[Influence of extracorporeal membrane oxygenation on in-hospital survival and prognosis of adult patients with fulminant myocarditis].

OBJECTIVE: To investigate the effect of extracorporeal membrane oxygenation (ECMO) on in-hospital survival and prognosis of adult patients with fulminant myocarditis. METHODS: The registration materials of 21 patients with fulminant myocarditis supported by veno-arterial ECMO (VA-ECMO) from March 2019 to January 2022 in the Heart Center of the First Hospital of Lanzhou University were selected from the Chinese Society for Extracorporeal Life Support (CSECLS) Registry Database. The clinical baseline data, laboratory and echocardiographic data, VA-ECMO related parameters, complications and in-hospital outcome were recorded. The main end events of follow-up were death and readmission due to heart failure. RESULTS: (1) The median age of 21 patients was (42.7±16.4) years, there were 12 males (57.1%) and 9 females (42.9%), and 16 patients (76.2%) survived in hospital and 5 patients (23.8%) died in hospital. (2) Compared with the survival group, patients in the death group had a higher proportion of invasive ventilator support and continuous renal replacement therapy (CRRT) [3/16 (18.8%) vs. 4/5 (80.0%), 3/16 (18.8%) vs. 4/5 (80.0%)], and a lower survival after VA-ECMO score (SAVE) [score: -5.0 (-5.0, -3.0) vs. 1.0 (-6.0, 5.0)], the serum creatinine (SCr) level was higher during VA-ECMO support [µmol/L: 248.0 (144.0, 447.0) vs. 83.0 (71.7, 110.9)], the platelet count (PLT) level was lower [×109/L: 60.0 (31.5, 96.5) vs. 100.0 (71.0, 139.3)], and the ECMO initial support flow rate was higher (L/min: 3.2±0.7 vs. 2.6±0.4). All the differences were statistically significant (all P < 0.05). (3) The echocardiography indexes of the survival group were significantly improved at discharge compared with those at admission [left ventricular ejection fraction (LVEF, %): 54.0±6.7 vs. 30.0±7.2], left ventricular end-diastolic volume [(LVESV, mL): 55.7±27.5 vs. 85.9±28.7], cardiac index [(CI, L×min-1×m-2): 2.6±0.4 vs. 1.9±0.6], cardiac output [(CO, L/min): 4.5±0.7 vs. 3.2±0.9]. All the differences were statistically significant (all P < 0.05). (4) The median follow-up time of the 16 survivial patients was 9 (2, 14) months. During the follow-up period, 5 patients (31.3%) were readmitted to the hospital due to heart failure (1 case of cardiogenic death). The average ECMO support duration of the 5 patients who readmitted to the hospital due to heart failure was significantly shorter than that of the 11 patients without heart failure [hours: 82.0 (47.0, 99.0) vs. 116.0 (98.0, 156.0), Z = -2.381, P = 0.017]. CONCLUSIONS: On the basis of immunomodulatory and other treatments, early application of VA-ECMO in adult patients with fulminant myocarditis can significantly improve in-hospital survival rate and cardiac function. Heart failure after discharge may be related to short VA-ECMO support time during hospitalization.

Limb Ischemia Complications of Veno-Arterial Extracorporeal Membrane Oxygenation.

Background: This study aimed to summarize and analyse the risk factors, clinical features, as well as prevention and treatment of limb ischemia complications in patients on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Methods: We retrospectively analyzed 179 adult patients who had undergone V-A ECMO support in the Cardiac Care Unit of the First Hospital of Lanzhou University between March 2019 and December 2021. Patients were divided into the limb ischemia group (LI group) and the non-limb ischemia group (nLI group) according to whether limb ischemia occurred on the ipsilateral side of femoral artery cannulation. In the LI group, patients were salvaged with a distal perfusion cannula (DPC) according to each patient's clinical conditions. The baseline data and ECMO data were compared between the two groups, and risk factors for limb ischemia complications were screened using multiple logistic regression analysis. Results: Overall, 19 patients (10.6%) had limb ischemia complications, of which 5 (2.8%) were improved after medication adjustment, 12 (8.4%) were salvaged with a DPC, and 2 had undergone surgical intervention. There were significant differences in terms of Extracorporeal Cardiopulmonary Resuscitation (ECPR), Intra-aortic balloon pump (IABP), peak vasoactive-inotropic score (VIS) within 24 h after ECMO (VIS-max), Left ventricular ejection fraction (LVEF), weaning from ECMO, and discharge rate between the two groups. ECPR, IABP, and VIS-max in the LI group were significantly higher than those in the nLI group, whereas weaning from ECMO, discharge rate, and LVEF were significantly lower in the LI group compared to those in the nLI group. Furthermore, multiple logistic regression analysis revealed that diabetes [odds ratio (OR) = 4.338, 95% confidence interval (CI): 1.193-15.772, P = 0.026], IABP (OR = 1.526, 95% CI: 1.038-22.026, P = 0.049) and VIS-max (OR = 1.054, 95% CI: 1.024-1.085, P < 0.001) were independent risk factors for limb ischemia complications in patients who underwent V-A ECMO. Conclusion: Diabetes, prevalence of IABP and VIS-max value in analyzed groups were independent risk factors for predicting limb ischemia complications in patients who underwent V-A ECMO. The cannulation strategy should be optimized during the establishment of V-A ECMO, and limb ischemia should be systematically evaluated after ECMO establishment. A DPC can be used as a salvage intervention for the complications of critical limb ischemia.

Veno-Arterial Extracorporeal Membrane Oxygenation in Elective High-Risk Percutaneous Coronary Interventions.

Background: The safety and feasibility of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as mechanical circulatory support in high-risk percutaneous coronary intervention (HR-PCI) remain unclear. Methods: This retrospective study included patients with complex and high-risk coronary artery disease who underwent elective PCI with VA-ECMO support pre-operatively during March 2019-December 2020. Rates of VA-ECMO-related complications, complications during PCI, death, myocardial infarction, and stroke during hospitalisation and 1-year post-operatively were analysed. Results: Overall, 36 patients (average age: 63.6 ± 8.9 years) underwent PCI. The average duration of VA-ECMO support was 12.5 (range, 3.0-26.3) h. Intra-aortic balloon pump counterpulsation was used in 44.4% of patients. The SYNTAX score was 34.6 ± 8.4 pre-operatively and 10.8 ± 8.8 post-operatively (P < 0.001). Intraoperative complications included pericardial tamponade (N = 2, 5.6%), acute left-sided heart failure (N = 1, 2.8%), malignant arrhythmia requiring electrocardioversion (N = 2, 5.6%), and no deaths. Blood haemoglobin levels before PCI and 24 h after VA-ECMO withdrawal were 145.4 ± 20.2 g/L and 105.7 ± 21.7 g/L, respectively (P < 0.001). Outcomes during hospitalisation included death (N = 1, 2.8%), stroke (N = 1, 2.8%), lower limb ischaemia (N = 2, 5.6%), lower limb deep venous thrombosis (N = 1, 2.8%), cannulation site haematoma (N = 2, 5.6%), acute renal injury (N = 2, 5.6%), bacteraemia (N = 2, 5.6%), bleeding requiring blood transfusion (N = 5, 13.9%), and no recurrent myocardial infarctions. Within 1 year post-operatively, two patients (5.6%) were hospitalised for heart failure. Conclusions: Veno-arterial extracorporeal membrane oxygenation mechanical circulation support during HR-PCI is a safe and feasible strategy for achieving revascularisation in complex and high-risk coronary artery lesions. VA-ECMO-related complications require special attention.

Duality-Gated Mutual Condition Network for RGBT Tracking.

Low-quality modalities contain not only a lot of noisy information but also some discriminative features in RGB-Thermal (RGBT) tracking. However, the potentials of low-quality modalities are not well explored in existing RGBT tracking algorithms. In this work, we propose a novel duality-gated mutual condition network to fully exploit the discriminative information of all modalities while suppressing the effects of data noise. In specific, we design a mutual condition module, which takes the discriminative information of a modality as the condition to guide feature learning of target appearance in another modality. Such a module can effectively enhance target representations of all modalities even in the presence of low-quality modalities. To improve the quality of conditions and further reduce data noise, we propose a duality-gated mechanism and integrate it into the mutual condition module. To deal with the tracking failure caused by sudden camera motion, which often occurs in RGBT tracking, we design a resampling strategy based on optical flow. It does not increase much computational cost since we perform optical flow calculation only when the model prediction is unreliable and then execute resampling when the sudden camera motion is detected. Extensive experiments on four RGBT tracking benchmark datasets show that our method performs favorably against the state-of-the-art tracking algorithms.

RGBT Tracking via Multi-Adapter Network with Hierarchical Divergence Loss.

RGBT tracking has attracted increasing attention since RGB and thermal infrared data have strong complementary advantages, which could make trackers all-day and all-weather work. Existing works usually focus on extracting modality-shared or modality-specific information, but the potentials of these two cues are not well explored and exploited in RGBT tracking. In this paper, we propose a novel multi-adapter network to jointly perform modality-shared, modality-specific and instance-aware target representation learning for RGBT tracking. To this end, we design three kinds of adapters within an end-to-end deep learning framework. In specific, we use the modified VGG-M as the generality adapter to extract the modality-shared target representations. To extract the modality-specific features while reducing the computational complexity, we design a modality adapter, which adds a small block to the generality adapter in each layer and each modality in a parallel manner. Such a design could learn multilevel modality-specific representations with a modest number of parameters as the vast majority of parameters are shared with the generality adapter. We also design instance adapter to capture the appearance properties and temporal variations of a certain target. Moreover, to enhance the shared and specific features, we employ the loss of multiple kernel maximum mean discrepancy to measure the distribution divergence of different modal features and integrate it into each layer for more robust representation learning. Extensive experiments on two RGBT tracking benchmark datasets demonstrate the outstanding performance of the proposed tracker against the state-of-the-art methods.

Protective effect of apigenin on ischemia/reperfusion injury of the isolated rat heart.

Apigenin (Api), a mainly bioactive component of Apium graveolens L. var. dulce DC. (a traditional Chinese medicinal herb), possesses a wide range of biological activities, including antioxidant effects. It also has been shown to associate with lower prevalence of cardiovascular diseases, but its mechanisms of action remain unclear. The aim of the present study is to investigate the role of Api in isolated rat heart model of ischemia/reperfusion (I/R). Langendorff-perfused isolated rat hearts were used in our study. Api was added to the perfusate before ischemia and during reperfusion in the isolated pulsed rat heart exposed to 30-min ischemia followed by 50-min reperfusion. The treatment with Api conferred a cardioprotective effect, and the treated hearts demonstrated an improved ischemic cardiac functional recovery, a decreased myocardial infarct size, a reduced activities of creatine kinase isoenzyme and lactate dehydrogenase in the coronary flow, a reduced number of apoptotic cardiomyocytes, a reduced activity of caspase-3, up-regulation of the anti-apoptotic protein Bcl-2 and down-regulation of the pro-apoptotic protein Bax. In addition, Api inhibited the phosphorylation of p38 MAPKS during I/R. In conclusion, these observations provide preliminary evidence that Api can protect cardiomyocytes from I-/R-induced injury, at least partially, through the inhibition of p38 MAPKS signaling pathway.

Nitric oxide and ATP-sensitive potassium channels mediate lipopolysaccharide-induced depression of central respiratory-like activity in brain slices.

Infection may result in early abnormalities in respiratory movement, and the mechanism may involve central and peripheral factors. Peripheral mechanisms include lung injury and alterations in electrolytes and body temperature, but the central mechanisms remain unclear. In the present study, brainstem slices harvested from rats were stimulated with lipopolysaccharide at different doses. Central respiratory activities as demonstrated by electrophysiological activity of the hypoglossal rootlets were examined and the mechanisms were investigated by inhibiting nitric oxide synthase and ATP-sensitive potassium channels. As a result, 0.5 µg/ml lipopolysaccharide mainly caused inhibitory responses in both the frequency and the output intensity, while 5 µg/ml lipopolysaccharide caused an early frequency increase followed by delayed decreases in both the frequency and the output intensity. At both concentrations the inhibitory responses were fully reversed by inhibition of nitric oxide synthase with Nω-nitro-L-arginine methyl ester hydrochloride (20 µM), and by inhibition of ATP- sensitive potassium channels with glybenclamide (100 µM). These results show that direct lipopolysaccharide challenge altered central respiratory activity in dose- and time- related manners. Nitric oxide synthase and ATP-sensitive potassium channels may be involved in the respiratory changes.

Association between inflammatory genetic polymorphism and acute lung injury after cardiac surgery with cardiopulmonary bypass.

BACKGROUND: Recently, single nucleotide polymorphisms were proposed as potentially new predictors for perioperative risks, such as myocardial infarction and organ dysfunction. The objectives of this study were to investigate whether IL-6 -572C/G, IL-10 -1082A/G, and TNF-alpha -308G/A were associated with acute lung injury after cardiac surgery with cardiopulmonary bypass. MATERIAL/METHODS: One hundred patients with acute lung injury at 24 hours after cardiac surgery with cardiopulmonary bypass and 112 patients without acute lung injury as controls were included. Genotyping assay was performed with real-time fluorescence-based allele-specific PCR. Serum levels of IL-6, IL-10, and TNF-alpha were also determined by ELISA. Associations between these polymorphisms and acute lung injury, as well as serum cytokine levels, were analyzed. All patients were genotyped for IL-6 -572C/G, IL-10 -1082A/G, and TNF-alpha -308G/A. Circulating level of these cytokines were also determined. RESULTS: Acute lung injury after cardiac surgery with cardiopulmonary bypass was associated with IL-6 -572C/G polymorphism, but not IL-10 -1082A/G or TNF-alpha -308G/A. This functional polymorphism was further confirmed by multivariate analyses. The ratio of circulating concentrations of IL-10/IL-6 was associated with IL-6 genotypes and incidence of acute lung injury as well. CONCLUSIONS: The IL-6 -572 polymorphism was associated with acute lung injury after cardiac surgery with cardiopulmonary bypass. Proinflammatory and anti-inflammatory imbalance might be the clinical significance of IL-6 polymorphism (ClinicalTrials.gov number, NCT00826072).