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Objective: To investigate the clinical characteristics and correlated factors of preoperative sleep disorders in patients undergoing various types of cardiac surgery. Methods: The data of patients at the Structural Heart Surgery Center of Beijing Anzhen Hospital, Capital Medical University, from April 2023 to February 2024 were retrospectively collected. Patients were categorized into five groups based on cardiac surgical diagnosis: coronary heart disease, valvular disease, large vessel disease, congenital heart disease, and others. Each group was further subdivided into normal sleep (NS) and sleep disorder (SD) groups based on the Pittsburgh Sleep Quality Index (PSQI) scores. Demographic information, cognitive function, psychiatric symptoms, and other relevant data were collected. Clinical characteristics were compared between groups, and factors associated with preoperative sleep disorders were analyzed using multivariate logistic regression. Results: A total of 1 016 patients aged (58.6±12.7) years were included in the study, including 701 males and 315 females. The incidence of SD was 45.6% (463/1 016). Multivariate logistic regression analysis showed that aging was a risk factor for sleep disorders in patients with coronary heart disease ( OR =1.050, 95% CI : 1.026-1.077) and valvular disease ( OR =1.033, 95% CI : 1.013-1.053). High Self-rating Depression Scale (SDS) score was a risk factor for sleep disorders in patients with valvular disease ( OR =1.050, 95% CI : 1.013-1.091). High score on the Montreal Cognitive Assessment (MoCA) subitem-abstraction ability was a protective factor for sleep disorders in patients with coronary heart disease ( OR =0.695, 95% CI : 0.490-0.981). Conclusions: The risk factors of preoperative sleep disorders in cardiac surgery patients vary based on the type of cardiac disease. Aging, depression and abstraction ability correlate with sleep disorders in cardiac surgical patients.

Objective: To explore the feasibility of endoscopic lymph node dissection(LND) with programmed breast approach for the treatment of papillary thyroid cancer. Methods: A case series study. The clinical data of 39 patients with papillary thyroid cancer who underwent endoscopic LND treatment with programmed breast approach in Shenzhen People's Hospital from January to November 2022 were retrospectively analyzed. There were 10 males and 29 females, aged (35.95±10.17) years. LND time, total surgical time, intraoperative bleeding volume, postoperative drainage volume, postoperative hospital stay and postoperative complications were analyzed. Results: Among 39 patients, there were 18 cases of unilateral thyroid cancer, 21 cases of bilateral thyroid cancer, 35 cases of unilateral LND, and 4 cases of bilateral LND. The maximum diameter of thyroid cancer lesions was (1.48±0.69) cm, and the maximum diameter of lymph node metastases was (1.63±0.58)cm. The operative time of unilateral neck dissection was (124.11±19.92) min (102-170 min), and the total operative time was (226.42±55.68) min (110-390 min). The number of lymph nodes cleaned was (32.40±10.44)(12-54), the number of metastasis and detection was 207/1 393. The postoperative drainage volume was (174.64±82.33) ml(41-350 ml). There were no neck hematomas, no skin burns or no shrugging disorders in the postoperative period. There were 7 cases of numbness and discomfort in neck skin sensation, which gradually relieved after half a year. Postoperative discharge time (4.77±1.94) d(3-15 d). Conclusion: It is safe and feasible to treat papillary thyroid cancer with endoscopic LND with programmed breast approach, which can improve surgical efficiency and clinical application value.

Objective: To explore the potential application of a three-dimensional visualization technique in adrenal vein sampling (AVS). Methods: The clinical data were retrospectively analyzed, which included 76 patients with primary aldosteronism (PA) who have undergone AVS in Guizhou Provincial People's Hospital from December 2017 to May 2020. All cases were examined by adrenal thin-section enhanced CT and blood was drawn by bilateral AVS. Among them, the adrenal vein blood of 46 cases was sampled with the help of three-dimensional (3D) visualization processing of CT data, while that of 30 cases was without 3D visualization processing. The rate of the catheter in place, the successful rate of AVS, the time of blood collection, the dosage of the contrast agent, and surgical complications were compared between the two groups. Results: There were 76 cases included, while 38 were male and 38 were female. The average age was 45 (25-57) years. Compared with the patients without the aid of 3D visualization, the success rate of right AVS of the patients with the aid of 3D visualization technology increased from 43% to 78% ( P <0.05). The success rate of adrenal vein blood collection increased from 53% to 83%. The dose of contrast agent decreased [the M ( Q 1 , Q 3 ) were78 (59, 89) ml vs 28 (16, 51) ml, P <0.05], and the time of blood sampling from the right adrenal vein approximately decreased [the M （ Q 1 ， Q 3 ） were 70 (66, 88) min vs 44 (22, 61) min, P <0.05]. Compared with the case without the aid of 3D visualization, the left adrenal vein catheterization rate of patients in the 3D visualization group increased from 97% to 98%, the success rate of adrenal vein blood collection increased from 97% to 98%, and the differences of the time of blood sampling and the dosage of the contrast were not statistically significant between the two groups. Among all the cases experienced bilateral AVS, only one patient without 3D reconstruction had contrast extravasation, and the others had no obvious complications. Conclusions: Before AVS, 3D visualization processing of adrenal vein from CT data is capable of increasing the success rate of blood sampling from the right adrenal vein, as well as reducing the dosage of contrast agent and the time of adrenal vein blood sampling. Therefore, it has a potential clinical value of the application.

Objective: To compare the clinical characteristics and prognosis of critical patients with COVID-19 and novel influenza A (H1N1) virus pneumonia (influenza pneumonia) applied with extracorporeal membrane oxygenation (ECMO). Methods: A total of 24 patients with influenza pneumonia treated with ECMO in respiratory intensive-care unit (ICU) of Beijing Chaoyang Hospital from March 2016 to December 2019 and 12 patients with COVID-19 hospitalized from February 1, 2020 to March 31, 2020 in 5 government designated infectious hospitals of Beijing and Hebei Province that applied with ECMO were enrolled. The demographic data, clinical manifestations, and ECMO related information were described and analyzed and all numerical variables are described as M ( P 25 , P 75 ). Results: The age of COVID-19 patients was 77 (66, 79) years old, which was older than influenza pneumonia patients [46 (32, 62) years old], P <0.05; acute lung injury score and respiratory ECMO survival prediction (RESP) score before ECMO application were 3.3 (3.0, 3.5) and 1 (0, 2), respectively, which were lower than influenza pneumonia patients [3.8 (3.5, 4.0) and 4 (2, 6), respectively], all P values<0.05. Thrombotic complications, bleeding complications, and ventilator-associated pneumonia occurred in ECMO applied COVID-19 patients were 4, 10 and 5 cases, respectively, which were more than that among influenza pneumonia patients (1, 9, and 2 cases, respectively), all P values<0.05. The length of ICU stay of COVID-19 patients was 31 (28, 75) d, which was longer than that of influenza pneumonia patients [27 (18, 39) d], P <0.05. The cases with successful decannulation of ECMO among COVID-19 and influenza pneumonia patients were 6 and 14 cases, respectively and mortality during ICU stay were 8 cases and 11 cases, respectively, and the difference were not statistically significant (all P values>0.05). Conclusion: COVID-19 patients applied with ECMO have more ECMO-related complications and a longer stay in the ICU than patients with influenza pneumonia.

Objective: To investigate the impact of metabolic syndrome (MS) and its individual components on long-term prognosis of patients undergoing percutaneous coronary intervention(PCI). Methods: Patients who underwent PCI in Fuwai Hospital in 2013 were enrolled and divided to two groups: with MS and without MS. The primary endpoint of 2-year follow-up was major adverse cardiovascular events (MACE), including death, myocardial infarction, and repeat revascularization. Results: Of the 10 422 PCI patients, there were 5 656 (54.27%) without MS and 4 766 (45.73%) with MS. Patients in the MS group were younger, tended to be male and had more comorbidities. There were no significant differences between the two groups in the proportion of drug-coated stents and the success rate of interventional therapy. The 2-year follow-up showed that the incidence of MACE in the MS group was significantly higher than that in the MS-free group (12.0% vs 10.0%, P< 0.001), which was mainly due to the significantly higher revascularization rate in the MS group than in the non-MS group (9.5% vs 7.9%, P= 0.003). Cox's regression analysis showed that MS was an independent risk factor for MACE. In MS component analysis, abnormal glucose metabolism was an independent risk factor for MACE events. Conclusions: Among the patients undergoing PCI, the incidence of MACE in patients with MS is significantly higher than that in patients without MS, and MS was an independent risk factor for MACE. In addition, hyperglycemia is an independent predictor for MACE.

Objective: To Summarize the experience of pump-controlled retrograde trial off (PCRTO) in the process of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) withdrawal in adult patients. Methods: Adult patients who received ECMO assistance in Intensive Care Unit for Cardiac Surgery from March to July 2019 were collected. According to our strategies, PCRTO was used if the patients can wean from VA-ECMO and hemodynamic indexes were recorded during the process. The statistics data was collected, including the 48 hours survival rate, ECMO re-assistance rate, thrombus complications, Intensive Care Unit (ICU) stay time and hospital stay time after weaning from VA-ECMO. The patients who failed in the test were continued to be assisted by ECMO. Results: There were 46 patients assisted by VA-ECMO in our center. In total, 21 adults who met the offline test standard underwent 26 PCRTOs, including 10 male adults (47.6%), with an age of 65 (55, 68) years old. Eighteen adults passed the withdrawal test. No new thrombus was found in the arteriovenous ultrasound of the lower extremity after weaning from ECMO, and no pulmonary embolism was found in the chest X-ray. The success rate of weaning from ECMO was 69.23%(18/26). The D-dimer decreased [584(348,2 107)μg/L vs 1 440(631,2 916)μg/L, P= 0.014] and the left ventricular ejection fraction (LVEF) increased (51.4%±8.5% vs 46.9%±10.6%, P= 0.013) on the next day after weaning. There were significant differences in heart rate (HR), central venous pressure (CVP), oxygenation index and lactate (Lac) during the PCRTO in the group which involved the cases of the 8 failed experiments (all P< 0.05). Compared with the failure group, there were significant differences in age, blood flow rate, CVP before the test, HR, pulse oxygen saturation(SpO(2)), CVP, Lac and oxygenation index after the test, and the variations of SpO(2), CVP and Lac. Conclusion: PCRTO is a simple, reversible, safe and effective weaning method. It can be used in the process of VA-ECMO withdrawal in adult patients.

Objective: To evaluate the relationship between admission mean platelet volume (MPV) and 2-year cardiac mortality in patients with stable coronary artery disease (CAD) undergoing elective percutaneous coronary intervention (PCI), and explored the consistence of this relationship in diabetes mellitus (DM) and non-DM subgroups. Method: A total of 4 293 patients who underwent PCI in Fuwai Hospital in 2013 were enrolled and divided into two groups according to MPV as follows: lower MPV ( n= 2 219, MPV≤10.5fL) and higher MPV ( n= 2 074, MPV>10.5fL). Result: Patients with high MPV had a higher rate of DM (30.4%(674/2 219) vs 34.5%(715/2 074)), smoking (53.3%(1 183/2219) vs 57.0%(1 182/2 074)), and previous coronary artery bypass grafting (CABG) (4.0%(88/2 219) vs 5.4%(112/2 074)), while left ventricular ejection fraction (LVEF) (64±7 vs 63±7), and glomerular filtration rate (eGFR) (92±14 vs 91±15) were lower compared with patients in the low MPV group (all P< 0.05). In the laboratory examination, patients with high MPV had higher glycosylated hemoglobin, and lower platelet count (all P< 0.05). In coronary angiography, there was no significant difference in SYNTAX scores, left main/three-vessel lesions, stent type, success rate of operation, and total stent length (all P> 0.05). Compared with low MPV group, patients with high MPV had ahigher cardiac mortality [18 (0.9%) vs 5 (0.2%), P= 0.004]. Kaplan-Meier analysis showed that compared to low MPV group, cardiac mortality in high MPV group was significantly higher (Log-rank P= 0.004). Multivariate Cox regression analysis showed that high MPV was independently associated with 2-year cardiac mortality ( HR 4.127, 95 %CI 1.373 to 12.405, P= 0.012). Receiver operating characteristic curve (ROC) analysis also showed that MPV had a good diagnostic value in predicting 2-year cardiac mortality (area under the curve=0.624, 95 %CI : 0.511-0.738, P= 0.04). Subgroup analysis showed that in patients with DM ( HR 2.090, 95 %CI 1.217-3.589, P= 0.008) and male ( HR 1.561, 95 %CI 1.007-2.421, P= 0.047), MPV was significantly related with cardiac mortality. Conclusion: In patients with stable CAD who underwent elective PCI, high MPV was independently associated with an increase in 2-year cardiac mortality, especially in patients with DM and male gender.

Objective: To evaluate the effect of ABO blood groups on long-term outcome of stable coronary artery disease (CAD) after percutaneous coronary intervention (PCI). Methods: A total of 4 272 patients with stable coronary artery disease and received PCI were consecutively enrolled from January to December 2013 and followed up for 2 years. Patients were divided into O group and non-O group according to their ABO groups. Multivariable COX regression was used to evaluated the relationship between ABO blood groups and prognosis of CAD. The endpoints included all-cause death, cardiac death, myocardial infarction(MI), revascularization, and stroke. Results: There were 1 302 patients in O group and 2 970 patients in non-O group. ABO blood group was not associated with age, sex and blood pressure ( P> 0.05). The comorbidity rate of hypertension, diabetes mellitus, smoking, family history, previous MI, previous cerebrovascular disease, previous PCI and left ventricular ejection fraction were similar between the two groups ( P> 0.05). Total cholesterol, low density lipid cholesterol level were significantly higher in non-O group compared with O group [(4.2±1.1)mmol/L vs (4.1±1.1)mmol/L, P= 0.027; (2.5±0.9)mmol/L vs (2.4±0.9) mmol/L, P= 0.025], while high density lipid cholesterol level was significantly lower[(1.04±0.26) mmol/L vs (1.06±0.28) mmol/L, P= 0.035]. As to angiographic results, non-O blood group was not related to the severity of coronary atherosclerosis assessed by SYNTAX score( P= 0.277). More cardiac death occurred in non-O group compared with that in O group [21 (0.7%) vs 2(0.1%)] during 2-year follow-up. After adjusted for confounding factors, multivariable COX regression revealed that non-O blood type was not associated with increased cardiac death [ HR (95 %CI )=7.30(0.97-55.09), P= 0.054]. Conclusion: Non-O blood group is associated with 2-year cardiac death in patients with stable coronary artery disease who received PCI, but it is not an independent risk factor for cardiac death.

Objective: To investigate the impact of beta-blockers on long-term outcomes in patients who underwent percutaneous coronary intervention (PCI) for stable coronary artery disease (SCAD) with adequate left ventricular ejection function (LVEF). Methods: A total of 3 946 consecutive SCAD patiens who underwent PCI with adequate LVEF between January and December 2013 in Fuwai Hospital were prospectively included in this study. According to beta-blocker use at discharge, patients were divided into no-beta-blocker group ( n =309) and beta-blocker group ( n =3 637). Major adverse cardiovascular and cerebrovascular events (MACCE) including all-cause death, myocardial infarction, revascularization, stroke and stent thrombosis at 2 years were compared between the two groups. Multivariate Cox regression analysis and Propensity-score matched analysis were used to identify independent risk factors of poor prognosis. Results: Compared with those in the beta-blocker group, patients of no-beta-blocker group were more likely to have lower body mass index, less complex comorbidities, slower heart rate either on admission or at discharge. There was no significant association of beta-blocker use with 2-year mortality (0.8% versus 1.3%, hazard ratio ( HR ) 0.65, 95% confidence interval ( CI ) 0.23 to 1.86, P =0.421), myocardial infarction ( HR 0.66, 95% CI 0.24 to 2.64, P =0.718) or MACCE ( HR 0.70, 95% CI 0.65 to 1.32, P =0.674). Results were similar in propensity score-matched analysis. Conclusions: In this large, prospective, single-center study, patients with beta-blocker prescription appear to have more risk factors. No beta-blockers at discharge is not an independent risk factor of poor prognosis at up to 2 years among stable patients who underwent PCI with adequate LVEF.

Objective: To investigate the long-term prognosis of Second generation drug-eluting stents(G2-DES) in diabetic mellitus(DM) and non-DM patients. Methods: Patients with coronary heart disease(CHD) in Fuwai Hospital from January 2013 to December 2013 who had exclusively G2-DES implantation, were consecutively included the follow-up period was 2 years. Results: A total of 6 094 patients with CHD were implanted with G2-DES, of which 1 862 patients with DM, and 4 232 patients without DM.The proportion of DM patients receiving G2-DES implantation with the following characteristics: advanced age, female, hypertension, hyperlipidemia, history of previous stroke, history of peripheral artery disease, previous history of PCI, and with triple vessel, high preoperative Syntax score, high number of target lesions, B2 or C type lesions, severe calcification lesions, and chronic occlusive disease were significantly higher than those of non-DM patients( P <0.05). The incidence of major adverse cardiac and cerebral vascular events(MACCE), target vascular revascularization(TVR) and target lesion revascularization(TLR) were higher in DM patients than in non-DM patients during 2 year's follow-up( P <0.05). The univariate COX regression analysis showed that diabetes was risk factor for MACCE in patients with CHD implanting G2-DES( HR =1.241, 95% CI : 1.053-1.463, P =0.010). However, multivariable COX analysis showed that DM was not an independent risk factor for MACCE in CHD patients with G2-DES( HR =1.125, 95% CI : 0.952-1.330, P =0.167). While age, female, preoperative Syntex score, triple vessel, B2 or C lesion were independent risk factors for poor clinical prognosis in CHD patients with G2-DES. Conclusions: (1) CHD patients with DM often accompany more clinical risk factors and complicated coronary lesions; (2) the incidence of MACCE, TVR and TLR in DM patients is significantly higher than non-DM patients with G2-DES during the 2 year's follow-up; (3) after multivariate adjustment, DM is not an independent risk factor for poor clinical prognosis in CHD patients with G2-DES, while traditional risk factors and complex coronary lesions are independent risk factors for poor clinical prognosis.

Objective: To investigate the association between high-sensitivity C-reactive protein (hs-CRP) and long-term outcomes in Chinese patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after drug-eluting stent (DES) implantation. Methods: A total of 4 815 consecutive NSTE-ACS patients who treated with DESs were included.Patients were divided into three groups: <1.00 mg/L, 1.00 to 2.99 mg/L and ≥3.00 mg/L, based on the level of hs-CRP on admission.Major adverse cardiovascular and cerebrovascular events (MACCE, including all-cause death, myocardial infarction, revascularization, in-stent thrombosis and stroke) were compared among groups during 2-year follow-up. Results: Patients with higher hs-CRP had more risk factors of cardiovascular events such as concomitant morbidities and multi-vessel lesions(68.5% vs 73.6% vs 76.2%, P <0.001). Higher hs-CRP value was associated with increased rates of MACCE (8.8% vs 11.2% vs 12.6%, P =0.003) and revascularization (6.5% vs 8.5% vs 9.8%, P =0.003). However, the rates of all-cause death, myocardial infarction, stroke, and stent thrombosis were comparable among groups(all P >0.05). Ongoing divergences in MACCE and revascularization among three groups were significant on Kaplan-Meier curves (both Log-rank P =0.003). Multivariable Cox regression analysis indicated that compared to hs-CRP<1.00 mg/L group, MACCE in the >3.00 mg/L group was increased by 42% [ HR 1.42 (1.13-1.78), P =0.002]. Meanwhile, multivessel leisions, ejection fraction<50%, elevated white blood cell counts were also independent risk factors.CRP≥3.00 mg/L( HR 1.56, 95% CI 1.16-2.08, P =0.003, compared to <1.00 mg/L) and multivessel leisions were independent predictors of revascularization. Conclusions: (1)Patients with higher hs-CRP on admission have more risk factors of cardiovascular events.(2)Higher hs-CRP value is associated with increased rates of MACCE and revascularization.(3)Pre-procedural hs-CRP is an independent predictor of 2-year outcomes for Chinese NSTE-ACS patients treated with DESs.

Objective: To investigate the long-term prognosis of coronary artery disease with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). Methods: A total of 10 724 patients with PCI were enrolled in 2013, and 2-year clinical outcomes in patients with AF (AF group) and without AF (non-AF group) were compared. Results: A total of 113 patients were with AF (1.1%), and 8 out of them were on triple antithrombotic therapy (9.5%), and AF group patients were with more complications. The 2-year follow-up results showed that the all-cause mortality in AF group was significantly higher than that in non-AF group (9.7% vs 1.1%; P <0.001). The incidence of cardiac death, stent thrombosis and stroke was also significantly higher in patients with AF. The incidence of major adverse cardiac and cerebrovascular events (MACCE) was also significantly higher in AF group compared with non-AF group (17.7% vs 8.8%; P <0.001), whereas the incidence of revascularization was significantly lower in the AF group than in the non-AF group (2.7% vs 8.7%; P =0.023). The incidence of myocardial infarction and bleeding had no significant difference between the two groups, and the adverse events between the two groups had no significant difference after propensity score (PS) either. Conclusions: The 2-year clinical follow-up of single-center, large-sample PCI patients shows poor prognosis in patients with AF compared with the non-AF patients. But there is no difference in the prognosis between the two groups after PS, however, this conclusion still needs to be confirmed by randomized controlled studies.

Objective: To evaluate the prognostic value of Global Registry of Acute Coronary Events(GRACE) discharge score for long-term out-of-hospital death in acute coronary syndrome (ACS) after drug-eluting stents (DES) and with Dual-antiplatelet Therapy (DAPT). Methods: Our study was a prospective, observational, single center (Fuwai Hospital of China) study.A total of 6 431consecutive ACS patients underwent percutaneous coronary intervention(PCI)between January 2013 and December 2013 were involved.The primary endpoint was all-cause death and second endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) as a composite of all-cause death, myocardial infarction, revascularization, stent thrombosis or stroke. Results: Finally, 5 867 ACS patients who were received DES with DAPT and had no in-hospital event included in this study, and 59 (1.01%) death and 608 (10.36%) MACCE were reported during 2-year follow-up after discharge.GRACE score was significantly higher among death patients than those survivalpatients (94± 28 vs 78± 24, P <0.001). According to risk stratification of GRACE discharge score, as compared to the low-risk group, death risk in high-risk group was 6.73 times ( HR =6.73, 95% CI 3.53-12.84; P <0.001) higher, but could not distinguish between the moderate and low risk group ( HR =1.61, 95% CI 0.88-2.95; P =0.124). The GRACE score showed predictive value in ACS patients after DESand with DAPT (area under the receiver operating characteristic curve (AUROC)=0.661; 95% CI 0.586-0.736, P <0.001). In subgroup analysis, GRACE score also showed predictive value both in unstable angina pectoris (UAP)(AUROC=0.660, 95% CI 0.576-0.744; P <0.001) and acute myocardial infarction(AMI)subgroup (AUROC=0.748, 95% CI 0.631-0.864; P =0.001). Conclusion: GRACE discharge score shows prognostic value for long-term out-of-hospital death in ACS patients undergoing PCI with DES and DAPT, and demonstrates good risk stratification of high and low-risk of death.

Objective: To investigate the clinical characteristics and prognosis in patients with stroke after percutaneous coronary intervention (PCI). Methods: From January 2013 to December 2013, 10 724 consecutive patients undergoing PCI including acute coronary syndrome and stable angina pectoris were enrolled.A two years' follow up was conducted among these patients to investigate the clinical characteristics and prognosis of patients with stroke and of those without. A comparison was done between the two groups. Results: One hundred and forty-five patients had stroke (1.4%) during the follow-up period after PCI, including 124 cases with ischemic stroke (1.2%), out of whom 4 (3.2%) patients died; 21 cases with hemorrhagic stroke, out of whom 9 patients (42.9%) died.There was more female, and more patients with risks factors, hypertension, previous myocardial infarction, previous stroke, etc. in the patients with stroke.During the 2-year follow-up, patients with stroke experienced higher incidence of all-cause mortality (9% vs 1.1%, P <0.000 1). There were no significant differences in the incidences of cardiac death, myocardial infarction, revascularization, stent thrombosis and major adverse cardiovascular event rates between the two groups.COX regression analysis showed that stroke after PCI was associated with the increased mortality ( HR =8.387, 95% CI : 4.725-14.855, P <0.000 1). Meanwhile, after propensity score matched analyses (129 pairs), the trend was not changed, and stroke was still an independent risk factor of all-cause mortality ( HR =6.737, 95% CI : 1.52-29.85, P =0.012). Conclusions: The patients underwent PCI, who had stroke later, had more clinical risk factors, and more serious degree of atherosclerosis.The incidence of stroke is an independent risk factor for all-cause mortality in patients with coronary heart disease after PCI.

Objective: To compare the cannulated screw internal fixation (IF) and hemiarthroplasty (HA) for displaced femoral neck fracture with cost-utility analysis (CUA). Methods: From January 2014 to August 2015, a total of 87 patients above 60 years old with displaced femoral neck fracture were admitted into the study and divided into 2 groups according to surgery type. There were 41 cases in IF group and 46 cases in HA group. During 1 year follow-up we collected the total cost due to fracture and applied EQ-5D index to evaluate the clinical effects. The value of EQ-5D index will be transformed to quality adjusted life year (QALY). Eventually the data including cost and QALY were used to calculate the cost utility ratio (CUR) for patients in each group. Results: All the patients completed the operation successfully. The total cost of IF and HA was 45 796 yuan and 56 657 yuan ( P <0.05), while the QALY was 0.79 and 0.83 respectively ( P >0.05). The CUR showed that patients in IF and HA group spent 57 970 yuan and 68 261 yuan for each QALY which means patients in HA group spent more 10 292 yuan for each QALY than that in IF group. Conclusions: Both IF and HA can provide satisfactory clinical outcome in 1 year follow-up, however the total cost of IF was obviously less than HA. Therefore IF may be more cost-effective for the treatment of displaced femoral neck fracture in terms of health economics.

Objective: To quantify the extent and complexity of residual coronary stenosis following PCI by the residual SYNTAX score, and to evaluate its impact on adverse ischemic outcomes in acute coronary syndrome(ACS) patients. Methods: From January 2013 to December 2013, a total of 1 414 consecutive moderate- and high-risk ACS patients who underwent any PCI with multi-vessel coronary artery disease were evaluated.Patients were stratified by rSS quartiles and their outcomes were compared. Results: The rSS was 4.8±6.7. 591 patients (41.8%) had rSS=0(CR), 233 patients (16.5%) had rSS>0 but ≤ 3, 296 patients (20.9%) had rSS>3 but ≤8 and 294 patients (20.8%) had rSS>8.Clinical risk factors were more frequent in patients with incomplete revascularization(IR) compared with complete revascularization(CR). The 2-year rates of all-caused death(1.2% vs 0.4%, 2.0%, 4.4%, P =0.003), cardiac death, revascularization and MACCE were significantly higher in high rSS group, compared to other groups.By multivariable analysis, rSS was a strong independent predictor of ischemic outcomes at 2-year, including all-cause mortality ( HR =1.05, 95% CI 1.01-1.09, P =0.019), cardiac death, revascularization and MACCE. Conclusions: The rSS is a strong independent predictor of all-caused death, cardiac death, revascularization and MACCE and has moderated predictive ability for those ischemic outcomes.

Objective: To evaluate the association between single nucleotide polymorphisms (SNPs) of RS1799937 located in WT1 gene with complete response to neoadjuvant chemotherapy in breast cancer patients. Methods: 171 breast cancer patients with neoadjuvant chemotherapy were investigated to detect the RS1799937 polymorphism by sequenom method. The relationship between RS1799937 polymorphism and pathologic complete response (pCR) were analyzed by χ 2 test and Fisher's exact test analysis. Predictors of pCR were analyzed using multivariate logistic regression analysis. Results: The frequency of CC, TC and TT genetype of RS1799937 was 50.3%, 41.5% and 8.2%. Of the 171 patients, pCR was achieved in 53 cases(30.9%) with CC allele 23 cases(26.7%), TC allele 23 cases(32.4%) and TT allele 7 cases(50.0%), however no statistical significant difference was observed (χ 2 = 3.156, P =0.204). RS1799937 polymorphism was associated with pCR in EC-T neoadjuvant therapy (χ 2 =6.660, P =0.033) but not in PE neoadjuvant therapy (χ 2 =0.473, P =0.873) cohort. Multivariate logistic regression analysis indicated that RS1799937 polymorphism, targeted therapy and clinical stage were independent predictors of pCR ( P <0.05) in EC-T neoadjuvant therapy cohort. Conclusion: RS1799937 polymorphism was associated with pCR rate only in anthracycline and taxane-based neoadjuvant therapy, breast cancer patients with the rs1799937 TT allele were more likely to achieve pCR.

Objective: TOX3 gene was considered to be breast cancer susceptibility gene in the European population and East Asian populations. This study was aimed to investigate the relevance of TOX3 gene rs3803662 single nucleotide polymorphisms and sporadic breast cancer susceptibility among the Han Nationality in Henan Province., Methods: A case-control study was performed among 253 patients with sporadic breast cancer and 343 control subjects in Henan Province. The SNP rs3803662 in TOX3 was genotyped by imLDR technique. Association analysis based on unconditional logistic regression was carried out to determine the odds ratio (OR) and 95% confidence interval (95% CI) for the SNP between different alleles and breast cancer., Results: There was no statistically significant difference in the distribution of TOX3 rs3803662 allele in different Ki-67 value and HER2 gene status in the case group. The distribution of TOX3 rs3803662 allele between breast cancer and the control group were different. Compared with allele AA and GA, allele GG increased the risk of breast cancer in codominant inheritance (OR=2.19, 95% CI:1.19-4.02) and recessive genetic models (OR=2.06, 95% CI: 1.15-3.70). Further stratifying analysis was conducted based on estrogen receptor status. The SNP rs3803662 showed significant associations with ER status, and was associated with positive ER status in the recessive (OR=1.92; 95% CI:1.00-3.67; P=0.05) and codominant models (OR=2.07; 95% CI:1.05--.08; P=0.036). And this SNP was associated with negative ER status breast cancers in both recessive (OR=2.38; 95% CI:1.10-5.15; P=0.028) and codominant models (OR=2.43; 95% CI:1.08-5.48; P=0.032). But there was no statistically significant difference in each subgroup stratified by ER status., Conclusion: This was a verification study in a Han population. In codominant and recessive genetic models, allele GG increased breast cancer risk and was associated with the pathogenesis of different ER status breast cancer. But there was no obvious correlation between this SNP and Ki-67 or HER2 gene. This is the first breast cancer susceptibility loci that is confirmed in Henan population. Our study only analyzes the correlation between the SNP and ER status in breast cancer. More studies and analyses about the association between SNPs and different characteristic of breast cancer should be performed.

Objective: To explore the laparoscopic surgery efficacy for the treatment of liver trauma., Methods: From January 2009 to March 2014. 32 patients were received laparoscopic surgery for liver trauma treated in our hospital. There were 21 males and 11 females with an average age of 33.7 years old. Among the group, 23 cases were closed abdominal injury, 9 cases were open injury. 7 cases were Combined organ injuries. The patients' injuries arose from various causes, 13 due to falling, 10 due to be crushed, and 9 due to be cut., Results: 32 patients were treated with laparoscopy completely. According Moore Classification standards. 2 cases were type I, 7 cases type II, 19 cases type III, 4 case type IV. 32 cases underwent electric coagulation, laparoscopic fibrin glue and soluble hemostatic gauze packing (n = 5), sutures to the broken liver (n = 20), debridement partial hepatectomy (n = 7). The patients combined with other organ injury were treated with laparoscope simultaneously. The operative duration time were 85 (30-210) mins. There was no postoperative death., Conclusion: Correct selection of indication and a deft laparoscopic liver resection help guarantee the laparoscopic surgery to be applicable way in treatment liver trauma.

Objective: To explore the effects of glutamine, eicosapntemacnioc acid (EPA) and branched-chain amino acids supplements in esophageal cancer patients on concurrent chemoradiotherapy and gastric cancer patients on chemotherapy., Methods: From April 2013 to April 2014, a total of 104 esophageal and gastric carcinoma patients on chemotherapy or concurrent chemoradiotherapy were recruited and randomly divided into experimental and control groups. Both groups received dietary counseling and routine nutritional supports while only experimental group received supplements of glutamine (20 g/d), EPA (3.3 g/d) and branched-chain amino acids (8 g/d). And body compositions, blood indicators, incidence of complications and completion rates of therapy were compared between two groups., Results: After treatment, free fat mass and muscle weight increased significantly in experiment group while decreased in control group (P < 0.05). And albumin, red blood cell count, white blood cell count and blood platelet count remained stable in experiment group while declined significantly in control group. During treatment, compared to control group, the incidences of infection-associated complication were lower (6% vs 19%, P < 0.05) and the completion rates of therapy were significantly higher in experiment group (96% vs 83%, P < 0.05)., Conclusion: Supplements of glutamine, EPA and branched-chain amino acids can help maintain nutrition status, decrease the complications and improve compliance for esophageal cancer patients on concurrent chemo-radiotherapy and gastric cancer patients on postoperative adjuvant chemotherapy.

Objective: To explore the techniques and efficacies of surgical resection of giant sellar region tumors via anterior interhemispheric approach., Methods: A series of 110 consecutive cases of giant sellar region tumors undergoing microsurgery through an anterior interhemispheric approach at our hospital were retrospectively analyzed. Their mean age was 35.6 (3-72) years. There were craniopharyngioma (n = 57), pituitary adenoma (n = 33), hypothalamic glioma (n = 5), meningioma (n = 4) and other lesions (n = 11). The maximal tumor diameter varied from 4.0 to 8.2 cm with a mean diameter of 4.8 cm. Active measurements were taken for managing blood sodium disorder and diabetes insipidus. During the follow-ups, the patients were monitored for residual or recurrent tumor by hormonal assessment (in cases of functioning adenomas) and postoperative contrast magnetic resonance imaging (MRI) performed 1-3 months after surgery., Results: Total lesion removal was achieved in 76 cases (69.1%). Twenty patients (18.2%) underwent subtotal resection and 14 (12.7%) had partial removal. No surgery-related mortality occurred. Visual acuity was preserved or improved in 97 patients (88.2%) within 1 week after surgery. The major postoperative complications included diabetes insipidus (n = 76, 69.1%), permanent diabetes insipidus (n = 23, 20.9%), electrolyte disorder (n = 62, 56.4%), seizures (n = 7, 6.4%), brain damage (3 cerebral contusions and 5 hematomas) (n = 8, 7.3%) and infarction(n = 2, 1.8%). During a median post-surgical follow-up period of 26 (3-96) months, 11 patients had recurrence. And 35 cases (31.8%) of endocrinological deficit received hormonal replacement after surgery., Conclusion: The interhemispheric approach is feasible for removing giant sellar region tumors without significant sequels. Active postoperative managements of diabetes insipidus and electrolyte disorder may accelerate early patient recovery.

Objective: To validate whether PET/MR could provide a semi-quantitative measurement (SUV(max)) comparable to that produced by PET/CT in normal organs., Methods: 277 subjects underwent an ordinary ¹⁸F-FDG PET/CT followed by a PET/MR scan with a 25-45 min interval. Region of interest (ROIs) were drawn in 4 reference normal organs/tissues in both MRAC-PET and CTAC-PET images and the liver and erector spinae in the dual-time point PET/CT images., Results: 259 malignant and 21 benign lesions, pathologically confirmed, were detected in the 220 subjects. SUV(max) derived from PET/CT (SUV(max)-CT) and PET/MR (SUV(max)-MRI) was highly correlated over the reference organ ROIs (r = 0.62-0.73), except lung (r = 0.44). The SUV(max)-MRI was significantly lower than the respective SUV(max)-CT in all 4 organs and after delay-correction in liver and muscle., Conclusion: The results indicate that PET/MR can provide reliable measurement in physiological organs.

Objective: To explore the clinical characteristics and treatment strategies of peripheral intracranial aneurysms., Methods: A total of 24 patients of peripheral aneurysms from October 2008 to October 2011 were retrospectively analyzed. There were 11 females and 13 males with a mean age of 46 (38-38) years. Of the 24 patients, 11 were female and 13 were male, mean age was 46 years (ranged 38-68). The distributions of the lesions included 12 peripheral anterior cerebral artery (n = 12), aneurysms, 3 peripheral middle cerebral artery (n = 3) aneurysms, 2 peripheral posterior cerebral artery (n = 2) aneurysms, 1 peripheral superior cerebellar artery (n = 1) aneurysm, 2 anterior inferior cerebellar artery (n = 2) aneurysms, 2 posterior inferior cerebellar artery (n = 2) aneurysms, and 2 medial posterior choroidal artery (n = 2) aneurysm. Eight procedures were performed by under neuro-navigation, and another 2 under were performed by intraoperative magnetic resonance imaging (MRI) and navigation. The procedures included Sixteen peripheral aneurysms were simple y clipping (n = 16)ed, 4 were clipping plus reconstruction of ed and parent arteries (n = 4) reconstructed, resection (n = 2) and resection plus reanastomosis 2 were resected, 1 was resected and of parent artery (n = 1) and EC-IC bypass (n = 1) was reanastomosed, and 1 was trapped with EC-IC bypass., Results: At discharge, 20 of them out of the 24 patients had a Glasgow Outcome Scale (GOS) score of 5, and another 4 patients had yielded a score of 4. Two oculomotor nerve palsies occurred postoperatively and , with both improved in during a 3-month follow-ing up period. One patient case had postoperative partial visual field defect., Conclusions: The Peripheral intracranial aneurysms are a rare in clinical practices kind of entity. Precise intraoperative localization of the lesions is the of key importance for management to the procedure. Different treatment strategies should be taken based on their diverse different characteristics of the aneurysm.

Objective: To explore the clinical characteristics and prognosis of estrogen receptor/progesterone receptor (ER/PR) positive breast cancer (luminal subtype) patients with liver metastases., Methods: A total of 182 patients with liver metastasis from luminal subtype breast cancer between January 2000 and December 2011 were retrospectively reviewed. Their clinical characteristics, treatments and prognosis were collected and analyzed., Results: Their median age was 47 years and 118 patients were younger than 50 years old. The median disease-free survival (DFS) after primary operation of breast cancer was 19.5 months. All patients received first-line chemotherapy for liver metastases. Overall response (CR+PR) rate was 60.4% (110/182) . Progression-free survival (PFS) and overall survival (OS) were 8 and 23 months respectively. The median OS was extended by 7 months in younger patients ( ≤ 50) than in older ones (>50) (P < 0.05). In addition, PFS and OS were also extended by 3 and 7 months in patients with complete and partial responses than those who had stable and progressive diseases (P < 0.05). No difference existed in PFS and OS with or without capecitabine-based regimens(both P > 0.05)., Conclusion: Age and response to treatment are independent prognostic factors for ER and/or PR positive breast cancer patients with liver metastasis.