Post-sternotomy wound infection (PSWI), particularly deep sternal wound infection (DSWI), sternal osteomyelitis, and post-sternotomy mediastinitis, is an uncommon but serious complication of cardiac surgery. Inconsistent terminology, heterogeneous diagnostic thresholds, and marked variation in antimicrobial and reconstructive practice have limited comparison across studies. This updated comprehensive narrative review was based on database-specific searches of PubMed, Web of Science Core Collection, China National Knowledge Infrastructure, and Wanfang Medical for literature published from January 2011 through June 2026, supplemented by reference tracking of major professional guidance documents. Evidence was prioritized by design and clinical relevance and was appraised at source level using a structured hierarchy covering study design, sample size, population, clinical role, principal limitations, and applicability. Case reports, conference abstracts, and small series were retained only when they illustrated rare pathogens, unusual diagnostic problems, or technically complex reconstruction, and they were not used to generate comparative efficacy estimates. A clinically useful review must distinguish superficial incisional infection, deep incisional infection, sternal osteomyelitis, and mediastinitis. Diagnosis requires integration of wound findings, systemic manifestations, deep microbiological sampling, and imaging; no single inflammatory biomarker or molecular assay can be regarded as universally diagnostic. Computed tomography is the principal cross-sectional imaging method, whereas quantitative polymerase chain reaction (qPCR), metagenomic next-generation sequencing (mNGS), and 18F-FDG PET/CT may be useful in selected difficult cases but remain limited by timing, contamination, cost, accessibility, and incomplete standardization. Management of DSWI requires prompt source control, culture-directed antimicrobial treatment, assessment of sternal viability and stability, and early multidisciplinary collaboration. Negative-pressure wound therapy can be used as a bridge to definitive closure, but it is not a substitute for adequate debridement or timely reconstruction. Current evidence supports a structured, multidisciplinary approach rather than a single universally superior diagnostic test, antimicrobial regimen, or reconstructive technique. Most comparative treatment evidence remains retrospective and vulnerable to selection bias; future studies should use standardized definitions, prespecified outcomes, prospective multicenter designs, and health-economic evaluation.
Patients with moderate to severe aortic stenosis undergoing hip fracture surgery are at high risk for perioperative complications, but data comparing spinal anesthesia and general anesthesia are limited. Historically, spinal anesthesia has been considered relatively contraindicated in patients with aortic stenosis, but there is no clear evidence supporting this assumption. We conducted a single-center retrospective observational study of patients with moderate to severe aortic stenosis undergoing hip fracture surgery. Patients were classified by anesthetic technique (general anesthesia or spinal anesthesia). The primary outcome was intraoperative hypotension, quantified as the area under the threshold, representing the duration and magnitude of mean arterial pressure below 65 mmHg. Secondary outcomes included the ratio of hypotensive time to total anesthesia time, vasopressor requirements, 30-day mortality, postoperative complications, time to first analgesic request, and numeric rating scale pain scores postoperatively. Among 103 patients analyzed (general anesthesia = 76; spinal anesthesia = 27), baseline characteristics were comparable between groups. Spinal anesthesia was associated with lower area under the threshold for mean arterial pressure below 65 mmHg (β = -390 mmHg·min, 95
Heart failure (HF) is a complex cardiovascular disease with high heterogeneity. The ubiquitin pathway plays a crucial role in various pathological processes, but its specific mechanisms in HF development and its relationship with the immune microenvironment remain unclear. Bulk RNA-seq datasets (GSE141910, GSE116250) and a single-cell RNA sequencing (scRNA-seq) dataset (GSE222144) were obtained from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) analysis, weighted gene co-expression network analysis (WGCNA), and ubiquitination-related gene sets (URGs) were integrated to identify candidate genes. Machine learning algorithms selected key genes and constructed a nomogram prediction model. Immune infiltration (CIBERSORTx), competing endogenous RNA (ceRNA)/transcription factor (TF) regulatory networks, scRNA-seq characterisation, and Mendelian randomisation (MR) analysis were performed. For experimental validation, primary neonatal mouse cardiac fibroblasts (NMCFs) were isolated and treated with 10 µM isoproterenol (ISO) for 24 h. Cell viability (CCK-8), reactive oxygen species (ROS), inflammatory cytokines (TNF-α, IL-1β), fibrotic markers (α-SMA, Collagen I), and expression of the four key genes were assessed by quantitative PCR (qPCR) and Western blot. MARK3 was overexpressed via pcDNA3.1-MARK3 transfection, and a rescue arm with recombinant TGF-β1 (10 ng/mL) was included to interrogate the TGF-β1/Smad3 signalling axis. Twenty ubiquitination-related candidate genes were identified, from which four key genes—CADPS2, DTX4, USP51 and MARK3—were selected by machine learning. The nomogram showed good predictive performance (AUC > 0.7). scRNA-seq revealed that fibroblasts chiefly expressed these genes and exhibited enhanced intercellular communication in HF. MR analysis indicated that low CADPS2 and MARK3 expression and high DTX4 expression may be associated with increased HF risk, whereas the estimate for USP51 was directionally consistent but did not reach statistical significance. Experimentally, ISO significantly impaired NMCF viability, elevated ROS, upregulated TNF-α, IL-1β, α-SMA and Collagen I, downregulated CADPS2 and MARK3, and upregulated DTX4 and USP51, consistent with bioinformatic predictions. MARK3 overexpression markedly attenuated ISO-induced oxidative stress, inflammation and fibrotic trans-differentiation while suppressing TGF-β1 and Smad3 phosphorylation. Exogenous TGF-β1 reversed these protective effects, confirming pathway dependence. This study identifies MARK3 as a protective regulator of cardiac fibroblast activation that functions at least partially through inhibition of the TGF-β1/Smad3 axis, providing a mechanistic basis and candidate therapeutic target for ubiquitination-directed anti-fibrotic strategies in HF.
This study aimed to compare two care pathways for initiating preoperative pulmonary exercise in elderly patients scheduled for lung cancer surgery. An exploratory retrospective review was conducted on elderly patients who underwent lung cancer surgery between January and December 2024. Data collected included age, sex, smoking history, health insurance status, cancer type, cancer stage, type of surgery, baseline pulmonary function, and timing of pulmonary exercise initiation. Patients were categorized into a admission-initiation group (exercise initiated upon hospital admission) and a clinic-initiation group (exercise initiated in the outpatient clinic upon surgical decision). Postoperative outcomes—including pulmonary function, length of hospital stay, and complication rates—were compared between the two groups. A total of 152 patients were included, with 76 in each group. Baseline characteristics were comparable, except for the duration of pulmonary exercise, which was significantly longer in the clinic-initiation group [11.0 (9.0, 16.5) vs. 2.0 (1.0, 4.0); p < 0.001]. Compared to the admission-initiation group, the clinic-initiation group demonstrated significantly better pulmonary function one day before surgery and three months postoperatively, shorter postoperative hospital stay, and a lower incidence of complications (p = 0.049, 0.004, 0.021, and 0.025, respectively). Compared with initiating pulmonary exercise later during hospital admission, initiating exercise in the clinic at the time of surgical decision was associated with improved postoperative pulmonary function, reduced length of hospital stay, and lower risk of postoperative complications in elderly patients undergoing elective lung cancer surgery. Further prospective studies are warranted.
Hypertrophic cardiomyopathy (HCM) is an inherited form of cardiomyopathy characterized predominantly by asymmetric myocardial hypertrophy. The condition demonstrates substantial clinical heterogeneity and is associated with an increased risk of adverse outcomes, including heart failure, cardiac arrhythmias, and sudden cardiac death. Accurate diagnosis and comprehensive management are therefore critical for optimizing clinical outcomes in affected individuals. Echocardiography, owing to its noninvasive nature, wide availability, and capacity for real-time assessment, serves as a central imaging modality in the diagnostic evaluation and management continuum of HCM. Recent developments in echocardiographic technology, including conventional modalities, speckle tracking imaging, three-dimensional echocardiography, and contrast-enhanced echocardiography, have expanded the role of this technique in disease detection, phenotypic classification, functional assessment, prognostic stratification, and therapeutic decision-making. This review summarizes current advances in echocardiographic applications in HCM and highlights their clinical utility in supporting optimized diagnostic and management strategies.
