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.

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.

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.

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.

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.

(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.

Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study.

OBJECTIVE: The purposes of this study were to evaluate the feasibility, safety, and advantages of nonintubated video-assisted thoracoscopic surgery (VATS) under epidural anesthesia, by comparing with the performance of conventional approaches. PATIENTS AND METHODS: A total of 354 patients (245 men and 109 women) were recruited in this study. The surgical procedures included bullae resection, pulmonary wedge resection, and lobectomy. The anesthetic technique (epidural vs general) was selected randomly. Patients who underwent nonintubated VATS under epidural anesthesia comprised the intervention group, and patients who received VATS under general anesthesia with double lumen tube comprised the control group. RESULTS: In total, 167 patients were included in the intervention group, and 180 patients were included in the control group. The 2 treatment groups of bullae resection showed significant differences in postoperative fasting time, duration of postoperative antibiotic use depending on the time when the white blood cells decreased to normal levels, and duration of postoperative hospital stay (P < .05). Nonintubated VATS is associated with a decreased level of inflammatory cytokines (P < .05). CONCLUSION: VATS under anesthesia with nontracheal intubation is safe and feasible, and has demonstrated advantages, including shorter postoperative fasting time, shorter duration of antibiotic use, and shorter hospital stay, compared with VATS under general anesthesia with double lumen tube.

Nonintubated uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax.

OBJECTIVE: The objective of the current study was to evaluate the feasibility and safety of nonintubated uniportal video-assisted thoracoscopic surgery (VATS) for the management of primary spontaneous pneumothorax (PSP). METHODS: From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidural anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6(th) intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months. RESULTS: The average time of surgery was 49.0 min (range, 33-65 min). No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients (93.75%) and moderate for two patients (6.25%). No recurrences of pneumothorax were observed at follow-up. CONCLUSIONS: The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.

Gene expression profile analysis for different idiopathic interstitial pneumonias subtypes.

OBJECTIVE: Idiopathic interstitial pneumonias (IIPs) are a group of diffuse parenchymal lung diseases of unknown etiology characterized by the presence of various degrees of inflammation and fibrosis. We aimed to screen the differences among IIPs subtypes in the gene level by using the microarray expression profiles of normal lung tissue and IIPs tissue for the key genes associated with early diagnosis and treatment of IIPs. METHODS: The gene expression profile of six kinds of IIPs (GSE 32537) subtypes tissue and normal lung tissues were downloaded. The differentially expressed genes (DEGs) in different IIPs subtypes were selected by using the expression profiling. In addition, the screened DEGs were further analyzed by function annotation, pathway analysis, and interaction network analysis to reveal the differences among these subtypes. RESULTS: The gene expression analysis showed that nine genes including SERPINA3, IL1R2, CBS, MGAM, SLCO4A1, S100A12, FPR1, SDR16C5, and MT1X in six subtypes of IIPs were significantly increased. There were significant differences in DEGs among six subtypes of IIPs, and the DEGs of some IIPs subtypes involved in immune, inflammatory response and cell adhesion processes. Moreover, the PPI network analysis indicated that SERPINA3 played an important role in the molecular mechanisms of IIPs. CONCLUSION: This comprehensive description of altered gene expression in different subtypes of IIPs underscores the complex biological processes characteristic of different subtypes of IIPs and may provide a foundation for future research into this devastating disease.

Thoracoscopic half carina resection and bronchial sleeve resection for central lung cancer.

BACKGROUND: The objectives of this study were to report the surgical techniques and clinical outcome of thoracoscopic half carina resection and thoracoscopic bronchial sleeve resection for central lung cancer. METHODS: Between January 2011 and November 2012, 675 patients with lung cancer underwent radical surgery by thoracoscopy, and 49 (7.3%) underwent bronchial sleeve resection. Among 49 patients, 20 (41%) received thoracoscopic bronchial sleeve lobectomy. Perioperative variables and postoperative outcomes of these cases were analyzed to evaluate the technical feasibility and safety of this operation. RESULTS: In one patient, right upper lung sleeve resection was combined with half-carinal resection and reconstruction. In another, right medial lung sleeve resection was combined with lower right dorsal segment resection. The average time of surgery was 239 ± 51 minutes (range = 142-330 minutes), and the average time of airway reconstruction was 44 ± 17 minutes (range = 22-75 minutes). The intraoperative blood loss averaged 207 ± 96 mL (range = 80-550 mL). The median postoperative hospital stay was 10 days (interquartile range = 8-12 days). Postoperatively, extubation was achieved in the recovery room without further need for mechanical ventilation. None of the patients developed anastomotic leak. Perioperative mortality was not observed. CONCLUSION: Thoracoscopic bronchial sleeve resection can be considered a feasible and safe operation for selected patients with central lung cancer. The complicated anastomosis technique of half carina resection was feasible.

[Electromagnetic navigation bronchoscopy real-time guidance lung biopsy for the diagnosis of small peripheral pulmonary lesions].

OBJECTIVE: To evaluate the diagnostic value and safety of electromagnetic navigation bronchoscopy real-time guidance lung biopsy (ENB-guided TBLB) of small peripheral lung lesions (diameter < 3 cm). METHODS: Patients were selected by small peripheral pulmonary lesions (diameter < 3 cm) on thoracic CT in our hospital between September 1, 2011 and May 30, 2012. ENB-guided TBLB was performed by flexible bronchoscope, while fluoroscopy-guided lung biopsy was performed as a control. Then the diagnostic yield of ENB-guided and fluoroscopy-guided lung biopsy was compared. The final diagnosis was confirmed by pathologic examination of surgically removed lesions or by 12 month follow-up until clinical cure being confirmed. The intraoperative and postoperative complications were recorded. RESULTS: Seventeen patients (11 males, 6 females) with 20 small peripheral pulmonary lesions all underwent ENB- guided TBLB. The patients' average age was (53 ± 14) yrs , and the lesions' average diameter was (1.8 ± 0.7) cm. Eleven patients finally received surgical resection, while other 6 patients received medical treatment and follow-up for more than 12 months to achieve clinical cure. Pathologic results showed that the diagnostic yield of ENB group was 80.0% (16/20) and that of the fluoroscopy group was 45.0% (9/20), the difference between the 2 groups being statistically significant (χ² = 5.227, P = 0.048). Subgroup analysis showed that, if the lesion diameter was 2-3 cm, the diagnostic yield between the 2 groups had no statistical difference (χ² = 0.000, P = 1.000), but if the lesion diameter was < 2 cm, the diagnostic yield of the 2 groups was statistically different (χ(2) = 8.224, P = 0.012). In the ENB method, the diagnostic yield between the diameter of 2-3 cm group and the < 2 cm group had no statistical difference (χ² = 0.208, P = 1.000). Analysis of the diagnostic yield of different navigation plan CT graph layer thickness showed that, the 1 cm group was higher than the 2 cm group (χ² = 6.111, P = 0.026). The diagnostic yield of lesions with "air bronchogram" was higher than that of lesions without "air bronchogram" (χ² = 6.111, P = 0.026). CONCLUSION: Electromagnetic navigation bronchoscopy real-time guidance lung biopsy for small peripheral pulmonary lesions is safe, and has higher diagnostic rate.

Safety and feasibility of video-assisted thoracoscopic surgery for stage IIIA lung cancer.

OBJECTIVE: The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery (VATS) radical treatment for patients with stage IIIA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery. METHODS: A total of 51 patients with radiologically or mediastinoscopically confirmed stage IIIA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher. RESULTS: A total of 51 patients with non-small cell lung cancer (NSCLC) were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41 (80.4%) had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50 (98%) received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage (>1,000 mL), and the postoperative recovery was satisfactory. Up to 45 patients (88.2%) did not suffer from any perioperative complication, and 6 (11.8%) experienced one or more complications. CONCLUSIONS: VATS radical treatment is a safe and feasible treatment for stage IIIA lung cancer.

Long-term survival outcomes of video-assisted thoracic surgery for patients with non-small cell lung cancer.

BACKGROUND: Video-assisted thoracic surgery (VATS) has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer (NSCLC). However, popularization of this relatively novel technique has been slow, partly due to concerns about its long-term outcomes. The present study aimed to evaluate the long-term survival outcomes of patients with NSCLC after VATS, and to determine the significant prognostic factors on overall survival. METHODS: Consecutive patients diagnosed with NSCLC referred to one institution for VATS were identified from a central database. Patients were treated by either complete-VATS or assisted-VATS, as described in previous studies. A number of baseline patient characteristics, clinicopathologic data and treatment-related factors were analyzed as potential prognostic factors on overall survival. RESULTS: Between January 2000 and December 2007, 1,139 patients with NSCLC who underwent VATS and fulfilled a set of predetermined inclusion criteria were included for analysis. The median age of the entire group was 60 years, with 791 male patients (69%). The median 5-year overall survival for Stage I, II, III and IV disease according to the recently updated TNM classification system were 72.2%, 47.5%, 29.8% and 28.6%, respectively. Female gender, TNM stage, pT status, and type of resection were found to be significant prognostic factors on multivariate analysis. CONCLUSIONS: VATS offers a viable alternative to conventional open thoracotomy for selected patients with clinically resectable NSCLC.

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.

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.

Video-assisted thoracoscopic surgery for stage I non-small cell lung cancer: long-term survival and prognostic factors.

The purpose of this study was to evaluate the long-term outcomes of video-assisted thoracoscopic surgery (VATS) major pulmonary resection in patients with stage I non-small cell lung cancer (NSCLC). Of the 411 stage I patients, 318 (77.4 %) underwent complete VATS (c-VATS), while 89 (21.7 %) underwent assisted VATS (a-VATS). There were no intraoperative deaths. There were three deaths (0.7 %) within 30 postoperative days. The 1-, 3-, and 5-year survival rates were 95.1 % (95 % CI, 92.9­97.3 %), 83.1 % (95 % CI, 79.2­87.0 %), and 73.4 % (95 % CI, 68.1­78.7 %), respectively. Univariate analysis by log-rank test revealed that tumor-node-metastasis (TNM) stage, primary tumor (pT) status, and type of resection were statistically significant factors affecting overall survival (OS; P = 0.029, P = 0.025, and P = 0.005, respectively). Less acute TNM stage and less extensive resection were significantly predictive for longer OS by multivariate analysis as well (P = 0.024 and P = 0.006, respectively). In experienced hands, c-VATS or a-VATS can be considered as an alternative to traditional incision in patients with stage I NSCLC. Lower TNM stage and less extensive resection were significantly predictive for better OS. A prospective randomized controlled study on a larger scale is required to reach definitive conclusions regarding the efficacy of VATS relative to other techniques.

[Value of endobronchial ultrasound-transbronchial needle aspiration biopsy for diagnosis of PET-CT positive mediastinal lymph nodes].

OBJECTIVE: To evaluate the clinical value of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) biopsy for diagnosis of PET-CT positive mediastinal lymph nodes. METHODS: One hundred and twenty-six patients with lung cancer undergoing both PET-CT scanning and EBUS-TBNA biopsy in the First Affiliated Hospital of Guanzhou Medical College from July 2008 to August 2010 were included in this study. There were 89 male and 37 female patients with a mean age of 56.3 years (range 34 to 81 years). (18)FDG-PET was considered positive in mediastinal nodes if the PET-CT reported hypermetabolic activity consistent with malignant disease (standardized uptake value > 2.5). All of the patients were clinically followed up. RESULTS: Among the 126 patients, 185 stations of lymph nodes were punctured. The mean diameter of the nodes was 13.6 mm and the range was 6 - 23 mm. There were no procedural complications. The diagnostic accuracy, sensitivity, and specificity of EBUS-TBNA were 95.7%, 95.7%, and 100%, respectively. CONCLUSIONS: EBUS-TBNA is a minimally invasive, highly effective and accurate, practical and safe procedure for diagnosis of PET-CT positive mediastinal lymph nodes.

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.

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.