ObjectiveTo investigate the influence of carotid artery stenosis on the incidence of neurological complication in patients undergoing off-pump coronary artery bypass grafting.MethodsWe prospectively analyzed 176 consecutive patients ≥60 years old undergoing selective off-pump coronary artery bypass grafting (from June 2010 to July 2011 ).Carotid duplex ultrasound screening was used to determine the presence and severity of carotid artery before surgery. Neurological complications 7 days after surgery were compared between the patients with ( ≥75％ ) and without severe carotid artery stenosis ( ＜ 70％ ).Multivariate analysis was used to determine the predictor of severe carotid artery disease.ResultsSixteen patients (9.1％ ) were found to have severe carotid artery stenosis before surgery. Thirty-seven patients (20.8％ ) had single or multiple neurological complications:1 (0.6％ ) had stroke; 12 (6.7％) had hypoxic-metabolic encephalopathy; 21 ( 11.8％ ) had cognitive dysfunction; 3 ( 1.7％ ) had depression.When compared with the counterparts,patients with severe carotid artery stenosis had a higher rate of neurological complications (43.8％ vs 18.8％ ; P =0.044).In multivariate analysis,significant predictive factor for severe carotid artery stenosis was prior stroke ( OR:4.04 ; 95％ CI 1.22-13.37 ).Conclusion Severe carotid artery stenosis alone is a risk factor for neurological complication after off-pump coronary artery bypass grafting and prior stroke is a predictor for sever carotid artery disease.

Objective To analyze the risk factors and clinical features of stroke following off-pump coronary artery bypass grafting in patients with prior stroke. Methods From January 2006 to July 2009, the clinical information of 437 patients undergoing OPCABC in Anzhen Hospital was collected. The patients were divided into stroke group and non-stroke group according to whether stroke occurred after operation. Preoperative and operative variants were evaluated by univariate and multivariate logistic stepwise regression analysis. Results 32 of 437 patients (7.3% ) suffered from stroke after OPCABG, 32 cases were cerebral infarction and no case was cerebral hemorrhage. There were more patients whose left ventricular ejection fraction ≤0. 50 in stroke group than that in non-stroke group (12 of 32, 37.5% versus 69 of 405, 17.0% , P = 0. 004), more patients had atrial fibrillation after operation in stroke group than that in non-stroke group (9 of 32, 28. 1% versus 27 of 405,6.7% , P ＜ 0.001), more patients had hypotension after operation in stroke group than that in non-stroke group (13 of 32,40.6% versus 42 of 405, 10. 4% ; P ＜ 0. 001), more patients had ventilatory time and ICU time after operation in stroke group than that in non-stroke group(9 of 32, 28.1% versus 49 of 405, 12.1% , P =0.021; 14of 32,43.8% versus 97 of 405, 24.0% , P = 0.013), and patients in stroke group took longer to stay in hospital than that in non-stroke group (29.0 ±15. 8 versus 22. 9 ± 10. 4, P = 0. 002 ). Logistic stepwise regression analysis showed that left ventricular ejection fraction SS0.50(OR=2.837, 95%CI: 1.238-6.498), atrial fibrillation after operation( OR =3. 065, 95% CI: 1.157-8.118) and hypotension after operation (OR =4.209, 95%CI: 1.805 -9. 813) were independent risk factors of stroke following offpump coronary artery bypass grafting in patients with prior stroke. Conclusion This data suggest that left ventricular ejection fraction ≤0. 50, atrial fibrillation and hypotension after operation are risk factors for stroke following off-pump coronary artery bypass grafting in patients with prior stroke. These patients with stroke after operation took longer to extubate and stay in ICU and hospital.

Objective To study neurologic injury after off-pump coronary artery bypass grafting (OPCABG) in elder patients with a history of stroke. Methods 108 patients (age≥60years) undergoing elective OPCABG with a history of stroke were studied. Each study patient was matched with 1 control patient who had no stroke history and was undergoing elective OPCABG either immediately before or immediately after the study patients by the same surgeon. Preoperative characteristics, ICU stay, hospital stay, hospital mortality, postoperative neurologic injury were compared in the two groups. Results The incidence of neurologic injury after operation among the study group was higher than those in control group (P＜0.01)(27.8% vs 4.6%). The incidence of delirium and stroke after operation among the study group was higher than those in control group(P＜0.05) (20.4% vs 3.7% ,7.4% vs 0.9%) ;The study group took longer to stay in ICU and hospital than the control group [(26.5±16.4)h vs (21.6±8.8)h ,(23.6±9.2)d vs(19.4±5.7)d, P＜0.01]. Logistic regression analysis showed that the risk factors of neurologic injury after OPCABG included previous stroke (OR 6. 269, 95% CI 2. 218-17. 717), age (OR 1.131,95% CI 1.032-1.239), hypertension (OR 5.072,95% CI 1. 420-18. 114) and diabetes (OR 2. 652,95% CI 1. 123-6. 260). Stroke after the operations was found in 8 of 108 study patients and included cerebral infarction in 6 and transient ischemic attack in 2. 8 patients had late stroke (＞ 24 hours).Conclusion The eldely patients with previous stroke undergoing OPCABG are more likely to have neurologic injury after operations, these patients had longer stays in ICU and hospital.

Objective To investigate the clinical features of stroke in young adults with infective endocarditis (IE).Methods This is a retrospective analysis of clinical data of young patients (aged between 18 and 44 years) diagnosed with IE in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2003 to March 2013.Results Three hundred IE patients (209 male and 91 female) were enrolled with mean age of (31.8 ± 7.8) years old.Fourteen of them were prosthetic valve endocarditis.All of the cases were found vegetations.The vegetations were mainly distributed in the mitral valve and/or aortic valve (262/300 patients).Congenital heart disease and rheumatic valvular disease were most frequently background diseases.Thirty-five cases (11.7％) were complicated with stroke.Among them,21 cases were with cerebral infarction (including 7 subjects with hemorrhagic transformation),9 cases with cerebral hemorrhage,3 cases with subarachnoid hemorrhage,and 2 with reasons unknown.Within the 21 cerebral infarction cases,the infarction sites were mainly distributed in internal carotid artery system with 5 cases involving bilateral internal carotid artery systems and 2 vertebro-basilar artery systems.As to the cerebral hemorrhage,lobar were the bleeding sites in all cases,and mainly distributed in internal carotid artery system.The proportions of left-sided endocarditis and rheumatic valvular disease were significantly higher in patients with stroke than those without [100.0％ (35/35) vs 86.4％ (229/265),P =0.02;22.8％ (8/35) vs 6.4％ (17/265),P =0.001,respectively].Regression analysis showed that the OR of the rheumatic valvular disease for stroke in young IE patients was 4.950 (95％ CI 1.626-15.072),and the OR of stroke for death was 8.387 (95％ CI 1.997-35.225),respectively.Conclusions Stroke is common in young patients with IE.Cerebral infarction often involves multiple vascular systems,and is prone to hemorrhagic transformation.Intracerebral hemorrhage often occurs in lobar.Rheumatic valvular disease might be a risk factor for stroke in young patients with IE,which is an independent risk factor for death of these patients.

Objective To summarize the characteristics of neurological symptoms in patients with aortic dissection.Methods The clinical data including symptoms,signs,and imaging of 865 consecutive patients with aortic dissection were analyzed retrospectively.Results Neurological symptoms occurred in 225 cases (26.0％) with aortic dissection.The most common symptom was dizziness (56 cases,6.5％),followed by syncope (49,5.7％),single lower limb sensory disturbances(47,5.4％),single lower extremity weakness(27,3.1％),coma (22,2.5％),paraplegia (19,2.2％),headache (13,1.5％)and hemiplegia (9,1.0％).The first manifestation of five cases was the neurological symptoms,including syncope (2),dizziness(1)and headache (2).Patients with type A aortic dissection were more vulnerable to the neurological symptoms than those with type B aortic dissection (34.6％ vs 14.7％),and the symptoms with significantly higher occurrence were syncope,coma,hemiplegia,paraplegia and lower limb sensory disturbances.Conclusion Neurological symptoms are common in patients with aortic dissection,especially in those with type A aortic dissection.

Objective To study the postoperative cognitive dysfunction (POCD) in elderly patients after off‐pump coronary artery bypass grafting (OPCABG)and its risk factors ,and the association between cerebrovascular function assayed by 320 dynamic volume CT and POCD .Methods Two hundred and thirteen elderly patients selected for OPCABG were divided into patients group (n=28) and control group (n=185) .The patients underwent 320 dynamic volume CT to show their cerebrovascular ,neurological and cognitive functions .The patients were assessed on day 14 after operation .The risk factors for POCD and the association between CT perfusion imaging parame‐ters and POCD w ere comparatively analyzed .Results T he incidence of cerebrovascular disease , diabetes mellitus ,CTA‐detected severe cerebrovascular stenosis and abnormal cerebral pufusion was significantly higher in patients group than in control group (P< 0 .01) .Logistic regression analysis showed that cerebrovascular disease history and abnormal cerebral pufusion were the in‐dependent risk factors for POCD (OR= 1 .837 ,95% CI:1 .075 -3 .141 ,P= 0 .026 ;OR= 3 .224 , 95% CI:2 .073-5 .013 ,P=0 .000) .Conclusion Early detection of abnormal cerebrovascular ste‐nosis ,poor cerebral perfusion and maintainence of stable blood glucose play an important role in reducing the incidence of POCD in elderly patients after OPCABG .

Objective To study the postoperative recovery in patients undergoing coronary artery bypass grafting (CABG)with a history of cerebral infarction.Methods From January 2007 to December 2007,112 patients undergoing elective off-pump coronary artery bypass grafting(OPCABG)with a history of cerebral infarction were studied retrospectively.Each of the 112 patients was matched with 1 control patient who had no cerebral infarction history and were undergoing an elective OPCABG either immediately before or immediately after the study patient,in most cases by the same surgeons.Preoperative characteristics,anesthesia time,awakening time,extubation time,ICU stay,hospital stay,reintubation,hospital mortality,postoperative confusion and stroke were compared in the two groups.Results There were no significant differences between the study and control Patients in the most preoperative characteristics,only the incidence of hypertension and diabetes mellitus were higher than those in control group,P<0.05(78 of 112,69.6% versus 61 of 112,54.5%;52 of 112,46.4% versus 26 of 112,23.2%).The study group took longer to awaken,extubate and stay in ICU and hospital than the control group,P<0.01[(6.4±4.0)h versus(4.6±2.7)h,(19.6±9.7)h versus(16.8±5.5)h,(27.3±16.8)h versus(22.1±10.6)h,(23.4±10.0)d versus(19.5±5.6)]d.The incidence of confusion,stroke and reintubation after operation among the study group was higher than those in control group,P<0.05(17 of 112,15.2% versus 4 of 112,6.3%;8 of 112,7.1% versus 1 of 112,0.9%;8 of 112,7.1% versus 1 of 112,0.9%),RR and 95% CI were 4.83(1.57～14.86)、8.54(1.05～69.45)and 8.54(1.05～69.45).There were no significant differences between the study and control patients in the anesthesia time and hospital mortality.Stroke after the operations was found in 8 of 112 study patients and included cerebral infarction in 6 and transient ischemic attack(TIA)in 2.The 8 patients included new stroke in 7 and worsening of old stroke in 1 without new abnomalities on head computed tomography.1 of 8 patients had early stroke(≤24 hours after operation)and others had late stroke(>24 hours).Conclusion The patients with previous cerebral infarction undergoing off-pump coronary artery bypass grafting took longer to awaken,extubate,stay in ICU and hospital.These patients were more likely to have reintubation,confusion and stroke after operation than those patients with no cerebral infarction history.

Objective To investigate the effects of anti-cell membrane associated DNA (mDNA) antibodies in the diagnosis of systemic lupus erythematosus (SLE) lacking of specific autoantibodies including anti Sm,anti ds-DNA,and anti-nucleosome antibodies.Methods Indirect immunofluorescence assay was used to measure anti-mDNA antibodies in serum of 145 SLE patients,and indirect immunofluorescence,Western-blot and ELISA were used to detect the anti-dsDNA ,anti-Sm and anti- nueleosome antibodies respectively to analysis the value of anti-mDNA antibodies on the specific autoantibodies negative patients with SLE.Results The sensitivity for anti-mDNA antibodies (69.7%) in SLE was significantly higher than anti-Sm (19.7%),anti-dsDNA ( 31.9% ) and anti-nucleosome (45.8% ).The incidences of anti-mDNA antibodies in SLE lacking of anti-dsDNA,Sm and anti-nueleosome antibodies (AnuA) were 64.3% ,70.2% and 60.3% respectively.Conclusion Anti-mDNA antibodies are serologic marker of SLE and important in diagnosis of SLE lacking of anti-dsDNA,Sm and nucleosome antibodies.

Objective To observe the effect of active components(glycyrrhizic acid monoaminate,total ginsenoside and to-tal ophiopogonoside)of Zhi Gancao Decoction(ZGD)and their combination on the triggered activity and myocardial dam-age in the isolated ischemia -reperfusion rat heart.Methods Isolated rat heart was treated with L angendroff perfusion and monophase action potential technology was applied.Results &Conclusion Total extract of ZGD,single active c omponents and their combination can markedly l ower the incidence of cardiac triggered activity,prevent the myocardiu m from injury and decrease the incidence of arrhythmia induced by ischemia -reperfusion in rats and the effects of their com bination are positively related to the doses.

Objective To evaluate the effeciency and safety of the implantation of phakic iris-fixated intraocular lens for high myopia.Methods 12 cases(18 eyes)with the mean spherieal equivalent refraction was(-15.12?5.23)diopters of myopia,following up 3~6 months after surgery(averaging 5.1 months)were enrolled.Visual acuity,intraocular pressure,contrast sensitivity,glare sensitivity,corneal endothelium and the stable of intraocular lens and the turbid level of lens were observed.Results A postoperation uncorrected visual acuity of(0.73?0.21)was observed in 18 eyes at 6 months.There was significant difference as compared with preoperation corrected visual acuity of(0.52?0.17)(P