[Technical exploration and early results of two-port total thoracoscopic aortic-mitral double-valve replacement]

Objective: To examine the clinical outcomes of patients undergoing total thoracoscopic aortic-mitral double-valve replacement. Methods: This is a retrospective case series study. The clinical data of 50 patients who underwent double-valve replacement under a total thoracoscopic two-port approach from November 2021 to August 2022 in the Department of Cardiovascular Surgery, Fujian Medical University Union Hospital were retrospectively analyzed. There were 32 males and 18 females, with an age of (55.3±8.8) years (range: 21 to 62 years). Among them, 36 cases had rheumatic heart disease and 14 cases had infective endocarditis. The 3rd intercostal space between the right anterior axillary line and the midclavicular line was selected as the main operating hole, the total thoracoscopic double-valve replacement were successfully carried out. Baseline data, intraoperative information, surgical outcomes, and postoperative complications were collected for all patients. Results: The cardiopulmonary bypass time was (168.2±30.9) minutes (range: 125 to 187 minutes), the aortic cross-clamping time was (118.8±16.5) minutes (range: 96 to 147 minutes). Five patients received bioprosthetic valves, and 45 received mechanical prosthetic valves. Postoperative mechanical ventilation lasted (9.6±3.4) hours (range: 5.1 to 14.2 hours), the ICU stay was (24.8±7.3) hours (range: 16.3 to 30.1 hours), and the postoperative hospital stay was (6.5±1.2) days (range: 5.0 to 8.0 days). Four patients received red blood cell transfusions of (2.7±0.9) units (range: 2 to 4 units), and the postoperative chest drainage volume was (222.1±56.3) ml (range: 175 to 289 ml). No deaths occurred intraoperatively or in the early postoperative period. One patient required reoperation due to bleeding in the aortic incision. Three patients had mild to moderate paravalvular leakage around the prosthetic aortic valve, with no cases of third-degree atrioventricular block or conversions to median sternotomy. Conclusions: The early outcomes of total thoracoscopic double valve replacement surgery are satisfactory, demonstrating safety and efficacy. This surgical approach expands the scope of total thoracoscopic cardiac surgery, which warrants further investigation and research.

[Early results of left ventricular assist device implantation for the treatment of heart failure]

Twenty-four male patients who underwent left ventricular assist device (LVAD) implantation due to advanced heart failure in Union Hospital, Fujian Medical University from June 2019 to June 2022 were retrospectively included. The age of patients was 32-61 (48.4±8.4) years. Everheat-Ⅰ, HeartCon and Corheart 6 left ventricular assist systems were used in 10, 6 and 8 cases, respectively. All patients were discharged successfully without mechanical failure, thrombosis or secondary thoracotomy for hemostasis. Early postoperative hemodynamics were significantly improved, left ventricular systolic diameter was reduced, left ventricular ejection fraction was gradually improved, and no hemolysis occurred. The patients were followed up for 3 to 39 (17.9±8.6) months, the cardiac function was restored to grade Ⅰ to Ⅱ, and the 6-minute walking test distance increased significantly. Therefore, satisfactory early results can be achieved with left ventricular assist device implantation for the treatment of heart failure.

Interference effect on the Andreev reflections induced by Majorana bound states

We investigate the effect of quantum interference on the Andreev reflections (ARs) induced by Majorana bound states (MBSs), by considering their additional coupling via a quantum-dot molecule. It is found that due to the direct and indirect couplings of MBSs, a quantum ring is constructed in this system. Consequently, the interference effect makes important contribution to the ARs, especially in the presence of the local magnetic flux. All the results are manifested as the tight dependence of the differential conductance and Fano factors on the magnetic flux phase factor, dot-MBS couplings, and the dot level, respectively. Moreover, at the zero-bias limit, the magnitudes of the Fano factors and their relation can be efficiently altered by the interference properties. We believe that quantum interference is important for manipulating the Andreev reflection behaviors of the MBSs.

Anti-site-induced diverse diluted magnetism in LiMgPdSb-type CoMnTiSi alloy

The effect of three kinds of anti-site disorder to electronic structure and magnetic properties of the LiMgPdSb-type CoMnTiSi alloy are investigated. It was found the Mn-Ti anti-site disorder can induce the diluted magnetism in CoMnTiSi matrix. The magnetic structure has an oscillation between the ferromagnetic and antiferromagnetic states with the different degree of Mn-Ti anti-site disorder. Two novel characteristics: the diluted antiferromagnetic half-metallicity and the diluted zero-gap half-metallity are found in the different degree range of the Mn-Ti anti-site disorder. The Co-Mn and Co-Ti anti-site disorder have little effect on the magnetic properties. The width of energy gap and the intensity of DOS at the Fermi level can be adjusted by the degree of Co-Mn or Co-Ti anti-site disorder. The independent control to the carrier concentration and magnetization can be realized by introducing the different anti-site disorder.

Significance of combined detection of HIF-1α, TXB2, 6-keto-PGF1α and HA in the diagnosis of hepatic microcirculatory disturbance in patients with chronic hepatitis B

AIM: To evaluate the significance of combined detection of HIF-1α, TXB2, 6-keto-PGF1α and HA in the diagnosis of hepatic microcirculatory disturbance in patients with chronic hepatitis B (CHB).

METHODS: In total, 275 patients with CHB and 15 normal volunteer were included. The ultrastructure of the liver was observed by transmission electron microscopy (TEM). HIF-1α expression in liver biopsies was detected by immunohistochemistry. Plasma levels of TXB2 and 6-keto-PGF1α were determined by chemiluminescence, and serum HA levels was measured by RIA.

RESULTS: As the pathological changes of the liver were aggravated, erythrocyte aggregation, stenosis and blockage of sinus hepaticas, collagen fiber deposition, and basal membrane formation became worsened, the strength and range of expression of HIF-1α was enhanced, the levels of serum HA and plasma TXB2 were raised gradually, and plasma levels of 6-keto-PGF1α slightly declined.

CONCLUSION: Combined detection of HIF-1α, TXB2, 6-keto-PGF1α and HA can help accurately diagnose hepatic microcirculatory disturbance in patients with CHB.

Investigation of pulsed low dose rate radiotherapy using dynamic arc delivery techniques

There has been no consensus standard of care to treat recurrent cancer patients who have previously been irradiated. Pulsed low dose rate (PLDR) external beam radiotherapy has the potential to reduce normal tissue toxicities while still providing significant tumor control for recurrent cancers. This work investigates the dosimetry feasibility of PLDR treatment using dynamic arc delivery techniques. Five treatment sites were investigated in this study including breast, pancreas, prostate, head and neck, and lung. Dynamic arc plans were generated using the Varian Eclipse system and the RapidArc delivery technique with 6 and 10 MV photon beams. Each RapidArc plan consisted of two full arcs and the plan was delivered five times to achieve a daily dose of 200 cGy. The dosimetry requirement was to deliver approximately 20 cGy/arc with a 3 min interval to achieve an effective dose rate of 6.7 cGy min⁻¹. Monte Carlo simulations were performed to calculate the actual dose delivered to the planning target volume (PTV) per arc taking into account beam attenuation/scattering and intensity modulation. The maximum, minimum and mean doses to the PTV were analyzed together with the dose volume histograms and isodose distributions. The dose delivery for the five plans was validated using solid water phantoms inserted with an ionization chamber and film, and a cylindrical detector array. Two intensity-modulated arcs were used to efficiently deliver the PLDR plans that provided conformal dose distributions for treating complex recurrent cancers. For the five treatment sites, the mean PTV dose ranged from 18.9 to 22.6 cGy/arc. For breast, the minimum and maximum PTV dose was 8.3 and 35.2 cGy/arc, respectively. The PTV dose varied between 12.9 and 27.5 cGy/arc for pancreas, 12.6 and 28.3 cGy/arc for prostate, 12.1 and 30.4 cGy/arc for H&N, and 16.2 and 27.6 cGy/arc for lung. Advanced radiation therapy can provide superior target coverage and normal tissue sparing for PLDR reirradiation of recurrent cancers, which can be delivered using dynamic arc delivery techniques with ten full arcs and an effective dose rate of 6.7 ± 4.0 cGy min⁻¹.

Cell migration in the rat embryonic neocortex

Three-dimensional reconstructions of the normal rat embryonic (E) neocortex on days E15, E17, E19, and E21, using Skandha (software designed by J. Prothero, University of Washington, Seattle), show that the neocortical ventricular zone shrinks rapidly in the medial direction during cortical morphogenesis. [3H]thymidine autoradiography indicates that the shrinkage of the ventricular zone occurs before neurons in lateral and ventrolateral parts of layers IV-II are generated. Consequently, most of these neurons originate 400-1000 microns medial to their settling sites in the cortical plate. Embryos killed at daily intervals up to E21 after a single injection of [3H]thymidine on either E17 or E18 revealed the presence of a prominent migratory path, the lateral cortical stream, used by neurons migrating to the lateral and ventrolateral cortical plate; neurons migrating to the dorsal cortical plate follow a direct radial path. Arrival times of neurons in the cortical plate depend on the migratory path and are proportional to the overall distance travelled. Neurons that migrate only radially arrive in the dorsal cortical plate in two days (shortest route). Neurons that migrate laterally arrive in the lateral cortical plate in 3 days (longer route) and in the ventrolateral cortical plate in 4 days (longest route). [3H]thymidine autoradiography also shows that cells generated in the neocortical ventricular zone migrate in the lateral cortical stream for 5 or more days and accumulate in a reservoir. Cells leave the reservoir to enter the piriform cortex and destinations (as yet undetermined) in the basal telencephalon. The lateral cortical stream is found wherever the neocortical primordium surrounds the basal ganglia and is absent behind the basal ganglia. A computer analysis of nuclear orientation in anterior and posterior parts of the intermediate zone in the dorsal neocortex between days E17 and E22 shows that horizontally oriented nuclei are more common anteriorly where many cells are migrating laterally than posteriorly where most cells are migrating radially.

Planar differences in nuclear area and orientation in the subventricular and intermediate zones of the rat embryonic neocortex

Nuclear area and orientation in the subventricular and intermediate zones was studied quantitatively in coronal vs. sagittal sections of the dorsomedial neocortex. Nissl-stained methacrylate-embedded normal rat embryos were studied between embryonic days (E) 13 and E22. The area of nuclear profiles and the degrees their long axes (defined as a straight line through the two most distant points in the nuclear profile) deviated from the horizontal (defined as parallel to the pial membrane) were determined with a computer-graphics program. Because the nucleus is the most clearly outlined structure in embryonic cells, the area and orientation of the nucleus was taken to reflect the overall size and orientation of the cell body. Nuclear area is larger in the coronal plane than it is in the sagittal plane, especially between E17 and E20. Cell body orientation in the subventricular and lower intermediate zones is predominantly horizontal in the coronal plane and predominantly vertical in the sagittal plane. In the upper intermediate zone, cell body orientation is predominantly vertical in both planes, but more so in the sagittal plane. These data indicate that the majority of cell bodies in the subventricular and lower intermediate zones have a horizontally oriented, flattened elliptical shape with their larger diameters lying within the coronal plane and their smaller diameters in the sagittal plane. Because of the flattening, the cell bodies falsely appear to be vertically oriented in the sagittal plane. Qualitative observations in horizontal sections confirmed the quantitative computer analysis. These results are related to other findings with [3H]thymidine autoradiography concerning cell migration and the sojourn of cells in the subventricular and intermediate zones.

The extent and distribution of intratubular collagen fibrils in human dentine

Dentine of 27 permanent human teeth was examined by scanning electron microscopy. The teeth were incisors, canines, premolars and molars, ranging in age from 18 to 54 yr. Intratubular collagen was found in 65% of the dental tubules in inner dentine (closest to the pulp) with 16% of the tubules containing large collagen bundles occupying more than one-fifth of the lumen. In middle dentine the corresponding figures were 42 and 7%, and for outer dentine, 12 and 0% This pattern of distribution was the same for all tooth families examined and appeared to be unrelated to age.