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AbstractStrategies for favoring close others, such as friends and in-group members, benefit individuals and society. Although younger and older children apply these sharing strategies, how they integrate these relationships remain understudied. Friendship and group membership sometimes conflict (e.g. a friend from another, even a rival group), driving the question of how children behave in such situations. To address this question, this preregistered study recruited 121 4–6-year-olds and 94 9–12-year-olds from a middle-class community in China. A 2 (friend vs. stranger) by 2 (in vs. out-group) between-subjects design was applied per age group. Participants were asked to share seven objects with a recipient, who was either a stranger, or a previously nominated friend and from an in- or out-group (manipulated in the Minimal Group Paradigm). The results showed that children in both age groups shared more with friends than with strangers. However, only 4–6-year-olds shared more resources with in-group members than with out-group ones. Moreover, 4–6-year-olds did not distinguish between an out-group friend and an in-group stranger, while 9–12-year-olds shared more with an out-group friend relative to an ingroup stranger, indicating that friendship outweighs minimal group membership only among 9–12-year-olds. Furthermore, there was an interaction between age and minimal group membership, implying a decrease in the minimal group effect between 4–6-year-olds and 9–12-year-olds. Accordingly, the implications of friendship and minimal group effects, and their relative influence on sharing during childhood are discussed. [ABSTRACT FROM AUTHOR]

While existing watermarking attack methods can disturb the correct extraction of watermark information, the visual quality of watermarked images will be greatly damaged. Therefore, a concealed attack based on generative adversarial network and perceptual losses for robust watermarking is proposed. First, the watermarked image is utilized as the input of generative networks, and its generating target (i.e. attacked watermarked image) is the original image. Inspired by the U-Net network, the generative networks consist of encoder-decoder architecture with skip connection, which can combine the low-level and high-level information to ensure the imperceptibility of the generated image. Next, to further improve the imperceptibility of the generated image, instead of the loss function based on MSE, a perceptual loss based on feature extraction is introduced. In addition, a discriminative network is also introduced to make the appearance and distribution of generated image similar to those of the original image. The addition of the discriminative network can remove watermark information effectively. Extensive experiments are conducted to verify the feasibility of the proposed concealed attack method. Experimental and analysis results demonstrate that the proposed concealed attack method has better imperceptibility and attack ability in comparison to the existing watermarking attack methods. [ABSTRACT FROM AUTHOR]

Realizing autonomous vehicles is one of the ultimate dreams for humans. However, perceptual information collected by sensors in dynamic and complicated environments, in particular, vision information, may exhibit various types of degradation. This may lead to mispredictions of context followed by more severe consequences. Thus, it is necessary to improve degraded images before employing them for context prediction. To this end, we propose a generative adversarial network to restore images from common types of degradation. The proposed model features a novel architecture with an inverse and a reverse module to address additional attributes between image styles. With the supplementary information, the decoding for restoration can be more precise. In addition, we develop a loss function to stabilize the adversarial training with better training efficiency for the proposed model. Compared with several state-of-the-art methods, the proposed method can achieve better restoration performance with high efficiency. It is highly reliable for assisting in context prediction in autonomous vehicles. [ABSTRACT FROM AUTHOR]

During the development of tight gas reservoir, the irreducible water saturation, rock permeability, and relative permeability change with formation pressure, which has a significant impact on well production. Based on capillary bundle model and fractal theory, the irreducible water saturation model, permeability model, and relative permeability model are constructed considering the influence of water film and stress sensitivity at the same time. The accuracy of this model is verified by results of nuclear magnetic experiment and comparison with previous models. The effects of some factors on irreducible water saturation, permeability, and relative permeability curves are discussed. The results show that the stress sensitivity will obviously reduce the formation permeability and increase the irreducible water saturation, and the existence of water film will reduce the permeability of gas phase. The increase of elastic modulus weakens the stress sensitivity of reservoir. The irreducible water saturation increases, and the relative permeability curve changes little with the increase of effective stress. When the minimum pore radius is constant, the ratio of maximum pore radius to minimum pore radius increases, the permeability increases, the irreducible water saturation decreases obviously, and the two-phase flow interval of relative permeability curve increases. When the displacement pressure increases, the irreducible water saturation decreases, and the interval of two-phase flow increases. These models can calculate the irreducible water saturation, permeability and relative permeability curves under any pressure in the development of tight gas reservoir. The findings of this study can help for better understanding of the productivity evaluation and performance prediction of tight sandstone gas reservoirs. [ABSTRACT FROM AUTHOR]

Abstract A novel reversible watermarking algorithm with two-stage data hiding strategy is presented in this paper. The core idea is two-stage data hiding (i.e., hiding data twice in a pixel of a cell), where the distortion after the first stage of embedding can be rarely removed, mostly reduced, or hardly increased after the second stage. Note that even the increased distortion is smaller compared to that of other methods under the same conditions. For this purpose, we compute lower and upper bounds from ordered neighboring pixels. In the first stage, the difference value between a pixel and its corresponding lower bound is used to hide one bit. The distortion can be removed, reduced, or increased by hiding another bit of data by using a difference value between the upper bound and the modified pixel. For the purpose of controlling capacity and reducing distortion, we determine appropriate threshold values. Finally, we present an algorithm to handle overflow/underflow problems designed specifically for two-stage embedding. Experimental study is carried out using several images, and the results are compared with well-known methods in the literature. The results clearly highlight that the proposed algorithm can hide more data with less distortion.

Reversible data hiding (RDH) has unique advantage in copyright and integrity protection for multimedia contents. As a typical RDH scheme, histogram shifting technique (HS) has found wide applications due to its high quality of marked image. At present, most existing HS-based RDH schemes rely on single histogram generated from cover image to hide data. Since the single histogram-based approach (SH_RDH) commonly employs smooth regions in the cover image for data hiding, it might not well utilize the cover image and exploit the correlations among image contents of different texture characteristics. In this paper, a novel RDH general framework using multiple histograms modification (MH_RDH) is proposed, which involves two key issues as follows: 1) the construction of multiple histograms based on optimized multi-features and 2) the rate allocation among multiple histograms is formulated as the one of rate-distortion optimization and solved with evolutionary algorithms. The experimental results show that the proposed method could considerably increase the payload of current MH_RDH-based embedding (ranging from 0.2 to 0.7 bpp for most test images) and outperform the other state-of-the-art SH_RDH and MH_RDH schemes. [ABSTRACT FROM AUTHOR]

Objective: We aimed to study the effect of cariporide (CP) on protecting the saphenous vein and the role of acetaldehyde dehydrogenase 2 (ALDH2) in coronary artery bypass grafting (CABG). Background: The saphenous vein is the main graft material used in CABG. Recent studies suggested that CP is effective in protecting against various cardiovascular diseases. Methods: Segments of a surgically removed saphenous vein were used to examine the vascular response to CP. The ALDH2 genotype and expression of related proteins were assessed by Western blotting and immunohistochemistry. Results: Among the conditions tested, the University of Wisconsin solution with CP (4°C, 5 min) treatment showed the best protective effect on the saphenous vein. The incidence of major adverse cardiac events was higher in the ALDH2-GA (heterozygous mutant) genotype population after CABG. Conclusion: CP plays a role in reducing the production of reactive oxygen species and apoptosis by ALDH2-mediated mitochondrial function improvement. The ALDH2 mutant genotype might be one of the risk factors for coronary atherosclerotic heart disease. [ABSTRACT FROM AUTHOR]

In this paper, the DBR all-visible mercury-free high-temperature and high-pressure multifunctional formation fluid PVT analyzer developed and produced by Schlumberger company is used to conduct an experimental study on phase behavior characteristics of one offshore high CO2 condensate gas wells. The experiments include two-phase flash experiment, constant composition expansion experiment (CCE experiment), and constant volume depletion experiment (CVD experiment). Experimental results show that the higher the CO2 content in the condensate gas system, the higher the gas-oil ratio of condensate gas, the greater the density of condensate oil, the higher the dew point pressure of condensate gas, the greater the relative volume of condensate gas, the smaller the amount of retrograde condensate oil. And the higher the CO2 content in the condensate gas system, the phase diagram is shifted to the left and up, the critical point of the phase diagram is shifted to the lower left, the smaller the area of the two-phase envelope, the lighter the condensate gas system, the condensate oil recovery is higher. The above experimental results revealed that CO2 is well soluble with condensate gas, the expansion capacity of the condensate gas system was slightly enhanced, and because CO2 has a good extraction capacity, the light components of condensate gas were constantly extracted, the retrograde condensate rate of condensate oil decreases, and the maximum retrograde condensate volume also decreased. However, the condensate oil was produced along with the natural gas, and the higher the CO2 content, the stronger the extraction, the more condensate oil was produced. It is mainly because CO2 has the strong gasification and extraction capacity, on the one hand, the retrograde condensation of condensate gas was inhibited, and on the other hand, reverse evaporation of condensate oil was enhanced. The above experimental results indicate the law of the effect of CO2 on the phase behavior characteristics of condensate gas reservoirs, providing theoretical basis and guidance for the efficient development of condensate gas reservoirs at sea. [ABSTRACT FROM AUTHOR]

Passive video forensics has drawn much attention in recent years. However, research on detection of object-based forgery, especially for forged video encoded with advanced codec frameworks, is still a great challenge. In this paper, we propose a deep learning-based approach to detect object-based forgery in the advanced video. The presented deep learning approach utilizes a convolutional neural network (CNN) to automatically extract high-dimension features from the input image patches. Different from the traditional CNN models used in computer vision domain, we let video frames go through three preprocessing layers before being fed into our CNNmodel. They include a frame absolute difference layer to cut down temporal redundancy between video frames, a max pooling layer to reduce computational complexity of image convolution, and a high-pass filter layer to enhance the residual signal left by video forgery. In addition, an asymmetric data augmentation strategy has been established to get a similar number of positive and negative image patches before the training. The experiments have demonstrated that the proposed CNN-based model with the preprocessing layers has achieved excellent results. [ABSTRACT FROM AUTHOR]

Background: Limited experiences of applying an on-pump beating-heart technique for surgical revascularization in patients with severe left ventricular dysfunction have been reported. Which strategy, either off-pump coronary artery bypass grafting (CABG) or on-pump beating-heart CABG surgery, is the best strategy for surgical revascularization in patients with severe left ventricular dysfunction is still controversial. This single-center study aimed to evaluate the impacts of an on-pump beating-heart versus an off-pump technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (LVEF) of 35% or less to explore which technique would be more suitable for surgical revascularization in patients with severe left ventricular dysfunction.Methods: A total of 216 consecutive patients with an echocardiographic estimated LVEF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 were included in this study and were divided into either an ONBEAT group (patients who received on-pump beating-heart CABG surgery, n = 88) or an OFF group (patients who received off-pump CABG surgery, n = 128). The early clinical outcomes were investigated and compared.Results: Patients in the ONBEAT group compared to the OFF group had a significant higher early postoperative LVEF (35.6 ± 2.9 vs. 34.8 ± 3.3%, p = 0.034) but shared a similar baseline LVEF (31.0 ± 2.8 vs. 31.0 ± 2.9%, p = 0.930). Patients in the ONBEAT group compared to the OFF group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7 ± 0.8 vs. 2.8 ± 0.6, p <0.001; 715 ± 187 ml vs. 520 ± 148 ml, p <0.001, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Additionally, logistic regression analysis showed that surgical technique (on-pump beating-heart CABG vs. off-pump CABG) had no independent influence on in-hospital mortality or major postoperative morbidity in patients with preoperative LVEF of 35% or less.Conclusions: The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated LVEF of 35% or less. [ABSTRACT FROM AUTHOR]

Background: Mild preoperative renal insufficiency is not rare in patients receiving isolated off-pump coronary artery bypass grafting surgery (OPCAB) surgery. However, there is less study aimed to evaluate the impact of mild preoperative renal insufficiency on in-hospital and follow-up outcomes after isolated OPCAB surgery. This single-centre, retrospective propensity score matching study aimed to evaluate the impact of mild preoperative renal insufficiency on in-hospital and long-term outcomes after first isolated OPCAB surgery.Methods: After propensity score matching, 1236 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m(2) undergoing first isolated OPCAB surgery from January 2007 to December 2011 were entered into this study and were divided to normal group (eGFR ≥ 90 ml/min/1.73 m(2), n = 618) and mild group (eGFR of 60-89 ml/min/1.73 m(2), n = 618). The in-hospital and long-term outcomes were investigated and retrospectively analyzed.Results: The 2 propensity score-matched groups had similar baseline and procedural characteristics except the baseline eGFR. Thirty-five patients died during the same hospitalization or within 30 days of operation, with a surgical mortality of 2.8 %. Sixty-seven patients died during follow-up, with a long-term survival of 94.1 %. Univariate factor analysis showed that the 2 propensity score-matched groups have similar rates among in-hospital outcomes. Kaplan-Meier curves displayed a similar in-hospital survival between the 2 groups (χ(2) = 0.728, p = 0.393), while a better long-term survival in patients with normal preoperative renal function compared with mild preoperative renal insufficiency (χ(2) = 4.722, p = 0.030). After Cox proportional model was used, the hazard ratio for long-term mortality in patients with mild preoperative renal insufficiency compared with normal preoperative renal function was 1.72 (95 % CI 1.06-2.83, p = 0.032).Conclusions: Mild preoperative renal insufficiency compared with normal preoperative renal function reduced long-term survival, without evidence of worse in-hospital outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT With the ongoing development of rendering technology, computer graphics (CG) are sometimes so photorealistic that to distinguish them from photographic (PG) images by human eyes has become difficult. To this end, many methods have been developed for automatic CG and PG classification. In this paper, we present a simple, yet efficient, multiresolution approach to distinguish CG from PG based on uniform gray-scale invariant local binary patterns (LBPs) with the help of support vector machines (SVM). We select YCbCr as the color model. The original Joint Photographic Experts Group (JPEG) coefficients of Y, Cb, and Cr components and their prediction errors are used for two LBP operators. From each 2D array and each LBP operator, we obtain 59 uniform LBP features. In total, 12 groups of 59 features are obtained from each image. But after multiresolution analysis, we select six groups of 59 features for CG and PG classification. The proposed features have been tested with thousands of CG and PG. Classification accuracy reaches 95.1% with support vector machines and outperforms the state-of-the-art works. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

HCN4 is a hyperpolarization-activated nucleotide-gated cation channel involved in the generation of the If current that drives cardiac pacemaker activity. Previous studies have demonstrated that HCN4 is highly expressed in a restricted manner in adult sinoatrial (SA) node [Eur. J. Biochem. 268 (2001) 1646]. However, its developmental expression pattern is unknown. We have examined expression of HCN4 mRNA during mouse heart development. HCN4 mRNA was first detected in the cardiac crescent at embryonic day (ED) 7.5. At ED 8 it was symmetrically located in the most caudal portion of the heart tube, the sinus venosus where pacemaker activity has previously been reported [Am. J. Physiol. 212 (1967) 407]. With further development, HCN4 expression became asymmetrically distributed, occupying the dorsal wall of the right atria, and was progressively restricted to the junction of the right atrial appendage and the superior vena cava. The site of HCN4 expression in late embryonic heart coincided with the location of the SA node in postnatal and adult heart [Cardiovasc. Res. 52 (2001) 51]. Our results suggest that HCN4 may be a unique marker of the developing SA node. [Copyright &y& Elsevier]

Injecting supercritical CO2 into gas reservoir is a novel trial to improve condensate gas recovery and decrease the hydrocarbon liquid dropout. A good understanding of the effect of supercritical CO2 on the phase behavior properties of these hydrocarbons is essential for accurately forecasting the displacing performance and storing process of the reservoirs with numerical simulators. This paper presents novel phase behavior experimental procedures and phase equilibrium evaluation methodology for gas-condensate phase system mixed with supercritical CO2 over a wide range of temperatures and pressures. A unique phase behavior phenomena was also reported. The mass transfer between two vapour phases was also measured. In order to interpret and identify the interface property between condensate gas and supercritical CO2, a multiphase thermodynamic VLV equilibrium model was established. Finally, taken YKL condensate gas in Northwest China as an example, the region where the conditions in terms of pressure, temperature and CO2 concentration can yield VLV equilibrium was found. The calculation results of multiphase thermodynamic model for condensate-CO2 system in this paper are close to the experimental data and can truthfully reflect the phase behavior of interface between CO2 and condensate gas. The research results indicate that it is the existence of the interface between CO2 and condensate gas that makes CO2 possible be an attractive option to successfully displace condensate gas and decrease CO2 emissions. [ABSTRACT FROM AUTHOR]

Hearts of mice lacking Isl1, a LIM homeodomain transcription factor, are completely missing the outflow tract, right ventricle, and much of the atria. isl1 expression and lineage tracing of isl1-expressing progenitors demonstrate that Isl1 is a marker for a distinct population of undifferentiated cardiac progenitors that give rise to the cardiac segments missing in isl1 mutants. Isl1 function is required for these progenitors to contribute to the heart. In isl1 mutants, isl1-expressing progenitors are progressively reduced in number, and FGF and BMP growth factors are downregulated. Our studies define two sets of cardiogenic precursors, one of which expresses and requires Isl1 and the other of which does not. Our results have implications for the development of specific cardiac lineages, left-right asymmetry, cardiac evolution, and isolation of cardiac progenitor cells. [Copyright &y& Elsevier]

Abstract: We have evaluated the anti-platelet and vascular pharmacology of AR246686, a novel 5-hydroxytryptamine2A (5-HT2A) receptor antagonist. AR246686 displayed high affinity binding to membranes of HEK cells stably expressing recombinant human and rat 5-HT2A receptors (K i =0.2 nM and 0.4 nM, respectively). Functional antagonism (IC50 =1.9 nM) with AR246686 was determined by inhibition of ligand-independent inositol phosphate accumulation in the 5-HT2A stable cell line. We observed 8.7-fold and 1360-fold higher affinity of AR246686 for the 5-HT2A receptor vs. 5-HT2C and 5-HT2B receptors, respectively. AR246686 inhibited 5-HT-induced amplification of ADP-stimulated human platelet aggregation (IC50 =21 nM). Similar potency was observed for inhibition of 5-HT stimulated DNA synthesis in rat aortic smooth muscle cells (IC50 =10 nM) and 5-HT-mediated contraction in rat aortic rings. Effects of AR246686 on arterial thrombosis and bleeding time were studied in a rat model of femoral artery occlusion. Oral dosing of AR246686 to rats resulted in prolongation of time to occlusion at 1 mg/kg, whereas increased bleeding time was observed at a dose of 20 mg/kg. In contrast, both bleeding time and time to occlusion were increased at the same dose (10 mg/kg) of clopidogrel. These results demonstrate that AR246686 is a high affinity 5-HT2A receptor antagonist with potent activity on platelets and vascular smooth muscle. Further, oral administration results in anti-thrombotic effects at doses that are free of significant effects on traumatic bleeding time. [Copyright &y& Elsevier]

The enormous majority of previous reports focused on evaluating the safety and efficacy of sequential saphenous vein (SV) coronary bypass grafting; however, no reports to date have revealed concern regarding the impacts of the number of distal anastomoses of sequential SV grafting on graft patency after coronary artery bypass grafting (CABG). This single-center retrospective study aimed to evaluate the impacts of three versus two distal anastomoses per single SV conduit on SV graft patency after off-pump CABG, and to determine the independent risk factors for sequential SV graft failure.From January 2011 to December 2014, 1320 eligible patients were assigned to either a triple group (three distal anastomoses of sequential SV grafting, n = 758) or a double group (two distal anastomoses of sequential SV grafting, n = 562). The primary endpoint was over a 2-year follow-up SV graft failure after off-pump CABG.The triple and double group received a similar total patency rate of sequential SV conduits (86.5% versus 87.1%, P = 0.757). The number of distal anastomoses of sequential SV grafting (three versus two) was not a predictive factor for the follow-up graft failure of sequential SV conduits (HR = 0.91, 95% CI: 0.66-2.29, P = 0.137). Moreover, the two groups received a similar follow-up survival freedom from repeat revascularization (χ 2 = 1.881, log-rank P = 0.170).Three versus two distal anastomoses per single SV conduit received a similar SV graft patency. The number of distal anastomoses of sequential SV grafting was not an independent risk factor for graft failure.

Sequential grafting may be an effective way to maximize the benefits of the left internal mammary artery (LIMA) conduit. Despite increasing clinical application, the strategy of sequential LIMA grafting has not been proven its superiority. This single-center retrospective study aimed to evaluate the in-hospital and mid-term outcomes of sequential grafting of in situ skeletonized LIMA to the left coronary system.According to the use of sequential or separate LIMA grafting, 1505 eligible patients were assigned to a sequential group (n = 230) and a control group (n = 1275). According to sequential LIMA graft configurations, patients with sequential LIMA grafting were divided into a DOM subgroup (n = 113) and a DLAD subgroup (n = 117). The clinical outcomes and LIMA graft patency were investigated and compared.Sequential LIMA grafting compared with separate LIMA grafting was not an independent predictor either of in-hospital adverse events or follow-up survival free from repeat revascularization during the follow-up period of 32.4 ± 8.5 months. Sequential LIMA grafting had similar LIMA graft patency with separate LIMA grafting (99.5% of 1st sequential sites and 97.7% of 2nd sites versus 98.2% of LIMA-LAD grafts) at 32.3 ± 8.5 months after coronary artery bypass grafting (CABG) surgery. Additionally, the two subgroups received similar mid-term clinical outcomes and graft patency of LIMA segments.Sequential grafting of in situ skeletonized LIMA to the left coronary system resulted in excellent clinical outcomes and graft patency. The two sequential LIMA graft configurations received similar clinical outcomes and graft patency.

This study aimed to evaluate the feasibility and the mid-term efficacy of an in situ skeletonized right internal mammary artery (IMA) bypass grafting to a left anterior descending artery (LAD), and to determine risk factors for IMA graft failure in a single-center study.From January 2012 to December 2015, 189 patients (173 males, 50.6 ± 6.0 years old) undergoing first isolated coronary artery bypass grafting surgery with the in situ skeletonized right IMA grafting to the LAD were included in this study. Baseline characteristics, peroperative data, and follow-up outcomes were investigated and analyzed.The length of the in situ skeletonized right IMA grafts was 18.6 ± 1.2 cm (17.0-22.0 cm). Intraoperative graft flow of the in situ skeletonized right IMA grafting to LAD was 42 ± 9 mL/minute (18-72 mL/minute) associated with measured pulsatility index of 0.8-4.3. In-hospital mortality was 0.5%. Postoperative morbidity included acute myocardial infarction (0.5%), stroke (0.5%), and deep sternal wound infections (1.1%). The mid-term survival was 97.2% and the incidence of repeat revascularization was 0.6%. The patency rate of the in situ skeletonized right IMA grafting to the LAD was 97.1% by computed tomography angiography examination during the follow-up period of 23.2 ± 9.7 months. Additionally, logistic regression analysis showed that intraoperative graft flow had an independent influence on the risk of the mid-term right IMA graft failure.The strategy of the in situ skeletonized right IMA grafting to the LAD is feasible and effective. Intraoperative graft flow was an independent risk factor for the mid-term right IMA graft failure.

Background: To evaluate in-hospital and mid-term outcomes of sequential vs. separate grafting of in situ skeletonized left internal mammary artery (LIMA) to the left coronary system in a single-center, propensity-matched study.Methods and Results:After propensity score-matching, 120 pairs of patients undergoing first scheduled isolated coronary artery bypass grafting (CABG) with in situ skeletonized LIMA grafting to the left anterior descending artery (LAD) territory were entered into a sequential group (sequential grafting of LIMA to the diagonal artery and then to the LAD) or a control group (separate grafting of LIMA to the LAD). The in-hospital and follow-up clinical outcomes and follow-up LIMA graft patency were compared. Both propensity score-matched groups had similar in-hospital and follow-up clinical outcomes. Sequential LIMA grafting was not found to be an independent predictor of adverse events. During a follow-up period of 27.0±7.3 months, 99.1% patency for the diagonal site and 98.3% for the LAD site were determined by coronary computed tomographic angiography after sequential LIMA grafting, both of which were similar with graft patency of separate grafting of in situ skeletonized LIMA to the LAD., Conclusions: Revascularization of the left coronary system using a skeletonized LIMA resulted in excellent in-hospital and mid-term clinical outcomes and graft patency using sequential grafting.

Background: Limited experiences of applying an on-pump beating-heart technique for surgical revascularization in patients with severe left ventricular dysfunction have been reported. Which strategy, either off-pump coronary artery bypass grafting (CABG) or on-pump beating-heart CABG surgery, is the best strategy for surgical revascularization in patients with severe left ventricular dysfunction is still controversial. This single-center study aimed to evaluate the impacts of an on-pump beating-heart versus an off-pump technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (LVEF) of 35% or less to explore which technique would be more suitable for surgical revascularization in patients with severe left ventricular dysfunction., Methods: A total of 216 consecutive patients with an echocardiographic estimated LVEF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 were included in this study and were divided into either an ONBEAT group (patients who received on-pump beating-heart CABG surgery, n = 88) or an OFF group (patients who received off-pump CABG surgery, n = 128). The early clinical outcomes were investigated and compared., Results: Patients in the ONBEAT group compared to the OFF group had a significant higher early postoperative LVEF (35.6 ± 2.9 vs. 34.8 ± 3.3%, p = 0.034) but shared a similar baseline LVEF (31.0 ± 2.8 vs. 31.0 ± 2.9%, p = 0.930). Patients in the ONBEAT group compared to the OFF group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7 ± 0.8 vs. 2.8 ± 0.6, p <0.001; 715 ± 187 ml vs. 520 ± 148 ml, p <0.001, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Additionally, logistic regression analysis showed that surgical technique (on-pump beating-heart CABG vs. off-pump CABG) had no independent influence on in-hospital mortality or major postoperative morbidity in patients with preoperative LVEF of 35% or less., Conclusions: The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated LVEF of 35% or less.