Objective: To investigate the risk factors, intraoperative recognition, management strategies, and preventive measures for iatrogenic tracheobronchial injuries associated with double-lumen tube (DLT) intubation during thoracic surgery, we retrospectively reviewed seven cases treated at our multicenter institution (comprising four hospitals) between 2011 and 2021, in conjunction with a comprehensive review of the relevant literature. Our aim was to optimize anesthetic airway management, standardize preoperative airway assessment, facilitate early injury detection, and refine postoperative management to improve patient outcomes. Methods: Clinical data from 7 patients (5 males and 2 females) who sustained tracheobronchial injuries related to left-sided DLTs were analyzed. DLTs from two manufacturers (Covidien and Yichang Humanwell) were used. One patient underwent radical esophagectomy, and the remaining six underwent right-sided pulmonary lobectomy. All procedures were performed under general anesthesia by experienced thoracic anesthesiologists. All tracheobronchial injuries were identified either intraoperatively or in the immediate postoperative period and were managed with prompt emergency airway repair. No perioperative mortality or major postoperative complications occurred. All patients recovered uneventfully and were discharged after a mean postoperative stay of 7 days. Conclusion: Iatrogenic tracheobronchial injury associated with left-sided DLTs remains a clinically significant complication. Predisposing factors include small body size, abnormal airway anatomy, excessive bronchial cuff pressure, and surgical manipulation near the carina. Preventive strategies include meticulous preoperative CT-based airway assessment, continuous bronchial cuff pressure monitoring, cuff deflation during tube repositioning or patient repositioning, routine fiberoptic bronchoscopy guidance, and close interdisciplinary collaboration during high-risk surgical steps.

The role of primary tumor resection (PTR) in patients with de novo stage IV breast cancer remains controversial, and evidence from randomized trials is inconsistent. Whether PTR is associated with improved survival in clinically defined subgroups such as lung-only metastatic disease warrants further investigation. Using the SEER database, we identified patients diagnosed with stage IV breast cancer between 2010 and 2020 with metastases confined to the lungs at diagnosis. Patients with bone, liver, brain, or other distant metastases were excluded. Overall survival (OS) and breast cancer–specific survival (CSS) were estimated using Kaplan–Meier methods and compared by log-rank tests. Cox proportional hazards models were used to evaluate factors associated with OS. Temporal trends in PTR utilization and year-specific survival were examined. Predictors of receiving PTR were assessed using multivariable logistic regression. A total of 1,479 eligible patients were included; 588 (39.8

Non-small cell lung cancer (NSCLC), a leading cause of cancer-related mortality, requires the identification of novel biomarkers for early detection and therapeutic intervention. In this study, we explored the regulatory interactions between miR-1260 and zinc finger (ZNF) family genes within the NSCLC microenvironment to determine their roles as diagnostic and prognostic indicators. Through bioinformatics analysis of public datasets from the GEO database, the expression patterns and prognostic significance of miR-1260 and ZNF genes were systematically evaluated. Tools, such as GEO 2R and the Weishengxin platform, were used for data processing and visualization to construct a comprehensive miRNA-mRNA regulatory network. The results revealed distinct expression profiles of miR-1260 and ZNF genes in NSCLC tissues compared to their normal counterparts, with significant correlations with patient survival outcomes. These findings not only highlight the potential of miR-1260 and ZNF genes as diagnostic biomarkers but also suggest that their therapeutic targeting could offer new strategies for NSCLC management. This study emphasized the importance of the miR-1260-ZNF regulatory axis in NSCLC pathogenesis, positioning these molecules as promising candidates for diagnosis, prognosis, and further clinical validation. Future research should focus on mechanistic exploration and large-scale clinical trials to translate these insights into improved oncological treatment protocols.

The aim of this study was to evaluate the safety and clinical benefits of adding concurrent radiotherapy to neoadjuvant chemoimmunotherapy in patients with resectable locally advanced esophageal squamous cell carcinoma (ESCC). This multicenter retrospective study enrolled eligible ESCC patients treated between November 2019 and July 2020 from four hospitals. Baseline characteristics were collected, and patients were categorized into two groups based on neoadjuvant regimens: the chemoimmunotherapy group (CI group) and the chemoimmunotherapy with concurrent radiotherapy group (CIR group). Treatment-related complications, surgical outcomes, pathological response, tumor recurrence, and survival were analyzed. A total of 78 eligible patients were included: 49 in the CI group and 29 in the CIR group. Baseline characteristics (age, sex, clinical stage, cardiopulmonary function) were balanced between groups. During neoadjuvant therapy, the CI group had significantly lower incidences of grade 3 and grade 4 leukopenia/neutropenia (15/49 vs. 15/29, P = 0.025), and lower incidences of grade 3 and grade 4 checkpoint inhibitor pneumonitis (CIP) (1/49 vs. 8/29, P = 0.002). All CI group patients achieved R0 resection after 1-3 neoadjuvant cycles versus 24/29 in the CIR group (P > 0.05). The CIR group showed higher major pathological response (including pathological complete response) rates (16/24 vs. 10/49), though statistically non-significant (P = 0.121). No significant differences were observed in 5-year progression-free survival or overall survival. Adding concurrent radiotherapy to neoadjuvant chemoimmunotherapy increased hematologic toxicity and CIP in resectable locally advanced ESCC patients, without conferring survival benefits.

Postoperative complications following complex brain tumor surgery remain a significant cause of morbidity. This study aimed to develop and independently validate a multi-modal artificial intelligence model integrating preoperative imaging, intraoperative physiological time-series, and biochemical data for complication prediction following glioma and skull base tumor surgery. This retrospective multi-center study included 15,000 patients from 7 centers across 5 countries. A Transformer-based architecture with cross-modal fusion was developed. Missing data were handled using multiple imputation. Model performance was evaluated using AUC, calibration metrics, decision curve analysis, SHAP interpretability, SHAP interaction analysis, and temporal attention visualization. The model achieved AUC 0.91 (95% CI: 0.89–0.93) in derivation (n = 8,300) and 0.87 (95% CI: 0.85–0.89) in independent multi-center validation (n = 6,700). Calibration was moderate (Brier score 0.112, 41.7% improvement over null; ECE = 0.048; H-L p = 0.017). Tumor midline invasion (OR = 3.2, 95% CI: 2.1–4.9, p = 0.001) and postoperative hemoglobin nadir < 100 g/L (OR = 2.8, 95% CI: 1.8–4.2, p = 0.003) were the strongest predictors. SHAP interaction analysis revealed a synergistic effect between midline invasion and hypotension duration (interaction SHAP = 0.062). Temporal attention visualization showed highest attention to MAP during induction/emergence and to BIS during tumor resection. Decision curve analysis demonstrated positive net benefit at clinically relevant thresholds (15%-35%). This multi-modal Transformer model showed good discrimination and moderate calibration across multi-ethnic populations, with imperfect calibration at high predicted probabilities. Key risk factors and their interactions were identified through SHAP analysis. Prospective validation against expert clinical judgment is needed before clinical deployment.

2638 Background: The optimal integration of immunotherapy with chemoradiotherapy (CRT) in the neoadjuvant treatment of esophageal squamous cell carcinoma (ESCC) remains unclear, largely due to limited mechanistic insight into immune determinants of response. Methods: we performed paired single-cell RNA and TCR sequencing of ESCC tumor samples collected before and after treatment across three neoadjuvant modalities—immunochemotherapy (NICT), chemoradiotherapy (NCRT), and immuno-chemoradiotherapy (NICRT)—to dissect intratumoral CD8 + T cell dynamics. Results: We identified two distinct immune response programs. In NICT responders, pre-existing immunoresponsive CXCL13 + PD-1 + CD8 + T cells underwent clonal expansion and transcriptional reprogramming into a less exhausted yet CXCL13+ progenitor-like state (CD8Tex_CXCR4), accompanied by the formation of tertiary lymphoid structures. Conversely, CRT responders exhibited depletion of the subset of CXCL13 + CD8 + T cells and enrichment of PD-1 - cytotoxic CD8Teff_NIBAN1 cells, which originated from the peripheral blood and were characterized by robust clonal expansion, high effector gene expression, and association with tumor regression. We validated the association of these two T cell subsets with distinct neoadjuvant modalities and treatment responses using public datasets and independent prospective cohorts encompassing NICT, NICRT, and NCRT. Mechanistically, conventional radiotherapy suppressed PD-1 + T cell expansion—even in the presence of ICB—while a sequential strategy of induction ICB followed by delayed radiotherapy preserved the process of clonal expansion in exhausted T cell populations and achieved superior tumor control in vivo. Conclusions: These findings reveal divergent CD8 + T cell–mediated immune programs driving response to neoadjuvant therapies in ESCC and identify CD8Teff_NIBAN1 as a key effector population following CRT. Our study provides mechanistic insight into ICB–radiotherapy interactions and supports the rational design of temporally optimized combination strategies in solid tumors.

BACKGROUND:Invasive pulmonary aspergillosis (IPA) and pulmonary mucormycosis (PM) stand as the most prevalent invasive mold pulmonary infections. The incidence of IPA and PM has progressively increased. Untimely or inappropriate intervention amplifies mortality rates in patients affected by IPA and PM. There exist numerous commonalities between the two with regard to the population susceptible to the disease and imaging characteristics. This renders it challenging to differentiate them in certain clinical practices, resulting in issues such as the inappropriate selection of treatment plans. Early and expeditious differential diagnosis of invasive pulmonary mold infections and prompt identification of severe cases are critical challenges in clinical practice. METHODS:A retrospective cohort study encompassed IPA and PM patients admitted to Beijing Chao-Yang Hospital from 2017 to 2022. Patients in the cohort were categorized into PM and IPA groups. A comprehensive analysis of clinical characteristics, laboratory parameters, and chest radiology findings was conducted. Subsequently, a comparative assessment of the prognosis between the two patient groups was carried out. All patients with invasive pulmonary mold infection were classified based on prognosis, and independent risk factors for poor prognosis were identified. Subsequent to these findings, exploration of novel disease assessment tools was undertaken, and their diagnostic efficacy was evaluated. RESULTS:In comparison to IPA, PM patients exhibited a younger age profile, with a higher incidence of diabetes and solid organ transplantation. PM occurrences postinfluenza infection were less frequent than IPA. Radiologically, consolidation and bronchial lumen stenosis were more prevalent in PM patients. Additionally, the diagnosis of PM patients relied more on pathological confirmation. No significant disparities were noted regarding ICU stays, mechanical ventilation ratios, and 90-day mortality between PM and IPA. Postinfluenza infection and the neutrophil-to-lymphocyte ratio (NLR) were identified as independent risk factors for ICU stays in PM/IPA patients. Postinfluenza infection and elevated hemoglobin A1c (HbA1c) levels were independent risk factors for mechanical ventilation. NLR, HbA1c levels, and postinfluenza infection collectively enhanced the predictive capacity of existing assessment tools for adverse outcomes in PM/IPA patients. CONCLUSIONS:PM patients exhibit distinctions from IPA in certain clinical characteristics, laboratory parameters, and chest radiology findings. Nevertheless, both PM and IPA patients experienced higher 90-day mortality and ICU utilization. The combination of NLR and HbA1c with existing disease assessment tools proves effective in prognosticating the disease, particularly during influenza epidemic seasons.

Lung cancer in young patients shows a rising incidence and distinct disease biology but remains understudied. We obtained clinical information and somatic mutation data for two large non-small-cell lung cancer (NSCLC) patient cohorts from the cBioPortal database-the China cohort (N = 1948) and the MSK cohort (N = 6220). Additionally, we extracted clinical data from an internal, real-world NSCLC patients (GZSY cohort, N = 3914) spanning the past decade. By comparing clinicopathological and genomic features across age and ethnicities, we systematically characterized the molecular and clinical phenotype of early-onset NSCLC. Young patients were more likely to be female and never smokers, and carried a higher frequency of actionable driver gene mutations, particularly involving EGFR, ALK, ROS1, and ERBB2 genes. In the China cohort, young patients exhibited significantly higher frequencies of EGFR and ERBB2 mutations and a higher rate of concurrent EGFR-TP53 co-mutations. Advanced stage at diagnosis and TP53 mutation status emerged as independent adverse prognostic factors in young patients. Integration of multi-ethnic genomic and clinical data in this study delineates the distinct clinical and molecular landscape of early-onset NSCLC and supports development of age-targeted, precision therapeutic strategies.

BACKGROUND Transcatheter arterial chemoembolization (TACE) failure or refractoriness in hepatocellular carcinoma (HCC) refers to patients who continue to experience tumor progression or recurrence after TACE. Drug-eluting bead (DEB) TACE guided by digital subtraction angiography (DSA) is a novel interventional technique. However, the efficacy of DEB-TACE varies among patients, making the analysis of the factors influencing treatment outcomes clinically important for optimizing therapeutic strategies and improving prognosis. AIM To explore the factors influencing the clinical efficacy of DSA-guided DEB-TACE in the treatment of TACE failure/refractoriness in patients with HCC. METHODS A retrospective analysis was conducted in 96 patients with HCC who were admitted to our hospital between January 2021 and December 2023, met the criteria for TACE failure or refractoriness, and underwent real-time DSA-guided DEB-TACE. Based on the modified response evaluation criteria in solid tumors criteria assessed at the 1-year follow-up, patients were classified into a favorable-outcome group (complete or partial response) and a poor-outcome group (stable or progressive disease). The clinical data of the two groups were compared, and multivariate logistic regression analysis was conducted to identify independent factors affecting treatment outcomes. RESULTS Among 96 patients with HCC and TACE failure/refractoriness, 64 had favorable outcomes, whereas 32 had poor outcomes. Univariate analysis revealed that the two groups exhibited statistically significant differences (P < 0.05) in lesion diameter >= 5 cm, multiple lesions, Child-Pugh class B, and preoperative alpha-fetoprotein (AFP) level >= 400 ng/mL. Multivariate logistic regression analysis identified lesion diameter, multiple lesions, Child-Pugh classification, and preoperative AFP levels as independent risk factors for poor outcomes in patients with HCC and TACE failure or refractoriness (P < 0.05). CONCLUSION The efficacy of DSA-guided DEB-TACE in patients with TACE-refractory HCC is closely linked to lesion diameter, multiplicity, Child-Pugh class, and preoperative AFP levels.

Background: Following the 2021 first International Consensus on Severe Lung Cancer, global attention to patients with PS 2-4 has grown significantly. Recent advances in novel therapies, interventional techniques, and supportive care, along with emerging real world data, have expanded treatment opportunities for this population. To incorporate these advances, we have updated the consensus. Methods: A multidisciplinary panel comprising experts from oncology, radiation oncology, thoracic surgery, radiology, interventional medicine, respiratory medicine, critical care medicine, and nursing. After being presented with a comprehensive review of the current evidence pertaining to severe lung cancer and thorough discussions, the panel reached a consensus on 11 recommendations, each with over 70% expert agreement. Results: The 11 consensus points focused on definition and causes (n=2), assessment and general strategies (n=4), and specific treatment modalities (n=5) were updated or newly developed. This updated consensus emphasizes dynamic and precise detection, robust life support, flexible application of novel therapies, and MDT guided treatment adjustment based on PS dynamics. Early rehabilitation and comprehensive supportive care are integral to disease management. Conclusions: This consensus updates the definition, diagnostic evaluation, and treatment strategies, providing a practical framework for clinicians based on current evidence and multidisciplinary expert consensus. Prospective trials focusing specifically on patients with severe lung cancer are urgently needed.

N-acetyltransferase 10 (NAT10)-catalyzed N4-acetylcytidine (ac4C) modification has been reported to drive tumor metastasis. Lysosomal dysregulation plays an important role in human diseases, but its function in esophageal cancer metastasis is unclear. It remains unknown whether NAT10 regulates lysosomal function, and the underlying mechanism and treatment strategy warrants investigation. Here, a novel role of NAT10 in inducing lysosomal acidification is revealed, and the clinical and biological significance of ATP6V0E1 in tumor metastasis is uncovered. Mechanistically, NAT10 promotes the translation efficiency of ATPase H+ transporting V0 subunit e1 (ATP6V0E1) mRNA in an ac4C-dependent manner to facilitate ATP6V0E1 expression and vacuolar H+-ATPase (v-ATPase) activity, enhancing the lysosomal degradation of E-cadherin, ultimately accelerating tumor metastasis. Furthermore, G-749 is screened and identified as a novel NAT10 inhibitor capable of effectively impeding lysosomal acidification and tumor metastasis by disrupting the NAT10-Ubiquitin-specific Peptidase 39 (USP39) interaction. Overall, the results unveil a novel role of ac4C modifications in regulating lysosomal acidification and propose a potential strategy by targeting NAT10 to inhibit esophageal cancer metastasis.

The diagnostic accuracy of circulating tumor DNA (ctDNA) for detecting molecular residual disease (MRD) after multimodal treatment remains unclear. In a prospective cohort of 132 patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant chemoradiotherapy (nCRT) followed by clinical response evaluation and surgery, tumor-informed personalized-panel and fixed-panel ctDNA assays are applied to serial blood samples. Personalized ctDNA assay demonstrates a superior baseline detection rate (99.2%) and outperforms fixed panels in diagnosing post-nCRT residual disease. Integrating personalized ctDNA with conventional clinical diagnostic methods increases sensitivity for predicting non-pathological complete response (non-pCR) from 78.4%-80.7% to 92.0%-93.2%. Patients with detectable MRD post-nCRT and/or post-surgery exhibit worse survival outcomes. In non-pCR patients, adjuvant immunotherapy improves disease-free survival in post-surgery MRD-positive cases, whereas MRD-negative patients derive no benefit. These findings support incorporating ctDNA into response assessment to guide organ-sparing strategies and adjuvant therapy decisions in ESCC. This study is registered at ClinicalTrials.gov (NCT03937362).

Background: Ultrasound is rarely used for lung biopsy because the ultrasound window is too narrow to capture puncture points and perform whole imaging of lesions. The present study examined the usefulness of computed tomography (CT) combined with real-time ultrasound-guided percutaneous needle biopsy for peripleural lesions in clinical practice. Methods: In total, 59 patients with peripleural lesions who had undergone CT combined with ultrasound-guided percutaneous biopsy and 70 patients who had undergone conventional CT-guided biopsy at the Radiology Department of Wuxi NO.2 People's Hospital between January 2017 and June 2023 were enrolled. The operation duration, machine room occupation duration, number of CT-guided scans, radiation dose absorbed from the CT scans, and puncture-related complications were compared between the 2 groups of patients. Results: The operation duration (CT: 31.21 ± 7.99 min vs. CT + ultrasound: 22.20 ± 5.14 min, P < 0.001) and room occupation duration (43.17 ± 7.94 vs. 32.78 ± 5.15 min, P < 0.001) were significantly shorter and the number of CT-guided scans (3.31 ± 0.84 vs. 2.22 ± 0.42 times, P < 0.01) and the radiation dose absorbed from the CT scans were significantly lower (3.89 ± 1.07 vs. 2.56 ± 0.64 mSv, P < 0.001) in the CT combined with ultrasound group than in the conventional CT-guided puncture group. The results were significant after adjusting for age, sex, lesion thickness, and puncture depth. Conclusions: CT combined with real-time ultrasound-guided biopsy may be a useful biopsy technique for peripleural lesions in general hospitals.

Background:McKeown minimally invasive esophagectomy (MIE-McKeown) is a safe and feasible surgical method. However, the conventional anesthetic management with endotracheal intubation for MIE-McKeown is associated with high respiratory morbidity. The discontinuous spontaneous ventilating anesthesia by laryngeal mask may have advantages over conventional intubated anesthesia in MIE-McKeown. This study was designed to describe the techniques and evaluate the feasibility of discontinuous spontaneous ventilating anesthesia by laryngeal mask for MIE-McKeown. Methods:Between October 2022 and September 2024, 33 patients underwent MIE-McKeown at First Affiliated Hospital of Guangzhou Medical University. The study cohort was divided into a discontinuous spontaneous ventilating anesthesia group (Group A) and an intubated anesthesia group (Group B). We retrospectively compared the characteristics and perioperative outcomes of patients who underwent MIE-McKeown. Results:The clinical characteristics of Group A were not different from Group B except for gender. Non-inferiority analysis demonstrated that in Group A, both the lowest pulse oxygen saturation (SpO2) and peak end-tidal carbon dioxide (EtCO2) during cervical and abdominal procedures were non-inferior to those in Group B. Although the peak EtCO2 during thoracic procedure was significantly higher in Group A than in Group B (57.05±9.12 vs. 45.38±3.97 mmHg, P<0.001), no severe hemodynamic changes, progressive decrease of SpO2 or requirement conversion to intubated anesthesia were observed. In Group A, pleural effusion occurred in one patient, respiratory failure occurred in one patient. In Group B, and respiratory failure occurred in two patients and paralysis of recurrent laryngeal nerve (RLN) occurred in one patient. There were no cases of perioperative mortality. Conclusions:The technique of discontinuous spontaneous ventilating anesthesia by laryngeal mask for MIE-McKeown is considered feasible. Careful evaluation of the patients, preoperative assessment and skillful surgical technique are the key factors of successful discontinuous spontaneous ventilating anesthesia by laryngeal mask for MIE-McKeown. The discontinuous spontaneous ventilating anesthesia by laryngeal mask can be a valid alternative to the conventional intubated anesthesia for MIE-McKeown.

Affordance detection aims to jointly address the fundamental "what-where-how" challenge in embodied AI by understanding "what" an object is, "where" the object is located, and "how" it can be used. However, most affordance learning methods focus solely on "how" objects can be used while neglecting the "what" and "where" aspects. Other affordance detection methods treat object detection and affordance learning as two independent tasks, lacking effective interaction and real-time capability. To overcome these limitations, we introduce YOLO Affordance (YOLOA), a real-time affordance detection model that jointly handles these two tasks via a large language model (LLM) adapter. Specifically, YOLOA employs a lightweight detector consisting of object detection and affordance learning branches refined through the LLM Adapter. During training, the LLM Adapter interacts with object and affordance preliminary predictions to refine both branches by generating more accurate class priors, box offsets, and affordance gates. Experiments on our relabeled ADG-Det and IIT-Heat benchmarks demonstrate that YOLOA achieves state-of-the-art accuracy (52.8 / 73.1 mAP on ADG-Det / IIT-Heat) while maintaining real-time performance (up to 89.77 FPS, and up to 846.24 FPS for the lightweight variant). This indicates that YOLOA achieves an excellent trade-off between accuracy and efficiency.

Despite substantial progress in the diagnosis and treatment of breast cancer, current therapeutic regimens exhibit limitations, necessitating the identification of more robust biomarkers to optimize personalized strategies. Circulating tumor DNA (ctDNA), as a non-invasive liquid biopsy modality, overcomes the inherent constraints of biopsies in capturing tumor heterogeneity. Accumulating evidence from prospective cohort studies demonstrates the clinical utility of ctDNA in risk stratification, guidance of therapeutic decision-making, recurrence surveillance and other clinical applications. Furthermore, ctDNA profiling enhances real-time pharmacodynamic monitoring and accelerates drug development by identifying molecular responders. The methodical requirements and challenges inherent in implementing liquid biopsy assessments in the clinic are examined. These encompass critical pre-analytical variables, the need for highly sensitive and specific analytical techniques, standardization of assays and bioinformatics pipelines across laboratories and the complexities of interpreting results. This review synthesizes current evidence supporting ctDNA integration into breast cancer management frameworks and systematically addresses its methodological challenges and clinical limitations.

With the widespread adoption of low-dose computed tomography (LDCT) screening, the detection rate of small pulmonary nodules has surged, necessitating precise localization for minimally invasive resection. Video-assisted thoracoscopic surgery (VATS), being the gold standard for diagnosis and treatment, faces significant challenges in localizing nodules <1 or >1.5 cm from the pleural surface, particularly ground-glass nodules, due to limited tactile feedback. This review systematically evaluates advancements in preoperative and intraoperative localization techniques, focusing on four domains: computed tomography (CT)-guided methods (e.g., liquid agents like indocyanine green, metallic markers, and robotic-assisted puncture), bronchoscopy-guided approaches [electromagnetic navigation, radial endobronchial ultrasound (EBUS), and robotic bronchoscopy], three-dimensional (3D) printing navigation, and emerging technologies (augmented reality and real-time noninvasive systems). Despite progress, limitations persist: CT-guided methods face complications like pneumothorax (20%) and operator dependency, while bronchoscopic techniques exhibit lower diagnostic yields (18-60% vs. 70-90% for percutaneous biopsy). Innovations such as four-hook anchor devices and hybrid robotic systems demonstrated promise in improving localization accuracy and patient outcomes in reducing learning curves and improving precision. Future directions emphasize integrating artificial intelligence with multi-modal platforms to optimize accuracy and accessibility. This synthesis underscores the imperative for tailored strategies in nodule management, balancing efficacy, safety, and technological feasibility.

Though prescribed as first-line drugs for esophageal squamous cell cancer (ESCC) therapy, the antitumor efficacy of Nab-Paclitaxel (Nab-PTX) is still unsatisfactory owing to the limitation on the dosage and therapy duration of Nab-PTX caused by adverse effects. Inspired by the very essential role of Selenoprotein N (SelN) in mediating the calcium homeostasis and the associated redox homeostasis in cells, herein, in this essay, we screened the inhibition effect of selenium-containing drugs in different forms on ESCC cell line. Investigation on KYSE-150 cells demonstrated that Nab-PTX in combination with low dosage of LNT-SeNPs may synergistically improve its antitumor efficacy on ESCC cells through promoting the cellular apoptosis. Proteomics analysis uncovered the core synergistic mechanism of LNT-SeNPs on Nab-PTX was significantly dependent on the endoplasmic reticulum (ER) stress induced by SelN-mediated Ca2+-IRE1α, IRE1α(S724)-CHOP-BCL2 axis. SelN knockdown KYSE-150 cell model further confirmed the very indispensable role of SelN in mediating the synergistic effect on Nab-PTX. Moreover, in vivo evaluation on KYSE-150 tumor-bearing mice models also demonstrated the supplementation of LNT-SeNPs with low dosage during the Nab-PTX treatment may synergize the antitumor efficacy and significantly mitigate the adverse reactions or toxicity resulting from a substantial dose of Nab-PTX. Overall, along with the facile accessibility of raw materials, this study reports LNT-SeNPs as a synergistic agent to promote the antitumor efficacy of Nab-PTX, which may be translated as a wide-applicable, efficient and highly safe strategy for clinical treatment of ESCC.

Background: Video-assisted thoracoscopic surgery (VATS) is the preferred treatment for pulmonary nodules, making preoperative localization crucial. Aim: This study compared the effectiveness and complications of two computed tomography (CT)-guided localization methods for pulmonary nodules: localization needle and medical glue. Methods: This retrospective study included 86 patients with pulmonary nodules undergoing preoperative localization at the First Affiliated Hospital of Guangxi Medical University (July 2023 – April 2024). The patients were divided into two groups: the localization needle group (n=64) and the medical glue group (n=22). Clinical data, including baseline characteristics, localization-related data, complications, and surgical outcomes, were collected and analyzed, and subgroup analyses were done to identify risk factors for pneumothorax and pulmonary hemorrhage. Results: Both methods achieved a 100% localization success rate, with all nodules successfully resected. The needle group had longer localization time (17.19 vs. 15.36 min, p<0.05) and higher pneumothorax incidence (23.4% vs. 4.5%, p<0.05). The needle group also had a lower cough incidence (1.6% vs. 22.7%, p<0.05) but higher pain scores (2.89 vs. 2.36, p<0.05). No significant differences were observed in intrapulmonary hemorrhage, operative time, surgical approach, or postoperative pathology (p>0.05) between the two groups. However, subgroup analysis revealed significant differences in puncture times, localization methods, nodule size, lung history, and puncture depth related to pneumothorax and hemorrhage (p<0.05). Conclusion: Both CT-guided localization methods are safe and effective for VATS. The number of punctures is a key risk factor for complications such as pneumothorax and intrapulmonary hemorrhage, emphasizing the importance of careful planning and technique during localization. Relevance for patients: Identifying the most effective localization methods for pulmonary nodules ensures a higher success rate in surgeries, with fewer complications, ultimately leading to better patient outcomes and faster recovery. Proper preoperative localization helps reduce the risk of adverse events like pneumothorax, ensuring safer procedures and improved overall care for patients.