Objective:To evaluate the safety and effectiveness of robot-assisted coronary artery bypass(RACAB).Methods:We retrospectively analyzed the clinical outcomes from 252 consecutive patients who underwent RACAB in our center between April 2021 and August 2023. The internal mammary artery(IMA) was harvested using the skeletonized technique with the assistance of the robotic system. Then, graft-to-target vessel anastomoses were performed via a 4-6 cm left fifth intercostal thoracotomy. Coronary angiography or coronary CTA was routinely performed before discharge.Results:149 patients(59.1%) underwent multi-vessel coronary bypass. 140 patients(55.6%) underwent total arterial bypass grafting, with 131 patients(52.0%) undergoing RACAB with in situ bilateral IMA. IMA harvesting failed in 6 patients(1.6%). One patient(0.4%) was assisted by extracorporeal circulation, and 5 patients(2.0%) underwent re-thoracotomy postoperatively. The patency rate of grafts was 96.6%(449/465). The 12-month and 24-month survival rate were 97.8% and 96.5% respectively; The 12-month and 24-month MACCE-free survival rate were 95.2% and 92.6%, respectively.Conclusion:RACAB is safe and feasible. With the assistance of the robotic system, in situ bilateral IMA can be obtained and bypassed to all target vessels territory. Extended follow-up is warranted.

Objective To investigate the effects and mechanism of Dahuang Lingxian Prescription on bile duct reaction of cholestatic liver fibrosis rats caused by bile duct ligation.Methods A total of 40 SD rats were randomly divided into blank group,model group,ursodeoxycholic acid group and Dahuang Lingxian Prescription group,with 10 rats in each group.Except for the blank group,the remaining groups of rats underwent bile duct ligation surgery to establish a cholestatic liver fibrosis model.After surgery,the ursodeoxycholic acid group was given ursodeoxycholic acid solution by gavage,Dahuang Lingxian Prescription group was given Dahuang Lingxian Prescription solution by gavage,and the blank group and model group were given equal volume of normal saline by gavage,once a day for 3 consecutive weeks.The activities of serum AST,ALT,ALP,GGT and the contents of TBIL,TBA were tetected,the morphology of liver tissue was observed by HE staining,and the liver fibrosis was observed by Masson staining,immunohistochromic staining and Western blot were used to detect the expressions of CK19,CK7,EpCAM and SOX9 proteins.Results Compared with the blank group,the liver surface of the model group rats was rough,with a harder texture and obvious graininess,HE staining showed damage to the liver lobule structure,forming pseudo lobules,a large number of bile duct hyperplasia and inflammatory cell infiltration,and a significant increase in collagen fiber deposition(P<0.01);the activities of serum AST,ALT,ALP,GGT,as well as the contents of TBIL and TBA significantly increased(P<0.01);the positive expressions of CK19,CK7 and EpCAM in liver tissue significantly increased(P<0.01),and the protein expressions of CK19,CK7,EpCAM and SOX9 significantly increased(P<0.01).Compared with the model group,the appearance and texture of the liver of the rats in the ursodeoxycholic acid group and Dahuang Lingxian Prescription group were relatively softer,the lobular structure was less damaged,the inflammatory cells infiltration was less,the collagen fiber deposition was significantly reduced(P<0.01),the activities of serum AST,ALT,ALP,GGT,and the contents of TBIL and TBA were significantly decreased(P<0.01);the expressions of TBA and TBIL were significantly decreased(P<0.01),the positive expressions of CK19,CK7 and EpCAM significantly decreased(P<0.01),and the protein expression of CK19,CK7,EpCAM and SOX9 significantly decreased(P<0.01).Conclusion Dahuang Lingxian Prescription can inhibit the bile duct reaction associated with liver progenitor cells,decrease the expression of CK19,CK7,EpCAM and SOX9,and thus improve the cholestatic liver fibrosis of rats induced by bile duct ligation.

Objective:To analyze the safety and efficacy of multi-vessel minimally invasive cardiac surgery-coronary artery bypass graft(MICS-CABG) through perioperative angiography results and complications.Methods:Clinical data of 1 073 patients who underwent multi-vessel MICS-CABG surgery at Peking University Third Hospital from December 2015 to June 2024 were collected using an ambispective cohort study. Among them, 745 were males(69.4%), with a median age of 65 years(58, 71), and a median ejection fraction of 0.66(0.56, 0.71). Double-vessel or triple-vessel lesions accounted for 932 cases(86.9%), while left main lesions were present in 449 cases(41.8%). The primary outcome was the evaluation of graft patency based on perioperative angiography or coronary artery computed tomography angiography results, while major cardiovascular adverse events during the perioperative period, surgical complications, and other surgical information were secondary outcomes. The clinical efficacy of multi-vessel MICS-CABG was evaluated.Results:In this study, the median number of grafts was 3, and complete revascularization was performed in 1 006 cases(93.8%); total arterial revascularization was performed in 308 cases(28.6%). Perioperative mortality was 11 cases(1.0%), and the main adverse cardiovascular and cerebrovascular events(MACCE) was 50 cases(4.8%). Three cases(0.3%) had poor wound healing, and 79 patients(7.4%) required transfusion. Postoperative coronary angiography was performed in 907 patients(84.5%) and coronary CTA was performed in 52 patients(4.8%), for an overall review rate of 89.4%(959/1073). The overall patency rate of the bridge vessel was 96.9%, and the patency rate of the left internal mammary artery was 98.2%.Conclusion:Multi-vessel MICS-CABG demonstrates excellent perioperative safety and is capable of achieving complete revascularization for the 3 regions of the heart. The quality of the anastomosis and the postoperative patency rate of the grafts is satisfactory.

Objective To investigate the effects and mechanism of Dahuang Lingxian Prescription on bile duct reaction of cholestatic liver fibrosis rats caused by bile duct ligation.Methods A total of 40 SD rats were randomly divided into blank group,model group,ursodeoxycholic acid group and Dahuang Lingxian Prescription group,with 10 rats in each group.Except for the blank group,the remaining groups of rats underwent bile duct ligation surgery to establish a cholestatic liver fibrosis model.After surgery,the ursodeoxycholic acid group was given ursodeoxycholic acid solution by gavage,Dahuang Lingxian Prescription group was given Dahuang Lingxian Prescription solution by gavage,and the blank group and model group were given equal volume of normal saline by gavage,once a day for 3 consecutive weeks.The activities of serum AST,ALT,ALP,GGT and the contents of TBIL,TBA were tetected,the morphology of liver tissue was observed by HE staining,and the liver fibrosis was observed by Masson staining,immunohistochromic staining and Western blot were used to detect the expressions of CK19,CK7,EpCAM and SOX9 proteins.Results Compared with the blank group,the liver surface of the model group rats was rough,with a harder texture and obvious graininess,HE staining showed damage to the liver lobule structure,forming pseudo lobules,a large number of bile duct hyperplasia and inflammatory cell infiltration,and a significant increase in collagen fiber deposition(P<0.01);the activities of serum AST,ALT,ALP,GGT,as well as the contents of TBIL and TBA significantly increased(P<0.01);the positive expressions of CK19,CK7 and EpCAM in liver tissue significantly increased(P<0.01),and the protein expressions of CK19,CK7,EpCAM and SOX9 significantly increased(P<0.01).Compared with the model group,the appearance and texture of the liver of the rats in the ursodeoxycholic acid group and Dahuang Lingxian Prescription group were relatively softer,the lobular structure was less damaged,the inflammatory cells infiltration was less,the collagen fiber deposition was significantly reduced(P<0.01),the activities of serum AST,ALT,ALP,GGT,and the contents of TBIL and TBA were significantly decreased(P<0.01);the expressions of TBA and TBIL were significantly decreased(P<0.01),the positive expressions of CK19,CK7 and EpCAM significantly decreased(P<0.01),and the protein expression of CK19,CK7,EpCAM and SOX9 significantly decreased(P<0.01).Conclusion Dahuang Lingxian Prescription can inhibit the bile duct reaction associated with liver progenitor cells,decrease the expression of CK19,CK7,EpCAM and SOX9,and thus improve the cholestatic liver fibrosis of rats induced by bile duct ligation.

Objective:To evaluate the safety and effectiveness of robot-assisted coronary artery bypass(RACAB).Methods:We retrospectively analyzed the clinical outcomes from 252 consecutive patients who underwent RACAB in our center between April 2021 and August 2023. The internal mammary artery(IMA) was harvested using the skeletonized technique with the assistance of the robotic system. Then, graft-to-target vessel anastomoses were performed via a 4-6 cm left fifth intercostal thoracotomy. Coronary angiography or coronary CTA was routinely performed before discharge.Results:149 patients(59.1%) underwent multi-vessel coronary bypass. 140 patients(55.6%) underwent total arterial bypass grafting, with 131 patients(52.0%) undergoing RACAB with in situ bilateral IMA. IMA harvesting failed in 6 patients(1.6%). One patient(0.4%) was assisted by extracorporeal circulation, and 5 patients(2.0%) underwent re-thoracotomy postoperatively. The patency rate of grafts was 96.6%(449/465). The 12-month and 24-month survival rate were 97.8% and 96.5% respectively; The 12-month and 24-month MACCE-free survival rate were 95.2% and 92.6%, respectively.Conclusion:RACAB is safe and feasible. With the assistance of the robotic system, in situ bilateral IMA can be obtained and bypassed to all target vessels territory. Extended follow-up is warranted.

Objective:To analyze the safety and efficacy of multi-vessel minimally invasive cardiac surgery-coronary artery bypass graft(MICS-CABG) through perioperative angiography results and complications.Methods:Clinical data of 1 073 patients who underwent multi-vessel MICS-CABG surgery at Peking University Third Hospital from December 2015 to June 2024 were collected using an ambispective cohort study. Among them, 745 were males(69.4%), with a median age of 65 years(58, 71), and a median ejection fraction of 0.66(0.56, 0.71). Double-vessel or triple-vessel lesions accounted for 932 cases(86.9%), while left main lesions were present in 449 cases(41.8%). The primary outcome was the evaluation of graft patency based on perioperative angiography or coronary artery computed tomography angiography results, while major cardiovascular adverse events during the perioperative period, surgical complications, and other surgical information were secondary outcomes. The clinical efficacy of multi-vessel MICS-CABG was evaluated.Results:In this study, the median number of grafts was 3, and complete revascularization was performed in 1 006 cases(93.8%); total arterial revascularization was performed in 308 cases(28.6%). Perioperative mortality was 11 cases(1.0%), and the main adverse cardiovascular and cerebrovascular events(MACCE) was 50 cases(4.8%). Three cases(0.3%) had poor wound healing, and 79 patients(7.4%) required transfusion. Postoperative coronary angiography was performed in 907 patients(84.5%) and coronary CTA was performed in 52 patients(4.8%), for an overall review rate of 89.4%(959/1073). The overall patency rate of the bridge vessel was 96.9%, and the patency rate of the left internal mammary artery was 98.2%.Conclusion:Multi-vessel MICS-CABG demonstrates excellent perioperative safety and is capable of achieving complete revascularization for the 3 regions of the heart. The quality of the anastomosis and the postoperative patency rate of the grafts is satisfactory.

Objective:To compare and discuss the mid-to-long-term outcomes of mitral valve repair (MVP) versus biological mitral valve replacement (bMVR) in patients aged 60 years and above with rheumatic mitral valve disease.Methods:This is a retrospective cohort study. A total of 765 patients aged 60 years and older, diagnosed with rheumatic mitral valve disease and who underwent MVP or bMVR at Beijing Anzhen Hospital from January 2010 to January 2023, were retrospectively included. Among them, 186 were male and 579 were female, with an age of (66.1±4.5) years (range: 60 to 82 years). Patients were divided into two groups based on the surgical method: the mitral valve repair group (MVP group, n=256) and the bioprosthetic mitral valve replacement group (bMVR group, n=509). A 1∶1 propensity score matching was performed using a caliper value of 0.2 based on preoperative data. Paired sample t-tests, χ2 tests, or Fisher′s exact tests were used for intergroup comparisons. Kaplan-Meier method was employed to plot survival curves and valve-related reoperation rate curves for both groups before and after matching, and Log-rank tests were used to compare the mid-to long-term survival rates and valve-related reoperation rates between the two groups. Results:A total of 765 patients who completed follow-up were ultimately included, with a follow-up period ( M(IQR)) of 5.1(5.0) years (range: 1.0 to 12.9 years). After matching, each group consisted of 256 patients. The incidence of early postoperative atrial fibrillation (39.1% vs. 49.2%, χ2=4.95, P=0.026) and early mortality rates (2.0% vs. 6.2%, χ2=4.97, P=0.026) were lower in the MVP group. Unadjusted Kaplan-Meier analysis showed significantly higher 5-year and 10-year survival rates for the MVP group (92.54% vs. 83.02%, 86.22% vs. 70.19%, Log-rank: P=0.001). After adjustment with propensity scores, the Kaplan-Meier analysis still indicated higher 5-year and 10-year survival rates in the MVP group compared to the bMVR group (92.54% vs. 85.89%, 86.22% vs. 74.83%, Log-rank: P=0.024). There were no significant differences in the rates of valve-related reoperation between the two groups before and after matching (5-year and 10-year reoperation rates pre-matching: 1.75% vs. 0.57%, 5.39% vs. 7.54%, Log-rank: P=0.207; post-matching: 1.75% vs. 0, 5.39% vs. 9.27%, Log-rank: P=0.157). Conclusion:For patients aged 60 years and above with rheumatic mitral valve disease, mitral valve repair offers better mid-to-long-term survival compared to biological valve replacement.

Objective:To compare and discuss the mid-to-long-term outcomes of mitral valve repair (MVP) versus biological mitral valve replacement (bMVR) in patients aged 60 years and above with rheumatic mitral valve disease.Methods:This is a retrospective cohort study. A total of 765 patients aged 60 years and older, diagnosed with rheumatic mitral valve disease and who underwent MVP or bMVR at Beijing Anzhen Hospital from January 2010 to January 2023, were retrospectively included. Among them, 186 were male and 579 were female, with an age of (66.1±4.5) years (range: 60 to 82 years). Patients were divided into two groups based on the surgical method: the mitral valve repair group (MVP group, n=256) and the bioprosthetic mitral valve replacement group (bMVR group, n=509). A 1∶1 propensity score matching was performed using a caliper value of 0.2 based on preoperative data. Paired sample t-tests, χ2 tests, or Fisher′s exact tests were used for intergroup comparisons. Kaplan-Meier method was employed to plot survival curves and valve-related reoperation rate curves for both groups before and after matching, and Log-rank tests were used to compare the mid-to long-term survival rates and valve-related reoperation rates between the two groups. Results:A total of 765 patients who completed follow-up were ultimately included, with a follow-up period ( M(IQR)) of 5.1(5.0) years (range: 1.0 to 12.9 years). After matching, each group consisted of 256 patients. The incidence of early postoperative atrial fibrillation (39.1% vs. 49.2%, χ2=4.95, P=0.026) and early mortality rates (2.0% vs. 6.2%, χ2=4.97, P=0.026) were lower in the MVP group. Unadjusted Kaplan-Meier analysis showed significantly higher 5-year and 10-year survival rates for the MVP group (92.54% vs. 83.02%, 86.22% vs. 70.19%, Log-rank: P=0.001). After adjustment with propensity scores, the Kaplan-Meier analysis still indicated higher 5-year and 10-year survival rates in the MVP group compared to the bMVR group (92.54% vs. 85.89%, 86.22% vs. 74.83%, Log-rank: P=0.024). There were no significant differences in the rates of valve-related reoperation between the two groups before and after matching (5-year and 10-year reoperation rates pre-matching: 1.75% vs. 0.57%, 5.39% vs. 7.54%, Log-rank: P=0.207; post-matching: 1.75% vs. 0, 5.39% vs. 9.27%, Log-rank: P=0.157). Conclusion:For patients aged 60 years and above with rheumatic mitral valve disease, mitral valve repair offers better mid-to-long-term survival compared to biological valve replacement.

Mitochondrial dysfunction after spinal cord injury (SCI) is recognized as a crucial pathological mechanism for secondary SCI. Studies have indicated that mitochondrial transfer plays a significant role in the process of neural regeneration following injury. After mitochondria migrating to injured neurons, they mainly function via enhancing the energy metabolism level of damaged neurons and reducing oxidative stress. In this article, we present an exhaustive overview on mechanism of mitochondrial transfer, and impact on neural regeneration after mitochondrial transfer so as to provide valuable insights for further exploring the role of mitochondrial transfer in SCI progression and offer innovative perspective on potential therapeutic strategies for SCI.

Objective:To explore the safety and effectiveness of axillary-coronary artery bypass (ACAB) of anterolateral incision multi-vessel coronary artery bypass surgery (MICS-CABG).Methods:Patients who underwent coronary artery bypass surgery in Peking University Third Hospital from May 2020 to December 2022 were included. 48 and 158 patients were included in MICS-ACAB and OPCABG group respectively. The mean age of the OPCABG group was (64.72±8.27) years old, and the male proportion was 77.2%(122 cases). The mean age of the MICS-ACAB group was (71.42±7.77) years old, and the male proportion was 79.2%(38 cases). Major adverse cardiovascular and cerebrovascular events (MACCE, including stroke, death, myocardial infarction and revascularization) and postoperative PCS scores of SF-36 were selected as the primary endpoint. The surgical complications and angiography patency rate of grafts were recorded to evaluate the clinical effects of MICS-ACAB.Results:The median number of bypass graft in two groups was 3. There were no significant differences in perioperative MACCE, re-operation rate, renal failure and lenth of postoperative hospital stay between two groups( P>0.05). 85.4% of patients reveived angiography assessment before discharge. There was no significant difference in graft patency between the MICS-ACAB group and OPCABG group (95.2% vs 88.8%, P=0.368). The results of propensity score matching analysis were consistent with the above conclusions. Both univariate analysis and multiple linear regression showed that MICS-ACAB could improve the PCS score of SF-36 at 7 days after surgery[(31.77±5.97) scores vs. (29.45±6.31) scores, P=0.025]. Conclusion:The safety of MICS-ACAB is satisfactory, which can achieve the completely revascularization and the patency rate of grafts is desirable. This procedure can significantly improve quality of life of patients in early postoperative period.