BackgroundCurrently, a constant shortage in the supply of platelets has become an important medical and society challenge, especially in developing country, and the in vitro production of megakaryocytic progenitor cells (MPs) from cord blood could represent an effective platelet substitute. In the present study, our objective was to determine the safety and feasibility of ex vivo generated MPs in patients.Methods and FindingsMPs were produced and characterized from cord blood mononuclear cells under a serum free medium with cytokines. We investigated the feasibility of expansion and infusion of cord blood-derived MPs in 24 patients with advanced hematological malignancyes. The primary end point was the safety and tolerability of the infusion of cord blood-derived MPs. No adverse effects were observed in patients who received ex vivo-generated cells at concentrations of up to a median value of 5.45×106cells/kg of body weight. With one year follow-up, acute and chronic GVHD had not been observed among patients who received MPs infusion, even without ABO blood group and HLA typing matching.ConclusionsThese initial results in patients are very encouraging. They suggest that infusion of cord blood-derived MPs appears safe and feasible for treatment of thrombocytopenia.Trial Registration www.chictr.org ChiCTR-TCH-09000333.

Metabolomics offers a noninvasive methodology to identify metabolic markers for pathogenesis and diagnosis of diseases. This work aimed to characterize circulating metabolic signatures of benign thyroid nodule (BTN) and papillary thyroid carcinoma (PTC) via serum-plasma matched metabolomics. A cohort of 1,540 serum-plasma matched samples and 114 tissues were obtained from healthy volunteers, BTN and PTC patients enrolled from 6 independent centers. Untargeted metabolomics was determined by liquid chromatography-quadrupole time-of-flight mass spectrometric and multivariate statistical analyses. The use of serum-plasma matched samples afforded a broad-scope detection of 1,570 metabolic features. Metabolic phenotypes revealed significant pattern differences for healthy versus BTN and healthy versus PTC. Perturbed metabolic pathways related mainly to amino acid and lipid metabolism. It is worth noting that, BTN and PTC showed no significant differences but rather overlap in circulating metabolic signatures, and this observation was replicated in all study centers. For differential diagnosis of healthy versus thyroid nodules (BTN + PTC), a panel of 6 metabolic markers, namely myo-inositol, acid, LysoPC(18:0) and LysoPC(18:1) provided area under the curve of 97.68% in the discovery phase and predictive accuracies of 84.78-98.18% in the 4 validation centers. Taken together, serum-plasma matched metabolomics showed significant differences in circulating metabolites for healthy versus nodules but not for BTN versus PTC. Our results highlight the true metabolic nature of thyroid nodules, and potentially decrease overtreatment that exposes patients to unnecessary risks.

A substantial limitation of dialysis fistulas is their high primary failure rate due to nonmaturation. Various studies have documented that patients with larger vein diameters exhibit reduced risks for nonmaturation. Nevertheless, some patients have small veins. Few studies have focused on patients with small veins. We hypothesize that sufficient venous dilation contributes to fistula maturation. Therefore, we studied the influence of cephalic vein dilation on fistula maturation in patients with small veins. Patients with small cephalic veins (diameter <2 mm) undergoing initial arteriovenous fistulae (AVF) operation were included. A total of 72 patients were enrolled in this study. A prospective study was performed, and the patients were followed for 6 weeks after surgery. Preoperative and postoperative duplex ultrasound mapping of veins was performed, and dilation of the cephalic vein was evaluated. The fistula maturation rate was 44.44%. Multivariate logistic regression analysis revealed a significant relationship between fistula maturation and preoperative cephalic vein dilation. Based on the results of ROC analysis, the fistula maturation rate in patients with vein dilation greater than or equal to the cut-off was 57.14% in the training data set and 54.55% in the testing data set. The independent influencing factors for fistula maturation were used to establish a combined index with logistic regression analysis. The fistula maturation rate in patients with combined indexes greater than or equal to the cut-off was 80.95% in the training data set and 77.78% in the testing data set. Our results demonstrated that preoperative venous dilation was associated with AVF maturation. For patients with small veins, venous distensibility needs to be carefully assessed before surgery, as it may be a better predictor of AVF maturation than venous diameter.

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Video-assisted thoracoscopic surgery (VATS) is becoming increasingly popular in the field of general thoracic surgery; however, VATS sleeve lobectomy still remains a big challenge for the thoracic surgeon. 1 The left secondary carinal reconstruction, a more complicated bronchoplasty procedure, has rarely been reported even in with open thoracic surgery.Here we present the case of a left main bronchus carcinoma partially invading the left upper bronchus. This patient underwent partial left main bronchus and upper bronchus resection with pulmonary preservation and a secondary carinal reconstruction in a complete VATS procedure. This case report was approved by our hospital's ethics committee. CLINICAL SUMMARYA 61-year-old man was admitted to our hospital for a left main bronchial mass with symptoms of productive cough and blood-stained sputum for longer than 2 months. A chest computed tomographic scan and bronchoscopy revealed a 15-mm endobronchial mass obstructing roughly 80% of the left main bronchial lumen ( Figure 1, A and B). Histologic examination of an endobronchial biopsy specimen confirmed squamous cell cancer. The patient had a history of left renal clear cell carcinoma 3 years previously, for which he had undergone a radical nephrectomy. Preoperative positron emission tomography, computed tomographic examination, and brain magnetic resonance imaging did not find any evidences of recurrence of renal clear cell carcinoma or metastasis of the left main bronchial tumor either. This patient's lung function was poor because of a 60 packyear history of smoking. The forced expiratory volume in 1 second and maximum voluntary ventilation were only 61.1% and 52.2% of predicted values, respectively. Arterial blood gas analysis showed that PaO 2 and PaCO 2 were 64.9 and 42.7 mm Hg, respectively.The operation was conducted completely as VATS, with a 30-mm anterolateral utility incision placed in the left fourth intercostal space, and another pair of 12-mm ports placed in the seventh intercostal space on the posterior axillary line and the sixth intercostal space on the midaxillary line, 1 for the videoscope and the other for the thoracoscopic instruments (Figure 2, A). No rib spreading was done.The first important step was isolating pulmonary artery trunk and removing lymph nodes nearby bronchi, which was helpful to release the tension on the subsequent anastomosis. Then the partial left main bronchus and upper bronchus with the luminal tumor was cut free of the bronchi with a scalpel under the bronchoscopic guidance (Figure 2, B). After negative margins were ascertained with frozen sectioning, the reconstruction of the left secondary carina was conducted. First, the membranous part of the left upper and lower bronchi were sutured together with 4 interrupted 4-0 absorbable sutures (Vicryl; Ethicon, Inc, Somerville, NJ), and the knots were tied on the outside with a knot pusher (Figure 2, C, F, and G). After this, the anastomosis between left main bronchus and the combination of upper and lower bronchi was performed wi...