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The particular Terrestrial Plastisphere: Variety and Polymer-Colonizing Potential involving Plastic-Associated Microbial Towns inside Soil.
PURPOSE There is a high incidence of complications after conventional open thoracic aortic arch replacement. Stent graft thoracic endovascular repair for aortic aneurysms has few complications. Vascular variability of the aortic arch branch is high and individualized aortic arch stent graft is required. We present our experience of using three-dimensional print-assisted fabrication of individualized stent graft. DESCRIPTION According to the patient's computed tomography angiography results before surgery, the aortic arch was printed three-dimensionally, and then an individualized stent graft was sewed. The prepared stents were placed in the descending aorta and the partial branches of the arch, and then released. EVALUATION Intraoperative stent placement was successful. The deep hypothermic circulatory arrest time was only 5 minutes. The patient recovered well postoperatively and no neurological complications occurred. Postoperative computed tomography angiography showed good stent expansion and no endoleak. CONCLUSIONS Three-dimensional printing-assisted fabrication of a stent graft can be used for endovascular repair of the total aortic arch. This technology can be used to accurately construct individualized aortic arch stents for different patients before surgery. BACKGROUND Repair of anomalous pulmonary venous return (APVR) when veins are remote from the left atrium (LA) is challenging, and may eventuate in a higher prevalence of pulmonary vein stenosis, superior vena cava (SVC) stenosis, or intracardiac baffle obstruction. We describe our experience in 6 patients with a technique, utilizing both anterior and posterior in-situ pericardial roll repairs, that reduce these complications. METHODS Six patients underwent in-situ pericardial roll repair of (APVR) at Cleveland Clinic between 2018-2019. Median age was 40 years (range 0.25 -65). Three patients had partial APVR of right upper and middle veins into SVC high above the right pulmonary artery without atrial septal defect; two had scimitar syndrome, and the infant had heterotaxy with unbalanced atrioventricular canal and mixed obstructed total APVR. APV drained into the respective cava far from the LA, not ideal for traditional repair techniques. In-situ pericardial roll directed APV to the LA. Most patients had concomitant complex cardiac procedures. RESULTS There was no mortality. Median hospital stay was 23 (range 4-60) days and median follow-up time is 20 (1-36) months. The infant required percutaneous dilatation and stenting of LA anastomosis but has since undergone ventricular switch. At last follow-up, pulmonary veins are unobstructed and adult patients are asymptomatic with excellent functional status. CONCLUSIONS In-situ autologous pericardial roll is a useful technique that abrogates the need for mobilization of distant APV with direct anastomosis or complex intracardiac baffles. It is suitable for multiple anatomic configurations, and can be used in infants and adults. BACKGROUND Randomized controlled trials have compared the early and mid-term prognosis of on-pump coronary artery bypass grafting (CABG) and off-pump CABG. However, the results are controversial, and there is limited information on graft patency and long-term outcomes. METHODS Betweeen May 2007 and October 2011, 349 patients were randomized to off-pump or on-pump CABG as part of the CORONARY trial at Fuwai Hospital. The primary outcome was coronary bypass graft patency, which was assessed at a mean of 6.7±1.7 years after surgery by multidetector computed tomography. A secondary endpoint was a composite outcome of death, nonfatal myocardial infarction, repeat coronary revascularization, or stroke; mean follow-up was 6.5±1.7 years. Graft patency was compared between the off-pump and on-pump CABG treatment arms in the 206 patients with follow-up computed tomography. RESULTS There were 107 patients in the off-pump CABG group and 99 in the on-pump group during the follow-up period. These patients underwent a total of 723 grafts, and the overall rate of graft patency did not differ significantly between the off-pump and on-pump groups (87.4% vs 88.9%, P=0.527). The patency rate of the posterior descending branch was lower than average. Higher incidence of mortality, nonfatal myocardial infarction and repeat revascularization was found in the off-pump patients however it did not reach significance. CONCLUSIONS There were no statistical differences in graft patency rates in off-pump versus on-pump CABG patients during the long-term follow-up. On-pump CABG group appeared to offer a better long-term prognosis even with no statistical differences for the limited study population. Non-small cell lung cancer (NSCLC) patients are sometimes referred for thoracic surgical consultation to address the possibility of resecting second primary lung cancer. We report a case of pulmonary resection for second primary lung adenocarcinoma after three cycles of pembrolizumab under circumstances in which the primary metastatic lung adenocarcinoma was controlled. The tumor statuses, including programmed death-ligand 1, epidermal growth factor receptor, and CD8+ tumor-infiltrating lymphocytes, were different between the surgically resected specimen and the previously biopsied sample. Surgery should be considered for second primary NSCLC in cases in which the primary NSCLC are well controlled with immune checkpoint inhibitors. selleck inhibitor The protective effect of methylene blue (MB) was investigated on the model of focal one-sided traumatic brain injury (TBI) of the sensorimotor cortex region from 1 to 7 days after the injury. TBI caused a reliable disruption of the functions of the limbs contralateral to injury focus, an increase in the expression of S100 protein and blood-brain barrier (BBB) permeability in the ipsilateral hemisphere. The single intravenous injection of MB (1 mg/kg body weight) 30 min after TBI significantly reduced the limb function impairment as well as a TBI-induced increase in the expression of inflammatory marker S100 protein, and BBB permeability. When modeling inflammation in vitro, MB was found to protect cultured neurons from the toxic effects of lipopolysaccharide. In conclusion, the preservation of blood-brain barrier and a decrease in the expression of S100 protein may be an important mechanism by means of which MB improves neurological outcome. Our data demonstrate that MB can be a very promising pharmacological compound with neuroprotective properties for TBI treatment.
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