Beijing Anzhen Hospital

AUTORES: Daniel J Klionsky1745,1749*, Kotb Abdelmohsen840, Akihisa Abe1237, Md Joynal Abedin1762, Hagai Abeliovich425,
\nAbraham Acevedo Arozena789, Hiroaki Adachi1800, Christopher M Adams1669, Peter D Adams57, Khosrow Adeli1981,
\nPeter J Adhihetty1625, Sharon G Adler700, Galila Agam67, Rajesh Agarwal1587, Manish K Aghi1537, Maria Agnello1826,
\nPatrizia Agostinis664, Patricia V Aguilar1960, Julio Aguirre-Ghiso784,786, Edoardo M Airoldi89,422, Slimane Ait-Si-Ali1376,
\nTakahiko Akematsu2010, Emmanuel T Akporiaye1097, Mohamed Al-Rubeai1394, Guillermo M Albaiceta1294,
\nChris Albanese363, Diego Albani561, Matthew L Albert517, Jesus Aldudo128, Hana Alg€ul1164, Mehrdad Alirezaei1198,
\nIraide Alloza642,888, Alexandru Almasan206, Maylin Almonte-Beceril524, Emad S Alnemri1212, Covadonga Alonso544,
\nNihal Altan-Bonnet848, Dario C Altieri1205, Silvia Alvarez1497, Lydia Alvarez-Erviti1395, Sandro Alves107,
\nGiuseppina Amadoro860, Atsuo Amano930, Consuelo Amantini1554, Santiago Ambrosio1458, Ivano Amelio756,
\nAmal O Amer918, Mohamed Amessou2089, Angelika Amon726, Zhenyi An1538, Frank A Anania291, Stig U Andersen6,
\nUsha P Andley2079, Catherine K Andreadi1690, Nathalie Andrieu-Abadie502, Alberto Anel2027, David K Ann58,
\nShailendra Anoopkumar-Dukie388, Manuela Antonioli832,858, Hiroshi Aoki1791, Nadezda Apostolova2007,
\nSaveria Aquila1500, Katia Aquilano1876, Koichi Araki292, Eli Arama2098, Agustin Aranda456, Jun Araya591,
\nAlexandre Arcaro1472, Esperanza Arias26, Hirokazu Arimoto1225, Aileen R Ariosa1749, Jane L Armstrong1930,
\nThierry Arnould1773, Ivica Arsov2120, Katsuhiko Asanuma675, Valerie Askanas1924, Eric Asselin1867, Ryuichiro Atarashi794,
\nSally S Atherton369, Julie D Atkin713, Laura D Attardi1131, Patrick Auberger1787, Georg Auburger379, Laure Aurelian1727,
\nRiccardo Autelli1992, Laura Avagliano1029,1755, Maria Laura Avantaggiati364, Limor Avrahami1166, Suresh Awale1986,
\nNeelam Azad404, Tiziana Bachetti568, Jonathan M Backer28, Dong-Hun Bae1933, Jae-sung Bae677, Ok-Nam Bae409,
\nSoo Han Bae2117, Eric H Baehrecke1729, Seung-Hoon Baek17, Stephen Baghdiguian1368,
\nAgnieszka Bagniewska-Zadworna2, Hua Bai90, Jie Bai667, Xue-Yuan Bai1133, Yannick Bailly884,
\nKithiganahalli Narayanaswamy Balaji473, Walter Balduini2002, Andrea Ballabio316, Rena Balzan1711, Rajkumar Banerjee239,
\nG abor B anhegyi1052, Haijun Bao2109, Benoit Barbeau1363, Maria D Barrachina2007, Esther Barreiro467, Bonnie Bartel997,
\nAlberto Bartolom e222, Diane C Bassham550, Maria Teresa Bassi1046, Robert C Bast Jr1273, Alakananda Basu1798,
\nMaria Teresa Batista1578, Henri Batoko1336, Maurizio Battino970, Kyle Bauckman2085, Bradley L Baumgarner1909,
\nK Ulrich Bayer1594, Rupert Beale1553, Jean-Fran¸cois Beaulieu1360, George R. Beck Jr48,294, Christoph Becker336,
\nJ David Beckham1595, Pierre-Andr e B edard749, Patrick J Bednarski301, Thomas J Begley1135, Christian Behl1419,
\nChristian Behrends757, Georg MN Behrens406, Kevin E Behrns1627, Eloy Bejarano26, Amine Belaid490,
\nFrancesca Belleudi1041, Giovanni B enard497, Guy Berchem706, Daniele Bergamaschi983, Matteo Bergami1401,
\nBen Berkhout1441, Laura Berliocchi714, Am elie Bernard1749, Monique Bernard1354, Francesca Bernassola1880,
\nAnne Bertolotti791, Amanda S Bess272, S ebastien Besteiro1351, Saverio Bettuzzi1828, Savita Bhalla913,
\nShalmoli Bhattacharyya973, Sujit K Bhutia838, Caroline Biagosch1159, Michele Wolfe Bianchi520,1378,1381,
\nMartine Biard-Piechaczyk210, Viktor Billes298, Claudia Bincoletto1314, Baris Bingol350, Sara W Bird1128, Marc Bitoun1112,
\nIvana Bjedov1258, Craig Blackstone843, Lionel Blanc1183, Guillermo A Blanco1496, Heidi Kiil Blomhoff1812,
\nEmilio Boada-Romero1297, Stefan B€ockler1464, Marianne Boes1423, Kathleen Boesze-Battaglia1835, Lawrence H Boise286,287,
\nAlessandra Bolino2063, Andrea Boman693, Paolo Bonaldo1823, Matteo Bordi897, J€urgen Bosch608, Luis M Botana1308,
\nJoelle Botti1375, German Bou1405, Marina Bouch e1038, Marion Bouchecareilh1331, Marie-Jos ee Boucher1901,
\nMichael E Boulton481, Sebastien G Bouret1926, Patricia Boya133, Micha€el Boyer-Guittaut1345, Peter V Bozhkov1141,
\nNathan Brady374, Vania MM Braga469, Claudio Brancolini1997, Gerhard H Braus353, Jos e M Bravo-San Pedro299,393,508,1374,
\nLisa A Brennan322, Emery H Bresnick2022, Patrick Brest490, Dave Bridges1939, Marie-Agn es Bringer124, Marisa Brini1822,
\nGlauber C Brito1311, Bertha Brodin631, Paul S Brookes1872, Eric J Brown352, Karen Brown1690, Hal E Broxmeyer480,
\nAlain Bruhat486,1339, Patricia Chakur Brum1893, John H Brumell446, Nicola Brunetti-Pierri315,1171,
\nRobert J Bryson-Richardson781, Shilpa Buch1777, Alastair M Buchan1819, Hikmet Budak1022, Dmitry V Bulavin118,505,1789,
\nScott J Bultman1792, Geert Bultynck665, Vladimir Bumbasirevic1470, Yan Burelle1356, Robert E Burke216,217,
\nMargit Burmeister1750, Peter B€utikofer1473, Laura Caberlotto1987, Ken Cadwell896, Monika Cahova112, Dongsheng Cai24,
\nJingjing Cai2099, Qian Cai1018, Sara Calatayud2007, Nadine Camougrand1343, Michelangelo Campanella1700,
\nGrant R Campbell1525, Matthew Campbell1249, Silvia Campello556,1876, Robin Candau1769, Isabella Caniggia1983,
\nLavinia Cantoni560, Lizhi Cao116, Allan B Caplan1656, Michele Caraglia1051, Claudio Cardinali1043, Sandra Morais Cardoso1579, Jennifer S Carew208, Laura A Carleton874, Cathleen R Carlin101, Silvia Carloni2002,
\nSven R Carlsson1267, Didac Carmona-Gutierrez1643, Leticia AM Carneiro312, Oliana Carnevali971, Serena Carra1318,
\nAlice Carrier120, Bernadette Carroll900, Caty Casas1324, Josefina Casas1116, Giuliana Cassinelli324, Perrine Castets1462,
\nSusana Castro-Obregon214, Gabriella Cavallini1841, Isabella Ceccherini568, Francesco Cecconi253,555,1884,
\nArthur I Cederbaum459, Valent ın Ce~na199,1281, Simone Cenci1323,2064, Claudia Cerella444, Davide Cervia1996,
\nSilvia Cetrullo1478, Hassan Chaachouay2028, Han-Jung Chae187, Andrei S Chagin634, Chee-Yin Chai626,628,
\nGopal Chakrabarti1502, Georgios Chamilos1601, Edmond YW Chan1142, Matthew TV Chan181, Dhyan Chandra1003,
\nPallavi Chandra548, Chih-Peng Chang818, Raymond Chuen-Chung Chang1653, Ta Yuan Chang345, John C Chatham1434,
\nSaurabh Chatterjee1910, Santosh Chauhan527, Yongsheng Che62, Michael E Cheetham1263, Rajkumar Cheluvappa1783,
\nChun-Jung Chen1153, Gang Chen598,1676, Guang-Chao Chen9, Guoqiang Chen1078, Hongzhuan Chen1077, Jeff W Chen1514,
\nJian-Kang Chen370,371, Min Chen249, Mingzhou Chen2104, Peiwen Chen1823, Qi Chen1674, Quan Chen172,
\nShang-Der Chen138, Si Chen325, Steve S-L Chen10, Wei Chen2125, Wei-Jung Chen829, Wen Qiang Chen979, Wenli Chen1113,
\nXiangmei Chen1133, Yau-Hung Chen1157, Ye-Guang Chen1250, Yin Chen1447, Yingyu Chen953,955, Yongshun Chen2135,
\nYu-Jen Chen712, Yue-Qin Chen1145, Yujie Chen1208, Zhen Chen339, Zhong Chen2123, Alan Cheng1702,
\nChristopher HK Cheng184, Hua Cheng1728, Heesun Cheong814, Sara Cherry1836, Jason Chesney1703,
\nChun Hei Antonio Cheung817, Eric Chevet1359, Hsiang Cheng Chi140, Sung-Gil Chi656, Fulvio Chiacchiera308,
\nHui-Ling Chiang958, Roberto Chiarelli1826, Mario Chiariello235,567,577, Marcello Chieppa835, Lih-Shen Chin290,
\nMario Chiong1285, Gigi NC Chiu878, Dong-Hyung Cho676, Ssang-Goo Cho650, William C Cho982, Yong-Yeon Cho105,
\nYoung-Seok Cho1064, Augustine MK Choi2095, Eui-Ju Choi656, Eun-Kyoung Choi387,400,685, Jayoung Choi1563,
\nMary E Choi2093, Seung-Il Choi2116, Tsui-Fen Chou412, Salem Chouaib395, Divaker Choubey1574, Vinay Choubey1936,
\nKuan-Chih Chow822, Kamal Chowdhury730, Charleen T Chu1856, Tsung-Hsien Chuang827, Taehoon Chun657,
\nHyewon Chung652, Taijoon Chung978, Yuen-Li Chung1194, Yong-Joon Chwae18, Valentina Cianfanelli254,
\nRoberto Ciarcia1775, Iwona A Ciechomska886, Maria Rosa Ciriolo1876, Mara Cirone1042, Sofie Claerhout1694,
\nMichael J Clague1698, Joan Cl aria1457, Peter GH Clarke1687, Robert Clarke361, Emilio Clementi1045,1398, C edric Cleyrat1781,
\nMiriam Cnop1366, Eliana M Coccia574, Tiziana Cocco1459, Patrice Codogno1375, J€orn Coers271, Ezra EW Cohen1533,
\nDavid Colecchia235,567,577, Luisa Coletto25, N uria S Coll123, Emma Colucci-Guyon516, Sergio Comincini1829,
\nMaria Condello578, Katherine L Cook2073, Graham H Coombs1929, Cynthia D Cooper2076, J Mark Cooper1395,
\nIsabelle Coppens601, Maria Tiziana Corasaniti1387, Marco Corazzari485,1884, Ramon Corbalan1566,
\nElisabeth Corcelle-Termeau251, Mario D Cordero1899, Cristina Corral-Ramos1289, Olga Corti507,1109, Andrea Cossarizza1767,
\nPaola Costelli1993, Safia Costes1518, Susan L Cotman721, Ana Coto-Montes946, Sandra Cottet566,1688, Eduardo Couve1301,
\nLori R Covey1015, L Ashley Cowart762, Jeffery S Cox1536, Fraser P Coxon1427, Carolyn B Coyne1846, Mark S Cragg1919,
\nRolf J Craven1679, Tiziana Crepaldi1995, Jose L Crespo1300, Alfredo Criollo1285, Valeria Crippa558, Maria Teresa Cruz1576,
\nAna Maria Cuervo26, Jose M Cuezva1277, Taixing Cui1907, Pedro R Cutillas987, Mark J Czaja27, Maria F Czyzyk-Krzeska1572,
\nRuben K Dagda2068, Uta Dahmen1404, Chunsun Dai800, Wenjie Dai1187, Yun Dai2059, Kevin N Dalby1940,
\nLuisa Dalla Valle1822, Guillaume Dalmasso1340, Marcello D’Amelio557, Markus Damme188, Arlette Darfeuille-Michaud1340,
\nCatherine Dargemont950, Victor M Darley-Usmar1433, Srinivasan Dasarathy205, Biplab Dasgupta202, Srikanta Dash1254,
\nCrispin R Dass242, Hazel Marie Davey8, Lester M Davids1560, David D avila227, Roger J Davis1731, Ted M Dawson604,
\nValina L Dawson606, Paula Daza1898, Jackie de Belleroche470, Paul de Figueiredo1180,1182,
\nRegina Celia Bressan Queiroz de Figueiredo135, Jos e de la Fuente1023, Luisa De Martino1775,
\nAntonella De Matteis1171, Guido RY De Meyer1443, Angelo De Milito631, Mauro De Santi2002,

BACKGROUND: With China's rapid economic development, the disease burden may have changed in the country. We studied the major causes of death and modifiable risk factors in a nationally representative cohort of 169,871 men and women 40 years of age and older in China. METHODS: Baseline data on the participants' demographic characteristics, medical history, lifestyle-related risk factors, blood pressure, and body weight were obtained in 1991 with the use of a standard protocol. The follow-up evaluation was conducted in 1999 and 2000, with a follow-up rate of 93.4 percent. RESULTS: We documented 20,033 deaths in 1,239,191 person-years of follow-up. The mortality from all causes was 1480.1 per 100,000 person-years among men and 1190.2 per 100,000 person-years among women. The five leading causes of death were malignant neoplasms (mortality, 374.1 per 100,000 person-years), diseases of the heart (319.1), cerebrovascular disease (310.5), accidents (54.0), and infectious diseases (50.5) among men and diseases of the heart (268.5), cerebrovascular disease (242.3), malignant neoplasms (214.1), pneumonia and influenza (45.9), and infectious diseases (35.3) among women. The multivariate-adjusted relative risk of death and the population attributable risk for preventable risk factors were as follows: hypertension, 1.48 (95 percent confidence interval, 1.44 to 1.53) and 11.7 percent, respectively; cigarette smoking, 1.23 (95 percent confidence interval, 1.18 to 1.27) and 7.9 percent; physical inactivity, 1.20 (95 percent confidence interval, 1.16 to 1.24) and 6.8 percent; and underweight (body-mass index [the weight in kilograms divided by the square of the height in meters] below 18.5), 1.47 (95 percent confidence interval, 1.42 to 1.53) and 5.2 percent. CONCLUSIONS: Vascular disease and cancer have become the leading causes of death among Chinese adults. Our findings suggest that control of hypertension, smoking cessation, increased physical activity, and improved nutrition should be important strategies for reducing the burden of premature death among adults in China.

The sodium-glucose cotransporter 2 inhibitor empagliflozin reduces the risk of cardiovascular death or heart failure hospitalization in patients with chronic heart failure, but whether empagliflozin also improves clinical outcomes when initiated in patients who are hospitalized for acute heart failure is unknown. In this double-blind trial (EMPULSE; NCT04157751 ), 530 patients with a primary diagnosis of acute de novo or decompensated chronic heart failure regardless of left ventricular ejection fraction were randomly assigned to receive empagliflozin 10 mg once daily or placebo. Patients were randomized in-hospital when clinically stable (median time from hospital admission to randomization, 3 days) and were treated for up to 90 days. The primary outcome of the trial was clinical benefit, defined as a hierarchical composite of death from any cause, number of heart failure events and time to first heart failure event, or a 5 point or greater difference in change from baseline in the Kansas City Cardiomyopathy Questionnaire Total Symptom Score at 90 days, as assessed using a win ratio. More patients treated with empagliflozin had clinical benefit compared with placebo (stratified win ratio, 1.36; 95% confidence interval, 1.09-1.68; P = 0.0054), meeting the primary endpoint. Clinical benefit was observed for both acute de novo and decompensated chronic heart failure and was observed regardless of ejection fraction or the presence or absence of diabetes. Empagliflozin was well tolerated; serious adverse events were reported in 32.3% and 43.6% of the empagliflozin- and placebo-treated patients, respectively. These findings indicate that initiation of empagliflozin in patients hospitalized for acute heart failure is well tolerated and results in significant clinical benefit in the 90 days after starting treatment.

This case series uses patient hospital data to summarize the clinical presentation and laboratory and imaging findings of 13 patients with confirmed 2019-nCoV infection admitted to hospitals in Beijing in January 2020.

Abstract Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3–6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

Objective Patients with renal failure suffer from symptoms caused by uraemic toxins, possibly of gut microbial origin, as deduced from studies in animals. The aim of the study is to characterise relationships between the intestinal microbiome composition, uraemic toxins and renal failure symptoms in human end-stage renal disease (ESRD). Design Characterisation of gut microbiome, serum and faecal metabolome and human phenotypes in a cohort of 223 patients with ESRD and 69 healthy controls. Multidimensional data integration to reveal links between these datasets and the use of chronic kidney disease (CKD) rodent models to test the effects of intestinal microbiome on toxin accumulation and disease severity. Results A group of microbial species enriched in ESRD correlates tightly to patient clinical variables and encode functions involved in toxin and secondary bile acids synthesis; the relative abundance of the microbial functions correlates with the serum or faecal concentrations of these metabolites. Microbiota from patients transplanted to renal injured germ-free mice or antibiotic-treated rats induce higher production of serum uraemic toxins and aggravated renal fibrosis and oxidative stress more than microbiota from controls. Two of the species, Eggerthella lenta and Fusobacterium nucleatum , increase uraemic toxins production and promote renal disease development in a CKD rat model. A probiotic Bifidobacterium animalis decreases abundance of these species, reduces levels of toxins and the severity of the disease in rats. Conclusion Aberrant gut microbiota in patients with ESRD sculpts a detrimental metabolome aggravating clinical outcomes, suggesting that the gut microbiota will be a promising target for diminishing uraemic toxicity in those patients. Trial registration number This study was registered at ClinicalTrials.gov ( NCT03010696 ).

AIM: The etiology of hypertension is various and complex, involving both genetic and behavioral factors. The relationship between psychosocial stress and hypertension has been hypothesized. More and more people experience increased anxiety, depression, and chronic psychosocial stress brought on by globalization, cultural changes, socioeconomic changes, and stress at the work place. Although a plethora of studies have investigated the interaction between psychosocial stress and hypertension, this relationship is still contentious. The objective of this study is twofold. First, a review of recent advancements in our understanding of the relationship between psychosocial stress and hypertension. Second, a meta-analysis aiming to assess the relationship between chronic psychosocial stress and blood pressure. METHODS: We systematically searched and identified relevant studies from five databases, including PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), CQVIP, and the Wanfang Database until April 2016. Eleven studies encompassing 5696 participants were included in the final analysis. RESULTS: Data showed that psychosocial stress was associated with an increased risk of hypertension (OR = 2.40, 95% CI = 1.65-3.49), and hypertensive patients had a higher incidence of psychosocial stress compared to normotension patients (OR = 2.69, 95% CI = 2.32-3.11). Based on our meta-analysis, chronic psychosocial stress may be a risk factor for hypertension. CONCLUSION: The few cohort and case-control studies on the association between psychosocial stress and hypertension employed variable definition of stressors and the responses, making the meta-analysis difficult. Although we found an association between chronic psychosocial stress and hypertension, more studies are needed to confirm this relationship.

Gene editing stands for the methods to precisely make changes to a specific nucleic acid sequence. With the recent development of the clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 system, gene editing has become efficient, convenient and programmable, leading to promising translational studies and clinical trials for both genetic and non-genetic diseases. A major concern in the applications of the CRISPR/Cas9 system is about its off-target effects, namely the deposition of unexpected, unwanted, or even adverse alterations to the genome. To date, many methods have been developed to nominate or detect the off-target sites of CRISPR/Cas9, which laid the basis for the successful upgrades of CRISPR/Cas9 derivatives with enhanced precision. In this review, we summarize these technological advancements and discuss about the current challenges in the management of off-target effects for future gene therapy.

BACKGROUND: The present article aims to provide accurate estimates of the prevalence, awareness, treatment, and control of hypertension in adults in China. METHODS AND RESULTS: Data were obtained from sphygmomanometer measurements and an administered questionnaire from 141 892 Chinese adults >/=18 years of age who participated in the 2002 China National Nutrition and Health Survey. In 2002, approximately 153 million Chinese adults were hypertensive. The prevalence was higher among men than women (20% versus 17%; P<0.001) and was higher in successive age groups. Overall, the prevalence of hypertension was higher in urban compared with rural areas in men (23% versus 18%; P<0.01) and women (18% versus 16%; P<0.001). Of the 24% affected individuals who were aware of their condition, 78% were treated and 19% were adequately controlled. Despite evidence to suggest improved levels of treatment in individuals with hypertension over the past decade, compared with estimates from 1991, the ratio of controlled to treated hypertension has remained largely unchanged at 1:4. CONCLUSIONS: One in 6 Chinese adults is hypertensive, but only one quarter are aware of their condition. Despite increased rates of blood pressure-lowering treatment, few have their hypertension effectively controlled. National hypertension programs must focus on improving awareness in the wider community, as well as treatment and control, to prevent many tens of thousands of cardiovascular-related deaths.

Microplastics have been detected in human stool, lungs, and placentas, which have direct exposure to the external environment through various body cavities, including the oral/anal cavity and uterine/vaginal cavity. Crucial data on microplastic exposure in completely enclosed human organs are still lacking. Herein, we used a laser direct infrared chemical imaging system and scanning electron microscopy to investigate whether microplastics exist in the human heart and its surrounding tissues. Microplastic specimens were collected from 15 cardiac surgery patients, including 6 pericardia, 6 epicardial adipose tissues, 11 pericardial adipose tissues, 3 myocardia, 5 left atrial appendages, and 7 pairs of pre- and postoperative venous blood samples. Microplastics were not universally present in all tissue samples, but nine types were found across five types of tissue with the largest measuring 469 μm in diameter. Nine types of microplastics were also detected in pre- and postoperative blood samples with a maximum diameter of 184 μm, and the type and diameter distribution of microplastics in the blood showed alterations following the surgical procedure. Moreover, the presence of poly(methyl methacrylate) in the left atrial appendage, epicardial adipose tissue, and pericardial adipose tissue cannot be attributed to accidental exposure during surgery, providing direct evidence of microplastics in patients undergoing cardiac surgery. Further research is needed to examine the impact of surgery on microplastic introduction and the potential effects of microplastics in internal organs on human health.

Coronavirus disease 2019 (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic. It is unclear whether convalescing patients have a risk of reinfection. We generated a rhesus macaque model of SARS-CoV-2 infection that was characterized by interstitial pneumonia and systemic viral dissemination mainly in the respiratory and gastrointestinal tracts. Rhesus macaques reinfected with the identical SARS-CoV-2 strain during the early recovery phase of the initial SARS-CoV-2 infection did not show detectable viral dissemination, clinical manifestations of viral disease, or histopathological changes. Comparing the humoral and cellular immunity between primary infection and rechallenge revealed notably enhanced neutralizing antibody and immune responses. Our results suggest that primary SARS-CoV-2 exposure protects against subsequent reinfection in rhesus macaques.

Cardiovascular disease (CVD) is the leading cause of death in Asia. To combat the harmful impacts of CVD on public health in Asian countries with more effective strategies and actions, it is crucial to understand the current epidemiologic features of CVD in Asia. Through a systematic study and analysis of various timely data on CVD epidemiology in Asian countries from multiple sources, this state-of-the-art review provides an overview of the important epidemiologic features of CVD in Asia. Current and future challenges in CVD prevention implied by the epidemiologic features in Asian countries are highlighted and discussed in this review.

Abstract Cardiovascular diseases are the leading cause of death globally; fortunately, 90% of cardiovascular diseases are preventable by long‐term monitoring of physiological signals. Stable, ultralow power consumption, and high‐sensitivity sensors are significant for miniaturized wearable physiological signal monitoring systems. Here, this study proposes a flexible self‐powered ultrasensitive pulse sensor (SUPS) based on triboelectric active sensor with excellent output performance (1.52 V), high peak signal‐noise ratio (45 dB), long‐term performance (10 7 cycles), and low cost price. Attributed to the crucial features of acquiring easy‐processed pulse waveform, which is consistent with second derivative of signal from conventional pulse sensor, SUPS can be integrated with a bluetooth chip to provide accurate, wireless, and real‐time monitoring of pulse signals of cardiovascular system on a smart phone/PC. Antidiastole of coronary heart disease, atrial septal defect, and atrial fibrillation are made, and the arrhythmia (atrial fibrillation) is indicative diagnosed from health, by characteristic exponent analysis of pulse signals accessed from volunteer patients. This SUPS is expected to be applied in self‐powered, wearable intelligent mobile diagnosis of cardiovascular disease in the future.

AIMS: VENTURE-AF is the first prospective randomized trial of uninterrupted rivaroxaban and vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation (NVAF) undergoing catheter ablation (CA). METHODS AND RESULTS: Trial size was administratively set at 250, the protocol-specified target. Events were independently and blindly adjudicated. We randomly assigned 248 NVAF patients to uninterrupted rivaroxaban (20 mg once-daily) or to an uninterrupted VKA prior to CA and for 4 weeks afterwards. The primary endpoint was major bleeding events after CA. Secondary endpoints included thromboembolic events (composite of stroke, systemic embolism, myocardial infarction, and vascular death) and other bleeding or procedure-attributable events. Patients were 59.5 ± 10 years of age, 71% male, 74% paroxysmal AF, and had a CHA2DS2-VASc score of 1.6. The average total heparin dose used to manage activated clotting time (ACT) was slightly higher (13 871 vs. 10 964 units; P < 0.001) and the mean ACT level attained slightly lower (302 vs. 332 s; P < 0.001) in rivaroxaban and VKA arms, respectively. The incidence of major bleeding was low (0.4%; 1 major bleeding event). Similarly, thromboembolic events were low (0.8%; 1 ischemic stroke and 1 vascular death). All events occurred in the VKA arm and all after CA. The number of any adjudicated events (26 vs. 25), any bleeding events (21 vs. 18), and any other procedure-attributable events (5 vs. 5) were similar. CONCLUSION: In patients undergoing CA for AF, the use of uninterrupted oral rivaroxaban was feasible and event rates were similar to those for uninterrupted VKA therapy. NAME OF THE TRIAL REGISTRY: Clinicaltrials.gov trial registration number is NCT01729871.

Over the past decade, the use of extracorporeal membrane oxygenation (ECMO) has increased exponentially, from approximately 30–40 patients per year in the United States 20 years ago, to over 2,000 per year currently, and rising.1 The increased utilization of ECMO has resulted from improved cannulation techniques, including percutaneous approach, as well as advances in the technology of the pumps, oxygenators, and cannulas. Despite these features, however, choosing appropriate candidates and managing their daily care can be extremely challenging. What follows is an in-depth discussion of the indications for venoarterial (VA) ECMO in adult patients affected by cardiac disease, the manner of its application, the physiology underlying the care for these patients, and the assessment and treatment of complications, including ethical and organizational issues. More in-depth material and information are provided in the Extracorporeal Life Support Organization (ELSO) 5th Edition Red Book.2 Furthermore, the recent ELSO indications about ECLS and cannulation nomenclature will be followed in this guideline.3,4 Decision Making in Adult VA ECMO for Acute Cardiac Failure VA ECMO may support patients for days or weeks as a “bridge-to-decision” that includes weaning after recovery of cardiac function, transplantation, long-term mechanical circulatory support (MCS), and withdrawal in the case of futility. Dedicated documents for the use of VA ECMO in the setting of cardiac arrest and postcardiotomy in adult patients are addressed by additional ELSO guidelines and as joint society position paper (expert consensus of EACTS/ELSO/STS/AATS).5 Indications Specific physiologic goals, monitoring, and patient selection. Cardiogenic shock suitable for ECMO is generally characterized by systemic systolic pressure less than 90, urine output < 30 ml/hour, lactate over 2, SVO2 less than 60%, altered conscious state for 6 hours unresponsive to optimal treatment (Table 1). The goal is to maintain systemic oxygen delivery at least 3 times oxygen consumption (the DO2:VO2 ratio is >3) (normal is 5, shock is 2): O2 delivery is arterial oxygen content (normal 20 ml/dl) times cardiac output (normal 30 dl/m2/min). In VA ECMO access, addressing the goal is easy because the cardiac output is the ECMO flow and the arterial hemoglobin saturation is 100%, so content is easily calculated, knowing the hemoglobin concentration (normal 15 g/dl). In VA ECMO, the drainage blood saturation (the SVO2) measures the DO2:VO2 ratio, and SVO2 is measured continuously. If the arterial saturation is 100% and the venous sat is 80%, the ratio is 5:1. So, adjusting flow and hemoglobin to maintain SVO2 over 66% assures that the goal of DO2/VO2 > 3 is met. Additional details are described in the Red Book chapter on physiology.2 Table 1. - Clinical Features of Cardiogenic Shock and Defined Contemporary Trials and Guidelines Clinical Trial/Guidelines Cardiogenic Shock Criteria SHOCK Trial (1999) • SBP < 90 mm Hg or vasopressor support to maintain SBP >90 mm Hg• Evidence of end-organ damage (UO < 30 ml/h or cool extremities)• Hemodynamic criteria: CI < 2.2 and PCWP > 15 mm Hg IABP-SOAP II (2012) • MAP < 70 mm Hg or SBP < 100 mm Hg despite adequate fluid resuscitation (at least 1 L of crystalloid or 500 ml of colloids)• Evidence of end-organ damage (AMS, mottled skin, UO < 0.5 ml/kg/h for 1 h or serum lactate >2 mmol/L) EHS-PCI (2012) • SBP < 90 mm Hg for 30 min or inotropes use to maintain SBP >90 mm Hg• Evidence of end-organ damage and increased filling pressure ESC-HF Guidelines (2016) • SBP < 90 mm Hg with appropriate fluid resuscitation with clinical and laboratory evidence of end-organ damage• Clinical: cold extremities, oliguria, AMS, narrow pulse pressure. Laboratory: metabolic acidosis, elevated serum lactate, elevated serum creatinine KAMIR-NIH (2018) • SBP < 90 mm Hg for >30 min or supportive intervention to maintain SBP >90 mm Hg• Evidence of end-organ damage (AMS, UO < 30 ml/h, or cool extremities) AMS, altered mental status; CI, cardiac index; EHS-PCI, Euro-Heart Survey Percutaneous Coronary Intervention Registry; ESC-HF, European Society of Cardiology—Heart Failure; IABP-SOAP II, Intra-aortic balloon pump in cardiogenic shock II; KAMIR-NIH, Korean Acute Myocardial Infarction Registry—National Institute of Health; MAP, mean arterial pressure; PCWP, pulmonary capillary wedge pressure; SBP, systolic blood pressure; SHOCK, Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock; UO, Urine output. Short-term MCS should be considered in patients with refractory cardiogenic shock with a potentially reversible or surgically correctable cause.6 Compared with other percutaneous temporary MCS, VA ECMO has advantages for patients with severe biventricular failure or in case of malignant arrhythmia as well as associated pulmonary failure. The classical scenario where VA ECMO should be considered occurs when medical treatment, including fluids, inotropes, and, potentially, intra-aortic balloon pump (IABP), fails. Ideally, VA ECMO should be initiated before multiorgan failure and after thorough echocardiography evaluation. The patient’s age, comorbidities, and prognosis of the underlying illness should also be factored into the ECMO decision making. Age per se’, however, should not be considered an absolute contraindication, especially when greater prospects of cardiac recovery exist, given that the suitability for bridging durable MCS and heart transplantation may diminish with advancing age. Common situations for ECMO are patients with medical (acute myocardial infarction, fulminant myocarditis, intoxication with cardiotoxic drugs, end-stage dilated or ischemic cardiomyopathy, hypothermia with refractory cardiocirculatory instability, and massive pulmonary embolism), and postsurgical (including posttransplantation) acute cardiogenic shock. Other emerging indications for VA ECMO are shown in Figure 1.Figure 1.: Common (dark gray) and emerging situations (light gray) for venoarterial extracorporeal life support in the context of cardiogenic shock. AMI, acute myocardial infarction; APE, massive pulmonary embolism; LVAD, left ventricular assist device; Sepsis, sepsis-associated cardiomyopathy.Contraindications Regarding the contraindications for VA ECMO implant, these are listed below: - • Cardiac recovery unlikely and no indication for heart transplant or durable left ventricular (LV) assists device • Poor life expectancy (end-stage peripheral-organ diseases, malignant tumor, massive pulmonary embolisms in cancer patients, chemotherapy-induced chronic cardiomyopathy, etc.) • Severe aortic valve regurgitation • Severe vascular disease with extensive aortic and peripheral vessel involvement (calcification, stenosis, and closure), including axillary arteries • Acute Type A or B aortic dissection with extensive aortic branches (ascending, supra-aortic and femoral) involvement (preoperatively) • Severe neurologic impairment (i.e., prolonged anoxic extensive and • Severe disease with blood and • B and In the to the VA ECMO patient to of and to the patient selection. The after VA ECMO (Table is a on the assessment from the ELSO The after VA ECMO is the for ECLS use in cardiogenic shock not to postcardiotomy Other ECMO in cardiogenic including or VA ECMO and described in Table Table - The Acute cardiogenic shock or 3 heart or transplantation 3 heart disease Other to cardiogenic shock VA ECMO Age 3 1 Acute or of before of ECMO pressure 3 cardiac arrest blood pressure before ECMO mm 3 pressure before ECMO mm before ECMO to to of to II to to 30 is at failure as or of serum or as well as and is as acute creatinine with or disease is as damage or for 6 h ECMO ECMO, extracorporeal membrane Extracorporeal ventricular ventricular Table - for Extracorporeal Life the VA ECMO Cardiogenic serum lactate cardiogenic age, left disease, serum Cardiogenic shock age, neurologic myocardial or blood lactate acute systolic AMI, acute myocardial infarction; index; creatinine left VA ECMO, venoarterial extracorporeal membrane VA ECMO should be considered for cardiogenic shock 6 hours of its refractory to and fluid and in patients with reversible cardiocirculatory or for cardiocirculatory for ventricular assist or appropriate ECMO should be considered to per se’, should not be as an absolute may be to information decision before Poor life severe disease, acute vascular disease, and for ECMO and and information ECMO and are also in other ELSO position and in the ELSO Red VA ECMO cannulation is the for and the and the and their A arterial is adequate to flow on the patient’s or may be in clinical as when flow is arterial be associated with increased vascular complications, including vascular the and the of is to the arterial and venous in to vascular and to If the venous should be in the as is a to the and peripheral VA ECLS cannulation the of the venous and arterial and from VA venoarterial extracorporeal life vascular as a is can be in for in the should be in the and We in the the and the and arteries to the of the and of the into the vessel and In the as a can vascular is at a of the vessel and are for the in of the of the and the of the and and the the vascular of the as to the and the vascular of the the to the and the position of the arterial and the of of adequate a is in the and a of are to In as and peripheral vascular disease, a may be for The are into their and or is to the of the and of the arterial and venous drainage and is to appropriate position after position of the in the and the of the drainage at the of Cardiac echocardiography in the position in the or axillary cannulation can be as a of peripheral may be in patients with peripheral vascular disease or so as to vascular cannulation at the including vascular or and Furthermore, this can patient in the case of a VA ECMO and to In this a or the use of a to the axillary may be with to with is the vascular as a of ECLS flow with no to as can in the case of a with a as in this The cannulation of the may be or with a for to the cannulation can be for arterial access, the increased of acute the of when or a are not peripheral to the cannulation is should be or into the If the is should with a in the the arterial the and into the of the in the by or may be and of flow by and of the is 15 and arterial may not be with decision by saturation by should be 60%, and should be less than a the In however, is with a 6 and may be associated with vascular and The of the is with a to the of the arterial the or the arteries be also considered not or to of flow adequate at least 100 is that be at the of ECMO in A of VA ECMO is the for and to the in and associated may be especially for the left and may aortic valve to acute pulmonary or of the cardiac or the aortic the for in VA ECMO should be and by the scenario Criteria to be for the assessment of aortic per venous pressure; intra-aortic balloon left left PCWP, wedge pressure; oxygen on a pulse pressure less than mm and a aortic valve with on should techniques, including a of ECMO flow end-organ to peripheral arterial increased to pulmonary arterial flow and cardiac drainage the ECMO or support to maintain to managing In myocardial recovery and should be addressed when (Table Table - and to or Extracorporeal Life Support Type of ECMO flow device device - ventricular the ventricular the valve Additional venous ECLS ECMO, extracorporeal membrane pressure; intra-aortic balloon for and the temporary percutaneous flow assist device or or cannulation and Intra-aortic balloon pump with inotropes may assist in as to support this are The of on weaning and that an of cardiac support with VA ECMO adequate and to appropriate and in the of severe peripheral vascular disease at the cannulation is in the postcardiotomy recent that in this to a peripheral cannulation is use of the for and for is The of to the is after aortic can be also as a to are advantages and when to peripheral cannulation (Table however, peripheral cannulation to and should be considered to a approach, in postcardiotomy Table - and of in Extracorporeal cannulation of flow drainage Cardiac support to ECMO flow the More with of More for of aortic valve of oxygenation cannulation flow suitable for support cardiac ECMO flow to cannulation or after for for cannulation of peripheral vessel and appropriate cannulation the of than flow suitable for prolonged patient cardiac ECMO flow of of prolonged support of of peripheral vessel and appropriate cannulation than ECMO flow flow less than cardiac of vascular ECMO, extracorporeal membrane left ventricular assist cannulation may be associated with improved and in of severe vascular disease, or axillary cannulation should be is at the of cannulation may be considered in postcardiotomy and when with severe peripheral vascular should be addressed when is as is associated with increased weaning and to be can be or with MCS or with percutaneous or and considered when the cannulation for MCS the underlying of cardiac and of the of pulmonary and of the of the and of of arterial and of the of and of as durable or patients with cardiac failure and pulmonary function, are for MCS on ECLS (Table Table - ECMO for Support in Cardiac Failure ECLS VA ECMO • for potentially reversible cardiogenic shock of VA ECMO • Failure to from where recovery for patients with cardiogenic shock where arterial VA ECMO axillary • cardiogenic shock where not cardiogenic shock with vascular aortic dissection • support where recovery is in weeks • support where recovery is in weeks • support where recovery is in weeks extracorporeal life left left LVAD, left ventricular assist device; pulmonary ventricular assist device; VA ECMO, venoarterial extracorporeal membrane its less with peripheral VA ECMO, with to or is a for patients with acute cardiac failure refractory to The of peripheral VA ECMO the use of ECMO to by to a temporary or a of biventricular with The extracorporeal membrane oxygenation can be as a biventricular assist device with support provided by the in the with from LVAD, left ventricular assist device; that a to left an in the may biventricular support and a pump with the to ventricular support when not this and cannulation of the left left and or is for of the cardiac recovery or for of a long-term mechanical assist for temporary including a to an support described this a left is potentially the for in the of cardiac recovery as a to or heart peripheral venoarterial ECMO to the use of ECMO as a temporary ventricular assist device with the of venoarterial ECMO ventricular cannulation and of drainage ventricular recovery and of temporary left ventricular cannulation to ECMO, extracorporeal membrane support can be provided with an ECMO in case of the of associated support or an percutaneous venous to the and to the pulmonary a is described for temporary support of the with of a long-term is to other of severe the can be and In the of the cannulation of the may be cannulation or a a percutaneous the is the cannulation may be with a or In patients with cardiac and pulmonary can myocardial recovery occurs and may be by to ECMO myocardial recovery is or with the use of ECMO, of blood to arterial and venous of the the of the blood in the by the axillary or cannulation has also described in this the drainage to the of the or may blood from the to the may also to A in this setting includes use of the ECMO as a temporary with an in the The device can be in (Table to support the left or and the can be from the when pulmonary or can support patients for a of to and the of and is to patients with acute in myocardial recovery is prolonged support may be Table - ECLS for Cardiac and Support ECMO VA ECMO • for potentially reversible cardiogenic shock of VA ECMO axillary • cardiogenic shock where not cardiogenic shock with vascular cardiogenic shock with long-term support with patient VA ECMO • Failure to from where recovery for patients with cardiogenic shock where arterial for severe cardiac and failure ECMO • circulatory on for severe cardiac and failure ECMO • to • to • to with to and to • Severe on VA Severe cardiac and failure where recovery is before recovery to or long-term support may be extracorporeal life left left LVAD, left ventricular assist device; pulmonary ventricular assist device; VA ECMO, venoarterial extracorporeal membrane ECMO should be so as to or biventricular failure. Poor pulmonary with to to aortic oxygenation may ECMO improved cardiac to or in the case of use of cannulation with a or The daily care for patients on VA ECMO is and of care and that from the the extracorporeal and the (Table and Figure Table - Clinical Extracorporeal arterial blood pressure • of ECMO blood flow • of oxygenation in aortic of oxygenation • of oxygenation in aortic of oxygenation • elevated filling pressure • Support indication for • cardiac output as indication of pulmonary flow pulmonary flow can be by • cardiac and of contraindications to VA ECMO • of vascular and cannulation • of ECMO support • assessment of and cardiac • Cardiac assessment weaning • • of and and extracorporeal life left VA ECMO, venoarterial extracorporeal membrane Figure to and managing the VA ECLS to use ELSO Red Book 5th VA venoarterial extracorporeal life and to to appropriate is the of VA ECMO venous saturation information oxygen and so to arterial blood pressure is in VA ECMO as the pulse pressure the of cardiac when in with an assessment of aortic valve and the pulse pressure may and The as well as pulse should be for blood as well as oxygenation to capillary may adequate pulse in may arterial blood to adequate A pulmonary or should be considered VA ECMO, as of elevated filling may the use of to in VA cardiac output VA ECMO is may an indication of pulmonary flow and in the can be by The of venous pressure as well as venous and venous oxygen should be with these may on the cannulation and and the of the extracorporeal and the and A of VA ECMO and is echocardiography and vascular indications from cardiac and of contraindications to VA ECMO, to of vascular and of the cannulation optimal of extracorporeal support and assessment of and cardiac to a weaning from VA ECMO to In this is to that the to be with the of the VA ECMO and its on patients should and on VA ECMO mechanical and, on the VA ECMO are a including of with a and and of with pressure are A may also to elevated may in the pulmonary and pulmonary The can also be or by pulmonary blood flow or pulmonary in VA ECMO, or a daily fluid the associated with in VA pulmonary is a in VA ECMO, should be by or as may on and long-term on ECMO should be considered to the of mechanical and and with and of and VA ECMO are in Table Table - Clinical Extracorporeal • with • pulmonary and pulse pressure mm Hg and aortic valve ECMO flow inotropes, or as and to and • • care • and • • and treatment of including vessel and • altered • for a fluid • device to ECMO ECMO, extracorporeal membrane left pressure. Specific of of VA ECMO are and with is a of VA ECMO as in in a ELSO and in recent and treatment of should be as a as The use of and to is with peripheral and on VA ECMO, should be that and of can be altered VA ECMO and illness and may and especially for patients with or Regarding and and be in the VA ECMO patients on ECMO for shock may before patients should as as after ECMO is to neurologic If is care with the of cardiac If is evidence of care should for neurologic If is no neurologic ECMO for should be of VA ECMO, is that prognosis is by the and of the underlying disease and multiorgan the and is of to bridging to long-term MCS or In care of VA ECMO includes the of mechanical to fluid and and as in Table and Figure Table - of Extracorporeal and of use of for cannulation of use of of and after VA ECMO pulse of of and after VA of after of MAP to a of inotropes, and for of pulmonary of when oxygenation of and saturation on of the and cannulation membrane after in ECMO flow and to and mm after the by of or pressure and or in case of or of or of blood left MAP, mean arterial pressure; MAP, mean arterial pressure; pulmonary VA ECMO, venoarterial extracorporeal membrane care should venous adequate oxygen delivery of including and to oxygenation pressure to cardiac blood and The use of a pulmonary to to acute of and as as support is prolonged of ECMO VA ECMO is an and are and potentially life and treatment are patient to will and Table - of of Extracorporeal ELSO to > Cardiac or or or 30 of with massive and are not with the use of are to cannulation should be by with and the use of a will the of from to may be an increased for in the the and the to Percutaneous with may and when to an of percutaneous over cannulation has not shown and in this are Furthermore, as the of of is use of or for and is are and may in than of the Specific to the ECMO A of ECMO is the especially in the can to failure acute the pump in and massive to ECMO is after prolonged resuscitation should in a ECMO ECMO of of for of and with the of are in VA ECMO in a of the or of a clinical Specific to VA ECMO is that VA ECMO however, the is the in blood pressure to the flow in to a and, aortic valve or VA ECMO flow should be at the adequate and however, with increased myocardial pulmonary and in the left cardiac at ECMO on the a when the is by of the blood when the and is severe damage to the heart and can to blood and saturation be from the If of not the an additional to the may and can easily will the of the and with are to on and to be by of arterial blood after of ECMO including of and is for percutaneous In the of is should be in of ECMO flow and at the arterial or venous cannulation may and after ECMO The of a to the should be considered in the of oxygenation and refractory and should be at ECMO should be also to and VA ECMO VA ECMO weaning should be considered when patients cardiac the for support to maintain an adequate pulse pressure mm Hg mean arterial pressure of mm and sat at of VA ECMO should be of pump flow and weaning weaning is and to biventricular function, of as well as is a of cardiac output. be in this to and cardiac output with the VA ECMO VA ECMO flow is by 500 ml are after of no support or at of 1 of ECMO flow to of the and heart may not be when of the ECMO or is Trial is a weaning that can be The arterial flow is and 1 L of flow is to the and venous In with the this for assessment of weaning is the are MAP > mm > systolic mm and on of inotropes or inotropes and are as a weaning should to that are associated with ECMO are to from VA ECMO support days be considered for temporary support to for recovery as as systolic is with systolic before VA ECMO be considered for or heart for should be on the Society for and guidelines is of neurologic multiorgan age, or cancer as contraindications to durable support and heart transplantation and to these is with of care in patients are not candidates for is to with a and withdrawal of involvement of care should be considered in patients with VA ECMO to assist with of the of and for ECMO and decision for venoarterial extracorporeal membrane oxygenation and in patients with cardiogenic shock. CI, cardiac index; venous pressure; LVAD, left ventricular assist device; left ventricular MAP, mean arterial blood pressure; VA venoarterial extracorporeal life VA ECMO weaning should be considered when patients in the of ECLS including MAP > mm > systolic mm and on Trial or a the arterial and venous assessment with or ELSO support ECMO a of that ethical by of its to as a for The ECMO the to and the use of ECMO in a that not life also the ethical its use to the patient and or the and The and the The of is generally because the situations in ECMO is are that the for after its The be of this and of ECMO support and of appropriate care should in situations where ECMO is unlikely to be of or supportive care or may be of in these and support to are for decision The ECMO the ECMO can as a of in about the utilization of ECMO for of and by a can of the of the to and of ECMO should be The Society In ECLS is not a to or the with the of the of ECMO to support patients is in clinical the evidence to support its use is to this is the of its in and the on to with the of of ECMO has to be and in clinical the of ECMO, decision should the of myocardial and, the of bridging to durable MCS or of the should a discussion of the the of bridging to and be a of support should recovery not in with the patient’s ECMO in the care of these patients should be in on this of a with should be for to and be of the ECMO We and the ELSO for in the

Galectin-3 is a member of the galectin family, which are β‑galactoside‑binding lectins with ≥1 evolutionary conserved carbohydrate‑recognition domain. It binds proteins in a carbohydrate‑dependent and ‑independent manner. Galectin‑3 is predominantly located in the cytoplasm; however, it shuttles into the nucleus and is secreted onto the cell surface and into biological fluids including serum and urine. It serves important functions in numerous biological activities including cell growth, apoptosis, pre‑mRNA splicing, differentiation, transformation, angiogenesis, inflammation, fibrosis and host defense. Numerous previous studies have indicated that galectin‑3 may be used as a diagnostic or prognostic biomarker for certain types of heart disease, kidney disease and cancer. With emerging evidence to support the function and application of galectin‑3, the current review aims to summarize the latest literature regarding the biomarker characteristics and potential therapeutic application of galectin‑3 in associated diseases.

Rapid socioeconomic progress has greatly affected the lifestyle in China. Consequently, owing to lifestyle changes, urbanization, and accelerated population aging, the risk of cardiovascular diseases (CVD) has increased. The incidence of CVD has been increasing continuously and this upward trend is projected to continue in the next decade. The growing burden of CVD has become a major public health issue. Accordingly, since 2005, the National Center for Cardiovascular Diseases of China has directed experts in cardiology, neurology, nephrology, diabetes, epidemiology, community healthcare, health economics, biostatistics, and other related fields to prepare the annual Report on Cardiovascular Diseases in China. This report aims to provide a timely review of the growing epidemic of CVD in the country as well as to assess the progress made in its prevention and control. We present herein an updated summary of the Report on Cardiovascular Diseases in China 2018 that includes trends in CVD, the morbidity and mortality of CVD, risk factor assessment, health resources for CVD, and a profile of medical expenditure.

AIMS: X-VeRT is the first prospective randomized trial of a novel oral anticoagulant in patients with atrial fibrillation undergoing elective cardioversion. METHODS AND RESULTS: We assigned 1504 patients to rivaroxaban (20 mg once daily, 15 mg if creatinine clearance was between 30 and 49 mL/min) or dose-adjusted vitamin K antagonists (VKAs) in a 2:1 ratio. Investigators selected either an early (target period of 1-5 days after randomization) or delayed (3-8 weeks) cardioversion strategy. The primary efficacy outcome was the composite of stroke, transient ischaemic attack, peripheral embolism, myocardial infarction, and cardiovascular death. The primary safety outcome was major bleeding. The primary efficacy outcome occurred in 5 (two strokes) of 978 patients (0.51%) in the rivaroxaban group and in 5 (two strokes) of 492 patients (1.02%) in the VKA group [risk ratio 0.50; 95% confidence interval (CI) 0.15-1.73]. In the rivaroxaban group, four patients experienced primary efficacy events following early cardioversion (0.71%) and one following delayed cardioversion (0.24%). In the VKA group, three patients had primary efficacy events following early cardioversion (1.08%) and two following delayed cardioversion (0.93%). Rivaroxaban was associated with a significantly shorter time to cardioversion compared with VKAs (P < 0.001). Major bleeding occurred in six patients (0.6%) in the rivaroxaban group and four patients (0.8%) in the VKA group (risk ratio 0.76; 95% CI 0.21-2.67). CONCLUSION: Oral rivaroxaban appears to be an effective and safe alternative to VKAs and may allow prompt cardioversion. NAME OF THE TRIAL REGISTRY: Clinicaltrials.gov; TRIAL REGISTRATION NUMBER: NCT01674647.

OBJECTIVE: To predict the global, regional, and national prevalence of Parkinson's disease by age, sex, year, and Socio-demographic Index to 2050 and quantify the factors driving changes in Parkinson's disease cases. DESIGN: Modelling study. DATA SOURCE: Global Burden of Disease Study 2021. MAIN OUTCOME MEASURES: Prevalent number, all age prevalence and age standardised prevalence of Parkinson's disease in 2050, and average annual percentage change of prevalence from 2021 to 2050; contribution of population ageing, population growth, and changes in prevalence to the growth in Parkinson's disease cases; population attributable fractions for modifiable factors. RESULTS: 25.2 (95% uncertainty interval 21.7 to 30.1) million people were projected to be living with Parkinson's disease worldwide in 2050, representing a 112% (95% uncertainty interval 71% to 152%) increase from 2021. Population ageing (89%) was predicted to be the primary contributor to the growth in cases from 2021 to 2050, followed by population growth (20%) and changes in prevalence (3%). The prevalence of Parkinson's disease was forecasted to be 267 (230 to 320) cases per 100 000 in 2050, indicating a significant increase of 76% (56% to 125%) from 2021, whereas the age standardised prevalence was predicted to be 216 (168 to 281) per 100 000, with an increase of 55% (50% to 60%) from 2021. Countries in the middle fifth of Socio-demographic Index were projected to have the highest percentage increase in the all age prevalence (144%, 87% to 183%) and age standardised prevalence (91%, 82% to 101%) of Parkinson's disease between 2021 and 2050. Among Global Burden of Disease regions, East Asia (10.9 (9.0 to 13.3) million) was projected to have the highest number of Parkinson's disease cases in 2050, with western Sub-Saharan Africa (292%, 266% to 362%) experiencing the most significant increase from 2021. The ≥80 years age group was projected to have the greatest increase in the number of Parkinson's disease cases (196%, 143% to 235%) from 2021 to 2050. The male-to-female ratios of age standardised prevalence of Parkinson's disease were projected to increase from 1.46 in 2021 to 1.64 in 2050 globally. CONCLUSIONS: By 2050 Parkinson's disease will have become a greater public health challenge for patients, their families, care givers, communities, and society. The upward trend is expected to be more pronounced among countries with middle Socio-demographic Index, in the Global Burden of Disease East Asia region, and among men. This projection could serve as an aid in promoting health research, informing policy decisions, and allocating resources.

ABSTRACT A number of studies investigated the distribution of BMD values and the prevalence of osteoporosis in China, but their findings varied. Until now, a BMD reference database based on uniform measurements in a large-scale Chinese population has been lacking. A total of 75,321 Chinese adults aged 20 years and older were recruited from seven centers between 2008 and 2018. BMD values at the lumbar spine (L1–L4), femoral neck, and total femur were measured by GE Lunar dual-energy X-ray absorptiometry systems. BMD values measured in each center were cross-calibrated by regression equations that were generated by scanning the same European spine phantom 10 times at every center. Cubic and multivariate linear regression were performed to assess associations between BMD values and demographic variables. Sex-specific prevalence of osteoporosis was age-standardized based on the year 2010 national census data for the Chinese population. The sex-specific BMD values at each site were negatively associated with age, positively associated with body mass index levels, and lower in the participants from southwest China than in those from other geographic regions after multivariate adjustment. Furthermore, BMD values at the femoral neck and total femur decreased with the year of BMD measurement. The peak BMD values at the lumbar spine, femoral neck, and total femur were 1.088 g/cm2, 0.966 g/cm2, and 0.973 g/cm2, respectively, for men, and 1.114 g/cm2, 0.843 g/cm2, and 0.884 g/cm2, respectively, for women. The age-standardized prevalence of osteoporosis at the spine or hip was 6.46% and 29.13% for men and women aged 50 years and older, respectively. Currently a total of 10.9 million men and 49.3 million women in China are estimated to have osteoporosis. In our national examination of BMD, we found that BMD values differed by demographic characteristics. We estimated the age-standardize prevalence of osteoporosis in China to be 6.46% and 29.13% respectively, for men and women aged 50 years and older.