Prognostic value of TCBI for short-term outcomes in ATAD patients undergoing surgery

OBJECTIVE

Nutritional status has been reported to be associated with the prognosis of cardiovascular diseases. The study aimed to investigate the prognostic value of Triglycerides-total Cholesterol-Body weight-Index (TCBI) for short-term mortality in acute type A aortic dissection (ATAD) patients undergoing surgery.

METHODS AND RESULTS

Totally, the data of 290 ATAD patients undergone surgery were, retrospectively, analyzed. After logistic regression analysis, TCBI was identified as an independent predictor of short-term mortality in ATAD surgery. The development of receive operating characteristic (ROC) curve demonstrated that TCBI (AUC = 0.745, P < 0.001) could provide well prognostic value for short-term mortality. Accordingly, the optimal cut-off value was identified as 883.5 and patients were divided into high TCBI (> 883.5) and low TCBI (≤ 883.5) groups. Furthermore, Kaplan-Meier analysis illustrated that short-term mortality increased significantly in the low TCBI group than in the high TCBI group (P < 0.0001). In addition, the incidence of postoperative renal failure was also elevated in the low TCBI group (P = 0.0011).

CONCLUSION

Malnutrition by preoperative TCBI presented strong prognostic value for patients following ATAD surgery. And TCBI could be applied for risk stratification and therapeutic strategy-making in ATAD.

Stem-cell therapy via gastroscopy improves the outcome of esophageal anastomotic leakage

Background

Esophageal anastomotic leakage (EAL) is a severe complication usually occurring after esophagectomy. Although there are various therapeutic methods for EAL treatment, they have not achieved satisfactory results. A previous study showed that the combination of mesenchymal stem cells (MSCs) and fibrin scaffold (FS) can treat EAL. This study aimed to evaluate the efficacy of the injection of MSCs and FS through a new engraftment gastroscope for EAL treatment.

Methods

Twelve adult pigs were randomly divided into the MSCs group (n = 6) and control group (n = 6). A stomach tube was then inserted through the leakage to construct the EAL model, which was removed after one week. The combination of MSCs and FS was autografted at the EAL site for pigs in the MSCs group using the tailor-made gastroscope while only FS was autografted for the pigs in the control group. Local status of EAL was evaluated using gastroscopy. Histological analyses and western blot (WB) were used to assess the gross specimens of esophagi around EALs.

Results

Gastroscopy showed a higher closure rate and a lower infection rate in the MSCs group than in the control group. However, the mortality was not significantly different between the two groups. HE staining showed a severe inflammatory response with dispersive infiltration of inflammatory cells and unhealed leakage in the control group. However, the infiltration of inflammatory cells was not altered in the MSCs group, and the leakage was completely healed. WB analyses showed that Myogenin and α-SMA expressions were significantly higher in the MSCs group than in the control group.

Conclusion

A porcine model of EAL was successfully developed by accessing the transplantation site through the esophagus. Further data revealed that the implantation of MSCs in FS via the novel engraftment gastroscope can promote the repair and occlusion of EAL. Therefore, the proposed method is a promising strategy for EAL treatment.

Calf Circumference and All-Cause Mortality: A Systematic Review and Meta-Analysis Based on Trend Estimation Approaches

OBJECTIVES

To perform a systematic review and meta-analysis and quantify the associations of total mortality with calf circumference (CC) in adults 18 years and older via combining various analyses based on empirical dichotomic CC, continuous CC, and dose-response CC.

METHODS

We conducted a systematic search of relevant studies in PubMed, EMBASE, Cochrane Library, and Web of Science published through April 12, 2022. This systematic review includes longitudinal observational studies reporting the relationships of total mortality with CC. We calculated the pooled relative risk (RR) and 95% confidence interval (CI) of total mortality with CC per 1 cm for each study and combined the values using standard meta-analysis approaches. Newcastle-Ottawa scale (NOS), Grading of Recommendations, Assessment, Development and Evaluations approach (GRADE), and the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) were assessed for meta-analyses.

RESULTS

Our analysis included a total of 37 cohort studies involving 62,736 participants, across which moderate heterogeneity was observed (I2=75.7%, P<0.001), but no publication bias was found. Study quality scores ranged from 6 to 9 (mean 7.7), with only three studies awarded a score of 6 (fair quality). We observed an inverse trend between total death risk and CC per 1 cm increase (RR, 0.95, 95% CI, 0.94-0.96; P<0.001; GRADE quality=high). Only a very slight difference was found among residents of nursing homes (6.9% mortality risk reduction per one cm CC increase), community-dwellers (5.4%), and those living in hospitals (4.8%), respectively (P for meta-regression=0.617). Low credible subgroup difference was found based on the ICEMAN tool.

CONCLUSIONS

Calf circumference is a valid anthropometric measure for mortality risk prediction in a community, nursing home, or hospital.

Stem-Cell Therapy for Esophageal Anastomotic Leakage by Autografting Stromal Cells in Fibrin Scaffold

Esophageal anastomotic leakage (EAL) is a devastating complication for esophagectomy but the available therapies are unsatisfactory. Due to the healing effects of mesenchymal stromal cells (MSCs) and supporting capability of fibrin scaffold (FS), we evaluated the efficacy of a stem-cell therapy for EAL by engrafting adult and autologous MSCs (AAMSCs) in FS and investigated the potential mechanism. Twenty-one rabbits were assigned to AAMSC/FS group (n = 12) and control group (n = 9). After harvested, AAMSCs were identified and then labeled with lenti.GFP. To construct EAL model, a polyethylene tube was indwelled through the anastomosis for 1 week. A total of 2 × 106 AAMSCs in 0.2 ml FS were engrafted onto the EAL for the AAMSC/FS group, whereas FS was injected for control. Magnetic Resonance Imaging (MRI) examination was performed after 5 weeks. Esophageal tissues were harvested for macroscopic, histological analyses, Western blot, and immunohistochemistry at 8 weeks. The animal model of EAL was established successfully. MRI scanning revealed a decreased inflammation reaction in AAMSC/FS group. Accordingly, AAMSC/FS group presented a higher closure rate (83.3% vs. 11.1%, p = .02) and lower infection rate (33.3% vs. 88.9%, p = .02). Histological analyses showed the autografted MSCs resided in the injection site. Furthermore, milder inflammation responses and less collagen deposition were observed in AAMSC/FS group. Western blot and immunohistochemistry studies suggested that the therapeutic effect might be related to the secretions of IL-10 and MMP-9. Engrafting AAMSCs in FS could be a promising therapeutic strategy for the treatment of EAL by suppressing inflammation response and alleviating fibrosis progression. Stem Cells Translational Medicine 2019;8:548-556.

The effect of energy restriction on fatty acid profiles of longissimus dorsi and tissue adipose depots in sheep

Sheep production systems in northwest China depend mostly on natural grasslands. Seasonal growth and maturity fluctuations can cause periodical restrictions in food quality and quantity. These fluctuations, in turn, result in variability in fat deposition and fatty acid profiles in different fat depots. Consequently, the study objective was to compare fat deposition, intramuscular fat (IMF) percentage and fatty acid profiles of the longissimus dorsi (LD), kidney fat (KF), tail fat (TF), and subcutaneous fat (SF) in lambs under ME restrictions similar to seasonal changes observed in the natural grasslands of northwest China. Nineteen male Dorper × Small Tailed Han lambs were assigned to 2 treatments, a control (CON) fed at 1.0 MJ / W × d and restricted (RES) by restricting ME sequentially every 30 d (0.56 MJ / W × d, 0.84 / W × d, 1.0 MJ / W × d, 0.84 MJ / W × d, 0.56 MJ / W × d, 0.28 MJ / W × d). All lambs were harvested at the end of the 180 d experimental period. Compared to CON fed lambs, restricting ME resulted in lesser IMF, fat deposition indexes ( < 0.05) except testicular and heart fat and greater ( < 0.05) SFA in LD, KF, and TF depots. The RES fed lambs had greater ( < 0.05) -3 PUFA, eicosatrienoic acid (C20:3n3), eicosapentaenoic acid (C20:5n3, EPA), and trans-linolelaidic acid (C18:2n6t) in LD muscle. The conjugated linoleic acids (CLA) content was greater in the SF depots of the CON fed lambs compared to the RES fed lambs. Fatty acid ratios (unsaturated fatty acid; USFA:SFA, MUFA:SFA, PUFA:SFA), and percentage USFA in RES fed lambs were lesser in muscle and adipose tissue compared to CON fed lambs ( < 0.05), except SF depots. In RES fed lambs, EFA were less ( < 0.05) in LD and KF depots and the ratios of functional fatty acids were lesser in LD and some adipose tissues ( < 0.05), including lesser n-6:n-3 in KF and SF ( < 0.05) depots, lesser USFA, SFA, MUFA, SFA in LD, KF, and TF ( < 0.05) depots, and lesser PUFA and SFA in LD and TF ( < 0.05) depots. Results from this research demonstrate that sequential energy restriction, as might be experience during seasonal forage quality and quantity changes in natural grasslands, result in lesser intramuscular fat with associated lesser quality, as well as, changes in fatty acid composition in different fat depots, which has implications for both meat quality and animal physiological functions.

Development of small intestinal enzyme activities and their relationship with some gut regulatory peptides in grazing sheep

Growth depends on an animal's capacity to digest and assimilate ingested nutrients, and insufficient supply and impairment will constrain lamb growth. Eight groups of Alpine Finewool lambs were harvested on 0, 3, 7, 14, 21, 28, 42, and 56 d to measure pH and enzymatic activities in the duodenum, proximal jejunum, middle jejunum, distal jejunum, and ileum mucosa or digesta. From the duodenum to the ileum the pH of intestinal mucosa and digesta increased, whereas pH changed very little with age. The trypsin, chymotrypsin, lipase, lactase, and α-amylase activities observed at birth decreased by d 3, followed by a nonuniform enzymatic response in the small intestine. The trypsin activity increased from d 3 to peak, at d 21, followed by a decline. Chymotrypsin activity followed the same general trend but with smaller responses in activities. Trypsin demonstrated greater enzymatic activity than chymotrypsin at the same age. The lipase activity of small intestinal mucosa and digesta changed little with age. The lactase activity was high at birth, decreased by d 3, and then increased, followed by a decrease as lambs approached weaning. α-Amylase activity was similar in the small intestinal mucosa and digesta at birth but increased with age for the duodenum and proximal jejunum. Plasma concentrations of cholecystokinin (CCK), secretin, and gastrin were positively correlated ( < 0.05) with ileal mucosa lipase activity. Plasma concentration of CCK, secretin, gastrin, and gastric inhibitory polypeptide (GIP) were positively correlated ( < 0.05) with ileal mucosa lactase activity. Plasma concentration of pancreatic polypeptide (PP) was negatively correlated ( < 0.05) with lactase activity in the middle jejunum and ileal mucosa. Plasma concentrations of CCK, secretin, gastrin, and GIP were positively correlated ( < 0.05) with α-amylase activity in the ileal mucosa but negatively correlated ( < 0.05) with duodenum, prejejunum, and middle jejunum. Plasma PP concentrations were positively correlated ( < 0.01) with α-amylase activity of duodenum, middle jejunum, and postjejunum mucosa but not with the enzyme activity of postjejunum and ileal mucosa ( > 0.05). Small intestinal enzymatic activities exist and may be sufficient to enhance lamb growth via appropriate nutrient supplementation.

Developmental changes in fatty acid-binding protein (H-FABP) mRNA expression and intramuscular fat (IMF) content in Oula sheep

Increasing meat consumption by Chinese people has created a focus for improving meat quality for increasing quality of life. Twenty-five Male Oula sheep were selected at 2, 21, 56, 84, and 112 d to investigate the developmental changes associated with age on the intramuscular fat (IMF) content of heart fatty acid-binding protein (H-FABP) mRNA expression in muscle. Longissimus dorsal muscle and biceps femoris muscle were sampled to measure IMF concentrations and total mRNA was extracted to measure H-FABP mRNA expression using real-time polymerase chain reaction (PCR). Growing male Oula sheep demonstrated that the IMF concentrations continuously increased with age and significant differences (P < 0.05) were detected among the age groups; 2. The IMF concentrations among tissues were different; 3. The development changes in H-FABP mRNA expression in longissimus dorsal muscle and biceps femoris muscle were similar with a decrease from 2 to 21 d, followed by continuously increasing concentrations being significant different (P < 0.05) among age groups; 4. The H-FABP mRNA expression in the longissimus dorsal muscle tissue was significantly (P < 0.05) higher compared to the biceps femoris muscle; 5. The muscle H-FABP mRNA expression concentration was positively correlated with IMF concentrations from d 21 to 112; 6. The correlation coefficients were significantly (P < 0.01)different between H-FABP gene mRNA expression in the longissimus dorsal muscle and IMF concentration of 0.815 compared to the biceps femoris muscle and IMF concentration of 0.787,which indicated that the H-FABP gene may be affecting the IMF concentrations in the early developmental stages of Oula sheep. These results support the hypothesis that H-FABP gene and its expression in muscle tissue is related to the IMF concentration of meat.

In Vivo Self-Powered Wireless Cardiac Monitoring via Implantable Triboelectric Nanogenerator

Harvesting biomechanical energy in vivo is an important route in obtaining sustainable electric energy for powering implantable medical devices. Here, we demonstrate an innovative implantable triboelectric nanogenerator (iTENG) for in vivo biomechanical energy harvesting. Driven by the heartbeat of adult swine, the output voltage and the corresponding current were improved by factors of 3.5 and 25, respectively, compared with the reported in vivo output performance of biomechanical energy conversion devices. In addition, the in vivo evaluation of the iTENG was demonstrated for over 72 h of implantation, during which the iTENG generated electricity continuously in the active animal. Due to its excellent in vivo performance, a self-powered wireless transmission system was fabricated for real-time wireless cardiac monitoring. Given its outstanding in vivo output and stability, iTENG can be applied not only to power implantable medical devices but also possibly to fabricate a self-powered, wireless healthcare monitoring system.

[Autografting mesenchymal stem cells with fibrin sealant for the therapy of esophageal anastomotic fistula]

OBJECTIVE

To investigate the efficacy of MSCs autografting with fibrin sealant could for the closure of cervical anastomotic fistula.

METHODS

Twenty-one healthy New Zealand rabbits were involved and randomly assigned to treatment group (n = 12) or control group (n = 9). After the bone marrow were aspirated, the MSCs were isolated, purified and labelled by transfection of Lenti. GFP. The rabbit models of cervical esophageal anastomotic fistula were established by leaving a caliber rubber tube inside esophageal lumen. One week later, a 0.2 ml FS with 2 x 10(6) GFP+ MSCs was employed to close the fistula for each animal in the treatment group, while the same procedure was performed without MSCs in the control group. MRI examination was performed to evaluate the closure of fistula after 5 weeks. All animals were killed and the esophageal tissues were collected 7 weeks later. Histology and immunohistochemistry study were performed.

RESULTS

The rabbit models of cervical anastomotic fistula were successfully established. There was no significant difference of fisutla caliber between both groups ( (2.30 ± 0.15) mm vs (2.20 ± 0.17) mm, P < 0.05), MRI exam revealed that there was only inflammation sign in the treatment group, by contrast, most of the rabbits were showed purulent infection sign which induced by persistent fistula in the control group. At the end of the study, the mortality of the treatment group and the control group were 3/12 and 5/9 (P = 0.20). However, the closure rates of the fistula were 10/12 and 1/9, respectively, with significant difference between two groups (P = 0.02). Histological study indicated that there was mild inflammation response and less collagen deposition for treatment group, compared to control group. Immunohistochemistry study further demonstrated that the autografted MSCs colonized to the fistula and differentiated into myofibroblasts.

CONCLUSION

Auto-transplantation of MSCs and FS can increase the closure rate of the cervical anastomotic fistula through the mechanisms of immunomodulatory, extracellular matrix reconstruction and anti-immigration effect of FS.

The Impact of Short or Long Transcatheter Occluder Waist Lengths on Postprocedure Complete Atrioventricular Block: A Retrospective Study

BACKGROUND

Complete atrioventricular block (cAVB) is considered the most serious adverse event after transcatheter closure of ventricular septal defect (VSD).

OBJECTIVES

To evaluate the incidence of postprocedure cAVB and its relationship with different waist lengths of transcatheter occluders.

METHODS

This is a retrospective study of patients with VSD who had been treated with transcatheter closure at the Shanghai Changhai Hospital from December 2001 to December 2010. Patients were treated with short-waist (n = 234) or long-waist occluders (n = 571). All patients were monitored by electrocardiogram (ECG) within 7 days post procedure.

RESULTS

Nine patients (3.8%) treated with short-waist occluders suffered from cAVB and 3 patients (1.3%) required permanent pacemaker implantation, compared with 4 patients (0.7%) and 1 patient (0.2%), respectively, in the long-waist occluder group (P<.001). There was a significantly higher incidence of postprocedure incomplete right bundle branch block (IRBBB) in patients treated with short-waist occluders compared with patients treated with long-waist occluders. There were no significant differences in other procedure-related complications between the two groups.

CONCLUSIONS

Long-waist VSD occluders are beneficial in the prevention of cAVB and the need for pacemaker implantation after transcatheter closure of VSD.

Genetic variation of 5 SNPs of MC1R gene in Chinese indigenous sheep breeds

The purpose of this study was to assess genetic diversity, genetic differentiation.relationship and population structure among 10 Chinese sheep populations using 5 single nucleotide polymorphisms (SNPs). in MC1R gene. The genetic diversity indices suggested that the intra-population variation levels of Chinese Merino and Large-tailed Han,breeds were lowest than Kazakh Fat-Rumped. Chinese sheep breeds have maintained a high intra-population variation levels (95.23%). The genetic differentiation patterns and genetic relationships among Chinese sheep breeds displayed a high consistency with the traditional classification. The cluster trees were constructed by UPMGA method. The results showed that Chinese indigenous sheep populations have distinct genetic differentiation. The inter-population variation levels in Chinese sheep populations indicated three geographically independent domestication events have occurred. The Bayesian cluster analyses also showed a reliable clustering pattern, which revealed three major clusters in.Chinese indigenous sheep populations (Mongolian group, Kazakh group and Tibetan group), except for Duolang and Minxian Black-fur. There were probably caused by different breeding history, geography isolation and different levels of inbreeding. The findings supported the related records in literature, ten sheep populations originated on different time stage from the primogenitor population and communicated genetically with each other in the process of natural and artificial selection, and in different ecological environment. It is concluded that Chinese indigenous sheep have higher genetic variation and diversity, genetic differentiation exist between Chinese sheep populations. The majority breeds are consistent with the geographical distribution and breed characteristic.

Analysis of geographic and pairwise distances among sheep populations

This study investigated geographic and pairwise distances among seven Chinese local and four introduced sheep populations via analysis of 26 microsatellite DNA markers. Genetic polymorphism was rich, and the following was discovered: 348 alleles in total were detected, the average allele number was 13.38, the polymorphism information content (PIC) of loci ranged from 0.717 to 0.788, the number of effective alleles ranged from 7.046 to 7.489, and the observed heterozygosity ranged from 0.700 to 0.768 for the practical sample, and from 0.712 to 0.794 for expected heterozygosity. The Wright's F-statistic of subpopulations within the total (FST) was 0.128, the genetic differentiation coefficient (GST) was 0.115, and the average gene flow (Nm) was 1.703. The phylogenetic trees based on the neighbor-joining method by Nei's genetic distance (DA) and Nei's standard genetic distance (DS) were similar. Sheep populations clustered into group 1 (Ta, M, L, H, O, G, and Q breeds) and group 2 (PD, WS, B, and T breeds). These results will have an important value applied and directive significance for sheep breeding in the future.

Combination of cetuximab and rapamycin enhances the therapeutic efficacy in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most deadly cancers worldwide. It is well known that the activation of PI3K/AKT/mTOR and the Ras/MAPK signaling pathway plays a critical role in cellular metabolism, growth and proliferation, and its inhibitors have been used as therapeutic drugs for hepatocellular carcinoma. Cetuximab, a chimerical monoclonal EGFR IgG1 antibody, can block the binding of EGF or other ligands to EGFR and thus inhibit ligands-induced receptor phosphorylation. In the present study, we found that rapamycin could enhance the antiproliferation effect of cetuximab in both HepG2 cells and Huh-7 cells and arrest the cell cycle. Cetuximab in combination with rapamycin had synergistic effects on inhibiting the phosphrylation of proteins in PI3K/AKT/mTOR and Ras/MAPK signaling pathway. Combination of cetuximab with rapamycin treatment significantly suppressed the HCC development in HepG2 cells-xenografted mice and improved the survival. Cetuximab and rapamycin inhibited the growth of HCC both in vitro and in vivo. These results suggest that the combination therapy using the inhibitors for both EGFR and PI3K/AKT/mTOR signaling pathways may be a novel therapeutic approach for HCC.

Acute type A dissection without intimal tear in arch: proximal or extensive repair?

OBJECTIVE

For acute type A dissection without an intimal tear in the arch, the optimal surgical strategy is unknown. The present study was designed to clarify the issue by comparing the early and late outcomes of proximal (PR) and extensive repair (ER).

METHODS

From January 2002 to June 2010, 331 patients with acute type A dissection were treated surgically at our institute. Of these 331 patients, 197 were identified without an arch tear on the preoperative imaging examination and by intraoperative inspection. Of these 197 patients, 74 underwent proximal repair, including the aortic root, ascending aortic, or hemiarch repair, and 88 underwent extensive repair, including proximal repair, total arch replacement and a stented elephant trunk technique. The perioperative variables and late results were statistically analyzed.

RESULTS

No significant difference was found in the rates of early mortality and morbidity between the 2 groups, despite the shorter duration of circulatory arrest in the PR group. During long-term follow-up (mean, 55.7 ± 33.1 months; maximum, 129), the overall survival rate in the whole cohort was 100%, 90.8%, and 71.1% at 1, 5, and 8 years, respectively. No difference was found in survival between the 2 groups (P > .05). However, complete thrombosis of the false lumen in the proximal descending aorta was achieved in 100% of the ER group and 24.6% of the PR group (P < .001). For patients with a patent false lumen in the PR group, distal anastomosis leakage and unclosed small intimal tears were identified in 53.3% and 35.6% patients, respectively. The reintervention rate was also lower in the ER group than in the PR group (4.9% vs 15.9%, P < .05) during follow-up. Moreover, the reintervention rate for patients with Marfan syndrome was 9.5% in the ER group and 38.5% in the PR group (P < .05).

CONCLUSIONS

For patients with acute type A dissection without an intimal tear in the arch, extensive repair could promote the occlusion of distal false lumen and decrease the reintervention rate without increasing the operative risk.

Meta-analysis of RAGE gene polymorphism and coronary heart disease risk

Background

Recent data from human and animal studies have shown an upregulated expression of advanced glycosylation end product–specific receptor (RAGE) in human atherosclerotic plaques 1 and in retina, messangial, and aortic vessels, suggesting an important role of RAGE in the pathogenesis of atherothrombotic diseases. In the past few years, the relationship between RAGE polymorphisms (−429T/C, −374T/A, and G82S) and coronary heart disease (CHD) has been reported in various ethnic groups; however, these studies have yielded contradictory results.

Methods

PubMed, ISI web of science, EMBASE and the Chinese National Knowledge Infrastructure databases were systematically searched to identify relevant studies. Data were abstracted independently by two reviewers. A meta-analysis was performed to examine the association between RAGE polymorphisms and susceptibility to CHD. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.

Results

A total of 17 studies including 4343 patients and 5402 controls were involved in this meta-analysis. Overall, no significant results were observed for −429T/C (OR  = 1.01, 95% CI: 0.92–1.12, P  = 0.78), −374T/A (OR  = 1.11, 95% CI: 0.98–1.26, P  = 0.09) and G82S (OR  = 1.12, 95% CI: 0.86–1.45, P  = 0.41) polymorphism. In the stratified analyses according to ethnicity, sample size, CHD endpoint and Hardy-Weinberg status, no evidence of any gene-disease association was obtained.

Conclusions

This meta-analysis demonstrates that there is no association between the RAGE −429T/C, −374T/A and G82S polymorphisms and CHD.

Quantitative assessment of the influence of paraoxonase 1 activity and coronary heart disease risk

Human paraoxonase 1 (PON1) is a calcium-dependent high-density lipoprotein associated ester hydrolase that has attracted considerable attention as a candidate factor for coronary heart disease (CHD) based on its function as a key factor in lipoprotein catabolism pathways. This meta-analysis aimed to clarify the inconsistency of published studies and to establish a comprehensive picture of the relationship between PON1 activity and CHD susceptibility. A systematic search was performed from PubMed, Web of Science, EMBASE, and CNKI databases. Ratio of means (RoM) between case and control and 95% confidence intervals (CIs) were calculated using a random-effects model. The source of heterogeneity was explored by subgroup analysis and meta-regression. We identified 47 eligible studies including a total of 9853 CHD cases and 11,408 controls. The pooled analysis showed that CHD patients had a 19% lower PON1 activity than did the controls (RoM=0.81; 95% CI: 0.74-0.89, p<10(-5)). In the subgroup analyses by CHD end points, a similar effect size was observed with coronary stenosis and myocardial infarction subgroups, with corresponding RoM of 0.81 (95% CI: 0.73-0.89, p<10(-4)) and 0.83 (95% CI: 0.74-0.93, p=0.001), respectively. Decreased PON1 activity associated with CHD risk was observed in almost all subgroup analysis according to ethnicity, sample size, study design, mean age of cases, source, and type of control. Decreased PON1 activity may act as a risk factor for the development of CHD. Progressive decrease in serum PON1 activity may exist for an individual with severe disease. However, larger studies using a prospective approach are needed to confirm our results.

Valve repair with autologous pericardium for organic lesions in rheumatic tricuspid valve disease

BACKGROUND

Surgical repair of pathologic tricuspid valve disease often fails because of severe anatomic distortion of the valve apparatus, particularly in patients with rheumatic heart disease. This usually leads to tricuspid valve replacement despite the associated prosthesis-related complications. This study examines our experience of tricuspid valve repair with autologous pericardium for organic rheumatic tricuspid valve disease.

METHODS

From 1996 to 2007, 31 patients underwent repairs for rheumatic tricuspid valve disease characterized by retracted leaflets and inadequate leaflet area. The patients, aged 14 to 56 years, had a mean New York Heart Association (NYHA) class of 2.9 +/- 0.6. All patients presented with severe tricuspid regurgitation and coexisting left-sided heart valve disease. Glutaraldehyde-treated autologous pericardial patch was used to augment tricuspid valve leaflets. Other techniques were applied as needed, including commissurotomy, leaflet mobilization, annuloplasty, and prosthetic ring implantation. Concomitant operations included left-sided valve replacement in all, and left atrial thrombus removal in 3 patients. Follow-up duration was 4 to 126 months.

RESULTS

No deaths or late reoperations occurred. All patients demonstrated clinical improvements on follow-up. Echocardiographic studies before hospital discharge showed less than mild tricuspid regurgitation in all patients. The most recent echocardiographic follow-up showed no tricuspid regurgitation in 10 patients (32.3%), trivial regurgitation in 12 (38.7%), mild regurgitation in 8 (25.8%), and moderate regurgitation in 1 (3.2%).

CONCLUSIONS

In selected patients, organic rheumatic tricuspid valve disease can be treated with pericardial patch to augment the retracted leaflets in combination with other techniques. Follow-up reveals excellent tricuspid valve function.

Preparation and characterization of bio-diesels from various bio-oils

Methyl, ethyl, 2-propyl and butyl esters were prepared from canola and linseed oils through transesterification using KOH and/ or sodium alkoxides as catalysts. In addition, methyl and ethyl esters were prepared from rapeseed and sunflower oils using the same catalysts. Chemical composition of the esters was determined by HPLC for the class of lipids and by GC for fatty acid compositions. The bio-diesel esters were characterized for their physical and fuel properties including density, viscosity, iodine value, acid value, cloud point, pure point, gross heat of combustion and volatility. Methyl and ethyl esters prepared from a particular vegetable oil had similar viscosities, cloud points and pour points, whereas methyl, ethyl, 2-propyl and butyl esters derived from a particular vegetable oil had similar gross heating values. However, their densities, which were 2 7% higher than those of diesel fuels, statistically decreased in the order of methyl approximately 2-propyl > ethyl > butyl esters. Butyl esters showed reduced cloud points (-6 degrees C to -10 degrees C) and pour points (-13 degrees C to -16 degrees C) similar to those of summer diesel fuel having cloud and pour points of -8 degrees C and -15 degrees C, respectively. The viscosities of bio-diesels (3.3-7.6 x 10(-4) Pa s at 40 degrees C) were much less than those of pure oils (22.4-45.1 x 10(-4) Pa s at 40 degrees C) and were twice those of summer and winter diesel fuels (3.50 and 1.72 x 10(-4) Pa s at 40 degrees C), and their gross heat contents of approximately 40 MJ/kg were 11% less than those of diesel fuels (approximately 45 MJ/kg). For different esters from the same vegetable oil, methyl esters were the most volatile, and the volatility decreased as the alkyl group grew bulkier. However, the bio-diesels were considerably less volatile than the conventional diesel fuels.

[Effects of semen Ziziphis Spinosae oil and Ziziphis Spinosae extract on the decrease of serum lipoprotein and inhibiton of platelet aggregation]

Our experiments have shown that oral administration of Semen Ziziphis Spinosae oil(SZSO) or Ziziphis Spinosae extract (ZSE) given to quails for 53 days can significantly reduce their TC, LDL and TG and markedly subdue the fatty degeneration in their livers. Also, SZSO pressed into the stomach of rats for five days can conspicuously inhibit their platelet aggregation, while ZSE cannot.

[Experimental research of the effect of polysaccharides in semen Ziziphis Spinosae and Ziziphis Spinosae on enhancing the immune function of mice injured by radiation]

This article surveys the pharmacological effect of the polysaccharides in Semen Ziziphis Spinosae and Ziziphis Spinosae. The result shows that oral administration of this polysaccharide (0.1g/kg/d) can strengthen the immune function of cells nd body fluids and to a certain extent protect mice from radioactive injuries.