Effect of different surgical approaches on the survival and safety of Siewert type II esophagogastric junction adenocarcinoma: a systematic review and meta-analysis.

BACKGROUND: Whether a transthoracic (TT) procedure by a thoracic surgeon or a transabdominal (TA) by a gastrointestinal surgeon is best for Siewert type II esophagogastric junction adenocarcinoma (EGJA) remains unknown. Survival and perioperative outcomes were compared between the two groups in this meta-analysis to clarify this argument. METHODS: We searched 7 databases for eligible studies comparing TT and TA procedures for Siewert type II EGJA. The final analyzed endpoints included intraoperative and hospitalization outcomes, recurrence, complication, and survival. RESULTS: Seventeen studies involving 10,756 patients met the inclusion criteria. The TA group had higher rates of overall survival (OS) (HR: 1.31 [1.20 ~ 1.44], p < 0.00001) and disease-free survival (DFS) (HR: 1.49 [1.24 ~ 1.79], p < 0.0001). The survival advantage of OSR and DFSR increased with time. Subgroup analysis of OS and DFS suggested that TA remained the preferred approach among all subgroups. More total/positive lymph nodes were retrieved, and fewer lymph node recurrences were found in the TA group. The analysis of perioperative outcomes revealed that the TA procedure was longer, had more intraoperative blood loss, and prolonged hospital stay. Similar R0 resection rates, as well as total recurrence, local recurrence, liver recurrence, peritoneal recurrence, lung recurrence, anastomosis recurrence and multiple recurrence rates, were found between the two groups. The safety analysis showed that the TT procedure led to more total complications, anastomotic leakages, cases of pneumonia, and cases of pleural effusion. CONCLUSIONS: The TA procedure appeared to be a suitable choice for patients with Siewert type II EGJA because of its association with longer survival, fewer recurrences, and better safety.

Prognostic value and immune landscapes of cuproptosis-related lncRNAs in esophageal squamous cell carcinoma.

BACKGROUND: Precisely forecasting the prognosis of esophageal squamous cell carcinoma (ESCC) patients is a formidable challenge. Cuproptosis has been implicated in ESCC pathogenesis; however, the prognostic value of cuproptosis-associated long noncoding RNAs (CuRLs) in ESCC is unclear. METHODS: Transcriptomic and clinical data related to ESCC were sourced from The Cancer Genome Atlas (TCGA). Using coexpression and Cox regression analysis to identify prognostically significant CuRLs, a prognostic signature was created. Nomogram models were established by incorporating the risk score and clinical characteristics. Tumor Immune Dysfunction and Rejection (TIDE) scores were derived by conducting an immune landscape analysis and evaluating the tumor mutational burden (TMB). Drug sensitivity analysis was performed to explore the underlying molecular mechanisms and guide clinical dosing. RESULTS: Our risk score based on 5 CuRLs accurately predicted poorer prognosis in high-risk ESCC patients across almost all subgroups. The nomogram that included the risk score provided more precise prognostic predictions. Immune pathways, such as the B-cell receptor signaling pathway, were enriched in the datasets from high-risk patients. High TMB in high-risk patients indicated a relatively poor prognosis. High-risk patients with lower TIDE scores were found to benefit more from immunotherapy. High-risk patients exhibited greater responsiveness to Nilotinib, BI-2536, P22077, Zoledronate, and Fulvestrant, as revealed by drug sensitivity analysis. Real-time PCR validation demonstrated significant differential expression of four CuRLs between ESCC and normal cell lines. CONCLUSIONS: The above risk score and nomogram can accurately predict prognosis in ESCC patients and provide guidance for chemotherapy and immunotherapy.

The feasibility and safety of simultaneous bilateral video-assisted thoracic surgery for the treatment of bilateral pulmonary lesions.

Background: The aim of this study was to evaluate the feasibility and safety of simultaneous bilateral video-assisted thoracic surgery (VATS) for the treatment of bilateral pulmonary lesions. Methods: The data of 11 patients who received simultaneous bilateral pulmonary surgery using VATS in the Department of Thoracic Surgery of The Third Affiliated Hospital of Naval Medical University between January 2016 and August 2021 were retrospectively analyzed. Results: The cases of four male and seven female patients, with a mean age of 57.54 ± 8.37 years (range, 44-67 years), were reviewed. Nonanatomic wedge resection, pulmonary segmentectomy or lobectomy via VATS were performed depending on each patient's situation. Mean 1 second forced expiratory volume (FEV1) was 2.55 ± 0.66 L(range, 1.49-3.88 L), mean intraoperative bleeding volume was 91.81 ± 49.56 mL(range, 30-150 mL), mean operating time was 273.72 ± 68.98 min(range, 132-390 min), and mean drainage duration was 5.27 ± 3.60 days(range, 2-14 days), with a mean total drainage volume of 1,515.90 ± 772.75 mL(range, 530-3,225 mL). Only one postoperative complication (air leakage) occurred, with an overall complication rate of 9.09%. The mean postoperative hospital stay was 8.81 ± 3.60 days (range, 5-18 days), and the mean total cost of hospitalization was 67,054.53 ± 20,896.49 RMB (range, 47,578.45-123,530.8 RMB). Conclusions: Simultaneous bilateral pulmonary surgery using VATS for the treatment of bilateral pulmonary lesions is safe and feasible and can therefore be considered after strict preoperative evaluation of the patient.

Natural killer cells associated with SARS-CoV-2 viral RNA shedding, antibody response and mortality in COVID-19 patients.

Coronavirus disease 2019 (COVID-19) is a novel infectious viral disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Two consecutively negative SARS-CoV-2 viral RNA test ( interval ≥ 24 hours), improved respiratory symptoms and obvious absorption of inflammation in pulmonary imaging are the discharge criteria for COVID-19 patients. The clearance profile of viral RNA in the upper respiratory tract specimens, including nasopharyngeal swab and/or oropharyngeal swabs, is related to innate immune cells such as Natural Killer cells. A total of 168 patients were included for the study. In this cohort, non-severe and severe groups showed significant differences in white blood cells, neutrophils, lymphocytes, basophils and platelets counts, as well as in infection related parameters such as CRP and serum cytokine IL-6. For lymphocyte subsets tests at admission, the severe group displayed significantly lower cell counts than the non-severe group. Higher counts of total T cells, CD4 + T cells, CD8 + T cells, and NK cells in peripheral blood showed a significant correlation with the shorter time taken to obtain the first negative viral RNA test and first positive IgM/ IgG antibody test. The number of B cells was only correlated with time to achieve the first positive IgM/IgG test. The count of NK cells was also correlated with a higher level of IgG antibody (p = 0.025). The lymphocytopenia group had a significantly worse survival rate (p = 0.022) and a longer duration (p = 0.023) of viral shedding than the normal lymphocyte count group. A lower NK cell count correlates the most with the worse survival rate (p<0.001) and a longer duration (p<0.001) of viral shedding. This study suggests the potential value of allo-Natural Killer cell therapy as an universal COVID-19 treatment strategy.

SARS-CoV-2 induced thrombocytopenia as an important biomarker significantly correlated with abnormal coagulation function, increased intravascular blood clot risk and mortality in COVID-19 patients.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a novel infectious viral disease, which lacks well-established diagnostic laboratory parameters that could be used to evaluate disease severity, thromboembolism or cardiovascular events and to predict clinical prognosis. Coagulation cascade and platelet functions have not been well studied in the COVID-19 patients. METHODS: A total of 178 patients enrolled in Wuhan Huoshenshan Hospital were included for the study. Blood platelets and coagulation functions were analyzed in COVID-19 patients with non-severe and severe subgroups. Other biochemical laboratory parameters were also analyzed. RESULTS: Forty-nine (27.5%) out of 178 patients were diagnosed with severe disease in this study, and 129 patients with non-severe disease. Severe disease group had significant lower platelet count 186.00 (103.50-249.00) ×109/L than 251.00 (202.00-317.00) ×109/L of non-severe group, p = 0.000. Severe group also had significantly abnormal coagulation parameters than non-severe group: prothrombin time (PT) 14.55 (13.40-16.53) s vs. 12.70 (12.15-13.59) s, p = 0.000; international normalized ratio (INR) 1.21 (1.13-1.36) vs. 1.06 (1.01-1.13), p = 0.000; thrombin time (TT) 16.35 (15.69-17.47) s vs. 15.68 (14.79-16.69) s, p = 0.011; D-Dimer 1.05 (0.68-5.90) mg/L vs. 0.42 (0.28-0.79) mg/L, p = 0.000; While the liver function parameter alanine aminotransferase (ALT) and aspartate aminotransferase (AST) didn't show significance between two groups, ALT 30.80 (19.00-58.30) IU/L vs. 28.80 (15.75-50.15) IU/L, p = 0.487; AST 27.80 (19.30-40.55) IU/L vs. 22.6 (16.7-32.03) IU/L, p = 0.102. Disseminated intravascular coagulation (DIC) rate was 6.1% in severe group while 0% in non-severe group. Survival rate of severe disease group was worse than non-severe group, 85.7% vs. 100%, p = 0.000. Thrombocytopenia correlated with coagulation function, DIC rate and survival. Six out of 7 death case had thrombocytopenia during hospitalization, and platelet count decreased subsequently until death. Thrombocytopenia occurred within 1 week after admission in 6 recovered patients. And increased platelet levels followed by positive SARS-CoV-2 IgM/IgG and negative coronavirus nucleic acid tested in 8 recovered patients. CONCLUSIONS: Low platelet count is associated with abnormal coagulation function and increased risk of DIC, severe disease manifestation and increased mortality in patients with COVID-19.

An original design of remote robot-assisted intubation system.

The success rate of pre-hospital endotracheal intubation (ETI) by paramedics is lower than physicians. We aimed to establish a remote robot-assisted intubation system (RRAIS) and expected it to improve success rate of pre-hospital ETI. To test the robot's feasibility, 20 pigs were intubated by direct laryngoscope or the robot system. Intubation time, success rate, airway complications were recorded during the experiment. The animal experiment showed that participants achieved a higher success rate in absolute numbers by the robot system. In summary, we have successfully developed a remote robot-assisted intubation system. It is promising for RRAIS to improve the success rate of pre-hospital ETI and change the current rescue model.

A novel optimal coordinated control strategy for the updated robot system for single port surgery.

BACKGROUND: Research into robotic systems for single port surgery (SPS) has become widespread around the world in recent years. A new robot arm system for SPS was developed, but its positioning platform and other hardware components were not efficient. Special features of the developed surgical robot system make good teleoperation with safety and efficiency difficult. METHODS: A robot arm is combined and used as new positioning platform, and the remote center motion is realized by a new method using active motion control. A new mapping strategy based on kinematics computation and a novel optimal coordinated control strategy based on real-time approaching to a defined anthropopathic criterion configuration that is referred to the customary ease state of human arms and especially the configuration of boxers' habitual preparation posture are developed. RESULTS: The hardware components, control architecture, control system, and mapping strategy of the robotic system has been updated. A novel optimal coordinated control strategy is proposed and tested. CONCLUSIONS: The new robot system can be more dexterous, intelligent, convenient and safer for preoperative positioning and intraoperative adjustment. The mapping strategy can achieve good following and representation for the slave manipulator arms. And the proposed novel control strategy can enable them to complete tasks with higher maneuverability, lower possibility of self-interference and singularity free while teleoperating.

The effects of cordycepin on the cell proliferation, migration and apoptosis in human lung cancer cell lines A549 and NCI-H460.

OBJECTIVES: Our study aimed to evaluate the effect of cordycepin on human lung cancer cell lines A549 and NCI-H460. METHODS: Human lung cancer A549 cells and NCI-H460 cells were treated with different concentrations of cordycepin for different times. Cells incubated without cordycepin were defined as a control. The cell proliferation, migration and apoptosis were, respectively, determined by MTT assay, transwell migration assay and flow cytometry. Additionally, the expression levels of related proteins associated with cell cycle, epithelial-mesenchymal transition (EMT) and apoptosis were examined. KEY FINDINGS: The survival rate of A549 cells and NCI-H460 cells treated with cordycepin significantly decreased compared with untreated cells in a concentration-dependent manner, while the apoptosis rate increased. The migration number of cells treated with cordycepin significantly decreased as the increase in concentration. qRT-PCR and Western blot analysis showed that the aberrant expression of related molecules associated with cell cycle, migration and apoptosis was observed in the lung cancer cells, such as cyclin B, cyclin E, MMP-9, caspase-3 and Bcl-2. CONCLUSIONS: Cordycepin may exert inhibitory effects on the development of human lung cancer via inhibiting cell proliferation, suppressing migration and inducing apoptosis, suggesting that cordycepin may have therapeutic potential for the treatment of this disease.

A portable thoracic closed drainage instrument for hemopneumothorax.

BACKGROUND: Hemopneumothorax is a common sequelae of traumatic thoracic injury. The most effective treatment of this condition is thoracic drainage. Despite the common occurrence of this condition, available instruments are difficult to use emergently, particularly when large amounts of patients need to be drained. In the present experiment, a newly designed chest tube and thoracic closed drainage package is described and preliminarily evaluated with the goal to improve the treatment of traumatic hemopneumothorax. METHOD: Twenty canines were divided into two groups. In one group, the newly designed thoracic closed drainage package was used, whereas in the other group a currently available chest tube and bottle were used. Drainage test, ultrasound examination, flushing test, and tension test were performed to evaluate the effectiveness of the drainage package. RESULTS: We found that the newly-designed drainage tube is as effective as the common tube when evaluated using all of the chosen methods. In addition, the package is very lightweight and portable. CONCLUSION: The newly-designed thoracic drainage package is very effective in the emergency treatment of thoracic trauma and may be more suitable for the emergency treatment of hemopneumothorax.

Video-assisted thoracic surgery versus thoracotomy for non-small-cell lung cancer.

Video-assisted thoracic surgery (VATS) has been recommended as more optimal surgical technique than traditional thoracotomy for lobectomy in lung cancer, but it is not well defined. Here, we compared VATS and traditional thoracotomy based on clinical data. From November 2008 to November 2010, 180 patients underwent lobectomy for non-small-cell lung cancer (NSCL) identified by computerized tomography. Of them, 83 cases were performed with VATS and 97 by thoracotomy. Clinical parameters, consisting of blood loss, operating time, number of lymph node dissection, days of pleural cavity drainage, and length of stay were recorded and evaluated with t test. No significant difference was observed between the VATS and thoracotomy groups in the average intraoperative blood loss, number of lymph node dissections, and days of pleural cavity drainage. While the average operating time in the VATS group was significantly longer than that in thoracotomy group, recurrence was only present in one case, as opposed to 7 cases in the thoracotomy group In conclusion, similar therapeutic effects were demonstrated in VATS and thoracotomy for NSCL. However, VATS lobectomy was associated with fewer complications, recurrence and shorter length of stay.

Effect of surgery on delayed inhaled foreign body: a case report.

The occurrence of foreign body is uncommon in youths and adults. We report here a case of 16-year-old boy who inhaled a foreign body which was overlooked for 6 months. The patient suffered productive cough and received antibiotic treatment for 10 days. But the symptoms did not improve. Chest radiography and CT scan revealed a 1-cm-long needle-like foreign object in the right inferior lobar bronchus. Wedge resection of lung was finally performed because of severe hemorrhage caused by prior bronchoscopy.

Multi-factor investigation of early postoperative cardiac arrhythmia for elderly patients with esophageal or cardiac carcinoma.

BACKGROUND: The purpose of the present study was to analyze the risk multi-factors of postoperative cardiac arrhythmia for elderly patients with esophageal or cardiac carcinoma. METHODS: A total of 756 operations for elderly patients (>65 years of age) with esophageal or cardiac carcinoma were performed in our department from January 1997 to December 2006. These included 197 cases (26.1%) of various types of cardiac arrhythmia after operation. Logistic regression was adopted to analyze the risk multi-factors of postoperative cardiac arrhythmia. RESULTS: It showed that complications of other diseases before operation, selection of operation method, duration of anesthesia and operation, postoperative pain, anoxia, hypovolemia, acid-alkali disequilibrium, and electrolyte imbalance might be the risk factors of postoperative cardiac arrhythmia in elderly patients with esophageal or cardiac carcinoma, whereas minimally invasive endoscopic operation might be a protective factor. CONCLUSIONS: In order to decrease the risk factors leading to postoperative cardiac arrhythmia for elderly patients with esophageal or cardiac carcinoma, it was necessary to completely evaluate the functions of heart and lung, improve the nutrition and metabolism of heart muscle, conduct effective breathing exercises, and correct the existing cardiac arrhythmia of such patients before operation, and perform the minimally invasive operation, shorten operation duration, relieve pain efficiently during the perioperative period, and correct hypovolemia and acid-alkali disequilibrium and electrolyte imbalance.

A modified CZ-1 preserving solution for organ transplantation: comparative study with UW preserving solution.

BACKGROUND: The University of Wisconsin colloid based preserving solution (UW solution) is the most efficient preserving solution for multiorgan transplantation. Unfortunately, unavailability of delayed organ preserving solutions hindered further progression of cardinal organ transplantation in China. In this study, we validated an organ preserving Changzheng Organ Preserving Solution (CZ-1 solution) and compared it with UW solution. METHODS: A series of studies were conducted on how and how long CZ-1 solution could preserve the kidneys, livers, hearts, lungs and pancreas of New Zealand rabbits and SD rats. Morphology of transplanted organs was studied by visible microscopy and electron microscopy; biochemical and physiological functions and the survival rate of the organs during prolonged cold storage were studied. RESULTS: There was no significant difference between CZ-1 and UW solutions in preserving the kidneys, livers, hearts or lungs of rabbits; kidneys, livers, intestinal mucosa or pancreases of SD rats or five deceased donors' testicles. In some aspects, such as preserving rabbits' hearts, rats' intestinal mucosa and pancreases, the effect of CZ-1 solution was superior to UW solution. CZ-1 could safely preserve kidneys for 72 hours, livers for 24 hours, hearts for 18 hours and lungs for 8 hours for SD rats. Twelve kidneys preserved in cold CZ-1 solution for 22 - 31 hours were transplanted successfully and the mean renal function recovery time was (3.83 +/- 1.68) days. CONCLUSIONS: CZ-1 solution is as effective as UW solution for organ preservation. The development of CZ-1 solution not only reduces costs and improves preservation of organs, but also promotes future development of organ transplantation in China.

[Clinical study on the metastatic patterns of lymph node in lung cancer].

BACKGROUND: To investigate the relationship between the size of primary tumor, pathologic classification, cell differentiation or location of tumor and lymph node metastasis in lung cancer. METHODS: Three hundred and thirty-two patients with lung cancer underwent pulmonectomy plus extensive dissection of hilar and mediastinal nodes. The law of lymph node metastasis was analyzed. RESULTS: A total of 3 280 lymph nodes were removed. Metastatic rates of N1 and N2 were 29.9% and 22.4% respectively. The total lymph node metastatic rates of T1, T2, and T3 diseases were 8.5%, 27.4% and 61.2% respectively ( P < 0.005). No lymphatic metastasis was observed in well-differentiated squamous cell carcinoma, however, the lymph node metastatic rates in moderate- and poor-differentiated squamous cell carcinoma were 16.8% and 19.6% respectively. The lymph node metastatic rates were 27.5% and 71.6% in moderate- and poor-differentiated adenocarcinoma respectively ( P < 0.005). The total lymph node metastatic rates in central and peripheral squamous cell carcinoma were 19.6% and 11.7% respectively ( P < 0.005), while in adenocarcinoma, the rates were 57.9% and 24.0% respectively ( P < 0.005). The N2 metastatic rates in central and peripheral squamous cell carcinoma were 10.9% and 2.9% respectively ( P < 0.005), while in adenocarcinoma, the rates were 47.5% and 17.8% respectively ( P < 0.005 ). Under the same T status, cell differentiation or location of tumor, the metastatic rate of adenocarcinoma was much higher than that of squamous cell carcinoma ( P < 0.005 ). CONCLUSIONS: The frequency of lymph node metastasis significantly correlate with size of primary tumor, pathological classification, cell differentiation and location of tumor.