OBJECTIVES:The accurate differentiation of thymic masses, particularly thymic carcinoma (TC), is imperative for guiding optimal treatment selection. This study investigated potential non-invasive biomarkers for discerning thymic malignancies and evaluated their clinical applicability. METHODS:Clinicopathological data from 1897 patients who underwent surgical resection for thymic masses across 2 institutions were retrospectively analysed. Associations between serum tumour markers and TC diagnosis were assessed using the area under the receiver operating characteristic curve (AUC). The clinical utility of the identified tumour markers was further evaluated. RESULTS:In the discovery cohort from Shanghai Pulmonary Hospital (SPH), cytokeratin 19 fragment antigen 21-1 (CYFRA 21-1) levels were significantly higher in the TC group compared to both the thymoma group and the non-thymic epithelial tumour (non-TET) group (median of 2.38 ng/mL vs 1.39 ng/mL or 1.28 ng/mL, both P < .001), with AUC value of 0.778 (95% CI: 0.735-0.822) compared to thymoma and 0.808 (95% CI: 0.766-0.849) compared to non-TET group. Validation in the cohort from Renmin Hospital of Wuhan University further demonstrated significant discrimination of CYFRA 21-1 for TC diagnosis (vs thymoma: AUC = 0.681 [95% CI: 0.518-0.843]; vs non-TET: AUC = 0.801 [95% CI: 0.622-0.980]). Furthermore, high CYFRA 21-1 levels were also correlated with a shorter median disease-free survival compared to the low CYFRA 21-1 group (10.0 years vs 14.9 years, P < .001) in patients with TET in the SPH cohort. CONCLUSIONS:CYFRA 21-1 emerges as a reliable diagnostic biomarker for distinguishing TC from other thymic masses. Moreover, it holds promise for prognosis evaluation and potentially for recurrence surveillance.

With the ongoing prevalence of the emerging variant and global vaccination efforts, the optimal surgical timing for patients with resectable lung cancer in the Omicron-dominant period requires further investigation. This prospective multicenter study involved patients who underwent radical surgery for lung cancer between January 29, 2023 and March 31, 2023. Patients were categorized into four groups based on the interval between SARS-CoV-2 infection and surgery. The main outcomes evaluated were 30-day mortality and 30-day morbidity. A total of 2081 patients were enrolled in the study, of which 1837 patients (88.3

BACKGROUND:Incidental thymus region masses during thoracic examinations are not uncommon. The clinician's decision-making for treatment largely depends on imaging findings. Due to the lack of specific indicators, it may be of great value to explore the role of radiomics in risk categorization of the thymic epithelial tumors (TETs).METHODS:Four databases (PubMed, Web of Science, EMBASE and the Cochrane Library) were screened to identify eligible articles reporting radiomics models of diagnostic performance for risk categorization in TETs patients. The quality assessment of diagnostic accuracy studies 2 (QUADAS-2) and radiomics quality score (RQS) were used for methodological quality assessment. The pooled area under the receiver operating characteristic curve (AUC), sensitivity and specificity with their 95% confidence intervals were calculated.RESULTS:A total of 2134 patients in 13 studies were included in this meta-analysis. The pooled AUC of 11 studies reporting high/low-risk histologic subtypes was 0.855 (95% CI, 0.817-0.893), while the pooled AUC of 4 studies differentiating stage classification was 0.826 (95% CI, 0.817-0.893). Meta-regression revealed no source of significant heterogeneity. Subgroup analysis demonstrated that the best diagnostic imaging was contrast enhanced computer tomography (CECT) with largest pooled AUC (0.873, 95% CI 0.832-0.914). Publication bias was found to be no significance by Deeks' funnel plot.CONCLUSIONS:This present study shows promise for preoperative selection of high-risk TETs patients based on radiomics signatures with current available evidence. However, methodological quality in further studies still needs to be improved for feasibility confirmation and clinical application of radiomics-based models in predicting risk categorization of the thymic epithelial tumors.

Pulmonary fibrosis (PF) is characterized by oxidative injury and excessive collagen synthesis in lung fibroblasts, causing impaired pulmonary function and chronic lung injury. Piceatannol, a dietary polyphenol, possesses vital pharmacological effects in metabolic disorders, cancers, cardiovascular disease and infectious disease; however, its role in PF is still not completely elucidated. Mice (8 to 10 weeks old) were administered bleomycin (BLM) intratracheally (2 U/kg) to establish an in vivo PF model. Murine primary lung fibroblasts were isolated and stimulated with TGF-β (10 ng/mL) for 48 h to induce its activation. Meanwhile, mice or primary lung fibroblasts were treated with different doses of piceatannol to observe its protective roles. Pulmonary function and arterial blood gas were detected to assess pulmonary physiological status. Collagen deposition and the mRNA levels of profibrotic genes were determined by H&E staining and RT-PCR. Meanwhile, the protein and mRNA markers, as well as end-product of oxidative stress were detected in vivo and in vitro. The results showed that pulmonary function was significantly impaired in BLM-induced mice, accompanied by elevated oxidative stress and excessive collagen synthesis. Piceatannol significantly improved pulmonary function and decreased oxidative injury as well as collagen synthesis in mice with PF. Mechanically, piceatannol treatment significantly inhibited the activation of JAK2/STAT3 signaling pathway in BLM-induced mice and TGF-β-induced lung fibroblasts. Additional findings also demonstrated that coumermycin A1 (C-A1), an agonist of JAK2, could abolish the effects of piceatannol on TGF-β-induced lung fibroblasts and reactivated the phosphorylation STAT3. Taken together, our study demonstrated that piceatannol could protect against oxidative injury and collagen synthesis during PF in a JAK2/STAT3 signaling pathway-dependent manner.

Background: To date, postoperative intractable cough (PIC) has not received adequate attention, and the complex perioperative factors when performing pulmonary resection often prevent researchers from addressing this issue. This study aimed to investigate the clinicopathological and radiographic indicators related to PIC in lung cancer patients. Methods: In all, 112 patients who had had right upper lobectomy for primary lung cancer from January 2019 to December 2020 were retrospectively reviewed. We collected data via the electronic medical database of our department. Bronchial morphological features were investigated comprehensively via three-dimensional chest computer tomography reconstruction images. Results: During outpatient follow-up visits, 41 (36.6%) patients complained about persistent dry cough after surgery. Compared with the non-cough group, patients in the refractory cough group showed significant differences in smoking history, right upper lobe stump length, changes of right bronchus intermedius (RBI) diameter, changes of right lower lobe (RLL) basal bronchus diameter, changes of RBI/RLL bronchial angle, and bronchial kink. However, according to multivariable regression analysis, stump length, bronchial kink, and diameter change of the right lower lobe basal bronchus were independently associated with postoperative refractory cough. A nebulization drug was prescribed for the 41 patients diagnosed with PIC, and 33 (80.5%) patients had improved by the next visit. Conclusions: After right upper lobectomy, the morphology of the remaining bronchial tree in the residual lung changed significantly. The bronchial morphological alterations were independent risk factors for PIC.

诺卡菌是常见于土壤、植被、水源等环境中的病原体,可通过伤口、呼吸道等途径传播,最常感染肺部.肺移植术后皮疽诺卡菌感染罕见,国内尚无报道.我们报道1 例肺移植患者术后皮疽诺卡菌感染从出现到诊治转归的全过程.

目的:应用胸骨上窝切口血管旁路结合腔内技术治疗复杂主动脉弓部病变,探讨此方法在弓部病变临床应用的技术特点.方法:回顾性研究2010年11月至2021年7月共72例复杂主动脉弓部病变患者,平均年龄(52.9±10.7)岁,支架锚定Zone 2区61例,Zone 1区11例;其中主动脉夹层57例(79.2％),弓部壁间血肿3例(4.2％),主动脉弓部瘤6例(8.3％),动脉瘤合并夹层6例(8.3％);同期手术60例,二期手术12例;所有患者均经胸骨上窝切口行血管旁路手术;观察切口相关性淋巴漏、神经损伤、感染,支架内漏、术后脑梗、桥血管通畅等并发症发生情况,随访平均时间40月(1～120月).结果:围手术期死亡1例(1/72,1.4％),术后血管旁路相关脑梗3例(3/72,4.2％),喉返神经损伤比例为6.9％(5/72);4例(5.5％)术后出现切口淋巴液漏;早期Ⅰ型内漏发生率为11.1％(7/72),晚期Ⅰ型内漏总发生率为4.2％(3/72);2例患者术后出现夹层逆撕,均为Zone 2区患者;术后有1例转流血管闭塞(1/72,1.4％).结论:改良的经胸骨上窝切口血管旁路复合手术治疗复杂主动脉弓部病变具有旁路血管通畅率高,中远期效果佳,术中需注意避免淋巴管及喉返神经损伤.

目的 总结手术肺动脉取栓治疗急性重症肺栓塞的临床特点.方法 2016年1月～2019年10月收治的急性重症肺栓塞病人8例,均采用体外循环下肺动脉取栓治疗,近期行颅内手术2例,肺栓塞同时合并下腔静脉血栓病人1例,术前行心肺复苏2例,其中1例行体外膜肺(ECMO)支持.结果 8例手术成功,所有病人术后肺动脉压力明显降低[(39.8±6.1)mmHg vs.(18.0±5.4)mmHg,P<0.05];围手术期因肺部感染死亡1例,治愈出院7例,病人术后随访(35.7±14.1)个月,无肺栓塞复发.结论 手术肺动脉取栓治疗急性重症肺动脉栓塞近中期效果良好,体外膜肺支持是提高救治成功率的有效手段,及时手术是成功救治的关键.

Objective: To investigate the management strategies for lung transplant patients in Wuhan areas during the COVID-19 epidemic period (from January 1, 2020 to April 8, 2020). Methods: During the epidemic period in Renmin Hospital of Wuhan University, three potential lung transplant patients on the waiting list were suspended for operation, one who underwent lung transplantation was carefully quarantined and the surrounding environment was disinfected, nine patients after lung transplantation received epidemic prevention instructions and were followed up through phone call or online communication. The clinical and follow-up data of these patients were collected and analyzed. Results: The patient with lung transplantation performed in the early stage of the epidemic was survived and didn't infected with SARS-CoV-2. Of the postoperative cases, only one was infected with SARS-CoV-2 which eventually caused death during the epidemic. Conclusion: During the COVID-19 epidemic, effective management strategies adopted in affected areas could reduce the incidence of SARS-CoV-2 infection in lung transplant patients. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.

PM2.5 refers to ambient air particulate matter with aerodynamic diameters ≤ 2.5 µm, which has been a global environmental problem threatening public health in recent years. Melatonin serving as one of the predominant hormones secreted by the pineal gland displays multiple pharmacological properties in various diseases. However, little is known about the possible effects of melatonin in the development of lung injury induced by PM2.5. This study was designed to explore the potential roles of melatonin as well as its possible mechanisms in PM2.5-induced lung injury. In the present study, mice were intratracheally instilled with PM2.5 dissolved in sterile water to induce lung injury with or without intragastric administration of melatonin. The results showed that melatonin treatment significantly alleviated lung pathological injury and edema, apart from inhibiting inflammatory cell infiltration. Meantime, melatonin also decreased the makers of ferroptosis and lipid peroxidation products in lung tissues challenged with PM2.5. Additionally, melatonin promoted the nuclear translocation and expression of Nrf2 and the protein degradation of Keap1. However, the pulmonary protection and anti-ferroptosis effect of melatonin were counteracted in Nrf2-deficiency mice. In vitro experiments further demonstrated that Nrf2 knockdown could offset anti-ferroptosis effect of melatonin in MLE-12 lung epithelial cells. Taken together, our study disclosed that melatonin could relieve PM2.5-induced lung injury via inhibiting ferroptosis of lung epithelial cells by activating Nrf2. Hence, melatonin may be a promising candidate against lung injury associated with air particulate matter.

Acute lung injury (ALI) is featured by pulmonary edema, alveolar barrier injury, inflammatory response, and oxidative stress. The activation of Sirt1 could relieve lipopolysaccharide- (LPS-) induced murine ALI by maintaining pulmonary epithelial barrier function. Oxypaeoniflorin (Oxy) serves as a major component of Paeonia lactiflora Pall., exerting cardioprotection by activating Sirt1. However, the role of Oxy in ALI induced by LPS remains unclear. The aim of the present study is to illustrate the modulatory effects and molecular mechanisms by which Oxy operates in ALI induced by LPS. The intraperitoneal injection of LPS was performed to establish the murine ALI model while LPS-treated alveolar epithelial cells were used to mimic the in vitro ALI model. Levels of lung injury, oxidative stress, and inflammatory response were detected to observe the potential effects of Oxy on ALI. Oxy treatment mitigated lung edema, inflammatory response, and oxidative stress in mouse response to LPS, apart from improving 7-day survival. Meanwhile, Oxy also increased the expression and activity of Sirt1. Intriguingly, Sirt1 deficiency or inhibition counteracted the protective effects of Oxy treatment in LPS-treated mice or LPS-treated alveolar epithelial cells by regulating the PTEN/AKT signaling pathway. These results demonstrated that Oxy could combat ALI in vivo and in vitro through inhibiting inflammatory response and oxidative stress in a Sirt1-dependent manner. Oxy owns the potential to be a promising candidate against ALI.

Therapeutic benefits and clinical application of paclitaxel for treating non-small cell lung cancers (NSCLCs) are extremely hampered due to the chemoresistance. A recent study found that fibronectin type III domain-containing protein 5 (FNDC5) was downregulated in NSCLCs cells and negatively correlated with the clinicopathological characteristics in patients with NSCLCs. However, the role and potential molecular basis for FNDC5 in paclitaxel sensitivity of NSCLCs remain unclear. Paclitaxel-sensitive or resistant NSCLCs cell lines were exposed to small interfering RNA against FNDC5 (siFndc5) or recombinant irisin in the presence or absence of paclitaxel. NSCLCs cell lines have decreased FNDC5 expression compared with the normal human lung epithelial cells, which was further downregulated in paclitaxel-resistant cells. Irisin treatment suppressed, whereas Fndc5 silence promoted NSCLCs cells proliferation under basal conditions. Besides, we found that FNDC5 increased paclitaxel chemosensitivity in paclitaxel-sensitive or resistant NSCLCs cell lines via downregulating multidrug resistance protein 1 (MDR1). Further studies revealed that FNDC5 inhibited MDR1 expression via blocking nuclear factor-κB (NF-κB) activation. FNDC5 promotes paclitaxel sensitivity of NSCLCs cells via inhibiting NF-κB/MDR1 signaling, and FNDC5 might be a novel therapeutic target for the treatment of NSCLCs.

目的 探讨肺移植对终末期肺病的治疗效果,总结肺移植围手术期治疗经验.方法 2016年12月～2019年9月间肺移植围手术期病人13例,回顾性分析其临床资料.结果 主要诊断为慢性阻塞性肺疾病、特发性肺纤维化各4例,支气管扩张3例,尘肺1例,Kartagener综合征1例.手术方式为双肺移植7例,左单肺3例,右单肺3例.围手术期死亡3例,死因分别为鲍曼不动杆菌合并铜绿假单胞菌感染1例,肺炎克雷伯菌感染1例,心跳骤停1例;余10例均治愈出院.结论 肺移植是治疗终末期肺病的有效方法,急诊抢救性手术效果不佳.

目的:探索建立高表达叶酸受体的Madison 109(M109)肺癌细胞的动物模型方法,并对其自然病程中循环肿瘤细胞(CTC)数量进行检测.方法:通过针剌注射不同浓度的肺癌细胞悬液,建立BALB/c小鼠的M109原位肺癌模型,观察各组小鼠原位肺癌成瘤率、中位生存期及转移情况;并利用基于叶酸受体的靶向反转录聚合酶链反应检测技术对这一模型病程中的CTC进行定量检测.结果:注射1×106细胞数组术后10～15 d即可全部成瘤,第25天均可见血性胸腔积液,胸膜、心包及对侧肺肉眼癌结节等转移征象;其中位生存期为28d.心脏取血检测CTC发现健康小鼠CTC值最低,且CTC数量随肺癌的进展逐渐增多.结论:针刺注射M109细胞悬液能在BALB/c小鼠体内成功构建原位肺癌模型,且具有高成瘤率和转移率的特点.以基于叶酸受体的靶向反转录聚合酶链反应检测法可应用于该模型的循环肿瘤细胞检测.

目的 探讨经颈部切口联合胸腔镜技术在颈纵隔良性肿瘤切除中的应用价值.方法 颈纵隔良性肿瘤病人6例,均采用低领状切口联合单侧胸腔镜手术.结果 6例均顺利完成手术,无中转侧开胸或正中劈胸,无手术相关并发症.手术时间(108.3±16.9)分钟,术中出血(51.7±16.3)ml,术后颈部引流管留置时间(1.3±0.5)天,胸管留置时间(2.7±0.8)天,术后住院时间(4.3±1.0)天.术后病理检查示囊性淋巴管瘤4例,结节性甲状腺肿1例,脂肪瘤1例.术后随访6 ～32个月,无局部复发.结论 经颈部切口联合胸腔镜手术行颈纵隔良性肿瘤切除安全、有效.

OBJECTIVES To evaluate the predictive value of the intraoperative thymofatty specimen weight (TFSW) index on predicting the prognosis of extended thymectomy (ET) for non-thymomatous myasthenia gravis. METHODS This is a prospective non-interventional study in which patients who underwent ET between January 2012 and June 2015 were enrolled. Resected thymus and surrounding adipose tissues were weighed using an electronic scale intraoperatively and adjusted to the body surface area (BSA) to calculate the TFSW index. The primary end point was defined as complete stable remission (CSR) according to the Myasthenia Gravis Foundation of America (MGFA) guidelines. RESULTS One hundred and eighteen patients who completed postoperative follow-up were included in this study. After a mean follow-up period of 44 months, 68 (57.6%) patients reached clinical CSR. The MGFA class, histopathology and TFSW index were associated with a postoperative CSR in univariate analysis. When the Cox hazard multiple regression model was used, the TFSW index was found to be an independent predictor for CSR (hazard ratio 2.056; 95% confidence interval 1.182-3.576). Based on ROC analysis, an optimal TFSW index cut-off value (35.9 g/m2) with the highest sensitivity and specificity was determined. CONCLUSIONS The TFSW index is an important independent predictor for mid-term CSR after ET in non-thymomatous myasthenia gravis patients. During the ET surgery, every effort should be made to take a tissue specimen with a TFSW index more than 35.9 g/m2.

Objective:To explore whether dividing inferior pulmonary ligament when treating primary spontaneous pneumothorax affect the surgical and postoperative outcomes.Methods:A prospective case-control study enrolled patients underwent video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax from January 2016 to April 2017.They were randomized to divide inferior pulmonary ligament or not during surgery.Postoperative data were compared between groups.Results:Finally 80 patients(40 in each group) were enrolled in this study.The baseline were similar between two groups.Except for the extended period of operation,there was no statistically significant difference in pulmonary reexpansion,thoracic drainage,chest tube duration or hospital staying between groups.Conclusion:It is no need to loosen inferior pulmonary ligament during thoracoscopic bullectomy.Omitting this step could bring convenience to the surgical procedure and minimize invasiveness.

Objective:To explore whether postoperative complications affect the long-term outcome in esophageal cancer patients.Methods:A retrospective study included patients undergone curative esophagectomy from January 2012 to December 2013.The risk factors of tumor recurrence,especially whether the postoperative complications could affect the oncological outcome were investigated.Results:Finally 177 patients were enrolled in this study.After a mean follow-up period of 28 months,88(49.7％) patients presented with recurrent tumor.Tumor invasive depth,lymph node involvement,nervous and vascular invasion,R1 resection and postoperative complications were significant risk factors of tumor recurrence.And postoperative complication no less than Clavien grade 1 was an independent prognostic factor for long-term oncological recurrence.Conclusion:Postoperative complications could significantly affect the long-term outcome in esophageal cancer patients with increased risk of tumor recurrence.

Objective To explore the surgical treatment of patient with esophageal cancer and right aortic arch(RAA).Methods We retrospectively reported a case of esophageal cancer combined with right aortic arch.And a literature review of 20 cases of Chinese and English databases was performed.Results The patient we accepted underwent esophagectomy and cervical esophagogastrostomy with two-field lymphadenectomy via left thoracotomy and laparotomy.The postoperative course was uneventful and no evidence of recurrence was observed at 2 months follow-up.In the literature review,20 patients with esophageal cancer and RAA were reported.3 cases underwent thoracoscopic surgery and the most popular approach was left thoracotomy McKeown operation.Postoperative courses were almost uneventful excepted one patient died due to pneumonia.Conclusion Surgical treatment via left thorax for patients with esophageal cancer and RAA will be feasible and reproducible,and the outcomes are comparable with the common esophageal cancer cases.

Left atrial appendage (LAA) obliteration is a proven stroke-preventive measure for patients with nonvalvular atrial fibrillation (AF). However, the efficacy of LAA obliteration for patients with AF after bioprosthetic mitral valve replacement (MVR) remains unclear.