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Herein, polyethylenimine-grafted nanocellulose (PEI

Surgical site infections (SSI) following congenital heart surgery (CHS) remain a significant source of morbidity. Delayed sternal closure (DSC) is often required to minimize the potential for hemodynamic instability. The purpose of this study was to determine the incidence of SSI among patients undergoing DSC versus primary chest closure (PCC) and to define a potential inflection point for increased risk of SSI as a function of open chest duration (OCD).A retrospective review of our institutional Society of Thoracic Surgeons dataset is to identify patients undergoing CHS at our institution between 2015 and 2020. Incidences of SSI were compared between DSC and PCC patients. DSC patients were evaluated to determine the association of OCD and the incidence of SSI.2582 operations were performed at our institution between 2015 and 2020, including 195 DSC and 2387 PCC cases. The incidence of SSI within the cohort was 1.8% (47/2,582). DSC patients had significantly higher incidences of SSI (17/195, 8.7%) than PCC patients (30/2387, 1.3%, p 0.001). Further, patients with an OCD of four or more days had a significantly higher incidence of SSI (11/62, 17.7%, p = 0.006) than patients with an OCD less than 4 days (6/115, 5.3%).The incidence of SSI following CHS is higher in DSC patients compared to PCC patients. Prolonged OCD of 4 days or more significantly increases the risk of SSI and represents a potentially modifiable risk factor for SSI predisposition. These data support dedicated, daily post-operative assessment of candidacy for chest closure to minimize the risk of SSI.

Herein, magnetic nitrogen doped porous biochar (Fe/N-PBC) was prepared by mixing KHCO

Retrograde cerebral perfusion (RCP) is a safe and effective technique to augment cerebral protection during lower body circulatory arrest in patients undergoing elective hemiarch replacement. However, recommendations guiding optimal temperature, flow rate, and perfusion pressure are outdated and potentially overly limiting. We report our experience using RCP for elective hemiarch replacement with parameters that challenge the currently accepted paradigm.This was a single-center, retrospective analysis of 319 adult patients who underwent elective hemiarch replacement between February 2010 and 2021 using hypothermic lower body circulatory arrest with RCP alone, RCP followed by antegrade cerebral perfusion (ACP), or ACP alone. Flow rates were adjusted to maintain cerebral perfusion pressure between 30 and 50 mm Hg for RCP and between 40 and 60 mm Hg for ACP.RCP was used in 22.6% (n = 72) of cases, whereas ACP alone was performed in 77.4% (n = 247) of cases. Baseline patient characteristics were similar between groups. Patients undergoing RCP demonstrated shorter cross-clamp time (97.0 min versus 100.0 min, P = 0.034) and shorter lower body circulatory arrest time (7.0 min versus 10.0 min, P 0.0001) compared with ACP alone. Nadir bladder temperature was equivalent between groups (27.3°C versus 27.5°C, P = 0.752). There were no significant differences in postoperative complications, neurologic outcomes, or mortality.Moderate hypothermic lower body circulatory arrest combined with RCP at target perfusion pressures of 30-50 mm Hg in patients undergoing elective hemiarch replacement results in equivalent neurologic outcomes and overall morbidity to cases using ACP alone. These results challenge the currently accepted paradigm for RCP, which typically uses deep hypothermia while keeping perfusion pressures below 25 mm Hg.

Xiaoliang Liang,1,* Fei Song,2,* Wanzhi Fang,1 Yu Zhang,1 Zihan Feng,1 Zeyin Chen,1 Lu Han,3 Zhong Chen1 1Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, People’s Republic of China; 2Department of General Surgery, Yancheng TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, 224002, People’s Republic of China; 3Department of Medicine, Jiangsu Vocational College of Medicine, Yancheng, 224005, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhong Chen, Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, People’s Republic of China, Email chenz9806@163.comPurpose: C-type lectin domain family 1 member B (CLEC1B) is a protein-coding gene involved in various processes, such as platelet activation, tumor cell metastasis and separation of blood/lymphatic vessels. However, how CLEC1B plays its role in hepatocellular carcinoma (HCC) has not been well studied. The purpose of this study was to investigate the clinical significance and biological function of CLEC1B in HCC.Patients and Methods: Based on (The Cancer Genome Atlas) TCGA database, CLEC1B expression matrix and corresponding clinical information were extracted. ROC curves and Kaplan–Meier method were generated to evaluate the value of CLEC1B as a diagnostic and prognostic biomarker. Moreover, single-gene difference analysis constructed by DESeq2 method and then the related genes were used to predict CLEC1B-related signaling pathways. The ssGSEA algorithm was conducted for studies related to immune infiltration. CLEC1B protein expression was evaluated and immunohistochemistry in HCC tissues through tissue microarray. Finally, the relationship between CLEC1B expression and T cell infiltration was assessed according to tissue microarray.Results: The mRNA and protein levels of CLEC1B were significantly down-regulated in HCC compared to paired normal tissues, which were further verified in clinical tissue samples. ROC curves and Kaplan–Meier survival analysis suggested the significant diagnostic and clinical prognostic value of CLEC1B. Meanwhile, downregulation of CLEC1B was significantly associated with clinical parameters such as clinical tumor vascular invasion and distant metastasis. Moreover, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) and gene set enrichment (GSEA) analysis indicated that CLEC1B has significant association with immune function. Finally, immune infiltration analysis indicated that CLEC1B was significantly associated with immune cell subsets and affected the efficacy of immunotherapy in cancer patient.Conclusion: Collectively, our findings suggested that CLEC1B could be a promising prognostic biomarker in HCC and its expression was related to immune cell infiltration.Keywords: CLEC1B, hepatocellular carcinoma, prognostic value, tumor immune infiltration, bioinformatics analysis

Background:Hepatocellular carcinoma (HCC) patients often undergo curative liver resection to treat this form of cancer. Hepatectomy is, however, a form of major surgery associated with many significant risks including prolonged hospitalization, high costs, impaired physiological function, and high postoperative complication rates. Enhanced recovery after surgery (ERAS) is a multidisciplinary approach that seeks to expedite postoperative recovery in patients undergoing major surgeries in order to lower postoperative complication rates. Prior studies have successfully employed ERAS approaches in the context of gynecological, urological, and cardiovascular surgeries. However, HCC is a complex disease and affected patients may also suffer from pre-existing liver disease, making it essential that they be administered appropriate individually tailored treatments. This study was thus designed to assess the efficacy and safety of individualized ERAS approaches in patients undergoing hepatectomy. Methods:In total, we retrospectively analyzed data from 90 HCC patients that underwent hepatectomy between October 2018 and August 2019. All patients met the study enrollment criteria and provided written informed consent to participate. All studies were approved by the Hospital Research Ethics Committee and were consistent with the Declaration of Helsinki. Patients were randomly divided into two groups (n=45 each) based on the employed perioperative treatment strategies: a conventional treatment group and an ERAS treatment group. Key outcomes were then compared between groups, including postoperative pain scores, duration of postoperative hospitalization, medical costs, and rates of readmission. Quantitative data are given as `x±s and were compared via Student’s t-tests, whereas categorical data were compared via chi-squared tests and Fisher's exact test.Results:ERAS treatment was associated with lower postoperative pain scores at 24, 48, and 72 h post-treatment (P0.05) or readmission rates (P>0.557) were observed between these groups. Conclusions:Individualized ERAS improves patient postoperative recovery more effectively than traditional treatment in patients undergoing hepatectomy.

The appropriate stent length in frozen elephant trunk replacements (FET) remains debated relative to the risk for paraplegia. However, landing the distal end of the stent beyond the curve of the arch facilitates distal reintervention, which is commonly beyond the 10 cm stent coverage when deployed proximal to the left subclavian artery. The aim of this study was to evaluate outcomes following the use of 15 cm stent grafts in zone 2 (z2, distal to the left common carotid).Using our single institution-maintained database, 103 zone 2 FET performed from 2016 to 2020 were reviewed.Of the 103 z2, a 15 cm stent graft was used in 51 operations. The indications for FET included acute and chronic aortic dissection, arch aneurysms, and pseudoaneurysms. The incidence of SCI was 0%. Seven deaths (13.7%) occurred.The data demonstrates the incidence of post-operative paraplegia to be 0% with 15 cm z2 FET. The understanding of SCI in FET should not only include the stent length but also from where it begins.

Background Hepatocellular carcinoma (HCC) patients often undergo curative liver resection to treat this form of cancer. Hepatectomy is, however, a form of major surgery associated with many significant risks including prolonged hospitalization, high costs, impaired physiological function, and high postoperative complication rates. Enhanced recovery after surgery (ERAS) is a multidisciplinary approach that seeks to expedite postoperative recovery in patients undergoing major surgeries in order to lower postoperative complication rates. This study was thus designed to assess the efficacy and safety of individualized ERAS approaches in patients undergoing hepatectomy. Methods In total, we retrospectively analyzed data from 90 HCC patients that underwent hepatectomy between October 2018 and August 2019. All patients met the study enrollment criteria and provided written informed consent to participate. All studies were approved by the Hospital Research Ethics Committee and were consistent with the Declaration of Helsinki. Patients were randomly divided into two groups (n = 45 each) based on the employed perioperative treatment strategies: a conventional treatment group and an ERAS treatment group. Key outcomes were then compared between groups, including postoperative pain scores, duration of postoperative hospitalization, medical costs, and rates of readmission. Results ERAS treatment was associated with lower postoperative pain scores at 24, 48, and 72 h post-treatment (P 0.05) or readmission rates (P > 0.557) were observed between these groups. Conclusions Individualized ERAS improves patient postoperative recovery more effectively than traditional treatment in patients undergoing hepatectomy.

Introduction: The optimal timing for imaging following ascending aortic replacement is unknown. Protocols currently differ based on institution. For the last 3 years, our institution has surveilled patients at 3 months, yearly for 3 years, and at 5 years following the operation. Hypothesis: We hypothesize surveillance CT scans performed at 3 months will identify any pathologies related to the ascending aortic repair that will require re-intervention; additional imaging may be superfluous. Methods: Using our single institution-maintained database, 311 patients who underwent an elective aortic hemiarch repair between February of 2010 and March of 2021 were identified. The timing for and stability of surveillance imaging was reviewed, paying special attention to pathology associated with the repair. Results: Of the 311 patients who underwent elective aortic hemiarch repair, 217 completed surveillance imaging. 187 patients had their initial imaging around 3 months following the operation, 85 patients completed imaging around one year, and 54 patients were imaged 2-8 years post-operatively with some patients undergoing multiple scans during this period. Nine patients required re-intervention; of these 9, four patients demonstrated pathology, on CT scan, associated with the actual ascending arch repair. Two patients developed a pseudoaneurysm (PSA), one at the distal aspect of the repair and one at the left ventricular outflow tract. The other two patients had degeneration of known distal aortic aneurysms. The two PSAs were intervened upon within the first 3 months and the degenerating aneurysms were intervened upon at 1 and 2.5 years post-operatively. Conclusions: These data support surveillance imaging completed at 3 months following ascending aortic replacement is sufficient to identify pathology related to the repair. While other indications may dictate ongoing surveillance, for most patients, the need for further imaging is potentially zero.

In order to solve the problem of person recognition in cross-view video sequences of non-overlapping camera, most of the current person re-identification models based on deep learning either need to manually label features as their attributes, or learn the overall single semantic level of feature representation. This paper proposes a person re-identification method based on DNN with multi-level feature fusion, it can automatically learn multi-level discriminative visual factors that are insensitive to viewing condition changes, and identify and utilize them when matching images. Firstly, this paper uses the HOG feature to perform person detection on the video of the two cameras respectively. The person images detected of the camera1 are used as the prob, the person images detected in the camera2 are used as the gallery, and then the two parts are put into the person re-ID model and completed by the training. Finally, the cross-view tracking is implemented for the re-identified persons in combination with the KCF algorithm. The experimental results confirm the accuracy and efficiency of the method.