Objective:To analyze the incidence and risk factors of postoperative new-onset atrial fibrillation(POAF) after lobectomy.Methods:A monocentric ambispective cohort study was conducted. The retrospective cohort included 1 902 patients who underwent lobectomy in our hospital between January 2017 and December 2019. The prospective cohort included 692 patients who underwent lobectomy in our hospital between August 2020 and July 2021. A total of 2 594 patients were enrolled in this study. The median age of enrolled patients was 61 years(interquartile range, 54-67 years), and the cohort consisted of 1 384(51.97%) females and 1 246(48.03%) males. Baseline and perioperative clinical data of enrolled patients were collected. Univariate and multivariate logistic regression analyses were performed to identify the risk factors related to POAF. Results:There was no patient died in hospital after surgery. A total of 111 cases of POAF were followed up during the postoperative hospital period, and the incidence of POAF was 4.28%. Multivariate regression analysis found that the elderly patients(aged 60 and above)( OR=1.58, 95% CI: 1.01-2.47, P=0.044), history of percutaneous coronary intervention( OR=2.50, 95% CI: 1.04-6.03, P=0.041), history of arrhythmia excluding atrial fibrillation/flutter( OR=3.96, 95% CI: 1.95-8.00, P<0.001), left upper lobectomy( OR=1.73, 95% CI: 1.11-2.68, P=0.015), low preoperative albumin level( OR=1.07, 95% CI: 1.00-1.14, P=0.048) and large cell neuroendocrine carcinoma( OR=4.70, 95% CI: 1.38-15.98, P=0.013) were independent risk factors for POAF after lobectomy. Conclusion:The incidence of POAF after lobectomy is 4.28% in this study. Elderly patients(aged 60 and above), history of percutaneous coronary intervention, history of arrhythmia excluding atrial fibrillation/flutter, left upper lobectomy, low preoperative albumin level, and large cell neuroendocrine carcinoma are the independent risk factors related to POAF after lobectomy.

Objective To establish a patient-derived xenograft (PDX) model library of lung cancer,and to compare the biological consistency between primary tumors and passaged tumors,at the same time to find the key factors affecting the formation of PDX tumor.Methods Fresh surgical or biopsy samples from lung cancer patients were collected and subcutaneously transplanted into immunodeficient mouse model (NOD-Prkdcnull-Il2rgnull) to establish the PDX model and then passaged with 3-5 generation.Structure and cell morphology,and biomarkers of passages of PDX tumor tissue and primary tumor tissue were compared.Combined with patients' clinical data,key factors affecting the tumor take rate were analyzed.Results a total of 195 lung cancer samples were collected and 59 cases of lung cancer PDX were successfully established.The rate of PDX tumor formation was 29.65％.The pathological analysis results of the tumor samples from all the tumor models of PDX were consistent with the corresponding primary tumors.The key factors affecting the take rate and tumor formation time were pathological types of primary tumors.The take rate of adenocarcinoma was 14.75％ whereas the take rate of squamous cell carcinoma was 56.60％.Conclusion The library of lung cancer PDX models we have established retained the key features of primary cancers,providing an effective resource for research and development of drug efficacy evaluation in pre-clinical trial and identification of biomarkers for drug responsiveness.

目的 探讨影响高龄（≥70岁）Ⅰ期非小细胞肺癌（non—small cell lungcancer，NSCLC）患者术后生存的预后因素。方法回顾性分析2003年4月～2013年12月我院211例70岁及以上I期NSCLC的临床及随访资料，对影响术后生存的预后因素采用Kaplan．Meier生存分析、log-rank检验及Cox回归分析。结果中位随访时间39个月（0～93个月）。5年总生存率为66．9％，Kaplan—Meier生存分析和Cox单因素回归分析显示病变部位、病理分期、病变直径、分化程度、查尔森合并症指数（Chalsoncomorbidityindex，ccI）对总生存期存在影响。Cox多因素回归分析显示：病变部位（HR=3．946，95％C11．571～9．910）、病理分化（HR=2．003，95％C11．049—3．824）、肿瘤直径（HR=2．841，95％C11．478～5．462）及CCI（HR：3．920，95％CI1．767～8．698）是影响高龄早期肺癌患者术后生存的独立预后因素。结论对于早期高龄NSCLC患者，CCI、病变部位、分化程度、肿瘤直径是影响术后生存的重要预后因素。CCI对长期生存预后有一定的价值。加强术前综合评估有利于指导预后。

建筑物提取是高分辨率光学遥感图像理解和目标识别的重要研究方向.实现自动化、智能化、可靠准确的遥感图像建筑物提取对基础地理数据获取和更新具有重要的应用价值和现实意义.在概述高分辨率光学遥感图像建筑物提取研究现状的基础上,综述了当前建筑物提取的主要思想和方法,将主流的建筑物提取代表性方法分为自底向上数据驱动方法(Data-driven)和自顶向下模型驱动方法(Model-driven)两大类,在综合比较评述各方法特性的基础上,对该领域仍然存在的问题和研究方向进行了分析和展望.

Objective Identify risk factors of N1 lymph node metastasis in clinical stage l non-small cell lung cancer,to try to improve the accuracy of preoperative N staging and help make treatment decision.Methods Records of patients with clinical stage Ⅰ NSCLC who had undergone pulmonary resection with systematic node dissection at Peking University People' s Hospital between September 2006 and December 2013 were retrospectively reviewed.To identify risk factors for N1 node metastasis,univariate and multivariate logistic regression analyses were performed.Results Among the 612 patients eligible for this study,intrapulmonary lymph node(N1) metastasis occurred in 59 patients(9.6％).In univariate analysis,7 risk factors were identified:male,cigarette smokers,tumor size,tumor location(central),non-adenocarcinoma,tumor differentiation degree and microvascular invasion.In multivariate analysis,3 independent risk factors were identified:tumor size(OR =1.903,P ＜ 0.01),tumor differentiation degree (OR =2.591,P ＜ 0.01) and microvascular invasion (OR =6.170,P ＜ 0.01).Through the analysis of ROC curve,the optimal cutoff point of tumor size was 2 cm,the N1 transfer rate was 4.9％ when tumer size ≤2 cm,the rate was 15.0％ when tumer size ＞ 2 cm.Conclusion The prevalence of N1 nodal metastasis in clinical stage Ⅰ NSCLC patients was 9.6％.Tumor size,tumor differentiation degree and microvascular invasion were identified as 3 independent predictive risk factors for N1 nodal metastasis in clinical stage Ⅰ NSCLC patients.Patients of clinical stage Ⅰ NSCLC with tumor size ＞ 2 cm were recommended to receive further N staging procedures(PET/CT or EBUS-TBNA) before surgery to attain a more accurate N stage.

Objective To evaluate the efficacy and safety of induction concurrent chemoradiation therapy with weekly docetaxel and cisplatin(DP) for stage Ⅲ A-N2 lung cancer.Methods Eighteen patients diagnosed of stage Ⅲ A-N2 NSCLC in our center were enrolled from March,2011 to November,2013.The induction regimen consisted of 5 cycles of docetaxel(20 mg/m2) and cisplatin(20 mg/m2) administered intravenously on days 1,8,15,22 and 29 with concurrent thoracic radiotherapy in fractions of 1.8Gy,to a total dose of 45Gy.Patients proceeded to surgery,if no progressive disease occurred,followed by adjuvant chemotherapy with DP strategy.Results Eighteen patients were enrolled and 12 underwent surgery.The tumor response for the induction therapy was 1 CR,10 PRs,6 SDs and 1 PD.Five of 18 patients presented with level 3 or above adverse effects,among which were 2 neutropenia,1 liver toxicity,1 anemia and 1 lymph node infection.The median operation time was 290 min,intraoperative blood loss was 350 ml,length for postoperative drainage was 5 d,and time to discharge was 7 d.The mediastinal lymphnodedownstaging rate was 50％ (3 pN0 cases and 3 pN1 ones),92％ of the operated patients reached complete resection.One-year survival was 75.9％ and 1-year progression free survival was 49.2％.Conclusion Weekly docetaxel and cisplatin strategy in induction concurrent chemoradiotherapy for stage Ⅲ A-N2 NSCLC patients has been validated to be safe and effective.

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 evaluate the clinical significance of activation of mammalian target of rapamycin (mTOR) pathway,represented by phosphorylation of mTOR protein,in stage Ⅰ lung adenocarcinomas.Methods The activation of mTOR was semi-quantitated in 222 samples of adenocarcinomas by using immunohistochemistry,and its correlation with clinical and survival data was analyzed statistically.Results Activation of mTOR pathway was identified in 55％ (122/222) adenocarcinomas.The activation was not significantly associated with clinical parameters,but patients with mTOR activation had longer survival (P ＜ 0.05).Conclusion mTOR pathway is frequently activated in stage Ⅰ lung adenocarcinomas and defines a subgroup of patients with a favorable outcome.

近年来,低剂量CT广泛用于肺癌筛查,肺微小结节(≤1 cm)和肺内磨玻璃影(GGO)的检出量日趋上升,术中定位的难度随之增加,对于定位手段的需要和依赖程度也随之提高[1].肺结节定位技术历经多年探索,已可借助不同设备、手段和材料实现定位.现对可行的肺微小结节和GGO的定位方法进行综述如下.

BACKGROUND:The pathological diagnosis is of critical importance to the subsequent treatment for the pathients with superior vena cava syndrome (SVCS). The aim of this study is to report our experience in the diagnosis of SVCS by endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA).METHODS:The data of 520 patients who underwent EBUS-TBNA from September 2009 to May 2012 at our institution were reviewed. Of these, there were 14 males and 6 females (mean age of 59.1 years) with SVCS who received EBUS-TBNA that were included in the analysis.RESULTS:The mean short axis diameter of the paratracheal lesions was (3.32 ± 1.79) cm (range, 1.69 to 9.50 cm) and 6 cases also had subcarinal lymph node enlargement with a mean short axis diameter of (2.14 ± 0.49) cm (range, 1.73 to 3.01 cm). An average of 4.3 punctures was performed per lesion. Malignancy was confirmed in 16 cases (10 small cell carcinomas, 4 adenocarcinomas, 1 squamous cell carcinoma and 1 Hodgkin lymphoma). In two patients, pathological examination of tissue revealed no evidence of malignancy and for 13 to 24 months of follow-up. One patient from whom adequate tissue was not obtained refused further surgical biopsy since he had undergone endovascular stenting of the SVC. One patient in whom a diagnosis was not obtained by EBUS-TBNA underwent thoracoscopic biopsy and the final diagnosis was B cell non-Hodgkin's lymphoma. The diagnosis accuracy of EBUS-TBNA in SVCS was 18/20 patients.CONCLUSION:EBUS-TBNA is a highly effective and safe procedure for the diagnosis of SVCS.

局部进展期非小细胞肺癌的治疗模式仍存在争议,新辅助放化疗后进行手术是目前临床研究的热点。新辅助放化疗对于局部晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)可以不同程度地降低疾病分期,使患者获得根治性手术机会,从而改善患者的预后。但患者手术前经过放疗、化疗后所产生的一些毒副反应可能会增加围术期并发症和死亡率。因此,术前应做好患者的心理护理、指导患者心肺功能的锻炼方法,提高患者对手术的耐受性;术后严密观察患者生命体征、加强呼吸道的管理、引流管的护理及疼痛的护理。这是预防各种术后并发症、促进患者顺利恢复、确保治疗效果的关键。

对1例主诉为"结肠癌术后5年,直肠癌术后2年,咳嗽咳痰、痰中带血半个月"的患者进行病例讨论.该患者5年前曾行结肠癌根治术,2年前行直肠癌根治术,目前发现肺多发转移灶.通过多学科讨论,意见1认为该病例虽为肺部多发转移,但仍可完全切除,建议手术治疗:意见2认为该患者除了肺部,其他部位可能存在潜在转移灶,建议保守治疗,采用FORFIRI方案化疗.该患者最终采取手术切除肺转移灶,术后采用FOLFIRI方案辅助化疗.

Objective To investigate the possibility of SLC35F2 inhibition by lentiviral vector-mediated RNA interference (RNAi) and the influence on cell proliferation and apoptosis in lung cancer cell line,and to set up a lung cancer cell line in which SLC35F2 is stably suppressed.Methods The lentiviral vector of siRNA targeted against SLC35F2 (SLC-siRNA) was constructed and transfected into the packaging cells 293T,and the viral supernatant was collected to transfect H1299 cells.After selection by puromycin and culture expansion,the stable cell clones were attained.Quantitative real-time fluorescent polymerase chain reaction (PCR) and Western blotting were used to detect the expression of SLC35F2.The effect of SLC35F2 silencing by RNAi on cell proliferation was quantified by CCK-8 assay.Annexin V-FITC/PI staining was employed to examine the apoptosis.Results Lentiviral vector SLC35F2-shRNA was constructed successfully.As compared with control group,the SLC35F2 expression was decreased to 81.8% in RNA and protein levels.CCK-8 revealed that the inhibition rate of H1299 cells transfected with SLC35F2 was 16.3%,and the apoptosis rate was significantly increased as compared with negative control group ( 14.88% vs 3.16% ,P ＜0.05 ).Conclusion Lentiviral vector-mediated RNA interference targeting against SLC35F2 can effectively inhibit SLC35F2 expression and cell proliferation.The lung cell line in which SLC35F2 gene was stably suppressed was successfully established.

2009年4月至2010年6月我们应用电视纵隔镜辅助颈腹两切口切除早期中上段食管癌17例,现总结报道如下. 临床资料 本组中男10例,女7例;年龄48～75岁,中位年龄57.3岁.所有病例术前均经上消化道钡透和胃镜、病理证实为食管中上段、距门齿23～27 cm鳞状细胞癌.胸部CT证实病灶无明显外侵.8例行PET-CT检查,纵隔内未见明显肿大淋巴结.根据美国癌症联合会(AJCC)组织修订的第7版食管癌TNM分期标准[1]:T1N0M0 7例,T2N0M09例,T3N0M01例;其中右侧胸膜炎、双侧胸膜炎、双肺陈旧性肺结核、慢性哮喘病各1例,右肺纤维增殖性肺结核2例,慢支肺气肿3例.

Objective By comparing the activity of signaling pathway in different cell lines affected by K-ras mutation, to investigate the resisitance to epidermal growth factor receptor (EGFR) inhibitors due to K-ras mutation. Methods Methyl thiazol tetrazolium (MTF) method was used to mensure the sensitivity and half maximal inhibitory concentration ( IC50 ) of AKT and STAT inhibitors after transfection of K-ras or blank plasmid into HCC827 and H292 cells. Western blotting was used to compare the activity of downstream signaling pathway in different cell lines. Results After transfection of mutant K-ras, the IC50 of AKT and STAT inhibitors in HCC827 cells was reduced by 1.9 and 5.3 times respectively, and that in H292 cells was reduced by 3.0 and 2. 0 times respectively. The activity of AKT and STAT pathways in HCC827 cells transfected with mutant K-ras was continuously activated, while that in H292 cells was suppressed. Conclusion K-ras-induced resistance to EGFR inhibitors may be related to other mechanisms. In the tumor cells bearing mutant or wild-type EGFR gene, there may exist different influences of K-ras mutations on AKT and STAT pathways.

自从3个月前在一次普通体检中发现肺部长了小结节,王阿姨寝食难安,一个月内跑了6家医院,看过呼吸科、胸外科、肿瘤科、检验科的大夫,有的医生建议观察,有的医生建议手术切除。在CT检查室外,王阿姨遇到了好几个肺内长小结节病人,都不知道该怎么办好,一个哈尔滨来北京就医的病人说,自查出一个月,看病已经花去3万元,全家人承受了巨大的精神压力。

当今,包括肺叶切除、食管切除等绝大部分胸外科手术均可以通过胸腔镜完成,特别是胸腔镜肺叶切除手术已经分别于2006年、2007年成为美国国家综合癌症网络(NCCN)和美国胸部医师协会(ACCP)肺癌治疗指南中肺癌的标准手术方式.

Objective To evaluate the presents of molecular predictors of epidermal growth factor receptor (EGFR) inhibitors, including EGFR protein over-expression, EGFR gene high copy number and gene mutations in non-small-cell lung cancer (NSCLC) samples from Chinese patients. Methods 226 surgically resected NSCLC samples were constructed into tissue micro-array, and investigated for EGFR gene copy number by fluorescence in situ hybridization (FISH) with commercial probe from Vysis and protein over-expression by immunohistochemistry. 94 adenocarcinoma samples were tested for EGFR gene mutations by PER sequencing. Statistical analysis was performed testing association of these abnormalities with clinical parameters and with each other. Results EGFR protein over-expression was found in 55.3% of the NSCLC samples, and was closely associated with squamous carcinoma (P=0.001 ). 42.0% of the samples had gene high copy number, which showed no statistical association with clinical parameters. 42.6% adenocarcinoma samples carried EGFR gene mutation. Among these EGFR abnormalities, only EGFR protein over-expression and gene high copy number was significantly associated (P=0.005). Conclusion Two of the molecular predictors of EGFR inhibitor, EGFR protein over-expression and gene high copy number were found in NSCLC samples from Chinese patients at similar frequency with those from Caucasian patients. EGFR gene mutation is the only predictors identified so far occnrred more often in Chinese patients who benefits more from EGFR inhibitors.

Objective To prepare, purify and characterize the polyclonal antibody against SLC35F2,and detect the expression of SLC35F2 protein in non-small-cell lung cancer (NSCLC).Methods Four polypeptides named peptide 1,2,3 and 4 were synthesized based on the bioinformatics analysis of SLC35F2.The mixed polypeptides were injected into New Zealand rabbits.The polyclonal antibody was purified by immunoaffinity chromatography, and identified by Western blot and immunohistochemistry.The expression of SLC35F2 protein in 129 cases of NSCLC and corresponding adjacent normal lung tissues was detected by tissue microarray with immunohistochemistry.Results The titers of polyclonal antibody were 1:105 detected by ELISA assay.Western blot confirmed its high specific 41 KD band.The expression of SLC35F2 protein was strongly positive (++ to +++) in90.7% (117/129) of the NSCLC samples.On the contrast, only 17.1% (22/129) adjacent normal lung tissues were strongly positive (++).The expression of SLC35F2 protein was significantly higher in NSCLC than in the adjacent normal lung tissues (P <0.01).Correlation analysis revealed that pathological stage had a low correlation with the expression of SLC35F2 protein.Factor analyses showed that 93.3% expression of SLC35F2 protein in NSCLC tissues were correlated with tumor differentiation and stage.Conclusion The specific antibody against human SLC35F2 was obtained.SLC35F2 protein was highly expressed in most of the NSCLC.