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Kachapila, M., M. Monahan, A. O. Ademuyiwa, Y. M. Adinoyi, B. M. Biccard, C. George, D. N. Ghosh, J. Glasbey, D. G. Morton, O. Osayomwanbo, et al., Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries, , vol. 7, pp. 100207, 2023. AbstractWebsite

BackgroundThis study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa.
Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($).
High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs.
High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

Gad, A., K. Joyce, N. G. Menjivar, D. Heredia, C. S. Rojas, D. Tesfaye, and A. Gonella-Diaza, "Extracellular vesicle-microRNAs mediated response of bovine ovaries to seasonal environmental changes", Journal of Ovarian Research, vol. 16, issue 1, pp. 101, 2023. AbstractWebsite

Among the various seasonal environmental changes, elevated ambient temperature during the summer season is a main cause of stress in dairy and beef cows, leading to impaired reproductive function and fertility. Follicular fluid extracellular vesicles (FF-EVs) play an important role in intrafollicular cellular communication by, in part, mediating the deleterious effects of heat stress (HS). Here we aimed to investigate the changes in FF-EV miRNA cargoes in beef cows in response to seasonal changes: summer (SUM) compared to the winter (WIN) season using high throughput sequencing of FF-EV-coupled miRNAs. In addition to their biological relevance, the potential mechanisms involved in the packaging and release of those miRNAs as a response to environmental HS were elucidated.

Zhang, X., M. Jiang, L. He, N. K. Niazi, M. Vithanage, B. Li, J. Wang, H. Abdelrahman, V. Antoniadis, J. Rinklebe, et al., "Pandemic COVID-19 ends but soil pollution increases: Impacts and a new approach for risk assessment", Science of The Total Environment, vol. 890, pp. 164070, 2023. AbstractWebsite

For three years, a large amount of manufactured pollutants such as plastics, antibiotics and disinfectants has been released into the environment due to COVID-19. The accumulation of these pollutants in the environment has exacerbated the damage to the soil system. However, since the epidemic outbreak, the focus of researchers and public attention has consistently been on human health. It is noteworthy that studies conducted in conjunction with soil pollution and COVID-19 represent only 4 % of all COVID-19 studies. In order to enhance researchers' and the public awareness of the seriousness on the COVID-19 derived soil pollution, we propose the viewpoint that “pandemic COVID-19 ends but soil pollution increases” and recommend a whole-cell biosensor based new method to assess the environmental risk of COVID-19 derived pollutants. This approach is expected to provide a new way for environmental risk assessment of soils affected by contaminants produced from the pandemic.

Zhang, P., C. - B. Duan, B. Jin, A. S. Ali, X. Han, H. Zhang, M. - Z. Zhang, W. - H. Zhang, and Y. - C. Gu, Recent advances in the natural products-based lead discovery for new agrochemicals, , 2023. AbstractWebsite

Crops will be harmed by fungi, pests and weeds during their growth. In the past half century, scientists have conducted in-depth research on natural products extracted from microorganisms, plants or animals, and used natural products and their derivatives as the lead for pesticides discovery. Natural product pesticides have the advantages of easy degradation in the environment, selective control and safety to non-target organisms. This review summarizes the studies on natural products pesticides in recent years, including natural products of chemical modification and biosynthesis, mainly fungicides, herbicides, insecticides and acaricides. We classify natural products according to their active fragments, and discuss their effects on the control of agricultural fungi, pests and weeds. Ultimately, we found that lead discovery based on natural products has great advantages in pesticide development.

Gohar, S. M., W. T. V. Hegelstad, B. Auestad, U. H. Haahr, I. Joa, J. O. Johannessen, T. K. Larsen, S. Opjordsmoen, B. R. Rund, J. I. Røssberg, et al., "Association between early suicidal trajectories in first-episode psychosis and 10-year follow-up: TIPS registry-linked study.", The lancet. Psychiatry, vol. 10, issue 7, pp. 528-536, 2023. Abstract

BACKGROUND: Although the risk of suicidality is high in first-episode psychosis, patterns and individual variability in suicidal thoughts and behaviours over time are under-researched. We aimed to identify early trajectories of suicidality over a 2-year follow-up, assess their baseline predictors, and explore associations between those trajectories and later suicidality.

METHODS: This longitudinal follow-up study was a part of the Early Treatment and Intervention in Psychosis (TIPS)study. Participants, linked to Norwegian and Danish death registries, were recruited from four catchment areas (665 000 inhabitants) in Norway and Denmark (both inpatient and outpatient). We included participants aged 15-65 years, with an intelligence quotient of more than 70, willing to give informed consent, and with a first episode of active psychotic symptoms. Individuals with comorbid neurological or endocrinal disorders, or those with contraindications to antipsychotics, were excluded. Growth mixture modelling was used to identify trajectories of suicidal thoughts and behaviours over the first 2 years. Multinomial logistic regression was applied to examine the baseline predictors of those trajectories and their associations with suicidality at 10-year follow-up.

FINDINGS: A total of 301 participants were recruited from Jan 1, 1997, to Dec 31, 2000. Of the 299 with completed suicidality data at baseline, 271 participated in 1-year follow-up, 250 in 2-year follow-up, 201 in 5-year follow-up, and 186 at 10-year follow-up. At baseline, 176 (58%) were male, 125 (42%) were female. The mean age was 27·80 years (SD 9·64; range 15-63). 280 (93%) participants were of Scandinavian origin. Four trajectories over 2 years were identified: stable non-suicidal (217 [72%]), stable suicidal ideation (45 [15%]), decreasing suicidal thoughts and behaviours (21 [7%]), and worsening suicidal thoughts and behaviours (18 [6%]). A longer duration of untreated psychosis (odds ratio [OR] 1·24, 95% CI 1·02-1·50, p=0·033), poorer premorbid childhood social adjustment (1·33, 1·01-1·73, p=0·039), more severe depression (1·10, 1·02-1·20, p=0·016), and substance use (2·33, 1·21-4·46, p=0·011) at baseline predicted a stable suicidal ideation trajectory. Individuals in the stable suicidal ideation trajectory tended to have suicidal thoughts and behaviours at 10-year follow-up (3·12, 1·33-7·25, p=0·008). Individuals with a worsening suicidal trajectory were at a higher risk of death by suicide between 2 and 10 years (7·58, 1·53-37·62, p=0·013).

INTERPRETATION: Distinct suicidal trajectories in first-episode psychosis were associated with specific predictors at baseline and distinct patterns of suicidality over time. Our findings call for early and targeted interventions for at-risk individuals with persistent suicidal ideation or deteriorating patterns of suicidal thoughts and behaviours, or both.

FUNDING: Health West, Norway; the Norwegian National Research Council; the Norwegian Department of Health and Social Affairs; the National Council for Mental Health and Health and Rehabilitation; the Theodore and Vada Stanley Foundation; the Regional Health Research Foundation for Eastern Region, Denmark; Roskilde County, Helsefonden, Lundbeck Pharma; Eli Lilly; Janssen-Cilag Pharmaceuticals, Denmark; a National Alliance for Research on Schizophrenia and Depression Distinguished Investigator Award and The National Institute of Mental Health grant; a National Alliance for Research on Schizophrenia & Depression Young Investigator Award from The Brain & Behavior Research Foundation; Health South East; Health West; and the Regional Centre for Clinical Research in Psychosis.

Ramaiah, P., F. M. A. Altalbawy, R. Margiana, B. N. Kumar, F. Kahar, A. T. Jalil, A. Komariah, V. E. Failoc‑Rojas, M. M. Kadhim, R. Sivaraman, et al., "The association between prenatal exposure to polycyclic aromatic hydrocarbons and childhood intelligence: a systematic review of observational studies", Environmental Science and Pollution Research, vol. 30, issue 8, pp. 19592-19601, 2023. 2-environmental_science_and_pollution_research.pdf
Gaber, A., A. M. Elbakry, R. M. Aljarari, F. A. Jaber, Y. A. Khadrawy, D. Sabry, R. E. Abo-ELeneen, and O. M. Ahmed, "Bone Marrow-Derived Mesenchymal Stem Cells and -Secretase Inhibitor Treatments Suppress Amyloid-25-35-Induced Cognitive Impairment in Rat Dams and Cortical Degeneration in Offspring.", Stem cells international, vol. 2023, pp. 2690949, 2023. Abstract

Alzheimer's disease (AD) is the most frequent cause of age-related neurodegeneration and ensuing cognitive impairment. Progressive deposition of extracellular amyloid beta (A) aggregates (plaques) and intracellular hyperphosphorylated Tau protein (p-Tau) are the core pathological markers of AD but may precede clinical symptoms by many years, presenting a therapeutic window of opportunity. Females are more frequently afflicted by AD than males, necessitating evaluation of novel treatments for the female population. The current study examined the protective efficacies of intravenous bone marrow-derived mesenchymal stem cells (BM-MSCs) and oral gamma-secretase inhibitor-953 (GSI-953) during pregnancy on cognitive impairment in rat dams and neurodegeneration in offspring induced by intracerebroventricular injection of A25-35 prior to pregnancy. The A25-35 (AD) group exhibited significant ( < 0.001) impairments in the Y-maze and novel object recognition test performance prior to conception. Histological analysis of the offspring cortex revealed substantial dendritic shrinkage and activation of microglial cells, while neurochemical analysis demonstrated significant increases in the proinflammatory cytokine interleukin-1 (IL-1) and tumor necrosis factor- (TNF-). In contrast, BM-MSC or GSI-953 treatment of dams following A25-35 injection significantly ( < 0.001) reduced the number and size of activated microglial cells, markedly increased dendrite length, and reversed proinflammatory cytokine elevations in offspring. Moreover, BM-MSC or GSI-953 treatment reversed the A25-35-induced amyloid precursor protein and p-Tau elevations in the offspring brain; these changes were accompanied by upregulation of the brain-derived neurotrophic factor and downregulation of glycogen synthase kinase-3 in the serum and brain. Treatment with BM-MSCs or GSI-953 also reversed A25-35-induced elevations in different gene expressions in the neonatal cortex. Finally, treatment of dams with BM-MSCs or GSI-953 prevented the A25-35-induced disruption of newborn brain development. Thus, BM-MSC and GSI-953 treatments have broad-spectrum effects against A25-35-induced brain pathology, including the suppression of neural inflammation, restoration of developmental plasticity, and promotion of neurotrophic signaling.

Safir, F., N. Vu, L. F. Tadesse, K. Firouzi, N. Banaei, S. S. Jeffrey, A. A. E. Saleh, B. P. T. Khuri-Yakub, and J. A. Dionne, "Combining Acoustic Bioprinting with AI-Assisted Raman Spectroscopy for High-Throughput Identification of Bacteria in Blood.", Nano letters, vol. 23, issue 6, pp. 2065-2073, 2023. Abstract

Identifying pathogens in complex samples such as blood, urine, and wastewater is critical to detect infection and inform optimal treatment. Surface-enhanced Raman spectroscopy (SERS) and machine learning (ML) can distinguish among multiple pathogen species, but processing complex fluid samples to sensitively and specifically detect pathogens remains an outstanding challenge. Here, we develop an acoustic bioprinter to digitize samples into millions of droplets, each containing just a few cells, which are identified with SERS and ML. We demonstrate rapid printing of 2 pL droplets from solutions containing , , and blood; when they are mixed with gold nanorods (GNRs), SERS enhancements of up to 1500× are achieved.We then train a ML model and achieve ≥99% classification accuracy from cellularly pure samples and ≥87% accuracy from cellularly mixed samples. We also obtain ≥90% accuracy from droplets with pathogen:blood cell ratios <1. Our combined bioprinting and SERS platform could accelerate rapid, sensitive pathogen detection in clinical, environmental, and industrial settings.

Lefrant, J. - Y., D. Benhamou, M. - O. Fischer, R. Pirracchio, B. Allaouchiche, S. Bastide, M. Biais, A. Blet, L. Bouvet, O. Brissaud, et al., "Comments on: Reducing the Risks of Nuclear War-The Role of Health Professionals.", Anaesthesia, critical care & pain medicine, pp. 101314, 2023.
Roczkowsky, A., D. Limonta, J. P. Fernandes, W. G. Branton, M. Clarke, B. Hlavay, R. S. Noyce, J. T. Joseph, N. S. Ogando, S. K. Das, et al., "COVID-19 induces neuroinflammation and suppresses peroxisomes in the brain", Ann Neurol, 2023. AbstractWebsite

Peroxisome injury occurs in the central nervous system (CNS) during multiple virus infections that result in neurological disabilities. We investigated host neuroimmune responses and peroxisome biogenesis factors during SARS-CoV-2 infection using a multiplatform strategy.|Brain tissues from COVID-19 (n=12) and other disease control (ODC) (n=12) patients, as well as primary human neural cells and Syrian hamsters, infected with a clinical variant of SARS-CoV-2, were investigated by ddPCR, RT-qPCR and immunodetection methods.|SARS-CoV-2 RNA was detected in the CNS of four patients with COVID-19 with viral protein (NSP3 and spike) immunodetection in the brainstem. Olfactory bulb, brainstem, and cerebrum from patients with COVID-19 showed induction of pro-inflammatory transcripts (IL8, IL18, CXCL10, NOD2) and cytokines (GM-CSF and IL-18) compared to CNS tissues from ODC patients (p<0.05). Peroxisome biogenesis factor transcripts (PEX3, PEX5L, PEX11β and PEX14) and proteins (PEX3, PEX14, PMP70) were suppressed in the CNS of COVID-19 patients compared to ODCs (p<0.05). SARS-CoV-2 infection of hamsters revealed viral RNA detection in the olfactory bulb at days 4 and 7 post-infection while inflammatory gene expression was upregulated in the cerebrum of infected animals by day 14 post-infection (p<0.05). Pex3 transcript levels together with catalase and PMP70 immunoreactivity were suppressed in the cerebrum of SARS-CoV-2 infected animals (p<0.05).|COVID-19 induced sustained neuroinflammatory responses with peroxisome biogenesis factor suppression despite limited brainstem SARS-CoV-2 neurotropism in humans. These observations offer insights into developing biomarkers and therapies, while also implicating persistent peroxisome dysfunction as a contributor to the neurological post-acute sequelae of COVID-19. This article is protected by copyright. All rights reserved.

Chen, R., N. Xiao, Y. Lu, T. Tao, Q. Huang, S. Wang, Z. Wang, M. Chuan, Q. Bu, Z. Lu, et al., "A de novo evolved gene contributes to rice grain shape difference between indica and japonica.", Nature communications, vol. 14, issue 1, pp. 5906, 2023. Abstractde_novo_.pdf

The role of de novo evolved genes from non-coding sequences in regulating morphological differentiation between species/subspecies remains largely unknown. Here, we show that a rice de novo gene GSE9 contributes to grain shape difference between indica/xian and japonica/geng varieties. GSE9 evolves from a previous non-coding region of wild rice Oryza rufipogon through the acquisition of start codon. This gene is inherited by most japonica varieties, while the original sequence (absence of start codon, gse9) is present in majority of indica varieties. Knockout of GSE9 in japonica varieties leads to slender grains, whereas introgression to indica background results in round grains. Population evolutionary analyses reveal that gse9 and GSE9 are derived from wild rice Or-I and Or-III groups, respectively. Our findings uncover that the de novo GSE9 gene contributes to the genetic and morphological divergence between indica and japonica subspecies, and provide a target for precise manipulation of rice grain shape.

Anazi, A. A. A., R. Satar, H. S. Jabbar, I. B. Sapaev, F. M. A. Altalbawy, A. A. Alameri, R. F. Obaid, A. A. Ramírez‑Coronel, R. H. C. Alflh, Y. F. Mustafa, et al., "Efectual and Rapid Synthesis of Hantzsch Derivatives in Solvent‑Free Conditions Catalyzed by a Mesoporous Basic Silica‑Based Nanomaterial", Silicon, vol. 15, pp. 3453–3461, 2023. 9-_silicon.pdf
AbdelRaouf, R. M., A. Tsujimoto, T. M. Hamdy, A. Alhotan, C. A. Jurado, M. F. Abadir, and N. A. Habib, "The Effect of Surface Treatments of Presintered Zirconia on Sintered Surfaces", Joiunal of Composites Science, vol. 7, pp. 396, 2023.
Jasim, S. A., F. M. A. Altalbawy, A. A. Alameri, A. A. Ramírez-Coronel, R. F. Obaid, M. M. Al-Hamdani, A. J. Kadhim, R. S. Zabibah, H. A. Alzahrani, S. G. Farsani, et al., "Effects of dietary Lactobacillus helveticus ATCC 15009 on growth performance, hematology parameters, innate immune responses, and the antioxidant status of rainbow trout (Oncorhynchus mykiss) under high rearing density", ANNALS OF ANIMAL SCIENCE, vol. 23, issue 3, pp. 833–844, 2023. 15-annals_of_animal_science.pdf
Gu, M., J. Tian, Y. Lou, J. Ran, A. Mohamed, N. O. Keyhani, S. Jaronski, G. Wang, X. Chen, L. - S. Zang, et al., "Efficacy of Metarhizium rileyi granules for the control of Spodoptera frugiperda and its synergistic effects with chemical pesticide, sex pheromone and parasitoid", Entomologia Generalis, vol. 43, issue 6, pp. 1211-1219, 2023.
Elaraby, A., M. Shahien, A. M. Jahan, M. Etoom, and A. H. Bekhet, "The Efficacy of Virtual Reality Training in the Rehabilitation of Orthopedic Ankle Injuries: A Systematic Review and Meta-analysis.", Advances in rehabilitation science and practice, vol. 12, pp. 11795727231151636, 2023. Abstract

INTRODUCTION: Orthopedic ankle injuries are considered among the most common musculoskeletal injuries. A wide variety of modalities and techniques have been used for the management of these injuries, and virtual reality (VR) is one modality that has been examined in ankle injuries rehabilitation.

PURPOSE: This study aims to systemically review previous studies evaluating the effect of virtual reality in rehabilitating orthopedic ankle injuries.

METHODS: We searched six online databases: PubMed, Web of Science (WOS), Scopus, the Physiotherapy Evidence Database (PEDro), Virtual Health Library (VHL), and Cochrane Central Register of Controlled Trials (CENTRAL).

RESULTS: Ten randomized clinical trials met the inclusion criteria. Our results showed that VR had a significant effect on overall balance compared to conventional physiotherapy (SMD = 0.359, 0.009-0.710  = 0.04), [ = 17%,  = 0.30]. Compared with conventional physiotherapy, VR programs significantly improved gait parameters such as speed and cadence, muscle power, and perceived ankle instability; however, no significant difference was detected in the foot and ankle ability measure (FAAM). Additionally, significant improvements in static balance and perceived ankle instability were reported after the use of VR balance and strengthening programs. Finally, only two articles were deemed to have good quality, and the other studies' quality ranged from poor to fair.

CONCLUSION: VR rehabilitation programs can be used to rehabilitate ankle injuries, as they are regarded as safe interventions and have promising effects. However, there is a need for studies with high quality since most included studies' quality varied from poor to fair.

Haowei, M. A., U. A. - R. Hussein, Z. H. Al-Qaim, F. M. A. Altalbawy, H. l. AI-Sadi, A. A. Fadhil, M. M. Al-Taee, S. K. Hadrawi, R. M. Khalaf, I. H. Jirjees, et al., "Employing Sisko non-Newtonian model to investigate the thermal behavior of blood flow in a stenosis artery: Effects of heat flux, different severities of stenosis, and different radii of the artery", Alexandria Engineering Journal, vol. 68, pp. 291–300, 2023. 1-alexandria_engineering_journal.pdf
Zhang, W., C. Jia, L. - S. Zang, M. Gu, R. Zhang, I. Eleftherianos, and A. A. Mohamed, "Entomopathogenic fungal-derived metabolites alter innate immunity and gut microbiota in the migratory locust", Journal of Pest Science, 2023. AbstractWebsite
Zhang, W., C. Jia, L. - S. Zang, M. Gu, R. Zhang, I. Eleftherianos, and A. A. Mohamed, "Entomopathogenic fungal-derived metabolites alter innate immunity and gut microbiota in the migratory locust", Journal of Pest Science, 2023. AbstractWebsite


Hanifar, K., Y. Q. Almajidi, H. S. Jabbar, A. A. Ramírez-Coronel, F. M. A. Altalbawy, A. F. Almulla, A. T. Jalil, S. A. Awad, and L. A. Barboza-Arenas, "An Environmental-friendly Procedure Based on Deep Eutectic Solvent for Extraction and Determination of Toxic Elements in Fish Species from Different Regions of Iraq", Journal of Food Protection, vol. 86, pp. 100102, 2023. 14-journal_of_food_protection.pdf
Fayad, M. A., S. I. Ibrahim, S. H. Omran, F. J. Martos, T. Badawy, A. A. M. Jubori, H. A. Dhahad, and M. T. Chaichan, "Experimental effect of CuO2 nanoparticles into the RME and EGR rates on NOX and morphological characteristics of soot nanoparticles", Fuel, vol. 331, issue 125549, 2023.
Yousef, A. A., A. F. Elmahrouk, T. E. Hamouda, A. M. Helal, A. M. Dohain, A. Alama, M. S. Shihata, O. O. Al-Radi, A. A. Jamjoom, and M. H. Mashali, "Factors affecting the outcomes after bidirectional Glenn shunt: two decades of experience from a tertiary referral center.", The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology, vol. 75, issue 1, pp. 53, 2023. Abstractfactors_affecting_the_outcomes_after_bidirectional_glenn.pdf

BACKGROUND: Despite the improved management of patients with a single ventricle, the long-term outcomes are not optimal. We reported the outcomes of the bidirectional Glenn procedure (BDG) and factors affecting the length of hospital stay, operative mortality, and Nakata index before Fontan completion.

RESULTS: This retrospective study included 259 patients who underwent BDG shunt from 2002 to 2020. The primary study outcomes were operative mortality, duration of hospital stay, and Nakata index before Fontan. Mortality occurred in 10 patients after BDG shunt (3.86%). By univariable logistic regression analysis, postoperative mortality after BDG shunt was associated with high preoperative mean pulmonary artery pressure (OR: 1.06 (95% CI 1.01-1.23); P = 0.02). The median duration of hospital stay after BDG shunt was 12 (9-19) days. Multivariable analysis indicated that Norwood palliation before BDG shunt was significantly associated with prolonged hospital stay (β: 0.53 (95% CI 0.12-0.95), P = 0.01). Fontan completion was performed in 144 patients (50.03%), and the pre-Fontan Nataka index was 173 (130.92-225.34) mm/m. Norwood palliation (β: - 0.61 (95% CI 62.63-20.18), P = 0.003) and preoperative saturation (β: - 2.38 (95% CI - 4.49-0.26), P = 0.03) were inversely associated with pre-Fontan Nakata index in patients who had Fontan completion.

CONCLUSIONS: BDG had a low mortality rate. Pulmonary artery pressure, Norwood palliation, cardiopulmonary bypass time, and pre-BDG shunt saturation were key factors associated with post-BDG outcomes in our series.

Biancari, F., A. Kaserer, A. Perrotti, V. G. Ruggieri, S. - M. Cho, J. K. Kang, M. Dalén, H. Welp, K. Jónsson, S. Ragnarsson, et al., "Hyperlactatemia and poor outcome After postcardiotomy veno-arterial extracorporeal membrane oxygenation: An individual patient data meta-Analysis.", Perfusion, pp. 2676591231170978, 2023. Abstract

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.

Azizan, A. F., W. N. A. W. Adnan, R. J. Johari, A. J. Azwa, and T. H. Ismail, "Intellectual Property in Malaysia: Initiatives, Challenges & Real Infringement Cases", Economic Affairs, vol. ahead-of-print, issue ahead-of-print, 2023.