IntroductionHepatoid adenocarcinoma of the lung (HAL) is a special type of adenocarcinoma originating from the lung with adenoid- and hepatocyte-like differentiation. HAL is rare in clinical practice. Here, we present the case of a patient with HAL.Case presentationA 59-year-old man was admitted to the hospital 4 days because of lung mas observed. Chest computed tomography (CT) revealed a lobulated mass shadow in the right lower lobe, approximately 3.5 × 3.3 cm in size. CT-guided percutaneous biopsy of the right lower lung was performed. The pathological results indicated a moderately to poorly differentiated adenocarcinoma. The patient underwent thoracoscopic right middle and lower lobectomy and systematic lymph node dissection. The postoperative pathology was primary HAL, with the staging of T2bN2M0 (stage III A). Recurrence-free survival and overall survival were 6 and 19 months, respectively Preoperatively, the level of alpha-fetoprotein was negative; however, after recurrence, it increased to 87.8.ConclusionPulmonary hepatoid adenocarcinoma is a rare subtype of malignant lung tumor, combined silicosis is more rare. Early surgical intervention can benefit patients in the early stages of the disease, whereas chemotherapy remains the main systemic treatment modality for postoperative and advanced stages. With the increasing popularity of genetic testing, it is important to focus on improving genetic examination.

BACKGROUND:Abnormal expression of protein tyrosine kinase 6 (PTK6) has been proven to be involved in the development of gynecological tumors. However, its immune-related carcinogenic mechanism in other tumors remains unclear. OBJECTIVE:The aim of this study was to identify PTK6 as a novel prognostic biomarker in pan-cancer, especially in lung adenocarcinoma (LUAD), which is correlated with immune infiltration, and to clarify its clinicopathological and prognostic significance. METHODS:The prognostic value and immune relevance of PTK6 were investigated by using bio-informatics in this study. PTK6 expression was validated in vitro experiments (lung cancer cell lines PC9, NCI-H1975, and HCC827; human normal lung epithelial cells BEAS-2B). Western blot (WB) revealed the PTK6 protein expression in lung cancer cell lines. PTK6 expression was inhibited by Tilfrinib. Colony formation and the Cell Counting Kit-8 (CCK-8) assay were used to detect cell proliferation. The wound healing and trans-well were performed to analyze the cell migration capacity. Then flow cytometry was conducted to evaluate the cell apoptosis. Eventually, the relationship between PTK6 and immune checkpoints was examined. WB was used to estimate the PD-L1 expression at different Tilfrinib doses. RESULTS:PTK6 was an independent predictive factor for LUAD and was substantially expressed in LUAD. Pathological stage was significantly correlated with increased PTK6 expression. In accordance with survival analysis, poor survival rate in LUAD was associated with a high expression level of PTK6. Functional enrichment of the cell cycle and TGF-β signaling pathway was demonstrated by KEGG and GSEA analysis. Moreover, PTK6 expression considerably associated with immune infiltration in LUAD, as determined by immune analysis. Thus, the result of vitro experiments indicated that cell proliferation and migration were inhibited by the elimination of PTK6. Additionally, PTK6 suppression induced cell apoptosis. Obviously, PD-L1 protein expression level up-regulated while PTK6 was suppressed. CONCLUSION:PTK6 has predictive value for LUAD prognosis, and could up regulated PD-L1.

目的 探讨胸腔镜肋骨骨折复位内固定术治疗多发肋骨骨折的安全性和有效性.方法 选择2019年11月至2020年12月厦门大学附属翔安医院收治的多发肋骨骨折患者67例,采用胸腔镜进行肋骨骨折复位并使用记忆合金反向肋骨环抱器进行内固定手术治疗67例多发肋骨骨折(≥3根)患者,回顾性分析切口长度、总手术时间、不同部位每根肋骨平均复位固定手术时间、放置成功率、术后并发症等情况.结果 67例患者均顺利完成手术,手术时间(102.5±31.1)min,无死亡及重大并发症发生.术中每例患者放置胸腔内记忆合金环抱器3～11枚,100％放置成功.手术切口长度(2.8±0.7)cm,出血量(80.7±17.6)ml.单根肋骨的切开复位固定时间,前肋(41.9±7.1)min,侧肋(62.9±14.3)min,后肋(24.7±8.4)min,骨折位于后肋者手术时间较其他部位更短.结论 胸腔镜下使用记忆合金反向肋骨环抱器进行胸腔内肋骨骨折固定安全可靠,内固定环抱器放置成功率高,骨折临床愈合良好,并具有创伤小、同期可治疗肺挫伤、肺大疱、肺结节等胸腔内其他疾病的优势,尤其适合后肋多发骨折的治疗.

目的 介绍胸腔镜下经原切口取出既往因手术治疗肋骨骨折放置的胸腔内记忆合金反向肋骨环抱器(以下简称"腔内接骨板")的方法.方法 回顾性分析2020年7月至2022年1月于胸腔镜下使用原手术切口,在肋骨骨折愈合后取出腔内接骨板的20例患者的临床资料.结果 腔内接骨板均顺利取出,其中接骨板位于右侧10例,左侧8例,双侧2例;单纯使用腔内接骨板8例,腔内接骨板+腔外接骨板12例;肋骨骨折内固定术后在1年内取出腔内接骨板者18例,超过1年取出腔内接骨板者2例.术后所有患者均未出现感染、再骨折、神经损伤、血管损伤及中转开胸.取出术后均获得3个月随访,机体功能均恢复正常.结论 胸腔镜下经原切口取出记忆合金反向肋骨环抱器,未出现感染、神经血管损伤等,无严重并发症,安全可行.

The key N 6 methyladenosine (m 6 A) RNA methylation regulator is associated with multiple tumour progression. However, the m 6 A‐associated regulators that influence non‐small cell lung cancer (NSCLC) development have not been fully clarified. The m 6 A regulator expression pattern of NSCLC patients from The Cancer Genome Atlas (TCGA) dataset was identified. Aberrations of m6A modulators are related to NSCLC development via cBioPortal database. Furthermore, we found that IGF2BP2, IGF2BP3, HNRNPA2B1, and FTO are significantly correlated with advanced stage disease or clinical outcomes in NSCLC by UALCAN and Kaplan–Meier plot. Bioinformatics analysis showed that m 6 A modulators (IGF2BP2, IGF2BP3, HNRNPA2B1, and FTO) are associated with immunomodulator and immune infiltration expression in NSCLC via the Tumor Immune Estimation Resource (TIMER) database. The co‐expression between these m6A‐associated modulators was analysed by protein‐protein interaction networks. Finally, we found that HNRNPA2B1 promotes NSCLC development in vitro by regulating cell proliferation and metastasis functions via Cell Counting Kit 8 (CCK8) and transwell assay. Our study showed that HNRNPA2B1 is a promising target and biomarker for cancer therapy in NSCLC.

Long noncoding RNA (lncRNA), specifically the upregulation of lncRNA NR2F1 antisense RNA 1 (NR2F1-AS1), has been involved in the progression of non-small cell lung cancer (NSCLC), but the mechanisms that underlie this remain unclear. In this study, the expression of NR2F1-AS1, miR-363-3p, and SOX4 was assessed in NSCLC cells. A loss-of-function assay was used to measure the tumorigenicity of NSCLC cells. The glycolysis and glutamine metabolism of NSCLC cells was also measured via extracellular acidification rate, consumption of glucose and glutamine, and production of lactate and ATP. The relationships among NR2F1-AS1, miR-363-3p, and SOX4 were detected via dual-luciferase reporter assay. HK-2, GLS1, and SOX4 levels were also analyzed. We found that both NSCLC tissues and cells had higher levels of NR2F1-AS1. Silencing of NR2F1-AS1 inhibited the tumorigenicity of cells in vitro and reduced the glycolysis and glutamine metabolism of NSCLC cells. Regarding its mechanism, NR2F1-AS1 positively regulated the SOX4 level by sponging miR-363-3p. Furthermore, miR-363-3p inhibition or SOX4 overexpression reversed the repressing role of sh-NR2F1-AS1 in the tumorigenicity of NSCLC cells. In summary, NR2F1-AS1 promotes the tumorigenicity of NSCLC cells by regulating miR-363-3p/SOX4.

Vasculogenic mimicry (VM) is associated with aggressive cancer cells. Salvianolic acid A (Sal-A), an antioxidant and anti-inflammatory agent, has bioactive properties from Salvia miltiorrhiza Bunge. Current investigation aspired to explore the activity of Sal-A in the VM formation of non-small cell lung cancer (NSCLC) and the mechanism underling this function. The CCK8, the scratch and boyden chemotaxis assay were presented to describe NSCLC cells viability, migration and invasion capabilities, respectively. The protein expression was verified by western blotting. In this report, Sal-A caused a reduction in viability, metastasis and capillaries structure formation of NSCLC cells. Additionally, Sal-A markedly prevented the key VM related proteins, containing EphA2, VE-cadherin and MMP2. Besides, Sal-A significantly diminished p-PI3K, p-Akt and p-mTOR level in NSCLC cells. More importantly, SC79 pretreatment reversed Sal-A inhibits NSCLC cells viability, metastasis and VM formation. These data exhibit that Sal-A could block VM network formation in NSCLC cells through modulating the PI3K/Akt/mTOR signalling pathway.

目的 探讨CKLF样MARVEL跨膜结构域超家族7(CMTM7)基因在食管癌中的表达情况及其过表达对食管癌细胞增殖的影响.方法 收集97例食管癌患者的手术标本,包括食管癌组织及癌旁正常组织,采用免疫组化法检测CMTM7在食管癌与癌旁组织组织中的表达情况.分别采用实时荧光聚合酶链式反应、Western Blot检测人食管癌细胞系CE81T和正常人食管鳞状上皮细胞Het-1A中CMTM7 mRNA及蛋白的表达情况.将食管癌细胞系CE81T分为两组,实验组加入转染过表达CMTM7的腺病毒表达载体(Ad-CMTM7),对照组加入空载体腺病毒,在培养24 h、48 h、72 h和96 h时,采用细胞活性检测法(CCK-8)检测两组细胞增殖情况.结果 免疫组化结果显示CMTM7在食管癌中低表达,在癌旁组织中高表达.正常食管上皮细胞Her-1A中的CMTM7 mRNA和蛋白表达水平明显高于食管癌细胞CE81T.CCK-8结果显示,各时间点CE81T细胞实验组的吸光值均低于对照组(P＜0.05).结论 食管癌的CMTM7表达水平下调,过表达CMTM7对食管癌细胞的增殖具有显著的抑制作用.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:比较手术治疗的肺部良性肿瘤与早期、中期肺癌患者的焦虑及抑郁症状的检出比率,探讨其影响因素。方法:研究对象为就诊于某三级综合医院的283例接受手术的肺部肿瘤患者,其中肺部良性肿瘤或病变患者107例,早期肺癌患者58例,中期肺癌患者118例。采用自编调查表收集社会人口学及临床相关信息,使用抑郁自评量表（SDS）和焦虑自评量表（SAS）分别评价肿瘤患者抑郁和焦虑症状,SDS标准分&gt;53分记为有抑郁症状,SAS标准分&gt;50分记为有焦虑症状。结果:肺部良性肿瘤或病变患者无明显焦虑及抑郁症状,早期和中期肺癌患者中53.40%存在焦虑症状,43.44%存在抑郁症状,差异有统计学意义（P&lt;0.001）。多重线性回归分析显示,中期肺癌（β=29.70,P&lt;0.001）及年龄65岁以上（β=2.58,P=0.018）是发生抑郁症状的危险因素,相对于良性肿瘤及早期肺癌患者,中期肺癌患者焦虑症状更重（β=27.22,P&lt;0.001）。结论:中期肺癌较良性肿瘤及早期肺癌更加容易导致患者出现焦虑和抑郁等负面心理应激;且老年肿瘤患者更容易出现抑郁症状。</span>

Objective To Evaluate the feasibility of video-assisted thoracoscopic surgery(VATS) reoperation for recurrent primary spontaneous pneumothorax.Methods The clinical and follow-up date of 35 recurrent pneumothorax patients,who received reoperation from January 2004 to November 2013 at the Beijing Haidian Hospital and Peking University People's Hospital were retrospectively reviewed.Chi square,t test and Kaplan-Meier curve was used to evaluate risk factors.Results The relapsed 35 patients included male 30,female 5.The median age was 22 years old(range 16-50 years).The median operating time was 100 min (range 40-190 min),the median blood loss was 50 ml (range 5-200 ml) and the median postoperative stay in the hospital was 7 days(range 3-13 days).VATS was successfully performed for all patients,without conversion.No morbidity or mortality occurred.The median follow-up time was 49months(range 12-133 months).Adhesions were observed from 34 patients,wherein,the severity ranged from mild to dense.New bullae or blebs were found in 26 patients (74.29％),9 (34.62％) of which were adjacent to the stapled incisal margin.No bullae or blebs were found on the 9 patients (26.71％)that underwent reoperation within 18 months from their initial operation.No recurrence was observed during the follow-up.Conclusion The recurrence of spontaneous pneumothorax was mostly caused by the formation of new bullae or blebs near the staple lines.Reoperation for recurrent pneumothorax was safe and advocated.VATS operation includes the dissection of pleural adhesions,wedge resection of neoformative bullae or blebs and elimination of the residual apical space.

Objective To investigate the influence factors for contralateral recurrence of spontaneous pneumothorax following thoracoscopic surgery in adolescents. Methods Two hundred and fifty-five adolescents with spontaneous pneumothorax were enrolled in the study,including 43 patients with postoperative contralateral recurrence and 212 patients without recurrence. The demographic characteristics,X-ray imaging,perioperative and operative information were compared between patients with and without contralateral recurrence. The influence factors for contralateral recurrence were analyzed by univariate and multivariate logistic regression analysis. Results Univariate analysis suggested that there were significant differences in height,body mass index,onset frequency of spontaneous pneumothorax,thoracic transverse diameters to anteriorposterior diameters,thoracic length and perioperative alveolus occurrence between two groups( P 0.05).Multiple logistic regression analysis suggested that thoracic transverse diameters to anteriorposterior diameters,perioperative alveolus occurrence,body mass index and onset frequency of spontaneous pneumothorax were the influence factors for postoperative contralateral recurrence. Conclusion The patients with slim body,several onset frequencies,flat chest and several pulmonary bulla observed during operation have increased risks of contralateral recurrence in adolescents with spontaneous pneumothorax undergoing thoracoscopic surgery.

Objective To determine the indications for primary spontaneous pneumothorax in young patients after closed drainage.Methods From Jaunary 2007 to December 2012,139 young patients,who had chest tube drainage in spontaneous pneumothorax and full information by telephone follow-up,patients were divided into recurrence and recurrence-free group.The possible influence factors related to recurrence were statistically analyzed.Results Single factor and multi-factor analysis indi cated that in the aspect of self-factors,the edge of the lung in chest X-ray were independent factors for recurrence prediction (P ＜ 0.05).Conclusion If the edge of lung is not smooth in X-ray,then VATS(video assisted thoracoscopic surgery) operation is needed.

Objective By long term follow-up study to investigate the curative effect and life quality of video-assisted thoracoscopic T2 sympathetic trunk blocking in the treatment of craniofacial hyperhidrosis. Methods From January 2002 to December 2007,the clinical data of 20 cases were followed up,follow-up with telephone inquiries proceeded every year,the last follow-up time was Junuary 2014,a minimum exceeded five years of follow-up. Results The mean operating time was( 37. 5 ± 7) min( range,30 to 45min). Symptoms of craniofacial hyperhidrosis disappeared in all patients. The rates of postoperative compensatory sweating on back and chest were 96. 7%,100%,the other parts of the body like belly and leg had different degrees of compensatory sweating. The rate of satisfaction about operation was 50 percent( 10 patients),the rate of general view was 35 percent( 7 patients),the rate of dissatisfaction was 15 percent( 3 patients). The postoperative quality of life gotobvious betterin 9 patients( 45 percent),betterin 8 patients( 40 percent),no betterin 3 patients( 15 percent). Conclusions Endoscopic thoracic of T2 sympathetic trunk blocking for craniofacial hyperhidrosis is effective. The operation improves patients' quality of life and gives satisfactory outcomes,But,all patients should be informed of compensatory hyperhidrosis before performing the operation.

目的:研究特异性富AT序列结合蛋白1(SATB1)在非小细胞肺癌(NSCLC)和正常肺组织中的差异性表达及其与临床、病理特征和预后之间的关系.方法:2008年8月至2009年12月间于我科接受手术治疗的60例NSCLC患者的60对NSCLC和癌旁正常肺组织标本,以实时定量RNA反转录聚合酶链式反应(real-time RT-PCR)验证SATB1在肺癌和正常肺组织间是否存在差异性表达.按SATB1基因表达量是否高于均值而将患者分为SATB1高、低表达两组,分析SATB1表达程度高低与NSCLC的病理类型、pTNM分期、无瘤生存时间(DFS)、总生存时间(OS)之间的关系.结果:SATB1 基因在NSCLC中的表达高于癌旁正常肺组织(P＜0.001).该基因的表达程度与肺癌患者性别 (P=0.155)、病理类型(P=0.809)、肿瘤分化程度(P=0.937)以及病理分期(P=0.704)之间无明显相关性.2例患者失访,余58例患者中位随访时间44个月(4-58个月).SATB1高、低表达组患者的3年无瘤生存率分别为33.7%和42.9%;中位DFS分别为18个月和28个月;3年总生存率分别为38.8%和71.4%,高表达组中位OS 21个月,低表达组中位OS未达到.结论:SATB1在肺癌组织中的表达高于正常肺组织,肺癌组织中SATB1高表达组患者的预后较低表达组为差.

Objective To assess the safety,effectiveness,indications and advantage of modified "Hemi-Clamshell" approach for giant anterior mediastinal tumor.Methods From Apr 2003 to May 2012,24 patients (18 males and 6 females,median aged 40 years old) with giant anterior mediastinal tumor (average dimension:11.3 cm × 9.3 cm) were treated through modified "Hemi-Clamshell" approach.In operation,anterolateral thoracotomy with sternum transection was performed through 3rd or 4th intercostal space from midclavicular line to contralateral parasternal line.Then a radical or palliative resection of the tumor was performed.Results There were no mortality and major morbidity peri-operatively.A myasthenic crisis occurred for a patient with thymoma and myasthenia gravis.16 operations were performed through 3rd intercostal space and 8 through 4th.15 cases of tumor were radically resectedaverage dimension of tumors was 11.2 cm × 9.1 cm while the other 9 were palliativly resectedthe average dimension of tumors was 11.3 cm × 9.5 cm.Because of the extranodal invasion of the tumor,14 patients received extended operations.All the patients were followed-up to Aug 2013,the overall period of follow-up were 6-124 months.The survival postoperative for the patients of radical resection group were 11-124 months and for the palliative resection group were 6-66 months.Conclusion Manufacture of the modified "Hemi-Clamshell" approach is fast and convenient,and the exploration of the mediastinal organs is satisfied.This modified approach can be used for great majority of the mediastinal tumors.This approach is suitable for promotion at the primary hospitals and the prospect of application is well.

Objective To discuss the feasibility of uniportal video-assisted thoracic surgery( VATS) technique applied to pulmonary bullae resection for the treatment of spontaneous pneumothorax. Methods Three hundred and twenty-seven cases undergoing video-assisted pulmonary bullae resction and pleurodesis were divided into uniportal VATS technique group( n = 194) and traditional two-port VATS technique group( n = 133). The clinical data including the operation time,postoperative thoracic cavity drainage volume,postoperative leakage time,postoperative extubation time,postoperative recurrence rate and perioperative staple-using number were compared between two groups. Results There were no significant differences in operation time,bleeding,postoperative recurrence,postoperative hospital stay and perioperative staple-using number between two groups( P 0. 05). The postoperative pain and wound numbness in the uniportal VATS technique group improved significantly compared with two-port VATS technique group( P 0. 05).Conclusion The uniportal VATS technique has similar effect with two-port VATS technique on spontaneous pneumothorax patients undergoing pulmonary bullae resction,but the patients using the uniportal technique have less pains and wound numbness after operation.

Objective To assess early and medium outcomes of pathologic N2 disease unexpectedly detected in patients undergoing total video-assisted thoracic surgery lobectomy for non-small cell lung cancer.Methods Between Sep.2006 and Dec.2010,348 patients with Non-small cell lung cancer underwent total video-assisted thoracic surgery lobectomy,and within them,35( 10.1％ ) were found to have pathologic N2 disease after operation.We retrospectively reviewed the clinical and pathologic features of patients with unexpected N2 disease after video-assisted thoracic surgery lobectomy and their early and medium outcomes,including survival and recurrence pattern.Results No perioperative mortality was noted.26 patients received a lobectomy directly,and the other 9 patients after a wedge resection.All the patients had R0 resection.The medium operation time was 190 minutes and medium blood loss was 200ml.The medium stations and numbers of dissected N2 lymph nodes in operation were 4 and 10,respectively.And the medium stations and numbers of metastatic N2 Lymph nodes were 1 and 2,respectively.Among patients with pathologic N2 disease,18 (51.4％) had single-station involvement.The median duration of chest tube placement was 8 days.The median length of hospital stay was 11 days.15 complications occurred in 12 (34.3％) patients.All of the patients underwent adjuvant chemotherapy with platinum postoperatively.The median follow-up time was 23 months.The 1 - and 2-year overall survival (OS) was 80.9％ and 67.9％,and the medium OS was not reached.During follow-up,16 (45.7％) patients had a recurrence.The pattern of recurrence was locoregional in 5,distant in 11.The 1 - and 2-year disease-free survival (DFS) was 71.9％ and 44.2％,and the medium DFS was 20 months (95％,8.1 to 31.9 months).Divided the patients with pathologic N2 disease into two groups considering single-station involvement or not,the 1-and 2-year OS and DFS for the single-station group and for the multiple-station group were 87.7％,78.9％ ; 88.9％,49.4％and 67.6％,59.1％ ; 55.3％,39.5％.The medium DFS for both the two groups was 23 and 16 months respectively.Conclusion For non-small cell lung cancer with N0 disease confirmed by an exactly preoperative staging workups,if it is feasible in technology,a total video-assisted thoracic surgery lobectomy should be recommended.Even if N2 lymph node metastasis is unexpectedly detected postoperatively,the metastasis was mostly micro- or single-station involved,and a similar outcome with conventional thoracotomy can be achieved.

Objective To study the risk factors of mediastinal lymph node metastasis in patients with ≤3 cm peripheral non small cell lung cancer. Methods From January 2000 to December 2010,a total of 281 patients with NSCLC [152 men and 129 women,aged （60. 31 ± 12. 13） years; ≤ 3 cm in diameter]underwent lobectomy or partial resection with systematic mediastinal lymphadenectomy in hospital. Clinical data included age,gender,

患者 女性,41岁,主因左侧肩背部疼痛、麻木4个月于2006年11月6日入院.患者首发症状为左侧肩背部疼痛、麻木,为持续性隐痛,偶有间断发作,疼痛及麻木局限在左侧肩部及肩胛间区,与活动和体位无明显关系.无发热、喘憋、胸痛、咳嗽等症状。