Continuous Versus Intermittent Control Cuff Pressure for Preventing Ventilator-Associated Pneumonia: An Updated Meta-Analysis.

OBJECTIVE: This study aimed to evaluate the effect of continuous control cuff pressure (CCCP) versus intermittent control cuff pressure (ICCP) for the prevention of ventilator-associated pneumonia (VAP) in critically ill patients. METHODS: Relevant literature was searched in several databases, including PubMed, Embase, Web of Science, ProQuest, the Cochrane Library, Wanfang Database and China National Knowledge Infrastructure between inception and September 2022. Randomized controlled trials were considered eligible if they compared CCCP with ICCP for the prevention of VAP in critically ill patients. This meta-analysis was performed using the RevMan 5.3 and Trial Sequential Analysis 0.9 software packages. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the level of evidence. RESULTS: We identified 14 randomized control trials with a total of 2080 patients. Meta-analysis revealed that CCCP was associated with a significantly lower incidence of VAP compared with ICCP (relative risk [RR] = 0.52; 95% confidence interval [CI]: 0.37-0.74; P < 0.001), although considerable heterogeneity was observed (I2 = 71%). Conducting trial sequential analysis confirmed the finding, and the GRADE level was moderate. Subgroup analysis demonstrated that CCCP combined with subglottic secretion drainage (SSD) had a more significant effect on reducing VAP (RR = 0.39; 95% CI = 0.29-0.52; P < 0.001). The effect of CCCP on ventilator-associated respiratory infection (VARI) incidence was uncertain (RR = 0.81; 95% CI = 0.53-1.24; P = 0.34; I2 = 61%). Additionally, CCCP significantly reduced the duration of mechanical ventilation (MV) (mean difference [MD] = -2.42 days; 95% CI = -4.71-0.12; P = 0.04; I2 = 87%). Descriptive analysis showed that CCCP improved the qualified rate of cuff pressure. However, no significant differences were found in the length of intensive care unit (ICU) stay (MD = 2.42 days; 95% CI = -1.84-6.68; P = 0.27) and ICU mortality (RR = 0.86; 95% CI = 0.74-1.00; P = 0.05). CONCLUSION: Our findings suggest that the combination of CCCP and SSD can reduce the incidence of VAP and the duration of MV and maintain the stability of cuff pressure. A combination of CCCP and SSD applications is suggested for preventing VAP.

Efficacy of Endotracheal Tube Cuff Modification in Preventing Ventilator-associated Pneumonia.

The aim of this study was to evaluate the effect of modifying the cuff on preventing ventilator-associated pneumonia (VAP). PubMed, Embase and Cochrane Library were systematically searched from inception to April 2022, for randomised controlled trials (RCTs) that compared the effect of a new type of cuff intubation with traditional cuff intubation on VAP incidence and intensive-care unit (ICU) mortality in mechanically ventilated patients. Nine RCTs with 1937 patients were finally evaluated. The pooled results for the incidence of VAP showed that the modified cuff significantly decreased the morbidity of VAP compared with the traditional cuff (relative ratio (RR) = 0.73, 95% confidence interval (CI) 0.56-0.95, p = 0.02). The subgroup analysis revealed that polyurethane (PU) cuff (RR = 0.82, 95% CI 0.46-1.48, p = 0.52), conical cuff (RR = 0.97, 95% CI 0.73-1.28, p = 0.82) and PU-conical cuff (RR = 1.36, 95% CI 0.85-2.18, p = 0.20) did not decrease the incidence of VAP. Moreover, the improved cuff combined with subglottic secretion drainage (SSD) could significantly reduce the VAP incidence (RR = 0.58, 95% CI 0.44-0.77, p = 0.0001). In terms of ICU mortality, there was no statistically significant difference (RR = 0.83, 95% CI 0.68-1.02, p = 0.08) between the two groups. The modified cuff is superior to the traditional cuff in VAP prevention. In particular, the modified cuff combined with subglottic secretion drainage has more advantages. Key Words: Ventilator-associated pneumonia, Intubation, Endotracheal cuff, Intensive care unit, Meta-analysis.

Exploring the Nursing Factors Related to Ventilator-Associated Pneumonia in the Intensive Care Unit.

Objective: The purpose of this study was to investigate the key nursing factors associated with ventilator-associated pneumonia (VAP) in critical care patients. Methods: Through the quality control platform of Hebei Province, questionnaires were sent to intensive care nurses in 32 tertiary hospitals in Hebei Province, China to collect data concerning the incidence of VAP and the status of the nursing staff. All the data were analyzed using an independent t-test and a one-way analysis of variance (ANOVA). The Pearson correlation coefficient was used to analyse the correlation between the nursing factors and the incidence of VAP. Multivariate logistic regression analysis was used to determine the risk factors affecting VAP. Results: In terms of nursing, the incidence of VAP was affected by the differential nursing strategies. Multivariate logistic regression analysis showed that the incidence of VAP was significantly associated with the following six variables: the ratio of nurses to beds (p = 0.000), the ratio of nurses with a bachelor's degree or higher (p = 0.000), the ratio of specialist nurses (p = 0.000), the proportion of nurses with work experience of 5-10 years (p = 0.04), the number of patients nurses were responsible for at night (p = 0.01) and the frequency of oral care (p = 0.000). Conclusion: The incidence of VAP is closely related to nursing factors. In terms of nursing human resources, even junior nurses (less experienced nurses) can play an essential role in reducing VAP. In addition, to reduce VAP, the number of patients that nurses are responsible for at night should be reduced as much as possible, and improving nursing qualifications.

Application values of prenatal screening and non-invasive gene sequencing in fetal birth defects.

OBJECTIVE: To investigate effects of prenatal screening and non-invasive gene sequencing on the clinical diagnosis of fetal birth defects and the outcome of pregnancy. METHODS: Totally 2520 pregnant women who received prenatal screening in our hospital were selected as the research subjects. The high-risk pregnant women were further tested by the non-invasive gene sequencing technology. Pregnant women with positive results were diagnosed by amniocentesis and fetal chromosome karyotype analysis, and the pregnancy outcome was followed up for one year. RESULTS: 870 out of the 2520 pregnant women was tested by non-invasive gene sequencing technology; 26 of the 870 women was 13-trisomy-positive and was diagnosed by amniocentesis and fetal chromosome karyotype analysis, 22 of which was diagnosed as 47, XN, +13 and four of which was normal; the diagnosis accuracy of non-invasive prenatal testing (NIPT) was 84.6%. 18 out of the 22 confirmed cases underwent abortion, three cases had termination of embryonic development, and one case had postnatal anomaly. Thirty four out of the 2520 pregnant women was 18-trisomy-positive and was diagnosed by amniocentesis and fetal chromosome karyotype analysis, 31 of which was diagnosed as 47, XN, +18 and three cases were normal; the diagnosis accuracy of NIPT was 91.2%. 29 out of the 31 confirmed cases underwent abortion and two cases had termination of embryonic development. Forty out of the 2520 pregnant women was 21-trisomy-positive and was diagnosed by amniocentesis and fetal chromosome karyotype analysis, 39 of which was diagnosed as 47, XN, +21 and one case was normal; the diagnosis accuracy of NIPT was 97.5%. Thirty four out of the 39 confirmed cases underwent abortion, three cases had termination of embryonic development, and two cases had postnatal anomaly. Twenty eight cases were tested as sex chromosome-positive and were diagnosed by amniocentesis and fetal chromosome karyotype analysis, 25 out of which was diagnosed as abnormal and three cases were normal; the diagnosis accuracy of NIPT was 89.3%. 24 out of the 25 confirmed cases underwent abortion, and one case had termination of embryonic development. CONCLUSION: Prenatal screening and non-invasive gene sequencing technology have a high accuracy in the diagnosis of fetal birth defects, which can reduce the maternal abortion injury as much as possible and relieve the psychological pressure. The promotion of the mode can be strengthened in clinics.

Chemical and genetic inhibition of STAT3 sensitizes hepatocellular carcinoma cells to sorafenib induced cell death.

Hepatocellular carcinoma (HCC) has become the second leading cause of cancer related death, with an increasing death rate in recent years. For advanced HCC, sorafenib is the first-line FDA approved drug, with no more than 3 months' overall survival advantage. Recently, a novel strategy has been proposed to improve sorafenib efficacy through enhancing the ability of sorafenib to induce cell death. STAT3 plays a key role in cancer development and recurrence by promoting cell proliferation, survival and immune evasion through its well-established function as a transcription factor in cancer. Notably, STAT3 transcription activity, indicated by its phosphorylation on Y705 is heterogeneous in different liver cancer cell lines. And sorafenib attenuates STAT3 phosphorylation on Y705. However, the role of STAT3 in sorafenib induced cell death is still largely unknown. Here, we show that liver cancer cells also exhibit heterogeneous sensitivities to sorafenib induced cell death, which co-relates with the STAT3-Y705 phosphorylation levels and JAK1/2 expression levels in Hep3B, Huh7 and HepG2 cells. Furthermore, overexpression or knockdown of STAT3 could switch HCC cells between resistant and sensitive to sorafenib induced cell death, which could be partially due to its regulation on Mcl-1, an anti-apoptotic protein. Finally, both inhibitors of STAT3 SH2 domain (S3i-201) or STAT3 upstream kinases JAKs (JAK inhibitor I) could synergistically enhance sorafenib induced cell death. Taken together, these data strongly suggest that STAT3 is not only a downstream effector of sorafenib, but also a key regulator of cellular sensitivity to sorafenib induced cell death, which provide support for the notion to develop STAT3-targeting drugs to improve clinical efficacy of sorafenib in liver cancer.

Ubiquitin-Specific Protease USP6 Regulates the Stability of the c-Jun Protein.

The c-Jun gene encodes a transcription factor that has been implicated in many physiological and pathological processes. c-Jun is a highly unstable protein that is degraded through a ubiquitination/proteasome-dependent mechanism. However, the deubiquitinating enzyme (DUB) that regulates the stability of the c-Jun protein requires further investigation. Here, by screening a DUB expression library, we identified ubiquitin-specific protease 6 (USP6) and showed that it regulates the stability of the c-Jun protein in a manner depending on its enzyme activity. USP6 interacts with c-Jun and antagonizes its ubiquitination. USP6 overexpression upregulates the activity of the downstream signaling pathway mediated by c-Jun/AP-1 and promotes cell invasion. Moreover, many aberrant genes that are upregulated in USP6 translocated nodular fasciitis are great potential targets regulated by c-Jun. Based on our data, USP6 is an enzyme that deubiquitinates c-Jun and regulates its downstream cellular functions.

A soft decoding algorithm and hardware implementation for the visual prosthesis based on high order soft demodulation.

BACKGROUND: High order modulation and demodulation technology can solve the frequency requirement between the wireless energy transmission and data communication. In order to achieve reliable wireless data communication based on high order modulation technology for visual prosthesis, this work proposed a Reed-Solomon (RS) error correcting code (ECC) circuit on the basis of differential amplitude and phase shift keying (DAPSK) soft demodulation. Firstly, recognizing the weakness of the traditional DAPSK soft demodulation algorithm based on division that is complex for hardware implementation, an improved phase soft demodulation algorithm for visual prosthesis to reduce the hardware complexity is put forward. Based on this new algorithm, an improved RS soft decoding method is hence proposed. In this new decoding method, the combination of Chase algorithm and hard decoding algorithms is used to achieve soft decoding. In order to meet the requirements of implantable visual prosthesis, the method to calculate reliability of symbol-level based on multiplication of bit reliability is derived, which reduces the testing vectors number of Chase algorithm. The proposed algorithms are verified by MATLAB simulation and FPGA experimental results. During MATLAB simulation, the biological channel attenuation property model is added into the ECC circuit. RESULTS: The data rate is 8 Mbps in the MATLAB simulation and FPGA experiments. MATLAB simulation results show that the improved phase soft demodulation algorithm proposed in this paper saves hardware resources without losing bit error rate (BER) performance. Compared with the traditional demodulation circuit, the coding gain of the ECC circuit has been improved by about 3 dB under the same BER of [Formula: see text]. The FPGA experimental results show that under the condition of data demodulation error with wireless coils 3 cm away, the system can correct it. The greater the distance, the higher the BER. Then we use a bit error rate analyzer to measure BER of the demodulation circuit and the RS ECC circuit with different distance of two coils. And the experimental results show that the RS ECC circuit has about an order of magnitude lower BER than the demodulation circuit when under the same coils distance. Therefore, the RS ECC circuit has more higher reliability of the communication in the system. CONCLUSIONS: The improved phase soft demodulation algorithm and soft decoding algorithm proposed in this paper enables data communication that is more reliable than other demodulation system, which also provide a significant reference for further study to the visual prosthesis system.

Proteome quantification of cotton xylem sap suggests the mechanisms of potassium-deficiency-induced changes in plant resistance to environmental stresses.

Proteomics was employed to investigate the molecular mechanisms of apoplastic response to potassium(K)-deficiency in cotton. Low K (LK) treatment significantly decreased the K and protein contents of xylem sap. Totally, 258 peptides were qualitatively identified in the xylem sap of cotton seedlings, of which, 90.31% were secreted proteins. Compared to the normal K (NK), LK significantly decreased the expression of most environmental-stress-related proteins and resulted in a lack of protein isoforms in the characterized proteins. For example, the contents of 21 Class Ш peroxidase isoforms under the LK were 6 to 44% of those under the NK and 11 its isoforms were lacking under the LK treatment; the contents of 3 chitinase isoforms under LK were 11-27% of those under the NK and 2 its isoforms were absent under LK. In addition, stress signaling and recognizing proteins were significantly down-regulated or disappeared under the LK. In contrast, the LK resulted in at least 2-fold increases of only one peroxidase, one protease inhibitor, one non-specific lipid-transfer protein and histone H4 and in the appearance of H2A. Therefore, K deficiency decreased plant tolerance to environmental stresses, probably due to the significant and pronounced decrease or disappearance of a myriad of stress-related proteins.

Electrochemically controlled hydrogen bonding. Nitrobenzenes as simple redox-dependent receptors for arylureas.

Reduction of nitrobenzene derivatives in the presence of arylureas in aprotic solvents results in large positive shifts in potential of the nitrobenzene(0/)(-) cyclic voltammetry wave with little change in wave shape. This behavior is indicative of reversible hydrogen bonding between nitrobenzene radical anions and arylureas. Computer fitting of the cyclic voltammetry of 4-nitroaniline, NA, plus 1,3-diphenylurea in DMF shows essentially no binding between urea and NA in the oxidized state (K(ox) < 1 M(-)(1)), but very strong binding in the reduced state (K(red) = 8 x 10(4) M(-)(1)), along with very rapid rates of hydrogen bond formation (k(f)'s approximately 10(8)-10(10) M(-)(1) s(-)(1)), making this system a fast on/off redox switch.