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BACKGROUND: Transapical off-pump NeoChord procedure is a novel minimally invasive surgical repair of degenerative mitral regurgitation (MR). Here, we report the first four cases of NeoChord procedure in patients with mitral valve prolapse in mainland China. METHODS: Four patients, aged 86, 84, 80 and 60 years, with severe MR due to posterior middle scallop prolapse (P2), underwent transapical off-pump artifi cial chordae implantation on April 9 and 10, 2019. The procedure was performed by left mini-thoracotomy under general anaesthesia and guided by 2D and 3D dimensional transoesophageal echocardiography (TEE). RESULTS: Mitral valve repair via NeoChord procedure was successfully performed with implantation of 3 artifi cial chordae in the fi rst patient and 3, 2, and 3 artifi cial chordae in the following patients, respectively. Intraoperative TEE and pre-discharge transthoracic echocardiography (TTE) showed only mild to moderate MR of these four patients and no postoperative complications were noted. There were no changes of TTE fi nding between one-month follow-up and pre-discharge. CONCLUSION: The successful NeoChord procedures in four Chinese indicate that the valve repair using the NeoChord system for Chinese population is feasible. [ABSTRACT FROM AUTHOR]

Importance: Previous studies revealed limited effectiveness of neuroprotective agents in treating acute ischemic stroke (AIS). Tongxinluo, developed from traditional Chinese medicines, has been recognized as a novel neuroprotective agent with anti-inflammatory properties that stabilize vulnerable plaques in animal models and patients with myocardial infarction., Objective: To assess the efficacy and safety of Tongxinluo in patients with acute ischemic stroke (AIS)., Design, Setting, and Participants: This multicenter, open-label, double-blind, randomized clinical trial included 2007 patients with AIS and a National Institutes of Health Stroke Scale score between 4 and 22 at admission. The trial was conducted at 50 hospitals in China from March 1, 2014, to October 31, 2016. Data were analyzed from November 14, 2016, to November 16, 2017., Interventions: Eligible patients were randomized within 72 hours of symptom onset to the Tongxinluo group or the control group. Participants received 4 oral capsules of Tongxinluo or placebo, 3 times a day for 90 days. Other treatment was administrated according to guidelines., Main Outcomes and Measure: The primary outcome was a favorable functional outcome at day 90 after randomization, defined as a modified Rankin Scale (mRS) score of 0 to 1 (on a scale of 0 [no neurologic deficit, no symptoms, or completely recovered] to 6 [death]). All statistical analyses were performed in a modified intention-to-treat population, defined as all patients who underwent randomization, were given any treatment, and underwent any posttreatment assessment., Results: Among 2007 patients with AIS who were randomized, 1946 (96.5%) were included in the modified intention-to-treat analysis (973 in the Tongxinluo group and 973 in the control group, with mean [SD] age of 60.5 [9.2] years and 1342 [69.0%] male). Patients in the Tongxinluo group had a significantly higher proportion of favorable functional outcomes at day 90 compared with those in the control group (mRS score of 0-1, 640 [65.8%] vs 575 [59.1%]; odds ratio, 1.33 [95% CI, 1.11-1.60]; P = .002). The prespecified subgroup analyses indicated that, among all subgroups, additional Tongxinluo treatment had similar outcomes., Conclusions and Relevance: Among patients with ischemic stroke within 72 hours after symptom onset, those additionally receiving Tongxinluo were more likely to have a favorable functional outcome, compared with a placebo group. Further research in patients with thrombolysis and endovascular treatment are needed to explore these outcomes., Trial Registration: ClinicalTrials.gov Identifier: NCT01919671.

Paridis Rhizoma is prepared from the dried rhizoma of Paris polyphylla var. yunnanensis or P. polyphylla var. chinensis. For the improvement of the quality standard of Paridis Rhizoma described in Chinese Pharmacopoeia(2015 edition), it is proposed that the quality marker no longer contains polyphyllin Ⅵ, and instead, polyphyllin H is an alternative for the quantitative analysis. To determine polyphyllin Ⅰ, Ⅱ, H and Ⅶ in the Paridis Rhizoma samples collected from the different growing area in China, HPLC method was established using the same chromatographic conditions as those for simultaneous determination of polyphyllin Ⅰ, Ⅱ, Ⅵ and Ⅶ described in Chinese Pharmacopoeia(2015 edition). The methodology validation indicated that there was a good linearity among the ranges of 0.006 48-0.828, 0.006 52-0.834, 0.006 17-0.790, 0.006 31-0.808 g·L~(-1) for polyphyllin Ⅰ, Ⅱ, H and Ⅶ, respectively. The average recoveries of four components were 100.2%-101.4%, with RSD less than 3.5%. The total amount of polyphyllin Ⅰ, Ⅱ, H and Ⅶ in the analyzed samples of P. polyphylla var. chinensis and P. polyphylla var. yunnanensis ranged from 0.050 9% to 3.99% and from 0.115% to 3.23%, respectively. In the tested samples collected from other Paris plants, there are high content of steroidal saponins in the samples of P. fargesii and P. forrestii, low content in the samples of P. polyphylla var. stenophylla, P. delavayi and P. thibetica, and almost not occurrence in the sample of P. mairei. As a representative adulterant of Paridis Rhizoma processed slices, 7 batches of Trillium samples contained high amount of polyphyllin Ⅵ and did not have polyphyllin H. Based on the present investigation, it is recommended that polyphyllin H together with polyphyllin Ⅰ, Ⅱ and Ⅶ are suitable for the improvement of quality standard of Paridis Rhizoma and the total amount of four components are not less than 0.80%.

Objective: The purpose of this study is to evaluate the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with a severe stenotic bicuspid aortic valve (BAV) in a Chinese population. While several groups have reported the feasibility, efficacy, and safety of TAVI for patients with a BAV, worldwide experience of the technique is still limited, especially in China., Methods: From March 2013 to November 2014, high surgical risk or inoperable patients with symptomatic severe aortic stenosis (AS) who had undergone TAVI at our institution were selected for inclusion in our study. RESULTS were compared between a BAV group and a tricuspid aortic valve (TAV) group., Results: Forty patients were included in this study, 15 (37.5%) of whom were identified as having a BAV. In the BAV group, the aortic valve area was smaller ((0.47±0.13) vs. (0.59±0.14) cm(2)), the ascending aortic diameter was larger ((40.4±4.4) vs. (36.4±4.3) mm), and the concomitant aortic regurgitation was lower. No significant differences were found between the groups in the other baseline characteristics. No differences were observed either in the choice of access or valve size. The procedural success achieved in this study was 100%. There were no differences between groups in device success (86.7% vs. 88.0%), 30-d mortality (6.7% vs. 8.0%), or 30-d combined end point (13.3% vs. 12.0%). The incidences of new pacemaker implantation, paravalvular regurgitation and other complications, recovery of left ventricle ejection fraction and heart function were similar in both groups., Conclusions: Patients with a severely stenotic BAV can be treated with TAVI, and their condition after treatment should be similar to that of people with a TAV.