Objective To summarize clinical results of 29 cases of multi-vessel coronary disease treated by hybrid revascularization.Methods A total of 29 consecutive patients(all male,aged 62.8?9.7 years) with coronary artery disease(two-vessel,n=10;three-vessel,n=19) were treated with minimally invasive direct coronary artery bypass(MIDCAB)(left internal mammary artery to left anterior descending artery,LIMA-to-LAD) and percutaneous coronary intervention(PCI) between January 2000 and April 2005.The left ventricular ejection fraction(LVEF) was 0.576?0.108.Concomitant diseases included hypertension in 23 patients,insulin-dependent diabetes mellitus in 5 patients,chronic obstructive pulmonary disease in 2 patients,and old myocardial infarction in 14 patients.Results The 29 patients received 33 grafts(LIMA: 27 grafts;great saphenous vein: 6 grafts).Balloon angioplasty was carried out in 41 coronary lesions,usually following surgery.The mean number of revascularization was 2.5 per patient.There was no surgery-related complications and mortality.The blood flow in the LIMA was 45?14 ml/min.The chest drainage volume was 274?197 ml.Blood transfusion was required in 2 patients(6.9%).The length of ICU stay was 1.9?0.1 d and the length of hospital stay was 4~11 d(mean,7.5 d).Follow-up for 2.2?0.9 years showed no late death and myocardial infarction.Postoperative New York Heart Association(NYHA) Classification showed Class Ⅰ in 25 patients and Class Ⅱ in 4 patients.Repeated angiography was conducted in 4 patients,which found great saphenous vein graft occluded in 1 patient and stent re-stenosis in 2 patients.Conclusions The midterm results of hybrid techniques for coronary artery disease are satisfactory.Hybrid procedure is beneficial to high-risk patients.The long-term results need further investigation.

Objective To evaluate the clinical application and midterm result of mitral valve repair with multiple techniques for patients with complex mitral valve regurgitation. Methods From January, 2000 to July, 2006, 34 patients with complex mitral regurgitation, including 24 males and 10 females, aged 23 - 65 years [ average (42.8 ± 11.7) years ], comprised the study group. The data of the cardiac function (NYHA/EF), the diameter of left ventricular, left atria and the degree of mitral regurgitation were analyzed before and after operation. Results There was no mortality or major morbidity or reoporatien. Patients were followed up from 1 to 54 months [ average (31.2 ± 19.4) months]. The degree of mitral valve regurgitation decreased significantly after operation. The mean degree of pre-operatien mitral regurgitation was 3.62 ± 0.49, and follow-up degree was 1.18 ± 0.99 ( P ＜ 0.05) respectively.The diameters of left ventricular and left atria reduced. The postoperative cardiac function improved apparently. EF increased from 0.55 ± 0.11 preoperatively to 0.57 ± 0.10 postoperatively ( P = 0.06). Conclusion The comprehensive application of multiple techniques in repairing complex mitral valve regurgitation may be effective, and with a satisfying midterm results.

OBJECTIVE: To evaluate the value of ultrasound S-Detect in the diagnosis of breast masses. METHODS: A total of 85 breast masses in 62 female patients were diagnosed by S-Detect technique and conventional ultrasound. The diagnostic efficacy of conventional ultrasound and S-Detect technique was analyzed and compared with postoperative pathological results as the gold standard. RESULTS: When operated by junior physicians, the diagnostic efficacy of conventional ultrasound was significantly lower than that of S-Detect technique (P < 0.05), but this difference was not observed in moderately experienced and senior physicians (P>0.05). S-Detect technique was positively correlated with the diagnostic results of senior physicians (r=0.97). Using S-Detect technique, the diagnostic efficacy did not differ significantly between the long axis section and its vertical section (P>0.05). Routine ultrasound showed a better diagnostic efficacy than S-Detect for breast masses with a diameter below 20 mm (P < 0.05), but for larger breast masses, its diagnostic efficacy was significantly lower than that of SDetect (P < 0.05). CONCLUSION S-Detect can be used in differential diagnosis of benign and malignant breast masses, and its diagnostic efficiency can be comparable with that of BI-RADS classification for moderately experienced and senior physicians, but its diagnostic efficacy can be low for breast masses less than 20 mm in diameter.
Breast/diagnostic imaging* ; Breast Neoplasms/diagnostic imaging* ; Diagnosis, Differential ; Female ; Humans ; Sensitivity and Specificity ; Ultrasonics ; Ultrasonography ; Ultrasonography, Mammary/methods*

Objective:To investigate the expression and clinical significance of wild-type p53-induced phosphatase 1 (Wip1) in thyroid carcinoma and biological effect of siRNA-targeting Wip1 on the thyroid carcinoma cell line. Methods:Immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR) were performed to detect the expression of Wip1 in 73 specimens of thy-roid carcinoma tissues and normal thyroid tissues (5 cm away from the margin of thyroid carcinoma), respectively. Wip1 siRNA was transiently transfected into the papillary thyroid carcinoma cell by using a liposome-mediated method and then detected by RT-PCR and Western blot. Methyl thiazolyl tetrazolium (MTT) assay and flow cytometry (FCM) were also conducted to observe cell proliferation, cell apoptosis, and cell cycle. Results:The positive rates of Wip1 protein were 80.8%in thyroid carcinoma tissues and 9.6%in the nor-mal tissues (χ2=47.036, P<0.05). The relative mRNA contents of Wip1 were 0.665 ± 0.046 and 0.225 ± 0.039 in carcinoma and normal tissues, respectively;these results significantly differed between the two types (t=12.637, P<0.05). Significant correlation was not ob-served between Wip1 expression and other factors, such as patient's gender, age, and tumor size (P>0.05). However, significant correla-tions among Wip1 expression, lymph node metastasis, clinical stages and tumor differentiation (P<0.05) were observed. RT-PCR and Western blot results showed that K1 cell-transfected Wip1 siRNA exhibited a relatively lower expression than normal cells (t=17.039, t=14.637, P<0.05). MTT assay results showed that the K1 cells transfected with Wip1 siRNA showed a lower survival fraction, higher cell apoptosis, higher percentage of G0/G1 phases, and lower cell concentration in G2/M and S phases (P<0.05). Conclusion:Wip1 pro-tein and mRNA were increased in thyroid carcinoma and are correlated with lymph node metastasis, clinical stages and tumor differenti-ation. Wip1 may be involved in proliferation, apoptosis, and cycle of thyroid cancer cells.

OBJECTIVETo observe the effect of Wenxin Granule (WG) on brain natriuretic peptide (BNP) and heart rate variability (HRV) of acute coronary syndrome (ACS) patients.

METHODSTotally 65 ACS patients were randomly assigned to the treatment group (35 cases) and the control group (30 cases). All patients were treated with routine therapies such as angiotensin conversing enzyme inhibitors (ACEI) and metoprolol. Those in the treatment group took WG, 9 g each time, three times daily. All were treated for 90 days. Plasma samples of BNP and HRV were determined before treatment and after treatment.

RESULTSThere was no statistical difference in pre-treatment plasma BNP (P > 0.05). Plasma BNP significantly decreased after treatment in the two groups when compared with before treatment (P < 0.05). The decrease was more obvious in the treatment group (P < 0.05). There was no statistical difference in pre-treatment HRV (P > 0.05). Compared with before treatment in the same group, RMSSD, PNN50%, and high frequency (HF) obviously increased, while low frequency (LF) and LF/HF ratio significantly decreased in the two groups, showing statistical difference (P < 0.05). The aforesaid indices were obviously better in the treatment group than in the control group (P < 0.05).

CONCLUSIONAdditional administration of WG could improve short-term clinical prognosis by down-regulating plasma BNP level (via improving myocardial ischemia) and modulating HRV.

Acute Coronary Syndrome ; blood ; drug therapy ; physiopathology ; Adult ; Aged ; Aged, 80 and over ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Phytotherapy ; Prognosis

【Objective】 To explore the composition of culturable bacteria in platelets through bacterial culturomics and verify the results of culturomics and metagenomics to improve the detection rate of bacteria in platelets. 【Methods】 Platelet samples from 6 healthy people were collected. Eight kinds of culture media were placed in aerobic conditions and 12 kinds of culture media were placed in anaerobic conditions for large-scale culture and isolation of bacteria in platelets. The isolated single colony was identified by 16S rRNA gene sequencing. The bacterial abundance of healthy human platelet microbiome was analyzed by metagenomic sequencing, and the cultivable bacterial species in platelets was confirmed based on metagenomic and culturomics results. 【Results】 A total of 90 strains of bacteria belonging to 3 phylums, 5 classes, 5 orders, 7 families, 9 genus and 23 species were isolated from 6 platelet samples by culturomics. Among them, the strains with more monoclonal clones at the species level were Brevundimonas aurantiaca (16.7%), Bacillus sp. Y1 (15.6%), Cutibacterium acnes (14.4%) and Brevibacillus brevis (13.3%). The platelet samples sequenced by mNGS showed that the abundance values of Proteobacteria, Firmicutes and Actinobacteria were high. The bacteria detected by both culturomics and metagenomic sequencing methods were as follows: Firmicutes: Bacillus sp. Y1, B. thuringiensis, B. cereus, B. mobilis, B. velezensis, Staphylococcus epidermidis, and Brevibacillus brevis; Actinobacteria: Cutibacterium acnes; Proteobacteria: Escherichia coli and Delftia tsuruhatensis. 【Conclusion】 The mutual validation of culturomics and metagenomics has identified some bacteria, proving that bacteria exist in platelets.

COVID-19 has been prevalent for three years. The virulence of SARS-CoV-2 is weaken as it mutates continuously. However, elderly patients, especially those with underlying diseases, are still at high risk of developing severe infections. With the continuous study of the molecular structure and pathogenic mechanism of SARS-CoV-2, antiviral drugs for COVID-19 have been successively marketed, and these anti-SARS-CoV-2 drugs can effectively reduce the severe rate and mortality of elderly patients. This article reviews the mechanism, clinical medication regimens, drug interactions and adverse reactions of five small molecule antiviral drugs currently approved for marketing in China, so as to provide advice for the clinical rational use of anti-SARS-CoV-2 in the elderly.

Tocilizumab has been reported to attenuate the "cytokine storm" in COVID-19 patients. We attempted to verify the effectiveness and safety of tocilizumab therapy in COVID-19 and identify patients most likely to benefit from this treatment. We conducted a randomized, controlled, open-label multicenter trial among COVID-19 patients. The patients were randomly assigned in a 1:1 ratio to receive either tocilizumab in addition to standard care or standard care alone. The cure rate, changes of oxygen saturation and interference, and inflammation biomarkers were observed. Thirty-three patients were randomized to the tocilizumab group, and 32 patients to the control group. The cure rate in the tocilizumab group was higher than that in the control group, but the difference was not statistically significant (94.12% vs. 87.10%, rate difference 95% CI-7.19%-21.23%, P = 0.4133). The improvement in hypoxia for the tocilizumab group was higher from day 4 onward and statistically significant from day 12 (P = 0.0359). In moderate disease patients with bilateral pulmonary lesions, the hypoxia ameliorated earlier after tocilizumab treatment, and less patients (1/12, 8.33%) needed an increase of inhaled oxygen concentration compared with the controls (4/6, 66.67%; rate difference 95% CI-99.17% to-17.50%, P = 0.0217). No severe adverse events occurred. More mild temporary adverse events were recorded in tocilizumab recipients (20/34, 58.82%) than the controls (4/31, 12.90%). Tocilizumab can improve hypoxia without unacceptable side effect profile and significant influences on the time virus load becomes negative. For patients with bilateral pulmonary lesions and elevated IL-6 levels, tocilizumab could be recommended to improve outcome.
Antibodies, Monoclonal, Humanized ; COVID-19/drug therapy* ; Humans ; SARS-CoV-2 ; Treatment Outcome