Incidence, risk factors and clinical outcomes of acute kidney injury after heart transplantation: a retrospective single center study.

OBJECTIVES: This study aimed to identify the incidence rate of Acute kidney injury (AKI) in our center and predict in-hospital mortality and long-term survival after heart transplantation (HTx). METHODS: This single-center, retrospective study from October 2009 and March 2020 analyzed the pre-, intra-, and postoperative characteristics of 95 patients who underwent HTx. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Risk factors were analyzed by multivariable logistic regression models. The log-rank test was used to compare long-term survival. RESULTS: Thirty-three (34.7%) patients developed AKI. The mortality in hospital in HTx patients with and without AKI were 21.21 and 6.45%, respectively (P < 0.05). Recipients in AKI who required renal replacement therapy (RRT) had a hospital mortality rate of 43.75% compared to 6.45% in those without AKI or RRT (P < 0.0001). A long cardiopulmonary bypass (CPB) time (OR:11.393, 95% CI: 2.183 to 59.465, P = 0.0039) was positively related to the occurrence of AKI. A high intraoperative urine volume (OR: 0.031, 95% CI: 0.005 to 0.212, P = 0.0004) was negatively correlated with AKI. AKI requiring RRT (OR, 11.348; 95% CI, 2.418-53.267, P = 0.002) was a risk factor for mortality in hospital. Overall survival in patients without AKI at 1 and 3 years was not different from that in patients with AKI (P = 0.096). CONCLUSIONS: AKI is common after HTx. AKI requiring RRT could contribute powerful prognostic information to predict mortality in hospital. A long CPB time and low intraoperative urine volume are associated with the occurrence of AKI.

Early Diagnostic Features of Left-to-Right Shunt-Induced Pulmonary Arterial Hypertension in Piglets.

BACKGROUND: We aimed to establish early diagnostic characteristics of left-to-right shunt-induced pulmonary arterial hypertension (PAH) in a piglet model. METHODS: A shunt-induced PAH in piglets (n = 9) was successfully established by anastomosis of vascular prosthesis from aorta to pulmonary artery with follow-up for 6 months by a number of diagnostic procedures. RESULTS: PAH developed with mean pulmonary arterial pressure [PAP] of 30.2 ± 6.0 mm Hg immediately after operation and 33.5 ± 8.7 mm Hg at 3 months after operation with pulmonary vascular resistance increased to 4.0 ± 0.9 Wood units. There was a weak correlation on systolic PAP between catheterization and echocardiography but the Tei index was significantly correlated to systolic PAP. Magnetic resonance imaging demonstrated that the end-diastolic volume index, systolic volume index, ejection fraction of the ventricle, and ventricular mass index were sensitive indices. Technetium-99m single-photon emission computed tomography indicated increased blood flow in the upper and middle zones of both lungs. Positron emission tomography-computed tomography (PET-CT) demonstrated a higher kilo count (kct) of 18F-fluorodeoxyglucose in the right ventricular wall and both chambers at 3 months postoperatively (right ventricular wall: 5,708.3 ± 428.4 versus 3,965.5 ± 138.6 preoperatively, p = 0.003; both chambers: 2,963.6 ± 219.4 versus 1,710.1 ± 35.4 preoperatively, p < 0.05) as well as at 6 months for both chambers (p < 0.05). CONCLUSIONS: In this successful left-to-right shunt-induced PAH model in piglets, sensitive indices including the Tei index, systolic volume index, ejection fraction, ventricular mass index, lung perfusion, and glycometabolism by PET-CT in early PAH are determined. For the first time, we report that glycometabolism by PET-CT is useful in early diagnosis. These indices may be used for the early diagnosis in the left-to-right shunt-induced PAH.

Chloride Channels are Involved in the Development of Atrial Fibrillation - A Transcriptomic and proteomic Study.

ABSTARCT: Electrical and structural remodeling processes are contributors to the self-perpetuating nature of atrial fibrillation (AF). However, their correlation has not been clarified. In this study, human atrial tissues from the patients with rheumatic mitral valve disease in either sinus rhythm or persistent AF were analyzed using a combined transcriptomic and proteomic approach. An up-regulation in chloride intracellular channel (CLIC) 1, 4, 5 and a rise in type IV collagen were revealed. Combined with the results from immunohistochemistry and electron microscope analysis, the distribution of type IV collagen and effects of fibrosis on myocyte membrane indicated the possible interaction between CLIC and type IV collagen, confirmed by protein structure prediction and co-immunoprecipitation. These results indicate that CLICs play an important role in the development of atrial fibrillation and that CLICs and structural type IV collagen may interact on each other to promote the development of AF in rheumatic mitral valve disease.

Mensenchymal stem cells can delay radiation-induced crypt death: impact on intestinal CD44(+) fragments.

Intestinal stem cells are primitive cells found within the intestinal epithelium that play a central role in maintaining epithelial homeostasis through self-renewal and commitment into functional epithelial cells. Several markers are available to identify intestinal stem cells, such as Lgr5, CD24 and EphB2, which can be used to sort intestinal stem cells from mammalian gut. Here, we identify and isolate intestinal stem cells from C57BL/6 mice by using a cell surface antigen, CD44. In vitro, some CD44(+) crypt cells are capable of forming "villus-crypt"-like structures (organoids). A subset strongly positive for CD44 expresses high levels of intestinal stem-cell-related genes, including Lgr5, Bmi1, Hopx, Lrig1, Ascl2, Smoc2 and Rnf43. Cells from this subset are more capable of developing into organoids in vitro, compared with the subset weakly positive for CD44. However, the organoids are sensitive to ionizing irradiation. We investigate the specific roles of mesenchymal stem cells in protecting organoids against radiation-induced crypt death. When co-cultured with mesenchymal stem cells, the crypt domains of irradiated organoids possess more proliferative cells and fewer apoptotic cells than those not co-cultured with mesenchymal stem cells. Cd44v6 continues to be expressed in the crypt domains of irradiated organoids co-cultured with mesenchymal stem cells. Our results indicate specific roles of mesenchymal stem cells in delaying radiation-induced crypt death in vitro.

The anti-fibrotic effects of mesenchymal stem cells on irradiated lungs via stimulating endogenous secretion of HGF and PGE2.

Radiation-induced pulmonary fibrosis is a common disease and has a poor prognosis owing to the progressive breakdown of gas exchange regions in the lung. Recently, a novel strategy of administering mesenchymal stem cells for pulmonary fibrosis has achieved high therapeutic efficacy. In the present study, we attempted to use human adipose tissue-derived mesenchymal stem cells to prevent disease in Sprague-Dawley rats that received semi-thoracic irradiation (15 Gy). To investigate the specific roles of mesenchymal stem cells in ameliorating radiation-induced pulmonary fibrosis, we treated control groups of irradiated rats with human skin fibroblasts or phosphate-buffered saline. After mesenchymal stem cells were infused, host secretions of hepatocyte growth factor (HGF) and prostaglandin E2 (PGE2) were elevated compared with those of the controls. In contrast, tumour necrosis factor-alpha (TNF-α) and transforming growth factor-beta1 (TGF-ß1) levels were decreased after infusion of mesenchymal stem cells. Consequently, the architecture of the irradiated lungs was preserved without marked activation of fibroblasts or collagen deposition within the injured sites. Moreover, mesenchymal stem cells were able to prevent the irradiated type II alveolar epithelial cells from undergoing epithelial-mesenchymal transition. Collectively, these data confirmed that mesenchymal stem cells have the potential to limit pulmonary fibrosis after exposure to ionising irradiation.