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Background Arbuscular Mycorrhizal Fungi (AMF) are beneficial microorganisms in soil-plant interactions; however, the underlying mechanisms regarding their roles in legumes environmental stress remain elusive. Present trials were undertaken to study the effect of AMF on the ameliorating of salt, drought, and cold stress in peanut ( Arachis hypogaea L.) plants. A new product of AMF combined with Rhizophagus irregularis SA, Rhizophagus clarus BEG142, Glomus lamellosum ON393, and Funneliformis mosseae BEG95 (1: 1: 1: 1, w/w/w/w) was inoculated with peanut and the physiological and metabolomic responses of the AMF-inoculated and non-inoculated peanut plants to salt, drought, and cold stress were comprehensively characterized, respectively. Results AMF-inoculated plants exhibited higher plant growth, leaf relative water content (RWC), net photosynthetic rate, maximal photochemical efficiency of photosystem II (PSII) (Fv/Fm), activities of antioxidant enzymes, and K + : Na + ratio while lower leaf relative electrolyte conductivity (REC), concentration of malondialdehyde (MDA), and the accumulation of reactive oxygen species (ROS) under stressful conditions. Moreover, the structures of chloroplast thylakoids and mitochondria in AMF-inoculated plants were less damaged by these stresses. Non-targeted metabolomics indicated that AMF altered numerous pathways associated with organic acids and amino acid metabolisms in peanut roots under both normal-growth and stressful conditions, which were further improved by the osmolytes accumulation data. Conclusion This study provides a promising AMF product and demonstrates that this AMF combination could enhance peanut salt, drought, and cold stress tolerance through improving plant growth, protecting photosystem, enhancing antioxidant system, and regulating osmotic adjustment.

Background Intercropping (IC) has been widely adopted by farmers for enhancing crop productivity and economic returns; however, the underpinning mechanisms from the perspective of below-ground interspecific interactions are only partly understood especially when intercropping practices under saline soil conditions. By using permeable (100 μm) and impermeable (solid) root barriers in a multi-site field experiment, we aimed to study the impact of root-root interactions on nutrient accumulation, soil microbial communities, crop yield, and economic returns in a peanut/cotton IC system under non-saline, secondary-saline, and coastal saline soil conditions of China. Results The results indicate that IC decreased the peanut pods yield by 14.00, 10.01, and 16.52% while increased the seed cotton yield by 61.99, 66.00, and 58.51%, respectively in three experimental positions, and consequently enhanced the economic returns by compared with monoculture of peanut (MP) and cotton (MC). The higher accumulations of nutrients such as nitrogen (N), phosphorus (P), and potassium (K) were also observed in IC not only in the soil but also in vegetative tissues and reproductive organs of peanut. Bacterial community structure analysis under normal growth conditions reveals that IC dramatically altered the soil bacterial abundance composition in both peanut and cotton strips of the top soil whereas the bacterial diversity was barely affected compared with MP and MC. At blossom-needling stage, the metabolic functional features of the bacterial communities such as fatty acid biosynthesis, lipoic acid metabolism, peptidoglycan biosynthesis, and biosynthesis of ansamycins were significantly enriched in MP compared with other treatments. Conversely, these metabolic functional features were dramatically depleted in MP while significantly enriched in IC at podding stage. Permeable root barrier treatments (NC-P and NC-C) counteracted the benefits of IC and the side effects were more pronounced in impermeable treatments (SC-P and SC-C). Conclusion Peanut/cotton intercropping increases crop yield as well as economic returns under non-saline, secondary-saline, and coastal saline soil conditions probably by modulating the soil bacterial abundance composition and accelerating plant nutrients accumulation.

Green leaf volatiles play vital roles in plant biotic stress; however, their functions in plant responses to abiotic stress have not been determined. The aim of this study was to investigate the possible role of (Z)-3-hexeny-1-yl acetate (Z-3-HAC), a kind of green leaf volatile, in alleviating the salinity stress of peanut ( ) seedlings and the underlying physiological mechanisms governing this effect. One salt-sensitive and one salt-tolerant peanut genotype were primed with 200 μM Z-3-HAC at the 4-week-old stage before they were exposed to salinity stress. Physiological measurements showed that the primed seedlings possessed higher relative water content, net photosynthetic rate, maximal photochemical efficiency of photosystem II, activities of the antioxidant enzymes, and osmolyte accumulation under salinity conditions. Furthermore, the reactive oxygen species, electrolyte leakage, and malondialdehyde content in the third fully expanded leaves were significantly lower than in nonprimed plants. Additionally, we found that application of Z-3-HAC increased the total length, surface area, and volume of the peanut roots under salinity stress. These results indicated that the green leaf volatile Z-3-HAC protects peanut seedlings against damage from salinity stress through priming for modifications of photosynthetic apparatus, antioxidant systems, osmoregulation, and root morphology.

Background Open repair of thoracoabdominal aortic aneurysm (TAAA) was characterized by significant risk of postoperative mortality and morbidity. The aim of this study was to determine the perioperative predictors of early and long-term mortality in patients undergoing open repair of TAAA. Besides, the postoperative outcomes in patients with open repair of TAAA were described. Methods This is a single-center retrospective study, and 146 patients with open repair of TAAA from January 4, 2011, to November 22, 2018 was involved. Categorical variables were analyzed by the Chi-square test or Fisher’s exact test, and continuous variables were analyzed by the independent sample t-test and the WilCoxon rank-sum test. Multivariate Logistic regression and Cox regression were applied to identify the predictors of 30-day and long-term mortality, respectively. The Kaplan Meier curves were used to illustrate survival with the Log-rank test. Results The 30-day mortality was 9.59% ( n  = 14). Older than 50 years, the intraoperative volume of red blood cell (RBC) and epinephrine use were independently associated with postoperative 30-day mortality in open repair of TAAA. Long-term mortality was 17.12% ( n  = 25) (median of 3.5 years (IQR = 2–5 years) of follow-up). Prior open thoracoabdominal aortic aneurysm (TAAA) repair, aortic cross-clamping (ACC) time, intraoperative volume of RBC and use of epinephrine were independently correlated with long-term mortality. Conclusions Identifying perioperative risk factors of early and long-term mortaliy is crucial for surgeons. Intraoperative volume of RBC and use of epinephrine were predictors of both early and long-term mortality. In addition, patients of advanced age, prior open repair of TAAA and prolonged ACC time should be paid more attention.

Arbuscular mycorrhizal fungi (AMF) species are essential for sustainable agriculture of legume crops; however, the AMF response in legume crops, especially from the perspective of physiological and molecular mechanisms under salinity conditions, is largely unknown. In this study, peanut (Arachis hypogaea L.) seeds were inoculated with AMF to investigate its salinity stress alleviation effects using the pot‐grown and 2‐year field experiments. Seeds from two peanut cultivars (HY22 and HY25) were inoculated with AMF Rhizophagus irregularis SA and Funneliformis mosseae BEG95 (1:1), and the physiological and transcriptional responses were compared between the AMF‐inoculated and non‐inoculated peanut plants. Under the salinity stress, compared with the control samples, the AMF‐inoculated plants showed higher net photosynthetic rate, leaf relative water content (RWC), plant height, osmolyte accumulation, but lower leaf relative electrolyte conductivity (REC). Also, the malondialdehyde (MDA) concentration was reduced while the antioxidant enzymes such as superoxide dismutase (SOD), guaiacol peroxidase (G‐POD), catalase (CAT), and ascorbate peroxidase (APX) were activated. Furthermore, transcriptome data revealed that AMF potentially alleviates salt stress by regulating redox processes, cell wall assembly, cell growth, and other similar processes. In the 2‐year field experiment, AMF‐inoculated peanut seeds of HY22 and HY25 were cultivated in both non‐saline and saline soils. Under salinity conditions, AMF inoculation induced the total protein concentration by 11.11 and 2.32% in kernels and further increased the peanut pod yield by 21.83 and 21.89% in HY22 and HY25, respectively. In non‐saline soil too, AMF increased the peanut pod yield by 11.47 and 23.98% in HY22 and HY25, respectively. Taken together, these results strongly demonstrate that the combination of AMF Rhizophagus irregularis SA and Funneliformis mosseae BEG95 (1:1) can alleviate salinity stress in peanuts by improving plant growth, photosystem, and antioxidant system. Additionally, it increases the peanut pod yield under both normal and salinity conditions. Combined with physiological and transcriptome analysis, the present study was carried out using both pot‐grown and 2‐year field experiments with two peanut cultivars. We demonstrate that seed priming with AMF Rhizophagus irregularis SA and Funneliformis mosseae BEG95 (1:1) could alleviate salinity stress in peanut by improving plant growth, regulating the photosystem, strengthening the antioxidant system, and further increasing the pod yield.

Postoperative thrombocytopenia is common in cardiac surgery with cardiopulmonary bypass, and its risk factors are unclear. This retrospective study enrolled 3,175 adult patients undergoing valve surgeries with cardiopulmonary bypass from January 1, 2017 to December 30, 2018 in our institute. Postoperative thrombocytopenia was defined as the first postoperative platelet count below the 10th quantile in all the enrolled patients. Outcomes between patients with and without postoperative thrombocytopenia were compared. The primary outcome was in-hospital mortality. Risk factors of postoperative thrombocytopenia were assessed by logistic regression analysis. The 10th quantile of all enrolled patients (75×109/L) was defined as the threshold for postoperative thrombocytopenia. In-hospital mortality was comparable between thrombocytopenia and non-thrombocytopenia groups (0.9% vs. 0.6%, P=0.434). Patients in the thrombocytopenia group had higher rate of postoperative blood transfusion (5.9% vs. 3.2%, P=0.014), more chest drainage volume (735 [550-1080] vs. 560 [430-730] ml, P<0.001), and higher incidence of acute kidney injury (12.3% vs. 4.2%, P<0.001). Age > 60 years (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.345-3.765, P=0.002], preoperative thrombocytopenia (OR 18.671, 95% CI 13.649-25.542, P<0.001), and cardiopulmonary bypass time (OR 1.088, 95% CI 1.059-1.117, P<0.001) were positively independently associated with postoperative thrombocytopenia. Body surface area (BSA) (OR 0.247, 95% CI 0.114-0.538, P<0.001) and isolated mitral valve surgery (OR 0.475, 95% CI 0.294-0.77) were negatively independently associated with postoperative thrombocytopenia. Positive predictors for thrombocytopenia after valve surgery included age > 60 years, small BSA, preoperative thrombocytopenia, and cardiopulmonary bypass time. BSA and isolated mitral valve surgery were negative predictors.

Frailty is associated with poor outcomes in elderly sepsis patients. This study investigated the relationship between Frailty Index-laboratory (FI-lab) and lymphocyte patterns in predicting 28-day mortality among elderly sepsis patients. We conducted a multicenter prospective observational study in four tertiary hospitals in Beijing, China. FI-lab was calculated using 24 laboratory parameters. Peripheral blood lymphocyte subsets were measured at ICU admission. Lymphocyte count trajectories were classified into four phenotypes based on patterns during the first 72 hours. The primary outcome was 28-day mortality. Among 1,197 patients (mean age 74.6 ± 7.4 years), those with high FI-lab risk showed higher mortality (22.2%) than intermediate (12.0%) and low-risk groups (6.1%). Age-stratified analysis demonstrated consistent FI-lab prognostic value in both 65-79 years (OR 2.18) and ≥80 years (OR 2.47) groups. All lymphocyte subset counts were lower in non-survivors, particularly natural killer cells. In multivariable analysis, high FI-lab risk (OR 2.31), APACHE-II scores (OR 1.08), heart rate (OR 1.01), NK cell count (OR 0.994), and pulmonary infection (OR 1.96) independently predicted 28-day mortality. A combined model incorporating these variables showed superior discriminative ability (AUC=0.788) with excellent internal validation (optimism-corrected AUC=0.775). FI-lab independently predicts mortality in elderly sepsis patients and correlates with lymphocyte abnormalities. When comprehensive immune assessment is unavailable, lymphocyte trajectory patterns offer a practical approach for risk stratification.

Background This cohort study aims to retrospectively investigate the incidence of severe systemic inflammatory response syndrome (sSIRS) in patients following total aortic arch replacement (TAR) under deep hypothermic circulatory arrest (DHCA) with selective cerebral perfusion and its effect on clinical outcomes. Methods All patients who underwent TAR with DHCA were consecutively enrolled from January 2013 until December 2015 at our institute. sSIRS was diagnosed between 12 and 48 h postoperatively if patients met all four criteria of the SIRS definition. Results Of the 522 patients undergoing TAR with DHCA, 31.4% developed sSIRS. Patients aged under 60 yr were characterized by a higher prevalence of sSIRS (OR = 2.93; 95% CI 2.01–4.28; P  <0.001). Higher baseline serum creatinine (OR = 1.61; 95% CI 1.18–2.20; P  = 0.003), concomitant coronary disease (OR = 2.00; 95% CI 1.15–3.48; P  = 0.015) and extended cardiopulmonary time (OR = 1.63; 95% CI 1.23–2.18; P  = 0.001) independently contributed to a greater likelihood of postoperative sSIRS onset, while the preferred administration of ulinastatin (OR = 0.69; 95% CI 0.51–0.93; P  = 0.015) and dexmedetomidine (OR = 0.36; 95% CI 0.23–0.56; P  < 0.001) attenuated it. Patients with sSIRS had a greater risk of developing postoperative major adverse complications compared with the no sSIRS group [56.7%(93/164) vs 26.8% (96/358), P  < 0.001]. sSIRS was found to be a significant risk factor for major adverse complications (OR, 4.52; 95% CI, 3.40–6.01; P  < 0.001). A significant difference was revealed in in-hospital death following TAR between the sSIRS group and the no-sSIRS group [4.88% (8/164) vs 1.12% (4/358), P  = 0.019]. The Kaplan-Meier curve indicated that the time to discharge from the intensive care unit was significantly prolonged in the sSIRS group compared with patients without it (log-rank p  < 0.001). Conclusions sSIRS occurs commonly in patients following TAR with DHCA. There is an inverse association between age and sSIRS onset, whereby age over 60 yr can lower the risk of it. sSIRS development can increase the likelihood of major postoperative major adverse events.

Chronic postoperative pain (CPSP) after cardiac surgery can cause severe health problems. As demonstrated in noncardiac surgeries, preoperative chronic pain can potentially lead to CPSP. However, the association between preoperative chronic pain and CPSP over follow-up in cardiac surgical settings in the context of sex differences is still lacking. This observational study aims to explore the role and sex differences of preoperative chronic pain in the occurrence and development of long-term CPSP and CPSP-related complications after cardiac surgery. This observational study enrolled 495 patients (35.3% women) who underwent cardiac surgery via median sternotomy in March 2019. Validated questionnaires were delivered to assess preoperative chronic pain and moderate to severe CPSP at 3 and 24 months following surgical procedures. The secondary outcomes included the occurrence of moderate to severe chronic pruritus, sleep disturbance, and daily activities interference at follow-up. Multivariable logistic regression was employed. Of 495 patients analyzed, the incidences of preoperative chronic pain (29.7% versus 20.6%) and moderate to severe CPSP (14.8% versus 8.1%) were both higher in females than males. Female sex (P = 0.048) and preoperative chronic pain (P = 0.008) were identified as significant risk factors for CPSP occurrence. However, preoperative chronic pain contributed significantly to CPSP (P = 0.008), sleep disturbance (P =0.047), and daily activities interference (P =0.019) in females, but not in males. The 2-year prevalence of moderate to severe CPSP after cardiac surgery was 10.5%. Compared to males, females are more susceptible to CPSP and pain-related outcomes in the long term. In addition, preoperative chronic pain was associated with a higher risk of CPSP in females but not in males.

Background In on-pump cardiac surgery, the albumin priming strategy could maintain colloid osmotic pressure better than crystalloid solutions and reduce excessive perioperative fluid balance. However, a high-quality meta-analysis is required to compare the safety of these approaches in perioperative red blood cell (RBC) transfusions. Owing to limited direct evidence, we conducted a network meta-analysis (NMA) to increase the pool of studies and provide indirect evidence. Methods The pre-defined primary outcomes were intraoperative and the first 24 h postoperative RBC transfusion volume in units. The pre-defined secondary outcome was postoperative blood loss (the first 24 h). We reviewed all randomized controlled trials comparing albumin, crystalloid, and artificial colloid priming strategies. Studies that only displayed pre-defined outcomes could be included. A pairwise meta-analysis was performed on studies that directly compared the pre-defined outcomes between albumin and crystalloids. Additionally, a random-effects network meta-analysis (NMA) model was employed to generate indirect evidence for the pre-defined outcomes between albumin and crystalloids. Results The literature search identified 830 studies,10 of which were included in the final analysis. Direct meta-analysis indicated that crystalloid priming significantly decreased total perioperative RBC transfusions (MD: -0.68U; 95%CI: -1.26, -0.09U; P  = 0.02) and intraoperative RBC transfusions (MD: -0.20U; 95%CI: -0.39, -0.01U; P  = 0.03) compared to albumin. Postoperative RBC transfusions showed a decreasing trend in the crystalloid group; however, the difference was not statistically significant. (MD: -0.16U; 95%CI: -0.45, 0.14U; P  = 0.30). After including indirect evidence, the NMA results continued to demonstrate a higher RBC receiving with the albumin priming strategy compared to crystalloids, although the differences did not reach statistical significance. For postoperative blood loss, direct evidence showed no significant differences between albumin and crystalloid priming strategies. However, NMA evidence displayed that albumin exist higher probability of reducing postoperative blood loss than crystalloid. Conclusion Both direct and NMA evidence indicated that the albumin priming strategy resulted in more perioperative RBC transfusions than crystalloids. Considering the additional blood management burden, the application of an albumin-priming strategy in on-pump cardiac surgery still needs more consideration.