Surgical Challenges in Multi-Vessel Minimally Invasive Coronary Artery Bypass Grafting.

OBJECTIVES: Minimally invasive coronary artery bypass grafting (MICS CABG) has emerged as an alternative treatment for patients with multi-vessel coronary artery disease, but there are certain surgical challenges inherent in the adoption of this approach. The present study was conducted to provide insight regarding the outcomes associated with our first 118 cases, to discuss the surgical difficulties encountered in these patients, and to outline the potential countermeasures. METHODS: Between January 2017 and January 2020, 118 patients underwent multi-vessel MICS CABG. These patients were stratified into two groups based upon whether they did or did not experience surgical challenges, and early clinical outcomes were compared between these groups to assess the incidence of technical difficulties and associated factors. RESULTS: Surgical challenges arose in 38 of the 118 cases in this study, including 13 cases of exposure-related difficulties, 11 cases of proximal anastomosis-related difficulties, 15 cases of distal anastomosis-related difficulties, 4 cases of LITA-related difficulties, and 3 cases of lung-related difficulties. Relative to the other 80 patients, those patients for whom intraoperative technical challenges arose experience significant increases in operative duration (4.94 ± 0.89 vs. 5.59 ± 1.11 h, P=0.001), intraoperative blood loss (667 ± 313 vs. 892 ± 532 mL, P=0.005), length of the ICU admission (17.59 ± 3.51 vs. 22.59 ± 17.31 h, P=0.015), and the duration of postoperative hospitalization (5.96 ± 1.23 vs. 6.71 ± 1.92 days, P=0.012). There were no significant differences between these groups with respect to the mean graft number, major complications such as stroke or organ dysfunction, or one-year graft patency. CONCLUSIONS: There is a substantial learning curve associated with performing off-pump MICS CABG to treat multi-vessel disease. Surgical challenges encountered during this procedure may increase the operative duration, intraoperative blood loss, ICU admission, and the duration of postoperative hospitalization. However, these issues do not appear to compromise the efficacy of complete revascularization, and early clinical outcomes associated with this procedure remain acceptable.

Three-dimensional computed tomography reconstructive diagnosis of snakebite-induced cerebral infarction.

Despite common injury caused by snakebite, snakebite-induced ischemic stroke is rare. We reported on a patient who incurred a large cerebral infarction after being bitten by a Deinagkistrodon acutus, one of the most poisonous snakes in the southwestern of China. Applying 3D computed tomography (CT) of head combined with cerebral angiography examinations showed a large cerebral infarction, hernia in the right brain, developmental abnormalities of the right middle cerebral artery and cerebral artery of right brain. In conclusion, head CT imaging combined with cerebral angiography provides an efficient approach in diagnosis of stroke caused by snakebites.

Interplay of human gastrointestinal microbiota metabolites: Short-chain fatty acids and their correlation with Parkinson's disease.

Short-chain fatty acids (SCFAs) are, the metabolic byproducts of intestinal microbiota that, are generated through anaerobic fermentation of undigested dietary fibers. SCFAs play a pivotal role in numerous physiological functions within the human body, including maintaining intestinal mucosal health, modulating immune functions, and regulating energy metabolism. In recent years, extensive research evidence has indicated that SCFAs are significantly involved in the onset and progression of Parkinson disease (PD). However, the precise mechanisms remain elusive. This review comprehensively summarizes the progress in understanding how SCFAs impact PD pathogenesis and the underlying mechanisms. Primarily, we delve into the synthesis, metabolism, and signal transduction of SCFAs within the human body. Subsequently, an analysis of SCFA levels in patients with PD is presented. Furthermore, we expound upon the mechanisms through which SCFAs induce inflammatory responses, oxidative stress, abnormal aggregation of alpha-synuclein, and the intricacies of the gut-brain axis. Finally, we provide a critical analysis and explore the potential therapeutic role of SCFAs as promising targets for treating PD.

Application of Flexible Holmium Laser Sheath in Rigid Ureteroscopy for the Treatment of Impacted Upper Ureteral Stones.

OBJECTIVE: By comparing with rigid ureteroscopy (r-URS), we explored the application value of flexible holmium laser sheath combined with r-URS in treating impacted upper ureteral stones. We also verified its effectiveness, safety and economy and investigated its application prospects at community or primary hospitals. METHODS: From December 2018 to November 2021, 158 patients with impacted upper ureteral stones were selected from Yongchuan Hospital of Chongqing Medical University. Seventy-five patients in the control group were treated with r-URS, and 83 patients in the experimental group were treated with r-URS combined with a flexible holmium laser sheath if necessary. The operation time, postoperative hospital stay, hospitalization expenses, stone clearance rate after r-URS, auxiliary extracorporeal shock wave lithotripsy (ESWL) ratio, auxiliary flexible ureteroscope, the incidence of postoperative complications and the stone clearance rate after one month were observed. RESULTS: The postoperative hospital stay, stone clearance rate after r-URS, the ratio of auxiliary ESWL, the ratio of the auxiliary flexible ureteroscope, and total hospitalization expenses in the experimental group were significantly less than those in the control group (p < 0.05). There was no significant difference in operation time, postoperative complications, and stone clearance rate after one month between the two groups (p > 0.05). CONCLUSIONS: r-URS combined with flexible holmium laser sheath in treating impacted upper ureteral stones can improve the stone clearance rate and reduce hospitalization expenses. Therefore, it has a certain application value in community or primary hospitals.

Indolent mucinous tubular and spindle cell carcinoma of the kidney: A case report and review of the literature.

Mucinous tubular and spindle cell carcinoma of the kidney (MTSCC) is a rare subtype of renal cancer. It consists of tubules separated by mucus stroma and a spindle cell. Few cases have been reported; thus, the imaging features of MTSCC are not well characterized. An MTSCC in the left kidney of a 65-year-old woman was incidentally discovered during a medical checkup. A review of the patient's medical history revealed that this kidney lump had an indolent growth process. The current study presented this case and reviewed the pathological features, imaging findings and treatment options of MTSCC to strengthen the recognition of this rare renal neoplasm by radiologists.

The relationship between inflammatory response markers and the prognosis of non-muscle invasive bladder cancer and the development of a nomogram model.

Purpose: Patients with non-muscle invasive bladder cancer (NMIBC) have a high possibility of recurrence after surgery. We aimed to assess the factors associated with tumor recurrence and to construct a nomogram model that can contribute to personalized treatment plans of each patient. Methods: 496 patients with primary bladder cancer (BC) from 2 centers were retrospectively analyzed. Preoperative neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and traditional clinical parameters were collected, then using univariate and multivariate Cox regression analysis to find out the independent risk factors associated with tumor recurrence among them, and then these independent factors were incorporated into the nomogram model. The internal calibration curves and the external calibration curves were used to verify their usefulness. Results: In the training cohort, 150 patients (43.1%) experienced recurrence. After Cox regression analysis, the independent risk factors affecting recurrence-free survival (RFS) were tumor grade, immediate postoperative instillation therapy (IPPIT), NLR, and SII. These factors were used to construct a model to predict RFS 1, 2, 3, and 5 years of NMIBC patients after surgery. And then, we found that the constructed model outperforms the conventional model in terms of accuracy and predictability, the results were verified by statistical tests. Conclusion: Preoperative inflammatory response markers have a predictive value for postoperative recurrence in patients with NMIBC. The constructed nomogram model can be helpful in guiding personalized clinical evaluation and subsequent treatment.

The comparison between contrast-enhanced ultrasound and contrast-enhanced magnetic resonance imaging in diagnosing bladder urothelial carcinoma.

PURPOSE: The surgical treatment of bladder urothelial carcinoma depends on whether the tumor has invaded the bladder muscular layer. Normal ultrasound and contrast-enhanced magnetic resonance imaging (contrast-enhanced MRI) are widely used in patients bear bladder tumors; the latter is also widely used in estimating the muscularis invasion of bladder cancer (BC). However, contrast-enhanced ultrasound (CEUS) is rarely used in this aspect. As the gold standard in diagnosing muscularis invasion remains being pathological examination, this study was set to find out whether there are differences between CEUS and contrast-enhanced MRI in diagnosing bladder malignant tumors and in diagnosing the muscularis invasion of the bladder urothelial carcinoma under the guide of the pathological results. METHODS: 160 patients from Yongchuan Hospital of Chongqing Medical University and The Second Affiliated Hospital of Chongqing Medical University were recruited from July 1st, 2021, to June 30th, 2022. Patients are arranged to undergo CEUS, contrast-enhanced MRI and then take a surgery. After surgery, we compare the results of CEUS, MRI and the pathological results, using software to run the statistical examinations. RESULTS: The accuracies of CEUS and contrast-enhanced MRI in diagnosing malignant bladder tumors were 85.90 and 84.62%, and they had no differences (P > 0.05). While the accuracies of CEUS and contrast-enhanced MRI in diagnosing the muscularis invasion were 84.62 and 76.92%, in which CEUS had a better sensitivity (P < 0.05). CONCLUSIONS: We found that CEUS and contrast-enhanced MRI had no differences in diagnosing the different pathological types (benign or malignant) of BC, but CEUS holds a better sensitivity in diagnosing muscularis invasions of bladder urothelial carcinoma than the contrast-enhanced MRI.

Case Report: Transcatheter treatment of aortic coarctation in a 58-year-old patient with LACHT syndrome and left lung agenesis.

LACHT (Lung Agenesis, Congenital Heart, and Thumb anomalies) syndrome is an extremely rare congenital anomaly and presents significant challenges in adults due to its poor survival rates. Herein, we report a case of late diagnosis and successful transcatheter treatment of aortic coarctation in a 58-year-old male patient with LACHT syndrome, medically resistant arterial hypertension, and left lung agenesis. Baseline CT angiography showed isthmic aortic coarctation and left lung agenesis, with compensatory right pulmonary artery and vein thickenings. The patient underwent balloon dilation and subsequent implantation of a covered NuMED 45 mm 8-ZIG CP stent with satisfactory outcomes. The pressure gradient decreased from 43 to 23 mmHg. The arterial pressures normalized during the follow-up with fewer medications. Genetic testing identified a heterozygous mutation (c.6583C > T) in the FBN2, supporting the diagnosis of variant Marfan syndrome.

A study on the perioperative effects of obesity on minimally invasive coronary artery bypass grafting and its surgical techniques.

OBJECTIVES: The aim of this study was to discuss the perioperative effects of obesity on minimally invasive coronary artery bypass grafting (CABG) and its surgical techniques. METHODS: A total of 582 patients with multivessel lesion who underwent off-pump CABG by our medical group of Beijing Anzhen Hospital between January 2017 and January 2021 were divided into the minimally invasive cardiac surgery (MICS) group and the conventional group (median sternotomy) according to the surgical method used. The body mass index of the patients was calculated, based on which both groups were divided into obese (≥28 kg/m2) and non-obese subgroups (<28 kg/m2). First, the perioperative data of the obese subgroups of both MICS and conventional groups were compared. Second, the obese and non-obese subgroups were compared in the MICS group. RESULTS: Despite a higher proportion of diabetes in the MICS group, there was no significant difference in preoperative baseline nor in the incidence of major complications within 30 days after surgery between obese subgroups of the MICS and conventional groups. The MICS group had a significantly lower rate of poor wound healing, along with a higher predischarge Barthel Index. Also, the preoperative baseline between the obese and non-obese subgroups of the MICS group exhibited no statistical differences. The obese subgroup had longer postoperative ventilator assistance, while other intraoperative data and postoperative observation indexes exhibited no significant differences. CONCLUSIONS: MICS CABG method is safe and feasible for obese patients with multivessel lesion. Minimally invasive surgery is beneficial to wound healing in obese patients. However, it requires a thorough preoperative evaluation and adequate surgical experience and skills.

DFSNE-Net: Deviant feature sensitive noise estimate network for low-dose CT denoising.

BACKGROUND: Computed tomography (CT) has radiation problems, and high-quality CT scanning is usually accompanied by high doses of radiation that can be harmful to humans, so low-dose CT denoising has received extensive academic attention. METHOD: In this paper, firstly, the concept of deviant features is proposed which lead to the hypothesis of correlation between noise and deviant features. Secondly, in order to estimate the noise in CT, a new method of deviant feature perception and downsampling is proposed. Specifically, the deviant feature perception module based on the multi-scale convolutional cooperative (MSC-DFPM) and Filtering module based on the self-information space attention(SISA-FM) are proposed, and construct the deviant feature sensitive noise estimate network (DFSNE-Net), then a balanced loss function and training strategy adapted to the DFSNE-Net are proposed. Finally, noise distribution normalization based on skewness and kurtosis(SK-NDN) and low credible noise suppression based on confidence interval(CI-LCNS) as the noise optimization methods are proposed to optimize the estimated noise of DFSNE-Net, which is applied to the denoising task of CT. CONCLUSIONS: Experiments and results demonstrate that our proposed denoising method in this paper obtains a better denoising effect than the current state-of-the-art denoising methods in different evaluation indicator, which proves the hypothesis that noise is strongly correlated with deviant features. It is also proved that the denoising method proposed in this paper can achieve the denoising task for different doses of CT.

Comparing patient outcomes following minimally invasive coronary artery bypass grafting surgery vs. coronary artery bypass grafting: a single-center retrospective cohort study.

Background: This present research was designed for comparing coronary artery disease (CAD) patient outcomes following minimally invasive coronary artery bypass grafting surgery (MICS) or coronary artery bypass grafting (CABG). Methods: From 2014-2017, 679 CAD patients underwent MICS (n=281) or CABG (n=398) and were evaluated for the present study. Patient data were analyzed using 1:1 propensity score-matched assessment and a multivariate Cox proportional hazards regression model, and primary study achievements comprised major adverse cardiac and cerebrovascular events (MACCEs), myocardial infarction (MI), cardiac death, heart failure (HF), revascularization, and stroke. The median follow-up period was 2.68 years. Results: CABG patients exhibited a trend towards higher cumulative overall rates of MACCEs at 2 years (CABG: 6.2% vs. MICS: 3.8%) and 4 years (CABG: 9.3% vs. MICS: 7.6%) [adjusted hazard ratio (HR): 1.33; 95% confidence interval (CI): 0.33-5.39 for CABG vs. MICS; P=0.687], although this difference was not significant. No significant differences in 2- or 4-year cardiac death rates were observed between groups (CABG: 3.5%, 5.6% vs. MICS 2.8%, 2.8%; adjusted HR: 0.23; 95% CI: 0.03-1.81 for CABG vs. MICS; P=0.160). Further, there existed no discrepancies in rates of MI (P=1.000), HF (adjusted HR: 4.76; 95% CI: 0.01-6.40 for CABG vs. MICS; P=0.996), stroke (adjusted HR: 9.58; 95% CI: 0.11-25.24 for CABG vs. MICS; P=0.320), or repeated revascularization (adjusted HR: 1.71; 95% CI: 0.01-7.21 for CABG vs. MICS; P=0.631) when comparing these patient groups. In a multivariable Cox proportional hazards regression analysis, patients that were male (adjusted HR: 5.28; 95% CI: 1.48-18.83; P=0.010) and cases with a history of previous MI epsiodes (adjusted HR: 3.20; 95% CI: 1.09-9.37; P=0.034) were found to be at a higher risk of MACCEs. Conclusions: Follow-up data indicated that the MICS and CABG treatments could achieve similar outcomes.

Multiple miscarriages in a female patient with two-chambered heart and situs inversus totalis: A case report.

BACKGROUND: Single atrium with single ventricle, or a two-chambered heart, is an extremely rare congenital malformation. Few cases with two-chambered heart surviving to adulthood have been reported. CASE SUMMARY: We reported an adult female patient with a two-chambered heart and situs inversus totalis accompanied by multiple pregnancies and abortions. Magnetic resonance imaging detected a two-chambered heart. B-ultrasound-guided uterine aspiration was performed to absorb 8 g and 10 g of organized villus and decidual tissues, respectively, with a small amount of bleeding. Postoperatively, cyanosis and fatigue-induced shortness of breath were gradually relieved. The patient has currently outlived all similar cases reported so far. CONCLUSION: Hemodynamic changes in pregnant women with two-chambered heart impaired cardiac function, responsible for hypoperfusion and miscarriage.

A Nomogram Model to Predict Recurrence of Non-Muscle Invasive Bladder Urothelial Carcinoma After Resection Based on Clinical Parameters and Immunohistochemical Markers.

OBJECTIVE: This study aims to establish a nomogram model by combining traditional clinical parameters with immunohistochemical markers to predict the recurrence of non-muscle invasive bladder urothelial carcinoma (NMIBUC) after resection. METHODS: In total, 504 patients were included in this study. Of these patients, 353 underwent transurethral resection of bladder tumor (TURBT) in the Yongchuan Hospital of Chongqing Medical University and were identified as a training cohort. Univariate and multivariate Cox regression analyses were used to determine the risk factors associated with recurrence in the training cohort and to establish a nomogram model. A total of 151 patients who were hospitalized in the Second Affiliated Hospital of Chongqing Medical University (validation cohort) were used for further validation. The calibration curve was generated for internal and external model validation. The clinical practicability of this model was further verified by comparing the consistency index (C-index) among various models. RESULTS: The mean follow-up time of the training cohort was 45.6 months (range 4-90). In total, 146 patients relapsed in training cohort. After univariate analysis, multivariate analysis further confirmed tumor grade (p=.034), immediate postoperative instillation therapy (p=.025), Ki67 (p=.047), P53 (p=.038) and CK20 (p=.049) as independent risk factors for recurrence, and these factors were included in the nomogram model. The model more accurately predicted recurrence compared with other models based on the highest C-index of 0.82 (95% CI, 0.78-0.86) in the training cohort and 0.80 (95% CI, 0.77-0.83) in the validation cohort. CONCLUSIONS: This proposed nomogram model based on traditional clinical parameters and immunohistochemical markers can more accurately predict postoperative recurrence in patients with NMIBUC.

The loss and fate of BaA, Chr, BbF, and BaP (PAH4) tracked by stable isotope during frying.

The objective of this work was to accurately quantify the loss of benzo(a)anthracene, chrysene, benzo(b)fluoranthene, and benzo(a)pyrene (PAH4) and investigate the fate of the lost PAH4 into their derivatives during frying. Stable isotopes (PAH4-d12) were used to simulate the loss and track the conversion of PAH4. The results showed that the rate of loss of PAH4-d12 increased with the increase of frying temperature and the loss rate of benzo(a)pyrene-d12 was the largest, indicating that benzo(a)pyrene had the strongest chemical reactivity during frying. Moreover, the identification of five PAH4 derivatives has confirmed the conversion of lost PAH4. Finally, the loss of PAH4 during frying positively correlated with the oxidation of oil, and a conversion mechanism of PAHs to derivatives was proposed. This work directly proved the loss and conversion of PAH4 and provided a comprehensive perspective for studying the changes in PAH4 during frying.

Comparison of early outcomes associated with coronary artery bypass grafting for multi-vessel disease conducted using minimally invasive or conventional off-pump techniques: a propensity-matched study based on SYNTAX score.

BACKGROUND: This study was designed to compare early outcomes associated with coronary artery bypass grafting for multi-vessel disease conducted using either minimally invasive or conventional off-pump techniques. METHODS: From January 2017 through January 2021, 582 patients with multi-vessel lesion coronary artery disease underwent either minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) or conventional off-pump coronary artery bypass grafting (OPCABG) treatment by our team at Anzhen Hospital. Patients in the MICS CABG group were propensity score-matched with those in the OPCABG at a 1:1 ratio (MICS CABG = 172; OPCABG = 172), using epidemiological data, preoperative clinical characteristics, and SYNTAX score as covariates. Perioperative outcomes and 6-month computed tomography angiography findings were compared between these groups. RESULTS: No significant differences between groups were observed with respect to 30-day postoperative mortality, myocardial infarction, and stroke incidence. Surgical data indicated that the MICS CABG procedure was able to cover all three main arterial territories with a relatively low need for circulatory assistance. The MICS CABG procedure was associated with a longer operative duration, but was also associated with higher postoperative hemoglobin and activities of daily living index values as well as a shorter duration of postoperative hospitalization (P < 0.05). No differences in 6-month graft patency were observed between groups. CONCLUSIONS: MICS CABG is a safe, less invasive alternative to OPCABG when performing complete revascularization provided patients are properly selected, yielding similar in-hospital outcomes and 6-month graft patency rates together with an earlier return of physical function.

Improving the fidelity of CT image colorization based on pseudo-intensity model and tumor metabolism enhancement.

BACKGROUND: Subject to the principle of imaging, most medical images are gray-scale images. Human eyes are more sensitive to color images compared to gray-scale images. The state-of-the-art medical image colorization results are unnatural and unrealistic, especially in some organs, such as the lung field. METHOD: We propose a CT image colorization network that consists of a pseudo-intensity model, tumor metabolic enhancement, and MemoPainter-cGAN colorization network. First, the distributions of both the density of CT images and the intensity of anatomical images are analyzed with the aim of building a pseudo-intensity model. Then, the PET images, which are sensitive to tumor metabolism, are used to highlight the tumor regions. Finally, the MemoPainter-cGAN is used to generate colorized anatomical images. RESULTS: Our experiment verified that the mean structural similarity between the colorized images and the original color images is 0.995, which indicates that the colorized image maintains the features of the original images enormously. The average image information entropy is 6.62, which is 13.4% higher than that of the images before metabolism enhancement and colorization. It indicates that the image fidelity is significantly improved. CONCLUSIONS: Our method can generate vivid and fresh anatomical images based on prior knowledge of tissue or organ intensity. The colorized PET/CT images with abundant anatomical knowledge and high sensitivity of metabolic information provide radiologists with access to a new modality that offers additional reference information.

Off-Pump Aortic Bypass for Hypoplastic Arch and Aortic Coarctation Via Anterolateral Thoracotomy.

We report the case of a 21-year-old woman who was referred with uncontrolled hypertension. Computed tomography angiography revealed aortic arch hypoplasia and severe aortic coarctation. An off-pump ascending-to-descending aortic bypass surgery using synthetic graft was performed via left anterolateral thoracotomy. The patient recovered well and was discharged home uneventfully after five days. This procedure was performed without touching the head vessels or any collateral vessels. We consider this a safe and less invasive alternative technique for adult coarctation patients who have aortic hypoplasia or interrupted aorta.

Bis(2-{2-[2-(benzyl-carbamo-yl)phen-oxy]acetamido}-eth-yl)ammonium nitrate ethanol disolvate.

In the title compound, C(36)H(40)N(5)O(6) (+)·NO(3) (-)·2C(2)H(5)OH, the nitrate anion is disordered over the two orientations of equal occupancy while the solvent mol-ecule reveals large displacement parameters. The cation is formed by protonation of the N atom of a secondary amine in the middle of the flexible chain and the whole compound has crystallographically imposed C-2 symmetry with the crystallographic b axis. An O atom of the nitrate anion links the acidic H atoms of the cation via N-H⋯O hydrogen bonding. In addition, neighbouring cations are connected by inter-molecular N-H⋯O hydrogen bonds and π-π inter-actions between the benzamide groups of the cations [centroid-centroid distance = 4.000 (3) Å], forming a chain along [001]. The ethanol solvent mol-ecules are arranged on the side of the chain through O-H⋯O hydrogen bonds.

miR-93 Promotes the Growth and Invasion of Prostate Cancer by Upregulating Its Target Genes TGFBR2, ITGB8, and LATS2.

This study aimed to evaluate the effects of miR-93 on the growth and invasiveness of prostate cancer (PC) cells (PCCs). Real-time PCR was carried out to detect the expression of miR-93 in the PC tissues and cell lines. The adjacent normal tissues served as controls. For in vitro experiments, methyl thiazolyl tetrazolium, clone formation, tumor cell invasion assays, and western blot analysis (WBA) were performed to confirm the variations in the proliferation and invasiveness of PCCs, prior and subsequent to transfection with an miR-93 antisense oligonucleotide (ASO), which blocks miR-93 binding to its target. Furthermore, the effect of miR-93 on the proliferation of PCCs was examined. Finally, the expression levels of the target genes of miR-93 were determined by WBA. miR-93 expression was higher in PC tissues than in the adjacent normal tissues, and a reduction in the miR-93 level remarkably inhibited the proliferation and invasiveness of PCCs. Moreover, miR-93 enhanced the expression of its target genes TGFΒR2, ITGB8, and LATS2. The results of this study suggest that miR-93 may promote the proliferation and invasion of PCCs by upregulating its target genes TGFBR2, ITGB8, and LATS2.