Objective To evaluate the guiding role of CYP2C19 gene assay in dual antiplatelet therapy(DAPT) after off-pump coronary artery bypass grafting ( OPCABG ) .Methods The patients who received scheduled OPCABG between May 2017 and May 2018 were recruited in this study.According to the results of CYP2C19 gene assay, the patients who carried CYP2C19 gene *2/*2,*2/*3 and*3/*3 mainly causing slow metabolism of clopidogrel were randomly divided into two groups: the clopidogrel group(patients receiving 100mg/qd aspirin plus 75mg/qd clopidogrel after surgery ), the ticagrelor group(patients receiving 100mg/qd aspirin plus 90mg/bid ticagrelor after surgery).Patients in the two groups underwent plate-let aggregation rate test first day before surgery and the 1, 4, 7 days antiplatelet therapy after surgery.And the major adverse cardiac events(MACE) was investigated 30 days after surgery in the two groups.Results A total of 244 patients were recrui-ted in the study with the clopidogrel group(n=122) and the ticagrelor group(n=122).The platelet aggregation rate after one day of postoperative DAPT in the ticagrelor group was lower than that in the clopidogrel group[(28.5 ±9.7)％ VS(51.8 ± 16.8)％, P<0.05].After 4 days of postoperative DAPT, platelet aggregation rate in the ticagrelor group maintained a stable and desired level.The MACE 30 days after surgery in the clopidogrel group and the ticagrelor group were 3.3％ and 1.6％ re-spectively, and ticagrelor plus aspirin reduced MACE in patients undergone coronary endarterectomy , P=0.043.Conclusion According to the results of CYP2C19 gene assay, ticagrelor replacing clopidogrel could shorten the duration of desired platelet aggregation rate in patients with DAPT after OPCABG , and may be reduce the risk of MACE after OPCABG and coronary end-arterectomy.

Objective: To evaluate the feasibility and validity of combined directly epicardial and transapical endocardial substrate ablation guided by Carto mapping for ventricular tachycardia(VT) with left ventricular aneurysm(LVA) intra-operation in a swine model. Methods: Twenty-four swine models with sustained VT and LVA were randomly divided into study group(radiofrequency ablation, RFCA, from epicardium via direct-view and endocardium via transapical access, 12 cases) and control group(endocardial RFCA via retrograde transaortic access, 12 cases). Substrate mapping for captured abnormal potentials via endocardium and epicardium was used to precisely locate the low-voltage areas. After ablation in two groups, VT was induced again to compare the effectiveness of different RFCA strategies. Results: Three dimensional electro-anatomic mapping was implemented successfully in two groups under open chest. And VT substrates were largely located in the border zone of LVA. All objects in the study group underwent endocardial ablation via transapical access smoothly without operative failure. When VT inducing again, 2 cases of study group was with inducible VT, however, VT recurrence in control group was 5 cases, P=0.04. Conclusion Combined direct epicardial and transapical endocardial substrate mapping and ablation appeared to be feasible and effective for treating VT with LVA under thoracotomy.

Objective: To analyze the clinical features of patients with chronic obstructive pulmonary disease(COPD) complicated with pulmonary thromboembolism(PTE). Methods: The clinical data of 21 patients with COPD and PTE and 26 patients with acute exacerbation of COPD(AECOPD) from June 2015 to March 2018 in Taiyuan Central Hospital were retrospectively analyzed.The SSPS 22.0 statistical software was used to analyze the clinical data.General data, blood gas analysis results, lung function, hemoglobin, coagulation parameters, combined disease were analyzed. Results: There were no statistically significant differences in age, gender and lung function grading between the COPD complicated with PTE group and AECOPD group (all P>0.05). The incidence rates of chest pain(8 cases, 38.1%) and syncope(2 cases, 10.5%) in the COPD complicated with PTE group were higher than those in the AECOPD group[chest pain(3 cases, 11.5%), syncope(1 case, 3.8%)](χ²=7.645, 9.413, all P<0.05). There was no statistically significant difference in carbon dioxide partial pressure(PaCO₂)retention between the two groups(P>0.05). The blood oxygen partial pressure(PaO₂) of the COPD complicated with PTE group was (62.86±15.10)mmHg, which was lower than that of the AECOPD group [(74.83±17.59)mmHg](t=4.642, P<0.05). The hemoglobin, activated partial thromboplastin time(APTT), fibrinogen(FIB), D-dimer levels in the COPD complicated with PTE group were (146.78±21.40)g/L, (35.62±5.93)s, (4.34±1.18)g/L, (5.02±3.63)mg/L, respectively, which were higher than those in the AECOPD group [(137.45±15.15)g/L, (29.38±3.16)s, (3.62±1.08)g/L, (0.92±0.42)mg/L] (t=4.375, 4.654, 3.869, 18.653, all P<0.05). There were no statistically significant differences in the proportion of comorbidities such as diabetes, hypertension, hyperlipidemia and lower extremity(all P>0.05). Conclusion COPD patients complicated with PTE have the following characteristics: elderly and male patients accounted for a high proportion, chest pain and syncope symptoms occurred in a high proportion, severe hypoxia, hemoglobin and D-dimer increased significantly.

Objective To evaluate the clinical efficacy of early coronary artery bypass grafting(CABG) to treat ST-segment elevation myocardial infarction(STEMI).Methods We retrospectively analyzed the clinical data of 196 patients within 2 weeks of STEMI attack undergoing CABG in our department from September 2010 to December 2014.According to the time-interval between onset of STEMI and the beginning of CABG,all subjects were divided into group Ⅰ (≤6 h,n =46),group Ⅱ (7-72 h,n =37),group Ⅲ (4-7 d,n =52) and groupⅣV (8-14 d,n =61).After CABG,patients' perioperative complications and survival status were analyzed under different surgical time-interval windows to assess the clinical efficacy of early surgical intervention in patients with STEMI.Results Overall in-hospital mortality was 9.18％ (18/196),from group Ⅰ to group ⅣV,the mortality was 10.87％ (5/46),21.62％ (8/37),5.77％ (3/52) and 3.28％ (2/61) respectively.In all groups,comparing with survivals,nonsurvivals were often women (61.11％ vs.24.16 ％,P =0.002),were more often companied by cardiac shock(83.33％ vs.24.16％,P ＜ 0.001),and had higher preoperative cardiac troponin Ⅰ(cTnⅠ) levels [(14.1 ± 8.4) ng/ml vs.(4.7 ± 3.8) ng/ml,P ＜ 0.001].Multi-variable logistic regrassion analysis revealed that age,female,cardiac shock,renal insufficiency and serum levels of cTnⅠ were independent risk factors affecting postoperative death.Conclusion Under optimal preoperative management strategies,CABG is relatively feasible and effective with the time-interval window as delay as possible after 3 days of STEMI attack.

Objective Saphenous vein graft(SVG) re-stenosis has an severe adverse effect on the long-term prognosis of coronary artery bypass grafting.Intimal hyperplasia(IH) is the prima~ cause and basic pathology of SVG re-stenosis.Comparing to arterial graft IH,different factors promotc IH of SVG.In this review,we summarized the special factors promoting IH of SVG.

Objective To analyze the epidemiologic and clinical features of post-engraftment blood stream infection (pePSI) after unrelated cord blood transplant (UCBT) in our hospital,and provide the basis for empiric antibacterial treatment.Methods 484 patients with hematological malignancies who received single-unit high intensity myeloablative UCBT in our hospital between April 2011 and November 2017 were enrolled.The incidence,etiology of BSI and associated mortality,drug resistance rate in the post-engraftment phase were investigated.Results Totally 25 episodes of BSI among 22 patients in the post-engraftment phase were documented,and the incidence of peBSI was 5 ％.Gram-negative organisms predominated over Gram positive,with Escherichia coli being the most frequent Gram-negative organism isolated (31.5％).Among Gram positive organisms,methicillin resistant Staphylococcus (MRS) was the most frequent species isolated (66％).Nearly 33％ of Escherichia coli isolates and 60％ Klebsiella pneumonia isolates were carbapenem-resistant.All Grampositive bacteria were sensitive to vaneomyein and linezolid.Among the 22 patients,14 patients were cured and survived (63％) eventually.Conclusion The most frequent causative agents of the peBSI after UCBT were Escherichia coli,Klebsiella pneumonia and MRS,etc.Combined antibacterial treatment including a carbapenem or beta lactamase inhibitor can be used for patients suffering fever in the post-engraftment phase as empiric antibacterial therapy.Vaneomyein and linezolid can be used as the first-line therapy for Gram-positive bacteria.

Objective: To explore the clinical efficacy and safety of unrelated umbilical cord blood transplantation (UCBT) in the treatment of refractory and relapsed acute leukemia (AL) patients. Methods: The clinical data of 22 refractory and relapsed AL patients who were treated with UCBT as salvage therapy from November 2009 to May 2017 were retrospectively analyzed. All patients received a myeloablative conditioning regimen for prevention of graft-versus-host disease (GVHD) with cyclosporine A (CSA)/short course of mycophenolate mofetil (MMF). Results: ①Of 22 patients, 9 cases were male and 13 female. The median age was 23 (15-44) years and median weight of 52.5 (43-82) kg. All patients were transplanted with a median umbilical cord blood nucleated cells of 3.07 (1.71-5.30)×10⁷/kg (by weight), the median CD34⁺ cells was 1.60 (0.63-3.04)×10⁵/kg (by weight). ②The myeloid cumulative implantation rate was 95.5% (95%CI 45.2-99.7%) after transplantation of 42 d, with the median implantation time of 19 (13-27) d. The platelet cumulative implantation rate after transplantation of 120 d was 81.8% (95%CI 54.2-93.6%), the median implantation time of 42 (20-164) d. ③The incidence of Ⅱ-Ⅳ, Ⅲ-Ⅳ aGVHD and the 2 year cumulative incidence of cGVHD were 36.4%, 13.6% and 40.3% respectively. ④ The transplant related mortality (TRM) after transplantation of 180d was 22.7%, 2 year cumulative rate of relapse was 18.7% (95%CI 3.6-42.5%), 2 year disease-free survival rate (DFS) and overall survival rate (OS) were 53.7% and 58.1%, respectively. Conclusion The preliminary results show that the use of UCBT is safe and effective for refractory and relapsed AL patients who fail to respond to conventional chemotherapy.

Objective To study the effects of extracted active components of Chaenomeles Speciosa (EACCS) on non-alcoholic fatty liver disease (NAFLD) in mice; To discuss the possible molecular mechanism. Methods Forty male KM mice were randomized into four groups, namely normal group, model group, low-dose (50 mg/kg) EACCS group and high-dose (100 mg/kg) EACCS group. Except that the normal group was daily given routine diet, the other groups were given high-fat–high-fructose diet (HFFD). The mice were put to death 4 weeks later. Body weight, liver weight and serum TG were measured. HE and oil red O staining were used to observe liver tissue morphology. RT-PCR and Western blot were used to detect the expression of lipid metabolism related genes. Results Compared with the normal group, the liver size, liver index (P<0.01) and epididymal fat index (P<0.05) increased significantly;The ALT and GLU in serum increased (P<0.05), TG increased (P<0.05), and pathological findings showed significant steatosis; RT-PCR and Western blot showed that the expression levels of SIRT1 and FoxO1 mRNA decreased and the level of SERBP-1c increased in the model group. Compared with the model group, the hepatic lipid accumulation of EACCS groups was obviously improved, and the serum ALT, GLU, and TG levels significantly decreased, the expression levels of hepatic SIRT1 and FoxO1 mRNA increased. Conclusion EACCS has protective effects on NAFLD mice induced by HFFD, and its mechanism may be related to the activation of SIRT1-FoxO1 signaling pathway in the liver tissues.

AIM To investigate the effects of Wuzi Yanzong Prescription (Lycii Fructus,Cuscutae Semen,Rubi Fructus,Plantaginis Semen and Schisandrae chinensis Fructus) on DNA damage of testis cells in adult male mice induced by cyclophosphamide (CTX).METHODS Forty out of fifty adult male Balb/C mice were injected intraperitoneally with CTX and then were randomly and equally divided into model control group (normal saline),Wuzi Yanzong Prescription low-,medium-and high-dose groups (100,200 and 400 mg/kg),and the other ten mice served as normal control group (normal saline).All mice were anesthetized by inhalation of ether,and then were sacrificed by cervical dislocation.The sperm count,sperm motility and malformation rate of sperm were tested.The content of 8-hydroxy-deoxyguanosine (8-OHdG) in serum was measured using ELISA;the DNA damage degree of cells in testis was detected by single cell gel electrophoresis;the protein expressions of p-P53 and γ-H2AX in testis were examined by Western blot.RESULTS Compared with the model control group,Wuzi Yanzong Prescription groups showed significant increase in the sperm count,sperm motility and significantly decreased malformation rate of sperm,the level of 8-OHdG in serum,and the protein expressions of p-P53 and γ-H2AX in testis were also significantly decreased.CONCLUSION Wuzi Yanzong Prescription can significantly alleviate the DNA damage of testis cells in mice induced by CTX through down-regulating protein expressions of p-P53 and γ-H2AX.

Objective To study the curative efficacy and safety of single-unit umbilical cord blood transplantation (sUCBT) for malignant hematologic diseases,which is provided by China's public cord blood bank.Methods We retrospectively analyzed 409 cases of malignant hematologic diseases who accepted myeloablative single-unit unrelated donor UCBT without ATG at our center between May 2008 and December 2016.A comparative analysis was made on the total nuclear cells (TNC) of the umbilical cord blood before freezing and after thawing,the cells of CD34+,the recovery rate of cells and the clinical effect of UCBT.Result 409 units of umbilical cord blood used in UCBT respectively came from eight China's public cord blood banks.The average TNC of 409 units of umbilical cord blood before freezing and after the tubular recovery were respectively 18.5 × 108 and 16.34 × 108 (p =0.000).The average recovery rate of the tubular recovery was 88.5％,and there was significant difference among cord blood banks (P =0.000).The average TNC of umbilical cord blood before freezing and transfusion were respectively 18.5 × 108 and 15.86 × 108 (p =0.000).The average recovery rate of umbilical cord blood transfusion was 85.9％,with the difference being significant among cord blood banks (P =0.000).The average number of CD34+ cells before freezing and after the tubular recovery was 11.18 × 106and 8.68 × 106 (p =0.000).The average recovery rate of CD34+ cells after the tubular recovery was 80.75 ％,with the difference being significant among the cord blood banks (P =0.000).At 42nd day after UCBT,the cumulative incidence of neutrophil engraftment was 95.4％,and the median time of the engraftment was 17 days (11-38 days).The cumulative incidence of platelet engraftment at 120th day was 84.6％,and the median time of the engraftment was 36 days (14-93 days).The cumulative incidence of erythrocyte engraftment at 60th day was 92％,and the median time of engraftment was 22 days (9d-60 days).After the umbilical cord blood provided by each bank was used in UCBT,it got the difference in cumulative incidence of engraftment.The P values for cumulative incidence of neutrophil,platelet and erythrocyte engraftment were respectively 0.004,0.01 and 0.000 2,with the differences being statistically significant.At 100th day after UCBT,the cumulative incidence of Ⅱ-Ⅳ and Ⅲ-Ⅳ degrees of acute graft-versus-host disease (aGVHD) was respectively 28.63％ and 15.7％.After umbilical cord blood provided by each bank was used in UCBT,it got the difference in cumulative incidence of aGVHD.There was no significant difference between Ⅱ-Ⅳ and Ⅲ-Ⅳ degrees (P =0.809 and 0.68 respectively).At 3rd year after UCBT,the cumulative incidence of relapse was 15.89％.After umbilical cord blood provided by each bank was used in UCBT,there was no significant difference in the cumulative incidence of relapse (P =0.898).At 3rd year after UCBT,the overall survival (OS) rate and disease free survival (DFS) rate were respectively 66.7％ and 59％.After umbilical cord blood provided by each bank was used in UCBT,it got the difference in OS and DFS.There was no significant difference in OS and DFS (P =0.566 and 0.703 respectively).At 3rd year after sUCBT,the rate of graft-versus-host diseases/relapse-free survival (GRFS) was 54.3％.After umbilical cord blood provided by each bank was used in UCBT,there was no significant difference in the rate of GRFS (P =0.449).Conclusion The umbilical cord blood provided by China's public cord blood bank was used in UCBT.It has a high safety and good efficacy in treating malignant hematologic diseases.But it needs to set up the standardized and normalized quality-control system of umbilical cord blood for China's public cord blood bank.