Computed tomography-based patient-specific cutting guides used for positioning of the femoral component of implants during unicompartmental knee arthroplasty: a cadaver study.

BACKGROUND: To investigate whether patient-specific instrumentation (PSI) improves the femoral component positioning of implants during unicompartmental knee arthroplasty (UKA) using cadaver bone models. METHODS: Fifty adult cadaveric femoral bone specimens collected from February 2016-2018, were randomized to receive medial UKA with a PSI guide (n = 25) or conventional instrumentation (CI) (n = 25). Standard anteroposterior and lateral view radiographs were obtained postoperatively to assess the coronal and sagittal positioning of the femoral prostheses, respectively. The osteotomy time was recorded to assess the convenience of PSI in guiding osteotomy. RESULTS: Osteotomy time significantly shortened in the PSI group (3.12 ± 0.65 versus 4.33 ± 0.73 min, p < 0.001). There was a significant difference in the postoperative coronal alignment of the femoral component between the PSI and CI groups (varus/valgus angle: 1.43 ± 0.93° vs. 2.65 ± 1.50°, p = 0.001). The prevalence of outliers in coronal alignment was lower in the PSI than the CI group (2/25, 8% vs. 9/25, 36%). Sagittal posterior slope angle of the femoral component was significantly different between the two groups (8.80 ± 0.65° and 6.29 ± 1.88° in the CI and PSI groups, respectively, p < 0.001). The malalignment rate of the femoral component in the sagittal plane was 60% in the CI group, whereas no positioning deviation was observed in the PSI group. CONCLUSION: This study used a cadaver model to support the fact that CT-based PSI shows an advantage over CI in optimizing implant positioning for UKAs.

Atrial giant cell myocarditis with preserved left ventricular function: a case report and literature review.

Giant cell myocarditis (GCM) is a rare and fatal inflammatory disorder induced by T-lymphocytes, typically affecting young adults. Generally, this disease presents with a rapidly progressive course and a very poor prognosis. In recent years, atrial GCM (aGCM) has been recognized as a clinicopathological entity distinct from classical GCM. As described by retrievable case reports, although its histopathological manifestations are highly similar to those of classical GCM, this entity is characterized by preserved left ventricular function and atrial arrhythmias, without ventricular arrhythmias. aGCM tends to show benign disease progression with a better clinical prognosis compared with the rapid course and poor prognosis of vGCM. We report a patient with aGCM with a history of renal abscess whose persistent myocardial injury considered to be associated with a history of renal abscess. Infection could be a potential trigger for the development of aGCM in this patient. An extensive literature review was also performed and the following three aspects were summarized: (1) Epidemiology and histopathological characteristics of aGCM; (2) The role of imaging in the evaluation of aGCM; (3) Diagnostic points and therapeutic decisions in aGCM.

Exosome modification to better alleviates endoplasmic reticulum stress induced chondrocyte apoptosis and osteoarthritis.

Osteoarthritis (OA) is characterized by cartilage matrix degeneration and chondrocyte apoptosis. Prolonged endoplasmic reticulum (ER) stress participates in chondrocyte apoptosis and cartilage degeneration in OA progression. miR-486-5p could suppress the apoptosis of nucleus pulposus cells and cardiomyocyte, yet whether miR-486-5p modified exosomes could modulate ER stress and apoptosis of chondrocytes remain unknown. We validated the increased inflammation and ER stress in OA synovium and cartilage, and the inhibition of ER stress could attenuate the IL-1ß induced chondrocyte apoptosis. Administration of exogenous miR-486-5p could inhibit the ER stress, alleviate chondrocytes apoptosis and promote matrix regeneration. In comparison with direct administration of miR-486-5p and miR-486-5p overexpressing ADSCs, miR-486-5p modified exosomes indicated a better effect in modulating chondrocyte homeostasis. MiR-486-5p containing exosomes could also regulate macrophage polarization. Our IVIS imaging data validated that intraarticular injection of miR-486-5p containing exosomes could sustain for at least 7 days. MiR-486-5p containing exosomes showed a better effect on alleviating rats OA compared with direct administration of miR-486-5p and miR-486-5p overexpressing ADSCs. Our data demonstrated that miR-486-5p modified exosomes have a better effect on alleviating chondrocyte apoptosis and osteoarthritis. This study provides evidence of this efficient strategy of exosomal miRNA delivery and the miRNA-based therapy for OA.

Investigation of Nano-Scale Segregation in Nanostructured Ferritic Alloy 14YWT after Heavy Ion Irradiation.

Oxide-dispersion-strengthened (ODS) steels, which contain nano-scale Y-Ti-O particles, are being considered for high-temperature radiation environments of nuclear reactors. It is important to accurately characterize the structure of grain boundaries and understand the behavior of segregation at grain boundaries in ODS steels during irradiation. The effect of heavy ion irradiation at 700 °C on Nanostructured Ferritic Alloy 14YWT was investigated using Atom Probe Tomography. Enrichment of Cr occurs at the grain boundaries as well as at nano oxide particle surfaces in the unirradiated sample. The enrichment of Ti and Y at a grain boundary corresponds with Y-Ti-O nano oxide particles with larger size compared to those in the grain, and the Cr enrichment is particularly accentuated at these larger nano oxide particles. The segregation of W occurs at the grain boundaries that are without nano oxide particles. O is segregated at grain boundaries without oxide particles after irradiation. The segregation behavior of Cr, W, Ti, and Y at the grain boundary in the irradiated samples is similar to that in the unirradiated sample. The nano oxide particles embedded in the grain boundary are a primary reason for the increase in Cr segregation at the grain boundary.

Ascending aortic perivascular adipose tissue inflammation associates with aortic valve disease.

BACKGROUND: Ascending aortic perivascular adipose tissue (AA-PVAT) mainly comprises brown adipose tissue (BAT), originates from neural crest cells that derive from ectoderm, and plays important role in angiotensin II-induced vascular inflammation and remodeling in mice. However, the characterization and function of human AA-PVAT remains highly unclear. METHODS: Patients with coronary artery disease (CAD) (n = 20) and aortic valve disease (AVD) (n = 23) who underwent cardiac surgery consented to take part in transcriptome and histological studies. Paired samples of AA-PVAT, epicardial adipose tissue (EAT), and subcutaneous adipose tissue (SAT) were obtained. RNA sequencing, histological analysis, quantitative reverse transcription polymerase chain reaction and western blot studies were performed on those samples. RESULTS: Human AA-PVAT exhibited smaller adipocyte morphology and high expression of brown adipocyte marker. Transcriptome analysis revealed that AA-PVAT showed unique transcriptome characteristics compared with EAT and SAT. While comparing CAD and AVD patients, AA-PVAT exhibited a decreasing brown phenotype and higher inflammatory response in AVD patients. Gene ontology enrichment and Kyoto Encyclopedia of Genes and Genomes pathway analysis suggested that the differentially expressed genes in AA-PVAT between CAD and AVD patients were involved mainly in the processes of inflammation and metabolism regulation. CONCLUSIONS: Human AA-PVAT is a BAT-like adipose tissue with unique transcriptome characteristics, and exhibits a weakened brown phenotype and an enhanced inflammation response in AVD patients.

Genistein loaded into microporous surface of nano tantalum/PEEK composite with antibacterial effect regulating cellular response in vitro, and promoting osseointegration in vivo.

Poly(ether-ether-ketone) (PEEK) with good biocompatibility exhibits high mechanical strengths but bioinert. In addition, tantalum (Ta) possesses outstanding osteogenesis but high density and elastic modulus, and cost. In this study, by blending Ta nanoparticles with PEEK, Ta/PEEK composite (TP) was prepared, which was then treated by concentrated sulfuric acid to form a microporous surface containing Ta particles on TP (TPS). Moreover, genistein (GS) with antibacterial property was loaded into the microporous surface of TPS (TPSG). Compared with TP, the surface properties (e.g., surface roughness and hydrophilicity) of TPS was obviously improved because of the microporous surface including Ta nanoparticles. Moreover, TPS showed low antibacterial properties because of presence of sulfonic group while TPSG exhibited excellent antibacterial properties due to GS loaded into the microporous surface. Furthermore, compared with TP, TPS obviously promoted attachment and proliferation of MG63 cells, while TPSG with GS remarkably inducing osteogenic differentiation of the cells compared with TPS in vitro. Moreover, in comparison with TP, TPS with optimized surface properties promoted new bone regeneration and osseointegration, while TPSG loading GS further enhanced bone regeneration as well as osseointegration in vivo. In summary, the GS loaded into microporous surface including Ta nanoparticles of TPSG exhibited antibacterial and osteogenic activity, which would have great potential for bone tissue repair.

Association of Pericardiac Adipose Tissue With Coronary Artery Disease.

Background and Aim: Coronary artery disease (CAD) poses a worldwide health threat. Compelling evidence shows that pericardial adipose tissue (PAT), a brown-like adipose adjacent to the external surface of the pericardium, is associated with CAD. However, the specific molecular mechanisms of PAT in CAD are elusive. This study aims to characterize human PAT and explore its association with CAD. Methods: We acquired samples of PAT from 31 elective cardiac surgery patients (17 CAD patients and 14 controls). The transcriptome characteristics were assessed in 5 CAD patients and 4 controls via RNA-sequencing. Cluster profile R package, String database, Cytoscape were applied to analyze the potential pathways and PPI-network key to DEGS, whereas the hubgenes were predicted via Metascape, Cytohubba, and MCODE. We use Cibersort, ENCORI, and DGIDB to predict immunoinfiltration, mRNA-miRNA target gene network, and search potential drugs targeting key DEGs. The predictable hubgenes and infiltrating inflammatory cells were validated in 22 patients (12 CAD samples and 10 control samples) through RT-qPCR and immunohistochemistry. Results: A total of 147 different genes (104 up-regulated genes and 43 down-regulated genes) were identified in CAD patients. These different genes were associated with immunity and inflammatory dysfunction. Cibersort analysis showed monocytes and macrophages were the most common subsets in immune cells, whereas immunohistochemical results revealed there were more macrophages and higher proportion of M1 subtype cells in PAT of CAD patients. The PPI network and module analysis uncovered several crucial genes, defined as candidate genes, including Jun, ATF3, CXCR4, FOSB, CCl4, which were validated through RT-qPCR. The miRNA-mRNA network implicated hsa-miR-185-5p as diagnostic targets and drug-gene network showed colchicine, fenofibrate as potential therapeutic drugs, respectively. Conclusion: This study demonstrates that PAT is mainly associated with the occurrence of CAD following the dysfunction of immune and inflammatory processes. The identified hubgenes, predicted drugs and miRNAs are promising biomarkers and therapeutic targets for CAD.

[Mutation Rate and Clinical Characteristics of CALR, JAK2 V617F and MPL W515K Genes in Patients With Primary Thrombocythemia].

OBJECTIVE: To analyze the mutation rate and clinical characteristics of CALR, MPL W515K and JAK2 V617F genes in patients with primary thrombocythemia (PT). METHODS: Fifty-six patients with PT were selected as the research objects in our hospital. The CALR and MPL W515K gene mutations were determined by genomic DNA-PCR direct sequencing of the PCR products, and the JAK2 V617F gene mutation was detected by allele specific PCR method. RESULTS: Among the 56 patients with PT there were 14 cases of CALR gene mutation with the incidence rate of 25%, including 6 cases of type I, 5 cases of type II and 3 cases of type III. The sex, age, platelet(Plt) count, white blood cell (WBC) count and hemoglobin (Hb) level in the type I case of CALR gene mutation all were not significantly different from that in type II and III(all P>0.05); the WBC level in type III group significantly increased in comparison of type II group (P<0.05), while the sex, age, Hb and Plt levels showed no significant difference between the type III and type II groups (P>0.05). There were 3 cases of MPL W515K gene mutation with the incidence rate of 5.36%; 21 cases of JAK2 V617F gene mutation with the incidence rate of 37.50%. There were 13 cases of CALR gene mutation in negative patients with MPL W515K and JAK2 V617F (18 cases) with 72.22% incidence rate (13/18), and there was no cases of 1 or 2 gene mutations coexisted. The levels of Hb and WBC in peripheral blood of patients with CALR mutation were significantly lower than those of JAK2 V617F mutation (both P<0.05). In 56 cases, there were 3 cases of abnormal karyotype, with the incidence rate of 5.36%. The mutation rate of CALR gene in abnormal karyotypes (66.67%) was significantly higher than that of normal karyotypes (20.75%) (P<0.01). CONCLUSION: The incidence of JAK2 V617F gene mutation increases in the patients with primary thrombocythemia; CALR mutation rate is higher in the patients with negative MPL W515K and JAK2 V617F gene mutation, which may closely correlate with abnormal karyotype; the levels of peripheral Hb and WBC in PT the patients with CALR gene mutation are significantly lower than those in patients with JAK2 V617F mutation.

Ten-year real-life effectiveness of coronary artery bypass using radial artery or great saphenous vein grafts in a single centre Chinese hospital.

OBJECTIVES: Long-term effectiveness of coronary artery bypass grafting using radial artery (RA) or great saphenous vein (SVG) grafts as a second conduit was compared. METHODS: Patients received simple elective off-pump coronary artery bypass involving both the left internal thoracic artery (LITA) and the left anterior descending artery between January 1999 and December 2005 at Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China. RA graft patients (n = 147 LITA + RA and n = 61 LITA + RA + SVG) were matched with SVG graft patients (n = 208 LITA + SVG). Mean follow-up was 86.5 months. RESULTS: Baseline characteristics were comparable before and after surgery. Intraoperative hospital mortality was not significantly different. In all, 378 (90.9%) patients completed postoperative follow-up (197 in the RA and 181 in SVG). Overall survival was significantly better in the RA group (Log-rank, P = 0.017) with 88% 10-year survival in the RA group and 81% in the SVG group. All-cause mortality was significantly lower in the RA group (hazard ratio 0.42, 95% confidence interval 0.20-0.88, P = 0.020). Major adverse cardiovascular event-free survival was significantly better in the RA group than in the SVG group (Log-rank, P = 0.019). No significant difference in the length of postoperative angina relief was found. CONCLUSIONS: Using the RA as the secondary graft for coronary artery bypass grafting improved long-term postoperative survival and reduced the incidence of postoperative major adverse cardiovascular events.

Comparison of Tibial Intramedullary Nailing Guided by Digital Technology Versus Conventional Method: A Prospective Study.

BACKGROUND This prospective study aimed to compare clinical effects of intramedullary nailing guided by digital and conventional technologies in treatment of tibial fractures. MATERIAL AND METHODS Thirty-two patients (mean age 43 years, 18 males and 14 females) who were treated for tibial fractures from October 2010 to October 2012 were enrolled. They were sequentially randomized to receive intramedullary nailing guided by either digital technology (digital group, n=16) or conventional technology (conventional group, n=16). The operation time, fluoroscopy times, fracture healing time, distance between the actual and planned insertion point, postoperative lower limb alignment, and functional recovery were recorded for all patients. RESULTS The mean operation time in the digital group was 43.1±6.2 min compared with 48.7±8.3 min for the conventional technology (P=0.039). The fluoroscopy times and distance between the actual and planned insertion point were significantly lower in the digital group than in the conventional group (both P<0.001). The accuracy rate of the insertion point was 99.12% by digital technology. No difference was found in fracture healing time and good postoperative lower limb alignment between the digital and conventional groups (P=0.083 and P=0.310), as well as the effective rate (100% vs. 87.50%, P=0.144). CONCLUSIONS Intramedullary nailing guided by digital technology has many advantages in treatment of tibial fractures compared to conventional technology, including shorter operation time, reduced fluoroscopy times, and decreased distance between the actual and planned insertion point of the intramedullary nail.

Development and Event-specific Detection of Transgenic Glyphosate-resistant Rice Expressing the G2-EPSPS Gene.

Glyphosate is a widely used herbicide, due to its broad spectrum, low cost, low toxicity, high efficiency, and non-selective characteristics. Rice farmers rarely use glyphosate as a herbicide, because the crop is sensitive to this chemical. The development of transgenic glyphosate-tolerant rice could greatly improve the economics of rice production. Here, we transformed the Pseudomonas fluorescens G2 5-enolpyruvyl shikimate-3-phosphate synthase (EPSPS) gene G2-EPSPS, which conferred tolerance to glyphosate herbicide into a widely used japonica rice cultivar, Zhonghua 11 (ZH11), to develop two highly glyphosate-tolerant transgenic rice lines, G2-6 and G2-7, with one exogenous gene integration. Seed germination tests and glyphosate-tolerance assays of plants grown in a greenhouse showed that the two transgenic lines could greatly improve glyphosate-tolerance compared with the wild-type; The glyphosate-tolerance field test indicated that both transgenic lines could grow at concentrations of 20,000 ppm glyphosate, which is more than 20-times the recommended concentration in the field. Isolation of the flanking sequence of transgenic rice G2-6 indicated that the 5'-terminal of T-DNA was inserted into chromosome 8 of the rice genome. An event-specific PCR test system was established and the limit of detection of the primers reached five copies. Overall, the G2-EPSPS gene significantly improved glyphosate-tolerance in transgenic rice; furthermore, it is a useful candidate gene for the future development of commercial transgenic rice.

Plasma levels of matrix metalloproteinase 9 in patients undergoing off-pump coronary artery bypass grafting.

BACKGROUND: Matrix metalloproteinase 9 (MMP9) has recently emerged as a risk predictor in patients with cardiovascular diseases. However, little is known about the significance of increased plasma MMP9 in patients with perioperative myocardial injury. We aimed to investigate the role of MMP9 in the occurrence of myocardial injury during off-pump coronary artery bypass grafting (OPCAB). METHODS: A total of 34 consecutive patients with coronary artery diseases (CAD) were recruited in this prospective, observational study. All patients were operated for OPCAB surgery. Serial blood samples were collected preoperatively and 12 hours after surgery. MMP9, together with cardiac troponin I (cTnI), creatinine kinase myocardial b fraction (CK-MB), C-reactive protein (CRP), and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in plasma were measured at each time-point. RESULTS: MMP9 levels increased significantly at 12 hours after surgery, attaining nearly 2 times the baseline levels (P=0.0001). There was a significant correlation between preoperative (pre-OP) circulating levels of MMP9 and the left ventricular ejection fraction (LVEF) (r=0.48; P=0.004) as well as European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (r=0.43; P=0.012). Patients were in New York Heart Association (NYHA) functional class III or IV heart failure showed a significantly higher MMP9 levels (1,348.0±337.2 vs. 630.4±93.0 ng/L, P=0.012) as compared to the patients in NYHA functional class I and II. No significant correlation was observed between MMP9 and age (P=0.612), serum creatinine (P=0.185), CRP (P=0.207), NT-proBNP (P=0.058). A significant correlation was observed in these data between the post-OP MMP9 and cTnI (r=0.35; P=0.003). CONCLUSIONS: Our study first established a connection between MMP9 and OPCAB procedure, suggesting that MMP9 could be a novel biomarker for identifying perioperative myocardial injury in patients undergoing OPCAB.

Off-pump coronary artery bypass surgery outcomes in patients with ischaemic left ventricular systolic dysfunction with or without detected viable myocardium.

OBJECTIVES: The prognostic value of myocardial viability before coronary bypass grafting remains controversial. The present study evaluated the effects of off-pump coronary artery bypass (OPCAB) grafting on patients with coronary artery disease (CAD) with or without viable myocardium (VM) preoperatively detected via nuclear imaging. METHODS: A total of 115 consecutive patients with 3-vessel disease and impaired left ventricular ejection fraction (LVEF ≤ 45%) who underwent OPCAB grafting were recruited in this prospective study. The patients were divided into 2 groups based on myocardial viability, the non-viable myocardium (NVM, 55 patients) and VM (60 patients) groups. Positron emission tomography and radionuclide imaging examination were applied to evaluate the myocardium viability. A Kaplan-Meier analysis was conducted to evaluate the 1-year survival rate. RESULTS: The preoperative data were similar between groups. An improvement in the LVEF was observed in both groups 12 months after OPCAB grafting (P < 0.05). A binary logistic regression revealed that NVM was an independent predictor of a 5% improvement in LVEF at 6 months (P = 0.012). The rate of main adverse cardiovascular and cerebrovascular events (MACCEs) rate at 1 year was similar between the 2 groups (P = 0.06). At 1 year, the death rates were 14.5% in the NVM group and 5% in the VM group (P = 0.17). A Cox regression analysis revealed that NVM and age were independent predictors of mortality [the hazard ratio for death associated with NVM and age were 1.62, 95% confidence interval (CI) = 1.16-2.89, P = 0.036 and 1.05, 95% CI = 0.98-1.12, P =0.025, respectively]. CONCLUSIONS: The MACCEs and mortality rates of the NVM group were higher than those of the VM group. However, OPCAB surgery improved LVEF, regardless of myocardium status. Therefore, the assessment of myocardial viability might not be the sole deciding factor in decision-making process regarding OPCAB surgery.

Bioinformatics analysis of gene expression profiles in B cells of postmenopausal osteoporosis patients.

OBJECTIVE: The aim of this study was to gain a better understanding of the molecular mechanisms and identify more critical genes associated with the pathogenesis of postmenopausal osteoporosis (PMOP). MATERIALS AND METHODS: Microarray data of GSE13850 were download from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified either in B cells from postmenopausal female nonsmokers with high bone mineral density (BMD) compared with those with low BMD (defined as DEG1 group) or in B cells from postmenopausal female smokers with high BMD compared with postmenopausal female nonsmokers with high BMD (defined as DEG2 group). Gene ontology and immune-related functional enrichment analysis of DEGs were performed. Additionally, the protein-protein interaction network of all DEGs was constructed and subnetworks of the hub genes were extracted. RESULTS: A total of 51 DEGs were identified in the DEG1 group, including 30 up- and 21 downregulated genes. Besides, 86 DEGs were identified in the DEG2 group, of which 46 were upregulated and 40 were downregulated. Immune enrichment analysis showed DEGs were mainly enriched in functions of CD molecules and chemokines and receptor, and the upregulated gene interleukin 4 receptor (IL-4R) was significantly enriched. Moreover, guanine nucleotide-binding protein G (GNAI2), filamin A alpha (FLNA), and transforming growth factor-ß1 (TGFB1) were hub proteins in the protein-protein interaction network. CONCLUSION: IL-4R, GNAI2, FLNA, and TGFB1 may be potential target genes associated with the pathogenesis of PMOP. In particular, FLNA, and TGFB1 may be affected by smoking, a risk factor of PMOP.

Outcomes of off-pump versus on-pump coronary artery bypass graft surgery in patients with severely dilated left ventricle.

BACKGROUND: Currently, off-pump coronary artery bypass (OPCAB) grafting has been the standard procedure for surgical revascularization in patients with coronary artery disease (CAD). This study aimed to examine the safety and applicability of OPCAB compared with on-pump coronary artery bypass (ONCAB) in patients with severely dilated left ventricle. METHODS: A retrospective study of giant left ventricle patients [left ventricular end diastolic diameter (LVEDD) ≥ VE mm] undergoing coronary bypass grafting from 2009 through 2015 at a single center was conducted. Preoperative and intraoperative risk factors, and postoperative outcomes were analyzed. Survival analysis was carried to analyze survival rate during follow-up. RESULTS: A total of 24 patients underwent ONCAB, and 26 underwent OPCAB. Both groups had similar preoperative profiles. Two cases from each group died during in-hospital time. In comparison to OPCAB, there was longer operation and post-surgery intubation time and more renal dysfunction in ONCAB group (P<0.05). One-year survival between OPCAB and ONCAB were not significantly different (87.5% vs. 92.3%, P>0.05). CONCLUSIONS: OPCAB is a safe and feasible alternative for CAD patients with giant left ventricle, offering a significant advantage over ONCAB with regards to renal function, operation duration and length of ventilation.

Plasma levels of growth differentiation factor-15 are associated with myocardial injury in patients undergoing off-pump coronary artery bypass grafting.

Growth differentiation factor-15 (GDF-15) has recently emerged as a risk predictor in patients with cardiovascular diseases. We therefore aimed to investigate the role of GDF-15 in the occurrence of cardiac injury during off-pump coronary artery bypass grafting (OPCAB). 55 consecutive patients with coronary artery diseases were recruited in this prospective, observational study. All patients were operated for OPCAB surgery. Serial blood samples were collected preoperatively, 12 hours and 36 hours after surgery. GDF-15, together with C-reactive protein, cardiac troponin I, creatine kinase MB and N-terminal pro B-type natriuretic peptide levels in plasma were measured at each time-point. GDF-15 levels increased significantly at 12 hours after surgery, attaining nearly 2.5 times the baseline levels (p < 0.001). Postoperative GDF-15 levels correlated positively with cTnI (p = 0.003) and EuroSCORE II (p = 0.013). According to the ROC curves, postoperative plasma GDF-15 was found to be the best biomarker to predict perioperative cardiac injury, compared with cTnI, CK-MB and EuroSCORE II. Circulating GDF-15 is a promising novel biomarker for identifying perioperative myocardial injury in patients undergoing OPCAB.

Robot-assisted coronary artery bypass grafting improves short-term outcomes compared with minimally invasive direct coronary artery bypass grafting.

BACKGROUND: Robot-assisted coronary artery bypass grafts (RACAB) utilizing the da Vinci surgical system are increasingly used and allow the surgeon to conveniently harvest internal mammary arteries (IMAs). The aim of this study was to compare the outcomes of off-pump RACAB and minimally invasive direct coronary artery bypass grafting (MIDCAB) in the short and medium term. METHODS: We performed a retrospective review of 132 patients with single- or multiple-vessel coronary artery disease who underwent minimally invasive off-pump CABG (OPCAB) between May 2009 and May 2014. The patients were divided into two groups based on the surgical approach, MIDCAB and RACAB group. The anastomosis of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) was performed as regular OPCAB through the incision on the beating heart using regular stabilization devices (Genzyme Corporation). The preoperative, intraoperative, postoperative, and follow-up data, including major adverse cardiac and cerebrovascular events (MACCE), were compared. RESULTS: The preoperative data were similar. RACAB significantly shorten the intensive care unit (ICU) stay and postoperative compared with the MIDCAB group (P<0.05). There were 12 (19.7%) patients treated with a two-stage hybrid procedure in the MIDCAB group and 34 (47.9%) patients in the RACAB group (P=0.001). Thirty-day mortality was 1.6% in the MIDCAB group. There were 9 (14.7%) MIDCAB patients and 2 (2.8%) RACAB patients (P=0.013) that developed new arrhythmia. The two groups showed comparable mid-term survival (P=0.246), but the MACCEs were significantly different (P=0.038). CONCLUSIONS: RACAB may be a valuable alternative for patients requiring single or simple multi-vessel coronary artery bypass grafting (CABG). Although the mid-term mortality outcomes are similar, RACAB improves short-term outcomes and mid-term MACCE-free survival compared with MIDCAB.

Mid-term results of coronary bypass graft surgery in patients with ischaemic left ventricular systolic dysfunction and no detected myocardial viability.

OBJECTIVES: There are concerns about effects of surgical revascularization on patients with ischaemic systolic dysfunction when no signs of myocardial viability have been detected by nuclear imaging preoperatively. We reviewed our data to determine the efficacy of coronary bypass graft in this special patient cohort. METHODS: A retrospective review with prospectively collected clinical data was conducted on 87 consecutive patients between 2000 and 2012 whose left ventricular ejection fraction was less than 40%. All patients received positron emission tomography examination before undergoing coronary artery bypass graft and showed no signs of myocardial viability. Improvements in ejection fraction, postoperative re-examination of myocardial viability by nuclear imaging and freedom from major cardiac events were observed. Survival was calculated using Kaplan-Meier analysis. RESULTS: The 30-day mortality rate was 7%. Ejection fraction improvement (defined as over 5%) was observed in 13 (16%) patients within 6 months postoperatively. Ejection fraction improvement was observed in 46 (58%) patients by the end of the first year and 50 (63%) patients by the second year. It was noted that 25 (32%) and 43 (54%) patients progressed to heart functional class I or II at 1 and 5 years, respectively. Positron emission tomography examination showed enhanced myocardial viability in the non-viable ventricular wall segment in 53 (67%) patients at 1 year. Freedom from major adverse cardiac events was observed in 56 (71%) patients at 1 year and 47 (60%) patients at 5 years. Survival rates were 82 and 66% at 1 and 5 years, respectively. CONCLUSIONS: Coronary artery bypass graft proved to be a positive choice of treatment for patients with severe ischaemic systolic dysfunction when there was no viable myocardium detected through nuclear imaging.

Identification of crucial genes related to postmenopausal osteoporosis using gene expression profiling.

BACKGROUND: Postmenopausal osteoporosis is a common bone disease and characterized by low bone mineral density. AIM: This study aimed to reveal key genes associated with postmenopausal osteoporosis (PMO), and provide a theoretical basis for subsequent experiments. METHODS: The dataset GSE7429 was obtained from Gene Expression Omnibus. A total of 20 B cell samples (ten ones, respectively from postmenopausal women with low or high bone mineral density (BMD) were included in this dataset. Following screening of differentially expressed genes (DEGs), coexpression analysis of all genes was performed, and key genes in the coexpression network were screened using the random walk algorithm. Afterwards, functional and pathway analyses were conducted. Additionally, protein-protein interactions (PPIs) between DEGs and key genes were analyzed. RESULTS: A set of 308 DEGs (170 up-regulated ones and 138 down-regulated ones) between low BMD and high BMD samples were identified, and 101 key genes in the coexpression network were screened out. In the coexpression network, some genes had a higher score and degree, such as CSTA. The key genes in the coexpression network were mainly enriched in GO terms of the defense response (e.g., SERPINA1 and CST3), immune response (e.g., IL32 and CLEC7A); while, the DEGs were mainly enriched in structural constituent of cytoskeleton (e.g., CYLC2 and TUBA1B) and membrane-enclosed lumen (e.g., CCNE1 and INTS5). In the PPI network, CCNE1 interacted with REL; and TUBA1B interacted with ESR1. CONCLUSIONS: A series of interactions, such as CSTA/TYROBP, CCNE1/REL and TUBA1B/ESR1 might play pivotal roles in the occurrence and development of PMO.