Clinical Application of Extracorporeal Membrane Oxygenation in the Treatment of Fulminant Myocarditis.

Fulminant myocarditis (FM) is a rare but serious clinical syndrome which can be characterized by the rapid deterioration of cardiac function, with cardiogenic shock (CS) and arrhythmic electrical storms being common presentations, often requiring adjunctive support with mechanical circulatory devices. With the development of mechanical circulatory support (MCS) devices, there are now more and more studies investigating the application of MCS in FM patients, and the use of extracorporeal membrane oxygenation (ECMO) to treat FM has shown good survival rates. This review elucidates the treatment of FM, and the application and clinical outcomes associated with ECMO intervention.

Ultra-efficient removal of aqueous hexavalent chromium by activated biochar nanoparticles derived from squid ink.

Biochar have been recognized as efficient and renewable carbon sorbents, which attracted much attention on Cr contamination remediation in wastewater. In this study, we propose a cost-effective one-step strategy to synthesize activated biochar nanoparticles derived from squid ink (AS-BC) for aqueous Cr(VI) removal. The results demonstrated that AS-BC achieved a removal rate of 24.29 h-1 at 700 °C (400-times higher than the unmodified one). This was also a state-of-the-art removal performance for aqueous Cr(VI) compared to other reported materials. AS-BC possessed an enormous specific surface (2408 m2/g at 700 °C) with abundant O- and N-containing groups, condensed aromatic structures, and high electron transfer capacity (3.64 and 2.13 mmol e-/g for EAC and EDC at 700 °C), contributing to the ultra-efficient removal of Cr(VI) by synergistic adsorption and reduction. AS-BC absorbed Cr(VI) in the form of HCrO4- by electrostatic attraction with protonated amine-N and hydroxy (-NH3+ and -OH2+) groups and Cr(III) in the form of Cr3+ by complexation with amine-N and hydroxy groups. With a hydroxy-quinone and conjugated π-electron system, AS-BC served as mediator and shuttle to accelerate electron transfer in Cr(VI) reduction with an electron donor. Therefore, our findings highlight the immense potential of AS-BC biochar nanoparticles represent a potential alternative for high-performance Cr(VI) remediation in wastewater.

A data-driven approach for understanding the structure dependence of redox activity in humic substances.

Humic substances (HS) can facilitate electron transfer during biogeochemical processes due to their redox properties, but the structure-redox activity relationships are still difficult to describe and poorly understood. Herein, the linear (Partial Least Squares regressions; PLS) and nonlinear (artificial neural network; ANN) models were applied to monitor the structure dependence of HS redox activities in terms of electron accepting (EAC), electron donating (EDC) and overall electron transfer capacities (ETC) using its physicochemical features as input variables. The PLS model exhibited a moderate ability with R2 values of 0.60, 0.53 and 0.65 to evaluate EAC, EDC and ETC, respectively. The variable influence in the projection (VIP) scores of the PLS identified that the phenols, quinones and aromatic systems were particularly important for describing the redox activities of HS. Compared with the PLS model, the back-propagation ANN model achieved higher performance with R2 values of 0.81, 0.65 and 0.78 for monitoring the EAC, EDC and ETC, respectively. Sensitivity analysis of the ANN separately identified that the EAC highly depended on quinones, aromatics and protein-like fluorophores, while the EDC depended on phenols, aromatics and humic-like fluorophores (or stable free radicals). Additionally, carboxylic groups were the best indicator for evaluating both the EAC and EDC. Good model performances were obtained from the selected features via the PLS and sensitivity analysis, further confirming the accuracy of describing the structure-redox activity relationships with these analyses. This study provides a potential approach for identifying the structure-activity relationships of HS and an efficient machine-learning model for predicting HS redox activities.

Pulmonary Embolism Caused by Tourniquets in the Lower Extremities Treated with ECMO - A Case Report.

BACKGROUND: Using tourniquets in the lower extremities can increase the incidence of deep vein thrombosis (DVT). Acute large-area pulmonary embolism (APE) occurs in severe cases, and it is fatal to most patients. Acute large-area pulmonary embolism causes haemodynamic instability, right heart failure, and circulatory failure. CASE PRESENTATION: A 47-year-old female patient was subjected to spinal anaesthesia for a comminuted fracture of the tibia and fibula of the left lower limb. After the tourniquet was released during the operation, she had sudden hypotension and lost consciousness. Thus, ECMO was used to support patient circulation. With ECMO-assisted CT examination, she was diagnosed to have a pulmonary embolism. On the next day, she was subjected to a bilateral pulmonary embolism and embolectomy. Lastly, she was transferred to the general ward and discharged smoothly. CONCLUSIONS: Patients undergoing fracture surgery should be wary of APE caused by the loss of DVT after the release of tourniquets. ECMO, as a rapid and effective temporary life support intervention, provides effective cardiopulmonary support and new treatment plans. It also saves time for further treatment of patients with high-risk APE.

A Case Report of Sedation Strategy for a Patient With Coronavirus Disease 2019 Supported by Extracorporeal Membrane Oxygenation After Cesarean Section.

Pneumonia caused by coronavirus disease 2019 (COVID-19) is a highly contagious disease. Unfortunately, research on extracorporeal membrane oxygenation (ECMO) assisted treatments for patients with COVID-19 infection is limited. In this case study, a patient who was in late pregnancy (35+2 weeks of pregnancy) and suffering from severe COVID-19 was extremely irritable during ECMO-assisted treatment after she underwent a cesarean section. Her Richmond Agitation Sedation Scale (RASS) score reached +3. Nevertheless, the patient successfully was treated with a continuous single/combined application of propofol, midazolam, dexmedetomidine, hibernation mixture, and other drugs for several days (maintaining RASS -2 to -4) and provided with anti-infection, mechanical ventilation, nutritional support, fluid balance under hemodynamic monitoring, liver support, and other organ function support treatments. ECMO-assisted sedation strategy for patients was introduced and discussed in this case to provide a certain reference for the clinical diagnosis and treatment of such patients.

Vascular Complications of Lower Limb Ischemia in Patients with Femoral Venoarterial Extracorporeal Membrane Oxygenation.

BACKGROUND: Lower limb ischemia in patients with extracorporeal membrane oxygenation (ECMO) via femoral artery catheterization negatively affects patient mortality and survivors' quality of life [Gulkarov 2020]. In this study, ECMO was established via femoral artery catheterization. This study aimed to identify the risk factors of lower limb ischemia to provide sufficient evidence for its prevention. METHODS: All patients with venoarterial (VA) ECMO via femoral artery catheterization in Zhongshan People's Hospital from January 2008 to November 2019 retrospectively were analyzed. Patients' general information and ECMO-related information were obtained, and the main outcome variables were survival and discharge and intubation-related adverse events (limb ischemia and incision bleeding). Logistic regression analysis was used to determine the independent risk factors of limb ischemia in patients with VA ECMO. RESULTS: A total of 179 (98 [54.7%] men and 81 [45.3%] women) eligible patients were included in this study. Moreover, a total of 90 patients (48.9%) had low cardiac output, 41 (22.3%) had acute myocardial infarction, and 33 (17.9%) had fulminant myocarditis. Eighty-six (48.04%) patients survived to hospital discharge, 36 (20.11%) had limb ischemia, and 42 (23.46%) had incision bleeding. Furthermore, the ECMO-assisted time was 114.23 ± 67.88 hours. There was no significant difference in age, sex, and Sequential Organ Failure Assessment score between the limb ischemia group and the non-limb ischemia group. Multivariate logistic regression analysis showed that peripheral artery disease (odds ratio, 27.12; 95% confidence interval, 5.614-130.96) was an independent risk factor of limb ischemia in patients with ECMO. CONCLUSION: Limb ischemia is a common complication in patients with VA ECMO, and peripheral artery disease is an independent risk factor of limb ischemia in patients with VA ECMO via femoral artery catheterization.

Full anti-apoptotic function of Bcl-XL complexed with Beclin-1 verified by live-cell FRET assays.

Binding of Bcl-XL to Beclin-1 reduces Beclin-1's capacity to induce autophagy. This report aims to explore whether this interaction affects Bcl-XL's anti-apoptotic function. Using fluorescence resonance energy transfer (FRET) two-hybrid assay to quantify the stoichiometry of Bcl-XL-Beclin-1 complex in living cells coexpressing Bcl-XL-CFP and Beclin-1-YFP, we showed that Bcl-XL bond to Beclin-1 to form hetero-oligomers whose stoichiometry increases from 1:1 to 2:1 or higher with the increasing relative expression level of Bcl-XL, indicating the multiple binding sites of Beclin-1 with Bcl-XL. Co-expression of Bcl-XL and Beclin-1 exhibited consistent anti-apoptotic ability against staurosporine (STS)-induced apoptosis with expression of Bcl-XL alone irrespective of the relative expression level between Beclin-1 and Bcl-XL. Collectively, Bcl-XL complexed with Beclin-1 maintains full anti-apoptotic ability independent of the stoichiometry of Bcl-XL-Beclin-1 complex.

Solithromycin monotherapy for treatment of community-acquired bacterial pneumonia: A meta-analysis of randomised controlled trials.

OBJECTIVES: Solithromycin is a new monotherapy option for community-acquired bacterial pneumonia (CABP) patients. However, the efficacy and safety of solithromycin monotherapy for the treatment of CABP remains controversial. The aim of this meta-analysis was to evaluate the role that solithromycin played in the treatment of CABP. METHODS: We systematically retrieved randomised controlled trials (RCTs) compared solithromycin with other antibiotics in the treatment of CABP, which were published on PubMed, ScienceDirect, Cochrane libary and the Clinical Trials.gov before July 2018. Ultimately, a meta-analysis of all RCTs eligible for inclusion criteria was performed. RESULTS: Three RCTs, comprising 1855 patients, were included in the meta-analysis. There were no statistically significant differences between patients given solithromycin and those given other antibiotics with regard to early clinical response (ECR) [1855 patients, odds ratio (OR) = 1.00, 95% confidence interval (CI) 0.80 to 1.24, P = 0.99] and clinical success rates at short-term follow-up (SFU) (1855 patients, OR = 0.78, 95% CI 0.60 to 1.01, P = 0.06) in the intention-to-treat (ITT) population, as were the ECR (787 patients, OR = 0.90, 95% CI 0.64 to 1.27, P = 0.55) and clinical success rates at SFU (358 patients, OR = 0.73, 95% CI 0.41 to 1.31, P = 0.30) in microbiological intention-to-treat population (mITT). Similarly, with regard to the occurrence of treatment-emergent adverse events (TEAEs), drug-related adverse events (AEs), serious AEs, serious drug-related AEs and mortality, no statistically significant difference between patients given solithromycin and those given other antibiotics was observed. CONCLUSION: In the treatment of CABP, solithromycin monotherapy is an effective and safe antibiotic regimen. Other advantages (ie anti-inflammatory effect, potent activity against expected pathogens of CABP and convenient clinical use) of solithromycin may make it a more fascinating option compared with the currently used regimens.

Compostibacillus humi gen. nov., sp. nov., a member of the family Bacillaceae, isolated from sludge compost.

Two novel Gram-staining-positive, rod-shaped, endospore-forming and moderately thermophilic bacteria, designated strains DX-3(T) and GIESS002, were isolated from sludge composts from Guangdong Province, China. Analysis of 16S rRNA gene sequences revealed that the isolates were closely related to each other with extremely high similarity (99.6 %), and were members of the family Bacillaceae. However, these two isolates formed a novel phylogenetic branch within this family. Their closest relatives were the members of the genera Ornithinibacillus, Oceanobacillus and Virgibacillus. Cells of both strains were facultatively anaerobic and catalase- and oxidase-positive. The cell-wall peptidoglycan type was A1γ (meso-diaminopimelic acid direct). The predominant isoprenoid quinone was MK-7. The main polar lipids were diphosphatidylglycerol, phosphatidylglycerol and phosphatidylethanolamine. The major cellular fatty acid was iso-C15 : 0. The DNA G+C content was 43.2-43.7 mol%. The results of a polyphasic taxonomic study indicated that strains DX-3(T) and GIESS002 represent a novel species in a new genus in the family Bacillaceae, order Bacillales, for which the name Compostibacillus humi gen. nov., sp. nov. is proposed. The type strain is DX-3(T) ( = KCTC 33104(T) = CGMCC 1.12360(T)).

Concatenated logic circuits based on a three-way DNA junction: a keypad-lock security system with visible readout and an automatic reset function.

Concatenated logic circuits operating as a biocomputing keypad-lock security system with an automatic reset function have been successfully constructed on the basis of toehold-mediated strand displacement and three-way-DNA-junction architecture. In comparison with previously reported keypad locks, the distinctive advantage of the proposed security system is that it can be reset and cycled spontaneously a large number of times without an external stimulus, thus making practical applications possible. By the use of a split-G-quadruplex DNAzyme as the signal reporter, the output of the keypad lock can be recognized readily by the naked eye. The "lock" is opened only when the inputs are introduced in an exact order. This requirement provides defense against illegal invasion to protect information at the molecular scale.

Disposable strip biosensor for visual detection of Hg(2+) based on Hg(2+)-triggered toehold binding and exonuclease III-assisted signal amplification.

A disposable strip biosensor for the visual detection of Hg(2+) in aqueous solution has been constructed on the basis of Hg(2+)-triggered toehold binding and exonuclease III (Exo III)-assisted signal amplification. Thymine-thymine (T-T) mismatches in the toehold domains can serve as specific recognition elements for Hg(2+) binding with the help of T-Hg(2+)-T base pairs to initiate toehold-mediated strand displacement reaction. Exo III-catalyzed target recycling strategy is introduced to improve the sensitivity. Using gold nanoparticles as a tracer, the output signals can be directly observed by the naked eye. The assay is ultrasensitive, enabling the visual detection of trace amounts of Hg(2+) as low as 1 pM without instrumentation. This sensing system also displays remarkable specificity to Hg(2+) against other possible competing ions. This sensor is robust and can be applied to the reliable monitoring of spiked Hg(2+) in environmental water samples with good recovery and accuracy. With the advantages of cost-effectiveness, simplicity, portability, and convenience, the disposable strip biosensor will be a promising candidate for point-of-use monitoring of Hg(2+) in environmental and biological samples.

Bacillus thermophilum sp. nov., isolated from a microbial fuel cell.

A novel thermophilic, Gram-staining positive bacterium, designated DX-2(T), was isolated from the anode biofilm of a microbial fuel cell. Cells of the strain were oxidase positive, catalase positive, facultative anaerobic, motile rods. The isolate grew at 30-60 °C (optimum 50 °C) and pH 5-9 (optimum pH 8-8.5). The pairwise 16S rRNA gene sequence similarities showed that strain DX-2(T) was most closely related to Bacillus fumarioli LMG 17489(T) (96.2 %), B. firmus JCM 2512(T) (96.0 %) and B. foraminis DSM 19613(T) (95.7 %). Phylogenetic analysis based on 16S rRNA gene sequences showed that strain DX-2(T) formed a cluster with B. smithii (95.5 %) and B. infernus (94.9 %). The genomic G+C content of DX-2(T) was 43.7 mol%. The predominant respiratory quinone was MK-7. The polar lipids consisted of diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine and unknown phospholipids. The major cellular fatty acid was iso-C16:0. Based on its phenotypic characteristics, chemotaxonomic features, and results of phylogenetic analysis, the strain was identified to represent a distinct novel species in the genus Bacillus, and the name proposed is B. thermophilum sp. nov. The type strain is DX-2(T) (=CCTCC AB2012194(T) = KCTC 33128(T)).

Pseudomonas sihuiensis sp. nov., isolated from a forest soil in South China.

A Gram-stain negative, motile, rod-shaped bacterium, designated strain WM-2(T), was isolated from a forest soil in Sihui City, South China, and characterized by means of a polyphasic approach. Growth occurred with 0-5 % (w/v) NaCl (optimum 0-1 %) and at pH 5.0-10.5 (optimum pH 8.5) and 4-40 °C (optimum 30 °C) in Luria-Bertani medium. Comparative 16S rRNA gene sequence analyses showed that strain WM-2(T) is a member of the genus Pseudomonas and most closely related to P. guguanensis, P. oleovorans subsp. lubricantis, P. toyotomiensis, P. alcaliphila and P. mendocina with 97.1-96.6 % sequence similarities. In terms of gyrB and rpoB gene sequences, strain WM-2(T) showed the highest similarity with the type strains of the species P. toyotomiensis and P. alcaliphila. The DNA-DNA relatedness values of strain WM-2(T) with P. guguanensis and P. oleovorans subsp. lubricantis was 48.7 and 37.2 %, respectively. Chemotaxonomic characteristics (the main ubiquinone Q-9, major fatty acids C18:1 ω7c/C18:1 ω6c, C16:0 and C16:1 ω7c/C16:1 ω6c and DNA G+C content 65.2 ± 0.7 mol%) were similar to those of members of the genus Pseudomonas. Polar lipids consisted of diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, an unknown aminophospholipid, an unknown phospholipid and five unknown lipids. According to the results of polyphasic analyses, strain WM-2(T) represents a novel species in the genus Pseudomonas, for which the name Pseudomonas sihuiensis sp. nov. is proposed. The type strain is WM-2(T) (=KCTC 32246(T)=CGMCC 1.12407(T)).

The selective ASIC3 inhibitor APETx2 alleviates gastric mucosal lesion in the rat.

This study aimed to assess the in vivo efficacy of acid sensing ion channel 3 (ASIC3) inhibitor APETx2 to alleviate acute gastric mucosal lesion (AGML) in a rat model. Thirty-six male Wistar rats were divided randomly into three groups: control group, water immersion restraint stress (WIRS) group, and APETx2 treatment group (n = 12). AGML was induced by WIRS for 6 h, and 25 microg/kg APETx2 was injected intraperitoneally before the onset of stress. Intragastric pH, ulcer index (UI) and gastric histopathological changes were measured, ASIC3 expression in thoracic dorsal root ganglia (DRG) neurons was examined by immunohistochemistry, PCR and Western blot analysis. Compared with control group, WIRS group showed obvious gastric injury with increased UI score, decreased intragastric pH and increased ASIC3 expression in DRG neurons (p < 0.05). APETx2 treatment before WIRS significantly alleviated gastric mucosal injury, decreased UI score, decreased gastric acidity and reduced ASIC3 expression in thoracic DRG neurons (p < 0.05). In conclusion, ASIC3 expression in DRG neurons projecting to the stomach is positively correlated with gastric mucosal lesion and acidosis in WIRS model. ASIC3 inhibitor APETx2 could improve gastric acidosis and alleviate AGML.

Dexmedetomidine Pretreatment Confers Myocardial Protection and Reduces Mechanical Ventilation Duration for Patients Undergoing Cardiac Valve Replacement under Cardiopulmonary Bypass.

PURPOSE: The study aims to assess the effects of dexmedetomidine (Dex) pretreatment on patients during cardiac valve replacement under cardiopulmonary bypass. METHODS: For patients in the Dex group (n = 52), 0.5 µg/kg Dex was given before anesthesia induction, followed by 0.5 µg/kg/h pumping injection before aortic occlusion. For patients in the control group (n = 52), 0.125 ml/kg normal saline was given instead of Dex. RESULTS: The patients in the Dex group had longer time to first dose of rescue propofol than the control group (P = 0.003). The Dex group required less total dosage of propofol than the control group (P = 0.0001). The levels of cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB), malondialdehyde (MDA), and tumor necrosis factor-α (TNF-α) were lower in the Dex group than the control group at T4, 8 h after the operation (T5), and 24 h after the operation (T6) (P <0.01). The Dex group required less time for mechanical ventilation than the control group (P = 0.003). CONCLUSION: The study suggests that 0.50 µg/kg Dex pretreatment could reduce propofol use and the duration of mechanical ventilation, and confer myocardial protection without increased adverse events during cardiac valve replacement.

The application of extracorporeal membrane oxygenation in emergent airway management - a single-center retrospective study.

BACKGROUND: Emergent airway occurrences pose a significant threat to patient life. Extracorporeal membrane oxygenation (ECMO) has been proven to be an effective method for managing emergent airways. METHODS: A retrospective analysis was conducted on all patients receiving ECMO as an adjunct for emergent airway management from January 2018 to December 2022 at the People's Hospital of Zhongshan City. We collected the basic information of the patients, their blood gas data before and after ECMO, the related parameters of ECMO, and the outcome and then analyzed and summarized these data. RESULTS: Six patients, with an average age of 51.0(28-66) years, received veno-venous (VV)- ECMO as an adjunct due to emergent airway issues. The average ECMO support duration was 30.5(11-48) hours. All six patients were successfully weaned off ECMO support, with five (83.3%) being successfully discharged after a hospital stay of 15.5(7-55) days. All six patients underwent VV-ECMO through femoral-internal jugular vein cannulation. Among these, five patients, whose airway obstruction was due to hemorrhage, underwent a non-anticoagulant ECMO strategy with no recorded thrombotic events. CONCLUSIONS: The rapid establishment of ECMO support is aided by the establishment of a standardized ECMO initiation protocol and the formation of a multidisciplinary rapid-response ECMO team, which is particularly crucial for emergent airway management. When airway obstruction results from hemorrhagic factors, the early adoption of a non-anticoagulant ECMO strategy can be considered when implementing VV-ECMO.