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A multimodality treatment conference with experts from across East Asia was held to establish a consensus for conversion therapy. An agreement was reached that conversion therapy was defined as surgery or chemoradiotherapy (CRT) aiming at cure after initial treatment for tumors that were initially unresectable due to adjacent organ invasion or distant metastasis.

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OBJECTIVES: Drainless thoracoscopic surgery, defined by omitting chest drain after surgery, has been demonstrated to be feasible in selected patients for pulmonary resection. However, drainless procedure for the treatment of primary spontaneous pneumothorax has raised concerns for its safety and thus has been less often reported. We aimed to share our preliminary experience regarding how to select patients with spontaneous pneumothorax for this procedure. METHODS: A retrospective study recruiting 303 consecutive patients with the diagnosis of spontaneous pneumothorax undergoing thoracoscopic surgery in our centre from August 2016 to June 2020 was done. After careful selection, the chest drain was omitted in selected patients who underwent non-intubated uniportal thoracoscopic surgery. Patients' clinical characteristics and perioperative outcomes were analysed. RESULTS: A total of 34 patients underwent drainless thoracoscopic surgery for the treatment of spontaneous pneumothorax. Pleural adhesion was noted in 9 patients during surgery, and all of them (100%) developed residual pneumothorax, among which intercostal drainage was required in 2 (22.2%) patients and ipsilateral pneumothorax recurred 3 years after surgery in 1 (11.1%) patient. Among the remaining 25 without pleural adhesion, 17 (68.0%) developed minor residual pneumothorax (P = 0.006), which all resolved spontaneously within 1-2 weeks, with no complications or recurrence during postoperative follow-up for at least 2 years. CONCLUSIONS: Drainless thoracoscopic surgery for the treatment of primary spontaneous pneumothorax is feasible but can be risky without careful patient selection. In our experience, the drainless procedure should be avoided in patients with identifiable pleural adhesion noted during surgery.

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OBJECTIVE: To compare the clinical efficacy of distal radius T-plate combined with suture anchor and distal clavicle anatomical locking plate combined with suture anchor in the treatment of Neer Ⅱb distal clavicle fracture. METHODS: From June 2014 to June 2018, 42 patients with Neer Ⅱb distal clavicle fractures were retrospectively analyzed. According to different surgical methods, they were divided into the observation group (T-shaped plate combined with suture anchor) and the control group (anatomical locking plate combined with suture anchor). There were 22 patients in the observation group and 20 patients in the control group. In the observation group, there were 13 males and 9 females, aged from 22 to 70 (45.78± 14.44) years old, 12 cases on the left side and 10 cases on the right side, 8 cases of traffic accident injury and 14 cases of fall. In the control group, there were 12 males and 8 females, aged from 24 to 66 (44.17±15.58) years, 13 cases on the left side and 7 cases on the right side, 6 cases of traffic accident injuryand 14 cases of fall. The operation time, intraoperative blood loss and fracture healing time were compared between the two groups, and Constant Murley score was used to evaluate shoulder joint function. RESULTS: The patients in both groups were followed up for 18 to 24 (20.96±2.02) months. The incisions of both groups were healed at stageⅠ. The fracture ends of both groups were bony healed at the last follow up. There was no significant difference in operation time, intraoperative blood loss and fracture healing time between two groups (P>0.05);there was no significant difference in shoulder joint function between two groups at 3 months after operation (P>0.05). CONCLUSION: The two methods can obtain satisfactory results in the treatment of Neer Ⅱb distal clavicle fractures, especially suitable for patients with comminuted distal clavicle fractures or osteoporosis; the clinical effect of the treatment of NeerⅡb distal clavicle fractures with T type distal radius plate combined with suture anchor is satisfactory, which provides another feasible treatment scheme for clinic.

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Acute kidney injury (AKI) was a frequent complication following hip fracture surgery, but recent studies reported inconsistent findings. Our study was aimed at clarifying the prevalence and risk factors of AKI after hip fracture surgery. Pubmed, Embase, and Web of Science were systematically searched from the inception to March 2020 to identify observational studies investigating the prevalence and risk factors of AKI in patients undergoing hip fracture surgery. Pooled prevalence and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Publication bias was evaluated with a funnel plot and statistical test. All the statistical analyses were performed using Stata version 12.0. A total of 11 studies with 16,421 patients was included in the current meta-analysis. The pooled prevalence of AKI in patients undergoing hip fracture surgery was 17% (95%CI, 14%-21%) with substantial heterogeneity (I2 = 95%). Postoperative serum albumin (OR 1.80; 95%CI, 1.38-2.36) was a significant predictor for AKI. Age (OR 1.01; 95%CI, 0.95-1.07) and ACE inhibitors (OR 1.38; 95%CI, 0.92-2.07) were associated with increased the risk of AKI, but the results were not statistically significant. No significant publication bias was identified through statistical tests (Egger's test, p = 0.258 and Begg's test, p = 0.087). In conclusion, our findings indicated that the pooled AKI following hip fracture surgery was approximately 17%. Postoperative serum albumin was a potential significant risk factor for AKI.

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In this study, magnetic visible light driven photocatalysts (bismuth ferrite, Bi2Fe4O9, BFO and Co-doped bismuth ferrite, Co-BFO) were successfully prepared by the facile hydrothermal method. The catalyst was used in the application of heterogeneous persulfate (PS) system under visible LED light irradiation for the degradation of levofloxacin (LFX), proving to be an excellent photocatalyst when evaluated by various characterization methods. The effect of Co-doping in the BFO structure was investigated that the decrease of band gap width and the generated photoelectrons and holes would effectively reduce the recombination of photogenerated electron-hole pairs, leading to the enhancement photocatalytic activity. The results demonstrated that Co-BFO catalyst had a high photodegradation efficiency over a wide pH range of 3.0-9.0 and the Co-BFO-2 composite displayed the optimal catalytic performance. It was found that the degradation rate of LFX by Co-BFO-2 catalyst was 3.52 times higher than that of pure BFO catalyst under visible light condition. The free radical trapping experiments and EPR tests demonstrated that superoxide, photogenerated holes and sulfate radicals were the main active species in the photocatalytic degradation of LFX. And a possible photocatalytic degradation mechanism of LFX was proposed in the Vis/Co-BFO/PS process. These findings provided new insight of the mechanism of heterogeneous activation of persulfate by Co-BFO under visible light irradiation.

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BACKGROUND: Pulmonary arteriovenous malformations are rare vascular abnormalities that permit direct communication between the pulmonary artery and vein. During pregnancy, pulmonary arteriovenous malformation carries an increased risk of enlargement and rupture, which could lead to life-threatening hemothorax. This is the first case reporting successful thoracoscopic surgery for a pregnant woman with pulmonary arteriovenous malformation rupture-related hemothorax. CASE PRESENTATION: We present a case of a 32-year-old pregnant Asian woman (31 weeks' gestation) whose pulmonary arteriovenous malformation ruptured, leading to right-sided spontaneous tension hemothorax. First, an emergency cesarean section for hypovolemic shock-related fetal distress was performed to save the baby. Immediately afterwards, video-assisted thoracic surgery with the single-incision approach allowed us to successfully obtain hemostasis and eradication of abnormal vasculature by conducting wedge resection of the pulmonary arteriovenous malformation. CONCLUSIONS: Emergency thoracoscopic surgery for a pregnant woman with pulmonary arteriovenous malformation rupture-related hemothorax is safe and feasible. In contrast to transcatheter arterial embolization, video-assisted thoracic surgery could simultaneously achieve hemostasis for prevention of mortality, eradication of abnormal vasculature, and removal of massive thrombi.

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Tracheobronchial injuries are rare but life-threatening conditions in patients with blunt thoracic trauma. The diagnosis and management of such injury may often be delayed due to other concomitant severe injuries. No reported case of a robotic-assisted bronchial reconstruction has ever been performed for a traumatic bronchial injury. A 23-year-old male suffered from traumatic left main bronchial (LMB) rupture with an initial presentation of pneumothorax and pneumomediastinum that eventually progressed to left main bronchus fibrosis and total obstruction, which led to left lung atelectasis and consolidation. Minimally invasive robotic-assisted sleeve surgery, 33 days after the initial trauma, successfully reconstructed the left main bronchus with satisfactory morphological and functional results. Recognition of a bronchial injury and precise localization of the lesion is mandated to ensure a prompt and adequate salvage surgical procedure in order to help patients recover from this critical condition.

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BACKGROUND: Mice with defects in the Klotho gene exhibit multiple aging phenotypes including arteriosclerosis. We hypothesised that the G-395A polymorphism in the promoter region of the human Klotho gene may contribute to the prevalence of Essential Hypertension (EH). METHODS: We investigate whether the G-395A polymorphism of Klotho is associated with EH in a population consisting of 215 patients with EH and 220 non-hypertensive subjects. We also tested whether a G/A substitution at the G-395A site affected the transcription level in vitro through the dual-luciferase reporter assay. RESULTS: Differences in the genotype distributions of the G-395A polymorphism between the EH and non-hypertension groups are statistically significant (P=0.032). There are differential effects of age, gender and smoking status on the association of the G-395A polymorphism with EH; the G-395A polymorphism is significantly associated with EH in subjects over 60years old, in females and in nonsmokers. A multiple logistic regression analysis indicated that the odds ratio for EH in the -395A allele carriers as compared with the control group was 0.593 (P=0.024) after adjusting for current traditional risk factors. The dual-luciferase reporter assay revealed that the -395A carrier of a 498-bp DNA fragment (containing the G-395A site) upstream of the Klotho gene has higher relative luciferase activity than the -395G carrier. CONCLUSIONS: The G-395A polymorphism of the human Klotho gene is associated with EH and may be a potential regulatory site.

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