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1.
Nucleic Acids Res ; 50(19): 10947-10963, 2022 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-36243980

RESUMO

Cellular senescence is a complex multifactorial biological phenomenon that plays essential roles in aging, and aging-related diseases. During this process, the senescent cells undergo gene expression altering and chromatin structure remodeling. However, studies on the epigenetic landscape of senescence using integrated multi-omics approaches are limited. In this research, we performed ATAC-seq, RNA-seq and ChIP-seq on different senescent types to reveal the landscape of senescence and identify the prime regulatory elements. We also obtained 34 key genes and deduced that NAT1, PBX1 and RRM2, which interacted with each other, could be the potential markers of aging and aging-related diseases. In summary, our work provides the landscape to study accessibility dynamics and transcriptional regulations in cellular senescence. The application of this technique in different types of senescence allows us to identify the regulatory elements responsible for the substantial regulation of transcription, providing the insights into molecular mechanisms of senescence.


Assuntos
Senescência Celular , Regulação da Expressão Gênica , Senescência Celular/genética , Montagem e Desmontagem da Cromatina , Sequências Reguladoras de Ácido Nucleico , Cromatina/genética
2.
J Org Chem ; 88(1): 493-503, 2023 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-36550408

RESUMO

Spiroindolizidine oxindoles represent a kind of privileged scaffold in many biologically active natural alkaloids. 2,3-Dihydrobenzofuran derivatives exhibit significant bioactivities in a variety of pharmaceuticals. Herein, we assembled these two privileged fragments into a small molecule via double-dearomative [3 + 2] cycloadditions with pyridinium ylides and 2-nitrobenzofurans. This protocol features remarkable advantages including wide substrate scope, mild condition, high level of diastereoselectivities and yields. Thus, a collection of spiroindolizidine-fused dihydrobenzofurans/indolines were facilely produced efficiently.


Assuntos
Alcaloides , Reação de Cicloadição , Estereoisomerismo , Catálise , Alcaloides/química , Ciclização
3.
Chem Rev ; 121(22): 13936-13995, 2021 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-33938738

RESUMO

This Review focuses on the establishment and development of self-assemblies governed by the supramolecular interactions between cyclic peptides. The Review first describes the type of cyclic peptides able to assemble into tubular structures to form supramolecular cyclic peptide nanotubes. A range of cyclic peptides have been identified to have such properties, including α-peptides, ß-peptides, α,γ-peptides, and peptides based on δ- and ε-amino acids. The Review covers the design and functionalization of these cyclic peptides and expands to a recent advance in the design and application of these materials through their conjugation to polymer chains to generate cyclic peptide-polymer conjugates nanostructures. The Review, then, concentrates on the challenges in characterizing these systems and presents an overview of the various analytical and characterization techniques used to date. This overview concludes with a critical survey of the various applications of the nanomaterials obtained from supramolecular cyclic peptide nanotubes, with a focus on biological and medical applications, ranging from ion channels and membrane insertion to antibacterial materials, anticancer drug delivery, gene delivery, and antiviral applications.


Assuntos
Nanoestruturas , Nanotubos , Nanoestruturas/química , Nanotubos/química , Peptídeos/química , Peptídeos Cíclicos/química , Polímeros/química
4.
Immun Ageing ; 20(1): 74, 2023 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-38098004

RESUMO

BACKGROUND: Alzheimer's disease (AD), which is the most common cause of dementia in elderly individuals, is a progressive neurodegenerative disorder. Neuroinflammation, which is an immune response that is activated by glial cells in the central nervous system, plays an important role in neurodegenerative diseases. Many studies have shown that interleukin-17A (IL-17A) plays an important role in AD, but research on the pathological effects of IL-17A on AD is limited. METHODS: We report the effect of IL-17A on AD progression in APPswe/PS1dE9 (APP/PS1) mice, which are the most widely used AD model mice. The BV2 cell line, which is a microglial cell line derived from C57/BL6 mice, was used to establish a cell model to verify the role of IL-17A in neuroinflammation at the cellular level. The HT22 hippocampal neuronal cell line was used to investigate the relationship between IL-17A and Aß deposition. RESULTS: In this research, we found that IL-17A promotes the progression of AD in the APP/PS1 mouse model. The role of IL-17A in neuroinflammation is related to tumour necrosis factor (TNF)-α. Circulating IL-17A stimulates the secretion of TNF-α by microglia through the Toll-like receptor 4 (TLR4)/nuclear factor (NF)-κB signalling pathway, thus exacerbating neuroinflammation. In addition, intraperitoneal injection of IL-17A antibody (IL17Ab) significantly improved the cognitive function of APP/PS1 mice. CONCLUSIONS: IL-17A increased TNF-α levels in the brain and exacerbated neuroinflammation through the TLR4/NF-κB signalling pathway and microglial activation in APP/PS1 mice. Moreover, IL-17A promoted the progression of AD by enhancing neuroinflammation, inhibiting microglial phagocytosis, and promoting the deposition of ß-amyloid 42 in AD model mice.

5.
Angew Chem Int Ed Engl ; 62(48): e202311224, 2023 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-37840434

RESUMO

Fluorescent materials with high brightness play a crucial role in the advancement of various technologies such as bioimaging, photonics, and OLEDs. While significant efforts are dedicated to designing new organic dyes with improved performance, enhancing the brightness of existing dyes holds equal importance. In this study, we present a simple supramolecular strategy to develop ultrabright cyanine-based fluorescent materials by addressing long-standing challenges associated with cyanine dyes, including undesired cis-trans photoisomerization and aggregation-caused quenching. Supra-cyanines are obtained by incorporating cyanine moieties in a cyclic peptide-based supramolecular scaffold, and exhibit high fluorescence quantum yields (up to 50 %) in both solution and in the solid state. These findings offer a versatile approach for constructing highly emissive cyanine-based supramolecular materials.

6.
Angew Chem Int Ed Engl ; 62(50): e202312568, 2023 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-37848394

RESUMO

A synthetic strategy based on biogenetic building blocks for the collective and divergent biomimetic synthesis of cleistoperlones A-F, a cinnamoylphloroglucinol collection discovered from Cleistocalyx operculatus, has been developed. These syntheses proceeded successfully in only six to seven steps starting from commercially available 1,3,5-benzenetriol and involving oxidative activation of stable biogenetic building blocks as a crucial step. Key features of the syntheses include a unique Michael addition/ketalization/1,6-addition/enol-keto tautomerism cascade reaction for the construction of the dihydropyrano[3,2-d]xanthene tetracyclic core of cleistoperlones A and B, and a rare inverse-electron-demand hetero-Diels-Alder cycloaddition for the establishment of benzopyran ring in cleistoperlones D-F. Moreover, cleistoperlone A exhibited significant antiviral activity against acyclovir-resistant strains of herpes simplex virus type 1 (HSV-1/Blue and HSV-1/153).


Assuntos
Syzygium , Biomimética , Estereoisomerismo , Reação de Cicloadição , Antivirais/farmacologia
7.
Molecules ; 27(15)2022 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-35897866

RESUMO

Piperidine and pyrrolidine derivatives are important nitrogen heterocyclic structures with a wide range of biological activities. However, reported methods for their construction often face problems of requiring the use of expensive metal catalysts, highly toxic reaction reagents or hazardous reaction conditions. Herein, an efficient route from halogenated amides to piperidines and pyrrolidines was disclosed. In this method, amide activation, reduction of nitrile ions, and intramolecular nucleophilic substitution were integrated in a one-pot reaction. The reaction conditions were mild and no metal catalysts were used. The synthesis of a variety of N-substituted and some C-substituted piperidines and pyrrolidines became convenient, and good yields were obtained.


Assuntos
Amidas , Pirrolidinas , Catálise , Piperidinas/química , Pirrolidinas/química , Estereoisomerismo
8.
Molecules ; 27(16)2022 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-36014379

RESUMO

An efficient continuous-flow nitration process of o-xylene at pilot scale was demonstrated. The effects of parameters such as temperature, ratio of H2SO4 to HNO3, H2SO4 concentration, flow rate, and residence time on the reaction were studied. Under the optimal conditions, the yield of products reached 94.1%, with a product throughput of 800 g/h. The main impurities of this continuous-flow nitration process were also studied in detail. Compared with batch process, phenolic impurity decreased from 2% to 0.1%, which enabled the omission of the alkaline solution washing step and thus reduced the wastewater emission. The method was also successfully applied to the nitrification of p-xylene, toluene, and chlorobenzene with good yields.


Assuntos
Tolueno , Xilenos
9.
Environ Geochem Health ; 44(12): 4311-4321, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35006476

RESUMO

Continuous fluorine (F) accumulation in soil by anthropogenic activities leads to variously global environmental and health issues. Herein, 300 farmland soil samples were collected from different anthropogenic activity dominated districts for studying the distribution and related health risk of F in soils. Co-existing metal concentrations in soil samples were also analysed to evaluate the relationship between the distribution of F and metals in soil. The median value of the total F concentration of 488 mg kg-1 in the present samples was higher than the median background F concentration in topsoil in Sichuan province of China (261 mg kg-1). Concentration of water-soluble F (1.33-26.2 mg kg-1) was two or three orders of magnitude less than that of total F in soil. Levels of total and water-soluble F in soils collected from the district with longer contamination history were higher than that from other districts with shorter contamination period, indicating a historical contribution of anthropogenic activities to F accumulation in soil. Notable positive correlation between the total F and vanadium (V) concentration in soil can be partly linked to the usually negative charged form or a common source of F and V in soil (e.g. coal combustion). Compared with inhalation and dermal contact, present human exposure of F in soil was mainly caused by oral ingestion, and the health risks posed by F in soil for both children and adults were acceptable. However, considering the higher potential risk for children than adults, the accumulation of F in soil induced by anthropogenic activities should not be neglect.


Assuntos
Poluentes do Solo , Solo , Criança , Humanos , Adulto , Fazendas , Flúor/análise , Poluentes do Solo/análise , Efeitos Antropogênicos , Monitoramento Ambiental , Medição de Risco , Fluoretos/análise , Água/análise
10.
Angew Chem Int Ed Engl ; 61(9): e202115208, 2022 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-34927320

RESUMO

Polymeric cylinders, a fascinating type of nanostructures with high surface area, internal volume and rigidity, have been exploited as novel drug delivery vehicles over the past decade. However, it's still an open challenge to afford cylindrical nanostructures using polymeric building blocks via traditional self-assembly processes. Herein, we report a hierarchical self-assembly strategy of preparing cylindrical aggregates (tubisomes) from an amphiphilic supramolecular bottlebrush polymer in which a cyclic peptide nanotube is employed as the noncovalent backbone. Additionally, an aggregation-induced emission (AIE) effect was introduced into the tubisomes to endow them with excellent fluorescent properties. Intriguingly, by encapsulating with the anticancer drug doxorubicin (DOX), both the fluorescence of tubisome and DOX can be quenched due to the energy transfer relay (ETR) effect. The release of DOX can induce the interruption of the ETR effect and recover the silenced fluorescence, thereby permitting the in-situ imaging of drug release. The AIE-featured supramolecular tubisomes reported here provide an alternative approach for fabricating cylindrical polymeric nanostructures and holds great potential for imaging-guided drug delivery.


Assuntos
Antibióticos Antineoplásicos/química , Doxorrubicina/química , Sistemas de Liberação de Medicamentos , Fluorescência , Humanos , Substâncias Macromoleculares/síntese química , Substâncias Macromoleculares/química , Nanoestruturas/química
11.
Angew Chem Int Ed Engl ; 61(44): e202210518, 2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36002384

RESUMO

We report the polymerisation-induced self-assembly of poly(lauryl methacrylate)-graft-poly(benzyl methacrylate) copolymers during reversible addition-fragmentation chain transfer (RAFT) grafting from polymerisation in a backbone-selective solvent. Electron microscopy images suggest the phase separation of grafts to result in a network of spherical particles, due to the ability of the branched architecture to freeze chain entanglements and to bridge core domains. Small-angle X-ray scattering data suggest the architecture promotes the formation of multicore micelles, the core morphology of which transitions from spheres to worms, vesicles, and inverted micelles with increasing volume fraction of the grafts. A time-resolved SAXS study is presented to illustrate the formation of the inverted phase during a polymerisation. The grafted architecture gives access to unusual morphologies and provides exciting new handles for controlling the polymer structure and material properties.

12.
J Am Chem Soc ; 143(1): 382-389, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33348987

RESUMO

Artificial light-harvesting systems in aqueous media which mimic nature are of significant importance; however, they are often restrained by the solubility and the undesired aggregation-caused quenching effect of the hydrophobic chromophores. Here, we report a generalized strategy toward the construction of efficient artificial light-harvesting systems based on supramolecular peptide nanotubes in water. By molecularly aligning the hydrophobic chromophores along the nanotubes in a slipped manner, an artificial light-harvesting system with a two-step sequential Förster resonance energy transfer process is successfully fabricated, showing an energy transfer efficiency up to 95% and a remarkably high fluorescence quantum yield of 30%, along with high stability. Furthermore, the spectral emission could be continuously tuned from blue through green to orange, as well as outputted as a white light continuum with a fluorescence quantum yield of 29.9%. Our findings provide a versatile approach of designing efficient artificial light-harvesting systems and constructing highly emissive organic materials in aqueous media.

13.
Sensors (Basel) ; 21(23)2021 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-34883824

RESUMO

The north and south poles of the earth (hereinafter referred to as the polar regions) are important components of the earth system. Changes in the material balance and movement of the polar ice shelf reflect the influence of the polar regions on global climate change and are also a response to global climate change. Through a comprehensive investigation of ice-shelf kinematics, with sufficient accuracy, it is possible to obtain ice-shelf elevation, movement-state data, ice-shelf material balance state, and the ice-shelf movement dynamics mechanism. Due to the extremely harsh environment in polar regions, remote sensing is currently widely used. Manual and equipment monitoring methods show insufficient accuracy or discontinuous time series. There is an urgent need to obtain continuous real-time ice-shelf kinematics-related parameters on the ground to verify the reliability of the parameters obtained by satellite remote sensing. These parameters should be combined with remote sensing monitoring to provide data support. In this paper, a monitoring system for the movement of polar ice and shelf ice cover is developed, and it is proposed that various data can be acquired by integrating high-precision GPS (global positioning system) and other sensors. Solutions to the problem of low-temperature power supply in the polar regions, data acquisition and storage strategies, and remote communication methods are proposed. Testing and remote sensing validation verified that the developed acquisition system can fulfill the requirements for monitoring the movement of the polar unmanned ice shelves and ice sheets.


Assuntos
Camada de Gelo , Tecnologia de Sensoriamento Remoto , Mudança Climática , Reprodutibilidade dos Testes
14.
Antimicrob Agents Chemother ; 64(10)2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32718963

RESUMO

Phosphoinositide-3 kinase signaling modulates many cellular processes, including cell survival, proliferation, differentiation, and apoptosis. Currently, it is known that the establishment of respiratory syncytial virus infection requires phosphoinositide-3 kinase signaling. However, the regulatory pattern of phosphoinositide-3 kinase signaling or its corresponding molecular mechanism during respiratory syncytial virus entry remains unclear. Here, the involvement of phosphoinositide-3 kinase signaling in respiratory syncytial virus entry was studied. PIK-24, a novel compound designed with phosphoinositide-3 kinase as a target, had potent anti-respiratory syncytial virus activity both in vitro and in vivo PIK-24 significantly reduced viral entry into the host cell through blocking the late stage of the fusion process. In a mouse model, PIK-24 effectively reduced the viral load and alleviated inflammation in lung tissue. Subsequent studies on the antiviral mechanism of PIK-24 revealed that viral entry was accompanied by phosphoinositide-3 kinase signaling activation, downstream RhoA and cofilin upregulation, and actin cytoskeleton rearrangement. PIK-24 treatment significantly reversed all these effects. The disruption of actin cytoskeleton dynamics or the modulation of phosphoinositide-3 kinase activity by knockdown also affected viral entry efficacy. Altogether, it is reasonable to conclude that the antiviral activity of PIK-24 depends on the phosphoinositide-3 kinase signaling and that the use of phosphoinositide-3 kinase signaling to regulate actin cytoskeleton rearrangement plays a key role in respiratory syncytial virus entry.


Assuntos
Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Animais , Camundongos , Fosfatidilinositóis , Infecções por Vírus Respiratório Sincicial/tratamento farmacológico , Transdução de Sinais , Internalização do Vírus
15.
Bioorg Med Chem Lett ; 30(13): 127236, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32386980

RESUMO

Aminobenzyloxyarylamide derivatives 1a-i and 2a-t were designed and synthesized as novel selective κ opioid receptor (KOR) antagonists. The benzoyl amide moiety of LY2456302 was changed into N-hydroxybenzamide and benzisoxazole-3(2H)-one to investigate whether it could increase the binding affinity or selectivity for KOR. All target compounds were evaluated in radioligand binding assays for opioid receptor binding affinity. These efforts led to the identification of compound 1c (κ Ki = 179.9 nM), which exhibited high affinity for KOR. Moreover, the selectivity of KOR over MOR and DOR increased nearly 2-fold and 7-fold, respectively, compared with (±)LY2456302.


Assuntos
Benzamidas/farmacologia , Ácidos Hidroxâmicos/farmacologia , Antagonistas de Entorpecentes/farmacologia , Receptores Opioides kappa/metabolismo , Animais , Benzamidas/síntese química , Benzamidas/metabolismo , Células CHO , Cricetulus , Desenho de Fármacos , Células HEK293 , Humanos , Ácidos Hidroxâmicos/síntese química , Ácidos Hidroxâmicos/metabolismo , Simulação de Acoplamento Molecular , Antagonistas de Entorpecentes/síntese química , Antagonistas de Entorpecentes/metabolismo
16.
Cell Mol Life Sci ; 76(14): 2833-2850, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30895337

RESUMO

POLD1, the catalytic subunit of DNA Pol δ, plays an important role in DNA synthesis and DNA damage repair, and POLD1 is downregulated in replicative senescence and mediates cell aging. However, the mechanisms of age-related downregulation of POLD1 expression have not been elucidated. In this study, four potential CpG islands in the POLD1 promoter were found, and the methylation levels of the POLD1 promoter were increased in aging 2BS cells, WI-38 cells and peripheral blood lymphocytes, especially at a single site, CpG 36, in CpG island 3. Then, the transcription factor E2F1 was observed to bind to these sites. The binding affinity of E2F1 for the POLD1 promoter was found to show age-related attenuation and was confirmed to be positively regulated by the E2F1 level and negatively regulated by POLD1 promoter methylation. Moreover, cell senescence characteristics were observed in the cells transfected with shRNA-E2F1 and could contribute to the downregulation of POLD1 induced by the E2F1 decline. Collectively, these results indicated that the attenuation of the binding affinity of E2F1 for the POLD1 promoter, mediated by an age-related decline in E2F1 and increased methylation of CpG island 3, downregulates POLD1 expression in aging.


Assuntos
Senescência Celular , DNA Polimerase III/metabolismo , Fator de Transcrição E2F1/metabolismo , Regulação da Expressão Gênica , Adulto , Idoso , Idoso de 80 Anos ou mais , Células Cultivadas , Ilhas de CpG , Metilação de DNA , DNA Polimerase III/genética , Reparo do DNA , Replicação do DNA , Regulação para Baixo , Fator de Transcrição E2F1/genética , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Regiões Promotoras Genéticas , Adulto Jovem
17.
Angew Chem Int Ed Engl ; 59(23): 8860-8863, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32045099

RESUMO

Typically, the morphologies of the self-assembled nanostructures from block copolymers are limited to spherical micelles, wormlike micelles and vesicles. Now, a new generation of materials with unique shape and structures, cylindrical soft matter particles (tubisomes), are obtained from the hierarchical self-assembly of cyclic peptide-bridged amphiphilic diblock copolymers. The capacity of obtained photo-responsive tubisomes as potential drug carriers is evaluated. The supramolecular tubisomes pave an alternative way for fabricating polymeric tubular structures, and will expand the toolbox for the rational design of functional hierarchical nanostructures.

18.
Acta Pharmacol Sin ; 39(3): 425-437, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29119966

RESUMO

STAT1 and STAT3 are two important members of the STAT (signal transducers and activators of transcription) protein family and play opposing roles in regulating cancer cell growth. Suppressing STAT3 and/or enhancing STAT1 signaling are considered to be attractive anticancer strategies. Cucurbitacin I (CuI) isolated from the cucurbitacin family was reported to be an inhibitor of STAT3 signaling and a disruptor of actin cytoskeleton. In this study we investigated the function and mechanisms of CuI in regulating STAT signaling in human cancer cells in vitro. CuI (0.1-10 mmol/L) dose-dependently inhibited the phosphorylation of STAT3, and enhanced the phosphorylation of STAT1 in lung adenocarcinoma A549 cells possibly through disrupting actin filaments. We further demonstrated that actin filaments physically associated with JAK2 and STAT3 in A549 cells and regulated their phosphorylation through two signaling complexes, the IL-6 receptor complex and the focal adhesion complex. Actin filaments also interacted with STAT1 in A549 cells and regulated its dephosphorylation. Taken together, this study reveals the molecular mechanisms of CuI in the regulation of STAT signaling and in a possible inhibition of human cancer cell growth. More importantly, this study uncovers a novel role of actin and actin-associated signaling complexes in regulating STAT signaling.


Assuntos
Citoesqueleto de Actina/metabolismo , Fator de Transcrição STAT1/metabolismo , Fator de Transcrição STAT3/metabolismo , Transdução de Sinais , Triterpenos/farmacologia , Linhagem Celular Tumoral , Relação Dose-Resposta a Droga , Humanos , Janus Quinase 2/metabolismo , Fosforilação/efeitos dos fármacos
19.
Sensors (Basel) ; 18(11)2018 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-30424503

RESUMO

At present, as growing importance continues to be attached to atmospheric environmental problems, the demand for real-time monitoring of these problems is constantly increasing. This article describes the development and application of an embedded system for monitoring of atmospheric pollutant concentrations based on LoRa (Long Range) wireless communication technology, which is widely used in the Internet of Things (IoT). The proposed system is realized using a combination of software and hardware and is designed using the concept of modularization. Separation of each function into independent modules allows the system to be developed more quickly and to be applied more stably. In addition, by combining the requirements of the remote atmospheric pollutant concentration monitoring platform with the specific requirements for the intended application environment, the system demonstrates its significance for practical applications. In addition, the actual application data also verifies the sound application prospects of the proposed system.

20.
Crit Care Med ; 45(7): e727-e733, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28441237

RESUMO

OBJECTIVE: To evaluate the effectiveness of noninvasive ventilation in patients with acute hypoxemic nonhypercapnic respiratory failure unrelated to exacerbation of chronic obstructive pulmonary disease and cardiogenic pulmonary edema. DATA SOURCES: PubMed, EMBASE, Cochrane library, Web of Science, and bibliographies of articles were retrieved inception until June 2016. STUDY SELECTION: Randomized controlled trials comparing application of noninvasive ventilation with standard oxygen therapy in adults with acute hypoxemic nonhypercapnic respiratory failure were included. Chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema patients were excluded. The primary outcome was intubation rate; ICU mortality and hospital mortality were secondary outcomes. DATA EXTRACTION: Demographic variables, noninvasive ventilation application, and outcomes were retrieved. Internal validity was assessed using the risk of bias tool. The strength of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation methodology. DATA SYNTHESIS: Eleven studies (1,480 patients) met the inclusion criteria and were analyzed by using a random effects model. Compared with standard oxygen therapy, the pooled effect showed that noninvasive ventilation significantly reduced intubation rate with a summary risk ratio of 0.59 (95% CI, 0.44-0.79; p = 0.0004). Furthermore, hospital mortality was also significantly reduced (risk ratio, 0.46; 95% CI, 0.24-0.87; p = 0.02). Subgroup meta-analysis showed that the application of bilevel positive support ventilation (bilevel positive airway pressure) was associated with a reduction in ICU mortality (p = 0.007). Helmet noninvasive ventilation could reduce hospital mortality (p = 0.0004), whereas face/nasal mask noninvasive ventilation could not. CONCLUSIONS: Noninvasive ventilation decreased endotracheal intubation rates and hospital mortality in acute hypoxemia nonhypercapnic respiratory failure excluding chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema patients. There is no sufficient scientific evidence to recommend bilevel positive airway pressure or helmet due to the limited number of trials available. Large rigorous randomized trials are needed to answer these questions definitely.


Assuntos
Ventilação não Invasiva/métodos , Insuficiência Respiratória/terapia , Doença Aguda , Adulto , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Intubação Intratraqueal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
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