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To investigate the risk factors for postoperative hepatic dysfunction (HD) in patients undergoing acute Stanford type A aortic dissection (ATAAD) surgery and to develop an individualized prediction model. We retrospectively analyzed cardiac surgery patients with ATAAD treated at our hospital from January 2020 to March 2024, dividing them into 7:3 training and validation cohorts and grouping them into HD and non-HD categories based on postoperative liver function. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were used to identify independent predictive factors for postoperative HD, which formed the basis of a nomogram prediction model. We assessed model accuracy, calibration and clinical utility using C-statistics, calibration plots and decision curve analysis (DCA) curves. Internal validation with 1000 Bootstrap resamples was performed to reduce overfitting bias. LASSO and multivariate logistic regression identified key risk factors for HD in ATAAD patients, including chronic kidney disease, preoperative creatinine, international normalized ratio (INR), red blood cell (RBC) transfusion volume, peak intraoperative lactate, aortic cross-clamping time greater than 99 min, and reoperation. Based on these factors, a nomogram prediction model was successfully developed. The Hosmer–Leme show test yielded a p value of 0.952, indicating a good model fit. The area under the curve (AUC) values in the training and validation cohorts were 0.856 (95% CI 0.777–0.936) and 0.958 (95% CI 0.915–1) respectively, indicating good discriminatory power. The calibration curve shows that the bias corrected line is close to the ideal line. The DCA curve indicates that the use of the nomogram provides greater net clinical benefit. The AUC values before and after Bootstrap validation were 0.860 (95% CI 0.795–0.924) and 0.858 (95% CI 0.795–0.924), respectively, reflecting stable model performance and minimal risk of overfitting. The internally validated prognostic nomogram demonstrates excellent discriminative power, calibration, and clinical utility for predicting the risk of HD in patients who have undergone ATAAD surgery. This allows for an individualized evaluation and the optimization of clinical outcomes.

Background Aortic aneurysms (AA) pose a significant risk to women of childbearing age due to the added physiological stress of pregnancy and hormonal changes. This study aims to assess the global disease burden of AA among women of childbearing age from 1990 to 2021, project future trends, and provide evidence-based insights to inform public health policies and clinical decision-making. Methods Aortic aneurysm mortality and disability-adjusted life years (DALYs) data for women of childbearing age (15–49 years) from 1990 to 2021 were extracted from the 2021 Global Burden of Disease (GBD) dataset. Temporal trends and attributable risks were evaluated using estimated annual percentage change (EAPC) and linear regression model from 1990 to 2021. Cluster analysis identified patterns across GBD regions. The Socio-demographic Index (SDI) assessed regional and national differences in mortality and DALYs rates related to AA. In addition, all potential risk determinants associated with AA were systematically examined. An age-period-cohort model assessed trends, period, and cohort effects, while the Bayesian age-period-cohort model predicted the disease burden through 2036. Results In 2021, AA was associated with 2,552 (95% UI: 2,273 to 2,827) mortality and 86,466 (95% UI: 72,510 to 115,049) DALYs counts worldwide among women of childbearing age. The age-standardized mortality rate (ASMR) and age-standardized DALYs rate for AA decreased from 1.58 (95% UI: 1.41 to 1.76) to 1.28 (95% UI: 1.10 to 1.42), and from 28.52 (95% UI: 25.56 to 32.53) to 23.01 (95% UI: 20.49 to 25.27), respectively, between 1990 and 2021. By SDI quintile, the EAPC for both mortality and DALYs increased in the low-middle and middle SDI regions. Using the average age, period, and cohort as reference groups, the risk of AA death increased with age [RR age (15−19)  = 0.026 to RR age (45−49)  = 0.384]. The risk of DALYs followed a similar age-related trend. Among the risk factors associated with AA, mortality counts and DALYs attributable to smoking declined over time, whereas those related to high systolic blood pressure and high body mass index (BMI) showed increasing trends. Predicted results indicate that mortality and DALY rates among women of childbearing age are expected to continue declining from 2022 to 2036. Conclusions Although the global burden of AA among women of childbearing age is decreasing, significant regional disparities persist, and the rising prevalence of hypertension and high BMI poses ongoing challenges. Strengthened prevention strategies targeting modifiable risk factors are urgently needed to further reduce disease burden and promote health equity. Graphical Abstract

Cardiovascular diseases are the leading cause of death globally, among which acute myocardial infarction (AMI) frequently occurs in the heart and proceeds from myocardium ischemia and endoplasmic reticulum (ER) stress-induced cell death. Numerous studies on miRNAs indicated their potential as diagnostic biomarkers and treatment targets for heart diseases. Our study investigated the role of miR-17-5p and its regulatory mechanisms during AMI. Echocardiography, MTT, flow cytometry assay, evaluation of caspase-3 and lactate dehydrogenase (LDH) activity were conducted to assess cell viability, apoptosis in an MI/R mice model, and an H₂O₂-induced H9c2 hypoxia cell model, respectively. The expression levels of ER stress responserelated biomarkers were detected using qRT-PCR, IHC, and western blotting assays. The binding site of miR-17-5p on Tsg101 mRNA was determined by bioinformatic prediction and luciferase reporter assay. The expression levels of miR-17-5p were notably elevated in MI/R mice and hypoxia cell models, accompanied by enhanced cell apoptosis. Inhibition of miR-17-5p led to decreased apoptosis related to ER stress response in the hypoxia model, which could be counteracted by knockdown of Tsg101 (tumor susceptibility gene 101). Transfection with miR-17-5p mimics downregulated the expression of Tsg101 in H9c2 cells. Luciferase assay demonstrated the binding between miR-17-5p and Tsg101. Moreover, 4-PBA, the inhibitor of the ER stress response, abolished shTsg101 elevated apoptosis in hypoxic H9c2 cells. Our findings investigated the pro-apoptotic role of miR-17-5p during MI/R, disclosed the specific mechanism of miR-17-5p/Tsg101 regulatory axis in ER stress-induced myocardium injury and cardiomyocytes apoptosis, and presented a promising diagnostic biomarker and potential target for therapy of AMI.

Background Dysregulated miRNAs are involved in carcinogenesis of the breast and may be used as prognostic biomarkers and therapeutic targets during the cancer process. The purpose of this study was to explore the effect of miR-105-3p on the tumourigenicity of breast cancer and its underlying molecular mechanisms. Methods Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was applied to detect the expression of miR-105-3p in breast cancer tissues and cell lines. The impacts of miR-105-3p on the proliferation, migration, invasion and apoptosis of human breast cancer cells (MCF-7 and ZR-75-30) were evaluated by CCK-8 assays, Transwell chamber assays, TUNEL assays and western blot analyses. In addition, bioinformatics and luciferase reporter assays were used to determine the target genes of miR-105-3p. Results The expression of miR-105-3p was elevated in breast cancer tissues and increased with tumour severity. Downregulation of miR-105-3p could inhibit cell proliferation, suppress cell migration/invasion, and promote cell apoptosis in MCF-7 and ZR-75-30 cells. Furthermore, Golgi integral membrane protein 4 (GOLIM4) was identified as the direct target gene of miR-105-3p by bioinformatics and luciferase reporter assays. In addition, silencing GOLIM4 restored the anti-breast cancer effects induced by miR-105-3p downregulation. Conclusions MiR-105-3p acts as an oncogene to promote the proliferation and metastasis of breast cancer cells by targeting GOLIM4, which provides a new target for the prevention and treatment of breast cancer.

The joint governance of transboundary river pollution is an important means to resolve disputes between upstream and downstream, to achieve regional coordinated development and water environment governance. In this paper, dissolved oxygen, chemical oxygen demand and ammonia nitrogen are used to measure water quality. Regarding the joint governance of transboundary water pollution as a quasi-natural experiment, this paper employs a difference-in-differences model of causal judgment to assess the effect of the policy on transboundary water quality based on the water quality monitoring week data from 2004 to 2016 in China. The results show that compared with non-trans-provincial rivers, the joint governance of water pollution at the provincial boundary could significantly promote the rise of dissolved oxygen, while reducing the chemical oxygen demand and ammonia nitrogen emissions. Additionally, the long-term dynamics based on the dynamic trend suggests that the implementation of this policy has fluctuations in the improvement of dissolved oxygen, but has a strong continuous effect on the reduction of chemical oxygen demand and ammonia nitrogen. These results stand up to robustness tests. Moreover, the green promotion pressure of officials and stakeholder supervision are important influence mechanisms of transboundary joint pollution control on improving transboundary water quality. An important implication is to provide a long-term way for collaborative water pollution control and solving transboundary water pollution disputes.

The impact of the digital economy is increasing, and its environmental effect has attracted more and more attention. The digital economy promotes the improvement of production efficiency and the government’s environmental governance capacity, and contributes to the reduction of urban carbon emission intensity. In order to study the impact of digital economy development on urban carbon emission intensity, this paper analyzes the theoretical basis of the digital economy on the reduction of carbon emission intensity, and then, based on the panel data of cities from 2011 to 2019, uses the two-way fixed effect model for empirical testing. The regression results show that the development of the digital economy has promoted the reduction of carbon emission intensity of cities, promoted the green transformation and upgrading of cities, and lays a foundation for China to achieve carbon peaking and carbon neutralization through the improvement of human capital investment and green innovation level. The basic conclusion is robust by changing core explanatory variables, changing samples, replacing regression methods, and shrinking and truncating tests. The impact of the digital economy on urban carbon emission intensity varies with the location, grade and size of the city. Specifically, the development of the digital economy in cities in the eastern and central regions, cities at or above the sub provincial level, large cities and non-resource-based cities has promoted the reduction of urban carbon emission intensity. In terms of resource-based cities, the development of the digital economy in renewable resource-based cities and resource-based cities dominated by iron ore and oil mining has promoted the decline in urban carbon emission reduction intensity.

To summarize the effect of mild hypothermia on function of the organs in patients with multiple organ dysfunction syndrome after cardiopulmonary bypass surgery. The patients were randomly divided into two groups, northermia group (n=71) and hypothermia group (n=89). We immediately began cooling the hypothermia group when test results showed multiple organ dysfunction syndrome, meanwhile all patients of two groups were drawn blood to test blood gas, liver and kidney function, blood coagulation function, and evaluated the cardiac function using echocardiography from 12 to 36 hours. We compared the difference of intra-aortic balloon pump, extracorporeal membrane oxygenation rate and mortality within one month after intensive care unit admission. Among the 160 patients, 36 died, 10 (11.24%) patients were from the hypothermia group and 26 (36.6%) from the northermia group (P<0.05). In northermia group, 45 (63.38%) patients used intra-aortic balloon pump and 4 (5.63%), extracorporeal membrane oxygenation; in hypothermia group, 35 (39.32%) patients used intra-aortic balloon pump and 2 (2.25%), extracorporeal membrane oxygenation（P<0.05). The patients’ heart rate decreased significantly in the hypothermia group. The heart rate of hypothermia group is significantly slower than the northermia group at the 36th hour (P<0.05). But the mean arterial pressure of hypothermia group is significantly higher than the northermia group at the 36th hour (P<0.05). In hypothermia group, PO2, SvO2 and lactate were improved significantly compared to pre-cooling (P<0.05), and they were significantly better than the northermia group at the 36th hour (P<0.05%). Prothrombin time and activated partial thromboplastin time have no significantly difference between the two groups (P>0.05). But the platelet count has significantly difference between the two groups at the 36th hour (P<0.05). The aspartate transaminase, alanine transaminase and creatinine were improved significantly in the hypothermia group, and they were significantly better than the northermia group (P<0.05). Mild hypothermia is feasible and safe for patients with multiple organ dysfunction syndrome after cardiopulmonary bypass surgery.

Intraoperative conversion, especially under emergent circumstances during off-pump coronary artery bypass (OPCAB), is associated with a significantly higher rate of hospital mortality. This study compared the clinical early outcomes of patients emergently converting to cardiopulmonary bypass (CPB) with or without cardioplegic arrest and evaluated the efficacy of an on-pump beating heart technique for these critically ill patients. A retrospective study of patients treated at The First Affiliated Hospital of China Medical University over an 8-year period (2005 to 2013). Between January 2005 and September 2013, 104 patients were emergently converted to CPB during OPCAB. In the first 55 patients (53%), the cardioplegic arrest was performed. In the most recent 49 patients (47%), the on-pump beating heart procedure was used without cardioplegic arrest. There were no significant differences in their baseline clinical characteristics, number of anastomoses performed per patient, and reasons for conversions (P > .05). A significant reduction occurred in the observed mortality between the cardioplegic arrest group and the on-pump beating heart group (25.6% vs 6.1%, P=.008). A statistical difference was found between the cardioplegic arrest group and the on-pump beating heart group in the time of CPB, peak cardiac troponin I, duration of inotropic support, time to extubation, intensive care unit stay, postoperative hospital stay, incidence of new intra-aortic balloon pump support, and pulmonary complications (P < .05). The incidence of blood requirements, postoperative myocardial infarction, new-onset atrial fibrillation, hemodialysis, stroke, infective complications, and resurgery for bleeding were lower in on-pump beating heart group, but the difference did not reach statistical significance (P > .05). The on-pump beating heart technique is the preferred method of emergency conversion to CPB during OPCAB. It has lower postoperative mortality and morbidity than the cardioplegic arrest.

Off-pump coronary artery bypass grafting (OPCAB) is a popular treatment for patients with ischemic heart disease, especially for high-risk patients. However, whether OPCAB can lead to better clinical outcomes than on-pump coronary artery bypass grafting (ONCAB) in patients with enlarged ventricles remains controversial. This prospective randomized study was designed to characterize comparison of early clinical outcome and mid-term follow-up following ONCAB versus OPCAB in patients with triple-vessel disease and enlarged ventricles. Prospective randomized trial of patients treated at The First Affiliated Hospital, China Medical University, over a 3-year period (2007-2010). A total of 102 patients with triple-vessel disease and enlarged ventricles (end-diastolic dimension >=6.0 cm) were randomized to OPCAB or ONCAB between July 2007 and December 2010. The in-hospital out.comes were analyzed. The study included a mid-term follow-up, with a mean follow-up time of 49.40 (12.88 months). No significant differences were recorded in the baseline clinical characteristics of ONCAB and OPCAB groups. A statistical difference was found between the two groups at the time of extubation, intensive care unit stay, hospital stay, blood requirements, incidence of intra-aortic balloon pump support, pulmonary complications, stroke, reoperation for bleeding, and inotropic requirements > 24 hours (P < .05). The number of anastomoses performed per patient, the incidence of postoperative ventricular arrhythmia, myocardial infarction, new-onset atrial fibrillation, hemodialysis, infective complications, recurrent angina, and percutaneous reintervention were similar between the 2 groups (P > .05). The left ventricular end-diastolic dimension was significantly smaller at 6 months' follow-up in the 2 groups than it was before operation ( < .05). No differences in hospital mortality and mid-term mortality between OPCAB and ONCAB groups were found. During the follow-up, no patient in either group had undergone repeat coronary artery bypass grafting. No differences in early and mid-term mortality were found between OPCAB and ONCAB in patients with triple-vessel disease and enlarged ventricles. However, OPCAB seems to have a beneficial effect on postoperative complications.

For patients with diabetes and triple-vessel disease, coronary artery bypass grafting (CABG) surgery is a well-established procedure, but cardiopulmonary bypass support may also lead to severe complications to these patients. The aim of this study was to compare myocardial protection and early outcomes in patients with diabetes and triple-vessel disease following different coronary surgical techniques. Prospective randomized trial of patients treated at the First Affiliated Hospital of China Medical University over a 3-year period (2011- 2013). In a single-center randomized trial, 668 patients with diabetes and triple-vessel disease were randomly assigned to off-pump (OPCAB) (number [n]=222), on-pump beating heart (OnP-BH) (n=223), and conventional CABG (OnP) (n=223) between January 2011 and October 2013. Myocardial injury was assessed by measuring the serial release of cardiac troponin I (cTnI) preoperatively, 1 hour, 12 hours, 24 hours, and 72 hours postoperatively. The early outcomes were compared among these 3 groups. Preoperative characteristics of the patients in all 3 groups were similar. No significant difference was found regarding the number of anastomoses, the use of the internal thoracic artery, postoperative new-onset atrial fibrillation, hemodialysis, stroke, reoperation for bleeding, and infective complications in the 3 groups (P > .05). The complete revascularization, postoperative drainage loss, intra-aortic balloon pump support, blood requirements, postoperative myocardial infarction, pulmonary complications, gastrointestinal complications, inotropic requirements > 24 hours, ventilation > 24 hours, intensive care unit stay > 24 hours, and in-hospital stay > 7 days were significantly lower in the OPCAB group than in the other 2 groups (P < .05). In-hospital mortality was lower in the OPCAB group than in the other 2 groups, but no statistical difference was observed (P > .05). Preoperative cTnI in the 3 groups was similar (P > .05); however, the lowest cTnI value was noted in the OPCAB group, followed by the OnP group, and it was highest in the OnP-BH group 1 hour, 12 hours, 24 hours, and 72 hours postoperatively (P < .05). OPCAB is superior to the OnP-BH and OnP techniques in terms of postoperative complications and myocardial protection in patients with diabetes and triple-vessel disease. Myocardial injury in the OnP-BH group was significantly higher than that in the OnP group.