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Jian Yang,&ast; Bin Zhang,&ast; Chengliang Qu,&ast; Li Liu,&ast; Yanyan Song Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yanyan Song, Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, 750004, People’s Republic of China, Tel +86 951-6743014, Fax +86 951-6744302, Email songyanyanyys60@126.comObjective: To investigate the risk factors of deep sternal wound infection (DSWI) after off-pump coronary artery bypass grafting and its prevention and treatment strategy.Methods: The clinical data of 465 patients who underwent OPCABG with a median chest incision were retrospectively analyzed. The patients were divided into the observation group (with DSWI, 32 cases) and the control group (without DSWI, 433 cases) according to the occurrence of DSWI. The preoperative, intraoperative, and postoperative clinical data relevant to DSWI were collected in both groups. The univariate and multivariate logistic regression analyses were adopted to analyze the risk factors for DSWI after OPCABG and investigateand its prevention and treatment strategy.Results: DSWI occurred in 32 cases with an incidence of infection of 6.89%. There were 5 cases died in the observation group (with DSWI), the overall mortality rate was 1.07% and the intra-group mortality rate was 15.6%. There were 16 cases died in the control group (without DSWI) because of low cardiac output syndrome and multiple organ failure, the overall and intra-group mortality rates were 3.44% and 3.69% respectively. By analyzing the risk factors of DSWI between the two groups, the differences in age, body mass index (BMI), history of diabetes mellitus (DM), operation time, tracheal intubation time, time of stay in thecardiac care unit, blood transfusion (blood plasma)> 800mL, blood transfusion (erythrocyte suspension)> 6um, secondary thoracotomy were statistically significant between the observation and control groups (P < 0.05 in all).Conclusion: Obesity, history of DM, prolonged operation time and tracheal intubation time, time of stay in CCU, utilization of blood product and secondary thoracotomy were DSWI independent risk factors after OPCABG.Some preventive measure should been implemented to reduce the incidence of DSWI, such as shorter operation time and tracheal intubation time, reducing the utilization of blood product.Keywords: off-pump coronary artery bypass grafting, sternal wound infection, risk factor

This study aims to investigate the correlation between the postoperative changes in serum amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels and the prognosis of patients with off-pump coronary artery bypass grafting.The patients were divided into two groups according to the left ventricular ejection fraction (LVEF) value of their cardiac ultrasound 48 h after surgery: the study group, those with early postoperative cardiac dysfunction (LVEF ≤45%, 36 cases), and the control group, those without early postoperative cardiac dysfunction (LVEF45%, 60 cases). The serum NT-proBNP levels at 24 h and 48 h after surgery and before discharge were measured in the two groups, and any major postoperative adverse events were observed to analyze the relationship between the NT-proBNP levels and early postoperative cardiac dysfunction and prognosis.The serum NT-proBNP levels in the study group were significantly higher than in the control group at 24 h and 48 h after surgery (p 0.05). However, there was no significant difference between the two groups in the serum NT-proBNP levels before discharge (p 0.05). The main adverse events of the study group during hospitalization were significantly higher than in the control group (p 0.05). The area under the curve of NT-proBNP in predicting early postoperative cardiac dysfunction was 0.850 (95% CI: 0.826-0.903) (p 0.001). The best diagnostic value was 5653.95 pg/ml, the sensitivity was 87.8%, and the specificity was 83.6%.The postoperative NT-proBNP level is closely related to early cardiac dysfunction and major adverse events after off-pump coronary artery bypass grafting.

This study highlights the creation of a curriculum system and teaching mode that adapts to the information era. According to an analysis of the shortages of traditional teaching mode for the course Principle and Application of Database and the status of teaching, a blending teaching mode design in the background of emerging engineering education, a case-driven reversal experimental teaching technique, and an assessment mechanism formulated in accordance with an analytic hierarchy process (AHP) are proposed. Relevant teaching activities are designed in detail. The new teaching mode considers the learning initiatives of students and individual acceptance differences. Assessment results and feedback from the data analysis of online investigation indicate that the improved teaching mode enhances teaching quality effectively. Moreover, the annual average growth of performance proportion that is better than “good” is 13% in the recent three years. Finally, the acceptability and satisfaction rates of students are higher than 90%.

OBJECTIVE This study aimed to investigate the clinical effects and perioperative treatment experience of elderly patients with valvular heart disease combined with coronary heart disease undergoing cardiac valve surgery (CVS) and coronary artery bypass grafting (CABG) concurrently. METHODS Seventy-eight patients with heart valve disease and coronary heart disease, aged over 65 and who underwent CVS and CABG concurrently between January 2016 and December 2020, were enrolled in this study. The clinical indexes related to cardiac function before and after surgery, early postoperative complications, and prognosis were analyzed retrospectively to explore the clinical effects and perioperative treatment experience of elderly patients undergoing these two procedures concurrently. RESULTS All patients were reexamined by echocardiography one month after surgery. The results showed that the left ventricular end-diastolic dimension, N-terminal pro-B-type natriuretic peptide levels, cardiothoracic ratio, and troponin-I levels were significantly lower than before surgery, and the differences were statistically significant (P < 0.05). The echocardiography revealed that the left ventricular end-diastolic volume, left ventricular ejection fraction, and left ventricular fractional shortening were larger than before surgery, and these differences were statistically significant (P < 0.05). CONCLUSION It is feasible and effective for elderly patients to undergo CVS and CABG concurrently. Perioperative management can reduce mortality, achieving good clinical effects.