[Feasibility and safety of minimally invasive cardiac coronary artery bypass grafting surgery for patients with multivessel coronary artery disease: Early outcome and short-mid-term follow up results].

OBJECTIVE: To explore the feasibility, safety and mid-term outcome of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) surgery. METHODS: Data of patients who underwent MICS CABG between November 2015 and November 2017 in Peking University Third Hospital were retrospectively analyzed. Results were compared with the patients who underwent off-pump coronary aortic bypass grafting (OPCABG) surgery over the same period. The two groups were matched in propensity score matching method according to age, gender, left ventricular ejection fraction, body mass index, severity of coronary artery disease, smoking, diabetes mellitus, hypertension, hyperlipidemia, renal insufficiency, history of cerebrovascular accident, and history of chronic obstructive pulmonary disease (COPD). RESULTS: There were 85 patients in MICS CABG group, including 68 males (80.0%) and 17 females (20%), with an average age of (63.8±8.7) years; 451 patients were enrolled in OPCABG group, and 85 patients were matched by propensity score as control group (OPCABG group). There was no significant difference in general clinical characteristics (P>0.05). The average grafts of MICS CABG and OPCABG were 2.35±0.83 and 2.48±0.72 respectively (P=0.284). No conversion to thoracotomy in MICS CABG group or cardiopulmonary bypass in neither group occurred. There was no significant difference in the major adverse cardiovascular events (MACCEs, 1.17% vs. 3.52%), reoperation (2.34 vs. 3.52%), new-onset atrial fibrillation rate (4.70% vs. 3.52%) or new-onset renal insufficiency rate (1.17% vs. 0%) between MICS CABG group and OPCABG group (P>0.05). The operation time in MICS CABG group was longer than that in OPCABG group [(282.8±55.8) min vs. (246.8±56.9) min, P < 0.05], while the time of ventilator supporting(16.9 h vs. 29.6 h), hospitalization in ICU [(29.3±20.8) h vs. (51.5±48.3) h] and total hospitalization [(18.3±3.2) d vs. (25.7±4.2) d] in MICS CABG group were shorter than those in OPCABG group (P < 0.05). The total patency rate (A+B levels) of MICS CABG was 96.5% after surgery. There was no significant difference in MACCEs rate between the two groups [1.18%(1/85) vs. 3.61%(3/83), P>0.05] in 1-year follow up. CONCLUSION: The MICS CABG surgery is a safe and feasible procedure with good clinical results in early and mid-term follow-up.

[Clinical experience of minimal invasive coronary surgery-coronary artery bypass grafting: a series of 244 cases].

Objective: To examine the safety and efficacy of minimally invasive coronary surgery-coronary artery bypass grafting (MICS-CABG). Methods: From the first case in November 2015 to November 2019, a total of 244 cases of MICS-CABG were performed in Department of Cardiovascular Surgery, Peking University Third Hospital. There were 197 males and 47 females, aging (62.3±8.7)years (range: 36 to 88 years). The operations were performed via the 5(th) intercostal space of left thoracic lateral incision (length: 4 to 5 cm extended for 8 to 10 cm), and were performed under off-pump, with the help of the chest wall suspension device and cardiac fixator. The proximal anastomosis on ascending aorta and the distal anastomosis of left anterior descending branch, circumflex branch and right coronary system were completed according to procedure. In all 244 cases, the proportion of 2 grafts was 53.7% (131 cases), 3 grafts was 36.1% (88 cases), 4 grafts was 9.8% (24 cases) and 5 grafts was 0.4% (1 case). The average of grafts was 2.6±0.7 (range: 2 to 5). The proportion of hybrid was 14.3% (35 cases), sequential bypass procedure was 43.0% (105 cases) and multiple artery grafts was 25.4% (62 cases). The perioperative complications of the patients were collected, the patency rate of the grafts was evaluated by coronary angiography or CT within 7 days after the operation, and main adverse cardiovascular and cerebrovascular events (MACCE) were followed up. The survival curve was drawn by Kaplan-Meier method, and the 1-year MACCE rate was calculated by survival analysis. Results: All cases had no transition to thoracotomy and cardiopulmonary bypass procedure, and no cases needed intra aortic balloon pumping and extracorporeal membrane oxygenation during the operation.There were 2 cases of poor incision healing, and reoperation was performed in 10 cases (6 cases of postoperative bleeding, 2 cases of incision debridement, and 2 cases of grafts problems). The rate of MACCE in 30 days was 2.6% (10 cases), which contained 3 cases of death (2 cases of grafts occlusion, 1 case of serious hemorrhage after thoracic puncture drainage), 3 cases of stroke and 5 cases of non-fatal myocardial infarction. By the re-examination of angiography in 7 days after operation, the overall patency of the grafts was 96.1%, and the patency of the left anterior descending was 98.6%. Kaplan-Meier survival analysis was conducted for 235 patients (96.3%) with 1 to 36 months follow-up results, and the 1-year MACCE rate was 5.6% (95%CI: 4.2% to 7.0%) . There was no significant difference among the incidences of MACCE at each stage of learning curve. Surgeon could reduce the operation time and complete more anastomosis with the accumulation of experience after the early 30 cases. Conclusions: MICS-CABG can safely achieve completed revascularization, which has good operative effects in short and medium-long term. There is no significant risk in the early cases of learning curve.

The role of miR-145 in promoting the fibrosis of pulmonary fibroblasts.

The effects of miR-145 (microRNA 145) on M. pneumoniae (MP)-infected MRC-5 (Medical Research Council cell strain 5) cell TGF-ß/Smad (transforming growth factor beta/Smad) fibrosis pathway were explored through constructing MP-infected MRC-5 cell models. In addition, the qPCR (quantitative real-time polymerase chain reaction) and Western blot were applied to detect the mRNA and protein expressions of miR-145, TGF-ß1 (transforming growth factor beta 1), Smad3, Smad4, MMP2 (matrix metalloproteinase 2), FN1 (fibronectin 1), ELN (elastin) and COLI α1 (collagen type I alpha 1) signaling molecules in TGF-ß/Smad fibrosis pathway. The results showed that the expression of miR-145 in MRC-5 cells was significantly increased after MP infection. In addition, miR-145 inhibited the fibrosis promoting TGF-ß/Smad pathway by targeting Smad3, a key factor in the TGF-ß/Smad pathway. It can be concluded that, in the process of MP infection, the expression of miR-145 is stimulated to negatively regulate the fibrosis-promoting pathway of TGF-ß/Smad.

[Early clinical outcomes of minimally invasive coronary surgery-total arterial coronary revascularization].

Objective: To summarize the early experience and clinical value of minimally invasive coronary surgery-total arterial coronary revascularization (MICS-TACR) through the left anterior small incision. Methods: Between May 2015 and June 2018, a total of 31 consecutive cases [21 males and 10 females, aged (63.2±9.3) years] in Peking University Third Hospital who were performed MICS-TACR with bilateral internal mammary artery and radial artery were enrolled. Meanwhile, 1 489 cases of conventional median sternal incision off-pump coronary artery bypass grafting (OPCABG) were matched as control group. According to exclusion criteria and matching score, 90 cases [55 males and 35 females, aged (63.8±9.5) years] were selected as the control group, and the perioperative data of the two groups were compared. All patients in MICS-TACR group underwent postoperative angiography and the graft patency was evaluated. Results: There were no statistically significant differences in baseline data between the two groups. The perioperative blood transfusion of MICS-TACR group was less than control group [0(0,0) U vs 0(0,4) U, P=0.003]. There were no statistically significant differences in operative mortality, intraoperative and postoperative intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) use, re-operation rate, perioperative major adverse cardiac and cerebrovascular events (MACCE), new-onset renal failure, atrial fibrillation, and multiple organ failure between the two groups. Postoperative angiography showed that there was no significant difference in the patency rate between the MICS-TACR group and control group(all P>0.05). Conclusion: Total arterial coronary revascularization can be successfully accomplished under the left anterior small incision, and the early clinical outcome is satisfied.

[Etiological monitoring and analysis of cases of acute flaccid paralysis in Hebei Province in 2011-2014].

Objective: To identify poliomyelitis(polio)virus, the VP1 gene, and its nucleotide sequence in fecal samples from patients with acute flaccid paralysis(AFP)in Hebei Province in 2011-2014. Methods: A surveillance system for AFP was established in Hebei Province in 2011-2014 and registered in 2014. Stool samples, each weighing 5 g, were collected from 1 504, 15-year-old symptomatic patients with AFP, resulting in a total of 3 001 samples(1 497 patients provided duplicate samples and 7 provided single specimens). Poliovirus nucleic acid was extracted, the RNA was reverse transcribed, and a VP1 gene fragment was amplified with real-time PCR. The PCR products were sequenced to construct a phylogenetic tree and check the relatedness of the strains to the Sabin vaccine strain. A χ2 test was used to compare the differences in the incidence of infection in different years. Results: Poliovirus was isolated from 50(1.7%)of the 3 001 stool samples, 10 of which were type Ⅰ strains, 15 were type Ⅱ strains, 16 were type Ⅲ strains, and 9 were mixed-type strains. The positive rates for poliovirus in the years 2011-2014 were 1.0%(9/890), 1.5%(12/824), 2.2%(17/770), and 2.3%(12/517), respectively(χ2=2.24, P=0.525). Analyses of the VP1 nucleotide and amino acid sequence homologies revealed that the type Ⅰ, type Ⅱ, and type Ⅲ poliovirus strains shared nucleotide sequence homologies with the Sabin vaccine strain of 98.8%- 100%, 99.1%- 100%, and 99.2%- 100%, respectively, and amino acid sequence homologies of 98.6%- 100%, 98.3%-100% and 98.6%-100%, respectively. A VP1-based phylogenetic analysis showed that the variation rates for the poliovirus type Ⅰ, type Ⅱ, and type Ⅲ strains were 0.66%, 0.66%, and 0.55%, respectively. Conclusion: Only one poliovirus strain was detected in Hebei Province in 2011-2014, except for the type Ⅱ vaccine-derived poliovirus. The remaining strains were all similar to the Sabin vaccine strain, with high VP1 homology.

A consortium of rhizobacterial strains and biochemical growth elicitors improve cold and drought stress tolerance in rice (Oryza sativa L.).

In the present study, a consortium of two rhizobacteria Bacillus amyloliquefaciens Bk7 and Brevibacillus laterosporus B4, termed 'BB', biochemical elicitors salicylic acid and ß-aminobutyric acid (SB) and their mixture (BBSB) were investigated for cold and drought stress tolerance in rice plants. After withholding water for 16 days, rice plants treated with BBSB showed 100% survival, improved seedling height (35.4 cm), shoot number (6.12), and showed minimum symptoms of chlorosis (19%), wilting (4%), necrosis (6%) and rolling of leaves. Similarly, BB inoculation enhanced plant growth and reduced overall symptoms in rice seedlings subjected to 0 ± 5 °C for 24 h. Our results imply several mechanisms underlying BB- and BBSB-elicited stress tolerance. In contrast to the control, both treatments significantly decreased leaf monodehydroascorbate (MDA) content and electrolyte leakage, and increased leaf proline and cholorophyll content. Moreover, activities of antioxidant enzymes, superoxide dismutase (SOD) and catalase (CAT) increased 3.0- and 3.6-fold, respectively. Moreover, expression of OsMYB3R-2, OsDIL, OsDREB1A and OsCDPK13 genes was significantly up-regulated, suggesting that these genes play important roles in abiotic stress tolerance of rice. In addition, bacterial strains Bk7 and B4 were able to produce high amounts of IAA and siderophores, and colonise the plant roots, while only strain Bk7 exhibited the capability to form biofilms and solubilise inorganic phosphate. This study indicates that the BB and BBSB bio-formulations can be used to confer induced systematic tolerance and improve the health of rice plants subject to chilling and drought stress.

Online monitoring of oil film using electrical capacitance tomography and level set method.

In the application of oil-air lubrication system, electrical capacitance tomography (ECT) provides a promising way for monitoring oil film in the pipelines by reconstructing cross sectional oil distributions in real time. While in the case of small diameter pipe and thin oil film, the thickness of the oil film is hard to be observed visually since the interface of oil and air is not obvious in the reconstructed images. And the existence of artifacts in the reconstructions has seriously influenced the effectiveness of image segmentation techniques such as level set method. Besides, level set method is also unavailable for online monitoring due to its low computation speed. To address these problems, a modified level set method is developed: a distance regularized level set evolution formulation is extended to image two-phase flow online using an ECT system, a narrowband image filter is defined to eliminate the influence of artifacts, and considering the continuity of the oil distribution variation, the detected oil-air interface of a former image can be used as the initial contour for the detection of the subsequent frame; thus, the propagation from the initial contour to the boundary can be greatly accelerated, making it possible for real time tracking. To testify the feasibility of the proposed method, an oil-air lubrication facility with 4 mm inner diameter pipe is measured in normal operation using an 8-electrode ECT system. Both simulation and experiment results indicate that the modified level set method is capable of visualizing the oil-air interface accurately online.

Design of a magnetic shielding system for the time of flight enhanced diagnostics neutron spectrometer at Experimental Advanced Superconducting Tokamak.

The novel neutron spectrometer TOFED (Time of Flight Enhanced Diagnostics), comprising 90 individual photomultiplier tubes coupled with 85 plastic scintillation detectors through light guides, has been constructed and installed at Experimental Advanced Superconducting Tokamak. A dedicated magnetic shielding system has been constructed for TOFED, and is designed to guarantee the normal operation of photomultiplier tubes in the stray magnetic field leaking from the tokamak device. Experimental measurements and numerical simulations carried out employing the finite element method are combined to optimize the design of the magnetic shielding system. The system allows detectors to work properly in an external magnetic field of 200 G.

Data acquisition system with pulse height capability for the TOFED time-of-flight neutron spectrometer.

A new time-of-flight neutron spectrometer TOFED has been constructed for installation at Experimental Advanced Superconducting Tokamak. A data acquisition system combining measurements of flight time and energy from the interaction of neutrons with the TOFED scintillators has been developed. The data acquisition system can provide a digitizing resolution better than 1.5% (to be compared with the >10% resolution of the recoil particle energy in the plastic scintillators) and a time resolution <1 ns. At the same time, it is compatible with high count rate event recording, which is an essential feature to investigate phenomena occurring on time scales faster than the slowing down time (≈100 ms) of the beam ions in the plasma. Implications of these results on the TOFED capability to resolve fast ion signatures in the neutron spectrum from EAST plasmas are discussed.

Light output function and assembly of the time-of-flight enhanced diagnostics neutron spectrometer plastic scintillators for background reduction by double kinematic selection at EAST.

The 2.5 MeV neutron spectrometer TOFED (Time-Of-Flight Enhanced Diagnostics) has been constructed to perform advanced neutron emission spectroscopy diagnosis of deuterium plasmas on EAST. The instrument has a double-ring structure which, in combination with pulse shape digitization, allows for a dual kinematic selection in the time-of-flight/recoil proton energy (tof/Ep) space, thus improving the spectrometer capability to resolve fast ion signatures in the neutron spectrum, in principle up to a factor ≈100. The identification and separation of features from the energetic ions in the neutron spectrum depends on the detailed knowledge of the instrument response function, both in terms of the light output function of the scintillators and the effect of undesired multiple neutron scatterings in the instrument. This work presents the determination of the light output function of the TOFED plastic scintillator detectors and their geometrical assembly. Results from dedicated experiments with γ-ray sources and quasi-monoenergetic neutron beams are presented. Implications on the instrument capability to perform background suppression based on double kinematic selection are discussed.

Design of the radiation shielding for the time of flight enhanced diagnostics neutron spectrometer at Experimental Advanced Superconducting Tokamak.

A radiation shielding has been designed to reduce scattered neutrons and background gamma-rays for the new double-ring Time Of Flight Enhanced Diagnostics (TOFED). The shielding was designed based on simulation with the Monte Carlo code MCNP5. Dedicated model of the EAST tokamak has been developed together with the emission neutron source profile and spectrum; the latter were simulated with the Nubeam and GENESIS codes. Significant reduction of background radiation at the detector can be achieved and this satisfies the requirement of TOFED. The intensities of the scattered and direct neutrons in the line of sight of the TOFED neutron spectrometer at EAST are studied for future data interpretation.

Monte Carlo simulation of a Bonner sphere spectrometer for application to the determination of neutron field in the Experimental Advanced Superconducting Tokamak experimental hall.

To assess the neutron energy spectra and the neutron dose for different positions around the Experimental Advanced Superconducting Tokamak (EAST) device, a Bonner Sphere Spectrometer (BSS) was developed at Peking University, with totally nine polyethylene spheres and a SP9 (3)He counter. The response functions of the BSS were calculated by the Monte Carlo codes MCNP and GEANT4 with dedicated models, and good agreement was found between these two codes. A feasibility study was carried out with a simulated neutron energy spectrum around EAST, and the simulated "experimental" result of each sphere was obtained by calculating the response with MCNP, which used the simulated neutron energy spectrum as the input spectrum. With the deconvolution of the "experimental" measurement, the neutron energy spectrum was retrieved and compared with the preset one. Good consistence was found which offers confidence for the application of the BSS system for dose and spectrum measurements around a fusion device.

Clinical application of carbon nanoparticle lymph node tracer in the VI region lymph node dissection of differentiated thyroid cancer.

The application and clinical significance of carbon nanoparticle lymph tracer in the VI region (central region) lymph node dissection of differentiated thyroid cancer was investigated. Eighty patients with differentiated thyroid cancer were equally divided into the carbon nanoparticle-marked group (ipsilateral thyroid injection) and the control group (no injection). All patients underwent standard primary tumor treatment and VI lymph node dissection. The number of lymph nodes retrieved in the carbon nanoparticle group (mean=6.725 pieces, range=1-13) was significantly higher than those retrieved in the control group (mean=3.6, range=1-7; P<0.05). The black staining lymph node rate was 69.89%. A significantly higher number of lymph nodes less than 2 mm were detected in the carbon nanoparticle group (P=0.0023). The transfer rates and lymph node metastasis rates did not differ significantly between the two groups. The black-staining lymph node metastasis rate was 20.74% (39/188) and the non-staining lymph node metastasis rate was 22.22% (18/81), which were not significantly different (P=0.7856). No parathyroid accidental resection was observed in the carbon nanoparticle group, whereas three cases occurred in the control group (P=0.2405). In conclusion, carbon nanoparticles show good lymphatic tracer effects, easy identification, increased number of lymph nodes retrieved, more accurate reflection of the VI region lymph node status, and increased accuracy of the clinical stage. These results should help develop reasonable surgery programs and follow-up comprehensive treatments, and can help to reduce the risk of accident parathyroid resection.

[The protective effects of tea catechins on the injury of cerebral ischemia and reperfusion in rats].

OBJECT: The protective effects of tea catechins on the injury of cerebral ischemia and reperfusion in rats were observed with rat cerebral ischemia and reperfusion model produced by bilaterally clamping the common carotid arteries and vagus nerves for 60 min and then removing the occlusion for 30 min. METHOD: Wistar rats were divided into normal control group, model group and catechin group (30 mg.kg-1 and 50 mg.kg-1 i.p., qd x 7 d). The changes of biochemical indications and pathology were observed. RESULT: The results presented that the concentration of MDA in brain tissue and serum of model rats were higher than that of control rats(P < 0.01). Compared with model group, tea catechin groups could decrease the concentration of MDA in brain tissue and serum, and tea catechin group (50 mg.kg-1 i.p., qd x 7 d) could improve the injury of blood brain barrier. CONCLUSION: Tea catechins have protective effects on the injury of cerebral ischemia and reperfusion in rats.

[Prophylactic and therapeutic effect of jiawei zhigancao tang injection on experimental arrhythmia in rats].

The antiarrhythmic effect of Jiawei Zhigancao Tang injection (JZTI) was studied in experimental arrhythmia induced by aconitine or by CaCl2 in anesthetized rats. The prophylactic dose of JZTI (5g/kg, i.v.) reduced the incidence rate of premature ventricular complexes, ventricular tachycardia (P < 0.01), delayed the onset time of arrhythmia induced by CaCl2 (P < 0.01), and the recovery time of sinus rhythm occurred earlier than that of control group (P < 0.01). The therapeutic dose of JZTI (10g/kg, i.v.) raised the rate of aconitine-induced arrhythmia to sinus rhythm conversion (P < 0.05). The results showed that JZTI could significantly antagonize arrhythmia induced by aconitine or by Cacl2 in rats.