Senescence contributes to the pathology of abdominal aortic aneurysm (AAA); however, the regulation of senescence in AAA remains unclear. Here, we sought to determine the role of gasdermin-E (GSDME)-dependent non-canonical pyroptosis in AAA. GSDME-dependent non-canonical pyroptosis is activated in the lesioned vascular walls of mouse models and patients with AAA. GSDME deficiency inhibits vascular senescence and AAA progression. Combined analyses of single-cell RNA sequencing (scRNA-seq), bulk RNA-seq, and multiplex flow cytometry demonstrate that GSDME is essential for the reprogramming of vascular smooth muscle cells (VSMCs) and the shift in immune statuses of macrophages, monocytes, and neutrophils in AAA. Reintroduction of GSDME in VSMCs, but not in myeloid cells, in mice with a GSDME deletion background, recapitulates the induced vascular senescence and AAA, which is abolished by senolytic therapy with dasatinib plus quercetin. These results indicate that GSDME-dependent non-canonical pyroptosis in VSMCs may be a ‘master switch’ in AAA and a potential therapeutic target for managing AAA.

Objective. There are four widely‐used formulae to calculate the perioperative glomerular filtration rate (GFR) of patients undergoing cardiac surgery. We assessed the predictive values of these formulae in the occurrence of postoperative acute kidney injury (AKI). Methods. Patients who underwent open‐heart valvular surgery with cardiopulmonary bypass from January 2015 to October 2017 were enrolled in this retrospective study. Demographic data and perioperative serum creatinine levels were collected. The estimated GFR (eGFR) was calculated using four formulae: Cockcroft Gault (CG), body surface area (BSA) corrected CG, simplified modification of diet in renal disease (MDRD), and chronic kidney disease‐epidemiology collaboration (CKD‐EPI) formula. The incidence of post‐operative AKI was calculated and the predictive capability of these formulae was evaluated. Results. A total of 290 patients were included. 136 patients (46.90%) developed AKI after surgery. The eGFR in the AKI group was significantly lower than those in the non‐AKI group at all investigated time points. In addition, the eGFR in the non‐AKI group increased temporarily on the day of operation, then decreased on the following days, and returned to preoperative level about one week after surgery. However, in the AKI group, the eGFR decreased from the day of operation, which still did not recover to the preoperative level by the end of the first week after surgery. The eGFR calculated by the BSA‐standardized CG formula had the highest AUC ROC curves of 0.699 and 0.774 before operation and on the day of operation, respectively. While eGFR calculated by CKD‐EPI formula had the highest AUC ROC of 0.874 and 0.887 at the first and second postoperative day. Conclusions. The eGFR formula is a powerful tool for perioperative renal function assessment. The BSA‐corrected CG and CKD‐EPI formula have better performance in predicting postoperative AKI after cardiopulmonary bypass than serum creatinine level and other formulae.

Background. Median sternotomy is the most applied approach in open‐heart surgery, while potential complications such as postoperative bleeding, sternal dehiscence, and deep sternal wound infection (DWSI) still remain a challenge to cardiac surgeons. Several new sternum‐closure products instead of stainless wire have been brought into clinical application. The objective of this retrospective study is to evaluate the novel sternum‐fixing product in terms of clinical outcomes. Methods. 689 consecutive cases undergoing cardiac surgery through median sternotomy between February 2015 and December 2018 in our center were enrolled in this study. All the cases were divided into two groups according to different sternum fixation methods: wire cerclage group and rigid fixator group. The demographic as well as clinical data including the mediastinal drainage of first, second, and third post‐op 24 hours, the total mediastinal drainage of post‐op 72 hours, ICU duration, length of hospital stay, and post‐op mortality in 30 days were collected and compared between the two groups. Results. 278 cases were enrolled in the wire cerclage group and 411 cases in the rigid fixator group. There is no significant difference in the demographic data between the two groups, while the mediastinal drainage in the first and third 24 hours after surgery and the total mediastinal drainage in postoperative 72 hours of the rigid fixator group were significantly less than those of the wire cerclage group (P < 0.05). No significant difference was found in other clinical outcomes between the groups including ICU duration, LOS in hospital, and 30‐day mortality. 14 cases (5.0%) in the wire cerclage group and 11 cases (2.7%) in the rigid fixator group had sternotomy‐related complications including severe postoperative bleeding, sternal dehiscence, and DSWI. Conclusion. Compared with the conventional wire cerclage, the new rigid fixator is superior in median sternotomy closure in terms of postoperative mediastinal bleeding as well as incidence of sternotomy‐related complications.

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Acute kidney injury (AKI) is a common complication after cardiopulmonary bypass (CPB) for cardiac surgery, and there is no effective treatment. This study was aimed at constructing an early warning model of AKI after CPB in adults and investigating the performance of this model. Patients who underwent CPB in the Department of Cardiac Surgery, Shanghai Tenth People’s Hospital, from January 2018 to December 2019 were recruited into the present study. Blood and urine samples were collected preoperatively (0 h) and 2 h, 6 h, 12 h, 24 h, and 48 h after surgery, and the creatinine and activating transcription factor 3 (ATF3) were detected. According to the diagnostic criteria of AKI, patients were divided into the AKI group and the non-AKI group, and the risk factors for AKI after CPB were screened. The receiver operating characteristic (ROC) curve analysis was used to identify the optimal biomarkers for the establishment of early warning model of AKI after CPB. Finally, the performance of this model was further verified. A total of 83 patients were included in this study, 42 of whom developed AKI after surgery. After CPB, the serum and urine levels of creatinine and ATF3 increased to different degrees, and the increase in urine ATF3 was the most obvious in the AKI group. The area under ROC (AUC) of urine ATF3 at 12 h after surgery was 0.691 (95% CI: 0.576-0.807). When ATF3 was higher than 1216 pg/mL, the sensitivity and specificity of ATF3 in the diagnosis of AKI were 0.43 and 0.85, respectively. The height, conjugated bilirubin on the surgery day, urine ATF3 12 h after surgery, and serum creatinine 24 h after surgery were independent risk factors for postoperative AKI. Urine ATF3 and other factors were used to establish AKI warning model after CPB, which showed good fitting and accuracy. In conclusion, ATF3 is an early biomarker of post-CPB AKI. Addition of urine ATF3 to AKI risk factors can improve the accuracy of early AKI prediction.