OBJECTIVES: To compare perioperative and mid-term results of multiple versus single arterial off-pump coronary artery bypass grafting (OPCABG) in patients with impaired left ventricular function. METHODS: This study was conducted among 86 patients with a left ventricular ejection fraction (LVEF) <50%, who underwent OPCABG at our hospital between January, 2018 and December, 2021. Of these patients, 22 underwent OPCABG with multiple arterial grafts (multiple graft group) and 64 received a single arterial graft in OPCABG (single graft group). The preoperative, intraoperative, and perioperative data were collected, and the patients were followed up for a mean of 29.28±14.84 months. The perioperative outcomes and follow-up results of the patients were compared, and the factors influencing major adverse cardiovascular events (MACE) were identified using logistic regression. Kaplan-Meier analysis was used to compare the postoperative survival rate without MACE. RESULTS: The patients in multiple graft group had a significantly younger age than those in single graft group (P<0.05), but the other baseline data were similar between the two groups (P>0.05). Perioperative mortality, 24-h postoperative drainage volume, length of ICU stay, intubation time, and the incidence of new-onset atrial fibrillation were all similar between the two groups (P>0.05), but the rate of postoperative hypotension was significantly higher in multiple graft group (34.78% vs 11.54%, P=0.009). No significant differences were found in the incidence of MACE or echocardiographic data during the follow-up. Logistic regression identified the female sex (OR: 0.191, 95% CI: 0.049-0.075) and creatinine level (OR: 1.016, 95% CI: 1.000-1.033) as factors affecting postoperative MACE occurrence. Kaplan-Meier analysis showed no significant difference in MACE-free survival rate between the two groups. CONCLUSIONS OPCABG with multiple arterial grafts does not increase severe perioperative complications or the risk of mid-term MACE in patients with impaired left ventricular function.
Humans ; Follow-Up Studies ; Postoperative Complications/epidemiology* ; Ventricular Dysfunction, Left/physiopathology* ; Coronary Artery Bypass, Off-Pump/adverse effects* ; Male ; Female ; Ventricular Function, Left ; Middle Aged ; Risk Factors ; Aged ; Perioperative Period ; Stroke Volume

Objective:To analyze the mobile of pediatric discharged patients in Beijing from 2013 to 2022 and provide data support for rational planning of pediatric medical resource allocation.Methods:The number,source and flow of pediatric discharges from secondary and higher-level medical institutions in Beijing were described and compared and analyzed visually.Two indicators,the cross-district consultation rate,and the load share ratio,were measured to reflect the outflow rate of patients from the outflow areas and the pressure on the supply of healthcare services in the inflow areas.Results:The proportion of pediatric discharged patients from secondary and upper medical institutions in Beijing was 53.34%.Hebei,Shandong,Henan,Inner Mongolia Autonomous Region,and Shanxi were the main source provinces,with a cumulative proportion of 68.02%.Pediatric patients from other provinces mainly flowed to Xicheng District,tertiary hospitals,and children's hospitals,which was consistent with the main flow of patients in Beijing.There was an interactive flow of pediatric patients between the 16 administrative districts.Between 2020 and 2022,the average annual cross-regional consultation rate of pediatric patients in Fangshan District,Daxing District,Huairou District,Pinggu District,Miyun District,and Yanqing District all had relatively large increases.After considering patients from outlying provinces,the load share of each administrative district increased to varying degrees,with Xicheng District showing a high multiplier increase.Conclusions:The mobility of pediatric patients from other provinces and cross-regional visits in Beijing was relatively high,and both had high targeting and concentration in their choice of visits.It is recommended that a targeted work plan for the relocation of medical functions be formulated,and paediatric patients should be reasonably triaged according to their population and needs,so as to guide a reasonable flow of paediatric patients to seek medical treatment.

Objective:To analyze the equality of health resource allocation in functional areas of Beijing from 2012 to 2022, so as to provide reference for optimizing the allocation of health resources during the 14th Five-Year Plan and long-term planning.Methods:According to the new urban master plan and the functional positioning of the capital, 16 districts in Beijing were divided into 4 functional regions(capital core area, urban functional expansion area, urban development new area, and ecological conservation area). Based on the analysis of permanent population, the levels of health resources in each region and each administrative district were compared, and the equity of health resources was measured by using the Dagum Gini coefficient.Results:In 2022, the Gini coefficients of medical and health resources in Beijing, including the number of beds, number of health technicians, and number of practicing(assistant) physicians, were 0.71, 0.65, and 0.63, respectively, with no significant change compared to 2012. While the Gini coefficient for equipment priced over 10 000 yuan was 0.75, slightly lower than 0.79 in 2012. The differences in resource allocation mainly came from different regions. The Gini coefficient of the above four indicators in the urban functional expansion area was the lowest, followed by the capital core area, and the Gini coefficient of the ecological conservation area was the highest. The Dagum Gini coefficient of the four indicators of urban development new area showed a decreasing trend year by year.Conclusions:In recent years, there has been no significant change in the overall equality of medical and health resource allocation in Beijing. Only the Gini coefficient of urban development new area has shown a downward trend. It is necessary to further promote the fair and reasonable allocation of medical and health resources among functional areas in Beijing.

Objective To explore the MRI characteristics of anatomy and injuries of the tendons and ligaments in the midfoot.Methods Twenty healthy volunteers and 46 patients with midfoot trauma were selected for retrospective analysis.All subjects underwent examination on MR T1WI and proton density-fat suppression(PD FS)scans on three planes,respectively.Then the MRI features of tendon and ligaments injury were compared.Results The tendons and ligaments of 20 healthy volunteers(40 lateral feet)showed homogeneous low signal intensity with varing thickness.The anterior tibialis tendons showed a thin linear shape,and the posterior tibialis tendons showed a slightly thick band with uniform low signal intensity,and the calcaneonavicular ligament showed thin linelike low signal in different directions.In the 46 patients with midfoot injuries,there were 16 cases of anterior tibialis tendons injuries,18 cases of posterior tibialis tendons injuries,and 12 cases of calcaneonavicular ligament injuries.According to the MRI findings,the degree of injuries of tendons and ligaments was divided into injury,partial tear,and complete rupture.Conclusion MRI can clearly show the anatomy and injury features of ligaments and tendons in midfoot,which is of important value for the early diagnosis and accurate treatment of the ligaments and tendons injuries.

【Objective】 To validate the performance of a nucleic acid testing(NAT) system for blood screening in the high-altitude Nagqu region of Tibet, in order to assess the capability of NAT in high-altitude areas and further enhance blood safety. 【Methods】 Various methods were employed to evaluate the analytical sensitivity, reproducibility, ability to prevent cross-contamination, and comparison between different NAT systems. 【Results】 The NAT system in the Nagqu region of Tibet achieved a 100% detection rate for high-concentration HBV DNA and HIV-1 RNA samples, and over 90% for medium-concentration samples. PROBIT analysis revealed the lower limits of detection (LOD) for HBV DNA and HIV-1 RNA to be 8.29 IU/mL (95% CI, 5.88~20.55 IU/mL) and 40.52 IU/mL (95% CI, 30.26~85.92 IU/mL), respectively. For HCV RNA genotype 2a, the LOD was 97.14 IU/mL (95% CI, 71.00~182.67 IU/mL), all of which were lower than the declared minimum detectable concentrations in the instructions. Reproducibility analysis demonstrated a 100% level of consistency within the system. Cross-contamination performance verification showed a strong ability to resist cross-contamination. Comparative analysis of repeated testing of low-concentration HBV DNA samples and multi-system testing in plain areas revealed consistency rates of 77.78%(14/18) and 77.27%(17/22), respectively, indicating certain differences between the NAT system in Nagqu region and other systems. 【Conclusion】 The NAT system exhibited excellent performance in blood screening at high altitudes. The results of performance validation in high-altitude blood screening NAT systems were largely consistent with those in plain areas, providing a reliable basis for enhancing blood safety in high-altitude regions.

Objective:To analyze the impact created by the reallocation of a tertiary hospital on the neurosurgery inpatients volume in the functional core area of Beijing as the capital city, for reference to improve the healthcare resource reallocation policy.Methods:The data were obtained from the data sheet of discharged patients and the monthly report of medical statistics in Beijing. The study analyzed the average monthly neurosurgery inpatients volume, surgical beds and bed utilization rate of secondary or higher level hospitals from the core area, a tertiary hospital(hospital A), and as well as three tertiary hospitals(hospitals B, C and D)within 5 kilometers of Hospital A original location before and after the reallocation of Hospitls A. Periods of November 2017 to August 2018 and November 2018 to August 2019 respectively serve as the time frame before and after the relocation of Hospital A.Results:After the reallocation, the average monthly total inpatients volume, inpatients volume from other places, and local inpatients volume of neurosurgery at secondary or higher level hospitals in the core area decreased from 2 238, 1 610 and 628 to 1 526, 996 and 530 respectively. The inpatients volume changes were all statistically different( P<0.001). The number of neurosurgery inpatients in Hospital A and Hospital B increased from 983 and 659 to 1 316 and 934 respectively, as well as the number of neurosurgery inpatients in Hospital C and Hospital D did not change much. After the relocation of Hospital A, the number of surgical beds in secondary or higher level hospitals in the core area was reduced from 5 213 to 4 782, while that of Hospital A increased from 557 to 750, while the other three tertiary hospitals remained unchanged. The changes of bed utilization rate of the 4 hosptials were all less than 7.00%. Conclusions:After the reallocation Hospital A, the neurosurgery inpatient volume in the core area decreased, which was mainly contributed by the decrease of patients from other places, suggesting a positive outcome by the reallocation of healthcare resources in Beijing. On the other hand, it is necessary to study the influence of alternative medical resources on the reallocation effect.

Objective:To investigate the predictive value of systemic inflammation response index (SIRI) before treatment for pathological complete response (pCR) in patients with breast cancer undergoing neoadjuvant chemotherapy.Methods:The clinicopathological data of 119 patients with primary breast cancer undergoing neoadjuvant chemotherapy and subsequent breast-conserving or modified radical surgery from Cangzhou Central Hospital of Hebei Province between January 2010 to March 2020 were retrospectively analyzed, and patients were divided into pCR group ( n=19) and non-pCR group ( n=100) based on postoperative pathology. The SIRI before treatment between the two groups was compared. The patients were divided into SIRI≤0.25 ( n=10) , 0.26-0.50 ( n=42) , 0.51-0.75 ( n=29) , 0.76-1.00 ( n=19) , and >1.00 ( n=19) groups according the SIRI before treatment, and the pCR ratios of the five groups were compared. Spearman correlation analysis was applied to evaluate the relationship between SIRI before treatment and pCR, logistic regression analysis was used to identify the influencing factors of pCR for neoadjuvant chemotherapy in breast cancer patients, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SIRI before treatment for pCR of neoadjuvant chemotherapy in breast cancer patients. Results:Tumor size ( Z=2.26, P=0.024) , axillary lymph node metastasis ( χ2=5.73, P=0.017) , human epidermal growth factor receptor-2 (HER-2) ( χ2=8.77, P=0.003) , Ki-67 ( Z=2.68, P=0.007) , cytological nuclear grade ( χ2=5.08, P=0.024) , neutrophil count before treatment ( Z=2.44, P=0.015) , monocyte/lymphocyte ratio before treatment ( Z=3.04, P=0.002) , and SIRI before treatment ( Z=3.29, P=0.001) had statistical differences between the pCR and non-pCR groups. The pCR ratios were 50% (5/10) in the SIRI ≤0.25 group, 21% (9/42) in the 0.26-0.50 group, 10% (3/29) in the 0.51-0.75 group, 11% (2/19) in the 0.76-1.00 group, and 0 (0/19) in the >1.00 group, with a statistic difference ( χ2=14.28, P=0.006) . SIRI before treatment was negatively related with pCR ( r=-0.30, P=0.001) . Univariate logistic regression analysis showed that tumor size ( OR=0.50, 95% CI: 0.28-0.89, P=0.019) , axillary lymph node metastasis ( OR=5.43, 95% CI: 1.19-24.83, P=0.029) , HER-2 ( OR=7.54, 95% CI: 1.65-34.36, P=0.009) , Ki-67 ( OR=1.03, 95% CI: 1.01-1.05, P=0.008) , cytological nuclear grade ( OR=0.20, 95% CI: 0.04-0.92, P=0.038) , neutrophil count before treatment ( OR=0.54, 95% CI: 0.32-0.92, P=0.023) , monocyte/lymphocyte ratio before treatment ( OR=0.00, 95% CI: 0.00-0.01, P=0.007) , and SIRI before treatment ( OR=0.03, 95% CI: 0.00-0.37, P=0.007) were influencing factors for pCR of neoadjuvant chemotherapy in breast cancer patients. Multivariate logistic regression analysis confirmed that tumor size ( OR=0.31, 95% CI: 0.14-0.72, P=0.007) , axillary lymph node metastasis ( OR=10.97, 95% CI: 1.35-89.61, P=0.025) , HER-2 ( OR=6.47, 95% CI: 1.18-35.65, P=0.032) , Ki-67 ( OR=1.04, 95% CI: 1.00-1.07, P=0.029) , cytological nuclear grade ( OR=7.87, 95% CI: 1.01-61.35, P=0.049) , and SIRI before treatment ( OR=0.03, 95% CI: 0.00-0.58, P=0.020) were independent influencing factors for pCR of neoadjuvant chemotherapy in breast cancer patients. The ROC curve showed that the area under the curve of SIRI before treatment for predicting pCR was 0.74 (95% CI: 0.65-0.82) , sensitivity was 68.0%, and specificity was 75.3%. The area under the curve of monocyte/lymphocyte ratio before treatment for predicting pCR was 0.72 (95% CI: 0.63-0.80) , sensitivity was 48.0%, and specificity was 84.2%. The area under the curve of neutrophil count before treatment for predicting pCR was 0.68 (95% CI: 0.59-0.76) , sensitivity was 61.0%, and specificity was 83.7%. Conclusion:SIRI before treatment may serve as a marker for predicting pCR in patients with breast cancer undergoing neoadjuvant chemotherapy, patients with low SIRI are more likely to obtain pCR.

ObjectiveTo investigate the long-term safety of triptolide ferulic acid ethosome gel in percutaneous administration. MethodWe mixed triptolide with ferulic acid to make liposomes gel in different doses and then administrated the gel to SD rats of both sexes with intact skin and damaged skin for 12 weeks. The daily dosages calculated based on triptolide for the low-， middle-， and high-dose groups were 63.75， 127.50， 255.00 μg·kg^-1， respectively. The body weight of each rat was measured weekly. The rats were sacrificed in the last week for the determination of serum biochemical parameters and organ indexes as well as the observation of histopathology. The toxicity was assessed based on the body weight and all the parameters and indexes. ResultAfter long-term administration， the body weight and serum biochemical parameters did not show significant difference between the gel-treated groups and the blank group with intact skin， which indicated that the percutaneous administration of triptolide and ferulic acid ethosomes gel was relatively safe. However， the rats in the high-dose group showed sparse hair and were easy to die in the case of unhairing with chloral hydrate at the late stage of the study. Comprared with the female rats with intact skin in the blank control group， the female rats with damaged skin in the middle-dose group showed decreased heart index （P<0.05）， which indicated certain cardiotoxicity. Moreover， damage appeared in skin and lung， which may be influeneced by dosage， sex， and skin state. ConclusionFerulic acid in combination with triptolide is relatively safe for percutaneous administration， whereas there are some risks of skin and lung damage in the case of long-term administration. Individualized administration scheme should be developed according to liver and kidney function and skin conditons to ensure the safety of clinical medication.

Objective To explore the pathways and patterns which CCAAT/enhancer binding protein β(CEBPβ) mRNA, miR-369-3p and rno-Rmdn2_0006 regulate the hepatocytes in G

Objective:To observe the effect of modified Bazhentang on the nutritional status and immune function of patients with Qi and blood deficiency syndrome in neoadjuvant chemotherapy （NAC） for gastric cancer. Method:One hundred and ten patients were randomly divided into observation group and control group with 55 cases each. Both groups accepted FOLFOX6 protocol. Patients in control group took Jianpi Shengxue tablets orally， 3 tablets/time， 3 times/day. Patients in observation group received modified Bazhentang， 1 dose/day. The course of treatment was six weeks in both groups. Before and after treatment， scores were graded according to patient generated-subjective global assessment （PG-SGA）， Qi and blood deficiency syndrome， and the Revised Piper Fatigue Scale （PFS-R）. Levels of serum total protein （TB）， albumin （ALB）， prealbumin （PAB）， CD4⁺， CD8⁺， helper T lymphocyte 17 （Th17）， regulatory T cell （Treg）， immunoglobulin G （IgG）， IgM， and IgA were detected before and after therapy. Body mass index （BMI） and fat free mass index （FFMI） were measured before and after treatment. Weight loss was recorded， and the acute or subacute toxicity of anticancer drugs was evaluated. Result:The degree of malnutrition in the observation group was lower than that in the control group （Z=2.401，P<0.01）. The levels of TB， ALB and PAB in the observation group were higher than those in the control group （P<0.01）. The CD4⁺， Treg and CD4⁺/CD8⁺ levels in the observation group were higher than those in the control group （P<0.01）. The CD8⁺， Th17 and Th17/Treg levels were lower than those in the control group （P<0.01）. Besides， the levels of IgM and IgA in the observation group were higher than those in the control group （P<0.01）. The PG-SGA score and weight loss in the observation group were lower than those in the control group （P<0.01）. The BMI and FFMI data of the observation group were higher than those of the control group （P<0.05）. The scores of PFS-R and Qi-blood deficiency syndrome were lower than those of the control group （P<0.01）. The incidence of nausea and vomiting in the observation group was 45.45% （25/55）， lower than 65.45% （36/55） in the control group （χ²=4.452，P<0.05）. Conclusion:Modified Bazhentang can be used to assist gastric cancer patients with NAC， which can improve nutritional status and immune function， promote immune balance， reduce clinical symptoms and fatigue， and reduce chemotherapy toxicity and side effects， so it is worthy of clinical use.