Objective:This study aimed to compare postoperative pain between minimally invasive coronary artery bypass grafting (MICS-CABG) and conventional CABG for multivessel coronary artery disease, comparing baseline characteristics and perioperative data between the two groups, and analyzing risk factors influencing postoperative pain.Methods:A total of 545 patients undergoing elective off-pump coronary artery bypass grafting (OPCABG) for multivessel coronary artery disease at Beijing Anzhen Hospital from July 2022 to July 2023 were included. There were 397 patients in the conventional CABG group (289 males, 108 females, aged 35-77 years) and 148 patients in the minimally invasive CABG group (121 males, 27 females, aged 37-84 years), with 148 patients in each group after propensity score matching. Pain levels were assessed using the Numeric Rating Scale (NRS) at the first 5 days postoperatively (acute postoperative pain, APP) and at 3, 6, and 12 months postoperatively (chronic post-surgical pain, CPSP). Logistic regression was used to analyze risk factors for CPSP at 3 months postoperatively in both groups. Results:Within 48 hours postoperatively, both groups reported maximum NRS pain intensities at rest (NRS 4.0 vs. 6.0) and during activity (NRS 5.2 vs. 7.5). From the third day after surgery, there were no significant differences in resting pain intensity between the two groups, and from the fourth day after surgery, there were no significant differences in pain intensity during movement. With 60.2% in the conventional group and 92.6% in the minimally invasive group experiencing moderate to severe pain at rest (NRS ≥ 4), and 83.5% in the conventional group and 98.0% in the minimally invasive group experiencing moderate to severe pain during activity (NRS ≥ 4). Immediately after drain removal, there was a significant reduction in pain intensity at rest in the minimally invasive group (pre-drain removal NRS 6.0 vs. post-drain removal NRS 2.7), compared to the conventional group (pre-drain removal NRS 4.0 vs. post-drain removal NRS 2.3). However, there was no significant difference in the reduction of pain intensity during activity between the minimally invasive group (pre-drain removal NRS 7.5 vs. post-drain removal NRS 4.2) and the conventional group (pre-drain removal NRS 6.0 vs. post-drain removal NRS 2.7). At 3 months postoperatively, the incidence of CPSP was 35.9% in the conventional group and 35.1% in the minimally invasive group. At 6 months postoperatively, the incidence of CPSP was significantly lower compared to 3 months in both groups (conventional group 8.7% vs. minimally invasive group 6.8%, P<0.001). In the conventional group, higher Europe SCORE Ⅱ was identified as an independent risk factor for CPSP at 3 months postoperatively, while in the minimally invasive group, higher BMI and postoperative use of flurbiprofen for rescue analgesia were identified as independent risk factors. Conclusion:In patients undergoing minimally invasive coronary artery bypass grafting (CABG), the early postoperative acute pain intensity and incidence were higher than those in the conventional CABG group. After drain removal, there were no significant differences in resting pain intensity between the two groups, but pain intensity during movement remained higher in the minimally invasive group compared to the conventional group. The incidence of chronic pain did not differ between the two groups but decreased significantly from 3 months postoperatively. Conventional CABG patients with high preoperative Europe SCORE Ⅱ scores, high preoperative BMI and severe postoperative acute pain tend to have more chronic pain after minimally invasive bypass surgery.

Objective To compare the safety and efficacy of minimally invasive coronary artery bypass grafting (MICS CABG) and traditional CABG in patients with coronary heart disease (CHD) and diabetes mellitus (DM). Methods From 2019 to 2021, the patients who received CABG by the same medical group in the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital were retrospectively enrolled. According to the surgery methods, the patients were divided into two groups: a MICS CABG group and a conventional group. The perioperative and postoperative follow-up data of patients were collected. The main observation results included all cause death events, myocardial infarction, cerebrovascular, revascularization, and adverse wound healing. Results According to the inclusion and exclusion criteria, 140 patients were enrolled, including 66 patients in the MICS CABG group [56 males and 10 females, aged (61.83±8.94) years], and 74 patients in the conventional group [55 males and 19 females, aged (58.61±8.26) years]. Compared with the conventional group, patients in the MICS CABG group had longer median surgical time (4.50 h vs. 4.00 h, P=0.005), less intraoperative bleeding (600.00 mL vs. 700.00 mL, P=0.020), and a lower rate of secondary debridement and suturing of surgical wounds (4.5% vs. 16.2%, P=0.023). The median follow-up time was 2.54 years. There was no statistically significant difference in the cumulative incidence of major adverse cardiac and cerebrovascular events (7.6% vs. 5.4%), all-cause mortality (0.0% vs. 0.0%), myocardial infarction (3.0% vs. 2.7%), cerebrovascular events (4.5% vs. 2.7%), or revascularization (0.0% vs. 0.0%) between the two groups of patients during the postoperative follow-up (P>0.05). Conclusion MICS CABG can achieve the same revascularization effect as traditional CABG in patients with CHD and DM. MICS CABG can effectively reduce adverse clinical outcomes or complications such as adverse chest wound healing and slow postoperative recovery of body function in patients with DM.

Objective:This study aimed to compare postoperative pain between minimally invasive coronary artery bypass grafting (MICS-CABG) and conventional CABG for multivessel coronary artery disease, comparing baseline characteristics and perioperative data between the two groups, and analyzing risk factors influencing postoperative pain.Methods:A total of 545 patients undergoing elective off-pump coronary artery bypass grafting (OPCABG) for multivessel coronary artery disease at Beijing Anzhen Hospital from July 2022 to July 2023 were included. There were 397 patients in the conventional CABG group (289 males, 108 females, aged 35-77 years) and 148 patients in the minimally invasive CABG group (121 males, 27 females, aged 37-84 years), with 148 patients in each group after propensity score matching. Pain levels were assessed using the Numeric Rating Scale (NRS) at the first 5 days postoperatively (acute postoperative pain, APP) and at 3, 6, and 12 months postoperatively (chronic post-surgical pain, CPSP). Logistic regression was used to analyze risk factors for CPSP at 3 months postoperatively in both groups. Results:Within 48 hours postoperatively, both groups reported maximum NRS pain intensities at rest (NRS 4.0 vs. 6.0) and during activity (NRS 5.2 vs. 7.5). From the third day after surgery, there were no significant differences in resting pain intensity between the two groups, and from the fourth day after surgery, there were no significant differences in pain intensity during movement. With 60.2% in the conventional group and 92.6% in the minimally invasive group experiencing moderate to severe pain at rest (NRS ≥ 4), and 83.5% in the conventional group and 98.0% in the minimally invasive group experiencing moderate to severe pain during activity (NRS ≥ 4). Immediately after drain removal, there was a significant reduction in pain intensity at rest in the minimally invasive group (pre-drain removal NRS 6.0 vs. post-drain removal NRS 2.7), compared to the conventional group (pre-drain removal NRS 4.0 vs. post-drain removal NRS 2.3). However, there was no significant difference in the reduction of pain intensity during activity between the minimally invasive group (pre-drain removal NRS 7.5 vs. post-drain removal NRS 4.2) and the conventional group (pre-drain removal NRS 6.0 vs. post-drain removal NRS 2.7). At 3 months postoperatively, the incidence of CPSP was 35.9% in the conventional group and 35.1% in the minimally invasive group. At 6 months postoperatively, the incidence of CPSP was significantly lower compared to 3 months in both groups (conventional group 8.7% vs. minimally invasive group 6.8%, P<0.001). In the conventional group, higher Europe SCORE Ⅱ was identified as an independent risk factor for CPSP at 3 months postoperatively, while in the minimally invasive group, higher BMI and postoperative use of flurbiprofen for rescue analgesia were identified as independent risk factors. Conclusion:In patients undergoing minimally invasive coronary artery bypass grafting (CABG), the early postoperative acute pain intensity and incidence were higher than those in the conventional CABG group. After drain removal, there were no significant differences in resting pain intensity between the two groups, but pain intensity during movement remained higher in the minimally invasive group compared to the conventional group. The incidence of chronic pain did not differ between the two groups but decreased significantly from 3 months postoperatively. Conventional CABG patients with high preoperative Europe SCORE Ⅱ scores, high preoperative BMI and severe postoperative acute pain tend to have more chronic pain after minimally invasive bypass surgery.

Objective     To investigate the perioperative clinical effects and follow-up results of minimally invasive coronary artery bypass grafting (MICS CABG) versus conventional coronary artery bypass grafting (CABG) in thoracotomy. Methods     The patients who received off-pump CABG in Beijing Anzhen Hospital from January 2017 to October 2021 were collected. Among them, the patients receiving MICS CABG performed by the same surgeon were divided into a minimally invasive group, and the patients receiving median thoracotomy were into a conventional group. By propensity score matching, preoperative data were balanced. Perioperative and postoperative follow-up data of the two groups were compared. Results     A total of 890 patients were collected. There were 211 males and 28 females, aged 60.54±9.40 years in the minimally invasive group, and 487 males and 164 females, aged 62.31±8.64 years in the conventional group. After propensity score matching, there were 239 patients in each group. Compared with the conventional group, patients in the minimally invasive group had longer operation time, shorter drainage duration, less drainage volume on the first postoperative day, shorter postoperative hospital stay, and lower rate of positive inotropenic drugs use, while there was no statistical difference in the mean number of bypass grafts, ICU stay, ventilator-assisted time, blood transfusion rate or perioperative complications (P>0.05). During the median follow-up of 2.25 years, there was no statistical difference in major adverse cardiovascular and cerebrovascular events, including all-cause death, stroke or revascularization between the two groups (P>0.05). Conclusion    Reasonable clinical strategies can ensure perioperative and mid-term surgical outcomes of MICS CABG not inferior to conventional CABG. In addition, MICS CABG has the advantages in terms of postoperative hospital stay, postoperative drainage volume, and rate of positive inotropic drugs use.

Objective:The perioperative and early follow-up data of the simultaneous hybrid CAS+ OPCABG and sequential CAS+ OPCABG were compared to evaluate the safety and efficacy of the simultaneous CAS+ OPCABG.Methods:A total of 26 patients with coronary heart disease complicated with carotid artery stenosis received CAS plus OPCABG hybrid surgery in our hospital from January 2020 to July 2021, among which 12 patients received simultaneous CAS+ OPCABG and 14 patients received staged sequential CAS+ OPCABG.The perioperative and postoperative follow-up data of 3 months were compared and analyzed.Results:There were no significant differences in the operation time, drainage on the first day after surgery, ventilator assisted time and ICU time between the two groups.The amount of intraoperative blood loss in the simultaneous group was more than that in the staged group, but no secondary thoracotomy occurred in both groups. The number of days in hospital after operation was significantly less in the simultaneous group. There was 1 case of perioperative cerebral infarction and 1 case of myocardial infarction in the staged group, but there was no statistical difference between the two groups. There was no new cerebral infarction in the two groups, carotid artery ultrasound stent was unobstructed, and there was no statistical difference in cardiac function grading and left ventricular ejection fraction 3 months after operation.Conclusion:Simultaneous CAS+ OPCABG surgery is safe and feasible, it is recommended as the first choice especially for patients with severe myocardial ischemiaor severe left main artery disease caused.How to reduce the risk of bleeding and alleviat carotid sinus reflex are major issues that need to be concerned.

Objective:To explore the perioperative effect of radial artery as a sequential graft in coronary artery bypass grafting(CABG).Methods:The clinical data and perioperative complications of 109 patients, who underwent radial artery(RA) or great saphenous vein(SVG) as a sequential graft during CABG from April 2020 to December 2020 in Beijing Anzhen Hospital, were analyzed, there were 86 males and 23 females, aged from 39 to 79 years, with an average of(61.1±8.0)years old. According to the graft materials, they were divided into the RA group(n=47) and SVG group(n=62).Results:There were no significant differences between the two groups in age, gender, comorbidities, echocardiographic results, transplant vascular indexes, coronary angiography results, and operation methods(on-pump or off-pump, use of left internal mammary artery, number and distribution of distal anastomoses)( P>0.05). There were also no significant difference between the two groups in ICU stay, postoperative hospital stay and drainage with 24 hours after CABG( P>0.05). The incidence of postoperative cerebrovascular events, postoperative infection and secondary thoracotomy in the RA group were higher than that in the SVG group. The incidence of myocardial infarction, postoperative ventricular arrhythmia and postoperative IABP assistance in the SVG were higher than that in the RA group, but the difference was not statistically significant( P>0.05). Conclusion:The application of radial artery as a sequential graft during CABG does not increase the risk of perioperative complications, and the patients recover smoothly.

Objective:To investigate the influence of the complexity of coronary artery disease based on SYNTAX score(SS) on the effect of minimally invasive or conventional bypass surgery.Methods:From January 2017 to January 2020, the medical group of the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital received a total of 760 patients undergoing off-pump coronary artery bypass grafting(OPCABG) surgery, including 596 males and 164 females. 28-85 years old, with an average of(60.88±9.36) years old. 379 cases underwent minimally invasive coronary artery bypass grafting(MICS CABG)(minimally invasive group) and 381 cases underwent median thoracotomy CABG(conventional group). In this study, according to the SS, patients of both groups were divided into 3 levels, and then the perioperative data of the two sets of high, medium, and low score intervals were compared respectively, and a preliminary analysis of the perioperative data for patients in each SS score section was performed.Results:There was no significant difference in the SS value between the minimally invasive group and the conventional group in the three intervals. There was no statistical difference in preoperative data including age, sex ratio, body mass index, hypertension, diabetes, abnormal head CT history, lung disease, history of tobacco and alcohol. The number of minimally invasive bypasses in the three groups was significantly less than that of the conventional group. The duration of minimally invasive surgery in the SS low score group was similar to that of conventional surgery, and the duration of minimally invasive surgery in the SS medium and high score group was longer than that in the conventional group. The hospital stay in the SS low and middle score group was less than that of the conventional group. There was no statistical difference in the proportion of MACCE and auxiliary equipment implantation in the 30-day perioperative period.Conclusion:In the same grade of SS group, there is no significant difference on the perioperative clinical effect between conventional CABG or MICS CABG group. The complexity of coronary artery disease is not the decisive basis for choosing minimally invasive or conventional bypass.

Objective     To compare the mid- and long-term efficacy of minimally invasive coronary artery bypass grafting (MICS) versus conventional coronary artery bypass grafting (CABG). Methods     This study analyzed 679 patients with coronary heart disease treated in the Minimally Invasive Heart Center of Beijing Anzhen Hospital from 2015 to 2019, including 532 males and 147 females with an average age of 61.16 years. A total of 281 patients underwent MICS (a MICS group) and 398 patients underwent conventional CABG (a CABG group). The clinical data of the patients in the two groups were analyzed. Results    The average operation time was longer (P<0.001), the total hospital stay was shorter (P<0.001), and the amount of drainage 24 h after the operation was less (P=0.029) in the MICS group. There was no statistical difference in the incidence of perioperative complications between the two groups. The median follow-up time was 2.68 years. The follow-up results showed that the total incidence of cumulative main adverse cardiovascular and cerebrovascular events in the CABG group was higher at 2 years (6.2% vs. 3.8%) and 4 years (9.3% vs. 7.6%), but the difference was not statistically significant (P>0.05). There was no statistical difference in 2- or 4-year all-cause death between the two groups (3.5% vs. 2.8%, 5.6% vs. 2.8%, P>0.05). At the same time, there was no statistical difference in the incidence of myocardial infarction, stroke or revascularization between the two groups (P>0.05). Conclusion    Compared with conventional CABG, MICS can achieve satisfactory mid- and long-term outcomes.

Salt stress may cause primary osmotic stress and ion toxicity, as well as secondary oxidative stress and nutritional stress in plants, which hampers the agricultural production. Salt stress-responsive transcription factors can mitigate the damage of salt stress to plants through regulating the expression of downstream target genes. Based on the soil salinization and its damage to plants, and the central regulatory role of transcription factors in the plant salt stress-responsive signal transduction network, this review summarized the salt stress-responsive signal transduction pathways that the transcription factors are involved, and the application of salt stress-responsive transcription factors to enhance the salt tolerance of plants. We also reviewed the transcription factors-regulated complex downstream gene network which is formed by forming homo- or heterodimers between transcription factors and by forming complexes with regulatory proteins. This paper provides a theoretical basis for understanding the role of salt stress-responsive transcription factors in the salt stress regulatory network, which may facilitate the molecular breeding for improved stress resistance.
Gene Expression Regulation, Plant ; Osmotic Pressure ; Plant Proteins/metabolism* ; Plants, Genetically Modified ; Salt Stress ; Salt Tolerance ; Stress, Physiological ; Transcription Factors/metabolism*

Objective    To explore coronary angiographic characteristics in patients with symptomatic recurrence after coronary artery bypass grafting (CABG). Methods    We performed a retrospective study of 997 patients with symptomatic recurrence after CABG in Beijing Anzhen Hospital from 2010 to 2020. There were 762 males and 235 females, with an average age of 62.41±8.70 years. Results    There was a high prevalence of risk factors like hypertension, diabetes and a history of smoking. Diseased arterial grafts accounted for 27.44% while saphenous vein graft 54.40%; 240 (24.07%) patients had all patent grafts. The main lesion characteristics of diseased grafts were chronic total occlusion lesions (79.57%). Most patients had more diseased native vessels after CABG than before. The type C coronary artery disease in native vessels relevant to ischemic area occurred in 674 (67.60%) patients; 525 (52.66%) patients with recurrent symptom after CABG had both diseased grafts and diseased native vessels. Conclusion     Graft status in patients with symptomatic recurrence after CABG is worse than we expected. The majority have newly developed lesions both in grafts and native vessels. Native vascular lesions will continue to progress after CABG.