Computational study of transcatheter aortic valve replacement based on patient-specific models-rapid surgical planning for self-expanding valves.

Transcatheter aortic valve replacement (TAVR) is a minimally invasive interventional solution for treating aortic stenosis. The complex post-TAVR complications are associated with the type of valve implanted and the position of the implantation. The study aimed to establish a rapid numerical research method for TAVR to assess the performance differences of self-expanding valves released at various positions. It also aimed to calculate the risks of postoperative paravalvular leak and atrioventricular conduction block, comparing these risks to clinical outcomes to verify the method's effectiveness and accuracy. Based on medical images, six cases were established, including the aortic wall, native valve and calcification; one with a bicuspid aortic valve and five with tricuspid aortic valves. The parameters for the stent materials used by the patients were customized. High strain in the contact area between the stent and the valve annulus may lead to atrioventricular conduction block. Postoperatively, the self-expanding valve maintained a circular cross-section, reducing the risk of paravalvular leak and demonstrating favorable hemodynamic characteristics, consistent with clinical observations. The outcomes of the six simulations showed no significant difference in valve frame morphology or paravalvular leak risk compared to clinical results, thereby validating the numerical simulation process proposed for quickly selecting valve models and optimal release positions, aiding in TAVR preoperative planning based on patients'geometric characteristics.

Differentiable optimization layers enhance GNN-based mitosis detection.

Automatic mitosis detection from video is an essential step in analyzing proliferative behaviour of cells. In existing studies, a conventional object detector such as Unet is combined with a link prediction algorithm to find correspondences between parent and daughter cells. However, they do not take into account the biological constraint that a cell in a frame can correspond to up to two cells in the next frame. Our model called GNN-DOL enables mitosis detection by complementing a graph neural network (GNN) with a differentiable optimization layer (DOL) that implements the constraint. In time-lapse microscopy sequences cultured under four different conditions, we observed that the layer substantially improved detection performance in comparison with GNN-based link prediction. Our results illustrate the importance of incorporating biological knowledge explicitly into deep learning models.

Commissural and coronary alignment of the Venus-A valve after transcatheter aortic valve replacement: a retrospective cross-sectional study.

Background: Previous studies have shown that neo-commissural orientation of transcatheter heart valve (THV) can influence coronary obstruction during transcatheter aortic valve replacement (TAVR), long-term durability of THV, and coronary artery access for reintervention after TAVR. Specific initial orientations of Evolut R/Pro and Acurate Neo aortic valves can improve commissural alignment. However, the method of achieving commissural alignment with the Venus-A valve remains unknown. Therefore, this study aimed to evaluate the extent of commissural and coronary alignment of the Venus-A self-expanding valve after TAVR using a standard system delivery technique. Methods: A retrospective cross-sectional study was performed. At the time of enrollment, patients who underwent pre- and post-procedural electrocardiographically-gated contrast-enhanced CT with a second-generation 64-row multidetector scanner were selected for the study. Commissural alignment was categorized as aligned (0-15° angle deviation), mild (15-30°), moderate (30-45°), or severe (45-60°) commissural misalignment (CMA). Coronary alignment was categorized as having no coronary overlap (CO) (>35°), moderate CO (20-35°), or severe CO (≤20°). The results were represented as proportions to assess the extent of commissural and coronary alignment. Results: Forty-five TAVR patients were ultimately included in the analysis. THVs were shown to be randomly implanted: 20.0% of THVs were aligned, 33.3% had mild CMA, 26.7% had moderate CMA, and 20.0% had severe CMA. The incidence of severe CO was 24.4% with the left main coronary artery, 28.9% with the right coronary artery, 6.7% with both coronary arteries, and 46.7% with one or both coronary arteries. Conclusions: The results showed that commissural or coronary alignment could not be achieved with the Venus-A valve using a standard system delivery technique. Therefore, specific methods to attain alignment with the Venus-A valve need to be identified.

A Biodegradable, Waterproof, and Thermally Processable Cellulosic Bioplastic Enabled by Dynamic Covalent Modification.

The growing environmental concern over petrochemical-based plastics continuously promotes the exploration of green and sustainable substitute materials. Compared with petrochemical products, cellulose has overwhelming superiority in terms of availability, cost, and biodegradability; however, cellulose's dense hydrogen-bonding network and highly ordered crystalline structure make it hard to be thermoformed. A strategy to realize the partial disassociation of hydrogen bonds in cellulose and the reassembly of cellulose chains via constructing a dynamic covalent network, thereby endowing cellulose with thermal processability as indicated by the observation of a moderate glass transition temperature (Tg  = 240 °C), is proposed. Moreover, the cellulosic bioplastic delivers a high tensile strength of 67 MPa, as well as excellent moisture and solvent resistance, good recyclability, and biodegradability in nature. With these advantageous features, the developed cellulosic bioplastic represents a promising alternative to traditional plastics.

Anatomical spatial distribution of the bilateral coronary ostia and aortic valve commissures relative to the aortic arch.

Background: Previous studies have shown the importance of achieving commissural alignment during transcatheter aortic valve replacement (TAVR). However, the anatomical spatial distribution of the bilateral coronary ostia and aortic valve commissures relative to the aortic arch is still unknown. This study aimed to evaluate this anatomical relationship. Methods: A retrospective cross-sectional study was designed. Patients who underwent pre-procedural electrocardiographically gated computed tomography (CT) angiography with a second-generation dual-source CT scanner were enrolled in this study. Three-dimensional reconstruction was performed, and the inner curve (IC) of the aortic arch was defined. The angles between the coronary arteries or aortic valve commissures and the IC were measured. Results: Ultimately, 80 patients were included in the analysis. The angle from the IC to the left main (LM) was 48.0°±17.5°, and the angle from the IC to the right coronary artery (RCA) was 172.6°±15.2°. The median angle from the IC to the non-coronary cusp (NCC)/left coronary cusp (LCC) commissure was -12.8° with an interquartile range (IQR) of -21.5° to -2.2°, the angle from the IC to the LCC/right coronary cusp (RCC) commissure was 102.4°±15.1°, and the angle from the IC to the RCC/NCC commissure was 219.9°±13.9°. Conclusions: This study found a fixed angular relationship between the coronary ostia or aortic valve commissures and the IC of the aortic arch. This relationship could help to establish an individualized implantation method that would enable commissural and coronary alignment to be achieved in TAVR.

HIGD1A inactivated by DNA hypermethylation promotes invasion of kidney renal clear cell carcinoma.

Hypoxia contributes to the tumorigenesis and metastasis of the tumor. However, the detailed mechanisms underlying hypoxia and kidney renal clear cell carcinoma (KIRC) development and progression remain unclear. Here, we investigated the role of the system HIG1 hypoxia inducible domain family member 1 A (HIGD1A) in the proliferation and metastasis of KIRC and elucidated the underlying molecular mechanisms. The expression of HIGD1A is significantly downregulated in KIRC due to promoter hypermethylation. HIGD1A could serve as a valuable diagnostic biomarker in KIRC. In addition, ectopic overexpression of HIGD1A significantly suppressed the growth and invasive capacity of KIRC cells in vitro under normal glucose conditions. Interestingly, the suppressive efficacy in invasion is much more significant when depleted glucose, but not in proliferation. Furthermore, mRNA expression of HIGD1A positively correlates with CDH1 and EPCAM, while negatively correlated with VIM and SPARC, indicating that HIGD1A impedes invasion of KIRC by regulating epithelial-mesenchymal transition (EMT). Our data suggest that HIGD1A is a potential diagnostic biomarker and tumor suppressor in KIRC.

Downregulation of hsa-miR-135b-5p Inhibits Cell Proliferation, Migration, and Invasion in Colon Adenocarcinoma.

Colon cancer is the most common malignant tumor of the gastrointestinal tract, and approximately 80%-90% of colon cancers are colon adenocarcinomas (COADs). This study aimed to screen key microRNAs (miRNAs) associated with COAD. Differentially expressed (DE) miRNAs were screened between COAD and adjacent cancer samples based on the Gene Expression Omnibus (GEO) and the Cancer Genome Atlas obtained from datasets. The miRNAs of interest were validated using quantitative real-time polymerase chain reaction. Moreover, the effects of hsa-miR-135b-5p on the biological behavior of COAD cells were observed. To obtain the target genes of hsa-miR-135b-5p, transcriptome sequencing of the SW480 cells was performed, followed by protein-protein interaction (PPI) network and hsa-miR-135b-5p-target gene regulatory network construction and prognostic analysis. Downregulation of hsa-miR-135b-5p significantly inhibited SW480 cell proliferation, migration, and invasion and significantly facilitated apoptosis (P < 0.05). A total of 3384 DEmRNAs were screened, and enrichment analysis showed that the upregulated mRNAs were enriched in 25 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways and 326 Gene Ontology Biological Processes (GO-BPs) while the downregulated mRNAs were enriched in 20 KEGG pathways and 276 GO-BPs. A PPI network was then constructed, and H2BC14, H2BC3, and H4C11 had a higher degree. In addition, a total of 352 hsa-miR-135b-5p-gene regulatory relationships were identified. Prognostic analysis showed that FOXN2, NSA2, MYCBP, DIRAS2, DESI1, and RAB33B had prognostic significance (P < 0.05). In addition, the validation analysis results showed that FOXN2, NSA2, and DESI1 were significantly expressed between the miR-135b-5p-inhibitor and negative control groups (P < 0.05). Therefore, downregulation of hsa-miR-135b-5p inhibits cell proliferation, migration, and invasion in COAD, and carcinogenesis may function by targeting FOXN2, NSA2, MYCBP, DIRAS2, DESI1, and RAB33B.

Slippery liquid-infused porous surface (SLIPS) with super-repellent and contact-killing antimicrobial performances.

Slippery liquid-filled porous surfaces (SLIPS) have attracted extensive research attention for their unique repellent properties, but such surfaces typically lack essential bactericidal activity and cannot defend against the spread of bacteria once bacterial contamination occurs. Herein, a slippery liquid-infused porous surface (SLIPS), endowed with both super-repellent and contact-killing antimicrobial performances is reported. Firstly, polystyrene (PS) based porous structures are developed via a facile microphase separation technique with poly(ethylene glycol) (PEG) as the sacrifice template. The porous surface was then covalently modified by 3-(trimethoxysilyl)propyl dimethyl undecyl ammonium chloride (QAC-Silane) to get the contact-killing antimicrobial performances. After lubricant (silicone oil) is introduced to the porous structure, the SLIPS surface demonstrates remarkably high super-repellence against both Gram-positive and negative bacteria, and also maintains essential contact-killing antimicrobial activities from the fixed QAC-11 groups, once the infused lubricant was depleted. Also, this surface demonstrates a reduced coefficient of friction (COF) of ∼56% as compared to that of the control flat surface. Moreover, this SLIPS surface can be easily realized on various substrates, such as silica glass, polycarbonate (PC), polyethylene terephthalate (PET), polyethylene (PE) and silicone catheter tube. Owing to its simple, low-cost and fast fabrication approach, this kind of surface may find unique biomedical applications where an effective antibacterial performance and lubricity are highly needed.

The relationship between serum lipid levels and colorectal serrated lesions: A systematic review and meta-analysis.

Objective: To clarify the relationship between colorectal serrated lesions and serum lipid levels, and provide a scientific basis for the identification and early clinical prevention and treatment of populations that are at risk for colorectal serrated lesions. Methods: Studies comparing serum lipid levels in patients with colorectal serrated lesions and controls were searched in PubMed, Embase, Web of Science, the Cochrane Library, China Biomedical Literature Database, CNKI, Wanfang Database, and VIP Database. Relevant literature was screened according to the inclusion and exclusion criteria. The mean and standard deviation of the serum lipid levels in patients and controls were extracted from the included literature. The combined weighted mean difference (WMD) and 95% confidence intervals (CIs) were calculated using Review Manager 5.0 software to evaluate the relationship between serum lipid levels and colorectal serrated lesions. Publication bias of the included studies was evaluated by the Egger test. Results: Twenty-three studies were included, comprising 2,063 patients and 63,909 controls. The serum high-density lipoprotein cholesterol (HDL-C) levels in the case group was significantly lower than in the control group (WMD = -0.122 mmol/L, 95% CI: 0.170-0.073). Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and serum triglyceride levels in the case group were significantly higher than in the control group, and the WMDs were 0.180 mmol/L (95% CI: 0.061-0.299), 0.155 mmol/L (95% CI: 0.038-0.273), and 0.241 mmol/L (95% CI: 0.181-0.302), respectively. Conclusion: Colorectal serrated lesions may be related to blood lipid levels. Hyperlipidemia might be a risk factor for colorectal serrated lesions.

Transfemoral transcatheter aortic valve replacement for severe aortic stenosis with concomitant left ventricular diverticulum: a case report.

Background: Left ventricular diverticulum (LVD) is a rare cardiac malformation in patients with severe aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) is not recommended due to the risk of diverticulum injury. However, for patients considered inoperable or at high surgical risk, TAVR might be the only treatment option. The safety and feasibility of TAVR for severe AS with concomitant LVD are still unclear. Case summary: An 80-year-old Asian woman complaining of shortness of breath was admitted to our hospital, whose echocardiogram showed calcified severe AS and a diverticulum in the left ventricular apex. A transfemoral 26 mm Venus-A prosthetic aortic valve was successfully implanted. Pre- and post-procedural cardiac magnetic resonance imaging revealed a remarkable volume reduction of LVD. Discussion: Transfemoral TAVR was not preferred because the straight-tip hydrophilic wire and catheter tip could injure the fragile diverticulum wall. If we could avoid the injury of the diverticulum, TAVR would be a good option for patients at high surgical risk.

DeepBindBC: A practical deep learning method for identifying native-like protein-ligand complexes in virtual screening.

Identifying native-like protein-ligand complexes (PLCs) from an abundance of docking decoys is critical for large-scale virtual drug screening in early-stage drug discovery lead searching efforts. Providing reliable prediction is still a challenge for most current affinity predicting models because of a lack of non-binding data during model training, lost critical physical-chemical features, and difficulties in learning abstract information with limited neural layers. In this work, we proposed a deep learning model, DeepBindBC, for classifying putative ligands as binding or non-binding. Our model incorporates information on non-binding interactions, making it more suitable for real applications. ResNet model architecture and more detailed atom type representation guarantee implicit features can be learned more accurately. Here, we show that DeepBindBC outperforms Autodock Vina, Pafnucy, and DLSCORE for three DUD.E testing sets. Moreover, DeepBindBC identified a novel human pancreatic α-amylase binder validated by a fluorescence spectral experiment (Ka = 1.0 × 105 M). Furthermore, DeepBindBC can be used as a core component of a hybrid virtual screening pipeline that incorporating many other complementary methods, such as DFCNN, Autodock Vina docking, and pocket molecular dynamics simulation. Additionally, an online web server based on the model is available at http://cbblab.siat.ac.cn/DeepBindBC/index.php for the user's convenience. Our model and the web server provide alternative tools in the early steps of drug discovery by providing accurate identification of native-like PLCs.

Thermo-processable chitosan-based plastic substitute with self-adaptiveness and closed-loop recyclability.

The increasing environmental burden generated by disposable plastic wastes makes the development of sustainable substitute materials an emergent task. As one of the most abundant bioresources, chitosan (CS) has been considered as a potential candidate for plastic substitution. Conventionally, CS-based materials are fabricated through a solution-processing procedure due to the high crystallinity of CS. Herein, we designed a CS-based material via integrating CS into the network of polyimine (PI), which shows thermomechanical processability similar to plastics. Strong interactions were achieved through dynamic imine bond and hydrogen bond and thus formed a thermo-processable dynamic composite network. These CS-based plastic substitutes exhibit exceptional mechanical performances, excellent thermal/chemical stability, and a series of self-adaptiveness, including re-healing, reprocessing and multi-layer laminating. Notably, CPs can be easily degraded and 100% recycled for the production of next-generation materials. This work provides an alternative route to produce green and sustainable biomass materials as a plastic substitute.

Epigenetic inactivation of ACAT1 promotes epithelial-mesenchymal transition of clear cell renal cell carcinoma.

BACKGROUND: Acetyl-CoA acyltransferase 1 (ACAT1) is a key enzyme catalyzing the production of mitochondrial ketone bodies. We have shown that ACAT1 is down-regulated in kidney renal clear cell carcinoma (KIRC) previously. OBJECTIVE: To investigate the reasons for downregulation of ACAT1 in KIRC and explore the underlying mechanisms involved in metastatic inhibition regulated by ACAT1. METHODS: The Gene Expression Omnibus (GEO) database was queried for meta-analysis of ACAT1 mRNA expression in KIRC. The UALCAN website was used to compare the methylation levels of the ACAT1 promoter region in KIRC and normal tissues. RT-qPCR was used to quantitate ACAT1 transcription levels. The GCBI and Tarbase V.8 databases were used to predict miRNAs that may target the mRNA of ACAT1. The correlation between mRNA expression of ACAT1, MMP7 (matrix metallopeptidase 7), CDH1 (E-cadherin), EpCAM (epithelial cell adhesion molecule), and VIM (vimentin) was analyzed. Extracellular MMP7 protein was quantitated using an ELISA assay. RESULTS: The methylation level of the ACAT1 promoter region in KIRC was significantly higher than that in the normal kidney tissues. The ACAT1 mRNA expression in the KIRC cell lines was restored after treatment with 5-aza-dC (p < 0.05). MiR-21-5p is a conserved microRNA targeting ACAT1. It is expressed at a significantly higher level in KIRC than in normal tissues (p < 0.001). MiR-21-5p miRNA expression negatively correlates with ACAT1 mRNA expression. The expression of miR-21-5p is higher at the T3-T4 stages and in the histologic grades G3-G4. Patients with high miR-21-5p expression tended to have lower overall survival, suggesting that miR-21-5p could serve as a potentially valuable diagnostic biomarker for KIRC (AUC = 0.957; p < 0.001). A mimetic of miR-21-5p inhibited the expression of ACAT1 mRNA and protein. In addition, ACAT1 mRNA expression positively correlates with CDH1 and EpCAM but is negatively correlated with VIM. Overexpression of ACAT1 suppresses the secretion of MMP7 in KIRC cells. CONCLUSION: Expression of ACAT1 in KIRC is controlled at two levels, firstly by the hypermethylation of the ACAT1 promoter region and secondly by overexpression of miR-21-5p. Downregulation of ACAT1 expression correlates with epithelial-mesenchymal transition (EMT).

Head-to-Head Comparison of 68Ga-PSMA-11 PET/CT and Multiparametric MRI for Pelvic Lymph Node Staging Prior to Radical Prostatectomy in Patients With Intermediate to High-Risk Prostate Cancer: A Meta-Analysis.

PURPOSE: To compare the diagnostic performance of 68Ga-PSMA-11 PET/CT and mpMRI for pelvic lymph node staging prior to radical prostatectomy in prostate cancer (PCa) patients based on per patient data. METHODS: PubMed and Embase databases were searched until October 2020 for eligible studies evaluating head-to-head comparison of 68Ga-PSMA-PET/CT and mpMRI for the detection of pelvic lymph node metastases (PLNMs) using pelvic lymph node dissection (PLND) as gold standard. The pooled sensitivity, specificity, and area under the summary receiver-operating characteristics curve (AUC) were determined for the two imaging modalities. RESULTS: Nine studies with 640 patients were included. The pooled sensitivity, specificity, and AUC for 68Ga-PSMA-11 PET/CT vs. mpMRI were 0.71 (95% CI: 0.48-0.86) vs. 0.40 (95% CI: 0.16-0.71), 0.92 (95% CI: 0.88-0.95) vs. 0.92 (95% CI: 0.80-0.97), and 0.92 (95% CI: 0.88-0.95) vs. 0.82 (95% CI: 0.79-0.86), respectively. There was substantial heterogeneity for both imaging modalities, and meta-regression analysis revealed that the number of patients, prevalence of PLNMs, PSA level, reference standard, and risk classification might be the potential causes of heterogeneity. CONCLUSION: This meta-analysis of head-to-head comparison studies confirms that there is a trend toward a higher sensitivity and diagnostic accuracy of 68Ga-PSMA-11 PET/CT compared to mpMRI for the detection of PLNMs in PCa patients. Nevertheless, according to current guidelines, PLND still needs to be recommended in case of negative results from 68Ga-PSMA-11 PET/CT due to significant risk of malignancy.

Epigenetic inactivation of hydroxymethylglutaryl CoA synthase reduces ketogenesis and facilitates tumor cell motility in clear cell renal carcinoma.

Previously, we have reported that the dysregulation of ketogenesis plays an important role in the carcinogenesis of clear cell renal cell carcinoma (ccRCC). Here, we demonstrate decreased expression of the HMGCS2 gene in ccRCC, a critical enzyme for the synthesis of the ketone body ß-hydroxybutyrate (ß-OHB). We found that the reduced transcription of the HMGCS2 gene in ccRCC cells was significantly correlated to a higher relative methylation rate in its promotor region. The higher methylation rate in the region of the transcription start site and 1st exon of the HMGCS2 gene was, in turn, correlated with a worse clinical outcome for patients. The transcription of HMGCS2 was possible to restore by treatment with 5-aza-2'-deoxycytidine and with the histone deacetylase inhibitor ß-OHB. Therefore, the low levels of the HMGCS2 enzyme in ccRCC may be the consequence of hypermethylation of the HMGCS2 promotor. The ensuing reduction in the ketone body levels further suppresses the transcription of HMGCS2 via a feedback loop. Ectopic expression of HMGCS2 attenuates the migration and invasion of ccRCC but does not affect the proliferative capacity of ccRCC cells in vitro. In addition, we showed that ectopic expression of HMGCS2 boosts the intracellular levels of ß-OHB and that exogenously applied ß-OHB suppresses the motility and invasion of ccRCC. Our study reveals crosstalk between genes that regulate metabolism and their metabolites, thus providing a better understanding of the epigenetic mechanism involved in ccRCC carcinogenesis and suggesting opportunities for metabolic therapy of tumors. Initially, we suggest that the mRNA level of HMGCS2 could serve as a potentially valuable diagnostic (AUC = 0.918, p < 0.001) and prognostic biomarker.

Decreased expression of miR-3135b reduces sensitivity to 5-fluorouracil in colorectal cancer by direct repression of PIM1.

5-Fluorouracil (5-FU)-based chemotherapy is the conventional treatment approach for patients with colorectal cancer (CRC). However, de novo and acquired resistance to 5-FU are frequently observed during treatment, which eventually lead to patients succumbing to the disease. Accumulating data have revealed an association of CRC resistance to 5-FU with aberrant expression of microRNAs (miRs). In the present study, Cell Counting Kit-8 was performed to measure cell viability, flow cytometry was performed to detect cell apoptosis, reverse transcription-quantitative PCR was conducted to measure proviral integration site for Moloney murine leukemia virus 1 (PIM1) and miR-3135b expression, western blotting was conducted to measure PIM1 expression. Microarray data analysis indicated that the level of miR-3135b expression was decreased in patients with recurrent CRC that were treated with 5-FU when compared with non-recurrent cases. Overexpression of miR-3135b increased the sensitivity of CRC cells to 5-FU treatment. Moreover, PIM1 was identified as a target gene of miR-3135b using bioinformatics analysis, reverse transcription-quantitative PCR and western blotting. The direct interaction between these two targets was confirmed by luciferase reporter assays. Notably, PIM1 overexpression compensated the effect of miR-3135b in CRC cells. Furthermore, an inverse correlation between PIM1 mRNA expression levels and miR-3135b expression was observed in clinical samples. Therefore, the present study identified miR-3135b as a novel regulator of 5-FU sensitivity in CRC.

[Retracted] miR-126 inhibits papillary thyroid carcinoma growth by targeting LRP6.

Following the publication of this paper, it was drawn to the Editors' attention by a concerned reader that certain of the western blotting data shown in Figs. 4C, 5B and 6D were strikingly similar to data appearing in different form in other articles by different authors. Owing to the fact that the contentious data in the above article were already under consideration for publication, or had already been published, elsewhere prior to its submission to Oncology Reports, the Editor has decided that this paper should be retracted from the Journal. After having been in contact with the authors, they agreed with the decision to retract the paper. The Editor apologizes to the readership for any inconvenience caused. [the original article was published in Oncology Reports 34: 2202­2210, 2015; DOI: 10.3892/or.2015.4165].

Protective effect of dexmedetomidine on perioperative myocardial injury in patients with Stanford type-A aortic dissection.

OBJECTIVE: To investigate the protective effect and mechanism of dexmedetomidine (Dex) on perioperative myocardial injury in patients with Stanford type-A aortic dissection (AD). METHODS: Eighty-six patients with Stanford type-A AD were randomly divided into Dex and control groups, with 43 cases in each group. During the surgery, the control group received the routine anesthesia, and the Dex group received Dex treatment based on routine anesthesia. The heart rate (HR) and mean arterial pressure (MAP) were recorded before Dex loading (t0), 10 min after Dex loading (t1), at the skin incision (t2), sternum sawing (t3), before cardiopulmonary bypass (t4), at the extubation (t5), and at end of surgery (t6). The blood indexes were determined before anesthesia induction (T0) and postoperatively after 12h (T1), 24h (T2), 48h (T3), and 72h (T4). RESULTS: At t2 and t3, the HR and MAP in the Dex group were lower than in the control group (P < 0.05). Compared with the control group, in the Dex group at T1, T2, and T3, the serum creatine kinase-MB, cardiac troponin-I, C-reactive protein, and tumor necrosis factor-α levels were decreased, and the interleukin-10 level, the serum total superoxide dismutase, and total anti-oxidant capability increased, while the myeloperoxidase and malondialdehyde levels decreased (all P < 0.05). CONCLUSIONS: Dex treatment may alleviate perioperative myocardial injury in patients with Stanford type-A AD by resisting inflammatory response and oxidative stress.

Protective effect of dexmedetomidine on perioperative myocardial injury in patients with Stanford type-A aortic dissection

SUMMARY OBJECTIVE: To investigate the protective effect and mechanism of dexmedetomidine (Dex) on perioperative myocardial injury in patients with Stanford type-A aortic dissection (AD). METHODS: Eighty-six patients with Stanford type-A AD were randomly divided into Dex and control groups, with 43 cases in each group. During the surgery, the control group received the routine anesthesia, and the Dex group received Dex treatment based on routine anesthesia. The heart rate (HR) and mean arterial pressure (MAP) were recorded before Dex loading (t0), 10 min after Dex loading (t1), at the skin incision (t2), sternum sawing (t3), before cardiopulmonary bypass (t4), at the extubation (t5), and at end of surgery (t6). The blood indexes were determined before anesthesia induction (T0) and postoperatively after 12h (T1), 24h (T2), 48h (T3), and 72h (T4). RESULTS: At t2 and t3, the HR and MAP in the Dex group were lower than in the control group (P < 0.05). Compared with the control group, in the Dex group at T1, T2, and T3, the serum creatine kinase-MB, cardiac troponin-I, C-reactive protein, and tumor necrosis factor-α levels were decreased, and the interleukin-10 level, the serum total superoxide dismutase, and total anti-oxidant capability increased, while the myeloperoxidase and malondialdehyde levels decreased (all P < 0.05). CONCLUSIONS: Dex treatment may alleviate perioperative myocardial injury in patients with Stanford type-A AD by resisting inflammatory response and oxidative stress.

RESUMO OBJETIVO: Investigar o efeito protetor e o mecanismo da dexmedetomidina (Dex) na lesão perioperativa do miocárdio em doentes com dissecação aórtica Tipo A de Stanford (AD). MÉTODOS: Oitenta e seis pacientes com o Tipo A de Stanford foram aleatoriamente divididos em Dex e grupos de controle, 43 casos em cada grupo. Durante a cirurgia, o grupo de controle recebeu a anestesia de rotina, e o grupo Dex recebeu tratamento Dex baseado na anestesia de rotina. A frequência cardíaca (AR) e a pressão arterial média (MAP) foram registradas no momento anterior ao Dex carregar (t0), 10 minutos após o Dex carregar (t1), incisão cutânea (t2), serragem de esterno (t3), antes do bypass cardiopulmonar (t4), extubação (t5) e fim da cirurgia (t6). Os índices de sangue foram determinados no momento antes da indução da anestesia (T0) e no pós-operatório 12 horas (T1), 24 horas (T2), 48 horas (T3) e 72 horas (T4). RESULTADOS: Em T2 e t3, o RH e o MAP do grupo Dex foram inferiores ao grupo de controle (p<0,05). Em comparação com o grupo de controle, no grupo Dex em T1, T2 e T3, os níveis séricos de creatina quinase-MB, troponina-I, proteína C-reativa e necrose do fator-α do tumor diminuíram, o nível interleucina-10 aumentou, o desalinhamento total do superóxido sérico e a capacidade antioxidante total aumentaram e os níveis de mielopeperóxido e malondialdeído diminuíram (todos p<0,05). CONCLUSÃO: O tratamento com Dex pode aliviar a lesão do miocárdio perioperativo em doentes com o Tipo A de Stanford por resistência à resposta inflamatória e ao estresse oxidativo.

MiR-483-3p inhibition ameliorates myocardial ischemia/reperfusion injury by targeting the MDM4/p53 pathway.

MiR-483-3p is involved in the pathogenesis of acute myocardial infarctions, but its association with myocardial ischemia reperfusion (IR) remains mostly unknown. In this study, an in vitro model of myocardial IR injury was established by putting H9c2 cells into hypoxia reoxygenation (HR) treatment to explore the effects and possible mechanisms of miR-483-3p in myocardial IR injury. HR exposure resulted in increased miR-483-3p levels in H9c2 cells. MiR-483-3p was overexpressed or downregulated in H9c2 cells by transfection of miR-483-3p mimic or miR-483-3p inhibitor. In HR-treated H9c2 cells, MiR-483-3p mimics inhibited cell viability, promoted lactate dehydrogenase release, and increased apoptosis, but miR-483-3p inhibitors caused the opposite effects. MDM4 was verified to be the target mRNA of miR-483-3p and negatively modulated by miR-483-3p. MiR-483-3p inhibitor upregulated MDM4 and Bcl-2, but downregulated p53 and Bax in HR-treated H9c2 cells, whereas miR-483-3p overexpression produced the opposite effects.. Moreover, MDM4 siRNA transfection partially reversed the role of miR-483-3p inhibition in HR injury and p53 pathway inactivation of H9c2 cells. In summary, by targeting the MDM4/p53 pathway, miR-483-3p inhibition may alleviate myocardial HR injury. MiR-483-3p may be a potential therapeutic target of myocardial IR injury.