The European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) have recently updated and published the 2024 ESC guidelines for the management of atrial fibrillation. Based on the latest evidences, the guidelines have been updated in many aspects, such as diagnostic criteria for atrial fibrillation, AF-CARE treatment principles, comorbidities and risk factor management. In particular, there are significant changes in the recommendations for surgical management of atrial fibrillation in the guidelines. Therefore, this paper aims to interpret the content updates of the guidelines in AF-CARE treatment principles, diagnostic criteria and surgical treatment of atrial fibrillation, especially highlighting the updates and new suggestions about surgical treatment of atrial fibrillation.

Currently, in precision cardiac surgery, there are still some pressing issues that need to be addressed. For example, cardiopulmonary bypass remains a critical factor in precise surgical treatment, and many core aspects still rely on the experience and subjective judgment of cardiopulmonary bypass specialists and surgeons, lacking precise data feedback. With the increasing elderly population and rising surgical complexity, precise feedback during cardiopulmonary bypass becomes crucial for improving surgical success rates and facilitating high-complexity procedures. Overcoming these key challenges requires not only a solid medical background but also close collaboration among multiple interdisciplinary fields. Establishing a multidisciplinary team encompassing professionals from the medical, information, software, and related industries can provide high-quality solutions to these challenges. This article shows several patents from a collaborative medical and electronic information team, illustrating how to identify unresolved technical issues and find corresponding solutions in the field of precision cardiac surgery while sharing experiences in applying for invention patents.

Background: Esophageal cancer is one of the leading causes of cancer deaths worldwide. T-cell immunoglobulin and mucin domain-containing protein 3 (Tim-3) has been shown to be implicated in the tumor immune escape, and associated with tumor progression and poor prognosis in a variety of malignancies. Aims: To investigate the expression of Tim-3 in esophageal tumorigenesis and its clinical significance. Methods: Paraffin-embedded tissues from 103 esophageal cancer, 21 high-grade esophageal intraepithelial neoplasia, 16 low-grade esophageal intraepithelial neoplasia, and 20 chronic esophagitis were collected in this study. Using immunohistochemistry, the expression level of Tim-3 was evaluated; and the correlation of Tim-3 expression in cancerous tissue with the clinicopathological parameters of esophageal cancer was analyzed. Results: Tim-3 expression was increased from chronic esophagitis, low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia to esophageal cancer (0.271±0.138, 0.368±0.198, 0.443±0.147, and 0.639±0.119, P<0.05). Moreover, Tim-3 expression was significantly correlated with depth of tumor invasion, regional lymph node metastasis and TNM staging of esophageal cancer (P<0.05), whereas no relationship was found between Tim-3 expression and gender, age and tumor location of esophageal cancer (P>0.05). Conclusions: Tim-3 expression is increased in esophageal tumorigenesis; overexpression of Tim-3 in esophageal cancer is closely correlated with tumor progression. Tim-3 might be served as a biomarker for development, progression and prognosis of esophageal cancer.

Objective     To evaluate the short-term outcome and influence of atrial fibrillation ablation and mitral valve replacement for patients with mitral valve stenosis and atrial fibrillation. Methods     Retrospective analysis was conducted for 44 patients with rheumatic mitral valve stenosis and atrial fibrillation who experienced mitral valve replacement with or without surgical atrial fibrillation ablation procedure in our hospital from January 2016 to June 2017. Eighteen patients experienced mitral valve replacement and surgical atrial fibrillation ablation procedure (a group 1), and the other 26 patients experienced mitral valve replacement without surgical atrial fibrillation ablation procedure (a group 2). In th group 1, there were 4 males and 14 females, aged 43-67 (55.67±7.56) years, and in the group 2 there were 6 males and 20 females, aged 40-72 (54.81±8.81) years. The patients’ data, preoperative echocardiography, surgery procedures, perioperative events, echocardiography and electrocardiogram at postoperative three months were collected to evaluate the short-term outcome and influence of surgical atrial fibrillation ablation procedure for those patients. Results     There was no statistical difference in the operation duration (P=0.867) and ICU stay (P=0.550) between the two groups. But the group 1 had longer extracorporeal circulation duration (P=0.006) and aorta arrest duration (P=0.001) than the group 2. No patient died perioperatively and one patient from the group 1 experienced reoperation because of too much chest tube drainage. At three months after operation, echocardiography and electrocardiogram examination showed that 16 patients in the group 1 and 2 patients in the group 2 had sinus rhythm. There was no statistical difference between postoperative and preoperative examination about variation in left ventricle ejection fraction, pulmonary arterial systolic pressure, left atrial diameter and left ventricular end diastolic diameter between the two groups (all P>0.05). Conclusion     Atrial fibrillation ablation does not increase the risk of mitral valve replacement for patients who have mitral valve stenosis and atrial fibrillation. The rate of converting to sinus rhythm is high, but additional atrial fibrillation ablation procedure does not have positive or negative influence on short-term recovery of cardiac structure and function after operation.

Objective To study laparoscopic microwave ablation (LWMA) in treating colorectal cancer liver metastases,and to evaluate its local efficacy and the factors influencing long-term survival.Methods A retrospective study was conducted on 24 patients with hepatic metastases after radical surgery of colorectal cancerin.These patients were treated with LWMA in Wenzhou People's Hospital from April 2012 to April 2017.The complete ablation,major complication,overall survival and disease-free survival rates were determined,and the factors influencing survival were analyzed.Results 71 tumor lesions in 24 patients were treated with LWMA.After the initial LWMA,complete tumor ablation was achieved in 70 lesions (98.6％).There were no serious adverse reactions and perioperative deaths.Conclusions LWMA had good short-term and long-term results.There were no serious adverse results.LWMA is an efficacious and safe treatment for patients with CRLM.

Objective To construct a rapid genetic DNA extraction method, with nano magnetic beads, self-designed reagents system and extracting process. Method Part I: DNA extraction from old blood cotton swab sample with self-designed DNA extraction kit, then quantiifed by UV spectrophotometer. The method was further optimized on the preliminary results. Part II: All kinds of difficult DNA sample were tested with optimized kit, to detect the applicability of the kit. Result By improving the experimental condition, the extraction effects of different DNA sample is good, meanwhile, the extraction cost is relatively low.

OBJECTIVETo determine the feasibility and efficacy of endoscopic submucosal dissection(ESD) in treating early gastric cancer(EGC) and precancerous lesions in the remnant stomach of patients after gastrectomy.

METHODSClinical data of 36 patients with EGC and precancerous lesions in remnant stomach undergoing ESD in Endoscopy Center of Zhongshan Hospital from January 2008 to December 2013 were retrospectively analyzed. Operative, postoperative conditions and long-term follow-up of these patients were evaluated.

RESULTSBoth the success rate and the complete resection rate were 100%. The average maximum diameter of the tumor was 1.5(range 0.6-4.5) cm. During the ESD process, two bleeding cases were treated successfully by endoscopic hemostasis. The average operation time was 40(10-80) min. The delayed hemorrhage developed in 2 cases within 1-3 days after operation, and were also treated successfully by endoscopic hemostasis. There was no perforation or delayed perforation. No emergency surgery was required for the complication. Twelve cases were diagnosed as mild-moderate dysplasia, 7 cases as high grade intraepithelial neoplasia, 16 cases as hyperplastic polyps, and 1 case as signet ring cell carcinoma with T1 stage, who underwent operation for resecting gastric stump and lymph node dissection 7 days after ESD without subsequent follow-up. The curative resection rate was 92.7%(35/36). The median follow-up of the remaining 35 patients was 36(6-78) months without discomfort and recurrence under gastroscopy.

CONCLUSIONESD is safe and effective for EGC and precancerous lesions in the remnant stomach.

Adenocarcinoma ; Dissection ; Gastrectomy ; Gastric Mucosa ; Gastric Stump ; Gastroscopy ; Hemostasis, Endoscopic ; Humans ; Lymph Node Excision ; Neoplasm Recurrence, Local ; Operative Time ; Retrospective Studies ; Stomach Neoplasms

Objective To determine the feasibility and efficacy of endoscopic submucosal dissection(ESD) in treating early gastric cancer(EGC) and precancerous lesions in the remnant stomach of patients after gastrectomy. Methods Clinical data of 36 patients with EGC and precancerous lesions in remnant stomach undergoing ESD in Endoscopy Center of Zhongshan Hospital from January 2008 to December 2013 were retrospectively analyzed. Operative, postoperative conditions and long-term follow-up of these patients were evaluated. Results Both the success rate and the complete resection rate were 100%. The average maximum diameter of the tumor was 1.5 (range 0.6-4.5) cm. During the ESD process, two bleeding cases were treated successfully by endoscopic hemostasis. The average operation time was 40 (10-80) min. The delayed hemorrhage developed in 2 cases within 1-3 days after operation , and were also treated successfully by endoscopic hemostasis. There was no perforation or delayed perforation. No emergency surgery was required for the complication. Twelve cases were diagnosed as mild-moderate dysplasia, 7 cases as high grade intraepithelial neoplasia, 16 cases as hyperplastic polyps, and 1 case as signet ring cell carcinoma with T1 stage, who underwent operation for resecting gastric stump and lymph node dissection 7 days after ESD without subsequent follow-up. The curative resection rate was 92.7%(35/36). The median follow-up of the remaining 35 patients was 36 (6-78) months without discomfort and recurrence under gastroscopy. Conclusion ESD is safe and effective for EGC and precancerous lesions in the remnant stomach.

Objective To determine the feasibility and efficacy of endoscopic submucosal dissection(ESD) in treating early gastric cancer(EGC) and precancerous lesions in the remnant stomach of patients after gastrectomy. Methods Clinical data of 36 patients with EGC and precancerous lesions in remnant stomach undergoing ESD in Endoscopy Center of Zhongshan Hospital from January 2008 to December 2013 were retrospectively analyzed. Operative, postoperative conditions and long-term follow-up of these patients were evaluated. Results Both the success rate and the complete resection rate were 100%. The average maximum diameter of the tumor was 1.5 (range 0.6-4.5) cm. During the ESD process, two bleeding cases were treated successfully by endoscopic hemostasis. The average operation time was 40 (10-80) min. The delayed hemorrhage developed in 2 cases within 1-3 days after operation , and were also treated successfully by endoscopic hemostasis. There was no perforation or delayed perforation. No emergency surgery was required for the complication. Twelve cases were diagnosed as mild-moderate dysplasia, 7 cases as high grade intraepithelial neoplasia, 16 cases as hyperplastic polyps, and 1 case as signet ring cell carcinoma with T1 stage, who underwent operation for resecting gastric stump and lymph node dissection 7 days after ESD without subsequent follow-up. The curative resection rate was 92.7%(35/36). The median follow-up of the remaining 35 patients was 36 (6-78) months without discomfort and recurrence under gastroscopy. Conclusion ESD is safe and effective for EGC and precancerous lesions in the remnant stomach.

BACKGROUND: Studies have demonstrated that trehalose possesses protective effects on cyropreserved sternum. But the mechanism of action remains poorly understood. OBJECTIVE: To investigate the effects of trehalose on bcl-2 and bax mRNA expression in cryopreserved sternum. METHODS: Four groups of freshly prepared solution were used: low-potassium dextran (LPD), LPD + dimethyl sulfoxide (DMSO), LPD + trehalose, LPD + DMSO + trehalose. Rat sternum was cut and then immediately cryopreserved in the tubes containing each group of solution. Fresh rat sternum tissue and 4 groups of samples cryopreserved for 120 days were taken and bcl-2 and bax mRNA expression in fresh and cryopreserved sternum was detected using reverse transcription-polymerase chain reaction.RESULTS AND CONCLUSION: bcl-2 mRNA expression in the LPD + trehalose group was significantly higher, but bax mRNA expression was significantly lower, than in the LPD, LPD + DMSO groups (both P < 0.01). LPD + DMSO + trehalose group showed highest bcl-2 mRNA expression and lowest bax mRNA expression, which were basically similar to fresh bone tissue (P > 0.05). These findings indicate that trehalose may protect cell activity in cryopreserved sternum by enhancing bcl-2 mRNA expression and inhibiting bax mRNA expression, and trehalose together with DMSO shows better protective effects.