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Abstract Background The new-onset postoperative atrial fibrillation (NOPAF) following pulmonary resection is a common clinical concern. The aim of this study was to construct a nomogram to intuitively predict the risk of NOPAF and offered protective treatments. Methods Patients who underwent pulmonary resection between January 2018 and December 2020 were consecutively enrolled. Forward stepwise multivariable logistic regression analyses were used to screen independent predictors, and a derived nomogram model was built. The model performance was evaluated in terms of calibration, discrimination and clinical utility and validated with bootstrap resampling. Results A total of 3583 patients who met the research criteria were recruited for this study. The incidence of NOPAF was 1.507% (54/3583). A nomogram, composed of five independent predictors, namely age, admission heart rate, extent of resection, laterality, percent maximum ventilation volume per minute (%MVV), was constructed. The concordance index (C-index) was 0.811. The nomogram showed substantial discriminative ability, with an area under the receiver operating characteristic curve of 0.811 (95% CI 0.758-0.864). Moreover, the model shows prominent calibration performance and higher net clinical benefits. Conclusion We developed a novel nomogram that can predict the risk of NOPAF following pulmonary resection, which may assist clinicians predict the individual probability of NOPAF and perform available prophylaxis. By using bootstrap resampling for validation, the optimal discrimination and calibration were demonstrated, indicating that the nomogram may have clinical practicality.

Background and objective Pre-operative accuracy of subcentimeter ground glass nodules (SGGNs) is a difficult problem in clinical practice, but there are few clinical studies on the benign and malignant prediction model of SGGNs. The aim of this study was to help identify benign and malignant lesions of SGGNs based on the imaging features of high resolution computed tomography (HRCT) and the general clinical data of patients, and to build a risk prediction model. Methods This study retrospectively analyzed the clinical data of 483 patients with SGGNs who underwent surgical resection and were confirmed by histology from the First Affiliated Hospital of University of Science and Technology of China from August 2020 to December 2021. The patients were divided into the training set (n=338) and the validation set (n=145) according to 7:3 random assignment. According to the postoperative histology, they were divided into adenocarcinoma group and benign lesion group. The independent risk factors and models were analyzed by univariate analysis and multivariate Logistic regression. The receiver operator characteristic (ROC) curve was constructed to evaluate the model differentiation, and the calibration curve was used to evaluate the model consistency. The clinical application value of the decision curve analysis (DCA) evaluation model was drawn, and the validation set data was substituted for external verification. Results Multivariate Logistic analysis screened out patients' age, vascular sign, lobular sign, nodule volume and mean-CT value as independent risk factors for SGGNs. Based on the results of multivariate analysis, Nomogram prediction model was constructed, and the area under ROC curve was 0.836 (95%CI: 0.794-0.879). The critical value corresponding to the maximum approximate entry index was 0.483. The sensitivity was 76.6%, and the specificity was 80.1%. The positive predictive value was 86.5%, and the negative predictive value was 68.7%. The benign and malignant risk of SGGNs predicted by the calibration curve was highly consistent with the actual occurrence risk after sampling 1,000 times using Bootstrap method. DCA showed that patients showed a positive net benefit when the predictive probability of the predicted model probability was 0.2 to 0.9. Conclusion Based on preoperative medical history and preoperative HRCT examination indicators, the benign and malignant risk prediction model of SGGNs was established to have good predictive efficacy and clinical application value. The visualization of Nomogram can help to screen out high-risk groups of SGGNs, providing support for clinical decision-making.

The authors present an intelligent metasurface system that uses a target detection algorithm combined with a depth camera, to automatically detect the position of moving targets and achieve real-time wireless communications. The system can operate for multiple targets in limited ambient light, outdoor and other realistic environments.

Abstract Inactivation of the p53 pathway is linked to a variety of human cancers. As a critical component of the p53 pathway, ubiquitin‐specific protease 7 (USP7) acts as a deubiquitinase for both p53 and its ubiquitin E3 ligase mouse double minute 2 homolog. Here, myeloid leukemia factor 2 (MLF2) is reported as a new negative regulator of p53. MLF2 interacts with both p53 and USP7. Via these interactions, MLF2 inhibits the binding of USP7 to p53 and antagonizes USP7‐mediated deubiquitination of p53, thereby leading to p53 destabilization. Functionally, MLF2 plays an oncogenic role in colorectal cancer, at least partially, via the negative regulation of p53. Clinically, MLF2 is elevated in colorectal cancer and its high expression is associated with poor prognosis in patients with colorectal cancer. In wild‐type‐p53‐containing colorectal cancer, MLF2 and p53 expressions are inversely correlated. These findings establish MLF2 as an important suppressor of p53 function. The study also reveals a critical role for the MLF2–p53 axis in promoting colorectal carcinogenesis.

ObjectiveIn order to solve the problem of time cooperative path planning for unmanned marine system (UMS) in complex environments, we propose a cooperative path planning method based on a differential evolution (DE) algorithm. MethodsFirst, natural environment and enemy threat models in the air, sea and underwater are established. The objective function of path planning with multiple constraints is constructed and a strategy proposed to solve the time coordination problem under the constraints of heterogeneous platforms starting at different times and places, but arriving at the same time and place. Next, a DE algorithm is used to optimize the solution, and the influence of the number of waypoints on the success rate of the planning is studied. ResultsBased on the reasonable selection of the number of waypoints, the DE algorithm can respectively plan the path that satisfies the time cooperative constraint for the UMS and find the shortest time to reaching the target in complex environments with multiple threats and obstacles. The results also show that either excessive or inadequate numbers of waypoints will result in success rate reduction of the path planning. ConclusionsThe results of this study show that the model and constraint conditions are reasonable, and the proposed algorithm can solve the problem of time coordination in the path planning of UMS, which has great practical application value.

BackgroundLung adenocarcinoma (LUAD) is a fatal malignancy in the world. Growing evidence demonstrated that autophagy-related genes regulated the immune cell infiltration and correlated with the prognosis of LUAD. However, the autophagy-based signature that can predict the prognosis and the efficiency of checkpoint immunotherapy in LUAD patients is yet to be discovered.MethodsWe used conventional autophagy-related genes to screen candidates for signature construction in TCGA cohort and 9 GEO datasets (tumor samples, n=2181; normal samples, n=419). An autophagy-based signature was constructed, its correlation with the prognosis and the immune infiltration of LUAD patients was explored. The prognostic value of the autophagy-based signature was validated in an independent cohort with 70 LUAD patients. Single-cell sequencing data was used to further characterize the various immunological patterns in tumors with different signature levels. Moreover, the predictive value of autophagy-based signature in PD-1 immunotherapy was explored in the IMvigor210 dataset. At last, the protective role of DRAM1 in LUAD was validated by in vitro experiments.ResultsAfter screening autophagy-related gene candidates, a signature composed by CCR2, ITGB1, and DRAM1 was established with the ATscore in each sample. Further analyses showed that the ATscore was significantly associated with immune cell infiltration and low ATscore indicated poor prognosis. Meanwhile, the prognostic value of ATscore was validated in our independent LUAD cohort. GSEA analyses and single-cell sequencing analyses revealed that ATscore was associated with the immunological status of LUAD tumors, and ATscore could predict the efficacy of PD-1 immunotherapy. Moreover, in vitro experiments demonstrated that the inhibition of DRAM1 suppressed the proliferation and migration capacity of LUAD cells.ConclusionOur study identified a new autophagy-based signature that can predict the prognosis of LUAD patients, and this ATscore has potential applicative value in the checkpoint therapy efficiency prediction.

Background and objective Small pulmonary nodules are usually difficult to identify during thoraco-scopic resection, and preoperative computed tomography (CT)-guided percutaneous puncture assisted localization can be helpful. The purpose of this study is to compare the localization effect and complication rates of two different methods by microcoil placement and sclerosing agent injection (Lauromacrogol). Methods A retrospective analysis of the clinical data of 371 patients with preoperative pulmonary nodules percutane us puncture localization was performed. According to the use of different materials, they were divided into the microcoil group (167 cases with 196 localized nodules ) and the sclerosing agent group (204 cases with 239 localized nodules). The localization effect, complication, pathological results and operation relates data were statistically analyzed. Results The localization failure rate (2.4%) was higher in the microcoil group than in the sclerosing agent group (0.5%) (P=0.011), and the localization time of sclerosing agent group was significantly shorter than the microcoil group [(18.78±6.91) min vs (11.99±3.77) min, P=0.000], but the distance between the selected localized nodules and the pleura was deeper in the microcoil group than in the sclerosing agent group [(9.59±8.62) mm vs (8.13±6.49)mm, P=0.002]. The overall complications in the microcoil group were significantly higher than those in the sclerosing agent group (P=0.000), in which pneumothorax was the most common. Through the analysis of related risk factors, we revealed that different positioning methods was independent risk factors. Wedge resection was the main type of surgical method and non-invasive carcinomas were the majority of postoperative pathological results. Conclusion Our study suggests that both microcoil placement and sclerosing agent injection are suitable for preoperative pulmonary nodule localization equivalently, however, compared with microcoils placement, injection of lauromacrogol, the sclerosing agent, had lower failure rate, less complications, shorter localization time and it is worthy of promotion also by easy operation and low cost.

IntroductionSegmentectomy is widely used for early-stage lung cancer presenting as single or multiple ground-glass opacities (GGOs). Precise segmentectomy is the recommended procedure in China. However, clinically, most routine segmentectomies are performed using only high-resolution computed tomography (CT). The aim of this study was to evaluate the effect of two segmentectomy approaches for GGOs in the lung.MethodsFrom January 2020 to September 2020, 55 precise segmentectomies performed with real-time guidance using 3D reconstruction and 343 routine segmentectomies for patients with single or multiple GGOs were performed as uniportal procedures. To reduce bias related to outcomes, preoperative clinical factors were used for propensity score matching (1:1); 55 precision and 55 routine segmentectomies were selected and further analyzed. Perioperative outcomes, namely operation time, blood loss, resection margins, number of removed lymph nodes, postoperative pulmonary function (1 month after surgery), length of postoperative stay, and postoperative complications were compared between the two groups.ResultsPatients constituted 43 men and 67 women, with an age range of 25–68 years (median: 53 years). No significant differences were seen between the groups regarding blood loss, complications, histological type, and postoperative pulmonary function, and there were no 30-day postoperative deaths in either group. The median operation time for the Precision group (74 min) was longer than in the Routine group (55 min) (p

IntroductionCancer progression is determined not only by the malignant behavior of tumors but also by the immune microenvironment. The tumor immune microenvironment also plays a pivotal role in determining the clinical response of non-small-cell lung cancer (NSCLC) to immunotherapies. To understand the possible mechanisms and explore new targets in lung cancer immunotherapy, we characterized the immune profiles in NSCLC patients.MethodsSeventy-one NSCLC patients who underwent radical resection were selected. The immune cell composition in paired tumor and adjacent normal lung tissues was tested by flow cytometry. The associations of tumor immune microenvironment characteristics with clinicopathological factors and overall survival were analyzed. Kaplan–Meier curves and Cox proportional hazards models were used to determine differences in survival.ResultsCompared with adjacent normal lung tissues, an increased proportion of CD45+ hematopoietic-derived cells, CD4+ T cell subtypes, Tregs and B cells was observed in tumor samples with a reduced frequency of myeloid cell populations. There was no significant increase in total CD8+ T cells, but both PD1+ and CD38+ CD8+ T cells were significantly enriched in tumor samples and statistically significantly associated with tumor size. In addition, positive CD38 expression was highly correlated with PD1 positivity. A high proportion of CD8+ T cells and a low percentage of PD1+ CD8+ T cells were statistically significantly associated with better survival in stage II and III patients, whereas a low frequency of CD38+ CD8+ T cells was statistically significantly associated with better survival in all patients and identified as an independent prognostic factor (p=0.049).ConclusionWe profiled the immune cells in the tumor tissues of NSCLC patients using flow cytometry. The results revealed significant enrichment of infiltrating immune cells. A strong correlation was identified between CD38 and PD-1 expression on CD8+ T cells in tumors. CD8+ T cells and their subtypes play a critical role in the prediction of prognosis.

ObjectiveThis study aimed to analyze the relationship between the number of examined lymph nodes (ELNs) at the N1 station and the postoperative clinicopathological features and prognosis of patients with pT1-3N0M0 non-small cell lung cancer (NSCLC).MethodsThe cut-off value of the number of ELNs at the N1 station was obtained using X-tile software analysis. Kaplan-Meier survival curve analysis and the Cox proportional hazard model were used to study the impact of the number of ELNs at the N1 station on the prognosis of postoperative patients with pT1-3N0M0 NSCLC.ResultsThe median survival time and 1-, 3- and 5-year survival rates of 0 ELNs at the N1 station were 28.0 months and 74.8%, 45.4%, and 21.2%, respectively. The median survival time and 1-, 3-, and 5-year survival rates of 1–4 ELNs at the N1 station were 45.0 months and 85.5%, 55.4%, and 39.1%, respectively. In the group with ≥ 5 ELNs at the N1 station, the median survival time and the 1-, 3- and 5-year survival rates were 59.0 months and 94.0%, 62.7%, and 48.2%, respectively. Both univariate and multivariate Cox regression analyses showed that the number of ELNs at the N1 station, T stage and operation type were independent factors affecting the prognosis of patients with pT1-3N0M0 NSCLC.ConclusionIncreasing the number of ELNs at the N1 station is positively correlated with the long-term survival rate of patients with T1-3N0M0 NSCLC. At least 5 LNs at the N1 station should be examined in pathological examination.

Background and objective Prolonged air leak (PAL) after anatomic lung resection is a common and challenging complication in thoracic surgery. No available clinical prediction model of PAL has been established in China. The aim of this study was to construct a model to identify patients at increased risk of PAL by using preoperative factors exclusively. Methods We retrospectively reviewed clinical data and PAL occurrence of patients after anatomic lung resection, in department of thoracic surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, from January 2016 to October 2016. 359 patients were in group A, clinical data including age, body mass index (BMI), gender, smoking history, surgical methods, pulmonary function index, pleural adhesion, pathologic diagnosis, side and site of resected lung were analyzed. By using univariate and multivariate analysis, we found the independent predictors of PAL after anatomic lung resection and subsequently established a clinical prediction model. Then, another 112 patients (group B), who underwent anatomic lung resection in different time by different team, were chosen to verify the accuracy of the prediction model. Receiver-operating characteristic (ROC) curve was constructed using the prediction model. Results Multivariate Logistic regression analysis was used to identify six clinical characteristics [BMI, gender, smoking history, forced expiratory volume in one second to forced vital capacity ratio (FEV1%), pleural adhesion, site of resection] as independent predictors of PAL after anatomic lung resection. The area under the ROC curve for our model was 0.886 (95%CI: 0.835-0.937). The best predictive P value was 0.299 with sensitivity of 78.5% and specificity of 93.2%. Conclusion Our prediction model could accurately identify occurrence risk of PAL in patients after anatomic lung resection, which might allow for more effective use of intraoperative prophylactic strategies.

Background and objective Facing the double pressures caused by cancer and surgery, many patients will appear series psychological problems like nervous, fear, pessimism, anxiety and so on. The aim of this study is to explone the anxiety, depression status of family members, the general psychological status of perioperative patients with lung cancer and the influence of the former on the latter. Methods Total 97 patients and 97 patient family members from the thoracic department of the Second Xiangya Hospital of Central South University were enrolled as the study subjects. The general information, the anxiety and depression status of the family members, and the general psychological status of perioperative patients with lung cancer were investigated using self-made general information questionnaire, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and symptom check-list 90 (SCL-90). Results The scores of seven factors, including total scores (153.28±41.98), somatization (1.78±0.42), compulsion (1.96±0.52), depression (1.77±0.67), anxiety (1.82±0.56), hostility (1.68±0.87), panic (1.44±0.75) and psychosis (1.56±0.51) in SCL-90 were remarkerbly higher than those in domestic norm (P

p53 plays a central role in tumor suppression. Emerging evidence suggests long noncoding RNA (lncRNA) as an important class of regulatory molecules that control the p53 signaling. Here, we report that the oncogenic lncRNA E2F1 messenger RNA (mRNA) stabilizing factor (EMS) and p53 mutually repress each other's expression. EMS is negatively regulated by p53. As a direct transcriptional repression target of p53, EMS is surprisingly shown to inhibit p53 expression. EMS associates with cytoplasmic polyadenylation element-binding protein 2 (CPEB2) and thus, disrupts the CPEB2-p53 mRNA interaction. This disassociation attenuates CPEB2-mediated p53 mRNA polyadenylation and suppresses p53 translation. Functionally, EMS is able to exert its oncogenic activities, at least partially, via the CPEB2-p53 axis. Together, these findings reveal a double-negative feedback loop between p53 and EMS, through which p53 is finely controlled. Our study also demonstrates a critical role for EMS in promoting tumorigenesis via the negative regulation of p53. [ABSTRACT FROM AUTHOR]

Background and objective Small pulmonary nodules are usually difficult to identify during thoracoscopic resection, and preoperative computed tomography (CT)-guided percutaneous puncture assisted localization can be helpful. The purpose of this study is to compare the localization effect and complication rates of two different methods by microcoil placement and sclerosing agent injection (Lauromacrogol). Methods A retrospective analysis of the clinical data of 371 patients with preoperative pulmonary nodules percutane us puncture localization was performed. According to the use of different materials, they were divided into the microcoil group (167 cases with 196 localized nodules ) and the sclerosing agent group (204 cases with 239 localized nodules). The localization effect, complication, pathological results and operation relates data were statistically analyzed. Results The localization failure rate (2.4%) was higher in the microcoil group than in the sclerosing agent group (0.5%) (P=0.011), and the localization time of sclerosing agent group was significantly shorter than the microcoil group [(18.78±6.91) min vs (11.99±3.77) min, P=0.000], but the distance between the selected localized nodules and the pleura was deeper in the microcoil group than in the sclerosing agent group [(9.59±8.62) mm vs (8.13±6.49)mm, P=0.002]. The overall complications in the microcoil group were significantly higher than those in the sclerosing agent group (P=0.000), in which pneumothorax was the most common. Through the analysis of related risk factors, we revealed that different positioning methods was independent risk factors. Wedge resection was the main type of surgical method and non-invasive carcinomas were the majority of postoperative pathological results. Conclusion Our study suggests that both microcoil placement and sclerosing agent injection are suitable for preoperative pulmonary nodule localization equivalently, however, compared with microcoils placement, injection of lauromacrogol, the sclerosing agent, had lower failure rate, less complications, shorter localization time and it is worthy of promotion also by easy operation and low cost. [ABSTRACT FROM AUTHOR]

Deregulated expression of c-Myc is an important molecular hallmark of cancer. The oncogenic function of c-Myc has been largely attributed to its intrinsic nature as a master transcription factor. Here, we report the long noncoding RNA (lncRNA) E2F1 messenger RNA (mRNA) stabilizing factor (EMS) as a direct c-Myc transcriptional target. EMS functions as an oncogenic molecule by promoting G1/S cell cycle progression. Mechanistically, EMS cooperates with the RNA binding protein RALY to stabilize E2F1 mRNA, and thereby increases E2F1 expression. Furthermore, EMS is able to connect c-Myc to cell cycle control and tumorigenesis via modulating E2F1 mRNA stability. Together, these findings reveal a previously unappreciated mechanism through which c-Myc induces E2F1 expression and also implicate EMS as an important player in the regulation of c-Myc function. [ABSTRACT FROM AUTHOR]