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Abstract Objective With the wide use of CT scan in clinical practice, more lung cancer was diagnosed in resectable stage. Pathological examination and genetic testing have become a routine procedure for lung adenocarcinoma following radical resection. This study analyzed special pathological components and gene mutations to explore their relationship with clinical characteristics and overall survival. Methods Clinical, pathological, and gene mutation data from 1,118 patients were collected. All patients underwent surgery at the Department of Thoracic Surgery, the Second Xiangya Hospital of Central South University. Patients were grouped based on pathological components and gene mutations. Differences in clinical features and overall survival were analyzed as well. Results Patients with mucinous, neuroendocrine, and poor-differentiated components were presented with more prognostic risk factors, including pleural invasion, carcinothrombosis, STAS, and advanced stages, along with varying frequencies of gene mutations. These factors significantly shortened overall survival. ALK and KRAS mutations were also associated with risk factors such as solid nodules, pleural invasion, STAS, and later stages. However, a significant reduction in overall survival was observed only in patients with the KRAS mutation. Relationship between gene mutations and pathological components still requires further investigation. Conclusion Special pathological components (mucinous, neuroendocrine, and poor-differentiated) and gene mutations had an influence on biological behavior of tumors, resulting in different clinical characteristics and prognosis.

Abstract Background Paragangliomas are rare neoplasms arising from extra-adrenal chromaffin cells, with mediastinal paragangliomas representing an exceptionally rare subset. This report details the surgical management of a complex mediastinal paraganglioma case, presenting with refractory hypertension and invasion of critical surrounding structures. A comprehensive review of the current literature is included to underscore existing cases, enhance clinical awareness, and share our insights and experience in the diagnosis and treatment of this challenging condition. Case presentation A 16-year-old female presented with recurrent headaches and persistent hypertension lasting over one year. Based on clinical findings and imaging studies, she was preliminarily diagnosed with a mediastinal paraganglioma. The patient underwent comprehensive preoperative management, including oral α- and β-adrenergic blockade, preoperative arterial embolization, and intravenous fluid volume expansion, to optimize endocrine control. Thoracoscopic resection of the mediastinal mass was initially attempted; however, the procedure became complex due to the high risk of uncontrolled hemorrhage and invasion of adjacent vital structures. Following the preoperative surgical plan, the incision was converted to a lateral thoracotomy, and cardiopulmonary bypass was initiated. Meticulous dissection enabled the complete removal of the tumor along with the affected posterior wall of the left atrium, followed by reconstruction of the left atrium and the right pulmonary vein. The surgery was successfully completed, and follow-up assessments showed no signs of tumor recurrence or metastasis. Conclusions Functional mediastinal paraganglioma is a rare neuroendocrine tumor, with complete surgical resection being the gold standard treatment. Stringent perioperative management is crucial to mitigate the risk of cardiovascular complications associated with functional tumors. Lifelong surveillance is recommended to detect potential recurrence or metastasis. Effective collaboration within a multidisciplinary team is essential for ensuring accurate diagnosis and delivering optimal, individualized care.

Objective: Segmentectomy has been widely performed in clinical practice, which required a comprehensive understanding of anatomical structure. In right lower lobe, studies of superior segment (S6) were relatively small-sized. And only one study focusing on subsuperior segment (S∗) was published, which showed different results with previous ones. As the close relationship between S6 and S∗, variation types and their prevalence rate were reported, aiming to providing larger-size study of S6 and showing new evidence on anatomical structure of S∗. Methods: 800 CT imaging data were collected from patients in our hospital. Three-dimensional reconstruction was performed after quality check. All images were screened according to the definition of corresponding segment and anatomical variations were analyzed. Results: The proportion of S6 variation types in the largest scale (718 patients) was reported with no significant difference compared to previous studies and newly classified subtypes of two-stem V6. The prevalence rate for S∗ in right lower lobe reached 28.3 % (203/718) with similar proportion of three types. Variation types and origins of pulmonary artery were analyzed in detail, finding two-stem A∗ only be observed in type III B∗. Conclusions: Through this study, the variation types and incidence rate of S6 were confirmed, and a different result of S∗ has been provided as well. The feasibility of the current classification standards and proposed new subclassifications were verified. The results would be a supplement to lung segmental anatomy and could advance researches in the future.

Abstract Electroceuticals, through the selective modulation of peripheral nerves near target organs, are promising for treating refractory diseases. However, the small sizes and the delicate nature of these nerves present challenges in simplifying the fixation and stabilizing the electrical-coupling interface for neural electrodes. Herein, we construct a robust neural interface for fine peripheral nerves using an injectable bio-adhesive hydrogel bioelectronics. By incorporating a multifunctional molecular regulator during network formation, we optimize the injectability and conductivity of the hydrogel through fine-tuning reaction kinetics and multi-scale interactions within the conductive network. Meanwhile, the mechanical and electrical stability of the hydrogel is achieved without compromising its injectability. Minimal tissue damage along with low and stable impedance of the injectable neural interface enables chronic vagus neuromodulation for myocardial infarction therapy in the male rat model. Our highly-stable, injectable, conductive hydrogel bioelectronics are readily available to target challenging anatomical locations, paving the way for future precision bioelectronic medicine.

Abstract Although hydrophobic interactions provide the main driving force for initial peptide aggregation, their role in regulating suprastructure handedness of higher-order architectures remains largely unknown. We here interrogate the effects of hydrophobic amino acids on handedness at various assembly stages of peptide amphiphiles. Our studies reveal that relative to aliphatic side chains, aromatic side chains set the twisting directions of single β-strands due to their strong steric repulsion to the backbone, and upon packing into multi-stranded β-sheets, the side-chain aromatic interactions between strands form the aromatic ladders with a directional preference. This ordering not only leads to parallel β-sheet arrangements but also induces the chiral flipping over of single β-strands within a β-sheet. In contrast, the lack of orientational hydrophobic interactions in the assembly of aliphatic peptides implies no chiral inversion upon packing into β-sheets. This study opens an avenue to harness peptide aggregates with targeted handedness via aromatic side-chain interactions.

Abstract Background Pectus excavatum, the most common chest wall deformity, is frequently treated with Nuss procedure. Here we will describe non-invasive procedure and analyze the variables associated vacuum bell therapy for patients with pectus excavatum. Methods Retrospective case–control study in a single center between July 2018 and February 2022, including patients with pectus excavatum treated with vacuum bell. Follow-up was continued to September 2022. The Haller index and Correction index was calculated before and after treatment to analysis the effectiveness of vacuum bell therapy. Results There were 98 patients enrolled in the treatment group, with 72 available for analysis, and the follow-up period ranged from 1.1 to 4.4 years (mean 3.3 years). When analyzing with the Haller Index, 18 patients (25.0%) showed excellent correction, 13 patients (18.1%) achieved good correction, and 4 patients (5.6%) had fair correction. The remaining patients had a poor outcome. Characteristics predicting a non-poor prognosis included initial age ≤ 11 years (OR = 3.94, p = 0.013) and patients with use over 24 consecutive months (OR = 3.95, p = 0.013). A total of 9 patients (12.5%) achieved a CI reduction below 10. Patients who started vacuum bell therapy at age > 11 had significantly less change compared to those who started at age ≤ 11 (P

Eliminating poverty, reducing inequality, and achieving balanced development are one of the United Nations Sustainable Development Goals. Objectively and accurately measuring regional economic vitality and development equilibrium is a pressing scientific issue that needs to be addressed in order to achieve common prosperity. Nighttime light (NTL) remote sensing data have been proven to be a good proxy variable for socio-economic development, and are widely used due to their advantages of convenient access and wide spatial coverage. Based on multi-source data, this study constructs an Economic Development Index (EDI) that comprehensively reflects regional economic vitality from two aspects, economic quality and development potential, combines the Nighttime Light Development Index (NLDI) as the evaluation indicators to measure the economic vitality and development equilibrium, analyzes the economic vitality and development equilibrium of 300 district and county units in China’s three major urban agglomerations from 2000 to 2020 and their temporal and spatial variation characteristics, and discusses the connotation of EDI and its availability. The results show the following: (1) From 2000 to 2020, the average growth rate of EDI in China’s three major urban agglomerations reached 36.32%, while the average decrease rate of NLDI reached 38.75%; both economic vitality and the development equilibrium have been continuously enhanced. Among them, the Yangtze River Delta (YRD) urban agglomeration experienced the fastest economic growth, while the Guangdong–Hong Kong–Macao Greater Bay Area (GBA) exhibited the strongest economic strength. (2) Both economic vitality and the development equilibrium in these three urban agglomerations exhibited distinct spatial agglomeration characteristics, namely center-surrounding distribution, coastal–inland distribution, and radial belt–pole distribution, respectively. (3) Over the past two decades, the economic development of these three urban agglomerations has progressed towards the pattern of regional coordinated development, pole-driven development and urban–rural integrated development. The research results can provide new research perspectives and scientific support for promoting regional balanced development, achieving sustainable development goals, and reducing inequality.

Abstract Background Aortoesophageal fistula (AEF) is an extremely rare and highly fatal complication leading to a high risk of morbidity and mortality. Successful management of AEF after esophagectomy for esophageal carcinoma has rarely been reported in the literature. Case presentation Here we present a rare case of a 44-year-old female with complications of AEF after esophagectomy for esophageal carcinoma, mainly presented as vomiting of blood. Both computed tomographic and computed tomography angiography of the chest showed bilateral pleural effusion and atelectasis, while gastroscopy showed large gastrointestinal bleeding. Emergency surgery was performed that included the removal of the mediastinal abscess, left lower pulmonary wedge resection, and thoracic endovascular aortic repair (TEVAR), followed by supportive treatment. The surgery went successful, and the patient was followed up for 1 year after discharge and showed good recovery. We also reviewed previous literature on the history, causes, pathophysiology, clinical presentation, diagnosis, and treatment of AEF after esophagectomy for esophageal adenocarcinoma. Conclusions In our case, thoracotomy combined with TEVAR was effective in treating AEF after esophagectomy for esophageal adenocarcinoma. This case provides successful experiences for clinical diagnosis and treatment of AEF after esophagectomy for esophageal carcinoma.

In this paper, an integrated device which realized the dual-mode integration of power amplifier (PA) and radio frequency (RF) switch based on GaN dual-gate (DG) structure is designed and fabricated. The integrated device provides two working modes and meets the performance requirements of PA and RF switch. In the transmit (Tx) mode, the integrated device is used as PA. At the frequency of 3.6 GHz, compared with the conventional GaN HEMT (high electron mobility transistor) as PA, due to the field modulation effect of the dual-gate structure, the current collapse is effectively suppressed, and the output power density $(P_{out})$ of the integrated device is increased from 6.90 W/mm to 7.85 W/mm, and the power added efficiency (PAE) is increased from 44.3% to 51.1%. In the receive (Rx) mode, the integrated device is used as RF switch. Compared with conventional RF switch, the isolation of integrated devices is significantly improved. At the frequency of 3.6GHz, the isolation is improved from 19.4 dB to 41.0 dB; At the frequency of 40 GHz, the isolation is improved from 3.0 dB to 29.7 dB. The integrated device provides a novel function integration scheme for RF frontends, with great potential for improving the integration and dimension of future communication systems.

Sea cucumber has many physiological functions, such as anti-tumor, anti-coagulation, anti-oxidation and immunity regulation. It has high edible and medicinal value, and has received much attention in nutrition and health care. There are few researches on the exploitation and utilization of sea cucumber viscera at home and abroad, and a lack of knowledge about the active components of sea cucumber viscera. The viscera of sea cucumber is often discarded as a by-product of processing and can not be fully utilized. At present, the utilization of sea cucumber viscera mainly focuses on the identification of active components and the removal of fishy products, and the research on the development of products is less. Based on the nutrients and active components of sea cucumber viscera, this paper expounds the processing and utilization of sea cucumber intestines, eggs, sperms, gonads and viscera, the establishment of removing fishy smell methods and the potential development direction of products from three aspects of papers, authorized patents and health food. In general, at present, there are generally shortcomings such as inconsistent processing methods of active components of sea cucumber offal and unclear practical ingredients of health food. With the development of processing technology, the comprehensive utilization of sea cucumber viscera by enzymatic hydrolysis and extraction will become an important direction.

Abstract Background Diagnosing and treating synchronous multiple primary lung cancers (sMPLC) are complex and challenging. This study aimed to report real‐world data on the comprehensive diagnosis and treatment of patients with early‐stage sMPLC. Materials and Methods A single‐center cohort study was carried out and a large number of patients with early‐stage sMPLC were included. A single‐ or two‐stage surgery was performed to remove the primary and co‐existing lesions. The “X” strategies, including ablation, SBRT, and EGFR‐TKIs treatment, were applied to treat the high‐risk residual lesions. Wide panel‐genomic sequencing was performed to assess the genetic heterogeneity of the co‐existing lesions. Results A total of 465 early‐stage sMPLC patients with 1198 resected lesions were included. Despite most patients being histologically different or harboring different genetic alternations, about 7.5% of the patients had the same histological type and driver gene mutation changes, comprehensive re‐evaluation is thus needed. The “Surgery + X” strategy showed remarkable efficacy and safety in treating multiple lesions. Follow‐up data revealed that the T2 stage (p = 0.014) and the solid presence of a primary lesion (p

The regional differences in carbon dioxide (CO2) variations from the Orbiting Carbon Observatory-2 (OCO-2) over the Beijing-Tianjin-Hebei (Jing-Jin-Ji) region from 2015 to 2021 are analyzed in this study. This study shows an annual increase and a seasonal cycle; the CO2 annual growth rate was about 2.63 ppm year−1, with the highest value being in spring and the lowest in summer. The spatial distribution is unbalanced, regional differences are prominent, and the CO2 concentration is lower in the north of the Jing-Jin-Ji region (like Zhangjiakou, Chengde, and Qinhuangdao). Land-type structures and population economy distributions are the key factors affecting CO2 concentration. By analyzing the land-type structures over Jing-Jin-Ji in 2020, we find that cropland, woodland, and grassland (CWG) are the main land cover types in Jing-Jin-Ji; the proportion of these three types is about 83.3%. The woodland areas in Zhangjiakou, Chengde, and Qinhuangdao account for about 65% of the total woodland areas in Jing-Jin-Ji; meanwhile, the grassland areas in these three regions account for 62% of the total grassland areas in Jing-Jin-Ji. CO2 concentration variation shows a high negative correlation with CWG land areas (coefficient of determination (R2) > 0.76). The regions with lower population and GDP secondary industry (SI) density also have lower CO2 concentration (like Zhangjiakou, Chengde, and Qinhuangdao), and the regions with higher population and GDP SI density also have higher CO2 concentration (like the southeast of Jing-Jin-Jin).

Earthquake disasters are marked by their unpredictability and potential for extreme destructiveness. Accurate information on building damage, captured in post-earthquake remote sensing images, is critical for an effective post-disaster emergency response. The foundational features within these images are essential for the accurate extraction of building damage data following seismic events. Presently, the availability of publicly accessible datasets tailored specifically to earthquake-damaged buildings is limited, and existing collections of post-earthquake building damage characteristics are insufficient. To address this gap and foster research advancement in this domain, this paper introduces a new, large-scale, publicly available dataset named the Major Earthquake Damage Building Feature Set (MEDBFS). This dataset comprises image data sourced from five significant global earthquakes and captured by various optical remote sensing satellites, featuring diverse scale characteristics and multiple spatial resolutions. It includes over 7000 images of buildings pre- and post-disaster, each subjected to stringent quality control and expert validation. The images are categorized into three primary groups: intact/slightly damaged, severely damaged, and completely collapsed. This paper develops a comprehensive feature set encompassing five dimensions: spectral, texture, edge detection, building index, and temporal sequencing, resulting in 16 distinct classes of feature images. This dataset is poised to significantly enhance the capabilities for data-driven identification and analysis of earthquake-induced building damage, thereby supporting the advancement of scientific and technological efforts for emergency earthquake response.

Abstract Background To explore the possible carcinogenesis and help better diagnose and treat patients with synchronous multiple primary lung cancers (sMPLC), we systematically investigated the genetic and DNA methylation profiles of early-stage sMPLC and single primary lung cancer (SPLC) and explored the immune profiles in the tumor microenvironment. Methods Hundred and ninety-one patients with 191 nodules in the SPLC group and 132 patients with 295 nodules in the sMPLC group were enrolled. All the samples were subjected to wide panel-genomic sequencing. Genome-wide DNA methylation was assessed using the Infinium Human Methylation 850 K BeadChip. RNA-seq and CIBERSORT analyses were performed to identify the immune characteristics in these two groups. Results Lesions from sMPLC patients had lower TMB levels than that from SPLC patients. sMPLC had a similar genetic mutational landscape with SPLC, despite some subgroup genetic discrepancies. Distinct DNA methylation patterns were identified between the two groups. The differentially methylated genes were related to immune response pathways. RNA-seq analyses revealed more immune-related DEGs in sMPLC. Accordingly, more immune-related biological processes and pathways were identified in sMPLC. Aberrant DNA methylation was associated with the abnormal expression of immune-related genes. CIBERSORT analysis revealed the infiltration of immune cells was different between the two groups. Conclusion Our study for the first time demonstrated genetic, epigenetic, and immune profile discrepancies between sMPLC and SPLC. Relative to the similar genetic mutational landscape, the DNA methylation patterns and related immune profiles were significantly different between sMPLC and SPLC, indicating their essential roles in the initiation and development of sMPLC.

In this study, we explore the exciton dynamics in a WS2/MoS2 van der Waals (vdW) heterostructure under varying pressures by integrating a laser-confocal photoluminescence (PL) spectroscope and an atomic force microscope (AFM). For the WS2/MoS2 heterostructure, the exciton emission belonging to MoS2 is too weak to be distinguished from the PL spectra. However, upon contact with a Si probe, the emission intensity of WS2 excitons significantly decreases from 34,234 to 6560, thereby matching the intensity level of MoS2. This alteration substantially facilitates the exploration of interlayer excitonic properties within the heterostructures using PL spectroscopy. Furthermore, the Si probe can apply out-of-plane localized pressure to the heterostructure. With increasing pressure, the emission intensity of the WS2 trions decreases at a rate twice that of other excitons, and the exciton energy increases at a rate of 0.1 meV nN−1. These results elucidate that the WS2 trions are particularly sensitive to the out-of-plane pressure within a WS2/MoS2 vdW heterostructure.

Background and objective: Anterior cruciate ligament (ACL) reconstruction calls for artificial ligaments with better bioactivity, however systematic reviews regarding bioactivity enhancement strategies, technologies, and perspectives of artificial ligaments have been rarely found. Methods: Research papers, reviews, and clinical reports related to artificial ligaments were searched and summarized the current status and research trends of artificial ligaments through a systematic analysis. Results: Having experienced ups and downs since the very first record of clinical application, artificial ligaments differing in material, and fabrication methods have been reported with different clinical performances. Various manufacturing technologies have developed and realized scaffold- and cell-based strategies. Despite encouraging in-vivo and in-vitro test results, the clinical results of such new designs need further clinical examinations. Conclusion: As the demand for ACL reconstruction dramatically increases, novel artificial ligaments with better osteoinductivity and mechanical performance are promising. The translational potential of this article: To develop novel artificial ligaments simultaneously possessing excellent osteoinductivity and satisfactory mechanical performance, it is important to grab a glance at recent research advances. This systematic analysis provides researchers and clinicians with comprehensive and comparable information on artificial ligaments, thus being of clinical translational significance.

This paper proposes a fabric defect detection algorithm based on the SA-Pix2pix network and transfer learning to address the issue of insufficient accuracy in detecting complex pattern fabric defects in scenarios with limited sample data. Its primary contribution lies in treating defects as disruptions to the fabric’s texture. It leverages a generative adversarial network to reconstruct defective images, restoring them to images of normal fabric texture. Subsequently, the reconstituted images are subjected to dissimilarity calculations against defective images, leading to image segmentation for the purpose of defect detection. This approach addresses the issues of poor defect image reconstruction accuracy due to the limited ability of remote dependency modeling within the generator’s convolutional neural network. It also tackles deficiencies in the generative adversarial network’s loss function in handling image details. To enhance the structure and loss function of the generative adversarial network, it introduces self-attention mechanisms, L1 loss, and an improved structural loss, thus mitigating the problems of low defect image reconstruction accuracy and insufficient image detail handling by the network. To counteract the issue of declining model training accuracy in the face of sparse complex fabric defect samples, a channel-wise domain transfer learning approach is introduced. This approach constrains the training of the target network through feature distribution, thereby overcoming the problem of target network overfitting caused by limited sample data. The study employs three methods to experimentally compare and investigate five distinct complex pattern fabric defects. The results demonstrate that, when compared to two other defect detection methods, the approach advocated in this paper exhibits superior detection accuracy in scenarios with limited sample data.

Objective: The prognostic role of perineural invasion (PNI) in resected non-small cell lung cancer (NSCLC) remains unclear. A meta-analysis was performed to compare the overall survival (OS) of patients with resected NSCLC with and without PNI. Methods: The PubMed, EMBASE, and Web of Science databases were systematically searched to identify relevant studies investigating the effect of PNI on OS in patients with resected NSCLC. Pooled hazard ratio (HR) and 95% confidence intervals (CI) were estimated using a random-effects model. Separate meta-analyses using adjusted or unadjusted HR for OS were performed using Stata/SE 12.0. Results: Eleven studies comprising 2,279 patients were included. In total, PNI was identified in 9% (median, 4%–31%) of patients with resected NSCLC. The unadjusted pooled effect of the PNI was significantly associated with worse OS (HR, 2; 95% CI, 1.65–2.43). Adjusting for potential confounders yielded a similar result, with OS being significantly worse (HR, 2.13; 95% CI, 1.8–2.51) for patients exhibiting PNI. Conclusion: This meta-analysis indicates that the PNI is a strong prognostic factor for unfavorable outcomes in patients with resected NSCLC. Further large-scale prospective lung cancer trials are required to validate these results.

A new species of the genus Pugnatrypaea Poore, Dworschak, Robles, Mantelatto & Felder, 2019, Pugnatrypaea ruiyui sp. nov., collected from the northern South China Sea, is described and illustrated. It is distinguishable from P. pugnatrix (de Man, 1905), P. iranica (Sepahvand, Momtazi & Tudge, 2015), and P. emanata Felder & Robles, 2020 in having the lower margin of the male major cheliped merus lacking a proximal hook. It is distinguishable from P. intermedia (de Man, 1905) and P. lobetobensis (de Man, 1905) in having the upper margins of both cheliped meri unarmed. A key to all species of Pugnatrypaea is provided.

A two-leg ladder with tunable gauge fields is achieved by one-dimensional synthetic momentum-state lattice of a noninteracting Bose gas.

The quantitative evaluation of the coupling coordination degree (CCD) between the regional economy and eco-environment systems is of great importance for the realization of sustainable development goals, which could identify economic or eco-environmental cold areas. To date, traditional evaluation frameworks mainly include the indicator system construction based on statistical data, which seldom utilize the geo-spatiotemporal datasets. Hence, this study aimed to evaluate the CCD change trend of the Yangtze River Delta (YRD) and explore the relationship between the CCD, economy, and eco-environment on the county scale. In this study, YRD was selected as the study area to evaluate its level of CCD at different periods, and then the nighttime difference index (NTDI) and eco-environmental comprehensive evaluation index (ECEI) were calculated to represent the difference in the development of the regional economy and the eco-environmental quality (EEQ). The CCD between the two systems was then calculated and analyzed using global, local, and Geary’s C spatial autocorrelation indicators, in addition to change trend methods. The main findings showed that: (1) During the period 2000–2020, the economic system in YRD showed a continuously upward trend (0.0487 a−1), with average NTDI values of 0.2308, 0.2964, 0.3223, 0.3971, and 0.4239, respectively. In spatial terms, the economy system showed a distribution of “high in the east and low in the west”. (2) YRD’s EEQ indicated a gradual upward trend (from 0.3590 in 2000 to 0.3970 in 2020), with a change trend value of 0.0020 a−1. Spatially, the regions with high ECEI were mainly located in southwestern counties. (3) In the past 20 years, the CCD between economic and eco-environment systems showed an increased change trend, with a change trend value of 0.0302 a−1. The average CCD values for the five periods were 0.3992, 0.4745, 0.4633, 0.5012, and 0.5369. The overall level of CCD improved from “moderate incoordination” to “low coordination”. (4) Both NTDI and ECEI indexes have a positive effect on the improvement of regional CCD. However, the contribution of NTDI is a little higher than that of ECEI.

Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) targeted therapy has become the standard of care for patients with EGFR-mutated metastatic non-small cell lung cancer (NSCLC) on the basis of improved prognosis and reduced toxicities compared with chemotherapy. In view of the therapeutic potential of EGFR-TKIs in EGFR-mutated advanced NSCLC, several scholars have explored the value of preoperative use of EGFR-TKIs in patients with EGFR-mutated resectable NSCLC. However, the field of neoadjuvant targeted therapy for EGFR-mutated resectable NSCLC is currently in its infancy. In this mini-review, we summarize the current evidence on neoadjuvant EGFR-TKIs targeted therapy for resectable EGFR-mutated NSCLC and focus on discussing potential clinical strategies of treating resectable EGFR-mutated patients by preoperative administration of EGFR-TKIs-based multimodality therapy.

Abstract Background The increase in the incidence of pulmonary nodules has made computed tomography (CT) screening a requirement for diagnosis and treatment. Small pulmonary nodule detection during video‐assisted thoracoscopic surgery (VATS) or thoracotomy is frequently challenging; however, accurate and efficient localization of nodules is critical for precise resection. Herein, we introduce and evaluate the feasibility and safety of a novel technique for preoperative pulmonary nodule localization. Methods From March 2018 to December 2019, 140 patients with 153 pulmonary nodules measuring

Background: Alectinib, a highly selective inhibitor of ALK, is currently used in the first-line setting of untreated advanced ALK-positive NSCLC and in the second-line setting of crizotinib-resistant ALK-positive NSCLC. Despite promising efficacy and tolerability in the treatment of advanced ALK-positive NSCLC, the activity of alectinib as neoadjuvant therapy in resectable ALK-positive NSCLC remains to be investigated.Case presentation: Herein, we report a case of a 58-year-old female patient presented to our hospital with hemoptysis for 1 month. Contrast-enhanced computerized tomography (CT) of the chest showed an approximately 4.2 × 3.4 cm mass in the right hilum with localized obstructive pneumonia in the right lower lobe and multiple enlarged lymph nodes in the right hilum and mediastinum. Serum oncological markers results showed elevated levels of CA19-9, CEA, CA125, and CA242. Bronchoscopic biopsy of the mass showed poorly differentiated pulmonary adenocarcinoma and immunohistochemical testing results confirmed ALK positivity. Neoadjuvant alectinib was given at a dosage of 600 mg twice per day for two cycles (56 days), achieving a partial response of the disease with 90% shrinkage of the mass at the subsequent whole-body positron emission tomography. Repeat serum oncological markers results showed that only CA125 was elevated, but lower than before therapy. A bilobectomy of the right middle and lower lobes and systemic lymphadectomy under video-assisted thoracoscopic approach was successfully performed 7 days after the last dose of alectinib. Postoperative pathology showed pathological complete response (pCR). The patient experienced an uneventful postoperative course and continued to receive alectinib and did not report any specific discomfort at her 8-month follow-up. Thoracoabdominal CT at 8 months postoperatively showed no recurrence and repeated examination of serum oncological markers were negative.Conclusion: We report a case of resectable ALK-positive NSCLC treated with neoadjuvant aletinib achieving pCR. Our case highlights the feasibility of alectinib as neoadjuvant therapy for the treatment of resectable ALK-positive NSCLC. Undoubtedly, the safety and efficacy of this novel treatment modality needs to be explored in future large clinical trials.

Abstract The role of the epidermal growth factor receptor (EGFR) mutation status testing in lung squamous cell carcinoma (SqCC) remains controversial. Evidence of the effectiveness of osimertinib in SqCC with EGFR T790M mutation is limited. Here, we describe a hitherto unreported case of a stage III SqCC patient with compound mutation of EGFR exon 19 deletion (19Del) and T790M mutation. Pathological complete tumor response was achieved after treatment with osimertinib. We suggest that EGFR mutation testing should be performed in Asian patients who have not been definitively diagnosed with SqCC due to small lung biopsy samples. Osimertinib has shown good efficacy in SqCC harboring a “primary” resistance mechanism (EGFR T790M). Key points An unreported case of stage III squamous cell carcinoma with synchronous occurrence of EGFR exon 19 deletion (19Del) and T790M mutation. Complete tumor response was achieved after treatment with osimertinib. EGFR mutation testing should be performed in Asian patients who are not definitively diagnosed with SqCC due to small lung biopsy samples. Osimertinib has shown good efficacy in SqCC harboring a “primary” resistance mechanism (EGFR T790M).

Abstract Background Malignant peripheral nerve sheath tumours (MPNSTs) of the trachea are extremely uncommon neoplasms with unknown genetic and clinical profiles. Only individual cases have been reported in the literature to date. Case presentation Here, we present a rare case of a 61-year-old female patient with a primary MPNST of the trachea who complained of irritating cough and progressively increasing breathlessness for 4 weeks. This patient initially underwent intraluminal resection of the mass and was misdiagnosed with clear cell sarcoma. Less than a year later, the mass relapsed, and the obstructive symptoms reappeared and gradually worsened. Debulking of the endotracheal tumour mass was performed once again, and an MPNST was definitively diagnosed. Open sleeve tracheal resection and tracheoplasty were later performed with curative intent. This patient was alive without recurrence at her six-month postoperative follow-up. We also compared the clinical outcomes of previously reported cases of MPNSTs and our case. Conclusions This paper emphasizes that thoracic surgeons should be aware that malignant peripheral nerve sheath tumours of the trachea can be misdiagnosed in clinical practice and must be included in the differential diagnosis of tracheal neoplasms.

Abstract Background Angioleiomyoma of the pulmonary artery is rare in the literature and few studies have been reported. Here we present a rare case of angioleiomyoma arising from the pulmonary artery in a young patient. Case presentation A 27-year-old male patient presented to our clinic due to the incidental finding of a nodule in the right lower lobe of the lung, which was unchanged from the prior year. Preoperative CT scans showed a well-demarcated nodule of soft tissue density penetrated by the basal branch of the right anterior basilar artery (RA8b). Single-port video-assisted RS8 segmentectomy was performed under the guidance of preoperative 3-dimensional reconstruction for histologic confirmation of the tumour. The tumour appeared as a solid tumour of a tube-like structure with vascular endothelium, composed of spindle-shaped smooth muscle cells lacking nuclear atypia and homogenous red-dye substances. The spindle cells were positive for immunostaining for smooth muscle actin (SMA), desmin and Ki-67 and were negative for immunostaining for Dog-1, HMB45, and Melan-A. A pathological diagnosis of primary angioleiomyoma of the pulmonary artery was finally made. Conclusions This report is a reminder for thoracic surgeons that angioleiomyoma should be included in the differential diagnosis of lung neoplasms, especially for the mass of soft tissue density penetrated by pulmonary blood vessels shown by CT. Awareness of this rare entity should potentially prevent underdiagnosis and improper surgical treatment.

Abstract To distinguish whether multiple lung nodules represent multiple primary lung cancers (MPLC) or intrapulmonary metastases (IPM) is crucial for staging and subsequent therapy. We herein present the first report of a patient with two simultaneously resected metachronous lung adenocarcinomas in the right upper lobe, each with a distinct driver mutation in the KRAS gene identified by targeted next generation sequencing (NGS). The nodules appeared chronologically metachronous, with a 3.7 year interval. Histopathology showed two histologically identical adenocarcinomas, without lymph node metastases. It was hard to decide whether they should be classified as either MPLC or IPM based only on the clinicopathological criteria. Sequencing further revealed distinct KRAS mutation in each tumor, with one tumor harboring the KRAS‐G12C mutation, and the other tumor harboring the KRAS‐Q61H mutation. Incorporation of the molecular data cleared the confusion with regard to staging and spared this patient from adjuvant therapy. This case highlights that molecular profiling allows for better differentiation between MPLC and IPM than histopathology alone. Key points To the best of our knowledge, this is the first case of multiple primary lung cancers harboring distinct KRAS mutations. The case highlights the importance of incorporating molecular profiling using NGS along with the clinicopathological criteria in classifying multiple lung tumors.

Background: Evidence of osimertinib as neoadjuvant therapy for resectable non-small cell lung cancer (NSCLC) are currently lacking. This case series study aimed to assess the safety and feasibility of neoadjuvant osimertinib therapy followed by surgery for resectable NSCLC.Materials and methods: Patients with resectable NSCLC with epidermal growth factor receptor (EGFR) mutation who received osimertinib as neoadjuvant therapy followed by surgery at our center were included. Demographic features, radiologic and pathological assessment of response, surgery-related details and complications, toxicity profiles, and prognostic outcomes were extracted.Results: A total of 13 patients were included in this study. The median age at the time of surgical resection was 57 years (interquartile range: 52–64 years), and eight (61.5%) patients were female. The objective response rate (ORR) was 69.2% (9/13), and the complete resection rate was 100%. The rates of pathologic downstaging and lymph node downstaging were 100% (13/13) and 66.7% (6/9), respectively. There were no perioperative deaths and only three (23.1%) patients had postoperative complications. Seven (53.8%) and 13 (100%) patients experienced grade 1 treatment-related adverse reactions and laboratory abnormalities, respectively. No patients experienced drug withdrawal or surgical delays due to the adverse events. No patients showed grade 2 or worse toxicity profiles. One patient was lost to follow-up. The other 12 patients were alive and free of disease recurrence with a median follow-up time of 9.5 months.Conclusion: Neoadjuvant osimertinib therapy seemed to be safe and feasible for resectable EGFR-mutated NSCLC. Future large prospective studies are warranted to confirm whether osimertinib as neoadjuvant therapy outperforms standard tyrosine kinase inhibitors (TKIs) or chemotherapy for resectable EGFR-mutated NSCLC.

Surgical resection is currently the mainstay of treatment for tracheobronchial mucoepidermoid carcinoma (TMEC). The parenchymal sparing secondary carinal resection and reconstruction for TMEC under the uniportal thoracoscopic approach has seldomly been reported in the literature. Here, we report a case of a 42-year-old male patient complaining of the incidental finding of a 1.5 × 1.2 cm neoplasm at the opening of the right bronchus intermedius and a 5.1 × 3.1 cm patchy lesion located at the left upper lobe by chest CT scans in February 2021. This patient successively underwent fiberoptic bronchoscopic biopsy of the bronchial neoplasm and CT-guided biopsy of the left upper lobe lesion. Pathological examination confirmed the diagnosis of the endobronchial mass in the right bronchus intermedius as low-grade mucoepidermoid carcinoma and left upper lobe lesion as tuberculosis. This patient successfully underwent uniportal thoracoscopic parenchymal sparing tumor resection, reconstruction of the secondary carina and lymphadenectomy at our center. Intraoperative frozen section showed no residual cancer at any bronchial stumps. Postoperative pathology indicated that no metastases were seen in any of the resected lymph nodes. The patient recovered well after surgery. He received a 9-month course of anti-tuberculosis treatment postoperatively. He did not complain of any special discomfort and there was no local recurrence at the 9-month postoperative follow-up. Although technical demanding, this case highlights that uniportal video-assisted thoracoscopic parenchymal sparing secondary carinal resection and reconstruction for TMEC is safe and feasible with the preservation of lung function and excellent outcomes.

Sonophotocatalysis is one of the most significant outcomes of the exploration of the interaction between piezoelectric field and charge carriers, which exhibits potential applications in dye degradation, water splitting, and sterilization. Although several heterojunction catalysts have been applied to improve the sonophotocatalytic capability, the importance of the morphology on the sonophotocatalytic capability has not been emphasized. In this study, brush-like ZnO nanorod arrays are synthesized on a stainless-steel mesh and subsequently vulcanized into ZnO/ZnS core–shell nanorod arrays to investigate the sonophotocatalytic capability of the heterojunction. The sonophotocatalytic capability increases from 25.1% to 45.4% through vulcanization. Afterward, the ZnO/ZnS nanorods are etched to ZnO/ZnS nanotubes without affecting the crystallography and distribution of the ZnS nanoparticle shell, further improving the capability to 63.3%. The improvement can be ascribed to the coupling effect of the enhanced piezoelectric field and the reduced migration distance, which suppresses the recombination of photoexcited electron–hole pairs while transforming the morphology from nanorod to nanotube, as proven by the electron spin resonance test and numerical simulations. This study explores a novel approach of morphology engineering for enhancing the sonophotocatalytic capability of heterojunction nanoarrays.