Comparing Short-Term Outcomes of Right Mini-Thoracotomy and Median Sternotomy for Isolated Left Atrial Myxoma Excision

Background: Left atrial myxoma (LAM) is the most common heart tumor in adults, requiring prompt surgical removal to prevent complications like valvular obstruction or embolization. Objectives: This study aimed to compare early postoperative outcomes between two surgical approaches—right mini-thoracotomy and median sternotomy—for the removal of isolated left atrial myxoma. Methods: We conducted a prospective observational study at the Department of Cardiac Surgery, National Heart Foundation Hospital & Research Institute (NHFH&RI), Mirpur, Dhaka, from March 2017 to August 2019. Twenty-eight patients undergoing surgery for isolated left atrial myxoma were included. The surgical approach was determined by the operating surgeon. We analyzed outcomes like intubation time, Intensive Care Unit (ICU) stay, pain levels (Visual Analogue Scale score), and overall hospital stay using SPSS. Statistical significance was set at p Results: Patients in the right mini-thoracotomy group had longer mean intubation times (11.43 vs. 5.93 hours, p Conclusion: Despite longer intubation and ICU times, the right mini-thoracotomy approach offers a minimally invasive alternative for isolated left atrial myxoma excision, with favorable outcomes overall.

Unroofing Technique for Anomalous Origin of the Left Coronary Artery from the Right Sinus of Valsalva: Report of a Case

Anomalous origin of the left coronary artery (AOLCA) from the right sinus of Valsalva constitutes a rare congenital coronary artery anomaly. Patients with an anomalous left main coronary artery face a significantly higher risk of sudden cardiac death compared to those with an anomalous right coronary artery. The anomalous coronary artery traversing between the ascending aorta and the pulmonary artery markedly heightens the risk of myocardial ischemia, arrhythmia, and sudden death. Symptomatic patients often exhibit a longer intramural course of the coronary artery, which may necessitate earlier intervention or influence the choice of surgical repair method. Surgical intervention is advocated for patients with this anomaly, even in the absence of symptoms. For anomalous aortic origin of a coronary artery from the opposite sinus of Valsalva with an intramural course, coronary unroofing is the preferred revascularization procedure. This report presents a case of AOLCA originating from the right sinus of Valsalva, treated surgically using the unroofing technique for the aortic intramural segment of the anomalous coronary artery traversing between the great vessels. The unroofing technique is recommended for treating AOLCA with an extensive intramural course that does not involve the commissure.

英汉方位隐喻的文化蕴涵比较——以up/down(上/下)、left/right(左/右)为例

隐喻不仅是一种语言现象,更是一种认知现象。借助方位隐喻能更好地实现抽象概念的表达。英语和汉语中的up/down(上/下)、left/right(左/右)两组方位词,在时间、地位、数量等方面形成的方位隐喻概念所蕴含的抽象文化意义体现出文化特色。

Copyright与Copyleft的经济学分析

Copyleft是一种全新的知识产权理念,它将知识产品的权利对外开放,对传统的版权(Copyright)制度提出了挑战,引起人们的广泛关注。通过从经济学角度对Copyright及Copyleft制度进行了比较分析,认为Copyleft满足了网络社会知识集体生产的需求,是对Copyright的超越与补充;两者都是人们在利益最大化原则下对知识产品产权形式的理性选择,并将长期共存。

Different treatment strategies and molecular features between right-sided and left-sided colon cancers

The colon is derived from the embryological midgut and hindgut separately,with the right colon and left colon having different features with regards to both anatomical and physiological characteristics.Cancers located in the right and left colon are referred to as right colon cancer(RCC) and left colon cancer(LCC),respectively,based on their apparent anatomical positions.Increasing evidence supports the notion that not only are there differences in treatment strategies when dealing with RCC and LCC,but molecular features also vary between them,not to mention the distinguishing clinical manifestations.Disease-free survival after radical surgery of both RCC and LCC are similar.In the treatment of RCC,the benefit gained from adjuvant FOLFIRI chemotherapy is superior,or at least similar,to LCC,but inferior to LCC if FOLFOX regimen is applied.On the other hand,metastatic LCC exhibits longer survival than that of RCC in a palliative chemotherapy setting.For KRAS wild-type cancers,LCC benefits more from cetuximab treatment than RCC.Moreover,advanced LCC shows a higher sensitivity to bevacizumab treatment in comparison with advanced RCC.Significant varieties exist at the molecular level between RCC and LCC,which may serve as the cause of all apparent differences.With respect to carcinogenesis mechanisms,RCC is associated with known gene types,such as MMR,KRAS,BRAF,and mi RNA-31,while LCC is associated with CIN,p53,NRAS,mi RNA-146 a,mi RNA-147 b,and mi RNA-1288.Regarding protein expression,RCC is related to GNAS,NQO1,telomerase activity,P-PDH,and annexin A10,while LCC is related to Topo I,TS,and EGFR.In addition,separated pathways dominate progressionto relapse in RCC and LCC.Therefore,RCC and LCC should be regarded as two heterogeneous entities,with this heterogeneity being used to stratify patients in order for them to have the optimal,current,and novel therapeutic strategies in clinical practice.Additional research is needed to uncover further differences between RCC and LCC.

Left to Right Extracardial Shunt to Control Hemorrhage of Ascending Aorta and Left Ventricle: A Report of 3 Cases

Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enclosing conduit graft was used as a sac bypassed to right atrium to form a extracardial left-toright shunt in order to control bleeding and the results turned out to be satisfactory. The bypass and hemodynamically ignorable shunt can close spontaneously without complications with recovery of coagulation system. The technique may find wide application in clinical practice.

Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts

AIM To analyze the outcomes of living-donor liver transplantation(LDLT) using left-lobe(LL) or right-lobe(RL) small-for-size(SFS) grafts.METHODS Prospectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short-and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight(GW) to recipient standard liver volume(RSLV)(GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTS Totally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age(median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women(165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW(P < 0.0001), GW/RSLV(P < 0.0001), and graft cold ischemic time(P = 0.007). When it comes to postoperative complication, the groups were comparable(P = 0.105). Five patients died in hospital,4(2%) in the RL-LDLT group and 1(5.3%) in the LLLDLT group(P = 0.918). There were 38 graft losses, 33(16.6%) in the RL-LDLT group and 5(26.3%) in the LL-LDLT group(P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group(95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates(RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSION The use of SFS graft in LDLT requires careful tailormade surgical planning and meticulous operation. LLLDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.

Influence of High-Velocity Blood Flow on Right-to-Left Shunt in Patients with Patent Foramen Ovale during the Valsalva Maneuver

In this study, we investigated the changes in the right-to-left shunt (RLS) of the patent foramen ovale (PFO) at different phases of the Valsalva maneuver and analyzed the possible mechanisms. The study population consisted of 57 patients with symptoms highly suggestive of a PFO. These patients had been diagnosed with apsychia, migraine with aura, cerebral infarction, transient ischemic attack (TIA), and cerebral ischemia with unknown cause. Routine echocardiography was performed in all patients to rule out a cardiac malformation. Contrast-transcranial Doppler (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) were used to visualize and quantify the RLS. The standard apical four chamber view was used to observe the changes of E peak, A peak, and velocity-time integral (VTI) ratio of tricuspid blood flow during the strain phase and release phase of the Valsalva maneuver. Paired t-test was used to compare E peak, A peak, and VTI ratio of tricuspid blood flow during the different phases. The right-to-left shunt across the PFO (PFO-RLS) was graded in the two phases and compared by Kruskal-Wallis test. Compared with the strain phase of the Valsalva maneuver, the parameters of E, A, and VTI in diastolic period in patients with PFO-RLS at the release phase were significantly increased [54.30 ± 13.65 cm/s vs 100.35 ± 21.11 cm/s, 42.21 ± 12.32 cm/s vs 57.30 ± 18.88 cm/s, 10.34 ± 3.27 cm/s vs 19.58 ± 4.56 cm/s, respectively], and the difference was statistically significant. The positive consequence of PFO-RLS, as diagnosed by c-TTE with the Valsalva maneuver at the release phase of the Valsalva maneuver, was significantly higher than that at the strain phase of the Valsalva maneuver. At the beginning of release phase of the Valsalva maneuver, decreased intrathoracic pressure led to increased venous backflow into the right atrium. Thus, high-velocity blood flow rapidly pushed the PFO open, which resulted in a significant increase in the PFO-RLS. Therefore, the increase of the PFO-RLS during the Valsalva maneuver is caused by the impact of high-velocity blood flow the PFO.

Does Right Coronary Artery Stenosis Increase Morbi-Mortality in Patients Undergoing Coronary Artery Bypass Graft for Left Main Coronary Artery Disease?

Background: The association of right coronary artery (RCA) stenosis in patients undergoing myocardial revascularization for left main coronary artery (LMCA) stenosis affects the prognosis. This study aimed to compare immediate results of patients with isolated LMCA stenosis and those with combined RCA stenosis. Patients and methods: We retrospectively evaluated 107 consecutive patients with LMCA disease who underwent coronary artery bypass grafts. The patients were divided into two groups: isolated LMCA stenosis (n = 36) and LMCA stenosis + RCA stenosis (n = 71). Different variables (preoperative, intra operative and post operative) were compared. Results: Patients with LMCA stenosis + RCA stenosis experienced higher prevalence of diabetes mellitus (p = 0.024) and smoker (p = 0.032). Also left ventricular EF was reduced (p = 0.004). Myocardial revascularization was more complete in patients with LMCA stenosis + RCA stenosis (p = 0.033), but in-hospital mortality rate was higher (12.6% vs 5.5%) in isolated LLMCA stenosis, but it did not reach statistical significance (p = 0.32). Except low output syndrome (LOS) that was frequent in presence of RCA stenosis (p = 0.026), no significant difference was found between groups for other complications. Conclusion: The presence of RCA stenosis in patients undergoing CABG for LMCA disease increases 30 day mortality but without significant impact on overall morbidities.

Intertwined leukocyte balances in tumours and peripheral blood as robust predictors of right and left colorectal cancer survival

BACKGROUND Colorectal cancer(CRC)accounts for 9.4%of overall cancer deaths,ranking second after lung cancer.Despite the large number of factors tested to predict their outcome,most patients with similar variables show big differences in survival.Moreover,right-sided CRC(RCRC)and left-sided CRC(LCRC)patients exhibit large differences in outcome after surgical intervention as assessed by preoperative blood leukocyte status.We hypothesised that stronger indexes than circulating(blood)leukocyte ratios to predict RCRC and LCRC patient outcomes will result from combining both circulating and infiltrated(tumour/peritumour fixed tissues)concentrations of leukocytes.AIM To seek variables involving leukocyte balances in peripheral blood and tumour tissues and to predict the outcome of CRC patients.METHODS Sixty-five patients diagnosed with colon adenocarcinoma by the Digestive Surgery Service of the La Paz University Hospital(Madrid,Spain)were enrolled in this study:43 with RCRC and 22 with LCRC.Patients were followed-up from January 2017 to March 2021 to record overall survival(OS)and recurrence-free survival(RFS)after surgical interventions.Leukocyte concentrations in peripheral blood were determined by routine laboratory protocols.Paraffin-fixed samples of tumour and peritumoural tissues were assessed for leukocyte concentrations by immunohistochemical detection of CD4,CD8,and CD14 marker expression.Ratios of leukocyte concentration in blood and tissues were calculated and evaluated for their predictor values for OS and RFS with Spearman correlations and Cox univariate and multivariate proportional hazards regression,followed by the calculation of the receiver-operating characteristic and area under the curve(AUC)and the determination of Youden’s optimal cutoff values for those variables that significantly correlated with either RCRC or LCRC patient outcomes.RCRC patients from the cohort were randomly assigned to modelling and validation sets,and clinician-friendly nomograms were developed to predict OS and RFS from the respective significant indexes.The accuracy of the model was evaluated using calibration and validation plots.RESULTS The relationship of leukocyte ratios in blood and peritumour resulted in six robust predictors of worse OS in RCRC:CD8+lymphocyte content in peritumour(CD8pt,AUC=0.585,cutoff<8.250,P=0.0077);total lymphocyte content in peritumour(CD4CD8pt,AUC=0.550,cutoff<10.160,P=0.0188);lymphocyte-to-monocyte ratio in peritumour(LMRpt,AUC=0.807,cutoff<3.185,P=0.0028);CD8+LMR in peritumour(CD8MRpt,AUC=0.757,cutoff<1.650,P=0.0007);the ratio of blood LMR to LMR in peritumour(LMRb/LMRpt,AUC=0.672,cutoff>0.985,P=0.0244);and the ratio of blood LMR to CD8+LMR in peritumour(LMRb/CD8MRpt,AUC=0.601,cutoff>1.485,P=0.0101).In addition,three robust predictors of worse RFS in RCRC were found:LMRpt(AUC=0.737,cutoff<3.185,P=0.0046);LMRb/LMRpt(AUC=0.678,cutoff>0.985,P=0.0155)and LMRb/CD8MRpt(AUC=0.615,cutoff>1.485,P=0.0141).Furthermore,the ratio of blood LMR to CD4+LMR in peritumour(LMRb/CD4MRpt,AUC=0.786,cutoff>10.570,P=0.0416)was found to robustly predict poorer OS in LCRC patients.The nomograms showed moderate accuracy in predicting OS and RFS in RCRC patients,with concordance index of 0.600 and 0.605,respectively.CONCLUSION Easily obtainable variables at preoperative consultation,defining the status of leukocyte balances between peripheral blood and peritumoural tissues,are robust predictors for OS and RFS of both RCRC and LCRC patients.

Propagation of Airy beams from right-handed material to left-handed material

Based on the ABCD matrix formalism,the propagation property of an Airy beam from right-handed material（RHM） to left-handed material（LHM） is investigated.The result shows that when the Airy beam propagates in the LHM,the intensity self-bending due to its propagation in the RHM can be compensated.In particular,if the propagation distance in the RHM is equal to that in the LHM and the refractive index of the LHM is n L =-1,the transverse intensity distribution of the Airy beam can return to its original state.

Cardiac-MRI demonstration of the ligamentum arteriosum in a case of right aortic arch with aberrant left subclavian artery

Right-sided aortic arch with aberrant left subclavian artery (RAA/ALSC) is the second most common mediastinal complete vascular ring. Adult presentation of dysphagia lusoria due to a RAA/ALSC is uncommon with fewer than 25 cases reported in the world literature. The left lateral portion of this vascular ring is not a vessel, but an atretic ductus arteriosus, the ligamentum arteriosum, which has been identified in different cases as the major cause of tracheo-esophageal impingement. Surgical division of the ligamentum arteriosum allows the vessels to assume a less constricting pattern decreasing dysphagic symptoms. Clear visualization of the ligamentum arteriosum by diagnostic imaging has not been obtained in previously reported cases. We demonstrated, using magnetic resonance imaging, the location and the complete course of a left-sided ligamentum arteriosum in a patient with adult-onset dysphagia due to a RAA/ALSC with a small Kommerell' s diverticulum, providing, during the same session, a complete assessment of both mediastinal vascular abnormalities and esophageal impingement sites.

Left Radial Approach versus Right Radial Approach of Coronary Angiography in the Diagnosis of Coronary Heart Disease

Background: Transradial coronary angiography has established itself as safe alternative to transfemoral approach. Today, the artery of approach lies completely on the operator’s choice. The Right Radial Approach (RRA) has been a favorite for most of the interventional cardiologists due to the convenience in operating from the right side. The Left Radial Approach (LRA) has always been a neglected route. LRA does have many advantages over the right, the vascular anatomy being one of them. The aim of our study was to compare the right radial approach of diagnostic coronary angiography with left radial approach. Method: A total of 70 cases of Coronary Angiography (CAG) with normal Allen test and satisfying the inclusion criteria were prospectively observed and studied after randomly assigning them into two equal groups, LRA (Left Radial Approach) n = 35 and RRA (Right Radial Approach) n = 35. Multipurpose TIG (Tiger) catheter was used in both the approaches to catheterize the right as well as left coronary artery. Results: The access time, catheter manipulation time, procedure time, amount of contrast used, hospital stay, intensity of pain experienced, cost of the procedure and quality of coronary angiogram observed were statistically insignificant while the fluoroscopy time was slightly statistically significant which was independent to catheter manipulation time. Conclusions: The neglected Left Radial Approach to coronary angiography is as efficacious, safe and cost effective with reduction in arterial spasm complications when compared to the Right Radial Approach performed by multipurpose Tiger catheter.

Right-and left-sided colorectal cancers respond differently to traditional Chinese medicine

AIM To explore the differences in the responses of left-sided colorectal cancer(LSCRC) and right-sided colon cancer(RSCC) to traditional Chinese medicine(TCM).METHODS Patients with postoperative stage I-III colorectal cancer(CRC) were enrolled and divided into the LSCRC with or without TCM and RSCC with or without TCM groups depending on the primary tumor side and TCM administration. Patients in the TCM group were given TCM for at least 6 mo. Our research adopted diseasefree survival(DFS) as the primary endpoint. We applied a Cox proportional hazards regression model for the multivariate factor analysis using Stata 12.0 and SPSS 22.0 software for data analysis.RESULTS Of the 817 patients included in our study, 617 had LSCRC(TCM group, n = 404; Non-TCM group, n = 213), and 200 had RSCC(TCM group, n = 132; NonTCM group, n = 68). The 6-year DFS for patients with LSCRC was 56.95% in the TCM group and 41.50% in the Non-TCM group(P = 0.000). For patients with RSCC, the 6-year DFS was 52.92% in the TCM group and 37.19% in the Non-TCM group(P = 0.003). Differences between LSCRC and RSCC were not statistically significant regardless of TCM ingestion.CONCLUSION Patients with either LSCRC or RSCC and who took TCM experienced longer DFS; furthermore, patients with RSCC benefited more from TCM in DFS.

A power divider based on a new kind of composite right/left-handed transmission line (CRLH TL) unit

A new power divider, composed of a novel composite right/left-handed (CRLH) transmission line (TL) unit, is proposed. The properties of the power divider based on four CRLH TL unit cells are investigated theoretically. By adjusting the parameters of the capacitors and the inductors, the power divider shows perfectly symmetric power division at 5.13 GHz, return loss up to ?24 dB, with the transmitted power being close to ?3.1 dB. The phenomena are demonstrated by simulation results. Being compact in size and low-cost, the proposed power divider is very suitable for microwave and millimeter wave integrated circuits.

“Taking the Left for the Upper” or “Taking the Right for the Upper”

Currently, there are two rituals coexist in the world:"taking the left for the upper"and"taking the right for the up?per". The former is usually taken in domestic affairs such as meetings, dinners, etc. while the latter enjoys an overwhelmingly fa?vor in the west and so that it becomes the international practice in every conceivable social activities. The paper intends to offer a deep explanation of the differences of two rituals with adequate evidence and examples in some specific situations, say different kinds of seat arrangement in various large and small meetings, respectively in China and the west. Then it follows to provide the underlying reasons for the differences from the perspective of cultural difference. It finds that different denotation of"left"and"right"in English and Chinese may shed some light on the understanding of the two different rituals.

Novel resonator based on composite right/left-handed transmission lines

A new approach was introduced to analyze composite right/left-handed transmission lines （CRLH TLs）. The Bloch impedance and the dispersion relations are directly obtained from the S parameters of the unit cells. The LH and RH frequency bands are then identified by the real parts of the Bloch impedance and the phase delay of the unit cells. The new approach has some advantages over the LC parameters extraction method introduced by Caloz et a1.（2004）. Based on the new approach, a novel resonator is designed using CRLH TLs. The simulation and experimental results accorded well with the theoretical analysis. The novel resonator may have potential applications in filters with high harmonic suppression and compact structures,

LEFT-RIGHT BROWDER LINEAR RELATIONS AND RIESZ PERTURBATIONS

A closed linear relation T in a Banach space X is called left(resp. right) Fredholm if it is upper(resp. lower) semi Fredholm and its range(resp. null space) is topologically complemented in X. We say that T is left(resp. right) Browder if it is left(resp. right)Fredholm and has a finite ascent(resp. descent). In this paper, we analyze the stability of the left(resp. right) Fredholm and the left(resp. right) Browder linear relations under commuting Riesz operator perturbations. Recent results of Zivkovic et al. to the case of bounded operators are covered.

Science Letters:Dual structure of composite right/left-handed transmission line

A dual structure of composite right/left handed (CRLH) transmission line (TL) is analyzed in which an inductance LR is in parallel with a capacitance CL and a shunt capacitance CR is in series with an inductance LL. Both the distributed and lumped cases are considered. The dispersion diagram and transmission properties of the dual CRLH TL are given and compared with those of a standard CRLH TL. Contrary to the frequency response of a standard CRLH TL, a dual CRLH TL has a left-handed (negative phase shift) band at higher frequencies and a right-handed (positive phase shift) band at lower frequencies. A novel dual-band balun is presented as an application.

Structure analysis of levitation chassis of medium-to-low speed maglev vehicles based on left-right decoupling

Levitation chassis, as an extremely important component of maglev vehicles, provides functions of transmitting levitation force and steering force, and directly affects the safety performance of the vehicle. Based on the vertical dynamics model of the levitation chassis, kinetic equations of the model are established, and a simulation program is designed to analyze the structural decoupling function of the chassis, especially under the influence of elastic constraints between the left and right modules, which are exclusively owned by maglev vehicles. A finite element model of the levitation chassis based on left-right decoupling is constructed. Analysis results of the model show that the mechanical properties of the chassis tailored for the vehicle meet the design requirements, and the stiffness and strength is adequate to bear the weight of the whole vehicle.