Optimal time for mesenchymal stem cell transplantation in rats with myocardial infarction

Background:Bone marrow mesenchymal stem cell (MSC) transplantation is a promising strategy in the treatment of myocardial infarction (MI). However, the time for transplanting cells remains controversial. The aim of this study was to find an optimal time point for cell transplantation. Methods: MSCs were isolated and cultured from Sprague-Dawley (SD) rats. MI model was set up in SD rats by permanent ligation of left anterior descending coronary artery. MSCs were directly injected into the infarct border zone at 1 h, 1 week and 2 weeks after MI, respectively. Sham-operated and MI control groups received equal volume of phosphate buffered saline (PBS). At 4 weeks after MI, cardiac function was assessed by echocardiography; vessel density was analyzed on hematoxylin-eosin stained slides by light microscopy; the apoptosis of cardiomyocytes was evaluated by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay; the expressions of proteins were analyzed by Western blot. Results: MSC transplantation improved cardiac function, reduced the apoptosis of cardiomyocytes and increased vessel density. These benefits were more obvious in 1-week group than in 1-h and 2-week groups. There are more obvious in-creases in the ratio of bcl-2/bax and the expression of vascular endothelial growth factor (VEGF) and more obvious decreases in the expression of cleaved-caspase-3 in 1-week group than those in other two groups. Conclusion: MSC transplantation was beneficial for the recovery of cardiac function. MSC transplantation at 1 week post-MI exerted the best effects on increases of cardiac function, anti-apoptosis and angiogenesis.

Ascending aortic dilatation rate after transcatheter aortic valve replacement in patients with bicuspid and tricuspid aortic stenosis: A multidetector computed tomography follow-up study

BACKGROUND: Current data is lacking about the progression of ascending aortic dilatation after transcatheter aortic valve replacement(TAVR) in aortic stenosis(AS) patients with bicuspid aortic valve(BAV) and tricuspid aortic valve(TAV). This study aims to assess the ascending aortic dilatation rate(mm/year) after TAVR in patients with BAV versus TAV using a multidetector computed tomography(MDCT) fol ow-up and to determine the predictors of ascending aortic dilatation rate.METHODS: Severe AS patients undergoing TAVR from March 2013 to March 2018 at our center with MDCT follow-ups were included. BAV and TAV were identified using baseline MDCT. Baseline and follow-up MDCT images were analyzed,and the diameters of ascending aorta were measured. Study end point is ascending aortic dilatation rate(mm/year). Furthermore,factors predicting ascending aortic dilatation rate were also investigated.RESULTS: Two hundred and eight patients were included,comprised of 86 BAV and 122 TAV patients. Five,4,3,2,and 1-year MDCT follow-ups were achieved in 7,9,30,46,and 116 patients. The ascending aortic diameter was significantly increased after TAVR in both BAV group(43.7±4.4 mm vs. 44.0±4.5 mm;P<0.001) and TAV group(39.1±4.8 mm vs. 39.7±5.1 mm;P<0.001). However,no difference of ascending aortic dilatation rate was found between BAV and TAV group(0.2±0.8 mm/year vs. 0.3±0.8 mm/year,P=0.592). Multivariate linear regression revealed paravalvular leakage(PVL) grade was independently associated with ascending aortic dilatation rate in the whole population and BAV group,but not TAV group. No aortic events occurred during follow-ups.CONCLUSION: Ascending aortic size continues to grow after TAVR in BAV patients,but the dilatation rate is mild and comparable to that of TAV patients. PVL grade is associated with ascending aortic dilatation rate in BAV patients post-TAVR.

Post-dilatation improves stent apposition in patients with ST-segment elevation myocardial infarction receiving primary percutaneous intervention: A multicenter, randomized controlled trial using optical coherence tomography

Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction (STEMI). This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention (pPCI) for acute STEMI. METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation. Patients were randomly assigned to control group (n=20) or post-dilatation group (n=21) in which a non-compliant balloon was inflated to >16 atm pressure. Strut apposition and coverage were evaluated by optical coherence tomography (OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up. The primary endpoint was rate of incomplete strut apposition (ISA) at 7 months after pPCI. RESULTS: There were similar baseline characteristics except for stent length (21.9 [SD 6.5] mm vs. 26.0 [SD 5.8] mm, respectively, P=0.03). In post-dilatation vs. control group, ISA rate was lower (2.5% vs. 4.5%, P=0.04) immediately after pPCI without affecting nal TIMI ow 3 rate (95.2% vs. 95.0%, P>0.05) or corrected TIMI frame counts (22.6±9.4 vs .22.0±9.7, P>0.05);and at 7-month follow-up (0.7% vs .1.8%, P<0.0001), the primary study endpoint, with similar strut coverage (98.5% vs. 98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events (MACE). CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood ow or 1-year MACE rate. Larger and longer term studies are warranted to further assess safety.

First-in-man implantation of the retrievable and repositionable VenusA-Plus valve

BACKGROUND: No retrievable and repositionable second generation transcatheter aortic valve is available in China. Here, we report the first-in-man implantation of the retrievable and repositionable VenusA-Plus valve. METHODS: A 76-year-old patient with symptomatic severe aortic stenosis and high surgical risk(STS 13.8%) was recommended for transcatheter aortic valve replacement(TAVR) by heart valve team. Type 0 bicuspid aortic valve with asymmetric calcification was identified by dual source computed tomography, and the unfavorable anatomies increased the possibility of malposition and paravalvular leakage during TAVR. Therefore, we used the retrievable and repositionable Venus APlus valve for the patient.RESULTS: Transfemoral TAVR was performed under local anesthesia with sedation, and a 26-mm VenusA-Plus valve was successfully implanted. No transvalvular pressure gradient and trace paravalvular leakage were found. CONCLUSION: The successful first-in-man implantation indicates the retrievable and repositionable Venus A-Plus valve is feasible in complicated TAVR cases such as bicuspid aortic valve.

Leukocyte cell-derived chemotaxin 2 inhibits development of atherosclerosis in mice

Leukocyte cell-derived chemotaxin 2 (LECT2), a multifunctional hepatokine, is involved in many pathological conditi ons. However, its role in atherosclerosis remains undefined. In this study, we admimistered vehicle or LECT2 to male Apoe^-/- mice fed a Western diet for 15 weeks. Atherosclerotic lesions were visualized and quantified with Oil-red O and hematoxylin staining. The mRNA expression levels of MCP-1, MMP-1, IL-8 IL-1β, and TNF-a were analyzed by quantitative real-time polymerase chain reaction. Serum TNF-a, IL-1β, IL-8, MCP-1, and MMP-1 concentrations were measured by en zyme-li nked immuno sorbent assay. CD68, CD31, and a-SMA, markers of macrophages, endothelial cells, and smooth muscle cells, respectively, were detected by immuno staining. Results showed that LECT2 reduced total cholesterol and low-density lipoprotein concentrations in serum and inhibited the development of atherosclerotic lesions, accompanied by reductions in inflammatory cytokines and lower MCP-1, MMP-1, TNF-a, IL-8, and IL-1β mRNA abundanee. Furthermore, LECT2 decreased CD68, but in creased cr SMA in atherosclerotic lesi ons, suggesting an in crease in smooth muscle cells and reduction in macrophages. In summary, LECT2 inhibited the development of atherosclerosis in mice, accompanied by reduced serum total cholesterol concentration and lower inflammatory responses.

The first two cases of transcatheter mitral valve repair with ARTO system in Asia

BACKGROUND:MAVERIC(Mitral Valve Repair Clinical Trial)validates the safety and effi cacy of the ARTO system.We here report the fi rst two successful cases of utilizing the ARTO system in patients with symptomatic heart failure(HF)with functional mitral regurgitation(FMR)in Asia.METHODS:Two patients,aged 70 and 63,had severe HF with FMR.Transesophageal echocardiography confirmed that the left ventricular ejection fractions were less than 50%with severe mitral regurgitation(MR)in both patients.Optimizing drug treatment could not mitigate their symptoms.Therefore,we used the ARTO system to repair the mitral valve for these patients on March 5 and 6,2019,respectively.RESULTS:Mitral valve repairs using the ARTO system were successfully performed under general anaesthesia for these two patients.MR was decreased immediately after the procedures in both patients.The 30-day and 3-month transthoracic echocardiography(TTE)revealed a moderate to severe MR in both patients,and the New York Heart Association(NYHA)scales were also partially improved.CONCLUSION:The first two cases in Asia indicate that the ARTO system is feasible for patients with heart failure with FMR,and the patient selection appears to be crucial.

The first four cases of successful NeoChord procedure in Chinese mainland

BACKGROUND:Transapical off-pump NeoChord procedure is a novel minimally invasive surgical repair of degenerative mitral regurgitation(MR).Here,we report the first four cases of NeoChord procedure in patients with mitral valve prolapse in Chinese mainland.METHODS:Four patients,aged 86,84,80 and 60 years,with severe MR due to posterior middle scallop prolapse(P2),underwent transapical off-pump artifi cial chordae implantation on April 9 and 10,2019.The procedure was performed by left mini-thoracotomy under general anaesthesia and guided by 2D and 3D dimensional transoesophageal echocardiography(TEE).RESULTS:Mitral valve repair via NeoChord procedure was successfully performed with implantation of 3 artifi cial chordae in the fi rst patient and 3,2,and 3 artifi cial chordae in the following patients,respectively.Intraoperative TEE and pre-discharge transthoracic echocardiography(TTE)showed only mild to moderate MR of these four patients and no postoperative complications were noted.There were no changes of TTE fi nding between one-month follow-up and pre-discharge.CONCLUSION:The successful NeoChord procedures in four Chinese indicate that the valve repair using the NeoChord system for Chinese population is feasible.

Myocardial infarction detected by a smartwatch after transcatheter aortic valve replacement during the COVID-19 pandemic

Dear editor,Transcatheter aortic valve replacement(TAVR)is a safe and effective first-line therapeutic management for patients with severe aortic stenosis.The evidence of multiple randomized clinical trials proves the safety and efficacy of TAVR in patients.[1-2]However,new-onset conduction disorders,atrial fi brillation,and acute coronary syndrome are still common complications after TAVR procedures.Acute life-threatening complications such as myocardial infarction may result in fatal clinical outcomes.The COVID-19 pandemic makes periodic and timely follow-ups for patients after TAVR more diffi cult.An ambulatory electrocardiogram(AECG)monitoring system by a smart wearable device has recently emerged as a tool to monitor cardiac events before and after TAVR.[3]Smartwatches can monitor and record multiple biometric parameters,like heart rate,step counts,sleep cycles,oxygen saturation,and analyze QRS complexes and P waves after triggering incidences。

A case of a successful post-transcatheter aortic valve replacement His bundle pacing

Dear editor,Transcatheter aortic valve replacement (TAVR) is a safe and effective treatment for severe aortic valve stenosis and aortic regurgitation. Multiple randomized trials have proved its therapeutic advantages in patients at any level of surgical risks.

Anemia and risk of periprocedural cerebral injury detected by diffusion-weighted magnetic resonance imaging in patients undergoing transcatheter aortic valve replacement

BACKGROUND: Anemia is prevalent in patients undergoing transcatheter aortic valve replacement(TAVR) and has been linked to impaired outcomes after the procedure. Few studies have evaluated the impact of anemia and new ischemic lesions post TAVR.METHODS: We prospectively enrolled 158 patients who received TAVR in our center. Anemia was defined according to the World Health Organization criteria as hemoglobin <12 g/dL in women and <13 g/dL in men. All patients underwent diffusion-weighted magnetic resonance imaging(DW-MRI) procedure before and within 4–7 days after TAVR. RESULTS: Anemia was present in 85(53.8%) patients who underwent TAVR, and 126(79.7%) patients had 718 new DW-MRI positive lesions with a mean of 4.54±5.26 lesions per patient. The incidence of new ischemic lesions was 81.2% in patients with anemia versus 78.1% in patients without anemia(P=0.629). Moreover, anemic patients had bigger total volume/lesions in the anterior cerebral artery/middle cerebral artery(ACA/MCA) and MCA regions compared to the non-anemic patients(31.89±55.78 mm^(3) vs. 17.08±37.39 mm^(3), P=0.049;and 54.54±74.72 mm^(3) vs. 33.75±46.03 mm^(3), P=0.034). Anemia was independently associated with the volume/lesion in the ACA/MCA(β=16.796, 95% confidence interval [95% CI] 2.001 to 31.591, P=0.026) and in the MCA zone(β=0.020, 95% CI 0.001 to 0.040, P=0.041). CONCLUSIONS: Patients with pre-procedural anemia may have bigger total volume/lesions in the ACA/MCA and MCA regions compared to the non-anemic patients. Whether the consequences of bigger total volume/lesions impact neurological and cognitive outcomes remains to be investigated.

Heat shock protein 90 protects rat mesenchymal stem cells against hypoxia and serum deprivation-induced apoptosis via the PI3K/Akt and ERK1/2 pathways

Mesenchymal stem cell(MSC) transplantation has shown a therapeutic potential to repair the ischemic and infracted myocardium,but the effects are limited by the apoptosis and loss of donor cells in host cardiac microenvironment.The aim of this study is to explore the cytoprotection of heat shock protein 90(Hsp90) against hypoxia and serum deprivation-induced apoptosis and the possible mechanisms in rat MSCs.Cell viability was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT) assay.Apoptosis was assessed by Hoechst 33258 nuclear staining and flow cytometric analysis with annexin V/PI staining.The gene expression of Toll-like receptor-4(TLR-4) and V-erb-b2 erythroblastic leukemia viral oncogene homolog 2(ErbB2) was detected by real-time polymerase chain reaction(PCR).The protein levels of cleaved caspase-3,Bcl-2,Bcl-xL,Bax,total-ERK,phospho-ERK,total-Akt,phospho-Akt,and Hsp90 were detected by Western blot.The production of nitric oxide was measured by spectrophotometric assay.Hsp90 improves MSC viability and protects MSCs against apoptosis induced by serum deprivation and hypoxia.The protective role of Hsp90 not only elevates Bcl-2/Bax and Bcl-xL/Bax expression and attenuates cleaved caspase-3 expression via down-regulating membrane TLR-4 and ErbB2 receptors and then activating their downstream PI3K/Akt and ERK1/2 pathways,but also enhances the paracrine effect of MSCs.These findings demonstrated a novel and effective treatment strategy against MSC apoptosis in cell transplantation.

Fractional Flow Reserve Guided Percutaneous Coronary ntervention Improves Clinical Outcome with Reduced Cost in Contemporary Clinical Practice

Background：Fractional flow reserve （FFR） is currently considered as the gold standard for evaluating the functional significance of coronary stenosis.However,its potential benefits in real-world practice remain unknown in China.This study aimed to test the hypothesis that the use of FFR is associated with improved outcome and reduced cost in Chinese real-world clinical practice.Methods：A retrospective cohort study was carried out using the database of Second Affiliated Hospital of Zhejiang University,a tertiary and high-volume center in China.Clinical events were compared using the Cox proportional hazards model during a median follow-up of 13 months.Results：The study cohort consisted of 366 consecutive patients referred for coronary revascularization with adjunct FFR and 366 matched controls,from 2010 to 2014.Major adverse cardiac events （MACEs） （death,myocardial infarction,repeated revascularization,or hospitalization for angina） at 4 years were found in 12.0% ofangiography-guided patients and 4.9% in the FFR-guided group （P 〈 0.001）.The mean number of implanted stents was significantly lower in FFR treated subjects （0.52 ± 0.82 stents） compared with the angiography-guided group （0.93 ± 0.96 stents） （P 〈 0.001）.No difference in overall costs at initial hospitalization was observed between angiography-guided percutaneous coronary intervention （PCI） compared with FFR-guided PCI （RMB 33,000 Yuan,range：RMB 7393-44,700 Yuan） versus RMB 21,200 Yuan （RMB 19,100-47,100 Yuan） （P =0.54）.However,costs for MACEs during follow-up were significantly reduced in the FFR-guided arm （P 〈 0.001）.Conclusions：In the contemporary clinical practice,FFR-guided PCI is associated with decreased use of stents,improved clinical outcome,and reduced costs,compared with angiography-guided PCI.

Percutaneous Ventricular Restoration Therapy Using the Parachute Device in Chinese Patients with Ischemic Heart Failure： Three-Month Primary End-point Results of PARACHUTE China Study

Background： The primary cause of ischemic heart failure （HF） is myocardial infarction （MI） resulting in left ventricle （LV） wall motion abnormality secondary to ventricular remodeling. A prospective, nonrandomized study conducted in China was designed to assess safety and efficacy of the percutaneous ventricular restoration therapy using Parachute device （CardioKinetix, lnc., CA, USA） in ischemic HF patients as a result of LV remodeling after anterior wall M1. Methods： Thirty-one patients with New York Heart Association （NYHA） Class I1, I11 ischemic HF, ejection traction between 15% and 40%, and dilated akinetic or dyskinetic anterior-apical wall without the need to be revascularized were enrolled from seven sites in China from October to December 2014. The Parachute device was implanted through femoral artery. All patients received low-dose aspirin and anticoagulation with warfarin tbr at least 12 months postdevice implantation. The primary end-point was the assessment of efficacy as measured by the reduction in LV end-systolic volume index （LVESVI） against baseline LVESVI at 3 months postdevice implantation, determined by the echocardiography and measured by echocardiography core laboratory. Quality of life was assessed using EQ-SD and visual analog scale （VAS）. For quantitative data comparison, paired t-test （normality data） and signed-rank test （abnormality data） were used： application of signed-rank test was tbr the ranked data comparison. Results： A change in LVESVI as measured by echocardiography from the preimplant baseline to 3-month postdevice implantation revealed a statistically significant reduction from 77.5 ~ 20.0 ml/m-＇ to 53,1 ~ 17.0 ml/m-＂ （P 〈 0.0001 ）, The trial met its primary end-point. Of the 31 patients, the procedural success was 96.8%. Overall, NYHA HF class assessment results showed an improvement of more than halfa class at 3 months （P 〈 0.001 ）. Quality of life assessed by the VAS value increased 11.5 points （P 〈 0.01 ）, demonstrating improvement at 3 months.Conclusion： The favorable outcomes observed in the high-risk patients provide reassuring safety and efficacy data to support adoption of this technology as a therapeutic option for ischemic HF patients. Trial Registration： ClinicalTrials.gov, NCT02240940; https：// clinicaltrials.gov/ct2/show/NCT02240940.

Complex coronary lesions and rotational atherectomy:one hospital's experience

Objective:To evaluate the safety and effectiveness of rotational atherectomy followed by drug eluting stent (DES) implantation in patients with complex coronary lesions. Methods:From August 2006 to August 2012, 253 consecutive patients with 289 lesions and who underwent rotational atherectomy in our center were enrolled in this study. Results:The overall procedure success rate was 98% with the cost of two (0.8%) coronary perforations, three (1.2%) dissections, five (2.0%) slow flows or no flows, three (1.2%) peri-procedure myocardial infarctions, and two (0.8%) in hospital deaths. During follow-up (mean three years), one (0.4%) patient died, two (0.8%) patients had acute myocardial infarction, 14 (5.5%) had restenosis, and target lesion revascularization occurred in eight patients (3.2%). Conclusions:Rotational atherectomy followed by DES implantation is a safe and effective technique for patients with complex coronary lesions, especially calcified and non-dilatable lesions.

Activation of Akt and cardioprotection against reperfusion injury are maximal with only five minutes of sevoflurane postconditioning in isolated rat hearts

It had been proved that administration of sevoflurane for the first two minutes of reperfusion effectively protects the heart against reperfusion injury in rats in vivo.Our aim was to investigate the duration of effective sevoflurane administration and its underlying mechanism in isolated rat hearts exposed to global ischemia/reperfusion(I/R) injury.Adult male Sprague-Dawley rats were randomly divided into six groups(n=12):a sham-operation group,an I/R group,and four sevoflurane postconditioning groups(S2,S5,S10,and S15).In the S2,S5,S10,and S15 groups,the duration times of sevoflurane administration were 2,5,10,and 15 min after the onset of reperfusion,respectively.The isolated rat hearts were mounted on the Langendorff system,and after a period of equilibrium were subjected to 40 min global ischemia and 120 min reperfusion.Left ventricular(LV) hemodynamic parameters were monitored throughout each experiment and the data at 30 min of equilibrium and 30,60,90,and 120 min of reperfusion were analyzed.Myocardial infarct size at the end of reperfusion(n=7 in each group) and the expression of myocardial phosphorylated Akt(p-Akt) after 15-min reperfusion were determined in a duplicate set of six groups of rat hearts(n=5 in each group).Compared with the I/R group,the S5,S10,and S15 groups had significantly improved left ventricular end-diastolic pressure(LVEDP),left ventricular developed pressure(LVDP),and the maximal rate of rise or fall of the LV pressure(±dP/dtmax),and decreased myocardial infarct size(P<0.05),but not the S2 group.After 15 min of reperfusion,the expression of p-Akt was markedly up-regulated in the S5,S10,and S15 groups compared with that in the I/R group(P<0.05),but not in the S2 group.Sevoflurane postconditioning for 5 min was sufficient to activate Akt and exert maximal cardioprotection against I/R injury in isolated rat hearts.

经导管主动脉瓣置入术在中国人群二叶式主动脉瓣重度狭窄中的安全性和有效性评估(英文)

目的:评估经导管主动脉瓣置入术在中国人群二叶式主动脉瓣重度狭窄中的安全性和有效性。创新点:首次在中国人群比较经导管主动脉瓣置入术在二叶式和三叶式主动脉瓣重度狭窄中的安全性和有效性。方法:选取2013年3月至2014年9月行经导管主动脉瓣置入术的40位主动脉瓣狭窄的患者,分二叶式和三叶式主动脉瓣两组,比较基线水平、手术以及随访1月结果的差别。结论:经导管主动脉瓣置入术在中国人群中二叶式主动脉瓣重度狭窄中的应用是安全有效的。

β-氨基丙腈相关的小鼠胸主动脉夹层模型的综述

胸主动脉夹层具有发病急、发展迅速、主动脉破裂率高的特点,是最致命的大动脉疾病之一。但是胸主动脉夹层的发病机制目前还没有被完全了解。本综述介绍了三种新兴的β-氨基丙腈相关的小鼠胸主动脉夹层模型,分别是:单用β-氨基丙腈;先用β-氨基丙腈处理(四周)再用血管紧张素2(Ang II)处理;β-氨基丙腈和Ang II同时进行处理。希望通过更好地运用这三种β-氨基丙腈相关的小鼠胸主动脉夹层模型,从而对胸主动脉夹层的分子机制有更深入的了解。

Temporal changes in circulating P-selectin,plasminogen activator inhibitor-1,magnesium,and creatine kinase after percutaneous coronary intervention

Objective:This study aims to determine the mechanisms underlying restenosis and ischemia-reperfusion injury of the myocardium after percutaneous coronary intervention(PCI).Methods:The present study examined serial changes(5 min,30 min,2 h,6 h,and 24 h after PCI) in circulating P-selectin,plasminogen activator inhibitor-1(PAI-1),magnesium(Mg),and creatine kinase-myocardial band fraction(CK-MB) levels,which may be associated with restenosis and myocardial injury in patients undergoing PCI.The occurrence rates of major adverse cardiovascular events were collected over a six-month follow-up.Results:PCI induced an early elevation of P-selectin,which correlated positively with the inflation pressure used in the PCI procedure.PCI also caused a significant and sustained decrease in serum Mg in PCI patients,without an effect on PAI-1.An increase in CK-MB was observed in PCI patients,although values were within normal reference range.In addition,elevated P-selectin and decreased Mg measured shortly after the coronary angioplasty procedure were associated with recurrent treatment and heart failure,respectively.Conclusions:Our study demonstrates that PCI induces temporal changes of P-selectin,Mg,and CK-MB,which may be involved in restenosis and ischemia-reperfusion injury.These findings highlight the need for using antiplatelet therapy and Mg to reduce the risks associated with PCI.

Gorham-Stout syndrome in China's Mainland:a case series of 67 patients and review of the literature

Objective:Gorham-Stout syndrome (GSS) is a rare disorder of uncertain etiology and unpredictable prognosis. This study aims to present a comprehensive understanding of this rare entity. Methods:A literature search in PubMed and three Chinese databases was performed to screen histologically proven GSS cases among Chinese residents in the mainland. We analyzed the patients' clinical characteristics, the value of different treatment modalities and their influence on the clinical outcome. Results:Sixty-seven cases were finally enrolled. There were 43 men (64.2%) and 24 women (35.8%). The mean age at diagnosis was 28 years (1.5-71 years). The most common clinical symptoms included pain (n=40, 59.7%), functional impairment (n=13, 19.4%), and swelling (n=12, 17.9%). The radiographic presentation of 37 cases (55.2%) was disappearance of a portion of the bone. The others presented as radiolucent foci in the intramedullary or subcortical regions. A total of 42 cases provided data on therapy, these included surgery (n=27, 40.3%), radiation therapy (n=6, 9.0%), surgery combined with radiation therapy (n=2, 3.0%), and medicine therapy (n=7, 10.4%). For 30 of these 42 cases, follow-up data were available:21 cases had the disorder locally controlled and 9 had a symptom progression. Fortunately, the disease is not fatal in the majority of cases. Conclusions:GSS has no specific symptoms and it should be taken into consideration when an unclear massive osteolysis occurs. The efficacies of different treatment modalities are still unpredictable and further research is required to assess the values of different treatments.