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Background: Different video-assisted thoracoscopic surgery (VATS) approaches may related to heterogeneous clinical outcomes in anterior mediastinal tumor surgery. Herein, we assessed the comparison between the subxiphoid and intercostal approach, and also compare the left versus the right incision in the intercostal approach for anterior mediastinal tumor patients. Methods: Clinical data of patients receiving thoracoscopic anterior mediastinal tumor resection were retrospectively collected. Patients were divided into two groups according to the approaches: subxiphoid and the intercostal group. The intercostal group was further subdivided into two groups according to different sides: left and right incision group. Intraoperative and postoperative variables were compared between subgroups. Results: A total of 238 patients were consecutively included in this analysis; 198 (83.2%) patients received intercostal procedure and 40 (16.8%) patients received subxiphoid approach. After 1:1 propensity score matching, all baseline characters were well balanced between intercostal and subxiphoid approach, left and right intercostal approach. The visual analogue scale (VAS) pain score was lower in patients underwent subxiphoid approach than intercostal group at first post-operative evaluation in 12-24 h (4.36 vs. 2.23; P=0.03). According to left and right approach, postoperative drainage time (1.9 vs. 1.2 days, P=0.016), postoperative drainage volume (312.1 vs. 193.9 mL, P=0.041) and hospitalization time (5.3 vs. 4.1 days, P=0.043) were significantly increased in the left thoracic approach group compared with the right thoracic approach. Conclusions: Subxiphoid approach is associated with less pain compared with intercostal approach. The right intercostal thoracic approach may offer better clinical effect of short-term postoperative recovery.

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Magnaporthe oryzae (M. oryzae) is a typical cause of rice blast in agricultural production. Isobavachalcone (IBC), an active ingredient of Psoralea corylifolia L. extract, is an effective fungicide against rice blast. To determine the mechanism of IBC against M. oryzae, the effect of IBC on the metabolic pathway of M. oryzae was explored by transcriptome profiling. In M. oryzae, the expression of pyruvate dehydrogenase E1 (PDHE1), part of the tricarboxylic acid (TCA cycle), was significantly decreased in response to treatment with IBC, which was verified by qPCR and testing of enzyme activity. To further elucidate the interactions between IBC and PDHE1, the 3D structure model of the PDHE1 from M. oryzae was established based on homology modeling. The model was utilized to analyze the molecular interactions through molecular docking and molecular dynamics simulation, revealing that IBC has π-π stacking interactions with residue TYR139 and undergoes hydrogen bonding with residue ASP217 of PDHE1. Additionally, the nonpolar residues PHE111, MET174, ILE 187, VAL188, and MET250 form strong hydrophobic interactions with IBC. The above results reveal that PDHE1 is a potential target for antifungal agents, which will be of great significance for guiding the design of new fungicides. This research clarified the mechanism of IBC against M. oryzae at the molecular level, which will underpin further studies of the inhibitory mechanism of flavonoids and the discovery of new targets. It also provides theoretical guidance for the field application of IBC.

Background: Prolonged length of stay after surgery is considered to increase cost and hospital-acquired complications. Therefore, we aimed to identify the risk factors that were associated with an increased length of stay after mediastinal tumor resection in the setting of an enhanced recovery after surgery (ERAS)-TUBELESS protocol.Methods: This prospective cohort study collected data on consecutive patients undergoing video-assisted thoracoscopic surgery (VATS) resection for mediastinal tumor between December 2015 and November 2018 at a single center in China. All patients followed the ERAS-TUBELESS protocol. A length of stay after VATS tumor resection (LOS) greater than 3 days was considered an increased LOS. Univariable and multivariable logistic regression models were used to identify potential factors associated with increased LOS. Factors were divided into patient-related risk factors and procedure-related risk factors.Results: A total of 204 patients were included, of which 85 (41.67%) patients had a LOS of more than 3 days. The median LOS for the entire cohort was 3 days. All the patient-related risk factors had no significantly associated with a prolonged LOS. Procedure-related risk factors that were significantly associated with a prolonged LOS were surgeon, operation time, intraoperative blood loss, drainage tube, analgesic drugs, and complications. Anesthesia with spontaneous ventilation was correlated with early discharge (LOS ≤1 day).Conclusions: In the setting of an ERAS-TUBELESS protocol, the main drivers of LOS were procedurerelated factors. Anesthesia with spontaneous ventilation was associated with early discharge (LOS ≤1 day) and thus promoted thoracic day surgery.