ABSTRACT
Objective:To explore the influencing factors of postoperative graft stenosis in patients undergoing left internal mammary artery-left anterior descending branch (LIMA-LAD) coronary artery bypass graft (CABG) surgery.Methods:A retrospective analysis of the clinical data of 86 patients who were admitted to the Second Affiliated Hospital of Hainan Medical College and received coronary angiography after CABG surgery from July 2019 to December 2020 due to recurrent chest tightness, chest pain and other symptoms. According to the degree of stenosis of the LIMA-LAD graft, the patients were divided into stenosis group ( n=25) and non-stenosis group ( n=61). The graft stenosis of patients in the stenosis group was ≥50%, and the graft stenosis of patients in the non-stenotic group was less than 50%. The general information, past medical history, CABG intraoperative data, current visit data and biochemical indicators of the two groups were compared. Measurement data were expressed as mean±standard deviation ( Mean± SD), comparison between groups was by t-test; count data comparison between groups was by Chi-square test. Logistic regression analysis was used to screen out the influencing factors of graft stenosis after CABG. Use the rms package in the R 4.0.2 software to build a nomogram prediction model. Using receiver operating characteristic (ROC) curve to evaluate the discriminative degree of the model. Use the calibration curve and deviation correction C-index to evaluate the nomogram prediction model. Use X-tile software to obtain the cutoff value of the nomogram model integral, use Kaplan-Meier method to draw the survival curve, and use Log-rank to test. Results:Logistic regression analysis showed that smoking, hypertension, pre-CABG left anterior descending branch (LAD) stenosis <75%, pre-CABG left internal mammary artery (LIMA) blood flow, and coronary angiography diffuse lesions are independent risk factors that affect LIMA-LAD graft stenosis after CABG ( P<0.05). The C-index value predicted by the nomogram model was 0.879 (95% CI: 0.818-0.955, P<0.001). The area under the ROC curve was 0.712 (95% CI: 0.594-0.801, P<0.001), with good discrimination. The calibration curve shows that the accuracy of the model prediction was good. Through the X-tile software screening to obtain the model score cutoff value, the patients were divided into low-risk group (≤54 points), medium-risk group (>54 points and ≤112 points), and high-risk group (>112 points). The results of survival analysis showed that the incidence of postoperative graft stenosis in the three groups was 20.9%, 50.0% and 80.0%, respectively. Conclusions:Smoking, hypertension, LAD stenosis before CABG <75%, LIMA blood flow before CABG, and coronary angiography diffuse lessions are independent risk factors that affect LIMA-LAD graft stenosis after CABG. The construction of a nomogram prediction model can provide a reference for evaluating the patency of the LIMA-LAD graft vessel before CABG operation, and reduce the probability of LIMA-LAD graft vessel stenosis after CABG operation.
ABSTRACT
In recent years, researchers have shown great interest in the mechanism of induced programmed cell death (PCD) in tumor cells. Pyroptosis is a newly-discovered programmed cell death, which has a proinflammatory effect and is accompanied by cell pore formation, cytoplasmic swelling, cell membrane rupture, and release of cytoplasmic contents into the extracellular environment. A large number of studies have shown that pyroptosis is closely related to the occurrence and development of various diseases such as cancer. Currently, gasdermin family mediate cell pyroptosis, due to gasdermin D and gasdermin E are two molecules that are extensively studied in pyroptosis. This article mainly explores the relevant mechanism of these two proteins and their relationship with cancer, which will broaden our understanding of new insights to cancer and provide a new perspective on cancer prevention and treatment.
ABSTRACT
Objective To research the improvement effect of acupuncture combined with massage on clinical symptoms and function of cervical vertebra in patients with vertebral artery type of cervical spondylosis.Methods 100 patients with vertebral artery type of cervical spondylosis were included in this study.They were divided into the observation group (52 cases) and the control group(48 cases) by the random number table method.The patients in the control group were treated with conventional treatment,and the observation group was given acupuncture combined with massage on the basis of the conventional treatment.The clinical efficacy,the improve degree of clinical symptoms and cervical vertebra function were compared between the two groups.Results The total effective rate of the observation group was 94.23 ％,which was significantly higher than 79.17 ％ of the control group,and there was statistically significant difference between the two groups (x2 =5.008,P =0.025).Before treatment,there were no significant difference between the two groups in terms of symptom scores and hemodynamic parameters (all P ＞ 0.05).After treatment,the clinical symptoms scores of the two groups were significantly higher.The average blood flow velocity (TMFV),peak systolic velocity(PSV),pulsatility index(PI) and resistance index(RI) of the observation group were (26.87 ±5.14) cm/s,(61.63 ± 10.11) cm/s,(0.74 ± 0.13),(0.53 ± 0.08),respectively,which of the control group were (24.18 ±4.48)cm/s,(54.47 ±9.34)cm/s,(0.92 ±0.22),(0.66 ±0.13),respectively,there were statistically significant differences between the two groups (t =2.779,3.669,5.026,6.073,P =0.006,0.000,0.000,0.000).Conclusion Acupuncture combined with massage in the treatment of vertebral artery type of cervical spondylosis,the local blood flow of patients is significantly increased,and the blood supply of the brain is effectively alleviated,so as to improve the clinical symptoms and cervical function.It can play a positive role in the treatment of vertebral artery type of cervical spondylosis.