Background::Hypothermia therapy has been suggested to attenuate myocardial necrosis; however, the clinical implementation as a valid therapeutic strategy has failed, and new approaches are needed to translate into clinical applications. This study aimed to assess the feasibility, safety, and efficacy of a novel selective intracoronary hypothermia (SICH) device in mitigating myocardial reperfusion injury.Methods::This study comprised two phases. The first phase of the SICH was performed in a normal porcine model for 30 minutes ( n = 5) to evaluate its feasibility. The second phase was conducted in a porcine myocardial infarction (MI) model of myocardial ischemia/reperfusion which was performed by balloon occlusion of the left anterior descending coronary artery for 60 minutes and maintained for 42 days. Pigs in the hypothermia group ( n = 8) received hypothermia intervention onset reperfusion for 30 minutes and controls ( n = 8) received no intervention. All animals were followed for 42 days. Cardiac magnetic resonance analysis (five and 42 days post-MI) and a series of biomarkers/histological studies were performed. Results::The average time to lower temperatures to a steady state was 4.8 ± 0.8 s. SICH had no impact on blood pressure or heart rate and was safely performed without complications by using a 3.9 F catheter. Interleukin-6 (IL-6), tumor necrosis factor-α, C-reactive protein (CRP), and brain natriuretic peptide (BNP) were lower at 60 min post perfusion in pigs that underwent SICH as compared with the control group. On day 5 post MI/R, edema, intramyocardial hemorrhage, and microvascular obstruction were reduced in the hypothermia group. On day 42 post MI/R, the infarct size, IL-6, CRP, BNP, and matrix metalloproteinase-9 were reduced, and the ejection fraction was improved in pigs that underwent SICH.Conclusions::The SICH device safely and effectively reduced the infarct size and improved heart function in a pig model of MI/R. These beneficial effects indicate the clinical potential of SICH for treatment of myocardial reperfusion injury.

Hepatocellular carcinoma(HCC) is one of the most common malignancies of the digestive system,which is prone to be associated with microvascular or macrovascular invasion. Among them,HCC with inferior vena cava tumor thrombus(IVCTT) or right atrium tumor thrombus(RATT) is rare and has a poor prognosis. However,surgical treatment of HCC with IVCTT and (or) RATT is rarely reported and summarized. The review described the classification of HCC tumor thrombus with IVCTT and (or) RATT, summarized the progress of surgical approaches and surgical operations,and introduced a case of thrombectomy after pushing from the outer surface of the atrium,rendering the RATT to the inferior vena cava under non-cardiopulmonary bypass. The review also proposed the prospective treatments for HCC with IVCTT or RATT,providing clinical guidance to hepatobiliary surgeons.

Hepatocellular carcinoma(HCC) is one of the most common malignancies of the digestive system,which is prone to be associated with microvascular or macrovascular invasion. Among them,HCC with inferior vena cava tumor thrombus(IVCTT) or right atrium tumor thrombus(RATT) is rare and has a poor prognosis. However,surgical treatment of HCC with IVCTT and (or) RATT is rarely reported and summarized. The review described the classification of HCC tumor thrombus with IVCTT and (or) RATT, summarized the progress of surgical approaches and surgical operations,and introduced a case of thrombectomy after pushing from the outer surface of the atrium,rendering the RATT to the inferior vena cava under non-cardiopulmonary bypass. The review also proposed the prospective treatments for HCC with IVCTT or RATT,providing clinical guidance to hepatobiliary surgeons.

Objective:To investigate the clinical features and prognosis of acute necrotizing encephalopathy (ANE) in children.Methods:The clinical data and follow-up information of 41 pediatric patients with ANE treated in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science & Technology from January 2014 to September 2019 were retrospectively reviewed.Results:The 41 patients included 23 males and 18 females with the onset age of (4.4±3.2) years.The main prodromal symptoms were gastrointestinal (20/41 cases, 48.8%) and respiratory infections (19/41 cases, 46.3%). Acute encephalopathy progressed rapidly following the prodromal infection [29 cases (70.7%) ≤2 days], and patients had clinical manifestations of coma (32/41 cases, 78.0%), convulsion (32/41 cases, 78.0%), multiple organ dysfunction (27/41 cases, 65.9%), shock and disseminated intravascular coagulation were rarely occured, and 28 cases (68.3%) were admitted to intensive care unit for treatment.Brain magnetic resonance imaging (MRI) showed lesion involving thalamus (41/41 cases, 100.0%), periventricular white matter (34/41 cases, 82.9%), brainstem (31/41 cases, 75.6%), basal ganglia (26/41 cases, 63.4%), cerebral cortex and subcortex (20/41 cases, 48.8%) and cerebellum (18/41 cases, 43.9%). The common presentations on the apparent diffusion coefficient mapping of brain MRI were " tricolor pattern" or " bicolor pattern" of the thalamus.During follow-up (≥ 6 months), MRI showed that hemorrhage, cystic degeneration and atrophy changed dynamically with the progression of ANE.All cases were treated with glucocorticoids, 38 cases(92.7%) with intravenous immune globulin.Seven cases (17.1%) were died and the 34 survivors had different degrees of neurological dysfunction.Conclusions:ANE in children is a distinctive type of clinicoradiologic syndrome with rapid progression and various presentations.Brain MRI has typical imaging characteristics and dynamically indicates the progression of this disease.The treatment options are still limited, the prognosis is poor and the survivors are often with neurological dysfunction.

Objective:To explore the method and clinical efficacy of Flow-through latissimus dorsi musculocutaneous flap to repair children’s limb wounds.Methods:From January, 2017 to September, 2019, the Flow-through latissimus dorsi myocutaneous flap was used to repair the limb wounds in 9 children, which were 3 cases of upper extremity wounds and 6 cases of lower extremity wounds. The patients were 5-12 years old, with an average age of 9.4 years. The wound debridement was performed in the first stage, and the wound was covered with VSD. The second operation was performed 5-8 days later. Flow-through free latissimus dorsi muscle flap was used to repair the wound, and 6 patients combined with skin grafting. During the operation, both ends of the recipient area artery were trimmed into a downward slant. The proximal end of the recipient area blood vessel was coincided with the subscapular artery, the distal end was coincided with the circumflex scapular artery, and the thoracodorsal vein and the recipient area vein were coincided. One patient had 2 thoracodorsal veins, and 8 patients had 1 thoracodorsal vein. After the operation, the patients were given anti-infection, anticoagulation and antispasmodic treatment. And regular follow-up.Results:In this group, 8 flaps survived completely, and 1 had partial epidermal necrosis, which healed under the scab. Skin grafting survives well. Nine patients were followed-up for 3 to 28 months, 7 of which were followed-up in the outpatient clinic, and 2 by WeChat. CDU showed smooth blood flow in all patients 1 month after operation, in addition of 3 after 1 year. The flap had good blood flow and soft texture. Flap plastic surgery was performed in 3 cases.Conclusion:Using Flow-through latissimus dorsi musculocutaneous flap to repair the wounds of the children’s limbs, the flap survived well after the operation, and the blood circulation of the main vessel in the affected area was smooth, which had no obvious effect on the blood supply to the distal limb of the affected area.

Objective To evaluate the efficacy of segmental tracheal resection with end-to-end anastomosis for cicatricial cervical tracheal stenosis.Methods The clinical outcomes of 40 patients treated with tracheal resection were retrospectively reviewed.There were 28 male patients and 12 female patients with the age ranged from 6 to 64 years (mean 33.7 years).The degree of stenosis was classified according to Myer-Cotton classification as follows:grade Ⅱ (n =7),grade Ⅲ (n =22) and grade Ⅳ (n =11).The stenosis extension ranged from 1.0 to 4.3 cm (mean 2.5 cm).The causes of the stenosis were postintubation (n =33),cervical trauma (n =6) and resection of tracheal neoplasm (n =1).Results Thirty-four(85.0％) patients were decannulated and 6 failed.Of the 6 patients failed,4 were decannulated after reoperation with the sternohyoid myocutaneous flap or thyroid alar cartilage graft.Complications occurred in 10 patients.In 8 patients granulation tissues formed at the site of the tracheal anastomosis,which needed endoscopic resction,and in 2 patients anastomosic dehiscence occurred.No injury to recurrent laryngeal nerve or trachoesophageal fistula occurred.Conclusion Segmental tracheal resection with end-to-end anastomosis is an effective surgical method for tracheal stenosis,which has a higher successful rate for primary operation and shorter therapeutic period.

Objective To evaluate the efficacy of endoscopic balloon dilation for subglottic stenosis.Methods The clinical outcomes of 9 pediatric patients treated with balloon dilation were retrospectively analyzed.There were 8 male and Ⅰ female.Their age ranged from 7 months to 7 years (mean 2.5 years).The degree of stenosis was classified according to Myer-Cotton classification as follows:grade Ⅱ (n =7) and grade Ⅲ (n =2).The causes of the stenosis were postintubation lesions (n =8) and laryngeal penetrating trauma (n =1).Results The patients had undergone 1 to 3 dilations with an average of 1.8 procedures per patient.Six (66.7％) patients were decannulated.Among them,4 (44.4％) were decannulated after one dilation procedure.Pneumothoraces occurred in 2 children postoperatively.Conclusion Endoscopic balloon dilation is an effective,relatively safe and minimally invasive surgical method for patients with low-grade subglottic stenosis.

Humans ; Reconstructive Surgical Procedures ; Trachea ; surgery

A 47-year-old man presented with recurrent oral ulcerations for more than 1 year and generalized vesicles for 9 months.Physical examination revealed multiple oral ulcers,patchy labial erosions with yellow or dark brown crusts,maceration and blanching of the angle of mouth resulting in difficulty in mouth opening.Cinnamomeous crusts were seen on the nasal limen,palpebral margin and coronary sulcus of penis,with pale red macules after decrustation.Diffuse erythematous patches and bullae were present on the trunk and extremities.The walls of bullae tightly clung to the skin,and some bullae were ruptured,leaving an erythematous and moist surface and giving an erythema multiforme-like appearance; some bullae were turbid and covered with adherent drugcontaining white crusts or black crusts.Nikolsky's sign was negative.Shrinking,edematous dark-red patches were seen in periungual regions of all the fingers and toes.Histologic biopsy and direct immunofluorescence examination of bullous lesions confirmed a diagnosis of paraneoplastic pemphigus (PNP).Histopathological and immunohistochemical findings from the mediastinal tumor were consistent with Castleman's disease (hyalinevascular type) with proliferation of follicular dendritic cells.Laboratory examination revealed a decrease in serum complement C3 and the presence of antinuclear,anti-nucleosome and anti-dsDNA antibodies.The final diagnosis included Castleman's disease,PNP and systemic lupus erythematosus.After 2 months of treatment with low-dose prednisone and azathioprine,skin lesions completely regressed.Then,the dose of prednisone and azathioprine was tapered.Six months later,the patient himself suddenly withdrew prednisone and azathioprine,and began to take traditional Chinese medicine; thereafter,the lesions developed into toxic epidermal necrolysis (TEN),and the patient died finally.This case demonstrates that immunosuppressive therapy should be maintained for a long period of time in patients with Castleman's disease after tumor removal,otherwise,skin lesions may recur or get worse.

Protein transport from endoplasmic reticulum (ER) to Golgi apparatus has long been known to be a central process for protein quality control and sorting. Recent studies have revealed that a large number of signal molecules are involved in regulation of membrane trafficking through ER, ER-Golgi intermediate compartment and Golgi apparatus. These molecules can significantly change the transport rate of proteins by regulating vesicle budding and fusion. Protein transport from ER to Golgi apparatus is not only controlled by signal pathways triggered from outside the cell, it is also regulated by feedback signals from the transport pathway.
Endoplasmic Reticulum ; metabolism ; Golgi Apparatus ; metabolism ; Humans ; Protein Transport ; physiology ; Secretory Pathway ; Signal Transduction