Efficacy of combining a medial superior malleolar perforator flap from the posterior tibial artery with a vacuum-assisted closure dressing for skin and soft tissue defects of the Achilles tendon area.

OBJECTIVE: This randomized clinical trial aimed to investigate the clinical efficacy of combining a medial superior malleolar perforator flap from the posterior tibial artery (PTAPF) with a vacuum-assisted closure (VAC) dressing for skin and soft tissue defects in the Achilles tendon area. METHODS: Twenty-eight patients were randomly divided into two equally sized groups: the control group received treatment with a medial superior malleolar perforator flap, while the experimental group was treated with a perforator flap from the posterior tibial artery in combination with a VAC dressing. Perioperative data, including average operative time, intraoperative blood loss, intraoperative complications, time to ambulation, and hospital stay after surgery, were recorded. Clinical outcomes were assessed based on the time to first weight-bearing walking, time to full weight-bearing activity, Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society hindfoot and ankle score, and the range of motion for ankle plantar flexion. RESULTS: The patients were monitored for 3-12 months (average, 8.5), and it was observed that the flaps remained stable without enlargement, and their texture and color were similar to the surrounding tissue. Significantly enhanced postoperative indices were noted in the experimental group compared to the control group (P<0.05). CONCLUSION: The medial superior malleolar perforator flap from the posterior tibial artery, especially when combined with a VAC dressing, proves to be an effective method for repairing medium-sized skin defects in the Achilles tendon area. This approach offers several benefits, including a reliable blood supply, simplicity of the procedure, decreased damage to the donor site, improved aesthetic outcomes, and fewer postoperative complications.

Reinforcement of suture lines with adventitial eversion in acute type A aortic dissection.

TECHNIQUE: The reinforcement of the suture lines in acute type A aortic dissection include the treatment of proximal and distal anastomoses. The intima of the proximal site is transected circumferentially, approximately 1.0 cm above the sinotubular junction. The adventitia is folded outwards along the cutting edge of the intima, and the eversion forms an overlap. An autologous pericardial strip is placed inside the aorta as a mattress and secured with 4-0 prolene running sutures to the adventitial eversion overlap to reinforce the proximal cuff without any glue.The distal aortic cuff is trimmed and retained at 1.5 cm longer than the stent graft.The autologous pericardial strip is placed between the aortic intima and the stent graft and secured with 4-0 prolene running sutures to the adventitial eversion overlap to reinforce the distal cuff and completely obliterate the distal false lumen. RESULTS: The modified sandwich technique using adventitial eversion combined with an autologous pericardial strip achieved complete hemostasis at the anastomosis site and effectively obliterated the false lumen of the proximal and distal aorta. CONCLUSIONS: The adventitial valgus technique combined with autologous pericardial strip reinforcement can be inexpensive and effective for the surgical treatment of acute type A aortic dissection, especially in patients with fragile aortic wall.

Analysis of Delta(9) fatty acid desaturase gene family and their role in oleic acid accumulation in Carya cathayensis kernel.

Carya cathayensis, commonly referred to as Chinese hickory, produces nuts that contain high-quality edible oils, particularly oleic acid (18:1). It is known that stearoyl-ACP desaturase (SAD) is the first key step converting stearic acid (C18:0, SA) to oleic acid (C18:1, OA) in the aminolevulinic acid (ALA) biosynthetic pathway and play an important role in OA accumulation. Thus far, there is little information about SAD gene family in C. cathayensis and the role of individual members in OA accumulation. This study searched the Chinese Hickory Genome Database and identified five members of SAD genes, designated as CcSADs, at the whole genome level through the comparison with the homologous genes from Arabidopsis. RNA-Seq analysis showed that CcSSI2-1, CcSSI2-2, and CcSAD6 were highly expressed in kernels. The expression pattern of CcSADs was significantly correlated with fatty acid accumulation during the kernel development. In addition, five full-length cDNAs encoding SADs were isolated from the developing kernel of C. cathayensis. CcSADs-green fluorescent protein (GFP) fusion construct was infiltrated into tobacco epidermal cells, and results indicated their chloroplast localization. The catalytic function of these CcSADs was further analyzed by heterologous expression in Saccharomyces cerevisiae, Nicotiana benthamiana, and walnut. Functional analysis demonstrated that all CcSADs had fatty acid desaturase activity to catalyze oleic acid biosynthesis. Some members of CcSADs also have strong substrate specificity for 16:0-ACP to synthesize palmitoleic acid (C16:1, PA). Our study documented SAD gene family in C. cathayensis and the role of CcSSI2-1, CcSSI2-2, and CcSAD6 in OA accumulation, which could be important for future improvement of OA content in this species via genetic manipulation.

Adjuvant immunotherapy in early-stage resectable non-small cell lung cancer: A new milestone.

Currently, chemotherapy is the standard adjuvant treatment for early-stage non-small cell lung cancer (NSCLC). However, adjuvant cisplatin-based chemotherapy after surgery has been shown to improve 5-year survival rates by only 4-5%. Immunotherapy using immune checkpoint inhibitors (ICIs) has revolutionized the treatment of advanced NSCLC, there is a growing interest in the role of immunotherapy in early-stage NSCLC. Here, we summarize the rationale for adjuvant immunotherapy, including the postoperative immunosuppressive environment and immunological effects of platinum chemotherapy. Many ongoing clinical trials and the related progress in adjuvant immunotherapy in early-stage resectable NSCLC are discussed. Furthermore, we highlight several unresolved challenges, including markers predictive of treatment benefit, the efficacy of treatment for some oncogene-addicted tumors, the optimal combination therapy, the duration of adjuvant immunotherapy, and optimal selection between neoadjuvant and adjuvant immunotherapy. Early findings in some clinical trials are promising, and updated overall survival results will be useful for validating the current role of adjuvant immunotherapy, particularly in the context of perioperative strategy.

Comparison of neoadjuvant chemoimmunotherapy and chemotherapy alone for resectable stage III non-small cell lung cancer: a real-world cohort study.

Background: We compared the real-world efficacy and safety of neoadjuvant chemoimmunotherapy to chemotherapy alone in patients with stage III non-small-cell lung cancer (NSCLC). Participants and methods: A total of 59 consecutive patients were finally selected and divided into two groups: the neoadjuvant chemotherapy group (n = 33) and the neoadjuvant chemoimmunotherapy group (n = 26). The primary endpoint was disease-free survival (DFS). The secondary endpoints were pathological response, clinical response, and adverse events. All patients were followed up to collect perioperative pathology and clinical data. Results: The objective response rate (ORR), pathological complete response (pCR), and major pathological response (MPR) were significantly higher in the neoadjuvant chemoimmunotherapy group than in the neoadjuvant chemotherapy group (73.1% vs. 45.5%, 34.6% vs. 3.0%, and 65.3% vs. 15.1%, respectively; P < 0.05). There was no statistically significant difference in disease-free survival between the neoadjuvant chemoimmunotherapy and neoadjuvant chemotherapy groups (P = 0.129). Patients in the neoadjuvant chemoimmunotherapy group had a higher rate of tumor regression than those in neoadjuvant chemotherapy group (37.0% [25 patients] vs. 29.0% [33 patients], P = 0.018). However, no discernible correlation between MPR achievement and the degree of tumor shrinkage was observed in either group (P > 0.05). The cumulative MPR rates were 42.3, 50, and 65.3% for 2, 3, and ≥ 4 cycles, respectively, in the neoadjuvant chemoimmunotherapy group and 9.1, 12.1, and 15.1% for ≤ 2, 3, and ≥ 4 cycles, respectively, in the neoadjuvant chemotherapy group. Moreover, No statistical difference was observed between the two groups regarding postoperative complications, resection range, operation time, surgical method, and extent of resection (P > 0.05). Although the incidence of grades III-IV adverse events was higher in the neoadjuvant chemotherapy group than in the neoadjuvant chemoimmunotherapy group (33.3% vs. 4.6%, P = 0.042), there was no significant difference in the incidence of adverse events between the two groups (64.6% vs. 83.6%, P = 0.072). Conclusion: In stage III NSCLC, neoadjuvant chemoimmunotherapy achieved higher pathological and clinical remission rates than chemotherapy alone, with compromising safety, making it an attractive choice for neoadjuvant therapy.

Fear of progression and its associated factors in parents of children undergoing cancer treatment: A cross-sectional study.

OBJECTIVE: Fear of progression (FoP) is a common psychosocial problem among adult cancer patients, but data on parents of children undergoing cancer treatment are scarce. This study aimed to determine the prevalence of FoP in parents of children undergoing cancer treatment and explore the associated factors. METHODS: Overall, 285 parents of children undergoing cancer treatment were recruited from three general hospitals in China. FoP in the parents was assessed using the Chinese version of the Fear of Progression Questionnaire-parent version (FoP-Q-SF/PR). Other questionnaires included the Self-Compassion Scale, Pittsburgh Sleep Quality Index, Posttraumatic Stress Disorder Checklist-Civilian Version, and items on socio-demographic and medical characteristics. Pearson correlation and multiple linear regression analysis were used to identify factors associated with FoP. RESULTS: A total of 75.1% of the participants showed dysfunctional levels of FoP. The mean FoP-Q-SF/PR score was 39.98 (standard deviation = 9.18). Parental FoP was significantly associated with a shorter time since diagnosis, lower levels of self-compassion, poor sleep quality, and severe posttraumatic stress symptoms (Adjusted R Squared = 0.369, F = 12.838, p < 0.01). CONCLUSIONS: FoP is a frequently reported problem among parents of children undergoing cancer treatment. In this cohort, parents of children with a shorter time since cancer diagnosis were at higher risk of suffering from FoP. Interventions to enhance self-compassion, improve sleep quality, and mitigate posttraumatic stress symptoms may help with the psychological adjustment and well-being of parents whose children are undergoing cancer treatment.

Pulmonary Embolism Caused by Tourniquets in the Lower Extremities Treated with ECMO - A Case Report.

BACKGROUND: Using tourniquets in the lower extremities can increase the incidence of deep vein thrombosis (DVT). Acute large-area pulmonary embolism (APE) occurs in severe cases, and it is fatal to most patients. Acute large-area pulmonary embolism causes haemodynamic instability, right heart failure, and circulatory failure. CASE PRESENTATION: A 47-year-old female patient was subjected to spinal anaesthesia for a comminuted fracture of the tibia and fibula of the left lower limb. After the tourniquet was released during the operation, she had sudden hypotension and lost consciousness. Thus, ECMO was used to support patient circulation. With ECMO-assisted CT examination, she was diagnosed to have a pulmonary embolism. On the next day, she was subjected to a bilateral pulmonary embolism and embolectomy. Lastly, she was transferred to the general ward and discharged smoothly. CONCLUSIONS: Patients undergoing fracture surgery should be wary of APE caused by the loss of DVT after the release of tourniquets. ECMO, as a rapid and effective temporary life support intervention, provides effective cardiopulmonary support and new treatment plans. It also saves time for further treatment of patients with high-risk APE.

Integrated transcriptome and proteome analysis of developing embryo reveals the mechanisms underlying the high levels of oil accumulation in Carya cathayensis Sarg.

Hickory (Carya cathayensis Sarg.) is an extraordinary nut-bearing deciduous arbor with high content of oil in its embryo. However, the molecular mechanism underlying high oil accumulation is mostly unknown. Here, we reported that the lipid droplets and oil accumulation gradually increased with the embryo development and the oil content was up to ~76% at maturity. Furthermore, transcriptome and proteome analysis of developing hickory embryo identified 32,907 genes and 9857 proteins. Time-series analysis of gene expressions showed that these genes were divided into 12 clusters and lipid metabolism-related genes were enriched in Cluster 3, with the highest expression levels at 95 days after pollination (S2). Differentially expressed genes and proteins indicated high correlation, and both were enriched in the lipid metabolism. Notably, the genes involved in biosynthesis, transport of fatty acid/lipid and lipid droplets formation had high expression levels at S2, while the expression levels of other genes required for suberin/wax/cutin biosynthesis and lipid degradation were very low at all the sampling time points, ultimately promoting the accumulation of oil. Quantitative reverse-transcription PCR analysis also verified the results of RNA-seq. The co-regulatory networks of lipid metabolism were further constructed and WRINKLED1 (WRI1) was a core transcriptional factor located in the nucleus. Of note, CcWRI1A/B could directly activate the expression of some genes (CcBCCP2A, CcBCCP2B, CcFATA and CcFAD3) required for fatty acid synthesis. These results provided in-depth evidence for revealing the molecular mechanism of high oil accumulation in hickory embryo.

Outcomes from the Use of Perioperative Extracorporeal Membrane Oxygenation in Patients Undergoing Thoracic Surgery: An 8-Year Single-Center Experience.

BACKGROUND Extracorporeal membrane oxygenation (ECMO) plays an important role in thoracic surgery. This retrospective study from a single center aimed to evaluate patient outcomes from the use of perioperative ECMO in 22 patients undergoing thoracic surgery during an 8-year period. MATERIAL AND METHODS Data were collected retrospectively from 22 patients who received ECMO (veno-arterial and veno-venous ECMO) as perioperative treatment during general thoracic surgery from January 2012 to October 2020. Patients required ECMO due to perioperative cardiopulmonary resuscitation (CPR) (2 cases), perioperative pulmonary embolism (PE) (2 cases), lung transplant (4 cases), undergoing complicated thoracic surgery (5 cases), postoperative acute respiratory distress syndrome (ARDS) (6 cases), and thoracic trauma (3 cases). RESULTS Veno-arterial ECMO was used for circulatory support in 13 cases and veno-venous ECMO was used for respiratory support in 9 cases. The average ECMO support time was 71.6±42.4 h. Twenty patients (90.9%) were successfully decannulated and 17 (77.2%) survived to discharge. Complications included severe hemorrhage (3/22 patients, 13.6%), sepsis (3/22, 13.6%), and destruction of blood cells (1/22, 4.5%). There were no significant differences in survival rates between patients receiving pre- or postoperative ECMO (P=0.135) or between veno-venous ECMO (V-V ECMO) and veno-arterial ECMO (V-A ECMO) (P=0.550). CONCLUSIONS The findings from this small retrospective study from a single center showed that perioperative ECMO improved cardiac and respiratory function in patients undergoing thoracic surgery. Optimal results require surgeons to have an understanding of the indications and ability to control the complications of ECMO.

Genome-Wide Identification of Tannase Genes and Their Function of Wound Response and Astringent Substances Accumulation in Juglandaceae.

Tannins are important polyphenol compounds with different component proportions in different plant species. The plants in the Juglandaceae are rich in tannins, including condensed tannins and hydrolyzable tannins. In this study, we identified seven tannase genes (TAs) responsible for the tannin metabolism from walnut, pecan, and Chinese hickory, and three nut tree species in the Juglandaceae, which were divided into two groups. The phylogenetic and sequence analysis showed that TA genes and neighboring clade genes (TA-like genes) had similar sequences compared with other carboxylesterase genes, which may be the origin of TA genes produced by tandem repeat. TA genes also indicated higher expressions in leaf than other tissues and were quickly up-regulated at 3 h after leaf injury. During the development of the seed coat, the expression of the synthesis-related gene GGTs and the hydrolase gene TAs was continuously decreased, resulting in the decrease of tannin content in the dry sample of the seed coat of Chinese hickory. However, due to the reduction in water content during the ripening process, the tannin content in fresh sample increased, so the astringent taste was obvious at the mature stage. In addition, the CcGGTs' expression was higher than CiGGTs in the initiation of development, but CcTAs continued to be down-regulated while CiTA2a and CiTA2b were up-regulated, which may bring about the significant differences in tannin content and astringent taste between Chinese hickory and pecan. These results suggested the crucial role of TAs in wound stress of leaves and astringent ingredient accumulation in seed coats of two nut tree species in the Juglandaceae.

Pathologic complete response after neoadjuvant tislelizumab and chemotherapy for Pancoast tumor: A case report.

A 60-year-old man was hospitalized because of numbness and weakness in the right upper limb. Magnetic resonance imaging revealed a large mass in the right upper lobe invading the right eighth cervical and first thoracic nerve root. Biopsy pathology confirmed primary lung adenocarcinoma with a clinical stage of cT4N0M0 IIIA, negative for anaplastic lymphoma kinase fusion gene and epidermal growth factor receptor mutations but positive for programmed death ligand 1 (3%). Neoadjuvant tislelizumab and chemotherapy were offered to this patient with Pancoast tumor, and tumor shrinkage of 71% was achieved. After the operation, surgical pathology indicated pathologic complete response (pCR). Circulating tumor cells testing was negative after the first adjuvant treatment. In this case, we provide real-world evidence of encouraging pCR with neoadjuvant tislelizumab and chemotherapy for a patient with Pancoast tumor.

Extracorporeal Membrane Oxygenation-Combined Surgery for Hemoptysis Caused by a Mediastinal Hemangioma.

The diagnosis and treatment of massive hemoptysis remain challenging. We report a 28-year-old woman with refractory massive hemoptysis caused by a mediastinal hemangioma. Despite multiple bronchial artery embolizations and fiberoptic bronchoscopy treatments, effective control of the bleeding and clearing of the airway was not possible. Finally, with the support of venovenous extracorporeal membrane oxygenation, mediastinal hemangioma resection and right upper lobe sleeve resection were simultaneously performed. During the operation, many blood clots in the airway were removed. The airway bleeding was effectively controlled, and the patient recovered.

Extracorporeal membrane oxygenation in patients with heart transplantation : A clinical prognosis analysis.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is indicated for bridging to heart transplantation, graft failure, and right heart failure after heart transplantation. This study explored risk factors affecting the clinical prognosis of cardiac transplantation patients treated with ECMO during the perioperative period. METHODS: Data on 28 heart transplantation patients with ECMO obtained from January 2012 to January 2018 in the People's Hospital of Zhongshan City were retrospectively analyzed. RESULTS: A total of 25 patients (20 male and 5 female) were finally included. Heart transplantation was performed mainly due to cardiomyopathy (77.8%). Of the treated patients, 18 (72%) survived and were discharged, 4 were treated with cardiopulmonary resuscitation (CPR) before ECMO, and 3 died in hospital. There were no differences between the surviving and death group donors (N-terminal pro b­type natriuretic peptide [NT-proBNP], creatine kinase-muscle/brain [CK-MB], warm ischemia time of donated heart, cold ischemia time of donated heart, total ischemia time of donated heart, and donor type). In univariate analysis, body mass index (BMI), length of stay in the intensive care unit (ICU), and CPR were relevant prognostic factors for heart transplantation patients with ECMO. Multi-factor logistic regression showed that CPR before ECMO (odds ratio, OR, 49.45; 95% confidence interval, CI, [1.37, 1781.6]; P = 0.033) is an independent risk factor influencing prognosis. CONCLUSION: ECMO is an important life support method for patients before and after heart transplantation surgery. Obesity, poor preoperative cardiac function, and considerable intraoperative red blood cell transfusion may influence prognosis. Extracardiac compression before ECMO is an independent risk factor for prognosis.

Comparison of the outcomes of monopolar and bipolar radiofrequency ablation in surgical treatment of atrial fibrillation.

OBJECTIVE: To compare the therapeutic effects and safety of monopolar and bipolar radiofrequency (RF) ablation used during cardiac surgery to treat atrial fibrillation. METHODS: We retrospectively studied a total of 81 patients with chronic atrial fibrillation who underwent open cardiac surgery with concomitant RF ablation between January 2007 and March 2011. Fifty-eight patients received bipolar RF ablation and 23 received monopolar RF ablation, respectively. The sinus rhythm restoration rate, the procedural duration, the frequency of severe perioperative complications, and mortality were compared between the two groups. RESULTS: The sinus rhythm restoration rate did not differ significantly between the two groups after follow-up of 15.1 ± 12.6 months (P=0.199). The frequencies of severe perioperative complications and mortality were also similar in the two groups. The total procedural time using bipolar RF ablation was significantly shorter than that using monopolar ablation (19.7 ± 4.6 minutes vs. 28.1 ± 8.5 minutes, P< 0.001). CONCLUSIONS: Both monopolar and bipolar RF ablation are safe and effective in treating chronic atrial fibrillation patients during open cardiac surgery, but bipolar RF ablation is more convenient in practice.

Hook wire localization of pulmonary pure ground-glass opacities for video-assisted thoracoscopic surgery.

OBJECTIVE: We compared the success of preoperative hook wire localization of pulmonary pure ground-glass opacities (pGGOs) with intraoperative palpation during video-assisted thoracoscopic (VAT) surgery and examined the safety of the preoperative hook wire method. METHODS: A total of 39 patients with 41 pulmonary pGGOs less than 2 cm in diameter underwent preoperative hook wire localization guided by DSA Innova CT before VAT lesion resection. The relationship between localization, as determined by finger palpation or hook wire, and clinicopathological factors was analyzed retrospectively. Complications resulting from hook wire localization are summarized. RESULTS: Twelve lesions (29.3%) were successfully identified by palpation, whereas 39 (95.1%) were successfully identified by hook wire (p < 0.01). The hook wire was dislodged in three cases (7.3%). No correlation was found between the positive rate of finger palpation or hook wire localization and the size, depth, position, or pathological grade of the lesion. Following surgery, five patients (12.8%) had asymptomatic minimal pneumothoraces, two patients (5.2%) had minimal hemothorax, and one patient (2.6%) had serious chest pain. CONCLUSIONS: Preoperative localization of pulmonary pGGOs is necessary for VATS when the lesions are less than 2 cm in diameter. Preoperative hook wire localization is safe and more successful than palpation for localization of pGGOs.

Personalized management of anastomotic leak after surgery for esophageal carcinoma.

OBJECTIVE: To summarize the management of anastomotic leak following surgery for esophageal carcinoma. METHODS: The medical records of the patients developing digestive tract leak after surgery for esophageal carcinoma in our hospital from January 2003 to March 2011 were retrospectively analyzed. RESULTS: A total of 36 patients were included, in whom 13 developed cervical anastomotic leak, 18 had intra-thoracic anastomotic leak, and 5 had intra-thoracic gastric necrosis. Of these patients, 7 were treated with resurgery, 6 with esophageal stent implantation, and 23 with conservative treatment. Treatment lasted for 5 to 181 days, averagely 47.0 +/- 31.9 days. After management, 9 patients died (25.0%). Among seven patients with resurgery, four had deceased, two were cured, and one developed leak again and was switched to conservative treatment until discharged. All the 6 patients treated with stent implantation were cured. Of the 24 patients receiving conservative treatment (including one switched from resurgery), 18 (75.0%) were cured and 1 was not cured but survived. CONCLUSIONS: Anastomotic leak following surgery for esophageal carcinoma should be treated individually based on the onset time, location, size, and extent of the leakage. Conservative treatment is still a safe and effective method. The efficacy of stent implantation needs further investigation to confirm.