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Kirsten rat sarcoma viral oncogene homolog (KRAS) aberrations frequently occur in patients with lung cancer. Oncogenic KRAS is characterized by excessive reactive oxygen species (ROS) accumulation, thus, ROS detoxification may contribute to KRAS‑driven lung tumorigenesis. In the present study, the influence of glutathione peroxidase 2 (GPX2) on malignant progression and cisplatin resistance of KRAS‑driven lung cancer was explored. The RNA sequencing data from TCGA lung cancer samples and GEO database were downloaded and analyzed. The effects of GPX2 on KRAS‑driven lung tumorigenesis were evaluated by western blotting, cell viability assay, soft agar assay, Transwell assay, tumor xenograft model, flow cytometry, BrdU incorporation assay, transcriptome RNA sequencing, luciferase reporter assay and RNA immunoprecipitation. In the present study, GPX2 was upregulated in patients with non‑small cell lung carcinoma (NSCLC), and positively correlated with poor overall survival. Ectopic GPX2 expression facilitated malignant progression of KRAS

Background Systematic nodal dissection plays a crucial role in improving survival and staging in resectable non-small cell lung cancer (NSCLC) patients but at the cost of increasing the occurrence of recurrent laryngeal nerve injury. Technology should be improved to protect the recurrent laryngeal nerve (RLN) during surgery. Methods NSCLC patients who underwent video-assisted thoracic surgery (VATS) surgical treatment by the same surgeon at our hospital from January 2016 to December 2017 were included as the research subjects and were divided into an energy-device group and a non-energy-device group. Their procedures included anatomic pulmonary resection, normative N1 dissection, and systemic N2 dissection. Results The rate of metastatically involved recurrent laryngeal nerve lymph nodes (RLNLNs) was 5.19% (39/752). Dissection device, side of primary, FEV1, operative time and BMI were independent predictors of recurrent laryngeal nerve injury (RLNI) (hazard ratio (HR) = 3.576, 95% confidence interval (CI): 1.490–8.583, P = 0.004; HR = 0.175, 95% CI: 0.072–0.424, P = Conclusions Every station of RLNLN had some degree of cancer metastasis in NSCLC patients and when dissecting RLNLNs, dissection device was an independent and artificially controlled predictor of RLNI. Using a non-energy device is a feasible method to protect the RLN as well as an improved recovery time of RLNI.

We report the transient intersegmental plane formed by circulation single-blocking, which is consistent with the true intersegmental plane, and its formation principles, characteristics and potential applications.

The right middle lobe subsegmentectomy (including multisubsegmentectomy and subsubsegmentectomy) has never been reported. This study aimed to describe a thoracoscopic right middle lobe subsegmentectomy.This retrospective study included 94 patients who underwent thoracoscopic right middle lobe subsegmentectomy between August 2018 and February 2021. All procedures were performed with the help of the preoperative 3-dimensional computed tomography bronchography and angiography.Ninety-four patients underwent thoracoscopic right middle lobe subsegmentectomy. The median operative time was 56 minutes (range, 35-86 minutes) and median blood loss was 86 mL (range, 50-150 mL). The median duration of chest tube retention was 2.5 days (range, 1-4 days). There were neither cases of postoperative right middle lobe torsion nor instances of perioperative death. The median size of the tumor in the resected segment was 1.3 cm (range, 1.1-1.8 cm). The median margin was 3.3 cm (range, 2.9-4.3). There were 88 cases of lung cancer and 6 cases of benign lesions. The median number of N1 lymph nodes sampled was 3 (range, 2-4). No lymph node involvement was observed postoperatively. No recurrence or mortality was observed during the median follow-up period of 26 months (range, 6-36 months).Thoracoscopic right middle lobe subsegmentectomy is feasible and safe. It may be valuable to preserve the lung parenchyma in patients with noninvasive lung cancer, multiple lung cancer, and benign diseases. Long-term lung function, survival, and cancer-free data are being collected.

Background Currently no optimal localization technique has been established for localization of ground glass opacity (GGO). We aimed to introduce a localization technique using geometric localization for peripheral GGO. Methods We delineated the location of pulmonary GGO using geometric method which was similar with localization of a point in a spatial coordinate system. The localization technique was based on the anatomical landmarkers (ribs or intercostal spaces, capitulum costae and sternocostal joints). The geometric parameters were measured on preoperative CT images and the targeted GGO could be identified intraoperatively according to the parameters. We retrospectively collected the data of the patients with peripheral GGOs which were localized using this method and were wedge resected between June 2019 and July 2020. The efficacy and feasibility of the localization technique were assessed. Results There were 93 patients (male 34, median = 55 years) with 108 peripheral GGOs in the study. All the targeted GGOs were successfully wedge resected in the operative field with negative surgical margin at the first attempt. For each GGO, the localization parameters could be measured in 2–4 min (median = 3 min) on CT images before operation, and surgical resection could be completed in 5–10 min (median = 7 min). A total of 106 (98.15%) GGOs achieved sufficient resection margin. No complications and deaths occurred related to the localization and surgical procedure. Conclusions The localization technique can achieve satisfactory localization success rate and good safety profile. It can provide an easy-to-use alternative to localize peripheral GGO.

OBJECTIVES The B3 downwards-shifting malformation was first proposed by Boyden in 1950. Here, we report 14 cases of this malformation in the right lung and the first case of segmentectomy for this malformation. METHODS All patients with pulmonary lesions underwent three-dimensional computed tomography bronchography and angiography (3D-CTBA) between January 2019 and January 2020, prior to surgery. A consecutive 2356 patients were included, and 14 cases of this malformation were identified; bronchovascular patterns were analysed in each patient. RESULTS The incidence of this malformation was 0.6%. It was further divided into 3 types: over downwards-shift, partial downwards-shift and normal downwards-shift. The normal downwards-shift type was the most common (8/14), where B3 shifted downwards completely to merge with B4 + 5. In the partial downwards-shift (5/14), only part of the B3 shifted. In the over downwards-shift type (1/14), both B3 and B1b shifted downwards. A bifurcated right upper lobe （RUL) bronchus (B1 defective) was observed in 3 cases. The incidence of V1a, V1b, V2a, V2b, V2c, V3a, V3b and V3c was 100% (14/14). The incidence rates of A1, A3a and A3b were 100% (14/14). The incidence of A2 rec and A2 asc was 92.9% (13/14) and 71.4% (10/14), respectively. CONCLUSIONS The B3 downwards-shifting malformation or ‘Boyden’s triad’ is a rare anomaly. Anatomical exploration of this malformation is important for surgery.

In this paper, we first synthesis three-dimensional jasmine-like Cu@L-aspartic acid(L-ASP) inorganic–organic hybrid nanoflowers to load palladium-platinum nanoparticles (Pd–Pt NPs) as the signal enhancer in order to quantify intracellular speckle-type POZ domain protein. Scanning electron microscope, fourier transform infrared, energy dispersive spectrometer, X-ray photoelectron spectroscopy analysis was used to characterize the newly synthesized materials. The newly formed Cu@L-Asp/Pd-PtNPs can catalyze the decomposition of hydrogen peroxide and exhibit excellent catalytic performance. When different concentration of speckle-type POZ domain protein is captured by speckle-type POZ domain protein antibody linked to the surface of Cu@L-Asp/Pd–Pt NPs, the current signal decreases with the increase concentration of speckle-type POZ domain protein. After optimization, the speckle-type POZ domain protein immunosensor exhibited a good linear response over a concentration range from 0.1–1 ng mL−1 with a low detection limit of 19 fg mL−1. The proposed sensor demonstrates good stability within 28 days, acceptable reproducibility (RSD = 0.52%) and selectivity to the speckle-type POZ domain protein in the presence of possible interfering substances and has potential application for detecting other intracellular macromolecular substances.

The right middle lobe segments (RS4 and RS5) are very small and the technique for segmentectomy is rarely reported. Here, we report 3 cases of thoracoscopic RS4 segmentectomy with VVBA (V, vein; V, ventilation; B, bronchus; A, artery) method. The VVBA method for thoracoscopic segmentectomy is a simple, safe, and effective procedure for RS4 segmentectomy with clear procedural steps. It overcomes the difficulty in manipulation of incomplete lung fissures and simplifies the surgical procedures.

In this paper, we first synthesis three-dimensional(3D) jasmine-like Cu@L-Asp inorganic-organic hybrid nanoflowers to load palladium-platinum nanoparticles as the signal enhancer in order to quantify intracellular speckle-type POZ domain protein (SPOP). Scanning electron microscope (SEM), fourier transform infrared (FT-IR), energy dispersive spectrometer (EDS), X-ray photoelectron spectroscopy (XPS) analysis was used to characterize the newly synthesized materials. The newly formed Cu@L-Asp/Pd-PtNPs can catalyze the decomposition of hydrogen peroxide and exhibit excellent catalytic performance. When different concentration of SPOP is captured by SPOP antibody linked to the surface of Cu@L-Asp/Pd-Pt NPs, the current signal decreases with the increase concentration of SPOP. After optimization, the SPOP immunosensor exhibited a good linear response over a concentration range from 0.1 pg mL-1-1 ng mL-1. The proposed sensor demonstrates good stability, acceptable reproducibility and excellent selectivity to the SPOP in the presence of possible interfering substances and has great potential application for detecting other intracellular macromolecular substances.

It remains unknown whether dissecting the intrapulmonary lymph nodes (stations 13 and 14) when resecting peripheral non-small cell lung cancer (NSCLC) is necessary for accurate tumor node metastasis (TNM) staging. This study investigated intrapulmonary lymph node dissection (stations 13 and 14) on the pathological staging of peripheral NSCLC and the metastatic pattern of the lymph nodes. This retrospective study included patients with primary peripheral NSCLC who underwent radical dissection between January 2013 and December 2015. The clinical data of patients and examination results of intrapulmonary stations 12, 13, and 14 lymph nodes were analyzed. Of 3019 resected lymph nodes in a total of 234 patients (12.9/patient), 263 (8.7%) had metastasis. Ninety-nine patients had lymph node metastasis (42.3%): 40 (17.1%) were N1, 11 (4.7%) were N2, 48 (20.5%) were both N1 and N2, and 135 (57.7%) had no N1 or N2 metastasis. Sixteen (6.8%) patients had metastasis of stations 13 and/or 14. Metastasis in N1 positive patients of stations 10, 11, 12, 13, and 14 were 2.7%, 10.5%, 9.8%, 10.4%, and 8.5%, respectively. Missed detection without station 13 and 14 dissection was up to 6.8% (16/234). Dissection of stations 13 and 14 could be helpful for the identification of lymph node metastasis and for the accurate TNM staging of primary NSCLC.

The effective differentiation between multiple primary lung tumors (MPs) and intrapulmonary metastases (IMs) in patients is imperative to discover the exact disease stage and to select the most appropriate treatment. In this study, the authors was to evaluate the efficacy and validity of large-scale targeted sequencing (LSTS) as a supplement to estimate whether multifocal lung cancers (MLCs) are primary or metastatic. Targeted sequencing of 520 cancer-related oncogenes was performed on 36 distinct tumors from 16 patients with MPs. Pairing analysis was performed to evaluate the somatic mutation pattern of MLCs in each patient. A total of 25 tumor pairs from 16 patients were sequenced, 88% (n = 22) of which were classified as MPs by LSTS, consistent with clinical diagnosis. One tumor pair from a patient with lymph node metastases had highly consistent somatic mutation profiles, thus predicted as a primary-metastatic pair. In addition, some matched mutations were observed in the remaining two paired ground-glass nodules (GGNs) and classified as high-probability IMs by LSTS. Our study revealed that LSTS can potentially facilitate the distinction of MPs from IMs. In addition, our results provide new genomic evidence of the presence of cancer invasion in GGNs, even pure GGNs.

We report the thoracoscopic RS5 segmentectomy with VVBA (V, vein; V, ventilation; B, bronchus; A, artery) method and confirmed that the segmental plane visualized by vein-first resection is slightly narrower than the traditional artery-first resection.

Pulmonary extranodal marginal zone lymphoma of the mucosa‐associated lymphoid tissue (MALT) presenting as a progressive pure ground‐glass nodule (GGN) coexisting with lung squamous cell carcinoma has not been reported. A 65‐year‐old male presented with a progressive lung GGN in the left upper lobe identified six and a half years ago but showed no symptoms. The patient had a history of tuberculosis, squamous cell carcinoma, and stomach MALT lymphoma. The patient was diagnosed with lung squamous cell carcinoma coexisting with pulmonary MALT lymphoma through computed tomography (CT)‐guided lung biopsy. A progressive lung GGN presenting in a patient with squamous cell carcinoma does not always indicate multiple primary lung adenocarcinoma, especially when given a specific medical history. The development of MALT lymphoma in the lung presenting as GGNs suggests a possible association between these two entities., Here, we present an extremely rare case of coexistence of lung squamous cell carcinoma with mucosa‐associated lymphoid tissue (MALT) lymphoma presenting as progressive lung ground‐glass nodules.

Circulating tumour cells (CTCs) are referred to the tumour cells that disseminated from the primary tumour and survive in circulating during the pro-ceeding of tumour growth. As surgical treatment evolves and local control has improved, the failure of cancer treatment has largely remained the re-sult of systemic metastasis. Selection of patients most likely to benefit from adjuvant strategies remains problematic. In order to develop a new standard of curative effect, this study was de-signed to track the number of CTCs in patients with lung cancer during chemotherapy. Methods: Samples of peripheral blood was taken from each lung cancer patients (n=32) on the day before chemotherapy as well as the third week after the chemotherapy cycle. The samples were subjected to real-time fluorescent quantitative reverse-tran- scriptase polymerase chain reaction (fqRT-PCR). Meanwhile the tumour size was determined by chest X-ray or computed tomograghy. Results Compared to that of pre-chemotherapy, the ex-pression level of cytokeratin (CK) 19 in the pa-tients significantly declined after chemotherapy (t=4.659,P=0.000). The level of CK19 mRNA in pa-tients with small cell lung cancer (SCLC) was higher than that of patients with non-small cell lung cancer (NSCLC) (t=1.944, P=0.061). The de-crease of CK19 mRNA level correlated well with the type during the treatment. Relatively the de-crease of SCLC is more obvious (t=6.073,P=0.000). The variation of CK19 mRNA level before and after chemotherapy was positively related to the dis-parity of tumour burden (r=0.593). There was also a significant association between the type (NSCLC vs. SCLC) and the change of tumour size (t=3.686, P=0.001).The positive rate before chemotherapy Supported by grant from the Natural Science Foundation in China (No.30972961). was 71.9% (23/32), while that after chemotherapy was 37.5% (12/32), indicating that 11 patients con- verted into negative after chemotherapy. Of the 16 patients which were in Ⅳ-stage, 11 cases were po- sitive (11/16,68.8%). Surprisingly, of the remaining 16 patients which were Ⅱ/Ⅲ stage, 12 cases were regarded as positive according to the criteria (12/6,75%). Conclusions: The real-time flu- ores-cent quantitative-PCR approach is useful for mea- suring the relative number of CTCs in a patients’ peripheral blood to monitor the effectiveness of treatment, and for designing more comprehensive and reasonable therapeutic regimes at earlier dates for patients. The treatment response can be immediately assessed by serial quantitation of CTCs after chemotherapy, and therefore this method highlights an alternative approach to rapidly access the patient’s response to treatment.

To investigate the effect of the lumican gene on the proliferation of lung adenocarcinoma cell A549 and the possible mechanism.The lung adenocarcinoma cell line A549 was infected with the recombinant lentivirus carrying the human lumican gene and a stable cell line was obtained via puromycin selection. The expression of lumican mRNA and protein was confirmed by fluorescence quantitative PCR(FQ-PCR) and Western blotting. We examined the cell growth curve, doubling time, proliferation index using MTT assay and flow cytometry and observed the status of the tumor in the experimental animals. Meanwhile, Western blotting was used to detect the expressions of RhoC and p-Akt proteins.The A549 cell line with the lumican gene over-expression was successfully built. Compared with the control group and the empty vector group, the cells in the experimental group grew faster (P0.05), the doubling time was shortened (P0.05), the proliferation index went up (P0.05), subcutaneous tumors in volume and mass increased and cells of the mitotic figures became more (P0.05), and the expressions of RhoC and p-Akt proteins were raised (P0.05). However, there was no obvious difference between the control group and the empty vecor group (P0.05).Lumican gene can promote the proliferation of lung adenocarcinoma cell A549, and its mechanism may be related to increased RhoC and p-Akt protein expressions.

With the most recent introduction of microarray technology to biology, it becomes possible to perform comprehensive analysis of gene expression in cancer cell. In this study the laser microdissection technique and cDNA microarray analysis were combined to obtain accurate molecular profiles of lymphatic metastasis in patients with lung squamous cell carcinoma.Primary lung squamous cancer tissues and regional lymph nodes were obtained from 10 patients who underwent complete resection of lung cancer. According to the source of lung cancer cells, the samples were classified into three groups: the primary tumor with lymphatic metastasis (TxN+, n=5), the primary tumor without lymphatic metastasis (TxN-, n=5) and matched tumor cells from metastatic lymph nodes (N+, n=5). Total RNA was extracted from laser microdissected tumor samples. Adequate RNA starting material of mRNA from primary tumor or metastatic nodes were labeled and then hybridized into the same microarray containing 6 000 known, named human genes/ESTs. After scanning, data analysis was performed using GeneSpring6.2.A total of 37 genes were found to be able to separate TxN+ from TxN-. TxN+ have higher levels of genes concerned with structural protein, signal transducer, chaperone and enzyme. TxN- have higher levels of genes coding for cell cycle regulator, transporter, signal transducer and apoptosis regulator. Interestingly, there were no differentially expressed genes between N+ and TxN+.The acquisition of the metastatic phenotype might occur early in the development of lung squamous cancer. We raise the hypothesis that the gene-expression signature described herein is valuable to elucidate the molecular mechanisms regarding lymphatic metastasis and to look for novel therapeutic targets.

Background and Aims: The failure to reduce the mortality of patients with solid tumours is mainly a result of the early dissemination of cancer cells to secondary site, which is usually missed by conventional diagnostic procedures used for tumour staging. The possibility to use easily accessible body fluids as a source for circulating tumour cells (CTCs) detection enables longitudinal observations of the disease. In the study, we evaluated the CTCs in lung cancer following locoregional radiation therapy. Methods: Samples of 5ml peripheral blood was taken from each lung cancer patients (n=15) both before and after the radiotherapy course. Meanwhile tumour size was determined by chest X-ray or computed tomography. Using cytokeratin 19(CK19) as marker,the blood samples were subjected to real time RT-PCR assay. All patients with lung cancer were treated with primary definitive and mediastinal radiotherapy. Results Compare to that of pre-treatment, the value of CK19 mRNA in peripheral blood after therapy decreased dramatically(5.0932±1.0628 vs. 4.2493±0.8323,t=3.192,P=0.007). The change of CK19 mRNA level before and after radiotherapy was closely related to the type (NSCLC vs. SCLC, 0.5389±0.9030 vs. 1.6826±0.9467,t=2.1465,P=0.051). Meanwhile, there appeared to be a close link between the grade (Well/Mod vs. Poor) and the change of CK19 mRNA (0.5024 vs. 1.5271,t=2.017,P=0.065). The change of CK19 mRNA level was related to variation of tumour burden during radiotherapy(r=0.0575,P=0.025). Of the 15 cases studied, 12 cases were positive before radiotherapy (12/15,80%). The positive rate was 53%(8/15) after radiotherapy, meaning that four patients converted into negative after radiotherapy. Conclusions: The disseminated circulating cancer cells can be affected by radiotherapy; meanwhile further more systemic adjuvant treatment should be conducted. Due to concordance between molecular response and radiological remission, assessment of the therapeutic response might be possible by serial quantitative of CTCs.