Search Results (164)

Cardiogenic pulmonary edema (CPE) is a life-threatening manifestation of acute heart failure characterized by rapid accumulation of fluid in the interstitial and alveolar spaces, leading to severe dyspnea, hypoxemia, and respiratory failure. The condition arises from elevated left-sided filling pressures that increase pulmonary capillary hydrostatic pressure, disrupt alveolo-capillary barrier integrity, and impair gas exchange. Neurohormonal activation further perpetuates congestion and increases myocardial workload, creating a vicious cycle of hemodynamic overload and respiratory compromise. Respiratory support is a cornerstone of management in CPE, aimed at stabilizing oxygenation, reducing the work of breathing, and facilitating ventricular unloading while definitive therapies, such as diuretics, vasodilators, inotropes, or mechanical circulatory support (MCS), address the underlying cause. Among available modalities, non-invasive ventilation (NIV) with continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) has the strongest evidence base in moderate-to-severe CPE, consistently reducing the need for intubation and providing rapid relief of dyspnea. High-flow nasal cannula (HFNC) represents an emerging alternative in patients with moderate hypoxemia or intolerance to mask ventilation, and should be considered an adjunctive option in selected patients with less severe disease or NIV intolerance, although its efficacy in severe presentations remains uncertain. Invasive mechanical ventilation is reserved for refractory cases, while extracorporeal membrane oxygenation (ECMO) and other advanced circulatory support modalities may be necessary in cardiogenic shock. Integration of respiratory strategies with hemodynamic optimization is essential, as positive pressure ventilation favorably modulates preload and afterload, synergizing with pharmacological unloading. Future directions include personalization of ventilatory strategies using advanced monitoring, novel interfaces to improve tolerability, and earlier integration of MCS. In summary, respiratory support in CPE is both a bridge and a decisive therapeutic intervention, interrupting the cycle of hypoxemia and hemodynamic deterioration. A multidisciplinary, individualized approach remains central to improving outcomes in this high-risk population. Full article

Hylocereus undatus growth is limited by long-term heat stress, and heat shock protein 70 (Hsp70) is crucial in the plant’s heat stress (HS) response. In a previous study, transcriptomic data revealed that Hsp70 family members in pitaya seedlings respond to temperature changes. This study identified 27 HuHsp70 genes in pitaya, analyzed their physicochemical properties (such as molecular weight and isoelectric point), and divided them into five subfamilies with conserved gene structures, motifs (short conserved sequence patterns), and cis-acting elements (regulatory DNA sequences). The Ks value (synonymous substitution rate) ranged from 0.93~3.54, and gene duplication events occurred between 71.17 and 272.19 million years ago (Mya). Under HS, eight and nine differentially expressed genes (DEGs) were detected at 24 h and 48 h, respectively. Quantitative real-time PCR (qRT-PCR, a method for measuring gene expression) verified the expression trends, with HuHsp70-11 expression increasing with heat shock duration, indicating that HuHsp70-11 is a key candidate. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses revealed that HuHsp70s, especially HuHsp70-11, play key roles in responding to high temperatures (HT) in H. undatus seedlings. A potential model by which HuHsp70-11 removes excess reactive oxygen species (ROS) and enhances cell membrane permeability was constructed. These results provide new perspectives for exploring the HS response mechanisms and adaptability of H. undatus plants to heat stress. Full article

Background: The management of acute pulmonary embolism (PE) in the Emergency Department (ED) remains challenging, particularly in hemodynamically and respiratory stable patients with minimal symptoms. Diagnostic and therapeutic difficulties are further compounded when the condition is complicated by a mobile right atrial (RA) thrombus, representing an extreme-risk phenotype. Case Presentation: We report the case of a 65-year-old male with a single known venous thromboembolism risk factor-chronic venous insufficiency-who presented to the ED following a transient episode of severe dyspnea at home. On admission, he was hemodynamically and respiratory stable, without the need for oxygen supplementation. Arterial blood gas analysis revealed a metabolically compensated acidosis with elevated lactate, while cardiac biomarkers were moderately increased. Emergency point-of-care transthoracic echocardiography (POCUS-TTE) demonstrated severe right ventricular (RV) dysfunction and a large, mobile intracardiac thrombus prolapsing through the tricuspid valve. Computed Tomography Pulmonary Angiography confirmed pulmonary embolism and revealed a massive and extensive bilateral thrombotic burden (Qanadli score 32 points). Given the extreme risk for fatal embolization, immediate full-dose systemic thrombolysis with Alteplase (100 mg over 2 h) was initiated in the ED. Thrombolysis was completed without hemorrhagic complications. Follow-up POCUS-TTE at 2 h showed complete resolution of the intracardiac thrombus and significant improvement of RV function (RV/RA gradient reduced from 40 mmHg to 28 mmHg). Conclusions: This case highlights the effectiveness and safety of early systemic thrombolysis guided by ED POCUS-TTE in PE with a massive thrombotic burden, complicated by a mobile intracardiac thrombus, even in the absence of shock. Such prompt intervention may reduce mortality risk in intermediate-to-high-risk PE subsets, despite limited guidance in current clinical recommendations. Full article

Cardiogenic shock (CS) remains a significant clinical challenge with persistently high mortality rates. Defined by impaired cardiac output resulting in end-organ hypoperfusion, CS commonly arises from acute myocardial infarction (AMI-CS) or acute exacerbations of heart failure (HF-CS). The severity of CS is classified by the Society for Cardiovascular Angiography and Interventions (SCAI) into stages A (at risk) through E (extremis), which informs treatment strategies, including pharmacotherapy and mechanical circulatory support (MCS). Recent advancements in percutaneous mechanical circulatory support devices, including intra-aortic balloon pumps (IABPs), Impella devices, TandemHeart, Protek-Duo, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), have transformed management paradigms by offering targeted hemodynamic support. While DanGer-SHOCK, a pivotal randomized trial, demonstrated improved outcomes with early Impella use in anterior STEMI-associated CS, the trial’s focus population and center expertise suggest that its findings should be interpreted in the context of broader AMI-CS and HF-CS presentations. Device selection is guided by shock severity, anatomical considerations, comorbidities, and institutional capabilities. This review synthesizes current evidence, evaluates the clinical utility and efficacy of existing and emerging percutaneous MCS technologies, and highlights ongoing clinical trials and future directions in optimizing CS management. Emphasis is placed on individualized patient selection, evidence-based deployment of MCS devices, and multidisciplinary team collaboration, which collectively represent a critical transition towards improving clinical outcomes in CS. Full article

Levosimendan, a calcium-sensitizing inodilator, has emerged as a promising adjunctive therapy in patients undergoing veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Its pharmacodynamic profile, combining positive inotropy with vasodilation and mitochondrial protective effects, offers a unique therapeutic potential in the context of mechanical circulatory support. Despite growing interest, the clinical impact of Levosimendan in ECMO remains debated, with heterogeneous evidence regarding its efficacy in improving weaning success, reducing vasopressor requirements or mitigating ischemia-reperfusion injury. This narrative review aims to critically appraise the current literature on Levosimendan use in ECMO settings, exploring its mechanistic rationale, pharmacologic behavior under extracorporeal circulation and potential role in various clinical scenarios including post-cardiotomy shock and refractory cardiogenic failure. The limitations of existing studies are critically examined, underscoring the need for high-quality clinical trials to define appropriate patient selection, optimal timing of administration and dosing strategies. This review synthesizes current evidence to determine whether Levosimendan constitutes a true therapeutic asset or remains merely an adjunctive agent in the complex management of ECMO supported patients. Full article

This review presents soybean responses to drought, heat, and salinity within a signal–transcript–chromatin framework. In this framework, calcium/reactive oxygen species and abscisic acid cues converge on abscisic acid-responsive element binding factor (ABF/AREB), dehydration-responsive element binding protein (DREB), NAC, and heat shock factor (HSF) families. These processes are modulated by locus-specific chromatin and non-coding RNA layers. Base-resolved methylomes reveal a high level of CG methylation in the gene body, strong CHG methylation in heterochromatin, and dynamic CHH ‘islands’ at the borders of transposable elements. CHH methylation increases over that of transposable elements during seed development, and GmDMEa editing is associated with seed size. Chromatin studies in soybean and model species implicate the reconfiguration of salt-responsive histone H3 lysine 27 trimethylation (H3K27me3) in G. max and heat-linked H2A.Z dynamics at thermoresponsive promoters characterized in Arabidopsis and other plants, suggesting that a conserved chromatin layer likely operates in soybean. miR169–NF-YA, miR398–Cu/Zn Superoxide Dismutases(CSD)/copper chaperone of CSD(CCS), miR393–transporter inhibitor response1/auxin signaling F-box (TIR1/AFB), and miR396–growth regulating factors (GRF) operate across leaves, roots, and nodules. Overexpression of lncRNA77580 enhances drought tolerance, but with context-dependent trade-offs under salinity. Single-nucleus and spatial atlases anchor these circuits in cell types and microenvironments relevant to stress and symbiosis. We present translational routes, sentinel epimarkers (bisulfite amplicons, CUT&Tag), haplotype-by-epigenotype prediction, and precise cis-regulatory editing to accelerate marker development, genomic prediction and the breeding of resilient soybean varieties with stable yields. Full article

Ions of Gd³⁺ and Yb³⁺ have radii similar to those of Zr⁴⁺, enabling them to form limited solid solutions in the ZrO₂ lattice through substitution. After solid solution formation, oxygen vacancy defects and complex defect aggregates are generated, which are crucial for stabilizing the high-temperature phase structure and reducing thermal conductivity. Therefore, in this study, 8 wt% Y₂O₃ and 5 wt% Yb₂O₃ were doped with 5 wt%, 10 wt%, and 15 wt% Gd₂O₃, respectively, to stabilize zirconia powders. GYYZO thermal barrier coatings (TBCs) were fabricated via atmospheric plasma spraying (APS). Subsequently, the GYYZO coatings with different Gd₂O₃ addition amounts were subjected to continuous thermal shock cycling at 1100 °C for 10, 30, 60, 90, and 150 cycles. The results indicate that the incorporation of Gd₂O₃, Yb₂O₃, and Y₂O₃ leads to the formation of stable tetragonal ZrO₂ phase in the GYYZO coatings. Although increasing the Gd₂O₃ addition amount reduces the thermal conductivity of the coatings, excessive Gd₂O₃ addition causes coating spallation. The GYYZO coating with 10 wt% Gd₂O₃ exhibits the lowest thermal conductivity of 0.59 W/(m·K). Additionally, the GYYZO coating with 10 wt% Gd₂O₃ can withstand thermal cycling for 150 cycles, while the one with 5 wt% Gd₂O₃ can endure 90 of thermal cycles. In contrast, the 8YSZ coating cracks and spalls after 60 thermal cycles. These findings demonstrate that doping ZrO₂ with Gd₂O₃, Yb₂O₃, and Y₂O₃ can enhance the thermal cycling resistance of the coatings and effectively reduce their thermal conductivity, but excessive Gd₂O₃ addition will decrease the coating adhesion strength. Full article

Introduction: Although the incidence of mechanical complications of myocardial infarction is decreasing, the associated mortality rate remains high. Such complications require an early diagnosis and multidisciplinary management. In most cases, surgery is the only definitive treatment, despite it being associated with high peri-operative mortality and morbidity. An intra-aortic balloon pump (IABP) or Extracorporeal Membrane Oxygenation (ECMO) may also be required for unstable patients. After the employment of mechanical assistance, ultrasound and chemical parameters are associated with successful weaning, indicating adequate cardiac function, perfusion, and oxygen delivery. Case presentation: The aim of this case report is to describe the weaning from the extracorporeal support in a case of post-myocardial-infarction ventricular septal defect (VSD) and Left ventricle (LV) apical aneurysm. The patient underwent surgery for VSD closure and aneurysm exclusion. After the emergency surgery, the patient developed a severe post-cardiotomy cardiogenic shock, which required veno-arterial femoral–femoral extracorporeal membrane oxygenation (VA-ff-ECMO), IABP, and maximal pharmacologic support. During the ICU stay, we weaned the patient from the ECMO support based on transesophageal echocardiography (TEE) imaging and pulmonary artery catheter (PAC) monitoring and quantified the shunt fraction. On the fifth post-operative day, we started the weaning trial. Hemodynamic and ultrasound monitoring showed an adequate cardiac function, and the shunt fraction calculated with both the ultrasound parameters and Fick’s law was acceptable. We removed the ECMO the day after, and the weaning was successful. Discussion: Data deriving from the Swan–Ganz catheter has been found to be important in guiding the process of weaning a patient from extracorporeal support. Nevertheless, the TEE played a pivotal role in the decision-making process and in clinical management. We reduced the ECMO blood flow following a real-time echocardiographic cardiac function assessment. Conclusions: Following the fundamental guides for both PAC monitoring and TEE imaging, we successfully removed the extracorporeal support, with a positive outcome. Full article

Magnesia-dolomite refractories have emerged as sustainable alternatives to traditional carbon- or chromium-containing linings in steelmaking and cement industries. Their outstanding thermochemical stability, high refractoriness, and strong basic slag compatibility make them suitable for converters, electric arc furnaces (EAF), and argon–oxygen decarburization (AOD) units. However, their practical application has long been constrained by hydration and thermal shock sensitivity associated with free CaO and open porosity. Recent advances, including optimized raw material purity, fused co-clinker synthesis, nano-additive incorporation (TiO₂, MgAl₂O₄ spinel, FeAl₂O₄), and improved sintering strategies, have significantly enhanced density, mechanical strength, and hydration resistance. Emerging technologies such as co-sintered magnesia–dolomite composites and additive-assisted microstructural tailoring have enabled superior corrosion resistance and extended service life. This review provides a comprehensive analysis of physicochemical mechanisms, processing routes, and industrial performance of magnesia–dolomite refractories, with special emphasis on their contribution to technological innovation, decarbonization, and circular economy strategies in high-temperature industries. Full article

With-No-Lysine (WNK) kinases constitute a subgroup within the serine/threonine protein kinase family, characterized by the absence of a catalytic lysine residue in the kinase subdomain II located in their N-terminal region. These kinases play critical roles in regulating plant growth, development, and responses to abiotic stressors. However, members of the WNK and their responses to heat stress in pepper (Capsicum annuum L.) remain unexplored. In the present study, we identified eleven WNK genes within the genome of pepper cultivar ‘UCD-10X-F1’ and designated them CaWNK1 to CaWNK11 according to their chromosomal positions. Comprehensive analyses were conducted to elucidate their phylogenetic relationships, chromosomal distribution, collinearity, gene structure, protein properties, and cis-acting elements within promoter regions. The findings revealed that the CaWNK gene family segregates into five distinct subgroups. Comparative genomic analysis identified eleven and nine segmental duplication gene pairs between pepper and tomato and between pepper and Arabidopsis, respectively. Within the pepper genome, two pairs of segmentally duplicated genes and two pairs of tandemly repeated genes were also detected. The CaWNK gene sequences in pepper exhibited a high degree of conservation; however, variations were observed in the number of introns and exons. Analysis of the promoter regions revealed an abundance of cis-acting elements associated with growth and development, stress responses, and hormone regulation. Subsequent transcriptomic analyses demonstrated that CaWNK genes displayed tissue-specific expression patterns and differential expression levels following treatments with exogenous plant hormones and abiotic stresses. Notably, the expression of CaWNK6 was significantly up-regulated under heat stress conditions. To elucidate the functional role of CaWNK6, virus-induced gene silencing (VIGS) was employed to suppress its expression in pepper seedlings. Silencing of CaWNK6 resulted in disrupted tissue architecture, stomatal closure, and diminished heat tolerance. These phenotypic changes correlated with excessive accumulation of reactive oxygen species (ROS), reduced activity of antioxidant enzymes, and down-regulation of heat shock factor (HSF) genes in the silenced plants. Collectively, these findings offer valuable insights into the functional roles of CaWNK genes and hold significant implications for the development of novel heat-tolerant pepper cultivars. Full article

Transesophageal echocardiography (TEE) has long been established as a cornerstone imaging modality in cardiac surgery and perioperative medicine. In recent years, however, its role has expanded into emergency and intensive care settings, where rapid and accurate hemodynamic assessment is crucial for survival. Point-of-care TEE provides advantages over transthoracic echocardiography when acoustic windows are limited, particularly in mechanically ventilated or critically unstable patients, allowing continuous high-quality visualization of cardiac function, volume status, and great vessel pathology to guide immediate therapeutic interventions. This narrative review examines the evolving role of TEE in acute settings, with emphasis on its application in shock, cardiac arrest, pulmonary embolism, tamponade, and its value in extracorporeal membrane oxygenation (ECMO) cannulation. Advances such as three-dimensional TEE, miniaturized probes, and the integration of artificial intelligence are also discussed, as potential drivers of innovation. While bridging technological progress with clinical practice, TEE emerges as a versatile tool in critical care. However, its broader adoption is still limited by probe availability, operator training, and institutional resources. Overcoming these barriers will be essential to translating technological advances into widespread practice. Full article

Cardiogenic shock (CS) is a complex, life-threatening syndrome characterized by inadequate tissue perfusion due to impaired cardiac function. Acute myocardial infarction (AMI) and acute decompensated heart failure are the leading causes, with mortality remaining high despite advances in revascularization and supportive care. The Society for Cardiovascular Angiography and Interventions (SCAI) classification allows risk stratification and guides clinical decision making by capturing the spectrum of shock severity. Percutaneous mechanical circulatory support (pMCS) devices, such as the intra-aortic balloon pump (IABP) and Impella, aim to stabilize hemodynamics by augmenting cardiac output and unloading the left ventricle. However, randomized trials and meta-analyses have not demonstrated a consistent survival advantage of Impella over IABP, while reporting higher rates of bleeding and vascular complications. Landmark trials, including ECLS-SHOCK and DanGer, have provided conflicting results, likely reflecting differences in baseline severity and timing of device implantation. Veno-arterial extracorporeal membrane oxygenator (VA-ECMO) offers full cardiopulmonary support but increases left ventricular afterload, potentially worsening myocardial injury. Combined strategies such as ECPELLA (Impella + VA-ECMO) or ECMO + IABP may mitigate left ventricle (LV) overload and improve bridging to recovery or advanced therapies, although evidence remains largely observational and complication rates are considerable. In right-sided or biventricular failure, tailored options (e.g., Impella RP, Bi-Pella) guided by invasive hemodynamics may be required. Current evidence suggests that pMCS benefits are limited to carefully selected subgroups, underscoring the importance of early diagnosis, prompt referral, and individualized intervention. Robust randomized data are still needed to define the optimal role of pMCS in AMI-related CS. Full article

Circulatory disturbances in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) present significant challenges in interventional cardiology. This review examines the pathophysiological mechanisms, management strategies, and outcomes associated with these hemodynamic complications, ranging from transient hypotension to severe cardiogenic shock (CS). The complex interplay between myocardial ischemia, reperfusion injury, and procedural stress creates a dynamic circulatory environment that requires careful monitoring and intervention. The review analyzes various causes of circulatory disturbances, including vasovagal reflexes, allergic reactions, cardiac arrhythmias, acute ischemia, and procedural complications. It emphasizes the importance of early recognition and appropriate management of these conditions to improve patient outcomes. The progression from hypotension to CS is examined, with a focus on assessment tools, prognostication, and revascularization strategies. The role of mechanical circulatory support devices in managing severe circulatory compromise is discussed, including intra-aortic balloon pumps, Impella devices, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Recent randomized controlled trials have yielded mixed results regarding the efficacy of these devices, highlighting the need for a nuanced, patient-centered approach to their use. This comprehensive analysis provides clinicians with a framework for anticipating, identifying, and managing circulatory disturbances in ACS patients undergoing PCI. It underscores the importance of risk stratification, multidisciplinary approaches, and ongoing research to optimize patient care and improve outcomes in this high-risk population. Full article

Background: Sickle cell disease (SCD) is a hereditary hemoglobinopathy associated with life-threatening complications such as acute chest syndrome (ACS), which may necessitate extracorporeal membrane oxygenation (ECMO) in refractory cases. Despite growing use, ECMO in SCD remains challenging due to risks of hemolysis, thrombosis, and anticoagulation complications. This systematic review consolidates existing evidence on ECMO outcomes in SCD, focusing on indications, complications, and survival. Methods: A systematic search of MEDLINE, Cochrane CENTRAL, and Google Scholar was conducted up to January 2025, identifying case reports/series on ECMO use in SCD. Studies reporting venovenous (VV) or venoarterial (VA) ECMO for acute cardiopulmonary failure were included. Data on demographics, laboratory findings, management, and outcomes were extracted. Quality assessment was performed using the Joanna Briggs Institute checklist. Results: Sixteen case reports (23 patients) were included. Most patients were female (65.2%), with ACS (47.8%) and pulmonary embolism (13.0%) as common ECMO indications. VV-ECMO (69.6% of cases) was primarily used for respiratory failure, with a 69% survival rate, while VA-ECMO (30.4%) had a 29% survival rate, often due to cardiogenic shock or cardiac arrest. Complications included hemorrhage (26.1%), neurological injury (21.7%), and thrombosis (13.0%). Exchange transfusion was frequently employed (43.5%), with post-ECMO echocardiography showing improved right ventricular function in survivors. Conclusions: VV-ECMO demonstrates favorable outcomes in SCD-related respiratory failure, whereas VA-ECMO carries higher mortality risks. Careful patient selection, anticoagulation management, and multidisciplinary coordination are essential. Larger prospective studies are needed to refine ECMO utilization in this high-risk population. Full article

Purpose: The venous-to-arterial carbon dioxide partial pressure difference [P(v-a)CO₂] reflects the adequacy of tissue perfusion, with elevated values suggesting impaired clearance of CO₂. While its prognostic role has been investigated in septic shock and high-risk surgery, evidence in postoperative critically ill patients remains limited. This study aimed to evaluate the prognostic value of ΔP(v-a)CO₂ after major abdominal surgery and its relationship with microcirculatory markers. Methods: We retrospectively analyzed 86 patients admitted to the intensive care unit (ICU) after major abdominal surgery between September 2020 and October 2023. Arterial and central venous blood gas analyses were performed immediately postoperatively and at 24 h. Patients were stratified into groups according to ΔP(v-a)CO₂ (≤ 0 vs. >0). Postoperative outcomes and correlations with central venous oxygen saturation (ScvO₂) were assessed. Results: In the subgroup analysis of patients with an initial P(v-a)CO₂ > 6 mmHg, those in the ΔP(v-a)CO₂ > 0 group required mechanical ventilation (54.5% vs. 22.2%, p = 0.033) and continuous renal replacement therapy (36.4% vs. 8.9%, p = 0.020) more frequently, with longer durations of both interventions (p = 0.011 and p = 0.016, respectively). ICU length of stay and the incidence of acute kidney injury were significantly lower in the ΔP(v-a)CO₂ ≤ 0 group. In addition, a modest negative correlation was observed between ScvO₂ measured at 24 h postoperatively and ΔP(v-a)CO₂. Conclusions: ΔP(v-a)CO₂ may serve as a useful marker for postoperative risk stratification in critically ill patients undergoing major abdominal surgery. However, given the retrospective design, small sample size, and single-center setting, these findings should be considered hypothesis-generating and require confirmation in larger, prospective multicenter studies. Full article