Objective To summarize the surgical experience gained from robotic mitral valve replacement (MVR), and demonstrate the long-term clinical follow-up results. Methods From Jan. 2007 to Jan. 2015, more than 700 patients underwent various types of robotic cardiac surgery in the Department the authors served in, and of them 43 patients underwent robotic MVR with da Vinci Surgical System (Intuitive Surgical, USA). Among the 43 patients, the average age was 47±11 years (ranged 19-65 years), and sex ratio (female to male) was 0.8:1. Six patients were with heart function of NYHA class Ⅰ, 30 patients were of NYHA class Ⅱ and 7 patients were of NYHA class Ⅲ. The left ventricular ejection fraction (LVEF) were 54%-78% (64.0%±7.1%), and 20 patients had atrial fibrillation on admission, and 35 patients were with rheumatic mitral stenosis (MS). Atrial septal defect (0.7cm in size) co-existed in 1 case and 1 patient had mild aortic regurgitation. Mechanical or bioprosthetic mitral valve was replaced via left atriotomy by using da Vinci robotic surgical system after cardiopulmonary bypass (CPB) set-up. Radiopaque titan clips was employed by Cor-Knot knot-tying device (LSI Solutions, Inc, Victor, NY) to anchor the prosthetic valve. Trans-esophageal echocardiography (TEE) was performed before and after surgery. The operative data were collected and patients were followed up at outpatient clinic regularly up to 6 years. Results All cases were performed successfully with the same surgery. No conversion to median sternotomy or operative mortality occurred. The average operation time was 292±62 minutes (ranged 140-450 minutes) with CPB time of 124±26 minutes and aortic occlusion time of 88±21 minutes. The postoperative mechanical ventilation support time was continued for 15±6 hours, and the average staying length in critical care unit was 4±1 days. No myocardial infarction, ventricular tachycardia or excessive bleeding was complicated. All patients were successfully followed up for a median of 3.5 years (ranged 1 month to 6 years). In the follow-up period, no incidence of death, stroke, re-operation due to prosthetic endocarditis or prosthetic failure was reported. However, 39.5% (n=17) patients still had atrial fibrillation after surgery. Conclusion Robotic MVR is a safe and effective procedure with excellent long term surgical outcome.

Objective To assess the effects of septal anterior ventricular exclusion(SAVE)procedure on left ventricular(LV)shape,volume and function in patients with post-infarction LV anterior aneurysm by intraoperative transesophageal echocardiography(TEE).Methods Twenty patients with LV anterior aneurysm underwent surgical ventrieular restoration(SVR)with the SAVE procedure.Intraoperative TEE was performed before cardiopulmonary bypass(CPB)and after weaning from CPB.LV volume and ejection fraction(EF)was measured using the biplane Simpson's method.LV end-diastolic and end-systolic volumes,indexed by body surface area(EDVI and ESVI,respectively)were calculated.To estimate the shape of LV,end-diastolic sphericity index(SI)of LV was determined.Results Compared with pre- CPB,after SVR,LV shape became more elliptical:SI increased from 0.76±0.04 to 0.84±0.05,P＜0.001.LV size became more normal:EDVI decreased from(121.51±16.91)ml/m2 to(60.27±9.93)ml/m2,P＜0.001,and ESVI decreased from(85.81±15.02)ml/m2 to (32.44±5.36)ml/m2,P＜0.001,respectively.EF was increased significantly:(46.02±3.90)% vs(29.52±6.0)%,P＜0.001.Conclusions The SAVE technique is easy to reshape LV to ellipsoid fogln and normal size and the resultant improved configuration may contribute to improving EF for patients with post-infarction LV anterior aneurysm.

Objective To explore the effects of polymorphisms of Crohn's disease related NOD2 gene and human beta-defensin 2 (hBD-2) on transcription of hBD-2 gene and its mechanism. Methods HEK293T cells were transfected with hBD-2 gene and NOD2 eukaryotic expression plasmid, and were then stimulated with LPS, TNF-α, or BAY 11-7082 (antagonist of NF-κB), respectively. Transcriptional activity of hBD-2 was detected afterwards. Results LPS could suppress transcription of hBD-2 (P=0. 020), which was increased by TNF-α in a dose-dependent manner (P =0. 004). In the presence of LPS, there was sig-nificant difference in transcriptional activity of hBD-2 between wild-NOD2 transfected group and mutated NOD2 (P268S) transfected group (P=0. 008), but there was no significant difference between wild hBD-2 transfected group and mutated hBD-2 transfected group (P=0. 053). With the stimulation of TNF-α (5 ng/ml), there was a significant difference between mutated hBD-2 transfected group and wild hBD-2 transfected group (P=0. 006), but no significant difference between wild-NOD2 transfected and mutated NOD2 transfected group was defected (P = 0. 064). Pretreatment with BAY 11-7082 before TNF-α (5 ng/ml) significantly inhibited the transcriptional activity of hBD-2 (P < 0. 001). Conclusion The poly-morphism of NOD2 affects the innate expression of hBD-2, the polymorphism of site in hBD-2 promoter (-233) may lead to significant decline of the inducible expression of hBD-2, and NF-κB might be a key pathway that NOD2 protein mediates the expression of defensin.

Objective To investigate the association of two single nuclear peptides(SNPs)polymorphisms(rs11209026 and rs11805303)which lies in interleukin-23 receptor(IL23R)gene with susceptibility to inflammatory bowel disease(IBD).Methods The target SNPs were directly sequenced by polymerase chain reaction(PCR)and gene polymorphisms of 50 healthy and 81 patients with IBD (Crohn's disease in 41 patients and ulcerative colitis in 40 patients)were analyzed using chromassoftware.Results The geno-type frequency and allelic frequency of rs11209026 were 7.3%and 3.7%in patients with Crohn's disease respectively,15.0%and 7.5%in patients with ulcerative colitis respectively as well as 14.0%and 7.0%in normal population respectively(all P value＞0.05).The geno-type frequency and allelic frequency of rs11805303 were 22.0%and 52.4%in patients with Crohn's disease respectively,15.0% and 41.2% in patients with ulcerative colitis respectively as well as 34.0%and 59.0%in normal population respectively(all P value＞0.05).But in allelic frequency there was significant difference between ulcerative colitis patients and normal population(P=0.018).The polymorphisms of rs11805303 loci did not correlate with age,gender,disease duration.activity and site in patients with ulcerative colitis.Conclusions IL23R gene polymorphism is not associated with the susceptibility to Crohn's disease.rs11805303 allele may be related with susceptibility to ulcerative colitis.But no correlation was found between the SNP polymorphisms and the clinical characteristic of ulcerative colitis.

Objective:To survey the experiences and perception of caregivers on home care service for community-dwelling elderly.Methods:From August to December 2021, individual semi-structured in-depth interviews were conducted with caregivers of the elderly from five community health centers in Beijing Xicheng and Miyun districts selected by purposive sampling.Results:Nine caregivers,2 males and 7 females aged 49-76 (62.8±9.4) years were interviewed in this study. The nursing care period was 3-48 (17±13) years. Four themes were extracted from the interview data: older people′s own condition was the primary factor influencing the home care needs; medical needs for home care were determined by the caregivers′ factors; community health service was important for meet home medical needs; and supporting of home care services for the elderly need to be strengthened.Conclusion:The experience of elderly home caregivers in using community home medical services is affected by many factors, and in the future, the content of home medical services should be improved, and the skills training of community elderly home caregivers should be strengthened, so as to improve the quality of life at home and promote the health literacy of the elderly.

Objective:To understand the attitude and perception of the community-dwelling elderly on the provision of ways of aged-care and home care services by primary health care institutions.Methods:The focus group interviews were conducted from July to December 2021 among 40 home-bound older adults aged≥65 years, selected by purposive sampling method from 5 community health service centers in Beijing Xicheng District and Miyun District, and 4 eligible participants from each community. The topics of the interview were home care and home medical services. The recorded data were transcribed, coded, and analyzed. The themes of interview contents were extracted, summarized and refined with NVivo12 software.Results:Among 40 participants, 20 were males and 20 were females with an average age of (70.95±4.62) years (65 to 83). Three themes were extracted from the interviews: the mode of provision for aged care is influenced by various factors; the role of community medical services for home-based care of the elderly is limited; the contents of community home medical services need to be expanded.Conclusions:The home-bound elderly have a need for home medical services provided by the community, which are limited at present. The implementation of telemedicine and increasing service coordination in the community will be conducive to convenient home medical services for the home-bound elderly.

OBJECTIVETo analysis the influence of surgical revascularization on different timing after ST-elevation myocardial infarction (STEMI) on patients with coronary artery disease and left ventricular dysfunction.

METHODSClinical data of 225 patients admitted from January 2003 to July 2012 with history of STEMI and left ventricular dysfunction (ejection faraction<50%) who underwent isolated coronary artery bypass grafting was retrospectively reviewed. There were 186 male and 39 female patients. According to the timing of surgical revascularization after STEMI, the patients were divided into early revascularization group (ER group, <21 days), mid-term revascularization group (MR group, 21 to 90 days) and late revascularization group (LR group, >90 days). There were 20 male and 9 female patients in ER group with mean age of (63 ± 10) years, 48 male and 16 female in MR group with mean age of (63 ± 8) years, 118 male and 14 female in LR group with mean age of (62 ± 10) years, respectively. Thirty-day post-operative mortality and major complications were determined as the endpoints to evaluate the early results of operation.

RESULTSThe 30-day post-operative mortality were 3.4%,0 and 2.3% among three groups respectively and there was no statistic difference between groups (χ(2) = 2.137, P = 0.330).Low cardiac output syndrome mortality were 13.8%, 3.1% and 2.3% among three groups respectively and there was statistic difference between groups (χ(2) = 8.344, P = 0.015). The ejection fractions was significantly improved in all the three groups from 42% ± 6%, 41% ± 6% and 42% ± 6% preoperatively to 46% ± 7%, 45% ± 10% and 45% ± 9% postoperatively (t = -3.378 to -2.339, all P < 0.05). The left ventricular end diastolic dimension were significantly reduced in MR group and LR group from (54 ± 6) mm and (55 ± 6) mm preoperatively to (47 ± 8) mm and (49 ± 9) mm postoperatively (t = 5.634, 5.885; P = 0.000). There was no significant change in ER group pre- and postoperatively ((51 ± 6) mm vs.(49 ± 7) mm, t = 1.524, P = 0.133).

CONCLUSIONSThe patients with coronary artery disease and left ventricular dysfunction can benefit from surgical revascularization on different timing after STEMI, presenting as the reverse of left ventricle remodeling and the improvement of left ventricle function. The short-term results are mainly determined by the patients' condition, surgical technique and the level of perioperative management.It is recommended for this patient cohort to accept surgical revascularization three weeks after STEMI.

Aged ; Cardiovascular Diseases ; Coronary Artery Bypass ; Coronary Artery Disease ; surgery ; Coronary Disease ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; surgery ; Myocardial Ischemia ; Retrospective Studies ; Time Factors ; Ventricular Dysfunction, Left ; Ventricular Function, Left