Objective: To compare the short-term outcomes between off-pump and on-pump coronary artery bypass graft (CABG) by experienced surgeons with similar surgical team in a single large-volume cardiac surgery center. Methods: A total of 31 075 patients with multivessel coronary disease who underwent isolated off-pump or on-pump CABG between January 1, 2009 and December 31, 2019 by experienced surgeons in Fuwai hospital were enrolled in this retrospective study. Patients was divided into on-pump CABG group and on-pump CABG group on an intention-to treat basis. Short term safety endpoints, including 30 days mortality, composite endpoint of major morbidity or mortality, prolonged postoperative length of stay (PLOS), and prolonged ICU length of stay (PICULOS), and distal anastomosis were compared between the two groups. Mortality was evaluated on 30 days post operation, other endpoints were collected before discharge. After 1∶1 propensity-score matching of baseline characteristics for on-pump and off-pump CABG, postoperative endpoints were compared with use of McNemar's test and further adjusted with the use of a logistic regression model. Results: After propensity-score matching, 10 243 matched pairs of patients were included in the final analysis, there were 4 605(22.5%) females and mean age was (60.7±8.6) years. The standardized differences were less than 5% for all baseline variables in matched cohort. Univariate analysis indicated lower risk of 30 days mortality (0.2% vs. 0.7%, P<0.001), major morbidity or mortality (5.7% vs. 8.8%, P<0.001), PLOS (3.2% vs. 4.9%, P<0.001), PICULOS (9.4% vs. 12.2, P<0.001), and lower number of distal anastomosis ((3.3±0.8) vs. (3.6±0.8), P<0.001) in off-pump CABG group than in on-pump CABG group. After adjustment of cofounders, multivariate analysis showed that off-pump CABG was still associated with a lower risk of 30 days mortality (OR=0.29, 95%CI: 0.09-0.87, P=0.027), composite endpoint of major morbidity or mortality (OR=0.60, 95%CI: 0.53-0.68, P<0.001), PLOS (OR=0.64, 95%CI 0.54-0.75, P<0.001), PICULOS (OR=0.76, 95%CI: 0.69-0.84, P<0.001). Conclusions: Off-pump CABG is related with superior short-term safety outcomes than on-pump CABG by experienced surgeons in our center.
Aged ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease/surgery* ; Female ; Humans ; Middle Aged ; Postoperative Complications/epidemiology* ; Retrospective Studies ; Surgeons ; Treatment Outcome

BACKGROUND: A patient's infectivity is determined by the presence of the virus in different body fluids, secretions, and excreta. The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease (COVID-19) remain unclear. This study analyzed the clearance time and factors influencing 2019 novel coronavirus (2019-nCoV) RNA in different samples from patients with COVID-19, providing further evidence to improve the management of patients during convalescence. METHODS: The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20, 2020 to February 10, 2020 were collected retrospectively. The reverse transcription polymerase chain reaction (RT-PCR) results for patients' oropharyngeal swab, stool, urine, and serum samples were collected and analyzed. Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive (minimum 24 h sampling interval) negative RT-PCR results for viral RNA from oropharyngeal swabs. The effects of cluster of differentiation 4 (CD4)+ T lymphocytes, inflammatory indicators, and glucocorticoid treatment on viral nucleic acid clearance were analyzed. RESULTS: In the 292 confirmed cases, 66 patients recovered after treatment and were included in our study. In total, 28 (42.4%) women and 38 men (57.6%) with a median age of 44.0 (34.0-62.0) years were analyzed. After in-hospital treatment, patients' inflammatory indicators decreased with improved clinical condition. The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5 (6.0-11.0) days. By February 10, 2020, 11 convalescent patients (16.7%) still tested positive for viral RNA from stool specimens and the other 55 patients' stool specimens were negative for 2019-nCoV following a median duration of 11.0 (9.0-16.0) days after symptom onset. Among these 55 patients, 43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs, with a median delay of 2.0 (1.0-4.0) days. Results for only four (6.9%) urine samples were positive for viral nucleic acid out of 58 cases; viral RNA was still present in three patients' urine specimens after throat swabs were negative. Using a multiple linear regression model (F = 2.669, P = 0.044, and adjusted R = 0.122), the analysis showed that the CD4+ T lymphocyte count may help predict the duration of viral RNA detection in patients' stools (t = -2.699, P = 0.010). The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (15 days vs. 8.0 days, respectively; t = 2.550, P = 0.013) and the duration of viral RNA detection in fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (20 days vs. 11 days, respectively; t = 4.631, P < 0.001). There was no statistically significant difference in inflammatory indicators between patients with positive fecal viral RNA test results and those with negative results (P > 0.05). CONCLUSIONS In brief, as the clearance of viral RNA in patients' stools was delayed compared to that in oropharyngeal swabs, it is important to identify viral RNA in feces during convalescence. Because of the delayed clearance of viral RNA in the glucocorticoid treatment group, glucocorticoids are not recommended in the treatment of COVID-19, especially for mild disease. The duration of RNA detection may relate to host cell immunity.
Adult ; Aged ; Betacoronavirus ; genetics ; Clinical Laboratory Techniques ; Coronavirus Infections ; diagnosis ; genetics ; rehabilitation ; Female ; Humans ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral ; genetics ; rehabilitation ; RNA, Viral ; genetics ; Real-Time Polymerase Chain Reaction ; Retrospective Studies

Background: A patient’s infectivity is determined by the presence of the virus in different body fluids, secretions, and excreta. The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease (COVID-19) remain unclear. This study analyzed the clearance time and factors influencing 2019 novel coronavirus (2019-nCoV) RNA in different samples from patients with COVID-19, providing further evidence to improve the management of patients during convalescence. Methods: The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20, 2020 to February 10, 2020 were collected retrospectively. The reverse transcription polymerase chain reaction (RT-PCR) results for patients’ oropharyngeal swab, stool, urine, and serum samples were collected and analyzed. Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive (minimum 24 h sampling interval) negative RT-PCR results for viral RNA from oropharyngeal swabs. The effects of cluster of differentiation 4 (CD4)+ T lymphocytes, inflammatory indicators, and glucocorticoid treatment on viral nucleic acid clearance were analyzed. Results: In the 292 confirmed cases, 66 patients recovered after treatment and were included in our study. In total, 28 (42.4%) women and 38 men (57.6%) with a median age of 44.0 (34.0–62.0) years were analyzed. After in-hospital treatment, patients’ inflammatory indicators decreased with improved clinical condition. The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5 (6.0–11.0) days. By February 10, 2020, 11 convalescent patients (16.7%) still tested positive for viral RNA from stool specimens and the other 55 patients’ stool specimens were negative for 2019-nCoV following a median duration of 11.0 (9.0–16.0) days after symptom onset. Among these 55 patients, 43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs, with a median delay of 2.0 (1.0–4.0) days. Results for only four (6.9%) urine samples were positive for viral nucleic acid out of 58 cases; viral RNA was still present in three patients’ urine specimens after throat swabs were negative. Using a multiple linear regression model (F=2.669, P=0.044, and adjusted R²=0.122), the analysis showed that the CD4+ T lymphocyte count may help predict the duration of viral RNA detection in patients’ stools (t=-2.699, P=0.010). The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (15 days vs 8.0 days, respectively; t=2.550, P=0.013) and the duration of viral RNA detection in fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (20 days vs 11 days, respectively; t=4.631, P <0.001). There was no statistically significant difference in inflammatory indicators between patients with positive fecal viral RNA test results and those with negative results (P >0.05). Conclusions In brief, as the clearance of viral RNA in patients’ stools was delayed compared to that in oropharyngeal swabs, it is important to identify viral RNA in feces during convalescence. Because of the delayed clearance of viral RNA in the glucocorticoid treatment group, glucocorticoids are not recommended in the treatment of COVID-19, especially for mild disease. The duration of RNA detection may relate to host cell immunity.

OBJECTIVETo investigate the hematopoietic reconstitution in immunodeficiency NPG(TM) mice after transplantation of G-CSF-mobilized peripheral blood CD34(+) hemopoietic stem cells.

METHODSCD34(+) cells were isolated from peripheral blood stem cells (PBSC) by magnetic activated cell sorting (MACS), and then were transplanted into NPG(TM) mice irradiated with sublethal dose of X ray by marrow cavity transplantation. The hemogram of mice after transplantation for 2, 4 weeks was observed; human cell populations (CD45(+), CD19(+)) in the peripheral blood of mice were dynamically analyzed by flow cytometry (FCM) at 4, 6, 8, 10 and 12 weeks after transplantation. Until the planned harvest at the 12 week after transplantation, the CD45(+), CD19(+) level in bone marrow, liver, spleen from each mouse were detected by flow cytometry; the expression of human Alu gene in the bone marrow cell of mouse was detected by PCR.

RESULTSThe purity of CD34(+) cells accounted for 96.3%; after irradiation, the nucleated cells and megalokaryocytes in the marrow cavity of NPG mice were reduced significantly or were lost, and reached the myeloablative effect. At week 4 after transplantation, components of blood cells in peripheral blood of transplanted mice were recovered to the level before irradiation; all the mice survived, human CD45(+), CD19(+) cells were found by FCM in the peripheral blood of all the surviving mice in transplantation group at week 4, 6, 8, 10, 12 after the transplantation; at the 12th week, the human Alu gene could be detected in the bone marrow of all the mice in transplantation group.

CONCLUSIONThe human-mouse chimeric model is successfully established in irradiation-induced NPG mouse by transplantation of CD34(+) HSC from G-CSF-mobilized peripheral blood via marrow cavity.

Animals ; Bone Marrow ; Bone Marrow Cells ; Bone Marrow Transplantation ; Cord Blood Stem Cell Transplantation ; Disease Models, Animal ; Granulocyte Colony-Stimulating Factor ; Hematopoietic Stem Cells ; Humans ; Mice ; Spleen

AIM: To understand the epidemiology and related factors of strabismic amblyopia of students of primary school, and to provide guidances for the prevention and control strategy.
METHODS: A total of 600 cases of primary school students of Leshan City, Jiajiang County were given vision, oblique incidence and ocular and other screening. The prevalence rate of poor eyesight of strabismus, amblyopia prevalence rate of different sexes, ages were compared, and the degree of amblyopia and strabismus of children with different types of amblyopia and whether or not had stereoscopic vision were counted.
RESULTS: The prevalence rate of amblyopia and strabismus prevalence rate were respectively 4. 0% and 2.5%;With the growth of all age, low vision of students was significantly decreased, the difference of comparison of low vision rate of each age had statistical significance (P<0. 05), but different ages, strabismus prevalence of different sexes, amblyopia prevalence were compared, the difference had no significant differences ( P>0. 05 );Ametropic amblyopia was the main type, accounting for 55. 6%, and the degree of amblyopia mainly was light, moderate; ametropic amblyopia, most of ametropic amblyopia and strabismus had stereo vision, but there were no stereopsis of most of the strabismic amblyopia and all esotropia.
CONCLUSION:Ametropic is mainly type of amblyopia, the prevalence of relationship between the incidence of strabismic amblyopia of primary school students and sexes is not obvious, but the oblique amblyopia treatment effect, such as the establishment of stereoscopic vision and the age, eye position has a close relationship, should be early discovered, early treatment.

Objective To analyze the clinical features,precaution and management of complete heart block (CHB) after transaortic extended septal myectomy operation (extended Morrow procedure) in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods From October 1996 to December 2011,10[6 men; mean age (45.4 ± 15.8) years,range 13-60 years] out of 160 consecutive HOCM patients underwent extended Morrow procedure developed CHB postoperatively.Their clinical data were retrospectively analyzed.Baseline transthoracic echocardiography showed that the left ventricular outflow tract (LVOT) gradients was from 68 to 149 (105.1 ±25.9) mm Hg (1 mm Hg =0.133 kPa),ECG showed right bundle branch block in 5 patients and atrial fibrillation,atrial premature beats or ST-T segment changes in other 5 patients.Besides extended Morrow procedure,concomitant surgical procedures included mitral valve replacement (MVR) in 2 (2/10) and MVR plus coronary artery bypass grafting in another 2 (2/10) patients.Follow-up data were obtained by subsequent clinic visits in outpatient department and telephone interviews.Results The in-hospital mortality was 20％ (these two patients died of low cardiac output syndrome and multiple organs failure).Four patients underwent MVR simultaneously survived the operation.Postoperative echocardiography demonstrated a reduced LVOT gradient[(13.6 ± 9.7) mm Hg,P ＜0.001].Permanent pacemakers were implanted in all 8 survived patients at 6 days to 7 months after operation.No other severe complications were observed.During follow-up [from 4 to 72 (19.4 ± 22.1) months],there was no death,1 patient readmitted to our center at 71 months post operation to change the pacemaker because of low voltage of previously implanted pacemaker.Physical capacity and quality of life improved significantly post operation in these 8 patients.The NYHA functional class remained at Ⅰ-Ⅱ post operation and during follow up.Conclusions CHB is a severe complication after extended Morrow procedure for patients with HOCM and timely permanent pacemaker implantation is mandatory for patients with post procedure CHB.

Objective To investigate the clinical benefits of emergent burr hole drainage in combination with decompressive craniotomy for patients with traumatic intracerebral haematoma-induced cerebral hernia. Methods A total of 291 patients with brain hernia caused by acute traumatic epidural and/or subdural hematoma were chosen in our study; 143 of them were treated with decompressive craniotomy alone (ordinary decompression group, admitted to our hospital from January 2003 to December 2006) and 148 of them were treated with emergent burr hole drainage in combination with decompressive craniotomy (emergent surgical intervention group,admitted to our hospital from January 2007 to June 2011).Clinical parameters,including Glasgow Outcome Scale (GOS) scores,incidence of massive cerebral infarction,pupil retraction rate,and Glasgow Coma Scale (GCS) scores,were evaluated retrospectively analyzed. Results Patients in ordinary decompression group had higher GOS scores than those in emergent surgical intervention group (Z=-4.012,P=0.000); mean rank indicated that the treatment efficacy in the emergent surgical intervention group was better than that in the other group.Patients in ordinary decompression group had significantly reduced incidence of massive cerebral infarction (45/148) as compared with patients in ordinary decompression group (70/143,P=0.000).Much more patients (124/148) enjoyed increment of GCS scores in the emergent surgical intervention group as compared with those in the ordinary decompression group (65/143,P=0.000). Conclusion Emergent burr hole drainage followed by decompressive craniotomy is an effective method in saving patients with brain hernia caused by acute traumatic intracerebral haematoma, which can notably resolve intracranial hypertension as soon as possible and give longer time for surgery,therefore,it can improve the prognosis.

Objective To explore the potential role of apolipoprotein A5 (apoA5) on the hypertriglyceridemia (HTG)-lowering effects of statin. Methods Twenty-four Sprague-Dawley rats were randomized into 3 groups: ( 1 ) control group ( n = 8), with no special treatment; (2) HTG group (n = 8),treated with 10% fructose water for 6 weeks; (3) statin group(n =8), treated with 10% fructose water for lipids and the hepatic expressions of apoA5 and peroxisome proliferstor activated receptor (PPAR)α were determined. In separate in vitro experiments, we tested the effects of atorvastatin on TG and the expressions of apoA5 and PPARα in HepG2 cells. Results ( 1 ) At 6 weeks, plasma TG was higher in rats in HTG group than in controls, which was significantly reduced in statin group (both P <0. 05). (2) Rat hepatic apoA5 expression in HTG group was significantly lower than in control group and was significantly higher in statin group than in HTG group ( both P < 0. 05 ). (3) Similarly, rat PPARα mRNA expression in HTG group was lower than in control group and was higher in statin group than in HTG group ( both P < 0. 05 ).(4) Statin significantly upregulated the expressions of apoA5 and PPARα and decreased TG in HepG2 cells.The above effects induced by statin was blocked in the presence of PPARα inhibitor. Conclusions Upregulation of apoA5 expression contributes to TG lowering effect of statin via PPARα signaling pathway.

OBJECTIVETo analyze the association between the platelet count of peripheral blood and clincopathologic parameters of esophageal carcinoma.

METHODSPlatelets of peripheral blood were measured in 415 cases of esophageal carcinoma and 325 healthy subjects as control. The correlation of platelet counts and clinicopathological features of cancer was analyzed.

RESULTPlatelet count in patients with esophageal carcinomas (286+/-88)x10(9)/L was significantly higher than that in the control subjects [(204+/-114)x10(9)/L, P<0.05 ]. Increased platelet counts (>300 x 10(9)/L) was significantly associated with tumor infiltration and lymph node metastasis in patients with esophageal cancer (P<0.05).

CONCLUSIONPlatelet count of peripheral blood might be associated with the development and progression of esophageal cancer.

Adult ; Aged ; Aged, 80 and over ; Blood Platelets ; cytology ; Carcinoma, Squamous Cell ; blood ; pathology ; Case-Control Studies ; Esophageal Neoplasms ; blood ; pathology ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Platelet Count

BACKGROUNDIncreased triglyceride (TG) occurs in patients with acute coronary syndrome (ACS), and apolipoprotein AV (apoAV) has been shown to lower TG levels. In the present study, we investigated plasma apoAV level and its relationship with TG and C-reactive protein (CRP) in ACS patients.

METHODSA total of 459 subjects were recruited and categorized into control group (n = 116), stable angina (SA) group (n = 115), unstable angina group (n = 116) and acute myocardial infarction group (n = 112). Plasma apoAV level was measured by a sandwich ELISA assay.

RESULTSCompared with controls ((100.27 +/- 22.44) ng/ml), plasma apoAV was decreased in SA patients ((76.54 +/- 16.91) ng/ml) but increased in patients with unstable angina ((330.89 +/- 66.48) ng/ml, P < 0.05) or acute myocardial infarction ((368.66 +/- 60.53) ng/ml, P < 0.05). Inverse correlations between apoAV and TG were observed in the control or stable angina groups (r = -0.573 or -0.603, respectively, P < 0.001), whereas positive correlations were observed in the patients with unstable angina or acute myocardial infarction (r = 0.696 or 0.690, respectively, P < 0.001). Furthermore, a positive relationship between apoAV and CRP was observed in the ACS patients but not in the non-ACS subjects.

CONCLUSIONThe plasma apoAV concentration is increased and positively correlates with TG and CRP in ACS patients.

Acute Coronary Syndrome ; blood ; metabolism ; Adult ; Aged ; Apolipoprotein A-V ; Apolipoproteins A ; blood ; C-Reactive Protein ; metabolism ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Male ; Middle Aged ; Triglycerides ; blood