[Impact of VA-ECMO combined with IABP and timing on outcome of patients with acute myocardial infarction complicated with cardiogenic shock]

Objective: To investigate the impact of combined use and timing of arterial-venous extracorporeal membrane oxygenation (VA-ECMO) with intra-aortic balloon pump (IABP) on the prognosis of patients with acute myocardial infarction complicated with cardiogenic shock (AMICS). Methods: This was a prospective cohort study, patients with acute myocardial infarction and cardiogenic shock who received VA-ECMO support from the Heart Center of Lanzhou University First Hospital from March 2019 to March 2022 in the registration database of the Chinese Society for Extracorporeal Life Support were enrolled. According to combination with IABP and time point, patients were divided into VA-ECMO alone group, VA-ECMO+IABP concurrent group and VA-ECMO+IABP non-concurrent group. Data from 3 groups of patients were collected, including the demographic characteristics, risk factors, ECG and echocardiographic examination results, critical illness characteristics, coronary intervention results, VA-ECMO related parameters and complications were compared among the three groups. The primary clinical endpoint was all-cause death, and the safety indicators of mechanical circulatory support included a decrease in hemoglobin greater than 50 g/L, gastrointestinal bleeding, bacteremia, lower extremity ischemia, lower extremity thrombosis, acute kidney injury, pulmonary edema and stroke. Kaplan-Meier survival curves were used to analyze the survival outcomes of patients within 30 days of follow-up. Using VA-ECMO+IABP concurrent group as reference, multivariate Cox regression model was used to evaluate the effect of the combination of VA-ECMO+IABP at different time points on the prognosis of AMICS patients within 30 days. Results: The study included 68 AMICS patients who were supported by VA-ECMO, average age was (59.8±10.8) years, there were 12 female patients (17.6%), 19 cases were in VA-ECMO alone group, 34 cases in VA-ECMO+IABP concurrent group and 15 cases in VA-ECMO+IABP non-concurrent group. The success rate of ECMO weaning in the VA-ECMO+IABP concurrent group was significantly higher than that in the VA-ECMO alone group and the VA-ECMO+IABP non-concurrent group (all P<0.05). Compared with the ECMO+IABP non-concurrent group, the other two groups had shorter ECMO support time, lower rates of acute kidney injury complications (all P<0.05), and lower rates of pulmonary edema complications in the ECMO alone group (P<0.05). In-hospital survival rate was significantly higher in the VA-ECMO+IABP concurrent group (28 patients (82.4%)) than in the VA-ECMO alone group (9 patients) and VA-ECMO+IABP non-concurrent group (7 patients) (all P<0.05). The survival rate up to 30 days of follow-up was also significantly higher surviving patients within were in the ECMO+IABP concurrent group (26 cases) than in VA-ECMO alone group (9 patients) and VA-ECMO+IABP non-concurrent group (4 patients) (all P<0.05). Multivariate Cox regression analysis showed that compared with the concurrent use of VA-ECMO+IABP, the use of VA-ECMO alone and non-concurrent use of VA-ECMO+IABP were associated with increased 30-day mortality in AMICS patients (HR=2.801, P=0.036; HR=2.985, P=0.033, respectively). Conclusions: When VA-ECMO is indicated for AMICS patients, combined use with IABP at the same time can improve the ECMO weaning rate, in-hospital survival and survival at 30 days post discharge, and which does not increase additional complications.

MiRNA-206 suppresses the metastasis of osteosarcoma via targeting Notch3

To investigate the role of microRNA-206 (miRNA-206) in the malignant progression of osteosarcoma and the underlying mechanism, expression pattern of miRNA-206 in osteosarcoma tissues and cell lines was determined by quantitative real-time polymerase chain reaction (qRT-PCR). Correlation between miRNA-206 level and prognosis of osteosarcoma patients was analyzed. Regulatory effects of miRNA-206 on the proliferation and metastasis of U2OS and MG63 cells were evaluated by cell counting kit-8 (CCK-8), Transwell and wound healing assay. Through dual-luciferase reporter gene assay, the target gene of miRNA-206 was verified. A series of rescue experiments were conducted to explore the role of miRNA-206/Notch3 in regulating the malignant progression of osteosarcoma. MiRNA-206 was downregulated in osteosarcoma tissues and cell lines, and its level was correlated to poor prognosis and distant metastasis of osteosarcoma patients. Overexpression of miRNA-206 attenuated the proliferative and metastatic abilities of osteosarcoma cells, and miRNA-206 knockdown obtained the opposite trends. Notch3 was verified to be the target gene of miRNA-206, which was upregulated in osteosarcoma and accelerated osteosarcoma cells to proliferate and metastasize. Finally, rescue experiments showed that Notch3 overexpression partially reversed the regulatory effects of miRNA-206 on cellular behaviors of osteosarcoma cells. MiRNA-206 is downregulated in osteosarcoma. Overexpression of miRNA-206 accelerates osteosarcoma cells to proliferate and metastasize by targeting Notch3, thus accelerating the malignant progression of osteosarcoma.

Caveolin-1 improves lung injury in rats with chronic obstructive pulmonary disease partially through Wnt/β-catenin signaling pathway

The aim of this study was to explore the effects of Caveolin-1 on lung injury in rats with chronic obstructive pulmonary disease (COPD). The forced expiratory volume in 0.3 s/forced vital capacity (FEV0.3/ FVC) and peak expiratory flow (PEF) were determined. The total white blood cells (WBC), neutrophil ratio (NEUT%), mononuclear macrophage ratio (MNM%), lymphocyte ratio (LY%) and protein concentration in bronchoalveolar lavage fluid (BALF) were measured. Both FEV0.3/FVC and PEF significantly declined in the COPD group compared with those in the Control group, while they significantly rose in the IWR-1 group and Daidzin group compared with those in the COPD group. HE staining showed that there were alveolar dilatation and enlargement with obviously increased intercept in the COPD group, while there were basically no changes in the alveoli in the IWR-1 group and Daidzin group. Massive apoptosis of alveolar tissues was observed in COPD group, and there was only a little apoptosis in IWR-1 group and Daidzin group. In COPD group, WBC, NEUT% and protein concentration in BALF were obviously increased, MNM% was obviously decreased, and there was no obvious difference in LY% compared with those in the Control group. In the the IWR-1 group and Daidzin group, WBC, NEUT%, protein concentration, MNM% and LY% in BALF had no obvious differences compared with those in the Control group. In the IWR-1 group and Daidzin group, WBC, NEUT% and protein concentration evidently declined, MNM% evidently rose, and there was no obvious difference in LY% compared with those in the COPD group. Caveolin-1, Wnt-1 and β-catenin in lung tissues were remarkably higher in the COPD group than those in the Control group. Caveolin-1 was remarkably higher in the IWR-1 group than that in the Control group. And Wnt-1 and β-catenin were higher in the Daidzin group than those in the Control group. In addition, Wnt-1 and β-catenin in lung tissues markedly declined in the IWR-1 group compared with those in the COPD group. Caveolin-1, Wnt-1 and β-catenin in lung tissues also markedly declined in the Daidzin group compared with those in the COPD group. Caveolin-1 can improve lung injury in COPD rats through the Wnt/β-catenin signaling pathway.

[The effects and related risk factors on cataract surgery in Shandong province]

Objective: To explore the efficacy and related risk factors on cataract surgery in Shandong province. Methods: A total of 108 190 cataract surgeries which were reported from 17 cities of Shandong province during January 2013 to December were reviewed. The demographic information, preoperative examination, surgery related information (including date of surgery, surgical methods, and intraoperative complications), and postoperative situations (naked eye visual acuity, curative efficacy after three days, and postoperative complications) were reviewed. Wilcoxon signed-ranks, univariate and orderly multivariate Logistic regression analysis were used according to nature of the data. Results: There were 64 852 female patients (59.9 %) and 43 338 male patients (40.1%) in all 108 190 cases. About 36.5% patients (39 496 cases), the highest proportion, were 71 to 80 years of age, 31.26% patients (33 711 cases) were 61 to 70 years old and 13.6% patients (14 720 cases) were over 81 years old. Visual acuity increased significantly after surgery (Z=165.24, P<0.01). Simple factor Logistic regression analysis showed that preoperative corrected visual acuity less than 0.1 (OR=2.30 95%CI: 0.59 to 1.07), complications (OR=8.50,95% CI: 1.34 to 2.94), congenital cataract (OR=1.69, 95%CI: 0.22 to 0.83), extracapsular cataract extraction (OR=1.99, 95% CI:0.57 to 0.81), postoperative complications in three days (OR=7.46, 95% CI:1.77 to 2.25) were predictors of worse outcome after cataract surgery. Multivariate logistic regression analysis showed that the efficacy of cataract surgery were influenced by history of diabetes (OR=1.79, 95% CI: 0.46 to 0.71), history of hypertension (OR=3.49, 95% CI: 1.07-1.43), postoperative complications in three days (OR=3.91, 95% CI: 1.53 to 1.20) and extracapsular cataract extraction (OR=1.54, 95% CI: 0.20 to 0.66). Young male patients (OR=0.82, 95% CI:-0.28 to -0.12), normal preoperative intraocular pressure (OR=0.79, 95%CI: -0.38 to -0.10) and pupil (OR=0.42, 95% CI:-1.17 to -0.57) were predictors of better outcome. Conclusions: Visual acuity improved significantly after cataract surgery in Shandong province. The efficacy of cataract surgery was influenced by many factors. It is important to control systemic diseases and to choose modern operation method. (Chin J Ophthalmol, 2016, 52: 929-935).