Background Few reports have documented left apical ventricular aneurysm attributable solely to aortic valve stenosis, rapidly exacerbated by prosthesis-patient mismatch (PPM), and necessitating unconventional redo surgical strategies. Case Summary A 42-year-old woman with a 17-year cardiac disease history was admitted to our institution. In 2018, she received a 17-mm mechanical aortic valve. In 2024, the unconventional redo procedures comprised left-ventricular aneurysmoplasty, direct-visualization endocardial radiofrequency ablation, Y-incision aortic root enlargement, and aortic and mitral valve replacement. Discussion During the initial operation, implantation of a 17-mm prosthesis created moderate PPM, deteriorating over time. Achieving a balance between avoiding PPM and the risk of iatrogenic mitral compromise is often challenging but clinically essential. Take-Home Messages Isolated aortic valve stenosis gives rise to an apical ventricular aneurysm, and PPM accelerates its expansion. The complex redo surgery demands meticulous preoperative planning and tactical intraoperative decision-making.

Background Coronary artery aneurysm (CAA) is a rare condition, often asymptomatic and incidentally detected, with large aneurysms (≥20 mm) typically requiring early elective surgery, limiting data on its long-term natural progression. Method This study presents a unique case of a patient with a giant right CAA, left CAA, and multiple fistulas who was monitored for 7 years before experiencing rupture, necessitating emergency surgery, and provides a video and report on the surgical intervention. Result The emergency surgery was successful, and the patient recovered well, with a 7-day hospital duration and an excellent condition at an appropriate 3-month follow-up. The aneurysms and fistulas were lately not observed by coronary computed tomography angiography. Conclusion CAA may become complex and threaten life when ruptured. Surgery for ruptured CAA is not routine and requires appropriate management of unexpected situations during surgery.

We determined whether there exists a complementary pathway of cordycepin biosynthesis in wild-type Cordyceps militaris , high-cordycepin-producing strain C. militaris GYS60, and low-cordycepin-producing strain C. militaris GYS80. Differentially expressed genes were identified from the transcriptomes of the three strains. Compared with C. militaris , in GYS60 and GYS80, we identified 145 and 470 upregulated and 96 and 594 downregulated genes. Compared with GYS80, in GYS60, we identified 306 upregulated and 207 downregulated genes. Gene Ontology analysis revealed that upregulated genes were mostly involved in detoxification, antioxidant, and molecular transducer in GYS60. By Clusters of Orthologous Groups of Proteins and Kyoto Encyclopedia of Genes and Genomes analyses, eight genes were significantly upregulated: five genes related to purine metabolism, one to ATP production, one to secondary metabolite transport, and one to RNA degradation. In GYS60, cordycepin was significantly increased by upregulation of ATP production, which promoted 3′,5′-cyclic AMP production. Cyclic AMP accelerated 3′-AMP accumulation, and cordycepin continued to be synthesized and exported. We verified the novel complementary pathway by adding the precursor adenosine and analyzing the expression of four key genes involved in the main pathway of cordycepin biosynthesis. Adenosine addition increased cordycepin production by 51.2% and 10.1%, respectively, in C. militaris and GYS60. Four genes in the main pathway in GYS60 were not upregulated.

The purpose of this work was to analyze and evaluate the functional properties of a new nanoemulsion that contained cordycepin. Droplet size and distribution were measured, and the stability of the nanoemulsion in different storage conditions was evaluated. We also tested skin irritation caused by the nanoemulsion, cordycepin stability in the nanoemulsion, anti-aging effect, and microbial challenge. The nanoemulsion was homogeneous with proper dispersion stability, and cordycepin was stable for eight months within the cosmetic nanoemulsion. The nanoemulsion did not irritate human hand and face skin, and the cosmetic nanoemulsion was effective in preventing microbial contamination of the product during use and storage. The new nanoemulsion containing cordycepin satisfied provisions of the 2015 Safety and Technical Standards for Cosmetics of the Ministry of Health, People's Republic of China.

OBJECTIVE:To compare the mid- and long-term outcomes of patients receiving mitral valve replacement through robotically assisted and conventional median sternotomy approach.METHODS:The data of 47 patients who underwent da Vinci robotic mitral valve replacement in our hospital between January, 2007 and December, 2015 were collected retrospectively (robotic group). From a total of 286 patients undergoing mitral valve replacement through the median thoracotomy approach between March, 2002 and June, 2014, 47 patients were selected as the median sternotomy group for matching with the robotic group at a 1:1 ratio. The perioperative data and follow-up data of the patients were collected, and the quality of life (QOL) of the patients at 30 days and 6 months was evaluated using the Quality of Life Short Form Survey (SF-12). The time of returning to work postoperatively and the patients' satisfaction with the surgical incision were compared between the two groups.RESULTS:All the patients in both groups completed mitral valve replacement successfully, and no death occurred during the operation. In the robotic group, only one patient experienced postoperative complication (pleural effusion); in median sternotomy group, one patient received a secondary thoracotomy for management of bleeding resulting from excessive postoperative drainage, and one patient died of septic shock after the operation. The volume of postoperative drainage, postoperative monitoring time, ventilation time, and postoperative hospital stay were significantly smaller or shorter in the robotic group than in the thoracotomy group (P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups. Assessment of the patients at 30 days after the operation showed a better quality of life in the robotic group, but the difference between the two groups tended to diminish at 6 months. The patients in the robotic group reported significantly better satisfaction with the incision than those in the thoracotomy group (P < 0.001). At 6 months after the operation, the patients in the robotic group showed significantly faster recovery of work and daily activities than those in the thoracotomy group.CONCLUSIONS:Robotically assisted mitral valve replacement is safe and reliable. Compared with the median sternotomy approach, the robotic approach is less invasive and promotes faster postoperative recovery of the patients, who have better satisfaction with the quality of life and wound recovery.

BACKGROUNDThe incidence, risk factors, and long-term prognosis of new-onset ventricular tachycardia (VT) and ventricular fibrillation (VF) after coronary artery bypass graft surgery (CABG) in patients with impaired left ventricular function have not been thoroughly examined. Methods: This study enrolled 612 consecutive patients with impaired left ventricular function (ejection fraction <50%) undergoing CABG at a single institution between March, 1996, and September, 2015. Outcomes were analyzed and compared, including in-hospital mortality and long-term survival. After a propensity-score, matching was performed to adjust for differences between the two cohorts. Factors significantly associated with VT/VF were also investigated using multivariate logistic regression.RESULTSOf the 600 patients included in the analyses, 92 (15.3%; 95% confidence interval [CI] 12.5-18.3%) had new-onset VT/VF postoperatively. Before propensity matching, patients with postoperative VT/VF were more likely to have renal failure, intra-aortic balloon pump support, lower preoperative ejection fraction (EF), and a larger left ventricle than those without VT/VF. Multivariate regression identified three preoperative risk factors and one protective factor that were independently associated with new-onset VT/VF: previous renal failure (odds ratio [OR] 4.42, P = .02), left ventricular end-diastolic dimension enlargement (OR 1.83, P = .03), ejection fraction (OR 1.88, P = .02 for EF ≥30 and <40% versus ≥40% and <50%; OR 5.46, P = .00 for EF <30% versus ≥40% and <50%), and preoperative β-blockers (OR 0.58, P = .03). The median follow-up time was 46.6 months. In the propensity-matched cohorts, survival for patients who had in-hospital VT/VF was lower than that of the non-VT/VF group (89.9% versus 97.6%; P < .05).CONCLUSIONThis study shows a high incidence of new-onset VT/VF after CABG in patients with impaired left ventricular function. The early and long-term survival rates were significantly lower in the VT/VF group. Preoperative renal failure, left ventricular end-systolic dimension enlargement, and the severity of left ventricular function were independently associated with the development of new-onset VT/VF after CABG surgery. Preoperative use of beta-blocker was proved to be protective in reducing both VT/VF incidence and in-hospital mortality in CABG patients with impaired left ventricular function following CABG. When considering these data, a prescription of beta-blockers is prognostically indicated to CABG patients, especially those with new-onset VT/VF postoperatively.

The present study aimed to identify biomarkers for the clinical diagnosis of acute myocardial infarction (AMI) in a Chinese population using microarray data collected from the Gene Expression Omnibus database under accession number GSE97320. This included the peripheral blood samples of three patients with AMI and three controls. Differentially expressed genes (DEGs) were identified using the limma package and protein‑protein interaction networks were constructed using data from the Search Tool for the Retrieval of Interacting Genes database, followed by module analysis to screen for hub genes. Functional enrichment analyses were performed using the Database for Annotation, Visualization and Integrated Discovery. The identified genes were verified by overlapping with the target genes of microRNAs (miRs) known to be associated with AMI, as well as the DEGs identified in other AMI datasets, including GSE24519, GSE34198 and GSE48060. As a result, 752 DEGs (449 upregulated and 303 downregulated) were identified in the GSE97320 dataset. The upregulated DEGs were predicted to participate in inflammatory pathways, including the toll‑like receptor (TLR) signaling pathway, including ras‑related C3 botulinum toxin substrate 1 (RAC1), TLR4, C‑C motif chemokine receptor (CCR)1; cytokine‑cytokine receptor interaction, including signal transducer and activator of transcription (STAT)3; chemokine signaling pathway, including CCR10; pathways associated with cancer, including colony stimulating factor 3 receptor (CSF3R); and leukocyte transendothelial migration, including matrix metallopeptidase 9 (MMP9). The downregulated DEGs were associated with the cell cycle, including alstrom syndrome protein 1 (ALMS1). These conclusions were made following functional analysis of the genes in the three identified modules. MMP9, TLR4, STAT3, CCR1 and ALMS1 were regulated by miR‑21‑5p, whereas RAC1 was regulated by miR‑30c‑5p. A comparison among the four datasets confirmed the roles of CSF3R and CCR10. HtrA serine peptidase 1 (HTRA1) was the only gene associated with both mortality and recurrence. In conclusion, inflammation‑associated genes, including STAT3, CCR1, RAC1, MMP9, CCR10, CSF3R and HTRA1, as well as cell cycle‑associated genes such as ALMS1, may be biomarkers for the diagnosis and prognosis of AMI in Chinese people.

Background: Coronary artery bypass grafting (CABG) is a common procedure to circumvent the obstruction of coronary arteries when stents are unsuitable. CABG is a very traumatic surgery that requires redirecting blood flow to an external pump. Thus, this procedure has many risks during and after surgery, and minimizing these risks would greatly benefit the patients.Material/Methods: We selected 126 patients with coronary artery syndrome and who were unsuitable for stent percutaneous coronary intervention. The observation group received minimally invasive direct coronary artery bypass (MIDCAB), while the control group was treated with off-pump CABG.Results: Blood markers and echocardiography before and after treatment improved equally in both groups. Neither group exhibited obvious adverse reactions, or liver and kidney function damage. However, surgical bleeding and postoperative observation days were significantly reduced in the MIDCAB group. Death and cardiac shock at the end of follow-up were significantly lower in the MIDCAB group.Conclusions: Overall, the clinical benefits of MIDCAB and OP-CABG were similar, but MIDCAB significantly reduced postoperative hospital stay and intraoperative blood transfusion, and improved clinical prognosis.

Objective The aim of the study was to explore the long-term benefits of coronary artery bypass grafting (CABG). Methods From January 2007 to November 2014, 240 patients (187 males and 53 females, average age 59 years) received robotic off-pump CABG assisted with da Vinci Surgical System (Intuitive Surgical, USA) in our center. Totally endoscopic coronary artery bypass (totally robot-assisted TECAB, n=100) or mini-thoracotomy direct coronary artery bypass (free of internal mammary artery, IMA, by robot, MIDCAB, n=140) grafting was performed. Patients were followed-up regularly, and their graft patency was assessed every 6 months by coronary angiography or 64-multi-slide CT angiography. Results All the procedures were completed successfully without conversion to median sternotomy or cardiopulmonary bypass , there was no operative mortality. 237 unilateral IMA grafts (98.7%) and 3 bilateral IMA grafts (1.3%) were used. Hybrid revascularization of non-left anterior descending vessels was performed in 24 patients (10%). In the follow-up of 41.1±12.9 months, no death, stroke or myocardial infarction occurred. All grafts were patent before discharge. The IMA graft patency was 97.1% in TECAB and 96.4 % in MIDCAB over 3 years (up to 91 months) after surgery. Conclusions Robotic off-pump CABG using IMA grafts is a safe and effective surgery method in selected patients. The long-term outcome and patency of IMA grafts are excellent. DOI: 10.11855/j.issn.0577-7402.2016.06.15

人体长期过量摄入残留农药、重金属和生物毒素可能对身体健康造成损害.因此,中药材和其制剂质量标准中有害残留物的最大限量制定是构成标准的重要组成部分.本文通过查阅大量国外研究报道的有关农药残留、重金属和黄曲霉毒素的毒理学相关实验数据和国内外药品标准,分析有关标准中有害残留物理论最大限量计算方法,模拟计算其最大限量理论值,并将其与中外药品标准中已有最大限量标准进行比较,分析影响限量确定的因素,阐明了标准中有害残留物最大限量制定方法和原则.

BACKGROUND:Atrioventricular septal defect (AVSD) accounts for up to 3 % of congenital cardiac defects, which is routinely repaired via median sternotomy. Minimally invasive approach such as endoscopic or robotic assisted repair for AVSD has not been reported in the literature. With the experience with robotic mitral valve surgery and congenital defect repair, we initiated robotic AVSD repair in adults.CASE PRESENTATION:In this report, we presented three cases of successful repair of partial and intermediate AVSD by using da Vinci SI surgical system (Intuitive Surgical, Inc., Sunnyvale, CA).CONCLUSIONS:Totally robotic AVSD repair via right atriotomy could be safely performed in adults and it may provide superior cosmesis with the comparable surgical outcome of the repair via sternotomy.

Background. Coronary artery bypass grafting (CABG) is the gold-standard treatment for coronary artery disease, but the long-term benefits of robotic CABG remain unclear.Methods. Between January 2007 and November 2014, 240 consecutive patients (187 male and 53 female, average age 59 years) underwent robotic off-pump CABG with the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) in our center. Totally endoscopic coronary artery bypass (TECAB) (n=100) or mini-thoracotomy coronary artery bypass (MINICAB) (n=140) grafting was performed with skeletonized internal mammary arteries (IMA). Patients were followed up and graft patency was assessed every 6 months by coronary angiography or 64-multi-slide computed tomographic angiography.Results. All cases were completed without conversion to median sternotomy or cardiopulmonary bypass. A total of 237 single IMA grafts (98.3%) and 4 bilateral IMA grafts (1.7%) were used. No operative mortality was observed. Hybrid revascularization of non-left anterior descending vessels was performed in 24 patients (10%). No death, stroke, or myocardial infarction occurred in the follow-up of 41.1 +/- 12.9 months. All grafts were patent before discharge. The IMA graft patency was 97.1% in TECAB and 96.4 % in MINICAB over 3 years (up to 91 months) postoperatively.Conclusions. Robotic off-pump CABG using IMA grafts is a safe and effective procedure in selected patients. The long-term outcome and patency of IMA grafts are excellent. (C) 2015 by The Society of Thoracic Surgeons

BACKGROUND:Robotically assisted cardiac surgery is an alternative to conventional, open-chest surgery. Although studies have been done on the clinical effect, morbidity, and mortality of robotically assisted atrial myxoma excision, few have addressed surgical outcomes, such as pain, quality of life (QOL), and length of sick leave from work. In this study, our aim was to evaluate these clinical variables among patients after they undergo robotically assisted atrial myxoma excision surgery.METHODS:Between January 2007 and January 2013, a total of 93 patients underwent either conventional sternotomy or robotically assisted atrial myxoma excision in our unit. The 36-item Medical Outcomes Study Short Form Survey was used to assess the clinical outcomes in these patients postoperatively, at day 30 and 6 months.RESULTS:The QOL scores for 7 of 8 variables in the robotically assisted group were significantly higher than those in the conventional group at postoperative day 30 (P < .05). The degree of pain and its influence on work or life was lower in the robotically assisted group (P < .05), and these patients returned to work after 0.9 ± 0.1 months, whereas those in the conventional group needed a sick leave of 3.3 ± 0.4 months.CONCLUSIONS:The level of restoration of normal QOL within 30 days after atrial myxoma surgery is excellent with the robotically assisted approach, which may enable early return to employment and satisfactory recovery.

OBJECTIVES:Robotic technology has been applied to atrial septal defect (ASD) repair for more than 10 years, but the number of cases reported is limited and results of long-term follow-up are not clear. This study reports on a large group of patients who underwent totally robotic ASD repair on an arrested or beating heart at a single institution with a 7-year follow-up.METHODS:From 2007 to 2013, 160 patients (median age, 36 years; range, 11-66 years) at our centre underwent selective repair of secundum-type ASD using the da Vinci robotic system. The first 54 cases were performed on an arrested heart (arrested-heart group, n = 54) and the remainder on a beating heart (beating-heart group, n = 106). The mean diameter of defects was 2.9 cm (range, 1.1-4.1 cm). Cardiopulmonary bypass was achieved via cannulation of the femoral vessels and the right internal jugular vein. Blood cardioplegic arrest was induced using a transthoracic Chitwood clamp in the arrested-heart group. With the assistance of a robotic surgical system, atrial septal defect repairs were performed with or without tricuspid valvuloplasty via three 8-mm ports, a camera port and a working port in the right chest. Transoesophageal echocardiography was used to evaluate surgical results and follow-up.RESULTS:Complete ASD closure was verified by intraoperative transoesophageal echocardiography in all patients. None of the procedures was converted to an alternate technique and there were no major complications. There were significant learning curves for cross-clamp time, operative duration and cardiopulmonary bypass time. The beating-heart group had significantly shorter operative and cardiopulmonary bypass durations than the arrested-heart group (P = 0.000). The two groups had similar durations of mechanical ventilation and intensive care unit and hospital stays, and similar drainage volumes. During the 39 ± 21 months of follow-up, no patient required reoperation because of a residual shunt or tricuspid valve regurgitation.CONCLUSIONS:ASD can be performed safely and effectively on an arrested or beating heart with the assistance of robotic technology. This totally endoscopic approach represents an option for patients seeking a reliable, minimally invasive ASD repair with an excellent long-term result.

Objective To design a quality detect method for brain functional magnetic resonance equipment and establish the personalized reference performance baseline to monitor the real-time performance of the equipment. Methods According to the ACR detect standard drawn up by American College of Radiology, designing the quality detect method by using the standard ACR MRI phantom and frequently-used functional imaging series to test the equipment periodically, and than collecting and processing the data to draw the performance baseline for each piece of the equipment. Results The performance baseline can monitor the real-time performance of the imaging system accurately and sometimes can predict some problems of the equipment. Conclusion The detect method is simple and can be finished in a short time, and the performance reference baseline can monitor the real-time performance of the equipment scientifically and accurately.

In order to explore the characteristics of dry matter accumulation of different organs at different stages of potato,The field experiment was studied by field trial,test analysis to determine the dry matter accumulation,in different organs and different growth stages under the condition of the conventional fertilizer application in Huijiayao potato planting bases in Hong sibu,where two different kinds of potatoes were used,the potato was studied the characteristics of the dry matter accumulation,provide theoretical basis for precision fertilization potato.And the results showed that: The dry matter accumulation content of potato showed a increased trend which was a S-shape from the seedling stage to the harvest stage,and the lowest in the seedling time,the highest in the harvest stage,increased the fastest in flowering stage and the starch stage.The accumulation of dry matter accumulation rate prior to blade speed,tuber formation after tuber accumulation is the largest.To harvest potato tuber percentage,the largest percentage of root is minimal.