Objective To study the feasibility of video-assisted thoracoscopic (VAT) minor pulmonary resection under local anesthesia. Methods From February to December 2000,8 patients (6 cases of peripheral pulmonary nodules,2 cases of respiratory insufficiency and radiographic pulmonary infiltrate)were operated on through video-assisted thoracoscopy under local anesthesia. Results Except 1 case was converted to general anesthesia and performed minithoracotomy to resect pulmonary coin lesion due to pleural adhesion,other 7 patients underwent VAT-pulmonary wedge ressction under local anesthesia and definitive diagonosis.(3 with tuberculosis,1 with metastatic adenocarcinoma,1 with inflammatory pseudotumor and 2 with pulmonary fibrosis)were obtained.The duration of the procedures was from 40 to 200 min. Spontaneous breathing and hemodynamics were maintained well during the operation.There was neither severe postoperative complications nor mortality.The postoperative hospitalized days were 2～5 days with a mean of 3 days. The average medical fee for pulmonary wedge ressction using our procedure was 5400 RMB. Conclusions VAT-minor pulmonary resection can be performed safely under local anesthesia.

Objective:To prospectively investigate the prevalence of heparin-induced thrombocytopenia (HIT) in critically ill children during extracorporeal membrane oxygenation(ECMO) and explore the clinical characteristics and prognosis of HIT during ECMO.Methods:A total of 22 critically ill children, who had received ECMO support for more than 96 hours in the Intensive Care Unit at the Children′s Hospital of Fudan University from March 2019 to December 2020, were enrolled.According to the 4T score and the heparin/platelet factor 4(PF4) antibody, children whose 4T scores were not less than 6 and heparin/ PF4 antibodies were positive, were classified into HIT group ( n=6), and non-HIT group ( n=16). The clinical outcomes and the incidence of thrombotic events were compared between two groups. Results:The incidence of HIT during ECMO in critically ill children was 27% in this study.The incidence of thrombosis in the ECMO circuit in the HIT group was higher (100% vs.63%, P=0.133), and the average time to the first thrombosis in ECMO circuit in the HIT group was shorter than that in the non-HIT group (3.70 d vs.5.44 d, P=0.06). During the first 14 days of ECMO, the proportion of children with thrombotic events no less than twice was higher in the HIT group (67% vs.19%, P=0.054). There was no significant difference regarding the survival rate at 28 days after ECMO withdrawal between two groups (33% vs.50%, P=0.664). Conclusion:The prevalence of HIT during ECMO in critically ill children is high.Thrombosis events tend to occur earlier and more extensively in children with HIT during ECMO.No significant effect of HIT on the survival rate of children during ECMO is found.Whether HIT has effect on the survival rate of children with ECMO requires a prospective and large clinical study.

Methanogens are unique microorganisms for methane production and the main contributor of the biogenic methane in atmosphere. Methyl-coenzyme M reductase (Mcr) catalyzes the last step of methane production in methanogenesis and the first step of methane activation in anaerobic oxidation of methane. The genes encoding this enzyme are highly conserved and are widely used as a marker in the identification and phylogenetic study of archaea. There has been a longstanding interest in its unique cofactor F430 and the underpinning mechanisms of enzymatic cleavage of alkane C-H bond. The recent breakthroughs of high-resolution protein and catalytic-transition-state structures further advanced the structure-function study of Mcr. In particular, the recent discovery of methyl-coenzyme M reductase-like (Mcr-like) enzymes that activates the anaerobic degradation of non-methane alkanes has attracted much interest in the molecular mechanisms of C-H activation without oxygen. This review summarized the advances on function-structure-mechanism study of Mcr/Mcr-like enzymes. Additionally, future directions in anaerobic oxidation of alkanes and greenhouse-gas control using Mcr/Mcr-like enzymes were proposed.
Archaea/metabolism* ; Methane ; Oxidation-Reduction ; Oxidoreductases/metabolism* ; Phylogeny