Non-small cell lung cancer (NSCLC) poses a great threat to patients’ survival and is associated with a poor prognosis. Dysregulated microRNAs play critical roles in NSCLC progression, but the function of miR-450a-5p is largely unexplored. This study investigated the clinical significance, biological function, and underlying mechanism of miR-450a-5p in NSCLC cell migration and invasion. MiR-450a-5p expression was validated in 120 paired NSCLC tissues and adjacent normal tissues via RT-qPCR. Clinical correlation and survival analysis were performed. The functional role in migration, invasion, and epithelial-mesenchymal transition (EMT) was examined via Transwell assays and RT-qPCR after gain/loss of function experiments. Target genes of miR-450a-5p were predicted and verified by RNA pull-down, dual-luciferase reporter assay, and rescue assay. MiR-450a-5p exhibited notable upregulation in both NSCLC cell lines and clinical tissue samples. Its elevated expression showed a strong correlation with higher TNM stages, lymph node metastasis, and poorer overall survival. In vitro, miR-450a-5p overexpression promoted cell migration, invasion, and EMT (downregulating E-cadherin, upregulating N-cadherin, Vimentin, and Snail1), while its knockdown had opposite effects. The miR-450a-5p target identified was TCF21. Of note, TCF21 overexpression reversed miR-450a-5p-induced pro-metastatic and EMT changes. MiR-450a-5p appears to function as an oncogenic miRNA in NSCLC that contributes to migration, invasion, and EMT mainly via direct targeting of TCF21. The miR-450a-5p/TCF21 axis may serve as a potential prognostic correlate and therapeutic target.
Although guidelines recommend bioprosthetic mitral valve replacement (MVRb) for patients aged 70 and older, an increasing number of younger patients (≤ 70 years) are undergoing MVRb due to specific clinical indications. This study aims to identify early postoperative prognostic markers associated with subsequent bioprosthetic mitral valve dysfunction (MVD) in patients ≤ 70 years who underwent MVRb. This retrospective study included 238 patients aged ≤ 70 years who underwent MVRb between January 2009 and December 2022. MVD was defined by new or progressive prosthetic morphological abnormalities with haemodynamic deterioration from the 1–3-month postoperative reference examination. LASSO-selected variables were entered into a multivariable cause-specific Cox model and incorporated into a nomogram. Internal validation used 1,000 selection-aware bootstrap resamples, and nomogram-based risk groups were compared using competing-risk analysis. During a median echocardiographic follow-up of 166.2 months (IQR, 77.8–175.5 months), MVD occurred in 64 of 238 patients. NYHA functional class ≥ III (HR, 1.89; 95
Pulsed-field ablation is a new treatment option for atrial fibrillation. However, information regarding the use of this type of energy during open-heart surgery is limited. In this study, we describe the use of an endocardial pulsed-field ablation system for treating atrial fibrillation during mitral valve surgery. Two patients underwent mitral valve surgery and concomitant pulsed-field ablation using an endocardial monopolar probe. Ablation procedures were successfully performed in both patients. Electrophysiological studies confirmed the competence of all ablation lines. No device-related adverse effect was observed. After 12 months, the patients were in sinus rhythm, without documented atrial fibrillation paroxysms. The use of pulsed-field energy for atrial fibrillation treatment during open cardiac surgery demonstrated promising results in these two initial patients. However, given the preliminary nature of this report, these findings must be interpreted cautiously. Further studies with larger sample sizes are warranted.
Excessive dynamic airway collapse (EDAC) is a rare cause of expiratory central airway obstruction (ECAC). Standard lung isolation with double-lumen tubes (DLTs) can be challenging in such patients, as they may impede assessment, placement of multiple sutures required for plication and risk airway trauma. We describe a novel technique for airway management in a series of patients with EDAC who underwent posterior splinting tracheoplasty. We present one of the cases here to highlight the airway management employed; an i-Gel supraglottic airway device with bronchial blocker placement under fibreoptic guidance, enabling effective one-lung ventilation without DLT. The patient tolerated the procedure well and was weaned from the ventilator at the end of the surgery. Placement of a bronchial blocker via an i-Gel supraglottic airway device provided reliable lung isolation and facilitated surgical access for complex tracheal surgery. This technique may be considered an alternative to DLTs in selected thoracic cases.
Redo mitral valve replacement is associated with increased surgical complexity and perioperative risk. Acute coronary obstruction caused by retained surgical materials is extremely rare but can lead to fatal myocardial ischemia. A 64-year-old woman with prior bioprosthetic mitral valve replacement underwent redo surgery for severe intraprosthetic regurgitation. Shortly after separation from cardiopulmonary bypass, she developed ventricular fibrillation and severe myocardial dysfunction, requiring reinstitution of bypass and subsequent extracorporeal membrane oxygenation (ECMO). Coronary angiography revealed a thrombus-like lesion at the left coronary ostium with preserved TIMI grade 3 flow; however, repeated aspiration failed to retrieve thrombotic material. Intravascular ultrasound demonstrated a solid non-thrombotic intraluminal obstruction. Surgical exploration confirmed complete occlusion of the left coronary ostium by a retained pledget from the previous operation. Removal of the pledget resulted in rapid improvement of myocardial contractility, and ECMO was successfully discontinued the following day. Coronary ostial embolization by retained pledget is a rare but life-threatening complication after redo mitral valve surgery. Early recognition, intravascular imaging, and timely surgical intervention with mechanical circulatory support are crucial for favorable outcomes.
