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ABSTRACT Introduction: Postoperative thrombocytopenia is common in cardiac surgery with cardiopulmonary bypass, and its risk factors are unclear. Methods: This retrospective study enrolled 3,175 adult patients undergoing valve surgeries with cardiopulmonary bypass from January 1, 2017 to December 30, 2018 in our institute. Postoperative thrombocytopenia was defined as the first postoperative platelet count below the 10th quantile in all the enrolled patients. Outcomes between patients with and without postoperative thrombocytopenia were compared. The primary outcome was in-hospital mortality. Risk factors of postoperative thrombocytopenia were assessed by logistic regression analysis. Results: The 10th quantile of all enrolled patients (75×109/L) was defined as the threshold for postoperative thrombocytopenia. In-hospital mortality was comparable between thrombocytopenia and non-thrombocytopenia groups (0.9% vs. 0.6%, P=0.434). Patients in the thrombocytopenia group had higher rate of postoperative blood transfusion (5.9% vs. 3.2%, P=0.014), more chest drainage volume (735 [550-1080] vs. 560 [430-730] ml, P<0.001), and higher incidence of acute kidney injury (12.3% vs. 4.2%, P<0.001). Age > 60 years (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.345-3.765, P=0.002], preoperative thrombocytopenia (OR 18.671, 95% CI 13.649-25.542, P<0.001), and cardiopulmonary bypass time (OR 1.088, 95% CI 1.059-1.117, P<0.001) were positively independently associated with postoperative thrombocytopenia. Body surface area (BSA) (OR 0.247, 95% CI 0.114-0.538, P<0.001) and isolated mitral valve surgery (OR 0.475, 95% CI 0.294-0.77) were negatively independently associated with postoperative thrombocytopenia. Conclusion: Positive predictors for thrombocytopenia after valve surgery included age > 60 years, small BSA, preoperative thrombocytopenia, and cardiopulmonary bypass time. BSA and isolated mitral valve surgery were negative predictors.
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Objective:To investigate the effects of mycophenolate mofetil ( MMF) on the differentiation and connective tissue growth factor(CTGF)and fibronectin(FN)expression of lung fibroblasts(LF)through interfering the transdifferentiation of LF into MF in vitro.Methods:LF of neonatal rat were cultured in vitro ,induced into MF by transforming growth factor-β1(TGF-β1),and treated with different concentrations of MMF ,which was 0μmol/L(control group),0.1μmol/L(low dose group),1μmol/L(middle dose group)or 10 μmol/L( high dose group ) .Morphology of LF and MF were observed by inverted phase contrast microscope , the expressions of vimentin and α-smooth muscle actin (α-SMA) were identified by immunofluorescence staining ,and then analyzed the effect of MMF on the transdifferentiation of fibroblasts .ELISA was used to detect the levels of connective tissue growth factor ( CTGF ) and fibronectin ( FN) .Results: LF was induced into MF by TGF-β196 hours later.The immune fluorescence performance of α-SMA in the lung fibroblasts revealed MMF could suppress the expression of α-SMA,but had no effect on the phenotype of myofibroblasts .The results of ELISA showed that the levels of CTGF and FN were significantly decreased compar with that of control group and was concentration -de-pendent ( P<0.05 ) .Conclusion: MMF can prevent lung fibroblasts from transdifferentiating into myofibroblasts and inhibit the expressions of CTGF and FN ,suggesting that MMF has anti-fibrosis effect and one of the mechanisms is by suppressing the expressions of CTGF and FN.