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.

Objective     To evaluate the clinical effectiveness of valve-sparing aortic root replacement (VSARR) in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot (TOF). Methods     A retrospective analysis was conducted on clinical data of TOF patients with aortic root dilation who underwent VSARR in our hospital from 2016 to 2022. Results     Finally 14 patients were collected, including 8 males and 6 females, with a median age of 22 years ranging from 12-48 years. Among them, 5 patients had severe aortic valve regurgitation, 4 moderate regurgitation, and 5 mild or no regurgitation. Six patients had sinus of valsalva dilation, and 8 significant dilation of the ascending aorta. One patient had residual shunt due to ventricular septal defect, and 9 severe pulmonary valve regurgitation. The David procedure was performed in 10 patients, Yacoub procedure in 2 patients, and Florida sleeve in 2 patients. There was no perioperative mortality in the group. The median follow-up time was 2.9 years (ranging from 0.4 to 6.0 years). One patient had mild aortic valve regurgitation, and the rest had minimal or no regurgitation. One patient had mild stenosis of the left ventricular outflow tract, and the rest patients had no obvious stenosis. Conclusion     VSARR is a satisfactory treatment for aortic root dilation in patients with TOF, with no significant increase in the incidence of left ventricular outflow tract stenosis or aortic regurgitation during mid-term follow-up.

Objective     To evaluate the association between pressure-controlled ventilation-volume guaranteed (PCV-VG) mode and volume-controlled ventilation (VCV) mode on postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic lung resection. Methods     A retrospective cohort analysis of 329 patients undergoing elective thoracoscopic lung resection in West China Hospital of Sichuan University between September 2020 and March 2021 was conducted, including 213 females and 116 males, aged 53.6±11.3 years. American Society of Anesthesiologists (ASA) grade wasⅠ-Ⅲ. The patients who received lung-protective ventilation strategy during anesthesia were divided into a PCV-VG group (n=165) and a VCV group (n=164) according to intraoperative ventilation mode. Primary outcome was the incidence of PPCs during hospitalization. Results     A total of 73 (22.2%) patients developed PPCs during hospitalization. The PPCs incidence of PCV-VG and VCV was 21.8% and 22.6%, respectively (RR=0.985, 95%CI 0.569-1.611, P=0.871). Multivariate logistic regression analysis showed that there was no statistical difference in the incidence of PPCs between PCV-VG and VCV mode during hospitalization (OR=0.846, 95%CI 0.487-1.470, P=0.553). Conclusion     Among patients undergoing thoracoscopic lung resection, intraoperative ventilation mode (PCV-VG or VCV) is not associated with the risk of PPCs during hospitalization.

Objective     To evaluate the association between anesthesia regimen (volatile or intravenous anesthetics) and postoperative infection in adult cardiac patients undergoing cardiac surgery. Methods    The clinical data of 496 elective adults undergoing cardiac surgery under cardiopulmonary bypass from June 2019 to June 2020 in West China Hospital of Sichuan University were retrospectively analyzed, including 251 females and 245 males with an average age of 54.1±11.4 years. American Society of Anesthesiologists grade was Ⅰ-Ⅲ. There were 243 patients in a volatile group with sevoflurane or desflurane, and 253 patients in an intravenous anesthesia group with propofol. The primary outcome was the incidence of infection within 30 days after cardiac surgery, including pulmonary infection, surgical site infection, sepsis, and urinary tract infection. The secondary outcomes were duration of mechanical ventilation, incidence of reintubation, ICU stay, postoperative length of hospital stay and total hospitalization cost. Results     A total of 155 (31.3%) patients developed postoperative infection within 30 days, with an incidence of 32.9% in the volatile group and 29.6% in the intravenous anesthesia group. There was no statistical difference in the incidence of infection (RR=1.111, 95%CI 0.855 to 1.442, P=0.431) or the secondary outcomes (P>0.05) between the two groups. Conclusion     The anesthesia regimen (volatile or intravenous anesthetics) has no association with the risk of occurrence of postoperative infection in adult  patients undergoing elective cardiac surgery with cardiopulmonary bypass.

In recent years, metagenomics(MGS)is the fastest growing fields in microbiology, and has been broadly applied in the detection of pathogenic microorganisms. Comparing with the traditional poly merase chain reaction(PCR)-based detecting technology which relies on microbial culture, MGS can directly detect the sequences of the total microbial DNA from uncultured samples with the high-throughput sequencing platform. It can help the doctors identify the involved pathogens more quickly and provide better medication guidance. Among the known ophthalmic diseases, a lot of them are caused by the infection of pathogens and have many difficulties in clinical diagnosis and treatment. The development of metagenomics provides us a more effective and reliable way for detecting the pathogens of ophthalmic diseases. This article was aimed to review the development of MGS, applications and in the field of ophthalmology, as well as its current deficiencies and the possible development directions in the future.

AIM: To evaluate the efficacy of rituximab in thyroid associated ophthalmopathy by using a Meta-analysis of the literature.

METHODS: Databases such as CNKI, Wanfang, Weipu, China Biomedical, PubMed, Web of Science, OVID, Cochrane Library, and ClinicalTrial.gov were searched. From the establishment of the database to December 31, 2019 on rituximab clinical studies on the treatment of thyroid associated ophthalmopathy. The clinical activity score of thyroid associated ophthalmopathy before and after treatment was used as the main judgment index of curative effect. The retrieved clinical studies were analyzed using RevMan 5.3 statistical software.

RESULTS: Six studies were included, two were randomized controlled trials, and four were cohort studies. Meta analysis showed that the application of rituximab in the treatment of moderate to severe thyroid associated ophthalmopathy can significantly reduce the clinical activity score of patients, and has statistical significance \〖SMD=-5.04, 95% CI(-7.08 to -3.01), P<0.00001\〗.

CONCLUSION: Rituximab can significantly reduce the clinical activity score of patients with moderate to severe thyroid associated ophthalmopathy, and has a good effect on disease control.

AIM: To investigate the clinical effect of vitamin A Palmitate Eye Gel combined with Tobramycin Eye Drops on corneal epithelial injury.

METHODS: Totally 80 patients(100 eyes)with corneal epithelial injury who came to our hospital from May 2015 to March 2016 were randomly divided into treatment group(50 eyes)and control group(50 eyes). The treatment group was treated with vitamin A Palmitate Eye Gel combined with Tobramycin Eye Drops, while the control group was treated with Tobramycin Eye Drops only. The curative effect of two groups was compared after 2wk and 4wk of treatment.

RESULTS: The cure rate was 80% and the effective rate was 94% in the treatment group. The cure rate was 70% and the effective rate was 78% in the control group. There was significant difference in the effective rate between the two groups(P<0.05). The results of SⅠt and BUT test showed that the time of treatment group was significantly longer than that of control group(P<0.01). The score of symptoms and signs in the treatment group was significantly lower than that in the control group after 2wk of treatment(P<0.01), but there was no significant between treatment groups and control grouop after 4wk of treatment(P>0.05).

CONCLUSION: Vitamin A Palmitate Eye Gel combined with Tobramycin Eye Drops can significantly improve dry eye symptoms and effectively shorten the healing time of corneal epithelium. It is an effective method to treat corneal epithelial injury.

Objective To analyze the results from adopted evaluation of Composite Adaptation of Assistive Devices Program (CAADP) in Shanghai. Methods 1996 potential adaptation objects were evaluated by professional assessment panel with the questionnaire developed by our research group in the early. Results and Conclusion Physical disabilities were the majority. 97.69% of the objects needed different assistance from others or aids in their daily lives, with low quality of life. The assistive devices recommended were an average of 4.3 per person with complete species.