Background: With the increasing number of small pulmonary nodules detected, effective localization of pulmonary nodules has become an issue. The goal of this study is to determine the safety and feasibility of a newly developed augmented reality navigation technology for intraoperative localization of small pulmonary nodules.Methods: We conducted a prospective single-center feasibility study of a novel augmented reality navigation system and lung localization (LungBrella) marker on ten patients between July and October 2020. For augmented reality navigation-guided localization, a preoperative chest computed tomography scan was performed to generate 3-dimensional (3D) virtual images and individualized localization plan, which were uploaded into Hololens (a head-mounted augmented reality device). Under the guidance of established procedure plan displayed by HoloLens, localization marker was placed in operating room. Segmentectomy or wedge resection was subsequently performed. The primary endpoint was the localization procedure success rate, and the secondary endpoints were localization time, operation time, and complications.Results: Localization was successful in seven of the ten procedures. Due to different reasons, failures were noted in three cases, after which immediate adjustments were made. In the successful cases, the LungBrella marker was positioned at a median of 5.8 mm (range, 0-10 mm) from the edge of the nodule. Median localization time was 9.4 min (range, 5-19 min), and median operation time was 172.9 min (range, 105-200 min). There were no complications during the entire process.Conclusions: This exploratory study suggests that augmented reality navigation-guided pulmonary nodule localization is a safe and feasible technique (ClinicalTrials.gov identifier, NCT04211051).

Primary small cell carcinoma of the esophagus (PSCCE) is a highly malignant tumor that is diagnosed by endoscopic biopsy and immunohistochemistry. Because of its low incidence, a high degree of malignancy, and rapid progress, it is difficult to conduct large, randomized controlled trials and to establish a standard treatment plan for this disease. In recent years, several retrospective studies have been reported, and with the rise of emerging therapies, PSCCE has gradually become a focus of thoracic surgery. This paper reviews progress in the diagnosis and treatment of PSCCE in recent years.

Background Airway-gastric fistulas (AGFs) are rare but life-threatening complications after esophagectomy for esophageal cancer. Their effective and reasonable management is challenging and still controversial. This study reports the classification and management strategies of post-esophagectomy AGF based on a retrospective analysis of 26 cases in two large volume centers in China. Methods Between January 2000 and December 2017, 6,316 consecutive patients with esophageal carcinoma underwent esophagectomy. AGF was verified in 26 patients. The patients with AGF were divided into two types based on the anatomic characteristics of the fistula. Type I was characterized by the presence of fistula orifices in digestive tract that were higher than those in the airway and were treated with conservative management. Type II had both fistula orifices located on the same horizontal plane and were treated with surgical management. Pearson Chi-Square (R software) was used to compare mortality rates. Results From January 2000 and December 2017, 26 cases occurred AGF in 6,316 consecutive patients with esophageal carcinoma underwent esophagectomy and the incidence of AGF was 0.4%. Ten of 12 patients with type I AGF survived. Nine of 14 patients with type II AGF died. There was a significantly difference in the mortality rates between patients with AGF type I and II, which was 16.7% (2/12) and 64.3% (9/14) (χ2=6.003, P=0.014), respectively. Conclusions AGF may be classified into two types according to the anatomic characteristics. Type I patients may be cured by conservative management and type II patients, require surgical intervention with pedicled tissues flap wrapping of the airway.

BACKGROUND:Radiological manifestations of coronavirus disease 2019 (COVID-19) featured ground-glass opacities (GGOs), especially in the early stage, which might create confusion in differential diagnosis with early lung cancer. We aimed to specify the radiological characteristics of COVID-19 and early lung cancer and to unveil the discrepancy between them.METHODS:One hundred and fifty-seven COVID-19 patients and 374 early lung cancer patients from four hospitals in China were retrospectively enrolled. Epidemiological, clinical, radiological, and pathological characteristics were compared between the two groups using propensity score-matched (PSM) analysis.RESULTS:COVID-19 patients had more distinct symptoms, tended to be younger (P<0.0001), male (P<0.0001), and had a higher body mass index (P=0.014). After 1:1 PSM, 121 matched pairs were identified. Regarding radiological characteristics, patients with a single lesion accounted for 17% in COVID-19 and 89% in lung cancer (P<0.0001). Most lesions were peripherally found in both groups. Lesions in COVID-19 involved more lobes (median 3.5 vs. 1; P<0.0001) and segments (median 6 vs. 1; P<0.0001) and tended to have multiple types (67%) with patchy form (54%). Early lung cancer was more likely to have a single type (92%) with oval form (66%). Also, COVID-19 and early lung cancer either had some distinctive features on computed tomography (CT) images.CONCLUSIONS:Both COVID-19 and early lung cancers showed GGOs, with similar but independent features. The imaging characteristics should be fully understood and combined with epidemiological history, pathogen detection, laboratory tests, short-term CT reexamination, and pathological results to aid differential diagnosis.

Esophagectomy is the core treatment modality for operable esophageal cancer. For middle and lower third esophageal carcinoma, Ivor Lewis two stage esophagectomy is increasingly performed worldwide. In recent years, minimally invasive esophagectomy (MIE) has been widely applied, which has the superiority over open esophagectomy in terms of postoperative morbidity and mortality. The robotic surgical system provides a three-dimensional, high definition view, and improved stability and flexibility for operation, which unveiled a new era of MIE. Robot-assisted Ivor-Lewis esophagectomy (RAILE) has been suggested as a safe and feasible procedure for the treatment of operable middle and distal esophageal cancer. This review focuses on the perioperative and oncological outcomes of RAILE based on available evidence.

[目的]探究预防性使用多孔纳米硒材料Se@SiO2能否抑制激素性股骨头坏死(SANFH)的发生.[方法]体外实验:选取SPF级4周龄SD大鼠2只,提取、培养并鉴定股骨头软骨细胞,利用细胞增殖与活性检测试剂(CCK-8)检测Se@SiO2在应用浓度下对软骨细胞活性的影响,再利用活性氧试剂盒检测Se@SiO2对软骨细胞抗氧 化应激作用的影响.体内实验:选取SPF级8周龄SD大鼠24只,随机选取12只SD大鼠作为实验组,每2d腹腔注射1mg/kg Se@SiO2共2周,之后24只大鼠利用静脉给予甲强龙建立激素性股骨头坏死动物模型,通过股骨头软骨组织IL-1β、MMP-13的表达和HE染色切片评估预防性使用Se@SiO2对股骨头软骨组织坏死的改善作用.[结果](1) Se@SiO2在应用浓度下对股骨头软骨细胞无明显细胞毒性,并且加入Se@SiO2干预可有效清除软骨细胞活性氧水平;(2)提前加入Se@SiO2干预2周后股骨头软骨组织IL-1β、MMP13表达明显下降,HE染色显示提前使用Se@SiO2干预能有效改善SANFH程度.[结论]提前2周给予Se@SiO2,能改善SANFH程度.

Doxorubicin (DOX) is an effective anticancer drug which is widely used in clinical treatment. However, the severe cardiotoxicity limits its use. Thus, it is an urgent need to attenuate the toxicity of DOX without impairing its efficacy. Many studies show that Se may protect normal tissues from damages of some anticancer drugs. Recently, Se@SiO2 nanocomposites emerges as better substitutes for direct element Se in treatment of cancer cells for their ideal biocompatibility. In the present article, we synthesized Se@SiO2 nanocomposites and confirmed their characterization according to previous studies. We accomplished a conjunctive use of Se@SiO2 nanocomposites with DOX then explored the toxicity and efficacy of this combination. In the in vivo experiments, the survival rate of mice with DOX treatment was significantly increased by Se@SiO2. And Se@SiO2 has few interference to the therapeutic effect of DOX. Particularly, Se@SiO2 significantly attenuated DOX-induced myocardial tissue damage (serum index, apoptosis index, western-blot index) and protected mice from reduction in LVEF induced by DOX in mice model. In summary, we concluded that the protective effect of Se@SiO2 in DOX-induced cardiotoxicity was possibly attributable to the inhibition of ROS production, showing great potential of Se@SiO2 nanocomposite in the clinical use of DOX.

Background Methylprednisolone (MPS) is an important drug used in therapy of many diseases. However, osteonecrosis of the femoral head is a serious damage in the MPS treatment. Thus, it is imperative to develop new drugs to prevent the serious side effect of MPS. Methods The potential interferences Se@SiO2 nanocomposites may have to the therapeutic effect of methylprednisolone (MPS) were evaluated by classical therapeutic effect index of acute respiratory distress syndrome (ARDS), such as wet-to-dry weight ratio, inflammatory factors IL-1β and TNF-α. And oxidative stress species (ROS) index like superoxide dismutase (SOD) and glutathione (GSH) were tested. Then, the protection effects of Se@SiO2 have in osteonecrosis of the femoral head (ONFH) were evaluated by micro CT, histologic analysis and Western-blot analysis. Results In the present study, we found that in the rat model of ARDS, Se@SiO2 nanocomposites induced SOD and GSH indirectly to reduce ROS damage. The wet-to-dry weight ratio of lung was significantly decreased after MPS treatment compared with the control group, whereas the Se@SiO2 did not affect the reduced wet-to-dry weight ratio of MPS. Se@SiO2 also did not impair the effect of MPS on the reduction of inflammatory factors IL-1β and TNF-α, and on the alleviation of structural destruction. Furthermore, micro CT and histologic analysis confirmed that Se@SiO2 significantly alleviate MPS-induced destruction of femoral head. Moreover, compared with MPS group, Se@SiO2 could increase collagen II and aggrecan, and reduce the IL-1β level in the cartilage of femoral head. In addition, the biosafety of Se@SiO2 in vitro and in vivo were supported by cell proliferation assay and histologic analysis of main organs from rat models. Conclusion Se@SiO2 nanocomposites have a protective effect in MPS-induced ONFH without influence on the therapeutic activity of MPS, suggesting the potential as effective drugs to avoid ONFH in MPS therapy.

Osteoarthritis is a common articular cartilage degenerative disease and the main cause is mechanical instability. The mechanical instability can reduce the number of chondrocytes and destroy extracellular matrix through direct injury, inducing cell apoptosis, and stimulating the production of inflammatory factors, leading to decrease of matrix typeⅡ collagen and proteoglycan and degeneration of cartilage. Long-term cartilage degeneration can result in osteoarthritis. Therefore, understanding how mechanical instability leads to the incidence of osteoarthritis can better improve the course of osteoarthritis from the perspective of mechanics.

Acute paraquat (PQ) poisoning is one of the most common forms of pesticide poisoning. Oxidative stress and inflammation are thought to be important mechanisms in PQ-induced acute lung injury (ALI). Selenium (Se) can scavenge intracellular free radicals directly or indirectly. In this study, we investigated whether porous Se@SiO2 nanospheres could alleviate oxidative stress and inflammation in PQ-induced ALI. Male Sprague Dawley rats and RLE-6TN cells were used in this study. Rats were categorized into 3 groups: control (n=6), PQ (n=18), and PQ + Se@SiO2 (n=18). The PQ and PQ + Se@SiO2 groups were randomly and evenly divided into 3 sub-groups according to different time points (24, 48 and 72 h) after PQ treatment. Porous Se@SiO2 nanospheres 1 mg/kg (in the PQ + Se@SiO2 group) were administered via intraperitoneal injection every 24 h. Expression levels of reduced glutathione, malondialdehyde, superoxide dismutase, reactive oxygen species (ROS), nuclear factor-κB (NF-κB), phosphorylated NF-κB (p-NF-κB), tumor necrosis factor-α and interleukin-1β were detected, and a histological analysis of rat lung tissues was performed. The results showed that the levels of ROS, malondialdehyde, NF-κB, p-NF-κB, tumor necrosis factor-α and interleukin-1β were markedly increased after PQ treatment. Glutathione and superoxide dismutase levels were reduced. However, treatment with porous Se@SiO2 nanospheres markedly alleviated PQ-induced oxidative stress and inflammation. Additionally, the results from histological examinations and wet-to-dry weight ratios of rat lung tissues showed that lung damage was reduced after porous Se@SiO2 nanosphere treatment. These data indicate that porous Se@SiO2 nanospheres may reduce NF-κB, p-NF-κB and inflammatory cytokine levels by inhibiting ROS in PQ-induced ALI. This study demonstrates that porous Se@SiO2 nanospheres may be a therapeutic method for use in the future for PQ poisoning.

Objective To observe the thermal tolerance of the knee joints in SD rats of different age,and to explore the development mechanism of age-related osteoarthritis (OA).Methods Male SD rats were divided into 3 groups:young (1-month-old),adult (6-month-old) and old rats (18-month-old).A volume of 100 μL Cu9S5@SiO2 nanoparticles was injected into the both knee joints in all 3 groups.The knee joints in the right side were irradiated with the 980 nm,0.72 W/cm2 laser.The temperature of the joint cavity was maintained for 5 minutes after it rose to 50℃.The knee joints were not irradiated and used as control.The knee joint damage was evaluated after 4 weeks.Primary chondrocytes were isolated from the knee joints.The senescence of chondrocytes was evaluated by means of the length of the telomere.Chondrocytes were divided into 3 groups by their origin:young,adult and old rats.CCK 8 was used to evaluate the proliferative ability of these chondrocytes with or without the addition of H2O2 and IL-1β.The apoptosis of chondrocytes exposed to 50 μmol/L H2O2 and 100 ng/mL IL 1β was assessed by TUNEL.Results At 4 weeks after the thermal injury,the severity of cartilage damage was increased in the following order:young,adult and old rats;while the proliferative ability of the chondrocytes decreased in the same age sequence(P＜0.05).The resistance capacity towards H2O2 decreased from the adult,young to the old rats.IL-1β at a concentration below 200 ng/mL exhibited positive effect on the chondrocytes from the young and adult rats,whereas exerted inhibitory effect on the chondrocytes from the old rats when the concentration was over 60 ng/mL.Upon the addition of 50 μmol/L H2O2,the apoptosis ratio was reduced in an order of young,adult and old SD rats(P＜0.05),but there was no significant difference among different age group under the exposure to 100 ng/mL IL 1β(P＞0.05).Conclusion The proliferative capacity and resistance capacity towards ROS and IL-1β of chondrocytes varied significantly among different age groups.The older the age,the lower the proliferation activity and the weaker the resistance capacity to external injury.The mechanism of agerelated osteoarthritis was preliminarily validated.

目的:了解上海市高校大学生对性用品的态度和使用状况,为进一步开展大学生生殖健康教育和服务提供依据.方法:于2014年12月～2015年3月,通过自编网上问卷,以分层整群抽样的方法调查了上海市6所高校的2000名在校大学生.调查内容主要包括:大学生对性用品的了解状况、态度和使用状况.结果:高校大学生对于性用品的总体了解程度不高,对于一般性用品非常了解、比较了解和一般了解的比例分别为6.8％、16.4％和33.3％,大学生对于特殊性用品的了解更少.总体上,高校大学生对于性用品的态度比较开放,对于一般性用品感觉正常使用、感觉很好奇,因为没见过的分别占48.0％、31.7％.高校大学生一般性用品和特殊性用品的总体使用率分别为15.6％和4.0％,使用率随着年级的增高呈上升趋势.大部分大学生不同程度地希望更加深入了解性用品.结论:大学生对性用品的态度比较开放,对性用品了解程度不高;建议在高校生殖健康教育中进一步融入性用品的知识.