OBJECTIVE:To compare the efficacy and clinical outcomes of flexible band versus rigid ring annuloplasty for the correction of moderate tricuspid regurgitation (TR) or greater. METHODS:In this single-center randomized trial, adult patients with moderate or greater TR were assigned to receive either a flexible band or a rigid ring. The primary outcome was recurrent TR during follow-up. Secondary outcomes included death, permanent pacemaker implantation, and other adverse events. RESULTS:In total, 400 patients were randomized with a 1:1 ratio, and 321 were included in the final analysis (flexible band, n = 156; rigid ring, n = 165). Baseline characteristics were balanced between arms. At discharge, recurrent TR was significantly greater in the flexible band arm than the rigid ring arm (10.1% vs 3.8%, P = .03). However, the significance was no longer significant during follow-up (6.1%/patient-years vs 4.7%/ patient-years, P = .21). Multivariable analysis identified female sex (subdistribution hazard ratio [sHR], 2.16, 95% CI, 1.1-4.22, P = .025), preoperative severe TR (sHR, 2.09; 95% CI, 1.06-4.11, P = .033) and massive TR (sHR, 4.63; 95% CI, 1.29-16.61, P = .019), and preoperative permanent pacemaker implantation (sHR, 3.69; 95% CI, 1.35-10.09, P = .011) as independent risk factors for recurrent TR. Subgroup analyses based on these factors showed no significant between-arm difference in the primary outcome. secondary outcomes were also comparable between the arms during follow-up. CONCLUSIONS:Both annuloplasty devices provided acceptable TR correction with similar adverse event rates over a median 3-year follow-up.

INTRODUCTION:Trans-thoracoscopic atrial fibrillation (AF) ablation combined with left atrial appendage excision (LAAE) is an alternative treatment approach for nonvalvular AF patients with a history of thromboembolic events. The primary objective of this research was to investigate the electrophysiological characteristics of recurrent atrial tachyarrhythmias and rhythm outcome in patients receiving repeat catheter ablation after surgical AF ablation plus LAAE. METHODS:Nonvalvular AF patients with previous thromboembolic events who underwent trans-thoracoscopic AF ablation plus LAAE and then received radiofrequency catheter ablation were enrolled. During the procedure, the reconnection of the left atrium (LA) and pulmonary veins (PVs) was investigated, and three-dimensional activation mapping of the LA and/or right atrium during atrial tachyarrhythmias was performed. RESULTS:From January 2014 to December 2021, 173 patients without a history of prior ablation underwent concurrent trans-thoracoscopic AF ablation and LAAE. A total of 74 patients experienced recurrent atrial tachyarrhythmias during a median follow-up period of 3.5 years (interquartile range [IQR]: 2.0 to 5.0 years) after the surgical procedure. A total of 22 patients with atrial tachyarrhythmias recurrence (11 males, aged 60 ± 9 years) underwent radiofrequency catheter ablation. Among them, 10 patients with recurrent AF were identified, and in two of them, non-PV triggers originated from the interatrial septum and the superior vena cava. Reconnected LA-PV conduction was detected in 12 patients, with a total of 27 PV gaps. Eighteen of these PV gaps were located at the roof or the bottom. Thirteen sustained atrial tachycardias (ATs) were mapped in 12 patients, including peri-mitral AT (n = 7), cavotricuspid isthmus-dependent AT (n = 3), remnant LAA-related micro-reentrant AT (n = 1), roof-dependent reentry AT (n = 1), and focal AT (n = 1). At a median follow-up of 9 months (IQR: 3-20 months) after the ablation procedure, the freedom rate from atrial tachyarrhythmias was 77%. CONCLUSION:Reconnection of LA-PVs and macro-reentry ATs are common in repeat catheter ablation after surgical treatment for AF, with peri-mitral AT being the most frequently observed AT. PV gaps are most often located at the roof or bottom. Additionally, LAAE may contribute to arrhythmogenesis in certain patients. Catheter ablation targeting these mechanisms resulted in a favorable short- to mid-term rhythm outcome.

This study evaluated the impact of atrial fibrillation (AF) recurrence during the “blanking period” following thoracoscopic ablation on long-term AF recurrence. This prospective observational study enrolled consecutive patients who underwent thoracoscopic AF ablation at our center between 2013 and 2020. Patients were grouped based on AF recurrence during the 3-month blanking period: no recurrence (Group A), early recurrence only (0–7 days, Group B), late recurrence only (8 days-3 months, Group C), or both early and late recurrence (Group D). The primary endpoint was long-term AF recurrence. We finally analyzed 171 patients (mean age 62.5 ± 8.4 years, 34.5

BACKGROUND:To evaluate the clinical outcomes and the validity of the in situ needle fenestration (ISNF) technique during thoracic endovascular aortic repair (TEVAR) for patients with aortic arch conditions. METHODS:A total of 115 patients with aortic arch conditions treated with ISNF during TEVAR between January 2018 and December 2021 were incorporated. RESULTS:The median age of the patients was 62.0 years, and 10.4% (12/115) were female. The median follow-up time was 31.0 months. A total of 175 supra-arch branches were reconstructed. A single branch was fenestrated in 80 patients, while the left subclavian artery (LSA) and left common carotid artery (LCCA) were fenestrated simultaneously in 11 patients, and all supra-arch branches were fenestrated in 24 patients. The rate of technical success was 100%, 30-day mortality was 3.5% (4/115), overall mortality was 8.7% (10/115), and aortic-related mortality was 2.6% (3/115). Aortic-related reintervention was required in 7.8% (9/115) of patients. Among the major postoperative complications, four patients developed retrograde type A dissection requiring emergent open surgery, three patients had cerebrovascular accidents, and one patient had an endoleak. No occlusions or stenoses of the main or branch aortic stents were observed. CONCLUSIONS:The mid-term results of the ISNF technique during TEVAR for aortic arch conditions were within the acceptable range; however, further follow-up results are needed and long-term stability and durability needs to be assessed. Related fenestration devices also require further development.

OBJECTIVES: Left atrial appendage intervention is an alternative to oral anticoagulation for thromboprophylaxis in atrial fibrillation. The aim of our study was to compare the incidence of silent cerebral embolisms after surgical and percutaneous intervention and to identify the risk factors for procedure-related silent cerebral embolisms after intervention.METHODS: This prospective observational study included consecutive atrial fibrillation patients from 2 independent cohorts (left atrial appendage excision (LAAE) cohort and left atrial appendage occlusion cohort) between September 2018 and December 2020. All patients underwent cerebral magnetic resonance imaging before and after the procedure. Silent cerebral embolism was defined as new focal hyperintense lesions detected only on postprocedural sequence.RESULTS: Thirty-two patients from the LAAE cohort and 42 patients from the occlusion cohort were enrolled. A significantly lower incidence of silent cerebral embolism was observed in the LAAE cohort as compared with occlusion (6.3% vs 54.8%, P < 0.001). In the left atrial appendage occlusion cohort, patients who developed silent cerebral embolism after the procedure had significantly higher CHA(2)DS(2)-VASc scores [odds ratio (OR) 2.172; 95% confidence interval (CI) 1.149-4.104; P = 0.017], longer occlusion placement time (OR 1.067; 95% CI 1.018-1.118; P = 0.006) and lower peak activated clotting time level after transseptal puncture (OR 0.976; 95% CI 0.954-0.998; P = 0.035).CONCLUSIONS: The incidence of procedure-related silent cerebral embolism was strikingly lower in patients with LAAE than in patients with occlusion. More cardiovascular comorbidities, longer occlusion placement time and lower activated clotting time level were significantly associated with the development of procedure-related silent cerebral embolism.

Objective: The study objective was to determine whether mini-invasive transthor-acoscopic atrial fibrillation ablation can delay the progression of atrial fibrillation from paroxysmal to persistent. Methods: Patients aged 18 to 80 years with paroxysmal nonvalvular atrial fibrillation and a history of stroke or systemic thromboembolism were consecutively enrolled from September 2014 to June 2019. In the treatment group, patients underwent transthoracoscopic atrial fibrillation ablation plus left atrial appendage excision (atrial fibrillation ablation plus left atrial appendage excision group). Patients unwill-ing to receive surgical intervention were treated with antiarrhythmic drugs and oral anticoagulants and recruited as a control group (atrial fibrillation plus antiar-rhythmic drugs group). The primary end point was the progression of atrial fibril-lation from paroxysmal to persistent. Results: This study included 49 patients in the atrial fibrillation plus antiarrhythmic drugs group (29 men) and 77 patients in the atrial fibrillation ablation plus left atrial appendage excision group (48 men). In the atrial fibrillation ablation plus left atrial appendage excision group, after a median follow-up of 951 days (interquartile range, 529-1366 days), 8 patients (10.4%) progressed to persistent atrial fibrillation. In the atrial fibrillation plus antiarrhythmic drugs group, after a median follow-up of 835 days (interquartile range, 548-1214 days), 14 patients (28.6%) progressed to persistent atrial fibrillation. The atrial fibrillation ablation plus left atrial appendage excision group had a significantly lower incidence of atrial fibrillation progression than the atrial fibrillation plus antiarrhythmic drugs group during follow-up (3.9 vs 12.3 per 100 person-years, log-rank 8.6, P 1/4 .003). Conclusions: Patients with paroxysmal nonvalvular atrial fibrillation who chose to undergo transthoracoscopic atrial fibrillation ablation had a lower incidence of pro-gression to persistent atrial fibrillation than patients who chose conservative ther-apy. This strategy might be especially suitable for patients with paroxysmal nonvalvular atrial fibrillation at high risk of stroke and high risk of bleeding. (J Thorac Cardiovasc Surg 2023;165:1387-94)

Background: A patent false lumen (FL) in patients with thoracic endovascular aortic repair (TEVAR)-treated type B aortic dissection (TBAD) can cause a significant risk for late aortic expansion (LAE). We hypothesize that preoperative features can predict the occurrence of LAE. Methods: Sufficient preoperative and postoperative follow-up clinical and imaging feature data for patients treated with TEVAR in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2020 were collected. A univariate analysis and multivariable logistic regression analysis were used to find potential risk factors of LAE. Results: Ninety-six patients were finally included in this study. The mean age was 54.5 ± 11.7 years and 85 (88.5%) were male. LAE occurred in 15 (15.6%) of 96 patients after TEVAR. Two preoperative factors showed strong associations with LAE according to the multivariable logistic regression analysis: preoperative partial thrombosis of the FL (OR = 10.989 [2.295–48.403]; p = 0.002) and the maximum descending aortic diameter (OR = 1.385 [1.100–1.743] per mm increase; p = 0.006). Conclusions: Preoperative partial thrombosis of the FL and an increase in the maximum aortic diameter are strongly associated with late aortic expansion. Additional interventions of the FL may help to improve the prognosis of patients with the high risk of late aortic expansion.

Background The study aimed to assess the correlation between the monitoring frequency of PT-INR and the long-term prognosis in patients with mechanical heart valve (MHV) replacement after discharge. Methods This single-center, observational study enrolled patients who underwent MHV replacement and discharged from June 2015 to May 2018. Patients or their corresponding family members were followed with a telephone questionnaire survey in July-October 2020. Based on monitoring intervals, patients were divided into frequent monitoring (FM) group (≤ 1 month) and less frequent monitoring (LFM) group (> 1 month). The primary endpoint was the composite of thromboembolic event, major bleeding or all-cause death. The secondary endpoints were thromboembolic event, major bleeding or all-cause death, respectively. Results A total of 188 patients were included in the final analysis. The median follow-up duration was 3.6 years (Interquartile range: 2.6 to 4.4 years). 104 (55.3%) patients and 84 (44.7%) patients were classified into the FM group and the LFM group, respectively. The FM group had a significantly lower incidence of the primary endpoint than the LFM group (3.74 vs. 1.16 per 100 patient-years, adjusted HR: 3.31 [95% CI 1.05–10.42, P = 0.041]). Secondary analysis revealed that the risk of thromboembolic events and all-cause death were also reduced in the FM group. Conclusions The management of warfarin treatment in patients after MHV replacement remains challenging. Patients with less frequent monitoring of PT-INR might have worse clinical prognosis than those with frequent PT-INR monitoring.

Introduction: For those cardiac resynchronization therapy (CRT) candidates who experience left-ventricular (LV) lead placement failure or underwent concomitant cardiac surgeries, surgical placement of epicardial LV lead guided by electroanatomic mapping may be a promising alternative. Methods: Electroanatomic mapping was used to guide positioning of the LV lead through a surgical approach. The LV lead was placed at the region with the latest local LV activation and normal voltage, away from the scar. Results: From April 2010 to September 2018, 10 consecutive patients (3 female) underwent surgical epicardial LV lead implantation. Among them, 3 had other surgical indications simultaneously (including 1 CRT non-responder), and 7 had failed transvenous LV lead placement. After CRT, the QRS duration was shortened from 149.3 ± 20.4 ms to 125.1 ± 15.2 ms (p = 0.01). At 6 months, the LV ejection fraction was significantly improved and remained stable in the follow-up (FU) period thereafter (baseline vs. 6 months, 31.0 ± 8.3% vs. 42.2 ± 13.4%, p = 0.006). Other parameters, including the threshold and impedance of the LV lead, were also stable at a mean FU of 755 ± 406 days, and the NYHA functional classification decreased from 2.9 ± 0.7 to 1.8 ± 0.8 (p = 0.002). Conclusions: Placement of an epicardial LV lead guided by electroanatomic mapping could be used as an adjunctive strategy in patients who were unable or refractory to conventional CRT therapy. This approach could also be applied in patients who had other surgical indications at the same time.

目的:总结孤立性房颤外科微创消融术同期行肺部占位切除术的方法与经验.方法:回顾性分析南京医科大学第一附属医院心脏大血管外科行微创孤立性房颤消融术同期行肺部占位切除术的6例患者的临床资料及手术过程,加以总结分析.其中双侧肺占位者2例,单侧肺占位者4例.结果:6例患者均手术顺利,无围手术期二次开胸、恶性心律失常及死亡.单纯行肺组织楔形切除术者3例,肺叶切除术者1例,肺癌根治术者2例.病理结果分别为:慢性肉芽肿4例,浸润性腺癌2例.出院前动态心电图示窦性心律5例,房扑心律1例.结论:通过合理的手术方案和手术路径,腔镜下同期处理孤立性房颤及肺部占位不但能减少患者的疾病痛苦也能减少社会的医疗经济负担,此手术方法是安全有效的.

BACKGROUND:A combination of endocardial and epicardial approaches has improved the overall success rate of ventricular tachycardia (VT) ablation in patients with cardiomyopathy. However, the origins of some VTs are truly intramural or close to coronary arteries, which makes this combined strategy either prone to failure or too risky.OBJECTIVES:This observational study aimed to explore the feasibility and efficacy of direct epicardial ablation combined with intramural ethanol injection via surgical approach for inaccessible intramural VTs or VTs too close to coronary arteries.METHODS:In four canines ventricular lesions produced by direct epicardial injection of ethanol were assessed. Six consecutive patients with recurrent VT refractory to catheter endocardial and epicardial RF ablation and that remained inducible after surgical epicardial mapping and RF ablation were included. Ethanol was injected by needle at the epicardial RF ablation sites. The primary outcome was freedom of sustained VT determined by device interrogation and periodical 24-h holter recordings subsequently.RESULTS:In an animal study, the lesions were homogenous and increased in size with the volume of ethanol injected. In all six patients, ethanol injection at the target sites in the anterior or lateral left ventricle abolished inducible VT. Over a median follow-up of 22 months (range, 6-65), all patients remained free of sustained VT. One patient died of pulmonary infection one year after the procedure.CONCLUSIONS:A hybrid strategy of surgical ablation combined with intramural ethanol injection is feasible and effective in patients with multiple failed percutaneous ablation attempts.

Atrial fibrillation (AF) patients with a previous stroke are often at a high risk of recurrent stroke and bleeding. Anticoagulation therapy in such patients is a challenging dilemma. Thoracoscopic left atrial appendage excision (LAAE) plus AF ablation is an interventional approach offered to some AF patients. We hypothesized that this approach may be suitable as a secondary stroke prevention strategy for these high-risk patients. Between January 2013 and December 2016, a total of 44 patients (26 male; mean age 65.0 ± 9.1 years) with nonvalvular AF and a previous stroke or systemic thromboembolic event were enrolled. The patients underwent thoracoscopic LAAE plus AF ablation by experienced operators and were followed up for 2 years (at 1, 3, 6, 9, and 12 months postoperatively and every 6 months thereafter). Thromboembolic and major bleeding events were recorded. Cerebral computed tomography or magnetic resonance imaging and 7-day Holter monitoring were performed annually. Mean CHA2DS2-VASc and HAS-BLED scores were 4.2 ± 1.2 and 3.3 ± 0.7, respectively. All patients discontinued oral anticoagulation therapy after the surgical intervention. One patient suffered a periprocedural transient ischemic attack, and another was diagnosed with a new ischemic stroke at 491 days after surgery. The annual rate of total thromboembolism was 2.05%. No deaths or major bleeding events were observed postoperatively. The rate of successful AF ablation with no AF recurrence was 76.3%. Transthoracoscopic LAAE plus AF ablation may be a promising approach for this high-risk population. Thromboembolism event in this secondary prevention cohort was low, even without oral anticoagulation treatment.

为探讨外科微创房颤消融术(Wolf mini-maze)后房颤复发的相关危险因素，收集2011年5月至2018年12月期间，南京医科大学第一附属医院心脏大血管外科收治的211例孤立性房颤患者资料。患者均行外科微创胸腔镜下房颤消融术(左心房后壁盒式消融＋左心耳切除术)，其中完成6个月以上随访患者共180例，按照其术后是否出现房颤复发分为复发组(55例)，未复发组(125例)，记录年龄、性别、病程长短、既往高血压、糖尿病病史、吸烟饮酒史、既往脑梗塞病史、遗留肢体活动障碍史、既往导管消融病史、CHADS2评分、CHADS2-VASc评分、HAS-BLED出血评分、心功能(NYHA分级)、房颤类型、左心房大小(LAD)、左心室射血分数(EF)、手术时间、术后胸腔引流管留置时间，进行术后房颤复发的相关危险因素分析。房颤复发的相关危险因素包括：房颤病程( P＝0.0467)；既往中风病史( P＝0.0414)；遗留肢体活动障碍( P＝0.0378)；持续性房颤( P＝0.0227)。其中，房颤病程( P＝0.017， β＝0.08， OR＝1.084，95% CI：1.014～1.158)；持续性房颤( P＝0.029， β＝0.763， OR＝2.145，95% CI：1.080～4.260)，是术后房颤复发的独立危险因素。房颤病史的延长，出现中风及肢体活动障碍，持续性房颤会增加外科微创房颤消融术后房颤复发的可能性，其中，持续性房颤患者，术后房颤复发的可能性显著增加，随着房颤病程的延长，术后房颤复发的可能性亦会增加。

目的 观察负压封闭引流(VSD)对心脏术后胸部正中切口愈合不良的治疗效果.方法 对心脏术后发生胸部正中切口愈合不良的17例患者使用VSD处理,并观察临床结局.结果 本组患者植入VSD时间为(19.6±10.7)d,术后更换VSD次数为(2.5±1.2)次.6例患者在VSD吸引7～10 d后切口肉芽组织新鲜,创面良好,无明显感染分泌物,予以Ⅱ期缝合切口.除1例主动脉夹层患者自动出院外,其余患者愈合良好,顺利出院.随访4～26个月,无感染再次复发或慢性窦道形成病例.结论 采用VSD治疗心脏术后胸部正中切口愈合不良患者的临床效果良好,安全性较高.

El tacrolimus de liberación prolongada (TLP) permite una dosificación única diaria, lo que simplifica el régimen inmunosupresor. El presente estudio describe la eficacia y la seguridad del uso de TLP de novo y precoz para el trasplante cardiaco.Se realizó un estudio observacional, retrospectivo y multicéntrico para comparar el uso de novo de TLP (grupo de TLP; n = 94), tacrolimus de liberación estándar (grupo de TLE; n = 42) y la conversión precoz (CP) de TLP a TLE (grupo de CP; n = 44). El TLP se usó entre 2007 y 2012. Se analizaron la tasa de incidencia de rechazo agudo, infección e infección por citomegalovirus al primer año tras el trasplante, así como parámetros de seguridad.Entre los grupos no hubo diferencias significativas en la dosis diaria y las concentraciones séricas de tacrolimus durante el primer año tras el trasplante. La incidencia de rechazo fue de 1,05 (IC95%, 0,51-1,54), 1,39 (IC95%, 1,00-1,78) y 1,11 (IC95%, 0,58-1,65) eventos/pacientes-años en los grupos de TLE, TLP y CP respectivamente (p = 0,48). La incidencia de infección fue de 0,75 (IC95%, 0,60-0,86), 0,62 (IC95%, 0,52-0,71) y 0,55 (IC95%, 0,40-0,68) en los grupos de TLE, TLP y CP respectivamente (p = 0,46). Se produjo infección por citomegalovirus en el 23,8, el 20,2 y el 18,2% respectivamente (p = 0,86). No hubo diferencias significativas entre los grupos en los parámetros de seguridad o la función del injerto. Falleció 1 paciente del grupo de TLE y 2 del grupo de TLP.Parece que el uso de novo de TLP o la CP de TLP a TLE tienen similares eficacia y seguridad que el TLE en el trasplante cardiaco.The extended-release formulation of tacrolimus (ERT) allows once-daily dosage, thus simplifying the immunosuppressive regimen. This study aimed to describe the safety and efficacy of the de novo and early use of ERT in heart transplantation.This was an observational, retrospective, multicenter study comparing the safety and efficacy of the de novo use of ERT (ERT group [n = 94]), standard-release tacrolimus (SRT group [n = 42]) and early conversion (EC) from SRT to ERT (EC group [n = 44]). Extended-release tacrolimus was used between 2007 and 2012. One-year incidence rates of acute rejection, infection, and cytomegalovirus infection were analyzed. Safety parameters were also evaluated.There were no significant between-group differences in the daily dose or trough levels of tacrolimus during the first year after transplantation. The rejection incidence rates were 1.05 (95%CI, 0.51-1.54), 1.39 (95%CI, 1.00-1.78), and 1.11 (95%CI, 0.58-1.65) episodes per patient-years in the SRT group, ERT group, and EC group, respectively (P = .48). The infection incidence rates were 0.75 (95%CI, 0.60-0.86), 0.62 (95%CI, 0.52-0.71), and 0.55 (95%CI, 0.40-0.68) in the SRT group, ERT group, and EC group, respectively (P = .46). Cytomegalovirus infection occurred in 23.8%, 20.2%, and 18.2% of the patients, respectively (P = .86). No significant between-group differences were found in laboratory tests or in allograft function. There was 1 death in the SRT group and 2 in the ERT group.Both de novo and early use of ERT seem to have similar safety and efficacy profiles to conventional SRT-based immunosuppression.Full English text available from: www.revespcardiol.org/en

BACKGROUND:Marfan syndrome (MFS) is an inherited connective tissue disorder affecting the ocular, skeletal and cardiovascular systems. Previous studies of MFS have demonstrated the association between genetic defects and clinical manifestations. Our purpose was to investigate the role of novel genetic variants in determining MFS clinical phenotypes.METHODS:We sequenced the whole exome of 19 individuals derived from three Han Chinese families. The sequencing data were analyzed by a standard pipeline. Variants were further filtered against the public database and an in-house database. Then, we performed pedigree analysis under different inheritance patterns according to American College of Medical Genetics guidelines. Results were confirmed by Sanger sequencing.RESULTS:Two novel loss-of-function indels (c.5027_5028insTGTCCTCC, p.D1677Vfs*8; c.5856delG, p.S1953Lfs*27) and one nonsense variant (c.8034C>A, p.Y2678*) of FBN1 were identified in Family 1, Family 2 and Family 3, respectively. All affected members carried pathogenic mutations, whereas other unaffected family members or control individuals did not. These different kinds of loss of function (LOF) variants of FBN1 were located in the cbEGF region and a conserved domain across species and were not reported previously.CONCLUSIONS:Our study extended and strengthened the vital role of FBN1 LOF mutations in the pathogenesis of MFS with an autosomal dominant inheritance pattern. We confirm that genetic testing by next-generation sequencing of blood DNA can be fundamental in helping clinicians conduct mutation-based pre- and postnatal screening, genetic diagnosis and clinical management for MFS.

Kodamaea ohmeri, a yeast used in food industry, is an emerging opportunist causing sepsis, endocarditis, cellulitis, urinary tract infection, peritonitis. Only 40 cases of Kodamaea ohmeri fungemia were reported worldwide till 2017. Many of them were associated with indwelling central venous catheter. Four Taiwan cases were founded in the literature, and one of them had underlying solid malignancy. Here we report a patient with newly diagnosed metastatic gastric cancer presenting with Kodamaea ohmeri fungemia. There was no previous history of central venous catheter insertion. Despite of antifungal treatment, the patient succumbed to rapid progression of gastric cancer after one course of chemotherapy. We conclude that Kodamaea ohmeri fungemia found in patients with advanced cancer may suggest poor clinical outcome in spite of treatment.

The surgical treatment for aortic diseases remains a challenge for any cardiac surgeon. The use of sutureless ring connector in aortic anastomosis can simplify the procedure and shorten anastomosis time. Therefore, we developed a novel device for sutureless aortic anastomosis. A series of experiments were carried out for tensile and leakproof-capacity assessments to verify the feasibility of the ring connector by using fresh swine aorta samples. In in vivo test, the ring connector was implanted in 6 swine with follow-up of 6 months. Radiographic and pathological studies of the aorta were performed. In the tensile tests, the strength was 32.7±5.9 Newton (N) in the sutureless anastomosis group, compared with 73.3±12.5 N in the control group by traditional manual suture. In the leakproof-capacity assessment, no sign of either leakage or bursting was evident at 280 mmHg of internal pressure in the aorta samples. In in vivo tests, it took 9.47±0.3 minutes for the sutureless anastomosis, compared with 15.58±1.39 minutes for hand-sewn suturing. Insertion was easy and rapid. Radiographic and pathological studies were performed at first month, third month and sixth month after surgery, each time obtained from the two swine, showed patency of the anastomosis and no signs of stenosis, blood leakage, migration or pseudoaneurysm formation, except one paralyzed swine developed of thrombo-occlusion at the site of the sutureless anastomosis. The result indicates that this novel ring connector offers considerable promise for sutureless aortic anastomosis.

With the wide application of RNA-Seq technology, thousands of circular RNAs (circRNAs) have been identified in different type of tissues and cells in many organisms, but little is known on the human aortic valve expressed circRNAs. In this study, we identified all circRNAs in two calcified human aortic valves, and characterized the features of all circRNAs. A total of 5476 circRNAs were identified in human aortic valves, including 1412 (25.79%) aortic valve specific circRNAs. Next, we showed that most aortic valve specific circRNAs were derived from the exonic regions of their host genes, and majority of the host genes contained less than three circRNAs. To predict the potential function of aortic valve specific circRNAs, we performed the GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) enrichment analysis for the host genes, and identified both microRNA (miRNA) and RNA binding protein (RBP) binding sites inside aortic valve specific circRNAs. Results showed that these host genes were involved in some aortic valve related function pathways, such as ECM-receptor interaction pathway, ErbB signaling pathway, and vascular smooth muscle contraction pathway. We also found that most aortic valve specific circRNAs harbored abundant miRNA response elements (MREs), and some aortic valve specific circRNAs could bind to RBP of interest. Functional analysis suggested that these aortic valve specific circRNAs could act as post-transcriptional regulators.

目的：评估一期颈部食管‐胃吻合术治疗食管破裂伴严重胸腔感染的效果。方法自2011年3月—2015年1月5例患者诊断为食管破裂伴严重胸腔感染，食管破裂原因分别为自发性食管破裂2例、食管癌1例和胸外伤2例。食管破裂到消化道重建的时间为3d～6周。对所有患者行食管切除，食管‐胃颈部吻合，2例采用左胸、左颈两切口，胃置于左胸，3例经右胸、腹正中、左颈部三切口，胃置于胸骨后。结果所有患者治愈，住院时间30～56 d ，1例发生颈部吻合口瘘经局部引流治愈。结论一期颈部食管‐胃颈部吻合术治疗食管破裂伴严重胸腔感染患者安全、有效。