Left Atrial Hemodynamics and Clinical Utility in Heart Failure.

Comprehensive knowledge of the left atrium (LA) and its pathophysiology has emerged as an important clinical and research focus in the heart failure (HF) arena. Although studies on HF focusing on investigating left ventricular remodeling are numerous, those on atrial structural and functional changes have received comparatively less attention. Studies on LA remodeling have recently received increasing attention, and LA pressure (LAP) has become a novel target for advanced monitoring and is a potential therapeutic approach for treating HF. Various devices specifically designed for the direct measurement of LAP have been developed to optimize HF treatment by reducing LAP. This review focuses on LA hemodynamic monitoring and effective LAP decompression.

Effect of Cardiac Rehabilitation on Cardiorespiratory Fitness in Patients With Acute Myocardial Infarction: Role of Diabetes Mellitus and Glycated Hemoglobin Level.

PURPOSE: Following acute myocardial infarction (AMI), patients with diabetes mellitus (DM) have a poorer prognosis than those without DM. This study aimed to investigate the benefit of cardiac rehabilitation on cardiorespiratory fitness in patients with AMI, examining whether this effect varied depending on DM and glycated hemoglobin (HbA1c) levels. METHODS: Data were collected from the medical records of 324 patients diagnosed with AMI who were subsequently referred to participate in a supervised exercise-based cardiac rehabilitation program. Cardiorespiratory fitness was assessed using cardiopulmonary exercise testing before and at 3 and 6 mo after the start of cardiac rehabilitation. Linear mixed models were used to evaluate changes in cardiorespiratory fitness between patients with and without DM during the follow-up period. RESULTS: In total, 106 patients (33%) had DM. Both patients with and without DM showed a significant improvement in cardiorespiratory fitness from baseline to the 6-mo follow-up. However, the improvement was significantly lower in patients with DM than in those without DM (1.9 ± 1.5 vs. 3.7 ± 3.2 mL/kg/min, P < .001). Among patients with DM, those with HbA1c levels < 7% showed a greater improvement in cardiorespiratory fitness than those with HbA1c ≥ 7% (2.7 ± 1.5 vs. 1.1 ± 1.8 mL/kg/min, P < .001) during the follow-up period. CONCLUSIONS: Improvements in cardiorespiratory fitness following cardiac rehabilitation were significantly lower in patients with AMI and DM. The response to cardiac rehabilitation in patients is influenced by HbA1c levels. These findings suggest potential implications for individualizing cardiac rehabilitation programming and ensuring optimal glycemic control in patients with AMI and DM.

Nerve growth factor gene polymorphisms may be associated with heroin dependence in women but do not mediate specific personality traits.

Heroin dependence (HD) is a complex disease with a substantial genetic contribution and is associated with traits of impulsivity and specific personality traits. The neurotrophic factor nerve growth factor (NGF) may mediate the reward processes in HD. This study aims to investigate whether NGF gene polymorphisms are associated with the co-occurrence of HD and impulsivity/specific personality traits in HD patients. To minimize the potential confounding effects of population stratification, we selected a homogeneous Han Chinese population and recruited 1364 participants (831 HD patients and 533 healthy controls). In addition, 163 female HD patients completed the Chinese version of the Barratt Impulsiveness Scale Version 11 (BIS-11), and 440 HD patients completed the Chinese version of the Tridimensional Personality Questionnaire (TPQ) for subsequent analysis. We identified three polymorphisms with altered allele and genotype frequency in HD patients versus controls (p = 0.035 for rs2254527; p = 0.005 for rs6678788; p = 0.006 for rs7523654), especially in the female subgroup. Four associations identified via haplotype analysis were significant in the female subgroup (p = 0.003 for T-T-A haplotype and p = 0.002 for C-C-A haplotype in block 1; p = 0.011 for T-T haplotype and p = 0.009 for C-T haplotypes in block 2), but not in the male subgroup. Male HD patients had higher novelty-seeking (NS) scores, and female HD patients had higher harm avoidance (HA) scores. However, there was no significant association between the selected NGF polymorphisms and BIS or TPQ scores in HD patients. NGF variants may contribute to the risk of HD development in females but do not mediate the relationship between impulsivity and specific personality traits in the female population.

Core-Shell Si@SiOC Particles Synthesized Using Supercritical Carbon Dioxide Fluid for Superior Li-Ion Storage Performance.

A supercritical carbon dioxide (SCCO2) fluid, characterized by gas-like diffusivity, near-zero surface tension, and excellent mass transfer properties, is used as a precursor to produce silicon oxycarbide (SiOC) coating. SCCO2 disperses and reacts with Si particles to form an interfacial layer consisting of Si, O, and C. After an 850 °C annealing process, a conformal SiOC coating layer forms, resulting in core-shell Si@SiOC particles. High-resolution transmission electron microscopy and its X-ray line-scan spectroscopy, X-ray photoelectron spectroscopy, Fourier-transform infrared spectroscopy, and Raman spectroscopy, are used to examine the SiOC formation mechanism. Effects of SCCO2 interaction time on the SiOC properties are investigated. The SiOC layer connects the Si@SiOC particles, improving electron and Li+ transport. Cyclic voltammetry, galvanostatic intermittent titration technique, and electrochemical impedance spectroscopy are employed to examine the role of SiOC during charging/discharging. Operando X-ray diffraction data reveal that the SiOC coating reduces crystal size of the formed Li15Si4 and increases its formation/elimination reversibility during cycling. The Si@SiOC electrode shows a capacitiy of 2250 mAh g-1 at 0.2 A g-1. After 500 cycles, the capacity retention is 72% with Coulombic efficiency above 99.8%. A full cell consisting of Si@SiOC anode and LiNi0.8Co0.1Mn0.1O2 cathode is constructed, and its performance is evaluated.

Bias polarity dependent low-frequency noise in ultra-thin AlOx-based magnetic tunnel junctions.

We exploit bias polarity dependent low-frequency noise (LFN) spectroscopy to investigate charge transport dynamics in ultra-thin AlOx-based magnetic tunnel junctions (MTJs) with bipolar resistive switching (RS). By measuring the noise characteristics across the entire bias voltage range of bipolar RS, we find that the voltage noise level exhibits an bias polarity dependence. This distinct feature is intimately correlated with reconfiguring of the inherently existing oxygen vacancies ( V O . . ) in as-grown MTJ devices during the SET and RESET switching processes. In addition, we observe two-level random telegraph noise (RTN) with a longer and shorter tunneling length in the high resistance state (HRS) and low resistance state (LRS) at a low bias voltage. The intrinsic voltage fluctuations of RTN arise from the dynamics of electron trapping/de-trapping processes at the V O . . -related trap sites. Notably, the RTN magnitude is similar in LRS but nonidentical in that of HRS for different bias polarity. These findings strongly suggest that the inherent V O . . are distributed near the top CoFe/AlOx interface in the HRS; in contrast, they are expanded to the middle region of the AlOx in the LRS. More importantly, we demonstrate that the location and distribution of the inherent V O . . can be electrically tuned, which plays an essential role in the charge transport dynamics in the ultra-thin AlOx-based MTJs and have significant implications for developing emergent memory and logic devices.

Optimizing cultivation strategies and scaling up for fucoxanthin production using Pavlova sp.

The microalgal-based production of fucoxanthin has emerged as an imperative research endeavor due to its antioxidant, and anticancer properties. In this study, three brown marine microalgae, namely Skeletonema costatum, Chaetoceros gracilis, and Pavlova sp., were screened for fucoxanthin production. All strains displayed promising results, with Pavlova sp. exhibiting the highest fucoxanthin content (27.91 mg/g) and productivity (1.16 mg/L·day). Moreover, the influence of various cultivation parameters, such as culture media, salinity, sodium nitrate concentration, inoculum size, light intensity, and iron concentration, were investigated and optimized, resulting in a maximum fucoxanthin productivity of 7.89 mg/L·day. The investigation was further expanded to large-scale outdoor cultivation using 50 L tubular photobioreactors, illustrating the potential of Pavlova sp. and the cultivation process for future commercialization. The biomass and fucoxanthin productivity for the large-scale cultivation were 70.7 mg/L·day and 4.78 mg/L·day, respectively. Overall, the findings demonstrated considerable opportunities for fucoxanthin synthesis via microalgae cultivation and processing.

Medullary-Sparing Antibiotic Cement Articulating Spacer Reduces the Rate of Mechanical Complications in Advanced Septic Hip Arthritis: A Retrospective Cohort Study.

Antibiotic cement articulating spacers eradicate infection during a two-stage revision for advanced septic hip arthritis (ASHA); however, mechanical complications have been reported. We hypothesized that the rate of mechanical complications would be lower in medullary-sparing (MS) than in non-medullary-sparing (n-MS) articulating spacers. A retrospective study of ASHA using n-MS or MS spacers was conducted between 1999 and 2019. The rate of mechanical complications and reoperation and risk factors for mechanical complications were analyzed. The cohort included 71 n-MS and 36 MS spacers. All patients were followed up for 2 years. The rate of spacer dislocation was lower in MS (0%) than in n-MS spacers (14.1%; p = 0.014). The reoperation rate for mechanical complications was lower in MS (0%) than in n-MS spacers (12.7%; p = 0.019). The rate of a diaphyseal stem during reimplantation was lower in MS (0%) than in n-MS spacers (19.4%; p = 0.002). The identified risk factors for n-MS spacer dislocation were postoperative under-restored femoral head diameter ≥3 mm, femoral offset ≥3 mm, and surgical volume (≤6 resection arthroplasties per year). Both spacers controlled infection. However, MS spacers had a lower spacer dislocation and reoperation rate and avoided the diaphyseal stem during reimplantation. We recommend using MS spacers to restore native femoral head diameter and femoral offset when ASHA is treated by surgeons with lower surgical volumes.

Serum Albumin was Associated with a Long Term Cardiovascular Mortality among Elderly Patients with Stable Coronary Artery Disease.

Background: Serum albumin (SA), a multifunction protein, contributes to maintaining a variety of physiological functions. Studies have linked SA to atherosclerosis with possible mechanisms including a response to inflammation. The contribution of albumin to cardiovascular (CV) mortality in elderly patients with stable coronary artery disease (CAD) remains unclear. Methods: We investigated 321 elderly patients with stable CAD undergoing coronary angiography between 2003 and 2006. CV mortality data were obtained from the National Registry of Deaths in Taiwan. CV mortality included deaths attributable to ischemic heart disease, congestive heart disease, and stroke. The association between baseline SA and CV mortality was assessed using a Cox model and Fine-Gray model when non-CV mortality was considered a competing event. Results: During a median follow-up of 97 months, 39 (12.1%) participants died from CV disease and 76 (23.7%) died from non-CV diseases. After adjusting for covariates, patients in the SA ≥ 3.75 g/dL group had a lower frequency of CV mortality compared with those in the SA < 3.75 g/dL group [hazard ratio (HR): 0.20; 95% confidence interval (CI): 0.08-0.49; p < 0.001]. Similarly, compared to the participants with non-CV mortality, the SA ≥ 3.75 g/dL group had a lower frequency of CV mortality compared with the SA < 3.75 g/dL group (subdistribution HR: 0.27; 95% CI: 0.11-0.65; p < 0.001) in adjusted competing risk models. Conclusions: A SA level ≥ 3.75 g/dL at admission was associated with decreased long-term CV mortality and may be useful for risk prediction in elderly patients with stable CAD.

Trends and treatments of pelvic and acetabular fractures in Taiwan: facing an aging society.

Pelvic-acetabular fractures lead to high mortality in elders and their association between different groups is not known. Our results indicate that older age with pelvic-acetabular fracture was significantly associated with mortality. This finding may help planning and allocating healthcare resources, risk stratification, and optimizing the treatment of pelvic fractures. PURPOSE: Pelvic or acetabular fractures are among main outcomes of low-energy trauma such as falls, especially in older adults. They represent approximately 3-8% of all fractures and are associated with a high mortality rate ranging from 4 to 28%. This study is aimed at comparing the incidence and trends of hip fractures and pelvic-acetabular fractures in the Taiwanese general population, gender differences in adults aged over 65 years, and mortality risk between pelvic or acetabular fractures and hip fractures and surgery trends in patients with these fractures. METHODS: A retrospective study was conducted extracting data from the National Health Insurance Research Database of patients diagnosed with hip fracture and pelvic acetabular fracture between 2000 and 2018. RESULTS: Older age with pelvic-acetabular fracture was significantly associated with increased mortality. No significant differences were found in comorbidities between the two fracture groups. Results provide clear epidemiological evidence for trends in pelvic-acetabular fractures in Taiwan and demonstrate the need for better strategies to manage these fractures and comorbidities, particularly in older adults. CONCLUSION: Findings of this study may aid in planning and allocating healthcare resources, risk stratification, and optimizing the treatment of pelvic fractures among older adults in Taiwan.

Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better?

Targeted temperature management (TTM) is often considered to improve post-cardiac arrest patients' outcomes. However, the optimal timing to initiate cooling remained uncertain. This retrospective analysis enrolled all non-traumatic post-cardiac arrest adult patients with either out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) who received TTM from July 2015 to July 2021 at our hospital. The values of time delay before TTM and time to target temperature were divided into three periods according to optimal cut-off values identified using receiver operating characteristic curve analysis. A total of 177 patients were enrolled. A shorter time delay before TTM (pre-induction time) was associated with a lower survival chance at 28 days (32.00% vs. 54.00%, p = 0.0279). Patients with a longer cooling induction time (>440 minis) had better neurological outcomes (1.58% vs. 1.05%; p = 0.001) and survival at 28 days (58.06% vs. 29.25%; p = 0.006). After COX regression analysis, the influence of pre-induction time on survival became insignificant, but patients who cooled slowest still had a better chance of survival at 28 days. In conclusion, a shorter delay before TTM was not associated with better clinical outcomes. However, patients who took longer to reach the target temperature had better hospital survival and neurological outcomes than those who were cooled more rapidly. A further prospective study was warranted to evaluate the appropriate time window of TTM.

Outcome prediction in hospitalized COVID-19 patients: Comparison of the performance of five severity scores.

Background: The aim of our study was to externally validate the predictive capability of five developed coronavirus disease 2019 (COVID-19)-specific prognostic tools, including the COVID-19 Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Shang COVID severity score, COVID-intubation risk score-neutrophil/lymphocyte ratio (IRS-NLR), inflammation-based score, and ventilation in COVID estimator (VICE) score. Methods: The medical records of all patients hospitalized for a laboratory-confirmed COVID-19 diagnosis between May 2021 and June 2021 were retrospectively analyzed. Data were extracted within the first 24 h of admission, and five different scores were calculated. The primary and secondary outcomes were 30-day mortality and mechanical ventilation, respectively. Results: A total of 285 patients were enrolled in our cohort. Sixty-five patients (22.8%) were intubated with ventilator support, and the 30-day mortality rate was 8.8%. The Shang COVID severity score had the highest numerical area under the receiver operator characteristic (AUC-ROC) (AUC 0.836) curve to predict 30-day mortality, followed by the SEIMC score (AUC 0.807) and VICE score (AUC 0.804). For intubation, both the VICE and COVID-IRS-NLR scores had the highest AUC (AUC 0.82) compared to the inflammation-based score (AUC 0.69). The 30-day mortality increased steadily according to higher Shang COVID severity scores and SEIMC scores. The intubation rate exceeded 50% in the patients stratified by higher VICE scores and COVID-IRS-NLR score quintiles. Conclusion: The discriminative performances of the SEIMC score and Shang COVID severity score are good for predicting the 30-day mortality of hospitalized COVID-19 patients. The COVID-IRS-NLR and VICE showed good performance for predicting invasive mechanical ventilation (IMV).

Optimizing heterotrophic production of Chlorella sorokiniana SU-9 proteins potentially used as a sustainable protein substitute in aquafeed.

Alternative protein sources for the reduction/replacement of fish meal in aqua-feeds are in urgent demand. Microalgae are considered sustainable protein sources for aquaculture due to their high-quality proteins with a complete profile of essential amino acids. This study examined the heterotrophic production of proteins from Chlorella sorokiniana SU-9. Culture parameters for maximal biomass and protein production are as follows: glucose - 10 g/L glucose, sodium nitrate - 1.5 g/L, and iron - 46 µM iron in BG-11 medium. Under optimal conditions, biomass content, protein content and protein productivity of SU-9 reached 4.14 ± 0.20 g/L, 403 ± 33 mg/g and 382 ± 36 mg/L/d, respectively. The protein profile of Chlorella sorokiniana SU-9 is comparable to fishmeal and soybean meal. The essential amino acids arginine, lysine and cysteine, along with glutamine and glutamate, were high. The production cost of SU-9 can be significantly reduced under heterotrophic cultivation conditions, making it a potential protein substitute in aquafeed.

Increased incidence of alcohol use disorder and alcohol-related psychiatric disorders in patients with obstructive sleep apnea: A nationwide population-based cohort study.

BACKGROUND: Obstructive sleep apnea (OSA) and alcohol-related diseases (ARDs), including alcohol use disorder, alcohol-related psychiatric disorders, alcoholic liver disease, alcoholic polyneuropathy alcoholic cardiomyopathy, and alcoholic gastritis, are both highly prevalent conditions. Alcohol consumption is associated with a higher risk of sleep apnea. However, whether OSA increases the risk of ARD has not, as yet, been studied comprehensively. Our study aimed to determine whether OSA increases the subsequent risk of ARD. METHODS: This study utilized the data from Taiwan's National Health Insurance Database between 2000 and 2015. We identified 7722 individuals newly diagnosed with OSA and randomly selected sex-, age-, and index date-matched (1:3) 22,166 controls without OSA, with a total of 29,888 subjects. We used the Fine and Gray's survival analysis to estimate the effects of OSA on ARD. RESULTS: The OSA cohort had an adjusted hazard ratio of subsequent ARDs as 1.486 (95% Confidence Interval: 1.301-1.698), when comparing the cohort without OSA. The Kaplan-Meier analysis showed that the cumulative incidence of ARDs was significantly higher in the OSA cohort than in the controls in the first year of follow-up, till the end of the follow-up. A post-hoc analysis showed that OSA was associated with alcohol use disorder, alcohol-related psychiatric disorders, and alcoholic liver disease, but not alcoholic polyneuropathy, alcoholic cardiomyopathy, and alcoholic gastritis. The use of psychoactive medication, including the sedative-hypnotics, antidepressants or antipsychotics were associated with a lower risk of ARDs. CONCLUSIONS: Our study demonstrates that the OSA patients are at a higher risk of developing ARDs.

What Are the Key Factors of Functional Outcomes in Patients with Spinopelvic Dissociation Treated with Triangular Osteosynthesis?

For patients with spinopelvic dissociation (SPD), triangular osteosynthesis is the current method for the fixation of the posterior pelvis. This study aimed to assess the recovery process and radiographic parameters associated with the functional outcomes in patients with SPD treated by triangular osteosynthesis. We collected data from 23 patients with SPD. To investigate the key aspect regarding the functional outcomes of these patients, we measured pre- and post-operative parameters, and a statistical analysis adjusted for age, gender, and time windows was used. The radiographic displacement measurement in the pre-operative period showed that the EQ-5D-5L increased by 2.141 per outlet ratio unit. The EQ-5D-5L increased by 1.359 per inlet ratio unit and 1.804 per outlet ratio during the postoperative period. The EQ-VAS increased significantly only with the inlet ratio in the postoperative period (1.270 per inlet ratio). A vertical reduction in SPD during the surgery can achieve more satisfactory outcomes than a horizontal anatomical reduction, in which the horizontal displacement causes inferior functional outcomes.

A novel two-stage process for the effective treatment of swine wastewater using Chlorella sorokiniana AK-1 based algal-bacterial consortium under semi-continuous operation.

This study aimed at developing an eco-friendly and effective treatment for swine wastewater (SWW) using a designer microalgae-bacteria consortium. A functional algal bacterial consortium was developed with SWW-derived bacteria and Chlorella sorokiniana AK-1. Light intensity (300 µmol/m2/s) and inoculum size (0.15 and 0.2 g/L for microalgae and bacteria) were optimized. Semi-batch operation treating 50 % SWW resulted in a COD, BOD, TN, and TP removal efficiency of 81.1 ± 0.9 %, 97.0 ± 0.7 %, 90.6 ± 1.6 % and 91.3 ± 1.1 %, respectively. A novel two-stage process with an initial bacterial start-up stage followed by microalgal inoculation was applied for attaining stable organic carbon removal, in addition to satisfactory TN and TP removal. Full strength SWW was treated with this strategy with COD, BOD, TN, and TP removal efficiencies of 72.1 %, 94.9 %, 88 %, and 94.6 %, respectively. The biomass consisted of 36 % carbohydrates, indicating a potential feedstock for biochar production. In addition, the effluent met the standards for effluent discharge in Taiwan.

Macroalgal biomass as a potential resource for lactic acid fermentation.

Lactic acid is an essential platform chemical with various applications in the chemicals, food, pharmaceutical, and cosmetic industries. Currently, the demand for lactic acid is driven by the role of lactic acid as the starting material for the production of bioplastic polylactide. Microbial fermentation for lactic acid production is favored due to the production of enantiomerically pure lactic acid required for polylactide synthesis, as opposed to the racemic mixture obtained via chemical synthesis. The utilization of first-generation feedstock for commercial lactic acid production is challenged by feedstock costs and sustainability issues. Macroalgae are photosynthetic benthic aquatic plants that contribute tremendously towards carbon capture with subsequent carbon-rich biomass production. Macroalgae are commercially cultivated to extract hydrocolloids, and recent studies have focused on applying biomass as a fermentation feedstock. This review provides comprehensive information on the design and development of sustainable and cost-effective, algae-based lactic acid production. The central carbon regulation in lactic acid bacteria and the metabolism of seaweed-derived sugars are described. An exhaustive compilation of lactic acid fermentation of macroalgae hydrolysates revealed that lactic acid bacteria can effectively ferment the mixture of sugars present in the hydrolysate with comparable yields. The environmental impacts and economic prospects of macroalgal lactic acid are analyzed. Valorization of the vast amounts of spent macroalgal biomass residue post hydrocolloid extraction in a biorefinery is a viable strategy for cost-effective lactic acid production.

Bioethanol production from microalgae biomass at high-solids loadings.

Industrial adoption of microalgae biofuel technology has always been hindered by its economic viability. To increase the feasibility of bioethanol production from microalgae, fermentation was applied to Chlorella vulgaris FSP-E biomass at high-solids loading conditions. First, Chlorella vulgaris FSP-E was cultivated to produce microalgae biomass with high carbohydrate content. Next, different ethanol-producing microorganisms were screened. Saccharomyces cerevisiae FAY-1 showed no inhibition when fermenting high initial glucose concentrations and was selected for the fermentation experiments at high-solids loadings. Optimization of acid hydrolysis at high biomass loading was also performed. The fermentation of microalgal biomass hydrolysate produced a final ethanol concentration and yield higher than most reported literature using microalgae feedstock. In addition, the kinetics of bioethanol fermentation of microalgae hydrolysate under high-solids loading were evaluated. These results showed the potential of fermenting microalgae biomass at high-solids loading in improving the viability of microalgae bioethanol production.

Exploiting exercise electrocardiography to improve early diagnosis of atrial fibrillation with deep learning neural networks.

Atrial fibrillation (AF) is the most common type of sustained arrhythmia. It results from abnormal irregularities in the electrical performance of the atria, and may cause heart thrombosis, stroke, arterial disease, thromboembolism, and heart failure. Prior to the onset of atrial fibrillation, most people experience atrial cardiomyopathy which, if effectively managed, can be prevented from progressing to atrial fibrillation. Electrocardiogram (ECG) can show changes in the heartbeats, and is a common and painless tool to detect heart problems. P-waves in exercise ECGs change more drastically than those in regular ECG, and are more effective in the detection of atrial myocardial diseases. In this paper, we propose a deep learning system to help clinicians to early detect if a patient has atrial enlargement or fibrillation. Firstly, a Convolutional Recurrent Neural Network is employed to locate the P-waves in the patient's exercise ECGs taken in the exercise ECG test process. Relevant parameters are then calculated from the located P-waves. Then a Parallel Bi-directional Long Short-Term Memory Network is applied to analyze the obtained parameters and make a diagnosis for the patient. With our proposed deep learning system, the changes of P-waves collected in different phases in the exercise ECG test can be analyzed simultaneously to get more stable and accurate results. The system can take data of different length as input, and is also applicable to any number of ECG collections. We conduct various experiments to show the effectiveness of our proposed system. We also show that the more ECG data collected in the exercise phase are involved, the more effective our system is in diagnosis of the diseases.