Comparison of bleeding and thrombotic outcomes in veno-venous extracorporeal membrane oxygenation: Heparin versus bivalirudin.

OBJECTIVES: We aimed to evaluate thrombotic and hemorrhagic complications with heparin versus bivalirudin use in veno-venous extracorporeal membrane oxygenation (V-V ECMO). METHODS: We performed a retrospective cohort study of adult patients placed on V-V ECMO with intravenous anticoagulation with either heparin or bivalirudin. Time to thrombotic event and major bleed were analyzed in addition to related outcomes. RESULTS: We identified 95 patients placed on V-V ECMO: 61 receiving heparin, 34 bivalirudin. The bivalirudin group had a higher rate of severe COVID-19, higher BMI, and longer ECMO duration. Despite this, bivalirudin was associated with reduced risk of thrombotic event (HR 0.14, 95% CI 0.06-0.32, p < .001) and increased average lifespan of the circuit membrane lung (16 vs. 10 days, p = 0.004). While there was no difference in major bleeding, the bivalirudin group required fewer transfusions of packed red blood cells and platelets per 100 ECMO days (means of 13 vs. 39, p = 0.004; 5 vs. 19, p = .014, respectively). Lastly, the bivalirudin group had improved survival to ECMO decannulation in univariate analysis (median OS 53 vs. 26 days, p = .015). CONCLUSIONS: In this real-world analysis of bivalirudin versus heparin, bivalirudin is a viable option for V-V ECMO and associated with lower risk of thrombotic complications and fewer transfusion requirements.

Influence of Land Cover and Soil Moisture based Brown Ocean Effect on an Extreme Rainfall Event from a Louisiana Gulf Coast Tropical System.

Extreme flooding over southern Louisiana in mid-August of 2016 resulted from an unusual tropical low that formed and intensified over land. We used numerical experiments to highlight the role of the 'Brown Ocean' effect (where saturated soils function similar to a warm ocean surface) on intensification and it's modulation by land cover change. A numerical modeling experiment that successfully captured the flood event (control) was modified to alter moisture availability by converting wetlands to open water, wet croplands, and dry croplands. Storm evolution in the control experiment with wet antecedent soils most resembles tropical lows that form and intensify over oceans. Irrespective of soil moisture conditions, conversion of wetlands to croplands reduced storm intensity, and also, non-saturated soils reduced rain by 20% and caused shorter durations of high intensity wind conditions. Developing agricultural croplands and more so restoring wetlands and not converting them into open water can impede intensification of tropical systems that affect the area.

Assimilation of SMOS Retrievals in the Land Information System.

The Soil Moisture and Ocean Salinity (SMOS) satellite provides retrievals of soil moisture in the upper 5 cm with a 30-50 km resolution and a mission accuracy requirement of 0.04 cm3 cm-3. These observations can be used to improve land surface model soil moisture states through data assimilation. In this paper, SMOS soil moisture retrievals are assimilated into the Noah land surface model via an Ensemble Kalman Filter within the NASA Land Information System. Bias correction is implemented using Cumulative Distribution Function (CDF) matching, with points aggregated by either land cover or soil type to reduce sampling error in generating the CDFs. An experiment was run for the warm season of 2011 to test SMOS data assimilation and to compare assimilation methods. Verification of soil moisture analyses in the 0-10 cm upper layer and root zone (0-1 m) was conducted using in situ measurements from several observing networks in the central and southeastern United States. This experiment showed that SMOS data assimilation significantly increased the anomaly correlation of Noah soil moisture with station measurements from 0.45 to 0.57 in the 0-10 cm layer. Time series at specific stations demonstrate the ability of SMOS DA to increase the dynamic range of soil moisture in a manner consistent with station measurements. Among the bias correction methods, the correction based on soil type performed best at bias reduction but also reduced correlations. The vegetation-based correction did not produce any significant differences compared to using a simple uniform correction curve.

Bystander effects in unicellular organisms.

Radiation-induced bystander effects have been seen in mammalian cells from diverse origins. These effects can be transmitted through the medium to cells not present at the time of irradiation. We have developed an assay for detecting bystander effects in the unicellular eukaryote, the fission yeast Schizosaccharomyces pombe. This assay allows maximal exposure of unirradiated cells to cells that have received electron beam irradiation. S. pombe cells were irradiated with 16-18 MeV electrons from a pulsed electron LINAC. When survival of the irradiated cells decreased to approximately 50%, forward-mutation to 2-deoxy-d-glucose resistance increased in the unirradiated bystander cells. Further increase in dose had no additional effect on this increase. In order to detect this response, it was necessary for the irradiated cell/unirradiated cell ratio to be high. Other cellular stresses, such as heat treatment, UV irradiation, and bleomycin exposure, also caused a detectable response in untreated cells grown with the treated cells. We discuss evolutionary implications of these results.