Objective To introduce a modified technique of right ventricular outflow tract (RVOT) reconstruction using a handmade bicuspid pulmonary valve crafted from expanded polytetrafluoroethylene (ePTFE) and to summarize the early single-center experience. Methods Patients with complex congenital heart diseases (CHD) who underwent RVOT reconstruction with a handmade ePTFE bicuspid pulmonary valve due to pulmonary regurgitation at Guangdong Provincial People’s Hospital from April 2021 to February 2022 were selected. Postoperative artificial valve function and right heart function indicators were evaluated. Results A total of 17 patients were included, comprising 10 males and 7 females, with a mean age of (18.18±12.14) years and a mean body weight of (40.94±19.45) kg. Sixteen patients underwent reconstruction with a handmade valved conduit, with conduit sizes ranging from 18 to 24 mm. No patients required mechanical circulatory support, and no in-hospital deaths occurred. During a mean follow-up period of 12.89 months, only one patient developed valve dysfunction, and no related complications or adverse events were observed. The degree of pulmonary regurgitation was significantly improved post-RVOT reconstruction and during follow-up compared to preoperative levels (P<0.001). Postoperative right atrial diameter, right ventricular diameter, and tricuspid regurgitation area were all significantly reduced compared to preoperative values (P<0.05). Conclusion The use of a 0.1 mm ePTFE handmade bicuspid pulmonary valve for RVOT reconstruction in complex CHD is a feasible, effective, and safe technique.

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

Objective:To analyze the effectiveness of radioactive iodine (RAI) treatment for papillary thyroid cancer (PTC) with an intermediate and high risk of recurrence.Methods:The clinical data of 709 cases of PTC, comprising 226 men and 483 women, who underwent surgical treatment for thyroid cancer at Xiangya Hospital of Central South University from Oct. 2010 to Jan. 2020 were retrospectively analyzed. According to whether RAI treatment was performed after initial surgery or not, they were divided into a RAI group (253 cases with intermediate risk and 209 cases with high risk) and a non-RAI group (147 cases with intermediate risk and 100 cases with high risk), and the relationship between RAI treatment and clinicopathological characteristics such as sex, age, and tumor size for intermediate- and high-risk PTC was analyzed by χ2 test or Fisher’s exact test and Logistic regression analysis. The Kaplan-Meier method was used to calculate the recurrence-free survival rate. Results:The treatment rate of intermediate-risk PTC RAI was 63.25% (253/400) and that of high-risk PTC RAI was 67.64% (209/309). Univariate analysis of intermediate-risk PTC showed that age, bilateral tumors, lymph node metastasis stage, number of lymph node metastases, and intermediate-risk PTC RAI treatment were closely related (all P values <0.05). Multi-factor regression analysis of intermediate-risk PTC showed that age ≥ 55 ( OR=0.282, P=0.005), lymph node metastasis stage N1b ( OR=19.245, P<0.001), and the number of lymph node metastases ≤ 5 ( OR=0.322, P<0.001) were independent predictors of RAI treatment for intermediate-risk PTC (all P values < 0.05). The recurrence-free survival curve for intermediate-risk PTC showed a lower recurrence-free survival rate in the RAI group than in the non-RAI group, but the difference was borderline significant ( P=0.049). Univariate analysis of high-risk PTC showed that age, multifocal tumors, bilateral tumors, lymph node metastasis stage, number of lymph node metastases and high-risk PTC RAI treatment were strongly associated (all P values <0.05). Multifactorial regression analysis for high-risk PTC showed that age ≥ 55 ( OR=0.382, P=0.020), bilateral tumors ( OR=2.173, P=0.030), lymph node metastasis stage N1b ( OR=11.215, P<0.001), and the number of lymph node metastases ≤5 ( OR=0.389, P=0.004) were independent predictors of RAI treatment for high-risk PTC patients (all P values <0.05). The recurrence-free survival curve for high-risk PTC showed a lower recurrence-free survival rate in the RAI group than in the non-RAI group, however, the difference was not statistically significant ( P=0.07) . Conclusions:No significant benefit was observed with RAI treatment for intermediate- and high-risk PTC and rigorous screening of eligible patients is recommended.

Objective    To investigate the surgical strategies and clinical efficacy of transmitral septal myectomy in the treatment of recurrent left ventricular outflow tract obstruction (LVOTO) after alcohol septal ablation. Methods    The clinical data of patients with recurrent LVOTO after alcohol septal ablation from July 2020 to July 2021 in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital were retrospectively analyzed. Patients were preoperatively evaluated by echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, 3D modeling and printing technology. A personalized surgical strategy was preoperatively developed according to multimodality imaging assessment, while visual exploration was performed on the digital model and simulated surgical resection was performed on the printed model. Results     Two female patients were enrolled, aged 62 years and 64 years, respectively. Totally endoscopic transmitral extended myectomy was successfully performed on both patients with aortic cross-clamping time of 96 min and 85 min, respectively. LVOTO was relieved immediately (subaortic peak pressure gradient decreased from 100 mm Hg to 4 mm Hg and from 84 mm Hg to 6 mm Hg, respectively) and the mitral regurgitation significantly improved after the procedure. No patient had complete atrioventricular block or required permanent pacemaker implantation. The patients were discharged uneventfully without postoperative complications. Conclusion    Personalized totally endoscopic transmitral extended myectomy combined with multimodality imaging assessment and 3D modeling and printing has an acceptable clinical effect in patients with recurrent LVOTO after alcohol septal ablation. The procedure can precisely resect the hypertrophic septal myocardium while avoiding serious complications such as septal perforation or complete atrioventricular block.

Studies have shown that ABO blood group is related to the susceptibility and disease progression of SARS-CoV-2 infection, and most studies indicated that group O individuals were less likely to get infected while group A conferred a higher susceptibility to infection and propensity to severe disease. ABO blood group antigens are oligosaccharides expressed on red cells and other tissues. People with different ABO blood type have different susceptibility to a variety of pathogens, including SARS-CoV-2. There are several hypotheses to explain the differences in SARS-CoV-2 infection between ABO blood group individuals. Firstly, anti-A and/or anti-B antibodies could bind to corresponding antigens on the viral envelope and contribute to viral neutralization, thereby preventing target cell from being infected. The SARS-CoV-2 virus and SARS-CoV spike (S) proteins may be bound by anti-A isoagglutinin, which may block interactions between virus and angiotensin-converting-enzyme-2-receptor, thereby preventing entering into lung epithelial cells. Secondly, the receptor binding domain (RBD) of S protein domain can bind to antigen A expressed in respiratory epithelium and promote its infection to respiratory epithelial cells. In conclusion, most studies indicated that group O may be associated with a lower risk of SARS-CoV-2 infection while group A with a higher risk along with severe disease, and the related mechanism needs to be further studied.

OBJECTIVE：To establish a method for the determination of aloesin in plasma of rats ，and to investigate pharmacokinetic characteristics of aloesin. METHODS ：The plasma samples were precipitated with methanol. Using aloeresin D as internal standard ，the plasma concentration of aloesin was determined by LC-MS/MS. The determination was performed on Synergi Hydro-RP column with mobile phase consisted of 0.1‰ formic acid-methanol （gradient elution ）at the flow rate of 0.50 mL/min. The column temperature was 30 ℃，and sample size was 5 µL. The electrospray ionization source was applied to carry out negative ion detection with multiple reaction monitoring mode . The ion transitions for quantitative analysis were m/z 393.1→272.9（aloesin） and m/z 555.3→144.9（internal standard ），respectively. The concentration of aloesin in venous blood was determined by above method at 0.083，0.167，0.333，0.667，1，1.5，2.5，4，6，8，10 h after intravenous injection （3.35 mg/kg）and intragastric administration（16.75 mg/kg）of aloesin. DAS 3.0 software was used to calculate pharmacokinetic parameters. RESULTS ：The linear range of aloesin were 1-600 ng/mL（r＝0.994 5）. The lower limit of quantification was 1 ng/mL，and RSDs of within and between batches were less than 15％；accuracies within and between batches were within ±15％. The matrix factors were （92.74± 4.33）％-（94.84±2.57）％，and extraction recoveries were （69.04±2.13）％-（75.03±2.84）％；the deviation between the measured results of the stability test and the theoretical values were within ±15％. After intravenous injection and intragastric administration of aloesin ，main pharmacokinetic parameters were as follows ：cmax were（10 693.3±2 745.3）and（223.3±36.2）ng/mL；t1/2 were （2.45±1.45）and（3.33±1.91）h；AUC0－24h were（4 190.6±883.6）and（1 210.1±93.9）ng·h/mL（n＝3）. Absolute bioavailabi- lity was 11.13％. CONCLUSIONS ：The established method is rapid and sensitive for plasma determination of aloesin ，and suitable for its pharmacokinetic study.

Alpinia officinarum Hance of the Chinese traditional herb for the treatment of emesis,abdominal pain and diarrhea has been used to counteract gastric disease induced by indomethacin in rats without obvious side effects.However,the role of herb-drug interaction between indomethacin and A.officinarum based on pharmacokinetic,tissue distribution and excretion still remains unknown.In this study,an ultra-fast liquid-tandem mass spectrometry(UFLC-MS/MS)method was developed for simultaneous determina-tion of indomethacin and its three metabolites,O-desmethylindomethacin(ODI),deschlor-obenzoylindomethacin(NDI)and indomethacin acyl-β-D-glucuronide(IDAβG)by oral administration of indomethacin solution with and without the ethanolic extract of A.officinarum and applied to comparative pharmacokinetic,tissue distribution and excretion studies.Our results clarified that oral administration of A.officinarum produced significant alterations in the pharmacokinetic parameters of indomethacin.And the pharmacokinetic interaction between indomethacin and A.officinarum reduced the systemic exposure of indomethacin and increased its elimination.Tissue distribution results demonstrated that co-administration of A.Officinarum could not reduce the accumulation of indo-methacin in the target tissue of the stomach,but could accelerate the excretions of indomethacin and its three metabolites including ODI,NDI and IDAβG in the bile and feces of rats in the excretion study.Therefore,A.Officinarum might have a gastrointestinal protective effect through the interaction role with indomethacin based on the pharmacokinetics and excretion in rats.

Objective:To investigate the potential prognostic value of cyclin D1 expression in patients with locally advanced oral squamous cell carcinoma (OSCC) and its relationship with taxol (Docetaxel)/cisplatin plus 5-fluorouracil (TPF) induction chemothera-py. Methods:A total of 256 patients with locally advanced OSCC were selected from Shanghai Ninth People's Hospital of Shanghai Ji-ao Tong University School of Medicine between March 2008 and December 2010 as the objects of study in this prospective randomized clinical trial. The effect of TPF induction chemotherapy was investigated. Immunohistochemical staining against cyclin D1 was per-formed in the pretreatment biopsy specimen of the patients. The relationship between cyclin D1 expression and prognostic data of the TPF induction arm and control arm was analyzed. Results:Cyclin D1 expression was detected in 232 out of the 256 patients. Patients with low cyclin D1 expression showed significantly better overall survival (OS) (P=0.001), disease-free survival (DFS) (P=0.003), lo-coregional recurrence-free survival (LRFS) (P=0.004), and distant metastasis-free survival (DMFS) (P=0.001) than those with high cy-clin D1 expression. No significant differences existed in OS, DFS, LRFS, or DMFS between the patients with TPF induction chemother-apy and the control. Cyclin D1 expression levels were not predictive of the benefit from TPF induction chemotherapy in the overall pop-ulation. However, patients with nodal stage cN2 and high cyclin D1 expression, who were undergoing TPF chemotherapeutic regimen, showed significantly higher OS (P=0.024) and DMFS (P=0.024) than cN2 patients with high cyclin D1 expression but undergoing stan-dard surgical treatment. Conclusion:Cyclin D1 can be used as a prognostic biomarker for patients with locally advanced OSCC. Fur-thermore, cN2 OSCC patients with high cyclin D1 expression can receive long-term benefit from the addition of TPF induction chemo-therapy to standard surgical treatment.

Objective:To investigate the protection mechanism of rosavin in learning and memory ability in subacute aged rats in-duced by D-galactose. Methods:Totally 48 SD rats were randomly divided into the normal group, model group, positive drug group, and rosavin group respectively at the dose of 6, 12 and 24 mg·g-1 . Except the normal group, the other rats were with neck subcuta-neous injection of D-galactose 120 mg · kg-1 · d-1 . After 4-week drug administration, the learning and memory ability of rats was studied using Morris water maze. PO2 , SaO2 , the activity of superoxide dismutase ( SOD) , catalase( CAT) and glutathione peroxidase ( GSH-Px) and the content of O2 and malonaldehyde( MDA) of rats in vivo were determined at the end of the experiment. Results:The aged rats treated with rosavin(12 or 24 mg·kg-1·d-1) were with significant shortened latent period in Morris water maze(P<0. 01 or P<0. 05), and with reduced total swimming distance and error angle. Meanwhile, rosavin(6,12 or 24 mg·kg-1·d-1) could im-prove the concentration of O2 ,PO2 and SaO2 , the activity of SOD, CAT and GSH-Px in brain, while decrease the content of MDA with certain dose-effect relationship. Conclusion:Rosavin can inhibit D-galactose induced learning and memory decrease in rats, and the effect may be related with the increase of oxygen content, enzyme activity protection of SOD, CAT, MAO and GSH-Px and decrease of MDA generation.

ObjectiveTo investigate the expression of human voltage-gated proton channel 1 (HVCN1) in hepatocellular carcinoma (HCC) and its significance in survival and prognosis after radical hepatectomy.MethodsClinical data of 92 patients with HCC undergoing radical hepatectomy in the Cancer Center of Guangzhou Medical University between August 2008 and December 2009 were retrospectively studied. The HCC ard para-carcinoma tissues were chosen and studied. Among the 92 patients, 82 were males and 10 were females with the average age of (51±12) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. HVCN1 expression in HCC and para-carcinoma tissues was detected by immunohistochemistry. HVCN1 expression in HCC tissues was observed and the correlation between the positive expression of HVCN1 and clinicopathological parameters was analyzed. In addition, the survival and prognosis of HCC patients as well as the influencing factors were also analyzed. The analysis on the correlation between the expression of HVCN1 and clinicopathological parameters was conducted using Chi-square test or Fisher's Exact Test. The survival analysis was conducted using Kaplan-Meier method and Log-rank test. The analysis on influencing factors of survival and prognosis was conducted using Cox Proportional Hazard Regression Model.Results The positive expression of HVCN1 in HCC tissues was 29% (27/92), which was significantly higher than 12% (5/40) of that in para-carcinoma tissues (χ2=2.076,P<0.05). High HVCN1 expression in HCC tissues was correlated with tumor capsule (P<0.05), vascular invasion (χ2=4.937,P<0.05) and early postoperative recurrence (χ2=8.081,P<0.05). The 1-, 3-, 5-year accumulated survival rate was respectively 81.5%, 41.0%, 29.3% for patients with positive HVCN1 expression, and 92.1%, 61.0%, 61.0% for patients with negative HVCN1 expression. The overall survival rate of patients with positive HVCN1 expression was significantly lower than that of patients with negative HVCN1 expression (χ2=8.226,P<0.05). The 1-, 3-, 5-year disease-free survival rate was respectively 51.9%, 13.5%, 13.5% for patients with positive HVCN1 expression and 70.6%, 34.0% and 34.0% for patients with negative HVCN1 expression. The disease-free survival rate of patients with positive HVCN1 expression was significantly lower than that of patients with negative HVCN1 expression (χ2= 5.302,P<0.05). Multivariate Cox regression analysis showed that positive HVCN1 expression and liver cirrhosis were the independent risk factors affecting the survival and prognosis of patients with HCC after radical hepatectomy (RR=2.520,2.408;P<0.05).Conclusions High HVCN1 expression in HCC tissues was correlated with tumor capsule, vascular invasion and early postoperative recurrence, and is the independent risk factor affecting the survival and prognosis of patients with HCC after radical hepatectomy, which can be used as the predictive index for patients with HCC after radical hepatectomy.