Objectives: To compare the long term outcomes between minimally invasive mitral valve repair (MiMVR) and conventional surgery. Current retrospective comparisons between the techniques frequently report echocardiograph...Objectives: To compare the long term outcomes between minimally invasive mitral valve repair (MiMVR) and conventional surgery. Current retrospective comparisons between the techniques frequently report echocardiographical (echo) outcomes early after surgery and rarely report them later. Methods: Patients were selected for MiMVR by the surgical multi-disciplinary meeting from June 2008-March 2013. Patients included had at least two transthoracic post-operative echocardiograms. Echocardiographic parameters including left ventricular size and systolic function, degree of mitral regurgitation (MR) and mean mitral valve gradient were recorded. Clinical outcomes including all-cause mortality, re-operation, recurrence of at least moderate MR and elevated mean mitral valve gradients > 5 mmHg were recorded and compared using Kaplan-Meier survival analysis. Results: 223 patients were screened, 96 (43%) met the criteria and were included. Thirty-seven patients underwent conventional surgery and 59 underwent MiMVR. Mean clinical follow-up was 6.3 years and echo follow up was 3.2 years. There was a significantly higher recurrence of moderate MR in the conventional group (38% (n = 19) versus 17% (n = 10)). The mean LV end-diastolic diameter was 4.8 cm (conventional) versus 5.0 cm (MiMVR). The incidence of elevated PG was 26% (n = 13, conventional) and 23% (n = 14, MiMVR). There was no significant difference in incidence in re-operation (conventional 12% (n = 6), MiMVR 8.3% (n = 5)). Long-term mortality was higher in the conventional group (1.7% vs. 18% p = 0.004) although the logistic Euroscore was significantly higher 6.8% ± 5.4 vs. 3.6% ± 1.6. Conclusions: Minimally invasive mitral valve surgery is safe and feasible in selected patients with good medium and long-term echocardiographic follow-up.展开更多
Two-dimensional graphene offers interesting electronic,thermal,and mechanical properties that are currently being explored for advanced electronics,membranes,and composites.Here we synthesize and explore the biologica...Two-dimensional graphene offers interesting electronic,thermal,and mechanical properties that are currently being explored for advanced electronics,membranes,and composites.Here we synthesize and explore the biological applications of nano-graphene oxide(NGO),i.e.,single-layer graphene oxide sheets down to a few nanometers in lateral width.We develop functionalization chemistry in order to impart solubility and compatibility of NGO in biological environments.We obtain size separated pegylated NGO sheets that are soluble in buffers and serum without agglomeration.The NGO sheets are found to be photoluminescent in the visible and infrared regions.The intrinsic photoluminescence(PL)of NGO is used for live cell imaging in the near-infrared(NIR)with little background.We found that simple physisorption viaπ-stacking can be used for loading doxorubicin,a widely used cancer drug onto NGO functionalized with antibody for selective killing of cancer cells in vitro.Owing to its small size,intrinsic optical properties,large specifi c surface area,low cost,and useful non-covalent interactions with aromatic drug molecules,NGO is a promising new material for biological and medical applications.展开更多
文摘Objectives: To compare the long term outcomes between minimally invasive mitral valve repair (MiMVR) and conventional surgery. Current retrospective comparisons between the techniques frequently report echocardiographical (echo) outcomes early after surgery and rarely report them later. Methods: Patients were selected for MiMVR by the surgical multi-disciplinary meeting from June 2008-March 2013. Patients included had at least two transthoracic post-operative echocardiograms. Echocardiographic parameters including left ventricular size and systolic function, degree of mitral regurgitation (MR) and mean mitral valve gradient were recorded. Clinical outcomes including all-cause mortality, re-operation, recurrence of at least moderate MR and elevated mean mitral valve gradients > 5 mmHg were recorded and compared using Kaplan-Meier survival analysis. Results: 223 patients were screened, 96 (43%) met the criteria and were included. Thirty-seven patients underwent conventional surgery and 59 underwent MiMVR. Mean clinical follow-up was 6.3 years and echo follow up was 3.2 years. There was a significantly higher recurrence of moderate MR in the conventional group (38% (n = 19) versus 17% (n = 10)). The mean LV end-diastolic diameter was 4.8 cm (conventional) versus 5.0 cm (MiMVR). The incidence of elevated PG was 26% (n = 13, conventional) and 23% (n = 14, MiMVR). There was no significant difference in incidence in re-operation (conventional 12% (n = 6), MiMVR 8.3% (n = 5)). Long-term mortality was higher in the conventional group (1.7% vs. 18% p = 0.004) although the logistic Euroscore was significantly higher 6.8% ± 5.4 vs. 3.6% ± 1.6. Conclusions: Minimally invasive mitral valve surgery is safe and feasible in selected patients with good medium and long-term echocardiographic follow-up.
基金by NIH-NCI funded CCNE TR at Stanford University.We are grateful to Drs.Alice Fan and Dean Felsher for providing the antibodies used in this work.
文摘Two-dimensional graphene offers interesting electronic,thermal,and mechanical properties that are currently being explored for advanced electronics,membranes,and composites.Here we synthesize and explore the biological applications of nano-graphene oxide(NGO),i.e.,single-layer graphene oxide sheets down to a few nanometers in lateral width.We develop functionalization chemistry in order to impart solubility and compatibility of NGO in biological environments.We obtain size separated pegylated NGO sheets that are soluble in buffers and serum without agglomeration.The NGO sheets are found to be photoluminescent in the visible and infrared regions.The intrinsic photoluminescence(PL)of NGO is used for live cell imaging in the near-infrared(NIR)with little background.We found that simple physisorption viaπ-stacking can be used for loading doxorubicin,a widely used cancer drug onto NGO functionalized with antibody for selective killing of cancer cells in vitro.Owing to its small size,intrinsic optical properties,large specifi c surface area,low cost,and useful non-covalent interactions with aromatic drug molecules,NGO is a promising new material for biological and medical applications.
