Giant retrosternal goiter may extend to the carina or below while remaining biologically benign. The main operative challenge is not size alone but whether the mediastinal component can be safely mobilized under direct control of the airway, inferior vessels, recurrent laryngeal nerve (RLN), and parathyroid blood supply. We report two elderly patients with carina-level giant retrosternal goiters to illustrate individualized surgical route selection between a cervical incision alone and a cervical incision with selective T-shaped extended. Two women aged 74 and 81 years underwent surgery for giant retrosternal goiter in 2025. Both underwent contrast-enhanced CT of the neck and chest, thyroid function testing, anesthetic assessment, multidisciplinary operative planning with thoracic surgical support, and preoperative blood typing and cross-matching with blood products available according to institutional protocol. In Case 1, the goiter had a substantial cervical component and extended to the carina. Complete resection was achieved through a cervical incision, but focal RLN transection occurred during difficult inferior-pole/thoracic-inlet dissection and was repaired immediately by end-to-end anastomosis. In Case 2, most of the goiter was retrosternal with minimal cervical bulk and extended approximately 1 cm below the carina. T-shaped extended cervical incision was added to improve exposure, allowing controlled complete resection with RLN preservation. Estimated blood loss was less than 150 mL in both patients. Final pathology confirmed nodular goiter. At 3 months, Case 1 had impaired right vocal-fold movement on laryngoscopy but no obvious hoarseness, subjective voice dissatisfaction, choking, or clinical aspiration. Case 2 had no significant laryngoscopic abnormality or voice/swallowing complaint. Both patients had no respiratory compromise, clinically significant calcium/PTH abnormality, symptomatic hypocalcemia, or clinical recurrence during short-term follow-up. These two cases illustrate the need for individualized surgical route selection in carina-level giant retrosternal goiter. A cervical approach may be reasonable in selected patients when the lesion remains continuous with the cervical thyroid and the mediastinal component, inferior vessels, RLN, and parathyroid glands can be controlled safely under direct visualization. A T-shaped extended cervical incision is an effective adjunct when cervical exposure is inadequate, especially in elderly patients with a deep mediastinal component and minimal cervical bulk. Careful management of the recurrent laryngeal nerve, protection of the parathyroid blood supply, and intraoperative willingness to customize the exposure are essential for achieving complete resection with low morbidity.

4091 Background: Adenocarcinoma of the esophagogastric junction (AEG) is a malignant tumor with high morbidity and mortality globally. Among subtypes, Siewert type Ⅱ AEG remains a clinical challenge owing to its unique anatomical location and distinct clinicopathological features. This study aimed to evaluate the efficacy and safety of Tislelizumab in combination with oxaliplatin and S-1 as neoadjuvant therapy for patients with locally advanced Siewert type Ⅱ AEG. Methods: This is a prospective, multicenter clinical trial. Eligible patients were aged 19-75 years with pathologically confirmed Siewert type II adenocarcinoma of the esophagogastric junction, clinical stage T2-4N0-3M0, ECOG performance status 0-1, and adequate major organ function. All patients received 3 cycles of neoadjuvant therapy consisting of: tislelizumab (200 mg, D1, Q3W), oxaliplatin (130 mg/m², D1, Q3W), and S-1 (40-60mg based on BSA, po, bid, D1-14, Q3W). Following efficacy evaluation, patients underwent resection of the esophagogastric junction adenocarcinoma 4-8 weeks after completion of neoadjuvant therapy. The primary endpoint is pathologic complete response (pCR). Secondary endpoints include major pathologic response (MPR), objective response rate, R0 resection rate, overall survival (OS), disease-free survival (DFS), and safety. Results: As of June 2025, a total of 40 patients were enrolled in this study. The median age was 66 years (range, 37-76), 87.5% were male, and 92.5% had an ECOG performance status of 0. Among them, 87.5% (n = 35) of the patients completed 3 cycles of neoadjuvant therapy. The remaining 5 cases completed 1 (n = 1, due to grade≥3 TRAEs), 2 (n = 2, due to grade≥3 TRAEs and patient decision, respectively), and 4 (n = 2, patient decision) cycles of treatment. All patients underwent resection of the esophagogastric junction adenocarcinoma. The R0 resection rate was 97.5% (39/40), with no patients requiring re-operation or experiencing perioperative mortality. The pathologic complete response (pCR) rate was 25% (10/40). The primary tumor pCR rate reached 30% (12/40), and the major pathologic response (MPR) rate was 37.5% (15/40). Treatment-related adverse events (TRAEs) of any grade occurred in 95% (38/40) of patients, with grade ≥3 TRAEs observed in 15% (6/40). Conclusions: Neoadjuvant therapy with Tislelizumab in combination with oxaliplatin and S-1for locally advanced Siewert type Ⅱ esophagogastric junction adenocarcinoma yields a favorable pathological complete response (pCR) rate and shows a good safety profile. Clinical trial information: ChiCTR2300075638.

To explore changes of tumor-infiltrating lymphocytes and the relationship with therapeutic effect before and after neoadjuvant chemoimmunotherapy in patients with esophageal squamous cell carcinoma(ESCC). This study collected clinical data from 25 ESCC patients with neoadjuvant chemoimmunotherapy from November 2019 to June 2022 in our hospital. After the completion of the neoadjuvant treatment, Mckeown MIE surgery was performed. The pathological specimen before therapy and after surgery was collected. Immunohistochemical analysis was performed to obtain the tumor-infiltrating lymphocytes (TILs) infiltration of the tumor before and after treatment. Seven (28

Background:Esophageal cancer (EC) is the eighth most prevalent malignancy worldwide and exhibits the sixth poorest prognosis. Esophageal squamous cell carcinoma (ESCC) is the predominant pathological subtype. Ferroptosis, an iron-dependent form of cell death, plays a critical role in cancer progression. Long non-coding RNAs (lncRNAs) have emerged as key regulators in the initiation and progression of EC. However, the role of lncRNAs in modulating ferroptosis within EC remains poorly understood. Therefore, this study aimed to identify key ferroptosis-related lncRNAs in ESCC and to investigate the role and mechanism of a specific lncRNA, long intergenic non-protein-coding RNA 92 (LINC00092). Methods:Bioinformatics analysis was conducted to identify ferroptosis-related lncRNAs, transcription factors (TFs), and genes associated with ESCC. The expression, function, tumor microenvironment, immunotherapy, and downstream molecular pathways were also determined. The expression levels of LINC00092, MYC-associated zinc finger protein (MAZ), and NFE2 like bZIP transcription factor 2 (NFE2L2) were detected using quantitative real-time polymerase chain reaction (qRT-PCR), immunohistochemical analysis, and western blotting. Fluorescence in situ hybridization (FISH) was performed to determine the subcellular localization of LINC00092. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), colony formation, wound healing, Transwell, and flow cytometry apoptosis assays were performed to determine the phenotypes and functions of loss- and gain-of LINC00092. RNA immunoprecipitation (RIP) and luciferase reporter assays were used to evaluate interactions involving LINC00092. The expression of ferroptosis-related proteins was verified by western blotting. Results:LINC00092 was found to be downregulated in ESCC datasets, cell lines, and tissue samples. Bioinformatics analysis revealed that LINC00092 was associated with ferroptosis and negatively correlated with NFE2L2 expression. Further investigations demonstrated that LINC00092 acted as a binder to the TF MAZ, modulating the expression of the ferroptosis-related gene NFE2L2. Overexpression of LINC00092 inhibited ESCC cell progression, whereas its downregulation promoted tumor progression. RIP and luciferase reporter assays confirmed that MAZ was a target of LINC00092, and NFE2L2 was a downstream target of MAZ. Western blot analysis showed that LINC00092 enhanced ferroptosis in ESCC cells. The LINC00092/MAZ/NFE2L2 axis appeared to inhibit cancer progression by promoting ferroptosis through the regulation of NFE2L2 and sequestration of the TF MAZ. Conclusions:LINC00092 exerts tumor-suppressive effects in ESCC cells by inhibiting cancer progression through the LINC00092/MAZ/NFE2L2 axis and promoting ferroptosis. Therefore, LINC00092 may serve as a potential therapeutic target for ESCC.

To evaluate the clinical efficacy of Grunenwald incision in cervicothoracic junction surgery. Methods: A retrospective analysis was performed on 29 patients treated at the Fourth Hospital of Hebei Medical University, including 28 patients with cervicothoracic junction tumors (11cases of upper mediastinal tumors, 7 cases of superior sulcus tumors, 4 cases of thyroid tumors with upper mediastinal invasion, 4 cases of chest wall tumors, 2 cases of esophageal cancers with supraclavicular lymph node metastasis) and 1 patient with cervicothoracic junction penetrating trauma. Grunenwald incision or additional posterolateral thoracic incision, median sternal incision or neck collar incision were used in all patients. There was no perioperative death in the whole group. Complete tumor resection was achieved in 25 cases; palliative resection was performed in three cases, and one case underwent complete foreign body removal. The operation time ranged from 120 to 430 minutes, with an average of (231.90 ± 85.30) minutes. The intraoperative blood loss was between 100 and 1000 milliliters, with an average of (286.56 ± 192.90) milliliters. The postoperative hospital stay lasted 6 to 28 days, with an average of (13.14 ± 5.12) days. Follow-up periods spanned 6 to 142 months, with an average of (66.66 ± 46.96) months. During the follow-up period, six patients died. Grunenwald incision can provide good exposure of the structures near the cervicothoracic junction, preserve the integrity of the sternoclavicular joint, reduce shoulder deformity, and has advantages for patients with cervicothoracic junction tumor, high rib resection, and cervicothoracic junction trauma.

Gap junction protein beta 3 (GJB3) has been reported as a tumor suppressor in most tumors. However, its role in lung adenocarcinoma (LUAD) remains unknown. The purpose of this study is to explore the role of GJB3 in the prognosis and tumor microenvironment of LUAD patients. The data used in this study were acquired from The Cancer Genome Atlas, Gene Expression Omnibus, and imvigor210 cohorts. We found that GJB3 expression was increased in LUAD patients and correlated with LUAD stages. LUAD patients with high GJB3 expression exhibited a worse prognosis. A total of 164 pathways were significantly activated in the GJB3 high group. GJB3 expression was positively associated with nine transcription factors and might be negatively regulated by hsa-miR-6511b-5p. Finally, we found that immune cell infiltration and immune checkpoint expression were different between the GJB3 high and GJB3 low groups. In summary. GJB3 demonstrated high expression levels in LUAD patients, and those with elevated GJB3 expression displayed unfavorable prognoses. Additionally, there was a correlation between GJB3 and immune cell infiltration, as well as immune checkpoint expression in LUAD patients

Background:Reasonable nutritional intervention is very important to promote wound healing and rehabilitation in patients with radical esophagectomy for esophageal cancer. This report aims to summarize the experience of nutritional and continuous nursing intervention in a patient who underwent radical resection of esophageal cancer after liver transplantation, by testing a comprehensive approach to optimize nursing plans in similar clinical practice. We hope that the implementation of home enteral nutrition can improve the nutrition status and quality of life of postoperative patients. Case Description:A patient with liver transplantation was admitted to The Fourth Hospital of Hebei Medical University for postoperative care. The nursing intervention were subsequently summarized and analyzed. In July 2023, the patient successfully underwent radical resection for esophageal cancer. Following the operation, the patient received regular medication and on-site nutritional intervention with the consent of her family. At discharge, the prealbumin, albumin, total protein and hemoglobin values of the patient were low, and body weight was 91 kg. The patient's nutritional risk screening (NRS2022) score was 5 points, and the Patient-Generated Subjective Global Assessment (PG-SGA) score was 4 points. After discharge, the patient continued to receive family enteral nutrition treatment, dietary guidance and psychological nursing. A follow-up review conducted 4 weeks after discharge showed improvements in the patient's NRS2022, albumin, total protein, hemoglobin, and body weight. Conclusions:Strengthening postoperative nutritional intervention are vital for promoting rehabilitation in patients who undergo radical resection of esophageal cancer after liver transplantation.

Objective:To investigate the clinical application of Grunenwald incision in cervicothoracic junction surgery.Methods:The clinical data of 25 patients with cervicothoracic junction tumor and 1 patient with cervicothoracic junction trauma in the single treatment group of Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University from December 2011 to September 2021 were analyzed retrospectively, including 19 males and 7 females, aged 9-73 years old. Among the 26 patients, there were 9 cases of upper mediastinal tumor, 6 cases of superior sulcus tumor, 4 cases of thyroid tumor invading the upper mediastinal, 4 cases of chest wall tumor, 2 cases of esophageal cancer combined with supraclavicular lymph node metastasis, and 1 case of foreign body penetrating injury at the cervicothoracic junction. Grunenwald incision or additional posterolateral thoracic incision, median sternal incision, neck collar incision were used in all patients. The degree of tumor resection was evaluated. The operation time, intraoperative blood loss, length of hospital stay were observed, and the postoperative follow-up was analyzed.Results:There was no perioperative death in the whole group. 14 cases were treated with Grunenwald incision alone, 6 cases with additional posterolateral chest incision, 4 cases with additional neck collar incision, and 2 cases with additional median sternal incision. The tumors were completely resection in 22 cases, palliative tumor resection in 3 cases, and complete foreign body removal in 1 case. Postoperative pathology included 4 cases of schwannoma; 3 cases of lung adenocarcinoma, thyroid cancer and myofibroblastoma, respectively; 2 cases of supraclavicular lymph node metastasis of esophageal cancer and lung squamous carcinoma, respectively; 1 case of large cell neuroendocrine carcinoma, metastatic carcinoma of the first rib after lung squamous cell carcinoma, ganglioneuroma, nodular goiter, hemangioma, well differentiated liposarcoma, vascular endothelial tumor and cavernous angioma, respectively. The operation time was 120-430 min, with a mean of(226.92±88.40)min. The intraoperative blood loss was 100-1 000 ml, with a mean of(273.46±196.34)ml. The length of hospital stay was 6-26 days, with a mean of(12.73±4.46 )days. 26 patients were followed up for 6-130 months, with a mean of(57.88±43.64) months. During the follow-up period, 6 patients died.Conclusion:Grunenwald incision can provide good exposure of the structures near the cervicothoracic junction, preserve the integrity of sternoclavicular joint, reduce shoulder deformity, and has advantages for patients with cervicothoracic junction tumors, high rib resection, and cervicothoracic junction trauma.

Objective: To explore the risk factors of anastomotic leakage after minimally invasive esophagectomy (MIE) and to build a prediction model of the probability of postoperative anastomotic leakage. Methods: Clinical data of patients undergoing MIE, admitted in the Fourth Hospital of Hebei Medical University from March 2018 to March 2022, were retrospectively selected, and risk factors of anastomotic leakage after MIE were analyzed by univariate and multivariate logistic regression. A prediction nomogram model was established based on the independent risk factors, and its prediction effect was evaluated. Results: A total of 308 patients were included. Thirty patients had postoperative anastomotic leakage, with an incidence of 9.74%. Logistic regression analysis showed that age, postoperative delirium, pleural adhesion, postoperative pulmonary complications, high postoperative white blood cell count and low lymphocyte count were risk factors for postoperative anastomotic leakage. A nomograph prediction model was constructed based on these risk factors. The predicted probability of occurrence of the nomograph model was consistent with the actual probability of occurrence. The calculated C-index value (Bootstrap method) was 0.9609, indicating that the nomograph prediction model had a good discrimination ability. By drawing the receiver operating characteristic (ROC) curve, we showed that the area under the curve (AUC) of the nomograph prediction model was 0.9609 (95%CI: 0.937-0.985), which indicated a good prediction efficiency of the model. Conclusions: The nomograph prediction model based on the independent risk factors of anastomotic leakage after MIE can accurately predict the probability of postoperative anastomotic leakage.

Objective:To exploring risk factors for perioperative respiratory complications in minimally invasive esophagectomy esophagectomy for esophageal cancer.Methods:A total of 100 patients with squamous esophageal cancer who were underwent total laparoscopic radical esophageal cancer surgery in the Fourth Hospital of Hebei Medical University from January 2021 to October 2022 were retrospectively included as study subjects, and all patients were divided into no-complication group(n=73)and complication group(n=27)according to whether or not they developed respiratory complications during the perioperative period.The baseline and surgery-related data of the patients were pooled and analyzed, and unifactorial and multifactorial logistic regression were applied to analyze the independent risk factors for the occurrence of respiratory complications during the perioperative period of total laparoscopic radical esophageal cancer surgery.Results:Among the 100 patients with squamous esophageal cancer who were underwent total laparoscopic radical esophageal cancer surgery, 27 patients developed respiratory complications during the perioperative period, including 1 patient with tracheal and bronchial injury, 9 patients with hoarseness accompanied by lung infections, 17 patients with pneumonia.There were no statistically significant differences in gender, body mass index, disease duration, history of alcohol consumption, history of hypertension, tumor location, pathological stage, intraoperative bleeding volume, intraoperative intercostal nerve block, and number of lymph node dissection between the complication group and the non-complication group(P>0.05). There were statistically significant differences in age, smoking history, preoperative diabetes mellitus, preoperative chronic obstructive pulmonary disease(COPD), intraoperative fluid infusion volume, operation time, intraoperative thoracic adhesion, and intraoperative recurrent laryngeal nerve injury between the complication group and the non-complication group(P<0.05). The results of multifactorial logistic regression analysis showed that age≥65 years, history of smoking, preoperative diabetes mellitus, preoperative COPD, intraoperative thoracic adhesions, and intraoperative recurrent laryngeal nerve injury were the independent risk factors for the occurrence of perioperative respiratory complications in total laparoscopic radical surgery for esophageal cancer.Conclusion:Perioperative respiratory complications during total laparoscopic radical surgery for esophageal cancer are closely related to age≥65 years, smoking history, preoperative diabetes mellitus, preoperative COPD, intraoperative thoracic adhesion, intraoperative recurrent laryngeal nerve injury.We can better prevent the above risk factors, reduce the occurrence of perioperative respiratory complications, and improve the prognosis of patients by performing nebulization, control of blood glucose levels, and neuroprotection during operation.

Objective:To explore the factors affecting the intraoperative conversion of video-assisted thoracoscopic surgery (VATS) to thoracotomy in patients with lung cancer.Methods:The clinical data of 80 patients with lung cancer in The Fourth Hospital of Hebei Medical University from May 2019 to December 2021 were retrospectively analyzed. The patients who were treated with VATS alone were included into thoracoscopy group (n= 40), and those who were intraoperatively converted from VATS to thoracotomy were included into conversion group (n= 40). The medical record data were collected, the influencing factors of intraoperative conversion from VATS to thoracotomy were analyzed, and the surgical indexes and postoperative complications were compared between the two groups.Results:Multivariate regression model showed that tumor in the upper lobe, central lung cancer, history of pulmonary tuberculosis, pleural adhesion ≥ Grade-4 and maximum tumor diameter ≥ 35 mm were risk factors for patients with lung cancer undergoing conversion from VATS to thoracotomy (p< 0.05). In the conversion group, the surgical duration and hospital stay were longer, the intraoperative bleeding volume and thoracic drainage volume were larger, and the total incidence of postoperative complications was higher than those in the thoracoscopy group (p< 0.05).Conclusion:Conversion from VATS to thoracotomy may increase the risk of complications in patients with lung cancer. Tumor in the upper lobe, central lung cancer, history of pulmonary tuberculosis, high degree of pleural adhesion and large tumor diameter are risk factors for conversion from VATS to thoracotomy.

This study was aimed at exploring the risk factors for thoracotomy in patients undergoing thoracoscopic resection of lung cancer and further analyzing the factors affecting the prognosis of patients. Ninety-six patients with non-small-cell lung cancer who underwent thoracoscopic pulmonary resection were recruited as the subjects, and they were enrolled into the thoracoscopic group (n=88) and the thoracotomy group (n=8) according to whether thoracotomy was performed. Univariate analysis and logistic multivariate regression were performed to analyze the risk factors for conversion to thoracotomy, and nomogram prediction model was employed to analyze the prognostic factors. The results revealed that the proportion of patients over 65 years old, with history of coronary heart disease, diabetes, and pulmonary tuberculosis, etc., in the thoracotomy group and the thoracoscopic group was significantly different (P<0.05). There were statistically significant differences in the development of interlobular cleft, pleural adhesion, tumor diameter>3.5 cm, vascular and lymph node invasion, and tumor TNM stage between the thoracotomy group and the thoracoscopic group (P<0.05). Overall, the age of patients≥65 years old, tumor diameter>3.5 cm, hypoplasia of interlobular fissure, history of pulmonary tuberculosis, pleural adhesion, and TNM stage IIIa were all independent risk factors for thoracoscopic resection of lung cancer to thoracotomy. Cox model and nomogram prediction model analysis showed that surgery methods, tumor diameter>3.5 cm, chemotherapy cycle<4, chemotherapy, and TNM stage IIIa were all independent factors influencing the prognosis of patients undergoing thoracoscopic lung cancer resection. This nomogram prediction model had high application value in patient prognosis prediction.

Objective:To investigate the clinicopathological characteristics and prognostic factors of patients with esophageal cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 447 patients with esophageal cancer who were admitted to the Fourth Hospital of Hebei Medical University from January 1, 2017 to December 31, 2020 were collected. There were 312 males and 135 females, aged 60(range, 37?82)years. Observation indica-tors: (1) clinicopathological characteristics; (2) treatment; (3) follow-up; (4) analysis of prognostic factors for esophageal cancer. Follow-up using telephone interview or outpatient examination was conducted to detect survival of patients up to December 2021. The total survival time was from the surgery date to death or the last follow-up. Patients with duration of follow-up more than 2 years were included for survival and prognostic analysis. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were represented as absolute numbers. Kaplan-Meier method was used to draw survival curves and calculate survival rates. Log-Rank test was used for survival analysis. Univariate analysis was conducted using the Log-rank test. Multivariate analysis was conducted using the COX hazard regression model. Results:(1) Clinicopathological characteristics. Of the 447 patients, 69.80%(312/447) were males and 30.20%(135/447) were females, and there were 3, 18, 101, 229, 93, 3 cases aged 30?39 years, 40?49 years, 50?59 years, 60?69 years, 70?79 years, 80?89 years, respectively. About the pathological type, there were 424 cases with squamous carcinoma, 11 cases with small cell carcinoma, 4 cases with adenosquamous carcinoma, 3 cases with sarco-matoid carcinoma, 2 cases with adenocarcinoma, 1 case with neuroendocrine carcinoma, 1 case with undifferentiated carcinoma, and 1 case with adenoid cystic carcinoma. There were 2 cases with tumor located at cervicothoracic segment, 49 cases with tumor located at upper thoracic segment, 273 cases with tumor located at mid-thoracic segment, and 123 cases with tumor located at lower thoracic segment. There were 6, 24, 74, 59, 192, 80, 12 cases in stage pT0, pT1a, pT1b, pT2, pT3, pT4a, pT4b of pathological T staging, respectively. There were 207, 63, 142, 28, 7 cases in stage pN0, pN1, pN2, pN3, pN4 of pathological N staging by Japan Esophagus Society (JES), respectively. There were 207, 128, 76, 36 cases in stage pN0, pN1, pN2, pN3 of pathological N staging by Union for International Cancer Control (UICC), respectively. About TNM staging, there were 25, 53, 127, 174, 68 cases in stage 0, Ⅰ, Ⅱ, Ⅲ, Ⅳa of JES staging, and 16, 9, 53, 35, 108, 96, 45, 85 cases in stage 0, Ⅰa, Ⅰb,Ⅱa, Ⅱb, Ⅲa, Ⅲb, Ⅲc of UICC staging, respectively. (2) Treatment. Of the 447 patients, 63 cases underwent neoadjuvant therapy(12 cases combined with immunotherapy), 384 cases underwent no neoadjuvant therapy. There were 347, 97, 2, 1 cases with surgical approach as right thoracic approach, left thoracotomy approach, cervical abdominal approach, left thoracoabdominal approach, respectively. There were 316, 5, 126 cases with surgical platform as totally endoscopic esophagec-tomy, Hybrid surgery, open surgery, respectively. There were 350 and 97 cases with digestive recons-truction as posterior mediastinal approach and intrathoracic approach, respectively. Surgical margin as R 0, R 1, R 2 resection was detected in 323, 116, 8 cases, respectively. Six of 447 patients died during the hospital stay. (3) Follow-up. All the 447 patients were followed up for 25(range, 2?48)months, including 233 cases with the follow-up more than 2 years. The median survival time of 233 patients was unreached, and the postoperative 2-year survival rate was 76.8%. (4) Analysis of prognostic factors for esophageal cancer. Results of univariate analysis showed that gender, neoadjuvant therapy, surgical margin, pT staging, pN staging by JES, pN staging by UICC, TNM staging by JES, TNM staging by UICC were related factors influencing prognosis of 233 patients with esophageal cancer ( χ2=6.62, 17.81, 32.95, 37.93, 27.06, 35.56, 45.24, 37.84, P<0.05). Results of multivariate analysis showed that gender, surgical margin, TNM staging by JES were independent factors influencing prognosis of 233 patients with esophageal cancer ( hazard ratio=0.48, 1.94, 1.46, 95% confidence intervals as 0.25?0.91, 1.07?3.52, 1.16?1.84, P<0.05). Conclusions:The incidence of esophageal cancer is relatively high in males, with the onset age mainly distribute in 60?69 years and the mainly pathological type as squamous carcinoma. Patients with esophageal cancer have advanced tumor staging, low proportion of neoadjuvant therapy, high R 0 resection rate of surgical treatment. Gender, surgical margin, TNM staging by JES are independent factors influencing prognosis of patients with esophageal cancer.

目的:探讨miR-515-5p对食管癌细胞增殖、迁移和侵袭的影响及其分子机制.方法:选取2020年6月至2020年12月在河北医科大学第四医院手术切除的60例食管癌患者的癌组织标本和20例健康成人的食管上皮组织标本,以及食管癌细胞TE1、Eca109、KYSE30和KYSE170,用qPCR法检测食管癌组织和细胞中miR-515-5p的表达水平.在Eca109细胞中转染miR-515-5p模拟物以及其阴性对照物、在TE1细胞中转染miR-515-5p抑制剂以及其阴性对照物,qPCR法检测转染效率,用CCK-8法、Transwell实验分别检测转染细胞的增殖、迁移及侵袭能力.采用生物信息学方法分析预测miR-515-5p的下游靶基因,双荧光素酶报告基因实验验证组蛋白去乙酰化酶2(histone deacetylase 2,HDAC2)为miR-515-5p的靶基因.应用GEPIA和TCGA数据集分析HDAC2在食管癌组织中的表达及其与患者临床特征的关系.结果:miR-515-5p在食管癌组织及细胞中表达降低(均P<0.01).过表达miR-515-5p抑制食管癌Eca109细胞的增殖、迁移和侵袭能力(P<0.05或P<0.01),而敲低miR-515-5p表达则可增强食管癌TE1细胞的增殖、侵袭和迁移能力(均P<0.05).双荧光素酶报告基因分析证明,HDAC2是miR-515-5p的靶基因.qPCR和WB实验结果显示,miR-515-5p对HDAC2 mRNA和蛋白表达具有负调控作用.挽救实验证实miR-515-5P通过靶向HDAC2抑制食管癌Eca109细胞的增殖、迁移和侵袭能力(P<0.05或P<0.01).结论:miR-515-5p通过靶向HDAC2影响食管癌细胞的增殖、迁移和侵袭能力.

The sensitivity and specificity of endoscopic ultrasound (EUS) for esophageal cancer are variable. The aim of the present study was to determine the accuracy of EUS for the T staging of esophageal cancer and to explore the factors that affect the accuracy. This was a retrospective study of patients with esophageal cancer who underwent EUS between January 2018 and September 2019 at the author's hospital. All patients underwent EUS, surgery, and pathological examination. The diagnostic value of ultrasound-based T (uT) staging was evaluated using the pathological T (pT) staging as the gold standard. Finally, 169 patients were included. Among the 169 patients, 37 were overstaged by EUS, 33 were understaged, and 99 were correctly staged. The overall accuracy of EUS was 58.6%. Sensitivity was low, at 0% to 70.8% depending upon the pT stage, but specificity was higher, at 71.0% to 100.0%, also depending upon the pT stage. The multivariable analysis revealed that highly differentiated tumors (odds ratio = 9.167, P = .041) and pT stage >= T2 (odds ratio = 2.932, P = .004) were independent factors of accurate uT stage. The staging of esophageal cancer using EUS has low sensitivity but high specificity. Highly differentiated tumors and pT stage >= 2 tumors were associated with the accuracy of uT staging.

Background: Adenocarcinoma is the most common primary lung malignant tumor. However, pulmonary carcinoid tumorlets are rare neuroendocrine tumors, and the coexistence of adenocarcinoma and pulmonary carcinoid tumorlets is extremely rare. Herein, we describe a case of lung adenocarcinoma complicated with carcinoid tumorlets. Case presentation: A 71-year-old female patient was admitted to the hospital after physical examination, multiple micronodules were in the inferior lobe of the left lung and right lung for 2 years, and a tumor was in the superior lobe of the left lung for 1 month. The patient underwent resection of the superior lobe of the left lung and wedge resection of the inferior lobe of the left lung by Video-assisted Thoracoscopic Surgery(VATS). The pathology of the superior lobe of the left lung was adenocarcinoma (pathological stage pT1cN0M0, IA3 stage), and the pathology of the inferior lobe of the left lung was carcinoid tumorlets. The patient was discharged from the hospital one week after the operation and recovered well after follow-up without recurrence. Conclusions: The lack of understanding of carcinoid tumorlets in the clinic causes their misdiagnosis or missed diagnosis. At the same time, the lack of understand also suggests that we should pay attention not only to mass-type lung tumors but also to pulmonary micronodules.

Lung cancer (LC) is a malignant tumor with the highest incidence in the world, and its specific pathogenesis is still unclear. Circular RNAs (circRNAs) are a group of non-coding RNAs that play a key role in the development and progression of various cancers. The expression pattern and function of circRNAs in LC are still not completely distinct. In this study, it was aimed to study the expression and potential mechanism of circ-UBR1 in LC cells. Then it was found that circ-UBR1 was up-regulated in LC cells, and had microRNA (miR)-545-5p binding sites. Meanwhile, it was confirmed by dual-luciferase reporter assay that circ-UBR1 directly bound to miR-545-5p and then repressed its expression. MiR-545-5p was down-regulated in LC cells and refrained its expression by binding to the downstream target gene SSFA2. Knockdown circ-UBR1 or enhancive miR-545-5p repressed A549 cell proliferation, migration, and invasion, but accelerated apoptosis. After transfection with circ-UBR1 low expression vector, upregulation of SSFA2 apparently reversed the depression of reduced circ-UBR1 on cell proliferation, migration, and invasion, and the promotion of cell apoptosis. Further tumor xenograft experiments in nude mice also confirmed that knockdown of circ-UBR1 could increase the expression of miR-545-5p, but decrease the expression of SSFA2, thus alleviating the progression of LC in vivo. Therefore, these results fully indicate that circ-UBR1 promotes LC cell proliferation, migration, and invasion, but represses apoptosis via the circ-UBR1 axis, which may be a closely related marker and therapeutic target of LC.

BACKGROUND:Video assisted thoracic surgery (VATS) is the main surgical method for lung cancer. The aim of this study was to analyze the reasons for conversion to thoracotomy in 83 cases among 1,350 consecutive cases who underwent video-assisted thoracic surgery (VATS) lobectomy by a single surgical team, in order to achieve a deeper understanding of the rules and the opportunity for conversion to thoracotomy in VATS lobectomy under normal conditions.METHODS:The clinical data of 1,350 patients who underwent VATS lobectomy between September 21, 2009 and June 1, 2020, by a single surgical team in the Fifth Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. There were 773 males and 577 females, aged 8-87 years, with a median age of 61.3 years, including 83 cases of benign diseases, 38 cases of lung metastases, and 1,229 cases of primary lung cancer. The cases with stage I, II and IIIa were 676, 323 and 230, respectively. The cases of left upper, left lower, right upper, right middle, right lower, right middle and upper and right middle and lower lobectomy were 301 (22.30%), 231 (17.11%), 378 (28.00%), 119 (8.81%), 262 (19.41%), 16 (1.19%) and 43 (3.19%), respectively.RESULTS:In the cohort of 1,350 consecutive patients with VATS lobectomy, 83 patients (6.15%) were converted to thoracotomy for different reasons. The conversion rate of benign lesions was significantly higher than that of malignant tumors (P<0.05). The conversion rate in stage IIIa was significantly higher than that in stage I and II (P<0.05). The conversion rate of combined lobectomy was significantly higher than that of single lobectomy (P=0.001). The conversion rate of left upper lobectomy was significantly higher than that of other single lobectomy (P<0.001). The conversion rate of right middle lobectomy was significantly lower than that of other single lobectomy (P=0.049). The main reasons for conversion were vascular injury (38.55%), lymph node interference (26.51%) and dense adhesion in thoracic cavity (16.87%). In the conversion group, the total operation time was (236.99±66.50) min and the total blood loss was (395.85±306.38) mL. The operation time in patients converted to thoracotomy due to lymph node interference was (322.50±22.68) min, which was significantly longer than that in the other groups (P<0.05). The intraoperative blood loss in patients converted to thoracotomy due to vascular injury was (560.94±361.84) mL, which was significantly higher than that in the other groups (P<0.05). With the increase in surgical experience, the number of vascular injuries gradually decreased at the early stage, mid-stage and late stage (P=0.045).CONCLUSIONS:In VATS lobectomy, benign lung lesions and more advanced malignant tumors led to more surgical difficulties and higher conversion rate. The conversion rate was different in different lobectomy sites, with the highest in left upper lobectomy, and the lowest in right middle lobectomy. Vascular injury, lymph node interference and dense adhesion were the main reasons for conversion to thoracotomy, which led to prolonged operation time and increased blood loss. With the increasing number of surgical cases, the rate of conversion to thoracotomy in VATS lobectomy continues to decline, which may be mainly due to the more advanced treatment of pulmonary vessels.

Background: Cervical anastomotic leakage (CAL) is one of the most common complications that occur minimally invasive esophagectomy (MIE). It is associated with high postoperative mortality. Some risk factors still remained controversial and so accurate prediction of risk groups for CAL remained very difficult. This study aimed to identify the risk factors of CAL after McKeown MIE to predict the accuracy of the technique as early as possible. Material and Methods: A total of 129 patients with esophageal cancer who underwent McKeown MIE at the Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, between January 2018 and June 2019 were retrospectively reviewed. Multivariate logistic regression analysis was used to identify the risk factors for CAL and receiver operating characteristic (ROC) curve analysis was used to predict the accuracy for each quantitative data variable and determine the cutoff value. Results: There were statistically significant differences between Group CAL and Group NCAL in FEV1 (p = 0.031), neoadjuvant chemotherapy (p = 0.001), intraoperative minimum PaCO2 (p = 0.002), and hospital stays (p <0.001). In multivariate logistic regression, FEV1 (OR = 0.440, p = 0.047), neoadjuvant chemotherapy (OR = 4.425, p = 0.003), and intraoperative minimum PaCO2 (OR = 1.14, p <0.001) were identified to be three risk factors of CAL. The ROC curve analysis showed that FEV1 <2.18L (p = 0.029) and intraoperative minimum PaCO2 >45.5 mmHg (p = 0.002) demonstrated good accuracy. Conclusion: FEV1, neoadjuvant chemotherapy, and intraoperative minimum PaCO2 in arterial blood gas (ABG) were considered as risk factors of CAL after McKeown MIE for esophageal cancer. Preoperative FEV1 <2.18L and intraoperative minimum PaCO2 >45.5 mmHg in ABG showed good accuracy in predicting risk factors for CAL.

This study aims at probing the inhibitory effect of transmembrane PBLs on non-small cell lung cancer (NSCLC) H446 cells and the potential application of PBLs on immune system of the experimental mice loaded with H446 cells. The changes of the gene expression of microRNA-25 and 223 in ICR mice with NSCLC were also investigated. Sixty ICR mice were randomly divided into experimental and control groups. The animal model was established via inoculation of NSCLC H446 cells at the hind thigh of mice. The plasmid PBLs was dissolved in saline solution and injected into the muscle of left thigh of the mice in experimental groups with different doses (0.1 mg, 0.2 mg and 0.3 mg per ICR mouse) using in situ injection method. After injection of PBLs solution, each three mice were killed at 12 h, 24 h, 36 h, and 48 h, respectively. The expression of microRNA-25 and 223 were detected by semi-quantitative reverse transcription-polymerase chain reaction. Tumor Necrosis Factor-γ (TNF-γ), Interleukelin-2 (IL-2) and Heat Shock Protein 70 (HSP70) in Bronchoalveolar Lavage Fluid (BALF) were detected by enzyme-linked immunosorbent assay. The expression of TNF-γ and IL-2 protein in lung tissue were detected by western blotting. The expression of microRNA-25 was up-regulated in the tissues and BALF with a dose- and time-dependent manner while microRNA-223 was down-regulated. The difference were statistically significant comparing the control group (P<0.05). The TNF-γ and IL-2 levels in BALF of ICR mice in experimental group were increased comparing the control group with a dose-dependent manner (P<0.05). Synergistic effect between PBLs and HSP70 was also studied. It was found that the growth of tumor was significantly suppressed after the transfection of PBLs. In the presence of PBLs, the proliferation of splenocytes and cytolysis in early phase of tumor development was significantly enhanced. Thus, such anti-tumor effect was further improved by the synergistic effect of PBLs with HSP70. The expression of microRNA-25 and 223 are associated with NSCLC in a dose- and time-dependent manner, they might be considered as potential biomarkers for early diagnosis of NSCLC.