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Objectives: The guidelines recommend fractional flow reserve-guided coronary artery bypass grafting (CABG) during primary valve surgery without evidence. Quantitative flow ratio (QFR) is a novel coronary angiography (CAG)-based fractional flow reserve measurement. We aimed to compare the early clinical outcomes between QFR-guided and CAG-guided CABG in these patients. Methods: This observational study screened all 2081 patients admitted to our institution for elective primary mitral and/or aortic valve surgery from January 2017 to September 2020. Of them, all 188 patients with comorbid coronary artery lesions (visual estimated stenosis ≥50%) were included. Sixty-nine patients with QFR analysis received bypasses only for lesions with QFR ≤0.80 (QFR-guided group). The remaining 119 patients without QFR analysis received bypasses for all stenosis ≥50% (CAG-guided group). Propensity overlap weighting was used to neutralize the intergroup imbalance. The primary end point was major adverse cardiovascular events. Results: After propensity score weighting, the baseline characteristics were comparable. Concomitant coronary artery bypass grafting was performed 58.1% versus 100% in the QFR-guided and CAG-guided groups, respectively. The mean number of grafts was significantly lower in QFR-guided group than in the CAG-guided group (0.9 ± 0.7 vs 1.6 ± 0.5 [P

Abstract The perplexing issues related to positive surgical margins and the considerable negative consequences associated with systemic chemotherapy have posed ongoing challenges for clinicians, especially when it comes to addressing bladder cancer treatment. The current investigation describes the production of nanocomposites loaded with gemcitabine (GEM) and cisplatin (CDDP) through the utilization of electrospinning technology. In vitro and in vivo studies have provided evidence of the strong effectiveness in suppressing tumor advancement while simultaneously reducing the accumulation of chemotherapy drugs within liver and kidney tissues. Mechanically, the GEM and CDDP-loaded electrospun nanocomposites could effectively eliminate myeloid-derived suppressor cells (MDSCs) in tumor tissues, and recruit CD8+ T cells and NKp46+ NK cells to kill tumor cells, which can also effectively inhibit tumor microvascular formation. Our investigation into the impact of localized administration of chemotherapy through GEM and CDDP-loaded electrospun nanocomposites on the tumor microenvironment will offer novel insights for tackling tumors. Graphical abstract Drug-loaded electrospun nanofibrous mats suppress bladder tumor growth by improving the tumor immune microenvironment.

Zinc (Zn)-based alloys are considered the next-generation biodegradable material for promising bone-implant devices due to their good degradability, formability, and functionality. Nevertheless, the as-cast Zn alloys showed a low strength-toughness, making it challenging to meet the mechanical properties requirements for high-load-bearing bone implants due to their hexagonal close-packed structure, coarse grain size, and less sliding system. Herein, we have developed biodegradable Zn–5Ce alloys by cerium (Ce) alloying followed by hot-rolling, hot-extrusion, and high-pressure torsion (HPT), respectively, for potential bone-implant application. Mechanical testing revealed that the HPT sample exhibited the best mechanical performance matching among the Zn–5Ce samples with a high ultimate tensile strength of ∼345 MPa, yield strength of ∼230 MPa, a moderate elongation of ∼11.4%, and macro-hardness of ∼96.6 HB. Electrochemical corrosion and static immersion testing revealed that the HPT sample showed the highest electrochemical corrosion rate of ∼416 μm/y and degradation rate of ∼43.8 μm/y in Hanks' solution among the Zn–5Ce samples, which is suitable for degradation rate requirements for bone-implant application. Bio-tribological testing revealed that the HPT sample showed high bio-tribological properties matching in Hanks’ solution with the lowest friction coefficients of ∼0.530 and moderate wear loss of ∼2.2 mg. Cytocompatibility and osteogenic differentiation assessment revealed that the diluted extract of the HPT sample showed the highest cytocompatibility towards 3T3 and MG-63 cells and osteogenic differentiation performance towards 3T3 cells among the most diluted extracts. Accordingly, the HPT Zn–5Ce sample is expected to be used for high-load-bearing degradable bone-implant devices, including bone fixation and guided bone regeneration systems.

Abstract Background The object was to compare changes in patients undergoing lung surgery before and after COVID-19 outbreak, and to explore the impact of COVID-19 on lung surgery and its coping strategies. Method A retrospective review of patients undergoing thoracic surgery at a single institution was conducted. Group A included patients treated between January 23, 2019, and January 23, 2020, while Group B included patients treated between June 1, 2020, and June 1, 2021, at our center. We compared the reasons of seeking medical treatment, the general characteristics of patients, imaging features, pathological features, surgical methods and postoperative recovery. Result Compared to Group A, the number of patients with pulmonary nodules screened by routine check-up increased in Group B (57.6% vs 46.9%, p

Abstract Transcutaneous auricular vagus nerve stimulation (taVNS) shows excellent effects on relieving clinical symptoms in migraine patients. Nevertheless, the neurological mechanisms of taVNS for migraineurs remain unclear. In recent years, voxel-wise degree centrality (DC) and functional connectivity (FC) methods were extensively utilized for exploring alterations in patterns of FC in the resting-state brain. In the present study, thirty-five migraine patients without aura and thirty-eight healthy controls (HCs) were recruited for magnetic resonance imaging scans. Firstly, this study used voxel-wise DC analysis to explore brain regions where abnormalities were present in migraine patients. Secondly, for elucidating neurological mechanisms underlying taVNS in migraine, seed-based resting-state functional connectivity analysis was employed to the taVNS treatment group. Finally, correlation analysis was performed to explore the relationship between alterations in neurological mechanisms and clinical symptoms. Our findings indicated that migraineurs have lower DC values in the inferior temporal gyrus (ITG) and paracentral lobule than in healthy controls (HCs). In addition, migraineurs have higher DC values in the cerebellar lobule VIII and the fusiform gyrus than HCs. Moreover, after taVNS treatment (post-taVNS), patients displayed increased FC between the ITG with the inferior parietal lobule (IPL), orbitofrontal gyrus, angular gyrus, and posterior cingulate gyrus than before taVNS treatment (pre-taVNS). Besides, the post-taVNS patients showed decreased FC between the cerebellar lobule VIII with the supplementary motor area and postcentral gyrus compared with the pre-taVNS patients. The changed FC of ITG-IPL was significantly related to changes in headache intensity. Our study suggested that migraine patients without aura have altered brain connectivity patterns in several hub regions involving multisensory integration, pain perception, and cognitive function. More importantly, taVNS modulated the default mode network and the vestibular cortical network related to the dysfunctions in migraineurs. This paper provides a new perspective on the potential neurological mechanisms and therapeutic targets of taVNS for treating migraine.

Objectives Unilateral percutaneous kyphoplasty (UPKP) has been effective in reducing the operative time, cement volume, and cement leakage (CL) rate compared with bilateral kyphoplasty. However, no device can help to determine the trajectory during operation, especially the inner inclination angle. To assess the safety and efficacy of a novel guide device (GD) for UPKP in the treatment of thoracolumbar osteoporotic vertebral fractures (TLOVFs). Methods From January 2019 to May 2021, 31 patients diagnosed with single TLOVF who underwent UPKP were retrospectively reviewed. The patients were divided into two groups: traditional UPKP (UPKP group, 15 patients) and UPKP assisted with GD (UPKP‐GD group, 16 patients). Pre‐procedure demographic, clinical and radiologic characteristics, operative procedure details, and clinical and radiologic outcomes at 1 day and 12 months post‐procedure were collected. Statistical analyses were carried out using SPSS 24.0. The baseline characteristics of the two groups were compared by the independent sample t test or the χ2 test. The anterior height or local kyphotic angle (LKA) of the fractured vertebrae, visual analog scale (VAS) score, and Oswestry Disability Index (ODI) within groups were compared using the paired t test. Results A total of 31 patients (five men and 26 women; age range: 58–90 years) completed the full 12‐month postoperative follow‐up schedule. No significant differences were observed between treatment groups with respect to sex, age, body mass index, preoperative bone mineral density, or surgical level. Compared with the UPKP group, the operation time in the UPKP‐GD group was significantly shorter (40.8 ± 5.5 min vs. 48.5 ± 8.5 min, p = 0.005), and the number of intraoperative fluoroscopy times in the UPKP‐GD group was significantly decreased (20.6 ± 4.5 vs. 25.2 ± 2.4, p = 0.001). Five (31.3%) patients in the UPKP‐GD group and four (26.7%) patients in the UPKP group had bone CL. The VAS and ODI scores, anterior height and LKA of the fractured vertebrae were significantly improved after surgery in each group. No significant differences in postoperative VAS and ODI scores, anterior height or LKA of the fractured vertebrae, volume of injected cement or CL were observed between the two groups. Conclusion Unilateral puncture using a novel GD is a safe and effective technique for patients with TLFs and UPKP assisted with a novel GD is associated with fewer intraoperative fluoroscopy times and shorter operation time.

Nowadays, the sustainable development of the construction industry has become a focus of attention. Crushing and grinding waste seashells originating from the fishery industry, such as oyster shells, cockle shells, mussel shells, and scallop shells, into different particle sizes for usage as aggregate and cement in concrete or mortar provides an effective and sustainable solution to environmental problems by reducing natural resource dependence. Numerous studies have attempted to analyze the suitability of waste seashell as a possible alternative to natural aggregates and cement in concrete or mortar. This paper presents an up-to-date review of the characteristics of different types of waste seashell, as well as the physical, mechanical, durability, and other notable functional properties of seashell concrete or mortar. From the outcome of the research, waste seashell could be an inert material, and it is important to conduct a series of proper treatment for a better-quality material. It is also seen from the results that although the mechanical properties of seashell concrete have been reduced, they all meet the required criteria set by various international standards and codes. Therefore, it is recommended that the replacement of seashells as aggregate and cement should not exceed 20% and 5%, respectively. Seashell concrete or mortar would then have sufficient workability and strength for non-structural purposes. However, there is still a lack of investigation concerning the different properties of reinforced concrete members using seashells as the replacement of aggregate or cement. Further innovative research can solidify its utilization towards sustainable development.

BackgroundCoronary artery bypass grafting using radial artery grafts (RA-CABG) has improved long-term outcomes. However, major adverse cardiovascular events (MACE-4, including all-cause death, myocardial infarction, stroke, and repeat revascularization) after RA-CABG still occur and the predictors remain uncertain. This study aimed to detect independent risk factors of MACE-4 after RA-CABG.MethodsThis is a retrospective case-control study (NCT04935086) conducted among patients who underwent primary isolated RA-CABG between 2009 and 2019 in our center. Baseline characteristics, procedure characteristics, and medication use were compared to identify the independent predictors of MACE-4, all-cause death, and myocardial infarction (MI) with univariate and then multivariate logistic regression.ResultsA total of 370 patients were analyzed using a mean follow-up duration of 48.8 ± 41.0 months. MACE-4, all-cause death, and MI occurred in 102 (27.6%), 27 (7.3%), and 66 patients (17.8%), respectively. Multivariate analysis revealed prior MI (OR = 2.12, 95%CI 1.05–4.25, P = 0.04) and RA to the left anterior descending artery (LAD) (non-left internal mammary artery to LAD) (OR = 4.87, 95%CI 1.41–16.82, P = 0.01) as independent predictors of MACE-4 after surgery. Female (OR = 4.53, 95%CI 1.06–19.41, P = 0.04), left ventricular ejection fraction (LVEF)

Objective Femoral fractures are a common cause of mortality and functional loss, mainly among older people, and there are few studies about the age in relation to traumatic femoral fractures. The aim of this study was to investigate the effect of age on the patterns of traumatic femoral fractures in patients presenting to our regional tertiary hospital. Methods The records of 2020 patients who presented with traumatic femoral fractures between 2013 and 2019 were retrospectively reviewed. The patients' clinical and radiographic records were reviewed. Univariate and multivariable logistic regression were used to identify independent risk factors for associated injuries and complications. Results The patients were divided into a child group (CH group, n = 342) aged under 18 years, a young adult group (YA group, n = 484) aged 18–60 years, and an older people group (OP group, n = 1194) aged 60 years and over. There were significant differences among the three groups in several indexes, such as sex ratio (χ2 = 301.699, p

Accurate fault diagnosis is essential for the safe operation of rotating machinery. Recently, traditional deep learning-based fault diagnosis have achieved promising results. However, most of these methods focus only on supervised learning and tend to use small convolution kernels non-effectively to extract features that are not controllable and have poor interpretability. To this end, this study proposes an innovative semi-supervised learning method for bearing fault diagnosis. Firstly, multi-scale dilated convolution squeeze-and-excitation residual blocks are designed to exact local and global features. Secondly, a classifier generative adversarial network is employed to achieve multi-task learning. Both unsupervised and supervised learning are performed simultaneously to improve the generalization ability. Finally, supervised learning is applied to fine-tune the final model, which can extract multi-scale features and be further improved by implicit data augmentation. Experiments on two datasets were carried out, and the results verified the superiority of the proposed method.

To address the problem that complex bearing faults are coupled to each other, and the difficulty of diagnosis increases, an improved envelope spectrum–maximum second-order cyclostationary blind deconvolution (IES-CYCBD) method is proposed to realize the separation of vibration signal fault features. The improved envelope spectrum (IES) is obtained by integrating the part of the frequency axis containing resonance bands in the cyclic spectral coherence function. The resonant bands corresponding to different fault types are accurately located, and the IES with more prominent target characteristic frequency components are separated. Then, a simulation is carried out to prove the ability of this method, which can accurately separate and diagnose fault types under high noise and compound fault conditions. Finally, a compound bearing fault experiment with inner and outer ring faults is designed, and the inner and outer ring fault characteristics are successfully separated by the proposed IES-CYCBD method. Therefore, simulation and experiments demonstrate the strong capability of the proposed method for complex fault separation and diagnosis.

Ambient vibration energy is widely being harnessed as a source of electrical energy to drive low-power devices. The vibration energy harvester (VEH) of interest employs an electromagnetic transduction mechanism, whereby ambient mechanical vibration is converted to electrical energy. The limitations affecting the performance of VEHs, with an electromagnetic transduction structure, include its operational bandwidth as well as the enclosure-size constraint. In this study, an analysis and design of a nonlinear VEH system is conducted using the Output Frequency Response Function (OFRF) representations of the actual system model. However, the OFRF representations are determined from the Generalised Associated Linear Equation (GALE) decompositions of the system of interest. The effect of both nonlinear damping and stiffness characteristics, to, respectively, extend the average power and operational bandwidth of the VEH device, is demonstrated.

Abstract Background Dual antiplatelet therapy (DAPT) is recommended in secondary prevention after coronary artery bypass grafting (CABG), but it is inevitably associated with the risk of bleeding, of which gastrointestinal bleeding accounts for more than half. Proton pump inhibitors (PPIs) may increase the risk of major cardiovascular adverse events when reducing the risk of upper gastrointestinal bleeding. Therefore, the optimal duration of a PPI in combination with DAPT is unclear. Methods The “Proton Pump Inhibitor Preventing Upper Gastrointestinal Injury in Patients on Dual Antiplatelet Therapy after CABG” (DACAB-GI-2) study is a prospective, single-center, open-label, parallel, randomized controlled trial. A total of 232 eligible subjects who are scheduled or initiated on DAPT (clopidogrel plus aspirin or ticagrelor plus aspirin) for 12 months immediately after CABG will be enrolled and be randomized in a 1:1 ratio to either a 12-month pantoprazole treatment arm or a 1-month treatment arm. The primary outcome is to assess the rate of gastroduodenal erosions and ulcers evaluated by esophagogastroduodenoscopy (EGD) within 12 months after randomization, based on the modified Lanza score. Secondary outcomes include reflux esophagitis and upper gastrointestinal bleeding. Other pre-specified outcomes include major adverse cardiovascular events, graft failure, and all-cause death. Discussion This study aims to compare the efficacy and safety of 12 months and 1 month of pantoprazole treatment in preventing DAPT-related upper gastrointestinal mucosal injury after CABG. Trial registration ClinicalTrials.gov NCT03908593 .

Abstract Background With the growing number of patients with coexisting pulmonary and mediastinal lesions detected, reports about simultaneous video-assisted thoracic surgery (VATS) for these concurrent diseases are still rare. To further explore the safety and effectiveness of simultaneous resection of pulmonary and mediastinal lesions by uniportal or biportal VATS, we retrospectively analyzed the clinical data of the largest series of cases to date. Methods From July 2018 to July 2021, all patients whose pulmonary lesions and mediastinal tumors were resected simultaneously in our institution were retrospectively reviewed. Their demographic and clinical data were collected and analyzed. Results A total of 54 patients were enrolled, of whom 44 underwent unilateral uniportal VATS, 3 underwent bilateral uniportal VATS and 7 underwent unilateral biportal VATS. Seven cases were converted to thoracotomy during surgery. For the remaining 47 patients with various demographic and clinical characteristics, most of the operations were completed within 3 h (n = 33, 70.2%) with blood loss of no more than 100 mL (n = 43, 91.5%). The duration of chest tube drainage was 5.66 ± 3.34 days, and the average daily volume was 196.90 ± 122.31 mL. Four cases of postoperative complications occurred during hospitalization. The length of postoperative hospital stay was 8.60 ± 3.63 days. No severe complications or deaths were observed during follow-up. Conclusions Uniportal and biportal VATS are safe and effective for simultaneous resection of selected coexisting pulmonary and mediastinal lesions, but the indications and operational details need more evaluation.

PurposeThe objective was to evaluate the influence of low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] on clinical outcomes in patients undergoing coronary artery bypass grafting (CABG).MethodsThis is a secondary analysis of a 5-year follow-up of the DACAB trial (NCT02201771), in which 500 patients who underwent primary isolated CABG were randomized to three-antiplatelet therapy for 1 year after surgery. Of them, 459 patients were recruited in this secondary analysis. Baseline LDL-C and Lp(a) levels were collected, and repeated measurement of LDL-C levels during the follow-up were recorded. Cut-off values for LDL-C were set at 1.8 and 2.6 mmol/L; thus, the patients were stratified into LDL-C

BackgroundDual antiplatelet therapy (DAPT) is recommended in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB). Clopidogrel is less effective among patients with loss-of-function (LoF) of CYP2C19 alleles, while ticagrelor has direct effects on P2Y12 receptor. Whether a CYP2C19 genotype plus platelet aggregation test (PAgT)-guided DAPT after CABG could improve clinical outcomes remain uncertain.Materials and methodsFrom August 2019 to December 2020, 1,134 consecutive patients who underwent OPCAB received DAPT for 1 year after surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. According to the actual treatment they received in real-world, 382 (33.7%) of them received a traditional DAPT: aspirin 100 mg qd + clopidogrel 75 mg qd, no matter the CYP2C19 genotype and response in platelet aggregation test (PAgT). The other 752 (66.3%) patients received an individual DAPT based on CYP2C19 genotype and PAgT: aspirin 100 mg qd + clopidogrel 75 mg qd if CYP2C19 was extensive metabolizer, or moderate metabolizer but normal response in PAgT; aspirin 100 mg qd + ticagrelor 90 mg bid if CYP2C19 was poor metabolizer, or moderate metabolizer but no or low response in PAgT. One-year follow-up was achieved for all patients. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, and stroke. The safety outcome was thrombolysis in myocardial infarction (TIMI) criteria major bleeding.ResultsCompared with the traditional DAPT group, the risk of MACE in the individual DAPT group was significantly lower (5.5 vs. 9.2%, HR 0.583; 95% CI, 0.371–0.915; P = 0.019), mainly due to the decreased risk of MI (1.7 vs. 4.2%, HR 0.407; 95% CI, 0.196–0.846; P = 0.016). The risk of TIMI major bleeding events was similar between the two groups (5.3 vs. 6.0%, RR 0.883; 95% CI, 0.537–1.453; P = 0.626).ConclusionFor patients who underwent OPCAB, individual DAPT (CYP2C19 genotype plus PAgT-guided strategy) was associated with a lower risk of MACE and a similar risk of major bleeding.

Bladder tissue engineering is a promising approach to generating new tissues to replace damaged or diseased organs, breaking the limitations of current therapies using reconfigured autogenous bowel segments. Adipose tissue extract (ATE) is a non-cellular three-dimensional macromolecular network that provides an appropriate local microenvironment for cells and affects cellular metabolism, proliferation, differentiation, or organoid formation. This study integrated electrospun nanofibers mats and hyaluronic acid colloidal solution to constitute a multilayered nanofibrous patch, where ATE was added as a biological additive. In vitro study, we observed an increase in the pluripotent marker proteins (Oct-4, Sox-2, and Nanog) of adipose-derived stem cells (ADSCs) and bone mesenchymal stem cells (BMSCs) when cultured with ATE. The CCK-8 test, scratch assay, transwell migration assay, and tube formation assay demonstrated the positive effect of ATE on endothelial cells (ECs) proliferation, migration, and angiogenesis. The feasibility and effectiveness of the patch were investigated in a rat bladder defect model. The primary ideal results revealed the patches' great potential for tissue engineering repair and regenerative medicine.

We present here a simplified procedure to manufacture auxetic PU foam via a single direction thermoforming compression process applied to conventional (pristine) open cell foam samples. The auxetic foams produced here have a Poisson’s ratio ν21 ranging from −1 to 0 in the 1–2 plane and a tangent modulus Et2 ranging from 0.2 MPa to 2 MPa. X-ray μ-CT and 3D skeletonization enabled the extraction of the topological parameters of the pristine and the auxetic foams. The auxetic foam is transverse isotropic with cell structures exhibiting a re-entrant shape along the thermoforming compression direction 1. More ribs are also oriented within the transverse plane 2–3, in which the stiffness is larger. Tensile and compression quasi-static tests have been carried out on samples cut along different directions and having various thermoforming compression ratios rc. Auxeticity is present in the in 1–2 plane only for compression ratios between 40% and 80%. Finite Element models for the pristine and auxetic foams have also been built from the μ-CT scanned 3D models. The numerical results show a good agreement with the experimental data and help explaining the deformation mechanisms of these auxetic foams.

Compared with traditional underwater vehicles, bio-inspired fish robots have the advantages of high efficiency, high maneuverability, low noise, and minor fluid disturbance. Therefore, they have gained an increasing research interest, which has led to a great deal of remarkable progress theoretically and practically in recent years. In this review, we first highlight our enhanced scientific understanding of bio-inspired propulsion and sensing underwater and then present the research progress and performance characteristics of different bio-inspired robot fish, classified by the propulsion method. Like the natural fish species they imitate, different types of bionic fish have different morphological structures and distinctive hydrodynamic properties. In addition, we select two pioneering directions about soft robotic control and multi-phase robotics. The hybrid dynamic control of soft robotic systems combines the accuracy of model-based control and the efficiency of model-free control, and is considered the proper way to optimize the classical control model with the intersection of multiple machine learning algorithms. Multi-phase robots provide a broader scope of application compared to ordinary bionic robot fish, with the ability of operating in air or on land outside the fluid. By introducing recent progress in related fields, we summarize the advantages and challenges of soft robotic control and multi-phase robotics, guiding the further development of bionic aquatic robots.