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An upper hemisternotomy (UHS) tends to be performed for aortic valve replacement. However, the safety of UHS for total arch replacement combined with frozen elephant trunk implantation in patients with acute type A dissections is ambiguous. We retrospectively analyzed 162 consecutive patients with acute type A dissections who underwent total arch replacement combined with frozen elephant trunk implantation between May 2016 and April 2018. A total of 153 patients enrolled were included, divided into the UHS group (n = 73, single upper hemisternotomy) and full sternotomy (FS) group (n = 80). Perioperative characteristics were recorded. There was no significant difference in any preoperative or intraoperative variables between groups. However, ventilation times (18 hours [range, 12-303 hours] versus 20.5 hours [range, 3-244 hours]; P =.002) were significantly shorter in the UHS group compared with the FS one. Results for the first 24 hours of chest tube drainage (160 mL [range, 70-700] versus 267.5 mL [range, 10-1,455 mL]; P =.001) were significantly less in the UHS group than the FS group. Total arch replacement combined with frozen elephant trunk implantation through a single upper-hemisternotomy approach in patients with acute type A dissections is a safe procedure that adds the benefit of a more cosmetic incision. [ABSTRACT FROM AUTHOR]

Kunitz-like protease inhibitors (KTIs) have been identified to play critical roles in insect defense, but evidence for their involvement in drought stress is sparse. The aim of this study was to identify and functionally characterize a Kunitz-like protease inhibitor, GsKTI , from the wild soybean (Glycine soja) variety ED059. Expression patterns suggest that drought stress and insect herbivory may induce GsKTI transcript levels. Transgenic Arabidopsis lines overexpressing GsKTI have been shown to exhibit enhanced drought tolerance by regulating the ABA signaling pathway and increasing xylem cell number. Transgenic Arabidopsis leaves overexpressing GsKTI interfered with insect digestion and thus had a negative effect on the growth of Helicoverpa armigera. It is concluded that GsKTI increases resistance to drought stress and insect attack in transgenic Arabidopsis lines. • This study identifies and characterizes the GsKTI gene from the strongly cotton bollworm-resistant wild soybean ED059. • The study investigated the subcellular localization and expression pattern of GsKTI in response to various stresses. • The study found that GsKTI positively regulates drought and cotton bollworm resistance in Arabidopsis. • The GsKTI overexpression Arabidopsis results in insect resistance by severely impairing the immune system of cotton bollworm larvae. [ABSTRACT FROM AUTHOR]