OBJECTIVES: To analyze the early clinical outcomes of the Xcor^TM transcatheter aortic valve replacement (TAVR) system in treating severe aortic stenosis. This study has been registered at Chinese Clinical Trial Registry (ChiCTR2200065593). METHODS: This single-arm, prospective clinical trial enrolled patients with severe aortic stenosis treated with the Xcor^TM TAVR system at the Section of Heart Valve & Coronary Artery Surgery, Guangdong Provincial People's Hospital. Perioperative and follow-up parameters were compared to evaluate differences in hemodynamic outcomes. All-cause mortality, aortic regurgitation, paravalvular leakage, cerebrovascular events, and reoperation were analyzed. RESULTS: Thirty-two patients with severe aortic stenosis were included (20 males, 12 females), with (70.9±4.3) years old and a Society of Thoracic Surgeons (STS) score of 6.45% (6.07%, 7.28%). Notably, 87.5% of patients had New York Heart Association (NYHA) class≥Ⅲ. All patients underwent successful Xcor^TM bioprosthesis implantation, achieving an immediate technical success rate of 100.0% and device success rate of 96.9%. Mean aortic valve gradient decreased from (55.21±23.17) mmHg (1 mmHg=0.133 kPa) to (8.45±5.30) mmHg, peak aortic jet velocity decreased from (4.66±0.85) m/s to (1.99±0.48) m/s, aortic valve area increased from (0.66±0.21) cm² to (2.09±0.67) cm² (all P<0.01). Intraoperative ventricular fibrillation occurred in one patient, while one case exhibited moderate prosthetic valve regurgitation and paravalvular leakage post-procedure. At 12-month follow-up, sustained improvements were observed in cardiac function, left ventricular ejection fraction, hemodynamic parameters, and SF-12 quality-of-life scores (all P<0.01). All-cause mortality was 12.5% (4/32), with 13.8% (4/29) developing moderate paravalvular leakage. CONCLUSIONS The Xcor^TM TAVR system demonstrated favorable early outcomes in severe aortic stenosis patients, significantly improving symptoms and hemodynamics while exhibiting excellent performance in preventing malignant arrhythmias and coronary obstruction.
Humans ; Male ; Female ; Aortic Valve Stenosis/surgery* ; Transcatheter Aortic Valve Replacement/methods* ; Aged ; Follow-Up Studies ; Prospective Studies ; Treatment Outcome ; Aged, 80 and over ; Heart Valve Prosthesis ; Middle Aged

In order to understand the epidemic situation of European porcine reproductive and re-spiratory syndrome virus 1(PRRSV1)in Henan Province,molecular epidemiological investigation and virus identification were conducted on clinical specimens from some large-scale pig farms in Henan Province.RT-PCR detection and sequencing were carried out using specific primers for PRRSVI ORF5 gene.As a result,eight PRRSV1 positive samples were detected with six ORF5 gene sequences and one full gene sequence obtained.A strain of PRRSVI named as HENZMD-10 was successfully isolated using PAM cells.Based on the genetic variation analysis,the six ORF5 genes obtained were all PRRSVI.The isolated strains have relatively large ORF5 gene genetic vari-ation,belonging to different branches on the genetic evolution tree.Among them,HENJZ-11,HENJY-7,and HENJY-8 were relatively close in genetic evolution and belonged to the same branch.The genome length of HENZMD-10 isolate was 15 071 bp.Alignment analysis showed that HENZMD-10 strain shared an 89.1％of nucleotide sequence with the LV strain;62.1％and 61.5％with PRRSV2 ATCC-VR2332 strain and the American NADC30 strain,respectively.The nucleotide similarity of HENZMD-10 strain with the domestic JXA1 strain was 61.6％.The phylo-genetic analysis using complete genome sequence showed that HENZMD-10 strain was relatively close to the domestic isolated PRRSV1 NVDC-NM1-2011,LNEU12 and FJEU13 strains.The suc-cessful isolation of one PRRSV1 strain in Henan Province provides the basis for understanding the epidemic dynamics and prevention and control of PRRSV1 in China.

Objective:In order to reduce the trauma associated with fetal cardiopulmonary bypass(F-CPB), Our team plans to develop a minimally invasive F-CPB through a small incision in the right axilla. The efficacy of this technique will be verified by using a big experimental animal model, thereby laying the foundation for fetal cardiac surgery supported by F-CPB in the future.Methods:Ten pregnant sheep were divided into F-CPB group(n=5) and control group(n=5). After fasting for 24 h, fetal lambs in the F-CPB group underwent a right axillary incision to establish F-CPB running for 1 h; The control group of fetal lambs only expose heart 1 h without F-CPB. Collect blood sample for laboratory test at the CPB vehicle before(T0), 30 min(T1), and 1 h after F-CPB running(T2) for the F-CPB group and through Superior Vena Cava before(T0), 30 min(T1), and 1 h after F-CPB running(T2) for the control group.Results:The blood routine indicators such as RBC, HCT, and Hb in the F-CPB group of fetal lambs decreased significantly during F-CPB, and their distribution showed significant statistical differences compared with the control group( P<0.05). There were no significant statistical differences in blood gas indicators such as pH, PO 2, PCO 2, and lactate concentration between the F-CPB group and the control group( P>0.05). There was no statistically significant difference in the concentration of cTnI in fetal lamb serum at each time point( P>0.05). There were significant statistical differences( P<0.05) in the distribution of fetal lamb Alb, γ-GGT, CK concentration and cholesterol concentration at various time points in the F-CPB group compared with the control group in liver function examination. In addition, the distribution of BUN in fetal lambs showed a significant difference between the two groups( P=0.006). Conclusion:A minimally invasive F-CPB via small incision in the right axilla is safe and feasible. The experimental animal model has demonstrated that this technique has minimal impact on the vital organ functions and internal environment of fetal lambs, thereby laying the foundation for clinical fetal cardiac surgery in the future.

In order to understand the epidemic situation of European porcine reproductive and re-spiratory syndrome virus 1(PRRSV1)in Henan Province,molecular epidemiological investigation and virus identification were conducted on clinical specimens from some large-scale pig farms in Henan Province.RT-PCR detection and sequencing were carried out using specific primers for PRRSVI ORF5 gene.As a result,eight PRRSV1 positive samples were detected with six ORF5 gene sequences and one full gene sequence obtained.A strain of PRRSVI named as HENZMD-10 was successfully isolated using PAM cells.Based on the genetic variation analysis,the six ORF5 genes obtained were all PRRSVI.The isolated strains have relatively large ORF5 gene genetic vari-ation,belonging to different branches on the genetic evolution tree.Among them,HENJZ-11,HENJY-7,and HENJY-8 were relatively close in genetic evolution and belonged to the same branch.The genome length of HENZMD-10 isolate was 15 071 bp.Alignment analysis showed that HENZMD-10 strain shared an 89.1％of nucleotide sequence with the LV strain;62.1％and 61.5％with PRRSV2 ATCC-VR2332 strain and the American NADC30 strain,respectively.The nucleotide similarity of HENZMD-10 strain with the domestic JXA1 strain was 61.6％.The phylo-genetic analysis using complete genome sequence showed that HENZMD-10 strain was relatively close to the domestic isolated PRRSV1 NVDC-NM1-2011,LNEU12 and FJEU13 strains.The suc-cessful isolation of one PRRSV1 strain in Henan Province provides the basis for understanding the epidemic dynamics and prevention and control of PRRSV1 in China.

Objective:In order to reduce the trauma associated with fetal cardiopulmonary bypass(F-CPB), Our team plans to develop a minimally invasive F-CPB through a small incision in the right axilla. The efficacy of this technique will be verified by using a big experimental animal model, thereby laying the foundation for fetal cardiac surgery supported by F-CPB in the future.Methods:Ten pregnant sheep were divided into F-CPB group(n=5) and control group(n=5). After fasting for 24 h, fetal lambs in the F-CPB group underwent a right axillary incision to establish F-CPB running for 1 h; The control group of fetal lambs only expose heart 1 h without F-CPB. Collect blood sample for laboratory test at the CPB vehicle before(T0), 30 min(T1), and 1 h after F-CPB running(T2) for the F-CPB group and through Superior Vena Cava before(T0), 30 min(T1), and 1 h after F-CPB running(T2) for the control group.Results:The blood routine indicators such as RBC, HCT, and Hb in the F-CPB group of fetal lambs decreased significantly during F-CPB, and their distribution showed significant statistical differences compared with the control group( P<0.05). There were no significant statistical differences in blood gas indicators such as pH, PO 2, PCO 2, and lactate concentration between the F-CPB group and the control group( P>0.05). There was no statistically significant difference in the concentration of cTnI in fetal lamb serum at each time point( P>0.05). There were significant statistical differences( P<0.05) in the distribution of fetal lamb Alb, γ-GGT, CK concentration and cholesterol concentration at various time points in the F-CPB group compared with the control group in liver function examination. In addition, the distribution of BUN in fetal lambs showed a significant difference between the two groups( P=0.006). Conclusion:A minimally invasive F-CPB via small incision in the right axilla is safe and feasible. The experimental animal model has demonstrated that this technique has minimal impact on the vital organ functions and internal environment of fetal lambs, thereby laying the foundation for clinical fetal cardiac surgery in the future.

Objective:To analyze the diagnosis and surgical treatment of high-risk anomalous aortic origin of coronary artery (AAOCA).Methods:This is a retrospective case series study. From January 2016 to July 2023, 24 cases of high-risk AAOCA underwent surgical treatment in Department of Cardiac Surgery, Guangdong Provincial People's Hospital. There were 18 males and 6 females, operatively aged ( M (IQR)) 13 (26) years (range: 0.3 to 57.0 years). They were confirmed by cardiac ultrasound and cardiac CT, all of which had anomalous coronary running between the aorta and the pulmonary artery. There were 15 cases of the right coronary artery from the left aortic sinus of Valsalva, 6 cases of left coronary artery from the right aortic sinus of Valsalva, 3 cases of the sigle coronary artery. Only 3 patients had no obvious related symptoms (2 cases were complicated with a positive exercise stress test and 1 case with other intracardiac malformations), 21 cases had a history of chest tightness, chest pain, or syncope after exercise. Three patients suffered syncope after exercise and underwent cardiopulmonary resuscitation (2 cases were treated with an extracorporeal membrane oxygenerator (ECMO)). The gap from the first symptom to the diagnosis was 4.0 (11.5) months (range: 0.2 to 84.0 months). The detection rate of coronary artery abnormalities suggested by the first cardiac ultrasound was only 37.5% (9/24). Seven patients were complicated with other cardiac diseases (4 cases with congenital heart defects, 2 cases with coronary atherosclerotic heart disease, 1 case with mitral valve disease). Results:All 24 patients underwent surgical treatment (23 cases underwent abnormal coronary artery unroofing, 1 case underwent coronary artery bypass grafting), and 5 patients underwent other intracardiac malformation correction at the same time. There were no death or surgery related complications in the hospital for 30 days after the operation. A patient with preoperative extracorporeal cardiopulmonary resuscitation was continuously assisted by ECMO after emergency AAOCA correction and had complications such as limb ischemia necrosis and renal dysfunction after the operation. During the follow-up of 2.2 (3.3) years (range: 1 month to 7.2 years), one patient who previously underwent percutaneous transluminal coronary angioplasty with a stent implant experienced significant postoperative symptomatic relief, and the other discharged patients had no related symptoms.Conclusions:The accurate rate of initial diagnosis for high-risk AAOCA is still low, but the risk of cardiovascular accidents is high. For sports-related chest pain and other symptoms, more attention should be paid to the detection of AAOCA, especially for adolescents. Exercise stress testing can be helpful in evaluating the cardiovascular risk of asymptomatic AAOCA. Instant surgical treatment can achieve satisfactory curative effects.

The clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9) system, belonging to the type II CRISPR/Cas system, is an effective gene-editing tool widely used in different organisms, but the size of Streptococcus pyogenes Cas9 (SpCas9) is quite large (4.3 kb), which is not convenient for vector delivery. In this study, we used a codon-optimized Staphylococcus aureus Cas9 (SaCas9) system to edit the tyrosinase (tyr), oculocutaneous albinism II (oca2), and paired box 6.1 (pax6.1) genes in the fish model medaka(Oryzias latipes), in which the size of SaCas9 (3.3 kb) is much smaller and the necessary protospacer-adjacent motif (PAM) sequence is 5'-NNGRRT-3'. We also used a transfer RNA (tRNA)‍-single-guide RNA (sgRNA) system to express the functional sgRNA by transcription eitherin vivo or in vitro, and the combination of SaCas9 and tRNA-sgRNA was used to edit the tyr gene in the medaka genome. The SaCas9/sgRNA and SaCas9/tRNA-sgRNA systems were shown to edit the medaka genome effectively, while the PAM sequence is an essential part for the efficiency of editing. Besides, tRNA can improve the flexibility of the system by enabling the sgRNA to be controlled by a common promoter such as cytomegalovirus. Moreover, the all-in-one cassette cytomegalovirus (CMV)‍-SaCas9-tRNA-sgRNA-tRNA is functional in medaka gene editing. Taken together, the codon-optimized SaCas9 system provides an alternative and smaller tool to edit the medaka genome and potentially other fish genomes.
Animals ; Oryzias/genetics* ; Gene Editing/methods* ; CRISPR-Cas Systems ; Codon ; RNA, Guide, CRISPR-Cas Systems/genetics* ; Monophenol Monooxygenase/genetics* ; CRISPR-Associated Protein 9/genetics* ; RNA, Transfer/genetics* ; Staphylococcus aureus/genetics* ; PAX6 Transcription Factor/genetics*

Objective:To analyze the diagnosis and surgical treatment of high-risk anomalous aortic origin of coronary artery (AAOCA).Methods:This is a retrospective case series study. From January 2016 to July 2023, 24 cases of high-risk AAOCA underwent surgical treatment in Department of Cardiac Surgery, Guangdong Provincial People's Hospital. There were 18 males and 6 females, operatively aged ( M (IQR)) 13 (26) years (range: 0.3 to 57.0 years). They were confirmed by cardiac ultrasound and cardiac CT, all of which had anomalous coronary running between the aorta and the pulmonary artery. There were 15 cases of the right coronary artery from the left aortic sinus of Valsalva, 6 cases of left coronary artery from the right aortic sinus of Valsalva, 3 cases of the sigle coronary artery. Only 3 patients had no obvious related symptoms (2 cases were complicated with a positive exercise stress test and 1 case with other intracardiac malformations), 21 cases had a history of chest tightness, chest pain, or syncope after exercise. Three patients suffered syncope after exercise and underwent cardiopulmonary resuscitation (2 cases were treated with an extracorporeal membrane oxygenerator (ECMO)). The gap from the first symptom to the diagnosis was 4.0 (11.5) months (range: 0.2 to 84.0 months). The detection rate of coronary artery abnormalities suggested by the first cardiac ultrasound was only 37.5% (9/24). Seven patients were complicated with other cardiac diseases (4 cases with congenital heart defects, 2 cases with coronary atherosclerotic heart disease, 1 case with mitral valve disease). Results:All 24 patients underwent surgical treatment (23 cases underwent abnormal coronary artery unroofing, 1 case underwent coronary artery bypass grafting), and 5 patients underwent other intracardiac malformation correction at the same time. There were no death or surgery related complications in the hospital for 30 days after the operation. A patient with preoperative extracorporeal cardiopulmonary resuscitation was continuously assisted by ECMO after emergency AAOCA correction and had complications such as limb ischemia necrosis and renal dysfunction after the operation. During the follow-up of 2.2 (3.3) years (range: 1 month to 7.2 years), one patient who previously underwent percutaneous transluminal coronary angioplasty with a stent implant experienced significant postoperative symptomatic relief, and the other discharged patients had no related symptoms.Conclusions:The accurate rate of initial diagnosis for high-risk AAOCA is still low, but the risk of cardiovascular accidents is high. For sports-related chest pain and other symptoms, more attention should be paid to the detection of AAOCA, especially for adolescents. Exercise stress testing can be helpful in evaluating the cardiovascular risk of asymptomatic AAOCA. Instant surgical treatment can achieve satisfactory curative effects.

Objective To summarize and analyze the preliminary clinical outcomes of the KokaclipTM transcatheter edge-to-edge mitral valve repair system for severe degenerative mitral regurgitation (DMR). Methods This study was a single-arm, prospective, single-group target value clinical trial that enrolled patients who underwent the KokaclipTM transcatheter edge-to-edge repair (TEER) system for DMR in the Department of Heart Surgery of Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute from June 2022 to January 2023. Differences in the grade of mitral regurgitation (MR) during the perioperative and follow-up periods were compared, and the incidences of adverse events such as all-cause death, thoracotomy conversion, reoperation, and severe recurrence of MR during the study period were investigated. Results The enrolled patient population consisted of 14 (50.0%) females with a mean age of 70.9±5.4 years. Twenty-eight (100.0%) patients were preoperatively diagnosed with typeⅡ DMR, with a prolapse width of 12.5 (11.0, 16.1) mm, a degree of regurgitation 4+ leading to pulmonary venous reflux, and a New York Heart Association cardiac function class≥Ⅲ. All patients completed the TEER procedure successfully, with immediate postoperative improvement of MR to 0, 1+, and 2+ grade in 2 (7.1%), 21 (75.0%), and 5 (17.9%) patients, respectively. Mitral valve gradient was 2.5 (2.0, 3.0) mm Hg. Deaths, thoracotomy conversion, or device complications such as unileaflet clamping, clip dislodgement, or leaflet injury were negative. Twenty-eight (100.0%) patients completed at least 3-month postoperative follow-up with a median follow-up time of 5.9 (3.6, 6.8) months, during which patients had a mean MR grade of 1.0+ (1.0+, 2.0+) grade and a significant improvement from preoperative values (P<0.001). There was no recurrence of ≥3+ regurgitation, pulmonary venous reflux, reoperation, new-onset mitral stenosis, or major adverse cardiovascular events. Twenty-two (78.6%) patients’ cardiac function improved to classⅠorⅡ. Conclusion The domestic KokaclipTM TEER system has shown excellent preliminary clinical results in selected DMR patients with a high safety profile and significant improvement in MR. Additional large sample volume, prospective, multicenter studies, and long-term follow-up are expected to validate the effectiveness of this system in the future.

An oral synechia is a fibrous or soft tissue adhesion between the maxilla and the mandible. These synechiae can appear at various locations in the oral cavity, with alveolar synechia being one of the manifestations. Alveolar synechia is a rare congenital deformity and often accompanied by additional congenital defects, such as cleft lip or palate, microglossia, micrognathia, or TMJ anomalies. Among these, cleft palate is the most common. A case of congenital alveolar synechiae with cleft palate is reported. The child is in good condition after surgical treatment. The etiology and treatment are discussed.