The support dilemma of stroke inpatients and family caregivers under COVID-19 prevention and control: a qualitative study in China.

China has implemented a strict isolation system in hospitals since the COVID-19 pandemic, that adversely affected the psychology of inpatients and their caregivers. Face-to-face, semi-structured interviews with 22 stroke inpatients from two municipal hospitals were conducted to explore the psychological, emotional and related support needs of stroke inpatients and their family caregivers under this environment. Results which showed that external support for stroke inpatients and their family caregivers was insufficient highlight the necessity for developing specific nursing interventions that meet the psychological and emotional needs of inpatients and the caregivers.

Hypoxic Macrophage-Derived VEGF Promotes Proliferation and Invasion of Gastric Cancer Cells.

BACKGROUND: Gastric cancer (GC) is one of the most common causes of cancer death. Hypoxia is an important property of the tumor microenvironment of GC. Increasing evidence demonstrates that tumor-associated macrophages are related to the metastasis of GC, while the precise mechanism of how hypoxic macrophages affect tumor progression is still not fully understood. AIMS: To examine whether the mediators released from hypoxic macrophages contribute to the invasion and proliferation of GC cells. METHODS: Cell Counting Kit-8 was utilized to determine the proliferation of SGC7901 and MKN45 cells. The invasion of SGC7901 and MKN45 cells was measured by transwell invasion assay. Expression of VEGF mRNA in THP-1-derived macrophages was determined by RT-PCR, and protein level of VEGF in the culture medium was detected by ELISA. RESULTS: The proliferation and invasion of SGC7901 and MKN45 cells were dramatically increased after treatment with conditioned medium (CM) collected from THP-1-derived macrophages under hypoxia (H-CM), and the phosphorylation of Akt and p38 in SGC7901 and MKN45 cells was also up-regulated by H-CM stimulation. Notably, blockage of PI3K-Akt or p38 MAP kinase abolished the effects of H-CM on the proliferation and invasion of SGC7901 and MKN45 cells. Furthermore, VEGF was increased in macrophages after hypoxia and administration with nintedanib, an inhibitor of VEGFR, significantly decreases the phosphorylation of Akt and p38, as well as the proliferation and invasion of SGC7901 and MKN45 cells in response to H-CM. CONCLUSIONS: Our findings suggest that hypoxia-injured macrophages contribute to the proliferation and invasion of GC cells through the release of mediators such as VEGF.

Management of Incomplete Initial Repair in the Treatment of Degenerative Mitral Insufficiency.

We sought to present our institutional protocol to manage incomplete initial repair of degenerative mitral regurgitation and to evaluate its mid-term outcomes. Eight hundred and fifteen patients with degenerative mitral insufficiency undergoing mitral valve repair were investigated in this study. The initial repair attempt was incomplete in 48 patients, leaving a degree of residual regurgitation > mild, and an elevated transmitral gradient or systolic anterior motion (SAM). These patients were further treated with medication or mitral valve re-repair or replacement under reinstituted cardiopulmonary bypass. Transesophageal echocardiographic reports and operational records were reviewed to identify morphological causes and establish management of incomplete initial repair. Mid-term outcomes of patients with re-repair and complete initial repair were evaluated and compared. Residual mitral regurgitation > mild was detected in 25 patients, an elevated transmitral gradient was detected in seven patients, and SAM was detected in 16 patients. The condition of eight patients with SAM was resolved with medication only. Mitral valve re-repair was performed in 23 patients and replacement was performed in 17, with comparable early mortality and morbidity. At 60.3 ± 25.5 months after surgery, late mitral stenosis and reoperation rate were significantly higher in re-repair patients than in patients with complete initial repair, despite comparable survival, left chamber reverse remodeling, and degree of residual regurgitation. Based on our institutional protocol, acceptable outcomes can be achieved for patients with incomplete initial mitral valve repair. Management should be tailored based on the characteristics of the mitral valve complex, expected repair durability, and operative risk.

Krüppel-like transcription factor 11 (KLF11) overexpression inhibits cardiac hypertrophy and fibrosis in mice.

The Krüppel-like factors (KLFs) belong to a subclass of Cys2/His2 zinc-finger DNA-binding proteins. The KLF family member KLF11 is originally identified as a transforming growth factor ß (TGF-ß)-inducible gene and is one of the most studied in this family. KLF11 is expressed ubiquitously and participates in diabetes and regulates hepatic lipid metabolism. However, the role of KLF11 in cardiovascular system is largely unknown. Here in this study, we reported that KLF11 expression is down-regulated in failing human hearts and hypertrophic murine hearts. To evaluate the roles of KLF11 in cardiac hypertrophy, we generated cardiac-specific KLF11 transgenic mice. KLF11 transgenic mice do not show any difference from their littermates at baseline. However, cardiac-specific KLF11 overexpression protects mice from TAC-induced cardiac hypertrophy, with reduced radios of heart weight (HW)/body weight (BW), lung weight/BW and HW/tibia length, decreased left ventricular wall thickness and increased fractional shortening. We also observe lower expression of hypertrophic fetal genes in TAC-challenged KLF11 transgenic mice compared with WT mice. In addition, KLF11 reduces cardiac fibrosis in mice underwent hypertrophy. The expression of fibrosis markers are also down-regulated when KLF11 is overexpressed in TAC-challenged mice. Taken together, our findings identify a novel anti-hypertrophic and anti-fibrotic role of KLF11, and KLF11 activator may serve as candidate drug for heart failure patients.

Clinical evaluation of cetuximab combined with an S-1 and oxaliplatin regimen for Chinese patients with advanced gastric cancer.

BACKGROUND: The prognosis of patients with advanced gastric cancer is poor. The goal of this study was to evaluate the efficacy and safety of combination therapy of cetuximab and S-1 combined with oxaliplatin (SOX) in Chinese patients with advanced gastric cancer. METHODS: For patients in the experimental group (cetuximab in combination with SOX (Ce-SOX), 30 patients), once-weekly cetuximab (400 mg/m2 at the first infusion then 250 mg/m2 every week) was administered. For patients in both the control (SOX alone, 26 patients) and experimental groups, oxaliplatin (100 mg/m2) was administered intravenously on day 1, while S-1 (80 mg/m2/day) was given orally twice daily for 14 days. The endpoints of this study included progression-free survival, response rate, and disease-control rate. RESULTS: There was no statistically significant difference in response rate between the Ce-SOX and SOX groups (54.8% versus 44%, P=0.225). The difference in disease-control rate was also statistically insignificant between the two groups (87.1% versus 76%, P=0.162). Median progression-free survival in the Ce-SOX group was significantly higher than that in the SOX group (12.8 versus 10.1 months, P=0.007). The median overall survival of the Ce-SOX group and SOX group was 14.0 and 12.2 months, respectively (P=0.043). The one-year survival rate for the Ce-SOX group was 57% compared to 40% in the SOX group. There was no statistical difference in the grade 3 or 4 adverse effects between the two groups. CONCLUSIONS: These findings suggest that the cetuximab combined with SOX regimen is feasible and shows promising efficacy with tolerable adverse effects in Chinese patients with advanced gastric cancer.

Regioselective Arylation of Amidoaryne Precursors via Ag-Mediated Intramolecular Oxy-Argentation.

An unprecedented silver-mediated intramolecular oxy-argentation of 3-amidoaryne precursors that quickly generates a heteroarylsilver species is developed. AgF acts as both a stoichiometric fluoride source and a reagent for the formation of a benzoxazolylsilver intermediate via aryne generation. Pd-catalyzed coupling reactions of (hetero)aryl iodides with a silver species, generated in situ, allow for the synthesis of various C7-arylated benzoxazoles. As a result, an aryl group is selectively introduced into the meta-position of 3-amidobenzyne precursors. Mechanistic studies have indicated the presence of a benzoxazolylsilver intermediate and revealed that the reaction proceeds via an intramolecular oxy-argentation process, which is initiated by a direct fluoride attack on the silyl group.

Identification of cytochrome P450 monooxygenase genes and their expression profiles in cyhalothrin-treated Colorado potato beetle, Leptinotarsa decemlineata.

Based on a Leptinotarsa decemlineata transcriptome dataset and the GenBank sequences, a total of 74 cytochrome P450 monooxygenase genes (Cyps) were identified. These genes fell into CYP2 clan, mitochondrial clan, CYP3 clan and CYP4 clan, and were classified into 19 families and 35 subfamilies according to standard nomenclature. Two new families were discovered in CYP4 clan, and were named CYP412 and CYP413 respectively. Four new families that were recently discovered in Tribolium castaneum, including mitochondrial family CYP353, CYP3 clan families CYP345 and CYP347, and CYP4 clan family CYP350, were also found in L. decemlineata. The phylogenetic trees of CYPs from L. decemlineata and other representative insect species were constructed, and these trees provided evolutionary insight for the genetic distance. Our results facilitate further researches to understand the functions and evolution of L. decemlineata Cyp genes. In order to find cyhalothrin-inducible Cyp genes, the expression levels of Cyps belonging to CYP12, CYP6, CYP9 and CYP4 families were determined by quantitative reverse transcriptase-PCR in cyhalothrin-treated and control fourth-instar larvae. Nine Cyp genes, i.e., Cyp12H2, Cyp6BH2, Cyp6BJ1, Cyp6BQ17, Cyp6EG1, Cyp6EH1, Cyp6EJ1 Cyp4BN13v1 and Cyp4BN15, were highly expressed in cyhalothrin-treated larvae. These CYPs are the candidates that are involved in cyhalothrin detoxification.

Prediction models for post-thrombectomy brain edema in patients with acute ischemic stroke: a systematic review and meta-analysis.

Objective: The objective of this study is to systematically evaluate prediction models for post-thrombectomy brain edema in acute ischemic stroke (AIS) patients. This analysis aims to equip clinicians with evidence-based guidance for the selection of appropriate prediction models, thereby facilitating the early identification of patients at risk of developing brain edema post-surgery. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Web of Science, Embase, The Cochrane Library, CNKI, Wanfang, and Vip, aiming to identify studies on prediction models for post-thrombectomy brain edema in AIS patients up to January 2023. Reference lists of relevant articles were also inspected. Two reviewers independently screened the literature and extracted data. The Prediction Model Risk of Bias Assessment Tool (PROBAST) and the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) guidelines were employed to assess study bias and literature quality, respectively. We then used random-effects bivariate meta-analysis models to summarize the studies. Results: The review included five articles, yielding 10 models. These models exhibited a relatively high risk of bias. Random effects model demonstrated that the AUC was 0.858 (95% CI 0.817-0.899). Conclusion: Despite the promising discriminative ability shown by studies on prediction models for post-thrombectomy brain edema in AIS patients, concerns related to a high risk of bias and limited external validation remain. Future research should prioritize the external validation and optimization of these models. There is an urgent need for large-scale, multicenter studies to develop robust, user-friendly models for real-world clinical application. Systematic review registration: https://www.crd.york.ac.uk, unique Identifier: CRD42022382790.

[Ecosystem structure and function of Sanmen Bay based on Ecopath model.] / 基于Ecopath模型的三门湾生态系统结构与功能.

Ecosystem structure determines material circulation, energy flow, and system function. Based on field investigation data in the Sanmen Bay, East China Sea from 2017 to 2018, ecological channel model was constructed by Ecopath, describing energy flow routes and functional characteristics of the Sanmen Bay ecosystem. Results showed that grazing food chain was the main energy circulation channel, and the trophic level of each functional group ranged from 1 to 3.80. Energy flow of the system was mainly concentrated in the first five levels, with an average energy conversion efficiency of 13.0%. Energy conversion efficiency was 12.8% and 14.5% from primary producers and debris, respectively. Connectance index (CI) and system omnivory index (SOI) were 0.40 and 0.24 respectively. Finn's cycling index (FIC) was 0.40, and Finn's mean path length (MPL) was 2.06. The ratio of total primary productivity to total respiration was 13.59. In conclusion, Sanmen Bay ecosystem was immature in material circulation and energy flow. This work is helpful to understand the structural and functional traits of coastal ecosystems in China.

Defining the ultrastructure of the hematopoietic stem cell niche by correlative light and electron microscopy.

The blood system is supported by hematopoietic stem and progenitor cells (HSPCs) found in a specialized microenvironment called the niche. Many different niche cell types support HSPCs, however how they interact and their ultrastructure has been difficult to define. Here, we show that single endogenous HSPCs can be tracked by light microscopy, then identified by serial block-face scanning electron microscopy (SBEM) at multiscale levels. Using the zebrafish larval kidney marrow (KM) niche as a model, we followed single fluorescently labeled HSPCs by light sheet microscopy, then confirmed their exact location in a 3D SBEM dataset. We found a variety of different configurations of HSPCs and surrounding niche cells, suggesting there could be functional heterogeneity in sites of HSPC lodgement. Our approach also allowed us to identify dopamine beta-hydroxylase (dbh) positive ganglion cells as a previously uncharacterized functional cell type in the HSPC niche. By integrating multiple imaging modalities, we could resolve the ultrastructure of single rare cells deep in live tissue and define all contacts between an HSPC and its surrounding niche cell types.

Colorectal cancer organoid models uncover oxaliplatin-resistant mechanisms at single cell resolution.

PURPOSE: Oxaliplatin-based chemotherapy is a standard treatment for advanced colorectal cancer (CRC) patients. However, chemoresistance-induced resistance is an essential cause for mortality. Therefore, it is necessary to study the mechanism of drug resistance in CRC. METHODS: Here, we established two strains of patient-derived organoids (PDOs) selected from oxaliplatin-resistant and treatment-naïve CRC patients. To dissect the drug-resistant mechanisms, these CRC-PDOs were subjected to single-cell RNA sequencing (scRNA-Seq). RESULTS: We found that the drug sensitivity test outcome from these organoids subjected to oxaliplatin and 5-FU exposure was consistent with the clinic readout. CRC-PDOs well recapitulated the morphology and histology of their parental biopsies based on HE and IHC staining of pathological biomarkers. The scRNA-Seq data filtered drug-resistant cell populations and related signaling pathways (e.g. oxidative phosphorylation and ATP metabolic process). The data also revealed several putative drug resistant-driven genes (STMN1, VEGFA and NDRG1) and transcription factors (E2F1, BRCA1, MYBL2, CDX2 and CDX1). CONCLUSION: We generated an oxaliplatin-resistant CRC organoid model that was employed to provide potential therapeutic targets for treating CRC patients exhibiting oxaliplatin-resistance.

Aortic coarctation with cardiac fibroma in a young patient: a case report.

BACKGROUND: Cardiac fibroma and aortic coarctation are rarely observed concomitantly in the same patient. We report a case of cardiac fibroma with aortic coarctation treated with a hybrid surgical procedure. To the best of our knowledge, this is the first case of these two abnormalities existing in one patient. CASE SUMMARY: A 22-year-old female patient visited the clinic with a 10-year history of hypertension. Physical examination revealed blood pressure of the upper extremities 50 mmHg higher than that of the lower extremities. Computed tomography angiography revealed a post-ductal-type aortic coarctation at the beginning segment of the descending aorta along with a 7.7 cm × 5.1 cm left ventricular mass. Transthoracic echocardiogram showed a mass at the middle segments of the lateral wall and apex and posterior wall of the left ventricle. Cardiac magnetic resonance imaging also showed the mass with hypointense signal on T1, hyperintense signal on T2, and intense signal on late gadolinium enhancement. No evidences of metastatic lesions were observed on 18F-fluorodeoxyglucose positron emission tomography. The patient underwent a hybrid surgery involving aortic stent implantation and complete left ventricular mass removal. The gradient between stenosis returned to <10 mmHg after the procedure. Pathologic findings revealed cardiac fibroma. DISCUSSION: It is rare to encounter a patient suffering from both cardiac fibroma and aortic coarctation. No evidences indicated a single cause or syndrome resulting in the coexistence of these two abnormalities. A hybrid surgery involving aortic stent implantation and complete cardiac mass resection could optimize the treatment in such cases.

Distal Remodeling After Operations for Extensive Acute Aortic Dissection.

BACKGROUND: The clinical predictors of distal aortic remodeling (DAR) after various procedures for extensive acute aortic dissection are not fully understood. METHODS: From 2008 to 2018, a total of 122 candidates with extensive acute type A and B aortic dissections survived operations of total arch replacement plus frozen elephant trunk (n = 36), ascending aortic replacement plus supraaortic debranching plus retrograde stenting (hybrid procedure; n = 25), and total endovascular repair (n = 61). We assessed DAR at 4 thoracoabdominal aortic levels based on true lumen expansion, false lumen patency, maximal aortic area, and the blood supply of major branches. Univariate and multivariate logistic and mixed-effect models were performed to delineate patterns and risks for DAR at midterm follow-up. RESULTS: At 3.9 years, 13 aorta-related adverse events (10.7%; including 3 aortic-related deaths [2.5%]) and 8 aortic reinterventions (6.6%) occurred. Follow-up computed tomography angiography was performed in all patients at 3.3 years (interquartile range, 2.7-4.4 years). The degree of DAR, which was relatively independent among aortic levels, was maximal at the pulmonary bifurcation level (90.2% complete false lumen thrombosis) and decreased along the distal aorta. Analyses of longitudinal data indicated that baseline overall false lumen patency was the only available factor to predict DAR at all 4 aortic levels. Dissection type, surgical technique, implant size, and medication did not sufficiently influence DAR at midterm follow-up. CONCLUSIONS: After distinct operations for extensive acute aortic dissection, DAR beyond the stent graft coverage is a local anatomical behavior independent of dissection type or proximal management.

Flying Squirrel-Inspired Motion Control of a Light-Deformed Pt-PAzoMA Micromotor through Drag Force Manipulation.

Micromotors require stable and precise motion control for complex tasks such as microsurgery, drug delivery in vivo, or environmental monitoring ex vivo. However, a continuous control signal is needed for micromotors to achieve motion control during their whole journey, which hinders their application in areas where external control stimuli are limited or unavailable. Fortunately, nature suggests an excellent solution that flying squirrel exhibits motion tuning capability by deforming itself when jumping off a tall tree. Inspired by this, we propose a Pt-PAzoMA Janus micromotor that precisely changes its shape (from a spherical shape to an elliptical shape) under a brief light signal (450 nm) and maintains this deformation until next signal reception. The deformed elliptical micromotor performs relatively low-speed motion compared to the spherical one, which is further confirmed by massive simulation results. In addition, by investigating motion behavior experimentally and theoretically, it is proved that the motion modulation is caused by the drag force changing brought from the deformation. This method represents a different route to regulate the motion of micromotors without a continuous signal, which is useful in application scenarios where the environmental control signal is inaccessible/limited or long-time operation with minimum energy input is required to maintain motion manipulation. With further function modification, this kind of shape-changing micromotor has potential in optimizing drug diffusion efficiency by speed altering and long-term monitoring at the diseased area by confining the active range of the micromotor in the targeted area through deformation.

Integration of a Metal-Organic Framework Film with a Tubular Whispering-Gallery-Mode Microcavity for Effective CO2 Sensing.

Carbon dioxide (CO2) sensing using an optical technique is of great importance in the environment and industrial emission monitoring. However, limited by the poor specific adsorption of gas molecules as well as insufficient coupling efficiency, there is still a long way to go toward realizing a highly sensitive optical CO2 gas sensor. Herein, by combining the advantages of a whispering-gallery-mode microcavity and a metal-organic framework (MOF) film, a porous functional microcavity (PF-MC) was fabricated with the assistance of the atomic layer deposition technique and was applied to CO2 sensing. In this functional composite, the rolled-up microcavity provides the ability to tune the propagation of light waves and the electromagnetic coupling with the surroundings via an evanescent field, while the nanoporous MOF film contributes to the specific adsorption of CO2. The composite demonstrates a high sensitivity of 188 nm RIU-1 (7.4 pm/% with respect to the CO2 concentration) and a low detection limit of ∼5.85 × 10-5 RIU. Furthermore, the PF-MC exhibits great selectivity to CO2 and outstanding reproducibility, which is promising for the next-generation optical gas sensing devices.

Acute Commissural Rupture in a Giant Aortic Root Aneurysm.

Idiopathic rupture of aortic valve commissure is an extremely rare cause of acute aortic regurgitation. Here, we report a case of commissural rupture with giant root aneurysm and history of chronic aortic regurgitation, emphasizing the diagnostic value of high-quality three-dimensional reconstructions of multimodality imaging in assessing the cause of abruptly deteriorating valve regurgitation.

[Trophic structure of pelagic fishery organism assemblage in the central and western South China Sea in spring revealed by carbon and nitrogen stable isotope analysis]. / åŸºäºŽç¢³æ°®ç¨³å®šåŒä½ç´ çš„å—æµ·ä¸­è¥¿éƒ¨æµ·åŸŸæ˜¥å­£ä¸­ä¸Šå±‚æ¸”ä¸šç”Ÿç‰©ç¾¤è½è¥å »ç»“æž„.

Carbon and nitrogen stable isotope analysis was carried out on pelagic fishery organisms caught in light traps and falling nets in the central and western South China Sea in the spring of 2018. The stable isotope values of the sampled individuals were used to elucidate the isotopic variations for the pelagic fishery organisms, to classify species into trophic functional groups, and to compare the differences of trophic structure among the classified trophic functional groups. The results showed that among 23 fishery species the mean δ13C value of Coryphaena hippurus was the lowest (-17.58‰±0.21‰), and that of Grammistes sexlineatus was the highest (-19.86‰±0.33‰). The mean δ15N values ranged from 8.31‰ in Psenes cyanophrys to (12.46±0.74)‰ in Chirocentrus dorab. The continuous trophic spectrum indicated that the trophic level (TL) for the sampled pela-gic fishery organisms ranged from 3.01 to 4.23, of which 19 species (83% of the total) fell between TL 3.0 and 4.0. The 23 species of fishery organisms were classified into three trophic functional groups, i.e., plankton feeding functional group (PFFG), nekton feeding functional group (NFFG), and mixed feeding functional group (MFFG). The analysis of standard ellipse area (SEA) showed that the PFFG occupied the largest trophic niche width (SEA=1.56‰2), followed by the MFFG (SEA=0.99‰2) and NFFG (SEA=0.31‰2). The MFFG overlapped with PFFG and NFFG in the trophic niche, with a relative percentage of 17% and 26%, respectively. There was no overlap between PFFG and NFFG.

Ruptured Bronchial Artery Aneurysm Treated With Aortic Stent Graft and Aneurysm Embolization.

BACKGROUND: Mediastinal bronchial artery aneurysms are uncommon, with fewer than 40 published case reports. This study objective was to evaluate the short term follow up of two cases ruptured Bronchial Artery Aneurysm (rBAA) treated with aneurysm embolization and subsequent aortic stent graft. METHODS: Two cases of rBAA were treated with a combination of an aortic stent-graft and aneurysm embolization. With rBAA, aneurysm embolization could be performed with sodium polymannuronate until the aneurysm was almost completely packed. One of the limitations of aneurysm embolization is spontaneous recanalization of previously occluded aneurysm. So a stent-graft was deployed to isolate the feeding artery of the rBAA from the descending aorta. The 3 months follow- up after the procedure included chest or back pain and computed tomographic angiography. RESULTS: The hospital stays of the 2 cases were 5 and 7 days. Chest or back pain was disappeared. There were no hospital deaths and late deaths. Computed tomographic angiogram showed no recanalization and no hemothorax. These 2 patients have not reported any complications up to now. CONCLUSION: Aortic stent graft combined with aneurysm embolization is a minimally invasive, effective and safe method for rBAA.

Mesenchymal stem cells rejuvenate cardiac muscle after ischemic injury.

Previous studies have shown that transplantation of mesenchymal stem cells (MSCs) enhances myocardial regeneration after myocardial infarction (MI), primarily resulting from the production and release of trophic growth factors and cytokines by MSCs. However, effects of MSCs or a subtype of MSCs on the ageing of injured cardiac muscle cells (CMCs) are limitedly known. Here, we addressed this question. CD146+ MSCs were isolated from total MSCs (tMSCs), and their effects on injured CMCs were assessed. In vivo, transplantation of isogenic CD146+ MSCs into MI-mice increased the proliferation of CMCs and reduced apoptosis of CMCs in a significantly higher degree than transplantation of tMSCs, resulting in significant improvement of the heart function. In vitro, CMCs were co-cultured under hypoxia condition with CD146+MSCs or tMSCs. We found that CD146+MSCs increased the proliferation of CMCs and reduced apoptosis of CMCs in a significantly higher degree, compared to tMSCs, likely resulting from reduction of aging-associated cellular reactive oxygen species in CMCs. Together, these data suggest that MSCs rejuvenate CMCs after ischemic injury and a subtype of MSCs, CD146+ MSCs, appears to have higher potential in coordinating this process.

Three-Dimensional Printed Models-Guided Surgical Repair for Recurrent Coronary Artery Fistula.

Recurrent coronary artery fistula is rare and can be difficult for surgical treatment because of anatomic complexity. Here, we reported a case of successful re-repair of a recurrent coronary artery fistula, with added evidence of the three-dimensional printed models guiding surgical correction of complex intracardiac abnormalities.