Objective To evaluate the safety and efficacy of total arterial off-pump coronary artery bypass grafting (OPCABG) using a left internal thoracic artery (LITA) combined with bilateral radial arteries (RAs). Methods We retrospectively analyzed the clinical data of patients with severe multi-vessel coronary artery disease who underwent total arterial OPCABG with a LITA and bilateral RAs at Sichuan Provincial People’s Hospital from November 2020 to April 2023. Results A total of 24 patients were included, comprising 23 males and 1 female, with a mean age of (53.63±4.33) years. The New York Heart Association (NYHA) functional class was Ⅱ to Ⅲ. The mean number of distal anastomoses was 3.17±0.38. A Y-graft was constructed in 12 patients and sequential grafting was performed in 4 patients. Concomitant procedures included coronary endarterectomy in 1 patient, intra-aortic balloon pump (IABP) implantation in 10 patients, and thymoma resection in 1 patient. The mean operative time was (308.13±30.39) min, mechanical ventilation time was (15.42±7.42) h, ICU stay was (46.08±27.32) h, and postoperative hospital stay was (11.71±1.90) d. There were no in-hospital deaths. Postoperative complications included one patient of acute renal failure and one patient of cerebral infarction. Pre-discharge color Doppler echocardiography revealed that the left ventricular end-diastolic diameter was significantly smaller than before surgery (P<0.05), while the left ventricular ejection fraction and fractional shortening were significantly higher (P<0.05). Coronary computed tomography angiography (CTA) showed that all arterial grafts were patent. During a mean follow-up of (14.58±8.75) months, no patients experienced angina recurrence or mortality. Repeat coronary CTA or angiography in 16 patients one year postoperatively confirmed that all arterial grafts remained patent. Conclusion Total arterial OPCABG using a LITA and bilateral RAs is a safe and effective treatment for patients with severe multi-vessel coronary artery disease. For high-risk patients, intraoperative IABP support is recommended.

Uncovering the risk factors of pulmonary hypertension and its mechanisms is crucial for the prevention and treatment of the disease.In the current study,we showed that experimental periodontitis,which was established by ligation of molars followed by orally smearing subgingival plaques from patients with periodontitis,exacerbated hypoxia-induced pulmonary hypertension in mice.Mechanistically,periodontitis dysregulated the pulmonary microbiota by promoting ectopic colonization and enrichment of oral bacteria in the lungs,contributing to pulmonary infiltration of interferon gamma positive(IFNγ+)T cells and aggravating the progression of pulmonary hypertension.In addition,we identified Prevotella zoogleoformans as the critical periodontitis-associated bacterium driving the exacerbation of pulmonary hypertension by periodontitis,and the exacerbation was potently ameliorated by both cervical lymph node excision and IFNγ neutralizing antibodies.Our study suggests a proof of concept that the combined prevention and treatment of periodontitis and pulmonary hypertension are necessary.

Objective To investigate the safety and efficacy of transesophageal echocardiography assisted thoracoscopic left atrial appendage clipping in atrial fibrillation patients with high risk of stroke and bleeding.Methods Clinical data of 14 atrial fibrillation patients with high risk of stroke and bleeding from November 2021 to May 2023 was retrospectively analyzed.All the patients had suffered from cerebral infarction.The CHA2DS2-VASc score was 3-7(mean,5.0±1.4)and the HAS-BLED score was 3-4(mean,3.3±0.5).The thoracoscopic surgery was performed with two ports.The left atrial appendage clipping was performed by using a domestically produced E-Clip left atrial appendage closure system,assisted by transesophageal echocardiography.Results All the operations were successfully performed.The mean operation time was(39.6±7.7)min,the mean drainage volume after operation was(80.4±37.1)ml,and the drainage tube was removed at(26.0±2.5)h after operation.All the 14 patients were followed up for 3-21 months,with a median of 8 months.Complete closure of the left atrial appendage without residual leakage and no thrombosis in the left atrium were confirmed by transthoracic echocardiography.No new cerebral infarction or bleeding lesions in the brain was detected by CT scanning.The electrocardiogram showed that 2 patients converted to sinus rhythm and 12 patients still maintained atrial fibrillation rhythm.Conclusions Transesophageal echocardiography assisted thoracoscopic left atrial appendage clipping can completely closure left atrial appendage and avoid new onset of stroke in atrial fibrillation patients with high risk of stroke and bleeding.It can also play a role in electrical isolation of left atrial appendage so as to cure atrial fibrillation in few patients.

Objective To observe the effect of X-ray-guided placement of intestinal obstruction tube for treating malignant bowel obstruction(MBO)caused by gynecological malignant tumors.Methods Data of 60 patients with intestinal MBO after surgical operations of malignant gynecological tumors,including 30 cases underwent X-ray-guided intestinal obstruction tube placement(group A)and 30 cases underwent traditional nasogastric tube placement(group B),all followed by continuous gastrointestinal decompression were retrospectively analyzed.The remission of MBO symptoms,time of exhaust and defecation,so as diet recovery after treatment were compared between groups.The mean drainage volume within 24 h,tube retention time and treatment-related complications were recorded,and the survival of patients within 1 year after treatment were followed up.Results All 60 patients were successfully catheterized.The time of exhaust and defecation,oral feeding and tube retention time after catheterization in group A were shorter than those in group B(all P＜0.05),while the mean drainage volume within 24 h in group A was larger than that in group B(P＜0.05).No significant difference of relief rate of intestinal obstruction symptoms was found between groups(P=0.472).Minor nasal bleeding occurred in 8 cases,and oropharyngeal discomfort occurred in 4 cases in group A,while each in 5 cases in group B,all relieved without special treatments.No significant difference of treatment-related complication was observed between groups(P=0.361).One year after treatments,28 cases were followed up and 2 cases were lost in both groups,and no significant difference of survival rate was detected between group A(7/28,25.00%)and group B(5/28,17.86%)(P=0.745).Conclusion X-ray-guided placement of intestinal obstruction tube was safe and effective for treating MBO caused by malignant gynecological tumor.

Objective:To investigate specificity of neurovascular compression in patients with primary trigeminal neuralgia (PTN) by three-dimension reconstruction and computational fluid dynamics.Methods:Clinical characteristics and preoperative magnetic resonance imaging (MRI) data of 20 patients with both PTN and single artery compression (PTN group) and 10 patients without PTN but having neurovascular contact in MRI images (control group) in the Second Affiliated Hospital of Zhengzhou University from January 2018 to December 2019 were collected and analyzed. After three-dimension reconstruction of the MRI images, curvature of the arterial loop, angle between the plane of arterial loop and the trigeminal nerve and location of the compression were observed. Then bidirectional structure-fluid coupling based on the optimized stereolithography models of arterial loop and nerve were processed by ANSYS 19.2 software. In the location of the compression of contact, equivalent stress (ES) of arterial loop on the nerve, shearing stress (SS) of the blood flow and local deformation of the nerve were iteratively computed. All parameters were analyzed and compared between the PTN group and the control group, and the correlation analysis was proceeded between the anatomical parameters and hemodynamical parameters.Results:The curvature of arterial loop [0.21(0.12) mm -1vs 0.13(0.07) mm -1, U=34.00, P<0.05], the angle between vascular loop and nerve [69.70(30.67)° vs 43.40(37.21)°, U=38.00, P<0.05] in the PTN group were significantly greater than those in the control group, and the location of compression was significantly closer to the root of nerve in the PTN group [PTN group: (4.23±1.29) mm vs control group: (5.54±1.85) mm, t=-2.26, P<0.05]. The average SS [15 952.48(5 365.56) Pa vs 12 501.97(6 355.26) Pa, U=53.00, P<0.05], ES [24 965.65(7 693.22) Pa vs 14 992.99(9 824.08) Pa, U=32.00, P<0.05] in the PTN group were significantly greater than those in the control group. The curvature of arterial loop was positively correlated with the SS ( r=0.931, P<0.05) and ES ( r=0.962, P<0.05), and the latter two ( r=0.787, P<0.05; r=0.853, P<0.05) were positively correlated with the local neural deformation. Conclusions:In patients with PTN, offending artery compresses the root of nerve by greater arterial curvature and angle between the arterial loop and nerve. These anatomical differences will cause significantly greater SS, ES and local neural deformation.

Objective:To investigate the clinical related factors that affecting peritumoral brain edema (PTBE) and its severity in meningiomas.Methods:A total of 139 patients with meningiomas, admitted to and underwent surgery in our hospital from from January 2017 to October 2020 were chosen; their clinical data were analyzed retrospectively. Meningioma volume and edema volume were calculated from drawn regions of interest on preoperative MRI images by 3D-slicer software. Edema index (EI) was used to evaluate the severity of PTBE. The clinical factors affecting PTBE and EI were determined by statistical methods, and the value of meningioma volume in predicting PTBE was further analyzed.Results:(1) The PTBE incidence was 33.8% (47/139), and average EI was 2.47±0.73. (2) Univariate analysis showed that there was significant difference in percentage of patients with benign/malignant meningiomas, meningioma location, meningioma volume, and Ki-67 index between patients from PTBE group ( n=47) and non-PTBE group ( n=92, P<0.05). Multivariate binary Logistic regression analysis showed that benign/malignant meningiomas and meningioma volumes were independent risk factors for PTBE ( P<0.05). (3) There were significant differences in EI values among patients with different gender, WHO grading, KI-67 index and meningioma volumes ( P<0.05). Multivariate linear regression analysis showed meningioma malignant degrees and meningioma volume were independent risk factors for EI ( P<0.05). (4) Receiver operating characteristic curve showed that the area under curve of meningiomas of the cranial base and non-meningiomas of the cranial base in predicting PTBE was 0.824 and 0.825, respectively, with sensitivity of 0.800 and 0.784, and with specificity of 0.818 and 0.729. Conclusions:(1) Malignant degrees and meningioma volumes are the main factors affecting the incidence of PTBE, and are positively correlated with EI. (2) Meningioma volume has high predictive value in PTBE occurrence.

Objective To analyze the cost-benefit ratio of primary trigeminal neuralgia patients with bad drug control and never accepted the surgical treatment through surgery [including microvascular decompression (MVD) ,percutaneous radiofrequency rhizotomy (RFR) ,stereotactic radiotherapy (SRS)] .Methods A total of 89 patients with primary trigeminal neuralgia who under-went surgical treatment for the first time from 2005 to 2013 were enrolled in this study ,including 27 patients with MVD ,23 patients with RFR and 39 patients with SRS .Evaluation criteria (effect factors) include facial pain (excellent :no pain and no drug treat-ment ;good :no pain but medication ;worse:less than 50% of patients with pain ;worse:more than 50% of patients with facial pain or need to undergo secondary surgery ) ,numbness ,cost and .Results The mean age of the patients treated with MVD was (50 .4 ± 14 .3)years old ,RFR was(73 .2 ± 13 .6) years old SRS was (72 .6 ± 11 .8) years old ,MVD group was younger than RFR and SRS group(P<0 .05);The average total cost of each surgical approach as follows :MVD was 50274 yuan ,RFR was 4539 yuan ,SRS was 38512 yuan (P<0 .05);The postoperative facial numbness proportion of MVD was 1 .1% ,RFR was 52 .2% and SRS was 28 .2% (P<0 .05);The ratio of patients who needed recurrent surgery in two years was MVD 26 .0% ,RFR 73 .9% and SRS 30 .7% (P<0 .05);The mean remission rate of MVD was 1 .6 years ,the RFR was 2 .1 years ,and the SRS was 1 .0 year(P<0 .05);The cost-benefit ratio of MVD was 31618 yuan ,RFR was 1982 yuan ,SRS was 39297 yuan(P<0 .05) .Conclusion The cost-ben-efit ratio of the three surgical from low to high were RFR ,MVD ,SRS ,which means the unit cost of RFR gain the highest ,followed by M VD and SRS .

Objective To compare the treatment effect of surgically clipping anterior circulation aneurysms by lateral supraorbital approach and supraorbital keyhole approach for guiding the selection of surgical approach for anterior circulation aneurysms.Methods The clinical data of 80 patients diagnosed as anterior circulation aneurysms due to spontaneous subarachnoid hemorrhage from January 2011 to January 2016 were retrospectively analyzed,including the operation time,craniotomy time,cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge,GOS scores at discharge were compared between the two groups and the literatures were reviewed.Results The operation time and craniotomy time of the lateral supraorbital approach were less than those of the supraorbital keyhole approach,and the differences between the two groups were statistically significant (P＜0.05);the cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge and GOS scores at discharge had no statistical differences between the two groups (P＞0.05).Conclusion The lateral supraorbital approach has the advantages of shorter operation time and craniotomy time,providing a better surgical field during operation,less intraoperative traction and less postoperative complications,and can serve as an alternative scheme for the supraorbital keyhole approach in clipping anterior circulation aneurysms.

Objective To summarize the clinical experience of off-pump coronary artery bypass grafting (OPCABG) for treating high risk coronary artery disease (CAD,SinoSCORE ≥ 6 points),and to evaluate its safety and efficacy.Methods The clinical data of 73 patients with high risk coronary artery disease treated through OPCABG (high risk group)in our center from April 2012 to December 2015 were retrospectively analyzed and compared with those of other low or moderate risk 78 patients treated through OPCABG (SinoSCORE＜ 6 points,low or moderate risk group) at the same period.Results All operations in the high risk group were successfully performed.Compared with the low or moderate risk group,the rate of using left internal mammary artery grafts in the high risk group was reduced significantly (P＜0.05),the operation time,postoperative ventilator support time,postoperative intensive care unit stay time and postoperative hospitalization time were prolonged significantly (P＜0.05),the rate of using intraaortic balloon pump support was increased significantly (P＜0.05),and the occurrence rate of postoperative severe complications was also increased significantly (P＜0.05).Sixty-nine cases were postoperatively followed up for (18.3±8.6) months.During the following-up period,2 cases died.11 branches of internal mammary artery grafts patency (11/11) and 38 branches of great saphenous vein grafts patency (38/43) were confirmed in 18 cases by coronary artery computer tomography angiography or coronary angiography.One cases was performed the PCI therapy due to angina relapse,and other cases had no angina symptoms with good life quality.Conclusion OPCABG is a relatively minimally invasive and safe operative mode.Strengthening perioperative management can reduce the operation risk and achieves good short or middle term efficacy in the patients with high risk CAD.

Objective To investigate the safety of left atrial appendage occlusion by silk thread ligation during open heart op‐eration in patients with rheumatic atrial fibrillation ,and to evaluate its effectiveness for prevention of cerebral embolism .Methods From April 2012 to March 2014 ,129 patients with rheumatic atrial fibrillation were undergone mitral valve replacement and left at‐rial appendage occlusion by ligation using two silk threads from the outside of the heart (ligation group) .The indexes related to the operation ,postoperative complications incidence ,and cerebral embolism incidence during the follow‐up period of ligation group were compared with the indexes of another 129 patients without ligation of left atrial appendage over the same period (control group) . Results The operation time ,the cardiopulmonary bypass time ,the clamp time ,the intensive care unit stay time ,the postoperative hospitalization time in ligation group were (235 ± 50)min ,(88 ± 24)min ,(57 ± 16)min ,(26 .5 ± 9 .3)h and (12 .4 ± 7 .5)d respective‐ly ,and significant difference was not found compared with control group (P>0 .05) .The thoracotomy for hemostasis(1 cases) ,low cardiac output syndrome(2 cases) ,acute renal failure(2 cases) ,pulmonary infection(3 cases) ,sternal wound dehiscence(2 cases) and other complications in ligation group had no significant difference ,compared with control group(P>0 .05);2 cases died in liga‐tion group ,3 patients died in control group ,the differences had no statistical significance(P>0 .05) .No cerebral embolism occurred in ligation group with 127 patients following‐up (23 .6 ± 11 .3) months ,but 5 patients suffered from cerebral embolism in control group with 126 patients following‐up (22 .9 ± 12 .1) months ,the difference had statistical significance(P<0 .05) .Conclusion Left atrial appendage occlusion by silk thread ligation during open heart operation in patients with rheumatic atrial fibrillation is simple and safe ,can reduce cerebral embolism incidence .