptosis and migration were documented. RESULTS: ECRG4 mRNA expression was reduced or absent in most primary hepatocellular carcinoma samples (95.8%, 23 out of 24 hepatocellular carcinoma samples) compared to their paired normal liver samples (P < 0.01). ECRG4 mRNA was significantly lower in HepG2 cells than QSG7701 cells (P < 0.05) along with decreased ECRG4 protein expression. HepG2 cells overexpressing ECRG4 showed decreased proliferation, increased apoptosis and reduced migration as compared with control cells (P < 0.05). CONCLUSIONS: ECRG4 expression is frequently down-regulated in hepatocellular carcinoma. Overexpression of ECRG4 inhibits the proliferation and migration but promotes apoptosis of HepG2 cells, suggesting that ECRG4 is a candidate tumor suppressor gene in hepatocellular carcinoma and therefore may serve as a novel target for precision therapy.

Developing a prognostic model using machine learning for disulfidptosis related lncRNA in lung adenocarcinoma.

Disulfidptosis represents a novel cell death mechanism triggered by disulfide stress, with potential implications for advancements in cancer treatments. Although emerging evidence highlights the critical regulatory roles of long non-coding RNAs (lncRNAs) in the pathobiology of lung adenocarcinoma (LUAD), research into lncRNAs specifically associated with disulfidptosis in LUAD, termed disulfidptosis-related lncRNAs (DRLs), remains insufficiently explored. Using The Cancer Genome Atlas (TCGA)-LUAD dataset, we implemented ten machine learning techniques, resulting in 101 distinct model configurations. To assess the predictive accuracy of our model, we employed both the concordance index (C-index) and receiver operating characteristic (ROC) curve analyses. For a deeper understanding of the underlying biological pathways, we referred to the Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) for functional enrichment analysis. Moreover, we explored differences in the tumor microenvironment between high-risk and low-risk patient cohorts. Additionally, we thoroughly assessed the prognostic value of the DRLs signatures in predicting treatment outcomes. The Kaplan-Meier (KM) survival analysis demonstrated a significant difference in overall survival (OS) between the high-risk and low-risk cohorts (p < 0.001). The prognostic model showed robust performance, with an area under the ROC curve exceeding 0.75 at one year and maintaining a value above 0.72 in the two and three-year follow-ups. Further research identified variations in tumor mutational burden (TMB) and differential responses to immunotherapies and chemotherapies. Our validation, using three GEO datasets (GSE31210, GSE30219, and GSE50081), revealed that the C-index exceeded 0.67 for GSE31210 and GSE30219. Significant differences in disease-free survival (DFS) and OS were observed across all validation cohorts among different risk groups. The prognostic model offers potential as a molecular biomarker for LUAD prognosis.

Enhanced efficacy of a novel aspirator in uniportal video-assisted thoracoscopic mediastinal lymph node dissection: a non-randomized prospective clinical trial.

Background: Video-assisted thoracoscopic surgery (VATS) is the standard approach in early-stage non-small cell lung cancer (NSCLC) and surgical aspirators play a crucial role. Traditional aspirators lack the ability to pull and lift tissue and cannot achieve optimal exposure. Therefore, we designed a new surgical aspirator that combined the function of thoracoscopic forceps. In this study, we aimed to validate the efficacy and safety of this new surgical aspirator. Methods: We performed a prospective non-randomized intervention trial and enrolled 504 consecutive patients scheduled for uniportal VATS in early NSCLC requiring mediastinal lymph node dissection. A novel aspirator we developed with a clamping function via a front pliers-like structure was implemented in intervention group, whereas traditional aspirator was used in control group. Time spent for nodal dissection in No. 2/4R and No. 7R/L (No. 7 lymph nodes resected through right or left side) lymph nodes and perioperative adverse events related to lymph node dissection were recorded. Mann-Whitey U test was applied to analyze sex and pathological type, an independent-samples t-test was applied to analyze surgery time and age. Results: In total, 250 of enrolled patients were allocated into traditional aspirator group and 254 of them were allocated into new aspirator group. Surgeons spent 544.71±120.80 (range, 332-917, median 541) seconds dissecting No. 2/4R lymph nodes with traditional aspirators and 507.54±100.00 (range, 348-702, median 520) seconds dissecting with new aspirators (P=0.008). The traditional aspirator group had an average surgery time of 507.11±104.61 (range, 310-785, median 510) seconds for No. 7R lymph nodes and 608.47±128.50 (range, 397-919, median 606) seconds for No. 7L lymph nodes, while that in the new aspirator group was 465.09±94.94 (range, 271-744, median 476) seconds (P=0.001) and 549.39±102.11 (range, 368-782, median 538) seconds (P<0.001). The new aspirator showed an efficacy advantage in mediastinal lymph node dissection in VATS, without additional risk. Conclusions: This is the first report about a new suction device combining the functions of both traditional surgical aspirators and forceps, which can effectively shorten the time of mediastinal lymph node dissection and improve the efficiency of thoracoscopic surgery without increasing lymph node dissection-related adverse events.

A radiomics nomogram for predicting postoperative recurrence in esophageal squamous cell carcinoma.

Purpose: To establish and validate a radiomics nomogram for predicting recurrence of esophageal squamous cell carcinoma (ESCC) after esophagectomy with curative intent. Materials and methods: The medical records of 155 patients who underwent surgical treatment for pathologically confirmed ESCC were collected. Patients were randomly divided into a training group (n=109) and a validation group (n=46) in a 7:3 ratio. ​Tumor regions are accurately segmented in computed tomography images of enrolled patients. Radiomic features were then extracted from the segmented tumors. We selected the features by Max-relevance and min-redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) methods. A radiomics signature was then built by logistic regression analysis. To improve predictive performance, a radiomics nomogram that incorporated the radiomics signature and independent clinical predictors was built. Model performance was evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analyses (DCA). Results: We selected the five most relevant radiomics features to construct the radiomics signature. The radiomics model had general discrimination ability with an area under the ROC curve (AUC) of 0.79 in the training set that was verified by an AUC of 0.76 in the validation set. The radiomics nomogram consisted of the radiomics signature, and N stage showed excellent predictive performance in the training and validation sets with AUCs of 0.85 and 0.83, respectively. Furthermore, calibration curves and the DCA analysis demonstrated good fit and clinical utility of the radiomics nomogram. Conclusion: We successfully established and validated a prediction model that combined radiomics features and N stage, which can be used to predict four-year recurrence risk in patients with ESCC who undergo surgery.

Dorsal incision shows more efficacy and safety to traditional incision in single-portal video-assisted thoracoscopic surgery segmentectomy of LS9+10: a non-randomized prospective clinical trial.

Background: Segmentectomy is increasingly performed as a surgical technique. Traditional anterior axillary line and mid-axillary line video-assisted thoracoscopic surgery (VATS) incision meets difficulties when dealing with left segment 9+10 (LS9+10), as the distance and angle of view make it uneasy to expose the trachea, blood vessels and intersegment plane. As an alternative, dorsal incision may be advantageous as which faces the key structures of LS9+10, may facilitate the management of trachea and blood vessels of LS9+10, but there was no clinical proof reported ever. This study is targeted to compare the efficacy and safety of these two incisions in segmentectomy of LS9+10. Methods: The dorsal incision is made behind the posterior axillary line, 8th intercostal space. Patients with ground glass opacity (GGO) which solid ingredients is less than 25%, locates at LS9+10, and segmentectomy of LS9+10 could ensure the cut edge were enrolled in the study and were allocated to the traditional incision group or dorsal incision group based on the parity of hospital number. Efficacy outcomes such as the duration of surgery and safety outcomes including postoperative air-leakage duration, length of hospital stay, amount of bleeding and pain score were recorded. The Independent-samples t-test and Mann-Whitey U test were applied in data analysis. Results: A total of 68 patients were enrolled and allocated into the traditional incision group and dorsal incision group. In the traditional incision group, the average surgery time was 71.03±6.87 min (median 71.5 min), while that in the dorsal incision group was an average of 62.72±6.24 min (median 61.0 min, P=0.001). The postoperative duration of air-leakage was 2.16±1.63 and 1.36±1.33 days for traditional incision group and dorsal incision group (P=0.030), respectively. The traditional incision group had a greater length of postoperative hospital stay (3.69±1.36 days) than the dorsal incision group (3.08±1.03 days, P=0.041), when amount of bleeding and pain score showed no differences between these two groups. Data suggested a statistically significant advantage for the dorsal incision procedure. Conclusions: Dorsal incision can facilitate the segmentectomy of LS9+10, and significantly reduce the surgery time, postoperative duration of air-leakage and length of hospital stay.

Peripheral pure ground-glass opacity: segmentectomy versus wedge resection.

INTRODUCTION: Sublobar resection has been widely accepted for treating pure ground-glass opacities (GGOs). As GGOs have good prognosis, preserving postoperative pulmonary function is the major concern in surgery. No studies have yet compared the success rates of pulmonary function reservation between segmentectomy and wedge resection. METHOD: The three-dimensional rebuild of computed tomography (CT) images was performed, the segmentectomy and wedge resection of the GGO in the target segment were simulated, and the area of cut surface was measured, which was important data for successful postoperative pulmonary recruitment maneuvers. RESULT: With equal volumes of tissue removed, segmentectomy and wedge resection showed similar surface area loss for RS4 and RS5, followed by LS7 + 8, LS6 and LS1 + 2 segments. Compared with other segments, wedge resection performed in RS10, LS3, LS10, RS9 and RS7 may lead to a loss of lot more surface area than segmentectomy. CONCLUSION: Wedge resection is suggested for segments RS4, RS5, LS1 + 2 and LS7 + 8, whereas segmentectomy is advised for segments RS1, LS4 + 5 and RS2. Meanwhile, deep wedge resection should be avoided for segments RS8, RS7, RS10, LS3, LS10. RS9 and LS9, in order to preserve a larger lung surface area.

Neoantigen load as a prognostic and predictive marker for stage II/III non-small cell lung cancer in Chinese patients.

BACKGROUND: The prognosis for patients with stage II/III non-small cell lung cancer (NSCLC) is unsatisfactory, even after complete tumor resection and adjuvant chemotherapy. Here, we assessed the prognostic and predictive value of immunogenomic signatures for stage II/III NSCLC in Chinese patients. METHODS: A total of 91 paired resected stage II/III NSCLC and normal tissues, including 47 squamous cell lung carcinomas (SCC) and 44 lung adenocarcinomas (ADC), were collected and analyzed using whole exome sequencing (WES) to identify immunogenomic signatures for association with clinicopathological variables and disease-free survival (DFS). RESULTS: Higher neoantigen load (NAL, >2 neoantigens/Mb) exhibited better DFS for SCC patients (p = 0.021) but not ADC patients. A benefit from adjuvant chemotherapy was correlated with lower NAL (≤2 neoantigens/Mb) (p = 0.009). However, tumor mutation burden (TMB), mutations of individual gene, oncogene pathways, and antigen presentation machinery genes, and human leukocyte antigen (HLA)-I number and HLA-I loss of heterozygosity (LOH) had no prognostic or predictive value for DFS of SCC or ADC patients. CONCLUSIONS: NAL is a useful biomarker for lung SCC prognosis and prediction of chemotherapy responses in Chinese patients. The predictive value of NAL for adjuvant immunotherapy should be further explored in patients with resected NSCLC.

Analysis of lymph node metastasis in 200 patients with non-small cell lung cancer.

BACKGROUND: Lymph node metastasis occurs although clinical stage IA is a relatively early stage for patients with non-small cell lung cancer (NSCLC). This study aimed to explore the influencing factors of lymph node metastasis. METHODS: A total of 200 patients diagnosed with clinical stage IA NSCLC preoperatively from July 2014 to July 2016 were examined. Every patient underwent lobectomy and systematic lymph node dissection. Their clinicopathological characteristics and status of lymph node metastasis are analyzed. RESULTS: The rates of both N1 and N2 lymph node metastasis increase with the increase in the tumor diameter. The N1 lymph node metastasis rate is 0%, 2.82%, and 9.52%, while the N2 lymph node metastasis rate is 0%, 4.23%, and 25.40% for pure ground-glass nodules, mixed ground-glass nodules (solid component <50%), and mixed ground-glass nodules (solid component >50%), respectively. The difference is statistically significant (P=0.000). Patients with squamous cell carcinoma have a relatively higher N1 lymph node metastasis rate comparing with patients with adenocarcinoma (P<0.05). Tumors locate in the inner half lobe (close to hilus) are prone to metastasize to lymph nodes (P=0.018). Multiple regression analysis shows that tumor diameter, solid component rate, and tumor location are relevant factors for lymph node metastasis. CONCLUSIONS: In patients with NSCLC, who have tumors smaller than 1 cm, pure ground-glass nodules, or tumors locate in the lateral half lobe, lymph node metastasis is rare and selective lymphadenectomy is considerable.

Quality of life with adjuvant gefitinib versus vinorelbine plus cisplatin in patients with completely resected stage II-IIIA (N1-N2) EGFR-mutant non-small-cell lung cancer: Results from the ADJUVANT (CTONG1104) study.

OBJECTIVES: Health-related quality of life (HRQoL) data complement conventional clinical endpoints when comparing adjuvant gefitinib with chemotherapy in patients with early-stage non-small-cell lung cancer (NSCLC) and epidermal growth factor receptor (EGFR) mutations. This study aimed to assess changes in HRQoL with adjuvant gefitinib vs chemotherapy in this patient group. MATERIALS AND METHODS: In the phase III ADJUVANT trial, patients with completely resected, stage II-IIIA (N1-N2), EGFR-mutant NSCLC were randomized (1:1) to receive either gefitinib for 24 months or vinorelbine plus cisplatin (VP) every 3 weeks for four cycles. HRQoL was assessed as a secondary endpoint using the Functional Assessment of Cancer Therapy-Lung Cancer (FACT-L), Lung Cancer Symptom Scale (LCSS) questionnaires, and Trial Outcome Index (TOI) composite score. HRQoL dynamics, improvements, and time to deterioration were compared between groups. RESULTS: At baseline, 104 of 106, and 80 of 87 patients receiving gefitinib and VP, respectively, completed two questionnaires (FACT-L and LCSS). Baseline scores were balanced between groups. Although HRQoL fluctuated and gradually improved in both groups, longitudinally higher scores were reported with gefitinib than VP (FACT-L, odds ratio 418.16, 95 % confidence interval [CI] 2.75-63509.05, p =  0.019; LCSS, 1.13, 1.04-1.22, p =  0.003; TOI, 88.39, 4.40-1775.05, p =  0.003). Time to deterioration in HRQoL was delayed with gefitinib compared with VP (FACT-L, median 69 vs 6 weeks, hazard ratio 0.62, 95 % CI 0.42-0.90, p =  0.013; LCSS, median 45 vs 6 weeks, 0.63, 0.43-0.93, p =  0.020; TOI, median 164 vs 9 weeks, 0.51, 0.33-0.77, p =  0.001). CONCLUSION: Adjuvant gefitinib is associated with improved HRQoL over VP, supporting its use in patients with stage II-IIIA (N1-N2), EGFR-mutant NSCLC.

The clinical features, diagnosis and management of recurrent thymoma.

Thymoma is a disease with malignant potential, which has a recurrence rate after complete resection ranging from 5 to 50 %. Multiple studies on the risk factors, treatment or prognosis have been reported. Many of them are controversial, however. In this review, we summarized some accepted risk factors, means of diagnosis and different treatments of recurrent thymoma. The risk factors of recurrent thymoma haven't been well-studied, and its management remains controversial. We reviewed the literatures and found some key points which should be noticed during the surgery of initial thymoma. Although reoperation should be taken into account preferentially, multimodal treatments are also available. The prognosis are also been discussed.

CA125 is a potential biomarker to predict surgically incurable gastric and cardia cancer: A retrospective study.

Preoperative evaluation of the curability of gastric and cardia cancer is important to avoid risks of unnecessary surgery. Our previous study has reported several clinical parameters associated with incurable gastric surgery. In this study, we aimed to evaluate the correlation between CA125 and the curability of gastric and cardia cancer.A total of 297 cases of gastric and cardia cancer were analyzed retrospectively, including 153 cases with radical surgery and 144 with surgery for incurable gastric or cardia cancer. χ test was performed to analyze the associations between curability or incurable factors and clinicopathological data, including CA125 value. ROC curves were generated, and cutoff points for curability, T status, N status, peritoneal metastasis, and distant metastasis were found, respectively. Binary logistic regression was performed to verify the associations between dependent variables (curability, T status, N status, peritoneal metastasis, and distant metastasis) and covariates (related clinicopathological data from step 1 and cutoff points from step 2).Esophageal involvement, T grade, and CA125 were risk factors of curability. T grade and Borrmann type were risk factors of T status. T grade and CA125 were risk factors of N status. Age, esophageal involvement, T grade, and CA125 were risk factors of peritoneal metastasis. CA125 was risk factor of distant metastasis.CA125 is a potential biological marker for curability prediction of gastric and cardia cancer.

The truncate mutation of Notch2 enhances cell proliferation through activating the NF-κB signal pathway in the diffuse large B-cell lymphomas.

The Notch2 is a critical membrane receptor for B-cell functions, and also displays various biological roles in lymphoma pathogenesis. In this article, we reported that 3 of 69 (4.3%) diffuse large B-cell lymphomas (DLBCLs) exhibited a truncate NOTCH2 mutation at the nucleotide 7605 (G/A) in the cDNA sequence, which led to partial deletion of the C-terminal of PEST (proline-, glutamic acid-, serine- and threonine-rich) domain. The truncate Notch2 activated both the Notch2 and the NF-κB signals and promoted the proliferation of B-cell lymphoma cell lines, including DLBCL and Burkitt's lymphoma cell lines. Moreover, the ectopic proliferation was completely inhibited by ammonium pyrrolidinedithiocarbamate (PDTC), an NF-κB inhibitor. Simultaneously, PDTC also reduced the expression level of Notch2. Based on these results, we conclude that the Notch2 receptor with PEST domain truncation enhances cell proliferation which may be associated with the activation of the Notch2 and the NF-κB signaling. Our results are expected to provide a possible target for new DLBCL therapies by suppressing the Notch2 and the NF-κB signaling.