Simple aspiration for spontaneous pneumothorax in adults: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Spontaneous pneumothorax (SP) is a widespread clinical entity, and methods of managing adult SP remain controversial. The aim of this meta-analysis was to further determine the clinical efficacy and safety of simple aspiration (SA) in comparison to intercostal tube drainage (ITD) during the management of adult SP. METHODS: EMBASE, Medline and the Cochrane Central Register of Controlled Trials via Ovid SP were searched (to June 2023) to identify randomized controlled trials (RCT) that reported outcomes of interest after comparing SA with ITD for the management of adult SP. RESULTS: The search strategy yielded 1447 citations, of which 10 RCTs enrolling 1044 subjects were included. Compared with the ITD group, the SA group had a significantly lower the initial success rate of the procedure for the management of SP (OR 0.63, 95% CI [0.47-0.86]; P = 0.004). Moreover, SA was associated with a decreased duration of hospitalization (mean difference-2.05 days, 95% CI [-2.66 - -1.44]; P < 0.001) and a decreased need for operation (P = 0.03). For frequently reported adverse events such as subcutaneous emphysema (P = 0.32), bleeding (P = 0.0.26) and wound infection (P = 0.07), no significant difference between the SA and ITD groups was found. There was no significant difference for other outcomes. Subgroup analysis found that there was no significant difference between SA and ITD in terms of the initial success rate, 1-week success rate or any type of adverse event for PSP patients. CONCLUSIONS: In the management of adult SP, the use of SA decreased the initial success rate but also decreased the duration of hospitalization and the need for operation compared with ITD. The incidence of adverse events did not differ between the two approaches. The research plan was registered at PROSPERO, and the registration number was CRD42023436770.

PEEP-Induced Lung Recruitment Maneuver Combined with Prone Position for ARDS: A Single-Center, Prospective, Randomized Clinical Trial.

Background: Prone position (PP) and the positive end-expiratory pressure (PEEP)-induced lung recruitment maneuver (LRM) are both efficient in improving oxygenation and prognosis in patients with ARDS. The synergistic effect of PP combined with PEEP-induced LRM in patients with ARDS remains unclear. We aim to explore the effects of PP combined with PEEP-induced LRM on prognosis in patients with moderate to severe ARDS and the predicting role of lung recruitablity. Methods: Patients with moderate to severe ARDS were consecutively enrolled. The patients were prospectively assigned to either the intervention (PP with PEEP-induced LRM) or control groups (PP). The clinical outcomes, respiratory mechanics, and electric impedance tomography (EIT) monitoring results for the two groups were compared. Lung recruitablity (recruitment-to-inflation ratio: R/I) was measured during the PEEP-induced LRM procedure and was used for predicting the response to LRM. Results: Fifty-eight patients were included in the final analysis, among which 28 patients (48.2%) received PEEP-induced LRM combined with PP. PEEP-induced LRM enhanced the effect of PP by a significant improvement in oxygenation (∆PaO2/FiO2 75.8 mmHg vs. 4.75 mmHg, p < 0.001) and the compliance of respiratory system (∆Crs, 2 mL/cmH2O vs. -1 mL/cmH2O, p = 0.02) among ARDS patients. Based on the EIT measurement, PP combined with PEEP-induced LRM increased the ventilation distribution mainly in the dorsal region (5.0% vs. 2.0%, p = 0.015). The R/I ratio was measured in 28 subjects. The higher R/I ratio was related to greater oxygenation improvement after LRM (Pearson's r = 0.4; p = 0.034). Conclusions: In patients with moderate to severe ARDS, PEEP-induced LRM combined with PP can improve oxygenation and dorsal ventilation distribution. R/I can be useful to predict responses to LRM.

Clinical value of the red blood cell distribution width to albumin ratio in the assessment of prognosis in critically ill patients with sepsis: a retrospective analysis.

Background: Red blood cell (RBC) distribution width (RDW) to albumin ratio is a novel biomarker and its prognostic effect on critically ill patients with sepsis has not been extensively investigated. The objective of this study was to identify the prognostic value of the RDW to albumin ratio in these patients. Methods: Data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. A Cox proportional hazards model and restricted cubic spline model were used to determine the association of RDW to albumin ratio with mortality. Receiver operating characteristic (ROC) curves and Kaplan-Meier survival curves were applied, and the area under the curve (AUC) was used to compare the predictive value. Results: A total of 3,969 eligible patients were enrolled. The median RDW to albumin ratio was significantly higher in non-survivors than in survivors at 30 and 90 days. Patients were divided into groups according to the RDW to albumin ratio, and the risk of 30- and 90-day mortality markedly increased in the group with a higher ratio. The relationship between the RDW to albumin ratio as a continuous variable and 30-day mortality also showed an upward trend in the restricted cubic spline. The AUC of the RDW to albumin ratio was 0.633 in discriminating 30-day mortality which was similar to that of the lactate to albumin ratio (AUC =0.617; P=0.133) and higher than that of the neutrophil percentage to albumin ratio (AUC =0.559; P<0.001). Conclusions: The RDW to albumin ratio is a promising biomarker for assessing the prognosis of critically ill patients with sepsis. Its predictive value in determining mortality was found to be similar to that of the lactate to albumin ratio and superior to that of the neutrophil percentage to albumin ratio.

Accounting for herbaceous communities in process-based models will advance our understanding of "grassy" ecosystems.

Grassland and other herbaceous communities cover significant portions of Earth's terrestrial surface and provide many critical services, such as carbon sequestration, wildlife habitat, and food production. Forecasts of global change impacts on these services will require predictive tools, such as process-based dynamic vegetation models. Yet, model representation of herbaceous communities and ecosystems lags substantially behind that of tree communities and forests. The limited representation of herbaceous communities within models arises from two important knowledge gaps: first, our empirical understanding of the principles governing herbaceous vegetation dynamics is either incomplete or does not provide mechanistic information necessary to drive herbaceous community processes with models; second, current model structure and parameterization of grass and other herbaceous plant functional types limits the ability of models to predict outcomes of competition and growth for herbaceous vegetation. In this review, we provide direction for addressing these gaps by: (1) presenting a brief history of how vegetation dynamics have been developed and incorporated into earth system models, (2) reporting on a model simulation activity to evaluate current model capability to represent herbaceous vegetation dynamics and ecosystem function, and (3) detailing several ecological properties and phenomena that should be a focus for both empiricists and modelers to improve representation of herbaceous vegetation in models. Together, empiricists and modelers can improve representation of herbaceous ecosystem processes within models. In so doing, we will greatly enhance our ability to forecast future states of the earth system, which is of high importance given the rapid rate of environmental change on our planet.

Mineral reactivity determines root effects on soil organic carbon.

Modern conceptual models of soil organic carbon (SOC) cycling focus heavily on the microbe-mineral interactions that regulate C stabilization. However, the formation of 'stable' (i.e. slowly cycling) soil organic matter, which consists mainly of microbial residues associated with mineral surfaces, is inextricably linked to C loss through microbial respiration. Therefore, what is the net impact of microbial metabolism on the total quantity of C held in the soil? To address this question, we constructed artificial root-soil systems to identify controls on C cycling across the plant-microbe-mineral continuum, simultaneously quantifying the formation of mineral-associated C and SOC losses to respiration. Here we show that root exudates and minerals interacted to regulate these processes: while roots stimulated respiratory C losses and depleted mineral-associated C pools in low-activity clays, root exudates triggered formation of stable C in high-activity clays. Moreover, we observed a positive correlation between the formation of mineral-associated C and respiration. This suggests that the growth of slow-cycling C pools comes at the expense of C loss from the system.

Understanding how conservation tillage promotes soil carbon accumulation: Insights into extracellular enzyme activities and carbon flows between aggregate fractions.

Conservation tillage has been shown to mitigate climate change by promoting the sequestration of soil carbon (C) in agroecosystems. However, knowledge on how conservation tillage accumulates soil organic C (SOC), especially at the aggregate scale, remains limited. This study aimed to clarify the effects of conservation tillage on SOC accumulation by measuring hydrolytic and oxidative enzyme activities and C mineralization in aggregates and developing an extended scheme of C flows between aggregate fractions using the 13C natural abundance (δ13C) method. Topsoils (0-10 cm) were sampled from a 21-year tillage experiment located in the Loess Plateau of China. Compared with conventional (CT) and reduced tillage with straw removal (RT), no-till (NT) and subsoiling with straw mulching (SS) enhanced the proportions of macro-aggregates (> 0.25 mm) (by 12-26%) and SOC contents in bulk soils and all aggregate fractions (by 12-53%). In bulk soils and all aggregate fractions, SOC mineralization and the activities of hydrolases (ß-1,4-glucosidase, ß-acetylglucosaminidase, ß-xylosidase, and cellobiohydrolase) and oxidases (peroxidase and phenol oxidase) were 9-35% and 8-56% lower, respectively, under NT and SS than under CT and RT. Partial least squares path model revealed that reductions in the activities of hydrolases and oxidases and increases in macro-aggregation decreased SOC mineralization in bulk soils and macro-aggregates. Furthermore, Δ13C values (aggregate-associated δ13C - bulk-soil δ13C) increased with decreasing size of soil aggregates, suggesting that C is younger in larger aggregates than in smaller aggregates. The probability of C flows from large to small soil aggregates was lower under NT and SS than under CT and RT, indicating that young SOC with low rates of decomposition in macro-aggregates was better protected under NT and SS. Overall, NT and SS enhanced SOC accumulation in macro-aggregates by decreasing the activities of hydrolases and oxidases and C flows from macro- to micro-aggregates, which promoted C sequestration in soils. The present study provides improved insights into the mechanism and prediction of soil C accumulation under conservation tillage.

Partial substitution of manure reduces nitrous oxide emission with maintained yield in a winter wheat crop.

Conventional fertilization of agricultural soils results in increased N2O emissions. As an alternative, the partial substitution of organic fertilizer may help to regulate N2O emissions. However, studies assessing the effects of partial substitution of organic fertilizer on both N2O emissions and yield stability are currently limited. We conducted a field experiment from 2017 to 2021 with six fertilizer regimes to examine the effects of partial substitution of manure on N2O emissions and yield stability. The tested fertilizer regimes, were CK (no fertilizer), CF (chemical fertilizer alone, N 300 kg ha-1, P2O5 150 kg ha-1, K2O 90 kg ha-1), CF + M (chemical fertilizer + organic manure), CFR (chemical fertilizer reduction, N 225 kg ha-1, P2O5 135 kg ha-1, K2O 75 kg ha-1), CFR + M (chemical fertilizer reduction + organic manure), and organic manure alone (M). Our results indicate that soil N2O emissions are primarily regulated by soil mineral N content in arid and semi-arid regions. Compared with CF, N2O emissions in the CF + M, CFR, CFR + M, and M treatments decreased by 16.8%, 23.9%, 42.0%, and 39.4%, respectively. The highest winter wheat yields were observed in CF, followed by CF + M, CFR, and CFR + M. However, the CFR + M treatment exhibited lower N2O emissions while maintaining high yield, compared with CF. Four consecutive years of yield data from 2017 to 2021 illustrated that a single application of organic fertilizer resulted in poor yield stability and that partial substitution of organic fertilizer resulted in the greatest yield stability. Overall, partial substitution of manure reduced N2O emissions while maintaining yield stability compared with the synthetic fertilizer treatment during the wheat growing season. Therefore, partial substitution of manure can be recommended as an optimal N fertilization regime for alleviating N2O emissions and contributing to food security in arid and semi-arid regions.

Recruitment manoeuvres during mechanical ventilation with sequential high-flow nasal oxygen after extubation to prevent postoperative pulmonary complications in patients undergone thoracic surgery: a protocol, prospective randomised controlled trial.

INTRODUCTION: The incidence of postoperative pulmonary complications (PPCs) following thoracic surgery is high, which increases the mortality rate, prolongs the length of hospital stay and increases medical costs. Some studies have confirmed that preoperative risk assessment, intraoperative anaesthesia methods and intraoperative mechanical ventilation strategies, including recruitment manoeuvres (RMs), can reduce the incidence of PPCs. Despite these improved strategies, the incidence of PPCs remains high. However, mechanical ventilation strategies have not been studied in the postoperative period. METHODS AND ANALYSIS: We assume that RM during mechanical ventilation with sequential high-flow nasal oxygen therapy (HFNO) after extubation can maintain the opening of the postoperative alveoli and ultimately reduce the incidence of PPCs after thoracic surgery. We will include thoracic surgery patients and divide them into the RM with sequential HFNO group and the control group. They will be given RMs and sequential HFNO or be given conventional treatment. The sample size is 654 adult patients (327 per group) undergone thoracic surgery and presenting to the intensive care unit. ETHICS AND DISSEMINATION: This study was approved by the Biomedical Research Ethics Committee of West China Hospital of Sichuan University (REC2019-730). It is expected that this study will lead to a randomised controlled trial. We assume that the findings will provide more evidence about PPCs and improve the management of patients undergone thoracic surgery. TRIAL REGISTRATION NUMBER: ChiCTR2100046356.

A quantitative analysis of microbial community structure-function relationships in plant litter decay.

Soil microbes play a central role in ecosystem element cycling. Yet a central question in microbial ecology remains unanswered: to what extent does the taxonomic composition of soil microbial communities mediate biogeochemical process rates? In this quantitative review, we explore the mechanisms that lead to variation in the strength of microbial community structure-function relationships over space and time. To evaluate these mechanisms, we conduct a meta-analysis of studies that have monitored the decomposition of sterilized plant litter inoculated with different microbial assemblages. We find that the influence of microbial community composition on litter decay is pervasive and strong, rivalling in magnitude the influence of litter chemistry on decomposition. However, no single environmental or experimental attribute was correlated with variation in the inoculum effect. These results emphasize the need to better understand ecological dynamics within microbial communities, particularly emergent features such as cross-feeding networks, to improve predictions of soil biogeochemical function.

Study protocol for a single-centre randomised controlled trial to investigate the effect of lung recruitment in paediatric patients after cardiac surgery.

INTRODUCTION: A number of published studies have revealed that lung recruitment can improve oxygenation, shorten the duration of mechanical ventilation (MV) and decrease mortality in adults with acute hypoxaemic respiratory failure, especially patients with acute respiratory distress syndrome. However, few articles have assessed lung recruitment in paediatric patients, especially after cardiac surgery. This clinical trial aimed to determine whether lung recruitment can reduce the duration of MV in paediatric patients with hypoxaemic respiratory failure after cardiac surgery. METHOD AND ANALYSIS: In this trial, we will randomly assign 234 paediatric patients (aged 28 days to 14 years) within 72 hours after cardiac surgery with an arterial oxygen tension (PaO2) to fraction of inspired oxygen (FiO2) ratio (PaO2/FiO2) of <300 to either a lung recruitment group or a conventional group. The primary endpoint will be the duration of MV. The secondary endpoints will be ventilator-free days, PaO2/FiO2, respiratory system compliance, duration of non-invasive ventilation, reintubation rate, length of intensive care unit stay, length of hospital stay, occurrence of serious adverse events (barotrauma, persistent hypotension and arrhythmia), postoperative pulmonary complications. ETHICS AND DISSEMINATION: The ethics committee of West China Hospital of Sichuan University granted ethics approval for this study (20 August 2019). The results will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: ChiCTR1900025990.

Sequential use of midazolam and dexmedetomidine for long-term sedation may reduce weaning time in selected critically ill, mechanically ventilated patients: a randomized controlled study.

BACKGROUND: Current sedatives have different side effects in long-term sedation. The sequential use of midazolam and dexmedetomidine for prolonged sedation may have distinct advantages. We aimed to evaluate the efficacy and safety of the sequential use of midazolam and either dexmedetomidine or propofol, and the use of midazolam alone in selected critically ill, mechanically ventilated patients. METHODS: This single-center, randomized controlled study was conducted in medical and surgical ICUs in a tertiary, academic medical center. Patients enrolled in this study were critically ill, mechanically ventilated adult patients receiving midazolam, with anticipated mechanical ventilation for ≥ 72 h. They passed the spontaneous breathing trial (SBT) safety screen, underwent a 30-min-SBT without indication for extubation and continued to require sedation. Patients were randomized into group M-D (midazolam was switched to dexmedetomidine), group M-P (midazolam was switched to propofol), and group M (sedation with midazolam alone), and sedatives were titrated to achieve the targeted sedation range (RASS - 2 to 0). RESULTS: Total 252 patients were enrolled. Patients in group M-D had an earlier recovery, faster extubation, and more percentage of time at the target sedation level than those in group M-P and group M (all P < 0.001). They also experienced less weaning time (25.0 h vs. 49.0 h; HR1.47, 95% CI 1.05 to 2.06; P = 0.025), and a lower incidence of delirium (19.5% vs. 43.8%, P = 0.002) than patients in group M. Recovery (P < 0.001), extubation (P < 0.001), and weaning time (P = 0.048) in group M-P were shorter than in group M, while the acquisition cost of sedative drug was more expensive than other groups (both P < 0.001). There was no significant difference in adverse events among these groups (all P > 0.05). CONCLUSIONS: The sequential use of midazolam and dexmedetomidine was an effective and safe sedation strategy for long-term sedation and could provide clinically relevant benefits for selected critically ill, mechanically ventilated patients. TRIAL REGISTRATION: NCT02528513 . Registered August 19, 2015.

Evaluation of carbon mineralization and its temperature sensitivity in different soil aggregates and moisture regimes: A 21-year tillage experiment.

Characterizing soil organic carbon (SOC) mineralization and its temperature sensitivity (Q10) under different soil moisture in tillage systems is crucial for determining global carbon balance under climate warming and increasing precipitation. Aggregate protection can potentially govern SOC mineralization and its Q10. However, how tillage and aggregate sizes affect SOC mineralization and its Q10, especially under varying soil moisture, remains unclear. Soil samples (0-10 cm and 10-20 cm) were collected from a 21-year field study with four tillage treatments: conventional tillage (CT), reduced tillage (RT), no-tillage (NT), and subsoiling (SS). Bulk soil and dry-sieved aggregates were incubated at 15°C and 25°C at low, medium, and high moistures (i.e., 40%, 70%, and 100% water-holding capacity, respectively). Macro-aggregates (> 0.25 mm) had lower SOC mineralization relative to micro-aggregates (< 0.25 mm) across all soil temperatures, moistures, and depths (P < 0.01), which was attributed to their lower SOC quality (i.e., higher ratio of SOC to total nitrogen and lower ratio of dissolved organic carbon to SOC). Moreover, NT and SS promoted macro-aggregation relative to CT and RT, and thereby decreased mineralization (P < 0.001). However, Q10 was higher in macro-aggregates than in micro-aggregates at low and medium moistures. The Q10 was negatively correlated with the SOC quality in macro-aggregates (P < 0.05). The macroaggregate-associated SOC quality was lower under NT and SS than under CT and RT, which resulted in a greater Q10 under NT and SS at low and medium moistures, suggesting that NT and SS may accelerate SOC losses under global warming. Furthermore, increased soil moisture could lower Q10, and no differences among tillage practices were observed at high moisture levels (P > 0.05). Overall, our findings indicated that NT and SS decreased SOC mineralization but increased Q10 because of their large amounts of macro-aggregates with low SOC quality, and the improvement of Q10 was constrained by increasing soil moisture.

Design, Synthesis, and Evaluation of Chalcone Derivatives as Multifunctional Agents against Alzheimer's Disease.

Fifteen chalcone derivatives 3a-3o were synthesized, and evaluated as multifunctional agents against Alzheimer's disease. In vitro studies revealed that these compounds inhibited self-induced Aß1-42 aggregation effectively ranged from 45.9-94.5 % at 20 µM, and acted as potential antioxidants. Their structure-activity relationships were summarized. In particular, (2E)-3-[4-(dimethylamino)phenyl]-1-(pyridin-2-yl)prop-2-en-1-one (3g) exhibited an excellent inhibitory activity of 94.5 % at 20 µM, and it could disassemble the self-induced Aß1-42 aggregation fibrils with ratio of 57.1 % at 20 µM concentration. In addition, compound 3g displayed good chelating ability for Cu2+ , and could effectively inhibit and disaggregate Cu2+ -induced Aß aggregation. Moreover, compound 3g exerted low cytotoxicity, significantly reversed Aß1-42 -induced SH-SY5Y cell damage. More importantly, compound 3g remarkably ameliorated scopolamine-induced memory impairment in mice. In summary, all the results revealed compound 3g was a potential multifunctional agent for AD therapy.

Neutrophil-to-lymphocyte ratio as a predictive marker for severe pediatric sepsis.

BACKGROUND: Although neutrophil-to-lymphocyte ratio (NLR) has been extensively studied in several diseases, its role in pediatric sepsis remains unclear. Our study aimed to assess the predictive significance of NLR for severe pediatric sepsis in the pediatric intensive care unit (PICU). METHODS: We retrospectively recruited critically ill children in the PICU with severe pediatric sepsis from January 2019 to January 2020 in West China Hospital of Sichuan University. Univariate and multivariable logistic regression analysis was used to assess the risk factors of severe pediatric sepsis. Receiver operating characteristic (ROC) curves were plotted for the comparison of the prediction significance of NLR. RESULTS: Overall, 202 patients (severe sepsis 45; non-severe sepsis 157) were included. In the severe sepsis group, the levels of NLR (P<0.001), procalcitonin (PCT; P<0.001), and the Pediatric Risk of Mortality score (PRISM III) were higher than those in the nonsevere sepsis group (P<0.001). The PICU stay time (P<0.001), mechanical ventilation length (P=0.004), and hospital stay time (P<0.001) in the severe sepsis patients were noticeably more extended than those in the control patients. The area under the ROC curve (AUC) of NLR was 0.715 (P<0.001), which was higher than that of the PRISM III score (AUC =0.651, P<0.001) and PCT (AUC =0.647, P<0.001). Furthermore, the constructed predictive model of NLR + PCT + PRISM III showed a better prediction significance than they alone (AUC =0.888, P<0.001). CONCLUSIONS: Results indicated that the initial NLR value was a significant biomarker for predicting severe pediatric sepsis. The combined NLR and PCT improved the evaluation for further early identification of severe sepsis in children.

Repair of severe traumatic nasal alar defects with combined pedicled flap and conchal cartilage composite grafts: a retrospective study.

BACKGROUND: Repair of traumatic alar defect is challenging because poor blood supply is caused by contracture scars, which sometimes extend beyond the alar groove. However, few studies have investigated the reconstruction results of severe traumatic cases. This study aimed to examine the clinical outcomes of severe traumatic alar defect reconstruction using either pedicled nasolabial or forehead flaps combined with conchal cartilage. METHODS: This retrospective study investigated the clinical characteristics and treatment effects of 17 patients with severe traumatic alar defects treated in a single plastic surgery center from March 1, 2015, to September 1, 2018. All cases were scored and graded with regard to the size and depth of the alar defect and the surrounding scar according to the Alar Defect Severity Score (ADSS). Surgical outcomes were evaluated on the basis of the severity of defect before repair, donor site distortion, and postoperative nasal symmetry, especially shape and color. RESULTS: The average ADSS of the cases was 8.1±0.8 (highest score, 9.0). No flap necrosis or any complications were observed postoperatively. The symmetry of the bilateral alae was satisfactory. No color distinction between grafts and surrounding tissues, retraction, or inferior displacement of the ala was observed at an average follow-up of 24.2±10.4 months (range, 8-42 months). The average postoperative surgeon-based evaluation score was 4.3±0.2 (highest score, 5.0). Esthetic and functional results were satisfactory in all cases. CONCLUSIONS: A pedicled flap combined with conchal composite grafts should be considered for the treatment of severe traumatic alar defect. This is a reproducible technique that enables a predictably decent outcome for severe traumatic alar defect, especially in Asian patients.

Prophylactic noninvasive positive pressure ventilation in the weaning of difficult-weaning tracheotomy patients.

BACKGROUND: Prophylactic noninvasive positive pressure ventilation (NPPV) reduces reintubation in endotracheal intubation patients. However, the efficacy of using the prophylactic NPPV in the weaning of tracheotomy patients is unclear. METHODS: We performed prophylactic NPPV in 11 tracheotomy patients who passed a spontaneous breathing trial (SBT), removed the tracheotomy tube, and closed the incision (intervention group). We matched another 11 tracheotomy patients who also passed an SBT but weaning and removing of tracheotomy tube were managed as conventional methods (control group). RESULTS: Patients in the control group had reinstitution of mechanical ventilation 36 times after the initial SBT success. Compared with the control group, the interventional group had fewer weaning days (3.0±2.1 vs. 11.3±9.2, P=0.01) from initial SBT success to successful weaning and shorter intensive care unit (ICU) length of stay (11.6±4.2 vs. 20.3±11.6, P=0.03) after initial SBT success. The interventional group had lower nosocomial pneumonia rates after initial SBT success (0/11 vs. 2/11), lower ICU mortality (0/11 vs. 2/11), lower hospital mortality (0/11 vs. 3/11), and higher successful weaning rate (11/11 vs. 8/11), but it didn't reach significant difference. Also, there was no significant difference between groups in total duration of ventilation (25.5±13.3 vs. 34.7±24.2 days), hospital stay after initial SBT success (24.0±22.3 vs. 37.4±31.3 days), total ICU stay (35.7±15.3 vs. 45.0±29.5 days), and total hospital stay (48.7±33.1 vs. 68.6±52.6 days). CONCLUSIONS: Prophylactic NPPV may be useful to accelerate weaning, and shorten ICU stay after initial SBT success in tracheotomy patients.

Airway pressure release ventilation versus low tidal volume ventilation for patients with acute respiratory distress syndrome/acute lung injury: a meta-analysis of randomized clinical trials.

BACKGROUND: It is uncertain whether airway pressure release ventilation (APRV) is better than low tidal volume ventilation (LTVV) for patients with acute respiratory distress syndrome (ARDS). The purpose of this meta-analysis was to compare APRV and LTVV on patients with ARDS. METHODS: Randomized controlled trials (RCTs) comparing outcomes in ARDS ventilator therapy with APRV or LTVV were identified using Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, the Cochrane Library, and The Chinese Biomedicine Literature Database (SinoMed) from inception to March 2019. RESULTS: A total of 7 RCTs with a 405 patients were eligible for our meta-analysis. The results revealed that APRV was associated with lower hospital mortality [405 patients; odds ratio (OR), 0.57; 95% confidence interval (CI), 0.37-0.88; P=0.01], a shorter time of ventilator therapy [373 patients; mean difference (MD), 5.36; 95% CI, 1.99-8.73; P=0.002], and intensive care unit (ICU) stay (315 patients; MD, -4.50; 95% CI, -6.56 to -2.44; P<0.0001), better respiratory system compliance on day 3 (202 patients; MD, 8.19; 95% CI, 0.84-15.54; P=0.03), arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) on day 3 (294 patients; MD, 44.40; 95% CI, 16.05-72.76; P=0.002), and higher mean arterial pressure (MAP) on day 3 (285 patients; MD, 4.18; 95% CI, 3.10-5.25; P<0.00001). There was no statistical difference in the incidence of pneumothorax (170 patients; OR, 0.40; 95% CI, 0.12-1.34; P=0.14). CONCLUSIONS: The meta-analysis showed that APRV could reduce hospital mortality, duration of ventilation and ICU stay, improve lung compliance, oxygenation index, and MAP compared with LTVV for patients with ARDS. We found APRV to be a safe and effective ventilation mode for patients with ARDS.

Noninvasive ventilation failure in patients with hypoxemic respiratory failure: the role of sepsis and septic shock.

BACKGROUND: Sepsis and septic shock are common in noninvasive ventilation (NIV) patients. However, studies on the association between sepsis and NIV failure are lacking. METHODS: A prospective multi-center observational study was performed in 16 Chinese intensive care units (ICUs). Patients who used NIV due to hypoxemic respiratory failure were enrolled. Sepsis and septic shock were diagnosed according to the guideline of sepsis-3. RESULTS: A total of 519 patients were enrolled. Sepsis developed in 365 patients (70%) and septic shock developed in 79 patients (15%). However, 75 patients (14%) had no sepsis. NIV failure was 23%, 38%, and 61% in patients, with no sepsis, sepsis, and septic shock, respectively. Multivariate analysis found that sepsis [odds ratio (OR) = 1.95, 95% confidence interval (CI): 1.06-3.61] and septic shock (OR = 2.47, 95% CI: 1.12-5.45) were independently associated with NIV failure. In sepsis and septic shock population, the NIV failure was 13%, 31%, 37%, 53%, and 67% in patients with sequential organ failure assessment (SOFA) scores of ⩽2, 3-4, 5-6, 7-8, and ⩾9, respectively. Patients with nonpulmonary induced sepsis had similar NIV failure rate compared with those with pulmonary induced sepsis, but had higher proportion of septic shock (37% versus 10%, p ⩽ 0.01) and lower ICU mortality (10% versus 22%, p ⩽ 0.01). CONCLUSIONS: Sepsis was associated with NIV failure in patients with hypoxemic respiratory failure, and the association was stronger in septic shock patients. NIV failure increased with the increase of organ dysfunction caused by sepsis. The reviews of this paper are available via the supplemental material section.

Effects of Glucagon-Like Peptide-2-Expressing Saccharomyces cerevisiae Not Different from Empty Vector.

Saccharomyces cerevisiae (S. cerevisiae) and glucagon-like peptide-2 (GLP-2) has been employed to improve weaned-animal's intestinal development. The goal of this study was to determine whether either exogenous S. cerevisiae or GLP-2 elicits the major effects on fecal microbiotas and cytokine responses in weaned-piglets. Ninety-six piglets weaned at 26 days were assigned to one of four groups: 1) Basal diet (Control), 2) empty vector-harboring S. cerevisiae (EV-SC), 3) GLP-2-expressing S. cerevisiae (GLP2-SC), and 4) recombinant human GLP-2 (rh-GLP2). At the start of the post-weaning period (day 0), and at day 28, fecal samples were collected to assess the bacterial communities via sequencing the V1-V2 region of the 16S-rRNA gene, and piglets' blood was also sampled to measure cytokine responses (i.e., IL-1ß, TNF-α, and IFN-γ). Revealed in this study, on the one hand, although S. cerevisiae supplementation did not significantly alter the growth of weaned-piglets, it exhibited the increases in the relative abundances of two core genera (Ruminococcaceae_norank and Erysipelotrichaceae_norank) and the decreases in the relative abundances of other two core genera (Lachnospiraceae_norank and Clostridiale_norank) and cytokine levels (IL-1ß and TNF-α) (P < 0.05, Control vs EV-SC; P < 0.05, rh-GLP2 vs GLP2-SC). On the other hand, GLP-2 supplementation had no significant influence on fecal bacterial communities and cytokine levels, but it had better body weight and average daily gain (P < 0.05, Control vs EV-SC; P < 0.05, rh-GLP2 vs GLP2-SC). Herein, altered the fecal microbiotas and cytokine response effects in weaned-piglets was due to S. cerevisiae rather than GLP-2.

Piezo1 induced apoptosis of type II pneumocytes during ARDS.

OBJECTIVE: The mechanisms of lung injury in acute respiratory distress syndrome (ARDS) are not well understood.Piezo1 was recently identified as a mechanotransduction protein. The present study found the expression of Piezo1 in type II pneumocytes and investigated its role in mediating ARDS-related lung injury. METHODS: Sprague-Dawley rats were used to establish an ARDS model, the expression of Piezo1,lung injuries, apoptosis as well as calcium influx were assessed. RESULTS: Piezo1 was expressed in type II pneumocytes as shown by immunofluorescence staining and expression was increased in the ARDS model. Knockdown of Piezo1 reduced apoptosis which was related to the elevation of Bcl-2.Calcium influx played a vital role in Piezo1-induced apoptosis. CONCLUSION: Piezo1 was expressed in type II pneumocytes. Mechanical stretch of alveoli during ARDS induced activation of the Piezo1 channel,which resulted in calcium influx. The increased intracellular Ca2+ induced the apoptosis of type II pneumocytes, which may be related to the Bcl-2 pathway.