Yongqiang Lai

Background: The validity and safety of simultaneously performing coronary artery bypass grafting (CABG) and lung cancer resection remain inconclusive. This study examined the clinical progression of patients undergone this surgery. Methods: Fifty-seven patients who underwent concurrent off-pump CABG (OPCABG) and pulmonary lobectomy between May 2006 and December 2019 in Beijing Anzhen Hospital were retrospectively analyzed. Baseline characteristic and clinical data of patients were collected, and postoperative follow-up was performed to evaluate the prognosis. Results: All procedures were performed with median or parasternal incision, and thoracoscope was used in 15 of them. No intraoperative deaths were reported. An average of 2.52±0.90 coronary vessels were grafted per procedure. One patient died in hospital due to postoperative low cardiac output, another due to respiratory failure. In Cox multivariate regression analysis, age >69 years [hazard ratio (HR): 1.223, 95% confidence interval (CI): 1.067–1.402, P=0.004, area under the curve (AUC) =0.657] and tumor stage >III (HR: 5.384, 95% CI: 1.917–15.125, P=0.001, AUC =0.715) emerged as significant predictors of adverse event risk for survival. During the 17-year follow-up, the mean survival time was 85.39±49.70 months, with a primary endpoint of death reached by 21.05% (12/57) of patients. All deaths were attributed to tumor progression, and there were no new myocardial infarction or heart failure readmissions. Conclusions: OPCABG combined with pulmonary resection is safe and effective in the treatment of patients with concomitant coronary artery disease (CAD) and lung cancer. Age and tumor stage were significantly correlated with postoperative survival. The predictive value of tumor stage above III surpasses that of age in prognostic assessment. For patients aged 69 years and with tumors of stage III or higher, surgical decision-making requires careful consideration due to the potentially increased risk of adverse outcomes.

Background: Traditional sutures often fail to meet the complex demands of wound closure across diverse anatomical environments. This study introduces a novel drug-eluting, multiscene absorbable biological suture derived from decellularized fish swim bladder, designed to address limitations in mechanical performance, pH resistance, and foreign body reactions. Methods: Swim bladders were decellularized, microdissected into 0.3-mm strips, and functionalized with rapamycin (RAPA) or necrostatin-1 (NEC-1) via hyaluronic acid/polyvinyl alcohol coatings. Sutures were evaluated for cytotoxicity [human umbilical vein endothelial cell (HUVEC) assays], mechanical properties (tensile/acid/alkali resistance), and efficacy in rat models of venous/arterial, intestinal, gastric, and abdominal wall closures ( n = 3/group). Histological (hematoxylin and eosin, immunofluorescence) and scanning electron microscopy analyses were performed. Results: The NEC-1 sutures demonstrated superior tensile strength (hydrated: 2.1 ± 0.3 N vs. RAPA: 1.8 ± 0.2 N, CTL: 1.5 ± 0.2 N; P In vitro , drug-loaded sutures significantly inhibited HUVEC proliferation by 40% ( P = 0.0096) without inducing apoptosis. In vivo evaluations across venous, arterial, intestinal, gastric, and abdominal wall closures revealed that NEC-1 sutures markedly reduced foreign body reactions, exhibiting the smallest capsule area (0.12 ± 0.03 mm ² vs. CTL: 0.35 ± 0.05 mm ² ; P P = 0.0015). All suture types achieved successful leak-free wound closures, with NEC-1 showing particularly strong suppression of neovascularization (CD31 + vessels: 12 ± 3 vs. CTL: 28 ± 5; P = 0.0001). The RAPA sutures also showed significant improvements over controls but were intermediate in performance between NEC-1 and uncoated CTL sutures. Mechanical testing confirmed that both drug-loaded variants (RAPA and NEC-1) maintained higher strength than CTL sutures under both dry and hydrated conditions, while histological analyses demonstrated progressive reductions in inflammatory markers (CD45 +, PCNA +, cleaved caspase 3 + cells) with drug-functionalized sutures. Conclusion: Swim bladder-derived sutures demonstrate universal applicability, staged drug release, and significant reductions in inflammatory responses, offering a promising alternative for multitissue surgical repairs. Graphic The process of making suture and summarizing the cross-tissue analysis protocol. A: Surgical extraction and processing workflow. ① Tissue harvest from fish. ② The swim bladder undergoes decellularization treatment. ③ Microdissection into standardized strips. ④ The swim bladder is processed to create a drug-carrying, multiscene, absorbable biological suture. B: Fish swim bladder suture is used to stitch various organs. (i) Inferior vena cava and infrarenal abdominal aorta. (ii) Small intestine. (iii) Stomach. (iv) Abdominal wall.

Objectives: The diameter, area, and volume of the true lumen and false lumen (FL) have been measured in previous studies to evaluate the extent of DeBakey type I aortic dissection. However, these indicators have limitations because of the irregular shapes of the true and false lumens and the constant oscillation of intimal flap during systole and diastole. The ratio of arch lengths seems to be a more reliable indicator. FL% was defined as the ratio of the arch length of FL to the circumference of the aorta at the different levels of the aorta. The purpose of this article was to investigate whether FL% is a predictor of the severity of acute DeBakey type I aortic dissection in patients undergoing frozen elephant trunk (FET) and total arch replacement.Methods: In this retrospective observational study, we analyzed a total of 344 patients with acute DeBakey type I aortic dissection that underwent FET and total arch replacement at our center from October 2015 to October 2019. The patients were divided into two groups by cluster analysis according to the perioperative course. Binary logistic regression analyses were performed to determine whether FL% could predict the severity of acute DeBakey type I aortic dissection. The area under the receiver operating characteristic curve (AUROC) was used to assess the power of the multivariate logistic regression model for the severity of acute DeBakey type I aortic dissection.Results: The patients in the ultra-high-risk group (109 patients) had significantly more severe clinical comorbidities and complications than the patients in the high-risk group (235 patients). The ascending aortic FL% [odds ratio (OR), 11.929 (95% CI: 1.421–100.11); P = 0.022], location of initial tear [OR, 0.68 (95% CI: 0.47–0.98); P = 0.041], the degree of left iliac artery involvement [OR, 1.95 (95% CI: 1.15–3.30); P = 0.013], and the degree of right coronary artery involvement [OR, 1.46 (95% CI: 1.01–2.12); P = 0.045] on preoperative computed tomography angiography were associated with the severity of acute DeBakey type I aortic dissection. The AUROC value of this multivariate logistic regression analysis was 0.940 (95% CI: 0.914–0.967; P < 0.001). The AUROC value of ascending aortic FL% was 0.841 (95% CI: 0.798–0.884; P < 0.001) for the severity of acute DeBakey type I aortic dissection in patients undergoing FET and total arch replacement.Conclusions: Ascending aortic FL% was validated as an essential radiologic index for assessing the severity of acute DeBakey type I aortic dissection in patients undergoing FET and total arch replacement. Higher values of ascending aortic FL% were more severe.