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Due to its asymptotic optimality, the Rapidly-exploring Random Tree star (RRT*) algorithm is widely used for robotic operations in complex environments. However, the RRT* algorithm suffers from poor path quality, slow convergence, and unstable generation of high-quality paths in the path planning process. This paper proposes an Improved Bi-Tree Obstacle Edge Search Artificial Potential Field RRT* algorithm (IBPF-RRT*) to address these issues. First, based on the RRT* algorithm, this paper proposes a new obstacle edge search artificial potential field strategy (ESAPF), which speeds up the path search and improves the path quality simultaneously. Second, a bi-directional pruning strategy is designed to optimize the bi-directional search tree branch nodes and combine the bi-directional search strategy to reduce the number of iterations for convergence speed significantly. Third, a novel path optimization strategy is proposed, which enables high-quality paths to be generated stably by creating an entirely new node between two path nodes and then optimizing the paths using a pruning strategy based on triangular inequalities. Experimental results in three different scenarios show that the proposed IBPF-RRT* algorithm outperforms other methods in terms of optimal path quality, algorithm stability, and the number of iterations when compared to the RRT*, Q-RRT*, PQ-RRT*, F-RRT* and CCPF-RRT* algorithms, and proves the effectiveness of the proposed three strategies.

Heavy metal pollution of the soil affects the environment and human health. Masson pine is a good candidate for phytoremediation of heavy metal in mining areas. Microorganisms in the rhizosphere can help with the accumulation of heavy metal in host plants. However, studies on its rhizosphere bacterial communities under heavy metal pollution are still limited. Therefore, in this study, the chemical and bacterial characteristics of Masson pine rhizosphere under four different levels of heavy metal pollution were investigated using 16 S rRNA gene sequencing, soil chemistry and analysis of plant enzyme activities. The results showed that soil heavy metal content, plant oxidative stress and microbial diversity damage were lower the farther they were from the mine dump. The co-occurrence network relationship of slightly polluted soils (C1 and C2) was more complicated than that of highly polluted soils (C3 and C4). Relative abundance analysis indicated Sphingomonas and Pseudolabrys were more abundant in slightly polluted soils (C1 and C2), while Gaiella and Haliangium were more abundant in highly polluted soils (C3 and C4). LEfSe analysis indicated Burkholderiaceae, Xanthobacteraceae, Gemmatimonadaceae, Gaiellaceae were significantly enriched in C1 to C4 site, respectively. Mantel analysis showed that available cadmium (Cd) contents of soil was the most important factor influencing the bacterial community assembly. Correlation analysis showed that eight bacterial genus were significantly positively associated with soil available Cd content. To the best of our knowledge, this is the first study to investigate the rhizospheric bacterial community of Masson pine trees under different degrees of heavy metal contamination, which lays the foundation for beneficial bacteria-based phytoremediation using Masson pines in the future.

At present, the state has introduced the policy of forest Chinese herbal medicine planting planning, strictly prohibiting the planting of Chinese herbal medicine in basic farmland, coupled with the fact that the continuous cropping obstacles of Panax notoginseng have not yet been solved, which makes the area of arable land suitable for planting become less and less. However, the effect of soil moisture regulation on the growth of Panax notoginseng cultivated on sloping arable land has not been reported. Thus, the aim of this study was to investigate the impact of various irrigation levels and slopes on Panax notoginseng agronomic traits, physiological characteristics, disease attributes, biomass, and quality characteristics. During 2018–2020, a field experiment was conducted in the Panax notoginseng growing seasons with three irrigation levels (I1: 70–75% θFC, I2: 75–80% θFC, I3: 80–85% θFC) and three slopes (S1: 2.43°, S2: 6.38°, S3: 16.38°). The results evidenced that the photosynthetic characteristics, root hydraulic conductivity characteristics, biomass and PNS of Panax notoginseng reached the maximum value in the I2S2 treatment, and at the same time, the incidence rate of Panax notoginseng root rot was the lowest. Therefore, based on the results of this study, irrigation volume I2S2 should be regarded as the optimal slope and irrigation management strategies for reducing Panax notoginseng diseases and realizing stable yield and quality improvement of Panax notoginseng. A multi-objective optimization model was established through binary quadratic regression analysis. The findings evidenced that when the irrigation interval was 187–203 mm and the slope interval was 5–10.7°, Panax notoginseng had the lowest incidengce rate, and the root biomass and saponin content reached > 95% of the maximum values at the same time.

The excessive rainfall and irrigation amount in the facility herbal medicine production system (FHmPS) in China leading to a severe root rot disease of Panax notoginseng, which endangers root yield and quality, compromise economic profit and waste resources. Therefore, the objective of our research was to seek optimal irrigation and cultivation management strategy for FHmPS to improve Panax notoginseng production and economic benefit. A three-year (2019, 2020 and 2021) field experiment was conducted on Panax notoginseng under two shelter-cultivation [rain-shelter cultivation (Sr) and unrain-shelter cultivation (NSr)] at three deficit irrigation levels [I1= 65%W, I2= 75%W, I3= 85% W, where W was the irrigation quota when the upper and lower limits of irrigation are (100% ∼ 40%)θFC under shelter-cultivation] to explore the combined practices effects on yield, quality, economic benefit, water productivity (WP) and nutrients uptake of Panax notoginseng, and to obtain the optimal irrigation and cultivation supply practice by the technique for order preference by similarity to ideal solution (TOPSIS). The results showed that SrI2 obtained relatively high plant nutrient uptake, net profit, WP, and quality. SrI2 significantly decreased the root rot incidence by 6–17.5% in comparison to other treatments. However, compared with rain-shelter cultivation, unrain-shelter cultivation weaken these effects in Panax notoginseng. Deficit irrigation promoted Sr to obtain higher WP than NSr. According to the result of TOPSIS, the comprehensive ranking of SrI2 and SrI3 were first and second among the practices, regardless of growing seasons and planting years. The SrI2 significantly decreased the yield of Panax notoginseng by 5.4%− 20.8% in comparison to other treatments. SrI2 and SrI3 were highly recommended for facility herbal medicine production system (FHmPS) in the semi-arid area of Southwest China.

Panax notoginseng cultivation planting conditions are harsh and require high soil moisture and slope of cultivated land, plus it takes 3–7 years from planting to harvesting. At present, the continuous crop barrier of Panax notoginseng has not been solved, which makes the arable land suitable for planting significantly reduced. And yet, there is almost no report on the impact of coupling water and slope on the growth of Panax notoginseng. Therefore, this study aims to explore the effects of different irrigation levels and slopes on soil water content (SWC) in the root zone, soil nutrient content, root characteristics, yield, water use efficiency (WUE), partial fertilizer productivity (PFP) and economic benefits of Panax notoginseng. During 2018–2020, a field experiment was conducted in the Panax notoginseng growing seasons with three irrigation levels (I1: 70–75% θFC, I2: 75–80% θFC, I3: 80–85% θFC) and three slopes (S1: 2.43°, S2: 6.38°, S3: 16.38°). The results evidenced that soil water and nutrient content increased with increasing irrigation and decreased with increasing slope. The yield of Panax notoginseng, root morphological characteristics, WUE, PFP, and economic benefits showed a trend of increasing first and then decreasing with the increase of irrigation amount and slope, which increased with the increase of planting years. These parameters reached their maximum at the irrigation I2 (75–80% θFC) and slope S2 (6.38°) treatments. Thus, based on the results of this study, medium irrigation I2 (75–80% θFC) and slope S2 (6.38°) should be considered as the best slope and water management strategy to obtain both high Panax notoginseng yield and economic benefits. Through establishing a multi-objective optimization model with binary quadratic regression analysis. It was indicated that Panax notoginseng yield, WUE, PFP, and economic benefits simultaneously reached ≥ 98% of their maximum values when irrigation interval was 152–193 mm and slope interval was 5.4–9°. In summary, the results obtained in this study have important practical significance for the water management of Panax notoginseng cultivation in slope farmland in Yunnan Province, China.

Soil mulching has been widely used to improve crop productivity around the world, but how various mulching practices affect soil hydrothermal conditions, water-temperature-radiation utilization and finally grain yield of rainfed maize has been poorly understood. A two-season field experiment was conducted on rainfed summer maize in 2021 and 2022 on the Loess Plateau of China, with six soil mulching practices: flat planting with non-mulching (FPNM), flat planting with full straw mulching (FPSM), flat planting with full black film mulching (FPBF), flat planting with full transparent film mulching (FPTF), ridge-furrow planting with black film mulching on the ridge (RFBF) and ridge-furrow planting with transparent film mulching on the ridge (RFTF). The results showed that compared with the traditional FPNM, the five mulching treatments (FPSM, FPBF, FPTF, RFBF and RFTF) greatly regulated root-zone soil hydrothermal conditions and resulted in obvious soil drying-wetting alternation, which significantly changed the daytime average root-zone soil temperature in the 0 – 25 cm soil layer (by − 1.1 ℃, − 1.9 ℃, + 2.7 ℃, − 1.6℃ and + 0.8 ℃, respectively) and significantly reduced crop evapotranspiration. The five mulching treatments promoted the root growth, leaf area index and canopy light interception rate due to the improved soil water and/or temperature conditions. The structural equation modeling indicated that soil hydrothermal condition and water-temperature-radiation use efficiency could directly or indirectly explain 98% of the grain yield variation under various soil mulching practices; radiation use efficiency (RUE) determined maize production in the water-sufficient year (2021), whereas maize production was mainly determined by crop water productivity (WP) in the water-limited year (2022). The RFBF increased maize production most, followed by RFTF. Compared with FPNM, RFBF increased leaf area index by 45.4%, canopy light interception rate by 19.1%, aboveground biomass by 68.8%, 1000-grain weight by 15.1%, grain yield by 58.6%, WP by 71.8%, thermal time use efficiency by 64.6% and RUE by 30.5%. In conclusion, RFBF optimized the root-zone soil hydrothermal conditions for root growth, which in turn promoted aboveground growth and water-temperature-radiation use efficiency, and finally improved the gain yield of rainfed summer maize on the Loess Plateau of China. Therefore, RFBF was considered as a promising agricultural practice to improve rain-fed summer maize production and resource utilization efficiency on the Loess Plateau of China.

Introduction: Depression is a common comorbidity in Parkinson's Disease (PD) and treatment of depression can significantly support PD management. Zishen pingchan granules (ZPG), a traditional Chinese herbal formula, may help ameliorate depressive symptoms in PD patients. However, the molecular mechanisms underlying the effects of ZPG remain unclear. This study aimed to investigate the impact of ZPG on serum levels of brain-derived neurotrophic factor (BDNF), interleukin-1β (IL-1β), interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) in PD patients with depression. Methods: Eighty PD patients treated with pramipexole but still experiencing mild to moderate depression symptoms were randomly allocated to a group receiving 12-week ZPG treatment (n = 40) or placebo (n = 40). The Hamilton Depression Scale 17 items (HAM-D-17) was utilized to evaluate changes in depressive symptoms from baseline over 12 weeks, while the Unified Parkinson's Disease Rating Scales (UPDRS) part 3 was employed to assess changes in motor symptoms over the same duration. Serum levels of BDNF, IL-1β, IL-6, CRP, and TNF-α were measured at baseline and post-treatment. Results: Seventy-one participants completed the study. Following treatment, both groups showed significantly reduced HAMD scores. The placebo group demonstrated a decrease in BDNF levels, while the ZPG group showed an increase in IL-6 levels post-treatment. In the examination of the group-time interaction, the ZPG group exhibited a greater decrease in HAMD scores and increase in IL-6 levels compared to the placebo group. Conversely, the placebo group showed a greater decrease in BDNF levels compared to the ZPG group. However, no significant group differences were observed in UPDRS part 3 change scores or serum levels of IL-1β, CRP, or TNF-α change from baseline. Conclusion: ZPG may potentially ameliorate depressive symptoms in PD patients, with the potential mechanism involving mitigation of reductions in serum BDNF level and an increase in IL-6 level.

The knowledge of seasonal nutrient demand is necessary for maximizing potato yield and resources use efficiency under drip fertigation, and it also can effectively mitigate the risk of nutrient leaching caused by excessive fertilization. To explore the coupling effects of irrigation level and fertilization rate on drip-fertigated potato growth, nutrient accumulation and determine the multi-objective optimal irrigation and fertilization regimes, a two-year (2018 and 2019) field experiment was conducted in the sandy regions of northern China. The experiments included three irrigation levels (I60, 60% ETC; I80, 80% ETC and I100, 100% ETC, where ETc is the crop evapotranspiration) and five fertilization rates (N0P0K0, 0 kg ha−1; N1P1K1, 100–17.5–124.5 kg ha−1; N2P2K2, 150–26.2–186.7 kg ha−1; N3P3K3, 200–34.9–248.9 kg ha−1 and N4P4K4, 250–43.7–311.2 kg ha−1, where the ratio of N, P and K was 1:0.17:1.24). The results showed that N, P and K accumulated rapidly from 42th to 95th, 50th to 96th and 46th to 91th days after sowing, respectively. For producing 1000 kg tuber yield, the required amounts of N, P and K were 1.97–4.16 kg, 0.55–0.81 kg and 4.83–7.65 kg, respectively. The uptakes of N, P and K in 1000 kg tubers across all treatments were 1:0.18–0.34:1.61–2.59, with the average N:P:K ratio of 1:0.23:2.05. Besides, irrigation level, fertilization rate and their interaction had significant effects on potato leaf area index, biomass, N, P and K accumulation. Deficit irrigation reduced seasonal LAI, biomass, N, P and K accumulation, tuber yield and apparent fertilizer recovery (AFR), but increased water productivity. High fertilization rate was conducive to promoting nutrient absorption, plant growth and improving tuber yield, while it reduced the unit nutrient productivity. The AFR increased first and then decreased with the increase of fertilization rate. To simultaneously achieve high potato yield and resources use efficiency, a multi-objective optimization model was established using the binary quadratic regression analysis between tuber yield, net income, water productivity, AFR and water–fertilizer regimes, which showed that tuber yield, net income, water productivity, and AFR could obtained ≥ 90% of their maximum values simultaneously when the irrigation interval was 204–262 mm and fertilization (N-P-K) interval ranged from 200–24–248 to 247–42–306 kg ha−1. The findings can provide useful information for optimizing irrigation and fertilization regimes in sandy regions of northern China.

Background: Dural ossification (DO) is strongly correlated with an increased incidence of complications during the surgery for the patients with thoracic ossification of the ligamentum flavum (OLF). Some methods for predicting DO have emerged, but the accuracy remains to be improved. We aimed to find a more accurate way to predict the appearance of DO. Methods: Retrospective study was adopted in this study. According to the intraoperative findings, ninety-one patients with thoracic OLF were ultimately included and divided into two groups based on the presence or absence of DO. Patient characteristics and radiographic data were recorded. The residual area ratio (RAR, residual area/cross-section area of normal spinal canal × 100%) and the short shaft ratio (SSR, the length of short shaft of the ellipse-like shape/the length of the spinal canal × 100%) were measured and calculated by 2 independent observers, followed by statistical analysis. The receiver operating characteristic curve was used to evaluate the accuracy of the SSR and RAR in predicting DO. Results: No significant differences were found in sex, age and BMI between the DO group and the non-DO group. The mean RAR (and standard deviation) in the Non-DO group (62.6% ± 10.2%) was significantly higher (p

Background & Aims: As an indispensable component of store-operated Ca2+ entry, stromal interaction molecule 1 (STIM1) is known to promote colorectal cancer and T-cell–mediated inflammatory diseases. However, whether the intestinal mucosal STIM1 is involved in inflammatory bowel diseases (IBDs) is unclear. This study aimed to investigate the role of intestinal epithelial STIM1 in IBD. Methods: Inflammatory and matched normal intestinal tissues were collected from IBD patients to investigate the expression of STIM1. Intestinal epithelium-specific STIM1 conditional knockout mice (STIM1ΔIEC) were generated and induced to develop colitis and colitis-associated colorectal cancer. The mucosal barrier, including the epithelial barrier and mucus barrier, was analyzed. The mechanisms by which STIM1 regulate goblet cell endoplasmic reticulum stress and apoptosis were assessed. Results: STIM1 could regulate intestinal epithelial homeostasis. STIM1 was augmented in the inflammatory intestinal tissues of IBD patients. In dextran sodium sulfate–induced colitis, STIM1 deficiency in intestinal epithelium reduced the loss of goblet cells through alleviating endoplasmic reticulum stress induced by disturbed Ca2+ homeostasis, resulting in the maintenance of the integrated mucus layer. These effects prevented commensal bacteria from contacting and stimulating the intestinal epithelium of STIM1ΔIEC mice and thereby rendered STIM1ΔIEC mice less susceptible to colitis and colitis-associated colorectal cancer. In addition, microbial diversity in dextran sodium sulfate–treated STIM1ΔIEC mice slightly shifted to an advantageous bacteria, which further protected the intestinal epithelium. Conclusions: Our results establish STIM1 as a crucial regulator for the maintenance of the intestinal barrier during colitis and provide a potential target for IBD treatment.

As a common zoonotic intestinal parasite, Giardia duodenalis could infect humans and various mammals worldwide, including pet dogs, leading to giardiasis. This study detected the infection of G. duodenalis in asymptomatic pet dogs in Zhengzhou, and evaluated the possibility of zoonosis and the relationship between gut microbiota and fecal characteristics. We randomly collected 448 fresh fecal samples from Zhengzhou, and G. duodenalis was screened based on the beta-giardin (bg), glutamate dehydrogenase (gdh), and triose phosphate isomerase (tpi) genes. The difference of gut microbiota between five G. duodenalis-positive and five G. duodenalis-negative samples was investigated by 16S rRNA gene sequencing. The overall prevalence of G. duodenalis was 7.1% (32/448) based on bg, gdh, and tpi locus, two G. duodenalis assemblages (C = 13, D = 14) and five (15.6%) mixed infection (C + D) were identified. Moreover, compared with the G. duodenalis-negative group, the diversity of gut microbiota increased in G. duodenalis-positive group. The decrease of Lactobacillus spp. and considerable increase of Prevotella spp. were associated with the fecal characteristics. These results show that the transmission of zoonotic giardiasis between humans and pet dogs is rare in Zhengzhou, central China, and support the use of Lactobacillus spp. as a potential probiotic agent to improve intestinal health in dogs, or even humans, by treating G. duodenalis. Therefore, the public health significance of G. duodenalis to humans, companion animals, and the environment should be further evaluated from One Health perspective.

Background: People's knowledge of and attitude to HIV/AIDS are key contributors to the success of public-health interventions. However, evidence on country-level HIV/AIDS knowledge and attitudes is still scarce across sub-Saharan countries. To address this knowledge gap, we have gathered evidence to estimate national trends in HIV/AIDS knowledge and attitude from 1990 to 2017 across 46 sub-Saharan African countries. Methods: We retrieved national surveys that have indicators of HIV/AIDS knowledge and attitude from Global Health Data Exchange (GHDx). There are ten indicators of knowledge of HIV transmission and risk reduction and four indicators that reflect attitude towards people living with HIV/AIDS. We extracted individual-level data on knowledge and attitude in a systematic and consistent way and collapsed these into country-level estimates. Multi-level multiple imputation was used to impute missing indicators on country level and we used spatial-temporal Gaussian process regression (ST-GPR) to estimate the trend of each indicator in each country. Findings: We included 313 national surveys in the study. From 1990 to 2017, most knowledge indicators slightly increased across all countries. However, the trends of knowledge on HIV mother-to-child transmission during pregnancy vary between countries, with significant decreasing trends in 18 of 46 countries including Kenya, Rwanda, and Zambia. For the attitude factors, we noted that the factors “willing to frequent a HIV-positive vendor”, “willing to take care of a HIV-positive family members in the house”, and “belief that a HIV-positive teacher should continue to work” all increased across countries. However, across the study period, people have become more reluctant to reveal a family member's positive status. In addition, our results indicate that men are slightly more knowledgeable about HIV/AIDS than are women. Interpretation: In sub-Saharan African countries, knowledge of HIV/AIDS increased slightly between 1990 and 2017, with people becoming more accepting of people with HIV/AIDS. Of concern is that knowledge about prevention of mother-to-child HIV transmission during pregnancy has not been improving as much, and is even decreasing in some countries. Of similar concern is that people are now less likely to reveal a family member's positive HIV status, suggesting that discrimination against people living with HIV/AIDS is still persistent and may be becoming worse. Efforts and resources are still needed to turn the tide in these areas. Funding: US National Institutes of Health and Bill & Melinda Gates Foundation.

Background: The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013. Methods: GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically. Findings: The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60–80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred. Interpretation: Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts. Funding: Bill & Melinda Gates Foundation.

Ultraperformance liquid chromatography/quadrupole time-of-flight mass spectrometry (UPLC/Q-TOF MS) was used to characterize ornidazole metabolites in human bile after intravenous doses. A liquid chromatography tandem mass spectrometry (LC–MS/MS) assay was developed for the determination of the bile level of ornidazole. Bile samples, collected from four patients with T-tube drainage after biliary tract surgery, were prepared by protein precipitation with acetonitrile before analysis. A total of 12 metabolites, including 10 novel metabolites, were detected and characterized. The metabolites of ornidazole in human bile were the products of hydrochloride (HCl) elimination, oxidative dechlorination, hydroxylation, sulfation, diastereoisomeric glucuronation, and substitution of NO2 or Cl atom by cysteine or N-acetylcysteine, and oxidative dechlorination followed by further carboxylation. The bile levels of ornidazole at 12 h after multiple intravenous infusions were well above its minimal inhibitory concentration for common strains of anaerobic bacteria.

Background: Surgery for perimembranous ventricular septal defects (VSD) is widely accepted procedure with minimal operative mortality. Recent publications have reported the feasible, safe, and effective with the new Amplatzer VSD occluder. This study was done to compare the effectiveness, cost, and complications of both the techniques., Methods: One hundred twenty-one consecutive patients from 2 to <18 years of age underwent VSD closure: 48 patients were treated surgically and 73 patients were treated with percutaneous Amplatzer occluder. Success rate, complications, cost, hospital stay, and home convalescent times were measured., Results: The closure rate was similar in the 2 groups: 48/48 patients (100%) in the surgical group versus 71/73 patients in the Amplatzer group (97%). Procedure complications affecting management occurred in four patients of the Amplatzer group (5.5%) and four patients of surgical patients (8.3%) (p=NS). The complications that did not need treatment were observed 25/48 patients (52%) in the surgical group versus 14/73 patients (19%) in the Amplatzer group (p<0.01). Both hospital stay and home convalescent times were significantly shorter after Amplatzer closure (median hospital stay: Amplatzer three days and surgery eleven days; median convalescent time: Amplatzer two weeks and surgery six weeks). Median cost was similar for both groups., Conclusions: The closure rate was similar in the Amplatzer VSD closure and surgical closure. There were more complications in the surgical group but the majority of these was minor and did not require any change in management. Hospital stay and home convalescent times were significantly shorter after Amplatzer closure. The cost of both techniques was similar. Nevertheless, the surgeon's ability to close any VSD, regardless of anatomy, remains an important advantage of surgery.