Chemokine CXC motif ligand 16 (CXCL16) is a multifaceted chemokine that has been shown to participate in a variety of inflammatory diseases. The role of CXCL16 in the immunopathology of sepsis remains unidentified. In this study, human patients with sepsis and healthy controls were used to obtain blood for in vitro studies, and female C57BL/6J mice were taken for in vivo studies. The effects of recombinant CXCL16 protein or anti-CXCL16 monoclonal antibody on sepsis were evaluated in a murine model of cecal ligation and puncture (CLP)–induced polymicrobial sepsis. On admission, human patients with sepsis had significantly higher soluble levels of serum CXCL16 than healthy controls. Soluble CXCL16 remained significantly elevated in septic patients from day 0 to 7. Admission levels of soluble CXCL16 were positively correlated disease severity and the serum levels of other inflammatory cytokines and chemokines. Furthermore, nonsurvivors displayed significantly higher admission levels of soluble CXCL16 compared with survivors of septic patients. Soluble CXCL16 levels revealed significant prognostic value for 28-day mortality, and CXCL16 was found to be an independent predictor of 28-day mortality in septic patients. In CLP-induced nonsevere sepsis, administration with recombinant CXCL16 increased mortality and tissue injury. Conversely, neutralizing CXCL16 by anti-CXCL16 monoclonal antibody decreased mortality and tissue injury in CLP-induced severe sepsis. However, CXCL16 did not affect the ability of these mice to clear bacteria in CLP. Taken together, CXCL16 could be linked to sepsis not only as a new marker of prognosis, but also as a potential target for therapeutic intervention.

36-year-old man with past medical history of liver cirrhosis presented to the ED during COVID-19 pandemic peak with a history of shortness of breath on minimal exertion, mild cough and fever. Findings on physical examination included hypoxic, tachypnoea, ascites, pedal edema and digital clubbing. No abnormal sounds were heard on lung and heart auscultation. Due to the high suspicion of COVID-19, tests were performed. Thoracic CT scan demonstrated neither ground glass opacities nor consolidation. SARS-CoV-2 testing was negative. ABG showed a PaO2 of 51 mm Hg with an A-a gradient of 68 mm Hg. A targeted history revealed platypnoea-orthodeoxia syndrome. Contrast echocardiography with saline was consistent with a diagnosis of hepatopulmonary syndrome. Patient was discharged with long-term oxygen. Currently, the patient is on the waiting list for a liver transplant.

Studies had confirmed that the abnormal proliferation and activation of FLS play a key role in the process of arthropathy. Inhibiting the abnormal proliferation and activation of FLS may be an effective method to control the development of RA. Many studies showed that EBP50 was a powerful factor in inhibiting the abnormal tumor cell proliferation and activation, but the expression characteristics and function of EBP50 in FLS had not yet been reported. In this study we showed that overexpression of EBP50 in CIA-FLS can inhibit the proliferation, which had no effect on the autophagy, and promoted the cell apoptosis by activating caspase-3. At the same time, relative results revealed that EBP50 overexpression markedly down-regulated the expression of MMP-9, but had no effect on MMP-2, E-cadherin and β-catenin, suggesting that one of the mechanisms for EBP50-regulated aggressive behavior of FLS is reducing MMP-9 production.

Introduction Ventricular arrhythmias (VAs) are a major cause of morbidity and mortality in patients with heart disease. Recent studies evaluated the effect of renal denervation (RDN) on the occurrence of VAs. We conducted a systematic review and meta-analysis to determine the efficacy and safety of this procedure. Methods and results A systematic search of the literature was performed to identify studies that evaluated the use of RDN for the management of VAs. Primary outcomes were reduction in the number of VAs and implantable cardioverter-defibrillator (ICD) therapies. Secondary outcomes were changes in blood pressure and renal function. Ten studies (152 patients) were included in the meta-analysis. RDN was associated with a reduction in the number of VAs, ATP (antitachycardia pacing), ICD shocks and overall ICD therapies of 3.53events/patient/month (95%CI=-5.48 to -1.57), 2.86events/patient/month (95%CI=-4.09 to -1.63), 2.04events/patient/month (95%CI=-2.12 to -1.97), and 2.68events/patient/month (95%CI=-3.58 to -1.78), respectively. Periprocedural adverse events occurred in 1.23% of patients and no significant changes were seen in blood pressure or renal function. Conclusions In patients with refractory VAs, RDN was associated with a reduction in the number of VAs and ICD therapies, and was shown to be a safe procedure. KEYWORDS: Renal denervation, ventricular arrhythmias, implantable cardioverter-defibrillator, antitachycardia pacing, ICD shocks.

Background: Patients with a history of mitral valve (MV) surgery can present with unique challenges during left atrial (LA) ablation due to abnormal atrial substrate and descriptions of ablation in this cohort is limited. We aim to evaluate LA ablation characteristics and outcomes in patients with a history of mitral valve surgery. Objective: We hypothesize that the success rate for ablations of LA arrhythmias in patients with prior MV surgery will be inferior to patients without prior MV surgery due to left atriopathy, presence of a MV prosthesis, and a higher burden of pre-ablation LA scar. Methods: In this single center, retrospective study, we evaluated patients who had a history of MV surgery and underwent LA ablation between January 2013 and May 2019. We analyzed baseline patient characteristics, type of MV disease and surgery, available pre-ablation voltage maps, and ablation outcomes. Results: We present a series of 20 patients who underwent a total of 30 LA ablation procedures. All 20 patients underwent pulmonary vein isolation and 11 patients also underwent ablation for LA macro-reentrant flutters. The majority of the patients (55%) were without recurrent documented arrhythmias at a mean follow-up of 22 months post-ablation. Two patients had acutely unsuccessful ablation. Conclusions: Although LA ablation in patients with previous MV surgery can be challenging due to abnormal atrial substrate and the presence of the valve prosthesis, the majority of patients in our cohort experienced atrial arrhythmia free survival at a mean follow-up of 22 months.

Changes in land use/land cover (LULC) may result in water shortages, flood risk and soil erosion, contributing to the degradation of living conditions. Recognition of the impacts of LULC changes on water resources is a crucial aspect of watershed management. Thus, this paper aims to determine how LULC change affects runoff and other hydrological components including: groundwater, water yield, procolation and evaportranspiration in Upper Prek Thnot watershed from 2006 to 2018 by using SWAT modelling. The result indicates that LULC of Upper Prek Thnot watershed experienced such significant changes during these 13 years. Conversion of forest area into agricultural land was the main modification in the study area, which accounts for 39%. This followed by an increase of rubber plantation, built-up area, barren land and water bodies and a decrease of the wood shrub. These changes resulted in a corresponding increase in annual average surface runoff (36%) and water yield (2%), and a decrease of groundwater (24%), percolation (8%) and evapotranspiration (1%). In particular, if the forest area is converted to agricultural land, especially if the conversion takes place in large numbers, the hydrological elements will be significantly affected. Consequently, due to a noticeable alteration of LULC in the study area, a sound strategic management plan should be applied considerably to ensure the sustainability of ecosystem services.

Human activity is increasingly and persistently disturbing nature and wild animals. Affected wildlife adopts multiple strategies to deal with different human influences. To explore the effect of human activity on habitat utilization of the Himalayan marmot (Marmota himalayana), habitat utilization patterns of three neighboring marmot populations in habitats affected differently by human activities were recorded and compared. We found that: (1) Distance between reproductive burrows becomes shorter under the influence of human activity, and further, the more disturbance a population suffers, the more burrows were dug as temporary shelter to reduce the distance to those shelters when threatened. More burrows that are closer in the disturbed habitats improve ability to escape from threats. (2) Burrow site selection is determined by the availability of mounds in the habitat. Breeding pairs selectively build burrows on mounds to reproduce, potentially to improve surveillance and the drainage of their burrows. Human activities generally drive breeding pairs away from the road to build their reproductive burrows, likely to reduce disturbance from vehicles. However, even heavy human activity exerts no pressure on the distance of reproductive burrows from the road or the mound volume of the high disturbance population, potentially because mounds are the best burrowing site in the habitat. Marmots deal with nonlethal human disturbance by digging more burrows in the habitat to flee more effectively and building reproductive burrows on mounds to gain better vigilance and drainage efficiency.

In this paper, we have defined the free boundary formulation for two extended Blasius problems. These problems are of interest in boundary layer theory and are deduced from the governing partial differential equations by using appropriate similarity variables. The computed results, for the so-called missing initial condition, are favourably compared with recent results available in the literature.

This work focuses on the Riemann problem of Euler equations with global constant initial conditions and a single-point heating source, which comes from the physical problem of heating one-dimensional inviscid compressible constant flow. In order to deal with the source of Dirac delta-function, we propose an analytical frame of double classic Riemann problems(CRPs) coupling, which treats the fluids on both sides of the heating point as two separate Riemann problems and then couples them. Three structures of the exact Riemann solution are found, which is consistent with the results of numerical methods. Furthermore, we establish the uniqueness of the Riemann solution with some restrictions on the Mach number of the initial condition.

The flow regime is of vital importance for the sustainable development of both human society and aquatic biota. Alterations in natural streamflow will modify the stability and biophysical distribution of river conditions, causing a series of adverse ecological and economic consequences. Climate change has been proven to pose potential threats to ecosystems; however, few studies have been conducted to quantify the variations between the flow regime of a future period and pristine natural flow specifically. This study investigates the future impacts induced by the changing climate in the Jinsha River Basin, which is known as the “Asian Water Tower” due to its rich hydroelectric energy resources. The SWAT model is used and calibrated to predict future streamflow. Seven GCMs from NASA NEX-GDDP with one ensemble average under two RCPs (RCP4.5 and RCP8.5) are used for both the NFP (2040s) and the FFP (2080s). The Indicators of Hydrologic Alteration (IHA) software and the river regime index (RRI) are used to assess the potential flow alterations of the Jinsha River. The results show that Pr, Tmax and Tmin all denote increasing trends, with the temperature trends being more obvious. For interannual alterations in flow regimes, most IHA values show moderate and high changes in all predicted conditions. In regard to the intra-annual changes, the results of the RRI show that river flow tends to be more concentrated in wet seasons than in cold seasons and denote evident seasonality and transience with advanced overall peaks of the river system. These findings together indicate that the flow patterns may have noticeable changes corresponding to the natural river regime.

We present three cases of impetigo and one case of bullous pemphigoid neonatorum that benefited from the homeopathic remedy Antimonium crudum, which has a wide spectrum of dermatological applications when prescribed according to symptom similarity. Further larger clinical studies are necessary to establish its role in pediatric dermatology.

Although isolated proximal interphalangeal (PIP) and distal interphalangeal (DIP) dislocations are commonly seen in the emergency room, simultaneous dislocation is a rare occurrence.

Background and Purpose: To investigate the treatment and mechanism of lanthanum hydroxide on hyperphosphate-induced vascular calcification in chronic renal failure. Experimental Approach: Develop a rat model of CKD hyperphosphatemia. Rats were randomly allocated to the model, lanthanum hydroxide, lanthanum carbonate, Calcium carbonate groups. Determination of serum biochemical indicators and the determination of pathological analysis of kidney tissue, Von Kossa staining and CT scan on the aortic vessels. The proteomic analysis of aortic tissue in Vivo. A calcified VSMCs model was established. The calcium content and ALP activity were measured. RT-PCR measures the mRNA expression level of SM22α, Runx2, BMP-2 and TRAF6. Western Blot measures the protein expression level of SM22α, Runx2, BMP-2, TRAF6 and NF-κB. Key Results: Through the detection of serum biochemical indicators and pathological analysis of kidney tissue, it can be summaryed that lanthanum hydroxide has the effect of delaying the progression of renal failure and protecting renal function. We found that the administration of lanthanum hydroxide delayed the development of vascular calcification induced by hyperphosphatemia in CKD. It can be concluded that lanthanum hydroxide may affect vascular calcification through the NF-κB pathway. In cultured VSMCs, treatment with Lanthanum chloride (LaCl3) blunted phosphate-induced calcification, osteo-/chondrogenic signaling, and NF-κB activation. Lanthanum hydroxide significantly reduces the expression of Runx2, BMP-2, TRAF6 and NF-κB. Conclusion and Implications: Lanthanum hydroxide has a protective effect on the kidneys, and can delay the development of vascular calcification by reducing serum phosphorus concentration. KEYWORDS: Lanthanum hydroxide, vascular calcification, chronic renal failure, hyperphosphatemia, pharmacological effect, mechanism

With the post-combustion CO2 capture process running for a long time, the degradation of aqueous amine-based is inevitable. Unfortunately, a simple and effective way to increase the economic feasibility of CO2 capture process after accumulated degradation products remains absent, and little attention has been paid to the real effect of degradation products on the CO2 capture performance in aqueous amine solutions. We propose a simple experimental and computational method that can evaluate the performance and regeneration energy of solvent after change. The method can determine key degradation products that affecting the performance of solvent, so as to guide the selective removal of degradation products and improve solvent performance.

The study proposed an isotopes-tagging method for investigation of reactions under the atmosphere of product gas. To illustrate this method, the calcination kinetics of calcium carbonate Ca13CO3 in CO2 atmospheres were investigated by monitoring 13CO2 produced using a micro fluidized bed reaction analyzer (MFBRA). The results demonstrated that the presence of CO2 in the reaction atmosphere increases the apparent activation energy. The increase in the apparent activation energy is, however, significantly overestimated by the TGA because of the excessive suppression by stagnated product gas inside the sample crucible. Comparatively, the results from the MFBRA are due primarily to the thermal equilibrium limitation, because the gas diffusion in the MFBRA is essentially eliminated. It is thus concluded that the MFBRA is quite capable of acquiring the real kinetics of reactions in such inhibitory atmospheres. atmosphere.

Solar CO2 reduction via photocatalysis enables sustainable carbon-cycle utilization, yet a challenge to date because of the relatively low conversion efficiency. Herein, we demonstrate that this photocatalytic process could be significantly improved by coupling an alternating magnetic field (AMF). Using NiO/TiO2 as a model photocatalyst, CO2 could be converted into CH4 in the presence of H2O vapor. Integrating with AMF, the conversion of CO2 to CH4 increased by 213%. The enhanced photocatalysis process by AMF coupling can not only increase the carrier density by inhibiting the combination of photogenerated electron-hole pairs, but also improve the oxidation ability of the catalyst under simulated sunlight, and promote the conversion of H2O to O2. Our investigation also elucidates that the Ni species act as the adsorption/activation sites of CO2 to promote the reduction of CO2 to CH4. This work opens a new research door in solar CO2 reduction by integrating AMF into photocatalysis.

Incidentally diagnosed, asymptomatic, paranasal fungus ball might occasionally undergo spontaneous healing. Accurate preoperative workup may avoid unnecessary surgical or anesthesiological procedures.

We report wound management using a vacuum-assisted closure (VAC) system for the cannula sites of long-term extracorporeal biventricular assist devices (BiVADs). A 23-year old Chinese female patient with a diagnosis of giant cell myocarditis needed extracorporeal BiVADs for more than 9 months. When the cannula sites appeared necrotic 3 months after BiVADs placement, she underwent negative pressure wound therapy prophylactically for four cannula sites, using a VAC system for 3 months, followed by no infections. Such prophylactic VAC therapy may be useful to avoid cannula site infections, which is still a fatal adverse event causing sepsis, especially in patients with extracorporeal BiVADs.

Background: There is insufficient evidence regarding the comparison of Rapid Deployment aortic valve replacement(RDAVR) to TAVR in intermediate-risk patients with severe symptomatic aortic stenosis(AS) Aims: We compare the 2-years outcomes between RDAVR with INTUITY and TAVR with SAPIEN 3 in intermediate-risk patients with AS. Methods: Inclusion criteria: severe AS implanted with RDAVR or TAVR; EUROSCORE II ≥ 4% and clinical evaluation by Heart Team. Regression adjustment for the propensity score was used to compare RDAVR with TAVR(1:1). Primary endpoint: composite criterion of death, disabling stroke or rehospitalization. Secondary endpoints: occurrence of major bleeding post-operative complications, paravalvular regurgitation (PVR)≥2 and patient-prosthesis mismatch(PPM) at 1 month and pacemaker implantation at 2 years. Results: A total of 152 patients were included from 2012 to 2018: 48 in the RDAVR group and 104 in the TAVR group. Mean age was 82.7±6, 51.3% were female, mean Euroscore II was 6.03±1.6% and mean baseline LVEF was 56±13%,mean indexed iEOA was 0.41±0.1cm/m2, mean gradient was 51.7±14.7mmHg. Patients with RDAVR were younger(79.5±6vs82.6±6,p=0.01), at higher risk (EUROSCORE2 6,61±1,8%vs5,63±1,5%, p=0.005), combined surgery was performed in 28 patients(58.3%). Twenty-two patients(45.99%) met the primary outcome in the RDAVR group and 32 patients(66.67%) in the TAVR group. By 1:1propensity score matching analysis, there was a significant difference between both groups in favor of RDAVR(HR=0.58[95%CI:0.34;1.00],p=0.04). No difference were observed in PPM occurrence(0.83;[0.35-1.94];p=0.67),major bleeding events(1.33;[0.47-3.93];p=0.59),PVR≥2(0.33[0-6.28],p=0.46), and pacemaker implantation (0.84[0.25-2.84],p=0.77).Conclusion: RDAVR is associated with better 2-years outcomes than TAVR in intermediate-risk patients with severe symptomatic AS.

Tushar W. et al. wrote a review paper on negawatt trading using blockchain technology. In their paper, four consensus algorithms in blockchain are introduced. They should address known security issues of the existing consensus algorithms in blockchain for robust system. In order to use the blockchain technology, detection and protection mechanisms must be embedded in blockchain applications for protecting vulnerabilities of known consensus algorithms.

Objective to evaluate the efficiency and safety of a novel technique to keep benefits of laparoscopic management in women with large ovarian benign cysts without affection of the ovarian reserve Design: An interventional study Setting: Kasr Alainy medical school, Cairo university hospital Population: 112 women with large benign ovarian cyst candidate for ovarian cystectomy. Methods: The technique started with laparoscopy followed by guided cyst aspiration followed by exteriorization of the ovary through minilaprotomy and completion of cystectomy through microsurgical technique. Main Outcome Measures: The primary outcome was ipsilateral recurrence of the cyst. Other outcomes included ovarian reserve assessment and postoperative pain. Results: The number of women with recurrence in the ipsilateral ovary after 12, 18 and 24 months were 5 (4.5%),16 (14.3%),20 (17.85%) respectively. Assessment of ovarian reserve revealed a significant decrease in the level of serum AMH (2.82±0.44 vs. 2.50±0.42) and a significant increase in AFC (3.5±1.7 vs. 4.9±1.3) after our novel technique in the surgical treatment of ovarian cysts (P-value <0.001). The operative time was 50±7 and 62±7 minutes in unilateral and bilateral cysts respectively. Conclusions: Laparoscopic guided minilaparotomy is a safe and effective technique for the management of large benign ovarian cysts with minimal recurrence rate, ovarian reserve affection, and adhesions.

In this work, a 0.9-2.4 GHz, 25 Watt output power, radio frequency (RF) power amplifier based on Class-E switchmode topology has been analyzed. A load-pull simulations method is used to optimize the power performance in the operating band. To design input and output matching networks an optimized low pass filter network was used. Simulated results of the power amplifier (PA) demonstrate wideband behavior which covers a 0.9 GHz to 2.4 GHz band with an efficiency of 32-78%, and an output power of 25 W (44 dBm), and an average gain of 20 dB. The designed PA provides attractive features associated with a wider band, high gain, and efficiency, which makes it a proper candidate for the mobile transmitter and cellular infrastructure applications.

THE DISTRIBUTION OF CHF WITHIN SOUTHERN WEST VIRGINIAFrank H Annie, PhD1; Muhammad Yasin, MD2, Aravinda Nanjundappa, MD2;1. CAMC Health Education and Research Institute3200 MacCorkle Ave. SE, Charleston, WV 25304.2. CAMC Vascular Center of Excellence, Charleston Area Medical Center.3200 MacCorkle Ave SE, Charleston, WV 25304Study Locations:Charleston Area Medical Center, 3100 McCorkle Ave SE, Charleston, WV, 25302 and Charleston Area Medical Center Research Institute and Center for Clinical Sciences Research, 3200 McCorkle Ave SE, Charleston, WV, 25302Correspondence:Frank Annie M.A; MPA, PhDResearch ScientistCAMC Health Education and Research Institute3200 MacCorkle Ave. SE,Charleston, WV 25304Phone 304-388-9921Fax: 304-388-9921Email: Frank.H.Annie@camc.orgTotal word count: 593Author Disclosure Block: NoneKey words: Access, CHFRunning Title: The Distribution of CHFTotal Number of Tables and Figures: Figures 1Per the United States (U.S) Census Bureau, rural areas are geographic designations excluding all population, housing, and territory included within an urbanized area or cluster (1). Approximately 20% of the U.S. population lives in these rural designations. The literature reports that rural populations face more barriers associated with access and quality of care compared with urban groups. Cultural attitudes, access difficulty, and absence of services are a few of several contributing factors (2).However, there is little evidence that specifically addresses the needs of rural patients suffering from congestive heart failure (CHF). A number of factors can cause CHF, including coronary artery disease, valvular disease, and systemic hypertension. Poor health literacy, roughly defined as the degree of difficulty an individual has while attempting to obtain, process, and understand basic health information and services, is associated with earlier heart failure hospitalization and all-cause mortality in rural patients with CHF in the U.S. (3). Elderly U.S. veterans who reside in rural designations are more vulnerable to delayed CHF treatment due to lack of transportation (4).Whether patients with CHF who reside in rural designations struggle to comprehend information due to culturally-based reservations or lack resources available to their urban counterparts, it is important to identify those who require improved access so that their perspective and needs can be better assessed. Appalachia is a distinct, non-homogenous region within the U.S. that is comprised of 13 states, in which 42% reside in rural areas or clusters (5). We conducted a retrospective analysis of CHF cases from 2005-2016 obtained from our Charleston Area Medical Center (CAMC) data warehouse in Charleston, West Virginia. Using a Hot Spot Analysis, we aimed to identify patients with CHF from rural territories and housing who have limited access. After the data were analyzed (n=22,404), patients were identified and examined using Arch 10.8 and geocoded. To investigate any potential spatial relationships, and a Hot Spot Analysis was performed. We controlled for population in order to understand the areas in which CHF had statistical significant hot and cold zones.The results suggest within (Figure 1) that areas in which CHF cases are further from major hospitals in Southern West Virginia appear to have increased cold spots within these zones. These zones are illustrated in bright blue and have a (P = 0.001). These results suggest access and health care resources are still a significant issue within Southern West Virginia, as illustrated in (Figure 1). These at-risk zones are outside the baseline 5 miles radius of the majority of substantial statistical zones. These results also suggest that further access in the form of CHF clinics and other households of access is essential.Figure LegendFigure 1 – Hot Spot Analysis of Congestive heart failure (CHF) (n=22,404)

Effect of VA - ECMO Vs Impella on Survival from Jan 1st 2017 – Aug 3rd 2020Frank H Annie, PhD1; Kayce Boggess1; Aravinda Nanjundappa, MD2;1. CAMC Health Education and Research Institute3200 MacCorkle Ave. SE, Charleston, WV 25304.2. CAMC Vascular Center of Excellence, Charleston Area Medical Center.3200 MacCorkle Ave SE, Charleston, WV 25304Study Locations:Charleston Area Medical Center, 3100 McCorkle Ave SE, Charleston, WV, 25302 and Charleston Area Medical Center Research Institute and Center for Clinical Sciences Research, 3200 McCorkle Ave SE, Charleston, WV, 25302Correspondence:Frank Annie M.A; MPA, PhDResearch ScientistCAMC Health Education and Research Institute3200 MacCorkle Ave. SE,Charleston, WV 25304Phone 304-388-9921Fax: 304-388-9921Email: Frank.H.Annie@camc.orgTotal word count: 451Author Disclosure Block: NoneKey words: ECMO, Impella, MIRunning Title: Effect of VA - ECMO Vs Impella on SurvivalTotal Number of Tables and Figures: Figures 1Extracorporeal membrane oxygenation (ECMO) is used as a heart-lung bypass to oxygenate and pump blood outside the body. VA – ECMO supports both heart and lungs. Impella catheter is a pump that is used to increase blood flow from the inlet area which pulls from the left ventricle through the aorta of the heart. As both of these devices are support devices their effectiveness in terms of mortality as a result of individuals having a myocardial infarction then that required the implantation of either an ECMO and or Impella or their long term survival outcome(1-2).In order to understand long term survival of ECMO vs Impella we queried the TriNetx database (Research Network) which is a network of 38 health care organizations with cases from Jan 1st 2017 – August 3, 2020. We identified VA-ECMO (N=579) and Impella (N=1,377). We followed the cases until follow-up was lost. In order to compare the differences we conducted a Prosperity Score Match with a 1:1 (N= 482/482) match with the covariates (Age, Male, Female, Hypertension, CAD, CHF, Diabetes, CKD, Smoking History, COPD, Stroke History, Liver Disease History, Cardiogenic Shock, Medications, ACE, ARB Warfarin). After the match was complete a measure of association and a Kaplan Meir survival curve was conducted as long with a long-rank test.The unmatched age at event of MI that required the use of VA – ECMO was (56.1± 13.5), Impella (67.1±11.9) (P = <0.01), CAD (70.2% vs 81.3%) (P= <0.01) COPD (13.6% vs 20.4%) (P = 0.04), ACE (26.5% vs 41.4%) (P= < 0.01) Cardiogenic Shock (82.9% vs 54.8%) (P=<0.001). The matched cohort had a difference of mortality of (45.8% vs 25.1%) (P = <0.01). The Kaplan Meir Survival Curve showed that VA-ECMO had a much lower chance of survival compared to Impella with a log-rank test of (P=<0.01) as seen in and a lower survival probability of (0.49/0.72).We found that it appears that VA-ECMO cases even after the PSM was conducted had worse outcome as compared to Impella cases in terms of mortality. Even controlling for literature driven covariates it appears that VA-ECMO as a result of MI have worse outcomes compared to Impella.Figure Legend - ECMO V IMPELLA (Morality)