The Assessment of Natural Cross Pollination Properties of a Novel Male-Sterile-Female-Fertile Mutation msLC01 in Soybean.

The value of a novel soybean male-sterile mutation msLC01 in breeding practice was determined by its outcrossing properties. Then, the effects of different planting arrangements on the pod set characteristics of male-sterile plants were assessed by using orthogonal experiments at two sites. At the same time, the effects of msLC01 male sterility on other traits were assessed in two C2F2 populations. In addition, the nectar secretion and natural outcross of male-sterile plants from four msLC01 lines were compared with one ms1 line and one ms6 line. The results of the orthogonal experiment showed that the pod numbers and pod set rates of male-sterile plants were decisively different between the two experimental sites but not between the two levels of the other factors. Both increasing the ratio of paternal parent to maternal parent and planting the parental seeds in a mixed way, the proportion of seeds pollinated by the target parent pollen could be increased. Except for the pod number per plant trait, there was no significant difference between male-sterile plants and their fertile siblings. The amount of nectar significantly differed among the lines. Compared with ms1 and ms6 male-sterile plants, the four msLC01 lines possessed significantly more or similar numbers of pod sets. The results of this study lay a foundation for the future use of this mutant in soybean breeding.

Urine metabolites for preoperative prediction of acute kidney injury after coronary artery bypass graft surgery.

OBJECTIVE: Acute kidney injury is a common complication after on-pump coronary artery bypass grafting. Prediction of acute kidney injury remains a challenge. Our study aims to identify a panel of urine metabolites for preoperative warning of acute kidney injury after on-pump coronary artery bypass grafting. METHODS: A total of 159 patients undergoing isolated on-pump coronary artery bypass grafting were enrolled from July 7, 2017, to May 17, 2019. Preoperative urine samples were analyzed with the approach of liquid chromatography-mass spectrometry-based urine metabolomics. The study end point was the episode of acute kidney injury within 48 hours postoperatively. The predictive performance was determined by the area under the curve and calibration curve. The results were validated using bootstrap resampling. RESULTS: The acute kidney injury (n = 55) and nonacute kidney injury (n = 104) groups showed significant different metabolic profiling. A total of 28 metabolites showed significant differences between the acute kidney injury and nonacute kidney injury groups. A metabolite panel of 5 metabolites (tyrosyl-gamma-glutamate, deoxycholic acid glycine conjugate, 5-acetylamino-6-amino-3-methyluracil, arginyl-arginine, and L-methionine) was discovered to have a good predicting performance (area under the curve, 0.89; 95% confidence interval, 0.82-0.93), which is higher than the clinical factor-based model (area under the curve, 0.63; 95% confidence interval, 0.53-0.72). Internal validation by bootstrap resampling showed an adjusted area under the curve of 0.88, and the calibration curve demonstrated good agreement between prediction and observation in the probability of postoperative acute kidney injury. Decision curve analysis revealed a superior net benefit of the metabolite model over the traditional clinical factor-based model. CONCLUSIONS: We present 5 urine metabolites related to acute kidney injury after coronary artery bypass grafting. This metabolite model may serve as a preoperative warning of acute kidney injury after on-pump coronary artery bypass grafting.

Genome-wide association studies for soybean epicotyl length in two environments using 3VmrMLM.

Germination of soybean seed is the imminent vital process after sowing. The status of plumular axis and radicle determine whether soybean seed can emerge normally. Epicotyl, an organ between cotyledons and first functional leaves, is essential for soybean seed germination, seedling growth and early morphogenesis. Epicotyl length (EL) is a quantitative trait controlled by multiple genes/QTLs. Here, the present study analyzes the phenotypic diversity and genetic basis of EL using 951 soybean improved cultivars and landraces from Asia, America, Europe and Africa. 3VmrMLM was used to analyze the associations between EL in 2016 and 2020 and 1,639,846 SNPs for the identification of QTNs and QTN-by-environment interactions (QEIs)".A total of 180 QTNs and QEIs associated with EL were detected. Among them, 74 QTNs (ELS_Q) and 16 QEIs (ELS_QE) were identified to be associated with ELS (epicotyl length of single plant emergence), and 60 QTNs (ELT_Q) and 30 QEIs (ELT_QE) were identified to be associated with ELT (epicotyl length of three seedlings). Based on transcript abundance analysis, GO (Gene Ontology) enrichment and haplotype analysis, ten candidate genes were predicted within nine genic SNPs located in introns, upstream or downstream, which were supposed to be directly or indirectly involved in the process of seed germination and seedling development., Of 10 candidate genes, two of them (Glyma.04G122400 and Glyma.18G183600) could possibly affect epicotyl length elongation. These results indicate the genetic basis of EL and provides a valuable basis for specific functional studies of epicotyl traits.

Identification of Drought-Tolerance Genes in the Germination Stage of Soybean.

Drought stress influences the vigor of plant seeds and inhibits seed germination, making it one of the primary environmental factors adversely affecting food security. The seed germination stage is critical to ensuring the growth and productivity of soybeans in soils prone to drought conditions. We here examined the genetic diversity and drought-tolerance phenotypes of 410 accessions of a germplasm diversity panel for soybean and conducted quantitative genetics analyses to identify loci associated with drought tolerance of seed germination. We uncovered significant differences among the diverse genotypes for four growth indices and five drought-tolerance indices, which revealed abundant variation among genotypes, upon drought stress, and for genotype × treatment effects. We also used 158,327 SNP markers and performed GWAS for the drought-related traits. Our data met the conditions (PCA + K) for using a mixed linear model in TASSEL, and we thus identified 26 SNPs associated with drought tolerance indices for germination stage distributed across 10 chromosomes. Nine SNP sites, including, for example, Gm20_34956219 and Gm20_36902659, were associated with two or more phenotypic indices, and there were nine SNP markers located in or adjacent to (within 500 kb) previously reported drought tolerance QTLs. These SNPs led to our identification of 41 candidate genes related to drought tolerance in the germination stage. The results of our study contribute to a deeper understanding of the genetic mechanisms underlying drought tolerance in soybeans at the germination stage, thereby providing a molecular basis for identifying useful soybean germplasm for breeding new drought-tolerant varieties.

QTL Mapping of Palmitic Acid Content Using Specific-Locus Amplified Fragment Sequencing (SLAF-Seq) Genotyping in Soybeans (Glycine max L.).

Soybeans are essential crops that supply protein and oil. The composition and contents of soybean fatty acids are relevant to human health and have a significant relationship with soybean oil processing and applications. Identifying quantitative trait locus (QTL) genes related to palmitic acid could facilitate the development of a range of nutritive soybean cultivars using molecular marker-assisted selection. In this study, we used a cultivar with higher palmitic acid content, 'Dongnong42', and a lower palmitic acid content cultivar, 'Hobbit', to establish F2:6 recombinant inbred lines. A high-density genetic map containing 9980 SLAF markers was constructed and distributed across 20 soybean chromosomes. The genetic map contained a total genetic distance of 2602.58 cM and an average genetic distance of 0.39 cM between adjacent markers. Two QTLs related to palmitic acid content were mapped using inclusive composite interval mapping, explaining 4.2-10.1% of the phenotypic variance in three different years and environments, including the QTL included in seed palmitic 7-3, which was validated by developing SSR markers. Based on the SNP/Indel and significant differential expression analyses of Dongnong42 and Hobbit, two genes, Glyma.15g119700 and Glyma.15g119800, were selected as candidate genes. The high-density genetic map, QTLs, and molecular markers will be helpful for the map-based cloning of palmitic acid content genes. These could be used to accelerate breeding for high nutritive value cultivars via molecular marker-assisted breeding.

GmIAA27 Encodes an AUX/IAA Protein Involved in Dwarfing and Multi-Branching in Soybean.

Soybean plant height and branching affect plant architecture and yield potential in soybean. In this study, the mutant dmbn was obtained by treating the cultivar Zhongpin 661 with ethylmethane sulfonate. The dmbn mutant plants were shorter and more branched than the wild type. The genetic analysis showed that the mutant trait was controlled by a semi-dominant gene. The candidate gene was fine-mapped to a 91 kb interval on Chromosome 9 by combining BSA-seq and linkage analysis. Sequence analysis revealed that Glyma.09g193000 encoding an Aux/IAA protein (GmIAA27) was mutated from C to T in the second exon of the coding region, resulting to amino acid substitution of proline to leucine. Overexpression of the mutant type of this gene in Arabidopsis thaliana inhibited apical dominance and promoted lateral branch development. Expression analysis of GmIAA27 and auxin response genes revealed that some GH3 genes were induced. GmIAA27 relies on auxin to interact with TIR1, whereas Gmiaa27 cannot interact with TIR1 owing to the mutation in the degron motif. Identification of this unique gene that controls soybean plant height and branch development provides a basis for investigating the mechanisms regulating soybean plant architecture development.

Dissection of the practical soybean breeding pipeline by developing ZDX1, a high-throughput functional array.

KEY MESSAGE: We developed the ZDX1 high-throughput functional soybean array for high accuracy evaluation and selection of both parents and progeny, which can greatly accelerate soybean breeding. Microarray technology facilitates rapid, accurate, and economical genotyping. Here, using resequencing data from 2214 representative soybean accessions, we developed the high-throughput functional array ZDX1, containing 158,959 SNPs, covering 90.92% of soybean genes and sites related to important traits. By application of the array, a total of 817 accessions were genotyped, including three subpopulations of candidate parental lines, parental lines and their progeny from practical breeding. The fixed SNPs were identified in progeny, indicating artificial selection during the breeding process. By identifying functional sites of target traits, novel soybean cyst nematode-resistant progeny and maturity-related novel sources were identified by allele combinations, demonstrating that functional sites provide an efficient method for the rapid screening of desirable traits or gene sources. Notably, we found that the breeding index (BI) was a good indicator for progeny selection. Superior progeny were derived from the combination of distantly related parents, with at least one parent having a higher BI. Furthermore, new combinations based on good performance were proposed for further breeding after excluding redundant and closely related parents. Genomic best linear unbiased prediction (GBLUP) analysis was the best analysis method and achieved the highest accuracy in predicting four traits when comparing SNPs in genic regions rather than whole genomic or intergenic SNPs. The prediction accuracy was improved by 32.1% by using progeny to expand the training population. Collectively, a versatile assay demonstrated that the functional ZDX1 array provided efficient information for the design and optimization of a breeding pipeline for accelerated soybean breeding.

Efficacy and safety of acupuncture for elderly patients with coronavirus disease 2019 (COVID-19): A protocol for systematic review and meta-analysis.

BACKGROUND: The study aims to evaluate the effectiveness and safety of acupuncture therapy for elderly patients with coronavirus disease 2019 (COVID-19). METHODS: Relevant articles from December 2019 to December 2020 will be searched in the following electronic databases: Medline, PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), and China Scientific Journals Database. All published randomized controlled trials (RCTs) and credible clinical observations about this topic will be included. Two independent researchers will operate article retrieval, duplication removing, screening and data analysis by EndNote X9.0 and Stata 15.0. We will use the Cochrane risk of bias tool for randomized trials to assess the risk of bias of included studies. Meta-analysis, subgroup analysis, and/or descriptive analysis will be performed according to the data conditions included. RESULTS: High-quality synthesis and/or descriptive analysis of current evidence will be provided from mortality rate, cure rate, C-reactive protein (CRP), creatine, troponin, aspartate aminotransferase, alanine aminotransferase, and improvements in chest CT scans, clinical symptoms (including fever, fatigue, cough, nausea, vomiting and diarrhea) and the side effects of acupuncture. CONCLUSION: This study will provide evidence of whether acupuncture is an effective and safe intervention for the elderly with COVID-19. PROSPERO REGISTRATION NUMBER: CRD42020225245.

Chemopreventive effect of dieckol against 7,12-dimethylbenz(a)anthracene induced skin carcinogenesis model by modulatory influence on biochemical and antioxidant biomarkers.

Skin cancer is the commonly found type, which contributes to 40% of whole cancer incidences worldwide. Dieckol is an active compound occurs in the marine algae with many biological benefits. In this exploration, we intended to investigate the therapeutic potency of dieckol against the 7,12-dimethylbenz(a)anthracene (DMBA)-triggered skin carcinogenesis in mice. The skin cancer was stimulated to the animals via injecting the 25 µg of DMBA in 100 µL of acetone in shaved dorsal portion along with the 30 mg/kg of dieckol supplementation for 25 week. The antioxidant enzymes and phase-I and -II detoxifying enzymes in the test animals were inspected via standard protocols. Pro-inflammatory markers (IL-6, IL-1ß, and TNF-α) level was examined via ELISA kits and the expression of inflammatory molecular markers like p-NF-ƙB, IƙBα and p-IƙBα were studied through western blotting. The expression status of pro- and anti-apoptotic proteins (p53, Bax, Bcl-2, caspase-3, caspase-9, COX-2, TGF-ß1) was investigated via real-time polymerase chain reaction (RT-PCR). Our results revealed that the 30 mg/kg of dieckol supplementation noticeably regained the body and liver weight and also diminished the tumor incidence in the DMBA-incited animals. Dieckol treatment exhibited an enhanced antioxidants (SOD, CAT, GPx, and GSH) and reduced phase-I enzymes Cyt-p450 and Cyt-b5 in the DMBA-induced animals. Dieckol also diminished the pro-inflammatory modulators like IL-6, IL-1ß and TNF-α. Western blotting result evidenced that the dieckol was inhibited the IƙB/NF-ƙB signaling pathway. RT-PCR study proved the enhanced expression of pro-apoptotic protein (p53, Bax, caspase-3 and -9) in the dieckol treated animals. Histological study also confirmed the therapeutic benefits of Dieckol. Altogether with these findings, it was clear that the dieckol has appreciably allayed the DMBA activated skin tumorigenesis in the mice and it could be a promising agent to treat the human skin cancer in future.

Genome-wide association study of soybean seed germination under drought stress.

Drought stress, which is increasing with climate change, is a serious threat to agricultural sustainability worldwide. Seed germination is an essential growth phase that ensures the successful establishment and productivity of soybean, which can lose substantial productivity in soils with water deficits. However, only limited genetic information is available about how germinating soybean seeds may exert drought tolerance. In this study, we examined the germinating seed drought-tolerance phenotypes and genotypes of a panel of 259 released Chinese soybean cultivars panel. Based on 4616 Single-Nucleotide Polymorphisms (SNPs), we conducted a mixed-linear model GWAS that identified a total of 15 SNPs associated with at least one drought-tolerance index. Notably, three of these SNPs were commonly associated with two drought-tolerance indices. Two of these SNPs are positioned upstream of genes, and 11 of them are located in or near regions where QTLs have been previously mapped by linkage analysis, five of which are drought-related. The SNPs detected in this study can both drive hypothesis-driven research to deepen our understanding of genetic basis of soybean drought tolerance at the germination stage and provide useful genetic resources that can facilitate the selection of drought stress traits via genomic-assisted selection.

Rationale and design of a multicenter randomized trial to compare the graft patency between no-touch vein harvesting technique and conventional approach in coronary artery bypass graft surgery.

BACKGROUND: Vein graft failure is a crucial challenge in coronary artery bypass graft (CABG) surgery. Previous studies have suggested a patency benefit of the No-Touch vein harvesting technique, but only with small sample sizes. MATERIALS AND METHODS: This study is a prospective, multicenter randomized clinical trial with a large sample size, aiming to investigate the efficacy of the No-Touch technique compared with the conventional approach. All patients requiring isolated CABG with left internal mammary artery plus at least one saphenous vein graft will be considered for entry into the study. Two thousand cases (1000 in each arm) will be enrolled over 1 to 2 years in 7 hospitals in China. Participants will be randomized in equal proportions between two surgical strategies: the No-Touch or conventional technique. The primary endpoint is graft vessel occlusion at 3 months after CABG surgery by CT coronary angiography. Secondary outcomes are major adverse cardiac or cerebrovascular events at 3 and 12 months post-operation and graft vessel occlusion at 1 year. DISCUSSION: This study will define the role of the No-Touch vein harvesting technique in CABG surgery and provide strong evidence to answer whether this technique could reduce vein graft occlusion.

Left main coronary artery atresia with concomitant mitral regurgitation in an adult: A case report.

INTRODUCTION: Left main coronary artery (LMCA) atresia is a quite rare congenital malformation, which may present with various symptoms. Past literatures were sporadic without recent summary of world-wide cases. We hereby report an adult case of LMCA atresia with concomitant mitral regurgitation and also summarize all cases found in published literatures. CASE PRESENTATION: A 48-year old female presented with sudden dyspnea. Preliminary impression was acute heart failure caused by mitral regurgitation. Preoperative coronary angiography demonstrated that there was no left coronary ostium and multiple collateral vessels arising from right coronary artery. The diagnosis of left main coronary atresia was made and the patient received successful valvuloplasty and coronary artery bypass grafting with left internal mammary artery anastomosed to the left anterior descending (LAD) artery. She recovered well and 3-month follow-up showed the graft was patent. CONCLUSION: This case highlights the importance of angiography for diagnosis of LMCA and performance of CABG once diagnosed.

Anatomical Repair Conversion After Bidirectional Cavopulmonary Shunt for Complex Cardiac Anomalies: Palliation is Not a One-Way Path.

Complex cardiac anomalies are sometimes channeled toward Fontan palliation for various reasons. Nevertheless, anatomical repair after bidirectional cavopulmonary shunt may be another option with theoretical benefits. In this study, we report our experience with anatomical repair conversion in challenging patients who had been palliated with bidirectional cavopulmonary shunt. Retrospective review was conducted in patients who underwent anatomical repair conversion from prior bidirectional cavopulmonary shunt palliation between January 2008 and March 2016. Patients who underwent a planned staged 1½-ventricular repair were excluded. Twenty-three patients underwent anatomical repair conversion at a median age of 6.5 years (range 2.7-20.0 years). The interval time between palliation and conversion was 4.6 ± 2.4 years (range 0.9-12.4). Indications for conversion were high-risk Fontan candidates (n = 11) and preference for biventricular anatomy (n = 12). In eight of the patients, bidirectional cavopulmonary shunts were taken down and superior vena cava was reconnected to the right atrium with Gore-Tex tube or bovine jugular venous tube. Mean cardiopulmonary bypass and aortic cross-clamp times were 225.6 ± 107.0 and 138.3 ± 76.6 min, respectively. After a mean follow-up of 2.7 ± 2.2 years, there was no mortality and reoperation. No patients presented sinoatrial node dysfunction and superior venous cave stenosis. All the patients were in the New York Heart Association functional class I or II. Patients with previous bidirectional cavopulmonary shunt should be re-evaluated before completion of Fontan and, if cardiac anatomy allows, anatomical repair conversion may be considered, especially in patients with high-risk Fontan completion. Initial bidirectional cavopulmonary shunt palliation should not be considered as a one-way path to Fontan. Although technically challenging, early- and mid-term clinical results of anatomical repair conversion were satisfactory.

Single-Trunk Anomalous Origin of Both Coronary Arteries From Pulmonary Artery: Serendipitous Diagnosis and Successful Surgical Treatment.

The origin of both coronary arteries from the pulmonary artery is generally a lethal condition from progressive heart failure. We report the clinical and surgical course in a child aged 18 months with this anomaly. The left ventricular ejection fraction was profoundly depressed. The common coronary trunk arose from the right anterior facing sinus. Direct coronary implantation to the aorta was used. The patient's left ventricular function improved to a nearly normal state at the 6-month follow-up visit.

Discovery of Potent Succinate-Ubiquinone Oxidoreductase Inhibitors via Pharmacophore-linked Fragment Virtual Screening Approach.

Succinate-ubiquinone oxidoreductase (SQR) is an attractive target for fungicide discovery. Herein, we report the discovery of novel SQR inhibitors using a pharmacophore-linked fragment virtual screening approach, a new drug design method developed in our laboratory. Among newly designed compounds, compound 9s was identified as the most potent inhibitor with a Ki value of 34 nM against porcine SQR, displaying approximately 10-fold higher potency than that of the commercial control penthiopyrad. Further inhibitory kinetics studies revealed that compound 9s is a noncompetitive inhibitor with respect to the substrate cytochrome c and DCIP. Interestingly, compounds 8a, 9h, 9j, and 9k exhibited good in vivo preventive effects against Rhizoctonia solani. The results obtained from molecular modeling showed that the orientation of the R(2) group had a significant effect on binding with the protein.

The functional status of neoaortic valve and left ventricular outlet tract after arterial switch operation for transposition of great arteries with left ventricular outlet tract obstruction.

OBJECTIVES: To assess the function of the left ventricular outlet tract and neoaortic valve after arterial switch operation for patients with transposition of the great arteries and left ventricular outlet tract obstruction. METHODS: The data of 40 patients, who underwent arterial switch surgery with transposition of the great arteries with left ventricular outlet tract obstruction and a concomitant left ventricular outlet tract obstruction relieving procedure, were retrospectively analysed. Ultrasonic cardiogram and intraoperative findings, surgical methods and early and follow-up results were also summarized. RESULTS: Early death occurred in one case. One patient died in follow-up stage and 3 patients were lost during follow-up. In all the 35 patients accepting follow-up, 1 patient had a reoccurring left ventricular outlet tract obstruction, 1 patient had mild neoaortic stenosis, whereas mild and moderate neoaortic regurgitation occurred in 11 and 2 patients, respectively. The median pressure gradient across the left ventricular outlet tract was 6.8 mmHg (range: 2-49 mmHg) during follow-up which was statistically significant compared with that before surgery. We defined death, reintervention and rehospitalization for cardiac reasons as a cardiac event; the survival rate of being free from cardiac event for 1 year and 5 years was 92.8 ± 0.04%, respectively. CONCLUSIONS: Anatomical features and pressure gradient should be used together to evaluate the severity of obstruction, whereas the mid-term outcomes can be satisfied after arterial switch operation for the appropriate candidates.

The China Patient-Centred Evaluative Assessment of Cardiac Events (China PEACE)-Prospective Study of 3-Vessel Disease: rationale and design.

INTRODUCTION: Complex coronary artery disease (left main and three-vessel disease) carries high risks of adverse events and cost burden. However, in China, little is known about which patients are directed toward which treatment strategies and what outcomes are being achieved. METHODS AND ANALYSIS: Using the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) research network, this prospective study of three-Vessel Disease, the China PEACE-3VD study, has a plan to consecutively register over 4000 patients with a diagnosis of 3VD and/or left-main disease by elective coronary angiography at 24 large cardiovascular centres in China. We centrally conducted medical record abstraction and SYNTAX Score calculation for all registered patients. The sites invited patients to the prospective cohort, and conducted 1-year follow-up on major events, including cardiac events, symptoms, secondary prevention and quality of life. The estimated entire sample size of eligible patients of 4000 was determined based on both feasibility and consideration of adequate statistical precision for describing the treatment decisions, guidelines adherence and appropriateness of treatment for patients with complex coronary artery diseases. The study is designed to investigate patient, clinician and hospital factors associated with each treatment strategy (percutaneous coronary intervention, coronary artery bypass grafting or medical therapy) as well as appropriateness of treatment choice, current guideline compliance and patient-reported outcomes for patients with complex coronary artery disease in large cardiovascular centres in China, as a foundation for enhanced knowledge in the field and to assist quality improvement initiatives. ETHICS AND DISSEMINATION: The study protocol was approved by the ethics committee at the China National Center for Cardiovascular Diseases. Findings will be shared with participating hospitals, policymakers and the academic community, to promote quality monitoring, quality improvement and the efficient allocation, and use of coronary revascularisation procedures in China. TRIAL REGISTRATION NUMBER: NCT01625312; Pre-results.

Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience.

OBJECTIVE: This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus. METHODS: From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years). RESULTS: Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years). Thirty patients (60%) were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9) units.m2 and 64.3±17.9 (range, 38 to 101) mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28%) patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335-43.092; p = 0.022). Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II. CONCLUSIONS: Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up.

The Chinese Cardiac Surgery Registry: Design and Data Audit.

BACKGROUND: In light of the burgeoning volume and certain variation of in-hospital outcomes of cardiac operations in China, a large patient-level registry was needed. We generated the Chinese Cardiac Surgery Registry (CCSR) database in 2013 to benchmark, continuously monitor, and provide feedback of the quality of adult cardiac operations. We report on the design of this database and provide an overview of participating sites and quality of data. METHODS: We established a network of participating sites with an adult cardiac surgery volume of more than 100 operations per year for continuous web-based registry of in-hospital and follow-up data of coronary artery bypass grafting (CABG) and valve operations. After a routine data quality audit, we report the performance and quality of care back to the participating sites. RESULTS: In total, 87 centers participated and submitted 46,303 surgical procedures from January 2013 to December 2014. The timeliness rates of the short-list and in-hospital data submitted were 73.6% and 70.2%, respectively. The completeness and accuracy rates of the in-hospital data were 97.6% and 95.1%, respectively. We have provided 2 reports for each site and 1 national report regarding the performance of isolated CABG and valve operations. CONCLUSIONS: The newly launched CCSR with a national representativeness network and good data quality has the potential to act as an important platform for monitoring and improving cardiac surgical care in mainland China, as well as facilitating research projects, establishing benchmarking standards, and identifying potential areas for quality improvements (ClinicalTrials.gov No. NCT02400125).

Influence of diabetes mellitus on long-term clinical and economic outcomes after coronary artery bypass grafting.

BACKGROUND: China has the most patients with diabetes mellitus (DM) in the world and, annually, approximately 1 million Chinese become diabetic. We investigated both clinical and economic outcomes in a large Chinese cohort of diabetic patients undergoing coronary artery bypass graft surgery (CABG). METHODS: All 9,240 consecutive patients who underwent isolated, primary, elective CABG between January 1999 and December 2008 were included and analyzed for long-term major adverse cardiovascular and cerebrovascular events and economic outcomes up to 2 years after the procedure. The DM patients were divided into DM subgroups controlled by diet (n = 375), medication (n = 1,826) or insulin (n = 481). RESULTS: During the study period, the proportion of patients undergoing CABG who have DM increased from 20.1% to 31.8% in China. None of the DM subgroups was independently associated with in-hospital death, but DM was an independent predictor for long-term major adverse cardiovascular and cerebrovascular events (hazard ratio 1.29, 95% confidence interval: 1.14 to 1.46). Medically controlled DM and insulin-dependent DM, but not diet-controlled DM were independent predictors of long-term outcomes after CABG. Cost for initial hospitalization was higher for DM patients (76,782 Ren Min Bi [RMB] versus 65,521 RMB, respectively; p < 0.001). At 2 years after CABG, costs for DM patients were 11,261 RMB (approximately US $1,623) higher than for non-DM patients (p < 0.001). CONCLUSIONS: CABG for patients with DM was significantly more expensive and was associated with worse long-term outcomes compared with non-DM patients. The rising incidence of DM, combined with the significant incremental costs represents significant clinical, economic, and social challenges for the Chinese healthcare system.