INTRODUCTION: Postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) is associated with significant mortality. Identification of patients at very high risk for death is elusive and the decision to initiate V-A-ECMO is based on clinical judgment. The prognostic impact of pre-V-A-ECMO arterial lactate level in these critically ill patients has been herein evaluated.

METHODS: A systematic review was conducted to identify studies on postcardiotomy VA-ECMO for the present individual patient data meta-analysis.

RESULTS: Overall, 1269 patients selected from 10 studies were included in this analysis. Arterial lactate level at V-A-ECMO initiation was increased in patients who died during the index hospitalization compared to those who survived (9.3 vs 6.6 mmol/L, < 0.0001). Accordingly, in hospital mortality increased along quintiles of pre-V-A-ECMO arterial lactate level (quintiles: 1, 54.9%; 2, 54.9%; 3, 67.3%; 4, 74.2%; 5, 82.2%, < 0.0001). The best cut-off for arterial lactate was 6.8 mmol/L (in-hospital mortality, 76.7% vs. 55.7%, < 0.0001). Multivariable multilevel mixed-effect logistic regression model including arterial lactate level significantly increased the area under the receiver operating characteristics curve (0.731, 95% CI 0.702-0.760 vs 0.679, 95% CI 0.648-0.711, DeLong test < 0.0001). Classification and regression tree analysis showed the in-hospital mortality was 85.2% in patients aged more than 70 years with pre-V-A-ECMO arterial lactate level ≥6.8 mmol/L.

CONCLUSIONS: Among patients requiring postcardiotomy V-A-ECMO, hyperlactatemia was associated with a marked increase of in-hospital mortality. Arterial lactate may be useful in guiding the decision-making process and the timing of initiation of postcardiotomy V-A-ECMO.

Hypervirulent Klebsiella pneumoniae (hvKp) is an emerging pathogen and it has more virulence factors than classical Klebsiella pneumoniae strains. Carbapenem-resistant hvKp (CR-hvKp) is a dangerous bacteria that has both high virulence and antibiotic resistance and poses a global public health problem worldwide. The current study was carried out to investigate the occurrence of hvKp as well as carbapenem-resistant Klebsiella pneumoniae (CRKP) and CR-hvKp among diarrheic farm animals. For this purpose, rectal swabs from 165 farm animals (45 cattle, 66 sheep, and 54 goats) were collected. Samples were processed for the isolation and identification of Klebsiella pneumoniae. Moreover, hvKp was detected using molecular techniques by amplification of biomarker virulence genes (rmpA, rmpA2, iucA, iroB, and peg-344), followed by a string test. On the other hand, all K. pneumoniae isolates were examined for carbapenem resistance by both phenotypic and molecular methods. The phylogenetic analysis of peg-344 sequences was carried out. The overall prevalence rates of K. pneumoniae, hvKp, CRKP, and CR-hvKp were 24.2%, 7.9%, 16.4%, and 6.1% respectively. HvKp and CR-hvKp were detected among all examined farm animal species. On a Molecular basis, all biomarker virulence genes were identified except iroB, but rmpA is the most prevalent one. The phylogenetic analysis of peg-344 sequences obtained from the study points out their genetic relatedness to those circulated among humans. In conclusion, the emergence of hvKp and CR-hvKp among diarrheic farm animals confers a great public health implication and thus, the possible animal reservoirs for such hypervirulent-antimicrobial resistant strains cannot be ruled out.

The goal of the present study is to investigate, delineate, and evaluate the shallow Miocene groundwater aquifer with vertical and lateral facies variations in the Gara oasis, western desert of Egypt. This oasis represents a typical arid region in North Africa. Through grid texture analysis, lineament detection, edge detection, thresholding, and identifying areas of structural complexity from the filtered residual reduced-to-pole magnetic anomaly map, it is possible to outline the fracture zones that principally control the groundwater aquifers and water flow in the area. The groundwater quality and quantity are examined hydro-geochemically through nine groundwater samples that were gathered from wells and springs distributed throughout the area around Gara Lake. Measurements of physio-chemical parameters (TDS, pH, and EC) are carried out and its spatial distribution is critically studied. The results reveal that the ion-exchange process caused by water-rock interaction is the dominant process. Furthermore, the main ions in the groundwater in the study areas were Na and Cl. This might be due to evaporation or halite dissolution with the upward flow of waters through the fractures from the deep aquifer of the Nubian sandstone to the shallow aquifer of the fractured Miocene limestone.

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The contamination of heavy metals is a cause of environmental concern across the globe, as their increasing levels can pose a significant risk to our natural ecosystems and public health. The present study was aimed to evaluate the ability of a copper (Cu)-resistant bacterium, characterized as Bacillus altitudinis
MT422188, to remove Cu from contaminated industrial wastewater. Optimum growth was observed at 37°C, pH 7, and 1 mm phosphate, respectively. Effective concentration 50 (EC
50
), minimum inhibitory concentration (MIC), and cross-heavy metal resistance pattern were observed at 5.56 mm, 20 mm, and Ni > Zn > Cr > Pb > Ag > Hg, respectively. Biosorption of Cu by live and dead bacterial cells in its presence and inhibitors 1 and 2 (DNP and DCCD) was suggestive of an ATP-independent efflux system.
B. altitudinis
MT422188 was also able to remove 73 mg/l and 82 mg/l of Cu at 4th and 8th day intervals from wastewater, respectively. The presence of Cu resulted in increased GR (0.004 ± 0.002 Ug
−1
FW), SOD (0.160 ± 0.005 Ug
−1
FW), and POX (0.061 ± 0.004 Ug
−1
FW) activity. Positive motility (swimming, swarming, twitching) and chemotactic behavior demonstrated Cu as a chemoattractant for the cells. Metallothionein (MT) expression in the presence of Cu was also observed by SDS-PAGE. Adsorption isotherm and pseudo-kinetic-order studies suggested Cu biosorption to follow Freundlich isotherm as well as second-order kinetic model, respectively. Thermodynamic parameters such as Gibbs free energy (∆G°), change in enthalpy (∆H° = 10.431 kJ/mol), and entropy (∆S° = 0.0006 kJ/mol/K) depicted the biosorption process to a feasible, endothermic reaction. Fourier Transform Infrared Spectroscopy (FTIR), Scanning Electron Microscopy (SEM), and Energy-Dispersive X-Ray Spectroscopy (EDX) analyses revealed the physiochemical and morphological changes in the bacterial cell after biosorption, indicating interaction of Cu ions with its functional groups. Therefore, these features suggest the potentially effective role of
B. altitudinis
MT422188 in Cu bioremediation.

Fishpond sediments are rich in organic carbon and nutrients; thus, they can be used as potential fertilizers and soil conditioners. However, sediments can be contaminated with toxic elements (TEs), which have to be immobilized to allow sediment reutilization. Addition of biochars (BCs) to contaminated sediments may enhance their nutrient content and stabilize TEs, which valorize its reutilization. Consequently, this study evaluated the performance of BCs derived from Taraxacum mongolicum Hand-Mazz (TMBC), Tribulus terrestris (TTBC), and rice straw (RSBC) for Cu, Cr, and Zn stabilization and for the enhancement of nutrient content in the fishpond sediments from San Jiang (SJ) and Tan Niu (TN), China. All BCs, particularly TMBC, reduced significantly the average concentrations of Cr, Cu, and Zn in the overlying water (up to 51% for Cr, 71% for Cu, and 68% for Zn) and in the sediments pore water (up to 77% for Cr, 76% for Cu, and 50% for Zn), and also reduced metal leachability (up to 47% for Cr, 60% for Cu, and 62% for Zn), as compared to the control. The acid soluble fraction accounted for the highest portion of the total content of Cr (43–44%), Cu (38–43%), and Zn (42–45%), followed by the reducible, oxidizable, and the residual fraction; this indicates the high potential risk. As compared with the control, TMBC was more effective in reducing the average concentrations of the acid soluble Cr (15–22%), Cu (35–53%), and Zn (21–39%). Added BCs altered the metals acid soluble fraction by shifting it to the oxidizable and residual fractions. Moreover, TMBC improved the macronutrient status in both sediments. This work provides a pathway for TEs remediation of sediments and gives novel insights into the utilization of BC-treated fishpond sediments as fertilizers for crop production.

Abstract High-quality epitaxial growth of oriented microcrystallites on a semiconductor substrate is demonstrated here for formamidinium lead bromide perovskite, by drop casting of precursor solutions in air. The microcrystallites exhibit green photoluminescence at room temperature, as well as lasing with low thresholds. Lasing is observed even though the substrate is fully opaque at the lasing wavelengths, and even though it has a higher refractive index as the perovskite active material. Moreover, the lasing is stable for more than 109 excitation pulses, which is more than what is previously achieved for devices kept in the air. Such highly stable lasing under pulsed excitation represents an important step towards continuous mode operation or even electrical excitation in future perovskite-based devices.