通过对中美两国胸心外科住院医师培训体系的培训前教育背景、培训制度及培训后执业方向进行比较,发现美国胸心外科住院医师培训入学门槛高、培养周期长、教育支出高,但其管理专业化、专科特点突出、评价体系完善,适合培养胸心外科专科医学人才.而我国目前的胸心外科住院医师培训尚需进一步完善,需借鉴美国住院医师培训体系的优点,制定更为合理和专业化的胸心外科住院医师培养方案,为我国培养优秀胸心外科专业人才.

Background: Although standard bicaval techniques has become popular in orthotopic heart transplantation, distortion, bleeding, thrombosis and arrhythmia were still causes for concern. This study was designed to compare the standard bicaval techniques and modified bicaval techniques in our institution. Materials and methods: A total of 70 recipients underwent orthotopic heart transplantation at our center from June 2015 to April 2019 (standard group = 24 cases, modified group = 46 cases). The average follow-up period was 46.4 & PLUSMN; 17.4 months. Atrioventricular cavity diameter was measured by ultrasonography and left atrial morphology was evaluated by CT-angiography and three-dimensional reconstruction. Results: Recipients in both groups were similar with pre-operative characteristics. Total ischemic, cardiopulmonary bypass and cross-clamp times were similar. The modified bicaval techniques group has a significantly fewer blood transfusion, lower post-transplant tricuspid regurgitation grade and the incidence of post-operative atrial arrhythmia than standard bicaval techniques group. CT-angiography and three-dimensional reconstruction illustrated ideal and physiologic left atrial morphological structure. Short-term survival differed significantly and the cumulative proportion of survival was significantly higher in the modified bicaval techniques group than that in the standard bicaval techniques group. Conclusions: This study showed that modified bicaval techniques offers a better early outcome than standard bicaval techniques. The significant reduction of intraoperative blood transfusion and posttransplant tricuspid regurgitation grade in the modified bicaval techniques group may has a major impact on the short-term survival. & COPY; 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Objective:To investigate the effectiveness and feasibility of 3D printing-assisted extracorporeal fenestration techniques in thoracic aortic endoluminal repair.Methods:Retrospectively analyzed the clinical data of patients who underwent endovenous repair of the thoracic aorta with the application of 3D printing technology-assisted extracorporeal windowing in the Department of Cardiovascular Surgery, Wuhan University Hospital from January 2019 to May 2021, and analyzed the surgical results as well as the occurrence of perioperative complications.Results:A total of 10 patients with a mean age of(53.3±15.7) years were included, including 4 cases of complex B aortic coarctation, 5 cases of thoracic aortic aneurysm and 1 case of abdominal aortic aneurysm. All patients in this group underwent endoluminal repair of the thoracic aorta with 3D printing assisted extracorporeal fenestration, including 1 case of PCI performed at the same time. There were no postoperative complications and no perioperative deaths.Conclusion:3D printing technology assisted extracorporeal fenestration and endoluminal aortic repair can accurately position aortic stents for fenestration, optimise endoluminal treatment options and improve patient prognosis.

心肾联合移植是治疗终末期心脏病合并终末期肾病的重要手段，但心肾联合移植数量较其他多器官联合移植(如心肺移植、心肝移植)明显要少。世界首例心肾联合移植于1978年实施[1]；我国首例心肾联合移植于2000年6月开展[2]，且数量更少。2014年中国心脏移植注册中心数据显示，2001年4月至2014年6月共上报8例心肾联合移植，且院内死亡4例[3]。但国外有研究显示，终末期心脏病伴有肾功能不全者心肾联合移植比单纯心脏移植取得了更好的临床效果[4]。由此可见，心肾联合移植临床经验亟待总结。武汉大学人民医院心血管外科2017年1月至2018年6月共完成2例心肾联合移植，取得良好的临床效果，至今仍院外随访，现将临床经验总结如下。

Objective: An inclusive contemporary analysis of spinal cord injury (SCI) rates in patients undergoing aneurysm repair and the factors associated with complications has not been performed. Methods: Following a systematic literature search, studies from 2008 to 2018 on repair of descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA) were pooled in a meta-analysis performed using the generic inverse variance method. The primary outcome was permanent SCI. Secondary outcomes were temporary SCI, operative mortality, long-term mortality, postoperative stroke, and cerebrospinal fluid (CSF) drain-related complications. Results: One-hundred sixty-nine studies (22,634 patients) were included. The pooled rate of permanent SCI was 4.5% (95% confidence interval [CI], 3.8-5.4); 3.5% (95% CI, 1.8-6.7) for DTA and 7.6% (96% CI, 6.2-9.3) for TAAA repair (P for subgroups = .02), 5.7% (95% CI, 4.3-7.5) for open repair and 3.9% (95% CI, 3.1-4.8) for endovascular repair (P for subgroups = .03). Rates for Crawford extents I,II,III, IV, and V aneurysms were 4.0% (95% CI, 3.0-5.0),15.0% (95% CI, 10.0-22.0), 7.o% (95% CI, 6.0-9.0), 2.0% (95% CI, 2.0-4.0), and 7.0% (95% CI, 2.0-23.0) respectively (P for subgroups <.001). The pooled rates for operative mortality, late mortality at a mean follow-up of 5.0 years, stroke, and temporary SCI were 7.4% (95% CI, 6.1-9.4), 1.0% (95% CI, 0.0-1.0), 4.2% (95% CI, 3.6-4.8), and 3.7% (95% CI, 3.0-4.6), respectively. The pooled rates for severe, moderate, and minor CSF-drain related complications were 5.1% (95% CI, 2.23-11.1), 4.1% (95% CI, 0.6-22.0), and 3.6% (95% CI, 1.2-8.0) respectively. Conclusions: Despite improvement, both open and endovascular aneurysm repair remain associated with a substantial risk of permanent SCI. The risk is greater for TAAA repair, especially extent II, III, and V.

The world's first porcine-to-human heart transplantation was performed at the University of Maryland School of Medicine (Baltimore, MD, USA), where a genetically modified pig heart was successfully transplanted into a 57-year-old man in the end stage of heart disease. After highly experimental surgery, the patient was able to move about freely in the absence of cardiopulmonary bypass assistance. The historic operation overcame the largest possible obstacle caused by hyperacute immune rejection and achieved a good short-term result.But the patient's condition began deteriorating, and died on March 9, 2022, two months after the transplant surgery. Preclinical studies of xenotransplantation have been carried out for a long time. However, a poor understanding of xenotransplantation and a lack of effective immunosuppression strategies resulted in failure in the end. For example, an infant who was transplanted with a heart from a baboon in 1983 survived for only 20 days.1Parisi F. Squitieri C. Marcelletti C. Heart transplantation in childhood: heredity of Baby Fae.G. Ital. Cardiol. 1996; 26: 353-355Google Scholar Due to novel genetic manipulation technologies, more appropriate donor organs, especially genetically engineered animal organs, can now be used for transplantation.The genetically modified pig heart was underwent 10 genetic modifications, knocked down 3 immune-rejection-related genes, and inserted 6 human genes and 1 growth gene for inactivation to control the size of the heart, which was provided by Revivicor, a regenerative medicine company based in Blacksburg, Virginia (USA). Different from the previous primate-to-human xenotransplantation, strong immune response among different species is the biggest barrier to xenotransplantation. Genetic engineering seems to provide a pragmatic solution for confusing issues. The removal of xenoantigens by gene manipulation is an important approach to reducing human immune rejection response. For instance, the α-1,3-galactosidase encoded by α-1,3-galactosyltransferase (GGTA1) is an important cell surface xenoantigen. In addition, N-glycolylneuraminic acid encoded by cytidine monophosphate-N-acetylneuraminic acid hydroxylase (CMAH) and β-1,4-N-acetyl-galactosaminyltransferase 2 (B4GalNT2) is also related to cross-species immunity response. After these genes are knocked out, pigs remain healthy and large proportions of cells are less likely to evoke immune responses from human immune cells.2Estrada J.L. Martens G. Li P. et al.Evaluation of human and non-human primate antibody binding to pig cells lacking GGTA1/CMAH/β4GalNT2 genes.Xenotransplantation. 2015; 22: 194-202Google Scholar In another group of genetic-modified pig cells that remain immunoreactive to human cells, the immune responses may be attributed to swine leukocyte antigen (SLA) class I, which is equivalent to human leukocyte antigen (HLA) class I. Deletion of these SLA genes may help to improve the host tolerance to pig organs.3Martens G.R. Reyes L.M. Li P. et al.Humoral reactivity of renal transplant-waitlisted patients to cells from GGTA1/CMAH/B4GalNT2, and SLA class I knockout pigs.Transplantation. 2017; 101: e86-e92Google Scholar Another approach to minimize host rejection is the genetic engineering of complement components and pathways called immune cloaking, which regulates the expression of cell-surface molecules from host species in donor cells. The expression of several human proteins can downregulate the activity of human complement and help the transplants escape from human immune system recognition. These proteins include CD55 (a complement decay-accelerating factor), CD59 (a membrane attack complex-inhibitory protein), CD46 (a complement regulatory protein), and the CD47 signal protein.4Elisseeff J. Badylak S.F. Boeke J.D. Immune and genome engineering as the future of transplantable tissue.N. Engl. J. Med. 2021; 385: 2451-2462Google Scholar,5Tena A.A. Sachs D.H. Mallard C. et al.Prolonged survival of pig skin on baboons after administration of pig cells expressing human CD47.Transplantation. 2017; 101: 316-321Google Scholar With the development of genetic engineering technologies, the elimination of host rejections will be prospective. The event would be a cornerstone in the development of organ transplantation, which provides an encouraging solution for the shortage of donor organs. However, animal organs bring great challenges to the present immunosuppression regimen, and it is still unknown whether the existing immunosuppressants can effectively control the response of the host rejections to xenografts. In the first attempt at pig heart-to-human transplantation, conventional antirejection drugs and a new immunosuppressing drug made by Kiniksa Pharmaceuticals (Lexington, MA, USA) were used. However, its long-term effects remain to be observed. Due to the different lifespans between humans and other animals, it will be interesting to know the longevity of transplanted organs. In addition, animal-derived diseases are another important issue in the setting of xenotransplantation. One reason for scientists to choose pigs as donor animals is that they are less likely than nonhuman primates to transmit pathogens because they are more distantly related to humans. In addition to transplantation techniques, immune rejection, and transmission of heterogeneous pathogens, medical ethics is a problem that needs to be solved in the pig-to-human heart transplant operation (Figure 1). The genetically modified heart,which emergency authorized by the US Food and Drug Administration (FDA), was transplanted into the end-stage heart disease patient who was ineligible for a conventional heart transplantation. The xenotransplantation would be the last chance for life. The type of animal species used is very important. Based on the transmission of pathogens and the objections raised by most societies and animal rights organizations, the transplantation of organs from primates will not be allowed. However, pigs are generally considered to be an ideal potential source of organs for human xenotransplantation. Pig organs are similar to human organs in size and shape. They are easy to obtain, and both inbred lines and outbred lines are used in preclinical research. In addition, pigs can be cloned by somatic cell nuclear transfer, and their genomes can be edited by engineered nucleases such as zinc finger nuclease, transcription activator-like effector nuclease (TALEN), and CRISPR-Cas9 systems. Based on the above reasons, scientists generally believe that pig organs are the best source for human xenotransplantation to eliminate the organ shortage crisis, which will be a great advance. After all, the long-term outcome is still unknown and whether these attempt can achieve great success in xenotransplantation remains to be seen. The authors declare no competing interests.

Background Several randomized trials have compared the patency of coronary artery bypass conduits. All of the published studies, however, have performed pairwise comparisons and a comprehensive evaluation of the patency rates of all conduits has yet to be published. We set out to investigate the angiographic patency rates of all conduits used in coronary bypass surgery by performing a network meta‐analysis of the current available randomized evidence. Methods and Results A systematic literature search was conducted for randomized controlled trials comparing the angiographic patency rate of the conventionally harvested saphenous vein, the no‐touch saphenous vein, the radial artery (RA), the right internal thoracic artery, or the gastroepiploic artery. The primary outcome was graft occlusion. A total of 4160 studies were retrieved of which 14 were included with 3651 grafts analyzed. The weighted mean angiographic follow‐up was 5.1 years. Compared with the conventionally harvested saphenous vein, both the RA (incidence rate ratio [IRR] 0.54; 95% CI, 0.35–0.82) and the no‐touch saphenous vein (IRR 0.55; 95% CI, 0.39–0.78) were associated with lower graft occlusion. The RA ranked as the best conduit (rank score for RA 0.87 versus 0.85 for no‐touch saphenous vein, 0.23 for right internal thoracic artery, 0.29 for gastroepiploic artery, and 0.25 for the conventionally harvested saphenous vein). Conclusions Compared with the conventionally harvested saphenous vein, only the RA and no‐touch saphenous vein grafts are associated with significantly lower graft occlusion rates. The RA ranks as the best conduit. Registration URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42020164492.

Objective:A retrospective analysis of 7 patients who died after heart transplantation in a single center, and to explore the risk factors for death after heart transplantation.Methods:From May 1, 2015 to May 1, 2019, 74 cases of orthotopic heart transplantation were performed in the Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University. By April 2020, with a follow-up time of 724 days, 65 recipients survived and 9 died. Two cases of death due to non-medical causes were excluded, and the recipients were divided into survival group (65 cases) and death group (7 cases). Preoperative, intraoperative, and postoperative parameters and corresponding donor conditions were collected for the survival group. Continuous variables that met the normal distribution were compared using the t-test, and continuous variables that were not normally distributed were analyzed using the Kruskal-Wallis test. Enumeration data were compared using Fisher′s exact test. Survival curves were plotted using the Kaplan-Meier method. Cox proportional hazards models were used to analyze risk factors for death after heart transplantation.Results:Of the 7 dead recipients, 4 died of transplant heart failure, rejection, respiratory failure and other organ failure during hospitalization, including 1 recipient of combined heart-lung transplantation and 3 recipients who died during follow-up: 2 cases with poor compliance with immunosuppressive agents, 1 case with transplant heart failure, rejection and liver failure. There were no significant differences in age at operation, body mass index, left ventricular ejection fraction, primary disease, preoperative cardiopulmonary resuscitation, vasoactive drug maintenance and ECMO transition between the surviving recipients (P>0.05). There were no significant differences in donor age, poor body weight, donor cold ischemia time, cause of brain death, donor/recipient sex and ABO blood group matching, and marginal donor ratio in the death and survival groups (P>0.05), and the proportion of donor/recipient age difference (>17 years) in the death group was higher than that in the survival group (P<0.05). The median cardiopulmonary bypass time was 201 (185, 226) and 170 (152, 197) min, the intraoperative packed red blood cell dosage was 8.0 (5.5, 9.0) and 4.0 (2.0, 6.0) U, and the platelet dosage was 4.0 (2.0, 6.0) and 2.0 (2.0, 2.0) U in the surviving recipients, and the differences were statistically significant (P<0.05). The ICU stay and postoperative ventilator use time of recipients in the death group were longer than those in the survival group, 11.1 (5.9, 17.7) and 3.8 (2.9-5.0) d, 58 (12, 172) and 8 (6, 15) h, respectively; meanwhile, the proportion of recipients who stayed in the ICU (stay >5 d) and used the ventilator for a long time (use > 24 h) in the death group was higher than that in the survival group, and the differences were statistically significant (P<0.05 for all). The 1-, 3-, and 5-year overall survival rates of the 74 recipients were 91.9%, 84.7%, and 74.1%, respectively. The factors with statistically significant differences in preoperative and intraoperative indicators and corresponding donor indicators between the two groups were included in Cox proportional hazards model analysis. The results showed that intraoperative platelet dosage was an independent risk factor for death after heart transplantation. For every U increase in intraoperative platelet use, the risk of postoperative death increased by 1.35 times (HR=2.35, 95% CI 1.28~4.32, P<0.05).Conclusions:The outcome after heart transplantation is influenced by many factors. Excessive differences in intraoperative red blood cell and platelet dosage and donor/recipient age are risk factors for death after heart transplantation.

Background To evaluate the graft outcomes after orthotopic heart transplantation (HTx) with a novel bicaval anastomosis technique between recipients with and without a history of prior cardiac surgery. Methods Of 70 patients who underwent HTx with a novel four-corners traction bicaval anastomosis technique from August 2017 to November 2019, 60 recipients underwent the HTx procedure as their first cardiac surgery (group A), while 10 recipients underwent HTx after prior cardiac surgery (group B). Patients in the two groups were compared in terms of their preoperative baseline variables such as etiological categories, history of blood transfusion and panel reactive antibody (PRA), intraoperative operation time and blood infusion volume, postoperative treatment time, and complications such as acute rejection and 30-day mortality as well as survival rates. Results Preoperative variables were comparable in group A and group B except for the history of blood transfusion (0% vs. 90.0%, P<0.001, respectively); the level of PRA was 7.5%±5.8% and 9.5%±10.9% for group A and B, respectively (P=0.583), but the time of the operation was nearly 1 hour longer for group B than group A (all P<0.05). No cases of left atrial thrombosis and donor heart distortion were observed in either group. Reoperation (1.7% vs. 10.0%, P=0.267), infection (0% vs. 10.0%, P=0.142), other postoperative complications as well as the 30-day mortality (1.7% vs. 10.0%, P=0.267), and postoperative survival rates (91.5% vs. 90.0%, P=0.805) were comparable between the two groups (all P>0.05). Conclusions Four-corner traction bicaval anastomosis combined with a continuous everting suture technique may result in approximately comparable prognoses for heart recipients with a history of cardiac surgery when compared with those without a history of cardiac surgery and this technique may reduce the incidence of left atrial thrombosis and distortion. Further follow-up of the long-term outcomes will be required to validate these results.

BACKGROUND: Several randomized trials have compared the patency of coronary artery bypass conduits. All of the published studies, however, have performed pairwise comparisons and a comprehensive evaluation of the patency rates of all conduits has yet to be published. We set out to investigate the angiographic patency rates of all conduits used in coronary bypass surgery by performing a network meta- analysis of the current available randomized evidence. METHODS AND RESULTS: A systematic literature search was conducted for randomized controlled trials comparing the angiographic patency rate of the conventionally harvested saphenous vein, the no- touch saphenous vein, the radial artery (RA), the right internal thoracic artery, or the gastroepiploic artery. The primary outcome was graft occlusion. A total of 4160 studies were retrieved of which 14 were included with 3651 grafts analyzed. The weighted mean angiographic follow- up was 5.1 years. Compared with the conventionally harvested saphenous vein, both the RA (incidence rate ratio [IRR] 0.54; 95% CI, 0.35– 0.82) and the no- touch saphenous vein (IRR 0.55; 95% CI, 0.39– 0.78) were associated with lower graft occlusion. The RA ranked as the best conduit (rank score for RA 0.87 versus 0.85 for no- touch saphenous vein, 0.23 harvested CONCLUSIONS: Compared with the conventionally harvested saphenous vein, only the RA and no- touch saphenous vein grafts are associated with significantly lower graft occlusion rates. The RA ranks as the best conduit.

Dendritic cells (DCs) are key mediators of transplant rejection. Numerous factors have been identified that regulate transplant immunopathology by modulating the function of DCs. Among these, microRNAs (miRNAs), small non-coding RNA molecules, have received much attention. The miRNA miR-223 is very highly expressed and tightly regulated in hematopoietic cells. It plays an important role in modulating the immune response by regulating neutrophils and macrophages, and its dysregulation contributes to multiple types of immune diseases. However, the role of miR-223 in immune rejection is unclear. Here, we observed expression of miR-223 in patients and mice who had undergone heart transplantation and found that it increased in the serum of both, and also in DCs from the spleens of recipient mice, although it was unchanged in splenic T cells. We also found that miR-223 expression decreased in lipopolysaccharide-stimulated DCs. Increasing the level of miR-223 in DCs promoted polarization of DCs toward a tolerogenic phenotype, which indicates that miR-223 can attenuate activation and maturation of DCs. MiR-223 effectively induced regulatory T cells (Tregs) by inhibiting the function of antigen-presenting DCs. In addition, we identified Irak1 as a miR-223 target gene and an essential regulator of DC maturation. In mouse allogeneic heterotopic heart transplantation models, grafts survived longer and suffered less immune cell infiltration in mice with miR-223-overexpressing immature (im)DCs. In the miR-223-overexpressing imDC recipients, T cells from spleen differentiated into Tregs, and the level of IL-10 in heart grafts was markedly higher than that in the control group. In conclusion, miR-223 regulates the function of DCs via Irak1, differentiation of T cells into Tregs, and secretion of IL-10, thereby suppressing allogeneic heart graft rejection.

Background: Labia minora hypertrophy is often overlooked in paraplegic women, here we present a rare case of bilateral labia minora hypertrophy with recurrent abscesses. A 31-year paraplegic woman presented with labia minora hypertrophy. The main patient complaints were the recurrent inflammation and swelling of the labia minora. Physical examination showed stage III labia minora hypertrophy with multiple cysts. Upon patient's agreement, edge resection of labia minora reduction was performed, and redundant labial tissue and cysts were resected completely. The patient was discharged for home care in good condition on postoperative day 7. Six-month post-operation telephone follow-up showed good recovery with no significant complications. In this case, long-term sitting together with diaper use might increase susceptibility to labia minora hypertrophy and labial abscesses, as a result of continuous mechanical irritation. Conclusions: We present this case to promote early awareness of such condition in paraplegic women and support early surgical treatment for patients suffering from labial abscesses.

Background To evaluate preoperative risk factors and postoperative outcomes in patients with preoperative renal insufficiency undergoing open surgical repair of the aortic root, ascending aorta, or aortic arch. Methods Our institutional database was reviewed for all patients undergoing elective aortic root, ascending aorta, and aortic arch open repairs. Patients were separated into two groups based on renal function. Patients with preoperative renal insufficiency were compared to those with normal renal function. Regression analyses were used to identify independent predictors of short and long term postoperative outcomes. Results The cohort consisted of 2140 patients, of which 55 had preoperative renal insufficiency (PRI). Patients with PRI were older and had worse cardiovascular risk profiles. On presentation, PRI patients were more likely to have lower ejection fraction. There was no difference in operative mortality between the two groups. The most frequent major postoperative complications among renal insufficiency patients were reoperation for bleeding (9.1%, P = .02). Logistic regression analysis indicated that PRI and left ventricular ejection fraction were independent predictors of major adverse events. Long-term survival was significantly reduced in preoperative renal insufficiency patients in the unmatched cohort. Conclusions Aortic patients with preoperative renal insufficiency have a higher risk profile of mortality. Renal insufficiency remains an independent predictor of adverse outcomes following aortic surgery and understanding this patient population can guide physicians to improve outcomes.

BackgroundTo determine the effect of atrial pacing on the rate of post-operative atrial fibrillation (POAF) following coronary artery bypass grafting.MethodsAfter a systematic literature search, randomized clinical trials (RCTs) comparing any combination of no pacing (NP), bi-atrial (BiA) pacing, left-atrial (LA) pacing and right-atrial (RA) pacing were included. Pairwise and network meta-analyses were performed using the generic inverse variance method. The primary outcome was POAF incidence. Secondary outcomes were postoperative bleeding, infection, and operative mortality. Leave-one-out and meta-regression were done.ResultsFourteen RCTs were included with a total of 1727 patients. Compared with NP, any form of atrial pacing was significantly associated with lower incidence of POAF (odds ratio [OR]: 0.49; 95% confidence interval [CI]: 0.35–0.69). BiA pacing was associated with the larger risk reduction (OR: 0.36; 95% CI: 0.20–0.64 vs. 0.59; 95% CI: 0.34–1.02 for LA and 0.64; 95% CI: 0.38–1.07 for RA). Secondary outcomes were similar between the no pacing and pacing groups. On meta-regression, age and the use of continuous monitoring were associated with lower reduction of the incidence of POAF. In the network meta-analysis, BiA pacing ranked the best strategy for the prevention of POAF (OR: 0.34; 95% CI: 0.21–0.55).ConclusionsCompared to other pacing modalities, BiA pacing is associated with lower rates of POAF following CABG.

Background In December 2019, Coronavirus Disease 2019(COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection appeared in Wuhan, Hubei Province, China. The disease is highly infectious. Wuhan, Hubei Province decided restrict personnel movement on January 23.We analyze relevant data to show the situation of the COVID-19 epidemic in China. Methods The data was classified according to Hubei group, non-Hubei group, Hong Kong, Macao and Taiwan group, and Chinese Mainland group, and analyze the current situation and trend of the epidemic. Results There was an explosive growth in the early stage of the epidemic. The epidemic situation began to improve in about two weeks after Wuhan was restricted,and the situation in non-Hubei was significantly better than that in Hubei. Conclusion The blockade of Wuhan was a correct decision, cut off the outflow of tinfection sources, and the epidemic situation in all places turned around after the incubation period.

BACKGROUND: The epidemiologic and clinical characteristics of heart transplant (HTx) recipients during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic remains unclear. We studied the characteristics of HTx recipients from December 20, 2019, to February 25, 2020, in an effort to understand their risk and outcomes. METHODS: All accessible HTx recipients were included in this single-center retrospective study. We collected information on the recipients using a web-based questionnaire as well as the hospital database. RESULTS: We followed 87 HTx recipients (72.4% were men, and the average age was 51 years). A total of 79 recipients resided in Hubei, and 57 recipients had a Wuhan-related history of travel or contact. Most took precautionary measures while in contact with suspicious crowds, and 96.6% of the families and communities undertook prevention and quarantine procedures. Four upper airway infections were reported, and 3 of them tested negative for SARS-CoV-2 (the fourth recovered and was not tested). All cases were mild and successfully recovered after proper treatment. Laboratory results of 47 HTx cases within the last 2 months were extracted. Of these, 21.3% of recipients had pre-existing lymphopenia, and 87.2% of recipients had a therapeutic concentration of tacrolimus (5-12 ng/ml). Liver and kidney insufficiency was seen in 5 and 6 recipients, respectively. CONCLUSION: HTx recipients who practiced appropriate prevention measures had a low rate of infection with SARS-CoV-2 and transition to the associated disease COVID-19. These early data will require confirmation as the pandemic establishes around the world. (C) 2020 International Society for Heart and Lung Transplantation. All rights reserved.

We have previously demonstrated that Mettl3-silencing dendritic cells (DCs) exhibited immature properties and prolonged allograft survival in a murine heart transplantation model. Exosomes derived from donor DCs (Dex) are involved in the immune rejection of organ transplantation, and blocking Dex transfer may suppress immune rejection. Herein, this study aimed to investigate whether Mettl3 knockdown inhibits the secretion and activity of donor Dex, thereby inhibiting donor Dex–mediated immune rejection. The imDex, mDex, shCtrl-mDex, and shMettl3-mDex were obtained from the culture supernatant of DCs (immature DCs, mature DCs, shCtrl-infected mature DCs, shMettl3-infected mature DCs) derived from donor BALB/c mouse bone marrow and then co-cultured with splenic T cell lymphocyte suspension from recipient C57BL/6 mice in vitro or injected into recipient C57BL/6 mice before the cardiac transplantation. Donor shMettl3-mDex expressed lower concentration of exosomes and lower expression of Mettl3, Dex markers (ICAM-1, MHC-I, MHC-II), as well as lower ability to activate T cell immune response than shCtrl-mDex. Administration of donor shMettl3-mDex attenuated immune rejection after mouse heart transplantation and prolonged the allograft survival. In summary, Mettl3 knockdown inhibits the immune rejection of Dex in a mouse cardiac allograft model.

OBJECTIVES:The optimal revascularization strategy for patients with ischaemic left ventricular systolic dysfunction (iLVSD) remains controversial. We aimed to compare percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical therapy (MT) in a network meta-analysis. METHODS:All randomized controlled trials and observational studies comparing any combination of PCI, CABG and MT in patients with iLVSD were analysed in a frequentist network meta-analysis (generic inverse variance method). Primary outcome was mortality at longest available follow-up. Secondary outcomes were cardiac death, stroke, myocardial infarction (MI) and repeat revascularization (RR). RESULTS:Twenty-three studies were included (n = 23 633; 4 randomized controlled trials). Compared to CABG, PCI was associated with higher mortality [incidence rate ratio (IRR) 1.32, 95% confidence interval (CI) 1.13-1.53], cardiac death (IRR 1.65, 95% CI 1.18-2.33), MI (IRR 2.18, 95% CI 1.70-2.80) and RR (IRR 3.75, 95% CI 2.89-4.85). Compared to CABG, MT was associated with higher mortality (IRR 1.52, 95% CI 1.26-1.84), cardiac death (IRR 3.83, 95% CI 2.12-6.91), MI (IRR 3.22, 95% CI 1.52-6.79) and RR (IRR 3.37, 95% CI 1.67-6.79). Compared to MT, PCI was associated with lower cardiac death (IRR 0.43, 95% CI 0.24-0.78). CABG ranked as the best revascularization strategy for mortality, cardiac death, MI and RR; MT ranked as the strategy associated with the lowest incidence of stroke. Left ventricular ejection fraction, year of study, use of drug-eluting stents did not affect relative treatment effects. CONCLUSIONS:CABG appears to be the best therapy for iLVSD, although mainly based on observational data. Definitive randomized controlled trials comparing CABG and PCI in iLVSD are required. PROSPERO REGISTRATION ID:132414.

Objective:To retrospectively analyze the experience of our center in the use of marginal donor heart, and to explore the principle of use and risk control of marginal donor heart.Methods:A total of 31 patients with end-stage heart disease underwent orthotopic heart transplantation in our center from January 2018 to December 2018, including 28 cases of pure heart transplantation, 2 cases of combined heart-lung transplantation, and 1 case of combined heart-kidney transplantation. 26 of the 31 cases were marginal donor hearts. These patients were all anastomosed by a double lumen method.Results:The rates of postoperative use of ECMO, IABP and acute rejection were zero in this study. The time of cardiopulmonary bypass in the marginal donor group was significantly longer compared with the conventional donor group( P<0.05), but there was no significant difference between the two groups in terms of hospitalization time, mechanical ventilation time, ICU stay time, abnormal rate of ECG, LVEF and blood biochemical indexes(all P>0.05). The postoperative follow-up rate was 100% in the two groups. One case of combined heart-lung transplantation in the marginal donor group died of multiple organ failure in the first month after surgery. During the postoperative follow-up period, the incidence of moderate to severe tricuspid regurgitation and the incidence of recurrent heart failure were zero in the two groups. There was no significant difference in the incidence of arrhythmia, LVEF, infection and blood biochemical parameters. Conclusion:The application of marginal donor heart has no significant effect on the short-term survival rate and recovery of patients after heart transplantation, but the long-term effect needs further follow-up.

Introduction: The complexities and risks inherent to the field of surgery and surgical interventions present unique challenges to the design and analysis of surgical randomized controlled trials (RCT). Prior studies have investigated the practical and methodologic challenges posed by surgical RCTs. To date, however, a comprehensive analysis of the contemporary literature across multiple surgical subspecialties does not exist. In this descriptive analysis, we set out to characterize surgical RCTs over the past 10 years across six major surgical specialties. Methods and analysis: A literature search by a medical librarian will be performed to identify all surgical randomized clinical trials published between January 2009 and December 2019 in the two journals with the highest impact factor for six surgical specialties as well as two large general medicine journals. Two reviewers will independently screen the citations retrieved from the literature search and extract data according to a previously described protocol via a pre-defined data collection form. Categorical variables will be reported as counts and percentages. Following assessment of normality, continuous variables will be reported as mean (standard deviation) or median (inter-quartile range). Based on normality of data, independent t-test or the Mann-Whitney U test will be used to compare continuous variables and chi-square and Fisher's exact tests to compare categorical variables. Comparisons across multiple sets will be performed using ANOVA or Kruskak-Wallis tests. Two-sided significance testing will be used and a p-value <0.05 will be considered significant without adjustment for multiple testing. All analyses will be performed using SPSS version 24 and R within RStudio. PROSPERO (ID number: 162797). Ethics and dissemination: There are no ethical concerns directly pertinent to this systematic review. The retrieved data will be made available upon request. The study will be written in English and submitted for publication in a peer-reviewed journal. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of Surgical Associates Ltd.