Risk scores for allograft failure: Are they still useful in liver recipients from donation after circulatory death?

BACKGROUND Liver grafts from donation after circulatory death(DCD)are associated with a higher risk of early graft dysfunction,determined by the warm ischemia and cold ischemia times.It is essential to have precise criteria to identify this complication in order to guide therapeutic strategies.AIM To validate different graft and recipient survival scores in patients undergoing liver transplantation(LT)with DCD grafts.METHODS A retrospective and observational unicentric study was conducted on 65 LT patients with grafts obtained from controlled DCD donors from November 2013 to November 2022.The United Kingdom(UK)risk score,early allograft dysfunction(EAD)Olthoff score,and model for early allograft function(MEAF)score were used to evaluate the risk of graft and recipient survival post-transplant.For survival analysis purposes,we used the Kaplan-Meier method,and the differences between subgroups were compared using the log-rank(Mantel-Cox)test.RESULTS Sixty-five patients were included in the study.The UK risk score did not demonstrate predictive capacity for recipient or graft survival.However,in donors aged over 70 years old(18.4%),it significantly predicted graft survival(P<0.05).According to Kaplan-Meier survival curves,graft survival rates at 6 months,2 years,and 5 years in the futility group dramatically decreased to 50%compared to the other groups(log-rank 8.806,P<0.05).The EAD Olthoff and MEAF scores did not demonstrate predictive capacity for recipient or graft survival.Based on Kaplan-Meier survival curves,patients with a MEAF score≥7 had a lower graft survival rate at 6 months,2 years,and 5 years compared to patients with a lower MEAF score(log-rank 4.667,P<0.05).CONCLUSION In our series,both UK DCD risk score and MEAF score showed predictive capability for graft survival.

Normothermic regional perfusion mobile teams in controlled donation after circulatory death pathway: Evidence and peculiarities

To facilitate the implementation of controlled donation after circulatory death(cDCD)programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation(ECMO)team(Spokes),some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion(NRP)implantation in the setting of a cDCD pathway.While ECMO teams have been clearly defined by the Extracorporeal Life Support Organization,regarding composition,responsibilities and training programs,no clear,widely accepted indications are to date available for NRP teams.Although existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs,there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD pathway.Thus,in the present manuscript we summarized the character-istics of an ECMO mobile team,highlighting similarities and differences with the NRP mobile team.We also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program,especially for those centers who are starting the program.Differences were identified between the mobile ECMO team and NRP mobile team.The common essential feature for both mobile teams is high skills and experience to reduce complications and,in the case of cDCD,to reduce the total warm ischemic time.Dedicated training programs should be developed for the launch of de novo NRP teams.

Older liver grafts from donation after circulatory death are associated with impaired survival and higher incidence of biliary non-anastomotic structure

Background:Grafts from older donors after circulatory death were associated with inferior outcome in liver transplants in the past.But it has seemed to remain controversial in the last decade,as a result of modified clinical protocols,selected recipients,and advanced technology of organ perfusion and preservation.The present study aimed to examine the impact of older donor age on complications and survival of liver transplant using grafts from donation after circulatory death(DCD).Methods:A total of 944 patients who received DCD liver transplantation from 2015 to 2020 were included and divided into two groups:using graft from older donor(aged≥65 years,n=87)and younger donor(age<65 years,n=857).Propensity score matching(PSM)was applied to eliminate selection bias.Results:A progressively increased proportion of liver transplants with grafts from older donors was observed from 1.68%to 15.44%during the study period.The well-balanced older donor(n=79)and younger donor(n=79)were 1:1 matched.There were significantly more episodes of biliary nonanastomotic stricture(NAS)in the older donor group than the younger donor group[15/79(19.0%)vs.6/79(7.6%);P=0.017].The difference did not reach statistical significance regarding early allograft dysfunction(EAD)and primary non-function(PNF).Older livers had a trend toward inferior 1-,2-,3-year graft and overall survival compared with younger livers,but these differences were not statistically significant(63.1%,57.6%,57.6%vs.76.9%,70.2%,67.7%,P=0.112;64.4%,58.6%,58.6%vs.76.9%,72.2%,72.2%,P=0.064).The only risk factor for poor survival was ABO incompatible transplant(P=0.008)in the older donor group.In the subgroup of ABO incompatible cases,it demonstrated a significant difference in the rate of NAS between the older donor group and the younger donor group[6/8(75.0%)vs.3/14(21.4%);P=0.014].Conclusions:Transplants with grafts from older donors(aged≥65 years)after circulatory death are more frequently associated with inferior outcome compared to those from younger donors.Older grafts from DCD are more likely to develop NAS,especially in ABO incompatible cases.

Persistent left superior vena cava in right hemiarch replacement under deep hypothermic circulatory arrest:A case report

BACKGROUND Persistent left superior vena cava(PLSVC),a relatively rare thoracic vascular malformation,can inconvenience perfusionists and operators when encountered during deep hypothermic circulatory arrest(DHCA).CASE SUMMARY Herein,we describe the case of a patient with concurrent giant aortic arch aneurysm,aortic stenosis,and PLSVC.To treat these conditions,we performed right hemiarch and aortic valve replacements under DHCA.Notably,we applied“bilateral superior vena cava retrograde cerebral perfusion(RCP)”for cerebral protection,which significantly optimized the surgical procedure and reduced the risk of postoperative complications.The patient was discharged 14 d after surgery with no complications.CONCLUSION Surgical intervention for PLSVC under DHCA can be performed using the bilateral superior vena cava RCP approach.

Splanchnic vasodilation and hyperdynamic circulatory syndrome in cirrhosis

Portal hypertension is a clinical syndrome which leads to several clinical complications, such as the formation and rupture of esophageal and/or gastric varices, ascites, hepatic encephalopathy and hepato-renal syndrome. In cirrhosis, the primary cause of the increase in portal pressure is the enhanced resistance to portal outflow. However, also an increase in splanchnic blood flow worsens and maintains portal hypertension. The vasodilatation of arterial splanchnic vessels and the opening of collateral circulation are the determinants of the increased splanchnic blood flow. Several vasoactive systems/substances, such as nitric oxide, cyclooxygenase-derivatives, carbon monoxide and endogenous cannabinoids are activated in portal hypertension and are responsible for the marked splanchnic vasodilatation. Moreover, an impaired reactivity to vasoconstrictor systems, such as the sympathetic nervous system, vasopressin, angiotensin II and endothelin-1, plays a role in this process. The opening of collateral circulation occurs through the reperfusion and dilatation of preexisting vessels, but also through the generation of new vessels. Splanchnic vasodilatation leads to the onset of the hyperdynamic circulatory syndrome, a syndrome which occurs in patients with portal hypertension and is characterized by increased cardiac output and heart rate, and decreased systemic vascular resistance with low arterial blood pressure. Understanding the pathophysiology of splanchnic vasodilatation and hyperdynamic circulatory syndrome is mandatory for the prevention and treatment of portal hypertension and its severe complications.

MicroRNA expression in the hippocampal CA1 region under deep hypothermic circulatory arrest

Using deep hypothermic circulatory arrest, thoracic aorta diseases and complex heart diseases can be subjected to corrective procedures. However, mechanisms underlying brain protection during deep hypothermic circulatory arrest are unclear. After piglet models underwent 60 minutes of deep hypothermic circulatory arrest at 14°C, expression of microRNAs(miRNAs) was analyzed in the hippocampus by microarray. Subsequently, TargetScan 6.2, RNA22 v2.0, miRWalk 2.0, and miRanda were used to predict potential targets, and gene ontology enrichment analysis was carried out to identify functional pathways involved. Quantitative reverse transcription-polymerase chain reaction was conducted to verify miRNA changes. Deep hypothermic circulatory arrest altered the expression of 35 miRNAs. Twenty-two miRNAs were significantly downregulated and thirteen miRNAs were significantly upregulated in the hippocampus after deep hypothermic circulatory arrest. Six out of eight targets among the differentially expressed miRNAs were enriched for neuronal projection(cyclin dependent kinase, CDK16 and SLC1 A2), central nervous system development(FOXO3, TYRO3, and SLC1 A2), ion transmembrane transporter activity(ATP2 B2 and SLC1 A2), and interleukin-6 receptor binding(IL6 R)– these are the key functional pathways involved in cerebral protection during deep hypothermic circulatory arrest. Quantitative reverse transcription-polymerase chain reaction confirmed the results of microarray analysis. Our experimental results illustrate a new role for transcriptional regulation in deep hypothermic circulatory arrest, and provide significant insight for the development of miRNAs to treat brain injuries. All procedures were approved by the Animal Care Committee of Xuanwu Hospital, Capital Medical University, China on March 1, 2017(approval No. XW-INI-AD2017-0112).

Local regulator adrenomedullin contributes to the circulatory disturbance in cirrhotic rats

AIM： To investigate whether adrenomedullin, a potent vasodilator peptide, plays a role in the circulatory disturbance in cirrhosis. METHODS： Cirrhosis was induced in rats by weekly gavage of carbon tetrachloride. Hemodynamic studies were performed in vivo using radioactive microspheres and in vitro using isolated aortic rings. The adrenomedullin concentrations were measured by radioimmunoassay. RESULTS： Acute administration of adrenomedullin to the control rats reduced the systemic arterial pressure along with an increase of serum levels of the stable metabolite of nitric oxide （NOx）, in a dose-dependent manner. Chronic infusion of adrenomedullin reduced the vascular resistance and increased the blood flow in the systemic and splanchnic circulation. Intravenous administration of anti-adrenomedullin antibody did not affect any hemodynamic parameters in the cirrhotic rats, whereas this antibody ameliorated the blunted contractile response to phenylephrine, o-adrenergic receptor agonist, in the aortic rings of the cirrhotic rats. The adrenomedullin concentrations in the aorta were higher in the cirrhotic rats than in the controls, and correlated with the mean arterial pressure in the cirrhotic rats. Moreover, adrenomedullin blunted the contractile response to phenylephrine in both of the control aorta and cirrhotic aorta, but not in the presence of NG-nitro L-arginine methyl ester, an NO synthase inhibitor. CONCLUSION： Adrenomedullin overproduced in the vascular wall may contribute to the circulatory disturbance in cirrhosis as a local regulator of the vascular tonus rather than a circulating hormone.

Role of PGI_2 in the formation and maintenance of hyperdynamic circulatory state of portal hypertensive rats

AIM: To investigate the role of prostacyclin (PGI2) and nitric oxide (NO) in the development and maintenance of hyperdynamic circulatory state of chronic portal hypertensive rats. METHODS: Ninety male Sprague-Dawley rats were divided into three groups: intrahepatic portal hypertension (IHPH) group by injection of CCI4, prehepatic portal hypertension (PHPH) group by partial stenosis of the portal vein and sham-operation control (SO) group. One week after the models were made, animals in each group were subdivided into 4 groups: saline controlled group (n = 23), Nω-nitro-L-arginine (L-NNA)group (n = 21) group, indomethacin (INDO) group (n = 22) and high-dose heparin group (n = 24). The rats were administrated 1mL of saline, L-NNA (3.3 mg/kg-d) and INDO (5 mg/kg·d) respectively through gastric tubes for one week/then heparin (200 IU/Kg/min) was given to rats by intravenous injection for an hour. Splanchnic and systemic hemodynamics were measured using radioactive microsphere techniques. The serum nitrate/nitrite(NO2-/NO3-) levels as a marker of production of NO were assessed by a colorimetric method, and concentration of 6-keto-PGF1α, a stable hydrolytic product of PGI2, was determined by radioimmunoassay. RESULTS: The concentrations of plasma 6-keto-PGFla (pg/mL) and serum NO2-/NO3- (μmol/L) in IHPH rats (1123.85±153.64, 73.34±4.31) and PHPH rats (891.88±83.11, 75.21±6.89) were significantly higher than those in SO rats (725.53±105.54, 58.79±8.47) (P<0.05). Compared with SO rats, total peripheral vascular resistance (TPR) and spanchnic vascular resistance (SVR) decreased but cardiac index (CI) and portal venous inflow (PVI) increased obviously in IHPH and PHPH rats (P<0.05). L-NNA and indomethacin could decrease the concentrations of plasma 6-keto-PGFla and serum NO2/7NO3-in IHPH and PHPH rats (P<0.05) .Meanwhile, CI, FPP and PVI lowered but MAP, TPR and SVR increased(P<0.05). After deduction of the action of NO, there was no significant correlation between plasma PGI2 level and hemodynamic parameters such as CI, TPR, PVI and SVR. However, after deduction of the action of PGI2, NO still correlated highly with the hemodynamic parameters, indicating that there was a close correlation between NO and the hemodynamic parameters. After administration of high-dose heparin, plasma 6-keto- concentrations in IHPH, PHPH and SO rats were significantly higher than those in rats administrated vehicle (P<0.05). On the contrary, levels of serum NO2-/NO3- in IHPH, PHPH and SO rats were significantly lower than those in rats administrated Vehicle (P<0.05). Compared with those rats administrated vehicle, the hemodynamic parameters of portal hypertensive rats, such as CI and PVI, declined significantly after administration of high-dose heparin (P<0.05), while TPR and SVR increased significantly (P<0.05). CONCLUSION: It is NO rather than PGI2 that is a mediator in the formation and maintenance of hyperdynamic circulatory state of chronic portal hypertensive rats.

1400W reduces ischemia reperfusion injury in an ex-vivo porcine model of the donation after circulatory death kidney donor

AIM: To investigate the effects of 1400W-a selective inducible nitric oxide synthase(iN OS) inhibitor in a model of donation after circulatory death(DCD) kidneys. METHODS: Porcine kidneys were retrieved after 25 min warm ischemia. They were then stored on ice for 18 h before being reperfused ex vivo with oxygenated autologous blood on an isolated organ perfusion system. The selective i NOS inhibitor 1400W(10 mg/kg) was administered before reperfusion(n = 6) vs control group(n = 7). Creatinine(1000 μmol/L) was added to the system, renal and tubular cell function and the level of ischemia reperfusion injury were assessed over 3 h of reperfusion using plasma, urine and tissue samples. RESULTS: Kidneys treated with 1400 W had a higher level of creatinine clearance(CrC l) [area under the curve(AUC) CrC l: 2.37 ± 0.97 mL /min per 100 g vs 0.96 ± 0.32 mL /min per 100 g, P = 0.004] and urine output [Total: 320 ± 96 mL vs 156 ± 82 mL, P = 0.008]. There was no significant difference in levels of fractional excretion of sodium(AUC, Fr ex Na+: Control, 186.3% ± 81.7%.h vs 1400 W, 153.4% ± 12.1%.h, P = 0.429). Levels of total protein creatinine ratio were significantly lower in the 1400 W group after 1 h of reperfusion(1h Pr/Cr: 1400 W 9068 ± 6910 mg/L/mmol/L vs Control 21586 ± 5464 mg/L/mmol/L, P = 0.026). Levels of 8-isoprostane were significantly lower in the 1400 W group [8-iso/creatinine ratio: Control 239 ± 136 pg/L/mmol/L vs 1400 W 139 ± 47 pg/L/mmol/L, P = 0.041].CONCLUSION: This study demonstrated that 1400 W reduced ischaemia reperfusion injury in this porcine kidney model of DCD donor. Kidneys had improved renal function and reduced oxidative stress.

Application of cerebral-myocardial perfusion combined with lower body circulatory arrest in pediatric complex aortic arch surgery

Background Adjunct RCP to DHCA ensures some extent uninterrupted cerebral perfusion and that promotes one-stage repair of complex aortic arch anomaly.One-stage repair may induce longer myocardial ischemic time.So there evolved cerebral-myocardial perfusion to reduce myocardial ischemic time.Methods We reviewed 78 patients from January 2010 to July 2017 in our center.

Donor preoperative oxygen delivery and post-extubation hypoxia impact donation after circulatory death hypoxic cholangiopathy

AIM: To evaluate donation after circulatory death (DCD) orthotopic liver transplant outcomes [hypoxic cholangiopathy (HC) and patient/graft survival] and donor risk-conditions.METHODS: From 2003-2013, 45 DCD donor transplants were performed. Predonation physiologic data from UNOS DonorNet included preoperative systolic and diastolic blood pressure, heart rate, pH, SpO2, PaO2, FiO2, and hemoglobin. Mean arterial blood pressure was computed from the systolic and diastolic blood pressures. Donor preoperative arterial O2 content was computed as [hemoglobin (gm/dL) × 1.37 (mL O2/gm) × SpO2%) + (0.003 × PaO2)]. The amount of preoperative donor red blood cell transfusions given and vasopressor use during the intensive care unit stay were documented. Donors who were transfused ≥ 1 unit of red-cells or received ≥ 2 vasopressors in the preoperative period were categorized as the red-cell/multi-pressor group. Following withdrawal of life support, donor ischemia time was computed as the number-of-minutes from onset of diastolic blood pressure < 60 mmHg until aortic cross clamping. Donor hypoxemia time was the number-of-minutes from onset of pulse oximetry < 80% until clamping. Donor hypoxia score was (ischemia time + hypoxemia time) ÷ donor preoperative hemoglobin.RESULTS: The 1, 3, and 5 year graft and patient survival rates were 83%, 77%, 60%; and 92%, 84%, and 72%, respectively. HC occurred in 49% with 16% requiring retransplant. HC occurred in donors with increased age (33.0 ± 10.6 years vs 25.6 ± 8.4 years, P = 0.014), less preoperative multiple vasopressors or red-cell transfusion (9.5% vs 54.6%, P = 0.002), lower preoperative hemoglobin (10.7 ± 2.2 gm/dL vs 12.3 ± 2.1 gm/dL, P = 0.017), lower preoperative arterial oxygen content (14.8 ± 2.8 mL O2/100 mL blood vs 16.8 ± 3.3 mL O2/100 mL blood, P = 0.049), greater hypoxia score >2.0 (69.6% vs 25.0%, P = 0.006), and increased preoperative mean arterial pressure (92.7 ± 16.2 mmHg vs 83.8 ± 18.5 mmHg, P = 0.10). HC was independently associated with age, multi-pressor/red-cell transfusion status, arterial oxygen content, hypoxia score, and mean arterial pressure (r2 = 0.6197). The transplantation rate was greater for the later period with more liberal donor selection [era 2 (7.1/year)], compared to our early experience [era 1 (2.5/year)]. HC occurred in 63.0% during era 2 and in 29.4% during era 1 (P = 0.03). Era 2 donors had longer times for extubation-to-asystole (14.4 ± 4.7 m vs 9.3 ± 4.5 m, P = 0.001), ischemia (13.9 ± 5.9 m vs 9.7 ± 5.6 m, P = 0.03), and hypoxemia (16.0 ± 5.1 m vs 11.1 ± 6.7 m, P = 0.013) and a higher hypoxia score > 2.0 rate (73.1% vs 28.6%, P = 0.006).CONCLUSION: Easily measured donor indices, including a hypoxia score, provide an objective measure of DCD liver transplantation risk for recipient HC. Donor selection criteria influence HC rates.

Mechanical Circulatory Support for the Failing Heart:Which Device to Choose

Critical cardiogenic shock remains a problem with staggering mortality,with the best hope of survival depending on timely and aggressive intervention.This often requires the use of extracorporeal mechanical support in addition to vasoactive medications to manage patients through their initial insult.The decision to use such support must be made early in the clinical presentation,and is best done in a multidisciplinary fashion.In this article,we review the literature and provide an algorithm for the treatment of cardiogenic shock.

Isolated Type C Interrupted Aortic Arch in Adult:Extra-anatomic Repair Using Circulatory Arrest

INTERRUPTED aortic arch （IAA） is a rare congenital malformation that occurs in 5.8 per million live births. 1 IAA was thought to be incompatible with life once the ductus arteriosus closed. However, ifextensive collateral circulation is p possible. We report treated successfully an unusual resent at case of with extra-anatomic under deep hypothermia drculatory arrest birth survival is IAA, who was aortic repair

Synthesis and Metabolism of 5-hydroxytryptamine in Peripheral Circulatory System of Suckling Piglets

[ Objective] To find the rule of 5-hydroxytryptamine （5-HT） synthesis and metabolism in peripheral blood of suckling piglets with aging. [ Method ] All of 15 British Large White pigs at 0, 5 and 15 d of age were selected as experimental animals, and their serumal concentrations of L- tryptophan （L-Trp）, 5-HT and 5-hydroxyindoleacetic acid （5-HIAA） in peripheral circulatory system were determined synchronously by reversed- phase high-performance liquid chromatography method with UV. [ Result] The concentration of L-Trp was （16. 92 ± 1.74） iJmol/L at birth, （59.94 ±10.88） iJmol/L at 5 d of age and （70.42± 6.48） μmol/L at 15 d of age. The concentration of 5-HT was （ 12.85 ± 1.79） iJmol/L at birth, （4.81 ±2.05） ijmol/L at 5 d of age and （5.49±1.09） μmol/L at 15 d of age. While 5-HIAA, the metabolic product of 5-HT, was not detected at all the samples selected. [ Conclusion] The L-Trp concentration of suckling piglets increase significantly with aging （ P 〈0. 05）. While the concentra- tion of 5-HT and the conversion ratio of L-Trp to 5-HT are both highest at birth （P〈0.05） and keep stable at 5 and 15 d of age.

Investigating the circulatory-respiratory response of elderly people during Tai Chi Yuttari-exercise

The purpose of this study was to examine the circulatory-respiratory dynamics in elderly people during Tai Chi Yuttari-exercise. The subjects were females with an average age of 74 years who had been continuously practicing Tai Chi Yuttari-exercise for at least six months. The heart rate and blood pressure were measured before and after the subjects performed four different versions of Tai Chi Yuttari-exercise. The perceived exertion was evaluated using the Borg scale. The respiratory rate, oxygen uptake and respiratory quotient (RQ) were measured using an expired gas analyzer. The results showed an increase in heart rate during exercise, but confirmed that the rise in HR was below the safety limit. The blood pressure tended to be low post-exercise. Regarding perceived exertion, the maximum heart-lungs Borg scale response was 9 (very light). A slight increase in the respiratory rate was observed while exercising, but no abnormal breathing patterns were observed. The average metabolic equivalents (METs) of the exercise ranged from 1.34 to 1.87, and the average RQ ranged from 0.82 to 0.90. The circulatory-respiratory dynamics observed in this study verified that elderly females with an average age of 70 years could safely perform the Tai Chi Yuttari-exercise. This study helped obtain basic data for expanding the indications for this exercise.

PSYCHOLOGICAL DEVELOPMENT OF CHILDREN AFTER CARDIAC SURGERY WITH PROFOUND HYPOTHERMIA AND CIRCULATORY ARREST

Fifty-three patients with congenital heart disease were follwed up 14 to 57months after cardiac surgery with profound hypothermia and circulatory arrest.Meanintelligence quotient(IQ)was 88.6±16.1The incidence of psychological underdevelopedwas 13.2(7/53),higher than normal children population,The high incidence may be attri-buted to poor preoperative intellecutual development.The circulatory arrest time weremore than 60 minutes in 9 cases,41-60 minutes in 32 cases and less than 40 minutes inanother 12 cases.The IQ of these three groups were 84.8±11.9,86.2±15.7and 95.3±19.2respctively and incidence of psychological underdeveloped were 11.1%,15.6% and 8.5%respectively,No significant difference existed between groups.The time of circulatory ar-rest also had no obvious correlation with IQ.

Gender Difference in Circulatory Associated Multi-Morbidity among the Elderly in Rural Southwest China

Aim: This study examined the prevalence of four chronic circulatory system diseases (hypertension, CHD, hyperlipemia, Stroke) and associated multi-morbidity in order to identify the risk factors among the elderly in Yunnan province. Methods: A cross-sectional survey including 2299 consenting adults aged ≥ 60 years from rural places was conducted in 2018. Data of demographic parameters and clinical characteristics were acquired from questionnaire and health examination. Categorical variables were presented as counts and percentages. Multivariable logistic regression analysis was used to analyze the association between individual SES and lifestyle variables and multimorbidity of the four chronic cardiovascular and cerebrovascular diseases. All analyses were conducted with SPSS 17.0 software. Results: Our study suggested that the prevalence of hypertension, CHD, hyperlipemia, Stroke was 57.1%, 4.2%, 5.9% and 5.3%, respectively and the prevalence of multimorbidity was 10.3%. Females had a higher prevalence of family history of chronic cardiovascular and cerebrovascular diseases, obesity, central obesity and illiteracy than males (P < 0.01), whereas males had a markedly higher prevalence of drinking, smoking and good sleeping quality than females (P < 0.01). The family genetic history, obesity, smoking, education, and diabetes were positively and drinking was negatively correlated with the prevalence of circulatory associated multimorbidity in elderly. Interestingly, some of the above associations were only observed in male/female but not the other sex. Conclusions: The prevalence of circulatory disease associated multimorbidity is relatively high among elderly population in rural places of Yunan province and the risk factors are different between females and males.

Influence of Free Indoor Football Play （FISP） on the Circulatory System, among Overweight Young Adult Male

For middle age individuals （male）, it may be difficult to find motivation for suitable exercise training, which has similarly favorable characteristics for cardiovascular adaptations as other exercises performed by younger individuals. Fifty four （n = 54）; （age = 41.57±3.25） untrained, overweight （F% = 19.52 ± 5.6）, range of （12.6-30.6）, （visceral fat area （VFA） = 111.1 cm^-2） healthy male （they are managers in four different Banks） were taking part in this research program. The participants took part on preliminary cardiac examination （echocardiography, GE Vivid 9 ultrasound machine. Body composition measured with type of ＂InBody720＂ （Biospace Co. Inc., Seoul, South Korea） Bioelectrical Impedance Analyzer （BIA）. The heart rate of the participants was measured continuously during all training sessions using heart rate belts （POLAR Team System, Finland）. Pulmonary gas exchange ＂Cardiosoft＂, （Milwaukee, USA were measured during a standardized treadmill test. Results： In many cases of the free indoor soccer play （FISP） recorded extremely high pulse rate, which is compared with the laboratory high pulse rate （LHPR）, much higher than the recommended physiological load level HR（FISP） 〉 190 beat/min; HR（LHPR） = 175 beat/min ; P 〈 0.001. Despite the many advantages of the Free Indoor Football Play （FISP） are hiding a lot of dangerous in the terms of circulatory adaptation.

Allometric Scaling by the Length of the Circulatory Network

Background: Allometric scaling is a well-known research tool used for the metabolic rates of organisms. It measures the living systems with fractal physiology. The metabolic rate versus the mass of the living species has a definite scaling and behaves like a four-dimensional phenomenon. The extended investigations focus on the mass-dependence of the various physiological parameters. Objective: Proving the length of vascularization is the scaling parameter instead of mass in allometric relation. Method: The description of the energy balance of the ontogenic growth of the tumor is an extended cell-death parameter for studying the mass balance at the cellular level. Results: It is shown that when a malignant cellular cluster tries to maximize its metabolic rate, it changes its allometric scaling exponent. A growth description could follow the heterogenic development of the tumor. The mass in the allometric scaling could be replaced by the average length of the circulatory system in each case. Conclusion: According to this concept, the dependence of the mass in allometric scaling is replaced with a more fundamental parameter, the length character of the circulatory system. The introduced scaling parameter has primary importance in cancer development, where the elongation of the circulatory length by angiogenesis is in significant demand.

Role of the circulatory interleukin-6 in the pathogenesis of gliomas:A systematic review

BACKGROUND Glioma is the most common primary tumor in the brain originating from glial cells.In spite of extensive research,the overall survival rate is not enhanced.A number of published articles observed differentially circulating levels of cytokines in glioma.Interleukin-6(IL-6)protein coded by IL-6 gene is regulated by the immune system and it has been found to have a significant role in progression and apoptosis resistance of glioma.AIM To review the role of circulatory IL-6 in the development and progression of glioma and its utility as a biomarker.METHODS Preferred Reporting Items for Systematic Reviews and Meta-analysis(PRISMA)guidelines were applied to filter the relevant studies based on inclusion and exclusion criteria.We used a combination of keywords and the Reference Citation Analysis(RCA)tool to search the potential studies and performed data extraction from selected studies.RESULTS The published results were inconsistent;however,most studies showed a significantly higher IL-6 level in glioma cases as compared to controls.Comparative IL-6 level among the different grades of glioma showed a higher level with low-grade gliomas and lower level with high-grade gliomas.CONCLUSION IL-6 level significantly differed between cases and controls,and among different cancer stages,which shows its potential as a diagnostic and prognostic marker.