Jian Zhu

Lung adenocarcinoma with cystic airspaces (LACA) poses clinical challenges due to its irregular morphology and uncertain biological behavior. We aimed to e

The Thoracic Training Course of the Royal College of Surgeons of Edinburgh in China is dedicated to training skilled thoracic surgeons to an elite level. Almost all the learners at the Nanjing training station showed great interest in a novel stapler tractor designed for dissociating segmental vessels during lung segmentectomy. This study aimed to unveil the beneficial of the novel stapler tractor. Three hundred twenty-three patients who underwent lung segmentectomy at the Nanjing training station were retrospectively analyzed. First, surgical outcomes were compared between those who used a stapler tractor for dissociating segmental vessels and those who did not. Secondly, the results of dissociating segmental vessels were compared between the group that used the stapler tractor and the other three techniques. Lastly, the same variable comparisons were made among the learners. Compared with the outcomes of the non-used stapler tractor patient group during the teaching period, the patients in the used stapler tractor group had shorter operation times (143.15 ± 28.05 min vs. 152.83 ± 37.92 min, P = 0.019), less intraoperative bleeding (51.41 ± 42.60 mL vs. 70.70 ± 63.19 mL, P = 0.017), shorter postoperative hospital stays (3.39 ± 0.81 days vs. 3.70 ± 1.07 days, P = 0.008), and a lower incidence of postoperative pulmonary embolism (0.3% vs. 4.2%, P = 0.035). Compared with the results of other techniques for dissociating segmental vessels, the stapler tractor group had a lower occurrence of intraoperative bleeding (P = 0.002), a reduced time for dissociating the vessel (P < 0.05), a greater successful traction ratio (P = 0.022), and a shorter vascular stump length (P = 0.000). The learners reproduced similar outcomes and results in 58 patients across different affiliations. The benefits of using stapler techniques for dissociating vascular structures in lung segmentectomy include, but are not limited to, shortened operation time, reduced intraoperative blood loss, shorter postoperative hospital stays, reduced postoperative air leakage rates, and a lower incidence of postoperative pulmonary embolism, whether during the teaching or learning period.

Adoptive cell therapy (ACT), an important component of tumor immunotherapy, achieves precise anti-cancer effects by reinfusing in vitro-processed immune cells, providing a new option for advanced tumor patients with resistance to chemotherapy or targeted therapy. Among them, antigen-specific cytotoxic T lymphocyte (ACTL) therapy innovatively integrates the natural expansion advantage of tumor-infiltrating lymphocytes (TILs) and the precise antigen-presenting mechanism of recombinant adeno-associated virus-transfected dendritic cells (rAAV-DCs), becoming a research focus. This case report describes a patient with IVa stage advanced lung adenocarcinoma with multiple intrapulmonary metastases carrying an epidermal growth factor receptor (EGFR) exon 19 deletion mutation. After receiving treatment with the third-generation EGFR-tyrosine kinase inhibitor (EGFR-TKI) drug osimertinib, the patient developed acquired resistance with unknown mechanisms and was in an immune-suppressed state. Subsequently, the patient received ACTL therapy and ultimately achieved a clinical complete response (cCR) and maintained it for six years of follow-up. This case is the first to report that ACTL therapy has achieved “clinical cure” in a patient with acquired EGFR-TKI resistance, indirectly suggesting the underlying mechanism of this therapy in reshaping the tumor immune microenvironment (TME). It illustrates that ACTL, as a novel cellular immunotherapy with both target precision and immune balance, has demonstrated potential in overcoming targeted resistance in advanced lung cancer and inducing deep remission.

Background: Recent studies have shown that immunotherapy improves survival outcomes for patients with a late staged cancer. However, in a small number of cases do not benefit from this treatment and instead experience rapid tumor progression, known as hyperprogressive disease (HPD). Currently, HPD is provisionally defined as occurring within two months of receiving immunotherapy. Is HPD that occurs after two months associated with immunotherapy? The existing literature does not provide an answer.Case presentation: A 59-year-old woman was diagnosed with unresectable squamous cell carcinoma of the lung. She received four months (6 cycles) of chemotherapy with albumin-bound paclitaxel and cisplatin, along with immunotherapy using Camrelizumab. After treatment, the lesion in the patient’s lung were significantly reduced. However, because the tumor did not disappear and due to the limitations dose of the chemotherapy drugs using for body, the patient turned to receive stereotactic radiation therapy (2 Gy per fraction). After 10 fractions of radiotherapy, the lesion in the patient’s lung significantly increased. The enlarged lesion was pathologically analyzed through a percutaneous lung biopsy and was confirmed to be squamous cell carcinoma. Following the cessation of radiotherapy, four cycles of targeted segment arterial chemoembolization resulted in another significant reduction in the lung lesion.Conclusions: This report is the first to present HPD after 5 months of immunotherapy, marking the longest recorded occurrence of this phenomenon. This particular case of post-immunotherapy HPD achieved satisfactory results through targeted segment arterial chemoembolization, offering a potential approach for managing this side effect.

The procedure for thoracoscopic and laparoscopic radical resection of esophageal cancer is complicated, so the operation time is long, which can easily negatively affect the self-confidence of young thoracic surgeons. This retrospective cohort study aimed to improve young thoracic surgeons’ understanding of this type of surgery by analyzing the learning curve. From October 2017 to August 2018, 64 patients who underwent thoracoscopic and laparoscopic radical resection of esophageal cancer by a single team were reviewed by a retrospective cohort study. These patients were divided into four groups according to the date of operation. The baseline data, operation time, the amount of bleeding during the operation, and the number of lymph nodes sampled were compared. Then, the quality of the different stages of the operation was analyzed and evaluated. There were no significant differences in the general baseline data, chest tube duration, or number of samples collected from the right laryngeal nodes among the four groups (p > 0.05). With the accumulation of experience, several key measures of surgical benefit were significantly different among the four groups. Specifically, the operation time became shorter, the amount of bleeding gradually decreased, the number of lymph nodes sampled gradually increased, and the number of left para-recurrent laryngeal nerve lymph nodes sampled gradually increased (p < 0.05). According to the learning curve, approximately 16 patients needed to complete this type of operation in 300 min, and 22 patients needed to be independently sampled from more than 20 lymph nodes.

Background: Lung segmentectomy has gained much more attention as an important surgical method for treating early-stage lung cancer. However, incomplete fissures increase the difficulty of lung segmentectomy. The aim of this study was to analyze the safety and efficacy of the fissure-first approach in precision resection of lung segments for patients with incomplete fissures.Methods: The clinical data of patients with incomplete fissures who underwent lung segmentectomy were retrospectively analyzed. Date was divided into fissure-first approach in lung segmentectomy group (group A) and fissure-last approach in lung segmentectomy group (group B). The general linear data, operation times, intraoperative adverse events, postoperative recovery dates and complications were compared.Results: A total of 122 patients with complete clinical data were included. Patients in group B had more COPD (p < 0.05), and the lesions in group A were more closely related to the hilum of the lung (p < 0.05). Compared to Group B, Group A achieved better surgical outcomes, such as operation time, postoperative hospital stays, intraoperative bleeding, number of intrapulmonary lymph nodes sampled, counts of resected subsegments (except the upper lobe of the right lung), and rate of conversion to thoracotomy (all p < 0.05).Conclusion: The fissure-first approach is a safe and effective surgical approach in lung segmentectomy for patients with incomplete fissures. This approach can reduce the counts of resected subsegments and improve techniques in lung segmentectomy for patients with lung incomplete fissures.

Objective: To evaluate the effect of sleep duration on blood pressure in patients with hypertension urgencies combined with SARS-CoV-2 infection in a Fangcang shelter hospital. Methods: From April 10, 2020 to May 20, 2022, we statistically analyzed the blood pressure and sleep conditions of 52 patients with combined hypertension urgencies and SARS-CoV-2 infection admitted in Shanghai National Convention and Exhibition Center Fangcang shelter hospital. They were divided into the short-term (daily sleep duration: < 7 h) and normal sleep group (7– 9 h). We performed a comparison of the control effects of basic antihypertensive drugs. Additionally, patients in the short-term sleep group underwent drug therapy for sleep regulation and continuous monitoring of blood pressure. Results: Among these patients, the blood pressure was higher in the short-term sleep group than that of the normal sleep group, and also more difficult to control (p < 0.05). Furthermore, the blood pressure of the patients in the short-term sleep group was more easily controlled after treatment with drugs for sleep regulation and basic antihypertensive drugs (p < 0.05). Conclusion: The blood pressure level in patients with combined SARS-CoV-2 infection and hypertension urgencies was higher in those with a shorter duration of daily sleep, and also more difficult to control in Fangcang shelter hospital. Drug therapy for sleep regulation should be administered early to obtain sufficient blood pressure control effects.

Background: The Fangcang shelter hospital has gradually become the primary management mode in China’s fight against this Corona Virus Disease 2019 (COVID-19) in 2020. In early 2022, the Fangcang shelter hospital management model was successfully applied to the new outbreak of COVID-19 in Shanghai also. Although Fangcang shelter hospitals are no longer the prevailing mode of prevention of COVID-19, the management experience of Shanghai makeshift hospitals is worthy of reference for public health. Methods: The authors conducted a descriptive statistical analysis of Hall 6-2 of the Shanghai National Convention and Exhibition Center Fangcang shelter hospital. The whole hall of the Fangcang shelter hospital was managed by the one hospital, and the inclusion of third-party management personnel alleviated the shortage of medical personnel human resources. Through practice, a new procedure for treating batch infected people was introduced. Results: By optimizing ward management, 72 on-duty doctors, 360 on-duty nurses, 3 sense-control administrators, and 15 administrators cured 18,574 infected people in 40 days, and created a record of a doctor managing 700 infected people without compromising the quality of treatment. There have been no deaths and no complaints from the infected people located in Hall 6-2 of the Shanghai National Convention and Exhibition Center Fangcang shelter hospital. Conclusion: Compared with previous data, the new management mode of Fangcang shelter hospitals provides a reference for the management of the new infectious diseases for public health.

Artificial intelligence (AI) adopting deep learning technology has been widely used in the med-ical imaging domain in recent years. It realized the automatic judgment of benign and malig-nant solitary pulmonary nodules (SPNs) and even replaced the work of doctors to some extent. However, misdiagnoses can occur in certain cases. Only by determining the causes can AI play a larger role. A total of 21 Coronavirus disease 2019 (COVID-19) patients were diagnosed with SPN by CT imaging. Their Clinical data, including general condition, imaging features, AI re-ports, and outcomes were included in this retrospective study. Although they were confirmed COVID-19 by testing reverse transcription-polymerase chain reaction (RT-PCR) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), their CT imaging data were misjudged by AI to be high-risk nodules for lung cancer. Imaging characteristics included burr sign (76.2%), lobulated sign (61.9%), pleural indentation (42.9%), smooth edges (23.8%), and cavity (14.3%). The accuracy of AI was different from that of radiologists in judging the nature of be-nign SPNs (p < 0.001, κ = 0.036 < 0.4, means the two diagnosis methods poor fit). COVID-19 patients with SPN might have been misdiagnosed using the AI system, suggesting that the AI system needs to be further optimized, especially in the event of a new disease outbreak.