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Objective To investigate the learning curve threshold for robot-assisted mitral valve replacement, and to provide guidance for clinical practice. Methods A retrospective analysis was performed for the clinical data of 37 patients who underwent robot-assisted mitral valve replacement in Department of Cardiovascular Surgery in our hospital from December 2014 to December 2017, and the patients were ordered based on date of surgery. The cumulative sum (CUSUM) was calculated for time of operation, duration of cardiopulmonary bypass (CPB), and aortic cross-clamp time, and the CUSUM learning curve was modeled by curve fitting. The patients were divided into two groups based on the highest CUSUM of time of operation, and the two groups were compared in terms of general information, time of operation, duration of CPB, aortic cross-clamp time, total drainage volume (the sum of retrosternal drainage volume and thoracic drainage volume) during the 3 days before surgery, length of hospital stay, use of drugs and blood products in the perioperative period, and whether secondary thoracotomy was performed. Results The fitting curve reached the top at the 9th case on the time of operation, and the highest numbers of CPB and aortic cross-clamp time were 12 and 11, respectively. The patients were divided into two groups at the 9th case, and there were significant differences between the two groups in total drainage volume and the amount of red blood cell and plasma used after surgery on days 2 and 3 (Z=2.21-2.55,P

Gait analysis systems are critical for assessing motor function in rehabilitation and elderly care. This study aimed to develop and optimize an abnormal gait classification algorithm considering joint impairments using inertial measurement units (IMUs) and walkway systems. Ten healthy male participants simulated normal walking, walking with knee impairment, and walking with ankle impairment under three conditions: without joint braces, with a knee brace, and with an ankle brace. Based on these simulated gaits, we developed classification models: distinguishing abnormal gait due to joint impairments, identifying specific joint disorders, and a combined model for both tasks. Recursive Feature Elimination with Cross-Validation (RFECV) was used for feature extraction, and models were fine-tuned using support vector machine (SVM), random forest (RF), and extreme gradient boosting (XGB). The IMU-based system achieved over 91% accuracy in classifying the three types of gait. In contrast, the walkway system achieved less than 77% accuracy in classifying the three types of gait, primarily due to high misclassification rates between knee and ankle joint impairments. The IMU-based system shows promise for accurate gait assessment in patients with joint impairments, suggesting future research for clinical application improvements in rehabilitation and patient management. [ABSTRACT FROM AUTHOR]

Phospholipase C is an essential isozyme involved in the phosphoinositide signaling pathway, which maintains cellular homeostasis. Gain-of-function and loss-of-function mutations in phospholipase C impact enzymatic activity and are therefore associated with several disorders. Alternative splicing variants of phospholipase C can interfere with complex signaling networks associated with oncogenic transformation and other diseases, including brain disorders. Cells and tissues with various mutations in phospholipase C contribute different phosphoinositide signaling pathways and disease progression; however, identifying cryptic mutations in phospholipase C remains challenging. Herein, we review both the mechanisms underlying phospholipase C regulation of the phosphoinositide signaling pathway and the genetic variation of phospholipase C in several brain disorders. In addition, we discuss the present challenges associated with the potential of deep-learning-based analysis for the identification of phospholipase C mutations in brain disorders. [ABSTRACT FROM AUTHOR]

Background: A bioprosthetic valve is recommended for women of childbearing age who require cardiac valve replacement in order to minimize the risk of blood clot formation. However, it should be noted that compared to mechanical valves, bioprosthetic valves have a shorter lifespan and a higher likelihood of requiring reoperation during follow-up. To assess the long-term postoperative results, including the incidence of structural valve deterioration (SVD) and other clinical outcomes, in female patients aged 50 years and younger who underwent BalMedic bovine pericardial bioprosthetic valve replacement, a multicenter retrospective study was implemented in China., Methods: Between 2004 and 2015, a cohort of 86 female patients across three medical centers underwent the implantation of 97 bioprosthetic valves. The primary outcome measure was overall survival (OS), while the secondary outcome measures were preliminary evidence of reoperation, SVD incidence, and bioprosthetic valve-related complications., Results: In this cohort study, 21 patients (24.4%, 21/86) died, while 37 patients (43.0%, 37/86) underwent a second valve replacement. The OS rates at 5 and 10 years were 97.56% and 71.93%, respectively. Additionally, the reoperation-free rates at 5 and 10 years were 92.83% and 80.68%, respectively. Similarly, the rates of freedom from SVD at 5 and 10 years were 95.65% and 51.82%, respectively, and the average duration of bioprosthetic valve replacement in our study was 9.34±3.31 years., Conclusions: Despite the recruitment of younger female patients of child-bearing age in our cohort, the OS, reoperation-free survival, and SVD-free rates of the BalMedic bovine pericardial bioprosthetic valve were not inferior to those of the other age groups in the study or those reported in the literature., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-441/coif). A.M.Q. is a consultant for W. L. Gore and Associates, Medtronic Inc. and B. Braun, and has received consulting fees and support for attending meetings from them, not related to the submitted article. The other authors have no conflicts of interest to declare., (2024 Journal of Thoracic Disease. All rights reserved.)

Background: In China, where Rheumatic heart disease is still prevalent, two thirds of valve replacements are in mitral position. Before a valve replacement operation is conducted, most patients have reached Class III/IV heart function under the New York Heart Association (NYHA) classification system. As the background to this disease is quite different to that of degenerated cases, which are more prevalent in Western countries, the development of an artificial heart valve that is suitable for local patients is very significant for China. In this medium long-term clinical follow-up study, a data analysis was conducted of domestic heart valve production for mitral replacement., Methods: A total of 288 patients who underwent mitral valve replacements from 2005 to 2015 at 2 cardiac surgery centres (i.e., The Affiliated Hospital of Qingdao University, and The First People's Hospital of Yulin) were evaluated. All implanted bioprostheses were BalMedic ® bovine pericardial bioprosthetic valves, which had been granted marketing approval by the China Food and Drug Administration (CFDA) in 2003. Double valve cases that involved both aortic and mitral replacements were not included in the study. On average, patients were aged 54.5±10.8 (range, 11 to 77 years) before the procedure. The mean follow-up period was 7.2±2.6 years. The study examined the overall survival (OS) curve, and different age group results. To gain further insights into the functions of the valves, the OS curve and the age group results for the reoperation-free and structural valve deterioration (SVD)-free rates are also presented., Results: The 10-year OS rate was 65.6%, the 10-year reoperation-free rate was 76.3%, and the 10-year SVD-free rate was 58.0%. In relation to the age group results, younger patients had higher survival rates, while older patients had higher reoperation-free rates and SVD-free rates., Conclusions: In relation to the medium long-term clinical follow-up results, the durability performance of the BalMedic ® bovine pericardial valve in the mitral position was satisfactory, especially among patients whose heart function was worse than that of Western sufferers. Survival rate, reoperation-free rate and SVD-free rate were used for the comprehensive analysis., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-21-734). The authors have no conflicts of interest to declare., (2021 Journal of Thoracic Disease. All rights reserved.)