Fluorescence-guided thoracoscopic surgery for postoperative chylothorax: A technical note with video vignette.

TECHNIQUE: The surgical management for high-output postoperative chylothorax typically necessitates ligation of the thoracic duct (TD) above the leak site and/or sealing the leak with a clip. However, pinpointing these structures during subsequent surgeries can be challenging due to their variable course and the presence of traumatized tissues surrounding the leak area. In response to this, we have developed a novel, fluorescence-guided technique that significantly enhances intraoperative identification of the leak point and the TD. This method was applied in the case of a 52-year-old man suffering from refractory chylothorax following a previous lung cancer surgery. This study documents the surgical procedure and includes a video vignette for a comprehensive understanding. RESULTS: A bilateral inguinal lymph node injection of saline (10 mL), guided by ultrasound and containing 2.5 mg/mL indocyanine green (ICG), was administered 20 min prior to surgery. During thoracoscopic exploration, the leak point was precisely pinpointed in the right paratracheal area by transitioning from bright light to fluorescent mode. The TD was clearly identified, and upon ligation, there was no further leakage of fluorescent lymph, indicating a successful closure of the lymphatic structure. The surgery proceeded uneventfully, and the patient was able to resume oral intake on the third postoperative day. There was no evidence of recurring symptoms, leading to his discharge. CONCLUSION: The intralymphatic injection of ICG offers a rapid visualization of the TD's anatomy and can effectively pinpoint the leak point, even amidst traumatized tissues. Moreover, it provides prompt feedback on the efficacy of ligation.

The impact of surgical learning curve on short-term outcomes after bilateral lung transplantation: results from a multidisciplinary surgical team.

OBJECTIVES: The aim of this study was to examine the impact of surgical learning curve on short-term clinical outcomes of patients after bilateral lung transplantation (LTx) performed by a surgical multidisciplinary team (MDT). METHODS: Forty-two patients underwent double LTx from December 2016 to October 2021. All procedures were performed by a surgical MDT in a newly established LTx program. The time required for bronchial, left atrial cuff and pulmonary artery anastomoses was the main end point to assess surgical proficiency. The associations between the surgeon's experience and procedural duration were examined by linear regression analysis. We employed the simple moving average technique to generate learning curves and evaluated short-term outcomes before and after achieving surgical proficiency. RESULTS: Both total operating time and total anastomosis time were inversely associated with the surgeon's experience. On analysing the learning curve for bronchial, left atrial cuff and pulmonary artery anastomoses using moving averages, the inflection points occurred at 20, 15 and 10 cases, respectively. To assess the learning curve effect, the study cohort was divided into early (cases 1-20) and late (cases 21-42) groups. Short-term outcomes-including intensive care unit stay, in-hospital stay and severe complications-were significantly more favourable in the late group. Furthermore, there was a notable tendency for patients in the late group to experience a decreased duration of mechanical ventilation along with reduced instances of grade 3 primary graft dysfunction. CONCLUSIONS: A surgical MDT can perform double LTx safely after 20 procedures.

[The Application of RNA-Sequencing in Pediatric B-Cell Acute Lymphoblastic Leukemia].

OBJECTIVE: To explore the molecular genetic characteristics of children with B-cell acute lymphoblastic leukemia (B-ALL) and the application value of RNA-sequencing (RNA-seq). METHODS: The clinical and laboratory examination data of newly diagnosed B-ALL children who were given treatment in the Department of Hematology, Children's Hospital of Chongqing Medical University from May 2015 to April 2020 were collected and analyzed. All children were confirmed by bone marrow morphology, histochemical staining and flow cytometry, and the karyotype analysis, FISH, RT-PCR and RNA-seq detection were conducted. RESULTS: There were 71 males and 58 females with a median age of 50(8-190) months in 129 newly diagnosed children with B-ALL. The fusion gene was positive in 99 children (76.7%). A total of 86 leukemia related or possibly related gene mutations were detected, with a positive rate of 66.7%. There was no significant difference in the detection rates of ETV6-RUNX1, BCR-ABL1, TCF3-PBX1 and KMT2A rearrangements among FISH, RT-PCR and RNA-seq. Rare fusion genes were detected by RNA-seq, including 1 case of KMT2A-USP2, 4 cases of Ph-like related fusion genes, 5 cases of MEF2D rearrangement, 5 cases of PAX5 rearrangement, 3 cases of ZNF384 rearrangement, as well as several fusion genes whose significance were not clear or had not been reported in children with leukemia. Besides, children with ETV6-RUNX1 fusion gene had good response to induction of remission, while children with BCR-ABL1 and ZNF384 rearrangement had poor response, the remission rate of minimal residual disease was statistically significant compared with other types (P<0.05). CONCLUSION: RNA-seq can not only detect known fusion genes, but also discover new or rare fusion genes and gene mutations. The application of RNA-seq has important guiding significance for risk classification and precise targeted therapy of pediatric B-ALL.

[Second-generation Sequencing Analysis of Ph+ and Ph-like Childhood T-cell Acute Lymphoblastic Leukemia].

OBJECTIVE: To screen the core genes of Philadelphia chromosome positive/Ph like T-cell acute lymphoblastic leukemia (Ph+/Ph like T-ALL) using bioinformatics methods, and analyze the core sub-networks for exploration of the development process of Ph+/Ph like T-ALL, so as to find the molecular targets that may be used in clinical diagnosis and treatment. METHODS: The WES/RNA-seq examination results of Ph+/Ph-like T-ALL children had be collected in our hospital, the genetic data that met the requirements had be downloaded from GEO database, then GRO2R online differentially expressed gene screening program was used to screen differentially expressed genes, finally, GO function enrichment analysis and KEGG pathway enrichment analysis were performed to compare differentially expressed genes. At the same time, STRING database and Cytoscape software were used to build protein interaction network and screen hub genes and core sub-networks. RESULTS: For Ph+/Ph like T-ALL, a total of 84 differentially expressed genes had been found, for Ph+ ALL a total of 249 differentially expressed genes, and for T-ALL a total of 175 differentially expressed genes. Based on the results of GO function enrichment, KEGG pathway enrichment analysis and protein interaction network, RPA1, POLD1, POLE and SOCS1 were selected as hub genes. DNA damage repair and JAK/STAT signal transduction pathway were the main functional sub-networks. CONCLUSION: There are obviously abnormal DNA damage repair pathways in children with Ph+/Ph like T-ALL. RPA1, POLD1 and POLE may be important relevant biomarkers for the occurrence and development of Ph+/Ph like T-ALL, which can provide a basis for further research.

Single-step localization and excision of small pulmonary nodules using a mobile 3D C-arm.

OBJECTIVES: The use of a hybrid operating room equipped with robotic C-arm cone-beam computed tomography for single-step localization and excision of small pulmonary nodules finds high cost barriers. The new generation of 3D C-arm system not only depicts soft tissues with high contrast but also offers a more affordable and sustainable solution. This approach has been chiefly applied in the field of orthopedic surgery. In this case series, we describe the use of a mobile 3D C-arm system for localizing and removing small pulmonary nodules. METHODS: Between July and September 2020, we identified 14 patients who underwent localization and removal of small pulmonary nodules with a 3D C-arm system. We retrospectively reviewed clinical records to document the feasibility and safety of the procedure. RESULTS: The median tumour size was 7.5 mm [interquartile range (IQR): 5 - 9.75 mm], with a median distance from the pleural surface of 4.2 mm (IQR: 0.5 - 6.45 mm). We successfully visualized all of the pulmonary lesions by intraoperative CT imaging. Localization was achieved in 13 patients, who subsequently underwent complete thoracoscopic resection. The median time required to localize lesions was 41.5 min (IQR: 33.75 - 53.25 min), with a median radiation exposure (expressed through the skin absorbed dose) of 143.45 mGy (IQR: 86.1 - 194.6 mGy). Failure to localize occurred in 1 patient because of pneumothorax caused by repeated needle puncture. All patients were successfully discharged and the median length of stay was 2.5 days (IQR: 2 - 3 days). CONCLUSIONS: This case series demonstrates the feasibility of single-step localization and excision of small pulmonary nodules using a mobile 3D C-arm.

SAA1 regulates pro-labour mediators in term labour by activating YAP pathway.

Term labour is associated with activation of inflammation which results in myometrial contractility, cervical ripening and decidual/membrane rupture. Serum amyloid A1 (SAA1) is an acute response protein, whose role and underlying regulatory mechanisms in human labour remain unknown. In this study, we found that the mRNA and protein expression of SAA1 in human myometrium at term was increased in labouring tissues compared to non-labouring tissues. In addition, the expression of SAA1 was significantly increased in human primary myometrial cells treated with the pro-inflammatory cytokines interleukin-1 beta (IL-1ß) or tumour necrosis factor-alpha (TNF-α). Knockdown of SAA1 using siRNA (siSAA1) resulted in a significant reduction in the expression and secretion of pro-inflammatory cytokines (IL8, IL6), chemokines (CXCL5, CCL2), adhesion molecules (ICAM1, ICAM5) and contraction-associated factors (COX2, PGE2). Mechanistically, the effects of SAA1 were mediated through activation of the Yes-associated protein (YAP) pathway. There was a decrease in the protein expression of phosphorylated YAP (pYAP) after treatment of siSAA1-transfected human primary myometrial cells with IL-1ß or TNF-α. Moreover, enhanced expression of YAP reversed the effect of siSAA1 on pro-labour mediators. In conclusion, these experiments demonstrated that SAA1 accelerates the inflammatory response associated with parturition by activating YAP pathway, which may be a novel understanding of the molecular mechanism of labour onset.

Current port maintenance strategies are insufficient: View based on actual presentations of implanted ports.

Nursing staff play a crucial role in maintaining a functional port. Nursing guidelines recommend standard maintenance with 10 ml irrigation without consideration for variations among patients and individual nursing staff. The aim of this study is to identify the efficacy of the current maintenance strategy and analyze the correlation between complications and actual port presentations, based on disassembled intravenous ports after removal from patients. We attempt to organize the information and propose a definite maintenance strategy.After treatment completion, or due to complications, 434 implanted intravenous ports were removed from patients. All ports were deconstructed to observe their actual presentations and were then analyzed in conjunction with medical records. The correlation between complications and actual presentations was analyzed.From March 2012 to December 2017, 434 implanted intravenous ports were removed from oncology patients after completion of treatment or catheter related complications. From the view of maintenance related presentations, injection chamber blood clot was highly correlated with chemotherapy completion (P < .001) and malfunction (P = .005), while tip blood clot (P = .043) was related with chemotherapy completion and catheter fibrin (P = .015) was related to malfunction. From the view of structure related presentations, broken catheter integrity was correlated to chemotherapy completion (P = .007), fracture (P < .001), and malfunction (P = .008). Compression groove was related to chemotherapy completion (P = .03) and broken catheter at protruding stud was related to fracture (P = .04), while diaphragm rupture was correlated to chemotherapy completion (P = .048) and malfunction. (P < .001).Current port maintenance is insufficient for ideal port maintenance, whereby maintenance-related presentations, including tip clot, catheter fibrin, and injection chamber blood clot were identified. We propose a recommended maintenance strategy based on our findings. Structure-related presentations, including broken catheter integrity, broken catheter at protruding stud and diaphragm rupture were seen in patients with longer implantation period. Removal of the implanted port may be considered after 5 years if no disease relapse is noted.

[Effect of exogenous salicylic acid and ultraviolet radiation on Ulva prolifera under different light conditions]. / ä¸åŒå ‰ç §æ¡ä»¶ä¸‹å¤–æºæ°´æ¨é ¸å¯¹æµ’è‹”å“åº”ç´«å¤–è¾å°„èƒè¿«çš„å½±å“.

To study the combined effects of exogenous salicylic acid (SA) and ultraviolet radiation (UV) on marine green algae Ulva prolifera under high (160 Μmol·m-2·s-1) and low (70 Μmol·m-2·s-1) light intensities, the growth, chlorophyll fluorescence parameters, photosynthetic rate of oxygen, superoxide dismutase (SOD) activity, soluble polysaccharide and soluble protein contents were investigated after they grew with or without ultraviolet (UV, 3.2 W·m-2) radiation in the presence or absence of SA (10 Μg·mL-1) for three days. The treatments included control group (CK), SA, UV and UV+SA treatments. Results showed that under the low light intensity without UV condition, the relative growth rate was enhanced, Chl a and soluble protein contents were decreased by SA. Under the high light intensity without UV condition, the relative growth rate was decreased, Chl a content, respiratory rate, photosynthetic rate of oxygen, soluble polysaccharide and soluble protein contents were enhanced by SA. Under the high light intensity with UV condition, the relative growth rate, Chl a and soluble polysaccharide contents were enhanced by UV+SA. Additionally, under the low light intensity with UV condition, compared to UV treatment, the maximum photochemical efficiency (Fv/Fm) and soluble protein contents were respectively increased by 139.8% and 32.2% under the UV+SA treatment. In conclusion, SA reduced the inhibitory effects of U. prolifera induced by UV, and the effects were more significant under the high light intensity.

[Investigation on Cheyletoidea mites breeding in culture environment of Eupolyphaga sinensis and morphologic observation of Eucheyletia reticulate Cunliffe].

OBJECTIVE: To investigate the species of Cheyletoidea mites breeding in the culture environment of Eupolyphaga sinensis and to observe the morphology of Eucheyletia reticulata Cunliffe. METHODS: The soil samples from an E. sinensis farm in northern Anhui were collected. The mites in the soil samples were separated directly under a microscope and the glass specimens were made to observe the morphological feature of the mites under a light microscope, then the mites species were identified and classified based on the morphological characteristics. RESULTS: In the culture soil of E. sinensis, totally 7 kinds of Cheyletoidea mites were isolated, namely Eucheyletia reticulata Cunliffe, Cheyletus eruditus Schrank, Cheyletus malaccensis Oudemans, Cheyletus troussarti Oudemans, Cheyletus aveisor Rohdendorz, Acaropsis sollers Rohdendorz and Cheletomorpha lepidopterorum Shaw. They belonged to genera Eucheyletia, Cheletomorpha, Acaropsis and Cheyletus of Cheyletidae Leach family. The Eucheyletia reticulata Cunliffe was firstly found in the culture environment of E. sinensis, and its gnathosoma was large, the pedipalpal femurs were expanding and there were two strips of comb hair and two smooth bristles on the pedipalpal tarsus, and the back of the body was covered with two pieces of tergum, which were decorated with reticular pattern. The body and foot setae were fan-shape. CONCLUSIONS: There are various of Cheyletoidea mites found in the breeding environment of E. sinensis. These mites are important species for pest control in the culture environments of E. sinensis. Related measures should be taken to prevent the excessive growth of Cheyletoidea mites, so as to avoid the adverse effects on the quality and quantity of E. sinensis.

The effect of different nutritional states on puberty onset and the expression of hypothalamic Kiss1/kisspepetin.

The possibility of an alteration in the age at which pubertal onset occurs has shown that we still lack knowledge on the molecular and physiological mechanisms of normal female puberty. In this study, the adjustment effects of different suckling and prepuberty nutrition on puberty onset and the expression of hypothalamic Kiss1/kisspeptin and gonadotrophin-releasing hormone (GnRH) were examined in 1-day-old female Sprague-Dawley rats. Animals were randomly assigned according to different suckling nutritional challenges (different milk intake before weaning) and prepuberty nutritional challenges (different food supply after weaning) into four groups: overnutrition group 1, overnutrition group 2 (O2), normal group (N, control group), and malnutrition group (M). In situ hybridization, Western blot analysis, and immunohistochemistry were used to analyze the expression of hypothalamic Kiss1/kisspeptin and GnRH. In the O1 group, GnRH and Kiss1/kisspeptin levels in the hypothalamus peaked at an early age, while malnutrition resulted in a delay in the GnRH and Kiss1/kisspeptin peaks. This study indicated that nutrition greatly affected the sexual development of female rats and that the effects of suckling nutrition were much greater than those of prepuberty nutrition.

Loss of TSLC1 expression in lung adenocarcinoma: relationships with histological subtypes, sex and prognostic significance.

The TSLC1 (tumor suppressor in lung cancer 1) gene is a tumor suppressor recently identified through functional complementation in a lung adenocarcinoma cell line A549. In this study we immunohistochemically examined the loss of TSLC1 expression in 93 cases of surgically resected lung adenocarcinoma, and investigated its correlation with clinicopathological parameters, including histological subtypes of tumors. The prognostic significance of loss of TSLC1 expression was analyzed by univariate and multivariate analyses, in parallel with other prognostic markers such as p53, p27, and Ki-67. In non-cancerous lung tissue, TSLC1 was weakly positive in bronchial and bronchiolar epithelial cells, type II pneumocytes and bronchial glands. Overall, TSLC1 was negative in 60 of 93 lung adenocarcinomas. TSLC1 was mainly localized in the cytoplasm of the cells, but cell membrane staining was also observed, especially at sites of cell-cell adhesion. TSLC1-negative tumors were more frequently observed in male cases (41/54 cases, 70.0%) than in female cases (19/39 cases, 48.7%) (P < 0.01). Notably, TSLC1 expression was preserved in a non-invasive, bronchiolo-alveolar histological pattern of tumor cells (P < 0.0001). Survival analyses showed that loss of TSLC1 expression was associated with lower patient survival in univariate and multivariate analyses (P < 0.05 and P = 0.059, respectively). Subset analyses further showed that the prognostic impact of loss of TSLC1 was significant for male patients (P = 0.0089), but not for female patients. We conclude that TSLC1 is expressed in a subset of lung adenocarcinomas, especially in those with bronchiolo-alveolar spread pattern. Loss of TSLC1 is associated with lower patient survival, supporting its role as a tumor suppressor.