Bias-corrected NESM3 global dataset for dynamical downscaling under 1.5 °C and 2 °C global warming scenarios.

Dynamical downscaling is vital for generating finer-scale climate projections. Recently, a set of simulations under four types of 1.5/2 °C global warming scenarios are available with Nanjing University of Information Science and Technology Earth System Model (NESM). However, NESM3's bias in large-scale driving variables would degrade downscaled simulations. We corrected NESM3 bias in terms of climate mean and inter-annual variance against ERA5 using a novel bias correction method and then produced a set of bias-corrected datasets for dynamical downscaling. The bias-corrected NESM3 spans the historical period for 1979-2014 and four future scenarios (i.e., 1.5 °C overshoot for 2070-2100, stabilized 1.5/2 °C for 2070-2100, and transient 2 °C for 2031-2061) with 1.25° × 1.25° horizontal resolution at six-hourly intervals. Our evaluation suggests that bias-corrected NESM3 outperforms the original NESM3 in the climatological mean of seasonal mean and variability, as well as climate extreme events during the historical period. This bias-corrected dataset is expected to generate more reliable projections for regional climate and environment under 1.5/2 °C global warming.

A Multi-Layer Stacked Microfluidic Tactile Display With High Spatial Resolution.

Pneumatic tactile displays dynamically customize surface morphological features with reconfigurable arrays of independently addressable actuators. However, their ability to render detailed tactile patterns or fine textures is limited by the low spatial resolution. For pneumatic tactile displays, the high-density integration of pneumatic actuators within a small space (fingertip) poses a significant challenge in terms of pneumatic circuit wiring. In contrast to the structure with a single-layer layout of pipes, we propose a multi-layered stacked microfluidic pipe structure that allows for a higher density of actuators and retains their independent actuation capabilities. Based on the proposed structure, we developed a soft microfluidic tactile display with a spatial resolution of 1.25 mm. The device consists of a 5 × 5 array of independently addressable microactuators, driven by pneumatic pressure, each of which enables independent actuation of the surface film and continuous control of the height. At a relative pressure of 1000 mbar, the actuator produced a perceptible out-of-plane deformation of 0.145 mm and a force of 17.7 mN. User studies showed that subjects can easily distinguish eight tactile patterns with 96% accuracy.

Risk Factors of Lower Extremity Deep Vein Thrombosis After Artificial Femoral Head Replacement for Elderly Femoral Neck Fractures and a Nomogram Model Construction.

Objective: To assess lower extremity deep vein thrombosis (DVT) risk factors after artificial femoral head replacement for elderly femoral neck fractures. A nomogram model was constructed to predict its risk. Methods: In analyzing 144 participants who underwent artificial femoral head replacement for elderly femoral neck fractures, researchers collected clinical data to identify factors associated with lower extremity DVT. The study collected numerous variables ranging from age and sex to history of lower extremity DVT and use of anticoagulant drugs after surgery. The patients were in two groups: those who developed DVT (n = 62) and those who did not (n = 82). Multivariate logistic regression analysis helped to identify factors influencing the occurrence of DVT after artificial femoral head replacement. The software packages used were R 4.1.0 and RMS. Results: Univariate and multivariate regression analysis identified age, ASA level, D-dimer of lower limb DVT, ALB, and PLT as predictive risk factors of lower extremity DVT after artificial femoral head replacement for elderly femoral neck fractures. Those risk factors were used to construct a clinical predictive nomogram. The calibration curves for hypertension in patients with OSAHS risk revealed excellent accuracy of the predictive nomogram model. The unadjusted concordance index (C-index) for the model was 0.877 [95% confidence interval (CI), 0.805-0.942]. The AUC was 0.8375002. Decision curve analysis showed that the predictive model could be applied clinically when the threshold probability was 20 to 80%. Conclusions: The researchers constructed and validated a clinical nomogram to predict the occurrence of lower extremity DVT after artificial femoral head replacement in elderly patients with femoral neck fractures. Age, ASA level, D-dimer, and history of lower limb DVT, ALB, and PLT were demonstrated to be predictive risk factors of lower extremity DVT in this circumstance. This practical prognostic nomogram may help improve clinical decision-making.

Voluntary Respiration Control: Signature Analysis by EEG.

The perception of voluntary respiratory consciousness is quite important in some situations, such as respiratory assistance and respiratory rehabilitation training, and the key signatures about voluntary respiration control may lie in the neural signals from brain manifested as electroencephalography (EEG). The present work aims to explore whether there exists correlation between voluntary respiration and scalp EEG. Evoke voluntary respiration of different intensities, while collecting EEG and respiration signal synchronously. Data from 11 participants were analyzed. Spectrum characteristics at low-frequency band were studied. Computation of EEG-respiration phase lock value (PLV) and EEG sample entropy were conducted as well. When breathing voluntarily, the 0-2 Hz band EEG power is significantly enhanced in frontal and right-parietal area. The distance between main peaks belonging to the two signals in 0-2 Hz spectrum graph tends to get smaller, while EEG-respiration PLV increases in frontal area. Besides, the sample entropy of EEG shows a trend of decreasing during voluntary respiration in both areas. There's a strong correlation between voluntary respiration and scalp EEG. Significance: The discoveries will provide guidelines for developing a voluntary respiratory consciousness identifying method and make it possible to monitor people's intention of respiration by noninvasive BCI.

Effects of neuraxial or general anaesthesia on postoperative adverse events in oldest-old patients (aged 90 years and older) with intertrochanteric fractures: a retrospective study.

BACKGROUND: To retrospectively analyse postoperative adverse events in oldest-old patients (aged 90 years and older) with intertrochanteric fractures treated under various anaesthetic techniques. METHODS: A total of 153 consecutive patients participated in this study, of which 127 patients who underwent surgery with neuraxial anaesthesia or general anaesthesia for intertrochanteric fractures between October 2019 and October 2022 were eligible and evaluated. They were divided into the neuraxial anaesthesia and general anaesthesia groups. The demographic characteristics and postoperative adverse events were compared between the two groups. RESULTS: A total of 13 patients (10.24%), including 6 in the neuraxial anaesthesia group (8.22%) and 7 in the general anaesthesia group (12.96%), died within 30 days after surgery. No significant differences between the two groups were observed. Postoperative delirium occurred in 40 patients (31.49%), including 17 (23.29%) in the neuraxial anaesthesia group and 23 (42.59%) in the general anaesthesia group; there was a significant difference between the two groups [P = 0.02, odds ratio (OR) = 0.41]. The other postoperative adverse events, including heart failure, acute stroke, acute myocardial infarction, pulmonary disease, anaemia, deep vein thrombosis, hypoproteinaemia, and electrolyte disorders, were not significantly different between the two groups. CONCLUSION: Our data suggest that different anaesthesia methods do not affect the incidence of adverse events, such as death within 30 days after surgery in oldest-old patients with intertrochanteric fractures. However, more patients developed delirium after surgery in the general anaesthesia group (23, 42.59%) than in the neuraxial anaesthesia group (17, 23.29%); this may indicate that spinal anaesthesia reduces the incidence of postoperative delirium (P = 0.02, OR = 0.41). TRIAL REGISTRATION: Retrospectively registered.

A seminested recombinase polymerase amplification assay to detect rickettsial pathogens in clinical samples.

Treatment at the early stage of onset is vital for the prognosis of rickettsioses. But the absence of specific clinical symptoms complicates the diagnosis of this condition. Herein we established a seminested recombinase polymerase amplification assay (snRPA-nfo) that enables quick detection and differentiation of rickettsial pathogens in clinical samples with high sensitivity and specificity. The conserved 17-kDa protein gene of Rickettsia sibirica and the 47-kDa protein gene of Orientia tsutsugamushi were targeted for the duplex RPA-nfo assay. The snRPA-nfo assay exhibited an increased LOD in spiked blood samples, up to 1000-fold in comparison to standard RPA-nfo, and a better detection rate (83.3%, 5/6) than TaqMan PCR (16.6%, 1/6, Ct ≤ 35) in clinically confirmed patient blood samples. Thus, snRPA-nfo assay represents a promising alternative to TaqMan PCR in the early diagnosis of rickettsioses for point-of-care testing as well as in resource-limited settings.

METTL14 mediates m6a modification on osteogenic proliferation and differentiation of bone marrow mesenchymal stem cells by regulating the processing of pri-miR-873.

N6-methyl-adenosine (m6a) is involved in the occurrence and development of various diseases such as autogenic immune disease and tumors. Methyltransferases regulate primary (pri)-microRNA (miRNA/miR) processing by mediating m6a modifications, consequently affecting pathological processes including immune-related diseases by regulating both innate and adaptive immune cells. However, the roles of m6a on the biological functions of bone marrow mesenchymal stem cells (BMSCs) remain to be elucidated. The relative expression levels of methyltransferase-like 14 (METTL14) and other methyltransferases, demethylases, and miR-873 in bone samples from patients with osteoporosis and from normal individuals were measured by reverse transcription-quantitative PCR. Cell Counting Kit-8 assay was used to examine the proliferation of BMSCs. Co-immunoprecipitation (Co-IP) was used to investigate the binding of METTL14 to DiGeorge syndrome critical region 8 (DGCR8). RNA immunoprecipitation (RIP) was used to examine the binding of METTL14 to pri-miR-873. METTL14 and m6a modifications were highly detected in patients with osteoporosis compared with the controls. Co-IP results indicated that silencing of METTL14 reduced METTL14 and m6a modification levels in BMSCs. Downregulation of METTL14 significantly promoted the proliferation of BMSCs. RIP results suggested that METTL14/m6a methylation modification promoted the processing of pri-miR-873 by binding to DGCR8 in BMSCs. Furthermore, overexpression of miR-873 inhibited the proliferation of BMSCs. The results also showed that miR-873 mimics significantly inhibited the proliferation in small interfering (si)-METTL14 transfected BMSCs; however, miR-873 inhibitors markedly promoted the proliferation of si-METTL14 transfected BMSCs. METTL14 and m6a modifications were upregulated in osteoporosis samples. METTL14 promoted the processing of pri-miR-873 into mature miR-873 by regulating m6a modification. Furthermore, overexpression of miR-873 significantly inhibited the proliferation of BMSCs. Therefore, the METTL14/m6a/miR-873 axis may be a potential target for the treatment of osteoporosis.

A Study of the Molecular Regulatory Network of VcTCP18 during Blueberry Bud Dormancy.

BRANCHED1 (BRC1) is a crucial member of the TEOSINTE BRANCHED1/CYCLOIDEA/PCF (TCP) gene family and is well known for playing a central role in shoot branching by controlling buds' paradormancy. However, the expression characteristics and molecular regulatory mechanism of BRC1 during blueberry bud dormancy are unclear. To shed light on these topics, shoots of three blueberry cultivars with different chilling requirements (CRs) were decapitated in summer to induce paradormancy release and subjected to different levels of chilling in winter to induce endodormancy release. The results showed that the high-CR cultivar 'Chandler' had the strongest apical dominance among the three cultivars; additionally, the expression of VcTCP18, which is homologous to BRC1, was the highest under both the decapitation treatment and low-temperature treatment. The 'Emerald' cultivar, with a low CR, demonstrated the opposite trend. These findings suggest that VcTCP18 plays a negative regulatory role in bud break and that there may be a correlation between the CR and tree shape. Through yeast 1-hybrid (Y1H) assays, we finally screened 21 upstream regulatory genes, including eight transcription factors: zinc-finger homeodomain protein 1/4/5/9, MYB4, AP2-like ethylene-responsive transcription factor AINTEGUMENTA (ANT), ASIL2-like, and bHLH035. It was found that these upstream regulatory genes positively or negatively regulated the expression of VcTCP18 based on the transcriptome expression profile. In summary, this study enriched our understanding of the regulatory network of BRCl during bud dormancy and provided new insights into the function of BRC1.

A Symbiotic Fungus Sistotrema Benefits Blueberry Rejuvenation and Abiotic Stress Tolerance.

Blueberry (Vaccinium spp.) rhizosphere microorganisms can significantly increase the absorption area and improve the efficiency of rhizospheric nutrient uptake. However, there has been little research on blueberry rhizosphere microorganisms, especially those that can complement root function deficiency. In this study, we analyzed the rhizosphere fungi of 'O'Neal,' 'Sharpblue,' and 'Premier' blueberry cultivars and found that 'Premier' blueberries showed strong growth potential and relatively high root regulation ability. The dominant symbiotic fungus Sistotrema was correlated with the strong growth of 'Premier' and was directionally screened and isolated based on conserved gene structures and COG function analysis. This fungus was reinoculated onto the roots of 'Gulfcoast' and 'Star' blueberry cultivars. Sistotrema promoted the growth of blueberries and improved their ability to resist stress and grow under adverse conditions, as indicated by maintained or increased chlorophyll content under such conditions. Further analyses showed that Sistotrema has certain functional characteristics such as the ability to dissolve iron in its insoluble form and then release it, to fix nitrogen, and to inhibit nitrification in soil. Thus, it effectively doubled the soil nitrogen content and increased the soluble iron content in soil by 50%. This investigation indicates sistotrema inoculation as an approach to increase blueberry stress tolerance and complete their root nutrition deficiency.

Mitogen-activated protein kinase 2 specifically regulates photorespiration in rice.

Photorespiration begins with the oxygenation reaction catalyzed by Rubisco and is the second highest metabolic flux in plants after photosynthesis. Although the core biochemical pathway of photorespiration has been well characterized, little is known about the underlying regulatory mechanisms. Some rate-limiting regulation of photorespiration has been suggested to occur at both the transcriptional and posttranslational levels, but experimental evidence is scarce. Here, we found that mitogen-activated protein kinase 2 (MAPK2) interacts with photorespiratory glycolate oxidase and hydroxypyruvate reductase, and the activities of these photorespiratory enzymes were regulated via phosphorylation modifications in rice (Oryza sativa L.). Gas exchange measurements revealed that the photorespiration rate decreased in rice mapk2 mutants under normal growth conditions, without disturbing photosynthesis. Due to decreased photorespiration, the levels of some key photorespiratory metabolites, such as 2-phosphoglycolate, glycine, and glycerate, significantly decreased in mapk2 mutants, but those of photosynthetic metabolites were not altered. Transcriptome assays also revealed that the expression levels of some flux-controlling genes in photorespiration were significantly downregulated in mapk2 mutants. Our findings provide molecular evidence for the association between MAPK2 and photorespiration and suggest that MAPK2 regulates the key enzymes of photorespiration at both the transcriptional and posttranslational phosphorylation levels in rice.

Clinicopathological characteristics of pheochromocytoma/paraganglioma and screening of prognostic markers.

BACKGROUND: Malignant pheochromocytoma/paraganglioma (PCPG) is lethal and difficult to diagnose before metastasis. This study is aiming to characterize the PCPG and explore novel prognostic markers. METHODS: Clinical data of patients with pathologically confirmed invasive and noninvasive PCPG were collected and analyzed. Then, the differentially expressed genes (DEGs) and HUB genes were identified by R package "limma" in GSE67066-GPL570. Afterward, the prognostic markers were screened out using R packages of "survival" and "survminer" based on the TCGA data. RESULTS: The 34 invasive PCPGs were characterized by irregular contour and unclear boundary on CT and capsule/extracapsule tissue invasion on pathology compared with the 42 noninvasive PCPGs. Then, 29 upregulated and 30 downregulated DEGs were identified in malignant PCPG compared with benign, which were mainly enriched in the terms of calcium ion binding, neuron cell-cell adhesion, axon, regulation of hormone levels, and regulation of secretion by cell. Of which, nine DEGs were furtherly selected as the HUB genes. Finally, CNTN4 and SH3GL2 were found to be highly expressed in malignant PCPGs and negatively correlated with progression-free interval. CONCLUSIONS: Malignant PCPGs tend to be aggressive in imaging and pathology. The high expression of CNTN4 and SH3GL2 in PCPGs may indicate a poor prognosis.

Genome-Wide Identification and Analysis of the MADS-Box Transcription Factor Genes in Blueberry (Vaccinium spp.) and Their Expression Pattern during Fruit Ripening.

MADS-box is a class of transcriptional regulators that are ubiquitous in plants and plays important roles in the process of plant growth and development. Identification and analysis of blueberry MADS-box genes can lay a foundation for their function investigations. In the present study, 249 putative MADS-box genes were identified in the blueberry genome. Those MADS-box genes were distributed on 47 out of 48 chromosomes. The phylogenetic and evolutionary analyses showed that blueberry MADS-box genes were divided into 131 type I members and 118 type II members. The type I genes contained an average of 1.89 exons and the type II genes contained an average of 7.83 exons. Motif analysis identified 15 conserved motifs, of which 4 were related to the MADS domain and 3 were related to the K-box domain. A variety of cis-acting elements were found in the promoter region of the blueberry MADS-box gene, indicating that the MADS-box gene responded to various hormones and environmental alterations. A total of 243 collinear gene pairs were identified, most of which had a Ka/Ks value of less than 1. Nine genes belonging to SEP, AP3/PI, and AGL6 subfamilies were screened based on transcriptomic data. The expression patterns of those nine genes were also verified using quantitative PCR, suggesting that VcMADS6, VcMADS35, VcMADS44, VcMADS58, VcMADS125, VcMADS188, and VcMADS212 had potential functions in blueberry fruit ripening. The results of this study provide references for an in-depth understanding of the biological function of the blueberry MADS-box genes and the mechanism of blueberry fruit ripening.

Adjuvant transarterial chemoembolization timing after radical resection is an independent prognostic factor for patients with hepatocellular carcinoma.

Background: It has been reported that postoperative adjuvant TACE (PA-TACE) treatment decreases recurrence and significantly improves the survival of patients who undergo radical resection of hepatocellular carcinoma (HCC) with high-risk recurrence factors. However, when to perform PA-TACE has not been fully studied. Methods: We retrospectively collected the clinicopathologic characteristics of the patients with HCC between October 2013 and June 2020. The optimal cutoff value for PA-TACE time was determined based on the R package "maxstat". Logistic regression and Cox regression analysis were used to determine the effect of the choice of PA-TACE timing on prognosis. Results: The analysis was performed on 789 patients with HCC, and 484 patients were finally involved and were divided into training cohort (378) and validation cohort (106). The PA-TACE timing was found to be associated with survival outcomes. Multivariate logistic analysis found independent predictors of the PA-TACE timing, including gender and history of HBV. Multivariate Cox analysis showed that Ki-67, tumor size, MVI and the PA-TACE timing were independent prognostic factors for RFS in HCC patients. Conclusions: Based on this study, HCC patients with high-risk recurrence factors can receive personalized assistance in undergoing PA-TACE treatment and improve their survival outcomes.

Tuning the Dual Active Sites of Functionalized UiO-66 for Selective Adsorption of Yb(III).

The recovery of rare earth elements (REEs) from discharged electronic devices or mineral waste water is highly essential but still facing challenges. In this work, two amino-functionalized carboxyl-UiO-66 (UiO-66-COOH-TETA and UiO-66-(COOH)2-ED) prepared via the postmodification method were employed as the adsorbents for Yb(III) capture. The experimental results revealed their superior adsorption capacities of 161.5 and 202.6 mg/g, respectively. Meanwhile, their adsorption processes can be described by the pseudo-second-order kinetic model and Langmuir model. Effects of initial pH and temperature on adsorptions were systematically evaluated, affording an optimal operating condition (i.e., pH of 5.5-6, T of 65 °C, t of 10 h). Moreover, the fabricated materials exhibited great reusability after five adsorption-regeneration cycles. UiO-66-COOH-TETA demonstrated good separation selectivity for Yb(III) over light REEs (i.e., 3.98 of Yb/Ce, 3.51 of Yb/Nd). Based on the density functional theory calculations and characterization analysis (XPS, Zeta, mapping, and IR), the adsorption mechanisms were mainly attributed to significant electrostatic attraction and strong surface complexation between N and O sites and Yb(III).

Tailoring abundant active-oxygen sites of Prussian blue analogues-derived adsorbents for highly efficient Yb(III) capture.

The removal of rare earth elements in mineral processing wastewater is highly desirable but still challenging. In this study, three bimetallic Prussian blue analogues (PBA) and six corresponding oxides are prepared by co-precipitation and calcination methods, and then utilized to adsorb aqueous Yb(III) solution. The results of XRD, SEM, BET, and XPS indicate the successful synthesis of all the adsorbents. Among them, three PBA-oxide samples (PBO-800) exhibit the superior adsorption capacities (˃250 mg/g). The adsorption processes of Yb(III) are in accordance with the pseudo-second-order kinetic model and Langmuir model, simultaneously showing the spontaneous and endothermic thermodynamics. Moreover, PBO-800 can be reused after alkaline solution regeneration with less than 10% degradation after five consecutive adsorption-desorption cycles. More importantly, PBO-800 exhibits the impressive separation selectivity of Yb(III) and most light rare earth ions (e.g., 5.51 of Yb/La, 4.03 of Yb/Pr), as well as the selectivity of Yb(III) and alkali metal ions (e.g., 300.5 of Yb/Na, 256.2 of Yb/Ca). According to the characterization analysis and DFT calculation, the adsorption mechanism of Yb(III) by PBO-800 is mainly attributed to the strong interaction between the abundant active-oxygen sites and Yb(III), and the significant electrostatic attraction.

Deforestation intensifies daily temperature variability in the northern extratropics.

While the biogeophysical effects of deforestation on average and extreme temperatures are broadly documented, how deforestation influences temperature variability remains largely unknown. To fill this knowledge gap, we investigate the biogeophysical effects of idealized deforestation on daily temperature variability at the global scale based on multiple earth system models and in situ observations. Here, we show that deforestation can intensify daily temperature variability (by up to 20%) in the northern extratropics, particularly in winter, leading to more frequent rapid extreme warming and cooling events. The higher temperature variability can be attributed to the enhanced near-surface horizontal temperature advection and simultaneously is partly offset by the lower variability in surface sensible heat flux. We also show responses of daily temperature variability to historical deforestation and future potential afforestation. This study reveals the overlooked effects of deforestation or afforestation on temperature variability and has implications for large-scale afforestation in northern extratropic countries.

Cancer-associated fibroblast-secreted miR-421 promotes pancreatic cancer by regulating the SIRT3/H3K9Ac/HIF-1α axis.

This study was designed to explore the effects of exosomal miR-421 secreted by cancer-associated fibroblasts (CAFs) on pancreatic cancer (PC) progression and the mechanisms involved. CAFs and exosomes (exos) were isolated and identified. PC cells were treated with CAF-derived exos (CAF-exos). Western blotting and quantitative polymerase chain reaction (qPCR) were used to measure miR-421, sirtuin-3 (SIRT3), and hypoxia duciblefactors-1 alpha (HIF-1α) levels. Cell counting kit-8 (CCK-8), wound-healing, and transwell migration assays were used to measure proliferation, migration, and invasion abilities of the cells. Dual-luciferase assay and RNA immunoprecipitation (RIP) experiment analyzed the relationship between miR-421 and SIRT3. Chromatin immunoprecipitation (f)-verified H3K9Ac enrichment in the HIF-1α promoter region. In vivo tumorigenesis experiments were performed to further explore the effects of exosomal miR-421 from CAFs on PC. CAFs and exos were successfully isolated. CAF-exo-treated PC cells highly expressed miR-421 and had increased cell proliferation, migration, and invasion abilities. Knocking down miR-421 increased the expression of SIRT3. SIRT3 is a target of miR-421, and inhibiting the expression of SIRT3 reversed the negative effects of miR-421 knockdown on PC cell. Knocking down miR-421 in CAF-exo inhibited the expression of HIF-1α in PC cells. Moreover, SIRT3-mediated HIF-1α expression by regulating H3K9Ac. HIF-1α overexpression reversed the inhibiting effects of SIRT3 overexpression on PC progression and counteracted the inhibiting effects of miR-421 knockdown on glycolysis. Moreover, in vivo tumorigenesis experiments showed that knocking down miR-421 attenuated CAF-exo induced tumor growth. Exosomal miR-421 from CAFs promoted PC progression by regulating the SIRT3/H3K9Ac/HIF-1α axis. This study provided insights into the molecular mechanism of PC.

Prevalence and risk factors of carbapenem-resistant Enterobacterales positivity by active screening in intensive care units in the Henan Province of China: A multi-center cross-sectional study.

Objective: In intensive care units (ICUs), carbapenem-resistant Enterobacterales (CRE) pose a significant threat. We aimed to examine the distribution, epidemiological characteristics, and risk factors for CRE positivity in ICUs. Materials and methods: This cross-sectional study was conducted in 96 ICUs of 78 hospitals in Henan Province, China. The clinical and microbiological data were collected. A multivariable logistic regression model was used to analyze the risk factors for CRE positivity. Results: A total of 1,009 patients were enrolled. There was a significant difference in CRE positive rate between pharyngeal and anal swabs (15.16 vs. 19.13%, P < 0.001). A total of 297 carbapenem-resistant Klebsiella pneumoniae (CR-KPN), 22 carbapenem-resistant Escherichia coli (CR-ECO), 6 carbapenem-resistant Enterobacter cloacae (CR-ECL), 19 CR-KPN/CR-ECO, and 2 CR-KPN/CR-ECL were detected. Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-beta-lactamase (NDM), and a combination of KPC and NDM were detected in 150, 9, and 11 swab samples, respectively. Multivariable logistic regression analysis determined length of ICU stay, chronic neurological disease, transfer from other hospitals, previous infection, and history of antibiotics exposure as independent risk factors for CRE positivity. Age and cardiovascular diseases were independent risk factors for mixed infections of CRE. The occurrence of CRE in secondary and tertiary hospitals was 15.06 and 25.62%, respectively (P < 0.05). Patients from tertiary hospitals had different clinical features compared with those from secondary hospitals, including longer hospital stays, a higher rate of patients transferred from other hospitals, receiving renal replacement therapy, exposure to immunosuppressive drugs, use of antibiotics, and a higher rate of the previous infection. Conclusion: In ICUs in Henan Province, CRE positive rate was very high, mostly KPC-type CR-KPN. Patients with prolonged ICU stay, chronic neurological disease, transfer from other hospitals, previous infection, and history of antibiotic exposure are prone to CRE. Age and cardiovascular diseases are susceptibility factors for mixed infections of CRE. The CRE positive rate in tertiary hospitals was higher than that in secondary hospitals, which may be related to the source of patients, antibiotic exposure, disease severity, and previous infection.