Objective:To examine the therapeutic strategy and its impacting factors by analyzing the perioperative outcomes of total thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation with cardiopulmonary bypass.Methods:This study is a retrospective case series. Totally 63 patients who underwent repeat mitral valve surgery by the same surgeon from January 2021 to December 2023 in Department of Cardiovascular Surgery, the First Medical Center of People′s Liberation Army General Hospital were retrospectively enrolled. There were 28 males and 35 females with an age of (58.3±15.9) years (range: 13 to 84 years). Surgery was performed using a totally thoracoscopic approach under moderate hypothermia-induced ventricular fibrillation. Mitral valvuloplasty was completed in 32 cases and mitral valve replacement in 31 cases. Preoperative baseline data and perioperative outcomes of the patients were collected and Logistic regression was used to analyze independent influencing factors of premature ventricular contractions in the early postoperative period.Results:The intraoperative cardiopulmonary bypass time was (191.5±50.9) minutes (range: 95 to 286 minutes), and the hypothermic ventricular fibrillation time was (99.0±39.8) minutes (range: 34 to 203 minutes). The anal temperature before the start of cardiopulmonary bypass was (36.3±0.5) ℃ (range: 35.2 to 38.0 ℃), the lowest intraoperative anal temperature was (27.3±1.3) ℃(range: 23.7 to 30.1 ℃), and the anal temperature at the time of the cessation of cardiopulmonary bypass was (36.3±0.4) ℃ (range: 35.2 to 37.0 ℃), and excessive rewarming was observed in 33 cases. Six cases applied the artificial heart assist device. Seventeen cases developed premature ventricular contractions in the early postoperative period. Two cases developed neurologic complications. Five cases developed respiratory complications. One case developed urological systemic complications. Six cases were mechanically ventilated for more than 3 days, and the duration of ICU stay in 16 cases was more than 3 days and the postoperative discharge time of ( M(IQR)) 8.0 (3.5) days (range: 3 to 26 days). Two cases died or were discharged voluntarily. Logistic regression results showed that persistent preoperative atrial fibrillation ( OR=11.424, 95% CI: 1.477 to 144.564, P=0.033) and excessive rewarming ( OR=15.249, 95% CI: 1.357 to 279.571, P=0.038) were independent risk factors for the appearance of premature ventricular contractions in the early postoperative period. Conclusions:The technique of total thoracoscopic surgery under induced moderate hypothermic ventricular fibrillation with cardiopulmonary bypass could be applied to repeated mitral valve surgeries with less trauma and faster recovery. Persistent preoperative atrial fibrillation and excessive rewarming are independent risk factors for the occurrence of premature ventricular contractions in the early postoperative period.

Objective:To examine the therapeutic strategy and its impacting factors by analyzing the perioperative outcomes of total thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation with cardiopulmonary bypass.Methods:This study is a retrospective case series. Totally 63 patients who underwent repeat mitral valve surgery by the same surgeon from January 2021 to December 2023 in Department of Cardiovascular Surgery, the First Medical Center of People′s Liberation Army General Hospital were retrospectively enrolled. There were 28 males and 35 females with an age of (58.3±15.9) years (range: 13 to 84 years). Surgery was performed using a totally thoracoscopic approach under moderate hypothermia-induced ventricular fibrillation. Mitral valvuloplasty was completed in 32 cases and mitral valve replacement in 31 cases. Preoperative baseline data and perioperative outcomes of the patients were collected and Logistic regression was used to analyze independent influencing factors of premature ventricular contractions in the early postoperative period.Results:The intraoperative cardiopulmonary bypass time was (191.5±50.9) minutes (range: 95 to 286 minutes), and the hypothermic ventricular fibrillation time was (99.0±39.8) minutes (range: 34 to 203 minutes). The anal temperature before the start of cardiopulmonary bypass was (36.3±0.5) ℃ (range: 35.2 to 38.0 ℃), the lowest intraoperative anal temperature was (27.3±1.3) ℃(range: 23.7 to 30.1 ℃), and the anal temperature at the time of the cessation of cardiopulmonary bypass was (36.3±0.4) ℃ (range: 35.2 to 37.0 ℃), and excessive rewarming was observed in 33 cases. Six cases applied the artificial heart assist device. Seventeen cases developed premature ventricular contractions in the early postoperative period. Two cases developed neurologic complications. Five cases developed respiratory complications. One case developed urological systemic complications. Six cases were mechanically ventilated for more than 3 days, and the duration of ICU stay in 16 cases was more than 3 days and the postoperative discharge time of ( M(IQR)) 8.0 (3.5) days (range: 3 to 26 days). Two cases died or were discharged voluntarily. Logistic regression results showed that persistent preoperative atrial fibrillation ( OR=11.424, 95% CI: 1.477 to 144.564, P=0.033) and excessive rewarming ( OR=15.249, 95% CI: 1.357 to 279.571, P=0.038) were independent risk factors for the appearance of premature ventricular contractions in the early postoperative period. Conclusions:The technique of total thoracoscopic surgery under induced moderate hypothermic ventricular fibrillation with cardiopulmonary bypass could be applied to repeated mitral valve surgeries with less trauma and faster recovery. Persistent preoperative atrial fibrillation and excessive rewarming are independent risk factors for the occurrence of premature ventricular contractions in the early postoperative period.

Objective:To explore the effectiveness of artificial intelligent (AI) quality control system on the standard mid-sagittal view of fetal face in 11-13 +6 weeks of gestation. Methods:The quality of the images was evaluated using online " Intelligent ultrasonic quality control system" for 1 063 sections of fetal Nuchal translucency ultrasound images in the Ultrasound Department of Shenzhen Maternity and Child Healthcare Hospital of Southern Medical University. The manual quality control results and time consuming of two experts were compared with AI. The gold standard was decided by experts group with higher seniority.Results:The overall standard rate, substandard rate and nonstandard rate of the image evaluated by the intelligent quality control system was 87.3%, 2.82%, and 9.88%. The overall accuracy of images was 96.6%. The coincidence rates between AI and the two experts were 96.1% and 96.3%, respectively, with strong consistency (Kappa were 0.835 and 0.845 respectively). The time required for intelligent quality control was significantly shorter than manual quality control (208 s vs 6 696 s/6 602 s). All the differences were statistically significant ( Z=-3.981, P<0.001). Conclusions:The intelligent quality control system could accurately and quickly evaluate whether the mid-sagittal view of fetal face in 11-13 +6 weeks of gestation is standard.

Objective:To develop an artificial intelligence (AI) quality control model of fetal heart in the first trimester and verify its effectiveness.Methods:A total of 18 694 images of the four-chamber view(4CV) and three-vessel and tracheal view(3VT) of fetal heart in the first trimester were selected from Shenzhen Maternal and Child Health Hospital Affiliated to Southern Medical University since January 2022 to December 2022. A total of 14 432 images were manually annotated. The one-stage target detection algorithm YOLO V5 was used to train the AI quality control model in the first trimester of fetal heart, and 4 262 images (golden standard set by expert group) were used to evaluate the application effectiveness of AI quality control model. Kappa consistency test was used to compare the results of section classification and standard degree judgment from AI quality control model, Doctor 1(D1) and Doctor 2(D2).Results:①Precision of the AI quality control model was 0.895, recall was 0.852, mean average precision (mAP 50) was 0.873.The average precision(AP) of the AI quality control model for section classification was 0.907 (4CV) and 0.989 (3VT), respectively. ②Compared with the gold standard, the overall coincidence rate and consistency of section classification of AI quality control model, D1 and D2 were 99.91% (Kappa=0.998), 100% (Kappa=1.000), 100% (Kappa=1.000), respectively. The coincidence rate and consistency of the plane standard degree evaluation from the AI quality control model, D1 and D2 were 97.46% (Weighted Kappa=0.932), 93.73% (Weighted Kappa=0.847), and 93.12% (Weighted Kappa=0.832), respectively. Strong consistency was displayed. Moreover, AI quality control model showed the highest coincidence rate and the strongest consistency in judging section standard degree, which was superior to manual quality control. The time-consuming of AI quality control (0.012 s/sheet) was significantly less than the way of manual quality control (4.76-6.11 s/sheet)( Z=-8.079, P<0.001). Conclusions:The use of artificial intelligent fetal heart quality control model in the first trimester can effectively and accurately control the image quality.

Objective:To summarize the experience of surgical treatment of prosthetic valve dysfunction and evaluate the safety of operation.Methods:The clinical data of 142 patients admitted by the same cardiovascular surgeon from January 2015 to December 2019 at the first medical center of Chinese People's Liberation Army General Hospital. The clinical data were retrospectively analyzed, including 60 males (42.25%) and 82 females (57.75%), with an average age of 59.4 years old. Inclusion criteria: patients received redo-valvuloplasty or valve replacement after valvuloplasty or replacement, excluding mitral balloon dilatation and tricuspid valvuloplasty without implantation of annuloplasty ring.Results:The reasons of redo heart valve surgery in the same valve position including: bioprosthetic valve failure, mechanical prosthetic valve dysfunction, valve dysfunction after valvuloplasty, prosthetic valve infectious endocarditis, perivalvular leakage. There was 2 death in 142 cases, and the operative mortality rate was 1.41%. The reasons of the perioperative period death include cerebral hemorrhage, coagulation dfsfunction; perioperative complications include low cardiac output syndrome (LCOS), hypoxic-ischemic encephalopathy, respiratory failure, tracheal re-intubation, re-thoratomy for hemaostsis.Conclusion:There are many reasons for reoperation of prosthetic valve dysfunction, and the reoperation surgery is a difficult procedure. However, choosing the suitable surgical option, strengthening the perioperative management of such patients can effectively reduce the incidence of postoperative mortality and complications, minimally invasive surgery can reduce the mortality and complications.

Objective:The aim of this study was to compare the perioperative outcomes of a totally thoracoscopic repeat mitral valve surgery under hypothermic ventricular fibrillation with those of a conventional median sternotomy approach for repeat mitral valve surgery and to explore the safety of the totally thoracoscopic repeat mitral valve surgery under hypothermic ventricular fibrillation.Methods:Patients requiring repeat mitral valve surgery admitted by the same surgeon at Cardiovascular Surgery, First Medical Center, Chinese PLA General Hospital from January 2018 to January 2022 were retrospectively enrolled. The patients were divided into the totally thoracoscopic group under hypothermic ventricular fibrillation and the conventional median sternotomy group according to the procedure, and the preoperative baseline data and perioperative outcomes were collected and statistically analyzed using SPSS 22.0.Results:A total of 91 patients matched the criteria for study enrollment, 25 in the totally thoracoscopic group and 66 in the median sternotomy group. There was no statistical difference in the preoperative baseline data between the two groups. The totally thoracoscopic group has advantages in mitral valvuloplasty rate(32.0% vs. 7.6%, P=0.008), transfusion rate(72.0% vs. 98.5%, P<0.001), mechanical ventilation time [(19.0±27.8)h vs.(43.3±58.3)h, P=0.009], chest drainage tube time [(2.2±1.9)days vs.(3.7±2.4)days, P=0.004], postoperative chest drainage volume [(489.6±319.1)ml vs.(913.6±568.4)ml, P=0.001], postoperative discharge time[(8.0±2.7)days vs.(13.9±12.8)days, P=0.026]. The totally thoracoscopic group had a longer cardiopulmonary bypass time [(180.8±41.7)min vs.(143.2±39.7)min, P<0.001], and it had an intraoperative ventricular fibrillation time of(100.2±42.5)min. There were no statistically significant differences in the postoperative complication rate(12.0% vs. 21.2%, P=0.481) and mortality(4.0% vs. 4.5%, P=1.000) between the two groups. Conclusion:The totally thoracoscopic approach has the characteristics of less invasion and faster recovery compared with the median sternotomy approach. Hypothermic ventricular fibrillation simplifies the procedure at the ascending aorta while reducing myocardial injury than conventional occlusion of the ascending aorta. Totally thoracoscopic mitral valve surgery under hypothermic ventricular fibrillation is a safe minimally invasive technique.

Objective:To summarize the clinical data of mitral valve surgery completed in a single surgical team in one year, to discuss the etiologic characteristics, methods, results and early postoperative outcomes of mitral valvuloplasty surgeries, and to analyze the epidemiologic trends of mitral valve diseases admitted to the hospital.Methods:A total of 209 mitral valve surgeries completed by the same surgeon in the single surgical team at the Cardiovascular Surgery, First Medical Center, Chinese PLA General Hospital, from January 2021 to December 2021 were retrospectively analyzed. Mitral valve surgery accounted for 53.6% of all surgeries in this team during the same period. There were 100 cases(47.8%) in males and 109 cases(52.2%) in females, aged 11-85 years old, with a mean of(53.5±15.2) years old. There were 121 cases(57.9%) of NYHA class Ⅱ and 88 cases(42.1%) of class Ⅲ/Ⅳ.Results:Of the 152 mitral valvuloplasty surgeries, 117(77%) were performed with a totally Thoracoscopic approach. Annuloplasty rings were applied in 145 cases(95.4%), including semi-rigid closed Physio II annuloplasty rings in 118 cases(81.4%), Gore-Tex artificial chordae were applied in 89 cases(58.6%) for a total of 145, leaflet repair in 15 cases(9.9%), edge-to-edge repair in 2 cases(1.3%), commissure suture in 34 cases(22.4%), and chordae tendineae and papillary muscle splitting in 15 cases(9.9%). The repair rate of degenerative mitral valve disease was 100%, and the repair rate of rheumatic mitral valve disease was 48.1%. The echocardiogram was received about one week after surgery, and there was no or trace regurgitation in 91 cases(59.9%), mild in 58 cases(38.2%), and moderate in 3 cases(2.0%). There were 2 cases(1.3%) of all-cause death.Conclusion:Degenerative mitral valve disease have become the leading cause of mitral valve disease in our center, and the proportion of rheumatic mitral valve disease has decreased. Degenerative mitral valve disease has a very high repair rate, and rheumatic mitral valve disease has a relatively low repair rate due to its special pathologic and anatomic characteristics. Most mitral valvuloplasty procedure can be performed in a totally thoracoscopic approach. The application of a mitral valvuloplasty ring combined with Gore-Tex artificial chordae by an experienced surgeon can achieve reliable repair results.

Objective:To confirm the safety and feasibility of totally thoracoscopic repair with leaflet folding, multiple artificial chordae implantation and ring annuloplasty for mitral regurgitation(MR) in Barlow disease.Methods:From June 2018 to December 2019, 10 consecutive Barlow’s disease patients underwent totally thoracoscopic repair with leaflet folding, multiple artificial chordae implantation and ring annuloplasty. The safety and feasibility of this technique was evaluated by its early clinical outcomes.Results:8 males and 2 females. The mean age was(33.5±11.0) years.There was no operative death and related complications. The mean cardiopulmonary bypass(CPB) time was(142±26)(112-194)min, and the aortic clamping time was(96±18)(78-128) min. The average number of artificial chordae implantation was(3.4±0.7)(2-4) pairs/case. Intraoperative transesophageal echocardiography(TEE) showed the mean mitral valve coaptation length and transvalvular pressure gradient was(1.2±0.2)(0.8-1.5) cm and(1.2±0.4) mmHg(1 mmHg=0.133 kPa), respectively, without MR or systolic anterior motion(SAM). During a follow-up of 1-18 months, there were 7 cases with no MR and 3 with trace MR, with a mean transvalvular pressure gradient of( 1.5±0.6 )mmHg.Conclusion:Totally thoracoscopic repair with leaflet folding, multiple artificial chordae implantation and ring annuloplasty was a safe and effective procedure with satisfied early clinical outcomes for MR in Barlow’s disease. However, further randomized and long-term follow-up studies were warranted to determine its clinical effects.

Objective:Reported our experience of 100 consecutive cases of thoracoscopic mitral valvuloplasty in the early period.Methods:Between September 2017 and December 2019, 100 consecutive cases of thoracoscopic mitral valvuloplasty had been completed in our institution. There were 56 males and 44 females. The mean age was(49.2±14.7) years old, ranging from 15 to 75 years old.The safety and feasibility of this technique was evaluated by its early clinical outcomes.Results:Mitral valve(MV) repair techniques included leaflet folding in 5 cases, cleft suture in 10, commissuroplasty in 15, edge to edge in 1, artificial chordae implantation in 76 cases with mean of(2.5±1.6)(1-4) pairs, and prosthetic annuloplasty in all cases. Intraoperative transoesophageal echocardiography(TEE) revealed no mitral regurgitation(MR) in 95 cases and a mild in 2 cases with all coaptation length more than 5 mm. The rest 3 cases with moderate or more MR were successfully reconstructed after being blocked again. The mean cardiopulmonary bypass(CPB) time was(164.4±51.0 )min and aortic clamping time was(119.7 ± 39.1) min, and the latest 10 cases were(140.2±45.3 )min and(96.3±25.4) min, the difference was statistically significant( P<0.05). There was one operative death for avulsion of left atrial suture after operation and 2 intraoperative re-exploration for bleeding. Severe MR was observed in 2 patients 3 months after operation, and mitral valve replacement(MVR) was performed through median sternotomy. Conclusion:Totally thoracoscopic mitral valvuloplasty is technically feasible, safe, effective and reproducible in clinical practice after crossing the learning curve. The short-term effect is satisfactory, however, further randomized and long-term follow-up studies are warranted to determine its clinical effects.

[Abstract] Objective: To explore the effects of triptolide on immune function and tumor cell proliferation in patients with cervical cancer. Methods: Sixty-two patients with cervical cancer admitted in the Department of Obstetrics and Gynecology of the Second Affiliated Hospital of Hebei North College between July 2015 and April 2018 were randomly divided into the control group (n=31) and the observation group (n=31). All patients received routine treatment after laparoscopy, while those in the observation group received additional triptolide. The treatment efficacy, serum immune cells, inflammatory factors and the levels of cyclinD1, estrogen receptor α (ERα ) were observed and compared between the two groups. Results: The total remission rate of the patients in the observation group was 87.10%, significantly higher than 61.29% in the control group (P<0.05). After treatment, the levels of CD3+ and CD4+ T lymphocytes and CD4+ /CD8+ T lymphocytes in the two groups increased significantly, with more obvious increase in the observation group than that in the control group (P<0.01). The levels of CD8+ and programmed cell death-ligand 1 (PD-L1) T lymphocytes in the two groups decreased significantly after treatment, with a more obvious decrease in observation group than that in control group (P<0.01). After treatment, the levels of interleukin-6 (IL-6), IL-10 and tumor necrosis factor-α (TNF-α) in the two groups decreased, and those in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the positive expression rate of cyclinD1 decreased and the positive expression rate of ER α increased in both groups (all P<0.05), with no significant difference between the two groups (all P>0.05). Conclusion: On the basis of routine surgical treatment, triptolide can effectively improve the immune function, reduce the inflammatory response, inhibit the proliferation of tumor cells and regulate the expression of cancer-related factors in patients with cervical cancer, which has a certain therapeutic effect on cervical cancer.