Higher matrix stiffness promotes VSMC senescence by affecting mitochondria-ER contact sites and mitochondria/ER dysfunction.

Abdominal aortic aneurysm (AAA) is a prevalent condition characterized by the weakening and bulging of the abdominal aorta. This study aimed to investigate the impact of a stiff matrix on vascular smooth muscle cells (VSMCs) in AAA development. Bioinformatics analysis revealed that differentially expressed genes (DEGs) in VSMCs of an AAA mouse model were enriched in cellular senescence and related pathways. To simulate aging-related changes, VSMCs were cultured on stiff matrices, and compared to those on soft matrices, the VSMCs cultured on stiff matrices exhibited cellular senescence. Furthermore, the mutual distance between mitochondria and endoplasmic reticulum (ER) in VSMCs was increased, indicating altered mitochondria-endoplasmic reticulum contacts (MERCs). The observed upregulation of reactive oxygen species (ROS) levels, antioxidant gene expression, and decreased mitochondrial membrane potential suggested the presence of mitochondrial dysfunction in VSMCs cultured on a stiff matrix. Additionally, the induction of ER stress-related genes indicated ER dysfunction. These findings collectively indicated impaired functionality of both mitochondria and ER in VSMCs cultured on a stiff matrix. Moreover, our data revealed that high lipid levels exacerbated the effects of high matrix stiffness on VSMCs senescence, MERC sites, and mitochondria/ER dysfunction. Importantly, treatment with the antilipemic agent CI-981 effectively reversed these detrimental effects. These findings provide insights into the role of matrix stiffness, mitochondrial dysfunction, ER stress, and lipid metabolism in AAA development, suggesting potential therapeutic targets for intervention.

Mesenchymal stem cell attenuates spinal cord injury by inhibiting mitochondrial quality control-associated neuronal ferroptosis.

Ferroptosis is a newly discovered form of iron-dependent oxidative cell death and drives the loss of neurons in spinal cord injury (SCI). Mitochondrial damage is a critical contributor to neuronal death, while mitochondrial quality control (MQC) is an essential process for maintaining mitochondrial homeostasis to promote neuronal survival. However, the role of MQC in neuronal ferroptosis has not been clearly elucidated. Here, we further demonstrate that neurons primarily suffer from ferroptosis in SCI at the single-cell RNA sequencing level. Mechanistically, disordered MQC aggravates ferroptosis through excessive mitochondrial fission and mitophagy. Furthermore, mesenchymal stem cells (MSCs)-mediated mitochondrial transfer restores neuronal mitochondria pool and inhibits ferroptosis through mitochondrial fusion by intercellular tunneling nanotubes. Collectively, these results not only suggest that neuronal ferroptosis is regulated in an MQC-dependent manner, but also fulfill the molecular mechanism by which MSCs attenuate neuronal ferroptosis at the subcellular organelle level. More importantly, it provides a promising clinical translation strategy based on stem cell-mediated mitochondrial therapy for mitochondria-related central nervous system disorders.

The footprint of the anterior horn of medial meniscus: A novel and reliable landmark for the tibial vertical cut in Oxford mobile-bearing medial unicompartmental knee arthroplasty.

BACKGROUND: Tibial vertical cut is crucial for rotational position and bony coverage in Oxford mobile-bearing medial unicompartmental knee arthroplasty (UKA). This study aimed to determine whether the footprint of the anterior horn of medial meniscus (FAM) is a reliable landmark for tibial vertical cut. METHODS: The FAM and the line through FAM and the edge of anterior cruciate ligament insertion (FAMA line) were identified by dissection five knee joint specimens. The angle between FAMA line and standard Akagi's line was measured. From 2022 to 2023, 64 patients (74 knees) diagnosed as anteromedial osteoarthritis were included to undergo primary Oxford medial UKA by two surgeons (Group 1 and 2), using FAMA line as a landmark for tibial vertical cut. The anteroposterior (AP) length, mediolateral (ML) length of tibial cut and tibial prothesis were measured by vernier caliper. ML/AP ratio was also calculated, and data were compared intragroup and intergroup. Mediolateral position and external rotation of tibial components were assessed postoperatively. RESULTS: FAMA line was parallel to standard Akagi's line. No significant differences were found in AP and ML lengths between tibial cut and tibial component (AP different value = 0.007 ± 0.154 cm, P = 0.674, ML different value = 0.020 ± 0.195 cm, P = 0.155). The ML/AP ratio was similar between the two groups (P = 0.141, 0.646, 0.255, 0.607, 0.384, size AA âˆ¼ D). No significant difference was found in mediolateral position (0.87 ± 0.03 vs. 0.86 ± 0.03, P = 0.156) and external rotation (6.88 ± 2.08 vs. 6.68 ± 2.22, P = 0.746) of the tibial component between the two groups. CONCLUSION: The FAM is a reliable landmark for tibial vertical cut in Oxford UKA.

Predicting key gene related to immune infiltration and myofibroblast-like valve interstitial cells in patients with calcified aortic valve disease based on bioinformatics analysis.

Background: Calcified aortic valve disease (CAVD) is the most prevalent valvular disease that can be treated only through valve replacement. We aimed to explore potential biomarkers and the role of immune cell infiltration in CAVD progression through bioinformatics analysis. Methods: Differentially ex-pressed genes (DEGs) were screened out based on three microarray datasets: GSE12644, GSE51472 and GSE83453. Gene Ontology (GO) and Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed to evaluate gene expression differences. Machine learning algorithms and DEGs were used to screen key gene. We used CIBERSORT to evaluate the immune cell infiltration of CAVD and evaluated the correlation between the biomarkers and infiltrating immune cells. We also compared bioinformatics analysis results with the valve interstitial cells (VICs) gene expression in single-cell RNA sequencing. Results: Collagen triple helix repeat containing 1 (CTHRC1) was identified as the key gene of CAVD. We identified a cell subtype valve interstitial cells-fibroblast, which was closely associated with fibro-calcific progress of aortic valve. CTHRC1 highly expressed in the VIC subpopulation. Immune infiltration analysis demonstrated that mast cells, B cells, dendritic cells and eosinophils were involved in pathogenesis of CAVD. Correlation analysis demonstrated that CTHRC1 was correlated with mast cells mostly. Conclusions: In summary, the study suggested that CTHRC1 was a key gene of CAVD and CTHRC1 might participate in the potential molecular pathways involved in the connection between infiltrating immune cells and myofibroblast phenotype VICs.

An In-Hospital Mortality Risk Model for Elderly Patients Undergoing Cardiac Valvular Surgery Based on LASSO-Logistic Regression and Machine Learning.

BACKGROUND: To preferably evaluate and predict the risk for in-hospital mortality in elderly patients receiving cardiac valvular surgery, we developed a new prediction model using least absolute shrinkage and selection operator (LASSO)-logistic regression and machine learning (ML) algorithms. METHODS: Clinical data including baseline characteristics and peri-operative data of 7163 elderly patients undergoing cardiac valvular surgery from January 2016 to December 2018 were collected at 87 hospitals in the Chinese Cardiac Surgery Registry (CCSR). Patients were divided into training (N = 5774 [80%]) and testing samples (N = 1389 [20%]) according to their date of operation. LASSO-logistic regression models and ML models were used to analyze risk factors and develop the prediction model. We compared the discrimination and calibration of each model and EuroSCORE II. RESULTS: A total of 7163 patients were included in this study, with a mean age of 69.8 (SD 4.5) years, and 45.0% were women. Overall, in-hospital mortality was 4.05%. The final model included seven risk factors: age, prior cardiac surgery, cardiopulmonary bypass duration time (CPB time), left ventricular ejection fraction (LVEF), creatinine clearance rate (CCr), combined coronary artery bypass grafting (CABG) and New York Heart Association (NYHA) class. LASSO-logistic regression, linear discriminant analysis (LDA), support vector classification (SVC) and logistic regression (LR) models had the best discrimination and calibration in both training and testing cohorts, which were superior to the EuroSCORE II. CONCLUSIONS: The mortality rate for elderly patients undergoing cardiac valvular surgery was relatively high. LASSO-logistic regression, LDA, SVC and LR can predict the risk for in-hospital mortality in elderly patients receiving cardiac valvular surgery well.

Exosomal long non-coding RNA TRAFD1-4:1 derived from fibroblast-like synoviocytes suppresses chondrocyte proliferation and migration by degrading cartilage extracellular matrix in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic, autoimmune and systemic inflammatory disease affecting 1% of the population worldwide. Immune suppression of the activity and progress of RA is vital to reduce the disability and mortality rate as well as improve the quality of life of RA patients. However, the immune molecular mechanism of RA has not been clarified yet. Our results indicated that exosomes derived from TNFα-stimulated RA fibroblast-like synoviocytes (RA-FLSs) suppressed chondrocyte proliferation and migration through modulating cartilage extracellular matrix (CECM) determining by MTS assay, cell cycle analysis, Transwell assay and Western blot (WB). Besides, RNA sequencing and verification by qRT-PCR revealed that exosomal long non-coding RNA (lncRNA) tumor necrosis factor-associated factor 1 (TRAF1)-4:1 derived from RA-FLSs treated with TNFα was a candidate lncRNA, which also inhibited chondrocyte proliferation and migration through degrading CECM. Moreover, RNA sequencing and bioinformatics analysis identified that C-X-C motif chemokine ligand 1 (CXCL1) was a target mRNA of miR-27a-3p while miR-27a-3p was a target miRNA of lnc-TRAF1-4:1 in chondrocytes. Mechanistically, lnc-TRAF1-4:1 upregulated CXCL1 expression through sponging miR-27a-3p as a competing endogenous RNA (ceRNA) in chondrocytes identifying by Dual-luciferase reporter gene assay. Summarily, exosomal lncRNA TRAFD1-4:1 derived from RA-FLSs suppressed chondrocyte proliferation and migration through degrading CECM by upregulating CXCL1 as a sponge of miR-27a-3p. This study uncovered a novel RA-related lncRNA and investigated the roles of RA-FLS-derived exosomes and exosomal lnc-TRAF1-4:1 in articular cartilage impairment, which might provide novel therapeutic targets for RA.

The novel strategy of designing perovskite fiber membrane as reactor for catalytic oxidation.

Negative impacts of wastewater contamination include harm to the environment, people, plants, and animals. Metal-based heterogeneous catalysts, particularly transition metal oxide catalysts, are a therapeutic option. However, they have limited reusability and cause secondary contaminations through metal leaching. In this work, a new membrane catalyst made of perovskite-type fiber was created and tested to remove methylene blue from wastewater. These innovative 3D perovskite ceramic catalysts work well in the breakdown of pollutants and dramatically lessen possible secondary contaminations caused by metal leaching from catalysts.

By-Product of the Red Ginseng Manufacturing Process as Potential Material for Use as Cosmetics: Chemical Profiling and In Vitro Antioxidant and Whitening Activities.

Red ginseng (RG), which is obtained from heated Panax ginseng and is produced by steaming followed by drying, is a valuable herb in Asian countries. Steamed ginseng dew (SGD) is a by-product produced in processing red ginseng. In the present study, phytochemical profiling of extracts of red ginseng and steamed ginseng dew was carried out using gas chromatography-mass spectrometry (GC-MS) and rapid resolution liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry (RRLC-Q-TOF-MS) analysis. Additionally, antioxidant activities (DPPH, ·OH, and ABTS scavenging ability) and whitening activities (tyrosinase and elastase inhibitory activity) were analyzed. Phytochemical profiling revealed the presence of 66 and 28 compounds that were non-saponin components in chloroform extracts of red ginseng and steamed ginseng dew (RG-CE and SGD-CE), respectively. Meanwhile, there were 20 ginsenosides identified in n-butanol extracts of red ginseng and steamed ginseng dew (RG-NBE and SGD-NBE). By comparing the different polar extracts of red ginseng and steamed ginseng dew, it was found that the ethyl acetate extract of red ginseng (RG-EAE) had the best antioxidant capacity and whitening effect, the water extract of steamed ginseng dew (SGD-WE) had stronger antioxidant capacity, and the SGD-NBE and SGD-CE had a better whitening effect. This study shows that RG and SGD have tremendous potential to be used in the cosmetic industries.

HSP90 facilitates stemness and enhances glycolysis in glioma cells.

BACKGROUND: Glioma is one of the most commonly occurring malignant brain cancers with high recurrence and mortality. Glioma stem cells (SCs) are a rare sub-group of glioma cells that play a critical role in tumor progression. Heat shock protein 90 (HSP90) is known to promote the stemness of glioma SCs. Here, we investigated the role of HSP90 in glioma SC metabolism, to reveal its potential as a novel therapeutic target. METHODS: Self-renewal assays were used to assess stemness. Cell migration, invasion and viability were measured using Transwell and CCK-8 assays, respectively. Tumor growth was evaluated in xenograft nude mouse models. The expression of known markers of stemness including CD44, A2B5, Oct4, Nestin, Lgr5, Sox2, CD24 were assessed by western blotting. HSP90 expression was assessed by western blotting and immunohistochemistry (IHC). Glucose consumption, lactic acid production and ATP levels were measured using commercially available kits. Extracellular acidification rates (ECAR) were measured using the Seahorse XFe/XF analyzer. RESULTS: HSP90 was upregulated in spheroid cells compared to parental cells. HSP90 facilitated the characteristics of SCs through enhancing self-renewal capacity, glucose consumption, lactic acid production, total ATP, ECAR and glycolysis. 2-DG, an inhibitor of glycolysis, reduced HSP90 expression and inhibited the stemness of glioma cells. CONCLUSIONS: We show that HSP90 accelerates stemness and enhances glycolysis in glioma cells. Inhibition of glycolysis with 2DG prevented stemness. This reveals new roles for HSP90 during glioma progression and highlights this protein as a potential target for much-needed anti-glioma therapeutics.

Transition metal oxide-based membranes for oxygen separation.

Tonnage oxygen production is still mostly based on the traditional technology of cryogenic distillation, a century-old, capital- and energy-intensive method. It is critical to create a novel low-cost, energy-efficient approach that can meet the growing demand for oxygen in industry from the clean environmental or energy standpoint. Ruddlesden-Popper (RP) perovskite like oxides -based ionic transport membranes for the oxygen transport have recently been developed as a possible replacement for the traditional cryogenic approach. In this work, we detailly reviewed the progress of RP perovskite oxides based membranes for oxygen transport from separation mechanism, material types, synthesis methods to the final separation performance. This work advances the development of RP perovskite membranes for oxygen transport.

Ascending Aorta Diameter Changes after Aortic Valve Replacement in Elderly Patients with Aortic Valve Stenosis.

Objective: To describe the natural history of the ascending aorta in elderly patients after aortic valve replacement (AVR) for aortic valve stenosis and to clarify the risk factors associated with the progression of the ascending aorta. Methods: This retrospective review included a total of 87 elderly patients who had undergone aortic valve replacement for severe aortic valve stenosis in Fuwai Hospital. The patients were categorized into two groups based on the height-based aortic height index (AHI) before AVR, as determined by echocardiography and computed tomography: Group A (n = 28) was defined as an AHI > 2.44 cm/m, and Group B (n = 59) was defined as an AHI ≤ 2.44 cm/m. The perioperative and follow-up data were collected, and a linear mixed-effect model was used to analyze and compare the change rate of the ascending aorta after AVR. Results: The mean follow-up period was 4.0 ± 1.3 years. The diameter of ascending aorta in group A increased from 37.2 ± 5.0 mm at discharge to 40.7 ± 4.7 mm at the last follow-up (P=0.001), while that of group B increased only from 33.3 ± 4.4 mm to 33.7 ± 4.1 mm (P > 0.05).The ascending aorta diameter expansive rate was 0.81 mm/year in group A and 0.14 mm/year in group B. The expansive rate was significantly greater in patients with an AHI>2.44 cm/m than in those with anything else (P = 0.009). A univariable linear mixed model analysis revealed that the AHI>2.44 cm/m was the only significant risk factor for ascending aortic dilatation rate after AVR. There were 4 patients who died in hospital and 11 late follow-up deaths. Particularly, there was no aortic event that occurred during follow-up. Conclusion: For elderly patients with aortic stenosis, the possibility of progressive ascending aortic dilatation after AVR demands regular follow-up, and AHI may be an important risk factor for the change rate of the diameter of the ascending aorta.

A Comparative Study on Surgical Treatment of Valvular Heart Disease between High-Volume Cardiac Centers in China and STS Data.

The goal of this study is to summarize valvular surgery data from the Chinese Cardiac Surgery Registry (CCSR) and compare it to the most recent data from the Society of Thoracic Surgeons (STS). From 2016 to 2018, a total of 34,386 cases of the seven most common valvular surgical procedures was obtained from the CCSR. We calculated the proportions of different procedures in the CCSR cohort (n = 34,386) as well as the change in operation volume for each procedure. We also compiled rates of postoperative in-hospital mortality and five major complications across all procedures. All of the results were compared to the STS data. The CCSR and STS data showed divergent trends in valvular heart disease features and operation volume. Although the proportion of MV repair in the CCSR (13.7%) data was lower than in the STS data (23.2%), it demonstrated a substantial upward trend. In terms of operation volume, the CCSR data showed an upward trend, but the STS data showed a downward trend. CCSR procedures showed lower mortality (2% vs. 2.6%), reoperation (2.8% vs. 4.3%), and permanent stroke (0.5% vs. 1.6%) rates than STS procedures but higher rates of prolonged ventilation (22.4% vs. 10.4%) and renal failure (5.6% vs. 3.2%). Valvular surgery quality in China's leading cardiac hospitals is roughly comparable to that in the United States. China, on the other hand, has some shortcomings that need improvement.

Clinical characteristics, outcomes and regional variations of acquired valvular heart disease patients undergoing cardiac surgery in China.

AIMS: To characterize surgical valvular heart diseases (VHDs) in China and disclose regional variations in VHD surgeries by analyzing the data derived from the Chinese Cardiac Surgery Registry (CCSR). METHODS AND RESULTS: From January 2016 to December 2018, we consecutively collected the demographic information, clinical characteristics and outcomes of 38,131 adult patients undergoing valvular surgery in China. We sought to assess the quality of VHD surgery by examining in-hospital deaths of all patients from 7 geographic regions. Using a hierarchical generalized linear model, we calculated the risk-standardized mortality rate (RSMR) of each region. By comparing VHD characteristics and RSMRs, we pursued an investigation into regional variations. The mean age was 54.4 ± 12.4 years, and 47.2% of the patients were females. Among cases, the number of aortic valve surgeries was 9361 (24.5%), which was less than that of mitral valve surgeries (n = 14,506, 38.0%). The number of concurrent aortic and mitral valve surgeries was 6984 (18.3%). A total of 4529 surgical VHD patients (11.9%) also underwent coronary artery bypass grafting (CABG) surgery. The overall in-hospital mortality rate was 2.17%. The lowest RSMR, 0.91%, was found in the southwest region, and the highest RSMR, 3.99%, was found in the northeast. CONCLUSION: Although the overall valvular surgical mortality rate in large Chinese cardiac centers was in line with high-income countries, there were marked regional variations in the characteristics and outcomes of surgical VHD patients across China.

Preoperative beta-blocker in ventricular dysfunction patients: need a more granular quality metric.

BACKGROUND: The use of preoperative beta-blockers has been accepted as a quality standard for patients undergoing coronary artery bypass graft (CABG) surgery. However, conflicting results from recent studies have raised questions concerning the effectiveness of this quality metric. We sought to determine the influence of preoperative beta-blocker administration before CABG in patients with left ventricular dysfunction. METHODS: The authors analyzed all cases of isolated CABGs in patients with left ventricular ejection fraction less than 50%, performed between 2012 January and 2017 June, at 94 centres recorded in the China Heart Failure Surgery Registry database. In addition to the use of multivariate regression models, a 1-1 propensity scores matched analysis was performed. RESULTS: Of 6116 eligible patients, 61.7% received a preoperative beta-blocker. No difference in operative mortality was found between two cohorts (3.7% for the non-beta-blockers group vs. 3.0% for the beta-blocker group; adjusted odds ratio [OR] 0.82 [95% CI 0.58-1.15]). Few differences in the incidence of other postoperative clinical end points were observed as a function of preoperative beta-blockers except in stroke (0.7% for the non-beta-blocker group vs. 0.3 for the beta-blocker group; adjusted OR 0.39 [95% CI 0.16-0.96]). Results of propensity-matched analyses were broadly consistent. CONCLUSIONS: In this study, the administration of beta-blockers before CABG was not associated with improved operative mortality and complications except the incidence of postoperative stroke in patients with left ventricular dysfunction. A more granular quality metric which would guide the use of beta-blockers should be developed.

Association between smoking and in-hospital mortality in patients with left ventricular dysfunction undergoing coronary artery bypass surgery: a propensity-matched study.

BACKGROUND: Data on the effect of smoking on In-hospital outcome in patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery are limited. We sought to determine the influence of smoking on CABG patients with left ventricular dysfunction. METHODS: A retrospective study was conducted using data from the China Heart Failure Surgery Registry database. Eligible patients with left ventricular ejection fraction less than 50% underwent isolated CABGS were included. In addition to the use of multivariate regression models, a 1-1 propensity scores matched analysis was performed. Our study (n = 6531) consisted of 3635 smokers and 2896 non-smokers. Smokers were further divided into ex-smokers (n = 2373) and current smokers (n = 1262). RESULTS: The overall in-hospital morality was 3.9%. Interestingly, current smokers have lower in-hospital mortality than non-smokers [2.3% vs 4.9%; adjusted odds ratio (OR) 0.612 (95% CI 0.395-0.947) ]. No difference was detected in mortality between ex-smokers and non-smokers [3.6% vs 4.9%; adjusted OR 0.974 (0.715-1.327)]. No significant differences in other clinical end points were observed. Results of propensity-matched analyses were broadly consistent. CONCLUSIONS: It is paradoxically that current smokers had lower in-hospital mortality than non-smokers. Future studies should be performed to further understand the biological mechanisms that may explain this 'smoker's paradox' phenomenon.

Outcomes of cardiac surgery in senior aged patients with ventricular dysfunction: analysis of a large national database.

OBJECTIVE: In patients undergoing cardiac surgery, reduced preoperative ejection fraction (EF) and senior age are associated with a worse outcome. As most outcome data available for these patients are mainly from Western surgical populations involving specific surgery types, our aim is to evaluate the real-world characteristics and perioperative outcomes of surgery in senior-aged heart failure patients with reduced EF across a broad range cardiac surgeries. METHODS: Data were obtained from the China Heart Failure Surgery Registry (China-HFSR) database, a nationwide multicenter registry study in mainland China. Multiple variable regression analysis was performed in patients over 75 years old to identify risk factors associated with mortality. RESULTS: From 2012 to 2017, 578 senior-aged (> 75 years) patients were enrolled in China HFSR, 21.1% of whom were female. Isolated coronary bypass grafting (CABG) were performed in 71.6% of patients, 10.1% of patients underwent isolated valve surgery and 8.7% received CABG combined with valve surgery. In-hospital mortality was 10.6%, and the major complication rate was 17.3%. Multivariate analysis identified diabetes mellitus (odds ratio (OR) = 1.985), increased creatinine (OR = 1.007), New York Heart Association (NYHA) Class III (OR = 1.408), NYHA class IV (OR = 1.955), cardiogenic shock (OR, 6.271), and preoperative intra-aortic balloon pump insertion (OR = 3.426) as independent predictors of in-hospital mortality. CONCLUSIONS: In senior-aged patients, preoperative evaluation should be carefully performed, and strict management of reversible factors needs more attention. Senior-aged patients commonly have a more severe disease status combined with more frequent comorbidities, which may lead to a high risk in mortality.

A 3-dimensional-printed left ventricle model incorporated into a mock circulatory loop to investigate hemodynamics inside a severely failing ventricle supported by a blood pump.

Intraventricular blood stasis is a design consideration for continuous flow blood pumps and might contribute to adverse events such as thrombosis and ventricular suction. However, the blood flow inside left ventricles (LVs) supported by blood pumps is still unclear. In vitro experiments were conducted to imitate how the hydraulic performance of an axial blood pump affects the intraventricular blood flow of a severe heart failure patient, such as velocity distribution, vorticity, and standard deviation of velocity. In this study, a silicone model of the LV was constructed from the computed tomography data of one patient with heart failure and was 3D printed. Then, intraventricular flow was visualized by particle image velocimetry equipment within a mock circulation loop. The results showed that the axial blood pump suctions most of the blood in a severely failing LV, there was an altered flow status within the LV, and blood stasis appeared in the central region of the LV. Some blood may be suctioned from the aortic valve to the blood pump because the patient's native heart was severely failing. Blood stasis at the LV center may cause thrombosis in the LV. The vortex flow near the inner wall of the LV can thoroughly wash the left ventricular cavity.

A novel nomogram to predict perioperative acute kidney injury following isolated coronary artery bypass grafting surgery with impaired left ventricular ejection fraction.

BACKGROUND AND OBJECTIVE: Heart failure (HF) is a global health issue, and coronary artery bypass graft (CABG) is one of the most effective surgical treatments for HF with coronary artery disease. Unfortunately, the incidence of postoperative acute kidney injury (AKI) is high in HF patients following CABG, and there are few tools to predict AKI after CABG surgery for such patients. The aim of this study is to establish a nomogram to predict the incidence of AKI after CABG in patients with impaired left ventricular ejection fraction (LVEF). METHODS: From 2012 to 2017, Clinical information of 1208 consecutive patients who had LVEF< 50% and underwent isolated CABG was collected to establish a derivation cohort. A novel nomogram was developed using the logistic regression model to predict postoperative AKI among these patients. According to the same inclusion criteria and the same period, we extracted the data of patients from 6 other large cardiac centers in China (n = 540) from the China Heart Failure Surgery Registry (China-HFSR) database for external validation of the new model. The nomogram was compared with 3 other available models predicting renal failure after cardiac surgery in terms of calibration, discrimination and net benefit. RESULTS: In the derivation cohort (n = 1208), 90 (7.45%) patients were diagnosed with postoperative AKI. The nomogram included 7 independent risk factors: female, increased preoperative creatinine(> 2 mg/dL), LVEF< 35%, previous myocardial infarction (MI), hypertension, cardiopulmonary bypass(CPB) used and perioperative blood transfusion. The area under the receiver operating characteristic curve (AUC) was 0.738, higher than the other 3 models. By comparing calibration curves and decision curve analyses (DCA) with other models, the novel nomogram showed better calibration and greater net benefit. Among the 540 patients in the validation cohort, 104 (19.3%) had postoperative AKI, and the novel nomogram performed better with respect to calibration, discrimination and net benefit. CONCLUSIONS: The novel nomogram is a reliable model to predict postoperative AKI following isolated CABG for patients with impaired LVEF.

Serum AFU, GGT and TK1 levels in PHC patients and their correlation with clinicopathology and diagnostic value.

To investigate the expression level and clinical significance of fucosidase (AFU), glutamyltranspeptidase (GGT), and thymidine kinase 1 (TK1) in the serum of patients with primary liver cancer (PHC). A total of 135 PHC patients in Baoji Central Hospital from September 2014 to February 2018 were selected as a research group (RG), while 127 healthy subjects were collected as a control group (CG). Enzyme-linked immunosorbent assay (ELISA) was used to detect the AFU, GGT, and TK1 concentrations in serum of the two groups, and the diagnostic value of combined detection of the three for PHC was analyzed. AFU, GGT, and TK1 concentrations in serum of the RG were dramatically higher than those of the CG (P< 0.050). ROC curve analysis showed that the sensitivity of AFU, GGT, and TK1 in the single diagnosis of PHC was 88.00, 94.00, and 66.00% respectively, and the specificity was 68.00, 54.00, and 66.00% respectively. The sensitivity and specificity of the combined diagnosis of PHC were 76.00 and 90.00%, respectively. AFU, GGT, and TK1 concentrations were different in the presence or absence of liver cirrhosis, TNM stage, and tissue type (P< 0.050). AFU, GGT, and TK1 concentrations in PHC patients were dramatically higher than those in healthy people. Combined detection of the three has good diagnostic value for PHC.

A Novel Risk Stratification System for Predicting In-Hospital Mortality Following Coronary Artery Bypass Grafting Surgery with Impaired Left Ventricular Ejection Fraction.

BACKGROUND: Coronary artery disease (CAD) is the most common cause of heart failure (HF), and impaired ejection fraction (EF<50%) is a crucial precursor to HF. Coronary artery bypass grafting (CABG) is an effective surgical solution to CAD-related HF. In light of the high risk of cardiac surgery, appropriate scores for groups of patients are of great importance. We aimed to establish a novel score to predict in-hospital mortality for impaired EF patients undergoing CABG. METHODS: Clinical information of 1,976 consecutive CABG patients with EF<50% was collected from January 2012 to December 2017. A novel system was developed using the logistic regression model to predict in-hospital mortality among patients with EF<50% who were to undergo CABG. The scoring system was named PGLANCE, which is short for seven identified risk factors, including previous cardiac surgery, gender, load of surgery, aortic surgery, NYHA stage, creatinine, and EF. AUC statistic was used to test discrimination of the model, and the calibration of this model was assessed by the Hosmer-lemeshow (HL) statistic. We also evaluated the applicability of PGLANCE to predict in-hospital mortality by comparing the 95% CI of expected mortality to the observed one. Results were compared with the European Risk System in Cardiac Operations (EuroSCORE), EuroSCORE II, and Sino System for Coronary Operative Risk Evaluation (SinoSCORE). RESULTS: By comparing with EuroSCORE, EuroSCORE II and SinoSCORE, PGLANCE was well calibrated (HL P = 0.311) and demonstrated powerful discrimination (AUC=0.846) in prediction of in-hospital mortality among impaired EF CABG patients. Furthermore, the 95% CI of mortality estimated by PGLANCE was closest to the observed value. CONCLUSION: PGLANCE is better with predicting in-hospital mortality than EuroSCORE, EuroSCORE II, and SinoSCORE for Chinese impaired EF CABG patients.