Critical patients with the coronavirus disease 2019 (COVID-19), even those whose nucleic acid test results had turned negative and those receiving maximal medical support, have been noted to progress ...to irreversible fatal respiratory failure. Lung transplantation (LT) as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients.
From February 10 to March 10, 2020, three male patients were urgently assessed and listed for transplantation. After conducting a full ethical review and after obtaining assent from the family of the patients, we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores.
Two of the three recipients survived post-LT and started participating in a rehabilitation program. Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved. The pathological results of the explanted lungs were concordant with the critical clinical manifestation, and provided insight towards better understanding of the disease. Government health affair systems, virology detection tools, and modern communication technology all play key roles towards the survival of the patients and their rehabilitation.
LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis. If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT, LT provided the final option for these patients to avoid certain death, with proper protection of transplant surgeons and medical staffs. By ensuring instant seamless care for both patients and medical teams, the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.
Temporal stability of net primary productivity (NPP) is important for predicting the reliable provisioning of ecosystem services under global changes. Although nitrogen (N) addition is known to ...affect the temporal stability of aboveground net primary productivity (ANPP), it is unclear how it impacts that of belowground net primary productivity (BNPP) and NPP, and whether such effects are scale dependent. Here, using experimental N addition in a grassland, we found different responses of ANPP and BNPP stability to N addition at the local scale and that these responses propagated to the larger spatial scale. That is, N addition significantly decreased the stability of ANPP but did not affect the stability of BNPP and NPP at the two scales investigated. Additionally, spatial asynchrony of both ANPP and BNPP among communities provided greater stability at the larger scale and was not affected by N addition. Our findings challenge the traditional view that N addition would reduce ecosystem stability based on results from aboveground dynamics, thus highlighting the importance of viewing ecosystem stability from a whole system perspective.
It remains unknown how would nitrogen (N) enrichment affect the stability of belowground productivity. Using a field experiment with six N addition rates in a temperate steppe, we found that N addition decreased the stability of ANPP, but did not affect the stability of BNPP and total NPP at both local and larger scales. Spatial asynchrony of both ANPP and BNPP provided greater stability at larger scale and was not affected by N addition, highlighting the importance of understanding stability from a whole system perspective.
Hyperlipidemia, type 2 diabetes mellitus, nonalcoholic fatty liver and many other metabolic disorder are frequently co-existing in patients. In addition, these diseases are closely related in ...pathophysiological settings. However, increasing of the disease incidence, lacking of comprehensive prevention and control measurements against the key pathology point concomitant occurrence with the pattem of the single disease, single target therapy, that is leading therapeutic strategy for these metabolic disorders in the setting of Western medicine （WM）. On the basis of the combination of the advantages of integrated Chinese medicine （CM） and WM, with unified understanding of such diseases, the new concept of glucolipid metabolic disease （GLMD） is introduced. In this new concept, disorders in glucose and lipid metabolism are recognized as the key trigger and major driving force for the progress of GLMD. The key points of pathology included dysfunction of neuronal-endocrine-immune system,insulin resistance, oxidative stress, inflammation and intestinal flora imbalance. In the core pathogenic perspective of CM, it can be explained as ＂Gan （Liver） Shi Shu Xie＂ （dysfunction of Gan in metabolism and emotion regulation） that will lead to the occurence/production of endogenous dampness and phlegm, blood stasis and turbid. This leads to the new concept of ＂Liver-based regulatory system for metabolic homeostasis＂ to be introduced further. The comprehensive prevention and control strategy ＂Tiao Gan Qi Shu Hua Zhuo＂ （modulating Gan, trigging key metabolic system to resolve pathogenic factors such as phlegm retention and dampness）. Its representative formula Fufang Zhenzhu Tiaozhi Capsule （复方贞术调脂胶囊） is innovated under such rationales. Comment for some commonly-used CM GLMD therapeutic drugs was presented. High-level evidence-based and epidemiological and mechanism studies should be carded out to further interpret and explain of the scientific connotation of GLMD.
Obesity and type 2 diabetes mellitus are complicated metabolic diseases that affect multiple organs and are characterized by hyperglycaemia. Currently, stable and effective treatments for obesity and ...type 2 diabetes mellitus are not available. Therefore, the mechanisms leading to obesity and diabetes and more effective ways to treat obesity and diabetes should be identified. Based on accumulated evidences, the PI3K/AKT signalling pathway is required for normal metabolism due to its characteristics, and its imbalance leads to the development of obesity and type 2 diabetes mellitus. This review focuses on the role of PI3K/AKT signalling in the skeletal muscle, adipose tissue, liver, brain and pancreas, and discusses how this signalling pathway affects the development of the aforementioned diseases. We also summarize evidences for recently identified therapeutic targets of the PI3K/AKT pathway as treatments for obesity and type 2 diabetes mellitus. PI3K/AKT pathway damaged in various tissues of the body leads to obesity and type 2 diabetes as the result of insulin resistance, and in turn, insulin resistance exacerbates the PI3K/AKT pathway, forming a vicious circle.
Identifying the thresholds for the positive responses of total net primary productivity (NPP) to nitrogen (N) enrichment is an essential prerequisite for predicting the benefits of N deposition on ...ecosystem carbon sequestration. However, the responses of below‐ground NPP (BNPP) to N enrichment are unknown in many ecosystems, which limits our ability to understand the carbon cycling under the scenario of increasing N availability. We examined the changes in above‐ground NPP (ANPP), BNPP, and NPP of a temperate meadow steppe across a wide‐ranging N addition gradient (0, 2, 5, 10, 20, and 50 g N m−2 year−1) during 5 years. Both ANPP and NPP increased nonlinearly with N addition rates. The N saturation threshold for ANPP (TA) and NPP (TN) was at the rate of 13.11 and 6.70 g N m−2 year−1, respectively. BNPP decreased with increasing N addition when N addition rates ˃5 g N m−2 year−1, resulting in much lower TN than TA. Soil N enrichment played a key role in driving the negative impacts of high N addition rates on BNPP, and consequently on the earlier occurrence of N saturation threshold for NPP. Our results highlight the negative effects of soil N enrichment on NPP in natural grasslands super‐saturated with N. Furthermore, by considering ANPP and BNPP simultaneously, our results indicate that previous findings from above‐ground might have over‐estimated the positive effects of N deposition on primary productivity.
Based on a field experiment with six nitrogen (N) addition rates in a temperate steppe, we found that the N saturation threshold for ANPP (TA) and NPP (TN) was 13.11 and 6.70 g N m−2 year−1, respectively. Soil N enrichment played a key role in driving the negative impacts of high N addition rates on BNPP, resulting in much lower TN than TA. Our results indicate that previous findings from above‐ground might have over‐estimated the positive effects of N deposition on primary productivity.
•The EE of three urban agglomerations considering environmental benefits is calculated.•The EE of BTH, YRD, and PRD urban agglomerations exists significant differences.•The economic development and ...EE of BTH urban agglomeration is “inverted U-shaped”.•Urbanization and energy structure have significant negative effects on EE.
China’s three major urban agglomerations, Beijing-Tianjin-Hebei (BTH), Yangtze River Delta (YRD), and Pearl River Delta (PRD), are expected the key areas of energy saving and emission reduction. Based on the connotation of energy saving and emission reduction, we constructed the input–output index system considering environmental benefits, and then used the SBM-Undesirable (Slack-based Measure Considering Undesirable-outputs) model to evaluate the energy saving and emission reduction efficiency (EE) of 49 cities in China’s three major urban agglomerations during 2006–2018. Finally, the paper applied the spatial econometric model to explore the influencing factors of EE. The research results indicate that the overall EE across cities is relatively low, only 7 cities have been on the production frontier. The EE of China’s three urban agglomerations is significant, presenting the development state of “PRD > YRD > BTH”. The spatial autocorrelation of BTH urban agglomeration changed from positive to negative, the YRD urban agglomeration kept relatively stable positive spatial autocorrelation, while the spatial autocorrelation of PRD urban agglomeration was negative during the study period. The results of the spatial econometric analysis show that the relationship between economic development and EE is an “inverted U-shaped” in BTH urban agglomeration, while an “S-shaped” in YRD and PRD urban agglomerations. The urbanization and energy structure have significant negative effects on EE in three major urban agglomerations, and the effect of urbanization on EE is much greater than that of energy structure. Besides, the industrial structure has a significant negative impact on the EE of BTH urban agglomeration. The opening-up degree can significantly inhibit the improvement of EE in YRD urban agglomeration. The impact of resource endowment on the EE of three urban agglomerations is not significant. According to the empirical results, some policy commendations are proposed.
Abstract Obesity, which has developed into a global epidemic, is a risk factor in most chronic diseases and some forms of malignancy. The discovery of leptin in 1994 has opened a new field in obesity ...research. Currently, we know that leptin is the primary signal from energy stores and exerts negative feedback effects on energy intake. However, most individuals with diet-induced obesity (DIO) develop leptin resistance, which is characterized by elevated circulating leptin levels and decreased leptin sensitivity. To date, though various mechanisms have been proposed to explain leptin resistance, the exact mechanisms of leptin resistance in obesity are poorly understood. Consequently, it's an important issue worth discussing regarding what the exact interrelations between leptin resistance and obesity are. Here, we review the latest advancements in the molecular mechanisms of leptin resistance and the exact interrelations between leptin resistance, obesity, and obesity-related diseases, in order to supply new ideas for the study of obesity.
This paper proposes a novel solution to the problems that exist in the conventional hill climb searching (HCS) maximum power point tracking (MPPT) algorithm for the wind energy conversion system. The ...presented solution not only solves the tracking speed versus control efficiency tradeoff problem of HCS but also makes sure that the changing wind conditions do not lead HCS in the wrong direction. It intelligently adapts the variable step size to keep up with the rapid changes in the wind and seizes the perturbation at the maxima to yield 100% control efficiency. For this purpose, a novel peak detection capability has been devised which, in contrast with conventional peak detection, can work robustly under changing wind conditions. The proposed MPPT performs self-tuning to cope with the nonconstant efficiencies of the generator-converter subsystems-a phenomenon quite rarely discussed in research papers so far. In addition, a smart speed-sensorless scheme has been developed to avoid the use of mechanical sensors. The experimental results confirm that the proposed algorithm is remarkably faster and more efficient than the conventional HCS.
Increasing availability of reactive nitrogen (N) threatens plant diversity in diverse ecosystems. While there is mounting evidence for the negative impacts of N deposition on one component of ...diversity, species richness, we know little about its effects on another one, species evenness. It is suspected that ecosystem management practice that removes nitrogen from the ecosystem, such as hay-harvesting by mowing in grasslands, would mitigate the negative impacts of N deposition on plant diversity. However, empirical evidence is scarce. Here, we reported the main and interactive effects of N deposition and mowing on plant diversity in a temperate meadow steppe with 4-year data from a field experiment within which multi-level N addition rates and multiple N compounds are considered. Across all the types of N compounds, species richness and evenness significantly decreased with the increases of N addition rate, which was mainly caused by the growth of a tall rhizomatous grass, Leymus chinensis. Such negative impacts of N addition were accumulating with time. Mowing significantly reduced the dominance of L. chinensis, and mitigated the negative impacts of N deposition on species evenness. We present robust evidence that N deposition threatened biodiversity by reducing both species richness and evenness, a process which could be alleviated by mowing. Our results highlight the changes of species evenness in driving the negative impacts of N deposition on plant diversity and the role of mowing in mediating such negative impacts of N deposition.
Macrophages play an important role in a wide variety of physiologic and pathologic processes. Plasticity and functional polarization are hallmarks of macrophages. Macrophages commonly exist in two ...distinct subsets: classically activated macrophages (M1) and alternatively activated macrophages (M2). M2b, a subtype of M2 macrophages, has attracted increasing attention over the past decade due to its strong immune‐regulated and anti‐inflammatory effects. A wide variety of stimuli and multiple factors modulate M2b macrophage polarization in vitro and in vivo. M2b macrophages possess both protective and pathogenic roles in various diseases. Understanding the mechanisms of M2b macrophage activation and the modulation of their polarization might provide a great perspective for the design of novel therapeutic strategies. The purpose of this review is to discuss current knowledge of M2b macrophage polarization, the roles of M2b macrophages in a variety of diseases and the stimuli to modulate M2b macrophage polarization.
Review outlines the current knowledge of the stimuli of M2b macrophage polarization and the roles of these cells in diseases.
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