[Summary] A 60-year-old man was admitted with main complaint of chest pain on exertion.Coronary angiogram showed severe triple vessel disease.He underwent the hybrid technique of treatment through two left minithoracotomy incisions.Both internal thoracic arteries were harvested under direct vision.The left internal mammary artery (LIMA)and right internal mammary artery (RIMA) compositing Y grafts was constructed. The LIMA was anastomosed to the left anterior descending branch and the RIMA was anastomosed to the ramus intermedius.The operation time was 306 min.The amount of bleeding during operation was 50 ml.Five days later he underwent percutaneous coronary intervention at right coronary artery lesion successfully.He was discharged from hospital 8 days after operation,and didn’t complain of chest pain during fellow-up for one month.This technique demonstrates to be an effective and minimally invasive alternative to treat patients with multivessel coronary artery disease.

Objective To investigate the learning curve of minimally invasive direct coronary artery bypass ( MIDCAB) via left anterior small thoracotomy. Methods We retrospectively reviewed results of a consecutive series of 80 patients underwent MIDCAB via left anterior small thoracotomy performed by a single surgeon.The patients were divided into 4 groups ( group A, B, C, D, n=20 in each group) according to the sequence of the operation.The left internal mammary artery ( LIMA) harvesting time, anastomosis time, total operative time, the drainage volume of the first day postoperation, mechanical ventilation time, hospital stays postoperation, in-hospital morbidity and mortality were compared.The learning curve was assessed by means of regression analysis with logarithmic curve fitting. Results The basic clinical characters were similar in all groups before the operation.The operations were accomplished successfully in all the 80 cases.No intraoperative conversion to sternotomy, death, or perioperative myocardial infarction happened.The LIMA-harvesting time in the group B, C, and D was significantly shorter than that in the group A [(53.7 ±19.2) min, (50.2 ±17.7) min, and (43.2 ±10.3) min vs.(77.0 ±30.0) min, P =0.001, 0.000, and 0.000].There was no difference between group B and C, B and D, C and D in the LIMA-harvesting time (P>0.05).The total operative time in the group B, C, and D was significantly shorter than in the group A [ (128.7 ±21.7) min, (129.0 ±33.3) min, and (112.2 ±14.5) min vs. (165.2 ±41.8) min, all P=0.000], without difference between the group B and C, B and D, C and D (P>0.05).The learning curve models were obtained: LIMA-harvesting time ( min) =113.77 -16.869 × ln ( operation number); total operative time (min)=220.281 -25.276 ×ln (operation number). Conclusion MIDCAB via left anterior small thoracotomy is safe and effective, with a learning curve of approximately 20 cases.

48 h) in the IABP Group (14/19) was significantly higher than that in the Control Group (19/45) ( ? 2=4 110, P =0 043). Conclusions In the absence of prophylactic IABP, OPCAB can be safely operated on in patients with low ejection fraction.

Objective To explore the value of endoscopic mini-incision greater saphenous vein harvesting for coronary artery bypass operation. Methods A total of 411 patients scheduled for coronary artery bypass operation were given either endoscopic vein harvesting(EVH Group,n=136) or open vein harvesting(OVH Group,n=275),based on patient's willingness.The operation outcomes and incision complications were compared between the two groups. Results The incidence of various incision complications was significantly lower in the EVH Group(18.4%,25/136) than in the OVH Group(36.7%,101/275)(?~2=14.406,P=0.000).As compared with the OVH Group,the EVH Group had lower incidences of edema(1.5% vs 35.3%;?~2=56.861,P=0.000),paraesthesia(7.4% vs 33.8%;?~2=33.937,P=0.000),hematoma(16.2% vs 27.3%;?~2=6.214,P=0.013),and incisional liquefaction(0.7% vs 8.7%;?~2=10.174,P=0.001) of the lower extemity.The total operation time were 226.3?28.5 min in the EVH Group and 224.7?19.2 min in the OVH Group,without significant difference between the two groups(t=0.673,P=0.502).Early graft failure happened in 1 case in each of the groups,without significant difference between the two groups(?~2=0.000,P=1.000).The numbers of distal coronary anastomoses were 3.6?0.8 in the EVH Group and 3.3?1.0 in the OVH Group,with significant difference(t=3.049,P=0.002). Conclusions Endoscopic greater saphenous vein harvesting can significantly reduce the morbidity associated with incision complications,whereas does not prolong the operative time,increase the incidence of early graft failure,and decrease the number of distal coronary anastomoses.

ObjectiveDiabetes is an independent risk factor for coronary artery bypasss grafting(CABG). Off pump coronary artery bypasss (OPCAB) experience in 251 cases was reviewed to determine whether diabetes wou ld be applicable in OPCAB procedures.MethodsConsecutive 251 patients underwent OPCAB over 12 month period. This study included 71 diebetic patients (DM group) and 180 nondiabetic patients (NDM group). Preoperative v ariables were compared between the two groups by univariate analysis.R esultsNo differences were found regarding the length of stay in cardio intensive care unit [DM group(2.4?0.3)d; NDM group (2.4?0.3) d;P=0. 386], and sternal complication (DM group: 5.7%;NDM group: 3.9%;P=0.511) . In hospital complications were as follows: death rate(DM group: 2.8%; NDM gr oup: 1.1%; P=0.680); stroke (DM group: 2 8%; NDM group: 1 7%; P=0 623 ); hemofiltratioin renal failure (DM group: 2.8%; NDM group: 0.5%; P=0.194); myocardial infarction(DM group: 0%; NDM group: 0.5%;P=1.000); blood using were more frequent in DM group comparied with NDM group (P=0.111). ConclusionOPCAB in diabetic patients is as safe as in non diabetic patients.

Objective To investigate the role of nuclear factor kappa-B（NF-κB）signaling pathway in tumor necrosis factor α（TNF-α）-induced apoptosis in gastric cancer cells.Methods Human gastric cancer cell line SGC7901 was treated with TNF-α for 24 hours.MTT assay,flowcytometry and Western blot was used to detect the cell viability and apoptosis.Transient transfection was performed by using Lipofectamine 2000 reagent.The cells of experimental group and control group were respectively transfected with mutant IκB cDNA and vectors.Results Under the treatment of 100,1 000 or 10 000 U/ml TNF-α,the cell viability of SGC7901 cells was（99.2±0.6）%,（92.0±2.7）% and（97.9±2.2）%,respectively.Further study showed that TNF-α engagement led to rapid activation of NF-κB signaling pathway.Blockage of TNF-α-induced NF-κB activation by transient transfection with a mutant IκB enhanced the sensitivity of cells towards TNF-α-induced apoptosis.Conclusion In human gastric cancer cells,activation of NF-κB signaling pathway by TNF-α might be responsible for the resistance to TNF-α-induced apoptosis.Blockage of NF-κB significantly enhanced the apoptosis induced by TNF-α.

Objective To investigate the role of phosphoinositide 3-kinases （PI3K）/Akt signaling pathway in TRAIL-induced cell apoptosis, and the effect of oxaliplatin on TRAIL-induced apoptosis in gastric cancer BGC823 cells. Methods Cell proliferation was roeasured using MTT assay. Cell apoptosis was determined by flow eytoroetry. The expression of Akt and phospbor-Akt were determined by Western blotting. Results 100 ng/mL TRAIL caused little cell apoptosis in BGC823 cells. TRAIL activated P13K/Akt pathway. Pretreated with PI3K in- hibitor LY294002 （25 μmol/L）for 1 h followed by exposure to TRAIL for 16 h,the cell apoptosis was obviously higher （12.7%±3,1% vs 3.5%±1.1% ,P 〈 0.05） than that without the treatment of LY294002. Treatment with 38 μg/mL oxaliplatin blocked the activation of P13K/ Akt signaling, and enhanced the sensitivity of cells to TRAIl,, the rate of cell apoptosis increased to 35.5%±4.5% （P 〈 0.05 ）. Conclusion Oxaliplatin enhanced the sensitivity of gastric cancer BGC823 cells to TRAIL by inhibiting TRAIL-induced the activation of PI3K/Akt pathway.

Objective: To compare the blood lfow of left internal mammary artery (LIMA) graft vessel between minimally invasive direct coronary artery bypass (MIDCAB) and traditional median sternotomyin off-pump coronary artery bypass (Traditional OPCAB) by transit-time lfow meter (TTFM). Methods: We retrospectively studied 300 patients who received OPCAB in our hospital from 2013-01 to 2015-07, all patients had LIMA to left anterior descending coronary artery (LAD) anastomosis. The patients were divided into 2 groups: MIDCAB group, n=70 and Traditional OPCAB group,n=230. Intra-operative blood lfow in graft vessel was measured by transit-time lfow meter. Pre- and post-operative indexes and the mean lfow (MF), pulsatile index (PI), diastolic fraction (DF) of LIMA graft were compared between 2 groups. Results: The following indexes in Traditional OPCAB group and MIDCAB group were as below: intra-operative transfusion was (3.00±5.42) U vs (1.06±2.17) U, post-operative peak value of cTnI was (2.84±9.93) ng/ml vs (0.69±1.74) ng/ml, mechanical ventilation time was (27.9±66.9) h vs (14.2±20.8) h and ICU stay time was (64.1±89.6) h vs (35.2±39.2) h, allP<0.05; while for the graft from LIMA to LAD, MF was (29.45±18.19) ml/min vs (29.04±15.85) ml/min, PI was (2.68±1.19) vs (2.44±0.84) and DF was (71.47±11.12) % vs (70.25±11.30) %, allP>0.05. Conclusion: With LIMA to LAD graft, MIDCAB may achieve the same effect as traditional OPCAB, the early post-operative anastomosis has been reliable.

Objective:To assess the feasibility and safety of 2-staged hybrid technique for treating coronary artery disease (CAD) patients with multi-vessel lesions.
Methods: Our research included 2 groups:Hybrid group, CAD patients with left anterior descending artery (LAD) lesion or with other major epicardial vessel stenosis>70%who received 2-staged hybrid treatment in our hospital from 2012-03 to 2015-03 and Control group, CAD patients received elective conventional off-pump coronary artery bypass (OPCAB) by the same surgeon at meanwhile. n=91 in each group. The peri-operative conditions and complications were compared between two groups.
Results: Compared with Control group, Hybrid group had the shorter post-operative mechanical ventilation time (7.9 ± 4.8) h vs (21.6 ± 35.9) h, shorter ICU-stay time (29.6 ± 20.8) h vs (47.5 ± 38.3) h, all P<0.01 and less peri-operative blood transfusion (0.59 ± 1.48) U vs (2.82 ± 3.81) U, P<0.01. The post-operative complications of mortality, MI occurrence and delayed wound healing were similar between 2 groups, P>0.05.
Conclusion:2-staged hybrid technique is a safe, feasible and minimally invasive technique for treating CAD patients with LAD and multi-vessel lesions.

Objective To analyze the clinical and perioperative data of off-pump coronary artery bypass grafting (OPCABG) in CHD patients with their age ≥75 years.Methods The ICU stay time,mechanical ventilation time,incidence of postoperative complications and mortality in 127 CHD patients with their age≥75 years who underwent OPCAB in our hospital were retrospectively analyzed.Results Of the 127 CHD patients,2 were transfered to extracorporeal circulation because it was difficult to maintain the intraoperative circulation,the remaining 125 (98.43％) underwent successful OPCABG.The mean number of grafted blood vessels was 2.44 ± 1.05,the postoperative mechanical ventilation time was 30.8±47.7 h,and the ICU stay time was 57.2±60.3 h.Perioperative myocardial infarction occurred in 6 patients,second operation was performed in 3 patients,postoperative renal failure was diagnosed in 1 patient,pulmonary complications were detected in 17 patients,death occurred in 4 patients (3.1％) after operation.Eighty-two patients (66.7％) were followed up for 28.3± 12.8 months.The postoperative 2-year survival rate was 95.9％.The incidence of postoperative MACCE was 8.5 ％.Conclusion OPCABG is safe and effective for CHD patients with their age ≥75 years and can thus be used as a routine procedure.