Objective To study the clinical efficacy of Off-Pump Coronary Artery Bypass Grafting (OPCABG) in the patients who have left main coronary artery stenosis and three-vessel lesion with low ejection fraction.MethodsFrom January 2010 to December 2010,28 cases with low ejection fraction,left main coronary artery stenosis and three-vessel lesion and received OPCABG were analyzed retrospectively.All cases underwent OPCABG under general anesthesia.The Hb,PLT,ALT,AST,BUN and Cr count before and 3 days after operation were recorded.LVEF andLVEDbeforeand 3monthsafter operationwererecorded.Thedata were compared.Results one case died of respiratory failure caused by pulmonary infection.The mortality rate was 3.75 ％.The value of six parameters are: Hb ( [ 137.94 ± 19.40 ],[ 111.06 ± 12.71 ] g/L),PLT ( [ 210.43 ±48.26 ] × 109/L,[ 148.4 ± 52.20 ] × 109/L),ALT ( [ 27.66 ± 11.51 ] U/L,[ 29.02 ± 16.40 ] U/L),AST ([26.55 ± 10.12] U/L,[27.75 ±8.14] U/L),BUN([6.51 ± 1.00] mmol/L,[6.88 ± 2.53] mmol/L),Cr ([96.35 ± 15.25]μmol/L,[95.11 ± 24.38 ] μmol/L).Comparison of the values showed that Hgb and PLT were different significantly before and 3 days after operations.There was no significant difference in the levels of ALT,AST,BUN and Cr before and after the treatment.Three months later,LVEF and LVED were significantly different from that before treatment ( P ＜ 0.05 ),with LVEF of( [ 36.23 ± 3.41 ] ％,[ 47.23 ± 5.13 ] ％ ) and LVED of( [62.23 ±5.93]mm,[58.08 ±5.02] mm).ConclusionOPCABG produces a satisfactory outcome in the patients who have left main coronary artery stenosis and three-vessel lesion combined with low ejection fraction.There is limited impact of OPCABG on the other organs.The long-term effect and prognosis are still need to be followed-up and analyzed.

Objective To explore the curative effect of the treatment for minor-size tissue defect of forefoot by pedicle fibular side flap of the hallux.Methods The data of 12 patients with minor-size tissue defect of forefoot was retrospectively analyzed who were repaired with fibular side flap of the hallux from September 2003 to June 2012.There were 9 males and 3 females,with an average of 27 years (range,19-55 years).Among them,4 injured on the left,8 on the right side; 3 on the dorsal side and 9 on the plantar.There were 4 cases of traumatic wound,4 of tumor,2 of ulcer,and 2 of scar.Sizes of tissue defect were 1.3 cm×0.5 cm-2.5 cm×2.0 cm,the minimal flap size was 1.5 cm×0.8 cm,and the maximal flap size was 3.0 cm×1.5 cm.All flaps were elevated with fibular side artery and nerve of the hallux,and with width less than 1.5 cm,so wound of donor site could be sutured directly.The postoperative curative effect was assessed from five respects including flap healing,the sensation of the flaps,the flap appearance,the scar and weight-bearing walking.Results This kind of flap all survived successfully in the 12 cases,with satisfying cosmetic effect and sensory,without skin necrosis and blood vessel crisis.Nine patients were followed up for 3-96 months (average,12 months).The flaps were covered with soft and intact normal colored skin,no abrasion or wearing out happened and no subsequent reshaping was needed in the last follow-up.The minor-sized donor site wound could be sutured up directly.Since donor site was selected from non-weight-bearing area,walking and weight-bearing function of the patients were nearly unaffected at all.Sensory of the flaps were normal,with two-point discrimination ranging between 4-10 mm.Conclusion Due to the advantages of thinness,nerve nourishing,constant anatomical position and hidden position of donor site,anterograde fibular side flap of the hallux can be an ideal choice in repairing minor-size tissue defect of forefoot.

ObjectiveTo access the predictive value in Postoperative mortality in patients undergoing coronary artery bypass grafting(CABG) by seven different Risk scoring system.MethodsTo collect the clinical information of patients undergoing CABG in our department.SinoSCORE,Additive EuroSCORE,Logistic EuroSCORE,OPR,Cleveland model,Parsonnet score,QMMI was used to predict postoperative mortality for all patients,and calculate the mean predictive postoperative mortality.To devided the patients to six group:group Ⅰ (0 - 1.99％ ),group Ⅱ (2.00％ - 3.99％ ),group Ⅲ (4.00％ - 5.99％ ),group Ⅳ ( 6.00％ - 7.99％ ),group Ⅴ (8.00％ - 9.99％ ),group Ⅵ ( ＞ 10％ ) by predictive postoperative mortality.Access the performance of risk scoring system predict the mortality through compare the predictive mortality and the observed mortality in different Risk stratification.To use Hosmer-Lemeshow goodness-of-fit test access the calibration.Discrimination was tested by determining the area under the receiver operating characteristic(ROC) curve(AUG).ResultsThe overall mean baseline age was ( 62.8 ± 8.8 ) years.The observed mortality in all our study patients was 1.99 ％ ( 22/1103 cases).The predictive mortality calculated by SinoSCORE,Additive EuroSCORE,Logistic EuroSCORE,OPR,Cleveland model,Parsonnet score and QMMI were 3.01％,4.38％,3.83％,1.69％,4.42％,6.71％ and3.71％.And the most closest is OPR,SinoSCORE,QMMI.Group tests confirmed Logistic EuroSCORE Overestimated the mortality in all the group.Predicted mortality calculated by Additive EuroSCORE was lower than the actual mortality in group Ⅵ and higher than the observed mortality in other group.SinoSCORE、Cleveland model、Parsonnet score、QMMI Overestimated the mortality in all the group expect group Ⅰ.OPR forecast a lower mortality Compared with observed mortality in group Ⅰ and group Ⅳ and a Slightly higher mortality in group Ⅱ,group Ⅲ.To use Hosmer - Lemeshow goodness-of-fit test access the calibration.The text proved all the risk scoring system had a good calibration for postoperative mortality (P ＞ 0.05 ).Discrimination was tested by ROC,only SinoSCORE ( AUC =0.751 ＞ 0.70) showed high discriminatory ability in predicting mortality.ConclusionSinoSCOBE have a good forecast performance for the postoperative mortality in the patients undergoing CABG in our department in seven different Risk scoring system.And SinoSCORE could be used in preoperative risk assessment.

Objective:To evaluate the effect of coronary artery anatomical score(SYNTAX score) on in-hospital mortality of CABG patients.Methods:The clinical data of patients who were performed with a CABG surgery alone in the Department of Cardiovascular Surgery, Tianjin Chest Hospital from July 2017 to December 2018 were collected. The clinical end point was all-cause in-hospital death or against-advice discharge after surgery. Univariate analysis and multivariate logistic regression analysis were performed on the clinical data of the patients to obtain the risk factors affecting the in-hospital death of CABG in our center, to evaluate the influence of SYNTAX score on the in-hospital death of CABG. Results:Univariate logistic analysis showed that age, critical condition, creatinine level, serum albumin level, NT-proBNP level, NYHA grade, internal mammary artery use, SYNTAX score were correlated with in-hospital mortality. Multivariate analysis showed that age(≥75 years old), history of diabetes mellitus, critical state, creatinine clearance rate < 85 ml/min, albumin <35 g/L, NYHA Ⅲ-Ⅳ, SYNTAX score(≥29) were independent risk factors for in-hospital mortality after CABG. Conclusion:Coronary artery anatomy score - SYNTAX score(≥29) was an independent risk factor for in-hospital mortality in CABG patients in our hospital.

Objective:To evaluate the efficacy of modified self-made Qingxin Buqi Pinggan Decoction combined with atomoxetine hydrochloride in the treatment of attention deficit hyperactivity disorder (ADHD).Methods:Randomized controlled trial. A total of 200 children with ADHD admitted to our hospital from January 2020 to January 2022 were selected as observation subjects by prospective cohort study, and were divided into two groups according to the random number table method. The control group was given oral administration of atomoxetine hydrochloride capsules, and the observation group was given self-made Qingxin Buqi Pinggan Decoction on the basis of the control group. Both groups were treated continuously for 3 months. Before and after treatment, the Traditional Chinese Medicine symptoms were scored, and the core symptoms of the children were evaluated by Swanson Nolan and Pelham-versionⅣ (SNAP-Ⅳ), and the hyperactivity tendency was assessed by Parent Symptom Questionnaire (PSQ). The serum cortisol (COR) and adrenocorticotropic hormone (ACTH) levels were measured by chemiluminescence immunoassay. Adverse reactions during treatment were observed and clinical efficacy was evaluated.Results:The total effective rate was 97.0% (97/100) in observation group and 88.0% (88/100) in control group ( χ2=5.84, P=0.016). After treatment, the scores of restlessness, hyperactivity, unsteadiness, emaciation, lusterless complexion and restless sleep in the observation group were significantly lower than those in the control group ( t=17.90, 11.79, 10.01, 23.27, 11.79, 12.03, P<0.01). The scores of impulsivity factor, learning factor, hyperactivity factor, behavior factor, psychosomatic factor and anxiety factor were significantly lower than those in the control group ( t=4.65, 42.83, 10.01, 41.89, 39.42, 18.30, P<0.01). The scores of attention deficit, hyperactivity-impulsivity and behavior performance were significantly lower than those in the control group ( t=11.68, 9.69, 28.42, P<0.01). After treatment, the levels of serum COR [(337.26±17.22) nmol/L vs. (275.51±15.49) nmol/L, t=26.66] and ACTH [(24.47±1.12) ng/L vs. (19.23±1.43) ng/L, t=28.85] were significantly higher in observation group than those in the control group ( P<0.01). During treatment, the incidence rate of adverse reactions was 6.0% in observation group and 5.0% in control group ( χ2=0.10, P=0.756). Conclusion:Modified self-made Qingxin Buqi Pinggan Decoction combined with atomoxetine hydrochloride can improve the clinical symptoms of children with ADHD, reduce the degree of hyperactivity disorder, increase the levels of serum COR and ACTH, and enhance the clinical efficacy.

Objective:Using different machine learning methods to construct and screen the best prediction model for predicting the risk of death within 30 days after surgery in patients with acute type A aortic dissection.Methods:Five hundred and twenty-one patients with acute type A aortic dissection who underwent surgery between 2015 and 2022 were included, after collecting their perioperative date and screening them, 329 patients were retained. two different groups of predictor variables were generated by using Lasso regression and principal component analysis, after that, logistic regression, support vector machine algorithm, random forest algorithm, gradient boosting algorithm, and super learning algorithm were used to develop prediction models for the risk of death within 30 days after surgery. Finally, we compare the models and select the best one. Results:The AUC values for all models rangrd from 0.791-0.959. The model using Lasso regression to determine the predictor variables and built by the super learning algorithm had the best prediction with an AUC value of 0.959. Conclusion:The super learning algorithm better than other algorithms in predicting death within 30 days after acute type A aortic dissection.

Objective:This study was conducted to investigate the independent risk factors for predicting the occurrence of acute Stanford type A aortic dissection(TAAD), and to construct a nomogram model for predicting the occurrence of TAAD.Methods:The clinical data of patients meeting the diagnostic criteria for TAAD admitted to Tianjin Chest Hospital from June 2016 to December 2021 and healthy people examined by the physical examination center of Tianjin Chest Hospital during the same period were retrospectively collected, and the independent risk factors for TAAD were predicted by propensity matching analysis. Univariate and multivariate Logistic regression were used to analyze the variables with statistical differences, and a nomogram model was constructed to predict the occurrence of TAAD disease according to the screened risk factors. Results:A total of 148 patients in the TAAD group and 5 690 patients in the control group were collected. After bias matching analysis, 148 pairs were successfully matched. Multivariate Logistic regression analysis was performed on the matching results. The results showed that hypertension(HBP), diabetes mellitus(T2DM), Lp(a), very low density lipoprotein(VLDL) and apolipoprotein A1/B(ApoA1/B) were independent risk factors for the development of TAAD. HBP, Lp(a) and ApoA1/B were pathogenic factors( OR 7.267, 1.010 and 2.199, P<0.05, respectively), while T2DM and VLDL were protective factors( OR 0.173 and 0.139, P<0.05). Based on the independent risk factors obtained by multi-factor Logistic regression analysis, a nomogram model of TAAD incidence was constructed. The area under ROC curve( AUC) for predicting the onset of TAAD was 81.6%(95% CI: 0.766-0.863), and the internal calibration curve was close to the standard curve. Conclusion:This model has a good degree of differentiation and calibration, which is helpful for clinicians to guide healthy people to prevent the occurrence of TAAD and provide a theoretical basis for the prevention of TAAD.

Objective To evaluate the application of combinatorial probe anchor synthesis (cPAS)?based high?throughput low coverage whole genome sequencing in chromosomal aberration detection in spontaneous miscarriage. Methods From September 2015 to May 2017, spontaneous miscarriage samples were collected from Inner Mongolia Maternal and Child Health Care Hospital. Those samples were further analyzed with two independent methods, fluorescence in situ hybridization (FISH) and low coverage whole genome sequencing on the BGISEQ?500 high?throughput platform. The performance of low coverage whole genome sequencing was assessed by comparing to FISH results. Results In 595 spontaneous miscarried specimens, low coverage whole genome sequencing revealed 144 cases (24.2%, 144/595) chromosomal abnormalities, of which a subset of 137 cases (23.0%, 137/595) were detected as aneuploidies, 2 cases (0.3%, 2/595) as mosaicisms and 5 cases (0.8%, 5/595) as copy number variation (≥5 Mb). Conclusion cPAS?based high?throughput low coverage whole genome sequencing is a reliable method in detecting chromosomal aberrations inspontaneous abortion tissues, including chromosome aneuploidies, mosaicisms and copy number variation (≥5 Mb).

Objective: To evaluate the application of combinatorial probe anchor synthesis (cPAS)-based high-throughput low coverage whole genome sequencing in chromosomal aberration detection in spontaneous miscarriage. Methods: From September 2015 to May 2017, spontaneous miscarriage samples were collected from Inner Mongolia Maternal and Child Health Care Hospital. Those samples were further analyzed with two independent methods, fluorescence in situ hybridization (FISH) and low coverage whole genome sequencing on the BGISEQ-500 high-throughput platform. The performance of low coverage whole genome sequencing was assessed by comparing to FISH results. Results: In 595 spontaneous miscarried specimens, low coverage whole genome sequencing revealed 144 cases (24.2%, 144/595) chromosomal abnormalities, of which a subset of 137 cases (23.0%, 137/595) were detected as aneuploidies, 2 cases (0.3%, 2/595) as mosaicisms and 5 cases (0.8%, 5/595) as copy number variation (≥5 Mb). Conclusion cPAS-based high-throughput low coverage whole genome sequencing is a reliable method in detecting chromosomal aberrations inspontaneous abortion tissues, including chromosome aneuploidies, mosaicisms and copy number variation (≥5 Mb).

Objective:To investigate the efficacy and safety of prolonged dual antiplatelet therapy (DAPT) (aspirin + clopidogrel) after coronary artery bypass grafting (CABG) for more than 12 months.Methods:1 900 patients who received CABG treatment in Tianjin Chest Hospital from January 2019 to October 2020 were continuously included, and 1 528 patients were finally identified according to the inclusion and exclusion criteria. According to whether the patients continued to take DAPT treatment 12 months after discharge, they were divided into the extended DAPT group and the standard DAPT group. Cox multivariate regression and propensity score matching (PSM) analysis were performed on major cardiovascular and cerebrovascular adverse events (MACCE) and clinically related bleeding events in the two groups during 12-24 months after discharge to evaluate the efficacy and safety of extended DAPT treatment for more than 12 months. Results:Of the 1 528 patients, 624 (40.8%) continued to take DAPT 12 months after discharge. Compared with patients receiving standard DAPT, patients receiving extended DAPT had a lower incidence of MACCE within 12 to 24 months ( HR=0.597, 95% CI: 0.399-0.892, P=0.012); ( HR=0.519, 95% CI: 0.338-0.798, P=0.003), and there was no significant increase in clinically relevant bleeding risk ( HR=1.209, 95% CI: 0.522-2.798, P=0.658), ( HR=1.112, 95% CI: 0.452-2.737, P=0.817). At the same time, prolonged DAPT treatment also brought a good net benefit. Conclusion:Prolonged DAPT treatment after CABG for more than 12 months significantly reduced the risk of ischemia at 12-24 months after surgery, and did not significantly increase the risk of bleeding at 12-24 months after surgery. It may be beneficial for patients treated with CABG to continue DAPT (aspirin+ clopidogrel) on the basis of intensive DAPT therapy for 1 year.