[Incidence of postoperative complications in Chinese patients with gastric or colorectal cancer based on a national, multicenter, prospective, cohort study]

Objective: To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications. Methods: This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression. Results: The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion: Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.

GSDMD-mediated pyroptosis promotes cardiac remodeling in pressure overload

BACKGROUND

Gasdermin D (GSDMD) forms membrane pores to execute pyroptosis. But the mechanism of how cardiomyocyte pyroptosis induces cardiac remodeling in pressure overload remains unclear. We investigated the role of GSDMD-mediated pyroptosis in the pathogenesis of cardiac remodeling in pressure overload.

METHODS

Wild-type (WT) and cardiomyocyte-specific GSDMD-deficient (GSDMD-CKO) mice were subjected to transverse aortic constriction (TAC) to induce pressure overload. Four weeks after surgery, left ventricular structure and function were evaluated by echocardiographic, invasive hemodynamic and histological analysis. Pertinent signaling pathways related to pyroptosis, hypertrophy and fibrosis were investigated by histochemistry, RT-PCR and western blotting. The serum levels of GSDMD and IL-18 collected from healthy volunteers or hypertensive patients were measured by ELISA.

RESULTS

We found TAC induced cardiomyocyte pyroptosis and release of pro-inflammatory cytokines IL-18. The serum GSDMD level was significantly higher in hypertensive patients than in healthy volunteers, and induced more dramatic release of mature IL-18. GSDMD deletion remarkably mitigated TAC-induced cardiomyocyte pyroptosis. Furthermore, GSDMD deficiency in cardiomyocytes significantly reduced myocardial hypertrophy and fibrosis. The deterioration of cardiac remodeling by GSDMD-mediated pyroptosis was associated with activating JNK and p38 signaling pathways, but not ERK or Akt signaling pathway.

CONCLUSION

In conclusion, our results demonstrate that GSDMD serves as a key executioner of pyroptosis in cardiac remodeling induced by pressure overload. GSDMD-mediated pyroptosis activates JNK and p38 signaling pathways, and this may provide a new therapeutic target for cardiac remodeling induced by pressure overload.

Analysis of Efficacy and Safety of Small-Volume-Plasma Artificial Liver Model in the Treatment of Acute-On-Chronic Liver Failure

To explore the efficacy and safety of a small-volume-plasma artificial liver support system (ALSS) in the treatment of acute-on-chronic liver failure (ACLF). A retrospective analysis was performed. All ACLF patients received ALSS of plasma exchange & double plasma molecular absorb system (PE+DPMAS) treatment, and successfully completed this treatment. Patients were divided into small-volume and half-volume plasma groups. We compared the changes of the indicators on liver function, kidney function, blood coagulation function, and blood ammonia level before and after PE+DPMAS treatment; we compared the short-term and long-term curative effects between small-volume and half-volume plasma groups; and the factors influencing Week 4 and Week 12 mortality of ACLF patients were analyzed. The Week 4 improvement rates were 63.96 % and 66.86 % in the small-volume and half-volume plasma groups, respectively. The Week 12 survival rates in the small-volume-plasma and half-volume plasma groups were 66.72 % and 64.61 %, respectively. We found several risk factors affecting Week 4 and Week 12 mortality. Kaplan-Meier survival curves suggested no significant difference in Week 4 and Week 12 survival rates between the small-volume and half-volume plasma groups (P=0.34). The small-volume-plasma PE+DPMAS treatment could effectively reduce bilirubin and bile acids, and this was an approach with high safety and few complications, similar to the half-volume-plasma PE+DPMAS treatment. The small-volume-plasma PE+DPMAS has the advantage of greatly reducing the need for intraoperative plasma, which is especially of importance in times of shortage of plasma.

Comparison of imputation methods for missing production data of dairy cattle

Nowadays, vast amounts of data representing feed intake, growth, and environmental impact of individual animals are being recorded in on-farm settings. Despite their apparent use, data collected in real-world applications often have missing values in one or several variables, due to reasons including human error, machine error, or sampling frequency misalignment across multiple variables. Since incomplete datasets are less valuable for downstream data analysis, it is important to address the missing value problem properly. One option may be to reduce the dataset to a subset that contains only complete data, but considerable data may be lost via this process. The current study aimed to compare imputation methods for the estimation of missing values in a raw dataset of dairy cattle including 454 553 records collected from 629 cows between 2009 and 2020. The dataset was subjected to a cleaning process that reduced its size to 437 075 observations corresponding to 512 cows. Missing values were present in four variables: concentrate DM intake (CDMI, missing percentage = 2.30%), forage DM intake (FDMI, 8.05%), milk yield (MY, 15.12%), and BW (64.33%). After removing all missing values, the resulting dataset (n = 129 353) was randomly sampled five times to create five independent subsets that exhibit the same missing data percentages as the cleaned dataset. Four univariate and nine multivariate imputation methods (eight machine learning methods and the MissForest method) were applied and evaluated on the five repeats, and average imputation performance was reported for each repeat. The results showed that Random Forest was overall the best imputation method for this type of data and had a lower mean squared prediction error and higher concordance correlation coefficient than the other imputation methods for all imputed variables. Random Forest performed particularly well for imputing CDMI, MY, and BW, compared to imputing FDMI.

Review: When worlds collide - poultry modeling in the 'Big Data' era

Within poultry production systems, models have provided vital decision support, opportunity analysis, and performance optimization capabilities to nutritionists and producers for decades. In recent years, due to the advancement of digital and sensor technologies, 'Big Data' streams have emerged, optimally positioned to be analyzed by machine-learning (ML) modeling approaches, with strengths in forecasting and prediction. This review explores the evolution of empirical and mechanistic models in poultry production systems, and how these models may interact with new digital tools and technologies. This review will also examine the emergence of ML and Big Data in the poultry production sector, and the emergence of precision feeding and automation of poultry production systems. There are several promising directions for the field, including: (1) application of Big Data analytics (e.g., sensor-based technologies, precision feeding systems) and ML methodologies (e.g., unsupervised and supervised learning algorithms) to feed more precisely to production targets given a 'known' individual animal, and (2) combination and hybridization of data-driven and mechanistic modeling approaches to bridge decision support with improved forecasting capabilities.

TAK1 Activation by NLRP3 Deficiency Confers Cardioprotection Against Pressure Overload-Induced Cardiomyocyte Pyroptosis and Hypertrophy

A comprehensive view of the role of NLRP3/caspase-1/GSDMD-mediated pyroptosis in pressure overload cardiac hypertrophy is presented in this study. Furthermore, mitigation of NLRP3 deficiency-induced pyroptosis confers cardioprotection against pressure overload through activation of TAK1, whereas this salutary effect is abolished by inhibition of TAK1 activity, highlighting a previously unrecognized reciprocally regulatory role of NLRP3-TAK1 governing inflammation-induced cell death and hypertrophic growth. Translationally, this study advocates strategies based on inflammation-induced cell death might be exploited therapeutically in other inflammatory and mechanical overload disorders, such as myocardial infarction and mitral regurgitation.

[A multicenter retrospective study on the efficacy of different anti-reflux reconstruction methods after proximal gastrectomy for gastric cancer]

Objective: To examine the clinical efficacy of 3 anti-reflux methods of digestive tract reconstruction after proximal gastrectomy for gastric cancer. Methods: The clinical data and follow-up data of gastric cancer patients who underwent anti-reflux reconstruction after proximal gastrectomy in 11 medical centers of China from September 2016 to August 2021 were retrospectively collected, including 273 males and 65 females, aging of (63±10) years (range: 28 to 91 years). Among them, 159 cases were performed with gastric tube anastomosis (GTA), 107 cases with double tract reconstruction (DTR), and 72 cases with double-flap technique (DFT), respectively. The duration of operation, length of postoperative hospital stay and early postoperative complications (referring to Clavien-Dindo classification) of different anti-reflux reconstruction methods were assessed. Body mass index, hemoglobin and albumin were used to reflect postoperative nutritional status. Reflux esophagitis was graded according to Los Angeles criteria based on the routinely gastroscopy within 12 months after surgery. The postoperative quality of life (QoL) was evaluated by Visick score system. The ANOVA analysis, Kruskal-Wallis rank sum test, χ² test and Fisher's exact test were used for comparison between multiple groups, and further comparison among groups were performed with LSD, Tamhane's test or Bonferroni corrected χ² test. The mixed effect model was used to compare the trends of Body mass index, hemoglobin and albumin over time among different groups. Results: The operation time of DFT was significantly longer than that of GTA and DTR ((352±63) minutes vs. (221±66) minutes, (352±63) minutes vs. (234±61) minutes, both P<0.01). The incidence of early complications with Clavien-Dindo grade Ⅱ to Ⅴ in GTA, DFT and DTR groups was 17.0% (27/159), 9.7% (7/72) and 10.3% (11/107), respectively, without significant difference among these three groups (χ²=3.51, P=0.173). Body mass index decreased more significantly in GTA than DFT group at 6 and 12 months after surgery (mean difference=1.721 kg/m², P<0.01; mean difference=2.429 kg/m², P<0.01). body mass index decreased significantly in DTR compared with DFT at 12 months after surgery (mean difference=1.319 kg/m², P=0.027). There was no significant difference in hemoglobin or albumin fluctuation between different reconstruction methods perioperative. The incidence of reflux esophagitis one year after surgery in DTR group was 12.9% (4/31), which was lower than that in DFT (45.9% (17/37), χ²=8.63, P=0.003). Follow-up of postoperative quality of life showed the incidence of Visick grade 2 to 4 in DFT group was lower than that in GTA group (10.4% (7/67) vs. 34.6% (27/78), χ²=11.70, P=0.018), while there was no significant difference between DFT and DTR group (10.4% (7/67) vs. 22.2% (8/36, P>0.05). Conclusions: Compared with GTA and DTR, DFT is more time-consuming, but there is no significant difference in early complications among three methods. DFT reconstruction is more conducive to maintain postoperative nutritional status and improve QoL, especially compared with GTA. The risk of reflux esophagitis after DTR reconstruction is lower than that of DFT.

[Predictive value of mismatch negativity and P3a combined with electroencephalogram reactivity for the prognosis of comatose patients after severe brain injury]

Objective: To explore the clinical value of mismatch negativity and P3a combined with electroencephalogram (EEG) reactivity to predict the prognosis of patients after severe brain injury. Methods: The clinical data of patients with severe brain injury who were admitted to the neurosurgical intensive care unit of Xiangya Hospital of Central South University from October 2019 to July 2020 were retrospectively analyzed. All patients underwent evaluation of auditory mismatch negativity (MMN), P3a, and EEG reactivity (EEG-R) within 28 days after the onset of coma. Patients were divided into two groups using the 3-month Glasgow Outcome Scale (GOS) after coma onset, a GOS score of 3-5 was defined as a favorable outcome, and GOS grades 1-2 were defined as an unfavorable outcome. The correlation between clinical indicators and prognosis was analyzed, and the predictive values of statistically significant indicators and the cut-off values were determined using the receiver operating characteristic (ROC) curve. Results: A total of 48 patients were enrolled in the study, including 35 males and 13 females (age range:18-68 years old). Twenty-nine of the patients had a favorable outcome and 19 had an unfavorable outcome. The Glasgow Coma Scale (GCS), EEG-R, absolute amplitude of MMN at Fz (FzMMNA), and amplitude of P3a at Cz (CzP3aA) were significantly correlated with the prognosis of comatose patients (P<0.001). Multivariate logistic regression analysis revealed that only EEG-R, FzMMNA, and CzP3aA were independent predictors for the prognosis of comatose patients after severe brain injury (all P<0.05), with the area under the curve (AUC) of 0.757 (0.613-0.900), 0.912 (0.830-0.994) and 0.887 (0.793-0.981), respectively. The combination of FzMMNA and CzP3aA and the combinationof EEG-R, FzMMNA and CzP3aA increased the value of AUC to 0.942 (0.879-1.000) and 0.964 (0.920-1.000), respectively. Moreover, a cut-off value of 1.27 μV and 2.64 μV for FzMMNA and CzP3aA, respectively, yielded the best sensitivity and specificity for the prognosis prediction of patients with severe brain injury [FzMMNA: 89.66%(26/29) and 84.21%(16/19); CzP3aA:82.76%(24/29) and 84.21%(16/19)]. Conclusion: This study indicates that the combination of EEG-R, FzMMNA, and CzP3aA may serve as a favorable prognostic indicator for comatose patients after severe brain injury.

[Myxiod pleomorphic liposarcoma: a clinicopathological and molecular genetic analysis of six cases]

Objective: To investigate the clinicopathologic and molecular genetic characteristics of myxoid pleomorphic liposarcoma (MPLPS). Methods: Six cases of MPLPS diagnosed and consulted in Fujian Provincial Hospital from 2015 to 2021 were collected for histomorphological observation, immunohistochemistry, and fluorescence in situ hybridization (FISH) detection of DDIT3 (CHOP) gene translocation and MDM2/CDK4 gene amplification. Results: There were four males and two females, aged 26-74 years (mean 53.8 years). The tumor size was 3.8-16.0 cm (mean 11.8 cm). All six cases had similar histopathologic features, showing overlapping histologic morphology of myxoid liposarcoma and pleomorphic liposarcoma. Four cases (4/6) were positive for S-100 protein, and the Ki-67 index was 50%-95%. All cases (6/6) were negative for DDIT3 (CHOP) translocation and MDM2/CDK4 amplification by FISH. TP53 (p.R248w) germline mutation was found in one case. Conclusions: MPLPS is a rare subtype of liposarcoma, characterized by overlapping morphology of myxoid liposarcoma and pleomorphic liposarcoma. Genetically, a few of them have TP53 gene germline mutations, but they lack of DDIT3 (CHOP) translocation or MDM2/CDK4 amplification.

Assessing The Utility of D-Dimer Driven Anticoagulation Strategies In Severely Obese Patients With COVID-19

Funding Acknowledgements

Type of funding sources: None.

Background

Many studies to date have documented significant inflammatory vascular sequelae in association with COVID-19. Current guidelines suggest an initial strategy of therapeutic-dose anticoagulation to non-critically ill, hospitalized patients requiring low-flow oxygen and a concurrent D-dimer level above the upper limit of normal. However, the utility of D-dimer values in predicting thrombosis in severely obese patients are equivocal to poor, with prior evidence suggesting falsely elevated levels with greater BMI. Given the weight-based dosing of heparin, these patients may also be inadvertently at elevated risk for major bleeds.

Purpose

To examine the utility of D-dimer levels in risk stratification and anticoagulation therapy in non-critically ill COVID-19 patients with severe obesity.

Methods

In this single-center, retrospective study, 32 severely obese patients (defined as BMI > 40) hospitalized with COVID-19 and requiring low flow oxygen delivery, without ICU level of care were analyzed. Clinical outcomes were compared between groups receiving therapeutic versus prophylactic doses of anticoagulation. All were treated with low molecular weight heparin (LMWH) per hospital protocol. The following data points were examined: length of hospitalization, mortality, anticoagulation therapy, initial d-dimer levels, thrombotic events, minor/major bleeds, and oxygen modality.

Results

In total, 78% of patients initially presented with a D-dimer level above the upper limit of normal, with 53% of patients meeting criteria for therapeutic anticoagulation. However, there were no significant differences in incidence of thrombotic events, mean length of hospitalization or overall mortality. Furthermore, despite utilization of appropriate therapeutic anticoagulation, it did not reduce the overall use of oxygen support requirements, including high flow oxygen or non-invasive ventilation, when compared to individuals receiving prophylactic dosing.

Conclusion

The clinical utility of D-dimer levels for guiding anticoagulation therapy in severely obese patients with COVID-19 may be limited. Here, we demonstrate that therapeutic dose approaches have nonsignificant differences in clinical outcomes when compared to prophylactic doses in this distinct population.

SS-31 Modification Inhibits the Proinflammatory Effect on Macrophages Induced by Superparamagnetic Iron Oxide Nanoparticles

Superparamagnetic iron oxide nanoparticles can induce macrophage polarization into the proinflammatory M1-type. This adverse effect is very likely to restrict the applications of superparamagnetic iron oxide nanoparticles in various inflammatory medical conditions. To inhibit the proinflammatory effect, the mitochondrial-targeted antioxidant peptide SS-31 was physically adsorbed on superparamagnetic iron oxide nanoparticles to develop superparamagnetic iron oxide nanoparticles@SS-31. The macrophages (RAW 264.7) were incubated with superparamagnetic iron oxide nanoparticles or superparamagnetic iron oxide nanoparticles@SS-31 at a concentration of 50 μg Fe3O4/mL for 24 hours. Compared to the superparamagnetic iron oxide nanoparticles group, the superparamagnetic iron oxide nanoparticles@SS-31 group demonstrated significantly reduced cell damage, as evidenced by the inhibition of cell viability loss, early cell apoptosis and the production of reactive oxygen species. Moreover, the proinflammatory factor TNF-α and M1-type cell surface markers CD86 and CD80 were significantly downregulated in the superparamagnetic iron oxide nanoparticles@SS-31 group as shown by enzyme-linked immunosorbent assay and flow cytometric analysis. Notably, compared with the superparamagnetic iron oxide nanoparticles group, levels of the anti-inflammatory factors IL-10, TGF-β and the M2-type cell surface marker CD163 were markedly upregulated in the superparamagnetic iron oxide nanoparticles@SS-31 group. In addition, severe disruption of the mitochondrial ultrastructure was observed by transmission electron microscopy in the superparamagnetic iron oxide nanoparticles group, but the superparamagnetic iron oxide nanoparticles@SS-31 group displayed structurally intact mitochondria. All of these results suggest that superparamagnetic iron oxide nanoparticles can promote macrophage M1-type polarization by inducing oxidative stress and mitochondrial damage, while superparamagnetic iron oxide nanoparticles@SS-31 can significantly inhibit superparamagnetic iron oxide nanoparticles-induced toxicity by releasing SS-31 to exert mitochondrial-targeted antioxidant and anti-inflammatory effects, indicating that the strategy of coloading the SS-31 peptide into superparamagnetic iron oxide nanoparticles has the potential to alleviate superparamagnetic iron oxide nanoparticles-induced proinflammatory effects.

Troponin T Elevation After Percutaneous Left Atrial Appendage Occlusion

Background: Cardiac troponin T (cTNT) has been widely used in detecting cardiac damage. Elevated cTNT level has been reported to be associated with increased mortality in multiple cardiac conditions. It is not uncommon to observe an increased level of cTNT in patients after left atrial appendage occlusion (LAAO). The objective of the study is to study the incidence, significance, and factors associated with cTNT elevation after LAAO.

Methods: We prospectively included patients who underwent LAAO from January 2019 to July 2020 in Fudan Zhongshan Hospital. Patients were divided into those with elevated cTNT after procedure and those with normal postprocedure cTNT. All individuals were followed up for 1 year. The primary outcome is major adverse cardiovascular events, which include myocardial infarction, heart failure, cardiac death, and stroke. The second outcome is periprocedure complication, including chest pain, tachycardia, cardiac tamponade, change of electrocardiograph, and atrial thrombus.

Results: A total of 190 patients were enrolled. Of the patients, 85.3% had elevated cTNT after LAAO, while 14.7% of them did not. Exposure time, dosage of contrast, types of devices, shapes, and sizes of LAA could contribute to elevated postprocedure cTNT. We found that patients with a Watchman device were more likely to have elevated postprocedure cTNT than those with a Lambre device (89.2 vs. 76.7%, p = 0.029). LAAO shapes were associated with cTNT levels in patients with a Watchman device, while the diameter of the outer disc and LAA depth mattered for the Lambre device. There was no significant difference in the primary and second outcome between the two groups (p-value: 0.619, 0.674).

Conclusion: LAAO was found to be commonly accompanied with cTNT elevation, which might not to be related to the complications and adverse cardiac outcomes within 1 year of follow-up. Moreover, eGFR at baseline, exposure time, dosage of contrast, types of LAAO device, and LAA morphology could contribute to cTNT elevation.

Involvement of Endoplasmic Reticulum Stress-Mediated Activation of C/EBP Homologous Protein in Aortic Regurgitation-Induced Cardiac Remodeling in Mice

Aortic regurgitation (AR) is a volume overload disease causing eccentric left ventricular (LV) hypertrophy and eventually heart failure. There is currently no approved drug to treat patients with AR. Endoplasmic reticulum (ER) stress and ER stress-mediated apoptosis is involved in many cardiovascular diseases, but whether they also participate in AR-induced heart failure is still elusive. In this study, we found ER stress activation in myocardial samples from patients with AR. With a unique murine model of AR which induced eccentric cardiac hypertrophy and heart failure, we also found aggravation of cardiac ER stress and apoptosis, as evidenced by a reduction of Bcl-2/Bax ratio and an increase of caspase-3 cleavage. We then examined the signaling effectors involved in ER-initiated apoptosis and found volume overload specifically activated C/EBP homologous protein (CHOP), but not caspase-12 or Jun N-terminal kinase (JNK). Interestingly, tauroursodeoxycholic acid (TUDCA), an ER stress inhibitor, improved cardiac function, and suppressed ER stress, apoptosis, and CHOP. Furthermore, genetic knockdown of CHOP inhibited cardiac Bcl-2/Bax ratio reduction and caspase-3 activation and rescued cardiac dysfunction. In summary, our findings suggest that ER stress-CHOP signaling is involved in the development of volume overload cardiac hypertrophy induced by AR through promoting cardiomyocytes apoptosis and provide a previously unrecognized target in heart failure induced by volume overload.

[Perirectal fascial anatomy and pelvic autonomic nerve preservation during the transanal total mesorectal excision]

The difficulty of transanal total mesorectal excision (TME) is to find the correct dissection plane of perirectal space. As a complex new surgical procedure, the fascial anatomic landmarks of transanal approach operation are more likely to be ignored. It is often found that dissection plane is false after the secondary injury occurs during the operation, which results in the damage of pelvic autonomic nerves. Meanwhile, the mesorectum is easily damaged if the dissection plane is too close to the rectum. Thus, the safety of oncologic outcomes could be limited by difficulty achieving adequate TME quality. The promotion and development of the theory of perirectal fascial anatomy provides a new thought for researchers to design a precise approach for transanal endoscopic surgery. Transanal total mesorectal excision based on fascial anatomy offers a solution to identify the transanal anatomic landmarks precisely and achieves pelvic autonomic nerve preservation. In this paper, the authors focus on the surgical experience of transanal total mesorectal excision based on the theory of perirectal fascial anatomy, and discuss the feature of perirectal fascial anatomy dissection and technique of pelvic autonomic nerve preservation during transanal approach operation.

Predictors and long-term prognosis of left ventricular aneurysm in patients with acute anterior myocardial infarction treated with primary percutaneous coronary intervention in the contemporary era

Background

Primary percutaneous coronary intervention (PCI) has been the standard reperfusion strategy for patients with acute myocardial infarction (AMI) in the contemporary era. Meanwhile, the incidence and prognosis of left ventricular aneurysm (LVA) in AMI patients remain ambiguous. The aim of the current study is to identify the predictor and long-term prognosis of LVA in patients with acute anterior myocardial infarction.

Methods

We prospectively enrolled 942 consecutive patients with acute anterior myocardial infarction who were treated by primary PCI. The baseline characteristics, procedural features, and one-year clinical outcomes were compared between the patients with and without LVA. The primary endpoint of major adverse cardiovascular and cerebrovascular events (MACCEs) was defined as a composite of cardiac death, target vessel revascularization, and ischemic stroke. Multiple logistic regression was applied to predict LVA formation and the receiver operating characteristic (ROC) curves were plotted to evaluate the accuracy of the multivariate analysis model.

Results

The general incidence of LVA was 15.92%. At one-year clinical follow-up, patients in the LVA group had significantly higher incidence of MACCEs (15.33% vs. 6.44%, P<0.01), mainly driven by an increased incidence of cardiac death (8.00% vs. 2.78%, P<0.01), target vessel revascularization (5.33% vs. 2.27%, P=0.03), and ischemic stroke (4.00% vs. 1.39%, P=0.03). Multivariate analysis found that longer symptom-to-balloon time (S2B) [odds ratio (OR): 1.16, 95% confidence interval (CI): 1.11–1.21, P<0.01], higher initial and residual SYNTAX score (iSS, OR: 1.19, 95% CI: 1.14–1.24, P<0.01; rSS, OR: 1.33, 95% CI: 1.22–1.45, P<0.01), lower left ventricular ejection fraction (LVEF) (OR: 1.15, 95% CI: 1.11–1.18, P<0.01), and persistent ST segment elevation (OR: 1.89, 95% CI: 1.06–3.38, P=0.03) were independent predictors of LVA formation.

Conclusions

LVA is still common in patients with acute anterior myocardial infarction in the contemporary PCI era, and the prognosis of these patients was significantly worse during the one-year clinical follow-up. Strategies of prompt reperfusion and complete revascularization may be helpful in preventing LVA formation and improving clinical outcomes.

Variations in Energy Metabolism Precede Alterations in Cardiac Structure and Function in Hypertrophic Preconditioning

Recent studies have unveiled that myocardial hypertrophic preconditioning (HP), which is produced by de-banding (De-TAC) of short-term transverse aortic constriction (TAC), protects the heart against hypertrophic responses caused by subsequent re-constriction (Re-TAC) in mice. Although cardiac substrate metabolism is impaired in heart failure, it remains unclear about the role of HP-driven energetics in the development of cardiac hypertrophy. Here, we investigated energy metabolism, cardiac hypertrophy, and function following variational loading conditions, as well as their relationships in HP. Male C57BL/6J mice (10–12 weeks old) were randomly subjected to Sham, HP [TAC for 3days (TAC 3d), de-banding the aorta for 4 days (De-TAC 4d), and then re-banding the aorta for 4 weeks (Re-TAC 4W)], and TAC (TAC for 4 weeks without de-banding). Cardiac echocardiography, hemodynamics, and histology were utilized to evaluate cardiac remodeling and function. The mRNA expression levels of fetal genes (ANP and BNP), glucose metabolism-related genes (glut4, pdk4), and fatty acid oxidation-related genes (mcad, pgc1α, mcd, pparα) were quantitated by real-time quantitative PCR. Activation of hypertrophy regulators ERK1/2, a metabolic stress kinase AMP-activated protein kinase (AMPK), and its downstream target acetyl-coA carboxylase (ACC) were explored by western blot. Compared with TAC 4W mice, Re-TAC 4W mice showed less impairment in glucose and fatty acid metabolism, as well as less cardiac hypertrophy and dysfunction. Moreover, no significant difference was found in myocardial hypertrophy, fibrosis, and cardiac function in TAC 3d and De-TAC 4d groups compared with Sham group. However, glut4, pdk4, mcad, pgc1α, mcd, and pparα were all decreased, while AMPK and ACC were activated in TAC 3d and returned to Sham level in De-TAC 4d, suggesting that the change in myocardial energy metabolism in HP mice was earlier than that in cardiac structure and function. Collectively, HP improves energy metabolism and delays cardiac remodeling, highlighting that early metabolic improvements drive a potential beneficial effect on structural and functional restoration in cardiac hypertrophy.

[Investigation of 603 medical staff occupational exposure with blood-borne pathogens]

Objective: To investigate the occupational exposure with blood-borne pathogens of medical staff, and explore the protective strategy. Methods: Using cluster sampling method, 603 medical staff with occupational exposure with blood-borne pathogens were analyzed, from July 2014 to July 2018 in a tertiary hospital. Results: In total of 603 occupational exposure incidents, 70.98% (428/603) were freshmen younger than 30 years old. 48.92% (295/603) nurses. The most cases of occupational exposure were in surgery (35.16%, 212/603) . Sharp injury was the major contact manner (86.90%, 524/603) . Hands were the main contact parts (90.38%, 545/603) . Ward (53.57%, 323/603) and the operating room (22.72%, 137/603) were the high-risk place. The most dangerous actions were needle injection (34.83%, 210/603) , surgery (20.89%, 126/603) and finishing/cleaning items (19.73%, 119/603) . The main items lead to injuries were scalp needles (34.73%, 182/524) . The most exposure source was hepatitis B virus (HBV) which occupied 39.30% (237/603) . Exposure source mainly comes from medical devices containing blood (81.92%, 494/603) . To compared the groups (χ(2)=19.940, P<0.01) and titer (t=-8.592, P<0.01) of hepatitis B surface antibody (HBsAb) before and after used prophylactics, the differences were statistically significant. Conclusion: Comprehensive strategies of occupational exposure protection education, operation norms and monitoring management were effective methods to reduce the occupational exposure in the medical staff with blood-borne pathogens.

[Predicting the prognosis for severe brain injury patients: short-latency somatosensory evoked potential combined with electroencephalogram reactivity]

Objective: To explore the the effectiveness of using short-latency somatosensory evoked potential(SLSEP) combined with electroencephalogram(EEG) reactivity to predict the prognosis of severe brain injury(SBI) patients. Methods: Consecutive patients with SBI admitted in neurosurgery intensive care unit(NSICU) at Xiangya Hospital of Central South University from July 2018 to January 2019 were prospectively collected. SLSEP and EEG were recorded in these patients in NSICU within two weeks after injury onset. EEG reactivity(EEG-R) was tested during EEG signal stabilization. In addition, the concentrations of serum neuron-specific enolase (NSE) and S100 protein were also detected. All patients were evaluated with Glasgow Outcome Scale(GOS) during 12 months' follow-up. GOS grade 3 to 5 was defined as favorable group, and GOS grade 1 to 2 was defined as unfavorable group. The association of relevant predictors with patient's prognosis was assessed. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate each potential predictor. Results: Forty-three patients were included in the study, with 26 patients of favorable outcomes and 17 patients with unfavorable prognosis. Univariate analysis revealed that the Glasgow Coma Scale (GCS) score, the concentration of serum NSE, EEG-R, the amplitude of SLSEP were all associated with the prognosis after 12 months' follow-up. Moreover, the AUC for prediction of favorable prognosis by GCS, NSE, EEG-R, SLSEP was 0.661(95%CI: 0.493-0.829), 0.697(95%CI: 0.531-0.862), 0.718(95%CI: 0.557-0.879) and 0.758(95%CI: 0.609-0.907) respectively. However, there was no significant difference of age, gender, pupillary light reflex and S100 protein between the two groups. Furthermore, multiple logistic regression analysis showed that only SLSEP amplitude (OR=2.058, 95%CI: 0.867-4.888) and EEG-R(OR=3.748, 95%CI: 0.857-16.394) were independent predictors of favorable prognosis, and the prognostic model containing these two variables yielded an predictive performance with an AUC of 0.798. Conclusion: The higher amplitude of SLSEP and the existence of EEG-R are predictors of good prognosis in SBI patients, and the combined use of SLSEP and EEG-R in predicting the prognosis of SBI patients is more reliable.

Left ventricular response in the transition from hypertrophy to failure recapitulates distinct roles of Akt, β-arrestin-2, and CaMKII in mice with aortic regurgitation

Background

Although aortic regurgitation (AR) is a clinically important condition that is becoming increasingly common, few relevant murine models and mechanistic studies exist for this condition. In this study, we attempted to delineate the pathological and molecular changes and address the roles of some potentially relevant molecules in an animal model of surgically induced AR.

Methods

AR was induced by puncturing the aortic valve leaflets in C57BL/6J mice under echocardiographic guidance.

Results

As early as 1 week following AR, the left ventricles (LV) displayed marked impairments in diastolic function and coronary flow reserve (CFR), as well as cardiac hypertrophy and chamber dilatation at both end-systole and end-diastole. LV free wall thickening and cardiomyocyte hypertrophy in LV were observed 2 weeks following of AR while a decline in ejection fraction was not seen until after 4 weeks. Nppa (natriuretic peptide A) and Nppb (natriuretic peptide B) increased over time, in conjunction with prominent Akt activation as well as slight CaMKII (Ca²⁺/calmodulin-dependent protein kinase II) activation and biphasic changes in β-arrestin-2 expression. Treatment of AR mice with Akt inhibition exacerbated the eccentric hypertrophy, while neither inhibition of CaMKII nor β-arrestin-2 overexpression influenced the response to AR.

Conclusions

Our structural, functional, molecular and therapeutic analyses reveal that Akt, but not CaMKII or β-arrestin-2, plays a regulatory role in the development of LV remodeling after AR in Mice. These results may shed important light on therapeutic targets for volume overloaded cardiomyopathy.

PNPLA3 polymorphism influences the association between high-normal TSH level and NASH in euthyroid adults with biopsy-proven NAFLD

AIM

We aimed to evaluate the association between serum thyroid stimulating hormone (TSH) levels, within the reference range, and the histological severity of nonalcoholic fatty liver disease (NAFLD), and whether this association was modulated by the patatin-like phospholipase domain-containing 3 (PNPLA3) rs738409 polymorphism.

MATERIALS AND METHODS

We enrolled 327 euthyroid individuals with biopsy-proven NAFLD, who were subdivided into two groups, i.e., a 'strict-normal' TSH group (TSH level 0.4 to 2.5mIU/L; n=283) and a 'high-normal' TSH group (TSH level 2.5 to 5.3mIU/L with normal thyroid hormones; n=44). Logistic regression analyses were performed to assess the association between TSH status and presence of nonalcoholic steatohepatitis (NASH) after stratifying subjects by PNPLA3 genotypes.

RESULTS

Compared to strict-normal TSH group, patients with high-normal TSH levels were younger and had a greater prevalence of NASH and higher histologic NAFLD activity score. After stratifying by PNPLA3 genotypes, the significant association between high-normal TSH levels and presence of NASH was restricted only to carriers of the PNPLA3 G risk allele and remained significant even after adjustment for potential confounding factors (adjusted-odds ratio: 3.279; 95% CI: 1.298-8.284; P=0.012).

CONCLUSION

In euthyroid individuals with biopsy-proven NAFLD, we found a significant association between high-normal TSH levels and NASH. After stratifying by PNPLA3 rs738409 genotypes, this association was observed only among carriers of the PNPLA3 G risk allele.

WHITE STRIPE LEAF8, encoding a deoxyribonucleoside kinase, is involved in chloroplast development in rice

WSL8 encoding a deoxyribonucleoside kinase (dNK) that catalyzes the first step in the salvage pathway of nucleotide synthesis plays an important role in early chloroplast development in rice. The chloroplast is an organelle that converts light energy into chemical energy; therefore, the normal differentiation and development of chloroplast are pivotal for plant survival. Deoxyribonucleoside kinases (dNKs) play an important role in the salvage pathway of nucleotides. However, the relationship between dNKs and chloroplast development remains elusive. Here, we identified a white stripe leaf 8 (wsl8) mutant that exhibited a white stripe leaf phenotype at seedling stage (before the four-leaf stage). The mutant showed a significantly lower chlorophyll content and defective chloroplast morphology, whereas higher reactive oxygen species than the wild type. As the leaf developed, the chlorotic mutant plants gradually turned green, accompanied by the restoration in chlorophyll accumulation and chloroplast ultrastructure. Map-based cloning revealed that WSL8 encodes a dNK on chromosome 5. Compared with the wild type, a C-to-G single base substitution occurred in the wsl8 mutant, which caused a missense mutation (Leu 349 Val) and significantly reduced dNK enzyme activity. A subcellular localization experiment showed the WSL8 protein was targeted in the chloroplast and its transcripts were expressed in various tissues, with more abundance in young leaves and nodes. Ribosome and RNA-sequencing analysis indicated that some components and genes related to ribosome biosynthesis were down-regulated in the mutant. An exogenous feeding experiment suggested that the WSL8 performed the enzymic activity of thymidine kinase, especially functioning in the salvage synthesis of thymidine monophosphate. Our results highlight that the salvage pathway mediated by the dNK is essential for early chloroplast development in rice.

P2262Intensity and cost of health care at the end of life among patients with heart failure

Background

Health care utilization increase towards the end of life. There is little known about the intensity of care, including use of in-hospital services, critical care units, and invasive procedures at the end of life in heart failure (HF).

Aims

To determine the type and intensity of health care services offered at the end of life to patients with HF, and to establish the determinants of and costs associated with death in the hospital versus at home.

Methods

We conducted a retrospective cohort study of adults (≥18 years) who died between April 1, 2004 and March 31, 2017 in Ontario, Canada. We included decedents with a diagnosis of HF in the 2 years preceding their death and a hospitalization for HF in their last year of life. We obtained demographic, clinical, healthcare utilization, and healthcare cost data from population-based administrative databases, using unique encrypted identifiers to link records. We calculated direct costs from the perspective of the Ministry of Health in our publicly-funded healthcare system. We used descriptive statistics and a 2-level multivariable logistic regression model) with patients (1st level) nested in regions (2nd level) to assess for predictors of death in the hospital versus at home.

Results

We identified 396,024 adults with HF who died between April 1, 2004 and March 31, 2017. Mean (standard deviation [SD]) age at death was 81.8 (10.7) years, and 48.5% were men. During the last 6 months of life, patients commonly experienced hospitalizations (78.1%), care from >10 different physicians (62.2%); intensive care unit (ICU) admissions (26.4%); mechanical ventilation (18.1%); hemodialysis (6.2%); and cardiac catheterization (3.7%). In the last 6 months of life, patients spent a mean (SD) of 17.4 (23.0) days in the hospital; 2.5 (8.3) days in an ICU; and 1.6 (7.9) days on a ventilator. While the proportion of deaths at home increased from 32.6% in 2004–2005 to 38% in 2016–2017, a majority of patients (53.4%) died in hospital during the study period. Factors independently associated with in-hospital death included age (OR 0.53 [95% CI 0.51–0.55] for age >85 years vs <60 years), sex (OR 0.88 [95% CI 0.87–0.89] for female vs male), and socioeconomic status (OR 0.87 [95% CI 0.85–0.89] for highest vs lowest income quintile). Palliative care services in the last 6 months of life was associated with higher odds of in-hospital death (OR 1.73 [95% CI 1.70–1.76]). Death in hospital was associated with higher mean [SD] healthcare costs in the terminal 6 months of life than death out of hospital ($52,349 [55,649] vs $35,943 [31,907]).

Conclusion

In this large cohort study in Ontario, Canada, patients with HF commonly received in-hospital, intensive, and invasive care in the last 6 months of life, and a majority of patients died in hospital. Death in hospital was associated with higher costs of care in the terminal 6 months than death outside hospital.

Acknowledgement/Funding

Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research

P3519Sex-based disparities in end of life care among patients with heart failure

Background

There are sex-based disparities in care and outcomes among patients with heart failure (HF), but the association between sex and health care services received at the end-of-life health is unknown.

Purpose

To assess for sex-based differences in location of death and the type and intensity of health care services received at the end of life among patients with HF.

Methods

We conducted a retrospective cohort study of adults (≥18 years) who died between April 1, 2004 and March 31, 2017 in Ontario, Canada. We included decedents who had a diagnosis of HF and a hospitalization for HF in the year preceding their death. We obtained demographic, clinical, health care utilization, and healthcare system cost data from population-based administrative databases, using unique encrypted identifiers to link records. We used descriptive statistics and a 2-level multivariable logistic regression model with patients (1st level) nested in regions (2nd level) to assess whether sex was independently associated with death in hospital.

Results

We identified 396,024 adults (51.5% women) who died of HF between April 1, 2004 and March 31, 2017. Mean (SD) age at death was 81.8 (10.7) years and a majority of deaths (53.4%) occurred in the hospital. During the last 6 months of life, a significantly lower proportion of women than men experienced emergency department visits (81.7% vs 86.5%; p<0.001); hospitalizations (75.6% vs 80.8%; p<0.001); intensive care unit (ICU) admissions (22.8% vs 30.1%; p<0.001); mechanical ventilation (15.5% vs 20.8%; p<0.001); cardiac catheterization (2.8% vs 4.6%; p<0.001); coronary revascularization (1.5% vs 2.6%; p<0.001); hemodialysis (4.8% vs 7.7%; p<0.001); or care from 10 or more different physicians (57.6% vs 67.1%; p<0.001). In the last 6 months of life, women spent fewer days than men in the hospital (mean 16.4 vs 18.3; mean difference [MD] 1.9 [95% confidence interval 1.7–2.0]; p<0.001), in an ICU (mean 2.1 vs 3.0; MD 0.9 [95% CI 0.8–0.9]; p<0.001), and on a ventilator (mean 1.4 vs 1.9; MD 0.5 [95% CI 0.5–0.5]; p<0.001). These differences persisted and remained significant in the last month of life. There was no difference in the proportion of women vs men receiving palliative care services (45.1% vs 45.0%; p=0.53) in the last 6 months of life. After adjusting for age, socioeconomic status, comorbidities, place of residence, and year of death, women had lower odds of dying in a hospital than men (adjusted odds ratio 0.88 [95% CI 0.87–0.89]).

Conclusion

In this large cohort study in Ontario, Canada, women with HF received disproportionately lower in-hospital and invasive care services than men in their last 6 months of life and were more likely than men to die at home.

Acknowledgement/Funding

Canadian Institutes of Health Research

[Clinical significance and cost-benefit analysis of serum calcitonin assay in diagnosis and treatment of medullary thyroid carcinoma]

Objective: To study the clinical significance of serum calcitonin in the diagnosis and treatment of medullary thyroid carcinoma and to analyze its cost-benefit. Methods: One hundred and forty one patients with medullary thyroid carcinoma who undertook calcitonin test and frozen pathological examination were enrolled in this study from Oct 2012 to Mar 2018. Using the method of χ(2) test, the positive rate of calcitonin test and frozen pathological examination in diagnosis of medullary thyroid carcinoma(MTC) were compared. Firstly, we compared the correct checkout cost of calcitonin test and that of frozen pathological examination (total number of patients×cost of examination/the correctly detected number of patients) . Secondly, we calculated whether calcitonin test help patients save money(average cost of treatment in hospital for MTC×number of patients who were evaluated to be candidate for surgery-cost of calcitonin test×total number of patients)/total number of patients. Results: 139 patients were positive in calcitonin test among 141 patients, and the positive rate was 98.58%. 91 patients were positive in frozen pathological examination, and the positive rate was 64.54% (χ(2)=97.821, P<0.000 1) . Cost-benefit analysis showed that the correct checkout cost of calcitonin test and frozen pathological examination were 71.01 yuan and 426.10 yuan, also,1 371 938.64 yuan could be saved totally and 9 730.06 yuan could be saved per patient because of calcitonin test. Conclusion: Serum calcitonin test had a significant effect on the diagnosis and treatment of medullary thyroid carcinoma and was economical and practical.

Magnolol inhibits Streptococcus suis-induced inflammation and ROS formation via TLR2/MAPK/NF-κB signaling in RAW264.7 cells

Our previous studies have shown that Magnolol (Mag) improves the symptoms and decreases the levels of cytokines during infection induced by Streptococcus suis (S. suis) in mice. Although some reports show that Mag inhibits lipopolysaccharide-induced inflammatory responses via downregulating mitogen-activated protein kinases (MAPK) and nuclear factor-κB (NF-κB) signaling pathways, the molecular mechanisms underlying Mag-mediated inhibition of S. suis-induced inflammatory responses are poorly understood. Here, RAW264.7 cells were stimulated with S. suis in the presence or absence of Mag. Cell viability and bactericidal effects were examined, and the concentrations of tumor necrosis factor-a (TNF-α), IL-1β (interleukin-1β), IL-6 (interleukin-6), and IL-8 (interleukin- 8) were determined by ELISA. The change in ROS (reactive oxygen species) was determined by fluorescence microscopy and ELISA. The levels of Toll-like receptor 2 (TLR2) and MAPK family proteins and NF-κB signaling were determined by Western blot analysis. S. suis induced massive RAW264.7 cell death, a decline in bactericidal activity, the release of inflammatory cytokines, increased oxidative stress, and activation of TLR2/MAPK/NF-κB signaling pathways. Mag treatment significantly suppressed macrophage cell death and caused a decline in bactericidal activity. Furthermore, Mag decreased inflammatory cytokines production and ROS generation. It also prevented p38, extracellular regulated protein kinases (ERK), c-Jun N-terminal kinase (JNK), inhibitor of NF-κB (IκB), and NF-κB phosphorylation induced by S. suis in a dose-dependent manner. Our results indicate that Mag exerts anti-inflammatory and cell-protective effects and mediates the activation of MAPK and NF-κB signaling by downregulating the expression of TLR2 upregulated by S. suis.

Co-loading antioxidant N-acetylcysteine attenuates cytotoxicity of iron oxide nanoparticles in hypoxia/reoxygenation cardiomyocytes

Purpose

Myocardial delivery of magnetic iron oxide nanoparticles (MNPs) might produce iron overload-induced myocardial injury, and the oxidative stress was regarded as the main mechanism. Therefore, we speculated antioxidant modification might be a reasonable strategy to mitigate the toxicity of MNPs.

Methods and results

Antioxidant N-acetylcysteine (NAC) was loaded into magnetic mesoporous silica coated Fe₃O₄ nanoparticles. Neonatal rat hypoxia/reoxygenation (H/R) cardiomyocytes were incubated with nanoparticles for 24 hrs. NAC can effectively mitigate iron-induced oxidative injury of cardiomyocytes, evidenced by reduced production of MDA, 8-iso-PGF2α, and 8-OHDG and maintained concentrations of SOD, CAT, GSH-Px, and GSH in ELISA and biochemical tests; downregulated expression of CHOP, GRP78, p62, and LC3-II proteins in Western Blot, and less cardiomyocytes apoptosis in flow cytometric analysis.

Conclusions

NAC modifying could suppress the toxic effects of Fe₃O₄ nanoparticles in H/R cardiomyocytes model in vitro, indicating a promising strategy to improve the safety of iron oxide nanoparticles.

Snail1-dependent cancer-associated fibroblasts induce epithelial-mesenchymal transition in lung cancer cells via exosomes

BACKGROUND

Epithelial-mesenchymal transition (EMT) is an essential component of metastasis. Our previous study demonstrated that cancer-associated fibroblasts (CAFs) induce EMT in lung cancer cells. In recent years, many studies have demonstrated that CAFs induce metastasis and drug resistance in cancer cells via exosomes.

AIM

We sought to discover the mechanism underlying how CAFs induce EMT in lung cancer cells, unveiling the role of exosomes in lung cancer progression.

DESIGN

We cultured lung cancer cell (i) with control medium, normal fibroblasts (NFs) or CAFs; (ii) with SNAI1-transfected or NC (negative control)-transfected CAFs; (iii) with exosomes extracted from NF- or CAF-conditioned medium; (iv) with exosomes released by SNAI1 or NC-transfected CAFs; (v) with CAF-conditioned medium or exosome-depleted CAF-conditioned medium.

METHODS

qRT-PCR was conducted to examine the expression of CDH1 (gene of E-cadherin) and VIM (gene of Vimentin), western blotting was conducted to examine E-cadherin and vimentin levels in lung cancer cells.

RESULTS

Exosomes released by CAFs-promoted EMT in lung cancer cells. Interestingly, SNAI1 levels in exosomes secreted from CAFs were correlated with SNAI1 expression in CAFs. Furthermore, the level of SNAI1 in exosomes was crucial for inducing EMT in lung cancer cells. Finally, treatment of CAFs with GW4869, an inhibitor of exosome release, noticeably inhibited their EMT-inducing effect on recipient epithelial cells.

CONCLUSIONS

The molecular mechanism underlying how CAFs induce EMT in cancer cells may be that CAFs deliver SNAI1 to recipient cancer cells via exosomes.

Multicentre evaluation of Erytra Eflexis®, a benchtop fully automated analyser with a compact design for routine use in blood transfusion laboratory

OBJECTIVES

Evaluation of the compact benchtop Erytra Eflexis® automated analyser was performed at three health centres representing a range of routine transfusion workload.

BACKGROUND

Automation instruments with the simplicity and flexibility adequate for small- to mid-sized blood transfusion services are an unmet need.

METHODS

Performance in pre-transfusion testing (2109 ABO/D, 382 Rh/K phenotype, 2001 antibody screening, 113 antibody identification, 151 DAT, 88 extended phenotype; 655 cross matching) in comparison to Erytra® as reference device was assessed. Throughput [time to first result (TTFR), final turn-around time (TAT), processing rate] was calculated; usability and adaptability in laboratory practice under routine and with emergency samples were surveyed.

RESULTS

Agreement between systems was 99·8% (11/5499 test discrepancies, all due to weak/doubtful positive reactions). Erytra Eflexis produced six true positives (two Rh/D, two B positives, two screening), four false positives (three screening and one cross matching) and one false negative (screening). Processing of eight routine samples with the Erytra Eflexis for ABO/Rh(D) and screening took 34-38 min and 32-37 min, respectively, independent of the simultaneous processing of a STAT sample, whether or not the incubator for STAT was reserved. In this scenario, a STAT sample requested within 2 min after the routine load was processed in 14-26 min. Processing rate tended to stabilise and optimise in the larger workloads, particularly in ABO/Rh(D)/K cards (16·7, 18 and 19·5 results/h for 10, 15 and 24 specimens, respectively).

CONCLUSION

Erytra Eflexis analyser was found to be reliable and suitable for pre-transfusion routine tests performed in a small-/medium-sized blood transfusion laboratory.

Are perioperative therapeutic doses of statins associated with postoperative pain and opioid consumption after hip surgery under spinal anaesthesia?

Background

The anti-inflammatory effects of statins have been suggested to relieve postoperative pain. This retrospective study tested the association between the perioperative routine use of statins in therapeutic doses, and opioid requirements and pain scores, after hip replacement surgery.

Methods

With IRB approval, data was obtained for adult patients who had elective hip replacement surgery under spinal anaesthesia at Cleveland Clinic between 2005 and 2015. Patients were compared using a joint hypothesis framework. We used the inverse probability of treatment weighting method to control for observed confounding factors (a total of 26).

Results

We included 611 statin users and 780 non-statin users. Pain score during the initial 72 h after surgery was 0.07 higher (95% CI: -0.02, 0.17) in statin users (noninferiority test in both directions P<0.001). The estimated ratio of geometric means in the cumulative i.v. morphine equivalent opioid consumption was 1.01 (95% CI: 0.93, 1.10) for statin vs non-statin users (noninferiority test P=0.001 in the hypothesized direction and<0.001 in the other direction) during the initial 72 h after surgery. The statin and non-statin patients were deemed equivalent on postoperative opioid consumption and pain score.

Conclusions

This is the first large retrospective clinical study that investigates the effects of statin use on postoperative pain and opioid consumption. We observed no difference between statin users and non-users during the initial 72 h after hip surgery. Our findings do not support the routine use of statins as part of an analgesic regimen.

[The role of the balance between Th17 and Treg in liver disease]

Naïve CD4+T cell differentiates into either Th17 or Treg in the microenvironment of various cytokines, among that, Th17 is induced by TGF-β and IL-6, while differentiates into Treg when there is only TGF-β. As the mainly transcription factors of Th17 and Treg respectively, RORγt and Foxp3 have important role in maintaining balance of Th17/Treg. Th17 and Treg are function antagonistically, so the balance of Th17/Treg means a lot for human body. Liver-a metabolic organof the body, it is susceptible to factors in vivo and in vitro. From basal hepatis to end-stage malignancy, common liver diseases are mainly including viral hepatitis, alcoholic liver disease, nonalcoholic fatty liver disease, autoimmune liver disease, hepatocellualr carcinoma and parasitic disease of liver, besides, the occurrence and development of all the diseases are correlated to the balance of Th17/Treg.

[Relationship between the suppressor of cytokine signaling 3 expression and antiviral efficacy of nucleos(t)ide and interferon alpha therapy for chronic hepatitis B]

Objective: To investigate the molecular mechanism of poor response of nucleoside and interferon therapy in some patients with chronic hepatitis B (CHB) and the negative regulatory factor of suppressor of cytokine signaling 3 (SOCS3) expression in the interferon-signaling pathway. Also, study the clinical relationship between SOCS3 and antiviral efficacy of nucleoside and interferon. Methods: Peripheral blood and matched liver tissue samples from 54 CHB patients who participated in the OSST study were selected. HBsAg was measured at different time points (baseline and weeks 12, 24, 36, and 48) to observe the antiviral efficacy. Meanwhile, quantitative real-time PCR, and immunohistochemistry were used to detect the expression levels of SOCS3 mRNA in peripheral blood mononuclear cells (PBMCs) and matched liver tissues (baseline and 48 weeks). At the end of the 48-week treatment, patients with HBsAg negative or HBeAg seroconversion were defined as response group, and vice versa. Paired t-tests were used to compare normal distribution variables and the Mann-Whitney U test was used to compare the median differences between groups of non-normally distributed variables. Results: After 48 weeks of treatment, serum HBsAg levels in the Peg-IFN group continued to decline (average decrease of 1.14 log(10) IU / ml at week 48; P = 0.001 compared with baseline), while the entecavir group remained almost unchanged during treatment (average decrease was 0.05 log(10) IU / ml at week 48; compared with baseline P = 0.12). The expression of SOCS3 mRNA (Messenger RNA, mRNA) in peripheral blood and liver tissues of non-responder group was significantly higher than the response group in the course of Peg-IFNα2a treatment. The immunohistochemical results of liver tissue showed that the expression of SOCS3 in the non-responder group was significantly higher than that in the response group at baseline (P = 0.027). After 48 weeks of treatment with Peg-IFNα2a, the expression of SOCS3 in the non-responder group was significantly higher than that in the baseline and response groups (P = 0.003, P = 0.012, respectively). Conclusion: The expression of SOCS3 in peripheral blood mononuclear cells and liver tissues of non-responding CHB patients was significantly higher than that of responding CHB patients during interferon and nucleoside antiviral therapy. We speculated that SOCS3 might affect the antiviral efficacy through negative regulation of JAK-STAT signaling pathway, and partly expose the mechanism of interferon resistance.