The low hemoglobin levels were associated with mortality in post-cardiotomy patients undergoing venoarterial extracorporeal membrane oxygenation.

BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used as a rescue strategy for patients with refractory post-cardiotomy cardiogenic shock (PCS). These patients often have varying degrees of reduced hemoglobin levels, and there are few detailed investigations about the impact of hemoglobin level on their mortality. The objective of this study was to evaluate whether hemoglobin levels at day 1 from VA-ECMO initiation were associated with in-hospital mortality. METHODS: We performed a retrospective analysis of adult VA-ECMO patients over approximately a 2-year period. We divided patients into survival and death groups based on their clinical outcomes and compared the differences in parameters between the two groups. Multivariate logistic regression analyses were performed to estimate whether hemoglobin level was related to the mortality. RESULTS: One hundred and sixteen patients were included in final analysis. There were 52 patients in the survival group and 64 in the death group. The patients were younger in the survival group than the death group (58 vs 63, p = .023). The median (IQR) hemoglobin level at day 1 was 80 (73-89) × g/L, and the median (IQR) RelΔ hemoglobin was 41% (32-48%). Survival patients had a higher hemoglobin level at day 1 and a lower RelΔ hemoglobin than the death patients (91 vs 76 g/L, p < .001; 35% vs 45%, p < .001). The multivariable logistic regression analyses showed that the low hemoglobin levels at day 1 were independently associated with in-hospital mortality (OR 0.808; 95% CI, 0.747-0.874; p < .001). The AUROC for hemoglobin level was 0.89 (95% CI, 0.83-0.95) which was better than that of RelΔ hemoglobin (0.77, 95% CI, 0.68-0.86). CONCLUSIONS: In patients receiving VA-ECMO for PCS, the low hemoglobin levels at day 1 were independently associated with in-hospital mortality.

Soluble ST2 predicts continuous renal replacement therapy in patients receiving venoarterial extracorporeal membrane oxygenation.

OBJECTIVE: This study aimed to evaluate the relationship between plasma soluble ST2 (sST2) levels 24 h after extracorporeal membrane oxygenation (ECMO) initiation and continuous renal replacement therapy (CRRT) in patients receiving venoarterial ECMO (V-A ECMO) support. METHODS AND RESULTS: Data of patients who received ECMO support for postcardiotomy cardiogenic shock between January 2017 and July 2019 were retrospectively collected from Beijing Anzhen Hospital, Capital Medical University. Ultimately, 116 patients were included in the present study for analysis. The concentration of sST2 was determined by enzyme-linked immunosorbent assay (ELISA). The log10 sST2 levels were higher in patients undergoing CRRT than those who did not (6.06 vs. 6.22, p = 0.019). Patients undergoing CRRT had a lower survival rate than those who did not (32.8% vs. 67.3%, p < 0.001). In the univariate logistic regression analysis, sST2, HCO3-, lactate, and creatinine levels 24 h after ECMO initiation were related to CRRT (p < 0.05). In the multivariate logistic regression analysis, HCO3- and sST2 were identified as independent risk factors for CRRT use in patients undergoing ECMO (p < 0.05). The area under receiver operator characteristic curve (AUC) for sST2 and HCO3- together was 0.72 (95% confidence interval (CI), 0.79-0.91), which was better than those of sST2 or HCO3- alone (0.63 vs. 0.67). CONCLUSIONS: sST2 and HCO3-levels at 24 h after ECMO initiation were associated with CRRT and could predict CRRT use in postcardiotomy cardiogenic shock patients undergoing ECMO.

Prevalence of burnout among perfusionists in China: A nationwide survey.

BACKGROUND: Burnout has gained increasing attention worldwide as a phenomenon that affects health care professionals. However, there is a lack of relevant research about its impact on practitioners in the field of cardiovascular perfusion in China. This study investigated the prevalence of and the factors associated with the burnout affecting perfusionists in mainland China. METHODS: This national cross-sectional study included perfusionists from 31 provinces in mainland China. Participants were asked to complete a self-administered questionnaire, which included three parts: (1) demographic information, (2) work-related information, and (3) dissatisfaction with work and sources of pressure. The levels of burnout were calculated, and logistic regression was used to analyze the factors associated with burnout. RESULTS: The questionnaire, created by the survey program "Questionnaire Star", was sent to 2211 perfusionists in mainland China. A final sample of 1813 perfusionists participated in the survey, with a participation rate of 82.0% (1813/2211). The prevalence of burnout and severe burnout was 86.0% (1559/1813, 95%CI: 84.3%-87.5%) and 13.3% (241/1813, 95%CI: 11.8%-15.0%), respectively. The logistic regression analysis revealed that age [20-29 years, odds ratio (OR) = 1; 30-39 years, OR = 2.009; 40-49 years, OR = 2.220], educational background (bachelor and below, OR = 1; postgraduate, OR = 1.472), and professional background (others, OR = 1; surgery, OR = 1.283; anesthesiology, OR = 2.004) were associated with burnout. We also found that age (20-29 years, OR = 1; 30-39 years, OR = 1.928), professional background (others, OR = 1; surgery, OR = 1.734; anesthesiology, OR = 2.257), annual cardiopulmonary bypass (CPB) case load in the most recent 3 years (< 50, OR = 1; 50-100, OR = 1.613; 100-300, OR = 1.702; ≥300, OR = 2.637), and income level [< 5000 (RMB/month), OR = 1; 5000-10,000, OR = 0.587; 10,000-20,000, OR = 0.366] were associated with severe burnout among perfusionists. CONCLUSIONS: Cardiovascular perfusionists in mainland China experience high rates of burnout. Age, the professional background, annual CPB caseload in the most recent 3 years, and income level are independently associated with the burnout rates experienced by these health care professionals.

Phylotranscriptomics reveals the complex evolutionary and biogeographic history of the genus Tsuga with an East Asian-North American disjunct distribution.

The disjunct distribution between East Asia and North America is one of the best established biogeographic patterns. A robust phylogeny is fundamental for understanding the biogeographic histories of taxa with this distribution pattern. Tsuga (hemlock) is a genus of Pinaceae with a typical intercontinental disjunct distribution in East Asia and eastern and western North America, and its phylogeny has not been completely reconstructed in previous studies. In this study, we reconstructed a highly resolved phylogeny of Tsuga using 881 nuclear genes, 60 chloroplast genes and 23 mitochondrial genes and explored its biogeographic and reticulate evolutionary history. The results of phylogenetic analysis, molecular dating and ancestral area reconstruction indicate that Tsuga very likely originated from North America in the late Oligocene and dispersed from America to East Asia via the Bering Land Bridge during the middle Miocene. In particular, we found complex reticulate evolutionary pattern among the East Asian hemlock species. T. sieboldii possibly originated from hybridization with the ancestor of T. chinensis from mainland China and T. forrestii as the paternal donor and the ancestor of T. diversifolia and T. ulleungensis as the maternal donor. T. chinensis (Taiwan) could have originated by hybridization together with T. sieboldii and then evolved independently after dispersal to the Taiwan Island, subsequently experiencing mitochondrial DNA introgression with T. chinensis from mainland China. Moreover, our study found that T. chinensis from western China is more closely related to T. forrestii than to T. chinensis from eastern China. The nonmonophyletic T. chinensis needs taxonomic reconsideration.

Phylotranscriptomics resolves interspecific relationships and indicates multiple historical out-of-North America dispersals through the Bering Land Bridge for the genus Picea (Pinaceae).

A robust phylogeny is prerequisite to understand the evolution and biogeography of organisms. However, ancient and recent evolutionary radiations occurred in many plant lineages, which pose great challenges for phylogenetic analysis, especially for conifers characterized by large effective population sizes and long generation times. Picea is an important component of the dark coniferous forests in the Northern Hemisphere. Previous studies improved our understanding of its evolutionary history, but its interspecific relationships and biogeographic history remain largely unresolved. In the present study, we reconstructed a well-resolved phylogeny of Picea by comparative transcriptomic analysis based on a complete species sampling. The phylogenetic analysis, together with molecular dating and ancestral area reconstruction, further supports the North American origin hypothesis for Picea, and indicates that this genus experienced multiple out-of-North America dispersals by the Bering Land Bridge. We also found that spruces in the Japanese Archipelago have multiple origins, and P. morrisonicola from the Taiwan Island has a close relationship with species from the Qinghai-Tibetan Plateau and adjacent regions. Our study provides the first complete phylogeny of Picea at the genomic level, which is important for future studies of this genus.

Cadmium supplement triggers endoplasmic reticulum stress response and cytotoxicity in primary chicken hepatocytes.

Cadmium (Cd), a potent hepatotoxin, has been reported to induce endoplasmic reticulum (ER) stress in various cell types. However, whether such effect exists in bird is still unclear. To delineate the effects of Cd exposure on ER stress response, we examined the expression of 78-kDa glucose-regulated protein (GRP78) and alteration in calcium homeostasis in primary chicken hepatocytes treated with 2-22 µM Cd for 24 h. A significant decrease of cell viability was observed in chicken hepatocytes following Cd administration. In cells treated with Cd, GRP78 protein levels increased in a dose-dependent manner. In addition, GRP78 and GRP94mRNA levels were elevated in response to Cd exposure. The increase of the intracellular Ca(2+) concentration in chicken hepatocytes was found during Cd exposure. Cd significantly decreased the CaM mRNA levels in hepatocytes. These results show that Cd regulates the expression of GRP78 and calcium homeostasis in chicken hepatocytes, suggesting that ER stress induced by Cd plays an important role in the mechanisms of Cd cytotoxicity to the bird hepatocytes.

[Feature extraction of motor imagery electroencephalography based on time-frequency-space domains].

The purpose of using brain-computer interface (BCI) is to build a bridge between brain and computer for the disable persons, in order to help them to communicate with the outside world. Electroencephalography (EEG) has low signal to noise ratio (SNR), and there exist some problems in the traditional methods for the feature extraction of EEG, such as low classification accuracy, lack of spatial information and huge amounts of features. To solve these problems, we proposed a new method based on time domain, frequency domain and space domain. In this study, independent component analysis (ICA) and wavelet transform were used to extract the temporal, spectral and spatial features from the original EEG signals, and then the extracted features were classified with the method combined support vector machine (SVM) with genetic algorithm (GA). The proposed method displayed a better classification performance, and made the mean accuracy of the Graz datasets in the BCI Competitions of 2003 reach 96%. The classification results showed that the proposed method with the three domains could effectively overcome the drawbacks of the traditional methods based solely on time-frequency domain when the EEG signals were used to describe the characteristics of the brain electrical signals.

Application of desulfurization gypsum as activator for modified magnesium slag-fly ash cemented paste backfill material.

Recycling industrial solid waste for mine backfill is one of the best ways to achieve green production in multiple industries. In this paper, the desulfurization gypsum (DG) as an activator is combined with the modified magnesium slag-fly ash cementitious paste backfill (MFPB) technology for the co-disposal of solid waste and goaf treatment, and the influence of DG on the performance of MFPB was comprehensively analyzed through rheological properties, mechanical properties, durability, microscopic analysis and environmental characteristics experiments. The results show that the fresh MFPB mortar conforms to the Herschel-Bulkley model at different maximum shear rate (γ̇max) conditions. When the γ̇max is 100 s-1, the mortar exhibits shear-thickening properties. The apparent viscosity, yield stress and static yield stress of mortar decreased first and then increased with the increase of DG content, and all had the minimum value when DG was 2.5 %. The thixotropy of the mortar was significantly increased with the addition of DG, and the change in thixotropy was significantly correlated with the difference between the two yield stresses. Both the rheological and mini-slump results demonstrate that DG can improve the flowability of MFPB mortars. In addition, the UCS of D0 under steam curing and standard water curing conditions for 28 d were 4.342 MPa and 2.827 MPa, and the sample containing DG were 6.109-8.241 MPa and 6.669-9.492 MPa, respectively. The addition of DG not only improves the strength of MFPB, but also improves the durability of MFPB. Microscopic analysis (XRD, SEM, and TG-DTG) indicated that this was mainly because DG promoted the hydration reaction of the MMS-FA system and accelerated the generation of C-S(A)-H and AFt. Finally, in the results of in situ leaching based on durability and leaching based on standard HJ 557, all the indexes of MFPB meet the standard of class III groundwater in GB/T 14848-2017, and it has an effective stabilization/solidification effect on heavy metals (As, Cu, Ni, Ba, Zn and Mo, etc.). To sum up, the collaboration of DG and MFPB technology can not only efficiently clean and utilize a variety of solid wastes (MMS, FA and DG), but also greatly improve the performance of MFPB to promote its application.

Quality of Life and Mid-Term Survival in Patients Receiving Extracorporeal Membrane Oxygenation After Cardiac Surgery.

There is a lack of data regarding mid-term outcomes of extracorporeal membrane oxygenation (ECMO) for refractory postcardiotomy cardiogenic shock (PCS). In this context, this research aimed to assess the mid-term survival and quality of life of PCS patients who receive ECMO by comparing them with cardiac surgery patients who do not receive ECMO. A retrospective analysis was performed on the clinical data of patients who had undergone ECMO treatment after cardiac surgery from January 2013 to June 2017 in a tertiary hospital (n = 102); non-ECMO patients who had undergone cardiac surgery and were discharged successfully were selected as the control group (n = 102). Survival and mid-term quality of life were assessed and compared through the Short-Form 36 (SF-36). Both groups were followed up by telephone, and SF-36 scores were obtained from the surviving patients. The data were available for 89 patients (87.3%) and 88 patients (86.3%) in the ECMO group and the control group, respectively. After discharge, the control group outperformed the ECMO group in survival (93.1% vs. 82.4%; p = 0.013). No significant differences in complications, all-cause mortality, first readmission for any cause, or work condition between the ECMO group and the control group were observed. The SF-36 scores in general health (GH) and vitality (VT) were significantly lower among the ECMO survivors (p < 0.05). The results of this study indicate that ECMO can provide acceptable mid-term survival with good quality of life for patients with refractory cardiogenic shock.

The Relative Early Decrease in Platelet Count Is Associated With Mortality in Post-cardiotomy Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation.

Background: The relationship between the magnitude of platelet count decrease and mortality in post-cardiotomy cardiogenic shock (PCS) patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) has not been well-reported. This study was designed to evaluate the association between the relative decrease in platelet count (RelΔplatelet) at day 1 from VA-ECMO initiation and in-hospital mortality in PCS patients. Methods: Patients (n = 178) who received VA-ECMO for refractory PCS between January 2016 and December 2018 at the Beijing Anzhen Hospital were reviewed retrospectively. Multivariable logistic regression analyses were performed to assess the association between RelΔplatelet and in-hospital mortality. Results: One hundred and sixteen patients (65%) were weaned from VA-ECMO, and 84 patients (47%) survived to hospital discharge. The median [interquartile range (IQR)] time on VA-ECMO support was 5 (3-6) days. The median (IQR) RelΔ platelet was 41% (26-59%). Patients with a RelΔ platelet ≥ 50% had an increased mortality compared to those with a RelΔ platelet < 50% (57 vs. 37%; p < 0.001). A large RelΔplatelet (≥50%) was independently associated with in-hospital mortality after controlling for potential confounders (OR 8.93; 95% CI 4.22-18.89; p < 0.001). The area under the receiver operating characteristic curve for RelΔ platelet was 0.78 (95% CI, 0.71-0.85), which was better than that of platelet count at day 1 (0.69; 95% CI, 0.61-0.77). Conclusions: In patients receiving VA-ECMO for post-cardiotomy cardiogenic shock, a large relative decrease in platelet count in the first day after ECMO initiation is independently associated with an increased in-hospital mortality.

The spread of low-credibility content by social bots.

The massive spread of digital misinformation has been identified as a major threat to democracies. Communication, cognitive, social, and computer scientists are studying the complex causes for the viral diffusion of misinformation, while online platforms are beginning to deploy countermeasures. Little systematic, data-based evidence has been published to guide these efforts. Here we analyze 14 million messages spreading 400 thousand articles on Twitter during ten months in 2016 and 2017. We find evidence that social bots played a disproportionate role in spreading articles from low-credibility sources. Bots amplify such content in the early spreading moments, before an article goes viral. They also target users with many followers through replies and mentions. Humans are vulnerable to this manipulation, resharing content posted by bots. Successful low-credibility sources are heavily supported by social bots. These results suggest that curbing social bots may be an effective strategy for mitigating the spread of online misinformation.

Anatomy of an online misinformation network.

Massive amounts of fake news and conspiratorial content have spread over social media before and after the 2016 US Presidential Elections despite intense fact-checking efforts. How do the spread of misinformation and fact-checking compete? What are the structural and dynamic characteristics of the core of the misinformation diffusion network, and who are its main purveyors? How to reduce the overall amount of misinformation? To explore these questions we built Hoaxy, an open platform that enables large-scale, systematic studies of how misinformation and fact-checking spread and compete on Twitter. Hoaxy captures public tweets that include links to articles from low-credibility and fact-checking sources. We perform k-core decomposition on a diffusion network obtained from two million retweets produced by several hundred thousand accounts over the six months before the election. As we move from the periphery to the core of the network, fact-checking nearly disappears, while social bots proliferate. The number of users in the main core reaches equilibrium around the time of the election, with limited churn and increasingly dense connections. We conclude by quantifying how effectively the network can be disrupted by penalizing the most central nodes. These findings provide a first look at the anatomy of a massive online misinformation diffusion network.

Expression and significance of GRHL2 in esophageal cancer.

Esophageal cancer (EC) is one of the most common causes of cancer-related mortality in the world. Although much effort has been made to improve the 5-year survival rate of patients with EC, it still remains low due to diagnosis at an advanced stage, aggressive local invasion, early metastasis, and resistance to chemotherapy. Although grainyhead-like 2 (GRHL2) has attracted interest since it has been recently identified as a novel suppressor of the epithelial-mesenchymal transition, clinical values of GRHL2 and its relationship with the metastasis-related factors, such as hypoxia-inducible factor 1α (HIF-1α) and vascular endothelial growth factor (VEGF), remain unclear. In order to investigate the expression of GRHL2, HIF-1α, and VEGF, and their correlation with angiogenesis in EC, 63 patients with EC were examined. The expression of GRHL2, HIF-1α, and VEGF in tumor tissues was higher than that in adjacent tissues and was associated with tumor differentiation. GRHL2 expression was significantly correlated with lymph node metastasis and invasion depth, whereas VEGF expression was associated with tumor (TNM) stage. A significant correlation was found between the expression of GRHL2 and HIF-1α. The patients expressing low GRHL2 and high HIF-1α showed significant reduction in both overall survival rate and disease-free survival rate. The results demonstrated that abnormal expression of GRHL2 is common in EC, and low expression of GRHL2 accompanied by a high expression of HIF-1α indicates poor prognosis.