For patients with moderate-to-severe functional mitral regurgitation (FMR) who continue to experience heart failure symptoms despite optimized medical and device therapy, transcatheter mitral valve edge-to-edge repair (TEER) is increasingly becoming a reliable treatment option. With the continuous research and development and improvement of TEER-related devices, there are currently dozens of domestically developed TEER devices undergoing clinical trials in China. In this study, we report the first case of a patient with severe FMR treated with the X-Clip® TEER system. The patient, a 60-year-old male, suffered FMR attributed to dilated cardiomyopathy. Preoperative transthoracic echocardiography showed severe mitral regurgitation (4+). He underwent percutaneous repair using the X-Clip® system, and immediate postoperative ultrasound showed mild mitral regurgitation. At the 1-month follow-up, the patient’s symptoms and New York Heart Association (NYHA) functional class improved, and a follow-up transthoracic echocardiogram showed mild mitral regurgitation (1+).

Objective To explore clinical efficacy of osteoplasty combined with percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP)alone in treating osteoporosis vertebral compression fractures(OVCFs).Methods The clini-cal data of 80 patients with single-level OVCFs treated from January 2021 to June 2022 were retrospectively analyzed,and were divided into treatment group and control group according to different surgical methods,40 patients in each group.In treatment group,there were 24 males and 16 females,aged from 60 to 83 years old with an average of(70.43±7.31)years old;bone min-eral density ranged from-3.30 to-2.50 SD with an average of(-2.84±0.24)SD;1 patient with T10,4 patients with T11,11 pa-tients with T12,7 patients with L1,7 patients with L2,5 patients with L3,3 patients with L4,2 patients with L5;bone setting tech-nique combined with PVP were performed.In control group,there were 27 males and 13 females,aged from 60 to 82 years old with an average of(68.98±6.94)years old;bone mineral density ranged from-3.40 to-2.50 SD with an average of(-2.76±0.23)SD;2 patients with T10,3 patients with T11,13 patients with T12,11 patients with L1,5 patients with L2,3 patients with L3,2 patients with L4,1 patient with L5;simple PKP were peformed.Visual analogue scale(VAS)and lumbar Oswestry disability in-dex(ODI)were compared between two groups before operation,3 days,3 and 12 months after operation.The changes of local kyphotic angle,vertebral wedge angle and vertebral anterior margin height ratio were compared between two groups before op-eration,3 days and 12 months after operation.Results All patients were successfully completed operation.Treatment group were followed up from 13 to 22 months with an average of(16.82±2.14)months,and control group were followed up from 13 to 23 months with an average of(16.45±2.56)months.Three patients were occurred bone cement leakage in treatment group,while 1 patient were occurred bone cement leakage and 1 patient occurred sensory disturbance of lower limb skin in control group;there were no significant difference in complications between two groups(P＞0.05).There were no significant difference in preoperative VAS and ODI between two groups(P＞0.05).At 3 days after operation,VAS of treatment group 3.68±0.62 was significantly higher than that of control group 4.00±0.72(P＜0.05).There were no significant difference in VAS and ODI be-tween two groups at 3 and 12 months after operation(P＞0.05).There were no significant difference in local kyphotic angle,vertebral wedge angle and vertebral anterior margin height between two groups at 3 days and 12 months after operation(P＞0.05).Conclusion Compared with PKP,bone setting manipulation combined with PVP for the treatment of OVCFs has advan-tages in early postoperative pain relief.In terms of vertebral height recovery,bone setting manipulation combined with PVP and PKP alone have similar clinical effects.

Objective To investigate the effect of varying ureteral wall thickness(UWT)at the site of ureteral stones on the clinical efficacy of ureteroscopic lithotripsy(URL).Methods The clinical data of 164 patients with ureteral stones in our hospital were retrospectively analyzed.According to different UWT,the patients were divided into the mild thickening group(84 cases,UWT<3.16 mm),the moderate thickening group(31 cases,UWT 3.16 to 3.49 mm),and the severe thickening group(49 cases,UWT>3.49 mm),and the differences of clinical related indicators among the three groups were compared.Results The incidence of postoperative renal colic and leukocyte disorder in the mild thickening group and the moderate thickening group were lower than those in the severe thickening group,and the differences were statistically significant(P<0.05).The postoperative catheterization time in the mild thickening group and the moderate thickening group were shorter than that in the severe thickening group,and the incidences of secondary lithotripsy,residual stones and stone return to kidney in the mild thickening group and the moderate thickening group were lower than those in the severe thickening group,with statistically significant differences(P<0.05).The length of hospital stay and hospitalization cost in the mild thickening group and the moderate thickening group were shorter/less than those in the severe thickening group,with statistically significant differences(P<0.05).Conclusion With the increase of UWT(especially when UWT>3.49 mm),the incidence of postoperative complications and hospitalization cost of URL increase to varying degrees,and the surgical efficacy decreases.In clinical work,UWT measurement holds potential value in predicting the surgical efficacy and complications of URL.

Objective To retrospectively analyze the ultra-fast track anesthesia(UFTA)methods and perioperative anesthesia management experiences of transcatheter mitral valve edge-to-edge repair(TEER)in the treatment of functional mitral regurgitant.Methods In this retrospective study,patients underwent the TEER procedure and received UFTA in Fuwai Yunnan Hospital,from May 2022 to September 2022 for heart failure combined with moderate to severe or severe functional mitral regurgitant were included.Baseline,preoperative complications,cardial function and anesthesia classification,amino-terminal probrain natriuretic peptide(NT-proBNP),ultrasound examination results,surgery time,extubation time,intraoperative anesthetic and vasoactive drug,complications related to TEER and UFTA,perioperative,and postoperative 30-day and one-year follow-up data were collected.All perioperative clinical data were recorded and analyzed.Results A total of 30 patients were enrolled,11 patients(36.7％)were female,mean age was(63.6±6.1)years,NYHA classification IV 14 patients(46.7％),left ventricular ejection fraction(LVEF)(36.0±8.1)％,the end-diastolic volume of the left ventricle(66.0±8.2)mm,mitral regurgitation 4+14 patients(56.7％),3+17 patients(43.3％),NT-proBNP(1 934.1±1 973.5)pg/ml,1 patient(3.3％)used high-dose vasoactive drugs during surgery.All patients did not experience nausea,vomiting,delirium,respiratory depression,perioperative transesophageal echocardiography-related gastrointestinal bleeding,pericardial effusion,cerebrovascular accidents,emergency surgery or secondary intervention,or other serious adverse events within 24 hours after surgery.No 30-day all-cause death occurred;the mean postoperative hospital stay was(7.4±2.8)days.All patients completed one-year follow-up,LVEF(37.6±11.1)％,the end-diastolic volume of the left ventricle(63.2±8.6)mm,mitral regurgitation 2+7 patients(23.3％),1+23 patients(76.7％),NT-proBNP(1 949.2±2 576.6)pg/ml.Conclusions Ultra-fast track anesthesia can be safely applied to TEER in treating functional mitral regurgitant patients.

Objective We aimed to compare the efficacy and prognosis of percutaneous coronary intervention(PCI)in complex and high-risk patients with coronary heart disease(CHD)treated with extracorporeal membrane oxygenation(ECMO)combined with intra-aortic balloon pump(IABP)assistance,and explore the application value of combined use of mechanical circulatory support(MCS)devices in complex PCI.Methods A total of patients who met the inclusion criteria and underwent selective PCI supported by MCS at the Department of Cardiology,the First Affiliated Hospital of the Air Force Medical University from January 2018 to December 2022 were continuously enrolled.According to the mechanical circulatory support method,the patients were divided into ECMO+IABP group and IABP group.Clinical characteristics,angiographic features,in-hospital outcomes,and complications were collected.The intra-hospital outcomes and major adverse cardiovascular events(MACE)at one month and one year after the procedure were observed.The differences and independent risk factors between the two groups in the above indicators were analyzed.Results A total of 218 patients undergoing elective PCI were included,of which 66 patients were in the ECMO+IABP group and 152 patients were in the IABP group.The baseline characteristics of the two groups of patients were generally comparable,but the ECMO+IABP group had more complex lesion characteristics.The proportion of patients with atrial fibrillation(6.1％vs.0.7％,P=0.030),left main disease(43.9％vs.27.0％,P=0.018),triple vessel disease(90.9％vs.75.5％,P=0.009),and RCA chronic total occlusion disease(60.6％vs.35.5％,P＜0.001)was higher in the ECMO+IABP group compared to the IABP group.The proportion of patients with previous PCI history was higher in the IABP group(32.9％vs.16.7％,P=0.014).There was no statistically significant difference in the incidence of in-hospital complications between the two groups(P=0.176),but the incidence of hypotension after PCI was higher in the ECMO+IABP group(19.7％vs.9.2％,P=0.031).The rates of 1-month MACE(4.5％vs.2.6％,P=0.435)and 1-year MACE(7.6％vs.7.9％,P=0.936)were comparable between the two groups.Multivariate analysis showed that in-hospital cardiac arrest(OR 7.17,95％CI 1.27-40.38,P=0.025)and after procedure hypotension(OR 3.60,95％CI 1.10-11.83,P=0.035)were independent risk factors for the occurrence of 1-year MACE.Conclusions Combination use of ECMO+IABP support can provide complex and high-risk coronary heart disease patients with an opportunity to achieve coronary artery revascularization through PCI,and achieve satisfactory long-term prognosis.

We report the first in man experience of robotic assisted transcatheter edge-to-edge repair(TEER)with pure Trans-esophageal echocardiography-guidance.A 55y female was diagnosed with heart failure with 4+functional MR despite optimal medical treatment.TEER procedure was planned with robotic assistance.After guiding catheter,the robotic system was incorporated into the TEER device to replace manual operation.Under pure echo-guidance one clip was successfully placed in A2/P2 region with marked reduction of MR to 1+.Patient was discharged without complication.

We report the successful treatment of mitral regurgitation by remote robotic transcatheter edge-to-edge repair(TEER)under pure transesophageal echocardiographic guidance in a 70-year-old male patient with severe mitral regurgitation due to ischemic cardiomyopathy.The patient showed no significant improvement after coronary interventional treatment and guideline-directed medical therapy before TEER.Following a multidisciplinary discussion,a TEER procedure was indicated and performed.The procedure utilized robotic assistance guided by echocardiography,combined with 5G communication technology,to remotely operate the surgical robot in Shenzhen from Beijing.Postoperatively,the patient's mitral regurgitation was reduced to trace,symptoms were markedly improved,there were no severe complications,and the patient was discharged five days after the operation.The integration of pure echo-guided interventional technology with remote robotic operation holds significant importance for enhancing the capabilities in treating cardiovascular diseases at the primary hospitals.

Objective To explore the impact of inspiratory muscle training(IMT)on enhancing cardio-pulmonary fitness and inspiratory muscle performance among hemiplegic stroke survivors.Methods A total of 58 hemiplegic stroke survivors treated at the Affiliated Jiangning Hospital of Nanjing Medical University between January 2012 and January 2023 were enrolled,and randomly divided into an IMT group and a control group,each of 29.Both groups were given a 12-week health education and rou-tine rehabilitation including physiotherapy and aerobic exercise,while the IMT group was additionally provided with IMT.Before and after intervention,both groups were assessed the maximal inspiratory pressure(MIP)and the inspiratory muscle strength index(IMSI)using the Power breathe K5 system,the 6-minute walk distance(6MWD)using the 6-minute walk test(6MWT),as well as the difference value between baseline and post-intervention 6MWD(6MWDd-value).During the process of 6MWT,gas exchange data were recorded using Cosmed K4b2 wirless telemetry gas analyzer,and the peak oxy-gen uptake(VO2peak)and peak ventilation(VEpeak)were determined.Meanwhile,the cardiopulmonary fit-ness and inspiratory muscle performance were compared,and the correlations of 6MWD to VO2peak and VEpeak were assessed,respectively.Results After intervention,a significant increase was observed in MIP,IMSI,6MWD,VO2peak,and VEpeak in both groups(P<0.05).Moreover,the IMT group demonstrat-ed more significant increases in MIP,IMSI,6MWDd-value,VO2peak,and VEpeak compared to the con-trol group(P<0.05).However,no significant difference was found in 6MWD between the two groups af-ter the intervention(P>0.05).Although 6MWD was positively correlated with VO2peak(r=0.298,P<0.05)and VEpeak(r=0.813,P<0.01),the 6MWDd-value was not significantly correlated with 6MWD,VO2peak or VEpeak(P>0.05).Meanwhile,6MWD and IMT can positively predict VO2peak(6MWD:B=0.023,P<0.01;IMT:B=0.341,P<0.01)and VEpeak(6MWD:B=0.503,P<0.01;IMT:B=7.486,P<0.01).Conclusion IMT can enhance cardiopulmonary fitness and inspiratory muscle performance in stroke sur-vivors with hemiplegia.Consequently,it is suggested that the integration of IMT with conventional stroke rehabilitation strategies may yield beneficial outcomes.Moreover,the six-minute walking test may be used to assess improvements in oxygen uptake and ventilation in stroke patients indirectly.

Objective:To evaluate the safety and efficiency of robotic visualization system(RVS)-assisted microsurgical re-construction of the reproductive tract in male rats and the satisfaction of the surgeons.Methods:We randomly divided 8 adult male SD rats into an experimental and a control group,the former treated by RVS-assisted microsurgical vasoepididymostomy(VE)or vaso-vasostomy(VV),and the latter by VE or VV under the standard operating microscope(SOM).We compared the operation time,me-chanical patency and anastomosis leakage immediately after surgery,and the surgeons'satisfaction between the two groups.Results:No statistically significant difference was observed the operation time between the experimental and the control groups,and no anasto-mosis leakage occurred after VV in either group.The rate of mechanical patency immediately after surgery was 100％in both groups,and that of anastomosis leakage after VE was 16.7％in the experimental group and 14.3％in the control.Compared with the control group,the experimental group achieved dramatically higher scores on visual comfort(3.00±0.76 vs 4.00±0.53,P＜0.05),neck/back comfort(2.75±1.16 vs 4.38±1.06,P＜0.01)and man-machine interaction(3.88±1.55 va 4.88±0.35,P＜0.05).There were no statistically significant differences in the scores on image definition and operating room suitability between the two groups.Conclusion:RVS can be used in microsurgical reconstruction of the reproductive tract in male rats and,with its advantages over SOM in ergonomic design and image definition,has a potential application value in male reproductive system micosurgery.

Objective:To explore the clinical effect of Triangle hierarchical management in patients with acute non-ST-segment elevation myocardial infarction(NSTEMI)after percutaneous coronary intervention(PCI).Methods:A total of 107 NSTEMI patients who underwent PCI in our hospital from Jan 2019 to Dec 2022 were selected.Ac-cording to the random number table method,patients were divided into control group(n=53)and observation group(n=54).Patients in the control group received routine rehabilitation training,while observation group re-ceived Triangle hierarchical management based on control group,both groups were intervened for 6 months.Car-diopulmonary function indexes,scores of myocardial infarction dimensional assessment scale(MIDAS)and general self-efficacy scale(GSES)before and after intervention,and incidence of adverse events during follow-up were compared between two groups.Results:During study period,two cases were lost in the control group and one case withdrew in the observation group,with 51 and 53 cases finally enrolled in each group,respectively.Compared with the control group after intervention,there were significant rise in forced expiratory volume in one second(FEV1)[(2.98±0.27)L vs.(3.30±0.35)L],FEV1/forced vital capacity(FVC)[(72.65±4.31)％vs.(77.06±3.95)％]and GSES score[(18.53±2.63)points vs.(26.89±3.19)points],and significant reduction in MIDAS total score[(65.53±4.86)points vs.(56.26±4.38)points]in observation group(P＜0.001 all).There was no significant difference in the incidence rate of adverse events between control group and observation group during fol-low-up(13.73％vs.7.55％,P=0.306).Conclusion:Triangle hierarchical management may significantly improve lung function,self-efficacy and quality of life with high safety in patients with acute non-ST-segment elevation myocardial infarction after PCI,suggesting that it worths promoting in clinical practice.