Objective To compare the clinical efficacies among three surgical approaches of small inci-sion in the lower segment of the sternum,small incision in the right axilla and thoracoscopic 3 incisions for re-pairing adult giant atrial septal defects(ASD).Methods The medical records of 112 patients with giant ASD undergoing surgical repair in this hospital from January 2018 to January 2024 were retrospectively analyzed.According to the different surgical approaches,the patients were divided into the group A(n=35,small inci-sion in the lower part of the sternum),group B(n=37,small incision in the right axilla)and group C(n=40,thoracoscopic 3 incisions).The general data,operation time,cardiopulmonary bypass time,blood transfusion volume,incision length,postoperative VAS score,postoperative mechanical ventilation time,ICU stay time,postoperative hospitalization duration,hospitalization cost and postoperative complications occurrence rates were compared among the various groups.Results There were no statistically significant differences in the operation time,cardiopulmonary bypass time,blood transfusion volume,postoperative mechanical ventilation time,ICU stay time and postoperative hospitalization duration among 3 groups(P＞0.05).The hospitalization cost in the group C was higher than that in the groups A and group B,the postoperative VAS score in the group B was higher than that in the group A and C,the incision size in the group C was shorter than that in the group A and group B,and the differences were statistically significant(P＜0.05).All patients were suc-cessfully repaired.The incidence rate of postoperative pulmonary infection in the group A and group C was lower than that in the group B,and the difference was statistically significant(P＜0.05).Conclusion All three surgical approaches could safely and effectively repair adult giant ASD.Different surgical approaches should be selected based on the specific conditions of the patients.

Objective To investigate the feasibility of a "pericardial lining" modified Bentall procedure for the treatment of patients with aortic root aneurysm. Methods This was a retrospective study that consecutively enrolled patients treated at the Affiliated Suzhou Hospital of Nanjing Medical University, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, and the First People's Hospital of Guangyuan from January 2023 to February 2024. Preoperative clinical data, imaging findings (including echocardiography and CT scans of the aortic root and the entire aorta), details of coronary artery management, surgical outcomes, and postoperative follow-up results were collected. All patients underwent the "pericardial lining" modified Bentall procedure: the aortic valve was replaced, and an autologous pericardial patch was divided into three equal leaflets based on the circumference of the aortic annulus measured by a valve sizer. These leaflets were then sutured to the aortic annulus. Fenestrations were created in two of the pericardial leaflets for anastomosis with the left and right coronary ostia. The pericardial leaflets were sutured to the wall of the aortic sinuses to form an integrated structure, thereby narrowing the sinus portion. A prosthetic vascular graft was anastomosed to the proximal and distal aorta, and no aortic root-to-right atrium shunt was created. Results A total of 5 patients, aged 37 to 68 years, were included. The preoperative Society of Thoracic Surgeons (STS) risk scores ranged from 2.8% to 3.9%. The diameter of the ascending aorta was 40-73 mm, the left ventricular end-diastolic diameter (LVEDD) was 45-71 mm, and the left ventricular ejection fraction (LVEF) was 47%-64%. Intraoperatively, the aortic cross-clamp time ranged from 85 to 180 min, and the cardiopulmonary bypass time ranged from 110 to 302 min. Postoperative follow-up echocardiography revealed that the ascending aortic diameter was 27-35 mm, LVEDD was 39-57 mm, and LVEF was 43%-61%. All surgeries were completed successfully with satisfactory immediate outcomes and no intraoperative complications. During the follow-up period, there was no mortality or reoperation. Conclusion For patients with aortic root aneurysm, the "pericardial lining" modified Bentall procedure yields satisfactory preliminary results, and the technique is demonstrated to be feasible.

Objective:To investigate the changing trends in cardiac function following xenogeneic heterotopic heart transplantation of multi-gene edited pig hearts and assess the impact of recipient immune responses on donor heart, laying experimental groundwork for the clinical application of gene editing technology.Methods:On December 16, 2023, xenogeneic heterotopic heart transplantation was performed between pigs and rhesus monkeys. Functional status of the graft under post-transplantation load conditions and recipient immune indicators were observed.Results:The recipient monkeys survived for 40 days with satisfactory functionality of both donor and recipient hearts, and no hyperacute or acute immune rejection reactions were observed.Conclusion:Multi-gene editing technology provides potential for xenotransplantation, yet further exploration is needed for its clinical application.

Objective:To evaluate the feasibility of a novel liver fiducial marker implantation method for internal fixation and removal of rabbit livers, in order to use in Cyberknife tracking therapy.Methods:Experiments were conducted in vivo and in vitro. In the in vivo experiment, three fiducial markers were implanted percutaneously in each liver of ten rabbits under anesthesia, and the fourth fiducial marker with an external catheter and fixed thin wire was implanted ten days later. After the reference group (the first and the second maker), and the casing group (the first and the fourth marker) were respectively registered and tracked with the Cyberknife, the implantation success rate, registration accuracy, and removal safety of fiducial markers were assessed. The tensile test was performed using liver in vitro by measuring the resistance required to dislodge the spring coil fiducial markers and the fiducial markers without spring coil from liver. Results:The intrahepatic catheter implantation and removal of fiducial marker in rabbit liver had a success rate of 100% and no distant migration. The operation-related and postoperative complications were not occurred. All fiducial markers were successfully traced. Compared to the reference group, the casing group had slightly higher translational errors in supero-inferior and antero-posterior directions ( Z=-11.77, -4.57, P<0.05), and lower translational errors in left-right direction ( Z=-2.52, P<0.05). The dislodgement forces for spring coil fiducial markers was (2.23±0.85) N, significantly different with (0.81±0.13) N for fiducial markers without spring coil ( Z=- 2.31, P < 0.05). Conclusions:The spiral coil structure provides superior fixation in the punctured needle channel, the thin line limits the distant displacement of the fiducial marker outside the liver, and the catheter establishes a channel for the removal. The general operation is simple and easy.

Backgroud Beta-cypermethrin and emamectin benzoate are widely used for the prevention and control of pests in the greenhouse planting industry, and their combined exposure may increase the accumulation of beta-cypermethrin and emamectin benzoate in organisms and affect human health. Objective Based on the changes in reproductive hormone levels in the hypothalamic-pituitary-ovarian (HPO) axis, to investigate the effect of combined exposure to beta-cypermethrin and emamectin benzoate on the estrous cycle of female mice. Methods Twenty-four healthy adult SD rats were randomly divided into a blank control group, a beta-cypermethrin group (Beta-CYP, 53 mg·m⁻³), an emamectin benzoate group (EMB, 8 mg·m⁻³), and a beta-cypermethrin and emamectin benzoate combined exposure group (Beta-CYP+EMB, Beta-CYP 53 mg·m⁻³ + EMB 8 mg·m⁻³). Six rats in each group were exposed to the designed treatment protocol by aerosol inhalation 6 d a week for 13 weeks. The general condition of the rats was observed in real time during the treatment. From the 12th week of exposure, a 10-day reproductive tract smear was performed on the rats to observe the estrous cycle. The rats were neutralized on the second day after the end of the treatment protocol, and the ovarian tissues were stained with HE to observe histopathological changes. Serum levels of gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) were measured by ELISA. Experimental results were expressed as mean ± standard deviation (\begin{document}$ \overline{x}\pm s $\end{document}). One-way ANOVA was used for comparison among groups, and LSD test for pairwise comparison between groups. The significance level was α=0.05. Results After four weeks of the treatment protocol, the rats in the Beta-CYP group and the Beta-CYP+EMB group continued to be hyperactive and irritable, while the EMB group showed symptoms of mental disorder, decreased activity, and slow response. On the 90th day of the treatment protocol, the body weight of rats in the control group increased to (314.51±2.44) g, and that in the Beta-CYP+EMB group only increased to (253.47±1.50) g. There was no abnormal cellular morphology in the control group; however, small deeply stained nuclei appeared in the Beta-CYP group, the EMB group, and the Beta-CYP+EMB group, and abnormal morphological development of keratinized epithelial cells in the Beta-CYP+EMB group was found. The estrous cycle of rats in the control group was (97.83±4.17) h, and compared with the control group, the estrous cycles of rats in the Beta-CYP group, the EMB group, and the Beta-CYP+EMB group were prolonged to (134.33±7.53) h, (126.50±5.28) h, and (156.00±6.66) h, respectively. The results of ANOVA showed that the numbers of leukocytes (527.17±15.83), keratinized epithelial cells (35.67±4.32), and non-keratinized epithelial cells (70.50±4.51) in the vaginal smears during diestrus in the Beta-CYP+EMB group were significantly lower than those in the control group (752.50±28.89, 50.50±2.74, 101.33±7.92) (P<0.001). The hormone levels of GnRH and FSH in the control group were (5.13±0.59) and (0.76±0.09) IU·L⁻¹ respectively, while the levels in the Beta-CYP+EMB group were increased to (16.86±0.59) and (3.80±0.19) IU·L⁻¹ respectively (P<0.05). The levels of LH and E2 in the control group were (12.93±0.81) IU·L⁻¹ and (22.23±1.44) pmol·L⁻¹ respectively, and the levels in the Beta-CYP+EMB group were decreased to (5.63±0.41) IU·L⁻¹ and (10.45±0.78) pmol·L⁻¹ respectively (P<0.05). Conclusion The combined exposure to beta-cypermethrin and emamectin benzoate may ultimately affect the estrous cycle of female rats by interfering with the secretion of reproductive hormones involved in the HPO axis.

Objective:To explore the feasibility of recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology in the Cyberknife Synchrony-based respiratory tracking.Methods:CT scans of an inflatable pig lung after anti-rot processing were obtained. Then, eight simulated tumor lesion sites were designed in the left and right lung lobes using intelligent navigation software, with four classified as the sputum bronchial environment group and four classified as the wet bronchial environment group. Based on the implantation principle of Cyberknife fiducial markers, 32 recoverable fiducial markers were implanted around various simulated tumor lesions via bronchus under intelligent guidance. Then, the end-expiratory state of the pig lung was simulated, the pig lung was scanned again to obtain CT images of the implanted recoverable fiducial markers, and the number of successfully implanted fiducial markers was recorded. Eight deliverable Synchrony treatment protocols were designed using the Cyberknife planning system (Multiplan v4.6), and then the pig lung with simulated respiratory movements was exposed to radiation. After radiation, the implanted recoverable fiducial markers were retrieved using the bronchoscopy technique, and the number of successfully retrieved fiducial markers was recorded. Moreover, the translational errors, rotational errors, and rigid body errors were extracted from the Cyberknife log file and analyzed.Results:No recoverable fiducial markers slipped or fell during the experiment. Thirty-two recoverable fiducial markers were successfully implanted and recovered under the guidance of intelligent navigation bronchoscopy, with implantation and recovery success rates of both 100%. Moreover, the tracking rate and rigid body errors of the fiducial markers were 100% and less than 5 mm, respectively. The data from the Cyberknife log file indicated that there was no significant difference between the sputum bronchial environment group and the wet bronchial environment group in the translational errors in the left-right direction, the rotational errors in the roll direction, and the rotational errors in the pitch direction ( P>0.05). Compared to the wet bronchial environment group, the sputum bronchial environment group had slightly higher translational errors in front-back ( Z=-3.57, P<0.01) and cranio-caudal ( Z=-2.53, P<0.05) directions, lower rotational errors along the yaw axis ( Z = -3.88, P < 0.01), and lower rigid body error ( Z=-3.32, P<0.01), and the differences were all statistically significant. Conclusions:The recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology is feasible. Recoverable fiducial markers are stable in the bronchus of the phantom, and the Cyberknife tracking precision can meet clinical requirements. Therefore, the recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology has promising prospects in clinical and teaching applications.

Objective To investigate and explore the awareness and willingness of breast cancer screening between Han and Mongolian women in Ordos, Inner Mongolia Autonomous Region, and to analyze the influence factors. Methods The patients answered investigation questionnaires face to face, and the content of questionnaire included demographic information, breast cancer awareness and relevant affecting factors on the awareness and willingness. Results 11162 (88.2 %) Han women and 1495 (11.8 %) Mongolian women were enrolled in the survey, with the average age of (45.4 ±7.1) years old and (45.4 ±6.8) years old. The education level (high school and above) of Han women was lower than that of Mongolian women [4456 women (40.0%) vs. 750 women (50.2%), χ2= 57.041, P< 0.001]. The Main way to delivery information on breast cancer screening in Han and Mongolian women was from their family members or friends [5002 women (44.9%) vs. 688 women (46.1%),χ2=40.699, P<0.001]. The proportions of never attending screening in the Han and Mongolian women were 41.7 % (4640 women) and 45.9 % (683 women), respectively (χ2=14.075, P=0.001). The breast self-examination rate of Han women were higher than that of Mongolian [71.1 % (7926 women) vs. 58.5 % (872 women), χ2= 98.466, P< 0.001]. According to logistics regression analysis, the cognitive level of women with high education level and breast disease history was higher (all P<0.001). Conclusions The cognitive level of breast cancer screening in Han women is better than that in the Mongolian, however, the overall level are low. It is necessary to strengthen the propaganda and education, and to encourage women to actively participate in breast cancer screening.