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BACKGROUND: Pulmonary resection is an important part of comprehensive treatment of lung cancer. Despite the progress in recent thoracic surgery, reoperation is occasionally inevitable for managing severe perioperative complications. This study aimed to investigate the incidence and causes of perioperative reoperation in lung cancer patients. METHODS: We retrospectively collected patients who underwent reoperation following pulmonary resection from January 2010 to February 2021 in China-Japan Friendship Hospital. RESULTS: Among the 5032 lung cancer patients who received primary pulmonary resection in our institute, 37 patients underwent perioperative reoperation with the rate being 0.74%. Lobectomy was the most frequently executed procedure (56.8%). The mean duration of the primary surgery was 143.6 ± 65.1 min. About half of the cases received secondary surgery within 24 h of the primary surgery, whereas only one case underwent secondary surgery 30 days after the primary surgery (due to chylous leakage). The major causes of the reoperation were bleeding (73.0%), chylous leakage (13.5%), lobar torsion (5.4%), air leakage (2.7%), atelectasis (2.9%), and cardiac herniation (2.7%). CONCLUSION: The most prevalent reasons for unplanned reoperation following pulmonary resection in lung cancer patients include bleeding, chylous leakage, and lobar torsion. The strict control of the surgical indications and standardization of surgical procedures are fundamental to reduce unplanned secondary operations after pulmonary resections. Timely identification of the need to secondary surgery is also important to ensure patients' safety.

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Introduction: To assess the feasibility and safety of placing a small-sized tube as drainage in patients after uniportal thoracoscopic lung resection. Patients and Methods: Patients who received uniportal video-assisted thoracoscopic surgery (U-VATS) lung resection were identified in our database. Patients placed small-sized tube drainage were compared with those placed conventional chest tube in terms of characteristics, operation modality, post-operative pulmonary complications, post-operative pain, chest tube duration and post-operative hospital stay. Propensity score matching was performed. Results: Of the 217 enrolled patients, 173 were assigned to the conventional tube group and 44 were assigned to the small-sized tube group. Rates of post-operative pulmonary complications were relatively low and similar between the two groups. After propensity score matching, operation duration was shorter (1 h vs. 1.21 h, P = 0.01) was shorter, and the maximum value of the Visual Analogue Scale (VAS) score after operation (1 vs. 1.5, P = 0.02) and the overall average value of VAS score after operation (0.33 vs. 0.88, P = 0.006) was lower in small-sized tube group. No significant difference was observed in chest tube duration (2 vs. 2, P = 0.34) and post-operative hospital stay (3 vs. 3, P = 0.34). Conclusions: Compared to conventional chest tubes, small-sized tubes for post-operative drainage after U-VATS lung resection may be a safe and promising approach for reducing post-operative pain.

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BACKGROUND: Low-density computed tomography (LDCT) improved early lung cancer diagnosis but introduces an excess of false-positive pulmonary nodules data. Hence, accurate diagnosis of early-stage lung cancer remains challenging. The purpose of the study was to assess the feasibility of using circulating tumour cells (CTCs) to differentiate malignant from benign pulmonary nodules. METHODS: 122 patients with suspected malignant pulmonary nodules detected on chest CT in preparation for surgery were prospectively recruited. Peripheral blood samples were collected before surgery, and CTCs were identified upon isolation by size of epithelial tumour cells and morphological analysis. Laser capture microdissection, MALBAC amplification, and whole-exome sequencing were performed on 8 samples. The diagnostic efficacy of CTCs counting, and the genomic variation profile of benign and malignant CTCs samples were analysed. RESULTS: Using 2.5 cells/5 mL as the cut-off value, the area under the receiver operating characteristic curve was of 0.651 (95% confidence interval: 0.538-0.764), with a sensitivity and specificity of 0.526 and 0.800, respectively, and positive and negative predictive values of 91.1% and 30.3%, respectively. Distinct sequence variations differences in DNA damage repair-related and driver genes were observed in benign and malignant samples. TP53 mutations were identified in CTCs of four malignant cases; in particular, g.7578115T>C, g.7578645C>T, and g.7579472G>C were exclusively detected in all four malignant samples. CONCLUSIONS: CTCs play an ancillary role in the diagnosis of pulmonary nodules. TP53 mutations in CTCs might be used to identify benign and malignant pulmonary nodules.

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BACKGROUND: This study aimed to demonstrate the learning curve of anatomical segmentectomy performed by uniportal video-assisted thoracoscopic surgery (U-VATS). METHOD: We conducted a retrospective study of U-VATS segmentectomies performed by the same surgeon between September 2019 and August 2022. The learning curve was demonstrated using risk-adjusted cumulative sum (RA-CUSUM) analysis in terms of perioperative complications, which reflected surgical quality and technique proficiency. The surgical outcomes were also compared between different phases. RESULT: The complication-based learning curve of U-VATS segmentectomy could be divided into two phases based on RA-CUSUM analysis: phase I, the initial learning phase (cases 1-50) and phase II, the proficiency phase (cases 51-141). Significantly higher complication rates (24.0 vs. 8.8%, p=0.013), longer surgical times (119.8±31.9 vs. 106.2±23.8 min, p=0.005), and more blood loss (20 [IQR, 20-30] vs. 20 [IQR, 10-20] ml, p=0.003) were observed in phase I than in phase II. CONCLUSION: The learning curve of U-VATS segmentectomy consists of two phases, and at least 50 cases were required to gain technique proficiency and achieve high-quality surgical outcomes.

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BACKGROUND: Proteasome 26S subunit, non-ATPase 3 (PSMD3) has been reported to participate in various human cancers. Nevertheless, the function of PSMD3 in lung cancer (LC) remains unclear. METHODS: RT-qPCR and western blot were used to detect the expression of PSMD3 in LC tissues form TCGA database and clinical samples, and LC cell lines. To study the effect of PSMD3 on LC cell proliferation, migration, invasion, and apoptosis, siRNAs targeting PSMD3 were synthesized and overexpressed plasmids were constructed. CCK-8 assay, Transwell assay, and etc. were used to evaluate the results. Tumor xenograft model was used to evaluate the function of PSMD3 on tumor growth. CO-IP and MS were used to scan the proteins that bind with PSMD3. The interaction between PSMD3 and ILF3 in lung cancer cells were studied using IF staining, CHX protein stability, and ubiquitination assay. Additionally, the effect of ILF3 on cell progression and LC tumor growth was demonstrated by conducting a recovery assay using siILF3 and an ILF3 inhibitor YM155. RESULTS: We observed that PSMD3 was significantly overexpressed in LC tissues and cells, which indicated a poor prognosis. Meanwhile, we found that PSMD3 promoted cell proliferation, migration, and invasion of LC cells. We also determined that PSMD3 stabilized the protein expression of ILF3 and the deubiquitination of ILF3 in lung cancer cells. Furthermore, animal experiments showed that the ILF3 inhibitor YM155 could suppress tumor growth with the presence of PSMD3. CONCLUSIONS: PSMD3 collectively regulated the stability of ILF3 protein and facilitated the ubiquitination of endogenous ILF3 in LC, which ultimately promoted the progression of LC cells. The PSMD3/ ILF3 axis could potentially be used as a novel strategy for both diagnosis and treatment of LC.

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Lung cancer is the major cause of cancer-related deaths around the world. Lung adenocarcinoma (LUAD), the most common subtype of lung cancer, contributed to the majority of mortalities and showed different clinical outcomes in prognosis. Tumor-infiltrated immune cells at the tumor site are associated with better survival and immunotherapy response. Thus, it is essential to further investigate the molecular mechanisms and new prognostic biomarkers of lung adenocarcinoma development and progression. In this study, a six-gene signature (CR2, FGF5, INSL4, RAET1L, AGER, and TNFRSF13C) was established to predict the prognosis of LUAD patients, as well as predictive value. The prognostic risk model was also significantly associated with the infiltration of immune cells in LUAD microenvironments. To sum up, a novel immune-related six-gene signature (CR2, FGF5, INSL4, RAET1L, AGER, and TNFRSF13C) was identified that could predict LUAD survival and is highly related to B cells and dendritic cells, which may provide a theoretical basis of personalized treatment for targeted immunotherapy.

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The COVID-19 pandemic had a significant impact on container transportation. Accurate forecasting of container throughput is critical for policymakers and port authorities, especially in the context of the anomalous events of the COVID-19 pandemic. In this paper, we firstly proposed hybrid models for univariate time series forecasting to enhance prediction accuracy while eliminating the nonlinearity and multivariate limitations. Next, we compared the forecasting accuracy of different models with various training dataset extensions and forecasting horizons. Finally, we analysed the impact of the COVID-19 pandemic on container throughput forecasting and container transportation. An empirical analysis of container throughputs in the Yangtze River Delta region was performed for illustration and verification purposes. Error metrics analysis suggests that SARIMA-LSTM2 and SARIMA-SVR2 (configuration 2) have the best performance compared to other models and they can better predict the container traffic in the context of anomalous events such as the COVID-19 pandemic. The results also reveal that, with an increase in the training dataset extensions, the accuracy of the models is improved, particularly in comparison with standard statistical models (i.e. SARIMA model). An accurate prediction can help strategic management and policymakers to better respond to the negative impact of the COVID-19 pandemic.

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BACKGROUND: Non-small cell lung cancer (NSCLC) is one of the most prevalent cancers. As reported, long non-coding RNAs (lncRNAs) induce various biological behaviors in cancers. LncRNA PCGEM1 prostate-specific transcript (PCGEM1) is reported to exert carcinogenic effect on certain cancers. Our research aimed to explore the role of PCGEM1 in NSCLC. METHODS: We enrolled forty NSCLC patients to explore PCGEM1 expression in clinical NSCLC tissues. Colony formation assay, CCK-8, Transwell assay were conducted to reveal cell proliferation, viability, migration and invasion. Luciferase reporter assay, RNA pull down, and RIP assay were performed to investigate the downstream axis of PCGEM1. RESULTS: PCGEM1 was significantly upregulated in NSCLC cells and tissues. Subsequently, in vitro loss-of-function experiments illustrated the carcinogenic role of PCGEM1 in NSCLC through promoting viability, proliferation, migration, and invasion. MiR-590-3p was confirmed to be a downstream gene of PCGEM1. Furthermore, SRY-box transcription factor 11 (SOX11) was verified to be a target of miR-590-3p. Additionally, rescue experiments indicated that miR-590-3p inhibitor or pcDNA3.1/SOX11 rescued the impacts of downregulated PCGEM1 on NSCLC cell proliferation, viability, migration and invasion. CONCLUSIONS: LncRNA PCGEM1 aggravated proliferative and migrative abilities in NSCLC via the miR-590-3p/SOX11 axis.

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BACKGROUND: The role of thulium laser in the treatment of interlobar fissures in lobectomy is not clear. We aimed to evaluate the safety, effectiveness and economy of thulium laser in the treatment of incomplete interlobar fissure during lobectomy. METHODS: A total of 76 patients were randomly divided into two groups: laser group and stapler group. The laser group was treated with thulium laser and the stapler group with stapler. RESULTS: Compared with stapler group, the laser group had a longer operation time, more postoperative drainage and lower operation cost, while there was no significant difference in hospitalization time, postoperative air leakage time and chest tube duration. CONCLUSIONS: Thulium laser is safe and effective in the treatment of incomplete interlobar fissure during lobectomy and can reduce the cost.

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BACKGROUND: We aimed to determine whether the use of pulmonary nodule diameter and CTR predicts lymph nodes (LNs) metastasis for early-stage (cT1N0M0) lung adenocarcinoma. METHODS: We retrospectively analyzed 433 consecutive patients who underwent therapeutic surgical resection in our hospital. Information about age, sex, history of malignancy, smoking index, high-resolution computed tomography (HRCT) imaging information, pathologic findings, and status of LNs metastasis were collected. RESULTS: A total of 433 patients were included 277 women and 156 men, with a median age of 58.09±9.41 years. On univariate and multivariate analysis, visceral pleural invasion (VPI) (P=0.005), the diameter of nodule measured by postoperative pathology (DP) (P=0.011), the largest axial diameter of the lesion on the mediastinal window (DM) (P<0.001), the ratio of the maximum diameter of consolidation relative to the maximum tumor diameter from the lung window (CTR) (P=0.01), and total dissected LNs number (P=0.005) categories were independent facto for LNs metastasis. The receiver operating characteristic (ROC) curve showed that DM ≥11.81 cm, or CTR ≥79.50%, or VPI indicated LNs metastasis. LNs metastasis patients could be better predicted by a total dissected LNs number with a cutoff point of 13.5 for lung cancer. CONCLUSIONS: VPI, DP, DM, CTR, and total dissected LNs number categories were independent factors for LNs metastasis. If DM ≥11.81 cm, or CTR ≥79.50%, or VPI systemic lymphadenectomy was recommended. We suggested 14 LNs as the cut point for the evaluation LNs examination.

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BACKGROUND: High Ki-67 expression is associated with poor prognosis in early-stage lung adenocarcinoma (LUAD). However, there are few studies on the associations between clinicopathological features and Ki-67 proliferation index (PI). The study aimed to explore the clinicopathological characteristics of peripheral clinical stage IA LUAD with high Ki-67 expression. METHODS: A case-control study was carried out in China-Japan Friendship Hospital from January 2017 to December 2018. The clinicopathological features of patients were reviewed. Univariate and multivariate analyses were used to analyze the association between clinicopathological characteristics and high Ki-67 expression. RESULTS: Three hundred and seventy-six patients were finally enrolled in the study. Univariate and multivariate analyses showed that males sex (OR =2.23, 95% CI: 1.30-3.83, P=0.004), carcinoembryonic antigen (CEA) positivity (OR =3.25, 95% CI: 1.44-7.33, P=0.005), several imaging features such as notch positivity (OR =2.55, 95% CI: 1.18-5.51, P=0.017), vascular convergence (OR =3.04, 95% CI: 1.03-8.95, P=0.044), and consolidation/tumor ratio (CTR) (OR =1.03, 95% CI: 1.02-1.04, P<0.001) were significantly associated with high Ki-67 expression. The area under curve of receiver operating characteristic (ROC) curve for CTR was 0.813 (95% CI: 0.768-0.858, P<0.001). When cutoff value was 72.5%, the sensitivity and specificity were 80.5% and 76.3%, respectively. CONCLUSIONS: Male sex, CEA positivity, notch positivity, vascular convergence, and CTR were significantly associated with high Ki-67 expression in patients with peripheral clinical stage IA LUAD. These findings could be used to assist clinical decision-making and prognostic evaluation.

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BACKGROUND: Spread through air space (STAS) is a risk factor for disease recurrence in patients with stage IA lung adenocarcinoma (LUAD) who undergo limited resection. Preoperative prediction of STAS could help intraoperative surgical decision-making in small LUAD patients. The aim of the study was to evaluate the predictive value of radiological features on STAS in stage cIA LUAD. METHODS: A case-control study was designed through retrospective analysis of the radiological features of patients who underwent curative surgery for LUAD with a clinical tumor size ≤3 cm. Univariable and multivariable analyses were used to identify the independent risk factors for STAS. The predicted probability of STAS was calculated by a specific formula. Receiver operating characteristic (ROC) curves were used to determine a cut-off value with appropriate specificity while maintaining high sensitivity for STAS positivity. RESULTS: STAS was frequently observed in acinar predominant (P<0.001), micropapillary predominant (P<0.001) and solid predominant (P<0.001) tumors and was significantly associated with larger pT size (P<0.001), presence of micropapillary component (P<0.001), lymphovascular invasion (LVI) (P<0.001), visceral pleura invasion (VPI) (P<0.001), both N1 and N2 lymph node metastasis (P<0.001) and ALK rearrangement (P<0.001). STAS-positivity was significantly associated with the presence of cavitation (P=0.047), lobulation (P=0.009), air bronchogram (P<0.001), and vascular convergence (P=0.016) and was also associated with greater maximum tumor diameter (P<0.001), maximum solid component diameter (P<0.001), maximum tumor area (P<0.001), consolidation/tumor ratio (CTR) (P<0.001), tumor disappearance ratio (TDR) (P<0.001) and computed tomography (CT) value (P<0.001). Multivariable analysis showed that STAS was associated with air bronchogram (P=0.042), maximum tumor diameter (P=0.015), maximum solid component diameter (P=0.022) and CTR (P<0.001). The ROC curve showed that the area under the curve (AUC) was 0.726 in the model for predicting STAS, with a sensitivity and specificity of 95.2% and 36.8%, respectively. CONCLUSIONS: STAS-positive LUAD was associated with air bronchogram, maximum tumor diameter, maximum solid component diameter and CTR. These radiological features could predict STAS with excellent sensitivity but inferior specificity.

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BACKGROUND: The objective of this retrospective study is to evaluate the impact of the CCI on short-term outcomes in pulmonary resection. METHODS: We retrospectively analyzed 1,309 patients who underwent pulmonary surgery consecutively in our hospital. RESULTS: All patients were divided into complication group and non-complication group. CCI (P=0.012), blood loss (P=0.015) and type of surgery (P<0.001) were an independent risk factors for complications in multivariate analysis. Assuming a threshold of 3 for defining poor outcomes for pulmonary resection, the sensitivity and specificity were 87.9% and 44.2%, respectively. The area under the curve for CCI was 0.711 (P<0.001). There were 918 (70.1%) patients in the CCI ≤3 group and 391 (29.9%) patients in the CCI ≤3 group. The rate of poor outcome was 3.3% in the CCI ≤3 group, and 9.2% in the CCI >3 group (P<0.001). CONCLUSIONS: The main finding of the present study was that CCI >3 was associated with a poor short-term outcome. For patients with CCI >3, it was suggested that the experienced surgical team should perform pulmonary resection in the shortest time and preserving the lung function as much as possible.

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BACKGROUND: Lung cancer is one of the most common cancers in the word. However, the underlying mechanism remains largely unknown. ACOT11 encodes enzymes hydrolyzing the fatty acyl-CoA esters into free fatty acids and CoA. Besides from its role in fatty acid metabolism, the other aspects regarding its function in the progression of lung cancer have not been revealed. METHODS: We first explored the clinical profile of ACOT11 in tumor samples. Next, we combined gene knockdown in vitro and in vivo and microarray gene profiling analysis to decipher the unknown regulatory role of ACOT11 in lung cancer carcinoma. Furthermore, we explored the potential molecular mechanisms of ACOT11 with immunoprecipitation. RESULTS: We found high expression of ACOT11 in tumor samples. High expression of ACOT11 showed significantly poor prognosis in lung squamous carcinoma (LUSC) patients. Knocking down of ACOT11 inhibited the cell proliferation, migration as well as invasion in vitro and in vivo. It also promoted the cell apoptosis and cell cycle arrest via multiple signaling pathways. Additionally, ACOT11 could bind with CSE1L, which was proved to be an oncogene in lung cancer and speculated to be a potential target of ACOT11. CONCLUSIONS: The results revealed that ACOT11 regulates proliferation, migration and invasion of lung cancer carcinoma via multiple signaling pathways, indicating its potential value in molecular therapy.

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We herein describe a patient with pulmonary mucormycosis and acute myelogenous leukemia. Computed tomography showed a widened pulmonary artery, a bronchopleural fistula, and the Westermark sign. Despite worsening hemoptysis, the operation was delayed for 6 months. The operation was very complicated and difficult. A thorough preoperative examination, adequate preoperative preparation, appropriate surgical timing, and rich clinical and surgical experience were the keys to successful surgery in this case.

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BACKGROUND: With the emerging radiological techniques and the increasing incidence of adenocarcinoma, the composition and structure of cavitary lung cancer have been significantly changed. The aim of the study was to demonstrate clinicopathological characteristics of solitary cavitary lung cancer which was ≤3 cm. METHODS: A case-control study was designed through retrospective data analysis of clinicopathological data of 946 cases with solitary lung cancer smaller than 3 cm. Univariable and multivariable analysis were used to identify the risk factors of cavitation. RESULTS: Cavitary lung cancer occurred more frequently in patients who were elderly (P=0.044), male (P=0.004), who had a smoking history (P=0.018), higher carcinoembryonic antigen (CEA) level (P<0.001), peripheral lesions (P=0.017), solid nodules (P<0.001), spiculation (P=0.003), vascular convergence (P<0.001), air bronchogram (P=0.004), larger tumor size (P<0.001), advanced T stage (P<0.001), lymph node metastasis (P=0.028) and advanced pTNM stage (P=0.004). In addition, cavitary lung cancer was more common in papillary predominant tumors (P=0.017), while noncavitary lung cancer occurred more frequently in AIS/MIA (P=0.002) and lepidic predominant tumors (P<0.001). It was confirmed that cavitation was significantly associated with elderly (P=0.013), male (P=0.003), larger maximum tumor diameter (P<0.001), solid nodules (P<0.001), larger pT size (P=0.016) and advanced pN stage (P=0.036) in multivariable analysis. ROC curves showed that the AUV was greater in maximum tumor diameter than in pT size predicting cavitation (0.71 vs. 0.66). A cut off value of 20.9 mm showed a discriminatory power of cavitation with a sensitivity of 68.7% and a specificity of 71.2%. CONCLUSIONS: Comparing with noncavitary lung cancer, cavitary lung cancer smaller than 3 cm may have worse prognostic clinical, radiological and pathological characteristics. Especially, cavitary lung cancer present as more solid nodules on CT images and present with more invasive on pathological findings.

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BACKGROUND: Neuron-specific enolase (NSE) has become a widely used and easily attainable laboratory assay of small cell lung cancer (SCLC). However, the prognostic value of NSE for SCLC patients remains controversial. The aim of the study was to evaluate the correlation between elevated serum NSE before therapy and survival of SCLC patients. METHODS: We performed a systematic review and meta-analysis. A systematic literature search was conducted in PubMed, Embase, and the Cochrane Central Register from the inception dates to December 2019. Eligible articles were included according to inclusion and exclusion criteria; then, data extraction and quality assessment were performed. The primary outcome was overall survival (OS), and the secondary endpoint was progression-free survival (PFS). RESULTS: We identified 18 studies comprising 2981 patients. Pooled results revealed that elevated NSE was associated with worse OS (HR = 1.78, 95% CI 1.55-2.06, p < 0.001) and PFS (HR = 1.50, 95% CI 1.16-1.93, p = 0.002). In subgroup analysis, elevated NSE did not predict worse OS in patients who received only chemotherapy (HR 1.22, 95% CI 0.96-1.55, p = 0.10) or part of whom received surgical resection before chemotherapy and radiotherapy (HR = 2.16, 95% CI 0.82-5.69, p = 0.12). CONCLUSION: Elevated serum NSE before any therapy of SCLC patients may be a negative prognostic factor for OS and PFS. The prognostic value of NSE for OS was particularly observed in patients treated by standard management.

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BACKGROUND: Pulmonary mucormycosis (PM) is a relatively rare but fatal infection. However, detailed surgery data have been lacking. We summarized the characteristics of this rare disease and clarified the experiences of surgical resection. METHODS: We conducted a single-center retrospective study of seven patients with PM who underwent surgical resection at China-Japan Friendship Hospital from May 2011 to May 2018. RESULTS: Patient ages ranged from 18 to 70 years, with a median age of 47 years. Manual workers (85.7%) were the most common occupation and their educational level was also below high school. Diabetes was the most common underlying condition. The most common radiographic finding was lobar consolidation. Three patients directly underwent open thoracotomy, one patient underwent video-assisted thoracic surgery (VATS) and three patients converted from VATS to thoracotomy. The median operation time was 240 min [interquartile range (IQR), 150-390 min], the median intraoperative blood loss was 500 mL (IQR, 100-1,200 mL) and the median intraoperative blood transfusion was 600 mL (IQR, 0-1,600 mL). In-hospital, 90-day, 1-year and 5-year mortality were 14.3%, 14.3%, 28.8% and 42.9%, respectively. CONCLUSIONS: PM is a rare but fatal infection. Due to chest adhesion and vascular invasion, the proportion of massive bleeding and long operation time has increased sharply.