Risk Factors for Aortic Regurgitation Progression After Repair of Sinus of Valsalva Aneurysm.

BACKGROUND: The main treatment for a ruptured sinus of Valsalva aneurysm (SVA) is surgical repair. Postoperative progression of aortic regurgitation (AR) following SVA repair increases the risk of reoperation, which decreases the long-term survival. Thus, identifying the risk factors for postoperative AR progression is of great significance. METHODS: Adult patients who were diagnosed with ruptured SVA and underwent surgical repair at the current centre were reviewed. Necessary data in the institutional database were extracted. The perioperative and follow-up assessments of the aortic valve by transthoracic echocardiography were also obtained. The aortic regurgitation progression was grouped into three categories: newly developing, recurrence, and worsening. Sixteen (16) variables were screened to identify potential risk factors by univariate logistic regression analysis or Chi-squared test. Variables with p-values <0.1 were further analysed by multivariate logistic regression models to find independent risk factors. RESULTS: A total of 198 consecutive patients from June 2006 to January 2018 were included. The overall incidence of postoperative AR progression was 19.2% (38 of 198). After the univariate analysis, SVA originating from the right coronary sinus, coexisting with ventricular septal defect, larger diameter of aortic annulus, and larger cardiothoracic ratio were screened as potential risk factors. Multivariate analysis indicated that coexisting with a ventricular septal defect (VSD) (OR, 2.82; 95% CI, 1.217-6.532; p=0.016) and larger cardiothoracic ratio (OR, 1.061; 95% CI, 1.001-1.124; p=0.047) were independent risk factors for postoperative AR progression. CONCLUSIONS: To prevent postoperative AR progression after surgical repair, more careful inspection and appropriate surgical techniques are necessary for patients coexisting with VSD or with a larger cardiothoracic ratio.

Left atrial appendage occlusion for patients with valvular diseases without atrial fibrillation (the OPINION Study): study protocol for a multicentre, randomised controlled trial.

INTRODUCTION: Atrial fibrillation (AF) is a significant cause of perioperative stroke in aortic and mitral valve surgeries. Although several large studies have evaluated surgical left atrial appendage occlusion (SLAAO) during cardiac surgeries, their retrospective nature and an uncontrolled broad spectrum of conditions leave them subject to potential residual confounding. This trial aims to test the hypothesis that opportunistic SLAAO can prevent long-term stroke after cardiac surgery in patients receiving mitral or aortic valve surgeries without a history of AF and with a CHA2DS2-VASc score of 2 or higher. METHODS AND DESIGN: This study is a single-blinded, multicentre, randomised controlled trial. A total of 2118 patients planning to undergo aortic or mitral surgery without AF will be recruited and equally randomised into intervention or control arms at a 1:1 ratio. In the intervention arm, suture excision of the left atrial appendage (LAA) will be performed during the operation in addition to the original surgery plan. In the control arm, the operation will be performed according to the surgery plan without any intervention on the LAA. The primary outcome is a composite of newly occurred ischaemic stroke or transient ischaemic attack and cardiovascular mortality during a 1-year follow-up. Secondary outcomes include postoperative AF, cardiovascular mortality, newly occurred ischaemic stroke, newly occurred transient ischaemic attack, newly occurred haemorrhagic stroke, bleeding events, and AF-associated health utilisation. ETHICS AND DISSEMINATION: The Ethics Committee in Fuwai Hospital approved this study. Patients will give informed consent to the study. An information leaflet will be provided to participating patients to introduce the SLAAO procedure. Patients and the public will not get involved in developing the research hypothesis, study design or any other part of this protocol. We plan to publish several papers in peer-reviewed journals about the current research and these will include a description of the study's development and the main findings of the study. TRIAL REGISTRATION NUMBER: ChiCTR2100042238.

Effects of peripheral blood neutrophil/lymphocyte ratio levels and their changes on the prognosis of patients with early cervical cancer.

Although some studies have reported on the levels and clinical significance of peripheral blood neutrophil/lymphocyte ratio (NLR) in cervical cancer, the role of NLR levels and their changes preoperatively and postoperatively in early cervical cancer remain unclear. Our analyses explored the preoperative and postoperative NLR in 203 patients with stage I-IIA cervical cancer and evaluated the relationship between NLR changes, clinicopathological characteristics, and patient prognosis. The cut-off preoperative and postoperative NLR values were determined using receiver operating characteristic curve analysis. Preoperative NLR correlated with age, menopausal status, tumor size, and vascular infiltration, whereas postoperative NLR correlated with tumor differentiation. Patients with cervical cancer with a high preoperative NLR had significantly shorter overall survival (OS) and progression-free survival (PFS) than other patients, whereas PFS was significantly lower in the high postoperative NLR group. When comparing postoperative and preoperative NLR values, we observed a significantly higher rate of increase in postmenopausal patients and those without vascular infiltration than that among premenopausal patients and those with vascular infiltration. However, no clear difference in prognosis was observed between the groups with increased and decreased NLR. Therefore, a high peripheral blood NLR may predict a poor prognosis in patients with early cervical cancer. The effect of NLR changes on the prognosis of patients with cervical cancer requires further verification in multicenter studies.

A chalcone-syringaldehyde hybrid inhibits triple-negative breast cancer cell proliferation and migration by inhibiting CKAP2-mediated FAK and STAT3 phosphorylation.

BACKGROUND: Although triple-negative breast cancer (TNBC) accounts for only 15% of breast cancer cases, it is associated with a high relapse rate and poor outcome after standard treatment. Currently, the effective drugs and treatment strategies for TNBC remain limited, and thus, developing effective treatments for TNBC is pressing. Several studies have demonstrated that both chalcone and syringaldehyde have anticancer effect, but their potential anti-TNBC bioactivity are still unknown. PURPOSE: The present study aimed to synthesize a chalcone-syringaldehyde hybrid (CSH1) and explore its potential anti-TNBC effects and the underlying molecular mechanism. METHODS: Cell cytotoxicity was determined by 3-(4,5-dimethythiazol)-2,5-diphenyltetrazolium bromide (MTT). The activity of cell proliferation was measured by colony formation assay and 5-ethynyl-2'-deoxyuridine (EdU) staining assay. Cell cycle distribution and cell apoptosis were determined by fluorescence-activated cell sorter (FACS). The situation of DNA damage was observed using fluorescence microscopy. The ability of cell-matrix adhesion, migration and invasion was detected using cell adhesion assay and transwell assay. Transcriptome sequencing was performed to find out the changed genes. Levels of various signaling proteins were assessed by western blotting. RESULTS: CSH1 treatment triggered DNA damage and inhibited DNA replication, cell cycle arrest, and cell apoptosis via suppressing signal transducer and activator of transcription 3 (STAT3) phosphorylation. Whole genome RNA-seq analysis suggested that 4% of changed genes were correlated to DNA damage and repair, and nearly 18% of changed genes were functionally related to cell adhesion and migration. Experimental evidence indicated that CSH1 treatment significantly affected the distribution of focal adhesion kinase (FAK) and its phosphorylation, resulting in cell-matrix-adhesion reduction and migration inhibition of TNBC cells. Further mechanistic studies indicated that CSH1 inhibited TNBC cell proliferation, adhesion, and migration by inhibiting cytoskeleton-associated protein 2 (CKAP2)-mediated FAK and STAT3 phosphorylation signaling. CONCLUSION: These results suggest that CKAP2-mediated FAK and STAT3 phosphorylation signaling is a valuable target for TNBC treatment, and these findings also reveal the potential of CSH1 as a prospective TNBC drug.

Extracardiac Tricuspid Annuloplasty: A Novel Technique for Functional Tricuspid Regurgitation.

We report 3 cases of functional tricuspid regurgitation and demonstrate a novel tricuspid repair technique through the right atrioventricular groove without cardiopulmonary bypass or open heart surgery, which provides a new idea for the treatment of functional tricuspid regurgitation.

The enlargement rate of ventricular septal rupture is a risk factor for 30-day mortality in patients with delayed surgery.

BACKGROUND: Postinfarction ventricular septal rupture (VSR) is an uncommon but challenging mechanical complication for surgeons. This study analyzed the impacts of rupture size on surgical outcomes in patients with VSR. METHODS: During a 15-year period, from January 2006 to December 2020, 112 patients underwent repairs of postinfarction VSR. Patient clinical data, including angiographic and echocardiographic findings, operative procedures, early morbidity and mortality, and survival time were collated. Univariable and multivariable analyses were performed to identify the risk factors of 30-day mortality. RESULTS: The 30-day mortality rate was 7.1% for the whole cohort. The mean survival time estimate was 147.2 months [95% confidence interval (CI): 135.6 to 158.9 months], with a 3-year survival rate of 91.2% and a 5-year survival rate of 89.0%. Multivariable analysis revealed that rupture enlargement rate is an independent risk factor of 30-day mortality. The receiver operating characteristic (ROC) curve indicated that the rupture enlargement rate could predicted the 30-day mortality with high accuracy. CONCLUSIONS: Delayed surgery may be considered for patients who respond well to aggressive treatment. The rupture enlargement rate is an independent risk factor for postoperative 30-day morality in patients with delayed VSR repair. Furthermore, the rupture enlargement rate has good predictive value for the prognosis of VSR patients.

[Application of atomic emission spectroscopy analysis in the atmospheric pressure plasma polishing process study].

The atmospheric pressure plasma polishing (APPP) is a novel precision machining technology. It performs the atom scale material removal based on low temperature plasma chemical reactions. As the machining process is chemical in nature, it avoids the surface/subsurface defects usually formed in conventional mechanical machining processes. APPP firstly introduces a capacitance coupled radio frequency (RF) plasma torch to generate reactive plasma and excite chemical reactions further. The removal process is a complicated integrating action which tends to be affected by many factors, such as the gas ratio, the RF power and so on. Therefore, to improve the machining quality, all the aspects should be considered and studied, to establish the foundation for further model building and theoretical analysis. The atomic emission spectroscopy analysis was used to study the process characteristics. A commercial micro spectrometer was used to collect the spectrograms under different parameters, by comparing which the influence of the RF power and gas ratio was initially studied. The analysis results indicate that an increase in RF power results in a higher removal rate within a certain range. The gas ratio doesn't show obvious influence on the removal rate and surface roughness in initial experiments, but the element compositions detected by X-ray photoelectron spectroscopy technology on the machined surfaces under different ratios really indicate distinct difference. Then the theoretical analysis revealed the corresponding electron transition orbits of the excited reactive fluorine atoms, which is necessary for further mechanism research and apparatus improvement. Then the initial process optimization was made based on the analysis results, by which the Ra 0.6 nm surface roughness and 32 mm3 x min(-1) removal rate were achieved on silicon wafers.