Single-stage extended replacement from the ascending to the distal descending aorta or beyond is a formidable operation that should be preserved for those who have no other option or those who are physically fit, and should be performed in the experienced centers. Hybrid operations combining open surgical repair with thoracic endovascular aortic repair through a median sternotomy incision are preferable because these operations are less invasive than the extended open aortic repair and the risk of spinal cord ischemia is lower compared with the frozen elephant trunk operation. However, these operations are associated with the inherent demerits of endovascular aneurysm exclusion. When the underlying aortic pathology necessitates extended open aortic repair in a single stage, approaches such as the anterolateral partial sternotomy, straight incision with rib cross, and extended thoracotomy with sternal transection may be useful to provide sufficient exposure for both aortic reconstruction and organ protection, with less surgical stress to the patients.

Purpose: Dysregulated circular RNAs (circRNAs) have shown crucial modulatory functions in tumorigenesis, containing non-small cell lung cancer (NSCLC). The purpose of this study was to explore the biological functions and regulatory theory of circ_0006220 in NSCLC.

Methods: Reverse transcription-quantitative polymerase chain reaction and Western blot assay were conducted to measure RNA and protein expression, respectively. A total of 73 cases of NSCLC tumor samples were collected for expression analysis, and A-549 and NCI-H1299 cell lines were used for functional experiments. Cell proliferation was assessed by cell counting kit-8 assay, colony formation assay, 5-ethynyl-2’-deoxyuridine assay, and flow cytometry. Cell apoptosis, motility, and angiogenesis ability were analyzed by flow cytometry, transwell assays, and capillary-like network formation assay. Dual-luciferase reporter assay and RNA immunoprecipitation assay were conducted to verify the target relationships.

Results: Circ_0006220 was highly expressed in NSCLC tissues and cell lines. Circ_0006220 silencing inhibited the proliferation, migration, invasion, and angiogenesis but induced the apoptosis of NSCLC cells. Circ_0006220 acted as a microRNA-342-3p (miR-342-3p) sponge, and circ_0006220 knockdown-induced changes on the phenotypes of NSCLC cells were largely overturned by the knockdown of miR-342-3p. miR-342-3p interacted with the 3’ untranslated region of glutamic-oxaloacetic transaminase 2 (GOT2), and GOT2 overexpression largely diminished miR-342-3p overexpression-mediated influences in NSCLC cells. Circ_0006220 could up-regulate GOT2 expression by sponging miR-342-3p.

Conclusion: Circ_0006220 promoted the malignant behaviors of NSCLC cells through mediating the miR-342-3p/GOT2 regulation cascade.

Purpose: We studied the association between operative timing and the feasibility of mitral valve (MV) repair in active infective endocarditis (IE).

Methods: Forty-nine active IE patients who underwent MV operation were classified according to operative timing: within 48 hours (Term I: n = 7), between 3 and 14 days (Term II: n = 22), and ≥15 days (Term III: n = 20). Patient profiles, operative outcomes, and feasibility of MV repair were evaluated. Complexity score and severity score were used to define the feasibility of MV repair depending on the extent of infected lesion and technical difficulties.

Results: There were no differences in basic profile in the three groups. Rate of major complications was higher in Term I (86%) than II (41%, p = 0.031) and III (25%, p = 0.005). In-hospital mortality was also higher in Term I (43%) than II (9%, p = 0.039) and III (5%, p = 0.015). The three groups did not differ by feasibility of MV repair calculated by the two-score system or by frequency of MV repair (I: 57%, II: 59%, and III: 55%).

Conclusions: Morbidity and mortality were high in urgent cases. Feasibility of MV repair is associated with the extent of infected lesion and technical difficulties, and not with operative timing.

Purpose: Computational fluid dynamics has enabled the evaluation of coronary flow reserve. The purpose of this study was to clarify the hemodynamic variation and reserve potential of the left internal thoracic artery (LITA).

Methods: Four patients were selected on the basis of various native coronary stenosis patterns and graft design. The wall shear stress and oscillatory shear index were measured, and one patient was selected. Next, we created three hypothetical lesions with 75%, 90%, and 99% stenosis in front of the graft anastomosis, and compared the changes in LITA blood flow and coronary flow distribution.

Results: In the 75% to 90% stenosis model, blood flow was significantly higher in the native coronary flow proximal to the coronary artery bypass anastomosis regardless of time phase. In the 99% stenosis model, blood flow from the LITA was significantly dominant compared to native coronary flow at the proximal site of anastomosis. The range of LITA flow variability was the largest at 99% stenosis, with a difference of 70 ml/min.

Conclusion: The 99% stenosis model showed the highest LITA flow. The range of LITA flow variability is large, suggesting that it may vary according to the rate of native coronary stenosis.

Background: Esophageal foreign body (FB) is usually seen in children, prisoners, or patients with psychiatric disorders, most of which can be removed with endoscope.

Case Presentation: We herein report a mentally normal adult inadvertently swallowing a needle, which pierced through the esophagus into the adventitia of pulmonary artery. Computed tomography angiography confirmed its specific location, and urgently, surgical removal was performed after the endoscopic attempt. The patient recovered well and was discharged without any complication of the esophageal perforation.

Conclusion: Surgical treatment should be carried out aggressively if the esophageal FB is out of reach for endoscopic removal or if complications cannot be resolved endoscopically.

A 72-year-old woman with past medical history of rectal cancer resection (adenocarcinoma, pT3N1aM0) presented with a 2-month history of dysphagia. Imaging studies found a thoracic esophageal cancer, for which subtotal esophagectomy with gastric conduit reconstruction via retrosternal route followed by chemoradiotherapy were performed (squamous cell carcinoma, pT4N1M0, RM1). Seven months after the esophagectomy, a contrast-enhanced computed tomography (CT) demonstrated a new asymptomatic mass inside the right atrium. A thrombus or a tumorous lesion was suspected. Positron emission tomography (PET)/CT showed abnormal uptake in the mass. After a thorough discussion by a multidisciplinary oncology group, we performed 1-week anticoagulant therapy first, resulting in mass enlargement. Then tumorectomy was carried out. The final pathological findings revealed that the mass was squamous cell carcinoma, yielding the diagnosis of cardiac metastasis from esophageal cancer. The patient’s postoperative course was unremarkable. PET/CT may help to estimate malignancy and to omit invasive heart surgery.

Neurological paraneoplastic syndrome is a relatively rare condition in patients with malignant tumors. Recently, it has been reported that anti-Aquaporin 4 (AQP4) antibody is highly specific for neuromyelitis optica. The patient was a 76-year-old man. He underwent right upper lobectomy for squamous cell carcinoma of the lung. Although the immediate postoperative course was uneventful, neurological symptoms became apparent from postoperative day (POD) 4. Magnetic resonance imaging showed longitudinally extended edematous lesions in the spinal cord, and a cerebrospinal fluid examination was positive for anti-AQP4 antibody, leading to the diagnosis of paraneoplastic neuromyelitis optica. Despite multiple rounds of steroid pulse therapy and plasma exchange, the neurological symptoms worsened and the patient died on POD 46. The development of neuromyelitis optica in the early postoperative period could be related to the influence of surgical stress or epidural anesthesia.