Preferred Revascularization Strategies in Patients with Ischemic Heart Failure: A Meta-Analysis

Clinically,coronary artery bypass grafting (CABG)or percutaneous coronary intervention (PCI)is generally used to treat patients with ischemic heart failure.However, the optimal treatment strategy remains unknown.This study examined the efficacy of the two coronary revascularization strategies for severe ischemic heart failure by using a meta-analysis.Studies comparing the efficacy of CABG and PCI were obtained from PubMed,EMBASE,Google Scholar and Cochrane Central Register of Controlled Trials (CENTRAL).The quality of each eligible article was evaluated by Newcastle-Ottawa Quality Assessment Scale (NOS),and the meta-analysis was performed using Stata version 12.0 software.Eventually,12 studies involving 9248 patients (n=4872 in CABG group;n=4376 in PCI group)were subject to the meta-analysis for subsequent pooling calculation.The pooled hazard ratio (HR)[HR=0.83,95%CI (0.76,0.90),P<0.001; heterogeneity,P=0.218,I^2=22.9%]of CABG compared with that of PCI revealed a statistical superiority of CABG to PCI in terms of the long-term mortality.Furthermore, CABG showed more advantages over PCI with respect to the incidence of myocardial infarction [HR=0.51,95%CI (0.39,0.67),P<0.001;heterogeneity,P=-0.707,I^2=0%]and repeat revascularization [HR=0.40,95%CI (0.27,0.59),P<0.001;heterogeneity,P<0.001, I^2=80.1%].It was concluded that CABG appears to be more advantageous than PCI for the treatment of ischemic heart failure in the given clinical setting.

Application of Endoscopic Vein Harvesting in Obese Patients Undergoing Coronary Artery Bypass Grafting

This study aims to evaluate the clinical outcomes of endoscopic vein harvesting （EVH） for coronary artery bypass grafting （CABG） in obese patients. Totally, 153 obese patients who underwent EVH （n=81） or standard bridging technique （SBT, n=72） in CABG surgery from May 2012 to October 2014 in our hospital were enrolled in this retrospective non-randomized controlled study. The general situation of operation, postoperative complications and short medium-term outcomes were analyzed. The baseline characteristics were similar between these two groups （P〉0.05）. There were no statistical differences in total operation time （226±28 min vs. 224±30 min, P〉0.05）, number of damaged vessels （0.12±0.05 vs. 0.16±0.06, P〉0.05） and short medium-term outcomes including revascularization rate （1.25% vs. 2.78%, P〉0.05）, vessel dysfunction rate （11.25% vs. 11.11%, P〉0.05） and mortality （0.00% vs. 0.00%, P〉0.05）. Use of EVH was associated with significant reduction of total harvesting time （41±6 min vs. 63±11 min, P〈0.05）, incision length （4.4±1.1 cm vs. 18.2±4.5 cm, P〈0.05） and postoperative lower extremity complications （P〈0.05）. EVH can reduce the risk of wound complications, whereas does not influence short- and medium-term outcomes in obese patients. It can be considered a reliable procedure of harvesting vessel conduits for obese patients undergoing CABG.

Single-channel vector magnetic information detection method based on diamond NV color center

A method of detecting the single channel triaxial magnetic field information based on diamond nitrogen-vacancy(NV)color center is introduced.Firstly,the incident angle of the bias magnetic field which can achieve the equal frequency difference optically-detected magnetic resonance(ODMR)spectrum of diamond NV color center is calculated theoretically,and the triaxial magnetic information solution model is also constructed.Secondly,the microwave time-controlled circuit module is designed to generate equal timing and equal frequency difference microwave pulse signals in one channel.Combining with the optical detection magnetic resonance technology,the purpose of sequentially locking and detecting the four formant signals on one side of the diamond NV color center(m_(s)=-1 state signal)is achieved,and the vector magnetic field information detection is accomplished by combining the triaxial magnetic information solution model.The system can obtain magnetic field detection in a range of 0 mT-0.82 mT.The system's magnetic noise sensitivity is 14.2 nT/Hz^(1/2),and the deviation angle errors of magnetic field detectionθ_(x) andθ_(y) are 1.3° and 8.2° respectively.

Perioperative extracorporeal membrane oxygenation in pediatric congenital heart disease:Chinese expert consensus

Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces more severe challenges due to the complex anatomical structure of the heart,special pathophysiology,perioperative complications and various concomitant malformations.The survival rate of ECMO for CHD was significantly lower than other classifica-tions of diseases according to the Extracorporeal Life Support Organization database.This expert consensus aims to improve the survival rate and reduce the morbidity of this patient population by standardizing the clinical strategy.Methods The editing group of this consensus gathered 11 well-known experts in pediatric cardiac surgery and ECMO field in China to develop clinical recommendations formulated on the basis of existing evidences and expert opinions.Results The primary concern of ECMO management in the perioperative period of CHD are patient selection,cannulation strategy,pump flow/ventilator parameters/vasoactive drug dosage setting,anticoagulation management,residual lesion screening,fluid and wound management and weaning or transition strategy.Prevention and treatment of complications of bleeding,thromboembolism and brain injury are emphatically discussed here.Special conditions of ECMO management related to the cardiovascular anatomy,haemodynamics and the surgical procedures of common complex CHD should be considered.Conclusions The consensus could provide a reference for patient selection,management and risk identification of periop-erative ECMO in children with CHD.

Status on Heart Transplantation in China

INTRODUCTION ＂End-stage heart disease＂ commonly refers to an irreversible stage of cardiac decompensation caused by a variety of pathologies that cannot be treated using conventional drugs or traditional surgical treatments. The life expectancy of patients with end-stage heart disease ranges from 〈6 months to 1 year. Therapeutic strategies for end-stage heart disease patients are primarily based on three approaches： Internal medicine therapy, surgical therapy （heart transplantation）, and multiple organ protection therapy via the core method of mechanical circulation assistance. Among these approaches, heart transplantation has become recognized as the most efl＇ective treatment.

Cerebral Metabolic Profiling of Hypothermic Circulatory Arrest with and Without Antegrade Selective Cerebral Perfusion： Evidence from Nontargeted Tissue Metabolomics in a Rabbit Model

Background： Antegrade selective cerebral perfusion （ASCP） is regarded to perform cerebral protection during the thoracic aorta surgery as an adjunctive technique to deep hypothermic circulatory arrest （DHCA）. However, brain metabolism profile after ASCP has not been systematically investigated by metabolomics technology. Methods： To clarify the metabolomics profiling of ASCP, 12 New Zealand white rabbits were randomly assigned into 60 min DHCA with （DHCA＋ASCP [DA] group, n = 6） and without （ DHCA [D] group, n = 6） ASCP according to the random number table. ASCP was conducted by cannulation on the right subclavian artery and cross-clamping of the innominate artery. Rabbits were sacrificed 60 min after weaning off cardiopulmonary bypass. The metabolic features of the cerebral cortex were analyzed by a nontargeted metabolic profiling strategy based on gas chromatography-mass spectrometry. Variable importance projection values exceeding 1.0 were selected as potentially changed metabolites, and then Student＇s t-test was applied to test for statistical significance between the two groups. Results： Metabolic profiling of brain was distinctive significantly between the two groups （Q2y = 0.88 for partial least squares-DA model）. In comparing to group D, 62 definable metabolites were varied significantly after ASCP, which were mainly related to amino acid metabolism, carbohydrate metabolism, and lipid metabolism. Kyoto Encyclopedia of Genes and Genomes analysis revealed that metabolic pathways after DHCA with ASCP were mainly involved in the activated glycolytic pathway, subdued anaerobic metabolism, and oxidative stress. In addition, L-kynurenine （P = 0.0019）, 5-methoxyindole-3-acetic acid （P = 0.0499）, and 5-hydroxyindole-3-acetic acid （P = 0.0495） in tryptophan metabolism pathways were decreased, and citrulline （P - 0.0158） in urea cycle was increased in group DA comparing to group D. Conclusions： The present study applied metabolomics analysis to identify the cerebral metabolic profiling in rabbits with ASCP, and the results may shed new lights that cerebral metabolism is better preserved by ASCP compared with DHCA alone.

Enhanced performance of solid-state Li–O_2 battery using a novel integrated architecture of gel polymer electrolyte and nanoarray cathode

The present work proposes a novel strategy to fabricate an integrated architecture of gel polymer electrolyte （GPE）-nanoarray cathode for lithium-O2 batteries （LOBs）. As a proof-of-concept experiment, the photo-initiated in situ polymerization of GPE was carried out via incorporating the precursor solution in advance into a self- standing binder-free oxygen electrode of Co3O4 nanosheets array grown on carbon cloth （Co3O4@CC）, forming an integrated GPE-Co3O4@CC architecture. The performance of the solid-state LOBs using the GPE-Co3O4@CC assembly is greatly enhanced compared to the counterparts with a traditional cell structure, in which GPE was sandwiched by a lithium metal and a cathode. The enhanced performance is ascribed to the combination of the in situ polymerization of GPE and the versatile structure of nanoarray electrode, which results in abundant interfacial contacts between GPE and electrode. This work presents an alternative way to develop high-performance solid-state LOBs by combining the advantages of both gel polymer electrolytes and nanoarray electrodes.

Synergistically enhancing cycleability and rate performance of sodium titanate nanowire anode via hydrogenation and carbon coating for advanced sodium ion batteries

Layered alkali-metal titanate materials are considered as attractive anodes for sodium ion batteries due to their favorable safety and low cost.However,their practical implementation faces major challenges of low electronic conductivity and inevitable volume variation during Na^(+)intercalation and de-intercalation,which are generally difficult to conquer by a single modification method.Herein,a synergistic ally enhancing strategy to promote the electrochemical performance of Na_(2)Ti_(2)O_(5)nanowire array anode via simultaneous hydrogenation and carbon coating is developed.Hydrogenation leads to partially reduced titanium;together with conductive carbon layer,it endows Na_(2)Ti_(2)O_(5)with fast electron transport and structural stability.The resulting H-Na_(2)Ti_(2)O_(5)@C anode exhibits enhanced rate capability(8.0C,165 mAh·g^(-1))and stable cycle performance up to 1000 times in sodium-ion half-cells(the capacity of H-Na_(2)Ti_(2)O_(5)without carbon fades drastically after only 100 cycles).In addition,a newcoupling full cell is further designed with graphene hybridized high-voltage Na_(3)(VO_(0.5))_(2)(PO4)_(2)F_(2)as cathode,capable of delivering a high specific energy density of 212.1 Wh·kg^(-1)(based on the mass of both anode and cathode)and good rate and cycling stability.This work may offer inspiration for synergistic optimization of electrode materials for advanced electrochemical energy storage devices.

Interactive image segmentation with a regression based ensemble learning paradigm

To achieve fine segmentation of complex natural images, people often resort to an interactive segmentation paradigm, since fully automatic methods often fail to obtain a result consistent with the ground truth. However, when the foreground and background share some similar areas in color, the fine segmentation result of conventional interactive methods usually relies on the increase o f manual labels. This paper presents a novel interactive image segmentation method via a regression-based ensemble model with semi-supervised learning. The task is formulated as a non-linear problem integrating two complementary spline regressors and strengthening the robustness of each regressor via semi-supervised learning. First, two spline regressors with a complementary nature are constructed based on multivariate adaptive regression splines （MARS） and smooth thin plate spline regression （TPSR）. Then, a regressor boosting method based on a clustering hypothesis and semi-supervised learning is proposed to assist the training of MARS and TPSR by using the region segmentation information contained in unlabeled pixels. Next, a support vector regression （SVR） based decision fusion model is adopted to integrate the results of MARS and TPSR. Finally, the GraphCut is introduced and combined with the SVR ensemble results to achieve image segmentation. Extensive experimental results on benchmark datasets of BSDS500 and Pascal VOC have demonstrated the effectiveness of our method, and the com- parison with experiment results has validated that the proposed method is comparable with the state-of-the-art methods for in- teractive natural image segmentation.

Comparable prognosis in different neonatal histidine-tryptophan-ketoglutarate dosage management

Background:Histidine-tryptophan-ketoglutarate(HTK)is a solution commonly used for organ transplantation.However,there is no certified fixed regimen for on-pump heart surgery in neonates.We aimed to retrospectively evaluate the outcomes related to different HTK dosages and to analyze the safety of high-dosage perfusion.Methods:A total of 146 neonates who underwent on-pump heart surgery with single-shot HTK perfusion were divided into two groups according to HTK dosages:a standard-dose(SD)group(n=63,40 mL/kg<HTK≤60 mL/kg)and a high-dose(HD)group(n=83,HTK>60 mL/kg).Propensity score matching(PSM)was performed to control confounding bias.Results:The SD group had a higher weight(3.7±0.4 vs.3.4±0.4 kg,P<0.0001),a lower proportion of complete transposition of the great artery(69.8%vs.85.5%,P=0.022),a lower cardiopulmonary bypass(CPB)time(123.5[108.0,136.0]vs.132.5[114.8,152.5]min,P=0.034),and a lower aortic x-clamp time(82.9±27.1 vs.95.5±26.0 min,P=0.005).After PSM,44 patients were assigned to each group;baseline characteristics and CPB parameters between the two groups were comparable.There were no significant differences in peri-CPB blood product consumption after PSM(P>0.05).The incidences of post-operative complications were not significantly different between the two groups.There were no significant differences in ventilation time,intensive care unit stay,and post-operative hospital stay(P>0.05).Follow-up echocardiography outcomes at 1 month,3 to 6 months,and 1 year showed that left ventricular ejection fraction and end-diastolic dimension were comparable between the two groups.Conclusions:In neonatal on-pump cardiac surgery patients,single-shot HD(>60 mL/kg)HTK perfusion had a comparable heart protection effect and short-term post-operative prognosis as standard dosage perfusion of 40 to 60 mL/kg.Thus,this study provides supporting evidence of the safety of HD HTK perfusion.