Electrical impedance tomography for titration of positive end-expiratory pressure in acute respiratory distress syndrome patients with chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of most common comorbidities in acute respiratory distress syndrome (ARDS). There are few specific studies on the appropriate ventilation strategy for patients with ARDS comorbid with COPD, especially regarding on positive end-expiratory pressure (PEEP) titration. METHODS: To compare the respiratory mechanics in mechanical ventilated ARDS patients with or without COPD and to determine whether titration of PEEP based on electrical impedance tomography (EIT) is superior to the ARDSnet protocol. This is a single center, perspective, repeated measure study. ARDS patients requiring mechanical ventilation who were admitted to the intensive care unit between August 2017 and December 2020 were included. ARDS patients were divided according to whether they had COPD into a COPD group and a non-COPD group. Respiratory mechanics, gas exchange, and hemodynamics during ventilation were compared between the groups according to whether the PEEP level was titrated by EIT or the ARDSnet protocol. RESULTS: A total of twenty-seven ARDS patients including 14 comorbid with and 13 without COPD who met the study eligibility criteria were recruited. The PEEP levels titrated by EIT and the ARDSnet protocol were lower in the COPD group than in the non-COPD group (6.93 ± 1.69 cm H2O vs. 12.15 ± 2.40 cm H2O, P < 0.001 and 10.43 ± 1.20 cm H2O vs. 14.0 ± 3.0 cm H2O, P < 0.001, respectively). In the COPD group, the PEEP level titrated by EIT was lower than that titrated by the ARDSnet protocol (6.93 ± 1.69 cm H2O vs. 10.43 ± 1.20 cm H2O, P < 0.001), as was the global inhomogeneity (GI) index (0.397 ± 0.040 vs. 0.446 ± 0.052, P = 0.001), plateau airway pressure (16.50 ± 4.35 cm H2O vs. 20.93 ± 5.37 cm H2O, P = 0.001), dead space ventilation ratio (48.29 ± 6.78% vs. 55.14 ± 8.85%, P < 0.001), ventilation ratio (1.63 ± 0.33 vs. 1.87 ± 0.33, P < 0.001), and mechanical power (13.92 ± 2.18 J/min vs. 15.87 ± 2.53 J/min, P < 0.001). The cardiac index was higher when PEEP was treated by EIT than when it was titrated by the ARDSnet protocol (3.41 ± 0.50 L/min/m2 vs. 3.02 ± 0.43 L/min/m2, P < 0.001), as was oxygen delivery (466.40 ± 71.08 mL/min/m2 vs. 411.10 ± 69.71 mL/min/m2, P = 0.001). CONCLUSION: Titrated PEEP levels were lower in patients with ARDS with COPD than in ARDS patients without COPD. In ARDS patient comorbid with COPD, application of PEEP titrated by EIT was lower than those titrated by the ARDSnet protocol, which contributed to improvements in the ventilation ratio, mechanical energy, cardiac index, and oxygen delivery with less of an adverse impact on hemodynamics.

Lignans, Monoterpenes and γ-Pyrone Derivatives from Patrinia scabiosifolia with Cytotoxic Activity against HCT-116 Cells.

One new dihydrobenzofuran neolignan, patrinianeolignan I, two new monoterpenes, 6,7-dehydrodissectol A and patriniaol A, and a new γ-pyrone derivative, hydroxymaltol 3-O-(6'-O-trans-caffeoyl)-ß-D-glucopyranoside, along with fifteen known lignans, eight known monoterpenes, and two known γ-pyrone derivatives, were isolated from the whole plant of Patrinia scabiosifolia. Their structures were elucidated by 1D- and 2D-NMR and HR-ESI-MS analysis. The absolute configuration of patrinianeolignan I was confirmed by circular dichroism (CD) spectrum. All compounds were evaluated in vitro for their cytotoxic activity against HCT-116 cells. The results showed that compounds patriniaol A and eudesmin exhibited moderate cytotoxicity against HCT-116 cells with IC50 values of 42.23 µM and 41.92 µM, respectively.

Fucoidan Alleviates Acetaminophen-Induced Hepatotoxicity via Oxidative Stress Inhibition and Nrf2 Translocation.

Acetaminophen (APAP) is a widely used analgesic and antipyretic drug that leads to severe hepatotoxicity at excessive doses. Fucoidan, a sulfated polysaccharide derived from brown seaweeds, possesses a wide range of pharmacological properties. However, the impacts of fucoidan on APAP-induced liver injury have not been sufficiently addressed. In the present study, male Institute of Cancer Research (ICR) mice aged 6 weeks were subjected to a single APAP (500 mg/kg) intraperitoneal injection after 7 days of fucoidan (100 or 200 mg/kg/day) or bicyclol intragastric administration. The mice continued to be administered fucoidan or bicyclol once per day, and were sacrificed at an indicated time. The indexes evaluated included liver pathological changes, levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the serum, levels of reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH) and catalase (CAT) in the liver, and related proteins levels (CYP2E1, pJNK and Bax). Furthermore, human hepatocyte HL-7702 cell line was used to elucidate the potential molecular mechanism of fucoidan. The mitochondrial membrane potential (MMP) and nuclear factor-erythroid 2-related factor (Nrf2) translocation in HL-7702 cells were determined. The results showed that fucoidan pretreatment reduced the levels of ALT, AST, ROS, and MDA, while it enhanced the levels of GSH, SOD, and CAT activities. Additionally, oxidative stress-induced phosphorylated c-Jun N-terminal protein kinase (JNK) and decreased MMP were attenuated by fucoidan. Although the nuclear Nrf2 was induced after APAP incubation, fucoidan further enhanced Nrf2 in cell nuclei and total expression of Nrf2. These results indicated that fucoidan ameliorated APAP hepatotoxicity, and the mechanism might be related to Nrf2-mediated oxidative stress.

Antidepressant-like effects of ginsenoside Rg2 in a chronic mild stress model of depression.

Major depression is a common neuropsychiatric disease with high lifetime prevalence and high incidence of suicide. This study aimed to evaluate the antidepressant effects of ginsenoside Rg2 in mice, and the possible mechanism was also determined. A single injection of both Rg2 (10 and 20mg/kg) and fluoxetine (positive control, 20mg/kg) induced notable antidepressant-like effects in the forced swim test and tail suspension test without affecting the locomotor activity of mice, and the tests were done 30min after the injection. Also, repeated daily treatment of Rg2 and fluoxetine for the last 2 weeks fully reversed the chronic mild stress (6 weeks)-induced depressive-like symptoms in mice. Moreover, western blot analysis showed that Rg2 administration significantly increased the BDNF signaling pathway in hippocampus. Importantly, the usage of TrkB shRNA fully blocked the antidepressant effects of Rg2 in mice. Collectively, these results suggest that Rg2 produces an antidepressant-like effect in mice which is mediated, at least in part, through promoting the hippocampal BDNF signaling pathway.

[Influence of corneal refractive surgery on wavefront aberrations of human eye].

OBJECTIVE: To analyze the aberration of human eyes after LASIK by using wavefront analyzer, to evaluate the eye aberrations by using the large spot in refractive surgery, and to compare the aberrations in different pupil zones. METHODS: This is a prospective clinical study. Preoperatively and postoperatively, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE) and aberrations were evaluated on each patient. The patients were divided into three different groups according to the SE diopter before the surgery. We used the SAS and SPSS10.0 statistic software to analyze the data. RESULTS: Preoperatively, BCVA was 4.98 +/- 0.07. Ten days after surgery, UCVA and BCVA were 4.92 +/- 0.10 and 4.95 +/- 0.09, respectively. One month after surgery, UCVA and BCVA were 4.96 +/- 0.09 and 4.99 +/- 0.09, respectively. Over time, visual acuity improved with Postoperatively, parts of the eye's BCVA were better than preoperatively. Ten days after LASIK, the SE of three groups were hyperopic. But with time, SE changes to myopia. In the Allegretto exam, high order aberrations increased immediately after surgery in each group (P < 0.05), but decreased with time (P > 0.05) and did not return to preoperative values at one month. Preoperatively, the total aberrations (RMSg) were larger than postoperatively. The aberrations especially spherical are larger in the 6.5 mm pupil zone than in the 4 mm pupil zone. Preoperatively, there were no significant differences of high order aberrations between the three groups (P > 0.05). But after surgery, there were significant differences (P < 0.05). CONCLUSIONS: Initially, high order aberrations increased after LASIK, but decreased over time. Preoperatively, there were no significant differences of aberrations between the three groups, but after surgery, significant differences existed. The aberrations especially spherical were larger in the 6.5 mm pupil zone than in the 4 mm pupil zone. Allegretto wave-front analyzer can be used for low to middle myopia.

[Relationship between temperature and the risks of mortality in China: a Meta-analysis].

OBJECTIVE: To understand the effect of temperature on the risk of mortality and the modification effect of latitude, in China. METHODS: Relevant papers were searched and Meta-analysis was used to determine the exposure-response relationship for each health outcome which was associated with the exposure to temperature. Meta-regression analysis was used to evaluate the effect modification by latitude. RESULTS: Ten studies in 15 cities were included in the study. When temperature increased by one centigrade, the risks of mortality showed the following changes:deaths from non-accidental increased by 2% (95%CI:1%, 3%), from cardiovascular disease increased by 4% (95%CI:2%, 6%)and from the respiratory disease increased by 2% (95%CI:1%, 4%). As temperature decreased by one centigrade, the mortality risks of the following diseases showed the changes as: non-accidental death increased by 4% (95% CI:2%, 7%), cardiovascular disease increased by 4% (95%CI:1%, 7%)and the respiratory diseases increased by 2% (95%CI:0%, 4%). When latitude ranged from 0 to 25, 26 to 30, 31 to 39 degree or over 40 degrees, respectively and the temperature decreased by one centigrade, the mortality risks of the general population increased by 6.5% (95%CI:-2.7%, 15.6%), 5.8% (95% CI:2.4%, 9.3%),0.8% (95%CI:0.4%, 1.2%),0.5% (95%CI: -0.5%, 1.5%). As temperature increased by one centigrade, mortality risk of the general population increased by 0.6% (95%CI:-0.3%, 1.4%), 1.9% (95%CI:0.7%, 3.1%), 2.0% (95%CI:1.0%, 3.0%) and 5.8% (95% CI:-3.2%, 14.8%). As latitude increased by five degrees with high temperature, the mortality risk of general people increased by 0.3% (95% CI:0.1% ,0.8%) while decreased by 0.8% (95% CI:0.5%, 0.9%) under low temperature. CONCLUSION: In China, the mortality risk increased along with the changes of temperature. The adaptability to coldness among people living in high latitude areas seemed to be stronger than those living in other areas of latitudes. Who were more vulnerable to high temperature.