[Long-term efficacy of balloon-assisted endplate augmentation combined with transforaminal pedicle screw fixation in the treatment of thoracolumbar burst fractures]

Objectives: To investigate the long-term efficacy of balloon assisted endplate reduction with vertebral augmentation combined with pedicle screw fixation in the treatment of thoracolumbar burst fractures, and to compare the clinical efficacy of calcium sulfate cement (CSC) and calcium phosphate cement(CPC). Methods: This study is a retrospective cohort study.The clinical data of 39 patients with thoracolumbar burst fractures admitted to Hefei Hospital Affiliated to Anhui Medical University from November 2013 to December 2017 were retrospectively analyzed.All patients were treated with pedicle screw reduction and fixation of the injured vertebra,balloon-assisted reduction of the collapsed endplate of the injured vertebra,and artificial bone vertebral body augmentation,and the follow-up time was >5 years.There were 24 males and 15 females,aged (42.9±13.3) years (range: 29 to 56 years).According to the Frankel spinal nerve dysfunction grading standard, there were 4 cases of grade C, 7 cases of grade D and 28 cases of grade E. There were 21 cases of CSC augmentation(CSC group) and 18 cases of CPC augmentation (CPC group). X-ray and CT were performed at 1 week, 1-, 2-, 5-year after surgery and at the last follow-up, and the imaging indicators were measured, including the injured vertebra anterior edge height ratio,the injured vertebra middle height ratio,the injured vertebra wedge angle,and the sagittal plane Cobb angle. The pain visual analogue scale (VAS) and the Oswestry disability index (ODI) was used for functional evaluation, nervous function was evaluated according to the Frankel spinal nerve dysfunction grading standard.Independent sample t test was used for inter-group comparison, and paired sample t test and repeated measure ANOVA were used for intra-group comparison. Results: All operative procedures were successfully completed, no spinal nerve function damage occurred. The postoperative imaging indexes of the patients were significantly improved compared with those before surgery (all P<0.01). The follow-up time of patients was (6.7±2.8)years (range: 5 to 9 years). Among the 11 patients with symptoms of neurological impairment before surgery, 9 patients completely recovered at the last follow-up, and 2 patients recovered from Frankel grade C to D. There were no significant differences in imaging indexes between the first week after surgery and the last follow-up in the CPC group (all P>0.05), while there were significant differences in imaging indexes between the CSC group and the last follow-up (all P<0.05). CPC group was superior to CSC group in frontal height ratio, middle height ratio, wedge angle variation and sagittal Cobb angle correction loss at 2 year, 5 year after surgery and the last follow-up, with statistical significance (all P<0.05). At the last follow-up, there were no differences in VAS and ODI between the two groups (all P>0.05). After absorption of CSC in the filling area, a hardened zone was formed around the area, and the central cavity remained without bone tissue filling. CPC absorption was very slow, and the CPC group was still filled satisfactorily at the last follow-up. Conclusions: Balloon assisted endplate reduction and vertebral augmentation combined with pedicle screw fixation through the injured vertebra have good long-term efficacy in the treatment of thoracolumbar burst fractures. Compared with CSC, CPC vertebral augmentation can better maintain the shape and spinal sequence of the injured vertebra in the long term, and can effectively reduce the collapse of the space above the injured vertebra.

Effects of different dietary vitamin D combinations during the grower phase and the feed restriction phase on growth performance and sternal morphology, mineralization, and related genes expression of bone metabolism in Pekin ducks

Our study aimed to investigate the effects of different dietary vitamin D (VD) combinations during the grower (1-32 d of age) and feed restriction (33-52 d of age) phases on growth performance. We also evaluated sternal morphology, mineralization, and related genes expression of bone metabolism as well as absorption of calcium and phosphorous in duodenal mucosa and kidney in Pekin ducks. During the grower phase, we used 2 VD regimes (Group A: 3,160 IU/kg VD3; Group B: 400 IU/kg VD3 + 69 μg/kg 25-OH-D3). Each dietary treatment had 50 replicate pens of 10 ducks per pen. During the feed restriction phase, 30 replicate pens selected from Group A and Group B, repetitively, were redivided into 5 different dietary VD regimes to form a 2 × 5 experimental design. Each group consisted of 6 replicates, each with 10 ducks. During the feed restriction phase, we evaluated 5 different dietary VD combinations were as follows: T1: 2,000 IU/kg VD3 ; T2: 5,000 IU/kg VD3; T3: 3,620 IU/kg VD3 + 34.5 μg/kg 25-OH-D3; T4: 2,240 IU/kg VD3 + 69 μg/kg 25-OH-D3; T5: 1,800 IU/kg VD3 + 80 μg/kg 25-OH-D3). Results showed that Group B combinations with T5 had a better growth performance and breast meat deposition (P < 0.1). Regardless of 5 dietary VD regimes during the feed restriction phase, Group B significantly increased (P < 0.05) 52 d sternal depth and tended to increase (P < 0.1) 52 d sternal defatted weight, ash content, and phosphate (P) content of ducks. A significant interactive effect (P < 0.05) was observed on the mRNA abundance of DMP1 and Sost1 as well as RANKL/OPG in sternum and of VDR in duodenal mucosa of ducks at 52 d of age between dietary VD combinations during 2 phases. These results indicated that dietary VD regimes during the grower phase could affect the effectiveness of dietary VD regimes during the feed restriction phases; Dietary VD combinations of both phases could affect the genes expression of bone formation and the absorption as well as reabsorption of calcium and phosphorus in duodenum and kidney.

Long-Term Anorectal Function in Rectal Cancer Patients Managed by a Watch-and-Wait Strategy after Neoadjuvant Therapy: A Cross-Sectional Study

PURPOSE/OBJECTIVE(S)

Rectal cancer patients reaching complete clinical response (cCR) after neoadjuvant chemoradiotherapy can be offered a nonoperative watch-and-wait (W&W) strategy. As evidence of good oncological outcomes accumulates, the functional outcomes remain less explored. The aim of this study is to comprehensively assess the long-term rectal toxicity and anorectal function in patients managed by a W&W strategy and to investigate the clinical risk factors for anorectal dysfunction.

MATERIALS/METHODS

Seventy W&W patients who were disease-free at the moment of recruitment were included. A minimum 2-year follow-up was considered. We graded late rectal toxicity according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) scale and the Late Effects of Normal Tissue/Subjective Objective Management Analytic (LENT/SOMA) system. Long-term anorectal function was assessed with the Wexner score, the Low Anterior Resection Syndrome score (LARS score), and the Memorial Sloan Kettering Bowel Function Instrument (MSK BFI).

RESULTS

All patients received standard chemoradiotherapy consisting of a total dose of 5000 cGy in 25 fractions. The median tumor distance from the anal verge was 3 (IQR 2-4) cm. After a median follow-up of 43 (IQR 28-66) months, less than half of patients developed Grade 1 (40.0%) or Grade 2 (1.4%) late rectal toxicity, and no patients complained of higher grades. LENT/SOMA criteria also identified more patients with mild symptoms. The most frequent symptoms were sphincter control problems, mainly manifested as fecal urgency, reported by 60.0% of patients. For long-term anorectal function, the median LARS score was 16 (IQR 4-25). 17.1% of patients reported minor LARS and 15.7% reported major LARS. The median Wexner score was 2 (IQR 0-3). The median MSK BFI total score was 82 (IQR 77-86). Smoking history was an independent risk factor for anorectal dysfunction in multivariate analyses (OR = 6.491, 95% CI 1.536-27.432).

CONCLUSION

Rectal cancer patients managed by a watch-and-wait strategy after neoadjuvant chemoradiotherapy have retained satisfactory anorectal function. However, fecal urgency might be a common problem. Smoking history was an independent risk factor for long-term anorectal dysfunction. Prospective studies with emphasis on bowel function outcomes containing a larger number of patients are needed.

A combined diagnostic model based on circulating tumor cell in patients with solitary pulmonary nodules

BACKGROUND

Although many prediction models in diagnosis of solitary pulmonary nodules (SPNs) have been developed, few are widely used in clinical practice. It is therefore imperative to identify novel biomarkers and prediction models supporting early diagnosis of SPNs. This study combined folate receptor-positive circulating tumor cells (FR+ CTC) with serum tumor biomarkers, patient demographics and clinical characteristics to develop a prediction model.

METHODS

A total of 898 patients with a solitary pulmonary nodule who received FR+ CTC detection were randomly assigned to a training set and a validation set in a 2:1 ratio. Multivariate logistic regression was used to establish a diagnostic model to differentiate malignant and benign nodules. The receiver operating curve (ROC) and the area under the curve (AUC) were calculated to assess the diagnostic efficiency of the model.

RESULTS

The positive rate of FR+ CTC between patients with non-small cell lung cancer (NSCLC) and benign lung disease was significantly different in both the training and the validation dataset (p < 0.001). The FR+ CTC level was significantly higher in the NSCLC group compared with that of the benign group (p < 0.001). FR+ CTC (odds ratio, OR, 95% confidence interval, CI: 1.13, 1.07-1.19, p < 0.0001), age (OR, 95% CI: 1.06, 1.01-1.12, p = 0.03) and sex (OR, 95% CI: 1.07, 1.01-1.13, p = 0.01) were independent risk factors of NSCLC in patients with a solitary pulmonary nodule. The area under the curve (AUC) of FR+ CTC in diagnosing NSCLC was 0.650 (95% CI, 0.587-0.713) in the training set and 0.700 (95% CI, 0.603-0.796) in the validation set, respectively. The AUC of the combined model was 0.725 (95% CI, 0.659-0.791) in the training set and 0.828 (95% CI, 0.754-0.902) in the validation set, respectively.

CONCLUSIONS

We confirmed the value of FR+ CTC in diagnosing SPNs and developed a prediction model based on FR+ CTC, demographic characteristics, and serum biomarkers for differential diagnosis of solitary pulmonary nodules.

Identification of the intersegmental plane via electromagnetic navigation for anatomical segmentectomy

Accurate identification of the physiological intersegmental plane is crucial for successful anatomical segmentectomy. Current techniques, such as the inflation-deflation method, may result in uncertain cutting lines, leading to unsuitable resection extents. Here, we demonstrated the successful use of electromagnetic navigation with methylene blue dye-marking to preoperatively and precisely identify the physiological intersegmental plane in two patients with small-sized peripheral non-small cell lung cancer (NSCLC). This novel technique offers the potential for precise cutting lines that align closely with the physiological intersegmental plane, thus improving the accuracy and efficacy of anatomical segmentectomy for these selected NSCLC patients.

Effects of supplemented mode of emulsifier on growth performance, serum biochemical index, quality of meat and skin fat, and nutrient utilization in Pekin ducks

In our previous experiment, we found that fats with pre-emulsification (PreE), a new supplemented mode of emulsifier, had an improved bioavailability for Pekin ducks than fats without PreE based on dietary EE utilization. Therefore, this study was conducted to investigate the effects of the supplemented mode of emulsifier (PreE vs. emulsifier direct supplementation) on the growth performance, serum biochemical index, quality of meat and skin fat, and nutrient utilization in Pekin ducks. A total of 640 healthy 10-day-old Pekin male ducks (408.65 ± 12.00 g) were randomly allocated into 4 treatments with 16 replicates of 10 birds each. The 4 dietary treatments were as follows: the positive control group (PC; the oil supplemented amount of 6%), the negative control group (NC; the oil supplemented amount of 5.4%), the emulsifier group (E; NC diet with an emulsifier added directly), and the oil pre-emulsification group (PreE; NC diet with oil PreE). The results showed reducing the amount of fat in the diet (NC vs. PC) significantly decreased growth performance and quality of skin fat, and affected serum lipid metabolism (P < 0.05). Interestingly, the body weight (BW), body weight gain (BWG), and the shear force of skin fat were increased, but the feed to gain ratio (F/G) was markedly decreased in the PreE group (P < 0.05) compared to those in the NC group, and these levels were similar to those in the PC group (P > 0.05). Additionally, the utilization of dietary dry matter (DM), ether extract (EE), and total phosphorous (TP) were increased, but the activity of aspartate aminotransferase (AST) in serum was decreased in the PreE group compared to those in the NC group (P < 0.05). Furthermore, compared to the E group, the F/G was decreased (P < 0.05), and the utilization of dietary EE, the shear force of skin fat and content of collagen in skin fat were markedly increased (P < 0.05) in the PreE group. However, no differences were observed (P > 0.05) in growth performance between the group administered a direct supplementation of emulsifier and the control groups (PC and NC). These results indicate that the negative effect of reducing the oil supplementation amount (-0.6%) in the diet can be restored by supplementation with emulsifier, especially by oil with PreE.

Effects of a high-fat diet on the growth performance, lipid metabolism, and the fatty acids composition of liver and skin fat in Pekin ducks aged from 10 to 40 days

This study aimed to investigate the effect of a high-fat diet on the growth performance, serum, liver, and skin lipid metabolism as well as the fatty acids composition of liver and skin fat in Pekin ducks from 10 to 40 d of age based on a pair-fed group. Two hundred forty healthy male ducks (10 d old, 470.53 ± 0.57 g) were randomly divided into 3 groups (8 replicates per cage of 10 ducks): a normal diet (ND, 3% fat), a high-fat diet (HFD, 9% fat), and a pair-fed diet (PFD, given the ND in an amount equal to that consumed of the HFD to eliminate the effects of feed intake). The results were as follows: compared to ND feeding, HFD feeding significantly decreased (P < 0.05) the feed intake and feed:gain ratio (F:G), along with serum triglyceride and nonesterified fatty acid contents. When compared with the ND and PFD, the HFD significantly decreased (P < 0.05) the liver weight and inhibited hepatic de novo lipogenesis (glucose-6-phosphate dehydrogenase and malate dehydrogenase activities), β-oxidation (carnitine palmitoyltransferase-1 content), and decreased saturated fatty acids and monounsaturated fatty acids deposition. Moreover, the HFD significantly increased (P < 0.05) the total fat content, lipid droplet area, and polyunsaturated fatty acids (PUFAs) content in the liver, as well as the abdominal fat weight, subcutaneous fat weight, the total fat and PUFAs content in skin fat. These results suggested that the HFD improved feed efficiency, which was related to HFD feeding inhibiting hepatic de novo lipogenesis and β-oxidation and promoting the deposition of fat in skin as well as altering the fatty acids composition of the liver and skin fat in Pekin ducks.

Genomic and clinicopathological features of lung adenocarcinomas with micropapillary component

BACKGROUND

Lung adenocarcinoma (LA) with a micropapillary component (LAMPC) is a histological subtype of lung cancer that has received increasing attention due to its correlation with poor prognosis, and its tendency to recur and metastasize. At present, comprehensive genomic profiles and clinicopathological features for LAMPC remain unclear and require further investigation.

METHODS

From September 2009 to October 2020, a total of 465 LAMPC patients were recruited and divided into four groups according to MPC proportions, and the correlations between varying proportions of MPCs and clinicopathological characteristics were analyzed. Twenty-nine (29) LAMPC patients and 89 LA patients without MPC (non-MPC) that had undergone NGS testing were selected for further study The comprehensively analyze genomic variations and the difference between LAMPC and MPC were determined. In addition, Gene alterations of LAMPC between Chinese and Western populations were also compared using cBioPortal data.

RESULTS

A higher proportion of MPCs, associated with higher tumor stage, pleural invasion, and vascular tumor thrombus formation, was determined in LA patients. Compared to non-MPC patients, LAMPC patients were determined to have a lower frequency of single nucleotide variants and a higher frequency of insertion-deletion mutations. Mutations in TP53, CTNNB1, and SMAD4, and ALK rearrangements/fusions were significantly more frequent in LAMPC patients. ERBB2 mutations were only detected in non-MPC patients. Gene mutations in the Wnt pathway were significantly more common in LAMPC patients as compared to non-MPC patients. ALK fusions were more prevalent in younger patients. Patients with KRAS or LBP1B mutations had significantly larger tumor diameters than patients with wild-type KRAS or LBP1B. Patients with KRAS mutations were more likely to develop vascular tumor thrombus. Using the cBioPortal public database, we determined that mutations in EGFR were significantly higher in Chinese patients than in a Memorial Sloan Kettering Cancer Center (MSKCC) Western cohort. ALK fusions were exclusively detected in the Chinese cohort, while mutations in KEAP1 and NOTCH4 were only detected in the MSKCC cohort. Our analysis of signaling pathways revealed that Wnt pathway gene mutations were significantly higher in the Chinese cohort.

CONCLUSION

LA patients with higher proportions of MPCs were determined to have a higher tumor stage, pleural invasion, and vascular tumor thrombosis formation. We comprehensively analyzed the genomic mutation characteristics of LAMPC patients and identified multiple, novel MPC-related gene alterations and pathway changes. Our data provide further understanding of the nature of the LAMPC and potential drug-targeted gene alterations, which may lead to new therapeutic strategies.

[Analysis on perioperative safety and feasibility of pure single-port laparoscopic distal gastrectomy for gastric cancer]

Objective: To investigate the safety and feasibility of pure single-port laparoscopic distal gastrectomy (SDG) in the radical treatment of gastric cancer. Methods: A retrospective cohort study with propensity score matching (PSM) was conducted. Subjects were included in the study who were diagnosed by imaging examination and pathology as early distal gastric cancer, no distant metastasis, no serious cardiovascular and cerebrovascular diseases and underwent radical gastrectomy. Patients with incomplete clinical data, unplanned second operation and complicated with other tumors were excluded. A retrospective analysis was performed on 15 patients who underwent pure SDG radical gastrectomy for gastric cancer from September 2020 to March 2022, namely the SDG group. Fifty-eight patients undergoing conventional five-port laparoscopic radical gastrectomy for gastric cancer were included as the control group, namely the LDG group. As it was found that there was a statistically significant difference in baseline body mass index (BMI) between the two groups [(20.8±0.8) kg/m² vs. (22.9±0.4) kg/m², t=2.456, P=0.017], one-to-one PSM was conducted between the two groups. Then the basic conditions of the two groups of patients in perioperative period were analyzed and compared. Results: There were 14 patients after PSM in the SDG group and the LDG group respectively. There were no significant differences in intraoperative bleeding, number of lymph nodes dissected, time to the first postoperative feeding and postoperative complications between the SDG group and the LDG group (all P>0.05). Compared with LDG group, the operative time in the SDG group was longer [(163.6±6.3) minutes vs. (133.9±4.4) minutes, t=3.866, P=0.001]. However, in the SDG group, time to the first flatus [(2.6±0.2) days vs. (3.3±0.1) days, t=3.053,P=0.005], time to drainage tube removal [(4.5±0.8) days vs. (6.9±0.2) days, t=2.914, P=0.007)] and postoperative hospital stay [(6.7±0.1) days vs. (9.2±1.0) days, t=2.534,P=0.018)] were significantly shorter, and pain score at the first postoperative day evaluated by NRS (1.86±0.29 vs. 2.86±0.35, t=2.205, P=0.037) was significantly lower as compared to the LDG group. Four patients in SDG group did not receive peritoneal drainage tube placement after surgery, and they all recovered safely. Conclusion: The pure single-port laparoscopic radical gastrectomy for gastric cancer is safe and feasible, and has an advantage over the LDG in postoperative recovery.

Corn distiller's dried grains with solubles as an alternative ingredient to corn and soybean meal in Pekin duck diets based on its predicted AME and the evaluated standardized ileal digestibility of amino acids

The study aimed to investigate the effects of dietary distillers dried grains with solubles (DDGS) levels on growth performance, carcass characteristic, serum biochemical indexes, meat physical and chemical quality, nutrient utilization, and standardized ileal digestibility of amino acids (SIDAA) in Pekin ducks aged 11 to 42 d based on the evaluation of its SIDAA. A total of 560 eleven-day-old Cherry Valley ducks were randomly allotted to 5 treatments with 7 replicate pens per treatment and 16 ducks per pen based on the average body weight. Six isonitrogenous and isocaloric experimental diets were formulated on a digestible amino acid basis to produce diets containing 0, 5, 10, 15, and 20% DDGS, respectively. With increasing of dietary DDGS levels, a linear and quadratic reduction (P < 0.05) was observed in the body weight (BW) at d 42, average day gain (ADG) and average day feed intake (ADFI) from d 11 to 42, breast meat yield, the moisture and protein content in the breast meat, and dietary DM and EE utilization. Moreover, a linear and quadratic increase (P < 0.05) was observed in the b* value of the breast meat and serum total cholesterol and triglyceride concentrations. Compared with the control group, the group with 10% inclusion of DDGS exhibited no adverse effect on growth performance, carcass characteristics, serum biochemical indexes, meat physical and chemical quality, nutrient utilization, and the SIDAA of the diets (P > 0.05). These results suggested that 10% of corn DDGS can function as an alternative ingredient to corn and soybean meal, and the optimal levels of DDGS in the diets of ducks aged from 11 to 42 d depends more on its quality.

Better tumor immune microenvironment in patients with older lung adenocarcinoma

e20544

Background: Lung adenocarcinomas (LUAD) is the most common histological subtype of lung cancers. Immunotherapies (ICIs) have been confirmed to improve the clinical outcomes of LUAD patients. Efficacies of ICIs are considered strongly associated with tumor immune microenvironments (TIME). Age-related immune dysfunction might induce difference on the efficacy of ICIs between younger and older patients. However, the potential effect of age on TIME remains little known and controversial. Herein, we aimed to analysis the association between age and TIME based on The Cancer Genome Atlas (TCGA) database. Methods: We screened out 582 LUAD patients with complete information, whose tumors underwent next-generation sequencing (NGS) detection in TCGA. All patients were divided into two groups according to age, the younger group (age < 50-year old) and the older group (age≥50-year old). The differences of immune-related signatures between the two groups were calculated according to previous reports. We also analyzed the differences in immune-related signature between different clinical stages. P-values were calculated via the T.Test. Results: In total 582 patients with LUAD in our study, 115 (19.76%) patients in younger group and 467 (80.24%) patients in older group were found. Many immune-related signatures were found significantly higher in older group than in younger group, including cytolytic activity (CYT) (p = 0.0352), expanded immune signature (p = 0.0065), T cell inflamed gene expression profile (GEP) (p = 0.0048), IFN-γ-related response genes (p = 0.0346), immune signature (p = 0.0022), immunosuppression (p = 0.0065), major histocompatibility complex class I (MHC class I) (p = 0.0319), T-cell survival (p = 0.0235), tertiary lymphoid structures (TLS) signature (p = 0.0001) and total_TILs_scores (p = 0.0020). In addition, tertiary lymphoid structure (p = 0.0355) and TLS_signature (p = 0.0243) were found significantly difference in different clinical staging, which decreased as the staging get later. On the contrary, cell cycle score (p = 0.0001) increased as the staging get later. Conclusions: Our study evaluated the impact of age and clinical stage on the TIME in patients with LUAD using a threshold of 50 years old for the first time. We founded that LUAD patients in older group had better TIME than in younger group and some immune-related signatures were significantly related with clinical staging.

Integrated analysis of genomic alterations of Chinese lung adenocarcinoma with micropapillary component

e15130

Background: Lung adenocarcinoma (LADC) with micropapillary component (MPC) is a special pathological subtype of LADC, which poses higher invasive with poor prognosis, regardless of proportion of MPC. The effectiveness of molecular targeted therapy in MPC-LADC patients is still being explored without sufficient clinical evidence. Herein, we comprehensive analyzed the genetic alterations of MPC-LADC in order to find effective potential drug-target genes and guide new therapeutic strategies. Methods: We enrolled 31 MPC-LADC patients at Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University from January 2019 to December 2020, and also randomly selected 89 non-MPC-LADC patients as a reference cohort. FFPE or fresh tumors and matched blood samples were performed for NGS-based target panel detection of at least 420 genes (range 420-638 genes), and we analyzed the genomic alterations of the genes with intersection in the above panels sequencing. Results: In our MPC-LADC cohort, the proportion of micropapillary component in 31 tumors were: 5 cases with MPC < 5%, 13 cases with MPC 5% - 20%, 10 cases with MPC ≥20% and other 3 cases unclear. The most frequently mutant genes were EGFR (61.3%, 19/31), TP53 (41.9%, 13/31), ALK (19.4%, 6/31), CTNNB1 (16.1%, 5/31), KRAS (12.9%, 4/31) and SMAD4 (12.9%, 4/31). Moreover, 90.3% (28/31) patients harbored genomic alterations in RTK/RAS/MAPK pathway, 54.8% (17/31) in cell-cycle pathway, 38.7% (12/31) in Wnt pathway, and 19.4% (6/31) in PI3K/AKT/mTOR pathway. Notably, the median age of patients with ALK fusions were younger than wild-type patients (53 vs 60 years, p < 0.05). Patients with KRAS mutations had larger tumor sizes than wild-type patients (Median: 3.4 vs 2.2 cm, p < 0.05), and their lesions are more prone to vascular invasion (p < 0.05). Compared with the reference group of non-MPC-LADC patients, three mutant genes were significantly enriched in MPC-LADC group, namely, CTNNB1 (16.1% vs 1.1%, p < 0.01), ALK (16.1% vs 2.2%, p < 0.05) and SMAD4 (12.9% vs 2.2%, p < 0.05). Finally, we obtained the date of micropapillary lung adenocarcinoma in Memorial Sloan-Kettering Cancer Center (MSK) from cBioPortal database, and survival outcome analysis displayed that EGFR mutations were significantly associated with poor overall survival (OS) (p < 0.05). Conclusions: In this study, we comprehensive revealed the genomic alterations of Chinese MPC-LADC patients and their association with clinicopathological characteristic. Several MPC-enriched genes including EGFR, ALK, KRAS, CTNNB1 and SMAD4 were identified which may be potential genetic drivers of micropapillary lung tumors and could help us to reveal distinct therapeutic avenues of MPC-LADC.

The long-term oncologic outcomes of robot-assisted bronchial single sleeve lobectomy for 104 consecutive patients with centrally located non-small cell lung cancer

Background

Up to now, no study has described the long-term survival and its prognostic factors of robot-assisted sleeve lobectomy. Here, the present cohort study reported the long-term oncologic outcomes of robot-assisted sleeve lobectomy to evaluate the oncological feasibility of sleeve lobectomy via a robotic surgical system in patients with centrally located non-small cell lung cancer (NSCLC).

Methods

A total of 104 consecutive patients with centrally located NSCLC who underwent robot-assisted bronchial single sleeve lobectomy between October 2014 and May 2021 were retrospectively reviewed. Bronchial single sleeve lobectomy only refers to the resection and end-to-end anastomosis reconstruction of the bronchus, without the resection of the pulmonary vessels or carina. The recurrence status during follow-up, 5-year overall survival (OS) and disease-free survival (DFS) were assessed.

Results

In the total cohort, 47 (45.2%) patients had pathological stage I disease, 28 (26.9%) patients had pathological stage II disease, and 29 (27.9%) patients had pathological stage III disease. Recurrence occurred in 26 (25.0%) patients, including locoregional recurrence in 10 (9.6%) patients and distant recurrence in 16 (15.4%) patients. No endobronchial nor perianastomotic recurrence was detected. The Kaplan-Meier curves indicated that the 5-year DFS and OS rates in the cohort were 67.9% and 73.0%, respectively. In terms of pathological stages, the 5-year DFS and OS rates were 82.9% and 82.2% for stage I patients, 57.8% and 69.7% for stage II patients, and 54.5% and 63.7% for stage III patients, respectively. Multivariable analyses demonstrated that higher pathological stage or N2 stage were independent risk factors for poorer DFS and OS.

Conclusions

Robot-assisted bronchial single sleeve lobectomy could be an oncologically adequate procedure for patients with centrally located NSCLC, due to the long-term survival was similar to that reported for video-assisted thoracoscopic surgery (VATS) or open technique. Further studies of comparative studies or high-quality randomized controlled trials are required.

Single utility port approach in robot-assisted sleeve segmentectomy for bronchial carcinoid tumor

Bronchial carcinoid tumors are low-grade malignant and lung-sparing surgery is preferred for the removal of these tumors. We describe a surgical technique of robot-assisted sleeve segmentectomy via single utility port approach with three robotic arms. This operation was performed in an aged patient with decreased pulmonary function, whose carcinoid tumor was located at the origin of the right superior segmental bronchus. A 1.5-cm incision was performed in the eighth intercostal space of the midaxillary line and another 4-cm incision was made in the fifth intercostal space of the anterior axillary line. Postoperative recovery of the patient was smooth without postoperative complications.

Effects of rapeseed meal on laying performance and egg quality in laying ducks

This study was conducted to investigate the effect of different varieties of rapeseed meal (RSM) with different concentrations of glucosinolates (Gls) and erucic acid (EA) on performance and egg quality of laying ducks. A total of 576 twenty eight-wk-old laying ducks were randomly allocated to 4 treatments. Each treatment had 8 replicates of 18 laying ducks raised in 6 adjacent cages with 3 laying ducks per cage. The control diet was corn soybean meal based without RSM. Three varieties of RSM varying in Gls concentrations were supplemented to the base diet at 10% by substituting soybean meal to formulate the three RSM diets. The experiment lasted 12 wk. Diets with 10% RSM decreased average egg weight (P < 0.01) and feed intake (P = 0.07) compared with the control diet, but there was no significant difference in laying performance among the 3 RSM diets. RSM increased color value (P < 0.05) and crude protein (CP) content (P < 0.05) of yolk compared with the control diet, but had no significant effects on the other egg quality indexes including eggshell strength, albumen height, Haugh unit, and the composition ratio of eggshell, albumen and yolk. RSM decreased total monounsaturated fatty acids (MUFA) (P < 0.01) and increased total polyunsaturated fatty acids (PUFA) (P < 0.01) of yolk, but total saturated fatty acids (SFA) proportions and UFA/SFA ratio of egg yolk were not significantly affected by RSM. RSM increased deposition of trimethylamine (TMA) and 5-vinyl-1,3-oxazolidine-2-thione (5-VOT) in yolk (P < 0.01); moreover, the high Gls RSM increased deposition of TMA (P < 0.01) and 5-VOT in yolk (P < 0.01) compared with the RSM varieties low in Gls. These results suggested that dietary inclusion of 10% RSM decreased egg weight of laying ducks, and affected yolk quality especially yolk color, fatty acid profile, CP, TMA, and 5-VOT content of yolk. Moreover, RSM with higher Gls concentration resulted in higher deposition of TMA and 5-VOT in egg yolk.

Systems biomarker characteristics of circulating alkaline phosphatase activities for 48 types of human diseases

BACKGROUND

Most human diseases are accompanied by systems changes. Systems biomarkers should reflect such changes. The phosphorylation and dephosphorylation of biomolecules maintain human homeostasis. However, the systems biomarker characteristics of circulating alkaline phosphatase, a routine blood test conducted for many human diseases, have never been investigated.

METHOD

This study retrieved the circulating alkaline phosphatase (ALP) activities from patients with 48 clinically confirmed diseases and healthy individuals from the database of our hospital during the past five years. A detailed analysis of the statistical characteristics of ALP was conducted, including quantiles, receiving operator curve (ROC), and principal component analysis.

RESULTS

Among the 48 diseases, 45 had increased, and three had decreased median levels of ALP activities compared to the healthy control. Preeclampsia, hepatic encephalopathy, pancreatic cancer, and liver cancer had the highest median values, whereas nephrotic syndrome, lupus erythematosus, and nephritis had decreased median values compared to the healthy control. Further, area under curve (AUC) values were ranged between 0.61 and 0.87 for 19 diseases, and the ALP activities were the best systems biomarker for preeclampsia (AUC 0.87), hepatic encephalopathy (AUC 0.87), liver cancer (AUC 0.81), and pancreatic cancer (AUC 0.81).

CONCLUSIONS

Alkaline phosphatase was a decent systems biomarker for 19 different types of human diseases. Understanding the molecular mechanisms of over-up-and-down-regulation of ALP activities might be the key to understanding the whole-body systems' reactions during specific disease progression.

Effects of Dietary Corn Germ Meal Levels on Growth Performance, Serum Biochemical Parameters, Meat Quality, and Standardized Ileal Digestibility of Amino Acids in Pekin Ducks

The study aimed to investigate the effects of dietary corn germ meal (CGM) levels on growth performance, carcass characteristic, serum biochemical indexes, meat physical and chemical quality, and standardized ileal digestibility of amino acids (SIDAA) in Pekin ducks from 10 to 42 d of age. A total of 420 ten-day-old Cherry Valley ducks were randomly allotted to 5 treatments with 6 replicate cages per treatment and 14 ducks per cages based on mean body weight. Five isonitrogenous and isocaloric experimental diets were formulated on a digestible amino acid basis to produce diets containing 0, 3, 6, 9, or 12% CGM. Results showed: 1) Compared with other groups, ducks fed 12% CGM significantly increased (P < 0.05) the feed to gain ratio. 2) Dietary CGM levels had no effect (P > 0.05) on the carcass traits and breast meat physical quality; but the content of crude protein presented a linear decrease (P < 0.05) in breast meat with increasing dietary CGM levels. 3) Serum biochemical indices (e.g., alanine aminotransferase, aspartate aminotransferase, glucose, high density lipoprotein cholesterol, total cholesterol, triglyceride, total protein, and urea) showed no significant differences among all groups (P > 0.05). 4) The levels of CGM had no significant effect on SIDAA of diets (P > 0.05), except for cysteine which showed a quadratic increase (P < 0.05). These results suggested that the optimal levels of CGM in diets for meat duck aged from 10 to 42 d should be below 9% based on feed to gain ratio and the content of crude protein in breast meat.

Effects of enzyme-treated soy protein on performance, digestive enzyme activity and mRNA expression of nutrient transporters of laying hens fed different nutrient density diets

It has been shown that enzyme-treated plant protein can increase performance and promote intestinal health, and save dietary protein. However, our understanding of the effects of enzyme-treated soy protein on performance and intestine function in laying hens, and its rational use, remains limited. The experiment was conducted to study the effect of enzyme-treated soy protein (ETSP) in different nutrient density diets on performance, egg quality, digestive enzyme activity and mRNA expression of amino acid transporters of laying hens. A total of 1 200 Lohmann laying hens (52 wk of age) was randomly divided into a 3 × 2 factorial design that included three nutrient levels: [positive control (PC), metabolisable energy (ME): 2 680 kcal/kg, CP: 15.5%; negative control 1 (NC1), ME: 2 630 kcal/kg, CP: 15%; negative control 2 (NC2), ME:2 580 kcal/kg, CP: 14.5%] and 2 ETSP levels (0 and 0.5%) for 12 weeks. Each treatment had 10 replicates with 20 birds. With the decrease of dietary nutrition density, egg production rate (P = 0.07) and feed conversion ratio (FCR) (P = 0.06) were reduced. Yolk colour was decreased, and yolk index was increased. Supplemented ETSP improved FCR (P = 0.05) and qualified egg rate (P < 0.05). The mass loss rate of egg was decreased after storage for 30 days (P < 0.05). An interaction between nutrient density and ETSP was observed on albumen height and Haugh unit (P < 0.05), and the effects were most noticeable in hens fed 0.5% ETSP in NC2 group. An increase in the activity of trypsin in duodenum (P < 0.05) and the relative expressions of jejunum peptide transporter 1 (PepT1) (P < 0.05) and B⁰ system neutral amino acid transport carrier (B⁰AT) mRNA (P < 0.01) was observed during ETSP supplementation. The nutrient density and ETSP supplementation had no significant effect on microbiota in the cecal contents. Overall, the results in this study indicated that the ME decreased 100 kcal/kg and CP decreased 1% in diet of laying hens had a decreasing trend on production performance, no effects on enzyme activity, amino acid transporter mRNA, and gut microbiota, whereas 0.5% ETSP can increase activity of trypsin, PepT1 and B⁰AT mRNA relative expressions, and improve FCR, qualified egg rate.

Author Correction: LncRNA HOTAIRM1 inhibits the progression of hepatocellular carcinoma by inhibiting the Wnt signaling pathway

Correction to: European Review for Medical and Pharmacological Sciences 2018; 22 (15): 4861-4868-DOI: 10.26355/eurrev_201808_15622-PMID: 30070317, published online 15 August 2018. After publication, the authors found some mistakes in the article. There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/15622.

Electromagnetic navigational bronchoscopy-guided dye marking to identify the subsegmental bronchus in thoracoscopic anatomic subsegmentectomy

Video‐assisted thoracoscopic surgery (VATS) subsegmentectomy has been widely used to resect small‐sized lung lesions in clinical practice. Precise identification of the subsegmental bronchus is one of the essential steps in performing thoracoscopic anatomic subsegmentectomy. Here, we report a thoracoscopic right S²a segmentectomy with preoperative electromagnetic navigational bronchoscopy (ENB)‐guided injection of methylene blue to identify the subsegmental bronchus in a 51‐year‐old male. We successfully performed complicated surgery using this method. This ENB‐guided dye marking method may accurately distinguish the subsegmental bronchus to effectively guide surgery.

Plasma miR-146a and miR-365 expression and inflammatory factors in patients with osteoarthritis

OBJECTIVE

To investigate the expression levels of micro-ribonucleic acid (miR)-146a and miR-365 in the plasma of osteoarthritis (OA) patients, to study their expression with the inflammatory factors and the severity of disease in patients and to analyse their diagnostic significance.

MATERIALS AND METHODS

A total of 42 OA patients diagnosed with OA and treated in our hospital from January 2017 to January 2018 were selected as the subjects, and 28 healthy people were enrolled as controls. The expressions of interleukin-1 beta (IL-1β) and IL-6 in the plasma of OA patients were detected via immunohistochemical staining. Moreover, the knee joint function of OA patients was evaluated by Lysholm score, Western Ontario and McMaster Universities (WOMAC) score and Visual Analogue Scale (VAS) score. The expression levels of plasma miR-146a and miR-365 in OA patients were measured through RT-PCR. Besides, the significance of the expression levels of miR-146a and miR-365 for the diagnosis of OA was analysed by ROC curves.

RESULTS

As compared with healthy people, OA patients had elevated expression levels of plasma IL-1β and IL-6, decreased Lysholm score, increased WOMAC and VAS scores as well as significantly up-regulated levels of plasma miR-146a and miR-365, which were of important significance for diagnosis.

CONCLUSION

The expression levels of plasma miR-146a, miR-365 and inflammatory factors are notably higher, the disease is more severe, and the function of knee joint movement is weaker in OA patients than those in healthy controls. It can be concluded that the levels of both miR-146a and miR-365 can serve as biomarkers of OA diagnosis.

The association between the vaginal microenvironment and fecundability: a register-based cohort study among Chinese women

OBJECTIVE

To evaluate the association between the vaginal microenvironment and fecundability among women.

DESIGN

Register-based nationwide cohort study.

SETTING

Chinese National Free Pre-conception Check-up Project from 2015 to 2018.

POPULATION

Our study included a total of 3 388 554 eligible women who were attempting to become pregnant.

METHOD

We assessed the vaginal microenvironment at baseline by considering four indices: vaginal pH, clue cell examination, whiff test and vaginal cleanliness grading. If any of these indicators was abnormal, the vaginal microenvironment was defined as poor. Propensity score matching was used to control for potential confounders and reduce bias. Logistic models were used to estimate the fecundability odds ratios (FORs) after adjustment for covariates.

MAIN OUTCOME MEASURES

Achievement of a pregnancy within 1 year.

RESULTS

Of the total study population, 379 718 women (11.2%) had a poor vaginal microenvironment and their pregnancy rate after 1 year was significantly lower than the group with a normal microenvironment (71.8% versus 76.1%, P < 0.001). After adjusting for potential confounders, the women with a poor vaginal microenvironment were associated with a 9% reduction in fecundability compared with the normal microenvironment group (FOR 0.91, 95% CI 0.90-0.92). The adverse effects of a poor vaginal microenvironment were stronger among multipara (FOR 0.89, 95% CI 0.87-0.90) or women with irregular menstruation (FOR 0.86, 95% CI 0.84-0.89).

CONCLUSION

There was a negative association between a poor vaginal microenvironment and the fecundability of women. These findings highlight the significance of assessing the vaginal microenvironment during pre-pregnancy health examinations.

TWEETABLE ABSTRACT

Women with a poor vaginal microenvironment were associated with a reduction in fecundability.

Risk of Acute Lung Injury after Esophagectomy

To develop a new approach for identifying acute lung injury (ALI) in surgical ward setting and to assess incidence rate, clinical outcomes, and risk factors for ALI cases after esophagectomy. We also compare the degree of lung injury between operative and non-operative sides. Consecutive esophageal cancer patients (n=1022) who underwent esophagectomy from Dec 2012 to Nov 2018 in our hospital were studied. An approach for identifying ALI was proposed that integrated radiographic assessment of lung edema (RALE) score to quantify degree of lung edema. Stepwise logistic regression identified risk factors for postoperative ALI incidence. The degree of bilateral lung injury was compared using the RALE score. The approach for identifying ALI in surgical ward setting was defined as acute onset, PaO₂/FiO₂≤300 mmHg, bilateral opacities on bedside chest radiograph with a RALE score≥16, and exclusion of cardiogenic pulmonary edema. Incidence rate of ALI was estimated to be 9.7%. ALI diagnosis was associated with multiple clinical complications, prolonged hospital stay, higher medical bills, and higher perioperative mortality. Nine risk factors including BMI, ASA class, DLCO%, duration of surgery, neutrophil percentage, high-density lipoprotein, and electrolyte disorders were identified. The RALE score of the lung lobes of the operative side was higher than the non-operative side. A new approach for identifying ALI in esophageal cancer patients receiving esophagectomy was proposed and several risk factors were identified. ALI is common and has severe outcomes. The lung lobes on the operative side are more likely to be affected than the non-operative side.

Perioperative safety and feasibility outcomes of stage IIIA-N2 non-small cell lung cancer following neoadjuvant immunotherapy or neoadjuvant chemotherapy: a retrospective study

Background

We sought to determine the perioperative safety and feasibility outcomes of stage IIIA (N2) non-small cell lung cancer (NSCLC) following neoadjuvant immunotherapy or neoadjuvant chemotherapy.

Methods

The clinical details of patients who attended the Affiliated Hospital of Qingdao University between January 2019 and December 2020 were retrospectively evaluated. Eligible patients had pathologically proven stage IIIA (N2) NSCLC and were randomly prescribed neoadjuvant therapy. Those in the neoadjuvant immunotherapy group received two cycles of nivolumab (3 mg/kg) and those in the control group received neoadjuvant chemotherapy (1,000 mg/m² gemcitabine and 80 mg/m² cisplatin). All patients were scheduled to undergo surgery. The primary endpoint was the risk of major complications within 30 days of surgery and the secondary endpoints were interval to surgery and 30-day mortality.

Results

A total of 107 eligible patients were evaluated of whom 25 were allocated to the neoadjuvant immunotherapy group and 82 to the neoadjuvant chemotherapy group. The median interval to surgery was similar in the two groups at 29.2 days [95% confidence interval (CI), 27.1 to 31.4 days] in the immunotherapy group and 28.7 days (95% CI, 27.6 to 29.8 days) in the chemotherapy group (P=0.656). While treatment-related adverse events were reported in most patients, all 25 patients completed two cycles of neoadjuvant immunotherapy and 80 of 82 patients completed two cycles of neoadjuvant chemotherapy, although one patient in the latter group died within 30 days of surgery. There was no statistically significant difference between the groups in the probability of grade 3 or higher postoperative complications within 30 days after surgery (P=0.757).

Conclusions

Most patients achieved the primary and secondary endpoints of the study. However, the major pathological response (MPR) showed statistically significant differences between the neoadjuvant immunotherapy and neoadjuvant chemotherapy groups.

The impacts of egg storage time and maternal dietary vitamin E on the growth performance and antioxidant capacity of progeny chicks

Two trials were designed to investigate the impacts of egg storage time and maternal dietary vitamin E (VE) supplementation on the growth performance and antioxidant capacity of progeny chicks. In total 512 Ross 308 broiler breeder hens (71-wk-old) were assigned to 2 dietary VE treatments (6 and 100 mg/kg) for 14 wk. Progeny chicks used in trials 1 and 2 were originated from eggs laid at week 10 (stored 0 d) and week 8 (stored 14 d), and week 14 (stored 0 d) and week 12 (stored 14 d), respectively. The 4 groups in trial 1 consisted of 2 levels of maternal VE (6 and 100 mg/kg) and 2 egg storage time (0 and 14 d). The 8 groups in trial 2 consisted of 2 levels of maternal VE (6 and 100 mg/kg), 2 egg storage time (0 and 14 d) and progeny sex (male and female). In trial 1, egg storage decreased the body weight, the liver total superoxide dismutase and total antioxidant capacity of 21-day-old offspring (P < 0.05), and the body weight gain and feed intake from 8 to 21 d and 1 to 21 d (P < 0.05); and increased the serum and liver malonaldehyde (MDA) of 7-day-old offspring and the ratio of feed: gain (F/G) from 1 to 7 d (P < 0.05). Maternal VE (100 vs. 6 mg/kg) decreased the F/G from 1 to 7 d and increased the serum total superoxide dismutase of 21-day-old offspring (P < 0.05). In trial 2, egg storage decreased the body weight of 42-day-old offspring, and the body weight gain and feed intake from 22 to 42 d and 1 to 42 d (P < 0.05); and increased the serum and liver MDA of 21- and 42-day-old offspring (P < 0.05). Maternal VE (100 vs. 6 mg/kg) reduced the serum MDA of 7-day-old offspring (P < 0.05). Interactively, maternal VE (100 vs. 6 mg/kg) reduced the serum MDA of offspring originated from stored eggs (P < 0.05), but not for that of offspring originated from unstored eggs in the two trials. It can be concluded that egg storage (14 vs. 0 d) decreased the growth performance and antioxidant capacity of offspring, while maternal dietary VE (100 vs. 6 mg/kg) supplementation could partly alleviate the reduction of antioxidant capacity (except for growth performance) of offspring induced by egg storage for the early phase post-hatch.

circFBXW7 attenuates malignant progression in lung adenocarcinoma by sponging miR-942-5p

Background

As a type of non-coding RNA, circular RNAs (circRNAs) are considered to be functional molecules associated with human cancers. An increasing number of circRNAs have been verified in malignant progression in a number of cancers. The circRNA, circFBXW7, has been proven to play an important role in tumor proliferation and metastasis. However, whether circFBXW7 influences progression in lung adenocarcinoma (LUAD) remains unclear.

Methods

Quantitative real-time reverse transcriptase PCR (qRT-PCR) was used to verify circFBXW7 in LUAD cell lines and LUAD tissues. Kaplan-Meier analysis was then used to compare the disease-free survival (DFS) and overall survival (OS) of these LUAD patients. The biological function of circFBXW7 was examined by overexpression and knockdown of circFBXW7 using MTT assay, EdU assay, wound-healing assay, and Transwell in vitro assays. To explore the mechanism of the circFBXW7, RNA pull-down assay, dual luciferase reporter assay, and RNA immunoprecipitation (RIP) assay were employed to examine the interaction between circFBXW7 and miR-942-5p. Western blot was used to study the fundamental proteins associated with the epithelial-mesenchymal transition (EMT) pathway. In vivo studies with BALB/c nude mice subcutaneously injected with cells stably overexpressing circFBXW7 were performed to further validate the in vitro results.

Results

circFBXW7 was downregulated in LUAD cell lines and tissues, and LUAD patients with lower levels had shorter DFS and OS. The in vitro study showed that circFBXW7 overexpression inhibited proliferation and migration of A549 and HCC2279 cell lines. These results were confirmed by circFBXW7 knockdown, which showed the reverse effect. The in vivo model showed that the circRNA levels influenced the tumor growth. Finally, we determined that circFBXW7 target miRNA-942-5p which regulates the EMT gene BARX2. The modulation of circFBXW7 levels produced significant changes in EMT genes in vitro and in vivo.

Conclusions

Our findings showed that circFBXW7 inhibits proliferation and migration by controlling the miR-942-5p/BARX2 axis in LUAD cell lines and its levels correlates with patient survival suggesting that regulating circFBXW7 could have therapeutic value in treating LUAD patients.

Dietary resistant potato starch improves growth performance and feather development in Pekin ducks fed a low phosphorus diet

This study investigated whether dietary resistant potato starch (RPS) inclusion could ameliorate the negative impact of a low nonphytate phosphorus (nPP) diet on growth performance, feather growth, feather follicles (FF) development, and carcass traits by improving nutrient utilization and cecal microbiome fermentation capacity in Pekin ducks. The experiment was performed with a 2 × 2 randomized block design with 2 levels of RPS (0 or 12%) and 2 levels of nPP (low or normal, low: 0.22% at 1–14 d and 0.18% at 15–35 d of age; normal: 0.40% at 1–14 d and 0.35% at 15–35 d of age) for a total of 4 treatments, each with 8 replicate pens per treatment of 12 birds per pen. As regards growth performance and carcass traits, RPS inclusion markedly increased (P < 0.05) BW of 14 and 35 d, BWG and FI of 1–14 d, 15–35 d, and 1–35 d as well as abdominal fat and breast meat percentage of 35 d in ducks fed low nPP diets; moreover, RSP inclusion significantly reduced (P < 0.05) mortality in ducks fed low nPP diets. As regards feather growth and follicles development of 35 d, RPS inclusion significantly increased (P < 0.05) the fourth primary feather length, absolute feather weight, and the density of primary FF in the back skin in ducks fed low nPP diets. In regard to nutrition utilization, RPS supplementation significantly increased (P < 0.05) the availability of DM, CP, and energy, as well as dietary AME at 35 d of age in ducks fed low nPP diets. However, RPS supplementation had no effect (P > 0.05) on the concentration of cecal short-chain fatty acids and the activities of cecal phytase and cellulase in ducks fed low nPP diets. These results indicate that RPS can improve nutrient availability to ameliorate the negative effects on performance and feather development caused by a low nPP diet in Pekin ducks.

A WRKY transcription factor, TaWRKY40-D, promotes leaf senescence associated with jasmonic acid and abscisic acid pathways in wheat

Leaf senescence is a complex and precise regulatory process that is correlated with numerous internal and environmental factors. Leaf senescence is tightly related to the redistribution of nutrients, which significantly affects productivity and quality, especially in crops. Evidence shows that the mediation of transcriptional regulation by WRKY transcription factors is vital for the fine-tuning of leaf senescence. However, the underlying mechanisms of the involvement of WRKY in leaf senescence are still unclear in wheat. Using RNA sequencing data, we isolated a novel WRKY transcription factor, TaWRKY40-D, which localizes in the nucleus and is basically induced by the progression of leaf senescence. TaWRKY40-D is a promoter of natural and dark-induced leaf senescence in transgenic Arabidopsis thaliana and wheat. We also demonstrated a positive response of TaWRKY40-D in wheat upon jasmonic acid (JA) and abscisic acid (ABA) treatment. Consistent with this, the detached leaves of TaWRKY40-D VIGS (virus-induced gene silencing) wheat plants showed a stay-green phenotype, while TaWRKY40-D overexpressing Arabidopsis plants showed premature leaf senescence after JA and ABA treatment. Moreover, our results revealed that TaWRKY40-D positively regulates leaf senescence, possibly by altering the biosynthesis and signalling of JA and ABA pathway genes. Together, our results suggest a new regulator of JA- and ABA-related leaf senescence, as well as a new candidate gene that can be used for molecular breeding in wheat.

Protease supplementation attenuates the intestinal health damage caused by low-protein diets in Pekin ducks

The objective of this study was to investigate the effects of low-protein diets with low digestibility of feed ingredients on intestinal damage and to explore whether the protease supplementation can alleviate the damage in Pekin ducks. A total of 576 Pekin ducklings (6 replicate pens, 16 ducks/pen) were randomly assigned to 6 dietary treatments (3 × 2 factorial arrangement) in a randomized complete block design. Factors were CP levels (13.5%, 15.5%, and 17.5%) and protease (0 or 20,000U/kg). Compared with the diets containing 17.5% CP, low-protein diets (13.5% CP) showed suppressed (P < 0.05) growth performance and feed intake (FI); reduced (P < 0.05) serum-free arginine, isoleucine, leucine, methionine, phenylalanine, valine, and proline as well as the cecal acetate and propionate concentration; increased (P < 0.05) plasma and ileal mucosal tumor necrosis factor-α (TNF-α) concentration; and downregulated (P < 0.05) mRNA expression of TNF-α, nuclear transcription factor-κb, interferon gamma, and Occludin in ileal mucosa. Irrespective of the dietary CP levels, protease supplementation significantly increased (P < 0.05) the serum-free glutamic acid concentration while decreasing (P < 0.05) the plasma endotoxin, IL-6, and the cecal isovalerate concentration. A significant interactive effect was observed between low-protein diets and protease supplementation (P < 0.05) on serum-free arginine concentration, the ratio of ileal villus height to crypt depth, and the IL-6 concentration in ileal mucosa. These results indicated that low-protein diets could damage intestinal integrity to induce systemic inflammation response and at last to suppress growth performance. Protease supplementation could partly attenuate the negative effects on gut health caused by low-protein diets in Pekin ducks.

Effects of graded levels of phytase supplementation on growth performance, serum biochemistry, tibia mineralization, and nutrient utilization in Pekin ducks

A total of 560 one-day-old Pekin ducks were randomly allocated to 7 treatments with 8 replicate cages of 10 ducks per cage. The treatments included a corn-rice bran-soybean meal-based diet with recommended nonphytate phosphorus (NPP) (0.40% for 1-14 D/0.35% for 15-35 D, positive control; PC), NPP-deficient diet (0.22% for 1-14 D/0.18% for 15-35 D, negative control; NC), and NC diets supplemented with different levels of phytase (500, 2,500, 5,000, 7,500, 10,000 FTU/kg). Compared with the PC diet, feeding the NC diet significantly decreased (P < 0.05) the bird growth performance, serum total protein, and albumin concentration as well as tibia bone mineralization and strength and increased (P < 0.05) serum calcium (Ca), urea content, and alkaline phosphatase activity throughout the experimental period. Phytase supplementation to NC diets at 5,000 to 10,000 FTU/kg restored (P < 0.05) growth performance, serum biochemical parameters, and tibia traits when compared with the levels of the PC. Moreover, the addition of phytase linearly increased (P < 0.05) dietary protein, Ca, and phosphorus (P) utilization as well as nitrogen output, and excreta iron, copper, manganese, and zinc concentration quadratically increased (P < 0.05) as well as P output. In conclusion, phytase at ≥5,000 FTU/kg was effective in ameliorating the negative effects of NC diets and reducing trace mineral supplementation in diet of Pekin ducks.

[Effect of Porphyromonas gingivalis infection on atherosclerosis in apolipoprotein-E knockout mice]

OBJECTIVE

Studies have indicated that periodontal pathogen Porphyromonas gingivalis (P. gingivalis) infection may contributed to accelerate the development of atherosclerosis. The aim of this study was to investigate the effect of inflammation, oxidative stress and the mechanism on atherosclerosis in apolipoprotein-E knockout (ApoE-/-) mice with P. gingivalis infection.

METHODS

Eight-week-old male ApoE-/- mice (C57BL/6) were maintained under specific pathogen-free conditions and fed regular chow and sterile water after 1 weeks of housing. The animals were randomly divided into two groups: (a) ApoE-/- + PBS (n=8); (b) ApoE-/- + P.gingivalis strain FDC381 (n=8). Both of the groups received intravenous injections 3 times per week for 4 weeks since 8 weeks of age. The sham control group received injections with phosphate buffered saline only, while the P. gingivalis-challenged group with P.gingivalis strain FDC381at the same time. After 4 weeks, oxidative stress mediators and inflammation cytokines were analyzed by oil red O in heart, Enzyme linked immunosorbent assay (ELISA) in serum, quantitative real-time PCR and Western blot in aorta.

RESULTS

In our study, we found accelerated development of atherosclerosis and plaque formation in aorta with oil red O staining, increased oxidative stress markers [8-hydroxy-2-deoxyguanosine (8-OHdG), NADPH oxidase (NOX)-2 and NOX-4], as well as increased inflammation cytokines [interleukin (IL)-1β, IL-6 and tumor necrosis factor-α (TNF-α)] in the serum and aorta of the P. gingivalis-infected ApoE-/- mice. Compared with the control group, there was a significant increase protein level of nuclear factor-kappa B (NF-κB) in aorta after P. gingivalis infection.

CONCLUSIONS

Our results suggest that chronic intravenous infection of P. gingivalis in ApoE-/- mice could accelerate the development of atherosclerosis by disturbing the lipid profile and inducing oxidative stress and inflammation. The NF-κB signaling pathway might play a potential role in the P. gingivalis-accelerated atherogenesis.

Different efficacy in the non-small cell lung cancer patient with bilateral synchronous lesions treated with neoadjuvant gefitinib therapy: a case report

Gefitinib, the first-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), has become the standard of care for the first-line of therapy for advanced non-small cell lung cancer (NSCLC) with common EGFR mutation. However, the efficacy of preoperative gefitinib therapy in patients with common EGFR mutations remains poorly defined. We describe a NSCLC patient with bilateral synchronous lesions who had a significantly positive response to gefitinib before radical surgical resection. At the time of initial diagnosis, we were unable to confirm whether the two lesions were metastatic or synchronous primary lesions. Accordingly, we performed CT-guided percutaneous left lung biopsy resulting in a diagnosis of lung adenocarcinoma with exon 21 L858R point mutation of EGFR, This diagnosis was followed by preoperative gefitinib therapy for 8 weeks leading to a significant reduction in the lesion in the left lower lobe. Then the left lower lobectomy and mediastinal lymphadenectomy were performed. In addition, 3 months following resection of the left lower lobe tumor the patient underwent a right lower lobe wedge resection. This report indicates that NSCLC patient harboring common EGFR mutation accepting the first-generation EGFR-TKI gefitinib as a neoadjuvant targeted therapy option is safe, feasible, and well-tolerated.

Effects of dietary protein levels and protease supplementation on growth performance, carcass traits, meat quality, and standardized ileal digestibility of amino acid in Pekin ducks fed a complex diet

This study aimed to investigate to the effects of dietary CP levels and protease supplementation on growth performance, carcass traits, meat quality, nutrients utilization, and standardized ileal digestibility of amino acid in Pekin ducks fed a complex diet. A total of 960 14-day-old male ducks were weighed and randomly allotted to a 2 × 5 factorial arrangement of 10 treatments with 6 replicate pens per treatment and 16 ducks per pen fed to 49 D of age. Experimental factors included five dietary CP levels ranging from 13.5 to 17.5% and with or without protease (200 mg/kg) supplementation. Between day 28 to 34, the digestible and metabolizable trials were performed. Significant CP × protease interactions (P < 0.05) on breast meat yield, DM, energy and nitrogen utilization, as well as standardized ileal digestibility values of 7 amino acids were observed. Regardless of protease supplementation, ducks fed 13.5, 14.5, and 15.5% CP had a poorer (P < 0.05) growth performance and breast meat yield than ducks fed with 16.5 and 17.5% CP. Ducks fed 13.5% CP had a positive effect (P < 0.05) on meat quality, dietary DM, energy and nitrogen utilization as well as standardized ileal digestibility of amino acids. Protease supplementation increased (P < 0.05) DM and phosphorus retention and decreased (P < 0.05) shear force of breast meat, regardless of CP level; when CP = 14.5%, protease significantly increased (P < 0.05) breast muscle yield. The optimal CP requirement without or with protease supplementation for BWG and FI were 17.02 or 16.53% and 16.64 or 16.75%, respectively, based on linear broken-line regression.

[Clinical Application of Vectorial Localization of Peripheral Pulmonary Nodules Guided by Electromagnetic Navigation Bronchoscopy in Thoracic Surgery]

背景与目的

随着计算机断层扫描技术（computed tomography scans, CT）的广泛应用，越来越多的肺小结节被发现，一些需要外科手术处理的结节数量也在增加。胸腔镜手术中对于不可直视及触摸到的肺外周小结节的准确定位较为困难。虽然目前一些常用的定位技术能够带来比较好的定位效果，如CT引导的穿刺定位和电磁导航支气管镜（electromagnetic navigation bronchoscopy, ENB）系统引导的亚甲兰染色定位，但同时仍存在着气胸、出血及定位不准确的问题。ENB引导的矢量定位法是我中心首创的一种新型定位技术，该技术避免了前两种

方法

可能出现的胸膜损伤或者定位区域扩大的问题，为ENB引导的定位技术提供了一定的指导。本文回顾性分析胸腔镜术前通过ENB引导矢量定位的临床结果来确定该方法的临床应用价值。方法回顾性分析2017年10月-2018年10月于青岛大学附属医院胸外科行ENB矢量定位法进行胸腔镜手术前定位的患者资料，统计患者临床资料、肺小结节影像学特征，评估该方法临床应用的安全性及有效性。

结果

我们成功实施了22例患者的22个肺外周结节在ENB引导下矢量定位和腔镜下楔形切除（22/22, 100%）。结节平均大小为（11.0±3.6）mm，距脏层胸膜表面距离为（16.5±6.2）mm；ENB系统显示屏导航定位装置（locatable guide, LG）与病灶距离为（14.5±10.1）mm，离体标本标记与病灶距离为（15.3±11.0）mm，ENB矢量定位平均时间为（17.5±4.2）min，无定位点LG发生移位（0.0%）。手术过程无中转开胸（0.0%），患者术中及术后未见明显并发症（0.0%），术后平均住院时间为（3.8±1.2）d，无围手术期患者死亡（0.0%）。术后病理结果为恶性肿瘤者19例，均得到了完全切除。

结论

我们应用ENB引导的矢量定位法在肺外周小结节术前定位和微创切除的初步经验提示该方法安全、可行、有效，可作为ENB操作中可选的一种定位方式。胸外科临床医师可以进一步研究该方法并应用到临床操作中。

Relevance and prognostic ability of Twist, Slug and tumor spread through air spaces in lung adenocarcinoma

BACKGROUND

Tumor spread through air spaces (STAS) is a novel pathologic characteristic in lung adenocarcinomas that indicates invasive tumor behavior. We aimed to explore the relationship between Twist, Slug and STAS in lung adenocarcinoma and to investigate the potential relationship between epithelial-mesenchymal transition (EMT) and STAS.

MATERIALS AND METHODS

Our study retrospectively analyzed 115 patients with resected lung adenocarcinomas to evaluate the relationship between Twist, Slug and STAS. STAS was diagnosed using hematoxylin-eosin (H&E) staining. Immunohistochemistry was used to evaluate the expression levels of Slug and Twist.

RESULTS

In this study, 56 (48.7%) patients had STAS, 40 (34.8%) patients had Slug overexpression, and 28 (24.3%) patients had Twist overexpression. Patients with either STAS or Slug and Twist overexpression experienced poor recurrence-free survival (RFS) and overall survival (OS). There were significant associations between Twist overexpression, Slug overexpression and the presence of STAS. The logistic model further revealed that pathological stage, Twist overexpression and Slug overexpression were independent risk factors for STAS. A multivariate analysis that contained Twist, Slug, pathologic stage and STAS, showed that pathologic stage and STAS were independent prognostic factors for poor RFS and OS. Another multivariate model that contained Twist, Slug and pathologic stage, showed that pathologic stage, Twist overexpression and Slug overexpression were independent risk factors for poor RFS and OS. In the cohort with STAS, the multivariate analysis showed that pathologic stage and Twist overexpression were independent risk factors for poor survival. The subgroup analysis showed that patients with both Slug overexpression and Twist overexpression with STAS received a poor prognosis.

CONCLUSIONS

STAS, Slug and Twist were correlated with poor RFS and OS in resected lung adenocarcinomas. Additionally, STAS was correlated with the overexpression of Twist and Slug, which could potentially provide information on the mechanism of STAS.

The effects of varieties and levels of rapeseed expeller cake on egg production performance, egg quality, nutrient digestibility, and duodenum morphology in laying hens

The objective of this study was to evaluate the effects of rapeseed expeller cake (REC) derived from Brassica napus rapeseed with different concentrations of glucosinolate (Gls) and erucic acid (EA) on the egg-production performance, egg quality, apparent nutrient digestibility, and intestinal morphology in laying hens. At 33 wk of age, a total of 1,080 laying hens were randomly divided into 9 treatment groups in a completely randomized design involving a control treatment without REC (a corn–soybean diet) and a 2 × 4 factorial arrangement with 2 concentrations of REC (at 7 and 14%) from 4varieties of rapeseed varying in Gls and EA concentrations [DY6 REC: 22.67 μmol/g (Gls, relative to rapeseed meal), 0.7% (EA, relative to total fatty acids); MB1 REC: 43.23 μmol/g, 3.5%; DY5 REC: 74.66 μmol/g, 16.20%; XH3 REC: 132.83 μmol/g, 44.60%]. The trial lasted for 8 wk. Compared with the control group, REC addition decreased the ADFI, egg production, egg weight, and egg mass of laying hens during wk1 to wk4, wk5 to wk8, and wk1 to wk8 (P < 0.05), and REC did not affect FCR, mortality during wk1 to wk4, wk5 to wk8, and wk1 to wk8 (P > 0.05). The XH3 REC group had a trend to lower egg weight when compared with the DY6 REC group during wk1 to wk8 (P = 0.07).REC decreased AME and DM digestibility at wk8 (P < 0.01), and REC addition in diet did not affect apparent nitrogen digestibility (P = 0.6). REC decreased villi height (P < 0.01) and increased crypt depth (P < 0.01). The XH3 REC group had a lower crude fat digestibility than the DY6 REC group, and the crude fat digestibility of the DY5 and MB1 REC groups was lower than the XH3 REC group (P < 0.01). The DY6 REC group had a higher villi height than the DY5, MB1, and XH3 REC groups (P < 0.01). The XH3 REC group had a higher crypt depth than the DY6, DY5, and MB1 REC groups (P < 0.01). The DY6 REC group had a higher value of the ratio of villi height to crypt depth than the DY5 and MB1 REC groups, and the DY5 and MB1 REC groups had a higher value of the ratio of villi height to crypt depth than the XH3 REC group (P < 0.01).REC decreased albumen height and Haugh unit during wk1 to wk8 (P < 0.01 and P = 0.004), and increased yolk color during wk1 to wk8 (P < 0.01).The XH3, MB1, and DY5 REC groups had a lower albumen height than the DY6 REC group during wk1 to wk8 (P < 0.01), and the XH3 and DY5 REC groups had a lower Haugh unit than the DY6 REC group during wk1 to wk8 (P < 0.01). The DY6 REC group had the highest value of yolk color than other three varieties of REC (DY5, MB1, XH3) at wk6 and wk8 (P < 0.01 and P < 0.01). It can be concluded that the exposure of laying hens to REC with higher Gls and EA (DY5, MB1, XH3) led to a lower egg weight, nutrient digestibility, intestinal absorptive area, and egg internal quality than those with lower Gls and EA (DY6).

Effects of Lonicera confusa and Astragali Radix extracts supplementation on egg production performance, egg quality, sensory evaluation, and antioxidative parameters of laying hens during the late laying period

Lonicera confusa (LC) and Astragali Radix (AR) extracts have been shown to have antioxidant and anti-inflammatory activities in human. To determine whether LC or/and AR extracts had similar functions to improve the egg production and egg quality, 1,440 (52-wk-old) Lohmann pink-shell hens were randomly distributed into 4 treatments with nine replicates of 40 hens. The hens were fed a basal diet (CON) or the basal diet supplemented with 0.1% LC extracts, 0.1% AR extracts, or 0.1% LC extracts plus 0.1% AR extracts (LC-AR) for 12 wk. The eggs were collected on week 6 and 12 for analysis, and the plasma and ovaries were collected at end of trial. Dietary treatment did not influence (P < 0.05) egg production, egg weight, and feed conversion ratio. However, LC-AR addition increased (P < 0.02) yolk color and sensory quality of hard-boiled eggs compared to other groups. The LC-AR supplementation increased (P = 0.02), and LC addition tended to increase (P = 0.08) Haugh unit of eggs on week 12 compared to CON. The LC-AR supplementation decreased (P < 0.001), and LC or AR individual addition tended to decrease (P < 0.10) plasma malondialdehyde concentration compared to CON. Conversely, LC supplementation increased (P = 0.02) total superoxide dismutase activity, and LC or/and AR supplementation increased the activities of manganese-containing superoxide dismutase (MnSOD) (P < 0.08) and glutathione peroxidase (GSH-Px) (P < 0.01) in plasma, and the mRNA abundance of MnSOD, GSH-Px1, and catalase in ovaries (P < 0.05) compared to CON. The LC or/and AR supplementation decreased the concentrations of interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α) in plasma (P < 0.05), and the mRNA abundance of IL-6 and TNF-α in ovaries (P < 0.04) compared to CON. These results suggested dietary inclusion of LC or/and AR improved the albumen quality, and a blend of LC and AR improved yolk color, which were associated with the enhancement of antioxidant capacity and the suppression of systemic inflammation in hens.

Calcium affects sternal mass by effects on osteoclast differentiation and function in meat ducks fed low nutrient density diets

Genetic progress and increasing nutrient density for greater body mass and meat yield in poultry has inadvertently led to an imbalance between pectorales mass and sternal development which may or may not be detrimental to productivity and welfare. Slowing weight gain while promoting bone mineralization could positively influence sternal health. Thus, the present study aimed to evaluate the effect of graded calcium (Ca) supplementation in low nutrient density (LND) diets on sternal mass and bone turnover in meat ducks. Male meat ducks (720, 15-day-old) were randomly assigned and fed a standard nutrient density positive control (PC) diet, and 4 LND diets with 0.5, 0.7, 0.9, and 1.1% Ca, respectively. Metabolic energy (ME) was reduced in the LND by 9.5 and 16.3% at 15-35 D and 36-56 D compared to PC diet, respectively, while maintaining proportionate essential nutrient proportions to energy similar as in the PC diet. Although the 0.9% Ca LND diet decreased body weight and sternal dimension, it increased the relative sternum weight, the trabecular bone volume/tissue volume (BV/TV) and Ca content of the sternum compared with PC diet. Feeding 0.7% or more Ca with the LND diet significantly increased the mineral content, bone density, BV/TV, and trabecular number of the sternum for 49-days-old ducks. Furthermore, the LND diet with 0.7% or more Ca-increased osteocyte-specific gene mRNA and osteoprotegerin (OPG) expression, and it blocked the expression of cathepsin K and decreased osteoclasts number per bone surface. Tartrate-resistant acid phosphatase (TRAP) staining also revealed that the addition 0.7% or more Ca to the LND diet significantly decreased the number of osteoclasts compared with the 0.5% Ca LND diet. Meanwhile TRAP activity in serum was significantly decreased in 0.7% or more Ca-treated groups. We concluded that LND diet with 0.7% or more Ca may maintain optimal sternal mass through suppressing bone resorption for meat duck.

Evaluation of the standardized ileal digestibility of amino acids of rapeseed meals varying in protein solubility for Pekin ducks

This study was conducted to determine whether protein solubility (PS) of rapeseed meals (RSM) can affect standardized ileal amino acid digestibility (SIDAA) in meat ducks. A total of 1,168, 14-days-old ducks were randomly allotted to 23 treatments (6 cages per diet, 8 ducks per cage) and 1 nitrogen-free diet treatment (8 cages, 8 ducks per cage) based on body weight. The 23 experimental diets consisted of a corn–soybean meal basal diet, and 22 diets containing 15% RSM: 85% basal diet. Titanium dioxide (0.5%) was included in all diets as an indigestible marker. On day 18, all ducks were euthanized by carbon dioxide asphyxiation and digesta samples from the ileum. The contents of PS, ether extract (EE), glucosinolate, isothiocyanate, and oxazolidine were significantly different (P < 0.05) in the 22 RSM, with the CV being 52.62, 49.23, 86.84, 90.19, and 81.98%, respectively. The content of lysine (Lys) and methionine in the 22 RSM samples ranged from 1.03 to 2.71% (CV 24.19%) and from 0.33 to 0.65% (CV 15.17%), respectively. The SIDAA, except for leucine (Leu) and tyrosine, of the 22 RSM samples varied significantly (P < 0.05). A positive correlation was observed (P < 0.05) between PS and standardized ileal digestibility (SID) of Lys, isoleucine, valine, phenylalanine, histidine, serine, cysteine, and tyrosine. The R² value of multiple linear regression equations for predicting the SID of amino acids (AA) was best for Lys (R² = 0.958 using dry matter, crude protein, EE, crude fiber, acid detergent fiber, and PS) and least significant for Leu (R² = 0.348 using crude fiber and ash) with intermediate values for other AA (R² = 0.359–0.837, P < 0.05). These results suggest that PS varying from 15.06 to 98.08%, also varied considerably in the proximate nutrient content, AA composition, and antinutritional factor content, which was reflected in considerable differences in the duck's SID of AA in RSM. Therefore, PS value can partly reflect the quality of RSM.

Study on the morphology and mineralization of the tibia in meat ducks from 1 to 56 d

The objective of this current study was to characterize the basic physiological data on morphological and mineralized properties of the tibia from 1 to 56 days, as well as the interrelationships of body weight (BW) and bone traits for meat ducks. A total of 176 1-d-old ducks was allocated into eight pens and fed with the same diet until the age of 56 d. Eight birds (1 ducks/pen) were randomly selected weekly for measuring BW and tibia characteristics. The BW of duck was increased with age throughout the whole study. Tibial length and width rapidly grew from 1 to 35 d, when it leveled off. The fat-free weight, ash, calcium (Ca) and phosphorus (P) content of tibia increased rapidly from 1 to 42 d and reached its plateau from 42 d onward. Tibial density and tibia-breaking strength increased in a regular manner with age until 42 d. Serum alkaline phosphatase activity was higher between 1 to 7 d in the duck. Regression and ontogenetic scaling analysis showed the age of maximal growth rate in tibia dimension and mineralization was earlier than that in BW; when compared with BW, tibial fat-free weight and tibia-breaking strength increased isometrically, tibia length displayed a negative allometry, and tibial width showed a positive allometric growth. Results indicate that the tibia displayed rapid bone growth (1 to 35 d) and mineralization (1 to 42 d), and alkaline phosphatase (ALP) plays a critical role in the early stage of tibia mineralization of meat duck. Intensive selection for growth rate in ducks has resulted in tibial morphology changes, which represents an interesting compromise of adaptation for increasing BW.

Three-dimensional printing in the preoperative planning of thoracoscopic pulmonary segmentectomy

Background

The purpose of this study is to explore whether 3D printing has a better clinical value for making a preoperative plan than three-dimensional computed tomography (3D-CT) in thoracoscopic pulmonary segmentectomy.

Methods

We collected a total of 124 patients' clinical data who underwent thoracoscopic pulmonary segmentectomy from October 2017 to August 2018. According to the preoperative examination, the patients were divided into three groups: general group, 3D-CT group, and 3D printing group. The clinical data of each group were analyzed and compared.

Results

Compared with the general group, intraoperative blood loss in 3D-CT group and 3D printing group decreased significantly (P<0.05). Operation time in 3D-CT group and 3D printing group was significantly shorter than in the general group (P<0.05). Between 3D-CT group and 3D printing group intraoperative blood loss and operation time had no significant differences (P>0.05). Postoperative chest tube duration and postoperative hospital stay had no significant differences between each group P>0.05). The incidence of postoperative hemoptysis in the general group occurred higher than in the 3D-CT group and 3D printing group, but the differences were not statistically significant (P>0.05). Postoperative complications of pneumonia, atelectasis, and pulmonary air leakage (>6 d) had no significant differences between each group (P>0.05).

Conclusions

3D printing and 3D-CT for making a preoperative plan have an equivalent effect in thoracoscopic pulmonary segmentectomy for experienced surgeons. Preoperative simulations using 3D printing for the assessment of pulmonary vessel and bronchi branching patterns is beneficial for the safe and efficient performance of thoracoscopic pulmonary segmentectomy.

A novel technique for identification of the segments based on pulmonary artery plane combined with oxygen diffusing discrepancy

Background

Segmentectomy has been widely accepted as a powerful tool to treat small lung nodules. Despite been commonly used, identify the intersegment plane precisely in visual during the operation still being a complex issue. We described a novel method in minimal invasive thoracic surgery utilizing arterial-navigation combined with oxygen diffusing discrepancy based on the variance of oxygen diffusion in target and reserved segments. We perspectively analyzed 24 cases with small lung nodules of T1N0M0 disease to examine the efficacy of the new method.

Methods

From June 2018 to September 2018, 24 patients with small primary lung cancers underwent segmentectomy at The Affiliated Hospital of Qingdao University. All the patients received minimally invasive procedures and standard anatomical segmentectomy. Ligation of the target segment artery followed by observation and the arterial-navigation line gradually appeared by color discrepancy in the visceral pleural surface. The plane was then testified by inflation-deflation method.

Results

The mean identification time of the intersegments plane was 8 minutes. The residual segments collapsed and stayed pink, meanwhile the target parts remained inflated and turned dark. It allowed a clear identification of the intersegments plane on the surface. All operations were successfully completed. There were no perioperative deaths or major complications. The coincidence rate of arterial-navigation and inflation-deflation technique was 22/24.

Conclusions

The arterial-navigation method is safe and feasible to identify the intersegmental plane in small lung tumor resection.

Prognostic model based on circular RNA circPDK1 for resected lung squamous cell carcinoma

Background

Circular RNA has been revealed as a potential biomarker in multiple malignancies. However, few studies have focused on its potential to be prognostic markers in lung squamous cell carcinoma (LSCC). In this work, we aimed to build a prognostic model of resected LSCC based on circular RNA pyruvate dehydrogenase kinase 1 (circPDK1) and other clinicopathological factors.

Methods

circPDK1 was identified via next-generation sequencing. Three hundred two cases of LSCC tissue and their adjacent normal lung tissues were obtained from multiple medical centers and divided into study cohort (n=232) and validation cohort (n=70). The expression of circPDK1 was detected for analyzing its potential prognostic value for recurrence-free survival (RFS) and overall survival (OS) in LSCC. Finally, combined with circPDK1, T staging, lymph nodes (LN) metastasis status, age, and serum squamous cell Carcinoma Antigen (SCCAg), we built a prognostic model by nomograms method and confirmed it in the validation cohort.

Results

CircPDK1 was identified to be overexpressed (P<0.01) in LSCC. Through analysis in study cohort, circPDK1^low patients (less than the mean expression, n=124) showed more lymph nodes metastasis (P=0.025), more vascular invasion (VI) (P=0.047), more visceral pleural invasion (VPI) (P=0.015) and poorer prognosis (P=0.003) than circPDK1^high ones (n=108). Univariate and multivariate analysis showed that circPDK1, T staging, LN status, age, and SCCAg were significant prognostic factors for RFS and OS. The prognostic model based on these factors showed the concordance index (C-index) of 0.8214 and 0.8359 for predicting 5-year RFS and OS, respectively. Finally, the calibration curves were performed in the study cohort and a validation cohort to evaluate the model's efficiency.

Conclusions

circPDK1 was identified as a potential biomarker of resected LSCC. The prognostic model including circPDK1, T staging, LN status, age, and SCCAg could effectively predict prognosis of resected LSCC.

Robotic sleeve lobectomy for centrally located non-small cell lung cancer: A propensity score-weighted comparison with thoracoscopic and open surgery

OBJECTIVE

To evaluate the surgical and oncologic outcomes of robotic sleeve lobectomy in comparison with video-assisted thoracoscopic surgery (VATS) and open surgery.

METHODS

Surgical outcomes in patients with non-small cell lung cancer who underwent sleeve lobectomy via robotic, VATS, and thoracotomy were assessed using the χ² test, Fisher exact test, and the Kruskal-Wallis rank sum test. Log-rank test and Cox proportional hazards model were used in survival analyses. Propensity score-weighted matching was used to achieve the balance of baseline among the 3 groups.

RESULTS

Between 2012 and 2017, 188 patients were included and divided into robotic (n = 49), VATS (n = 73), and open (n = 66) groups. After weighted matching that retained all patients, no statistical difference in 90-day mortality or morbidity among the 3 groups was shown. Patients in the robotic group had less bleeding loss (P < .001), operative time (P < .001), and tube drainage time (P < .001) than the other 2 groups. No positive bronchial margin or conversion presented in the robotic group. In multivariable analyses, surgical technique was independently associated with neither overall survival nor disease-free survival (P > .050).

CONCLUSIONS

Robotic sleeve lobectomy is a safe, feasible, and effective procedure. Compared with VATS and open techniques, robotic sleeve lobectomy has a similar oncologic prognosis for patients with centrally located non-small cell lung cancer. Further studies with a larger sample size and long-term follow-up are needed.

LncRNA HOTAIRM1 inhibits the progression of hepatocellular carcinoma by inhibiting the Wnt signaling pathway

OBJECTIVE

To explore the possible role of long non-coding RNA (lncRNA) HOTAIRM1 in the pathogenesis of hepatocellular carcinoma (HCC) and its underlying mechanism.

PATIENTS AND METHODS

LncRNA HOTAIRM1 expressions in 30 pairs of hepatocellular carcinoma tissues and paracancerous tissues were detected by quantitative Reverse Transcriptase-Polymerase Chain Reaction (qRT-PCR). The survival analysis and receiver operating characteristic (ROC) curve were introduced to explore the relationship between lncRNA HOTATRM expressions and prognosis of HCC patients. The correlation between progression-free survival (PFS) and clinical variables of HCC patients was estimated by single-factor and multiple-factor regression analysis, respectively. Overexpression plasmid of lncRNA HOTAIRM1 was designed and transfected into HCC cells according to the instructions of Lipofectamine 2000. Cell proliferation and apoptosis were detected by cell counting kit-8 (CCK-8) assay and flow cytometry, respectively. Moreover, expressions of apoptosis-related genes and the Wnt pathway-related proteins were detected by Western blot.

RESULTS

Lower lncRNA HOTAIRM1 expressions were observed in the HCC tissues than those of the paracancerous tissues. ROC curve indicated a high sensitivity and specificity of lncRNA HOTAIRM1 for HCC. PFS in HCC patients was correlated with tumor size and lncRNA HOTAIRM1 expression, whereas not correlated with age, sex, GGT, AFP, Child-Pugh grade, HBsAg, cirrhosis, number of tumors, micro-vessel metastasis, tumor differentiation, and TNM stage of HCC. Overexpression of HOTAIRM1 led to decreased proliferative ability and increased apoptosis of HepG2 and HHCC cells. In addition, overexpressed lncRNA HOTAIRM1 remarkably increased the expression of apoptosis promotor Bax, but decreased the expressions of apoptosis inhibitors Bcl-2 and Bid. Meanwhile, expressions of related proteins in the Wnt pathway were decreased as well.

CONCLUSIONS

HOTAIRM1, which was downregulated in HCC, might inhibit the proliferative ability and promote the apoptosis of HCC cells by suppressing the Wnt pathway, thereby inhibiting the progression of hepatocellular carcinoma.