Downregulation of circFASTKD1 ameliorates myocardial infarction by promoting angiogenesis.

Circular RNAs (circRNAs), a novel class of endogenous long non-coding RNAs, have attracted considerable attention due to their closed continuous loop structure and potential clinical value. In this study, we investigated the function of circFASTKD1 in vascular endothelial cells. CircFASTKD1 bound directly to miR-106a and relieved its inhibition of Large Tumor Suppressor Kinases 1 and 2, thereby suppressing the Yes-Associated Protein signaling pathway. Under both normal and hypoxic conditions, the ectopic expression of circFASTKD1 reduced the viability, migration, mobility and tube formation of vascular endothelial cells, whereas the downregulation of circFASTKD1 induced angiogenesis by promoting these processes. Moreover, downregulation of circFASTKD1 in mice improved cardiac function and repair after myocardial infarction. These findings indicate that circFASTKD1 is a potent inhibitor of angiogenesis after myocardial infarction and that silencing circFASTKD1 exerts therapeutic effects during hypoxia by stimulating angiogenesis in vitro and in vivo.

External Validation of Survival-Predicting Models for Acute Myocardial Infarction with Extracorporeal Cardiopulmonary Resuscitation in a Chinese Single-Center Cohort.

BACKGROUND This study was designed as an external evaluation of potentially relevant models for acute myocardial infarction (AMI) with extracorporeal cardiopulmonary resuscitation (E-CPR). MATERIAL AND METHODS Twenty AMI adults that met criteria were retrospectively analyzed from January 2009 to January 2015. Six possible models - ENCOURAGE, SAVE, ECPR, GRACE, SHOCK, and a simplified risk chart - were identified by literature review and model scores calculated based on original data. Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment, commonly used in intensive care units, served as controls. A receiver operating characteristic curve was used to compare the models' discriminative power for predicting survival to discharge. RESULTS The ECPR model showed the best discriminative performance, with an area under the curve (AUC) of 0.893 (95% confidence interval [CI], 0.733-1.530, p=0.006); the cutoff was 12.5 points, with 66.7% sensitivity and 100% specificity. The "clinical" SHOCK model (including infarct site) showed weaker but still good discriminative power, with an AUC of 0.804 (95% CI, 0.580-1.027, p=0.035); the cutoff was 45.5 points, with 83.3% sensitivity and 71.4% specificity. The remaining models did not show significant discriminative power for predicting survival to discharge. Risk stratifications indicated that a statistically significant difference was observed in the distribution of patients into the ECPR group with different prognoses when stratified by its cutoff (p=0.003), while a trend of significant difference was shown when applied to the SHOCK model (p=0.05). CONCLUSIONS The ECPR and SHOCK models possess important abilities to predict intrahospital outcomes of AMI patients treated with E-CPR.

Performance of Multiple Risk Assessment Tools to Predict Mortality for Adult Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation Therapy: An External Validation Study Based on Chinese Single-center Data.

BACKGROUND: There has been no external validation of survival prediction models for severe adult respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) therapy in China. The aim of study was to compare the performance of multiple models recently developed for patients with ARDS undergoing ECMO based on Chinese single-center data. METHODS: A retrospective case study was performed, including twenty-three severe ARDS patients who received ECMO from January 2009 to July 2015. The PRESERVE (Predicting death for severe ARDS on VV-ECMO), ECMOnet, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score, a center-specific model developed for inter-hospital transfers receiving ECMO, and the classical risk-prediction scores of Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) were calculated. In-hospital and six-month mortality were regarded as the endpoints and model performance was evaluated by comparing the area under the receiver operating characteristic curve (AUC). RESULTS: The RESP and APACHE II scores showed excellent discriminate performance in predicting survival with AUC of 0.835 (95% confidence interval [CI], 0.659-1.010, P = 0.007) and 0.762 (95% CI, 0.558-0.965, P = 0.035), respectively. The optimal cutoff values were risk class 3.5 for RESP and 35.5 for APACHE II score, and both showed 70.0% sensitivity and 84.6% specificity. The excellent performance of these models was also evident for the pneumonia etiological subgroup, for which the SOFA score was also shown to be predictive, with an AUC of 0.790 (95% CI, 0.571-1.009, P = 0.038). However, the ECMOnet and the score developed for externally retrieved ECMO patients failed to demonstrate significant discriminate power for the overall cohort. The PRESERVE model was unable to be evaluated fully since only one patient died six months postdischarge. CONCLUSIONS: The RESP, APCHAE II, and SOFA scorings systems show good predictive value for intra-hospital survival of ARDS patients treated with ECMO in our single-center evaluation. Future validation should include a larger study with either more patients' data at single-center or by integration of domestic multi-center data. Development of a scoring system with national characteristics might be warranted.

[The use of extracorporeal membrane oxygenation in sustaining pulmonary function patients with influenza A H1N1].

OBJECTIVE: To summarize the clinical method and initial experience of extracorporeal membrane oxygenation (ECMO) supportive treatment in influenza A H1N1 serious patients. METHODS: In 5 critically ill patients with influenza A H1N1, their arterial oxygen saturation was 0.70 to 0.85 with oxygen concentration (FiO(2)) 1.00 under mechanical ventilation. In these 5 patients, 3 males and 2 females, vein-vein mode ECMO bypass (femoral vein-internal jugular vein) was carried out to assist pulmonary function. The ratio between ECMO oxygen flow and blood flow was 2-1:1, FiO(2) was 0.21 to 1.00, FiO(2) for mechanical ventilation was 0.30 to 0.70, and positive end expiratory pressure (PEEP) was 5-10 cm H(2)O (1 cm H(2)O= 0.098 kPa). Activated coagulation time (ACT) was maintained at 160-250 s. When artery oxygen saturation and artery-venous blood gas became normal on discontinuation of ECMO, ECMO was weaned, and venous cannulas were removed. Mechanical ventilation was continued. RESULTS: In 5 patients the assisting time of ECMO was 48-330 hours, the mean duration was 178.2 hours. ECMO assisted flow was 2.4-4.0 L/min. The observation time after stoppage of ECMO was 4-24 hours. Four patients were weaned from ECMO, with continuation of assisted respiration successfully. One patient died because the family member gave up hope and the treatment was stopped. CONCLUSION: Vein-vein mode ECMO bypass through femoral vein-internal jugular vein can offer effective aid to pulmonary function in influenza A H1N1 patients who are critically ill. The strategy can win time for the patients to be able to continue mechanical ventilation treatment.