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.

Objective To analyze the long-term outcome of modified Morrow surgery (interventricular septal cardiomyectomy) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM) in children. Methods The clinical data of the children with HOCM (aged≤14 years) who underwent modified Morrow surgery from January 2010 to August 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed, including changes in hospitalization status, perioperative period, and long-term 15-lead electrocardiogram and echocardiography. Results A total of 29 patients were collected, including 22 males and 7 females, aged 10.00 (5.00, 12.00) years. Five (17.9%) patients had New York Heart Association (NYHA) heart function grade Ⅲ or Ⅳ. Ventricular septal cardiomyectomy was performed in all patients. All 29 patients survived and their cardiac function recovered after operation. Before discharge, right bundle branch block was observed in 2 patients and left bundle branch block in 6 patients. After surgery, in the left ventricular septal cardiomyectomy, the left atrial diameter decreased (P＜0.001), left ventricular end-systolic diameter increased (P=0.009), the peak pressure gradient of left ventricular outflow tract decreased (P＜0.001), and the thickness of ventricular septum decreased (P＜0.001). The systolic anterior motion of mitral valve disappeared and mitral regurgitent jet area decreased (P＜0.001). The flow velocity and peak pressure gradient of right ventricular outflow tract also decreased in the patients who underwent right ventricular septal cardiomyectomy. The average follow-up of the patients was 69.03±10.60 months. All the patients survived with their NYHA cardiac function grading Ⅰ or Ⅱ. No new-onset arrythmia event was found. Echocardiography indicated that the peak pressure gradient of the left ventricular outflow tract remained low (P<0.001). Moderate mitral regurgitation occurred in 2 patients, and left ventricular outflow tract obstruction with moderate mitral regurgitation occurred in 1 patient after simple right ventricular septal cardiomyectomy. Conclusion Right ventricular or biventricular obstruction is frequent in the children with HOCM and they usually have more symptoms before surgery. Modified Morrow surgery can effectively relieve outflow tract obstruction and improve their cardiac function. The long-term outcome is satisfactory. However, the posterior wall of the left ventricle remains hypertrophic. Also, there is an increased risk of a conduction block.

The registration of preoperative magnetic resonance (MR) images and intraoperative ultrasound (US) images is very important in the planning of brain tumor surgery and during surgery. Considering that the two-modality images have different intensity range and resolution, and the US images are degraded by lots of speckle noises, a self-similarity context (SSC) descriptor based on local neighborhood information was adopted to define the similarity measure. The ultrasound images were considered as the reference, the corners were extracted as the key points using three-dimensional differential operators, and the dense displacement sampling discrete optimization algorithm was adopted for registration. The whole registration process was divided into two stages including the affine registration and the elastic registration. In the affine registration stage, the image was decomposed using multi-resolution scheme, and in the elastic registration stage, the displacement vectors of key points were regularized using the minimum convolution and mean field reasoning strategies. The registration experiment was performed on the preoperative MR images and intraoperative US images of 22 patients. The overall error after affine registration was (1.57 ± 0.30) mm, and the average computation time of each pair of images was only 1.36 s; while the overall error after elastic registration was further reduced to (1.40 ± 0.28) mm, and the average registration time was 1.53 s. The experimental results show that the proposed method has prominent registration accuracy and high computational efficiency.
Humans ; Imaging, Three-Dimensional/methods* ; Magnetic Resonance Imaging/methods* ; Ultrasonography/methods* ; Algorithms ; Surgery, Computer-Assisted/methods*

Objective To investigate the risk factors of prolonged postoperative mechanical ventilation for adult patients with atrioventricular septal defect (AVSD). Methods We retrospectively analyzed the clinical data of 76 patients with AVSD aged more than 18 years in our hospital from January 1, 2011 to December 31, 2017. The patients ventilated longer than 24 hours were described as a prolonged ventilation group (n=27) and the others as a normal group (n=49). There were 9 males and 18 females aged 32.22±9.64 years in the prolonged ventilation group, and 16 males and 33 females aged 35.98±11.34 years in the normal group. Perioperative variables between the two groups were compared and selected, and then analyzed by logistic regression analysis. Results The result of univariate analysis showed that there was a statistical difference in weight, preoperative pulmonary artery systolic pressure, duration of cardiopulmonary bypass, the level of postoperative platelet, hemoglobin, blood glucose, lactic acid and serum creatinine, postoperative maximum heart rate and postoperative infection rate between the prolonged ventilated group and the normal group. Multivarable logistic regression showed that preoperative pulmonary artery hypertension (OR=1.056, 95%CI 1.005 to 1.110, P=0.030), prolonged duration of cardiopulmonary bypass (OR=1.036, 95%CI 1.007 to 1.066, P=0.016) and the low postoperative hemoglobin level (OR=0.874, 95%CI 0.786 to 0.973, P=0.014) were the risk factors of prolonged postoperative mechanical ventilation. Conclusion Preoperative pulmonary artery hypertension, long duration of cardiopulmonary bypass and postoperative anaemia are the risk factors associated with prolonged postoperative mechanical ventilation.

Deep hypothermic circulatory arrest (DHCA) is an important assistant technique for complex cardiac surgery, which creates convenient operating conditions for surgery, and is also one of the measures to protect the brain during operation. However, the complications caused by this technique cannot be ignored, and it should be noticed that the occurrence of intestinal injury is relatively insidious, but brings great pain to patients and significantly reduces the quality of life after operation. Studies have shown that intestinal ischemia-reperfusion injury is induced by DHCA. It causes mast cells to activate and release many inflammatory mediators that destroy the intestinal mucosal epithelium barrier, and eventually lead to intestinal injury. This article reviewed the research progress of mast cells in the mechanism of DHCA-induced intestinal injury.

Objective To investigate the diagnostic value of multimodal MRI for dual pathology (DP)in temporal lobe epilepsy (TLE).Methods The methods of voxel based morphometry (VBM)and voxel based analysis (VBA)had been employed to study the difference between 36 patients (20 cases left group and 16 cases right group)with TLE caused by DP and 36 healthy subjects on the grey matter (GM)volume,exponential apparent diffusion coefficient (eADC)and cerebral blood flow (CBF)value.The corresponding statistical study had also been conducted.Results There were significant statistical differences (FDR correction,P=0.001)between healthy subj ects and patients on the GM volume,eADC and CBF value.Those values decreased with diseased laterality and wider range in functional imaging.These overlaying abnormal brain regions were located in the temporal pole (superior temporal gyrus), temporal pole (middle temporal gyrus),middle temporal gyrus,inferior temporal gyrus,fusiform gyrus,hippocampus and parahippocampal gyrus which represented in all examination results.Conclusion The combined findings of multimodal MRI can improve the localization ability of seizure focus in TLE,which caused by DP,before surgery.

In recent years, transesophageal echocardiography has a trend toward miniaturization, so it has great clinical significance and broad clinical application prospect in the management of Cardiac Surgery ICU patient. This paper presents the characteristics of miniaturized transesophageal echocardiography and its clinical application. And we also focused on the contrast between miniaturized transesophageal echocardiography and standard transesophageal echocardiography and transthoracic echocardiography.

BACKGROUND:Exploration on nonlinear acoustic response of the contrast agent microbubble contained in microvessel under ultrasound excitation is of great significance to maximizing ultrasonic energy deposition, promoting the development of quantitative imaging algorithm, revealing the damage mechanism or evaluating the targeted therapy, and overcoming the limitations of the traditional methods that are mainly used in large-size vessels, and measuring microvessel elasticity.
OBJECTIVE:To build a microvessel containing an ultrasound microbubble, revealing the internal mechanism among ultrasound, microbubble, blood flow and microvessel.
METHODS:Based on the finite element analysis and the lumped parameter model, three-dimensional microvessel containing microbubble model was built and simulated on Comsol Multiphysics 4.4 platform.
RESULTS AND CONCLUSION:Microbubble exhibited slower radial motion compared with axial motion due to vascular wal limitation, but maximum displacement and stress were found near the microbubble center because of the oscil ation coupling of the microbubble with the vascular wal . Under the same ultrasound pressure, the excitation frequency increased, accompanied by decreased and stabilized microvessl constriction and dilation;under the same frequency, with the enhancement of ultrasound pressure, the local microbubble oscil ation lasted longer. With the increase of Young’s modulus of the microvessel wal , the frequency of microbubble oscil ation was reduced, while the amplitude increased. Al these findings indicate that the frequency of microbubble oscil ation increased with the reduction of microvessel size, while its amplitude decreased. The frequency of microbubble oscil ation increased with the enhancement of ultrasound excitation, while the amplitude decreased. On the contrary, ultrasound pressure affected the dynamic characteristics of microbubble and microvessel. In particular, it was the first to demonstrate that the elasticity of microvessel has approximate linear positive correlation with the amplitude of microbubble oscil ation, which reveals the relationship between microvessel elasticity and microbubble response so as to provide theoretical basis for indirect measurement of microvessel elasticity.

Medical parasitology education has been facing some difficulties because it is a course of wide range lacking clini?cal cases and concerned specimens of parasites currently. In addition its relationship with life is not closely enough. All these reasons may impact the effect of class education negatively. Therefore it is important to increase the vitality of parasitology edu?cation and diversify the instructional mode by using the resources from Internet. In recent years the Discovery Channel has up?loaded a documentary Monsters Inside Me online. This documentary is high professional and closely linked with parasitology. It maintains numbers of clinical cases about parasitic diseases. Each episode is about 3 minutes and shortly enough to be intro?duced into class teaching. However this resource has not been fully used in domestic temporally. We found that direct introduc?tion of the documentary into class teaching can enrich teaching forms to attract learning interest of students and finally improve the teaching effect of class. Above that another popular documentary A Bite of China involves many related knowledge points of parasitology. The appropriate usage of the knowledge can build up close linkage between book and life which is extremely help?ful to give students a deep impression of parasitology. In brief it is our strong recommendation to introduce the documentary Monsters Inside Me into class.

The virtual surgical system is a surgical simulated software adopting image processing and 3-D visualization technology. It can help the surgeons to determine the operating position, simulate operation and plan for a optimal operation. VTK which exhibits high performance in visualization and ITK which has strong ability in image processing were integrated to solve the key problems such as image segmentation, image registration and fusion, 3-D reconstructing and virtual cropping. Experiments indicated that the integrated 3-D virtual surgical system can help surgeons to observe the surgical process and improve its reliability and quality.