Kaplan-Meier for Mortality Rate Following-up Five Years.

<p>Kaplan-Meier for Mortality Rate Following-up Five Years.</p

Results of plasma markers of inflammation in the three groups.

<p>(A) serum IL-6, interleukin-6; (B) serum TNF-α, tumor necrosis factor-α. Data are presented as mean±SD, n = 6, *<i>P</i> <0.05 versus Group C. For graphs pooled estimates for pairwise comparisons derived from Analysis of Covariance with adjustment for baseline serum IL-6 at 0.94±0.13μg/L, serum TNF-α 0.32±0.05ng/L, were as follows: <b>IL-6;</b> 5min post CPB(T2): Group C, 1.37±0.16μg/L, Group U, 1.01±0.13μg/L. Test for overall treatment effect <i>p</i> = 0.021. 120min post CPB(T3): Group C, 1.38±0.28μg/L, Group U, 1.13±0.24μg/L. Test for overall treatment effect <i>P</i> = 0.001. <b>TNF-α</b>; 5min post CPB(T2): Group C, 0.37±0.19 ng/L, Group U, 0.33±0.19ng/L. Test for overall treatment effect <i>P</i> = 0.075. 120min post CPB(T3): Group C, 0.35±0.13 ng/L, Group U, 0.32±0.13 ng/L. Test for overall treatment effect <i>P</i> = 0.088.</p

RISK pathway protein phosphorylation and gene expression of stem cell retention and survival.

<p>The protein phosphorylation level in RISK pathway. The pAkt(A) but not Erk(B) phosphorylation level was higher in RIPoC+IPoC, RIPoC and IPoC group than that in IR group (p<0.05). The gene expression of stem cell retention (stromal cell derived factor-1 alpha, SDF-1α, p<0.05) and survival (vascular endothelium growth factor, VEGF, p<0.05) was up-regulated in RIPoC+IPoC, RIPoC and IPoC group than that in IR group(C). Group A: RIPoC+IPoC group, received the combined algorithms of RIPoC and IPoC; Group B: RIPoC group, which received 3 cycles of 30 seconds reperfusion and re-occlusion on the limb at the onset of reperfusion; Group C: IPoC group, received 3cycles of 30 seconds reperfusion and re-occlusion on the LAD; Group D: IR group, received reperfusion without interruption after ischemia; Group E: sham group, received only open chest.</p

Study Population Recruitment Summary.

<p>Study Population Recruitment Summary.</p

Typical histological examination results in the three groups.

<p>A, Group S, Tubules and glomeruli appear normal (H&E×400); B, Group C, after 2h CPB, kidney histologic changes include tubular dilatation(*), vacuole formation(▲), and glomerular over-filling (arrow) appeared obvious (H&E×400); C, Group U, injury changes of kidney still exist as tubular dilatation(*), vacuole formation(▲), and glomerular over-filling (<i>arrow</i>) but were milder with intervention of ulinastatin(H&E×400).</p

Effects of Metabolic Syndrome with or without Obesity on Outcomes after Coronary Artery Bypass Graft. A Cohort and 5-Year Study

<div><p>Background</p><p>Metabolic syndrome (MetS) and obesity are risk factors for cardiovascular disease, however, it remains unclear about effects of MetS with or without obesity on perioperative and long-term morbidity and mortality after coronary artery bypass graft (CABG).</p><p>Methods</p><p>An observational cohort study was performed on 4,916 consecutive patients receiving isolated primary CABG in Fuwai hospital. Of all patients, 1238 patients met the inclusion criteria and were divided into three groups: control, MetS with obesity and MetS without obesity (n = 868, 76 and 294 respectively). The patient’s 5-year survival and major adverse cerebral and cardiovascular events (MACCE) were studied.</p><p>Results</p><p>Among all three groups, there were no significant differences in in-hospital postoperative complications, epinephrine use, stroke, ICU stay, ventilation time, atrial fibrillation, renal failure, coma, myocardial infarction, repeated revascularization, and long-term stroke. The patients in MetS without obesity group were not associated with increased perioperative or long-term morbidities and mortality. In contrast, the patients in MetS with obesity group were associated with significant increased perioperative complications including MACCE (30.26% vs. 20.75%, 16.7%, p = 0.0074) and mortality (11.84% vs. 3.74%, 3.11%, p = 0.0007) respectively. Patients in MetS with obesity group was associated with significantly increased long-term of MACCE (adjusted OR:2.040; 95%CI:1.196–3.481; P＜0.05) and 5-years of mortality (adjusted HR:4.659; 95%CI:1.966–11.042; P＜0.05).</p><p>Conclusions</p><p>Patients with metabolic syndrome and obesity are associated with significant increased perioperative and long-term complications and mortality, while metabolic syndrome without obesity do not worsen outcomes after CABG.</p></div

Multivariable-Adjusted Odd Ratio of Long-term MACCE.

<p>Multivariable-Adjusted Odd Ratio of Long-term MACCE.</p

Mitochondrial function and inflammation reaction.

<p>The myocardial ATP level (A) and mitochondrial function gene expression levels (B) were also detected. The myocardial ATP level was higher in RIPoC+IPoC, RIPoC and IPoC group than that in IR group (p<0.01). The mRNA expression levels of <i>Cycs</i>, <i>Ndufa8</i>, <i>Cox7a1</i> and <i>TFAM</i> were significantly regulated up in RIPoC+IPoC, RIPoC and IPoC group than that in IR group. The myeloperoxidase(MPO) assay, which indexed inflammation reaction, also determined(C). The MPO level was lower in RIPoC+IPoC, RIPoC and IPoC group than that in IR group (p<0.01). Group A: RIPoC+IPoC group, received the combined algorithms of RIPoC and IPoC; Group B: RIPoC group, which received 3 cycles of 30 seconds reperfusion and re-occlusion on the limb at the onset of reperfusion; Group C: IPoC group, received 3 cycles of 30 seconds reperfusion and re-occlusion on the LAD; Group D: IR group, received reperfusion without interruption after ischemia; Group E: sham group, received only open chest.</p

Results of markers of kidney injury in the three groups.

<p>(A) serum creatinine; (B) serum BUN; (C) serum CysC; (D) urine NAG, urine N-acetyl-β-D-glucosaminidase. Data are presented as mean±SD, n = 6, *<i>P</i> <0.05 versus Group C, Ψ<i>P</i> <0.05 versus Group S. For graphs pooled estimates for pairwise comparisons derived from Analysis of Covariance with adjustment for baseline serum creatinine at 53.61±9.53μmmol/L, serum BUN 4.31±1.34μmmol/L, serum CysC 24.35±4.2μg/L, were as follows: <b>serum creatinine;</b> 5min post CPB(T2): Group C, 64.24±12.53μmmol/L, Group U, 62.33±11.73μmmol/L. Test for overall treatment effect <i>P</i> = 0.074. 120min post CPB(T3): Group C, 86.62±11.41μmmol/L, Group U, 71.72±12.55μmmol/L. Test for overall treatment effect <i>P</i> = 0.032. <b>serum BUN;</b> 5min post CPB(T2): Group C, 5.43±1.87μmmol/L, Group U, 5.41±1.72μmmol/L. Test for overall treatment effect <i>P</i> = 0.081. 120min post CPB(T3): Group C, 7.37±1.72μmmol/L, Group U, 6.13±1.69μmmol/L. Test for overall treatment effect <i>P</i> = 0.025. <b>serum CysC;</b> 5min post CPB(T2): Group C, 30.47±4.4μg/L, Group U, 26.66±5.7μg/L. Test for overall treatment effect <i>P</i> = 0.069. 120min post CPB(T3): Group C, 40.62±6.5μg/L, Group U, 30.72±6.2μg/L. Test for overall treatment effect <i>P</i> = 0.001.</p

Antioxidative stress reaction and gene expression.

<p>The level of anti-oxidative stress(A) and lipid peroxidation(B) at 3 days after myocardium reperfusion (n = 4). RIPoC+IPoC, RIPoC and IPoC procedure increased the levels of anti-oxidative stress and decreased the lipid peroxidation reaction in reperfusion myocardium (p<0.01).The SOD1 and SOD2 gene expression level at the borderline of ischemic myocardium were detected(C). The gene expression of SOD1 and SOD2 were enhanced in RIPoC+IPoC, RIPoC and IPoC group compared with that in IR group (p<0.01). Group A: RIPoC+IPoC group, received the combined algorithms of RIPoC and IPoC; Group B: RIPoC group, which received 3 cycles of 30 seconds reperfusion and re-occlusion on the limb at the onset of reperfusion; Group C: IPoC group, received 3 cycles of 30 seconds reperfusion and re-occlusion on the LAD; Group D: IR group, received reperfusion without interruption after ischemia; Group E: sham group, received only open chest.</p