A deep eutectic-based, self-emulsifying subcutaneous depot system for apomorphine therapy in Parkinson's disease.

Apomorphine, a dopamine agonist, is a highly effective therapeutic to prevent intermittent off episodes in advanced Parkinson's disease. However, its short systemic half-life necessitates three injections per day. Such a frequent dosing regimen imposes a significant compliance challenge, especially given the nature of the disease. Here, we report a deep eutectic-based formulation that slows the release of apomorphine after subcutaneous injection and extends its pharmacokinetics to convert the current three-injections-a-day therapy into an every-other-day therapy. The formulation comprises a homogeneous mixture of a deep eutectic solvent choline-geranate, a cosolvent n-methyl-pyrrolidone, a stabilizer polyethylene glycol, and water, which spontaneously emulsifies into a microemulsion upon injection in the subcutaneous space, thereby entrapping apomorphine and significantly slowing its release. Ex vivo studies with gels and rat skin demonstrate this self-emulsification process as the mechanism of action for sustained release. In vivo pharmacokinetics studies in rats and pigs further confirmed the extended release and improvement over the clinical comparator Apokyn. In vivo pharmacokinetics, supported by a pharmacokinetic simulation, demonstrate that the deep eutectic formulation reported here allows the maintenance of the therapeutic drug concentration in plasma in humans with a dosing regimen of approximately three injections per week compared to the current clinical practice of three injections per day.

I Single-Atom Doped P-Rich CoPn Nanocluster@CoP with Enhanced HER.

Constructing I single-atom (ISA) doped CoP electrocatalyst for HER is extremely challenging and has not been reported to date. Herein, an ISA doping-phosphatization strategy is proposed to prepare a novel I single-atom doped P-rich CoPn nanocluster@CoP electrocatalyst (ISA-CoPn/CoP) with enhanced HER performance first. ISA-CoPn/CoP shows a low overpotential of only 44 and 81 mV in 0.5 m H2SO4 solution, to drive a current density of 10 and 100 mA cm-2. ISA and P-rich CoPn nanocluster show unique synergies, which can optimize the H adsorption energy and accelerate the kinetics of HER in the CoP system. The intermediate I─H bond vibration peak is directly observed through in situ Raman testing, demonstrating that ISA doping helps accelerate the HER process. Additionally, the ΔGH of ISA-CoPn/CoP is only 0.05 eV by density functional theory (DFT) calculation, which is conducive to H2 evolution.

Colloidal Synthesis of Carbon Dot-ZnSe Nanoplatelet Van der Waals Heterostructures for Boosting Photocatalytic Generation of Methanol-Storable Hydrogen.

Methanol is not only a promising liquid hydrogen carrier but also an important feedstock chemical for chemical synthesis. Catalyst design is vital for enabling the reactions to occur under ambient conditions. This study reports a new class of van der Waals heterojunction photocatalyst, which is synthesized by hot-injection method, whereby carbon dots (CDs) are grown in situ on ZnSe nanoplatelets (NPLs), i.e., metal chalcogenide quantum wells. The resultant organic-inorganic hybrid nanoparticles, CD-NPLs, are able to perform methanol dehydrogenation through CH splitting. The heterostructure has enabled light-induced charge transfer from the CDs into the NPLs occurring on a sub-nanosecond timescale, with charges remaining separated across the CD-NPLs heterostructure for longer than 500 ns. This resulted in significantly heightened H2 production rate of 107 µmole·g-1·h-1 and enhanced photocurrent density up to 34 µA cm-2 at 1 V bias potential. EPR and NMR analyses confirmed the occurrence of α-CH splitting and CC coupling. The novel CD-based organic-inorganic semiconductor heterojunction is poised to enable the discovery of a host of new nano-hybrid photocatalysts with full tunability in the band structure, charge transfer, and divergent surface chemistry for guiding photoredox pathways and accelerating reaction rates.

The residual cancer burden index as a valid prognostic indicator in breast cancer after neoadjuvant chemotherapy.

PURPOSE: The residual cancer burden index (RCB) was proposed as a response evaluation criterion in breast cancer patients treated with Neoadjuvant Chemotherapy (NAC). This study evaluated the relevance of RCB with replase-free survival (RFS). METHODS: The clinical data of 254 breast cancer patients who received NAC between 2016 and 2020 were retrospectively collected. The relationship between clinicopathologic factors and RFS was evaluated using Cox proportional hazards regression models. RFS estimates were determined by Kaplan-Meier(K-M) analysis and compared using the log-rank test. Multivariate logistic regression analysis was used to evaluate the risk factors associated with RCB. Receiver operating characteristic (ROC) curves showed the potential of the RCB and MP grading systems as biomarkers for RFS. RESULTS: At a median follow-up of 52 months, 59 patients(23.23%) developed relapse. Multivariate Cox regression showed that older age (P = 0.022), high Pathologic T stage after NAC (P = 0.023) and a high RCB score(P = 0.003) were risk factors for relapse. The outcomes of the multivariate logistic analysis indicated that RCB 0 (pathologic complete response [pCR]) was associated with HER2-positive patients (P = 0.002) and triple-negative breast cancer (TNBC) patients (P = 0.013). In addition, the RCB and MP scoring systems served as prognostic markers for patients who received NAC, and their area under curves (AUCs) were 0.691 and 0.342, respectively. CONCLUSION: These data suggest that RCB can be equally applied to predict RFS in Chinese patients with NAC. The application of RCB may help guide the selection of treatment strategies.

A Multicenter Study of the Mid-term Outcomes of Patients with Uncomplicated Type B Aortic Dissection After Distal Porous Talos Stent-Graft Implantation.

BACKGROUND: The Talos stent-graft has extended length to improve aortic remodeling, and distal porous design to decrease the rate of spinal cord ischemia (SCI). This study retrospectively analyzed its mid-term outcomes for uncomplicated type B aortic dissection in a multicenter study. METHODS: The primary safety end point was 30-day major adverse events, including all-cause mortality, dissection-related mortality, conversion to open surgery, and device-related adverse events. The primary efficacy end point was treatment success at 12 months postoperation, defined as no technical failure or secondary dissection-related reintervention. The survival status of the patients was visualized using the Kaplan-Meier curve. Aortic growth was assessed at 4 levels, and SCI was evaluated at 12 months. RESULTS: 113 patients participated with a mean age of 54.4 (11.1) years and 71.7% (81/113) were male. The 30-day mortality was 0.9% (1/113), no conversions to open surgery or device-related adverse events were recorded. The 12-month treatment success rate was 99.1% (112/113), with no dissection-related reinterventions. There was no spinal cord or visceral ischemia at 12 months. At a median of 34 months follow-up, 9 further deaths were recorded and the 3-year survival rate was 91.7%. The percentage of aortic growth was 1.8% (2/111) at the tracheal bifurcation, 3.6% (4/111) below the left atrium, 6.0% (5/83) above the celiac artery, and 12.1% (9/74) below the lower renal artery. The total thrombosis rate of the false lumen at the stented segment was 80.5% (91/113). CONCLUSIONS: The results showed satisfactory results of Talos stent-graft in terms of safety and efficacy. More data are needed to confirm the long-term performance.

Reconfigurable microwave photonic mixer for hybrid macro-micro cellular systems.

Microwave photonic mixing can realize the frequency conversion of microwave signals in the optical domain, breaking through the bandwidth bottleneck and electromagnetic interference problems of traditional microwave mixing methods. In the background of the hybrid macro-micro cellular system, a wideband, large dynamic range and reconfigurable microwave photonic mixer is proposed, theoretically analyzed and experimentally demonstrated in this paper. By adjusting the modulator bias voltages and matching the proper digital domain operations, a microwave photonic mixer with reconfigurable functions including single-ended dispersion immune mixing, I/Q frequency down-conversion, image rejection mixing, and double-balanced mixing are realized, respectively. Meanwhile, optimizing the electrical attenuator using convex optimization can suppress the third-order intermodulation distortion (IMD3), maximize the conversion gain, and finally improve the spur-free dynamic range (SFDR). Experimental results show that the proposed scheme can be operated with a frequency from 5 to 20 GHz, and the SFDR can achieve 118.3 dB·Hz4/5. Over the whole frequency range, I/Q frequency down-conversion can be well conducted with an amplitude imbalance below 0.7 dB and a phase imbalance below ±0.7°. After an I/Q imbalance compensation algorithm, the image rejection ratio of over 60 dB is produced. The power fading caused by fiber dispersion is also compensated successfully. For a vector signal with 16 quadrature amplitude modulation, the best error vector magnitude (EVM) reaches 3.4%.

Erythrocyte-driven immunization via biomimicry of their natural antigen-presenting function.

Erythrocytes naturally capture certain bacterial pathogens in circulation, kill them through oxidative stress, and present them to the antigen-presenting cells (APCs) in the spleen. By leveraging this innate immune function of erythrocytes, we developed erythrocyte-driven immune targeting (EDIT), which presents nanoparticles from the surface of erythrocytes to the APCs in the spleen. Antigenic nanoparticles were adsorbed on the erythrocyte surface. By engineering the number density of adsorbed nanoparticles, (i.e., the number of nanoparticles loaded per erythrocyte), they were predominantly delivered to the spleen rather than lungs, which is conventionally the target of erythrocyte-mediated delivery systems. Presentation of erythrocyte-delivered nanoparticles to the spleen led to improved antibody response against the antigen, higher central memory T cell response, and lower regulatory T cell response, compared with controls. Enhanced immune response slowed down tumor progression in a prophylaxis model. These findings suggest that EDIT is an effective strategy to enhance systemic immunity.

Clinical features, treatment, and prognosis of 16 breast cancer patients with ocular metastases.

The incidence of ocular metastases in patients with disseminated breast cancer is increasing. This study aimed to investigate the clinical features, treatment, and prognosis of breast cancer patients with ocular metastases. For this purpose, a total of 16 patients were diagnosed with ocular metastases. Demographic, treatment, and other clinical data were obtained from patients' charts. The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) statuses of the patients were obtained from the histopathologic reports. Demographic features were analyzed through descriptive statistics, and the Kaplan-Meier method was used for survival analysis. The results showed that among the 16 patients (median age: 41 years), 10 had ER-positive, 8 had PR-positive, and 3 had HER2-positive disease. The choroid was the most commonly involved structure (n = 8). Nine (56%) patients had blurred vision. Treatments for these patients included systemic therapy (six patients), radiotherapy (three patients), and combined therapy (seven patients). The median time from the diagnosis of breast cancer to the diagnosis of ocular metastasis was 52.9 months, and the median time from the diagnosis of metastatic breast cancer at any other site to the diagnosis of ocular metastasis was 21.3 months. The median overall survival (OS) was 136.5 months (95% confidence interval, 40.6-232.4 months), and the median survival duration after ocular metastasis was 32.4 months (95% confidence interval, 20.1-44.7 months). The OS of patients with unilateral eye involvement and bilateral eye involvement did not differ significantly (P = 0.573), nor did the OS of those diagnosed before 2000 and in 2000 or later (P = 0.409). In general, a breast cancer patient with ocular metastasis can have a good prognosis after therapy. However, large-scale clinical studies are needed to confirm our findings.

Preparation Process Optimization and Performance Characterization of Feed Plant Essential Oil Microcapsules.

The exploration of safe antibiotic substitutes is one of the research hotspots in animal husbandry. Adding suitable plant essential oils into feed could improve the growth performance and immune capacity of animals. In order to make plant essential oil play a better role in feed application, sodium alginate and chitosan were used as the wall materials, and blended plant essential oils (BEO) as the core material to prepare BEO microcapsules by the sharp-hole condensation method. On the basis of single-factor experiments, the optimal preparation conditions for BEO microcapsules were obtained by response surface experiments. The physicochemical properties were characterized and analyzed by Fourier-transform infrared spectroscopy (FTIR) and field scanning electron microscope (FSEM). Meanwhile, the release mechanism was studied by simulating a gastrointestinal sustained-release experiment. The results showed that under the optimal preparation conditions, the encapsulation efficiency of BEO microcapsules could reach 80.33 ± 2.35%. FTIR and SEM analysis displayed that the microcapsules obtained had uniform color and size and a complete and compact structure. In vitro study indicated that the release amount of BEO microcapsules in the simulated intestinal fluid is higher than that in the simulated intestinal fluid, which was consistent with animal digestive and absorptive characteristics.

Targeted Therapy with Anlotinib for a Patient with an Oncogenic FGFR3-TACC3 Fusion and Recurrent Glioblastoma.

We describe a case of recurrent glioblastoma treated with anlotinib in this report. The patient was administered anlotinib 12 mg p.o. once every day (days 1-14, with a 21-day cycle) (anlotinib clinical study NCT04004975) and oral temozolomide chemotherapy 100 mg/m2 (days 1-7, days 15-21, 28-day cycle; 12 cycles). After 2 months of therapy, the patient achieved a partial response that has been maintained for >17 months of follow-up. Molecular characterization confirmed the presence of a TERT promoter mutation, wild-type IDH1/2, an FGFR3-TACC3 fusion, and FGFR3 amplification in the patient. Anlotinib is a multitarget tyrosine kinase inhibitor that was originally designed to inhibit VEGFR2/3, FGFR1-4, PDGFRα/ß, and c-Kit. Patients with TERT promoter mutations and high-grade IDH-wild-type glioma have shorter overall survival than patients with IDH-wild-type glioma without TERT promoter mutations. However, this patient had a favorable clinic outcome, and FGFR3-TACC3 fusion may be a new marker for treatment of glioma with anlotinib. KEY POINTS: This case study is believed to be the first report that FGFR3-TACC3 fusion could be a novel indication to treat recurrent glioblastoma with the drug anlotinib. This case exhibited an exceptional response (maintained partial response >17 months) after 2-month combined therapy of anlotinib and oral temozolomide chemotherapy. This case also underscores the importance of molecular diagnosis for clinically complex cases. Tumor tissue-based assessment of molecular biomarkers in brain tumors has been successfully translated into clinical application.

What is the abdomen? Rationalising clinical and anatomical perspectives using formal semantics.

The meaning of the term 'abdomen' has become increasingly ambiguous, as it has to satisfy the contemporary requirements of natural language discourse, literature, gross and radiological anatomy and its role in ontologies supporting electronic records and data modelling. It is critical that there is an agreed understanding of the semantics of the abdominopelvic cavity, its component volumes including the abdomen proper, true and false pelvic cavities, and its boundaries and regional contents. The expression of part-whole (meronymic) relationships is essential for inferences to be drawn by computer algorithms, but unless these are rigorously reviewed and tested incorrect assumptions are drawn. The SNOMED CT terminology descriptions and hierarchy of anatomical concepts relating to the trunk were scrutinised for ambiguity and sub-optimal relationships using a panel of reference sources. Any identified errors were corrected and the impact of any changes reviewed iteratively by evaluating their effect on dependant hierarchies (modelled with the associated anatomical concepts). Anatomical concepts are generally structured according to a traditional gross standpoint, but in clinical practice covert complex regional notions are frequently used and during the evaluation process a new viewpoint relating to projectional (transmissive) or emissive radiological perspective was identified. The subtle but important differences in the boundaries, volumes and contents of these distinctive perspectives of the 'abdomen' are presented. Three significant complex variants have been identified which relate to the most common uses of the word 'abdomen'. The merits and disadvantages of using 'abdomen' as common synonym to more than one concept (polysemy) are briefly discussed and the solution adopted by SNOMED International described. The review of existing ontologies and academic literature confirmed the frequent varied use of the word 'abdomen', which raises concerns when derived data are increasingly being used remotely from the point of clinical contact, potentially leading to incorrect inferences. The documented regional truncal volumes from an anatomical regional, segmental and cross-sectional perspective have been integrated into a logical and comprehensive model suitable for computer processing. The robust modelling of meronymic hierarchies has to be rigorous to avoid systematic errors and it is thus timely that a proposed standard description of these subtly related volumes and structures is made available for discussion and comment.

Linearity optimization of multi-octave analog photonic links based on power weighting, polarization multiplexing and bias control.

We present and demonstrate an approach to linearizing analog photonic links (APLs) with substantially enhanced multi-octave spurious-free dynamic range (SFDR). Combining with power weighting, polarization multiplexing and bias control techniques, the proposed approach enables the second-order harmonic distortion (HD2) and third-order intermodulation distortion (IMD3) to be suppressed simultaneously. To maximize the RF output power, an optimization model is established. The simulation results indicate that the maximum RF power can be attained when the power weighting factor and polarization incident angle are equal to 0.5 and 0.34 radians, respectively. The link is validated with a proof-of-principle experiment. The third-order SFDR is 112.3 dB·Hz2/3, corresponding to the improvement of 15.5 dB as compared with a quadrature-biased link. The second-order SFDR reaches as high as 94.6 dB·Hz1/2. Furthermore, the adjacent channel power ratio (ACPR) is measured to be up to 54.6 dBc, which is 5.4 dB greater than that of a quadrature-biased link. Finally, the system tolerances for the RF and optical input power are also investigated in terms of error vector magnitudes (EVMs). Therefore, by introducing optimization model, our scheme provides further insight into the APL linearization technique and a better performance is also achieved.

Analog radio-over-fiber links with a high SFDR for passive distributed antenna system applications using Lagrange multiplier optimization.

An analog radio-over-fiber scheme with a high spurious-free dynamic range (SFDR) is proposed for constructing a passive distributed antenna system (DAS). By developing a Lagrange multiplier constrained optimization model, the best trade-off among RF output power, the polarization incident angle, and the RF power ratio is obtained. Consequently, the third-order intermodulation distortion and second-order harmonic distortion can be suppressed simultaneously simply by varying the polarization incident angle. The simulated and experimental results show that the proposed scheme is effective and feasible. Additionally, this Letter offers valuable insights into the nonlinear optimization, and it may be of great significance in future design and manufacture.

L-carnitine regulated Nrf2/Keap1 activation in vitro and in vivo and protected oxidized fish oil-induced inflammation response by inhibiting the NF-κB signaling pathway in Rhynchocypris lagowski Dybowski.

Nrf2/Keap1 pathway is associated with oxidative stress. l-carnitine is currently under preclinical evaluation as a antioxidant, but the use of l-carnitine in aquaculture has been poorly evaluated and so far no mechanism has been demonstrated. Here, we explored the effects of l-carnitine in vitro and in vivo and discussed the possible molecular mechanisms involved. Firstly, Nrf2-siRNA significantly knocked down the mRNA level of Nrf2 in FHM cells. Thus, the activities of antioxidant enzymes (T-SOD, CAT, GSH-PX) and the level of antioxidant substance (GSH) and the level of MDA showed that Nrf2-siRNA pretreatment weakened the protective effect of l-carnitine. Moreover, the mRNA levels of Keap1, Nrf2, Maf and HO-1 indicated that l-carnitine regulated Nrf2/Keap1 activation. Furthermore, oxidized fish oil remarkably suppressed growth in Rhynchocypris lagowski Dybowski, and the lower antioxidant capacity was also observed in liver. According to the results of immune related indexes (the levels of IL-1ß, TNF-α, LZM, AKP) in serum and the mRNA levels of immune related genes (NF-κB, IL-1ß, TNF-α, IL-8, IL-10 and TGF-ß) in liver, oxidized fish oil also induced inflammatory response in fish. Also, l-carnitine supplementation can relieve this bad condition. In conclusion, l-carnitine regulated Nrf2/Keap1 activation in vitro and in vivo and protected oxidized fish oil-induced inflammation response by inhibiting the NF-κB signaling pathway in Rhynchocypris lagowski Dybowski.

Upregulation of Fibroblast Growth Factor 19 Is Associated with the Initiation of Colorectal Adenoma.

Fibroblast growth factor 19 (FGF19) promotes tumor growth in various types of cancer, but its function has not been investigated in the context of colorectal adenoma. Here, we report that FGF19 expression was greater in colorectal adenoma than in normal tissues, as measured by an enzyme-linked immunosorbent assay, quantitative reverse-transcription PCR and immunohistochemistry. FGF19 expression was also elevated in a subset of human colon cancer cell lines. Moreover, FGF receptor 4 (FGFR4), the cognate receptor for FGF19, was upregulated in colorectal adenoma tissues. Lipid levels and body mass index values strongly correlated with FGF19 and FGFR4 levels in patients with colon adenomas. These observations indicate that the FGF19/FGFR4 pathway may be involved in the development of neoplasia, and that FGF19 may be a valuable diagnostic marker for the identification of patients with colorectal adenomas.

Bacteria-Resistant Single Chain Cyclized/Knotted Polymer Coatings.

Further to conventional linear, branched, crosslinked, and dendritic polymers, single chain cyclized/knotted polymers (SCKPs) have emerged as a new class of polymer structure with unique properties. Herein, the development of bacteria-resistant SCKPs is reported and the effect of this structure on the resistance of polymer materials to bacteria is investigated. Four SCKPs were synthesized by reversible addition fragmentation chain transfer (RAFT) homopolymerization of multivinyl monomers (MVMs) and then crosslinked by UV light to form SCKP films. Regardless of MVM type used, the resulting SCKP films showed much higher resistance to bacteria, and up to 75 % less bacterial attachment and biofilm formation, in comparison with the corresponding non-SCKP films. This is due to the altered surface morphology and hydrophobicity of the SCKP films. These results highlight the critical role of the SCKP structure in enhancing the resistance of polymeric materials to bacteria.

All-optical and broadband microwave fundamental/sub-harmonic I/Q down-converters.

Microwave I/Q down-converters are frequently used in image-reject super heterodyne receivers, zero intermediate frequency (zero-IF) receivers, and phase/frequency discriminators. However, due to the electronic bottleneck, conventional microwave I/Q mixers face a serious bandwidth limitation, I/Q imbalance, and even-order distortion. In this paper, photonic microwave fundamental and sub-harmonic I/Q down-converters are presented using a polarization division multiplexing dual-parallel Mach-Zehnder modulator (PDM-DPMZM). Thanks to all-optical manipulation, the proposed system features an ultra-wide operating band (7-40 GHz in the fundamental I/Q down-converter, and 10-40 GHz in the sub-harmonic I/Q down-converter) and an excellent I/Q balance (maximum 0.7 dB power imbalance and 1 degree phase imbalance). The conversion gain, noise figure (NF), even-order distortion, and spurious free dynamic range (SFDR) are also improved by LO power optimization and balanced detection. Using the proposed system, a high image rejection ratio is demonstrated for a super heterodyne receiver, and good EVMs over a wide RF power range is demonstrated for a zero-IF receiver. The proposed broadband photonic microwave fundamental and sub-harmonic I/Q down-converters may find potential applications in multi-band satellite, ultra-wideband radar and frequency-agile electronic warfare systems.

Prevalence and extent of right-to-left shunt on contrast-enhanced transcranial Doppler in Chinese patients with migraine in a multicentre case-control study.

Background The association between RLS and migraine is still debated. The aim of this study is to investigate the prevalence and grade of RLS in Chinese patients with migraine and to evaluate the relationship between RLS and migraine. Methods A multi-center case-control study of contrast-enhanced transcranial Doppler was conducted in 931 consecutive patients with migraine (240 of 931 had migraine with aura and 691 of 931 were in the migraine without aura group) and 282 were healthy adults. Clinical trial no. NCT02425696. Results The prevalence of RLS was 63.8% and 39.9% in the migraine with aura group (MA+) and migraine without aura group (MA-), respectively, significantly higher than that of the healthy group (29.4%, p < 0.001; p < 0.001). The positive rate of large RLS in the MA+ group and MA- group was 32.1% and 16.5%, respectively, significantly higher than healthy group (6.4%, p < 0.001; p < 0.001). There was no difference among groups in terms of positive rate of permanent RLS ( p = 0.704). Conclusion This multi-centre case-control study suggested that there is an association between RLS and migraine with and without aura, especially when the shunt is large.

Brushlike Cationic Polymers with Low Charge Density for Gene Delivery.

Using a combined synthesis approach comprising reversible addition-fragmentation transfer polymerization and ring opening reaction, a series of poly glycidyl methacrylate (polyGMA) polymers were designed and synthesized for gene delivery. These polymers characterized by low cationic charge respective to established gene delivery vectors such as PEI were studied to further elucidate the key structure-activity parameters that mediate efficient and biocompatible gene delivery. Compared to PEI, these brushlike polymers facilitated markedly improved safety and gene delivery efficiency.

An unusual case of giant aneurysm of the noncoronary sinus of Valsalva with rupture into the left ventricular outflow tract along with distortion of the mitral valve.

Aneurysms of the aortic sinus are well-known clinical entities that can bulge into adjacent heart chambers or vessels. They usually reside in the right ventricle and very rarely bulge into the left ventricle causing mitral valve deformation. A 47-year-old man was admitted for shortness of breath and chest pain after exertion. He was diagnosed with a noncoronary sinus of Valsalva aneurysm bulging into the mitral valve's anterior leaflet. The aortic valve and mitral valve annulus were severely damaged and irreparable. A Bentall procedure and mechanical mitral valve replacement were performed. The patient recovered uneventfully and was discharged 11 days later.