Enhancing cancer therapy: The role of drug delivery systems in STAT3 inhibitor efficacy and safety.

The signal transducer and activator of transcription 3 (STAT3), a member of the STAT family, resides in the nucleus to regulate genes essential for vital cellular functions, including survival, proliferation, self-renewal, angiogenesis, and immune response. However, continuous STAT3 activation in tumor cells promotes their initiation, progression, and metastasis, rendering STAT3 pathway inhibitors a promising avenue for cancer therapy. Nonetheless, these inhibitors frequently encounter challenges such as cytotoxicity and suboptimal biocompatibility in clinical trials. A viable strategy to mitigate these issues involves delivering STAT3 inhibitors via drug delivery systems (DDSs). This review delineates the regulatory mechanisms of the STAT3 signaling pathway and its association with cancer. It offers a comprehensive overview of the current application of DDSs for anti-STAT3 inhibitors and investigates the role of DDSs in cancer treatment. The conclusion posits that DDSs for anti-STAT3 inhibitors exhibit enhanced efficacy and reduced adverse effects in tumor therapy compared to anti-STAT3 inhibitors alone. This paper aims to provide an outline of the ongoing research and future prospects of DDSs for STAT3 inhibitors. Additionally, it presents our insights on the merits and future outlook of DDSs in cancer treatment.

Identification of Immune-Related Genes as Biomarkers for Uremia.

Purpose: Uremia, which is characterized by immunodeficiency, is associated with the deterioration of kidney function. Immune-related genes (IRGs) are crucial for uremia progression. Methods: The co-expression network was constructed to identify key modular genes associated with uremia. IRGs were intersected with differentially expressed genes (DEGs) between uremia and control groups and key modular genes to obtain differentially expressed IRGs (DEIRGs). DEIRGs were subjected to functional enrichment analysis. The protein-protein interaction (PPI) network was constructed. The candidate genes were identified using the cytoHubba tool. The biomarkers were identified using various machine learning algorithms. The diagnostic value of the biomarkers was evaluated using receiver operating characteristic (ROC) analysis. The immune infiltration analysis was implemented. The biological pathways of biomarkers were identified using gene set enrichment analysis and ingenuity pathway analysis. The mRNA expression of biomarkers was validated using blood samples of patients with uremia and healthy subjects with quantitative real-time polymerase chain reaction (qRT-PCR). Results: In total, four biomarkers (PDCD1, NGF, PDGFRB, and ZAP70) were identified by machine learning methods. ROC analysis demonstrated that the area under the curve values of individual biomarkers were > 0.9, indicating good diagnostic power. The nomogram model of biomarkers exhibited good predictive power. The proportions of six immune cells significantly varied between the uremia and control groups. ZAP70 expression was positively correlated with the proportions of resting natural killer (NK) cells, naïve B cells, and regulatory T cells. Functional enrichment analysis revealed that the biomarkers were mainly associated with translational function and neuroactive ligand-receptor interaction. ZAP70 regulated NK cell signaling. The PDCD1 and NGF expression levels determined using qRT-PCR were consistent with those determined using bioinformatics analysis. Conclusion: PDCD1, NGF, PDGFRB, and ZAP70 were identified as biomarkers for uremia, providing a theoretical foundation for uremia diagnosis.

Nanotheranostics in cancer lymph node metastasis: The long road ahead.

Lymph node metastasis (LNM) significantly impacts the prognosis of cancer patients. Despite significant advancements in diagnostic techniques and treatment modalities, clinical challenges continue to persist in the realm of LNM. These include difficulties in early diagnosis, limited treatment efficacy, and potential side effects and injuries associated with treatment. Nanotheranostics, a field within nanotechnology, seamlessly integrates diagnostic and therapeutic functionalities. Its primary goal is to provide precise and effective disease diagnosis and treatment simultaneously. The development of nanotheranostics for LNM offers a promising solution for the stratified management of patients with LNM and promotes the advancement of personalized medicine. This review introduces the mechanisms of LNM and challenges in its diagnosis and treatment. Furthermore, it demonstrates the advantages and development potential of nanotheranostics, focuses on the challenges nanotheranostics face in its application, and provides an outlook on future trends. We consider nanotheranostics a promising strategy to improve clinical effectiveness and efficiency as well as the prognosis of cancer patients with LNM.

Designing a sustainable collection and transportation routes for domestic wastes in the agro-pastoral ecotone of the Tibetan Plateau.

The absence of an efficient and safe routes for the timely collection and transportation of domestic waste (DW) may have negative effects on the environment and public health. However, the existing collection and transportation routes (CTR) for domestic waste (DW) based on territorial management are not suitable for the special socio-ecological system of the agro-pastoral ecotone (APE). Therefore, it is crucial to develop a low-cost, high-efficiency, and risk-free CTR to mitigate the threat of DW to the environmental sustainability in the APE of the Tibetan Plateau. This study selected Haidong as a research case and constructed a sustainable CTR optimization framework based on an integrated perspective on temporal, spatial and eco-safety risk. We used the improved Ant Colony Optimization (ACO) to simulate optimal spatial-temporal routes, and the eco-safety risk level of the CTR was assessed by using the Minimum Cumulative Resistance model (MCR). Results demonstrated that: (1) After the sustainable model was optimized, the total transportation mileage and the frequency of collection and transportation were reduced by 45.88% and 38.07% respectively, the economic cost savings were decreased by 32.29%. Optimized routes were more effective and can better adapt to the dispersed pollution-producing characteristics in the APE. (2) The optimized routes reduced greenhouse gas (GHG) emissions by 41.09%, and reduced the eco-safety risk of the high and relative high-risk routes, which account for 29.05% of total routes, can protect important ecological functions and reduce the adverse impacts of DW transportation on soil, atmosphere, water, and the living environment. (3) The cores of adaptive management for sustainable CTR in APE were to change from the current single-county administrative organization to a cross-county administrative organization; adjust the transportation cycle based on pollution-producing characteristics; sort the DW locally; and cultivate environmental awareness among farmers and herdsmen. This study designed new sustainable collection and transportation routes for domestic waste to improve environmental sustainability in the agro-pastoral ecotone.

Whole genome sequencing of drug resistance Mycobacterium tuberculosis from extra-pulmonary sites.

This study aimed to determinate characteristics of drug resistance Mycobacterium tuberculosis from patients with extra-pulmonary tuberculosis (EPTB). Patients were retrospectively studied from January 2020 to December 2021. All the isolates were cultured, tested drug susceptibility, and detected the gene mutation using whole genome sequencing. The correlations of whole genome sequencing, pattern of DR, patients' distribution, and transmission were analyzed. 111 DR-EPTB isolates included pre-XDR-TB (53.2%), MDR-TB (29.7%), and poly-DR-TB (12.6%). The resistant drugs were INH followed by RFP and SM. The genotypes of 111 strains were lineage 2 and lineage 4. KatG_p.Ser315Thr was main gene mutation for resistance to INH; rpsL_p.Lys43Arg for SM, rpoB_p.Ser450Leu for rifampicin, embB_p.Met306Val for ethambutol, gyrA_p.Asp94Gly for FQs, and pncA_p.Thr76Pro for PZA. The residence was a significant risk factor for cluster transmission by patients and phenotypic DR types of strains for lineage 2 transmission. In the local area of southwest China INH, rifampicin and SM were main drugs in patients with DR-EPTB. KatG_p.Ser315, rpoB_p.Ser450Leu, and rpsL_p.Lys43Arg were main gene mutations. Phenotypic DR types and residence were main risk of transmission.

Toddalia asiatica extract attenuates adjuvant-induced arthritis by modulating colon Th17/Treg balance and colony homeostasis.

ETHNOPHARMACOLOGICAL RELEVANCE: Given the adverse effects of the current principal treatments, there is still a great need for effective cures for rheumatoid arthritis (RA), an immune-mediated disease. Toddalia asiatica (L.) Lam is a traditional medicinal herb that can be used for RA treatment because of its anti-inflammatory and analgesic properties. AIM OF THE STUDY: To investigate the possible effects of Toddalia asiatica extract (TAE) on intestinal immunity and the intestinal bacterial flora in a rat model of RA. MATERIALS AND METHODS: The anti-arthritis effect of TAE was evaluated in arthritis rats induced by complete Freund's adjuvant-induced arthritis (AIA). Arthritis index (AI) scores, systemic inflammation scores, histopathologic changes in the colon and ankle were detected by hematoxylin and eosin staining. Western blot analysis was performed to assess the protein expression of IL-17A, RORC, IL-1ß, IL-6, FOXP3, IL-10 in the colon. RT-PCR was performed to assess the expression of the colon's mRNA. Finally, changes to the gut microbiome by sequencing 16S rDNA. Microbial function prediction was performed using PICRUSt with the KEGG databases and correlation analysis was carried out by computing Spearman's rank correlations. RESULTS: demonstrated that TAE administration at a dose of 3 g/kg dramatically decreased AI scores, systemic inflammation scores, and histopathologic lesions of the ankle and colon in AIA rats. TAE was found to significantly reduce the expression levels of Th17-related proteins and mRNAs (IL-17A, RORC, IL-1ß and IL-6) in the colon, while increasing the expression levels of Treg-related proteins and mRNA (IL-10 and FOXP3), which helped restore the balance of Th17/Treg immune cells in the colon. Meanwhile, TAE was also found to be capable of remodeling the gut microbiota in AIA rats. Depleting RA-associated genera and thereby increasing α-diversity enriched the gut microbiota's diversity and shifted the community composition dramatically, leading to the increase of Firmicutes_unclassified, Ruminococcaceae_unclassified, Muribaculum, Subdoligranulum, Lachnospira, Marvinbryantia, and the reduction of RA-related bacteria Ligilactobacillus, Streptococcus and Eubacterium-eligens-group. Furthermore, PICRUSt analysis revealed that metabolic pathways were associated with TAE treatment, with metabolic pathways dominating. Among them, metabolic pathways were predominant. Correlation studies showed that a total of 9 microorganisms, including Ligilactobacillus, Eubacterium-eligens-group and Subdoligranulum, were significantly associated with Th17/Treg expression. CONCLUSIONS: This study demonstrates that TAE is a low-toxicity poly alkaline drug that can rapidly and effectively improve joint symptoms in RA rats and increases beneficial intestinal bacteria and decreases harmful ones, which is associated with modulating Th17/Treg interactions in intestinal T cells and reversing microbial disorders.

Del-Nido cardioplegia in cardiac surgery for elderly patients: a propensity score-matched analysis.

OBJECTIVES: To compare the safety and efficacy of del-Nido cardioplegia (DNC) with traditional 4:1 cold blood cardioplegia (CBC) in coronary artery bypass grafting and/or valve surgeries in elderly patients. METHODS: The present study is a retrospective case-series study that included 302 consecutive patients aged 70 years and over who underwent on-pump valve surgery and/or coronary artery bypass graft (CABG). DNC was administered to 90 patients and CBC to 212 patients. After propensity-score matching, 89 pairs were compared. The safety and efficacy were analyzed between the two groups. RESULTS: The DNC group had a similar mortality (3.4% vs. 5.6%, OR = 0.79, P = 0.720) and extracorporeal membrane oxygenation (ECMO) implantation rate (1.1% vs. 2.2%, OR = 0.75, P = 1.000) to the CBC group, a lower incidence of postoperative intra-aortic balloon pump (IABP) implantation (1.1% vs. 9.0%, OR = 0.54, P = 0.034) and a higher left ventricular ejection fraction (LVEF) at discharge (60 (56-64) % vs. 57 (51-62)%, P = 0.007). The estimated glomerular filtration rate (eGFR) in the DNC group was higher when the patient was transferred to the intensive care unit (79.4 (65.0-94.3) ml/min/1.73m2 vs. 77.2 (59.8-88.7) ml/min/1.73m2, P = 0.014), but no significant differences were identified after 24 h. The serum lactate values of the DNC group were significantly lower than those of the CBC group (0 h: 2.7 (2.0-3.2) vs. 3.2 (2.4-4.4), P = 0.001; 3 h: 3.2 (2.0-4.8) vs. 4.8 (2.8-6.6), P < 0.001; 6 h: 3.5 (2.2-5.4) vs. 5.8 (3.4-8.4), P < 0.001; 9 h: 3.4 (2.0-7.0) vs. 5.5 (2.9-8.3), P = 0.005). There were no differences between the two groups in respect of lactate levels at 12 h and thereafter. Postoperative creatinine kinase-MB concentrations were similar between the two groups. CONCLUSIONS: Del-Nido cardioplegia is safe and effective in elderly patients undergoing CABG and/or valve surgery.

Safety and effectiveness of indocyanine green fluorescence imaging-guided laparoscopic hepatectomy for hepatic tumor: a systematic review and meta-analysis.

Introduction: Previous clinical investigations have reported inconsistent findings regarding the feasibility of utilizing indocyanine green fluorescence imaging (ICGFI) in laparoscopic liver tumor removal. This meta-analysis aims to comprehensively evaluate the safety and effectiveness of ICGFI in laparoscopic hepatectomy (LH). Methods: A systematic search of pertinent clinical studies published before January 30th, 2023 was conducted in databases including PubMed, Embase, Cochrane, and Web of Science. The search strategy encompassed key terms such as "indocyanine green fluorescence," "ICG fluorescence," "laparoscopic hepatectomy," "hepatectomies," "liver Neoplasms," "hepatic cancer," and "liver tumor." Additionally, we scrutinized the reference lists of included articles to identify supplementary studies. we assessed the quality of the incorporated studies and extracted clinical data. Meta-analysis was performed using STATA v.17.0 software. Either a fixed-effects or a random-effects model was employed to compute combined effect sizes, accompanied by 95% confidence intervals (CIs), based on varying levels of heterogeneity. Results: This meta-analysis encompassed eleven retrospective cohort studies, involving 959 patients in total. Our findings revealed that, in comparison to conventional laparoscopic hepatectomy, patients receiving ICGFI-guided LH exhibited a higher R0 resection rate (OR: 3.96, 95% CI: 1.28, 12.25, I2 = 0.00%, P = 0.778) and a diminished incidence of intraoperative blood transfusion (OR: 0.42, 95% CI: 0.22, 0.81, I 2 = 51.1%, P = 0.056). Additionally, they experienced shorter postoperative hospital stays (WMD: -1.07, 95% CI: -2.00, -0.14, I 2 = 85.1%, P = 0.000). No statistically significant differences emerged between patients receiving ICGFI-guided LH vs. those undergoing conventional LH in terms of minimal margin width and postoperative complications. Conclusion: ICGFI-guided LH demonstrates marked superiority over conventional laparoscopic liver tumor resection in achieving R0 resection and reducing intraoperative blood transfusion rates. This technique appears to hold substantial promise. Nonetheless, further studies are needed to explore potential long-term benefits associated with patients undergoing ICGFI-guided LH. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD 42023398195.

The spatial stress of urban land expansion on the water environment of the Yangtze River Delta in China.

In highly urbanized and industrialized areas, the demand for construction land is expanding, which should have an impact on the water environment. Taking the Yangtze River Delta (YRD) and considering chemical oxygen demand (COD) and ammonia nitrogen (NH3-N) as characteristic pollutants, this study investigated the spatial-temporal characteristics of water pollutant emissions at the county level, optimized the spatial lag model (SLM) to estimate the spatial interaction of urban expansion and water pollutant emissions through direct and indirect effects. The results show that from 2011 to 2015, water pollutant emissions in the YRD decreased significantly and that the high-emissions pattern changed from a contiguous to a scattered distribution. The emissions of COD and NH3-N in counties at various distances from the Yangtze River and coastline show a logarithmic curve relationship. The association between urban expansion and water pollutant emissions was significant and stable. In 2015, every 1% increase in the scale of urban expansion resulted in 0.299% and 0.340% increases in local COD and NH3-N emissions, respectively, and emissions in the adjacent counties synchronously increased by 0.068% and 0.084%, respectively. The results show that to break the association and spatial interaction between urban expansion and water pollutant emissions and alleviate the environmental stress on the YRD, in addition to delimiting an urban expansion boundary and strictly restraining the scale of expansion, improvement in the regional environmental carrying capacity through urban water pollutant treatment facilities and pipe network construction is urgently needed.

Deconstructing the driving factors of land development intensity from multi-scale in differentiated functional zones.

Land development intensity (LDI) is an important indicator of how much human exploitation of land resources. Against the background of rapid urbanization and industrialization, in order to curb the over-occupation of agricultural and ecological space by urbanized space, China has proposed the Major Functional Zoning Planning (MFZP) as a new spatial governance model, which attempts to implement differentiated LDI control according to the functional positioning of different regions. To observe the spatio-temporal evolution and drivers of LDI in the first five years since the implementation of the MFZP, we chose the Yangtze River Delta, the most urbanized region in China, as a case area. The multi-scale distribution pattern of LDI was analyzed by combining macro and micro scales, and a new spatial measurement method integrating global and local regression models was developed to quantitatively deconstruct the natural-human drivers of LDI in different functional zones. Results demonstrate that LDI decreases in a gradient of the urbanized zone (UZ) > main agricultural production zone (MAPZ) > key ecological function zone (KEFZ). In the UZ, LDI is influenced by natural-human multi factors, e.g., terrain conditions (SLP), proportion of cultivated land area (PCL), proportion of ecologically important area (EID), population urbanization rate (PUR), GDP per capita (PGDP), fixed asset investment size per land (FAI) and fiscal expenditure as a percentage of GDP (FD). The LDI in the MAPZ is mainly affected by the facilitating role of PCL, EID, FAI, and the prominent role of FD, while that in the KEFZ is mainly inhibited by SLP, EID, and driven by the PGDP. The diverse drivers of LDI in different functional zones remind us to implement differentiated spatial control according to functional positioning and to adopt refined policy tools of zoning and classification to ensure that land resources within each type of functional zone can be used sustainably.

Study on the Differences between Various Gas Injection Sources in the Process of Coal Seam Methane Replacement by Gas Injection.

To study the differences between various gas injection sources in the process of coal seam methane replacement, experimental research was conducted to study the influences of different gas injection sources and gas injection ratios on coal seam methane replacement by considering the strong adsorption gas CO2 and the weak adsorption gas N2. The experimental results show that the temperature rise effect of the CO2 injection gas is greater and lasts longer than that of the N2 injection gas in the process of coal seam methane replacement by gas injection, and the temperature rise can promote the desorption of adsorbed methane well. However, due to the different effects of gas compressibility, the increase in gas pressure caused by injecting N2 under the same conditions is higher than that of CO2; due to the strong adsorption of CO2, the gas pressure after injecting CO2 continues to decrease slowly. From the displacement effect, the adsorbability of the injection source gas has a significant effect on the displacement rate and injection-placement ratio, while the injection ratio has a significant effect on CO2 displacement but not on N2 injection. From the experimental results, for N2 injection, the effects of coal seam methane replacement by gas injection can be enhanced by improving the gas injection method and process; for CO2 injection, the effects of coal seam methane replacement by gas injection can be improved by the following two aspects: gas injection volume and gas injection time.

Cross-administrative and downscaling environmental spatial management and control system: A zoning experiment in the Yangtze River Delta, China.

Promoting the downscaling and integration of zonal management and control of various environmental pollution sources is an effective way to systematically deal with the current high-intensity and complex environmental problems. Through single-factor and comprehensive pollutant emission intensity evaluation and cluster analysis, we built a full-coverage and cross-scale environmental spatial management and control system for pollution sources, then proposed environmental zoning patterns and pollution control strategies at three scales in the Yangtze River Delta (YRD), China. At the grid scale, the reclassified 7 types of pollution source spaces can be divided into 5 levels based on pollution emission intensity, and the most urgent environmental control subjects can be determined accordingly. Up to the county scale, combined with emission intensity and regional functions, 305 counties can be divided into 5 control intensity zones, which directly correspond to different environmental control intensity, requirements and policies. Finally, at the city scale, 41 cities can be clustered into 7 pollution control zones, which are classified and named as the three-level form of geographic location, development orientation and pollution source characteristics. Fully using the zoning units at different scales of cities, counties and grids can break the limitation of inherent administrative boundaries and allow environmental integration policies to be implemented across departments and regions, also let differentiated policies be more accurately implemented to different administrative levels and pollution source, and then truly improve the efficiency of environmental management.

Study on the Response Characteristics of the Pressure and Temperature Fields of Source Gas Injection under Loading Conditions.

To study the safety of the source gas in coal seams after gas injection displacement, choosing N2 as an example, the pressure and temperature field variation characteristics of the source gas in coal were studied via experimental research, numerical simulation, and theoretical analysis methods, starting from the variation characteristics of the gas pressure and temperature fields in the coal. In this work, 2-9 MPa stress was applied to the top of the coal samples. The experimental results indicated that during the coal loading process, the gas pressure and temperature in the coal generally exhibited a decreasing trend and that the pressure and temperature could increase in some areas due to pore closure and frictional heat generation, but the increase range was not significant. Based on the numerical simulation results, in the 200 min loading process, the gas pressure inside the coal body decreased by approximately 0.25 MPa and the overall temperature slightly decreased. Only the temperature near the borehole greatly changed, and the maximum decrease reached approximately 8 °C. Considering the experimental and numerical simulation results, under the condition of stress concentration, the pressure and temperature fields of the source gas injected into the coal body mainly revealed a decreasing trend and the possibility of inducing outbursts was low.

Study on Driving Factors and Spatial Effects of Environmental Pollution in the Pearl River-Xijiang River Economic Belt, China.

As a typical basin area in China, the Pearl River-Xijiang River Economic Belt (PRXREB) faces multiple types of environmental problems caused by the different development conditions of basins. To identify the situations of environmental pollution in the PRXREB, this paper constructed the Environment Pollution Composite Index (EPCI) by using four environmental pollutant emission indicators based on the entropy weight method, and explored the spatial effects and driving factors of environmental pollution by using the Spatial Error Model (SEM). The results showed that: (1) EPCI of the PRXREB decreased significantly from 2012 to 2016, and the spatial patterns were relatively stable. Wherein, the midstream and downstream were always the critical areas of environmental pollution. (2) Spatial spillover effects were significant in the PRXREB, which revealed that the local environmental pollution degree was affected by adjacent areas. (3) Industrial structure, infrastructure construction, and regulatory measures were the main driving factors of environmental pollution in the PRXREB. (4) To balance economic development and environmental protection in basin areas, environmental regulations such as environmental access, pollution payment, and cross-border early warning should be jointly established.

Totally endoscopic aortic valve replacement: Techniques and early results.

Objective: To demonstrate the technical details of total endoscopic aortic valve replacement using a standard prosthesis, compare the clinical effect and safety of endoscopic aortic valve replacement and traditional aortic valve replacement. Methods: From 2020 to 2021, 60 consecutive patients underwent elective isolated aortic valve replacement (AVR). They were divided into two groups: the total endoscopic AVR group (TE-AVR group, 29 patients, nine women, aged 51.65 ± 11.79 years), and the traditional full-sternotomy group (AVR group, 31 patients, 13 women, aged 54.23 ± 12.06 years). Three working ports were adopted in the TE-AVR procedure. Results: No patient died in either group. The cardiopulmonary bypass (CPB) time and aortic cross-clamp (ACC) time in the TE-AVR group were longer than those in the AVR group (CPB time: 177.6 ± 43.2 vs. 112.1 ± 18.1 min, p < 0.001; ACC time: 118.3 ± 29.7 vs. 67.0 ± 13.2 min, p < 0.001). However, the mechanical ventilation duration (14.2 ± 9.3 vs. 24.0 ± 18.9 h, p = 0.015) and postoperative hospital stay (6.0 ± 1.7 vs. 8.0 ± 4.5 days, p = 0.025) were shorter in patients of TE-AVR group than those of AVR group. Although the ICU stay (55.1 ± 26.9 vs. 61.5 ± 44.8 h, p = 0.509) and post-operative chest drainage of the first 24 h (229.8 ± 125.0 vs. 273.2 ± 103.2 ml, p = 0.146) revealed no statistical difference, there was a decreasing trend in the TE-AVR group. Among the patients of the TE-AVR group, two patients were converted to thoracotomy because of mild to moderate paravalvular leakage identified by intraoperative transesophageal echocardiography. Conclusion: Total endoscopic aortic valve replacement is safe and feasible, with less trauma and quicker recovery.

Endoscopic repeat isolated tricuspid valve surgery after left-sided valve replacement: valvuloplasty or replacement.

BACKGROUND: The strategy of isolated tricuspid valve surgery has undergone innovations in recent years. This study aimed to summarize our experience using an endoscopic approach to repeat isolated tricuspid valve surgery (RITS) after left-sided valve replacement (LSVR). METHODS: From June 2013 to May 2019, 79 patients underwent endoscopic RITS after LSVR at our institution. Patients were divided into the tricuspid valvuloplasty (TVP) group (N.=49) and the tricuspid valve replacement (TVR) group (N.=30); perioperative outcomes and follow-up results were compared. RESULTS: There were seven postoperative deaths (8.9%). In-hospital mortality was higher in the TVR group than in the TVP group, although this difference was not statistically significant (13.3% vs. 6.1%, P=0.417). More patients experienced residual moderate-to-severe tricuspid regurgitation (TR) at discharge in the TVP group than in the TVR group (26.7% vs. 0%, P=0.003). Five patients died from heart, and multiorgan failure during follow-up; the overall 3- and 5-year survival rates were 93.8% [95% confidence interval (CI): (87.1-99.9%)] and 85.3% (95% CI: 73.3-99.2%), respectively, and no significant differences were found between the two groups (P=0.103). The overall rates of the 3- and 5-year freedom from severe recurrent TR were 93.2% (95% CI: 85.9-99.9%) and 89.0% (78.7-99.9%), respectively, and no significant difference was found between groups (P=0.176). CONCLUSIONS: Repeat isolated tricuspid valve surgery after left-sided valve replacement is associated with adverse perioperative outcomes. Endoscopic access offers an alternative approach for RITS after LSVR with acceptable results. TVP results in lower surgical mortality than TVR while carrying a higher risk of residual moderate-to-severe TR.

Outcomes of redo-isolated tricuspid valve surgery after left-sided valve surgery.

OBJECTIVES: To compare early and long-term outcomes of redo-isolated tricuspid surgery (RITS) after left-sided valve surgery. METHODS: We retrospectively reviewed 173 patients who underwent RITS for severe tricuspid regurgitation after previous left-sided valve surgery from January 1999 to December 2019. Patients were divided into two groups: RITS by median sternotomy (m-RITS; n = 78) and totally endoscopic approach (e-RITS; n = 95). Perioperative outcomes and follow-up results were analyzed. RESULTS: There were 19 (11%) in-hospital deaths (14.1% in m-RITS and 8.4% in e-RITS, p = .234) that decreased from 16.7% (1999-2014) to 6.9% (2015-2019) (p = .044). Tricuspid valve replacement (odds ratio [OR] = 4.989, 95% confidence interval [CI]: 1.133-29.790, p = .041) and NYHA function class IV (OR = 9.611, 95% CI: 2.102-43.954, p = .004) were independent risk factors for in-hospital mortality. The overall 1-, 5-, 10-, and 15-year survival rates were 97.2% (95% CI: 94.5%-99.9%), 80.3% (95% CI: 71.7%-88.9%), 59.2% (95% CI: 43.5%-75.5%), and 49.3% (95% CI: 27.2%-71.4%), respectively. CONCLUSION: Patients undergoing RITS carry a high risk of early mortality. There was no significant difference in early mortality or long-term survival between the endoscopy and median sternotomy, whereas the endoscopy approach was associated with shorter intensive care unit stays and fewer reoperations. Repair resulted in lower surgical mortality than replacement with acceptable residual tricuspid regurgitation.

Total thoracoscopic repair of ventricular septal defect: A single-center experience.

OBJECTIVES: To explore the safety and efficacy of total thoracoscopic repair of ventricular septal defects (VSD). We compared clinical outcomes of VSD via a total thoracoscopic approach with those of mini-sternotomy. METHODS: We retrospectively reviewed clinical data from patients with VSD from 2012 to January 2019. According to the surgical pattern, they were divided into two groups: the total thoracoscopic surgery group (36 patients, 27 females, aged 29 ± 9.52 years), and a mini-sternotomy group (31 patients, 12 females, aged 28 ± 8.67 years). RESULTS: There were no deaths in either group. In the thoracoscopic group, cardiopulmonary bypass (CPB) time and aortic cross-clamping (ACC) time were significantly longer than those of the mini-sternotomy group (CPB time: 112 ± 23.16 min vs. 78 ± 37.90 min, respectively, p < .001; ACC time: 65 ± 19.94 min vs. 50 ± 24.90 min, respectively, p < .001). postoperative hospital stay time (5.11 ± 2.48 days vs. 5.90 ± 6.27 days, p = .488) and chest drainage (139.86 ± 111.71 ml vs. 196.13 ± 147.34 ml, p = .081) tended to be lower in the thoracoscopy group, although there was no significant difference. No residual shunt or tricuspid regurgitation was found at follow-up. CONCLUSIONS: Total thoracoscopic repair is safe and effective in patients with VSD, with or without tricuspid regurgitation.

The gap between public perceptions and monitoring indicators of environmental quality in Beijing.

This paper explores the differences between public perceptions and existing monitoring indicators in environmental quality in Beijing. The results reveal, existing indicators do not accurately reflect public perceptions of the environment. Some environmental problems, such as fluffy catkins, are not reflected in the existing indicators, yet have a relatively large influence on public perception. The policymakers and public's variegated understanding of the environment, the lag period of public perceptions of environmental quality change, and lack of standards and monitoring for emerging problems are the three main reasons that resulted in a deviation of monitoring indicators from the public perceptions. Resultantly, to improve the level of environmental governance, it is necessary to take relevant measures that reduce the difference between public perceptions and monitoring indicators. Residents should be surveyed regularly to obtain their public perceptions, and the selection of indicators should not be limited to environmental pollution. In particular, some indicators based on public perception should be developed to complement the existing environmental monitoring protocol. In addition, due to the emerging environmental problems, quality standards and monitoring systems should be updated regularly.

Spatiotemporal variations and determinants of water pollutant discharge in the Yangtze River Economic Belt, China: A spatial econometric analysis.

Water pollution is an urgent problem that needs to be controlled via green transformation and the development of the Yangtze River Economic Belt (YREB). Based on the water pollutant discharge and socio-economic database of prefecture-level cities in the YREB from 2011 to 2015, this study explores the spatiotemporal variations in water pollutant discharge in the YREB via two main indicators: chemical oxygen demand (COD) and ammonia nitrogen (NH3-N). Further, the spatial effects and determinants of water pollutant discharge are quantitatively estimated. The results show that (1) the water pollutant discharge in the YREB has decreased significantly, with the COD and NH3-N discharge reduced by 10.46% and 10.79%, respectively, and the discharge reduction in the lower reaches was the most prominent; (2) the spatial pattern of water pollutant discharge in the YREB was generally stable and partially improved, and cities with a high rate of water pollutant reduction in the YREB were distributed in the main stream region of the Yangtze River and the intersection of the main stream and tributaries; (3) spatial effects had a significant impact on water pollutant discharge in the YREB, with regional cooperation and economic radiation through environmental management and control initially showing a combined reduction trend in regional water pollutants; and (4) determinants of population size and agricultural economic share declined to varying degrees at the end of the study period, although the urbanization level continued to increase, indicating that urbanization in the YREB occurred too quickly and that water pollutant discharge reduction was limited. However, economic development leading to the deterioration of the water environment was alleviated. In addition, foreign direct investment (FDI) inflows and rapid industrialization processes must be monitored to increase the reduction in characteristic water pollutants.